RET fusions in a small subset of advanced colorectal cancers at risk of being neglected

Abstract

Background

Recognition of rare molecular subgroups is a challenge for precision oncology and may lead to tissue-agnostic approval of targeted agents. Here we aimed to comprehensively characterize the clinical, pathological and molecular landscape of RET rearranged metastatic colorectal cancer (mCRC).

Patients and methods

In this case series, we compared clinical, pathological and molecular characteristics of 24 RET rearranged mCRC patients with those of a control group of 291 patients with RET negative tumors. RET rearranged and RET negative mCRCs were retrieved by systematic literature review and by taking advantage of three screening sources: 1) Ignyta's phase 1/1b study on RXDX-105 (NCT01877811); 2) cohorts screened at two Italian and one South Korean Institutions; 3) Foundation Medicine Inc. database. Next generation sequencing data were analyzed for RET rearranged cases.

Results

RET fusions were more frequent in older patients (median age of 66 vs. 60 years, p = 0.052), with ECOG PS 1-2 (90% vs. 50%, p = 0.02), right-sided (55% vs. 32%, P=0.013), previously unresected primary tumors (58% vs. 21%, P<0.001), RAS and BRAF wild-type (100% vs. 40%, p < 0.001) and MSI-high (48% vs. 7%, P<0.001). Notably, 11 (26%) out of 43 patients with right-sided, RAS and BRAF wild-type tumors harbored a RET rearrangement.At a median follow-up of 45.8 months, patients with RET fusion-positive tumors showed a significantly worse OS when compared with RET-negative ones (median OS 14.0 vs. 38.0 months, HR: 4.59; 95% CI, 3.64-32.66; P<0.001). In the multivariable model, RET rearrangements were still associated with shorter OS [HR: 2.97; 95% CI, 1.25-7.07; P=0.014], while primary tumor location, RAS and BRAF mutations and MSI status were not.

Conclusions

Though very rare, RET rearrangements define a new subtype of mCRC that shows poor prognosis with conventional treatments and is therefore worth of a specific management.

Treatment and frequency of follow-up of BCC patients in the Netherlands

Abstract

The incidence of Basal Cell Carcinoma (BCC) rises by 5% per decade in the Netherlands (1), representing an important burden on the health care system and dermatologists' workload (2,3). There is no evidence that intensive follow-up results in better outcomes (burden of disease, cosmetic results) in patients with low risk BCCs (4–6). According to the Dutch BCC guideline, follow-up after treatment is not indicated for patients with a low risk BCC (7), but patients may come for follow-up more frequently for various reasons (4,7,8). Considering the enormous amount of patients, extra follow-up visits represent a substantial workload and healthcare costs. Therefore, we studied follow-up of 482 BCC patients, diagnosed in 2010 from general hospitals (N=291 – random sample from a population-based cancer registry) and academic hospitals (N=191), who had a total of 578 BCC diagnosed in 2010. Information on medical history, tumor characteristics and the treatment and follow-up of all diagnosed BCCs was retrieved from the patient files until April 2015.

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Immunohistochemical identification of nail matrix melanocytes

Abstract

Background

No previous studies have been conducted to determine the normal number of nail matrix melanocytes in Latin American individuals. The objective of this work was to determine the number of melanocytes per linear millimeter present in the nail matrix and the nail bed in samples obtained from Colombian individuals.

Methods

Twenty-six unilateral biopsies were taken from 19 cadavers subjected to clinical and medico-legal autopsies. These biopsy samples were processed with conventional histotechnology and immunohistochemistry (IHC) with anti-HMB-45 and anti-MiTF. Three sets of photographs (HE, HMB-45 and MiTF) were taken of each biopsy sample and independently assessed by three pathologists. Each observer counted the number of melanocytes present in 1 linear mm of the nail matrix or bed.

Results

We found an average of 4.6 melanocytes x linear mm with H & E staining, 9.8 with HMB-45 and 12.4 with MiTF.

Conclusions

The use of IHC significantly increases and facilitates the identification of melanocytes in unilateral biopsies. Our IHC counts exceed the averages found in the literature. This finding warrants new studies to verify whether the Colombian population presents higher numbers of melanocytes in the nail matrix than other populations or whether the observed increase is a result of the use of MiTF.

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A case of subepidermal autoimmune bullous disease with autoantibodies against 200-kDa and 290-kDa antigens

Abstract

Epidermolysis bullosa acquisita (EBA) and anti-p200 pemphigoid are uncommon subepidermal autoimmune bullous diseases caused by autoantibodies against the 200-kDa protein and 290-kDa type VII collagen, respectively. Here we describe a patient with autoantibodies against both 200-kDa and 290-kDa antigens.A 63-year-old-man had itchy tense blisters and edematous erythemas scattered on his trunk, buttocks, extremities and soles (Fig. 1a). There were no ocular or mucosal lesions. Psoriatic skin lesions were not observed. There was no personal or family history of serious diseases.

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Patch Testing in Gastrointestinal Diseases – A Systematic Review of the Patch Test (PT) and Atopy Patch Test (APT)

Abstract

Food allergy is common and the prevalence is increasing. The pathogenesis of food allergy has been extensively reviewed. Immunologic and clinical tolerance to food requires production of regulatory T cells that are food-antigen specific. Loss of tolerance to food can lead to IgE-mediated reactions and non-IgE-mediated reactions.

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Contact hypersensitivity in rosacea – a report on 143 cases

Abstract

Rosacea is a chronic skin disease characterized by inflammatory processes affecting mainly the center of the face. The pathophysiology is complex, environmental factors seem to play an important role in the exacerbation and worsening of the lesions. The barrier-dysfunction theory in atopic dermatitis has been well described in the literature.

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Reply to: Kubiak K. And al. Endosymbiosis and its significance in dermatology

Abstract

We would like to begin by congratulating Kubiak K et al on their work[1], which has the potential to contribute to review the question of endosymbiosis and its significance.We would like to add some new data, notes and comments. Some data regarding viral endosymbiosis other than those discussed by the authors, showed the transmission of a Gemycircularvirus - Sclerotinia sclerotiorum hypovirulence-associated DNA1- like virus (SsHADV-1–LV)- via insect vectors - Lycoriella ingenua.

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The iris signal: blue periphery, tan collaret and freckles pattern – strong indicators for epidermal skin cancer in South-Eastern Europe

Abstract

Background

Eye and skin share the embryological origin. Both are established risk factors in epidermal skin cancer. There are few reports using iris colour classification scales, most of them analyse colour in general or are too complex to use in daily practice.

Objectives

To investigate which iris colour pattern is associated with epidermal skin cancer in a S-E European Caucasian population.

Methods

A case control study was conducted on 480 patients: 229 skin cancers patients and 251 controls (dermatological patients free of skin cancers), admitted in two medical clinics of Dermatology in Bucharest, between October 2011 and May 2014. High resolution iris photos were taken for each patient. Three parameters of the iris were analysed individually and in association for each patient: periphery, collaret and freckles.

Results

The most frequent iris colour pattern associated with epidermal skin cancer was blue periphery with light brown collaret and freckles present. In terms of individual parameters, the strongest indicators for skin cancer patients were blue periphery and blue collaret.

Conclusions

The results of this study sustain the hypothesis that blue periphery with light brown collaret and freckles iris pattern is a reliable phenotypic marker for epidermal skin cancer. The results of this study differ from previous reports in which skin cancer risk was associated with a homogenous blue iris. We account these differences to the characteristics of the recruited patients (S-E European, skin type II and III). The assessment of iris colour patterns is an easy and inexpensive detection tool in skin cancer risk assessment.

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5 alpha-reductase inhibitor treatment for frontal fibrosing alopecia: An evidence-based treatment update

Abstract

Background

Treatment for frontal fibrosing alopecia (FFA) is challenging and its treatment regimen often mirrors other lymphocytic-predominant cicatricial alopecia. 5 alpha-reductase inhibitor (5ARI) has been reported with some treatment success in severe cases of FFA.

Objective

To carry out evidence-based analysis of articles published on treatment efficacy and safety of 5 alpha-reductase inhibitor for the treatment of FFA.

Methods

Articles published on the use of 5ARI to treat FFA between 2005 to 2017 were reviewed, analysed and graded according to the American College of Physicians outcome study grading system.

Results

There were two studies with moderate-level of evidence that described the efficacy of 5ARI for treatment of FFA. 5ARI was commonly used as adjunctive therapy with positive results in recalcitrant disease. Mild to moderate hair regrowth was reported in one grade 2 and three lower grade (one grade 3 and two grade 4) studies. There is limited evidence on the safety aspects of this medication in most studies that were analysed.

Limitations

Database studies might not fully account for confounders and is subjected to variations in methodology and data collection.

Conclusion

This review demonstrated that FFA patients treated with 5ARI could achieve either disease stability or reduction in the rate of progression in selected cases. A well designed randomised, double-blind, controlled study would strengthen the role of 5ARI as part of treatment armamentarium for FFA.

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(Meth)acrylate allergy: frequently missed?

Mutilating male genital Crohn's without gastrointestinal involvement

Abstract

A 58 year old gentleman developed multiple fissures and discharging sinuses in the groin and perineum. Skin biopsies showed non-caseating granulomas suggestive of Crohn's disease. The patient had no gastrointestinal symptoms and a radio-labelled white cell scan demonstrated no bowel involvement.

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Long-Term Optimization of Outcomes With Flexible Adalimumab Dosing in Patients With Moderate to Severe Plaque Psoriasis

Abstract

Background

The recently updated dosing recommendation for adalimumab for moderate to severe plaque psoriasis states that patients with inadequate response to adalimumab every other week (EOW) after 16 weeks may benefit from an increase in dosing frequency to 40 mg every week (EW).

Objective

To determine the long-term efficacy of adalimumab in patients with psoriasis with flexibility to escalate and de-escalate between EOW and EW dosing.

Methods

Data from an open-label study in patients with psoriasis who had received adalimumab in phase 2/3 studies and their extensions were included. Patients initially received 40 mg adalimumab EOW for 24 weeks. From weeks 24 to 252, patients whose Psoriasis Area and Severity Index response was <50% (PASI 50) could be dose-escalated to 40 mg EW and were re-evaluated at 6 and 12 weeks and then every 12 weeks thereafter. Patients who dose-escalated and achieved a PASI 75 response were de-escalated to EOW and could re-escalate to EW if response fell below PASI 50 again; no further de-escalation was allowed. Changes in PASI scores were reported at the last visit before dose escalation or de-escalation.

Results

By week 24, 64.1% of patients in the overall population (n=1256) achieved ≥PASI 75 response, 40.3% ≥PASI 90 response, and 21.7% PASI 100 response. Patients who had a <PASI 50 during weeks 24 to 252 (349/1256, 27.8%) were dose-escalated to EW; 182 (52.1%) remained on EW dosing and 167 (47.9%) achieved a PASI 75 response and were de-escalated to EOW; 83 patients were later re-escalated to EW dosing owing to a <PASI 50 response. Dose escalation was not associated with additional safety concerns.

Conclusion

Optimizing therapy by temporarily increasing the dosing of adalimumab to EW in patients with psoriasis and an inadequate response to adalimumab 40 mg EOW permitted the achievement and long-term maintenance of clinical improvement.

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Erythromelalgia: improvement in pain with transcranial magnetic stimulation

Clinical evaluation of simultaneously applied monopolar radiofrequency and targeted pressure energy as a new method for noninvasive treatment of cellulite in postpubertal women

Summary

Introduction

This study investigates noninvasive cellulite treatments based on simultaneous application of monopolar radiofrequency (RF) and targeted pressure energy to evaluate efficacy and safety and to see whether simultaneous application has any benefits in noninvasive cellulite treatments.

Methods

Thirty women with cellulite (fibrous/adipose/aqueous types) received 4 gluteofemoral treatments (~24 minutes; ~1000 cm²) using a simultaneous application of RF and targeted pressure energy. Clinical improvement was assessed using a pentile grading scale and satisfaction questionnaires. Hip/thigh circumference was measured. Ultrasonography and thermography observed changes in dermal/subcutaneous tissue composition and in gluteofemoral thermal profile. Evaluation at 3 months posttreatment was compared against the baseline.

Results

The clinical improvement averaged 2.17 ± 0.95 (54% improvement). Cellulite was reduced in 93% of cases, while 73% of patients showed good/very good/excellent improvement, with most significant improvement seen in patients with moderately severe cellulite. Hips and thigh circumference decreased on average by 2.31 cm and 2.13 cm, respectively (P < .001). Patient satisfaction was very high, averaging 4.47 ± 0.57 points (1-5 scale). Ultrasonography revealed smoothing and thickening (+0.28 ± 0.15 mm) of the dermis and an average reduction of 1.96 ± 1.60 mm in fat thickness (P < .05). Subjects with significant cellulite reduction had a more homogenous thermal profile at follow-up as a result of therapy-induced diminution of topographic skin defects. No adverse events were recorded.

Conclusion

The application is effective and safe for treating cellulite. The level of clinical improvement after 4 sessions is comparable to results reported after 6-20 sessions in studies on stand-alone RF/laser/targeted pressure energy devices. The technology is promising and deserves further attention and research.

Blunt cannula subcision is more effective than Nokor needle subcision for acne scars treatment

Summary

Background and aim

A comprehensive study comparing two different modalities, Nokor needle subcision (NNS) and blunt cannula subcision (BCS), for treatment of acne scars, has not been reported previously. The aim was to compare the effectiveness of these two methods based on patient's and doctor's satisfaction measures, in addition to the late complications 3 months postsubcision.

Method of intervention

Patients had 18-65 years old, with acne scars on both malar sides. They were treated at one malar side with NNS and with BCS at another side. They were monitored during the first week, at one and 3 months postintervention. Patient's and two dermatologist's satisfactions were compared during 3 months, for each modality and between modalities.

Results

From 34 patients, 29.4%, 55.9%, and 14.7% had mild, moderate, and severe acne scars, respectively. Ecchymosis, nodule formation post-NNS, and edema after BCS were the complications. Patients were satisfied with BCS during 3-month monitoring (P = .021), but not with NNS (P = .353). Physician-1 was satisfied from the outcome of both BCS and NNS procedures (P = .044 and .006, respectively). However, physician-2 was only satisfied with NNS at the month 3 than the month 1 (P = .002). All patients and physicians were significantly more satisfied with BCS than NNS (P = .000). Anyway, at the month 3, physician-2 had no significant different points of view about applied methods (P = .25).

Discussion

Considering the complications and satisfaction rates, BCS was more efficient than NNS for acne scar treatment. Then, we suggest BCS as a good replacement for NNS.

Antiaging and antioxidant effects of topical autophagy activator: A randomized, placebo-controlled, double-blinded study

Summary

Background

Recently, potential roles of autophagy in skin homeostasis received many interests. But, little has been reported for the potential antiaging effects of autophagy activator.

Objective

With the newly synthesized autophagy activator, heptasodium hexacarboxymethyl dipeptide-12 (Aquatide™) in vitro and clinical efficacy of the topical autophagy activator as an antiaging cosmeceutical ingredient was evaluated.

Methods

Antioxidant effect of Aquatide™ was evaluated by radical scavenging assay. In vitro effect was assessed by measuring the cytotoxicity of hydrogen peroxide in cultured normal human epidermal keratinocytes. Clinical evaluation was performed by a randomized, placebo-controlled, double-blinded study. Antioxidant efficacy was observed by measuring the carbonylated proteins in stratum corneum (SC) by fluorescein-5-thiosemicarbazide (FTZ) staining.

Results

Radical scavenging effects of Aquatide were observed with the ABTS assay, and significant reduction in hydrogen peroxide-induced cytotoxicity was observed in Aquatide™-treated cells. Autophagy inhibitor treatment abrogated cytoprotective effects of Aquatide™. In a clinical study, statistically significant increase in skin elasticity was observed after 4 and 8 weeks. Quantitative analysis of carbonylated proteins in SC also showed significant reduction in Aquatide™-treated group, which is consistent with the in vitro data.

Conclusion

These results suggest that autophagy plays important roles in antioxidant system and aging process in skin, and topical autophagy activators can be potential cosmeceutical ingredients for skin antiaging.

Interleukin-31 and interleukin-31 receptor–new therapeutic targets for atopic dermatitis

Abstract

Atopic dermatitis (AD) is characterized by chronic, eczematous, severe pruritic skin lesions caused by skin barrier dysfunction and T helper (Th)2 cell–mediated immunity. Interleukin (IL)-31 is a potent pruritogenic cytokine primarily produced by Th2 cells. Both IL-31 transgenic mice and wild-type mice treated with IL-31 exhibit AD-like skin lesions and scratching behaviour. IL-31 receptor α-chain (IL-31RA) are also expressed in peripheral nerves and epidermal keratinocytes, and the roles of IL-31 on pruritus and skin barrier have been investigated. Recently, an anti–IL-31 receptor antibody was shown to significantly improve pruritus in AD patients. This review focuses on IL-31 and IL-31RA in AD.

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Pyriform Aperture Stenosis Repair in Infants

Congenital nasal pyriform aperture stenosis is a rare developmental anomaly, which is considered a variant of holoprosencephaly. It is characterized by a pyriform aperture width of 11mm or less on maxillofacial computed tomography, and is frequently associated with a solitary median maxillary central incisor. It presents with cyclical cyanosis, feeding difficulty, and respiratory distress. Conservative management includes nasal decongestant, saline and steroid drops, or a McGovern nipple. When conservative management fails, surgical intervention is indicated.

Pediatric Sinus Surgery for Chronic Rhinosinusitis

Pediatric chronic rhinosinusitis (CRS) is a common health problem. Pathophysiology is complicated which leads to different treatment options and approaches. Medical treatment with antibiotics and topical nasal sprays is first line treatment. Surgical intervention includes adenoidectomy and endoscopic sinus surgery (ESS). ESS has proven to be an effective and safe option when everything else fails. In this article, we review the indications, our surgical approach and techniques, and the safety considerations in pediatric ESS.

Columellar Reconstruction in Children

Defects of the nasal complex can cause significant functional and psychosocial impairment. Nasal reconstruction aims to restore the normal trilaminar structure of the nose, which includes the internal lining, cartilaginous framework, and soft tissue envelope. Among the nasal subunits, the columella is especially challenging to reconstruct due to its unique contour and composite nature. Multiple techniques have been described, each carrying distinct advantages and disadvantages; however, the optimal procedure for an isolated defect of the columella remains elusive.

Surgical Management of Inferior Turbinate Hypertrophy

Nasal obstruction remains a common complaint and is a frequent reason for children to see otolaryngologists. Due to its location, proximal to the internal nasal valve, enlargement of the inferior turbinate can cause significant nasal obstruction. Symptoms vary widely and treatment may include both medical and surgical options. Surgeons may utilize monopolar cautery, microdebriders, or coblation technology. This article describes techniques with specific reference to children with nasal symptoms.

Balloon Catheter Sinuplasty in Pediatric Chronic Rhinosinusitis

In this article, we review indications for balloon catheter sinuplasty in children with chronic rhinosinusitis who have failed medical therapy and adenoidectomy. We will discuss our surgical approach, complications, postoperative care, and share some tips and pearls about the procedure. Balloon sinuplasty is a safe procedure that can be used alone or concomitantly with other procedures such as adenoidectomy and/or endoscopic sinus surgery. Balloon catheter sinuplasty has been shown to be effective in selected cases, and in isolation or in combination with other procedures, has resulted in great outcomes for these children.

Transnasal Repair of Congenital Choanal Atresia

Choanal atresia is a relatively rare congenital nasal anomaly that must be repaired to allow infants to adequately breathe and feed. Techniques used in repair have evolved with the development of high-quality optical equipment, such that an endoscopic approach is now most commonly employed. Operative adjuncts include lasers, topical steroids, and stenting. Restenosis is common in the first few years, but this can be improved with dilation.

Endoscopic Management of Congenital Dacryocystocele

Congenital dacryocystocele is a relatively rare oculonasal anomaly which can result in symptomatic obstruction of the nasolacrimal system. Techniques utilized in the management of this condition include nasolacrimal duct probing, endoscopic dacryocystorhinostomy, and transnasal marsupialization. Operative adjuncts include balloon dacryocystoplasty, bicanalicular silastic intubation, and intranasal stenting. Recurrence is relatively uncommon and can be addressed with the application of long-term nasolacrimal stenting.

Pediatric Septoplasty

While septoplasty is routinely performed in the adult population, concerns regarding nasal and facial growth have restricted use of this effective procedure in the pediatric population. As a growing number of studies have demonstrated the safety of this technique and its positive effect on quality of life outcomes, septoplasty is gaining greater acceptance as a central treatment for pediatric nasal obstruction. This article explores the controversies, indications, pre-operative evaluation, and techniques of pediatric septoplasty including closed and open approaches.

Pediatric Anatomy: Nose and Sinus

The sinonasal anatomy of children differs significantly when compared to the sinonasal anatomy of adults. Even within the pediatric group, the anatomy varies depending on the age of the patient, as structures reach full maturation in the teenage years. Knowledge of pediatric anatomy is important for all otolaryngologists, particularly those planning to operate within the nose of a child. This chapter will present the pediatric nasal and sinonasal anatomy with reference to development and related operative planning.

Introduction: The simple act of breathing

When an infant comes into this world, its parents′ greatest hope is that it will be born healthy. Congenital anomalies of the nose present early and can have devastating effects because neonates are obligate nasal breathers. Otolaryngologists need to have a working knowledge of these anomalies and how to manage them.

A Surgical Approach to the Harvest of the Vascularized Submandibular and Submental Lymph Node Flap: The “Through-the-Gland” Dissection Technique

Background Extremity lymphedema is a pathological condition resulting from absence of lymph nodes and disease of lymphatic vessels, often due to oncologic clearance of lymph nodes. In recent years, vascularized lymph node transfer has become a rapidly emerging method of lymphatic reconstruction shown to lead to lymphatic regeneration. In particular, lymphatic flaps based on the submental artery have shown good results with its favorable donor site and available nodes. The lymph nodes here are in close relation to the submandibular gland and require careful dissection around and through the gland for safe harvest. We studied this region of the neck and describe the blood supply to the lymph nodes, their variable positions in relation to the gland, and our technique of dissecting through the submandibular gland while keeping the lymph nodes' hilar blood supply intact. Methods We dissected 2 cadaver heads (4 sides of the neck) to study the submandibular and submental lymph nodes, where to locate them in relation to the submandibular gland and how best to dissect through the submandibular gland for access while keeping the hilar supply intact. We applied this knowledge in 6 clinical cases and provide a brief description of our "through-the-gland" dissection technique. Results The submandibular lymph nodes may lie (1) superficial and posterior to the gland, (2) between the superficial and deep parts of the submandibular gland, or (3) anteriorly and submental. They are classified as superficial, deep, and submental, respectively. The through-the-gland dissection technique gave the surgeon improved access and exposure to the lymph nodes. It also facilitated safer dissection because their hilar blood supply is well visualized. Conclusions The through-the-gland technique of harvesting vascularized submandibular lymph node flaps is a safe technique that allows the surgeon to clearly identify and preserve blood supply of lymph nodes.

The Perineal Turnover Perforator Flap: A New and Simple Technique for Perineal Reconstruction After Extralevator Abdominoperineal Excision

Background Extralevator abdominoperineal excision (ELAPE) is increasingly used to treat locally advanced low rectal cancer as it has been related to superior oncological outcomes than traditional abdominoperineal excision. However, ELAPE also has been associated with high perineal wound morbidity rates as it creates a larger perineal cavity than standard abdominoperineal excision. This greater defect, along with the effects of preoperative chemoradiation on wound healing, makes uneventful perineal reconstruction post-ELAPE a real challenge for the plastic surgeon. In this paper, the authors present a new technique for perineal reconstruction post-ELAPE, using a perforator, islanded, turnover, de-epithelialized local flap (perineal turnover perforator [PTO] flap). Methods The PTO flap is raised based on perforators from internal pudendal artery. The flap is based on the concept that thick gluteal dermis can act as an "autologous dermal vascularized" substitute for the excised pelvic floor muscles, whereas the bulk of its subcutaneous tissue is used to obliterate dead space. Fourteen patients underwent perineal reconstruction using this approach. Patients' demographics, neoadjuvant chemoradiotherapy, histopathology, duration of surgery, follow-up, and complications were analysed retrospectively. Results Median operating time was 49 minutes. There were no flap, donor site, or major wound complications. One patient had superficial skin dehiscence, and one patient developed perineal hernia. None of the patients developed chronic perineal pain. Conclusions The PTO flap is a quick, simple yet safe and reliable option for perineal reconstruction after ELAPE that offers many advantages over the heretofore used reconstructive techniques including primary closure, myocutaneous flaps, and biological meshes.

Assessment of the Effect of Autograft Orientation on Peripheral Nerve Regeneration Using Diffusion Tensor Imaging

Purpose Given no definite consensus on the accepted autograft orientation during peripheral nerve injury repair, we compare outcomes between reverse and normally oriented autografts using an advanced magnetic resonance imaging technique, diffusion tensor imaging. Methods Thirty-six female Sprague-Dawley rats were divided into 3 groups: sham—left sciatic nerve isolation without injury, reverse autograft—10-mm cut left sciatic nerve segment reoriented 180° and used to coapt the proximal and distal stumps, or normally oriented autograft—10-mm cut nerve segment kept in its normal orientation for coaptation. Animals underwent sciatic functional index and foot fault behavior studies at 72 hours, and then weekly. At 6 weeks, axons proximal, within, and distal to the autograft were evaluated using diffusion tensor imaging and choline acetyltransferase motor staining for immunohistochemistry. Toluidine blue staining of 1-μm sections was used to assess axon count, density, and diameter. Bilateral gastrocnemius/soleus muscle weights were compared to obtain a net wet weight. Comparison of the groups was performed using Mann-Whiney U or Kruskal-Wallis H tests to determine significance. Results Diffusion tensor imaging findings including fractional anisotropy, radial diffusivity, and axial diffusivity were similar between reverse and normally oriented autografts. Diffusion tensor imaging tractography demonstrated proximodistal nerve regeneration in both autograft groups. Motor axon counts proximal, within, and distal to the autografts were similar. Likewise, axon count, density, and diameter were similar between the autograft groups. Muscle net weight at 6 weeks and behavioral outcomes (sciatic functional index and foot fault) at any tested time point were also similar between reverse and normally oriented autografts. Conclusions Diffusion tensor imaging may be a useful assessment tool for peripheral nerve regeneration. Reversing nerve autograft polarity did not demonstrate to have an influence on functional or regenerative outcomes.

Basic Microvascular Anastomosis Simulation Hub Microsurgery Course: An Innovative Competency-Based Approach to Microsurgical Training for Early Year's Plastic Surgery Trainees

Early year's plastic surgery trainees are faced with a large choice of microsurgery courses to select from. In the context of dwindling study budgets and busy on-call rotas, the pressure to select a high yield course that delivers value for money is of paramount importance. The Basic Microvascular Anastomosis Simulation Hub Microsurgery Course is a GBP £600 (US $790) 5-day 40-hour course based at Barts and The London School of Medicine and Dentistry increasing in popularity among junior trainees to fit this brief.

Labiaplasty: A 24-Month Experience in 58 PatientsOutcomes and Statistical Analysis

Background Because there has been a great raise in the interest of this type of surgery in our area, we decided to study if there were any differences among our patients and also to review our results. Objective The purpose of this study was to review our experience with labiaplasty. We assessed surgical complications and quality outcomes and compared surgical results according to maternal parity. Methods We conducted a retrospective chart review of all cases of primary or secondary labia minora reduction surgery performed by the same surgeon from January 2014 to December 2015. We recorded patient demographics, sexual activity, parity, and presurgical and postsurgical quality of life, as well as surgical technique and complications. Results During the study period, we performed 58 labia minora reduction procedures. The average patient age was 32.16 years. Among the patients, 50% were single, 65.52% sexually active, and 62.07% nulliparous. A wedge excision was performed in 75.8% of cases. A complication occurred in 12.06% of cases, usually owing to underresection. The surgical experience was rated very good or excellent by 96.55% of patients. Women with children reported greater satisfaction with their surgical outcome on our postoperative questionnaire. We identified no statistically significant outcome differences according to surgical technique. Conclusions Labiaplasty is safe and shows high rates of overall satisfaction. Women with children reported greater postoperative satisfaction than women who had never given birth.

Universal Applicability of the Furlow Palatoplasty: Resident as Primary Surgeon in a Consecutive, Nonselective Series

Background Questions persist regarding the general applicability of the Furlow palatoplasty technique, and thus, widespread adoption of its use has been uneven. This study describes a consecutive, nonselective series of primary Furlow palatoplasties. Highlighted is the unique fact that plastic surgical residents functioned as the primary surgeon for all steps of all procedures throughout the series. Methods A retrospective review was undertaken of all primary palatoplasties performed under the direction of the senior surgeon between December 2005 and April 2012. A stringent requirement for speech outcome reporting was patient age at the latest assessment of older than 4.5 years. Other measured parameters included fistula rate, incidence of secondary surgery, and procedure duration. Results Seventy-five patients were included in this study. Nasal resonance was rated as "normal" in 56.1% of the patients and "mildly hypernasal or better" in 95.1% of the patients. Articulation errors were detected in 14.6% of the patients, and symptoms related to nasal air emission were detected in 4.9% of the patients. Overall fistula rate was 5.3%. The following associations were detected: (1) Veau cleft type and procedure duration, P = 0.001; (2) resident year of training and procedure duration, P = 0.009; (3) developmental delay and resonance score, P = 0.002; (4) patient age at surgery and resonance score, P = 0.025; and (5) presence of syndrome and resonance score, P = 0.036. Conclusions This nonselective series of consecutive Furlow palatoplasty procedures demonstrates that plastic surgical residents are able to match best published clinical results performing the entire procedure under the close supervision and guidance of an assisting surgical mentor.

Labia Majora Augmentation Combined With Minimal Labia Minora Resection: A Safe and Global Approach to the External Female Genitalia

Background All the labia minora reduction techniques fail to treat the other component of the abnormally increased labia minora to majora ratio: the labia majora atrophy. The purpose of this study is to describe a technique of female genitalia beautification, which combines labia majora augmentation and conservative labia minora reduction. Methods The hypertrophied labia minora were first treated by a conservative inferior wedge excision with a superior flap. The conservative excision was done to obtain labia minora that would still protrude beyond the labia majora because it will be masked by the augmentation of the labia majora. Labia majora augmentation was done by autologous fat transplantation. The newly augmented labia majora completely masked the conservatively reduced labia minora. Results Twenty-one patients underwent surgery for labia majora augmentation and labia minora reduction. One patient (4.7%) had a small separation of the labial edge postoperatively that resolved with no additional interventions. There was no flap necrosis or infections. No patient reported pain or sexual dysfunction. Seventeen patients (81%) were satisfied or very satisfied with their results. Conclusions Labia majora augmentation combined with a conservative labia minora reduction is an appealing procedure because it enhances the global aspect of the female genitalia while reducing the labioplasty complications.

Optimizing Radiotherapy for Keloids

No abstract available

Flap-Mastopexy in Autologous Breast Reconstruction: Timing and Technique

Background Techniques in breast reconstruction have significantly advanced the possibility to create more natural and aesthetically appealing breasts. Despite thorough preoperative planning and vigilant operative technique, symmetry remains a concern for select patients who have undergone autologous breast reconstruction. Although symmetry procedures of the contralateral breast have been well described in the literature, little has been published regarding secondary revision in the autologous reconstructed breast, leaving uncertainty as to the appropriate timing and technique for revision procedures that will not hinder the viability of the flap. In this article, we provide an effective, reproducible and safe method of mastopexy after autologous breast reconstruction. Methods A retrospective review of all patients undergoing autologous breast reconstruction by a single surgeon between 2007 and 2014 was performed. Patients who underwent mastopexy after autologous breast reconstruction were included. Patient characteristics, type of reconstruction, staging of procedures, secondary operations, and complications were recorded. Results Ten patients with asymmetric autologous breast reconstruction underwent flap mastopexy in 1 or both breasts. Indications for mastopexy included asymmetry resulting from immediate loss of autologous flaps, unilateral fat necrosis, scarring after mastectomy flap necrosis, excess ptosis, and volume asymmetries. No flap loss, fat necrosis, or nipple loss occurred after flap mastopexy. Conclusions The autologous mastopexy technique is a useful option in secondary refinement procedures for breast reconstruction. It provides a reliable and predictable method to adjust the inframammary fold, increase projection, and address excess ptosis. It has a low complication rate and can be safely and reliably performed as early as 3 months after initial reconstruction.

An Evaluation of the Choice for Contralateral Prophylactic Mastectomy and Patient Concerns About Recurrence in a Reconstructed Cohort

Background Rising contralateral prophylactic mastectomy rates are a subject of national concern. This study assessed (1) factors critical to patients when deciding on contralateral prophylactic mastectomy and (2) patients' quality of life related to concerns about recurrence after unilateral or bilateral breast reconstruction. Methods Patients with stage 0 to III breast cancer who underwent unilateral mastectomy or contralateral prophylactic mastectomy and breast reconstruction at a single institution between 2000 and 2012 were identified. Demographic and clinical data were extracted by chart review. Women's fears about breast cancer recurrence were assessed using the Concerns About Recurrence Scale, and motivational factors for contralateral prophylactic mastectomy were identified using the Decisions for Contralateral Prophylactic Mastectomy Survey. Results Survey responses were received from 157 patients (59%) who underwent unilateral reconstruction and 109 (41%) who underwent bilateral reconstruction. The top 3 reasons for choosing contralateral prophylactic mastectomy were (1) decreasing the risk of contralateral breast disease (97%), (2) peace of mind (96%), and (3) improved survival (93%). Women who chose contralateral prophylactic mastectomy reported significantly greater overall fear and worry compared with the unilateral group, specifically, greater fears of dying and worries about adequately fulfilling roles of daily life (P

Monitoring of Myocutaneous Flaps by Measuring Capillary Glucose and Lactate Levels: Experimental Study

Introduction In surgery, certain defects require reconstruction with a microsurgical flap. The free flap failure rate varies between 2% and 5%. Vascular thrombosis is the most frequent complication and represents 15% to 73% of failures. The success rate of salvage therapy is greater when salvage surgery is early. Currently, clinical monitoring is the criterion standard but many noninvasive or minimally invasive techniques have been developed to improve early diagnosis of complications of vascular thrombosis. The aim of our experimental study was to compare clinical assessments with measurements of capillary glycemia and lactatemia during the monitoring of free flaps. Materials and Methods Myocutaneous latissimus dorsi flaps with skin paddles were created in pigs under general anesthesia. For each animal, 2 flaps were created (right and left) using the same technique. Four groups were made: group 1 (no flap ligation: control group), group 2 (flap with permanent ligation of the artery), group 3 (flap with permanent ligation of the two veins), group 4 (flap with transient ligation of the artery and 2 veins for 1 hour). The postoperative monitoring protocol consisted of monitoring the clinical, biological (glucose and lactate), and histological parameters. Results Eight animals were operated on and sixteen flaps were created. Each flap was clinically and biologically tested 25 times. Clinical, biological, and histological monitoring showed significant variations between the groups. The analysis of variance of capillary glycemia and lactatemia showed statistically significant difference between control group and group 2 (P

Low Versus High Vacuum Suction Drainage of the Submuscular Pocket in Primary Breast Reconstruction: A Retrospective Study

Background Placement of suction drainage in submuscular pockets is routinely performed in breast reconstruction. Days of drain permanence (DDP) are associated with hospital stay and related health care costs. The aims of this study are to retrospectively compare data related to DDP and total drainage volume between high and low vacuum suction drainage groups and to identify correlations with patient or surgery-related factors. Methods We retrospectively analyzed data of 100 patients undergoing immediate or delayed breast reconstruction with expanders and implants. We considered 2 groups depending on suction pressure applied by 2 different surgical teams: group A (number, 50 patients) with high vacuum suction and group B (number, 50 patients) with low vacuum suction. Results Days of drain permanence was not significantly different between group A and group B (P = 0.451). The same was found for total drainage volume (P = 0.183). The distribution of DDP was statistically different only between patients with or without intraoperative bleeding in group A (P = 0.005) and smoking or nonsmoking patients in group A (P = 0.045). Statistical significance was kept in multivariate regression. Conclusions There is no significant difference in DDP and total drainage volume using low or high vacuum suction drainage in breast reconstruction. The only factors affecting drainage permanence were intraoperative filling of expander, smoking, and intraoperative bleeding. Therefore, we can reduce the DDP, avoiding overfilling of expander and using of high vacuum suction in nonsmoking patients and in patients with significant intraoperative bleeding.

The Use and Delivery of Stem Cells in Nerve Regeneration: Preclinical Evidence and Regulatory Considerations

Outcomes following peripheral nerve injury remain poor despite the regenerative capacity displayed by the peripheral nervous system. Current therapies are limited and do not provide satisfactory functional recovery in a multitude of cases. Biomaterials have decreased the need for nerve autograft across small nerve gaps in small-caliber nerves, but the lack of a cellular substrate presents a limiting factor to the effectiveness of this therapy. Schwann cells are the supportive cells in the peripheral nervous system and play an integral role in the physiological response and regeneration following nerve injury. Limitations to autologous Schwann cells include donor site morbidity during harvesting, limited expansion capability, and finite source. Stem cells are multipotent or pluripotent cells with self-renewing capabilities that show promise to improve functional recovery following nerve injury. Differentiation of stem cells into supportive Schwann cells could provide additional trophic support without the disadvantages of autologous Schwann cells, providing an avenue to improve existing therapies. A variety of stem cells have been evaluated in animal models for this clinical application; the current options, along with their clinical feasibility, are summarized in this article.

Skin Burn Associated With Photochemotherapy

Objective psoralen and ultraviolet A (PUVA) phototherapy (PT) has become a standard treatment for several severe skin diseases. Photosensitization is done by oral psoralen intake. In minor cases, PUVA can lead to skin changes like erythema and hyperpigmentation. However, it can also lead to severe burn injuries when exposed to extensive UV light. This makes the treatment in a burn center inevitable. Methods We report the clinical observation of a 38-year-old man presenting with an extensive burn injury caused by sun tanning after PUVA PT. Conclusions There are just few cases of extensive burns induced by PUVA PT. Prevention becomes manifest in patient information, correct calculation of dosage, evaluation of photosensitivity, and close observation. In cases of severe burn injuries, patients should be referred to a burn center for optimal conservative treatment. Surgical intervention is usually not necessary.

Surgeon Sleep Deprivation, Surgical Complications, and the Ethical Imperatives of Evidence-Based Persuasion

No abstract available

Antegrade Intramedullary Pinning in Subacute Fifth Metacarpal Neck Fracture After Failed Conservative Treatment: A Prospective Comparative Study With Acute Fracture

Purpose The purposes of this study were to evaluate the efficacy of antegrade intramedullary pinning performed for neck fractures with angulations of over 30 degrees after failed conservative treatment during the subacute phase and to compare the radiologic and clinical results with those of acute fractures with angulations of over 30 degrees treated via the same procedure. Methods Seventy-three patients with a fifth metacarpal neck fracture were admitted to our institute between January 2010 and April 2015. Among them, 26 patients with an acute fracture (group 1) and 27 patients with a subacute fracture after failed conservative treatment who met the inclusion/exclusion criteria were investigated. After surgery, improvements in angulation and shortening, visual analog scale score for postoperative pain, Disabilities of the Arm, Shoulder, and Hand score, active range of motion, and grip strength were evaluated and compared. Results The mean durations of surgery from injury were 4.92 and 32.74 days in groups 1 and 2, respectively, with a significant difference (P 0.05). At the final follow-up, the angulation had definitively improved compared with before surgery in both groups (P

Outcomes of Ventral Hernia Repair With Concomitant Panniculectomy

Purpose Combined ventral hernia repair and panniculectomy (VHR/PAN) is controversial, and the safety profile including anticipated complications has been questioned. We present a retrospective case series review of patients from the University of Maryland Medical Center to help surgeons counsel patients on the risks and benefits of this procedure. Methods A retrospective database was collected using current procedural terminology codes for VHR/PAN. The patient-specific variables that were studied include the following: sex, body mass index (BMI), smoking, diabetes, chronic obstructive pulmonary disease, cirrhosis, immunosuppression, length of operation, acute incarcerated hernias, hernia size and location, mesh size and location, pannus weight, concomitant component separation, use of negative-pressure wound therapy, intestinal violation, follow-up duration, ventral hernia working group, history of bariatric surgery, previous hernia repair, skin dehiscence, skin necrosis, chronic wound, surgical site infection, seroma, hematoma, fascial dehiscence, hernia recurrence, unplanned return to operating room, and medical complication. Both univariate and multivariate analyses were performed to determine which factors affected the complication outcomes. Results There were 106 patients with an average age and BMI of 53 years and 39, respectively. Fifty-eight patients (54.72%) had at least 1 surgical site occurrence. Twenty-three patients (21.70%) had at least 1 repair failure. Twenty-eight patients (26.42%) had an unplanned trip back to the operating room. Seventeen patients (16.04%) had at least 1 medical complication. Conclusions The risk factors associated with developing complications are higher BMI, longer operating time, larger mesh size, larger hernia size, component separation, use of biologic mesh, chronic obstructive pulmonary disease, and intestinal violation. The use of negative-pressure wound therapy decreased complication rates, and patients with a previous hernia repair seemed to benefit the most from having a combined VHR/PAN. However, when compared with previous reports of VHR alone, VHR/PAN does seem to increase wound complications and reoperation rates.

Step Cut Lengthening: A Technique for Treatment of Flexor Pollicis Longus Tendon Rupture

Reconstruction of a tendon defect is a challenging task in hand surgery. Delayed repair of a ruptured flexor pollicis longus (FPL) tendon is often associated with tendon defect. Primary repair of the tendon is often not possible, particularly after debridement of the unhealthy segment of the tendon. As such, various surgical treatments have been described in the literature, including single-stage tendon grafting, 2-stage tendon grafting, flexor digitorum superficialis tendon transfer from ring finger, and interphalangeal joint arthrodesis. We describe step cut lengthening of FPL tendon for the reconstruction of FPL rupture. This is a single-stage reconstruction without the need for tendon grafting or tendon transfer. To our knowledge, no such technique has been previously described.

A New Option for the Reconstruction of Primary or Recurrent Ischial Pressure Sores: Hamstring-Adductor Magnus Muscle Advancement Flap and Direct Closure

Background Owing to the high recurrence rates of ischial pressure sores, surgeons should consider the possibility of future secondary flap surgery during flap selection. The purpose of this article is to present a new surgical option for the reconstruction of primary or recurrent ischial pressure sores using a simple hamstring-adductor magnus advancement flap and direct closure. Methods After horizontal fusiform skin excision, complete bursa excision and ischiectomy were performed. The tenomuscular origin of the adductor magnus and the conjoined tenomuscular origin of the biceps femoris long head and semitendinosus were isolated and completely detached from the inferior border of the ischial tuberosity. They were then advanced in a cephalad direction without detachment of the distal tendon or muscle and securely affixed to the sacrotuberous ligament. The wound was directly closed without further incision or dissection. Results Twelve ischial pressure sores (6 primary and 6 recurrent; 12 patients) were surgically corrected. The follow-up period was 12 to 65 months. All patients healed successfully without early postoperative complications, such as hematoma, seroma, infection, wound dehiscence, or partial necrosis. Late complications included wound disruption 5 weeks after surgery that spontaneously healed in 1 case and recurrence 3 years later in another case. Conclusions The new surgical option presented herein, which involves hamstring-adductor magnus advancement flap and direct closure, is a simple and reliable method for providing sufficient muscle bulk to fill the dead space and proper padding to the bone stump while preserving the main vascular perforators and pedicles as well as future surgical options.

Splinting After Ear Reconstruction: A Stepwise and Inexpensive Workflow Protocol

Background Long-term postoperative splinting plays a role in the prevention of contracture of the grafted skin after a second-stage ear reconstruction. The scar retraction could lead to an unfavorable aesthetic outcome. Splinting could play a role to overcome or prevent the loss of projection and the obliteration of the sulcus. Material and Methods We have defined the characteristics of an ideal long-term splint and present a stepwise clinical protocol for the fabrication of an ethylene-vinyl acetate splint. The splint was applied to all patients included in a prospective study on the postoperative splinting regime. Ethylene-vinyl acetate has proved its safety and longevity in dental prosthetics. Conclusions Patient compliance was optimal, and no allergic reactions, pressure sores, or skin necrosis were reported. The splint is self-retaining and light weight. Because of its transparent color, it can be easily camouflaged. A stepwise clinical protocol for the fabrication of a low-cost patient-specific ear splint is presented.

Variability in diagnosis and management of acquired cold-induced urticaria

Publication date: Available online 9 March 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Yael Gernez, Scott H. Sicherer, Julie Wang

Preterm Birth and Small-for-Gestational Age in Singleton In Vitro Fertilization Births Using Donor Oocytes

Abstract

We used 2006-2015 US National Assisted Reproductive Technology Surveillance System data to compare preterm birth and fetal growth for livebo n singletons (24-42 week gestation) following donor versus autologous oocyte in vitro fertilization (IVF). Using binary and multinomial logistic regressi n, we computed adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between use of donor oocytes and preterm delivery, small-f r-gestational-age (SGA), and large-for-gestational age (LGA), stratified by fresh and thawed embryo status and accounting for maternal characteristics and year of birth. There were 204,855 singleton births from fresh embryo transfers and 106,077 from thawed embryo transfers. Among fresh embryo transfers, donor oocyte births had higher odds of preterm (aOR 1.32, 95% CI 1.27-1.38) and LGA (aOR 1.27, 95% CI 1.21-1.33) but lower odds of SGA (aOR 0.81, 95% CI 0.77-0.85). Among thawed embryo transfers, donor oocyte births had higher odds of preterm (aOR 1.57, 95% CI 1.48-1.65) and SGA (aRR 1.22, 95% CI 1.14-1.31), but lower odds of LGA (aOR 0.87, 95% CI 0.82-0.92). Use of donor oocytes was associated with increased odds of preterm delivery irrespective of embryo status; odds of SGA were increased for donor versus autologous oocyte births among thawed embryo transfers only.

Healthcare efficiency assessment using DEA analysis in the Slovak Republic

A regional disparity is becoming increasingly important growth constraint. Policy makers need quantitative knowledge to design effective and targeted policies. In this paper, the regional efficiency of healthc...

Personalized 3D Printed Surgical Tool for Guiding the Chisel during Hump Reduction in Rhinoplasty

Summary: The authors aimed to present an introduction of patient-specific model in rhinoplasty by introducing a 3D printed surgical guide designed and adapted in an individualized manner for guiding dorsal hump reduction. To introduce the tool, we have designed a six step workflow. First, we obtain a digital 3D model of patient anatomy using computed tomography (CT) images. Second, we conduct a surgical preoperative planning of the rhinoplasty on the mentioned model. Third step consists of designing the guide, while taking into account nasal anthropometries and resection objectives. Fourth step is printing the guide and sterilizing it. Fifth step is performing the surgery. The last step is analyzing the main outcomes of the surgery. Our surgical guide allowed us to perform only 1 step osteotomy instead of the usual multistep osteotomy and remove exactly the amount of dorsum that we decided to remove during the preoperative planning. The duration of intervention was considerably shorter than conventional osteotomy. Using the guide was technically easier than the conventional method and reduced the learning curve from years to minutes (once the guide is printed). Moreover, the patient understanding of the procedure was significantly better after showing the 3D model of the surgery. The surgical guide allows a surgeon to transfer with extreme simplicity the presurgical planning to the surgical field. We have to point out that the design of the study does not allow us to quantify predictability, so future studies are needed to demonstrate an accuracy benefit over the former techniques.

Photodamage attenuating potential of Nectandra hihua against UVB-induced oxidative stress in L929 fibroblasts

Publication date: Available online 9 March 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Mariana Maciel de Oliveira, Regina Gomes Daré, Érica Oliveira Barizão, Jesuí Vergílio Visentainer, Mariza Barion Romagnolo, Celso Vataru Nakamura, Maria da Conceição Torrado Truiti
The total phenolic content (TP) and antioxidant activity of the ethanolic extract and fractions that were obtained from the leaves of Nectandra hihua were assessed using different assays. The ethanolic extract (EE) and ethyl acetate fraction (EAF) had the best antioxidant capacity, which was comparable to butylated hydroxytoluene and quercetin (ABTS⁺ 2.55 ± 0.06, 3.54 ± 0.03 mmol TE/g; DPPH IC50 10.27 ± 0.05, 9.88 ± 0.02 μg/mL; FRAP 2.17 ± 0.08, 2.38 ± 0.04 mmol TE/g; ORAC 5.16 ± 0.08, 5.35 ± 0.07 mmol TE/g; TP 568.05 ± 18.15, 397.20 ± 17.88 mg GAE/g, respectively). The cytoprotective effect, reactive oxygen species (ROS) and lipid peroxidation inhibitions on L929 fibroblasts irradiated with UVB (600 mJ/cm²) in pre- and post-treatments with EE and EAF were determined. These plant materials demonstrated high ROS scavenging activity and lipid peroxidation inhibition on L929 fibroblasts in both treatments, especially with pre-treatment (EE 38.47 ± 1.95% and EAF 40.20 ± 4.5% inhibition of ROS production, and EE 39.03 ± 3.33% and EAF 41.67 ± 7.6% of lipid peroxidation inhibition), indicating the best cytoprotection with pre-treatment (13.52 ± 1.66% and 13.34 ± 2.61% increases in cell viability). The antioxidant flavonoids quercitrin, avicularin, juglalin, afzelin and astragalin were isolated from EAF. The results obtained indicate that EE and EAF present photodamage attenuating potential against UVB-induced oxidative stress and can be useful as a starting point for developing dermatological products to prevent oxidative skin damage.

Titanium hypersensitivity causing painful intra-abdominal oedema after staple-fixed inguinal hernia repair

Systemic antibiotic use for nonbacterial dermatological conditions among referring providers

Abstract

Background

As usage of systemic antibiotic therapies has increased, so too has bacterial resistance. Antibiotic stewardship thus rests in part on judicious use of empiric treatment. The specific factors which underlie erroneous prescription patterns for dermatological conditions have not yet been well elucidated.

Objective

The objective of this study was to identify whether a predefined group of dermatologic conditions under the heading "pseudobacterial"—including eczematous conditions, arthropod assault, herpes zoster, neurodermatoses, autoimmune blistering disorders, and neutrophilic dermatoses—are associated with increased antibiotic use prior to dermatology referral.

Methods

This observational prospective study included 207 participants referred to an academic dermatology referral center for acute skin conditions which were ultimately deemed to be of a nonbacterial cause. Preceding antibiotic prescription, final diagnosis, and patient, and provider characteristics were reviewed.

Results

Antibiotic prescription were provided to 31/207 individuals. Patients with pseudobacterial diagnoses (66/207 individuals) had 4.79 (95% CI, 2.03–11.3) times the odds of empiric antibiotic treatment compared to all others. Rural referring providers (OR, 8.54; 95% CI, 1.81–40.3) and referring providers in areas with a low density of medical specialists (OR, 3.70; 95% CI, 1.43–10.0) also displayed increased odds of empiric antibiotic prescription for nonbacterial skin disease, though the former finding may be limited by the low number of rural vs. urban providers (7 vs. 200) included in the study.

Conclusion

Patients with noninfectious pseudobacterial dermatological conditions experienced greater odds for unnecessary exposure to antibiotics. Additional independent risk factors included rural settings and diminished access to specialist care.

Issue Information

Cutaneous pseudolymphoma following quadrivalent human papillomavirus vaccination – a rare adverse event

Laser tattoo removal: do we already have picosecond lasers?