An Evaluation of Different Bridging Techniques for Short Nerve Gaps

Background: In this study, we investigated sensory and motor outcomes for different bridging techniques for short nerve gaps. Material and Methods: This study was conducted in the Postdoctoral Department of Burns, Plastic, and Reconstructive Surgery of our institution from August 2014 to May 2017. All patients with posttraumatic short nerve gaps of 3 cm or less of median, ulnar, and/or both in forearm and wrists were included in the study. Patients with known causes of neuropathies were excluded. Groups 1, 2, 3, and 4 included 9 patients each, and the nerve gap was managed with reverse sural nerve autograft, inside-out vein conduit autograft, reverse sural nerve with covering inside-out vein autograft, and inside-out great saphenous vein autograft filled with denervated gastrocnemius skeletal muscle autograft, respectively. All the patients were followed-up and examined for sensory and motor recovery with a 2-point discrimination test (2PD) at finger tips in the distribution of reconstructed nerves and medical research council scale (MRCS) for muscle power innervated by the reconstructed nerves. The 2PD and MRCS muscles were compared between the groups using SPSS version 23 through 1-way analysis of variance. Results: All the patients in each group recovered either completely or partially. The 2PD and MRCS muscle power means were compared between the groups. On comparing the mean 2PD and mean MRCS muscle power were compared between the groups using 1-way analysis of variance test. All the groups have been found statistically comparable in spite of the apparent clinical difference. Conclusions: Although the nerve autograft is the criterion standard for managing the nerve gaps, the vein conduit is a viable alternative to nerve autograft for bridging the nerve gaps 3 cm or less, whereas filled conduit needs more study. However, more patients need to be studied to complete a relevant statistical study.

Use of Fat Grafts in Facial Reconstruction on the Wounded Soldiers From the First World War (WWI) by Hippolyte Morestin (1869–1919)

Introduction: During the Great War of 1914 to 1918, spectacular progress was made in the field of facial reconstruction. The sheer number and severity of facial lesions inflicted during the fighting obliged French and German surgeons to take a close interest in the treatment of patients wounded in such a manner. As head surgeon of the fifth division "blessés de la face" at the hospital of Val-de-Grace, Hippolyte Morestin was responsible for one of the largest surgical departments specializing in facial surgery and reconstruction during the war. During his time of service, he developed various surgical techniques such as autoplasties using cartilaginous and adipose grafts to reconstruct tissue defects. This study focuses primarily on the adipose graft techniques and their aesthetic outcome used by Morestin during and in the aftermath of World War I. Methods: This is a historical descriptive study. Our research is based on documents available at the museum and archives of the Val-de-Grace Army Health Service (hospital activity reports, pre- and postoperative patient photographs, newspaper clippings, documented accounts of ward nurses, wax anatomy models). Thirty-four clinical cases published by Hippolyte Morestin dealing with facial reconstruction during the World War I were studied. Results: Fat was mainly used to fill craniofacial substance losses after carrying out often complex reconstructions. The surgical technique is well documented and subdivided into 3 succeeding procedures. Most of the time, the grafts were of autologous origin but sometimes heterologous samples were used. Although the primary objective was to increase volume, an improved quality of skin healing and better skin flexibility were observed. The fat thus allowed the filling of substance losses, and its positive effects on scarring were noticed even before the regenerative properties of the stem cells present in body fat were discovered. Conclusions: Hippolyte Morestin can be named one of the pioneers of facial reconstruction. A retroperspective analysis of his work with adipose grafts proves interesting because even though not being the first to apply this technique, he contributed, by means of experimentation and reproduction to proving it an innovative and useful method in facial reconstruction. It was not until the 1990s that adipose grafts were again applied under the name of lipostructure. Nowadays, they are commonly used in cosmetic and restorative surgery.

Response to the letter to the editor: “Understanding the impact of preservation methods on the integrity and functionality of placental allografts”

No abstract available

Microsurgery Fellowship at St Vincent's Hospital, Sydney, Australia: The Ultimate Hidden Gem

No abstract available

Significance of the Lateral Thoracic Artery in Pectoralis Major Musculocutaneous Flap Reconstruction: Quantitative Assessment of Blood Circulation Using Indocyanine Green Angiography

Abstract: Free tissue transfer is the preferred reconstruction option in most major head and neck reconstructions. The pectoralis major muscle musculocutaneous (PMMC) flap is commonly used in salvage of necrotic free flaps and is the first choice for patients who are not candidates for free flaps. The lateral thoracic artery (LTA), which is thought to contribute to blood perfusion of the inferior and lateral mammary area, is not preserved in a conventionally harvested PMMC flap. With regard to blood supply, it has been suggested that the LTA should be preserved, in addition to the pectoral branch of the thoracoacromial artery, when a skin island is designed in the lower chest to attain a pedicle length sufficient for head and neck reconstruction. However, an effect on hemodynamic improvement using the LTA has not been shown quantitatively. In this study, we examined 8 patients with oral cancer who underwent reconstruction procedures with a bipedicle PMMC flap that included the LTA, in addition to the thoracoacromial artery. Intraoperative indocyanine green angiography was performed to examine circulation to the PMMC flap with or without LTA clamping after harvesting. After image processing, data were analyzed using a new quantitative perfusion assessment system with parameters that we recently established for assessment of peripheral arterial disease of the lower limbs. All patients had good clinical courses with whole-flap survival, no vascular insufficiency of the skin island, and no fistula formation. Intraoperative indocyanine green angiography showed an increased inflow rate into the skin island in an LTA-declamped condition in all cases, implying that the preserved LTA increased the blood supply to skin islands in the pectoralis major muscle. We conclude that preserving the LTA in a PMMC flap can increase blood perfusion and stabilize the vascularity of the flap, making the reconstruction more effective and reliable than with use of a conventionally harvested flap. Therefore, it is worthwhile to preserve the LTA as a major contributor to a lateral and distal PMMC flap.

Gluteal Augmentation With Intramuscular Implants in Patients With Human Immunodeficiency Virus With Lipoatrophy Related to the Use of Antiretroviral Therapy

Introduction: Lipodystrophy syndrome associated with highly active antiretroviral therapy (HAART) may lead to low self-esteem and poor compliance with the drug treatment on patients infected with human immunodeficiency virus (HIV), which is a matter of concern for the health system. The aim of this study was to evaluate patients with HIV submitted to gluteal augmentation with intramuscular silicone implants to correct gluteal lipoatrophy related to the use of HAART. Methods: This is a retrospective evaluation of 10 patients submitted to gluteal augmentation with intramuscular silicone implant for correction of gluteal lipoatrophy related to the use of HAART, operated between 2012 and 2015. Postoperative complications and the degree of patient's satisfaction were analyzed. Results: There were 3 postoperative complications including 1 case of surgical wound dehiscence and 2 cases of seroma. Six months after surgery, 8 patients had an excellent degree of satisfaction, and 2 patients had a good degree of satisfaction related to the procedure. Although this intervention does not offer functional advantages, it improves the body contour, increases patients' self-esteem, and helps them to accept their body image. These advantages can lead to higher compliance with prolonged HAART. Conclusions: Gluteal augmentation with intramuscular silicone implant can be a viable option to treat patients with HIV with gluteal lipoatrophy related to the use of HAART. The patients were satisfied with the outcomes of the procedure, and there were only minor self-limited postoperative complications.

Reverse Distal Transverse Palmar Arch in Distal Digital Replantation

Background: Refinements in microsurgery have made distal finger replantation an established technique with high success rates and good functional and aesthetic outcomes. However, it still represents a technically demanding procedure due to the small vessel caliber and frequent lack of vessel length, requiring the use of interpositional venous grafts in some instances. We describe a new technique for anastomosis in fingertip replantation, whereby the need for venous grafts is eliminated. Methods: Applying the reverse distal transverse palmar arch technique, 11 cases of distal digital replantation were performed between January 2011 and July 2016. The described procedure was used for arterial anastomosis in 10 cases and arteriovenous shunting for venous drainage in 1 case. A retrospective case review was conducted. The technical description and clinical outcome evaluations are presented. Results: Ten of the 11 replanted digits survived, corresponding to an overall success rate of 91%. One replant failed due to venous insufficiency. Blood transfusions were not required for any of the patients. Follow-up (range, 1.5–5 months) revealed near-normal range of motion and good aesthetic results. All of the replanted digits developed protective sensation. The average length of hospital admission was 5 days. All patients were satisfied with the results and were able to return to their previous work. Conclusions: The use of the reverse distal transverse palmar arch is a novel and reliable technique in distal digital replantation when an increase in vessel length is required, allowing for a tension-free arterial repair without the need for vein grafts.

Does the Sequence of Tattooing and Nipple Reconstruction Affect Nipple Projection?

Background: In nipple reconstruction, the maintenance of adequate projection is one of the most important and challenging aspects. However, no reports have evaluated whether tattooing after nipple reconstruction affects nipple projection. This study aimed to test our hypothesis that tattooing after reconstruction adversely affects nipple projection. Method: Between September 2001 and July 2009, 384 nipples were reconstructed using the modified top hat technique after breast reconstruction with a transverse rectus abdominis musculocutaneous flap. Of these, 320 were reconstructed before tattooing, and 64 were reconstructed after tattooing. Projection at 6 months and 1 year was compared with that measured immediately after the operation, and projection was compared between the nipples reconstructed after tattooing and those reconstructed before tattooing. Results: After 6 months, the mean loss of projection was 52.5% in the tattoo-after group and 55.1% in the tattoo-before group. After 1 year, it was 59.2% in the tattoo-after group and 58.6% in the tattoo-before group. There were no significant differences between the groups regarding the sequence of the procedures. The additional tattoo and retattoo rate was 20% in the tattoo-before group and 1% in the tattoo-after group. Conclusions: These findings showed that the sequence of nipple reconstruction and tattooing had no significant effect on the projection of the reconstructed nipple. It is easier to tattoo homogeneously before nipple reconstruction because of the flat surface but more difficult to make a smooth areolar peripheral margin and circular areolar shape when reconstructing the nipple. The sequence of tattooing and nipple reconstruction can be determined according to esthetic and clinical considerations.

Pediatric Lower Extremity Lawn Mower Injuries and Reconstruction: Retrospective 10-Year Review at a Level 1 Trauma Center

Introduction: From 2004 to 2013, there were 9341 lawn mower injuries in children under 20 years old. The incidence of lawn mower injuries in children has not decreased since 1990 despite implementation of various different prevention strategies. In this report, the authors review the results of pediatric lawn mower–related lower-extremity injuries treated at a tertiary care referral center as well as review the overall literature. Methods: A retrospective review was performed at a level 1 trauma center over a 10-year period (2005–2015). Patients younger than 18 years who presented to the emergency room with lower extremity lawn mower injuries were included. Results: Of the 27 patients with lower-extremity lawn mower injuries during this period, the mean age at injury was 5.5 years and Injury Severity Score was 7.2. Most (85%) patients were boys and the predominant type of mower causing injury was a riding lawn mower (96%). Injury occurred in patients who were bystanders in 78%, passengers in 11%, and operators in 11%. Mean length of stay was 12.2 days, and mean time to reconstruction was 7.9 days. Mean number of surgical procedures per patient was 4.1. Amputations occurred in 15 (56%) cases with the most common level of amputation being distal to the metatarsophalangeal joint (67%). Reconstructive procedures ranged from direct closure (41%) to free tissue transfer (7%). Major complications included infection (7%), wound dehiscence (11%), and delayed wound healing (15%). Mean follow up was 23.6 months and 100% of the patients were ambulatory after injury. The subgroup of patients with the most severe injuries, highest number of amputations, and need for overall surgical procedures were patients aged 2 to 5 years. A review of the literature also showed consistent findings. Conclusions: This study demonstrates the danger and morbidity that lawn mowers present to the pediatric population, particularly children aged 2 to 5 years. Every rung of the so-called reconstructive ladder is used in caring for these children. Increased public awareness is insufficient to decrease the incidence of these injuries. These products should have additional warning labels and meet updated changes to the design of lawn mowers to prevent these mutilating injuries successfully.

The Classic Pitanguy Technique and Its Modifications in Mammaplasty: Ten Years of Experiences

Background: Mammaplasty surgery has been modified in the past few years, as plastic surgeons worked to improve and maintain the breast shape and especially the "bottoming out" of the gland. The classic Pitanguy's technique has been shown to be an anatomically safe technique in the management of the breast. However, as first described, cannot be applied in gigantomastia or in severe breast ptosis cases or in cases of dense breast parenchyma or for a long-lasting breast lift result. Using 2 different modifications, the Pitanguy technique can be applied for breasts of all sizes and for all cases of breast ptosis. Methods: A retrospective study of 140 patients who underwent the Pitanguy method and its 2 modifications was performed. The first modification consists of dissecting the upper pole of the breast vertically to the fascia of the pectoralis major muscle and laterally to the nac. The medial flap is then advanced superiorly, rotated 90 degrees, and sutured to point A, whereas the lateral flap is placed below the medial one. The second modification describes an inferior chest wall-based flap for achieving a desirable shape that can be maintained over a long period. The inferior flap is based only in the thoracic wall vasculature, completely detached from surrounding structures, maintaining a good volume. The upper flap of the breast covers the inferior flap. Results: The follow-up included 140 patients and the follow-up period ranged from 1 to 10 years. Five patients were operated on less than 4 months ago and were not involved in this study. All patients gained natural-shaped breasts, and they were pleased with the results. Serious complications, including flap necrosis, were avoided because caution was used to preserve the internal mammary perforators while performing the Pitanguy's technique and its 2 modifications. Conclusions: The classic Pitanguy technique and its 2 modifications provide a versatile, well-vascularized pedicle that allows elevation of the nipple areola complex at the desired height. Using these 2 modifications, the Pitanguy's technique can be applied for breasts of all sizes and for all cases of breast ptosis.

Identification of Risk Factors in Lymphatic Surgeries for Melanoma: A National Surgical Quality Improvement Program Review

Introduction: Sentinel lymph node biopsy (SLNB) and lymphadenectomy (LAD) are commonly performed in the staging and care of patients with malignant melanoma. These procedures are accompanied by complications that may result in hospital readmission, negatively affecting patient outcomes and potentially affecting surgical procedure reimbursement. The National Surgical Quality Improvement Program (NSQIP) database offers a large data set allowing physicians to evaluate 30-day readmission for surgical complications. We used this database to explore predictors of 30-day hospital readmission for SLNB and LAD in the axillary, cervical, and inguinal regions. Methods: Data from the years 2005 to 2014 of the American College of Surgeons NSQIP database were used. Cohorts were constructed according to International Classification of Diseases, Ninth Revision, classification and current procedural terminology codes. The outcome of 30-day return to hospital was defined as patients who were readmitted to the hospital or the operating room within 30 days. Multiple logistic regression results are presented for a prespecified set of predictors and predictors that were significant on univariate logistic regression analysis. Odds ratios and confidence intervals were calculated using maximum likelihood estimates, along with Wald test P values. Results: A total of 3006 patients were included. Of those, 151 (5.0%) returned to the hospital. Among 1235 LAD patients, 65 (5.3%) returned; among 1771 SLNB patients, 86 (4.9%) returned. Smoking was a predictor of hospital readmission for overall SLNB and for cervical SLNB on multivariate analysis. Age was a significant predictor for cervical and inguinal LAD. Hypertension was significant for cervical LAD. Diabetes, preoperative hematocrit, and male sex were predictors for inguinal SLNB. There were no significant predictors for axillary SLNB and axillary LAD, as well as overall LAD procedures. Conclusions: This is the first and largest study using American College of Surgeons NSQIP to examine 30-day readmission after SLNB and LAD for melanoma in 3 commonly operated anatomical regions. We have found several significant risk factors associated with hospital readmission, which are now being used as a quality measure for hospital performance and reimbursement, that may help surgeons optimize patient selection for SLNB and LAD.

Sweet Syndrome After Bilateral Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Case Report

Abstract: We describe a case of Sweet's Syndrome after bilateral deep inferior epigastric perforator flap breast reconstruction in a patient with ductal carcinoma of the left breast.

The Boreds

No abstract available

Analysis of Mechanical Behavior of Dermal Fibroblasts Obtained From Various Anatomical Sites in Humans

Purpose: Facial skin fibroblasts imposed with cyclic stretch at 10% magnitude display considerable mechanotransduction properties and biochemical reactions in our previous study. However, it is poorly understood how these shared traits are fully parallel to the common features across all fibroblasts derived from different skin-based anatomical regions in response to cyclic stretch stimulation. Thus, the purpose of this study was to evaluate the effects of various cyclic stretches on fibroblasts derived from multiple anatomical skin sites of human bodies, and the optimal stretch magnitude was defined based on the changes to cell mechanical behavior. Methods: Fibroblasts from skin areas of the scalp, anterior chest, suprapubic, axilla, and planta were cultured and characterized in vitro. Cyclic stretch at 0%, 5%, 10%, 15%, and 20% magnitudes was imposed at a loading frequency of 0.1 Hz for 48 hours, and thereafter, the mechanical behavior and biochemical reaction of the dermal fibroblasts were analyzed. Results: Dermal fibroblasts from various anatomical sites preconditioned with varying cyclic stretch led to an evident increase in the cell proliferation ability, the expression of integrin β1 and p130 Crk-associated substrate messenger RNA and protein, and the productions of type I collagen and transforming growth factor β1, most importantly in a strain magnitude-dependent manner with the peak appearing in the range of 10% to 15% magnitude cyclic stretch. Conclusions: These findings may facilitate the subsequent studies on the conversion of normal skin fibroblasts into hypertrophic scar cells, which should be considered in an interpretation of the mechanisms of hypertrophic scarring and skin mechanics.

Free Lateral Digital Flap for Reconstruction of the Fingers

Background: The region between the proximal interphalangeal (PIP) and the metacarpophalangeal (MP) creases has greater laxity than other regions in the fingers, allowing for primary closure of the donor site. We postulated if we could consistently locate perforators from the region between the PIP and the MP crease on the radial side of the middle and ring fingers, on which a scar would be less conspicuous than one on the radial side of the index finger, these regions would be ideal donor sites for digital reconstruction using very small flaps. Methods: In 20 fingers (10 middle fingers and 10 ring fingers) from 5 volunteers, perforators from the radial proper digital artery were visualized between the PIP and the MP creases using ultrasonography. Based on this information, and to evaluate its feasibility, a free lateral digital flap was used for reconstruction of small digital defects in 3 cases. Results: Of the 20 fingers, 19 had at least 1 digital artery perforator (DAP) arising from the radial proper digital artery between the PIP and MP creases. The average distance from the PIP crease to the DAP was 9.0 mm. The average diameter of the DAP was 0.37 mm. In all clinical cases, flaps survived completely with pleasing cosmesis. There were no donor site complications. Conclusions: With their consistent anatomy and relatively low donor site morbidity, free lateral digital flaps from the radial side of the middle or ring fingers may be a reliable option for reconstruction of the volar surface of the digits.

Acute-Onset Quadriplegia With Recovery After High-Voltage Electrical Injury

Abstract: Although uncommon, electrical injuries are associated with significant morbidity and mortality. There have been several reports of neurological sequelae secondary to electrical injury; however, the neurophysiology is still not completely understood. These neurological complications pose the greatest risk for permanent disability. We present a case of acute-onset quadriplegia after high-voltage electrical injury without radiographic evidence. Two months after the injury, the patient went on to regain partial sensorimotor function. Only a few case reports in the literature exist describing neurological recovery after electrical burn-induced quadriplegia. These cases are reviewed.

The Use of Bilayered Fascia Lata With an Interpositional Omental Flap for Autologous Repair of Contaminated Abdominal Fascial Defects

Introduction: Contaminated abdominal fascial defects, such as those seen in enterocutaneous fistula, or wound dehiscence with mesh exposure, are a significant source of morbidity and present unique reconstructive challenges. We present our technique of using the fascia lata, augmented with an interpositional omental flap, for complete autologous reconstruction of contaminated fascial defects, and the postoperative results of 3 cases. Methods: Three patients with contaminated abdominal defects underwent wound debridement/fistula resection and immediate reconstruction with fascia lata and omentum flap. Defect size ranged from 15 × 8 cm (120 cm2) to 25 × 12 cm (300 cm2). The fascia lata graft was inset using an underlay technique, and the omentum was tunneled through a subcostal slit in the semilunar line to augment the vascularity of the subcutaneous plane and protect the graft. Skin coverage was achieved by undermining and direct closure or local myocutaneous flaps. Results: Three patients underwent abdominal wall reconstruction with our technique. The median follow-up was 12 months. There were no recurrent infections, fistulae, or herniae. All patients experienced full functional recovery with return to independent activities of daily living by 6 months postoperatively. Conclusions: Since the use of synthetic material is contraindicated in contaminated abdominal fascial defects. We propose that our combination of fascia lata and an interpositional omental flap is a useful technique for the reconstruction of these challenging defects.

Lesions Associated With Calcium Gluconate Extravasation: Presentation of 5 Clinical Cases and Analysis of Cases Published

Introduction: Calcium gluconate extravasation is a process, which, while not common, occurs more frequently in neonatal intensive care units. The aim of this study is to present a number of cases of calcium gluconate extravasation, which have occurred in our hospital, and to carry out a review of those clinical cases published in the literature to obtain relevant epidemiological data. Methods: Data were gathered on the medical histories of 5 patients who presented lesions secondary to calcium gluconate extravasation in our center. A review of the literature was also performed to include clinical cases of calcium gluconate extravasation already published. Results: Data were collected on 60 cases published in 37 articles. Most patients (55%) were neonates. The average age of these neonates was 8 days. The commonest location of injuries was the back of the hand and wrist (42%). The 2 most frequent symptoms were the appearance of erythema (65%) and swelling/edema (48%) followed by the appearance of skin necrosis (47%), indurated skin (33%), and yellow-white plaques or papules (33%). Most cases are cured within a period of 3 to 6 months. Fifty percent of patients required surgery, and in 13% of cases, skin grafts were performed. The most frequent histological finding was the presence of calcium deposits. Other histological findings described were the presence of necrosis, lymphohistiocytic infíltrate, and granulomas. Most histological findings were located in the dermis. Most x-rays showing calcium deposits had been performed at 3 to 4 weeks. Conclusions: Calcium gluconate extravasation is a process, which, although infrequent, is associated with serious skin and soft-tissue lesions, mainly affecting infants. Further studies are needed to determine possible specific procedures to be carried out in these cases.

Impact of Abdominal Lipectomy on Post-Sleeve Gastrectomy Surgery Weight Loss

Background: Abdominal lipectomy after bariatric surgery is recommended because of residual excess skin resulting in difficulty with maintaining hygiene, recurrent infections, and functional impairment, interfering with daily activities. There is a dearth of literature examining weight loss outcomes in patients undergoing abdominal lipectomy post sleeve gastrectomy (SG). The purpose of this study was to examine whether post-SG patients who received abdominal lipectomy achieved greater percent excess weight loss (%EWL) than post-SG patients who did not receive abdominal lipectomy. Methods: Retrospective study of patients who underwent minimally invasive SG at the University of Illinois Hospital and Health Sciences System from March 2008 to June 2015 was conducted. The cohort was divided into 2 groups: patients who underwent abdominal lipectomy after SG (PS-SG) and patients who underwent SG alone (SG). Demographics, comorbidities, and %EWL were examined. Results: Twenty-nine patients were included in the PS-SG group versus 287 patients in the SG group. Significant differences were found in %EWL at 24 (P

Chemotherapy Extravasation Management: 21-Year Experience

Abstract: Chemotherapy extravasation may result in serious damage to patients, with irreversible local injures and disability. Evidence-based standardization on extravasation management is lacking and many institutions do not practice adequate procedures to prevent the severer damages. Our aim was to explore the prevention and treatment of extravasation injuries, proposing a standard therapeutic protocol together with a review of the literature. From January 1994 to December 2015, 545 cases were reviewed (age range, 5–87 years; 282 men and 263 women). Our therapeutic protocol consisted of local infiltration of saline solution and topical occlusive applications of corticosteroids. The infiltrations were administrated 3 to 6 times a week depending on damage severity. Our protocol allowed us to prevent ulceration in 373 cases. Only 27 patients required surgery (escarectomy, skin graft, regional, and free flap). Numerous treatments have been proposed in literature. The antidotes have been discussed controversially and are not considered standard methods for treatment, especially when polychemotherapy is administrated and the identification of the responsible drug is not possible. We proposed the use of saline solution injection to dilute rapidly the drug, thus reducing its local toxic effects. This method is easy to use and always reproducible even when the drug is not known or when it is administrated in combination with other drugs. It is possible to perform it in ambulatory regimen, and, overall, it represents a standard method.

Dynamic computational simulations for evaluating tissue loads applied by Regulated negative pressure-assisted wound therapy (RNPT) system for treating large wounds

Publication date: Available online 28 October 2017
Source:Journal of Tissue Viability
Author(s): Rona Katzengold, Moris Topaz, Amit Gefen
Regulated negative pressure-assisted wound therapy (RNPT) is one of the most important wound treatment technologies developed and applied over the last two decades. To-date RNPT has been proven to be clinically effective in treating chronic wounds, however, the effects of different specific pressure delivery protocols on the progress and quality of tissue repair are not adequately understood yet. Here, we suggest a viscoelastic, three-dimensional finite element modeling framework of RNPT, with several realistic features such as a non-symmetrically configured multi-layered tissue structure. The effects of the RNPT system on the wound-bed were simulated by applying time varying pressure boundary conditions. Three commonly-used operation modes were simulated: continuous, non-continuous intermittent and dynamic, and each mode was applied at four different pressure levels. Outcome measures of strain and stress magnitudes and distributions were acquired from the dermis and subcutaneous fat. Taken together, the strain and stress data from the different simulated RNPT modes and intensities demonstrated that tissue loads which are actually applied in and around the wound, and at the different tissue components of the wound, can differ substantially from the pressure levels that are set in the device during therapy sessions. This is critical information for understanding the potential effects of RNPT, for setting the device prior to therapy and for designing the next generation of these systems.

Impact on Quality of Life in Dermatology Patients Attending an Emergency Department

Publication date: Available online 28 October 2017
Source:Actas Dermo-Sifiliográficas
Author(s): A. Alegre-Sánchez, D. de Perosanz-Lobo, A. Pascual-Sánchez, C. Pindado-Ortega, P. Fonda-Pascual, Ó.M. Moreno-Arrones, P. Jaén-Olasolo
IntroductionDermatological complaints have been estimated to represent up to 5–10% of all the visits to emergency departments. The main objective of our study was to determine how affected is the Health related Quality of Life (HRQL) in a series of patients attending an emergency department due to skin symptoms.Patients and methodsA prospective study during one month (July 2016) was conducted in a hospital with full-time on-call dermatologists. The Short-Form SF-12v2 Health Survey and the Dermatology Life Quality Index (DLQI) were offered to all the patients over 18 years old attending the emergency department with cutaneous complaints. Clinical and epidemiological characteristics were also collected.ResultsIn total 108 patients completed the study. Mean age found was 45.1±16.1 years. Mean DLQI score found was 10.56±6.12. Fifty-three patients (49%) had a score of 11 or higher in the DLQI questionnaire. Most affected subscales were "Symptoms and Feelings" in DLQI scale and "Overall Health" and "Vitality" for the SF-12. A very significant difference (p<0.0001) was found between women's (12.4±5.7) and men's (7.5±5.6) DLQI mean score (mean difference of 4.9; 95% confidence interval of the difference: 2.7–7.1).ConclusionsPatients visiting emergency units with cutaneous complaints seem to feel a moderate-large impact on their quality of life which is mainly related to the symptoms and feelings that they are experiencing. This impact is significantly higher among women.

Graphical abstract

Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee

In 2002, the National Rosacea Society assembled an expert committee to develop the first standard classification of rosacea. This original classification was intended to be updated as scientific knowledge and clinical experience increased. Over the last 15 years, significant new insights into rosacea's pathogenesis and pathophysiology have emerged, and the disorder is now widely addressed in clinical practice. Growing knowledge of rosacea's pathophysiology has established that a consistent multivariate disease process underlies the various clinical manifestations of this disorder, and the clinical significance of each of these elements is increasing as more is understood.

Sleep disturbance in children with moderate/severe atopic dermatitis: A case-control study

Sleep is disturbed in 60% of children with atopic dermatitis (AD).

Evidence-based update on rosacea comorbidities and their common physiologic pathways

Rosacea is a common chronic inflammatory disease affecting the facial skin whose etiology and pathophysiology are the subject of much investigation. Risk factors include genetic and environmental elements that may predispose individuals to localized inflammation and abnormal neurovascular responses to stimuli. Recent studies have introduced an array of systemic rosacea comorbidities, such as inflammatory bowel disease and neurologic conditions, that can be challenging to synthesize. We critically review the current data behind reported rosacea comorbidities and identify and highlight underrecognized physiologic mediators shared among rosacea and associated comorbidities.

Dealing with treatment and transfer requests: how PGD-professionals discuss ethical challenges arising in everyday practice

Abstract

How do professionals working in pre-implantation genetic diagnosis (PGD) reflect upon their decision making with regard to ethical challenges arising in everyday practice? Two focus group discussions were held with staff of reproductive genetic clinics: one in Utrecht (The Netherlands) with PGD-professionals from Dutch PGD-centres and one in Prague (Czech Republic) with PGD-professionals working in centres in different European countries. Both meetings consisted of two parts, exploring participants' views regarding (1) treatment requests for conditions that may not fulfill traditional indications criteria for PGD, and (2) treatment and transfer requests involving welfare-of-the-child considerations. There was general support for the view that people who come for PGD will have their own good reasons to consider the condition they wish to avoid as serious. But whereas PGD-professionals in the international group tended to stress the applicants' legal right to eventually have the treatment they want (whatever the views of the professional), participants in the Dutch group sketched a picture of shared decision-making, where professionals would go ahead with treatment in cases where they are able to understand the reasonableness of the request in the light of the couple's reproductive history or family experience. In the international focus group there was little support for guidance stating that welfare-of-the child considerations should be taken into account. This was different in the Dutch focus group, where shared decision-making also had the role of reassuring professionals that applicants had adequately considered possible implications for the welfare of the child.

Quantifying the visual appearance of sunscreens applied to the skin using indirect computer image colorimetry

Abstract

Background

There is no accepted method to objectively assess the visual appearance of sunscreens on the skin.

Methods

We present a method for sunscreen application, digital photography, and computer analysis to quantify the appearance of the skin after sunscreen application. Four sunscreen lotions were applied randomly at densities of 0.5, 1.0, 1.5 and 2.0 mg/cm² to areas of the back of 29 subjects. Each application site had a matched contralateral control area. High-resolution standardized photographs including a color card were taken after sunscreen application. After color balance correction, CIE L*a*b* color values were extracted from paired sites. Differences in skin appearance attributed to sunscreen were represented by ΔE, which in turn was calculated from the linear Euclidean distance within the L*a*b* color space between the paired sites.

Results

Sunscreen visibility as measured by median ΔE varied across different products and application densities and ranged between 1.2 to 12.1. The visibility of sunscreens varied according to product SPF, composition (organic vs. inorganic), presence of tint and baseline b* of skin (p< 0.05 for all).

Conclusion

Standardized sunscreen application followed by digital photography and indirect computer-based colorimetry represents a potential method to objectively quantify visibility of sunscreen on the skin.

This article is protected by copyright. All rights reserved.

Narrow band UVB effects on cutaneous vitamin D receptor expression and serum 25-hydroxyvitamin D in generalized vitiligo

Abstract

Background/purpose

Vitamin D has a role in variety of autoimmune diseases including vitiligo. Narrow band UVB (NB-UVB) treatment of vitiligo might act through its effects on vitamin D and its receptor

Methods

The present study is the first to elucidate NB-UVB effects on immunohistochemical vitamin D receptor (VDR) expression in generalized vitiligo and correlate it with serum vitamin D and repigmentation response. Using immunohistochemistry, VDR expression was estimated in skin biopsies of 30 controls and 30 vitiligo patients; from vitiligo lesion, perilesional skin at baseline and from repigmented and non responding skin after 24 NB-UVB sessions. Baseline serum 25-hydroxyvitamin D [25(OH)D] was investigated and repeated after 24 NB-UVB sessions

Results

VDR expression and serum 25(OH)D in controls were significantly higher compared to vitiligo patients. After NB-UVB therapy, there was a significant rise in VDR expression and serum 25(OH)D. VDR expression was significantly higher in repigmented skin compared to non responding lesion. Improvement in the clinical outcome score was associated with higher baseline VDR expression and higher serum 25(OH)D

Conclusions

NB-UVB phototherapy is associated with improved cutaneous VDR expression and vitamin D synthesis. Better repigmentation response to NB-UVB may be related to higher baseline VDR expression and its upregulation after phototherapy.

This article is protected by copyright. All rights reserved.

Src kinase mediates UV-induced TRPV1 trafficking into cell membrane in HaCaT keratinocytes

Abstract

The skin is constantly exposed to harmful external stimuli such as pathogen, particulate matter, and sunlight. Solar radiation consists of various types of rays, among which ultraviolet (UV), visible light, and infrared can reach the earth and thereby affect human skin (1). Especially, UV has several detrimental effects on the skin including cutaneous cancer, inflammation, and photoaging (2). When skin cells are exposed to UV, it causes nuclear factor kappa B (NF-kB) signaling pathway leading to the increases of proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, IL-6, and IL-8 (3).

This article is protected by copyright. All rights reserved.

Youth Access to Indoor Tanning Salons in Urban Versus Rural/Suburban Communities

Abstract

Research suggests that youth proximity to tanning salons may promote use, however little is known about tanning salon proximity to schools. We assessed the proximity of tanning salons to schools in urban versus rural/suburban communities across Worcester County, Massachusetts (population > 800K). To put findings in context, we compared school proximity to tanning salons to school proximity to McDonald's restaurants, a large franchise that also caters to young people. Accessibility was measured by ArcGIS 10.2 Network Analyzer (ESRI, Redlands, CA) and the most current road network data layer from Massachusetts Department of Transportation (MassDOT). A total of 145 schools were observed in the study area, of which about 39% of schools were within 1 mile from a tanning salon. Urban schools (53.41%) had a higher proportion within 1 mile of a tanning salon than rural/suburban schools (17.54%; p < 0.001). More schools (39.31%) were within 1 mile of a tanning salon than schools within 1 mile of a McDonald's (22.70%; p < 0.001). Schools may be particularly impactful for implementing skin cancer prevention programming.

This article is protected by copyright. All rights reserved.

Narrow band ultraviolet B phototherapy outcomes in atopic dermatitis – a single-centre retrospective review

Abstract

Systemic and biological therapies are evolving treatment modalities in the management of atopic dermatitis (AD). Despite these welcome advances in the management of refractory cases, phototherapy remains the recommended¹ second-line treatment option for AD when topical treatments fail to control symptoms. According to a recently published survey of UK dermatologists², 46% of dermatologists still choose phototherapy, either narrow-band ultraviolet B (NB UVB) or psoralen ultraviolet A (PUVA) ahead of systemic therapy which is favoured by 36%.

This article is protected by copyright. All rights reserved.

Bio fabrication of silver nanoparticles as an effective wound healing agent in the wound care after anorectal surgery

Publication date: Available online 27 October 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Yating Wang, Yinghong Qiao, Pei Wang, Qiang Li, Chaofeng Xia, Man Ju
Nowadays biological mediated syntheses of metal nanoparticles were utilized for various life caring applications. Our research group utilized Delonix elata leaf aqueous extract for the synthesis of silver nanoparticles. Further the synthesized silver nanoparticles were subjected for various characterization techniques which resulted in spherically agglomerated with biological components entrapped in it and also with average particle size of 36nm were studied and reported. Later the synthesized silver nanoparticles were subjected for wound healing property by size of measured lessions and body weight which results in better wound healing property were studied and discussed.

Graphical abstract

A novel research model for evaluating sunscreen protection in the UV-A1

Publication date: Available online 28 October 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Sônia Aparecida Figueiredo, Dayane Cristina de Moraes, Fernanda Maria Pinto Vilela, Amanda Natalina de Faria, Marcelo Henrique dos Santos, Maria José Vieira Fonseca
The use of a broad spectrum sunscreen is considered one of the main and most popular measures for preventing the damaging effects of ultraviolet radiation (UVR) on the skin. In this study we have developed a novel in vitro method to assess sunscreens efficacy to protect calcineurin enzyme activity, a skin cell marker. The photoprotective efficacy of sunscreen products was assessed by measuring the UV-A1 radiation-induced depletion of calcineurin (Cn) enzyme activity in primary neonatal human dermal fibroblast (HDFn) cell lysates. After exposure to 24J/cm² UV-A1 radiation, the sunscreens containing larger amounts of UV-A1 filters (brand B), the astaxanthin (UV-A1 absorber) and the Tinosorb® M (UV-A1 absorber) were capable of preventing loss of Cn activity when compared to the sunscreens formulations of brand A (low concentration of UV-A1 filters), with the Garcinia brasiliensis extract (UV-B absorber) and with the unprotected cell lysate and exposed to irradiation (Irradiated Control - IC). The Cn activity assay is a reproducible, accurate and selective technique for evaluating the effectiveness of sunscreens against the effects of UV-A1 radiation. The developed method showed that calcineurin activity have the potential to act as a biological indicator of UV-A1 radiation-induced damages in skin and the assay might be used to assess the efficacy of sunscreens agents and plant extracts prior to in vivo tests.

Graphical abstract

Biocompatible nanocomposite of TiO2 incorporated bi-polymer for articular cartilage tissue regeneration: A facile material

Publication date: Available online 28 October 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Lei Cao, Xiaofeng Wu, Qiugen Wang, Jiandong Wang
The development and design of polymeric hydrogels for articular cartilage tissue engineering have been a vital biomedical research for recent days. Organic/inorganic combined hydrogels with improved surface activity have shown potential for the repair and regeneration of hard tissues, but have not been broadly studied for articular cartilage tissue engineering applications. In this work, bi-polymeric hydrogel composite was designed with the incorporation some quantities of stick-like TiO2 nanostructures for favorable surface behavior and enhancement of osteoblast adhesions. The microscopic investigations clearly exhibited that the stick-like TiO2 nanostructured materials are highly inserted into the PVA/PVP bi-polymeric matrix, due to the long-chain PVA molecules are promoted to physical crosslinking density in hydrogel network. The results of improved surface topography of hydrogel matrixes show that more flatted cell morphologies and enhanced osteoblast attachment on the synthesized nanocomposites. The crystalline bone and stick-like TiO2 nanocomposites significantly improved the bioactivity via lamellipodia and filopodia extension of osteoblast cells, due to its excellent intercellular connection and regulated cell responses. Consequently, these hydrogel has been enhanced the antibacterial activity against Staphylococcus aureus and Escherichia coli bacterial pathogens. Hence it is concluded that these hydrogel nanocomposite with improved morphology, osteoblast behavior and bactericidal activity have highly potential candidates for articular cartilage tissue regeneration applications.

Graphical abstract

Characterization of non-covalent binding of 6-hydroxyflavone and 5,7-dihydroxyflavone with bovine hemoglobin: Multi-spectroscopic and molecular docking analyses

Publication date: Available online 28 October 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Sourav Das, Alka Karn, Rubi Sarmah, Mostofa Ataur Rohman, Sudipta Koley, Pooja Ghosh, Atanu Singha Roy
Flavonoids are biologically imperative compounds used as anti-oxidants, anti-cancer, anti-bacterial agents etc. The current work reports comprehensive binding studies of two important flavonoids, 6-hydroxyflavone and 5,7-dihydroxyflavone (chrysin) with bovine hemoglobin (BHb) at 298K and 308K, in aqueous medium using UV-vis spectroscopy, steady state fluorescence, circular dichroism (CD) measurements, Fourier Transform infrared spectroscopy (FT-IR) and molecular docking studies. Both 6-hydroxyflavone and chrysin can quench the intrinsic fluorescence intensity of BHb via static quenching mechanism. The values of binding constant (Kb) for BHb-chrysin complex (3.177±0.992×10⁴M⁻¹, at 298K) was found to be greater than that of BHb-6-hydroxyflavone complex (2.874±0.863×10⁴M⁻¹, at 298K) and the Kb values decreased with the rise in temperature. The thermodynamic parameters indicated that hydrophobic forces and H-bonding play crucial role in BHb-6-hydroxyflavone complexation whereas electrostatic interaction plays the major role in the binding of BHb and chrysin. The binding distances from donor BHb to the acceptor ligands (6-hydroxyflavone and chrysin) were estimated using the Föster's theory and the possibility of non-radiative energy transfer from BHb to 6-hydroxyflavone/chrysin was observed. The ligands, 6-hydroxyflavone and chrysin induced conformational change around Trp residues in BHb as confirmed by synchronous and 3D fluorescence results. CD and FT-IR studies indicated that the % α-helicity of BHb was enhanced due to 6-hydroxyflavone/chrysin binding. Both the flavonoids showed remarkable inhibitory effect towards BHb glycation. Hydrophobic probe (8-anilino-1-naphthalenesulfonic acid, ANS) displacement and molecular docking studies revealed that the ligands bind within the hydrophobic pocket of BHb.

Graphical abstract

Ultraviolet Germicidal Efficacy as a Function of Pulsed Radiation Parameters Studied by Spore Film Dosimetry

Publication date: Available online 28 October 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Stefan Bauer, Hans Holtschmidt, Günter Ott
Disinfection by pulsed ultraviolet (UV) radiation is a commonly used method, e.g. in industry or medicine and can be carried out either with lasers or broadband UV radiation sources. Detrimental effects to biological materials depending on parameters such as pulse duration τ or pulse repetition frequency fp are well-understood for pulsed coherent UV radiation, however, relatively little is known for its incoherent variant. Therefore, within this work, it is the first time that disinfection rates of pulsed and continuous (cw) incoherent UV radiation studied by means of spore film dosimetry are presented, compared with each other, and in a second step further investigated regarding two pulse parameters. After analyzing the dynamic range of the Bacillus subtilis spore films with variable cw radiant exposures H=5–100Jm⁻² a validation of the Bunsen-Roscoe law revealed its restricted applicability and a 28% enhanced detrimental effect of pulsed compared to cw incoherent UV radiation. A radiant exposure H=50Jm⁻² and an irradiance E=0.5Wm⁻² were found to be suitable parameters for an analysis of the disinfection rate as a function of τ=0.5–10ms and fp=25–500Hz unveiling that shorter pulses and lower frequencies inactivate more spores. Finally, the number of applied pulses as well as the experiment time were considered with regard to spore film disinfection.

Graphical abstract

Photochemoprotective effect of a fraction of a partially purified extract of Byrsonima crassifolia leaves against UVB-induced oxidative stress in fibroblasts and hairless mice

Publication date: Available online 28 October 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Rebeca Oliveira de Souza, Geórgia de Assis Dias Alves, Ana Luiza Scarano Aguillera, Hervé Rogez, Maria José Vieira Fonseca
Ultraviolet B (UVB) irradiation increases the risk of various skin disorders, leading to inflammation and oxidative stress and thereby increasing the risk of skin photoaging and carcinogenesis. The use of photochemoprotectors such as natural products with antioxidant and anti-inflammatory properties represents a strategy for preventing UVB-induced skin damage. We investigated the photochemoprotective effect of a fraction of a partially purified extract of Byrsonima crassifolia leaves (BCF) on fibroblasts and hairless mice exposed to UVB radiation. The mixture of phenolic compounds in BCF prevented the decrease in reduced glutathione (GSH) levels in fibroblast cultures induced by UVB radiation more than some of their individual standards ((+)-catechin (CAT), epigallocatechin gallate and quercetin 3-O-β-d-glucopyranoside). Prepared gel formulations increased skin antioxidant activity, and BCF components and the CAT standard were retained in the HRS/J hairless mice epidermis 2h after application. Topical treatment with the BCF or CAT formulations (1%) significantly reduced the decrease in GSH levels and decreased myeloperoxidase activity and the secretion of pro-inflammatory cytokines IL-1β and IL-6 induced by UVB radiation (P<0.05), indicating that both BCF and CAT had anti-inflammatory effects. BCF inhibited UVB-induced metalloproteinase (MMP)-9 secretion/activity, whereas CAT had no effect on MMP-9 activity in the skin of treated animals. These results therefore suggest that BCF can be used as a photochemoprotective agent and antioxidant in the prevention/treatment of inflammation and oxidative stress of the skin induced by UVB radiation.

How the morphological properties of Mentha longifolia.(L.) Huds. may be affected by geographical differences

Publication date: Available online 28 October 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Hossein Ali Asadi-Gharneh, Mohammad Mohammadi, Mohammad Miransari
With respect to the benefits of medicinal plants for human health and their use as food, they are extensively being researched and planted in different parts of the world including Iran. Among the most important parameters, which may affect the growth and the yield of medicinal plants is their geographical (ecotype) properties. Accordingly, a research work was proposed to investigate the effects of 10 different regions or ecotypes on the morphological properties of pennyroyal [Mentha longifolia. (L.) Huds.] from the Lamiaceae family in one of the Iranian provinces, namely Ilam. According to the geographical characteristics of the experimental province, the longitudes were in the range of 60–65^°, the latitudes varied from 36–37^° and the heights above the sea level were in the range of 860–1410m. The experiment was a completely randomized block design in three replicates and for each plant ecotype, 20 plant samples in three replicates were collected. Different plant morphological properties related to plant stem, leaf, inflorescence, rhizome, and dry weight were determined. Data were subjected to analysis of variance and different plant statistical properties were determined. Using the Ward's method, the cluster analysis of data was also conducted and similar ecotypes were grouped. Data indicated the significant effects of regional (ecotype) differences on plant morphological properties and dry weight. The highest stem length was related to the Alamdar region (90cm), stem diameter and leaf number to Kolm region at 0.76cm and 128, respectively, leaf length to Chenarbashi at 4.07cm, leaf width to Helaesm at 2.83cm, inflorescence number and length to Sarab at 22.10 and 11.63cm, respectively, inflorescence width to Kolm at 1.04cm, rhizome length to Mishkhas at 11.00cm, and rhizome width to Kolm at 1.03cm. The highest dry weights were resulted by Siahkal (260g), Kolm (205g) and Chemarbashi (220g). Interestingly, stem length (22.17), inflorescence width (12.12) and rhizome length (27.11) indicated the least rate of coefficient of variation and had the highest effects on plant growth and yield production. Data indicated how geographical and soil properties (such as organic matter) may affect pennyroyal growth and yield. Such analyses can be used for the selection and the subsequent domestication of wild populations of pennyroyal with the highest efficiency.

Graphical abstract

Disinfection and healing effects of 222-nm UVC light on methicillin-resistant Staphylococcus aureus infection in mouse wounds

Publication date: Available online 27 October 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Kouji Narita, Krisana Asano, Yukihiro Morimoto, Tatsushi Igarashi, Michael R. Hamblin, Tianhong Dai, Akio Nakane
UVC radiation is known to be highly germicidal. However, exposure to 254-nm-UVC light causes DNA lesions such as cyclobutane pyrimidine dimers (CPD) in human cells, and can induce skin cancer after long-term repeated exposures. It has been reported that short wavelength UVC is absorbed by proteins in the membrane and cytosol, and fails to reach the nucleus of human cells. Hence, irradiation with 222-nm UVC might be an optimum combination of effective disinfection and biological safety to human cells. In this study, the biological effectiveness of 222-nm UVC was investigated using a mouse model of a skin wound infected with methicillin-resistant Staphylococcus aureus (MRSA). Irradiation with 222-nm UVC significantly reduced bacterial numbers on the skin surface compared with non-irradiated skin. Bacterial counts in wounds evaluated on days 3, 5, 8 and 12 after irradiation demonstrated that the bactericidal effect of 222-nm UVC was equal to or more effective than 254-nm UVC. Histological analysis revealed that migration of keratinocytes which is essential for the wound healing process was impaired in wounds irradiated with 254-nm UVC, but was unaffected in 222-nm UVC irradiated wounds. No CPD-expressing cells were detected in either epidermis or dermis of wounds irradiated with 222-nm UVC, whereas CPD-expressing cells were found in both epidermis and dermis irradiation with 254-nm UVC. These results suggest that 222-nm UVC light may be a safe and effective way to reduce the rate of surgical site and other wound infections.

Synergy of vaccination and agonist OX40 treatment—toward a mechanism-driven combination of glioma immunotherapy

See the article by Jahan et al on pages XX–YY.

Safety, Pharmacokinetics and Antitumor Response of Depatuxizumab Mafodotin as Monotherapy or in Combination with Temozolomide in Patients with Glioblastoma

Abstract

Background

We recently reported an acceptable safety and pharmacokinetic profile of depatuxizumab mafodotin (depatux-m), formerly called ABT-414, plus radiation and temozolomide in newly diagnosed glioblastoma (Arm A). The purpose of this study was to evaluate the safety and pharmacokinetics of depatux-m, either in combination with temozolomide in newly diagnosed or recurrent glioblastoma (Arm B) or as monotherapy in recurrent glioblastoma (Arm C).

Methods

In this multicenter phase 1 dose escalation study, patients received depatux-m (0.5-1.5 mg/kg in Arm B, 1.25 mg/kg in Arm C) every two weeks by intravenous infusion. Maximum tolerated dose (MTD), recommended phase 2 dose (RP2D) and preliminary efficacy were also determined.

Results

Thirty-eight patients were enrolled as of March 1, 2016. The most frequent toxicities were ocular, occurring in 35/38 (92%) patients. Keratitis was the most common grade 3 adverse event observed in 6/38 (16%) patients; thrombocytopenia was the most common grade 4 event seen in 5/38 (13%) patients. The MTD was set at 1.5 mg/kg in Arm B and was not reached in Arm C. RP2D was declared as 1.25 mg/kg for both arms. Depatux-m demonstrated a linear pharmacokinetic profile. In recurrent glioblastoma patients, the progression-free survival rate at 6 months was 30.8% and the median overall survival was 10.7 months. Best RANO responses were 1 complete and 2 partial responses.

Conclusions

Depatux-m alone or in combination with temozolomide demonstrated an acceptable safety and pharmacokinetic profile in glioblastoma. Further studies are currently underway to evaluate its efficacy in newly diagnosed (NCT02573324) and recurrent glioblastoma (NCT02343406).

Towards global consensus on core outcomes for Hidradenitis Suppurativa research: An update from the HISTORIC consensus meetings I and II

Abstract

Background

A Core Outcomes Set (COS) is an agreed minimum set of outcomes that should be measured and reported in all clinical trials for a specific condition. Hidradenitis suppurativa (HS) has no agreed upon COS. A central aspect in the COS development process is to identify a set of candidate outcome domains from a long list of items. Our long list had been developed from patient interviews, a systematic review of literature and a health care professionals (HCPs) survey and initial votes had been cast in two e-Delphi surveys. In this manuscript, we describe two in-person consensus meetings of Delphi participants designed to ensure an inclusive approach to generation of domains from related items.

Objectives

The main objectives were to consider which items from a long list of candidate items to exclude and which to cluster into outcome domains.

Methods

The study used an international and multi-stakeholder approach, involving patients, dermatologist, surgeons, the pharmaceutical industry and medical regulators. The study format was a combination of formal presentations, small group work based on nominal group theory and a subsequent online confirmation survey.

Results

41 individuals from 13 countries and four continents participated. Nine items were excluded and there was consensus to propose seven domains: disease course, physical signs, HS-specific quality of life, satisfaction, symptoms, pain, and global assessment.

Conclusions

The HISTORIC consensus meetings I and II will be followed by further e-Delphi rounds to finalize the core domain set, building on the work of the in-person consensus meetings.

This article is protected by copyright. All rights reserved.

Reirradiation of Skull Base Tumors With Advanced Highly Conformal Techniques

Abstract

Purpose of Review

Skull base reirradiation is challenging due to complex anatomy, enrichment of treatment-resistant clonogens, and increased risk of severe treatment complications. Without local therapy, early mortality is certain and tumor progression can result in debilitating symptoms. Modern radiotherapy advancements, such as image-guided radiation therapy (IGRT), intensity-modulated radiation therapy (IMRT), particle therapy, and stereotactic radiation therapy (SRT), are attractive for skull base reirradiation.

Recent Findings

Although limited by their retrospective nature and heterogeneous patient populations, several studies have demonstrated that reirradiation with these highly conformal techniques is feasible. Compared to IMRT or particle therapy reirradiation, SRT reirradiation appears promising with lower toxicity and increased convenience.

Summary

Here, we provide thorough explanations for each technology and summarize the most relevant and recent studies, with particular attention to efficacy and toxicity. Skull base reirradiation using these extremely conformal therapy techniques requires meticulous treatment planning and should be delivered by experienced teams.

Treatment for Malignant Pheochromocytomas and Paragangliomas: 5 Years of Progress

Abstract

Purpose of Review

The purpose of this manuscript is to review the progress in the field of therapeutics for malignant pheochromocytomas and sympathetic paraganglioma (MPPG) over the past 5 years.

Recent Findings

The manuscript will describe the clinical predictors of survivorship and their influence on the first TNM staging classification for pheochromocytomas and sympathetic paragangliomas, the treatment of hormonal complications, and the rationale that supports the resection of the primary tumor and metastases in patients with otherwise incurable disease. Therapeutic options for patients with bone metastasis to the spine will be presented. The manuscript will also review chemotherapy and propose a maintenance regimen with dacarbazine for patients initially treated with cyclophosphamide, vincristine, and dacarbazine. Finally, the manuscript will review preliminary results of several phase 2 clinical trials of novel radiopharmaceutical agents and tyrosine kinase inhibitors.

Summary

MPPGs are very rare neuroendocrine tumors. MPPGs are usually characterized by a large tumor burden, excessive secretion of catecholamines, and decreased overall survival. Recent discoveries have enhanced our knowledge of the pathogenesis and phenotypes of MPPG. This knowledge is leading to a better understanding of the indications and limitations of the currently available localized and systemic therapies as well as the development of phase 2 clinical trials for novel medications.

Index des auteurs

Publication date: Available online 28 October 2017
Source:Annales de Dermatologie et de Vénéréologie

Programme des communications orales

Publication date: Available online 28 October 2017
Source:Annales de Dermatologie et de Vénéréologie

Incidence and relative survival of melanoma in children and adolescents in the Netherlands, 1989-2013

Abstract

Background

Melanoma is rare in the first two decades of life. Trends in incidence differ across countries.

Objective

To describe incidence and relative survival of children and adolescents with melanoma in the Netherlands for children (0 through 11 years) and adolescents (12 through 19 years) separately. We hypothesized that adolescent melanoma increased in contrast to childhood melanoma, possibly due to a difference in cancer biology and sun exposure patterns.

Methods

Data on all patients of 0-19 years diagnosed between 1989-2013 with histologically confirmed cutaneous invasive melanoma were retrieved from the Netherlands Cancer Registry (NCR). Incidence trends were analyzed with Joinpoint regression. Relative survival analysis was performed.

Results

Between 1989 and 2013, 80 children and 544 adolescents with melanoma were registered in the NCR. Median age at diagnosis was 17 years (IQR 15-18); the female to male ratio was 1.7:1 Statistically significant incidence trends were found in the older age group (12-19 years): an increasing incidence since 1991 (annual percentage change [APC] 3.2%, 95%CI 1.3-5.1) followed by a decrease from 2005-2013 (APC -4.9%, 95%CI -9.6-0.0). No incidence trends for childhood melanoma were observed (APC 0.3%, 95% CI -3.0-3.8%). Relative survival at 1, 5 and 10 years was 98% (95% CI 97-99%), 94% (95% CI 92-96%) and 90% (95% CI 87-92%) respectively. Survival was worse in males and higher Breslow thickness.

Conclusion

Melanoma is very rare under the age of 12 with stable incidence rates. In comparison to childhood melanoma, melanomas in adolescents are more common with a decreasing trend in the past decade. Male sex and increasing Breslow thickness are associated with worse survival in pediatric melanoma patients.

This article is protected by copyright. All rights reserved.

Koebner's sheep in Wolf's clothing: does the isotopic response exist as a distinct phenomenon?

Abstract

Until 1995, a case of psoriasis developing within the dermatome of a healed herpes zoster was taken as a Koebner phenomenon. In this year, however, the term "isotopic response" was introduced by Wolf et al. to describe "the occurrence of a new skin disorder at the site of another, unrelated and already healed skin disease", thus appearing "on apparently unaffected and healthy skin." Initially, the term was mainly related to herpes zoster, but today the name "Wolf's isotopic response" is used to include a plethora of other triggering factors such as healed cutaneous leishmaniasis, tinea, or varicella. For obvious reasons, such triggering factors cannot be taken as examples of "unaffected and healthy skin". Notably, the authors themselves have categorized the dermatome of a healed herpes zoster as a "vulnerable area". In a recent commentary, Wolf et al. have expanded the definition of healed skin diseases triggering an "isotopic response". They now included "scars, pigment changes, color changes or various other minimal changes by the first disease." Hence, there is no clear-cut criterion to distinguish the isotopic response from a Koebner reaction. Wolf et al. even argue that, if the triggered disorder precedes the appearance of generalized skin lesions, then it is not a Koebner reaction but "Wolf's isotopic response". In our view, such definition is unacceptable. All reactions of this kind represent examples of a Koebner phenomenon. Accordingly, the "isotopic response" should today be taken as a historical error.

This article is protected by copyright. All rights reserved.

Oral manifestations as the main feature of late-onset recessive dystrophic epidermolysis bullosa

Abstract

Dystrophic epidermolysis bullosa (EB) is a heterogeneous group of inherited blistering diseases with skin cleavage beneath the basement membrane caused by mutations in COL7A1, encoding collagen VII (1). Clinical features include skin and mucosal blistering and scarring, and cover a broad range of degrees of severity. Clinical manifestations of severe generalized dystrophic EB due to loss-of-function mutations are typical, allowing a clinical diagnosis.

This article is protected by copyright. All rights reserved.

Reply to - Chronic exposure to tetracyclines and subsequent diagnosis for non-melanoma skin cancer in a large Mid-Western US population

Abstract

We thank Drs Nwabudike and Tatu for their interest in our recently published report "Chronic exposure to tetracyclines and subsequent diagnosis for non-melanoma skin cancer in a large Midwestern U.S. patient population" [1]. In their correspondence, Nwabudike and Tatu [2] raised some interesting and thought-provoking questions.

This article is protected by copyright. All rights reserved.

Sporotrichosis transmitted by a cockatiel (Nymphicus hollandicus)

Abstract

Sporotrichosis is caused by dimorphic, pathogenic species from the genus Sporothrix, which are found in nature as saprophytes in decaying vegetation and soil. Classic transmission occurs after traumatic inoculation while manipulating contaminated plant material, and zoonotic transmission is uncommon. The genus Sporothrix contains relevant species with diverse clinical features, infection routes and virulence traits.

This article is protected by copyright. All rights reserved.

Ultrastructure of Acrokeratoelastoidosis

Abstract

Acrokeratoelastoidosis (AKE) is a genodermatosis characterized by small, firm papules or plaques on the sides of the hands and feet ¹, it was first described in 1953 by Costa, in a Brazilian patient. It is a rare disease, both autosomal dominant and sporadic forms have been observed ². It is characterized by multiple hyperkeratotic papules on the palms, soles, and dorsum of the hands and feet.

This article is protected by copyright. All rights reserved.

Dermatological moulage collections in the Nordic countries

Abstract

Background

The art of producing and acquiring dermatological wax models, moulages, flourished all over Europe in the beginning of the twentieth century, whereas very little is known about the existence of moulage collections in the Nordic countries.

Objective

The aim of this paper is to elucidate the presence, the origin, the production place, the use and the condition of dermatological moulage collections in the Nordic countries.

Methods

In each Nordic country, an extensive survey was undertaken during spring 2016. Dermatological departments, museums with medical collections, persons assumed to have specific information about wax moulages as well as secondary sources were contacted and interviewed.

Results

Several hitherto undescribed collections have survived in each country, most however damaged and in disrepair. One Danish and part of a Finnish collection have been restored. Only few moulages are exhibited some have been photographed and digitalized. Denmark and Sweden have had a local moulage production.

Responses to the survey indicate that the result covers all collections of dermatological moulages in the Nordic countries, though some moulages may remain in private collections unknown to the authors, or uncatalogued in museums.

Conclusion

Moulages are medical gems from bygone days before modern technology facilitated new means of communication. Restoration and appropriate storing should be considered for at least selected items from the Nordic collections.

This article is protected by copyright. All rights reserved.

Body mass index (BMI) and body surface area (BSA) in scleroderma patients

Abstract

Dysfunctions of the digestive tract in the course of systemic sclerosis were observed in as many as 90% cases [1]. It causes fluctuations of body composition and consequently lead to body mass disorders. Among the methods of assessing the nutritional condition, the most traditional is BMI (Body Mass Index) technique. Moreover, the BSA (Body Surface Area) is also used.

This article is protected by copyright. All rights reserved.

A severe case of mango dermatitis

Abstract

A 27-year-old Japanese woman visited our hospital with eruptions on the lips, which had appeared two days after she took acetaminophen. At day 15, her lips were severely swollen with erosions, most of which were covered with dense crusts (Figure 1). Clinically, Stevens–Johnson syndrome due to acetaminophen was suspected. However, the drug-induced lymphocyte stimulation test for the reagent was negative (stimulation index: 156%; normal: < 179%), and the eruption did not recur after she resumed acetaminophen.

This article is protected by copyright. All rights reserved.

Response to - Chronic exposure to tetracyclines and subsequent diagnosis for non-melanoma skin cancer in a large Mid-Western US population

Abstract

I would first of all like to begin by congratulating the authors on their work¹, which, with the large population analysed, has the potential to pertinently contribute to answering the question of risk of non-melanoma skin cancer (NMSC) with tetracycline use. Certain questions arise from a reading of this work, which I would request of the authors to clarify for all readers.

This article is protected by copyright. All rights reserved.

Planning of skull reconstruction based on a statistical shape model combined with geometric morphometrics

Abstract

Purpose

Virtual reconstruction of large cranial defects is still a challenging task. The current reconstruction procedures depend on the surgeon's experience and skills in planning the reconstruction based on mirroring and manual adaptation. The aim of this study is to propose and evaluate a computer-based approach employing a statistical shape model (SSM) of the cranial vault.

Methods

An SSM was created based on 131 CT scans of pathologically unaffected adult crania. After segmentation, the resulting surface mesh of one patient was established as template and subsequently registered to the entire sample. Using the registered surface meshes, an SSM was generated capturing the shape variability of the cranial vault. The knowledge about this shape variation in healthy patients was used to estimate the missing parts. The accuracy of the reconstruction was evaluated by using 31 CT scans not included in the SSM. Both unilateral and bilateral bony defects were created on each skull. The reconstruction was performed using the current gold standard of mirroring the intact to the affected side, and the result was compared to the outcome of our proposed SSM-driven method. The accuracy of the reconstruction was determined by calculating the distances to the corresponding parts on the intact skull.

Results

While unilateral defects could be reconstructed with both methods, the reconstruction of bilateral defects was, for obvious reasons, only possible employing the SSM-based method. Comparing all groups, the analysis shows a significantly higher precision of the SSM group, with a mean error of 0.47 mm compared to the mirroring group which exhibited a mean error of 1.13 mm. Reconstructions of bilateral defects yielded only slightly higher estimation errors than those of unilateral defects.

Conclusion

The presented computer-based approach using SSM is a precise and simple tool in the field of computer-assisted surgery. It helps to reconstruct large-size defects of the skull considering the natural asymmetry of the cranium and is not limited to unilateral defects.

Validity and feasibility of the Wound-QoL questionnaire on health-related quality of life in chronic wounds

Abstract

Chronic wounds have a major socio-economic impact due to their frequency, chronicity and societal costs. Patients experience substantial quality of life (QoL) impairments. The use of questionnaires for a continuous assessment of quality of life and resulting interventions to improve the situation of the individual are an important cornerstone of a guideline-based wound care. The aim of this study was to investigate the validity of the Wound-QoL questionnaire.

Patients with chronic wounds from two different centers were included in the prospective study. All patients completed the Wound-QoL questionnaire and 2 other QoL questionnaires (European Quality of Life-5 Dimensions, EQ-5D, and Freiburg Life Quality Assessment for wounds, FLQA-wk) at baseline and at 2 more time points (4 and 8 weeks, respectively). Wound status was defined with an anchor question.

227 patients (48.5% women) participated in the study. Mean age was 66.9 (range 17 - 96, median 69.5). Indications were venous leg ulcers (40.1%), pyoderma gangraenosum (14.1%), diabetic or ischaemic foot ulcers (5.3%), pressure ulcers (2.6%) and other aetiologies (37.9%). Wound-QoL showed good internal consistency, with high Cronbach's alpha in all the subscales and in the global scale in all time points (> 0.8). Convergent validity was satisfactory since there was a significant (p < 0.001) good correlation with EQ-5D (range = 0.5 - 0.7) and FLQA-wk global score (r > 0.8) at every time point. Responsiveness was high, too.

Wound- QoL is a simple, valid tool for the longitudinal assessment of QoL in patients with chronic wounds. This questionnaire is suitable for use in clinical trials, quality of care studies and in clinical routine. This article is protected by copyright. All rights reserved.

The framing of research questions using the PICOT format in randomized controlled trials of venous ulcer disease is sub-optimal: a systematic survey

Abstract

Despite several publications on venous ulcers, there is still a lack of evidence from randomized controlled trials (RCTs) to support certain treatments for patients with this disorder. Well-designed research questions using the PICOT (Population; Intervention; Comparator; Outcome; Time-frame) format in RCTs can improve the quality of research. The objectives of this study were to assess how the PICOT format is used to frame research questions in RCTs published on venous ulcer disease and to determine the factors associated with better adherence to the PICOT format. We conducted a systematic survey of RCTs on venous ulcers published in the PubMed database between January 2009 and May 2016. All RCTs published in English addressing therapeutic interventions for venous ulcer disease in human subjects were included. We examined whether the five elements of the PICOT format were used in formulating the research question and scored them between 0 and 5. The primary outcome of this systematic survey was the percentage of studies that adequately reported all 5 PICOT elements. Eighty-five (85) RCTs were included with median PICOT score of 3 (IQR = 1.5). Four elements of PICOT were present in 28 reports (32.9%) and only 2 RCTS (2.3%) reported all the PICOT elements. Population and intervention were often appropriately described, in (70/85) 82.4% and (83/85) 97.6% of the studies, respectively; however, comparison intervention and outcome were presented in only (53/85) 62.3% and (48/85) 56.5% of studies, respectively. Very few RCTs (7.1%; 6/85) reported the study time-frame. No journal or RCT characteristics were found to be significantly associated with better reporting. Use of the PICOT format to frame research questions in RCTs published on venous ulcers is sub-optimal, and our study reinforces the importance of framing a good research question to improve the design of trials and quality of evidence in venous ulcer disease. This article is protected by copyright. All rights reserved.

Review of Tony Wall and David Perrin: Slavoj Žižek: A Žižekian Gaze at Education

International Law, Institutional Moral Reasoning, and Secession

Abstract

This paper argues for the superiority of international law's existing ban on unilateral secession over its reform to include either a primary or remedial right to secession. I begin by defending the claim that secession is an inherently institutional concept, and that therefore we ought to employ institutional moral reasoning to defend or criticize specific proposals regarding a right to secede. I then respond to the objection that at present we lack the empirical evidence necessary to sustain any specific conclusion regarding an international legal right to secession. Specifically, I argue that we ought to adopt a precautionary approach, and that such an approach justifies giving no weight to promoting political self-determination per se when considering whether to reform international law governing secession. I conclude with several reasons to think that even a remedial right to unilateral secession will detract from, not enhance, the international legal order's ability to promote peace and human rights.

A Randomized Phase 3 Study Evaluating the Efficacy of Single-dose NEPA, a Fixed Antiemetic Combination of Netupitant and Palonosetron, Versus an Aprepitant Regimen for Prevention of Chemotherapy-induced Nausea and Vomiting (CINV) in Patients Receiving Highly Emetogenic Chemotherapy (HEC)

Abstract

Background

Co-administration of multiple antiemetics that inhibit several molecular pathways involved in emesis is required to optimize CINV control in patients receiving highly emetogenic chemotherapy (HEC). NEPA, a fixed combination of a highly selective NK1 receptor antagonist (RA), netupitant (300 mg), and the pharmacologically distinct 5-HT3RA, palonosetron (PALO 0.50 mg), has shown superior CINV prevention compared to PALO in cisplatin and anthracycline/cyclophosphamide-based settings. This study is the first head-to-head comparison of NEPA versus an aprepitant (APR)/granisetron (GRAN) regimen.

Patients and methods

This randomized, double-blind Phase 3 study conducted in Asia was designed with the primary objective to demonstrate non-inferiority of a single oral dose of NEPA compared with a 3-day oral APR/GRAN regimen in chemotherapy-naïve patients receiving cisplatin-based HEC. All patients also received oral dexamethasone (DEX) on days 1-4. The primary efficacy endpoint was complete response (CR: no emesis/no rescue medication) during the overall (0-120 h) phase. Non-inferiority was defined as a lower 95% CI greater than the non-inferiority margin set at -10%. Secondary efficacy endpoints included no emesis, no rescue medication, and no significant nausea (NSN).

Results

Treatment groups were comparable for the 828 patients analyzed: predominantly male (71%); mean age 54.5 years; ECOG 0-1 (98%); lung cancer (58%). NEPA demonstrated non-inferiority to APR/GRAN for overall CR [NEPA 73.8% vs APR/GRAN 72.4%, 95%CI (-4.5%, 7.5%)]. No emesis [NEPA 75.0% vs APR/GRAN 74.0%, 95%CI (-4.8%, 6.9%)] and NSN rates [NEPA 75.7% vs APR/GRAN 70.4%, 95%CI (-0.6%, 11.4%)] were similar between groups, but significantly more NEPA patients did not take rescue medication [NEPA 96.6% vs APR/GRAN 93.5%, 95%CI (0.2%, 6.1%)]. NEPA was well tolerated with a similar safety profile to APR/GRAN.

Conclusions

In this first study comparing NK1RA regimens and DEX, NEPA administered only on day 1 was non-inferior to a 3-day oral APR/GRAN regimen in preventing CINV associated with HEC.

Safety and efficacy of alternating treatment with EP2006, a filgrastim biosimilar, and reference filgrastim: a phase 3, randomised, double-blind clinical study in the prevention of severe neutropenia in patients with breast cancer receiving myelosuppressive chemotherapy

Abstract

Background

In 2015, the biosimilar filgrastim EP2006 became the first biosimilar approved by the US Food and Drug Administration (FDA) for commercial use in the United States, marketed as Zarxio®. This phase 3 randomised, double-blind registration study in patients with breast cancer receiving (neo)adjuvant myelosuppressive chemotherapy (TAC; docetaxel+doxorubicin+cyclophosphamide) compares reference filgrastim, Neupogen^®, with two groups receiving alternating treatment with reference and biosimilar every other cycle.

Patients and methods

A total of 218 patients receiving 5 µg/kg/day filgrastim over six chemotherapy cycles were randomised 1:1:1:1 into four arms. Two arms received only one product, biosimilar or reference (unswitched), and two arms (switched) received alternating treatments every other cycle (biosimilar then reference or vice versa over six cycles). Since the switch occurred from Cycle 2 onwards, this analysis compared pooled switched groups to the unswitched reference group for efficacy during Cycles 2─6. Safety was also assessed. Non-inferiority in febrile neutropenia (FN) rates between groups for Cycles 2─6 was shown if 95% confidence intervals (CIs) were within a pre-defined margin of –15%.

Results

A total of 109 patients switched treatment, and 52 patients received reference in all cycles. Baseline characteristics were similar between groups. The incidence of FN was 0% (reference) versus 3.4% (n=3, switched) across Cycles 2–6, with a difference of –3.4% (95% CI: –9.65–4.96), showing non-inferiority. Infections occurred in 9.3% (switched) versus 9.9% (reference). Hospitalisation due to FN was low (one patient in Cycle 6; switched). Adverse events related to filgrastim were reported in 42.1% (switched) versus 39.2% (reference) (all cycles). Musculoskeletal/connective tissue disorders related to filgrastim occurred in 35.5% (switched) versus 39.2% (reference) (all cycles), including bone pain (30.8% versus 33.3%). No neutralising antibodies were detected.

Conclusions

There were no clinically meaningful results regarding efficacy, safety or immunogenicity when switching from reference to biosimilar filgrastim/EP2006, or vice versa.

Characterization of male breast cancer: Results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program

Abstract

Background

Male breast cancer (BC) is rare, managed by extrapolation from female BC. The International Male BC Program aims to better characterize and manage this disease. We report the results of part 1, a retrospective-joint-analysis of cases diagnosed during a 20-year-period.

Methods

Patients with follow-up and tumor samples, treated between 1990-2010, in 93 centers/nine countries. Samples were centrally analyzed in three labs (UK, NL, US).

Results

Of 1822 patients enrolled, 1483 were analyzed; 63.5% were diagnosed between 2001-2010, 57 (5.1%) had metastatic disease (M1). Median age at diagnosis: 68.4 years. Of 1054 M0 cases, 56.2% were node-negative (N0) and 48.5% had T1 tumors; 4% had breast conserving surgery (BCS), 18% sentinel lymph-node biopsy; half received adjuvant radiotherapy; 29.8% (neo)adjuvant chemotherapy and 76.8% adjuvant endocrine therapy (ET), mostly tamoxifen (88.4%). Per central pathology, for M0 tumors: 84.8% ductal invasive carcinomas, 51.5% grade 2; 99.3% ER-positive; 81.9% PR-positive; 96.9% AR-positive (ER, PgR or AR Allred score ≥3); 61.1% Ki67 expression low (<14% positive cells); using IHC surrogates, 41.9% were Luminal-A-like, 48.6% Luminal-B-like/HER-2-negative, 8.7% HER-2-positive, 0.3% triple negative. Median follow-up: 8.2 years (0·0-23·8) for all, 7.2 years (0·0 -23·2), for M0, 2.6 years (0·0-12·7) for M1 patients. A significant improvement over time was observed in age-corrected-breast-cancer-mortality. Breast-cancer-specific-mortality was higher for men <50 years. Better OS and RFS were observed for highly-ER + (p = 0·001), highly-PR + (p = 0·002), highly-AR+ disease (p = 0·019). There was no association between OS/RFS and HER-2 status, Ki67, IHC subtypes nor grade.

Conclusions

Male BC is usually ER, PR, and AR positive, Luminal B-like/HER2-negative. 56% patients had T1 tumors but only 4% had BCS. ER was highly positive in > 90% of cases but only 77% received adjuvant ET. ER, PR, and AR were associated with OS and RFS, while grade, Ki67, and IHC surrogates were not. Significant improvement in survival over time was observed.

Hypercalcemia Secondary to Silicone Breast Implant Rupture: A Rare Entity to Keep in Mind

No abstract available

Assessment of correlation between time period and risk of fat embolism after liposuction: Animal model.

Related Articles

Assessment of correlation between time period and risk of fat embolism after liposuction: Animal model.

Arch Plast Surg. 2017 Oct 27;:

Authors: Lim KR, Cho JM, Yoon CM, Lee KC, Lee SY, Ju MH

Abstract
Background: Liposuction has become one of the most frequently performed operation among the aesthetic surgical field recently. Fat embolism syndrome after liposuction is overlooked or underestimated easily. Occasionally, fulminating fat embolism syndrome could be developed and lead to critical situation within 2-3 days after lipoplasty. Time period changes in amount of circulating fat particle and histology of major organs are not studied yet.
Methods: This study was conducted using 18 male Sprague Dawley rats aged 12weeks and weighing 500-628g (562g on average). Fifteen rats were used as experimental group and three as a control group. Under general anesthesia, tumescent technique liposuction was performed at the lateral flank areas and abdomen for 1 hour. Blood, lung and brain tissue specimens were obtained at 1hr, 1 day and 2 days after liposuction procedure.
Results: The average number of fat particle in the blood specimen was 25,960/dl for the 1 hour group, 111,100/dl for the 24 hour group and 21,780/dl for the 48 hour group. The differences between study groups were significant statistically. Both intra and extravascular fat particles with inflammation were seen in all 15 rats, as were inflammatory cell infiltration, hemorrhage and consolidation with shrinkage of the lung alveoli.
Conclusions: These results imply that strong possibility of fat embolism syndrome after liposuction in real clinical practice and the first 24-48 hours after operation was found to be the most important for prevention of pulmonary embolism and progression to fulminating state.

PMID: 29076330 [PubMed - as supplied by publisher]

Multiple venous anastomoses decrease the need for intensive postoperative management in Tamai zone-I replantations.

Related Articles

Multiple venous anastomoses decrease the need for intensive postoperative management in Tamai zone-I replantations.

Arch Plast Surg. 2017 Oct 27;:

Authors: Ryu DH, Roh SY, Kim JS, Lee DC, Lee KJ

Abstract
Background: Venous anastomosis is an important component of digital replantation but is not always feasible in all cases, which can require external bleeding to prevent or treat venous congested in the replanted tissue. Our study evaluates the relationship between number of vein anastomosis and survival rate for Tamai zone I replantations.
Methods: A retrospective review was performed for all patients who received replantation of fingertip amputation between 2014 and 2016. Patient charts were reviewed for demographic information, mechanism of injury, number of arterial and venous anastomoses, and for the use of anticoagulation, external bleeding, and/or leeches. The cohort was divided into three groups depending on the number of venous anastomosis: no vein (Group 1), a single vein (Group 2), and two or more veins (Group 3). Survival rates and external bleeding rates were analyzed across the groups.
Results: The review identified 143 fingertip replantations among 134 patients. Overall replant survival rate was 94% (135/143). Replant failures were due equally to venous complications (n=4, 50%) and to arterial complications (n=4, 50%) Our analysis did not identify any correlation between the number of veins anastomosed and replant survival rate (p = 0.689). However, increased number of anastomosis was associated with significantly lower frequency of external bleeding (p = 0.017).
Conclusions: The number of venous anastomosis did not correlated with survival rates. However, higher number of venous anastomosis was associated with decreased need for external bleeding, which can represent a significant decrease in the need for intensive postoperative monitoring and leech therapy.

PMID: 29076329 [PubMed - as supplied by publisher]

Modified Toe Pulp Fillet Flap Coverage: Better Wound Healing and Satisfactory Length Preservation.

Related Articles

Modified Toe Pulp Fillet Flap Coverage: Better Wound Healing and Satisfactory Length Preservation.

Arch Plast Surg. 2017 Oct 27;:

Authors: Baek SO, Suh HW, Lee JY

Abstract
Background: Amputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic toe, preservation of the bony structure is important for preventing the collapse of adjacent digits into the amputated space. However, in the popular terminal Syme's amputation technique, partial amputation of the distal phalanx could cause increased tension on the wound margin. Herein, we introduce a new way to resect sufficient bony structure while maintaining the normal length, based on a morphological analysis of the toes.
Methods: Unlike the pulp of the finger in the distal phalanx, the toe has abundant tear-drop--shaped pulp tissue. The ratio of the vertical length to the longitudinal length in the distal phalanx was compared between the toes and fingers. Amputation was performed at the proximal interphalangeal joint level. Then, a mobilizable pulp flap was rotated 90 degrees cephalad to replace the distal soft tissue. This modified toe fillet flap was performed in 5 patients.
Results: The toe pulp was found to have a vertically oriented morphology compared to that of the fingers, enabling length preservation through cephalad rotation. All defects were successfully covered without marginal ischemia.
Conclusions: While conventional toe fillet flap coverage focuses on the principle of length preservation as the first priority, our modified method takes both wound healing and length into account. The fattiest part of the pulp is advanced to the toe tip, providing a cushioning effect and enough length to substitute for phalangeal bone loss. Our modified method led to satisfactory functional and aesthetic outcomes.

PMID: 29076328 [PubMed - as supplied by publisher]

Autogenous Fat Grafting for Mild-to-Moderate Postoperative Temporal Hollowing after Decompressive Craniectomy: 1-Year Follow-Up.

Related Articles

Autogenous Fat Grafting for Mild-to-Moderate Postoperative Temporal Hollowing after Decompressive Craniectomy: 1-Year Follow-Up.

Arch Plast Surg. 2017 Oct 27;:

Authors: Choi J, Choi H, Shin D, Kim J, Lee M, Kim S, Jo D, Kim C

Abstract
>Background: Temporal hollowing is inevitable after decompressive craniectomy. This complication affects self- perception and quality of life, and various techniques and materials have therefore been used to restore patients' confidence. Autologous fat grafting in postoperative scar tissue has been considered challenging because of the hostile tissue environment. However, in this study, we demonstrate that autologous fat grafting can be a simple and safe treatment of choice, even for postoperative depressed temporal scar tissue.
Methods: Autologous fat grafting was performed in 13 patients from 2011 to 2016. Fat was harvested according to Coleman's strategy, using a tumescent technique. Patient-reported outcomes were collected preoperatively and at 1-month and 1-year follow-ups. Photographs were taken at each visit.
Results: The thighs were the donor site in all cases for the first procedure. The median final volume of harvested fat was 29.4 mL (interquartile range [IQR], 24.0-32.8 mL). The median final volume of fat transferred into the temporal area was 4.9 mL on the right side (IQR, 2.5-7.1) and 4.6 mL on the left side (IQR, 3.7-5.9). There were no major complications. The patient-reported outcomes showed significantly improved self-perceptions at 1 month and at 1 year.
Conclusions: Despite concerns about the survival of grafted fat in scar tissue, we advise autologous fat grafting for patients with temporal hollowing resulting from a previous craniectomy.

PMID: 29076327 [PubMed - as supplied by publisher]

Orthognathic Treatment of Facial Asymmetry Due to Temporomandibular Joint Ankylosis.

Related Articles

Orthognathic Treatment of Facial Asymmetry Due to Temporomandibular Joint Ankylosis.

Arch Plast Surg. 2017 Oct 27;:

Authors: Gulsen A, Sibar S, Ozmen S

Abstract
The aim of this study was to present a case series of the orthognathic treatment of facial asymmetry due to temporomandibular joint (TMJ) ankylosis and to characterize the current treatment modalities through a literature review. Four patients who presented with facial asymmetry due to TMJ ankylosis between 2010 and 2014 were included in this study. TMJ ankylosis was surgically treated before bimaxillary surgery with advancement genioplasty in some of the cases. In 2 cases, 3-dimensional (3D) models were used for diagnosis and treatment planning, as 3D models are very important tools for planning surgical maneuvers. Aesthetically pleasant facial symmetry and a good facial profile were obtained in all the cases.

PMID: 29076326 [PubMed - as supplied by publisher]

A Shark Attack Treated in a Tertiary Care Centre: Case Report and Review of the Literature.

Related Articles

A Shark Attack Treated in a Tertiary Care Centre: Case Report and Review of the Literature.

Arch Plast Surg. 2017 Oct 27;:

Authors: Roy M, Plant M, Snell L

Abstract
Although uncommon, shark attacks can lead to devastating outcomes for victims. Surgeons also face unique challenges during operative management such as exsanguination, shock, specific injury patterns and infections. This case report presents the management of a 39-year-old previously healthy female attacked by a shark while on vacation in Mexico. The patient sustained severe injuries to her left arm and her left thigh. She was transferred to a Canadian institution after ambiguous operative management in Mexico and presented with no clear antibiotic coverage and a Volkman's contracture of the left upper extremity. In total, the patient underwent four washouts of wounds, two split-thickness skin grafts, one free anterolateral thigh flap, and one free transverse rectus abdominus myocutaneous flap for the reconstruction and salvage of the left lower extremity. This article highlights the specifics of this case and describes important points in managing these devastating injuries.

PMID: 29076325 [PubMed - as supplied by publisher]