Humification process in different kinds of organic residue by composting and vermicomposting: have microbioreactors really accelerated the process?

Abstract

The organic matter existing in nature presents as a complex system of various substances. The humic fraction refers to the humic substances (HS) and consists of humic acids (HA), fulvic acids (FA), and humins, according to solubility in aqueous solution. The physical and chemical characteristics of HA, FA, and humins depend on many factors, among which is the type of original organic material. Two processes for the stabilization of organic materials are known worldwide: composting and vermicomposting. Cattle manure, rice straw, sugarcane bagasse, and vegetable wastes from leaves were the organic residues chosen for the composting and vermicomposting processes. In this study, the differences between the HS extracted from such composted and vermicomposted residues were evaluated. The so-extracted HS were evaluated by spectroscopy in the regions of infrared and ultraviolet-visible, and pyrolysis coupled with gas chromatography with mass spectrometric detection is applied. Thus, we expect that the results obtained here indicate which of the two processes is more efficient in the biotransformation of organic residues in a short period with respect to the HS content. It was also observed that the basic units of the humic fractions generated (although they presented different degrees of maturation) are the same. Altogether, the data reported here bring to light that the structures of the HS are very similar, differing in quantities. These results can still be extrapolated to several other raw materials, since the most variable organic matrices were used here to allow this data extrapolation. In addition, the process seems to lead to the formation of more aliphatic substances, counterpoising what is found in the literature.

Comparison of Lipid Accumulation Product Index with Body Mass Index and Waist Circumference as a Predictor of Metabolic Syndrome in Indian Population

Metabolic Syndrome and Related Disorders, Ahead of Print.

The Effects of a Community-Based Lifestyle Intervention on Metabolic Syndrome and Its Components in Adolescents: Findings of a Decade Follow-Up

Metabolic Syndrome and Related Disorders, Ahead of Print.

Metabolic Syndrome and Vitamin D Levels in Patients with Obstructive Sleep Apnea Syndrome

Metabolic Syndrome and Related Disorders, Ahead of Print.

Does Simultaneous Liposuction Adversely Affect the Outcome of Thread Lifts? A Preliminary Result

Abstract

Background

Along with advances in thread lift techniques and materials, ancillary procedures such as fat grafting, liposuction, or filler injections have been performed simultaneously. Some surgeons think that these ancillary procedures might affect the aesthetic outcomes of thread lifting possibly due to inadvertent injury to threads or loosening of soft tissue via passing the cannula in the surgical plane of the thread lifts. The purpose of the current study is to determine the effect of such ancillary procedures on the outcome of thread lifts in the human and cadaveric setting.

Methods

We used human abdominal tissue after abdominoplasty and cadaveric faces. In the abdominal tissue, liposuction parallel to the parallel axis was performed in one area for 5 min. We counted 30 passes when liposuction was performed in one direction. This was repeated as we changed the direction of passages. The plane of thread lifts (dermal vs subcutaneous) and angle between liposuction and thread lifts (parallel vs perpendicular) were differentiated in this abdominal tissue study group. Then, we performed parallel or perpendicular thread lifts using a small slit incision. Using a tensiometer, the maximum holding strength was measured when pulling the thread out of the skin as much as possible. We also used faces of cadavers to prove whether the finding in human abdominal tissue is really valid with corresponding techniques.

Results

Our pilot study using abdominal tissue showed that liposuction after thread lifts adversely affects it regardless of the vector of thread lifts. In the cadaveric study, however, liposuction prior to thread lifting does not significantly affect the holding strength of thread lifts.

Conclusions

Liposuction or fat grafting in the appropriate layer would not be a hurdle to safely performing simultaneous thread lifts if the target lift tissue is intra-SMAS or just above the SMAS layer.

Level of Evidence V

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Methylene Blue: A Color Test for a Quality De-epithelialization

Lower Lateral Cartilage Cephalic Malposition: An Over-Diagnosed Entity

Abstract

Background

Lower lateral cartilage malposition is represented by anterior convexity of the lower lateral cartilage (LLC) dome with posterior pinch, as defined by Sheen and Constantian. This anatomic variation consists of cephalic, or upward and inward, rotation of lateral crura, particularly in bulbous tip patients. In most cases, "bulbous pinch" LLC is positioned toward the medial canthus, not laterally, so it is referred to as cephalic displacement. Accordingly, it is recommended to caudally displace cartilage in the majority of rhinoplasty cases in which variation is seen.

Objectives

The purpose of this paper is to measure the exact angle of lateral crura with fixed reference points on the face.

Methods

We drew and marked LLC contours and vertical/horizontal lines in 40 consecutive rhinoplasty cases. We then divided them into two groups: (1) bulbous pinch and (2) flat LLCs. The right- and left-sided LLC angles to midline and horizontal lines were measured and compared to assess whether there was any significant difference between the two subgroups.

Results

There was no significant difference between the angles of LLC rotation in the bulbous and flat LLCs groups, measured both vertically and horizontally.

Conclusion

Based on our findings, although cephalic malposition of LLCs may be present in some patients but in the majority of cases the etiology of nasal lateral wall pinching is not cephalic displacement of lateral crura but most probably is due, rather, to severe convexity of the posterior and lateral crura. According to our findings, cephalic malposition is an uncommon anatomic variation of LLCs that has been reported at high frequency (60–70% of their rhinoplasty cases). This finding may help to correct this deformity into a normal anatomic configuration.

Level of Evidence IV

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Glandular Liposculpture in the Treatment of Gynecomastia

Longitudinal Analysis of Superficial Midfacial Fat Volumes Over a 10-Year Period

Abstract

Background

Volumetric changes to facial fat that occur with aging remain poorly understood. The aim of this study was to evaluate for longitudinal changes to midfacial fat volumes in a group of individuals.

Methods

We conducted a retrospective longitudinal study of adult subjects who underwent multiple facial computed tomographic (CT) scans timed at least 8 years apart. Subjects who underwent facial surgery or suffered facial trauma were excluded. Facial CT scans were analyzed, and superficial cheek fat volumes were measured and compared to track changes that occurred with aging.

Results

Fourteen subjects were included in our analysis of facial aging (5 male, 9 female; mean initial age 50.9 years; mean final age 60.4 years). In the right superficial cheek there was an increase in mean (SD) superficial fat volume from 10.33 (2.01) to 10.50 (1.80) cc, which was not statistically significant (P = 0.75). Similar results were observed in the left cheek. There were no statistically significant longitudinal changes to caudal, middle, or cephalad subdivisions of bilateral superficial cheek fat. A simple linear regression was performed to predict superficial cheek fat pad volume based on age which did not reach statistical significance (P = 0.31), with an R² of 0.039.

Conclusions

This study is the first to quantitatively assess for longitudinal changes to midfacial fat in a group of individuals. Superficial cheek fat remained stable as subjects aged from approximately 50 to 60 years old, with no change in total volume or redistribution within a radiographically defined compartment.

Level of Evidence IV

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Bone and Soft Tissue Nasal Angles Discrepancies and Overlying Skin Thickness: A Computed Tomography Study

Abstract

Background

The aim of this study was to derive the normal values for bone and soft tissue nasal angles as well as the overlying skin thickness and to attempt to determine the correlation between differences in bone and soft tissue angles and overlying skin thickness in Middle Eastern patients.

Materials and Methods

Three-dimensional cephalometric analysis was performed for 100 patients who underwent computed tomography of the paranasal sinuses. The nasofrontal angle, pyramidal angle-nasal root, pyramidal angle-tip of the nasal bone, and overlying skin thickness were measured, and the results were analyzed according to sex, age, and body mass index (BMI).

Results

All soft tissue angles were significantly larger than the bone angles, with the mean difference being 11.62°, 30.80°, and 27.05° for the nasofrontal angle (P = 0.000), pyramidal angle-nasal root (P = 0.000), and pyramidal angle-tip of the nasal bone (P = 0.000), respectively. The mean overlying skin thickness was 3.89 ± 1.48 mm at the nasion, 1.16 ± 0.6 mm at the rhinion, and 2.93 ± .97 mm at the nasal tip. Differences in the nasofrontal angle were strongly correlated with the skin thickness at the nasion (P = 0.001).

Conclusion

A simple clinical exam of the soft tissue nasal angles does not reflect the underlying bone angles that will be encountered during rhinoplasty. BMI does not influence nasal shape, and rhinoplasty surgery should take into account the ethnic group, age, and sex of the patient. Surgeons should leave a minor skeletal hump at the end of the nasal bone for Middle Eastern patients.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Shape, Position and Dimension of the Nipple Areola Complex in the Ideal Male Chest: A Quick and Simple Operating Room Technique

Abstract

Introduction

The anatomical features of the chest identify an individual as male or female and even the smallest details of these features determine the appropriate appearance for each gender. In female-to-male patients, the creation of an aesthetically pleasing male chest is the most important step. Incorrect positioning of the nipple areola complex (NAC) on the chest wall and suboptimal shaping and sizing of the NAC are common pitfalls in male NAC creation.

Patients and Methods

We have analyzed the anatomical chest features of 26 water polo players, to verify our hypothesis of the relationship between the pectoralis major muscle and NAC and to create a method for repositioning the NAC that is applicable in the operating room, is easy, practical and reproducible without the use of formulas and based on an easily identifiable landmark.

Results

In our reference group, the NAC has a constant relationship with the pectoralis major muscle, positioned on average 3 cm medial to the lateral border of the pectoralis muscle and 2.5 cm above the inferior pectoralis major insertion. This supports our hypothesis and our surgical technique. We use the index finger to find a vertical axis and a line 2.5 cm above the inferior pectoralis shadow to find the horizontal axis. We also introduce a modification to the receiving site to recreate an oval areola more similar to that of an ideal male chest.

Conclusions

Our anatomical study and statistical analysis support a consistent relationship between the position and shape of the NAC and the borders of the pectoral muscle. We have used this relationship to develop our "trick," which is easily applicable in the operating room to find the NAC position without using formulas and numbers. This method allowed us to place the NAC in a position very close to that of a typical male subject, and it permitted us to reduce the surgery time.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Letter to the Editor Regarding: Fleming D, Stone J, Tansley P. Spontaneous Regression and Resolution of Breast Implant-Associated Anaplastic Large Cell Lymphoma: Implications for Research, Diagnosis and Clinical Management. Aesth Plast Surg, 2018

Axillary Accessory Breast: Optimal Time for Operation

Abstract

Background

Accessory breasts are usually located in the axilla. Symptoms associated with an axillary accessory breast (AAB) may newly develop or worsen after pregnancy. After childbirth, AAB engorgement and hyperplasia may occur due to milk formation. We evaluated the optimal time for AAB excision and assessed variations in clinical presentations and surgical outcomes associated with pregnancy.

Methods

In total, 540 women whose symptoms began from puberty and underwent AAB excision were retrospectively analyzed. Group 1 comprised 416 patients who underwent operations before pregnancy, and Group 2 comprised 124 patients who underwent operations after childbirth. AABs were classified according to the Damsoyu–Lee (DL) classification. Satisfaction was measured by pain and cosmesis 3 months postoperatively.

Results

Group 2 had more patients with severe symptoms [DL class II (n = 8, 6.5%) and III (n = 15, 12.1%)] than Group 1 (p = 0.049). The specimen weight and liposuction volume were greater in Group 2. The reoperation rate was also higher in Group 2 [loosening skin excision (n = 4, 3.2%) and remnant gland excision (n = 3, 2.4%)] (p = 0.032). In Group 2, 31 (25%) patients had AAB engorgement after childbirth and 7 (5.6%) had milk secretion from the accessory nipple after childbirth. The overall satisfaction score was lower in Group 2 than 1.

Conclusions

Pregnancy may cause accessory breast gland hyperplasia. After childbirth, symptoms such as AAB engorgement and milk secretion from the accessory nipple may occur. The optimal timing for operation for AAB appears to be before the onset of pregnancy because of lower reoperation rates and greater patient satisfaction.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Buttock Lifting Using Elastic Thread (Elasticum ® ) with a New Classification of Gluteal Ptosis

Abstract

Purpose

Conventional buttock lifting is invasive, so it is difficult to recommend it to patients especially to those who do not have severe gluteal ptosis. In addition, the gluteal area is a large area change among the joints. Therefore, this surgery can cause pain during hip flexion after lifting using a conventional thread. The authors report on buttock lifting using an elastic thread with high satisfaction from patients.

Methods

From July 2016 to June 2017, 60 patients were enrolled in this study. The degree of gluteal ptosis was graded from Grade 0 to Grade 6. All patients underwent lifting of both buttocks using Elasticum^®. We drew a circle along the outer edge of the buttock and another small circle inside the first circle. A stab incision was done at 5 points (A, B, C, C′, and D), and then according to the circle, lifting was done. Postoperative grade changes and complications were evaluated.

Result

Grades 2–5 were lifted to at least Grade 2 after surgery, but Grade 6 was at most Grade 3 (14.2%), with 85.8% of these to either Grade 5 or Grade 6. Seven patients (11.67%) complained of postoperative pain, and 6 patients (10.00%) showed skin dimpling or creases 10 days after surgery, all of which disappeared at 1 month after surgery.

Conclusion

Buttock lifting with elastic thread is effective in pre-ptosis to moderate gluteal ptosis. Because of the elasticity of the thread, postoperative pain is low on hip flexion, so the lifting is done naturally.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Epicanthal Restoration Surgery with Scar Excision in Severe Epicanthal Scar

Abstract

Background

Medial epicanthoplasty is a common aesthetic surgery in Asia to remove the epicanthal fold. With increasing use of this surgery, unsatisfactory results have grown. Several methods have been developed to correct it. However, there are limitations in restoration if the patient has a severe scar or does not have enough skin for reconstruction. By aggressively removing scar tissue, the authors present a better reverse redraping epicanthoplasty.

Methods

The procedure was performed on 512 patients who had complications of medial epicanthoplasty from May 2011 to October 2015. The mean age was 31.3 years. Those who had already undergone reconstruction were 15.4% (n = 79). Of these, 68 patients received a V–Y flap and the rest had V–Y modification surgery. After the design, the skin-muscle flap was dissected and elevated. The upper and lower eyelid skin was pulled medially. The previous scar tissue was widely excised while removing skin excess, and the new epicanthal fold was created without a rectangular shape.

Results

The mean interepicanthal distance has been increased from 32.8 to 36.6 mm. The mean lengthening effect is 3.8 mm. Lacrimal lake exposure, fierce and narrow appearance, and incomplete medial eyelid closure were improved.

Conclusions

Medial epicanthoplasty is a common cosmetic surgery in the Asian population. A demand for an effective reconstructive method has grown in association with higher complication rates. The authors have better results to make a natural epicanthal fold through aggressive scar removal in the reverse redraping epicanthoplasty.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Judicial Precedent-Based Clinical Practice Guidelines of Propofol in Sedative Esthetic Surgery

Abstract

Background

Propofol is has been widely used for sedation in the field of esthetic surgery because of its favorable pharmacokinetic profile. Propofol sedation-induced side effects are rare. However, when present, they can be serious. The number of malpractice claims associated with propofol sedation has increased in recent years. This study aims to show which procedures lead to the most claims in the field of esthetic surgery through a review of Korean precedents.

Methods

Thirteen precedent cases of propofol sedation in the field of esthetic surgery were collected between 2000 and 2016. We analyzed the type of procedure, administration route, anesthesia provider, complications, timing of damaging events, average indemnification, plaintiff's (patients) winning rate, ratio and the reason of limitation of liability and the key factors affecting the judgement in these cases.

Results

Most plaintiffs were women, and in most cases (11/13, 73.3%), the times of the damaging events were in maintenance and the anesthesia provider was the surgeon. The most common complication related to propofol sedation was hypoxic brain damage. Among the 13 cases, 12 were won by the plaintiff. The mean claim settlement was 339,455,814 KRW (USD 301,792.15). The key factors affecting the judgement were administration method and staff, monitoring method, preparation of emergency kit, response to emergencies, transfer to a higher-level hospital, detailed medical recording about event and informed consent.

Conclusion

The number of claims owing to propofol sedation after esthetic surgery is increasing. Close monitoring during the operation, immediate reaction to an event and thorough medical records were main key factors that influenced the judgement. Preoperative explanation about the possibility of complications was important. The findings will help surgeons achieve high patient satisfaction and reduce liability concerns.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Correction to: Randomized Controlled Study Comparing Disposable Negative-Pressure Wound Therapy with Standard Care in Bilateral Breast Reduction Mammoplasty Evaluating Surgical Site Complications and Scar Quality

Abstract

The second to last sentence in the Results section of the Abstract should be corrected to, "At 180-days follow-up, there was a significant improvement in total VAS scores."

Our Surgical Repair for Macrostomia with Two Novel Small Triangular Flaps Long-term Follow-up and Results

Background: The surgical methods for repairing congenital macrostomia should be carefully selected from both functional and aesthetic points of view. The surgical correction of macrostomia results in normal orbicularis oris function and symmetry of the repaired lip. Herein, we report our novel technique and the results obtained, assessed retrospectively. Methods: Twelve primary cases of macrostomia underwent surgical repair between 1996 and 2013. The age at operation ranged from 3 to 78 months. Our operative procedure uses two small triangular flaps with a superficial layer of orbicularis muscle to preserve the dynamic action of muscle fibers attached to the skin of the triangular flaps, with suturing across the orbicularis muscle bundles. The optimal length of a medial small triangular flap is 1.5-2.0 mm, and the length of a lateral flap is 5-8 mm. Evaluation was based on the degree of symmetry of the lips as a ratio of the affected side to the non-affected side, as well as the scar characteristics. Results: The follow-up period in this retrospective study ranged from 3 to 21 years. The same method was applied to all 12 cases, and the results over several years showed satisfactory outcomes, in the reconstruction of a natural appearance and dynamic function of the oral commissure. Conclusions: Our technique is very useful in the primary operation for macrostomia as the dynamic action of muscle fibers is preserved, if the muscle is not dissected from the skin in the cleft margin that includes the two medial small triangular flaps. The authors have no financial Interest to declare in relation to the content of this article. Presented at The 13th International Congress on Cleft Palate and Related Craniofacial Anomalies in Mahabalipuram, India on February 8-11, 2017. Corresponding author: Keisuke Imai, MD, Department of Plastic & Reconstructive Surgery, Osaka City General Hospital, 2-13-22, Miyakojimahondori, Miyakojima-ku, Osaka, Osaka, Japan. Imai-k@abox3.so-net.ne.jp ©2018American Society of Plastic Surgeons

Using the BODY-Q to Understand Impact of Weight Loss, Excess Skin and the Need for Body Contouring Following Bariatric Surgery

Background: A consequence of bariatric surgery is redundant skin for most patients. We measured health-related quality of life and appearance following bariatric surgery in relation to weight loss, excess skin and need for body contouring. Methods: The sample included participants from the BODY-Q field-test study recruited between November 2013 and July 2014 from a bariatric program in Canada. Participants were invited to complete BODY-Q scales and questions to assess weight loss, amount of excess skin and need for body contouring, between 7 June 2016 and 29 November 2016. Results: 214 patients responded (75% response rate). Of the 210 who had bariatric surgery, percentage total weight loss (%TWL) ranged from 4 to 58%; most were left with excess skin (n=196, 93%) and needed body contouring (n=168, 80%). Average time since bariatric surgery was 3.4 years (0.4 to 7.6). Higher %TWL correlated with more excess skin (r=0.24, p=0.001), the need for more body contouring procedures (r=0.29,

“Chronic Recurrent Multifocal Osteomyelitis of the Mandible: A Diagnostic Challenge”

Summary: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory bone disorder of children and adolescents characterized by mono- or multi-focal inflammatory bone lesions that are culture-negative on biopsy, associated with periods of exacerbation and resolution that can last over several months to years. Although it is predominantly a disease of long bones and the spine, craniofacial involvement is not uncommon, affecting the mandible in up to a fifth of cases. Similarities with other etiologies of osteitis in clinical presentation and imaging, as well as the lack of specific symptoms or laboratory tests, make CRMO mainly a diagnosis of exclusion. An accurate diagnosis is required for appropriate treatment in order to induce remission. This manuscript highlights the challenges faced by plastic and oral surgeons in diagnosing mandibular CRMO, and describes two pediatric patients affected with the disease. Both cases were initially confused with other entities, leading to unnecessary initial treatments and a delayed diagnosis. A review aimed at surgeons summarizes the major aspects of this condition so that it is considered as a differential diagnosis in young patients presenting with a facial bony mass. * Camison and Mai are co-first authors Financial Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Corresponding Author: Joseph E. Losee, MD, FACS, FAAP, Division Chief, Pediatric Plastic Surgery, Children's Hospital of Pittsburgh of UPMC, Children's Hospital Drive, 45th & Penn, Pittsburgh, PA. 15224, Phone: 412-692-6203, Fax: 412-692-5263 ©2018American Society of Plastic Surgeons

Surgeon volume and the outcomes of Dupuytren’s surgery: Results from a Dutch multicenter study

Objective: For a number of major complex surgical procedures, the outcomes are better when performed by surgeons with higher procedure volumes. The purpose of this study was to examine the relations between surgeon procedure volume and the outcomes of Dupuytren's surgery. Design: Observational study from 2011-14 Setting: Consortium of 6 dedicated hand surgery practice sites in The Netherlands Participants: 588 patients who underwent surgery for Dupuytren's contracture by one of the 16 surgeons from the participating sites. Exposure: Annual surgeon volume Main outcome measures: The degree of residual contracture, full release rate and any postoperative adverse event examined within 3 months of surgery. Results: Mean annual surgeon volume was 51 among the 16 surgeons, and ranged from 4 to 86 procedures. The majority of patients had primary Dupuytren's contracture (79%) and underwent open fasciectomy (74%). Multivariable regression analyses showed that surgeon volume was linearly related to all three outcomes, and identified no optimal volume threshold. Performing 10 additional procedures per year was independently associated with nearly 0.8 degree less residual contracture (p=0.002), 9% higher odds of attaining a full release (p=0.037), and 11% lower odds of experiencing an adverse event (p

Effect of One-Stage versus Two-Stage Palatoplasty on Hypernasality and Fistula Formation in Children with Complete Unilateral Cleft Lip and Palate: A Randomized Controlled Trial

Background: Is one or two-stage palatoplasty more effective preventing fistula formation and hypernasality in patients with complete unilateral cleft lip and palate? Methods: This parallel blocked randomized controlled trial included 100 patients with non-syndromic complete unilateral cleft lip and palate with a repaired cleft lip, divided into 2 groups of 50 each. Group A had one-stage palatoplasty at age 12-13 months while group B had two-stage palatoplasty with soft palatoplasty at age 12-13 months and hard palatoplasty at age 24-25 months. Presence of a fistula was tested clinically at 3 years and speech was tested using nasometry and perceptual analyses at 6 years. Group C were the non-cleft controls (n=20, age 6 years) for speech using nasometry. Fistula rates, ratings of hypernasality and nasalance scores were compared between groups A and B. Nasometry recordings of group A and B were compared with control group C. Results: There was no difference in fistula rates between groups A and B (p=0.409; 95% CI=[0.365...11.9]). Mean nasalance scores of group A showed higher nasalance than group B (p=0.006, 95CI=[1.16…6.53]). Perceptual analysis showed no difference between groups A and B (p=0.837 and p=1.000). When compared to group C, Group A showed higher mean nasalance (p=0.837 and p=1.000) while group B showed no difference (p=0.088, 95% CI=[-0.14…2.02]). Conclusion: There was no difference in fistula rates between groups. Nasalance was slightly higher in patients who had one-stage palatoplasty when compared to those that had two-stage palatoplasty, but the difference may not be clinically significant. Financial disclosure and products page: Sources of funds supporting the work This study was partly funded by the former World Health Collaborating Centre, Radboudumc Nijmegen, The Netherlands. Statement of financial interest No financial interest to declare Corresponding Author: Rajgopal R. Reddy, Deputy Director, GSR Institute of Craniofacial Surgery, # 17-1-383/55, Vinay Nagar Colony, I. S. Sadan, Saidabad, Hyderabad- 500 059, Telephone:+91405764884, Facsimile: +91 40 24530000, Email: raj@craniofacialinstitute.org ©2018American Society of Plastic Surgeons

“Forearm Based Turnover Muscle Flaps for Elbow Soft Tissue Reconstruction: A Comparison of Regional Coverage Based on Distal Flap Perfusion.”

Background: Elbow wounds pose a reconstructive challenge. Prior studies have described the vascular anatomy of both the brachioradialis (BR) and flexor carpi ulnaris (FCU) muscle flaps. The goal of this study was to describe the distal flap perfusion of the flexor carpi radialis (FCR), with a direct comparison of the BR, FCU, and FCR muscle flaps for coverage around the elbow. Methods: Six fresh-frozen upper extremity specimens were dissected for BR, FCR, and FCU flaps. Vascular data from prior studies was combined with our anatomical measurements to determine the area of perfused coverage around the elbow for the BR and FCU. The FCR flap distal vascular perfusion was separately examined with transverse sections at 1 cm intervals after India-ink injections to determine distal flap perfusion and elbow coverage. Perfusion data was plotted on an x- and y-axis over the posterior elbow. Results: The BR muscle covered an average of 56% of the x-axis and 7.4% of the y-axis. The FCU muscle covered an average of 90% of the elbow along the x-axis and 23.3% of elbow along the y-axis. Based on our perfusion data, the FCR covered an average of 34% of the x-axis and 4.8% of the y-axis. Conclusion: The FCU muscle provides the most versatile and robust coverage over the posterior elbow, followed by the BR muscle which consistently provides coverage over the lateral epicondyle. The FCR may be used in select cases for lateral epicondyle coverage and may be considered as a secondary option. Presented at the 71st Annual Meeting for the American Society for the Surgery of the Hand in Austin, Texas, from September 29 to October 1, 2016; Annual Meeting for American Association for Hand Surgery in Waikoloa, Hawaii, from January 11 to January 14, 2017. Financial Disclosure Statement: Financial support for this study was provided from funds awarded through the Piedmont Orthopedic Society Research Grant (https://ift.tt/2GVPRmi). Corresponding Author: Yash J. Avashia, MD, Division of Oral, Maxillofacial, and Plastic Surgery, Duke University Medical Center, 40 Duke Medicine Circle, M150, Green Zone, DUMC 2824, Durham, NC 27710, Email Address: yja@duke.edu ©2018American Society of Plastic Surgeons

The impact of once versus twice daily enoxaparin prophylaxis on risk for venous thromboembolism and clinically relevant bleeding

Introduction: Venous thromboembolism (VTE) is a life or limb threatening complication that occurs in plastic surgery patients. At present, the optimal dose of enoxaparin that balances the risk of VTE and the risk of medication related adverse drug events, specifically bleeding, remains unknown. Methods: This study compared pharmacodynamic and clinical outcomes, including 90-day VTE and 90-day clinically relevant bleeding, between two prospectively performed clinical trials whose sole difference was post-operative anticoagulation strategy. Patients in Trial #1 received enoxaparin 40mg once daily for the duration of inpatient stay, and patients in Trial #2 received enoxaparin 40mg twice daily for the duration of inpatient stay. The study also examined the potential impact of a weight-based twice daily prophylaxis strategy to achieve in range anti-Factor Xa levels. Results: The study compared 94 patients who received once daily enoxaparin to 118 patients who received twice daily enoxaparin. Twice daily enoxaparin was associated with a significant decrease in 90-day acute VTE (0% vs. 5.3%, p=0.012) and a non-significant increase in 90-day clinically relevant bleeding (6.8% vs. 3.2%, p=0.25). Twice daily enoxaparin at 0.4-0.5mg/kg may allow an increased proportion of patients to avoid both inadequate anticoagulation and over-anticoagulation, based on anti-Factor Xa levels. Conclusion: Twice daily enoxaparin is superior to once daily enoxaparin for 90-day acute VTE risk reduction. Twice daily enoxaparin may increase clinically relevant bleeding, although observed differences in this study were not significant. Weight based twice daily enoxaparin dosing may optimize the risks and benefits of prophylactic anticoagulation after plastic & reconstructive surgery. Meeting Disclosure: These data have not been presented. Financial disclosure page: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Funding for this study was provided by the Plastic Surgery Foundation (National Endowment for Plastic Surgery grant, to CJP) and the Agency for Healthcare and Research Quality's R03 mechanism (1 R03 HS024326, to CJP). Dr. Pannucci also receives research support from the American Association of Plastic Surgeon's AAPS/PSF Academic Scholar Award. CLINICAL TRIAL IDENTIFIER: Studies registered on clinicaltrials.gov: NCT02411292 and NCT02687204 ACKNOWLEDGEMENTS: Funding for this study was provided by the Plastic Surgery Foundation (National Endowment for Plastic Surgery, to CJP) and the Agency for Healthcare and Research Quality (1 R03 HS024326, to CJP). Dr. Pannucci also receives research support from the American Association of Plastic Surgeon's AAPS/PSF Academic Scholar Award. Corresponding Author: Christopher J. Pannucci, MD MS, Assistant Professor, Division of Plastic Surgery, Division of Health Services Research, University of Utah, 801 581 7719 (phone), 801 581 5794 (fax), Christopher.Pannucci@hsc.utah.edu ©2018American Society of Plastic Surgeons

Topical Aloe Vera Gel for Accelerated Wound Healing of Split-Thickness Skin Graft Donor Sites: A Double-Blind, Randomized, Controlled Trial and Systematic Review.”

Background: Aloe vera has been used to treat wounds since ancient times. However, the efficacy of Aloe vera for burns and split-thickness skin graft (STSG) donor sites are inconclusive. Methods: A double-blind, randomized, controlled trial was conducted. Patients who underwent STSG harvesting from the thigh were included. STSG donor sites were divided into two groups: Aloe vera group and placebo group. The visual analogue scale (VAS) score evaluated pain and complete epithelialization was assessed. We searched electronic databases and included only international clinical trials published in the English language. Results: Twelve patients with 24 donor sites participated. Times to complete epithelization for the Aloe vera and placebo groups were 11.5 + 1.45 and 13.67 + 1.61 days (p

The Look of a Woman – Facial Feminization Surgery and the Aims of Trans-Medicine. By Eric Plemons. Pp. 192. Duke University Press, Durham and London, 2017. Price: $23.95.

No abstract available

Eliminating Geographical Bias Improves Match Results: An Analysis of Program Preferences and Their Impact on Rank Lists and Results

Background: Previous studies have demonstrated that programs emphasize USMLE scores, publications, and geography in creating rank lists. We aimed to quantify the importance of geography and to determine how eliminating geographic preferences would affect Match outcomes. Methods: The Match algorithm was implemented and validated on six years of de-identified data from SF Match (2009-2014). A "consensus" ranking was generated for each year—all applicants were ordered into a single list using Markov chain rank aggregation. Each program's rank list was reordered using the consensus list, and a new Match result simulated. Statistical analysis was carried out with Microsoft Excel. Results: Variation of program rank lists from the consensus rank list was driven by geography (training in the same medical center or state as the ranking program), "pedigree" (top 25 ranking of applicants' prior training), and foreign medical graduation status. Step 1 scores, publications, and medical school or residency region were not factors. The simulated Match resulted in a slight increase in the match rate. The median normalized number needed to match decreased from 6.7 to 6.5, and 80% of applicants had an unchanged or better result compared to the actual Match. Conclusions: Geography is the primary driver of variation between program rank lists. Removing this variation would result in fewer unfilled positions, no significant change in average number needed to match, and improved Match outcomes for most applicants. Programs should critically evaluate whether their geographic biases reflect underlying information about applicant quality. Acknowledgments: Financial disclosures: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Corresponding author: Purushottam Nagarkar, M.D., Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, 4th Floor, Dallas, TX 75390, Purushottam.Nagarkar@utsouthwestern.edu ©2018American Society of Plastic Surgeons

Asymptomatic Deep Vein Thrombosis During Free Flap: Concerns in Free Flap Surgery

Background: Venous insufficiency is the most frequent cause of failure in free flap reconstruction of the lower extremity. When deep vein thrombosis (DVT) is detected during preoperative assessment of the lower extremity, decisions regarding treatment plans become difficult, and no relevant guidelines regarding surgery and preoperative treatment of patients with DVT who need a free flap transfer are currently available. Methods: In order to find a relevant guideline in decision-making regarding surgery and preoperative treatment of patients with DVT who require free flap reconstruction, a systematic literature review was conducted searching MEDLINE, PubMed Central, Cochrane, and Embase databases for articles published between 1996 and 2015. In addition, we introduced six of our cases of DVT diagnosed before free flap operation in which the flap survived. Results: The literature review identified two articles that discussed intra-operative DVT diagnosed in three patients, including the reported cases. Analyses included epidemiology, etiology, and management strategy. A consensus for the management of asymptomatic DVT before free flap is still lacking. In our cases, successful flap transfer was possible by proceeding with an appropriate preoperative evaluation, intensive anticoagulation treatment, intraoperative reperfusion procedure, and postoperative care. Conclusion: Preoperatively detected asymptomatic DVT is not a contraindication for free flap reconstruction, and a flap transfer can be successfully performed with suitable planning and management. Acknowledgement: None Financial Disclosure: The author(s) declare no potential conflicts of interest with respect to the research, authorship, and / or publication of this article. Funding: The work was supported by the Ewha Womans University Research Grant of 2015. Corresponding author: Bo Young Park, M.D., Ph.D., Department of Plastic and Reconstructive Surgery, School of Medicine, Ewha Womans University, Seoul, Korea, Mok 5-dong, Yangcheon-Gu, Seoul, S. Korea, 158-710, Tel.: 82-2-2650-5149/ Fax: 82-2-3410-0036/ E-mail: byps@icloud.com ©2018American Society of Plastic Surgeons

Enhancement of Progenitor Cells by Two Step Centrifugation of Emulsified Lipoaspirates

Background: Adipose-derived stem cells (ASCs), endothelial progenitor cells (EPCs) and soluble factors jointly contribute to the regenerative effect of fat grafts. The nanofat grafting technique is a simple method to mechanically emulsify the lipoaspirate and increase the ASC yield in the lipoaspirate. In the present study, we evaluated our extended nanofat grafting method that includes two additional centrifugation steps and results in a lipoaspirate of low volume that we termed "lipoconcentrate". Furthermore, we investigated the oily fractions after centrifugation for its regenerative potential. Methods: Lipoaspirates of 20 healthy patients were collected and processed by emulsification and/or centrifugation. Six groups were created: native (not emulsified) fat, 1x centrifuged native fat, 2x centrifuged native fat, nanofat (emulsified), 1 x centrifuged nanofat and lipoconcentrate (=2x centrifuged nanofat). The oily phases after the centrifugation steps also were collected. Progenitor cells and protein levels of bFGF, IGF-1, MMP-9, PDGF-BB and VEGF-A were measured by flow cytometry and immunoassays, respectively. Results: Lipoconcentrate contained significantly higher numbers of ASCs and EPCs per gram when compared to all other fractions. No difference in the content of all five soluble factors between the groups was found. The oily phases after centrifugation showed none or very little numbers of ASCs, EPCs and none or very low levels of soluble factors. Conclusion: Centrifugation of emulsified lipoaspirates increases the progenitor cell count in the lipoaspirate. The oily phase after centrifugation of lipoaspirates may be disposable due to the little content of progenitor cells and soluble factors. Financial Disclosure Statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript Corresponding author: Norbert Pallua, M.D., Ph.D., Department of Plastic Surgery and Hand Surgery – Burn Center, University Hospital of the RWTH Aachen , Pauwelsstrasse 30 52074 Aachen, Germany. Phone: +49 241 8089701, Fax +49 241 8082448, email: npallua@ukaachen.de ©2018American Society of Plastic Surgeons

Liposuction aspirate fluid-ASCs injection and secondary healing in fingertip injury, a pilot study.

BACKGROUND: Although fingertip injuries account for a high proportion of trauma patients, the correct surgical approach is still debated. This prospective study compares the traditional conservative approach and a new treatment based on the injection of liposuction aspirate fluid (LAF). METHODS: 40 consecutive patients with a fingertip injury were dichotomized into group A (control group: conservative approach) and B (treatment group). Group B underwent liposuction, followed by filtration of the lipoaspirate in a closed device (MyStemEvo®kit), allowing the nonenzymatic separation of LAF, which was then injected at injured site. Objective outcomes were time for healing, strength, mobility of joint, touch and sensory function. Subjective outcomes were cold intolerance, pain, hand disability and aesthetic result. An aliquot of LAF was sent to the laboratory for cellular isolation and analysis by flow cytometry and in vitro differentiation assays. RESULTS: The average number of days for healing was 22,3 days in group B and 24,9 in group A (p

Anatomical consideration for the safe elevation of the deep circumflex iliac artery in the flap surgery

Background: Deep circumflex iliac artery (DCIA) osteocutaneous flap transfer was frequently applied to large defects in the maxillary and mandible regions, but the utilization rate has gradually decreased due to the complicated anatomy of the DCIA. This study investigated the comprehensive anatomy of the DCIA in relation to flap surgery with the aim of providing navigational guidelines for safe DCIA harvesting. Methods: Sixty-two sides of the hemiabdominal wall were dissected in fixed Korean cadavers. Several dimensions of the DCIA and its positional relationships with surgical landmarks were measured, and the patterns of the arterial supply and anastomosis were identified. Results: The mean distance between the anterior superior iliac spine (ASIS) and the lateral border of the femoral artery was 57.5 mm. The DCIA generally originated almost at the same level as the inguinal ligament (IL), and its highest level was 14.8 mm superior to that ligament. Emerging points of the ascending branch were observed both medial and lateral to the ASIS, but no transverse branch pierced the transversus abdominis muscle medial to the ASIS. Conclusion: The incision line for safe DCIA harvesting was parallel and 2 cm superior to the IL and 6 cm from the ASIS. This position of the safe incision line can be easily determined using the thumb. Sex differences in the incidence of the DCIA originating above or below the IL will be another useful guide for easily detecting the DCIA. Financial Disclosure: The authors have no financial interest to declare in relation to the content of this article. No funding was received for this work. *Correspondence to: Woo-Chul Song, M.D., Ph.D., Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea. Telephone: +82-2-20307836, Fax: +82-2-20307819, E-mail: anatomy@kku.ac.kr ©2018American Society of Plastic Surgeons

National Mortality Rates After Outpatient Cosmetic Surgery and Low Rates of Perioperative Deep Vein Thrombosis Screening and Prophylaxis

Background: Concerns have arisen over reports of deaths occurring after certain outpatient plastic surgery procedures. Here, we present a detailed analysis of the American Association for the Accreditation of Ambulatory Surgical Facilities (AAAASF) database and report on deaths occurring after outpatient cosmetic surgical procedures, causative factors, and venous thromboembolism (VTE) screening rates. Methods: A retrospective analysis of the AAAASF database was performed for the years 2012-2017. We retrieved data for all deaths occurring in association with cosmetic plastic surgery procedures. Patient demographics, procedural data, VTE risk factor assessment, and cause of death were analyzed. De-identified medical records, including coroner's reports, were reviewed where available. Results: Data for 42 deaths were retrieved. Of these, 90.5% (n=38) were female, and 61.9% were Caucasian (n=26). Mean age was 51.6 years (standard deviation, SD ±14.8), while mean BMI was 29.5kg/m2 (SD ±5.5). Overall, 54.8% of these deaths occurred after abdominoplasty: 42.9% in isolation, 9.5% in combination with breast surgery, and 2.4% with facial surgery. Of the causes of death, most (38.1%) were thromboembolic in origin. Notably, in 25 of 42 cases, VTE risk factor assessment was incorrect or absent (59.5%). Conclusions: Accreditation agencies provide transparency and insight into outpatient surgical mortality on a national scale. Results suggest that adoption of venous thromboembolism screening techniques may not be universal despite an existing large body of published evidence. Optimization of thromboembolism prevention pathways remains vital, and consideration of anticoagulation in those undergoing abdominoplasty may be important in lowering outpatient mortality. Financial Disclosures: Dr. Gary Brownstein, Dr. Lawrence Reid, and Dr. David Watts are on the Executive Committee for the American Association for Accreditation of Ambulatory Surgery Facilities and receive an annual stipend. None of the remaining authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Correspondence may be directed to: Samuel J Lin, MD, MBA, 110 Francis St., Suite 5A, Boston, MA 02215, Tel: 617-632-7369, sjlin@bidmc.harvard.edu David Watts, MD, American Association for Accreditation of Ambulatory Surgery Facilities, Gurnee, Illinois, Tel. 856-691-0200, dwatts@aaaasf.org ©2018American Society of Plastic Surgeons

Ganoderma Lucidum Polysaccharide Peptide Attenuates Skin Flap Ischemia-Reperfusion Injury in a Thioredoxin-Dependent Manner

Background: Thioredoxin-1 (Trx-1) plays an important role in defensing the skin flap ischemia-reperfusion injury. Ganoderma lucidum polysaccharide peptide (GLPP) is the major component of Ganoderma lucidum, which possesses potent antioxidant and antiapoptotic activity. Our study aims to determine whether GLPP could attenuate the skin flap ischemia-reperfusion injury and investigate possible mechanisms involved. Methods: The dermoprotective effect and mechanisms were assessed by an in vivo mouse ischemia-reperfusion flap model and an in vitro epithelial skin cell hypoxia/reoxygenation model. GLPP was administered to mice and cells before the procedures of ischemia-reperfusion and hypoxia/reoxygenation, respectively. Trx-1 inhibitor PX-12 was introduced in the counterevidence group. The flap tissues and cells were tested by hematoxylin-eosin and immunohistochemistry staining, TUNEL assay, SOD and MDA measurement, and Western blot. Results: The survival rates of ischemia-reperfusion flaps and hypoxia/reoxygenation cells increased significantly following GLPP treatment. Mitigated tissue damage, reduced apoptosis, and enhanced antioxidant activity were observed in ischemia-reperfusion flaps replenishing GLPP. Western blot analysis revealed Trx-1 depletion and a remarkable increase in ASK-1, p-p38, cl-caspase-3 and c-PARP abundance in ischemia-reperfusion flaps and hypoxia/reoxygenation cells, while GLPP dramatically upregulated Trx-1 and reduced the apoptosis-related protein expression. However, the rescue effect of GLPP was notably blunted by supplementation with PX-12. Conclusions: Our investigation highlights the protective role of GLPP in skin flap ischemia-reperfusion injury through Trx-1-dependent antioxidant and antiapoptotic pathway. This initial foray demonstrates the therapeutic value of GLPP against ischemia-reperfusion and facilitates the understanding of its dermoprotective mechanism. Disclosure: The authors have no financial interest to disclose in relation to the content of this article. Acknowledgements: The authors thank Prof. Baoxue Yang, Peking University Health Science Center, and Prof. Zhibin Lin, Fuzhou Institute of Green Valley Bio-Pharm Technology, for kindly providing the compound of Ganoderma lucidum polysaccharide peptide. This work was supported by National Natural Science Foundation of China (grants No. 81703167, 81703591). *Corresponding author: Address correspondence to: Zhuming Yin, M.D., Department of Breast Reconstruction, Tianjin Medical University Cancer Institute and Hospital, Tiyuanbei, Huanhu West Road, Hexi District, Tianjin 300060, China. Phone: +86-22-23340123-1173, E-mail: yinzhuming@tmu.edu.cn ©2018American Society of Plastic Surgeons

Incomplete facial paralysis - The use of the ipsilateral residual facial nerve as a donor nerve for facial reanimation.

Background: The reconstructive approach for incomplete facial paralysis is not yet determined. In this article we present a new surgical approach for patients with incomplete facial paralysis in which residual, ineffective movement is detected pre-operatively in the ipsilateral bucco-zygomatic territory of the paretic facial nerve. Methods: Sixteen patients with incomplete facial paralysis were found eligible for the procedure and underwent one-stage facial reanimation by the senior author (E.G.). Reanimation was performed using free gracilis muscle transfer with neural coaptation to an active facial nerve branch/es responsible for the pre-detected bucco-zygomatic residual movement. Patients were reviewed in a systematic fashion using a combined still photo and video scoring scale for symmetry at rest and at dynamic states. Results: Following surgery, improved symmetry was observed in the majority of observations of the mouth region at rest and while smiling and nasolabial fold region while smiling. There was no significant change in symmetry in the majority of observations of the eye region at rest and while smiling and nasolabial fold region at rest. Video assessment of dynamic facial symmetry while smiling demonstrated improved symmetry in 91% of the observations (n=191 observations). Comparison of mean scores for dynamic smile symmetry produced a statistically significant improvement of 1.68 points following surgery (p

Commentary on Primary Septal Cartilage Graft for the Unilateral Cleft Rhinoplasty

No abstract available

“Successful non-invasive treatment of festoons.”

No abstract available

Reply: Commetary on Primary Septal Cartilage Graft for the Unilateral Cleft Rhinoplasty

No abstract available

Diagnóstico histológico de lesiones melanocíticas y melanoma: todo un desafío

Publication date: Available online 7 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): D. Morgado-Carrasco, S.S. Ertekin, A. Combalia, L. Ferrandiz

Dermatitis por contacto fotoalérgica a protectores solares con oxibenzona en La Plata, Argentina

Publication date: Available online 11 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): J.P. Russo, A. Ipiña, J.F. Palazzolo, A.B. Cannavó, R.D. Piacentini, B. Niklasson
AntecedentesLa dermatitis por contacto fotoalérgica (DCFA) a oxibenzona fue por primera vez documentada en 1980, siendo hoy el principal fotoalérgeno de Estados Unidos de América, Canadá y el cuarto en Europa. En Argentina no existen datos ni publicaciones con respecto a esta reacción cutánea.ObjetivoConocer el porcentaje de pacientes con fotosensibilidad afectados con fotoalergia a oxibenzona.MetodologíaEstudio descriptivo de corte transversal. Un total de 35 pacientes con reacciones fotosensibles con prueba del fotoparche en el Centro de investigación del Hospital Público San Martín, en la ciudad de La Plata, fueron estudiados durante los años 2015 y 2016.ResultadosSe observó el 17,14% de DCFA, presentando 5 (14,28%) pacientes al menos una reacción positiva a oxibenzona en el test de fotoparche, 4 pacientes solo en la zona irradiada con 5J/cm² (de UVA) y solo un paciente tanto en la zona irradiada como en la no irradiada.ConclusionesLa DCFA a protectores solares compuestos por oxibenzona es frecuente y se presume infradiagnosticada debido a la falta de estudios confirmatorios como la prueba del fotoparche. El porcentaje de sensibilización varía de acuerdo con cada región, sobre todo por las distintas composiciones y costumbres de uso en protectores solares, cosméticos y tratamiento tópico.BackgroundPhotoallergic contact dermatitis (PACD) to oxybenzone was reported for the first time in 1980. Oxybenzone is the most common photoallergen in the United States and Canada and the fourth most common .in Europe. There are no studies or data on the prevalence of oxybenzone PACD in Argentina.ObjectiveTo determine the proportion of photosensitive patients with PACD to oxybenzone.MethodsWe conducted a descriptive cross-sectional study of 35 patients with photosensitivity reactions confirmed by photopatch testing at the Research Center of Hospital Público San Martín in La Plata, Argentina, in 2015 and 2016.ResultsPACD was identified in 6 patients (17.14%). Five of these (14.28%) had at least one positive reaction to oxybenzone in the photopatch test; 4 had a reaction at irradiated sites only (5 J/cm² UVA) and one had a reaction at both irradiated and nonirradiated sites.ConclusionsPACD to sunscreens containing oxybenzone is common and is probably underdiagnosed due to a lack of confirmation by photopatch tests or other diagnostic tools. Sensitization rates vary according to region and are influenced by sunscreen ingredients and variations in the use of sunscreen products, cosmetics, and topical drugs.

Graphical abstract

Estudio transversal acerca de los hábitos de prescripción en alopecia androgénica de los dermatólogos en España en 2017

Publication date: Available online 12 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): C. Pindado-Ortega, D. Saceda-Corralo, D. Buendía-Castaño, P. Fernández-González, Ó.M. Moreno-Arrones, P. Fonda-Pascual, A. Alegre-Sánchez, A.R. Rodrigues-Barata, S. Vañó-Galván
IntroducciónA pesar de que los únicos fármacos con indicación aprobada en nuestro país para la alopecia androgénica (AGA) son minoxidil tópico y finasterida oral, es común la utilización de numerosas terapias fuera de indicación, provocando una gran variabilidad en el manejo de estos pacientes. El objetivo principal de este trabajo fue describir los hábitos de prescripción de los dermatólogos en España en AGA masculina (MAGA) y AGA femenina (FAGA).Material y métodosEstudio descriptivo transversal mediante cuestionarios digitales autocumplimentados por dermatólogos que ejercen en territorio español.ResultadosSe incluyeron las respuestas de un total de 241 dermatólogos. En MAGA los tratamientos más utilizados fueron en este orden: minoxidil tópico (98%), finasterida oral (96%), nutricosméticos (44%), finasterida tópica (37%), dutasterida oral (33%), plasma rico en plaquetas (14%) y láser de baja potencia (8%). En FAGA premenopáusica: minoxidil tópico (98%), anticonceptivos orales (81%), nutricosméticos (72%), acetato de ciproterona (58%), finasterida oral (39%), finasterida tópica (39%), espironolactona (27%), plasma rico en plaquetas (20%), dutasterida oral (20%), flutamida oral (18%) y láser de baja potencia (7%). En FAGA posmenopáusica: minoxidil tópico (98%), finasterida oral (84%), nutricosméticos (68%), finasterida tópica (50%), dutasterida oral (35%), plasma rico en plaquetas (21%), espironolactona (16%), acetato de ciproterona (16%), flutamida oral (9%) y láser de baja potencia (9%). Como limitaciones de nuestro estudio, no se incluyeron terapias novedosas para AGA como minoxidil oral o microinyecciones de dutasterida.ConclusionesLos agentes terapéuticos más utilizados en MAGA y FAGA posmenopáusica por los dermatólogos en España fueron minoxidil tópico, finasterida oral y nutricosméticos, mientras que en FAGA premenopáusica fueron minoxidil tópico, anticonceptivos orales y nutricosméticos.BackgroundTopical minoxidil and oral finasteride are the only drugs approved for the treatment of androgenetic alopecia (AGA) in Spain. However, the management of this condition is highly variable because numerous treatments are used off-label. The main aim of this study was to describe the prescribing habits of dermatologists in Spain for male AGA (MAGA) and female AGA (FAGA).Material and methodsDescriptive cross-sectional study using online questionnaires completed by dermatologists working in Spain.ResultsThe responses of 241 dermatologists were analyzed. The most common treatments prescribed for MAGA were minoxidil (98%), oral finasteride (96%), nutricosmetics (44%), topical finasteride (37%), oral dutasteride (33%), platelet-rich plasma (14%), and low-level laser therapy (8%). For premenopausal FAGA, the most common treatments were topical minoxidil (98%), oral contraceptives (81%), nutricosmetics (72%), cyproterone acetate (58%), oral finasteride (39%), topical finasteride (39%), spironolactone (27%), platelet-rich plasma (20%), oral dutasteride (20%), oral flutamide (18%), and low-level laser therapy (7%). Finally, for postmenopausal FAGA, the most common treatments prescribed were topical minoxidil (98%), oral finasteride (84%), nutricosmetics (68%), topical finasteride (50%), oral dutasteride (35%), platelet-rich plasma (21%), spironolactone (16%), cyproterone acetate (16%), oral flutamide (9%), and low-level laser therapy (9%).A limitation of our study is that we did not analyze novel AGA treatments such as oral minoxidil and dutasteride mesotherapy.ConclusionsThe most common treatments prescribed for AGA by dermatologists in Spain are topical minoxidil, oral finasteride, and nutricosmetics for MAGA and postmenopausal FAGA and topical minoxidil, oral contraceptives, and nutricosmetics for premenopausal FAGA.

Utilidad de la ecografía en el diagnóstico diferencial de un nódulo doloroso en el tórax

Publication date: Available online 9 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): D. Morgado-Carrasco, S. Gómez, L. Alós, P. Giavedoni

Teledermatología urbana: concepto, ventajas y desventajas

Publication date: Available online 9 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): G. Romero-Aguilera, L. Ferrandiz, D. Moreno-Ramírez

Disección ganglionar en el paciente con melanoma y metástasis en el ganglio centinela: propuesta de decisión basada en la evidencia actual

Publication date: Available online 9 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): D. Moreno-Ramírez, A. Boada, L. Ferrándiz, E. Samaniego, G. Carretero, E. Nagore, P. Redondo, P. Ortiz-Romero, J. Malvehy, R. Botella-Estrada
La reciente publicación de los resultados de ensayos clínicos en los que la disección ganglionar no ha demostrado beneficio de supervivencia en pacientes con metástasis en el ganglio centinela plantea la necesidad de modificar el tratamiento del paciente con melanoma. El presente trabajo aporta una actualización de la evidencia sobre diferentes aspectos necesarios (vías de progresión metastásica, factores predictores, tratamiento adyuvante, etc.) para la toma de decisiones en el paciente con melanoma y metástasis en el ganglio centinela y plantea un algoritmo de toma de decisiones para este escenario clínico. La evidencia actualmente disponible respalda el abandono de la disección ganglionar en aquellos pacientes con metástasis de bajo riesgo en el ganglio centinela (carga tumoral en el ganglio centinela inferior o igual a 1mm).Recent publication of the results of clinical trials in which lymph node dissection was not associated with any survival benefit in patients with sentinel node metastasis makes it necessary to reconsider the treatment of patients with melanoma. This article provides an update on the available evidence on the diverse factors (routes of metastatic spread, predictors, adjuvant therapy, etc.) that must be considered when treating patients with sentinel node-positive melanoma. The authors propose a decision-making algorithm for use in this clinical setting. The current evidence no longer supports lymph node dissection in patients with low-risk sentinel node metastasis (sentinel node tumor load ≤1mm).

Pelillos a la mar

Publication date: Available online 12 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): S. Sánchez-Pérez, C. Torres-Sánchez, V. Alonso-Usero

Erupción dermatomiositis-like en una paciente tratada con hidroxiurea

Publication date: Available online 7 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): E. Moreno-Artero, J.J. Paricio, J. Antoñanzas, A. España

FR- Rapamicina tópica adyuvante al tratamiento con láser en malformaciones capilares

Publication date: Available online 7 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): A. Alegre-Sánchez, P. Boixeda

Regresión completa espontánea del tumor primario en el carcinoma de células de Merkel

Publication date: Available online 7 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): J. Marcoval, F. Valentí-Medina, R.M. Penín, J. Bermejo

Aplicación del colgajo de keystone en dermatología. Experiencia clínica en 18 pacientes

Publication date: Available online 4 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): R. Aragón-Miguel, M. Gutiérrez-Pascual, A. Sánchez-Gilo, J. Sanz-Bueno, F.J. Vicente-Martin
Introducción y objetivosEl colgajo de keystone es un colgajo fasciocutáneo cuya vascularización proviene de las arteriolas perforantes musculares. Su aplicación en dermatología es para cubrir defectos en zonas de piel poco distensible (miembros inferiores, superiores y de la espalda). Presentamos nuestra experiencia clínica y los resultados quirúrgicos del centro.Material y métodosEstudio descriptivo retrospectivo de pacientes con tumores cutáneos malignos en miembros inferiores en los que se realizó el colgajo de keystone.ResultadosSe operaron 18 pacientes con una edad media de 77,83 años. Se realizaron 17 mediante la técnica propuesta por Behan y uno con la técnica modificada de Moncrieff. El 38,8% de los tumores extirpados fueron carcinomas basocelulares, el 33,3% carcinomas epidermoides y el 27,7% tumores malignos pigmentados. El 72,22% presentaba algún factor de riesgo cardiovascular. Se observó un 38,8% de complicaciones menores y ningún caso de necrosis parcial o total del colgajo.ConclusionesConsideramos que el colgajo de keystone es una buena alternativa terapéutica a otros colgajos e injertos para la reconstrucción de defectos en miembros inferiores. Los resultados estéticos y funcionales son buenos, con una tasa de éxito elevada.Introduction and objectivesThe keystone flap is a fasciocutaneous flap supplied by perforating arteries. It is used in dermatology to repair surgical defects in areas with low skin extensibility (the upper and lower limbs and the back). We review the clinical experience gained with keystone flap reconstruction at our hospital and report on the surgical outcomes.Material and methodsDescriptive retrospective study of patients with malignant skin tumors on the lower limbs who underwent keystone flap reconstruction.ResultsEighteen patients (mean age, 77.83 years) underwent keystone flap reconstruction using the Behan technique in 17 cases and the modified Moncrieff technique in one. Basal cell carcinomas accounted for 38.8% of the tumors excised, squamous cell carcinomas 33.3%, and malignant pigmented tumors 27.7%. Cardiovascular risk factors were observed in 72.2% of patients. Minor complications occurred in 38.8% of patients, and there were no cases of partial or total flap necrosis.ConclusionsWe consider the keystone flap to be a good alternative to other flaps and grafts for the surgical reconstruction of lower limb defects. The success rate was high, and the cosmetic and functional outcomes were good.

Graphical abstract

Tratamiento de úlcera venosa refractaria mediante la «interrupción terminal de la fuente de reflujo»

Publication date: Available online 4 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): M. Mendieta-Eckert, J.L. Azpiazu-Macho, N. Landa-Gundin

FR- Riesgo de cáncer cutáneo no melanoma en pacientes hemodializados

Publication date: Available online 3 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): P. Aguayo Carreras, J. Tercedor Sánchez, R. Ruiz Villaverde

Lesión solitaria en el lateral del segundo dedo de la mano

Publication date: Available online 3 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): F.J. García-Martínez, I. López-Martín

Proyección internacional de Actas Dermo-Sifiliográficas

Publication date: April 2018
Source:Actas Dermo-Sifiliográficas, Volume 109, Issue 3
Author(s): S. Arias-Santiago, Y. Gilaberte

Solitary Filiform Papule in the Left Nasal Vestibule

Publication date: April 2018
Source:Actas Dermo-Sifiliográficas, Volume 109, Issue 3
Author(s): S. Lopes, T. Baudrier, F. Azevedo

Síndrome de Gorlin

Publication date: April 2018
Source:Actas Dermo-Sifiliográficas, Volume 109, Issue 3
Author(s): I. Palacios-Álvarez, R. González-Sarmiento, E. Fernández-López
El síndrome de Gorlin es una enfermedad infrecuente de herencia autosómica dominante producida por mutaciones en genes de la vía de señalización Sonic Hedgehog, entre los que destaca PTCH1. Se caracteriza por el desarrollo de múltiples carcinomas basocelulares en edades tempranas, que pueden ir asociados a otras manifestaciones cutáneas como pits palmoplantares, o a manifestaciones extracutáneas, entre las que destacan los queratoquistes odontogénicos y el meduloblastoma. El papel del dermatólogo es importante en la sospecha de este síndrome, pero suele ser necesario un equipo multidisciplinar en el diagnóstico, seguimiento y en el tratamiento de estos pacientes. El tratamiento dermatológico puede ser complicado debido al alto número de carcinomas basocelulares y a su extensión. En los últimos años se han desarrollado nuevos fármacos que inhiben la vía Sonic Hedgehog y parecen prometedores para estos pacientes, aunque su eficacia está limitada por los efectos secundarios y la creación de resistencias.Gorlin syndrome is a rare autosomal dominant disease caused by mutations in the sonic hedgehog signaling pathway. Of particular importance is the PTCH1 gene. The disease is characterized by the development of multiple basal cell carcinomas at young ages. These tumors may present with other skin manifestations such as palmoplantar pits and with extracutaneous manifestations such as odontogenic keratocysts and medulloblastoma. Although the dermatologist may be key for recognizing clinical suspicion of the syndrome, a multidisciplinary team is usually necessary for diagnosis, treatment, and follow-up. Skin treatment may be complicated due to the large number of basal cell carcinomas and the extent of involvement. In recent years, new drugs that inhibit targets in the sonic hedgehog pathway have been developed. Although these agents appear promising options for patients with Gorlin syndrome, their efficacy is limited by adverse effects and the development of resistance.

Graphical abstract

Programme scientifique du 31e Congrès de l’ADF

Publication date: Available online 14 April 2018
Source:Annales de Dermatologie et de Vénéréologie

Traitement des toxidermies graves

Publication date: Available online 13 April 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): S. Ingen-Housz-Oro, T.-A. Duong, N. de Prost, A. Colin, L. Fardet, B. Lebrun-Vignes, A. Barbaud, O. Chosidow, P. Wolkenstein

Localisation cutanée de la maladie de Rosai Dorfmann

Publication date: Available online 11 April 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): R. Doghri, Y. Houcine, M. Driss, R. Sellami, L. Charfi, K. Mrad

Professor Giampaolo Velo 31.4.1943–17.8.2017

A mechanistic approach to explore the neuroprotective potential of zonisamide in seizures

Abstract

Background

Epilepsy, a disease of the brain, is one of the most common serious neurological conditions. It is associated with a group of processes which alter energy metabolism, interrupt cellular ionic homeostasis, cause receptor dysfunction, activate inflammatory cascade, alter neurotransmitter uptake and result in neuronal damage. The increasing knowledge and understanding about the basis of neuronal changes in epilepsy lead to investigate the mechanistic pathway of neuroprotective agents in epilepsy. With this background, the present study is designed to reveal the molecular and biochemical mechanisms involved in the neuroprotective potential of zonisamide in epilepsy.

Methods

Seizure-induced neuronal damage was produced by maximal electroshock seizures in animals. The oxidative stress and neuroinflammatory and apoptotic markers were assessed in the brain tissue of animals.

Results and discussion

The present findings revealed that zonisamide treatment prevented the development of seizures in animals. Seizures-induced free radicals production and neuroinflammation were markedly ameliorated by zonisamide administration. In conclusion, the present study demonstrated the mechanisms behind the strong neuroprotective potential of zonisamide against seizures by attenuating the oxidative stress, inflammatory cascade and neuronal death associated with progression of seizures. It can be further developed as a neuroprotective agent for epilepsy and other neurodegenerative disorders.

Curcumin ameliorates palmitate-induced inflammation in skeletal muscle cells by regulating JNK/NF-kB pathway and ROS production

Abstract

Curcumin, a natural polyphenol compound, has the beneficial effects on several diseases such as metabolic syndrome, cancer, and diabetes. The anti-inflammatory property of curcumin has been demonstrated in different cells; however, its role in prevention of palmitate-induced inflammation in skeletal muscle C2C12 cells is not known. In this study, we examined the effect of curcumin on the inflammatory responses stimulated by palmitate in C2C2 cells. The results showed that palmitate upregulated the mRNA expression and protein release of IL-6 and TNF-α cytokines in C2C12 cells, while pretreatment with curcumin was able to attenuate the effect of palmitate on inflammatory cytokines. The anti-inflammatory effect of curcumin was associated with the repression of phosphorylation of IKKα-IKKβ, and JNK. Palmitate also caused an increase in reactive oxygen species (ROS) level that curcumin abrogated it. Collectively, these findings suggest that curcumin may represent a promising therapy for prevention of inflammation in skeletal muscle cells.

Probiotic mixture of Lactobacillus and Bifidobacterium alleviates systemic adiposity and inflammation in non-alcoholic fatty liver disease rats through Gpr109a and the commensal metabolite butyrate

Abstract

Aims

The study explored the systemic adiposity and inflammation through Gpr109a and the commensal metabolite butyrate during the treatment of non-alcoholic fatty liver disease rats with the probiotic mixture of Lactobacillus and Bifidobacterium for 16 weeks.

Methods

Fifteen male SD rats were randomly divided into three groups of five rats each: normal control group (basal feed), high-fat diet (HFD) feeding group (83% basal feed + 10% lard oil + 5% sucrose + 1.5% cholesterol + 0.5% cholate), and probiotic mixture intervention group (HFD + 0.6 g kg⁻¹ day⁻¹ probiotic mixture). Body composition, serum lipids, serum inflammatory markers, Gpr109a, and the commensal metabolite butyrate were assessed.

Results

Compared with HFD group, probiotic mixture significantly reduced body weight and the levels of serum FFA, TG, ALT, IL-1β, and IL-18 (P < 0.05). The levels of Gpr109a and the commensal metabolite butyrate also changed significantly (P < 0.05).

Conclusions

Probiotic mixture might inhibit systemic adiposity and inflammation through Gpr109a and the commensal metabolite butyrate in response to the insult of HFD.

Brazilian green propolis hydroalcoholic extract reduces colon damages caused by dextran sulfate sodium-induced colitis in mice

Abstract

This study investigated the effects of Brazilian green propolis hydroalcoholic extract (BPE) in 3% w/v dextran sodium sulfate (DSS)-induced colitis in mice. The effects of BPE (3, 30 and 300 mg/kg, p.o, by 7 days) on the morphological (colon length and colon weight), clinical (disease activity index and weight loss), microscopic (histological score and mucin levels) and biochemical parameters were determined. The effects of BPE (300 mg/kg, p.o) in the gastrointestinal transit of mice were also evaluated. As expected, the DSS ingestion damaged the colonic tissue, lowered the body weight, decreased the mucin levels, increased MPO activity, reduced SOD activity and GSH amount. In contrast, the treatment with BPE (300 mg/kg) significantly reduced macroscopic colonic injury and the mucosal damage in colon on histopathological examination and reversed the decrease in mucin levels induced by DSS. It also significantly normalized the SOD activity and the levels of GSH, but did not elicit any effect on MPO activity in the colon. In addition, BPE did not change the gastric emptying or the intestinal transit rate of mice. Together, these results suggested that BPE reduced the signs of DSS-induced colitis in mice through maintenance of intestinal mucin barrier and favoring intestinal antioxidant defenses.

Curcumin–galactomannoside complex inhibits pathogenesis in Ox-LDL-challenged human peripheral blood mononuclear cells

Abstract

Oxidised low-density lipoprotein (ox-LDL) is a pro-atherogenic molecule, which induces inflammatory response and contributes to the pathogenesis of vascular dysfunction to atherosclerosis. The aim of the present study was to explore the anti-inflammatory effect of a novel bioavailable formulation of curcumin as 'curcumagalactomannosides' (CGM) against ox-LDL-induced inflammatory responses in human peripheral blood mononuclear cells (hPBMCs). Curcumagalactomannosides was made from natural curcumin using the soluble dietary fibre (galactomannans) derived from fenugreek seeds (Trigonella foenumgracum) and the hPBMCs were isolated from healthy human volunteers. The cells were cultured in collagen-coated plates at 37 °C and grouped as Group I (Control), Group II (ox-LDL treated) and Group III (ox-LDL + CGM treated). Further analysis of inflammatory markers, reactive oxygen species and mRNA expression levels indicated significantly increased expressions of iNOS, TNF-α, IL-6 and VCAM-1 in ox-LDL-treated group along with the nuclear translocation of NF-κB. Other inflammatory markers such as LOX, PGE2, total COX and lipid peroxidation level were also found to be significantly (p < 0.05) increased upon ox-LDL treatment. The treatment with CGM on the other hand was found to down-regulate and reverse the ox-LDL-induced alterations indicating its potential anti-inflammatory effect on hPBMCs via. NF-κB signalling pathway.

Inosine improves cognitive function and decreases aging-induced oxidative stress and neuroinflammation in aged female rats

Abstract

In the present study, the effect of inosine was evaluated on learning and memory of 18 months old aged female rats. Inosine (50, 100 and 200 mg/kg; i.p.) was administered to separate groups of rats for 15 successive days. Donepezil (1 mg/kg; i.p.), an acetylcholinesterase inhibitor, was used as a standard drug. Behavioral models such as Morris water maze and elevated plus maze were used to evaluate the effect of drugs on learning and memory of rats. After behavioral studies, animals were killed and their brain was isolated and further processed for estimation of various biochemical parameters such as acetylcholinesterase activity, oxidative stress markers, proinflammatory marker and histological examinations. Inosine (100 and 200 mg/kg) significantly improved learning and memory of aged rats. Further, inosine significantly reduced lipid peroxidation and nitrite, and increased the levels of reduced glutathione and superoxide dismutase. However, no significant difference in AChEs activity was observed in inosine-treated rats as compared to aged control rats. TNF-α level was found to be ameliorated in aged rats by inosine. Histopathological evaluation showed that inosine-treated aged rats have less number of pyknotic neurons in hippocampal CA1 region as compared to aged control rats. In conclusion, inosine significantly improved learning and memory of aged female rats possibly through its antioxidant as well as anti-inflammatory effect and improvement of neuronal survival in the hippocampal CA1 region. However, additional studies are required to further explore the downstream signaling pathways involved in the neuroprotective effect of inosine in aged animals.

Gastrodin microinjection suppresses 6-OHDA-induced motor impairments in parkinsonian rats: insights into oxidative balance and microglial activation in SNc

Abstract

Purpose of the research

In this study, we appraised the effect of pre-treatment with intra-cerebro ventricular (i.c.v) microinjection of gastrodin (Gst) on catalepsy, motor imbalance, substantia nigra pars compacta (SNc) myeloperoxidase (MPO) activity, lipid peroxidation levels, nitric oxide (NO) production and total antioxidant capacity (TAC) in 6-hydroxydopamine (6-OHDA) rats model of PD.

Materials and methods

Male Wistar rats were pre-treated with i.c.v microinjections of Gst (20, 40 and 80 μg/3 μl/rat) for five consecutive days. Then, catalepsy and motor balance were induced by unilateral infusion of 6-OHDA (8 μg/2 μl/rat) into the SNc. The anti-cataleptic and motor balance improving effect of Gst was assessed by the Bar test and Rotarod 3 weeks after neurotoxin injection, respectively. SNc MPO activity and lipid peroxidation levels, NO production and TAC were assessed at the end of behavioral experiments.

Results

Our data demonstrated that Gst pre-treatment significantly (p < 0.001) was prevented motor in-coordination and catalepsy in neurotoxin lesioned rats. The most motor improving effect was seen at 80 μg Gst (p < 0.001). Pre-treatment of parkinsonian rats with Gst meaningfully (p < 0.001) was suppressed MPO activity, lipid peroxidation and NO production. Furthermore, the TAC level in the SNc was increased (p < 0.001) in Gst-microinjected rats about to the normal non-parkinsonian animals.

Major conclusions

In summary, pre-treatment with Gst abolished 6-OHDA-induced catalepsy and improved motor incoordination by decreasing: SNc MPO activity, lipid peroxidation levels and NO production, and restoring SNc levels of TAC to the levels of healthy rats.

Graphical abstract

Flavonoid quercetin–methotrexate combination inhibits inflammatory mediators and matrix metalloproteinase expression, providing protection to joints in collagen-induced arthritis

Abstract

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation of synovial tissues in joints, leading to progressive destruction of cartilage and joints. The disease-modifying anti-rheumatic drugs currently in use have side-effects. Thus, there is an urgent need for safe anti-inflammatory therapies for RA. This study aimed to evaluate the therapeutic effect of the flavonoid quercetin on arthritis in mice immunized with type II collagen (CII). An arthritis model was established in C57/BL6 mice by intradermal administration of chicken CII mixed with Freund's complete adjuvant. Quercetin (30 mg/kg orally) and methotrexate (0.75 mg intraperitoneally twice a week) were administered to investigate their protective effects against collagen-induced arthritis (CIA). Levels of tumour necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), IL-6, and the matrix metalloproteinases (MMP), 3, and 9 were detected to assess the anti-inflammatory effect of quercetin. The mRNA expression of MMP3, MMP9, CCL2, and TNF-α was also measured by quantitative real-time PCR. Quercetin significantly alleviated joint inflammation by reducing the levels of circulating cytokines and MMPs. There was a significant decrease in the expression of TNFα and MMP genes in the ankle joints of arthritic mice. A significant reduction in the levels of knee-joint inflammatory mediators were observed with combined quercetin and methotrexate treatment. Thus, quercetin has the potential to prevent joint inflammation and could be used as an adjunct therapy for RA patients who have an inadequate response to anti-rheumatic monotherapy.

Versorgung geriatrischer Patienten am Beispiel Bronchialkarzinom und neue Ansätze zur Versorgungsforschung

Läsionale Therapieoptionen beim maligen Melanom

Zusammenfassung

Hintergrund

In den letzten Jahren kam es bezüglich der systemischen Therapie des metastasierten malignen Melanoms durch die Einführung der Immuncheckpointinhibitoren und die Möglichkeit der zielgerichteten Therapie mit BRAF- und MEK-Inhibitoren zu einer revolutionären Entwicklung. Problematisch können allerdings die Nebenwirkungen der Therapien sein, und zudem ist man noch weit davon entfernt, allen Patienten ein Benefit mit diesen Therapien zu bescheren. Viele Melanompatienten entwickeln im metastasierten Stadium kutane, subkutane oder Lymphknotenmetastasen, die einer lokalen oder intraläsionalen Therapie zugänglich sind.

Material und Methode

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed zum Thema „Läsionale Therapie beim malignen Melanom".

Ergebnisse und Schlussfolgerung

Auch im Bereich der läsionalen Therapie des metatasierten malignen Melanoms konnten Fortschritte mit neuen Therapiestrategien erreicht werden. Von besonderem Interesse sind hier die oftmals aktuell in klinischen Studien getesteten Kombinationstherapien, die unter Umständen die Möglichkeit der Resistenzüberwindung gegenüber einer Checkpointinhibitor-Monotherapie ermöglichen.

FGFR-Inhibition beim cholangiozellulären Karzinom

Zervixkarzinom in der Schwangerschaft

Zusammenfassung

Hintergrund

Das Zervixkarzinom stellt in der Schwangerschaft das am häufigsten diagnostizierte gynäkologische Malignom dar. Da eine leitliniengerechte Therapie analog der Behandlung nichtschwangerer Patientinnen in den meisten Fällen nicht mit dem Erhalt einer Schwangerschaft vereinbar wäre, ist nach interdisziplinärer Diskussion des Falls die Erstellung eines individuellen Therapiekonzepts unter Berücksichtigung des Patientenwunsches von zentraler Bedeutung.

Ergebnisse

Prinzipiell wird die Therapie neben dem FIGO-Stadium (FIGO International Federation of Gynecology and Obstetrics) der Erkrankung und dem Nodalstatus maßgeblich von zwei weiteren Faktoren bestimmt: dem Schwangerschaftsalter bei Erstdiagnose sowie dem Wunsch eines Schwangerschafts- bzw. Fertilitätserhalts seitens der Patientin. Während bei klinischem Verdacht auf eine zervikale Neoplasie diagnostische Maßnahmen wie die Kolposkopie und Biopsie auch in der Schwangerschaft jederzeit möglich sind, sollten operative Maßnahmen erst nach Abschluss des 1. Trimenons erfolgen. Zur möglichst präzisen Risikoeinschätzung ist ab Stadium FIGO IB1 eine laparoskopische pelvine Lymphonodektomie empfohlen. Bei höhergradigen FIGO-Stadien kann die Durchführung einer neoadjuvanten Chemotherapie mit einem Cisplatin-haltigen Regime das Fortführen der Schwangerschaft bis zum Erreichen der fetalen Reife ermöglichen.

Schlussfolgerung

Trotz der insgesamt spärlichen Datenlage scheint ein Schwangerschaftserhalt in den meisten Fällen möglich zu sein, ohne signifikant die Prognose der Patientin zu verschlechtern.

Positive und negative Veränderungen im Leben nach der Krebsdiagnose

Zusammenfassung

Fragestellung

Diese Studie ging der Frage nach, welche positiven und negativen Veränderungen von erwachsenen Krebspatienten während der ersten 2 Jahre nach der Diagnose erlebt werden.

Methoden

Patienten wurden zu Beginn des Krankenhausaufenthalts eingeschlossen und kurz vor Entlassung sowie 2 Jahre später nachbefragt. Sie wurden gebeten anzugeben, in welchen Lebensbereichen es bei ihnen negative oder positive Ereignisse gegeben habe und welcher Art diese gewesen seien. Die Antworten wurden wörtlich erfasst und anschließend in Kategorien zusammengefasst. Als mögliche Prädiktoren von Verschlechterungen wurden Alter, Geschlecht und Tumorentität mittels multipler logistischer Regression untersucht.

Ergebnisse

Es nahmen 447 Patienten an der Befragung teil. Sie berichteten positive Ereignisse v. a. in den Bereichen Freunde/Verwandte (66 %), Hobbys, Urlaube, sportliche Aktivitäten (64 %) und Partnerschaft (61 %). Negative Ereignisse bezogen sich besonders häufig auf Sexualität (54 %), Gesundheit (35 %) und die finanzielle Situation (32 %). Über Verschlechterungen der Sexualität klagten v. a. Männer (Odds Ratio [OR] 4,1; 95 %-Konfidenzintervall [95 %-KI] 2,0–8,5; p < 0,01), Patientinnen mit gynäkologischen Tumoren (OR 2,6; 95 %-KI 1,1–6,2; p = 0,04), Patienten mit Prostatakarzinom (OR 8,3; 95 %-KI 3,9–17,7; p < 0,01) und mit anderen urologischen Tumoren (OR 2,3; 95 %-KI 1,1–5,0; p = 0,04). Ältere Patienten gaben seltener Verschlechterungen in der Sexualität (OR 0,5; 95 %-KI 0,3–0,9; p = 0,01) und bei finanziellen Problemen (OR 0,6; 95 %-KI 0,4–0,9; p = 0,01) an. Im Bereich der Gesundheit gab es keine Hinweise auf einen Zusammenhang von Alter, Geschlecht oder Tumorentität mit negativen Ereignissen. Am häufigsten genannt wurden hier Schmerzen, Probleme mit dem Stütz- und Bewegungsapparat, psychische Probleme, eingeschränkte Beweglichkeit, komorbide internistische Erkrankungen und Fatigue.

Schlussfolgerung

In der Nachsorge sollte nicht nur auf gesundheitliche Themen eingegangen werden, sondern auch auf mögliche finanzielle und sexuelle Probleme der Betroffenen.

Strahlenbelastung in der Schwangerschaft

Zusammenfassung

Hintergrund

Eine Strahlenexposition in einer Schwangerschaft ist häufig mit einer starken Verunsicherung der betroffenen Patientin verbunden. Die für das Kind mit der Strahlenexposition verbundenen Risiken sind stark abhängig von der Art der Exposition und der untersuchten Region.

Ziel

Die Risiken der Strahlenexposition einer schwangeren Patientin werden dargestellt und Möglichkeiten des Umgangs mit strahlenexponierten Schwangeren aufgezeigt.

Material und Methoden

Diese Arbeit basiert auf einer selektiven Literaturrecherche und einer Analyse der Berichte und Empfehlungen der International Commission on Radiological Protection, der UN Scientific Committee reports, der deutschen Strahlenschutzkommission und der Deutschen Gesellschaft für Medizinische Physik und Deutschen Röntgengesellschaft.

Ergebnisse und Diskussion

Bei Projektionsaufnahmen sind die bei korrekter Anwendung auftretenden Expositionen und das Risiko für das ungeborene Kind gering. Bei Anwendungen der Computertomographie, der interventionellen Radiographie, der nuklearmedizinischen Diagnostik und Therapie sowie der Strahlentherapie können die Dosiswerte in einigen Fällen mit gewissen Risiken verbunden sein und müssen daher genauer betrachtet werden. Die Risiken werden dargestellt und eine Vorgehensweise zur Bewertung der Strahlenexposition gegeben. Die notwendigen Überlegungen zu einem möglichen Schwangerschaftsabbruch werden diskutiert.

A randomised controlled trial of the clinical effectiveness of multi‐layer silicone foam dressings for the prevention of pressure injuries in high‐risk aged care residents: The Border III Trial

International Wound Journal, EarlyView.

Cicer arietinum extract ameliorate γ-irradiation disorders via modulation of oxidative/antioxidative pathway

Publication date: Available online 14 April 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Amany A. Sayed, Osama A. Abbas, Mona A. Saad, Mohamed-Assem S. Marie
Ionized radiations trigger thoughtful adverse hazards through multiple organ dysfunctions. Recently, antioxidant-based biodrugs are used to prevent and treat ionizing radiation hazards. The present study aimed to investigate the prospective ameliorative effect of Cicer arietinum extract (CAE) against γ-irradiation and the pathway of this amelioration in male albino rats. Twenty four rats were allocated into four groups; (i) control group, (ii) CAE group in which rats treated with a dosage of 500 mg CAE/kg b.wt, (iii) γ-irradiated group in which rats exposed to 6Gy γ-irradiation, (iv) γ-irradiated+CAE group; rats of this group treated with CAE 1 h post exposure. All rats treated for 21 days. Liver, kidney and femoral bone were rapidly excised and homogenized for the biochemical analysis. Energy dispersive X-ray (EDX) and inductively coupled plasma emission spectrometer (ICP) analyses exhibit that γ-irradiation elicits significant change in the essential trace elements content in liver, kidney, and bone. Further, significant increases in TBARS and H2O2 contents accompanied by significant decreases in GSH, SOD, CAT, and GPx activities in liver, kidney and bone tissues were recorded in the γ-irradiated rats compared to control group. Additionally, marked reduction in the thickness of cortical bone was recorded in rats exposed to γ-irradiation. Conversely, CAE (500 mg/kg b.wt, p.o) administration for 21 days to γ-irradiated rats effectively reverses most of the altered parameters of the γ-irradiated rats. In conclusion, the present findings suggested that CAE is a potential agent that can be used against radiation hazards. This effect may be owing to its antioxidant mechanism, as CAE has an inhibitory effect against hydrogen peroxide (H2O2) and superoxide radical (O2^·−) beside its ferric reducing antioxidant power (FRAP). This finding recommended that CAE can be utilized clinically to mitigate ionized radiation-induced hazard effects.

Epidemiology of pediatric nickel sensitivity: Retrospective review of North American Contact Dermatitis Group (NACDG) data 1994-2014

Nickel is a common allergen responsible for allergic contact dermatitis.

A comparative study on defluoridation capabilities of biosorbents: isotherm, kinetics, thermodynamics, cost estimation, and eco-toxicological study

Abstract

The present study aims towards fluoride remediation from synthetic water using steam-activated carbon of Aegle marmelos (bael shell/wood apple) (BAC) and Parthenium hysterophorus (PHAC) according to batch sorption techniques. The impact of different parametric conditions viz. initial fluoride concentration (4–12 mg/L), time (0–5 h), temperature (293.15–333.15 K), adsorbent dosage (4–14 g/L), pH (4–9), and RPM (150–350) were considered for both the adsorbents. Maximum defluoridation of 89% was achieved by BAC at a concentration of 10 mg/L, adsorbent dose 6 g/L, pH 5, temperature 313.15 K, agitation speed 250 rpm, and contact time 9 h, whereas PHAC attained maximum removal of 78% at an initial concentration of 8 mg/L, adsorbent dose 10 g/L, pH 4, temperature 313.15 K, and contact time 12 h. Instrumental analysis by SEM, EDX, and FTIR confirmed about the fluoride binding ability of the adsorbents. The Langmuir isotherm model provided the best fit (R² = 0.9962 and 0.9945) to the removal process with maximum adsorptive uptake of 16.85 and 6.22 mg/g by BAC and PHAC respectively. The adsorption phenomenon was found to obey pseudo-second-order kinetics. The endothermic, spontaneous, and feasible nature of the sorption process was confirmed by the thermodynamic study. The total costs of 1 kg adsorbent preparation were calculated as 1.122 USD and 1.0615 USD which helped us in determining the economic feasibility of the adsorbents in large-scale applications. The growth of Chlorella sorokiniana BTA 9031 was also observed to be affected by the fluoride solution. Comparing the removal efficiencies of both the adsorbents, it can be concluded that BAC shell proved to be an efficient adsorbent over PHAC for fluoride elimination from aqueous solution.

Graphical abstract

Defluoridation of aqueous solution using biochar derived from Aegle marmelos shell and Parthenium hysterophorus.

Monitoring OH-PCBs in PCB transport worker’s urine as a non-invasive exposure assessment tool

Abstract

In this study, we analyzed hydroxylated polychlorinated biphenyls (OH-PCBs) in urine of both PCB transport workers and PCB researchers. A method to monitor OH-PCB in urine was developed. Urine was solid-phase extracted with 0.1% ammonia/ methanol (v/v) and glucuronic acid/sulfate conjugates and then decomposed using β-glucuronidase/arylsulfatase. After alkaline digestion/derivatization, the concentration of OH-PCBs was determined by HRGC/HRMS-SIM. In the first sampling campaign, the worker's OH-PCB levels increased several fold after the PCB waste transportation work, indicating exposure to PCBs. The concentration of OH-PCBs in PCB transport workers' urine (0.55~11 μg/g creatinine (Cre)) was higher than in PCB researchers' urine (< 0.20 μg/g Cre). However, also a slight increase of OH-PCBs was observed in the researchers doing the air sampling at PCB storage area. In the second sampling, after recommended PCB exposure reduction measures had been enacted, the worker's PCB levels did not increase during handling of PCB equipment. This suggests that applied safety measures improved the situation. Hydroxylated trichlorobiphenyls (OH-TrCBs) were identified as a major homolog of OH-PCBs in urine. Also, hydroxylated tetrachlorobiphenyls (OH-TeCBs) to hydroxylated hexachlorobiphenyls (OH-HxCBs) were detected. For the sum of ten selected major indicators, a strong correlation to total OH-PCBs were found and these can possibly be used as non-invasive biomarkers of PCB exposure in workers managing PCB capacitors and transformer oils. We suggest that monitoring of OH-PCBs in PCB management projects could be considered a non-invasive way to detect exposure. It could also be used as a tool to assess and improve PCB management. This is highly relevant considering the fact that in the next 10 years, approx. 14 million tons of PCB waste need to be managed. Also, the selected populations could be screened to assess whether exposure at work, school, or home has taken place.

NaCl impact on Kosteletzkya pentacarpos seedlings simultaneously exposed to cadmium and zinc toxicities

Abstract

Data regarding NaCl impact on halophyte plant species exposed to a polymetallic contamination remain scarce. Seedlings of the salt marsh species Kosteletzkya pentacarpos were simultaneously exposed to cadmium (10 μM) and zinc (100 μM) in the absence or presence of 50 mM NaCl. Heavy metal exposure reduced plant growth and increased Cd and Zn concentrations in all organs. Cd and Zn accumulation reduced net photosynthesis in relation to stomatal closure, decreased in chlorophyll concentration and alteration in chlorophyll fluorescence-related parameters. Salinity reduced Cd and Zn bioaccumulation and translocation, with a higher impact on Cd than Zn. It mitigated the deleterious impact of heavy metals on photosynthetic parameters. NaCl reduced the heavy metal-induced oxidative stress assessed by malondialdehyde, carbonyl, and H₂O₂ concentration. Subcellular distribution revealed that Cd mainly accumulated in the cell walls, but NaCl increased it in the cytosol fraction in the leaf and in the metal-rich granule fraction in the roots. It had no impact on Zn subcellular distribution. The additional NaCl contributed to a higher sequestration of Cd on phytochelatins and stimulated glutathione synthesis. The positive impact of NaCl on K. pentacarpos response to polymetallic pollution made this species a promising candidate for revegetation of heavy metal-contaminated salt areas.

Performance of synthesized cast and electrospun PVA/chitosan/ZnO-NH 2 nano-adsorbents in single and simultaneous adsorption of cadmium and nickel ions from wastewater

Abstract

The performance of synthesized cast and electrospun polyvinyl alcohol/chitosan/zinc oxide/aminopropyltriethoxylsilane (PVA/chitosan/ZnO-APTES) nano-adsorbents were compared in removal of Cd(II) and Ni(II) ions from wastewater. The adsorbents were characterized by SEM, BET, FTIR and TGA analyses. Furthermore, the swelling investigations were carried out to study the adsorbent stability in aqueous solution. The effect of several parameters such as contents of ZnO-NH₂, contact time, initial Cd(II) and Ni(II) concentration and temperature on the adsorption capacity was investigated in a batch mode. In comparison with cast adsorbent, nanofiber adsorbent indicated the better adsorption performance. The experimental data well fitted the double-exponential kinetic model. In single metal ion system, the maximum adsorption capacity of nanofiber for Cd(II) and Ni(II) ions is estimated to be 1.239 and 0.851 mmol/g, respectively, much higher than q_m of cast adsorbent for Cd(II) (0.625 mmol/g) and Ni(II) (0.474 mmol/g) ions. Thermodynamic parameters were investigated to identify the nature of adsorption process. In binary system of Cd(II)-Ni(II) ions, the inhibitory effect of competitive Cd(II) ion on the Ni(II) adsorption was greater than the inhibitory effect of competitive on the Cd(II) adsorption. The selectivity adsorption of both nanofiber and cast adsorbents was in order of Cd(II) > Ni(II).