Photodynamic Therapy Interventions in Facial Photodamage: A Systematic Review

Publication date: Available online 30 December 2017
Source:Actas Dermo-Sifiliográficas
Author(s): G. Sanclemente, V. Ruiz-Cañas, J.M. Miranda, A.P. Ferrín, P.A. Ramirez, G.N. Hernandez
IntroductionPhotodynamic therapy (PDT) involves the combination of a light source and a photosensitizing agent to induce tissue damage via the generation of singlet oxygen. Although topical PDT has been approved for other indications, its use in facial photodamage is uncertain.AimsTo assess the efficacy and safety of PDT in facial skin photoaging.MethodsAll randomized clinical trials (RCTs) evaluating the efficacy and safety of any form of topical PDT for the treatment of facial photodamage (dermatoheliosis) or photoaging in patients older than 18 years, were included. Photodynamic-therapy using any topical photosensitizing agent at any dose, and with any light-source, were considered. Comparators were chemical exfoliation, intense pulsed light (IPL), light emitting diodes (LED), dermabrasion or microdermabrasion, ablative or non-ablative lasers, injectables, surgery, placebo and/or no treatment.A systematic search in PubMed, Embase, Lilacs, Google Scholar and RCT's registry databases, was performed.ResultsSearch was conducted up to May 4th 2016. Four authors independently selected and assessed methodological quality of each RCT. According to inclusion criteria, twelve studies were included (6 aminolevulinate (ALA) trials and 6 methyl aminolevulinate (MAL) trials), but the majority of them had methodological constraints particularly in randomization description and patients/outcome assessors blindness.Discussion and conclusionsOverall results indicated that PDT either with ALA or with MAL was effective and safe for facial photodamage treatment, but high quality of evidence was found mainly for MAL studies.

Graphical abstract

Mice over-expressing placenta growth factor in the skin exhibit increased vascularization and vessel permeability independently of VEGF-A

Placenta growth factor (PlGF), a member of the vascular endothelial growth factor (VEGF) family, shows strong pro-angiogenic properties in adult pathological angiogenesis [1]. In the skin, where keratinocytes represent the major source of VEGF-A and PlGF, these two factors are contemporaneously induced [2,3]. VEGF-A is also expressed in macrophages, and at minimal levels in dermal fibroblasts and endothelial cells; PlGF is also expressed in endothelial cells, at higher levels than VEGF-A. PlGF binds to tyrosine kinase receptor VEGFR-1 (Flt-1), while VEGF-A also binds to VEGFR-2 (Flk-1), which mediates the strongest angiogenic response.

Virus and Antibody Dynamics in Travelers With Acute Zika Virus Infection

Abstract

Background

To improve our understanding of the natural history of Zika virus (ZIKV) infection in humans, we described the dynamics of ZIKV RNA shedding in different body fluids and antibody responses in patients with acute infection.

Methods

Twenty-nine adults with travel-associated infection and 1 case of sexual transmission were enrolled and followed up with weekly ZIKV RNA testing in blood, urine, saliva, and semen samples and antibody testing.

Results

ZIKV RNA was detected in plasma, urine, and saliva of 57%, 93.1%, and 69.2% of participants, with estimated median times to clearance of 11.5 days (interquartile range [IQR] 6–24 days), 24 days (IQR, 17–34), and 14 days (IQR, 8–31), respectively. In 2 pregnant women, ZIKV RNA persisted in blood until delivery of apparently healthy infants. ZIKV RNA was detected in semen of 5 of 10 tested men; median time to clearance was 25 days (IQR 14–29), and the longest time of shedding in semen was 370 days. In flavivirus-naive patients, the median times to detection of ZIKV nonstructural protein 1 (NS1)–specific immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies were estimated as 8 days (IQR, 5–15 days) and 17 days (IQR, 12–26 days), respectively. ZIKV NS1 IgM antibodies were undetectable in patients with previous dengue.

Conclusions

Prolonged viremia and ZIKV RNA shedding in urine, saliva, and semen occur frequently in patients with acute ZIKV infection. At the time of diagnosis, about half of patients are ZIKV IgM negative. ZIKV NS1 IgM antibodies remain undetectable in patients with previous dengue. Estimates of the times to viral clearance and seroconversion are useful to optimize diagnostic algorithms.

Evidence for Mother-to-Child Transmission of Zika Virus Through Breast Milk

Abstract

Zikavirus (ZIKV) is an emerging viral pathogen that continues to spread throughout different regions of the world. Herein we report a case that provides further evidence that ZIKV transmission can occur through breastfeeding by providing a detailed clinical, genomic, and virological case-based description.

Impact of Dengue Vaccination on Serological Diagnosis: Insights From Phase III Dengue Vaccine Efficacy Trials

Abstract

Background

We previously reported that vaccination with the tetravalent dengue vaccine (CYD-TDV; Dengvaxia) may bias the diagnosis of dengue based on immunoglobulin M (IgM) and immunoglobulin G (IgG) assessments.

Methods

We undertook a post hoc pooled analysis of febrile episodes that occurred during the active surveillance phase (the 25 months after the first study injection) of 2 pivotal phase III, placebo-controlled CYD-TDV efficacy studies that involved ≥31000 children aged 2–16 years across 10 countries in Asia and Latin America. Virologically confirmed dengue (VCD) episode was defined with a positive test for dengue nonstructural protein 1 antigen or dengue polymerase chain reaction. Probable dengue episode was serologically defined as (1) IgM-positive acute- or convalescent-phase sample, or (2) IgG-positive acute-phase sample and ≥4-fold IgG increase between acute- and convalescent-phase samples.

Results

There were 1284 VCD episodes (575 and 709 in the CYD-TDV and placebo groups, respectively) and 17673 other febrile episodes (11668 and 6005, respectively). Compared with VCD, the sensitivity and specificity of probable dengue definition were 93.1% and 77.2%, respectively. Overall positive and negative predictive values were 22.9% and 99.5%, respectively, reflecting the much lower probability of correctly confirming probable dengue in a population including a vaccinated cohort. Vaccination-induced bias toward false-positive diagnosis was more pronounced among individuals seronegative at baseline.

Conclusions

Caution will be required when interpreting IgM and IgG data obtained during routine surveillance in those vaccinated with CYD-TDV. There is an urgent need for new practical, dengue-specific diagnostic algorithms now that CYD-TDV is approved in a number of dengue-endemic countries.

Arbovirus Diagnostics: From Bad to Worse due to Expanding Dengue Virus Vaccination and Zika Virus Epidemics

dengueZikadiagnosticsserologyarbovirus

Improved survival and cure rates with concurrent treatment for MDR-TB/HIV co-infection in South Africa

Abstract

Background

The global epidemic of multidrug-resistant tuberculosis (MDR-TB) threatens gains in TB and HIV outcomes over the past two decades. Mortality in MDR-TB/HIV co-infection has historically been high, but most studies predated the availability of antiretroviral therapy (ART). We prospectively compared survival and treatment outcomes in MDR-TB/HIV co-infected patients on ART to those in patients with MDR-TB alone.

Methods

This prospective, observational study enrolled culture-confirmed MDR-TB patients, with and without HIV co-infection, in South Africa between 2011–2013. Participants received standardized MDR-TB and HIV regimens and were followed monthly for treatment response, adverse events, and adherence. The primary outcome was survival.

Results

Among 206 participants, 150 were HIV-infected, 131 (64%) were female, and the median age was 33 years (IQR 26-41). Of the 191 participants with a final MDR-TB outcome, 130 (73%) were cured or successfully completed treatment, which did not differ by HIV status (p=0.50). After two years, the median CD4 count was 386 cells/mm³ (IQR 219-510), an increase of 140 cells/mm³ from baseline (p=0.005), and 64% had an undetectable HIV viral load. HIV-infected and HIV-uninfected participants had high rates of survival (86% and 94%, respectively; p=0.34). The strongest risk factor for mortality was having a CD4 count ≤100 cells/mm³ (aHR 15.6, 95%CI 4.4-55.6).

Conclusions

Survival and treatment outcomes among MDR-TB/HIV individuals receiving concurrent ART were improved, approaching those of HIV-uninfected MDR-TB patients. The greatest risk of death was among HIV-infected individuals with CD4 counts ≤100 cells/mm³. These findings provide critical evidence to support concurrent treatment of MDR-TB and HIV.

Dolutegravir plus lamivudine maintain HIV-1 suppression through week 48 in a pilot randomized trial

Abstract

In this randomized pilot clinical trial, dolutegravir plus lamivudine was non-inferior to continuation of standard three-drug maintenance therapy in virologically-suppressed HIV-1 infected individuals. There was no emergence of drug resistance in the participant with virologic failure on dolutegravir plus lamivudine.

Impact of Culture-Independent Diagnostic Testing on Recovery of Enteric Bacterial Infections

Abstract

Background

Culture-independent diagnostic tests (CIDT) are increasingly used to identify enteric pathogens. However, foodborne illness surveillance systems have relied upon culture confirmation to estimate disease burden and identify outbreaks through molecular subtyping. This study examined the impacts of CIDT and estimated costs for culture verification of Shigella, Salmonella, Shiga-Toxin producing E. coli (STEC), and Campylobacter at the Tennessee Department of Health Public Health Laboratory (PHL).

Methods

This observational study included laboratory and epidemiological surveillance data collected between years 2013-2016 from patients with the reported enteric illness. We calculated pathogen recovery at PHL based on initial diagnostic test type reported at the clinical laboratory. Adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were estimated with Modified Poisson Regression. Estimates of cost were calculated for pathogen recovery from CIDT positive specimens compared to recovery from culture-derived isolates.

Results

During the study period, PHL received 5553 specimens from clinical laboratories from patients with the enteric illness. Pathogen recovery was 57% (984/1713) from referred CIDT positive stool specimens and 95% (3662/3840) from culture-derived isolates (PR=0.61, 95% CI: 0.56-0.66). Pathogen recovery from CIDT-positive specimens varied based on pathogen type: Salmonella (72%), Shigella (64%), STEC (57%) and Campylobacter (26%). Compared to stool culture-derived isolates, the cost to recover pathogens from 100 CIDT positive specimens was higher for Shigella ($6,192), Salmonella ($18,373) and STEC ($27,783).

Conclusions

Pathogen recovery was low from CIDT positive specimens for enteric bacteria. This has important implications for the current enteric disease surveillance system, outbreak detection and costs for public health programs.

Busting the Myth of “Static vs. Cidal”: A Systemic Literature Review

Abstract

We sought to determine if clinical data validate the dogma that bactericidal antibiotics are more clinically effective than bacteriostatic agents. We performed a systematic literature review of published, randomized controlled trials that compared a bacteriostatic agent to a bactericidal agent in the treatment of clinical, bacterial infections. From among a total of 56 identified trials, 49 found no significant difference in efficacy between bacteriostatic and bactericidal agents. Six trials found that the bacteriostatic agent was superior in efficacy to the bactericidal agent. Only one trial found that the bactericidal agent was superior; in this case, the inferiority of the static agent was explainable by under-dosing of the drug based on pharmacokinetic-pharmacodynamic analysis. Thus, virtually all available data from high quality, randomized controlled trials demonstrate no intrinsic superiority of bactericidal compared to bacteriostatic agents. Other drug characteristics, such as optimal dosing, pharmacokinetics, and tissue penetration, may be more important efficacy drivers.

Characteristics and outcomes of influenza-associated encephalopathy cases among children and adults in Japan, 2010-2015

Abstract

Background

Influenza-associated encephalopathy (IAE) can result in severe neurologic disease with high mortality. Most IAE cases have been reported among children worldwide; understanding of IAE among adults is limited.

Methods

Data were collected on IAE cases reported through the National Epidemiological Surveillance of Infectious Diseases database in Japan during 2010 through 2015. IAE cases were stratified by age category and analyzed using descriptive statistics to assess differences in characteristics and outcomes.

Results

Among 385 reported IAE cases, median age at diagnosis was 7 years (range 0-90), and 283 (74%) were children aged <18 years. The mean seasonal incidence of IAE cases among children and adults (≥18 years) was 2.83 and 0.19 cases per 1,000,000 population, respectively. IAE incidence did not vary by predominant influenza A virus subtype. The frequency of IAE was highest in school-aged (5-12 years) children (38%), followed by young children aged 2-4 years (21%) and adults aged 18-49 years (11%). The proportion of cases with seizures was more common in pediatric IAE cases. There were more cases with cerebrospinal fluid pleocytosis among adults than in children (p<0.01), especially among those aged 18-49 (17%) and 50-64 (19%) years. Case fatality proportion was highest in those aged 40-64 (17%) and ≥65 (20%) years.

Conclusions

We identified differences in the characteristics of IAE patients between adults and children in Japan. Although IAE cases were more frequently reported among children, mortality was higher in adults. Further efforts are needed to prevent and improve survival of patients with IAE, especially in adults.

The limits of non-standard contingency

Abstract

Gideon Rosen has recently sketched an argument which aims to establish that the notion of metaphysical modality is systematically ambiguous. His argument contains a crucial sub-argument which has been used to argue for Metaphysical Contingentism, the view that some claims of fundamental metaphysics are metaphysically contingent rather than necessary. In this paper, Rosen's argument is explicated in detail and it is argued that the most straight-forward reconstruction fails to support its intended conclusion. Two possible ways to save the argument are rebutted and it is furthermore argued that the crucial sub-argument only supports a rather particular variant of Metaphysical Contingentism.

Evaluation of 1-Nitropyrene as a Surrogate Measure for Diesel Exhaust

Abstract

We investigated the viability of particle bound 1-nitropyrene (1-NP) air concentration measurements as a surrogate of diesel exhaust (DE) exposure, as compared with industry-standard elemental carbon (EC) and total carbon (TC) measurements. Personal exposures are reported for 18 employees at a large underground metal mine during four different monitoring campaigns. Full-shift personal air exposure sampling was conducted using a Mine Safety and Health Administration (MSHA) compliant diesel particulate matter (DPM) impactor cassette downstream of a GS-1 cyclone pre-selector. Each DPM filter element was analyzed for EC and organic carbon (OC) using NIOSH Method 5040. After EC and OC analysis, the remaining portion of each DPM filter was analyzed for 1-NP using liquid chromatography tandem mass spectrometry (LC/MS/MS). We observed high correlations between the quantiles of 1-NP and EC exposures across 10 different work shift task groups (r = 0.87 to 0.96), and a linear relationship with a slope between 6.0 to 6.9 pg 1-NP per µg EC. However, correlation between 1-NP and EC was weak (r =0.34) for the 91 individual sample pairs due to low EC concentrations and possible heterogeneity of DE composition. While both 1-NP and EC differentiated between high and low exposure groups categorized by job location, measurements of 1-NP, but not EC further differentiated between specific job activities. Repeated measurements on individual subjects verified the relationship between 1-NP and EC and demonstrated substantial within-subject variability in exposure. The detection limit of TC air concentration ranged between 18 and 28 µg m⁻³ and was limited by OC contamination of the quartz filters in the MSHA compliant DPM samplers.

Molecular signature of nitric oxide on major cancer hallmarks of colorectal carcinoma

Abstract

Colorectal cancer (CRC) is the one of the most important diseases throughout the world. Several aetiological risk factors, viz. sedentary life style, smoking, alcohol intake, less physical activity, red meat, and microbiota, are associated with the development of CRC. Molecular pathophysiology of CRC implies inflammation, metastasis, apotosis and angiogenesis. Inflammation involves interaction between various immune cells, inflammatory cells, chemokines, cytokines, and pro-inflammatory mediators, such as cyclooxygenase (COX) and lipoxygenase (LOX) pathways, which may lead to signalling towards, tumour cell proliferation, growth, and invasion whereas nitric oxide (NO) has been associated with metastasis, apoptosis, and angiogenesis. Therefore, this review emphasises on the potential molecular mechanisms associated with NO with alteration of cancer biomarkers during development of colorectal carcinogenesis.

Pili torti, pale and elastic skin, and severe neurological impairment

Localized subepidermal blistering: not always bullous pemphigoid but a diagnostic challenge

Leukemia cutis in a patient with chronic myelomonocytic leukemia

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Introduction: Antibody-Mediated Therapy Special Issue Part 2

Antibodies have been used therapeutically for well over a century but the breadth and depth of their applications are increasing so rapidly and successfully that clinical studies are informing mechanistic questions while basic research continues to interrogate how antibodies are made and function, so their properties can be further refined. The first part of this Special Issue comprised five review articles (1); this second part includes four more reviews. Once again, we thank the authors for their excellent contributions. This issue also includes an original research article that builds on observations from patients with hyper-IgM syndrome to further define the mechanism for antibody class-switch recombination (CSR).

Cover

Table of Contents

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.

Depletion of recombination-specific cofactors by the C-terminal mutant of the activation-induced cytidine deaminase causes the dominant negative effect on class switch recombination

Abstract

Activation-induced cytidine deaminase (AID) is essential for class-switch recombination (CSR) and somatic hypermutation (SHM) of immunoglobulin genes. Studies on in vitro mutagenized AID as well as its mutations in human patients with hyper-IgM (HIGM)-syndrome type II revealed that C-terminal AID mutations were defective in CSR whereas their DNA cleavage and SHM activities remained intact. The C-terminal mutants of AID were speculated to exert the dominant negative effect on wild-type (WT) AID whereas its mechanism remains unknown. We generated the JP41 (R190X) mutation in one allele and a null mutation on the other allele in a mouse B cell line (CH12F3-2A) using CRISPR/Cas9 genome-editing tools and studied the effect of JP41 expression on the function of exogenously introduced WT AID fused with estrogen receptor (AIDER) in AID^JP41/∆/AIDER CH12F3-2A cells. We found that JP41 expression strongly suppressed not only CSR but also Igh/c-Myc chromosomal translocations by AIDER. We showed that the dominant negative effect is not evident at the DNA cleavage step but obvious at both deletional and inversional recombination steps. We also confirmed the dominant negative effect of other C-terminal mutants, JP8Bdel (R183X) and P20 (34-aa insertion at residue 182) in AID-deficient spleen B cells. Finally, we showed that the expression of JP41 reduced the binding of AIDER with its cofactors (hnRNP L, SERBP1 and hnRNP U). Together, these data indicate that dominant negative effect of JP41 on CSR is likely due to the depletion of the CSR-specific RNA-binding proteins from WT AID.

Targeted antibody therapy and relevant novel biomarkers for precision medicine for rheumatoid arthritis

Abstract

Over the past two decades, the management of rheumatoid arthritis (RA) has progressed remarkably, encompassing the development of new diagnostic tools and efficacious biological agents, such as monoclonal antibodies against inflammatory cytokines and surface markers on immune cells. In addition to the significant efficacy of these biological agents, biomarkers for RA are under consideration for their potential to classify heterogeneous patients into several groups based on clinical and immunological phenotypes for the prediction of clinical course and prognosis and the facilitation of appropriate and precise treatment with the appropriate therapeutic monoclonal antibodies. Biomarkers, particularly those for the prediction and monitoring of the responses to therapeutic monoclonal antibodies for RA, are in demand, with many approaches examined in recent years. In this article, we have summarized the background research on biomarkers and introduced recent topics in the field that enable the possible clinical applications of biomarkers, especially those related to pathogenic cytokines, to guide the treatment of RA.

Sweet SIGNs: IgG glycosylation leads the way in IVIG-mediated resolution of inflammation

Abstract

A hallmark of many chronic inflammatory and autoimmune diseases is that there is an impaired resolution of inflammation and return to the steady state. The infusion of high doses of pooled serum IgG preparations from thousands of donors [intravenous immunoglobulin (IVIG) therapy] has been shown to induce resolution of inflammation in a variety of chronic inflammatory and autoimmune diseases, suggesting that IgG molecules can instruct the immune system to stop inflammatory processes and initiate the return to the steady state. The aim of this review is to discuss how insights into the mechanism of IVIG activity may help to understand the molecular and cellular pathways underlying resolution of inflammation. We will put a special emphasis on pathways dependent on the IgG F_C domain and IgG sialylation, as several recent studies have provided new insights into how this glycosylation-dependent pathway modulates innate and adaptive immune responses through different sets of C-type or I-type lectins.

IVIG-mediated effector functions in autoimmune and inflammatory diseases

Abstract

Intravenous immunoglobulin (IVIG) is a pooled preparation of normal IgG obtained from several thousand healthy donors. It is widely used in the immunotherapy of a large number of autoimmune and inflammatory diseases. The mechanisms of action of IVIG are complex and, as discussed in this review, experimental and clinical data provide an indicator that the therapeutic benefit of IVIG therapy is due to several mutually non-exclusive mechanisms affecting soluble mediators as well as cellular components of the immune system. These mechanisms depend on Fc and/or F(ab′)₂ fragments. A better understanding of the effector functions of IVIG should help in identification of biomarkers of responses to IVIG in autoimmune patients.

The impacts of the axial-to-radial airflow quantity ratio and suction distance on air curtain dust control in a fully mechanized coal face

Abstract

To understand the impacts of the axial-to-radial airflow quantity ratio (denoted as R) and the suction distance (denoted as D_s) on air curtain dust control in a fully mechanized coal face, the 3_down610 coal face in Jiangzhuang coal mine was numerically simulated in this study. A mathematic model was established to describe the airflow migration and dust diffusion in a coal face, and a scaled physical model was constructed. The comparison between simulation results and field measurements validated the model and the parameter settings. Furthermore, the airflow migration and dust diffusion at various R and D_s are analyzed using Ansys CFD. The results show that a reduction of R and D_s is conducive to the formation of an effective axial dust control air curtain; the dust diffusion distance decreases with the decrease of both R and D_s. By analyzing the simulation results, the optimal parameter for air curtain dust control in the 3_down610 coal face and those faces with similar production conditions is determined as R = 1/9 and D_s = 2 m. Under the optimal parameter condition, the high-concentration dust can be confined in front of the mining driver within a space 5.8 m away from the coal face.

Removal mechanism of di- n -butyl phthalate and oxytetracycline from aqueous solutions by nano-manganese dioxide modified biochar

Abstract

In this work, nano-manganese dioxide (nMnO₂)-modified biochar (BC) was synthesized in order to improve BC's adsorption capacity for di-n-butyl phthalate (DBP) and oxytetracycline (OTC). The results showed that nMnO₂ on the BC surface exhibited a poor crystallinity and oxidation state (Mn (IV)). Sorption experiments showed that, compared to BC, DBP sorption capacity of nMnO₂-BC (1:20) and OTC sorption capacity of nMnO₂-BC (1:10) were 0.0364 and 0.0867 mmol/g, respectively, which are significantly higher than that of BC (0.0141 and 0.0151 mmol/g). Kinetics and isotherm experiments indicated that physical adsorption and chemical interactions have both exerted their impacts on the adsorption process. Further X-ray photoelectron spectroscopy (XPS) analysis showed that part of the Mn (IV) in nMnO₂-BC was reduced to Mn (III) and Mn (II) after DBP or OTC adsorption. Therefore, we suggest the nMnO₂ also acted as an oxidizer on modified BC, which may accelerate the degradation of DBP and OTC.

Hyo-neck lift evolution: Neck lift with fixation of the platysma to the deep cervical fascia

Publication date: Available online 29 December 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): C. Le Louarn
The aim of any neck lift obviously includes the restoration of an acute cervicomandibular angle. The hyo neck lift, first published in April 2016, did proposed a new technique of neck lift with a sub-cutaneous neck dissection and suture of the platysma to the hyoid through this sub-cutaneous approach. To enhance results and efficiency, a major change of the hyo neck lift technique is herein proposed with a vertical anterior sub-platysmal and sub-platysmal fat opening and dissection. This anterior dissection ensures a precise and efficient fixation of the platysma to the deep cervical fascia on direct visual control. This permits to create an horizontal and posterior vector of tension on both platysma and skin, which induces flattening of the submental area and consequently creates or recreates an acute cervicomandibular angle. The sub-cutaneous dissection is no more necessary at the hyoid level. In addition, the posterior border of the anterior platysmal flap is suspended to the mastoid fascia. If necessary, the submandibular gland, through this lateral approach, can be partially excised inside it's capsule, after strong bipolar coagulation. A botulinum toxin injection, realized in early post-op, will definitively stabilize the platysma to deep cervical fascia fixation. Fifteen patients underwent the new technique of neck lift with fixation of the platysma to the deep cervical fascia and suspension of the lateral platysma (Platysma Fixation Platysma Suspension: PF PS) and were evaluated at one year post-op and compared to the results obtained with the first preliminary prospective study "hyo neck lift technique" published in April 2016. As now subcutaneous dissection is limited, recovery is faster. No transient nerve damage happened because dissection planes are designed to be far from nerve branches.ConclusionsThe simplest way to obtain an acute cervicomandibular angle is to reattach the platysma to the deep cervical fascia along the platysma cords. The new neck lift with fixation of the anterior platysma to the deep cervical fascia and suspension of the lateral platysma, is faster to perform, induces a faster recovery and is safer and more efficient than the subcutaneous hyo neck lift and other described types of anterior platysma plasties.

The effect of flurbiprofen oral spray and ibuprofen versus ibuprofen alone on postoperative tonsillectomy pain: an open randomised controlled trial

Abstract

Objective

This prospective clinical study was carried out to evaluate the analgesic efficacy and safety of oral spray form of flurpiprofen in the treatment of postoperative pain in tonsillectomy patients.

Study Design

Open randomised controlled clinical study.

Setting

Tertiary care training and research hospital.

Participants

One hundred (53 males, 47 females) with an age range of 18-53 years old (mean 27.4 ± 9.3 SD) undergoing tonsillectomy were enrolled to this prospective controlled study.

Main outcome measures

Patients receiving oral ibuprofen and flurbiprofen as spray form were enrolled as study group (53) whereas patients receiving only oral ibuprofen were enrolled as control group (47) in postoperative period. Postoperative pain was evaluated through visual analog scale on 12th hour, first, third and seventh days after surgery.

Results

The mean maximal pain score of patients who have received flurbiprofen spray and ibuprofen was 3.36 ± 1.93 SD that was statistically lower than the mean maximal pain score of patients who were medicated with only ibuprofen which was 4.06 ± 1.29 SD on postoperative seventh day (p=0.013).

Conclusion

This study revealed that addition of flurbiprofen spray to oral ibuprofen is effective in the management of postoperative pain in tonsillectomy patients with no notable complications.

This article is protected by copyright. All rights reserved.

Cold/Cold vs. Bipolar Dissection Tonsillectomy: A Surgeon-Controlled Study of 400 Cases

Abstract

Surgeon controlled study of 200 cold/cold and 200 hot/hot tonsillectomy cases in one institution

Hot/hot resulted in higher overall rates of early and late post-tonsillectomy haemorrhage and return-to-theatre when compared to cold/cold methods.

Bipolar diathermy tonsillectomy resulted in a statistically significant higher rate of secondary post-tonsillectomy haemorrhage than cold-steel of nearly three times.

Trainee surgeons performed better in bipolar haemostasis than cold-steel dissection with regard to post-operative morbidity.

With continued use of cold-steel tonsillectomy methods in both junior and senior surgeons, it is hoped that the rates of PTH and RTT will continue to improve.

This article is protected by copyright. All rights reserved.

Double Suspension Sutures: a simple Surgical Technique for Selected Cases of obstructive Sleep Apnea: our experience with twenty two patients

Abstract

This work aimed at presenting a simple modification of expansion pharyngoplasty using bilateral double palatal suspension sutures for the treatment of selected cases of snoring and OSA.

Between Marsh 2013 and August 2017, twenty- two patients underwent the double suspension sutures technique as a treatment for retropalatal collapse of obstructive sleep apnea.

Postoperatively, the mean AHI and the mean lowest oxygen saturation level showed highly significant improvement. Both the retropalatal and interpillar distances were increased significantly.

No persistent postoperative complications were reported. Snoring disappeared in 86.4% of patients.

The procedure is simple, well-tolerated by patients and reversible. It is an economic and less traumatic maneuver. It could be applied as a part of multilevel surgery.

This article is protected by copyright. All rights reserved.

Effect of fresh human amniotic membrane on radiation-induced wounds in a murine experimental model

Abstract

Background

Radiation-induced wounds are extremely difficult to treat. They may lead to severe infections and can even be life-threatening. Wound dressings, negative pressure wound treatment, hyperbaric oxygen therapy, and antibiotics are the main treatment modalities for radiation-induced wounds. Amniotic membrane is the innermost surface of the placenta. It has been shown that amniotic membrane induces re-epithelization, regulates angiogenesis, and decreases inflammation and fibrosis. Our proposed theory was that amniotic membrane can have a role in treating radiation-induced wounds by inducing epithelization and increasing wound tensile strength.

Methods

Out of 24 rats, 3 groups were composed. In group A, 21 days after one session of radiotherapy, a 2-cm incision was made on the gluteal region then an amniotic membrane was placed under the skin flaps. In group B, 21 days after one session of radiotherapy, a 2-cm incision made on the gluteal region and wound is sutured back after 2 × 2 cm of area was undermined. In group C, no radiotherapy is given. We just made an incision and sutured it back again with the same size of area undermined. Three weeks after these surgeries, wound regions were excised en bloc and taken out for biomechanical and histopathological assessments.

Results

The end results in amniotic membrane group (group A) were statistically higher than those in the other groups in the terms of wound healing and biomechanical measurements.

Conclusions

After biomechanical and histopathological evaluation, amniotic membrane, with its antimicrobial, anti-inflammatory, angiogenic, and epithelial-inductive effects, was found to be affective in post-radiation wound treatment. Due to the features of amniotic membrane mentioned above, it can be an option in treatment of patients which received neoadjuvant radiotherapy to prevent future wounds. It can also be used for the care and treatment of post-radiation wounds.

Level of Evidence: Not ratable

Rhinoplasty in elderly patients: analysis of outcomes and patient’s satisfaction following 20 years experiences

Abstract

Background

Rhinoplasty is one of the most complex procedures in plastic surgery. In patients over 65, the procedure is even more demanding because of the coexistence of multiple complicating psychological and anatomical factors. The aims of our study were to analyze the necessity of rhinoplasty in elderly patients, to analyze the perception of patients before and after procedures and compare these patients with younger population, to review all cases done in our department over the past 20 years, and to summarize all procedures.

Methods

We designed a retrospective study of patients that had submitted to primary rhinoplasty by the same surgical team from 1997 to 2017. The inclusion criteria were as follows: Italian national patients of either sex over 65 years old who underwent primary rhinoplasty in our department. The exclusion criteria were as follows: psychiatric disorder, abuse of alcohol or drugs, patients who had undergone secondary rhinoplasty, or patients with previous trauma. Our final sample was 125 patients. We submitted FACE-Q rhinoplasty module to 25 patients comparing the results with a control group of younger patients.

Results

Of 1703 patients who underwent primary rhinoplasty in our Department of Plastic Surgery from 1997 to 2017, only 125 were over 65 years old. The average age was 68 years old, with 72 male and 53 female patients. From June 2016 to May 2017, the Italian version of FACE-Q rhinoplasty module was given to 25 elderly patients pre- and postoperatively and to 25 younger patients (control group), for comparison. All patients answered the postoperative module 6 months after their procedure. The most noticeable result was in tip perception, in fact in the > 65 years old group. Two surgeons reviewed and summarized all 125 cases and procedures, which were 89 open approach, 36 closed approach, 17 reduction rhinoplasty, 108 augmentation rhinoplasty, 47 dorsum grafts, 159 tip grafts, 9 alar region grafts, and 5 other grafts.

Conclusions

The tip of the nose is the focus of attention for older patients who want to undergo this surgery and require surgical procedures for increased projection and support. Augmentation rhinoplasty plays a fundamental role in the remodeling of the nose in patients over 65 years old.

Level of Evidence: Level III, risk/prognostic study.

MAPK pathway inhibitors rescue lethal phenotypes in a BRAF gain-of-function Drosophila melanogaster model

Abstract

Mutant BRAF is the leading oncogene in melanoma and is found in close to 50% of all melanoma patients (Cancer_Genome_Atlas_Network, 2015). The oncogenic capacity of the BRAFV600E mutation has also been demonstrated in a murine melanoma model (Dankort et al., 2009). This mutation causes the activation of the mitogen-activated protein kinase (MAPK) pathway, which involves BRAF kinase and downstream mitogen-activated extracellular signal-regulated kinases 1/2 (MEK1/2) and extracellular signal-regulated kinases 1/2 (ERK1/2).

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