Phyto-mediated synthesized multifunctional Zn/CuO NPs hybrid nanoparticles for enhanced activity for kidney cancer therapy: A complete physical and biological analysis

Publication date: Available online 6 July 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Yifeng Xue, Guoxin Yu, Zhengfei Shan, Zhonglian Li

Abstract

Cancer in human society is one of the most problematic health issue responsible for outnumbered deaths worldwide. The consumption of developed NPs in cancer diagnosis is a rapidly emerging field of bio-medical nanotechnology. Recent years, greener synthesized metal oxide hybrid nanoparticles have attracted great attention in cytotoxicity to different cancer therapy. Herein, we report that Duchesnea indica plant mediated green synthesis plant extract mediated Zn doped CuO (Zn/CuO) nanoparticles (NPs) prepared by hydrothermal method and these physico-chemical properties were characterized by XRD, UV-DRS, FTIR, and SEM with EDAX analytical techniques. The XRD pattern findings indicated that the crystal structure of the base CuO matrix are not distorted by the substitution of Cu²⁺ (0.73 Å) ions by Zn²⁺ (0.65 Å) ions. The average crystallite size of undoped and Zn/CuO NPs samples are found to be in between the range of 23 to 36 nm. And we can see that the Zn/CuO NPs are large aggregates, containing small particles with sizes of 100–300 nm with spherical shaped morphology by SEM and TEM microscopic images. The normal cell viability and cancer cell inhibition results on A-498 cancer cells and also normal human epithelial cells exhibited that no significant changes in the cell viability with normal kidney epithelial cells and doped NPs given excellent cell inhibition treated on A-498 kidney tumor cells.

Graphical Abstract

Transcriptomics and metabonomics analyses of maternal DEHP exposure on male offspring

Abstract

The objectives of this study were to evaluate the effect of maternal Di-2-ethylhexyl phthalate (DEHP) exposure on male offspring and to explore the mechanism of changes with the metabolic alterations and differential genes. Pregnant female Sprague-Dawley (SD) rats were intragastrically administered with 600 mg/kg body weight of DEHP or corn oil (CON) throughout pregnancy and lactation. The growth of male offspring was investigated until 14 weeks old, the indices of blood were detected, and mechanism was studied using metabonomics and transcriptomics. Compared with the CON group, body weight, body length, food intake, body fat weight, Lee's index, organ coefficient, blood lipids, and oral glucose tolerance test (OGTT) of male offspring were not significantly changed in maternal DEHP group. However, serum biochemical indexes such as alanine transaminase (ALT), total protein (TP), albumin (ALB), blood urea nitrogen (BUN), and creatinine (CREA) were markedly reduced in maternal DEHP group (p < 0.05). In addition, insulin level was elevated and catalase (CAT) level was decreased notably in maternal DEHP group compared with the CON group (p < 0.05). Furthermore, thyroxine (T₄) level was lower and thyroid stimulating hormone (TSH) level was higher in maternal DEHP group (p < 0.05). Metabonomics revealed seven principal metabolites were identified, including increased L-allothreonine, creatine, uric acid, retinyl ester, L-palmitoylcarnitine, and decreased glycocholic acid and LysoPC (18:3). Transcriptomics displayed 35 differential genes were involved in the mechanism of maternal DEHP exposure. Therefore, this research confirms the effect of a certain dose of maternal DEHP exposure on male offspring and understands exactly the mechanism of these changes with metabonomics and transcriptomics.

Impact of Focal White Matter Damage on Localized Subcortical Gray Matter Atrophy in Multiple Sclerosis: A 5-Year Study [ADULT BRAIN]

BACKGROUND AND PURPOSE:

It is unclear to what extent subcortical gray matter atrophy is a primary process as opposed to a result of focal white matter damage. Correlations between WM damage and atrophy of subcortical gray matter have been observed but may be partly attributable to indirect relationships between co-occurring processes arising from a common cause. Our aim was to cross-sectionally and longitudinally characterize the unique impact of focal WM damage on the atrophy of connected subcortical gray matter regions, beyond what is explainable by global disease progression.

MATERIALS AND METHODS:

One hundred seventy-six individuals with MS and 47 healthy controls underwent MR imaging at baseline and 5 years later. Atrophy and lesion-based disruption of connected WM tracts were evaluated for 14 subcortical gray matter regions. Hierarchic regressions were applied, predicting regional atrophy from focal WM disruption, controlling for age, sex, disease duration, whole-brain volume, and T2-lesion volume.

RESULTS:

When we controlled for whole-brain volume and T2-lesion volume, WM tract disruption explained little additional variance of subcortical gray matter atrophy and was a significant predictor for only 3 of 14 regions cross-sectionally (R² = 0.004) and 5 regions longitudinally (R² = 0.016). WM tract disruption was a significant predictor for even fewer regions when correcting for multiple comparisons.

CONCLUSIONS:

WM tract disruption accounts for a small percentage of atrophy in connected subcortical gray matter when controlling for overall disease burden and is not the primary driver in most cases.

Primary Angioplasty without Stenting for Symptomatic, High-Grade Intracranial Stenosis with Poor Circulation [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Although the Stenting versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study demonstrated a high incidence of perioperative complications for Intracranial Atherosclerotic disease (ICAD) treatments with stent placement, some studies have shown that submaximal angioplasty with an undersized balloon limits the risks of perioperative complications, suggesting that intervention may remain an alternative option for ICAD if perioperative complications are minimized. We sought to evaluate clinical and angiographic outcomes after primary angioplasty without stent placement in patients with symptomatic, high-grade intracranial stenosis and poor antegrade flow who were refractory to medical therapy.

MATERIALS AND METHODS:

All cases with high-grade, symptomatic intracranial stenosis and poor antegrade flow treated with intracranial angioplasty without stent placement at Xuanwu Hospital, Capital Medical University, from January 2010 to December 2016, were retrospectively reviewed. The main outcomes included the changes in antegrade flow and residual stenosis and any stroke or death within 1 month. We also evaluated functional outcomes, stroke, and restenosis in patients on follow-up.

RESULTS:

Thirty-five patients (mean age, 64.3 years) were included, and the mean follow-up time was 9.7 months. The average preprocedural stenosis was 88.4%. The immediate, average postprocedure stenosis rate was 25.3%, and the average postprocedural stenosis rate at last angiographic follow-up was 34.7%. The primary end point of major stroke or death at 30 days was observed in 1 patient (1/35, 2.9%), and no patient had intraprocedural complications. The incidence of stroke or death at the last follow-up was 2.9%, which was superior to the results of the medical and stent-placement arms of the SAMMPRIS study. Severe restenosis was observed in 3 (3/25, 12%) patients but without any symptoms.

CONCLUSIONS:

In this retrospective series, primary balloon angioplasty was an effective treatment option for symptomatic intracranial stenosis with a high risk of stroke.

Noncontrast Head CT in Children: National Variation in Radiation Dose Indices in the United States [PEDIATRICS]

BACKGROUND AND PURPOSE:

Radiologists should manage the radiation dose for pediatric patients to maintain reasonable diagnostic confidence. We assessed the variation in estimated radiation dose indices for pediatric noncontrast head CT in the United States.

MATERIALS AND METHODS:

Radiation dose indices for single-phase noncontrast head CT examinations in patients 18 years of age and younger were retrospectively reviewed between July 2011 and June 2016 using the American College of Radiology CT Dose Index Registry. We used the reported volume CT dose index stratified by patient demographics and imaging facility characteristics.

RESULTS:

The registry included 295,296 single-phase pediatric noncontrast head CT studies from 1571 facilities (56% in male patients and 53% in children older than 10 years of age). The median volume CT dose index was 33 mGy (interquartile range = 22–47 mGy). The volume CT dose index increased as age increased. The volume CT dose index was lower in children's hospitals (median, 26 mGy) versus academic hospitals (median, 32 mGy) and community hospitals (median, 40 mGy). There was a lower volume CT dose index in level I and II trauma centers (median, 27 and 32 mGy, respectively) versus nontrauma centers (median, 40 mGy) and facilities in metropolitan locations (median, 30 mGy) versus those in suburban and rural locations (median, 41 mGy).

CONCLUSIONS:

Considerable variation in the radiation dose index for pediatric head CT exists. Median dose indices and practice variations at pediatric facilities were both lower compared with other practice settings. Decreasing dose variability through proper management of CT parameters in pediatric populations using benchmarks generated by data from registries can potentially decrease population exposure to ionizing radiation.

Brain Perfusion Measurements Using Multidelay Arterial Spin-Labeling Are Systematically Biased by the Number of Delays [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Multidelay arterial spin-labeling is a promising emerging method in clinical practice. The effect of imaging parameters in multidelay arterial spin-labeling on estimated cerebral blood flow measurements remains unknown. We directly compared 3-delay versus 7-delay sequences, assessing the difference in the estimated transit time and blood flow.

MATERIALS AND METHODS:

This study included 87 cognitively healthy controls (78.7 ± 3.8 years of age; 49 women). We assessed delay and transit time–uncorrected and transit time–corrected CBF maps. Data analysis included voxelwise permutation-based between-sequence comparisons of 3-delay versus 7-delay, within-sequence comparison of transit time–uncorrected versus transit time–corrected maps, and average CBF calculations in regions that have been shown to differ.

RESULTS:

The 7-delay sequence estimated a higher CBF value than the 3-delay for the transit time–uncorrected and transit time–corrected maps in regions corresponding to the watershed areas (transit time–uncorrected = 27.62 ± 12.23 versus 24.58 ± 11.70 mL/min/100 g, Cohen's d = 0.25; transit time–corrected = 33.48 ± 14.92 versus 30.16 ± 14.32 mL/min/100 g, Cohen's d = 0.23). In the peripheral regions of the brain, the estimated delay was found to be longer for the 3-delay sequence (1.52408 ± 0.25236 seconds versus 1.47755 ± 0.24242 seconds, Cohen's d = 0.19), while the inverse was found in the center of the brain (1.39388 ± 0.22056 seconds versus 1.42565 ± 0.21872 seconds, Cohen's d = 0.14). Moreover, 7-delay had lower hemispheric asymmetry.

CONCLUSIONS:

The results of this study support the necessity of standardizing acquisition parameters in multidelay arterial spin-labeling and identifying basic parameters as a confounding factor in CBF quantification studies. Our findings conclude that multidelay arterial spin-labeling sequences with a high number of delays estimate higher CBF values than those with a lower number of delays.

Fabrication of fasudil hydrochloride modified graphene oxide biocomposites and its defensive effect acute renal injury in septicopyemia rats

Publication date: Available online 5 July 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Jing Fu, Li Chang

Abstract

This investigation aspired to the impacts of intraperitoneal injection of suspended graphene oxide-bovine serum albumin (GO-BSA) biocomposite blended in fasudil (FSD)-against intense renal damage in septicopyemia rodent's models. It was picked a model of acute renal injury by an intraperitoneal organization of fasudil. Our outcomes demonstrated that few markers of renal capacity, for example, blood urea nitrogen (BUN), creatinine (SC), and intratubular waste levels were altogether diminished essentially in fasudil blended GO-BSA intraperitoneally infusion groups during the first week, showing that GO-BSA has an uncommon ability to ensure FSD discharges. Additionally, surprisingly, while rats got GO-BSA intraperitoneally, biomedical examination demonstrated the fruitful decrease of blood urea nitrogen and creatinine blood factors showing that GO-BSA has an uncommon ability alone to repair the acute renal injury. It appears that GO-BSA can adsorb ECM proteins and encourages their exchange to the intense renal damage tissue and expands its repair speed, in addition, GO-BSA ensures the FSD and along these lines the helpful adequacy of the FSD in intense renal damage enhanced by the grip of living cells to GO-BSA biocomposites. It could be inferred that GO-BSA material improves the rate of achievement of FSD conveys in intense renal damage in septicopyemia animals.

Graphical Abstract

Solar energy at birth and human lifespan

Publication date: Available online 5 July 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): George E. Davis, Walter E. Lowell

Abstract

Purpose

The purpose of this paper is to examine the role of UVR at birth and its relationship to lifespan and determine whether there are significant differential effects on sex and race. We test if variation in UVR, as determined by solar cycles (long-term variation), is related to survival as measured by age at death.

Methods

The data used 78 million death records from the National Center for Health Statistics (NCHS) from 1979 to 2013 with accidents, suicides, and war casualties deleted resulted in ~63 million records. Records of persons ≤ 47 years old were also scrubbed because we could not show an effect on lifespan based upon the intensity of solar energy as reflected by sunspot number (SSN). This we hypothesize is due to the protective effect of the hormones associated with growth and reproduction. Also selected were persons afflicted with multiple sclerosis (MS).

Results

Males of all races born with a UVR intensity as estimated by sunspot number (SSN) ≤ 90 had an average lifespan of 74.4 years, for females of all races, 78.1 years; males born with >90 had an average lifespan of 66.3 years, for females of all races, 70.2 years, resulting in a lifespan decrease of 8.1 years for males and 8.5 years for females. For African-American males born ≤ 90 SSN, 70.8 years and for >90 SSN, 62.5 years, an 8.3-year decrease; similarly, for African-American females ≤ 90 SSN, 75.0, for >90 SSN, 65.4 years, a 9.6-year decrease. Higher solar energy at birth had an adverse effect on human lifespan. We also found that there were twice as many persons with MS born in >80–90 SSN as in the general population.

Conclusions

There is a statistically significant inverse relationship between exposure to solar energy at birth and average human lifespan. Solar energy by some mechanism alters the epigenome at birth, but the effect of higher solar energy becomes apparent after the age of natural selection.

High background in ELISpot assays is associated with elevated levels of immune activation in HIV‐1‐seronegative individuals in Nairobi

Immunity, Inflammation and Disease, EarlyView.

Alternative scenarios for ecological urbanizations using ENVI-met model

Abstract

Natural areas are quickly degraded by opening new settlement and industrial areas in order to meet the increasing demand of the growing population. Concreting, modification of land surfaces, complex urban structures, and depressed urban environments contribute to the formation of an Urban Heat Island (UHI). In this study, the outdoor measurements, meteorological parameters related to the thermal indices such as humidity, temperature, wind velocity, and direction for 24 h measurements, were evaluated. The ENVI-met micro-scale model was performed for evaluating alternative scenarios for winter and summer on thermal comfort for better urban environments. Meteorological parameters together with vegetation characteristics were analyzed for making possible scenarios in botanical garden_, auto industrial area_, city center, and rural open area. The average of the vegetated simulations of the botanical garden was about 2.2 °C cooler than this of the mean of current situation in the city center. Based upon the average of all stations, it was determined that the temperature increased 1.4 °C with the simulation of both wooded areas in winter. However, the mean temperature of all stations with coniferous plants was 1.2 °C cooler, in summer. It was concluded that deciduous plants in city center produced more positive results than coniferous plants in winter. In general, it can be said that afforestation in cold climatic regions provides great advantages for both summer and winter and positively affects outdoor thermal comfort. However, it needs further measurement and further research in this regard.

Internal dose of particles in the elderly—modeling based on aerosol measurements

Abstract

The paper presents an integrated methodology that combines experimental and modeling techniques and links exposure to airborne particulate matter (PM) with internal dose in the respiratory system and burden in adjacent tissues over a period of time. The methodology is used to estimate doses in the respiratory systems of elders that reside in 10 elderly care centers (ECCs) in the metropolitan area of Lisbon. Measurements of PM were performed in the ECCs and combined with a time-budget survey for the occupants. This information served as input to the first model that estimated particle doses in the different regions of the respiratory tract of the elderly, and then a second model was used to calculate particle build-up in the alveolar region, the interstitium and the hilar lymph nodes of the elders over a 5-year exposure period. It was found that in 5 years of continuous exposure to the average particle concentration measured over all ECCs, 258 mg of all particles are deposited on the surface of the alveoli of which 79.6% are cleared, 18.8% are retained in the alveolar region, 1.5% translocate to the hilar lymph nodes, and 0.1% are transferred to the interstitium.

Comment on “Guidelines of care for the management of basal cell carcinoma”

Reply to Comment on “Guidelines of Care for the Management of Basal Cell Carcinoma”

Skin Confident: A skin health and acne educational intervention to improve Acne Quality of Life measures in adolescents

Atypical Fibroxanthoma: Systematic Review and Meta-analysis of Treatment with Mohs Micrographic Surgery or Excision

The two treatment modalities most commonly used for AFX are wide local excision (WLE) and Mohs micrographic surgery (MMS). Mohs micrographic surgery (MMS) is associated with a lower local recurrence rate than WLE. MMS should be considered for treatment of AFX, especially in anatomically sensitive areas and in immunosuppressed patients.

Human Acellular Dermis Increases Surgical Site Infection and Overall Complication Profile When Compared with Submuscular Breast Reconstruction: An Updated Meta-Analysis Incorporating New Products

Human acellular dermal matrix (HADM) is an increasingly used adjunct to breast reconstruction. Previous meta-analysis demonstrate increased risks of complications, but these studies represent largely represent one product. The purpose of this study is to stratify outcomes based on a meta-analysis of complications incorporating all new studies after 2012 and their associated new human-based products.

Contribution of Eisenia andrei earthworms in pathogen reduction during vermicomposting

Abstract

Vermicomposting is a process of degradation of biowaste which involves complex interactions between earthworms and microorganisms. This process lacks a thermophilic stage and thus, the possible presence of pathogens poses a potential health hazard. To assess the contribution of earthworms during the selective reduction of various pathogens, apple pomace substrate was artificially inoculated with Escherichia coli, Salmonella spp., thermotolerant coliform bacteria, and Enterococci. The artificial bacterial load did not influence the weight, reproduction, or intestinal enzymatic activity of the earthworms, but it caused reversible histological changes to the epithelial layer and chloragogen tissue of their intestines. The reduction of pathogenic Enterococci and E. coli from the substrate was accelerated by earthworms (63-fold, 77-fold, and 840-fold for Enterococci and 6-fold, 36-fold, and 7-fold for E. coli inoculated substrates after 2, 4, and 6 weeks, respectively). Moreover, the rapid elimination of Salmonella spp. was supported by the upregulated expression of two pattern recognition receptors which bind lipopolysaccharide, coelomic cytolytic factor, and lipopolysaccharide-binding protein. Further, the microbiomes of the intestine and the composting substrate differed significantly.

Graphical abstract

Stable carbon and nitrogen isotopic composition of PM 10 over Indo-Gangetic Plains (IGP), adjoining regions and Indo-Himalayan Range (IHR) during a winter 2014 campaign

Abstract

For source identification, a field campaign involving simultaneous sampling of particulate matter (PM₁₀) was conducted at eight sampling sites in the Indian mainland during winter 2014. The sampling sites include Delhi (upper IGP), Lucknow (middle IGP), and Kolkata (lower IGP) in the Indo-Gangetic Plains (IGP); Mohal-Kullu and Darjeeling in the Indo-Himalayan Range (IHR). In addition, Ajmer, located upwind of the IGP in NW-India and Giridih and Bhubaneswar, in the downwind to the IGP has also been chosen. To characterize the sources of the ambient PM₁₀, stable isotope ratios of carbon (δ¹³C_TC) and nitrogen (δ¹⁵N_TN) for the total carbon (TC) and total nitrogen (TN) fractions have been considered. Ancillary chemical parameters, such as organic carbon (OC), elemental carbon (EC), and water-soluble ionic components (WSIC) mass concentrations are also presented in this paper. There was very small variation in the daily average δ¹³C_TC ratios (− 24.8 to − 25.9‰) among the sites. Comparison with end-member stable C isotopic signatures of major typical sources suggests that the PM₁₀ at the sites was mainly from fossil fuel and biofuel and biomass combustion. Daily average δ¹⁵N_TN ratios were not observed to vary much between sites either (8.3 to 11.0‰), and the low δ¹⁵N_TN levels also indicate substantial contributions from biofuel and biomass burning of primarily C3 andC4 plant matter.

Graphical abstract

Scatter plot of the average (± 1 standard deviation (SD)) δ¹³C_TC (‰) compared to δ¹⁵N_TN (‰) at the sampling sites.

Novel magnetic ion-imprinted polymer: an efficient polymeric nanocomposite for selective separation and determination of Pb ions in aqueous media

Abstract

A novel ion-imprinted polymer (IIP) toward Pb(II) recognition was synthesized on the surface of magnetic multi-walled carbon nanotubes (magnetic MWCNTs). In order to prepare magnetic functionalized-MWCNT/IIP (magnetic f-MWCNT/IIP), copolymerization of methylenebisacrylamide (MBAm) and acrylamide (AM) in the presence of dithizone-Pb(II) complex was carried out on the surface of the magnetic f-MWCNTs. Selectivity of the new synthesized sorbent toward Pb(II) and the influence of a variety of foreign ions on the recognition, preconcentration, and removal of Pb(II) were evaluated using adsorption experiments in aqueous solution. The synthesized sorbent exhibited a good affinity with high adsorption capacity (Q = 80.81 mg/g) and an excellent selectivity toward Pb(II) in comparison with other common cations including alkaline, alkaline earth, and transition metals such as Na⁺, K⁺, Mg²⁺, Ca²⁺, Cd²⁺, and Ni²⁺. The parameters such as adsorption and desorption time, adsorption capacity, effect of the sorbent mass, eluent type, concentration and volume, and also pH of the solutions were investigated. The result demonstrated that the proposed sorbent provided a fast removal and higher maximum binding capacity compared to other reported synthesized sorbents. The characteristics of the magnetic f-MWCNT/IIP were analyzed using Fourier transform infrared spectroscopy (FT-IR), scanning electron microscopy (SEM), X-ray diffraction (XRD), energy-dispersive spectroscopy (EDS), vibrating sample magnetometer (VSM), and elemental analysis (EA).

Graphical abstract

ᅟ

Contributors

LOREN S. SCHECHTER, MD

Breast and Body Contouring for Transgender and Gender Nonconforming Individuals

Even after long-term hormone therapy, many transwomen still have challenges in the size and shape of their breasts and also of the contour of their trunk areas. Though distinct anthropomorphic differences in skeletal structure exist and pose limitations to an ideal result, considerable improvements can be obtained through breast augmentation and trunk feminization. There are challenges that are unique to the transfeminine chest and trunk, and important considerations for the priority of fat grafting to the buttocks and hips when grafted fat is in short supply.

Forthcoming Issues

Lower Facial Rejuvenation: A Multispecialty Approach

Multidisciplinary Care and the Standards of Care for Transgender and Gender Nonconforming Individuals

In providing care to transgender patients, surgeons interact with health care providers of other disciplines, including medical and mental health providers. Mental health or medical providers often see a patient first, when hormones are initiated. The Standards of Care recommend that mental health professionals assess patients for surgery according to set criteria and send surgeons their evaluations prior to surgery. Open communication is essential between surgical, medical, and mental health providers as well as with patients, who must give informed consent. A patient's multidisciplinary team can continue to provide care across a patient's life span.

Chest Surgery for Transgender and Gender Nonconforming Individuals

Chest surgery can greatly facilitate the experience of living in a gender role. For transfeminine chest surgery, most surgeons recommend a 12-month period of feminizing hormone therapy prior to breast augmentation. For those who already have some breast volume due to hormone treatment, lipofilling can be a good option. Transmasculine chest surgery includes mastectomy and creation of a male chest. Preoperative parameters to be evaluated include breast volume, degree of excess skin, nipple-areola complex size and position, and skin elasticity. The algorithm the authors developed and modified can help choose from 5 techniques, resulting in an aesthetically pleasing male chest.

Hormonal Management for Transfeminine Individuals

Transfeminine individuals are treated with estradiol and anti-androgen agents to transition to a more feminine appearance. The physical changes that occur with estradiol therapy include breast development, body fat redistribution, and decreased muscle mass. Transfeminine treatment regimens require monitoring and dose adjustments to achieve appropriate physiologic targets to enhance feminization and decrease risk of adverse outcomes. Adverse effects associated with estradiol use include thromboembolic disease, macroprolactinoma, breast cancer, coronary artery disease, cerebrovascular disease, cholelithiasis, and hypertriglyceridemia. Benefits of hormonal treatment may include both an improvement in quality of life and a decrease in gender dysphoria.

Gender-Affirming Penile Inversion Vaginoplasty

In recent years, greater acceptance of transgender individuals in society and the inclusion of medical coverage for gender-affirmation surgeries has led to an increasing number of patients seeking gender-affirming vaginoplasty. Since the first descriptions of neovaginal reconstruction for gender affirmation were described in the early and mid-1900s, various techniques and revisions have been introduced. This article provides a brief historical perspective, defines the goals of surgical treatment within a multidisciplinary approach adhering to World Professional Association for Transgender Health standards, and focuses on issues related to what is currently the most common approach to primary neovaginal reconstruction, the penile inversion vaginoplasty.

Facial Gender Confirmation Surgery

Facial feminization surgery was pioneered in the 1980s to provide options for trans women who were having difficulty with their outward appearance. This process presented a novel application of craniofacial surgery at the time. This text outlines the basic differences between male and female facial morphology, as well as the procedures we use to feminize the face.

Urologic Complications After Phalloplasty or Metoidioplasty

In the past decade, issues facing transgender individuals have come to the forefront of popular culture, political discourse, and medical study. The evaluating physician should have knowledge of the reconstructed anatomy, as well as potential postoperative complications. This knowledge will aid in providing appropriate care and recognizing issues that may require specialized urologic care. Transgender anatomic definitions and a synopsis of common urologic complications specific to transmen, including urethrocutaneous fistulae, neourethral strictures, and persistent vaginal cavities are discussed.

Phalloplasty Flap-Related Complication

This article focuses on flap-related complications after creation of a neophallus for transgender individuals. It outlines the most frequently used flaps for this procedure and how flap-related complications can affect the overall outcome of the phalloplasty. With surgeons staging the procedure in different stages, it is important to understand the different strategies and the implication a flap-related complication can have on the end result and how it may be prevented.

Contents

Loren S. Schechter and Bauback Safa

Copyright

ELSEVIER

Gender Confirmation Surgery

CLINICS IN PLASTIC SURGERY

Gender Surgery: A Truly Multidisciplinary Field

Recent years have seen significant advances in the care of transgender and gender-diverse individuals. These advances have been timely as broadened insurance coverage has generated greatly increased demand for gender-affirming care, thereby exposing an inadequate supply of qualified practitioners. In order to help correct this discrepancy, much emphasis has been placed on practitioner education, spanning both surgical and nonsurgical specialties. For example, the World Professional Authority for Transgender Health initiated a Global Education Initiative, developing expert practitioners globally to better care for transgender and gender-diverse individuals.

Sexual Function After Shallow and Full-Depth Vaginoplasty: Challenges, Clinical Findings, and Treatment Strategies— Urologic Perspectives

This article presents an ordered review of the role of sexual function in discussion and planning before genital gender-affirming surgery and through recovery to initiation of sexual activity after surgery. Strategies are proposed to optimize sexual function postoperatively. Clinical observations are reviewed and genital and surgical anatomy is reviewed to explain the rationale for the treatment strategies proposed. The importance of offering shallow-depth vaginoplasty to all patients is discussed. Lastly, specific strategies to maximize and enhance recovery of erogenous sensation after surgery are focused on.

Comparative study of the physicochemical and photocatalytic properties of water-soluble polymer-capped TiO 2 nanoparticles

Abstract

TiO₂ shows great potential as ideal and powerful photocatalyst to degrade and eliminate harmful organic pollutants from waste water. It is desirable to prepare anatase TiO₂ with good aqueous solubility and photocatalytic activity for water decontamination. In this paper, water-soluble TiO₂ nanoparticles were successfully prepared using polytetramethylene ether glycol (PTMG), poly(ethylene glycol) (PEG), and poly(propylene glycol) (PPG) as stabilizers. The anatase phase of TiO₂ was well controlled by introduction of HCl in the reaction system. The results showed that all the polymer-capped TiO₂ were well dissolved in water and their aqueous solutions could maintain stable for more than 2 months. The photocatalytic activities of polymer-capped TiO₂ were evaluated by monitoring the degradation of Rhodamine B (RhB) with Degussa P25 as a control. The results showed that all the polymer-capped TiO₂ presented better photocatalytic activity than that of Degussa P25. PTMG capped TiO₂ exhibited the longest average lifetime of charge carriers, indicating the lowest charge recombination rate. Thus, PTMG capped TiO₂ presented the best photocatalytic activity. In summary, PTMG, PEG, and PPG can be used as stabilizers to prepare water-soluble TiO₂. PTMG is an ideal stabilizer for the synthesis of water-soluble TiO₂ with good photocatalytic activity.

The development of a protocol for diagnosing hand dermatitis from photographic images

Contact Dermatitis, EarlyView.

Pesticide contact dermatitis in agricultural workers of Himachal Pradesh (India)

Contact Dermatitis, EarlyView.

miR-128 targets the CC chemokine ligand 18 gene (CCL18) in cutaneous malignant melanoma progression

The CC chemokine ligand 18 (CCL18) has a higher expression in some tumors, while the CCL18 level can be a marker of tumor progression and prognosis. We previously reported that the expression of CCL18 gene was dramatically up-regulated in cutaneous malignant melanoma (CMM) and its expression levels were correlated with tumor thickness.

Quantitative histological analyses and transcriptional profiling reveal structural and molecular changes of the dermal extracellular matrix in cellulite

Cellulite is a chronic skin condition that is characterized by dimpling and lumpiness of the skin on the thighs, hips and buttocks (Fig. 1a). It has been suggested that the incidence of cellulite correlates with the body mass index (BMI) [1] but also women with a low/normal BMI (BMI: 18–25) frequently show the appearance of cellulite [2]. Thus, cellulite is not simply caused by overweight or obesity, but other, thus far unknown factors apparently contribute to its pathogenesis. Since the exact mechanisms and causes of cellulite formation have not yet been determined, there are at present a large number of conflicting hypotheses [3,4].

Genetic Polymorphism predicting Methotrexate efficacy in Chinese patients with psoriasis vulgaris

Psoriasis is an immune-mediated chronic, relapsing, inflammatory, polygene genetic disease characterized as erythrocyte plaque, hyperplasia of keratinocytes and infiltration of lymphocytes [1–4]. Currently, the clinical drugs for psoriasis is increasing, the traditional drugs included methotrexate, retinoids, and cyclosporine A, etc [5]. There are a lot of new biological agents included TNF-α inhibitors, anti-IL-17, anti-IL-23 antibodies in clinical or under clinical studies. Although the treatment of psoriasis has entered a new era of biological agents, traditional medicines still hold an important position in the treatment of psoriasis.

Phenotype variability in tumor disorders of the skin appendages associated with mutations in the CYLD gene

Abstract

Mutations in the tumor suppressor gene CYLD underlie phenotypically heterogeneous hereditary tumor disorders of the skin appendages. These diseases are inherited autosomal dominantly and include Brooke–Spiegler syndrome (BSS; OMIM 605041), familial cylindromatosis (FC; OMIM 132700) and multiple familial trichoepithelioma (MFT; OMIM 601606). Clinically, cylindromas, trichoepitheliomas and spiradenomas can be found in affected individuals. We sought to elucidate the molecular genetic basis in individuals with newly diagnosed cylindromas, trichoepitheliomas and/or spiradenomas. Mutation analysis using polymerase chain reaction (PCR)-based techniques was performed in seven German patients and one Turkish patient. We detected two missense, two nonsense, two deletions and two duplication mutations in the CYLD gene, of which seven have not yet been reported. No genotype–phenotype correlation was detected amongst the patients. Our data provide additional information on the clinical and molecular genetic heterogeneity of disorders associated with CYLD mutations.

Anthocyanins from black soybean seed coat prevent radiation-induced skin fibrosis by downregulating TGF-β and Smad3 expression

Abstract

The aim of this study was to evaluate the protective effects of anthocyanins from the black soybean seed coat against radiation injury in dermal fibroblasts and mouse skin. Dermal fibroblasts treated with 50 and 100 µg/mL anthocyanins were irradiated with single doses of 20 Gy. Cell viability, intracellular reactive oxygen species (ROS) production, and mRNA expression were measured. A total of 60 mice were used for an in vivo study. A dose of 100 µg/mL anthocyanins was administered daily for 5 days before or after radiation therapy. Following irradiation (45 Gy), mice were inspected for gross pathology twice per wk for 8 weeks. At 4 and 8 weeks post-irradiation, dorsal skin was harvested for histopathologic examination and protein isolation. In dermal fibroblasts, treatment with 50 and 100 µg/mL anthocyanins significantly reduced radiation-induced apoptosis at 72 h and intracellular reactive oxygen species generation at 48 h. Furthermore, 100 µg/mL anthocyanins markedly decreased Smad3 mRNA expression and increased Smad7 mRNA expression at 72 h post-irradiation. In mice, treatment with 100 µg/mL anthocyanins resulted in a significant reduction in the level of skin injury, epidermal thickness, and collagen deposition after irradiation. Treatment with 100 µg/mL anthocyanins significantly decreased the number of α-SMA-, TGF-β-, and Smad3-positive cells after irradiation. Our study demonstrated that black soybean anthocyanins inhibited radiation-induced fibrosis by downregulating TGF-β and Smad3 expression. Therefore, anthocyanins may be a safe and effective candidate for the prevention of radiation-induced skin fibrosis.

Ex vivo nonlinear microscopy imaging of Ehlers–Danlos syndrome-affected skin

Abstract

Ehlers–Danlos syndrome (EDS) is the name for a heterogenous group of rare genetic connective tissue disorders with an overall incidence of 1 in 5000. The histological characteristics of EDS have been previously described in detail in the late 1970s and early 1980s. Since that time, the classification of EDS has undergone significant changes, yet the description of the histological features of collagen morphology in different EDS subtypes has endured the test of time. Nonlinear microscopy techniques can be utilized for non-invasive in vivo label-free imaging of the skin. Among these techniques, two-photon absorption fluorescence (TPF) microscopy can visualize endogenous fluorophores, such as elastin, while the morphology of collagen fibers can be assessed by second-harmonic generation (SHG) microscopy. In our present work, we performed TPF and SHG microscopy imaging on ex vivo skin samples of one patient with classical EDS and two patients with vascular EDS and two healthy controls. We detected irregular, loosely dispersed collagen fibers in a non-parallel arrangement in the dermis of the EDS patients, while as expected, there was no noticeable impairment in the elastin content. Based on further studies on a larger number of patients, in vivo nonlinear microscopic imaging could be utilized for the assessment of the skin status of EDS patients in the future.

UVA-photoprotective potential of silymarin and silybin

Abstract

Exposure to solar radiation is a major cause of environmental human skin damage. The main constituent of solar UV light is UVA radiation (320–400 nm); however, the need for protection against UVA has been marginalized for a long time. As a result, there is still a lack of useful agents for UVA protection. In this study, the effect of silymarin (SM) and its main constituent silybin (SB) pre-treatment on UVA-stimulated damage to primary human dermal fibroblasts were carried out. The cells were pre-treated for 1 h with SB or SM and then were exposed to UVA light, using a solar simulator. The effect of SB and SM on reactive oxygen species (ROS) and glutathione (GSH) level, caspase-3 activity, single-strand breaks (SSB) formation and protein level of matrix metalloproteinase-1 (MMP-1), heme oxygenase-1 (HO-1), and heat shock protein (HSP70) was evaluated. Treatment with both SM and SB resulted in a reduction in UVA-stimulated ROS generation and SSB production, as well as in the prevention of GSH depletion, a decrease in the activation of caspase-3 and protein level of MMP-1. They also moderately increased HO-1 level and reduced HSP70 level. Our data showed that both SM and SB are non-phototoxic and have UVA-photoprotective potential and could be useful agents for UV-protective dermatological preparations.

Expression of IL33 and IL35 in oral lichen planus

Abstract

Oral lichen planus (OLP) is a complex immunological disorder, mediated in part by the release of cytokines by activated T-cells. Recently, the role of novel cytokines including IL33 and IL35 has been described in various chronic inflammatory diseases. IL33, a member of the IL-1 superfamily of cytokines, functions as an 'alarmin' released after cell necrosis to alert the immune system to tissue damage or stress. IL35, a member of IL12 cytokine family, is produced by regulatory T-cells and suppresses the immune response. The expression of IL33 and IL35 is yet to be investigated in OLP. The aim of this study was to determine the presence and topographical distribution of IL33 and IL35 in OLP using immunohistochemistry and quantitative real-time reverse transcriptase polymerase chain reaction (qPCR). For IHC, formalin-fixed paraffin-embedded archival specimens of OLP (n = 10) and a non-specific inflammatory (NSI) control group (n = 9) were used. A double-labelling immunofluorescence technique was used to determine the expression of IL33 and IL35 on CD3⁺ T-cells. In addition, 12 fresh tissue samples (OLP n = 6 and NSI controls n = 6) were used to determine the gene expression of IL33 and EBI3 (one chain of the dimeric IL35). Quantitative and qualitative analysis was performed with statistical significance set at p < 0.05. IHC showed positive immunostaining with IL33 and IL35 in both OLP and NSI. Comparison of the numbers of IL33⁺ and IL35⁺ cells in OLP and NSI did not show any significant difference. In OLP, there were significantly more IL33⁺ cells in the deeper connective tissue region than at the epithelial–connective tissue interface. Interestingly, all IL35⁺ cells observed in both OLP and NSI tissues showed ovoid/plasmacytoid morphology. Double-labelling immunofluorescence showed that IL33 and IL35 expression was not localized within CD3⁺ T-cells. The gene expression experiments showed significantly higher expression of EBI3 (fold regulation 14.02) in OLP when compared to the inflammatory controls. IL33 gene expression was not different between the groups. However, within the OLP tissues, there was a significantly higher expression of IL33 than EBI3. Our data demonstrate the expression of IL33 and IL35 in OLP lesions. Further studies are needed to understand the functional role of these cytokines in OLP pathogenesis.

IL-17 inhibition: is it the long-awaited savior for alopecia areata?

Abstract

Interleukin-17 (IL-17) has been implicated in the pathogenesis of a large number of inflammatory and autoimmune conditions, including skin disorders such as psoriasis. Recently, much data have accumulated on the possible role of IL-17 in the pathogenesis of alopecia areata (AA). In this review, the available information on the connection between AA and IL-17 is described. While IL-17 levels are consistently reported to be elevated in the serum and lesional skin of AA patients, there is no clear connection between IL-17 levels and disease severity or duration. Some evidence has suggested an association between IL-17 and an early-onset disease, although this awaits further confirmation. While there is enough information to support clinical trials with IL-17-targeted treatments, it is possible that they will be effective only in a subset of AA patients. Further studies are warranted to better delineate the exact role of IL-17 in AA pathogenesis.

Dermal white adipose tissue undergoes major morphological changes during the spontaneous and induced murine hair follicle cycling: a reappraisal

Abstract

In murine skin, dermal white adipose tissue (DWAT) undergoes major changes in thickness in synchrony with the hair cycle (HC); however, the underlying mechanisms remain unclear. We sought to elucidate whether increased DWAT thickness during anagen is mediated by adipocyte hypertrophy or adipogenesis, and whether lipolysis or apoptosis can explain the decreased DWAT thickness during catagen. In addition, we compared HC-associated DWAT changes between spontaneous and depilation-induced hair follicle (HF) cycling to distinguish between spontaneous and HF trauma-induced events. We show that HC-dependent DWAT remodelling is not an artefact caused by fluctuations in HF down-growth, and that dermal adipocyte (DA) proliferation and hypertrophy are HC-dependent, while classical DA apoptosis is absent. However, none of these changes plausibly accounts for HC-dependent oscillations in DWAT thickness. Contrary to previous studies, in vivo BODIPY uptake suggests that increased DWAT thickness during anagen occurs via hypertrophy rather than hyperplasia. From immunohistomorphometry, DWAT thickness likely undergoes thinning during catagen by lipolysis. Hence, we postulate that progressive, lipogenesis-driven DA hypertrophy followed by dynamic switches between lipogenesis and lipolysis underlie DWAT fluctuations in the spontaneous HC, and dismiss apoptosis as a mechanism of DWAT reduction. Moreover, the depilation-induced HC displays increased DWAT thickness, area, and DA number, but decreased DA volume/area compared to the spontaneous HC. Thus, DWAT shows additional, novel HF wounding-related responses during the induced HC. This systematic reappraisal provides important pointers for subsequent functional and mechanistic studies, and introduces the depilation-induced murine HC as a model for dissecting HF–DWAT interactions under conditions of wounding/stress.

Increased tenascin C and DKK1 in vitiligo: possible role of fibroblasts in acral and non-acral disease

Abstract

Recently, multiple culprits—in addition to melanocytes—have been implicated in the pathogenesis of vitiligo. Among those factors are fibroblasts. However, their exact role has not been clearly elucidated. The aim of the study was to evaluate the possible role played by fibroblasts in vitiligo via studying the expression Tenascin C and DKK1 in acral versus non-acral vitiligo lesions. This case–control study included 19 non-segmental vitiligo patients and ten controls. All patients were subjected to thorough clinical evaluation. Both Tenascin C and DKK1 were measured in lesional and peri-lesional skin of acral and non-acral lesions using ELISA technique. The measured levels of Tenascin C and DKK1 were significantly higher in the vitiligo group when compared to controls in all assessed sites (P < 0.05). Tenascin C was found to be significantly higher in lesional areas compared to peri-lesional ones only in the acral sites. DKK1 was significantly higher in lesional areas in all assessed sites (P < 0.05). The current work suggests a malfunction of fibroblasts in vitiligo, through demonstrating significant up-regulation of two melanogenesis inhibitory products (Tenascin C and DKK1) in patients compared to controls. Larger scale studies are warranted to detect the possible implications of such findings on vitiligo treatment.

Androgen modulation of Wnt/β-catenin signaling in androgenetic alopecia

Abstract

Androgenetic alopecia (AGA) is a dermatological disorder of scalp hair loss characterized by a progressive miniaturization of hair follicles with shortened anagen phase leading to a decreased number of hairs on the scalp. It is a complex polygenic trait prevailing around two-thirds of the male population. Elevated expressions of 5α-dihydrotestosterone and androgen receptor are the causal factors for AGA. This review describes recent studies on the role of androgens and androgen receptor (AR) transactivation activity in modulating the Wnt/β-catenin signaling in the dermal papilla cells of the balding scalp in androgenetic alopecia. Here, we analyse the androgen-induced dermal papilla secreted factors on stimulating catagen entry in hair follicles and the molecular cross-talk between AR and Wnt/β-catenin signaling with a brief mention on alternative treatment strategy targeting Wnt/β-catenin signaling for promoting hair growth.

Determinants of quality of life and psychological status in adults with psoriasis

Abstract

We investigated whether disease severity and clinical manifestations were associated with depression, anxiety, stress and quality of life in adults with psoriasis. Participants were recruited from a dermatology outpatient clinic at a teaching hospital. Information on sociodemographic characteristics, disease severity, presence of arthropathy and head involvement was specifically recorded. Disease severity was assessed using the Psoriasis Area and Severity Index (PASI). Quality of life and psychological symptoms were measured using the Dermatology Life Quality Index (DLQI) and the Depression Anxiety Stress Scale (DASS), respectively. One hundred individuals were recruited. Unadjusted analysis revealed that head involvement was associated with depression [odds ratio (OR) 8.509; 95% confidence interval (CI) 1.077–67.231] and anxiety (OR 6.46; 95% CI 1.401–29.858). Severe disease was associated with a poorer quality of life compared to mild disease (OR 3.750; 95% CI 1.330–10.577). Younger age was associated with an increased risk of depression [mean difference (MD) − 8.640; 95% CI − 16.390 to − 0.890], anxiety (MD − 11.553; 95% CI − 18.478 to− 4.628), stress (MD − 11.440; 95% CI − 19.252 to − 3.628) and severely impaired quality of life (MD − 12.338; 95% CI − 19.548 to − 5.127). Following adjustments for age and disease severity, anxiety, stress and depression remained associated with severely impaired quality of life.

How to weight patient-relevant treatment goals for assessing treatment benefit in psoriasis: preference elicitation methods vs. rating scales

Abstract

In psoriasis, several patient-relevant treatment goals must be met to be able to consider a treatment beneficial. To assess treatment benefit, the validated questionnaire Patient Benefit Index (PBI) can be used. Its global score summarizes the degree of patient-relevant treatment goals achieved after treatment, weighted by their individual importance on rating scales. These treatment goals have empirically been assigned to five dimensions. While the weighting procedure of the PBI provides information about the importance patients attach to treatment goals on a rating scale from 0 to 4, methods of preference elicitation provide information on how patients would trade off certain treatment goals against each other. However, since the treatment goals defined in the PBI often overlap conceptually, the dimensions of the PBI might be more suitable for exploration in preference elicitation methods. We used an analytic hierarchy process (AHP) and a discrete choice experiment (DCE) to generate preference-based importance weights for the PBI dimensions, and compared these weights to those derived from the rating scales. We were further interested in the effect of importance weights on the calculation of the PBI score. A total of 120 patients with psoriasis completed a questionnaire at baseline, including AHP, DCE and the rating scales, and at follow-up, regarding the attainment of treatment goals, to calculate the PBI score. In contrast to the results derived from the average rating scores, use of AHP and DCE resulted in both similar importance weights and rankings of dimensions. Presumably, patients rated treatment goals differently than the respective dimension they belong to. However, the differently calculated importance weights led to similar values of the PBI score. Our findings nevertheless provide clear evidence that, regardless of the method used, the importance of treatment goals differs between psoriasis patients, and this should be reflected in treatment decisions.

Identification of a novel mutation in the mechanoreceptor-encoding gene CXCR1 in patients with keloid

Abstract

Keloids are skin fibroproliferative tumors characterized by locally invasive growth of fibroblasts and excessive collagen deposition. The objective of this study is to investigate the molecular basis of the keloid scar by studying the mutation of related genes. We performed gene screening of mechanoreceptors by quantitative polymerase chain reaction (qPCR), Sanger sequencing to detect the CXCR1gene mutation, and immuno-histochemistry to determine CXCR1 protein expression. Among the genes encoding mechanoreceptors, the expression of CXCR1 mRNA was significantly higher in keloid scar tissues than in the surrounding tissues of normal controls (P < 0.05). Sequencing analysis identified a novel missense mutation, c.574G > A (p.Gly192Glu). Immunohistochemistry showed heightened protein expression of CXCR1 in keloid scars as compared to controls. Our findings indicate that CXCR1 gene mutation and altered protein expression are associated with keloid scar development. Identification of the CXCR1 gene mutation might provide insights into the molecular mechanism underlying keloid scar and underscores the potential importance of mechanoreceptors in keloid scar pathogenesis.

Dermoscopy of chondrodermatitis nodularis helicis

Abstract

Chondrodermatitis nodularis helicis (CNH) is a benign auricular disease whose differentiation with nonpigmented tumors is mandatory. Clinical characteristics of CNH are well known, but there is no information about the dermoscopic features that could help differentiate CNH from squamous cell carcinoma and other non-melanoma skin cancers. To describe the dermoscopic appearance of CNH and to formulate a differential diagnostic model, we conducted  a retrospective, single center, observational dermoscopic study on a sample of 189 biopsy-proven lesions: 25 CNH; 26 squamous cell carcinomas; 62 basal cell carcinomas and 76 other benign and malignant tumors. Univariate and multivariate analyses were conducted by logistic regression. The most significant dermoscopic finding for CNH was a peculiar global configuration (daisy pattern), consisting of white thick lines, radially arranged, converging to a central rounded yellow/brown clod (an erosion covered by keratin or sero-crust). This pattern achieved 92 and 98% of specificity for discriminating CNH with squamous cell carcinoma and basal cell carcinoma, respectively. In conclusion, dermoscopy is valuable for the diagnosis of CNH as a first screening tool because of a consistent global dermoscopic configuration (daisy pattern), consisting of radially arranged white thick lines surrounding a central rounded yellow/brown clod.

Expression and localization of VEGFR-2 in hair follicles during induced hair growth in mice

Abstract

Recently, VEGFR-2 has been detected not only in vascular and lymphatic endothelial cells but also in some non-vascular endothelial cells, particularly human hair follicles, sebaceous glands, and sweat glands. In addition, VEGFR-2 has been confirmed to play direct roles in hair follicle keratinocyte regulation beyond simply angiogenesis. To elucidate whether VEGFR-2 activation plays a role in hair follicle cycling regulation, immunofluorescence of VEGFR-2 expression was performed during hair cycling of the dorsum of the mouse induced by hair plucking. We observed that staining for VEGFR-2 in hair follicles during anagen II and IV was much stronger than during anagen VI, catagen and telogen. During anagen II, intense staining for VEGFR-2 was observed on the keratinocyte strands of the hair follicle. Subsequently, we detected intense staining for VEGFR-2 in the ORS, IRS and hair bulb during anagen IV. Moderate staining for VEGFR-2 was detected in the ORS and hair bulb, but staining was most intense in IRS during anagen VI. During catagen, staining for VEGFR-2 in the IRS remained intense, while staining in the ORS and hair bulb was significantly weakened and was negative in the dermal papilla. During telogen, we detected VEGFR-2 in germ cells, cap, and club hair adjoining the epidermis. In conclusion, VEGFR-2 was expressed on the hair follicles of the dorsum of the mouse and varied in expression on the mouse hair follicles during hair cycling, suggesting that VEGFR-2 may exert roles in hair cycle regulation in hair follicles on the dorsum of mice.

Haplotypes of ABCB1 1236C >T (rs1128503), 2677G >T/A (rs2032582), and 3435C >T (rs1045642) in patients with bullous pemphigoid

Abstract

Bullous pemphigoid (BP) constitutes the most prevalent disease in the group of bullous dermatoses with the autoimmune background. Some authors suggest that certain cytokines (IL-2, IFN-γ) may be transported by P-glycoprotein (P-gp), the product of the ABCB1 gene. ABCB1 polymorphism might affect not only the effectiveness of treatment with drugs that are P-gp substrates but also contribute to the development of diseases, including BP. In the present work, we resolved to conduct a haplotype analysis of ABCB1 in patients with BP and to answer the question of whether any of the haplotypes are able to affect the incidence of this entity. The study involved 71 patients with BP and 100 healthy volunteers. Determination of polymorphisms 1236C > T and 3435C > T in ABCB1 was carried out with the PCR–RFLP (Polymerase Chain Reaction–Restriction Fragment Length Polymorphism) method. The 2677G > T/A ABCB1 polymorphism was analyzed with the allele-specific PCR method. It was observed that the 1236T-2677G-3435T haplotype occurred with a statistically significantly lower frequency in patients with BP than in controls (1.4 vs. 10.0%). Carriers of this haplotype were also shown to have had a low relative risk for BP (OR = 0.13, p = 0.003). Haplotype analysis of ABCB1 conducted in patients with BP demonstrated that the 1236T-2677G-3435T haplotype may protect against development of this entity.

Assessment of vulnerability and control measures to protect the Salbarua ecosystem from hypothetical spill sites

Abstract

Population pressure, urbanization, and industrial developments, among other factors, have resulted in severe degradation of environmental resources such as wetlands. Thus, a groundwater model (MODFLOW) was integrated with a particle tracking MODPATH model to simulate the hydrodynamic flow head field and to analyze the vulnerability of the Salburua ecosystem and propose control measures to protect the riparian area. The simulations show that pathways of particle tracking originating at potential contaminant sources will tend to migrate downwards towards the sensitive ecosystem, which suggests that the quality of the hydrological ecosystem is likely to deteriorate in the future. Variation in exit points of particles indicates that the time-related capture areas are affected by changes of the hydraulic gradients. Two control measures of potential sources of pollutants in the vicinity of the Salbarua ecosystem were analyzed. The study results suggest that the travel time-related capture zone with a funnel-and-gate system is much smaller than without the control alternative, which indicates that the gate configuration has an effect on capture zone size and shape and on the residence time with a better attenuation performance. It is also shown that a leakage-proof barrier is less effective for point-source containment, assuming that hydraulic control performance and cost-efficiency are the criteria for pollution control effectiveness. Instead, a program of monitoring wells would effectively characterize water quality in the aquifer and provide a decision support system. This approach may be used in helping water managers to develop more physically based and quantitative protection strategies.

Harvesting of Chlorella vulgaris using Fe 3 O 4 coated with modified plant polyphenol

Abstract

The Chlorella vulgaris harvesting was explored by magnetic separation using Fe₃O₄ particles coated with the plant polyphenol chemically modified by a Mannich reaction followed by quaternization (Fe₃O₄@Q-PP). The –N(R)₄⁺ and Cl–N⁺–C perssad of the Q-PP were linked to the Fe₃O₄ particles by N–O bonds, as suggested by the X-ray photoelectron spectroscopy spectra. The thermogravimetric analysis displayed the mass percentage of the Q-PP coated on the Fe₃O₄ surface was close to ~ 5%. Compared with the naked Fe₃O₄ particles, zeta potentials of the Fe₃O₄@Q-PP particles were improved from the range of − 17.5~− 25.6 mV to 1.9~36.3 mV at pH 2.1~13.1. A 70.2 G coercive force was obtained for the Fe₃O₄@Q-PP composite, which demonstrated its ferromagnetic behavior. The use of Fe₃O₄@Q-PP resulted in a harvesting efficiency of 90.9% of C. vulgaris cells (3.06 g/L). The Fe₃O₄ particles could be detached from the cell flocs by ultrasonication leading to a recovery efficiency of 96.1% after 10 cycles. The recovered Fe₃O₄ could be re-coated with Q-PP and led to a harvesting efficiency of 80.2% after 10 cycles. The magnetic separation using Fe₃O₄@Q-PP included charge neutralization followed by bridging and then colloid entrapment.

Fish and microchips: on fish pain and multiple realization

Abstract

Opponents to consciousness in fish argue that fish do not feel pain because they do not have a neocortex, which is a necessary condition for feeling pain. A common counter-argument appeals to the multiple realizability of pain: while a neocortex might be necessary for feeling pain in humans, pain might be realized differently in fish. This paper argues, first, that it is impossible to find a criterion allowing us to demarcate between plausible and implausible cases of multiple realization of pain without running into a circular argument. Second, opponents to consciousness in fish cannot be provided with reasons to believe in the multiple realizability of pain. I conclude that the debate on the existence of pain in fish is impossible to settle by relying on the multiple realization argument.

Occurrence and recovery of small-sized plastic debris from a Brazilian beach: characterization, recycling, and mechanical analysis

Abstract

Small-sized plastic debris are an increasing global concern, particularly in environmental protected areas. Consequently, tourism-based economy of poor coastal regions is also impaired. Nevertheless, little interest has been shown about recycling approaches of such materials, mostly because of the natural degradation of polymers on these conditions. This research presents the report of the occurrence of plastic debris nearby Lençóis Maranhenses National Park, on the northeast Brazilian coast, aiming to provide a feasible method for recycling. We collected more than 80 samples from the sediment and classified them via FT-IR. Degraded polypropylene samples were selected for blending with virgin material using different concentration rates, and were mechanically tested. Tensile testing results suggest that 5% recycled material concentration mixture has suitable mechanical properties on the elastic regime for applications on new parts. Our findings show that particular interest should be addressed on the recovery of commodity plastic debris from environmental protected areas.

Treponema denticola transcriptional profiles in serum-restricted conditions

Abstract

Treponema denticola is a major pathogen in periodontal disease, and is frequently isolated from the lesions of patients with chronic periodontitis. T. denticola utilizes serum components as nutrient sources so as to colonize and proliferate in the gingival crevice. However, the mechanisms of serum utilization remain unclear. Therefore, the aim of the present study was to identify T. denticola serum utilization genes. Precultured T. denticola cells were suspended in a tryptone-yeast extract-gelatin-volatile fatty acids medium containing 0, 1%, and 10% serum, respectively, and incubated anaerobically for 17 h. Total RNA was isolated, and T. denticola gene expression was compared by microarray and reverse transcription-polymerase chain reaction. In serum-depleted conditions, the expression levels of a potential hydroxylamine reductase, several ABC transporters, and phosphoenolpyruvate synthase were increased, while those of genes encoding methyl-accepting chemotaxis proteins and a transcriptional regulator were decreased. These results suggest that T. denticola may uptake serum components mainly through the action of ABC transporters. In particular, the decrease in the dmcA expression level with decreasing serum concentration suggests its involvement in chemotaxis toward serum-rich environments.

Association of Autologous Fat Injection in Facial Artery With Ophthalmological Complications

This experimental animal study examines the association of ophthalmic complications with the injection of autologous fat, fat lipid, fat granule, or normal saline into the facial artery of rabbits.

Investigating Methods to Prevent Blindness From Facial Fat Injections

In the article "Association of Autologous Fat Injection in Facial Artery With Ophthalmological Complications: An Experimental Animal Study" in this issue of JAMA Facial Plastic Surgery Liu et al highlight the importance of understanding this very rare but dreaded complication associated with facial fat injections. Using a rabbit model, the authors investigated ophthalmological consequences of retrograde injection into the facial artery, comparing minced fat, fat granules, fat lipid, and saline control injections. They found that the method of adipose tissue procurement played a significant role, contributing to the higher rates of blindness in the autologous (minced) particles. In documenting the detrimental effects of intraarterial fat injections using clinical and diagnostic measurements, their methodology and results support their claims in a convincing clinical and statistical fashion.

Forthcoming Meetings

Edited by Albert H. Kim and Jennie W. Taylor

De novo and secondary anaplastic meningiomas: natural history, prognosis, and the TERT promoter

See the article by Peyre et al., pp. 1113–1121.

Highlights from the Literature

Is it time to reconsider the role of irinotecan for the treatment of high-grade gliomas?

Irinotecan is a topoisomerase 1 inhibitor that is converted to the active metabolite SN-38 by carboxylesterase.¹ Based on preclinical data showing that irinotecan had activity against gliomas, and the assumption that irinotecan crossed the blood–brain barrier (BBB), a single arm phase II study was conducted in 60 patients with recurrent high-grade gliomas (HGGs).² This study used an irinotecan dose of 125 mg/m² once weekly for 4 weeks followed by a 2-week rest, and reported a partial response rate of 15%, with 55% of patients having stable disease for at least 12 weeks. These results suggested that irinotecan had activity in this patient population and led to the adoption of this agent for treatment of recurrent HGG.

The trials of neuro-oncology clinical research

See the article by Vanderbeek et al., pp. 1034–1043.

Review of environmental effects of oxybenzone and other sunscreen active ingredients

With increasing awareness regarding the risks of sunburn, photoaging and skin cancer, the use of sunscreens has increased. Organic and inorganic filters are used in sunscreen products worldwide. Concerns have been raised on commonly used organic UV filters including oxybenzone (benzophenone-3; BP-3), 4-methylbenzylidene camphor (4-MBC), octocrylene (OC), and octinoxate (ethylhexyl methoxycinnamate; EHMC) on their effects on the environment. Studies have identified UV filters such as oxybenzone, octocrylene, octinoxate and ethylhexyl salicylate (ES) in almost all water sources around the world and have commented that these filters are not easily removed by common waste water treatment plant techniques.

Rajeunir, c’est vieux comme le monde…

Publication date: Available online 4 July 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): J. Glicenstein, T. Awada

Résumé

Les légendes et les mythes sur l'éternelle jeunesse existent depuis l'Antiquité. Avant le XIX^e siècle, ceux qui souhaitaient rajeunir utilisaient des bains ou des injections de sang, recherchaient la Fontaine de Jouvence, ou faisaient appel à un alchimiste qui prétendait avoir trouvé l'élixir de longue vie. Au XIX^e siècle, Charles Edouard Brown Séquard, (1819–1894) après la découverte du rôle des glandes endocrines et des sécrétions testiculaires, s'injecta un extrait de testicule de cobaye et de chien et s'en trouva rajeuni ! Au début du XX^e siècle, plusieurs chirurgiens transplantèrent des testicules humains, provenant de condamnés à mort exécutés ou de donneurs volontaires. Les transplantations de testicules de singe par Serge Voronoff (1866–1951), dans les années 1920, eurent un grand retentissement et plus de 300 interventions de ce type furent réalisées. La simple ligature des canaux déférents (vasectomie) fut préconisée par Eugen Steinach (1866–1944). Sigmund Freud en fut l'un des « bénéficiaires ». Steinach proposa aussi l'irradiation des ovaires pour le rajeunissement féminin. Alexis Carrel (1873–1944) et Charles Lindbergh (1902–1974) réalisèrent en 1935 une pompe destinée à nourrir et à rajeunir des organes isolés. La découverte récente des cellules souches pluripotentes et celles de molécules sénolytiques suscitent de nouveaux espoirs.

Summary

Legends and myths regarding eternal youth exist since Antiquity. Prior to the 19th century those wishing to rejuvenate used baths or blood injections, searching to the Fountain of Youth or calling for an alchemist claiming to have found the Elixir of Youth. In the 19th century, Charles Edouard Brown Séquard (1819–1894), after the discovery of the function of the endocrinal glands and testicular secretions, inject himself with an extract from guinea pigs and dogs. He found himself rejuvenated! In the beginning of the 20th century, several surgeons transplanted human testicles coming from death row prisoners inmates or voluntary donors. The transplantation of monkey testicles by Serge Voronoff (1866–1951) had a important aftermath and more than 300 similar interventions took place. The simple ligation of the vas deferens (vasectomy) was recommended by Eugen Steinach (1866–1944). Sigmund Freud was one of the "beneficiaries". Steinach also advised the irradiation of the ovaries for female rejuvenation. In 1935, Alexis Carrel (1873–1944) and Charles Lindbergh (1902–1974) built a pump to feed and regenerate targeted organs. The discovery of pluripotent stem cells and senolytic molecules are building up new hopes on the matter.

Secondary bladder exstrophy repair with a bilateral gracilis muscle flap in an adult female patient: Case report of an original procedure

Publication date: Available online 3 July 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): J.-B. Schaff, E. Fontaine, C. Dariane, A. Mejean, L. Lantieri, M. Hivelin

Summary

Classical bladder exstrophy (CBE), affecting 1 birth out of 30,000, is characterized by an evaginated bladder plate through a defect in the lower abdominal wall, multiple abdominal wall anomalies including a pubic bone arch dehiscence. Numerous approaches from childhood to adulthood are thus required, depending on the severity of the deformity, including the associated genital anomalies. We report the case of a 19-year-old woman with CBE with a history of three-failed primary closure. We performed a secondary neck closure with a concomitant suspension of the bladder neck and reconstruction of the lower abdominal wall using a bilateral gracilis muscle flap transposition. The early postoperative course was uneventful. The patient was discharged at day ten postoperatively. The upper part of the genital sutures (labia minora) secondary healed in three weeks. Assessment at 2, 6 and 16 months postoperatively, respectively noticed a complete healing with successful sexual intercourses, perceived gracilis contraction by the patient, and finally, recent attempts to get pregnant. Neither urinary infection nor urinary leaks occurred. Bilateral crossed gracilis muscles transfer linking both rectus abdominis muscle in front of the reconstructed bladder neck might benefit to bladder exstrophy patients.

Résumé

L'extrophie vésicale est une malformation caractérisée par une évagination de la plaque vésicale au travers d'une déhiscence de la paroi abdominale inférieure associée à de multiples anomalies, notamment une déhiscence de l'arche osseuse pubienne. L'incidence est de 1 sur 30 000 naissances. Plusieurs interventions sont souvent nécessaires pour rétablir la continence et corriger les malformations génitales. Nous rapportons le cas d'une patiente de 19 ans que nous avons pris en charge dans notre centre après trois tentatives infructueuses de fermeture du col vésical. Nous avons effectué une reconstruction secondaire du col vésical et de la paroi abdominale inférieure en utilisant un double lambeau musculaire de gracilis. Les suites postopératoires ont été simples. La patiente est rentrée à domicile au dixième jour. Une désunion de la suture à la jonction des petites lèvres a été laissée en cicatrisation dirigée. Le suivi à 2, 6 et 16 mois a montré une cicatrisation complète. La patiente a repris une activité sexuelle avec un projet de grossesse. Il n'y a pas eu de nouvelles fuites ou d'infection urinaire. La reconstruction par double lambeau de gracilis croisés peut être une option pour la prise en charge chirurgicale de l'exstrophie vésicale.

Le portfolio de l’interne de chirurgie plastique : un outil d’aide à la formation des internes de chirurgie plastique en France ?

Publication date: Available online 3 July 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): A. Bout-Roumazeilles, S. Dast, N. Assaf, C. Herlin, R. Sinna

Résumé

La réforme du troisième cycle des études médicales a modifié le modèle d'apprentissage des internes de chirurgie plastique, en lui amputant une année de formation. La réforme précise qu'un portfolio devra suivre l'interne au cours de sa formation. Jusqu'à présent la formation pratique des internes de chirurgie plastique était exclusivement dévolue au coordonnateur local de la spécialité et aucun contrôle officiel des connaissances n'avait lieu avant l'examen national du DESC. Prenant en compte ces faits nous avons imaginé le portfolio de l'interne de chirurgie plastique qui permettrait de guider l'interne dans sa progression pratique et dans l'acquisition de ses connaissances théoriques. Il permettrait aussi d'homogénéiser la formation nationale de la spécialité et pourrait, à terme, servir de support à une évaluation formelle des compétences pratiques des internes de chirurgie plastique. Dans un premier temps nous faisons un état des lieux de la formation avant l'apparition de la réforme. Puis nous détaillons les changements qui seront apportés par la réforme. Enfin nous décrivons le portfolio en détail, son contenu, son utilisation et son intérêt.

Summary

A recent reform of the French government has shortened the plastic surgery residency from 5 to 4 years. Until today, the evaluation and validation of the residency was shared between the local coordinator for practical skills and, after the residency, by the French College of Plastic Surgery for theorical knowledges. The new reform suggests to add a portfolio that will follow the resident during his surgical training. Based on the French reform and syllabus of others medical specialities, we designed a surgical portfolio that will help the resident both with his practical progression and his knowledges acquisition. The aim of the portfolio is to get a national unity of the plastic surgery training. As a first step we will describe the actual plastic surgery residency. Then, we will detail what the reform is going to change. At last, we will introduce the surgical portfolio, its content, its use and its goals.

The trapezius perforator flap: Versatility for locoregional reconstruction

Publication date: Available online 22 June 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): P. Frobert, F. Bekara, N. Bertheuil, E. Delay, C. Herlin, B. Chaput

Summary

Only a few surgical choices are available for cervical and thoracic spine coverage. The trapezius perforator flap is relatively unknown and only a few authors have published on this subject. In this article, we report on four clinical cases where a trapezius perforator flap was used either as a propeller flap, as a tunnelized island flap, or as a supercharged flap for cervical spine, thoracic spine and anterior cervical defects. Harvesting this flap is quite simple and enables high quality reconstruction with low donor-site morbidity in complex situations.

Résumé

Les solutions chirurgicales pour la couverture du rachis cervical ou thoracique sont assez restreintes. Le lambeau perforant trapèze est assez méconnu et peu d'auteurs ont publié sur ce sujet. Dans cet article, nous rapportons notre expérience de quatre cas où le lambeau perforant trapèze a été utilisé, soit dans sa version en hélice, soit en îlot tunnelisé, soit dans une version superchargée. Nous l'avons utilisé pour la reconstruction du rachis dans sa portion cervicale et thoracique, ou la région cervicale antérieure. Réaliser ce lambeau est relativement simple et permet des reconstructions de grande qualité avec peu de séquelles du site donneur, même dans des situations complexes.

Technique de prélèvement du lambeau fessier pour la reconstruction mammaire

Publication date: Available online 18 June 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): V. Duquennoy-Martinot, C. Depoortère, C. Calibre, P. Guerreschi, P. Patenotre

Résumé

Le lambeau fessier inférieur est une technique de reconstruction mammaire autologue microchirurgicale utilisant les parties molles de la région du sillon sous-fessier. Le prolongement périnéal permet d'augmenter le volume prélevé. Le pédicule comportant un artère et deux grosses veine remonte dans l'échancrure ischiatique et peut atteindre 8 à 12 cm. Le changement de position en peropératoire, la relative brièveté du pédicule et la fermeté des tissus transférés sont contrebalancés par la discrétion des séquelles du site donneur et le volume toujours suffisant même chez la femme mince. La meilleure indication de cette technique est la reconstruction mammaire bilatérale mais il est aussi une solution en cas de contre-indication des autres lambeaux autologues, notamment le DIEP.

Summary

The lower gluteal flap is an autologous microsurgical breast reconstruction procedure using the soft tissue of the region of the gluteal sulcus. The perineal extension increases the volume of the sample. The pedicle with one artery and two large veins extends up the ischial notch and can reach 8 to 12 cm. The two operative positions, the relative shortness of the pedicle and the firm tissues transferred are balanced by the discretion of the sequelae of the donor site and the volume which is always enough even in the slim woman. The best indication of this technique is two-sided breast reconstruction but it also provides a solution in case of contraindication of other autologous flaps, especially DIEP.

Complications du traitement chirurgical des carcinomes basocellulaires après 75 ans. Étude rétrospective des facteurs pronostiques sur 158 cas

Publication date: Available online 8 June 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): A. Chossat, O. Marco, M. Chaouat, M. Mimoun, D. Boccara

Résumé

Introduction

Le carcinome basocellulaire (CBC) est une pathologie à évolution locale, fréquente chez les sujets âgés qui présentent une fragilité pouvant freiner les indications du traitement chirurgical, bien qu'il soit le traitement de référence. L'objectif de cette étude est d'analyser la morbidité et la mortalité associées au traitement chirurgical des CBC chez des patients de plus de 75 ans, afin d'isoler d'éventuels facteurs pronostics de complications postopératoires.

Matériel et méthode

Il s'agit d'une étude rétrospective réalisée chez des patients de plus de 75 ans traités chirurgicalement pour un ou plusieurs CBC entre 2010 et 2015 dans le service de chirurgie plastique reconstructrice et esthétique de l'hôpital Saint-Louis à Paris. Les caractéristiques démographiques, les caractéristiques du traitement ainsi que le taux de complications majeures postopératoires ont été recensés. Une analyse univariée puis multivariée des différents facteurs de risque retrouvés ont été effectuées.

Résultats

Au total, 158 patients ont été analysés, avec un taux de complications majeures de 12 %. Les analyses statistiques ont retrouvé 5 facteurs de risque significatifs : un âge supérieur à 85 ans (p = 0,006), la prise d'un traitement anticoagulant au long cours (p = 0,02), la présence d'au moins une comorbidité (p = 0,018), une hospitalisation traditionnelle (p = 0,002) et la réalisation d'une anesthésie générale (p = 1,2e⁻¹⁰).

Conclusion

Il a été identifié 5 facteurs de risque de complications majeures postopératoires dans le traitement chirurgical des CBC chez les patients de plus de 75 ans. Ces facteurs pourraient orienter les équipes médico-chirurgicales dans la prise en charge optimale du CBC chez le patient âgé.

Summary

Introduction

Basal cell carcinoma (BCC) is a pathology that evolves locally and it is common in elderly subjects whose frailty could restrict the indications for the reference treatment, which is based on surgery. The aim of this study was to investigate the morbidity and the mortality associated with surgical treatment of BCC in patients over 75 years of age, so as to identify possible prognostic factors for postoperative complications.

Materials and methods

This was a retrospective study carried out with patients over 75 years of age who were treated surgically for one or several BCC between 2010 and 2015 in the reconstructive and cosmetic plastic surgery unit of the Saint-Louis Hospital in Paris (France). We collated the demographic characteristics, the characteristics of the treatment, as well as the rate of major postoperative complications. We performed a univariate and then a multivariate analysis of the various risk factors that were identified.

Results

A total of 158 patients were analyzed and they exhibited a rate of major complications of 12%. The statistical analysis identified five significant risk factors: being over 85 years of age (P = 0.006), long-term use of anticoagulant treatment (P = 0.02), the presence of at least one comorbidity (P = 0.018), a conventional hospitalization (P = 0.002), and the use of general anesthesia (P = 1.2e⁻¹⁰).

Conclusion

Five risk factors for major postoperative complications with the surgical treatment of BCC in patients over 75 years of age were identified. These factors may provide direction to medico-surgical teams in regard to the optimal treatment of BCC in elderly patients.

Le lambeau de grand épiploon : traitement des plaies et lymphorrhees chroniques : à propos d’un cas

Publication date: June 2018

Source: Annales de Chirurgie Plastique Esthétique, Volume 63, Issue 3

Author(s): D. Boccara, K. Serror, M. Mimoun, M. Chaouat

Résumé

Introduction

Les complications cicatricielles post-chirurgie abdominale ou pelvienne sont plus fréquentes chez les patientes obèses. L'infection, les séromes et les retards de cicatrisation occasionnés peuvent dans ce cas être extrêmement difficiles à traiter. L'objectif de cette note technique est de vous présenter un cas original d'une patiente de 48 ans obèse, opérée neuf ans auparavant d'une hystérectomie par laparotomie et présentant de manière chronique une fistule chronique associée à une lymphorrée septique non résolutive malgré de multiples interventions chirurgicales, dont la guérison a pu être obtenue par un lambeau de grand épiploon.

Technique chirurgicale

L'idéal est de réaliser cette intervention en double équipe avec un chirurgien digestif en cas de survenue de plaie viscérale ou vasculaire intra-abdominale durant la dissection. Le lambeau de grand épiploon était levé de manière classique sur l'artère gastro-épiploïque droite. Un orifice suffisamment large doit être laissé au niveau de l'aponévrose abdominale afin d'éviter toute compression du pédicule. Enfin, le lambeau doit être étalé sur toute la surface du décollement et fixé à l'aponévrose antérieure.

Conclusion

La fiabilité et la richesse à la fois vasculaire et lymphatique font du lambeau de grand épiploon une méthode très efficace dans les cas de plaies chroniques associées à une lymphorrhée majeure. La cicatrisation obtenue dans le cas clinique présenté met ainsi en valeur les qualités spécifiques de ce lambeau.

Summary

Introduction

Cicatricial complications after abdominal or pelvic surgery are more frequent in obese patients. In this case, infection, seroma and delays in scarring can be extremely difficult to treat. The objective of this technical note is to present an original case of an obese patient operated nine years ago of a hysterectomy by laparotomy and chronically presenting a non-resolving septic seroma despite multiple surgical procedures whose healing could be obtained by a flap of greater omentum.

Surgical technique

The ideal is to carry out this intervention in a double team with a digestive surgeon in case of intra-abdominal visceral or vascular wound during dissection. The greater omentum flap was raised in a conventional manner over the gastroepiploic artery. A sufficiently wide orifice should be left at the level of the abdominal aponeurosis in order to avoid any compression of the pedicle. Finally, the flap must be spread over the whole surface of the detachment and fixed to the anterior aponeurosis.

Conclusion

Reliability and vascular and lymphatic richness make the greater omentum flap a very effective method in chronic wound cases associated with important seroma. The scarring obtained in the clinical case presented thus highlights the specific qualities of this flap.

Reconstruction par lambeau de Taylor après amputation abdomino-périnéale : à propos de 68 cas

Publication date: June 2018

Source: Annales de Chirurgie Plastique Esthétique, Volume 63, Issue 3

Author(s): D. Boccara, K. SerroR, J. Lefevre, M. Mimoun, M. Chaouat

Résumé

Introduction

La cicatrisation après amputation abdomino-périnéale est souvent difficile notamment chez les patients ayant bénéficié d'une radiothérapie. La reconstruction vaginale est également un enjeu important pour les femmes ayant bénéficié de cette chirurgie. Nous décrivons et analysons ici notre série de reconstructions périnéales par lambeau de Taylor modifié.

Matériel et méthode

Entre 2010 et 2016, 68 (52 femmes, 16 hommes) patients ont bénéficié d'une reconstruction par lambeau musculocutané de grand droit de l'abdomen à pédicule inférieur et à palette oblique dans les suites d'un cancer du canal anal (53), d'adénocarcinome du bas rectum (9) ou d'autres tumeurs malignes du périnée.

Résultats

À distance de l'intervention, tous les patients ont cicatrisé avec une médiane à 30 jours. Le taux de reprises chirurgicales était de 11,7 % dont 1 pour éventration. Les principales causes de retard de cicatrisation étaient les désunions cicatricielles, les abcès et les nécroses partielles. Aucun lambeau n'a ainsi été déposé. La durée moyenne d'hospitalisation était de 23,7 jours.

Conclusion

La reconstruction des pertes de substance périnéales post-amputation abdomino-périnéale a été grandement améliorée et fiabilisé par la réalisation de lambeaux de Taylor modifiés. Elle permet une cicatrisation complète et rapide avec un faible comorbidité.

Summary

Purposes

Healing after abdomino-perineal resection is often difficult, especially in patients who have undergone radiation therapy. Vaginal reconstruction is also an important issue for the women who undergo this surgery. We describe and analyze here our series of perineal reconstructions with modified Taylor flaps. Between 2010 and 2016, 68 patients (52 women, 16 men) with cancer of the anal canal (53), adenocarcinoma of the lower rectum (9), or other malignant neoplasms of the perineum underwent reconstruction with a rectus abdominis myocutaneous (RAM) flap with an inferior pedicle and an oblique skin paddle.

Results

This review of records showed that all patients healed, with a median of 30 days. The reoperation rate was 11.7% including 1 for eventration. The principal causes for delayed healing were scar dehiscence, abscess, and partial necrosis. No flap required removal, however. The mean duration of hospitalization was 23.7 days.

Conclusion

Modified Taylor flaps substantially improved the reconstruction of defects resulting from abdomino-perineal resection. They enabled complete and rapid healing with low comorbidity.

Ombilicoplastie en aile de mouette : technique et satisfaction ; à propos de 96 cas

Publication date: June 2018

Source: Annales de Chirurgie Plastique Esthétique, Volume 63, Issue 3

Author(s): R. Merle, K. Serror, O. Marco, M. Chaouat, S. Teissier, M. Mimoun, D. Boccara

Résumé

But de l'étude

L'ombilic a un rôle majeur dans l'esthétique de la paroi abdominale antérieure. De nombreuses publications portent sur les dermolipectomies abdominales, mais peu se focalisent sur les ombilicoplasties. Celles-ci sont pourtant essentielles dans l'appréciation du résultat esthétique. L'ombilicoplastie en aile de mouette utilisée dans notre service est fiable et facilement reproductible. Dans cet article, nous évaluons la satisfaction des patientes ayant eu une dermolipectomie abdominale avec cette technique de transposition.

Matériel et méthode

Une étude rétrospective a été réalisée dans le service de chirurgie plastique de l'hôpital Saint-Louis à Paris, elle concernait les patientes opérées d'une dermolipectomie abdominale avec transposition de l'ombilic, entre le 1^er janvier 2012 et le 31 décembre 2012. Toutes les patientes ont été opérées selon notre technique d'ombilicoplastie : désinsertion de l'ombilic en V, réinsertion de l'ombilic en « aile de mouette », un dégraissage périombilical associé à une plicature de la tige ombilicale. Les complications recensées dans les dossiers médicaux des patients et la satisfaction ont été évaluées par un questionnaire téléphonique.

Résultats

Quatre-vingt-seize patientes ont été incluses. Aucune patiente n'a présenté de souffrance ou de nécrose ombilicale. Le résultat global de la transposition ombilicale était jugé de bon à excellent pour 92,7 % des patientes.

Conclusion

L'ombilicoplastie en aile de mouette présente de nombreux avantages : c'est une technique simple, facilement reproductible, fiable, dont les patientes sont pour la plupart très satisfaites.

Summary

Goal of the study

The umbilicus has a major role in the aesthetics of the anterior abdominal wall. Many publications deal with abdominal dermolipectomies but few focus on umbilicoplasty. However, these are essential in assessing the aesthetic result. Umbilicoplasty in "aile de mouette" used in our service is reliable and easily reproducible. In this article, we evaluate the satisfaction of patients with abdominal dermolipectomy with this technique of transposition.

Materials and method

In the plastic surgery department of the Saint-Louis Hospital in Paris, we carried out a retrospective study of patients undergoing abdominal dermolipectomy with transposition of the umbilicus, between 1 January 2012 and 31 December 2012. All patients were operated according to our technique of umbilicoplasty: disinsertion of the umbilicus in V, reinsertion of the umbilic in "aile de mouette", a degreasing periumbilical associated with a plication of the umbilical stem. The complications identified in patients medical records and satisfaction were assessed by a telephone questionnaire.

Results

Ninety-six patients were included. No patient presented umbilical necrosis. The overall result of umbilical transposition was considered good to excellent for 92.7% of patients.

Conclusion

Umbilicoplasty in gull wing has many advantages: it is a simple, easily reproducible, reliable technique, the patients of which are for the most part very satisfied.

Élaboration d’un questionnaire de satisfaction encadrant la chirurgie de féminisation faciale chez les patientes transsexuelles male to female (QESFF1) : Phase qualitative

Publication date: June 2018

Source: Annales de Chirurgie Plastique Esthétique, Volume 63, Issue 3

Author(s): C. Verbruggen, R. Weigert, P. Corre, V. Casoli, M. Bondaz

Résumé

Objectif

La chirurgie de féminisation faciale fait partie intégrante du processus de transformation des patientes transsexuelles male to female. Une évaluation globale de la satisfaction de ces patientes par un questionnaire spécifique est fondamentale afin de confirmer le bénéfice de cette chirurgie et d'optimiser les pratiques cliniques. L'objectif de cette étude est de développer un outil fiable et valide permettant de mesurer la satisfaction de ces patientes.

Méthodes

Une revue de la littérature, l'avis d'une commission d'experts et des entretiens avec des patientes issues de la population cible ont permis de mettre en place le Conceptual Framework du questionnaire. Il regroupe l'ensemble des domaines majeurs du questionnaire et a permis la création des différents items.

Résultats

Aucun questionnaire n'existe à ce jour pour mesurer de manière spécifique la satisfaction de ces patientes. Dix experts et 18 patientes ont participé à l'étude. Le Conceptual Framework se compose des domaines suivants : satisfaction concernant l'apparence féminine du visage ; les séquelles postopératoires ; qualité de vie. Le questionnaire comprend quatorze échelles de Likert indépendantes entre elles, utilisables en préopératoire et postopératoire. La fiabilité du questionnaire est excellente avec un score Alpha de Cronbach moyen de 0,85. La satisfaction mesurée après chirurgie de féminisation faciale dans cet étude est très bonne avec une moyenne de 83,7 ± 7,41.

Conclusion

Le QESFF1 est un questionnaire fiable dont la création respecte les étapes du patients reported outcomes process. La démonstration de sa validité nécessite une étude pluricentrique ultérieure. Il permet aux praticiens de mesurer objectivement l'impact de la chirurgie de féminisation faciale chez les patientes transsexuelles male to female et peut également être utilisé en recherche clinique.

Summary

Objective

Facial feminization surgery is becoming a more frequently requested procedure in transsexual male to female patients transformation. A global way of reporting outcomes data and showing the beneficial impact of this specific procedure is necessary. The objective of this study is to develop a reliable and valid tool to report patients' outcomes after facial feminization surgery.

Methods

A systematic literature review, input from experts working with transsexual patients and patient interviews were used to develop the conceptual framework of the questionnaire. It includes the outcomes deemed important to facial feminization surgery and it was used to construct items of the questionnaire.

Results

There is no specific tool for measuring patients outcomes after facial feminization surgery. Ten experts and 18 patients participated to this study. The conceptual framework includes the following themes: satisfaction with facial feminine appearance; adverse effects; quality of life. The questionnaire includes fourteen separate Likert scales, with preoperative and postoperative versions. The reliability of the questionnaire is excellent with a medium Alpha score of 0.85. Facial feminization surgery is associated with high patient satisfaction in this sample (83.7 ± 7.41).

Conclusion

QESFF1 is a reliable questionnaire and its development follows the steps recommended by the patient-reported outcomes process. A large sample pilot test is needed to demonstrate its validity. The QESFF1 can provide physicians with the necessary tools to measure the impact of facial feminization surgery on male to female transsexual patients and also has the potential to support clinical trials.

Injections d’acides hyaluroniques au niveau de visages atteints de malformations faciales. Étude préliminaire de l’assouplissement des zones cicatricielles et de l’amélioration esthétique

Publication date: June 2018

Source: Annales de Chirurgie Plastique Esthétique, Volume 63, Issue 3

Author(s): G. Franchi, C. Neiva-Vaz, A. Picard, M.-P. Vazquez

Résumé

Objectif de l'étude

Les « volumateurs » à base d'acide hyaluronique réticulé sont la référence pour traiter les rides superficielles, les plis profonds et les creux liés au vieillissement du visage. Cette étude a pour objectif d'évaluer, en plus des effets d'augmentation de volume, les effets sur la souplesse et l'élasticité des tissus cicatriciels, de 3 acides hyaluroniques réticulés commercialisés (dosés à 15 mg/mL, 17,5 mg/mL et 20 mg/mL), après chirurgie réparatrice chez des patients atteints d'anomalies faciales congénitales ou acquises.

Patients et méthode

Nous avons débuté l'usage des acides hyaluroniques réticulés en gel injectable dans ces indications en 2013 et avons réalisé à ce jour 46 séances d'injections, chez 32 patients âgés de 13–32 ans. Les résultats ont été évalués par le patient lui-même et par un chirurgien, environ 15 jours après les injections et 6–18 mois plus tard.

Résultats

Les acides hyaluroniques réticulés ont apporté des résultats morphologiques et esthétiques très subtils, en complément des interventions chirurgicales, avec un niveau de satisfaction élevé des patients. Dans les zones cicatricielles fibreuses, la première session d'injections améliorait la souplesse et l'élasticité ; la seconde session améliorait les volumes. Les acides hyaluroniques sont capables de restaurer simultanément les volumes manquants et l'élasticité des tissus cicatriciels.

Conclusion

Au-delà de leur fonction de volumateur, un second effet des acides hyaluroniques réticulés est démontré cliniquement : l'augmentation de la souplesse et de l'élasticité des tissus cicatriciel fibreux. Plusieurs études expérimentales corroborent nos résultats en démontrant qu'ils modifient la composition des matrices extra cellulaires notamment en stimulant la production d'élastine et de collagène.

Summary

Background

Cross-linked hyaluronic acid-based fillers have gained rapid acceptance for treating facial wrinkles, deep tissue folds and sunken areas due to aging. This study evaluates, in addition to space-filling properties, their effects on softness and elasticity as a secondary effect, following injection of 3 commercially available cross-linked hyaluronic acid-based fillers (15 mg/mL, 17,5 mg/mL and 20 mg/mL) in patients presenting with congenital or acquired facial malformations.

Patients et methods

We started injecting gels of cross-linked hyaluronic acid-based fillers in those cases in 2013; we performed 46 sessions of injections in 32 patients, aged from 13–32. Clinical assessment was performed by the patient himself and by a plastic surgeon, 15 days after injections and 6–18 months later.

Results

Cross-linked hyaluronic acid-based fillers offered very subtle cosmetic results and supplemented surgery with a very high level of satisfaction of the patients. When injected in fibrosis, the first session enhanced softness and elasticity; the second session enhanced the volume. Cross-linked hyaluronic acid-based fillers fill sunken areas and better softness and elasticity of scar tissues.

Conclusion

In addition to their well-understood space-filling function, as a secondary effect, the authors demonstrate that cross-linked hyaluronic acid-based fillers improve softness and elasticity of scarring tissues. Many experimental studies support our observations, showing that cross-linked hyaluronic acid stimulates the production of several extra-cellular matrix components, including dermal collagen and elastin.