Publication date: Available online 20 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): J.A. LoGiudice, J.G. Yan, B.L. Massey, J. Neilson, N. Flugstad, J. Mann
The anterolateral thigh flap (ALT) is a workhorse for a spectrum of reconstructive problems including head and neck defects. Its versatility as a chimeric flap employing a variety of soft tissues with a robust pedicle is useful for three-dimensional defects. The authors investigated the anatomical relationship between the vascular supply to the ALT and anterior femur. We studied 16 fresh cadaver limbs to identify the typical branching patterns to the femur off the descending branch of the lateral circumflex femoral artery. These patterns can facilitate dissection of this type of chimeric ALT. The authors have integrated a bone component of vascularised femur in this flap off the lateral circumflex femoral artery system to address oral cancer defects in two patients. A retrospective review of these cases correlating with the anatomic study was undertaken. Both patients had recurrent disease with limited donor site options. Both had extensive floor of mouth and tongue defects as well as small mandible defects of 2 cm. Both went on to heal at the donor and recipient sites at 32 months' follow-up.
Τετάρτη 20 Δεκεμβρίου 2017
Feasibility of a bone and soft tissue chimeric anterolateral thigh free flap? anatomic study and report of two cases for oral cavity reconstruction
Pressure injury identification, measurement, coding, and reporting: Key challenges and opportunities
Pressure injury (PI) rates are a commonly used indicator of performance of health care facilities, both in acute and subacute settings. However, measuring PI rates in an accurate and reproducible fashion has been challenging. The consequences of poor measurement may include failure to identify poorly performing institutions or incorrect accusations of poor quality care. In this article, we describe the main challenges in identification, coding, and reporting of PIs. Issues include inconsistent identification of PIs at the time of admission, variations in the intensity of PI detection, and differing approaches to coding and the adjustment for differing risks amongst different patient population. These are compounded by differences in the epidemiological approach because rates will differ according to whether patients are surveyed cross-sectionally (eg, on a set day per month) or if the survey is undertaken at discharge. In some cases, financial incentives may also influence PI reporting. We also discuss potential strategies for improving data collection and benchmarking as an aid to reducing PI prevalence.
Combination of low-dose total skin electron beam therapy and subsequent localized skin electron beam therapy as a therapeutic option for advanced-stage mycosis fungoides
Summary
Electron beam therapy (EBT) is an established treatment for mycosis fungoides (MF), but evidence for the use of EBT in advanced cutaneous conditions is limited, and optimal scheduling of the regimen for such conditions remains unclear. We report the case of a 44-year-old woman diagnosed with MF with widespread cutaneous lesions, including multiple huge tumours in the craniofacial area. Low-dose total skin (TS)EBT and subsequent localized skin (LS)EBT achieved striking improvements in eruptions. Oral etretinate was also administered during therapy. Our experience implies that combined TSEBT and LSEBT may be worth attempting when a patient presents with both widespread lesions and prominent tumours, even when the tumours are extremely large.
Extraocular sebaceous carcinoma accompanied by invasive squamous cell carcinoma: The first case report and consideration of histogenesis
Abstract
A 61-year-old man presented with a dome-shaped nodule, 1.2 cm in size, with a central crater covered by keratinous material near the left lateral malleolus. Histological findings demonstrated a basophilic circular cone in the center, surrounded and sharply demarcated by a broad eosinophilic area. The central conical mass was composed mainly of atypical basaloid cells intermingled with scattered atypical sebaceous cells with scalloped nuclei and microvesicular cytoplasms, suggesting sebaceous carcinoma. The peripheral area consisted of atypical keratinizing squamoid cells without sebaceous cells, suggesting invasive squamous cell carcinoma. Atypical sebaceous cells were positive for adipophilin. Atypical basaloid cells were positive for 34βE12 and CAM5.2. Peripheral squamoid cells were positive for 34βB4 and 34βE12 throughout, and were positive for LHP1 in the superficial layer. We herein describe the first case of extraocular sebaceous carcinoma accompanied by invasive squamous cell carcinoma, which might have arisen from biphasic differentiation of cancer stem cells.
Thermo-alkali-stable α-carbonic anhydrase of Bacillus halodurans : heterologous expression in Pichia pastoris and applicability in carbon sequestration
Abstract
Recombinant α-carbonic anhydrase of the polyextremophilic bacterium Bacillus halodurans TSLV1 (rBhCA) has been produced extracellularly in active form in Pichia pastoris under methanol inducible (AOX1) as well as constitutive (GAP) promoters. A marked improvement in rBhCA production was achieved by developing a P. pastoris recombinant that produces rBhCA constitutively as compared to that under inducible promoter. The purified rBhCA from P. pastoris is a glycosylated protein that displays a higher molecular mass (79.5 kDa) than that produced from E. coli recombinant (75 kDa); the former has a Tm of 75 °C, which is slightly higher than that of the latter (72 °C). The former rBhCA exhibits higher thermostability than the latter. The former sequestered CO2 efficiently similar to that of the native BhCA and the latter. This is the first report on the production of recombinant carbonic anhydrase extracellularly in P. pastoris.
Fractionation and leaching of heavy metals in soils amended with a new biochar nanocomposite
Abstract
In this study, surface soils of the Bama Pb-Zn mine-impacted area were sampled for an area surrounding the mineral processing plant. After collecting 65 samples and analyzing them for initial Cu, Pb, Zn, and Cd metal contents, the area was zonated based on the concentration distribution using ordinary kriging in R. A single homogenous sample was prepared by mixing equal weights of each sample as being representative of the whole impacted area (ST). Next, a synthetic model soil (SM) was prepared according to the mean ST texture (SM), divided into two portions, where one portion was amended with a biochar composite (10% w/w) (SMA), both portions were artificially contaminated with Cu, Pb, Zn, and Cd (SMAC and SMC). The mixed soil ST, and the model soils SMC and SMAC, were subjected to soil sequential extraction procedure to determine the variations in fractionation of heavy metals. Results showed that the fractionation in the unamended model soil (SMC) was very close to the original real soil (ST). Moreover, in both amended and unamended soils, Cd and Pb had the highest and the lowest mobility, respectively. Zn and Cu showed intermediate mobilities. The performance of the amendment was evaluated using a 150-day column leaching test taking leachate samples at designated time intervals, and Cu, Pb, Zn, and Cd concentrations were analyzed. Results of column leaching were in good agreement with the soil fractionation as Cd and Pb showed the highest and the lowest mobilities, respectively. Leaching through the soil column was also simulated by HP1 model. Results of simulation found in acceptable proximity to the experimental data despite remarkable differences due to limitations in defining soil to the simulation system.
Complex Reconstruction After Sarcoma Resection and the Role of the Plastic Surgeon: A Case Series of 298 Patients Treated at a Single Center
Background More than 1000 new patients present to the London Sarcoma Unit each year and between 5% and 10% require plastic surgery intervention. Advancements in radiotherapy and chemotherapy protocols combined with higher expectations for limb preservation has led to increased reconstructive challenges. Frequently, primary closure is achievable; however, larger tumors often require specialist reconstruction. Study Design A retrospective chart review of all referred patients from the London Sarcoma Unit requiring reconstruction between February 2006 and January 2015 was performed. Patients who underwent primary amputation were excluded. Results The total number of operations performed was 298 and the mean follow-up was 16 months (12–46 months). 51% of patients had major comorbidities. Patients could be separated into early (0–1 week postoperatively, n = 167) and late reconstructions (>1 week postoperatively, n = 131). 32 patients were reconstructed with skin grafts, 137 patients were managed with regional flaps and 129 patients were treated with free flaps. Conclusions A patient with 3 or more major comorbidities resulted in a significantly increased risk of reconstructive failure (PInhibition of Lymphatic Drainage With a Self-Designed Surgical Approach Prolongs the Vascularized Skin Allograft Survival in Rats
Abstract Vascularized composite allotransplantation (VCA) is an emerging treatment for significant tissue defects. However, VCAs usually consist of multiple highly antigenic skin tissues. Previous studies have shown that the lymphatic system in skin plays important roles in the initiation of immune responses during acute rejection, by transporting T cells and antigen-presenting dendritic cells to regional lymph nodes. Therefore, we designed a new surgical treatment to inhibit lymphatic drainage of skin allografts and investigated whether this approach could promote the survival of allografts and suppress immunological events after transplantation. This procedure was achieved by connecting the vascularized allografts to recipient tissues with only an annular plastic holder, allowing the minimum of allograft contact with recipients. Our results showed that the self-designed treatment for inhibiting lymphatic drainage promoted the survival of allografts, reduced the serum concentration of IL-2, and decreased the percentage of CD4+CD25+ and CD8+CD25+ from the lymphatic nodes draining the transplantation region. In conclusion, these data suggest that self-designed surgical approach is effective in inhibiting lymphatic drainage of skin allografts, and the lymphatic system may be new therapeutic targets for developing techniques or drugs against acute rejection after VCAs.Defining the Anatomy of the Tendinous Intersections of the Rectus Abdominis Muscle and Their Clinical Implications in Functional Muscle Neurotization
Purpose Little is known about the definitive course of the tendinous intersections from anterior to posterior through the rectus abdominis (RA) muscle. The implications of a full thickness intersection may have effects on the ability to neurotize the RA. We hypothesized that these tendinous inscriptions would be fully adherent to the anterior rectus sheath, but there would be an incomplete penetrance into the posterior surface, thereby allowing for muscle fibers and neurovascular structures to run the entire course of the RA muscle. Methods Fifty-five cadaveric, hemiabdominal walls were evaluated. Measurements were taken of RA muscle thickness, depth of penetrance of the tendinous intersections, and intersection thickness. Results Of the 32 cadavers, 2 had 4 paired tendinous intersections and the remaining 30 cadavers had 3 paired tendinous intersections. Rectus abdominis muscle belly tended to be thicker at midbelly, between intersections than at the level of the corresponding intersection. A total of 168 tendinous intersections were assessed. Thirty (18%) of these inscriptions proved to be full thickness extending from anterior rectus sheath to posterior rectus sheath without any intervening muscle or neurovascular structures. Twenty-three (42%) of the 55 hemiabdomens assessed had at least one full-thickness tendinous intersection. Conclusions The majority of RA muscles have 3 paired tendinous intersections. Most intersections are incomplete and only encompass the anterior rectus sheath. However, there may be a higher percentage of full-thickness intersections than previously appreciated and the clinical relevance behind these remains unclear.Poly Implants Prosthèse Breast Implants: A Case Series and Review of the Literature
Background Silicone breast implants from the French manufacturer Poly Implants Prosthèse (PIP) were recalled from the European market after the French regulator has revealed the implants contain non–medical-grade silicone filler. In December 2011, following a large increase in reported rupture rate and a possible cancer risk, the French Ministry of Health recommended consideration of the PIP explantation, regardless of their condition. In 2012, the Israel Ministry of Health recommended to replace the implants only upon suspected implant rupture. Objectives The aims of this study were to characterize breast-augmented Israeli patients with PIP implants, compare their outcomes with those of breast-augmented patients with different implant types, and review the current PIP literature. Methods Breast-augmented patients who underwent an elective breast implant exchange in Israel between January 2011 and January 2017 were included in the study. Data were collected from electronic and physical medical files. Results There were 73 breast-augmented female patients with 146 PIP breast implants included in this study. Average implant age was 6.7 ± 2.79 years. Mean implant size was 342.8 ± 52.9 mL. Fourteen women (19 implants [16%]) had a high-grade capsular contracture (Baker grade 3–4). During exchange, 28 implants were found to be ruptured (19.2%). Conclusions Less than 10 years following breast augmentation, PIP implants demonstrated higher rupture rate compared with other implants. Our data are comparable to overall available rupture rate. Among patients with definitive rupture diagnosis, an elective implant removal should be recommended. In cases of undamaged implants, plastic surgeons should also seriously consider PIP implant explantation. When the patient does not desire to remove the implant, an annual physical examination and breast ultrasound are recommended, beginning a year after augmentation.Effects of the Metallic Port in Tissue Expanders on Dose Distribution in Postmastectomy Radiotherapy: A Tridimensional Experimental Model of Dosimetry in Breast Reconstruction
Abstract The purpose of this research was to develop an experimental model of dosimetry using a breast phantom and evaluate the effects of the metallic port in tissue expanders on dose distribution in postmastectomy radiotherapy. Dose distribution was assessed using an experimental acrylic dosimetry simulator in the absence and presence of a metallic disc (MD), which is similar to that used in tissue expanders containing a magnetic port, by collecting coronal and sagittal radiochromic films. Dosimetry film analysis did not show any changes in dose distribution, except for a MD shadow in the sagittal film where the dose distribution rate was on average 14% lower than in other areas. This model very closely resembled actual breast reconstruction with a tissue expander containing a magnetic port. Scattering or attenuation of the irradiation dose due to interference of the MD was not evident in areas that could jeopardize the effectiveness of radiation therapy. Therefore, the presence of the MD inside the tissue expander does not likely have an impact on radiotherapy effectiveness during immediate breast reconstruction.Complications After Total Skin-Sparing Mastectomy and Expander-Implant Reconstruction: Effects of Radiation Therapy on the Stages of Reconstruction
Background Many patients undergoing total-skin sparing mastectomy (TSSM) and 2-staged expander-implant (TE-I) reconstruction require postmastectomy radiation therapy (PMRT). Additionally, many patients undergoing TSSM for recurrent cancer have a history of lumpectomy and radiation therapy (XRT). Few studies have looked at the impact of XRT on the stages of TE-I reconstruction. Methods Patients undergoing TSSM and immediate TE-I reconstruction between 2006 and 2013 were identified from a prospectively maintained database. Rates of TE-I loss and severe infection requiring intravenous antibiotics were compared in patients with prior XRT (85 cases) and PMRT (133 cases). Complications were divided by stage of reconstruction: first stage (TSSM and TE placement) and second stage (TE-I exchange). Results Mean follow-up time was 2.5 years. Patients with prior XRT had more complications after the first stage of reconstruction than the second (TE-I loss: 15% vs 5%, P = 0.03; infection: 20% vs 8%, P = 0.04). Patients receiving PMRT had low complication rates after the first stage, when they had not yet received radiation (TE-I loss: 2%; infection: 5%). However, complication rates after TE-I exchange (TE-I loss, 18%; infection, 31%) were significantly higher, and nearly 4-fold higher than patients with prior XRT. Conclusions Patients with prior XRT are at high risk for complications after the first stage of TE-I reconstruction after TSSM; however, the risk of complications at the second stage is comparable to patients without radiation exposure and significantly lower than patients receiving PMRT. Patients receiving radiation therapy should be given appropriate preoperative counseling regarding their risks.Objective Effects of Breast Reduction Surgery on Physical Fitness
Background Reduction mammaplasty is known for excellent outcomes and patient satisfaction. Although patients report improvements in pain, weight loss, and exercise levels, objective data on physical fitness benefits are limited. Methods Using the Stanford Military Data Repository, we identified 89 US Army active duty women with at least 1 pre- and postoperative Army Physical Fitness Test (APFT) who underwent reduction mammaplasty during 2011 to 2014. We used paired t tests to compare pre- and postoperative APFT score means and raw values for push-ups, sit-ups, and the 2-mile run. Results There were 56 subjects (62.9%) who improved in total APFT scores. Total score means increased from 235.9 preoperatively to 243.4 postoperatively (P = 0.0065). Of 28 subjects with at least 2 APFT scores before and after surgery, 20 (71.4%) improved in total scores. The subgroup's mean total score increased from 237.8 to 251.3 (P = 0.0009). Comparing individual pre- and postprocedure APFTs, all subjects demonstrated a mean 3.9% (SD, 0.1) improvement in total scores, and the subpopulation of 28 improved by 6.3% (SD, 0.1). In all events, mean performance values trended toward better postoperative scores. Differences were statistically significant for the total population for the number of sit-ups (P = 0.035), and, for the subgroup of 28, differences were statistically significant for the total score (P = 0.0009), sit-ups (P = 0.0002), and push-ups (P = 0.0134). Conclusions Reduction mammaplasty was associated with postoperative physical fitness improvements among US Army active duty women. Soldier data are useful for objectively assessing physical fitness effects of breast reduction surgery.
An Outcomes Study on the Effects of the Singapore General Hospital Burns Protocol
Introduction The Singapore General Hospital Burns Protocol was implemented in May 2014 to standardize treatment for all burns patients, incorporate new techniques and materials, and streamline the processes and workflow of burns management. This study aims to analyze the effects of the Burns Protocol 2 years after its implementation. Methods Using a REDCap electronic database, all burns patients admitted from May 2013 to April 2016 were included in the study. The historical preimplementation control group composed of patients admitted from May 2013 to April 2014 (n = 96). The postimplementation prospective study cohort consisted of patients admitted from May 2014 to April 2016 (n = 243). Details of the patients collected included age, sex, comorbidities, total body surface area (TBSA) burns, time until surgery, number of surgeries, number of positive tissue and blood cultures, and length of hospital stay. Results There was no statistically significant difference in the demographics of both groups. The study group had a statistically significant shorter time to surgery compared with the control group (20.8 vs 38.1, PDetermining the False-Negative Rate Using Fluorescence Image–Assisted Sentinel Lymph Node Biopsy in Cutaneous Melanoma
Introduction Despite the advances in cutaneous melanoma management, the false-negative rates (FNRs) of sentinel lymph node biopsy (SLNB) are still high. These rates are dependent not only on the technique but also on definitional terms and percentage of head/neck melanoma (highest false-negative SLNB). Fluorescence imaging technology is well acquainted in plastic surgery and other specialties. Having demonstrated that fluorescence-assisted SLNB is effective in melanoma, we are interested in determining its FNR. Methods We obtained institutional review board approval to follow up prospectively all patients with cutaneous melanoma who underwent radioisotope/fluorescence-assisted SLNB with the intent to capture 100 negative SLNB patients. Inclusion criteria were as follows: (1) National Comprehensive Cancer Network criteria; (2) an SLNB report; (3) at least 24 months of follow-up in the negative SLNB group. The outcome variables were FNR and adjusted FNR of SLNB, considering the criterion standard of assessing the accuracy of SNLB. The FNR was defined as the proportion of patients with false-negative SLNB to patients with true-positive and false-negative SLNB [false negative/(false negative + true positive)]. Adjusted FNR refers to the previously described false-negative SLNB, but in the absence of local/in-transit recurrence or distant metastases. Furthermore, false-negative incidence (false-negative/negative SLNB patients) was also calculated. Length of follow-up was date of surgery to the date of last follow-up/death. Results A total of 125 participants, with 52.0% being male and 48.0% being female, were included. One hundred patients had an SLNB negative for metastases, whereas the rest had positive SLNB results. Median follow-up time of the cohort and that of the negative SLNB group were 36.7 (2.6–58.5) and 37.9 (24.0–58.5) months, respectively. A relatively high number (24.8%) of head/neck melanoma were included. We identified 2 cases of false-negative SLNB, with one having in-transit metastases. Thus, the FNR and adjusted FNR were 7.4% and 3.7%, respectively. The false-negative incidence and adjusted false-negative incidence were 2.0% and 1.0%, respectively. Conclusions This is the first prospective study examining the FNR of fluorescence-assisted SLNB for patients with cutaneous melanoma. Our study reveals that this technique has one of the lowest FNRs published, especially considering the large percentage of participants with head/neck melanoma involved.Upper Extremity Patterns of Injury and Management at a Plastic and Reconstructive Surgery Referral Center in Mexico City
Background Acute upper extremity injuries remain one of the most common consultations in the emergency departments for plastic surgery services. These injuries can affect a person's quality of life and negatively affect work-related or social interactions if not properly managed. We aim to evaluate our experience and management in a specialized referral center in Mexico City. Methods A retrospective review was performed. All patients with hand trauma managed by our service from July 2010 to June 2015 were included; their demographic characteristics were described as well as the most common patterns of injury, management, and outcome. Results A total of 4751 patients with injuries in the upper extremities were included, 77% were males with a mean age of presentation of 26.9 ± 17.9 years; the age group most commonly affected was between 16 to 30 years (39%); 54% of the cases affected the right hand. Lacerative wounds were the most common mechanism of injury (60.7%), followed by blunt trauma (28.7%). Management was surgical in 87% of the cases. Conclusions Upper extremity trauma encompasses a wide range of clinical presentations, from simple lacerations to catastrophic injuries that require extensive or multiple reconstructive procedures. The clear understanding of the trauma mechanisms and how they are related with certain patterns of injury might maximize awareness and guide a surgeon's management effectively.Localized Leg Volume Index: A New Method for Body Type–Corrected Evaluation of Localized Leg Lymphedematous Volume Change
Background Volume measurement is one of the most common evaluations for lower-extremity lymphedema. However, volume comparison between different patients with different physique may be inappropriate, and it is difficult to evaluate localized limb volume change using leg volume evaluation. Methods Localized leg volumes (Vk, k = 1–5) and localized leg volume indices (LEVIk) at 5 points (1, thigh; 2, knee; 3, lower leg; 4, ankle; 5, foot) of 106 legs of 53 examinees with no leg edema were calculated based on physical measurements, leg circumferences and lengths, and body mass index (BMI). Interrater and intrarater reliabilities of LEVIk were assessed, and Vk and LEVIk were compared between lower BMI (BMI 0.98). Between lower and higher BMI groups, significant differences were observed in all Vk: V1 (P = 3.7 × 10−7), V2 (P = 4.7 × 10−8), V3 (P = 4.5 × 10−5), V4 (P = 1.6 × 10−3), and V5 (P = 2.4 × 10−4). Regarding LEVI between groups, significant differences were seen in LEVI3 (P = 0.009), LEVI4 (P = 0.004), and LEVI5 (P = 1.3 × 10−7); no significant difference was seen in LEVI1 (P = 0.23) or LEVI2 (P = 0.51). Conclusions Localized leg volume index is a highly reproducible and convenient method for evaluation of localized volume change of the lower extremity, which is less affected by body type compared with leg volumetry.Joint Denervation in the Digits: Technique and Patient Satisfaction
Background Traditional approaches to treating painful osteoarthritis of the fingers include arthrodesis and arthroplasty. Although highly effective for pain control, arthrodesis sacrifices joint motion and can be complicated by nonunion, malunion, and infection. Implant arthroplasty preserves motion but is likewise subject to complications—particularly at the level of the proximal interphalangeal joint. In contrast, finger joint denervation is a simple outpatient procedure that maintains joint motion. In this study, we describe our surgical techniques for joint denervation and review our survey of patient satisfaction. Methods A retrospective review was performed of all patients undergoing finger joint denervation for osteoarthritis at our institution from 2012 to 2014. Each patient was contacted by phone and asked to rate their pre- and postoperative pain and function. Patients were also asked about any complications experienced and if they would choose to undergo the operation again. Results Over the 2-year period, 12 patients underwent denervation of 23 joints. Of the 12 patients in the study, 11 undergoing 22 joint denervations were available for our survey. Patient-reported pain scores fell from a median of 5/5 preoperatively to 0/5 after recovery (PEvidence-Based Medicine in Plastic Surgery: Are We There Yet?
Background The practice of evidence-based medicine in plastic surgery is no longer a trend but a reality, with a growing number of studies published in recent years using evidence-based medicine as an assessment tool. Objective The aim of this study was to verify whether the number of citations to articles with a high level of evidence is greater than articles with low level of evidence. Methods A search was conducted in the 4 main international journals of plastic surgery. All original articles published in 2011 were analyzed, selected, and classified based on the study design. The articles were then divided into 2 groups: group 1, high level of evidence; and group 2, low level of evidence. Next, Scopus was searched for the number of citations of each article in the 2 subsequent years. The proportion of the number of citations received by articles in groups 1 and 2 was statistically compared. Results The articles with the highest level of evidence were the most cited among original articles, with 48.6% of them being cited more than 10 times over 2 years, whereas only 18.4% of articles in group 2 were cited with the same frequency. The mean number of citations was 12.6 citations per article in group 1 and 6.56 citations in group 2, with a significant difference between groups (POsseointegrated Prosthetic Ear Reconstruction in Cases of Skin Malignancy: Technique, Outcomes, and Patient Satisfaction
Background Ear reconstruction with osseointegrated prosthetic implants is a well-established method of reconstruction after resection of skin malignancies on the external ear. There is limited literature reporting technique, outcomes, and patient satisfaction. Methods We evaluated our outcomes over a 5-year period looking at osseointegrated prosthetic reconstruction after auriculectomy for external ear skin malignancies. We report demographics, disease characteristics, technique, and complications. The patients were surveyed looking at 6 domains: satisfaction, stability, comfort, ease of use, level of self-consciousness, and preoperative education. Results Of the 21 patients included in the study, 14 (67%) were treated for invasive melanoma (Breslow depth, >0.8mm), 4 (19%) for squamous cell carcinoma, 2 (10%) for basal cell carcinoma, and 1 (5%) for an atypical fibroxanthoma. Complications rates were low. There were no cases of infection, hematoma, or bleeding. In 2 patients (9.5%), 1 of the 3 implants failed to osseointegrate and was removed, but the prosthesis was able to be secured with the remaining 2 posts. There were 3 cases (14%) of delayed healing and 1 with excessive granulation tissue growth. Survey results showed high satisfaction in all measured domains. Conclusions In cases of skin malignancy requiring total or subtotal auriculectomy, prosthetic ear reconstruction with osseointegrated implants is a good alternative to reconstruction with autologous tissue. Our experience demonstrates good outcomes and with low complication rates and high patient satisfaction.Three-Dimensional Analysis of the Ear Morphology
Abstract
Background
For surgical treatment of the face, detailed surgical planning is necessary to avoid later unaesthetic results. Most of the studies in the literature concentrate on the ears' anatomy during childhood and adolescence. Nearly no study evaluates the anatomy of ears of people aged 50 or older. It was our aim to measure and evaluate the ear's anatomy in Caucasians between the ages of 21 and 65.
Methods
Three-dimensional scans of 240 volunteers were taken. The subjects were divided into groups of males and females and each of them into three groups by age (21–35, 36–50, 51–65). Landmarks were placed in these scans. Distances, relations and angles between them were recorded.
Results
The distance between the subaurale and superaurale significantly increases (p < 0.001) during the aging process in males and females. Also, the width of the ear, measured between the preaurale and postaurale, significantly increased (p = 0.007) with advancing age. When the length of the ear is divided into four parts by anatomical landmarks, it extended the most in the lower quadrant with increasing subject age.
Conclusion
The ear of Caucasians does not stop changing its shape during adulthood. Even after the body has stopped growing, the ear still does. With the measured values in this study, it should be possible for the surgeon to plan the operation in advance and achieve satisfactory aesthetic outcomes.
Level of Evidence V
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
Assessing Normal Smiling Function Through 3D–3D Surfaces Registration: An Innovative Method for the Assessment of Facial Mimicry
Abstract
Smiling has a great importance, both from a functional and an aesthetic point of view. The introduction of modern 3D acquisition and elaboration methods may provide additional help in the evaluation of facial mimicry. This study aims at proposing an innovative method to assess facial and labial movements in different types of smiles. Twenty healthy subjects (10 males, 10 females, mean age 27.5 years, SD 4.5 years), were recorded through a stereophotogrammetric system in neutral position and in three types of smiles: Mona-Lisa smile, canine smile, full-denture smile. All the 3D smiling models were superimposed on the corresponding neutral one and point-to-point root mean square (RMS) differences were computed. Labial surface areas in rest position and during each smile were calculated as well, together with the percentage modification in different types of smile. RMS values (facial and labial models), labial surface areas and percentage modifications were compared through ANCOVA tests to verify possible statistically significant differences according to sex and type of smile (p < 0.05). Intercanthal labial width was considered a covariate. RMS values progressively increased from Mona-Lisa to full-denture smile; statistically significant differences were found among all types of smiles, both for facial and labial models (p < 0.05), while no statistically significant sex and sex × smile interactions were found (p > 0.05). Labial surface and percentage of modification showed statistically significant differences according to both sex and type of smile (p < 0.05). The study provides a novel contribution to the field of sexual dimorphism in smiling.
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
Closed-Suction Drains After Subcutaneous Mastectomy for Gynecomastia: Do They Reduce Complications? A Different Approach
Abstract
Introduction
We read the manuscript entitled "Closed-suction drains after subcutaneous mastectomy for gynecomastia: do they reduce complications? » published by Chao et al. (Aesthetic Plast Surg, 2017. http://ift.tt/2ktUSFg). They have concluded that drains may reduce rates of seromas requiring needle aspiration after surgical treatment, but also that there are several adverse effects of drains: patients' discomfort, anxiety, cost and additional clinic visits. They also recalled several limitations: (1) bias in terms of surgeon decision to place a drain, (2) nuances in technique. Here we want to discuss our different technique of drainage. To prevent all the disadvantages, we have chosen to replace closed-suction drains with silicone blades and a wide scar opening at the level of the periareolar scar.
Method
We carried out a retrospective study in our department in 2016.
Results
This series consisted of 83 patients (153 breasts) aged 26.7 years of age (15–67), with an average BMI of 28.6 (19.5–39). All were followed during the 12 months postoperatively. We considered here only grade 1–2a gynecomastia with palpable fibrous glandular tissue. The surgical procedure consisted of initial liposuction, then open surgical excision via the periareolar approach. We did not notice any seroma or collection requiring intervention. However, 4 patients (4/153; 2.6%) had hematomas requiring intervention the day after surgery.
Conclusion
Our technique presents a lot of advantages, reduced length of stay in the hospital, costs from drain site care and clinic visits, patients' discomfort, and antibiotic prescriptions.
Level of Evidence V
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
Feasibility of a bone and soft tissue chimeric anterolateral thigh free flap? anatomic study and report of two cases for oral cavity reconstruction
The anterolateral thigh flap (ALT) is a workhorse for a spectrum of reconstructive problems including head and neck defects. Its versatility as a chimeric flap employing a variety of soft tissues with a robust pedicle is useful for three-dimensional defects. The authors investigated the anatomical relationship between the vascular supply to the ALT and anterior femur. We studied 16 fresh cadaver limbs to identify the typical branching patterns to the femur off the descending branch of the lateral circumflex femoral artery.
In vitro elicitation, isolation, and characterization of conessine biomolecule from Holarrhena antidysenterica (L.) Wall. callus and its larvicidal activity against malaria vector, Anopheles stephensi Liston
Abstract
In vitro elicitation of an important compound conessine has been done in the bark-derived callus culture of Holarrhena antidysenterica (L.) Wall. employing different elicitors. For induction of callus, green bark explants excised from field-grown plants were cultured on MS medium augmented with different concentrations (0, 1, 2.5, 5, and 10 μM) of various growth regulators such as BA, IBA, NAA, and 2,4-D either alone or in combinations. The maximum amount of conessine (458.18 ± 0.89d μg/g dry wt.) was achieved in callus developed on MS medium supplemented with 5 μM BA and 5 μM 2,4-D through HPLC analysis. Elicitation in conessine content in the above callus was achieved employing a variety of organic (phenylalanine, tyrosine, chitosan, tryptophan, casein hydrolysate, proline, sucrose, and yeast extract) as well as inorganic elicitors (Pb(NO3)2, As2O3, CuSO4, NaCl, and CdCl2) in different concentrations. The optimum enhancement in conessine content (3518.58 ± 0.28g μg/g dry wt.) was seen at the highest concentration (200 mg/L) of phenylalanine. The enhancement was elicitor specific and dose dependent. The overall increment of the conessine content was seen in the order of phenylalanine > tryptophan > Pb(NO3)2 > sucrose > NaCl > As2O3 > casein hydrolysate > CdCl2 > chitosan > proline > yeast extract > CuSO4 > tyrosine. The isolation and purification of conessine was done using methanol as a solvent system through column chromatography (CC) and TLC. The isolated compound was characterized by FT-IR, 1H-NMR, and HRMS which confirmed with the structure of conessine. The bioassays conducted with the isolated compound revealed a strong larvicidal activity against Anopheles stephensi Liston with LC50 and LC90 values being 1.93 and 5.67 ppm, respectively, without harming the nontarget organism, Mesocyclops thermocyclopoides Harada, after 48 h of treatment. This is our first report for the isolation and elicitation of conessine in the callus culture of H. antidysenterica.
Photocatalytic degradation of the herbicide chloridazon on mesoporous titania/zirconia nanopowders
Abstract
Advanced oxidation processes using semiconducting photocatalysts for the degradation of organic pollutants are a promising approach for the remediation of pesticide-contaminated wastewater. High photodegradation efficiency and stability of the photocatalyst are of key importance for practical application of the semiconductor. In this study, mesoporous TiO2/ZrO2 nanopowders were synthesized via two techniques; evaporation-induced self-assembly (EISA) and sol-gel using triblock copolymers Pluronic P123 and F127. The photodegradation activities of the composites were determined by employing the herbicide chloridazon as a model compound. Due to well-developed mesoporosity, the TiO2/ZrO2 nanocomposite synthesized by EISA displays high surface area and small crystallite sizes leading to higher photocatalytic activity than pristine TiO2 prepared under similar condition and commercial Degussa P25 nanopowder. The optimum amount of zirconium required for the highest activities was identified and found to be 0.14 and 0.05 mol% for the EISA and sol-gel-prepared samples, respectively. Systematic studies of the post-thermal treatment step for both samples show that Zr inhibits an anatase-to-rutile phase transition only up to 600 °C, at higher temperature phase separation occurs. Samples synthesized by EISA method showed enhanced degradation activity than sol-gel-synthesized samples.
Surface restructuring of red mud to produce FeO x (OH) y sites and mesopores for the efficient complexation/adsorption of β-lactam antibiotics
Abstract
In this work, iron oxide in the red mud (RM) waste was restructured to produce mesopores with surface [FeOx (OH)y ] sites for the efficient complexation/adsorption of β-lactam antibiotics. Red mud composed mainly by hematite was restructured by an acid/base process followed by a thermal treatment at 150–450 °C (MRM150, MRM200, MRM300, and MRM450) and fully characterized by Mössbauer, XRD, FTIR, BET, SEM, CHN, and thermogravimetric analyses. The characterization data showed a highly dispersed Fe3+ oxyhydroxy phase, which was thermally dehydrated to a mesoporous α-Fe2O3 with surface areas in the range of 141–206 m2 g−1. These materials showed high efficiencies (21–29 mg g−1) for the adsorption of β-lactam antibiotics, amoxicillin, cephalexin, and ceftriaxone, and the data was better fitted by the Langmuir model isotherm (R 2 = 0.9993) with monolayer adsorption capacity of ca. 39 mg g−1 for amoxicillin. Experiments such as competitive adsorption in the presence of phosphate and H2O2 decomposition suggested that the β-lactamic antibiotics might be interacting with surface [FeOx (OH)y ] species by a complexation process. Moreover, the OH/Fe ratio, BET surface area and porosity indicated that this complexation is occurring especially on [FeOx (OH)y ]surf sites contained in the mesopore space.
Antifungal exploitation of fungicides against Fusarium oxysporum f. sp. capsici causing Fusarium wilt of chilli pepper in Pakistan
Abstract
The research was conducted to evaluate in-vitro efficacy of numerous fungicides against Fusarium oxysporum f. sp. capsici. In present research, six treatments (T) viz. Carbendazim, Benomyl, Topsin-M, Difenoconazole, Nativo, and Alliete along with control, various concentrations (C), days (D), and their interactions, i.e., (T × C), (T × D), (C × D), and (T × C × D) were exploited in a laboratory through food poison technique. Alliete expressed maximum colony growth (1.93 cm) as compared to all other fungicides with respect to control. Interaction between treatments and concentration (T × C) exhibited maximum colony growth of all treatments (Carbendazim, Benomyl, Topsin-M, Difenoconazole, Nativo, and Alliete), i.e., 0.87, 1.23, 1.73, 2.20, 2.53, and 2.93 cm at 300 ppm as compared to 500 and 700 ppm concentrations, respectively. Similar trend was also observed concerning interaction between (fungicides × days) and (tested concentrations × days). Results of the present study revealed that among tested fungicides, Carbendazim at 700 ppm expressed significant reduction in fungal growth.
Removal of pharmaceutical compounds from urban wastewater by an advanced bio-oxidation process based on fungi Trametes versicolor immobilized in a continuous RBC system
Abstract
Conventional wastewater treatment plants (WWTPs) are not able to remove completely some emerging contaminants, such as residual pharmaceutical compounds (PCs) with potential ecotoxicity to water bodies. An advanced bio-oxidation process (ABOP) using white-rot fungi (WRF) has been proposed as alternative biological treatment for degradation of non-biodegradable compounds. A synthetic and real wastewater spiked with 12 PCs at 50 μg L−1 was treated by means of ABOP based on WRF in a rotating biological contactor (RBC) at 1 day of hydraulic retention time (HRT). The ABOP achieved a remarkable biological performance in terms of TOC removal and reduction of N-NH4+ and P-PO43− nutrients. Likewise, 5 of the 12 PCs were eliminated with removal efficiencies ranging from 80 to 95%, whereas 6 of 12 PCs were eliminated with removal values ranging from 50 to 70%. The anaerobic digestion of the fungal sludge generated upon the treatment was also evaluated, obtaining a methane yield of 250 mL CH4 gVS−1. These results evidenced that the proposed ABOP is a promising alternative for the sustainable wastewater treatment of urban effluents, combining advanced oxidation with biological operation for the removal of emerging PCs and energy recovery.
Thin films containing oxalate-capped iron oxide nanomaterials deposited on glass substrate for fast Fenton degradation of some micropollutants
Abstract
The main goal of the study was to evaluate the catalytic activity of two hybrid nanocatalysts consisting in Fe3O4 nanoparticles modified with either chitosan (CS) or polyethylene glycol (PEG)/ferrous oxalate (FO), and further deposited on solid substrate as thin films. X-ray powder diffraction (XRD), Fourier transform infrared (FT-IR) spectroscopy, and scanning electron microscopy (SEM) were employed for the structural and morphological characterizations of the heterogeneous catalysts. The degradation kinetic studies of two reactive azo dye (Reactive Black 5 (RB5) and Reactive Yellow 84 (RY84)) as well as Bisphenol A (BPA) solutions were carried out using Fenton-like oxidation, in the presence of different concentrations of H2O2, at initial near-neutral pH and room temperature. The results indicated that a low amount of catalytic material (0.15 g/L), deposited as thin film, was able to efficiently trigger dye degradation in solution in the presence of 6.5 mmol/L H2O2 for RB5 and of only 1.6 mmol/L H2O2 in the case of BPA and RY84. In the presence of complex matrices such as WWTP waters, the removal of BPA was low (only 24% for effluent samples). Our findings recommend the studied immobilized nanocatalysts as promising economical tools for the pre-treatment of wastewaters using advanced oxidation processes (AOPs).
Carbon dioxide emissions from the electricity sector in major countries: a decomposition analysis
Abstract
The electric power sector is one of the primary sources of CO2 emissions. Analyzing the influential factors that result in CO2 emissions from the power sector would provide valuable information to reduce the world's CO2 emissions. Herein, we applied the Divisia decomposition method to analyze the influential factors for CO2 emissions from the power sector from 11 countries, which account for 67% of the world's emissions from 1990 to 2013. We decompose the influential factors for CO2 emissions into seven areas: the emission coefficient, energy intensity, the share of electricity generation, the share of thermal power generation, electricity intensity, economic activity, and population. The decomposition analysis results show that economic activity, population, and the emission coefficient have positive roles in increasing CO2 emissions, and their contribution rates are 119, 23.9, and 0.5%, respectively. Energy intensity, electricity intensity, the share of electricity generation, and the share of thermal power generation curb CO2 emissions and their contribution rates are 17.2, 15.7, 7.7, and 2.8%, respectively. Through decomposition analysis for each country, economic activity and population are the major factors responsible for increasing CO2 emissions from the power sector. However, the other factors from developed countries can offset the growth in CO2 emissions due to economic activities.
Can in vivo surface dental enamelmicrobiopsies be used to measure remote lead exposure?
Abstract
Measuring lead in the surface dental enamel (SDE) using biopsies is a rapid, safe, and painless procedure. The dental enamel lead levels (DELLs) decrease from the outermost superficial layer to the inner layer of dental enamel, which becomes crucial for the biopsy depth (BD) measurement. However, whether the origin of lead found in SDE is fully endogenous is not yet established. There is also controversy about the biopsy protocol. The aims of this study were to investigate if DELLs are altered by extrinsic contamination (A) and to evaluate the real geometric figure formed by the erosion provoked by biopsy procedure and the respective BD in SDE (B). To accomplish the aim A, lead from 90 bovine incisor crowns lead was determined by graphite furnace atomic absorption spectrometer as a function of exposure time and lead concentration. Two biopsies were performed in each tooth, before and after lead exposure. Six 15-tooth groups differed by exposure time (1 or 30 min) and lead concentrations (A. 0 mg/L—placebo, B. 0.01 mg/L—standard for drinking water, or C. 0.06 mg/L—concentration found in contaminated groundwater). Phosphorus was determined by an inductively coupled plasm optical emission spectrometer to quantify the enamel removed. To compare intakes/losses of lead in SDE among the groups, values of DELL differences between before and after lead exposure were compared by ANOVA (p < 0.05). To attain the objective B, one extracted human permanent tooth was studied by confocal Raman microscopy. Lead measurements and the surface profile were determined. There was no difference in DELL among the groups (p = 0.964). The biopsy bottom surface area, analyzed by microscopy, showed an irregular area, with regions of peaks and valleys, where areas with depth ranging from 0.2 (peaks) to 1.8 μm (valleys) (± 0.1 μm) could be found. BD carried out in vivo is commonly calculated using the cylinder height formula. The real BD was shown to be very similar to already published data. In conclusion, the SDE of erupted teeth does not seem to be susceptible to environmental lead intake, being thus reliable to measure remote exposures to lead.
Speciation of naturally occurring radionuclides in Mediterranean soils: bioavailabilty assessment
Abstract
Knowledge of soil-to-plant transfer processes is a key element that can have a significant health impact. Much effort has been taken to characterize the speciation of anthropogenic radionuclides released into the environment. However, the information about naturally occurring radionuclides is scarce. This work evaluate the potential risks of transference, that is, the bioavailability of the 234,238U, 226Ra, 228,230,232Th, and 210Po in three different soils collected in Mediterranean ecosystems. Chemical speciation of these radionuclides was carried out according to two different methods, Pavlotskaya and a modification of Tessier's protocol. Most of these radionuclides were associated to fractions strongly bound to soil particles and not able to be transferred. Increasing concentrations of U and Th extracted with increasing volume of NH4OAc 1 M were observed, until it reached saturation. Readily bioavailable fraction in both methods (either exchangeable or water soluble + exchangeable) decreased in the following order: 226Ra > 234,238 U > 228,230,232Th > 210Po. It was found that < 3% of the natural radionuclide concentration in soil are readily bioavailable for plant uptake in this region of Spain, and the resulting human health risk is negligible from natural radionuclide ingestion.
Teilhard de Chardin’s oeuvre within an ongoing discussion of a gene drive release for public health reasons
Abstract
Within the domain of public health, vector-borne diseases are among the most vehemently discussed issues. Recent scientific breakthroughs in genome editing technology provided a solution to this issue in the form of a gene drive that might decrease and even eradicate vector-borne diseases. Gene drives are engineered, and designed genes that can break typical inheritance rules and be passed to almost all of the carrier's offspring. This genome editing and gene drive technology has become a powerful tool for ecological and environmental engineering, through which man can manipulate his surroundings, adjusting it to himself and directly mastering evolution and the ecosystem. Although the gene drive technology has been perceived as promising in the public health domain, ecological implications of its use are not to be underestimated. The primary aim of this paper is to overcome the ongoing discussion which mostly focuses on whether priority should be given to the environment or to public health, and to find an adequate answer and solution. In this quest to find the proper answer and solution, Pierre Teilhard de Chardin's thought might be useful, especially his concepts of the biosphere and the noosphere which may provide some clarifications as to why we are at the moment so cautious with gene drive technology and how we need to move towards a better common future on earth.
HIV-1 group O infection in France: clinical features and immunovirological response to antiretrovirals
Pegylated IFN-α-induced NK cell activation is associated with HIV-1 DNA decline in ART-treated HIV-1/HCV co-infected patients
Deployment of Transchromosomal Bovine for Personalized Antimicrobial Therapy
Effectiveness of protease inhibitor/nucleos(t)ide reverse transcriptase inhibitor-based second-line antiretroviral therapy for the treatment of HIV-1 infection in sub-Saharan Africa: systematic review and meta-analysis
Hepatitis C in Patients with Minimal or No Hepatic Fibrosis: The Impact of Treatment and Sustained Virologic Response on Patient-Reported Outcomes
Increased Cervical HIV RNA Shedding Among HIV-Infected Women Randomized to Loop Electrosurgical Excision Procedure (LEEP) compared to Cryotherapy for Cervical Intraepithelial Neoplasia 2/3
Surveillance for and Discovery of Borrelia Species in US Patients Suspected of Tickborne Illness
Evaluating the risk factors for hospital-onset Clostridium difficile infections in a large healthcare system
Cetirizine-associated bradycardia: A case report
Publication date: Available online 19 December 2017
Source:Dermatologica Sinica
Author(s): Seçkin Engin, Nurten Nur Aydın, İftihar Köksal
Risk assessment of groundwater environmental contamination: a case study of a karst site for the construction of a fossil power plant
Abstract
This paper presents a demonstration of an integrated risk assessment and site investigation for groundwater contamination through a case study, in which the geologic and hydrogeological feature of the site and the blueprint of the fossil power plant (FPP) were closely analyzed. Predictions for groundwater contamination in case of accidents were performed by groundwater modeling system (GMS) and modular three-dimensional multispecies transport model (MT3DMS). Results indicate that the studied site area presents a semi-isolated hydrogeological unit with multiplicity in stratum lithology, the main aquifers at the site are consisted of the filled karst development layer with a thickness between 6.0 and 40.0 m. The poor permeability of the vadose zone at the FPP significantly restricted the infiltration of contaminants through the vadose zone to the subsurface. The limited influence of rarely isotropic porous karstified carbonate rocks on the groundwater flow system premised the simulate scenarios of plume migration. Analysis of the present groundwater chemistry manifested that that the groundwater at the site and the local area are of the HCO3–Ca, HCO3, and SO4–Ca types. A few of the water samples were contaminated by coliform bacteria and ammonia nitrogen as a result of the local cultivation. Prediction results indicate that the impact of normal construction and operation processes on the groundwater environment is negligible. However, groundwater may be partly contaminated within a certain period in the area of leakage from the diesel tanks, the industrial wastewater pool, and the cooling tower water tank in case of accidents. On a positive note, none of the plumes would reach the local sensitive areas for groundwater using. Finally, an anti-seepage scheme and a monitoring program are proposed to safeguard the groundwater protection. The integrated method of the site investigation and risk assessment used in this case study can facilitate the protection of groundwater for the construction of large-scale industrial project.
Oxidative stress triggers aggregation of GFP-tagged Hsp31p, the budding yeast environmental stress response chaperone, and glyoxalase III
Abstract
The Saccharomyces cerevisiae Hsp31p protein belongs to the ubiquitous DJ-1/ThiJ/PfpI family. The most prominent member of this family is human DJ-1; defects of this protein are associated with Parkinson's disease pathogenesis. Numerous recent findings reported by our group and others have revealed the importance of Hsp31p for survival in the post-diauxic phase of cell growth and under diverse environmental stresses. Hsp31p was shown to possess glutathione-independent glyoxalase III activity and to function as a protein chaperone, suggesting that it has multiple cellular roles. Our previous work also revealed that HSP31 gene expression was controlled by multiple stress-related transcription factors, which mediated HSP31 promoter responses to oxidative, osmotic, and thermal stresses, toxic products of glycolysis, and the diauxic shift. Nevertheless, the exact role of Hsp31p within budding yeast cells remains elusive. Here, we aimed to obtain insights into the function of Hsp31p based on its intracellular localization. We have demonstrated that the Hsp31p-GFP fusion protein is localized to the cytosol under most environmental conditions and that it becomes particulate in response to oxidative stress. However, the particles do not colocalize with other granular subcellular structures present in budding yeast cells. The observed particulate localization does not seem to be important for Hsp31p functionality. Instead, it is likely the result of oxidative damage, as the particle abundance increases when Hsp31p is nonfunctional, when the cellular oxidative stress response is affected, or when cellular maintenance systems that optimize the state of the proteome are compromised.
Transcriptional and Environmental Control of Bacterial Denitrification and N2O Emissions
Vibrioferrin production by the food spoilage bacterium Pseudomonas fragi
Silver@ graphene oxide nanocomposite: synthesize and application in removal of imidacloprid from contaminated waters
Abstract
Silver@graphene oxide nanocomposite was synthesized through an efficient approach, characterized by FTIR, EDX, and TEM instruments and then was used as adsorbent for imidacloprid removal from water in batch procedure. Effective variants such as contact time, pH, adsorbent dosage, and initial concentration of imidacloprid on procedure by two methods, one at a time and experimental design methods, were studied. Results in optimum conditions based on one at a time experiments is removal of 63% of the pesticide from 50 mL water containing 10 mg/L of imidacloprid by 0.03 g of the adsorbent at pH = 6.6 after 60 min while, experimental design method predict similarity results, 66% uptake of the poison by 0.06 g of the adsorbent in pH = 8. Kinetics and isotherm for adsorption processes follows Freundlich and pseudo-second-order models. Results confirm that Ag@graphene oxide nanocomposite can be applicable for removal of imidacloprid from real polluted water.
Passengers waste production during flights
Abstract
We assume that during flights the amount of waste that is produced is limited. However, daily, approximately 8000 commercial airplanes fly above Europe's airspace while at the same time, more than 17,000 commercial flights exist in the entire world. Using primary data from airlines, which use the Larnaca's International Airport (LIA) in Cyprus, we have tried to understand why wastes are produced during a typical flight such as food waste, paper, and plastics, as well as how passengers affect the production of those wastes. The compositional analysis took place on 27 flights of 4 different airlines which used LIA as final destination. The evaluation indicated that the passenger's habits and ethics, and the policy of each airline produced different kinds of waste during the flights and especially food waste (FW). Furthermore, it was observed that the only waste management strategy that exists in place in the airport is the collection and the transportation of all those wastes from aircrafts and from the airport in the central unit for further treatment. Hence, this research indicated extremely difficulties to implement any specific waste minimization, or prevention practice or other sorting methods during the flights due to the limited time of the most flights (less than 3 h), the limited available space within the aircrafts, and the strictly safety roles that exist during the flights.
Herpes Zoster Rates in a Large Cohort of Patients With Systemically Treated Psoriasis
Digital Photographic Assessment of Acne Vulgaris Using NORA Technology
Hypopigmented, Atrophic, and Folliculocentric Papules on the Trunk
Newborn Treated With Drug That Triggered Maternal SJS During Pregnancy
Tumor Classifications in 7th and 8th Editions of AJCC Cancer Staging Manual
A case report of erythroderma in a patient with borderline leprosy on reversal reaction: a result of the exacerbated reaction?
Abstract
Background
Erythroderma is characterized by erythema and scaling affecting more than 90% of the body surface area. Inflammatory, neoplastic and, more rarely, infectious diseases may culminate with erythroderma. Diagnosis of the underlying disorder is therefore crucial to institute the appropriate therapy. Leprosy is a chronic infectious disease that is endemic in Brazil. Here we present an unusual case of leprosy and reversal reaction causing erythroderma, and we discuss the underlying immunological mechanisms which could contribute to the generalized skin inflammation.
Case presentation
We report a case of a patient with reversal reaction (RR) in borderline borderline leprosy presenting with erythroderma and neural disabilities. Histopathology of the skin showed regular acanthosis and spongiosis in the epidermis and, in the dermis, compact epithelioid granulomas as well as grouped and isolated bacilli. This duality probably reflects the transition from an anergic/multibacillary state to a state of more effective immunity and bacillary control, typical of RR. Leprosy was successfully treated with WHO's multidrug therapy, plus prednisone for controlling the RR; the erythroderma resolved in parallel with this treatment. Immunologic studies showed in situ predominance of IFNγ + over IL-4+ lymphocytes and of IL-17+ over Foxp3+ lymphocytes, suggesting an exacerbated Th-1/Th-17 immunoreactivity and poor Th-2 and regulatory T-cell responses. Circulating Tregs were also diminished. We hypothesize that the flare-up of anti-mycobacteria immunoreactivity that underlies RR may have triggered the intense inflammatory skin lesions that culminated with erythroderma.
Conclusions
This case report highlights the importance of thorough clinical examination of erythrodermic patients in search for its etiology and suggests that an intense and probably uncontrolled leprosy RR can culminate in the development of erythroderma.
Do clinical and laboratory variables have any impact on the diagnostic performance of 18F-FDG PET/CT in patients with fever of unknown origin?
Abstract
Objective
To assess the influence of clinical features and laboratory test results on the determination of fever of unknown origin (FUO) by means of 18F-FDG PET/CT.
Methods
Retrospective and longitudinal analysis, including all the PET/CT studies requested for FUO. Reference standard was established by serology, cultures or biopsy with other laboratory tests or clinical follow-up when necessary. Clinical variables, inflammation markers, protein analysis, serology and culture results close to the PET scan were obtained. The final diagnosis was classified into three groups attending to the etiology; group 1: infection or neoplasm, group 2: vasculitis, autoimmune disease or non-infectious inflammatory disease and group 3: auto-limited fever or persistent fever without diagnosis. PET/CT scans were classified as positive or negative and helpful or not in the diagnosis of the fever origin. The effect of clinical features and laboratory variables on the PET/CT results was analyzed.
Results
Sixty-seven patients were evaluated. The final diagnosis was: Group 1 (25), Group 2 (20) and Group 3 (22). 89.6% of patients had a positive inflammation marker, 28.4% proteinogram alterations and 20.9% positive cultures. PET/CT was positive in 52/67 patients. PET/CT helped in the establishment of the fever origin in 35 cases and was especially helpful in groups 1 and 2. Sensitivity, specificity and accuracy of PET/CT were: 84, 31 and 61%. PET results shown significant relations with the final diagnosis (p = 0.035) and culture results (p = 0.037). No significant relations were observed with the rest of clinical or laboratory variables.
Conclusions
18F-FDG PET/CT had a high sensitivity but a low specificity in the diagnosis of the fever origin, probably due to the high rate of diffuse and auto-limited aetiologies. Patients who are most likely to benefit from the PET/CT study would be those with several positive inflammation markers, reflecting a higher pre-test probability of active disease.
Sub-Populations of Dermal Skin Fibroblasts Secrete Distinct Extracellular Matrix: Implications for Using Skin Substitutes in the Clinic
Summary
Background
While several commercial dermo-epidermal scaffolds can promote wound healing of the skin, the achievement of complete skin regeneration still represents a major challenge.
Objective
We postulated that three dimensional structures derived through the physiological cell secretion of extracellular matrix (ECM) may be a bioinspired scaffold for skin tissue engineering. In the present study we performed a biological characterization of self-assembled ECMs from three different sub-populations of fibroblasts found in human skin; papillary fibroblasts (Pfi), reticular fibroblasts (Rfi), and dermal papilla fibroblasts (DPfi).
Methods
Fibroblast sub-populations were cultured with ascorbic acid to promote cell assembled matrix production for 10 days. Subsequently, cells were removed and the remaining matrices were characterized. Additionally, in another experiment, keratinocytes were seeded on the top of cell depleted ECMs to generate epidermal only skin constructs.
Results
We found that the ECM self-assembled by Pfi exhibited randomly oriented fibers associated with highest interfibrillar space, reflecting ECM characteristics which are physiologically present within the papillary dermis. Mass spectrometry followed by validation with immunofluorescence analysis showed that THROMBOSPONDIN 1 (THBS1) is preferentially expressed within the DPfi derived matrix. Moreover we observed that epidermal constructs grown on DPfi or Pfi matrices exhibited normal basement membrane formation, while Rfi matrices were unable to support membrane formation.
Conclusion
We argue that inspiration can be taken from these different ECMs, to improve the design of therapeutic biomaterials in skin engineering applications.
This article is protected by copyright. All rights reserved.
Does spending matters? Re-looking into various covariates associated with Out of Pocket Expenditure (OOPE) and catastrophic spending on accidental injury from NSSO 71st round data
Accidental Injury is a traumatic event which not only influences physical, psychological, and social wellbeing of the households but also exerts extensive financial burden on them. Despite the devastating econ...
Therapeutic potential of phages in autoimmune liver diseases
Summary
Autoimmune liver disease (ALD) poses a difficult medical challenge as there is a significant number of patients in whom current therapy offers questionable or no benefit yet its side effects may be serious including the development of malignancy. Bacterial viruses (phages) have been increasingly recognized as immunomodulators contributing to immune homeostasis and curbing inflammation. Accumulating data suggest that phages may be useful in immunotherapy of ALD. Phages have been shown to downregulate the expression and/or production and activity of factors associated with hepatic injury (reactive oxygen species, TLR4 activation, NF-kappaB activation, pro-inflammatory and pro-coagulant activities of platelets) and upregulate the expression and/or production of factors demonstrated as playing protective role (Il-10, Il-1 receptor antagonist). This article is protected by copyright. All rights reserved.
Autologous Stem Cell Transplantation After Second Line Brentuximab Vedotin in Relapsed or Refractory Hodgkin Lymphoma
On the Identification of Culturable Microorganisms for the Assessment of Biodiversity in Bioaerosols
Protective effects of cilostazol on ethanol-induced damage in primary cultured hepatocytes
Abstract
Alcoholic liver disease (ALD) caused by excessive alcohol consumption is associated with oxidative stress, mitochondrial dysfunction, and hepatocellular apoptosis. Cilostazol, a licensed clinical drug used to treat intermittent claudication, has been reported to act as a protective agent in a spectrum of diseases. However, little information regarding its role in ethanol-induced hepatocellular toxicity has been reported. In the current study, we investigated the protective effects and mechanisms of cilostazol on ethanol-induced hepatocytic injury. Rat primary hepatocytes were pretreated with cilostazol prior to ethanol treatment. MTT and LDH assay indicated that ethanol-induced cell death was ameliorated by cilostazol in a dose-dependent manner. Our results display that overproduction of intracellular reactive oxygen species (ROS) and 4-hydroxy-2-nonenal (4-HNE) induced by ethanol was attenuated by pretreatment with cilostazol. Furthermore, cilostazol significantly inhibited ethanol-induced generation of ROS in mitochondria. Importantly, it was shown that cilostazol could improve mitochondrial function in primary hepatocytes by restoring the levels of ATP and mitochondrial membrane potential (MMP). Additionally, cilostazol was found to reduce apoptosis induced by ethanol using a terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay. Mechanistically, we found that cilostazol prevented mitochondrial pathway-mediated apoptotic signals by reversing the expression of Bax and Bcl2, the level of cleaved caspase-3, and attenuating cytochrome C release. These findings suggest the possibility of novel ALD therapies using cilostazol.
Reconstruction of Congenital Sternal Clefts: Surgical Experience and Literature Review
Background: Sternal cleft is a rare anomaly with a reported incidence of 1:100,000 cases per live births. Surgical intervention represents a crucial factor altering the overall patient prognosis, since they are at high risk of impaired oxygenation, as well as multiple chest infections. Herein, we are reporting our experience of surgical management of such rare cases, alerting plastic surgeons to their possibly crucial role in the reconstructive team. Methods: A retrospective chart review of 2 cases presenting with chest wall defects. All perioperative data were collected and presented. Results: Two patients with sternal clefts of variable degrees were managed. The first was an 18-month-old boy with partial inferior sternal cleft, who was otherwise asymptomatic. The patient underwent reconstruction at the same age using autologous rib graft and pectoralis major flaps due to ectopia cordis that was putting the patient at higher risk for cardiac trauma. The second patient was a 3-month-old girl having a V-shaped partial superior cleft with lung herniation. Surgical reconstruction was applied due to difficulty in weaning the patient off of ventilator support. Initially, reconstruction was applied with SurgiMend dermal matrix, but this was complicated by chest retraction and high oxygen requirement. Definitive reconstruction was later applied with allogeneic bone graft and pectoralis major flaps. Conclusions: Meticulous patient assessment and screening for associated anomalies are crucial. Surgical intervention is warranted at an early age. The use of acellular dermal matrix products in the reconstruction is of interest, but should be approached with caution.Hemi-Intravascular Stenting for Supermicrosurgical Anastomosis
Background: Although supermicrosurgical anastomosis is a widely known reconstructive microsurgical technique, it is difficult to perform. To expand the clinical use of supermicrosurgery, we used hemi-intravascular stenting (hemi-IVaS), which is performed by inserting an intravascular stent into one side of the vessel. We conducted lymphaticovenular anastomosis, free perforator flap transfer, and fingertip replantation with supermicrosurgical anastomosis using hemi-IVaS technique and examined its usefulness. Methods: Between January 2013 and February 2015, 11 anastomoses in 11 cases of lymphaticovenular anastomosis for lymphedema patients, 14 anastomoses in 7 cases of free perforator flap transfer with supermicrosurgical perforator-to-perforator anastomosis, and 9 anastomoses in 5 cases of fingertip replantation were performed using hemi-IVaS. Time required for anastomosis and complications were examined. Flap survival rate was also examined in free perforator flap transfer cases and fingertip replantation cases. Results: In all cases, anastomoses were performed without complications such as inadvertent catching of the back wall of the vessel during the procedure or the need for reanastomoses. The average time required to complete the anastomosis was 16.4 ± 3.20 minutes using the hemi IVaS technique. All flaps survived in the supermicrosurgical perforator-to-perforator anastomosis as well as fingertip replantation cases. Conclusions: Hemi-IVaS could be a useful alternative to conventional intravascular stenting techniques and is also effective for supermicrosurgical perforator-to-perforator anastomosis. Further studies are needed to improve the success rate and to explore its other possible utilizations in supermicrosurgery.Long-term mucocutaneous adverse effects of imatinib in Indian chronic myeloid leukemia patients
Abstract
Background
Short-term mucocutaneous adverse effects are well documented with imatinib. However, studies on long-term adverse effects and in the ethnic population are lacking.
Objective
To study the long-term mucocutaneous adverse effects of imatinib and factors predicting these adverse effects.
Methods
In this cross-sectional study, consenting adult chronic myeloid leukemia patients on imatinib for more than 250 days were recruited. The details of imatinib treatment were retrieved from hematology clinic records.
Results
Four hundred and thirty-eight patients who were on imatinib for a mean duration of 1820 days were recruited. A mean number of 1.42 ± 0.98 cutaneous adverse effects were seen per patient. Melasma-like pigmentation, periorbital edema, oral lichenoid reaction, cutaneous hypopigmentation, and vesicobullous eruptions were seen in 236 (53.9%), 81 (18.5%), 70 (16%), 42 (9.6%), and 12 (2.7%) patients, respectively. Drug-induced cutaneous eruptions (9.1%) and cutaneous hypopigmentation (9.6%) were seen less frequently. Cutaneous hyperpigmentation was more likely seen in younger patients (P = 0.001) and females (P < 0.001). On multivariate analysis, female gender was a significant risk factor for developing cutaneous hyperpigmentation and periorbital edema.
Conclusion
Cutaneous hyperpigmentation and periorbital edema are common long-term adverse effects of imatinib in Indian patients. Female gender is a significant risk factor for the development of both these adverse effects.
The association between stress and acne among female medical students in Jeddah, Saudi Arabia.
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The association between stress and acne among female medical students in Jeddah, Saudi Arabia.
Clin Cosmet Investig Dermatol. 2017;10:503-506
Authors: Zari S, Alrahmani D
Abstract
Introduction: Although there is widespread acceptance of a relationship between stress and acne, not many studies have been performed to assess this relationship. The objective of this study was to determine the relationship between stress and acne severity.
Methods: A cross-sectional study was conducted among 144 6th year female medical students 22 to 24 years in age attending the medical faculty at King Abdulaziz University. This study used the global acne grading system (GAGS) to assess acne severity in relation to stress using the Perceived Stress Scale (PSS). The questionnaire also included some confounding factors involved in acne severity.
Results: The results indicated an increase in stress severity strongly correlated with an increase in acne severity, which was statistically significant (p<0.01). Subjects with higher stress scores, determined using the PSS, had higher acne severity when examined and graded using the GAGS.
Conclusion: On the basis of this study, it is concluded that stress positively correlates with acne severity.
PMID: 29255370 [PubMed]
Neoplastic Multifocal Skin Lesions: Biology, Etiology, and Targeted Therapies for Nonmelanoma Skin Cancers
Neoplastic skin lesions are multifocal, diffuse skin infiltrations of particular relevance in the differential diagnosis of ulcerative, nodular, or crusting skin lesions. Nonmelanoma skin cancers (NMSCs), namely, basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and also actinic keratosis (AK), are the most common malignant tumors in humans. BCCs do not proliferate rapidly and most of the times do not metastasize, while SCCs are more infiltrative, metastatic, and destructive. AKs are precursor lesions of cutaneous SCCs. The classical therapy of NMSCs makes use of photodynamic therapy associated with chemotherapeutics. With improved understanding of the pathological mechanisms of tumor initiation, progression, and differentiation, a case is made towards the use of targeted chemotherapy with the intent to reduce the cytotoxicity of classical treatments. The present review aims to describe the current state of the art on the knowledge of NMSC, including its risks factors, oncogenes, and skin carcinogenesis, discussing the classical therapy against new therapeutic options.
Skin Pharmacol Physiol 2018;31:59-73
From art to science: a new epistemological status for medicine? On expectations regarding personalized medicine
Abstract
Personalized medicine plays an important role in the development of current medicine. Among the numerous statements regarding the future of personalized medicine, some can be found that accord medicine a new scientific status. Medicine will be transformed from an art to a science due to personalized medicine. This prognosis is supported by references to models of historical developments. The article examines what is meant by this prognosis, what consequences it entails, and how feasible it is. It refers to the long tradition of epistemological thinking in medicine and the use of historical models for the development of medicine. The possible answers to the question "art or science" are systematized with respect to the core question about the relationship between knowledge and action. The prediction for medicine to develop from an 'empirical healing art' to a 'rational, molecular science' is nonsensical from an epistemological point of view. The historical models employed to substantiate the development of personalized medicine are questionable.
Eczematous dermatitis in an infantile hemangioma with minimal or arrested growth
Abstract
Infantile hemangiomas (IHs) with minimal or arrested growth differ from standard IHs in that they have a reduced or absent growth phase. An association between IHs with minimal or arrested growth and superimposed eczematous dermatitis has not been described in the literature. We present a case detailing this association in which an IH with minimal or arrested growth responded well to treatment with propranolol and the superimposed eczema cleared completely with topical hydrocortisone.
Pediatric dermatology procedures and pearls: Multimodal revision of earlobe keloids
Abstract
Keloid scars are benign proliferations of fibrous tissue and collagen that usually occur in response to cutaneous injury. Many treatment modalities have been described in the literature, with variable rates of recurrence and no clear consensus. Keloids remain a therapeutic challenge to patients and physicians alike. Herein we describe a novel technique for treating recurrent earlobe keloids in an outpatient setting with multimodal therapy including shave removal followed immediately by ablative fractional laser resurfacing (AFR) and laser-assisted delivery (LAD) of corticosteroids.
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Publication date: Available online 25 July 2018 Source: Journal of Photochemistry and Photobiology B: Biology Author(s): Marco Ballestr...
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Editorial AJR Reviewers: Heartfelt Thanks From the Editors and Staff Thomas H. Berquist 1 Share + Affiliation: Citation: American Journal...
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