Head and Neck Diseases by Alexandros G.Sfakianakis: 09/06/17

Τετάρτη 6 Σεπτεμβρίου 2017

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Guidelines for Contributing Authors

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The effect of anaerobic digestion and storage on indicator microorganisms in swine and dairy manure

Abstract

The aim of this experimental study was to evaluate the influence of anaerobic digestion and storage on indicator microorganisms in swine and dairy excreta. Samples were collected every 90 days for 15 months at eight farms, four pig, and four dairy farms, four of them having a biogas plant. Moreover, to evaluate storage effects on samples, 20 l of manure and slurry taken at each farm (digested manure only in farms with a biogas plant) were stored in a controlled climatic chamber at 18 °C, for 6 months. The bacterial load and the chemical-physical characteristics of excreta were evaluated at each sampling time, stored slurry, and manure were sampled and analyzed every 2 months. A high variability of the concentration of bacteria in the different excreta types was observed during the experiment, mainly depending on the type and time of treatment. No sample revealed either the presence of Escherichia coli O157:H7 or of Salmonella, usually linked to the temporary rearing of infected animals in facilities. Anaerobic digestion and storage affected in a significant way the reduction of indicator bacteria like lactobacilli, coliforms, and streptococci. Anaerobic digestion lowered coliforms in pig slurry (− 2.80 log, P < 0.05), streptococci in dairy manure (− 2.44 log, P < 0.001) and in pig slurry (− 1.43 log, P < 0.05), and lactobacilli in pig slurry (− 3.03 log, P < 0.05). Storage lowered coliforms and the other indicators counts, in particular in fresh wastes, while clostridia did not show a reduction in concentration.

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The effect of different organic materials amendment on soil bacteria communities in barren sandy loam soil

Abstract

To effectively improve soil productivity and optimize organic fertilizer management while reducing environmental pollution and resource wasting in farmland system, the present study was conducted in Wuqiao Experiment Station of China Agricultural University, Hebei Province. Taking crop straw treatment as control, four kinds of organic materials including pig manure (PM), biogas residue (BR), biochar (BC) and crop straw (ST) were applied to soil at the same nitrogen (N) level. The soil bacteria community characteristics were explored using Illumina Miseq high-throughput sequencing technologies. The results were as follows: (1) Compared with ST, PM, BR and BC had no significant effect on Chao 1 and Shannon index. The dominant bacterial groups include Proteobacteria, Acidobacteria, Actinobacteria, Bacteroidetes, and Chloroflexi in sandy loam soil after the application of different organic materials. The abundance of Proteobacteria in BC treatment was significantly lower than that of ST (control) treatment (p < 0.05). On the contrary, compared to ST, the abundances of Acidobacteria increased by 65.0, 40.7, and 58.7% in the BC, BR, and PM treatments, respectively. (2) Compared to ST, the BC treatment significantly (p < 0.05) increased in soil organic carbon (SOC) and pH in the arable layer (0–20 cm) in the farmland (p < 0.05), and significantly increased the soil pH with a value of 0.26 level (p < 0.05). (3) Pearson correlation analysis results showed that the PCoA1 scores and soil pH were closely correlated (R ² = 0.3738, p < 0.05). In addition, pairwise regression between PCoA1 scores and SOC (R ² = 0.5008, p < 0.05), PCoA2 scores and SOC (R ² = 0.4053, p < 0.05) were both closely correlated. In general, our results indicated that organic materials amendment shaped the bacterial community in sandy loam soil through changing the soil pH and SOC.

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Environmental impacts caused by cemeteries and crematoria, new funeral technologies, and preferences of the Northeastern and Southern Brazilian population as for the funeral process

Abstract

Cemeteries and crematoria are the main funeral ways used in the world nowadays. It is a little-studied segment in the present days, mainly as for the possible environmental impacts in the environment, such as those derived from dental amalgam, prostheses, and dioxins, among other. This article aimed to identify the environmental impacts caused by cemeteries and crematoria and to point out new trends in funeral processes such as freeze-drying and alkaline hydrolysis. The study is justified due to the large part of the Brazilian population that do not know the environmental impacts caused by cemeteries and crematoria, as well as to bring information about the new processes. For that, a research was carried out with 400 people. The main results show that among all the funeral processes, the new freeze-drying process was opted by 33% of the sample. We also identified that the main reasons for choosing the funeral process were less environmental impact (28%), no after-death expenses (grave payment) (16.1%), and the possibility of putting away or throwing away the remains wherever you want (14.9%). Finally, new funeral processes were well accepted by the Brazilian population—those who were interviewed—due to their benefits.

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Mild electrokinetic treatment of cadmium-polluted manure for improved applicability in greenhouse soil

Abstract

Applications of cadmium (Cd) and salinity-containing manures contribute to Cd pollution and salinization in greenhouse soils. In this study, chicken manure polluted with Cd (5.6 mg/kg) was mildly electrokinetically treated (0.25 V/cm) for 48 h with intermittent replacement of catholyte with 20 mM acetic acid solution to remove Cd and salinity for application without need of post-treatment in greenhouse soil. The electrokinetic treatment created pH conditions mainly ranging from 5.0 to 8.0 within the manure for minimizing re-precipitation of desorbed Cd and evaporative loss of ammonium. However, without manure pre-acidification, electrokinetic treatment resulted in negligible removal of total Cd but 61.7% of increase in the small fraction of exchangeable Cd, due to poor desorption but enhanced formation of exchangeable Cd. In contrast, manure pre-acidification with 20 mM acetic acid favored Cd desorption, leading to electrokinetic removal of exchangeable, carbonate-bound, and total Cd by 32.2%, 34.5%, and 14.5%, respectively. Mild electrokinetic treatment of manure with and without pre-acidification resulted in similar removal of salinity (72.3% and 68.0%), similar pH condition (7.2 and 7.4), and basically same evaporative loss of ammonium (14.6% and 14.2%). Overall, the mild electrokinetic treatment considerably lowered the risk of Cd and the salinity from the pre-acidified manure for improved applicability in greenhouse soil, and more studies are needed to enhance the performance of electrokinetic Cd removal from manure.

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Expression of transcription factors in MEN1-associated pancreatic neuroendocrine tumors

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Summary

MEN1-associated pancreatic neuroendocrine tumors (pNETs) may potentially express distinct hormones, but the mechanism has not been elucidated. Transcription factors such as MafA and Pdx1 have been identified to lead to beta cell differentiation, while Arx and Brn4 to alpha cell differentiation in developing pancreas. We hypothesized those transcription factors are important to produce specific hormones in pNETs, similarly to developing pancreas, and examined the expression of transcription factors in a case of MEN1 who showed immunohistological coexistence of several hormone-producing pNETs including insulinoma. A 70-year-old woman was found to manifest hypoglycemia with non-suppressed insulinemia and hypercalcemia with elevated PTH level. She was diagnosed as MEN1 based on the manifestation of primary hyperparathyroidism, pituitary adenoma and insulinoma, with genetic variation of MEN1 gene. She had pylorus-preserving pancreaticoduodenectomy because CT scan and SACI test indicated that insulinoma was localized in the head of the pancreas. Histopathological finding was MEN1-associated NET, G1. Interestingly, immunohistological examination of the resected pancreas revealed that two insulinomas, a glucagon-positive NET and a multiple hormone-positive NET coexisted. Hence, we examined the expression of transcription factors immunohistochemically to elucidate the role of the transcription factors in MEN1-associated hormone-producing pNETs. We observed homogeneous expressions of MafA and Pdx1 in insulinomas and Arx in glucagon-positive NET, respectively. Moreover, multiple hormone-positive NETs expressed several transcription factors heterogeneously. Collectively, our results suggested that transcription factors could play important roles in the production of specific hormones in MEN1-associated pNETs, similar to islet differentiation.

Learning points:

To date, it has been shown that different hormone-producing tumors coexist in MEN1-associated pNETs; however, the underlying mechanism of the hormone production in MEN1-associated pNETs has not been well elucidated.

Although this case presented symptomatic hypoglycemia, several hormone-producing pNETs other than insulinoma also coexisted in the pancreas.

Immunohistochemical analysis showed MafA and Pdx1 expressions distinctly in insulinoma, and Arx expression particularly in a glucagon-positive NET, while a multiple hormone-positive NET expressed MafA, Pdx1 and Arx.

Collectively, clinicians should consider that several hormone-producing pNETs may coexist in a MEN1 case and examine both endocrinological and histopathological analysis of pNETs, regardless of whether symptoms related to the excess of hormones are observed or not.

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Expression of transcription factors in MEN1-associated pancreatic neuroendocrine tumors

Summary

Learning points:

Although this case presented symptomatic hypoglycemia, several hormone-producing pNETs other than insulinoma also coexisted in the pancreas.

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Indeterminate dendritic cell neoplasm of the skin: A 2-case report and review of the literature

Indeterminate dendritic cell neoplasm (IDCN) is an exceedingly rare and mostly cutaneous histiocytosis, frequently associated with other hematopoietic malignancies. We report 2 cases of multilesional cutaneous IDCN. A 55-year-old male with no associated malignancy and complete response to ultraviolet light therapy; and a 72-year-old male with chronic myelomonocytic leukemia (CMML). Both cases showed histiocytoid cytology, positivity for CD1a and no expression of Langerin or BRAF^V600E. With our patients, the literature describes 79 cases of IDCNs, including 65 (82%) with only skin involvement, 7 cases (9%) with involvement of skin and a second site, 5 cases (6%) involving lymph nodes only, 1 splenic lesion and 1 systemic disease. Seventeen cases (22%) were associated with other hematopoietic malignancies, most commonly CMML (6 cases), follicular lymphoma (4 cases) and acute myeloid leukemia (3 cases). All IDCNs associated with myeloid malignancies were limited to the skin, while most cases associated with lymphoma were limited to lymph nodes. Reported responses of cutaneous lesions to ultraviolet light therapy are encouraging, while systemic chemotherapy is appropriate for clinically aggressive cases and treatment of associated malignancies. Recognition of the clinico-morphologic spectrum of IDCNs should prevent misdiagnoses and prompt investigation of possible associated neoplasms.

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TIMP-3 mRNA expression levels positively correlates with levels of miR-21 in in situ BC and negatively in PR positive invasive BC

Publication date: Available online 6 September 2017
Source:Pathology - Research and Practice
Author(s): Nina Petrovic, Ahmad Sami, Jelena Martinovic, Marina Zaric, Irina Nakashidze, Silvana Lukic, Snezana Jovanovic-Cupic
BackgroundBreast carcinomas (BC) belong to a heterogeneous group of malignant diseases. Correct categorization of BC based on molecular biomarkers has a very important role in deciding the proper course of therapy for each patient. It has been already shown that the decrease of TIMP metalloproteinase inhibitor 3 (TIMP-3) together with overexpression of microRNA-21 (miR-21) might be involved in the process of BC invasion. This is the first study that examined relationship among miR-21, TIMP-3 mRNA and TIPM-3 protein levels in BC groups formed according to invasiveness.MethodsIn this study, we used 46 breast cancer samples. Estrogen and progesterone receptor (ER, PR) protein levels were evaluated by immunohistochemistry (IHC) method. TIMP-3 mRNA expression was examined by two-step real-time quantitative PCR (qRT-PCR). Western blot analysis was performed for 16 samples.ResultsStatistically significant differences in TIMP-3 expression levels between invasive groups were discovered in ER positive (ER+) (p=0.015), Her-2 negative (p=0.026) subgroups, and patients without lymph-node metastasis (p=0.039). Interestingly, significant positive correlation was detected between miR-21 and TIMP-3 mRNA levels (P<0.001, ρ=0.949) in the group of in situ tumors. TIMP-3 mRNA expression levels highly negatively correlated with levels of miR-21 in PR+ invasive BCs (p=0.007, ρ=−0.641). TIMP-3 protein levels negatively correlated with miR-21 levels in pure invasive BCs.ConclusionThese data suggest that signaling pathways involved in formation and progression of BCs in groups formed according to invasiveness might be different. Our findings propose that TIMP-3 mRNA expression levels could be significant prognostic parameter, but within specific BC subtypes.

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The Ire1 Twist that Links Proteostatic with Lipostatic Control of the Endoplasmic Reticulum

Publication date: Available online 5 September 2017
Source:Trends in Cell Biology
Author(s): Tomás Aragón, Eelco van Anken
The unfolded protein response (UPR) governs homeostasis of both luminal content and membrane of the endoplasmic reticulum (ER). In Molecular Cell, Halbleib et al. identified how a twist in the juxta-membrane amphipathic helix of the UPR transducer Ire1 in yeast is essential for responding to both proteostatic and lipostatic ER stress.

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Tissue Microstructure Estimation Using a Deep Network Inspired by a Dictionary-based Framework

Publication date: Available online 6 September 2017
Source:Medical Image Analysis
Author(s): Chuyang Ye
Diffusion magnetic resonance imaging (dMRI) captures the anisotropic pattern of water displacement in the neuronal tissue and allows noninvasive investigation of the complex tissue microstructure. A number of biophysical models have been proposed to relate the tissue organization with the observed diffusion signals, so that the tissue microstructure can be inferred. The Neurite Orientation Dispersion and Density Imaging (NODDI) model has been a popular choice and has been widely used for many neuroscientific studies. It models the diffusion signal with three compartments that are characterized by distinct diffusion properties, and the parameters in the model describe tissue microstructure. In NODDI, these parameters are estimated in a maximum likelihood framework, where the nonlinear model fitting is computationally intensive. Therefore, efforts have been made to develop efficient and accurate algorithms for NODDI microstructure estimation, which is still an open problem. In this work, we propose a deep network based approach that performs end-to-end estimation of NODDI microstructure, which is named Microstructure Estimation using a Deep Network (MEDN). MEDN comprises two cascaded stages and is motivated by the AMICO algorithm, where the NODDI microstructure estimation is formulated in a dictionary-based framework. The first stage computes the coefficients of the dictionary. It resembles the solution to a sparse reconstruction problem, where the iterative process in conventional estimation approaches is unfolded and truncated, and the weights are learned instead of predetermined by the dictionary. In the second stage, microstructure properties are computed from the output of the first stage, which resembles the weighted sum of normalized dictionary coefficients in AMICO, and the weights are also learned. Because spatial consistency of diffusion signals can be used to reduce the effect of noise, we also propose MEDN+, which is an extended version of MEDN. MEDN+ allows incorporation of neighborhood information by inserting a stage with learned weights before the MEDN structure, where the diffusion signals in the neighborhood of a voxel are processed. The weights in MEDN or MEDN+ are jointly learned from training samples that are acquired with diffusion gradients densely sampling the q-space. We performed MEDN and MEDN+ on brain dMRI scans, where two shells each with 30 gradient directions were used, and measured their accuracy with respect to the gold standard. Results demonstrate that the proposed networks outperform the competing methods.

Graphical abstract

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Prevention of Mandible Reconstruction Plate Exposure by Costal Cartilage Wrapping

Summary: After mandibulectomy in cancer surgery, reconstruction is often performed with a reconstruction plate covered with a soft-tissue free flap in patients in poor condition. However, the rate of complications for mandibular reconstruction is higher with a reconstruction plate than with vascularized bone grafts. We have developed a costal cartilage wrapping method to prevent exposure of the mandible reconstruction plate. The eighth costal cartilage was removed and split into 2 pieces to wrap around the reconstruction plate. In our case, the artificial plate wrapped with costal cartilage graft was not exposed and the skin over the plate did not become atrophic over 27 months follow-up even after irradiation. Wrapping around an artificial reconstruction plate with autologous costal cartilage grafts may be more effective than using only a flap covering to prevent exposure of the plate after tumor ablation and radiation therapy.

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Patient-Reported Disability Measures Do Not Correlate with Electrodiagnostic Severity in Carpal Tunnel Syndrome

Background: Electrophysiologic studies including electromyography and nerve conduction studies play a role in the evaluation of carpal tunnel syndrome (CTS), despite evidence that these studies do not correlate with CTS-specific symptom scores. There is a lack of evidence comparing electrophysiologic data with general measures of function. Methods: Fifty patients presenting for CTS treatment over an 8-month period were analyzed retrospectively. All patients completed surveys including the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) and the Medical Outcomes Study 12-Item Short-Form Survey [(physical component summary 12, mental component summary (MCS-12)]. Electromyography and nerve conduction studies were performed on all patients and compared with outcome scores. Results: Analysis demonstrated no relationship between DASH or MCS-12 and electrodiagnostic severity. No significant correlations were noted between DASH or MCS-12 and median motor or sensory latency. There was a moderate–weak correlation (rho = 0.34) between more severe electrophysiologic grade and better function based on physical component summary 12. Conclusions: Electrodiagnostic severity grades do not correlate with patient-reported disability, including the DASH and MCS–12 surveys. There is a counterintuitive correlation between more-severe electrodiagnostic findings and decreased physical disability. These findings indicate that disability may not correlate with electrodiagnostic severity of median neuropathy in CTS.

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Double-Pedicled Free Deep Inferior Epigastric Perforator Flap for the Coverage of Thigh Soft-Tissue Defect

Summary: Soft-tissue defects caused by radiation injury are a challenging task for the reconstructive surgeon, due to the extent of the soft-tissue damage and the associated injuries of the local blood vessels and bone tissue. We present the application of the versatile deep inferior epigastric perforator (DIEP) flap for the coverage of an extended lateral thigh soft-tissue defect after the surgical resection of an undifferentiated pleomorphic high-grade sarcoma, neoadjuvant chemotherapy, and adjuvant chemo- and radiotherapy. A double-pedicled free DIEP flap (756 cm2) was harvested and anastomosed to the transverse branch of the lateral femoral circumflex artery and a lateral branch of the popliteal artery (P1). The flap survived completely without serious complications, and the patient was able to walk with crutches 3 months postoperatively. This is the first case report of a free bipedicled DIEP flap for the coverage of a thigh defect in a male patient.

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Meta-Analysis of Long Thoracic Nerve Decompression and Neurolysis Versus Muscle and Tendon Transfer Operative Treatments of Winging Scapula

Background: Injury to long thoracic and the spinal accessory nerves can cause winging scapula as a result of weakness and paralysis of the trapezius and serratus anterior muscles. Although these nerve and muscle operations have been reported to correct winging scapula due to various causes, there is no report on comparing the outcomes of these procedures in peer-reviewed Pubmed-indexed literature. In this article, we compared the improvements in the restoration of shoulder functions in winging scapula patients after long thoracic nerve decompression (LTND) in our present study with outcomes of muscle and tendon transfer operations published in the literature (Aetna cited articles). Methods: Twenty-five winging scapula patients met the inclusion criteria, who had LTND and neurolysis at our clinic since 2008. Electromyographic evaluation of the brachial plexus and long thoracic nerve distribution was performed preoperatively for all our patients in this study. Operating surgeon (R.K.N.) examined all patients and measured pre- and postoperative range of motion of the affected shoulder. The mean follow-up was 23 months (range, 13–46 months). Age of our patients in this study at the time of surgery was between 13 and 63 years. These patients had winging scapula between 5 days (tennis injury) and several years before surgery and some were unknown. Results: Shoulder flexion and abduction improved to an average of 163˚ (P

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Wide Awake Trapeziectomy for Thumb Basal Joint Arthritis

No abstract available

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Dual Vascular Free Anterolateral Thigh Flap

Background: The optimum number of microvascular anastomoses for safe free tissue transfer is controversial. Although the case for 2 venous anastomoses versus 1 anastomosis has been argued, the use of an additional arterial anastomosis has not been examined in detail. Methods: Twelve patients who underwent 2 arterial anastomoses for a free flap transfer were identified retrospectively from the medical records of patients undergoing reconstruction for head and neck cancer. The free flaps were limited to anterolateral thigh (ALT) flaps. Results: All flaps survived. Complications included venous thrombosis (n = 1), reexploration (n = 1), and leakage (n = 3). The vascular patterns of dual-arterialized ALT flaps were classified into 3 groups. Types 1 and 2 were ALT flaps that had 2 vascular sources from the descending and lateral branches of the lateral circumflex femoral artery. The number of accompanying veins differed between type 1 (3 veins) and type 2 (2 veins). Type 3 differed from a conventional ALT flap nourished by the descending branch of the lateral circumflex femoral artery (1 vein) by the addition of anastomosis of an artery branching from the descending branch to the vastus medialis muscle. The total operation times for these 3 types of ALT were similar. Conclusions: An additional arterial anastomosis to the free cutaneous flap did not cause any congestion or disturb the balance between inflow and outflow. If the surgeon considers that the first arterial anastomosis is unreliable, an additional anastomosis might be an option in ALT transfer.

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Acellular Dermal Matrix: Treating Periocular Melanoma in a Patient with Xeroderma Pigmentosa

We report a 7-year-old girl with xeroderma pigmentosum (XP), who presented in our clinic with a large melanoma (35 × 50 × 20 mm, Breslow depth 18 mm) in the zygomatic-malar area. Palliative surgery was performed to maintain her residual vision and to reduce the pain caused by the compression of local structures. Because of the limited access of autologous skin grafts in pediatric patients with XP who are severely affected, we opted to use an acellular dermal matrix. There was 100% graft uptake, and the pain due to compression by the tumor was alleviated. This case demonstrates that acellular dermal matrices can be safely and effectively used in oncological facial reconstruction, especially in patients with progressive conditions such as XP.

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Deltopectoral and Pectoralis Musculocutaneous Flap Technique for Cervical Esophageal Reconstruction after Free-Jejunal-Flap Necrosis

Background: Free jejunal transfer has a high success rate, but if vascular thrombosis occurs, the salvage of failing flap with reanastomosis is difficult. This study described a combined deltopectoral (DP) and pectoralis major musculocutaneous (PMMC) flap 2-step technique for cervical esophageal reconstruction after free-jejunal-flap necrosis. Methods: In step 1, the detection of free jejunal flap with the subsequent debridement of necrotic and infected tissue was followed by the construction of external fistula on the pharyngeal side with the hole in cervical skin and the construction of another external fistula on the esophageal side and tracheal stoma with a single or double DP flap. In step 2, after the primary healing of all wounds was confirmed, a wide hinge flap was elevated for reconstructing the posterior wall or full circumferential defect of cervical esophagus. PMMC flap harvested from either the left or right anterior chest wall was used for reconstructing the cervical surface defect or anterior pharyngeal wall. Results: This technique was used for cervical esophageal reconstruction after free-jejunal-flap necrosis in 5 patients. Step 1 surgery was performed at an average of 10 days after primary-free-jejunal flap transfer. Oral intake was resumed in all cases at an average of 117 days after step 2 surgery. No complications including esophageal stricture were found during a 6-month follow-up period. Conclusions: Combined DP and PMMC flap technique was useful for cervical esophageal reconstruction after free-jejunal-flap necrosis and applicable to patients with the late detection of jejunal necrosis and surgical-site infection.

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Interosseous Membrane Release for Long-Standing Upper Limb Lymphedema: A Procedure Often Neglected

No abstract available

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Evaluation of a Novel Hybrid Viable Bioprosthetic Mesh in a Model of Mesh Infection

Background: The reported incidence of mesh infection in contaminated operative fields is as high as 30% regardless of material used. Our laboratory previously showed that augmenting acellular bioprosthetic mesh with allogeneic mesenchymal stem cells (MSC) enhances resistance to bacterial colonization in vivo and preserves mesh integrity. This study's aim was to determine whether augmentation of non-crosslinked porcine dermis (Strattice) with commercially available, cryopreserved, viable MSC-containing human placental tissue (Stravix) similarly improves infection resistance after inoculation with Escherichia coli (E. coli) using an established mesh infection model. Methods: Stravix was thawed per manufacturer's instructions and 2 samples were tested for cell viability using a Live/Dead Cell assay at the time of surgery. Rats (N = 20) were implanted subcutaneously with 1 piece of Strattice and 1 piece of hybrid mesh (Strattice + Stravix sutured at the corners). Rats were inoculated with either sterile saline or 106 colony-forming units of E. coli before wound closure (n = 10 per group). At 4 weeks, explants underwent microbiologic and histologic analyses. Results: In E. coli–inoculated animals, severe or complete mesh degradation concurrent with abscess formation was observed in 100% (10/10) hybrid meshes and 90% (9/10) Strattice meshes. Histologic evaluation determined that meshes inoculated with E. coli exhibited severe acute inflammation, which correlated with bacterial recovery (P

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Mastectomy Flap Thickness and Complications in Nipple-Sparing Mastectomy: Objective Evaluation using Magnetic Resonance Imaging

Background: Ischemic complications after nipple-sparing mastectomy (NSM) have been associated with numerous variables. However, the impact of NSM flap thickness has been incompletely evaluated. Methods: NSM flap thickness was determined for all NSMs from 2006 to 2016 with available pre- or postoperative breast magnetic resonance imaging (MRIs). Demographics and outcomes were stratified by those with and without ischemic complications. Results: Of 1,037 NSM reconstructions, 420 NSMs had MRI data available, which included 379 preoperative MRIs and 60 postoperative MRIs. Average total preoperative skin/subcutaneous tissue NSM flap thickness was 11.4 mm. Average total postoperative NSM flap thickness was 8.7 mm. NSMs with ischemic complications were found to have significantly thinner overall postoperative NSM flap thickness compared with those without ischemic complications (P = 0.0280). Average overall postoperative NSM flap thickness less than 8.0 mm was found to be an independent predictor of ischemic complications (odds ratio, 6.5263; P = 0.026). In NSMs with both pre- and postoperative MRIs, the overall average postoperative NSM flap thickness was 68.2% of preoperative measurements. Average overall postoperative NSM flap thickness was significantly less than average overall preoperative NSM flap thickness (P

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Optimization of an Arterialized Venous Fasciocutaneous Flap in the Abdomen of the Rat

Background: Although numerous experimental models of arterialized venous flaps (AVFs) have been proposed, no single model has gained widespread acceptance. The main aim of this work was to evaluate the survival area of AVFs produced with different vascular constructs in the abdomen of the rat. Methods: Fifty-three male rats were divided into 4 groups. In group I (n = 12), a 5-cm-long and 3-cm-wide conventional epigastric flap was raised on the left side of the abdomen. This flap was pedicled on the superficial caudal epigastric vessels caudally and on the lateral thoracic vein cranially. In groups II, III, and IV, a similar flap was raised, but the superficial epigastric artery was ligated. In these groups, AVFs were created using the following arterial venous anastomosis at the caudal end of the flap: group II (n = 13) a 1-mm-long side-to-side anastomosis was performed between the femoral artery and vein laterally to the ending of the superficial caudal epigastric vein. In group III (n = 14), in addition to the procedure described for group II, the femoral vein was ligated medially. Finally, in group IV (n = 14), the superficial caudal epigastric vein was cut from the femoral vein with a 1-mm-long ellipse of adjacent tissue, and an end-to-side arterial venous anastomosis was established between it and the femoral artery. Results: Seven days postoperatively, the percentage of flap survival was 98.89 ± 1.69, 68.84 ± 7.36, 63.84 ± 10.38, 76.86 ± 13.67 in groups I–IV, respectively. Conclusion: An optimized AVF can be produced using the vascular architecture described for group IV.

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Mucosal Perfusion Preservation by a Novel Shapeable Tissue Expander for Oral Reconstruction

Background: There are few methods for expanding oral mucosa, and these often cause complications such as tissue necrosis and expander eruption. This study examines mucosal blood perfusion following insertion of a novel shapeable hydrogel tissue expander (HTE). The canine model used subgingival insertion of HTE following tooth extraction and alveolar bone reduction. The primary goal of this study was to gain understanding of epithelial perfusion and reparative responses of gingival mucosa during HTE expansion. Methods: Nine Beagle dogs underwent bilateral premolar maxillary and mandibular tooth extraction. Three to four months later, HTE-contoured inserts were implanted submucosally under the buccal surface of the alveolar ridge. After removal and following a 6- to 7-month period of healing, new HTE implants were inserted at the same sites. The area was assessed weekly for tissue perfusion and volume of expansion. Biopsies for histological analysis were performed at the time of expander removal. Results: Within 2 weeks following the second insertion, blood flow returned to baseline (defined as the values of perfusion measurements at the presurgery assessment) and remained normal until hydrogel full expansion and removal. Volume expansion analysis revealed that the hydrogel doubled in volume. Histological assessment showed no macrophage or inflammatory infiltration of the mucosa. No superficial fibrosis, decreased vascularity, or mucosal change was seen. Conclusion: Maintenance of adequate tissue perfusion is a clinically important aspect of tissue expander performance to reduce risk of device loss or injury to the patient, particularly for areas with a history of previous surgeries.

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Carpal Tunnel Syndrome in the Setting of Mucopolysaccharidosis II (Hunter Syndrome)

Background: Carpal tunnel syndrome (CTS) is a rare finding in children, but heavily represented in pediatric patients with mucopolysaccharidoses. Diagnosis is a challenge due to lack of the stereotypical symptomatic complaints and relies on examination and objective nerve conduction studies. Methods: We present a case of delayed presentation of CTS in a 12-year-old boy with Hunter syndrome, followed by a review of the literature. Results: Patient Z.D. presented with minimal reported CTS symptoms but advanced median nerve damage on electromyography. He underwent bilateral carpal tunnel release with median nerve neurolysis and flexor tenosynovectomies. Intraoperative examination demonstrated the presence of a "waist sign" of the median nerve and moderate flexor tenosynovial hypertrophy bilaterally. Parents reported mild subjective improvement of dexterity and fine motor skills postoperatively. Conclusion: To optimize functional outcome, routine screening for CTS and intervention at an early age are emphasized in the mucopolysaccharidoses population.

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A Proposal for Updated Standards of Photographic Documentation in Aesthetic Medicine

Summary: In 1998, DiBernardo et al. published a very helpful standardization of comparative (before and after) photographic documentation. These standards prevail to this day. Although most of them are useful for objective documentation of aesthetic results, there are at least 3 reasons why an update is necessary at this time: First, DiBernardo et al. focused on the prevalent standards of medical photography at that time. From a modern perspective, these standards are antiquated and not always correct. Second, silver-based analog photography has mutated into digital photography. Digitalization offers virtually unlimited potential for image manipulation using a vast array of digital Apps and tools including, but not limited to, image editing software like Photoshop. Digitalization has given rise to new questions, particularly regarding appropriate use of editing techniques to maximize or increase objectivity. Third, we suggest changes to a very small number of their medical standards in the interest of obtaining a better or more objective documentation of aesthetic results. This article is structured into 3 sections and is intended as a new proposal for photographic and medical standards for the documentation of aesthetic interventions: 1. The photographic standards. 2. The medical standards. 3. Description of editing tools which should be used to increase objectivity.

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Prioritization for Plastic Surgery Procedures Aimed to Improve Quality of Life: Moral Considerations

Background: Different health conditions are treated in a Plastic Surgery unit, including those cases whose main goal is to enable patients to feel and integrate better within society and therefore improving quality of life, rather then physical functions. Methods: We discuss moral principles that can be used as a guide for health professionals to revise and create policies for plastic surgery patients presenting with non–life-threatening conditions. Results: A specific anatomical feature is not always an indicator of patient's well-being and quality of life, and therefore it cannot be used as the sole parameter to identify the worst-off and prioritize the provision of health care. A policy should identify who preoperatively are the worst-off and come to some plausible measure of how much they can be expected to benefit from an operation. Policies that do not track these principles in any reliable way can cause discrimination. Conclusions: A patient-centered operating system and patient's informed preferences might be implemented in the process of prioritizing health. In circumstances when the effectiveness of a specific treatment is unproven, professionals should not make assumptions based on their own values.

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Sclerosing thymoma-like thymic amyloidoma with nephrotic syndrome: a case report

Primary localized amyloidosis presenting as an isolated mediastinal mass is extremely rare, especially in the thymus. Sclerosing thymoma is also an extremely rare anterior mediastinal tumor, pathologically cha...

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Virtual Reality: The Next Frontier of Audiology

No abstract available

http://ift.tt/2iZEiyX

Embracing Robotics for CIs

No abstract available

http://ift.tt/2wKgcvu

Symptom: Failed Cochlear Implant

No abstract available

http://ift.tt/2wKg9Qk

Advancing Tinnitus Awareness Through Animation

No abstract available

http://ift.tt/2wJRifp

Heroes With Hearing Loss®

No abstract available

http://ift.tt/2wKi5bl

Animal-Assisted Interventions in Audiology

No abstract available

http://ift.tt/2wJYecc

Feel the Vibrations: Understanding the Hearing-Emotion Connection

No abstract available

http://ift.tt/2wJZc8p

Diffusion Tensor Imaging of the ‘Auditory Connectome’

No abstract available

http://ift.tt/2xcD8pW

Tips for Traveling With Hearing Loss

No abstract available

http://ift.tt/2xcbUjo

Barriers And Opportunities in Rural Hearing Health

No abstract available

http://ift.tt/2xce3f0

Preventive Care for Dementia and Hearing Loss

No abstract available

http://ift.tt/2xckAGp

Preparing for Relational Audiology: Things I Wish Someone Told Me Before I Started Working in Pediatric Audiology

No abstract available

http://ift.tt/2xc7clR

Humanitarian Outreach in Otology

No abstract available

http://ift.tt/2xc5pxd

Hearing Loss and Misunderstandings

No abstract available

http://ift.tt/2xc4iNF

Manufacturers News

No abstract available

http://ift.tt/2wKa8mA

Primary epithelioid hemangioendothelioma of the dorsal spine: A review

Joe M Das, Rony Louis, Sunilkumar BS, Anil Kumar Peethambaran

Neurology India 2017 65(5):1180-1186

http://ift.tt/2gMomPM

Memorable clinical experiences, all in one year at Queen Square, London, United Kingdom (1968-1969): A tribute to Neurology legends

K Srinivasan

Neurology India 2017 65(5):944-947

http://ift.tt/2vNMesW

Magnetic resonance imaging findings in heat stroke-related encephalopathy

Ravi K Jakkani, Vijay K Agarwal, Suryanarayana Anasuri, Sriharish Vankayalapati, Rahul Koduri, Sandeep Satyanarayan

Neurology India 2017 65(5):1146-1148

http://ift.tt/2gOLyx7

Dr. Harry M. Zimmerman (1901 – 1995): Neuropathologist who autopsied Dr. Harvey Cushing, and his interactions with Indian colleagues

Sunil K Pandya, SK Shankar

Neurology India 2017 65(5):948-963

http://ift.tt/2gMwcZH

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Τετάρτη 6 Σεπτεμβρίου 2017

Abstract

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Graphical abstract

Αρχειοθήκη ιστολογίου