Publication date: Available online 15 December 2017
Source:Piel
Author(s): Alfredo Cardemil-Balari, Daniela Soto, Héctor Fuenzalida, Francisco Chávez
Πέμπτη 14 Δεκεμβρίου 2017
Eritema anular centrífugo como manifestación de sífilis secundaria
Reconstructive methods in Mohs micrographic surgery in Uruguay: A bidirectional descriptive cohort analysis
Publication date: Available online 14 December 2017
Source:Actas Dermo-Sifiliográficas
Author(s): J. Navarrete, J. Magliano, M. Martínez, C. Bazzano
Background and objectivesThe primary goal of Mohs micrographic surgery (MMS) is to completely excise a cancerous lesion and a wide range of reconstructive techniques of varying complexity are used to close the resulting wound. In this study, we performed a descriptive analysis of patients who underwent MMS, with a focus on wound closure methods.Material and methodsWe conducted a bidirectional descriptive cohort analysis of all MMS procedures performed by a single surgeon between November 2013 and April 2016. Cosmetic outcomes were photographically assessed by a dermatologist after a minimum follow-up of 90 days.ResultsWe analyzed 100 MMS procedures in 71 patients with a median age of 73 years. The tumors were basal cell carcinoma (70%), squamous cell carcinoma (29%), and dermatofibrosarcoma protuberans (1%); 75% were located on the head and neck. The reconstructive techniques used were flap closure (48%), simple closure (36%), closure by second intention (11%), and other (5%). Cosmetic outcomes were assessed for 70 procedures (47 patients) and the results were rated as excellent in 20% of cases, very good in 40%, good in 20%, moderate in 17%, and bad/very bad in 2.9%. No significant associations were observed between cosmetic outcome and sex, Fitzpatrick skin type, hypertension, diabetes mellitus, or smoking. Worse outcomes, however, were significantly associated with larger tumor areas and defects, location on the trunk, and flap and second-intention closure.ConclusionsAlthough there was a tendency to use simple wound closure for lesions located on the trunk and surgical defects of under 4.4cm2, the choice of reconstructive technique should be determined by individual circumstances with contemplation of clinical and tumor-related factors and the preference and experience of the surgeon.
Graphical abstract
La investigación clínica en la Academia Española de Dermatología y Venereología vista desde su corazón
Publication date: Available online 14 December 2017
Source:Actas Dermo-Sifiliográficas
Author(s): M.A. Descalzo
Pitiriasis versicolor atrófica
Publication date: Available online 14 December 2017
Source:Actas Dermo-Sifiliográficas
Author(s): F. Allegue, C. Fachal, D. González-Vilas, A. Zulaica
Can't touch this
Publication date: Available online 14 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Özay Özkaya, Ayça Ergan Şahin
Rectus abdominis detrusor myoplasty (RADM) for acontractile/hypocontractile bladder in spinal cord injury patients: preliminary report
Publication date: Available online 14 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Pawan Agarwal, Shabbir Husain, Sudesh Wankhede, D. Sharma
Background-Urinary bladder dysfunction in the form of acontractile/hypocontractile bladder is very common after spinal cord injury and it may lead to recurrent urinary tract infection (UTI), stones formation, and deteriorating renal function. Conventionally, these patients evacuate their bladders by life-long clean intermittent catheterization (CIC) or an indwelling catheter (IC). For these patients, another option is to use innervated skeletal muscle wrap around the bladder to augment detrusor function and voluntary evacuation of bladder.Methods- We selected 5 patients with acontractile/hypocontractile bladder following spinal cord trauma. These patients were assessed by urodynamic study for post-void residual volume (PVRV), detrusor pressure (Pdet), urine flow rate (Vmax), and bladder contractility index (BCI). All five patients underwent Rectus Abdominis Detrusor Myoplasty (RADM). Results-Complete spontaneous voiding was achieved in all patients. Rectus abdominis detrusor myoplasty (RADM) elicits a statistically significant reduction in PVRV and statistically significant increase in urine flow rate, bladder contractility and detrusor pressure after 6 months. Recurrent UTIs ceased in all patients. There were no immediate or late complications.Conclusion- RADM appears to be a promising option in a patient with acontractile/ hypocontractile bladder to restore the bladder function. It avoids CIC in all patients leading to improvement in quality of life in select group of patients.
Surviving fourniers gangrene: multivariable analysis and a novel scoring system to predict length of stay.
Publication date: Available online 14 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Saum B. Ghodoussipour, Daniel Gould, Jacob Lifton, Ido Badash, Aaron Krug, Gus Miranda, Jeffrey Loh-Doyle, Joseph Carey, Hooman Djaladat, Leo Doumanian, Ginsberg David
BackgroundThere is no contemporary scoring system to predict hospital length of stay and morbidity in Fournier's gangrene. A retrospective study was conducted to formulate a scoring system to predict duration of hospitalization, resource utilization, need for reconstruction, morbidity and mortality.MethodsA retrospective chart review was performed on 54 patients treated for FG from 2010-2016 at LAC+USC Medical Center, the largest public hospital in Los Angeles County. Strobe guidelines were followed and the study was approved by the IRB. Predictors of LOS, morbidity, mortality and resource utilization were identified and univariate linear regressions performed to determine significance. Significant univariate predictors were used to develop a novel scoring system, the Combined Urology and Plastics Index (CUPI). The CUPI score was then compared to existing scoring systems for predicting length of stay.ResultsThe mean patient age was 49.3, and the mean BMI was 28.6. Patients on average were hospitalized for 37.5 days, with a mean of 8.3 days in the ICU. Three patients (5.6%) died during their hospital stay, and 33 (61%) required reconstructive surgery. Multivariate logistic modeling showed that BMI (p = 0.001) and alkaline phosphatase (p < 0.001) correlated with decreasing length of stay, while age at admission was not significantly correlated (p = 0.369). Univariate analysis of existing scoring systems showed that FGSI, LRINEC, NLR, and CCI were not significantly correlated with length of stay, while the newly calculated CUPI score was shown to be a significant predictor of longer hospital stays (p = 0.001).DiscussionEarly emphasis on supportive care, nutrition, and involvement of reconstructive surgeons can decrease LOS in patients with Fournier's gangrene. The CUPI score on admission may be a useful tool for predicting LOS in this population.
Optimal Fat Suppression in Head and Neck MRI: Comparison of Multipoint Dixon with 2 Different Fat-Suppression Techniques, Spectral Presaturation and Inversion Recovery, and STIR [HEAD & NECK]
BACKGROUND AND PURPOSE:
Uniform complete fat suppression is essential for identification and characterization of most head and pathology. Our aim was to compare the multipoint Dixon turbo spin-echo fat-suppression technique with 2 different fat-suppression techniques, including a hybrid spectral presaturation with inversion recovery technique and an inversion recovery STIR technique, in head and neck fat-suppression MR imaging.
MATERIALS AND METHODS:Head and neck MR imaging datasets of 72 consecutive patients were retrospectively reviewed. All patients were divided into 2 groups based on the type of fat-suppression techniques used (group A: STIR and spectral presaturation with inversion recovery gadolinium-T1WI; group B: multipoint Dixon T2 TSE and multipoint Dixon gadolinium-T1WI TSE). Objective and subjective image quality and scan acquisition times were assessed and compared between multipoint Dixon T2 TSE versus STIR and multipoint Dixon gadolinium-T1WI TSE versus spectral presaturation with inversion recovery gadolinium-T1WI using the Mann-Whitney U test.
RESULTS:A total of 64 patients were enrolled in the study (group A, n = 33 and group B, n = 31). Signal intensity ratios were significantly higher for multipoint Dixon T2 and gadolinium-T1WI techniques compared with STIR (P < .001) and spectral presaturation with inversion recovery gadolinium-T1WI (P < .001), respectively. Two independent blinded readers revealed that multipoint Dixon T2 and gadolinium-T1WI techniques had significantly higher overall image quality (P = .022 and P < .001) and fat-suppression grades (P < .013 and P < .001 across 3 different regions) than STIR and spectral presaturation with inversion recovery gadolinium-T1WI, respectively. The scan acquisition time was relatively short for the multipoint Dixon technique (2 minutes versus 4 minutes 56 seconds for the T2-weighted sequence and 2 minutes versus 3 minutes for the gadolinium-T1WI sequence).
CONCLUSIONS:The multipoint Dixon technique offers better image quality and uniform fat suppression at a shorter scan time compared with STIR and spectral presaturation with inversion recovery gadolinium-T1WI techniques.
Feasibility of Permanent Stenting with Solitaire FR as a Rescue Treatment for the Reperfusion of Acute Intracranial Artery Occlusion [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
The Solitaire FR can be used not only as a tool for mechanical thrombectomy but also as a detachable permanent stent. Our aim was to assess the feasibility and safety of permanent stent placement with the Solitaire FR compared with other self-expanding stents for intracranial artery recanalization for acute ischemic stroke.
MATERIALS AND METHODS:From January 2011 through January 2016, we retrospectively selected 2979 patients with acute ischemic stroke. Among them, 27 patients who underwent permanent stent placement (13 patients with the Solitaire FR [Solitaire group] and 14 patients with other self-expanding stents [other stent group]) were enrolled. The postprocedural modified TICI grade and angiographic and clinical outcomes were assessed. The safety and efficacy of permanent stent placement of the Solitaire FR for acute large-artery occlusion were evaluated.
RESULTS:Stent placement was successful in all cases. Modified TICI 2b–3 reperfusion was noted in 84.6% of the Solitaire group and in 78.6% of the other stent group. Procedural time was significantly shorter in the Solitaire group than in the other stent group (P = .022). Shorter procedural time was correlated with favorable outcome ( = 0.46, P = .035). No significant differences were found in the modified TICI grade, NIHSS score, mRS, and hemorrhagic transformation rate between the 2 groups. The acute in-stent thrombosis rate at discharge was significantly lower when a glycoprotein IIb/IIIa inhibitor was injected during the procedure (P = .013).
CONCLUSIONS:Permanent stent placement with the Solitaire FR compared with other self-expanding stents appears to be feasible and safe as a rescue tool for refractory intra-arterial therapy.
Improved Precision of Automatic Brain Volume Measurements in Patients with Clinically Isolated Syndrome and Multiple Sclerosis Using Edema Correction [ADULT BRAIN]
BACKGROUND AND PURPOSE:
The presence of edema will result in increased brain volume, which may obscure progressing brain atrophy. Similarly, treatment-induced edema reduction may appear as accelerated brain tissue loss (pseudoatrophy). The purpose of this study was to correlate brain tissue properties to brain volume, to investigate the possibilities for edema correction and the resulting improvement of the precision of automated brain volume measurements.
MATERIALS AND METHODS:A group of 38 patients with clinically isolated syndrome or newly diagnosed MS were imaged at inclusion and after 1, 2, and 4 years using an MR quantification sequence. Brain volume, relaxation rates (R1 and R2), and proton density were measured by automated software.
RESULTS:The reduction of normalized brain volume with time after inclusion was 0.273%/year. The mean SDs were 0.508%, 0.526%, 0.454%, and 0.687% at baseline and 1, 2, and 4 years. Linear regression of the relative change of normalized brain volume and the relative change of R1, R2, and proton density showed slopes of –0.198 (P < .001), 0.156 (P = .04), and 0.488 (P < .001), respectively. After we applied the measured proton density as a correction factor, the mean SDs decreased to 24.2%, 4.8%, 33.3%, and 17.4%, respectively. The observed atrophy rate reduced from 0.273%/year to 0.238%/year.
CONCLUSIONS:Correlations between volume and R1, R2, and proton density were observed in the brain, suggesting that a change of brain tissue properties can affect brain volume. Correction using these parameters decreased the variation of brain volume measurements and may have reduced the effect of pseudoatrophy.
Diagnostic Accuracy of Amino Acid and FDG-PET in Differentiating Brain Metastasis Recurrence from Radionecrosis after Radiotherapy: A Systematic Review and Meta-Analysis [ADULT BRAIN]
BACKGROUND:
Current studies that analyze the usefulness of amino acid and FDG-PET in distinguishing brain metastasis recurrence and radionecrosis after radiation therapy are limited by small cohort size.
PURPOSE:Our aim was to assess the diagnostic accuracy of amino acid and FDG-PET in differentiating brain metastasis recurrence from radionecrosis after radiation therapy.
DATA SOURCES:Studies were retrieved from PubMed, Embase, and the Cochrane Library.
STUDY SELECTION:Fifteen studies were included from the literature. Each study used PET to differentiate radiation necrosis from tumor recurrence in contrast-enhancing lesions on follow-up brain MR imaging after treating brain metastasis with radiation therapy.
DATA ANALYSIS:Data were analyzed with a bivariate random-effects model. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were pooled, and a summary receiver operating characteristic curve was fit to the data.
DATA SYNTHESIS:The overall pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of PET were 0.85, 0.88, 7.0, 0.17, and 40, respectively. The area under the receiver operating characteristic curve was 0.93. On subgroup analysis of different tracers, amino acid and FDG-PET had similar diagnostic accuracy. Meta-regression analysis demonstrated that the method of quantification based on patient, lesion, or PET scan (based on lesion versus not, P = .07) contributed to the heterogeneity.
LIMITATIONS:Our study was limited by small sample size, and 60% of the included studies were of retrospective design.
CONCLUSIONS:Amino acid and FDG-PET had good diagnostic accuracy in differentiating brain metastasis recurrence from radionecrosis after radiation therapy.
Imaging of Anaplastic Thyroid Carcinoma [HEAD & NECK]
SUMMARY:
Anaplastic thyroid carcinoma is fatal if unresectable. However, improved survival has been reported after gross total resection and multimodality therapy. In this report, we describe the contrast-enhanced high-resolution CT characteristics of anaplastic thyroid carcinoma in 57 patients. Anaplastic thyroid carcinoma presented as a large neck mass with necrosis in 82% of cases. The tumors demonstrated common extrathyroidal extension (91%). Sixty-two percent of tumors demonstrated calcification. Visceral space invasion involved the esophagus (62%), trachea (57%), and larynx (29%). Carotid artery encasement was present in 42%, and 43% involved the internal jugular vein. Sixty-three percent had lateral compartment lymphadenopathy; 58% of these nodes were necrotic, and 11% were cystic. No metastatic nodes had calcification. Central compartment lymphadenopathy was seen in 56% of cases, and lateral retropharyngeal lymphadenopathy was detected in 12%. Knowledge of these imaging features aids in guiding the approach to the initial tissue diagnosis with either fine-needle aspiration or core biopsy, assessing the feasibility of surgical resection, and determining prognosis.
Measuring Cerebral and Cerebellar Glutathione in Children Using 1H MEGA-PRESS MRS [PEDIATRICS]
BACKGROUND AND PURPOSE:
Glutathione is an important antioxidant in the human brain and therefore of interest in neurodegenerative disorders. The purpose of this study was to investigate the feasibility of measuring glutathione in healthy nonsedated children by using the 1H Mescher-Garwood point-resolved spectroscopy (MEGA-PRESS) sequence at 3T and to compare glutathione levels between the medial parietal gray matter and the cerebellum.
MATERIALS AND METHODS:Glutathione was measured using MEGA-PRESS MRS (TR = 1.8 seconds, TE = 131 ms) in the parietal gray matter (35 x 25 x 20 mm3) of 6 healthy children (10.0 ± 2.4 years of age; range, 7–14 years; 3 males) and in the cerebellum of 11 healthy children (12.0 ± 2.7 years of age; range, 7–16 years; 6 males). A postprocessing pipeline was developed to account for frequency and phase variations in the edited ON and nonedited OFF spectra. Metabolites were quantified with LCModel and reported both as ratios and water-scaled values. Glutathione was quantified in the ON-OFF spectra, whereas total NAA, total Cho, total Cr, mIns, Glx, and taurine were quantified in the OFF spectra.
RESULTS:We found significantly higher glutathione, total Cho, total Cr, mIns, and taurine in the cerebellum (P < .01). Glx and total NAA were significantly higher in the parietal gray matter (P < .01). There was no significant difference in glutathione/total Cr (P = .93) between parietal gray matter and cerebellum.
CONCLUSIONS:We demonstrated that glutathione measurement in nonsedated children is feasible. We found significantly higher glutathione in the cerebellum compared with the parietal gray matter. Metabolite differences between the parietal gray matter and cerebellum agree with published MRS data in adults.
Combining Quantitative Susceptibility Mapping with Automatic Zero Reference (QSM0) and Myelin Water Fraction Imaging to Quantify Iron-Related Myelin Damage in Chronic Active MS Lesions [ADULT BRAIN]
BACKGROUND AND PURPOSE:
A hyperintense rim on susceptibility in chronic MS lesions is consistent with iron deposition, and the purpose of this study was to quantify iron-related myelin damage within these lesions as compared with those without rim.
MATERIALS AND METHODS:Forty-six patients had 2 longitudinal quantitative susceptibility mapping with automatic zero reference scans with a mean interval of 28.9 ± 11.4 months. Myelin water fraction mapping by using fast acquisition with spiral trajectory and T2 prep was obtained at the second time point to measure myelin damage. Mixed-effects models were used to assess lesion quantitative susceptibility mapping and myelin water fraction values.
RESULTS:Quantitative susceptibility mapping scans were on average 6.8 parts per billion higher in 116 rim-positive lesions compared with 441 rim-negative lesions (P < .001). All rim-positive lesions retained a hyperintense rim over time, with increasing quantitative susceptibility mapping values of both the rim and core regions (P < .001). Quantitative susceptibility mapping scans and myelin water fraction in rim-positive lesions decreased from rim to core, which is consistent with rim iron deposition. Whole lesion myelin water fractions for rim-positive and rim-negative lesions were 0.055 ± 0.07 and 0.066 ± 0.04, respectively. In the mixed-effects model, rim-positive lesions had on average 0.01 lower myelin water fraction compared with rim-negative lesions (P < .001). The volume of the rim at the initial quantitative susceptibility mapping scan was negatively associated with follow-up myelin water fraction (P < .01).
CONCLUSIONS:Quantitative susceptibility mapping rim-positive lesions maintained a hyperintense rim, increased in susceptibility, and had more myelin damage compared with rim-negative lesions. Our results are consistent with the identification of chronic active MS lesions and may provide a target for therapeutic interventions to reduce myelin damage.
European Society for Medical Oncology (ESMO) position paper on supportive and palliative care
Abstract
Oncology has come a long way in addressing patients' quality of life, together with developing surgical, radio-oncological and medical anticancer therapies. However, the multiple and varying needs of patients are still not being met adequately as part of routine cancer care. Supportive and palliative care interventions should be integrated, dynamic, personalised and based on best evidence. They should start at the time of diagnosis and continue through to end-of-life or survivorship. ESMO is committed to excellence in all aspects of oncological care during the continuum of the cancer experience. Following the 2003 ESMO stand on supportive and palliative care (Cherny N, Catane R, Kosmidis P. ESMO takes a stand on supportive and palliative care. Ann Oncol 2003; 14(9): 1335–1337), this position paper highlights the evolving and growing gap between the needs of cancer patients and the actual provision of care. The concept of patient-centred cancer care is presented along with key requisites and areas for further work.Nitrate trends in groundwater of the Campania region (southern Italy)
Abstract
The Environmental Protection Agency of the Campania region in Italy (ARPAC) manages a groundwater quality monitoring network. For almost all the polluted waters, the key parameter driving the classification is the concentration of nitrate; hence, the Campania region, in coherence with the EU regulations, outlined the vulnerable areas and undertook remediation policies. The best groundwater quality is recorded for carbonate aquifers of the Apennine chain; on the contrary, the Tyrrhenian coastal plains are affected by severe contamination, with a locally very contaminated groundwater of the shallow and also the deeper aquifers. The study is especially focused on a large coastal plain of Campania region, where nitrate concentration sometimes exceeds 200 mg/L. The study, based on almost 200 sampling points for the whole region during the period 2003–2015 (approx two samples per year), verified the effectiveness of the groundwater monitoring network, the present distribution of nitrate in groundwater, and the evolution of nitrate trends at different scales: regional, groundwater body, and single well, using spatial and time series statistical approaches. Significant variations in contamination evolution within the study area have been observed and the correlation with land use has been highlighted.
T-Cell Inhibitors for Atopic Dermatitis
The management of atopic dermatitis is changing with the development of novel biological agents to target specific molecules in the inflammatory cascade. Dupilumab has proven its ability to act on the IL-4 receptor in treating atopic dermatitis. Thymic stromal lymphopoietin (TSLP) monoclonal antibody (AMG157/ MEDI9929) and OX40 blocking antibody (GBR 830) were developed by target the same pathway as dupilumab. The clinical data on the efficacy for these drugs is not yet known. There is some early evidence that AMG157/ MEDI9929 attenuates most measures of allergen-induced asthmatic responses.
Monoclonal Antibodies Against IL-13 and IL-31RA in Development for Atopic Dermatitis
The IL-13 and IL-31 cytokines and inflammatory pathways have been identified as important for atopic dermatitis (AD) pathophysiology. Monoclonal antibodies against IL-13 have been studied for the treatment of asthma since 2011. More recently, two phase two trials have been completed with these antibodies in atopic dermatitis treatment. In both trials, significant reductions of Eczema Area and Severity Index (EASI) scores were seen. IL-31 is thought to play a role transmitting itch sensation to the central nervous system, and blocking IL-31 activity reduces itch in atopic dermatitis patients.
Emerging Therapies for Atopic Dermatitis: Jak Inhibitors
The Janus Kinase-Signal Transducer and Activator of Transcription (JAK-STAT) pathway is a conserved master regulator of immunity and myeloproliferation. Advanced understanding of this pathway has led to development of targeted inhibitors of Janus Kinases (Jakinibs). As a class, Jakinibs effectively treat a multitude of hematologic and inflammatory diseases. Given such success, use of Jakinibs for mitigation of atopic dermatitis is under active investigation. Herein, we review the evolving data on the safety and efficacy of Jakinibs in treatment of atopic dermatitis.
Phosphodiesterase 4 (PDE4) Inhibitors
Historically, drugs available for treating atopic dermatitis (AD) have been limited to topical corticosteroids (TCS) and topical calcineurin inhibitors (TCI), with systemic immunosuppressants and phototherapy reserved for severe AD. Despite their efficacy, with long term use, these agents have associated safety concerns and limitations. More targeted options with fewer systemic and cutaneous side effects are needed for treating atopic dermatitis. Phosphodiesterase 4 is involved in the regulation of proinflammatory cytokines via the degradation of cAMP.
Emerging Therapies for Atopic Dermatitis: The Prostaglandin/Leukotriene Pathway
The role of leukotrienes and prostaglandins in development of atopy has been prototypically established in studies of asthma pathogenesis. Likewise, both in vitro and in vivo studies of atopic dermatitis have demonstrated that these molecules maintain important pathophysiologic roles. Thus, it follows that targeted therapies against these molecules may be promising in management of atopic dermatitis. Montelukast has had questionable efficacy in patients with atopic dermatitis, while small pilots using zileuton did have some clinically significant improvement.
New Therapies for Atopic Dermatitis: Additional Treatment Classes
A wide array of miscellaneous agents is being studied for the treatment of atopic dermatitis (AD), including targeted topical, oral systemic and biologic agents.
Rectus abdominis detrusor myoplasty (RADM) for acontractile/hypocontractile bladder in spinal cord injury patients: preliminary report
-Urinary bladder dysfunction in the form of acontractile/hypocontractile bladder is very common after spinal cord injury and it may lead to recurrent urinary tract infection (UTI), stones formation, and deteriorating renal function. Conventionally, these patients evacuate their bladders by life-long clean intermittent catheterization (CIC) or an indwelling catheter (IC). For these patients, another option is to use innervated skeletal muscle wrap around the bladder to augment detrusor function and voluntary evacuation of bladder.
Can't touch this
According to the data of American Society for Aesthetics Plastic Surgery breast augmentation is the second most common surgical aesthetic procedure of 2016. Complications of breast augmentation in early period are hematoma/seroma formation, asymmetry, scarring, implant rippling, malposition; whereas a late-term complications consist of inadequate satisfaction, capsular contracture glandular atrophy and a newly recognized complication: Anaplastic Large Cell Lymphoma.1 It has been discussed in the literature that the biofilm that forms around the implant; mostly around the textured ones, is one of the most important reasons leading to ALCL.
Surviving fourniers gangrene: multivariable analysis and a novel scoring system to predict length of stay.
There is no contemporary scoring system to predict hospital length of stay and morbidity in Fournier's gangrene. A retrospective study was conducted to formulate a scoring system to predict duration of hospitalization, resource utilization, need for reconstruction, morbidity and mortality.
Amine-functionalized diatom frustules: a platform for specific and sensitive detection of nitroaromatic explosive derivative
Abstract
In the present study, an attempt was made to develop a proof of concept for the detection of nitroaromatic explosive derivatives through the photoluminescence (PL) quenching process using functionalized diatom frustules as a sensing platform. The diatom frustules are composed of nanostructured, highly porous biogenic silica material and emit strong, visible blue PL upon UV excitation. PL-active biosilica was isolated from the marine diatom Nitzschia sp. and was amine-functionalized to develop a sensing platform. Functionalized diatom frustules were further characterized using field emission scanning electron microscope and a series of spectroscopic methods. When nitroaromatic compounds were bound to the functionalized diatom frustules biosilica, the PL intensity from the functionalized biosilica was partially quenched due to the electrophilic nature of the nitro (–NO) groups. The quenching process confirmed the Meisenheimer complex formation and was investigated by using Fourier transform infrared spectroscopy and time-resolved photoluminescence studies. The developed platform was further evaluated for its sensitivity and specificity, and the limit of detection (LOD) of the assay was determined as 1 μM for a series of nitroaromatic explosive compounds. In conclusion, the developed sensing platform will have great utility in the development of on-site detection platforms for sensitive detection of warfare explosive nitroaromatic compounds from the environment.
Psychosocial adjustment to skin conditions resulting in visible difference (disfigurement): What do we know? Why don’t we know more? How shall we move forward?
This article offers an overview of the current understanding of the psychological factors and processes that play a part in the continuum of distress and positive adjustment in people who are affected by dermatological conditions that affect appearance. Despite research demonstrating the significant psychosocial challenges posed by visible difference and mounting evidence of the role played by psychosocial variables in the etiology, exacerbation, and treatment of skin conditions, current healthcare provisions focus predominantly on the amelioration of physical manifestations.
Transgene escape and persistence in an agroecosystem: the case of glyphosate-resistant Brassica rapa L. in central Argentina
Abstract
Brassica rapa L. is an annual Brassicaceae species cultivated for oil and food production, whose wild form is a weed of crops worldwide. In temperate regions of South America and especially in the Argentine Pampas region, this species is widely distributed. During 2014, wild B. rapa populations that escaped control with glyphosate applications by farmers were found in this area. These plants were characterized by morphology and seed acidic profile, and all the characters agreed with B. rapa description. The dose-response assays showed that the biotypes were highly resistant to glyphosate. It was also shown that they had multiple resistance to AHAS-inhibiting herbicides. The transgenic origin of the glyphosate resistance in B. rapa biotypes was verified by an immunological test which confirmed the presence of the CP4 EPSPS protein and by an event-specific GT73 molecular marker. The persistence of the transgene in nature was confirmed for at least 4 years, in ruderal and agrestal habitats. This finding suggests that glyphosate resistance might come from GM oilseed rape crops illegally cultivated in the country or as a seed contaminant, and it implies gene flow and introgression between feral populations of GM B. napus and wild B. rapa. The persistence and spread of the resistance in agricultural environments was promoted by the high selection pressure imposed by intensive herbicide usage in the prevalent no-till farming systems.
Isolation and Evaluation of cocktail phages for the control of multi-drug resistant Escherichia coli serotype O104: H4 and E. coli O157: H7 isolates causing diarrhea
Abstract
Escherichia coli serotype O157: H7 and E. coli O104: H4 are well known food borne pathogens causing sever enteric illness. Using bacteriophages as biocontrol agents of some food borne pathogens and multi-drug resistant bacteria has a great attention nowadays. This study aims to test the effect of cocktail phages on the growth of some food borne pathogens and MDR E. coli. Routine conventional PCR was used to confirm the identification of E. coli isolates. Double-layered culture technique was used to isolate phages from sewage water. Morphology of bacteriophage was described using Transmission Electron Microscopy (TEM) and spot test was performed to determine host range of the phage cocktail. Phage Cocktail of Siphoviridae and Podoviridae family infecting E. coli O157: H7, E. coli O104: H4 and untypeable E. coli (neither O157 nor O104) has been isolated from sewage water. Phage cocktail showed both lytic and lysogenic activity. Lytic activity was observed against E. coli O157: H7, E. coli O104: H4 isolates, Staphylococcus. aureus ATCC6538 and Pseudomonas aeruginosa ATCC 10145 while the lysogenic activity was observed against the untypeable strain. The tested phage cocktail showed a promising inhibitory action on E. coli O157: H7 and O104: H4, S. aureus ATCC6538 and P. aeruginosa ATCC 10145, suggesting the possibility of its use as a biocontrol tool or as natural food preservatives for many food products.Vermilionectomy in Malignant and Premalignant Lower Lip Lesions
This cohort study examines the effectiveness of vermilionectomy in patients with lower lip actinic cheilitis.
Mental Health and Nasal Function—Reply
In Reply Mental health is complex, and there may be various domains that influence perception of nasal function. For instance, our research suggests that there is an association between mental well-being and self-esteem, but not between mental well-being and body dysmorphia. Dr Bartley's suggestion about the association between anxiety and a worse perception of nasal function is well worth consideration, especially given that patients with anxiety often experience symptoms of dyspnoea. Our study did not evaluate anxiety as a factor influencing perception of nasal function, nor was hyperventilation assessed during the objective nasal function testing, and this makes it difficult for us to comment on the association.
Asian Upper Blepharoplasty
This Surgical Pearl describes the eyelid crease blepharoplasty, or aesthetic blepharoplasty, in Asian patients using a beveled approach and trapezoidal debulking of preaponeurotic tissues.
Mental Health and Nasal Function
To the Editor Strazdins and colleagues have noted that patients with poor mental health status have a poorer self-perception of nasal function. More than 60 years ago, Holmes et al observed a similar relationship between anxiety and a number of nasal symptoms, including nasal congestion. In a previous report, I noted that hyperventilation and hyperventilation syndrome, which is associated with both anxiety and depression, is common in patients presenting with nasal congestion, particularly after failed nasal surgery. Hanna et al have made similar observations. Physiological, epidemiological, and clinical evidence support a "unified" upper and lower respiratory airway model. The limbic system or emotional brain has an independent control over lower respiratory breathing pattern and rate. People who are prone to anxiety attacks have lower arterial carbon dioxide levels (5 mm Hg on average) compared with controls, and their carbon dioxide receptors are more responsive to changes in arterial carbon dioxide levels.
Spreader and Butterfly Graft Comparison in Cadaveric Models
This cadaver study uses computational fluid dynamics to compare nasal airflow resistance following butterfly and spreader graft surgical interventions for treating nasal valve compromise.
Improving a compact biofilm reactor to realize efficient nitrogen removal performance: step-feed, intermittent aeration, and immobilization technique
Abstract
Purifying tank as a compact biofilm reactor has been widely used to remove organic matter in rural sewage, but its potential for nitrogen removal is rare to be discussed. This study developed a lab-scale compact biofilm reactor to realize an efficient nitrogen removal performance by step-feed, intermittent aeration, and immobilization technique. The results show that an efficient simultaneous nitrification and denitrification (SND) process took place by feeding with synthetic wastewater under high C/N ratio of 2 and with real sewage as well, mainly due to the step-feed. The average removal efficiency of total inorganic nitrogen arrived at 72.7 and 63.3% for synthetic wastewater and real sewage, respectively. Besides the step-feed operation, the intermittent aeration was adopted to enhance SND, which allowed hydraulic behavior of compact biofilm reactor following the model of completely stirred tank reactor. The high-throughput sequencing analysis indicates that Sphaerotilus became the dominant genera with relative abundance of 30.29% under high C/N ratio, and the nitrifiers were not greatly inhibited. Moreover, the immobilization technique helped restore microbial activity under low temperature, promoting the satisfactory nitrogen removal performance of recovered microorganism to be rebuilt by feeding nutrient solution. Overall, the long-term SND process and maintaining effective biofilm activity can be established in the compact biofilm reactor through several improving alternatives.
Characterization of multiple antibiotic resistance of culturable microorganisms and metagenomic analysis of total microbial diversity of marine fish sold in retail shops in Mumbai, India
Abstract
Marine fish species were analyzed for culturable and total metagenomic microbial diversity, antibiotic resistance (AR) pattern, and horizontal gene transfer in culturable microorganisms. We observed a high AR microbial load of 3 to 4 log CFU g−1. Many fish pathogens like Providencia, Staphylococcus, Klebsiella pneumoniae, Enterobacter, Vagococcus, and Aeromonas veronii were isolated. Photobacterium and Vibrio were two major fish and human pathogens which were identified in the fish metagenome. Other pathogens that were identified were Shewanella, Acinetobacter, Psychrobacter, and Flavobacterium. Most of these pathogens were resistant to multiple antibiotics such as erythromycin, kanamycin, neomycin, streptomycin, penicillin, cefotaxime, bacitracin, rifampicin, trimethoprim, ciprofloxacin, and doxycycline with a high multiple antibiotic resistance index of 0.54–0.77. The fish microflora showed high prevalence of AR genes like bla TEM, Class I integron, tetA, aph(3′)-IIIa, ermB, aadA, and sul1. Nineteen of 26 AR isolates harbored Class I integrons showing high co-resistance to trimethoprim, kanamycin, doxycycline, and cefotaxime. Mobile R-plasmids from 6 of the 12 AR pathogens were transferred to recipient E. coli after conjugation. The transconjugants harbored the same R-plasmid carrying bla CTX-M, dfr1, tetA, bla TEM, and cat genes. This study confirms that fish is a potential carrier of AR pathogens which can enter the human gut via food chain. To the best of our knowledge, this is the first study in the Indian subcontinent reporting a direct evidence of spread of AR pathogens to humans from specific marine fish consumption.
Impaired reproduction and individual growth of the water flea Daphnia magna as consequence of exposure to the non-ester pyrethroid etofenprox
Abstract
The effect of the pesticide etofenprox (0.76, 0.95, 1.18, 1.48, and 1.85 μg L−1) on survival, reproduction, and growth of Daphnia magna organisms was monitored using 21-day exposure tests. In order to test pesticide effects on D. magna, survival, length, mean total neonates per female, mean brood size, time to first reproduction, mean number broods per female, cumulative molting, and the population parameter intrinsic rate of natural increase (r) were used. Reproduction was seriously affected by etofenprox. Concentrations of etofenprox higher than 1.18 μg L−1affected all the reproductive parameters analyzed as well as individual length. However, daphnids' survival after 21 days of pesticide exposure did not exhibited differences among experimental and control groups. The no observed effect concentration (NOEC), the lowest observed effect concentration (LOEC), and the maximum acceptable toxicant concentration (MATC) were calculated for the different parameters. A MATC estimation of 1.32 μg L−1 was calculated for mean brood size, mean number of broods per female, mean number of neonates per female, and the intrinsic rate of growth population. Etofenprox effect on the algae Nannochloris oculata was also evaluated. The selected etofenprox concentrations did not affect algal growth rate (μ) after 24 h; however, N. oculata exposed during 48 and 72 h to the highest etofenprox concentration showed a decreased in its population rate.
Ameloblastic Fibrodentinoma: A Rarity in Odontogenic Tumors
Abstract
Ameloblastic fibrodentinoma is a rare, benign, mixed odontogenic tumor composed of odontogenic epithelium, immature connective tissue and is characterized by the formation of dysplastic dentin. An incidence of 0.1% is reported for this benign odontogenic tumor which indicates the rarity of this lesion. In the present review, a case of ameloblastic fibrodentinoma of the mandible in an african male is presented which was managed by surgical enucleation of the lesion along with the removal of impacted tooth associated with it.
3-D Miniplates Versus Conventional Miniplates in Treatment of Mandible Fractures
Abstract
Aim
To study whether the use of 3-D miniplate, when compared with conventional miniplate, gives better clinical outcomes with fewer complications in patients with fracture mandible.
Materials and Methods
A prospective study was conducted in the Department of Oral and Maxillofacial Surgery, Trauma Care Centre, on 40 patients. They were randomly divided into Group-I and Group-II with 20 patients in each group. In Group-I, 3-D miniplate was used and in Group-II, conventional miniplate was used. Parameters such as fracture stability, occlusal status, mouth opening, nerve paresthesia, infection, pain, swelling, and complications were evaluated on 1st, 7th postoperative day, 1st month and 3rd month.
Results
Fracture stability and occlusion were clinically better in Group-I than in Group-II on each follow-up; however, it was not statistically significant. Infection rate was lesser in Group-I than in Group-II (p = 0.003). Mouth opening was more in Group-II than in Group-I on immediate (p = 0.001) and 7th post-op day (p = 0.002). Overall complications were lesser in Group-I than in Group-II (p > 0.005).
Conclusion
There is no major difference observed in clinical outcomes between 3-D miniplate and conventional miniplate. Either method of fixation can be used successfully in treatment of mandible fractures with comparable rates of complications.
Schleimhautpemphigoid
Zusammenfassung
Das Schleimhautpemphigoid (SHP) gehört zur Gruppe der Pemphigoiderkrankungen. Die Erkrankung ist definiert durch das Auftreten von Autoantikörpern gegen die dermoepidermale Junktionszone und den vorwiegenden Befall der Schleimhäute. Die Diagnose des SHP wird bei entsprechendem klinischem Phänotyp durch lineare Ablagerungen von IgG und/oder IgA und/oder Komplement C3 an der dermoepidermalen Junktionszone in der direkten Immunfluoreszenz einer periläsionalen Biopsie gestellt. Zirkulierende Autoantikörper lassen sich meist mittels indirekter Immunfluoreszenz auf humaner Spalthaut und ELISA („enzyme-linked immunosorbent assay") oder Immunoblotuntersuchungen unter Verwendung zellulärer oder rekombinanter Antigene nachweisen. Zur systemischen Therapie des SHP werden Kortikosteroide, Dapson, Mykophenole und Azathioprin eingesetzt. Bei schweren Fällen und rascher Progression kommen zusätzlich Cyclophosphamid, Rituximab, hoch dosierte intravenöse Immunglobuline und Immunadsorption zum Einsatz. Entscheidend für die erfolgreiche Behandlung des SHP ist die Zusammenarbeit mit Kollegen anderer Fachrichtungen, wie Zahn-, Augen- und HNO-Ärzten sowie Gastroenterologen und Gynäkologen.
Identification and functional analysis of potential prophage-derived recombinases for genome editing in Lactobacillus casei
Abstract
Numerous lactic acid bacteria (LAB) bacteriophage genomes have been sequenced, while the functional genes are yet to be exploited. In this study, a λ Red-like recombinase operon LCABL_13040–50-60 was identified from a prophage PLE3 in Lactobacillus casei BL23 genome, and its recombination function was confirmed by the replacement of a 167-bp galK fragment with chloramphenicol-resistant gene (cat) in the L. casei BL23 genome. Further functional analysis showed that LCABL_13040 and LCABL_13060 were analogs to the host nuclease inhibitor (Redγ) and 5΄-3΄ exonuclease (Redα/RecE), respectively. After optimization of recombineering conditions, including induction, homology length, recovery time and double-strand DNA substrates quantity, the recombineering efficiency reached ∼2.2 × 10−7. Subsequently, combining cre-lox technology, the optimal LCABL_13040–50-60 proteins could catalyze markerless deletion of a 167-bp galK fragment and insertion of the gfp gene as well as precision point mutation of rpoB gene in the L. casei BL23 genome, suggesting the LCABL_13040–50-60 operon encoded for three recombineering proteins. Moreover, with the assistance of Redγ, the LCABL_13040–50-60 proteins also showed recombinase activity in six other L. casei strains, L. paracasei OY and L. plantarum WCSF1. All the results demonstrated that the prophage-associated recombinases LCABL_13040–50-60 have great potential to be used for genome editing in LAB.Identification and characterization of mcr mediated colistin resistance in extraintestinal Escherichia coli from poultry and livestock in China
Abstract
Antimicrobial resistance to colistin has emerged worldwide threatening the efficacy of one of the last-resort antimicrobials used for the treatment of multidrug-resistant Enterobacteriaceae infection in humans. In this study, we investigated the presence of colistin resistance genes (mcr-1, mcr-2, mcr-3) in Escherichia coli strains isolated from poultry and livestock collected between 2004 and 2012 in China. Furthermore, we studied the maintenance and transfer of the mcr-1 gene in E. coli after serial passages. Overall, 2.7% (17/624) of the E. coli isolates were positive for the mcr-1 gene while none were positive for the mcr-2 and mcr-3 genes. The prevalences of mcr-1 were similar in E. coli isolates from chickens (3.2%; 13/404), pigs (0.9%; 1/113) and ducks (6.8%; 3/44) but were absent in isolates from cattle (0/63). The mcr-1 gene was maintained in the E. coli after six passages (equivalent to 60 generations). In vitro transfer of mcr-1 was evident even without colistin selection. Our data indicate the presence of mcr-1 in extraintestinal E. coli from food-producing animals in China, and suggest that high numbers of the mcr-1-positive bacteria in poultry and livestock do not appear to be readily lost after withdrawal of colistin as a food additive.A Systematic Review of Safety and Immunogenicity of Influenza Vaccination Strategies in Solid Organ Transplant Recipients
Abstract
Immunogenicity from seasonal inactivated influenza vaccine (IIV) remains suboptimal in solid organ transplant recipients (SOTR). We conducted a systematic review that compared the safety and immunogenicity of non-standard influenza vaccination strategies to single dose IIV in SOTR. Booster dose(s) and possibly high dose (HD) influenza vaccination strategies appear to hold promise for improving vaccination immunogenicity in SOTR. Administration of intradermal and MF59-adjuvanted trivalent IIV (IIV3) did not improve vaccine immunogenicity compared to single dose intramuscular IIV. Alternative vaccine strategies were generally well-tolerated; a higher frequency of injection site reactions and systemic adverse events were noted in SOTR who received HD, intradermal or adjuvanted IIV3 and HD IIV3 respectively. Allograft rejection rates were similar in both groups. SOTR should continue to receive standard dose IIV annually in accordance to current recommendations pending future studies to determine the optimal timing, frequency and dose(s) of IIV using the booster dose strategy.A Double Blind Randomized Trial of High Dose vs. Standard Dose Influenza Vaccine in Adult Solid Organ Transplant Recipients
Abstract
Background
The annual standard dose influenza vaccine has suboptimal immunogenicity in solid organ transplant recipients (SOTR). Influenza vaccine containing higher doses of antigens may lead to greater immunogenicity in this population. Methods
We conducted a randomized, double blind trial comparing the safety and immunogenicity of the 2016-17 high dose (HD; FluzoneHD,Sanofi) versus standard dose (SD; Fluviral,GSK) influenza vaccine in adult SOTR. Preimmunization and 4-week postimmunization sera underwent strain-specific hemagglutination inhibition assay. Results
We enrolled 172 patients who received study vaccine and 161 (84 HD; 77 SD) were eligible for analysis. Seroconversion to at least 1 of 3 vaccine antigens was present in 78.6% vs. 55.8% in HD vs. SD vaccine respectively (p<0.001). Seroconversion to A/ H1N1, A/H3N2 and B strains were 40.5% vs. 20.5%, 57.1% vs. 32.5%, and 58.3% vs. 41.6% in HD vs. SD vaccine (p=0.006, 0.002, 0.028 respectively). Post-immunization geometric mean titers of A/H1N1, A/H3N2, and B strains were significantly higher in HD group (p=0.007, 0.002, 0.033). Independent factors associated with seroconversion to at least one vaccine strain were the use of HD vaccine (OR 3.23, 95% CI 1.56-6.67) and use of mycophenolate doses less than 2g daily (OR 2.76, 95% CI 1.12-6.76). Conclusions
High-dose vaccine demonstrated significantly better immunogenicity than SD vaccine in adult transplant recipients and may be the preferred influenza vaccine for this population.Silent Cerebral Small-Vessel Disease Twice as Prevalent in Middle-Aged Well-Controlled cART-Treated HIV-Infected Individuals Than HIV-Uninfected Individuals
Abstract
Background
Silent cerebral small-vessel disease (CSVD) is defined as white matter hyperintensities, silent brain infarction or microbleeds. CSVD is responsible for future vascular events, cognitive impairment, frailty and shorter survival. CSVD prevalence among middle-aged persons living with well-controlled HIV infection (PLHIVs) is unknown. Methods
ANRS EP51 MicroBREAK (NCT02082574) is a cross-sectional study with prospective enrollment of treated PLHIVs, ≥50 years old with viral load controlled for ≥12 months, and frequency age- and sex-matched HIV-uninfected controls (HUCs). It was designed to estimate CSVD prevalence on 3T MRI (3D FLAIR, DWI and T2*), as diagnosed by 2 blinded neuroradiologists. A logistic-regression model was used to assess the impact of HIV on CSVD after adjustment for traditional risk factors. Results
Between June 2013 and May 2016, 456 PLHIVs and 154 HUCs were recruited. Respective median ages were 56 and 58 years (P=0.001), among whom 84.9% and 77.3% (P=.030) were men. CSVD was detected in 51.5% of PLHIVs and 36.4% of HUCs with an adjusted odds ratio (aOR) of 2.3. The HIV impact differed according to age, with aOR values of 5.3, 3.7 and 1.0 for age groups <54, 54–60 and >60 years, respectively (P=.022). Older age, hypertension or lower CD4-cell nadir was independently associated with a higher risk of CSVD among PLHIVs. Conclusions
HIV is an independent risk factor for CSVD. Despite sustained immunovirological control, the CSVD prevalence was twice as high among middle-aged PLHIVs than HUCs.Diagnostic accuracy of high resolution T2-weighted MRI versus contrast enhanced T1-weighted MRI to screen for cerebellopontine angle lesions in symptomatic patients
Abstract
Objective
To evaluate diagnostic accuracy of high resolution T2-weighted MRI (T2w) for detecting cerebellopontine angle (CPA) lesions compared to a combined protocol including gadolinium enhanced T1-weighted MRI (GdT1w).
Setting
Department of Radiology & Nuclear Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands.
Participants
A random sample of MRIs from 350 patients (700 CPAs) with asymmetrical audiovestibular complaints was used, acquired between 2013-2016.
Main outcome measures
Sensitivity, specificity, positive and negative predictive values of T2w results compared to GdT1w and, in patients with any suggestion of CPA pathology, to the complete examination (T1w, GdT1w and T2w). Inter-rater agreement between an experienced neuroradiologist and a less experienced observer was calculated.
Results
Results of 678 CPAs in 340 patients were analyzed. On T2w the neuroradiologist identified all 27 lesions >2 mm in size out of a total of 30 CPA lesions (sensitivity: 90% [95%CI:73.5-97.9%]). Negative predictive value reached 99.5% [95%CI:98.7-99.9]. One missed lesion of 2 mm would have been detected in clinical practice, as this was one of 14 patients for which additional GdT1w would have been ordered based on T2w alone, increasing sensitivity to 93% [95%CI:77.9-99.2%] and negative predictive value to 99.7% [95%CI:98.9-100%]. Inter-rater agreement for T2w was 98% [95%CI:96.4-98.8].
Conclusion
T2w has a very high diagnostic accuracy for the presence of CPA lesions in patients with asymmetrical audiovestibular complaints. However, in a screening protocol with T2w only, smallest vestibular schwannomas as well as rare differential diagnoses that probably only would be detected on GdT1w may remain unnoticed.
Garden terror – case series of twenty eight serious ear injuries caused by yucca plants
Abstract
The yucca plant (genus Yucca, family Asparagaceae, subfamily Agavoideae) is a ubiquitous plant whose long and sharp leaf spines (Fig 1) are accountable for an increasing number of ear injuries presenting to the Emergency Department of our specialised tertiary hospital. Whereas most cases presented as easy-to-diagnose traumatic tympanic membrane perforations (TMP) which healed quickly, 4 cases were complicated by perilymphatic fistula (PLF), and these presented a diagnostic dilemma that resulted in late diagnoses.
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Surgical Anatomy of the Round Window – Implications for Cochlear Implantation
Abstract
Background
The round window is an important portal for the application of active hearing aids and cochlear implants. The anatomical and topographical knowledge about the round window region is a prerequisite for successful insertion for a cochlear implant electrode.
Objective of review
To sum up current knowledge about the round window anatomy and to give advice to the cochlear implant surgeon for optimal placement of an electrode.
Type of review
Systematic Medline search.
Search strategy
Search term "round window[Title]" with no date restriction. Only publications in the English Language were included. All abstracts were screened for relevance, i.e. a focus on surgical anatomy of the round window. The search results were supplemented with hand searching of selected reviews and reference lists from included studies.
Evaluation method
Subjective assessment.
Results
There is substantial variability in size and shape of the round window. The round window is regarded as the most reliable surgical landmark to safely locate the scala tympani. Factors affecting the optimal trajectory line for atraumatic electrode insertion are anatomy of the round window, the anatomy of the intracochlear hook region and the variable orientation and size of the cochlea's basal turn.
Conclusions
The very close relation to the sensitive inner ear structures necessitates a thorough anatomic knowledge and careful insertion technique, especially when implanting patients with residual hearing. In order to avoid electrode migration between the scalae and to achieve protect the modiolus and the basilar membrane, it is recommended to aim for an electrode insertion vector from postero-superior to antero-inferior.
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Endothelial Dysfunction May Promote Keloid Growth
Abstract
Keloid is a cutaneous fibroproliferative disorder. It results from impaired wound healing that generates persistent inflammation and extensive deposition of collagen fibers in the wound/scar. Keloids tend to be worse in hypertensive patients. The present prospective cross-sectional study assessed whether endothelial dysfunction, which occurs in hypertension, associates with keloid formation and progression. This study included randomly-selected patients with keloids who were assessed for surgical keloid treatment in 2013–2014. A series of non-keloid patients admitted to the hospital was also recruited during this period. To measure endothelial function, all patients underwent digital reactive hyperemia-peripheral arterial tonometry. Test results were expressed as reactive hyperemia index (RHI) and augmentation index (AI). In total, 57 patients with keloids and 19 non-keloid controls were recruited. Keloid patients did not differ from the controls in terms of demographic or clinical variables, but had significantly worse RHI and AI values. Moreover, poor RHI and AI values associated with keloid development on binomial logistic regression. The keloid patients were then divided into four groups depending on whether their keloids started at age 0–12, 13–18, 19–29, or ≥30 years. Patients whose keloids arose before and well after puberty tended to have lower RHI than the controls, but these differences did not achieve statistical significance. However, these two groups did have significantly poorer AI values than the controls. Thus, endothelial dysfunction could cause keloid formation and/or aggravation. This indicates that vascular endothelial cells are important for wound healing. This article is protected by copyright. All rights reserved.
Extracellular matrix/stromal vascular fraction gel conditioned medium accelerates wound healing in a murine model
Abstract
Conditioned medium (CM) is a new treatment modality in regenerative medicine and has shown a successful outcome in wound healing. We recently introduced extracellular matrix/stromal vascular fraction gel (ECM/SVF-gel), an adipose-derived stem cell and adipose native extracellular matrix-enriched product for cytotherapy. This study aimed to evaluate the effect of CM from ECM/SVF-gel (Gel-CM) on wound healing compared with the conventional CM from adipose tissue (Adi-CM) and stem cell (SVF-CM). In vitro wound healing effect of three CMs on keratinocytes and fibroblasts was evaluated in terms of proliferation property, migratory property, and extracellular matrix production. In vivo, two full-thickness wounds were created on the back of each mice. The wounds were randomly divided to receive Gel-CM, Adi-CM, SVF-CM, and PBS injection. Histologic observations and collagen content of wound skin were made. Growth factors concentration in three CMs was further quantified. In vitro, Gel-CM promoted the proliferation and migration of keratinocytes and fibroblasts and enhanced collagenIsynthesis in fibroblasts compared to Adi-CM and SVF-CM. In vivo, wound closure was faster, and dermal and epidermal regeneration was improved in the Gel-CM-treated mice compared to that in Adi-CM and SVF-CM-treated mice. Moreover, The growth factors concentration (i.e., vascular endothelial growth factor, basic fibroblast growth factor, hepatocyte growth factor, and transforming growth factor-β) in Gel-CM were significantly higher than those in Adi-CM and SVF-CM. Gel-CM generated under serum free conditions significantly enhanced wound healing effect compared to Adi-CM and SVF-CM by accelerating cell proliferation, migration, and production of ECM. This improved trophic effect may be attributed to the higher growth factors concentration in Gel-CM. Gel-CM shows potential as a novel and promising alternative to skin wound healing treatment. But limitations include the safety and immunogenicity studies of Gel-CM still remain to be clearly clarified and more data on mechanism study are needed. This article is protected by copyright. All rights reserved.
Contrast-enhanced ultrasound for needle biopsy of central lung cancer with atelectasis
Abstract
Purpose
Contrast-enhanced ultrasound (CEUS) can distinguish between central lung cancer and atelectatic lung tissue. The aim of this study was to explore the clinical value of CEUS for biopsy in patients with central lung cancer with obstructive atelectasis.
Methods
One hundred and twelve patients were selected and CEUS was performed to display central lung cancer and atelectatic lung tissue. The front edge of central lung cancer was punctured with a needle, avoiding the necrotic area, under the guidance of CEUS.
Results
All of the 112 lesions were diagnosed with a clear central lung cancer mass and atelectatic lung tissue. In 104 cases, the central lung cancer mass presented with a "slow-in and fast-out" pattern compared to atelectatic lung tissue. In eight cases, the central lung cancer mass presented with a "fast-in and fast-out" pattern compared to atelectatic lung tissue. The mean number of punctures was 2.6, and the success rate of puncture biopsy was 98%. Of the 112 patients, six cases had hemoptysis during the procedure and 10 patients had bloody sputum in the postoperative period. No complications were found in the other cases.
Conclusion
CEUS has important clinical value for needle biopsy of central lung cancer with atelectasis.
Enhanced Recovery After Surgery: The Plastic Surgery Paradigm Shift
Abstract
Background
With a focus on providing high quality care and reducing facility based expenses there has been an evolution in perioperative care by way of enhanced recovery after surgery (ERAS). ERAS allows for a multidisciplinary and multimodal approach to perioperative care which not only expedites recovery but maximizes patient outcomes. This paradigm shift has been generally accepted by most surgical specialties, including plastic surgery. Objectives
The goal of this study was to evaluate the impact of ERAS on outcomes in cosmetic plastic surgery. Methods
A prospective study consisting of phone call questionnaires was designed where patients from two senior plastic surgeons (N.H.R. and J.D.F.) were followed. The treatment group (n = 10) followed an ERAS protocol while the control group (n = 12) followed the traditional recovery after surgery which included narcotic usage. Patients were contacted on postoperative days (POD) 0 through 7+ and surveyed about a number of outcomes measures. Results
The ERAS group demonstrated a significant reduction in postoperative pain on POD 0, 1, 2, and 3 (all P < 0.01). There was also statistically less nausea/vomiting, fatigue/drowsiness, constipation, and hindrance on ambulation compared to the control group (all P < 0.05). Significance was achieved for reduction in fatigue/drowsiness on POD 0 and 1 (P < 0.01), as well as ability to ambulate on POD 0 and 3 (P = 0.044). Lastly, opioid use (P < 0.001) and constipation (P = 0.003) were decreased. Conclusions
ERAS protocols have demonstrated their importance within multiple surgical fields, including cosmetic plastic surgery. The utility lies in the ability to expedite patient's recovery while still providing quality care. This study showed a reduction in postoperative complaints by avoiding narcotics without an increase in complications. Our findings signify the importance of ERAS protocols within cosmetic plastic surgery. Level of Evidence: 4
Allergen-specific immunotherapy with storage mites
Abstract
As a result of the German Therapy Allergen Ordinance and justified demands for large, double-blind, placebo-controlled studies on allergen-specific immunotherapy, rare therapy allergens as immunotherapeutic agents have moved out of the scientific and allergological spotlight. Allergen-specific immunotherapy with house dust mite extracts is well established, but beside house dust mites, storage mites may cause similar allergic symptoms that also require a causal treatment. Especially in Asia storage mites are the most important inhalative allergens, but they are important allergens as well for some patients in Germany. The cross-reactivity between house dust mites and storage mites but also cross-reactivity between different kinds of storage mites is low. Therefore, storage mites should be included in diagnostic procedures to prevent misdiagnosis in patients suffering from perennial rhinitis. Thus, manufacturer should guarantee the availability of storage mite extracts for diagnostics and allergen-specific immunotherapy. Clinical trials documenting the efficacy of these extracts are necessary.
Evaluation of bone metastatic burden by bone SPECT/CT in metastatic prostate cancer patients: defining threshold value for total bone uptake and assessment in radium-223 treated patients
Abstract
Objectives
To establish a new three-dimensional quantitative evaluation method for bone metastasis, we applied bone single photon emission tomography with computed tomography (SPECT/CT). The total bone uptake (TBU), which measures active bone metastatic burden, was calculated as the sum of [mean uptake obtained as standardized uptake value (SUV) above a cut-off level] × (the volume of the lesion) in the trunk using bone SPECT/CT. We studied the threshold value and utility of TBU in prostate cancer patients treated with radium-223 (Ra-223) therapy.
Methods
To establish the threshold value of TBU, we compared bone metastatic and non-metastatic regions in 61 prostate cancer patients with bone metastasis and 69 without. Five fixed sites in each patient were selected as evaluation points and divided into bone metastatic and non-metastatic sites. Sensitivity and specificity analysis was applied to establish the threshold level. Using the obtained threshold value, we then calculated the TBU in nine prostate cancer patients who received Ra-223 therapy, and compared the results with the bone scan index (BSI) by BONENAVI® and visual evaluation of bone scintigraphy.
Results
Uptake was significantly lower in non-metastatic sites in patients with bone metastasis than in patients without metastasis. Sensitivity and specificity analysis revealed SUV = 7.0 as the threshold level. There was a discrepancy between TBU and BSI change in two of the nine patients, in whom TBU change correlated with visual judgement, but BSI change did not. In two patients, BSI was nearly 0 throughout the course, but the TBU was positive and changed, although the change was not large. These results suggest that TBU may be more accurate and sensitive than BSI for quantitative evaluation of active bone metastatic burden.
Conclusion
We established a threshold value (SUV > 7.0) for three-dimensional TBU for evaluating active bone metastatic burden in prostate cancer patients using bone SPECT/CT. Despite the small number of patients, we expect the change in TBU could be more accurate and sensitive than the change in BSI among patients who received Ra-223.
Relational autonomy in the care of the vulnerable: health care professionals’ reasoning in Moral Case Deliberation (MCD)
Abstract
In Moral Case Deliberation (MCD), healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals' moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient's nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient's autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients' influence and at the same time take responsibility for their needs as vulnerable humans.
How many melanomas might be prevented if more people applied sunscreen regularly?
Summary
Background
Ultraviolet radiation causes cutaneous melanoma. Sunscreen prevents sunburn and protects skin cells against mutations. High-quality epidemiological studies suggest regular sunscreen use prevents melanoma.
Objectives
To calculate the potential impact fraction (PIF) for melanoma in the U.S.A. and Australia assuming a range of different intervention scenarios intended to increase sunscreen use.
Methods
We calculated the PIF, the proportional difference between the observed number of melanomas arising under prevailing levels of sunscreen use compared with the number expected under counterfactual scenarios. We used published melanoma incidence projections for Australia and the white population in the U.S.A. from 2012 through to 2031 as the baseline condition, with estimates for protective effects of 'regular sunscreen use' from the literature. Sunscreen prevalence was sourced from national or state surveys.
Results
Under a plausible public health intervention scenario comprising incremental increases in sunscreen prevalence over a 10-year implementation programme, we estimated that cumulatively to 2031, 231 053 fewer melanomas would arise in the U.S. white population (PIF 11%) and 28 071 fewer melanomas would arise in Australia (PIF 10%). Under the theoretical maximum model of sunscreen use, almost 797 000 (PIF 38%) and approximately 96 000 (PIF 34%) melanomas would be prevented in the U.S.A. and Australia, respectively between 2012 and 2031. A sensitivity analysis using weaker effect estimates resulted in more conservative PIF estimates.
Conclusions
Overall, interventions to increase use of sunscreen would result in moderate reductions in melanoma incidence, assuming no compensatory overexposure to the sun. Countries with a high incidence of melanoma should monitor levels of sunscreen use in the community.
DRESS et virus. Comment avancer ?
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A. Barbaud, N. Dupin, J.-C. Roujeau
Seasonal variations in size distribution, water-soluble ions, and carbon content of size-segregated aerosols over New Delhi
Abstract
Size distribution, water-soluble inorganic ions (WSII), and organic carbon (OC) and elemental carbon (EC) in size-segregated aerosols were investigated during a year-long sampling in 2010 over New Delhi. Among different size fractions of PM10, PM0.95 was the dominant fraction (45%) followed by PM3–7.2 (20%), PM7.2–10 (15%), PM0.95–1.5 (10%), and PM1.5–3 (10%). All size fractions exceeded the ambient air quality standards of India for PM2.5. Annual average mass size distributions of ions were specific to size and ion(s); Ca2+, Mg2+, K+, NO3−, and Cl− followed bimodal distribution while SO42− and NH4+ ions showed one mode in PM0.95. The concentrations of secondary WSII (NO3−, SO42−, and NH4+) increased in winters due to closed and moist atmosphere whereas open atmospheric conditions in summers lead to dispersal of pollutants. NH4+and Ca2+were dominant neutralization ions but in different size fractions. The summer-time dust transport from upwind region by S SW winds resulted in significantly high concentrations of PM0.95 and PM3–7.2 and PM7.2–10. This indicted influence of dust generation in Thar Desert and its transport is size selective in nature in downwind direction. The mixing of different sources (geogenic, coal combustions, biomass burning, plastic burning, incinerators, and vehicular emissions sources) for soluble ions in different size fractions was noticed in principle component analysis. Total carbon (TC = EC + OC) constituted 8–31% of the total PM0.95 mass, and OC dominated over EC. Among EC, char (EC1) dominated over soot (EC2 + EC3). High SOC contribution (82%) to OC and OC/EC ratio of 2.7 suggested possible role of mineral dust and high photochemical activity in SOC production. Mass concentrations of aerosols and WSII and their contributions to each size fraction of PM10 are governed by nature of sources, emission strength of source(s), and seasonality in meteorological parameters.
Development and validation of a loop-mediated isothermal amplification assay for the detection of Mycoplasma bovis in mastitic milk
Abstract
Mycoplasma mastitis is often difficult to control due to a lack of rapid and accurate diagnostic tools. The aim of the current study was to develop a loop-mediated isothermal amplification (LAMP) assay for the detection of Mycoplasma bovis (M. bovis) in mastitic milk. The assay was developed using primers designed for three different target genes: uvrC, 16S rRNA, and gyrB, and validated using mastitic milk samples previously found positive for the target pathogen. Specificity of the developed assay was determined by testing cross-reactivity of LAMP primers against closely related bovine mastitis bacterial pathogens. The sensitivity was found to be higher compared to conventional polymerase chain reaction (PCR). The LAMP assay was also capable of detecting M. bovis in PCR-negative milk samples of cows with clinical mastitis. The uvrC primers were found to be more sensitive, while gyrB primers were more specific; however, 16S rRNA primers were less specific and sensitive compared to either uvrC or gyrB primers. Cohen's kappa values for uvrC, gyrB, and 16S rRNA primers used in the LAMP assays were 0.940, 0.970, and 0.807, respectively. There was a high level of agreement between the test results and the true-disease status as indicated by the receiver operating characteristic (ROC) curve. Our findings suggest that the newly developed LAMP assays targeting the uvrC and gyrB genes could be a useful tool for rapid and accurate diagnosis of mastitis caused by M. bovis.
Orbital Subperiosteal Abscess Associated with Mandibular Wisdom Tooth Infection: A Case Report
Abstract
Background
Orbital infection related to mandibular third molar infection is extremely rare. Most of cases reported in literature are related to maxillary molar teeth. Odontogenic infections are not common causes of orbital abscess but it should always be put in consideration when dealing with orbital cellulitis and abscess.
Case presentation
This is a case of orbital abscess involving the left eye as consequence of lower left third molar infection in otherwise healthy 35-year-old black male patient. CT scan confirmed the unusual pathway of this space infection from the lower third molar and excluded any intracranial involvement. The abscess was drained immediately by intraoral incisions and the tooth was extracted. There was a dramatic improvement in a very short time with normal eye movement.
Conclusion
This case demonstrates one of the serious consequences of odontogenic infection which may lead to cavernous sinus thrombosis and blindness if not treated promptly.
Ictiosis epidermolítica: respuesta insatisfactoria a secukinumab
Publication date: Available online 13 December 2017
Source:Piel
Author(s): Ricardo Ruiz-Villaverde, David Lopez-Delgado, Manuel Galán Gutierrez, Jose Aneiros-Fernández
A Game Changer for the Aesthetic Surgery Journal
This month, we begin publishing the Aesthetic Surgery Journal (ASJ) 12 times per year. Publishing two more issues per year will result in faster speed to print. But how fast is fast enough in today's digital day and age?
Commentary on: Efficacy of Retrobulbar Hyaluronidase Injection for Vision Loss Resulting from Hyaluronic Acid Filler Embolization
The problem of sudden loss of vision associated with cosmetic facial filler treatments is a rare event that strikes fear in most of us. As of this writing, there are no known effective treatments for patients with blindness, although several authors have promoted retrobulbar injections of hyaluronidase.1,2 As far as I am aware, patients with total blindness − no light perception (NLP) − at presentation have not responded well to any treatment protocol. In contrast, partial success is not uncommon in patients with only partial visual field obstruction at presentation (in short, NLP seems to be a very bad prognostic indicator). It is not clear whether the treatment was responsible for the observed improvement, since there are no control groups in these scattered case reports, and some patients with partial defects improved spontaneously with only supportive care. This article consists of a report of four cases of filler associated vision loss treated (unsuccessfully) with retrobulbar hyaluronidase (HYAL) and a thoughtful review of the literature.3 The authors argue that retrobulbar HYAL is ineffective.
Corrigendum to: Are Predatory Conferences the Dark Side of the Open Access Movement?
Cress PE. Are Predatory Conferences the Dark Side of the Open Access Movement? Aesthet Surg J. 2017; 37(6):734–738; DOI: http://ift.tt/2qwxYkd
ASJ Expands to Monthly Publication
We can remember well the looks on the faces of Aesthetic Surgery Journal's Editorial Board when, as Editor-in-Chief and Associate Editor, we announced that it was under consideration to increase the Journal's publication frequency from 10 to 12 issues per year. First there was silence, and then a number of concerned questions were raised.
Scholarship and Pragmatism Help ASJ Achieve Monthly Publication
Since becoming an Aesthetic Society member in 1996, it has been both exciting and very gratifying to watch the evolution of the Aesthetic Surgery Journal (ASJ). Certainly, in terms of manpower, it's had three of the best and brightest minds in our specialty at the editorial helm. From Founding Editor Bob Bernard, MD, to Stan Klatsky, MD, and now to one of our best educators, Foad Nahai, MD, ASJ has travelled from newsletter to peer reviewed and indexed clinical journal.
Commentary on: Computer-Assisted Planning and 3D Printing-Assisted Modeling for Chin Augmentation
This is actually a wonderful article1 on a method that will not take off in the United States for a few reasons. Although the cost noted to produce the final product in country (Korea) is low, it would cost much more here in the United States, and that is problematic when most surgeons want an easier route to success. Aside from the unnecessary long course of antibiotic, and my own fixation with drain usage, the method has great merit albeit from an intraoral access; it fine tunes on operation long viewed here (in the United States) as secondary to a rhinoplasty. This method also increases patient input relative to the final result. In addition, the comment that this procedure is 3 hours without this planning vs 1 hour with, is unrealistic as this procedure can easily be done in experienced hands by any route in 60 to 80 minutes or less.
Commentary on: Cannula vs Sharp Needle for Placement of Soft Tissue Fillers: An Observational Cadaver Study
Over the last ten years, the use of synthetic cosmetic tissue fillers has become transformative with regards to what outcomes may be accomplished. While there are many choices in fillers, most injectors utilize hyaluronic acid (HA) class fillers as their first choice for wrinkle filling or volume enhancement. Throughout this time, innovators have discovered additional tissue planes and off-label techniques for correction of areas such as the tear trough.1,2 Reported adverse events relating to filler use can occur with virtually any location, from mild, such as the Tyndall effect, to extremely serious, like intra-arterial injections that produce local tissue slough, blindness, or stroke.3,4 Conversely, minor-level filler-related adverse events seem to occur for unknown reasons. The good news, however, is that HA tissue fillers produce good clinical outcomes time and time again for patients. The bad news is that there are myths and wrong assumptions regarding precision of where the filler goes once it leaves the needle. When we think that we are acting in a safe, precise fashion, a new study like this one is a cause to reassess how one injects tissue fillers. Going forward, we simply cannot be attempting advanced tissue filler techniques with techniques of yesteryear and wrong techniques.
Asian Cleft Rhinoplasty: The Open Structural Approach
Abstract
Background
Asian cleft rhinoplasty is a unique procedure with specific challenges. Objectives
This paper presents our experience with the use of an open structural technique for Asian cleft rhinoplasty utilizing a complete autologous approach. Methods
An open approach that reconstructs the malpositioned nasal cartilage was utilized. Centrally, the septocolumella graft fixed securely in the midline with extender spreader grafts was utilized to project and lengthen the nose. The dislocated lateral crura on the cleft side was completely detached from the accessory cartilages and mobilized off the vestibular lining. The deficient medial crura was lengthened with the lateral crural steal procedure. The resultant shortened lateral crura was then reconstructed with the lateral crural strut graft (LCSG). This gave the versatility needed to bring the tip cartilages into a more anatomic and symmetrical position. Tip suturing and grafting was performed and dorsal augmentation achieved through diced cartilage wrapped in deep temporal fascia. At closure, when indicated, a modified Tajima reverse-U excision of the vestibular lining was performed to correct the alar hooding on the cleft side. Alar base modifications were done as indicated. Results
From January 2010 to December 2015, 35 Asian patients underwent open cleft rhinoplasty. There were 18 female patients and 17 male patients. Twenty-nine patients were unilateral cleft and 6 were bilateral cleft. The mean follow up was 23 months. All patients were highly satisfied with the functional and aesthetic improvement of the procedure. The complications and revision rates were low. Conclusions
The autologous open structural approach can predictably and consistently give excellent results for Asian cleft rhinoplasty. The result attainable is superior to results attainable before adopting this approach for our patients. Level of Evidence: 4
Erratum to: Response to “Commentary on: Gluteal Augmentation Techniques: A Comprehensive Literature Review”
Oranges CM, Tremp M, Haug M, Kalbermatten DF, Schaefer DJ. Response to "Commentary on: Gluteal Augmentation Techniques: A Comprehensive Literature Review". Aesthet Surg J. 2017; DOI: http://ift.tt/2A0r64q
Meretoja Syndrome: General Considerations and Contributions of Plastic Surgery in Surgical Treatment
Meretoja syndrome (familial amyloid polyneuropathy type IV) is a rare disease of the amyloidal system inherited in a dominant autosomal manner, and was first described in 1969.1 The largest affected population is found in Finland, where approximately 400 to 600 cases have been described. This disease is rare in other countries and only 15 cases have been described elsewhere, mainly in Japan, Europe, Iran, and the United States.2-7
Eyelid Make-Up to Manage Transient Blepharoptosis After Botulinum Toxin Injection
Transient blepharoptosis is a feared complication after botulinum toxin-A (BTX-A) cosmetic injections into the upper third of the face. Alpha-adrenergic agonist eyedrops are usually employed to address this adverse effect.1-3 However, response may vary among patients and their use may be associated with ocular adverse effects.2-4 The use of eyelid make-up might be an alternative approach to manage temporary upper eyelid ptosis. The authors had previous experience using a similar approach to conservatively manage severe myopathic blepharoptosis cases when surgical correction was contraindicated.5
Exploring the Genetic Role of Capsular Contracture in Three Family Generations With a Case Report and a Literature Review
Capsular contracture (CC) is a well-known complication of augmentation mammaplasty. The mechanism of capsule formation is multifactorial and the risk factors can be broadly categorized as implant-related or surgical technique-dependent.1,2 In this case report we consider a patient-related factor, that of familial tendency. We review the literature for known genetic markers and consider whether CC may or may not be related to a familial tendency. To our knowledge this is the first description of bilateral CC affecting three successive generations of the same family.
Non-Tuberculous Mycobacteria Infection Following Autologous Fat Grafting on the Face
Abstract
Autologous fat grafting (AFG) for facial augmentation has become more and more popular because of its biocompatibility and low donor site morbidity. The differential diagnoses of delayed nodule formation after the procedure include fat necrosis and atypical infection. In this study, we report on a female patient suffering from nontuberculous mycobacteria (NTM) infection after AFG for facial augmentation. Multiple flesh-colored and erythematous nodules and tumors developed on her face 6 weeks after the procedure. Tissue culture yielded Mycobacterium abscessus. The management of NTM infections is discussed and a reminder of the importance of standard aseptic surgical techniques is provided. Level of Evidence: 5
Clinically Oriented Software for Facial Symmetry, Morphology, and Aesthetic Analysis
Lord Kelvin once said: "If you cannot measure it, you can't improve it." This excerpt reflects one of the fundamental rules of plastic surgery. Only based on a meticulous analysis of the region of interest can one develop an optimal treatment plan and assess its outcome, which will eventually result in improvement of his/her skills. This is particularly true in the case of surgical procedures involving structurally complex regions, such as the face. The most common methods for facial analysis include clinical examination, direct anthropometry, cephalometry, subjective and objective evaluation of two-dimensional photographs, and 3-dimensional (3D) models.1-5
Long-Term Safety of Textured and Smooth Breast Implants
Abstract
In this review, the authors provide a 20-year review and comparison of implant options and describe the evolution of breast implant surface textures; compare available implant surfaces; present long-term safety data from the 10-year US-based Core clinical studies; list the key benefits and risks associated with smooth and textured implants; and provide perspectives on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The authors explore the key benefits and risks associated with all available devices so that optimal and safe patient outcomes can be achieved.Response to “Commentary on: Gluteal Augmentation Techniques: A Comprehensive Literature Review”
We thank Dr Senderoff for his thoughtful comments on our article entitled "Gluteal Augmentation Techniques: A Comprehensive Literature Review," published in the May 2017 issue of Aesthetic Surgery Journal.1,2 We are indeed honored to have Dr Senderoff, a surgeon who has widely contributed to our understanding of this subject, discuss our paper. His previous investigations on implant-based gluteal augmentation, with a specific reference to the US experience of using solid silicone implants, can be considered as fundamental for every surgeon interested in performing gluteoplasty effectively and safely.3-6
Commentary on: Female-to-Male Gender Affirming Top Surgery: A Single Surgeon’s 15-Year Retrospective Review and Treatment Algorithm
In "Female-to-Male Gender Affirming Top Surgery: A Single Surgeon's 15-Year Retrospective Review and Treatment Algorithm," the authors report on a retrospective study of 1358 subcutaneous mastectomies performed in 679 female-to-male (FTM) transgender patients.1 The objective of this study was to determine the safety profile and aesthetic outcome of two different operative techniques that were utilized for male chest contouring. The first technique, the so-called "keyhole" technique, was performed in 104 patients (15.3%), whereas 575 patients (84.7%) underwent the second technique, the "double incision free nipple graft (DIFNG)" technique. The keyhole technique is the operative procedure that is routinely utilized for gynecomastia resection through a semicircular (semi-areolar) incision as described in 1946 by Webster.2 The DIFNG technique also is a classical surgical procedure, first described by Thorek more than 50 years ago, involving an elliptical mastectomy excision with a free full-thickness skin graft to reconstruct the nipple-areola complex (NAC).3
Female-to-Male Gender Affirming Top Surgery: A Single Surgeon’s 15-Year Retrospective Review and Treatment Algorithm
Abstract
Background
Mastectomy, referred to here as "Top Surgery," is an important surgical step for female-to-male (FTM) transgender patients. The goal is to excise breast tissue and create a masculine chest contour. Despite the rising demand for Top Surgery, debate still exists regarding how to select the most appropriate surgical technique to optimize aesthetic outcomes safely. Objectives
To determine the safety profile and aesthetic outcome of one surgeon's 15-year FTM Top Surgery experience. To provide an algorithm for FTM surgery technique selection based on this experience. Methods
A retrospective chart review was performed on 679 FTM patients (1358 mastectomies) undergoing Top Surgery from October 2001 to July 2016. The author's Top Surgery algorithm utilizes two techniques, "Keyhole" and "Double Incision Free Nipple Graft (DIFNG)," based on breast ptosis, inferior vertical skin pinch, and skin elasticity. Demographic data, operative details, complications, and reoperations along with their reasons were collected and analyzed. Results
Of the 679 patients, 15.3% underwent Keyhole and the remaining 84.7% underwent DIFNG procedure. The total complication rate was 18.1% and the total reoperation rate was 11.2% and these rates were shown to decrease over time. The two techniques differed significantly (P < 0.001) in operating time (136 vs 102 min), breast weight excised (215 vs 638 g), and complication rate (33 vs 16%). The aesthetic rating of results was 4.6/5 for Keyhole and 3.7/5 for DIFNG. Conclusions
Safe and aesthetically pleasing results were achieved using this simplified algorithm. Experience with FTM techniques can decrease complication and reoperation rates over time. Level of Evidence: 3
Commentary on: Heterogeneity in Body Contouring Outcomes Based Research: The Pittsburgh Body Contouring Complication Reporting System
Complications following body contouring for massive weight loss (MWL) can add significant morbidity to an already major operation recovery. Complications following postbariatric procedures are very common due to malnutrition, comorbidities, the presence of long incision lengths, significant undermining, and very large areas of tissue rearrangement. The authors note that there is currently no standardized recommendation regarding complication reporting.1 They also note the significant variability of under or over reporting of complications in the literature. The authors note the significant heterogeneity in manuscripts regarding body contouring following MWL as well as lack of consensus and institution variability on how to define complications and on which complications to report.
Heterogeneity in Body Contouring Outcomes Based Research: The Pittsburgh Body Contouring Complication Reporting System
Abstract
Background
Body contouring complications after massive weight loss (MWL) vary significantly in frequency and type. Currently, no standardized recommendations exist regarding which complications are most important to report. Objectives
We aim to provide a guideline for complication reporting in the body contouring literature. The Pittsburgh Body Contouring Complication Reporting System (PBCCRS) will aid in risk stratification of body contouring procedures and will decrease under-, over-, and nonreporting of complications. Methods
The authors reviewed the literature for the terms "body contouring," "MWL," and "complications." Elimination criteria included: non-English language, case report, meta-analysis, outpatient, non-MWL, unclear demographics, N <30 and lack of numeric results. Data were analyzed in 2 groups: truncal contouring and extremity contouring. Results
Eighty-nine papers were reviewed and 21 met inclusion criteria. The weighted mean rates as percentages for complications in the extremity group were: dehiscence (29.0), seroma (18.6), scarring (14.9), infection (8.8), lymphedema (7.8), hematoma (3.5), necrosis (1.9), deep venous thrombosis (DVT) or pulmonary embolism (PE) (0), and death (0). In the truncal group, weighted mean complication rates as percentages were: dehiscence (15.4), seroma (13.1), scarring (2.9), infection (9.4), lymphedema (1.3), hematoma (6.4), necrosis (7.2), DVT/PE (1.5), and death (0.6). Lymphedema was seldom reported, and suture extrusion was not reported in any selected papers. Weighted mean rates of DVT/PE in the extremity vs truncal contouring groups were significantly different. Differences in rates of scarring, lymphedema, and hematoma rates neared significance. Conclusions
Heterogeneity amongst selected studies is explained by variability in how complications are defined. The Pittsburgh Body Contouring Complication Reporting System provides suggested recommendations on complication reporting in massive weight loss body contouring surgery.
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