Medicine by Alexandros G. Sfakianakis: 07/06/18

Παρασκευή 6 Ιουλίου 2018

New challenges in the application of advanced oxidation processes

A case of chronic eosinophilic pneumonia successfully treated with mepolizumab

Publication date: Available online 7 July 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Masako To, Yuta Kono, Satoshi Yamawaki, Seiko Soeda, Otohiro Katsube, Hirohisa Kishi, Yasuo To

Quality of life of food-allergic patients before, during and following oral immunotherapy

Publication date: Available online 7 July 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Na'ama Epstein-Rigbi, Michael R. Goldberg, Michael B. Levy, Liat Nachshon, Arnon Elizur

Abstract

Background

Oral immunotherapy (OIT) for food allergy is demanding but data on patients' quality of life (QOL) throughout the process is limited.

Objective

To characterize changes in QOL of food-allergic patients during and following OIT.

Methods

In a prospective cohort study the FAQLQ-Parental Form (FAQLQ-PF) was administered to parents of 191 consecutive children aged 4-12 years, undergoing OIT for food allergy. Questionnaires were administered at OIT initiation, mid up-dosing, upon reaching maintenance and 6 months after. Age and gender- matched food-allergic children (n=48) not undergoing OIT served as controls.

Results

FAQOL-PF scores had significantly improved (decreased) from OIT initiation to reaching full (Total score; 3.69 to 3.19 p<0.001, Emotional Impact (EI); 3.66 to 3.32 p=0.001, Food Anxiety (FA); 3.90 to 3.32 p<0.001, Social and Dietary Limitation (SDL); 3.50 to 2.94 p<0.001) and partial maintenance, while no change was noted in control patients. Worse baseline QOL, single food allergy, and younger age, predicted greater QOL improvement. Of the 85/96 (88.5%) patients who completed the FAQLQ-PF at mid up-dosing and for whom QOL deteriorated, a significant improvement was noted upon reaching maintenance. Additional significant improvement in QOL was observed in the 95/107 (88.8%) patients who completed the FAQLQ-PF six months after reaching maintenance (Total; 3.266 to 2.614 P=0.001, EI; 3.414 to 2.993 P=0.049, FA; 3.37 to 2.593 P=0.001, SDL; 2.989 to 2.264 p=0.001).

Conclusions

QOL of food-allergic children improves significantly upon reaching OIT maintenance, with additional improvement 6 months later. The detrimental effect of OIT on some patients' QOL during up-dosing is reversed upon reaching maintenance.

Wheat-dependent, co-factor augmented anaphylaxis; a prospective study of exercise, aspirin and alcohol efficacy as co-factors

Publication date: Available online 7 July 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Morten J. Christensen, Esben Eller, Charlotte G. Mortz, Knut Brockow, Carsten Bindslev-Jensen

Abstract

Background

Wheat-dependent, exercise-induced anaphylaxis (WDEIA) is severe and potentially life-threatening allergy caused by wheat ingestion and most commonly in combination with exercise.

Objective

To investigate the role and impact of different co-factors (exercise, aspirin and alcohol) in patients with WDEIA.

Methods

We studied 25 adult patients with WDEIA. Diagnostic workup included specific-IgE to omega-5 gliadin and skin prick test (SPT) with wheat flour and gluten. Titrated oral challenge was performed with gluten at rest, combined with treadmill exercise, aspirin, alcohol or exercise+aspirin.

Results

A positive challenge to gluten was found at rest (without co-factors) in 48%(12/25), with exercise in 92%(23/25), aspirin in 84%(21/25), alcohol in 56%(9/19) and with exercise+aspirin in 82%(18/22). With exercise as co-factor the median threshold was 24g (range 4.8g–80g), with aspirin 8g (range 2.4g–80g) and with alcohol 28g (range 0–45g). The combination of two co-factors (exercise and aspirin) resulted in a median threshold of 4.3g (range 1.1g–48g). The threshold for the clinical reaction was lowered by 63%, 83%, 36% and 87% respectively, compared to at rest.

The mean severity grade (scale 0-5) according to Sampson's severity score was at rest 0.8 (range 0-2), combined with exercise 2.1 (range 0-5), with aspirin 1.9 (range 0-5), with alcohol 0.8 (range 0-2) and with the combination of exercise + aspirin 1.5 (range 0-2)

Conclusions

Our results demonstrate that exercise and aspirin augment clinical reactions in WDEIA by lowering threshold and increase the severity of the allergic reaction, whereas alcohol gave ambiguous results. Secondly, a combination of two co-factors (exercise+aspirin) further increase the risk of reactions.

Editorial board

JSID's Fellowship Shiseido Research Grant

The Editor's Choice

Prevention of Frey Syndrome

Frey syndrome (gustatory sweating) is a common and often times significant consequence of parotid gland surgery. The classic signs and symptoms include facial sweating, flushing, rubor and sensation of heat over the preauricular region during oral stimulation. These clinical findings may provoke quality of life changes, and thus, are considered significant. Both surgical and non- surgical treatment modalities have been advanced in the treatment of this disorder. Surgical treatment is aimed at prevention of the development of Frey syndrome and consists of a constellation of techniques which are designed to interpose tissue in the parotid surgical bed to act as a barrier to prevent aberrant parasympathetic fiber ingrowth and innervation to facial skin eccrine sweat glands.

Intraperitoneal sodium metavanadate exposure induced severe clinicopathological alterations, hepato-renal toxicity and cytogenotoxicity in African giant rats ( Cricetomys gambianus , Waterhouse, 1840)

Abstract

Pollution of environment due to increased exploitation of minerals has been on the rise, and vanadium, a metal in the first transition series essential for mammalian existence, is a major component of air pollution. This study investigated the clinico-pathological, hepato-renal toxicity, and cytogenotoxicity of intraperitoneal exposure of African giant rats (AGRs), a proposed model for ecotoxicological research to sodium metavanadate. A total of 27 adult male African giant rats weighing 975 ± 54.10 g were distributed into two major groups: sodium metavanadate (SMV) treated and control. They were observed daily for clinical signs of toxicity. Four rats from each group were randomly collected and sacrificed after 3, 7, and 14 days of SMV treatment. Liver, kidney, and bone marrow were analyzed for histopathology and micronucleated normochromated and polychromated erythrocytes (MNNCE and MNPCE), respectively. Clinical signs in treated AGR include sluggish and weak movements, un-groomed fur, and labored breathing. Histology of the kidney revealed severe glomerular atrophy, tubular ectasia, and vacuolar degeneration of tubular epithelium, while liver histology showed sinusoidal congestion and severe hepatocellular necrosis after 14 days SMV exposure. Also, MNNCE and MNPCE significantly increased with a decrease in PCE/NCE ratio in SMV-treated AGR, suggestive of alternations in bone marrow cell proliferation. Hence, SMV treatment to AGR resulted to severe clinicopathologic alterations, kidney, and liver dysfunction and cytogenotoxicity evident by somatic mutation induction which could be severe with prolonged exposure. This suggests African giant rat as an ecotoxicological model to measure major health risks to animals and human populations in highly polluted environment.

Status, sources and contamination levels of organochlorine pesticide residues in urban and agricultural areas: a preliminary review in central–southern Italian soils

Abstract

Organochlorine pesticides (OCPs) are synthetic chemicals commonly used in agricultural activities to kill pests and are persistent organic pollutants (POPs). They can be detected in different environmental media, but soil is considered an important reservoir due to its retention capacity. Many different types of OCPs exist, which can have different origins and pathways in the environment. It is therefore important to study their distribution and behaviour in the environment, starting to build a picture of the potential human health risk in different contexts. This study aimed at investigating the regional distribution, possible sources and contamination levels of 24 OCP compounds in urban and rural soils from central and southern Italy. One hundred and forty-eight topsoil samples (0–20 cm top layer) from 78 urban and 70 rural areas in 11 administrative regions were collected and analysed by gas chromatography–electron capture detector (GC–ECD). Total OCP residues in soils ranged from nd (no detected) to 1043 ng/g with a mean of 29.91 ng/g and from nd to 1914 ng/g with a mean of 60.16 ng/g in urban and rural area, respectively. Endosulfan was the prevailing OCP in urban areas, followed by DDTs, Drins, Methoxychlor, HCHs, Chlordane-related compounds and HCB. In rural areas, the order of concentrations was Drins > DDTs > Methoxychlor > Endosulfans > HCHs > Chlordanes > HCB. Diagnostic ratios and robust multivariate analyses revealed that DDT in soils could be related to historical application, whilst (illegal) use of technical DDT or dicofol may still occur in some urban areas. HCH residues could be related to both historical use and recent application, whilst there was evidence that modest (yet significant) application of commercial technical HCH may still be happening in urban areas. Drins and Chlordane compounds appeared to be mostly related to historical application, whilst Endosulfan presented a complex mix of results, indicating mainly historical origin in rural areas as well as potential recent applications on urban areas. Contamination levels were quantified by Soil Quality Index (SoQI), identifying high levels in rural areas of Campania and Apulia, possibly due to the intensive nature of some agricultural practices in those regions (e.g., vineyards and olive plantations). The results from this study (which is in progress in the remaining regions of Italy) will provide an invaluable baseline for OCP distribution in Italy and a powerful argument for follow-up studies in contaminated areas. It is also hoped that similar studies will eventually constitute enough evidence to push towards an institutional response for more adequate regulation as well as a full ratification of the Stockholm Convention.

Psoriasis y pitiriasis versicolor: juntas pero no revueltas

Publication date: Available online 6 July 2018

Source: Actas Dermo-Sifiliográficas

Author(s): J. Romaní, A. Casulleras

Nevus epidérmicos y síndromes relacionados. Parte 1: nevus queratinocíticos

Publication date: Available online 6 July 2018

Source: Actas Dermo-Sifiliográficas

Author(s): J. Garcias-Ladaria, M. Cuadrado Rosón, M. Pascual-López

Resumen

Los nevus epidérmicos son hamartomas originados en la epidermis y/o en las estructuras anexiales de la piel que se han clasificado clásicamente partiendo de la morfología. En los últimos años se han descrito variantes nuevas y se han producido avances en el campo de la genética que han permitido caracterizar mejor estas lesiones y comprender su relación con algunas de las manifestaciones extracutáneas a las que se han asociado. En esta primera parte revisaremos los nevus derivados de la epidermis y los síndromes que se han descrito asociados a ellos.

Abstract

Epidermal nevi are hamartomatous lesions derived from the epidermis and/or adnexal structures of the skin; they have traditionally been classified according to their morphology. New variants have been described in recent years and advances in genetics have contributed to better characterization of these lesions and an improved understanding of their relationship with certain extracutaneous manifestations. In the first part of this review article, we will look at nevi derived specifically from the epidermis and associated syndromes.

Graphical abstract

Graphical abstract for this article

Belief and credence: why the attitude-type matters

Abstract

In this paper, I argue that the relationship between belief and credence is a central question in epistemology. This is because the belief-credence relationship has significant implications for a number of current epistemological issues. I focus on five controversies: permissivism, disagreement, pragmatic encroachment, doxastic voluntarism, and the relationship between doxastic attitudes and prudential rationality. I argue that each debate is constrained in particular ways, depending on whether the relevant attitude is belief or credence. This means that (i) epistemologists should pay attention to whether they are framing questions in terms of belief or in terms of credence and (ii) the success or failure of a reductionist project in the belief-credence realm has significant implications for epistemology generally.

Novel Bacillus cereus strain from electrokinetically remediated saline soil towards the remediation of crude oil

Abstract

A new strain SWH-15 was successfully isolated after initial electrokinetic remediation experiment using the same saline soil sampled from Shengli Oilfield, China. Four methods (morphological and biochemical characteristics, whole-cell fatty acid methyl esters (FAMEs) analysis, 16S rRNA sequence analysis and DNA G + C content and DNA–DNA hybridization analysis) were used to identify the taxonomic status of SWH-15 and confirmed that SWH-15 was a novel species of the Bacillus (B.) cereus group. Then, we assessed the degrading ability of the novel strain SWH-15 to crude oil through a microcosm experiment with four treatments, including control (CK), bioremediation using SWH-15 (Bio), electrokinetic remediation (EK), and combined bioremediation and electrokinetic remediation (Bio + EK). The results showed that the Bio + EK combined remediation treatment was more effective than the CK, Bio, and EK treatments in degrading crude oil contaminants. Bioaugmentation, by addition of the strain SWH-15 had synergistic effect with EK in Bio + EK treatment. Bacterial community analysis showed that electrokinetic remediation alone significantly altered the bacterial community of the saline soil. The addition of the strain SWH-15 alone had a weak effect on the bacterial community. However, the strain SWH-15 boosted the growth of other bacterial species in the metabolic network and weakened the impact of electrical field on the whole bacterial community structure in the Bio + EK treatment.

When and why is it disrespectful to excuse an attitude?

Abstract

It is intuitive that, under certain circumstances, it can be disrespectful or patronizing to excuse someone for an attitude (even for an attitude one finds objectionable). While it is easy enough to find instances where it seems disrespectful to excuse an attitude, matters are complicated. When and why, precisely, is it disrespectful to judge that someone is not responsible for his attitude? In this paper, I show, first, that the extant philosophical literature on this question is underdeveloped and overgeneralized: the writers who address the question suggest quite strikingly that it is always disrespectful to excuse a sane, rational agent for his attitude, and their arguments rely on false generalizations about what is involved in excusing an attitude. I then sketch an account of respect (something conspicuously missing in the literature on this question) to explain when and why it is disrespectful to excuse an attitude. Using this account, I show that one can coherently (and respectfully) excuse an attitude even in some cases where that attitude was produced by a responsiveness to reasons.

In vitro genomic and proteomic evidence of a type IV pili-like structure in the fish pathogen Piscirickettsia salmonis

Abstract

Piscirickettsia salmonis is an intracellular γ-proteobacteria and the etiological agent of piscirickettsiosis, which causes massive economic losses in the Chilean salmon industry. The type IV pili (T4P) play an important role in adherence to host cell surfaces and bacterial pathogenicity. T4P contains a variable number of components, as predicted in P. salmonis genomes. However, no studies have determined if P. salmonis possesses T4P. The aims of this investigation were to identify T4P components in the P. salmonis type strain LF-89^T, evaluate respective transcript expressions, and analyze the main putative T4P proteins using bioinformatics and proteomic approaches. Two main clusters of P. salmonis T4P genes were found. Expression of the pilA gene was up-regulated at 4 h post-infection (hpi), while pilQ was up-regulated 4 d post-infection. At 16 hpi, pilB and pilD were strongly up-regulated. The PilA amino acid sequence analysis showed a conserved N-terminal domain and sequence motifs critical for T4P biosynthesis. MudPIT analysis revealed PilA in the P. salmonis LF-89^T proteome, and TEM showed pili-like filamentous structures on the P. salmonis surface. These results strongly suggest the presence of a T4P-like structure in P. salmonis.

Exposure to Upper Arm Elevation During Work Compared to Leisure Among 12 Different Occupations Measured with Triaxial Accelerometers

Abstract

Regarding prevention of neck and shoulder pain (NSP), unsupported arm elevation is one factor that should be taken into account when performing work risk assessment. Triaxial accelerometers can be used to measure arm elevation over several days but it is not possible to differentiate between supported and unsupported arm elevation from accelerometers only. Supported arm elevation is more likely to exist during sitting than standing. The aim of the study was to evaluate the use of whole workday measurements of arm elevation with accelerometers to assess potentially harmful work exposure of arm elevation, by comparing arm elevation at work with arm elevation during leisure, in a population with diverse work tasks, and to assess how the exposure parameters were modified when upper arm elevation during sitting time was excluded. The participants, 197 workers belonging to 12 occupational groups with diverse work tasks, wore triaxial accelerometers on the dominant arm, hip, and back for 1–4 days to measure arm elevation and periods of sitting. None of the groups were found to have higher exposure to arm elevation during work compared to leisure. Even though some occupations where known to have work tasks that forced them to work with elevated arms to a large extent. A high proportion of arm elevation derived from sitting time, especially so during leisure. When arm elevation during sitting time was excluded from the analysis, arm elevation was significantly higher at work than during leisure among construction workers, garbage collectors, manufacturing workers, and domestic cleaners. Together this illustrates that it is not suitable to use whole workday measurments of arm elevation with accelerometer as a sole information source when assessing the risk for NSP due to arm elevation. Information on body posture can provide relevant contextual information in exposure assessments when it is known that the potential harmful exposure is performed in standing or walking.

A Systematic Review of the Routes and Forms of Exposure to Engineered Nanomaterials

Abstract

Background

Establishing the routes of exposure is a fundamental component of the risk assessment process for every dangerous substance. The present study systematically reviews the available literature to assess the relevance of the different routes and forms of exposure that are of concern for the protection of workers during the manufacture, handling, or end-use of engineered nanomaterials (ENMs).

Methods

A systematic review of the peer-reviewed literature published between 2000 and 2015 was completed. Only studies including measurements of inhalation or dermal exposure were selected and used to identify the exposure situations for which the measurements were collected. The identified exposure situations were grouped based on the type of ENM (i.e. carbon nanotubes and fibres, silicon-based, titanium dioxide, other metal oxides, pure elemental metals, and other ENMs) and activity involved. The grouped exposure situations were assessed to provide a conclusion regarding the likelihood, form, and route of exposure. Assessment of the likelihood of exposure was based on well-defined criteria using a previously established decision logic for inhalation exposure and the outputs from measurements and/or conceptual models for dermal/ingestion exposure. For each combination of nano-activity and type of ENM, the aggregated likelihood across all relevant individual assessments was used to draw conclusions about the relevance of both the inhalation and dermal/ingestion routes. Based on the quality of the data, the strength of the evidence was also evaluated.

Results

One hundred and seven studies were identified during the review process, reporting 424 individual exposure assessments. Measurement data were limited for dermal/ingestion exposure and for inhalation exposure for downstream use and end-of-life. However, the data provided high-quality evidence that in occupational settings all three routes can be of relevance for exposure to ENMs. In general, whenever inhalation exposure occurs then dermal and inadvertent ingestion exposure may occur due to surface deposition and transfer due to the ENMs release. However, for some forms of exposure (e.g. suspension/liquids), dermal exposure can occur even when inhalation exposure is unlikely. An increased likelihood of exposure was observed for manual activities such as cleaning and maintenance, collection/harvesting, spraying, and finishing as well as those involving feeding into a process and handling of powders outside enclosures. The likelihood of exposure was affected by the presence of risk management measures and the scale of the production involved.

Conclusion

This literature review provides evidence that for ENMs, as found for other materials, the likelihood of the exposure depends largely on the physical form of the substance as well as the applied process and operational conditions. These results can be used to provide first indications of the likelihood of exposure and guidance for exposure controls in workplaces. However, there is a clear lack of high-quality exposure data, in particular for downstream use and end-of-life scenarios and in low- and medium-income countries.

Exposure to Wood Dust, Microbial Components, and Terpenes in the Norwegian Sawmill Industry

Abstract

Sawmill workers are exposed to wood dust (a well-known carcinogen), microorganisms, endotoxins, resin acids (diterpenes), and vapours containing terpenes, which may cause skin irritation, allergy, and respiratory symptoms including asthma. The health effects of most of these exposures are poorly understood as most studies measure only wood dust. The present study assessed these exposures in the Norwegian sawmill industry, which processes predominantly spruce and pine. Personal exposures of wood dust, resin acids, endotoxin, fungal spores and fragments, mono-, and sesquiterpenes were measured in 10 departments in 11 saw and planer mills. The geometric mean (GM) and geometric standard deviation (GSD) thoracic exposures were: 0.09 mg m⁻³ dust (GSD 2.6), 3.0 endotoxin units (EU) m⁻³ (GSD 4.9), 0.4 × 10⁵ fungal spores m⁻³ (GSD 4.2), 2 × 10⁵ fungal fragments m⁻³ (GSD 3.2), and 1560 ng m⁻³ of resin acids (GSD 5.5). The GM (GSD) inhalable exposures were: 0.72 mg m⁻³ dust (2.6), 17 EU m⁻³ (4.3), 0.4 × 10⁵ fungal spores m⁻³ (3.8), and 7508 ng m⁻³ (4.4) of resin acids. The overall correlation between the thoracic and inhalable exposure was strong for resin acid (r_p = 0.84), but moderate for all other components (r_p = 0.34–0.64). The GM (GSD) exposure to monoterpenes and sesquiterpenes were 1105 µg m⁻³ (7.8) and 40 µg m⁻³ (3.9), respectively. Although mean exposures were relatively low, the variance was large, with exposures regularly exceeding the recommended occupational exposure limits. The exposures to spores and endotoxins were relatively high in the dry timber departments, but exposures to microbial components and mono-and sesquiterpenes were generally highest in areas where green (undried) timber was handled. Dust and resin acid exposure were highest in the dry areas of the sawmills. Low to moderate correlation between components (r_p ranging from 0.02 to 0.65) suggests that investigations of exposure–response associations for these components (both individually and combined) are feasible in future epidemiological studies.

What type of man against machine?

Pathologic Features of Response to Neoadjuvant Anti-PD-1 in Resected Non-Small Cell Lung Carcinoma: A Proposal for Quantitative Immune-Related Pathologic Response Criteria (irPRC)

Abstract

Background

Neoadjuvant anti-PD-1 may improve outcomes for patients with resectable NSCLC and provides a critical window for examining pathologic features associated with response. Resections showing major pathologic response (MPR) to neoadjuvant therapy, defined as ≤ 10% residual viable tumor (RVT), may predict improved long-term patient outcome. However, %RVT calculations were developed in the context of chemotherapy (%cRVT). An immune-related %RVT (%irRVT) has yet to be developed.

Patients and Methods

The first trial of neoadjuvant anti-PD-1 (nivolumab, NCT02259621) was just reported. We analyzed hematoxylin and eosin-stained slides from the post-treatment resection specimens of the 20 patients with non-small cell lung carcinoma who underwent definitive surgery. Pre-treatment tumor biopsies and pre-resection radiographic 'tumor' measurements were also assessed.

Results

We found that the regression bed (the area of immune-mediated tumor clearance) accounts for the previously noted discrepancy between CT imaging and pathologic assessment of residual tumor. The regression bed is characterized by (1) immune activation—dense tumor infiltrating lymphocytes with macrophages and tertiary lymphoid structures; (2) massive tumor cell death—cholesterol clefts; and (3) tissue repair—neovascularization and proliferative fibrosis (each feature enriched in major pathologic responders vs. non-responders, p < 0.05). This distinct constellation of histologic findings was not identified in any pre-treatment specimens. Histopathologic features of the regression bed were used to develop "Immune-Related Pathologic Response Criteria" (irPRC), and these criteria were shown to be reproducible amongst pathologists. Specifically, %irRVT had improved inter-observer consistency compared to %cRVT [median per-case %RVT variability 5% (0-29%) vs. 10% (0-58%), p = 0.007] and a two-fold decrease in median standard deviation across pathologists within a sample (4.6 vs. 2.2, p = 0.002).

Conclusions

irPRC may be used to standardize pathologic assessment of immunotherapeutic efficacy. Long-term follow-up is needed to determine irPRC reliability as a surrogate for recurrence-free and overall survival.

BRAF and MEK inhibitor therapy eliminates Nestin‐expressing melanoma cells in human tumors

Pigment Cell &Melanoma Research, EarlyView.

Skin commensal bacteria S. epidermidis promote survival of melanocytes bearing UVB‐induced DNA damage, while bacteria P. acnes inhibit survival of melanocytes by increasing apoptosis

Photodermatology, Photoimmunology &Photomedicine, Volume 0, Issue ja, -Not available-.

Genetic variants associated with skin photosensitivity in a southern European population from Spain

Photodermatology, Photoimmunology &Photomedicine, Volume 0, Issue ja, -Not available-.

Evidence of an increased neuronal activation-to-resting glucose uptake ratio in the visual cortex of migraine patients: a study comparing 18FDG-PET and visual evoked potentials

Migraine attacks might be triggered by a disruption of cerebral homeostasis. During the interictal period migraine patients are characterized by abnormal sensory information processing, but this functional abn...

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

Publication date: Available online 6 July 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): J. Michael Smith, Justin M. Broyles, Ying Guo, Sami H. Tuffaha, David Mathes, Justin M. Sacks

ABSTRACT

Background

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.

Methods

A query of the MEDLINE database for articles on HADM and breast reconstruction from 1/2012 to 10/2015 yielded 172 citations. Two levels of screening identified 47 relevant studies. Thirteen studies were used in comparative meta-analysis.

Results

Complication rates were higher in HADM patients: total complications, 17.7 versus 6.1 %; seroma, 8.3 versus 5.4 %; infection, 7.2 versus 5.9 %; and flap necrosis, 14.7 versus 7.1 %.

Meta-analysis revealed a statistically significant increased risk of total complications in patients undergoing reconstruction with HADM when compared with their submuscular cohort (p = 0.03; RR = 1.46; CI: 1.04-2.04). Patients undergoing reconstruction with HADM demonstrated a significantly increased risk of flap necrosis (p < 0.01; RR = 2.39; CI: 1.8-3.16) and infection (p=0.02; RR = 1.5; CI: 1.07-2.09) when compared with submuscular reconstruction. There was no significant difference in seroma, hematoma, or implant explantation between these two groups.

Conclusions

This study suggests an increased risk of overall complications, specifically infection and flap necrosis, in patients undergoing tissue expander/implant breast reconstruction with HADM when compared with submuscular placement. This must be weighed against the advantages in enhancing aesthetic outcomes, increasing intraoperative fill volume, and ameliorating capsular contracture.

An analysis of the breast reduction mammaplasty research pipeline

Publication date: June 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6

Author(s): Jake X. Checketts, Alaina Simpson, Jared Scott, Lacy Brame, Laurie Duckett, Matt Vassar