Publication date: Available online 28 September 2017
Source:Dermatologic Clinics
Author(s): Neil S. Sadick
Πέμπτη 28 Σεπτεμβρίου 2017
Cosmetic Dermatology for Men
Study of skin and nail Candida species as a normal flora based on age groups in healthy persons in Tehran-Iran
Publication date: Available online 28 September 2017
Source:Journal de Mycologie Médicale
Author(s): Z. Rafat, S.J. Hashemi, K. Ahamdikia, F. Bazvandi
The skin is the body's largest organ that hosts heterogeneous inhabitants. Until now, the diversity of the cutaneous microbiome was mainly investigated for bacteria and there is a little information about the skin fungal flora. Also, among skin fungal flora, Candida is found as a main member whose distribution is affected by sex, age, climate. In this study, differences in Candida community structure associated with 9 different skin sites of 238 healthy people during 10 months from July to March 2016, are described. These subjects were divided by age into 4 groups: infants, children, adults and geriatrics. The collected samples were examined by culture on Sabouraud Chloramphenicol Agar and CHROM-agar Candida. For precise identification of species ITS1-5. 8S-ITS2 rDNA regions were sequenced where needed. The frequency of Candida species was significantly different between age groups. The most Candida isolations were related to the elderly age group and the fewest in the infants. C. parapsilosis virtually, was the predominant isolated species in all age groups. This study showed no statistically significant effect of the subject's sex on Candida population resident on human skin surface.
Sensibilización alérgica a isotiazolinonas en pacientes remitidos a estudio fotobiológico
Publication date: Available online 28 September 2017
Source:Actas Dermo-Sifiliográficas
Author(s): M. Giácaman-von der Weth, A. Pérez-Ferriols, C. Sierra-Talamantes, V. Zaragoza-Ninet
Tumor fibroso solitario cutáneo: una neoplasia fusocelular con una inmunohistoquímica particular
Publication date: Available online 28 September 2017
Source:Actas Dermo-Sifiliográficas
Author(s): J. Santos-Juanes, B. García-García, Y. Hidalgo, B. Vivanco
Dermatitis de contacto a antisépticos tópicos. ¿Qué posición ocupa la Mercromina Film®?
Publication date: Available online 28 September 2017
Source:Actas Dermo-Sifiliográficas
Author(s): F.J. Navarro-Triviño
Malignant Blue Nevus: A Challenge for Dermatologists and Dermatopathologists
Publication date: Available online 28 September 2017
Source:Actas Dermo-Sifiliográficas
Author(s): T. Toledo-Pastrana, I. Rodríguez Pérez, P. Eguino Gorrochategui
Tumor de rápido crecimiento en el párpado
Publication date: Available online 28 September 2017
Source:Actas Dermo-Sifiliográficas
Author(s): C.A. Morales-Cardona, C. Rodríguez-Zakzuk, A. Téllez-Lozada
Colgajo de keystone tipo i
Publication date: Available online 28 September 2017
Source:Actas Dermo-Sifiliográficas
Author(s): H.A. Cocunubo-Blanco, A. Pérez-Bustillo, E. Manrrique, M.Á. Rodríguez-Prieto
Úlcera dolorosa en paciente de raza negra
Publication date: Available online 28 September 2017
Source:Actas Dermo-Sifiliográficas
Author(s): I. Latour-Álvarez, M. Arteaga-Henriquez, A. de Andrés-del Rosario
Ampliando el espectro ecográfico de las anomalías vasculares
Publication date: Available online 28 September 2017
Source:Actas Dermo-Sifiliográficas
Author(s): F. Alfageme
Placas anulares bilaterales en manos y antebrazos
Publication date: Available online 28 September 2017
Source:Actas Dermo-Sifiliográficas
Author(s): E. Rozas-Muñoz, J.F. Mir-Bonafé, E. Serra-Baldrich
Manejo práctico de inmunosupresores en dermatología
Publication date: Available online 28 September 2017
Source:Actas Dermo-Sifiliográficas
Author(s): V.M. Leis-Dosil, I. Prats-Caelles
Las enfermedades inflamatorias y autoinmunes constituyen un desafío terapéutico por frecuencia y complejidad. Su tratamiento se basa en la inmunosupresión del paciente con glucocorticoides, inmunosupresores ahorradores de corticoides y fármacos biológicos, siendo imprescindible por tanto conocer su manejo. Cuando se va a pautar un inmunosupresor es necesario realizar un estudio previo para detectar contraindicaciones, infecciones latentes o determinar la dosis más adecuada del fármaco. Durante el tratamiento se deben realizar controles periódicos para detectar efectos secundarios. Cada fármaco tiene un tiempo de inicio de acción que es preciso conocer, así como una duración o dosis acumulada máxima recomendada. Los dermatólogos estamos habituados al uso estos fármacos inmunosupresores, pero es necesario tener claras las pautas y los controles necesarios con cada uno, para disminuir la variabilidad y evitar efectos adversos potencialmente graves.The treatment of inflammatory and autoimmune diseases is challenging because of their frequency and complexity. Treatment of these diseases is based on the suppression of the patient's immune system using corticosteroids, corticosteroid-sparing immunosuppressive agents, and biologic drugs, making an understanding of the management of immunosuppressive therapy essential.Before an immunosuppressive agent is prescribed, a study must be carried out to identify contraindications, detect latent infections, and determine the most appropriate dose. During treatment, regular monitoring is required to detect adverse effects. The clinician must be familiar with the time lag between start of treatment and onset of the immunosuppressive effect as well as the maximum recommended duration of treatment and cumulative dose for each drug. As dermatologists we are accustomed to using these immunosuppressive agents, but we should have a good knowledge of the guidelines for their use and the monitoring required in each case if we are to reduce variability and avoid potentially serious adverse effects.
Analyse clinique avant chirurgie de rajeunissement cervico-facial
Source:Annales de Chirurgie Plastique Esthétique
Author(s): M. Rouif, P. Bogaert
L'examen clinique est la première étape de toute démarche thérapeutique médicale ou chirurgicale. Sa qualité est essentielle afin d'adapter le traitement à la demande du patient. Dans le cadre du rajeunissement facial, l'interrogatoire et la compréhension des motivations, photos anciennes à l'appui, participent à l'évaluation. La connaissance de l'anatomie et du processus de vieillissement facial facilite l'analyse. Il s'agit non seulement de déterminer le degré de ptôse tissulaire, mais aussi d'évaluer les variations volumétriques. Enfin, les tensions musculaires et la qualité cutanée participent à la genèse de rides distinctes. Ces modifications complexes aboutissent à un aspect fatigué ou triste, voire âgé. Les demandes des patients, souvent limitées à une seule région, ne doivent pas dispenser d'une analyse globale. Le rôle du praticien est aussi de faire prendre conscience au patient, avec tact, de l'incidence des autres régions sur l'impression générale. L'objectif sera d'obtenir un résultat harmonieux, naturel qui signe l'excellence du savoir-faire médicochirurgical. L'examen clinique doit, en outre, permettre de repérer les difficultés techniques. Enfin, un bilan photographique, voire vidéo, fixe l'analyse et permet de disposer d'éléments objectifs pour affiner le traitement, aider à sa compréhension et évaluer le résultat. Le temps passé à examiner et expliquer permet de statuer avec le patient sur les choix thérapeutiques et d'en préciser leurs limites. Il permettra ainsi d'accroître la satisfaction du patient qui doit s'approprier le résultat. Cet effort d'analyse est dès lors un acte opératoire, tout aussi important que la technique elle-même. Apporter un résultat « sur mesure », indispensable lorsqu'il s'agit de l'image de la personne, constitue enfin la garantie du plaisir à toujours vouloir améliorer notre pratique.The first step to determine a medical or surgical intervention is the clinical exam. The clinical exam is the paramount step to provide a treatment plan that can be modified and individualized accounting the patient preferences. During the consultation for facial rejuvenation, attention should be paid to understand the patient's motivation and expectations. A thorough understanding of the anatomy and the natural history of ageing will facilitate the analysis of the face. Not only the degree of ptosis but also the degree of volume loss will need to be assessed, as well as the influence of the facial muscles, the skin quality, and the different causes of rythids. The comprehensive age-related anatomical changes are often perceived and described as tiredness or sadness. Patients very commonly only point out a single anatomical region. During the consultation, the surgeon should provide the patient with the information of the comprehensive interplay of the different anatomical regions and their individual ageing process. Obtaining a harmonious, natural appearing outcome is the result of excellent surgical skills and applied knowledge. The clinical exam should also find out traps and technical difficulties. Although standardized photographs allow a static evaluation of one's result, video may deliver additional information about the postoperative result, and may contribute to the understanding of the technique used. Spending the additional time by performing a thorough facial analysis and preoperative planning is well-invested time. Having a good understanding of the possible surgical improvements and limitations will be beneficial for both, the patient and the surgeon. Managing the expectations of the patient and careful preoperative planning will increase patient's satisfaction. At the same time, the surgeon will able to critically assess his/her own result and taking pleasure improving their own technique.
Lambeau fasciocutané sous fessier fiabilisé par une perforante de l’artère fémorale profonde en reconstruction d’escarre ischiatique
Publication date: Available online 28 September 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): L. Gebert, F. Boucher, A. Lari, F. Braye, A. Mojallal, M. Ismaïl
IntroductionLa chirurgie des escarres chez les patients paraplégiques ou tétraplégiques est marquée par le risque de récidive à long terme. À l'ère des lambeaux perforants, de nouvelles solutions thérapeutiques dans la prise en charge des escarres s'ouvrent sans compromettre l'utilisation ultérieure de lambeaux locorégionaux musculaires ou musculocutanés. La couverture d'escarres ischiatiques par lambeau fasciocutané fiabilisé par une perforante de l'artère fémorale profonde apparaît être une solution intéressante en première intention dans l'indication des escarres limitées.Patients et méthodeIl s'agissait d'une série de quinze patients paraplégiques ou tétraplégiques présentant au moins une escarre ischiatique avec ostéite. La perforante de l'artère fémorale profonde était repérée en utilisant « L'Atlas des artères perforantes de la peau du tronc et des membres » couplé à un doppler acoustique bidirectionnel. Un lambeau fasciocutané de transposition était levé, ayant pour point pivot le pont cutané centré sur la perforante, puis mise en place au niveau de la perte de substance. Le site donneur était autofermant.RésultatsQuinze patients ont été opérés, de novembre 2015 à novembre 2016. Il s'agissait de 16 premiers épisodes d'escarres ischiatiques de stade 4 avec ostéite reconstruit par ce lambeau perforant de l'artère fémorale profonde. Le résultat cicatriciel et fonctionnel était satisfaisant.ConclusionLambeau fasciocutané sous fessier fiabilisé par une perforante de l'artère fémorale profonde apparaît avoir une place de choix dans l'arsenal thérapeutique dans l'indication de couverture d'escarre ischiatique. Les options de lambeaux musculocutanés d'ischiojambiers, de gluteus maximus ne sont pas compromises. Ce lambeau pourrait être l'indication de première intention pour couvrir les escarres ischiatiques limitées.IntroductionThe surgical management of pressure ulcers in the paraplegic or quadriplegic population is marked by the high risk of recurrence in the long-term. In the current era of perforator flaps, newer reconstructive options are available for the management of pressure ulcers, decreasing the need to use the classically described muscular or musculocutaneous locoregional flaps. The coverage of ischial sores described in this article by a pedicled flap based on a deep femoral artery perforator, appears to be an effective first-line reconstructive option for the management of limited size pressure ulcers.Patients and methodA number of fifteen paraplegic or quadriplegic patients having at least one ischial bed sore with underlying osteomyelitis were included in this series. The approximate location of the deep femoral artery perforator was initially identified using the "The Atlas of the perforator arteries of the skin, the trunk and limbs", which was confirmed, with the use of a Doppler device. A fasciocutaneous transposition flap was elevated, with the pivot point based on the cutaneous bridge centered on the perforator, and then transposed to cover the area of tissue loss. The donor site was closed primarily.ResultsA total of fifteen patients were operated from November 2015 to November 2016. The series comprised of 16 first presentations of a stage 4 pressure ulcers associated with underlying osteomyelitis that were subsequently reconstructed by the pedicled deep femoral artery perforator flap. The healing rate and functional results were both satisfactory.ConclusionFasciocutaneous flap reliable by deep femoral artery perforator appears to have a promising role in the treatment of ischial pressure sores. It is an attractive option to spare the use of musculocutaneous flaps in the area. Thus this flap could be used as a first-line option to cover ischial pressure ulcers of limited size.
Palmoplantar keratoderma in Slurp1/Slurp2 double-knockout mice
Mutations in SLURP1, encoding a secreted protein of keratinocytes, cause a palmoplantar keratoderma (PPK) known as mal de Meleda [1]. When the link between SLURP1 mutations and mal de Meleda was uncovered, there was speculation that SLURP1 might be a ligand for a cell-surface receptor of keratinocytes [1]. Also, because the predicted structure of SLURP1 resembled cobra neurotoxins, there was speculation that SLURP1 might influence acetylcholine signaling [1]. Pharmacologic studies have supported that concept [2–4], but there is no clear evidence that SLURP1 binds to acetylcholine receptors, nor is it clear why perturbations in acetylcholine signaling would cause PPK.
Skin Testing or sIgE Testing Is Necessary Before Early Introduction of Peanut for Prevention of Peanut Allergy: Pro-Con Debate
Publication date: Available online 28 September 2017
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Mimi L.K. Tang, Jennifer J. Koplin, Hugh A. Sampson
Overweight, Obesity, and Lung Function in Children and Adults—A Meta-analysis
Publication date: Available online 28 September 2017
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Erick Forno, Yueh-Ying Han, James Mullen, Juan C. Celedón
BackgroundThere is conflicting evidence on the effect of obesity on lung function in adults and children with and without asthma. We aimed to evaluate the relation between overweight or obesity and lung function, and whether such relationship varies by age, sex, or asthma status.MethodsWe searched PubMed, Scopus, CINAHL, Cochrane, and EMBASE for all studies (in English) reporting on obesity status (by body mass index) and lung function, from 2005 to 2017. Main outcomes were forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, forced expiratory flow between 25th and 75th percentile of the forced vital capacity (FEF25-75), total lung capacity (TLC), residual volume (RV), and functional residual capacity (FRC). Random-effects models were used to calculate the pooled risk estimates; each study was weighed by the inverse effect size variance. For each outcome, we compared overweight or obese ("obese") subjects with those of normal weight.ResultsAll measures of lung function were decreased among obese subjects. Obese adults showed a pattern (lower FEV1, FVC, TLC, and RV) different from obese children (more pronounced FEV1/FVC deficit with unchanged FEV1 or FVC). There were also seemingly different patterns by asthma status, in that subjects without asthma had more marked decreases in FEV1, TLC, RV, and FRC than subjects with asthma. Subjects who were obese (as compared with overweight) had even further decreased FEV1, FVC, TLC, RV, and FRC.ConclusionsObesity is detrimental to lung function, but specific patterns differ between children and adults. Physicians should be aware of adverse effects of obesity on lung function, and weight control should be considered in the management of airway disease among the obese.
Use of the Basophil Activation Test May Reduce the Need for Drug Provocation in Amoxicillin-Clavulanic Allergy
Publication date: Available online 28 September 2017
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): María Salas, Rubén Fernández-Santamaría, Cristobalina Mayorga, Esther Barrionuevo, Adriana Ariza, Teresa Posadas, Jose Julio Laguna, María Isabel Montañez, Noemi Molina, Tahia Diana Fernández, María José Torres
BackgroundReports of selective reactions to clavulanic acid (CLV) have increased in recent decades because of its increased prescription in combination with amoxicillin (AX) as AX-CLV. Basophil activation test (BAT) is used for diagnosing beta-lactam immediate hypersensitivity and is the only available in vitro assay for diagnosing patients with immediate hypersensitivity to CLV. However, few studies, and with limited numbers of patients have been published.ObjectiveThe aim of this study was to establish the sensitivity, specificity, and negativization rates of BAT to AX and CLV.MethodsWe studied 115 patients with immediate allergic reactions after AX-CLV treatment, 57 with selective reactions to AX (group A), 58 with selective reactions to CLV (group B), and 28 tolerant subjects. BAT was performed with AX in group A and with CLV in group B. A 4-year follow-up study was performed in patients with an initial positive BAT result.ResultsThe overall sensitivity of BAT was 55%, specificity 89%, and positive predictive value (PPV) 96%. For group A, sensitivity was 47%, specificity 93%, and PPV 93%; for group B, sensitivity was 62%, specificity 89%, and PPV 92%. Follow-up study showed a faster negativization rate of BAT for group A, with around 40% of patients becoming negative at 12 months in both groups.ConclusionsThe high PPV of BAT to CLV shows its potential value as a complementary tool to the allergological workup of patients with immediate allergic reactions after AX-CLV treatment. Importantly, the assay should be done within the first 12 months after the reaction to reduce false-negative results.
Asthma Cost-Effectiveness Analyses: Are We Using the Recommended Outcomes in Estimating Value?
Publication date: Available online 28 September 2017
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Chong H. Kim, Piyameth Dilokthornsakul, Jonathan D. Campbell, Job F.M. van Boven
BackgroundAsthma medication cost-effectiveness analyses (CEAs) lack the qualitative assessment regarding whether they capture the National Institutes for Health (NIH) 2012 recommended outcomes necessary to allow robust cross-study comparisons.ObjectiveWe aimed to assess the current asthma outcomes used in CEAs and recommend a direction for improvement.MethodsWe performed a systematic search using electronic databases including PubMed, EMBASE, Tufts CEA registry, Cochrane, and NHSEED from January 2010 through December 2015. Key words included (1) cost-effectiveness, cost-utility, economic evaluation, health economics, or cost-benefit AND (2) asthma. All CEA studies evaluating 1 or more asthma medication were included. Authors assessed each CEA study with respect to asthma-specific NIH outcome recommendations including core (hospitalizations, emergency department visits, outpatient visits, medication, interventions costs), supplemental (visit categories and work/school absence), and emerging (academic/job-related) asthma outcomes. Besides outcomes of each CEA, issues that could prevent robust cross-study comparison were identified and thematically summarized.ResultsA total of 12 pre-NIH and 14 post-NIH recommendation CEAs were included. Eleven (91.7%) and 14 (100%) of the pre-/post-NIH studies included at least 1 core outcome, respectively. Of the 26 total studies, 7 (26.9%) included asthma-specific outpatient visit categories, 6 (23.1%) included asthma school or work absences, 5 (19.2%) included respiratory health care use, and none of the studies included emerging outcomes. Other issues that hamper cross-study comparison include lack of standardized cost data, time frames, quality-of-life measures, and incorporation of adherence.ConclusionsAlthough the use of NIH-recommended asthma core outcomes has improved, there is still room for improvement in using supplemental and emerging outcomes. To allow robust cross-study comparisons, future work should focus on further standardizing of data sources and methods.
T-cell lymphopenia in 22q11.2 deletion syndrome: Relationship to cardiac disease
Publication date: Available online 28 September 2017
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Kathleen E. Sullivan, T. Blaine Crowley, Kelly Maurer, Elizabeth Goldmuntz, J. William Gaynor, Elaine Zackai, Donna McDonald-McGinn
Methotrexate Versus Cyclosporine in Adults with Moderate-to-Severe Atopic Dermatitis: A Phase III Randomized Noninferiority Trial
Publication date: Available online 28 September 2017
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Catherine Goujon, Manuelle Viguier, Delphine Staumont-Sallé, Claire Bernier, Gérard Guillet, Morad Lahfa, Marie-Christine Ferrier Le Bouedec, Frédéric Cambazard, David Bottigioli, Sophie Grande, Karima Dahel, Frédéric Bérard, Muriel Rabilloud, Catherine Mercier, Jean-François Nicolas
BackgroundMethotrexate is currently used to treat atopic dermatitis but has never been assessed versus cyclosporine in adults.ObjectiveThis study evaluated the efficacy and safety of methotrexate versus cyclosporine in patients with moderate-to-severe atopic dermatitis.MethodsPatients were randomized to receive either oral methotrexate (15 mg/wk) or cyclosporine (2.5 mg/kg/d) for 8 weeks. The primary end point was a patient achieving 50% improvement in the SCORing Atopic Dermatitis index (SCORAD 50) at week 8. When the primary end point was not achieved, methotrexate was increased to 25 mg and cyclosporine to 5 mg during the next 16 weeks. The secondary end points were a patient achieving a 50% reduction in the Eczema Area Severity Intensity index (EASI 50) and SCORAD 50 at each visit (ClinicalTrials.gov no. NCT00809172).ResultsA total of 97 patients received methotrexate 15 mg (n = 50) or cyclosporine 2.5 mg (n = 47). Regarding the primary end point at week 8, methotrexate was inferior to cyclosporine because the proportion of patients with SCORAD 50 was 8% (4 of 50) in the methotrexate arm versus 42% (18 of 43) in the cyclosporine arm. The difference in percentages for the 2 treatment groups (2-sided 90% CI) was −34% (−48% to −20%). At week 8, methotrexate and cyclosporine dosages were increased in 56% and 49% of the patients, respectively. Regarding EASI 50, the noninferiority end point was reached at week 20 in 92% (22 of 24) of patients in the methotrexate arm and 87% (26 of 30) of patients in the cyclosporine arm. The treatment-related adverse events were more frequent with cyclosporine (P < .0001).ConclusionsMethotrexate 15 mg/wk was inferior to cyclosporine 2.5 mg/kg/d at week 8. Increasing the doses of methotrexate to 25 mg/wk induced a significant improvement versus cyclosporine at week 20.
Mucosal Perfusion Preservation by a Novel Shapeable Tissue Expander for Oral Reconstruction
Background: There are few methods for expanding oral mucosa, and these often cause complications such as tissue necrosis and expander eruption. This study examines mucosal blood perfusion following insertion of a novel shapeable hydrogel tissue expander (HTE). The canine model used subgingival insertion of HTE following tooth extraction and alveolar bone reduction. The primary goal of this study was to gain understanding of epithelial perfusion and reparative responses of gingival mucosa during HTE expansion. Methods: Nine Beagle dogs underwent bilateral premolar maxillary and mandibular tooth extraction. Three to four months later, HTE-contoured inserts were implanted submucosally under the buccal surface of the alveolar ridge. After removal and following a 6- to 7-month period of healing, new HTE implants were inserted at the same sites. The area was assessed weekly for tissue perfusion and volume of expansion. Biopsies for histological analysis were performed at the time of expander removal. Results: Within 2 weeks following the second insertion, blood flow returned to baseline (defined as the values of perfusion measurements at the presurgery assessment) and remained normal until hydrogel full expansion and removal. Volume expansion analysis revealed that the hydrogel doubled in volume. Histological assessment showed no macrophage or inflammatory infiltration of the mucosa. No superficial fibrosis, decreased vascularity, or mucosal change was seen. Conclusion: Maintenance of adequate tissue perfusion is a clinically important aspect of tissue expander performance to reduce risk of device loss or injury to the patient, particularly for areas with a history of previous surgeries.Long-Term Safety of Textured and Smooth Breast Implants
Abstract
In this review, the authors provide a 20-year review and comparison of implant options and describe the evolution of breast implant surface textures; compare available implant surfaces; present long-term safety data from the 10-year US-based Core clinical studies; list the key benefits and risks associated with smooth and textured implants; and provide perspectives on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The authors explore the key benefits and risks associated with all available devices so that optimal and safe patient outcomes can be achieved.Response to “Commentary on: Gluteal Augmentation Techniques: A Comprehensive Literature Review”
We thank Dr Senderoff for his thoughtful comments on our article entitled "Gluteal Augmentation Techniques: A Comprehensive Literature Review," published in the May 2017 issue of Aesthetic Surgery Journal.1,2 We are indeed honored to have Dr Senderoff, a surgeon who has widely contributed to our understanding of this subject, discuss our paper. His previous investigations on implant-based gluteal augmentation, with a specific reference to the US experience of using solid silicone implants, can be considered as fundamental for every surgeon interested in performing gluteoplasty effectively and safely.3-6
Five-Year Safety Data for More than 55,000 Subjects following Breast Implantation: Comparison of Rare Adverse Event Rates with Silicone Implants versus National Norms and Saline Implants
Background: The U.S. Food and Drug Administration has required postapproval studies of silicone breast implants to evaluate the incidence of rare adverse events over 10 years after implantation. Methods: The Breast Implant Follow-Up Study is a large 10-year study (>1000 U.S. sites) evaluating long-term safety following primary augmentation, revision-augmentation, primary reconstruction, or revision-reconstruction with Natrelle round silicone breast implants compared with national norms and outcomes with saline implants. Targeted adverse events in subjects followed for 5 to 8 years included connective tissue diseases, neurologic diseases, cancer, and suicide. Results: The safety population comprised 55,279 women (primary augmentation, n = 42,873; revision-augmentation, n = 6837; primary reconstruction, n = 4828; and revision-reconstruction, n = 741). No targeted adverse events occurred at significantly greater rates in silicone implant groups versus national norms across all indications. The standardized incidence rate (observed/national norm) for all indications combined was 1.4 for cervical/vulvar cancer, 0.8 for brain cancer, 0.3 for multiple sclerosis, and 0.1 for lupus/lupus-like syndrome. Silicone implants did not significantly increase the risk for any targeted adverse events compared with saline implants. The risk of death was similar with silicone versus saline implants across all indications. The suicide rate (10.6 events per 100,000 person-years) was not significantly higher than the national norm. No implant-related deaths occurred. Conclusions: Results from 5 to 8 years of follow-up for a large number of subjects confirmed the safety of Natrelle round silicone implants, with no increased risk of systemic disease or suicide versus national norms or saline implants. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.A Retrospective Cohort Study on Payor Type and the Effect on Revisions in Breast Reconstruction
Background: Patients who are insured by Medicare and Medicaid are less likely to undergo breast reconstruction than their privately insured counterparts. Whether insurance type also affects subsequent revisions remains unknown. This study explores the relationship among payor type, revision procedures, and the completion of breast reconstruction. Methods: A retrospective cohort study was created including patients who underwent breast reconstruction at the authors' institution from 1996 to 2016. Data collected included age, cancer stage, race, laterality, initial breast reconstruction type, total number of procedures, number of trips to the operating room, and subsequent revisions. Analysis of covariance and logistic regression were used to estimate the controlled mean number of revisions and probability of completion of reconstruction as a function of insurance type. Results: A total of 3113 patients were included: 2271 (72.9 percent) with private insurance, 450 (14.5 percent) with Medicare, and 392 (12.6 percent) with Medicaid. On controlled analysis, there was no difference in total number of procedures, number of revisions, or number of trips to the operating room among the three insurance types. There was no difference in the proportion of patients undergoing symmetry procedures or nipple-areola reconstruction. Conclusions: To the authors' knowledge, this is the first study to evaluate discrepancies in number of procedures, revisions, and the proportion of patients completing breast reconstruction among insurance types. When controlling for other factors, the authors report no differences in care based solely on payor type. Instead, patient and surgeon variables may be responsible for the differences observed, and should be targeted in future research to improve equity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Immediate Breast Reconstruction with Abdominal Free Flap and Adjuvant Radiotherapy: Evaluation of Quality of Life and Outcomes
Background: The effects of postoperative radiotherapy on free flap–based breast reconstruction are still controversial. Poor outcomes, breast distortion, and fat necrosis have been traditionally documented. The aim of this study was to evaluate whether adjuvant radiotherapy affects the quality of life, satisfaction, and cosmetic result in patients undergoing immediate breast reconstruction with autologous free flap. Methods: Between January of 2013 and December of 2016, 230 patients underwent mastectomy with immediate free flap reconstruction at the authors' institution. Patients were divided into two groups depending on whether they received postmastectomy radiotherapy. Quality of life measured with the BREAST-Q questionnaire, self-reported aesthetic outcomes, and general satisfaction were assessed and compared. Fat necrosis of the flap and its severity were also analyzed as the main surgical outcomes. Results: Mean follow-up time after reconstruction was 23 months (range, 6 to 48 months). No significant difference in quality of life or satisfaction scores were found between patients that underwent postmastectomy radiotherapy and patients who did not receive adjuvant radiotherapy. There were no significant differences in rates of fat necrosis between the groups (11.1 percent versus 13.76 percent; p = 0.75). Conclusions: Postmastectomy radiotherapy in patients undergoing immediate breast reconstruction with free flaps does not seem to affect quality of life, satisfaction with the outcome, or the cosmetic result as perceived by the patients. The potential need for postoperative radiotherapy should not hinder women from the benefits of autologous immediate breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.Transparency in Functional Rhinoplasty: Benefits of Routine Prospective Outcome Measurements in a Tertiary Referral Center
Background: Patients, governments, health care providers, and insurance companies are increasingly interested in medical performance. Transparent outcome reporting requires a thorough methodologic design, dedicated prospective data collection process, and preferably no interference with the efficacy of daily practice. The primary aim of this article is to describe how these bottlenecks are tackled with an automated prospective rhinoplasty outcome routine. The secondary aim is to motivate others by describing practical benefits encountered during implementation. Methods: Since April 2014, 269 consecutive patients referred for functional-aesthetic (revision) rhinoplasty were included. The Nasal Obstruction Symptom Evaluation scale, the Utrecht Questionnaire, and visual analogue scales were offered to all patients before primary consultation and follow-up to translate the subjective burden of nasal problems and change herein following surgery, into data. These data were exported for real-time automated outcome analysis supported by graphic output through a customized Web-based dashboard. Results: One hundred seventy-one patients proved eligible for rhinoplasty, of which 121 had sufficient follow-up. The dashboard provides an overview of demographic characteristics of different populations, reasons why rhinoplasties were not performed, and real-time short- and long-term change in functional and aesthetic outcome in both primary and revision cases. Practical benefits of the instruments used are presented and discussed. Conclusions: Routine prospective outcome monitoring provides an evidence-based response to the increasing demand for transparency in health care. The dashboard proved valuable during patient counseling, patient selection, and management of expectations and has the potential to compare rhinoplasty results between surgeons and institutions, provided that the populations share similar characteristics. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.Outcomes of Buccinator Treatment With Botulinum Toxin in Facial Synkinesis
This cohort study evaluates outcomes for patients treated with botulinum toxin applied to the buccinator muscle in the setting of facial synkinesis.
Botulinum Neuromodulators in Facial Synkinesis Management
This randomized clinical trial evaluates the effectiveness of 3 commercially available botulinum toxin neuromodulators in the treatment of facial synkinesis.
Photo and biocatalytic activities along with UV protection properties on polyester fabric through green in-situ synthesis of cauliflower-like CuO nanoparticles
Publication date: Available online 27 September 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Ali Bashiri Rezaie, Majid Montazer, Mahnaz Mahmoudi Rad
In this paper, a facile environmentally friendly method is introduced for in-situ synthesis and fabrication of cauliflower-like CuO nanoparticles on the polyester fabric to produce photo and biocatalytic activities with UV protection properties on polyester fabric. The ash of burnt leaves and stems of Seidlitzia rosmarinus plant called Keliab was used as a natural and nontoxic alkaline source for simultaneous synthesis of CuO nanoparticles and surface modification of polyester without using any other compounds. The images of field-emission scanning electron microscopy, patterns of energy-dispersive spectroscopy, UV–visible spectrum and X-ray diffraction confirmed successful synthesis and loading of CuO nanoparticles on the polyester fabric. The treated fabrics showed very good antibacterial activities toward two pathogen bacteria including Staphylococcus aureus as a Gram-positive and Escherichia coli as a Gram-negative bacteria with no adverse effects on human dermal fibroblasts based on MTT test. The treated fabrics confirmed significant photocatalytic activity for degradation of methylene blue under sunlight, self-cleaning properties under UV light and also UV protection properties. Further a colorant effect along with an improvement in the wettability and mechanical properties of the treated fabrics were indicated. Overall, this method can be applied as a clean route for producing photo and bio active textiles protecting against UV irradiation.
Graphical abstract
Transcutaneous aponeurotic repair with small detachment of the levator aponeurosis for aponeurotic blepharoptosis in Japanese patients
Publication date: Available online 28 September 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Hiromichi Matsuda, Takuya Shiba, Yasuhiro Takahashi, Hiroshi Tsuneoka
PurposeTo examine the surgical outcomes of a modified transcutaneous aponeurotic repair for aponeurotic blepharoptosis in a Japanese population.MethodsThis retrospective study included 75 eyelids of 45 patients with aponeurotic blepharoptosis who had undergone a modified transcutaneous aponeurotic repair. This procedure included a long skin incision for securing a wide surgical field, creation of a double eyelid crease, and a small extent of detachment of the levator aponeurosis from the tarsal surface. Functional success was defined as a postoperative margin reflex distance-1 of 2–5 mm without serious complications at 3 months postoperatively. Cosmetic success was judged by achieving a ≤1-mm laterality of eyelid height, a ≤2-mm laterality of pretarsal show, and symmetry of the eyelid contour at 3 months postoperatively.ResultsThe functional success rate was 70.7% among all patients, with 84.4%, 86.7%, and 88.9% of patients showing cosmetic success regarding symmetry of eyelid height, pretarsal show, and eyelid contour, respectively. After applying functional and all 3 cosmetic criteria simultaneously, 28 patients (62.2%) were satisfied in this study. No serious complications occurred during the follow-up period.ConclusionsThis modified procedure provided good functional and cosmetic outcomes for aponeurotic blepharoptosis, indicating an acceptable blepharoptosis repair for East Asian patients.
Reduction mammoplasty in adolescents and elderly a ten year case series analyzing age related outcome with focus on safety and complications
Publication date: Available online 28 September 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): AE. Wirthmann, L. Welsch, SV. Wellenbrock, L. Kasper, T. Schlosshauer, A. Bozkurt, S. Hüttinger, UM. Rieger
IntroductionReduction mammoplasty alleviates symptoms of macromastia in various ways. Current study results mainly identify perioperative risk factors for middle aged patients. We investigated a large series of consecutive breast reductions procedures to study whether patients' age at the time of operation is related to the postoperative outcome.MethodsWe retrospectively reviewed all non-oncologic breast reduction procedures at a single institution over a ten year time period, analyzing patients (age, BMI, comorbidities, medication) and operation specific characteristics' (pedicle, nipple-to-sternal notch, resection weight, complications) to identify risk factors related to patients' age at the time of operation. Patients were therefore divided into three groups, according to their age (group I ≤20 years, group II ≥60 years, group III 21 to 59 years).Results539 patients were included in the study, in total 1065 reduction mammoplasties were performed over a ten year period. The overall complication rate was 33% (n=175). Excluding minor complications, the total complication rate was 9.5% (n=51). High body mass index (≥30 kg/m2)(p=0.02) could be identified as a statistically significant risk factor for major and minor complications. Smoking (p=0.09) and age ≥ 60 years (p=0.08) showed a tendency toward higher risk for major and minor complications.ConclusionThis study shows an increased risk for complications when performing reduction mammoplasty in older patients, presumably due to the higher prevalence of comorbidities in this patient group as compared to young patients.
Use of reflectance confocal microscopy to evaluate 5-fluorouracil 0.5% /salicylic acid 10% in the field-directed treatment of sub-clinical lesions of actinic keratosis: sub-analysis of a Phase III, randomised, double-blind, vehicle-controlled trial
Abstract
Background
Actinic keratosis (AK) is a common skin disorder that can progress to invasive squamous-cell carcinoma. AK can present as clinical (visible) or sub-clinical (invisible) lesions within areas of chronic sun damage. The importance of treating sub-clinical AK is gaining support. We present a sub-analysis of a previously published Phase III, double-blind, vehicle-controlled study (NCT02289768), to assess 5-fluorouracil (5-FU) 0.5% /salicylic acid 10% treatment of sub-clinical AK lesions, based on reflectance confocal microscopy (RCM).
Objective
To determine the efficacy of 5-FU 0.5% /salicylic acid 10% as field-directed treatment for sub-clinical AK lesions using RCM.
Methods
For inclusion in this sub-analysis, patients had to have at least three sub-clinical AK lesions within a 25 cm2 area of skin. Sub-clinical AK lesions were diagnosed according to the presence of three key RCM criteria: architectural disarray; keratinocyte atypia and pleomorphism at the basal, spinous and granular layer. Sub-clinical AK lesions were evaluated by RCM at baseline, after 4, 6 and 12 weeks of 5-FU 0.5% /salicylic acid 10% treatment or vehicle, and 8 weeks following the end of treatment.
Results
Twenty-seven patients were included: 17 (mean age = 72.2 years, standard deviation [SD] = 6.3) received 5-FU 0.5% /salicylic acid 10% treatment and 10 (mean age = 76.4 years, SD = 3.9) received vehicle. Eight weeks following the end of treatment, the mean number of sub-clinical lesions declined (from 3.0 at baseline) to 0.3 (95% confidence interval [CI] 0.06–0.57) for the 5-FU 0.5% /salicylic acid 10% group and 1.6 (95% CI 0.52–2.68) in the vehicle group (reductions of 90% [95% CI 72.1–107.1] vs. 47% [95% CI 24.8–69.5], respectively; P = 0.005). The proportion of patients receiving 5-FU 0.5% /salicylic acid 10% showing complete clearance of three pre-selected sub-clinical AK lesions was numerically greater than in the vehicle group (69% vs. 40%, respectively; P = 0.183).
Conclusion
To the best of our knowledge, this is the first randomised, vehicle-controlled study investigating 5-FU 0.5% /salicylic acid 10% treatment for sub-clinical AK lesions. The present data suggest some treatment efficacy for sub-clinical AK lesions detected using RCM. However, this sub-analysis was not sufficiently powered and should be reproduced in a larger, subsequent cohort.
This article is protected by copyright. All rights reserved.
Clinical interpretation of the Uremic Pruritus in Dialysis Patients (UP-Dial) scale: a novel instrument for the assessment of uremic pruritus
Abstract
Background
The Uremic Pruritus in Dialysis Patients (UP-Dial) scale is valid and reliable for uremic pruritus (UP) assessment. However, it remains unknown how the scores should be interpreted in clinical practices.
Objectives
To establish a clinical interpretation of the UP-Dial by identifying severity cut-off scores according to the disease severity and burden of pruritus.
Methods
This cross-sectional study developed a classification system for the UP-Dial scores using the patient-based anchors method. From May 2012 through January 2017, 697 dialysis patients were screened. Of these, a total of 258 met the criteria for UP and completed the UP-Dial scale and three sets of patient-assessed anchor questions: (i) global UP intensity by visual analogue scale (VAS)-UP, (ii) Dermatology Life Quality Index, and (iii) global kidney disease-related quality of life. The cut-off scores were generated based on the kappa (κ) coefficient of agreement and the area under receiver operating characteristic curve (AuROC) statistics. Subgroup analyses were performed to explore associations between patient characteristics and the UP-Dial severity bands.
Results
The proposed scores were ≤12 (mild), 13-21 (moderate), and ≥22 (severe) with κ coefficient ranging between 0.39 and 0.46. Assigned scores were associated with all patient-based anchors. The highest association was with the VAS-UP, AuROC were 0.80 (mild; 95% CI, 0.75-0.86), 0.66 (moderate; 0.60-0.71), and 0.83 (severe; 0.77-0.89). In subgroup analysis according to patient characteristics, we did not find any significant difference.
Conclusions
The estimated UP-Dial severity band can facilitate the interpretation of UP in practice-based research settings and can be used to support treatment decisions.
This article is protected by copyright. All rights reserved.
Risk of uncommon cancers in patients with psoriasis: a Danish nationwide cohort study
Abstract
Background
Cancer-associated mortality is increased in psoriasis. However, little is known about the risk of less common cancers.
Objective
We aimed to evaluate the risk of less common cancers in patients with psoriasis compared to persons without psoriasis using a nationwide cohort study.
Methods
Between January 1st 2008 and December 31st 2012, we identified all Danish patients with a first-time hospital diagnosis of a less common cancer defined as <100 new cases/year/100.000 persons in Denmark. The primary endpoint was the occurrence of a diagnosis of cancer.
Results
We included 4,361,869 individuals. Of these, 58,138 were classified as having psoriasis. After adjusting for age, sex, socioeconomic status, and health care consumption, we found significantly elevated hazard ratios for cancers of bone and cartilage (HR 4.97 [2.32-10.62], P<0.0001) in patients with psoriasis on systemic treatment.
Conclusion
We provide further evidence of an increased cancer of bone and cartilage risk in patients with psoriasis.
This article is protected by copyright. All rights reserved.
Fasciite de Shulman associée à un infiltrat granulomateux sarcoïdosique
Source:Annales de Dermatologie et de Vénéréologie
Author(s): E. Zuelgaray, C. Sallé de Chou, M.-D. Vignon-Pennamen, M. Battistella, S. Leonard-Louis, L. Hefez, F. Guibal, M. Bagot, J.-D. Bouaziz
IntroductionLa fasciite de Shulman, ou fasciite à éosinophiles (FE), est une pathologie rare caractérisée par un œdème des extrémités d'évolution scléreuse et une hyperéosinophilie fréquente. Elle peut être dans certains cas associée à une hémopathie (en particulier une aplasie médullaire), un cancer solide ou une maladie auto-immune. Elle n'est généralement pas associée aux granulomatoses inflammatoires.ObservationNous rapportons le cas d'un patient de 80 ans qui présentait un œdème bilatéral des membres inférieurs évoluant vers une sclérose, évocateur de fasciite de Shulman, associé à la présence de granulomes cutanés et ganglionnaires. L'évolution était favorable sous traitement par prednisone orale.DiscussionL'association FE et granulomatose inflammatoire est rare. Le cas de notre patient montre qu'une réaction granulomateuse peut exister au cours de la fasciite de Shulman.BackgroundEosinophilic fasciitis (EF) is a rare condition characterized by swelling of the extremities, sclerodermatous evolution and frequent hypereosinophilia. Hematological disorders, including aplastic anemia, solid tumors and autoimmune diseases, may be associated with EF. EF is usually not associated with granulomatous diseases.Case reportHerein we describe the case of an 80-year-old man with symmetrical swelling and sclerosis of the legs, typical of EF, associated with skin and lymph node granulomas. Oral prednisone treatment resulted in complete clinical remission.DiscussionAssociation of EF and granulomatous disease is uncommon. Our case highlights the possible association of EF with sarcoidosis-like reactions.
Consentir
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M.-L. Armand, J.-M. Debarre, R. Malet, L. Martin, L. Haddad, D. Penso-Assathiany
Psoriasis Protects Against a Low Minimal Erythema Dose
Publication date: Available online 28 September 2017
Source:Actas Dermo-Sifiliográficas (English Edition)
Author(s): M.V. de Gálvez
Radiomic subtyping improves disease stratification beyond key molecular, clinical and standard imaging characteristics in patients with glioblastoma.
Abstract
Background
To analyze the potential of radiomics for disease stratification beyond key molecular, clinical and standard imaging features in patients with glioblastoma. Methods
Quantitative imaging features (n=1043) were extracted from the multiparametric MRI of 181 patients with newly-diagnosed glioblastoma prior to standard-of-care treatment (allocated to a discovery and validation set, 2:1 ratio). A subset of 386/1043 features were identified as reproducible (in an independent MRI-test-retest cohort) and selected for analysis. A penalized Cox-model with 10-fold cross-validation (Coxnet) was fitted on the discovery set to construct a radiomic signature for predicting progression-free and overall survival (PFS, OS). The incremental value of a radiomic signature beyond molecular (MGMT-promoter methylation, DNA-methylation subgroups), clinical (patients age, KPS, extent-of-resection, adjuvant treatment) and standard imaging parameters (tumor volumes) for stratifying PFS and OS was assessed with multivariate Cox-models (performance quantified with prediction error curves). Results
The radiomic signature (constructed from 8/386 features identified through Coxnet) increased the prediction accuracy for PFS and OS (in both discovery and validation set) beyond the assessed molecular, clinical and standard imaging parameters (p≤0.01). Prediction errors decreased by 36% for PFS and 37% for OS when adding the radiomic signature (as compared to 29% and 27% with molecular + clinical features alone). The radiomic signature was – along with MGMT-status – the only parameter with independent significance on multivariate analysis (p≤0.01). Conclusions
Our study stresses the role of integrating radiomics into a multi-layer decision framework with key molecular and clinical features to improve disease stratification and to potentially advance personalized treatment of patients with glioblastoma.Glioma CpG Island Methylator Phenotype (G-CIMP): Biological and Clinical Implications
Abstract
Gliomas are a heterogeneous group of brain tumors with distinct biological and clinical properties. Despite advances in surgical techniques and clinical regimens, treatment of high-grade glioma remains challenging and carries dismal rates of therapeutic success and overall survival. Challenges include the molecular complexity of gliomas, as well as inconsistencies in histopathological grading, resulting in an inaccurate prediction of disease progression and failure in the use of standard therapy. The updated 2016 World Health Organization (WHO) classification of tumors of the central nervous system reflects a refinement of tumor diagnostics by integrating the genotypic and phenotypic features, thereby narrowing the defined subgroups. The new classification recommends the molecular diagnosis of the IDH mutational status in gliomas. IDH-mutant gliomas manifest the CpG Island Methylator Phenotype (G-CIMP). Notably, the recent identification of clinically relevant subsets of G-CIMP tumors (G-CIMP-high and G-CIMP-low) provide a further refinement in glioma classification that is independent of grade and histology. This scheme may be useful for predicting patient outcome and may be translated into effective therapeutic strategies tailored to each patient. In this review, we highlight the evolution of our understanding of the G-CIMP subsets and how recent advances in characterizing the genome and epigenome of gliomas may influence future basic and translational research.Primary Large Cell Neuroendocrine Carcinoma of the Skin: An under-recognized entity and a mimic of metastatic disease
Primary large cell neuroendocrine carcinomas of the skin are exceptionally rare and can be diagnosed only when a metastasis from another organ has been excluded. We report the case of a 62 year old woman with a cutaneous papule on the mid-chest which generated a differential diagnosis of vascular lesion and basal cell carcinoma. Following excision, microscopic evaluation revealed a dermal large cell undifferentiated carcinoma, with a brisk mitotic rate and focal geographic necrosis. Mucin production was absent. On immunohistochemistry, the lesion expressed CK7, AE1AE3, CK8/18, chromogranin, synaptophysin, CD56, calcitonin (patchy) and TTF-1 (minimal focal). Stains for neurofilament, CK20, CK5/6, p40, p63, SOX10, MART-1, EMA, CEA, ER /PR, GATA3, GCDFP, mammoglobin, PAX-8, CDX2, napsin, ERG and MCPyV proved negative. The histopathological diagnosis was of a large cell neuroendocrine carcinoma, likely metastatic. The patient underwent comprehensive clinical, laboratory and radiographic investigations and no underlying primary carcinoma was detected. During a 20 month follow-up period with an oncologist the patient remains well and free of any apparent carcinoma. This suggests a primary large cell neuroendocrine carcinoma of skin. To date, 3 such cases have been reported in Japanese patients. This is the first in a Caucasian resident of North America.
Expression of connexin43 (Cx43) in the human hair follicle: emphasis on the Cx43 protein levels in the bulge and through the keratinization process
Introduction
Gap junctions form communication compartments between cells. These channels assemble from connexin (Cx) subunits.
Objective
To investigate the immunoexpression of Cx43 in adult human hair follicles.
Materials and methods
Cases were retrospectively obtained from our archives.
Results
We identified immunoexpression of Cx43 in the matrix, the papilla, the outer root sheath, the bulge, the medulla, the cortex, the shaft, and the secretory part of the sebaceous gland. There was very low expression (VLE) of Cx43 in the perifollicular sheath, the mantle, and the arrector pili muscle. The internal root sheath showed high-density expression in the bulb. Such expression abruptly decreased at different points in each of its layers at the point of keratinization. The isthmus showed Cx43 positive staining in the middle layers and all along, whereas there was VLE in the two outermost layers. The infundibulum showed expression all along the middle layers, whereas it showed VLE in the two outermost layers and in the two or three innermost layers.
Conclusions
The bulge contains Cx43. Our results suggest that keratinization in the hair follicle is closely related to the decrease in Cx43 expression.
A Historical Review of the Reconstruction of Hand Injuries.
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A Historical Review of the Reconstruction of Hand Injuries.
Arch Plast Surg. 2017 Sep;44(5):472-473
Authors: Gupta A, Niyazi MS, Tiwari VK
PMID: 28946734 [PubMed]
Interstitial Granulomatous Dermatitis with Granuloma Annulare-Like Pattern Following Liposuction.
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Interstitial Granulomatous Dermatitis with Granuloma Annulare-Like Pattern Following Liposuction.
Arch Plast Surg. 2017 Sep;44(5):470-471
Authors: Agarwal I, Thomas A, Agarwal M, Cibull T
PMID: 28946733 [PubMed]
Reconstruction of the Alar-Facial Groove Using a Nasolabial Flap and Medial Directional Force with a 'Tissue-Adding' Effect.
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Reconstruction of the Alar-Facial Groove Using a Nasolabial Flap and Medial Directional Force with a 'Tissue-Adding' Effect.
Arch Plast Surg. 2017 Sep;44(5):469-470
Authors: Lee CA, Kim JW
PMID: 28946732 [PubMed]
Managing Complications in Abdominoplasty: A Literature Review.
| Related Articles |
Managing Complications in Abdominoplasty: A Literature Review.
Arch Plast Surg. 2017 Sep;44(5):457-468
Authors: Vidal P, Berner JE, Will PA
Abstract
BACKGROUND: Abdominoplasty, with or without liposuction, is among the most frequently performed aesthetic procedures. Its main objective is to improve the body contour by means of excising redundant skin and fat tissue. Although abdominoplasty is considered a safe procedure with high satisfaction rates, intraoperative and postoperative complications can become a challenge for the surgical team. The aim of this article is to offer a synopsis of the most common complications arising after abdominoplasty, along with evidence-based guidelines about how to prevent and treat them.
METHODS: A systematic MEDLINE search strategy was designed using appropriate Medical Subject Headings (MeSH) terms, and references were scanned for further relevant articles.
RESULTS: According to the published case series, local complications are considerably more common than complications with systemic repercussions. Approximately 10% to 20% of patients suffer a local complication following abdominoplasty, while fewer than 1% suffer a systemic complication. Prevention and management strategies are critically discussed for complications including seroma, haematoma, infection, skin necrosis, suture extrusions, hypertrophic scars, neurological symptoms, umbilical anomalies, deep venous thrombosis and pulmonary thromboembolism, respiratory distress, and death.
CONCLUSIONS: The complications of abdominoplasty vary in severity and in the impact they have on the aesthetic outcomes. Recommendations for prevention and management are based on various levels of evidence, with a risk of observer bias. However, most complications can be treated appropriately following the current standards, with satisfactory results.
PMID: 28946731 [PubMed]
The Rolling Earlobe Flap for Dilated Ear Holes Following Ear Gauging: A Novel Approach to Aesthetically Preserving Earlobe Soft Tissue Volume.
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The Rolling Earlobe Flap for Dilated Ear Holes Following Ear Gauging: A Novel Approach to Aesthetically Preserving Earlobe Soft Tissue Volume.
Arch Plast Surg. 2017 Sep;44(5):453-456
Authors: Pek WS, Goh LHT, Pek CH
Abstract
Patients are increasingly seeking repair of their earlobes following ear gauging. Research has shown that current repair techniques either excessively reduce the lobular volume or leave an obvious scar along the free edge of the earlobe. In our case series, we describe the use of a novel technique for repairing earlobes following ear gauging using a rolling earlobe flap that preserves the lobular volume and avoids leaving a scar on the free edge of the lobule. The procedure was performed on 3 patients (6 earlobes) who had defects from ear gauging that ranged from 3.0 to 6.5 cm. There were no postoperative complications of infection, wound dehiscence, flap necrosis, hypertrophic scars, or keloids, and all patients were highly satisfied with the postoperative results. This versatile technique allows for an aesthetically pleasing reconstruction of the lobule with the advantages of: the absence of a surgical scar on the free edge of the lobule, preserving the lobule volume, and presenting a highly customizable technique that allows lobules to be created with various shapes and volumes.
PMID: 28946730 [PubMed]
Two-Blade Guillotine Technique for Nipple Graft Harvest.
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Two-Blade Guillotine Technique for Nipple Graft Harvest.
Arch Plast Surg. 2017 Sep;44(5):449-452
Authors: Wong AW, Chew KY, Tan BK
Abstract
The nipple-sharing technique for nipple reconstruction offers excellent tissue matching. The method used for nipple graft harvesting determines the quality of the graft and hence, the success of nipple sharing. Here, we described a guillotine technique wherein the nipple is first transfixed with 2 straight needles to stabilise it. Two No. 11 blades are then inserted in the center and simultaneously swept outwards to amputate the distal portion of the nipple. This technique provides good control, resulting in a very evenly cut base. The recipient bed is deepithelialized thinly, and the nipple graft is inset with interrupted 8-0 nylon sutures under magnification. Being a composite graft, it is protected with splint dressings for 6 weeks, and the dressing is regularly changed by the surgeon. The height of the nipple grafts ranges from 4 to 8 mm. This technique was performed in 9 patients with an average follow-up of 2.9 years (range, 1-4.5 years). Apposition between the nipple graft and its bed is crucial for the success of this technique. When correctly applied, we observed rapid revascularization of the graft.
PMID: 28946729 [PubMed]
Acute Osteomyelitis in the Hand Due to Dog Bite Injury: A Report of 3 Cases.
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Acute Osteomyelitis in the Hand Due to Dog Bite Injury: A Report of 3 Cases.
Arch Plast Surg. 2017 Sep;44(5):444-448
Authors: Lee R, Lee HY, Kim JH, Han YS, Kim DC, Tark KC
Abstract
As many people keep small dogs as pets, dog bites are common injuries, accounting for approximately 80%-90% of all animal bite injuries. These injuries usually occur on the upper extremities, most commonly on the fingers. Most of these injuries appear as simple lacerations or abrasions of the skin. Common symptoms include inflammatory reactions of the soft tissue, such as pain, swelling, erythema, and cellulitis. However, the complications of small dog bites may include joint or cartilage injuries, including acute osteomyelitis. Once osteomyelitis develops, it is difficult to diagnose since it has a latency period of approximately 2 weeks. Plain radiography, magnetic resonance imaging, and 3-phase bone scans should be performed when acute osteomyelitis is suspected, and broad-spectrum empiric antibiotic treatment should be administered for approximately 8-12 weeks. We report 3 very rare cases of acute osteomyelitis that occurred after a dog bite injury.
PMID: 28946728 [PubMed]
A Rare Case of Kimura Disease with Bilateral Parotid Involvement.
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A Rare Case of Kimura Disease with Bilateral Parotid Involvement.
Arch Plast Surg. 2017 Sep;44(5):439-443
Authors: Woo SH, Kim HK, Kim WS, Bae TH, Kim MK
Abstract
Kimura disease is a rare idiopathic chronic inflammatory disorder. It typically presents in the head and neck area, whereas bilateral involvement is unusual. Its diagnosis requires it to be differentiated from other inflammatory diseases and from head and neck tumors. Treatment methods include conservative management, steroid administration, radiotherapy, and surgery; however, no single treatment of choice has been established. Herein, we report an unusual presentation of Kimura disease with bilateral parotid involvement. This case was treated by surgical excision.
PMID: 28946727 [PubMed]
Management of a Dentigerous Cyst in a Child with Robin Sequence.
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Management of a Dentigerous Cyst in a Child with Robin Sequence.
Arch Plast Surg. 2017 Sep;44(5):434-438
Authors: Mirhaidari S, Murthy A
Abstract
This is a brief clinical report describing an 18-month-old female with Robin sequence found to have an incidental mandibular cystic lesion on a head computed tomography scan in the preoperative workup before performing mandibular distraction. She underwent enucleation of the tumor, which was found to be a dentigerous cyst. One year following cyst enucleation, mandibular distraction was performed in order to alleviate her tongue-based obstruction. This case demonstrates the ability of the mandibular bone to successfully regenerate after undergoing cyst enucleation.
PMID: 28946726 [PubMed]
Hand Surgery Fellowship Selection Criteria: A National Fellowship Director Survey.
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Hand Surgery Fellowship Selection Criteria: A National Fellowship Director Survey.
Arch Plast Surg. 2017 Sep;44(5):428-433
Authors: Egro FM, Vangala SK, Nguyen VT, Spiess AM
Abstract
BACKGROUND: Candidate characteristics for hand surgery fellowship training remains unknown, as very little data is available in the literature. This study aims to provide information on the criteria that are employed to select candidates for the hand surgery fellowship match.
METHODS: A 38-question survey was sent in April 2015 to all Accreditation Council for Graduate Medical Education recognized hand surgery fellowship program directors (n=81) involved in the U.S. match. The survey investigated factors used for the selection of applicants, including medical school, residency training, research experience, fellowship interview, and candidate characteristics. A 5-point Likert scale was used to grade 33 factors from "not at all important" (1) to "essential in making my decision" (5); or for five controversial factors from "very negative impact" (1) to "very positive impact in making my decision" (5).
RESULTS: A total of 52% (42 out of 81) of responses were received from hand surgery fellowship program directors. The most important influential factors were interactions with faculty during interview and visit (4.6±0.6), interpersonal skills (4.6±0.5), overall interview performance in the selection process (4.6±0.6), professionalism and ethics (4.6±0.7), and letters of recommendation from hand surgeons (4.5±0.7). Factors that have a negative impact on the selection process include visa requirement (2.1±1.2), graduate of non-plastic surgery residency program (2.4±1.3), and graduate of a foreign medical school (2.4±1.1).
CONCLUSIONS: This study provides data on hand surgery fellowship directors' perception on the criteria important for fellowship applicant selection, and showed that interview-related criteria and letters of recommendation are the important factors.
PMID: 28946725 [PubMed]
The Anconeus Muscle Free Flap: Clinical Application to Lesions on the Hand.
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The Anconeus Muscle Free Flap: Clinical Application to Lesions on the Hand.
Arch Plast Surg. 2017 Sep;44(5):420-427
Authors: Jeon BJ, Jwa SJ, Lee DC, Roh SY, Kim JS
Abstract
BACKGROUND: It can be difficult to select an appropriate flap for various defects on the hand. Although defects of the hand usually must be covered with a skin flap, some defects require a flap with rich blood supply and adequate additive soft tissue volume. The authors present their experience with the anconeus muscle free flap in the reconstruction of various defects and the release of scar contractures of the hand.
METHODS: Ten patients underwent reconstruction of the finger or release of the first web space using the anconeus muscle free flap from May 1998 to October 2013. Adequate bed preparations with thorough debridement or contracture release were performed. The entire anconeus muscle, located at the elbow superficially, was harvested, with the posterior recurrent interosseous artery as a pedicle. The defects were covered with a uniformly trimmed anconeus muscle free flap. Additional debulking of the flap and skin coverage using a split-thickness skin graft were performed 3 weeks after the first operation.
RESULTS: The average flap size was 18.7 cm2 (range, 13.5-30 cm2). All flaps survived without significant complications. Vein grafts for overcoming a short pedicle were necessary in 4 cases.
CONCLUSIONS: The anconeus muscle free flap can be considered a reliable reconstructive option for small defects on the hand or contracture release of the web space, because it has relatively consistent anatomy, provides robust blood supply within the same operative field, and leads to no functional loss at the donor site.
PMID: 28946724 [PubMed]
Selection of Implants in Unilateral Prosthetic Breast Reconstruction and Contralateral Augmentation.
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Selection of Implants in Unilateral Prosthetic Breast Reconstruction and Contralateral Augmentation.
Arch Plast Surg. 2017 Sep;44(5):413-419
Authors: Kim SJ, Song SY, Lew DH, Lee DW
Abstract
BACKGROUND: In breast reconstruction using implants after unilateral mastectomy, it is challenging to create a natural, ptotic contour, and asymmetry is a potential drawback. To achieve breast symmetry and an ideal shape for both breasts, we performed contralateral augmentation in patients undergoing breast reconstruction with implants.
METHODS: Patients underwent unilateral mastectomy and 2-stage reconstruction. During the second stage of the procedure, contralateral augmentation mammoplasty was performed. Preoperatively, we obtained the patients' demographic information, and we then assessed breast volume, the volume and dimensions of the inserted implants, and complications. Breast symmetry was observed by the surgeon and was assessed by measuring the disparity between the final volume of each breast.
RESULTS: Contralateral augmentation was performed in 52 cases. When compared to patients who did not undergo a contralateral balancing procedure, patients who received contralateral augmentation were younger, thinner, and had smaller breasts. During implant selection for contralateral augmentation, we chose implants that were approximately 1 cm shorter in width, 1 level lower in height, and 1 or 2 levels lower in projection than the implants used for reconstruction. The postoperative breast contours were symmetric and the final volume discrepancy between each breast, which was measured by 3-dimensional scanning, was acceptable.
CONCLUSIONS: We demonstrate that contralateral augmentation can be recommended for patients who perceive their breasts to be small and not beautiful in order to achieve an ideal and beautiful shape for both breasts. Furthermore, this study offers guidelines for selecting the implant that will lead to the optimal aesthetic outcome.
PMID: 28946723 [PubMed]
Prognostic Factors of Orbital Fractures with Muscle Incarceration.
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Prognostic Factors of Orbital Fractures with Muscle Incarceration.
Arch Plast Surg. 2017 Sep;44(5):407-412
Authors: Lee SC, Park SH, Han SK, Yoon ES, Dhong ES, Jung SH, You HJ, Kim DW
Abstract
BACKGROUND: Among the various signs and symptoms of orbital fractures, certain clinical findings warrant immediate surgical exploration, including gaze restriction, computed tomographic (CT) evidence of entrapment, and prolonged oculocardiac reflex. Despite proper surgical reconstruction, prolonged complications such as diplopia and gaze restriction can occur. This article evaluated the prognostic factors associated with prolonged complications of orbital fractures with muscle incarceration.
METHODS: The medical records of 37 patients (37 orbits) with an orbital fracture with muscle incarceration from January 2001 to January 2015 were reviewed. The presence of Incarcerated muscle was confirmed via CT, as well as by intraoperative findings. Various factors potentially contributing to complications lasting for over 1 year after the injury were categorized and analyzed, including age, cause of injury, injury-to-operation time, operative time, fracture type, nausea, vomiting and other concomitant symptoms and injuries.
RESULTS: All patients who presented with extraocular muscle limitations, positive CT findings, and/or a positive forced duction test underwent surgery. Of the 37 patients, 9 (24%) exhibited lasting complications, such as diplopia and gaze restriction. The mean follow-up period was 18.4 months (range, 1-108 months), while that of patients who experienced prolonged complications was 30.1 months (range, 13-36 months). Two factors were significantly associated with prolonged complications: injury-to-operation time and nausea/vomiting. Loss of vision, worsening of motility, and implant complication did not occur.
CONCLUSIONS: Patients who present with gaze limitations, with or without other signs of a blow-out fracture, require a thorough evaluation and emergent surgery. A better prognosis is expected with a shorter injury-to-operation time and lack of nausea and vomiting at the initial presentation.
PMID: 28946722 [PubMed]
Effect of Preoperative Nasal Retainer on Nasal Growth in Patients with Bilateral Incomplete Cleft Lip: A 3-Year Follow-Up Study.
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Effect of Preoperative Nasal Retainer on Nasal Growth in Patients with Bilateral Incomplete Cleft Lip: A 3-Year Follow-Up Study.
Arch Plast Surg. 2017 Sep;44(5):400-406
Authors: Kim YC, Jeong WS, Oh TS, Choi JW, Koh KS
Abstract
BACKGROUND: The purpose of this study was to evaluate changes in nasal growth after the implementation of a preoperative nasal retainer in patients with bilateral incomplete cleft lip.
METHODS: Twenty-six infants with bilateral incomplete cleft lip and cleft palate were included in the study. A preoperative nasal retainer was applied in 5 patients from the time of birth to 2.6-3.5 months before primary cheiloplasty. Twenty-one patients who were treated without a preoperative nasal retainer were placed in the control group. Standard frontal, basal, and lateral view photographs were taken 3 weeks before cheiloplasty, immediately after cheiloplasty, and at the 1- and 3-year postoperative follow-up visits. The columella and nasal growth ratio and nasolabial angle were indirectly measured using photographic anthropometry.
RESULTS: The ratio of columella length to nasal tip protrusion significantly increased after the implementation of a preoperative nasal retainer compared to the control group for up to 3 years postoperatively (P<0.01 for all time points). The ratios of nasal width to facial width, nasal width to intercanthal distance, columellar width to nasal width, and the nasolabial angle, for the two groups were not significantly different at any time point.
CONCLUSIONS: Implementation of a preoperative nasal retainer provided significant advantages for achieving columellar elongation for up to 3 years postoperatively. It is a simple, reasonable option for correcting nostril shape, preventing deformities, and guiding development of facial structures.
PMID: 28946721 [PubMed]
Contemporary Koreans' Perceptions of Facial Beauty.
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Contemporary Koreans' Perceptions of Facial Beauty.
Arch Plast Surg. 2017 Sep;44(5):390-399
Authors: Rhee SC, An SJ, Hwang R
Abstract
BACKGROUND: This article aims to investigate current perceptions of beauty of the general public and physicians without a specialization in plastic surgery performing aesthetic procedures.
METHODS: A cross-sectional and interviewing questionnaire was administered to 290 people in Seoul, South Korea in September 2015. The questionnaire addressed three issues: general attitudes about plastic surgery (Q1), perception of and preferences regarding Korean female celebrities' facial attractiveness (Q2), and the relative influence of each facial aesthetic subunit on overall facial attractiveness. The survey's results were gathered by a professional research agency and classified according to a respondent's gender, age, and job type (95%±5.75% confidence interval). Statistical analysis was performed using SPSS ver. 10.1, calculating one-way analysis of variance with post hoc analysis and Tukey's t-test.
RESULTS: Among the respondents, 38.3% were in favor of aesthetic plastic surgery. The most common source of plastic surgery information was the internet (50.0%). The most powerful factor influencing hospital or clinic selection was the postoperative surgical results of acquaintances (74.9%). We created a composite face of an attractive Korean female, representing the current facial configuration considered appealing to the Koreans. Beauty perceptions differed to some degree based on gender and generational differences. We found that there were certain differences in beauty perceptions between general physicians who perform aesthetic procedures and the general public.
CONCLUSIONS: Our study results provide aesthetic plastic surgeons with detailed information about contemporary Korean people's attitudes toward and perceptions of plastic surgery and the specific characteristics of female Korean faces currently considered attractive, plus trends in these perceptions, which should inform plastic surgeons within their specialized fields.
PMID: 28946720 [PubMed]
Effects of Remote Ischemic Conditioning Methods on Ischemia-Reperfusion Injury in Muscle Flaps: An Experimental Study in Rats.
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Effects of Remote Ischemic Conditioning Methods on Ischemia-Reperfusion Injury in Muscle Flaps: An Experimental Study in Rats.
Arch Plast Surg. 2017 Sep;44(5):384-389
Authors: Keskin D, Unlu RE, Orhan E, Erkilinç G, Bogdaycioglu N, Yilmaz FM
Abstract
BACKGROUND: The aim of this study was to investigate the effects of remote ischemic conditioning on ischemia-reperfusion injury in rat muscle flaps histopathologically and biochemically.
METHODS: Thirty albino rats were divided into 5 groups. No procedure was performed in the rats in group 1, and only blood samples were taken. A gracilis muscle flap was elevated in all the other groups. Microclamps were applied to the vascular pedicle for 4 hours in order to achieve tissue ischemia. In group 2, no additional procedure was performed. In groups 3, 4, and 5, the right hind limb was used and 3 cycles of ischemia-reperfusion for 5 minutes each (total, 30 minutes) was applied with a latex tourniquet (remote ischemic conditioning). In group 3, this procedure was performed before flap elevation (remote ischemic preconditoning). In group 4, the procedure was performed 4 hours after flap ischemia (remote ischemic postconditioning). In group 5, the procedure was performed after the flap was elevated, during the muscle flap ischemia episode (remote ischemic perconditioning).
RESULTS: The histopathological damage score in all remote conditioning ischemia groups was lower than in the ischemic-reperfusion group. The lowest histopathological damage score was observed in group 5 (remote ischemic perconditioning).
CONCLUSIONS: The nitric oxide levels were higher in the blood samples obtained from the remote ischemic perconditioning group. This study showed the effectiveness of remote ischemic conditioning procedures and compared their usefulness for preventing ischemia-reperfusion injury in muscle flaps.
PMID: 28946719 [PubMed]
Effects of Topical Tamoxifen on Wound Healing of Burned Skin in Rats.
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Effects of Topical Tamoxifen on Wound Healing of Burned Skin in Rats.
Arch Plast Surg. 2017 Sep;44(5):378-383
Authors: Mehrvarz S, Ebrahimi A, Sahraei H, Bagheri MH, Fazili S, Manoochehry S, Rasouli HR
Abstract
BACKGROUND: This study aimed to assess the effects of the topical application of tamoxifen on wound healing of burned skin in Wistar rats by evaluating 3 healing characteristics: fibrotic tissue thickness (FTT), scar surface area (SSA), and angiogenesis in the healed scar tissue.
METHODS: Eighteen male Wistar rats were used in this study. A third-degree burn wound was made on the shaved animals' back, measuring 2×2×2 cm. In the first group, a 2% tamoxifen ointment was applied to the wound twice daily for 8 weeks. The second group received a placebo ointment during the same period. The third group did not receive any treatment and served as the control group.
RESULTS: The median (interquartile range=[Q1, Q3]) FTT was 1.35 (1.15, 1.62) mm, 1.00 (0.95, 1.02) mm, and 1.25 (0.8, 1.5) mm in the control, tamoxifen, and placebo groups, respectively (P=0.069). However, the FTT in the tamoxifen group was less than in the placebo and control groups. The median angiogenesis was 3.5 (3.00, 6.25), 8.00 (6.75, 9.25), and 7.00 (5.50, 8.25) vessels per high-power field for the control, tamoxifen, and placebo groups, respectively (P=0.067). However, the median angiogenesis was higher in the tamoxifen group than in the control group. No significant difference was observed in the mean SSA between the tamoxifen group and the control group (P=0.990).
CONCLUSIONS: Local application of tamoxifen increased angiogenesis and decreased the FTT, with no change in the SSA in burned skin areas. These effects are expected to expedite the wound healing process, reducing contracture and preventing hypertrophic scar and keloid formation.
PMID: 28946718 [PubMed]
Effects of Human Adipose-Derived Stem Cells on the Survival of Rabbit Ear Composite Grafts.
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Effects of Human Adipose-Derived Stem Cells on the Survival of Rabbit Ear Composite Grafts.
Arch Plast Surg. 2017 Sep;44(5):370-377
Authors: Kim CM, Oh JH, Jeon YR, Kang EH, Lew DH
Abstract
BACKGROUND: Composite grafts are frequently used for facial reconstruction. However, the unpredictability of the results and difficulties with large defects are disadvantages. Adipose-derived stem cells (ADSCs) express several cytokines, and increase the survival of random flaps and fat grafts owing to their angiogenic potential.
METHODS: This study investigated composite graft survival after ADSC injection. Circular chondrocutaneous composite tissues, 2 cm in diameter, from 15 New Zealand white rabbits were used. Thirty ears were randomly divided into 3 groups. In the experimental groups (1 and 2), ADSCs were subcutaneously injected 7 days and immediately before the operation, respectively. Similarly, phosphate-buffered saline was injected in the control group just before surgery in the same manner as in group 2. In all groups, chondrocutaneous composite tissue was elevated, rotated 90 degrees, and repaired in its original position. Skin flow was assessed using laser Doppler 1, 3, 6, 9, and 12 days after surgery. At 1 and 12 days after surgery, the viable area was assessed using digital photography; the rabbits were euthanized, and immunohistochemical staining for CD31 was performed to assess neovascularization.
RESULTS: The survival of composite grafts increased significantly with the injection of ADSCs (P<0.05). ADSC injection significantly improved neovascularization based on anti-CD31 immunohistochemical analysis and vascular endothelial growth factor expression (P<0.05) in both group 1 and group 2 compared to the control group. No statistically significant differences in graft survival, anti-CD31 neovascularization, or microcirculation were found between groups 1 and 2.
CONCLUSIONS: Treatment with ADSCs improved the composite graft survival, as confirmed by the survival area and histological evaluation. The differences according to the injection timing were not significant.
PMID: 28946717 [PubMed]
Experimental In-Vivo Models Used in Fat Grafting Research for Volume Augmentation in Soft Tissue Reconstruction.
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Experimental In-Vivo Models Used in Fat Grafting Research for Volume Augmentation in Soft Tissue Reconstruction.
Arch Plast Surg. 2017 Sep;44(5):361-369
Authors: Lujan-Hernandez J, Appasani R, Sullivan K, Siegel-Reamer L, Lalikos JF
Abstract
As the popularity of fat grafting research increases, animal models are being used as the source of pre-clinical experimental information for discovery and to enhance techniques. To date, animal models used in this research have not been compared to provide a standardized model. We analyzed publications from 1968-2015 to compare published accounts of animal models in fat grafting research. Data collected included: species used, graft characteristics (donor tissue, recipient area, amount injected, injection technique), time of sacrifice and quantification methods. Mice were most commonly used (56% of studies), with the "athymic nude" strain utilized most frequently (44%). Autologous fat was the most common source of grafted tissue (52%). Subcutaneous dorsum was the most common recipient site (51%). On average, 0.80±0.60 mL of fat was grafted. A single bolus technique was used in 57% of studies. Fat volume assessment was typically completed at the end of the study, occurring at less than 1 week to one year. Graft volume was quantified by weight (63%), usually in conjunction with another analysis. The results demonstrate the current heterogeneity of animal models in this research. We propose that the research community reach a consensus to allow better comparison of techniques and results. One example is the model used in our laboratory and others; this model is described in detail. Eventually, larger animal models may better translate to the human condition but, given increased financial costs and animal facility capability, should be explored when data obtained from small animal studies is exhausted or inconclusive.
PMID: 28946716 [PubMed]
Research, Plastic Surgery, and Archives of Plastic Surgery.
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Research, Plastic Surgery, and Archives of Plastic Surgery.
Arch Plast Surg. 2017 Sep;44(5):359-360
Authors: Lee WJ
PMID: 28946715 [PubMed]
Alterations in circulating lymphoid cell populations in systemic small vessel vasculitis are non-specific manifestations of renal injury
Summary
Innate lymphocyte populations, such as innate lymphoid cells (ILCs), γδ T cells, invariant natural killer T (iNKT) cells and mucosal associated invariant T (MAIT) cells are emerging as important effectors of innate immunity and are involved in various inflammatory and autoimmune diseases. The aim of this study was to assess the frequencies and absolute numbers of innate lymphocytes as well as conventional lymphocytes and monocytes in peripheral blood from a cohort of ANCA associated vasculitis (AAV) patients. 38 AAV patients and 24 healthy and disease controls were included in the study. Patients with AAV were sampled both with and without immunosuppressive treatment, and in the setting of both active disease and remission. The frequencies of MAIT and ILC2 cells were significantly lower in patients with AAV, and in the disease control group, compared to healthy controls. These reductions in the AAV patients remained during remission. B cell count and frequencies were significantly lower in AAV in remission compared to patients with active disease and disease controls. Despite the strong Th2 preponderance of eosinophilic granulomatosis with polyangiitis, we did not observe increased ILC2 frequency in this cohort of patients. The frequencies of other cell types were similar in all groups studied. Reductions in circulating ILC2 and MAIT cells previously reported in patients with AAV are not specific for AAV, but are more likely to be due to non-specific manifestations of renal impairment and chronic illness. Reduction in B cell numbers in AAV patients experiencing remission is probably therapy-related. This article is protected by copyright. All rights reserved.
H-ferritin and pro-inflammatory cytokines are increased in the bone marrow of patients affected by macrophage activation syndrome
Abstract
Macrophage activation syndrome (MAS) is hyper-inflammatory life-threatening syndrome, typically associated with high levels of serum ferritin. This is an iron storage protein including heavy (H) subunits and light (L) subunits, categorised on their molecular weight. The H-/L-subunits ratio may be different in tissues, depending on the specific tissue and pathophysiologic status.
In this work, we analysed the bone marrow (BM) biopsies of adult MAS patients to assess the presence of: i. H-ferritin and L-ferritin; ii. CD68+/H-ferritin+ and CD68+/L-ferritin+; iii. IL-1β, TNF, IFN-γ. We also explored possible correlations of these results with clinical data.
H-ferritin, IL-1β, TNF and IFN-γ resulted to be significantly increased in MAS. Furthermore, an increased number of CD68+/H-ferritin+ cells and an infiltrate of cells co-expressing H-ferritin and IL-12, suggesting an infiltrate of M1 macrophages, were observed. H-ferritin levels and CD68+/H-ferritin+ cells resulted to be correlated with haematological involvement of the disease, serum ferritin and C-reactive protein. L-ferritin and CD68+/L-ferritin+ cells did not correlate with these parameters.
In conclusion, during MAS, H-ferritin, CD68+/H-ferritin+ cells and pro-inflammatory cytokines resulted to be significantly increased in the BM inflammatory infiltrate, pointing out a possible vicious pathogenic loop. To date, H-ferritin and CD68+/H-ferritin+ were significantly associated with haematological involvement of the disease, suggesting bio-markers assessing severity of clinical picture. This article is protected by copyright. All rights reserved.
Safety of Secukinumab in Hepatitis B Virus
Abstract
The usage of TNF antagonists in patients with hepatitis B virus (HBV) can result in viral reactivation and potential liver failure. However, little is known about the risk of viral reactivation with the newer IL-17 antagonists. We report a patient with seropositive hepatitis B, ankylosing spondylitis, and disabling palmar plantar psoriasis treated successfully with secukinumab without liver complications.
This article is protected by copyright. All rights reserved.
Multiple switches between GP2015, an etanercept biosimilar, with originator product do not impact efficacy, safety and immunogenicity in patients with chronic plaque-type psoriasis: 30-week results from the phase 3, confirmatory EGALITY study
Abstract
Background
EGALITY was a phase III confirmatory efficacy and safety study conducted in patients with plaque-type psoriasis as a part of totality of evidence gathered during the development of GP2015, an etanercept biosimilar.
Objective
To demonstrate equivalent efficacy and comparable safety and immunogenicity of GP2015 and the etanercept originator product (ETN, Enbrel®), and evaluate effects of repeated switching between GP2015 and ETN. Results for efficacy, safety and immunogenicity during treatment period (TP) 2 (TP2) are presented pooling the two continued treatment arms (pooled continued) versus the two treatment arms with repeated switches (pooled switched).
Methods
Patients (n=531) were randomised 1:1 to self-administer GP2015 or ETN twice-weekly subcutaneously during TP1. Patients with a ≥50% improvement in Psoriasis Area and Severity Index (PASI 50) at week 12 were re-randomised for TP2 to continue the same treatment at once-weekly dosing or to undergo 3 consecutive treatment switches between GP2015 and ETN until week 30. Patients continued the last-assigned treatment during TP2, until week 52.
Results
Mean (standard deviation [SD]) PASI scores at baseline were similar in patients who underwent multiple switches compared to those with continued treatments during TP2. During TP2, PASI 50, PASI 75 and PASI 90 response rates, percent change from baseline in PASI scores and all other efficacy parameters were similar between the pooled switched and pooled continued treatment groups at all time points. The incidence of treatment-emergent adverse events including injection site reactions was comparable between the pooled switched (36.7%) and pooled continued (34.9%) groups. None of the patients in either treatment group were positive for binding anti-drug antibodies in TP2.
Conclusion
Treatment efficacy, safety and immunogenicity were similar between the pooled continued and pooled switched treatments during TP2, indicating that there are no effects in the short term on clinical data of multiple switches between GP2015 and ETN.
This article is protected by copyright. All rights reserved.
Secukinumab treatment of moderate to severe plaque psoriasis in routine clinical care: Real-life data of prior and concomitant use of psoriasis treatments from the PROSPECT study
Abstract
Background
Secukinumab, a fully human anti-interleukin-17A monoclonal antibody, has demonstrated efficacy and safety in patients with moderate to severe psoriasis. However, as per study protocols, transition periods from prior psoriasis treatments of a defined minimal length were required and use of concomitant psoriasis medication was prohibited. There is therefore a lack of data on the effect of shorter transition periods and concomitant psoriasis treatment with other pharmacologically active substances on the effectiveness and safety of secukinumab in routine clinical practice
Objectives
The PROSPECT study was designed to assess prior and concomitant use of psoriasis treatments in subjects receiving secukinumab and the duration of transition periods from prior treatments to secukinumab. Here we report the baseline characteristics and the duration of transition period in an interim analysis of the first 805 subjects.
Methods
PROSPECT is an ongoing 24-week, single-cohort, non-interventional study. Subjects with moderate to severe psoriasis with a decision to receive secukinumab were included.
Results
The majority of subjects were male (491/796, 61.7%), with a mean age of 47.7 years (SD 13.7). The baseline Psoriasis Area and Severity Index (PASI) was available for 92.4% (744/805) of subjects and mean baseline PASI was 17.5 (SD 13.1, n=744). 93.4% (752/805) of subjects had signs of high disease severity. Use of concomitant treatment increased with the number of signs. Within the last 12 months prior to inclusion, 10%, 40%, and 28% of subjects had received topical, conventional systemic, or biologic treatments as their last prior psoriasis therapy, respectively and 22% of subjects had not received any psoriasis therapy. Discontinuation of prior treatment due to adverse events was high in subjects with conventional systemic treatment (93/413, 22.5%) compared to biologic treatment (5/210, 2.4%). The median duration of the transition period was 14.0, 30.5, and 38.0 days for prior topical, conventional systemic, and biologic treatments, respectively.
Conclusion
PROSPECT is the first study to investigate prior and concomitant use of psoriasis treatments in subjects receiving secukinumab in a real world setting. The majority of the subjects had a high disease burden and use of concomitant treatment increased with disease severity. The duration of the transition period depended on prior treatment.
This article is protected by copyright. All rights reserved.
The person-centered acne severity scale study
Abstract
Acne is one of the most common skin conditions seen by dermatologists. As with many other cutaneous diseases, due to its visibility, acne often produces a large psychosocial impact on patients who suffer from the disease. Such psychosocial burdens are exacerbated by the variation in acne presentation that can lead to the usage of multiple different treatments before visible improvements are appreciated. Although many scales have been established to determine severity from the clinician standpoint, patient-oriented scales are lacking. Clinicians use these severity tools to guide management and judge patient improvement from visit to visit. Creation of such a severity scale from a patient's perspective would allow patients to not only assess their perception of their acne independent of a physician but could also be used to determine patient satisfaction with treatment that would then help to more effectively guide management. Therefore the goal of this study is to create and validate a patient-centered acne severity scale using a visual analogue scale format.
Gougerot-Sjogren-like syndrome under PD-1 inhibitor treatment.
pembrolizumabgougerot-sjrokentoxicityimmune related adverse events
Bevacizumab + chemotherapy versus chemotherapy alone in elderly patients with untreated metastatic colorectal cancer: a randomized phase II trial - PRODIGE 20 study results
Abstract
BACKGROUND
Metastatic colorectal cancer frequently occurs in elderly patients. Bevacizumab in combination with front line chemotherapy is a standard treatment but some concern raised about tolerance of bevacizumab for these patients. The purpose of PRODIGE 20 was to evaluate tolerance and efficacy of bevacizumab according to specific endpoints in this population. PATIENTS AND METHODS
Patients aged 75 and over were randomly assigned to bevacizumab + chemotherapy (BEV) versus chemotherapy (CT). LV5FU2, FOLFOX and FOLFIRI regimen were prescribed according to investigator's choice. The composite co-primary endpoint, assessed 4 months after randomization, was based on efficacy (tumor control and absence of decrease of the Spitzer QoL index) and safety (absence of severe cardiovascular toxicities and unexpected hospitalization). For each arm, the treatment will be consider as inefficient if 20% or less of the patients met the efficacy criteria and not safe if 40% or less met the safety criteria. RESULTS
102 pts were randomized (51 BEV and 51 CT), median age was 80 years (range 75-91). Primary endpoint was met for efficacy in 50% and 58% and for safety in 61% and 71% of patients in BEV and CT respectively. Median progression-free survival was 9.7 months in BEV and 7.8 months in CT. Median overall survival (OS) was 21.7 months in BEV and 19.8 months in CT. The 36-months OS rate was 27% in BEV and 10.1% in CT. Severe toxicities grade 3/4 were mainly non hematologic toxicities (80.4% in BEV, 63.3% in CT). CONCLUSION
Bevacizumab combined with chemotherapy was safe and efficient. Both arms met the primary safety and efficacy criteria.
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Publication date: Available online 25 July 2018 Source: Journal of Photochemistry and Photobiology B: Biology Author(s): Marco Ballestr...
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Editorial AJR Reviewers: Heartfelt Thanks From the Editors and Staff Thomas H. Berquist 1 Share + Affiliation: Citation: American Journal...
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Publication date: Available online 28 September 2017 Source: Actas Dermo-Sifiliográficas Author(s): F.J. Navarro-Triviño
