The underreporting of cost perspective in cost-analysis research: a systematic review of the plastic surgery literature

Publication date: Available online 21 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Madeleine M. Blank, Lilian Chen, Marianna Papageorge, Daniel Driscoll, Roger Graham, Abhishek Chatterjee
BackgroundCost-analysis research can influence healthcare policies and practices. There is inherent bias depending on the chosen cost perspective (hospital, third-party payer, societal), and conclusions can change based on the perspective used. These perspectives may or may not be well declared or justified when performing cost analysis research. The goal of this study was to perform a literature review of cost-analysis research in the Plastic Surgery literature to determine the prevalence of studies declaring and justifying their perspective, and to inform the reader on why such declarations are important in understanding potential bias.MethodsA systematic review was completed to retrieve cost-utility and cost-effectiveness research within the scope of Plastic Surgery. The search was limited to English-language studies in North America and Europe published between 2006 and 2016. Articles were selected using predefined data fields and specific inclusion criteria.ResultsA total of 2304 abstracts were identified, of which 47 met inclusion criteria. Seventy-two percent of studies (n=34) declared a cost perspective. Of the studies that identified a cost perspective, 32% incorrectly identified the cost perspective. Only 49% of all studies (n=23) both accurately declared and justified their chosen perspective.ConclusionsOnly half of studies correctly declare their cost perspective and justify why the perspective was chosen. Not doing so potentially hides bias from the reader. Future efforts when performing cost-analysis studies should require a clear declaration and justification of the cost perspective taken. A table of our recommendations for reporting cost perspective is provided.

Comparative toxicity of azo dyes to two infaunal organisms ( Hexagenia spp. and Tubifex tubifex ) in spiked-sediment exposures

Abstract

Azo dyes are synthetic compounds used as industrial colorants, and some are predicted to be inherently toxic, bioaccumulative, and/or persistent based upon their chemical composition. This study addresses data gaps in current research which include the need to evaluate the toxicity of hydrophobic azo dyes to benthic invertebrates. The toxicity of a solvent dye, Sudan Red G (SRG), and two disperse dyes, Disperse Yellow 7 (DY7) and Disperse Orange 13 (DO13), to Hexagenia spp. and Tubifex tubifex was assessed in spiked-sediment exposures. The dye compounds appeared to degrade readily in the equilibrium and exposure periods, suggesting a limited persistence of the parent compounds in the environment under test conditions. Although azo dye degradation products could not be reliably quantified, one was detected in DY7 sediment samples that elicited toxic effects to Hexagenia and Tubifex, providing evidence that DY7 degrades. Hexagenia survival and growth endpoints responded with similar sensitivity to the dyes, but DY7 was the most toxic, with a 21-day IC25 (concentration associated with 25% inhibition) for growth of 9.6 μg/g. Comparatively, Tubifex reproduction was the most sensitive endpoint for all dyes with 28-day IC25s for young production ranging from 1.3 to 11.8 μg/g. At sublethal concentrations, toxic effects to Tubifex differed between dyes: the solvent dye exerted an effect primarily on gametogenesis (cocoon production), while disperse dyes, most notably DY7, caused effects on embryogenesis (development of worm inside the cocoon). This study indicates that there could be potential hazard to oligochaetes based on the observed effect concentrations, but given the lack of environmental measurements, the risk of these compounds is unknown. Further research is required to determine if degradation products were formed in all dye samples and whether toxicity was caused by the parent molecules, which have limited persistence under test conditions, or by their degradation products. To avoid underestimating toxicity, this study stresses the need to use an infaunal deposit feeder such as the oligochaete Tubifex in sediment toxicity assessments where highly hydrophobic compounds are present.

Heavy metal contamination in the muscle of Aegean chub ( Squalius Fellowesii ) and potential risk assessment

Abstract

Especially after the industrial revolution, the amount of contaminants released in aquatic ecosystems has considerably increased. For this reason, the necessity to carry on research on the existence of contaminants, specifically heavy metals, has emerged. In this study, heavy metal concentrations in muscle tissues of Aegean chub, which was an endemic species of south western part of Turkey, gathered from Tersakan River were examined. Heavy metal concentrations of the samples were analyzed with ICP-MS. Estimated daily intakes (EDI), target hazard quotient (THQ), and carcinogenic risk (CR) of elements were calculated. The heavy metals detected in muscle tissues were Zn > Cu > Cr > Mn > Pb > Cd, consecutively. According to the results of the applied health risk assessment (EDI, THQ and CR) for heavy metal exposure from fish consumption in children and adults, it was determined that there was no any significant threat to human health.

Molecular characterization of AmiC, a positive regulator in acetamidase operon of Mycobacterium smegmatis

Abstract

Mycobacterium smegmatis, a rapidly growing non-pathogenic mycobacterium, is currently used as a model organism to study mycobacterial genetics. Acetamidase of M. smegmatis is the highly inducible enzyme of Mycobacteria, which utilizes several amide compounds as sole carbon and nitrogen sources. The acetamidase operon has a complex regulatory mechanism, which involves three regulatory proteins, four promoters, and three operator elements. In our previous study, we showed that over-expression of AmiA leads to a negative regulation of acetamidase by blocking the P2 promoter. In this study, we have identified a new positive regulatory protein, AmiC that interacts with AmiA through protein-protein interaction. Gel mobility shift assay showed that AmiC protein inhibits AmiA from binding to the P2 promoter. Interaction of AmiC with cis-acting elements identified its binding ability to multiple regulatory regions of the operon such as P3, OP3, and P1 promoter/operator. Consequently, the addition of inducer acetamide to AmiC complexe trips the complexes, causing AmiC to appear to be the sensory protein for the amides. Homology modeling and molecular docking studies suggest AmiC as a member of Periplasmic binding proteins, which preferentially bind to the inducers and not to the suppressor. Over-expression of AmiC leads to down-regulation of the negative regulator, amiA, and constitutive up-regulation of acetamidase. Based on these findings, we conclude that AmiC positively regulates the acetamidase operon.

Use of the hCONSORT Criteria as a Reporting Standard for Herbal Interventions for Common Dermatoses - A Systematic Review

Abstract

Background

The use of complementary and alternative medicine (CAM) is increasing in western countries, including in the area of dermatology. However, western healthcare providers have not integrated CAM into regular practice due to a lack of reliable data supporting its use. In order to encourage high quality research related to the use of CAM and specifically herbal interventions, the CONSORT extension criteria on reporting herbal interventions (hCONSORT) were published in 2006.

Objectives

This study aimed to evaluate the adherence of randomized controlled trials investigating herbal interventions for 3 common dermatoses (acne, atopic dermatitis, and psoriasis) to the hCONSORT criteria.

Methods

A comprehensive search of Medline, Embase, and Cochrane library databases was conducted. Randomized control trials published between 2009 and 2014 assessing therapeutic outcomes of plant-based interventions for acne, atopic dermatitis, or psoriasis were included. Investigators determined the number of unique hCONSORT criteria satisfied per report. Analysis of variance was used to examine differences in scores by disease entity.

Results

The vast majority of reviewed studies reported less than 50% of information recommended in the hCONSORT criteria.

Limitations

Limitations include small number of dermatologic conditions examined, exclusion of reports based on language, and lack of assessment of overall adherence to CONSORT criteria

Conclusions

Our data indicates lack of adherence to hCONSORT extension criteria. Adherence to hCONSORT guidelines should be encouraged in order to provide high quality reporting of research on herbal interventions in dermatology. Doing so may ease the integration of CAM into conventional medical practice and provide actionable data to providers.

This article is protected by copyright. All rights reserved.

Percutaneous Purse-String Suture: An Innovative Percutaneous Technique for Inframammary Fold Creation and Improved Breast Projection in Reconstructive Surgery

Abstract

Background

Lipofilling for breast reconstruction has become increasingly common. Creation of a well-defined inframammary fold (IMF) is integral to achieving symmetrical aesthetic results. This has traditionally been done under direct vision through an open incision.

Objectives

The authors present their experience in reconstructive breast surgery with a novel percutaneous technique for IMF creation and improvement of projection without the need for large incisions.

Methods

From June 2011 to January 2015, 180 patients underwent a percutaneous purse-string suture (PPSS) to enhance their IMF and improve breast projection. After completion of lipofilling, a curved cannula is tunneled subcutaneously. The suture is placed into the cannula and passed around the circumference of the breast footprint. After the completion of two passes in different anatomic levels around the footprint, the suture is tightened at the breast's tail zone to achieve the desired IMF definition and breast projection. Surgical technique, results, and follow up are presented.

Results

The PPSS technique was combined either with lipofilling only or as part of flap breast reconstruction in 30 and 150 patients, respectively. The average follow-up time was 34 months (range, 11-48 months). PPSS was redone in 25 patients to further improve breast projection. One patient complained of postoperative pain. No other PPSS-related complication was reported.

Conclusions

PPSS is an innovative technique designed to complement the emerging field of lipofilling for breast reconstruction. The technique is safe, easily reproduced, and provides excellent results. Breast IMF and projection are immediately improved without the need for open incisions.

Level of Evidence: 4

Progress in surgical strategies for treatment of simple congenital syndactyly: A systematic review

Abstract

Background

Plenty of surgical strategies for treatment of simple syndactyly have been reported in the past decades. We are most interested in what progresses have been made over the recent 10 years. Our aim was to make a summary of the modified techniques that have been described in the last decade.

Methods

We reviewed English articles from PubMed and Chinese articles from CKNI and CQVIP published between January 2007 and December 2016. We limited the inclusion criteria to simple syndactyly and excluded complex, complicated, and syndrome-associated syndactylies.

Results

We identified 1650 articles and selected 94 for inclusion. Almost half of the included papers proposed modified flaps for web reconstruction. In most cases, a zigzag incision and Buck-Gramcko flaps were still the first choice to separate the fused digits and create the nail folds. Several new donor sites were recommended for skin grafts and several substitute biomaterials were introduced to replace skin grafts. External fixator devices were applied in a wider range for desyndactylization. However, it was not considered to be superior to other graft-less strategies. Postoperative complications were discussed in most papers, but an effective strategy to eradicate these is lacking.

Conclusions

With the development of biomaterials and surgeon's experiences, more and more modified techniques have been conceived. However, no specific technique can be announced to be superior to others. Furthermore, more sensitive outcome measures should be established, and relationship between operative procedures and postoperative complications should be further defined.

Level of evidence: not ratable.

Case report of Schöpf–Schulz–Passarge syndrome resulting from a missense mutation, p.Arg104Cys, in WNT10A

Abstract

Schöpf–Schulz–Passarge syndrome (SSPS) is a rare ectodermal dysplasia characterized by cysts of the eyelids, hypodontia, hypotrichosis, palmoplantar keratosis and onychodystrophy, and it is not common in Asia according to the published work. This autosomal recessive disorder was believed to result from mutations in the WNT10A gene. We report a 54-year-old Taiwanese man with SSPS resulted from a homozygous mutation (p.Arg104Cys) in WNT10A. This mutation has not been reported in odonto-onycho-dermal dysplasia but was demonstrated to link with dental abnormalities. This report implies the significance of WNT10A gene mutation in ectodermal dysplasia and highlights the clinical features of SSPS.

Neutrophilic urticarial dermatosis: a novel association with poststreptococcal rheumatic disease

Summary

Neutrophilic urticarial dermatosis (NUD), a particular clinical and histological entity, can provide a strong pointer to underlying systemic disease, most frequently rheumatological diseases. We report the first case of NUD in association with a post-streptococcal rheumatic disease, with symptoms including recurrent sore throat, raised antistreptolysin O titre, persistent transient urticaria, polyarthralgia, rheumatic mitral valve disease and Jaccoud arthropathy. Histologically, NUD is characterized by an intense superficial and deep neutrophilic interstitial and perivascular infiltrate, without significant oedema or blood vessel damage. These neutrophils may have a tendency to concentrate along the basement membrane and extend into the epidermis, hair follicles, sebaceous glands and sweat glands (a feature termed 'neutrophilic epitheliotropism'). Clinicians should remain cognizant of NUD, and in particular its frequent association with an underlying inflammatory disorder.

Rational ideation and empiric validation of an innovative digital dermographic tester

Summary

Background

Dermographism is a condition characterized by a weal response to a combination of pressure and traction on skin surface, and its diagnosis is based on medical history, clinical criteria and provocation test. The Dermographic Tester^®, a pen-sized tool containing a spring-loaded blunt tip, is the most widely used instrument for the provocation test, and it exerts increasing pressures on the skin surface according to an arbitrary units (AU) scale. Analysing the mechanism of function and trying to convert the AUs to SI units (g/mm²), we found that this instrument had some defects and limits that would compromise a true and repeatable quantification of the weal response threshold. Consequently, we decided to develop a new instrument, the Digital Dermographic Tester (DDT), which is engineered with an inside force sensor to implement features lacking in the current tools, in the hope of enhancing the precision of the provocation test.

Aim

To validate the effectiveness and accuracy of the DDT.

Methods

We tested the DDT on 213 participants purposely sampled to obtain three groups, each with a different pattern of reaction to mechanical stimuli. Based on anamnestic, diagnostic and symptomatic criteria, patients were divided into dermographic urticaria (DU), spontaneous urticaria (SU) and healthy control (HC) groups. The DDT was used to apply 12 levels of pressure to the skin surface, and a frequency distribution of positive reactions was displayed for each group.

Results

A force of 36–40 g/mm² appropriately differentiated physiological from pathological conditions with high sensitivity and specificity.

Conclusions

The DDT was found to be capable of differentiating patients with DU patients from those with SU and from HCs, and was able to precisely identify the weal elicitation threshold.

Biorational substitution of piperonyl butoxide in organic production: effectiveness of vegetable oils as synergists for pyrethrums

Abstract

Piperonyl butoxide is a semi-synthetic synergist for natural pyrethrum and synthetic pyrethroid insecticides in phytochemicals and biocides. As such it is used in large quantities for crop treatments, stored grain protection, disinfestation of grain storage facilities and indoor uses. Piperonyl butoxide is consequently a regular contaminant in stored grains, and subsequently in corresponding cereal food products and meat via feed uses. Therefore it is regularly monitored and its MRL is ongoing a reassessment. It is also considered as a possible human carcinogen and a suspected endocrine disruptor. For all these reasons and considerations most of the countries have already banned its use in Organic Farming as France in 2017. Thus, ecological substitution of with biorational and sustainable solutions is required. Vegetable oils have been described as exhibiting similar potency and synergistic effects. We have reviewed the literature and have proceeded to ecotoxicological efficacy tests in order to determine the best and most durable substitution candidates. Sesame and rape seed oil were determined to be the most efficient.

Impacts of biofouling on the removal of pharmaceutically active compounds by a nanofiltration membrane

Abstract

The impacts of biofouling on the retention of pharmaceutically active compounds (PhACs) by a commercially available nanofiltration membrane (NF 270) were systematically studied. Biofouling was achieved through inoculating live and dead Pseudomonas aeruginosa into artificial wastewater. In comparison to a clean membrane, an increase in PhAC rejection during biofouling with live cells was observed. However, the rejection behaviors presented more complex changes during biofouling with dead cells: PhAC rejection was below the clean membrane in the early biofouling stage; however, in the later stage, PhAC rejection was above the clean membrane. In addition, PhAC rejection behaviors present the similar tendency as salt rejection under both biofouling conditions. In addition, solute rejections were much lower for biofouling with dead cells than those for biofouling with live cells. Combined with biofilm characterization under both biofouling conditions, we could conclude that biofilm enhanced osmotic pressure (BEOP) due to higher cell counts and biofilm thickness led to a decrease in PhAC retention, especially for the dead cells. In addition, more dominant steric exclusion in the later stage of biofouling due to higher extracellular polymeric substances (EPS) concentration on the membrane surface resulted in an increase in PhAC retention.

Compound washing remediation and response surface analysis of lead-contaminated soil in mining area by fermentation broth and saponin

Abstract

The development of eluent is the key to soil washing remediation, and a compound eluent was constructed using the prepared citric acid fermentation broth and saponin in this study. It displayed a good washing performance for Pb, Cu, Cr, and Cd in red soil, and the removal rates, especially Pb, gained an improvement compared with a single eluent. Based on this, the compound eluent was applied to remediation of Pb-contaminated soil in mining area; the desorption of Pb is a heterogeneous diffusion process, and Pb in large particle size soil is relatively easy to remove. An available response surface analysis model was established; its P < 0.0001 is very significant, and the P of the missing item is 0.1152. The degree of influence of three significant factors on removal of Pb is liquid-to-solid ratio > washing time > saponin concentration, and liquid-to-solid ratio and washing time show interaction. Moreover, the Pb removal rate can reach 56.20% under the optimized conditions: 0.25% saponin concentration, 20 mL/g liquid-to-solid ratio, and 320-min washing time, which is close to the predicted value of 56.20% with a difference of 1.41%. In addition, most of the active Pb was removed and environmental risks were lowered after washing.

Spatiotemporal characteristics of aerosols and their trends over mainland China with the recent Collection 6 MODIS and OMI satellite datasets

Abstract

With the rapid development of China's economy and high rate of industrialization, environmental pollution has become a major challenge for the country. The present study is aimed at analyzing spatiotemporal heterogeneities and changes in trends of different aerosol optical properties observed over China. To achieve this, Collection 6 Level 3 data retrieved from the Moderate Resolution Imaging Spectroradiometer (MODIS; 2002–2016) and Ozone Monitoring Instrument (OMI; 2005–2016) sensors were used to investigate aerosol optical depth (AOD₅₅₀), Ångstrӧm exponent (AE_470–660), and Absorption Aerosol Index (AAI). The spatial distribution of annual mean AOD₅₅₀ was noticed to be high over economically and industrialized regions of the east, south, and northeast of China, while low aerosol loadings were located over rural and less-developed areas of the west and northeast of China. High AE_470–660 (> 1.0) values were characterized by the abundance of fine-mode particles and vice versa, likely attributed to large anthropogenic activities. Similarly, high AOD with corresponding high AE and low AAI was characterized over the urban-industrialized regions of the central, east, and south of China during most of the months, being more pronounced in June and July. On seasonal scale, AOD values were found to be high during spring, followed by the summer and autumn, and low during the winter season. It is also evident that all aerosol parameters showed a single-peak frequency distribution in all seasons over entire China. Further, the annual, monthly, and seasonal spatial trends revealed a decreasing trend in AOD over most regions of China, except in the southwest of China, which showed a positive increasing trend. Significant increasing trends were noted in AAI for all the seasons, particularly during autumn and winter, resulting in a large amount of the absorbing type of aerosols produced from biomass burning and desert dust.

POLSOIL: research on soil pollution in China

Facing to real sustainability—conservation agriculturalpractices around the world

Environmental assessment in health care organizations

Abstract

The aim of this research is to design a multi-criteria model for environmental assessment of health care organizations. This is a model which guarantees the objectivity of the results obtained, is easy to apply, and incorporates a series of criteria, and their corresponding descriptors, relevant to the internal environmental auditing processes of the hospital. Furthermore, judgments were given by three experts from the areas of health, the environment, and multi-criteria decision techniques. From the values assigned, geometric means were calculated, giving weightings for the criteria of the model. This innovative model is intended for application within a continuous improvement process. A practical case from a Spanish hospital is included at the end. Information contained in the sustainability report provided the data needed to apply the model. The example contains all the criteria previously defined in the model. The results obtained show that the best-satisfied criteria are those related to energy consumption, generation of hazardous waste, legal matters, environmental sensitivity of staff, patients and others, and the environmental management of suppliers. On the other hand, those areas returning poor results are control of atmospheric emissions, increase in consumption of renewable energies, and the logistics of waste produced. It is recommended that steps be taken to correct these deficiencies, thus leading to an acceptable increase in the sustainability of the hospital.

Characterization and 2D structural model of corn straw and poplar leaf biochars

Abstract

The integrated experimental methods were used to analyze the physicochemical properties and structural characteristics and to build the 2D structural model of two kinds of biochars. Corn straw and poplar leaf biochars were gained by pyrolysing the raw materials slowly in a furnace at 300, 500, and 700 °C under oxygen-deficient conditions. Scanning electron microscope was applied to observe the surface morphology of the biochars. High temperatures destroyed the pore structures of the biochars, forming a particle mixture of varying sizes. The ash content, yield, pH, and surface area were also observed to describe the biochars' properties. The yield decreases as the pyrolysis temperature increases. The biochars are neutral to alkaline. The biggest surface area is 251.11 m²/g for 700 °C corn straw biochar. Elemental analysis, infrared microspectroscopy, solid-state C-13 NMR spectroscopy, and pyrolysis gas chromatography-mass spectrometry (Py-GC-MS) were also used to study the structural characteristics and build the 2D structural models of biochars. The C content in the corn straw and poplar leaf biochars increases with the increase of the pyrolysis temperature. A higher pyrolysis temperature makes the aryl carbon increase, and C=O, OH, and aliphatic hydrocarbon content decrease in the IR spectra. Solid-state C-13 NMR spectra show that a higher pyrolysis temperature makes the alkyl carbon and alkoxy carbon decrease and the aryl carbon increase. The results of IR microspectra and solid-state C-13 NMR spectra reveal that some noticeable differences exist in these two kinds of biochars and in the same type of biochar but under different pyrolysis temperatures. The conceptual elemental compositions of 500 °C corn straw and poplar leaf biochars are C₆₁H₃₃NO₁₃ and C₅₉H₄₁N₃O₁₂, respectively. Significant differences exist in the SEM images, physicochemical properties, and structural characteristics of corn straw and poplar leaf biochars.

Does the Volume of CSF Removed Affect the Response to a Tap in Normal Pressure Hydrocephalus? [LETTERS]

Reply: [LETTERS]

Prenatal Factors Associated with Postnatal Brain Injury in Infants with Congenital Diaphragmatic Hernia [PEDIATRICS]

BACKGROUND AND PURPOSE:

Approximately 60% of infants with congenital diaphragmatic hernia have evidence of brain injury on postnatal MR imaging. It is unclear whether any brain injury is present before birth. In this study, we evaluated fetal MR imaging findings of brain injury and the association of congenital diaphragmatic hernia severity with postnatal brain injury.

MATERIALS AND METHODS:

Fetal MR imaging and postnatal brain MR imaging were retrospectively evaluated in 36 cases of congenital diaphragmatic hernia (from 2009 to 2014) by 2 pediatric neuroradiologists. Brain injury on postnatal MR imaging and brain injury and congenital diaphragmatic hernia severity on fetal MR imaging were recorded. Correlations between brain abnormalities on fetal and postnatal brain MR imaging were analyzed. Postnatal brain injury findings correlating with the severity of congenital diaphragmatic hernia were also assessed.

RESULTS:

On fetal MR imaging, enlarged extra-axial spaces (61%), venous sinus distention (21%), and ventriculomegaly (6%) were identified. No maturational delay, intracranial hemorrhage, or brain parenchymal injury was identified on fetal MR imaging. On postnatal MR imaging, 67% of infants had evidence of abnormality, commonly, enlarged extra-axial spaces (44%). Right-sided congenital diaphragmatic hernia was associated with a greater postnatal brain injury score (P = .05). Low observed-to-expected lung volume was associated with postnatal white matter injury (P = .005) and a greater postnatal brain injury score (P = .008). Lack of liver herniation was associated with normal postnatal brain MR imaging findings (P = .03).

CONCLUSIONS:

Fetal lung hypoplasia is associated with postnatal brain injury in congenital diaphragmatic hernia, suggesting that the severity of lung disease and associated treatments affect brain health as well. We found no evidence of prenatal brain parenchymal injury or maturational delay.

MR Imaging-Based Evaluations of Olfactory Bulb Atrophy in Patients with Olfactory Dysfunction [HEAD & NECK]

BACKGROUND AND PURPOSE:

Although the olfactory bulb volume as assessed with MR imaging is known to reflect olfactory function, it is not always measured during olfactory pathway assessments in clinical settings. We aimed to evaluate the utility of visual olfactory bulb atrophy and neuropathy analyses using MR imaging in patients with olfactory dysfunction.

MATERIALS AND METHODS:

Thirty-four patients who presented with subjective olfactory loss between March 2016 and February 2017 were included. Patients underwent a nasal endoscopic examination, olfactory testing with the Korean Version of the Sniffin' Sticks test, and MR imaging. All patients completed the Sino-Nasal Outcome Test and Questionnaire of Olfactory Disorders. Olfactory bulb atrophy and neuropathy were evaluated on MR images by 2 head and neck radiologists.

RESULTS:

The etiology of olfactory loss was chronic rhinosinusitis with/without nasal polyps in 15 (44.1%) patients, respiratory viral infection in 7 (20.6%), trauma in 2 (5.9%), and idiopathic in 10 (29.4%) patients. Although 10 (29.4%) of the 34 patients were normosmic according to the Sniffin' Sticks test, their scores on the other tests were like those of patients who were hyposmic/anosmic according to the Sniffin' Sticks test. However, the detection rate of olfactory bulb atrophy was significantly higher in patients with hyposmia/anosmia than it was in patients with normosmia (P = .002). No difference in olfactory bulb neuropathy was identified among patients with normosmia and hyposmia/anosmia (P = .395).

CONCLUSIONS:

MR imaging evaluations of olfactory bulb atrophy can be used to objectively diagnose olfactory dysfunction in patients with subjective olfactory loss.

Pressure Mapping and Hemodynamic Assessment of Intracranial Dural Sinuses and Dural Arteriovenous Fistulas with 4D Flow MRI [ADULT BRAIN]

SUMMARY:

The feasibility of 4D flow MR imaging to visualize flow patterns and generate relative pressure maps in the dural venous sinus in healthy subjects (n = 60) and patients with dural arteriovenous fistulas (n = 7) was investigated. Dural venous drainage was classified based on torcular Herophili anatomy by using 4D flow MR imaging–derived angiograms and magnitude images. Subjects were scanned in a 3T clinical MR imaging system. 4D flow MR imaging enabled noninvasive characterization of dural sinus anatomy and mapping of relative pressure differences.

White Matter Changes Related to Subconcussive Impact Frequency during a Single Season of High School Football [ADULT BRAIN]

BACKGROUND AND PURPOSE:

The effect of exposing the developing brain of a high school football player to subconcussive impacts during a single season is unknown. The purpose of this pilot study was to use diffusion tensor imaging to assess white matter changes during a single high school football season, and to correlate these changes with impacts measured by helmet accelerometer data and neurocognitive test scores collected during the same period.

MATERIALS AND METHODS:

Seventeen male athletes (mean age, 16 ± 0.73 years) underwent MR imaging before and after the season. Changes in fractional anisotropy across the white matter skeleton were assessed with Tract-Based Spatial Statistics and ROI analysis.

RESULTS:

The mean number of impacts over a 10-g threshold sustained was 414 ± 291. Voxelwise analysis failed to show significant changes in fractional anisotropy across the season or a correlation with impact frequency, after correcting for multiple comparisons. ROI analysis showed significant (P < .05, corrected) decreases in fractional anisotropy in the fornix-stria terminalis and cingulum hippocampus, which were related to impact frequency. The effects were strongest in the fornix-stria terminalis, where decreases in fractional anisotropy correlated with worsening visual memory.

CONCLUSIONS:

Our findings suggest that subclinical neurotrauma related to participation in American football may result in white matter injury and that alterations in white matter tracts within the limbic system may be detectable after only 1 season of play at the high school level.

Better Than Nothing: A Rational Approach for Minimizing the Impact of Outflow Strategy on Cerebrovascular Simulations [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Computational fluid dynamics simulations of neurovascular diseases are impacted by various modeling assumptions and uncertainties, including outlet boundary conditions. Many studies of intracranial aneurysms, for example, assume zero pressure at all outlets, often the default ("do-nothing") strategy, with no physiological basis. Others divide outflow according to the outlet diameters cubed, nominally based on the more physiological Murray's law but still susceptible to subjective choices about the segmented model extent. Here we demonstrate the limitations and impact of these outflow strategies, against a novel "splitting" method introduced here.

MATERIALS AND METHODS:

With our method, the segmented lumen is split into its constituent bifurcations, where flow divisions are estimated locally using a power law. Together these provide the global outflow rate boundary conditions. The impact of outflow strategy on flow rates was tested for 70 cases of MCA aneurysm with 0D simulations. The impact on hemodynamic indices used for rupture status assessment was tested for 10 cases with 3D simulations.

RESULTS:

Differences in flow rates among the various strategies were up to 70%, with a non-negligible impact on average and oscillatory wall shear stresses in some cases. Murray-law and splitting methods gave flow rates closest to physiological values reported in the literature; however, only the splitting method was insensitive to arbitrary truncation of the model extent.

CONCLUSIONS:

Cerebrovascular simulations can depend strongly on the outflow strategy. The default zero-pressure method should be avoided in favor of Murray-law or splitting methods, the latter being released as an open-source tool to encourage the standardization of outflow strategies.

Systematic Radiation Dose Reduction in Cervical Spine CT of Human Cadaveric Specimens: How Low Can We Go? [PATIENT SAFETY]

BACKGROUND AND PURPOSE:

While the use of cervical spine CT in trauma settings has increased, the balance between image quality and dose reduction remains a concern. The purpose of our study was to compare the image quality of CT of the cervical spine of cadaveric specimens at different radiation dose levels.

MATERIALS AND METHODS:

The cervical spine of 4 human cadavers (mean body mass index; 30.5 ± 5.2 kg/m²; range, 24–36 kg/m²) was examined using different reference tube current–time products (45, 75, 105, 135, 150, 165, 195, 275, 355 mAs) and a tube voltage of 120 kV(peak). Data were reconstructed with filtered back-projection and iterative reconstruction. Qualitative image noise and morphologic characteristics of bony structures were quantified on a Likert scale. Quantitative image noise was measured. Statistics included analysis of variance and the Tukey test.

RESULTS:

Compared with filtered back-projection, iterative reconstruction provided significantly lower qualitative (mean noise score: iterative reconstruction = 2.10/filtered back-projection = 2.18; P = .003) and quantitative (mean SD of Hounsfield units in air: iterative reconstruction = 30.2/filtered back-projection = 51.8; P < .001) image noise. Image noise increased as the radiation dose decreased. Qualitative image noise at levels C1–4 was rated as either "no noise" or as "acceptable noise." Any shoulder position was at level C5 and caused more artifacts at lower levels. When we analyzed all spinal levels, scores for morphologic characteristics revealed no significant differences between 105 and 355 mAs (P = .555), but they were worse in scans at 75 mAs (P = .025).

CONCLUSIONS:

Clinically acceptable image quality of cervical spine CTs for evaluation of bony structures of cadaveric specimens with different body habitus can be achieved with a reference mAs of 105 at 120 kVp with iterative reconstruction. Pull-down of shoulders during acquisition could improve image quality but may not be feasible in trauma patients with unknown injuries.

The underreporting of cost perspective in cost-analysis research: a systematic review of the plastic surgery literature

Cost-analysis research can influence healthcare policies and practices. There is inherent bias depending on the chosen cost perspective (hospital, third-party payer, societal), and conclusions can change based on the perspective used. These perspectives may or may not be well declared or justified when performing cost analysis research. The goal of this study was to perform a literature review of cost-analysis research in the Plastic Surgery literature to determine the prevalence of studies declaring and justifying their perspective, and to inform the reader on why such declarations are important in understanding potential bias.

Discussion: Abdominal Contouring Outcomes in Class III Obesity: Analysis of the ACS-NSQIP Database

Comment on: Complications and Treatment Strategy After Breast Augmentation by Polyacrylamide Hydrogel Injection—Summary of 10 Years’ Clinical Experience

Public Interest in Breast Augmentation: Analysis and Implications of Google Trends Data

Abstract

Introduction

Breast augmentation is the most common aesthetic surgery performed in the United States (US) annually. Analysis of Google Trends (GT) data may give plastic surgeons useful information regarding worldwide, national, and regional interest for breast augmentation and other commonly performed aesthetic surgeries.

Methods

Data were collected using GT for breast augmentation and associated search terms from January 2004 to May 2017. Case volume was obtained from the American Society of Plastic Surgeons (ASPS) annual reports for the calendar year 2005–2016.

Results

Trend analysis showed that total search term volume for breast augmentation and breast implants gradually decreased worldwide and in the US over the study period while the search term boob job slowly increased. Univariate linear regression demonstrated a statistically significant positive correlation between average annual Google search volume of "breast augmentation" and the annual volume of breast augmentations performed in the US according to ASPS data (R ² = 0.44, p = 0.018). There was no significant correlation between national volume of breast augmentations performed and search volume using the terms "breast implants" or "boob job" over time (p = 0.84 and p = 0.07, respectively). In addition, there appears to be country specific variation in interest based on time of year and peaks in interest following specific policies.

Conclusions

To our knowledge, this is the first and only analysis of GT data in the plastic surgery literature to date. To that end, this study highlights this large and potentially powerful data set for plastic surgeons both in the US and around the world.

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.

Panniculectomy Outcomes in Patients with End-Stage Renal Disease in Preparation for Renal Transplant

Abstract

Purpose

End-stage renal disease (ESRD) is associated with increased cardiovascular risk factors, electrolyte imbalances, and iron deficiency anemia. These factors may increase the risk of adverse outcomes in patients undergoing panniculectomy. There is a paucity of data regarding outcomes in patients with ESRD undergoing panniculectomy. The purpose of this study is to investigate whether ESRD is associated with increased rate of complications following a panniculectomy.

Method

The Nationwide Inpatient Sample database (2006–2011) was used to identify patients who underwent a panniculectomy. Among this cohort, patients diagnosed with end-stage renal disease were identified. Patients excluded from the study were emergency admissions, pregnant women, patients less than 18 years old, and patients with concurrent nephrectomy or kidney transplants. Demographic factors, comorbidities, and postoperative complications were evaluated. Chi-squared and risk-adjusted multivariate logistic regression analyses were performed to determine whether end-stage renal disease was associated with increased rate of postoperative complications.

Results

A total of 34,779 panniculectomies were performed during the study period. Of these, 613 (1.8%) were diagnosed with ESRD. Patients with ESRD were older (mean age 58.9 vs. 49.3, p < 0.01) and more likely to have Medicare (63.5 vs. 18.4%, p < 0.01). They had higher rates of comorbidities, including diabetes, hypertension, congestive heart failure, chronic lung disease, chronic anemia, liver disease, peripheral artery disease, obesity, and coagulopathies (p < 0.01). The procedure was more likely to occur at a large, teaching hospital (p < 0.01). Postoperatively, patients with ESRD had a higher rate of death (3.3 vs. 0.2%, p < 0.01), wound complications (10.6 vs. 6.2%, p < 0.01), venous thromboembolism (4.9 vs. 0.8%, p < 0.01), blood transfusions (25.3% vs. 7.0%, p < 0.01), non-renal major medical complications (40.0% vs. 8.4%), and longer hospital stay (9.2 vs. 3.8 days, p < 0.01). Multivariate logistic regression analysis controlling for age, race, sex, hospital location/teaching hospital, payer, and all comorbidities demonstrated that ESRD was independently associated with increased venous thromboembolisms (OR 2.38, 95% CI 1.48–3.83) and non-renal major medical complications (OR 1.51, 95% CI 1.19–1.91). ESRD was not independently associated with increased rate of wound complications or transfusions.

Conclusion

Patients with ESRD are at increased risk of VTE and non-renal major medical complications following panniculectomy. Moreover, patients with ESRD have longer hospital stays and higher rates of mortality.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.

Expander/Implant Removal After Breast Reconstruction: Analysis of Risk Factors and Timeline

Abstract

Introduction

Removal of tissue expanders (TE) or implants is a dire consequence of breast reconstruction, and has the potential to halt the reconstructive efforts. Our goals were to characterize a cohort of patients with TE/implant removal, to perform a time-based analysis, and to review the bacteriology associated with explanted devices.

Materials and Methods

Review of a prospectively maintained database was performed to identify patients who underwent TE/implant removal. Patient characteristics, surgical technique, adjuvant therapies, indications, complications, culture results were obtained. Data were analyzed according to timing of explantation.

Results

A total of 55 TE and implants were removed in 43 patients. Reasons for explantation were infection (58%), patient request (22%), and wound-related complications (20%). The majority of explantations occurred after 30 days (62%), and after Stage I (81%). Median days to explantation was 62. Patients of older age (p = 0.01) and higher BMI (p = 0.02) were more likely to undergo explantation after Stage I. The most commonly cultured organisms were S. epidermidis (10.9%), S. aureus (10.9%) and P. aeruginosa (10.9%). Antibiotic resistance was commonly encountered for ampicillin, cefazolin, penicillin, and erythromycin.

Conclusion

Infection is the most common reason for explantation after prosthetic breast reconstruction. Patients should be carefully monitored for a prolonged period of time after Stage I, as the majority of explantations occur in this stage but beyond 30 days. For oral treatment, fluoroquinolones and trimethoprim–sulfamethoxazole and for IV treatment a combination of vancomycin or daptomycin with piperacillin–tazobactam or imipenems/carbapenems appear to be appropriate choices according to our culture results.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.

Surgical Management of the Giant Pannus: Indications, Strategies, and Outcomes

Abstract

The obesity pandemic continues to produce an inexorable increase in the number of patients requiring surgical treatment of obesity and obesity-related complications. Along with this growing number of patients, there is a concomitant increase in the complexity of management. One particular example is the treatment of patients with an exceptionally large and morbid pannus. In this report, we detail the management of seven patients suffering from a giant pannus. Medical and surgical variables were assessed. A quality of life questionnaire was administered pre- and postoperatively. All seven patients suffered some obesity-related medical morbidity and six of seven (86%) had local complications of the giant pannus. Each patient underwent giant panniculectomy [resection weight > 13. 6 kg (30 lb)]. The mean resection weight was 20.0 kg. Four of seven (57%) patients experienced postoperative complications, with two (29%) requiring re-operation and blood transfusion. Six patients were available for long-term follow-up; 100% of participants indicated an increased quality of life while five (83%) reported additional postoperative weight loss, increase in exercise frequency and walking ability, and improved ability to work. Our results indicate that giant panniculectomy is a challenging and risky procedure, but careful patient selection and intraoperative scrutiny can ameliorate these risks and afford patients a dramatically improved quality of life.

Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.

Commentary on ‘Using Four-Layers Sculpted Rib Cartilage Framework to Increase Transverse Height of the Reconstructive Ear in One Operative Stage for Microtia Patients’

Commentary for Modified Island Technique for Prominent Ears

Histone deacetylase inhibitor (HDACi) upregulates activin A and activates the Smad signaling pathway in melanomas

Protein function is affected by post-translational modifications, including phosphorylation, methylation and acetylation [1]. Levels of protein acetylation are controlled by two enzymes: histone acetyltransferase (HAT) and histone deacetylase (HDAC) [2]. Although HAT is involved primarily in histone acetylation, it also acetylates non-histone proteins, including p53, STAT3 and microtubules [3–5]. Acetylation status, in turn, affects gene transcription.

“Vectra 3D Imaging for Quantitative Volumetric Analysis of the Upper Limb: A Feasibility Study for Tracking Outcomes of Lymphedema Treatment”#8232;

No abstract available

Soft Tissue Reconstruction of the Complicated Knee Arthroplasty: Principles and Predictors of Salvage

Purpose: Total-knee-arthroplasty (TKA) is a common orthopedic procedure in the US and complications can be devastating. Soft-tissue compromise or joint infection may cause failure of prosthesis requiring knee fusion or amputation. The role of a plastic surgeon in TKA is critical for cases requiring optimization of the soft tissue envelope. The purpose of this study is to elucidate factors associated with TKA salvage following complications and clarify principles of reconstruction to optimize outcomes. Methods: A retrospective review of patients requiring soft-tissue reconstruction by the senior author after TKA over 8 years was completed. Logistic-regression and Fisher's exact tests determined factors associated with the primary outcome, prosthesis salvage versus knee fusion or amputation. Results: Seventy-three knees in 71 patients required soft-tissue reconstruction (mean follow-up 1.8y) with salvage rate of 61.1%, mostly using medial-gastrocnemius flaps. Patients referred to our institution with complicated periprosthetic wounds were significantly more likely to lose their knee prosthesis than patients only treated within our system. Patients with multiple prior knee surgeries before definitive soft-tissue reconstructive had significantly decreased rates of prosthesis salvage and increased risk of amputation. Knee salvage significantly decreased with positive joint cultures (gram-negative > gram-positive) and particularly at the time of definitive reconstruction, which also trended towards increased the risk of amputation. Conclusions: In revision TKA, prompt soft tissue reconstruction improves likelihood of success and protracted surgical courses and contamination increase failure and amputations. We show a benefit to involving plastic surgeon early in the course of TKR complications to optimize genicular soft tissues. Financial Disclosures: Dr. Stephen J. Kovach is a paid consultant for Bard-Davol. The authors have no other disclosures. Corresponding Author: Stephen J. Kovach, Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Perelman Center for Advanced Medicine, South Pavilion 7th floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104; Phone: 215-662-2520; Fax: 215-615-0474; Email: stephen.kovach@uphs.upenn.edu ©2017American Society of Plastic Surgeons

Optimising aesthetics with prosthetic prepectoral breast reconstruction

No abstract available

Reply: How to pre-shape the breast for a successful nipple sparing mastectomy and direct to implant breast reconstruction in the challenging breast.

No abstract available

“Prophylactic Nipple-Sparing Mastectomy and Direct-to-Implant Reconstruction of the Large and Ptotic Breast: Is Preshaping of the Challenging Breast a Key to Success?”

No abstract available

“20-year experience with 202 segmental mandibulectomy defects: A defect classification system, algorithm for flap selection, and surgical outcomes”

Background: This study establishes a novel and broadly-applicable defect classification system and flap selection algorithm for segmental mandibulectomy defects that emphasize the importance of the soft tissue deficit, in addition to that of the bony defect. Methods: Between 1992 and 2011, 202 patients with mandibulectomy defects underwent immediate reconstruction by a single surgeon. Details of the bony and soft tissue defects, recommendations for the most appropriate reconstruction for each clinical scenario, and surgical outcomes are presented. Results: A total of 211 flaps were performed in 202 patients. Forty-one (19%) were non-osseous only, and 170 (81%) were osseous-containing. The majority of osseous flaps were fibula osseous or osteocutaneous flaps (91%), and the majority of non-osseous flaps were vertical rectus abdominis myocutaneous (VRAM) flaps (68%). Flap selection was influenced by the number of soft tissue zones resected; defects of ≤1 soft tissue zone were predominantly reconstructed with an osseous flap, whereas defects that involved ≥4 zones underwent reconstruction with only a soft tissuey flap in 55% of cases. Conclusion: The algorithm for reconstruction of the mandibulectomy defect must include both non-osseus and osseus flaps based on defect size, location, and number of soft tissue zones involved. As the extent of the soft tissue defect increases, non-osseus flaps are preferred due to greater reliability of the skin island. The surgical outcomes associated with this algorithm are similar to or better than what is published in the literature. This series represents the largest reported single surgeon experience with mandibulectomy defect reconstruction. Financial Disclosure Statement: The authors have nothing to disclose. This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748. Presented at: none Corresponding author: Peter G. Cordeiro, MD, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, MRI 1007B, New York, New York 10065, Phone: 212-639-3099, Fax: 212-717-3677, Email: cordeirp@mskcc.org ©2017American Society of Plastic Surgeons

Re: Tumor-to-Nipple Distance as a Predictor of Nipple Involvement Expanding the Inclusion Criteria for Nipple-Sparing Mastectomy

No abstract available

Cranial Nerve Co-activation and Implication for Nerve Transfers to the Facial Nerve

Summary: In reanimation surgery, effortless smile can be achieved by a non-facial donor nerve. The underlying mechanisms for this smile development, as well as which is the best non-facial neurotizer, need further clarification. The aim of the present study was therefore to further explore the natural co-activation between facial mimic muscles and muscles innervated by the most common donor nerves used in smile reanimation. The study was conducted in 10 healthy adults. Correlation between voluntary facial muscle movements and simultaneous electromyographic (EMG) activity in muscles innervated by the masseter, hypoglossal and spinal accessory nerves was assessed. The association between voluntary movements in the latter muscles and simultaneous EMG activity in facial muscles was also studied. Smile co-activated the masseter and tongue muscles equally. During the seven mimic movements, the masseter muscle had fewer EMG-measured co-activations compared to the tongue (2/7 vs. 5/7). The trapezius muscle demonstrated no co-activation during mimic movements. Movements of the masseter, tongue and trapezius muscles induced EMG-recorded co-activation in the facial muscles. Bite resulted in the strongest co-activation of the zygomaticus major muscle. We demonstrated co-activation between voluntary smile and the masseter and tongue muscles. During voluntary bite, strong co-activation of the zygomaticus major muscle was noted. The narrower co-activation pattern in the masseter muscle may be advantageous for central re-learning and the development of a spontaneous smile. The strong co-activation between the masseter muscle and the zygomaticus major indicates that the masseter nerve may be preferred in smile reanimation. This study was supported by Uppsala County Council Research and Developmental Funding, Uppsala University, Acta Otolaryngologica Foundation and ALF Funding. The authors would like to thank Nermin Hadziosmanovic, Uppsala Clinical Research Center for help with statistical analysis. Products and devices used in this research: Needle electrode (Dantec™ DCF 25) Surface electrode (Ambu® NF-50-K/W/12) Ground electrode (Ambu® Neuroline Ground electrode 71410-M/1) Routine clinical EMG equipment (Keypoint®) None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Correspondence: David Jensson, MD. Department of Surgical Sciences, Plastic and Maxillofacial Surgery, Uppsala University, SE-75185 Uppsala, Sweden. E-mail: davidjensson81@gmail.com ©2017American Society of Plastic Surgeons

Skin Rejuvenation through HIF-1alpha modulation

The constant intrinsic and extrinsic stress the skin is exposed to leads to significant impairments of the regenerative capacity of aging skin. Current skin rejuvenation approaches lack the ability to holistically support the biological processes which exhaust during aging skin degeneration, such as collagen production, cell migration and proliferation as well as new vessel formation. Similar to chronic wounds, aged skin is characterized by dysfunction of key cellular regulatory pathways impairing regeneration. Recent evidence suggests that the same mechanisms hindering a physiologic healing response in chronic wounds are the basis of impaired tissue homeostasis in aged skin. Dysfunction of a main response to injury pathway, the Hypoxia Inducible Factor 1a (HIF-1α) regulatory pathway, has been identified as pivotal both in chronic wounds and aging skin degeneration. HIF-1α signaling is significantly involved in tissue homeostasis and neovascularization resulting in the production of new collagen, elastin and nourishing blood vessels. Modulating the functionality of this pathway has been demonstrated to significantly enhance tissue regeneration. In this review, we present an overview of the regenerative effects linked to the upregulation of HIF-1α functionality, potentially resulting in skin rejuvenation on both the cellular and the tissue level. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript * These authors contributed equally to this work Conflict of Interest: The authors have no financial interest to declare in relation to the content of this article. Corresponding Author: Dr. med. univ. Dominik Duscher, Director Division of Experimental Plastic Surgery, Department of Plastic and Hand Surgery, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany. dominik.duscher@mri.tum.de ©2017American Society of Plastic Surgeons

Quilting sutures after latissimus dorsi breast reconstruction in breast cancer patients might lead to reduced risk of developing arm lymphedema by reducing seroma risk

No abstract available

Validation of the Clinician-Graded Electronic Facial Paralysis Assessment: Discussion by Timothy J Eviston, Lauren SH Chong, Jonathan R Clark

No abstract available

Reply to Letter to the Editor “Vectra 3D imaging for suprapubic lymphedema and volume change of the lower abdomen associated with lower extremity lymphedema”

No abstract available

Do Our Large Surgical Databases Need a Transition?

No abstract available

Validation of the Clinician-Graded Electronic Facial Paralysis Assessment

No abstract available

Selective Serotonin Reuptake Inhibitor-Induced Hyponatremia and the Plastic Surgery Patient

No abstract available

Reply: Optimizing Aesthetics with Prosthetic Prectoral Breast Reconstruction

No abstract available

Reply: Indications for Prepectoral Breast Reconstruction

No abstract available

Indications for Prepectoral Breast Reconstruction

No abstract available

“Why Videos Matter so much in Plastic Surgery today - A complete index of videos in PRS and PRS/Global Open”

The main purpose of this article is to provide the reader with an easily searchable on line index of the first 1976 videos published in Plastic and Reconstructive Surgery and PRS Global Open journals to facilitate access to readers. The authors also describe the history and evolution of video papers in the first journal to provide a large offline video library of Plastic Surgery. The importance of video in plastic surgery education is explored. Financial Disclosure Statement: None of the authors have any disclosures. No funding was received for this article. Financial Disclosures and Products: Dr. Kaitlin Boehm has no disclosures. Dr. Rod J. Rohrich receives instrument royalties from Eriem Surgical, Inc and book royalties from Thieme Medical Publishing. No funding was received for this article. Dr. Don Lalonde has no disclosures. No funding was received for this article. Corresponding Author: Don H. Lalonde, MD, Suite C204, 600 Main Street, Saint John, New Brunswick, Canada. E2K 1J5, drdonlalonde@nb.aibn.com ©2017American Society of Plastic Surgeons

Injectable poly-L-lactic acid: instant hydration in lukewarm water bath and use of a thin needle to filter particles

Treatment of artificial wastewater containing two azo textile dyes by vertical-flow constructed wetlands

Abstract

The release of untreated dye textile wastewater into receiving streams is unacceptable not only for aesthetic reasons and its negative impacts on aquatic life but also because numerous dyes are toxic and carcinogenic to humans. Strategies, as of now, used for treating textile wastewaters have technical and economical restrictions. The greater part of the physico-chemical methods, which are used to treat this kind of wastewater, are costly, produce large amounts of sludge and are wasteful concerning some soluble dyes. In contrast, biological treatments such as constructed wetlands are cheaper than the traditional methods, environmental friendly and do not produce large amounts of sludge. Synthetic wastewater containing Acid Blue 113 (AB113) and Basic Red 46 (BR46) has been added to laboratory-scale vertical-flow construction wetland systems, which have been planted with Phragmites australis (Cav.) Trin. ex Steud. (common reed). The concentrations 7 and 208 mg/l were applied for each dye at the hydraulic contact times of 48 and 96 h. Concerning the low concentrations of BR46 and AB113, the unplanted wetlands are associated with significant (ρ < 0.05) reduction performances, if compared with planted wetlands concerning the removal of dyes. For the high concentrations of AB113, BR46 and a mixture of both of them, wetlands with long contact times were significantly (ρ < 0.05) better than wetlands that had short contact times in terms of dye, colour and chemical oxygen demand reductions. Regarding nitrate nitrogen (NO₃-N), the reduction percentage rates of AB113, BR46 and a mixture dye of both of them were between 85 and 100%. For low and high inflow dye concentrations, best removals were generally recorded for spring and summer, respectively.

Influence of photolabile pharmaceuticals on the photodegradation and toxicity of fluoxetine and fluvoxamine

Abstract

Pharmaceuticals in the aquatic environment may be decomposed by abiotic and biotic factors. Photodegradation is the most investigated abiotic process, as it occurs in the natural environment and may be applied in wastewater treatment technology. Although pharmaceuticals are detected in effluents and surface water in a mixture, the photodegradation process is mainly evaluated with single compounds. The photodegradation of fluoxetine (FLU) and fluvoxamine (FLX) in the presence of diclofenac (DCF) and triclosan (TCS) was investigated with HPLC and bioassay. FLU did not degrade under UV-Vis irradiation in SunTest CPS+ either with or without the tested additives, although small amounts of desmethyl fluoxetine and 4-(trifluoromethyl)phenol were formed. In contrast, during irradiation, FLX isomerized to cis-FLX. This process was enhanced by DCF and TCS, but to a lesser degree than by humic acids. Thus, the presence and composition of the matrix should be considered in the environmental risk assessment of pharmaceuticals. As the toxicity of the tested solutions depended only on the concentration of the tested drugs, it was suggested that the biological activity of the photodegradation products was lower than that of the parent compounds.

Response to “Comments on ‘Double-Blind Comparison of Ultrasonic and Conventional Osteotomy in Terms of Early Postoperative Edema and Ecchymosis’”

We thank Dr Cağici for his kind thoughts and for commenting¹ on our article.² Dr Cağici is correct that one cannot consider a study as "double-blinded" if both patients and surgeons are not blinded. Unfortunately, Dr Cağici misunderstood in thinking that our surgeon was not blinded. Patients who underwent surgery during odd-numbered months received conventional osteotomy, and patients who underwent surgery during even-numbered months received ultrasonic osteotomy. However, the surgeon was blinded as to which patients were included in the study, which was our randomization method for the surgeon. The patients were also blinded, as they were not informed preoperatively which osteotomy procedure they would undergo.

Comments on “Double-Blind Comparison of Ultrasonic and Conventional Osteotomy in Terms of Early Postoperative Edema and Ecchymosis”

I read the manuscript by Ilhan et al¹ with great interest. The authors performed a randomized study comparing two types of osteotomy in rhinoplasty: ultrasonic and conventional osteotomy. They found that ultrasonic osteotomy results in less edema and ecchymosis. Their patients were blind to the study and not informed about which osteotomy technique was applied to them. The same surgeon performed both types of surgery and was not blinded. The postoperative evaluation of the surgical results was performed by blinded examiners. Although the authors called their study a "double-blinded" comparison, I do not agree with them.

Three-Dimensional Imaging and Breast Measurements: How Predictable Are We?

Abstract

Background

Outcomes in aesthetic breast surgery are dependent on preoperative breast measurements. The accuracy of 3-dimensional (3D) imaging in measuring critical landmarks in augmentation mammaplasty surgery has not been described.

Objectives

We aimed to determine the predictability of 3D imaging compared to direct measurements.

Methods

Two raters measured the breasts of 28 women using four anthropometric (direct) measurements: sternal notch to nipple distance (Sn-N), nipple to midline (N-M), nipple to inframammary-fold distance under maximal stretch (N-IMF), and base width (BW). Measurements (indirect) were also obtained using 3D imaging. Statistical analysis was completed with Bland-Altman plots.

Results

Each rater collected 56 data points for each of the four measurements. This resulted in 224 data points per rater. The Sn-N measurement had a 0.05 cm (SD, 0.65) difference in the mean values obtained between direct and indirect measurements. N-M had a mean difference of 0.20 cm (SD, 0.62). The mean difference for BW was 1.26 cm (SD, 0.69 cm), and N-IMF showed a mean difference of 1.22 cm (SD, 0.74 cm). Three-dimensional imaging overestimated Sn-N, N-M, and BW, while it underestimated N-IMF.

Conclusions

Three-dimensional imaging has good utility and is most accurate for Sn-N and N-M measurements, which require frontal imaging of a standing patient. BW and N-IMF are less accurate due to obscured landmarks on frontal imaging. The medial and lateral aspects of the breast may be obscured when measuring BW on 3D imaging, which may explain this difference. N-IMF is a dynamic measurement, and as a result, 3D imaging has limited ability to measure this distance accurately.

Level of Evidence: 3

Evaluating and Optimizing the Diagnosis of Erythematotelangiectatic Rosacea

Publication date: Available online 21 December 2017
Source:Dermatologic Clinics
Author(s): Mohammed D. Saleem, Jonathan K. Wilkin

Teaser

Erythematotelangiectatic rosacea is the most prevalent rosacea subtype. Multiple dermatologic conditions may mimic erythematotelangiectatic rosacea. The authors review a comprehensive approach to evaluating subjects with a suspected diagnosis of erythematotelangiectatic rosacea and discuss findings that may warrant further investigation. Differential diagnoses can be narrowed based on the presence of characteristics such as transient erythema, nontransient erythema, and telangiectasias. A thorough history and physical examination are critical in ruling out conditions such as dermatomyositis, lupus erythematosus, atopic dermatitis, and seborrheic dermatitis.

Patient Costs Associated with Rosacea

Publication date: Available online 21 December 2017
Source:Dermatologic Clinics
Author(s): Jackson G. Turbeville, Hossein Alinia, Sara Moradi Tuchayi, Naeim Bahrami, Leah A. Cardwell, Olabola Awosika, Irma Richardson, Karen E. Huang, Steven R. Feldman

Teaser

The recalcitrance of rosacea to many treatment options may prompt patients to spend exorbitant amounts of money on unsubstantiated treatment regimens in an effort to achieve relief. The authors examine the relationship between disease severity and treatment cost across several demographic and socioeconomic strata. Familiarization of evidence-based clinical recommendations and consensus guidelines may equip physicians to educate patients about the most efficacious and cost-effective treatment options to assist patients in making cost-conscious decisions in the management of their rosacea.

A Review of the Current Modalities for the Treatment of Papulopustular Rosacea

Publication date: Available online 21 December 2017
Source:Dermatologic Clinics
Author(s): Sean McGregor, Hossein Alinia, Alyson Snyder, Sara Moradi Tuchayi, Alan Fleischer, Steven R. Feldman

Teaser

Papulopustular rosacea is characterized by papules and pustules in the central facial region. We review the literature surrounding the treatment of papulopustular rosacea. PubMed, EMBASE, and Cochrane (Central) databases searches of articles published from 1980 to 2015 were performed using the MeSH terms or keywords "rosacea" and "clinical trial." Additional searches were performed to include rosacea and each treatment modality used. Topical metronidazole, azelaic acid, ivermectin, and oral doxycycline have the most robust data to support their use. Variation in assessment tools and a lack of clinical trial standardization makes comparison of therapeutic options difficult.

Suturing Technique for the Correction of the Obtuse Nasolabial Angle—Reply

In Reply We thank Drs D'Ascanio and Piazza for pointing us in the direction of the history of techniques dealing with the obtuse nasolabial angle. We had not found these articles in our literature search because of their early year of publication. Nevertheless, it is very interesting to read that a similar technique was already described in 1943 by Aufricht and republished by Daley in 1944. Furthermore, it is pleasing to know that that technique is successfully being used by the associates of "Valerio Micheli-Pellegrini" Study Center. First, it shows us the relevance of the described problem, and second, the tenability of the technique.

Adverse Events and Litigation for Injectable Fillers

This cross-sectional review used the US Food and Drug Administration's manufacturer and user facility device experience database to evaluate for complications from the use of soft-tissue fillers.

Suturing Technique for the Correction of the Obtuse Nasolabial Angle

To the Editor We read the article, "The Columella Retraction Suture: A Powerful Suture Technique," by Nolst Trenité and Nolst Trenité, and watched the related video. We congratulate the authors on their work; however, some aspects should be underlined in their study.

Corrigendum: In Other Shoes: Music, Metaphor, Empathy, Existence

In Other Shoes: Music, Metaphor, Empathy, Existence

Minimally Invasive Genioplasty Procedure

Summary: In this technical note, we present a new surgical approach for genioplasty in which a minimally invasive procedure is used to perform the chin osteotomy. The main goal was to reduce postoperative functional recovery time and possible complications, especially reduction of lip incompetence, chin ptosis, and muscle dysfunction, by retaining the intactness of the mentalis muscles.

Make Surgeons’ Position More Comfortable

No abstract available

Numerical simulation of pollutant transport in soils surrounding subway infrastructure

Abstract

With continued urbanization, public transport infrastructure, e.g., subways, is expected to be built in historically industrial areas. To minimize the transfer of volatile organic compounds and metalloids like arsenic from industrial areas into subway environments and reduce their impact on public health, the transport of pollutants in soil was simulated in this study. During numerical simulations of a contaminated site, the pollutant (arsenic) was transported from layers of higher to lower concentration, and concentration changes were particularly evident in the early simulation stages. The pollutant was transported in soil along the direction of groundwater flow and spread from the center to the periphery of the contaminated zone without inputs from pollution sources. After approximately 400 days, the concentration of all layers became uniform, with slow decreases occurring over time. The pollutant supply rate had a major influence on the pollutant diffusion distance. When other conditions were kept constant, higher supply rates resulted in longer diffusion distances. The simulation results show that a diaphragm wall of a certain depth can effectively control the diffusion of pollutants in soil. These results can be used to improve environmental assessments and remediation efforts and inform engineering decisions during the construction of urban infrastructure at sites affected by historical pollution.

A pro-inflammatory role of Fcα/μR on marginal zone B cells in sepsis

Abstract

Fc receptors play important roles for a wide array of immune responses. In contrast to the well-defined Fcγ and Fcε receptors, the molecular and functional characteristics of Fc receptors for IgA and IgM have remained incompletely understood for years. Recent progress has unveiled the characteristics of Fc receptors for IgA and IgM, including Fcα/μ receptor (Fcα/μR) (CD351), polymeric immunoglobulin receptor (poly-IgR), Fcα receptor (FcαRI) (CD89) and Fcμ receptor (FcμR). In this review, we summarize the molecular and functional characteristics of Fcα/μR in comparison with poly-IgR, FcμR and FcαRI, and focus particularly on the pro-inflammatory function of Fcα/μR expressed on marginal zone B cells in sepsis.

Characterization of a novel MIIA domain-containing protein (MdcE) in Bradyrhizobium spp.

Abstract

Several genes coding for proteins with metal ion-inducible autocleavage (MIIA) domains were identified in type III secretion system tts gene clusters from draft genomes of recently isolated Bradyrhizobium spp. MIIA domains have been first described in the effectors NopE1 and NopE2 of Bradyrhizobium diazoefficiens USDA 110. All identified genes are preceded by tts box promoter motifs. The identified proteins contain one or two MIIA domains. A phylogenetic analysis of 35 MIIA domain sequences from 16 Bradyrhizobium strains revealed four groups. The protein from Bradyrhizobium sp. LmjC strain contains a single MIIA domain and was designated MdcE (MdcE_LmjC). It was expressed as a fusion to maltose-binding protein (MalE) in E. coli and subsequently purified by affinity chromatography. Recombinant MalE-MdcE_LmjC-Strep protein exhibited autocleavage in the presence of Ca²⁺, Cu²⁺, Cd²⁺ and Mn²⁺, but not by Mg²⁺, Ni²⁺ or Co²⁺. Site-directed mutagenesis at the predicted cleavage site abolished autocleavage activity of MdcE_LmjC. An LmjC mdcE⁻ mutant was impaired in the ability to nodulate Lupinus angustifolius and Macroptilium atropurpureum.

Individual Differences in Retronasal Odor Responsiveness: Effects of Aging and Concurrent Taste

Abstract

Introduction

Individual differences in taste sensitivity have been considered the primary chemosensory factor in studies of chemical senses/ingestive behavior. Recent findings suggest, however, that retronasal odor perception is equally important in food preference and selection and, furthermore, the presence of a congruent taste can modulate responsiveness to retronasally perceived odors. The primary objective of this study was to measure individual differences in responsiveness to food odors in the presence and absence of a congruent taste. In order to achieve this goal, we experimentally manipulated the way taste and odor stimuli are presented. We hypothesized that when measured independently, variations across subjects in responsiveness to retronasal odors are greater than those of tastes, but that these variations are effectively reduced by the presence of a congruent taste, especially for the older cohort.

Methods

Two groups of subjects (young vs. old cohorts) were asked to sample two tastants, four food odorants, and the congruent taste-odor pairs, and rate intensities for appropriate categories.

Results

Results showed that responsiveness to odors varied greatly across individuals compared to that of tastes and further that variations in odor responsiveness were greater for old compared to young cohort. In the presence of a congruent taste, however, the variations in responsiveness to the odors were significantly reduced, in particular for the old cohort.

Implication

The current data suggest that older individuals and those with low olfactory sensitivity may not recognize the reduced sensitivity when consuming foods.

The performance of 3D ABUS versus HHUS in the visualisation and BI-RADS characterisation of breast lesions in a large cohort of 1,886 women

Abstract

Objectives

This study aimed to evaluate automated breast ultrasound (ABUS) compared to hand-held traditional ultrasound (HHUS) in the visualisation and BIRADS characterisation of breast lesions.

Materials and methods

From January 2016 to January 2017, 1,886 women with breast density category C or D (aged 48.6±10.8 years) were recruited. All participants underwent ABUS and HHUS examination; a subcohort of 1,665 women also underwent a mammography.

Results

The overall agreement between HHUS and ABUS was 99.8 %; kappa=0.994, p<0.0001. Two cases were graded as BI-RADS 1 in HHUS, but were graded as BIRADS 4 in ABUS; biopsy revealed a radial scar. Three carcinomas were graded as BI-RADS 2 in mammography but BI-RADS 4 in ABUS; two additional carcinomas were graded as BI-RADS 2 in mammography but BI-RADS 5 in ABUS. Two carcinomas, appearing as a well-circumscribed mass or developing asymmetry in mammography, were graded as BI-RADS 4 in mammography but BI-RADS 5 in ABUS.

Conclusions

ABUS could be successfully used in the visualisation and characterisation of breast lesions. ABUS seemed to outperform HHUS in the detection of architectural distortion on the coronal plane and can supplement mammography in the detection of non-calcified carcinomas in women with dense breasts.

Key Points

• The new generation of ABUS yields comparable results to HHUS.

• ABUS seems superior to HHUS in detecting architectural distortions.

• In dense breasts, supplemental ABUS to mammography detects additional cancers.

Effective collateral circulation may indicate improved perfusion territory restoration after carotid endarterectomy

Abstract

Objectives

To investigate the relationship between the level of collateral circulation and perfusion territory normalisation after carotid endarterectomy (CEA).

Methods

This study enrolled 22 patients with severe carotid stenosis that underwent CEA and 54 volunteers without significant carotid stenosis. All patients were scanned with ASL and t-ASL within 1 month before and 1 week after CEA. Collateral circulation was assessed on preoperative ASL images based on the presence of ATA. The postoperative flow territories were considered as back to normal if they conformed to the perfusion territory map in a healthy population. Neuropsychological tests were performed on patients before and within 7 days after surgery.

Results

ATA-based collateral score assessed on preoperative ASL was significantly higher in the flow territory normalisation group (n=11, 50 %) after CEA (P < 0.0001). The MMSE (mean change=1.36±0.96) and MOCA (mean change=1.18±0.95) test scores showed a significant postoperative (7 days after CEA) improvement in the flow territory normalisation group [>mean differences+2SD among control (MMSE=1.35, MOCA=1.02)].

Conclusions

This study demonstrated that effective collateral flow in carotid stenosis patients was associated with normalisation of t-ASL perfusion territory after CEA. The perfusion territory normalisation group tends to have more cognitive improvement after CEA.

Key Points

• Evaluation of collaterals before CEA is helpful for avoiding ischaemia during clamping.

• There was good agreement on ATA-based ASL collateral grading.

• Perfusion territories in carotid stenosis patients are altered.

• Patients have better collateral circulation with perfusion territory back to normal.

• MMSE and MOCA test scores improved more in the territory normalisation group.

Erratum to: Effects of radiation dose reduction in volume perfusion CT imaging of acute ischaemic stroke

Pulmonary mucormycosis: serial morphologic changes on computed tomography correlate with clinical and pathologic findings

Abstract

Purpose

To evaluate serial computed tomography (CT) findings of pulmonary mucormycosis correlated with peripheral blood absolute neutrophil count (ANC).

Materials and methods

Between February 1997 and June 2016, 20 immunocompromised patients (10 males, 10 females; mean age, 48.9 years) were histopathologically diagnosed as pulmonary mucormycosis. On initial (n=20) and follow-up (n=15) CT scans, the patterns of lung abnormalities and their changing features on follow-up scans were evaluated, and the pattern changes were correlated with ANC changes.

Results

All patients were immunocompromised. On initial CT scans, nodule (≤3cm)/mass (>3cm) or consolidation with surrounding ground-glass opacity halo (18/20, 90%)) was the most common pattern. On follow-up CT, morphologic changes (13/15, 87%) could be seen and they included reversed halo (RH) sign, central necrosis, and air-crescent sign. Although all cases did not demonstrate the regular morphologic changes at the same timeline, various combinations of pattern change could be seen in all patients. Sequential morphologic changes were related with recovering of ANC in 13 of 15 patients.

Conclusion

Pulmonary mucormycosis most frequently presents as consolidation or nodule/mass with halo sign at CT. Morphologic changes into RH sign, central necrotic cavity or air-crescent sign occur with treatment and recovery of ANC.

Key points

• Pulmonary mucormycosis showed various CT-morphology including CT halo sign

• Pulmonary mucormycosis had trends of serial morphologic changes on follow-ups

• Recovery of absolute neutrophil count changed CT-morphology of mucormycosis in immune-compromised patients

Prostate cancer detection among readers with different degree of experience using ultra-high b-value diffusion-weighted Imaging: Is a non-contrast protocol sufficient to detect significant cancer?

Abstract

Aim

To evaluate the accuracy of a T2-weighted (T2w) – and a parallel transmit zoomed b = 2000 s/mm2 (b2000) – diffusion-weighted imaging sequence among three readers with different degrees of experience for prostate cancer (Pca) detection.

Methods

Ninety-three patients with suspected Pca were enrolled. For b2000 a two-dimensional spatially-selective RF pulse using an echo-planar transmit trajectory was applied, and the field of view (FOV) was reduced to one-third. All three readers (Reader A: 7, B 4 and C <1 years of experience in prostate MRI) independently evaluated b2000 with regard to the presence of suspicious lesions that displayed increased signal. The results were compared to histopathology obtained by real-time MR/ultrasound fusion and systematic biopsy.

Results

In 62 patients Pca was confirmed. One significant Pca (Gleason score (GS) 7b) was missed by Reader C. Overall, sensitivity/specificity/positive predictive value/negative predictive value were 90/71/86/79% for Reader A, 87/84/92/76% for Reader B and 85/74/87/72% for Reader C, respectively. Detection rates for significant Pca (GS >7a) were 100/100/94% for Readers A/B/C, respectively. Inter-reader agreement was generally good (Kappa A/B: 0.8; A/C: 0.82; B/C: 0.74).

Conclusion

B2000 in combination with a T2w could be useful to detect clinically significant Pca.

Key Points

• Significant prostate cancer using zoomed ultra-high b-value DWI was detected.

• Diagnostic performance among readers with different degrees of experience was good.

• mp- MRI of the prostate using a comprehensive non-contrast protocol is clinically feasible.

Multispectral optoacoustic tomography of the human breast: characterisation of healthy tissue and malignant lesions using a hybrid ultrasound-optoacoustic approach

Abstract

Background and aim

Multispectral optoacoustic tomography (MSOT) represents a new in vivo imaging technique with high resolution (~250 μm) and tissue penetration (>1 cm) using the photoacoustic effect. While ultrasound contains anatomical information for lesion detection, MSOT provides functional information based on intrinsic tissue chromophores. We aimed to evaluate the feasibility of combined ultrasound/MSOT imaging of breast cancer in patients compared to healthy volunteers.

Methods

Imaging was performed using a handheld MSOT system for clinical use in healthy volunteers (n = 6) and representative patients with histologically confirmed invasive breast carcinoma (n = 5) and ductal carcinoma in situ (DCIS, n = 2). MSOT values for haemoglobin and oxygen saturation were assessed at 0.5, 1.0 and 1.5 cm depth and selected wavelengths between 700 and 850 nm.

Results

Reproducible signals were obtained in all wavelengths with consistent MSOT signals in superficial tissue in breasts of healthy individuals. In contrast, we found increased signals for haemoglobin in invasive carcinoma, suggesting a higher perfusion of the tumour and tumour environment. For DCIS, MSOT values showed only little variation compared to healthy tissue.

Conclusions

This preliminary MSOT breast imaging study provided stable, reproducible data on tissue composition and physiological properties, potentially enabling differentiation of solid malignant and healthy tissue.

Key Points

• A handheld MSOT probe enables real-time molecular imaging of the breast.

• MSOT of healthy controls provides a reproducible reference for pathology identification.

• MSOT parameters allows for differentiation of invasive carcinoma and healthy tissue.

The influence of microvascular injury on native T1 and T2* relaxation values after acute myocardial infarction: implications for non-contrast-enhanced infarct assessment

Abstract

Objectives

Native T1 mapping and late gadolinium enhancement (LGE) imaging offer detailed characterisation of the myocardium after acute myocardial infarction (AMI). We evaluated the effects of microvascular injury (MVI) and intramyocardial haemorrhage on local T1 and T2* values in patients with a reperfused AMI.

Methods

Forty-three patients after reperfused AMI underwent cardiovascular magnetic resonance imaging (CMR) at 4 [3-5] days, including native MOLLI T1 and T2* mapping, STIR, cine imaging and LGE. T1 and T2* values were determined in LGE-defined regions of interest: the MI core incorporating MVI when present, the core-adjacent MI border zone (without any areas of MVI), and remote myocardium.

Results

Average T1 in the MI core was higher than in the MI border zone and remote myocardium. However, in the 20 (47%) patients with MVI, MI core T1 was lower than in patients without MVI (MVI 1048±78ms, no MVI 1111±89ms, p=0.02). MI core T2* was significantly lower in patients with MVI than in those without (MVI 20 [18-23]ms, no MVI 31 [26-39]ms, p<0.001).

Conclusion

The presence of MVI profoundly affects MOLLI-measured native T1 values. T2* mapping suggested that this may be the result of intramyocardial haemorrhage. These findings have important implications for the interpretation of native T1 values shortly after AMI.

Key points

• Microvascular injury after acute myocardial infarction affects local T1 and T2* values.

• Infarct zone T1 values are lower if microvascular injury is present.

• T2* mapping suggests that low infarct T1 values are likely haemorrhage.

• T1 and T2* values are complimentary for correctly assessing post-infarct myocardium.

Comparison between free-breathing radial VIBE on 3-T MRI and endoscopic ultrasound for preoperative T staging of resectable oesophageal cancer, with histopathological correlation

Abstract

Objectives

To compare the T staging of resectable oesophageal cancer (OC) using radial VIBE (r-VIBE) and endoscopic ultrasound (EUS) with pathological confirmation of the T stage.

Methods

Forty-three patients with endoscopically proven OC and indeterminate T1/T2/T3/T4a stage by computed tomography (CT) and EUS were imaged on a 3-T magnetic resonance imaging (MRI) scanner. T stage was scored on MRI and EUS by two independent radiologists and one endoscopist, respectively, and compared with postoperative pathological findings. T staging agreement between r-VIBE and EUS with postoperative pathological T staging was analysed by a kappa test.

Results

EUS and pathological T staging showed agreement of 69.8% (30/43). Radial VIBE and pathological T staging agreement was 86.0% (37/43) and 90.7% (39/43) for readers 1 and 2, respectively. High accuracy for T1/T2 stage was obtained for both r-VIBE readers (90.5% and 100% for reader 1 and reader 2, respectively) and EUS reader (100%). For T3/T4, r-VIBE showed accuracy of 81.8% and 90.9% for reader 1 and reader 2, respectively, while for EUS, accuracy was only 68.2% compared with pathological T staging.

Conclusions

Contrast-enhanced r-VIBE is comparable to EUS in T staging of resectable OC with stage of T1/T2, and is superior to EUS in staging of T3/T4 lesions.

Key Points

• Radial VIBE may be useful in preoperative T staging of OC

• Accuracy of staging on r-VIBE is higher in T1/2 than in T3/4

• Accuracy of EUS was 100% and 68.2% for T1/T2 and T3/T4 stage

• Inter-reader agreement of T staging for r-VIBE was good

Erratum to: Greater occipital nerve infiltration under MR guidance: Feasibility study and preliminary results

Abstract

The original version of this article, published on 12 July 2017, unfortunately contained mistakes. The following corrections have therefore been made in the original:

Accurate late gadolinium enhancement prediction by early T1- based quantitative synthetic mapping

Abstract

Objectives

Early synthetic gadolinium enhancement (ESGE) imaging from post-contrast T1 mapping after adenosine stress-perfusion cardiac magnetic resonance (CMR) was compared to conventional late gadolinium enhancement (LGE) imaging for assessing myocardial scar.

Methods

Two hundred fourteen consecutive patients suspected of myocardial ischaemia were referred for stress-perfusion CMR. Myocardial infarct volume was quantified on a per-subsegment basis in both synthetic (2–3 min post-gadolinium) and conventional (9 min post-gadolinium) images by two independent observers. Sensitivity, specificity, PPV and NPV were calculated on a per-patient and per-subsegment basis.

Results

Both techniques detected 39 gadolinium enhancement areas in 23 patients. The median amount of scar was 2.0 (1.0–3.1) g in ESGE imaging and 2.2 (1.1–3.1) g in LGE imaging (p=0.39). Excellent correlation (r=0.997) and agreement (mean absolute difference: -0.028±0.289 ml) were found between ESGE and LGE images. Sensitivity, specificity, PPV and NPV of ESGE imaging were 96 (78.9–99.9), 99 (97.1–100.0)%, 96 (76.5–99.4) and 99.5 (96.6–99.9) in patient-based and 99 (94.5–100.0), 100 (99.9–100.0)%, 97.0 (91.3–99.0) and 100.0 (99.8–100.0) in subsegment-based analysis.

Conclusion

ESGE based on post-contrast T1 mapping after adenosine stress-perfusion CMR imaging shows excellent agreement with conventional LGE imaging for assessing myocardial scar, and can substantially shorten clinical acquisition time.

Key Points

• Synthetic gadolinium enhancement images can be used for detection of myocardial scar.

• Early synthetic gadolinium enhancement images can substantially shorten clinical acquisition time.

• ESGE has high diagnostic accuracy as compared to conventional late gadolinium enhancement.

• Quantification of myocardial scar with ESGE closely correlates with conventional LGE.

• ESGE after stress perfusion CMR avoids need for additional gadolinium administration.

Repeat biopsy of patients with acquired resistance to EGFR TKIs: implications of biopsy-related factors on T790M mutation detection

Abstract

Objectives

To find predictors of non-diagnostic repeat biopsy specimen acquisition for mutational analysis and detection of epidermal growth factor receptor (EGFR) T790M mutation.

Methods

We retrospectively reviewed 90 non-small cell lung cancer patients harbouring EGFR mutations who underwent repeat cone-beam CT-guided transthoracic needle biopsy. Clinical characteristics as well as biopsy-related factors were compared between patients with and without diagnostic specimen acquisition and between patients with and without T790M mutation. After univariate analysis, multivariate logistic regression analysis was performed to reveal independent predictors.

Results

Diagnostic biopsy specimens for mutational test were obtained in 90% (81/90) of patients, of which 62% (50/81) possessed T790M mutation. None of the analysed variables were significantly associated with non-diagnostic specimen acquisition. For T790M detection, duration of EGFR tyrosine kinase inhibitor treatment (p = 0.066), duration of total chemotherapy (p = 0.026), tumour size (p = 0.066), and metastatic lung lesion as a biopsy target (p = 0.029) showed p values less than 0.10. Multivariate analysis revealed that target tumour size (odds ratio, 0.765; p = 0.031) was an independent predictor of T790M mutation. Metastatic lesions as biopsy targets (odds ratio, 4.194; p = 0.050) showed marginal statistical significance.

Conclusions

Non-diagnostic repeat biopsy specimen acquisition was not related to the clinical or technical factors. However, detection of T790M at repeat biopsy might be associated with smaller target tumour size and selection of metastatic lesions as biopsy targets.

Key Points

• Cone-beam CT-guided repeat biopsy yielded high diagnostic specimen acquisition rate.

• Biopsy-related features were associated with the detection of T790M mutation.

• Target tumour size was an independent predictor of the T790M detection.

• Biopsy targeting metastatic lung nodules might help detect the T790M mutation.

Iodine-based contrast media, multiple myeloma and monoclonal gammopathies: literature review and ESUR Contrast Media Safety Committee guidelines

Abstract

Objectives

Many radiologists and clinicians still consider multiple myeloma (MM) and monoclonal gammopathies (MG) a contraindication for using iodine-based contrast media. The ESUR Contrast Media Safety Committee performed a systematic review of the incidence of post-contrast acute kidney injury (PC-AKI) in these patients.

Methods

A systematic search in Medline and Scopus databases was performed for renal function deterioration studies in patients with MM or MG following administration of iodine-based contrast media. Data collection and analysis were performed according to the PRISMA statement 2009. Eligibility criteria and methods of analysis were specified in advance. Cohort and case-control studies reporting changes in renal function were included.

Results

Thirteen studies were selected that reported 824 iodine-based contrast medium administrations in 642 patients with MM or MG, in which 12 unconfounded cases of PC-AKI were found (1.6 %). The majority of patients had intravenous urography with high osmolality ionic contrast media after preparatory dehydration and purgation.

Conclusions

MM and MG alone are not risk factors for PC-AKI. However, the risk of PC-AKI may become significant in dehydrated patients with impaired renal function. Hypercalcaemia may increase the risk of kidney damage, and should be corrected before contrast medium administration. Assessment for Bence-Jones proteinuria is not necessary.

Key Points

• Monoclonal gammopathies including multiple myeloma are a large spectrum of disorders.

• In monoclonal gammopathy with normal renal function, PC-AKI risk is not increased.

• Renal function is often reduced in myeloma, increasing the risk of PC-AKI.

• Correction of hypercalcaemia is necessary in myeloma before iodine-based contrast medium administration.

• Bence-Jones proteinuria assessment in myeloma is unnecessary before iodine-based contrast medium administration.

Reperfusion facilitates reversible disruption of the human blood–brain barrier following acute ischaemic stroke

Abstract

Objectives

We aimed to detect early changes of the blood–brain barrier permeability (BBBP) in acute ischaemic stroke (AIS), with or without reperfusion, and find out whether BBBP can predict clinical outcomes.

Methods

Consecutive AIS patients imaged with computed tomographic perfusion (CTP) before and 24 h after treatment were included. The relative permeability–surface area product (rPS) was calculated within the hypoperfused region (rPS_hypo-i), non-hypoperfused region of ischaemic hemisphere (rPS_nonhypo-i) and their contralateral mirror regions (rPS_hypo-c and rPS_nonhypo-c). The changes of rPS were analysed using analysis of variance (ANOVA) with repeated measures. Logistic regression was used to identify independent predictors of unfavourable outcome.

Results

Fifty-six patients were included in the analysis, median age was 76 (IQR 62–81) years and 28 (50%) were female. From baseline to 24 h after treatment, rPS_hypo-i, rPS_nonhypo-i and rPS_hypo-c all decreased significantly. The decreases in rPS_hypo-i and rPS_hypo-c were larger in the reperfusion group than non-reperfusion group. The rPS_hypo-i at follow-up was a predictor for unfavourable outcome (OR 1.131; 95% CI 1.018–1.256; P = 0.022).

Conclusion

Early disruption of BBB in AIS is reversible, particularly when greater reperfusion is achieved. Elevated BBBP at 24 h after treatment, not the pretreatment BBBP, predicts unfavourable outcome.

Key points

• Early disruption of blood–brain barrier (BBB) in stroke is reversible after treatment.

• The reversibility of BBB permeability is associated with reperfusion.

• Unfavourable outcome is associated with BBB permeability at 24 h after treatment.

• Contralateral non-ischaemic hemisphere is not 'normal' during an acute stroke.

An open-label, prospective, observational study of the efficacy of bisphosphonate therapy for painful osteoid osteoma

Abstract

Objectives

To assess the efficacy of bisphosphonate therapy on bone pain in patients with osteoid osteoma (OO) (main objective), and to describe bisphosphonate-induced changes in nidus mineralisation and regional bone-marrow oedema (BMO).

Methods

A prospective, observational study was conducted from 2011 to 2014. Patients with risk factors for complications of percutaneous or surgical ablation or recurrence after ablation, were offered once monthly intravenous bisphosphonate treatment until significant pain alleviation was achieved.

Results

We included 23 patients. The first two patients received pamidronate and the next 21 zoledronic acid (mean, 2.95 infusions per patient). Bisphosphonate therapy was successful in 19 patients (83%), whose mean pain visual analogue scale score decreased by 76.7%; this pain-relieving effect persisted in 17 patients (74%) with a mean follow-up time of 36 months. Computed tomography (CT) demonstrated a mean nidus density increase of 177.7% (p = 0.001). By magnetic resonance imaging (MRI), mean decreases were 38.4% for BMO surface area and 30.3% for signal intensity (p = 0.001 and p = 0.000, respectively).

Conclusions

In 17/23 patients with painful OO managed conservatively with bisphosphonates, long-term final success was achieved. Bisphosphonates may accelerate the spontaneous healing of OO.

Key points

• 19/23 patients with OO managed with bisphosphonates experienced significant pain relief

• Pain relief was sustained in 17/23 patients, mean follow-up of 36 months

• CT demonstrated a significant increase in nidus mineralisation

• MRI demonstrated a significant decrease in bone marrow oedema

• Bisphosphonate therapy may accelerate the spontaneous healing of OO

How to differentiate acute pelvic inflammatory disease from acute appendicitis ? A decision tree based on CT findings

Abstract

Purpose

To construct a decision tree based on CT findings to differentiate acute pelvic inflammatory disease (PID) from acute appendicitis (AA) in women with lower abdominal pain and inflammatory syndrome.

Materials and methods

This retrospective study was approved by our institutional review board and informed consent was waived. Contrast-enhanced CT studies of 109 women with acute PID and 218 age-matched women with AA were retrospectively and independently reviewed by two radiologists to identify CT findings predictive of PID or AA. Surgical and laboratory data were used for the PID and AA reference standard. Appropriate tests were performed to compare PID and AA and a CT decision tree using the classification and regression tree (CART) algorithm was generated.

Results

The median patient age was 28 years (interquartile range, 22–39 years). According to the decision tree, an appendiceal diameter ≥ 7 mm was the most discriminating criterion for differentiating acute PID and AA, followed by a left tubal diameter ≥ 10 mm, with a global accuracy of 98.2 % (95 % CI: 96–99.4).

Conclusion

Appendiceal diameter and left tubal thickening are the most discriminating CT criteria for differentiating acute PID from AA.

Key points

• Appendiceal diameter and marked left tubal thickening allow differentiating PID from AA.

• PID should be considered if appendiceal diameter is < 7 mm.

• Marked left tubal diameter indicates PID rather than AA when enlarged appendix.

• No pathological CT findings were identified in 5 % of PID patients.