Journal of Medical Primatology, EarlyView.
Κυριακή 21 Οκτωβρίου 2018
Painful Complications After Cosmetic Surgery: Management of Peripheral Nerve Injury
Abstract
Background
Aesthetic procedures are among the most common surgeries performed by plastic surgeons. The prevalence of persistent pain remains unknown and underappreciated in the plastic surgery literature. Objectives
The purpose of this article was to increase awareness of this problem while describing the diagnostic and management strategies for patients with postoperative pain after aesthetic plastic surgery. Methods
A literature review of was performed using the PubMed database to identify painful complications of: brachioplasty, blepharoplasty, rhytidectomy, abdominoplasty, breast augmentation, mastopexy, and breast reduction. A treatment algorithm was described to guide plastic surgeons presented with patients reporting pain after aesthetic surgery. Results
Title and abstract review followed by application of inclusion and exclusion criteria finally resulted in a total of 20 clinical studies that were included in this review. These included: lateral femoral cutaneous nerve, iliohypogastric nerve, and intercostal nerves after Abdominoplasty; median antebrachial cutaneous nerve after brachioplasty; supraorbital, supratrochlear and infratrochlear nerves after blepharoplasty; greater auricular nerve, auriculotemporal nerve, and zygomaticofacial nerve after rhytidectomy; intercostobrachial nerve after breast surgery. Conclusions
Neuromas can be the source of pain following aesthetic surgery. The same clinical and diagnostic approach used for upper and lower extremity neuroma pain can be used in patients with persistent pain after aesthetic surgery.Google Ranking of Plastic Surgeons Values Social Media Presence Over Academic Pedigree and Experience
Abstract
Background
Patients increasingly rely on online resources to make healthcare decisions. Google dominates the search engine market, with first page results receiving the majority of web traffic, therefore serving as an important indicator of consumer reach. Objectives
Our objective was to analyze the respective importance of physician academic pedigree, experience and social media presence on plastic surgeon Google first page search result placement. Methods
A Google.com search was conducted in the top 25 United States metropolitan areas to identify the top 20 websites of board-certified plastic surgeons. Social media presence was quantified by tracking the number of followers on Facebook, Twitter, and Instagram for every surgeon, as well as medical school and year of graduation. The primary outcome was website ranking in the first page of Google search results. To identify the independent predictors of presence on the front page, we performed a multivariate logistic regression. Results
Total number of social medial followers was associated with Google front page placement (p<0.001), while medical school ranking and years in practice were not (p = 0.17 and 0.39, respectively). 19.6% of plastic surgeon practices in our study cohort still had no social media accounts whatsoever. Conclusions
For the past few decades, plastic surgery practices relied on referrals, word of mouth, the surgeon's reputation and academic pedigree to attract new patients. It is now clear that this practice building model is being rapidly supplanted by a new paradigm based on social media presence to reach potential patients.Ageism and Health in Patients Undergoing Cosmetic Procedures
Abstract
Background
Ageism is a common form of prejudice that negatively affects the health of older adults. Anti-aging procedures are increasingly popular among patients seeking aesthetic surgery and minimally-invasive treatments. Objectives
This study aimed to identify the prevalence of age-based discrimination, and its relationship to health, among patients seeking cosmetic procedures. Methods
Patients from a university-based single-surgeon aesthetic plastic surgery clinic completed the Everyday Discrimination Scale, which assesses the frequency with which individuals have experienced "microaggressions" and the main reason(s) for discrimination (including age). Participants also completed: measures of perceived age discrimination across interpersonal, romantic, work, and health care contexts and anticipation of age-based discrimination in the future via a single-item measure of self-rated health (rated 1-5) and the Rosenberg Self-Esteem Scale. Results
Fifty patients consented to participate in the study (94% women, 78% white, mean age 49.4 ± 13.5 years). Over 30% of participants reported age as the main reason for everyday discrimination. Participants who reported experiencing age-based discrimination, compared to those who did not, had worse self-rated health, lower self-esteem, and greater anticipated age-based discrimination. Participants most frequently endorsed experiencing age-based discrimination in an interpersonal context (36.0%), followed by work settings (20.0%). Conclusions
A significant portion of patients seeking cosmetic procedures may experience age-based discrimination, which could negatively affect their health and well-being. Patients might benefit from expectation management about how their procedure may or may not address their concerns about age-based discrimination. More research is needed to determine whether cosmetic procedures help to mitigate discrimination in aging patients.Crisaborole Ointment Improves Quality of Life of Patients with Mild to Moderate Atopic Dermatitis and Their Families
Abstract
Introduction
The impact of crisaborole ointment, a nonsteroidal phosphodiesterase 4 inhibitor for the treatment of mild to moderate atopic dermatitis (AD), on quality of life (QoL) was assessed in two identically designed phase 3 studies (AD-301: NCT02118766; AD-302: NCT02118792, both at http://www.clinicaltrials.gov).
Methods
In both studies, patients aged ≥ 2 years with mild to moderate AD per the Investigator's Static Global Assessment were randomly assigned 2:1 to receive crisaborole or vehicle twice daily for 28 days. QoL was assessed using the Children's Dermatology Life Quality Index (CDLQI) (2–15 years), the Dermatology Life Quality Index (DLQI) (≥ 16 years), and the Dermatitis Family Impact Questionnaire (DFI) (parents/caregivers/family of patients aged 2–17 years). Established QoL score severity bands provided clinical context.
Results
Greater mean improvement in QoL was observed in crisaborole-treated patients than in vehicle-treated patients at day 29 [mean change from baseline (∆BL), CDLQI: − 4.6 vs. − 3.0; P < 0.001; DLQI: − 5.2 vs. − 3.5; P = 0.015]. At baseline, more than half the patients had a "moderate effect" or higher of AD on QoL. At day 29, there was a trend toward more crisaborole- than vehicle-treated patients having "small effect" to "no effect", The QoL of parents/caregivers/family improved more for crisaborole-treated than for vehicle-treated patients (∆BL, DFI: − 3.7 vs. − 2.7; P = 0.003).
Conclusion
Crisaborole treatment results in clinically meaningful improvement in QoL for patients and their parents/caregivers/families.
Trial Registration
AD-301: http://www.clinicaltrials.gov, NCT02118766; AD-302: http://www.clinicaltrials.gov, NCT02118792.
Funding
Anacor Pharmaceuticals, Inc., a wholly owned subsidiary of Pfizer Inc., New York, NY.
MALDI-TOF MS identification of Malassezia species isolated from patients with pityriasis versicolor at the seafarers’ medical service in Dakar, Senegal
Publication date: Available online 16 October 2018
Source: Journal de Mycologie Médicale
Author(s): K. Diongue, O. Kébé, M.D. Faye, D. Samb, M.A. Diallo, M. Ndiaye, M.C. Seck, A.S. Badiane, S. Ranque, D. Ndiaye
Abstract
Pityriasis versicolor (PV) is a superficial mycosis caused by yeast of the genus Malassezia. The most common isolated Malassezia species in PV lesions differ among M. furfur, M. globosa and M. sympodialis. We purpose to determine the distribution of Malassezia species in PV patients at the seafarers' medical service in Dakar, Senegal and to examine whether any association between identified Malassezia species and patients' profile. From May 2017 to August 2017, first a questionnaire was filled to get informative data before collection of skin scrapings taken from most scaly site using sterile scalpel blade and application of scotch® for direct examination (DE). At the laboratory, DE, culture and identification by MALDI-TOF MS were done. One hundred patients with PV – all men – were included with a mean age of 34 years. Among seafarers, 81% were sailors. Clinical prevalence of PV was highest in aged adults patients with ages of 31 to 60 years (56%). Seafarers with high level of education were less representative with only 2%. The mean duration of the PV was 26.83 months. 20% of subjects suffered lesions in more than one location. The chest was the most affected anatomical site. Furthermore, possible predisposing factors associated with PV were also detected. DE was positive in 95% but culture growth only in 46%. MALDI-TOF MS analysis of the positive cultures could be performed in 84.8% (39/46). Only M. furfur was identified in 100% (39/39). In definitive, M. furfur is the only causative agent of PV in Dakar.
Tacrolimus, not triamcinolone acetonide, interacts synergistically with itraconazole, terbinafine, bifonazole, and amorolfine against clinical dermatophyte isolates
Publication date: Available online 15 October 2018
Source: Journal de Mycologie Médicale
Author(s): J. Zhang, J. Tan, L. Yang, Y. He
Abstract
Objectives
To compare the in vitro interactions between tacrolimus (TAC)/triamcinolone acetonide (TRI) with itraconazole (ITC), terbinafine (TRB), bifonazole (BIZ), and amorolfine (AMF) in 28 clinical dermatophyte isolates, including 13 Trichophyton rubrum, 6 Trichophyton mentagrophytes, 5 Microsporum canis, and 4 Epidermophyton floccosum strains.
Materials and methods
The interactions between TAC or TRI with antifungal agents were tested according to the microdilution checkerboard technique adapted from the CLSI M38-A2 microdilution method.
Results
TAC and TRI did not exhibit significant antifungal activity against the tested strains at the highest concentration (MICs > 8 μg/mL). However, a strong synergistic interaction was observed for combinations of TAC with ITC (53%), TRB (53%), or BIZ (63%) against Trichophyton strains. Comparatively, TRI/ITC (11%) and TRI/BIZ (16%) combinations showed weaker synergistic activity against the same Trichophyton strains. TAC also showed synergistic interaction with ITC against 20% M. canis strains, with TRB against 60% M. canis strains, and with BIZ against 25% E. floccosum strains. No synergism was observed when M. canis and E. floccosum strains were exposed to TRI in combination with these drugs. Antagonism was not observed for any combinations.
Conclusions
Compared with TRI, TAC showed better synergy when combined with antifungal agents, especially topical TRB and BIZ, against dermatophyte isolates.
Molecular epidemiology of environmental Cryptococcus species isolates based on amplified fragment length polymorphism
Publication date: Available online 12 October 2018
Source: Journal de Mycologie Médicale
Author(s): K. Pakshir, H. Fakhim, A. Vaezi, J.F. Meis, M. Mahmoodi, K. Zomorodian, J. Javidnia, S. Ansari, F. Hagen, H. Badali
Abstract
Objective
Cryptococcosis is a major opportunistic fungal infection caused by members of the genus Cryptococcus, mainly those belonging to the Cryptococcus neoformans/Cryptococcus gattii species complexes. Here, we report a comprehensive molecular epidemiological study of the environmental distribution of Cryptococcus isolates in Shiraz, Iran with review of litreature.
Method
A total of 406 samples were obtained from Eucalyptus trees and 139 samples from pigeon droppings. Cryptococcus species identification and genotyping were performed by amplified fragment length polymorphism (AFLP) fingerprinting sequencing and sequencing of the ITS rDNA region.
Results
Majority of the isolates belonged to the Naganishia taxon (n = 69) including N. albida (formerly C. albidus, n = 62), N. globosa (formerly C. saitoi, n = 4), N. adeliensis (formerly C. adeliensis, n = 2), N. diffluens (formerly C. diffluens, n = 1), and the identified C. neoformans isolates (n = 25) belonged to genotype AFLP1/VNI (n = 22) and AFLP1B/VNII (n = 3).
Conclusion
More research efforts should be employed to isolate C. gattii species complex from environmental niches in Iran and provide additional evidence related to novel molecular types.
Molecular characterization of Aspergilli isolated from outdoor air
Publication date: Available online 3 October 2018
Source: Journal de Mycologie Médicale
Author(s): S. Aghaei-Gharehbolagh, M. Shams-Ghahfarokhi, S. Amanloo, M. Razzaghi-Abyaneh
Abstract
Ubiquitous airborne conidia of the genus Aspergillus are responsible for a diverse group of human disorders from allergy to life treating invasive aspergillosis and mycotoxicoses. The aim of this study was to determine the population structure of Aspergillus isolated from outdoor air in Tehran by comparing the nucleotide sequences of ITS region and the PCR-RFLP molecular method. Internal transcribed spacer domains of 47 Aspergillus spp. were amplified and sequenced and PCR products were digested individually with restriction enzymes TaqI and EcoRI. For all species the PCR reaction produced a fragment of approximately 600 bp in length. All of the nucleotide sequences were highly similar with the corresponding reference sequences registered at the gene bank. The all isolates displayed same banding pattern on the basis EcoR1 cleavage. While Taq1 enzyme profiling provided 5 different banding pattern. The results show that the A. niger section has the highest frequency with 27 isolates (57.4%). Of these, 23 isolates (48.9%) belonged to the A. niger complex and 4 isolates (8.5%) to the A. aculeatus complex. The A. flavus complex was also placed in the next ranking with 9 isolates (19.1%). These results strongly support the need for using molecular markers as an auxiliary tool in differentiating Aspergillus species.
Repeated mutKRAS ctDNA measurements represent a novel and promising tool for early response prediction and therapy monitoring in advanced pancreatic cancer
Abstract
Background
The presence of mutated KRAS (mutKRAS ctDNA) in plasma samples has been consistently shown to be a negative prognostic indicator in pancreatic cancer (PC). Only small pilot studies have evaluated the value of serial mutKRAS ctDNA-measurements in PC. Patients and methods
The aim of the present study was to explore the potential of repeated mutKRAS ctDNA measurements for response prediction and therapy monitoring in advanced PC patients. We used the BEAMing technology to determine levels of mutKRAS ctDNA, CA 19-9, CEA and CYFRA 21-1 in 284 plasma samples of 54 patients with advanced PC receiving gemcitabine-based chemotherapy. Absolute levels and kinetics of mutKRAS ctDNA, CA 19-9, CEA and CYFRA 21-1 were correlated to radiological response, progression-free and overall survival. Results
mutKRAS ctDNA was present in a majority of advanced PC patients (n = 36/54, 67%) and indicated tissue KRAS mutation status with a high sensitivity (75%) and specificity (100%). The presence of mutKRAS ctDNA, as well as higher levels of CA 19-9, CEA and CYFRA 21-1 before initiation of the first-line chemotherapy, was significantly correlated to an adverse overall survival. During therapy, changes in mutKRAS ctDNA levels were more rapid and pronounced than changes in protein-based tumor markers. A decrease in mutKRAS ctDNA levels during therapy was an early indicator of response to therapy, while there was no significant correlation between kinetics of CA 19-9, CEA or CYFRA 21-1 and response to chemotherapy during the first four weeks of treatment. Repeated mutKRAS ctDNA measurements during follow-up appeared to be superior to protein-based tumor markers in detecting progressive disease (sensitivity: 83%, specificity: 100%). Conclusion
mutKRAS ctDNA kinetics appear to be a powerful and highly specific tool in early response prediction and therapy monitoring of advanced PC patients receiving chemotherapy.Low-dose sulfasalazine in a case of Pyodermatitis-pyostomatitis Vegetans
Publication date: Available online 21 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Suo Li, Zhiliang Li, Suying Feng
Lack of evidence for feminization of males exposed to spironolactone in utero: a systematic review
Publication date: Available online 21 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Walter Liszewski, Christina Boull
Morphea and systemic sclerosis are associated with an increased risk of melanoma and non-melanoma skin cancer
Publication date: Available online 21 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Emily Boozalis, Ami A. Shah, Fredrick Wigley, Sewon Kang, Shawn G. Kwatra
Efficacy and safety of Etanercept for postoperative Pyoderma Gangrenosum after infliximab serum sickness
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
Σάββατο 20 Οκτωβρίου 2018
The Emerging Roles of Steroid Hormone Receptors in Ductal Carcinoma in Situ (DCIS) of the Breast
Abstract
Ductal carcinoma in situ (DCIS) is a non-obligate precursor to most types of invasive breast cancer (IBC). Although it is estimated only one third of untreated patients with DCIS will progress to IBC, standard of care for treatment is surgery and radiation. This therapeutic approach combined with a lack of reliable biomarker panels to predict DCIS progression is a major clinical problem. DCIS shares the same molecular subtypes as IBC including estrogen receptor (ER) and progesterone receptor (PR) positive luminal subtypes, which encompass the majority (60–70%) of DCIS. Compared to the established roles of ER and PR in luminal IBC, much less is known about the roles and mechanism of action of estrogen (E2) and progesterone (P4) and their cognate receptors in the development and progression of DCIS. This is an underexplored area of research due in part to a paucity of suitable experimental models of ER+/PR + DCIS. This review summarizes information from clinical and observational studies on steroid hormones as breast cancer risk factors and ER and PR as biomarkers in DCIS. Lastly, we discuss emerging experimental models of ER+/PR+ DCIS.
STAT5-Driven Enhancers Tightly Control Temporal Expression of Mammary-Specific Genes
Abstract
The de novo formation of milk-secreting mammary epithelium during pregnancy is regulated by prolactin through activation of the transcription factor STAT5, which stimulates the expression of several hundred mammary-specific genes. In addition to its key role in activating gene expression in mammary tissue, STAT5, which is ubiquitously expressed in most cell types, implements T cell-specific programs controlled by interleukins. However, the mechanisms by which STAT5 controls cell-specific genetic programs activated by distinct cytokines remain relatively unknown. Integration of data from genome-wide surveys of chromatin markers and transcription factor binding at regulatory elements may shed light on the mechanisms that drive cell-specific programs. Here, we have illustrated how STAT5 controls cell-specific gene expression through its concentration and an auto-regulatory enhancer supporting its high levels in mammary tissue. The unique genomic features of STAT5-driven enhancers or super-enhancers that regulate mammary-specific genes and their dynamic remodeling in response to pregnancy hormone levels are described. We have further provided biological evidence supporting the in vivo function of a STAT5-driven super-enhancer with the aid of CRISPR/Cas9 genome editing. Finally, we discuss how the functions of mammary-specific super-enhancers are confined by the zinc finger protein, CTCF, to allow exclusive activation of mammary-specific genes without affecting common neighboring genes. This review comprehensively summarizes the molecular pathways underlying differential control of cell-specific gene sets by STAT5 and provides novel insights into STAT5-dependent mammary physiology.
Beyond DNA: the Role of Epigenetics in the Premalignant Progression of Breast Cancer
Abstract
Ductal Carcinoma in Situ (DCIS) is an early breast cancer lesion that is considered a nonobligate precursor to development of invasive ductal carcinoma (IDC). Although only a small subset of DCIS lesions are predicted to progress into a breast cancer, distinguishing innocuous from minacious DCIS lesions remains a clinical challenge. Thus, patients diagnosed with DCIS will undergo surgery with the potential for radiation and hormone therapy. This has led to a current state of overdiagnosis and overtreatment. Interrogating the transcriptome alone has yet to define clear functional determinants of progression from DCIS to IDC. Epigenetic changes, critical for imprinting and tissue specific development, in the incorrect context can lead to global signaling rewiring driving pathological phenotypes. Epigenetic signaling pathways, and the molecular players that interpret and sustain their signals, are critical to understanding the underlying pathology of breast cancer progression. The types of epigenetic changes, as well as the molecular players, are expanding. In addition to DNA methylation, histone modifications, and chromatin remodeling, we must also consider enhancers as well as the growing field of noncoding RNAs. Herein we will review the epigenetic interactions that have been uncovered in early stage lesions that impact breast cancer progression, and how these players may be utilized as biomarkers to mitigate overdiagnosis and overtreatment.
Dissecting Tissue-Specific Super-Enhancers by Integrating Genome-Wide Analyses and CRISPR/Cas9 Genome Editing
Abstract
Recent advances in genome-wide sequencing technologies have provided researchers with unprecedented opportunities to discover the genomic structures of gene regulatory units in living organisms. In particular, the integration of ChIP-seq, RNA-seq, and DNase-seq techniques has facilitated the mapping of a new class of regulatory elements. These elements, called super-enhancers, can regulate cell-type-specific gene sets and even fine-tune gene expression regulation in response to external stimuli, and have become a hot topic in genome biology. However, there is scant genetic evidence demonstrating their unique biological relevance and the mechanisms underlying these biological functions. In this review, we describe a robust genome-wide strategy for mapping cell-type-specific enhancers or super-enhancers in the mammary genome. In this strategy, genome-wide screening of active enhancer clusters that are co-occupied by mammary-enriched transcription factors, co-factors, and active enhancer marks is used to identify bona fide mammary tissue-specific super-enhancers. The in vivo function of these super-enhancers and their associated regulatory elements may then be investigated in various ways using the advanced CRISPR/Cas9 genome-editing technology. Based on our experience targeting various mammary genomic sites using CRISPR/Cas9 in mice, we comprehensively discuss the molecular consequences of the different targeting methods, such as the number of gRNAs and the dependence on their simultaneous or sequential injections. We also mention the considerations that are essential for obtaining accurate results and shed light on recent progress that has been made in developing modified CRISPR/Cas9 genome-editing techniques. In the future, the coupling of advanced genome-wide sequencing and genome-editing technologies could provide new insights into the complex genetic regulatory networks involved in mammary-gland development.
Magnetic hyperthermia of breast cancer cells and MRI relaxometry with dendrimer-coated iron-oxide nanoparticles
Recently, some studies have focused on dendrimer nanopolymers as a magnetic resonance imaging (MRI) contrast agent or a vehicle for gene and drug delivery. Considering the suitable properties of these material...
Möglichkeiten und Grenzen der Eigenfetttransplantation
Mithilfe der autologen Transplantation von abgesaugtem subkutanem Fettgewebe lassen sich gute Ergebnisse zum Beispiel bei der Brustvergrößerung erzielen. Der folgende Beitrag beschreibt verschiedene Möglichkeiten, wie Patientinnen und Patienten erfolgreich mit der sogenannten BEAULI™-Methode behandelt werden können.
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