This paper analyses the volume-outcome relationship and the effects of minimum volume regulations in the German hospital sector.
Τετάρτη 26 Σεπτεμβρίου 2018
Volume-outcome relationship and minimum volume regulations in the German hospital sector – evidence from nationwide administrative hospital data for the years 2005–2007
Development of intraoperative plantar pressure measuring system considering weight bearing axis
Abstract
Purpose
Surgical reconstructions in three dimensions are needed for treatment of foot and ankle deformities. However, surgical results might be influenced by the skill and experience of doctors which complement the limited information for reconstructions in three dimensions. To solve these, studies were carried out to measure plantar pressure distribution during surgery. Though, it was impossible to accurately measure plantar pressure distribution accurately during operation. Therefore, we proposed an intraoperative plantar pressure measurement (IPPM) device that enables proper navigation in the push direction.
Methods
For this purpose, first, we investigated how the physiological load axis passes through the human body to identify the pushing direction of the pressure sensor of the device toward the patient's foot. In particular, we hypothesized that the physiological load axis passes through the femoral head center and we evaluated this in a measurement experiment with nine healthy subjects. Second, based on these results, we developed the IPPM device that has two force sensors to identify the pushing direction toward the femoral head center and a conductive ink sensor to measure plantar pressure distribution. Finally, we conducted the experiments with nine healthy subjects and two users.
Results
From the first experimental results, the physiological load axis was found to pass through the femoral head center in normal standing posture. From the evaluation experiment, there are no significant differences statistically in plantar pressure distributions between the conditions of using IPPM device and without using it for both a medical student and a surgeon. However, in some cases the plantar pressure distribution can be reproduced similarly to that of the standing posture, and also from the evaluation experiment concerning the relation between CoP position and NCC, the NCC tends to increase when the position of the CoP is closer to that at the standing posture.
Conclusion
The IPPM device has possibility to reproduce the plantar pressure distribution during surgery and prevent the recurrence of surgical complications.
Low-dose blue light irradiation enhances the antimicrobial activities of curcumin against Propionibacterium acnes
Publication date: Available online 26 September 2018
Source: Journal of Photochemistry and Photobiology B: Biology
Author(s): Ming-Yeh Yang, Kai-Chih Chang, Liang-Yü Chen, Anren Hu
Abstract
Propionibacterium acnes (P. acnes) is an opportunistic infection in human skin that causes acne vulgaris. Antibiotic agents provide the effective eradication of microbes until the development of drug-resistant microbes. Photodynamic inactivation (PDI) is a non-antibiotic therapy for microbial eradication. In this study, the visible blue light (BL, λmax = 462 nm) was used to enhance the antimicrobial activities of curcumin, a natural phenolic compound. Individual exposure to curcumin or BL irradiation does not generate cytotoxicity on P. acnes. The viability of P. acnes was decreased significantly in 0.09 J/cm2 BL with 1.52 μM of curcumin. Furthermore, the low-dose blue light irradiation triggers a series of cytotoxic actions of curcumin on P. acnes. The lethal factors of photolytic curcumin were investigated based on the morphology of P. acnes by SEM and fluorescent images. The membrane disruption of microbes was observed on the PDI against P. acnes. Chromatography and mass spectrometry techniques were also used to identify the photolytic metabolites. Curcumin could be photolysed into vanillin through BL irradiation, which presents a strong linear relationship in quantitation. Because the safety of blue light in mammalian cell has been proven, the photolytic curcumin treatment could support non-antibiotic therapy to eradicate P. acnes on clinical dermatology.
Graphical abstract
Intérêt du dosage de la calprotectine fécale au cours des panniculites chroniques d’étiologie indéterminée
Publication date: Available online 25 September 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): K. Kaddour, J. Lemasson, B. Haettich-Pialoux, N. Guedj, N. Belmatoug, X. Treton, H. Becheur, B. Fantin, V. Descamps, P. Le Bozec
Vehiculización de fármacos asistida por láser
Publication date: Available online 25 September 2018
Source: Actas Dermo-Sifiliográficas
Author(s): A. Alegre-Sánchez, N. Jiménez-Gómez, P. Boixeda
Resumen
La absorción de productos tópicos a través de la epidermis está limitada por la función de barrera cutánea. Existen distintas técnicas, tales como el microneedling, la dermoabrasión, la radiofrecuencia o los láseres, que se han empleado para aumentar la absorción de estas sustancias en una estrategia conocida como vehiculización transdérmica de fármacos. Entre estas técnicas destaca la vehiculización de fármacos asistida por láseres (VFAL), especialmente láseres fraccionales ablativos (CO2/Er:YAG), por su capacidad de generar canales de microablación. En la VFAL se deben ajustar los parámetros en función del tipo de paciente, la dermatosis, la localización y el fármaco empleado. Se ha estudiado la VFAL en el uso de corticoides, fotosensibilizantes o inmunoterapia tópica (imiquimod o 5-fluorouracilo), entre otros, y en múltiples indicaciones: cicatrices, cáncer cutáneo no melanoma, fotodaño, etc. La VFAL es una técnica prometedora que permite aumentar la absorción de moléculas tópicas consiguiendo, además, el efecto sinérgico del láser.
Abstract
Absorption of topical products through the epidermis is limited by the skin's barrier function. Numerous techniques and agents such as microneedling, dermabrasion, radiofrequency, and lasers have been used to increase penetration within an approach known as transdermal drug delivery. One of these techniques is laser-assisted drug delivery (LADD), which often uses ablative fractional lasers (CO2 or erbium:YAG lasers) because of their capacity to produce microscopic ablated channels. The parameters in LADD need to be adjusted to the patient, the skin condition and its location, and the drug. LADD has been used with various topical products, such as corticosteroids, photosensitizers, and immunotherapy agents (imiquimod or 5-fluorouracil) to treat numerous conditions, including scars, nonmelanoma skin cancer, and photodamage. LADD is a promising technique that enhances the absorption of topical molecules while adding the synergic effect of the laser.
Graphical abstract
The Safety of Antibiotic Skin Testing in Severe T-cell-Mediated Hypersensitivity of immunocompetent and immunocompromised hosts
Publication date: Available online 26 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Jason A. Trubiano, Abby P. Douglas, Michelle Goh, Monica A. Slavin, Elizabeth J. Phillips
A Case of Voriconazole-Induced Pseudoporphyria
Publication date: Available online 25 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Guillermo Rodriguez-Nava, Archi Patel, Dima Youssef, George A. Youngberg, Alexei Gonzalez-Estrada
Toxicidad cutánea de los fármacos anti-PD-1/anti-PD-L1
Publication date: Available online 25 September 2018
Source: Piel
Author(s): Noelia Rivera, Aram Boada
Optimizing clinical images with a smartphone and light-emitting diode
Publication date: Available online 26 September 2018
Source: Journal of the American Academy of Dermatology
Author(s): Cheng Zhou, Man Li, Xi Chen, Bo Li, Xueyan Yao, Jianzhong Zhang
Follicular Involvement is Frequent in Lentigo Maligna: Implications for Treatment
Publication date: Available online 26 September 2018
Source: Journal of the American Academy of Dermatology
Author(s): Karen L. Connolly, Cerrene Giordano, Stephen Dusza, Klaus J. Busam, Kishwer Nehal
Abstract
Background
Follicular involvement of lentigo maligna (LM) is considered a histopathologic hallmark, but its prevalence and characteristics have not been well-defined. The depth of intrafollicular extension by neoplastic melanocytes may have clinical importance in the treatment of lentigo maligna.
Objective
To describe the prevalence and features of follicular involvement in LM, including depth of follicular growth by melanocytes.
Methods & Materials
Single-center retrospective study of 100 consecutive cases of surgically excised LM treated from 2013 to 2015. Slide review for cases with residual LM on debulk specimen was performed by a dermatologic surgeon and dermatopathologist to characterize follicular involvement.
Results
Seventy-two of 100 specimens met inclusion criteria for histopathologic evaluation. Follicular involvement was seen in 95.8% of specimens (95% CI: 88.3%-99.1%), with a mean 68% of follicles involved in a single specimen. The mean depth of intrafollicular growth by lesional melanocytes was 0.45 mm (SD=0.23, range 0.1 mm to 1.1 mm). Tumor cells were confined to the infundibular portion of the hair follicle in 60.9% of specimens.
Conclusion
Superficial follicular involvement is a ubiquitous finding in LM. When considering treatment options for LM with a depth-dependent modality aiming for tumor clearance, mean and maximum depths of involvement should be considered.
Camp Sun Safe: A community level sun safety intervention
Publication date: Available online 26 September 2018
Source: Journal of the American Academy of Dermatology
Author(s): Virginia A. Tracey, Katharine P. Saussy, Jacqueline G. Witt, Alexandra M. Haugh, Brittany J. Stumpf
Treatment of oral mucosal neuromas with carbon dioxide laser
Publication date: Available online 26 September 2018
Source: Journal of the American Academy of Dermatology
Author(s): Emily A. Weig, Gretchen M. Roth, Karolyn A. Wanat, Nkanyezi N. Ferguson
The role of S100 proteins in the pathogenesis and monitoring of autoinflammatory diseases
S100A8/A9 and S100A12 are released from activated monocytes and granulocytes and act as proinflammatory endogenous toll-like receptor (TLR)4-ligands. S100 serum concentrations correlate with disease activity, ...
How Intraoperative Tools and Techniques Have Changed the Approach to Brain Tumor Surgery
Abstract
Purpose of Review
Surgical treatment of brain tumors remains an integral part of a comprehensive treatment plan. Here, we review technological advances that have enhanced what surgeons are capable of doing within and outside the traditional operating room.
Recent Findings
Extent of surgical resection has improved with the use of MRI and fluorescent dyes intraoperatively. Neurological injury during brain tumor surgery has decreased with appropriate use of neurophysiological monitoring. New operative scopes have enhanced ability of surgeons to visualize tissues during dissection. Laser interstitial therapy and radiation treatment have made possible the treatment of previously considered non-operable brain tumors in addition to replacing or serving as adjunct to surgical treatment of brain tumors.
Summary
Surgery remains an important pillar in treatment of most brain tumors. Ongoing technological advances have augmented extent of what is possible in this realm.
Molecular Mechanisms of Cisplatin Chemoresistance and Its Circumventing in Testicular Germ Cell Tumors
Abstract
Purpose of Review
Testicular germ cell tumors (TGCTs) represent the most common solid tumors affecting young men. Majority of TGCTs respond well to cisplatin-based chemotherapy. However, patients with refractory disease have limited treatment modalities associated with poor prognosis. Here, we discuss the main molecular mechanisms associated with acquired cisplatin resistance in TGCTs and how their understanding might help in the development of new approaches to tackle this clinically relevant problem. We also discuss recent data on the strategies of circumventing the cisplatin resistance from different tumor types potentially efficient also in TGCTs.
Recent Findings
Recent data regarding deregulation of various signaling pathways as well as genetic and epigenetic mechanisms in cisplatin-resistant TGCTs have contributed to understanding of the mechanisms related to the resistance to cisplatin-based chemotherapy in these tumors. Understanding of these mechanisms enabled explaining why majority but not all TGCTs patients are curable with cisplatin-based chemotherapy. Moreover, it could lead to the development of more effective treatment of refractory TGCTs and potentially other solid tumors resistant to platinum-based chemotherapy.
Summary
This review provides additional insights into mechanisms associated with cisplatin resistance in TGCTs, which is a complex phenomenon, and there is a need for novel modalities to overcome it.
Efficacy of oral tranexemic acid in refractory melasma: A clinico–immuno‐histopathological study
Dermatologic Therapy, EarlyView.
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