No abstract availableΠέμπτη 26 Οκτωβρίου 2017
Do Bacteria and Biofilm Play a Role in Double-Capsule Formation around Macrotextured Implants?
Background: The double capsule is a complication mostly described in aggressive macrotextured implants. Mechanical shear stress applied onto an immature periprosthetic capsule has been linked to their formation. The authors aim to demonstrate the role of bacterial phenotype and biofilm in the development of the double capsule. Methods: Seven double capsules formed at the interface of macrotextured breast expander implants were studied using scanning electron microscopy. Two samples for each surface of the inner capsule layer (the prosthesis interface and the intercapsular space) were analyzed for bacteria cell size, bacterial density, and biofilm deposition. Results: Although all routine bacterial cultures were negative, the prosthesis interface had both higher bacteria load and biofilm deposition compared with the intercapsular space (Mann-Whitney U test, p = 0.004 and p = 0.008, respectively). Moreover, bacteria cell sizes were significantly smaller at the prosthesis interface in six of seven samples. Comparison of bacteria density and biofilm dispersion showed an increase of biofilm extracellular matrix deposition over 2000 cells/mm2 (linear regression, p = 0.0025). These results indicate a common trend among bacteria species. Conclusions: Bacterial expression between the different surfaces of the double capsule displays significant differences; bacteria at the prosthesis interface are mostly in a biofilm state, whereas they demonstrate a planktonic phenotype at the intercapsular space. When a sufficient amount of bacteria are present at a specific location, quorum sensing may trigger a biofilm phenotypic switch in planktonic bacteria cells. Biofilm formation may alter capsule formation through immune response, thereby weakening capsule strength and facilitating extracellular matrix delamination and double-capsule formation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.Five Steps to Internal Mammary Vessel Preparation in Less than 15 Minutes
Background: Modern breast reconstruction often involves microvascular reconstruction. The most common recipient vessels are the internal mammary artery and vein. Recently, there has been great focus on efficiency, but much of this emphasis has been directed to faster flap harvest or recovery protocols for expeditious discharge. An equally important aspect is internal mammary vessel preparation. Methods: Breast reconstruction was performed in 415 patients (715 breasts) using autologous tissue (850 flaps) from 2012 to 2016. In 97.6 percent of these breast reconstructions, the internal mammary vessels were used. The preparation of these vessels was routinely performed using the five-step technique described here. Results: Internal mammary preparation time ranged from 7 to 45 minutes (median, 15 minutes). The procedure involves five simplified steps, as follows: step 1, the rib is exposed by splitting the pectoralis major muscle; step 2, the perichondrium anterior to the cartilage is incised and dissected away from the cartilage; step 3, the cartilage is removed with a rongeur; step 4, laterally the perichondrium is elevated and incised (under direct vision, this perichondrium is then split directly over the vessels and the cranial and caudal flaps are resected); and step 5, careful dissection is performed on the artery and vein. Conclusions: Safe preparation of recipient vessels in microvascular reconstruction is essential for success. In modern breast reconstruction, the internal mammary artery and vein are typically used. Exposure of these vessels should be predictable and efficient. The authors have found that a systematic approach using the above five steps accomplishes these goals.Evidence-Based Clinical Practice Guideline: Autologous Breast Reconstruction with DIEP or Pedicled TRAM Abdominal Flaps
Summary: The American Society of Plastic Surgeons commissioned a multistakeholder Work Group to develop recommendations for autologous breast reconstruction with abdominal flaps. A systematic literature review was performed and a stringent appraisal process was used to rate the quality of relevant scientific research. The Work Group assigned to draft this guideline was unable to find evidence of superiority of one technique over the other (deep inferior epigastric perforator versus pedicled transverse rectus abdominis musculocutaneous flap) in autologous tissue reconstruction of the breast after mastectomy. Presently, based on the evidence reported here, the Work Group recommends that surgeons contemplating breast reconstruction on their next patient consider the following: the patient's preferences and risk factors, the setting in which the surgeon works (academic versus community practice), resources available, the evidence shown in this guideline, and, equally important, the surgeon's technical expertise. Although theoretical superiority of one technique may exist, this remains to be reported in the literature, and future methodologically robust studies are needed.Fat Grafting in Hollow Upper Eyelids and Volumetric Upper Blepharoplasty
Background: Periorbital volume loss creates a shadow frame, and traditional excisional blepharoplasties may aggravate the situation. Divergence in filling treatments establishes a demand for simple and reproducible techniques to achieve consistent results. Here, the author's hollow upper eyelid evaluation and treatment approach are presented. Methods: A retrospective photographic analysis was conducted of 32 women who underwent fat grafting for hollow upper eyelids between 2012 and 2016. Preoperative and postoperative evaluations of upper eyelid ratios at the medial and lateral corneal limbus, together with lateral contour modifications, were used to determine the efficacy of the technique to restore youthful proportions and contours. Results: Preoperative analysis showed 20 eyelids with an inner shadow, or A-pattern; and 44 eyelids with the complete extension of the hollow, or C-pattern. Three patients presented mild blepharoptosis, and eight patients had undergone a previous upper blepharoplasty. Mean grafting volume was 0.4 cc in the deep plane and 2.8 cc in the superficial plane. Fat grafting exclusively was performed in six patients, improving all ratios and correcting the A-pattern deformity. Volumetric upper blepharoplasty combining fat grafting in two levels and orbicularis oculi muscle imbrication was performed in 26 patients, correcting every inverted ratio (pBreast Cleavage Remodeling with Fat Grafting: A Safe Way to Optimize Symmetry and to Reduce Intermammary Distance
Background: In their descriptions of the ideal breast, most studies have focused primarily on the dimensions, shape, and proportions. The distance between the breasts has only very rarely been considered. The intermammary distance and the medial symmetry between the breasts are important parts of the outcome of surgery and have a strong bearing on patient satisfaction. However, the control surgeons have over these factors is only relative, and depends heavily on the underlying anatomical characteristics of the patients. Methods: Eighty-six patients undergoing breast augmentation, breast reduction, or mastopexy and breast reconstruction with separated or asymmetric breasts underwent fat grafting in the medial quadrants. Intermammary distances were measured before fat grafting and 12 months later. Complications were also recorded. Results: This technique obtained a statistically significant reduction in the mean intermammary distance (pImpact of Patient Subtype and Surgical Variables on Abdominoplasty Outcomes: A 12-Year Massachusetts General Hospital Experience
Background: The traditional abdominoplasty is one of the most common surgical procedures performed. This study evaluates the impact of different surgical techniques and clinical patient factors on abdominoplasty outcomes. Methods: A retrospective review of consecutive patients undergoing abdominoplasty was performed. Results: Seven hundred seventy-nine patients with a mean age of 43.7 years and a body mass index of 27 kg/m2 underwent abdominoplasty. The majority were women (92.9 percent), and massive weight loss was present in 34.8 percent. Abdominoplasty techniques included traditional (59.4 percent), belt lipectomy (17.9 percent), fleur-de-lis (16.4 percent), umbilical float (9.2 percent), and mini-abdominoplasty (2.8 percent). Half of the study population [n = 384 (49.3 percent)] had concurrent surgical procedures. Total complications (23.0 percent) consisted primarily of wound- and scar-related complications (15.3 percent). Approximately 60 percent of patients received heparin chemoprophylaxis, with overall thromboembolic and hematoma rates less than 1 percent. Univariate analysis revealed that massive weight loss (p = 0.04), fleur-de-lis (p = 0.03) or belt lipectomy (p = 0.05) techniques, and concurrent medial thigh lift (pInjection of Compressed Diced Cartilage in the Correction of Secondary and Primary Rhinoplasty: A New Technique with 12 Years’ Experience
Background: There are instances where small or large pockets are filled with diced cartilage in the nose, without use of wrapping materials. For this purpose, 1-cc commercial syringes were used. The obtained results were partial and incomplete. For better and improved results, the author designed new syringes, with two different sizes, which compress the diced cartilage for injection. Methods: The author presents his experience accrued over the past 12 years with 2366 primary, 749 secondary, 67 cleft lip and nose, and a total of 3182 rhinoplasties, using his new syringe design, which compresses diced cartilage and injects the diced cartilages as a conglutinate mass, simulating carved costal cartilage, but a malleable one. Results: In 3125 patients, the take of cartilage graft was complete (98.2 percent) and a smooth surface was obtained, giving them a natural appearance. In 21 patients (0.65 percent), there was partial resorption of cartilage. Correction was performed with touch-up surgery by reinjection of a small amount of diced cartilage. In 36 patients (1.13 percent), there was overcorrection that, 1 year later, was treated by simple rasping. Conclusions: Compared with diced cartilage wrapped with Surgicel or fascia, the amount of injected cartilage graft is predictable because it consists purely of cartilage. The injected diced cartilage, because it is compressed and becomes a conglutinated mass, resembles a wood chip and simulates carved cartilage. It is superior to carved cartilage in that it is moldable, time saving, and gives a good result with no late show or warping. The injection takes only a few minutes.Managing Alar Flare in Rhinoplasty
Summary: Alar flare is a common feature that contributes to the width of the lower third of the nose. In the right patient, alar flare reduction can improve nasal harmony and facial aesthetic balance; however, it is also difficult to correct if conducted inappropriately or overzealously. The unique anatomy and diverse morphologies of the alar lobule, and the dynamic relationship between flare and changes in tip projection, must be considered. The authors provide guidelines for flare reduction: when it is appropriate and how to tailor the excision pattern to safely and effectively refine nasal width. Alar flare is classified into three types according to alar rim shape on basal view analysis. By designing the excision pattern based on specific flare type, the lower third of the nose is narrowed without creating an operated appearance. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
The Evolution of Chemical Peeling and Modern-Day Applications
Summary: Despite the growth of technically more sophisticated skin resurfacing modalities, such as those based on light, radiofrequency, and ultrasound, chemical peel procedures have risen 5 to 25 percent over the past year alone. Chemexfoliation carries historical significance and has markedly evolved since its inception in ancient times. As a result of plastic surgery and dermatologic advancements, modern-day chemexfoliation offers plastic surgeons additional safe and effective options for patients with rhytides, dyschromias, and other signs of light- and environment-induced skin damage. This review discusses the historical evolution of chemexfoliation procedures, highlights modern-day practice habits, and touches on the clinically relevant applications of chemical peels.
Denosumab-induced cutaneous hypersensitivity reaction with distinct clinical and histopathologic findings
Targeted biologic agents are increasingly approved for the treatment of a wide range of medical conditions. Cutaneous drug reactions are seen to varying degrees with these agents, and postmarketing surveillance is critical to identifying adverse and uncommon events. Denosumab is a monoclonal antibody to receptor activator of nuclear factor kappa-B ligand (RANKL) that results in decreased osteoclast activation.
The association of HLA B*15:02 allele and Stevens–Johnson syndrome/toxic epidermal necrolysis induced by aromatic anticonvulsant drugs in a South Indian population
Abstract
Background
The presence of HLA-B*15:02 allele is considered a risk factor for development of Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) in patients taking aromatic anticonvulsant drugs like carbamazepine and phenytoin. The genetic association is ethnicity specific. Testing for HLA-B*15:02 allele is suggested as a prerequisite before starting carbamazepine in certain ethnic groups. There are only a few/no studies from south India on HLA association of SJS/TEN.
Aims
To identify any association between HLA-B*15:02 allele and SJS/TEN induced by carbamazepine/phenytoin among native population.
Methods (including settings, design, and statistical analysis used)
A case–control study done in a tertiary care center at Kottayam in Kerala state of south India. Cases were 12 native patients who developed SJS/TEN owing to aromatic anticonvulsant drugs (phenytoin – 8; carbamazepine – 4), and controls were 11 persons tolerant to these drugs from unrelated families of the same ethnic group. HLA-B typing was done by PCR SSP method.
Results
There was only one HLA-B*15:02 carrier among cases and controls. He/she had SJS/TEN induced by carbamazepine.
Conclusions
Association of HLA-B*15:02 with phenytoin-induced SJS/TEN is rare in the population studied. The one limitation of the study was the small sample size.
Lichen planus pigmentosus and its variants: review and update
Abstract
Lichen planus pigmentosus (LPP) is considered a rare variant of lichen planus (LP). It is characterized by acquired dark brown to gray macular pigmentation located on sun-exposed areas of the face, neck, and flexures, commonly found in dark-skinned patients. In patients with LPP, an inflammatory lichenoid response results in marked pigmentary incontinence. It has been associated with hepatitis C virus, sun exposure, and contactants such as mustard oil and nickel. LPP-inversus affects fair and dark skin, predominantly involving flexural and intertriginous areas, while sun-exposed areas are spared; friction is an associated trigger. LPP along Blaschko's lines has been associated with susceptibility to genetic mosaicisms. LPP can present concomitantly with other variants of LP such as frontal fibrosing alopecia, as well as endocrinopathies, and autoimmune diseases. Treatment is difficult and consists of avoidance of triggers and topical and systemic medications in order to stop the inflammatory reaction and reduce pigmentation, improving aesthetic appearance and quality of life.
Dermoscopy in vitiligo: diagnosis and beyond
Abstract
Background
Vitiligo is essentially a clinical diagnosis, and dermoscopy may aid in noninvasive confirmation of diagnosis by excluding other clinically simulating hypopigmentary conditions. More importantly, dermoscopy is rapidly gaining ground as an important adjunct tool to evaluate disease activity.
Aim
To study the dermoscopic features of vitiligo and ascertain their correlation with disease activity.
Methods
Retrospective analysis of dermoscopy of 60 cases suffering from vitiligo was undertaken. Dermoscopy was performed using Dermlite II hybrid m dermatoscope at 10× magnification in polarized mode, and photographs were captured by Apple iphone 6. Variables assessed in the dermoscopic evaluation included perifollicular changes, perilesional changes, altered pigmentary network, and presence of specific features such as the starburst appearance, comet tail appearance, leukotrichia, telangiectasia, and any new findings.
Results
Sixty patients with stable, progressive, or repigmenting vitiligo were retrospectively studied. While perifollicular depigmentation (PFD) was predictive of stable vitiligo, perifollicular pigmentation (PFP) was characteristic of active disease. Starburst appearance, altered pigment network, and comet tail appearance, were also noted, and these were typical of progressive vitiligo. A new dermoscopic feature, the 'tapioca sago' appearance (sabudana), was observed in the skin adjacent to the vitiligo lesion only in patients with progressive vitiligo.
Conclusion
Dermoscopy is useful in assessing the stage of evolution and the status of disease activity in vitiligo. The most useful dermoscopic clues are observed in the perifollicular region, since progressive lesions display perifollicular pigmentation and stable/remitting lesions display perifolliclar depigmentation.
The effect of plasma rich in growth factors combined with follicular unit extraction surgery for the treatment of hair loss: A pilot study
Summary
Background
Hair transplant surgery using follicular unit extraction technique (FUE) is a common surgical procedure for the treatment of severe hair loss. Blood-derived autologous growth factors have also proved to promote hair regeneration in patients with different types of alopecia.
Aims
The aim of this study was to evaluate the safety and clinical efficacy of plasma rich in growth factors (PRGF) technology as an adjuvant therapy for FUE surgery in hair loss affected patients.
Methods
The biologic potential of PRGF was firstly in vitro evaluated over follicular germinal matrix and dermal papilla cells. Afterward, fifteen patients were subjected to routine FUE procedure while 15 patients underwent FUE+PRGF therapy. PRGF group included intradermal injections of growth factors and follicular transfer unit (FTU) preservation in an autologous fibrin clot. Postsurgical patient satisfaction and clinical improvement were evaluated, and PRGF or saline-preserved hair grafts were histomorphometrically analyzed.
Results
Follicular cell proliferation and migration was induced after autologous growth factors treatment. PRGF-preserved FTUs presented higher bioactivity signals and improved integrity of perifollicular structures and extracellular matrix proteins such as collagen and elastic fibers. PRGF not only reduced the postsurgical crust healing and hair fixation period, but also decreased the inflammatory pain and itching sensation.
Conclusions
This preliminary data demonstrate that PRGF is able to minimize the postsurgical follicle loss and potentiate the performance of grafted hairs. The fibrin clot not only acts as a protective barrier against environmental factors, but also provides a biologically active scaffold that induces resident cell proliferation and maintains an optimal integrity of the grafted hair.
Prevention of non-melanoma skin cancers with nicotinamide in transplant recipients: a case-control study
Abstract
Background
Nicotinamide is the precursor of nicotinamide adenine dinucleotide (NAD+), an essential cofactor for adenosine triphosphate (ATP) production. It has recently been reported to be effective in reducing the rates of new non-melanoma skin cancers (NMSCs) and actinic keratosis (AKs).
Objectives
We studied the efficacy of oral nicotinamide as treatment for AKs in transplant recipients.
Materials & methods
We recruited 38 transplant (eight liver and 30 kidney) patients with single or multiple AKs. Nineteen patients were randomly assigned to Group 1 and took nicotinamide 500 mg/daily (cases); the other 19 patients were randomly assigned to Group 2 without nicotinamide (controls). At base-line, AKs were identified, measured, and photographed for follow-up. Five patients underwent an AK biopsy for histopathology. Statistical analyses were performed using the Student t test.
Results
At baseline, no statistically significant differences were observed regarding AK size between the two groups. After six months, among the cases, AKs had significantly decreased in size in 18/19 patients (88%). Among these 18 patients, seven patients (42%) had shown complete clinical regression and no patient developed new AKs. Conversely, among the controls, 91% showed an increase in AK size and/or developed new AKs. Seven pre-existing AKs progressed to squamous-cell carcinoma.
Conclusion
Nicotinamide appears to be effective in preventing and treating AKs, although the mechanisms are still unclear. Further studies with a larger sample of organ transplant recipients and a longer follow-up period are needed to further support our conclusions.
Treatment patterns and outcomes for patients with locally advanced basal cell carcinoma before availability of Hedgehog pathway inhibitors: a retrospective chart review
Abstract
Background
Understanding the molecular basis of basal cell carcinoma (BCC) has led to development of Hedgehog pathway inhibitors (HPIs) for patients with advanced forms of BCC (aBCC). A practical definition of aBCC as a distinct disease entity is unavailable, and epidemiological information is limited.
Objectives
To conduct the RONNIE study to describe characteristics, treatment patterns, and outcomes of patients with aBCC during the period preceding HPI introduction, as well as results from patients with locally advanced BCC (laBCC).
Materials & methods
A retrospective chart review was conducted using data from adult patients with a new diagnosis of laBCC between 1st January 2005 and 31st December 2010. The study period was 1st January 2005 to 31st December 2011 to allow for inclusion of at least 12 months of follow-up information for all patients.
Results
Treatment data were available for 106/117 patients. Radiation and excisional surgery were the most common first-line treatment options (43.4% and 23.5% of patients, respectively). Patients typically received multiple subsequent treatments; no apparent trend or pattern was observed. Complete visual response, partial visual response, and stable disease were obtained in 51.9%, 25.9%, and 11.1% of patients, respectively, after first-line surgery, and in 53.7%, 22.0%, and 9.8%, respectively, after first-line radiation. Median progression-free survival after first-line treatment was 32.1 months. Median overall survival was 78.8 months.
Conclusions
These data represent a baseline for laBCC before HPIs became part of the treatment algorithm. The observed heterogeneity of treatment patterns highlights the lack of an established standard treatment for laBCC before HPIs were available.
Comorbid autoimmune diseases in patients with pemphigus: a nationwide case-control study in Taiwan
Abstract
Background
Previous studies have proposed the association between pemphigus and several autoimmune diseases, but no large-scale study has been reported.
Objectives
To delineate the association between pemphigus and autoimmune diseases including psoriasis.
Materials & Methods
A total of 1,998 patients with pemphigus and 7,992 control subjects were enrolled from the National Health Insurance Research Database in Taiwan from 1997 to 2010. The odds of comorbidities between these two groups were analysed by multivariate logistic regression.
Results
Compared with control subjects, patients with pemphigus were much more likely to have Sjögren's syndrome (odds ratio [OR]: 15.0; 95% confidence interval [CI]: 3.16-71.5), psoriasis (OR: 7.18; 95% CI: 5.55-9.29), systemic lupus erythematosus (OR: 4.46; 95% CI: 1.88-10.6), and alopecia areata (OR: 2.68; 95% CI: 1.26-5.67). According to gender-stratified analyses, however, the association between pemphigus and Sjögren's syndrome or alopecia areata was found to be significant only in the female patients.
Conclusion
We confirm the association between pemphigus and some autoimmune diseases, including Sjögren's syndrome, systemic lupus erythematosus, and alopecia areata. In addition, we present the novel finding that patients with pemphigus have an increased risk of psoriasis.
Cutaneous Kaposi sarcoma during treatment with superpotent topical steroids and methotrexate for bullous pemphigoid: three cases
Abstract
Background
Iatrogenic Kaposi sarcoma (KS) has previously been reported in patients with bullous pemphigoid (BP), in relation to systemic steroids.
Objectives
To report three cases of previously unreported cutaneous KS during treatment with superpotent topical steroids (STS) and methotrexate (MTX).
Patients and Methods
All patients were elderly men with BP treated with STS for 2 to 32 months (cumulative doses: 2,700-9,150 g) beforeMTXwas introduced (dosage: 10-12.5 mg/week).
Results
KS occurred one to nine months after the combined therapy. In one case, KS rapidly resolved after withdrawal of MTX. In two cases, vinblastine and/or radiotherapy were required to achieve regression of KS. Human herpes virus 8 (HHV8) latency-associated nuclear antigen was not expressed in BP lesions biopsied prior to development of KS (n = 3), but HHV8 DNA was detected in BP lesions from the patient with the most aggressive KS.
Conclusion
Several predisposing factors were identified, including sex and age, high cumulative doses of STS, combination with MTX, and impaired immune status. In such cases, serum antibodies against HHV8 infection may be investigated in BP patients before introduction of MTX in order to guide clinical monitoring.
Adipose Triglyceride Lipase Gene Polymorphisms is Not Associated with Free Fatty Acid Levels in Chinese Han Population
Metabolic Syndrome and Related Disorders Nov 2017, Vol. 15, No. 9: 474-479.
Experiencia de elastografía strain en 2 casos de lesiones subcutáneas sospechosas de malignidad
Publication date: Available online 26 October 2017
Source:Actas Dermo-Sifiliográficas
Author(s): A. Vilas-Sueiro, F. Alfageme-Roldán, P. Nájera, G. Roustán
Association between Carotid Plaque Features on CTA and Cerebrovascular Ischemia: A Systematic Review and Meta-Analysis [EXTRACRANIAL VASCULAR]
BACKGROUND:
CTA is a widely available imaging examination that may allow the evaluation of high-risk carotid plaque features.
PURPOSE:Our aim was to evaluate the association between specific carotid plaque features on CTA and ipsilateral cerebrovascular ischemia.
DATA SOURCES:We performed a systematic review of Ovid MEDLINE, Ovid Embase, Scopus, and the Cochrane Library from inception to March 2016 for articles that evaluated the relationship between CTA-detected carotid plaque features and ischemic events, defined as ipsilateral ischemic stroke or transient ischemic attack.
STUDY SELECTION:Sixteen studies were ultimately included after screening 12,557.
DATA ANALYSIS:Two readers recorded data from each study and assessed the study quality with all disagreements resolved by a third reader. A random-effects OR was used to evaluate the association between cerebrovascular ischemia and each of the evaluated plaque features.
DATA SYNTHESIS:We found significant positive relationships with cerebrovascular ischemia for the presence of soft plaque (OR, 2.9; 95% CI, 1.4–6.0), plaque ulceration (OR, 2.2; 95% CI, 1.4–3.4), and increased common carotid artery wall thickness (OR, 6.2; 95% CI, 2.5–15.6). We found a significant negative relationship between calcified plaque and ipsilateral ischemia (OR, 0.5; 95% CI, 0.4–0.7).
LIMITATIONS:We found heterogeneity in the existing literature secondary to lack of standardized plaque features and clinical definitions.
CONCLUSIONS:Soft plaque, plaque ulceration, and increased common carotid artery wall thickness on CTA are associated with ipsilateral cerebrovascular ischemia, while calcified plaque is negatively associated with downstream ischemic events.
Comparison between the Prebolus T1 Measurement and the Fixed T1 Value in Dynamic Contrast-Enhanced MR Imaging for the Differentiation of True Progression from Pseudoprogression in Glioblastoma Treated with Concurrent Radiation Therapy and Temozolomide Chemotherapy [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Glioblastoma is the most common primary brain malignancy and differentiation of true progression from pseudoprogression is clinically important. Our purpose was to compare the diagnostic performance of dynamic contrast-enhanced pharmacokinetic parameters using the fixed T1 and measured T1 on differentiating true from pseudoprogression of glioblastoma after chemoradiation with temozolomide.
MATERIALS AND METHODS:This retrospective study included 37 patients with histopathologically confirmed glioblastoma with new enhancing lesions after temozolomide chemoradiation defined as true progression (n = 15) or pseudoprogression (n = 22). Dynamic contrast-enhanced pharmacokinetic parameters, including the volume transfer constant, the rate transfer constant, the blood plasma volume per unit volume, and the extravascular extracellular space per unit volume, were calculated by using both the fixed T1 of 1000 ms and measured T1 by using the multiple flip-angle method. Intra- and interobserver reproducibility was assessed by using the intraclass correlation coefficient. Dynamic contrast-enhanced pharmacokinetic parameters were compared between the 2 groups by using univariate and multivariate analysis. The diagnostic performance was evaluated by receiver operating characteristic analysis and leave-one-out cross validation.
RESULTS:The intraclass correlation coefficients of all the parameters from both T1 values were fair to excellent (0.689–0.999). The volume transfer constant and rate transfer constant from the fixed T1 were significantly higher in patients with true progression (P = .048 and .010, respectively). Multivariate analysis revealed that the rate transfer constant from the fixed T1 was the only independent variable (OR, 1.77 x 105) and showed substantial diagnostic power on receiver operating characteristic analysis (area under the curve, 0.752; P = .002). The sensitivity and specificity on leave-one-out cross validation were 73.3% (11/15) and 59.1% (13/20), respectively.
CONCLUSIONS:The dynamic contrast-enhanced parameter of rate transfer constant from the fixed T1 acted as a preferable marker to differentiate true progression from pseudoprogression.
Patterns of Sonographically Detectable Echogenic Foci in Pediatric Thyroid Carcinoma with Corresponding Histopathology: An Observational Study [HEAD & NECK]
BACKGROUND AND PURPOSE:
Small echogenic foci within pediatric thyroid nodules are commonly seen by ultrasound and are one of the features used to determine the level of suspicion for malignancy. These are sometimes termed "microcalcifications," but their relation with malignancy is controversial due to the lack of standard terminology. Our aim was to evaluate sonographic patterns of echogenic foci in malignant pediatric thyroid nodules and describe the distribution of corresponding psammoma bodies and other histopathologic findings in thyroidectomy specimens.
MATERIALS AND METHODS:Ultrasounds of 15 pathologically proved malignant thyroid nodules in children were retrospectively reviewed by 2 radiologists who separately classified echogenic foci into the 4 morphologic patterns described in the American College of Radiology Thyroid Imaging, Reporting and Data System and noted their presence and distribution. Interobserver agreement was assessed, and consensus was reached for nodules for which there was disagreement. Surgical pathology findings from thyroidectomy specimens were retrospectively reviewed for the presence and distribution of psammomatous and dystrophic/stromal calcifications and eosinophilic/sticky colloid. Ultrasound and histopathologic ratings were compared, and frequencies and percentages corresponding to observed agreement levels were calculated.
RESULTS:Interobserver agreement between radiologists' sonographic assessments for the presence and distribution of echogenic foci ranged from 53% to 100% for all categories. Punctate echogenic foci were present in all nodules, and macrocalcifications, in 27%. Histopathology of the 15 nodules revealed that only 4 (27%) had psammomatous calcifications, while 9 (60%) had stromal calcifications and 8 (53%) had sticky colloid.
CONCLUSIONS:Sonographically detectable echogenic foci in malignant pediatric thyroid nodules can be reliably classified on the basis of American College of Radiology Thyroid Imaging, Reporting and Data System, with punctate echogenic foci composing the most common subtype. These echogenic foci do not represent psammomatous calcifications most of the time; instead, more than half of the malignant thyroid nodules with echogenic foci contained stromal calcifications or sticky colloid.
Do Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Represent Good Collaterals before Reperfusion Therapy? [ADULT BRAIN]
BACKGROUND AND PURPOSE:
In acute ischemic stroke, whether FLAIR vascular hyperintensities represent good or poor collaterals remains controversial. We hypothesized that extensive FLAIR vascular hyperintensities correspond to good collaterals, as indirectly assessed by the hypoperfusion intensity ratio.
MATERIALS AND METHODS:We included 244 consecutive patients eligible for reperfusion therapy with MCA stroke and pretreatment MR imaging with both FLAIR and PWI. The FLAIR vascular hyperintensity score was based on ASPECTS, ranging from 0 (no FLAIR vascular hyperintensity) to 7 (FLAIR vascular hyperintensities abutting all ASPECTS cortical areas). The hypoperfusion intensity ratio was defined as the ratio of the time-to-maximum >10-second over time-to-maximum >6-second lesion volumes. The median hypoperfusion intensity ratio was used to dichotomize good (low hypoperfusion intensity ratio) versus poor (high hypoperfusion intensity ratio) collaterals. We then studied the association between FLAIR vascular hyperintensity extent and hypoperfusion intensity ratio.
RESULTS:Hypoperfusion was present in all patients, with a median hypoperfusion intensity ratio of 0.35 (interquartile range, 0.19–0.48). The median FLAIR vascular hyperintensity score was 4 (interquartile range, 3–5). The FLAIR vascular hyperintensities were more extensive in patients with good collaterals (hypoperfusion intensity ratio ≤0.35) than with poor collaterals (hypoperfusion intensity ratio >0.35; P for Trend = .016). The FLAIR vascular hyperintensity score was independently associated with good collaterals (P for Trend = .002).
CONCLUSIONS:In patients eligible for reperfusion therapy, FLAIR vascular hyperintensity extent was associated with good collaterals, as assessed by the pretreatment hypoperfusion intensity ratio. The ASPECTS assessment of FLAIR vascular hyperintensities could be used to rapidly identify patients more likely to benefit from reperfusion therapy.
MR Elastography Analysis of Glioma Stiffness and IDH1-Mutation Status [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Our aim was to noninvasively evaluate gliomas with MR elastography to characterize the relationship of tumor stiffness with tumor grade and mutations in the isocitrate dehydrogenase 1 (IDH1) gene.
MATERIALS AND METHODS:Tumor stiffness properties were prospectively quantified in 18 patients (mean age, 42 years; 6 women) with histologically proved gliomas using MR elastography from 2014 to 2016. Images were acquired on a 3T MR imaging unit with a vibration frequency of 60 Hz. Tumor stiffness was compared with unaffected contralateral white matter, across tumor grade, and by IDH1-mutation status. The performance of the use of tumor stiffness to predict tumor grade and IDH1 mutation was evaluated with the Wilcoxon rank sum, 1-way ANOVA, and Tukey-Kramer tests.
RESULTS:Gliomas were softer than healthy brain parenchyma, 2.2 kPa compared with 3.3 kPa (P < .001), with grade IV tumors softer than grade II. Tumors with an IDH1 mutation were significantly stiffer than those with wild type IDH1, 2.5 kPa versus 1.6 kPa, respectively (P = .007).
CONCLUSIONS:MR elastography demonstrated that not only were gliomas softer than normal brain but the degree of softening was directly correlated with tumor grade and IDH1-mutation status. Noninvasive determination of tumor grade and IDH1 mutation may result in improved stratification of patients for different treatment options and the evaluation of novel therapeutics. This work reports on the emerging field of "mechanogenomics": the identification of genetic features such as IDH1 mutation using intrinsic biomechanical information.
Improved Spatiotemporal Resolution of Dynamic Susceptibility Contrast Perfusion MRI in Brain Tumors Using Simultaneous Multi-Slice Echo-Planar Imaging [ADULT BRAIN]
SUMMARY:
DSC perfusion MR imaging in brain tumors requires a trade-off between spatial and temporal resolution, resulting in less spatial coverage to meet the temporal resolution requirements for accurate relative CBV estimation. DSC-MR imaging could potentially benefit from the advantages associated with simultaneous multi-slice imaging, including increased spatiotemporal resolution. In the current article, we demonstrate how simultaneous multi-slice EPI can be used to improve DSC-MR imaging spatiotemporal resolution in patients with glioblastoma.
Clinicopathologic features of 28 cases of nail matrix nevi (NMNs) in Asians: Comparison between children and adults
Clinical distinction between nail matrix nevus (NMN) and subungual melanoma (SUM) can be challenging. More precise delineation of the clinicodermoscopic characteristics specific for NMNs is needed.
Prevalence and clinicopathologic characteristics of multiple myeloma with cutaneous involvement: A case series from Korea
Multiple myeloma (MM) is a plasma cell dyscrasia characterized by the presence of a clonal proliferation of tumor cells. Cutaneous involvement of MM is very rare and remains poorly understood.
Comorbidities in rosacea: A systematic review and update
Rosacea is linked to abnormalities of cutaneous vasculature and dysregulation of the inflammatory response. Recent reports on rosacea have shown a significant association with cardiovascular, gastrointestinal, and psychiatric diseases, all of which may affect morbidity and mortality among these patients.
Sweet syndrome in patients with and without malignancy: A retrospective analysis of 83 patients from a tertiary academic referral center
Sweet syndrome is a neutrophilic dermatosis that may be categorized into classic, malignancy-associated, and drug-induced subtypes. Few studies have systematically analyzed this rare disorder.
Langerhans cell histiocytosis: A neoplastic disorder driven by Ras-ERK pathway mutations
Langerhans cell histiocytosis (LCH) is a disorder of myeloid neoplasia of dendritic cells that affects 1 in 200,000 children <15 years of age and even fewer adults. LCH presents with a spectrum of clinical manifestations. High-risk stratification is reserved for infiltration of blood, spleen, liver, and lungs. After decades of debate on the disease pathogenesis, a neoplastic mechanism is now favored on the basis of LCH cell clonality, rare cases of familial clustering, and recent evidence of mutations involving the Ras/Raf/MEK (mitogen-activated protein kinase kinase)/ERK (extracellular signal-regulated kinase) pathway in lesional biopsy specimens.
Reply to: “A novel three dimensional imaging method for the measurement of area in vitiligo and chemical leukoderma”
We read with great interest the recent letter by Hayashi et al. describing three dimensional (3D) imaging in vitiligo and chemical leukoderma [1]. We acknowledge their conclusion that the VECTRA® H1 device offers an efficient and accurate method to objectively assess vitiligo and chemical leukoderma, however feel that an inadequate review of the literature was performed. We acknowledge that there is a paucity of evidence to substantiate the use of 3D imaging in diseases of skin hypopigmentation, and we would like to highlight the letter in Experimental Dermatology that investigated 3D imaging of vitiligo using the Canfield Vectra Whole Body 360 (WB360) [2].
Secreted immunoregulatory proteins in the skin
The skin, thought initially to protect the body passively from pathogenic organisms and other environmental insults, is now recognised additionally as a sophisticated immune organ that actively regulates local immunity. Studies linking local innate and adaptive immunity to skin health and disease have revealed a complex network of cell communication and cytokine signalling. Here, we review the last 10 years of literature on this topic, and its relevance to skin immunity.
Three-dimensional poly lactic-co-glycolic acid scaffold containing autologous platelet-rich plasma supports keloid fibroblast growth and contributes to keloid formation in a nude mouse model
Keloid formation is an excessive response to dermal injury. The pathology develops when collagen fibers repair the wound surface with an overgrowth of fibrous connective tissues[1]. The response manifests as lumpish scars that are higher than the surrounding normal skin, and that continuously grow beyond the boundaries of the original wound[1–3]. These lesions are usually accompanied by red skin pigmentation, itchiness, and pain, and skin movement is affected. Keloids may occur following any type of skin injury that can lead to scarring (acne, burns, chickenpox, ear piercing, scratches, surgical cuts, and vaccination sites, et al.) [1–3].
Mastopexy on Reconstructed Breast Following Massive Weight Loss: An Innovative Technique Using Dermo-Capsular Flaps
Abstract
Background
We have developed a dermo-capsular flap mastopexy technique for patients who have experienced massive weight loss after breast reconstruction. The aim of this technique is to lift the inframammary fold, adequately cover the implant, and remove excess skin, elevating the breast and obtaining symmetry with the contralateral breast.
Methods
Between January 2014 and February 2017, we performed this technique on 20 women who were candidates for second-stage breast reconstruction following nipple-sparing mastectomy. All patients had experienced substantial weight loss (> 15 kg) and presented with ptosis after first-stage reconstruction.
Results
There were 8 patients with bilateral reconstruction following bilateral mastectomy (4 with bilateral nipple-sparing mastectomy). There were 12 patients with unilateral mastectomy, all with contralateral breast ptosis treated by augmentation via inverted-T mastopexy (n = 7) or crescent mastopexy (n = 5). The average lift of the nipple-areola complex was 5 cm (range 2–8 cm). The average follow-up was 12 months (range 4–36 months). Two patients had complications, including partial wound dehiscence (in a heavy smoker) and recurrence of breast asymmetry.
Conclusions
Implant breast reconstruction after massive weight loss is still possible even in the setting of thin, ptotic, and anelastic breast tissue. Our inverted-T dermo-capsular flap mastopexy technique for reconstructed breast is safe and effective with good outcomes and high patient satisfaction.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
Comment to: “Complications and Outcomes After Gynecomastia Surgery: Analysis of 204 Pediatric and 1583 Adult Cases from a National Multi-center Database”
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
Augmentation Mastopexy with a Dermal Encapsulated Round or Anatomic Autoprosthesis
Abstract
Introduction
Several factors, such as aging, pregnancy, and weight loss, reduce the elasticity of the breast tissue, and ptosis occurs. Due to aging and gravity, it is not possible to completely prevent breast ptosis. The goal is to delay the recurrence of ptosis as much as possible.
Patients and Methods
This study included 20 female patients aged 25–55 years. The patients who underwent surgery had different levels of ptosis. Although the patients wanted their breasts to be lifted and an increase in projection, they did not want implants to be used. For this reason, autologous flaps were prepared from the patients, and these flaps were called autoprosthesis flaps. The flap donor area (FA) boundaries consisted of the inframammary fold at the bottom, the medial and lateral pillar legs at the two sides and the lower margin of the areola at the top. The skin on the FA was de-epithelialized. A hand dermatome was used to ensure that the extracted skin was not too thick because the rest of the dermal skin would form the cover of the planned autoprosthesis flap. Before surgery, the autoprosthesis flap baseline width, projection, and shape (round or anatomic) were planned for each patient. The autoprosthesis flap was prepared as a central pedicle, and the dermal layer, which was 1 cm wider than the flap, was then attached over the autoprosthesis flap to the pectoral muscle fascia with at least 10 sutures in the recipient area. For a round autoprosthesis flap, the flap base diameter was 10–12 cm on average, whereas for an anatomic autoprosthesis flap, the width of the flap was 10–12 cm and the height was 12–14 cm. Autoprosthesis flap projections varied from 4 to 6 cm.
Results
Because of the autoprosthesis flap, breast projection was more prominent, even in the lying position. All the patients were very satisfied with their size, shape, projection, and natural appearance. In particular, the image in the lying position was very similar to a mastopexy performed with an actual breast implant; thus, sagging was not observed.
Conclusion
In augmentation mastopexy patients who do not want implants, upper pole filling and adequate breast projection can be easily achieved with this method. The potential risks of capsule formation, implant rejection, and implant rupture were not observed with this technique.
Level of Evidence V
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
Recent Advances on the Application of Negative Pressure External Volume Expansion in Breast Plastic Surgery
Abstract
Background
External volume expansion (EVE) has been effectively applied as an assistance to fat transplantation on breast plastic surgery. Many indicators and refinements have been made in clinical practice; meanwhile, the related mechanism and more optimized preclinical model also have been explored in experimental studies.
Methods
A literature search was conducted using PubMed with the keywords: EVE, negative pressure, breast enlargement, breast augmentation, breast reconstruction, breast plastic surgery and breast aesthetic surgery. Studies dealing with the clinical and preclinical aspects of the subject and also in vitro experiments related to a certain period of negative pressure and adipose-derived cells were selected, and those only focused on negative pressure were excluded.
Results
The indications, contraindications, complications and treatments of EVE in clinical practice were summarized. The experimental studies were mainly classified into two groups (mechanical and translational) according to their contents. Mechanical studies were further divided into inference experimental validation phase studies. For the experimental validation phase, EVE was verified to promote angiogenesis, while it still remained controversial whether it would enhance adipogenesis and cell proliferation.
Conclusion
Clinically, our experience is on the stage of exploration, and there is a lack of standardized guidelines on its clinical application. Experimentally, the previous studies showed some subtly different views on the functional mechanisms. However, it is not enough to regulate the clinical practice yet. Therefore, related basic studies and long-term clinical follow-up are needed.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
Intergenerational Transmission of Birth Weight Across Three Generations
Abstract
While previous studies have shown intergenerational transmission of birth weight from mother to child, only one study has assessed whether this continuity persists across three generations. We used the Aberdeen Maternity and Neonatal Databank to examine the intergenerational correlations of birth weight, birth weight adjusted for gestational age and sex, and small- and large for gestational age births among 1,457 grandmother-mother-grandchild triads across three generations. All participants were born between 1950 and 2015. The intergenerational transmission was examined with linear regression analyses. Our findings showed that grandmaternal birth weight was associated with grandchild birth weight, independently of prenatal and sociodemographic covariates and maternal birth weight (B = 0.12 Standard deviation units, 95% Confidence Interval: 0.07, 0.18). Similar intergenerational continuity was found for birth weight adjusted for sex and gestational age, and for small for gestational age births. To conclude, birth weight and fetal growth show intergenerational continuity across three generations. The developmental origins of birth weight and hence later health and disease are already present in earlier generations.Sex Differences in Risk of Smoking- Associated Lung Cancer: Results From a Cohort of 600,000 Norwegians
Abstract
Whether women are more susceptible than men to smoking-related lung cancer has been a topic of controversy. To address this question we compared risk of lung cancer associated with smoking by sex. Altogether 585,583 participants from three Norwegian cohorts (Norwegian Counties Study, 40 Years Study and CONOR) were followed until December 31, 2013 through linkage of data to national registries. We used Cox proportional hazards models and 95% confidence intervals (CIs). During nearly 12 million person-years of follow-up, 6,534 participants (43% women) were diagnosed with lung cancer. More men than women were heavier smokers. Compared with never smokers men and women current smokers who smoked ≥16 pack-years had a hazard ratio for lung cancer of 27.24 (95% CI: 22.42, 33.09) and 23.90 (95% CI: 20.57, 27.76) respectively, (Pheterogeneity = 0.30). In contrast, for current smokers, in the model of pack-years measured continuously, men had a hazard ratio of 1.43 (95% CI: 1.39, 1.48) and women a hazard ratio of 1.64 (95% CI: 1.57, 1.71) for each 10 pack-years increment, (Pheterogeneity < 0.01). Our results suggest that women have an increased susceptibility to lung cancer compared to men, given the same lifetime smoking exposure.Relationship of lipids and lipid-lowering medications with cognitive function: The Multi-Ethnic Study of Atherosclerosis
Abstract
Studies on the relationship of cholesterol concentrations and lipid-lowering medications with dementia risk have yielded inconsistent findings. Therefore, we investigated the relationship of lipid concentrations and lipid-lowering medications with cognitive function in the Multi-Ethnic Study of Atherosclerosis across three different cognitive domains assessed by the Cognitive Abilities Screening Instrument (version 2), Digit Symbol Coding and Digit Span (DS) tests in 2010–2012. After adjusting for sociodemographic and confounding factors including other lipid concentrations and lipid-lowering medication, higher total cholesterol, low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol concentrations were modestly associated with higher DS test scores. None of the lipid parameters were associated with Cognitive Abilities Screening Instrument and Digit Symbol Coding test scores. Similarly, changes in lipid concentrations were not associated with any cognitive function test score. Using treatment effects model analysis, and after adjusting for confounding factors including lipid concentrations, the use of any lipid-lowering medication, especially statins, was associated with higher score on the Cognitive Abilities Screening Instrument and backward DS tests, but not Digit Symbol Coding and forward DS test scores. Our study does not support a robust association between lipid concentrations and cognitive function or the use of lipid-lowering medication, especially statins, with worse cognitive function.Systematic Assessment of Multiple Routine and Near-Real Time Indicators to Classify the Severity of Influenza Seasons and Pandemics in the United States, 2003–04 Through 2015–2016
Abstract
Assessments of influenza season severity can guide public health action. We used the Moving Epidemic Method to develop intensity thresholds (IT) for 3 US surveillance indicators from the 2003–04—2014–15 influenza season (excluding the 2009 pandemic): 1) outpatient visits for influenza-like illness, 2) influenza-related hospitalizations, and 3) influenza- and pneumonia-related deaths. ITs were developed for the overall population and children, adults, and older adults separately and were the upper limit of the 50% (IT50), 90% (IT90), and 98% (IT98) one-sided CIs of the geometric mean of each season's 3 highest values. Severity was classified as low if ≥2 systems peaked below IT50, moderate if ≥2 peaked between IT50 and IT90, high if ≥2 peaked between IT90 and IT98, and very high if ≥2 peaked above IT98. We piloted this method with the 2015–16 season and the 2009 pandemic. Overall, 4 seasons were classified as low severity, 7 as moderate, 2 as high, and none as very high. While older adults had the most seasons (n = 3) classified as high, children were the only group to have seasons (n = 2) classified as very high. We will apply this method to classify the severity of future seasons and inform pandemic response.Mood Disorders and Risk of Herpes Zoster in Two Population-Based Case-Control Studies in Denmark and the United Kingdom
Abstract
We examined the association between mood disorders and risk of herpes zoster in two case-control studies using data from nationwide Danish registries and practices in the UK Clinical Practice Research Datalink. We included incident zoster cases diagnosed in general practice (using systemic antivirals as proxy in Denmark) or hospital during 1997–2013 in Denmark (n = 190,671) and during 2000–2013 in the UK (n = 177,361). We risk-set sampled four matched population controls per case. Conditional logistic regression analyses adjusted for zoster risk factors showed that the odds ratios (ORs) for previous mood disorder among cases vs. controls were 1.15 (99% confidence interval (CI): 1.12, 1.19; prevalence 7.1% vs. 6.0%) in Denmark and 1.12 (99% CI: 1.11, 1.14; prevalence 31.6% vs. 29.2%) in the UK. In Denmark, ORs were higher for anxiety (1.23; 99% CI: 1.17, 1.30) and severe stress and adjustment disorder (1.24; 99% CI: 1.18, 1.30) than for depression (1.11; 99% CI: 1.07, 1.14). In the UK, ORs for these conditions were similar: 1.12 (99% CI: 1.10, 1.13), 1.12 (99% CI: 1.10, 1.14), and 1.14 (99% CI: 1.10, 1.19) for depression, anxiety, and severe stress and adjustment disorder, respectively. In conclusion, mood disorders were associated with an increased risk of zoster.Investigating the Impact of Maternal Residential Mobility on Identifying Critical Windows of Susceptibility to Ambient Air Pollution During Pregnancy
Abstract
Identifying periods of increased vulnerability during pregnancy to air pollution with respect to the development of adverse birth outcomes can improve understanding of possible mechanisms of disease development and provide guidelines for protection of the child. Exposure to air pollution during pregnancy is typically based on the residence at delivery, potentially resulting in exposure misclassification and biasing the estimation of critical windows. In this work, we determine the impact of maternal residential mobility during pregnancy on defining weekly exposure to PM10 and the estimation of windows of susceptibility for term low birth weight utilizing birth cohort datasets from Connecticut (1988–2008) that include information on all residential addresses for each woman between conception and delivery. A simulation study is designed to investigate the impact of increasing levels of mobility on critical window identification. Increased PM10 exposure during pregnancy weeks 16–18 is associated with an increased probability of term low birth weight. Ignoring residential mobility when defining weekly exposure has only minor impact on the identification of critical windows for PM10 and term low birth weight in the data application and simulation study. Critical window identification is robust to exposure misclassification caused by ignoring residential mobility in these Connecticut birth cohorts.Fish intake, genetic predisposition to alzheimer's disease and decline in global cognition and memory in five cohorts of older persons
Abstract
Fish are a primary source of long-chain omega-3 fatty acids, which may help delay cognitive aging. We pooled participants from the French Three-City study and four US cohorts (Nurses' Health Study, Women's Health Study, Chicago Health and Aging Project and Rush Memory and Aging Project) with diet and cognitive data (n = 23,688 Caucasians aged ≥65 years, 88% female, baseline year range, 1992–1999, median follow-up range, 3.9–9.1 years) to investigate the relation of fish intake to cognitive decline and examine interactions with Alzheimer's disease-related genes. We estimated cohort-specific associations between fish and change in composite scores of global cognition and episodic memory using linear mixed models, and pooled results using inverse-variance weighted meta-analysis. In multivariate analyses, higher fish intake was associated with slower decline in both global cognition and memory (P-trend ≤ 0.031). Consuming ≥4 versus <1 fish serving/week was associated with 0.018 (95% CI: 0.004, 0.032) standard units lower rate of memory decline; an effect estimate equivalent to that found for 4 years of age. For global cognition, no comparisons of higher versus low fish intake reached statistical significance. In this meta-analysis, increasing fish intake was associated with decreasing memory decline. We found no evidence of effect modification by Alzheimer's disease genes.Characterizing and Comparing the Seasonality of Influenza-Like Illnesses and Invasive Pneumococcal Diseases Using Seasonal Waveforms
Abstract
The seasonalities of influenza-like illnesses (ILIs) and invasive pneumococcal diseases (IPDs) remain incompletely understood. Experimental evidence indicates that influenza-virus infection predisposes to pneumococcal disease, so that a correspondence in the seasonal patterns of ILIs and IPDs might exist at the population level. We developed a method to characterize seasonality by means of easily interpretable summary statistics of seasonal shape—or seasonal waveforms. Non-linear mixed-effects models were used to estimate those waveforms based on weekly case reports of ILIs and IPDs in five regions spanning continental France from July 2000 to June 2014. We found high variability of ILI seasonality, with marked fluctuations of peak amplitudes and peak times, but a more conserved epidemic duration. In contrast, IPD seasonality was best modeled by a markedly regular seasonal baseline, punctuated by two winter peaks in late December–early January and January–February. Comparing ILI and IPD seasonal waveforms, we found indication of a small, positive correlation. Direct models regressing IPDs on ILIs provided comparable results, even though they estimated moderately larger associations. The method proposed is broadly applicable to diseases with unambiguous seasonality and is well-suited to analyze spatially or temporally grouped data, which are common in epidemiology.Exercise for the Prevention of Low Back Pain: Systematic Review and Meta-Analysis of Controlled Trials
Abstract
The aim of this systematic review and meta-analysis was to assess the effect of exercise in population-based interventions to prevent low back pain (LBP) and associated disability. Comprehensive literature searches were conducted in multiple databases including PubMed, Embase, and Cochrane Library from their inception through June 2017. Thirteen randomized controlled trials and three non-randomized controlled trials qualified for meta-analyses. Exercise alone reduced the risk of LBP by 33% (risk ratio = 0.67, 95% CI: 0.53, 0.85, I2 = 23%, 8 randomized controlled trials, n = 1,634) and exercise combined with education by 27% (risk ratio = 0.73, 95% CI: 0.59, 0.91, I2 = 6%, 6 trials, n = 1,381). The severity of LBP and disability from LBP were also lower in exercise than control groups. Moreover, results were not changed by excluding the non-randomized controlled trials, or by adjustment for publication bias. Few trials assessed healthcare consultation or sick leave for LBP, and meta-analyses did not show statistically significant protective effects of exercise on those outcomes. Exercise reduces the risk of LBP and associated disability, and a combination of strengthening with either stretching or aerobic exercises performed 2–3 times/week can reasonably be recommended for prevention of LBP in the general population.Early Outcomes After Surgical Repair of Orbital Floor Fractures
This database analysis uses the American College of Surgeons National Surgical Quality Improvement Program Participant User File to characterize the epidemiologic, surgical, and hospitalization patterns and postoperative complications in patients undergoing repair of orbital floor fracture.
In Memoriam: Jack P. Gunter, MD
Renowned rhinoplasty surgeon, Jack P. Gunter, MD, recently died on July 11, 2017, at the age of 79. Jack was born in Fort Smith, Arkansas, where he spent a good deal of his early life. He attended Westminster College in Fulton, Missouri, where he was recognized as a scholar and an athlete. Jack went to medical school at the University of Oklahoma. He then proceeded to complete a residency in otolaryngology at Tulane University in New Orleans, Louisiana. In 1969, Jack took a faculty position in the department of otolaryngology at University of Texas Southwestern Medical School in Dallas. He ultimately became the chairman of the division of otolaryngology at UT Southwestern Medical School, where he had a good relationship with the plastic surgery department. Then, in 1979, Jack decided to complete a residency in plastic surgery at the University of Michigan. He became one of the early surgeons to become double boarded in otolaryngology and plastic surgery. He returned to Dallas in 1980 and practiced primarily plastic surgery. Jack realized that his passion was performing rhinoplasty. This started his journey to become one of the world's best rhinoplasty surgeons that ever lived.
In Memoriam: Gary Burget, MD (1941-2017)
Facial plastic surgery recently lost a dear friend, teacher, and colleague on May 31, 2017, with the passing of Gary Burget, MD. Dr Burget was born in Toledo, Ohio, on April 20, 1941, the second child of Dean E. and Marie A. Burget. His parents were schoolteachers who had grown up on small working farms in southern Ohio near West Virginia near the Appalachian foothills. His parents obtained schoolteaching jobs in the Toledo, Ohio, public school system after graduating from Bowling Green State University at the height of the Great Depression. Dr Burget attended Thomas A. DeVilbiss High School and served as president of the student council his senior year. He attended Yale University and graduated with a BA in English and then followed his older brother, Dean, to Yale Medical School, which he completed in 1967. During his fourth year of medical school, he arranged a surgical clerkship in Edinburgh, Scotland, under the direction of Andrew Logan, MD, which increased his interest in surgery. Following medical school, he pursued an internship at Columbia University College of Physicians and Surgeons in New York City and spent much of his time at Harlem Hospital. He then went to Jackson Memorial Hospital at the University of Miami as a resident in general surgery, followed by a residency in plastic surgery under D. Ralph Millard, Jr, MD. He was influenced by his older brother, Dean, who preceded him into a career in plastic surgery. Following completion of his plastic surgery residency, he was invited to join Dr Millard as an associate partner in his private practice. While honored, Dr Burget decided to enter private practice with Walter Garst, MD. After several years, Dr Burget struck out on his own and opened a practice in Miami. Henry W. Menn, MD, an early Mohs surgeon, referred a large number of patients with difficult facial defects to Dr Burget. It was during these years that Dr Burget realized the importance of the aesthetic units of the face and the need to sometimes remove additional tissue to move scars into favorable positions.
Nostril Sill Repair by Muscle Tension Line Group Reconstruction
This Surgical Pearl describes the technique of nostril sill repair to restore the first auxiliary tension line group in patients with cleft lip.
Yeast phospholipase C is required for stability of casein kinase I Yck2p and expression of hexose transporters
Abstract
Phospholipase C (Plc1p) in Saccharomyces cerevisiae is required for normal degradation of repressor Mth1p and expression of the HXT genes encoding cell membrane transporters of glucose. Plc1p is also required for normal localization of glucose transporters to the cell membrane. Consequently, plc1Δ cells display histone hypoacetylation and transcriptional defects due to reduced uptake and metabolism of glucose to acetyl-CoA, a substrate for histone acetyltransferases. In the presence of glucose, Mth1p is phosphorylated by casein kinase I Yck1/2p, ubiquitinated by the SCFGrr1 complex, and degraded by the proteasome. Here we show that while Plc1p does not affect the function of the SCFGrr1 complex or the proteasome, it is required for normal protein level of Yck2p. Since stability of Yck1/2p is regulated by a glucose-dependent mechanism, PLC1 inactivation results in destabilization of Yck1/2p and defect in Mth1p degradation. Based on our results and published data, we propose a model in which plc1Δ mutation causes increased internalization of glucose transporters, decreased transport of glucose into the cells, and consequently decreased stability of Yck1/2p, increased stability of Mth1p and decreased expression of the HXT genes.Regulatory role of XynR (YagI) in catabolism of xylonate in Escherichia coli K-12
Abstract
The genome of Escherichia coli K-12 contains ten cryptic phages, altogether constituting about 3.6% of the genome in sequence. Among more than 200 predicted genes in these cryptic phages, 14 putative transcription factor (TF) genes exist, but their regulatory functions remain unidentified. As an initial attempt to make a breakthrough for understanding the regulatory roles of cryptic phage-encoded TFs, we tried to identify the regulatory function of CP4–6 cryptic prophage-encoded YagI with unknown function. After SELEX screening, YagI was found to bind mainly at a single site within the spacer of bidirectional transcription units, yagA (encoding another uncharacterized TF) and yagEF (encoding 2-keto-3-deoxy gluconate aldolase, and dehydratase, respectively) within this prophage region. YagEF enzymes are involved in the catabolism of xylose downstream from xylonate. We then designated YagI as XynR (regulator of xylonate catabolism), one of the rare single-target TFs. In agreement with this predicted regulatory function, the activity of XynR was suggested to be controlled by xylonate. Even though low-affinity binding sites of XynR were identified in the E. coli K-12 genome, they all were inside open reading frames, implying that the regulation network of XynR is still fixed within the CR4–6 prophage without significant influence over the host E. coli K-12.Körperdysmorphe Störung
Zusammenfassung
Menschen mit einer körperdysmorphen Störung (KDS) machen sich übermäßig Sorgen und beschäftigen sich exzessiv mit einer objektiv nichtexistenten – oder zumindest von anderen als unerheblicher Defekt angesehenen – Veränderung in ihrem Erscheinungsbild. Sie können vor ihren eigenen Augen nicht bestehen, fühlen sich hässlich, sind überzeugt, dass ihre Nase, ihr Körperbau, ihre Haut sie entstellen. Je mehr sie sich mit ihrem Aussehen beschäftigen, umso mehr richtet sich der Blick auf die scheinbaren Schönheitsmakel und verfestigt sich der Eindruck der eigenen Unattraktivität. Die Betroffenen empfinden sich nicht als krank; vielmehr sind sie überzeugt, dass es ein körperlicher Makel ist, der sie immer wieder vor den Spiegel zwingt. Solche Patienten suchen einen Hautarzt auf, manche auch einen plastischen Chirurgen, um ihrem Schönheitsideal näherzukommen – dieses bleibt aber für die Patienten aufgrund ihrer verzerrten Körperwahrnehmung unerreichbar.
Shear wave elastography evaluation in pediatric testicular microlithiasis: a comparative study
Abstract
Purpose
The aim of this study was to evaluate the testicular parenchyma in pediatric patients with testicular microlithiasis by shear wave elastography (SWE) and compare the values with normal control subjects.
Methods
Twenty-three patients previously diagnosed with testicular microlithiasis under follow-up for 20 ± 11 months were included in the study group. In the control group, 31 patients with no medical history that could affect testicular tissue were prospectively included. Forty-six testes in the study group and 62 testes in the control group were evaluated with gray-scale ultrasound and SWE.
Results
There were no differences in age and testes volume between the study and control groups. The mean SWE values of all testes based on elasticity and speed parameters in the study group were 8.84 ± 2.86 kPa and 1.66 ± 0.26 m/s, respectively. In the control group, mean SWE values were 5.26 ± 1.17 kPa and 1.31 ± 0.14 m/s, respectively. Elasticity values were significantly higher in testes with microlithiasis as compared with the control group (p < 0.001).
Conclusions
SWE evaluation demonstrates the effects of ultrastructural changes in elasticity that are not detected on gray-scale ultrasound. SWE is a more reliable method in follow-up examinations for pediatric testicular microlithiasis.
Cancer resistance to treatment and antiresistance tools offered by multimodal multifunctional nanoparticles
Chemotherapeutic agents have limited efficacy and resistance to them limits today and will limit tomorrow our capabilities of cure. Resistance to treatment with anticancer drugs results from a variety of facto...
Cortical beta EEG oscillations related to changes in muscle tone activity during sleep in spider monkey (Ateles geoffroyi)
Abstract
Background
The physiological mechanisms that allow for sleeping in a vertical position, which is primordial for arboreal primates, have not been studied yet.
Methods
A non-invasive polysomnographic study of 6 spider monkeys (Ateles geoffroyi) was conducted. The relative beta power of the motor cortex and its linear relation with muscle tone in the facial mentalis muscle and the abductor caudae medialis muscle of the tail during wakefulness and sleep stages were calculated.
Results
A strong negative linear relationship (r = −.8, P = .03) was found between the relative power of the beta2 band in the left motor cortex and abductor caudae medialis muscle tone during delta sleep.
Conclusions
The left motor cortex, through beta2 band activity, interacts with abductor caudae medialis muscle tonicity during delta sleep. This interaction takes part in the mechanisms that regulate the sleep postures.
Secukinumab-induzierter subakut-kutaner Lupus erythematodes
Zusammenfassung
Wir berichten über eine 52-jährige Patientin, die unter der Therapie mit Secukinumab einen medikamenteninduzierten subakut kutanen Lupus erythematodes („drug induced lupus erythematodes" [SC-DILE]) entwickelte. Unter einer lokalen Therapie mit einem Steroid der Klasse 3 zeigte sich innerhalb von 4 Wochen eine wesentliche Besserung. Die Systemtherapie wurde auf Ustekinumab umgestellt. DILE („drug induced lupus erythematodes") ist eine seltene, aber zu bedenkende Nebenwirkung unter Biologikatherapie bei 0,5–1 % aller Patienten, die auch bei IL(Interleukin)-17-Blockade auftreten kann. Eine Umstellung der Biologikatherapie ist in den meisten Fällen notwendig.
Efficacy of microneedling with 70% glycolic acid peel vs microneedling alone in treatment of atrophic acne scars—A randomized controlled trial
Summary
Background
Microneedling with dermaroller and glycolic acid peels is commonly used for treatment of acne scars.
Objective
To compare efficacy of microneedling alone versus combination of microneedling with serial 70% glycolic acid peel in management of atrophic acne scars.
Methods & Materials
Sixty patients with atrophic acne scars were randomized into group 1 receiving microneedling at 0, 6, and 12 weeks and group 2 receiving microneedling at 0, 6, and 12 weeks along with 70% glycolic acid peel at 3, 9, and 15 weeks. Acne scar scoring was performed by a blinded observer using ECCA (Echelle d'evaluation clinique des cicatrices d'acne) scoring at baseline and after 22 weeks. Additionally, patients were asked to grade the improvement in acne scars and skin texture on visual analogue scale (VAS).
Results
Of 60 patients, 52 completed the 22-week study period. The decrement from baseline in mean ECCA score was more in group 2 as compared to group 1 (39.65±2.50 vs 29.58±0.18; P<.001). Group 2 also showed more improvement in skin texture as compared to group 1 on VAS.
Conclusion
Addition of sequential 70% glycolic acid peel to microneedling gives better scar improvement as compared to microneedling alone. In addition to this, it also improves skin texture.
Prosthetic valve Candida spp. endocarditis: new insights into long term prognosis - the ESCAPE study
Abstract
Background
Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations consisting in the combination of surgery and subsequent azole treatment. Methods
PVE-C collected in Spain and France between 2001 and 2015 were retrospectively analyzed with a focus on management and outcome. Results
Forty-six cases were followed up for a median of 9 months. Twenty-two (48%) patients had a past history of endocarditis; 30 (65%) cases were nosocomial or healthcare-related, 9 (20%) patients were intravenous drug users. "Induction" therapy mainly consisted in a liposomal amphotericin B-based (n=21) or an echinocandin-based therapy (n=13). Overall, 19 (41%) patients were operated. Patients less than 66 years old and without cardiac failure more likely underwent cardiac surgery (aOR [95% IC] = 6.80 [1.59-29.13]) and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival at 6 months. Patients who received liposomal amphotericin B alone had a better 6-month survival than those who received an echinocandin alone (aOR [95%CI] =13.52 [1.03-838.10]). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months [range 2-84] led to minor adverse effects. Conclusion
During PVE-C, liposomal amphotericin B "induction" treatment improves survival. A medical treatment followed by "maintenance" long-term fluconazole may be the best treatment option for frail patients.Sonographic assessment of subacromial bursa distension during arm abduction: establishing a threshold value in the diagnosis of subacromial impingement syndrome
Abstract
Purpose
In this study, we aimed to establish a quantitative threshold value in the diagnosis of subacromial impingement syndrome by measuring the thickness of the subacromial bursa during abduction and adduction.
Materials and methods
Forty-five patients with subacromial impingement syndrome and 54 healthy individuals underwent dynamic shoulder ultrasonography. The subacromial bursa, between the supraspinatus tendon margin and peribursal adipose tissue, was measured between the acromion and humeral head at its widest part. The subacromial impingement ratio was calculated by dividing the subacromial bursa thickness during abduction to the subacromial bursa thickness during adduction. Shapiro–Wilk test was used in the assessment of normal distribution of parameters.
Results
The mean subacromial bursa thickness in the abduction position was 1.8 ± 1.1 mm in the study group and 0.9 ± 0.3 mm in the control group. The mean subacromial bursa thickness in the adduction position was 0.9 ± 0.5 mm in the study group and 0.8 ± 0.3 mm in the control group. The subacromial impingement ratio showed a statistically significant difference between groups (p < 0.0001), and the ratio being 2.0 ± 0.5 in the study group and 1.2 ± 0.1 in the control group. For measurements performed in the abduction position, the best cut-off value was calculated as 1.3 mm, and sensitivity and specificity were 70.6 and 85.2%, respectively. The best cut-off value was 1.4 for the subacromial impingement ratio, and sensitivity and specificity were 88.2 and 96.3%, respectively.
Conclusion
Subacromial impingement ratio is a very practical and reliable method in subacromial impingement syndrome diagnosis.
Quantum dot–Cramoll lectin as novel conjugates to glycobiology
Publication date: Available online 25 October 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Cássia R.A. Cunha, Camila G. Andrade, Maria I.A. Pereira, Paulo E. Cabral Filho, Luiz B. Carvalho, Luana C.B.B. Coelho, Beate S. Santos, Adriana Fontes, Maria T.S. Correia
The optical properties of quantum dots (QDs) make them useful tools for biology, especially when combined with biomolecules such as lectins. QDs conjugated to lectins can be used as nanoprobes for carbohydrate expression analysis, which can provide valuable information about glycosylation changes related to cancer and pathogenicity of microorganisms, for example. In this study, we evaluated the best strategy to conjugate Cramoll lectin to QDs and used the fluorescent labeling of Candida albicans cells as a proof-of-concept. Cramoll is a mannose/glucose–binding lectin with unique biological properties such as immunomodulatory, antiparasitic, and antitumor activities. We probed covalent coupling and adsorption as conjugation strategies at different pH values. QDs conjugated to Cramoll at pH7.0 showed the best labeling efficiency in the fluorescence microscopy analysis. Moreover, QD-Cramoll conjugates remained brightly fluorescent and preserved identical biological activity according to hemagglutination assays. Flow cytometry revealed that approximately 17% of C. albicans cells were labeled after incubation with covalent conjugates, while approximately 92% of cells were labeled by adsorption conjugates (both at pH7.0). Inhibition assays confirmed QD-Cramoll specificity, which reduced the labeling to at most 3%. Therefore, the conjugates obtained by adsorption (pH7.0) proved to be promising and versatile fluorescent tools for glycobiology.
Graphical abstract
HLA-Cw6 and psoriasis
Abstract
Psoriasis is a multifactorial disease with a strong genetic background. HLA-Cw6 is one of the most strongly associated psoriasis susceptibility allele. It is repeatedly observed to affect disease course, phenotypic features, severity, comorbidities, and treatment outcomes. To the best of our knowledge, the roles of HLA-Cw6 in psoriasis have not yet been thoroughly reviewed. The worldwide frequency of HLA-Cw6 allele varies greatly, with HLA-Cw6 allele frequency being generally higher in Caucasians compared to Asians. The allele is associated with Type I early onset psoriasis. Stress, obesity, and streptococcal pharyngitis are commonly observed in HLA-Cw6 positive patients. Phenotypically, HLA-Cw6 is found to be associated with guttate psoriasis in some studies. In addition, patients carrying the allele are more likely to have arm, leg, trunk involvement, and Koebner's phenomenon. Psoriatic arthritis patients with HLA-Cw6 more often have early onset and tend to show cutaneous symptoms before musculoskeletal symptoms. HLA-Cw6 positive patients have been shown to be more responsive to methotrexate and ustekinumab in several studies. However, this difference in ustekinumab efficacy was only moderate in a post hoc analysis of phase III pivotal study. HLA-Cw6 positivity also tends to be less frequent in high-need patients who failed conventional therapy. Small studies have also investigated the role of HLA-Cw6 in remission of psoriasis during pregnancy, photosensitivity and atherosclerosis as comorbidity of psoriasis. Given the diverse nature of psoriasis pathogenesis, as well as the difference of HLA-Cw6 positivity in different ethnic groups, more studies are needed to confirm the role of HLA-Cw6 in psoriasis.
This article is protected by copyright. All rights reserved.
The role of the microbiome in psoriasis: moving from disease description to treatment prediction?
Abstract
With several million microbes per cm2 of skin, the task of mapping the physiological cutaneous microbiome is enormous. Indeed, the reliance on bacterial culture to identify cutaneous bacterial communities has led to a systematic under-appreciation of cutaneous microbial diversity, potentially limiting our understanding of common inflammatory skin diseases including psoriasis.
However, based heavily on developments in molecular biology and bioinformatics, including next generation sequencing, the last decade has witnessed a marked increase in our understanding of the extent and composition of the cutaneous microbiome. It is already clear that skin-specific (skin site and skin microenvironment), individual-specific (hygiene, sex, age, and hormonal status), disease-specific (atopic eczema, acne) and genetic factors can all influence the cutaneous microbiome, albeit to varying and, as yet ill-defined, extents. This review briefly describes the process of 16S ribosomal RNA sequencing, before charting our current understanding of the cutaneous microbiome in health and the alterations (dysbiosis) associated with chronic inflammatory diseases with particular reference to psoriasis. The possibility and clinical relevance of intra-individual cross-talk between the various microbiomes is discussed and potential mechanisms underpinning the interactions between resident skin flora and the immune system are highlighted. We outline how the power of microbiome studies can be harnessed to provide new insights into disease pathogenesis and treatment selection. Ultimately, in the age of personalized medicine, the integration of cutaneous microbiome signatures and comprehensive disease and drug response endotypes will herald a novel approach in the clinical management of chronic, multi-system inflammatory diseases.
This article is protected by copyright. All rights reserved.
Surgical Site Irrigation in Plastic Surgery
Abstract
Background
The incidence of infection following breast implant reconstruction remains high at the level of 24%. Surgical site irrigation is commonly used for its prevention. However, the lack of evidence-based guidelines for antibiotic prophylaxis in breast implant surgery necessitates research for optimal irrigation technique. Objectives
composition and exposure time of irrigation solution for surgical site infection (SSI) prophylaxis using an in vitro model of a surgical site. Methods
The study design was an in vitro model to assess antibiotic irrigation of a surgical site. Strains of Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus, Group A Streptococcus, and Pseudomonas aeruginosa were seeded on blood agar growth medium and irrigated with various antibiotic and antiseptic solutions under different exposure times. The presence and quantity of the colonies grown were estimated after 24-hour incubation. Repetition of the studies for 5 times with each investigated irrigation solution and microorganism was performed. Optimal irrigation agents were chosen based on the ability to achieve sterility with minimal tissue toxicity. Results
The optimal wound irrigation agents for SSI prophylaxis in our study were found to be 0.05% chlorhexidine or triple antibiotic antibiotic solutions. Adding of vancomycin to the irrigation solutions did not show an increase in their effectiveness. Prolonged irrigation exposure time was necessary to achieve sterility of the in vitro model of a surgical site. Conclusions
We recommend 0.05% chlorhexidine or triple antibiotic solution for topical SSI prophylaxis in breast implant surgery. Sufficient time of irrigation can be achieved by maintaining some of the solution in the pocket and delaying drainage for at least 30 minutes. Level of Evidence: 5
Commentary on: Surgical Site Irrigation in Plastic Surgery: What is Essential?
Searching for the Holy Grail for the ideal surgical site irrigation solution has been a preoccupation of clinicians and researchers for decades. Due to the complexity of the problem, it is difficult to evaluate the myriad of proposed solutions. Also, what happens in a Petri dish may have limited relevance to what is occurring in a complex biologic system, further compromised by a foreign body, such as a breast implant.
Commentary on: Effects of Thermal Protection in Patients Undergoing Body Contouring Procedures: A Controlled Clinical Trial
The authors1 are to be congratulated on the development of a study of hypothermia on three controlled groups of plastic surgical patients who had body contouring, primarily liposuction. It has been reported that perioperative hypothermia occurs in 50% to 90% of all surgical patients when warming measures are not employed.2 The deleterious effects of hypothermia that have been reported widely vary and include increased infection rates and postoperative pain, a range of negative effects on blood clotting, prolonged anesthesia recovery times, and shivering. Shivering causes pain and unpleasant sensations for the patient in addition to increasing significant other metabolic side effects.
Effects of Thermal Protection in Patients Undergoing Body Contouring Procedures: A Controlled Clinical Trial
Abstract
Background
Hypothermia is common in many plastic surgery procedures, but few measures to prevent its occurrence are taken. Objectives
This study evaluated the effect of hypothermia in patients undergoing plastic surgery procedures and the effect of utilizing simple and inexpensive measures to prevent patient hypothermia during surgery. Methods
A randomized controlled clinical trial was performed among 3 groups of patients who underwent body contouring surgery for longer than 3.5 hours. In group 1, no protective measures were taken to prevent hypothermia; in group 2, maneuvers were applied intraoperatively for the duration of the entire surgical procedure; and in group 3, measures were taken preoperatively and intraoperatively. The results were quantified and analyzed through a bivariate analysis, including degree of hypothermia, anesthesia recovery time, time spent in the recovery area, intensity of pain, cold perception, response to opioids, and nausea. Results
There were 122 patients included in the study: 43 in group 1, 39 in group 2, and 40 in group 3. All patients in group 1 had a higher degree of hypothermia, longer recovery time from anesthesia, longer overall recovery time, increased pain, increased feeling of cold, and more nausea. These patients also required a greater amount of opioids compared with the patients in groups 2 and 3. Many of the results were statistically significant. Conclusions
The adoption of simple and inexpensive measures before and during plastic surgery can prevent patient hypothermia during the procedures, leading to a shorter anesthesia recovery time and avoiding the undesirable effects associated with hypothermia. In addition, these measures may have significant economic savings. Level of Evidence: 2
“Metaphysics Without Ethics is Blind”: The Legacy of Hilary Putnam
Abstract
Two convictions underlie the following article. The first is that Hilary Putnam has been one of the greatest thinkers of our time, a philosopher who was able to propose groundbreaking ideas in virtually every area of philosophy. As the reader will see, the topics he tackled in his writings included questions of philosophy of science, philosophy of language, philosophy of mathematics and logic, philosophy of mind, metaethics, the fact-value dichotomy, the interpretation of Wittgenstein's later thought, the question of relativism, the analysis of rationality, the analysis of religious experience, the character of Jewish philosophy, the interpretation of pragmatism, the elucidation of the concept of truth, the question of realism, the relationship between mind and the world. The second is that the changes some of his positions underwent, far from being a point of weakness—as some critics have sometimes felt compelled to claim—reveal the freshness and genuineness of Putnam's way of philosophising and at the same time the essence of philosophical discussion itself.
Updates in Head and Neck Reconstruction.
Learning Objectives: After reading this article, the participant should: 1. have a basic understanding of virtual planning, rapid prototype modeling, 3D printing, and computer-assisted design and manufacture, 2. understand the principles of combining virtual planning and vascular mapping, 3. understand principles of flap choice and design in preoperative planning of free osteocutaneous flaps in mandible and midface reconstruction, and 4. discuss advantages and disadvantages of computer-assisted design and manufacture in reconstruction of advanced oncologic mandible and midface defects. Summary: Virtual planning and rapid prototype modeling is increasingly employed in head and neck reconstruction with the aim of achieving superior surgical outcomes in functionally and aesthetically critical areas of the head and neck compared to conventional reconstruction. The reconstructive surgeon must be able to understand this rapidly-advancing technology with its advantages and disadvantages. There is no limit to the degree to which patient-specific data may be integrated into the virtual planning process. For example, vascular mapping can be incorporated into virtual planning of mandible or midface reconstruction. Representative mandible and midface cases are presented to illustrate the process of virtual planning. Although virtual planning has become helpful in head and neck reconstruction, its routine may be limited by logistic challenges, increased acquisition costs, and limited flexibility for intraoperative modifications. Nevertheless, the authors believe that the superior functional and aesthetic results realized with virtual planning outweigh the limitations. (C)2017American Society of Plastic Surgeons
Developing, conducting, and publishing appropriate systematic review and meta-analysis papers.
The volume of medical literature is growing at a rate that renders decision-making difficult without specialized summary tools. Systematic reviews and meta-analyses are important research instruments used to condense and clarify a broad scope of information into manageable summaries. When used effectively, these reports can pool cumulative data across primary studies, formulate clinical guidelines, and guide future research endeavors. However, errors in study design can result in ineffective or misleading analyses. This special article presents the appropriate uses for systematic review and meta-analysis by introducing a framework for creating summary studies, and supplying specific examples of pitfalls in study design and execution. (C)2017American Society of Plastic Surgeons
Optimization of surgical outcome in lower extremity nerve decompression surgery.
Background: There is still debate whether the surgical release of entrapped lower extremity nerves reduces complaints of associated neuropathy and results in gain of sensory function. The aim of this study is to investigate which factors are associated with a favorable surgical outcome, by follow-up of patients previously participating in a randomized controlled trial. Methods: We evaluated the 5-years follow-up of diabetic patients previously participating in the Lower Extremity Nerve entrapment Study (LENS). Visual Analogue Pain scores, satisfaction, complaints, quality of life (QoL, SF-36 and EQ-5D), sensory function and incident ulceration and amputations were assessed. Differences between patients who underwent unilateral versus bilateral decompressions were investigated. Results: 31 of the original 42 LENS study participants were measured, of which eight patients underwent additional decompression of the contralateral leg, after 12 months LENS follow-up. At 5-years, bilateral operated patients (n=8) had significantly lower pain scores and higher QoL compared to unilateral operated patients (n=23), were younger, had a lower age when diagnosed with diabetes and a lower body mass index (BMI) at baseline. Pain scores of the additional decompressed leg decreased similarly as the initial decompressed leg, during follow-up. Patients with severe pre-operative sensory loss did worse. 41.2% of the LENS-FU subjects underwent or considers having contralateral surgery. Conclusions: Our results suggest that the beneficial effects of lower extremity nerve decompression surgery are reserved for a select group of patients, of which pre-operative nerve damage, age, duration of diabetes and BMI are important effect modifiers. (C)2017American Society of Plastic Surgeons
Adult T-Cell Leukemia/Lymphoma With Primary Lacrimal Gland Involvement.
A 69-year-old Japanese male presented with a 3-month history of bilateral ptosis with lacrimal gland bulge. He came from western Japan, an area endemic for human T-lymphotropic virus Type 1 infection. Physical examination and imaging revealed bilaterally enlarged lacrimal glands. Hematologic testing, biopsy with histopathology, and immunohistochemistry were all consistent with adult T-cell leukemia/lymphoma. (C) 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Infected Nasal Dermoid Cyst/Sinus Tract Presenting With Bilateral Subperiosteal Supraorbital Abscesses: The Midline Nasal Tuft of Hair, an Overlooked Finding.
This case is, to the authors' knowledge, the first reported case in the literature of bilateral orbital abscesses as result of an infected nasal dermoid. The baby presented with what proved to be bilateral supraorbital subperiosteal abscesses with associated frontal osteitis/osteomyelitis and soft tissue infection of the glabella. Methicillin-sensitive staphylococcus aureus infection was found in the setting of a midline nasal dermoid with tuft of hair and infected sinus tract that was at least initially missed on diagnosis. (C) 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Patients’ Perspectives on the Impact of Genital Psoriasis: A Qualitative Study
Abstract
Introduction
Plaque psoriasis is a chronic skin disease where genital involvement is relatively common. Yet health care providers do not routinely evaluate psoriasis patients for genital involvement and patients do not readily initiate discussion of it.
Methods
A qualitative study of 20 US patients with dermatologist-confirmed genital psoriasis (GenPs) and self-reported moderate-to-severe GenPs at screening was conducted to identify key GenPs symptoms and their impacts on health-related quality of life (HRQoL).
Results
Patients had a mean age of 45 years, 55% were female, and patients had high rates of current/recent moderate-to-severe overall (65%) and genital (70%) psoriasis. Patients reported the following GenPs symptoms: genital itch (100%), discomfort (100%), redness (95%), stinging/burning (95%), pain (85%), and scaling (75%). Genital itching (40%) and stinging/burning (40%) were the most bothersome symptoms. Impacts on sexual health included impaired sexual experience during sexual activity (80%), worsening of symptoms after sexual activity (80%), decreased frequency of sexual activity (80%), avoidance of sexual relationships (75%), and reduced sexual desire (55%). Negative effects on sexual experience encompassed physical effects such as mechanical friction, cracking, and pain as well as psychosocial effects such as embarrassment and feeling stigmatized. Males reported a higher burden of symptoms and sexual impacts. Other HRQoL impacts were on mood/emotion (95%), physical activities (70%), daily activities (60%), and relationships with friends and family (45%). These impacts significantly affected daily activities. Physical activities were affected by symptoms and flares, and increased sweat and friction worsened symptoms. Patients reported daily practices to control outcomes.
Conclusion
The high level of reported symptoms and sexual and nonsexual impacts reflects the potential burden of moderate-to-severe GenPs. GenPs can impact many facets of HRQoL and providers should evaluate their patients for the presence of genital psoriasis and its impact on their quality of life.
Funding
Eli Lilly and Company.
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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
