Balloon-Guide Catheters Are Needed for Effective Flow Reversal during Mechanical Thrombectomy [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Blood flow management in the carotid artery during mechanical thrombectomy is crucial for safety and effectiveness. There is an ongoing discussion about whether balloon-guide catheters or large-bore sheaths are needed for effective flow management. We compared general flow characteristics of proximal aspiration through a large-bore sheath and a balloon-guide catheter in a porcine in vivo model.

MATERIALS AND METHODS:

We investigated blood flow in a porcine common carotid artery with and without aspiration (VacLok syringe and Penumbra pump, Pump MAX) through an 8F-long sheath and an 8F balloon-guide catheter. Blood hemodynamics were assessed via continuous duplex sonography.

RESULTS:

Average vessel diameter and baseline blood flow were 4.4 ± 0.2 mm and 244 ± 20 mL/min, respectively. For the 8F sheath, pump aspiration resulted in a significant flow reduction (225 ± 25 mL/min, P < .001), but with a persisting antegrade stream. Manual aspiration resulted in collapse of the vessel in 2 of 7 measurements and oscillatory flow with antegrade systolic and retrograde diastolic components in the remaining 5 measurements. Net flow was antegrade (52 ± 44 mL/min) in 3 and retrograde (–95 ± 52 mL/min) in the remaining 2 measurements. For balloon-guide catheters, balloon inflation always resulted in flow arrest. Additional pump or manual aspiration resulted in significant flow reversal of –1100 ± 230 and –468 ± 46 mL/min, respectively (both, P < .001).

CONCLUSIONS:

Only balloon-guide catheters allow reliable blood flow arrest and flow reversal in combination with aspiration via syringes or high-flow pump systems. Aspiration through an 8F sheath results in either collapse of the vessel or oscillatory flow, which can result in a net antegrade or retrograde stream.

Cerebral Blood Flow and Marrow Diffusion Alterations in Children with Sickle Cell Anemia after Bone Marrow Transplantation and Transfusion [PEDIATRICS]

BACKGROUND AND PURPOSE:

Hematopoietic marrow hyperplasia and hyperperfusion are compensatory mechanisms in sickle cell anemia. We have observed marrow diffusion and arterial spin-labeling perfusion changes in sickle cell anemia following bone marrow transplantation. We aimed to compare arterial spin-labeling perfusion and marrow diffusion/ADC values in patients with sickle cell anemia before and after bone marrow transplantation or transfusion.

MATERIALS AND METHODS:

We reviewed brain MRIs from patients with sickle cell anemia obtained during 6 consecutive years at a children's hospital. Quantitative marrow diffusion values were procured from the occipital and sphenoid bones. Pseudocontinuous arterial spin-labeling perfusion values (milliliters/100 g of tissue/min) of MCA, anterior cerebral artery, and posterior cerebral artery territories were determined. Territorial CBF, whole-brain average CBF, and marrow ADC values were compared for changes before and after either bone marrow transplantation or transfusion. Bone marrow transplantation and transfusion groups were compared. Two-tailed paired and unpaired Student t tests were used; P < .05 was considered significant.

RESULTS:

Fifty-three examinations from 17 patients with bone marrow transplantation and 29 examinations from 9 patients with transfusion were included. ADC values significantly increased in the sphenoid and occipital marrow following bone marrow transplantation in contrast to patients with transfusion (P > .83). Whole-brain mean CBF significantly decreased following bone marrow transplantation (77.39 ± 13.78 to 60.39 ± 13.62 ml/100 g tissue/min; P < .001), without significant change thereafter. CBF did not significantly change following the first (81.11 ± 12.23 to 80.25 ± 8.27 ml/100 g tissue/min; P = .47) or subsequent transfusions. There was no significant difference in mean CBF between groups before intervention (P = .22).

CONCLUSIONS:

Improved CBF and marrow diffusion eventuate following bone marrow transplantation in children with sickle cell anemia in contrast to transfusion therapy.

Optimization of Acquisition and Analysis Methods for Clinical Dynamic Susceptibility Contrast MRI Using a Population-Based Digital Reference Object [RESEARCH PERSPECTIVES]

BACKGROUND AND PURPOSE:

The accuracy of DSC-MR imaging CBV maps in glioblastoma depends on acquisition and analysis protocols. Multisite protocol heterogeneity has challenged standardization initiatives due to the difficulties of in vivo validation. This study sought to compare the accuracy of routinely used protocols using a digital reference object.

MATERIALS AND METHODS:

The digital reference object consisted of approximately 10,000 simulated voxels recapitulating typical signal heterogeneity encountered in vivo. The influence of acquisition and postprocessing methods on CBV reliability was evaluated across 6912 parameter combinations, including contrast agent dosing schemes, pulse sequence parameters, field strengths, and postprocessing methods. Accuracy and precision were assessed using the concordance correlation coefficient and coefficient of variation.

RESULTS:

Across all parameter space, the optimal protocol included full-dose contrast agent preload and bolus, intermediate (60°) flip angle, 30-ms TE, and postprocessing with a leakage-correction algorithm (concordance correlation coefficient = 0.97, coefficient of variation = 6.6%). Protocols with no preload or fractional dose preload and bolus using these acquisition parameters were generally less robust. However, a protocol with no preload, full-dose bolus, and low (30°) flip angle performed very well (concordance correlation coefficient = 0.93, coefficient of variation = 8.7% at 1.5T and concordance correlation coefficient = 0.92, coefficient of variation = 8.2% at 3T).

CONCLUSIONS:

Schemes with full-dose preload and bolus maximize CBV accuracy and reduce variability, which could enable smaller sample sizes and more reliable detection of CBV changes in clinical trials. When a lower total contrast agent dose is desired, use of a low flip angle, no preload, and full-dose bolus protocol may provide an attractive alternative.

The Woven EndoBridge Finally Coming Home across the Atlantic: What to Expect? [EDITORIALS]

MR Venous Flow in Sigmoid Sinus Diverticulum [HEAD & NECK]

BACKGROUND AND PURPOSE:

Case reports demonstrate that coiling of a sigmoid sinus diverticulum can treat pulsatile tinnitus. We hypothesized that MR imaging 4D flow and computational fluid dynamics would reveal distinct blood flow patterns in the venous outflow tract in these patients.

MATERIALS AND METHODS:

Patients with pulsatile tinnitus of suspected venous etiology underwent MR imaging at 3T, using venous phase contrast-enhanced MR angiography, 4D flow, and 2D phase contrast. The contrast-enhanced MRA contours were evaluated to determine the presence and extent of a sigmoid sinus diverticulum. Computational fluid dynamics analysis was performed using the 4D flow inlet flow and the luminal contours from contrast-enhanced MRA as boundary conditions. In addition, computational fluid dynamics was performed for the expected post treatment conditions by smoothing the venous geometry to exclude the sigmoid sinus diverticulum from the anatomic boundary conditions. Streamlines were generated from the 4D flow and computational fluid dynamics velocity maps, and flow patterns were examined for the presence of rotational components.

RESULTS:

Twenty-five patients with pulsatile tinnitus of suspected venous etiology and 10 control subjects were enrolled. Five (20%) of the symptomatic subjects had sigmoid sinus diverticula, all associated with an upstream stenosis. In each of these patients, but none of the controls, a stenosis-related flow jet was directed toward the opening of the sigmoid sinus diverticulum with rotational flow patterns in the sigmoid sinus diverticulum and parent sigmoid sinus on both 4D flow and computational fluid dynamics.

CONCLUSIONS:

Consistent patterns of blood flow can be visualized in a sigmoid sinus diverticulum and the parent sinus using 4D flow and computational fluid dynamics. Strong components of rotational blood flow were seen in subjects with sigmoid sinus diverticula that were absent in controls.

What's the “buzz” about propolis? Propolis‐induced systemic contact dermatitis

Contact Dermatitis, EarlyView.

Differential diagnosis of late‐type reactions to injected local anaesthetics: Inflammation at the injection site is the only indicator of allergic hypersensitivity

Contact Dermatitis, EarlyView.

October iotaderma (#296)

November Iotaderma (#297)

Seasonal patterns in alopecia areata, totalis, and universalis

To the Editor: Although seasonal patterns of pediatric alopecia areata (AA), totalis (AT), and universalis (AU) have been suspected clinically, there is limited research about whether disease flares follow a temporal pattern.1-3 Patients and families report increased hair loss during the winter, with cycles of regrowth in summer months. Through retrospective review of medical records, we sought to identify whether AA, AT, and AU flares show seasonal variation in pediatric patients and to characterize temporal patterns.

Answers to CME examination

Editorial Board

CME examination

Table of Contents

CME examination

Information for Readers

Answers to CME examination

JAAD Case Reports Article List

Lichen planus and lichenoid dermatoses

Having reviewed the diverse clinical subtypes of lichenoid disease and the postulated molecular basis thereof in the first article in this 2-part continuing medical education series, we discuss herein the existing and emerging treatment strategies in the most common clinical forms of lichenoid inflammation and provide an overview of their pharmacodynamics and evidence base. The scope of this review is not to exhaustively discuss treatment modalities for all lichenoid variants discussed in the previous article of this series.

Journal Based CME Instructions and Information

Announcement: A New Section Entitled Technology Pearls

Dermatology Calendar

Lichen planus and lichenoid dermatoses

Deriving from the Greek word λειχήν for "tree moss" and the Latin word planus for "planar," lichen planus is a relatively uncommon and heterogeneous cutaneous disorder that typically develops in middle-aged adults. Despite the significant clinical burden associated with the disorder, little well-conducted molecular research has been undertaken, possibly because of heterogeneity impeding consistent and confident phenotyping. The multiple variants of lichenoid disease bear overlapping clinical and pathologic features despite manifesting as distinct clinical disorders.

Headache disorder and the risk of dementia: a systematic review and meta-analysis of cohort studies

Until now, headache disorders have not been established as a risk factor for dementia. The aim of this study was to determine whether headache was associated with an increased risk of dementia.

The impact of geriatric nutritional risk index on surgical outcomes after esophagectomy in patients with esophageal cancer

Abstract

Background

Geriatric Nutritional Index (GNRI) was shown to be closely associated with nutrition-related complications and mortality in elderly hospitalized patients. Impact of GNRI on postoperative outcomes in surgically treated esophageal squamous cell carcinoma (ESCC) patients has not been evaluated extensively.

Methods

A total of 240 patients with ESCC who underwent radical esophagectomy with two- or three-field lymphadenectomy between April 2000 and April 2012 were included in this retrospective study. GNRI formula was as follows: 1.489 × albumin (g/dl) + 41.7 × current weight/ideal weight. Patients were categorized as GNRI-low (GNRI < 92) or GNRI-high (GNRI ≥ 92) according to the receiver operating characteristics (ROC) curves generated for multiple logistic regression analysis using 5-year overall survival as the end point. The impact of GNRI status on short- and long-term outcomes of curative surgery for ESCC was examined.

Results

There were 44 (18.3%) and 196 (82.7%) patients in the GNRI-low and GNRI-high groups, respectively. Among the investigated demographic factors, the rate of nodal metastasis and pathological stage were significantly higher in the GNRI-low group than in the GNRI-high group (p < 0.01 and p < 0.01, respectively). Univariate analysis of postoperative complications revealed that the rate of lung complications was significantly higher in the GNRI-low group than in the GNRI-high group (p = 0.024), while GNRI was not an independent risk factor for the development of lung complications by multivariate analysis (Odds Ratio: 1.746; p = 0.126). 5-year overall survival (OS) was significantly lower in the GNRI-low group than in the GNRI-high group (p < 0.01). Moreover, GNRI was an independent prognostic factor for OS [Hazard ratio: 1.687; 95% confidence interval (CI): 1.038–2.742; p = 0.035], but not for cancer-specific survival. Analysis with stratification by tumor stage revealed that both OS and Cancer-Specific Survival (CSS) were worse in patients with low GNRI than those with high GNRI only among those with stage III ESCC (34.4% vs. 52.1%, p = 0.049 and 36.1% vs. 57.2%, p = 0.041, respectively). In the stage III ESCC, primary tumor size tends to be greater in the GNRI-low group than in the GNRI-high group (5.69 vs. 4.75 cm, p = 0.085) and the incidence of preoperative dysphagia was significantly higher in the GNRI-low group than in the GNRI-high group (74% vs. 45.9%, p = 0.032).

Conclusion

GNRI was closely associated with long-term survival after curative surgery in patients with stage III ESCC. Intensive follow-up after surgery should be performed for ESCC patients with low GNRI.

Management of Orbital Fractures

Fractures of the orbit are a very common injury, and are often treated by multiple facial subspecialties. Many fractures can be asymptomatic and do not require surgical therapy, but for those fractures where intervention is indicated, neglect, delay or inappropriate technique can have permanent consequences on visual function and facial deformity. In this article, the indications and techniques of repair for specific fractures will be discussed, as well as possible risks and complications.

Techniques of Enucleation and Evisceration

There are many conditions that may require removal of the eye. The most common and obvious reasons involve severe irreversible trauma or potentially life-threatening malignancy. There are, however, other reasons for the therapeutic removal of the eye, including recalcitrant pain and cosmetic deformity. This article will discuss the indications for removal of the eye, as well as describe the alternative techniques of enucleation and evisceration, including their relative advantages.

Dacryocystorhinostomy: Indications and Surgical Technique

The following article reviews the clinical presentation, evaluation, and surgical treatment of patients with nasolacrimal duct obstruction, with an emphasis placed on the surgical techniques of external and internal/endoscopic dacryocystorhinostomy.

Multimodal Approaches in the Management of Malignancies Involving the Orbit

Malignancies involving the orbit comprise heterogeneous pathologies with a variety of ophthalmic and otolaryngic presentations resulting from compression and destruction of native orbital contents. Surgical ablation with negative margins with adjuvant treatment remains a cornerstone for optimal oncologic control and successful operative outcomes. Historically, attempts at tumor extirpation were first performed by neurosurgeons via open craniotomies to access orbital contents. While these approaches remain a mainstay within the superolateral compartment, endoscopic techniques pioneered by otolaryngologists have emerged as a standard in managing inferomedial orbital tumors.

Reduced intensity conditioning regimens, prior chronic lymphocytic leukemia, and graft versus host disease are associated with higher rates of skin cancer following allogeneic hematopoietic stem cell transplantation

Effects of Silicone Implants on the Mammary Gland: Ultrasonographic and 3D Study

Abstract

Background

Breast implants may be responsible for secondary deformities produced by parenchymal atrophy. However, few studies in the literature have reported changes in breast tissue after augmentation surgery. In this study, the breast thickness of patients undergoing breast augmentation was monitored by ultrasound, and correlations with surface, volume and projection measurements were examined.

Methods

We studied the parenchymal thickness at the lower pole of the breast with ultrasound in 36 women (72 breasts). In another group of 33 patients (66 breasts), we studied the thickness at the upper and lower poles along the meridian of each breast by ultrasound and measured the anthropometric metrics, volume and projection of the breast with a 3D camera.

Results

Midline measurements close to the areola showed reduced thickness at the lower pole, with 31.8% at the midpoint of the lower pole and 42% at the infra-areolar level (p < 0.0001). At the upper pole, there was a decrease of 14.6% (p < 0.001), but the thickness was increased by 6% and 38% at more cranial levels. No correlations with volume were found. Anatomical implants produced more atrophy at the lower pole, and round implants at the upper pole. More atrophy was found with subfascial than submuscular augmentation. Compared with the expected values, the final volume was very similar, but the projection was 29% less. Surface measurements changed significantly up to 4 months postoperatively and remained stable thereafter.

Conclusions

Implants affect significatively the thickness of the glandular tissue. All changes occur very soon postoperatively but stabilize after 4 months.

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.

Removal of Polyurethane Implants

Abstract

Polyurethane (PU) implants are associated with great difficulties in extraction if secondary surgery is needed. The published data are contradictory, often misleading, making the decision for the secondary surgery complicated, the time period and the procedure itself not optimal, thus negatively influencing the final result.

Materials and Methods

Typical videos of PU implant removal in different periods after primary surgeries with polyurethane implants were selected for the study. The videos show the strength and extent of the tissue ingrowth and the manipulations needed for implant extraction in different periods from the initial procedure. Classifications of the types of adhesion and adhesion patterns are introduced.

Conclusions

The data provided in this article facilitate the decision-making process if secondary surgery is indicated. Secondary surgery should be performed in the first 30 days after the initial surgery or in the period after 6 months. The optimal layer for removal of the PU implant depends on the time after the primary surgery. The polyurethane implant should be exchanged after 1 month if the properties of the polyurethane foam are expected to be used.

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, refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

A Multi-state Model for Analysing Transitions between Body Mass Index Categories During Childhood - Generation XXI Birth Cohort Study

Abstract

Prevalence of overweight and obesity in young children has risen dramatically in the last decades in most developed countries. Childhood overweight and obesity are known to have immediate and long-term health consequences and are now recognized important public health concerns. We used a Markov 4-state model with states defined by four body mass index (BMI) categories (underweight, normal weight, overweight, and obese) to study the rates of transition of children aged 4 to 10 years to higher or lower BMI categories. This model was also used to study the relation of explanatory variables to their transition rates. The participants consisted of 4887 children from Generation XXI birth cohort, Porto – Portugal, with anthropometric evaluation at the age 4 and at least in one of the subsequent follow up waves. Children who were normal weight are more likely to move to higher BMI categories than lower categories; whereas overweight children attained similar rates of transition to the two adjacent categories. The influence of maternal age and education, type of delivery, sex and birth weight on childhood overweight or obesity was evaluated, but statistical significant results were only observed for sex and maternal education on the progressive transitions.

Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States

Abstract

The potential for HIV preexposure prophylaxis (PrEP) to reduce the racial disparities in HIV incidence in the United States may be limited by racial gaps in PrEP care. We used a network-based mathematical model of HIV transmission for younger black and white men who have sex with men (B/WMSM) in the Atlanta area to evaluate how race-stratified transitions through the PrEP care continuum from initiation to adherence and retention could impact HIV incidence overall and disparities in incidence between races, using current empirical estimates of BMSM continuum parameters. Relative to a no-PrEP scenario, implementing PrEP according to observed BMSM parameters was projected to yield a 23% decline in HIV incidence (HR = 0.77) among BMSM at year 10. The racial disparity in incidence in this observed scenario was 4.95 per 100 person-years at risk (PYAR), a 19% decline from the 6.08 per 100 PYAR disparity in the no-PrEP scenario. If BMSM parameters were increased to WMSM values, incidence would decline by 47% (HR = 0.53), with an associated disparity of 3.30 per 100 PYAR (a 46% decline in the disparity). PrEP could simultaneously lower HIV incidence overall and reduce racial disparities despite current gaps in PrEP care. Interventions addressing these gaps will be needed to substantially decrease disparities.

Comparison of Methods to Generalize Randomized Clinical Trial Results without Individual-Level Data for the Target Population

Abstract

Our study explored the application of methods to generalize randomized controlled trial results to a target population without individual-level data. We compared four methods using aggregate data for the target population to generalize the JUPITER trial results to a target population of trial-eligible patients in Clinical Practice Research Datalink (CPRD). The gold-standard method used individual data from both the trial and CPRD to predict probabilities of being sampled in the trial and reweight trial participants to reflect CPRD patient characteristics. Methods 1 and 2 used weighting methods based on simulated individual data or the method of moments, respectively. Method 3 weighted the trial subgroup-specific treatment effects to match the distribution of an effect modifier in CPRD. Method 4 calculated the expected absolute benefits in CPRD assuming homogeneous relative treatment effect. Methods based on aggregate data for the target population generally yielded results between the trial and gold-standard estimates. Methods 1 and 2 yielded estimates closest to the gold-standard when continuous effect modifiers were represented as categorical variables. Although individual data or data on joint distributions remains the best approach to generalize the trial results, these methods using aggregate data may be useful tools for timely assessment of randomized trial generalizability.

Validation of Asthma Control Assessment Among Urban Adolescents Using the Asthma Control and Communication Instrument (ACCI)

Publication date: Available online 11 October 2018

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

Author(s): Sande O. Okelo, Andrew L. Bilderback, Maria Fagnano, Jill S. Halterman

ABSTRACT

Background

NIH guidelines recommend questionnaires to assess asthma control, but there are few self-reported asthma morbidity surveys validated among urban, African American, Hispanic and/or poor adolescents. The ACCI is a 12-item self-reported questionnaire previously validated among a diverse adult population, but not among adolescents.

Objective

To assess the ability of the ACCI to accurately describe asthma control in an urban adolescent population.

Methods

Between November 13, 2014 – March 2, 2017, we collected information using the Asthma Control and Communication Instrument (ACCI), Asthma Control Test (ACT), Pediatric Asthma Quality of Life Questionnaire (PAQLQ), and lung function among a population of adolescents enrolled in a school-based asthma intervention study. The ACCI measure of asthma control was validated by evaluating accuracy (based on receiver operator curve [ROC]), internal reliability and concurrent, discriminative validity.

Results

We collected information on 280 adolescents (mean age 13.4 years; 56% male; 51% African American). ACCI control showed good internal reliability and strong concurrent and discriminative validity with ACT and PAQLQ. The accuracy of the ACCI in classifying adolescents with uncontrolled asthma was good (area under the curve .83; 95% CI 0.79, 0.88).

Conclusions

The ACCI, a clinical tool developed to assist communication about asthma control, has demonstrated strong construct validity as a self-reported questionnaire within an urban, African American and Hispanic sample of adolescents. The ACCI has the potential to assist in the assessment of asthma control in urban, minority and/or poor adolescents.

C-reactive protein as a diagnostic tool in differential diagnosis of hypereosinophilic syndrome and ANCA-negative eosinophilic granulomatosis with polyangiitis

Publication date: Available online 11 October 2018

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

Author(s): Amélie Leurs, Cécile Chenivesse, Benjamin Lopez, Jean-Baptiste Gibier, Guillaume Clément, Matthieu Groh, Marie-Christine Copin, Delphine Staumont, Geoffrey Mortuaire, Marie-Hélène Balquet, Frédéric Dezoteux, Nathalie Bautin, Anne-Laure Buchdahl, Noémie Le Gouellec, Nicolas Etienne, Louis Terriou, Sylvain Dubucquoi, Myriam Labalette, Sandrine Morell-Dubois, Hélène Maillard-Lefebvre

Needs Assessment Survey for a Food Allergy Control Tool

Publication date: Available online 11 October 2018

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

Author(s): Elizabeth Lippner, Scott H. Sicherer, Michael H. Land, Michael Schatz, Chitra Dinakar

Rocuronium hypersensitivity: Does off-target occupation of the MRGPRX2 receptor play a role?

Publication date: Available online 10 October 2018

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

Author(s): Athina L. Van Gasse, Jessy Elst, Chris H. Bridts, Christel Mertens, Margaretha Faber, Margo M. Hagendorens, Luc S. De Clerck, Vito Sabato, Didier G. Ebo

Three-Dimensional Evaluation of Static and Dynamic Effects of Botulinum Toxin A on Glabellar Frown Lines

Abstract

Background

The use of injectable solutions for aesthetic purposes has increased tremendously, but lacks objective support. We aimed at assessing static and dynamic effects of botulinum toxin A (BoNTA) on glabellar lines by use of an objective three-dimensional methodology.

Methods

We prospectively collected three-dimensional stereographic photographs of two different facial expressions (pretreatment, 30 and 90 days posttreatment) in 21 patients, receiving a total of 20 units of BoNTA in both corrugator supercilii muscles. The primary endpoint was the three-dimensional static and dynamic surface irregularity, and secondary endpoints were the glabellar line scale and overall patient satisfaction. Blinded retrospective data analysis and statistical evaluation were performed with p < 0.05 considered statistically significant.

Results

Static glabellar lines (neutral facial expression) were significantly reduced by − 17% and − 24% on day 30 and 90 posttreatment, respectively (vs. pretreatment; both p < 0.0001). Dynamic glabellar frown lines (firmest possible bilateral eye closure) demonstrated a reduction of surface irregularity by − 26% and − 21% on day 30 and 90 posttreatment, respectively (vs. pretreatment; both p < 0.0001). The subjective dynamic glabellar line scale documented a statistically significant improvement on day 30 posttreatment (mean ± SD: 1.5 ± 0.8; p < 0.05) versus pretreatment (2.8 ± 1.0). Polled patients confirmed a subjective wrinkle improvement 90 days posttreatment.

Conclusion

The presented setup detected even subtle changes of BoNTA treatment for facial wrinkling and is a promising asset for scientific evaluations of clinical studies analyzing the outcome and duration of efficacy of injectable solutions on the face.

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.

Surgical Trainee Daytime Sleepiness and Technical Skill When Performing Septoplasty

This cohort study of surgical residency and fellowship physicians at 2 academic institutions uses technical skill scores rated by attending physicians to assess the association of trainees' self-reported daytime sleepiness with their intraoperative skill while performing septoplasty.

Interspecies interaction of Serratia plymuthica 4Rx13 and Bacillus subtilis B2g alters the emission of sodorifen

Abstract

Sodorifen is the major volatile of Serratia plymuthica 4Rx13. It is assumed to be a long-distance communication signal. However, so far the emission patterns of sodorifen had been studied using mono-cultures of S. plymuthica 4Rx13 neglecting that in natura bacteria live in communities. Here, we show that the structured co-cultivation of S. plymuthica 4Rx13 and Bacillus subtilis B2g in a low-diversity model community grown under nutrient rich conditions led to quantitative changes in sodorifen emission compared to self-paired mono-cultivations. Co-culturing revealed a decreased emission of sodorifen (50%) during exponential growth phase whereas in the late stationary stage of growth the amount of headspace sodorifen was increased compared to self-paired mono-cultivation (217% at 500 h of cultivation). Six other compounds which are most probably related to sodorifen or are isomers showed similar emission patterns. The data indicated that S. plymuthica 4Rx13 enhances its communication signal sodorifen as a consequence of interaction with B. subtilis B2g.

Food-Grade Gene Transformation System Constructed in Lactobacillus plantarum using a GlmS-Encoding Selection Marker

Abstract

Food-grade gene expression systems in lactic acid bacteria enable production of functional proteins or product testing without antibiotic requirement. Here, we expanded the available selection markers by developing a novel food-grade genetic transformation system for Lactobacillus plantarum WCFS1 using the glucosamine-6-phosphate synthase gene (glmS1). A glmS-vector pSIPH497 was constructed by replacing the erythromycin resistance gene (erm) with L. plantarum glmS1 under control of the PldhL promoter from WCFS1. The selection efficiency and stability of the glmS-vector were shown to be comparable to those of the erm-based plasmid. Moreover, using mCherry expression as a reporter gene, we showed the feasibility of the system for producing foreign proteins. This food-grade host/vector system will provide an effective and safe technique for the application of lactic acid bacteria in the food and medical industries. Furthermore, this study provides a useful strategy for developing food-grade selection markers in other host/vector systems.

Prediction and identification of novel sRNAs involved in Agrobacterium strains by integrated genome wide and transcriptome based methods

Abstract

sRNAs are a class of gene regulators in bacteria, playing a central role in its response to environmental changes. Bioinformatic prediction facilitates the identification of sRNAs expressed at different conditions. We propose a novel method of prediction of sRNAs from the genome of Agrobacterium based on PWM matrix of conditional sigma factors. sRNAs predicted from the genome are integrated with the virulence specific transcriptome data to identify putative sRNAs that are over expressed during Agrobacterial virulence induction. A total of 384 sRNAs are predicted from transcriptome data analysis of Agrobacterium fabrum and 100–500 sRNAs from the genome of different Agrobacterial strains. In order to refine our study, a final set of 10 novel sRNAs with best features across different replicons targeting virulence genes are experimentally identified using semi-quantitative PCR. Since Ti plasmid plays major role in virulence, out of 10 sRNAs across the replicons, 4 novel sRNAs differentially expressed under virulence induced and non-induced conditions are predicted to be present in the Ti plasmid T-DNA region flanking virulence related genes like agrocinopine synthase, indole 3-lactate synthase, mannopine synthase and tryptophan monooxygenase. Further, validating the function of these sRNAs in conferring virulence would be relevant to explore its role in Agrobacterium-mediated plant transformation.

Effects of Climate and Latitude on Age at Maturity and Longevity of Lizards Studied by Skeletochronology

Abstract

Longevity and age at maturity are key life-history traits, directly linked to fitness attributes such as survival and reproductive output. It has been proposed that these traits are strongly influenced by environmental factors, such as temperature, seasonality, and precipitations, which determine the existence of a continuum of life-histories that goes from the "slow" life histories characterized by late maturity and high longevity of cold and highly seasonal climates to the "fast" life histories characterized by early maturity and low longevity, typical of the tropical climates. However, large-scale studies that address these topics in lizards are scarce and most of them are based on heterogeneous data, which may overlook the real patterns. Using skeletochronology, we studied age at maturity and longevity of two species of Phymaturus lizards, Phymaturus aguanegra from the Andes and P. zapalensis from the Patagonian steppe (Argentina). Then, we confronted longevity and age at maturity in these species with published skeletochronology-based data on 46 other lizard species to examine possible association of these life-history traits with latitude and mean annual temperature, thermal amplitude and precipitations. Both Phymaturus species showed late sexual maturity (7 years and 8-9 years, respectively) and high longevity (16 years and 14-15 years, respectively) in coincidence with the other species of the genus studied up to date. The phylogenetic comparative analysis revealed that the most important variable in the determination of longevity patterns in the species studied was latitude: at higher latitudes lizards tend to live longer. In contrast, age at sexual maturity was dependent on mean annual temperature most, especially in males, as lizards from hotter climates mature earlier than lizards from cold sites.

Pachyonychia congenita: A case report of a successful treatment with rosuvastatin in a patient with a KRT6A mutation

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.

Use of the index of ideality of correlation to improve models of eco-toxicity

Abstract

Persistent organic pollutants are compounds used for various everyday purposes, such as personal care products, food, pesticides, and pharmaceuticals. Decomposition of considerable part of the above pollutants is a long-time process. Under such circumstances, estimation of toxicity for large arrays of organic substances corresponding to the above category of pollutants is a necessary component of theoretical chemistry. The CORAL software is a tool to establish quantitative structure—activity relationships (QSARs). The index of ideality of correlation (IIC) was suggested as a criterion of predictive potential of QSAR. The statistical quality of models for eco-toxicity of organic pollutants, which are built up, with use of the IIC is better than statistical quality of models, which are built up without use of data on the IIC.

Deficiency of sun protection advertising exists in consumer magazines across demographic groups and varies by target demographic

Publication date: Available online 11 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): L.E. Wiznia, J. Wang, A.B. Steuer, N. Elbuluk

Re-evaluating the Need for Routine Laboratory Monitoring in Isotretinoin Patients: A Retrospective Analysis

Publication date: Available online 11 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Radhika Shah, Daniela Kroshinsky

Galeatomy: A Useful Technique Aiding High-Tension Scalp Closures

Publication date: Available online 10 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Marjon Vatanchi, Roy C. Grekin

Prevalence of low inflammatory tinea genitalis in southern China

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

Evaluation of corrosion control products on a distribution system through crowdsourcing

Abstract

Crowdsourcing of citizens was used to determine the effectiveness of corrosion control in a water distribution system. This study examines the frequency and severity of "Red Water" complaints over a period of 4 years, and two different corrosion control chemicals, polyphosphate and zinc orthophosphate. The data revealed that the frequency of Red Water complaints was higher when using zinc orthophosphate while the severity (higher iron) was higher when using polyphosphates. Varying the dose of zinc orthophosphate to account for cold months induced a greater number of customer complaints. Moreover, corrosion coupons studies suggest similar performance of both corrosion inhibitor products. The corrosion and complaints might be driven by microbial-induced processes in which diatoms might play a significant role.

Effects of oral supplementation with FOS and GOS prebiotics in women with adult acne: the “S.O. Sweet” study: a proof-of-concept pilot trial

Increased IL17‐expressing γδ T Cells in Seborrheic Dermatitis‐like Lesions of the Mpzl3 Knockout Mice

Experimental Dermatology, Volume 0, Issue ja, -Not available-.

Sequential cyclic changes of hair roots revealed by dermoscopy demonstrate a progressive mechanism of diffuse alopecia areata over time

Experimental Dermatology, Volume 0, Issue ja, -Not available-.

Eritrodermia en el adulto: un enfoque práctico para el diagnóstico y tratamiento

Publication date: Available online 10 October 2018

Source: Actas Dermo-Sifiliográficas

Author(s): A. Cuellar-Barboza, J. Ocampo-Candiani, M.E. Herz-Ruelas

Resumen

La eritrodermia es un síndrome inflamatorio de la piel caracterizado por descamación y eritema en más del 90% de la superficie corporal. Representa la etapa final de muchas enfermedades dermatológicas en el adulto. La causa más frecuente es la psoriasis, le siguen las enfermedades eccematosas, las reacciones medicamentosas, la pitiriasis rubra pilaris y los linfomas cutáneos de células T. El abordaje diagnóstico debe incluir una historia y examen físicos exhaustivos. Si se desconoce la etiología de la eritrodermia es posible que múltiples biopsias a lo largo del curso de la enfermedad aumenten las posibilidades de un diagnóstico correcto. El abordaje inicial de la eritrodermia debe incluir la evaluación de un experto en nutrición, la valoración del balance hidroelectrolítico, medidas para mantener la función de barrera de la piel, antihistamínicos con efecto sedante y la exclusión de infecciones bacterianas secundarias. Presentamos una revisión práctica de la etiología, diagnóstico y tratamiento de esta entidad.

Abstract

Erythroderma is an inflammatory skin syndrome that involves desquamation and erythema of more than 90% of the body surface area. It represents a final clinical endpoint for many adult dermatological conditions. The most frequent cause of erythroderma is psoriasis followed by eczematous conditions, drug-induced reactions, pityriasis rubra pilaris and cutaneous T-cell lymphomas. Diagnostic approach must include a thorough history and clinical examination. If the etiology of erythroderma is uncertain multiple skin biopsies may enhance diagnostic accuracy. The initial management of erythroderma must include a nutrition expert evaluation, fluid imbalance assessment, maintaining skin barrier function, sedative antihistamines and exclusion of secondary bacterial infection. We present a practical review of the etiology, diagnosis, and treatment of this entity.

Impact of antibiotic use on survival in patients with advanced cancers treated on immune checkpoint inhibitor phase I clinical trials

How do immune checkpoint targeted antibodies work? The need for improved pharmacokinetic evaluation in early phase studies

Letrozole and palbociclib versus chemotherapy as neoadjuvant therapy of high-risk luminal breast cancer

Abstract

Background

Palbociclib is a CDK4/6 inhibitor with demonstrated efficacy and safety in combination with endocrine therapy in advanced luminal breast cancer (LBC). We evaluated the respective efficacy and safety of chemotherapy and letrozole-palbociclib (LETPAL) combination as neoadjuvant treatment in patients with high-risk LBC.

Patients and Methods

NeoPAL (UCBG10/4, NCT02400567) is a randomised, parallel, non-comparative phase II study. Patients with ER-positive, HER2-negative, Prosigna®-defined luminal B, or luminal A and node-positive, stage II-III breast cancer, not candidate for breast-conserving surgery, were randomly assigned to either letrozole (2.5 mg daily) and palbociclib (125 mg daily, 3 weeks/4) during 19 weeks, or to FEC100 (5FU 500 mg/m², epirubicin 100 mg/m², cyclophosphamide 500 mg/m²) x3 21-day courses followed by docetaxel 100 mg/m² x3 21-day courses. Primary endpoint was residual cancer burden (RCB 0-1 rate). Secondary endpoints included clinical response, proliferation-based markers, and safety.

Results

Overall, 106 patients were randomised (median Prosigna® ROR Score 71 (22-93)). RCB 0-I was observed in four and eight patients in LETPAL [7.7% (95% CI 0.4-14.9)] and chemotherapy [15.7% (95% CI 5.7-25.7)] arms, respectively. pCR rates were 3.8% and 5.9%. Clinical response (75%) and breast-conserving surgery rates (69%) were similar in both arms. Preoperative Endocrine Prognostic Index 0 scores (breast cancer-specific survival) were observed in 17.6% and 8.0% of patients in LETPAL and chemotherapy arms, respectively. Safety profile was as expected, with two versus 17 serious adverse events (including 11 grade 4 serious AEs in the chemotherapy arm).

Conclusion

LETPAL combination was associated with poor pathological response but encouraging clinical and biomarker responses in Prosigna®-defined high-risk LBC. Contemporary chemotherapy regimen was associated with poor pathological and biomarker responses, with a much less favourable safety profile. LETPAL combination might represent an alternative to chemotherapy in early high-risk LBC.

Clinical Trial Number

NCT02400567

Dissection of DLBCL Microenvironment Provides a Gene Expression-Based Predictor of Survival Applicable to Formalin-Fixed Paraffin-Embedded Tissue

Abstract

Background

Gene-expression-profiling (GEP) studies recognized a prognostic role for tumor microenvironment (TME) in diffuse large B-cell lymphoma (DLBCL), but the routinely adoption of prognostic stromal signatures remains limited.

Patients and methods

Here, we applied the computational method CIBERSORT to generate a 1,028-gene matrix incorporating signatures of 17 immune and stromal cytotypes. Then, we performed a deconvolution on publicly available GEP data of 482 untreated DLBCLs to reveal associations between clinical outcomes and proportions of putative tumor-infiltrating cell types. 45 genes related to peculiar prognostic cytotypes were selected and their expression digitally quantified by NanoString technology on a validation set of 175 formalin-fixed, paraffin-embedded DLBCLs from two randomized trials. Data from an unsupervised clustering analysis were used to build a model of clustering assignment, whose prognostic value was also assessed on an independent cohort of 40 cases. All tissue samples consisted of pretreatment biopsies of advanced-stage DLBCLs treated by comparable R-CHOP/R-CHOP-like regimens.

Results

In silico analysis demonstrated that higher proportion of myofibroblasts (MF), dendritic cells, and CD4⁺ T-cells correlated with better outcomes and the expression of genes in our panel is associated with a risk of overall and progression-free survival. In a multivariate Cox model, the microenvironment genes retained high prognostic performance independently of the cell-of-origin (COO), and integration of the two prognosticators (COO + TME) improved survival prediction in both validation set and independent cohort. Moreover, the major contribution of MF-related genes to the panel, Gene Set Enrichment Analysis suggested a strong influence of extracellular matrix determinants in DLBCL biology.

Conclusions

Our study identified new prognostic categories of DLBCL, providing an easy-to-apply gene panel that powerfully predicts patients' survival. Moreover, owing to its relationship with specific stromal and immune components, the panel may acquire a predictive relevance in clinical trials exploring new drugs with known impact on TME.

Vitamin K1 cream significantly reduces incidence and severity of cetuximab-related acneiform skin rash in women: A post hoc analysis of the EVITA trial

Reply to the Letter to the Editor "A Centralised multidisciplinary clinic approach for germ cell tumours" by Crawford SM

“Personalized biomarker-based treatment strategy for patients with squamous cell carcinoma of the head and neck: EORTC position and approach.”

Abstract

The molecular landscape of squamous cell carcinoma of the head and the neck (SCCHN) has been characterized and actionable or targetable genomic alterations have been identified. However, targeted therapies have very limited activity in unselected SCCHN and the current treatment strategy is still based on tumor location and disease stage and not on tumor biology.Trying to select upfront the patients who will benefit from a specific treatment might be a way to improve patients' outcome. With the objective of optimizing the activity of targeted therapies and immunotherapy, we have designed an umbrella biomarker-driven study dedicated to recurrent and/or metastatic SCCHN patients (EORTC-1559-HNCG, NCT03088059).In this paper, we review the different trial designs for biomarker-driven studies with their respective advantages and opportunities but also the potential pitfalls that led to the design of the EORTC-1559-HNCG protocol. We also discuss the scientific and logistic challenges of biomarker-driven trials.

A comparison of matched interim analysis publications and final analysis publications oncology clinical trials

Abstract

Background

Progression-free survival is an increasingly popular surrogate endpoint for overall survival. The strength of correlation between the two endpoints varies, raising questions about the correlation between results of interim analyses that report mature progression-free survival data with the subsequent final publication that report overall survival.

Methods

We searched PubMed from 2005 to 2015 for randomized controlled trials that measured both progression-free survival and overall survival. We matched interim publications that reported mature progression-free survival data with their final analyses that reported overall survival. We included 25 matched pairs and 8 unmatched interim analyses whose final analyses are not published. Our primary objectives are to compare interim publications with matched final publications in terms of journal prominence and Altmetric score and to compare progression-free survival and overall survival effect sizes.

Results

All interim analyses (n = 33) were prespecified and there was a statistically significant progression-free survival benefit in 31 (93.9%). Only 8 matched final analyses had statistically significant overall survival data. Interim analyses were more often published in top-5 general medicine journals (p < .01) but not in top-5 oncology journals (p = .26). Altmetric scores were higher in interim analyses (p < .01). Progression-free survival effect sizes from interim analyses were a median of 31% larger than overall survival effect sizes from final analyses.

Conclusion

Interim analyses with progression-free survival data may generate hype in oncology, as evidenced by journal impact factors and Altmetric scores. The cause of this hype may be due, in part, to large progression-free survival effect sizes. Regardless, in trials that investigate progression-free and overall survival, publishing interim analyses with mature progression-free survival data apart from the final analyses with mature overall survival should be cautioned.

Developing prognostic models for advanced prostate cancer when the goal line keeps changing

Response to the letter sent by Dr. Viroj Wiwanitkit entitled “Coffee waste, vector control and dengue”

Dermatologic findings of vitamin B12 deficiency in infants

Pediatric Dermatology, EarlyView.

Comparative effects of arsenite (As(III)) and arsenate (As(V)) on whole plants and cell lines of the arsenic-resistant halophyte plant species Atriplex atacamensis

Abstract

Whole plants and hypocotyl-derived calli of the halophyte plant species Atriplex atacamensis were exposed to 50 μM arsenate (As(V)) or 50 μM arsenite (As(III)). At the whole plant level, As(III) was more toxic than As(V): it reduced plant growth, stomatal conductance, photosystem II efficiency while As(V) did not. In roots, As accumulated to higher level in response to As(III) than in response to As(V). Within root tissues, both arsenate and arsenite were identified in response to each treatment suggesting that oxidation of As(III) may occur. More than 40% of As was bound to the cell wall in the roots of As(V)-treated plants while this proportion strongly decreased in As(III)-treated ones. In leaves, total As and the proportion of As bound to the cell wall were similar in response to As(V) and As(III). Non-protein thiol increased to higher extent in response to As(V) than in response to As(III) while ethylene synthesis was increased in As(III)-treated plants only. Polyamine profile was modified in a contrasting way in response to As(V) and As(III). At the callus level, As(V) and As(III) 50 μM did not reduce growth despite an important As accumulation within tissues. Calli exposed to 50 μM As did not increase the endogenous non-protein thiol. In contrast to the whole plants, arsenite was not more toxic than arsenate at the cell line level and As(V)-treated calli produced higher amounts of ethylene and malondialdehyde. A very high dose of As(V) (1000 μM) strongly reduced callus growth and lead to non-protein thiols accumulation. It is concluded that As(III) was more toxic than As(V) at the plant level but not at the cellular level and that differential toxicity was not fully explained by speciation of accumulated As. Arsenic resistance in A. atacamensis exhibited a cellular component which however did not reflect the behavior of whole plant when exposed to As(V) or As(III).

Editorial Board

Publication date: November 2018

Source: Journal of Photochemistry and Photobiology B: Biology, Volume 188

Author(s):

Synergistic effects of melatonin and distinct spectral lights for enhanced production of anti-cancerous compounds in callus cultures of Fagonia indica

Publication date: Available online 10 October 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Taimoor Khan, Muhammad Asad Ullah, Laurine Garros, Christophe Hano, Bilal Haider Abbasi

Abstract

Fagonia indica is one of the commercially vital medicinal plant species. It is well-known for biosynthesis of anticancer phenolics and flavonoids metabolites. The plant has been exploited for in vitro studies and production of vital phytochemicals, however, the synergistic effects of melatonin and lights remains to be investigated. In current study, we have evaluated the synergistic effects of melatonin and different light emitting diodes (LEDs) in callus cultures of F. indica. Both, light and melatonin play vital role in physiological and biochemical processes of plant cell. The highest Fresh weight (FW: 320 g/L) and Dry weight (DW: 20 g/L) was recorded in cultures under white LEDs. Optimum total phenolics content (11.3 μg GAE/mg), total flavonoids content (4.02 μg QAE/mg) and Free radical scavenging activity (97%) was found in cultures grown under white LED and melatonin. Furthermore, cultures maintained under white light were also found with highest levels of phenolic and flavonoids production (total phenolic production; 226.9 μg GAE/mg, Total flavonoid production; 81 μg QAE/mg) than other LED-grown cultures. However, the antioxidant enzymes; Superoxide dismutase (SOD: 0.53 nM/min/mg FW) and Peroxidase (POD:1.18 nM/min/mg FW) were found optimum in cultures grown under blue LED. The HPLC data showed that enhanced total production of metabolites was recorded in cultures under white LED (6.765 μg/mg DW) than other lights and control. The findings of this study comprehend the role of melatonin and influence of light quality on biomass accumulation and production of phytochemicals in callus cultures of F. indica.

Cationic red emitting fluorophore: A light up NIR fluorescent probe for G4-DNA

Publication date: Available online 11 October 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Beena Kumari, Akanksha Yadav, Sushree P. Pany, P.I. Pradeepkumar, Sriram Kanvah

Abstract

Guanine (G) quadruplexes (G4) are nucleic acid secondary structures formed by G-rich sequences, which are commonly found in human telomeric and oncogene-promoter regions, and they have emerged as targets for regulation of multiple biological processes. Considering their importance, targeting the G-quadruplex structure with small molecular binders is extremely pertinent. In this work, red emitting water soluble fluorophores bearing push-pull substituents were synthesized and examined for their interaction with human telomeric G4 and duplex (ds) DNAs. The presence of a strong electron donating (dimethylamino) and electron withdrawing (cationic pyridinium) groups linked through a conjugated double bond helps in water solubility and enabling the emission in the near IR region (>700–720 nm). Binding of this cationic dye to the G4-DNA yields multi-fold emission enhancement (~70 fold with G4-DNA vs. ~7 fold with ds-DNA) along with hypsochromic wavelength shifts (35 nm with G4-DNA and 8 nm with ds-DNA). The remarkable emission changes, ~2–4 fold enhanced binding efficiency noted with the antiparallel conformation of G4-DNA indicates preferential selectivity over ds-DNA. The molecular docking and dynamics studies of the ligands with duplex and interactions of the ligands with duplex and G4 DNA were performed, and they provide insights into the mode of binding of these dyes with G4-DNA and supplement the experimental observations.

Graphical Abstract

Factive knowability and the problem of possible omniscience

Abstract

Famously, the Church–Fitch paradox of knowability is a deductive argument from the thesis that all truths are knowable to the conclusion that all truths are known. In this argument, knowability is analyzed in terms of having the possibility to know. Several philosophers have objected to this analysis, because it turns knowability into a nonfactive notion. In addition, they claim that, if the knowability thesis is reformulated with the help of factive concepts of knowability, then omniscience can be avoided. In this article we will look closer at two proposals along these lines (Edgington in Mind 94(376):557–568, 1985; Fuhrmann in Synthese 191(7):1627–1648, 2014a), because there are formal models available for each. It will be argued that, even though the problem of omniscience can be averted, the problem of possible or potential omniscience cannot: there is an accessible state at which all (actual) truths are known. Furthermore, it will be argued that possible or potential omniscience is a price that is too high to pay. Others who have proposed to solve the paradox with the help of a factive concept of knowability should take note (Fara in Synthese 173(1):53–73, 2010; Spencer in Mind 126(502):466–497, 2017).

Real‐life effectiveness of MP‐AzeFlu in Irish patients with persistent allergic rhinitis, assessed by visual analogue scale and endoscopy

Immunity, Inflammation and Disease, EarlyView.

Platelet-rich plasma as a potential therapeutic approach against lead nitrate- and/or gamma radiation-induced hepatotoxicity

Abstract

Because of the potential regenerative and cytoprotective effects of its content of numerous bioactive growth factors and cytokines, platelet-rich plasma (PRP) became an attractive biomaterial for therapeutic purposes. Therefore, the current study was designed to investigate the potential therapeutic effect of PRP against lead nitrate- and/or γ-radiation-induced hepatotoxicity. To do so, hepatotoxicity was induced in rats by intraperitoneal administration of lead nitrate (7.5 mg/kg) thrice weekly for two consecutive weeks and/or a whole-body γ-irradiation at a single dose of 6 Gy. Activated PRP (0.5 ml/kg) was injected subcutaneously 24 h after the last dose of lead nitrate and/or γ-irradiation and continued twice weekly for three successive weeks. Lead nitrate intoxication and/or γ-irradiation resulted in a significant elevation of serum alanine transaminase and aspartate transaminase activities accompanied with a significant decrease in serum levels of total protein and albumin. Further, a significant increase in malondialdehyde level and nitric oxide content accompanied with a significant decrease in the reduced glutathione content and the enzyme activities of glutathione-S-transferase, superoxide dismutase, and catalase were observed. Additionally, hepatic extracellular signal-regulated kinase (ERK) and Akt signaling pathways were stimulated. PRP treatment notably ameliorated the induced cell injury, reduced the intracellular oxidative and interestingly increased the upregulation of phosphorylated ERK1/2 and Akt. Moreover, PRP treatment relieved lead nitrate and/or γ-radiation-induced hepatic histological damages. In conclusion, this study sheds the light on a probable therapeutic role of PRP against lead nitrate- and/or γ-radiation-induced hepatotoxicity which might attribute to its ability to activate ERK and Akt signaling pathways.

The Masseter Muscle and Its Role in Facial Contouring, Aging, and Quality of Life: A Literature Review

BACKGROUND: Masseter muscle hypertrophy manifests itself as enlargement of masseter muscle. It can be associated with square shaped lower face, pain, dental attrition, maxillary and mandibular bone resorption, and accelerated aging process of the lower face. OBJECTIVE: Is to assess efficacy and safety of botulinum toxin type A in contouring the masseter and its impact on quality of life, the aging process of the lower face, and it's role in full face rejuvenation. METHODS: A PubMed search was conducted for articles on masseter treatment with botulinum toxin type A, masseter muscle hypertrophy, and aging process of the lower face. Key studies are reviewed and findings are summarized. RESULTS: Botulinum toxin type A can be injected in the lower posterior aspect of the masseter muscle. Treatment decreases muscle bulk and reshapes the lower face. Furthermore, patient quality of life measures, including pain and symptoms of grinding and clenching are improved. Treatment can decrease shear stress on maxillary and mandibular bones and can possibly prevent tooth loss and progressive bone resorption of the lower face. Adverse effects are minimal and short lasting. CONCLUSION: Botulinum toxin type A is a safe and effective treatment of masseter hypertrophy. The treatment results in improvement of functionality, cosmesis and restoring facial harmony. Financial Disclosure: This manuscript received no financial support. Sabrina G. Fabi is an investigator and consultant for Allergan, Merz, Galderma, and Revance. Corresponding author: Rawaa M. Almukhtar, MD, MPH, Louisiana State University, Department of Dermatology, 1542 Tulane Ave., Ste. 639 , New Orleans, LA 70112, Email: ralmuk@lsuhsc.edu ©2018American Society of Plastic Surgeons

Tissue Expander Complications Do Not Preclude A Second Successful Implant Based Breast Reconstruction

Background: Implant based breast reconstruction is the most common method of breast reconstruction in the United States but the outcomes of subsequent implant based reconstruction after a tissue expander (TE) complication are rarely studied. The purpose of this study is to determine the long term incidence of implant loss in patents with a previous TE complication. Methods: This is a retrospective review of the long term outcomes of all patients with TE complications at a large academic medical center from 2003-2013. Patients with subsequent TE or implant complications were compared to those with no further complications to assess risk factors for additional complications, or reconstructive failure. Results: One hundred sixty-two women were included in this study. The mean follow up was 8.3 ± 3.1 years. Forty-eight women (30%) went on to have a second TE or implant placed. They did not differ from women who went on to autologous reconstruction or no further reconstruction. Of these, 34 women (71%) had no further complications, and 38 women (79%) had a successful implant based reconstruction at final follow-up. There were no patient or surgical factors significantly associated with a second complication or implant loss. Conclusions: Following TE complications, it is reasonable to offer women a second attempt at tissue expansion and implant placement. This study demonstrates that long term success rates are high and there are no definitive patient or surgical factors that preclude a second attempt at implant based breast reconstruction. Financial Disclosure Statement: Dr. Myckatyn receives grant funding, consultant, and advisory board fees from Allergan, investigator-initiated grant funding and consultant fees from LifeCell, investigator-initiated grant funding and consultant fees from RTI, and advisory board fees from Viveve. No other authors report any disclosures. No funds were received to conduct this study. Presented at: Not Applicable Corresponding Author: Terence M. Myckatyn, MD, 1020 North Mason Road, Suite #110, Creve Coeur, MO 63141 ©2018American Society of Plastic Surgeons

Effect of the endogenous vascular endothelial growth factor on flap surgical delay in a rat flap model

Background: Experimental evidence suggests that endogenous vascular endothelial growth factor (VEGF) may play a major role in the surgical delay phenomenon. The purpose of this study was to investigate the effect of the endogenous vascular endothelial growth factor on flap surgical delay. Methods: A total of 82 adult male Sprague-Dawley rats with an average weight of 330g were used for these experiments. These experiments were then conducted in two parts. In part 1, thirty-two rats were used to assess the effectiveness of VEGF inhibitor through western blot assay and ELISA. In part 2, fifty rats were used to investigate the effect of VEGF on flap surgical delay via arteriography, histology analysis, and flap viability. Results: The VEGF protein inhibition ratio reached the maximum (approximately 91.6%) on the 5 to 7 days. The number of transverse arteries and the number of vessels > 0.1mm in diameter on the 3-day delay duration and the 6-day delay duration were significantly greater than those of the normal group. The number of transverse arteries and the number of vessels > 0.1mm in diameter on the 6-day inhibition duration were not significantly changed compared with the normal group. Microvascular density on the 6-day delay duration obviously increased whereas the 6-day inhibition duration was not significantly changed in comparison to the normal group. Conclusions: Endogenous VEGF is an initiating factor of the surgical delay effect by controlling choke vessel dilation and neovascularization within the choke zones. Conflict of interest: None Source of fund: This work is supported by the National Natural Science Foundation of China (NO.81472062). Corresponding Authors:* Xu Gong, E-mail: 13944099151@163.com, Tel.: +86 13944099151, Address: Department of Hand Surgery, The First Hospital of Jilin University, No.71, Xinmin Street, Changchun, Jilin Province, 130021, China. ©2018American Society of Plastic Surgeons

Evaluation of prepectoral implant placement and complete coverage with TiLoop® Bra mesh for breast reconstruction: a prospective study on long-term and patient reported BREAST-Q outcomes.

Background: Breast reconstruction is rapidly evolving, owing to the changing face of cancer surgery and the growing acceptance of acellular dermal matrices (ADM) and synthetic meshes. Although some early reports showed encouraging results after prepectoral breast reconstruction, there is a paucity of data on long term outcomes. Methods: Between January 2012 and March 2015, 179 patients undergoing mastectomy were enrolled at our institution. Patients underwent mastectomy and immediate prepectoral breast reconstruction with the definitive implant entirely wrapped in a titanium-coated polypropylene mesh (TiLoop®). BREAST-Q questionnaire was administered prior to surgery and after 2 years. Capsular contracture was evaluated by Baker scale. Oncological, surgical and aesthetic outcomes along with the changes in BREAST-Q score were analyzed over time. Results: Patients were followed up for an average of 38.5 months. A total of 250 mastectomies were performed. Locoregional recurrence rate was 2.1 %. Complications requiring a reoperation were recorded in 6 patients (2.4%) and implant removal was necessary in 3 cases (1.2%), followed by reconstruction with submuscular expanders. Grade IV capsular contracture was detected in 5 breasts (2%), while 212 breasts were evaluated as grade I (84.8%), 28 breasts as grade II (11.2%) and 5 breast as grade III (2%). Patients reported significant high rates in the BREAST-Q overall satisfaction with outcome (73.8), overall satisfaction with breasts (72.5), psychosocial well-being (77.7) and sexual well-being (57.9), scoring a significant increase in these domains from the preoperative to the postoperative period (p

“Three-Dimensional Topography of the Emerging Point of the Ophthalmic Artery.”

Background: During periorbital noninvasive and surgical procedures there is the risk of iatrogenic injury to the emerging point of the ophthalmic artery. This study aimed to determine the three-dimensional location of the emerging point of the ophthalmic artery and to provide clinicians with anatomic information that would help them to avoid associated complications. Methods: Seventeen hemifaces of the emerging point of the ophthalmic artery from 10 Korean and 7 Thai cadavers were dissected and scanned by a three-dimensional scanner. The emerging points of the ophthalmic artery of 30 healthy Korean volunteers were also detected using an ultrasound imaging system. Results: The transverse distance from the medial canthus to the emerging of the ophthalmic artery was 3.8±1.0 mm medially, while the vertical distance was 14.0±2.9 mm superiorly. The transverse distance from the midline was 16.5±1.7 mm to the emerging point of the ophthalmic artery and 20.0±2.0 mm to the medial canthus. The measured depth from the skin surface to the emerging point of the ophthalmic artery was 4.8±1.7 mm in three-dimensional scanning and 4.5±1.1 mm in ultrasound detection. The vertical distance from the inferior margin of the superior orbital rim to the emerging point of the ophthalmic artery was 5.3±1.4 mm. Conclusions: These data inform clinicians about the anatomic three-dimensional location of the emerging point of the ophthalmic artery, which will help them to avoid iatrogenic injury when they are performing periorbital clinical procedures. Lists of Authors and their participation: * None of the authors have financial or private relationships with commercial, academic, or political organizations or people that could have improperly influenced this research. All cadaveric objects in this study were legally donated to Yonsei Medical Center and Chulalongkorn University. Financial Disclosure Statement: None of the authors has received any financial support for this study. The institutional ethics committee approved the study, and the volunteers provided written informed consents after the study had been fully explained to them (IRB No. 2-2017-0023). Correspondence to: Name: Hee-Jin Kim, Address: Room 601, Division in Anatomy & Developmental Biology, Department of Oral Biology, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Telephone: +82-2-2228-3067; Fax: +82-2-393-8076 E-mail: hjk776@yuhs.ac ©2018American Society of Plastic Surgeons

The First AAPS Cannon Student Scholarship Experience

No abstract available

Preparing for the Plastic Surgery In-Service Examination: Evidence-Based Essentials for the Plastic Surgery Resident

No abstract available

ATP promotes immunosuppressive capacities of mesenchymal stromal cells by enhancing the expression of indoleamine dioxygenase

Immunity, Inflammation and Disease, EarlyView.