It is truly an honor to be invited to be the guest editor of an issue of Operative Techniques in Otolaryngology Head and Neck Surgery. What's more, the issue focusses on one of my favorite subjects: salivary gland pathology and surgery. When considering parotid tumors alone, the incidence is approximately 4/100,000 in the United States. The current census of the United States is 324 million and approximately 25% of whom are children1. If one assumes that 243 million Americans over the age 18 are at risk for developing these tumors, then approximately 10,000 parotid tumors will occur and potentially present each year.
Παρασκευή 21 Σεπτεμβρίου 2018
Introduction
Increased expression of aquaporin-1 in dermal fibroblasts and dermal microvascular endothelial cells possibly contributes to skin fibrosis and edema in patients with systemic sclerosis
Aquaporin-1 (AQP1), a water channel protein controlling the water contents of cells and tissues, exerts pleiotropic effects on various biological activities, including inflammation, angiogenesis, and extracellular matrix remodeling, by regulating cell behaviors and tissue water balance.
Monopoiesis in humans and mice
Abstract
Monocytes are a widely conserved cell population in vertebrates with important roles in both inflammation and homeostasis. Under both settings, monocytes continuously arise from hematopoietic progenitors in the bone marrow and, on demand, migrate into tissues through the bloodstream. Monocytes are classified into three subsets — classical, intermediate and non-classical — based on their cell-surface expression of CD14 and CD16 in humans and Ly6C, CX3CR1 and CCR2 in mice. In tissues, monocytes differentiate further into monocyte-derived macrophages and dendritic cells to mediate innate and adaptive immune responses and maintain tissue homeostasis. Recently, the progenitors that strictly give rise to monocytes were identified in both humans and mice, thereby revealing the monocyte differentiation pathways.Aggregation makes a protein allergenic at the challenge phase of basophil-mediated allergy in mice
Abstract
Hapten is a small molecule that is not immunogenic on its own but can stimulate the production of antibodies at the sensitization phase when conjugated to carrier proteins. The hapten then reacts specifically with the antibodies generated against it to elicit an immune or allergic response at the challenge phase. Here we compared various carrier proteins conjugated with the same hapten in their ability to induce hapten-specific IgE-mediated allergic responses in vitro and in vivo, and characterized the nature of carrier proteins that determines the magnitude of response at the challenge phase of allergic reactions. Hapten TNP-conjugated ovalbumin (TNP-OVA) and bovine serum albumin (TNP-BSA) elicited TNP-specific, mast cell-dependent, immediate-type allergic reactions at a comparable level in mice that had been passively sensitized with TNP-specific IgE. In contrast, TNP-OVA but not TNP-BSA efficiently induced a basophil-dependent, IgE-mediated chronic allergic inflammation (IgE-CAI), even though both proteins could stimulate basophils in vitro at a comparable level. By comparing different carrier proteins and structurally modifying them, we found that the formation of large aggregates is crucial for TNP-conjugated carrier proteins to efficiently elicit IgE-CAI, regardless of the type of proteins. Thus, aggregation status of carrier proteins appears to determine the magnitude of allergic response at the challenge phase of hapten-specific IgE-CAI. Our findings suggest that the allergenicity of substances is a matter of importance not only at the sensitization but also at the challenge phase in a certain type of allergy including a basophil-mediated allergic inflammation.Kindlin-1 regulates epidermal growth factor receptor signalling
Kindler syndrome (KS) is an autosomal recessive genodermatosis that results from mutations in the FERMT1 gene encoding t kindlin-1. Kindlin-1 localises to focal adhesion and is known to contribute to the activation of integrin receptors. Most cases of KS show a reduction or complete absence of kindlin-1 in keratinocytes, resulting in defective integrin activation, cell adhesion and migration. However, roles for kindlin-1 beyond integrin activation remain poorly defined. In the current study we show that skin and keratinocytes from KS patients have significantly reduced expression levels of the epidermal growth factor receptor (EGFR), resulting in defective EGF-dependent signalling and cell migration.
Recycling Full Thickness Skin Graft from Failing Free Flaps in Salvage Procedures
Free flap loss is a dreaded complication in microsurgery. When a second free flap is harvested, the enlarged donor site may not be amenable to primary closure, and a split thickness skin graft (STSG) is necessary. If we salvage the skin portion of the failing flap for subsequent wound closure, we not only minimize additional donor sites, we also reap the many functional and cosmetic advantages of full thickness skin grafts (FTSG) over STSG. The recyclability of salvaged skin is mainly dependent on the warm ischemia time.
Cytokine levels in persistent skin lesions of adult-onset Still disease
To the Editor: Adult-onset Still disease (AOSD) is an inflammatory disease characterized by fever, polyarthritis, and skin inflammation, with increased serum levels of interferon-γ (IFN-γ), interleukin 1β (IL-1β), IL-18, IL-6, tumor necrosis factor-α, IL-8, IL-2 receptor, C-X-C motif chemokine 10, and C-X-C motif chemokine 13 (CXCL13).1 The cutaneous manifestations of AOSD include the classic evanescent skin eruption (ESE) and atypical persistent skin eruptions (APSEs), the latter possibly being related to more severe AOSD forms.
A PRISMA-compliant systematic review of the endpoints employed to evaluate symptomatic treatments for primary headaches
Primary headache are prevalent and debilitating disorders. Acute pain cessation is one of the key points in their treatment. Many drugs have been studied but the design of the trials is not usually homogeneous...
Migraine and cluster headache – the common link
Although clinically distinguishable, migraine and cluster headache share prominent features such as unilateral pain, common pharmacological triggers such glyceryl trinitrate, histamine, calcitonin gene-related...
Using the child behavior checklist to determine associations between psychosocial aspects and TMD-related pain in children and adolescents
Since children and adolescents are frequently experiencing emotional and behavioral consequences due to pain, their parents should be aware of this emotional and behavioral status. Therefore, the aim of this s...
Food Protein-Induced Enterocolitis Syndrome Food Challenges: Experience from a Large Referral Center
Publication date: Available online 20 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Kathleen Y. Wang, Juhee Lee, Antonella Cianferoni, Melanie A. Ruffner, Amy Dean, Jerome M. Molleston, Nicholas A. Pawlowski, Jennifer Heimall, Rushani W. Saltzman, Gita S. Ram, Joel Fiedler, Laura M. Gober, Jonathan M. Spergel, Terri F. Brown-Whitehorn
Abstract
BACKGROUND
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy that is diagnosed based on clinical findings, but can be confirmed with oral food challenge (OFC). OFC is more often performed to assess development of tolerance. Most studies describing OFC in FPIES are limited in size.
OBJECTIVE
We sought to describe our experience with OFCs using our FPIES protocol. Patients were given one-third of serving size with a four hour observation period, followed by home titration to full dose.
METHODS
We conducted a retrospective chart review of patients who underwent OFC via FPIES protocol from 2014 to 2017. Data regarding history of reaction, age at time of challenge, and reactions during challenge or with home introduction was collected.
RESULTS
A total of 169 OFCs were completed under FPIES protocol, in 119 patients to 19 different foods. Thirty challenges (18%) were positive, with 17 challenges (10%) during initial challenge and 13 (7.7%) during home dosing. Most reactions during initial challenge required intravenous fluids (IVF), but hypotension was uncommon. One hundred thirty-nine (82%) OFCs were negative with home introduction, indicating tolerance to the challenged foods. The mean age of passing a challenge to milk, soy, and grain was earlier than that of other solid foods.
CONCLUSION
Our data suggests that our FPIES OFC protocol is safe. Early administration of IVF may prevent the development of hypotension. It is difficult to stratify risk of severe or delayed reaction based on patient characteristics and more data is needed to identify those appropriate for home introduction.
Controversies in Drug Allergy: Beta-Lactam Hypersensitivity Testing
Publication date: Available online 20 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Maria J. Torres, N. Franklin Adkinson, Jean-Christoph Caubet, David A. Khan, Mona I. Kidon, Louis Mendelson, Eva Rebelo Gomes, Ticha Rerkpattanapipat, Shuchen Zhang, Eric Macy, AAAAI/WAO 2018 Symposium Penicillin and Cephalosporin Allergy Testing Working Group
All beta-lactam use is associated with a certain rate of adverse reactions. Many of these adverse reactions result in an allergy to the beta-lactam being entered into the patient's medical record. Unfortunately, only a small minority of these recorded allergies are clinically significant immunologically mediated drug hypersensitivity. An unconfirmed allergy to beta-lactams is a significant public health risk, because patients so labeled typically do not receive narrow-spectrum penicillins and cephalosporins when clinically indicated. The alternative antibiotics they receive result in poorer clinical outcomes, increased incidence of serious antibiotic-resistant infections, prolonged hospitalizations, and greater health care utilization. There is a wide variation in beta-lactam allergy incidence and prevalence around the world, based in part on the specific beta-lactams used and overused. There is a wide variation in specific protocols used to confirm current tolerance of beta-lactams and remove these inaccurate allergy reports. Harmonizing testing protocols, when possible, may lead to more widespread use of narrow-spectrum beta-lactams, when clinically indicated, and improve patient safety worldwide. Further research is needed to better understand the regional differences in reporting beta-lactam allergy as this relates to regional differences in beta-lactam use and overuse, the frequency of clinically significant immunologically mediated beta-lactam hypersensitivity, and the optimal testing strategies to confirm current tolerance, based on presenting clinical symptoms.
Real-world-Datenquellen für die Versorgungsforschung zum Hautkrebs
Zusammenfassung
Dermatologische Versorgungsforschung mit dem Ziel der Verbesserung von Prävention, effizienter Diagnostik und Therapie des Hautkrebses braucht Real-world-Daten aus allen Sektoren der Versorgung. Der Beitrag liefert eine Übersicht aktuell verfügbarer, relevanter Real-world-Datenquellen und ihres Nutzungspotenzials und führt beispielhaft Ergebnisse vorliegender Studien auf: Sekundärdatenanalysen mit Abrechnungsdaten der gesetzlichen Krankenkassen wurden genutzt, um u. a. die Teilnahmerate am gesetzlichen Hautkrebsscreening abzuschätzen. Diese betrug im Zweijahreszeitraum ca. 31 %, war in den westlichen Bundesländern höher als in den östlichen und bei Frauen höher als bei Männern. Für die dermatologische Versorgungsplanung stehen regionale Daten in Kombination mit sozialstrukturellen und soziodemografischen Indikatoren zur Verfügung, und die Analyse verweist auf einen Zusammenhang mit der Hautkrebsprävalenz. Primäre Daten sind verfügbar und notwendig zur Erfassung patientenberichteter Endpunkte sowie der arztseitigen Bewertung der Versorgung von Hautkrebspatienten. Umfangreiche histopathologische Datenbanken erfassen neben klinischen auch soziodemografische Parameter und deuten auf einen Zusammenhang von Diagnose- bzw. Therapiezeitpunkt mit dem Versicherungsstatus und Wohnortmerkmalen hin. Neben dem Nutzungspotenzial werden spezifische Limitationen der Datenquellen aufgeführt.
Leveraging EUnetHTA’s conceptual framework to compare HTA decision drivers in France, Italy, and Germany from a manufacturer’s point of view
Health Technology Assessments (HTA) procedures differ substantially across the various European countries. We reviewed recent appraisals of a pharmaceutical manufacturer in three major European markets (France...
Prevalence of potential contact allergens in baby cosmetic products
Clinical and Experimental Dermatology, EarlyView.
Les indications des reconstructions mammaires après mastectomie selon la situation carcinologique
Publication date: Available online 20 September 2018
Source: Annales de Chirurgie Plastique Esthétique
Author(s): C. Mathelin, C. Bruant-Rodier
Résumé
La reconstruction mammaire fait partie intégrante du traitement du cancer du sein. Elle doit être systématiquement évoquée lors de l'annonce de la maladie et proposée à un moment optimal lors de la prise en charge du cancer. En cas de carcinome canalaire in situ, la reconstruction doit être proposée dans le même temps que la mastectomie qui préserve généralement l'étui cutané. La conservation de la plaque aréolo-mamelonnaire doit faire l'objet d'évaluations complémentaires. En cas de carcinome mammaire invasif, la reconstruction mammaire est généralement proposée à distance du temps carcinologique, sauf pour les patientes ne nécessitant ni chimiothérapie ni radiothérapie postopératoire pour lesquelles la reconstruction peut être immédiate. Enfin, en cas de mastectomie controlatérale synchrone prophylactique, la reconstruction ne doit jamais retarder la prise en charge globale du cancer mammaire.
Summary
Breast reconstruction is an integral part of breast cancer treatment. It must be systematically mentioned when the disease is announced and proposed at an optimal time during cancer management. In case of ductal carcinoma in situ, reconstruction should be proposed at the same time as mastectomy, which generally preserves the skin. The conservation of the nipple-areolar complex should be further evaluated. In the case of invasive breast carcinoma, breast reconstruction is generally proposed at a distance from the oncological time, except for patients requiring neither chemotherapy nor postoperative radiotherapy for whom reconstruction can be immediate. Finally, in the case of prophylactic synchronous contralateral mastectomy, reconstruction should never delay the overall management of breast cancer.
Predictors of complications following breast reduction surgery: A national surgical quality improvement program study of 16812 cases.
Publication date: Available online 20 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Andrew M. Simpson, Daniel P. Donato, Alvin C. Kwok, Jayant P. Agarwal
Abstract
Background
Breast reduction is one of the most common procedures performed by plastic surgeons. Despite good outcomes and high patient satisfaction, there is little national data examining the predictors leading to complications in this patient population. We accessed a national outcomes database to examine these factors.
Methods
This is a retrospective study examining the National Surgical Quality Improvement Program database from 2006 through 2015. Patients undergoing primary breast reduction were identified. Patients undergoing any cancer-related procedures were excluded. We identified patient-related and procedure related factors for analysis. Univariate and multivariate logistic regression analysis were used to identify independent predictors of complications.
Results
16812 individual cases were identified. The overall complication rate for the cohort was 6.2% and the major complication rate was 3.0%. Diabetes, bleeding disorder, hypertension, obesity, smoking, steroid use and prolonged operative time were associated with increased risk of complications (p<0.05). Concurrent body contouring was a predictor of increased major complications, however liposuction was not.
Conclusions
Common surgical risk factors are associated with complications in breast reduction surgery. Although liposuction is not an independent risk factor, concurrent body contouring is associated with increased complications. Surgeons should be aware of these associations when discussing breast reduction with patients.
The dynamic-lymphaticovenular anastomosis method for breast cancer treatment-related lymphedema: creation of functional lymphaticovenular anastomoses with use of preoperative dynamic ultrasonography
Publication date: Available online 20 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Yukio Seki, Akiyoshi Kajikawa, Takumi Yamamoto, Takayuki Takeuchi, Takahiro Terashima, Norimitsu Kurogi
Abstract
Background
Lymphaticovenular anastomosis (LVA) is generally effective for breast cancer treatment-related upper extremity lymphedema (UEL). Clinical improvement is, however, limited by the degree of sclerosis of the lymphatic vessels. We have developed a method by which we use dynamic ultrasonography to depict vessels through which lymph can be propelled into the LVA under the power of the patient's natural hand movements.
Methods
We assessed the dynamic-LVA method by comparing clinical details of 15 cases of breast cancer treatment-related lymphedema treated by dynamic LVA and 15 corresponding cases treated by conventional LVA.
Results
Placement of incisions at a total of 90 forearm sites (3 per patient) yielded creation of 90 LVAs (32 in "linear ICG lymphography pattern incisions" and 58 in "stardust pattern incisions." Sclerotic lymphatic vessels were encountered at greater frequency in "linear pattern incisions" in the dynamic LVA group than in the conventional LVA group (7.1% vs. 38.9%, P = 0.030). Postoperative volume reduction was significantly greater in the dynamic LVA group than in the conventional LVA group; the UEL index at 1 month was 8.12 ± 3.08 vs. 3.74 ± 5.82, respectively (P = 0.018) and at 1 year was 10.23 ± 6.16 vs. 2.03 ± 9.36, respectively (P = 0.014).
Conclusions
Dynamic LVA is clinically beneficial because the imaging guides decisions over where the incisions should be placed so that a patient's natural hand motions can be utilized to propel lymph into the anastomosis despite the presence of sclerosis and because even early improvements are obtained.
Use of a perforator/subcutaneous pedicled propeller flap for reconstruction of lower eyelid defects
Publication date: Available online 20 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Asım USLU
Summary
Full thickness skin grafts (FTSGs) and flaps from the upper eyelid or cheek can be used for reconstruction of lower eyelid defects, including the anterior lamella. However, the upper eyelid has a limited and insufficient amount of skin, while cheek flaps have a restricted arch of rotation. Here we report the procedure and outcomes of a perforator/subcutaneous pedicled propeller flap for reconstruction of lower eyelid defects including the anterior lamella.
A retrospective study of 12 patients who underwent treatment for eyelid anterior lamella defects with perforator/subcutaneous pedicled propeller flaps was conducted between March 2015 and June 2017. The propeller flap was planned to rotate around the perforator (as the pivot point), which was detected with a hand-held Doppler in the vicinity of the defect.
The flaps were perforator pedicled for 10 patients and subcutaneous pedicled for the other two patients. The flap was rotated around the pedicle and placed on each patient's defect without tension. No vascular compromise occurred with any of the flaps. The most important complications were postoperative oedema and ecchymosis.
Inferior eyelid defects including anterior lamella could be reconstructed by using propeller flaps from the adjacent tissue. The main advantages of this flap included easy access to the defect, no impairment in eyelid function, and very good aesthetic results.
Adipose-derived regenerative cells and fat grafting for treating breast cancer-related lymphedema: Lymphoscintigraphic evaluation with one year follow-up
Publication date: Available online 20 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): NM Toyserkani, CH Jensen, S Tabatabaeifar, MG Jørgensen, S Hvidsten, JA Simonsen, DC Andersen, SP Sheikh, JA Sørensen
Abstract
Background: Breast cancer-related lymphedema (BCRL) is a feared late complication. Present treatment options are lacking. Recent studies have suggested that mesenchymal stromal cells can alleviate lymphedema. Herein, we report the results from the first human pilot study with adipose-derived regenerative cells (ADRC) for treating BCRL with one year follow-up. Material and methods: We included ten BCRL patients. ADRCs were injected directly into the axillary region together with a scar releasing fat graft procedure. Primary endpoint was change in arm volume. Secondary endpoints were change in patient reported outcome, lymphoscintigraphy changes and safety. Results: During follow up, no significant change in volume was noted. Patient reported outcomes improved significantly over time. Five patients reduced their use of conservative management. Quantitative lymphoscintigraphy did not improve on the lymphedema affected arms. ADRCs were well-tolerated and only minor transient adverse events related to liposuction were noted. Conclusions: In this pilot study, a single injection of ADRC improved lymphedema based on patient reported outcome measures and there were no serious adverse events in the follow-up period. Lymphoscintigraphic evaluation showed no improvement after ADRC treatment. There was no change in excess arm volume. Results of this trial need to be confirmed in randomized clinical trials.
Outcomes of shoulder abduction after nerve surgery in patients over 50 following traumatic brachial plexus injury
Publication date: Available online 20 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Joshua A. Gillis, Joseph S. Khouri, Michelle F. Faupel, Robert J. Spinner, Allen T. Bishop, Alexander Y. Shin
Abstract
Purpose
There is controversy regarding the effectiveness of brachial plexus reconstruction in older patients as it is felt that outcomes are poor. The aim of this study is to determine the outcomes of shoulder abduction obtained after nerve reconstruction in patients over the age of 50 and factors related to success.
Methods
Forty patients over the age of 50 underwent nerve surgery to improve shoulder function after a traumatic brachial plexus injury. Patients were evaluated pre- and post-operatively for shoulder abduction strength and range of motion (ROM), Disability of the Arm, Shoulder, and Hand (DASH) scores, pain, age bracket, gender, body mass index (BMI), delay from injury to operation, concomitant trauma, severity of trauma, and type of reconstruction.
Results
The average age was 58.2 years (range 50-77) with an average follow-up of 18.8 months. The average modified BMRC (British Medical Research Council) shoulder abduction grade improved significantly from 0.23 to 2.03 (p<0.005). Fourteen patients achieved functional shoulder abduction of ≥M3 post-operatively. There was no correlation between age or age range stratification and BMRC grade or those obtaining useful shoulder abduction ≥M3. Active shoulder abduction improved significantly from 18.25° to 40.64°, with no difference based on age or age stratification. There were improved modified BMRC grades with nerve transfers versus nerve grafts. Less patients achieved ≥M3 function if surgery was delayed >6 months. The mean DASH score decreased from 45.3 to 40.7 post-operatively and the average pain score decreased from 3.7 to 3.0. Patients with higher post-operative BMRC grade for shoulder abduction had improved post-operative DASH scores and VAS for pain (p=0.011 and 0.005, respectively).
Conclusion
Brachial plexus nerve reconstruction for shoulder abduction in patients over the age of 50 can yield useful BMRC scores and ROM and age should not be used to exclude nerve reconstruction in these patients.
Complejo de esclerosis tuberosa asociado a hemihipertrofia y malformaciones vasculares combinadas
Publication date: Available online 20 September 2018
Source: Actas Dermo-Sifiliográficas
Author(s): M.Á. Flores-Terry, A. Alegre-Sánchez, P. Boixeda, J.C. López-Gutiérrez
The prognostic impact of Consensus Molecular Subtypes (CMS) and its predictive effects for bevacizumab benefit in metastatic colorectal cancer: molecular analysis of the AGITG MAX clinical trial
Abstract
Background
The Consensus Molecular Subtypes (CMS) is a transcriptome-based classification of colorectal cancer (CRC) initially described in early-stage cohorts, but the associations of CMS with treatment outcomes in the metastatic setting are yet to be established. This study aimed to evaluate the prognostic impact of CMS classification and its predictive effects for bevacizumab benefit in metastatic CRC by correlative analysis of the AGITG MAX trial. Patients and Methods
The MAX trial previously reported improved progression-free survival (PFS) for the addition of bevacizumab (B) to chemotherapy (capecitabine (C) +/- mitomycin (M)). Archival primary tumours from 237 patients (50% of trial population) underwent gene expression profiling and classification into CMS groups. CMS groups were correlated to PFS and overall survival (OS). The interaction of CMS with treatment was assessed by proportional hazards model. Results
The distribution of CMS in MAX were: CMS1 18%, CMS2 47%, CMS3 12%, CMS4 23%. CMS1 was the predominant subtype in right-sided primary tumours, while CMS2 was the predominant subtype in left-sided. CMS was prognostic of overall survival (OS) (P=0.008), with CMS2 associated with the best outcome and CMS1 the worst. CMS remained an independent prognostic factor in a multivariate analysis. There was a significant interaction between CMS and treatment (P-interaction=0.03), for PFS, with hazard ratios (95% CI) for CB+CBM versus C arms in CMS 1,2,3 and 4: 0.83 (0.43-1.62), 0.50 (0.33-0.76), 0.31 (0.13-0.75) and 1.24 (0.68-2.25) respectively. Conclusions
This exploratory study found that CMS stratified OS outcomes in metastatic CRC regardless of first-line treatment, with prognostic effects of CMS groups distinct from those previously reported in early-stage cohorts. In CMS associations with treatment, CMS2 and possibly CMS3 tumours may preferentially benefit from the addition of bevacizumab to first-line capecitabine-based chemotherapy, compared to other CMS groups. Validation of these findings in additional cohorts is warranted. Clinical trial number
This is a molecular sub-study of MAX clinical trial (NCT00294359)Oral vitamin D3 5000 IU/day as an adjuvant in the treatment of atopic dermatitis: a randomized control trial
International Journal of Dermatology, EarlyView.
Gardner‐Diamond syndrome: a systematic review of treatment options for a rare psychodermatological disorder
International Journal of Dermatology, EarlyView.
Serum irisin: A prognostic marker for severe acne vulgaris
Journal of Cosmetic Dermatology, EarlyView.
SWEET SYNDROME FOLLOWING A POSITIVE MANTOUX TEST DUE TO PULMONARY TUBERCULOSIS
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
Topical diltiazem for ulceration of striae distensae associated with bevacizumab therapy
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
“Chemical” surgery in treating basal cell carcinoma in elderly
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
Enzymes in the Seafood Industry: Time for Health Studies with High-Quality Exposure Assessment
Enzymes are biocatalysts that increase the rate of most reactions within cells and are crucial for the function of humans and other living creatures. In addition, the use of enzymes in industry and everyday products largely of bacterial or fungal origin has increased in recent years. Food and beverages, detergent, perfume, pharmaceutical, textile, and chemical industries are increasingly using enzymes to improve fragrance, taste, and flavour (Budnik et al., 2017). A classic example is improver enzymes such as α-amylase, routinely added to accelerate, modify, and control dough making (Jones et al., 2016). Although the detrimental effects of these added active or inactive enzymes on the development of allergy and respiratory health are recognized (Baur, 2005; Jones et al., 2016), detailed exposure characterization and data to conduct dose–response relations for enzymes are lacking with the exception of a few agents such as α-amylase (Houba et al., 1996).
A Randomized Trial of Early Endovenous Ablation in Venous Ulceration: a critical appraisal
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
Identifying Predictors of Time to Soft Tissue Reconstruction Following Open Tibia Fractures
INTRODUCTION: Controversy remains regarding the optimal timing of soft tissue coverage following severe lower extremity trauma. This study identifies nationwide practice patterns and factors associated with discrepancies in time to first flap surgery following open tibia fractures. METHODS: A retrospective analysis was performed on the National Trauma Databank from 2008-2015 to identify patients who presented with an open tibia fracture and underwent subsequent flap reconstruction. A lasso algorithm was performed, revealing those factors most significantly associated with differences in time to flap surgery from hospitalization. RESULTS: A total of 3,297 patients were included in the analysis. Mean and median times to first flap surgery were 230.1 hours (SD; 246.7 hours), and 169.1 hours, respectively. Older age, a non-white race, treatment in the South, and a non-private insurance status were all independently associated with an increased time to flap surgery. In addition, more surgical debridements, a higher injury severity and/or abbreviated injury score, and a nerve, vascular, and/or crush injury were independent predictors of an increased time to flap surgery. CONCLUSION: Most patients who present with open tibia fractures requiring soft tissue coverage undergo flap reconstruction after the historical 72-hour window. Specific sociodemographic and clinical factors were independently predictive of an increased time to flap surgery. These findings suggest that not all patients in the United States are receiving the same level of care in lower extremity trauma reconstruction, emphasizing the need to develop more explicit national standards. * These authors contributed equally to this work Financial Disclosure Statement: None of the authors have a financial disclosure Corresponding Author Contact Information: Scott T. Hollenbeck, MD, Associate Professor, Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Box 3945, Durham, NC 27710, USA. Phone: (919) 681-5079 | Fax: (919) 681-2670, Email: scott.hollenbeck@duke.edu ©2018American Society of Plastic Surgeons
Optimal Sites for Supermicrosurgical Lymphaticovenular Anastomosis: An Analysis of Lymphatic Vessel Detection Rates on 840 Surgical Fields in Lower Extremity Lymphedema Patients
Background: Supermicrosurgical lymphaticovenular anastomosis (LVA) is becoming a useful treatment option for progressive lower extremity lymphedema (LEL) with its minimal invasiveness. Finding lymphatic vessel is a minimum requirement for LVA surgery, but no study has reported comprehensive analysis on factors associated with lymphatic vessel detection (LVD). Methods: One hundred thirty-four female secondary LEL patients who underwent indocyanine green (ICG) lymphography and LVA without past history of lymphedema surgery were included. Medical charts were reviewed to obtain clinical, ICG lymphographic, and intraoperative findings. LVD was defined as positive when one or more lymphatic vessels were found in a surgical field of LVA. Logistic regression analysis was used to identify independent factors associated with LVD. Results: Patients' age ranged from 36 to 81 years, duration of edema from 3 to 324 months, and BMI from 16.2 to 33.3 kg/m2. Forty-eight patients (35.8%) had past history of radiation, and 76 patients (56.7%) had past history of cellulitis. LVAs were performed in 840 surgical fields, among which LVD was positive in 807 fields; overall LVD rate was 96.1%. Multivariate analysis revealed inverse associations in higher body mass index (odds ratio [OR] 0.323; P = 0.008) and S-region/D-region on ICG lymphography compared with L-region (OR 1.049 x 10-8/1.724 x 10-9; P
“Towards the Assessment of Core Procedural Competencies amongst Canadian Plastic Surgery Residents.”
Background: Plastic surgery residency training programs are working towards integrating competency-based education into program curriculum and training, a key component of which involves establishing Core Procedural Competencies. This study aims to determine the exposure of graduating Canadian plastic surgery residents to established Core Procedural Competencies. Methods: A retrospective review of case log procedure data using three databases (T-Res, POWER, New Innovations) from graduating residents at all 10 Canadian English-speaking plastic surgery training programs between 2004-2014 was completed. Case logs were coded according to 177 Core Procedural Competencies identified as 'Core' by the Delphi Method amongst an expert panel of Canadian plastic surgeons. Results: A total of 59,405 procedures were logged by 55 graduating residents across Canada between 2004-2014 (average 1,080 ± 352 procedures per resident). Of thirteen plastic surgery domains, 44% of all procedures were within either Hand, Upper Extremity & Peripheral Nerve (28.3%) or Non-Aesthetic Breast (16.1%). The most frequently performed Core Procedural Competencies (average case logs per resident) included: breast reduction (65.3 ± 33.9), open carpal tunnel release (46.7 ± 34.2), breast reconstruction – implant-based (39.6 ± 20.5), and wound management (35.7 ± 28.6). Sixty-two of 177 procedures were logged on average less than once in 5 years of residency, including: escharotomy, temporal parietal fascia flap, Guyon's canal release and soft tissue fillers. Conclusions: This study identifies areas of exposure and underexposure to plastic surgery Core Procedural Competencies, and can help focus surgical education on areas of greater need for surgical skills training and acquisition. Financial Disclosure Statement:D Courtemanche is a shareholder and board member of Resilience Software. Resilience Software makes and supports T-Res. Presented at: 70th Annual Meeting of the Canadian Society of Plastic Surgeons 2016 in Ottawa, Ontario. Acknowledgements: We would like to thank the Postgraduate Medical Education Office, program directors and database vendors at University of Toronto and Western University for their assistance and support in extracting data from the POWER (©Knowledge4YouCorporation) and New Innovations (©New Innovations, Inc.) databases, respectively. In addition to participating in the research involved in this study, Dr. Courtemanche also generated the anonymous data set for the other 9 Canadian plastic surgery training programs that use T-Res. Corresponding Author: Jessica G. Shih, MD, The Division of Plastic & Reconstructive Surgery, 149 College Street, 5th Floor, Suite 508, Toronto, Ontario M5T 1P5, e-mail address: jessica.shih@utoronto.ca ©2018American Society of Plastic Surgeons
The Osteoseptocutaneous Fibula Flap: Concise Review, Goal-Oriented Surgical Technique, and Tips and Tricks
The fibula osteoseptocutaneous flap is a workhorse flap for bone reconstruction. Mastery of the flap is essential for a rewarding reconstruction. Yet, there's no complete work on this versatile flap. The authors provide concise review of the literature, address the myths and challenges associated with the flap, and describe their refined techniques for different reconstruction scenarios and possible anatomic variations. Conflict of interest: The authors have no conflict of interest to declare. Correspondence Author and Requests for Reprints: Fu-Chan Wei. MD, FACS, Distinguished Chair Professor, Chang Gung University Medical College, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei 10591, Taiwan, E-mail: ,Tel: +886- 3-328-1200 ext 3535 or 2007 ©2018American Society of Plastic Surgeons
Microvascular Hepatic Artery Anastomosis in Pediatric Living Donor Liver Transplantation: 73 Consecutive Cases by a Single Surgeon
Background: Living donor liver transplantation (LDLT) is an important strategy of procuring segmental liver allografts for pediatric patients with liver failure, as suitably sized whole donor organs are scarce. Early pediatric LDLT experience was associated with high rates of hepatic artery thrombosis, graft loss, and mortality. Collaboration with microsurgeons for hepatic artery anastomosis in pediatric LDLT has decreased rates of arterial complications; however, reported outcomes are limited. Methods: A 14-year retrospective review was undertaken of children at our institution who underwent LDLT with hepatic artery anastomosis performed by a single microsurgeon using an operating microscope. Data were collected on demographics, etiology of liver failure, graft donor, vessel calibre, vessel anastomosis, arterial complications, and long-term follow up. Results: Seventy-three children with end stage liver failure underwent LDLT with microvascular hepatic artery anastomosis. The commonest etiology for liver failure was biliary atresia (63%). A total of 83 end to end hepatic artery anastomoses were completed using an operating microscope. Hepatic artery complications occurred in 5 patients, consisting of 3 cases of kinked anastomoses that were revised without complications and 2 cases of hepatic artery thrombosis (3%), of which one resulted in graft loss and patient death. Patient survival was 94% at 1 year and 90% at 5 years. Conclusions: Microvascular hepatic artery anastomosis in pediatric patients undergoing LDLT is associated with a low hepatic artery complication rate and excellent long-term liver graft function. Collaboration between microsurgeons and transplant surgeons can significantly reduce technical complications and improve patient outcomes. Financial Disclosure Statement: none Presented at the 2017 Annual Meeting of the American Society of Reconstructive Microsurgery in Waikoloa, HI, USA, January 14-17, 2017 and the 71st Annual Meeting of the Canadian Society of Plastic Surgeons in Winnipeg, MB, Canada, June 20-24, 2017. Corresponding Author: Dr. Ronald M. Zuker MD, FRCS(C), FACS, FAAP, Professor, Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children , 555 University Avenue, Toronto, ON M5G 1X8, Phone: 416-813-6447, Fax: 416-813-6147, E-mail: ronald.zuker@sickkids.ca ©2018American Society of Plastic Surgeons
Πέμπτη 20 Σεπτεμβρίου 2018
Dilated Vein of the Filum Terminale on MRI: A Marker for Deep Lumbar and Sacral Dural and Epidural Arteriovenous Fistulas [SPINE]
BACKGROUND AND PURPOSE:
Conventional MR imaging can provide important clues regarding the location of a spinal vascular malformation. We hypothesized that a dilated vein of the filum terminale, identified as a curvilinear flow void on T2WI, could be an imaging marker for a lower lumbar (L3–L5) or sacral fistula.
MATERIALS AND METHODS:We retrospectively identified all spinal dural and spinal epidural arteriovenous fistulas from 2 large tertiary referral centers from 2005 to 2018. All patients had a lumbar spinal MR imaging and a conventional spinal angiography. Images were reviewed by 2 neuroradiologists who categorized the level of the arterial feeder to the fistula and the presence or absence of a dilated vein of the filum terminale on T2WI and T1 postcontrast images. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of the presence of a dilated filum terminale vein for a deep lumbar or sacral fistula.
RESULTS:One hundred sixty-two patients were included. An enlarged filum terminale vein was identified in 39 patients. Sensitivity, specificity, positive predictive value, and negative predictive value of the presence of a dilated filum terminale vein for a deep lumbar or sacral fistula were 86%, 98.3%, 94.9%, and 95.1%, respectively.
CONCLUSIONS:The presence of a dilated vein of the filum terminale can accurately localize a spinal dural arteriovenous fistula/spinal epidural arteriovenous fistula to the lower lumbar or sacral spine in patients being evaluated for such lesions. This finding can be used to facilitate both noninvasive and conventional spinal angiography.
The ASNR-ACR-RSNA Common Data Elements Project: What Will It Do for the House of Neuroradiology? [PRACTICE PERSPECTIVES]
SUMMARY:
The American Society of Neuroradiology has teamed up with the American College of Radiology and the Radiological Society of North America to create a catalog of neuroradiology common data elements that addresses specific clinical use cases. Fundamentally, a common data element is a question, concept, measurement, or feature with a set of controlled responses. This could be a measurement, subjective assessment, or ordinal value. Common data elements can be both machine- and human-generated. Rather than redesigning neuroradiology reporting, the goal is to establish the minimum number of "essential" concepts that should be in a report to address a clinical question. As medicine shifts toward value-based service compensation methodologies, there will be an even greater need to benchmark quality care and allow peer-to-peer comparisons in all specialties. Many government programs are now focusing on these measures, the most recent being the Merit-Based Incentive Payment System and the Medicare Access Children's Health Insurance Program Reauthorization Act of 2015. Standardized or structured reporting is advocated as one method of assessing radiology report quality, and common data elements are a means for expressing these concepts. Incorporating common data elements into clinical practice fosters a number of very useful downstream processes including establishing benchmarks for quality-assurance programs, ensuring more accurate billing, improving communication to providers and patients, participating in public health initiatives, creating comparative effectiveness research, and providing classifiers for machine learning. Generalized adoption of the recommended common data elements in clinical practice will provide the means to collect and compare imaging report data from multiple institutions locally, regionally, and even nationally, to establish quality benchmarks.
Spinal Imaging Findings of Open Spinal Dysraphisms on Fetal and Postnatal MRI [SPINE]
BACKGROUND AND PURPOSE:
Fetal MRI has become a valuable tool in the evaluation of open spinal dysraphisms making studies comparing prenatal and postnatal MRI findings increasingly important. Our aim was to determine the accuracy of predicting the level of the spinal dysraphic defect of open spinal dysraphisms on fetal MR imaging and to report additional findings observed when comparing fetal and postnatal MR imaging of the spine in this population.
MATERIALS AND METHODS:A single-center retrospective analysis was performed of fetal MRIs with open spinal dysraphisms from 2004 through 2016 with available diagnostic postnatal spine MR imaging. Images were reviewed by 2 board-certified fellowship-trained pediatric neuroradiologists. Corresponding clinical/operative reports were reviewed.
RESULTS:One hundred nineteen fetal MRIs of open spinal dysraphisms were included. The level of the osseous defect between fetal and postnatal MR imaging was concordant in 42.9% (51/119) of cases and was 1 level different in 39% (47/119) of cases. On postnatal MR imaging, type II split cord malformation was seen in 8.4% (10/119) of cases, with only 50% (5/10) of these cases identified prospectively on fetal MR imaging. Syrinx was noted in 3% (4/119) of prenatal studies, all cervical, all confirmed on postnatal MR imaging.
CONCLUSIONS:Fetal MR imaging is accurate in detecting the level of the spinal dysraphic defect, which has an impact on prenatal counseling, neurologic outcomes, and eligibility for fetal surgery. In addition, fetal MR imaging is limited in its ability to detect split cord malformations in patients with open spinal dysraphisms. Although rare, fetal MR imaging has a high specificity for detection of cervical spinal cord syrinx.
Facial Venous Malformations Are Associated with Cerebral Developmental Venous Anomalies [HEAD & NECK]
BACKGROUND AND PURPOSE:
A number of studies have demonstrated the existence of segmental vascular disorders affecting soft tissues of the head and neck along with the intracranial vasculature. The purpose of this study was to determine whether there is an association between cerebral developmental venous anomalies and venous malformations of the face, head, and neck.
MATERIALS AND METHODS:A consecutive series of patients with head and neck venous malformations who underwent MR imaging of the brain with postcontrast T1- or T2*-weighted imaging were included. Developmental venous anomaly prevalence in this patient population was compared with an age- and sex-matched control group without venous malformations at a ratio of 1:2. All images were interpreted by 2 neuroradiologists. Data were collected on venous malformation location, developmental venous anomaly location, developmental venous anomaly drainage pattern, and metameric location of venous malformations and developmental venous anomalies. Categoric variables were compared using 2 tests.
RESULTS:Forty-two patients with venous malformations were included. The mean age was 38.1 ± 11.1 years, and 78.6% of patients were female. The prevalence of developmental venous anomalies in this patient population was 28.6%. The control population of 84 patients had a mean age of 40.0 ± 5.9 years, and 78.6% of patients were female. The prevalence of developmental venous anomalies in this patient population was 9.5% (P = .01). In 83.3% of cases, developmental venous anomalies were ipsilateral to the venous malformation, and in 75% of cases, they involved the same metamere.
CONCLUSIONS:Our case-control study demonstrated a significant association between brain developmental venous anomalies and superficial venous malformations. These findings suggest that there may be a similar pathophysiologic origin for these 2 entities.
Imaging of Clival Hypoplasia in CHARGE Syndrome and Hypothesis for Development: A Case-Control Study [PEDIATRICS]
BACKGROUND AND PURPOSE:
We present the largest case series to date on basiocciput abnormalities in CHARGE syndrome (Coloboma of the eye, Heart defects, Atresia of the choanae, Retardation of growth and/or development, Genital and/or urinary abnormalities, and Ear abnormalities and/or deafness). We aimed to show that basiocciput abnormalities are common and may aid in diagnosis. We furthermore explored whether clivus size correlates with the type of chromodomain-helicase-DNA binding protein 7 gene (CHD7) mutation, which causes CHARGE syndrome, and with clinical criteria according to Blake et al and Verloes.
MATERIALS AND METHODS:We retrospectively analyzed the clivus of 23 patients with CHARGE syndrome with CHD7 mutations on MR imaging or CT. We recorded the size of the clivus, the Welcher angle, basilar invagination, and Chiari I malformations. We compared the clival size and Welcher angle of patients with CHARGE syndrome with those of 72 age-matched controls. Additionally, we tested for correlations between clivus size and mutation type or clinical criteria.
RESULTS:Eighty-seven percent of the patients with CHARGE syndrome had an abnormal clivus; 61% had a clivus >2.5 SD smaller than that of age-matched controls. An abnormally large Welcher angle was observed in 35%. Basiocciput hypoplasia was found in 70%, and basilar invagination, in 29%. None of the patients had a Chiari I malformation. At the group level, patients with CHARGE syndrome had a smaller clivus and larger Welcher angle than controls. No significant correlation between clivus size and mutation type or clinical criteria was found.
CONCLUSIONS:Most patients with CHARGE syndrome have an abnormal clivus. This suggests that clivus abnormalities may be used as an additional diagnostic tool. Our results provide evidence that CHD7, which is expressed in the presomitic mesoderm during somitogenesis, plays an important role in the formation of the clivus.
Cerebrovascular Reactivity during Prolonged Breath-Hold in Experienced Freedivers [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Experienced freedivers can endure prolonged breath-holds despite severe hypoxemia and are therefore ideal subjects to study apnea-induced cerebrovascular reactivity. This multiparametric study investigated CBF, the spatial coefficient of variation as a correlate of arterial transit time and brain metabolism, dynamics during prolonged apnea.
MATERIALS AND METHODS:Fifteen male freedivers (age range, 20–64 years; cumulative previous prolonged breath-holds >2 minutes and 30 seconds: 4–79,200) underwent repetitive 3T pseudocontinuous arterial spin-labeling and 31P-/1H-MR spectroscopy before, during, and after a 5-minute breath-hold (split into early and late phases) and gave temporally matching venous blood gas samples. Correlation of temporal and regional cerebrovascular reactivity to blood gases and cumulative previous breath-holds of >2 minutes and 30 seconds in a lifetime was assessed.
RESULTS:The spatial coefficient of variation of CBF (by arterial spin-labeling) decreased during the early breath-hold phase (–30.0%, P = .002), whereas CBF remained almost stable during this phase and increased in the late phase (+51.8%, P = .001). CBF differed between the anterior and the posterior circulation during all phases (eg, during late breath-hold: MCA, 57.3 ± 14.2 versus posterior cerebral artery, 42.7 ± 10.8 mL/100 g/min; P = .001). There was an association between breath-hold experience and lower CBF (1000 previous breath-holds reduced WM CBF by 0.6 mL/100 g/min; 95% CI, 0.15–1.1 mL/100 g/min; P = .01). While breath-hold caused peripheral lactate rise (+18.5%) and hypoxemia (oxygen saturation, –24.0%), cerebral lactate and adenosine diphosphate remained within physiologic ranges despite early signs of oxidative stress [–6.4% phosphocreatine / (adenosine triphosphate + adenosine diphosphate); P = .02].
CONCLUSIONS:This study revealed that the cerebral energy metabolism of trained freedivers withstands severe hypoxic hypercarbia in prolonged breath-hold due to a complex cerebrovascular hemodynamic response.
Engorgement of Deep Medullary Veins in Neurosarcoidosis: A Common-Yet-Underrecognized Cerebrovascular Finding on SWI [ADULT BRAIN]
SUMMARY:
We describe the prevalence and potential significance of deep medullary vein engorgement on SWI in patients with neurosarcoidosis, a finding that has not been described previously. Engorgement was evaluated for possible associations with meningeal or perivascular disease, intracranial hemorrhage, and venous thrombosis, as well as with modified Rankin Scale scores at the time of MR imaging and at follow-up. Deep medullary vein engorgement was seen in 7 of 21 patients and was more common in men. Patients with venous engorgement had a significantly increased incidence of microhemorrhages, perivascular disease, and hydrocephalus. There was no association with the degree of leptomeningeal disease, venous dural sinus thrombosis, or modified Rankin Scale scores. In conclusion, deep medullary vein engorgement was common in our patients with neurosarcoidosis. Although its pathophysiology remains uncertain, it could be related to venous or perivenous abnormalities and may represent a useful secondary finding of cerebrovascular disease.
Correct species identification (reclassification in CNCTC) of strains of Staphylococcus intermedius -group can improve an insight into their evolutionary history
Abstract
A group of 59 putative strains of Staphylococcus intermedius/Staphylococcus pseudintermedius deposited in the Czech National Collection of Type Cultures (CNCTC, National Institute for Public Health, Prague, Czech Republic) and the National Reference Laboratory for Staphylococci (NRL for Staphylococci, National Institute for Public Health, Prague, Czech Republic) was reclassified using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). There the biggest human collection of S. pseudintermedius in Europe was analysed; 44 samples (75%) were of human origin. Twenty-two percent (n = 13) of the strains were isolated from animals, and two staphylococci were of unknown origin. This study revealed the prevalence of Staphylococcus pseudintermedius (94%, n = 53) vs. Staphylococcus intermedius (6%, n = 6) in the collection of human and veterinary staphylococci after reclassification. Results of PCR-RFLP analysis were verified by comparison with a repetitive element sequence-based polymerase chain reaction (Rep-PCR) analysis on 26 (44%) randomly selected strains. Due to a low-resolution ability of PCR-RFLP to separate Staphylococcus intermedius from Staphylococcus delphini, four isolates of Staphylococcus intermedius were biochemically verified further to exclude the presence of Staphylococcus delphini in the collection. Our results indicate that S. intermedius and S. pseudintermedius have occurred independently over an age-long period of their co-evolution.
Clinical, Dermoscopic and Histologic Features of Recurrent Cutaneous Eosinophilic Vasculitis Cases
Publication date: Available online 20 September 2018
Source: Actas Dermo-Sifiliográficas (English Edition)
Author(s): E.G. Quijano-Gomero, M.J.M. Rodríguez-Zúñiga, M.E. Sanz-Montero, D. Durand-Buse
Abstract
Primary recurrent cutaneous eosinophilic vasculitis is a rare condition characterized by pruritic, erythematous, purpuric plaques associated to edema. We compared and analyze the clinical, dermoscopic and histological features of the disease in 4 patients from our hospital and 13 patients published in the literature. Seventeen patients were included, with a median age of 56 yo, a median duration of disease of 6 months. Lesions were most frequently generalized (47%) or localized in lower limbs (41%). The most frequent features were purpuric color (71%), local edema (65%), necrotizing vasculitis (94%) and eosinophil infiltration (100%) in histology. Most of the patients (82.4%) were given oral steroids with a median dose of 30 mg. Primary recurrent cutaneous eosinophilic vasculitis might be an infra-diagnosed condition. The analysis of the patients allowed us to propose diagnostic criteria for the definition of this disease. We suggest a therapeutic strategy with high-potency steroids and dapsone, which might be considered as first-line treatment.
Resumen
La vasculitis eosinofílica recurrente cutánea primaria es una enfermedad rara, caracterizada por placas purpúricas, eritematosas y pruriginosas asociadas a edema. Comparamos y analizamos las características clínicas, dermatoscópicas e histológicas de la enfermedad en 4 pacientes de nuestro hospital y en 13 casos de pacientes publicados previamente. Se incluyeron 17 pacientes, con una mediana de edad de 56 años, y una mediana de duración de la enfermedad de 6 meses. En la mayoría de los casos las lesiones fueron generalizadas (47%) o localizadas en los miembros inferiores (41%). Las características histológicas más frecuentes fueron: color purpúrico (71%), edema local (65%), vasculitis necrosante (94%) e infiltración eosinofílica (100%). La mayoría de los pacientes (82,4%) recibió esteroides orales (mediana de la dosis de 30 mg). La vasculitis eosinofílica recurrente cutánea primaria podría ser una entidad clínica infradiagnosticada. El análisis de los pacientes nos permitió proponer algunos criterios diagnósticos para su definición. Recomendamos una estrategia terapéutica con esteroides de alta potencia y dapsona, pudiéndose considerar como el tratamiento de primera línea.
The Effectiveness of a Twice-weekly Narrowband Ultraviolet B Phototherapy Schedule in Early-stage Mycosis Fungoides in a Cohort of 18 Argentinian Patients
Publication date: Available online 19 September 2018
Source: Actas Dermo-Sifiliográficas (English Edition)
Author(s): D.A. De Luca, E.A. Zambrano, R.L. Galimberti, P.A. Enz
Erratum zu: Rohstoffpotenzial von MVA-Rostaschen für Metallrückgewinnung und Karbonatisierung
Erratum zu:
Österr Wasser- und Abfallw 2018
https://ift.tt/2OGYG3g
Statt Abb. 9 wurde irrtümlicherweise Abb. 7 wiederholt abgedruckt. In Abb. 9 ist die Verteilung der potenziell kritischen (PKE) und der kritischen Elemente (KE) auf die Outputströme der Fe/NE-Scheidung 6,3–10 mm und
Detectable levels of eHSP72 in plasma are associated with physical activity and antioxidant enzyme activity levels in hypertensive subjects
Abstract
Previous studies reported that extracellular HSP72 (eHSP72) correlates with poor prognosis, markers of vascular dysfunction, and the severity of cardiovascular diseases, associated with a systemic oxidative and inflammatory profile. On the other hand, eHSP72 may represent immune-regulatory signaling that is related to exercise benefits, but the association between physical activity levels and eHSP72 levels is not established. Thus, since regular physical activity may avoid oxidative stress and inflammation, we investigate whether detectable levels of eHSP72 in plasma are associated with physical activity and antioxidant enzyme activity levels in hypertensive subjects. Physical activity levels of hypertensive subjects (n = 140) were measured by tri-axial movement sensor pedometer for 24 h during 5 consecutive days. One day after, blood was collected into heparinized tubes for oxidative stress analyses (catalase—CAT and superoxide dismutase—SOD activities and malondialdehyde levels) or in disodium EDTA tubes for eHSP72 assays. Thus, hypertensive subjects were classified as physically inactive (< 10,000 footsteps/day) or active (> than 10,000 footsteps/day) and according detectable or not detectable eHSP72 levels in plasma, performing the inactive/eHSP72−, active/eHSP72−, inactive/eHSP72+, and active/eHSP72+ groups. We found that detectable levels of eHSP72 in plasma were associated with physical activity levels and low oxidative stress profile (Higher CAT and SOD activities and low malondialdehyde levels). eHSP72 levels can be used as a biomarker of the amount of physical activity necessary to improve antioxidant defense and thus cardiovascular health in hypertensive subjects.
Should physicians be empathetic? Rethinking clinical empathy
Abstract
The role and importance of empathy in clinical practice has been widely discussed. This paper focuses on the ideal of clinical empathy, as involving both cognitive understanding and affective resonance. I argue that this account is subject to a number of objections. Affective resonance may serve more as a liability than as a benefit in clinical settings, and utilizing this capacity is not clearly supported by the relevant empirical literature. Instead, I argue that the ideal account of empathy in medicine remains cognitive, though there is a central role for expressing empathic concern toward patients.
Aufklärung bei kosmetischen Eingriffen
Zusammenfassung
Die Aufklärung ist vor einem geplanten kosmetischen Eingriff die rechtliche Stütze für eine wirksame Einwilligung des Patienten und damit vom Operateur auf keinen Fall zu vernachlässigen. Sie darf unter keinen Umständen auf nichtärztliches Personal delegiert werden und muss, insbesondere auch dann, wenn Aufklärungsformulare zum Einsatz kommen, stets rechtzeitig im Rahmen eines Aufklärungsgesprächs erfolgen. Bei kosmetischen Eingriffen ist im Vergleich zu medizinisch indizierten Eingriffen besonders schonungslos aufzuklären. Bei Fehlern in der Aufklärung kann der Operateur zivilrechtlich wegen Arzthaftung in Anspruch genommen werden und riskiert im schlimmsten Fall ein staatsanwaltliches Ermittlungsverfahren wegen Körperverletzung. Oftmals dringt der Patient auch mit Hornorarrückforderungen durch.
Wound dressings for leg ulcers in Germany: distribution, regional variations and health care providers
Publication date: Available online 19 September 2018
Source: Wound Medicine
Author(s): Kristina Hagenström, Kerstin Protz, Gerd Glaeske, Matthias Augustin
ABSTRACT
Background
Although there are standards in guideline-compliant treatment of chronic wounds, little is known about the use of wound dressings in Germany.
Objective
The objective of the longitudinal study was to analyze the use of wound dressings, to explore regional differences and to characterize prescriptions by different physician specialties in patients with leg ulcers in Germany.
Methods
Wound dressing rates for incident leg ulcers were analyzed from a German statutory health insurance between 2010 and 2012.
Results
From 2010 to 2012, out of 7,248,644 insured persons 0.52 % [95 %-CI 0.51–0.52 %] were identified as having an incident ulcer. 76.0 % were treated with hydroactive wound dressings. By contrast, in 23.7 % only non-hydroactive dressings were used, and more often prescribed in venous (24.0 %) than in mixed leg ulcers (20.8 %). Most frequently used products were foam dressings (49.7 %), followed by gauze compresses (29.5 %). Wound specialized physicians had the highest overall proportion of prescriptions (60.2 %) and a slightly higher proportion of non-hydroactive wound dressings. Large regional variations were observed.
Conclusion
In Germany, a high level of use of hydroactive wound dressings in leg ulcers and marked regional variations were found.
Affluent-Born White Mother’s Descending Neighborhood Income and Infant Mortality: A Population-Based Study
Abstract
Objectives To determine whether affluent-born White mother's descending neighborhood income is associated with infant mortality rates (< 365 day, IMR). Methods Stratified and multilevel logistic regression analyses were completed on the Illinois transgenerational dataset of singleton births (1989–1991) to non-Latina White mothers (1956–1976) with an early-life residence in affluent neighborhoods (defined as the fourth quartile of income distribution). The breadth of descending neighborhood income was defined by mother's neighborhood income at the time of delivery. Results Infants of White mothers (n = 4890) who did not suffer descending neighborhood income by the time of delivery had a first-year mortality rate of 5.1/1,000. Infants of White mothers who experienced minor (n = 5112), modest (n = 2158), or extreme (n = 339) descending neighborhood income had IMR of 6.5/1,000, 14.4/1,000, and 11.8/1,000, respectively; RR [95% CI] = 1.3 [0.8, 2.1], 2.8 [1.7, 4.8], and 2.3 [0.8, 6.6], respectively. The incidence of young maternal age, inadequate prenatal care utilization, and cigarette smoking rose as descending neighborhood income increased, p < 0.01. In multilevel logistic regression models, the adjusted (controlling for selected individual-level co-variates) OR [95% CI] of infant mortality for White women with an early-life residence in affluent neighborhoods who subsequently experienced minor or modest to extreme (versus absent) descending neighborhood income equaled 1.0 [0.6, 1.8] and 2.1 [1.1, 3.8] respectively. Conclusions White mother's modest to extreme descending neighborhood income from early-life residence in affluent neighborhoods is associated with a twofold greater risk of infant mortality independent of selected biologic, medical, and behavioral characteristics.
Disparities in Risk Factors and Birth Outcomes Among American Indians in North Dakota
Abstract
Objectives High infant mortality rates among American Indians in North Dakota contribute to a 20-year gap in average age at death compared to whites. Geographic- and race-specific health disparities data to drive policy making and interventions are not well disseminated. The current study examines prenatal risk factors and birth outcomes between American Indian and whites in North Dakota. Methods A retrospective descriptive analysis of North Dakota live births from 2007 to 2012 was conducted. Period prevalence and prevalence ratios were calculated. Results The infant mortality rate from 2010 to 2012 for infants born to American Indian women was 3.5 times higher than whites. Racial disparities existed in education, teen births, tobacco use during pregnancy, and breastfeeding initiation. Disparities widened for inadequate prenatal care, illegal drug use during pregnancy, and infant mortality from 2007–2009 to 2010–2012 and narrowed for sexually transmitted infections and alcohol use during pregnancy. Conclusions for Practice American Indians are disproportionately affected by poor pregnancy and birth outcomes in North Dakota. Future geographic-specific American Indian research is warranted to aid current and future public health interventions.
Newborn Screening Collection and Delivery Processes in Michigan Birthing Hospitals: Strategies to Improve Timeliness
Abstract
Objectives This study aimed to determine which steps in the newborn screening collection and delivery processes contribute to delays and identify strategies to improve timeliness. Methods Data was analyzed from infants (N = 94,770) who underwent newborn screening at 83 hospitals in Michigan between April 2014 and March 2015. Linear mixed effects models estimated effects of hospital and newborn characteristics on times between steps in the process, whereas simulation explored how to improve timeliness through adjustments to schedules for the state laboratory and for specimen pickup from hospitals. Results Time from collection to receipt of arrival to the state laboratory varied greatly with collection timing (P < 0.001), with specimens collected on Friday or Saturday delayed an average of 9–12 h compared to other specimens. Simulation estimates shifting specimen pickup from 6 p.m. Sunday–Friday to 9 p.m. Sunday–Friday could lead to an additional 12.6% of specimens received by the Michigan laboratory within 60 h of birth. Conclusions for Practice The time between when a specimen is collected and received by the laboratory can be a significant bottleneck in the newborn screening process. Modifying hospital pickup schedules appears to be a simple way to improve timeliness.
Evaluation of a Multilevel Intervention to Reduce Preterm Birth Among Black Women in Newark, New Jersey: A Controlled Interrupted Time Series Analysis
Abstract
Objective To evaluate the effectiveness of a multilevel intervention, Healthy Babies are Worth the Wait (HBWW), in reducing preterm birth (PTB) and very preterm birth (VPTB) among black women in Newark, NJ. Methods HBWW is a program linking the local March of Dimes office, providers, community-based organizations, and public health institutions to increase uptake of evidence based preterm birth interventions. We used birth certificate data before (2009–2011) and after (2012–2015) the introduction of HBWW in Newark. We estimated differences in PTB and VPTB between these periods among black women in Newark and compared them to rate differences among black women in the rest of NJ (difference-in-differences). We used interrupted time series analysis (ITSA) to examine declines in PTB and VPTB following the introduction of HBWW controlling for secular trends. All models adjusted for maternal age, education and parity. Results PTB declined in Newark 1.1 case per 100 (95% confidence interval (CI) − 2.3, 0) and in the rest of NJ 0.5 case per 100 (− 1.4, 0.4) (difference-in-differences = 0.6 fewer cases per 100 in Newark, 95% CI − 1.6, 0.3). VPTB declined in both Newark (− 0.6 cases per 100, 95% CI − 1.0, 0) and the rest of NJ (− 0.2 cases per 100, 95% CI − 0, 0.3) (difference-in-differences = 0.4 fewer cases per 100 in Newark, 95% CI − 0.9, 0). However, using ITSA the downward VPTB trend in Newark was not different from the rest of NJ or pre-intervention trends. Conclusions for Practice Our study supports the importance of critically evaluating and advancing complex interventions to reduce PTB among black women.
Structural and organisational conditions for being a machine
Abstract
Although the analogy between macroscopic machines and biological molecular devices plays an important role in the conceptual framework of both neo-mechanistic accounts and nanotechnology, it has recently been claimed that certain complex molecular devices (consisting of biological or synthetic macromolecular aggregates) cannot be considered machines since they are subject to physicochemical forces that are different from those of macroscopic machines. However, the structural and physicochemical conditions that allow both macroscopic machines and microscopic devices to work and perform new functions, through a combination of elemental functional parts, have not yet been examined. In order to fill this void, this paper has a threefold aim: first, to clarify the structural and organisational conditions of macroscopic machines and microscopic devices; second, to determine whether the machine-like analogy fits nanoscale devices; and third, to assess whether the machine-like analogy is appropriate for describing the behaviour of some biological macromolecules. Finally, the paper gives an account of 'machine' which, while acknowledging the physicochemical and organisational differences between man-made machines and biological microscopic devices, nevertheless identifies a common conceptual core that allows us to consider the latter 'machines'.
Clinical feasibility of early scanning after administration of 68 Ga-DOTATOC
Abstract
Objective
Positron emission tomography (PET)/computed tomography (CT) using 68Ga-labeled 1,4,7,10-tetraazacyclododecane-N,N′,N″,N‴-tetraacetic acid-d-Phe1-Tyr3-octreotide (DOTATOC) is usually performed about 1-h post-injection; however, because of rapid blood clearance, the waiting time for scanning could possibly be shortened without affecting diagnostic performance. The purpose of this study was to investigate the feasibility of early scanning at 30 min post-injection.
Methods
Thirty-eight patients who underwent DOTATOC-PET/CT were analyzed. After administration of 68Ga-DOTATOC, data acquisition was performed twice, at 30-min and 60-min post-injection. The number of known or suspected pathological lesions, and quantitative values of those lesions and physiological uptake were compared. SUVmax, SUVpeak, metabolic tumor volume (MTV), and total lesion uptake (TLU) were calculated as quantitative values of the pathological lesions.
Results
A total of 125 known or suspected pathological lesions were found at both timepoints, with no differences between the two datasets. The SUVmax, SUVpeak, MTV, and TLU were highly reproducible, with Spearman's ρ of 0.983, 0.986, 0.918, and 0.981, respectively. The average percent differences (%DIFFave) defined as the differences of the values divided by the value at 1-h post-injection were 11.1% for SUVmax, 8.5% for SUVpeak, 15.1% for MTV, and 20.6% for TLU. Physiological uptake in the two datasets was closely comparable in the pituitary gland (Spearman's ρ = 0.954, %DIFFave = 11.0%), liver (0.989, 3.9%), spleen (0.970, 6.3%), adrenal glands (0.879, 13.0%), and pancreatic uncus (0.946, 12.7%).
Conclusion
The diagnostic performance of visual interpretation should be comparable between DOTATOC-PET/CT images obtained at 30-min and 60-min post-injection. Some differences between quantitative values may exist; however, they appear to be minimal.
Assessment and treatment of trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder
Publication date: Available online 19 September 2018
Source: Clinics in Dermatology
Author(s): Grant Jones, Nancy Keuthen, Erica Greenberg
Abstract
Recommendations are provided for the assessment and treatment of trichotillomania (hair pulling disorder, or HPD) and excoriation disorder (skin picking disorder, or SPD), two body-focused repetitive behavior (BFRB) disorders, based on their severity, comorbidities, and behavioral style. Habit reversal training (HRT) and stimulus control are first-line behavioral treatments that can be used in cases of all severity levels and may be particularly helpful when pulling or picking is performed with lowered awareness/intention. Acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT) are behavioral treatments that can be employed to augment HRT/stimulus control, especially when negative emotions trigger the pulling or picking. There are currently no FDA-approved pharmacologic treatments for HPD or SPD, though certain medications/supplements have shown varying degrees of efficacy in trials. N-acetylcysteine (NAC) should be considered for all severity levels and styles given its moderate gain/low side effect profile. Other pharmacologic interventions, including selective serotonin reuptake inhibitors (SSRIs), should be considered in cases with significant comorbidities or previous behavioral/NAC treatment failure.
Business administration training for dermatology residents: Preparing for the business of medicine
Publication date: Available online 19 September 2018
Source: Clinics in Dermatology
Author(s): Jordan V Wang, Christian A Albornoz, Ezra Hazan, Matthew Keller, Nazanin Saedi
Abstract
Previous studies have evidenced the lack of practice management and business training components in the residency curriculum, and satisfaction with this training, when provided, was low. Whether considered good or bad, medicine has been moving increasingly towards becoming more business-centric. Dermatology represents a unique field, since most residents choose to pursue private practice, where competent business skills are helpful to running a successful clinic. Our study examines the current state of business administration training for dermatology residents in ACGME-approved programs as of 2017–2018. Our results show that residents both value and desire business administration training. However, the current training provided is considered to be insufficient and inadequate. Promoting and encouraging the teaching of business administration skills, while still balancing core competencies, may help to prepare residents in navigating the future of our field.
Psychosomatic and Psychiatric Disorders and Psychologic Factors in Pruritus
Publication date: Available online 19 September 2018
Source: Clinics in Dermatology
Author(s): Astrid Stumpf, Gudrun Schneider, Sonja Ständer
Abstract
Chronic pruritus (CP) is a bothersome symptom of many different diseases and is often associated with psychosomatic and psychiatric comorbidity. This review gives an overview of psychologic factors that influence the perception and modulation of pruritus based on the well-known biopsychosocial model. Not only psychic comorbidities, such as anxiety and depression, play an important role in the etiology and perception of pruritus, but also internal factors, including personality, mentalization, suggestibility, and external factors, as well as stress. Expectations concerning the intensity of pruritus can also play a role in itch perception that can be modulated by cognitions and behavior of the patient. Obsessive rituals of scratching and skin manipulation with instruments present challenges in the treatment of CP. Initial studies on the efficacy of psychotherapeutic approaches to different problems, such as scratching, comorbidity or stress-associated itch, show that these might be very useful additions to the multidisciplinary treatment of pruritus.
The dynamic-lymphaticovenular anastomosis method for breast cancer treatment-related lymphedema: creation of functional lymphaticovenular anastomoses with use of preoperative dynamic ultrasonography
Lymphaticovenular anastomosis (LVA) is generally effective for breast cancer treatment-related upper extremity lymphedema (UEL). Clinical improvement is, however, limited by the degree of sclerosis of the lymphatic vessels. We have developed a method by which we use dynamic ultrasonography to depict vessels through which lymph can be propelled into the LVA under the power of the patient's natural hand movements.
Adipose-derived regenerative cells and fat grafting for treating breast cancer-related lymphedema: Lymphoscintigraphic evaluation with one year follow-up
Background: Breast cancer-related lymphedema (BCRL) is a feared late complication. Present treatment options are lacking. Recent studies have suggested that mesenchymal stromal cells can alleviate lymphedema. Herein, we report the results from the first human pilot study with adipose-derived regenerative cells (ADRC) for treating BCRL with one year follow-up. Material and methods: We included ten BCRL patients. ADRCs were injected directly into the axillary region together with a scar releasing fat graft procedure.
Outcomes of shoulder abduction after nerve surgery in patients over 50 following traumatic brachial plexus injury
There is controversy regarding the effectiveness of brachial plexus reconstruction in older patients as it is felt that outcomes are poor. The aim of this study is to determine the outcomes of shoulder abduction obtained after nerve reconstruction in patients over the age of 50 and factors related to success.
Use of a perforator/subcutaneous pedicled propeller flap for reconstruction of lower eyelid defects
Full thickness skin grafts (FTSGs) and flaps from the upper eyelid or cheek can be used for reconstruction of lower eyelid defects, including the anterior lamella. However, the upper eyelid has a limited and insufficient amount of skin, while cheek flaps have a restricted arch of rotation. Here we report the procedure and outcomes of a perforator/subcutaneous pedicled propeller flap for reconstruction of lower eyelid defects including the anterior lamella.A retrospective study of 12 patients who underwent treatment for eyelid anterior lamella defects with perforator/subcutaneous pedicled propeller flaps was conducted between March 2015 and June 2017.
Predictors of complications following breast reduction surgery: A national surgical quality improvement program study of 16812 cases.
Breast reduction is one of the most common procedures performed by plastic surgeons. Despite good outcomes and high patient satisfaction, there is little national data examining the predictors leading to complications in this patient population. We accessed a national outcomes database to examine these factors.
Excess vascular endothelial growth factor-A disrupts pericyte recruitment during blood vessel formation
Abstract
Pericyte investment into new blood vessels is essential for vascular development such that mis-regulation within this phase of vessel formation can contribute to numerous pathologies including arteriovenous and cerebrovascular malformations. It is critical therefore to illuminate how angiogenic signaling pathways intersect to regulate pericyte migration and investment. Here, we disrupted vascular endothelial growth factor-A (VEGF-A) signaling in ex vivo and in vitro models of sprouting angiogenesis, and found pericyte coverage to be compromised during VEGF-A perturbations. Pericytes had little to no expression of VEGF receptors, suggesting VEGF-A signaling defects affect endothelial cells directly but pericytes indirectly. Live imaging of ex vivo angiogenesis in mouse embryonic skin revealed limited pericyte migration during exposure to exogenous VEGF-A. During VEGF-A gain-of-function conditions, pericytes and endothelial cells displayed abnormal transcriptional changes within the platelet-derived growth factor-B (PDGF-B) and Notch pathways. To further test potential crosstalk between these pathways in pericytes, we stimulated embryonic pericytes with Notch ligands Delta-like 4 (Dll4) and Jagged-1 (Jag1) and found induction of Notch pathway activity but no changes in PDGF Receptor-β (Pdgfrβ) expression. In contrast, PDGFRβ protein levels decreased with mis-regulated VEGF-A activity, observed in the effects on full-length PDGFRβ and a truncated PDGFRβ isoform generated by proteolytic cleavage or potentially by mRNA splicing. Overall, these observations support a model in which, during the initial stages of vascular development, pericyte distribution and coverage are indirectly affected by endothelial cell VEGF-A signaling and the downstream regulation of PDGF-B-PDGFRβ dynamics, without substantial involvement of pericyte Notch signaling during these early stages.
pH and a mixed carbon-substrate spectrum influence FocA- and FocB-dependent, formate-driven H2 production in Escherichia coli
Abstract
Escherichia coli encodes two formate channels, FocA and FocB, which either export formate or import it for further disproportionation by the formate hydrogenlyase (FHL) complex to H2 and CO2. We show that FocA/B appear to change their substrate-translocation direction depending on pH and electron donor. When cells were grown on glucose and glycerol at pH 7.5 formate accumulated in focB or focA-focB mutants when glucose or formate was used as electron donor because H2 production increased ∼2 and ∼1.5 fold, respectively. Moreover, addition of external formate to the growth medium increased H2 production in a focA-focB mutant. This indicates that in the wild type, formate is preferentially exported at pH 7.5 and that another FocA/B-independent uptake system exists. At pH 6.5 and 5.5 the formate channel mutants showed reduced H2 production, suggesting that formate is usually imported by them to produce H2 at acidic pH. Addition of formate to the growth medium increased H2 production at these pHs. Notably, glycerol failed to act as an effective electron donor for formate production. Taken together, our results suggest that regulation of formate translocation direction by FocA/FocB channels is important for maintaining internal pH and proton motive force by modulating H2 production.The Smallest Intestine (TSI) – a low volume in vitro model of the small intestine with increased throughput
Abstract
There is a growing interest in understanding the fate and behaviour of probiotic microorganisms and bioactive compounds during passage of the human gastrointestinal tract (GIT). Here we report the development of a small volume in vitro model called The smallest Intestine (TSI) with increased throughput focusing on simulating passage through the stomach and small intestine (SI). The basic TSI module consists of 5 reactors, with a working volume of 12 ml each. During the simulated passage through the SI, bile is absorbed and pH is adjusted to physiologically relevant values for duodenum, jejunum and ileum. A consortium of seven representative bacterial members of the ileum microbiota is included in the ileal stage of the model. The behaviour of 3 putative probiotic Lactobacillus strains during in vitro simulated upper GIT passage was tested in the model and results were compared to previous studies describing probiotic survival. It was found, that probiotic persistence is strongly related to whether food was ingested, but also to presence of the ileal microbiota, which significantly impacted probiotic survival. In conclusion TSI allows testing a substantial number of samples, at low cost and short time, and is thus suitable as an in vitro screening platform.Highly Cited Papers in Microbiology: Identification and Conceptual Analysis
Abstract
Microbiology is an area with a high research production, classified in different branches. Thus, it is difficult to identify research trends without many backgrounds. The present paper aims to apply bibliometric methods to identify the highly cited papers that contribute to the Microbiology development. Furthermore, a science mapping analysis allows discovering the main thematic areas covered by those detected papers. From the 572,153 papers (articles and reviews) indexed in the Web of Science Microbiology category (1900–2017), a total of 645 highly cited papers were detected. Concerning the main scientific producers in Microbiology, Applied and Environmental Microbiology as a journal, R. Knight from the University of Colorado (USA) as an author, and the USA as a country are the most productive actors. Nevertheless, taking into account the gross domestic product (GDP) per capita, China and Spain are remarkable countries. Furthermore, according to the relative priority index (RPI), Denmark, Belgium, Spain, and The Netherlands are the countries that make a higher scientific effort in this field. About the co-word analysis, several important themes were detected, such as Next Generation Sequencing, Gene, Escherichia Coli or Gene Expression. Concerning these results, this work supposes a framework on which to base future research.Antibiotic allergy labels in children are associated with adverse clinical outcomes
Publication date: Available online 19 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Michaela Lucas, Annabelle Arnold, Aine Sommerfield, Michelle Trevenen, Laure Braconnier, Alina Schilling, Fuad Abass, Lliana Slevin, Brittany Knezevic, Christopher Blyth, PhD. Kevin Murray, Britta von Ungern-Sternberg, Kristina Rueter
Abstract
Background
Self-reported antibiotic allergies are common among hospitalised adults and children. There is a paucity of studies investigating the impact of an antibiotic allergy label in childhood.
Objective
To investigate the impact of antibiotic allergy labelling on clinical outcomes in children.
Method
Retrospective study conducted in a major paediatric tertiary hospital, to capture 1672 inpatient admissions in April 2014 and April 2015. Data, collected by chart review, included documented antibiotic allergy labels, antibiotic prescriptions, admitting specialty, hospital length of stay, and hospital readmissions.
Results
Of the 1672 paediatric patients surveyed, 58.1% were male and 44.8% were prescribed antibiotics. Antibiotic allergy labels were recorded in 5.3% of patients; the majority were beta-lactam labels (85%), mostly to unspecified penicillins. There was an increasing incidence of antibiotic allergy label with age, which was statistically significant (P<0.001); no gender effect was seen. Patients with antibiotic allergy labels received more macrolide (p=0.045), quinolones (P=0.01), lincosamide antibiotics (P<0.001) as well as metronidazole (p=0.009) than patients without an antibiotic allergy label. After adjusting for patient age, sex, principal diagnosis and admitting specialty, children with any antibiotic or beta-lactam allergy label had longer hospital lengths of stay (OR 1.62, 95% CI 1.05-2.50, P=0.03; with mean length of stay of 3.8 days for those without a label and 5.2 days for those with a beta-lactam allergy label).
Conclusions
This is the first study demonstrating the negative impact of antibiotic allergy labels on clinical outcomes in children, as evidenced by significant alternate antibiotic use and longer hospital lengths of stay.
Initiating yellow jacket venom immunotherapy with a 100-μg dose: A challenge?
Publication date: Available online 19 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Byrthe J.P.R. Vos, Anthony E.J. Dubois, Michèle M. Rauber, Wolfgang Pfützner, Michaela Miehe, Barbara Bohle, Christian Möbs, Joanne N.G. Oude Elberink
Predictors of inhaled corticosteroid taper failure in adults with asthma
Publication date: Available online 19 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Juan Carlos Cardet, Christopher D. Codispoti, Tonya S. King, Leonard Bacharier, Tara Carr, Mario Castro, Vernon Chinchilli, Ryan Dunn, Fernando Holquin, Linda Engle, Kyle Nelson, Victor E. Ortega, Michael Peters, Sima Ramratnam, Jerry A. Krishnan, Michael E. Wechsler, Elliot Israel, NHLBI Asthmanet
Comparison of Common Monogenic Defects in a Large Predominantly Antibody Deficiency Cohort
Publication date: Available online 19 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Reza Yazdani, Hassan Abolhassani, Fatemeh Kiaee, Sima Habibi, Gholamreza Azizi, Marzieh Tavakol, Zahra Chavoshzadeh, Seyed Alireza Mahdaviani, Tooba Momen, Mohammad Gharagozlou, Masoud Movahedi, Amir Ali Hamidieh, Nasrin Behniafard, Mohammamd Nabavi, Mohammad Hassan Bemanian, Saba Arshi, Rasol Molatefi, Roya Sherkat, Afshin Shirkani, Reza Amin
Abstract
Background
Predominantly antibody deficiencies (PADs) are the most common primary immunodeficiencies, characterized by hypogammaglobulinemia and inability to generate effective antibody responses.
Objective
We intended to report most common monogenic PADs and to investigate how PAD patients who were primarily diagnosed as agammaglobulinemia, hyper IgM syndrome (HIgM) and common variable immunodeficiency (CVID) have different clinical and immunological findings.
Methods
Stepwise next generation sequencing and Sanger sequencing were performed for confirmation of the mutations in the patients clinically diagnosed as agammaglobulinemia, HIgM and CVID.
Results
Among 550 registered patients, the predominant genetic defects associated with agammaglobulinemia (48 BTK and 6 μ heavy chain deficiencies), HIgM (21 CD40L and 7 AID deficiencies) and CVID (17 LRBA deficiency and 12 atypical ICF syndromes) were identified. Clinical disease severity was significantly higher in patients with μ heavy chain and CD40L compared to patients with BTK (P = 0.003) and AICDA (P = 0.009) mutations. Paralysis following live polio vaccination was considerably higher in patients with μ heavy chain deficiency compared with BTK deficiency (P <0.001). We found a genotype–phenotype correlation among patients with BTK mutations regarding clinical manifestation of meningitis and chronic diarrhea. Surprisingly, we noticed that first presentations in the majority of ICF patients were respiratory complications (P = 0.008), while first presentations in LRBA patients were non-respiratory complications (P = 0.008).
Conclusion
This study highlights similarities and differences in clinical and genetic spectrum of the most common PAD-associated gene defects. This comprehensive comparison will facilitate clinical decision making, and improve prognosis and targeted treatment.
Facial Reanimation Procedures Performed With Total Parotidectomy and Facial Nerve Sacrifice
This cross-sectional database analysis assesses the incidence and types of facial nerve reanimation performed concurrently with total parotidectomy and facial nerve sacrifice among patients identified in the American College of Surgeons–National Surgical Quality Improvement Project database.
Nuances of the Tongue-in-Groove Technique for Controlling Tip Projection and Rotation
This Surgical Pearl presents the tongue-in-groove technique in rhinoplasty surgery for controlling tip projection and rotation.
The Incisionless Otoplasty Technique
This Surgical Pearl describes a technique for performing an incisionless otoplasty to reduce ear prominence.
A Decade of Thread-Lifting—What Have We Learned Over the Last 10 Years?
This Viewpoint evaluates the use of the thread-lifting technique for face-lifts in the 10 years since its introduction.
Local Anesthesia Shortages—Adapting to a New Way of Life
To the Editor Over the past several months, there have been increasing numbers of medication shortages throughout North America, exacerbated (but not solely caused) by Hurricane Maria's effect on the pharmaceutical manufacturing industry on the island of Puerto Rico. Medication shortages are affecting health care facilities in new ways on a weekly basis without imminent solutions. In particular, within the field of facial plastic and reconstructive surgery, we have noted a shortage in formulations of lidocaine and bupivacaine. We have received various sizes of bottles of these anesthetics in varying concentrations with varying concentrations of epinephrine, further complicating our "typical" anesthesia protocol. Our clinic's typical anesthesia was a 1:1 mixture of lidocaine, 1%, with a dilutional ratio of 1:100 000 and bupivacaine, 0.5%, with a dilutional ratio of 1:200 000.
Autologous Fat Transfer in Facial Reconstructive Surgery
This systematic review and meta-analysis investigates the safety and efficacy of autologous fat transfer in facial reconstruction.
Preoperative Photographing and Morphing for Predictable Profiles in Rhinoplasty
This Surgical Pearl discusses preoperative photographing and morphing for predictable profiles in rhinoplasty.
Association of Dorsal Reduction and Tip Rotation With Social Perception
This survey study examines social perceptions of age, approachability, perceived success, overall health, intelligence, and attractiveness of people who have undergone cosmetic rhinoplasty for dorsal hump reduction, tip rotation, or both in combination.
Lateral Wall Insufficiency Severity and Patient-Reported Nasal Obstruction Measures
This cohort study examines differences in lateral wall insufficiency severity in patients seen in consultation for functional, cosmetic, and combined rhinoplasty.
Volumizing Hyaluronic Acid Filler for Infraorbital Hollows
This observational study reports safety and patient satisfaction outcomes of Juvéderm Voluma XC hyaluronic acid filler for correction of infraorbital hollows.
Perceived Facial Distortions in Selfies Are Explained by Viewing Habits—Reply
In Reply Drs Cooper and Banks raise an important, well-studied point: the human visual system can correctly convert from a 2-dimensional image (or a 2-dimensional projection on the retina) into 3 dimensions when the objects subtend the same angle and distance at initial capture and when subsequently viewed. In real life, this is almost instantaneous. The moment we see an individual in front of us, we perceive them and there is essentially no chance of there being a mismatch and the correct viewing angle/distance is a moot point. Interestingly, this phenomenon is mostly studied in controlled environments (eg, using a bite bar) and for specific tasks (eg, estimating angles between planes). As far as we know, it has never been studied for the specific task of evaluating the appearance of one's nose. As the authors of the Letter to the Editor have rightfully noted, if the viewing distance is too close then there is a mismatch between the "correct" and actual viewing distances. As our Discussion stated, "photographs taken at shorter distances will increase the perceived ratio of nasal breadth to bizygomatic breadth." The focus here is on this perceived distortion.
A 3-Dimensional–Printed Short-Segment Template Prototype for Mandibular Fracture Repair
This feasibility study explores the potential application of a 3-dimensional–printed short-segment mandibular template in the management of complex mandibular fractures.
Diagnostic and Therapeutic Management of Nasal Airway Obstruction
This review summarizes advances in diagnosis and treatment of patients with nasal airway obstruction as reported in studies published within the past 5 years.
Outcomes From Lateral Eyelid Coupling for Facial Paralysis Using Modified Tarsoconjunctival Flap
This cohort study assesses whether lateral eyelid coupling in patients with facial paralysis improves quality of life as measured by the Facial Clinimetric Evaluation scale and Moe Ectropion Grading Scale.
A Scarless Repair Technique for the Lower Lip in Patients With Facial Palsy
This Surgical Pearl describes the vermilion-mucosal advancement flap, a technique that provides the benefits of surgery without the stigma of a surgical facial scar.
Temporal Hollowing Augmentation by Targeted Fat-Grafting Technique in Chinese Adults
This cohort study evaluates the safety and efficacy of the targeted fat-grafting technique for temporal hollowing augmentation of the face in Chinese adults.
Slow-Growing Giant Disfiguring Mass on the Left Side of the Face
A woman presented for evaluation of a disfiguring facial mass on the left side of her face; the mass had started as a 1-cm subcutaneous nodule on her left upper eyelid at birth and gradually grew to more than 94 cm in length. What is your diagnosis?
Treatment of Frontal Secondary Headache Attributed to Nerve Entrapment
This cohort study compares treatment outcomes of oral medication, botulinum toxin type A injections, and endoscopic decompression surgery in patients with frontal secondary headache attributed to supratrochlear nerve and supraorbital nerve entrapment.
Zygomaticomaxillary Complex–Orbit Fracture Alignment—Buccal vs Orbital Approach Techniques
This study proposes the use of a sublabial incision without a lower eyelid incision to address zygomaticomaxillary complex fractures involving the orbital rim.
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A Case of Diprosopus Tetraophthalmos: Ocular Findings and Surgical Treatment of Exposure KeratopathyDiprosopus is a rare variation of conjoined twinning. In this report, ophthalmic findings in an infant with diprosopus tetraophthalmos are p...
