The Joint Effects of Antenatal Steroids and Gestational Age on Improved Outcomes in Neonates

Abstract

Objectives

Antenatal corticosteroids are standard of care for women at risk of a preterm birth and demonstrated to be protective against poor outcomes in neonates including respiratory disorders, mortality and intraventricular hemorrhage (IVH). Its benefits may vary by gestational age, and accurate estimation is needed in a single-center population to account for practice variation.

Methods

A retrospective cohort of infants admitted to the hospital's neonatal intensive care unit, 1997–2015. Using Poisson regression, we separately modeled the incidence rate ratio of death, grade III or IV intraventricular hemorrhage (IVH), and moderate to severe bronchopulmonary dysplasia (BPD) testing the moderating effects of gestation on antenatal steroids, controlling for potential confounding.

Results

Among 5314 infants admitted, death occurred in 298 (6%), severe IVH in 244 (5%), and BPD in 527 (10%). Antenatal steroids were protective of death and BPD in the adjusted analysis, and there was multiplicative interaction where each week increase in gestational age combined with steroid therapy resulted in 13% reduced incidence for each outcome.

Conclusions for Practice

Antenatal steroids are protective against severe IVH and moderate to severe BPD, and when combined with gestational age, steroids are associated with greater protective benefits in older neonates. There is likely an ideal window to maximize the benefits of antenatal steroids, and future etiologic research should consider the joint effects with gestational age.

Epidural abscess caused by Schizophyllum commune: a rare case of rhinogenic cranial complication by a filamentous basidiomycete

Summary

Central nervous system (CNS) infections due to filamentous basidiomycetes are extremely rare. We encountered a case of epidural abscess due to Schizophyllum commune that extended from sinusitis. A 53-year-old Japanese man presented at our hospital with a headache. Computed tomography (CT) of the cranium and sinuses showed ethmoid and sphenoid sinusitis with no intracranial abnormalities. The patient was diagnosed with acute sinusitis and underwent antibiotic treatment. However, the symptoms deteriorated, and the patient came to our hospital again with consciousness disturbance. CT scan of the cranium and sinuses showed no improvement of sinusitis after antibiotic therapy and an epidural abscess emerged in the middle cranial fossa. Therefore, emergency craniotomy and endoscopic sinus fenestration were performed. Filamentous fungal elements were observed in both rhinorrhoea and epidural abscess. The symptoms improved after the operation and administration of liposomal amphotericin B. The clinical isolate was identified as S. commune by a molecular-based method. To our knowledge, this is the first report of epidural abscess due to this fungus. Although rare, clinicians should be aware that S. commune could be a causative agent of CNS infections.

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Primary prophylaxis of invasive fungal infections with posaconazole or itraconazole in patients with acute myeloid leukemia or high-risk myelodysplastic syndromes undergoing intensive cytotoxic chemotherapy: a real world comparison

Abstract

This is an observational-retrospective study comparing the real-world outcomes associated with posaconazole vs. itraconazole as prophylaxis treatments. Two hundred and ninety-three patient admissions attributable to 174 patients were included in the study. Patients were treated with itraconazole (n = 114 admissions; 39%) or posaconazole (n = 179; 61%). Antifungal prophylaxis failure (APF) due to treatment-related adverse events (in 34 out of 293 patient admissions; 11.6%) was more frequent in the posaconazole group (6.1% vs. 15.1%; P = 0.024). There were 9 patient admissions for episodes of APF due to probable/proven breakthrough fungal infection (primary endpoint): 6 and 3 in the itraconazole and posaconazole group, respectively (5.3% vs. 1.7%; P = 0.095). All of them were associated with invasive pulmonary aspergillosis (IPA). APF was more frequent with itraconazole (65% vs. 30%; P < 0.001), along with failure due to possible/probable/proven IPA (25% vs. 10%; P = 0.002) and overall failure by any of the three different causes of prophylaxis failure (70% vs. 38%; P < 0.001). In agreement with clinical trial data, this real-world evidence supports the use of posaconazole over itraconazole in AML or MDS patients undergoing intensive chemotherapy.

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A Cross-sectional Epidemiological Study of Hidradenitis Suppurativa in an Irish Population

Abstract

Background

Hidradenitis suppurativa (HS), a chronic inflammatory disease that affects apocrine gland–bearing skin, has a significant impact on patient quality of life. Estimates of the epidemiologic prevalence of HS are highly variable, and clinical data on disease characteristics and patient burden of disease remain limited.

Objective

The primary objective of this study was to determine the number of patients with HS attending dermatology clinics in a hospital setting in Ireland (within a 6-month time period). Secondary objectives included the assessment of disease characteristics and the collection of patient responses on disease burden and work productivity.

Methods

This was an epidemiologic, non-interventional, cross-sectional study across 4 dermatology clinics in Ireland over a 6-month time period. The disease prevalence was estimated by calculating the percentage of total patients with a diagnosis of HS (the primary population) across the selected sites. Secondary analyses were performed using the full analysis set, which consisted of eligible adults (≥18 years of age) from the primary population who provided informed consent. Data from these analyses are presented as descriptive summary statistics, with the use of an analysis of covariance for continuous endpoints.

Results

The prevalence of HS across the 4 selected sites was estimated at 1.4% (95% CI, 1.24–1.62). One hundred fifty eligible patients comprised the full analysis set. The majority of participants were white (95%), female (70%), cigarette smokers (56%), and overweight or obese (body mass index ≥25 kg/m², 82%). Most patients presented with Hurley stage II (45%), and more than a third had a relative with HS (35%). Questionnaire responses revealed a profound impact on quality of life, including diminished work productivity and various psychological comorbidities.

Conclusion

This study offers insight into the clinical features and disease burden of hidradenitis suppurativa in an Irish population.

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Milker's nodule:an occupational infection and threat to the immunocompromised

Abstract

Milker's nodule virus, also called paravaccinia virus is a DNA virus of the parapoxvirus genus transmitted from infected cows to humans. It results from contact with cattle, cattle byproducts, or fomites. Classified as an occupational disorder, those at risk of exposure include farmers, butchers, and agricultural tourists. The viral infection begins 5-15 days after inoculation as an erythematous-purple, round nodule with a clear depressed center, and a surrounding erythematous ring. While familiar to those in farming communities, the presence of the nodule may be concerning to others, particularly the immunosuppressed. Milker's nodules are self-limited in immunocompetent individuals and heal without scarring within 8 weeks.

Another member of the Parapoxvirus genus, the orf virus, is also transmitted from animals to humans by direct-contact. While complications are rare, hematopoietic stem cell transplant recipients are at risk of graft-versus-host disease, as the parapoxvirus may trigger these complications in immunocompromised individuals. In addition, paravaccinia may serve as the antigen source for the development of erythema multiforme.

The unique structure and replication process of viruses in the Poxvirus family, while includes the Parapoxvirus genus, have been a focus for treatment of infections and cancer. Manipulation of these viruses has demonstrated promising therapeutic possibilities as vectors for vaccines and oncologic therapy.

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Integration of dermoscopy and reflectance confocal microscopy for distinguishing melanomas from nevi of the breast area

Abstract

Background

Nevi of special sites encompass a class of benign lesions characterized by the presence of atypical clinical and histopathologic features that can be difficult to distinguish from melanoma. Dermoscopy and reflectance confocal microscopy may improve the clinical assessment of melanocytic lesions in order to avoid unnecessary excisions.

Objectives

The aim of this study was to assess the value of specific dermoscopic and confocal criteria in distinguishing melanomas from nevi of the breast area.

Methods

Dermoscopic and confocal images from consecutive patients with at least 1 clinically and/or dermoscopically equivocal melanocytic skin lesion of the breast area were retrospectively evaluated. In this case-control study, only histopathologically-proven melanomas (cases) and nevi (controls) were included. Spearman's coefficients were first calculated to flag significant correlation; then univariate and multivariate logistic regression analysis were performed to assess which factors were independently associated with the histopathological diagnosis. Finally, a mixed dermoscopic/confocal score was created to distinguish nevi from melanomas on the breast area.

Results

The study population included 55 skin lesions of the breast area, 34 (61.8%) nevi and 21 (38.2%) melanomas. Among dermoscopic criteria, atypical network and irregular pigmentation resulted independently associated with melanoma diagnosis (OR: 11.1; 95%CI 1.0-119.9; P:.048 and OR: 6.5; 95%CI 1.1-37.5; P:.037, respectively). Furthermore, on RCM examination the presence of pagetoid cells was an independent positive predictor for melanoma (OR: 38.5; 95%CI 3.9-379.6; P:.002). The mixed score showed high levels of sensitivity and specificity, 95.2% and 82.4%, respectively, which were higher than dermoscopic and confocal evaluations alone.

Conclusion

The combined use of dermoscopy and confocal microscopy in the triage of pigmented lesions of the breast area may help in increasing the diagnostic accuracy and avoiding unnecessary excisions.

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Expression of Janus Kinase 1 in vitiligo & psoriasis before and after narrow band UVB: a case–control study

Abstract

Janus kinases (JAKs) are non-receptor protein tyrosine kinases that are expressed in many tissues. Once the JAKs are activated, a cascade of further signaling events is triggered involving phosphorylation of selected receptor chain tyrosines, binding of signal transducer and activator of transcription (STAT) proteins and phosphorylation of these STATs. Due to their ability to selectively modulate immune function, targeted JAK inhibitors are promising candidates for some skin diseases such as psoriasis and atopic dermatitis. The aim of this study was to assess the level of JAK1 in both vitiligo and psoriasis patients before and after treatment with NB-UVB which is considered a gold standard therapy for both diseases. This study was conducted on 10 patients with psoriasis, 10 patients with vitiligo and 10 controls. JAK1 levels before and after treatment with NB-UVB 311 nm (36 sessions) were measured using Western blot assay. The level of JAK1 was significantly higher in vitiligo and psoriasis patients than controls. There was a decline in the level of JAK1 after treatment, which was statistically significant. VASI and PASI scores of patients decreased after treatment with NB-UVB. In psoriatic patients, the JAK1 level positively correlated with the female participants, disease duration and PASI change. It was concluded that JAK1 plays a role in the pathogenesis of both vitiligo and psoriasis based on its upregulated level before treatment and downregulated level after treatment. This raises the possibility of using the JAK1 inhibitors as targeted immunotherapy for vitiligo and psoriasis.

Estradiol Levels Are Altered in Human Immunodeficiency Virus–Infected Pregnant Women Randomized to Efavirenz-Versus Lopinavir/Ritonavir-Based Antiretroviral Therapy

Abstract

Background

Combination antiretroviral therapy (cART) use in pregnancy has been associated with hormonal dysregulation. We performed a secondary retrospective analysis of longitudinal progesterone and estradiol levels in pregnancy using specimens from the Protease Inhibitors to Reduce Malaria Morbidity in HIV-infected Pregnant Women study, which randomized Ugandan human immunodeficiency virus (HIV)–infected ART-naive women to initiate either lopinavir/ritonavir (LPV/r)–based or efavirenz (EFV)–based cART.

Methods

Three hundred twenty-six women (160 randomized to the EFV arm and 166 women to the LPV/r arm) with at least 1 plasma sample collected during pregnancy were included. Enrollment samples collected prior to cART initiation were used as a cART-naive comparator group. Hormone levels were quantified by enzyme-linked immunosorbent assay.

Results

Estradiol levels were differentially affected by the 2 cART regimens. Exposure to LPV/r was associated with an increase in estradiol (P < .0001), whereas exposure to EFV was associated with a decrease in estradiol (P < .0001), relative to the cART-naive gestationally matched comparator group. Lower estradiol levels correlated with small for gestational age (SGA) (P = .0019) and low birth weight (P = .019) in the EFV arm, while higher estradiol levels correlated with SGA in the LPV/r arm (P = .027). Although progesterone levels were similar between treatment arms, we observed an association between SGA and lower progesterone in the LPV/r arm (P = .04). No association was observed between hormone levels and preterm birth in either arm. Levels of progesterone and estradiol were lower in cases of stillbirth, and levels of both hormones declined immediately prior to stillbirth in 5 of 8 cases.

Conclusions

Combination ART regimens differentially affect estradiol levels in pregnancy, a hormone critical to the maintenance of a healthy pregnancy. Identifying cART regimens that minimize perinatal HIV transmission without contributing to hormonal dysregulation represents an urgent public health priority.

Clinical Trials Registration

NCT00993031.

Mechanical thrombectomy for acute ischemic stroke secondary to infective endocarditis

Abstract

Intravenous thrombolysis is contraindicated in acute ischemic stroke secondary to infective endocarditis. We report our initial experience of six cases with proximal vessel occlusion treated with mechanical thrombectomy. It was safe (no bleeding) and effective (significant, early neurological improvement) and might therefore be useful in this clinical setting.

Risk of Pelvic Inflammatory Disease in Relation to Chlamydia and Gonorrhea Testing, Repeat Testing, and Positivity: A Population-Based Cohort Study

Abstract

Background

There is uncertainty around whether the risks of pelvic inflammatory disease (PID) differ following Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhea) infection. We quantified the risk of PID associated with chlamydia and gonorrhea infection and subsequent repeat infections in a whole-population cohort.

Methods

A cohort of 315123 Western Australian women, born during 1974–1995, was probabilistically linked to chlamydia and gonorrhea testing records and to hospitalizations and emergency department presentations for PID from 2002 to 2013. Time-updated survival analysis was used to investigate the association between chlamydia and gonorrhea testing, and positivity, and risk of PID.

Results

Over 3199135 person-years, 120748 women had pathology test records for both chlamydia and gonorrhea, 10745 chlamydia only, and 653 gonorrhea only. Among those tested, 16778 (12.8%) had ≥1 positive chlamydia test, 3195 (2.6%) ≥1 positive gonorrhea test, and 1874 (1.6%) were positive for both. There were 4819 PID presentations (2222 hospitalizations, 2597 emergency presentations). Adjusting for age, Aboriginality, year of follow-up, health area, and socioeconomic status, compared to women negative for chlamydia and gonorrhea, the relative risk (adjusted incidence rate ratio) of PID was 4.29 (95% confidence interval [CI], 3.66–5.03) in women who were both chlamydia and gonorrhea positive; 4.54 (95% CI, 3.87–5.33) in those only gonorrhea positive; and 1.77 (95% CI, 1.61–1.94) in those only chlamydia positive.

Conclusions

Gonorrhea infection conferred a substantially higher risk than chlamydia of hospitalization or emergency department presentation for PID. The emergence of gonorrhea antimicrobial resistance may have a serious impact on rates of PID and its associated reproductive health sequelae.

Cost-effectiveness of community-based HIV self-testing in Blantyre, Malawi

Abstract

Background

HIV self-testing (HIVST) is effective, with scale-up underway in sub-Saharan Africa. We assessed cost-effectiveness of adding HIVST to existing facility-based HIV testing and counselling (HTC) services. Both 2010 (initiate at CD4<350 cells/μl) and 2015 (initiate all) WHO guidelines for antiretroviral treatment (ART) were considered.

Methods

A microsimulation model was developed that evaluated cost-effectiveness, from both health provider and societal perspectives, of an HIVST service implemented in a cluster-randomised trial (CRT) (ISRCTN02004005) in Malawi. The economic model drew upon health outcomes data observed in the CRT, and primary health economic studies undertaken in the trial population. Costs and health outcomes were evaluated over a 20-year time horizon, using a discount rate of 3%. Probabilistic sensitivity analysis was conducted to account for parameter uncertainty.

Results

From the health provider perspective and 20-year time horizon, facility HTC using 2010 WHO ART guidelines was the least costly (US$294.71 per person, 95%CrI:270.79-318.45) and least effective (11.64 QALYs per person, 95%CrI:11.43-11.86) strategy. Compared to this strategy, the incremental cost-effectiveness ratio (ICER) for facility HTC using 2015 WHO ART guidelines was US$226.85 (95%CrI:198.79-284.35) per quality-adjusted life year (QALY) gained. The strategy of facility HTC plus HIVST, using 2010 WHO ART guidelines, was extendedly dominated. The ICER for facility HTC plus HIVST, using 2015 WHO ART guidelines, was US$253.90 (95%CrI:201.71-342.02) per QALY gained compared with facility HTC and using 2015 WHO ART guidelines.

Conclusions

HIVST may be cost-effective in a Malawian population with high HIV prevalence. HIVST is suited to an early HIV diagnosis and treatment strategy.

Correlation between microcirculation and contrast-enhanced ultrasonography after crush injury of limbs

Abstract

Purpose

To explore the microcirculation formation mechanism of contrast-enhanced (CE) ultrasonography imaging performance in rabbits with limb muscle crush injury.

Methods

Seventy-two New Zealand white rabbits were randomly divided into two groups. A limb muscle crush injury model was created by airing a balloon cuff device with a force of 40 kpa. CE ultrasonography parameters were detected in the first group. In vivo microcirculation parameters were detected in the second group. Fine blood vessel diameter and blood flow velocity were calculated before extrusion and 0.5, 2, 6, 24 h, and 3 days after decompression.

Results

Compared with the uninjured muscle, reperfusion of the injured muscles showed early and high enhancement in CE ultrasonography images. The time-intensity curve showed a trend of rapid elevation and gradual drop. Compared with the control group, fine artery and vein diameters in the experimental group were wider and the blood flow velocity was slower, especially in the fine veins.

Conclusion

In vivo microcirculation detection can reflect changes in muscle microvascular diameter and blood flow velocity, which have a correlation with quantitative ultrasound imaging parameters.

Immediate Enhancement of Nerve Function Using a Novel Axonal Fusion Device After Neurotmesis

Background: The management of peripheral nerve injuries remains a large challenge for plastic surgeons. With the inability to fuse axonal endings, results after microsurgical nerve repair have been inconsistent. Our current nerve repair strategies rely upon the slow and lengthy process of axonal regeneration (~1 mm/d). Polyethylene glycol (PEG) has been investigated as a potential axonal fusion agent; however, the percentage of axonal fusion has been inconsistent. The purpose of this study was to identify a PEG delivery device to standardize outcomes after attempted axonal fusion with PEG. Materials and Methods: We used a rat sciatic nerve injury model in which we completely transected and repaired the left sciatic nerve to evaluate the efficacy of PEG fusion over a span of 12 weeks. In addition, we evaluated the effectiveness of a delivery device's ability to optimize results after PEG fusion. Results: We found that PEG rapidly (within minutes) restores axonal continuity as assessed by electrophysiology, fluorescent retrograde tracer, and diffusion tensor imaging. Immunohistochemical analysis shows that motor axon counts are significantly increased at 1 week, 4 weeks, and 12 weeks postoperatively in PEG-treated animals. Furthermore, PEG restored behavioral functions up to 50% compared with animals that received the criterion standard epineurial repair (control animals). Conclusions: The ability of PEG to rapidly restore nerve function after neurotmesis could have vast implications on the clinical management of traumatic injuries to peripheral nerves.

Buccal Mucosa Neourethras Grow Proportionally After Puberty

No abstract available

A Low-Cost Simulator for Training in Endoscopic-Assisted Transaxillary Dual-Plane Breast Augmentation

Background: Endoscopic-assisted transaxillary dual-plane (EATD) technique is a popular procedure for breast augmentation, especially for Chinese women. However, frustration is often expressed by plastic surgeons when first attempting EATD surgery. Simulation-based teaching is beneficial for EATD training, but it is expensive. This study presents a low-cost simulator to help plastic surgeons exercise psychomotor skills during EATD surgery. Methods: The low-cost simulator was invented by Dr Jie Luan (the senior author) and made of some easily available materials including a mannequin, a T-shirt printed the bottom anatomical structure of the chest, the order of dissection, and the potential bleeding spot, and an elastic compression garment printed the upper anatomical structure and the cut-off position to sever the pectoralis major muscle. The first-year residents of plastic surgery assessed their improvement by completing a 5-item evaluation questionnaire at the beginning and at the end of the simulation. Results: Fifty participants enrolled in this study. There was a significant difference (P

Application of Epineural Sheath as a Novel Approach for Fat Volume Maintenance

Introduction: Various methods have been suggested to improve fat graft survival and decrease graft loss. The exact mechanism of fat graft survival is still unclear, and new strategies are needed to further investigate it. Materials and Methods: The efficacy of epineural sheath in fat volume maintenance was tested in rat model. Five experimental groups were created: group 1, fat graft without any coverage; group 2, epineural sheath tube alone; group 3, epineural sheath tube filled with fat graft; group 4, fat graft mixed with minced epineural sheath without any coverage; and group 5, fat graft covered with the epineural sheath patch. All grafts were implanted into the dorsal subcutaneous region and were followed for up to 12 weeks, when samples were harvested for hematoxylin and eosin and immunostaining for vascular endothelial growth factor expression and perilipin evaluation of fat viability. Results: In groups 1 and 4, over 25% of graft loss was observed at first week, over 50% at third week, and 100% at sixth week postimplantation. The weight of fat graft within the epineural sheath tube and the weight of epineural tube (ET) alone were maintained up to 12 weeks postimplantation. The weight of fat graft within the epineural patch was maintained up to 6 weeks, but 50% of weight loss was observed between 6 and 12 weeks. Structure of the epineural sheath tubes and patches was intact, and no leakage of fat graft was observed. Based on hematoxylin and eosin staining, normal structure and integrity of the fat graft within the ET were preserved up to 12 weeks postimplantation. Characteristic adipocyte morphology was confirmed by perilipin staining, showing viable fat cells in groups 3 and 5 at 12 weeks. Increased vascular endothelial growth factor expression was observed in groups 2, 3, 4, and 5. Conclusions: Both, the ETs and epineural patches maintained 100% and 50% of fat graft weight at 12 weeks postimplantation, respectively. These results were confirmed by histology and immunostaining showing viable adipocytes within the epineural patches (6 weeks) and tubes (12 weeks). These results are encouraging and justify further evaluation of fat volume maintenance in preclinical large animal model in preparation to clinical application.

Smartphone-Based Patient Education in Plastic Surgery

Background: Internet use for health information has dramatically increased in the past decade. Mobile medical applications (MMAs) could be a useful tool to improve postoperative patient education and care. The objective of this study is to evaluate the impact of an MMA on patient care in plastic surgery. Methods: An MMA was developed to improve postoperative plastic surgery patients care. All patients who underwent surgery at our plastic surgery department between August and November 2014 and were willing to download the MMA were included. Two to 4 weeks after the procedure, the patients were asked to fill a questionnaire that assessed the content, design, and efficacy of the application. Results: Sixty patients were included. The patients reported that their questions regarding the postoperative management were addressed by the application with a mean score of 4.1 over 5. Most patients would recommend the application to other plastic surgery patients with a mean score of 4.6 over 5. The application prevented 12 patients (20%) from calling the plastic surgeon or the emergency department. Conclusions: A smartphone application can optimize the plastic surgery patient care. It can provide additional information allowing the patients to get involved in their own medical care.

Enhanced Informed Consent in Hand Surgery: Techniques to Improve the Informed Consent Process

No abstract available

Book Review: Dupuytren Disease and Related Diseases: The Cutting Edge

No abstract available

Multiple Tissue Expansion for Giant Congenital Melanocytic Nevus

Objective: Tissue expansion is the preferred technique for the treatment of giant congenital melanocytic nevus (GCMN) located on the face, abdomen, and legs. We believe that the use of multiple tissue expanders in the same surgery is a safe and effective technique for the treatment of GCMN. Materials and Methods: A total of 14 patients were treated between 2013 and 2016 for GCMN removal with placement in the same surgery of 3 or more tissue expanders. We analyzed esthetic results and complications. Results: The locations of the GCMN on the 14 patients were on the abdomen, thigh, and shoulder. The number of tissue expanders placed was 3 in 5 patients, 4 in 6 patients, 5 in 1 patient, and 6 in 2 patients. The average stay was 4.29 days (1–9 days), and the average time until the removal of the expanders was 84.71 days (47–127 days). Only 2 patients had postoperative complications, with one having dehiscence of the surgical wound and the other an infection of the expander. Conclusions: The use of multiple tissue expanders for GCMN is a safe technique that reduces the number of surgical interventions, achieving a total excision of the nevus in less time and at a younger age. The esthetic results are similar, and we have not observed a higher rate of complications.

Absence of an Additional Metabolic Effect of Body Contour Surgery in Patients With Massive Weight Loss After Laparoscopic Roux-En-Y Gastric Bypass

Introduction: Body contour surgery (BCS) is a combination of soft tissue resections that have proven to be an effective treatment for the aesthetic and functional problems related to massive weight loss (MWL). There are no studies analyzing the metabolic effect of large volume adipose tissue flap resection in patients with MWL after bariatric surgery. Methods: This study was a retrospective review of adults who underwent BCS after gastric bypass. Preoperative clinical and laboratory data were compared with 1- and 2-year postoperative follow-up. Results: A total of 62 patients with a mean age of 41 years were analyzed. Seventy-nine percent of them were women. Most procedures included abdominal flap resection alone or in combination with other areas. Mean resected tissue weight was 6.2 kg. We found that weight and body mass index (BMI) were lower 1 year after BCS (P

Cell-Based Soft Tissue Reconstruction in a Hydrogel Scaffold

Background: Renevia is a hyaluronin-gelatin crosslinked matrix scaffold that has been studied as an alternative to adipose transfer in soft tissue reconstruction. It is designed to emulate the native extracellular matrix environment by supporting stromal vascular fraction (SVF) cell attachment, survival, and proliferation, thus promoting cell-based volume restoration. However, the concentration of incorporated cells for a clinically relevant result has yet to be determined. Methods: Five experimental groups of seven CD-1 nude immunodeficient mice were given 250 μL grafts of the following composition: 1 million human SVF cells per mL of Renevia scaffold, 6 million human SVF cells per mL scaffold, 12 million human SVF cells per mL scaffold, Renevia scaffold-alone or human adipose tissue–alone. Volumetric analysis was conducted at discrete time points over 16 weeks using 3-dimensional ultrasound, after which time the grafts were explanted for histologic analysis. Results: At the conclusion of the study at week 16, the Renevia scaffold group incorporating the highest concentration of human SVF cells (12 million cells per mL scaffold) had significantly greater volume retention compared with the 2 lower concentrations, scaffold-alone and fat-alone groups. Histology of the 12 million scaffold group revealed abundant adipocyte formation within the scaffold, exceeding that observed in the 6 million, 1 million, and scaffold-alone groups. The 12 million group also demonstrated significantly increased vascularity per CD31 staining. Conclusions: Stromal vascular fraction cells coupled with Renevia hydrogel scaffold can enhance soft tissue volume reconstruction. In this study, we observed the greatest effect with 12 million cells per mL. From the perspective of volume retention, incorporation of higher concentrations of SVF cells with Renevia may be an alternative to conventional adipose tissue grafting.

Effect of Drain Placement on Infection, Seroma, and Return to Operating Room in Expander-Based Breast Reconstruction

Introduction: There is significant variability in the location and management of drains in breast reconstruction, with most surgeons attempting to shorten the duration of drains while preventing complications possibly related to early removal. The aim of this work was to compare our experiences with placement of 1 versus 2 drains in tissue expander breast reconstruction. Methods: This is a retrospective cohort study comparing 2 groups of patients after breast tissue expander placement in a complete submuscular pocket and without the use of acellular dermal matrix. In the first group, a single subcutaneous drain was placed; in the second group, both a subcutaneous and a submuscular drain were placed. These groups were evaluated on their relative duration of drain placement, incidence of seroma formation, incidence of infection, and rates of complication necessitating return to operating room (OR). Results: The single-drain group was found to have a significantly shorter duration of drain placement (14.58 vs 22.84 days, P =

Plastic and Reconstructive Surgeons and Zika Virus Infection

No abstract available

Barbed Ribbon Device for Progressive Tension Closure Reduces Seroma After Breast Reconstruction

Purpose: Implant-based breast reconstruction is fraught with complications related to seroma formation. Soft tissue stabilization with progressive tension closure (PTC) has been shown to decrease seroma formation after various procedures but is less suitable for mastectomy flap stabilization. We evaluate the incidence of seroma in breast reconstruction using bioabsorbable barbed ribbon devices (BRDs) as a novel approach to PTC. Methods: We performed a retrospective review of all patients whose mastectomy flaps were stabilized with BRDs. These patients were compared with consecutive patients who underwent mastectomy and reconstruction without progressive tension flap stabilization. Patient demographics and outcomes were recorded, including comorbidities, complications, presence of seroma, and total drain days. Results: In the BRD-PTC group, there were 36 breasts compared with 56 in the nonstabilized control group. There were no significant differences in rate of tobacco use, age, or body mass index. We identified 11 seromas in the control group (19.6%) and none in the intervention group (P = 0.05). In the PTC group, drains were removed an average of 5 days sooner than those in controls (P = 0.006). Conclusion: Progressive tension stabilization of mastectomy flaps with BRD significantly reduces seroma formation and the duration for which closed suction drainage is required.

Different Recipient Vessels for Free Microsurgical Fibula Flaps in the Treatment of Avascular Necrosis of the Femoral Head: A Systematic Review and Meta-analysis

Background: Several recipient vessels can be used in free microsurgical fibula flaps (MFFs) for the treatment of avascular necrosis of the femoral head (ANFH). Few articles investigate the influence of different recipient vessels on outcomes of MFF for ANFH. Methods: A comprehensive literature search of databases including PubMed-Medline, Ovid-Embase, and Cochrane Library was performed to collect the related studies. The Medical Subject Headings used were "femur head necrosis" and "bone transplantation." The relevant words in title or abstract included but not limited to "fibula flap," "fibular flap," "vascularized fibula," "vascularized fibular," "free fibula," "free fibular," "femoral head necrosis," "avascular necrosis of femoral head," and "ischemic necrosis of femoral head." The methodological index for nonrandomized studies was adopted for assessing the studies included in this review. Results: Finally, 15 studies encompassing a total of 1267 patients (1603 hips) with ANFH were pooled in the overall analysis. Recipient vessels for MFF included the ascending branch of the lateral circumflex femoral artery and vein in 8 studies, descending branch of the lateral circumflex femoral artery and vein in 2 studies, second perforating branch of the deep femoral artery and vein in 4 studies, and inferior gluteal artery and vein in 1 study. Preoperative and postoperative average Harris hip score and pooled analyses of the rate of conversion, radiographic progression, and hip surgery–related complications showed no significant difference on the outcomes of MFF on ANFH between using different recipient vessels. Conclusions: Different recipient vessels did not affect outcomes in MFF procedures for ANFH. High-quality randomized controlled trials and prospective studies would be necessary to clarify reliable advantages and disadvantages between different recipient vessels. Until then, surgeons are justified in using ascending branch of the lateral circumflex femoral artery and vein, descending branch of the lateral circumflex femoral artery and vein, second perforating branch of the deep femoral artery and vein, and inferior gluteal artery and vein vessels according to care circumstances and customary practice.

Role of Homeodomain-Interacting Protein Kinase 2 in the Pathogenesis of Tissue Fibrosis in Keloid-Derived Keratinocytes

Abstract: Epithelial-mesenchymal transition (EMT) plays a critical role in fibrotic keloid formation, which is characterized by excessive collagen and extracellular matrix synthesis and deposition. Growing evidence suggests that the serine/threonine kinase homeodomain-interacting protein kinase 2 (HIPK2) acts upstream of several major fibrosis signaling pathways; however, the role of HIPK2 in the keloid fibrogenesis remains unknown. In the current study, we investigated the roles of HIPK2 in the pathogenesis of keloids. Primary normal skin and keloid keratinocytes were cultured and pretreated with transforming growth factor (TGF)–β1. Next, keratinocytes were transfected with scrambled small interfering RNA (siRNA) and anti-HIPK2 siRNA. The TGF-β1–associated HIPK2 alterations were investigated by quantitative real-time polymerase chain reaction. Protein levels were analyzed by western blotting. The HIPK2 was markedly increased in the keloid-derived keratinocytes compared with normal skin keratinocytes. In addition, HIPK2 induced the expression of EMT markers in normal skin keratinocytes by TGF-β1–SMAD family member 3 (SMAD3). The effect of TGF-β1–related EMT markers and SMAD3 phosphorylation in response to added TGF-β1 was significantly abrogated when the cells were transfected with HIPK2 siRNA. We conclude that HIPK2 is a crucial factor in the pathogenesis of keloids, suggesting that HIPK2 might be a novel potential drug target for antikeloid therapy.

Plastic Surgery Management of Victims of Terrorist Violence in Ankara, Turkey

Abstract: Terror attacks have been progressively increasing worldwide through the present era. The management of the consequences of terrorism events is under debate in almost every scientific area. The organization and advancement of health services constitute important components of the crisis management. Similar to other specialty areas in medicine, the medical management of terrorist attacks is becoming important in terms of plastic and reconstructive surgery. Ankara, the capital of Turkey, has been subject to 2 terrorist events in public places within a year. The total number of patients involved in both cases was 434. Ankara Numune Training and Research Hospital is a tertiary health care institution and one of the most important trauma centers in the region. A total of 178 Patients exposed to these events referred to our hospital. Of the total, 34 patients were completely or partially treated in the plastic and reconstructive surgery clinic. In this study, we tried to discuss the difficulties encountered in the classification of patients and plastic surgery during the treatment period of patients who experienced these attacks. Data were obtained from The National News Agency, hospital, and our own clinic registries. Patient classification was based on the injured parts of the body. Statistical analysis was performed for all data. In conclusion, the role and the importance of plastic surgery department especially in trauma management have been emphasized in the light of our findings.

Fat Graft Survival After Recipient Site Pretreatment With Fractional Carbon Dioxide Laser

Background: Fat grafting is a commonly performed procedure not only for augmenting the soft tissue but also for regeneration in esthetic and reconstructive plastic surgery. However, unpredictable fat survival rate because of high resorption rate is remained as the main problem. The purpose of this study was to investigate the effect of pretreatment of the recipient site to the fat survival using fractional carbon dioxide (CO2) laser. Methods: The rats were divided to 2 groups. Inguinal fat pads of rats were transplanted to the dorsum without pretreatment in the control group. The study group was preconditioned by fractional CO2 laser to the recipient site 1 week before fat graft. The pulse energy was set to 100 mJ. Transplanted fat tissues were harvested at postoperative days 1, 3, 7, 14, and 28 and were analyzed morphologically, histologically, and immunohistochemically. Results: Weight and volume in the control group was more decreased than in the study group at postoperative day 28. Histological evaluation showed less inflammation, less fibrosis, less vacuolization, and better integrity of adipocytes. Immunohistologically, microvessel density in the study group was higher than in the control group (P

Risk Factors for Urethrocutaneous Fistula Repair After Hypospadias Surgery: A Retrospective Study

Objectives: We review our experience in urethrocutaneous fistula (UCF) repair after hypospadias surgery to investigate the risk factors for unsuccessful outcome. Methods: Two hundred eleven patients had undergone UCF repair in our department from January 2005 to December 2015. This study included 185 patients who were followed up for more than 6 months. The age of patients, size, site and number of UCFs, number of UCF repairs, urethral complications other than UCF, and postoperative infection were included as potential risk factors. Binary logistic regression analysis was used for multivariate analysis. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated. Stratified analysis and assessment of additive interaction were performed to have a better understanding of the relation between the risk factors. Results: Urethrocutaneous fistula repairs failed in 38 patients (20.5%) at first attempt. In the univariate analysis, size of UCFs (P = 0.012), times of UCF repair (P = 0.008), and postoperative infection (P = 0.044) were statistically related with the outcome of surgery. In the multivariate analysis, only the size of UCFs (P = 0.030; adjusted OR, 2.42; 95% CI, 1.09–5.36) and times of repair (P = 0.008; adjusted OR, 3.09; 95% CI, 1.35–7.07) were identified as risk factors for unsuccessful outcome. We had consistent results in the stratified analysis. No additive or multiplicative interaction between the 2 risk factors was found. Conclusions: Our study suggested that UCF repairs after hypospadias surgery were easier to fail if one of the UCFs was larger than 2 mm or it had been repaired repeatedly. But when both factors existed, the increase of the risk was not statistically significant. The age of patients, site and number of UCFs, complications other than UCF, and postoperative infection were not significantly related to the success rate of UCF repair.

Characteristics, Management Techniques, and Outcomes of the Most Common Soft-Tissue Hand Tumors: A Literature Review and Our Experience

Introduction: Diagnosis of the hand's soft-tissue tumors is often difficult because of the different anatomic structures present in this region and yet clinicians must be able to distinguish typical benign entities from life-threatening or limb-threatening malignant diseases. Materials and Methods: At the Department of Plastic and Reconstructive Surgery at the University of Palermo, 629 patients with hand tumors were studied. Treatment was surgical for all of them; also radiotherapy and chemotherapy were necessary based on the histological diagnosis. Conclusions: Our retrospective study with a literature review aims to present the most commonly observed soft-tissue hand lesions, analyzing their causes, their objective and instrumental evaluation, and their treatments.

Is Article Methodological Quality Associated With Conflicts of Interest?: An Analysis of the Plastic Surgery Literature

Purpose: Conflicts of interest (COI) are an emerging area of discussion within the field of plastic surgery. Recently, several reports have found that research studies that disclose COI are associated with publication of positive outcomes. We hypothesize that this association is driven by higher-quality studies receiving industry funding. This study aimed to investigate the association between industry support and study methodological quality. Methods: We reviewed all entries in Plastic and Reconstructive Surgery, Annals of Plastic Surgery, and Journal of Plastic, Reconstructive, and Aesthetic Surgery within a 1-year period encompassing 2013. All clinical research articles were analyzed. Studies were evaluated blindly for methodology quality based on a validated scoring system. An ordinal logistic regression model was used to examine the association between methodology score and COI. Results: A total of 1474 articles were reviewed, of which 483 met our inclusion criteria. These articles underwent methodological quality scoring. Conflicts of interest were reported in 28 (5.8%) of these articles. After adjusting for article characteristics in the ordinal logistic regression analysis, there was no significant association between articles with COI and higher methodological scores (P = 0.7636). Conclusions: Plastic surgery studies that disclose COI are not associated with higher methodological quality when compared with studies that do not disclose COI. These findings suggest that although the presence of COI is associated with positive findings, the association is not shown to be driven by higher-quality studies.

How Well is the Medical Home Working for Latino and Black Children?

Abstract

Objective To examine the benefits of having a medical home among Latino and Black school-aged children, both with and without special health care needs (CSHCN). Methods Data from the 2011–2012 National Survey of Children's Health (NSCH) were analyzed to examine the associations of preventive dental and medical care, unmet dental or medical care, or missed school days with having a medical home among Latino and Black children compared to White children. Multivariate logistic regression with survey weights was used to adjust for child, parent, home, and geographic characteristics and an interaction term to estimate differences in outcomes among Black or Latino children receiving care in a medical home compared to White children with a medical home. Results Approximately 35% of Latino CSHCN and Latino non-CSHCN ages 6–17 years of age had a medical home. In the adjusted model comparing the effectiveness of the medical home by race and ethnicity, Latino non-CSHCN compared to White non-CSHCN were associated with lower odds of having one or more preventive dental visit in the last 12 months (OR 0.66; 95% CI 0.46–0.95) and no other associations between having a medical home and outcomes were found among Latinos compared to Whites regardless of non-CSHCN or CHSCN status. Meanwhile, having a medical home among Black non-CHSCN and CHSCN, compared to their White counterparts, showed potential benefits in regards to unmet medical care needs after adjusting for covariates, (OR 0.15; 95% CI 0.06–0.35; OR 0.16; 95% CI 0.05–0.55). Conclusions Medical homes may not be effective in delivering health services to the majority of Latino children but provide some benefit to Black children with and without CSHCN. Alternatively, the medical home may function differently for Latinos due to the specific medical home components measured by NSCH.

Natural and anthropogenic particulate-bound aliphatic and polycyclic aromatic hydrocarbons in surface waters of the Gulf of Gabès (Tunisia, southern Mediterranean Sea)

Abstract

Particulate-bound aliphatic and polycyclic aromatic hydrocarbons (AHs and PAHs) were investigated in the surface waters of the Gulf of Gabès (Tunisia, southern Mediterranean Sea). Samples were collected off the Sfax and Gabès-Ghannouch coasts. Concentrations in total resolved n-alkanes ranged from 0.03 to 3.2 μg L⁻¹, and concentrations in total parents + alkylated PAHs ranged from bdl to 108.6 ng L⁻¹. The highest concentrations were recorded in the southern Sfax. AHs were mainly of biogenic origin with odd n-alkane predominance, although an anthropogenic contribution was also detected. The PAH molecular patterns revealed a mixed origin with the presence of low molecular weight and alkylated compounds, characteristic of uncombusted oil-derived products, and the presence of high molecular weight compounds, typical of combustion residues. Rainfall events induced an increase in PAH concentrations by a factor 1.5–23.5. The particle-water partition coefficients (K_oc) suggest that the partitioning of PAHs between the particulate and dissolved phases is driven by hydrophobicity and organic matter composition.

Determination of membrane disruption and genomic DNA binding of cinnamaldehyde to Escherichia coli by use of microbiological and spectroscopic techniques

Publication date: Available online 10 November 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Tian-Fu He, Zhi-Hong Zhang, Xin-An Zeng, Lang-Hong Wang, Charles S. Brennan
This work was aimed to investigate the antibacterial action of cinnamaldehyde (CIN) against Escherichia coli ATCC 8735 (E. coli) based on membrane fatty acid composition analysis, alterations of permeability and cell morphology as well as interaction with genomic DNA. Analysis of membrane fatty acids using gas chromatography–mass spectrometry (GC–MS) revealed that the proportion of unsaturated fatty acids (UFA) and saturated fatty acids (SFA) were the major fatty acids in plasmic membrane, and their levels were significantly changed after exposure of E. coli to CIN at low concentrations. For example, the proportion of UFA decreased from 39.97% to 20.98%, while the relative content of SFA increased from 50.14% to 67.80% as E. coli was grown in increasing concentrations of CIN (from 0 to 0.88mM). Scanning electron microscopy (SEM) showed that the morphology of E. coli cells to be wrinkled, distorted and even lysed after exposure to CIN, which therefore decreased the cell viability. The binding of CIN to genomic DNA was probed using fluorescence, UV–Visible absorption spectra, circular dichroism, molecular modeling and atomic force microscopy (AFM). Results indicated that CIN likely bound to the minor groove of genomic DNA, and changed the secondary structure and morphology of this biomacromolecule. Therefore, CIN can be deem as a kind of natural antimicrobial agents, which influence both cell membrane and genomic DNA.

Mitochondrial gene expression changes in cultured human skin cells following simulated sunlight irradiation

Publication date: Available online 10 November 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): J. Kelly, J.E. Murphy
BackgroundExposure of skin to simulated sunlight irradiation (SSI) has being extensively researched and shown to be the main cause for changes in the skin including changes in cellular function and generation of reactive oxygen species (ROS). This oxidative stress can subsequently exert downstream effects and the subcellular compartments most affected by this oxidative stress are mitochondria.The importance of functional mitochondrial morphology is apparent as morphological defects are related to many human diseases including diabetes mellitus, liver disease, neurodegenerative diseases, aging and cancer.ObjectiveThe main objective of this study was to evaluate solar radiation-induced changes in mitochondrial gene expression in human skin cells using a Q-Sun solar simulator to deliver a close match to the intensity of summer sunlight.MethodsSpontaneously immortalised human skin epidermal keratinocytes (HaCaT) and Human Dermal Fibroblasts (HDFn) were divided into two groups. Group A were irradiated once and Group B twice 7days apart; following irradiation, mitochondrial gene expression was evaluated 1, 4 and 7days post primary exposure for group A and 1, 4, 7 and 14days post-secondary exposure for group B.ResultsBoth the epidermal and dermal cells displayed significant reduced expression of the genes analysed for mitochondrial morphology and function; however, epidermal cells displayed this reduction post SSI earlier then dermal cells at multiple time points.ConclusionThe data presented here reinforces the fact that epidermal cells, while displaying a heightened sensitivity to sunlight, are less prone to changes in gene expression, while dermal cells, which appear to be more resilient are possibly more prone to genomic instability and mitochondrial damage.

Biopolymer gelatin-coated zinc oxide nanoparticles showed high antibacterial, antibiofilm and anti-angiogenic activity

Publication date: Available online 10 November 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Mani Divya, Baskaralingam Vaseeharan, Muthukumar Abinanya, Sekar Vijayakumar, Marimuthu Govindarajan, Naiyf S. Alharbi, Shine Kadaikunnan, Jamal M. Khaled, Giovanni Benelli
The use of natural polymers in drug design plays an important role in biomedical applications. Combinations of nanoparticles (NPs) and biopolymers have been shown to be useful for many purposes. This study focused on gelatin-coated zinc oxide NPs synthesized by co-precipitation. The particles were characterized by UV–Vis, showing a main peak at 375nm. The stability and crystalline nature of the particle was evaluated by Zeta potential and X-ray diffraction analyses. Fourier transform infrared spectroscopy (FTIR) revealed the possible functional groups of Ge-ZnO NPs with strong bands at 3851, 3447, and 2923cm⁻¹. Moreover, transmission electron microscopy (TEM) revealed spherically shaped Ge-ZnO NPs that were 20nm in size. Energy dispersive analysis X-ray (EDX) analysis showed that the zinc elemental content of Ge-ZnO NPs was 59.10%. The results for antibacterial activity revealed higher inhibition of Ge-ZnO NPs against Gram-negative Pseudomonas aeruginosa at 100μg/mL than that against Gram-positive Enterococcus faecalis. Greater inhibition of biofilm formation was observed for Gram-negative bacteria compared to that for Gram-positive bacteria. In addition, Ge-ZnO NPs effectively inhibit the biofilm growth of the fungus Candida albicans at 50μg/mL. Ge-ZnO NPs reduced the viability of hepatocarcinoma cancer cell lines at a concentration of 100μg/mL. Moreover, in chick embryos, notable anti-angiogenesis effects were observed for Ge-ZnO NPs and zinc acetate at 50μg/mL compared to that observed for gelatin. Overall, based on the results, Ge-ZnO NPs may be used as a nutraceutical agent for the control of biofilm forming microbial pathogens.

Graphical abstract

Evaluation of 4 Outcomes Measures in Microtia Treatment: Exposures, Infections, Aesthetics, and Psychosocial Ramifications

Background:In craniofacial microsomia, microtia and canal atresia pose formidable reconstructive challenges. We review our institutional experience in treating microtia and atresia to identify variables associated with 4 outcomes measures: complications, surgical revisions, aesthetic outcomes, and psychosocial function. Methods:Craniofacial microsomia patients treated at the University of California Los Angeles Craniofacial Clinic between 2008 and 2014 greater than 13 years of age (n = 68) were reviewed for microtia and atresia treatment and outcomes. Results:In total, 91.2% of patients diagnosed with craniofacial microsomia presented with microtia, affecting 75 ears. Both a male and right-sided predominance were observed. Fifty-six patients (90.3%) underwent autologous external ear reconstruction at an average age of 8.5 years. Age, type of incision, and size of cartilage framework did not predict total number of surgeries or complications. Severity of ear anomalies correlated with increased number of surgeries (P

Oxidative removal of metronidazole from aqueous solution by thermally activated persulfate process: kinetics and mechanisms

Abstract

Metronidazole (MNZ) is widely used in clinical applications and animal feed as an antibiotic agent and additive, respectively. Widespread occurrence of MNZ in wastewater treatment and hospital effluents has been reported. In this study, the mechanism of MNZ degradation in aqueous solutions via thermally activated persulfate (TAP) process was established under different conditions. The kinetic model was derived for MNZ degradation and followed pseudo-first-order reaction kinetics and was consistent with the model fitted by experimental data (R ² > 98.8%). The rate constant increased with the initial dosage of persulfate, as well as the temperature, and the yielding apparent activation energy was 23.9 kcal mol⁻¹. The pH of the solutions did not have significant effect on MNZ degradation. The degradation efficiency of MNZ reached 96.6% within 180 min for an initial MNZ concentration of 100 mg L⁻¹ under the optional condition of [PS]₀ = 20 mM, T = 60 °C, and unadjusted pH. \( {SO}_4^{\cdotp -} \) and HO ^· were confirmed using electron paramagnetic resonance (EPR) spectra during TAP process. Radical quenching study revealed that \( {SO}_4^{\cdotp -} \) was mainly responsible for MNZ degradation at an unadjusted pH. MNZ mineralization evaluation showed that the removal efficiency of total organic carbon (TOC) reached more than 97.2%.

Quality assessment of atopic dermatitis clinical practice guidelines in ≤ 18 years

Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects the patients' quality of life greatly often from a very young age. Its worldwide incidence in children and adults varies, but it is usually among the first ten causes of dermatological consultation worldwide. There is a wide variety of treatment options for this condition including topical and systemic regimes. The decision to choose a treatment option in dermatological diseases is greatly influenced by the personal experience of each specialist, which increases variability in the selection of available therapies. Clinical practice guidelines (CPGs) not only offer recommendations supported on the available scientific evidence, but also are intended to assist in making appropriate decisions in clinical scenarios. To standardize the way in which CPGs should be developed, an instrument called AGREE II (Appraisal of Guidelines for Research and Evaluation) is used. In this study, ten clinical practice guidelines in ≤ 18 years were evaluated. Six domains (scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence) were assessed for each guideline, by three reviewers. Most of the domains obtained high scores except in the applicability domain. It is suggested that future atopic dermatitis CPGs should emphasize in the facilitating factors and barriers that may influence the application of guideline recommendations.

Erasmus Mundus Master of Bioethics: a case for an effective model for international bioethics education

Abstract

Designing bioethics curriculum for international postgraduate students is a challenging task. There are at least two main questions, which have to be resolved in advance: (1) what is a purpose of a particular teaching program and (2) how to respectfully arrange a classroom for students coming from different cultural and professional backgrounds. In our paper we analyze the case of the Erasmus Mundus Master of Bioethics program and provide recommendations for international bioethics education. In our opinion teaching bioethics to postgraduate international students goes beyond curriculum. It means that such a program requires not only well-defined goals, including equipping students with necessary skills and knowledge, but also it should first and foremost facilitate positive group dynamics among students and enables them to engage in dialogue to learn from one another.

Dermatology and its unique diagnostic heuristics

Publication date: Available online 10 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Eve J. Lowenstein

Anatomical Study of Cutaneous Venous Flow of the Palm.

Related Articles

Anatomical Study of Cutaneous Venous Flow of the Palm.

Ann Plast Surg. 2017 Apr;78(4):448-454

Authors: Kim BK, Kwon H, Imanishi N, Chang H

Abstract
BACKGROUNDS: Various flaps elevated from the palm have been widely used for finger and hand reconstruction. Recently, perforator-based free flaps or venous free flaps have received popularity due to several advantages. The cutaneous venous system has been chosen as the circulatory outlet when designing and harvesting the flap from the palmer area due to the small size and thin nature of the flap. However, there have been few descriptions about the anatomy of the palmar cutaneous veins. A more detailed knowledge will be valuable for elevating various flaps from the palmar area.
METHODS: Whole-body and hand venography with a contrast medium was performed on 9 fresh cadavers. Dissection and investigation of the skin and subcutaneous tissue were performed using a soft x-ray system with a stereogram. During all the processes that involved elevating the tissue, observations were made on the macroscopic structure of the palmar vein.
RESULTS: In the palm, a complex network of veins are connected with the distal branches of the cephalic vein, basilic vein, and dorsal venous arch. The pattern and geometric formation of the venous network in all cases showed distinctive features according to each region of the palm. The venous branches create a network extending to palmar margins and webs between fingers.
CONCLUSIONS: Venous arrangement should be considered when designing flaps from the palm to prevent venous congestion and safely extend the length of the flap.

PMID: 27845962 [PubMed - indexed for MEDLINE]

The impact of urbanization on CO 2 emissions in China: an empirical study using 1980–2014 provincial data

Abstract

Towns and cities are not only the focus of attention for their consumption of energy and resources; they are also scrutinized closely for their emissions of greenhouse gases. China's urbanization level now exceeds 50%, but there is still much disparity compared with the level of urbanization in developed countries. This study selects China's urban population and carbon emissions data for the years 1980–2014 and discusses the timing and cause effect of urbanization and the corresponding carbon emissions using the Granger causality test and an error correction model (ECM) then uses STIRPAT models to extract six indicators to measure the quality of urbanization, namely, the level of urbanization, area of built-up regions, added value of tertiary industries, disposable income per capita, green areas per capita, and energy intensity. These six indicators represent population agglomeration, the expansion of urban areas, industrial agglomeration, quality of life improvements, ecological conservation, and technological improvements, respectively. The study divides 29 provinces in China into three groups based on the quality of urbanization and analyzes the impacts of the six indicators of urbanization quality on carbon emissions. The findings show that the impacts of different factors on carbon emissions vary substantially among the provinces. Finally, the study uses the findings to give suggestions on how to develop low-carbon urbanization.

Potassium iodide: A forgotten remedy for cutaneous cryptococcosis

A prospective observational study to compare efficacy of topical triamcinolone acetonide 0.1% oral paste, oral methotrexate, and a combination of topical triamcinolone acetonide 0.1% and oral methotrexate in moderate to severe oral lichen planus

Abstract

Topical corticosteroids are considered to be the most effective treatment for oral lichen planus (OLP). Methotrexate has been found to be effective in extensive cutaneous lichen planus. The objectives of the study were to evaluate the clinical efficacy and safety of topical triamcinolone 0.1% oral paste, oral methotrexate and a combination of these in symptomatic moderate-to- severe OLP. Forty-five patients were recruited and were allocated to three treatment arms with 15 patients in each treatment arm. They were treated for a period of 16 weeks or until complete clinical remission, whichever was earlier. The parameters assessed were clinical severity score, visual analogue score, and quality of life impairment questionnaire score. Forty-three patients completed the study. All three treatment modalities were effective. The patients in the combination group had significantly better reduction in the outcome parameters assessed compared to the other two groups. Nine patients achieved complete clinical remission, 6 in the combination group and 3 in the topical triamcinolone group. Systemic methotrexate, alone or in combination with topical triamcinolone, is effective in management of moderate to severe OLP.

Janus kinase inhibitors for the use of alopecia areata: A promising therapeutic of the future

Treating multiple body parts for skin laxity and fat deposits using a novel focused radiofrequency device with an ultrasound component: Safety and efficacy study

Summary

Background and objectives

Growing demand for noninvasive skin tightening and reduction in fat results in an increasing pressure for devices with good clinical efficacy, consistency of results, and high patient comfort. The objective was to validate clinical efficacy and versatility of a novel device, which combines radiofrequency (RF) and ultrasound for treating skin laxity and fat deposits.

Methods

We treated 34 subjects with facial skin laxity and/or abundant body or arm fat deposits. Subjects were divided based on their indications. Ten subjects received treatments to the face, 7 subjects to arms, 8 subjects to thighs, and 9 subjects on abdomen. All patients received 4 treatments on a weekly basis. Photographs of patients were assessed by blinded evaluators to recognize the baseline images from the 3-month follow-up images. Patient comfort and satisfaction were evaluated using a 5-point Likert scale questionnaire. Any adverse events were recorded.

Results

Patient images were correctly recognized in >90% of cases in all study groups. Patient questionnaires showed overall satisfaction with the therapy course and results. On a scale of 1 to 5, the patients agreed (4.1) that they are satisfied with the results that the treatment is comfortable (4.1) and that they are satisfied with the treatment time (4.1). No adverse events were reported.

Conclusions

Consistent clinical efficacy was confirmed across all the treated areas, together with high patient comfort and satisfaction. We conclude the device is a highly versatile solution that can deliver results across body parts and different indications.

The octopus and the unity of consciousness

Abstract

If the octopus were conscious, what would its consciousness be like? This paper investigates the structure octopus consciousness, if existent, is likely to exhibit. Presupposing that the configuration of an organism's consciousness is correlated with that of its nervous system, it is unlikely that the structure of the sort of conscious experience that would arise from the highly decentralized octopus nervous system would bear much resemblance to those of vertebrates. In particular, octopus consciousness may not exhibit unity, which has long been assumed to be the normal or default structure of consciousness. The octopus nervous system is characterized by the following features: its three anatomically distinct components have extensive functional autonomy and little intercommunication; much of the sensory processing and motor control routines—that in vertebrates are localized in the brain—take place within the peripheral arm nervous system; and proprioception and somatotopic representation (point-for-point mapping of the body) are significantly downplayed. In this paper, I present the octopus as a highly successful biological organism in which it is plausible that the unified model of consciousness does not hold.

T-cell responses against rhinovirus species A and C in asthmatic and healthy children

Abstract

Background

Infections by rhinovirus (RV) species A and C are the most common causes of exacerbations of asthma and a major cause of exacerbations of other acute and chronic respiratory diseases. Infections by both species are prevalent in pre-school and school-aged children and, particularly for RV-C, can cause severe symptoms and a need for hospitalization. While associations between RV infection and asthma are well established, the adaptive immune-mechanisms by which RV infections influence asthma exacerbations are yet to be defined.

Objective

The aim of this study was to characterize and compare T-cell responses between RV-A and RV-C and to test the hypothesis that T-cell responses would differ between asthmatic children and healthy controls.

Methods

A multi-parameter flow cytometry assay was used to characterize the in vitro recall T-cell response against RV-A and RV-C in PBMCs from children with acute asthma (n = 22) and controls (n = 26). The responses were induced by pools of peptides containing species-specific VP1 epitopes of RV-A and RV-C.

Results

Regardless of children's clinical status, all children that responded to the in vitro stimulation (>90%) had a similar magnitude of CD4+ T-cell responses to RV-A and RV-C. However, asthmatic children had a significantly lower number of circulating regulatory T cells (Tregs), and healthy controls had significantly more Tregs induced by RV-A than RV-C.

Conclusions and Clinical Relevance

The comparable recall memory T-cell responses in asthmatic and control children to both RV-A and RV-C show that differences in the antibody and inflammatory responses previously described are likely to be due to regulation, with a demonstrated candidate being reduced regulatory T-cells. The reduced Treg numbers demonstrated here could explain the asthmatic's inability to appropriately control immunopathological responses to RV infections.

The two most clinically relevant rhinovirus species, RV-A and RV-C, stimulate similar recall CD4+ T cell responses in asthmatic and healthy children. However, the lower number of circulating regulatory T cells found for asthmatic children could contribute to their inability to control the immune response to rhinovirus infections, leading to pathological outcomes such as airway hyper-responsiveness commonly seen in exacerbations of asthma.

Depletion of recombination specific co-factors by the C-terminal mutant of the activation-induced cytidine deaminase causes the dominant negative effect on class switch recombination

Abstract

Activation-induced cytidine deaminase (AID) is essential for class-switch recombination (CSR) and somatic hypermutation (SHM) of immunoglobulin (Ig) genes. Studies on in vitro mutagenized AID as well as its mutations in human patients with Hyper-IgM (HIGM)-syndrome type II revealed that C-terminal AID mutations were defective in CSR whereas their DNA cleavage and SHM activities remained intact. The C-terminal mutants of AID were speculated to exert the dominant negative effect on wild type WT AID whereas its mechanism remains unknown. We generated the JP41 (R190X) mutation in one allele and null mutation on the other allele in mouse B cell line (CH12F3-2A) using CRISPR/Cas9 genome editing tools and studied the effect of JP41 expression on the function of exogenously introduced WT AID fused with estrogen receptor (AIDER) in AID ^JP41/∆/AIDER CH12F3-2A cells. We found that JP41 expression strongly suppressed not only CSR but also Igh/c-Myc chromosomal translocations by AIDER. We showed the dominant negative effect is not evident at the DNA cleavage step but obvious at both deletional and inversional recombination steps. We also confirmed the dominant negative effect of other C-terminal mutants, JP8Bdel (R183X) and P20 (34-aa insertion at residue 182) in AID deficient spleen B cells. Finally, we showed that the expression of JP41 reduced the binding of AIDER with its cofactors (hnRNP L, SERBP1, and hnRNP U). Together these data indicate that dominant negative effect of JP41 on CSR is likely due to the depletion of the CSR-specific RNA binding proteins from WT AID.

Changes in the lung bacteriome in relation to antipseudomonal therapy in children with cystic fibrosis

Abstract

The lung in cystic fibrosis (CF) is home to numerous pathogens that shorten the lives of patients. The aim of the present study was to assess changes in the lung bacteriome following antibiotic therapy targeting Pseudomonas aeruginosa in children with CF. The study included nine children (9–18 years) with CF who were treated for their chronic or intermittent positivity for Pseudomonas aeruginosa. The bacteriomes were determined in 16 pairs of sputa collected at the beginning and at the end of a course of intravenous antibiotic therapy via deep sequencing of the variable region 4 of the 16S rRNA gene, and the total bacterial load and selected specific pathogens were assessed using quantitative real-time PCR. The effect of antipseudomonal antibiotics was observable as a profound decrease in the total 16S rDNA load (p = 0.001) as well as in a broad range of individual taxa including Staphylococcus aureus (p = 0.03) and several members of the Streptococcus mitis group (S. oralis, S. mitis, and S. infantis) (p = 0.003). Improvements in forced expiratory volume (FEV₁) were associated with an increase in Granulicatella sp. (p = 0.004), whereas a negative association was noted between the total bacterial load and white blood cell count (p = 0.007). In conclusion, the data show how microbial communities differ in reaction to antipseudomonal treatment, suggesting that certain rare species may be associated with clinical parameters. Our work also demonstrates the utility of absolute quantification of bacterial load in addition to the 16S rDNA profiling.

Analysis of various effects of abamectin on erythrocyte morphology in Japanese quails ( Coturnix japonica )

Abstract

Although previous studies have already confirmed the toxicological potential of abamectin (ABA) in different experimental models (from invertebrates to vertebrates), almost nothing is known about the impacts the exposure to this pesticide can cause on birds. Thus, the aim of our study is to investigate the cytotoxic effects on the erythrocytes of female Japanese quails (Coturnix japonica) exposed to low abamectin concentrations. In order to do so, three experimental groups were proposed: "control," composed of quails exposed to abamectin-free drinking water; "ABA 1% median lethal dose (LD₅₀)," comprising birds exposed to water containing 15.5 mg a.i./L of abamectin (via commercial formulation Kraft® 36EC), and "ABA 10% LD₅₀," composed by birds exposed to water containing 155.0 mg a.i./L of abamectin. The micronucleus test and the tests applied to other nuclear abnormalities in the peripheral blood of birds were conducted 40 days after exposure. Our study revealed significant physical abnormalities in nuclear shapes (erythrocytes with asymmetric constriction nuclei, notched nuclei, indented and moved nucleus) of those birds exposed to higher abamectin levels. When all nuclear abnormalities were tallied, a significant dose-dependent trend was noted. Therefore, our study presents initial imprints on determination of abamectin-mediated cellular toxicity in avifauna which can be instrumental in checking polluted ecosystems.

Mechanism Discovery and Design Explanation: Where Role Function Meets Biological Advantage Function

Abstract

In the recent literature on explanation in biology, increasing attention is being paid to the connection between design explanation and mechanistic explanation, viz. the role of design principles and heuristics for mechanism discovery and mechanistic explanation. In this paper we extend the connection between design explanation and mechanism discovery by prizing apart two different types of design explanation and by elaborating novel heuristics that one specific type offers for mechanism discovery across species. We illustrate our claims in terms of two lines of biological research on the biological advantages of organismal traits, one on the eye-size of giant squid, the other on foraging habits of specific bat species. We argue that this research illustrates useful heuristics for mechanism discovery across species, viz. reasoning strategies to infer likely mechanisms for a certain biological role based on assessments of the environmental conditions in which the role is performed efficiently (i.e., offers a biological advantage) and less or in-efficiently. We bring out the novel features of our analysis in terms of a comparison with mechanistic approaches to mechanism discovery, amongst which graph-theoretical ones, and by comparing the different types of design explanation and the discovery heuristics they support.

Generating new evidence, improving clinical practice and developing research capacity: the benefits of recruiting to the U.K. Dermatology Clinical Trials Network's STOP GAP and BLISTER trials

Summary

Clinical trials may benefit clinical practice in three ways: firstly, clinicians may change their practice according to the new trial evidence; secondly, clinical processes can improve when working on a trial; and thirdly, research capacity is increased. We held a meeting to present and discuss the results of two large multicentre randomized controlled trials delivered through the U.K. Dermatology Clinical Trials Network. Investigators gave reflections on how the trials had changed their clinical practice. The STOP GAP trial showed that prednisolone and ciclosporin are equally effective as first-line systemic treatment for pyoderma gangrenosum. The final decision of which treatment to use should be based on the different adverse event profiles of the two drugs in relation to comorbidities, along with age, disease severity and patient preference. The BLISTER trial showed that starting people with pemphigoid on doxycycline produces acceptable short-term effectiveness and a superior safety profile to oral corticosteroids. Recruiting to these trials has led to the development of new specialist clinics with improved documentation. It has increased the profile of participating departments and embedded research in the department's activities. Helping to design and run these trials has also allowed trial staff to develop new skills in research design, which has been beneficial for career development. These and other benefits of recruiting to the trials are summarized here. We hope that these reflections will inspire wider involvement in clinical research.

Identification of potential aryl hydrocarbon receptor ligands by virtual screening of industrial chemicals

Abstract

We have developed a virtual screening procedure to identify potential ligands to the aryl hydrocarbon receptor (AhR) among a set of industrial chemicals. AhR is a key target for dioxin-like compounds, which is related to these compounds' potential to induce cancer and a wide range of endocrine and immune system-related effects. The virtual screening procedure included an initial filtration aiming at identifying chemicals with structural similarities to 66 known AhR binders, followed by 3 enrichment methods run in parallel. These include two ligand-based methods (structural fingerprints and nearest neighbor analysis) and one structure-based method using an AhR homology model. A set of 6445 commonly used industrial chemicals was processed, and each step identified unique potential ligands. Seven compounds were identified by all three enrichment methods, and these compounds included known activators and suppressors of AhR. Only approximately 0.7% (41 compounds) of the studied industrial compounds was identified as potential AhR ligands and among these, 28 compounds have to our knowledge not been tested for AhR-mediated effects or have been screened with low purity. We suggest assessment of AhR-related activities of these compounds and in particular 2-chlorotrityl chloride, 3-p-hydroxyanilino-carbazole, and 3-(2-chloro-4-nitrophenyl)-5-(1,1-dimethylethyl)-1,3,4-oxadiazol-2(3H)-one.

Heterogeneity in retinoblastoma: a tale of molecules and models

Retinoblastoma, an intraocular pediatric cancer, develops in the embryonic retina following biallelic loss of RB1. However, there is a wide range of genetic and epigenetic changes that can affect RB1 resulting in...

Response to “Providing dermatological care in resource-limited settings: barriers and potential solutions” – reply from authors

We thank Drs. Mahé and Faye for their interest in our article. We applaud them for their tremendous work in improving the delivery of dermatologic care through their programme with healthcare professionals in Mali.

This article is protected by copyright. All rights reserved.

Psychological stress and psoriasis. A systematic review and meta-analysis

Abstract

Background

Psychological stress has long been linked with psoriasis exacerbation/onset. However, it is unclear if they are associated.

Objective

To determine if antecedent psychological stress and psoriasis exacerbation/onset are associated.

Methods

A comprehensive search of Pubmed, PsycINFO, Cochrane library, and clinicaltrials. gov databases was performed. Studies investigating the association between preceding psychological stress and psoriasis exacerbation/onset were classified as cross-sectional, case-control or cohort. Surveys evaluating beliefs regarding stress-reactivity were analysed separately. Suitable studies were meta-analysed.

Results

Thirty-nine studies were included evaluating 32,537 patients: 19 surveys, 7 cross-sectional, 12 case-controls and 1 cohort. Based on surveys and cross-sectional studies, 46% of patients believed their disease was stress-reactive and 54% recalled preceding stressful events. Case-control studies evaluating stressful events rates prior to psoriasis exacerbation (N=6) or onset (N=6) varied in time lag to recollection (≤9 month to ≥ 5 years). Pooling 5 studies evaluating stressful events preceding psoriasis onset yielded an OR of 3.4 (95%CI, 1.8-6.4, I² =87%), however the only study evaluating documented stress disorder diagnosis reported similar rates (OR 1.2, 95%CI, 0.8-1.8) between patients and controls. Four studies evaluating stressful events prior to psoriasis exacerbation reported comparable rates with controls, while 2 found more frequent/severe preceding events among psoriasis patients. A small prospective cohort study reported a modest association between stress-levels and psoriasis exacerbation (r = 0.28, p < 0.05).

Conclusions

The association between preceding stress and psoriasis exacerbation/onset is based primarily on retrospective studies with many limitations. No convincing evidence exists that preceding stress is strongly associated with psoriasis exacerbation/onset.

This article is protected by copyright. All rights reserved.

Response to “Providing dermatological care in resource-limited settings: barriers and potential solutions”

We read with interest the paper from Chang et al (1). However, the authors overlooked certain solutions that were developed by our team to improve on a large scale the problem of skin diseases (SD) in resource limited settings (RLS), through an organized, public health approach (2-4).

This article is protected by copyright. All rights reserved.

Metal availability, soil nutrient, and enzyme activity in response to application of organic amendments in Cd-contaminated soil

Abstract

The study investigated the effects of organic amendments: green tea amendment (GTA) and oil cake amendment (OCA) on Cd bioavailability, soil nutrients, and soil enzyme activity in Cd-contaminated soil. The amendments were added to the soil at the doses of 1, 3, and 5% and were incubated for 45 days. Then, pakchoi cabbage was planted to test the remediation effect of the above two organic amendments. The diethylenetriaminepentaacetic acid (DTPA)-extractable Cd in GTA and OCA treatments was reduced by 14.69–27.51 and 13.75–68.77%, respectively, compared to no amendment-applied treatment. The application of GTA and OCA notably decreased the proportion of exchangeable fraction of Cd, but increased the percentage of oxide and organic-bound fraction of Cd, thereby suppressing the uptake by pakchoi cabbage. Cd concentration of aboveground parts decreased by 8.21–18.05 and 7.77–35.89% in GTA and OCA treatments, respectively. Relative to the no amendment-applied treatment, both GTA and OCA had enhanced soil nutrients and enzyme activities largely. Redundancy analysis showed that organic matter, total P, available N, and DTPA-extractable Cd significantly affected the enzyme activities. Furthermore, the application of OCA at the dose of 5% was more effective in reducing bioavailable Cd, enhancing soil available nutrients and urease and catalase activities in contaminated soil. These results indicated that oil cake should be used to immobilize metal and improve fertility and quality of Cd-contaminated soil.

Diffusion-Weighted Imaging of the Head and Neck: Influence of Fat-Suppression Technique and Multishot 2D Navigated Interleaved Acquisitions [HEAD & NECK]

BACKGROUND AND PURPOSE:

DWI of the head and neck can reveal valuable information, but the effects of fat suppression and multishot acquisition on image quality have not been thoroughly investigated. We aimed to comprehensively compare the quality of head and neck DWI at 3T using 2 fat-suppression techniques, STIR, and spectral presaturation with inversion recovery, which were used with both single- and multishot EPI.

MATERIALS AND METHODS:

Sixty-five study participants underwent 3 DWI sequences of single-shot EPI–STIR, single-shot EPI–spectral presaturation with inversion recovery, and multishot EPI–spectral presaturation with inversion recovery of the head and neck. In multiple anatomic regions, 2 independent readers assessed 5-point visual scores for fat-suppression uniformity and image distortion, and 1 reader measured the contrast-to-noise ratio and ADC.

RESULTS:

The mean visual score for fat-suppression uniformity was higher in single-shot EPI–STIR than in other sequences (all regions except for the orbital region, P < .05). The mean visual score for image distortion was higher in multishot EPI–spectral presaturation with inversion recovery than in single-shot EPI sequences (all regions, P < .001). Contrast-to-noise ratio was mostly lower in single-shot EPI–STIR than in other sequences (P < .001), and ADC was significantly higher in multishot EPI–spectral presaturation with inversion recovery than in single-shot EPI sequences (P ≤ .001).

CONCLUSIONS:

Overall, multishot EPI–spectral presaturation with inversion recovery provided the best image quality, with relatively homogeneous fat suppression, less image distortion than single-shot EPI sequences, and higher contrast-to-noise ratio than single-shot EPI–STIR. The measured ADC values can be higher in multishot EPI–spectral presaturation with inversion recovery, which necessitates cautious application of the previously reported ADC values to clinical settings.

Semiautomated Evaluation of the Primary Motor Cortex in Patients with Amyotrophic Lateral Sclerosis at 3T [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Amyotrophic lateral sclerosis is a neurodegenerative disease involving the upper and lower motor neurons. In amyotrophic lateral sclerosis, pathologic changes in the primary motor cortex include Betz cell depletion and the presence of reactive iron-loaded microglia, detectable on 7T MR images as atrophy and T2*-hypointensity. Our purposes were the following: 1) to investigate the signal hypointensity-to-thickness ratio of the primary motor cortex as a radiologic marker of upper motor neuron involvement in amyotrophic lateral sclerosis with a semiautomated method at 3T, 2) to compare 3T and 7T results, and 3) to evaluate whether semiautomated measurement outperforms visual image assessment.

MATERIALS AND METHODS:

We investigated 27 patients and 13 healthy subjects at 3T, and 19 patients and 18 healthy subjects at 7T, performing a high-resolution 3D multiecho T2*-weighted sequence targeting the primary motor cortex. The signal hypointensity-to-thickness ratio of the primary motor cortex was calculated with a semiautomated method depicting signal intensity profiles of the cortex. Images were also visually classified as "pathologic" or "nonpathologic" based on the primary motor cortex signal intensity and thickness.

RESULTS:

The signal hypointensity-to-thickness ratio of the primary motor cortex was greater in patients than in controls (P < .001), and it correlated with upper motor neuron impairment in patients ( = 0.57, P < .001). The diagnostic accuracy of the signal hypointensity-to-thickness ratio was high at 3T (area under the curve = 0.89) and even higher at 7T (area under the curve = 0.94). The sensitivity of the semiautomated method (0.81) outperformed the sensitivity of the visual assessment (0.56–0.63) at 3T.

CONCLUSIONS:

The signal hypointensity-to-thickness ratio of the primary motor cortex calculated with a semiautomated method is suggested as a radiologic marker of upper motor neuron burden in patients with amyotrophic lateral sclerosis. This semiautomated method may be useful for improving the subjective radiologic evaluation of upper motor neuron pathology in patients suspected of having amyotrophic lateral sclerosis.

MR Imaging of the Superior Cervical Ganglion and Inferior Ganglion of the Vagus Nerve: Structures That Can Mimic Pathologic Retropharyngeal Lymph Nodes [PERIPHERAL NERVOUS SYSTEM]

BACKGROUND AND PURPOSE:

The superior cervical ganglion and inferior ganglion of the vagus nerve can mimic pathologic retropharyngeal lymph nodes. We studied the cross-sectional anatomy of the superior cervical ganglion and inferior ganglion of the vagus nerve to evaluate how they can be differentiated from the retropharyngeal lymph nodes.

MATERIALS AND METHODS:

This retrospective study consists of 2 parts. Cohort 1 concerned the signal intensity of routine neck MR imaging with 2D sequences, apparent diffusion coefficient, and contrast enhancement of the superior cervical ganglion compared with lymph nodes with or without metastasis in 30 patients. Cohort 2 used 3D neurography to assess the morphology and spatial relationships of the superior cervical ganglion, inferior ganglion of the vagus nerve, and the retropharyngeal lymph nodes in 50 other patients.

RESULTS:

All superior cervical ganglions had homogeneously greater enhancement and lower signal on diffusion-weighted imaging than lymph nodes. Apparent diffusion coefficient values of the superior cervical ganglion (1.80 ± 0.28 x 10^–3mm²/s) were significantly higher than normal and metastatic lymph nodes (0.86 ± 0.10 x 10^–3mm²/s, P < .001, and 0.73 ± 0.10 x 10^–3mm²/s, P < .001). Ten and 13 of 60 superior cervical ganglions were hypointense on T2-weighted images and had hyperintense spots on both T1- and T2-weighted images, respectively. The latter was considered fat tissue. The largest was the superior cervical ganglion, followed in order by the retropharyngeal lymph node and the inferior ganglion of the vagus nerve (P < .001 to P = .004). The highest at vertebral level was the retropharyngeal lymph nodes, followed, in order, by the inferior ganglion of the vagus nerve and the superior cervical ganglion (P < .001 to P = .001). The retropharyngeal lymph node, superior cervical ganglion, and inferior ganglion of the vagus nerve formed a line from anteromedial to posterolateral.

CONCLUSIONS:

The superior cervical ganglion and the inferior ganglion of the vagus nerve can be almost always differentiated from retropharyngeal lymph nodes on MR imaging by evaluating the signal, size, and position.

Long-Term Effectiveness of Direct CT-Guided Aspiration and Fenestration of Symptomatic Lumbar Facet Synovial Cysts [SPINE]

BACKGROUND AND PURPOSE:

Lumbar facet synovial cysts are commonly seen in facet degenerative arthropathy and may be symptomatic when narrowing the spinal canal or compressing nerve roots. The purpose of this study was to analyze the safety, effectiveness, and long-term outcomes of direct CT-guided lumbar facet synovial cyst aspiration and fenestration for symptom relief and for obviating an operation.

MATERIALS AND METHODS:

We retrospectively reviewed the medical records and imaging studies of 64 consecutive patients between 2006 and 2016 who underwent 85 CT-guided lumbar facet synovial cyst fenestration procedures in our department. We recorded patient demographics, lumbar facet synovial cyst imaging characteristics, presenting symptoms, change in symptoms after the procedure, and whether they underwent a subsequent operation. We also assessed long-term outcomes from the medical records and via follow-up telephone surveys with patients.

RESULTS:

Direct CT-guided lumbar facet synovial cyst puncture was technically successful in 98% of procedures. At first postprocedural follow-up, 86% of patients had a complete or partial symptomatic response. During a mean follow-up of 49 months, 56% of patients had partial or complete long-term relief without the need for an operation; 44% of patients underwent an operation. Patients with calcified, thick-rimmed, or low T2 signal intensity cysts were less likely to respond to the procedure and more likely to need an operation.

CONCLUSIONS:

CT-guided direct lumbar facet synovial cyst aspiration and fenestration procedures are safe, effective, and minimally invasive for symptomatic treatment of lumbar synovial facet cysts. This procedure obviates an operation in a substantial number of patients, even at long-term follow-up, and should be considered before surgical intervention.

Effect of an Arm Traction Device on Image Quality and Radiation Exposure during Neck CT: A Prospective Study [HEAD & NECK]

BACKGROUND AND PURPOSE:

The image quality of neck CT is frequently disturbed by streak artifact from the shoulder girdles. Our aim was to determine the effects of an arm traction device on image quality and radiation exposure in neck CT.

MATERIALS AND METHODS:

Patients with lymphoma with complete remission who were scheduled to undergo 2 consecutive follow-up neck CT scans for surveillance within a 1-year interval were enrolled in this prospective study. They underwent 2 consecutive neck CT scans (intervention protocol: patients with an arm traction device; standard protocol: no positioning optimization) on the same CT system. The primary outcome measures were image noise in the lower neck and dose-length product. Secondary outcomes were streak artifacts in the supraclavicular fossa, volume CT dose index, and the extent of the biacromial line shift.

RESULTS:

Seventy-three patients were enrolled and underwent 2 consecutive CT scans with a mean interval of 155 days. In the intervention protocol, a mean noise reduction in the lower neck of 25.2%–28.5% (P < .001) was achieved, and a significant decrease in dose-length product (413 versus 397, P < .001) was observed. The intervention protocol significantly decreased streak artifacts (P < .001) and volume CT dose index (13.9 versus 13.4, P < .001) and could lower the biacromial line an average of 2.1 cm.

CONCLUSIONS:

An arm traction device can improve image quality and reduce radiation exposure during neck CT. The device can be simply applied in cooperative patients with suspected lower neck lesions, and the approach offers distinct advantages over the conventional imaging protocol.

Spinal Cord Gray Matter Atrophy in Amyotrophic Lateral Sclerosis [SPINE]

BACKGROUND AND PURPOSE:

There is an emerging need for biomarkers to better categorize clinical phenotypes and predict progression in amyotrophic lateral sclerosis. This study aimed to quantify cervical spinal gray matter atrophy in amyotrophic lateral sclerosis and investigate its association with clinical disability at baseline and after 1 year.

MATERIALS AND METHODS:

Twenty-nine patients with amyotrophic lateral sclerosis and 22 healthy controls were scanned with 3T MR imaging. Standard functional scale was recorded at the time of MR imaging and after 1 year. MR imaging data were processed automatically to measure the spinal cord, gray matter, and white matter cross-sectional areas. A statistical analysis assessed the difference in cross-sectional areas between patients with amyotrophic lateral sclerosis and controls, correlations between spinal cord and gray matter atrophy to clinical disability at baseline and at 1 year, and prediction of clinical disability at 1 year.

RESULTS:

Gray matter atrophy was more sensitive to discriminate patients with amyotrophic lateral sclerosis from controls (P = .004) compared with spinal cord atrophy (P = .02). Gray matter and spinal cord cross-sectional areas showed good correlations with clinical scores at baseline (R = 0.56 for gray matter and R = 0.55 for spinal cord; P < .01). Prediction at 1 year with clinical scores (R² = 0.54) was improved when including a combination of gray matter and white matter cross-sectional areas (R² = 0.74).

CONCLUSIONS:

Although improvements over spinal cord cross-sectional areas were modest, this study suggests the potential use of gray matter cross-sectional areas as an MR imaging structural biomarker to monitor the evolution of amyotrophic lateral sclerosis.

Prediction of IDH1-Mutation and 1p/19q-Codeletion Status Using Preoperative MR Imaging Phenotypes in Lower Grade Gliomas [ADULT BRAIN]

BACKGROUND AND PURPOSE:

WHO grade II gliomas are divided into three classes: isocitrate dehydrogenase (IDH)-wildtype, IDH-mutant and no 1p/19q codeletion, and IDH-mutant and 1p/19q-codeleted. Different molecular subtypes have been reported to have prognostic differences and different chemosensitivity. Our aim was to evaluate the predictive value of imaging phenotypes assessed with the Visually AcceSAble Rembrandt Images lexicon for molecular classification of lower grade gliomas.

MATERIALS AND METHODS:

MR imaging scans of 175 patients with lower grade gliomas with known IDH1 mutation and 1p/19q-codeletion status were included (78 grade II and 97 grade III) in the discovery set. MR imaging features were reviewed by using Visually AcceSAble Rembrandt Images (VASARI); their associations with molecular markers were assessed. The predictive power of imaging features for IDH1-wild type tumors was evaluated using the Least Absolute Shrinkage and Selection Operator. We tested the model in a validation set (40 subjects).

RESULTS:

Various imaging features were significantly different according to IDH1 mutation. Nonlobar location, larger proportion of enhancing tumors, multifocal/multicentric distribution, and poor definition of nonenhancing margins were independent predictors of an IDH1 wild type according to the Least Absolute Shrinkage and Selection Operator. The areas under the curve for the prediction model were 0.859 and 0.778 in the discovery and validation sets, respectively. The IDH1-mutant, 1p/19q-codeleted group frequently had mixed/restricted diffusion characteristics and showed more pial invasion compared with the IDH1-mutant, no codeletion group.

CONCLUSIONS:

Preoperative MR imaging phenotypes are different according to the molecular markers of lower grade gliomas, and they may be helpful in predicting the IDH1-mutation status.

List of reviewers 2017

Trendy Tattoos—Maybe a Serious Health Risk?

Abstract

Background

The literature reports many cases of cutaneous malignancy in the setting of skin tattoos. In this study, we review the reported incidence of and risk factors for tattoo-associated skin cancer.

Methods

A PubMed literature review was performed for all cases of tattoo-associated skin cancer, including squamous cell carcinoma, basal cell carcinoma, malignant melanoma, keratoacanthoma, and other rare skin malignancies (source: PubMed/until June 2017).

Results

The authors identified 51 publications and 63 total cases of tattoo-associated skin cancer. We also report on a single new case of tattoo-associated skin cancer observed at one of our co-authors' institutions. Among these 64 total cases, 58% were associated with black and blue inks and 34% were associated with red ink.

Conclusions

Overall, while the strength of association remains unclear, the literature reports many cases of tattoo-associated skin cancer. Among these cases, black, blue, and red inks were particularly worrisome for their carcinogenic potential.

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 http://ift.tt/18t7xNj.