Medicine by Alexandros G. Sfakianakis: 09/11/18

Τρίτη 11 Σεπτεμβρίου 2018

Spotting Zika spots: descriptive features of the rash used in 66 published cases

Clinical and Experimental Dermatology, EarlyView.

Rituximab for the treatment of autoimmune subepidermal blistering diseases

Dermatologic Therapy, EarlyView.

Total and available metal concentrations in soils from six long-term fertilization sites across China

Abstract

Approximately 19% of agricultural soils in China are contaminated by heavy metals. However, the effects of agricultural management practices on soil contamination are not well understood. Taking advantage of six long-term (23–34 years) field sites across China, this study examined the effects of different agricultural fertilization treatments, including control (no fertilization), inorganic nitrogen, phosphorus and potassium fertilization (NPK), manure fertilization (M), and NPK plus manure fertilization (NPKM), on the total and available metal concentrations in soils. The results showed that after 23–34 years of fertilization, the M and NPKM treatments significantly increased the total concentration of cadmium (Cd), copper (Cu), and zinc (Zn) in soils compared with the concentrations measured for the control and NPK treatments. In contrast, the fertilization treatments had almost no influence on soil lead (Pb) and nickel (Ni) concentrations. The results of analysis via diffusive gradients in thin films demonstrated that long-term sheep or cattle manure fertilization increased the available metals, especially Cd, Cu, and Zn, but long-term swine manure application decreased the available metals, except for Cu and Zn, in soils. Further analysis revealed that the manure source, soil pH level, and biogeochemical properties of metals affected the availability of Cd, Cu, Pb, Zn, and Ni in soils. Collectively, organic fertilizers had the potential to reduce metal uptake by crops, but caution should be taken to reduce metal concentrations in manure.

Nuclear magnetic resonance-based metabolomic investigation reveals metabolic perturbations in PM 2.5 -treated A549 cells

Abstract

Exposure to PM_2.5 is associated with an increased risk of lung diseases, and oxidative damage is the main reason for PM_2.5-mediated lung injuries. However, little is known about the early molecular events in PM_2.5-induced lung toxicity. In the present study, the metabolites in PM_2.5-treated A549 cells were examined via a robust and nondestructive nuclear magnetic resonance (NMR)-based metabolic approach to clarify the molecular mechanism of PM_2.5-induced toxicity. NMR analysis revealed that 12 metabolites were significantly altered in PM_2.5-treated A549 cells, including up-regulation of alanine, valine, lactate, ω-6 fatty acids, and citrate and decreased levels of gamma-aminobutyric acid, acetate, leucine, isoleucine, D-glucose, lysine, and dimethylglycine. Pathway analysis demonstrated that seven metabolic pathways which included alanine, aspartate and glutamate metabolism, aminoacyl-tRNA biosynthesis, taurine and hypotaurine metabolism, arginine and proline metabolism, starch and sucrose metabolism, valine, leucine and isoleucine biosynthesis, and tricarboxylic acid cycle were mostly influenced. Our results indicate that NMR technique turns out to be a simple and reliable method for exploring the toxicity mechanism of air pollutant.

Arthroderma chiloniense sp. nov. isolated from human stratum corneum: description of a new Arthroderma species

Mycoses, Volume 0, Issue ja, -Not available-.

Early P2X7R-dependent activation of microglia during the asymptomatic phase of autoimmune encephalomyelitis

Abstract

Microglia-mediated neuroinflammation accompanies many central nervous system (CNS) diseases, including multiple sclerosis (MS), and is strongly dependent on the purinergic P2X7 receptor. The nature of the inflammatory response in MS is studied for decades indicating, that proinflammatory microgliosis is involved in advanced stages of MS and is associated with active tissue damage and neurological dysfunctions. Evidence on the role of microgliosis in initial stages of the disease is scarce. Thus, in the present study, we investigated the time course of microglial activation in rat brain subjected to experimental autoimmune encephalomyelitis (EAE) which is the animal model of MS. We show that activation of microglia occurs in brains of immunized rats at a very early stage of EAE, well before the development of neurological symptoms of the disease. Enhanced immunoreactivity of microglia/macrophage-specific protein Iba-1, together with morphological features of microgliosis, was identified beginning at day 4 post immunization. Concomitantly, microglial expression of P2X7R was also examined. Moreover, our results reveal that administration of Brilliant Blue G, an antagonist of P2X7R, delays the onset of the disease and partially inhibits development of neurological symptoms in EAE rats. Blockage of P2X7R significantly reduces activation of microglia as confirmed by decreased Iba-1 immunoreactivity and suppresses neuroinflammation in EAE rat brains, as indicated by decreased protein levels of investigated proinflammatory cytokines: IL-1β, IL-6 and TNF-α. Our results indicate that microglia are involved in inducing neuroinflammation at a very early stage of MS/EAE via a P2X7R-dependent mechanism.

Longstanding history of verrucous tumors on both lower legs

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.

Gender as an Independent Risk Factor for the Components of Metabolic Syndrome Among Individuals Within the Normal Range of Body Mass Index

Metabolic Syndrome and Related Disorders, Ahead of Print.

Markov-switching vector autoregressive neural networks and sensitivity analysis of environment, economic growth and petrol prices

Abstract

The paper aims at evaluating the nonlinear and complex relations between CO₂ emissions, economic development, and petrol prices to obtain new insights regarding the shape of the environmental Kuznets curve (EKC) in the USA and in the UK in addition to introducing a newly proposed nonlinear approach. Within this respect, the paper has three purposes: the first one is to combine the multilayer perceptron neural networks (MLP) with Markov-switching vector autoregressive (MS-VAR) type nonlinear models to obtain the MS-VAR-MLP model. The second is to utilize one of the largest datasets in the literature covering the 1871–2016 period, a long span of data starting from the late eighteenth century. Since the emission, economic development, and petrol price relation is subject to nonlinearity and trajectory changes due to many historical events, the development of the MS-VAR-MLP model is a necessity to contribute to the ongoing debate regarding the shape of the EKC curve and the stability of the relation. The third purpose is to develop the MS-VAR-MLP-based regime-dependent sensitivity analysis, which eases the visual interpretation of the nonlinear causal relationships, which are allowed to have asymmetric interactions in different phases of the expansionary and recessionary periods of the business cycles. Our results provide clear deviations from the findings in the literature: (i) the shape of the EKC curve cannot be assumed to be stable and is subject to regime dependency, nonlinearity, and magnitude dependency; (ii) the forecast results suggest that incorporation of regime switching and neural networks provide significant improvement over the MS-VAR counterpart; and (iii) for both USA and UK and for the 1871–2016 period, the positive impacts of economic growth on emissions cannot be rejected for the majority of the phases of the business cycles; however, the magnitude of this effect is at various degrees. In addition, the incorporation of petrol price provides significant findings considering its effects on emission and economic growth rates. The analysis suggest clear deviations from the expected shape of the EKC curve and puts forth the necessity to utilize more complex empirical methodologies to evaluate the EKC since the emissions-economic development relation is more complex than it was assumed. Following these findings, several policy recommendations are provided. Lastly, the proposed MS-VAR-MLP methodology is compared with the MS-VAR model and various advantages and disadvantages are enumerated.

Different pathways of nitrogen and phosphorus regeneration mediated by extracellular enzymes in temperate lakes under various trophic state

Abstract

Several Italian and Chinese temperate lakes with soluble reactive phosphorus concentrations < 0.015 mg L⁻¹ were studied to estimate nitrogen and phosphorus regeneration mediated by microbial decomposition and possible different mechanisms driven by prevailing oligo- or eutrophic conditions. Leucine aminopeptidase (LAP), beta-glucosidase (GLU) and alkaline phosphatase (AP), algal, and bacterial biomass were related to trophic and environmental variables. In the eutrophic lakes, high algal and particulate organic carbon concentrations stimulated bacterial respiration (> 20 μg C L⁻¹ h⁻¹) and could favor the release of inorganic phosphorus. High extracellular enzyme activities and phosphorus solubilizing bacteria abundance in sediments accelerated nutrient regeneration. In these conditions, the positive GLU-AP relationship suggested the coupling of carbon and phosphorus regeneration; an efficient phosphorus regeneration and high nitrogen levels (up to 0.067 and 0.059 mg L⁻¹ NH₄ and NO₃ in Italy; 0.631 and 1.496 mg L⁻¹ NH₄ and NO₃ in China) led to chlorophyll a peaks of 14.9 and 258.4 μg L⁻¹ in Italy and China, respectively, and a typical algal composition. Conversely, in the oligo-mesotrophic lakes, very low nitrogen levels (in Italy, 0.001 and 0.005 mg L⁻¹ NH₄ and NO₃, respectively, versus 0.053 and 0.371 mg L⁻¹ in China) induced high LAP, while low phosphorus (33.6 and 46.3 μg L⁻¹ total P in Italy and China, respectively) led to high AP. In these lakes, nitrogen and phosphorus regeneration were coupled, as shown by positive LAP-AP relationship; however, the nutrient demand could not be completely met without the supply from sediments, due to low enzymatic activity and phosphorus solubilizing bacteria found in this compartment.

The role of renewable and non-renewable energy consumption in CO 2 emissions: a disaggregate analysis of Pakistan

Abstract

The energy sector has become the largest contributor to greenhouse gas (GHG) emissions. Among these GHG emissions, most threatening is CO₂ emission which comes from the consumption of fossil fuels. This empirical work analyzes the roles of renewable energy consumption and non-renewable energy consumption in CO₂ emissions in Pakistan. The empirical evidence is based on an auto-regressive distributive lag (ARDL) model of data from 1970 to 2016. The disaggregate analysis reveals that renewable energy consumption has an insignificant impact on CO₂ emission in Pakistan and that, in the non-renewable energy model, natural gas and coal are the main contributors to the level of pollution in Pakistan. Economic growth positively contributes to CO₂ emission in the renewable energy model but not in the non-renewable energy model. Policies that emphasize the contribution of renewable energy to economic growth and that add more clean energy into the energy mix are suggested.

MicroRNA-340 inhibits squamous cell carcinoma cell proliferation, migration and invasion by downregulating RhoA

Squamous cell carcinoma (SCC) originates from the malignant transformation of epidermal keratinocyte with over 250,000 incidences in the United States every year [1,2]. The risk factors of SCC mainly include exposure to UV radiation, chemical carcinogens and immunosuppression [3]. Specifically, the patients who received immunosuppressive therapy, such as organ transplant recipients (OTRs), are at an increasing risk of SCC. While most sporadic SCCs can be cured by surgery and/or radiation therapy, the OTR-derived SCCs are characterized by a high frequency of metastasis, greatly contributing to the patients' mortality [4–6].

Cross-Sectional Survey on Disease Severity in Japanese Patients with Harlequin Ichthyosis/Ichthyosis: Syndromic Forms and Quality-of-Life Analysis in a Subgroup

Congenital ichthyoses (CIs) are a group of genetic disorders caused by mutations in genes involved in skin barrier functions. Patients with CI clinically suffer from persistent scaling and hyperkeratosis that are often associated with erythema from birth or the neonatal period.

Association between itch and cancer in 16,925 pruritus patients: Experience at a tertiary care center

Pruritus has been associated with underlying malignancy. This article provides a comprehensive analysis of the association between pruritus and a diverse array of malignancies, with additional stratification by race, Knowledge of these associations can guide clinicians in pursuing malignancy workup for patients with unexplained pruritus

Myofibroblastic sarcoma: Clinicopathologic features and experience from a sarcoma tertiary referral center

Background: Myofibroblastic sarcomas (MS) are rare malignancies characterized histologically by spindled cells with myofibroblastic differentiation. There is no common consensus on optimal management with surgery and adjuvant chemoradiotherapy yielding variable results.

Associations of Religious Upbringing With Subsequent Health and Well-Being From Adolescence to Young Adulthood: An Outcome-Wide Analysis

Abstract

In the present study, we prospectively examined the associations of religious involvement in adolescence (including religious service attendance and prayer or meditation) with a wide array of psychological well-being, mental health, health behavior, physical health, and character strength outcomes in young adulthood. Longitudinal data from the Growing Up Today Study were analyzed using generalized estimating equations. Sample sizes ranged from 5,681 to 7,458, depending on outcome; the mean baseline age was 14.74 years, and there were 8–14 years of follow-up (1999 to either 2007, 2010, or 2013). Bonferroni correction was used to correct for multiple testing. All models were controlled for sociodemographic characteristics, maternal health, and prior values of the outcome variables whenever data were available. Compared with no attendance, at least weekly attendance of religious services was associated with greater life satisfaction and positive affect, a number of character strengths, lower probabilities of marijuana use and early sexual initiation, and fewer lifetime sexual partners. Analyses of prayer or meditation yielded similar results. Although decisions about religion are not shaped principally by health, encouraging service attendance and private practices in adolescents who already hold religious beliefs may be meaningful avenues of development and support, possibly leading to better health and well-being.

Trajectory of Postconcussive Symptoms 12-Months Post-Deployment in Soldiers with and without Mild Traumatic Brain Injury - Warrior STRONG Study

Abstract

Postconcussive symptoms are believed to resolve in days or months in most instances for civilian injuries, though recent evidence suggests that recovery may be slower for injuries sustained during military deployment. The present study is based on a cohort of recently deployed soldiers from two US Army military bases (Fort Carson and Fort Bragg, followed from 2009-2015). Soldiers with and without a recent history of a deployment mild traumatic brain injury (mTBI) were evaluated within days of return and at 3, 6, and 12-months. Those with mTBI were more likely than non-mTBI to endorse one or more postconcussive symptoms at a severe and or very severe level (47% vs. 21% baseline; aRR=1.7 95% CI: 1.51,1.93 all-time points) and remained significant after adjusting for PTSD (aRR=1.34 95%CI: 1.41,1.82). Prevalence and relative risks (for three of most common baseline symptoms remained constant over time: sleep problems (RR=2.19), forgetfulness (RR=2.56), irritability (RR=2.73). The pattern was slightly different for headache, decreasing from RR=3.44 at baseline to RR=3.26 at 12 months, due to increased prevalence of headache in those without mTBI. . The prevalence of clinically relevant postconcussive symptoms remained relatively constant over one year of follow-up, whether or not symptoms were associated with concussion. Service members with recent mTBI reported more symptoms than non-mTBI at all time-points.

The Causal Effect of Education on Tooth Loss: Evidence from UK Schooling Reforms

Abstract

Associations between education and oral health have frequently been reported, but until now there is no causal evidence. Exploiting exogenous variation in years of schooling due to 1947 and 1972 reforms in mandatory schooling in the UK; we examined the causal relationship between education and tooth loss in older age. A cross-sectional study was conducted using data from the English Longitudinal Study of Ageing (waves 3, 5 and 7). A Two-Stage Least Squares instrumental variables approach was employed. 5,667 respondents (average age = 67.8; 44.4% were men) were included in the analyses, of which 819 (14.5%) had no teeth. The schooling reforms increased years of education by an average of 0.624 years (95% CI: 0.412, 0.835). For respondents born within +/−6 years from the pivotal cohorts, a one-year increment of education causally reduced edentulism by 9.1 (95% CI: 1.5, 16.8) % points. The effects were stronger for the 1947 reform than for the 1972 reform. Results were robust against broadening the cohort bandwidth and functional form of the cohort trend. The findings suggest oral health later in life improves in return to investments in school education.

Cohort Differences in Cognitive Impairment and Cognitive Decline among Mexican-Americans Aged 75 and Older

Abstract

Research suggests the prevalence and incidence of cognitive impairment among older adults is decreasing. This analysis used data from nine waves (1993-2016) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly to assess the cognitive status and cognitive decline for two cohorts of Mexican-Americans aged ≥75 in 1993/94 versus 2004/05. Logistic regression, joint longitudinal-survival models, and illness-death models for interval-censored data were used to examine cohort differences in the odds of prevalent cognitive impairment, trajectories of cognitive decline, and the risk for 10-year incident cognitive impairment, respectively. Results indicated that compared to the 1993/94 Cohort, the 2004/05 Cohort had higher odds for prevalent cognitive impairment (odds ratio: 2.51, 95% confidence interval [CI]: 1.92, 3.29), particularly among participants with <4 years of education (odds ratio:2.99 95% CI: 2.14, 4.18). Conversely, the 2004/05 Cohort exhibited significantly slower rates of cognitive decline (βˆ: 0.50, 95% CI: 0.39, 0.62) and had a significantly lower risk for incident cognitive impairment (hazard ratio: 0.75, 95% CI: 0.62, 0.91) compared to the 1993/94 Cohort. This analysis provides mixed results for cohort trends in the cognitive health of older Mexican-Americans. Continued research is needed to identify risk factors that contribute to these population-level trends.

The population-level impacts of excluding norovirus infected food workers: a mathematical modeling study

Abstract

Norovirus is the leading cause of acute gastroenteritis and of foodborne disease in the United States. The Food and Drug Administration recommends foodworkers infected with norovirus be excluded from work while symptomatic and 48 hours after their symptoms subside. Compliance with this recommendation is not ideal and the population-level impacts of changes in foodworker compliance have yet to be quantified. We aimed to assess population impacts of varying degrees of compliance with the current recommendation through a compartmental model. We modeled the number and proportion of symptomatic norovirus cases averted in the U.S. population, by specific age ranges (0–4 year-olds, 5–17 year-olds, 18–64 year-olds, and 65+ year-olds), under various scenarios of foodworker exclusion (i.e., proportion compliant and days of post-symptomatic exclusion) compared to a referent scenario, which assumes 66.6̅% of norovirus symptomatic foodworkers and 0% of post-symptomatic foodworkers are excluded. Overall, we estimated 6.0 million norovirus cases have already been avoided annually under the referent scenario and 6.7 million (28%) more cases may be avoided through 100% compliance with the current recommendations. Substantial population-level benefits were predicted from improved compliance in exclusion of norovirus infected foodworkers – benefits that may be realized through policies or programs incentivizing self-exclusion.

Incision Choices in Nipple-Sparing Mastectomy: A Comparative Analysis of Outcomes and Evolution of a Clinical Algorithm

Background: Nipple-sparing mastectomy (NSM) allows for preservation of the entire nipple-areola complex utilizing various incision patterns. Reconstructive trends and overall risk associated with these diverse NSM incisions have yet to be fully elucidated. Methods: All NSMs from 2006 to 2017 were identified; outcomes were stratified by type of mastectomy incision: lateral or vertical radial, inframammary fold, Wise pattern, previous, and periareolar. Results: A total of 1212 NSMs were performed with 1207 NSMs included for final analysis. Of these, 638 (52.9%) utilized an inframammary fold incision, 294 (24.4%) utilized a lateral radial incision, 161 (13.3%) used a vertical radial incision, 60 (5.0) utilized a Wise pattern incision, 35 (2.9%) used a previous incision, and 19 (1.6%) utilized a periareolar incision. The groups were heterogeneous and differed significantly with regards to various factors including age (p

Unplanned Emergency Department Visits within 30-Days of Mastectomy and Breast Reconstruction

Background: Unplanned emergency department (ED) visits are often overlooked as an indicator of care quality. Our objectives were to (1) determine the rate of 30-day ED visits following mastectomy with or without immediate reconstruction, (2) perform a risk analysis of potential factors associated with ED return, and (3) assess for potentially preventable visits with a focus on returns for pain. Methods: Using the Healthcare Cost and Utilization Project data, we identified adult women who underwent mastectomy with or without reconstruction. Multivariable logistic regression was performed to evaluate risk of unplanned ED visits. We identified and sorted diagnostic codes to investigate why patients were seeking ED care. Additionally, we performed a subgroup analysis on patients returning with a pain-related diagnosis to evaluate risk. Results: Of 159,275 cases of mastectomy with or without immediate reconstruction, 4,917 (3.1%) experienced an unplanned return to the ED within 30 days of operation. Being younger, having any payer type other than a private payer, or having any number of comorbid conditions resulted in increased odds of revisit to ED. A substantial proportion of those who returned (23%) presented with a pain-related diagnosis. Only 0.9% of cases with a 30-day ED return were readmitted. Conclusions: Numerous patients return to the ED within 30-days of mastectomy with or without immediate reconstruction. There is a need for policy makers and physicians to implement strategies to reduce discretionary ED utilization, specifically among younger or publically insured patients. Combining unplanned ED visits with readmission rates as a care quality indicator warrants consideration. Funding: The work was supported by a Midcareer Investigator Award in Patient-Oriented Research (2 K24-AR053120-06) to Kevin C. Chung. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additional funding for this work was supported by awards from the Chang Gung Memorial Hospital (project CORPG3G0111 and CORPG3G0161) to Ting-Ting Chung. Corresponding author: Kevin C. Chung, MD, MS, Section of Plastic Surgery, The University of Michigan Health System, 1500 E. Medical Center Drive , 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109-5340, Phone: 734-936-5885, Fax: 734-763-5354, E-mail: kecchung@med.umich.edu ©2018American Society of Plastic Surgeons

The Relationship between Bone Remodeling and the Clockwise Rotation of the Facial Skelton – A Computed Tomography Imaging based Evaluation

Objective: Changes in midfacial skeletal angles and widths have been identified to contribute to the appearance of the aging face. However, information on the onset and gender differences of these changes, as well as a complete understanding of the theory behind this clockwise rotation, remain elusive. Material and Methods: 157 Caucasian individuals (10 males and 10 females of each: 20 – 29yrs, 30 – 39yrs, 40 – 49yrs, 50 – 59yrs, 60 – 69yrs, 70 – 79yrs, 80 – 89yrs & 8 males and 9 females 90 – 98 years) were investigated. Multi-planar computed tomographic scans with standardized angle and distance measurements in all 3 anatomical axes (x, y, z) in alignment to the sella – nasion (horizontal) line were conducted. Results: Both males and females displayed an increase in orbital floor angle (p

The Stacked Hemi-Abdominal Extended Perforator (SHAEP) flap for autologous breast reconstruction

Background: Options for bilateral autologous breast reconstruction in thin women are limited. The aim of this study was to introduce a novel approach to increase abdominal flap volume with the stacked hemi-abdominal extended perforator (SHAEP) flap. We described the surgical technique and analyzed our results. Methods: A prospective study was conducted of all SHAEP flap breast reconstructions performed since February 2014. Patient demographics, operative details, complications and flap re-explorations were recorded. The bipedicled hemi-abdominal flap was designed as a combination of the deep inferior epigastric perforator (DIEP) and a second, more lateral pedicle: the deep or superficial circumflex iliac perforator vessels (DCIA/SCIA), the superficial inferior epigastric artery (SIEA), or a lumbar artery or intercostal perforator. Results: A total of 90 SHAEP flap breast reconstructions were performed in 49 consecutive patients. Median operative time was 500 minutes (range 405-797). Median hemi-abdominal flap weight that was used for reconstruction was 598 grams (range 160-1389). No total flap losses were recorded. Recipient-site complications included partial flap loss (2.2%), hematoma (3.3%), fat necrosis (2.2%), and wound problems (4.4%). Minor donor-site complications occurred in five patients (10.2%). Most flaps were harvested on a combination of the DIEP and DCIA vessels. Conclusions: This study demonstrated that the SHAEP flap is an excellent option for bilateral autologous breast reconstruction in women who require significant breast volume but have insufficient abdominal tissue for a bilateral DIEP flap. The bipedicled SHAEP flap allows for enhanced flap perfusion, increased volume, and abdominal contour improvement using a single abdominal donor site. Financial disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Conflicts of interest: None. Funding: None. Trial registration: Not applicable. Acknowledgements: The authors would like to acknowledge Dr. Edward Buchel for his great work on the DCIA flap as a combined flap with the DIEP or SIEA, which was the foundation for the SHAEP flap. Corresponding author: Joshua L. Levine, M.D., Center for Breast Reconstruction, 3 Columbus Circle #1410, New York, NY 10019, United States of America. Phone: 212 – 245 – 8140. Fax: 212 – 245 – 8157. Email: info@joshualevinemd.com ©2018American Society of Plastic Surgeons

“The Constriction Arm Band Deformity in Brachioplasty Patients: Characterization and Incidence Using a Prospective Registry”

Background: Demand for post-passive weight loss (MWL) brachioplasty in the United States has seen a dramatic increase, from 338 procedures in 2000 to 17,099 in 2015. New challenges are emerging, some without clear solutions. Here we describe our series of arm band deformities not yet been described in the literature. Methods: This is a retrospective review of MWL patients undergoing brachioplasty at our institution (2000-2016). Pre- and post-operative photographs were reviewed to identify the defect. Descriptive statistics and t-test were used. Results: In our cohort of 1,090 MWL patients, 172 patients underwent brachioplasty, 25 patients (15%) were identified with the deformity. Twenty-four (96%) were female (ave 60y [36y,85y], BMI 34 at time of surgery, ave 2y since GBP, mean delta BMI 22). The bands were generally single bands (100%) found bilaterally (68%) in the distal third (74%) of the upper arm and exacerbated (50%) by brachioplasty. The average specimen weighed 1005g. We found arm banding was associated with higher current BMI, but not with maximum BMI or delta BMI. Conclusions: For MWL patients, arm band deformity is a challenging problem which can be exacerbated by brachioplasty and is not currently surgically correctable. It can be identified pre-operatively to aid in counseling. We found patients with higher current BMI to be at a higher risk for the arm band deformity after brachioplasty. Financial Disclosure Statement: The authors have no disclosures. Corresponding Author: J. Peter Rubin, MD, University of Pittsburgh Department of Plastic Surgery, 3550 Terrace Street 6B Scaife Hall, Pittsburgh, PA, 15261, USA. rubipj@upmc.edu ©2018American Society of Plastic Surgeons

Development of the BODY-Q Chest Module Evaluating Outcomes Following Chest Contouring Surgery

Background: Plastic surgery to improve chest appearance is becoming increasingly popular. The BODY-Q is a patient-reported outcome (PRO) instrument designed for weight loss and/or body contouring. In this paper, we describe the development of a new module for masculinizing chest contouring surgery. Methods: Qualitative methods were used to develop and refine the content of the BODY-Q Chest Module, which was subsequently field-tested in Canada, USA, Netherlands and Denmark between June 2016 and June 2017. Participants were men and trans men aged 16 years or older and seen for gynecomastia, weight loss or trans men chest surgery. Data were collected using either a web-based application or paper questionnaire. Rasch Measurement Theory (RMT) analysis was performed. Results: The sample included 739 participants (i.e., 174 gynecomastia, 224 weight loss, 341 gender confirming). RMT analysis refined a 10-item chest and 5-item nipple scale. All items had ordered thresholds and good item fit, and scales evidenced reliability, i.e., Person Separation Index and Cronbach's alpha values were 0.95 and 0.98 (chest scale) and 0.87 and 0.94 (nipple scale). Scores for both scales correlated more strongly with similar (satisfaction with the body) versus dissimilar (psychological and social function) BODY-Q scales. The mean score for the chest and nipples scales was significantly higher (p

“Fat Grafting for Pedal Fat Pad Atrophy in a 2-Year, Prospective, Randomized Cross-over, Single-Center Clinical Trial”

Background: By age 60, 30% of Americans suffer from fat pad atrophy of the foot. Forefoot fat pad atrophy results from long-term aggressive activity, genetics dictating foot type, multiple forefoot steroid injections, surgery and foot trauma. Methods: We present data from a two-year, prospective, randomized cross-over study performed to assess pain and disability indexes, fat pad thickness, forces and pressures of stance and gait. Group 1 underwent fat grafting with two years of follow-up, while Group 2 underwent conservative management for 1 year, then received fat grafting with 1 year of follow-up. Results: 18 subjects (14 female, 4 male) comprised Group 1. 13 subjects (9 female, 4 male) comprised Group 2. Group 1 reported the worst pain at baseline, Group 2 experienced the worst pain at 6, 12-month Standard of Care (SOC) visits; pain for both groups immediately improved following fat grafting and lasted through study follow up (p

The Feasibility Determination of Risky Severe Complications of Arterial Vasculature Regarding to the Filler Injection Sites at the Tear Trough

Background: The tear trough is a significant sign of the eye and periorbital aging and has been usually corrected with filler injection. However, the arterial supply surrounding the tear trough could be inadvertently injured during injection; therefore, this study aimed to evaluate the nearest arterial locations related to the tear trough and investigate the possibility of severe complications following filler injection. Methods: Thirty hemi-faces of 15 Thai embalmed cadavers were utilized in this study. Results: The artery located closest to both the inferior margin (TT1) and mid pupil level (TT2) of tear trough was found to be the palpebral branch of the infraorbital artery. Furthermore, at 0.5 mm along the tear trough from the medial canthus (TT3), the angular artery was identified which was a found to be a branch of ophthalmic artery. The artery at TT1 and TT2 was located both of the zygomaticus major muscle and orbicularis oculi muscle. The distances from TT1 to the artery were measured as follows; laterally. 2.79 ± 1.08 mm along the X-axis and inferiorly 2.88 ± 1.57 mm along the Y-axis. For the TT2, the artery was located infero-medially from the landmark of 4.65 ± 1.83 mm along the X-axis and 7.13 ± 3.99 mm along the Y-axis. However, the distance along the X-axis at TT3 was located medially as 4.00 ± 2.37 mm. Conclusion: The high risky injured artery at the tear trough should be considered due to the numerous arterial supplies which accompany the facial artery and traverse at varying tissues depths to this area. Financial Disclosure Statement: All authors have nothing to disclose. No funding was received for this article. Acknowledgments: The 100th Anniversary Chulalongkorn University Fund for Doctoral Scholarship from the Graduate School, Chulalongkorn University Corresponding author: Tanvaa Tansatit, MD, MSc, Department of Anatomy, Faculty of Medicine, and The Chula Soft Cadaver Surgical Training Center, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama 4 Road, Pathumwan, Bangkok 10330 Thailand. E-Mail: orange_anatomist@hotmail.com ©2018American Society of Plastic Surgeons

“The Impact of Upper Face Botulinum Toxin Injections on Eyebrow Height and Forehead Lines: A Randomized Controlled Trial and an Algorithmic Approach to Forehead Injection”

Background: No previous study has objectively evaluated the effect of different forehead injection patterns on the eyebrow height and forehead lines. Methods: The patients were divided into three groups. Botulinum toxin was injected in both the lateral and medial eyebrow depressors in all groups. The frontalis was injected using either a V-pattern (group1), a middle horizontal pattern (group 2) or a high horizontal pattern (group 3). Objective eyebrow measurements were performed using standardized pre-and- post injection photographs. Validated photonumeric scales were used to assess the forehead lines. Results: 15 patients (30 eyebrows) were included in each group. In all the groups, 2 weeks after the injection, the brow was lower at all the measured positions in the exception of the lateral brow edge that was higher in the 3 injection patterns. No difference was found when comparing group 1 to groups 2 and 3. The middle forehead injection pattern lowered the eyebrow more than the upper forehead injection pattern. The 3 techniques improved the forehead lines at rest and with contraction. The forehead lines with contraction were more improved in group 1 when compared to both groups 2 and 3. Conclusion: Each forehead injection pattern yielded different results on forehead lines and eyebrow position. Upper forehead injections were less effective on forehead lines but prevented eyebrow ptosis. Financial Disclosure Statement: All the authors have nothing to disclose. No funding was received for the article. List of product used: Dysport© (Ipsen Ltd, Berks, UK) Ethical approval was obtained from the institutional review board of Hotel Dieu de France Hospital, Beirut, Lebanon. All participating patients gave informed written consent. Clinical trial registration information: Name of trial database: ClinicalTrials.gov Registration number: NCT03186001 URL: https://ift.tt/2P4J7TC Corresponding author: Samer Jabbour, MD, Faculty of Medicine Saint-Joseph University Hotel Dieu de France Hospital, Alfred Naccash boulevard, samermed@gmail.Com ©2018American Society of Plastic Surgeons

Immediate Implant-Based Breast Reconstruction with Acellular Dermal Matrix: A Comparison of Sterile and Aseptic AlloDerm in 2039 Consecutive Cases

Background: Sterile, ready-to-use acellular dermal matrix (RTU ADM), introduced as an alternative to aseptic, freeze-dried acellular dermal matrix (FD ADM) for implant-based breast reconstruction (IBR), has been investigated in a limited number of studies. The purpose of this study was to compare outcomes in IBR with RTU ADM and FD ADM. Methods: We analyzed patients undergoing IBR with either FD ADM or RTU ADM, including demographics, clinical variables, and outcomes. An a priori power analysis was performed and logistic regression modeling was used to quantify the effect of ADM on outcomes while controlling for potential confounders. Results: 1285 consecutive patients undergoing 2039 immediate prosthetic breast reconstructions comprised the population: 612 (n=910 breasts) with FD ADM and 673 (n=1129 breasts) with RTU ADM. The FD ADM cohort had a significantly higher rate of explantation compared to RTU ADM cohort (18.0% versus 12.0%, p = 0.0036), but surgical site infection, wound dehiscence, mastectomy flap necrosis, seroma, and hematoma did not differ significantly between groups. On multivariate regression, patients having reconstruction with FD ADM, compared to RTU ADM, did not have higher odds of experiencing surgical site infections (OR 1.064, p = 0.7455), but did have higher odds of explantation (OR 1.570, p = 0.0161). Tobacco use (OR 2.809, p = 0.0002) and BMI (OR 1.054, p

Clinical Implications of Gluteal Fat Graft Migration – A Dynamic Anatomic Study.

Background: The intraoperative mortality and overall complication rate for gluteal augmentation with fat transplantation is unacceptably high. The current controversy among experts regarding safety is whether fat should be placed within the gluteus muscle or only limited to the subcutaneous space. The purpose of the present study is to test the hypothesis that under certain pressures, fat injected within the gluteal muscle can actually migrate out of the muscle and into a deeper plane containing critical neurovascular structures, via the process of Deep Intramuscular Migration. Methods: A total of eight human cadaver dissections were performed. Four hemi-buttocks were selected for intramuscular fat injection. The patterns of sub-fascial fat migration were evaluated in three of these hemi-buttocks by direct visual inspection and in one hemi-buttock by endoscopic evaluation. Four other hemi-buttocks were selected for subcutaneous or supra-fascial fat injection. Results: Proxy fat was found to migrate through the muscle and into the deep submuscular space with each intramuscular injection. With subcutaneous injection, no proxy fat was found during dissection in the intramuscular septae or submuscular space. Conclusion: The intramuscular insertion of fat, which up to this point has been considered reasonable to perform in the superficial muscle and even recommended in the literature, is now deemed to be an inexact and risky surgical technique. This technique, because of its migratory nature, should be avoided from further use in fat transplantation to the gluteal region. Disclosures: Rod J. Rohrich, MD receives instrument royalties from Eriem Surgical, Inc and book royalties from Thieme Medical Publishing, he is a Clinical and Research Expert for Allergan, Inc and MTF Biologics, and the Owner of Medical Seminars of Texas, LLC. No funding was received for this article Dr. Del Vecchio is a founder of Surgistem Technologies, LLC; a device company involved in fat transplantation, receives royalties from Microaire, and is a founding member of Peninsula Partners, LLC a consulting firm in the plastic surgery sector. Acknowledgements: Dr. Rod Rohrich Research Fund from UT Southwestern Department of Plastic Surgery, Garret Adams of Stryker for compartment pressure monitor, Jourdan Carboy for illustrations and the Willed Body Program UTSW Corresponding Author: Daniel A. Del Vecchio, MD, 38 Newbury Street, Boston, MA 02116, Fatvsfiction@gmail.com ©2018American Society of Plastic Surgeons

Breast Implant Mycobacterial Infections – An Epidemiological Review and Outcome Analysis

Background: Epidemiological evidence of periprosthetic mycobacterial infections (PMIs) is limited. The recent boom in cosmetic surgery tourism has been associated with a rise of surgical site infections (SSIs) in returning patients. This review aims to explore available data, examine trends of documented PMIs and analyze outcomes of management techniques. Methods: A search in Biosis, Embase, LILACS, Medline, and Web of Science databases from inception until December 2017 for "Breast Implants" and "Mycobacterial Infections" and equivalents was performed. Data were pooled after two screening rounds following full-text retrieval and cross-referencing. Results: Forty-one reports describing 171 female patients who had breast prosthesis-related mycobacterial infections were identified. Bibliometric case-based analysis revealed a rise of PMIs in developing countries since the start of the millennia. The mean age was 37.9 years and the majority of cases followed bilateral breast augmentation. Most patients presented with breast pain or tenderness, after an average incubation period of nine months. M. fortuitum was isolated from 90 (52.6%) of cases. Immediate explantation, with or without delayed re-implantation was most commonly employed surgical strategy, complemented by combination antimicrobial therapy for an average of 4.6 months. The mean follow-up time was 39.7 months, during which recurrences were observed in 21/171 patients (12.3%). Conclusion: The emergence of PMIs in relation to cosmetic medical tourism alerts clinicians to the importance of educating the public about the associated risks. In addition, this study identifies risk factors associated with recurrence of PMIs. Conflicts of Interest: None of the authors has a financial interest in this manuscript. Source of Funding: No funds were received in support of this study. Address correspondence and reprint requests to: Omar Fouda Neel, MBBS, MMgt, FRCSC, FAAP, FACS, Division of Plastic Surgery, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada Phone Number: 5142249054 , Fax Number: 5142249054 , Email: foudaneel@gmail.com ©2018American Society of Plastic Surgeons

A Staged Procedure in the Treatment of Primary Lacrimal Sac Epithelial Malignancy: A Retrospective Cases Analysis

Purpose: To determine the effect of a staged procedure in the treatment of primary lacrimal sac epithelial malignancy. Methods: This is a retrospective case series of 18 consecutive patients with primary lacrimal sac epithelial malignancy treated at an orbital tumor referral center between 2002 and 2017. Study was conducted in compliance with the Declaration of Helsinki. All patients underwent biopsy of the mass to confirm the diagnosis pathologically. Chemotherapy concurrent with radiotherapy was delivered to the patients to reduce and concrete the tumor prior to surgery. En bloc resection of the lacrimal sac malignancy and nasolacrimal duct was followed. Results: Eleven patients were male and 7 patients were female. The median follow-up time was 72.2 months. Nine patients had squamous cell carcinoma, 7 poorly differentiated carcinoma, 1 transitional cell carcinoma, and 1 adenoid cystic carcinoma. After chemotherapy and radiotherapy, the tumor volume was reduced significantly (p

Orbital Myxofibrosarcoma: Case Report and Review of Literature

Myxofibrosarcoma is rarely found in the orbit, let alone as a primary orbital tumor. With this having only been previously reported 5 times in the literature, there is a very limited understanding of its presentation and course. Typical management involves surgical excision with or without postoperative radiotherapy. Low-grade malignancy, although rare to metastasize, still has a high rate of local recurrence and with each recurrence increases the risk of metastatic potential. With this in mind, analysis of each case is critical in better understanding the disease, and this case adds to the current literature. Accepted for publication July 17, 2018. The authors have no financial or conflicts of interest to disclose. Presented at American Society of Ophthalmic Plastic and Reconstructive Surgery Fall Meeting, November 12-13, 2015, Las Vegas, NV, U.S.A. Address correspondence and reprint requests to George Salloum, M.D., Center For Vision Care, 550 Harrison St. Suite L, Syracuse, NY 13202. E-mail: salloum.george@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Efficacy and Safety of Botulinum Toxin Type A Injection in Patients with Bilateral Trapezius Hypertrophy

Abstract

Objective

To evaluate aesthetic outcomes in patients with bilateral trapezius hypertrophy treated by botulinum toxin type A (BTxA) injection for aesthetic reconstruction of the upper trapezius.

Methods

From May 2015 to May 2016, 30 women with a short neck shape resulting from bilateral trapezius hypertrophy were treated with botulinum toxin type A (BTxA) injection at the most affected area of the upper trapezius. Pre- and postoperative values of S_ACDF (irregularly shaped area of the four points A, C, D, and F) and S_ACDE (irregularly shaped area of the four points A, C, D, and E), responses to patients' and doctors' Global Aesthetic Improvement Scale (GAIS) questionnaires for neck aesthetic assessment, as well as reported adverse events, were recorded and analyzed.

Results

Duration of follow-up ranged from 4 to 12 months. Subjects experienced non-severe adverse events and complete recovery after a single BTxA injection. In patients' GAIS questionnaires, "very much improved" accounted for 53%, "much improved" accounted for 13%, and "improved" accounted for 27%. In doctors' GAIS questionnaires, "very much improved" accounted for 27%, "much improved" accounted for 33%, "improved" accounted for 33%, and "no change" accounted for 7%. The overall degree of improvement was high. Statistically significant differences were observed with respect to the "very much improved" response to GAIS questionnaires between patients and doctors (P = 0.035).

Conclusion

A single injection of BTxA for aesthetic reconstruction of the upper trapezius is safe and effective in patients with bilateral trapezius hypertrophy.

Level of Evidence IV

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

Uptake effects of toxic heavy metals from growth soils into jujube and persimmon of China

Abstract

Compared with other agricultural plants, information about uptake effects of toxic heavy metals from growth soils into persimmon and jujube are scarce. In this study, the single and comprehensive uptake effects of five toxic heavy metals (Pb, As, Cd, Cr, and Hg) between the two fruits and their growth soils were investigated. The results showed that the average concentrations of heavy metals in the two fruits were found to be 30 (Pb), 6.6 (As), 2.3 (Cd), 38 (Cr), and 0.33 (Hg) μg/kg, respectively. The average concentrations of heavy metals in their growth soils were 26.31 (Pb), 9.63 (As), 0.12 (Cd), 57.6 (Cr), and 0.049 (Hg) mg/kg, respectively. An uptake effect was observed for the two fruits. The values of Nemerow pollution index (NPI) in the two fruits and their growth soils were 0.10 and 0.55, respectively. The average bioconcentration factor (BCF) values of Pb, As, Cd, Cr, and Hg in the two fruits were 0.0012, 0.00075, 0.021, 0.00077, and 0.012, respectively. Based on the residue levels of toxic heavy metals in the growth soils and soil parameters, the prediction models for NPI and BCF were established, with the adjusted regression coefficients of 0.65 (NPI) and 0.81 (BCF). The contribution rates of different soil parameters to NPI were 21.7% (OC), 16.1% (Pb), 17.1% (Cr), 19.8% (Cd), and 25.4% (As), respectively. The contribution rates of different soil parameters to BCF were 10.2% (OC), 9.4% (Cr), and 80.4% (Cd), respectively.

Role of sorption energy and chemisorption in batch methylene blue and Cu 2+ adsorption by novel thuja cone carbon in binary component system: linear and nonlinear modeling

Abstract

Functionalized thuja cone carbon (FTCC) was synthesized thermochemically. It was carried out by carbonization (250 °C) and activation (320 °C), followed by surface functionalization in 0.5 M HAN (HNO and HCl₃) mixture and subsequent heating in H₂SO₄ (95%) at 90 °C. This was used for methylene blue (MB) adsorption in single component system (SCS) and binary component system (BCS) with Cu²⁺. Maximum adsorption capacity of MB (83.4 mg/g) was achieved at pH 10 at 100 mg/L of adsorbate solution. MB and Cu²⁺ adsorption onto FTCC obeyed pseudo-second-order model kinetics. Spontaneous and endothermic MB adsorption was noticed with negative Gibbs free energy change (− 6.34, − 9.20, and − 13.78 kJ/mol) and positive enthalpy change (133.91 kJ/mol). At low concentrations, Cu²⁺ adsorption increased by 14 mg/g with least reduction of MB adsorption (< 4 mg/g) in BCS. Isotherm models (Langmuir, Freundlich, Temkin, and Dubinin-Radushkevich) support the increase in Cu²⁺ adsorption in BCS. The sorption heat of MB shifted from 165.16 kJ/mol (SCS) to 150.85 kJ/mol in BCS (Temkin) and from 57.74 kJ/mol (SCS) to 50.50 kJ/mol in BCS (D-R), which supports the lower MB uptake in BCS due to decrease in sorption energy. The sorption heat of Cu²⁺ is increased (148.43 kJ/mol) in the BCS than SCS (155.36 kJ/mol), which makes the equal distribution of increased bonding energies; therefore, FTCC surface sites increased the Cu²⁺ uptake in the BCS. Desorption studies concluded the reusability of FTCC by 75% and 79% for MB and Cu²⁺ adsorption respectively. This study recommends to determine the best fit of isotherm and kinetic models to adsorption data by linear as well as nonlinear regression fit.

Pseudovascular squamous cell carcinoma: A review of the published work and reassessment of prognosis

The Journal of Dermatology, EarlyView.

Use of immune checkpoint inhibitors prolonged overall survival in a Japanese population of advanced malignant melanoma patients: Retrospective single institutional study

The Journal of Dermatology, EarlyView.

Neoadjuvant rectal score: run with the hare and hunt with the hounds

Oncogenes expand during evolution to withstand somatic amplification

Abstract

Background

Cancer-related genes are under intense evolutionary pressure. We conjectured that gene size is an important determinant of amplification propensity for oncogenes and thus cancer susceptibility and therefore could be subject to natural selection.

Patients and Methods

Gene information, including size and genomic locations, of all protein-coding genes were downloaded from Ensembl (release 87). Quantification of gene amplification was based on GISTIC scores obtained from available The Cancer Genome Atlas studies.

Results

Oncogenes are larger in size as compared with non-cancer genes (mean size: 92.1 kb vs 61.4 kb; p < 0.0001) in the human genome, which is contributed by both increased total exon size (mean size: 4.6 kb vs 3.4 kb; p < 0.0001) and higher intronic content (mean %: 84.8 vs 78.0; p < 0.01). Such non-random size distribution and intronic composition are conserved in mouse and Drosophila (all p-values < 0.0001). Stratification by gene age indicated that young oncogenes have been subject to a stronger evolutionary pressure for gene expansion than their non-cancer counterparts. Pan-cancer analysis demonstrated that larger oncogenes were amplified to a lesser extent. Tumor-suppressor genes also moved towards small oncogenes in the course of evolution.

Conclusions

Oncogenes expand in size whereas tumor-suppressor genes move closer to small oncogenes in the course of evolution to withstand oncogenic somatic amplification. Our findings have shed new light on the previously unappreciated influence of gene size on oncogene amplification and elucidated how cancers have shaped our genome to its present configuration.

A Centralised multidisciplinary clinic approach for germ cell tumours

Immunotherapy for melanoma

Abstract

Background

Prior to the approval of the anti-CTLA-4 antibody ipilimumab in 2011, patients suffering from melanoma with distant metastases faced a poor prognosis with a median overall survival of 6–10 months. The approval of immune check point inhibitors, which can achieve long-term survival for patients with metastatic melanoma, represents a breakthrough.

Aim and methods

The currently approved systemic therapies for melanoma, taking into account the data presented at the Annual Meeting 2017 of the American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO), are summarized in this review.

Results and discussion

Compared to ipilimumab, the two anti-PD-1 antibodies pembrolizumab and nivolumab are showing higher efficacy with lower toxicity. The combination of nivolumab and ipilimumab was approved in 2016 and achieved a response rate of 58% and a 3-year survival rate of 58%. Severe grade 3/4 adverse events occurred in 55% of the patients. The early diagnosis of immune-mediated side effects and their adequate treatment, using systemic glucocorticosteroids and other immunosuppressive drugs if necessary, is an indispensable prerequisite for successful therapy. Combined nivolumab and ipilimumab achieved intracranial response rates of 42–55% in patients with metastatic melanoma and brain metastases, with no increase in toxicity compared to patients without brain metastases. In light of the therapeutic success of immune checkpoint inhibitors, several studies are currently underway to evaluate anti-PD-1 antibodies in the adjuvant setting. Current and future studies are increasingly investigating innovative immunocombination therapies, e. g. anti-PD-1 antibodies in combination with IDO inhibitors (IDO, indoleamine-pyrrole 2,3-dioxygenase). Data available now suggest high efficacy and low toxicity.

Leserbrief zu Steger et al. „Methadon gegen Krebs“

An international comparison of Google searches for sunscreen, sunburn, skin cancer, and melanoma: current trends and public health implications

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

Skin Cancer Projections and Cost Savings 2014‐2045 of Improvements to the Danish Sunbed Legislation of 2014

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

The potential role of antioxidants in mitigating skin hyperpigmentation resulting from ultraviolet and visible light induced oxidative stress

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

Reconstruction mammaire autologue microchirurgicale par lambeau libre perforant PAP (Profund Artery Perforator Flap) aux dépens de l’artère fémorale profonde : technique de prélèvement, modelage et résultats

Publication date: Available online 10 September 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): M. Hivelin, L. Lantieri

Résumé

L'utilisation de lambeaux libres perforants en reconstruction mammaire permet des reconstructions pérennes avec une morbidité réduite, offrant une meilleure qualité de vie à long terme. Ces lambeaux perforants peuvent être prélevés aux dépens des vaisseaux épigastrique inférieur profond (DIEP) et des artère glutéale supérieure (SGAP) ou inférieure (IGAP). Prélevé dans la même région que le lambeau musculocutané de gracilis à palette transverse haute (TUG), plus postérieure et sans muscle associé, la peau de la cuisse postérieure interne de la racine de la cuisse vascularisée sur des perforantes de l'artère fémorale profonde (PAP) est utilisée en reconstruction mammaire depuis 2010. Nous présentons la technique de prélèvement, branchement et modelage de ce lambeau PAP et ses résultats. Les perforantes de l'artère fémorale profonde, constantes, sont sélectionnées sur un angioscanner, puis repérée par doppler. La palette cutanée elliptique, de 20 × 7 à 10 cm, est dessinée du sillon genito-crural jusqu'au pli sous-fessier. La dissection se déroule dans un plan sous-fascial jusqu'au vaisseau perforant. Le pédicule, long de 8 à 12 cm permet des anastomoses avec les vaisseaux mammaires internes ou circonflexes scapulaires. La forme elliptique longue de la palette permet par un modelage conique une reconstruction mammaire plus naturelle. Le site donneur est peu morbide et des cicatrices sont cachées dans le pli sous-fessier. Le PAP, complété par greffe adipocytaire, est respectivement une option excellente et satisfaisante en reconstructions mammaires immédiates et différées.

FR - Utilidad del láser de colorante pulsado en el lupus eritematoso cutáneo

Publication date: Available online 10 September 2018

Source: Actas Dermo-Sifiliográficas

Author(s): P. García-Montero, R. Pérez-Mesonero, A. Barrutia-Borque, P. Boixeda

Rheumatoid nodule‐like cutaneous granuloma associated with RAG1‐deficient severe combined immunodeficiency: a rare case

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

Commentary to the review article: Subedi S, Yu Q, Chen Z, Shi Y. Management of pediatric psoriasis with acitretin: A review. Dermatol Ther. 2018 Jan;31(1)

Dermatologic Therapy, EarlyView.