Androgenetic alopecia (AGA) is a common hair loss disorder caused by genetic and hormonal factors that are characterized by androgen-related progressive thinning of scalp hair in a defined pattern. By the age of 60 years, 45% of men and 35% of women develop AGA. Currently, U.S. Food and Drug Administration-approved treatments for AGA include oral finasteride and topical minoxidil. Due to the limited number of effective therapies for AGA, platelet-rich plasma (PRP) has become an effective alternative treatment.
Παρασκευή 21 Σεπτεμβρίου 2018
Platelet-rich plasma for androgenetic alopecia: A review of the literature and proposed treatment protocol
Effects of dextran sulfate, 4-t-butylcyclohexanol, pongamia oil and hesperidin methyl chalcone on inflammatory and vascular responses implicated in rosacea.
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Effects of dextran sulfate, 4-t-butylcyclohexanol, pongamia oil and hesperidin methyl chalcone on inflammatory and vascular responses implicated in rosacea.
Clin Cosmet Investig Dermatol. 2018;11:421-429
Authors: Hernandez-Pigeon H, Garidou L, Galliano MF, Delga H, Aries MF, Duplan H, Bessou-Touya S, Castex-Rizzi N
Abstract
Background: Rosacea is a chronic facial skin disorder characterized by inflammation and vascular abnormalities. The pathophysiology of rosacea involves increased activation of the capsaicin receptor, TRPV1, the vascular endothelial growth factor (VEGF) pathway, and cathelicidin LL-37, MMP-9, and KLKs. We evaluated the activity of four compounds (dextran sulfate, 4-t-butylcyclohexanol [BCH; TRP-regulin®], pongamia oil, and hesperidin methyl chalcone [HMC]) on inflammatory and vascular responses implicated in rosacea.
Materials and methods: The anti-inflammatory activity of dextran sulfate was evaluated on PGE2 production after PMA stimulation of NCTC-2544 keratinocytes, and on normal human epidermal keratinocytes (NHEKs) after proinflammatory stimulation to mimic a rosacea environment. The anti-angiogenic activity of dextran sulfate was measured by analyzing pseudotube formation in co-cultured human microvascular endothelial cells/normal human dermal fibroblasts. HMC modulation of vascular responses and IL-8 cytokine production after SP stimulation was evaluated in human skin explants. We also assessed the effect of BCH on TRPV1 activation, and the effect of combined BCH and pongamia oil on the inflammatory response of NHEKs.
Results: Dextran sulfate strongly and significantly inhibited PMA-induced PGE2 production, inhibited KLK5 and MMP-9 mRNA expression, and IL-8, IL-1α and VEGF production, and displayed a highly significant inhibitory effect on VEGF-induced pseudotube formation. In SP-stimulated human skin explants, HMC significantly decreased the proportion of dilated vessels, total vessel area, and IL-8 production. BCH significantly and dose-dependently inhibited TRPV1 activation, and BCH and pongamia oil inhibited CXCL1 and CXCL6 mRNA expression and IL-8 production in NHEKs. Combined BCH/pongamia oil inhibited IL-8 production synergistically.
Conclusion: These in vitro results showed that dextran sulfate, BCH, pongamia oil and HMC, possess complementary soothing and anti-redness properties, supporting their combination in Avène redness-relief cosmetic products for sensitive skin prone to redness, and for topical adjunctive rosacea treatment.
PMID: 30233225 [PubMed]
European research trends in nuclear medicine
Abstract
Written by associate editors of the Annals of Nuclear Medicine, this invited review article is intended to offer our readers a condensed global view on the high-quality research work that has been published in Europe last year. We have divided this article into five sections. The first three sections from the oncology category include "[18F]fluorodeoxyglucose (FDG) positron-emission tomography (PET) for therapy monitoring in malignant lymphoma", "[18F]fluoromisonidazole (FMISO) PET for hypoxia", and "lymphoscintigraphy update". It is followed by a section on "amyloid PET for Alzheimer's disease" using [11C]Pittsburgh Compound B (PiB) and [18F]florbetapir from the neurology category. The final section reviews three original articles in the field of "basic and translational molecular imaging" regardless of the category, which investigated new PET tracers such as L-4-borono-2-[18F]fluoro-phenylalanine (FBPA), O-(2-[18F]fluoroethyl)-L-tyrosine (FET) and 64Cu-NOTA-pertuzumab in small animals. We hope that this review article will arouse greater interest in our readers in recent European research trends in the field of nuclear medicine.
Transcutaneous oximetry and laser Doppler flowmetry values in patients with chronic skin ulcers treated with platelet rich plasma and stromal vascular fraction cells: a pilot study
Abstract
Background
Stromal vascular fraction cells (SVFs) hold great promise for use in regenerative medicine applications, as a result of their ability to promote the healing process through in situ differentiation and the secretion of paracrine factors. The aim of this paper was to evaluate whether and how the topical application of SVF with platelet-rich plasma (PRP) for the treatment of chronic skin ulcers modified the cutaneous perfusion of the treated areas.
Methods
Perilesional laser Doppler flowmetry (LDF) and transcutaneous oximetry (tcpO2) values were recorded for a 3-month period in 15 patients with chronic skin ulcers of various etiologies, who had been previously treated with single co-administered perilesional and intralesional injections of SVF+PRP.
Results
No significant differences were found between pretreatment, 1 month, and 3 month posttreatment values regarding both LDF values (basal: p = 0.10 and declivous: p = 0.0976) and declivous tcpO2 levels (p = 0.0804). The only significant difference reported was between pretreatment and 3-month posttreatment basal tcpO2 levels (p = 0.0466).
Conclusions
These results may reflect improved subcapillary circulation of the treated areas at 3 months postinjection, without a significant improvement in capillary perfusion.
Level of Evidence: Level IV, therapeutic study.
The first step of patient-specific design calvarial implant: A quantitative analysis of fresh parietal bones
Abstract
Background
Accurate knowledge of the fracture of cranial bone can provide insight into the prevention of skull fracture injuries and help aid the design of energy-absorbing head protection systems and safety helmets. When cranial bone needs to be removed or is lost, subsequent reconstruction of the defect is necessary to protect the underlying brain, or correct esthetic deformities, or both. Ideal reconstruction of defected bone is possible utilizing a biocompatible implant with a bone-like design individualized for the specific patient. The purpose of this study is to investigate the anatomical and mechanical characteristics of fresh frozen human parietal bones and determine compliance of polylactic acid-based personalized three-dimensional implants in terms of mechanical properties in order to replace such defective bones.
Methods
Parietal bone specimens were extracted from 19 fresh frozen cadavers. Morphological parameters of individual bone specimens were measured using Image J software. Three-point bend tests were performed to extract Young's modulus and tensile strength of the specimens from the measured force and displacement data by modeling the bone specimens as curved linear elastic beams. Also, three-point bend tests were performed to polylactic acid-based three-dimensional replicas mimicking geometry of the bone specimens in order to determine whether the material's Young's modulus and tensile strength properties comply with parietal bones.
Results
Entire fresh parietal specimens were observed to be comprised of a three-layered structure: external layers consisting of compact, high-density cortical bone and the central layer consisting of low-density, irregularly porous bone structure. Mean thickness of three-layered structure was 6.25 ± 1.46 mm. Mean Young's modulus and tensile strength of the specimens were 1.40 ± 1.34 GPa and 44.56 ± 21.94 MPa, respectively where no statistically significant differences among genders were detected (p > 0.05). Mean Young's modulus and tensile strength of the polylactic acid-based three-dimensional implants mimicking geometry of the bone specimens were 1.8 ± 0.7 GPa and 72.8 ± 2.5 MPa, respectively.
Conclusions
Polylactic acid-based three-dimensional implants can be considered as acceptable candidates for temporary replacement of parietal defects in terms of mechanical properties.
Level of Evidence: Not ratable.
Poly Implant Prothèse silicone breast implants: implant dynamics and capsular contracture
Abstract
Background
The Poly Implant Prothèse (PIP) implants were withdrawn from the market in 2010 due to the use of low-grade silicone, causing a high risk for implant rupture. The aim of this study was to investigate the implant dynamics of PIP breast implants, as well as to determine the rate and predictors of implant gel bleeding, rupture, and capsular contracture in PIP implants.
Methods
Eighty women with a total of 152 PIP implants who underwent a reoperation in 2012 were enrolled in this study. Physical investigation included assessing the Baker score and demographics were retrospectively traced in medical records. The pre- and post-operative volumes of the implants were calculated and their state was determined intraoperatively by the surgeon.
Results
The implants were removed after a mean implant duration of 11 ± 2.1 years. Gel bleed and implant rupture occurred in respectively 42 and 25% of the implants. Intact implants had post-operative volume increase as well as decrease. There was a correlation between gel bleeding and more post-operative implant volume increase (P ≤ 0.05). Capsular contracture had a protective effect against post-operative implant volume increase (P ≤ 0.05), while a post-operative implant volume increase provided a protective influence in developing capsular contracture (P ≤ 0.05). Additionally, implant rupture led to a higher risk of capsular contracture (P ≤ 0.05).
Conclusions
We managed to illustrate that PIP implant shells were too permeable and that there is a correlation between gel bleeding and the increase of the post-operative implant volume. Implant rupture led to a higher risk for developing capsular contracture.
Level of evidence: Level III, risk / prognostic study.
Split-thickness skin grafting using grafts of different thickness
Abstract
Background
Split-thickness skin grafting (STSG) is the most commonly used technique in the treatment of traumatic, post-burn, and post-operative wounds, when direct wound edge closure is unavailable. There is currently no general agreement on the optimal thickness of skin grafts. We aimed to analyze the early results of recipient wound healing after STSG, using grafts of different thicknesses.
Methods
This randomized, controlled, and parallel-group pilot clinical trial included 98 adult patients who underwent STSG transplantation surgery for post-burn, post-traumatic, or post-operative skin defects. Patients were randomized into three groups to receive a skin graft of 0.2, 0.3, or 0.4-mm thickness. After skin transplantation, the healing parameters of the recipient wounds were evaluated after 3 days, 7 days, 2 weeks, and 1 month. At each time, epithelialization and pain parameters were evaluated.
Results
Our study showed that thinner split-thickness skin grafts had better epithelialization scores at the second post-operative week. However, thinner split-thickness skin grafts caused greater pain to the patients.
Conclusions
Thickness of the skin graft is a significant factor affecting recipient wound healing parameters. It is necessary to evaluate healing of the donor wound, as well as distant treatment outcomes, such as scarring, pigmentation, and esthetic results of skin grafting with different thickness grafts.
Level of Evidence: Level I, therapeutic study.
A systematic review of the risk of postoperative bleeding with perioperative non-steroidal anti-inflammatory drugs (NSAIDs) in plastic surgery
Abstract
Background
NSAIDs are used extensively in the perioperative period, for analgesia, or for preexisting conditions. However, potential risks of NSAID-induced haemorrhage have raised concerns regarding their use. NSAIDs inhibit platelet aggregation and have been shown to significantly increase bleeding time. In the available literature, there is an apparent lack of consensus regarding the use of NSAIDs and their clinical effects. A systematic review was undertaken to collate all relevant published data to provide a combined measure of the overall risk of serious complications when using NSAIDs in the perioperative period.
Methods
The search for potentially relevant studies was undertaken in PubMed for all publications up to August 2016, using appropriate medical subject (MeSH) headings. There were no restrictions on publication date or status. This was conducted in concordance with and adherence to the 2009 PRISMA guidance. Data harvested relevant papers was tabulated and analysed utilising Review Manager software to calculate a risk ratio (Mantel-Haenszel method, random effects).
Results
Twelve articles were included in the analysis, comprising 6581 patients, of which 1785 received an NSAID and 4796 were controls. Within the 1785 patients receiving NSAIDs, a total of 102 (5.7%) experienced moderate to severe complications, compared with 108 (2.2%) in the control groups.
Conclusions
Based on the assembled data, the authors conclude that the use of perioperative NSAIDs in plastic surgical procedures increases the risk of postoperative bleeding complications. Despite this, the rate of bleeding complications remains low.
Level of Evidence: Not ratable.
Surgical management of giant congenital melanocytic nevus of face in the adult—outcomes and experience
Abstract
Background
Congenital melanocytic nevi (CMN), especially those of the face, cause great psychological stress to the patient. Giant-sized lesions coupled with the complex anatomy and functional demands of the region complicate treatment, more so in adults. We present our outcomes and our experience in the treatment of such lesions in the adult.
Methods
A retrospective review was carried out of all patients over the age of 14 years undergoing surgical treatment for giant CMN of the face at a tertiary care hospital. This three-year study focuses on nevi of the face; nevi elsewhere are not included. Surgical techniques employed, and complications and esthetic outcome are discussed.
Results
Seventeen patients were included in the study. Primary reconstructive procedures included tissue expansion (TE), split-thickness skin graft (STSG), full-thickness skin graft (FTSG), and free tissue transfer (FTT). Additionally, secondary procedures were required in 15 patients. Esthetic outcomes were superior with TE and FTT.
Conclusions
Size and location of the lesion, and compliance of the patient are the primary determinants of the choice of procedure. However, potential for malignant transformation and optimal esthetic results have to be also borne in mind. Treatment should be prompt, reconstruction should be individualized and follow-up should be prolonged.
Level of Evidence: Level IV, therapeutic study.
Reconstruction of abdominal wall defects using extended trilobed rectus abdominis musculocutaneous flap
Abstract
Reconstruction of extensive abdominal wall defects is difficult in many cases. We performed peritoneal reconstruction by free fascia lata transplantation and abdominal wall reconstruction with an extended trilobed rectus abdominis musculocutaneous flap. Firstly, the peritoneum is closed by free fascia lata transplantation. Then, the rectus abdominis musculocutaneous flap is prepared adjacent to the abdominal wall defect and centering on the rectus abdominis muscle body on the contralateral side. The rectus abdominis musculocutaneous flap is elevated with the first flap toward the xiphoid process on the cranial side, the second flap toward the middle axillary line on the lateral side, and the third flap toward the lower abdominal region on caudal side as an extended trilobed rectus abdominis musculocutaneous flap with a deep inferior epigastric arteriovenous pedicle and transposed to the abdominal wall defect. This method was applied to a full-thickness abdominal wall defect produced by colon cancer resection in two patients. Case 1 was a 10 × 15-cm full-thickness right abdominal wall defect, and case 2 was an 8 × 14-cm full-thickness left abdominal wall defect. The postoperative course was favorable, and no complication, such as abdominal incisional hernia, developed. The rectus abdominis musculocutaneous flap could be collected from the same surgical field, and its preparation as an extended musculocutaneous flap widely beyond the range of the muscle body was possible. By preparing a trilobed flap, the flap-donor region could also be easily closed. This method may be useful for reconstruction of extensive full-thickness abdominal wall defects.
Level of Evidence: Level V, therapeutic study.
A case of important weight loss after a prepectoral breast reconstruction
Abstract
The submuscular implant-based breast reconstruction is the most common reconstructive technique following mastectomy. Recently, subcutaneous implant positioning, together with acellular dermal matrix, has become a promising technique in selected patients. We present the case of a 42-year-old woman who underwent left nipple-sparing mastectomy with prepectoral acellular dermal matrix (ADM) assisted direct-to-implant (DTI) breast reconstruction and contralateral mastopexy. The implant was completely wrapped around by Braxon®, a preshaped porcine ADM. A few months after surgery, she experienced a severe weight loss resulting in the aesthetic deterioration of both breasts. The patient showed a migration of the left implant inferiorly and laterally, and deflation of the contralateral breast. In order to improve the left breast, a lateral capsulectomy was performed to reduce the prepectoral pocket size and lift the implant. Subsequently, a modified donut mastopexy was performed to obtain an upward migration of the nipple-areolar complex. One of the limiting factors of prosthetic reconstruction, as compared to autologous reconstruction, is the aesthetic deterioration determined by any weight change. Differently from submuscular implant reconstruction, the prepectoral implant reconstruction follows body changes after weight changes and ageing. In fact, Braxon's integration determines the formation of a capsule adhering to the mastectomy flap which makes the implant more sensible to dermatochalasis. The greater thickness of the mastectomy flap due to the larger representation of the subcutaneous tissue makes the reconstruction more sensitive to weight changes. A tailored partial capsulectomy combined with a donut mastopexy can be a solution in these patients after an important weight loss.
Level of Evidence: Level V, therapeutic study.
Reconstruction with artificial dermis of oncological surgical defects in the craniofacial district—Matriderm® versus Integra®: a non-randomized, unblinded single-operator case series
Abstract
Background
The use of dermal templates after oncologic surgery, such as Matriderm® and Integra®, allows the reconstruction of wide defects without the use of flaps or tissue expanders, minimizing the operative time and the hospital stay. In this study, we aim to analyze the results of Matriderm® and Integra®, both used in the reconstruction of oncological surgical defects in the craniofacial. Our evaluation takes into account the location of the surgical defect, the type of dermal template, and the surgical technique employed.
Methods
Data were collected retrospectively from our database from Jan 2012 to Aug 2016. The patients with a craniofacial skin cancer treated with a dermal template were identified. Preoperative, intraoperative, and postoperative data were recorded.
Results
In the period from Jan 2012 to Aug 2016, a total of 50 patients were operated for craniofacial skin cancer excision and reconstruction with a dermal template. Both Integra® and Matriderm® were used in 25 patients. The complete healing was generally achieved in 5 weeks for the one-step reconstructions and in 8 weeks for the two-step reconstructions. The global rate of complications was of 20%, and therefore, most of them were resolved with conservative therapy.
Conclusions
We observed that Integra® has a better integration on poorly vascularized surfaces, such as the skull bones; however, the thickness of the dermis obtained is lower than the one obtained with Matriderm®. The latter, when used with the two-step technique, allows complete restoration of the thickness gap obtaining a better cosmetic result.
Level of Evidence: Level III, therapeutic study.
How to avoid common errors in writing scientific manuscripts
Abstract
When writing scientific manuscripts, many important details are left a side which many times causes the rejection of the manuscript from high impact journals. Scientific writing is a combination of a comprehensive literature search and study, collection of statistical data, and a clear and concise structured writing, while avoiding common and known errors. The knowledge and implementation of basic rules of style, structure, and presentation when writing a scientific paper increase the chances of success and ultimately publication. This article aims to contribute with the existing information on how to recognize and avoid common errors for a successful scientific writing and consequently being published.
Level of Evidence: Not ratable.
Prominent nose, its modalities and their treatment
Abstract
Background
Size of the nose varies in the different parts of the world, and perception of what is the aesthetically acceptable nose shows large differences depending on the ethnic background, type of the society, gender and age. Nose which is generally larger than the average nose in a given society, particularly regarding the height of its nasal bridge, could be defined as a prominent nose.
Methods
Photographs of the 414 consecutive patients who underwent rhinoplasty by the author during the years 2014 and 2015 were reviewed. Attention was directed to the following outer features: overall length, height and width of the nose, nasofrontal angle, nasolabial angle, nose-lip and nose-chin relations, shape and position of the chin and the evaluation of the respiratory function. Among determinants was formula of Goode, which delineates the approximate relationship between tip projection and nasal length.
Results
A total of 144 patients, 112 females and 31 males, who fulfilled criteria of prominent nose were selected for the further analysis. A total of 70% of the patients were of Middle-Eastern origin. The following four types of prominent nose were recognised: (1) short prominent nose, or tension nose was present in 38 patients. It has overprojecting dorsum, which usually forms a hump. Nasolabial angle is obtuse, and nasal spina is frequently overgrown. The rate of functional problems is quite high due to the overdevelopment and subsequent deviation of the septal cartilage. (2) Long prominent nose, present in 96 patients, usually has an arched dorsum, sharp NL angle and drooping tip. (3) Long nose depending on the height of the dorsum in the lateral projection can be the low long nose and it was seen in four patients, or when the nose is both long and the tip is overprojecting, it is called Pinocchio nose and it was present in eight patients. (4) Rhinomegaly is the term describing nose which is very large in all dimensions, the height, length and width and was also seen in eight patients.
Conclusions
Prominent nose has several modalities and each of them requires different techniques applied during the surgical intervention. Both aesthetic and functional topics are frequently present, and multiple nasal structures, both external and internal, are commonly involved. In the aesthetically pleasing Caucasian nose, Goode's ratio should equal 0.55 to 0.60. If there is before operation unrecognised deviation from this norm, which is also persistent after the rhinoplasty, the final result will be substandard.
Level of Evidence IV, risk / prognostic study.
Correction of eyelid retraction using a half-thickness tarsal flap for lengthening of the eyelid following ptosis surgery
Abstract
Various surgical procedures for correction of upper eyelid retraction have been reported, many of which have had favorable results. However, most of these reports are concerned with the correction of upper eyelid retraction in patients with thyroid ophthalmopathy, and few have focused on upper eyelid retraction caused by overcorrection during ptosis surgery. Corrective surgery for upper eyelid retraction resulting from ptosis surgery is often difficult because of the extensive irregular contracture caused by scar tissue. However, as this is a repeat surgery following ptosis surgery, it is important to ensure good postoperative evaluation indices, particularly favorable symmetry, appropriate palpebral fissure width, appropriate crease height, and natural-looking parabolic eyelid margins. Here, we report the lengthening of the upper eyelids using a half-thickness tarsal flap to address upper eyelid retraction secondary to ptosis surgery. By using a half-thickness tarsal flap, the anatomy of the levator insertion onto the tarsal plate is retained, so that good eyelid contour can be obtained, and the results are quantitatively reproducible. Therefore, this technique can be considered for the treatment of upper eyelid retraction and has a potentially wide range of applications.
Level of Evidence: Level V, therapeutic study.
Quality of life before and after rhinoplasty surgery measured with SF-36, RSES, and WHOQOL-BREF
Abstract
Background
Rhinoplasty continues to be among the most popular surgical cosmetic treatments around the world. This is often a reflection of the significance of nose shapes in sociocultural, ethnic, and psychological contexts. Despite developments in the therapeutic field of cosmetic surgery, there is scarce information available within current literature concerning the effects of cosmetic procedures on quality of life (QOL), particularly in Iran. The purpose of this study was to survey QOL among Iranian adults before and after rhinoplasty.
Methods
From July 2015 to July 2016, 83 patients over 16 years of age seeking cosmetic rhinoplasty were included in this study. Demographic information such as age, sex, marital status, education, occupation, and monthly income of patients were recorded. SF-36 version 2, Rosenberg self-esteem scale (RSES), and WHOQOL-BREF questionnaires were completed by a single trained interviewer for all patients, before and 6 months after rhinoplasty. Data analysis was conducted using SPSS ver. 16. Results before and after surgery were compared.
Results
The mean age of the subjects was 24.87 ± 5.8 years, with a median of 24 years. The female-to-male ratio was 4.53:1. In all cases and all questionnaires, QOL was improved after rhinoplasty. Significant differences were observed on six subscales of SF-36 comprised bodily pain (p = 0.003), general health (p = 0.002), vitality (p = 0.005), social functioning (p < 0.001), emotional role (p = 0.02), and mental health state (p = 0.012). According to RSES and WHOQOL-BREF questionnaires, self-esteem (p = 0.002), psychological health (p < 0.001), social relationships (p < 0.001), and general quality of life (p = 0.011) indicated significant differences.
Conclusions
Our data suggest that QOL can be improved after rhinoplasty in Iranian adult patients. With proper patient selection and a successful operation, improvement of QOL can be expected.
Level of Evidence: Level III, risk / prognostic study
Introduction
It is truly an honor to be invited to be the guest editor of an issue of Operative Techniques in Otolaryngology Head and Neck Surgery. What's more, the issue focusses on one of my favorite subjects: salivary gland pathology and surgery. When considering parotid tumors alone, the incidence is approximately 4/100,000 in the United States. The current census of the United States is 324 million and approximately 25% of whom are children1. If one assumes that 243 million Americans over the age 18 are at risk for developing these tumors, then approximately 10,000 parotid tumors will occur and potentially present each year.
Increased expression of aquaporin-1 in dermal fibroblasts and dermal microvascular endothelial cells possibly contributes to skin fibrosis and edema in patients with systemic sclerosis
Aquaporin-1 (AQP1), a water channel protein controlling the water contents of cells and tissues, exerts pleiotropic effects on various biological activities, including inflammation, angiogenesis, and extracellular matrix remodeling, by regulating cell behaviors and tissue water balance.
Monopoiesis in humans and mice
Abstract
Monocytes are a widely conserved cell population in vertebrates with important roles in both inflammation and homeostasis. Under both settings, monocytes continuously arise from hematopoietic progenitors in the bone marrow and, on demand, migrate into tissues through the bloodstream. Monocytes are classified into three subsets — classical, intermediate and non-classical — based on their cell-surface expression of CD14 and CD16 in humans and Ly6C, CX3CR1 and CCR2 in mice. In tissues, monocytes differentiate further into monocyte-derived macrophages and dendritic cells to mediate innate and adaptive immune responses and maintain tissue homeostasis. Recently, the progenitors that strictly give rise to monocytes were identified in both humans and mice, thereby revealing the monocyte differentiation pathways.Aggregation makes a protein allergenic at the challenge phase of basophil-mediated allergy in mice
Abstract
Hapten is a small molecule that is not immunogenic on its own but can stimulate the production of antibodies at the sensitization phase when conjugated to carrier proteins. The hapten then reacts specifically with the antibodies generated against it to elicit an immune or allergic response at the challenge phase. Here we compared various carrier proteins conjugated with the same hapten in their ability to induce hapten-specific IgE-mediated allergic responses in vitro and in vivo, and characterized the nature of carrier proteins that determines the magnitude of response at the challenge phase of allergic reactions. Hapten TNP-conjugated ovalbumin (TNP-OVA) and bovine serum albumin (TNP-BSA) elicited TNP-specific, mast cell-dependent, immediate-type allergic reactions at a comparable level in mice that had been passively sensitized with TNP-specific IgE. In contrast, TNP-OVA but not TNP-BSA efficiently induced a basophil-dependent, IgE-mediated chronic allergic inflammation (IgE-CAI), even though both proteins could stimulate basophils in vitro at a comparable level. By comparing different carrier proteins and structurally modifying them, we found that the formation of large aggregates is crucial for TNP-conjugated carrier proteins to efficiently elicit IgE-CAI, regardless of the type of proteins. Thus, aggregation status of carrier proteins appears to determine the magnitude of allergic response at the challenge phase of hapten-specific IgE-CAI. Our findings suggest that the allergenicity of substances is a matter of importance not only at the sensitization but also at the challenge phase in a certain type of allergy including a basophil-mediated allergic inflammation.Kindlin-1 regulates epidermal growth factor receptor signalling
Kindler syndrome (KS) is an autosomal recessive genodermatosis that results from mutations in the FERMT1 gene encoding t kindlin-1. Kindlin-1 localises to focal adhesion and is known to contribute to the activation of integrin receptors. Most cases of KS show a reduction or complete absence of kindlin-1 in keratinocytes, resulting in defective integrin activation, cell adhesion and migration. However, roles for kindlin-1 beyond integrin activation remain poorly defined. In the current study we show that skin and keratinocytes from KS patients have significantly reduced expression levels of the epidermal growth factor receptor (EGFR), resulting in defective EGF-dependent signalling and cell migration.
Recycling Full Thickness Skin Graft from Failing Free Flaps in Salvage Procedures
Free flap loss is a dreaded complication in microsurgery. When a second free flap is harvested, the enlarged donor site may not be amenable to primary closure, and a split thickness skin graft (STSG) is necessary. If we salvage the skin portion of the failing flap for subsequent wound closure, we not only minimize additional donor sites, we also reap the many functional and cosmetic advantages of full thickness skin grafts (FTSG) over STSG. The recyclability of salvaged skin is mainly dependent on the warm ischemia time.
Cytokine levels in persistent skin lesions of adult-onset Still disease
To the Editor: Adult-onset Still disease (AOSD) is an inflammatory disease characterized by fever, polyarthritis, and skin inflammation, with increased serum levels of interferon-γ (IFN-γ), interleukin 1β (IL-1β), IL-18, IL-6, tumor necrosis factor-α, IL-8, IL-2 receptor, C-X-C motif chemokine 10, and C-X-C motif chemokine 13 (CXCL13).1 The cutaneous manifestations of AOSD include the classic evanescent skin eruption (ESE) and atypical persistent skin eruptions (APSEs), the latter possibly being related to more severe AOSD forms.
A PRISMA-compliant systematic review of the endpoints employed to evaluate symptomatic treatments for primary headaches
Primary headache are prevalent and debilitating disorders. Acute pain cessation is one of the key points in their treatment. Many drugs have been studied but the design of the trials is not usually homogeneous...
Migraine and cluster headache – the common link
Although clinically distinguishable, migraine and cluster headache share prominent features such as unilateral pain, common pharmacological triggers such glyceryl trinitrate, histamine, calcitonin gene-related...
Using the child behavior checklist to determine associations between psychosocial aspects and TMD-related pain in children and adolescents
Since children and adolescents are frequently experiencing emotional and behavioral consequences due to pain, their parents should be aware of this emotional and behavioral status. Therefore, the aim of this s...
Food Protein-Induced Enterocolitis Syndrome Food Challenges: Experience from a Large Referral Center
Publication date: Available online 20 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Kathleen Y. Wang, Juhee Lee, Antonella Cianferoni, Melanie A. Ruffner, Amy Dean, Jerome M. Molleston, Nicholas A. Pawlowski, Jennifer Heimall, Rushani W. Saltzman, Gita S. Ram, Joel Fiedler, Laura M. Gober, Jonathan M. Spergel, Terri F. Brown-Whitehorn
Abstract
BACKGROUND
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy that is diagnosed based on clinical findings, but can be confirmed with oral food challenge (OFC). OFC is more often performed to assess development of tolerance. Most studies describing OFC in FPIES are limited in size.
OBJECTIVE
We sought to describe our experience with OFCs using our FPIES protocol. Patients were given one-third of serving size with a four hour observation period, followed by home titration to full dose.
METHODS
We conducted a retrospective chart review of patients who underwent OFC via FPIES protocol from 2014 to 2017. Data regarding history of reaction, age at time of challenge, and reactions during challenge or with home introduction was collected.
RESULTS
A total of 169 OFCs were completed under FPIES protocol, in 119 patients to 19 different foods. Thirty challenges (18%) were positive, with 17 challenges (10%) during initial challenge and 13 (7.7%) during home dosing. Most reactions during initial challenge required intravenous fluids (IVF), but hypotension was uncommon. One hundred thirty-nine (82%) OFCs were negative with home introduction, indicating tolerance to the challenged foods. The mean age of passing a challenge to milk, soy, and grain was earlier than that of other solid foods.
CONCLUSION
Our data suggests that our FPIES OFC protocol is safe. Early administration of IVF may prevent the development of hypotension. It is difficult to stratify risk of severe or delayed reaction based on patient characteristics and more data is needed to identify those appropriate for home introduction.
Controversies in Drug Allergy: Beta-Lactam Hypersensitivity Testing
Publication date: Available online 20 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Maria J. Torres, N. Franklin Adkinson, Jean-Christoph Caubet, David A. Khan, Mona I. Kidon, Louis Mendelson, Eva Rebelo Gomes, Ticha Rerkpattanapipat, Shuchen Zhang, Eric Macy, AAAAI/WAO 2018 Symposium Penicillin and Cephalosporin Allergy Testing Working Group
All beta-lactam use is associated with a certain rate of adverse reactions. Many of these adverse reactions result in an allergy to the beta-lactam being entered into the patient's medical record. Unfortunately, only a small minority of these recorded allergies are clinically significant immunologically mediated drug hypersensitivity. An unconfirmed allergy to beta-lactams is a significant public health risk, because patients so labeled typically do not receive narrow-spectrum penicillins and cephalosporins when clinically indicated. The alternative antibiotics they receive result in poorer clinical outcomes, increased incidence of serious antibiotic-resistant infections, prolonged hospitalizations, and greater health care utilization. There is a wide variation in beta-lactam allergy incidence and prevalence around the world, based in part on the specific beta-lactams used and overused. There is a wide variation in specific protocols used to confirm current tolerance of beta-lactams and remove these inaccurate allergy reports. Harmonizing testing protocols, when possible, may lead to more widespread use of narrow-spectrum beta-lactams, when clinically indicated, and improve patient safety worldwide. Further research is needed to better understand the regional differences in reporting beta-lactam allergy as this relates to regional differences in beta-lactam use and overuse, the frequency of clinically significant immunologically mediated beta-lactam hypersensitivity, and the optimal testing strategies to confirm current tolerance, based on presenting clinical symptoms.
Real-world-Datenquellen für die Versorgungsforschung zum Hautkrebs
Zusammenfassung
Dermatologische Versorgungsforschung mit dem Ziel der Verbesserung von Prävention, effizienter Diagnostik und Therapie des Hautkrebses braucht Real-world-Daten aus allen Sektoren der Versorgung. Der Beitrag liefert eine Übersicht aktuell verfügbarer, relevanter Real-world-Datenquellen und ihres Nutzungspotenzials und führt beispielhaft Ergebnisse vorliegender Studien auf: Sekundärdatenanalysen mit Abrechnungsdaten der gesetzlichen Krankenkassen wurden genutzt, um u. a. die Teilnahmerate am gesetzlichen Hautkrebsscreening abzuschätzen. Diese betrug im Zweijahreszeitraum ca. 31 %, war in den westlichen Bundesländern höher als in den östlichen und bei Frauen höher als bei Männern. Für die dermatologische Versorgungsplanung stehen regionale Daten in Kombination mit sozialstrukturellen und soziodemografischen Indikatoren zur Verfügung, und die Analyse verweist auf einen Zusammenhang mit der Hautkrebsprävalenz. Primäre Daten sind verfügbar und notwendig zur Erfassung patientenberichteter Endpunkte sowie der arztseitigen Bewertung der Versorgung von Hautkrebspatienten. Umfangreiche histopathologische Datenbanken erfassen neben klinischen auch soziodemografische Parameter und deuten auf einen Zusammenhang von Diagnose- bzw. Therapiezeitpunkt mit dem Versicherungsstatus und Wohnortmerkmalen hin. Neben dem Nutzungspotenzial werden spezifische Limitationen der Datenquellen aufgeführt.
Leveraging EUnetHTA’s conceptual framework to compare HTA decision drivers in France, Italy, and Germany from a manufacturer’s point of view
Health Technology Assessments (HTA) procedures differ substantially across the various European countries. We reviewed recent appraisals of a pharmaceutical manufacturer in three major European markets (France...
Prevalence of potential contact allergens in baby cosmetic products
Clinical and Experimental Dermatology, EarlyView.
Les indications des reconstructions mammaires après mastectomie selon la situation carcinologique
Publication date: Available online 20 September 2018
Source: Annales de Chirurgie Plastique Esthétique
Author(s): C. Mathelin, C. Bruant-Rodier
Résumé
La reconstruction mammaire fait partie intégrante du traitement du cancer du sein. Elle doit être systématiquement évoquée lors de l'annonce de la maladie et proposée à un moment optimal lors de la prise en charge du cancer. En cas de carcinome canalaire in situ, la reconstruction doit être proposée dans le même temps que la mastectomie qui préserve généralement l'étui cutané. La conservation de la plaque aréolo-mamelonnaire doit faire l'objet d'évaluations complémentaires. En cas de carcinome mammaire invasif, la reconstruction mammaire est généralement proposée à distance du temps carcinologique, sauf pour les patientes ne nécessitant ni chimiothérapie ni radiothérapie postopératoire pour lesquelles la reconstruction peut être immédiate. Enfin, en cas de mastectomie controlatérale synchrone prophylactique, la reconstruction ne doit jamais retarder la prise en charge globale du cancer mammaire.
Summary
Breast reconstruction is an integral part of breast cancer treatment. It must be systematically mentioned when the disease is announced and proposed at an optimal time during cancer management. In case of ductal carcinoma in situ, reconstruction should be proposed at the same time as mastectomy, which generally preserves the skin. The conservation of the nipple-areolar complex should be further evaluated. In the case of invasive breast carcinoma, breast reconstruction is generally proposed at a distance from the oncological time, except for patients requiring neither chemotherapy nor postoperative radiotherapy for whom reconstruction can be immediate. Finally, in the case of prophylactic synchronous contralateral mastectomy, reconstruction should never delay the overall management of breast cancer.
Predictors of complications following breast reduction surgery: A national surgical quality improvement program study of 16812 cases.
Publication date: Available online 20 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Andrew M. Simpson, Daniel P. Donato, Alvin C. Kwok, Jayant P. Agarwal
Abstract
Background
Breast reduction is one of the most common procedures performed by plastic surgeons. Despite good outcomes and high patient satisfaction, there is little national data examining the predictors leading to complications in this patient population. We accessed a national outcomes database to examine these factors.
Methods
This is a retrospective study examining the National Surgical Quality Improvement Program database from 2006 through 2015. Patients undergoing primary breast reduction were identified. Patients undergoing any cancer-related procedures were excluded. We identified patient-related and procedure related factors for analysis. Univariate and multivariate logistic regression analysis were used to identify independent predictors of complications.
Results
16812 individual cases were identified. The overall complication rate for the cohort was 6.2% and the major complication rate was 3.0%. Diabetes, bleeding disorder, hypertension, obesity, smoking, steroid use and prolonged operative time were associated with increased risk of complications (p<0.05). Concurrent body contouring was a predictor of increased major complications, however liposuction was not.
Conclusions
Common surgical risk factors are associated with complications in breast reduction surgery. Although liposuction is not an independent risk factor, concurrent body contouring is associated with increased complications. Surgeons should be aware of these associations when discussing breast reduction with patients.
The dynamic-lymphaticovenular anastomosis method for breast cancer treatment-related lymphedema: creation of functional lymphaticovenular anastomoses with use of preoperative dynamic ultrasonography
Publication date: Available online 20 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Yukio Seki, Akiyoshi Kajikawa, Takumi Yamamoto, Takayuki Takeuchi, Takahiro Terashima, Norimitsu Kurogi
Abstract
Background
Lymphaticovenular anastomosis (LVA) is generally effective for breast cancer treatment-related upper extremity lymphedema (UEL). Clinical improvement is, however, limited by the degree of sclerosis of the lymphatic vessels. We have developed a method by which we use dynamic ultrasonography to depict vessels through which lymph can be propelled into the LVA under the power of the patient's natural hand movements.
Methods
We assessed the dynamic-LVA method by comparing clinical details of 15 cases of breast cancer treatment-related lymphedema treated by dynamic LVA and 15 corresponding cases treated by conventional LVA.
Results
Placement of incisions at a total of 90 forearm sites (3 per patient) yielded creation of 90 LVAs (32 in "linear ICG lymphography pattern incisions" and 58 in "stardust pattern incisions." Sclerotic lymphatic vessels were encountered at greater frequency in "linear pattern incisions" in the dynamic LVA group than in the conventional LVA group (7.1% vs. 38.9%, P = 0.030). Postoperative volume reduction was significantly greater in the dynamic LVA group than in the conventional LVA group; the UEL index at 1 month was 8.12 ± 3.08 vs. 3.74 ± 5.82, respectively (P = 0.018) and at 1 year was 10.23 ± 6.16 vs. 2.03 ± 9.36, respectively (P = 0.014).
Conclusions
Dynamic LVA is clinically beneficial because the imaging guides decisions over where the incisions should be placed so that a patient's natural hand motions can be utilized to propel lymph into the anastomosis despite the presence of sclerosis and because even early improvements are obtained.
Use of a perforator/subcutaneous pedicled propeller flap for reconstruction of lower eyelid defects
Publication date: Available online 20 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Asım USLU
Summary
Full thickness skin grafts (FTSGs) and flaps from the upper eyelid or cheek can be used for reconstruction of lower eyelid defects, including the anterior lamella. However, the upper eyelid has a limited and insufficient amount of skin, while cheek flaps have a restricted arch of rotation. Here we report the procedure and outcomes of a perforator/subcutaneous pedicled propeller flap for reconstruction of lower eyelid defects including the anterior lamella.
A retrospective study of 12 patients who underwent treatment for eyelid anterior lamella defects with perforator/subcutaneous pedicled propeller flaps was conducted between March 2015 and June 2017. The propeller flap was planned to rotate around the perforator (as the pivot point), which was detected with a hand-held Doppler in the vicinity of the defect.
The flaps were perforator pedicled for 10 patients and subcutaneous pedicled for the other two patients. The flap was rotated around the pedicle and placed on each patient's defect without tension. No vascular compromise occurred with any of the flaps. The most important complications were postoperative oedema and ecchymosis.
Inferior eyelid defects including anterior lamella could be reconstructed by using propeller flaps from the adjacent tissue. The main advantages of this flap included easy access to the defect, no impairment in eyelid function, and very good aesthetic results.
Adipose-derived regenerative cells and fat grafting for treating breast cancer-related lymphedema: Lymphoscintigraphic evaluation with one year follow-up
Publication date: Available online 20 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): NM Toyserkani, CH Jensen, S Tabatabaeifar, MG Jørgensen, S Hvidsten, JA Simonsen, DC Andersen, SP Sheikh, JA Sørensen
Abstract
Background: Breast cancer-related lymphedema (BCRL) is a feared late complication. Present treatment options are lacking. Recent studies have suggested that mesenchymal stromal cells can alleviate lymphedema. Herein, we report the results from the first human pilot study with adipose-derived regenerative cells (ADRC) for treating BCRL with one year follow-up. Material and methods: We included ten BCRL patients. ADRCs were injected directly into the axillary region together with a scar releasing fat graft procedure. Primary endpoint was change in arm volume. Secondary endpoints were change in patient reported outcome, lymphoscintigraphy changes and safety. Results: During follow up, no significant change in volume was noted. Patient reported outcomes improved significantly over time. Five patients reduced their use of conservative management. Quantitative lymphoscintigraphy did not improve on the lymphedema affected arms. ADRCs were well-tolerated and only minor transient adverse events related to liposuction were noted. Conclusions: In this pilot study, a single injection of ADRC improved lymphedema based on patient reported outcome measures and there were no serious adverse events in the follow-up period. Lymphoscintigraphic evaluation showed no improvement after ADRC treatment. There was no change in excess arm volume. Results of this trial need to be confirmed in randomized clinical trials.
Outcomes of shoulder abduction after nerve surgery in patients over 50 following traumatic brachial plexus injury
Publication date: Available online 20 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Joshua A. Gillis, Joseph S. Khouri, Michelle F. Faupel, Robert J. Spinner, Allen T. Bishop, Alexander Y. Shin
Abstract
Purpose
There is controversy regarding the effectiveness of brachial plexus reconstruction in older patients as it is felt that outcomes are poor. The aim of this study is to determine the outcomes of shoulder abduction obtained after nerve reconstruction in patients over the age of 50 and factors related to success.
Methods
Forty patients over the age of 50 underwent nerve surgery to improve shoulder function after a traumatic brachial plexus injury. Patients were evaluated pre- and post-operatively for shoulder abduction strength and range of motion (ROM), Disability of the Arm, Shoulder, and Hand (DASH) scores, pain, age bracket, gender, body mass index (BMI), delay from injury to operation, concomitant trauma, severity of trauma, and type of reconstruction.
Results
The average age was 58.2 years (range 50-77) with an average follow-up of 18.8 months. The average modified BMRC (British Medical Research Council) shoulder abduction grade improved significantly from 0.23 to 2.03 (p<0.005). Fourteen patients achieved functional shoulder abduction of ≥M3 post-operatively. There was no correlation between age or age range stratification and BMRC grade or those obtaining useful shoulder abduction ≥M3. Active shoulder abduction improved significantly from 18.25° to 40.64°, with no difference based on age or age stratification. There were improved modified BMRC grades with nerve transfers versus nerve grafts. Less patients achieved ≥M3 function if surgery was delayed >6 months. The mean DASH score decreased from 45.3 to 40.7 post-operatively and the average pain score decreased from 3.7 to 3.0. Patients with higher post-operative BMRC grade for shoulder abduction had improved post-operative DASH scores and VAS for pain (p=0.011 and 0.005, respectively).
Conclusion
Brachial plexus nerve reconstruction for shoulder abduction in patients over the age of 50 can yield useful BMRC scores and ROM and age should not be used to exclude nerve reconstruction in these patients.
Complejo de esclerosis tuberosa asociado a hemihipertrofia y malformaciones vasculares combinadas
Publication date: Available online 20 September 2018
Source: Actas Dermo-Sifiliográficas
Author(s): M.Á. Flores-Terry, A. Alegre-Sánchez, P. Boixeda, J.C. López-Gutiérrez
The prognostic impact of Consensus Molecular Subtypes (CMS) and its predictive effects for bevacizumab benefit in metastatic colorectal cancer: molecular analysis of the AGITG MAX clinical trial
Abstract
Background
The Consensus Molecular Subtypes (CMS) is a transcriptome-based classification of colorectal cancer (CRC) initially described in early-stage cohorts, but the associations of CMS with treatment outcomes in the metastatic setting are yet to be established. This study aimed to evaluate the prognostic impact of CMS classification and its predictive effects for bevacizumab benefit in metastatic CRC by correlative analysis of the AGITG MAX trial. Patients and Methods
The MAX trial previously reported improved progression-free survival (PFS) for the addition of bevacizumab (B) to chemotherapy (capecitabine (C) +/- mitomycin (M)). Archival primary tumours from 237 patients (50% of trial population) underwent gene expression profiling and classification into CMS groups. CMS groups were correlated to PFS and overall survival (OS). The interaction of CMS with treatment was assessed by proportional hazards model. Results
The distribution of CMS in MAX were: CMS1 18%, CMS2 47%, CMS3 12%, CMS4 23%. CMS1 was the predominant subtype in right-sided primary tumours, while CMS2 was the predominant subtype in left-sided. CMS was prognostic of overall survival (OS) (P=0.008), with CMS2 associated with the best outcome and CMS1 the worst. CMS remained an independent prognostic factor in a multivariate analysis. There was a significant interaction between CMS and treatment (P-interaction=0.03), for PFS, with hazard ratios (95% CI) for CB+CBM versus C arms in CMS 1,2,3 and 4: 0.83 (0.43-1.62), 0.50 (0.33-0.76), 0.31 (0.13-0.75) and 1.24 (0.68-2.25) respectively. Conclusions
This exploratory study found that CMS stratified OS outcomes in metastatic CRC regardless of first-line treatment, with prognostic effects of CMS groups distinct from those previously reported in early-stage cohorts. In CMS associations with treatment, CMS2 and possibly CMS3 tumours may preferentially benefit from the addition of bevacizumab to first-line capecitabine-based chemotherapy, compared to other CMS groups. Validation of these findings in additional cohorts is warranted. Clinical trial number
This is a molecular sub-study of MAX clinical trial (NCT00294359)Oral vitamin D3 5000 IU/day as an adjuvant in the treatment of atopic dermatitis: a randomized control trial
International Journal of Dermatology, EarlyView.
Gardner‐Diamond syndrome: a systematic review of treatment options for a rare psychodermatological disorder
International Journal of Dermatology, EarlyView.
Serum irisin: A prognostic marker for severe acne vulgaris
Journal of Cosmetic Dermatology, EarlyView.
SWEET SYNDROME FOLLOWING A POSITIVE MANTOUX TEST DUE TO PULMONARY TUBERCULOSIS
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
Topical diltiazem for ulceration of striae distensae associated with bevacizumab therapy
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
“Chemical” surgery in treating basal cell carcinoma in elderly
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
Enzymes in the Seafood Industry: Time for Health Studies with High-Quality Exposure Assessment
Enzymes are biocatalysts that increase the rate of most reactions within cells and are crucial for the function of humans and other living creatures. In addition, the use of enzymes in industry and everyday products largely of bacterial or fungal origin has increased in recent years. Food and beverages, detergent, perfume, pharmaceutical, textile, and chemical industries are increasingly using enzymes to improve fragrance, taste, and flavour (Budnik et al., 2017). A classic example is improver enzymes such as α-amylase, routinely added to accelerate, modify, and control dough making (Jones et al., 2016). Although the detrimental effects of these added active or inactive enzymes on the development of allergy and respiratory health are recognized (Baur, 2005; Jones et al., 2016), detailed exposure characterization and data to conduct dose–response relations for enzymes are lacking with the exception of a few agents such as α-amylase (Houba et al., 1996).
A Randomized Trial of Early Endovenous Ablation in Venous Ulceration: a critical appraisal
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
Identifying Predictors of Time to Soft Tissue Reconstruction Following Open Tibia Fractures
INTRODUCTION: Controversy remains regarding the optimal timing of soft tissue coverage following severe lower extremity trauma. This study identifies nationwide practice patterns and factors associated with discrepancies in time to first flap surgery following open tibia fractures. METHODS: A retrospective analysis was performed on the National Trauma Databank from 2008-2015 to identify patients who presented with an open tibia fracture and underwent subsequent flap reconstruction. A lasso algorithm was performed, revealing those factors most significantly associated with differences in time to flap surgery from hospitalization. RESULTS: A total of 3,297 patients were included in the analysis. Mean and median times to first flap surgery were 230.1 hours (SD; 246.7 hours), and 169.1 hours, respectively. Older age, a non-white race, treatment in the South, and a non-private insurance status were all independently associated with an increased time to flap surgery. In addition, more surgical debridements, a higher injury severity and/or abbreviated injury score, and a nerve, vascular, and/or crush injury were independent predictors of an increased time to flap surgery. CONCLUSION: Most patients who present with open tibia fractures requiring soft tissue coverage undergo flap reconstruction after the historical 72-hour window. Specific sociodemographic and clinical factors were independently predictive of an increased time to flap surgery. These findings suggest that not all patients in the United States are receiving the same level of care in lower extremity trauma reconstruction, emphasizing the need to develop more explicit national standards. * These authors contributed equally to this work Financial Disclosure Statement: None of the authors have a financial disclosure Corresponding Author Contact Information: Scott T. Hollenbeck, MD, Associate Professor, Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Box 3945, Durham, NC 27710, USA. Phone: (919) 681-5079 | Fax: (919) 681-2670, Email: scott.hollenbeck@duke.edu ©2018American Society of Plastic Surgeons
Optimal Sites for Supermicrosurgical Lymphaticovenular Anastomosis: An Analysis of Lymphatic Vessel Detection Rates on 840 Surgical Fields in Lower Extremity Lymphedema Patients
Background: Supermicrosurgical lymphaticovenular anastomosis (LVA) is becoming a useful treatment option for progressive lower extremity lymphedema (LEL) with its minimal invasiveness. Finding lymphatic vessel is a minimum requirement for LVA surgery, but no study has reported comprehensive analysis on factors associated with lymphatic vessel detection (LVD). Methods: One hundred thirty-four female secondary LEL patients who underwent indocyanine green (ICG) lymphography and LVA without past history of lymphedema surgery were included. Medical charts were reviewed to obtain clinical, ICG lymphographic, and intraoperative findings. LVD was defined as positive when one or more lymphatic vessels were found in a surgical field of LVA. Logistic regression analysis was used to identify independent factors associated with LVD. Results: Patients' age ranged from 36 to 81 years, duration of edema from 3 to 324 months, and BMI from 16.2 to 33.3 kg/m2. Forty-eight patients (35.8%) had past history of radiation, and 76 patients (56.7%) had past history of cellulitis. LVAs were performed in 840 surgical fields, among which LVD was positive in 807 fields; overall LVD rate was 96.1%. Multivariate analysis revealed inverse associations in higher body mass index (odds ratio [OR] 0.323; P = 0.008) and S-region/D-region on ICG lymphography compared with L-region (OR 1.049 x 10-8/1.724 x 10-9; P
“Towards the Assessment of Core Procedural Competencies amongst Canadian Plastic Surgery Residents.”
Background: Plastic surgery residency training programs are working towards integrating competency-based education into program curriculum and training, a key component of which involves establishing Core Procedural Competencies. This study aims to determine the exposure of graduating Canadian plastic surgery residents to established Core Procedural Competencies. Methods: A retrospective review of case log procedure data using three databases (T-Res, POWER, New Innovations) from graduating residents at all 10 Canadian English-speaking plastic surgery training programs between 2004-2014 was completed. Case logs were coded according to 177 Core Procedural Competencies identified as 'Core' by the Delphi Method amongst an expert panel of Canadian plastic surgeons. Results: A total of 59,405 procedures were logged by 55 graduating residents across Canada between 2004-2014 (average 1,080 ± 352 procedures per resident). Of thirteen plastic surgery domains, 44% of all procedures were within either Hand, Upper Extremity & Peripheral Nerve (28.3%) or Non-Aesthetic Breast (16.1%). The most frequently performed Core Procedural Competencies (average case logs per resident) included: breast reduction (65.3 ± 33.9), open carpal tunnel release (46.7 ± 34.2), breast reconstruction – implant-based (39.6 ± 20.5), and wound management (35.7 ± 28.6). Sixty-two of 177 procedures were logged on average less than once in 5 years of residency, including: escharotomy, temporal parietal fascia flap, Guyon's canal release and soft tissue fillers. Conclusions: This study identifies areas of exposure and underexposure to plastic surgery Core Procedural Competencies, and can help focus surgical education on areas of greater need for surgical skills training and acquisition. Financial Disclosure Statement:D Courtemanche is a shareholder and board member of Resilience Software. Resilience Software makes and supports T-Res. Presented at: 70th Annual Meeting of the Canadian Society of Plastic Surgeons 2016 in Ottawa, Ontario. Acknowledgements: We would like to thank the Postgraduate Medical Education Office, program directors and database vendors at University of Toronto and Western University for their assistance and support in extracting data from the POWER (©Knowledge4YouCorporation) and New Innovations (©New Innovations, Inc.) databases, respectively. In addition to participating in the research involved in this study, Dr. Courtemanche also generated the anonymous data set for the other 9 Canadian plastic surgery training programs that use T-Res. Corresponding Author: Jessica G. Shih, MD, The Division of Plastic & Reconstructive Surgery, 149 College Street, 5th Floor, Suite 508, Toronto, Ontario M5T 1P5, e-mail address: jessica.shih@utoronto.ca ©2018American Society of Plastic Surgeons
The Osteoseptocutaneous Fibula Flap: Concise Review, Goal-Oriented Surgical Technique, and Tips and Tricks
The fibula osteoseptocutaneous flap is a workhorse flap for bone reconstruction. Mastery of the flap is essential for a rewarding reconstruction. Yet, there's no complete work on this versatile flap. The authors provide concise review of the literature, address the myths and challenges associated with the flap, and describe their refined techniques for different reconstruction scenarios and possible anatomic variations. Conflict of interest: The authors have no conflict of interest to declare. Correspondence Author and Requests for Reprints: Fu-Chan Wei. MD, FACS, Distinguished Chair Professor, Chang Gung University Medical College, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei 10591, Taiwan, E-mail: ,Tel: +886- 3-328-1200 ext 3535 or 2007 ©2018American Society of Plastic Surgeons
Microvascular Hepatic Artery Anastomosis in Pediatric Living Donor Liver Transplantation: 73 Consecutive Cases by a Single Surgeon
Background: Living donor liver transplantation (LDLT) is an important strategy of procuring segmental liver allografts for pediatric patients with liver failure, as suitably sized whole donor organs are scarce. Early pediatric LDLT experience was associated with high rates of hepatic artery thrombosis, graft loss, and mortality. Collaboration with microsurgeons for hepatic artery anastomosis in pediatric LDLT has decreased rates of arterial complications; however, reported outcomes are limited. Methods: A 14-year retrospective review was undertaken of children at our institution who underwent LDLT with hepatic artery anastomosis performed by a single microsurgeon using an operating microscope. Data were collected on demographics, etiology of liver failure, graft donor, vessel calibre, vessel anastomosis, arterial complications, and long-term follow up. Results: Seventy-three children with end stage liver failure underwent LDLT with microvascular hepatic artery anastomosis. The commonest etiology for liver failure was biliary atresia (63%). A total of 83 end to end hepatic artery anastomoses were completed using an operating microscope. Hepatic artery complications occurred in 5 patients, consisting of 3 cases of kinked anastomoses that were revised without complications and 2 cases of hepatic artery thrombosis (3%), of which one resulted in graft loss and patient death. Patient survival was 94% at 1 year and 90% at 5 years. Conclusions: Microvascular hepatic artery anastomosis in pediatric patients undergoing LDLT is associated with a low hepatic artery complication rate and excellent long-term liver graft function. Collaboration between microsurgeons and transplant surgeons can significantly reduce technical complications and improve patient outcomes. Financial Disclosure Statement: none Presented at the 2017 Annual Meeting of the American Society of Reconstructive Microsurgery in Waikoloa, HI, USA, January 14-17, 2017 and the 71st Annual Meeting of the Canadian Society of Plastic Surgeons in Winnipeg, MB, Canada, June 20-24, 2017. Corresponding Author: Dr. Ronald M. Zuker MD, FRCS(C), FACS, FAAP, Professor, Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children , 555 University Avenue, Toronto, ON M5G 1X8, Phone: 416-813-6447, Fax: 416-813-6147, E-mail: ronald.zuker@sickkids.ca ©2018American Society of Plastic Surgeons
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Publication date: Available online 25 July 2018 Source: Journal of Photochemistry and Photobiology B: Biology Author(s): Marco Ballestr...
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Editorial AJR Reviewers: Heartfelt Thanks From the Editors and Staff Thomas H. Berquist 1 Share + Affiliation: Citation: American Journal...
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Publication date: Available online 28 September 2017 Source: Actas Dermo-Sifiliográficas Author(s): F.J. Navarro-Triviño
