Publication date: December 2017
Source:Actas Dermo-Sifiliográficas, Volume 108, Issue 10
Author(s): E. Serra Baldrich
Τρίτη 28 Νοεμβρίου 2017
En memoria del doctor Demetrio Luis Alvarado Moncayo
El libro blanco del cáncer de piel de la AEDV
Publication date: December 2017
Source:Actas Dermo-Sifiliográficas, Volume 108, Issue 10
Author(s): L. Ríos Buceta
Lipoblastoma en la extremidad inferior de un lactante. Un caso representativo
Publication date: Available online 28 November 2017
Source:Actas Dermo-Sifiliográficas
Author(s): L. Giraldo Mordecay, M.P. Novoa Candia, C.E. Torres Fuentes, A.M. Sastre Zuluaga
Tatuaje de fresa en 3D
Publication date: December 2017
Source:Actas Dermo-Sifiliográficas, Volume 108, Issue 10
Author(s): A. Imbernón-Moya, E. Fernández-Cogolludo, M.Á. Gallego-Valdés
Association of urinary concentrations of four chlorophenol pesticides with cardiometabolic risk factors and obesity in children and adolescents
Abstract
This study was undertaken to determine the association of four chlorophenol pesticides with cardiometabolic risk factors and obesity in children and adolescents. This cross-sectional study was conducted in 2016 on 242 children and adolescents, aged 6 to 18 years. The concentrations of 2,4-dichlorophenol (2,4-DCP), 2,5-dichlorophenol (2,5-DCP), 2,4,5-trichlorophenol (2,4,5-TCP), and 2,4,6-trichlorophenol (2,4,6-TCP) in the urine were examined and their association with indices of obesity and cardiometabolic risk factors was determined. Multivariate linear regression and multinomial logistic regression analyses were applied. Overall, 242 participants with mean (SD) ages of 11.3 (2.5) years completed the survey. After adjustment for confounders, a significant positive association was found between body mass index (BMI) z-score and waist circumference (WC) with 2,5-DCP (0.07 (95% CI 0.04, 0.1)) and 0.79 (95% CI 0.54, 1.03), respectively. A significant association of 2,4,5-TCP was only found with WC (0.23 (95% CI 0.0, 0.46), but the relationship with 2,4-DCP was not significant. 2,5-DCP had a significant relationship only with obesity (1.09 (95% CI 1.1, 1.19)), while 2,4-DCP and 2,4,5-TCP showed no significant correlation with overweight or obesity. 2,4-DCP showed a significant positive relationship with high density lipoprotein-cholesterol (HDL-C). Moreover, 2,5-DCP showed a significant negative relationship only with systolic blood pressure and 2,4,5-TCP had a statistically significant inverse association with total cholesterol and HDL-C (−0.71 (95% CI −0.98, −0.45)). This study suggests potential associations of chlorophenol pesticides with overweight, obesity, lipid profile, and blood pressure in children and adolescents. Longitudinal studies are necessary to assess the clinical impact of these findings.
Observed differentials in the levels of selected environmental contaminants among Mexican and other Hispanic American children, adolescents, adults, and senior citizens
Abstract
Starting with the 2007–2008 cycle, the National Health and Nutrition Examination Survey (NHANES) also oversampled Hispanics other than Mexicans (OHISP) making it possible to treat OHISP as a separate demographic group along with Mexican Americans (MAs), non-Hispanic whites (NHWs), and non-Hispanic blacks (NHBs). Yet, more often than not, OHISP have been merged with MA to form an all-Hispanic demographic group (HISP) thus limiting comparisons between NHW, NHB, and HISP. Consequently, for the first time, this study was undertaken to evaluate differences in the observed levels of selected environmental contaminants between MA and OHISP from five groups of environmental contaminants, namely, polycyclic aromatic hydrocarbons (PAHs), iodine uptake inhibitors (IUIs), environmental phenols (EPHs), priority pesticides (PPs), and perfluoroalkyl acids (PFAAs). Data for 2007–2010 from NHANES were used to conduct this study. OHISP children born in USA had higher levels of selected PAH metabolites than USA-born MA, and Mexican-born MA adolescents had higher levels of selected PAH metabolites than USA-born MA adolescents. USA-born adolescent MA had higher levels of selected parabens than USA-born adolescent OHISP, and OHISP adults born in another Spanish-speaking country had higher levels of selected parabens than USA-born OHISP adults. USA-born MA adults and seniors had higher levels of selected dichlorophenols than Mexico-born MA adults and seniors, respectively. Females had higher levels of selected PAH metabolites, EPHs, and PPs than males among children, adolescents, adults, and seniors, but the reverse was true for the levels of selected IUIs and PFAAs among adolescents and seniors. Smokers had higher levels of almost all PAH metabolites than non-smokers for adolescents, adults, and seniors. The same was true for urinary thiocynate for adolescents, adults, and seniors. OHISP is a multiracial multiethnic demographic group substantially different from MA with possibly different smoking behavior and with possibly differential levels of exposure to certain environmental contaminants and as such should be treated as a demographic group by itself.
Online education improves pediatric residents’ understanding of atopic dermatitis
Abstract
Background/Objectives
Pediatricians manage skin conditions such as atopic dermatitis (AD) but report that their dermatologic training is inadequate. Online modules may enhance medical education when sufficient didactic or clinical teaching experiences are lacking. We assessed whether an online module about AD improved pediatric residents' knowledge and changed their clinical management of AD.
Methods
Target and control cohorts of pediatric residents from two institutions were recruited. Target subjects took a 30-question test about AD early in their residency, reviewed the online module, and repeated the test 6 months and 1 year later. The control subjects, who had 1 year of clinical experience but had not reviewed the online module, also took the test. The mean percentage of correct answers was calculated and compared using two-sided, two-sample independent t tests and repeated-measures analysis of variance. For a subset of participants, clinical documentation from AD encounters was reviewed and 13 practice behaviors were compared using the Fisher exact test.
Results
Twenty-five subjects in the target cohort and 29 subjects in the control cohort completed the study. The target cohort improved from 18.0 ± 3.2 to 23.4 ± 3.4 correctly answered questions over 1 year (P < .001). This final value was greater than that of the control cohort (20.7 ± 4.5; P = .01). Meaningful differences in practice behaviors were not seen.
Conclusion
Pediatric residents who reviewed an online module about AD demonstrated statistically significant improvement in disease-specific knowledge over time and had statistically significantly higher scores than controls. Online dermatology education may effectively supplement traditional clinical teaching.
Analysis of the Strength of Legal Firearms Restrictions for Perpetrators of Domestic Violence and Their Association With Intimate Partner Homicide
Abstract
In this research, we estimate the association of firearm restrictions for domestic violence offenders with intimate partner homicides (IPHs), based on the strength of the policies. We posit that the association of firearm laws with IPHs depends on the laws': 1) breadth of coverage of high-risk individuals and situations restricted; 2) power to compel firearm surrender or removal from prohibited persons; and 3) systems of accountability that prevent prohibited persons from obtaining guns. We conducted a quantitative policy evaluation using annual state-level data from 1980 through 2013 for 45 US states. Based on the results of a series of robust negative binomial regression models with state fixed effects, domestic violence restraining order firearm prohibition laws are associated with 9% reductions in IPH. Statistically significant protective associations were evident only when restraining order prohibitions covered dating partners (−10%) and ex parte orders (−12%). Laws prohibiting access to those convicted of non-specific violent misdemeanors were associated with a 23% reduction in IPH rates; there was no association when prohibitions were limited to domestic violence. Permit-to-purchase laws were associated with 10% reductions in IPHs. These findings should inform policymakers considering laws to maximize protections against intimate partner homicide.Incidence and risk factors for deep surgical site infection after open reduction and internal fixation of closed tibial plateau fractures in adults
This study aimed to investigate the incidence and risk factors of deep surgical site infection (DSSI) during hospitalisation after closed tibial plateau fractures treated with open reduction and internal fixation (ORIF). We performed this retrospective study at a university-affiliated hospital with an advanced trauma centre. The data of adult patients with closed tibial plateau fractures treated with ORIF from January 2012 to February 2017 were extracted from the electronic medical records. Demographics, injury-related and surgery-related variables of DSSI and non-DSSI groups were compared by univariate test. Multivariate logistic analysis models were used to investigate the independent risk factors. In total, 676 patients with complete data met the inclusion criteria and were included, and of them, 17 developed DSSI (2.51%) during hospitalisation. Approximately 60% (9/17) of DSSI was caused by Staphylococcus aureus. Compared to the non-DSSI group, DSSI patients had a significantly longer stay in hospital (25.8 vs 15.2 days). Independent risk factors of DSSI identified by multivariate analysis were higher BMI (>26.0) (OR, 1.58; 95% CI, 1.09 to 3.27; P = 0.032), prolonged surgical duration (>138 min) (OR, 4.26; 95% CI, 1.54 to 11.19; P = 0.005) and current smoking (OR, 3.42; 95% CI, 1.47 to 8.62; P = 0.01). A relatively low incidence rate of DSSI (2.51%) was found in this study, and several significant risk factors were identified. Smoking cessation programmes should be implemented immediately after hospitalisation, especially for obesity and morbid obesity patients. Detailed and comprehensive preoperative assessment and a considerate operative plan should be guaranteed to reduce surgical duration.
Ethanol traces in natural waters checked using a new DMFC enzymatic device
Abstract
The use of fuels with strong percentage of ethanol that is done in countries such as Brazil and Australia causes a more and more relevant presence of traces of ethanol in natural waters. The ethanol present in these fuels seems to contribute to increase, through various mechanisms, the concentration of hydrocarbons in the same waters and soil. The ethanol content in natural waters must therefore be monitored frequently. It was therefore proposed a very simple innovative method, based on a catalytic fuel cell with the alcohol dehydrogenase enzyme immobilized in the anodic compartment of the device. The analytical performances of this new device were then evaluated by checking traces of alcohol in different types of natural waters (rain, river, and groundwater), with a good degree of precision and with an acceptable level of accuracy.
Correction to: Community reporting of ambient air polychlorinated biphenyl concentrations near a Superfund site
Abstract
The original version of this article unfortunately contains a mistake. The correct Author names should be Staci M. Rubin and Keri C. Hornbuckle.
Effect of simvastatin on sensorial, motor, and morphological parameters in sciatic nerve crush induced-neuropathic pain in rats
Abstract
The present study compares the effects of a low and high doses of simvastatin in a model of peripheral neuropathy by evaluating sensorial, motor, and morphological parameters. First, male Wistar rats were orally treated with vehicle (saline, 1 mL/kg), simvastatin (2 and 80 mg/kg) or morphine (2 mg/kg, s.c.), 1 h before 2.5% formalin injection. Neuropathic pain was induced by crushing the sciatic nerve, and mechanical and cold allodynia, nerve function, histology, MPO and NAG concentrations, as well as mevalonate induced-nociception were evaluated. Animals were orally treated with vehicle, simvastatin, or gabapentin (30 mg/kg) for 18 days. Simvastatin (2 and 80 mg/kg) reduced the inflammatory pain induced by formalin, but failed to decrease the paw edema. Mechanical allodynia was reduced by the simvastatin (2 mg/kg) until the 12th day after injury and until the 18th day by gabapentin. However, both simvastatin and gabapentin treatments failed in attenuated cold allodynia or improved motor function. Interestingly, both doses of simvastatin showed a neuroprotective effect and inhibited MPO activity without altering kidney and hepatic parameters. Additionally, only the higher dose of simvastatin reduced the cholesterol levels and the nociception induced by mevalonate. Our results reinforce the antinociceptive, antiallodynic, and anti-inflammatory effects of oral simvastatin administration, which can strongly contribute to the sciatic nerve morphology preservation. Furthermore, our data suggest that lower and higher doses of simvastatin present beneficial effects that are dependent and independent of the mevalonate pathway, respectively, without causing signs of nerve damage.
Free flap reconstruction for trauma in the early post-partum period
Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Rebecca A. Rollett, Helen E. Douglas, Philippa Jackson, Jonathan D. Wiper
We present the case of a patient who suffered significant polytrauma, fracturing her pelvis, femur and tibia and requiring emergency caesarian section of her 36-week old foetus. Forty eight hours later she underwent free flap reconstruction of her open tibial fracture. The issues involved in performing free flap surgery in the early postpartum period and specific surgical and pharmacological measures taken to overcome the physiological hypercoagulable state of post-partum patients are described along with a summary of the literature.
Silicone lip implant for augmentation in cleft lip
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): A. Paddle, M. Wordsworth, D. Atherton
Patients with a history of cleft lip repaired in childhood commonly present requesting upper lip revision to improve deficiency in the volume of the upper lip vermillion and disharmony with respect to the volume of the lower lip. There are a number of techniques available to address this issue, however some of these carry the risk of potential donor site morbidity and the longevity of the volume of enhancement achieved is often unpredictable. We describe six successful cleft lip augmentation cases using a silicone lip implant, a technique only previously reported in the aesthetic augmentation population, and show how in the right patient, this can be a rewarding reconstructive option.
Robotic nipple-sparing mastectomy with immediate reconstruction by robotically harvested latissimus dorsi muscle in a single position: cadaveric study
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Samuel Struk, Nicolas Leymarie, Jean-François Honart, Antoine Missistrano, Frédéric Kolb, Françoise Rimareix, Benjamin Sarfati
Review of follow-up requirements of low-risk squamous cell carcinomas after surgical excision
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Priyanka Chadha, Nihull Jakharia-Shah, Jenny Geh
Refining the cross-finger flap: considerations of flap insetting, aesthetics and donor site morbidity
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Chew-Wei Chong, Cheng-Hung Lin, Yu-Te Lin, Chung-Chen Hsu, Shih-Heng Chen
We described a laterally based cross-finger flap for reconstruction of soft tissue defects in the fingers. This modification enables coverage of volar or dorsal soft tissue defects at the distal, middle or proximal phalanx. From March 2015 to January 2017, a total of 12 patients (13 fingers) underwent soft tissue reconstruction of the fingers with a laterally based cross-finger flap. The flap dimensions ranged from 13 x 7 mm to 43 x 13 mm. Eleven of the 13 flaps survived completely. The two flap failures were attributed to injuries in the donor fingers, rendering the blood supply of the flaps unreliable. All donor sites were closed primarily without the need for skin grafting, negating the problem of donor site morbidity that is associated with skin graft harvesting. The laterally based cross-finger flap is a versatile flap with less donor site morbidity and better aesthetics than a conventional cross-finger flap. We described the design of the flap, as well as the advantages and disadvantages, in doing a laterally based cross-finger flap.
Analysis of the Correlation between Deformational Plagiocephaly and Neurodevelopment delay: methodological issues
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Saeid Safiri, Salman Khazaei, Erfan Ayubi
Long-term functional outcome in case series of tibial osteomyelitis reconstruction with free tissue transfer
Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Keisuke Takanari, Kazuhiro Toriyama, Miki Kambe, Ryota Nakamura, Yutaka Nakamura, Hideyoshi Sato, Katsumi Ebisawa, Satoshi Tsukushi, Yoshihiro Nishida, Yuzuru Kamei
Short correspondence: reverse lymphatic mapping without radioisotope in the surgical treatment of lymphedema
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Rachel E. Aliotta, Graham Schwarz
Post-operative care of VRAM flaps for perineal reconstruction
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): David Boccara, Kevin Serror, Samuel Levy, Maurice Mimoun, Marc Chaouat
The use of a ‘pocket’ printer to improve documentation and patient care
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): John A.G. Gibson, Thomas D. Dobbs, Emman J. Combellack, Iain S. Whitaker
Spreader graft placement: location, location, location
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Marc A. Seifman, Andrew L. Greensmith
Surgical-site infection following lymph node excision indicates susceptibility for lymphedema: a retrospective cohort study of malignant melanoma patients
Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Mads Gustaf Jørgensen, Navid Mohamadpour Toyserkani, Jørn Bo Thomsen, Jens Ahm Sørensen
Background and ObjectivesCancer-related lymphedema is a common complication following lymph node excision. Prevention of lymphedema is essential, as treatment options are limited. Known risk factors are firmly anchored to the cancer treatment itself; however potentially preventable factors such as seroma and surgical-site infection (SSI) have yet to be asserted.MethodsAll malignant melanoma patients treated with sentinel lymph node biopsy (SNB) and/or complete lymph node dissection (CLND) in the axilla or groin between January 2008 and December 2014 were retrospectively identified. Identified patients were followed until March 2017 for the incidence of lymphedema.ResultsWe identified 70 cases of extremity lymphedema following 640 SNB/CLND. SSI was an independent risk factor for developing lymphedema (HR 8.46, 95%CI 4.37-16.36, p < 0.001), whilst seroma was an independent risk factor for developing SSI (OR 6.92, 95%CI 4.11-12.54, p < 0.001). In addition, the risk of lymphedema was significantly larger following inguinal incisions compared to axillary incisions (HR 2.49, 95%CI 1.36-4.55, p < 0.05).ConclusionSSI was the greatest independent risk factor for developing lymphedema. Additionally, patients' that developed postoperative seroma were at an increased risk of also developing SSI. Future studies should examine if lymphedema can be prevented, by reducing seroma and SSI.
Analysis of the correlation between deformational plagiocephaly and neurodevelopment delay: methodological issues
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Mohammed Ahmed Hussein, Jinae Lee, Yong Oock Kim
Bleeding on the cutting edge; a systematic review of anticoagulant and antiplatelet continuation in minor cutaneous surgery
Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Alexander Isted, Lilli Cooper, R. James Colville
BackgroundAnticoagulant and antiplatelet (AC/AP) use is common and practice surrounding AC/AP continuation or cessation peri-operatively for minor cutaneous surgery lacks evidence-based consensus.ObjectiveTo determine the risks of haemorrhagic and thromboembolic complications associated with the continuation or cessation of AC/AP therapy in minor cutaneous surgery.MethodsA systematic literature search was conducted using PubMed, MEDLINE, Embase and CENTRAL, to identify all articles involving the use of AC/AP in patients undergoing minor cutaneous surgery, including skin grafts and local flaps. Eligible studies were randomised control trials, prospective studies and retrospective studies in the English language. Studies investigating free-flap repairs, oculoplastic surgery and hand surgery were excluded.Results30 studies included data from over 14,000 patients, of which more than 5,000 took regular AC/AP therapy. Thromboembolic events were rare but carry high morbidity and even mortality, and in these studies three events were associated with cessation of AC/AP. There was no increase in haemorrhagic complications in patients taking aspirin monotherapy, but evidence is conflicting regarding warfarin and clopidogrel monotherapy, which show a small increase in rate of bleeding complications. However, no increase in wound dehiscence, graft failure, wound infection or cosmetic outcome was seen. Too few studies investigated DOAC use to draw reliable conclusions. Data are sparse in comparing multiple versus single AC/AP regimens. Use of skin grafts or local flaps may have a greater complication rate than direct closure in patients on one or more AC/AP, but evidence is limited.ConclusionA case-by-case risk assessment is warranted in all patients but where possible, clinicians should prioritise meticulous haemostasis over cessation of agents.
Immediate nipple reconstruction during skin-sparing mastectomy utilising the nipple sharing technique and harvesting the nipple graft from the mastectomy specimen
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Agata Plonczak, Demitrios J. Hadiminas, Francis P. Henry, Simon H. Wood
Outcome measurement in plastic surgery
Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Justin C.R. Wormald, Jeremy N. Rodrigues
Outcome measurement in plastic surgery is often surgeon-centred, and clinician-derived. Greater emphasis is being placed on patient-reported outcomes (PROs), in which the patient's perspective is measured directly from them. Numerous patient-reported outcome measures (PROMs) have been developed in a range of fields, with a number of good quality PROMs in plastic surgery. They can be deployed to support diagnosis, disease severity determination, referral pathways, treatment decision-making, post-operative care and in determining cost-effectiveness. In order to understand the impact of disease and health interventions, appropriate PROMs are a logical choice in plastic surgery, where many conditions involve detriment of function or cosmesis. PROMS can be classified as disease-specific, domain-specific, dimension-specific, population-specific and generic. Choosing the correct outcome and measure can be nebulous. The two most important considerations are: is it suitable for the intended purpose? and how valid is it? Measurement that combines being patient-centred and also aligns with clinicians' understanding is achievable, and can be studied scientifically. Rational design of new PROMs and considered choice of measures is critical in clinical practice and research. There are a number of tools that can be employed to assess the quality of PROMs that are outlined in this overview. Clinicians should consider the quality of measures both in their own practice and when critically appraising evidence. This overview of outcome measurement in plastic surgery provides a tool set enabling plastic surgeons to understand, implement and analyse outcome measures across clinical and academic practice.
Aesthetic day surgery safety in a UK facility- a 4 year retrospective study and discussion of the literature
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): B. Strong, D. Sainsbury, P. Hodgkinson, M. Ragbir, N. Williams
Sentinel node biopsy in desmoplastic thin melanoma: histogenetic reccomandations
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Pusiol Teresa
A prospective, randomized-controlled pilot study comparing closed suction versus negative pressure drains for panniculectomy patients
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Marc E. Walker, Cynthia Tsay, P. Niclas Broer, Victor Z. Zhu, Tracy Sturrock, Reuben Ng, Leslie M. Scoutt, J. Grant Thomson, Stephanie L. Kwei
Serial excision with power-stretching of the skin in giant melanocytic nevi therapy
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Hans-Martin Häfner, Helmut Breuninger
Efficacy and safety of topical depigmenting agent in healthy human fair skin female volunteers: A single-arm study
Summary
Background
Skin hyperpigmentation is the darkening of skin due to the increased production of melanin in the body.
Objectives
To evaluate the efficacy and safety of a botanical-based Rosa E pigmentation serum in healthy fair skin female volunteers with wrinkles, skin tone, and pigmentation.
Methods
This was a single-arm, open label study conducted in healthy Indian females; 18 subjects aged 30-55, having fair Caucasian-like skin with at least 2 dark skin pigments with facial wrinkles diagnosed by dermatologist were selected. Rosa E pigmentation serum was applied twice a day for 84 days. Effect was evaluated by (i) instrumental technique (spectrophotometer® 2600D), (ii) clinically by dermatologist regarding product efficacy (skin tone, antiwrinkle, pigmentation), and (iii) volunteers self-evaluation.
Results
The L* value of spectrophotometer reading represents lightness in the skin pigment. Reduction in the pigment was reported from day 14, with significant reductions observed till day 84 compared with baseline. Significant (P < .0001) skin pigmentation lightening was seen on day 14 (1.11) vastly improving on day 84 (1.94) based on photographic assessments. The significant reduction in skin pigment was 76.85%, Felix von Luschan skin color score was 30.24% (P < .0001) with a 7.38-fold reduction in skin tone and 57% reduction in facial wrinkles at day 84 from baseline.
Conclusions
Rosa E pigmentation serum was found safe and effective in significant reduction in skin pigments, improvement of skin tone, and antiwrinkle properties instrumentally, clinically, and self-evaluation by volunteers. In these evaluations, best results were seen the longer the Rosa E was used.
Synechococcus plasticity under environmental changes
Abstract
Cyanobacteria are among the oldest photoautotrophic organisms on Earth, and have contributed to shaping the planet's biogeochemistry with their significant biomass and key metabolic activities. Synechococcus, the focus of this review, is one of the prevalent genera in the order Chroococcales, common in oceans and lakes and characterized by a coccoid unicellular or microcolony morphology. The evolution of its phycobilisomes is the key of the adaptation of this tiny photosynthetic cell to different light regimes and environmental conditions. Furthermore, Synechococcus strains are widely distributed from the equator to the poles, showing an extreme adaptability to high and low temperatures. Because of their structural plasticity and ecological adaptability, these cyanobacteria are particularly interesting in the current condition of fast climate change. Moreover, picocyanobacteria of the Synechococcus genus have a potentially vast impact on global cycles thanks to their significant role in the biogeochemical cycles of aquatic ecosystems. As increasing abundances are predicted for this genus worldwide, and in light of the connection between cyanobacteria and global change events, a better characterization of these organisms promises important and timely ecological insights. Here, I will summarize the morphological and genetic characteristics of Synechococcus strains and their distribution in freshwater lakes, also considering its marine counterpart.Antibiotic treatment disrupts bacterial communities in the colon and rectum of simian immunodeficiency virus-infected macaques
Abstract
Antibiotic therapies are known to disrupt gastrointestinal (GI) bacterial communities. HIV and pathogenic simian immunodeficiency virus (SIV) infections have also been associated with disrupted GI bacterial communities. We administered a combination antibiotic therapy to six SIV-infected rhesus macaques and collected colon biopsies, stool samples and rectal swabs before and after antibiotics, and evaluated the bacterial communities at each sample site using high-throughput 16S rRNA gene sequencing. The colon mucosa and stool samples displayed different bacterial communities, while the rectal swabs showed a mixture of the mucosal and stool-associated bacteria. Antibiotics disrupted the native bacterial communities at each sample site. The colon mucosa showed depleted abundances of the dominant Helicobacteraceae, while we found depleted abundances of the dominant Ruminococcaceae sp. in the stool. The rectal swabs showed similar trends as the colon mucosa, but were more variable. After the antibiotic treatment, there were increased abundances of similar taxa of facultative anaerobic bacteria, including Lactobacillaceae and Enterobacteriaceae at each sample site.Nicotinamide and skin cancer chemoprevention: The jury is still out
Abstract
Following the publication of the results of a Phase III trial, the administration of oral nicotinamide has been widely advocated as effective in non-melanoma skin cancer chemoprevention in high-risk individuals. However, I performed a Bayesian analysis of the reported findings and show there is insufficient evidence to demonstrate its efficacy, highlighting the significant probability that the positive conclusions drawn will not be reproducible. Given the potential widespread use of oral nicotinamide, future position statements regarding its efficacy are likely to require higher standards of evidence.
Assessment of three plant-based biodiesels using a Daphnia magna bioassay
Abstract
Biodiesel is an alternative fuel that is gradually replacing petroleum-based diesel use. Although biodiesel is considered friendlier to the environment, the potential toxic effects of biodiesel to aquatic organisms are still uncertain due to the wide range of feedstocks used to generate the fuel. The aquatic cladoceran Daphnia magna (D. magna) has been commonly used as a lethal and/or sub-lethal toxicological model organism in ecological risk assessments for contaminated water environments. In this work, we evaluated whether significant differences exist in the sensitivity of freshwater aquatic life to different biodiesels. The acute toxicity of three plant-based biodiesels was investigated using D. magna over a 96-h period. In addition, diesel fuel was tested as a reference. Increased immobility was observed as time progressed following exposure. Testing revealed of the four fuel products, diesel proved most toxic to D. magna, with half maximal effective concentration (EC50) values of 4.7 μg/mL (24 h) and 3.4 μg/mL (72 h). Among the biodiesels, safflower methyl biodiesel was most toxic, with EC50 values of 1026 μg/mL (24 h) and 71 μg/mL (48 h). Our data indicate that although not all biodiesels were toxic, the short-term exposure of D. magna to sub-lethal concentrations of biodiesels affects their mobility and thus decreases their reproductive potential. Overall, this research provides insights into the sub-lethal effects of biodiesels on an aquatic organism.
Aging of the bony orbit is a major cause of age-related intraorbital fat herniation
We evaluated the relationship between infraorbital fat herniation and age-related changes in the bony orbit and orbital fat density using computed tomography. Two hundred and sixty-five patients were enrolled (60 patients were evaluated for changes in the bony orbit and 205 for changes in orbital fat density). Five measurements using parasagittal sections and 1 measurement using three-dimensional images were obtained. Intraorbital fat herniation length was positively correlated with orbital rim inclination.
A prospective, randomized-controlled pilot study comparing closed suction versus negative pressure drains for panniculectomy patients
Panniculectomy following massive weight loss has a reported complication rate of 31-76% with seroma formation 14-28%.(1) The authors performed a prospective, randomized study comparing seroma formation with standard bulb drains (BD) versus internal drains attached to continuous negative pressure (NP) following panniculectomy. NP drains were placed on continuous powered-suction at -125mmHg via Renasys*GO drain device (Smith&Nephew, Memphis,TN).
Aesthetic day surgery safety in a UK facility- a 4 year retrospective study and discussion of the literature
Widespread uptake day case surgery has been relatively slow, with concerns about its safety, and perceived liability for complications should the patient be discharged "too soon". The literature has since demonstrated safety for select procedures, leading to an increase in day surgery popularity over the last 25 years1. Aesthetic day surgery procedures are widespread across the United States, where the healthcare system allows for practitioners to set up their own surgical facilities. Day surgery has benefits for both patients and providers in terms of convenience and financial burden.
Updated anatomy of the buccal space and its implications for plastic, reconstructive and aesthetic procedures
The buccal space an integral deep facial space which is involved in a variety of intra- and extra-oral pathologies and provides a good location for the harvest of the facial artery. The age-related anatomy of this space was investigated and compared to previous reports.
Immediate nipple reconstruction during skin-sparing mastectomy utilising the nipple sharing technique and harvesting the nipple graft from the mastectomy specimen
Nipple reconstruction is an integral part of the breast reconstructive process. Studies have described the positive psychological impact of nipple reconstruction as part of post-mastectomy breast reconstruction. Timing of nipple reconstruction does make a difference; it was shown that a longer interval between mound and nipple reconstruction decreases patient satisfaction1. Losken et al.2 demonstrated that the average time to completion of reconstruction was 12.25 months but this was significantly influenced by type of reconstruction and risk factors such as postoperative chemotherapy and radiation therapy.
Surgical-site infection following lymph node excision indicates susceptibility for lymphedema: a retrospective cohort study of malignant melanoma patients
Cancer-related lymphedema is a common complication following lymph node excision. Prevention of lymphedema is essential, as treatment options are limited. Known risk factors are firmly anchored to the cancer treatment itself; however potentially preventable factors such as seroma and surgical-site infection (SSI) have yet to be asserted.
Serial excision with power-stretching of the skin in giant melanocytic nevi therapy
Giant Congenital Melanocytic Nevi (GCMN) are defined as being at least 20 centimetres in diameter in adulthood. Thus, for newborns, a GCMN is defined as being nine centimetres on the head and six centimetres on the trunk and extremities1. GCMN cause an aesthetic burden in affected children. Efficient treatment is controversial2. The main treatment options include serial resections, skin grafting/flaps or skin expander-techniques. Normally, they are used in children older than two years of age2. Because the skin of newborns and infants has a pronounced capacity to recover from trauma, we developed a surgical method that takes advantage of the high skin-elasticity and the small absolute size of GCMNs in very young children.
Free flap reconstruction for trauma in the early post-partum period
We present the case of a patient who suffered significant polytrauma, fracturing her pelvis, femur and tibia and requiring emergency caesarian section of her 36-week old foetus. Forty eight hours later she underwent free flap reconstruction of her open tibial fracture. The issues involved in performing free flap surgery in the early postpartum period and specific surgical and pharmacological measures taken to overcome the physiological hypercoagulable state of post-partum patients are described along with a summary of the literature.
Split-sciatic Nerve surgery: a new microsurgical model in experimental nerve repair
Sciatic experimental surgery in rat often leads to hindlimb autophagy, with considerable ethical and research issues. In this work, the distal part of the sciatic nerve was split following the natural bifurcation between tibial and peroneal branches, before applying regenerative stem cells in a fibrin conduit on the peroneal segment.The new microsurgical model was tested in terms of animal morbidity and consistency of research outcomes, particularly comparing to the standard total sciatic axotomy procedure.
Bleeding on the cutting edge; a systematic review of anticoagulant and antiplatelet continuation in minor cutaneous surgery
Anticoagulant and antiplatelet (AC/AP) use is common and practice surrounding AC/AP continuation or cessation peri-operatively for minor cutaneous surgery lacks evidence-based consensus.
Liposuction as an effective treatment for lower extremity lymphoedema: a single surgeon's experience over nine years
Lymphoedema is a chronic, debilitating condition caused by a compromised lymphatic system. In recent years, the success of treating upper extremity lymphoedema with liposuction has been translated to patients with lower extremity lymphoedema (LEL), yet there remains a paucity of clinical evidence firmly supporting its use within this patient group.
Refining the cross-finger flap: considerations of flap insetting, aesthetics and donor site morbidity
We described a laterally based cross-finger flap for reconstruction of soft tissue defects in the fingers. This modification enables coverage of volar or dorsal soft tissue defects at the distal, middle or proximal phalanx. From March 2015 to January 2017, a total of 12 patients (13 fingers) underwent soft tissue reconstruction of the fingers with a laterally based cross-finger flap. The flap dimensions ranged from 13 x 7 mm to 43 x 13 mm. Eleven of the 13 flaps survived completely. The two flap failures were attributed to injuries in the donor fingers, rendering the blood supply of the flaps unreliable.
Sentinel node biopsy in desmoplastic thin melanoma: histogenetic reccomandations
Dunne et al have performed a full systematic literature review of sentinel lymph node biopsy (SLNB) in patients affected by desmoplastic melanoma (DM). Sixteen studies were included in the review and 1519 patients with SLNB were identified with nodal positivity in 99 cases (65%). Instead, the number of SLNB in desmoplastic thin melanoma (DTM) has been not reported. The authors believe that further research should be undertaken to establish if all patients with DTM should be offered SLNB based on stratification using clinico-pathological features (1).
The use of a ‘pocket’ printer to improve documentation and patient care
Photography provides an unsurpassed method of communicating accurate visual pathologies to both patients and colleagues1. It has become the standard of practice for documenting pre-operative, operative and post-operative clinical findings in a number of medical specialities, including Plastic and Reconstructive Surgery. In some areas of the World, electronic notes systems are commonly used to incorporate photographs and to create clinical letters, however in our experience this is not the norm. Digital technology has revolutionised photography, simplifying the process of capturing and recording images.
Short correspondence: reverse lymphatic mapping without radioisotope in the surgical treatment of lymphedema
Lymphatic mapping of the extremity using lymphoscintigraphy incorporates injection of radioisotope (technetium) into the web space of the hand or foot to assess lymphatic transit and drainage pathways. Reverse lymphatic mapping (RLM), a technique originally described for selective axillary lymphadenectomy in cancer and subsequently adopted for vascularized lymph node transfer procedures, utilizes a dual tracer approach to delineate lymphatic drainage pathways from individual anatomic regions in order to reduce incidence of iatrogenic lymphedema (1-2).
Silicone lip implant for augmentation in cleft lip
Patients with a history of cleft lip repaired in childhood commonly present requesting upper lip revision to improve deficiency in the volume of the upper lip vermillion and disharmony with respect to the volume of the lower lip. There are a number of techniques available to address this issue, however some of these carry the risk of potential donor site morbidity and the longevity of the volume of enhancement achieved is often unpredictable. We describe six successful cleft lip augmentation cases using a silicone lip implant, a technique only previously reported in the aesthetic augmentation population, and show how in the right patient, this can be a rewarding reconstructive option.
Post-zygotic genomic changes in glutamate and dopamine pathway genes may explain discordance of monozygotic twins for schizophrenia
Monozygotic twins are valuable in assessing the genetic vs environmental contribution to diseases. In the era of complete genome sequences, they allow identification of mutational mechanisms and specific genes...
Activation of PKB/Akt and p44/42 by Mechanical Stretch utilizes Desmosomal Structures and the Keratin Filament
Mechanical stress is an ubiquitous challenge of human cells with fundamental impact on cell physiology. Previous studies have shown that stretching promotes signaling cascades involved in proliferation and tissue enlargement.
Homozygous acceptor splice site mutation in DSG1 disrupts plakoglobin localization and results in keratoderma and skin fragility
Heterozygous mutations in DSG1, encoding desmoglein 1, result in autosomal dominant striate palmoplantar keratoderma (SPPK type 1; MIM 148700) [1] and approximately 25 different mutations have been reported. Although SPPK is the major finding, the keratoderma may sometimes be more focal or diffuse [2], and skin fragility can occur [3].
Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits
Background: Acellular dermal matrix has gained widespread acceptance in immediate expander/implant reconstruction because of perceived benefits, including improved expansion dynamics and superior aesthetic results. Although previous investigators have evaluated its risks, few studies have assessed the impact of acellular dermal matrix on other outcomes, including patient-reported measures. Methods: The Mastectomy Reconstruction Outcomes Consortium Study used a prospective cohort design to evaluate patients undergoing postmastectomy reconstruction from 10 centers and 58 participating surgeons between 2012 and 2015. The analysis focused on women undergoing immediate tissue expander reconstruction following mastectomies for cancer treatment or prophylaxis. Medical records and patient-reported outcome data, using the BREAST-Q and Numeric Pain Rating Scale instruments, were reviewed. Bivariate analyses and mixed-effects regression models were applied. Results: A total of 1297 patients were evaluated, including 655 (50.5 percent) with acellular dermal matrix and 642 (49.5 percent) without acellular dermal matrix. Controlling for demographic and clinical covariates, no significant differences were seen between acellular dermal matrix and non–acellular dermal matrix cohorts in overall complications (OR, 1.21; p = 0.263), major complications (OR, 1.43; p = 0.052), wound infections (OR, 1.49; p = 0.118), or reconstructive failures (OR, 1.55; p = 0.089) at 2 years after reconstruction. There were also no significant differences between the cohorts in the time to expander/implant exchange (p = 0.78). No significant differences were observed in patient-reported outcome scores, including satisfaction with breasts, psychosocial well-being, sexual well-being, physical well-being, and postoperative pain. Conclusions: In this multicenter, prospective analysis, the authors found no significant acellular dermal matrix effects on complications, time to exchange, or patient-reported outcome in immediate expander/implant breast reconstruction. Further studies are needed to develop criteria for more selective use of acellular dermal matrix in these patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.Clinical and Quantitative Isokinetic Comparison of Abdominal Morbidity and Dynamics following DIEP versus Muscle-Sparing Free TRAM Flap Breast Reconstruction
Background: The deep inferior epigastric perforator (DIEP) flap, which is a modification of the muscle-sparing free transverse rectus abdominis musculocutaneous (TRAM) flap, is being more frequently used in an effort to reduce postoperative abdominal morbidity. However, there is no consensus as to which of these flaps is superior. The authors aimed to compare quantitative measurements of abdominal function obtained with an isokinetic dynamometer after DIEP and muscle-sparing free TRAM flap elevation. Methods: Patients who underwent unilateral single-pedicled DIEP (n = 42) or muscle-sparing free TRAM flap (n = 36) breast reconstruction performed by a single surgeon were included in this study. Preoperative and postoperative trunk flexion parameters were measured prospectively using an isokinetic dynamometer in all patients. The occurrence of postoperative pain, stiffness, and bulging along with patient activity level were also investigated. Results: At 3 months postoperatively, abdominal functions were decreased in both groups, with a larger decline in the muscle-sparing free TRAM flap group. However, at 6 months postoperatively, abdominal muscle function recovered to preoperative levels in both groups. These findings were consistent with the absence of a statistically significant difference in patient postoperative abdominal pain and stiffness, activity level, and the incidence of bulging between the two groups at 6 months postoperatively. Conclusion: From these results, we propose that the surgeon can select the muscle-sparing free TRAM flap, without hesitation or concern regarding abdominal morbidity, when a thick and reliable perforator does not exist and multiple thin perforators must be incorporated. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.Revisiting the Abdominal Donor Site: Introducing a Novel Nomenclature for Autologous Breast Reconstruction
Background: As abdominally based free flaps for breast reconstruction continue to evolve, significant effort has been invested in minimizing donor-site morbidity. The impact on the donor site remains a prevailing principle for breast reconstruction, and thus must be adequately reflected when classifying what is left behind following flap harvest. Although successful in describing the type of flap harvested, the existing nomenclature falls short of incorporating certain critical variables, such as degree of muscular preservation, fascial involvement, mesh implantation, and segmental nerve anatomy. Methods: In an effort to expand on Nahabedian's 2002 classification system, this descriptive study revisits and critically reviews the existing donor-site classification system following abdominally based breast reconstruction. Results: The authors propose a nomenclature system that emphasizes variability in flap harvest technique, degree of muscular violation, fascial resection, mesh implantation, and degree of nerve transection. Conclusion: With this revised classification system, reconstructive surgeons can begin reporting more clinically relevant and accurate information with regard to donor-site morbidity.
The Impact of Autologous Breast Reconstruction on Body Mass Index Patterns in Breast Cancer Patients: A Propensity-Matched Analysis
Background: Weight gain is common in breast cancer patients and increases the risk of recurrence and mortality. The authors assessed the impact of autologous breast reconstruction on body mass index patterns after diagnosis in mastectomy patients. Methods: Women undergoing therapeutic mastectomy at the authors' institution from 2008 to 2010 were identified. Patients undergoing no breast reconstruction or autologous breast reconstruction were propensity-matched by age at diagnosis, baseline obesity, mastectomy laterality, and adjuvant therapies. Multivariable regression was used to estimate covariate associations with percentage body mass index change and percentage body mass index change greater than 5.0 percent at 1 to 4 years after diagnosis. Results: Of 524 total patients, 80 propensity-matched pairs were identified. In multivariable regression, women undergoing immediate autologous breast reconstruction had reduced body mass index changes after diagnosis, compared with nonreconstruction patients, at 1 year (β = −5.25 percent; pEvidence-Based Performance Measures: Quality Metrics for the Care of Patients Undergoing Breast Reconstruction
Summary: The American Society of Plastic Surgeons commissioned the Breast Reconstruction Performance Measure Development Work Group to identify and draft quality measures for the care of patients undergoing breast reconstruction surgery. Two outcome measures were identified. The first desired outcome was to reduce the number of returns to the operating room following reconstruction within 60 days of the initial reconstructive procedure. The second desired outcome was to reduce flap loss within 30 days of the initial reconstructive procedure. All measures in this report were approved by the American Society of Plastic Surgeons Breast Reconstruction Performance Measures Work Group and the American Society of Plastic Surgeons Executive Committee. The Work Group recommends the use of these measures for quality initiatives, Continuing Medical Education, Maintenance of Certification, American Society of Plastic Surgeons' Qualified Clinical Data Registry reporting, and national quality reporting programs.Prospective Controlled Study of Chin Augmentation by Means of Fat Grafting
Background: Although fat grafting is a valuable tool for different areas of plastic surgery, its use in the chin area has never been evaluated. A variety of methods are available for adjusting suboptimal chin morphology, and they each present drawbacks. Methods: A prospective controlled study was performed to evaluate whether fat grafting increases the chin volume and sagittal projection and to determine the magnitude and nature of the observed changes. Forty-two consecutive patients underwent chin augmentation by means of fat grafting between October of 2014 and January of 2016. All patient images were analyzed using a software program (Fiji package of ImageJ), which creates a three-dimensional version of the chin that is used to produce reliable estimates of the volume and gain in sagittal projection. Results: All 42 patients showed an increase in the sagittal projection and total volume at 4 weeks and 6 months after surgery. The sagittal projection increased from 4 mm to 12 mm (average, 8.9 mm) and from 3 mm to 11 mm (average, 7 mm) after 4 weeks and 6 months, respectively. The total volume increase ranged from 3 to 11 ml (average, 8 ml) after 4 weeks and from 3 to 8 ml (average, 7.4 ml) after 6 months. Conclusion: Fat grafting to the chin area is a reliable method for improving chin volumes (to a maximum of approximately 10 cc in our study) and sagittal projections (to a maximum of approximately 11 mm in our study). CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.Trends and Predictors of National Institutes of Health Funding to Plastic Surgery Residency Programs
Background: Recent studies have demonstrated low levels of National Institutes of Health funding for surgical research. The authors compared the funding in plastic surgery with the funding for other surgical specialties. Methods: A query of National Institutes of Health grants awarded to departments of surgical specialties was performed using the National Institutes of Health RePORTER database (2008 to 2016). Trends in funding were compared by specialty and adjusted for the number of active physicians in each specialty. Plastic surgery residency program characteristics were correlated with funding procurement. Results: Eight hundred eighty-nine faculty at 94 plastic surgery residency programs were queried. Forty-eight investigators (5.4 percent) at 23 programs (24.4 percent) had National Institutes of Health funding. From 2008 to 2016, a total of $84,142,138 was awarded through 81 grants. Funding supported translational (44.6 percent), clinical (26.4 percent), basic science (27.2 percent), and educational (1.7 percent) research. In 2016, plastic surgery received the least amount of National Institutes of Health funding per active physician ($1,530) relative to orthopedic surgery ($3124), obstetrics and gynecology ($3885), urology ($5943), otolaryngology ($9999), general surgery ($11,649), ophthalmology ($11,933), and neurologic surgery ($20,874). Plastic surgery residency program characteristics associated with National Institutes of Health funding were high ranking and had more than 10 clinical faculty (pMentor Contour Profile Gel Implants: Clinical Outcomes at 10 Years
Background: Contour Profile Gel/MemoryShape breast implants consist of a textured silicone elastomer shell filled with silicone gel. The objective of this clinical study was to assess the safety and effectiveness of Contour Profile Gel/MemoryShape breast implants in women who were undergoing primary breast augmentation, primary breast reconstruction, or revision surgery (revision-augmentation or revision-reconstruction). Methods: This was a prospective, open-label, multicenter clinical study involving Contour Profile Gel/MemoryShape breast implants in 955 female subjects, including 572 primary augmentation, 124 revision-augmentation, 190 primary reconstruction, and 69 revision-reconstruction subjects. Safety was assessed based on the incidence, severity, and method of resolution of all complications. Endpoints were examined on both a per-subject and a per-implant basis. Results: For the primary augmentation, revision-augmentation, primary reconstruction, and revision-reconstruction cohorts, the Kaplan-Meier estimated 10-year cumulative incidence rates for the key complications at the subject level were as follows: Baker grade III/IV capsular contracture, 3.6 (primary augmentation), 15.5 (revision-augmentation), 14.3 (primary reconstruction), and 16.4 (revision-reconstruction) percent; infection, 0.7 (primary augmentation), 1.9 (revision-augmentation), 1.6 (primary reconstruction), and 2.9 (revision-reconstruction) percent; explantation with or without replacement, 9.2 (primary augmentation), 25.9 (revision-augmentation), 34.1 (primary reconstruction), and 49.0 (revision-reconstruction) percent; explantation with replacement with study device, 4.0 (primary augmentation), 10.8 (revision-augmentation), 16.7 (primary reconstruction), and 27.9 (revision-reconstruction) percent; and any reoperation, 22.3 (primary augmentation), 35.0 (revision-augmentation), 52.7 (primary reconstruction), and 59.7 (revision-reconstruction) percent. Conclusion: The results of this study demonstrate that Contour Profile Gel/MemoryShape breast implants are safe and effective for primary and revision breast augmentation and reconstruction for women at least 22 years old.
Prospective, Double-Blind Evaluation of Umbilicoplasty Techniques Using Conventional and Crowdsourcing Methods
Background: Umbilical reconstruction is an important component of deep inferior epigastric perforator (DIEP) flap breast reconstruction. This study evaluated the aesthetics of three different umbilical reconstruction techniques during DIEP flap breast reconstruction. Methods: From January to April of 2013, a total of 29 consecutive patients undergoing DIEP flap breast reconstruction were randomized intraoperatively to receive one of three umbilicoplasty types: a diamond, an oval, or an inverted V incision. Independent plastic surgeons and members of the general public, identified using an online "crowdsourcing" platform, evaluated aesthetic outcomes in a blinded fashion. Reviewers were shown postoperative photographs of the umbilicus of all patients and a four-point Likert scale was used to rate the new umbilicus on the size, scar formation, shape, localization, and overall appearance. Results: Results for the focus group of independent plastic surgeons and 377 members of the public were retrieved (n = 391). A total of 10 patients (34.5 percent) were randomized into having the diamond incision, 10 (34.5 percent) had the oval incision, and nine (31.0 percent) had the inverted V incision. Patients were well matched in terms of overall characteristics. The general public demonstrated a significant preference for the oval incision in all five parameters. There was no preference identified among surgeons. Conclusion: This study provides evidence that a sample of the U.S. general public prefers the aesthetics of the oval umbilicoplasty incision, which contrasted with the lack of preference identified within this focus group of plastic surgeons. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.Breast Cancer Survives by Releasing Self-Serving Glutamate
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By Jamshed Arslan Pharm.D.
Triple-negative breast cancer (TNBC) is difficult to treat because it does not express the receptors (estrogen, progesterone, and HER2) against which effective therapies are available. TNBC defeats the body's regulation on unchecked growth, but its winning strategy remained unclear until recently. A research team, led by Dr. William Kaelin at the Dana-Farber Cancer Institute in Boston, recently discovered that TNBC cells release glutamate to disable a cancer-stunting enzyme, EglN1. This enzyme targets the transcription factor hypoxia-inducible factor (HIF-1α) for degradation under normal oxygen conditions. HIF-1α enables cells to adapt to low oxygen conditions by promoting genes involved in glycolysis, angiogenesis, and energy conservation. The team found that TNBC cells stabilize HIF-1α for survival by releasing glutamate.
The initial clue of this novel survival mechanism came when immunohistochemical analysis revealed an increase in HIF-1α in breast cancer tissue microarrays. Immunoblots and real-time PCR showed that enhanced HIF-1α protein levels correlated with increased expression of HIF-1α-responsive genes. Interestingly, accumulation of HIF-1α was not preceded by an increase in HIF-1α mRNAs, indicating that a post-translational mechanism regulates HIF-1α protein expression. However, levels of the enzyme (EglN1) responsible for the post-translational modification, prolyl-hydroxylation, which degrades HIF-1α, were not reduced in TNBC cells, suggesting the presence of some factor that stabilizes HIF-1α.
Immunohistochemistry: ER alpha/NR3A1 Antibody (CL1196) [NBP2-34478] - Staining of human breast cancer shows moderate to strong nuclear positivity in a subset of tumor cells.
Some of the crucial properties of the unknown factor included a size of less than 3 kDa, and an insensitivity to boiling, RNases, DNase, and proteinase K treatments. Among all the potential candidates revealed by the NMR spectroscopy analysis of HPLC fractions with the highest HIF-inducing activity, only L-glutamate fit the bill. Other potential molecules did not meet the criteria: in contrast to L-glutamate, the addition of D-glutamate or L-glutamine to fresh media did not induce HIF-1α in TNBC cells. Pharmacological inhibition and RNA interference experiments further showed that release of L-glutamate from TNBC cells was mediated by the xCT cystine-glutamate antiporter. As the name suggests, this antiporter is responsible for both the uptake of cystine (oxidized dimer of amino acid cysteine) and the extracellular release of glutamate.
Researchers found that abundance of extracellular glutamate inactivates the antiporter, interrupting the uptake of cystine and decreasing the intracellular cysteine. In vitro assays showed that EglN1 activity correlates with the levels of cysteine. Thus, reduced intracellular cysteine inactivates EglN1, resulting in downregulation of HIF-1α-degradation. All in all, when EglN1 activity is low, there is nothing much cells can do to stop HIF-1α from promoting tumor growth.
Kaelin's team is the first one to indicate that TNBC's victory over cellular anti-cancerous mechanisms is dependent, at least partly, on a single molecule: glutamate. They can also pride themselves in being the first to discover that EglN1 senses cysteine. They found that under oxidizing conditions and when intracellular cysteine is low, EglN1 undergoes inactivation through oxidation of its own cysteine residues. Their research also provides at least two viable pharmacotherapy strategies against TNBCs: antagonism of extracellular L-glutamate and inhibition of L-glutamate release from cancer cells. Blocking the self-serving glutamate from TNBCs can hopefully provide an effective strategy against this refractory disease.
Explore Hypoxia Signaling Targets
University of Alabama at Birmingham, School of Medicine
Dr. Arslan studies cell signaling in mitochondrial defects in C. elegans and transgenic mice.
References
Briggs, Kimberly J., et al. "Paracrine Induction of HIF by Glutamate in Breast Cancer: EglN1 Senses Cysteine." Cell, vol. 166, no. 1, 2016, pp. 126–139. doi: 10.1016/j.cell.2016.05.042.
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Subcranial Le Fort III Advancement with Equine-Derived Bone Grafts to Correct Syndromic Midfacial Hypoplasia: A Case Report
Abstract
Patients with hypoplasia of the midface normally present a flattening of their facial profile due to insufficient development of the nose and maxilla. Treatment aimed to restore function and an aesthetic appearance calls for a Le Fort III osteotomy and the advancement of the midfacial segment either through distraction or interposition of autogenous bone blocks. However, drawbacks in using autogenous bone suggest that use of alternative graft material may be advisable. The present report describes a Le Fort III advancement using two enzyme-treated equine cancellous bone blocks to correct syndromic midfacial hypoplasia in a 22-year-old patient. A 12-mm surgical advancement was achieved, improving the patient's facial profile. At the 28-month follow-up, the midface advanced position was stable. Equine bone blocks could be a valid alternative to autogenous bone in Le Fort III midface advancement.
Charcot-Fuß coupiert durch Erysipel und periphere arterielle Verschlusskrankheit
Zusammenfassung
Neben dem Charcot-Fuß wird auch von einer Charcot-Erkrankung oder Charcot-Arthropathie gesprochen. Basierend auf einer peripheren Neuropathie mit einhergehender gestörter Schmerzwahrnehmung, gestörter Vasomotorik mit vermehrter Vasodilatation und Fehlbelastungen resultiert eine aseptische Knochen- und Gelenkzerstörung des Fußes. Nicht selten spät diagnostiziert und damit primär auch falsch behandelt, entstehen oftmals schwerste Komplikationen. Ein 86-jähriger Patient wurde in reduziertem Allgemeinzustand notfallmäßig mit der Diagnose eines Erysipels des rechten Fußes zugewiesen. Der Fuß war glänzend ödematös aufgequollen und wies eine Nekrose des Endgliedes des III. Digitus auf. Nach einer Laufstrecke von ca. 20 m bereitete ihm das Gehen Schmerzen. Neben dem Erysipel wurde bei bestätigter neuropathischer Arthropathie und radiologischen Kennzeichen für einen Charcot-Fuß als dritte Diagnose eine periphere arterielle Verschlusskrankheit (pAVK) gesichert. Trotz mehrfach umgestellter systemischer Antibiotikatherapie kam es zu einem progredienten Krankheitsverlauf mit steigenden Entzündungsparametern bei zunehmender Verschlechterung des Allgemeinzustandes. Trotz gefäßchirurgischer und intensivmedizinischer Maßnahmen kam es zu einer ausgeprägten Befundverschlechterung und letztlich zum Tod des Patienten. Am vorliegenden Fall sollen die Kennzeichen und die jeweilige diagnostische Sicherung der 3 überlappenden Diagnosen „Erysipel", „Charcot-Fuß" und „pAVK" erarbeitet werden.
Qualität von selbst angelegten Kompressionsverbänden bei Patienten mit chronischem Ulcus cruris venosum
Zusammenfassung
Hintergrund
Für eine effektive Kompressionstherapie der Patienten mit Ulcus cruris venosum ist ein suffizienter Kompressionsdruck essenziell. Im Alltag sind es häufig die Patienten selbst, die Kompressionsverbände anlegen. Viele dieser Patienten sind jedoch bewegungseingeschränkt und selten adäquat geschult worden. Daher stellte sich die Frage, wie effizient die von Patienten selbstständig angelegten Kompressionsverbände sind.
Patienten und Methoden
Es wurden konsekutiv 100 Patienten mit Ulcus cruris venosum gebeten, einen Kompressionsverband am eigenen Bein anzulegen. Wir ermittelten sowohl den erreichten Kompressionsdruck als auch formale Kriterien der korrekten Anlage.
Ergebnisse
Insgesamt 59 Frauen und 41 Männer mit einem durchschnittlichen Alter von 70,3 Jahren konnten in die Studie eingeschlossen werden. Es waren 43 Patienten aufgrund körperlicher Einschränkungen nicht in der Lage, einen Kompressionsverband anzulegen. Die bei 57 Patienten gemessenen Druckwerte lagen bei 6–93 mm Hg (Mittelwert 28,3). Elf Patienten erreichten den vorgegebenen effektiven Kompressionsdruck. Hiervon zeigten sich bei 6 Patienten formale Fehler, sodass lediglich 5 Patienten die Kompressionsverbände korrekt angelegt haben.
Schlussfolgerung
Unsere Daten zeigen, dass die meisten Patienten mit Ulcus cruris venosum nicht in der Lage sind, einen effektiven Kompressionsverband mit Kurzzugbinden selber anzulegen. Mit Mehrkomponentensystemen, adaptiven Kompressionsbandagen und Ulkusstrumpfsystemen stehen heute möglicherweise einfachere und effektive Alternativen für das Selbstmanagement zur Verfügung. Alternativ können Verbände mit Kurzzugbinden von geschulten Personen – möglichst unter Kontrolle mit Druckmesssonden – angelegt werden.
5α-Reductase isozymes and aromatase mRNA levels in plucked hair from young women with female pattern hair loss
Abstract
Female pattern hair loss (FPHL) is an important hair disorder, especially when young women are affected. However, pharmacological treatments are not successful in all women. Androgens, especially dihydrotestosterone (DHT), may play a role in FPHL, but many women with this disorder have normal serum androgen levels. It therefore appears that hair follicle levels of DHT depend on in situ testosterone (T) metabolism. Because T can be converted to DHT or estradiol (E2) by 5α-reductase (5α-R) and aromatase, respectively, these enzymes would determine DHT and E2 concentrations and their ratio. We propose and apply a low-invasive, sensitive and precise method for the absolute quantification of mRNA levels of aromatase and 5α-R isozymes (type 1, type 2 and type 3) in plucked hair from young women with FPHL. Normoandrogenic women with FPHL and controls were studied. Plucked hair samples were obtained by trichogram from vertex scalp and mRNA levels quantified by real-time RT-PCR. We revealed for the first time the presence of 5α-R3 mRNA in human hair. Interestingly, one, two, or even three 5α-R isozymes were increased in some women with FPHL but not in others, which may explain the lack of response to 5α-R inhibitors in some FPHL cases. Aromatase mRNA levels were significantly lower in women with FPHL than in controls. It may therefore produce a reduction in oestrogen levels and an increase in the androgen/oestrogen ratio in hair. The proposed low-invasive technique offers a molecular aetiologic diagnosis of FPHL for the selection of more appropriate pharmacological treatments with early predicted effectiveness.
Vasorelaxant activities and the underlying pharmacological mechanisms of Gynura procumbens Merr. leaf extracts on rat thoracic aorta
Abstract
Previous studies have investigated the cardiovascular activity of Gynura procumbens Merr. single-solvent extracts. The objective of this study was to evaluate the in vitro vasorelaxant properties and the underlying pharmacological mechanisms of serial extracts and fractions of Gynura procumbens (GP). The leaves of GP were serially extracted with petroleum ether, chloroform, methanol and water using the maceration method. Suspended aortic ring preparations were pre-contracted with phenylephrine (PE 1 µM), followed by cumulative addition of GP extracts (0.25–3 mg/mL). The petroleum ether extract (GPPE) was the most potent among the four extracts. Pre-incubation of endothelium-intact aorta with atropine (1 µM), indomethacin (10 µM), methylene blue (10 µM), propranolol (1 µM) and potassium channel blockers such as TEA (1 µM), glibenclamide (10 µM), 4-aminopyridine (1 µM) and barium chloride (10 mM) had no effect on GPPE-induced vasorelaxation. The vasorelaxant effect of GPPE was partly diminished by pretreatment of aortic rings preparations with l-NAME (10 µM) and even more so in endothelium-denuded aortic rings, indicating a minimal involvement of endothelium-dependent pathway in GPPE-induced vasorelaxation. The calcium-induced vasocontractions were antagonized significantly and concentration-dependently by GPPE in calcium free and high potassium medium. These results illustrate that Ca2+ antagonizing actions of GPPE in rat isolated aorta are comparable to that of verapamil and may be mainly responsible for its vasodilation effect. The antioxidant activity of GPPE supports its vasorelaxant effect by attenuating the production of deleterious free radicals and reactive oxygen species in the vasculature.
Granular cell basal cell carcinoma: a case report
Abstract
Granular cell basal cell carcinoma (BCC) is a rare histopathological variant of BCC, Our review of the literature revealed only 17 previously identified cases. We report the case of a 47-year-old man who presented with an ulceration on his right upper lip which was subsequently removed. Histopathologic examination revealed that the tumor was composed solely of granular cells with numerous cytoplasmic eosinophilic round inclusion bodies. Mitotic figures ranged from 8 to 15 per 10 high-power fields with a Ki-67 proliferative index approximated at 5%. Immunohistochemically, the granular cells showed strong and diffuse positivity for Ber-EP4, pan-cytokeratin, AE1/AE3, CK5/6, and p63 and focal positivity for lysozymes, CD68 (clone KP1) and Bcl-2.
Red Tattoo Related Mycosis Fungoides-like CD8+ Pseudolymphoma
Abstract
Cutaneous tattoo reactions are most often seen to red tattoo ink.1 Spongiotic, lichenoid, psoriasiform, granulomatous, and pseudolymphomatous inflammatory reaction patterns have been described.2 Those dyes containing mercury sulfide (cinnabar) are thought to be particularly reactive although the more recently utilized organic red pigments are reactive and can manifest as exuberant delayed hypersensitivity reactions.
Imperative roles of halotolerant plant growth-promoting rhizobacteria and kinetin in improving salt tolerance and growth of black gram ( Phaseolus mungo )
Abstract
The salinity stress causes a major threat for plant growth, yield, and biomass production. The present study was designed to assess the effect of exogenously applied kinetin and halotolerant plant growth-promoting rhizobacteria (H-PGPR) on alleviation of salt stress in black gram (Phaseolus mungo). A total of 15 rhizobacterial isolates obtained from a salt-affected area were analyzed for their capability to improve growth of P. mungo plants growing in greenhouse conditions. Out of the tested rhizobacteria, the two bacterial isolates which exhibited maximum growth potential were screened and their growth-promoting attributes were evaluated. The role of screened H-PGPR and/or kinetin (8 and 10 μM) was evaluated in P. mungo plants irrigated with three levels of brackish water (S1 = 3, S2 = 5, and S3 = 7 dSm−1) under field condition. Salt stress reduced transpiration rate, stomatal conductance, salt tolerance index, growth, leaf area, photosynthetic pigments, leaf relative water content (LRWC), biomass production, and seed yield in subjected plants. Conversely, the salinized plants treated with kinetin and/or H-PGPR exhibited improved levels of chlorophyll contents, LRWC, root growth, shoot growth, biomass production, and seed yield. The H-PGPR and/or kinetin supplementation also reduced electrolyte leakage in salt-stressed plants. Overall, the present findings will be of great value to recognize the mechanism of salt stress alleviation in P. mungo plants under the influence of H-PGPR and/or kinetin.
The impact of hydro-biofuel-wind energy consumption on environmental cost of doing business in a panel of BRICS countries: evidence from three-stage least squares estimator
Abstract
The renewable energy sources are considered the vital factor to promote global green business. The environmental cost of doing business is the pre-requisite to analyze sustainable policies that facilitate the eco-minded entrepreneurs to produce healthier goods. This study examines the impact of renewable energy sources (i.e., hydro energy, biofuel energy, and wind energy) on the environmental cost of doing business in a panel of BRICS (Brazil, Russian Federation, India, China, and South Africa) countries, for the period of 1995–2015. The study employed principal component analysis to construct an "integrated environmental index" by using three alternative and plausible factors including carbon dioxide emissions, fossil fuel energy consumption, and chemicals used in the manufacturing process. The environmental index is used as an interactive term with the three cost of doing business indicators including business disclosure index, the cost of business start-up procedures, and logistics performance index to form environmental cost of doing business (ECDB) indicators. The results of three-stage least squares (3SLS) estimator show that foreign direct investment (FDI) inflows supported the green business while trade openness deteriorates the environment, which partially validates the "pollution haven hypotheses (PHH)" in a panel of countries. There is no evidence for environmental Kuznets curve (EKC) hypothesis; however, there is a monotonic decreasing relationship between per capita income and ECDB indicators. The hydro energy supports the sustainable business environment, while biofuel consumption deteriorates the environmental impact on the cost of business start-up procedures. Finally, wind energy subsequently affected the ECDB indicators in a panel of BRICS countries. The overall results conclude that growth factors and energy sources both have a considerable impact on the cost of doing business; therefore, there is a momentous need to formulate sustainable policy vista to magnetize green business across countries.
Assessment of the effects of skin microneedling as adjuvant therapy for facial melasma: a pilot study
Abstract
Background
Melasma is a common chronic and relapsing acquired dyschromia. Skin microneedling was reported resulting sustained long-term improvement of recalcitrant melasma, however, the exact mechanism that promotes this skin lightening is not known. This study aimed to investigate clinical and histologic alterations promoted by skin microneedling in facial melasma.
Methods
Open pilot trial including six women with facial refractory melasma submitted to two sessions of microneedling (1.5 mm) each 30 days followed by daily triple combination and broad-spectrum sunscreen. Comparison of pretreatment (T0) and 15 days after last microneedling procedure (T45) was made by standardized pictures, skin colorimetry, MASI, MELASQoL and histological parameters (haematoxylin-eosin, picrosirius-red, periodic acid Schiff and Fontana-Masson staining).
Results
The age of the subjects varied from 34 to 46 years-old, the phototypes were III and IV (Fitzpatrick), and age of melasma onset was 20 to 38 years. Improvement of melasma was perceived in all subjects. There was a significant reduction of MASI score (−70%), MELASQoL (−55%) and increase in L* (+13%) colorimetric value (p < 0.03). All cases evidenced epithelium thickening, decrease in melanin pigmentation and densification of upper dermis collagen (p = 0.03). Patients were followed by 6 months under broad-spectrum sunscreen and triple combination without relapse.
Conclusion
In addition to classic treatment (broad-spectrum sunscreen and triple combination), skin microneedling promoted clinical and histological improvement of refractory facial melasma.
Is Proprietary Software Unjust? Examining the Ethical Foundations of Free Software
Abstract
"Free software" is software that respects the users' freedoms by granting them access to the source code, and allowing them to modify and redistribute the software at will. Richard Stallman, founder of the Free software movement, has argued that creating and distributing non-Free software is always a moral injustice. In this essay, I try to identify the ethical foundations of Stallmanism. I identify three major trends in Stallman's thinking—libertarian, utilitarian, and communitarian—and I argue that none is sufficient to justify the radical claim that distributing non-Free software is always wrong (unless we accept extremely demanding ethical standards that Stallman himself does not consistently endorse). I recommend thinking of Stallmanism as an attempt to optimize the satisfaction of a number of core values, including freedom, cooperation, and happiness, and I stress the importance of connecting the Free software movement to other political struggles against oppression.
Dupilumab with concomitant topical corticosteroids in adult patients with atopic dermatitis who are not adequately controlled with or are intolerant to ciclosporin A, or when this treatment is medically inadvisable: a placebo-controlled, randomized phase 3 clinical trial (LIBERTY AD CAFÉ)
Abstract
Background
Atopic dermatitis (AD) is a chronic inflammatory skin disease that may require systemic therapy. Ciclosporin A (CsA) is a widely-used, potent immunosuppressant for AD. CsA is not effective in all patients, and side effects limit its use. Dupilumab, a fully human anti-interleukin (IL)-4 receptor-alpha monoclonal antibody, inhibits signaling of IL-4 and IL-13, key drivers of type 2/Th2-mediated inflammation, and is approved in the U.S.A. and the E.U. for the treatment of adults with moderate-to-severe AD.
Objectives
To evaluate efficacy and safety of dupilumab with concomitant topical corticosteroids (TCS) in adults with AD with inadequate response to/intolerance of CsA, or for whom CsA was medically inadvisable.
Methods
In this 16-week, double-blind, randomized, placebo-controlled, phase 3 trial, patients were randomized 1:1:1 to subcutaneous dupilumab 300 mg weekly (qw):every two weeks (q2w):placebo. All received concomitant medium-potency TCS from Week −2 through Week 16; dosage could be tapered if lesions cleared, or stopped for adverse reactions to TCS.
Results
390 patients were screened; 325 were randomized and 318 completed the trial. Treatment groups had similar baseline characteristics. Significantly more patients on dupilumab qw+TCS/q2w+TCS achieved ≥75% improvement from baseline in Eczema Area and Severity Index at Week 16 vs placebo+TCS (primary endpoint) (59.1%/62.6% vs 29.6%; P<0.0001 vs placebo+TCS, both doses). Dupilumab qw+TCS/q2w+TCS significantly improved other clinical outcomes and AD symptoms, including pruritus, pain, sleep disturbance, symptoms of anxiety and depression, and quality of life (QOL). Treatment groups had similar overall rates of adverse events (69.1%/72.0%/69.4%; qw+TCS/q2w+TCS/placebo+TCS) and serious adverse events (1.8%/1.9%/1.9%). Conjunctivitis was more frequent with dupilumab+TCS; skin infections were more frequent with placebo+TCS.
Conclusions
Dupilumab+TCS significantly improved signs and symptoms of AD and QOL in adults with history of inadequate response to/intolerance of CsA, or for whom CsA treatment was medically inadvisable. No new safety signals were identified.
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Mosaic pathogenic HRAS variant in a patient with nevus spilus with agminated Spitz nevi and parametrial-uterine rhabdomyosarcoma
Abstract
The role of HRAS mutations in the pathogenesis of various human cancers has been long established. Recent studies indicate that cutaneous nevi can also harbor HRAS, KRAS and NRAS mutations, and this group of RAS mutation positive birthmarks has been referred to as the mosaic RASopathies.1
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Optical coherence tomography of basal cell carcinoma: influence of location, subtype, observer variability and image quality on diagnostic performance
Abstract
Background
We previously described the principal results from an observational, prospective, multi-centre, clinical trial of the diagnostic value of optical coherence tomography (OCT) for basal cell carcinoma (BCC) in a clinical setting. In this trial, much additional useful information was gathered that warranted further analysis, presented here.
Objectives
To investigate the influence of candidate diagnostic criteria, OCT image quality, lesion location, and observer confidence and inter-observer variability on the diagnostic performance, and to assess potential for diagnosis of BCC subtypes.
Methods
A total of 234 clinically unclear "pink lesions" were evaluated in three steps: after clinical examination, after adding dermoscopy and finally after adding OCT. In addition to the diagnoses (including lesion subtype), observers also recorded which of 15 diagnostic criteria the OCT image contained, their confidence in the diagnoses, the OCT image quality, and the anatomical location of the lesion.
Results
Diagnostic performance of OCT did not depend on the lesion anatomical location. Good OCT image quality was correlated with improved diagnostic performance; but diagnostic performance for lesions with mediocre image quality was still better than by clinical and dermoscopic examination. The main reason for reduced image quality was superficial scales and crusting. Observer confidence in their diagnosis was correlated with diagnostic performance. Inter-observer diagnostic performance was consistently higher than clinical examination and dermoscopy across all sites. BCC subtype could be determined with moderate accuracy but further independent image markers are required.
Conclusion
This work supports the conclusion that OCT is useful for aiding the diagnosis of BCC.
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The minor allele HCP5 rs3099844 A, PSORS1C1 rs3131003 G are associated with allopurinol-induced severe cutaneous adverse reactions in Han Chinese: a multicentre retrospective case-control clinical study
Abstract
allopurinol-induced severe cutaneous adverse reactions (SCARs), which includes drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), are life threatening conditions and occur almost exclusively in HLA-B*5801 positive individuals in Han Chinese1-4.
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Role of nature reserves in giant panda protection
Abstract
Giant panda (Ailuropoda melanoleuca) is a flagship species in nature conservation of the world; to protect this species, 67 nature reserves have been established in China. To evaluate the protection effect of giant panda nature reserves, we analyzed the variation of giant panda number and habitat area of 23 giant panda nature reserves of Sichuan province based on the national survey data released by State Forestry Administration and Sichuan Forestry Department. Results showed that from the third national survey to the fourth, giant panda number and habitat area of 23 giant panda nature reserves of Sichuan province failed to realize the significant increase. Furthermore, we found that the total population growth rate of 23 nature reserves in the last 12 years was lower than those of the province total of Sichuan and the national total of China, and the total habitat area of the 23 nature reserves was decreasing in the last 12 years, but the province total and national total were all increasing. We propose that giant panda protection should pay more attention to how to improve the protective effects of nature reserves.
Health risk evaluation of heavy metals in green land soils from urban parks in Urumqi, northwest China
Abstract
Here, we sampled, tested, and analyzed heavy metals in soil obtained from green land in urban parks of Urumqi. Analysis included soil nutrient contents, particle size distribution, and health risks of heavy metal contaminants. Results showed that (1) organic matter and rapidly available phosphorus contents of all samples ranged from 6.07–58.34 and 6.52–116.15 mg/kg, with average values of 31.26 and 36.24 mg/kg, respectively; (2) silt (particle size 20–200 μm) comprised most of the particle distribution, accounting for 46.56–87.38% of the total, and the remaining particles were clay particles (0–20 μm) and sand (200–2000 μm); (3) calculations of HQing, HQinh, and HQderm for eight heavy metals in three exposure patterns revealed values less than 1 for children and adults, indicating a level of carcinogenic risk for these heavy metals; and (4) calculating the carcinogenic risks of nickel, chromium, and cadmium through breathing pathway indicating no potential carcinogenic risk for any of the three. This research showed high soil nutrient content, providing fertile ground for plant growth in the green land of these urban parks. However, measures such as using sprinklers and increased green vegetation areas have been proposed to improve soil texture. This research can serve as a reference point for soil environmental protection efforts as well as future plant growth in urban Urumqi parks.
Integriertes Hochwasserrisikomanagement in den Bundesländern am Beispiel Steiermark und Oberösterreich
Zusammenfassung
Integriertes Hochwasserrisikomanagement hat in der Steiermark bereits jahrzehntelange Tradition, die sich sukzessive weiterentwickelt hat. Bereits 1986 wurden mit dem „Maßnahmenkatalog für den Naturnahen Wasserbau" die ersten verbindlichen Schritte für einen integralen Planungsprozess gesetzt. Noch unter dem Eindruck der Hochwasserereignisse des Jahres 2002 erarbeitete die Abteilung Raumplanung gemeinsam mit der Wasserwirtschaftsabteilung ein Sachprogramm, welches klare rechtliche Rahmenbedingungen für Baumaßnahmen in Hochwassergebieten geschaffen hat und somit einen wichtigen Beitrag für präventiven Hochwasserschutz in Siedlungsgebieten leistete. Die Erstellung der Hochwasserrisikomanagementpläne gemäß EU-Hochwasserrichtlinie (RL 2007/60/) war ein Beteiligungsprozess mit begleitender Öffentlichkeitsarbeit, bei dem neben den Fachdienststellen des Bundes und des Landes auch andere Einrichtungen und Institutionen wie z. B. Gemeinden, Feuerwehren, die Raumordnung und der Katastrophenschutz in das Hochwasserrisikomanagement eingebunden wurden.
In Oberösterreich wird neben der Verbesserung der Prognosesysteme vor allem auf integrale Bearbeitungen bei Gefahrenzonenplänen und im Bereich des Katastrophenschutzes gesetzt. Die erstellten Hochwasserrisikomanagementpläne leisten hierbei einen wertvollen Beitrag.
Floodplain Evaluation Matrix (FEM) – Eine umfassende Methode zur Bewertung von Überflutungsräumen im Rahmen eines integrierten Hochwasserrisikomanagements
Zusammenfassung
Der Schutz – und wo möglich die Wiederherstellung – von Überflutungsflächen im Rahmen eines integrierten Hochwasserrisikomanagements wird seit Jahren von höchster Ebene als nachhaltige und nicht-strukturelle Maßnahme gefordert. Dennoch steht dem in der Realität ein fortschreitender Flächenverbrauch für Siedlungen und Infrastruktur insbesondere auf flussnahen Flächen gegenüber. Die hier vorgestellte Floodplain Evaluation Matrix (FEM) stellt eine Methode dar, mit der es möglich wird, den Wert von zusammenhängenden Überflutungsflächen festzustellen und Grenzwerte zu definieren, die eine fortschreitende Verbauung und damit den Summationseffekt hintanhalten. Basierend auf der Analyse verschiedener hydrologischer und hydraulischer Parameter wird eine Bewertung jeder Fläche vorgenommen und deren Wirksamkeit quantifiziert, um diese folglich auf Basis national einheitlicher Grenzwerte im Wasserrechtsverfahren aber auch mit geeigneten Mitteln der Raumordnung und des Baurechts freihalten zu können.
Management of childhood psoriasis in France. A national survey among general practitioners, pediatricians, and dermatologists
Abstract
Psoriasis affects 0.5–2% of children. Severe forms required use of systemic treatments. Few studies are published on efficiency and tolerance of systemic treatments in children. We conducted a survey in France to better understand management of children with psoriasis. A survey on childhood psoriasis management was sent by e-mail to GPs, pediatricians, and dermatologists. The survey included 384 physicians. Respectively 53.1%, 49.8%, and 83.3% of GPs, pediatricians, and dermatologists declare to have seen at least one child with psoriasis during the 3 previous months. Less than 5% of GPs and pediatricians used severity score versus 23.7% of dermatologists. If most of physicians declare to use local treatments, less than 5% of GPs and pediatricians used systemic treatments. 32.4% of dermatologists declared to use at least one systemic treatment, but only 2.9% to use the 4 systemic treatments available in France. This survey shows that only half of GPs and pediatricians see children with psoriasis, but most of dermatologists. However, the management of severe forms seems limited by the underuse of severity scores and systemic treatments. These results should stimulate dermatology societies to promote prospective studies and guidelines in young populations with psoriasis.
Use of adapalene in alopecia areata: Efficacy and safety of mometasone furoate 0.1% cream versus combination of mometasone furoate 0.1% cream and adapalene 0.1% gel in alopecia areata
Abstract
Alopecia areata (AA) is an autoimmune disease characterized by non-cicatricial hair loss. No definitive therapy currently exists for AA. To compared the efficacy and safety of the mometasone furoate 0.1% cream alone with the mometasone furoate 0.1% cream plus adapalene 0.1% gel in treatment of AA. Twenty patients with AA and with mean age of 27.4 ± 9.2 years were enrolled. Patches with a diameter of < 5 cm were treated with mometasone furate 0.1% cream (M), and patches with a diameter of ≥5 cm were treated with mometasone furate 0.1% cream plus adapalene 0.1% gel (M + D) for a period of 12 weeks. Hair regrowth was evaluated using a Re-growth score (RGS). Mean RGSs of M + D group were higher than M group for 4th week (2.60 vs. 1.45); 8th week (3.85 vs. 2.40) and 12th week (4.40 vs. 3.30). Mean percentages of hair re-growth in M + D group were statistically higher than M group for 4th (50.2% vs. 23.5%), 8th (78.5% vs. 50.7%), and 12th week (90.5% vs. 71%). Study revealed the efficacy and safety of adapalene and mometasone furoate combination in AA. Adapalene can be used as a new therapeutic modality in AA.
High-voltage electrical injury: Modified surgical technique for optimal defect closuring of extra-large cranial defect
Abstract
Electrical burns are group of traumatic injuries with a mortality rate of 3–15%. High-voltage induced extensive electric burns are rarely seen in the cranial area, compared to upper and lower limbs, but extremely difficult for treatment, due to the limited flexibility in this area. The spectrum of therapeutic interventions in electrical burns in general, evolving initial necrectomy, decompression, and aggressive debridement with early skin coverage is usually not enough in cases of extensive cranial defects. The performance of a suitable flap combined with skin graft in donor site, and further implantation of expander is challenging in this area. We present a case of a high-voltage induced extra-large cranial injury in a 38-year-old man, treated with modified single large rotation flap and a split skin-thickness graft technique, for optimal defect closuring with satisfied aesthetic result.
Complete cure of Fusarium solani sp. complex onychomycosis with Qs NdYAG treatment
Abstract
The incidence of non dermatophytic mould (NDM) onychomycosis (OM) has been steadily increasing Fusarium spp is the most common cause of NDM OM in most geographical locations. Fusarium spp and other NDMs are largely resistant to commonly used anti-fungals. The successful use of laser and light based devices has been demonstrated in dermatophytic OM, but there is no previous report of their successful use in any NDM OM. We describe a patient with OM caused by Fusarium solani spp, who was clinically (with a normal appearing nail) and mycologically (with negative microscopy and culture on repeated samples) cured of her infection following treatment with 2 sessions of Qs NdYAG (532nm and 1064nm) given 1 month apart.
Styling without shedding: Novel topical formula reduces hair shedding by contracting the arrector pili muscle
Abstract
Approximately 40% of women experience excessive hair shedding during styling (e.g., hair brushing). Previously, we demonstrated that topically applied phenylephrine, a potent α1 adrenergic receptor agonist, can be used to contract the arrector pili muscle of the follicular unit; thus, increasing the force required to pluck hair and reducing shedding during brushing. While demonstrating efficacy, phenylephrine has several drawbacks when applied to the scalp, including the possibility cardiovascular events. We hypothesized that a high concentration of a weak α1 agonist would allow for: (a) rapid penetration through the stratum corneum eliciting a quick response; (b) a low probability of cardiac adverse events owing to the low receptor binding affinity; and (c) an efficacy of the weak α1 agonist similar to that of phenylephrine at the local site of application. Accordingly, we developed a novel topical solution, AB-102, containing a high concentration of a weak α1 agonist. Several studies were conducted to test the safety and efficacy of AB-102. In a dose escalating safety study, utilizing a wearable holter monitor, we observed no cardiac or hemodynamic adverse events. In addition, in a controlled efficacy study, AB-102 reduced the number of hairs shed during brushing by up to 77% (average of 38%).
The role of zinc in the treatment of acne: A review of the literature
Abstract
Acne vulgaris is a chronic disease of the pilosebaceous units presenting as inflammatory or noninflammatory lesions in individuals of all ages. The current standard of treatment includes topical formulations in the forms of washes, gels, lotions, and creams such as antibiotics, antibacterial agents, retinoids, and comedolytics. Additionally, systemic treatments are available for more severe or resistant forms of acne. Nevertheless, these treatments have shown to induce a wide array of adverse effects, including dryness, peeling, erythema, and even fetal defects and embolic events. Zinc is a promising alternative to other acne treatments owing to its low cost, efficacy, and lack of systemic side effects. In this literature review, we evaluate the effectiveness and side-effect profiles of various formulations of zinc used to treat acne.
Infantile hemangioma: pathogenesis and mechanisms of action of propranolol
Summary
Infantile hemangioma (IH) is the most common benign tumor of childhood, with a prevalence of 4 % to 10 %. It is characterized by a proliferative rapid growth phase, which starts after a few weeks of life, followed by a slow regression phase. In IH cases that are potentially disfiguring or life-threatening (10 % to 15 % of all cases), systemic therapy should be promptly initiated.
Data source
The present study reviews published scientific articles available in reliable electronic databases. Selected were all studies that evaluated the pathogenesis of IH and the mechanisms of action of propranolol.
Conclusions
The pathogenesis of IH has not been fully elucidated. Studies show that, in the proliferative phase of IH, there is an imbalance of angiogenic factors and an increase in the levels of vascular endothelial growth factor and matrix metalloproteinases 2 and 9. In the regression phase, the levels of these factors decrease, whereas those of antiangiogenic factors, including tissue inhibitors of matrix metalloproteinases, increase. Since 2008, propranolol has become the drug of choice in the treatment of IH, targeting vascular tone, angiogenesis, and apoptosis. Current insights into the pathogenesis of IH allow for the development of new therapeutic strategies.
Do perioperative antibiotics reduce the risk of surgical site infections following excision of ulcerated skin cancers? a critically appraised topic
Summary
Aim
To review the efficacy of perioperative antibiotics in reducing the risk of surgical site infections (SSI) following excision of ulcerated skin cancers.
Setting and Design
Study selection, data extraction and analysis were carried out independently by four authors. Only randomised controlled trials (RCTs) reported in the English Language were included.
Included studies
Randomised controlled trials (RCTs) in the English language in which patients received perioperative topical, intralesional, or oral antibiotics for dermatological surgery including Mohs micrographic surgery in General Practice, Dermatology or Plastic Surgery Departments were included.
Outcome
The proportion of participants developing surgical site infection (SSI) following excision of skin lesions.
Results
Thirteen RCTs17-20,26-33,35 were identified from our literature search of Pubmed and Embase which evaluated SSI following use of topical (n=5)26-29,35, oral (n=3)17-19, intramuscular (n=2)20,32, intravenous (n=1)33 and intralesional antibiotics (n=2)30,31 in dermatological surgery. Two RCTs specifically investigated SSI in ulcerated skin cancer excisions; one RCT investigated SSI rate following surgical treatment specifically for ulcerated skin cancers in individuals randomised to topical antibiotics versus oral cephalexin and one RCT compared intravenous cefazolin to no antibiotic demonstrating significant reduction in SSI rates for ulcerated tumours (p=0.04).
Conclusion
The heterogeneity of the RCTs included in this study makes it difficult to make a direct comparison of the outcomes measured. High quality evidence demonstrating a beneficial effect of the use of peri-operative antibiotics to prevent SSI following excision of ulcerated skin cancers is lacking. In the absence of an evidence-base, we propose that a well-designed multi-centred RCT could evaluate the effect of peri-operative antibiotics following excision of ulcerated tumours, and potentially reduce inappropriate antibiotic prescribing.
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Publication date: Available online 25 July 2018 Source: Journal of Photochemistry and Photobiology B: Biology Author(s): Marco Ballestr...
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Editorial AJR Reviewers: Heartfelt Thanks From the Editors and Staff Thomas H. Berquist 1 Share + Affiliation: Citation: American Journal...
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https://www.youtube.com/watch?v=DFOhpBjLqN4&t=1s , Η ΘΕΡΑΠΕΙΑ ΓΙΑ ΟΛΕΣ ΤΙΣ ΑΣΘΕΝΕΙΕΣ 1 Περιεχόμενα Σύντομο βιογραφικό Πρόλογος μεταφραστ...
