Publication date: Available online 21 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Madeleine M. Blank, Lilian Chen, Marianna Papageorge, Daniel Driscoll, Roger Graham, Abhishek Chatterjee
BackgroundCost-analysis research can influence healthcare policies and practices. There is inherent bias depending on the chosen cost perspective (hospital, third-party payer, societal), and conclusions can change based on the perspective used. These perspectives may or may not be well declared or justified when performing cost analysis research. The goal of this study was to perform a literature review of cost-analysis research in the Plastic Surgery literature to determine the prevalence of studies declaring and justifying their perspective, and to inform the reader on why such declarations are important in understanding potential bias.MethodsA systematic review was completed to retrieve cost-utility and cost-effectiveness research within the scope of Plastic Surgery. The search was limited to English-language studies in North America and Europe published between 2006 and 2016. Articles were selected using predefined data fields and specific inclusion criteria.ResultsA total of 2304 abstracts were identified, of which 47 met inclusion criteria. Seventy-two percent of studies (n=34) declared a cost perspective. Of the studies that identified a cost perspective, 32% incorrectly identified the cost perspective. Only 49% of all studies (n=23) both accurately declared and justified their chosen perspective.ConclusionsOnly half of studies correctly declare their cost perspective and justify why the perspective was chosen. Not doing so potentially hides bias from the reader. Future efforts when performing cost-analysis studies should require a clear declaration and justification of the cost perspective taken. A table of our recommendations for reporting cost perspective is provided.
Πέμπτη 21 Δεκεμβρίου 2017
The underreporting of cost perspective in cost-analysis research: a systematic review of the plastic surgery literature
Comparative toxicity of azo dyes to two infaunal organisms ( Hexagenia spp. and Tubifex tubifex ) in spiked-sediment exposures
Abstract
Azo dyes are synthetic compounds used as industrial colorants, and some are predicted to be inherently toxic, bioaccumulative, and/or persistent based upon their chemical composition. This study addresses data gaps in current research which include the need to evaluate the toxicity of hydrophobic azo dyes to benthic invertebrates. The toxicity of a solvent dye, Sudan Red G (SRG), and two disperse dyes, Disperse Yellow 7 (DY7) and Disperse Orange 13 (DO13), to Hexagenia spp. and Tubifex tubifex was assessed in spiked-sediment exposures. The dye compounds appeared to degrade readily in the equilibrium and exposure periods, suggesting a limited persistence of the parent compounds in the environment under test conditions. Although azo dye degradation products could not be reliably quantified, one was detected in DY7 sediment samples that elicited toxic effects to Hexagenia and Tubifex, providing evidence that DY7 degrades. Hexagenia survival and growth endpoints responded with similar sensitivity to the dyes, but DY7 was the most toxic, with a 21-day IC25 (concentration associated with 25% inhibition) for growth of 9.6 μg/g. Comparatively, Tubifex reproduction was the most sensitive endpoint for all dyes with 28-day IC25s for young production ranging from 1.3 to 11.8 μg/g. At sublethal concentrations, toxic effects to Tubifex differed between dyes: the solvent dye exerted an effect primarily on gametogenesis (cocoon production), while disperse dyes, most notably DY7, caused effects on embryogenesis (development of worm inside the cocoon). This study indicates that there could be potential hazard to oligochaetes based on the observed effect concentrations, but given the lack of environmental measurements, the risk of these compounds is unknown. Further research is required to determine if degradation products were formed in all dye samples and whether toxicity was caused by the parent molecules, which have limited persistence under test conditions, or by their degradation products. To avoid underestimating toxicity, this study stresses the need to use an infaunal deposit feeder such as the oligochaete Tubifex in sediment toxicity assessments where highly hydrophobic compounds are present.
Heavy metal contamination in the muscle of Aegean chub ( Squalius Fellowesii ) and potential risk assessment
Abstract
Especially after the industrial revolution, the amount of contaminants released in aquatic ecosystems has considerably increased. For this reason, the necessity to carry on research on the existence of contaminants, specifically heavy metals, has emerged. In this study, heavy metal concentrations in muscle tissues of Aegean chub, which was an endemic species of south western part of Turkey, gathered from Tersakan River were examined. Heavy metal concentrations of the samples were analyzed with ICP-MS. Estimated daily intakes (EDI), target hazard quotient (THQ), and carcinogenic risk (CR) of elements were calculated. The heavy metals detected in muscle tissues were Zn > Cu > Cr > Mn > Pb > Cd, consecutively. According to the results of the applied health risk assessment (EDI, THQ and CR) for heavy metal exposure from fish consumption in children and adults, it was determined that there was no any significant threat to human health.
Molecular characterization of AmiC, a positive regulator in acetamidase operon of Mycobacterium smegmatis
Abstract
Mycobacterium smegmatis, a rapidly growing non-pathogenic mycobacterium, is currently used as a model organism to study mycobacterial genetics. Acetamidase of M. smegmatis is the highly inducible enzyme of Mycobacteria, which utilizes several amide compounds as sole carbon and nitrogen sources. The acetamidase operon has a complex regulatory mechanism, which involves three regulatory proteins, four promoters, and three operator elements. In our previous study, we showed that over-expression of AmiA leads to a negative regulation of acetamidase by blocking the P2 promoter. In this study, we have identified a new positive regulatory protein, AmiC that interacts with AmiA through protein-protein interaction. Gel mobility shift assay showed that AmiC protein inhibits AmiA from binding to the P2 promoter. Interaction of AmiC with cis-acting elements identified its binding ability to multiple regulatory regions of the operon such as P3, OP3, and P1 promoter/operator. Consequently, the addition of inducer acetamide to AmiC complexe trips the complexes, causing AmiC to appear to be the sensory protein for the amides. Homology modeling and molecular docking studies suggest AmiC as a member of Periplasmic binding proteins, which preferentially bind to the inducers and not to the suppressor. Over-expression of AmiC leads to down-regulation of the negative regulator, amiA, and constitutive up-regulation of acetamidase. Based on these findings, we conclude that AmiC positively regulates the acetamidase operon.
Use of the hCONSORT Criteria as a Reporting Standard for Herbal Interventions for Common Dermatoses - A Systematic Review
Abstract
Background
The use of complementary and alternative medicine (CAM) is increasing in western countries, including in the area of dermatology. However, western healthcare providers have not integrated CAM into regular practice due to a lack of reliable data supporting its use. In order to encourage high quality research related to the use of CAM and specifically herbal interventions, the CONSORT extension criteria on reporting herbal interventions (hCONSORT) were published in 2006.
Objectives
This study aimed to evaluate the adherence of randomized controlled trials investigating herbal interventions for 3 common dermatoses (acne, atopic dermatitis, and psoriasis) to the hCONSORT criteria.
Methods
A comprehensive search of Medline, Embase, and Cochrane library databases was conducted. Randomized control trials published between 2009 and 2014 assessing therapeutic outcomes of plant-based interventions for acne, atopic dermatitis, or psoriasis were included. Investigators determined the number of unique hCONSORT criteria satisfied per report. Analysis of variance was used to examine differences in scores by disease entity.
Results
The vast majority of reviewed studies reported less than 50% of information recommended in the hCONSORT criteria.
Limitations
Limitations include small number of dermatologic conditions examined, exclusion of reports based on language, and lack of assessment of overall adherence to CONSORT criteria
Conclusions
Our data indicates lack of adherence to hCONSORT extension criteria. Adherence to hCONSORT guidelines should be encouraged in order to provide high quality reporting of research on herbal interventions in dermatology. Doing so may ease the integration of CAM into conventional medical practice and provide actionable data to providers.
This article is protected by copyright. All rights reserved.
Percutaneous Purse-String Suture: An Innovative Percutaneous Technique for Inframammary Fold Creation and Improved Breast Projection in Reconstructive Surgery
Progress in surgical strategies for treatment of simple congenital syndactyly: A systematic review
Abstract
Background
Plenty of surgical strategies for treatment of simple syndactyly have been reported in the past decades. We are most interested in what progresses have been made over the recent 10 years. Our aim was to make a summary of the modified techniques that have been described in the last decade.
Methods
We reviewed English articles from PubMed and Chinese articles from CKNI and CQVIP published between January 2007 and December 2016. We limited the inclusion criteria to simple syndactyly and excluded complex, complicated, and syndrome-associated syndactylies.
Results
We identified 1650 articles and selected 94 for inclusion. Almost half of the included papers proposed modified flaps for web reconstruction. In most cases, a zigzag incision and Buck-Gramcko flaps were still the first choice to separate the fused digits and create the nail folds. Several new donor sites were recommended for skin grafts and several substitute biomaterials were introduced to replace skin grafts. External fixator devices were applied in a wider range for desyndactylization. However, it was not considered to be superior to other graft-less strategies. Postoperative complications were discussed in most papers, but an effective strategy to eradicate these is lacking.
Conclusions
With the development of biomaterials and surgeon's experiences, more and more modified techniques have been conceived. However, no specific technique can be announced to be superior to others. Furthermore, more sensitive outcome measures should be established, and relationship between operative procedures and postoperative complications should be further defined.
Level of evidence: not ratable.
Case report of Schöpf–Schulz–Passarge syndrome resulting from a missense mutation, p.Arg104Cys, in WNT10A
Abstract
Schöpf–Schulz–Passarge syndrome (SSPS) is a rare ectodermal dysplasia characterized by cysts of the eyelids, hypodontia, hypotrichosis, palmoplantar keratosis and onychodystrophy, and it is not common in Asia according to the published work. This autosomal recessive disorder was believed to result from mutations in the WNT10A gene. We report a 54-year-old Taiwanese man with SSPS resulted from a homozygous mutation (p.Arg104Cys) in WNT10A. This mutation has not been reported in odonto-onycho-dermal dysplasia but was demonstrated to link with dental abnormalities. This report implies the significance of WNT10A gene mutation in ectodermal dysplasia and highlights the clinical features of SSPS.
Neutrophilic urticarial dermatosis: a novel association with poststreptococcal rheumatic disease
Summary
Neutrophilic urticarial dermatosis (NUD), a particular clinical and histological entity, can provide a strong pointer to underlying systemic disease, most frequently rheumatological diseases. We report the first case of NUD in association with a post-streptococcal rheumatic disease, with symptoms including recurrent sore throat, raised antistreptolysin O titre, persistent transient urticaria, polyarthralgia, rheumatic mitral valve disease and Jaccoud arthropathy. Histologically, NUD is characterized by an intense superficial and deep neutrophilic interstitial and perivascular infiltrate, without significant oedema or blood vessel damage. These neutrophils may have a tendency to concentrate along the basement membrane and extend into the epidermis, hair follicles, sebaceous glands and sweat glands (a feature termed 'neutrophilic epitheliotropism'). Clinicians should remain cognizant of NUD, and in particular its frequent association with an underlying inflammatory disorder.
Rational ideation and empiric validation of an innovative digital dermographic tester
Summary
Background
Dermographism is a condition characterized by a weal response to a combination of pressure and traction on skin surface, and its diagnosis is based on medical history, clinical criteria and provocation test. The Dermographic Tester®, a pen-sized tool containing a spring-loaded blunt tip, is the most widely used instrument for the provocation test, and it exerts increasing pressures on the skin surface according to an arbitrary units (AU) scale. Analysing the mechanism of function and trying to convert the AUs to SI units (g/mm2), we found that this instrument had some defects and limits that would compromise a true and repeatable quantification of the weal response threshold. Consequently, we decided to develop a new instrument, the Digital Dermographic Tester (DDT), which is engineered with an inside force sensor to implement features lacking in the current tools, in the hope of enhancing the precision of the provocation test.
Aim
To validate the effectiveness and accuracy of the DDT.
Methods
We tested the DDT on 213 participants purposely sampled to obtain three groups, each with a different pattern of reaction to mechanical stimuli. Based on anamnestic, diagnostic and symptomatic criteria, patients were divided into dermographic urticaria (DU), spontaneous urticaria (SU) and healthy control (HC) groups. The DDT was used to apply 12 levels of pressure to the skin surface, and a frequency distribution of positive reactions was displayed for each group.
Results
A force of 36–40 g/mm2 appropriately differentiated physiological from pathological conditions with high sensitivity and specificity.
Conclusions
The DDT was found to be capable of differentiating patients with DU patients from those with SU and from HCs, and was able to precisely identify the weal elicitation threshold.
Biorational substitution of piperonyl butoxide in organic production: effectiveness of vegetable oils as synergists for pyrethrums
Abstract
Piperonyl butoxide is a semi-synthetic synergist for natural pyrethrum and synthetic pyrethroid insecticides in phytochemicals and biocides. As such it is used in large quantities for crop treatments, stored grain protection, disinfestation of grain storage facilities and indoor uses. Piperonyl butoxide is consequently a regular contaminant in stored grains, and subsequently in corresponding cereal food products and meat via feed uses. Therefore it is regularly monitored and its MRL is ongoing a reassessment. It is also considered as a possible human carcinogen and a suspected endocrine disruptor. For all these reasons and considerations most of the countries have already banned its use in Organic Farming as France in 2017. Thus, ecological substitution of with biorational and sustainable solutions is required. Vegetable oils have been described as exhibiting similar potency and synergistic effects. We have reviewed the literature and have proceeded to ecotoxicological efficacy tests in order to determine the best and most durable substitution candidates. Sesame and rape seed oil were determined to be the most efficient.
Impacts of biofouling on the removal of pharmaceutically active compounds by a nanofiltration membrane
Abstract
The impacts of biofouling on the retention of pharmaceutically active compounds (PhACs) by a commercially available nanofiltration membrane (NF 270) were systematically studied. Biofouling was achieved through inoculating live and dead Pseudomonas aeruginosa into artificial wastewater. In comparison to a clean membrane, an increase in PhAC rejection during biofouling with live cells was observed. However, the rejection behaviors presented more complex changes during biofouling with dead cells: PhAC rejection was below the clean membrane in the early biofouling stage; however, in the later stage, PhAC rejection was above the clean membrane. In addition, PhAC rejection behaviors present the similar tendency as salt rejection under both biofouling conditions. In addition, solute rejections were much lower for biofouling with dead cells than those for biofouling with live cells. Combined with biofilm characterization under both biofouling conditions, we could conclude that biofilm enhanced osmotic pressure (BEOP) due to higher cell counts and biofilm thickness led to a decrease in PhAC retention, especially for the dead cells. In addition, more dominant steric exclusion in the later stage of biofouling due to higher extracellular polymeric substances (EPS) concentration on the membrane surface resulted in an increase in PhAC retention.
Compound washing remediation and response surface analysis of lead-contaminated soil in mining area by fermentation broth and saponin
Abstract
The development of eluent is the key to soil washing remediation, and a compound eluent was constructed using the prepared citric acid fermentation broth and saponin in this study. It displayed a good washing performance for Pb, Cu, Cr, and Cd in red soil, and the removal rates, especially Pb, gained an improvement compared with a single eluent. Based on this, the compound eluent was applied to remediation of Pb-contaminated soil in mining area; the desorption of Pb is a heterogeneous diffusion process, and Pb in large particle size soil is relatively easy to remove. An available response surface analysis model was established; its P < 0.0001 is very significant, and the P of the missing item is 0.1152. The degree of influence of three significant factors on removal of Pb is liquid-to-solid ratio > washing time > saponin concentration, and liquid-to-solid ratio and washing time show interaction. Moreover, the Pb removal rate can reach 56.20% under the optimized conditions: 0.25% saponin concentration, 20 mL/g liquid-to-solid ratio, and 320-min washing time, which is close to the predicted value of 56.20% with a difference of 1.41%. In addition, most of the active Pb was removed and environmental risks were lowered after washing.
Spatiotemporal characteristics of aerosols and their trends over mainland China with the recent Collection 6 MODIS and OMI satellite datasets
Abstract
With the rapid development of China's economy and high rate of industrialization, environmental pollution has become a major challenge for the country. The present study is aimed at analyzing spatiotemporal heterogeneities and changes in trends of different aerosol optical properties observed over China. To achieve this, Collection 6 Level 3 data retrieved from the Moderate Resolution Imaging Spectroradiometer (MODIS; 2002–2016) and Ozone Monitoring Instrument (OMI; 2005–2016) sensors were used to investigate aerosol optical depth (AOD550), Ångstrӧm exponent (AE470–660), and Absorption Aerosol Index (AAI). The spatial distribution of annual mean AOD550 was noticed to be high over economically and industrialized regions of the east, south, and northeast of China, while low aerosol loadings were located over rural and less-developed areas of the west and northeast of China. High AE470–660 (> 1.0) values were characterized by the abundance of fine-mode particles and vice versa, likely attributed to large anthropogenic activities. Similarly, high AOD with corresponding high AE and low AAI was characterized over the urban-industrialized regions of the central, east, and south of China during most of the months, being more pronounced in June and July. On seasonal scale, AOD values were found to be high during spring, followed by the summer and autumn, and low during the winter season. It is also evident that all aerosol parameters showed a single-peak frequency distribution in all seasons over entire China. Further, the annual, monthly, and seasonal spatial trends revealed a decreasing trend in AOD over most regions of China, except in the southwest of China, which showed a positive increasing trend. Significant increasing trends were noted in AAI for all the seasons, particularly during autumn and winter, resulting in a large amount of the absorbing type of aerosols produced from biomass burning and desert dust.
Environmental assessment in health care organizations
Abstract
The aim of this research is to design a multi-criteria model for environmental assessment of health care organizations. This is a model which guarantees the objectivity of the results obtained, is easy to apply, and incorporates a series of criteria, and their corresponding descriptors, relevant to the internal environmental auditing processes of the hospital. Furthermore, judgments were given by three experts from the areas of health, the environment, and multi-criteria decision techniques. From the values assigned, geometric means were calculated, giving weightings for the criteria of the model. This innovative model is intended for application within a continuous improvement process. A practical case from a Spanish hospital is included at the end. Information contained in the sustainability report provided the data needed to apply the model. The example contains all the criteria previously defined in the model. The results obtained show that the best-satisfied criteria are those related to energy consumption, generation of hazardous waste, legal matters, environmental sensitivity of staff, patients and others, and the environmental management of suppliers. On the other hand, those areas returning poor results are control of atmospheric emissions, increase in consumption of renewable energies, and the logistics of waste produced. It is recommended that steps be taken to correct these deficiencies, thus leading to an acceptable increase in the sustainability of the hospital.
Characterization and 2D structural model of corn straw and poplar leaf biochars
Abstract
The integrated experimental methods were used to analyze the physicochemical properties and structural characteristics and to build the 2D structural model of two kinds of biochars. Corn straw and poplar leaf biochars were gained by pyrolysing the raw materials slowly in a furnace at 300, 500, and 700 °C under oxygen-deficient conditions. Scanning electron microscope was applied to observe the surface morphology of the biochars. High temperatures destroyed the pore structures of the biochars, forming a particle mixture of varying sizes. The ash content, yield, pH, and surface area were also observed to describe the biochars' properties. The yield decreases as the pyrolysis temperature increases. The biochars are neutral to alkaline. The biggest surface area is 251.11 m2/g for 700 °C corn straw biochar. Elemental analysis, infrared microspectroscopy, solid-state C-13 NMR spectroscopy, and pyrolysis gas chromatography-mass spectrometry (Py-GC-MS) were also used to study the structural characteristics and build the 2D structural models of biochars. The C content in the corn straw and poplar leaf biochars increases with the increase of the pyrolysis temperature. A higher pyrolysis temperature makes the aryl carbon increase, and C=O, OH, and aliphatic hydrocarbon content decrease in the IR spectra. Solid-state C-13 NMR spectra show that a higher pyrolysis temperature makes the alkyl carbon and alkoxy carbon decrease and the aryl carbon increase. The results of IR microspectra and solid-state C-13 NMR spectra reveal that some noticeable differences exist in these two kinds of biochars and in the same type of biochar but under different pyrolysis temperatures. The conceptual elemental compositions of 500 °C corn straw and poplar leaf biochars are C61H33NO13 and C59H41N3O12, respectively. Significant differences exist in the SEM images, physicochemical properties, and structural characteristics of corn straw and poplar leaf biochars.
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Abstract Objectives To investigate factors related to reasoning skills in 434 school children aged 5–9 years. Methods The Leiter Interna...
