No abstract available
Πέμπτη 26 Ιουλίου 2018
Comparing Therapeutic versus Prophylactic Nipple-Sparing Mastectomy: Does Indication Inform Oncologic and Reconstructive Outcomes?
Background: Initially performed only in prophylactic cases, indications for nipple-sparing mastectomy have expanded. Trends and surgical outcomes stratified by nipple-sparing mastectomy indication have not yet been fully examined. Methods: Demographics and outcomes for all nipple-sparing mastectomies performed from 2006 to 2017 were compared by mastectomy indication. Results: A total of 1212 nipple-sparing mastectomies were performed: 496 (40.9 percent) for therapeutic and 716 (59.1 percent) for prophylactic indications. Follow-up time was similar between both the therapeutic and prophylactic nipple-sparing mastectomy groups (47.35 versus 46.83 months, respectively; p = 0.7942). Therapeutic nipple-sparing mastectomies experienced significantly greater rates of major (p = 0.0165) and minor (p = 0.0421) infection, implant loss (p = 0.0098), reconstructive failure (p = 0.0058), and seroma (p = 0.0043). Rates of major (p = 0.4461) and minor (p = 0.2673) mastectomy flap necrosis and complete (p = 0.3445) and partial (p = 0.7120) nipple necrosis were equivalent. The overall rate of locoregional recurrence/occurrence per nipple-sparing mastectomy was 0.9 percent: 2.0 percent in therapeutic nipple-sparing mastectomies and 0.1 percent in prophylactic nipple-sparing mastectomies (pSocial Media and the Dissemination of Research: Insights from the Most Widely Circulated Articles in Plastic Surgery
Background: The purpose of this study is to quantify the relationship between social media use and the dissemination of research across nontraditional channels. Methods: Between June and August of 2016, the authors identified 10 plastic surgery journals with the highest impact factor and their 10 most widely circulated articles. Article age; journal impact factor; "distinguished" article designation; and social media metadata of the first authors, last authors, and journals were incorporated into a multivariate regression model to predict the Altmetric Attention Score, a quantitative measure of popularity across Web-based media platforms. Results: A total of 100 articles, 181 authors, and 10 journals were identified. Older articles tended to be less popular. The article's popularity was associated with the journal's audience size, but not with the author's social media activity. For each 1000 additional Twitter followers of the journal of publication, the Altmetric score is greater by a factor of 1.72 (95 percent CI, 1.076 to 2.749), which is the equivalent of 72 percent more Tweets. There is also a small but statistically significant negative association between the author's social media audience size and the popularity of his or her articles: for every 1000 additional followers, the Altmetric score is lower by a factor of 0.822 (95 percent CI, 0.725 to 0.932), which is the equivalent of 17.8 percent fewer Tweets. Conclusion: The popularity of an article across social media platforms is associated with the journal's audience on social media, not with the magnitude of the author's social media activity.Correcting Poland Syndrome with a Custom-Made Silicone Implant: Contribution of Three-Dimensional Computer-Aided Design Reconstruction
Background: Poland syndrome is historically associated with hypoplasia of the pectoral major muscle and abnormalities of the upper limbs. The authors propose an innovative procedure for correcting Poland syndrome thoracic malformations using three-dimensional modeling. Moreover, the authors evaluated aesthetic improvement, satisfaction, and quality of life after reconstruction with computer-aided design customized silicone implants. Methods: Since 1993, the authors have treated 129 patients for Poland syndrome. Before 2007, the implants were made from plaster molds; since 2007, they have been made using three-dimensional computer-aided design. Patient satisfaction was assessed using a standardized questionnaire, and quality of life was evaluated using the Medical Outcomes Study 36-Item Short-Form Health Survey. Results: Lipofilling was performed in combination with computer-aided design in one-third of cases, and breast prostheses were required in 24 percent of cases. We found three exposed prostheses and two infections. Cosmetic results were excellent in more than 90 percent of cases, and more than 80 percent of patients were very satisfied or satisfied, with no significant difference between men and women (p = 0.382). The Medical Outcomes Study 36-Item Short-Form Health Survey scores revealed significant improvements in role emotional (pAnti-CTGF Oligonucleotide Reduces Severity of Postsurgical Hypertrophic Scars in a Randomized, Double-Blind, Within-Subject, Placebo-Controlled Study
Background: Connective tissue growth factor (CTGF) levels are up-regulated in wounded skin and are thought to play a major role in scar formation. An antisense oligonucleotide targeting CTGF was evaluated in adult patients undergoing hypertrophic scar revision surgery, to determine effects on reducing the severity of subsequent scars. Methods: In a randomized, double-blind, within-subject, placebo-controlled study, 23 female subjects (aged 28 to 55 years) with bilateral, symmetric, hypertrophic surgical scars of the breast underwent scar revision surgery. The resulting breast incisions were randomized to receive EXC 001 (5 mg/cm) or placebo injected intradermally at postsurgery weeks 2, 5, 8, and 11. Scar severity assessments were performed at weeks 12 and 24 by an expert panel using blinded photographs, and by physicians and subjects using a scar scoring scale, the Patient and Observer Scar Assessment Scale. An assumption of the design is that within-subject variance would be small and that whatever within-subject variance there was would be controlled through the randomization process. Results: EXC 001 significantly reduced scar severity at both 12 and 24 weeks after scar revision surgery in all three measures (expert panel and physician Patient and Observer Scar Assessment Scale, pVertical Spacing of Perforators in Deep Inferior Epigastric Perforator Flap Breast Reconstruction Can Affect the Outcomes
Background: The present study aimed to evaluate the influence of vertical location and spacing of perforators within flaps on the outcomes of deep inferior epigastric perforator (DIEP) flap breast reconstruction. Methods: Patients who underwent unilateral breast reconstruction with unipedicle DIEP flaps were identified. They were categorized into cohorts based on the entry of perforators in the middle third (cohort 1), upper third (cohort 2), and multiple third parts (cohort 3) of the flaps. Perfusion-related complications including fat necrosis diagnosed with ultrasound and donor-site morbidity were compared between the cohorts. Results: A total of 287 patients were analyzed, including 51 in cohort 1, 75 in cohort 2, and 161 in cohort 3. The cohorts were well matched, except for a greater number of perforators and more frequent harvest of both medial and lateral row perforators in cohort 3. Rates of overall perfusion-related complications and fat necrosis differed significantly between cohorts, with the highest rates in cohort 2. Fat necrosis occurred predominantly in the caudal portion of the flap in cohort 2, whereas it was relatively evenly distributed in the cephalic and caudal portions in cohorts 1 and 3. Rates of donor-site complications were similar across the cohorts. Multivariate analyses demonstrated that vertical spacing of perforators had an independent influence on developing perfusion-related complications and fat necrosis, showing that cohort 2 had significantly higher odds compared with cohorts 1 and 3, respectively. Conclusion: Vertical spacing of perforators might affect the risk of perfusion-related complications in DIEP flap breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.Medicare for the Plastic and Reconstructive Surgeon
Summary: Medicare, a federally funded insurance program in the United States, is a complex program about which many physicians may not receive formal training or education. Plastic surgeons, residents, and advanced practitioners may benefit from at least a basic understanding of Medicare, its components, reimbursement methods, and upcoming health care trends. Medicare consists of Parts A through D, each responsible for a different form of insurance coverage. Medicare pays hospitals, physicians, and graduate medical education. Since the introduction of Medicare, several reforms and programs have been introduced, particularly in recent years with the implementation of the Affordable Care Act. Many of these changes are moving reimbursement systems away from the traditional fee-for-service model toward quality-of-care programs. The aim of this review is to provide a brief history of Medicare, explain the basics of coverage and relevant reforms, and describe how federal insurance programs relate to plastic surgery both at academic institutions and in a community practice environment.Prospective Evaluation of Obese Patients Undergoing Autologous Abdominal Free Flap Breast Reconstruction
Background: Obesity has been viewed as a relative contraindication against autologous free flap breast reconstruction because of increased risks of complications, including flap loss. Methods: The authors conducted a prospective analysis of obese patients undergoing autologous breast reconstruction. Results: Overall, 72 patients (average age, 48.5 years; average body mass index, 35.7 kg/m2) underwent abdominal free flap breast reconstruction. There were 43 bilateral reconstructions and the remainder were unilateral (n = 115 flaps). There were 67 muscle-sparing transverse rectus abdominis musculocutaneous (TRAM) flaps (58.3 percent), 44 deep inferior epigastric perforator (DIEP) flaps (38.2 percent), two free bipedicle DIEP flaps, one superficial inferior epigastric perforator flap, and one free TRAM flap. Forty-two patients (58.3 percent) had prior radiation, and 51 (70.8 percent) had prior chemotherapy. Forty-three patients (59.7 percent) underwent delayed reconstruction and 21 (29.2 percent) underwent immediate reconstruction. Eight patients (11.1 percent) had bilateral reconstruction, with one breast reconstructed in an immediate and the other in a delayed fashion. Half of the patients (n = 36) had mesh placed in an underlay fashion to reinforce the donor site. Regarding breast complications, there were 11 wound dehiscences, one hematoma, one infection, and two patients with mastectomy skin flap necrosis. Twelve patients had donor-site wound healing complications, there were four infections, and three patients developed a bulge/hernia. There were no flap losses. Comparison to historic controls demonstrated no significant differences in overall flap loss rates (p = 0.061) or donor-site bulge/hernia (p = 0.86). Conclusion: Autologous abdominal free flaps can be performed safely in obese patients without increased risks for donor-site bulge/hernia or flap loss compared to nonobese patients; however, patients should be counseled carefully regarding the potential risks of complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IVModified Nipple Flap with Free Areolar Graft for Component Nipple-Areola Complex Construction: Outcomes with a Novel Technique for Chest Wall Reconstruction in Transgender Men
Background: A primary goal in chest wall reconstruction ("top surgery") for trans men is achieving a symmetric, aesthetically pleasing position of the reconstructed male nipple-areola complex. Methods: The senior author's (A.H.) technique for component nipple-areola complex creation in chest wall reconstruction for trans men with a modified skate flap and free areolar graft, in conjunction with double-incision mastectomy, is described. A retrospective analysis of 50 consecutive patients who underwent primary, bilateral chest wall reconstruction with this technique was undertaken for the period of March of 2015 to October of 2016. Results: The average patient age was 30.64 years, and the average body mass index was 28.54 kg/m2. Eighty-two percent of the sample received preoperative testosterone therapy, and average operative time was 2 hours 59 minutes. Average overall mastectomy specimen weight was 627.80 g, average length of hospital stay was 0.96 days, and average follow-up duration was 19.02 months. Complications occurred in five patients (10 percent), including seroma (4 percent), cellulitis (2 percent), hematoma (2 percent), and suture granuloma (2 percent). Only five patients (10 percent) underwent postoperative revision to adjust nipple-areola complex size, projection, or symmetry. Twenty-eight patients (56 percent) underwent secondary revisions, including scar revisions (56 percent), liposuction (12 percent), and fat grafting (2 percent). Conclusion: The use of a modified nipple flap and free areola graft in transgender chest wall reconstruction for trans men allows for flexible, component construction of the male nipple-areola complex in a safe and effective manner. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.The Implications of Barbed Sutures on Scar Aesthetics: A Systematic Review
Background: Barbed sutures have become increasingly popular in the field of aesthetic plastic surgery, particularly in body contouring and breast operations, in which the use of barbed sutures may offer both time and cost savings. Scar aesthetics is an important outcome for both surgeons and patients in these procedures; however, there is a paucity of studies assessing the aesthetic outcome of barbed sutures with regard to scarring. Methods: A systematic review of the PubMed, EMBASE, and Cochrane databases was performed from the date of their inception through July of 2017 using the search terms "barbed suture" combined with "scar" or "wound." Studies were included if they were prospective, evaluator-blind, randomized, controlled trials; closed the dermal layer of incisions using barbed sutures; and included an evaluator-blind aesthetic assessment of scarring. Results: Six prospective, randomized, controlled trials met inclusion criteria. The cosmetic result of scars in 926 patients was evaluated after an average of 8.1 months. Five of the six controlled trials found the aesthetic results of wounds closed with barbed sutures to be equivalent to those closed with traditional sutures, and one study showed significantly superior aesthetic results with barbed sutures. Use of barbed sutures resulted in shorter operating times in four of the five studies that timed incision closure. Similar complication rates were observed in all evaluated studies. Conclusion: Based on this systematic review, the majority of studies concluded that there were no differences in scarring aesthetics when dermal layers were closed using barbed sutures compared with traditional suturing techniques.Risk Factors for Delays in Adjuvant Chemotherapy following Immediate Breast Reconstruction
Background: Concerns exist that immediate breast reconstruction may delay adjuvant chemotherapy initiation, impacting oncologic outcomes. Here, the authors determine how postoperative complications impact chemotherapy timing, and identify factors associated with greater risk for delays. Methods: Retrospective chart review identified patients undergoing immediate breast reconstruction and adjuvant chemotherapy at a single institution from 2010 to 2015. Patients were analyzed based on occurrence of postoperative complications and time to chemotherapy. Results: A total of 182 patients (244 breast reconstructions) were included in the study; 210 (86 percent) reconstructions did not experience postoperative complications, and 34 (13.9 percent) did. Patients who experienced postoperative complications had an older mean age (53.6 years versus 48.1 years; p = 0.002) and higher rates of diabetes (23.5 percent versus 3.8 percent; pTreatment of Facial Hypopigmented Scars by the Laser Hole Technique Using a Nonfractional Carbon Dioxide Laser in Asians
Background: Facial hypopigmented scars are usually characterized by white color and a glossy surface. To correct the two problems simultaneously, the authors attempted to induce persistent postinflammatory hyperpigmentation for color and to build multiple pitted scars like facial skin pores for texture. This study describes a laser hole method using a traditional nonfractional carbon dioxide laser for treatment of facial hypopigmented scars and evaluates the clinical results. Methods: Forty-three facial hypopigmented scars in 27 patients were treated, excluding protruding or thick scars. A carbon dioxide laser was set in the superpulse mode by continuous delivery. Multiple small holes were made in the scar at a distance of 1 to 3 mm. Each laser hole was produced by continuously repeated shots at one point until the deep dermis was involved. All lesions were exposed without protection. At 1 or 2 months after initial treatment, the remaining hypopigmentation was treated by the same procedure. Results: Treatment sessions were performed once for nine scars, twice for 22 scars, and three times for 12 scars. In most cases, postinflammatory hyperpigmentation was slightly diminished but maintained until the last follow-up. The fine irregular surface with multiple pitted scars was similar to that of normal skin. Scar improvement evaluation showed marked or excellent in 39 scars (90.7 percent) and minimal or partial in four deep or thick scars. Conclusion: The laser hole technique using a nonfractional carbon dioxide laser may be an excellent option for simultaneously treating the color and texture of superficial or thin hypopigmented facial scars in Asians.Anatomical Study of the Popliteal Artery Perforator–Based Propeller Flap and Its Clinical Application
Summary: There is lack of anatomical information regarding the cutaneous perforator of the popliteal artery and its connections with the descending branch of the inferior gluteal and profunda femoris arteries. The authors aimed to evaluate the anatomical basis of the popliteal artery perforator–based propeller flap from the posterior thigh region and to demonstrate their experience using this flap. Ten fresh cadaveric lower extremities were dissected following injection of a silicone compound into the femoral artery. The authors investigated the number, location, length, and diameter of cutaneous perforators of the popliteal artery. Based on the results, the authors treated three cases with a large soft-tissue defect around the knee using a popliteal artery perforator–based propeller flap. The authors found a mean of 1.9 cutaneous perforators arising from the popliteal artery, with a mean pedicle length of 6 cm and a mean arterial internal diameter of 0.9 mm, which were located at an average of 4 cm proximal to the bicondylar line. The most distal perforator consistently arose along the small saphenous vein and connected proximally with the concomitant artery of the posterior femoral cutaneous nerve, forming a connection with perforating arteries of the profunda femoris artery. A mean of 4.5 cutaneous perforators branched from the arterial connection sites. All clinical cases healed without any complications. The popliteal artery perforator–based propeller flap is reliable for reconstruction of soft-tissue defects around the knee. The flap should include the deep fascia and concomitant artery along with the posterior femoral cutaneous nerve for maintaining the blood supply.Microanatomy of Sensory Nerves in the Upper Eyelid: A Cadaveric Anatomical Study
Background: Plastic surgery requires detailed knowledge of upper eyelid anatomy, but few authors have sufficiently described the specifics of upper eyelid nerve anatomy. This study aimed to provide a thorough description of sensory nerve anatomy in the upper eyelid and to propose considerations for upper eyelid surgery. Methods: Sixteen orbits were dissected from 16 fixed, adult human cadavers. Microscopically, the authors identified the main trunks of the infratrochlear, supratrochlear, and supraorbital nerves and all branches that projected toward the upper eyelid. The number, size, and distribution of nerve branches were recorded. Results: The branches of the infratrochlear, supratrochlear, and supraorbital nerves covered a wide range in the upper eyelid. The mean numbers of branches per nerve were 1.6 ± 1.2, 3.2 ± 1.5, and 2.6 ± 1.4, respectively. The branches of the infratrochlear nerve were distributed throughout the medial area of the upper eyelid. Those of the supratrochlear nerve were distributed throughout the medial and central areas, and the palpebral branches of the supraorbital nerve were distributed throughout the central and lateral areas of the upper eyelid. The lateral branches of the supraorbital nerve and the cutaneous branches of the lacrimal nerve were distributed in the lateral region of the orbit. Conclusions: The authors show that upper eyelid sensation is transmitted mainly by the supratrochlear and supraorbital nerves, and the authors provide a map of the distribution of upper eyelid sensory nerves. This precise anatomical knowledge about upper eyelid sensory nerves will facilitate pain control and help minimize nerve injuries during surgery.Statistical versus artificial intelligence -based modeling for the optimization of antifungal activity against Fusarium oxysporum using Streptomyces sp. strain TN71
Publication date: Available online 26 July 2018
Source: Journal de Mycologie Médicale
Author(s): S. Smaoui, K. Ennouri, A. Chakchouk-Mtibaa, I. Sellem, K. Bouchaala, I. Karray-Rebai, L. Mellouli
Abstract
A Streptomyces sp. strain TN71 was isolated from Tunisian Saharan soil and selected for its antimicrobial activity against phytopathogenic fungi. In an attempt to increase its anti–Fusarium oxysporum activity, GYM + S (glucose, yeast extract, malt extract and starch) culture medium was selected out of five different production media. Plackett–Burman design (PBD) was used to select yeast extract, malt extract and calcium carbonate (CaCO3) as parameters having significant effects on antifungal activity, and a Box–Behnken design was applied for further optimization. The analysis revealed that the optimum concentrations for the anti–F. oxysporum activity of the tested variables were yeast extract 5.03 g/L, malt extract 8.05 g/L and CaCO3 4.51 g/L. Artificial Neural Networks (ANNs): the Multilayer perceptron (MLP) and the Radial basis function (RBF) were created to predict the anti–F. oxysporum activity. The comparison between experimental and predicted outputs from ANN and Response Surface Methodology (RSM) were studied. The ANN model presents an improvement of 14.73%. To our knowledge, this is the first work reporting the statistical versus artificial intelligence -based modeling for the optimization of bioactive molecules against mycotoxigenic and phytopathogenic fungi.
Acné fulminans desencadenado por isotretinoína
Publication date: Available online 26 July 2018
Source: Piel
Author(s): Amaia Saenz Aguirre, Ana Martínez de Salinas Quintana, Sofía Goula Fernández, José Luis Díaz-Ramón
Hybrid 3D/2D Convolutional Neural Network for Hemorrhage Evaluation on Head CT [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Convolutional neural networks are a powerful technology for image recognition. This study evaluates a convolutional neural network optimized for the detection and quantification of intraparenchymal, epidural/subdural, and subarachnoid hemorrhages on noncontrast CT.
MATERIALS AND METHODS:This study was performed in 2 phases. First, a training cohort of all NCCTs acquired at a single institution between January 1, 2017, and July 31, 2017, was used to develop and cross-validate a custom hybrid 3D/2D mask ROI-based convolutional neural network architecture for hemorrhage evaluation. Second, the trained network was applied prospectively to all NCCTs ordered from the emergency department between February 1, 2018, and February 28, 2018, in an automated inference pipeline. Hemorrhage-detection accuracy, area under the curve, sensitivity, specificity, positive predictive value, and negative predictive value were assessed for full and balanced datasets and were further stratified by hemorrhage type and size. Quantification was assessed by the Dice score coefficient and the Pearson correlation.
RESULTS:A 10,159-examination training cohort (512,598 images; 901/8.1% hemorrhages) and an 862-examination test cohort (23,668 images; 82/12% hemorrhages) were used in this study. Accuracy, area under the curve, sensitivity, specificity, positive predictive value, and negative-predictive value for hemorrhage detection were 0.975, 0.983, 0.971, 0.975, 0.793, and 0.997 on training cohort cross-validation and 0.970, 0.981, 0.951, 0.973, 0.829, and 0.993 for the prospective test set. Dice scores for intraparenchymal hemorrhage, epidural/subdural hemorrhage, and SAH were 0.931, 0.863, and 0.772, respectively.
CONCLUSIONS:A customized deep learning tool is accurate in the detection and quantification of hemorrhage on NCCT. Demonstrated high performance on prospective NCCTs ordered from the emergency department suggests the clinical viability of the proposed deep learning tool.
MR Thermography-Guided Head and Neck Lesion Laser Ablation [HEAD & NECK]
SUMMARY:
Interstitial laser ablation has been successfully used as a minimally invasive treatment option for tumors in many parts of the body, including the head and neck. In this article, we describe the use of MR imaging guidance and mapping sequences for accurate localization of the target lesion, percutaneous interstitial laser ablation methods, and the use of MR thermography for temperature monitoring during laser ablation, with a focus on applications in the head and neck region.
Pseudo-Leptomeningeal Contrast Enhancement at 3T in Pediatric Patients Sedated by Propofol [PEDIATRICS]
BACKGROUND AND PURPOSE:
Propofol is a cerebral vasoconstrictor that modulates cerebral perfusion by decreasing the metabolic rate of oxygen. Because younger children often undergo intravenous sedation for MR imaging, this study set out to evaluate the degree of leptomeningeal contrast enhancement on 3T postcontrast brain MR imaging and to determine whether this phenomenon relates to sequence, sedation dosage, or patient age or weight.
MATERIALS AND METHODS:During a 2-year period, of 152 children 1–5 years of age who underwent MR imaging, 43 were included for MRI review. Of these, 37 underwent postcontrast imaging with either solely gradient-echo T1WI (n = 20) or spin-echo T1WI (n = 17); notably, 6 patients underwent both sequences. Three neuroradiologists separately graded the degree of leptomeningeal contrast enhancement (grades 0–3) that was correlated with various factors and calculated the interobserver reliability.
RESULTS:For the 43 patients, the mean patient age was 3.1 ± 1.4 years. The leptomeningeal contrast-enhancement grade was significantly greater (P < .0001) on spin-echo T1WI (1.9–2.1) versus gradient-echo TIWI (1.2–1.4). Patient weight (r = –0.366 to –.418, P = .003–.01) and age (r = –0.315 to –0.418, P = .004–.032) moderately and inversely correlated with the leptomeningeal contrast-enhancement grade, while the propofol dosage, sedation duration, and time to T1WI post-contrast administration did not (each, P > .05). The interobserver was strong regarding the leptomeningeal contrast-enhancement grade on both spin-echo T1WI ( = 0.609–0.693, P < .0001) and gradient-echo TIWI ( = 0.567–0.698, P < .0001).
CONCLUSIONS:Leptomeningeal contrast enhancement (or "pseudo"-leptomeningeal contrast enhancement) occurs with a greater frequency and degree on 3T postcontrast spin-echo T1WI relative to gradient-echo TIWI in younger children sedated with propofol and should not be mistaken for disease. This phenomenon may be more prominent with lower age or size and may arise from propofol-induced vascular smooth-muscle dilation.
Five-Year Longitudinal Study of Neck Vessel Cross-Sectional Area in Multiple Sclerosis [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Alterations of neck vessel cross-sectional area in multiple sclerosis have been reported. Our aim was to investigate the evolution of the neck vessel cross-sectional area in patients with MS and healthy controls during 5 years.
MATERIALS AND METHODS:Sixty-nine patients with MS (44 relapsing-remitting MS, 25 progressive MS) and 22 age- and sex-matched healthy controls were examined twice, 5 years apart, on a 3T MR imaging scanner using 2D neck MR angiography. Cross-sectional areas were computed for the common carotid/internal carotid arteries, vertebral arteries, and internal jugular veins for all slices between the C3 and C7 cervical levels. Longitudinal cross-sectional area differences at each cervical level and the whole-vessel course were tested within study groups and between patients with MS with and without cardiovascular disease using mixed-model analysis and the related-samples Wilcoxon singed rank test. The Benjamini-Hochberg procedure was performed to correct for multiple comparisons.
RESULTS:No significant cross-sectional area differences were seen between patients with MS and healthy controls at baseline or at follow-up. During the follow-up, significant cross-sectional area decrease was found in patients with MS for the common carotid artery–ICAs (C4: P = .048; C7: P = .005; whole vessel: P = .012), for vertebral arteries (C3: P = .028; C4: P = .028; C7: P = .028; whole vessel: P = .012), and for the internal jugular veins (C3: P = .014; C4: P = .008; C5: P = .010; C6: P = .010; C7: P = .008; whole vessel: P = .002). Patients with MS without cardiovascular disease had significantly greater change than patients with MS with cardiovascular disease for internal jugular veins at all levels.
CONCLUSIONS:For 5 years, patients with MS showed significant cross-sectional area decrease of all major neck vessels, regardless of the disease course and cardiovascular status.
Longitudinal Microstructural Changes in Traumatic Brain Injury in Rats: A Diffusional Kurtosis Imaging, Histology, and Behavior Study [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Traumatic brain injury is a major public health problem worldwide. Accurately evaluating the brain microstructural changes in traumatic brain injury is crucial for the treatment and prognosis assessment. This study aimed to assess the longitudinal brain microstructural changes in traumatic brain injury in the rat using diffusional kurtosis imaging.
MATERIALS AND METHODS:Diffusional kurtosis imaging was performed in a group of 5 rats at preinjury and 3, 14, and 28 days after traumatic brain injury. The diffusional kurtosis imaging parameters were measured in the bilateral cortex, hippocampus, and corpus callosum. Another 4 groups of 5 rats were used in brain immunohistochemistry analysis of neuron (neuron-specific nuclear protein [NeuN]), astroglia (glial fibrillary acidic protein [GFAP]), microglia (ionized calcium binding adaptor molecule 1 [Iba-1]), and myelin (myelin basic protein [MBP]) in the same area as the diffusional kurtosis imaging parameter measurements. Furthermore, 2 groups of 6 rats underwent a Morris water maze test at 28 days after traumatic brain injury. The diffusional kurtosis imaging parameters, immunohistochemistry results, and Morris water maze test results were compared longitudinally or between traumatic brain injury and control groups.
RESULTS:Compared with baseline, traumatic brain injury in the rat showed higher mean kurtosis and mean diffusivity values in the ipsilateral perilesional cortex and hippocampus and lower fractional anisotropy values in the corpus callosum (P < .05). The traumatic brain injury group showed higher staining of GFAP and Iba-1 and lower immunohistochemistry staining of NeuN and MBP in all ipsilateral ROIs (P < .05). There was no significant difference in the contralateral ROIs in diffusional kurtosis imaging parameters or immunohistochemistry results. The Morris water maze test revealed lower platform crossing times in the probe test (P < .05).
CONCLUSIONS:Our study indicated that there were longitudinal changes in diffusional kurtosis imaging parameters, accompanied by multiple pathologic changes at different time points following traumatic brain injury, and that mean kurtosis is more sensitive to detect microstructural changes, especially in gray matter, than mean diffusivity and fractional anisotropy.
Added Value of Spectroscopy to Perfusion MRI in the Differential Diagnostic Performance of Common Malignant Brain Tumors [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Perfusion and spectroscopic MR imaging provide noninvasive physiologic and metabolic characterization of tissues, which can help in differentiating brain tumors. We investigated the diagnostic role of perfusion and spectroscopic MR imaging using individual and combined classifiers of these modalities and assessed the added performance value that spectroscopy can provide to perfusion using optimal combined classifiers that have the highest differential diagnostic performance to discriminate lymphomas, glioblastomas, and metastases.
MATERIALS AND METHODS:From January 2013 to January 2016, fifty-five consecutive patients with histopathologically proved lymphomas, glioblastomas, and metastases were included after undergoing MR imaging. The perfusion parameters (maximum relative CBV, maximum percentage of signal intensity recovery) and spectroscopic concentration ratios (lactate/Cr, Cho/NAA, Cho/Cr, and lipids/Cr) were analyzed individually and in optimal combinations. Differences among tumor groups, differential diagnostic performance, and differences in discriminatory performance of models with quantification of the added performance value of spectroscopy to perfusion were tested using 1-way ANOVA models, receiver operating characteristic analysis, and comparisons between receiver operating characteristic analysis curves using a bivariate 2, respectively.
RESULTS:The highest differential diagnostic performance was obtained with the following combined classifiers: maximum percentage of signal intensity recovery–Cho/NAA to discriminate lymphomas from glioblastomas and metastases, significantly increasing the sensitivity from 82.1% to 95.7%; relative CBV–Cho/NAA to discriminate glioblastomas from lymphomas and metastases, significantly increasing the specificity from 92.7% to 100%; and maximum percentage of signal intensity recovery–lactate/Cr and maximum percentage of signal intensity recovery–Cho/Cr to discriminate metastases from lymphomas and glioblastomas, significantly increasing the specificity from 83.3% to 97.0% and 100%, respectively.
CONCLUSIONS:Spectroscopy yielded an added performance value to perfusion using optimal combined classifiers of these modalities, significantly increasing the differential diagnostic performances for these common brain tumors.
Acutely Ruptured Intracranial Aneurysms Treated with Flow-Diverter Stents: A Systematic Review and Meta-Analysis [INTERVENTIONAL]
BACKGROUND:
The implantation of flow-diverter stents for the treatment of ruptured intracranial aneurysms required further investigation.
PURPOSE:Our aim was to analyze the outcomes after flow diversion of ruptured intracranial aneurysms.
DATA SOURCES:A systematic search of 3 databases was performed for studies published from 2006 to 2018.
STUDY SELECTION:According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies (from 2010 to 2018) reporting acutely ruptured intracranial aneurysms treated with flow diversion.
DATA ANALYSIS:Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, rebleeding, and factors influencing the studied outcomes.
DATA SYNTHESIS:We included 20 studies evaluating 223 patients with acutely ruptured intracranial aneurysms treated with flow-diverter stents. Immediate angiographic occlusion was obtained in 32% (29/86; 95% CI, 15.4%–48%; I2 = 79.6%) of aneurysms, whereas long-term complete/near-complete aneurysm occlusion was 88.9% (162/189; 95% CI, 84%–93.5%; I2 = 20.9%) (mean radiologic follow-up of 9.6 months). The treatment-related complication rate was 17.8% (42/223; 95% CI, 11%–24%; I2 = 52.6%). Complications were higher in the posterior circulation (16/72 = 27%; 95% CI, 14%–40%; I2 = 66% versus 18/149 = 11.7%; 95% CI, 7%–16%; I2 = 0%) (P = .004) and after treatment with multiple stents (14/52 = 26%; 95% CI, 14%–45%; I2 = 59%) compared with a single stent (20/141 = 10%; 95% CI, 5%–15%; I2 = 0%) (P = .004). Aneurysm rebleeding after treatment was 4% (5/223; 95% CI, 1.8%–7%; I2 = 0%) and was higher in the first 72 hours.
LIMITATIONS:Small and retrospective series.
CONCLUSIONS:Flow-diversion treatment of ruptured intracranial aneurysms yields a high rate of long-term angiographic occlusion with a relatively low rate of aneurysm rebleeding. However, treatment is associated with a complication rate of 18%. When coiling or microsurgical clipping are not feasible strategies, anterior circulation ruptured aneurysms can be effectively treated with a flow-diversion technique, minimizing the number of stents deployed. Given the 27% rate of complications, flow diversion for ruptured posterior circulation aneurysms should be considered only in selected cases not amenable to other treatments.
Estimating tomato tolerance to heavy metal toxicity: cadmium as study case
Abstract
This work aimed to develop a reliable and fast approach to estimate the plant tolerance degree to heavy metal (HM) phytotoxicity. Two independent experiments were carried out using tomato accessions, with contrasting morphological features, that were grown in a hydroponic solution containing different CdCl2 concentrations for 7 days. Plant dry weight and chlorophyll content (SPAD units) were evaluated, and tolerance degree to Cd toxicity was estimated according to the tolerance index (TI), which is a new mathematical formula based on plant biomass proposed in this study. Although with different magnitudes, tomato exhibited reductions in their dry weight concurrently with the increasing CdCl2 concentration. By contrast, chlorophyll content presented no standard response, decreasing and even increasing according to CdCl2 concentrations, indicating that only under certain conditions (particularly, at CdCl2 50 μM), this parameter can be used to estimate plant tolerance to Cd toxicity. TI was efficiently able to segregate tomato cultivars with similar performance (based on the total dry weight of plants), and such segregation was optimized when the hydroponic solution contained from 25 to 50 μM CdCl2. Within this range, data pointed at 35 μM CdCl2 as the best concentration to be employed in studies related to the tomato tolerance/sensitivity to Cd toxicity. In conclusion, TI proved to be a reliable estimator of tolerance degree to Cd exposure in genetically distinct tomato accessions. Moreover, TI can be used for this same purpose in plants under other HM-induced stresses.
Insulin Resistance and Metabolic Syndrome: Clinical and Laboratory Associations in African Americans Without Diabetes in the Hemochromatosis and Iron Overload Screening Study
Metabolic Syndrome and Related Disorders, Volume 16, Issue 6, Page 267-273, August 2018.
Optimizing irrigation and nitrogen requirements for maize through empirical modeling in semi-arid environment
Abstract
Uncertainty in future availability of irrigation water and regulation of nutrient amount, management strategies for irrigation and nitrogen (N) are essential to maximize the crop productivity. To study the response of irrigation and N on water productivity and economic return of maize (Zea mays L.) grain yield, an experiment was conducted at Water Management Research Center, University of Agriculture Faisalabad, Pakistan in 2015 and 2016. Treatments included of full and three reduced levels of irrigation, with four rates of N fertilization. An empirical model was developed using observed grain yield for irrigation and N levels. Results from model and economic analysis showed that the N rates of 235, 229, 233, and 210 kg ha−1 were the most economical optimum N rates to achieve the economic yield of 9321, 8937, 5748, and 3493 kg ha−1 at 100%, 80%, 60%, and 40% irrigation levels, respectively. Economic optimum N rates were further explored to find out the optimum level of irrigation as a function of the total water applied using a quadratic equation. The results showed that 520 mm is the optimum level of irrigation for the entire growing season in 2015 and 2016. Results also revealed that yield is not significantly affected by reducing the irrigation from full irrigation to 80% of full irrigation. It is concluded from the study that the relationship between irrigation and N can be used for efficient management of irrigation and N and to reduce the losses of N to avoid the economic loss and environmental hazards. The empirical equation can help farmers to optimize irrigation and N to obtain maximum economic return in semi-arid regions with sandy loam soils.
Utilidad de una Unidad de Psicodermatología en el hospital
Publication date: Available online 26 July 2018
Source: Piel
Author(s): Carmen Brufau Redondo, Ramón Martín Brufau
Quoi de neuf dans les malformations capillaires ?
Publication date: Available online 26 July 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): A. Dompmartin
The first 30 years of the American Academy of Dermatology skin cancer screening program: 1985-2014
Publication date: Available online 26 July 2018
Source: Journal of the American Academy of Dermatology
Author(s): Jean-Phillip Okhovat, Derek Beaulieu, Hensin Tsao, Allan C. Halpern, Dominique S. Michaud, Shimon Shaykevich, Alan C. Geller
Background
The incidence of melanoma is rising faster than that of any other preventable cancer in the United States. The American Academy of Dermatology has sponsored free skin cancer education and screenings conducted by volunteer dermatologists in the United States since 1985.
Objective
We aimed to assess the American Academy of Dermatology's national skin cancer screening program from 1986 to 2014 by analyzing the risk factor profile, access to dermatologic services, and examination results.
Methods
We conducted several detailed statistical analyses of the screening population.
Results
From 1986 to 2014, records were available for 2,046,531 screenings, 1,963,141 (96%) of which were subjected to detailed analysis. Men comprised 38% of all participants. The number of annual screenings reached approximately 100,000 in 1990 and remained relatively stable thereafter. From 1991 to 2014 (data for 1995, 1996 and 2000 were unavailable), clinical diagnoses were rendered for 20,628 melanomas, 156,087 dysplastic nevi, 32,893 squamous cell carcinomas, and 129,848 basal cell carcinomas. Only 21% of screenees had a regular dermatologist. Those with a clinical diagnosis of skin cancer were more likely than the general screening population to be uninsured.
Limitations
Inability to verify clinical diagnoses histopathologically.
Conclusion
Our findings suggest that the SPOTme program has detected thousands of skin cancers that may have gone undetected or experienced a delay in detection.
Daily Application of an Aqueous, Acidifying, Peelable Nail Polish versus Weekly Amorolfine for Topical Onychomycosis Treatment: A Prospective, Randomized, Blinded Trial
Abstract
Introduction
Onychomycosis is a fungal nail infection, frequently caused by dermatophytes, which occurs in 2–14% of Western adults. The present study was set up to evaluate the efficacy and safety of a water-based, peelable nail polish (daily application), which acidifies the nail environment, versus a 5% amorolfine nail lacquer (weekly application) for topical treatment of mild-to-moderate onychomycosis.
Methods
One hundred two adults were randomized in this open, prospective, blinded trial. Clinical efficacy was evaluated at baseline and days 30, 60, 120, and 180, respectively. All patients underwent microbiological testing (at baseline and study end). The primary objective of this trial was the change in the percentage of healthy nail surface at day 180.
Results
The percentage of healthy surface between baseline and day 180 increased with 11.8% in the test product group and 13.2% in the amorolfine group, which were statistically comparable. Other onychomycosis-related parameters (dystrophy, discolouration, thickening, and healthy aspect, respectively) showed significant (p < 0.05) improvement after 180 days (versus baseline) with both treatments. Clinical performance was further confirmed by the frequency of patients showing onychomycosis improvement or success at the end of the study: 96.0% (test product) versus 79.6% (amorolfine). Microbiological results and improved quality of life confirmed clinical performance. Both treatments were well tolerated and appreciated for their properties and efficacy.
Conclusion
The present trial confirmed the clinical performance of daily acidification of the nail, as reflected by (1) a comparable increase of percentage of healthy nail surface following treatment with the test product versus amorolfine, (2) the overall improvement of other onychomycosis-related parameters, (3) user convenience, and (4) absence of side effects. These data indicate that daily application of an aqueous, acetic acid-based, peelable solution can be a convenient, safe, and equally effective alternative for the topical management of onychomycosis.
Trial Registration
ClinicalTrials.gov identifier; NCT03382717
Funding
Oystershell Laboratories.
Topical Application of 5-Fluorouracil Associated with Distant Seborrheic Dermatitis-like Eruption: Case Report and Review of Seborrheic Dermatitis Cutaneous Reactions after Systemic or Topical Treatment with 5-Fluorouracil
Abstract
Introduction
5-Fluorouracil is a fluoropyrimidine antineoplastic medication that is used to topically treat actinic keratoses. Although local adverse effects to the drug are common and anticipated, distant skin reactions are rare and unexpected. In this case report, we describe a patient who developed seborrheic dermatitis-like eruption at a distant site after topical application of 5-fluorouracil to his arms.
Case report
A 63-year-old man with actinic keratoses on his arms developed a facial seborrheic dermatitis-like reaction after topically applying 5-fluorouracil 5% cream twice daily to actinic keratoses on his forearms for 7 days. The facial dermatosis resolved shortly after discontinuation of the 5-fluorouracil; upon rechallenge of topical 5-fluorouracil on his arms, the facial seborrheic dermatitis recurred.
Discussion
Several case reports have been published which describe exacerbations of preexisting seborrheic dermatitis with local topical 5-fluorouracil. Additionally, one case series describes the development of scrotal dermatitis in two patients after distant treatment with 5-fluorouracil. The pathogenesis that causes this distant reaction is unclear.
Conclusion
We describe a patient with a seborrheic dermatitis eruption after topical application of 5-fluorouracil at a distant site. The etiologic association between the drug and adverse effect was confirmed with multiple cycles of application and discontinuation of the offending agent.
Brow Position After Paramedian Forehead Flap Nasal Reconstruction
This study compared preoperative and postoperative photographs of patients who underwent nasal reconstruction with paramedian forehead flaps to analyze differences in brow position.
The Incisionless Otoplasty Technique
This Surgical Pearl describes a technique for performing an incisionless otoplasty to reduce ear prominence.
A Decade of Thread-Lifting—What Have We Learned Over the Last 10 Years?
This Viewpoint evaluates the use of the thread-lifting technique for face-lifts in the 10 years since its introduction.
Supportive Therapieansätze beim hepatozellulären Karzinom
Zusammenfassung
Hintergrund
Die Therapieoptionen bei Patienten mit hepatozellulärem Karzinom (HCC) nach Versagen einer Therapie mit Sorafenib sind derzeit weiterhin eingeschränkt. Insbesondere bei Verschlechterung der Leberfunktion, der häufigsten HCC-bedingten Todesursache, erfolgt eine supportive Behandlung als akzeptierter Standard.
Methoden
Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed zum Thema supportive Behandlung bei HCC.
Ergebnisse
Was genau eine supportive Behandlung bei HCC beinhaltet, ist in aktuellen Leitlinien und der Literatur jedoch unzureichend definiert. Außer zum Pruritus liegen kaum validierte Daten vor. Die meisten Patienten entwickeln im weiteren Krankheitsverlauf Symptome der Leberinsuffizienz (Aszites, Syntheseeinbruch mit Gerinnungsstörungen und Blutungen, Ödeme, u. a.). Klassische tumorassoziierte Beschwerden wie Schmerzen und Mangelernährung treten im weiteren Krankheitsverlauf auf. Eine Schmerztherapie erfolgt bevorzugt mit Paracetamol, ggf. mit Opiaten. Eine typische HCC-assoziierte Komplikation ist die maligne Pfortaderthrombose, über deren Therapie Uneinigkeit besteht. Als relativ seltene Komplikationen treten Cholestase/Cholangitis sowie symptomatische Knochen- und Lungenmetastasen auf.
Schlussfolgerung
Die vorliegende Übersicht fasst die derzeitige Datenlage zur supportiven Therapie inkl. der aktuellen Leitlinienempfehlungen zusammen.
Stationär behandlungsbedürftige odontogene Abszesse: zum Zeitpunkt der Fokussanierung
Zusammenfassung
Odontogene Abszesse erfordern eine frühzeitige Erkennung, suffiziente chirurgische Eröffnung sowie zielgerichtete antibiotische Therapie. Die Sanierung der Ursache des Infektes ist obligat. Über den genauen Zeitpunkt der Fokussanierung wird in der Literatur kontrovers berichtet. Einer unmittelbaren Fokussanierung steht die Empfehlung einer Sanierung im Intervall gegenüber.
Retrospektiv wurden die Daten von insgesamt 210 (116: männlich, 94: weiblich) Abszesspatienten, die in den Jahren 2012–2015 in der hiesigen Klinik stationär aufgrund einer odontogenen Ursache behandelt worden waren, ausgewertet.
In 89 Fällen wurde eine Fokussanierung im Rahmen der Abszesseröffnung durchgeführt; in 121 Fällen erfolgte diese im Intervall. In 7 Fällen kam es zu Komplikationen im Sinne einer weiteren Abszessausbreitung (n = 4), eines Rezidivs (n = 2) oder der Ausbildung einer Osteomyelitis (n = 1). Statistisch relevante Risikofaktoren konnten hierfür nicht gefunden werden. Insbesondere hatte der Zeitpunkt der Fokussanierung keinen signifikanten Einfluss.
Eine simultane Fokussanierung erhöht somit das Risiko von Komplikationen im Sinne von Osteomyelitiden, septischen Krankheitsverläufen oder fortgeleiteten Entzündungen nicht. Somit bestätigen die Ergebnisse dieser Studie die Empfehlungen der aktuellen Leitlinie.
Allerdings wurden Hochrisikopatienten, d. h. Patienten mit einem Zustand nach Radiotherapie im Kopf-Hals-Bereich, laufender Bisphosphonat- oder Chemotherapie nicht in die Studie einbezogen.
Der individuellen Entscheidung des Operateurs sollte es daher weiterhin unterliegen, ob eine sekundäre Fokussanierung vorzuziehen ist. Entscheidende Kriterien hierfür sind, neben dem Ausmaß der Sanierung, allgemeine medizinische Risikokonstellationen des individuellen Patienten.
Physiological, hematological and biochemical factors associated with high-altitude headache in young Chinese males following acute exposure at 3700 m
High-altitude headache (HAH) is the most common sickness occurred in healthy people after rapid ascending to high altitude, and its risk factors were still not well understood. To investigate physiological, he...
Poor sleep quality in migraine and probable migraine: a population study
Probable migraine (PM) is a subtype of migraine that is prevalent in the general population. Previous studies have shown that poor sleep quality is common among migraineurs and is associated with an exacerbati...
Survival outcome and mortality rate in patients with migraine: a population-based cohort study
Whether the patients with migraine have an elevated mortality risk in Taiwan is unclear.
Sehr hochfrequenter Ultraschall in der ästhetischen Medizin und Chirurgie
Zusammenfassung
Der sehr hochfrequente Ultraschall (SHF-US) basiert auf einem nichtinvasiven Einsatz von Ultraschall(US)-Wellen mit Frequenzen über 10 MHz. Behandlungen mit solchen US-Frequenzen fanden in letzten Jahren eine breite Anwendung in der Dermatologie und in der ästhetischen Medizin. SHF-US kann in der ästhetischen Medizin sowohl als effektive Stand-alone-Behandlungsmethode eingesetzt werden als auch in Kombination mit anderen energiebasierten Methoden, verschiedenen Injektionsanwendungen sowie als supportive Maßnahme in der ästhetisch-plastischen Chirurgie.
The first 30 years of the American Academy of Dermatology skin cancer screening program: 1985-2014
The incidence of melanoma is rising faster than that of any other preventable cancer in the United States. The American Academy of Dermatology has sponsored free skin cancer education and screenings conducted by volunteer dermatologists in the United States since 1985.
Large cell neuroendocrine carcinoma of the lung with atypical evolution and a remarkable response to lutetium Lu 177 dotatate
Abstract
Large cell neuroendocrine carcinoma of the lung (LCNEC) is a high-grade, poorly differentiated tumor that typically does not express somatostatin receptors. Thus, it does not benefit from treatment with somatostatin analogs and peptide receptor radionuclide therapy (PRRT). The current study objective was to demonstrate that treatment with PRRT may be a valid option in neuroendocrine carcinomas with high expression of somatostatin receptors. This is a case report of a 58-year-old man who was diagnosed with LCNEC and received chemotherapy treatment with little benefit. Extensive hepatic and bone metastasis was detected on 111In-pentetreotide scintigraphy following high uptake of the radionuclide by the tumors. The patient benefitted from neuroendocrine treatment initially and from lutetium Lu 177 dotatate subsequently. A significant clinical and radiological response was observed, along with an improvement in quality of life. The use of PRRT is a valid alternative to chemotherapy in patients with LCNEC involving the expression of somatostin receptors.
Dermatofiller in der ästhetischen Medizin – ein Überblick
Zusammenfassung
Hintergrund
Minimal-invasive Verfahren wie die Fillertherapie spielen eine zunehmend große Rolle in der plastisch-ästhetischen Chirurgie. Üblicherweise werden Filler zur Gewebeaugmentation und Hautverjüngung eingesetzt. Die Anwendung von Fillern bietet die Möglichkeit, gute ästhetische Ergebnisse mit einem deutlich geringeren Risiko für größere Komplikationen als bei einem invasiven chirurgischen Eingriff zu erzielen.
Methode
Der vorliegende Beitrag gibt einen Überblick über die aktuell verwendeten Filler und deren Komplikationen in der klinischen Anwendung. Dazu wurden Auszüge aus der aktuellen Literatur mit den eigenen Erfahrungen kombiniert.
Ergebnisse
Resorbierbare Filler zeigen eine bessere Biokompatibilität und geringere Komplikationsraten als nichtresorbierbare. Die häufigsten Indikationen im Gesicht sind die Nasolabial- und Marionettenfalte, die Lippen sowie die Jochbein- und Wangenregion. Je nach Anwendungsort und verwendetem Präparat werden verschiedene Injektionstechniken eingesetzt. Injektionsfehler sind leicht zu erkennen und bei Hyaluronsäureprodukten am einfachsten zu korrigieren. Das häufigste unerwünschte Ergebnis ist die zu oberflächliche Injektion von Präparaten für tiefere Schichten. Die Anwendung zu hoher Füllvolumina, zu große Bolusinjektionen und zu häufige Injektionen führen zu ästhetisch unattraktiven Verformungen und Störungen der Gesichtstopographie. Zu den häufigsten unerwünschten Wirkungen gehören Pigmentveränderungen, Ödeme und Deformationen nach der Injektion.
Schlussfolgerungen
Das Wissen über die unterschiedlichen Eigenschaften der verschiedenen Filler sowie deren professionelle Anwendung ist unabdingbar für ein optimales Ergebnis. Des Weiteren sichert ein frühzeitiges Erkennen der mit Fillern verbundenen Nebenwirkungen die Möglichkeit eines frühzeitigen Eingreifens, um größere Komplikationen zu vermeiden.
Statistical Inference of Health Disparity Indices for Complex Surveys
The United States National Cancer Institute developed the Health Disparities Calculator (HD*Calc) to facilitate disparity research. HD*Calc calculates multiple measures of health disparities using data collected from population-based disease surveillance systems, such as cancer registries. In this paper, we extend the use of HD*Calc to complex survey data by developing plug-in point estimators and Taylor linearization variance estimators that consider complex designs: stratification, multistage clustering, and differential weighting. Our simulation indicates that the plug-in estimators are approximately unbiased and the Taylor linearization variance estimators are accurate. Using the National Health and Nutrition Examination Survey 2011–2016 data, we demonstrated the use of these estimators in evaluating socioeconomic disparities in adolescent obesity prevalence in the US Statistical software was developed for ease of disparity analyses using complex survey data.
Origins of the 1918 Pandemic: Revisiting the Swine “Mixing Vessel”
How influenza A viruses host-jump from animal reservoir species to humans to initiate global pandemics is a central question in pathogen evolution. The zoonotic and spatial origins of the 1918 "Spanish influenza" pandemic virus have been debated for decades. Outbreaks of respiratory disease in US swine occurred concurrently with disease in humans, raising the possibility that the 1918 virus originated in pigs. Swine also were proposed as "mixing vessel" intermediary hosts between birds and humans during the 1957 "Asian" and 1968 "Hong Kong" pandemics. Swine have presented an attractive explanation for how avian viruses overcome the substantial evolutionary barriers presented by different cellular environments in humans and birds. However, key assumptions underpinning the swine "mixing vessel" model of pandemic emergence have been challenged by new evidence. Increased surveillance in swine reveals that human-to-swine transmission actually occurs far more frequently than swine-to-human transmission, and there is no empirical evidence that swine played a role in the emergence of human influenza in 1918, 1957, or 1968. Swine-to-human transmission occurs periodically and can trigger pandemics, as in 2009. But swine are not necessary to mediate the establishment of avian viruses in humans, inviting new perspectives on the evolutionary processes underlying pandemic emergence.
Stillbirth Risk and Spatial Variation in Excess Death Rates During the 1918–1920 Influenza Pandemic in Arizona, USA
A large body of epidemiologic research has concentrated on the 1918 influenza pandemic, but more work is needed to understand spatial variation in pandemic mortality and pandemic impact on natality and stillbirths. We collected and analyzed 35,151 death records from Arizona for 1915–1921 and 21,334 birth records from Maricopa county, for 1915–1925. We estimated stillbirth risk and excess death rates and assessed the temporal association between pandemic-related excess mortality and stillbirths at different lags. There was a significant difference in stillbirth risk in the pandemic vs. post-pandemic periods (risk ratio = 1.96, P < 0.05). Pregnant women aged 20–39 years had the highest stillbirth risk during the pandemic. We found a significant trough in live births 10 and 11 months after the peak in excess deaths for males (rdb(10) = −0.26) and females (rdb(11) = −0.24). Moreover, northern counties with higher Native American population densities exhibited higher excess mortality rates, suggesting a link between ethnic and/or socio-demographic factors and risk of pandemic death. The relationship between stillbirth and pandemic mortality risk should be further studied at different spatial scales and in different ethnic groups.
¿Por qué no debemos olvidar el papel del psicólogo clínico en el abordaje terapéutico de los pacientes con psoriasis?
Publication date: Available online 26 July 2018
Source: Actas Dermo-Sifiliográficas
Author(s): A. Martin-Gorgojo, R. Martin-Brufau
Occurrence, distribution, and environmental risk of four categories of personal care products in the Xiangjiang River, China
Abstract
The Xiangjiang River is the mother river of the Hunan Province; also, it is a stream receiving effluents from wastewater treatment plants and even sewage, providing raw water for drinking water and habitat for various kinds of aquatic organisms. Thus, the occurrence and distribution of personal care products (PCPs) in the Xiangjiang River, including seven preservatives, four anticorrosion agents, two antimicrobials, and six UV filters, were detected to evaluate their environmental risk. Of 13 detected PCPs, methyl paraben, propyl paraben, 1H-benzotriazole, 5,6-dimethyl-1H-benzotriazole, triclosan, and triclocarban were detected with a high frequency (81.4–100%), and their concentrations were up to 3173.9, 1040.4, 520.5, 15.6, 20.0, and 13.3 ng/L, respectively. Seasonal and spatial differences of the PCP distributions were observed with p < 0.05. Compared with other 37 rivers around the world, the overall pollution level of the Xiangjiang River was moderate, characterized with higher preservatives, lower anticorrosion agents and UV filters in concentration. The risk assessment revealed that methyl paraben, propyl paraben, 2-hydroxy-4-methoxybenzophenone, triclosan, and triclocarban were likely to have ecotoxicological effects on the fish, daphnias, and algae.
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Publication date: Available online 25 July 2018 Source: Journal of Photochemistry and Photobiology B: Biology Author(s): Marco Ballestr...
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Editorial AJR Reviewers: Heartfelt Thanks From the Editors and Staff Thomas H. Berquist 1 Share + Affiliation: Citation: American Journal...
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Publication date: Available online 28 September 2017 Source: Actas Dermo-Sifiliográficas Author(s): F.J. Navarro-Triviño
