Background: Current guidelines for randomized controlled trial (RCT) reporting do not require authors to justify their choice of time horizon. This is concerning, as the time horizon when an outcome is assessed has important implications for the interpretation of study results, and resources allocated to an investigation. Therefore, this study seeks to examine the standards of time horizon reporting in the plastic surgery literature. Methods: This is a systematic review of plastic surgery RCTs published within the last 4 years. The MEDLINE database was searched to yield relevant studies. All studies included were English language, prospective, non-pharmaceutical RCTs, comparing two plastic surgical interventions. Studies were classified into plastic surgery domains, and information regarding study population, time horizon reporting, and justification of chosen time horizons, was extracted. Results: The search retrieved 720 articles, of which 103 were eligible for inclusion. Time horizons were reported as either a standardized time point at which all patients were assessed, a follow-up duration range, or were not reported at all. Although most studies (85.4%) reported a standardized time horizon, the majority (85.4%) failed to provide a valid justification to support their selection of time horizons. Conclusion: Clinical investigators failed to justify their choice of time horizons in the majority of published RCTs. To limit heterogeneity, time horizons for given interventions should be standardized to improve validity of outcome assessments, enable future pooling of results, and increase research efficiency. The authors have no financial interests to declare. Corresponding Author: Achilleas Thoma, MD, MSc, 101-206 James Street South, Hamilton, ON L8P 3A9, Canada. athoma@mcmaster.ca, ©2018American Society of Plastic Surgeons
Παρασκευή 14 Σεπτεμβρίου 2018
Improvement of ternary fuel combustion with various injection pressure strategies in a toroidal re-entrant combustion chamber
Abstract
The present experimental work focuses on the influence injection pressure and toroidal re-entrant combustion chamber in a single cylinder diesel engine fuelled with ternary fuel (diesel-biodiesel-ethanol) blend. Ternary fuel (TF) is prepared by blending 70% diesel, 20% biodiesel, and 10% ethanol blends and its fuel properties were investigated and compared with diesel fuel. Since the physic-chemical properties of TF are well behind the diesel fuel, it is proposed to be blended with 20 ppm alumina nano additives which act as an ignition enhancer and catalytic oxidizer. The resulting fuel mixture (TF + 20 ppm alumina additive) is named as high performance fuel (HPF). Experimentations were conducted on HPF subjected to various injection pressures of 18 MPa, 20 MPa, 22 MPa, and 24 MPa respectively and are operated in toroidal re-entrant chamber geometry (TG) at an injection timing of 22 obTDC. From experimentation, it was identified that, for TG-HPF, higher injection pressure of 22 MPa ensued highest BTE (Brake Thermal Efficiency) of 35.5% and lowest BSEC (Brake Specific Fuel Consumption) of 10.13 MJ/kWh owing to the pooled effect of higher swirl formation, improved atomization enhanced evaporation rate, and better air-fuel mixing. Emission wise TG-HPF operated at 22 MPa lowered the HC (hydrocarbon), CO (carbon monoxide), and smoke emissions by 18.88%, 7.19%, and 5.02%, but with marginally improved NOx (oxides of nitrogen) and CO2 (carbon dioxide) emissions by 3.92% and 3.89% respectively. In combustion point of view, it is observed that injection pressure increased the cylinder pressure, heat release rate (HRR), and cumulative heat release rate (CHRR) by 5.35%, 5.08%, and 3.38% respectively indicating improved combustion rate as a result of enhanced atomization, evaporation, and high turbulence inducement. Overall, it is concluded that operating the ternary fuel at 22 MPa injection pressure at toroidal re-entrant combustion chamber results in improved performance and minimized emissions.
The Evolution of Iliac Bone Graft Donor Site Analgesia in Cleft Patients: Transversus Abdominis Plane Block Is Safe and Efficacious
Background The transversus abdominis plane (TAP) block has been increasingly used as a means of abdominal wall analgesia. This study aims to determine if TAP block analgesia provides a benefit in cleft patients undergoing alveolar bone grafting with iliac crest cancellous bone graft. Methods Two groups of 20 consecutive patients undergoing alveolar bone grafting with iliac crest cancellous bone with either TAP block or indwelling catheter pain pump were examined in a retrospective fashion. Demographic data, pharmacologic use, and hospital length of stay were examined. Results Mean lengths of stay were identical between both groups. Patients in both groups received similar cumulative doses of morphine equivalents, codeine, ibuprofen, and ondansetron at 6 and 24 hours postoperatively. Transversus abdominis plane block patients received greater amounts of Tylenol at both 6 and 24 hours (P = 0.0015 and P = 0.0106). Pain scores did not differ significantly across our groups at 6 or 24 hours postoperatively. No adverse events were reported with the TAP block procedure. Conclusions Patients undergoing TAP blocks receive the benefit of a single stage procedure without an indwelling catheter and similar 6- and 24-hour morphine usage. Given the safety profile of the procedure, its effectiveness and comfort without indwelling catheter, we advocate for TAP block analgesia as an adjunct therapy in the management of postoperative pain in this population.Discrepancies Between Surgical Oncologists and Plastic Surgeons in Patient Information Provision and Personal Opinions Towards Immediate Breast Reconstruction
Background Immediate breast reconstruction (IBR) may improve quality of life of patients receiving mastectomy. However, a significant hospital variation exists in the use of IBR due to various reasons. To better understand this variation, the present study investigated preoperative information provision to patients and personal opinions of surgical oncologists and plastic surgeons towards potential contra-indications for IBR. Methods An online survey (35 questions) was developed including questions on respondent demographics, information provision to the patient about IBR and potential contra-indications by IBR technique. Results One-hundred-eighty-nine physicians participated: 118 surgical oncologists and 71 plastic surgeons. All clinicians discussed the possibility of IBR with their patients. Complications (79% versus 100%, P 75 years, breast size >D-cup, BMI >40 kg/m2, smoking (for implant reconstruction), pulmonary/cardiac comorbidities (for autologous reconstruction) and radiotherapy were considered a contra-indication more frequently by plastic surgeons. In contrast, surgical oncologists reported tumor stage (≥cT3), nodal stage (≥cN2) and chemotherapy more frequently to be a contra-indication for IBR. Conclusion We observed that all respondents discussed the possibility of IBR with their patients, whereas patient-tailored information was given more frequently by plastic surgeons. Physicians differed in their opinions towards contra-indications for IBR, with plastic surgeons reporting patient-related risk factors for wound healing problems and surgical oncologists reporting oncological contra-indications more frequently. Consensus between physicians regarding contra-indications for IBR may optimize patient counseling and shared decision-making.The Effect of the Histone Deacetylase Inhibitor Suberoylanilide Hydroxamic Acid and Paclitaxel Treatment on Full-Thickness Wound Healing in Mice
Introduction Neoadjuvant chemotherapy prior to lumpectomy or mastectomy for breast cancer challenges wound healing. Suberoylanilide hydroxamic acid (SAHA), a histone deacetylase inhibitor, has been shown to work synergistically with paclitaxel in vitro and in preclinical studies. In addition, our laboratory has demonstrated that SAHA treatment decreases paclitaxel-associated stem cell toxicity, modulates inflammatory response, and promotes wound healing in injured fibroblast cells. Our goal was to determine if combined SAHA and paclitaxel treatment would improve wound healing in an in vivo full-thickness murine model, without altering antitumor effect. Methods Thirty-two nude athymic mice received intraperitoneal injections of paclitaxel (20 mg/kg), SAHA (25 mg/kg), paclitaxel + SAHA (20 mg/kg + 25 mg/kg), or no treatment for 2 weeks prior to surgery. Under general anesthesia, 8-mm full-thickness dorsal wounds were created in all animals, and a silicone splint was attached to minimize wound contraction. The wounds were measured twice a week with a surgical caliper until healing was complete. To evaluate the in vivo effect of drug treatment, 16 athymic nude mice with MDA-MB-231 xenografts received the treatments described previously, following which tumor volumes were compared between groups. Results Average wound healing time was prolonged in mice treated with paclitaxel (20 ± 1.9 days), and combination SAHA + paclitaxel therapy improved average wound healing time (17.0 ± 1.8 days). In the xenograft model, the antitumor effect of SAHA and paclitaxel (average tumor volume 43.9 ± 34.1 mm3) was greater than paclitaxel alone (105.8 ± 73.8 mm3). Conclusions The addition of SAHA to taxane chemotherapy improves the therapeutic effect on triple-negative breast cancer while decreasing the detrimental effect of paclitaxel on wound healing. This may have substantial implications on improving outcomes in breast reconstruction following chemotherapy.Reconstruction of Soft Tissue Defects Around the Knee With Pedicled Perforator Flaps
Purpose To study the availability and effects for application of 4 kinds of perforator flaps in repairing skin and soft tissue defects in different positions around the knee joints. Methods The present study included 26 cases (16 males and 10 females) with soft tissue defects with ages from 7 to 82 years who came to our hospital during September 2012 to August 2016. The wound size ranged from 6 × 3 cm to 15 × 12 cm, and the exposed area ranged from 4 × 2 cm to 10 × 8 cm. Patients were treated with different perforator flaps (descending genicular artery perforator flap, sural neurocutaneous flap, lateral superior genicular artery perforator flap, and lateral popliteal artery perforator flap) and were followed up for 6 months. Results All the transplanted flaps survived well without advent events. Exposed bone, ligament, and skin and soft tissue defects healed well. In the early period, flaps were locally bloated. In the later period, the appearance of flaps was good and close to normal, with abrasion-resistant surfaces. All patients were satisfied with the flap appearance and functional recovery. No secondary necrosis, ulcers, deep infection, or nonunion of bone occurred during the follow-up. Conclusions These 4 kinds of perforator flaps are available methods to repair the skin and soft tissue defects around the knee joints. Suitable perforator flaps should be chosen for different locations of wounds. Level of Evidence Therapeutic study, level IV.Preoperative Implant Size Is Strongly Associated With Alternations of Implant Size During Secondary Breast Augmentation
Background Breast augmentation is one of the most popular cosmetic surgeries performed worldwide. In turn, there has been an increasing number of secondary breast augmentation procedures in recent years. Implant selection at secondary breast augmentation can be a challenge and is affected by a number of factors. The aim of this study was to assess the main factors affecting the decision-making process with regard to implant volume determination prior to implant exchange. Methods Women who underwent elective breast implant exchange between 2012 and 2016 were included in this study. Medical records were used to acquire implant and patient data. The patient's desires, as well as medical considerations, were taken into account during the implant selection process. Results Two hundred forty-five women with an average age of 43 years (range, 21–69 years) were included in the study. The mean time between primary augmentation and implant exchange was 10 ± 5.7 years. Overall, 192 implants (38.9%) were exchanged with larger implants, 84 implants (17%) were exchanged with smaller implants, and 218 implants (44.1%) were exchanged with implants similar to the preoperative size (±25 mL). In patients who received smaller implants, the mean reduction in implant volume was found to be 78.88 mL. Women were more likely to receive a smaller implant during implant exchange if the preoperative implant volume was larger than 367 mL (P = 0.00006). Among patients who received larger implants, no correlation was found between preoperative and postoperative implant size. A positive correlation was found between the implant age and a reduction in implant size (P = 0.036). However, no correlation was found between the patient's age and the decision to reduce or enlarge implant size upon revision. Conclusions Almost half of patients receive similarly sized implants during elective implant exchange. Among those who did decide to change their implant size, more than twice as many patients opted for a larger implant as opposed to a smaller one. Relatively large preoperative implant size and longer time since primary augmentation were associated with the selection of smaller implants during exchange. Further studies should be conducted to reinforce these results.Long-term Outcomes After Pediatric Free Flap Reconstruction
Introduction Whereas free tissue transfer has evolved to minimize morbidity in adults, less is known about outcomes after free flaps in children. This study sought to assess short- and long-term outcomes after microvascular reconstruction in the pediatric population. Methods Short- and long-term outcomes of free tissue transfer were assessed using chart-review and quality-of-life surveys. The Pediatric Outcomes Data Collection Instrument was used to evaluate overall health, pain, and ability to participate in normal daily and more vigorous activities. Patient or parent responses were compared against normative data. Results Forty-two patients underwent 48 flap reconstructions at a mean age of 8 years. Median follow-up was 14.9 years. Indications included congenital nevi (n = 19, 42%), lymphatic/vascular malformations (n = 8, 19%), and trauma/burns (n = 6, 14%). There were 21 fasciocutaneous (44%), 19 muscle/myocutaneous (40%), 6 fascial/peritoneal (13%), and 2 osteocutaneous flaps (4%). Major flap complications were observed in 4 patients (9%), whereas major donor-site complications occurred in 2% (1 patient). Valid contact information was available for 25 patients; 16 of these completed surveys (64%). Pediatric Outcomes Data Collection Instrument scores for mobility (median, 52), sports/physical functioning (median, 56), happiness (median, 50), and pain/comfort (median, 56) were not significantly different from normative population score of 50. Similarly, median global functioning score was 99 (maximum, 100) and did not differ between flap types. Discussion Free tissue transfer in the pediatric population is reliable and well-tolerated over time. Surgeons should not hesitate to use free flaps when clinically indicated for pediatric patients.Aesthetic Refinement in the Creation of the Clitoris, Its Preputial Hood, and Labia Minora in Male-to-Female Transsexual Patients
Background In male-to-female genital sex reassignment surgery, the clitoris, its prepuce, and the labia minora remain among the most difficult structures to construct. We describe the authors' clitoroplasty and vulvoplasty technique. Methods All patients who underwent male-to-female sex reassignment surgery at a single center, between June 2012 and June 2016, were prospectively included. The standard pedicled island neurovascular flap of the glans penis was harvested in a letter M fashion with attached preputial skin. The central triangle of the M was used for the neoclitoris formation. Labia minora and the clitoral prepuce were created with both legs of the M and the preputial skin attached to it. Tactile and erogenous sensitivity was evaluated. Results Ninety-seven patients were included (mean age, 32 years; range, 17–54 years). All clitoroplasties and vulvoplasties were completed in the same surgical stage as the vaginoplasty. There were no cases of deep or total flap necrosis. Eight patients developed partial and superficial skin necrosis of the flap; one presented an abscess in labia majora, and another patient had urethral hematoma; both required drainage. None of the complications left any sequelae. At 6 months' follow-up all patients maintained tactile and erogenous sensitivity. Conclusions The proposed technique represents an aesthetic refinement of the previously described pedicled glans penis flap by allowing the creation of a sensate neoclitoris, its preputial hood, and labia minora with excellent outcomes in the same surgical stage as the sex reassignment.A Comparative Clinical Study of Flap Thickness: Medial Sural Artery Perforator Flap Versus Anterolateral Thigh Flap
Introduction The purpose of this study is to measure flap thicknesses of anterolateral thigh (ALT) and medial sural artery perforator (MSAP) flaps in healthy subjects by Doppler ultrasonography and compare the results in relation to sex and body mass index (BMI). Method The perforators of ALT and MSAP flaps were marked on 30 healthy subjects. The thickness of skin and subcutaneous tissue was measured in millimeters at the site of the perforator using Doppler ultrasonography. Results The mean ± SD age of the participants was 36.4 ± 10.5, the mean ± SD BMI was 25.2 ± 3.9 (19.4–32.5). The mean ± SD flap thickness was 11.55 ± 4.38 mm for ALT and 8.31 ± 3.6 mm mm for MSAP (PBreast Reconstruction May Improve Work Ability and Productivity After Breast Cancer Surgery
Objective The aim of this study was to evaluate work ability and productivity in women who had undergone different types of surgical treatment for breast cancer, as well as breast reconstruction after mastectomy. Methods This cross-sectional study assessed 152 women between 30 and 60 years of age, who worked outside the home in formal or informal jobs, or as self-employed. Thirty-eight of them had no history of breast cancer (control group), and 114 had undergone surgical treatment for breast cancer at least 1 year before their enrollment in the study, and were allocated as follows: mastectomy group (n = 38), breast-conserving surgery group (n = 38), or breast reconstruction breast reconstruction group (n = 38). The validated Brazilian versions of the Work Productivity and Activity Impairment-General Health questionnaire and Work Limitations Questionnaire were self-administered. Results The groups were homogeneous regarding age, education level, and other sociodemographic characteristics. Patients in the mastectomy and breast-conserving surgery groups showed reduced work performance and productivity compared with women in the breast reconstruction and control groups (P = 0.0004 and P = 0.0006, respectively). In addition, women in the mastectomy group had more difficulty in performing activities of daily living compared with those in other groups (P = 0.0121). Conclusions Women who had undergone mastectomy or breast-conserving surgery had decreased work ability and productivity compared with women without a history of breast cancer and to those who had undergone breast reconstruction.Disparities in Postmastectomy Breast Reconstruction: A Systematic Review of the Literature and Modified Framework for Advancing Research Toward Intervention
Background As the United States' population diversifies, eliminating disparities in health and healthcare has become increasingly important across all disciplines of medicine, including plastic and reconstructive surgery. This is evidenced by the growing body of literature in recent years focusing on disparities in postmastectomy breast reconstruction. No study to date has evaluated whether this research is progressing appropriately to promote tangible evidence-based interventions to reduce these disparities. Methods A systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was performed to identify studies focusing on disparities in postmastectomy breast reconstruction. A previously established public health framework for advancing health disparities research was used to inform analysis of the quality and progression of the included studies. This triphasic framework categorizes disparities research as follows: detecting (identifies and measures disparities in vulnerable populations), understanding (establishes determinants of disparities), or reducing (proposes and evaluates interventions for eliminating disparities). Results Ninety-five studies were identified between 1979 and 2016, with 61 (64.2%) published after 2010. The majority of studies (51.6%) were retrospective cohort or case-control studies (American Society of Plastic Surgery level III evidence). Fifty-eight (63.7%), 31 (34.1%), and 2 (2.2%) studies provided detecting-, understanding- and reducing-phase disparities research, respectively. Non–plastic and reconstructive surgery journals accounted for 70.5% of all articles and for most higher phase research articles, publishing 83.9% and 100% of second and third phase studies, respectively. Disparity categories investigated included race/ethnicity, age, income, insurance status/type, geography, and education level, with race/ethnicity being the most common (73.7%). The most commonly measured outcome was percent of subpopulation receiving reconstruction (63, 66.3%), followed by reconstruction type (14, 16.7%). Patient-, provider-, system-, and research-level factors were all identified as potential targets for interventions to reduce disparities. Conclusions Despite a recent increase in literature focusing on postmastectomy breast reconstruction disparities, the majority focuses on identifying vulnerable populations with inadequate progression to second (understanding) and third (reducing) phases. Increasing research funding, availability of language-concordant and culturally concordant educational materials, and advocacy and sociopolitical awareness within the plastic surgery community is necessary to advance research on postmastectomy breast reconstruction and, ultimately, eliminate it.Low-Temperature Burn on Replanted Fingers and Free Flaps in Hand
Background Patients who have undergone microsurgery for reconstruction with a free flap or finger replantation are vulnerable to heat injury. Moreover, some of these injuries can occur at low temperatures. Although the temperature does not reach the threshold to cause burns in the adjacent normal tissues, burns can occur in the areas that underwent microsurgery. On the other hand, this type of burn is not completely understood and there are few reports of the clinical prognosis. Methods The medical records of patients who received warm therapy using an infrared heat lamp with the appropriate temperature after hand surgery from January 2009 to December 2016 were reviewed. The patients were classified into 2 groups. Group A comprised patients who underwent free flap or replantation surgery of the hand. Group B comprised patients who underwent other hand surgeries without microsurgery, such as tenorrhaphy, tenolysis, or joint surgery. Through the medical records, all patients with second- or third-degree thermal burns were selected. The relationship between the 2 types of surgery and thermal injury and the timing of the burn after microsurgery were analyzed. Results Groups A and B were composed of 370 (mean age, 48.2 years) and 7010 patients (mean age, 44.5 years), respectively. Burns requiring treatment occurred in 4 patients in group A and in 1 patient in group B. The proportion of low-temperature burns was 4 of 370 in group A and 1 of 7010 in group B. The occurrence of low-temperature burns was more associated with patients who had undergone microsurgery for a hand reconstruction with free flap or finger replantation (POutcome Analysis of Metacarpal and Phalangeal Fixation Techniques at Bellevue Hospital
Purpose Phalangeal fractures represent a significant portion of upper extremity injuries but are not well studied as a single entity. We define our approach at a level 1 trauma center and determine whether plating or lag screws (ie, rigid fixation) have superior functional outcomes compared with Kirschner wire fixation for phalangeal or metacarpal fractures. Methods We performed a systematic review of all surgically managed hand fracture cases at Bellevue Hospital during 2012 and 2013. Demographics, type of fixation, length of operation, period of immobilization, range of motion, time to return to work, and complications including reoperation were noted. Comparisons were assessed for significance using Student t tests and Fisher exact test (P 0.05). Total active motion and return to work were similar regardless of type of intervention in both fracture types. No patients treated with rigid fixation required reoperation. Conclusions To our best knowledge, this is the first review to study phalangeal fractures concurrently but also separately from metacarpal fractures. Despite shorter periods of immobilization, rigid fixation does not appear to lead to improved total active motion or time to return to work.Medial Plantar Venous Flap: Classic Donor Site Modification for Hand Defects
Background Destruction of digits from trauma results in a much more significant influence on patients' mental state and quality of life than do injuries to other parts. The purpose of this study was to describe a novel modification of medial plantar venous flap for soft tissue defects in the hands and digits. Methods Nine patients received medial plantar venous flap to resurface soft tissue defects in the hands or digits between January 2015 and February 2017. This flap can be used either in a free-island pattern or in a flow-through pattern through the medial branch of the great saphenous vein. All patient data including preoperative statues and follow-up examinations (flap survival rates, complication rates, total active motion, static 2-point discrimination, and Semme-Weinstein test score) were analyzed. Results We included 6 men and 3 women, with a mean age of 34.2 years. The medial plantar venous flaps were used for vascularization in 5 patients because of segmental defects of bilateral digit arteries. Eight flaps survived uneventfully in this study. One flap partially failed (20% of the flap area) because of venous congestion. The functional outcomes and sensory restoration were satisfied for all 9 flaps. Conclusions Compared with the traditional medial plantar flap, the medial plantar venous flap involves a simpler surgical procedure and allows for revascularization of distal areas using the flow-through technique. Furthermore, the medial plantar area presents a sensitive, glabrous skin with proper bulkiness and allows for movement of the underlying structure.Surgical Resection of Occult Subungual Glomus Tumors: Cold Sensitivity and Sonographic Findings
Purpose We surgically treated subungual masses that were suspected glomus tumors, although definitive clinical and radiological findings were lacking. We report the outcomes of a retrospective case series. Methods Of 42 patients treated by surgical resection between March 1996 and December 2015, 7 who met our inclusion/exclusion criteria were evaluated. At least 1 symptom of the typical triad (temperature sensitivity, severe pain, and localized tenderness) was absent, and computed tomography (CT) and magnetic resonance imaging (MRI) findings were normal. After ultrasonographic evaluation, we resected the masses using a transungual approach or a nail-preserving method. After pathological confirmation of the diagnosis, we followed all patients for at least 2 years to evaluate tumor recurrence and nail deformity. Results In 5 patients, cold sensitivity was the only symptom; no physical finding was suggestive of a glomus tumor. Tenderness was evidenced by the 2 patients who lacked cold sensitivity. None of the 7 patients exhibited CT or MRI abnormalities, but small acoustic shadows were evident in 4 patients, and blood-rich nodules were noted in 2 patients. The mean diameter of the 7 tumors was 2.1 mm, and pathological examination revealed typical glomus bodies. No major surgery-associated complication developed during follow-up. The final mean visual analog scale score (assessing pain) improved to 0.3 from the mean preoperative value of 3.6. Conclusions Small glomus tumors exhibit few traditional symptoms and signs and no definitive radiological CT/MRI finding. However, cold sensitivity alone is a powerful surgical indication, and occasionally, ultrasonographic findings are useful even in the absence of CT/MRI findings.A Systematic Review of Zosteriform Rash in Breast Cancer Patients: An Objective Proof of Flap Reinnervation and a Management Algorithm
Background Zosteriform rash in cancer patients provides objective clues to the process of reinnervation of the reconstructed breast. This rash should also raise suspicion for metastasis, which can be confused with herpes zoster. Objectives The aims of this study were to explain the reconstruction flap sensory reinnervation mechanism based on the clinical findings and provide a diagnostic and management algorithm of zosteriform rash in breast cancer patients. Methods On November 15, 2017, we conducted a search of published articles in MEDLINE and Cochrane databases. All the articles describing a zosteriform rash in a patient with a history of breast cancer were included in this review. Results Eleven articles from the literature and 1 case from our practice were selected for inclusion in this systematic review. Five patients had a breast reconstruction with a flap. The flap skin was affected by the rash in 4 of these patients, providing an objective proof of the reinnervation of the reconstructed breast. In 6 patients, the presentation was typical, and the diagnosis of herpes zoster was made without additional diagnostic testing. In 4 cases, the eruption was atypical, and a biopsy was done to confirm the diagnosis of a cancer metastasis. In 2 patients, the rash was multidermatomal, and a polymerase chain reaction was done to confirm the diagnosis of disseminated herpes zoster. Conclusions Zoster reactivation in breast reconstructed patients is an objective proof of the reinnervation of the skin flap. Moreover, zosteriform rash in cancer patients should raise suspicion for metastasis, which can be confused with herpes zoster.Long-term Outcomes of Cranioplasty: Titanium Mesh Is Not a Long-term Solution in High-risk Patients
Background Titanium mesh is a popular material for cranioplasty. However, long-term outcomes of these reconstructions remain unknown. We aimed to compare long-term outcomes between patients undergoing both (1) skull reconstruction with titanium mesh and other commonly used cranioplasty materials and (2) scalp reconstructions with locoregional flaps and free tissue transfers. Methods A retrospective review of patients treated with 466 cranioplasties (401 patients) between 2002 and 2014 was performed. Results Materials used for reconstructions included nontitanium alloplast (52.0%), titanium mesh (38%), and autologous bone (10%). Median cranial defect size was 58.4 cm2. Eighty-three reconstructions (18%) included full-thickness scalp defect with a median area of 155.4 cm2. Median follow-up was 3.9 years. Retention rate for isolated cranioplasty was 90%, 89.9%, and 77.1% for titanium mesh, nontitanium alloplast, and autologous bone, respectively (P > 0.05). In composite defect cases, retention rate for autologous bone was comparable, 81.8% (P > 0.05), whereas for titanium mesh and nontitanium alloplast it was significantly lower, 46.8% and 72.0%, respectively (PΠέμπτη 13 Σεπτεμβρίου 2018
A Patient With Multiorgan Failure and Fusiform Rod-Shaped Bacteria in the Blood Smear
A 65-year-old man without a significant medical history presented to the emergency department with abdominal pain and diarrhea. He did not use any relevant medication. At physical examination, he was somnolent and hemodynamically unstable with a high fever. His peripheral circulation was poor with significant marbling of both legs, his abdomen was diffusely painful on palpation, his left leg had a necrotizing wound without an additional abscess or cellulitis (Figure 1), and he had scratches on both hands. The rest of his physical examination findings were unremarkable.
Erratum
An error appeared in the initial publication of this article [Ram R, Halavy Y. Amit O. Extended versus Bolus Infusion of Broad Spectrum β-Lactams for Febrile Neutropenia: an Unblinded Randomized Trial. Clin Infect Dis https://doi.org/10.1093/cid/ciy258]. This article was originally published with the following error: In Table 3, under Per-Protocol population section, the first column should be labeled "Intermittent Bolus (n = 48)" and the second column should be labeled "Extended Infusion (n = 43)".
Safety and Clinical Activity of Atezolizumab in Head and Neck Cancer: Results From a Phase I Trial
Abstract
Background
Head and neck cancer (HNC) has a poor prognosis at advanced stages. Given the immunosuppressive tumor microenvironment in HNC, inhibition of the programmed death-ligand 1/programmed death-1 (PD-L1/PD-1) signaling pathway represents a promising therapeutic approach. Atezolizumab (anti–PD-L1) is efficacious against many tumor types. Here we report the clinical safety and activity from the HNC cohort of the phase Ia PCD4989g clinical trial. Patients and methods
Patients with previously-treated, advanced HNC received atezolizumab intravenously every 3 weeks for 16 cycles, up to 1 year or until loss of clinical benefit. Patients were monitored for safety and tolerability, and evaluated for response at least every 6 weeks. Baseline PD-L1 expression level and human papillomavirus (HPV) status were evaluated. Results
Thirty-two patients were enrolled; 7 patients (22%) had a primary tumor in the oral cavity, 18 (56%) in the oropharynx, 1 (3%) in the hypopharynx, 2 (6%) in the larynx, and 4 (13%) in the nasopharynx. Seventeen patients (53%) had ≥2 prior lines of therapy. Twenty-one patients (66%) experienced a treatment-related adverse event (TRAE), with 3 experiencing grade 3 TRAEs and 1 experiencing a grade 4 TRAE. No grade 5 TRAEs were reported. Objective responses by Response Evaluation Criteria In Solid Tumors version 1.1 (RECIST v1.1) occurred in 22% of patients, with a median duration of response of 7.4 months (range 2.8–45.8 months). Progression-free survival was 2.6 months (range 0.5–48.4 months), and median overall survival was 6.0 months (range 0.5–51.6+ months). Responses showed no association with HPV status or PD-L1 expression level. Conclusions
In this heavily pre-treated advanced HNC cohort, atezolizumab had a tolerable safety profile and encouraging activity, with responses observed regardless of HPV status and PD-L1 expression level. These findings warrant further investigation of atezolizumab in HNC. ClinicalTrials.gov number
NCT01375842.9 weeks vs 1 year adjuvant trastuzumab in combination with chemotherapy: final results of the phase III randomized Short-HER study
Abstract
Background
Chemotherapy plus 1-year trastuzumab is the standard adjuvant treatment for HER2-positive breast cancer. The efficacy of less extended trastuzumab exposure is under investigation. The Short-HER study was aimed to assess the non-inferiority of 9 weeks vs 1 year of adjuvant trastuzumab combined with chemotherapy. Patients and methods
HER2-positive breast cancer patients with node-positive or, if node negative, with at least one risk factor (pT > 2cm, G3, lympho-vascular invasion, Ki-67>20%, age ≤35 years, or hormone receptor negativity) were randomly assigned to receive sequential anthracycline-taxane combinations plus 1-year trastuzumab (arm A, long) or plus 9-weeks trastuzumab (arm B, short). This study was designed as a non-inferiority trial with disease-free survival (DFS) as primary end-point. A DFS Hazard Ratio (HR) <1.29 was chosen as the non-inferiority margin. Analyses according to the frequentist and Bayesian approach were planned. Secondary endpoints included 2-year failure rate and cardiac safety. Results
1254 patients from 82 centers were randomized (arm A, long: n = 627; arm B, short: n = 626). Five-year DFS is 88% in the long and 85% in the short arm. The HR was 1.13 (90%CI 0.89;1.42), with the upper limit of the CI crossing the non-inferiority margin. According to the Bayesian analysis, the probability that the short arm is non-inferior to the long one is 80%. The 5-yr OS is 95.2% in the long and 95.0% in the short arm (HR 1.07, 90%CI0.74;1.56). Cardiac events are significantly lower in the short arm (risk-ratio 0.33, 95%CI0.22;0.50, p < 0.0001). Conclusions
This study failed to show the non-inferiority of a shorter trastuzumab administration. 1-year trastuzumab remains the standard. However, a 9-week administration decreases the risk of severe cardiac toxicity and can be an option for patients with cardiac events during treatment and for those with a low risk of relapse.Help-Seeking Behaviors and Intimate Partner Violence-Related Traumatic Brain Injury
Violence and Gender, Ahead of Print.
Longitudinal Persistence of Meningeal Enhancement on Postcontrast 7T 3D-FLAIR MRI in Multiple Sclerosis [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Preliminary research has demonstrated that postgadolinium 3D-FLAIR MR imaging at 7T may be a valuable tool for detecting abnormal meningeal enhancement and inflammation in MS; however, researchers have not systematically investigated its longitudinal persistence. We hypothesized that persistence of meningeal enhancement in MS varies on the basis of pattern of enhancement as well as demographic and clinical factors such as treatment status, disease phenotype, and disability score.
MATERIALS AND METHODS:Thirty-one subjects with MS were prospectively scanned before and after intravenous contrast administration at 2 time points, approximately 1 year apart. Fifteen subjects in the cohort were scanned at another time approximately 1 year later. Foci of enhancement were categorized into 4 subtypes: subarachnoid spread/fill, subarachnoid nodular, vessel wall, and dural foci. We reviewed follow-up scans to determine whether foci changed between time points and then compared persistence with demographic and clinical variables.
RESULTS:Persistence ranged from 71% to 100% at 1 year and 73% to 100% at 2 years, depending on the enhancement pattern. Subarachnoid spread/fill and subarachnoid nodular subtypes persisted less often than vessel wall and dural foci. Persistence was not significantly different between those on/off treatment and those with progressive/nonprogressive disease phenotypes. The number of persisting foci was significantly different in subjects with/without increasing Expanded Disability Status Scale scores (median, 12 versus 7.5, P = .04).
CONCLUSIONS:Longitudinal persistence of meningeal enhancement on 3D-FLAIR at 7T in MS varies by pattern of enhancement and correlates with worsening disability; however, it is not significantly different in those on/off treatment or in those with progressive/nonprogressive disease phenotypes.
Quantification of Blood Velocity with 4D Digital Subtraction Angiography Using the Shifted Least-Squares Method [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
4D-DSA provides time-resolved 3D-DSA volumes with high temporal and spatial resolutions. The purpose of this study is to investigate a shifted least squares method to estimate the blood velocity from the 4D DSA images. Quantitative validation was performed using a flow phantom with an ultrasonic flow probe as ground truth. Quantification of blood velocity in human internal carotid arteries was compared with measurements generated from 3D phase-contrast MR imaging.
MATERIALS AND METHODS:The centerlines of selected vascular segments and the time concentration curves of each voxel along the centerlines were determined from the 4D-DSA dataset. The temporal shift required to achieve a minimum difference between any point and other points along the centerline of a segment was calculated. The temporal shift as a function of centerline point position was fit to a straight line to generate the velocity. The proposed shifted least-squares method was first validated using a flow phantom study. Blood velocities were also estimated in the 14 ICAs of human subjects who had both 4D-DSA and phase-contrast MR imaging studies. Linear regression and correlation analysis were performed on both the phantom study and clinical study, respectively.
RESULTS:Mean velocities of the flow phantom calculated from 4D-DSA matched very well with ultrasonic flow probe measurements with 11% relative root mean square error. Mean blood velocities of ICAs calculated from 4D-DSA correlated well with phase-contrast MR imaging measurements with Pearson correlation coefficient r = 0.835.
CONCLUSIONS:The availability of 4D-DSA provides the opportunity to use the shifted least-squares method to estimate velocity in vessels within a 3D volume.
The Diagnostic Value of Diffusion-Weighted Imaging in Differentiating Metastatic Lymph Nodes of Head and Neck Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis [HEAD & NECK]
BACKGROUND:
Accurate lymph node staging is crucial for proper treatment planning for metastasis in patients with head and neck squamous cell carcinoma.
PURPOSE:Our aim was to evaluate the diagnostic performance of DWI for differentiating metastatic cervical lymph nodes from benign cervical lymph nodes in patients with head and neck squamous cell carcinoma and to identify optimal cutoff values for ADC.
DATA SOURCES:A computerized literature search was performed to identify relevant original articles in Ovid MEDLINE and EMBASE.
STUDY SELECTION:Studies evaluating the diagnostic performance of DWI for differentiating metastatic cervical lymph nodes from benign cervical lymph nodes were selected.
DATA ANALYSIS:Diagnostic meta-analysis was conducted with a bivariate random-effects model, and a hierarchical summary receiver operating characteristic curve was obtained. Meta-regression was also performed.
DATA SYNTHESIS:Nine studies with 337 patients were included. In all studies, ADC values derived from metastatic lymph nodes were significantly lower than ADC values derived from benign lymph nodes. The median ADC cutoff value was 0.965 x 10–3 mm2/s. The pooled sensitivity and specificity for the diagnostic performance of DWI in differentiating metastatic lymph nodes from benign lymph nodes were 90% (95% CI, 84%–94%) and 88% (95% CI, 80%–93%), respectively. In the meta-regression, sensitivity was significantly higher in the studies using a 3-mm slice thickness (93% [95% CI, 88%–98%]) than in studies using a slice thickness of >3 mm (86% [95% CI, 77%–95%], P < .01).
LIMITATIONS:A small number of studies were included in our meta-analysis.
CONCLUSIONS:DWI demonstrated high diagnostic performance for differentiating metastatic lymph nodes from benign lymph nodes in patients with head and neck squamous cell carcinoma, and the median ADC cutoff value was 0.965 x 10–3 mm2/s. A 3-mm DWI slice thickness can provide a slight improvement in sensitivity.
The Impact of Persistent Leukoencephalopathy on Brain White Matter Microstructure in Long-Term Survivors of Acute Lymphoblastic Leukemia Treated with Chemotherapy Only [PEDIATRICS]
BACKGROUND AND PURPOSE:
Survivors of acute lymphoblastic leukemia are at risk for neurocognitive deficits and leukoencephalopathy. We performed a longitudinal assessment of leukoencephalopathy and its associations with long-term brain microstructural white matter integrity and neurocognitive outcomes in survivors of childhood acute lymphoblastic leukemia treated on a modern chemotherapy-only protocol.
MATERIALS AND METHODS:One hundred seventy-three survivors of acute lymphoblastic leukemia (49% female), treated on a chemotherapy-only protocol, underwent brain MR imaging during active therapy and repeat imaging and neurocognitive testing at follow-up (median, 13.5 years of age; interquartile range, 10.7–17.6 years; median time since diagnosis, 7.5 years; interquartile range, 6.3–9.1 years). Persistence of leukoencephalopathy was examined in relation to demographic and treatment data and to brain DTI in major fiber tracts and neurocognitive testing at follow-up.
RESULTS:Leukoencephalopathy was found in 52 of 173 long-term survivors (30.0%) and persisted in 41 of 52 (78.8%) who developed it during therapy. DTI parameters were associated with leukoencephalopathy in multiple brain regions, including the corona radiata (fractional anisotropy, P = .001; mean diffusivity, P < .001), superior longitudinal fasciculi (fractional anisotropy, P = .02; mean diffusivity, P < .001), and superior fronto-occipital fasciculi (fractional anisotropy, P = .006; mean diffusivity, P < .001). Mean diffusivity was associated with neurocognitive impairment including in the genu of the corpus callosum (P = .04), corona radiata (P = .02), and superior fronto-occipital fasciculi (P = .02).
CONCLUSIONS:Leukoencephalopathy during active therapy and neurocognitive impairment at long-term follow-up are associated with microstructural white matter integrity. DTI may be more sensitive than standard MR imaging for detection of clinically consequential white matter abnormalities in childhood acute lymphoblastic leukemia survivors treated with chemotherapy and in children undergoing treatment.
Clinical Evaluation of Highly Accelerated Compressed Sensing Time-of-Flight MR Angiography for Intracranial Arterial Stenosis [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Time-of-flight MR angiography is the preferred imaging technique to assess intracranial arterial stenosis but is limited by a relatively long acquisition time. Compressed sensing provides an innovative approach in undersampling k-space to minimize the data-acquisition time. We aimed to evaluate the diagnostic accuracy of compressed sensing TOF for detecting intracranial arterial stenosis by comparison with conventional parallel imaging TOF-MRA.
MATERIALS AND METHODS:Compressed sensing TOF and parallel imaging TOF were performed in 22 patients with intracranial arterial stenosis. The MRA scan times were 2 minutes and 31 seconds and 4 minutes and 48 seconds for compressed sensing TOF and parallel imaging TOF, respectively. The reconstructed resolutions were 0.4 x 0.4 x 0.4 and 0.4 x 0.4 x 0.6 mm3 for compressed sensing TOF and parallel imaging TOF, respectively. The diagnostic quality of the images and visibility of the stenoses were independently ranked by 2 neuroradiologists blinded to the type of method and were compared using the Wilcoxon signed rank test. Concordance was calculated with the Cohen . Edge sharpness of the arteries and the luminal stenosis ratio were analyzed and compared using a paired-sample t test.
RESULTS:The interrater agreement was good to excellent. Compressed sensing TOF resulted in image quality comparable with that of parallel imaging TOF but boosted confidence in diagnosing arterial stenoses (P = .025). The edge sharpness of the intracranial arteries for compressed sensing TOF was significantly higher than that for parallel imaging TOF (P < .001). The luminal stenosis ratio on compressed sensing TOF showed no significant difference compared with that on parallel imaging TOF.
CONCLUSIONS:Compressed sensing TOF both remarkably reduced the scan time and provided adequate image quality for the diagnosis of intracranial arterial stenosis.
Multidelay Arterial Spin-Labeling MRI in Neonates and Infants: Cerebral Perfusion Changes during Brain Maturation [PEDIATRICS]
BACKGROUND AND PURPOSE:
Arterial spin-labeling with multiple postlabeling delays can correct transit times. We tried to evaluate CBF in neonates and infants using multidelay arterial spin-labeling.
MATERIALS AND METHODS:Multidelay arterial spin-labeling was applied to 13 preterm neonates (mean postmenstrual age, 34.9 weeks), 13 term-equivalent-age neonates (mean postmenstrual age, 39.2 weeks), and 6 infants (mean postmenstrual age, 57.8 weeks). Transit time–corrected CBF in the caudate, thalamus, frontal GM, occipital GM, frontal WM, and occipital WM was measured, and relative CBF compared with the whole-brain CBF was calculated. Inter- and intragroup comparisons were performed among the 3 age groups. A correlation and nonlinear regression analysis were performed between postmenstrual age and CBF.
RESULTS:Intergroup comparisons showed significantly higher whole-brain CBF in infants (38.3 mL/100 g/min) compared with preterm (15.5 mL/100 g/min) and term-equivalent-age (18.3 mL/100 g/min) neonates (P < .001). In the intragroup comparison, all 3 groups showed significantly higher relative CBF values in the occipital WM (63.6%–90.3%) compared with the frontal WM (46.3%–73.9%). In term-equivalent-age neonates, the occipital GM (120.8%) had significantly higher relative CBF values than the frontal GM (103.5%). There was a significant negative correlation between postmenstrual age and the relative CBF of the thalamus (r = – 0.449, P = .010). There were significant positive relationships between postmenstrual age and the relative CBF of the frontal WM (R2 = 0.298, P = .001) and occipital WM (R2 = 0.452, P < .001).
CONCLUSIONS:Multidelay arterial spin-labeling with transit time–corrected CBF showed developmental changes and regional differences of CBF in neonates and infants.
Longitudinal Findings of MRI and PET in West Syndrome with Subtle Focal Cortical Dysplasia [PEDIATRICS]
BACKGROUND AND PURPOSE:
Despite the development of neuroimaging, identification of focal cortical dysplasia remains challenging. The purpose of this study was to show the longitudinal changes of MR imaging and FDG-PET in patients with West syndrome and subtle focal cortical dysplasia.
MATERIALS AND METHODS:Among 52 consecutive patients with West syndrome, 4 were diagnosed with subtle focal cortical dysplasia on 3T MR imaging. MR imaging and PET findings were evaluated longitudinally at onset and at 12 and 24 months of age.
RESULTS:At the onset of West syndrome, MR imaging demonstrated focal signal abnormalities of the subcortical white matter in 2 patients. In the other 2 patients, focal subcortical high-intensity signals became visible on follow-up T2WI as myelination progressed. PET at onset showed focal cortical hypometabolism in 3 patients, with 1 of these patients also having focal hypermetabolism and 1 having normal findings. On PET at 24 months, hypometabolism persisted in 2 patients and disappeared in 1, and hypermetabolism disappeared in 1. In 1 patient with normal MR imaging and PET findings at onset, focal hyperintensity and hypometabolism first appeared at 24 months of age. The findings on MR imaging and PET in these patients evolved differently with brain maturation and the clinical course.
CONCLUSIONS:Subtle focal cortical dysplasia can be undetectable on MR imaging at the onset of West syndrome and is not always accompanied by hypometabolism or hypermetabolism on PET. Longitudinal MR imaging and PET studies may be useful for detecting such lesions. Even in West syndrome with a congenital structural abnormality, PET findings evolve differently with brain maturation and the clinical condition.
Automated Integration of Multimodal MRI for the Probabilistic Detection of the Central Vein Sign in White Matter Lesions [ADULT BRAIN]
BACKGROUND AND PURPOSE:
The central vein sign is a promising MR imaging diagnostic biomarker for multiple sclerosis. Recent studies have demonstrated that patients with MS have higher proportions of white matter lesions with the central vein sign compared with those with diseases that mimic MS on MR imaging. However, the clinical application of the central vein sign as a biomarker is limited by interrater differences in the adjudication of the central vein sign as well as the time burden required for the determination of the central vein sign for each lesion in a patient's full MR imaging scan. In this study, we present an automated technique for the detection of the central vein sign in white matter lesions.
MATERIALS AND METHODS:Using multimodal MR imaging, the proposed method derives a central vein sign probability, ij, for each lesion, as well as a patient-level central vein sign biomarker, i. The method is probabilistic in nature, allows site-specific lesion segmentation methods, and is potentially robust to intersite variability. The proposed algorithm was tested on imaging acquired at the University of Vermont in 16 participants who have MS and 15 participants who do not.
RESULTS:By means of the proposed automated technique, participants with MS were found to have significantly higher values of than those without MS (MS = 0.55 ± 0.18; non-MS = 0.31 ± 0.12; P <.001). The algorithm was also found to show strong discriminative ability between patients with and without MS, with an area under the curve of 0.88.
CONCLUSIONS:The current study presents the first fully automated method for detecting the central vein sign in white matter lesions and demonstrates promising performance in a sample of patients with and without MS.
Correlation between Human Papillomavirus Status and Quantitative MR Imaging Parameters including Diffusion-Weighted Imaging and Texture Features in Oropharyngeal Carcinoma [HEAD & NECK]
BACKGROUND AND PURPOSE:
The incidence of Oropharyngeal Squampus Cell Carcinoma (OPSCC) cases is increasing especially in the Western countries due to the spreading of human papilloma virus (HPV) infection. Radiological investigations, MRI in particular, are used in the daily clinical practice to stage OPSCC. The aim of this study was to investigate the association of quantitative MR imaging features including diffusion-weighted imaging and human papillomavirus status in oropharyngeal squamous cell carcinoma.
MATERIALS AND METHODS:We retrospectively analyzed 59 patients with untreated histologically proved T2–T4 oropharyngeal squamous cell carcinoma. Human papillomavirus status was determined by viral DNA detection on tissue samples. MR imaging protocol included T2-weighted, contrast-enhanced T1-weighted (volumetric interpolated brain examination), and DWI sequences. Parametric maps of apparent diffusion coefficient were obtained from DWI sequences. Texture analysis was performed on T2 and volumetric-interpolated brain examination sequences and on ADC maps. Differences in quantitative MR imaging features between tumors positive and negative for human papillomavirus and among subgroups of patients stratified by smoking status were tested using the nonparametric Mann-Whitney U test; the false discovery rate was controlled using the Benjamini-Hochberg correction; and a predictive model for human papillomavirus status was built using multivariable logistic regression.
RESULTS:Twenty-eight patients had human papillomavirus-positive oropharyngeal squamous cell carcinoma, while 31 patients had human papillomavirus-negative oropharyngeal squamous cell carcinoma. Tumors positive for human papillomavirus had a significantly lower mean ADC compared with those negative for it (median, 850.87 versus median, 1033.68; P < .001). Texture features had a lower discriminatory power for human papillomavirus status. Skewness on volumetric interpolated brain examination sequences was significantly higher in the subgroup of patients positive for human papillomavirus and smokers (P = .003). A predictive model based on smoking status and mean ADC yielded a sensitivity of 83.3% and specificity 92.6% in classifying human papillomavirus status.
CONCLUSIONS:ADC is significantly lower in oropharyngeal squamous cell carcinoma positive for human papillomavirus compared with oropharyngeal squamous cell carcinoma negative for it. ADC and smoking status allowed noninvasive prediction of human papillomavirus status with a good accuracy. These results should be validated and further investigated on larger prospective studies.
Spinal Instrumentation Rescue with Cement Augmentation [SPINE]
BACKGROUND AND PURPOSE:
Altered biomechanics or bone fragility or both contribute to spine instrumentation failure. Although revision surgery is frequently required, minimally invasive alternatives may be feasible. We report the largest to-date series of percutaneous fluoroscopically guided vertebral cement augmentation procedures to address feasibility, safety, results and a variety of spinal instrumentation failure conditions.
MATERIALS AND METHODS:A consecutive series of 31 fluoroscopically guided vertebral augmentation procedures in 29 patients were performed to address screw loosening (42 screws), cage subsidence (7 cages), and fracture within (12 cases) or adjacent to (11 cases) the instrumented segment. Instrumentation failure was deemed clinically relevant when resulting in pain or jeopardizing spinal biomechanical stability. The main study end point was the rate of revision surgery avoidance; feasibility and safety were assessed by prospective recording of periprocedural technical and clinical complications; and clinical effect was measured at 1 month with the Patient Global Impression of Change score.
RESULTS:All except 1 procedure was technically feasible. No periprocedural complications occurred. Clinical and radiologic follow-up was available in 28 patients (median, 16 months) and 30 procedures. Revision surgery was avoided in 23/28 (82%) patients, and a global clinical benefit (Patient Global Impression of Change, 5–7) was reported in 26/30 (87%) cases at 1-month follow-up, while no substantial change (Patient Global Impression of Change, 4) was reported in 3/30 (10%), and worsening status (Patient Global Impression of Change, 3), in 1/30 (3%).
CONCLUSIONS:Our experience supports the feasibility of percutaneous vertebral augmentation in the treatment of several clinically relevant spinal instrumentation failure conditions, with excellent safety and efficacy profiles, both in avoidance of revision surgery and for pain palliation.
CT versus MR Imaging in Estimating Cochlear Radiation Dose during Gamma Knife Surgery for Vestibular Schwannomas [PATIENT SAFETY]
BACKGROUND AND PURPOSE:
Leksell stereotactic radiosurgery is an effective option for patients with vestibular schwannomas. Some centers use a combination of stereotactic CT fused with stereotactic MR imaging to achieve an optimal target definition as well as minimize the radiation dose delivered to adjacent structures that correlate with hearing outcomes. The present prospective study was designed to determine whether there is cochlear dose variability between MR imaging and CT.
MATERIALS AND METHODS:Fifty consecutive patients underwent stereotactic radiosurgery for vestibular schwannomas. Dose-planning was performed using high-definition fused stereotactic MR imaging and stereotactic CT images. The 3D cochlear volume was determined by delineating the cochlea on both CT and T2-weighted MR imaging. The mean radiation dose, maximum dose, and 3- and 4.20-Gy cochlear volumes were identified using standard Leksell Gamma Knife software.
RESULTS:The median mean radiation dose delivered to the cochlea was 3.50 Gy (range, 1.20–6.80 Gy) on CT and 3.40 Gy (range, 1–6.70 Gy) on MR imaging (concordance correlation coefficient = 0.86, r2 = 0.9, P ≤ .001). The median maximum dose delivered to the cochlea was 6.7 Gy on CT and 6.6 Gy on MR imaging (concordance correlation coefficient = 0.89, r2 = 0.90, P ≤ .001). Dose-volume histograms generated from CT and MR imaging demonstrated a strong level of correlation in estimating the 3- and 4.20-Gy volumes (concordance correlation coefficient = 0.81, r2 = 0.82, P ≤ .001 and concordance correlation coefficient = 0.87, r2 = 0.89, P ≤ .001).
CONCLUSIONS:Both MR imaging and CT provide similar cochlear dose parameters. Despite the reported superiority of CT in identifying bony structures, high-definition MR imaging alone is sufficient to identify the radiation doses delivered to the cochlea.
First case of secukinumab successful therapy in a very elderly psoriatic patient
Dermatologic Therapy, EarlyView.
Environmental hazards associated with open-beach breaking of end-of-life ships: a review
Abstract
End-of-life (EOL) ships contribute significantly to the flow of recycled industrial Fe and non-Fe metal materials in resource-poor developing countries. The ship scrapping (breaking) and recycling industry (SBRI) recycles 90–95% of the total weight of EOL ships and is currently concentrated in Bangladesh, India, Pakistan, Turkey, and China, due to the high demand for recyclable and reusable materials there, an abundance of low-cost labor, and lenient environmental regulations. However, the SBRI has long been criticized for non-compliance with standards relating to occupational health, labor safety, and to the management of hazardous materials. Among the different EOL recycling options, Bangladesh, India, and Pakistan use open beaching, a technique that exposes all spheres of the environment to the release of hazardous materials from EOL ships. This article summarizes the current state of knowledge on the environmental exposure of hazardous materials from SBRI, to judge the risks associated with the dismantling of EOL ships on open beaches. Our work includes an overview of the industry and its recent growth, compares available ship-breaking methods, provides an inventory of hazardous releases from EOL ships, and reviews their movement into different spheres of the environment. The economic dynamics behind open beaching, and apportionment of responsibility for hazards related to it, are discussed, in order to generate policy and legal recommendations to mitigate the environmental harm stemming from this industry.
Determination of azole fungal residues in soils and detection of Aspergillus fumigatus -resistant strains in market gardens of Eastern France
Abstract
Medical azole antifungals are major compounds used to prevent and to treat invasive aspergillosis (IA). Azole fungicides, called DMI (14-alpha demethylase inhibitors), are also widely used for crop protection and have been reported to be linked to azole-resistant A. fumigatus (aR-Af) development in the environment. The aim of this study was to determine whether or not market gardens that spray DMIs in Eastern France are also affected by the presence of aR-Af. Forty aR-Afs were detected in soils in only two of the four market gardens using DMIs, with 23% (7/30) and 10% (3/30) of soils containing aR-Af. A total of 87.5% of these isolates had the TR34/L98H mutation and 22.5% the TR46/Y121F/T289A mutation on the cyp51A gene. Analyses of residual azole concentrations in soils showed the presence of difenoconazole for up to 2 years after spraying, but only in soils of market gardens where aR-Af was detected. It is very important to identify professional activities that could lead to aR-Af development and to develop preventive measures for at-risk patients living near professional activities using DMIs. We have to better understand why, in some cases, the use of DMI is not linked to aR-Af. Measures should be taken to avoid the use of DMI conferring cross-resistance to preserve the efficiency of human therapeutics.
Rapidly growing verrucous axillary tumors, multiple erosions, pustules, and cheilitis
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.
Use of carbon-based composites to enhance performance of TiO 2 for the simultaneous removal of nitrates and organics from aqueous environments
Abstract
The simultaneous photocatalytic removal of nitrate from aqueous environment in presence of organic hole scavenger using TiO2 has long been explored. However, the use of unmodified TiO2 in such reaction resulted in non-performance or release of significant amount of undesirable reaction products in the process, a problem that triggered surface modification of TiO2 for enhanced photocatalytic performance. Previous studies focused on decreasing rate of charge carrier recombination and absorption of light in the visible region. Yet, increasing active sites and adsorption capacity by combining TiO2 with a high surface area adsorbent such as activated carbon (AC) remains unexploited. This study reports the potential of such modification in simultaneous removal of nitrates and oxalic acid in aqueous environment. The adsorptive behaviour of nitrate and oxalic acid on TiO2 and TiO2/AC composites were studied. The Langmuir adsorption coefficient for nitrate was four times greater than that of oxalic acid. However, the amount of oxalic acid adsorbed was about 10 times greater than the amount of nitrate taken up. Despite this advantage, the materials did not appear to produce more active photocatalysts for the simultaneous degradation of nitrate and oxalic acid. The photocatalytic activity of TiO2 and its carbon-based composites was improved by combination with Cu2O particles. Consequently, 2.5 Cu2O/TiO2 exhibited the maximum photocatalytic performance with 57.6 and 99.8% removal of nitrate and oxalic acid, respectively, while selectivity stood at 45.7, 12.4 and 41.9% for NH4+, NO2− and N2, respectively. For the carbon based, 2.5 Cu2O/TiO2-20AC showed removal of 12.7% nitrate and 80.3% oxalic acid and achieved 21.6, 0 and 78.4% selectivity for NH4+, NO2− and N2, respectively. Using the optimal AC loading (20 wt%) resulted in significant decrease in the selectivity for NH4+ with no formation of NO2−, which unveils that selectivity for N2 and low/no selectivity for undesirable products can be manipulated by controlling the rate of consumption of oxalic acid. In contract, no nitrate reduction was observed with Cu2O promoted TiO2-T and its TiO2-(T)-20AC, which may be connected to amorphous nature of TiO2-T and perhaps served as charge carrier trapping sites that impeded activity.
Inflammasome, interleukine 1, maladies auto-inflammatoires et dermatoses neutrophiliques
Publication date: Available online 13 September 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): M.-S. Doutre
Percutaneous Radiofrequency Lower Face and Neck Tightening Technique
This Surgical Pearl presents the technique for use of 2 types of percutaneous radiofrequency devices to deliver electrothermal energy into the hypodermal skin layers of the face and neck.
Association of Hair Loss With Health Utility Measurements Before and After Hair Transplant Surgery
This questionnaire study measures health utility scores for the objective assessment of sex-specific alopecia and hair transplant surgery and assesses perception of alopecia compared with other chronic health conditions by laypersons.
Intermediaries Supporting Occupational Health and Safety Improvements in Small Businesses: Development of Typology and Discussion of Consequences for Preventive Strategies
Abstract
Intermediaries have been suggested as a potential source for improving Occupational Health and Safety (OHS) in small businesses (SBs), because SB due to their sheer number and limited managerial and financial resources typically have weak OHS management and higher occupational risks. SB furthermore typically has a reactive approach to OHS and do not seek out OHS assistance on their own. We propose, based on a large comparative study of SB and intermediaries, a general typology for intermediaries in relation to SB, and further, discuss the implications for preventive strategies in SB. We argue that there is a strong potential for improving OHS by including various intermediaries, however, the inclusion is not enough in itself. The interests of the intermediaries and the OHS improvement must be aligned, and the efforts across various intermediaries should be orchestrated among the key actors to maximize the outcome.Conference Summary Understanding Small Enterprises Conference, 25–27 October 2017
Abstract
Objectives
The specific objectives of the 2017 Understanding Small Enterprises Conference were to: (i) identify successful strategies for overcoming occupational safety and health (OS&H) barriers in small and medium-sized enterprises (SMEs); (ii) disseminate best practices to research and business communities; (iii) build collaborations between different stakeholders including researchers, insurers, small enterprises, government agencies; and (iv) better inform OS&H research relevant to SMEs. Methods
A two and a half day international conference was organized, building upon three previously successful iterations. This conference brought together researchers, practitioners, and other stakeholders from 16 countries to share best practices and emerging strategies for improving OS&H in SMEs. Findings
Cross-cutting themes that emerged at the conference centered around: 1) stakeholder and intermediary involvement; 2) what occupational health and safety looks like across different industries; 3) intervention programs (tools and resources); 4) precarious and vulnerable work and the informal sector; and 5) Total Worker Health® in SMEs. Conclusion
A number of innovative initiatives were shared at the conference. Researchers must build collaborations involving a variety of stakeholder groups to ensure that OS&H solutions are successful in SMEs. Future OS&H research should continue to build upon the successful work of the 2017 Understanding Small Enterprises Conference.Components of an Occupational Safety and Health Communication Research Strategy for Small- and Medium-Sized Enterprises
Abstract
The majority of the global labor force works in firms with fewer than 50 employees; firms with fewer than 250 employees make up 99% of workplaces. Even so, the lack of extensive or comprehensive research has failed to focus on occupational safety and health communication to these small- and medium-sized enterprises (SMEs). Given that the magnitude of all occupational safety and health (OSH) morbidity, mortality, and injury disproportionately occurs in businesses with fewer than 250 employees, efforts to communicate with employers to engage in preventative occupational safety and health efforts merit attention. This article provides an overview of important components that should be considered in developing an occupational safety and health (OSH) communication research strategy targeting SMEs. Such a strategy should raise awareness about the diversity and complexity of SMEs and the challenges of targeting OSH communication toward this diverse group. Companies of differing sizes (e.g. 5, 50, 500 employees) likely require differing communication approaches. Communication strategies will benefit from deconstructing the term 'small business' into smaller, more homogenous categories that might require approaches. Theory-based research assessing barriers, message content, channels, reach, reception, motivation, and intention to act serve as the foundation for developing a comprehensive research framework. Attention to this type of research by investigators is warranted and should be encouraged and supported. There would also be value in developing national and international strategies for research on communication with small businesses.Health and Safety Education in Auto Body Collision and Machine Tool Technology Programs in Vocational Colleges: Challenges and Opportunities
Abstract
Collision repair, machining, and metal manufacturing are industries with a large percentage of small businesses whose owners face unique challenges implementing health and safety regulatory requirements. Previous research found that 72% of collision repair technicians and 47% of machinists attended some classes or graduated from vocational colleges. Although health and safety is a mandatory part of the curricula for post-secondary vocational education, little is known about what, how, and when health and safety is taught and if teaching is effective. Surveys and discussion groups were used to evaluate health and safety education in two vocational colleges in Minnesota. Six instructors and 76 students in collision repair, and 6 instructors and 130 students in machine tool technology programs participated. Instructors had no formal training in health and safety, few teaching materials, and lacked opportunities to learn about safety in their trade. Teaching was unscripted and heavily influenced by each instructor's™ industry experience, knowledge, perceptions and attitude towards safety, with little or no guidance from school administration, or safety professionals. Student survey results show that graduates have significant gaps in safety and health knowledge. Standardized trade-specific curricula and instructor training are needed to ensure students receive adequate health and safety education.Construction Safety and Health in the USA: Lessons From a Decade of Turmoil
Abstract
The construction industry is one of the largest and also most hazardous industries in the USA. It is affected more severely by the business cycle than most other industries. We examined industry trends during the last decade including the severe recession. During 2008 to 2010, as a result of the recession, 2.7 million workers and 20% of all employers left the industry. By 2010, the number and rate of traumatic fatalities had reached its lowest point ever, only to gradually increase again as the industry recovered from the recession. The risks of a fatality were disproportionate with employer size. The small employers (<20 employees), which account for 37.5% of employment, were responsible for 57% of all fatalities. These small employers are less likely to embrace essential safety culture practices and are slow to adopt new approaches to occupational safety and health. These employers—especially those which hire immigrant workers and self-employed workers—lag far behind in terms of adopting even essential elements of good safety cultures and management practices. Currently, there are no restrictions on going into business as a construction contractor or seeking employment as a construction worker. There is a great need to find ways to establish minimum qualifications for becoming a construction contractor and for becoming a construction worker. Some jurisdictions have established minimum occupational safety and health training. This is a good start, but qualifications must include greater emphasis on minimum skills requirements. State and local jurisdictions have good policy tools which could be deployed for this purpose but which have largely been neglected: licensing of both companies and workers could include skills qualifications; construction permits could include requirements for occupational safety and health; and greater use of criminal prosecution could be pursued where it is obvious that basic requirements for safety and health have been ignored.Safety Talk and Safety Culture: Discursive Repertoires as Indicators of Workplace Safety and Health Practice and Readiness to Change
Abstract
Background
Small construction businesses (SCBs) account for a disproportionate share of occupational injuries, days lost, and fatalities in the US and other modern economies. Owner/managers of SCBs confront risks associated with their own and workers' safety and business survival, and their occupational safety and health (OSH) related values and practices are key drivers of safety and business outcomes. Given owner/mangers are the key to understanding and affecting change in smaller firms, as well as the pressing need for improved OSH in small firms particularly in construction, there is a critical need to better understand SCB owners' readiness to improve or adopt enhanced OSH activities in their business. Unfortunately, the social expectation to support safety can complicate efforts to evaluate owners' readiness. Objectives
To get a more accurate understanding of the OSH values and practices of SCBs and the factors shaping SCB owners' readiness and intent to implement or improve safety and health programming by comparing their discourse on safety with their self-rated level of stage of change. Methods
In-depth, semi-structured interviews were conducted with 30 SCB owner managers. Respondents were asked to self-rate their safety program activity on a 5-point scale from unaware or ignorant ('haven't thought about it at all') to actively vigilant ('well-functioning safety and health program for at least 6 months'). They were also asked to discuss the role and meaning of OSH within their trade and company, as well as attitudes and inclinations toward improving or enhancing business safety practices. Analysis and results
Respondents' self-rating of safety program activity was compared and contrasted with results from discourse analysis of their safety talk, or verbal descriptions of their safety values and activities. Borrowing from normative and stage theories of safety culture and behavioral change, these sometimes contradictory descriptions were taxonomized along a safety culture continuum and a range of safety cultures and stages of readiness for change were found. These included descriptions of strong safety cultures with intentions for improvement as well as descriptions of safety cultures with more reactive and pathological approaches to OSH, with indications of no intentions for improvement. Some owner/managers rated themselves as having an effective OSH program in place, yet described a dearth of OSH activity and/or value for OSH in their business. Conclusion
Assessing readiness to change is key to improving OSH performance, and more work is needed to effectively assess SCB OSH readiness and thus enable greater adoption of best practices.What Could Total Worker Health® Look Like in Small Enterprises?
Abstract
Small enterprises have fewer resources, are more financially precarious, and have higher rates of occupational injury and illness compared with larger enterprises. Interventions that address the promotion of health and well-being in addition to traditional occupational safety and health hazards, a Total Worker Health® (TWH) approach, may be effective in reducing injuries and preventing illness. However, little research has examined the impact of TWH interventions in small enterprises. The aim of this research was to explore and characterize health and safety practices, policies, and programs in small Midwestern enterprises from a TWH perspective. Utilizing a case studies approach, site visits were conducted with small business, between 10 and 250 employees, from 2014 through 2016 and included workplace audits and interviews with multiple employees in varying roles within each organization. Both open and closed coding were used to identify specific themes. Eight themes emerged from the site visits: value and return on investment, organizational factors, program design, engaging employees, low-cost strategies, evaluation, and integration. These themes overlapped with both the National Institute for Occupational Safety and Health's (NIOSH) Essential Elements of TWH and the NIOSH Fundamentals. Industry sector and enterprise size also affect resources and integration of these resources. As TWH expands to organizations of all sizes, it is necessary to address the unique needs of smaller enterprises.Engaging Small Residential Construction Contractors in Community-Based Participatory Research to Promote Safety
Abstract
Construction is a large employment sector with a high prevalence of small businesses. Despite the high injury rates reported for employees of small construction firms, these firms are under-represented in occupational safety research studies. Such studies are needed to understand barriers experienced by these firms and to examine ways to overcome them. However, challenges accessing and recruiting this hard-to-reach population are frequently reported. Traditional approaches of recruiting through unions or workers' compensation insurers may not be appropriate or effective for small construction businesses. Previous studies have demonstrated the value of academic collaborations with community-based organizations for recruiting participants from hard-to-reach populations for research studies. In accordance with the principles of Community-Based Participatory Research (CBPR), we formed a recruitment team comprised of staff from a local union, a community organization, and a community outreach team to recruit small construction contractors in Lawrence, MA. Media marketing strategies, participation in community events, exploring neighborhoods in search of ongoing residential projects, and partnership with vocational training institutions and building trade associations were some of the strategies implemented during this project. We recruited 118 contractors, supervisors, and foremen from more than 50 construction firms across the Greater Lawrence area to participate in an intervention project to reduce falls and silica exposure. The CBPR approach facilitated the development and implementation of recruitment strategies that resulted in the participation of a significant number of hard-to-reach small construction contractors.The Impact of Worksite Wellness Programs by Size of Business: A 3-Year Longitudinal Study of Participation, Health Benefits, Absenteeism, and Presenteeism
Abstract
Objective
Worksite wellness programs (WWP) may positively impact employee health, medical expenditures, absenteeism, and presenteeism. However, there has been little research to assess the benefits of WWP in small businesses. The purpose of this study is to prospectively evaluate changes in health, absenteeism, and presenteeism for employees who participated in a WWP. Methods
We conducted an observational, 3-year cohort study of 5766 employees from 314 businesses of differing sizes. We followed two cohorts of employees, who completed at least two annual health risk assessments (HRA) between May 2010 and December 2014. Changes from baseline to the first and second follow-up periods were assessed for chronic and non-chronic health conditions, absenteeism, and presenteeism. Results
Small business employees were more likely to participate in the WWP than were employees from large businesses. Changes in chronic and non-chronic health conditions varied by size of business, with small business employees showing improvements in stress, overall health, depression, smoking status, vegetable and fruit consumption, and physical activity, and in their perceptions of job health culture. In contrast, large business employees experienced improvements in stress, vegetable consumption, and alcohol use. No changes in absenteeism or presenteeism were observed. Conclusions
Small businesses achieve higher employee participation rates and more health improvements when compared to employees from large employers. Findings suggest that small businesses may gain the most from a WWP.Developing an Integrated Approach to Workplace Mental Health: A Hypothetical Conversation with a Small Business Owner
Abstract
An integrated approach to workplace mental health encompasses three main areas of activity: (i) protecting mental health by reducing work-related and other risk factors for mental health problems, (ii) promoting mental health by developing the positive aspects of work as well as worker strengths and positive capacities, and (iii) responding to mental health problems as they manifest at work regardless of cause (work-related or otherwise). This represents an effort to distil what is a complex issue warranting a correspondingly complex set of responses into information for action that is accessible and engaging to workplace stakeholders, and that enables workplaces to begin from varying starting points to build over time towards mature multicomponent workplace mental health programs. This article, based on a plenary presentation at the Understanding Small Enterprises 2017 international conference (25–27 October 2017, Denver), is presented in two parts. Part I is a concise summary of our integrated approach to workplace mental health. Part II presents a hypothetical conversation with a small business owner/operator who has yet to implement workplace mental health programs, but is considering doing so. In this Conversation, representing an effort in knowledge translation, we attempt to convince the small business owner/operator to begin taking action.Quantifying beta agonist utilization: occasions or puffs?
Publication date: Available online 13 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Stanley J. Szefler, Heather Hoch, Michael Tuffli, Rahul Gondalia, Meredith A. Barrett, David Van Sickle, David A. Stempel
Antimicrobial photodynamic therapy alone or in combination with antibiotic local administration against biofilms of Fusobacterium nucleatum and Porphyromonas gingivalis
Publication date: Available online 12 September 2018
Source: Journal of Photochemistry and Photobiology B: Biology
Author(s): Lívia J. Tavares, Erica D. de Avila, Marlise I. Klein, Beatriz H.D. Panariello, Denise M.P. Spolidório, Ana Cláudia Pavarina
Abstract
Antimicrobial photodynamic therapy (aPDT) kills several planktonic pathogens. However, the susceptibility of biofilm-derived anaerobic bacteria to aPDT is poorly characterized. Here, we evaluated the effect of Photodithazine (PDZ)-mediated aPDT on Fusobacterium nucleatum and Porphyromonas gingivalis biofilms. In addition, aPDT was tested with metronidazole (MTZ) to explore the potential antimicrobial effect of the treatment. The minimum inhibitory concentration (MIC) of MTZ was defined for each bacterial species. Single-species biofilms of each species were grown on polystyrene plates under anaerobic conditions for five days. aPDT was performed by applying PDZ at concentrations of 50, 75 and 100 mg/L, followed by exposure to 50 J/cm2 LED light (660 nm) with or without MTZ. aPDT exhibited a significant reduction in bacterial viability at a PDZ concentration of 100 mg/L, with 1.12 log10 and 2.66 log10 reductions for F. nucleatum and P. gingivalis in biofilms, respectively. However, the antimicrobial effect against F. nucleatum was achieved only when aPDT was combined with MTZ at 100× MIC. Regarding P. gingivalis, the combination of PDZ-mediated aPDT at 100 mg/L with MTZ 100× MIC resulted in a 5 log10 reduction in the bacterial population. The potential antimicrobial effects of aPDT in combination with MTZ for both single pathogenic biofilms were confirmed by live/dead staining. These results suggest that localized antibiotic administration may be an adjuvant to aPDT to control F. nucleatum and P. gingivalis biofilms.
Graphical Abstract
Methionine oxidation by hydrogen peroxide in peptides and proteins: A theoretical and Raman spectroscopy study
Publication date: Available online 12 September 2018
Source: Journal of Photochemistry and Photobiology B: Biology
Author(s): Béatrice Sjöberg, Sarah Foley, Bruno Cardey, Michel Fromm, Mironel Enescu
Abstract
The oxidation of proteins results in their deterioration via the oxidation of reactive amino acids. Oxidation of the amino acid, methionine plays an important role during biological conditions of oxidative stress, and equally a role in protein stability. In this study the oxidation of the methionine residue using the tripeptide GlyMetGly with respect to hydrogen peroxide has been studied using both Raman spectroscopy and DFT calculations. Spectral modifications following the formation of methionine sulfoxide are shown with the appearance of the SO vibration whilst there is also the modification of the C
S vibrations at approximately 700 cm−1. The changes in the intensity of the C
S stretching band were used to calculate the kinetic rate constant as 7.9 ± 0.6 × 10−3 dm3 mol−1 s−1. The energy barrier for the reaction. is determined both experimentally and using DFT calculations. The reaction of the dairy protein beta-lactoglobulin with hydrogen peroxide is equally studied using the same technique. The solvent accessible surface area of the methionine residues within the protein were also determined and a comparison of the reaction rate constant and the energy barriers of reaction for the oxidation of the tripeptide and for the protein respectively thus, provides information about the role of the protein environment in the oxidation process.
Graphical abstract
Versorgungsforschung in der Dermatologie 2018 – Kraft des Faktischen
Zusammenfassung
In der in Deutschland praktizierten Dermatologie ist Versorgungsforschung eine etablierte und hoch differenzierte Disziplin. In vielen universitären dermatologischen Einrichtungen und niedergelassenen Praxen werden Studien zu Vorgängen der gesundheitlichen Versorgung bei Hautkrankheiten durchgeführt. Unter dem Dach der Deutschen Dermatologischen Gesellschaft und des Berufsverbandes der Deutschen Dermatologen wird ein wesentlicher Teil der Studien und Projekte des Competenzzentrums Versorgungsforschung in der Dermatologie (CVderm) als bundesweites Referenzzentrum getragen. Wichtige Projekte sind Implementierung von Patientenregistern, Umsetzung nationaler Versorgungsstudien, Forschung mit Sekundärdaten sowie Durchführung methodischer Studien zur Weiterentwicklung wissenschaftlicher Fragestellungen. Wichtige Ergebnisse sind die nationalen Versorgungskonferenzen für Psoriasis, Hautkrebs, Wunden und Neurodermitis, die regionalen Versorgungsnetze sowie Projekte und Kooperationen mit Krankenkassen, Selbstverwaltung und öffentlichen Trägern. Im Interesse der verbesserten Patientenversorgung werden wichtige Faktoren der Versorgung laufend verbessert. Zukünftige dermatologische Versorgungsforschung wird in noch effizienterer Weise zur besseren Versorgungsplanung und -lenkung beitragen. Patientenregister werden den Transfer von Innovationen in die Versorgung erleichtern und dazu beitragen, dass neue Therapieverfahren angewendet werden können. Register unterstützen auch die Optimierung der Therapieansätze, die inzwischen beispielsweise bei Psoriasis wegen der Fülle an zur Verfügung stehenden Arzneimitteln nicht mehr allein auf der Basis klinischer Studien durchgeführt werden kann. Im Zeitalter der digitalen Medizin kommt der Versorgungsforschung eine noch wichtigere Funktion zu.
Micro-edaphic factors affect intra-specific variations in trace element profiles of Noccaea praecox on ultramafic soils
Abstract
The aim of this study was to compare trace element profiles of Noccaea praecox (Wulfen) F. K. Mey. growing on ultramafic soils in different habitat types and to observe differences in uptake and translocation of trace elements. Physico-chemical characteristics of the soil and concentrations of P2O5, K2O, Ca, Fe, Mn, Zn, Cu, Ni, Cr, Pb, Cd, and Co in plant samples were presented. Biological concentration, accumulation, and translocation factors were calculated to estimate accumulation potential of different N. praecox accessions. All of the studied accessions were Ni hyperaccumulators (with shoot concentrations up to 14,593 mg kg−1), but with notable differences in accumulation and translocation rates. Significant differences in accumulation and translocation patterns of trace elements were observed among accessions from habitats characterized as serpentine steppes on dry, shallow soils in contrast to the accessions from habitats with higher soil moisture, and higher content of organic matter.
Levels, distribution, and sources of organophosphate flame retardants and plasticizers in urban soils of Shenyang, China
Abstract
Seventy-four soil samples from the road greenbelts, residential areas, drylands, waste grasslands, education lands, industrial areas, city parks, and rural homesteads of Shenyang city, China, were collected and analyzed for 13 organophosphate esters (OPEs). OPEs were detected in all analyzed soil samples, which indicate that OPEs are ubiquitously environmental contaminants. The ∑13OPEs concentrations ranged from 0.039 to 0.95 mg/kg dry weight (dw), with the mean and median concentrations of 0.23 and 0.16 mg/kg dw, respectively. The pollution levels of OPEs in different land use types were different; the concentrations of OPEs in dryland soils were maximum and in city park soils were minimum. Of 13 OPEs, tri-iso-butyl phosphate (TiBP), tris-(1-chloro-2-propyl) phosphate (TCPP), tri-butoxyethyl phosphate (TBEP), and tris[2-chloro-1-(chloromethyl) ethyl] phosphate (TDCP) were the most abundant OPEs, contributing 42.0 ± 12.8, 12.4 ± 2.32, 6.31 ± 1.88, and 5.76 ± 1.86% of ∑13OPEs, respectively. Principal component analysis (PCA) and absolute principal component score-multiple linear regression (APCS-MLR) suggested that OPE pollution in soils may be derived from atmospheric deposition, road runoff and vehicular traffic emission, and wastewater/reclaimed water irrigation and sludge application, their contributions were accounting for 62.4, 17.6, and 20.0%, respectively. As compared to the results from other studies, the pollution of OPEs in the urban soils of Shenyang is relatively serious.
Nichtkleinzelliges Lungenkarzinom – Pathologie und Biologie
Zusammenfassung
Hintergrund
Nichtkleinzellige Lungenkarzinome (NSCLC) machen ca. 75 % der malignen epithelialen Lungentumoren aus. In den vergangenen Jahren konnten profunde Erkenntnisse über molekulare Mechanismen der Krebsentstehung der Lunge gewonnen werden und in der Folge zielgerichtete Substanzen („targeted drugs") und immuntherapeutisch wirksame Medikamente entwickelt werden. Diese Fortschritte haben den Ablauf der pathologischen Diagnostik maßgeblich beeinflusst.
Ziel
Der vorliegende Artikel soll einen Überblick über die häufigsten histologischen Subtypen der NSCLC, ihre morphologischen, immunhistochemischen und molekularpathologischen Charakteristika geben.
Material und Methoden
Eine selektive Literaturrecherche der Datenbank Pubmed wurde durchgeführt.
Ergebnisse und Diskussion
Adenokarzinome, Plattenepithelkarzinome und großzellige Karzinome sind die häufigsten histologischen Subtypen. Durch die in der pathologischen Routine verfügbaren Zusatzuntersuchungen lassen sich in der Regel auch gering differenzierte Tumoren gut zuordnen. NSCLC zeigen eine Reihe genetischer Veränderungen, therapeutisch nutzbar sind Alterationen von EGFR, MET, ALK1 und ROS1.
Langerhans cells express human β‐defensin 3: relevance for immunity during skin ageing
British Journal of Dermatology, EarlyView.
Variation in daily ultraviolet light exposure and sun protection behaviours of melanoma survivors: an observational single‐arm pilot study with a wearable sensor
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
GM‐CSF as a therapeutic target in psoriasis: randomised, controlled investigation using namilumab – a specific, human anti‐GM‐CSF monoclonal antibody
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
Τετάρτη 12 Σεπτεμβρίου 2018
Novel lytic bacteriophages of Klebsiella oxytoca ABG-IAUF-1 as the potential agents for mastitis phage therapy
Abstract
Mastitis is an inflammation of the mammary gland that occurs when pathogenic microorganisms enter the udder. Even though tremendous advancements in veterinary diagnosis and therapeutics, mastitis is still the most frequent and costly disease of dairy herds overall the world. The purpose of this research was to isolate and identify the lytic phages as a potential method for biological control of bovine mastitis. In this study Klebsiella oxytoca was isolated from contaminated milk samples of Isfahan dairy herds, Isfahan, Iran and characterized as K. oxytoca ABG-IAUF-1 and its 16s-rDNA sequence was deposited in GenBank under the accession numbers of MF175803.1. Then, the four novel specific lytic bacteriophages of K. oxytoca ABG-IAUF-1 from Isfahan public wastewater were isolated and identified. The results of transmission electron microscopy indicated that theses isolated phages were related to Myoviridae and Podoviridae families of bacteriophages. Also the analysis of the growth curve of K. oxytoca ABG-IAUF-1 before and after treatment with lytic phage showed the 97% success rate of the phages in preventing of bacterial growth. This is the first report indicating the use of bacteriophages as the potential agents for eliminating the pathogenic bacteria responsible for bovine mastitis in Iran. The applications of these lytic phages could be an asset for biocontrolling of pathogenic agents in medical and veterinary biotechnology.Non-conventional Yeast cell factories for sustainable bioprocesses
Abstract
The non-conventional yeasts Kluyveromyces lactis, Yarrowia lipolytica, Ogataea polymorpha and Pichia pastoris have been developed as eukaryotic expression hosts because of their desirable growth characteristics, including inhibitor and thermo-tolerance, utilization of diverse carbon substrates, and high amount of extracellular protein secretion. These yeasts already have established in the heterologous production of vaccines, therapeutic proteins, food additives, and bio-renewable chemicals, but recent advances in genetic tool box have the potential to greatly expand and diversify their impact on biotechnology. The diversity of these yeasts includes many strains possessing highly useful, and in some cases even uncommon, metabolic capabilities potentially helpful for bioprocess industry. This review outlines the recent updates of non-conventional yeast in sustainable bioprocesses.
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