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Παρασκευή 27 Ιουλίου 2018
Microscopic and Macroscopic Fat Embolism (MIFE and MAFE): Solving the puzzle with cases reports .
Introduction: The frequency of fat embolism mortality after liposuction has increased. As the only dependable evidence for this problem is that available in the medical literature, a study of clinical case reports is warranted. Materials and Methods: We reviewed the medical literature by searching for case reports of fat embolism after liposuction in humans who manifested either of the variants of the condition: microscopic fat embolism (MIFE) or macroscopic fat embolism (MAFE). We performed a literature search of the PubMed and PubMed Central (PMC) databases from the first case of fat embolism syndrome associated with liposuction reported until March 2017; keywords FAT EMBOLISM (FAT EMBOLISM SYNDROME), LIPOSUCTION, and CASE (((fat embolism) AND liposuction) AND case) were used. A detailed analysis of the data contained in the clinical case reports was conducted. Results: In total, 39 and 98 articles were found in PubMed and PMC, respectively, using the keywords ((fat+embolism)+AND+liposuction)+AND+case). After analysis, only 15 reports corresponded to cases of MAFE or MIFE after liposuction, and the basic statistics of the two proposed variants were examined. Conclusion: This work provides relevant information regarding very important characteristics of MIFE and MAFE. Despite the diagnostic difficulty, clinical diagnosis remains the gold standard for identifying MIFE and MAFE. The establishment of a rapid and timely diagnosis is of great help for appropriate treatment. Financial Disclosure Statement: The authors have nothing to disclose. No funding was received for this article Corresponding author: Dr. Héctor Durán. Calle 54 Num. 365 Int. 317, Centro Médico de las Américas, Colonia Centro, Mérida Yucatán México, CP 97000, E mail : hcdv@hotmail.com ©2018American Society of Plastic Surgeons
A Critique of the Impact Factor and Ramifications of its Misuse in Plastic and Reconstructive Surgery: The Real Impact of the Impact Factor
The impact factor (IF) is used to compare the number of citations of a journal with its number of publications. Though first used to assess the significance of various journals, its very creator has stated it is an imperfect system. Presently, the IF overvalues the importance of large-readership journals and undervalues that of smaller more specialized journals. While no metric can serve as a perfect assessment of a journal's worth, it is vital when selecting journals for publication, resource allocation, funding, or citation to not only weigh the IF of a large-volume journal, but also the added value of lower IF but also effective specialized subspecialty journals. Financial Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Corresponding Author: Oluwaseun A. Adetayo, MD FACS FAAP, Assistant Professor, Plastic Surgery, Section Chief, Pediatric Plastic Surgery, Director, Cleft-Craniofacial Center, Albany Medical Center & The Bernard & Millie Duker Children's Hospital at Albany Medical Center, 50 New Scotland Avenue, MC- 190, Albany, NY 12208, Phone: (518) 262-2229, Fax: (518) 262-6358, Email: Adetayo.md@gmail.com ©2018American Society of Plastic Surgeons
In Vitro Models for Studying Invasive Transitions of Ductal Carcinoma In Situ
Abstract
About one fourth of all newly identified cases of breast carcinoma are diagnoses of breast ductal carcinoma in situ (DCIS). Since we cannot yet distinguish DCIS cases that would remain indolent from those that may progress to life-threatening invasive ductal carcinoma (IDC), almost all women undergo aggressive treatment. In order to allow for more rational individualized treatment, we and others are developing in vitro models to identify and validate druggable pathways that mediate the transition of DCIS to IDC. These models range from conventional two-dimensional (2D) monolayer cultures on plastic to 3D cultures in natural or synthetic matrices. Some models consist solely of DCIS cells, either cell lines or primary cells. Others are co-cultures that include additional cell types present in the normal or cancerous human breast. The 3D co-culture models more accurately mimic structural and functional changes in breast architecture that accompany the transition of DCIS to IDC. Mechanistic studies of the dynamic and temporal changes associated with this transition are facilitated by adapting the in vitro models to engineered microfluidic platforms. Ultimately, the goal is to create in vitro models that can serve as a reproducible preclinical screen for testing therapeutic strategies that will reduce progression of DCIS to IDC. This review will discuss the in vitro models that are currently available, as well as the progress that has been made using them to understand DCIS pathobiology.
In Vitro Models for Studying Invasive Transitions of Ductal Carcinoma In Situ
Abstract
About one fourth of all newly identified cases of breast carcinoma are diagnoses of breast ductal carcinoma in situ (DCIS). Since we cannot yet distinguish DCIS cases that would remain indolent from those that may progress to life-threatening invasive ductal carcinoma (IDC), almost all women undergo aggressive treatment. In order to allow for more rational individualized treatment, we and others are developing in vitro models to identify and validate druggable pathways that mediate the transition of DCIS to IDC. These models range from conventional two-dimensional (2D) monolayer cultures on plastic to 3D cultures in natural or synthetic matrices. Some models consist solely of DCIS cells, either cell lines or primary cells. Others are co-cultures that include additional cell types present in the normal or cancerous human breast. The 3D co-culture models more accurately mimic structural and functional changes in breast architecture that accompany the transition of DCIS to IDC. Mechanistic studies of the dynamic and temporal changes associated with this transition are facilitated by adapting the in vitro models to engineered microfluidic platforms. Ultimately, the goal is to create in vitro models that can serve as a reproducible preclinical screen for testing therapeutic strategies that will reduce progression of DCIS to IDC. This review will discuss the in vitro models that are currently available, as well as the progress that has been made using them to understand DCIS pathobiology.
Short-Term Birth Sequelae of the 1918–20 Influenza Pandemic in the United States: State-Level Analysis
Abstract
This paper illuminates short-term birth sequelae of the influenza pandemic of 1918–20 in the USA using monthly data on births and all-cause deaths for 19 US states in conjunction with data on maternal deaths, stillbirths, and premature births. The data on births and all-cause deaths are adjusted for seasonal and trend effects, and the residual components of the two time series coinciding with the timing of peak influenza mortality are examined for these sequelae. Notable findings include 1) a drop in births in the three months following peak mortality, 2) a reversion in births to normal levels occurring 5–7 months after peak mortality, and 3) a steep drop in births occurring 9–10 months after peak mortality. Interpreted in the context of parallel data showing elevated premature births, stillbirths, and maternal mortality during times of peak influenza mortality, these findings suggest that the main impacts of the 1918–20 influenza on reproduction occurred through 1) impaired conceptions, possibly due to effects on fertility and behavioral changes, 2) an increase in the preterm delivery rate during the peak of the pandemic, and 3) elevated maternal and fetal mortality, resulting in late-term losses in pregnancy.The Number of Events per Confounder for Valid Estimation of Risk Difference Using Modified Least-Squares Regression
Abstract
Risk difference is a relevant effect measure in epidemiological research. Although it is well known that when there are few events per confounder, logistic regression is not suitable for confounding control, it is not clear how many events per confounder are required for valid estimation of risk difference using linear binomial models. Because the maximum likelihood method has a convergence problem, we investigated the number of events per confounder necessary to validly estimate risk difference using modified least-squares regression in a simulation. We simulated 864 scenarios, according to the number of confounders (2 to 20), the number of events per confounder (2 to 12), marginal risk (0.5% to 40%), exposure proportion (20% and 40%), and 3 sizes of risk difference. Our simulation showed that modified least-squares regression provided unbiased risk difference—regardless of the number of events per confounder—and reliable confidence intervals when more than 5 events were expected in the exposed and in the unexposed, irrespective of the number of events per confounder. We illustrated the modified least-squares regression analysis using perinatal epidemiological data. Modified least-squares regression is considered to be a useful analytical tool for rare binary outcomes relative to the number of confounders.A Prospective Investigation of Dietary Intake and Functional Impairments among the Elderly
Abstract
Limited information is available in Asian populations regarding the association of dietary intake and patterns with age-related functional impairments. Using data from two population-based cohort studies, the Shanghai Women's Health Study (1996-2015) and Shanghai Men's Health Study (2002-2015), we prospectively examined adherence to dietary guidelines, including the Chinese Food Pagoda, the Dietary Approaches to Stop Hypertension and the Alternative Healthy Eating Index, as well as specific food consumption, for their associations with impairment in function, both physical (walking, hearing/vision) and mental (memory, decision-making). Included in the analyses were 30,484 participants who had been followed up for an average of 14.4 years and were between the ages of 70 and 86 at the functional status assessment. Higher dietary recommendation adherence scores were associated with a lower likelihood of developing functional impairments. The odds ratios ranged from 0.61 (95% confidence interval (CI): 0.54, 0.70) to 0.83 (95% CI: 0.72, 0.95) when extreme quintiles were compared. Higher fish, poultry, vegetable and fruit intake, moderate red meat intake, and low rice consumption were associated with a reduced probability of having physical or mental impairments. Our findings highlight the importance of a high quality diet in maintaining functional status among the aged population.Socioeconomic Position and DNA Methylation Age Acceleration across the Lifecourse
Abstract
Accelerated DNA methylation age is linked to all-cause mortality and environmental factors, but studies of associations with socioeconomic position are limited. Studies generally use small selected samples, and it is unclear how findings with two commonly used methylation age calculations (Horvath and Hannum) translate to general population samples including younger and older adults. In 1099 UK adults aged 28-98 y in 2011-12, we assessed the relationship of Horvath and Hannum DNA methylation age acceleration with a range of social position measures: current income and employment, education, income and unemployment across a 12-year period, and childhood social class. Accounting for confounders, participants less advantaged in childhood were epigenetically 'older' as adults: compared to participants with professional/managerial parents, Hannum age was 1.07 years higher (95% confidence interval (CI):0.20-1.94) for those with parents in semi-skilled/unskilled occupations, and 1.85 years higher (95%CI:0.67-3.02) for participants without a working parent at age 14. No other robust associations were seen. Results accord with research implicating early life circumstances as critical for DNA methylation age in adulthood. Since methylation age acceleration as measured by the Horvath and Hannum estimators appears strongly linked to chronological age, research examining associations with the social environment must take steps to avoid age-related confounding.Melanins from two selected isolates of Pseudocercospora griseola grown in-vitro: Chemical features and redox activity
Publication date: Available online 27 July 2018
Source: Journal of Photochemistry and Photobiology B: Biology
Author(s): Alejandra Bárcena, Mariela Bruno, Ana Gennaro, M. Fernanda Rozas, María V. Mirífico, Pedro A. Balatti, Mario C.N. Saparrat
Abstract
Pseudocercospora griseola is the causal agent of Angular Leaf Spot (ALS), a disease of common bean. Due to its coevolution with beans, two major groups have been defined, "Andean" (P. griseola f. griseola) and "Mesoamerican" (P. griseola f. mesoamericana). The aim of this study was to characterize the dark pigment, melanin, synthetized by a selected isolate of each genic group of P. griseola when grown on Potato-dextrose broth. P. griseola f. griseola isolate S3b and P. griseola f. mesoamericana T4 produced 1.7 ± 0.6 and 4.1 ± 0.9 mg of melanin per g of dry biomass, respectively. Although both melanins possessed similar UV–visible absorption spectroscopic pattern, P. griseola f. mesoamericana T4 melanin had a lower UV–visible absorption, higher reducing activity and metal chelating ability than melanin from P. griseola f. griseola isolate S3b. However, when the size of the sample was 10 mg S3b melanin had a higher content of free phenolic groups. Furthermore, cell wall polysaccharides modified in melanin the availability of active phenolic groups, which was dependent on the fungal isolate and the size of the sample. Therefore, the amount and chemical features of melanin as well as its deposition in mycelium walls within isolates is different, which might explain the different pigmentation and physiological behaviours of these representatives of the two groups of Pseudocercospora griseola.
In vitro mitochondria-mediated anticancer and antiproliferative effects of Annona glabra leaf extract against human leukemia cells
Publication date: Available online 27 July 2018
Source: Journal of Photochemistry and Photobiology B: Biology
Author(s): Ying Liu, Donghai Liu, Wuqing Wan, Hong Zhang
Abstract
We investigated the in vitro mitochondria-mediated anticancer and antiproliferative effects of extracts of Annona glabra leafs on human leukemia cells. A. glabra is a tropical tree that exhibits several clinical and pharmacological properties in humans and is effective against cancer. We investigated the antiproliferative effects of an alcoholic extract of A. glabra on MC-1010 human monocytic leukemia cells (crl-12253) based on phytochemical analyses, cell viability, free radical scavenging activity, intracellular reactive oxygen species (ROS) levels, ATP content, mitochondrial fragmentation, and cell migration assays. The results indicated the presence of flavonoids, terpenoids, glycosides, steroids, saponins, tannins, anthraquinones, and acidic compounds in extracts. Leukemia cell viability was reduced up to 28% after incubation with the extract, while the free radical reducing power and scavenging activity were significantly increased. Higher concentrations of extract significantly inhibited leukemia cell colony formation. ROS increased up to 66% following incubation with extract, while the ATP content decreased up to 31%. Condensed, fragmented, and clumped mitochondria were observed in treated cells. In flow cytometric analyses, 10.7% and 22.4% of cells were apoptotic following incubation with 80 and 100 μg/mL extract, respectively. Moreover, treated leukemia cells exhibited reduced migratory potential. Overall, the results suggest that leaf extracts of A. glabra may act as potential anticancer agents against human leukemia cells.
Comparison of two functionalized fullerenes for antimicrobial photodynamic inactivation: Potentiation by potassium iodide and photochemical mechanisms
Publication date: Available online 27 July 2018
Source: Journal of Photochemistry and Photobiology B: Biology
Author(s): Liyi Huang, Brijesh Bhayana, Weijun Xuan, Richard P. Sanchez, Billy J. McCulloch, Sanjiv Lalwani, Michael R. Hamblin
Abstract
A new fullerene (BB4-PPBA) functionalized with a tertiary amine and carboxylic acid was prepared and compared with BB4 (cationic quaternary group) for antimicrobial photodynamic inactivation (aPDI). BB4 was highly active against Gram-positive methicillin resistant Staphylococcus aureus (MRSA) and BB4-PPBA was moderately active when activated by blue light. Neither compound showed much activity against Gram-negative Escherichia coli or fungus Candida albicans. Therefore, we examined potentiation by addition of potassium iodide. Both compounds were highly potentiated by KI (1–6 extra logs of killing). BB4-PPBA was potentiated more than BB4 against MRSA and E. coli, while for C. albicans the reverse was the case. Addition of azide potentiated aPDI mediated by BB4 against MRSA, but abolished the potentiation caused by KI with both compounds. The killing ability after light decayed after 24 h in the case of BB4, implying a contribution from hypoiodite as well as free iodine. Tyrosine was readily iodinated with BB4-PPBA plus KI, but less so with BB4. We conclude that the photochemical mechanisms of these two fullerenes are different. BB4-PPBA is more Type 2 (singlet oxygen) while BB4 is more Type 1 (electron transfer). There is also a possibility of direct bacterial killing by electron transfer, but this will require more study to prove.
In vitro antidermatophytic activity and cytotoxicity of extracts derived from medicinal plants and marine algae
Publication date: Available online 27 July 2018
Source: Journal de Mycologie Médicale
Author(s): N.W. Sit, Y.S. Chan, S.C. Lai, L.N. Lim, G.T. Looi, P.L. Tay, Y.T. Tee, Y.Y. Woon, K.S. Khoo, H.C. Ong
Abstract
Objectives
This study was conducted to evaluate the antidermatophytic activity of 48 extracts obtained from medicinal plants (Cibotium barometz, Melastoma malabathricum, Meuhlenbeckia platyclada, Rhapis excelsa, Syzygium myrtifolium, Vernonia amygdalina) and marine algae (Caulerpa sertularioides, Kappaphycus alvarezii) against Trichophyton rubrum and Trichophyton interdigitale (ATCC reference strains), and the cytotoxicity using African monkey kidney epithelial (Vero) cells. Active plant extracts were screened for the presence of phytochemicals and tested against clinical isolates of Trichophyton tonsurans.
Methods
Six different extracts (hexane, chloroform, ethyl acetate, ethanol, methanol and water) were obtained from each plant or algae sample using sequential solvent extraction. The antidermatophytic activity for the extracts was assessed using a colourimetric broth microdilution method. The viability of Vero cells was measured by Neutral Red uptake assay.
Results
All the extracts (except the water extracts of V. amygdalina, C. sertularioides and K. alvarezii) showed antidermatophytic activity against Trichophyton spp. The minimum fungicidal concentration (MFC) ranges for the plant extracts against T. rubrum and T. interdigitale are 0.0025–2.50 and 0.005–2.50 mg/mL, respectively. The algae extracts exhibited lower potency against both species, showing MFC ranges of 0.08–2.50 and 0.31–2.50 mg/mL, respectively. The ethanol and methanol extracts from the leaves of R. excelsa, and the methanol and water extracts from the leaves of S. myrtifolium were highly active (MFC < 0.1 mg/mL) and with high selectivity indices (SI > 2.8) against reference strains of T. rubrum and T. interdigitale, and most of the clinical isolates of T. tonsurans. Phytochemical analysis indicates the presence of alkaloids, anthraquinones, flavonoids, saponins, tannins, phenolics and triterpenoids in the extracts.
Conclusions
The medicinal plant extracts exhibited stronger antidermatophytic activity compared to the algae extracts. The leaves of R. excelsa and S. myrtifolium are potential sources of new antidermatophytic agents against Trichophyton spp.
The Effect of Mass Evacuation on Infant Feeding: The Case of the 2016 Fort McMurray Wildfire
Abstract
Objectives We examine the ways in which the 2016 Fort McMurray wildfire evacuation affected infant feeding. Our primary objective is to understand the decisions and perceptions of primary caregivers of children age 0–36 months who evacuated from Fort McMurray, Canada. Methods We used a mixed methods approach to assess the overall impact that the evacuation had on infant feeding. Specific outcome variables for the quantitative research are: decision-making, access to support and resources, and changes in routine. Participants were recruited using a purposive sampling technique through infant feeding in emergency support groups on social media in which members were primarily evacuees from the Fort McMurray wildfire. Loglinear results include a model of feeding methods before and after the wildfire evacuation. Results Content analyses results from qualitative data support findings from the loglinear model. Specifically, the findings suggest that the evacuation was associated with a reduction in breastfeeding and an increase in use of infant formula The open-ended data revealed that caregivers experienced stress during and after the evacuation due to moving from place to place, food insecurity associated with artificial feeding, warding off unhealthy food for older children, and managing family reunification. In addition, respondents reported that breastfeeding was a source of comfort for infants and contributed to a sense of empowerment. Conclusions for Practice This study sets forth important groundwork for understanding decision-making, stress, logistics, and social factors that influence infant feeding in a large-scale evacuation event. Emergency management, health workers, and nutrition experts can provide support to families in disasters to mitigate some of the adverse impacts the evacuation may have on infant feeding.
Inner posture as aspect of global meaning in healthcare: a conceptual analysis
Abstract
Based on our empirical research on global meaning in people with spinal cord injury and people with stroke, we formulated 'inner posture' as a concept in rehabilitation. Inner posture, as we concluded from our empirical data, refers to the way in which people bear what cannot be changed. It helps them to live with their injury. Considering that much has already been written about meaning from a variety of disciplines, the question arises whether the concept of inner posture adds something new to the existing literature, or is just another name for a phenomenon that has already been described before in different terms. In this paper, we aim to investigate this and to clarify our conceptualization, by comparing the concept of inner posture with influential concepts in healthcare literature which seem to be more or less related. In the work of Puchalski regarding spirituality, Pargament regarding religion, Eliott regarding hope and Frankl regarding attitude, we found definitions and descriptions that seemed to come close to the phenomenon we refer to as inner posture. Because these concepts have various theoretical backgrounds, the comparison can help to better understand our concept of inner posture, through a process of dialogue between traditions, following Gadamer's notion of dialogue as fusion of horizons of understanding. We conclude that inner posture differs from the other concepts in several ways. Some of these differences are more fundamental, other are partial. This suggests that we identified a new perspective on a phenomenon partially described earlier. The comparison also inspired us to slightly adjust our definition and to formulate new research questions.
Headache in transient ischemic attacks
Headache is a common feature in acute cerebrovascular disease but no studies have evaluated the prevalence of specific headache types in patients with transient ischemic attacks (TIA). The purpose of the prese...
A mixed-reality surgical trainer with comprehensive sensing for fetal laser minimally invasive surgery
Abstract
Purpose
Smaller incisions and reduced surgical trauma made minimally invasive surgery (MIS) grow in popularity even though long training is required to master the instrument manipulation constraints. While numerous training systems have been developed in the past, very few of them tackled fetal surgery and more specifically the treatment of twin-twin transfusion syndrome (TTTS). To address this lack of training resources, this paper presents a novel mixed-reality surgical trainer equipped with comprehensive sensing for TTTS procedures. The proposed trainer combines the benefits of box trainer technology and virtual reality systems. Face and content validation studies are presented and a use-case highlights the benefits of having embedded sensors.
Methods
Face and content validity of the developed setup was assessed by asking surgeons from the field of fetal MIS to accomplish specific tasks on the trainer. A small use-case investigates whether the trainer sensors are able to distinguish between an easy and difficult scenario.
Results
The trainer was deemed sufficiently realistic and its proposed tasks relevant for practicing the required motor skills. The use-case demonstrated that the motion and force sensing capabilities of the trainer were able to analyze surgical skill.
Conclusion
The developed trainer for fetal laser surgery was validated by surgeons from a specialized center in fetal medicine. Further similar investigations in other centers are of interest, as well as quality improvements which will allow to increase the difficulty of the trainer. The comprehensive sensing appeared to be capable of objectively assessing skill.
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