Whole Body MRI: Non-oncological Musculoskeletal Applications

Abstract

Purpose of the Review

Whole-body MRI is an emerging imaging technique on continuous evolution, used in many oncologic indications and introduced more recently in rheumatologic and systemic disorders. In this article, we review the recent musculoskeletal applications of this technique outside the field of cancer.

Recent Findings

Whole-body MRI, with its high sensitivity to bone marrow and soft-tissue alterations, and ability of extensive body coverage, is progressively regarded as an effective and powerful imaging tool for the detection, staging, and monitoring under treatment of many rheumatic diseases and systemic pathologies affecting the musculoskeletal system. Disease specific imaging protocols have been designed.

Summary

Whole-body MRI is an appealing, non-irradiating tool emerging in musculoskeletal imaging. It is becoming the imaging of choice in several non-oncologic indications, and its application field is on continuous expansion.

Review of the medical literature and assessment of current utilization patterns regarding the use two common fluorescence in situ hybridization assays in the diagnosis of dermatofibrosarcoma protuberans and clear cell sarcoma

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.

Immunohistochemical expression of melanocytic and myofibroblastic markers and their molecular correlation in atypical fibroxanthomas and pleomorphic dermal sarcomas MiTF and calponin expression in AFX and PDS

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.

“We're Going to Leave You for Last, Because of How You Are”: Transgender Women's Experiences of Gender-Based Violence in Healthcare, Education, and Police Encounters in Latin America and the Caribbean

Violence and Gender, Ahead of Print.

Icariin inhibits inflammation via immunomodulation of the cutaneous hypothalamus–pituitary–adrenal axis in vitro

Clinical and Experimental Dermatology, EarlyView.

Editors’ letter

Laser therapy for ocular lesions of naevus of Ota

Australasian Journal of Dermatology, EarlyView.

Associated factors of widespread pattern of dermatitis among patch test population: 12‐Year retrospective study

Australasian Journal of Dermatology, EarlyView.

Severe cutaneous eruptions following the topical use of preparations containing bufexamac: Is it time to reconsider its registration in Australia?

Australasian Journal of Dermatology, EarlyView.

Identifying demographic, social and clinical predictors of biologic therapy effectiveness in psoriasis: a multicentre longitudinal cohort study

British Journal of Dermatology, EarlyView.

A 10‐year longitudinal follow‐up study of a U.K. paediatric transplant population to assess for skin cancer

British Journal of Dermatology, EarlyView.

Dermatology on the General Practice Bookshelf

British Journal of Dermatology, EarlyView.

Comparison of Immediate versus Delayed DIEP Flap Reconstruction in Women Who Require Postmastectomy Radiotherapy

Background: The authors investigated aesthetic outcome and patient satisfaction in women who have undergone deep inferior epigastric artery perforator (DIEP) flap reconstruction in the setting of postmastectomy radiotherapy. Patients who underwent DIEP flap reconstruction without postmastectomy radiotherapy were the control group. Methods: Participants who had undergone DIEP flap reconstruction between September 1, 2009, and September 1, 2014, were recruited, answered the BREAST-Q, and underwent three-dimensional surface-imaging. A panel assessed the aesthetic outcome by reviewing these images. Results: One hundred sixty-seven women participated. Eighty women (48 percent) underwent immediate DIEP flap reconstruction and no postmastectomy radiotherapy; 28 (17 percent) underwent immediate DIEP flap reconstruction with postmastectomy radiotherapy; 38 (23 percent) underwent simple mastectomy, postmastectomy radiotherapy, and DIEP flap reconstruction; and 21 (13 percent) underwent mastectomy with temporizing implant, postmastectomy radiotherapy, and DIEP flap reconstruction. Median satisfaction scores were significantly different among the groups (p

Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits

No abstract available

Ethics in Plastic Surgery: Applying the Four Common Principles to Practice

Summary: The topic of ethics in plastic surgery remains underrepresented in the literature. By applying the four principles of biomedical ethics—respect for autonomy, beneficence, nonmaleficence, and justice—as described by Beauchamp and Childress to proposed ethical scenarios, this article attempts to provide plastic surgeons with a systematic approach to recognize and address ethical dilemmas as they present in day-to-day practice. Through the perspective of an experienced plastic surgeon and medical ethicist, this article is intended to spark discussion, reflection, and debate on ethical challenges in plastic surgery.

Transversus Abdominis Plane Blocks in Microsurgical Breast Reconstruction: Analysis of Pain, Narcotic Consumption, Length of Stay, and Cost

Background: Transversus abdominis plane blocks are increasingly being used in microvascular breast reconstruction. The implications of these blocks on specific reconstructive, patient, and institutional outcomes remain to be fully elucidated. Methods: Patients undergoing abdominally based microvascular breast reconstruction from 2015 to 2017 were reviewed. Length of stay, complications, narcotic consumption, donor-site pain, and hospital expenses were compared between patients who did and did not receive transversus abdominis plane blocks with liposomal bupivacaine. Outcomes were subsequently compared in patients with elevated body mass index. Results: Fifty patients (43.9 percent) received blocks [27 (54.0 percent) under ultrasound guidance] and 64 patients (56.1 percent) did not. Patients with the blocks had significantly decreased oral and total narcotic consumption (p = 0.0001 and p

Rethinking Evidence-Based Medicine in Plastic and Reconstructive Surgery

No abstract available

Hand and Wrist Surgery, Third Edition

No abstract available

Nitroglycerin Ointment for Reducing the Rate of Mastectomy Flap Necrosis in Immediate Implant-Based Breast Reconstruction

Background: Mastectomy flap necrosis remains a challenging complication in immediate tissue expander breast reconstruction. Nitroglycerin ointment has been shown to reduce the incidence of mastectomy flap necrosis in a randomized controlled study, using 45 g per breast and treating one side only in bilateral cases. This study was conducted to determine the efficacy of 15 g of nitroglycerin ointment per breast, therefore permitting application to both breasts in cases of bilateral mastectomy. Methods: A retrospective cohort study of patients undergoing immediate tissue expander breast reconstruction performed by a single reconstructive surgeon was conducted. The intervention cohort consisted of all patients between June 10, 2015, and June 9, 2016 (94 patients, 158 breasts), where 15 g of nitroglycerin ointment was routinely applied per breast. The control cohort consisted of all patients from June 10, 2014, to June 9, 2015 (107 patients, 170 breasts), where nitroglycerin was not applied. All complications were tracked, including minor wound healing problems. Results: There was an overall 22 percent decreased incidence of mastectomy flap necrosis in the nitroglycerin ointment cohort (47.5 percent versus 60.6 percent; p = 0.002), with a 44 percent reduction in full-thickness mastectomy flap necrosis that trended toward statistical significance (9.5 percent versus 16.5 percent; p = 0.06). On multivariate analysis, nitroglycerin application was independently associated with a decrease in mastectomy flap necrosis or need for mastectomy flap débridement. There was no significant difference in the incidence of postoperative hypotension (3.8 percent versus 2.9 percent) or headache among cohorts. Conclusion: Topical nitroglycerin ointment application to mastectomy skin flaps at 15 g per breast is a cost-effective means of decreasing the incidence of mastectomy flap necrosis in unilateral and bilateral immediate tissue expander breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Reply: Objective Assessment of the Unilateral Cleft Lip Nasal Deformity Using Three-Dimensional Stereophotogrammetry Severity and Outcome

No abstract available

Discussion: Nitroglycerin Ointment for Reducing the Rate of Mastectomy Flap Necrosis in Immediate Implant-Based Breast Reconstruction

No abstract available

Lymph Flow Restoration after Tissue Replantation and Transfer: Importance of Lymph Axiality and Possibility of Lymph Flow Reconstruction without Lymph Node Transfer or Lymphatic Anastomosis

Background: The lymph system plays important roles in maintaining fluid balances, the immune system, and lipid metabolism. After tissue replantation or transfer, some cases suffer long-lasting edema or lymphedema caused by interruption of main lymph flows; however, this mechanism has yet to be clarified. Methods: The medical charts of 38 patients who underwent indocyanine green lymphography after tissue replantation or free flap transfer were reviewed to obtain data regarding clinical demographics, intraoperative findings, and postoperative indocyanine green lymphographic findings. Postoperative lymph flow restoration based on indocyanine green lymphographic findings was evaluated according to intraoperative findings, including raw surface in lymph axiality and compatible lymph axiality. Results: Lymph flow restoration was observed in 24 cases (63 percent). There were significant differences in positive lymph flow restoration with regard to sex (male, 78 percent; female, 40 percent; p = 0.017), cause of defect (trauma, 83 percent; others, 33 percent; p = 0.002), type of operation (replantation, 94 percent; free flap, 41 percent; p = 0.001), and compatible lymph axiality (positive, 96 percent; negative, 0 percent; p

Novel Approach for Risk-Reducing Mastectomy: First-Stage Implant Placement and Subsequent Second-Stage Mastectomy

Background: Risk-reducing mastectomy with tissue expander and then implant-based breast reconstruction conventionally involved immediate submuscular placement of tissue expanders during mastectomy and then, after expansion, replacement of expanders for permanent implants in a second-stage operation. Use of acellular dermal matrix can achieve a single-stage operation; however, acellular dermal matrices are costly and may have potential complications. The authors aim to assess the feasibility of placement of implants as a first-stage procedure before risk-reducing mastectomy as a novel technique of reconstruction that avoids the need for serial outpatient expansion and acellular dermal matrix. Methods: Patients for whom risk-reducing mastectomy was planned were offered first-stage dual-plane placement of fixed volume silicone gel permanent implants by means of inframammary fold incisions. Risk-reducing mastectomy was undertaken several months later as the second operation, leaving the implants in place protected by the muscle and capsule pocket. Nipples were preserved or reconstructed according to the patient's choice. Results: Eight patients with 15 operated breasts were recruited. Anatomically shaped implants were used in all patients, and complete coverage of each implant was achieved. Mean implant volume was 433 ml (range, 290 to 545 ml). There were no complications, and good aesthetic outcomes were achieved. Conclusions: This proof-of-principle study finds that placement of implants before risk-reducing mastectomy is a novel technique for women at high breast cancer risk that could reduce the use of tissue expanders and acellular dermal matrices and their associated problems. Two-stage risk-reducing mastectomy with first-stage implant placement and subsequent risk-reducing mastectomy leaving the implants in place is feasible, with no complications, and can produce a good cosmetic outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Discussion: The Ethical and Professional Use of Social Media in Surgery A Systematic Review of the Literature

No abstract available

Opioid Use following Outpatient Breast Surgery: Are Physicians Part of the Problem?

Background: The increasing rate of opioid abuse warrants standardization of postoperative pain management. The purpose of this study was to analyze the use of opioids in pain control and patient satisfaction following ambulatory breast surgery. Methods: This was a prospective study of a consecutive series of patients undergoing secondary breast reconstruction (n = 60) or breast reduction (n = 35). All patients were given a pain questionnaire preoperatively. Postoperatively, women received 30 tablets of oxycodone 5.0 mg/acetaminophen 325 mg. Patients were contacted three times: postoperative days 3 to 5, 8 to 10, and 30 or higher. All patients were queried on narcotic use, pain level (0 to 10), and satisfaction with pain control. Patients with allergies or taking narcotics preoperatively were excluded. Results: Most in the secondary breast reconstruction group (61.5 percent) had stopped taking opioids by postoperative day 5. Patients consumed a mean of 11.4 tablets following secondary breast reconstruction and a mean of 17.5 tablets after breast reduction. A majority reported feeling satisfied with their pain management. At postoperative day greater than 30, most experienced very mild pain, with an improvement of 3.74 points following breast reduction. There were 18.6 and 12.5 tablets per patient left over for secondary breast reconstruction and breast reduction, respectively. A total of 1551 unused tablets were left over for the entire cohort at postoperative day greater than 30. There was no significant difference in average pain scores or interference with enjoyment or activity between those who did or did not take pain medication. Conclusions: This commonly prescribed pain regimen provides adequate pain relief and satisfaction for breast surgery, with a substantial number of leftover tablets. Physicians as prescribers should be aware of discrepancies. Prescription of 30 opioid tablets after outpatient breast surgery appears unnecessary and excessive. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Treatment of Facial Hypopigmented Scars by the Laser Hole Technique Using a Nonfractional Carbon Dioxide Laser in Asians: Correction

No abstract available

Discussion: Opioid Use following Outpatient Breast Surgery Are Physicians Part of the Problem?

No abstract available

Reply: Smaller Diameter Anastomotic Coupling Devices Have Higher Rates of Venous Thrombosis in Microvascular Free Tissue Transfer

No abstract available

Robotic Nipple-Sparing Mastectomy with Immediate Prosthetic Breast Reconstruction: Surgical Technique

Summary: Robotic nipple-sparing mastectomy could be a significant advancement in the treatment and prophylaxis of selected breast cancers. Motion-scaling, high-resolution, three-dimensional optics; tremor elimination; and instruments with enhanced precision with 7 degrees of freedom have allowed surgeons to overcome the limitations experienced with the endoscopic approach in breast surgery. Advantages of this procedure, in comparison with the open technique, are a shorter and more acceptable scar located in the lateral thoracic region, and greater respect for the vascularization of the mastectomy skin flap, because there is no incision on the breast and no retractors are used. The authors recently received approval from both the French health authorities and the ethics committee to carry out a clinical trial in their institution to assess feasibility, reproducibility, and safety of robotic nipple-sparing mastectomy with immediate prosthetic breast reconstruction. The aims of this article are to describe the surgical technique they have developed, and to share, through a video, the clinical experience gained from over 60 procedures performed so far.

Reply: The Role of Tranexamic Acid in Plastic Surgery Review and Technical Considerations

No abstract available

The Use of Bone Dust to Correct the Open Roof Deformity in Rhinoplasty

Background: Hump removal frequently results in an open roof during rhinoplasty, which is conventionally closed with lateral osteotomies. However, if the patient has a narrow bony vault, lateral osteotomies are problematic. In this article, the author presents a new and practical approach to fix the open roof deformity. Methods: A total of 240 patients (female, n = 187; male, n = 53) were enrolled and operated on with the presented technique. This approach has four steps, as follows: complete submembranous dissection, preparation of spreader flaps, harvesting of bone dust from the bony hump, and placement of the bone dust. The patient's nasal dorsum was evaluated by ultrasonography. During the follow-up period, all patients were photographed postoperatively from standard views using a digital camera. Photographs were inspected by two independent plastic surgeons. A palpation test for the nasal dorsum was conducted by a senior surgeon to identify any irregularities. A rhinoplasty outcomes evaluation questionnaire was administered to all patients at a 1-year follow-up visit. Functional improvement was assessed with self-evaluation of nasal patency. The chi-square test was used for statistical analysis. Results: Of the 240 patients, 182 completed the 1-year follow-up period and rhinoplasty outcomes evaluation questionnaire. Thirty-seven patients were evaluated by ultrasonography at 1 year postoperatively. During the follow-up period, no resorption or displacement was detected. High patient satisfaction was achieved, and no complications were encountered. Conclusion: The presented four-step surgical concept was useful for rhinoplasty surgeons to successfully manage open roof deformity in selected patients.

Optimizing Perforator Selection: A Multivariable Analysis of Predictors for Fat Necrosis and Abdominal Morbidity in DIEP Flap Breast Reconstruction

Background: This study aims to elucidate the important predicting factors for fat necrosis and abdominal morbidity in the patient undergoing deep inferior epigastric artery perforator flap reconstruction. Methods: The authors conducted a retrospective review of 866 free-flap breast reconstructions performed at one institution from 2010 to 2016. Twenty-eight potential predictors were included in multivariable analyses to control for possible confounding interactions. Results: Four hundred nine total deep inferior epigastric artery perforator flaps were included in the statistical analysis. Of these, 14.4 percent had flap fat necrosis, 21.3 percent had an abdominal wound or complication, and 6 percent had an abdominal bulge or hernia. Analysis showed an increase in the odds of fat necrosis with increasing flap weight (OR, 1.002 per 1-g increase; p = 0.0002). A decrease in the odds of fat necrosis was seen with lateral row (OR, 0.29; p = 0.001) and both medial and lateral row perforator flaps (OR, 0.21; p = 0.001), if indocyanine green angiography was used (OR, 0.46; p = 0.04), and with increasing total flow rate of the flap (OR, 0.62 per 1-mm/second increase; p = 0.05). Increased odds of abdominal bulge or hernia were seen with lateral row or both medial and lateral row perforators (OR, 3.21; p = 0.05) versus medial row perforator-based flaps, and with patients who had an abdominal wound postoperatively (OR, 2.59; p = 0.05). Conclusions: The authors' results suggest that using larger caliber perforators and perforators from the lateral row alone, or in addition to medial row perforators, can decrease fat necrosis more than simply harvesting more perforators alone. However, lateral and both medial and lateral row perforator flaps come at the cost of increasing abdominal bulge rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Wonder, Guarding Against Thoughtlessness in Education

Abstract

Hannah Arendt has a particular notion of thinking that both is and is not (in her sense of the term) philosophical. While not guided by the search for meta principles, nor concerned with establishing logical systems, her notion of thinking as the examination of "whatever happens to come to pass," and its significance for saving our world from thoughtlessness, retains and is motivated by the fundamental pathos at the heart of philosophy—wonder. In this paper, I consider the limiting and enabling sense in which Arendt invokes "wonder" for the possibility of thinking. I do so, in turn, to explore what the pathos of wonderment might offer education—an institution charged with cultivating "thinking" and, yet, constantly susceptible to the thoughtless trappings of technocratic jargon and the mechanical logic of assessment, learning processes and social reproduction. Can wonder—the very pathos of philosophy—cultivate a thinking that helps us retain an "unclouded attentiveness" to what is educational in education? Might wonder help us to overcome the thoughtlessness that dulls our attention to what we do to each other through education?

The Use of Pulse Oximetry to Diagnose Limb Ischaemia

The accurate diagnosis of limb ischaemia in the acute trauma setting is time critical. In cases of polytrauma and complex limb injuries this assessment can be difficult and is often first performed by a junior member of the team. The assessment of neurovascular status of these injuries is much the same as it was decades ago. Recently clinical methods thought to be of use are being proven otherwise. In our trauma centre we now routinely use pulse oximetry in the assessment of limb and digit ischaemia.

Characterization of the immune microenvironment of diffuse intrinsic pontine glioma: Implications for development of immunotherapy

Abstract

Background

Diffuse Intrinsic Pontine Glioma (DIPG) is a uniformly fatal CNS tumor diagnosed in 300 American children per year. Radiation is the only effective treatment and extends overall survival to a median of 11 months. Due to its location in the brainstem, DIPG tumors cannot be surgically resected. Immunotherapy has the ability to target tumor cells specifically, however, little is known about the tumor microenvironment in DIPGs. We sought to characterize infiltrating immune cells and immunosuppressive factor expression in pediatric low- and high-grade gliomas and DIPG.

Methods

Tumor microarrays were stained for infiltrating immune cells. RNA was isolated from snap-frozen tumor tissue and Nanostring analysis performed. DIPG and glioblastoma cells were co-cultured with healthy donor macrophages, T cells, or NK cells, and flow cytometry and cytotoxicity assays performed to characterize the phenotype and function, respectively, of the immune cells.

Results

DIPG tumors do not have increased macrophage or T cell infiltration relative to non-tumor control, nor do they overexpress immunosuppressive factors such as PD-L1 or TGF1. H3.3-K27M DIPG cells do not repolarize macrophages, but are not effectively targeted by activated allogeneic T cells. NK cells lysed all DIPG cultures.

Conclusions

DIPG tumors have neither a highly immunosuppressive nor inflammatory microenvironment. Therefore, major considerations for the development of immunotherapy will be the recruitment, activation, and retention of tumor-specific effector immune cells.

Europäische PanCare-Studien zu Spätfolgen nach Krebs im Kindes- und Jugendalter

Late adverse outcomes after treatment of testicular cancer

Abstract

Background

Modern oncological treatment has rendered testicular cancer (TC) a curative malignant disease but there is a risk of decreasing survival and reduced health-related quality of life (HR-QoL) related to long-term adverse health outcomes (AHOs).

Aim

To provide an overview on AHOs after oncological treatment of TC.

Material and methods

Summary of published studies and previous reviews.

Results

Relative survival rates decrease among TC survivors 25 years after diagnosis, mainly due to treatment-related second cancer and/or cardiovascular disease, the latter mediated by components of the metabolic syndrome. With increasing age cisplatin-induced ototoxicity becomes a clinical problem in patients, whereas reported peripheral neurotoxicity only exceptionally achieves major clinical relevance. Anxiety but not depression represents the dominating psychological problem. In most patients HR-QoL is good, but working ability may be reduced by very intensive treatment.

Conclusion

Awareness of long-term AHOs among TC survivors and health professionals can contribute to reduce long-term morbidity and mortality and to improve QoL by initiating early preventive and therapeutic measures. Radiotherapy should be avoided as much as possible during risk-adapted treatment of TC. Existing data indicate premature aging among strongly treated TC survivors but larger studies and longer follow-up in longitudinal studies are required to confirm these preliminary observations.

Survival benefit of multimodal local therapy for repeat recurrence of thoracic esophageal squamous cell carcinoma after esophagectomy

Abstract

Background

This study was performed to clarify the optimal therapeutic strategy for recurrent disease after esophagectomy.

Methods

We investigated the prognosis of 37 patients who developed recurrence among 128 patients who underwent curative thoracoscopic esophagectomy (TE) at Kanazawa University Hospital. The prognostic factors after recurrence were examined by univariate and multivariate analyses.

Results

Of these 37 recurrences, 29 patients underwent local therapy (surgery, 10 patients; surgery followed by radiation, 2 patients; radiation, 17 patients). Radiation includes intensity-modulated radiation therapy, chemoradiation, and simple radiation therapy. Seventeen patients (58.6%) were considered to have undergone successful therapy by disappearance or diminishment of the targeted region without regrowth. Eleven of 17 patients (64.7%) showed repeat recurrence at another site. Multiple local therapy was performed for repeat recurrence or uncontrollable first therapy. Finally, 57 local therapies were performed. Using multimodal local therapy, 37 (64.9%) of 57 recurrences were successfully managed. The 12 patients treated by surgery as the initial therapy showed the most favorable survival. Seventeen patients who underwent successful initial therapy showed better survival than others. Multiple or miscellaneous organ metastasis, abdominal lymphatic recurrence and best supportive care at recurrence were statistically significant negative variables for survival after recurrence. Performance of surgery and successful therapy as the initial recurrence were statistically significant positive variables for survival after recurrence. Multivariate analysis showed that successful therapy at the initial recurrence was the only independent variable for survival after recurrence.

Conclusions

Multimodal local therapy for repeat recurrence after TE contributes to the improvement of survival after recurrence.

``Re-Using the internal mammary artery as recipient artery in cervicofacial reconstruction by fibular flap''

Publication date: Available online 28 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Jérôme Adnot, Frédéric Crampon, Fabrice Duparc, Olivier Trost

Inferior portion of the perpendicular plate of the ethmoid as a suitable grafting material in rhinoplasty and septoplasty procedures

Publication date: Available online 28 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Yang An, Xiao Yang, Hongyu Xue, Lifeng Xie, Bolin Pan, Xin Yang, Dong Li

 

Risk factors for developing capsular contracture in women after breast implant surgery: A systematic review of the literature

Publication date: Available online 28 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Yara Bachour, Marco J.P.F. Ritt

Letter responds to comment on published paper: “Using the internal mammary artery as recipient artery in cervicofacial reconstruction by fibular flap”

Publication date: Available online 28 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): S Decaudaveine, JT Bachelet, C Vacher, F Combes, A Mojallal, L Benichou

One-Stage Treatment for Maxillo-Facial Asymmetry with Orthognathic and Contouring Surgery using virtual surgical planning and 3D-printed surgical templates

Publication date: Available online 27 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Zhifan Qin, Zhen zhang, Xiang Li, Yu Wang, Peng Wang, Jihua Li

Summary

Purpose

Asymmetry is one of the most common maxillo-facial deformities. One-stage treatment for maxillo-facial asymmetry with orthognathic and contouring surgery has been rarely reported. This retrospective study aims to investigate the feasibility of simultaneous orthognathic and facial bone contouring surgery with the help of virtual surgical planning and 3D-printed navigation templates for facial asymmetry.

Patients and Methods

From January 2012 to December 2015, 51 patients diagnosed with maxillo-facial asymmetry received treatment of combined orthognathic and contouring surgery under the guidance of virtual surgical planning and 3D-printed templates. Photographs and measurements were taken before and after operation to evaluate the effectiveness of the treatment.

Results

Photographs and cephalometric analysis showed the asymmetry was effectively corrected. All patients were satisfied with the aesthetic results.

Conclusion

This study suggested the clinical feasibility of simultaneous orthognathic and contouring surgery for treatment of maxillo-facial asymmetry. Virtual surgical planning and 3D-printed surgical templates enable the surgeons to plan and carry out the procedure more predictably and achieve satisfactory outcomes.

The value of urgent care dermatology

International Journal of Dermatology, EarlyView.

Pediatricians diagnosed few patients with childhood-presented hereditary angioedema: Icatibant Outcome Survey findings

Publication date: Available online 28 August 2018

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

Author(s): Anete S. Grumach, Hilary Longhurst, Werner Aberer, Laurence Bouillet, Teresa Caballero, Anette Bygum, Andrea Zanichelli, Jaco Botha, Irmgard Andresen, Marcus Maurer, IOS investigators

Teenagers and those with severe reactions are more likely to use their epinephrine autoinjector in cases of anaphylaxis in Canada

Publication date: Available online 28 August 2018

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

Author(s): Sofianne Gabrielli, Ann Clarke, Judy Morris, Harley Eisman, Jocelyn Gravel, Paul Enarson, Edmond S. Chan, Jennifer Gerdts, Andrew O'Keefe, Robert Porter, Rodrick Lim, Yarden Yanishevsky, Adil Adatia, Moshe Ben-Shoshan

MHC-II deficiency among Egyptians: novel mutations and unique phenotypes

Publication date: Available online 28 August 2018

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

Author(s): Rabab E. El Hawary, Andrea A. Mauracher, Safa S. Meshaal, Alia Eldash, Dalia S. Abd Elaziz, Radwa Alkady, Sohilla Lotfy, Lennart Opitz, Nermeen M. Galal, Jeannette A. Boutros, Jana Pachlopnik Schmid, Aisha M. Elmarsafy

Abstract

Background

Major histocompatibility complex class (MHC-II) deficiency leads to defective CD4+ T cell function that results from impaired antigen presentation. A genetic disorder in one of four genes results in this syndrome that is associated with the clinical phenotype of combined immunodeficiency.

Objectives

We describe the clinical, immunological and molecular characteristics of 10 Egyptian patients from 9 different families having presented with MHC-II deficiency between 2012 and 2017.

Methods

An initial diagnosis based on the combination of clinical features and low HLA- DR expression by flow cytometry was confirmed by genetic analyses.

Results

Symptoms included failure to thrive (n=9), persistent diarrhea (n=5) and pneumonia (n=8). Septicemia due to coagulase-negative staphylococci (n=1) and Candida krusei (n=1) was diagnosed. Nine patients orally received the live attenuated polio vaccine and three patients developed acute flaccid paralysis thereafter. Nine patients received the BCG vaccine and none developed obvious signs of BCGitis. Four patients carried RFXANK gene mutations, 3 carried RFX5 gene mutations, one carried a CIITA gene mutation and none carried RFXAP gene mutation. 6/7 detected mutations were previously unreported mutations: c.431T>C, c.247_250delTCAG and c.600delG in RFXANK, c.116+1G>A and c.715C>T in RFX5 and c.929delA in CIITA.

Conclusion

Given that Egypt is a North African country with a high rate of consanguinity, MHC-II deficiency is not rare. However, the molecular defects differ from those reported in nearby countries. Early diagnosis must be based upon suspicious clinical signs and laboratory diagnosis since the defect can be missed by T cell receptor excision circles based neonatal screening.

Predictive power of ovomucoid and egg white sIgE in heated egg OFCs

Publication date: Available online 28 August 2018

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

Author(s): Kyohei Takahashi, Noriyuki Yanagida, Sakura Sato, Motohiro Ebisawa

Antibiotic choice and duration associate with repeat prescriptions in infective asthma exacerbations

Publication date: Available online 28 August 2018

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

Author(s): Marie Stolbrink, Laura J. Bonnett, John D. Blakey

Abstract

Background

Patients with asthma who present with lower respiratory tract infections (LRTI) often receive antibiotics. There is uncertainty about the need for and consequences of antibiotic administration.

Objective

Characterise the demographics of and antibiotic prescriptions for adult asthma patients with LRTI and investigate factors associated with repeat antibiotic courses.

Methods

We analysed prescriptions of antibiotics for LRTI in UK primary care from 2010 to 2015 using the Optimum Care Database. The primary outcome was a second antibiotic prescription for a LRTI code within 14 days of index prescription, as a proxy of initial treatment failure. A model for repeat prescriptions was derived using uni- and multivariable logistic regression analysis.

Results; We assessed 28,289 cases with complete datasets, 6.5 % of which received a second antibiotic course. Amoxicillin and clarithromycin respectively were used most commonly as index and second agents. Most frequent course length was 7 days for both index and repeat prescriptions.

Multivariable analysis demonstrated that age, index antibiotic and duration, smoking status, location, number of consultations and oral steroid courses in previous year were significantly associated with repeat prescription. The derived model predicted the binary outcome adequately (Cox-Snell R² 0.012; area under curve 0.62, 95 % CI 0.61-0.63). Co-morbidities, vaccinations, asthma treatment and exacerbation number were only significant in univariable analysis.

Conclusion; The current index prescribing preference of 7 days of amoxicillin correlated to fewer repeat courses. Baseline asthma treatment was not associated with risk of further prescriptions. Antibiotic administration in older patients with a smoking history could be a target for future studies.

Gender-specific asthma phenotypes, inflammatory patterns and asthma control in a cluster analysis

Publication date: Available online 28 August 2018

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

Author(s): Han-Pin Hsiao, Meng-Chih Lin, Chao-Chien Wu, Chin-Chou Wang, Tsu-Nai Wang

Abstract

Background

Asthma is a heterogeneous disease with complex mechanisms and involves many risk factors and in vivo cellular molecules. It is notable that gender differences may have a potential effect on asthma phenotype.

Objective

Our study aims to identify gender-specific phenotypes and health outcomes of asthma.

Methods

We conducted the Taiwanese adult asthma cohorts (TAAC) study to enroll female (n=421) and male (n=299) adult stable asthma patients. Eight variables were selected by a factor analysis. We further performed a two-step and sensitivity cluster analysis to classify asthma clusters. The risks of asthma-related outcomes among the clusters were assessed using simple logistic regressions.

Results

Three different clusters were identified in males and females. In the female clusters, atopy/eosinophil-predominant (cluster 2), and obesity/neutrophil-predominant pattern (cluster 3) had more than a two-fold risk of asthma exacerbations (OR=2.51, 95% CI=1.12 to 5.59 and OR=2.22, 95% CI=1.01 to 4.93). In the male clusters, current smoker/neutrophilic atopic cluster (cluster 5), and ex-smoker/eosinophil-predominant or mixed inflammatory pattern (cluster 6) also had a higher risk of asthma exacerbations.

Conclusions

This study identified heterogeneous characteristics between genders. In females, the analysis showed atopy with eosinophil-predominant and obese with neutrophil-predominant inflammation. Two distinct asthma phenotypes were found in current and ex-smokers in males. Understanding asthma phenotypes and explaining the potentially biological pathways have become important.

Deferoxamine Can Prevent Pressure Ulcers and Accelerate Healing in Aged Mice

Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.

Trichotillomania (hair pulling disorder): Clinical characteristics, psychosocial aspects, treatment approaches, and ethical considerations

Dermatologic Therapy, EarlyView.

Cyclosporine for corticosteroid‐refractory acute generalized exanthematous pustulosis due to hydroxychloroquine

Dermatologic Therapy, EarlyView.

The effects of ultraviolet supplementation to the artificial lighting on rats' bone metabolism, bone mineral density, and skin

Publication date: Available online 27 August 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Rong Guo, Yao Du, Shi Zhang, Hong Liu, Yuming Fu

Abstract

Working and living under artificial lighting environment for a long duration do not allow sufficient sunlight exposure, resulting in an adverse effect on bone. Common artificial light source, white LED light, does not include ultraviolet irradiation that plays an important role in bone metabolism. Ultraviolet supplementation in artificial lighting environment can be used to simulate the effect of sunlight irradiation on bone metabolism. In this paper, we report the effects of long-term exposure of low-dose ultraviolet irradiation on the rats' bones and skin. We studied the changes in body weight, bone metabolism markers, bone mass content, bone mineral density, and skin of rats, under long-term exposure of low-dose ultraviolet irradiation. We found that the rats exposed to ultraviolet irradiation showed an increase in bone formation rate, decrease in bone resorption rate, and improvement in bone mass content and bone mineral density without adverse effects on skins. This paper provides an effective basis for future application of LED light to create a healthier, safer, and more comfortable indoor lighting environment.

Contact hypersensitivity in adolescents

Pediatric Dermatology, EarlyView.

Pregnancy Outcomes in Women with Multiple Sclerosis

Abstract

Few studies have assessed the risk for adverse pregnancy outcomes in women with multiple sclerosis (MS). We used two large United States administrative databases (2011-2015 Truven Health Marketscan® Database; 2007-2011 Nationwide Inpatient Sample) to identify delivery cohorts. MS and pregnancy outcomes (infections, Cesarean section, preterm delivery, poor fetal growth, preeclampsia, chorioamnionitis, postpartum hemorrhage, stillbirth, infant malformations) were identified during pregnancy and at delivery. We calculated adjusted risk ratios by MS status and relapses in the year before delivery. Among over 5 million pregnancies, we identified 3,875 in women with MS. Women with MS had an increased risk of infections during pregnancy (adjusted risk ratio Truven: 1.22 [95% confidence interval {CI}: 1.16, 1.27]) and preterm delivery (Truven 1.19 [95% CI: 1.04, 1.35]; Nationwide Inpatient Sample 1.30 [95% CI: 1.16, 1.44]). The risk of other outcomes was similar for women with and without MS. In Truven, risk ratios of the pregnancy outcomes in women experiencing relapses versus those without relapses were between 0.9 and 1.4, and confidence intervals overlapped the null. Overall, women with MS had an increased risk of infections and preterm delivery, however, their risks for other adverse pregnancy outcomes were not elevated. Disease activity before delivery was not a strong predictor of outcomes.

Investigating the Legacy of 1918 Pandemic on Age-Related Sero-Epidemiology and Immune Responses to Subsequent Influenza A(H1N1) Viruses Through a Structural Equation Model

Abstract

Influenza A(H1N1) strains were responsible for two pandemics in the last century. As infections early in life may have long-lasting influence on future immune response against other influenza strains, we drew on previously collected sero-incidence data (n = 2554) to investigate if the 1918 pandemic virus and its early descendants produced an age-related signature in immune responses against the A/California/7/2009(H1N1)pdm09 virus of 2009. Hemagglutination inhibition assays revealed a J-shaped relationship; the oldest birth cohort (years 1911 – 1926) had the highest titers followed by the youngest (years 1987 – 1992). Differential response by vaccination history was also observed, with seasonal influenza vaccine associated with higher titers mainly in the oldest birth cohort. On the assumption that antibody titers are a correlate of protection, structural equation modeling predicted that titer-mediated effect by the vaccine could on its own account for a negative association with seroconversion equivalent to a relative risk reduction of 0.77 (95% confidence interval: 0.60, 0.99) in the oldest birth cohort (years 1911 – 1926). A subset of 503 samples tested against A/Brisbane/59/2007(H1N1) and A/Puerto Rico/8/1934(H1N1) also revealed different age-related antibody profiles. Effectiveness of seasonal influenza vaccines against future pandemic strains could thus be age-dependent and related to early life exposures.

Reassessing Serosurvey-Based Estimates of the Zika Symptomatic Proportion

Abstract

Since the 2007 Zika epidemic in Yap, it has been apparent that not all people infected with Zika virus (ZIKV) experience symptoms. However, the proportion of infections that result in symptoms remains unclear. Existing estimates varied in their interpretation of symptoms due to other causes and the case definition used, and assumed perfect test sensitivity and specificity. Using a Bayesian model and data from ZIKV serosurveys in Yap (2007), French Polynesia (2013-14), and Puerto Rico (2016), we found that assuming perfect sensitivity and specificity generally led to lower estimates of the symptomatic proportion. Incorporating reasonable assumptions for assay sensitivity and specificity, we estimated that 27% (95% Credible Interval: 15–37%) (Yap), 44% (26-66%) (French Polynesia), and 50% (34-92%) (Puerto Rico) of infections were symptomatic, with variation due to differences in study populations, study designs, and case definitions. The proportion of ZIKV infections causing symptoms is critical for surveillance system design and impact assessment. Here, we accounted for key uncertainties in existing seroprevalence data and found that estimates for the symptomatic proportion ranged from 27% to 50%, suggesting that while the majority of infections are asymptomatic or mildly symptomatic, symptomatic infections might be more common than previously estimated.

Ischemic Heart Disease Mortality and Diesel Exhaust and Respirable Dust Exposure in the Diesel Exhaust in Miners Study

Abstract

Diesel exhaust is a suggested risk factor for ischemic heart disease (IHD), but evidence from cohorts using quantitative exposure metrics is limited. We examined the impact of respirable elemental carbon (REC), a key surrogate for diesel exhaust, and respirable dust (RD) on IHD mortality, using data from the Diesel Exhaust in Miners Study (DEMS). In a cohort of male workers followed from 1948-1968 until 1997, we fitted Cox proportional hazards models to estimate hazard ratios (HR) of IHD mortality for cumulative and average intensity of exposure to REC and RD. Segmented linear regression models allowed for non-monotonicity. HRs for cumulative and average REC declined relative to the lowest exposure category before increasing to 0.79 and 1.25, respectively, in the highest category. Relative to the category containing the segmented regression change-points, HRs for the highest category were 1.69 and 1.54 for cumulative and average REC, respectively. HRs for RD increased across the full exposure range to 1.33 and 2.69 for cumulative and average RD, respectively. Tests for trend were statistically significant for cumulative REC (above the change-point) and for average RD. Our findings suggest excess risk of IHD mortality in relation to increased exposure to REC and RD.

Perceived Stress and Fecundability: A Preconception Cohort Study of North American Couples

Abstract

While some epidemiologic studies support the hypothesis that stress can adversely affect fertility, few prospective studies have assessed the association in couples from the general population. We used data from Pregnancy Study Online, a web-based preconception cohort study of pregnancy planners from the United States and Canada (2013-2018), to examine the association between female and male preconception perceived stress levels and fecundability. Women (aged 21-45 years) and their male partners (aged ≥21 years) who were attempting conception without fertility treatment were eligible. We measured perceived stress using the 10-item Perceived Stress Scale (PSS). We ascertained pregnancy information using female bi-monthly follow-up questionnaires. We followed 4,769 couples until self-reported pregnancy, initiation of fertility treatment, loss to follow-up, or 12 menstrual cycles of attempt time, whichever came first. We used proportional probabilities regression models to estimate fecundability ratios and 95% confidence intervals, adjusting for potential confounders. Higher female PSS scores were associated with slight reductions in fecundability (fecundability ratio comparing PSS ≥25 vs. <10=0.87, confidence interval: 0.74, 1.02). Male PSS scores were not substantially associated with fecundability.

Changes in Neighborhood Socioeconomic Deprivation and Mortality in US Adults

Abstract

Low neighborhood socioeconomic status has been linked to adverse health outcomes. However, it is unclear whether changing the neighborhood may influence health. We examined the 10-year change in neighborhood socioeconomic deprivation in relation to mortality rate among 288,555 participants (age 51-70) who enrolled in the NIH-AARP Diet and Health Study in 1995-1996 (baseline) and did not move during the study. Changes in neighborhood socioeconomic deprivation between 1990 and 2000 was measured by US Census data at the census tract level. All-cause, cardiovascular and cancer deaths were ascertained by annual linkage to the Social Security Administration Death Master File between 2000 and 2011. Overall, our results suggested that improvement in neighborhood socioeconomic status was associated with lower mortality rate, while deterioration was associated with higher mortality rate. More specially, a 30 percentile points reduction in neighborhood deprivation among more deprived neighborhoods was associated with 11% and 19% reduction in total mortality rate in men and women respectively. On the other hand, a 30 points increase in neighborhood deprivation in less deprived neighborhoods was associated with a 11% increase in mortality rate in men. Our findings support a longitudinal association between changing neighborhood conditions and mortality.

Risk of Hospitalization for Cancer, Musculoskeletal Disorders, Injuries, and Poisonings Surrounding Widowhood

Abstract

Psychological distress has been indicated to affect the risk of death from cardiovascular disease, cancer, and external causes. Mortality from these major causes of death is also known to be elevated after widowhood when distress is at a heightened level. Surprisingly little is known about changes in health other than mental and cardiac health shortly before widowhood. We used longitudinal data of widowing (n=19,185) and continuously married individuals (n=105,939) in Finland (1996-2002) to assess the risk of hospitalization for cancer and the external and musculoskeletal causes surrounding widowhood or random dates. The study employed population-averaged logit models for longitudinal data of older adults aged 65 and over. The results show that hospitalization for injuries had already increased prior to widowhood and clearly peaked after it. The increases were largely related to falls. A similar increasing pattern of findings was not found around a random date for a group of continuously married individuals. Hospitalizations for cancer and musculoskeletal disorders appeared to be unrelated to the process of widowhood. Hospitalizations for poisonings increased after widowhood. The results imply that the process of widowhood is multifaceted and that various types of health changes should be studied separately and already before the actual loss.

Hepatocellular carcinoma after prior sorafenib treatment: incidence, healthcare utilisation and costs from German statutory health insurance claims data

To estimate both the number of patients with hepatocellular carcinoma (HCC) eligible annually for second-line therapy following sorafenib in Germany and the healthcare costs accrued by patients meeting eligibi...

Effects of capitation payment on utilization and claims expenditure under National Health Insurance Scheme: a cross-sectional study of three regions in Ghana

Ghana introduced capitation payment under National Health Insurance Scheme (NHIS), beginning with pilot in the Ashanti region, in 2012 with a key objective of controlling utilization and related cost. This stu...

Tertiary prevention of occupational skin diseases: Prevalence of allergic contact dermatitis and pattern of patch test results

Contact Dermatitis, EarlyView.

Effect of some osmoregulators on photosynthesis, lipid peroxidation, antioxidative capacity, and productivity of barley ( Hordeum vulgare L.) under water deficit stress

Abstract

Water deficit stress is an abiotic stress that causes reductions in growth and yield of many field crops around the world. The present research was aimed to elucidate the mitigating efficiency of exogenous application of select osmoregulators and biostimulants, i.e., potassium dihydrogen phosphate, actosol® (humic acid), Amino more (amino acids), and Compound fertilizer, applied as a spray that reached both foliage and the soil, on growth characteristics, antioxidant capacity, and productivity of barley (Hordeum vulgare L. Giza123) under water deficit stress during two successive growing seasons of field experiments in Egypt. Water deficit resulted in stress as estimated by stress indicators and decreased growth and poor health and development as reflected in statistically significant decreases in chlorophyll a and b and major nutrient (NPK) levels in tissues, stem length, number of leaves, and fresh and dry mass as well as yield components such as spike length, grains per spike, biological yield, grain yield, and 1000-grain weight. As a response to water deficit stress, reactive oxygen species (ROS, i.e., superoxide and hydrogen peroxide) levels increased significantly resulting in lipid peroxidation and decreased membrane integrity and significant increases in antioxidant enzymes such as catalase (CAT), polyphenol oxidase (PPO), and peroxidase (POX). All four treatments alleviated the detrimental impacts of water deficit stress as evidenced by statistically significantly increased photosynthetic pigment concentration, tissue NPK levels, growth, and yield parameters compared to the water deficit-stressed control, while the stress responses were significantly reduced. The osmoregulators used either partially restored the growth and yield of osmotic-stressed barley plants or certain treatments enhanced them. All osmoregulators tested mitigated the adverse impacts of water deficit stress on barley plants, but the highest induction was found when plants were treated with actosol®. The beneficial effects of the osmoregulators tested were the strongest overall in the order actosol® ˃ potassium dihydrogen phosphate ˃ Amino more ˃ Compound fertilizer.

Methylmercury exposure develops atherosclerotic risk factors in the aorta and programmed cell death in the cerebellum: ameliorative action of Celastrus paniculatus ethanolic extract in male Wistar rats

Abstract

Methylmercury (MeHg) is a bioaccumulative global environmental contaminant present in fishes and seafood. MeHg is the methylated form of mercury emitted from diverse anthropogenic and natural sources. MeHg is accumulated in the aquatic environment and eventually reaches human system via food chain by biomagnification. We have reported previously that the neurotoxic effect of MeHg in rat cerebellum is mitigated by the administration of an ayurvedic medicinal plant, Celastrus paniculatus ethanolic extract. The present study has focussed to further explore the mechanism of action of Celastrus paniculatus against MeHg-induced neurotoxicity in the cerebellum. We have also inspected the effect of Celastrus paniculatus (CP) against MeHg-induced atherosclerotic risk factors like alterations in antioxidant levels, aortic lipid profile, and aortic histology by MeHg in the largest vasculature, aorta, which are the initiating factors of cardiovascular diseases. Male Wistar rats were divided as (i) control, (ii) MeHg (5 mg/kg b.w.), (iii) MeHg + CP (200 mg/kg b.w.), and (iv) CP alone (200 mg/kg b.w.). All were given orally for 21 days. In cerebellum Celastrus paniculatus, there were increased mitochondrial electron transport chain (p < 0.05) activity, reduced cytochrome c release (p < 0.05), and caspase 3 mRNA expression (p < 0.05). In the aorta, MeHg-induced oxidative stress, lipid profile changes, and endothelial denudation were ameliorated by Celastrus paniculatus. Hence, we conclude that Celastrus paniculatus protects against MeHg toxicity by inhibiting mitochondrial cytochrome c/caspase 3 apoptotic pathway in the cerebellum and reducing the development of atherosclerotic risk factors in the aorta.

Toxic metals in Perna viridis mussel and surface seawater in Pasir Gudang coastal area, Malaysia, and its health implications

Abstract

Contamination of toxic metals in P. viridis mussels has been prevalently reported; hence, health risk assessment for consuming this aquaculture product as well as the surrounding surface seawater at its harvesting sites appears relevant. Since Kampung Pasir Puteh, Pasir Gudang is the major harvesting site in Malaysia, and because the last heavy metal assessment was done in 2009, its current status remains unclear. Herein, flame atomic absorption spectrometry and flow injection mercury/hydride system were used to determine the concentrations of Pb, Cd, Cu and total Hg in P. viridis mussels and surface seawater (January–March 2015), respectively. Significantly higher concentrations of these metals were found in P. viridis mussels (p < 0.05) than that of surface seawater samples. The concentrations for Pb (4.27–6.55 μg/g) and Cd (1.55–2.21 μg/g) in P. viridis mussels exceeded the maximum permitted proportion prescribed by the Malaysian law. The concentrations of all metals in surface seawater also violated the Malaysia Marine Water Quality Criteria and Standards. Significant (p < 0.05) and high strength of association (r = 0.787) observed between Pb concentration in P. viridis mussel with the surface seawater indicates its possible application for inferring Pb concentrations in the mussel. Since both the calculated target hazard quotient and hazard index for Pb and Cd exceeded 1, the possible detrimental health impacts on human for consuming P. viridis mussels from this rearing site cannot be ignored. Hence, promoting continuous monitoring programmes and developing efficient toxic metal removal techniques prior to entering the market are required.

Dynamic transport of antibiotics and antibiotic resistance genes under different treatment processes in a typical pharmaceutical wastewater treatment plant

Abstract

The propagation of antibiotic resistance is a challenge for human health worldwide, which has drawn much attention on the reduction of the resistance genes. To understand their occurrence during different treatment processes, in this study, four classes of antibiotics (tetracyclines, sulfonamides, quinolones, and macrolides), eight antibiotic resistance genes (ARGs) (tetB, tetW, sul1, sul2, gyrA, qepA, ermB, and ermF), and two mobile elements (int1 and int2) were investigated in a typical pharmaceutical plant. The total concentrations of antibiotics were detected in the range of 2.6 × 10² to 2.5 × 10³ ng/L in the treatment processes, and the high abundance of ARGs was detected in the biological treatment unit. The dynamic trend analysis showed that antibiotics were partially removed in the anaerobic/aerobic processes, where ARGs were proliferated. The abundance of tetB and gyrA genes was positively correlated with pH and EC (p < 0.05), and the tetW, sul1 and sul2 genes were significantly correlated with TOC, TN, and DO (p < 0.05), indicating the influence of physicochemical properties of the solution on the levels of ARG subtypes. The phylogenetic analysis showed that the tetW clones had high homology with some pathogenic microorganisms, such as Klebsiella pneumonia and Neisseria meningitides, which would threaten human health. Results indicated that the horizontal transfer acted as a major driver in the ARGs evolution.