The etiology of scrotal pain is clinically classified in terms of the necessity for emergency surgery. Lately, color Doppler ultrasonography has reduced unnecessary surgeries, but there are still some cases that require immediate exploration because of an uncertain diagnosis. Here, we describe the case of a 14-month-old boy, who could not deliver his complaint accurately, presenting with a grumpy mood and a red swollen scrotum. Emergency surgery revealed that the cause was intense inflammation of the hydrocele wall, which typically does not cause acute scrotum. We also reviewed rare etiologies of scrotal pain for general physicians to develop the differential diagnosis.
http://ift.tt/2C3oG1M
Τετάρτη 7 Φεβρουαρίου 2018
Unusual Cause of Acute Scrotal Pain-Inflammatory Noncommunicating Hydrocele: A Pediatric Case Report
Imatinib-induced diffuse hyperpigmentation of the oral mucosa, the skin, and the nails in a patient affected by chronic myeloid leukemia: report of a case and review of the literature
Abstract
Background
Imatinib mesylate is a tyrosine-kinase inhibitor used as the first-line treatment in chronic myeloid leukemia patients, but it is also indicated for other hematological diseases and solid tumors. Imatinib treatment is often associated with hypopigmentation, but only a few cases of hyperpigmentation are described in literature.
Methods
We are reporting the first case of imatinib-related hyperpigmentation involving the oral mucosa, skin, and nails in a patient affected by chronic myeloid leukemia and treated with imatinib since 2002. A review of all the available literature regarding the imatinib-related hyperpigmentation was performed, and one additional case was analyzed. Due to the possibility of a post-inflammatory hyperpigmentation, all cases of pigmentary changes previously characterized by a rash and/or pruritus in the same body areas were excluded.
Results
Thirty cases of well-documented imatinib-related hyperpigmentation were described in literature. In our case, imatinib therapy was well tolerated for several years, and it led to an excellent hematological and cytogenetic response. However, the patient gradually developed a blue-gray pigmentation that involved the nose, fingernails, toenails, pretibial regions, posterior axillary folds, and hard palate. Other causes of pigmentary changes were excluded, and histopathological examination confirmed the clinical suspicion of imatinib-related hyperpigmentation.
Conclusions
Hyperpigmentation induced by imatinib is an adverse reaction rarely described in literature. The underlying pathogenetic mechanisms are not yet completely clear, and further studies are necessary to elucidate them. Currently, no treatment is required for this condition, and there is no indication to discontinue imatinib treatment.
http://ift.tt/2nRWGZP
Treatment efficacy of probiotics on atopic dermatitis, zooming in on infants: a systematic review and meta-analysis
Abstract
Probiotic treatment of atopic dermatitis is widely studied with controversial results. The objective of this study is to review the efficacy of probiotics for the treatment of atopic dermatitis in infants. PubMed, Embase, and Cochrane Central Register of Controlled Trials databases, and reference lists were searched up to July 2017. Double-blinded randomized clinical trials were included. The primary outcome was the Scoring Atopic Dermatitis index. Subgroups analyses were conducted on probiotic species, treatment duration, participant age, and disease severity. Eight clinical trials (741 infants) were included in the quantitative synthesis. The overall pooled change in Scoring Atopic Dermatitis index (95% CI) in infants was −5.71 (−8.37, −3.04), P < 0.01. Subgroup analysis revealed that the effect was protective in moderate-to-severe patients −8.32 (−16.35, −0.28), with preparations containing Lactobacillus −5.76 (−9.21, −2.30). Probiotics for the treatment of infantile atopic dermatitis is beneficial.
http://ift.tt/2nO10Kn
Toxicity and growth inhibition potential of vetiver, cinnamon, and lavender essential oils and their blends against larvae of the sheep blowfly, Lucilia sericata
Abstract
Background
Myiasis induced by the sheep blowfly, Lucilia sericata, represents a public health problem widely distributed throughout the world. L. sericata larval stages feed on both humans and animals. L. sericata adults and larvae can play a role in spreading agents of mycobacterial infections.
Objectives
It is critical to establish new and safe alternative methods of controlling L. sericata.
Methods
The insecticidal effectiveness and growth inhibition potential of three commercially available essential oils (EOs), vetiver (Chrysopogon zizanioides), cinnamon (Cinnamomum zeylanicum), and lavender (Lavandula angustifolia), as well as their blends, were tested against the second (L2) and third (L3) larval stages of L. sericata. Sunflower (Helianthus annuus) oil was used as a carrier and tested on L2 and L3 larvae. To the best of our knowledge, all applied essential oils, except lavender, and oil blends were tested against L. sericata for the first time.
Results
All applied oils did not repel L2 from the treated liver but adversely affected their development. Contact treatments on L. sericata L3 indicated that vetiver and cinnamon oils significantly affected treated larvae. Total mortality rates were 93.33 and 95.56%, respectively. Furthermore, oil blends tested through contact assays killed larvae when used at higher concentrations; adult emergence was eliminated post-treatment with doses >30% for oil blend 1 and >10% for oil blend 2.
Conclusion
Overall, cinnamon and vetiver oils (5%) were selected as reliable and cheap biopesticides for controlling larvae of L. sericata. The tested oils are inexpensive and represent new promising botanical insecticides in the fight against blowflies causing myiasis.
http://ift.tt/2nS20w8
Development of a new adsorbent from pumpkin husk by KOH-modification to remove copper ions
Abstract
Heavy metal pollution in watercourses is a major environmental problem throughout the world due to rapid population growth, industrialization, and economic development. Considering this, the present study aimed to develop a new adsorbent from pumpkin husk (PH) by KOH modification to remove copper (Cu2+) ions and to explore its adsorptive potential. The sorption studies of Cu2+ on KOH-modified PH were carried out as functions of particle size, solution pH, adsorbent dose, temperature, initial metal concentration, and contact time. The sorption capacity of KOH-modified PH was found to be higher than that of raw PH, as 19.4 and 10.2 mg g−1, respectively. Morphology and surface structures of adsorbents were characterized by determination of zero point charge, a Fourier transform infrared spectrometer (FTIR–ATR) spectra, and a scanning electron microscopy (SEM) of PH powders before and after the sorption of Cu2+. The pHzpc of PH was found to be 5.0. FTIR–ATR analyses indicated that amino, amide, hydroxyl, carboxyl, and oxygenated groups of PH play an important role in the sorption process. Sorption isotherm, kinetic, and thermodynamic parameters of Cu2+ on KOH-modified PH were studied. The kinetic process was well represented by the Logistic model. The maximum sorption was found as 73.16 mg g−1 according to the well-fitting of Langmuir isotherm. Results of sorption and thermodynamic studies indicated that the process was exothermic, being feasible, and spontaneous. KOH-modified PH as an eco-friendly adsorbent had great potential to remove Cu2+ ions from aquatic system.
http://ift.tt/2Bhax44
Postoperative chemoradiotherapy in patients with head and neck cancer aged 70 or older with positive margins or extranodal extension and the influence of nodal classification
Abstract
Background
Postoperative concomitant chemoradiotherapy (CRT) improves outcomes for younger adults with head and neck squamous cell carcinoma (HNSCC) and positive margins or extranodal extension (ENE), but its benefit for older adults is not well established.
Methods
Patients from the National Cancer Data Base (NCDB) with HNSCC undergoing curative-intent resection, neck dissection, and postoperative radiation with positive margins or ENE were identified.
Results
This analysis included 1199 patients aged ≥ 70 years with median follow-up of 42.6 months. Postoperative concurrent CRT was associated with improved overall survival (OS; hazard ratio [HR] 0.752; 95% confidence interval [CI] 0.638-0.886) compared to radiation alone in multivariable analysis. Three-year OS was 52.4% with CRT versus 43.4% with radiation (P = .012) in propensity-score matched cohorts. The survival impact of CRT varied by N classification (P = .002 for interaction), with benefit seen only in those with N2 to N3 disease.
Conclusion
Postoperative concurrent CRT may benefit older patients with HNSCC with positive margins or ENE, particularly those with higher nodal burden.
http://ift.tt/2E9tJiY
Prevalence of adverse pathological features in 1 to 4 cm low-risk differentiated thyroid carcinoma
Abstract
Background
The American Thyroid Association (ATA) recommends thyroid lobectomy for 1 to 4 cm tumors without adverse features. We studied the prevalence of adverse pathological features in patients eligible for unilateral lobectomy.
Methods
We conducted a retrospective study of patients who underwent total thyroidectomy. Patients with differentiated thyroid cancer (DTC) with tumors measuring 1 to 4 cm with no known preoperative adverse features were included in this study. Patients with nodal and distant metastasis, tumors <1 cm to > 4 cm, age < 17 years old, and gross extrathyroidal extension were excluded. Patients with bilateral nodularity on imaging were excluded from the final analysis on adverse features.
Results
There were 59.1% of patients undergoing thyroidectomy with tumors measuring 1 to 4 cm and no preoperatively known adverse features who were eligible for lobectomy under current ATA guidelines who would have needed a completion thyroidectomy after pathological analysis of the index tumor.
Conclusion
Two thirds of the patients may require a completion thyroidectomy if unilateral lobectomy is done in tumors measuring 1 to 4 cm based on adverse pathological features.
http://ift.tt/2ELgSEB
Quality of life during the first year after partial laryngectomy: Longitudinal study
Abstract
Background
This prospective study was conducted to assess changes in quality of life (QOL) of patients who undergo a partial laryngectomy.
Methods
The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires Core and Head and Neck (EORTC-QLQ-C30, QLQ-H&N35) were used preprocedure (n = 218), 1 week (n = 159), 3 months (n = 122), and 1 year after partial laryngectomy (n = 88). Changes over time were analyzed with the Wilcoxon signed rank test and the Holm-Bonferroni method, and interpreted regarding clinical relevance.
Results
Most subscales worsened 1 week postprocedure, but many recovered to baseline level after 1 year. Dyspnea and cognitive functioning deteriorated over time, with worst scores recorded after 1 year. Financial difficulties and fatigue increased after surgery and maintained that level throughout the follow-up period; sticky saliva remained worse than at baseline, despite some improvements over time.
Conclusion
The discovered limitations of QOL should be observed more closely during follow-up treatment, and patients should be informed about these potential effects before partial laryngectomy.
http://ift.tt/2E9tCUA
Thyroidectomy in patients who have undergone gastric bypass surgery
Abstract
Background
Morbid obesity is a chronic condition that may be challenging to treat. Gastric bypass surgery is used to treat morbid obesity and its complications. Hypocalcemia, a known complication after thyroidectomy, is usually transient and treatable. There is a growing body of literature indicating that patients with previous gastric bypass surgery are at an increased risk for recalcitrant, symptomatic hypocalcemia after thyroidectomy. The management of hypocalcemia in patients with prior gastric bypass surgery may be exceedingly difficult.
Methods
Relevant articles published between 2008 and January 2017 were reviewed by topic. The review of literature was conducted using a systematic search of database resources, such as PubMed and EMBASE.
Results
Prior gastric bypass surgery may be an independent risk factor for developing profound hypocalcemia after thyroid surgery.
Conclusion
Refractory hypocalcemia in patients who have undergone gastric bypass surgery is underreported. Careful consideration should be given to performing staged thyroidectomy and, in some cases, reversal of the bariatric surgery.
http://ift.tt/2ENyi3p
Role of adjuvant chemoradiotherapy in T4N0 stage IV head and neck cancer: A National Cancer Database analysis
Abstract
Background
The purpose of this study was to evaluate the role of postoperative adjuvant radiotherapy (surgery + adjuvant RT) versus adjuvant chemoradiotherapy (surgery + adjuvant CRT) in patients with T4N0M0, stage IV head and neck squamous cell carcinoma (HNSCC).
Methods
Between 1998 and 2011, 3518 and 885 patients were treated with surgery + adjuvant RT and surgery + adjuvant CRT, respectively. Three-year overall survival (OS) rates were determined and crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were computed.
Results
Median follow-up was 41.8 months with 2193 reported deaths. The 3-year OS was 67.5% for surgery + adjuvant RT and 70.5% for surgery + adjuvant CRT (P = .013). For negative margins, the corresponding 3-year OS was 70.1% and 74.9% (P = .005). For positive margins, the corresponding 3-year OS was 56.0% and 60.6% (P = .079). On multivariate analysis, the beneficial effect for adjuvant CRT over adjuvant RT was not significant (HR 0.90; CI 0.79-1.03; P = .124).
Conclusion
In this cohort of patients with T4N0 HNSCC treated with surgery, there was no observed survival benefit of adjuvant CRT over adjuvant RT on multivariate analysis.
http://ift.tt/2E8JbvO
Glycan distribution and density in native skin's stratum corneum
Abstract
Background
The glycosylation of proteins on the surface of corneocytes is believed to play an important role in cellular adhesion in the stratum corneum (SC) of human skin. Mapping with accuracy the localization of glycans on the surface of corneocytes through traditional methods of immunohistochemistry and electron microscopy remains a challenging task as both approaches lack enough resolution or need to be performed in high vacuum conditions.
Materials and methods
We used an advanced mode of atomic force microscope (AFM), with simultaneous topography and recognition imaging to investigate the distribution of glycans on native (no chemical preparation) stripped samples of human SC. The AFM cantilever tips were functionalized with anti-heparan sulfate antibody and the lectin wheat germ agglutinin (WGA) which binds specifically to N-acetyl glucosamine and sialic acid.
Results
From the recognition imaging, we observed the presence of the sulfated glycosaminoglycan, heparan sulfate, and the glycans recognized by WGA on the surface of SC corneocytes in their native state. These glycans were found associated with bead-like domains which represent corneodesmosomes in the SC layers. Glycan density was calculated to be ~1200 molecules/μm2 in lower layers of SC compared to an important decrease, (~106 molecules/μm2) closer to the surface due probably to corneodesmosome degradation.
Conclusion
Glycan spatial distribution and degradation is first observed on the surface of SC in native conditions and at high resolution. The method used can be extended to precisely localize the presence of other macromolecules on the surface of skin or other tissues where the maintenance of its native state is required.
http://ift.tt/2nJDI8f
Early development of the enteric nervous system visualized by using a new transgenic zebrafish line harboring a regulatory region for choline acetyltransferase a (chata) gene
Source:Gene Expression Patterns, Volume 28
Author(s): Masataka Nikaido, Saki Izumi, Honoka Ohnuki, Yuki Takigawa, Kyo Yamasu, Kohei Hatta
The enteric nervous system (ENS) is the largest part of the peripheral nervous system in vertebrates. Toward the visualization of the development of the vertebrate ENS, we report our creation of a new transgenic line, Tg(chata:GGFF2) which has a 1.5-kb upstream region of the zebrafish choline acetyltransferase a (chata) gene followed by modified green fluorescent protein (gfp). During development, GFP + cells were detected in the gut by 60 h post-fertilization (hpf). In the gut of 6- and 12-days post-fertilization (dpf) larvae, an average of 92% of the GFP + cells were positive for the neuronal marker HuC/D, suggesting that GFP marks enteric neurons in this transgenic line. We also observed that 66% of the GFP + cells were choline acetyltransferase (ChAT)-immunopositive at 1.5 months. Thus, GFP is expressed at the larval stages at which ChAT protein expression is not yet detected by immunostaining. We studied the spatiotemporal pattern of neural differentiation in the ENS by live-imaging of this transgenic line. We observed that GFP + or gfp + cells initially formed a pair of bilateral rows at 60 hpf or 53 hpf, respectively, in the migrating enteric neural crest cells. Most of the GFP + cells did not migrate, and most of the new GFP + cells were added to fill the space among the previously formed GFP + cells. GFP expression reached the anus by 72 hpf. New GFP + cells then also appeared in the dorsal and ventral sides of the initial GFP + rows, resulting in their distribution on the entire gut by 4 dpf. A small number of new GFP + cells were found to move among older GFP + cells just before the cells stopped migration, suggesting that the moving GFP + cells may represent neural precursor cells searching for a place for the final differentiation. Our data suggest that the Tg(chata:GGFF2) line could serve as a useful tool for studies of enteric neural differentiation and cell behavior.
http://ift.tt/2EcBE2X
Oxygen-induced alterations in the expression of chromatin modifying enzymes and the transcriptional regulation of imprinted genes
Source:Gene Expression Patterns, Volume 28
Author(s): William M. Skiles, Avery Kester, Jane H. Pryor, Mark E. Westhusin, Michael C. Golding, Charles R. Long
Embryo culture and assisted reproductive technologies have been associated with a disproportionately high number of epigenetic abnormalities in the resulting offspring. However, the mechanisms by which these techniques influence the epigenome remain poorly defined. In this study, we evaluated the capacity of oxygen concentration to influence the transcriptional control of a selection of key enzymes regulating chromatin structure. In mouse embryonic stem cells, oxygen concentrations modulated the transcriptional regulation of the TET family of enzymes, as well as the de novo methyltransferase Dnmt3a. These transcriptional changes were associated with alterations in the control of multiple imprinted genes, including H19, Igf2, Igf2r, and Peg3. Similarly, exposure of in vitro produced bovine embryos to atmospheric oxygen concentrations was associated with disruptions in the transcriptional regulation of TET1, TET3, and DNMT3a, along with the DNA methyltransferase co-factor HELLS. In addition, exposure to high oxygen was associated with alterations in the abundance of transcripts encoding members of the Polycomb repressor complex (EED and EZH2), the histone methyltransferase SETDB1 and multiple histone demethylases (KDM1A, KDM4B, and KDM4C). These disruptions were accompanied by a reduction in embryo viability and suppression of the pluripotency genes NANOG and SOX2. These experiments demonstrate that oxygen has the capacity to modulate the transcriptional control of chromatin modifying genes involved in the establishment and maintenance of both pluripotency and genomic imprinting.
http://ift.tt/2C3tAvG
Strengthening and toughening austenitic steel by introducing gradient martensite via cyclic forward/reverse torsion
Publication date: 5 April 2018
Source:Materials & Design, Volume 143
Author(s): Ning Guo, Zhimin Zhang, Qingshan Dong, Hongbing Yu, Bo Song, Linjiang Chai, Cong Liu, Zhongwen Yao, Mark R. Daymond
Converting austenite to martensite is a very effective and low-cost strategy for steel strengthening, but it results in a significant loss of ductility. In this study, we propose a novel method which simultaneously strengthens and toughens austenitic steels by introducing a gradient of martensite phase. We find that a gradient of deformation-induced martensite (α′-M) particles, with a volume fraction increasing from core to surface can be obtained in cylindrical AISI 304 stainless steel (304 SS) rods by applying free-end-torsion (FET). We compared the microstructures and tensile properties of gradient-structured 304 SS prepared by unidirectional-torsion (UT) and cyclic forward/reverse torsion (CFRT). It appears that piled-up dislocations formed near the core region during FET processing play a key role in the subsequent tensile deformation, and control the strain-hardening ability of the FET treated samples. The gradient α′-M enhances the strength of the surface layer and improves the tensile properties of the FET treated samples as a whole. Compared to UT, CFRT is more effective in inducing martensitic transformation, and enhances the gradient distribution of the α′-M. These findings provide a pathway for developing high strength and good ductility steels and other alloyed metals via gradient distributed second phase particles.
Graphical abstract
http://ift.tt/2C36cON
Effect of layer sequence on the mechanical properties of Ti/TiAl laminates
Publication date: 5 April 2018
Source:Materials & Design, Volume 143
Author(s): Shaoyuan Lyu, Yanbo Sun, Guodong Li, Wenlong Xiao, Chaoli Ma
The Ti/TiAl metal-intermetallic laminates were fabricated by hot-pressing starting from the elemental Ti and Al foils. The final microstructures of laminates consist of alternating layers of ductile Ti and brittle intermetallic. The relationships between mechanical properties and layer sequence of Ti/TiAl laminates have been studied by examining the effects of solid solubility of Al in Ti layer, the volume fraction of intermetallic layer and the interlayer spacing. In these three cases, the samples with the best performance are obtained and among them the optimal sample is confirm with fracture strength 752MPa, KIC 48MPa·m1/2. In particularly, a novel theoretical formula of strength calculation is proposed according to the mixing rule of composites. The theoretically calculated results agree well with the experimental results.
Graphical abstract
http://ift.tt/2EbGH3X
The controllable preparation of Co3O4 nanostructure for designing optimal mechanical and magnetic properties of graphite/kaolin based compounds
Publication date: 5 April 2018
Source:Materials & Design, Volume 143
Author(s): Keyun Zhang, Jiujie Zhang, Lili Ma, Yanqin Liang, Xianjin Yang, Zhenduo Cui, Shengli Zhu, Zhaoyang Li
Low heating efficiency of graphite crucible limits the application in electromagnetic induction heating system because of the diamagnetism of graphite. In the present work, Co3O4 nanostructures were successfully prepared by means of a hydrothermal method, and introduced them into graphite and kaolin as raw material of crucible to improve their electromagnetic heating efficiency. The morphology of Co3O4 was adjusted by introducing silk fibroin. The microstructures and morphology of the silk-fibroin-Co3O4 composites were characterized by XRD, SEM, TEM, and Raman. The magnetic and mechanical properties of these compounds were also evaluated. Adding silk fibroin can optimize the morphology of Co3O4 and increase its magnetism. The addition of Co3O4 calcined at 350°C (with silk fibroin) to graphite increases its magnetism without sacrificing its compressive strength. Co3O4/graphite/kaolin (5:3:2) compounds show desired magnetic and mechanical properties.
Graphical abstract
http://ift.tt/2C5bc5A
Thermal conductivity enhancement of phase change materials with form-stable carbon bonded carbon fiber network
Publication date: 5 April 2018
Source:Materials & Design, Volume 143
Author(s): Zhao Jiang, Ting Ouyang, Yang Yang, Lei Chen, Xiaohua Fan, Yunbo Chen, Weiwei Li, Youqing Fei
Carbon bonded carbon fiber (CBCF) monoliths were prepared from graphite fibers with high thermal conductivity, to promote heat transfer and to stabilize the shape of phase change material (PCM). The CBCF monoliths with density from 0.09 to 0.39g/cm3 were filled with paraffin wax to form PCM composites. Due to the anisotropy of the CBCF material, the PCM composites had varied thermal conductivities with their directions. Results showed that the in-plane thermal conductivity of the PCM composites was markedly improved by 18 to 57 times over the pure wax, depending on the density of CBCF composites, while the out-of-plane thermal conductivity was also increased by 3.7 to 5.5 times. In addition, the improvements in thermal conductivity showed almost linear relationship with the volume fraction of carbon fibers in the PCM composites. The charging time of the composites with the high CBCF density was reduced to one quarter of pure paraffin, while the discharging time was about one sixth. The apparent enthalpy of PCM composites was found to vary with the loadings of paraffin wax, by differential scanning calorimetry (DSC). After 40cycles, the wax loadings in the PCM composites were retained at 56–70%.
Graphical abstract
http://ift.tt/2EaVqvU
An Enhanced Recovery after Surgery Pathway for Microvascular Breast Reconstruction Is Safe and Effective
Background: The aim of this study was to develop, implement, and evaluate a standardized perioperative enhanced recovery after surgery (ERAS) clinical care pathway in microsurgical abdominal-based breast reconstruction. Methods: Development of a clinical care pathway was informed by the latest ERAS guideline for breast reconstruction. Key features included shortened preoperative fasting, judicious fluids, multimodal analgesics, early oral nutrition, early Foley catheter removal, and early ambulation. There were 3 groups of women in this cohort study: (1) traditional historical control; (2) transition group with partial implementation; and (3) ERAS. Narcotic use, patient-reported pain scores, antiemetic use, time to regular diet, time to first walk, hospital length of stay, and 30-day postoperative complications were compared between the groups. Results: After implementation of the pathway, the use of parenteral narcotics was reduced by 88% (traditional, 112 mg; transition, 58 mg; ERAS, 13 mg; Phttp://ift.tt/2E9sMHk
Incisional Negative Pressure Wound Therapy for Prevention of Wound Healing Complications Following Reduction Mammaplasty
Background: It has been proposed that negative pressure wound therapy (NPWT) applied prophylactically to a closed incision may decrease the incidence of wound complications. Patients undergoing reduction mammaplasty are at risk of wound complications such as delayed healing, infection, and dehiscence, and the bilateral nature of the surgery allows for a within-patient randomized study to evaluate incisional NPWT's effect in reducing healing complications. Methods: In this multicenter trial, 200 patients undergoing bilateral reduction mammaplasty were treated with PICO Single-Use NPWT System or standard wound-care dressings randomized to right or left breast for up to 14 days to enable within-patient comparison. Follow-up assessments were conducted to evaluate the difference in incision healing complications up to 21 days postsurgery. Healing complications (for the primary endpoint) were defined as delayed healing (incision not 100% closed by 7 days) and occurrence of dehiscence or infection within 21 days. Individual healing complications were assessed separately as secondary endpoints. Results: Significantly fewer healing complications (primary endpoint) were noted in NPWT-treated breasts [113 (56.8%)] versus standard care [123 (61.8%)]. The difference of 10 (5.0%) patients with fewer healing complications using NPWT was statistically significant (P = 0.004). NPWT also resulted in a significantly lower incidence of dehiscence (secondary endpoint) compared with standard care [32 patients (16.2%) versus 52 patients (26.4%)] by day 21, a relative reduction of 38% (Phttp://ift.tt/2EKZ901
Successful Hand Replantation in a Case of Total Avulsion without Vein Graft
Summary: Replantation is the reattachment of a severed body part, with attempts to restore neurovascular and musculoskeletal integrity, function, and aesthetics. On September 7, 1964, the first extremity replantation—a completely amputated hand—by vascular anastomosis technique was successfully performed.1 Soon after, the first replantation of a complete thumb amputation using microvascular anastomosis in a human was successfully conducted by Komatsu et al.2 in 1968. The overall success rate of limb replantation surgery is around 83.2%.3 The mechanism of injury plays a role in the outcome; guillotine amputations—for example—carry a better prognosis than crush amputations.4 We present a case report of a 36-year-old male patient who presented with a total avulsion of the right hand with multiple fracture levels at the level of trans-carpal, distal radius extra-articulation fracture, and total avulsion of the hand. The patient was managed by a multidisciplinary team who were able to reattach his hand successfully with good functional outcome.http://ift.tt/2EcI8L2
Single-Stage Breast Reconstruction Using an All-In-One Adjustable Expander/Implant
Background: When tissue expansion is necessary in breast reconstruction, a single-stage approach is possible using adjustable expander/implants, with or without the use of acellular dermal matrix. We aimed to present the senior author's single-stage experience over a period of 12 years using combined expander/implants in breast reconstruction. Methods: This is a Single-institution, retrospective review of breast reconstruction with combined expander/implants from 2002 to 2014. Logistic regression was performed to evaluate the impact of multiple variables on long-term outcomes. Results: A total of 162 implants in 105 patients were included in this study. Mean follow-up time was 81.7 months (SD, ± 39.2; range, 15–151). Complication rates were as follows: 0.62% extrusion, 1.2% mastectomy flap necrosis, 1.2% hematoma, 1.9% dehiscence, 2.5% seroma, 4.9% infection, and 15.4% deflation. The following associations were identified by logistic regression: adjuvant radiotherapy and capsular contracture (P = 0.034), tumor size and deflation (P = 0014), and smoking history and infection (P = 0.013). Conclusions: Overall, 81% of breasts were successfully reconstructed in a single stage. Single-stage reconstruction using all-in-one expander/implants reduces costs by eliminating the need for a second procedure under general anesthesia and can achieve results comparable with other alloplastic reconstructions reported in the literature.http://ift.tt/2EOKIIh
Dimensional Error in Rapid Prototyping with Open Source Software and Low-cost 3D-printer
Summary: Rapid prototyping models (RPMs) had been extensively used in craniofacial and maxillofacial surgery, especially in areas such as orthognathic surgery, posttraumatic or oncological reconstructions, and implantology. Economic limitations are higher in developing countries such as Mexico, where resources dedicated to health care are limited, therefore limiting the use of RPM to few selected centers. This article aims to determine the dimensional error of a low-cost fused deposition modeling 3D printer (Tronxy P802MA, Shenzhen, Tronxy Technology Co), with Open source software. An ordinary dry human mandible was scanned with a computed tomography device. The data were processed with open software to build a rapid prototype with a fused deposition machine. Linear measurements were performed to find the mean absolute and relative difference. The mean absolute and relative difference was 0.65 mm and 1.96%, respectively (P = 0.96). Low-cost FDM machines and Open Source Software are excellent options to manufacture RPM, with the benefit of low cost and a similar relative error than other more expensive technologies.http://ift.tt/2E8qqbS
Immediate Breast Reconstruction among Patients with Medicare and Private Insurance: A Matched Cohort Analysis
Background: By eliminating economic hurdles, the Women's Health and Cancer Rights Act of 1998 represented a paradigm shift in the availability of breast reconstruction. Yet, studies report disparities among Medicare-insured women. These studies do not account for the inherent differences in age and comorbidities between a younger privately insured and an older Medicare population. We examined immediate breast reconstruction (IBR) utilization between a matched pre- and post-Medicare population. Methods: Using the Nationwide Inpatient Sample database (1992–2013), breast cancer patients undergoing IBR were identified. To minimize confounding medical variables, 64-year-old privately insured women were compared with 66-year-old Medicare-insured women. Demographic data, IBR rates, and complication rates were compared. Trend over time was plotted for both cohorts. Result: A total of 21,402 64-year-old women and 25,568 66-year-old women were included. Both groups were well matched in terms of demographic type of reconstruction and complication rates. 72.3% of 64-year-old and 71.2 of % 66-year-old women opted for mastectomy. Of these, 25.5% (n = 3,941) of 64-year-old privately insured and 17.7% (n = 3,213) of 66-year-old Medicare-insured women underwent IBR (Phttp://ift.tt/2EPPsxE
Use of Viable Cryopreserved Placental Membrane as an Adjunct to Facial Keloid Resection
Summary: Keloids are the physical manifestation of an exaggerated inflammatory response resulting in excess collagen deposition. The resulting fibroproliferative mass can be distressing for patients due to appearance, pruritus, and/or pain. Despite extensive research into the pathophysiology of keloid formation and the development of numerous treatments, keloids remain a challenge to treat. Even when the initial treatment is successful, a risk of recurrence remains. Basic science research into viable cryopreserved placental membranes and viable cryopreserved umbilical tissue has demonstrated their anti-inflammatory and anti-fibrotic effects, which may decrease keloid recurrence after excision. In this article, we present the first-reported case of viable cryopreserved placental membrane, with living mesenchymal stem cells, to treat a painful preauricular keloid in conjunction with surgical resection.http://ift.tt/2Ea4rRQ
The Pedicled LICAP Flap Combined with a Free Abdominal Flap In Autologous Breast Reconstructions
Background: Previous surgery or slim body configuration can limit the size of the available abdominal flap in autologous breast reconstruction. However, redundant skin and subcutaneous tissue lateral to the mastectomy site can be utilized as the pedicled lateral intercostal artery perforator (LICAP) flap. This study evaluates the combination of a free abdominal flap and a pedicled LICAP flap to achieve increased breast size and improved cosmetic outcome. Methods: Patients undergoing secondary autologous breast reconstruction were included in a prospective study. The combination with a LICAP flap was used for women with insufficient abdominal flap tissue in relation to the desired breast size. The authors also assessed their modification of the original lateral thoracodorsal flap design to improve the aesthetic outcome. Results: In 109 patients, 121 free abdominal flaps were performed. The combination with a pedicled LICAP flap was used in 82 free abdominal flap reconstructions (68%). The LICAP flap provided additional volume and resulted in better projection and ptosis of the neo-mamma. The overall complication rate for the LICAP flaps was 26 %; all minor complications. Despite combining flaps, the majority of patients needed additional surgery to improve breast symmetry. Breast reduction of the native breast was the most common symmetrizing procedure. Conclusion: In selected patients with insufficient abdominal flap tissue, a combination of a free abdominal flap and a pedicled LICAP flap is a valuable option to increase breast size and cosmetic outcome. Additional symmetrizing surgery might still be necessary.http://ift.tt/2EO2HyR
Adjuvant Therapy for Revision Rhinoplasty of Contracted Nose Using Polydeoxyribonucleotide and Invasive Bipolar Radiofrequency
Summary: Most cases of severely contracted nose require revision rhinoplasty and septoplasty, wherein preoperative and/or intraoperative expansion of nasal soft tissue is necessary for tension-free revision surgery. The present study aimed to evaluate the efficacy and safety of pre- and postoperative adjuvant therapy using polydeoxyribonucleotide (PDRN) and invasive, pulsed-type, bipolar, alternating current radiofrequency (RF) for revision surgery of a contracted nose. In total, 30 patients were treated with 16 sessions (8 preoperative sessions and 8 postoperative sessions) of intralesional injection of PDRN and invasive RF treatment using microneedle electrodes at 1-week intervals. One week after the final combined pretreatment using PDRN and invasive bipolar RF, the skin of contracted noses was sufficiently softened, and nasal skin mobility was notably improved in all the patients. During revision rhinoplasty and septoplasty, the contracted nasal skin in each patient was adequately released for proper covering of the nasal tip without tension. Postoperatively, 8 sessions of adjuvant therapy elicited marked clinical improvements in persistent nasal tip dimpling and contracture, septal deviation, and warping from the incomplete recovery of nasal contracture after revision surgery. In conclusion, our pre- and postoperative adjuvant therapies using PDRN and invasive bipolar RF remarkably improved the therapeutic outcomes of revision rhinoplasty and septoplasty for contracted skin of the nose without major side effects.http://ift.tt/2E8qg4g
Complications following Nipple-Sparing Mastectomy and Immediate Acellular Dermal Matrix Implant-based Breast Reconstruction—A Systematic Review and Meta-analysis
Background: Acellular dermal matrix was introduced in breast reconstruction in 2001 and is gradually becoming a standard component for immediate breast reconstruction and nipple-sparing mastectomy. The reconstructive technique allows for improved aesthetic outcomes. However, there seems to be uncertainty regarding complication rates. The aim of this review was to systematically evaluate complication rates related to this method. Methods: This systematic review was conducted according to the recommendations outlined in the Cochrane Handbook for reviews and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Relevant databases were searched for in the literature concerning the use of acellular dermal matrix in implant-based nipple-sparing mastectomy and immediate breast reconstruction. All studies underwent detailed quality assessment. Summarized outcome rates were computed using meta-analysis. Results: Nine of 1,039 studies were eligible for inclusion yielding 778 procedures. The quality was acceptable for all included studies. The meta-analysis found the rate of skin necrosis to be 11%, nipple necrosis 5%, infection in 12%, hematoma in 1%, treated seroma in 5%, explantation 4%, and unplanned return to the operating room in 9%. Conclusion: The use of acellular dermal matrix in nipple-sparing mastectomy and implant-based breast reconstruction can be done with acceptable complication rates in selected patients. We recommend future studies to include specific definitions when reporting complication rates. Furthermore, future studies should elaborate on demographic characteristics of the included study samples and include predictor analysis to enhance knowledge of high risk patients.http://ift.tt/2ERB3kB
V-shaped Internal Nasal Vestibular Flap for Reconstruction of Iatrogenic Columellar Defect
Summary: Columella is an important structure in the center of the face, and its structural integrity has an important functional, social, and psychological role. Columella reconstruction can be very challenging for surgeons and the ideal technique remains elusive. This article describes a reconstruction technique in a young woman with columella necrosis due to nasal continuous positive airway pressure treatment. The method of reconstruction described here, with a V-shaped internal nasal vestibular flap and a cartilage grafts from lateral crura, is simple and easily reproducible, providing an optimal aesthetic result and in addition the donor site does not create a secondary deformity by disrupting normal anatomy.http://ift.tt/2EaHUUM
Latissimus Dorsi and Immediate Fat Transfer (LIFT) for Complete Autologous Breast Reconstruction
Background: Despite the popularity of latissimus dorsi (LD) flap in breast reconstruction, a breast implant is often necessary to achieve sufficient volume. Prior reports describe fat grafting to the LD flap as a secondary procedure to correct contour deformities and improve volume. Our institution has instituted autologous breast reconstruction with an LD flap and immediate fat transfer (LIFT). Methods: A retrospective review of all patients undergoing the LIFT procedure was undertaken. Patient age, total volume of fat transfer, length of follow-up, need for adjuvant therapy, and complications were recorded. The procedure begins with harvest of the LD flap and fat. Prior to disorigination of the latissimus muscle, fat is injected into the flap. Flap harvest is then completed and inset to create a breast mound. Results: Eighteen patients underwent LIFT procedures over 3 years with an average follow-up of 8.7 months (range, 2–24). Four breasts (22.2%) had previously received adjuvant radiation therapy. The mean total fat grafting volume was 515.5 mL (range, 325–730) per breast. The average estimated fat graft take was 66.8% (range, 50–80%). Four patients (22.2%) experienced complications. Conclusion: Autologous augmentation of the LD flap with lipotransfer has been used to avoid placement of an implant. We improve the technique by performing lipotransfer during index reconstruction. Furthermore, we perform lipotransfer prior to disorigination of the LD muscle to minimize trauma to the flap and increase the efficiency of fat grafting. Our experience demonstrates that this technique is a viable autologous alternative to microsurgical breast reconstruction.http://ift.tt/2ENcJjF
Superficial Inferior Epigastric Artery Flap Salvage Technique Using Deep Inferior Epigastric Artery Graft
Summary: Superficial inferior epigastric artery (SIEA) flap salvage remains challenging, particularly in cases of arterial insufficiency due to vessel spasm, pedicle kinking, or thrombosis. The already small, short SIEA pedicle, in addition to its inherent tendency toward spasm, renders the SIEA flap more difficult to manage when anastomotic revision is required. Furthermore, arterial thrombosis will cause dilation of the internal mammary artery, exacerbating vessel mismatch. In our previously published experience with 145 SIEA flaps, no flap with postoperative arterial thrombosis was salvageable. Following this experience, a new salvage technique using deep inferior epigastric artery grafts has been utilized and is described here.http://ift.tt/2E9MR0m
Light-emitting Diode Transilluminator for the Identification of Recipient Veins in Finger Reconstruction
No abstract availablehttp://ift.tt/2Eavr3A
Earfold Implantable Clip System for Correction of Prominent Ears: Analysis of Safety in 403 Patients
Background: The Earfold system, a new treatment for the correction of prominent ears, consists of 3 components: the Earfold implant, the Earfold introducer, and the Prefold positioner. Methods: This is an interim report based on an ongoing analysis of safety in a series of patients treated for prominent ears with the Earfold implant between February 2013 and September 2014. Safety was assessed based on adverse event reports and the need for implant revision; follow-up is ongoing. Results: Seven surgeons used 1,200 Earfold implants to treat 403 patients (ages, 7–70 years; 63% male); the time since the initial implant procedure now ranges from 30 to 48 months. To date, 145 patients (36%) have returned for a follow-up visit (mean, 7.7 months [range, 1–34 months]). Adverse events requiring intervention have affected 39 of 403 (9.7%) patients; these include implant revisions (n = 17 [4.2%], most often due to implant visibility), skin erosion over the implant (n = 15 [3.7%]), and infection (n = 7 [1.7%]). Bleeding, recurrence of prominence, hematoma, deformity, or adverse scarring did not occur. Conclusions: This interim analysis has shown that Earfold prominent ear correction system is associated with relatively few adverse events that require intervention; a small number of patients experienced infection, implant extrusion, or implant visibility that required revision. Most adverse events were related to either patient selection or technical errors at implantation. It is expected that with continued use of Earfold by surgeons experienced in otoplasty, the adverse event incidence will decrease.http://ift.tt/2ERARSp
Virtual Surgical Planning: The Pearls and Pitfalls
Objective: Over the past few years, virtual surgical planning (VSP) has evolved into a useful tool for the craniofacial surgeon. Virtual planning and computer-aided design and manufacturing (CAD/CAM) may assist in orthognathic, cranio-orbital, traumatic, and microsurgery of the craniofacial skeleton. Despite its increasing popularity, little emphasis has been placed on the learning curve. Methods: A retrospective analysis of consecutive virtual surgeries was done from July 2012 to October 2016 at the University of Montreal Teaching Hospitals. Orthognathic surgeries and free vascularized bone flap surgeries were included in the analysis. Results: Fifty-four virtual surgeries were done in the time period analyzed. Forty-six orthognathic surgeries and 8 free bone transfers were done. An analysis of errors was done. Eighty-five percentage of the orthognathic virtual plans were adhered to completely, 4% of the plans were abandoned, and 11% were partially adhered to. Seventy-five percentage of the virtual surgeries for free tissue transfers were adhered to, whereas 25% were partially adhered to. The reasons for abandoning the plans were (1) poor communication between surgeon and engineer, (2) poor appreciation for condyle placement on preoperative scans, (3) soft-tissue impedance to bony movement, (4) rapid tumor progression, (5) poor preoperative assessment of anatomy. Conclusion: Virtual surgical planning is a useful tool for craniofacial surgery but has inherent issues that the surgeon must be aware of. With time and experience, these surgical plans can be used as powerful adjuvants to good clinical judgement.http://ift.tt/2E9sIY6
Reexploring the Anatomy of the Distal Humerus for its Role in Providing Vascularized Bone
Background: The lateral arm flap is used for composite defects in need of vascularized soft tissue, skin, and bone. From its original description, the distal humeral metaphysis can be included with the flap, supplied by the periosteal extensions of the posterior branch of the radial collateral artery. We sought to reexplore the anatomy of the lateral arm to determine its utility as a donor site for vascularized bone. Methods: Twelve fresh, silicone-injected cadaver dissections were performed. Arteriovenous anatomy, pedicle length and diameter, and anatomic variability as well as photo documentation was recorded. Results: The distal extent of the deltoid, lateral intermuscular septum and lateral humeral epicondyle were identified before the dissection. A septocutaneous perforator was consistently located 10 cm proximal to the lateral humeral epicondyle, which could be used for a skin paddle to monitor. Harvest of a 1.5 cm × 2 cm corticocancellous bone graft was performed. Average pedicle length was 9.1 ± 1.1 cm, and average pedicle diameter was 1.74 ± 0.52 mm. The inferior lateral cutaneous nerve of the arm and the posterior cutaneous nerve of the forearm were consistently identified and preserved. Conclusion: The predictable anatomy of the lateral distal humerus make it an ideal donor site for small segments of vascularized bone.http://ift.tt/2ERAMhz
Enhanced Preoperative Deep Inferior Epigastric Artery Perforator Flap Planning with a 3D-Printed Perforasome Template: Technique and Case Report
Summary: Optimizing preoperative planning is widely sought in deep inferior epigastric artery perforator (DIEP) flap surgery. One reason for this is that rates of fat necrosis remain relatively high (up to 35%), and that adjusting flap design by an improved understanding of individual perforasomes and perfusion characteristics may be useful in reducing the risk of fat necrosis. Imaging techniques have substantially improved over the past decade, and with recent advances in 3D printing, an improved demonstration of imaged anatomy has become available. We describe a 3D-printed template that can be used preoperatively to mark out a patient's individualized perforasome for flap planning in DIEP flap surgery. We describe this "perforasome template" technique in a case of a 46-year-old woman undergoing immediate unilateral breast reconstruction with a DIEP flap. Routine preoperative computed tomographic angiography was performed, with open-source software (3D Slicer, Autodesk MeshMixer and Cura) and a desktop 3D printer (Ultimaker 3E) used to create a template used to mark intra-flap, subcutaneous branches of deep inferior epigastric artery (DIEA) perforators on the abdomen. An individualized 3D printed template was used to estimate the size and boundaries of a perforasome and perfusion map. The information was used to aid flap design. We describe a new technique of 3D printing a patient-specific perforasome template that can be used preoperatively to infer perforasomes and aid flap design.http://ift.tt/2E8q7he
Atypical Melanocytic Proliferations: A Review of the Literature
BACKGROUND Ambiguous histopathologic diagnoses represent a challenge for clinicians because of a lack of definitive diagnosis and related uncertainty about management. OBJECTIVE To review the literature on atypical melanocytic proliferations and detail synonymous terms, epidemiology, diagnostic work-up, histopathology, treatment, and prognosis. METHODS Databases from PubMed and Web of Science were searched for articles related to atypical melanocytic proliferations. RESULTS Intraepidermal melanocytic proliferations with features worrisome for possible melanoma in situ (MIS) are generally excised as for MIS. Reported rates of upstaging of such cases to invasive melanoma on review of the excision are very low. Because invasion, lymph node spread, and metastasis can occur in atypical melanocytic lesions with a thick intradermal component, these are often treated as for malignant melanoma. CONCLUSION Because the diagnosis dictates treatment, it is incumbent to establish a diagnosis as definitive as possible, obtaining second or third opinions and using ancillary studies when appropriate. When the diagnosis remains uncertain, it is difficult to provide guidelines for treatment. Clinical care decisions for patients with an uncertain diagnosis are best done on a case-by-case basis weighing probabilities of adverse outcomes against potential benefits and risks from various treatment options.http://ift.tt/2Eabfmv
Pathologists' Use of Second Opinions in Interpretation of Melanocytic Cutaneous Lesions: Policies, Practices, and Perceptions
BACKGROUND Research examining the role of second opinions in pathology for diagnosis of melanocytic lesions is limited. OBJECTIVE To assess current laboratory policies, clinical use of second opinions, and pathologists' perceptions of second opinions for melanocytic lesions. MATERIALS AND METHODS Cross-sectional data collected from 207 pathologists in 10 US states who diagnose melanocytic lesions. The web-based survey ascertained pathologists' professional information, laboratory second opinion policy, use of second opinions, and perceptions of second opinion value for melanocytic lesions. RESULTS Laboratory policies required second opinions for 31% of pathologists and most commonly required for melanoma in situ (26%) and invasive melanoma (30%). In practice, most pathologists reported requesting second opinions for melanocytic tumors of uncertain malignant potential (85%) and atypical Spitzoid lesions (88%). Most pathologists perceived that second opinions increased interpretive accuracy (78%) and protected them from malpractice lawsuits (62%). CONCLUSION Use of second opinions in clinical practice is greater than that required by laboratory policies, especially for melanocytic tumors of uncertain malignant potential and atypical Spitzoid lesions. Quality of care in surgical interventions for atypical melanocytic proliferations critically depends on the accuracy of diagnosis in pathology reporting. Future research should examine the extent to which second opinions improve accuracy of melanocytic lesion diagnosis.http://ift.tt/2EbDtNT
Massively Metastatic Dermatofibrosarcoma Protuberans With Fibrosarcomatous Transformation Years After Surgical Resection
No abstract availablehttp://ift.tt/2C598dQ
Use of Google Trends to Examine Interest in Mohs Micrographic Surgery: 2004 to 2016
BACKGROUND Mohs micrographic surgery (MMS) is the gold standard for treatment of high-risk skin cancers. There has been an upward trend in the use of this procedure as demonstrated by data from Medicare and the National Ambulatory Medical Care Survey. OBJECTIVE To assess interest in MMS among members of the general public as measured by number of online searches, and how that interest has changed over time. MATERIALS AND METHODS Google Trends was used to plot interest in search terms including "Mohs surgery," "basal cell carcinoma," "squamous cell carcinoma," "melanoma," and "skin cancer" from January 1, 2004, to November 30, 2016. RESULTS Search interest for the term "Mohs surgery" has steadily increased since 2004 and correlates closely with increased interest for "basal cell carcinoma" (r = 0.82) and "squamous cell carcinoma" (r = 0.85). Search interest in MMS did not correlate well with searches for melanoma (r = −0.15) or skin cancer (r = −0.29). CONCLUSION Public interest in MMS has continued to steadily increase in the United States, which may be a reflection of the increasing volume of MMS that is performed.http://ift.tt/2EbdTs4
Clinical and Confocal Microscopy Study of Plasma Exeresis for Nonsurgical Blepharoplasty of the Upper Eyelid: A Pilot Study
BACKGROUND Plasma exeresis is an evolving technique for nonsurgical treatment of several skin conditions. Reflectance confocal microscopy (RCM) is a noninvasive tool that allows the "in vivo" imaging of the skin. OBJECTIVE To evaluate the clinical improvement and collagen remodeling of the upper eyelid dermatochalasis after plasma exeresis. METHODS Ten patients were subjected to 3 interventions of plasma exeresis. Photographic and RCM images were acquired at T0 (baseline) and T1 (4–6 weeks after final plasma exeresis). Eyelid dermatochalasis was rated as absent, mild, moderate, and severe according to the facial laxity rating scale, at clinical images at T0 and T1. An expert RCM evaluator classified collagen according to the predominant pattern of reticulated, coarse, huddled, or curled at T0 and T1. RESULTS Clinical improvement of 2.6 ratings was observed at clinical evaluation. Collagen was classified as long straight fibers in all cases, according to RCM images. CONCLUSION Plasma exeresis in this pilot study shows promising remodeling effects on the collagen of the upper eyelid, as viewed by RCM, and clinically improved appearance for the patient cohort, without any serious adverse events. This study suggests that plasma exeresis could be a valid solution for eyelid dermatochalasis, but further studies are required.http://ift.tt/2C587SU
Correlation Between Original Biopsy Pathology and Mohs Intraoperative Pathology
BACKGROUND The pathology observed on initial biopsy specimens for nonmelanoma skin cancer (NMSC), specifically the tumor subtype, weighs heavily into the selection of the treatment modality. Recognizing aggressive features on intraoperative Mohs micrographic surgery (MMS) frozen sections that were not indicated on initial biopsy reports is not uncommon. To date, there is limited data describing this discrepancy. OBJECTIVE To investigate the frequency and nature of incongruity between the pathology seen in initial biopsies and intraoperative Mohs sections, providing information that will potentially impact skin cancer treatment and biopsy recommendations. METHODS Retrospective chart review of cases of NMSC referred for MMS at the authors' institution over a 1-year period, recording changes between tumor subtypes observed at biopsy and those observed during MMS. RESULTS Cases (50.5%) (n = 163) changed aggressiveness. Of these, 33% (n = 108) were more aggressive, whereas 17% (n = 55) were less aggressive. CONCLUSION A substantial discrepancy was observed between preoperative biopsy and intraoperative pathology, including a significant portion tumors that became more aggressive. These results suggest that treatment modalities without margin control may not provide adequate treatment for a considerable number of NMSC based on preoperative tumor type alone.http://ift.tt/2Ecu1tl
Laser Hair Removal in Alopecia Areata of the Scalp: A Novel Therapeutic Approach
No abstract availablehttp://ift.tt/2C593a2
A Novel Mohs Precision Tool
BACKGROUND Effective treatment by Mohs micrographic surgery requires preparation of high-quality slides. OBJECTIVE To examine a novel tissue alignment device designed to address variability in tissue processing because of excessive sample trimming. MATERIALS AND METHODS A device was designed to account for angular errors and unparalleled tissue embedding. A retrospective chart review was performed both with and without the use of the device over the course of a 4-year period (2012–2015). RESULTS Between January 1, 2012, and June 10, 2014, before device implementation, mean number of stages per case was 1.65 (n = 3,680) and mean number of surgeries per day was 6.34 (n = 640). Between June 11, 2014, and October 02, 2015, with device implemented, the average number of stages per case between decreased to 1.58 (n = 2,562) and the number of daily surgeries increased to 7.05 (n = 358). This represents a significant decrease in number of stages per case by 0.07 stages (95% CI: −0.01 to −0.13, p = .02), as well as an increase in the number of cases per day by 0.71 cases (95% CI: 0.12–1.3, phttp://ift.tt/2E9VQmj
Rate of Surgical Site Infections With New Protocol of Prophylactic Antibiotic Use in Dermatologic Surgery
No abstract availablehttp://ift.tt/2C6JNAk
Mohs Melanoma Chemosurgery Simplified to a Single Brief Caustic Application: Possible Vaccine Effect
No abstract availablehttp://ift.tt/2C3S9IE
Novel Modality for Neck Rejuvenation: A Prospective Multicenter Trial of Percutaneous Radiofrequency Ablation of the Cervical Branch of the Facial Nerve
BACKGROUND Neck rejuvenation offers few modalities of treatments limited to either invasive plastic surgery or temporary neuromodulation using botulinum toxin. OBJECTIVE To access the efficacy, longevity, and safety of percutaneous monopolar radiofrequency (RF) ablation of the cervical branch of the facial nerve innervating the platysma for neck rejuvenation. MATERIALS AND METHODS This prospective, multicenter trial enrolled 19 adult patients with noticeable platysmal banding at 2 different centers. All patients underwent RF ablation on the cervical branch of the facial nerve. Response was assessed immediately after treatment and then at 1, 4, 12, and 24 weeks after the procedure using photography. Masked investigators compared baseline photography and follow-up intervals to evaluate the results. RESULTS Seventeen of the 18 patients had improvement in the platysmal banding. One patient was disqualified after ablation. Long-term sequalae such as scarring, burns, ulceration, hypopigmentation, or hyperpigmentation were not reported. CONCLUSION The results of this multicenter study support that RF ablation of the cervical branch of the facial nerve is a novel technique that results in improvement of platysmal banding. This technique is an emerging alternative, nonsurgical option for neck rejuvenation that is relatively safe, with little downtime for the patient.http://ift.tt/2Ea7RYV
The Cellular Response of Keloids and Hypertrophic Scars to Botulinum Toxin A: A Comprehensive Literature Review
BACKGROUND Keloids and hypertrophic scars are conditions of pathologic scarring characterized by fibroblast hyperproliferation and excess collagen deposition. These conditions significantly impact patients by causing psychosocial, functional, and aesthetic distress. Current treatment modalities have limitations. Clinical evidence indicates that botulinum toxin A (BoNT-A) may prevent and treat keloids and hypertrophic scars. OBJECTIVE To examine investigated cellular pathways involved in BoNT-A therapeutic modulation of keloids and hypertrophic scars. METHODS The authors searched PubMed, Embase, and Web of Science for basic science articles related to botulinum toxin therapy, scarring, fibroblasts, keloids, and hypertrophic scars. RESULTS Eleven basic science articles involving keloids and hypertrophic scars were reviewed. DISCUSSION BoNT-A may reduce skin fibrosis by decreasing fibroblast proliferation, modulating the activity of transforming growth factor-β, and reducing transcription and expression of profibrotic cytokines in keloid-derived and hypertrophic scar–derived dermal fibroblasts. BoNT-A may modulate collagen deposition, but there is a paucity of evidence regarding specific mechanisms of action. CONCLUSION Overall, BoNT-A has the potential to prevent or treat pathologic scars in patients with a known personal or family history of keloids and hypertrophic scars, which may improve patient psychosocial distress and reduce clinic visits and health care costs. Variability in keloid and hypertrophic scar response to BoNT-A may be due to interexperiment differences in dosing, tissue donors, and assay sensitivity.http://ift.tt/2C4fj1w
Prefrontal direct current stimulation in hoarding disorder: A case report
Source:Brain Stimulation
Author(s): Mirjam Handrack, Ulrich Voderholzer, Caroline Schwartz, Alkomiet Hasan, Frank Padberg, Ulrich Palm
http://ift.tt/2EnuOHn
Transcranial direct current stimulation unveils covert consciousness
Source:Brain Stimulation
Author(s): Aurore Thibaut, Camille Chatelle, Audrey Vanhaudenhuyse, Géraldine Martens, Helena Cassol, Charlotte Martial, Manon Carrière, Alice Barra, Steven Laureys, Olivia Gosseries
http://ift.tt/2sggpYG
Language and style: A barrier to neurosurgical research and advancement in Latin America.
Language and style: A barrier to neurosurgical research and advancement in Latin America.
Surg Neurol Int. 2017;8:308
Authors: Ashfaq A, Lazareff J
Abstract
Background: The neurosurgical burden in Latin America is understudied and likely underestimated, thus it is imperative to improve quality, training, and delivery of neurosurgical care. A significant aspect of this endeavor is for Latin America to become an integral aspect of the global neurosurgical community, however, there is a paucity of ideology and literature coming from Central and South America. We sought to explore neurosurgical dialogue originating from Latin America as well as barriers to the advancement of neurosurgery in this region.
Methods: We conducted a systematic literature review exploring research originating in Latin America in three international neurosurgical journals - Journal of Neurosurgery, Surgical Neurology International, and World Neurosurgery. We utilized PubMed search algorithms to identify articles. Inclusion criteria included publication within the three aforementioned journals, author affiliation with Latin American institutions, and publication within the specified time frame of January 2014 to July 2017.
Results: There were 7469 articles identified that met the search criteria. Of these 7469 articles, 326 (4.4%) were from Latin American nations.
Conclusion: Our data suggests a relatively low percentage of neurosurgical research originating from Latin America, suggesting a significant lack of participation in the global neurosurgical community. Barriers to global scientific communication include language, rhetorical style, culture, history, biases, funding, and governmental support. Despite challenges, Latin America is making strides towards improvement including the development of neurosurgical societies, as well as international collaborative training and research programs. We consider our report to be a valid initiation of discussion of the broader issue of neurosurgical communication.
PMID: 29404195 [PubMed]
http://ift.tt/2nLm04B
Perioperative malnutrition and its relationship to length of stay and complications in patients undergoing surgery for cervical myelopathy.
Perioperative malnutrition and its relationship to length of stay and complications in patients undergoing surgery for cervical myelopathy.
Surg Neurol Int. 2017;8:307
Authors: Guan J, Holland CM, Ravindra VM, Bisson EF
Abstract
Background: Surgical treatment of cervical myelopathy is common, and the impact of perioperative malnutrition in these patients is unclear; yet, malnutrition pre- and postoperatively has been associated with higher rates of wound infection in spine patients. We evaluated the association of low prealbumin level, a marker for poor nutrition, with length of hospitalization and complication rates after surgery for cervical myelopathy.
Methods: We retrospectively identified patients with cervical myelopathy who underwent anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, or posterior cervical decompression and fusion over a 5-year period. Patients' prealbumin levels were measured within 4 days of surgery; they were divided into low and normal groups (threshold 15 mg/dL). Demographic, clinical, operative, and postoperative parameters were correlated with prealbumin levels by utilizing univariate and multivariable analyses.
Results: Eighteen patients were in the "low prealbumin" group and 37 were in the "normal prealbumin" group. Patients with low prealbumin were significantly more likely to have an extended length of hospitalization/stay (LOS) (median 6 days, interquartile range 7.5 days vs. median 3 days, interquartile range 2 days, P < 0.001) and more postoperative complications (33% versus 0%, P < 0.001). Multivariable analysis revealed that only the low prealbumin category (P < 0.001) was associated with a prolonged LOS.
Conclusions: Low prealbumin levels were associated with prolonged LOS after surgery for cervical myelopathy. We need to better define the effects of malnutrition in patients with cervical myelopathy in the future.
PMID: 29404194 [PubMed]
http://ift.tt/2nRoi1b
Descent of the anterior communicating artery after removal of pituitary macroadenoma using transsphenoidal surgery.
Descent of the anterior communicating artery after removal of pituitary macroadenoma using transsphenoidal surgery.
Surg Neurol Int. 2017;8:306
Authors: Hayashi Y, Sasagawa Y, Fukui I, Oishi M, Kita D, Misaki K, Kozaka K, Tachibana O, Nakada M
Abstract
Background: After removal of pituitary macroadenoma, the anterior communicating artery (AComA) descends toward the original position. However, the process and contributing factors of this descent are not elucidated.
Methods: This retrospective study included 102 patients who underwent transsphenoidal surgery (TSS) for macroadenomas with maximum diameters of >2 cm. Sequential T2-weighted magnetic resonance images were used to assess the AComA flow void and its distance from the planum sphenoidale before and after TSS. The AComA position in relation to the adenoma was divided into four groups as follows: anterior, anterosuperior, superior, and posterior. The descent was compared to the presence of intratumoral hemorrhage or adenoma extension into the sphenoid sinus.
Results: One week after TSS, the AComA descent was more pronounced than when originally in the superior position (6.5 ± 3.7 mm vs 4.4 ± 3.5 mm, P < 0.0001). The postoperative descents of the AComA were well correlated with those of residual adenomas only when in the superior position (P = 0.030). The AComA descent was more significant at 1 week (4.4 ± 3.5 mm) than at 1 week to 3 months (0.7 ± 1.0 mm) in all the groups. Both intratumoral hemorrhage and sphenoid sinus extension of adenoma did not affect the AComA descent in each group.
Conclusion: AComA descent was most influenced when it was superior to the macroadenoma and progressed mostly within 1 week after TSS, probably initiating during TSS. The position of the AComA in relation to a macroadenoma should be considered preoperatively to avoid vascular injury.
PMID: 29404193 [PubMed]
http://ift.tt/2nOIUIn
Spinal cord herniation after brachial plexus injury.
Spinal cord herniation after brachial plexus injury.
Surg Neurol Int. 2017;8:305
Authors: Bamps S, Put E, Bruno T, Calenbergh FV
Abstract
Background: Spinal cord herniation (SCH) is an uncommon cause of myelopathy. Documented trauma is a rare cause, and most cases are idiopathic. One special type of trauma that may lead to SCH is a brachial plexus injury. We report a case of SCH with delayed neurological symptoms after a brachial plexus injury. We reviewed the literature and illustrated the closing technique as described by Batzdorf.
Case Description: Following a motor vehicle accident, a 27-year-old male sustained a brachial plexus injury and multiple left-sided nerve root avulsions (C6, C7, and C8) resulting into a full paralysis of the left arm. There was also a loss of pain and temperature sensation on the right side of the body. He underwent reconstructive surgery without any functional improvement. After 6 to 7 years his condition worsened. Magnetic resonance imaging revealed a left-sided SCH at the level of C7. He underwent a C6-C7 laminectomy which revealed a pseudomeningocele at C6-C7 accompanied by focal SCH at the location of the C7 root. The SCH was reduced intradurally and the dural defect of the meningocele was covered with a Neuropatch membrane wrapped around the spinal cord (between the spinal cord and the dura) according to the technique described by Batzdorf. Postoperatively, the neurological symptoms improved.
Conclusion: SCH should be surgically repaired utilizing the technique described by Batzdorf if further neurological deficits develop.
PMID: 29404192 [PubMed]
http://ift.tt/2nRogGB
Long-chain omega-3 fatty acids in aneurysmal subarachnoid hemorrhage: A randomized pilot trial of pharmaconutrition.
Long-chain omega-3 fatty acids in aneurysmal subarachnoid hemorrhage: A randomized pilot trial of pharmaconutrition.
Surg Neurol Int. 2017;8:304
Authors: Saito G, Zapata R, Rivera R, Zambrano H, Rojas D, Acevedo H, Ravera F, Mosquera J, Vásquez JE, Mura J
Abstract
Background: Functional recovery after aneurysmal subarachnoid hemorrhage (SAH) remains a significant problem. We tested a novel therapeutic approach with long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs) to assess the safety and feasibility of an effectiveness trial.
Methods: We conducted a multicentre, parallel, randomized, open-label pilot trial. Patients admitted within 72 hours after SAH with modified Fisher scale scores of 3 or 4 who were selected for scheduled aneurysm clipping were allocated to receive either n-3 PUFA treatment (parenteral perioperative: 5 days; oral: 8 weeks) plus usual care or usual care alone. Exploratory outcome measures included major postoperative intracranial bleeding complications (PIBCs), cerebral infarction caused by delayed cerebral ischemia, shunt-dependent hydrocephalus, and consent rate. The computed tomography evaluator was blinded to the group assignment.
Results: Forty-one patients were randomized, but one patient had to be excluded after allocation. Twenty patients remained for intention to treat analysis in each trial arm. No PIBs (95% confidence interval [CI]: 0.00 to 0.16) or other unexpected harm were observed in the intervention group (IG). No patient suspended the intervention due to side effects. There was a trend towards improvements in all benefit-related outcomes in the IG. The overall consent rate was 0.91 (95% CI: 0.78 to 0.96), and there was no consent withdrawal.
Conclusions: Although the balance between the benefit and harm of the intervention appears highly favourable, further testing on SAH patients is required. We recommend proceeding with amendments in a dose-finding trial to determine the optimal duration of parenteral treatment.
PMID: 29404191 [PubMed]
http://ift.tt/2nLlQdv
A proposed classification for assessing rupture risk in patients with intracranial arteriovenous malformations.
A proposed classification for assessing rupture risk in patients with intracranial arteriovenous malformations.
Surg Neurol Int. 2017;8:303
Authors: Padilla-Vazquez F, Zenteno MA, Balderrama J, Escobar-de la Garma VH, Juan DS, Trenado C
Abstract
Background: Whether cerebral arteriovenous malformations (AVMs) should be treated remains an ongoing debate. Nevertheless, there is a need for predictive factors that assist in labelling lesions as low or high risk for future rupture. Our aim was to design a new classification that would consider hemodynamic and anatomic factors in the rapid assessment of rupture risk in patients with AVMs.
Methods: This was a retrospective study that included 639 patients with ruptured and unruptured AVMs. We proposed a new classification score (1-4 points) for AVM rupture risk using three factors: feeding artery mean velocity (Vm), nidus size, and type of venous drainage. We employed descriptive statistics and logistic regression analysis.
Results: A total of 639 patients with cerebral AVMs, 388 (60%) had unruptured AVMs and 251 (40%) had ruptured AVMs. Logistic regression analysis revealed a significant effect of Vm, nidus size, and venous drainage type in accounting for the variability of rupture odds (P = 0.0001, R2 = 0.437) for patients with AVMs. Based in the odds ratios, grades 1 and 2 of the proposed classification were corresponded to low risk of hemorrhage, while grades 3 and 4 were associated with hemorrhage: 1 point OR = (0.107 95% CI; 0.061-0.188), 2 point OR = (0.227 95% CI; 0.153-0.338), 3 point OR = (3.292 95% CI; 2.325-4.661), and 4 point OR = (23.304 95% CI; 11.077-49.027).
Conclusion: This classification is useful and easy to use, and it may allow for the individualisation of each cerebral AVM and the assessment of rupture risk based on a model of categorisation.
PMID: 29404190 [PubMed]
http://ift.tt/2nO2Da2
Abstracts from the Fourteenth Rambam Research Day, December 7, 2017.
Abstracts from the Fourteenth Rambam Research Day, December 7, 2017.
Rambam Maimonides Med J. 2018 Jan 29;9(1):
Authors: Blazer S, Klein E
PMID: 29406849 [PubMed]
http://ift.tt/2E93yZv
Unilateral Vocal Cord Paralysis of a Great Jewish Opera Singer.
Unilateral Vocal Cord Paralysis of a Great Jewish Opera Singer.
Rambam Maimonides Med J. 2018 Jan 29;9(1):
Authors: Duek I, Cohen JT, Gil Z
Abstract
George London was one of the most compelling vocal artists of the early twentieth century. At the age of 47, the great bass-baritone retired from singing. It has been suggested that the premature ending of his operatic career was due to unilateral vocal cord palsy (UVCP). When London retired, the common belief was that this UVCP was caused by viral hepatitis, although there is no evidence to support such an etiology. London's medical records eliminate the possible etiology of a neck neoplasm, and the long period of time between a heart attack he experienced and his diagnosis of UVCP makes a cardiovascular etiology an unlikely causative factor. London's relatively young age, the diagnosis of laryngitis prior to his UVCP, and the course of his disease indicate that the underlying cause of the termination of his singing career was post-viral neuropathy. This paper describes the clinical evidence related to London's vocal cord function and explores the possible causes for his UVCP, which apparently led to his early retirement.
PMID: 29406848 [PubMed]
http://ift.tt/2EPBUlE
Outer Limits of Biotechnologies: A Jewish Perspective.
Outer Limits of Biotechnologies: A Jewish Perspective.
Rambam Maimonides Med J. 2018 Jan 29;9(1):
Authors: Loike JD, Kadish A
Abstract
A great deal of biomedical research focuses on new biotechnologies such as gene editing, stem cell biology, and reproductive medicine, which have created a scientific revolution. While the potential medical benefits of this research may be far-reaching, ethical issues related to non-medical applications of these technologies are demanding. We analyze, from a Jewish legal perspective, some of the ethical conundrums that society faces in pushing the outer limits in researching these new biotechnologies.
PMID: 29406847 [PubMed]
http://ift.tt/2EaBJQF
Six Values Never to Silence: Jewish Perspectives on Nazi Medical Professionalism.
Six Values Never to Silence: Jewish Perspectives on Nazi Medical Professionalism.
Rambam Maimonides Med J. 2018 Jan 29;9(1):
Authors: Kolman JM, Miller SM
Abstract
An ideological case study based on medical profession norms during the Third Reich will be used to exemplify the importance of diversity in the manifestations of professional ethics. The German professional medical community banned their Jewish colleagues from treating German citizens. This included legally mandated employment discrimination and outright censure which led to a professional ethic devoid of diverse voices. While the escalation to the T-4 program and medicalized genocide was influenced by many causes, the intentional, ethnocentric-based exclusion of voices was an important contributing element to the chronicled degradation of societal mores. For illustration, six core Jewish values-life, peace, justice, mercy, scholarship, and sincerity of intention-will be detailed for their potential to inspire health-care professionals to defend and protect minorities and for readers to think critically about the role of medical professionalism in Third Reich society. The Jewish teachings highlight the inherent professional obligations physicians have toward their patients in contrast to the Third Reich's corruption of patient-centered professionalism. More fundamentally, juxtaposing Jewish and Nazi teachings exposes the loss of perspective when a profession's identity spurns diversity. To ensure respect for persons in all vulnerable minorities, the first step is addressing professional inclusion of minority voices.
PMID: 29406846 [PubMed]
http://ift.tt/2EQKYH2
Learning from Job: A Rare Genetic Disease and Lessons of Biblical Proportions.
Learning from Job: A Rare Genetic Disease and Lessons of Biblical Proportions.
Rambam Maimonides Med J. 2018 Jan 29;9(1):
Authors: Milner JD
Abstract
Dominant negative mutations in STAT3, a critical signaling molecule and transcription factor in multiple organ systems, lead to a rare monogenic disease called the STAT3 loss-of-function, autosomal dominant hyper-IgE syndrome (STAT3LOF AD-HIES). The original name for this syndrome, Job's syndrome, was derived from the observation that patients had a propensity to develop skin boils, reminiscent of the affliction cast upon the biblical Job. Many fascinating observations have been made regarding the pathogenesis of the disease and the role STAT3 plays in human health and disease. Additionally, quite a few phenotypic descriptions from the Book of Job are similar to those seen in patients with STAT3LOF AD-HIES, beyond just the boils. This complex multisystem genetic disorder is a challenge clinically and scientifically, but it also brings into question how we approach genetic syndromes beyond just the technical aspects of research and treatment.
PMID: 29406845 [PubMed]
http://ift.tt/2EctVy4
An Insight into the Effect of Exercises on the Prevention of Osteoporosis and Associated Fractures in High-risk Individuals.
An Insight into the Effect of Exercises on the Prevention of Osteoporosis and Associated Fractures in High-risk Individuals.
Rambam Maimonides Med J. 2018 Jan 29;9(1):
Authors: Senderovich H, Kosmopoulos A
Abstract
The purpose of this review was to investigate what type of exercises can potentially prevent osteoporosis (OP) and its associated fractures in high-risk populations. MEDLINE was searched for work relevant to various types of exercises used to prevent osteoporotic fractures in high-risk population, from the year 1995 onwards. Twelve articles were identified, and, from them, four were deemed suitable to the objective. The studies reviewed show that various types of exercise are effective and safe in preventing the onset of OP. For example, high-intensity progressive resistance training (HiPRT) has been shown to increase vertebral height and femoral neck bone mineral density (BMD), in addition to improving functional performance. Additional studies reviewed suggested that bone reabsorption levels may be positively impacted by low-impact exercise, such as walking. This review provides insight into the effectiveness of various types of exercise to combat and possibly prevent OP for high-risk individuals, which include postmenstrual Caucasian females, people with multiple comorbidities, individuals who smoke or consume alcohol, and the frail elderly population. The prevention of OP should reduce both the social (emotional) and economic burdens faced by patients, caregivers, and health-care systems. Moving forward, research that identifies and bridges pharmaceutical treatment and exercise should be conducted, in addition to the comparison of passive versus active forms of exercise to determine which treatment best prevents OP in high-risk populations.
PMID: 29406844 [PubMed]
http://ift.tt/2EN1w2z
Factors Affecting Surgical Decision-making-A Qualitative Study.
Factors Affecting Surgical Decision-making-A Qualitative Study.
Rambam Maimonides Med J. 2018 Jan 29;9(1):
Authors: Gunaratnam C, Bernstein M
Abstract
BACKGROUND: Guidelines and Class 1 evidence are strong factors that help guide surgeons' decision-making, but dilemmas exist in selecting the best surgical option, usually without the benefit of guidelines or Class 1 evidence. A few studies have discussed the variability of surgical treatment options that are currently available, but no study has examined surgeons' views on the influential factors that encourage them to choose one surgical treatment over another. This study examines the influential factors and the thought process that encourage surgeons to make these decisions in such circumstances.
METHODS: Semi-structured face-to-face interviews were conducted with 32 senior consultant surgeons, surgical fellows, and senior surgical residents at the University of Toronto teaching hospitals. An e-mail was sent out for volunteers, and interviews were audio-recorded, transcribed verbatim, and subjected to thematic analysis using open and axial coding.
RESULTS: Broadly speaking there are five groups of factors affecting surgeons' decision-making: medical condition, information, institutional, patient, and surgeon factors. When information factors such as guidelines and Class 1 evidence are lacking, the other four groups of factors-medical condition, institutional, patient, and surgeon factors (the last-mentioned likely being the most powerful)-play a significant role in guiding surgical decision-making.
CONCLUSIONS: This study is the first qualitative study on surgeons' perspectives on the influential factors that help them choose one surgical treatment option over another for their patients.
PMID: 29406843 [PubMed]
http://ift.tt/2EboY8J
A Unique Publication Model that Works.
A Unique Publication Model that Works.
Rambam Maimonides Med J. 2018 Jan 29;9(1):
Authors: Blazer S
PMID: 29406842 [PubMed]
http://ift.tt/2EPBTy6
The influence of tissue composition uncertainty on dose distributions in brachytherapy
Source:Radiotherapy and Oncology
Author(s): Dylan Mann-Krzisnik, Frank Verhaegen, Shirin A. Enger
Background and purposeModel-based dose calculation algorithms (MBDCAs) have evolved from serving as a research tool into clinical practice in brachytherapy. This study investigates primary sources of tissue elemental compositions used as input to MBDCAs and the impact of their variability on MBDCA-based dosimetry.Materials and methodsRelevant studies were retrieved through PubMed. Minimum dose delivered to 90% of the target (D90), minimum dose delivered to the hottest specified volume for organs at risk (OAR) and mass energy-absorption coefficients (μen/ρ) generated by using EGSnrc "g" user-code were compared to assess the impact of compositional variability.ResultsElemental composition for hydrogen, carbon, oxygen and nitrogen are derived from the gross contents of fats, proteins and carbohydrates for any given tissue, the compositions of which are taken from literature dating back to 1940–1950. Heavier elements are derived from studies performed in the 1950–1960. Variability in elemental composition impacts greatly D90 for target tissues and doses to OAR for brachytherapy with low energy sources and less for 192Ir-based brachytherapy. Discrepancies in μen/ρ are also indicative of dose differences.ConclusionsUpdated elemental compositions are needed to optimize MBDCA-based dosimetry. Until then, tissue compositions based on gross simplifications in early studies will dominate the uncertainties in tissue heterogeneity.
http://ift.tt/2E8cTRC
The first clinical implementation of real-time image-guided adaptive radiotherapy using a standard linear accelerator
Source:Radiotherapy and Oncology
Author(s): Paul J. Keall, Doan Trang Nguyen, Ricky O'Brien, Vincent Caillet, Emily Hewson, Per Rugaard Poulsen, Regina Bromley, Linda Bell, Thomas Eade, Andrew Kneebone, Jarad Martin, Jeremy T. Booth
PurposeUntil now, real-time image guided adaptive radiation therapy (IGART) has been the domain of dedicated cancer radiotherapy systems. The purpose of this study was to clinically implement and investigate real-time IGART using a standard linear accelerator.Materials/methodsWe developed and implemented two real-time technologies for standard linear accelerators: (1) Kilovoltage Intrafraction Monitoring (KIM) that finds the target and (2) multileaf collimator (MLC) tracking that aligns the radiation beam to the target. Eight prostate SABR patients were treated with this real-time IGART technology. The feasibility, geometric accuracy and the dosimetric fidelity were measured.ResultsThirty-nine out of forty fractions with real-time IGART were successful (95% confidence interval 87–100%). The geometric accuracy of the KIM system was −0.1 ± 0.4, 0.2 ± 0.2 and −0.1 ± 0.6 mm in the LR, SI and AP directions, respectively. The dose reconstruction showed that real-time IGART more closely reproduced the planned dose than that without IGART. For the largest motion fraction, with real-time IGART 100% of the CTV received the prescribed dose; without real-time IGART only 95% of the CTV would have received the prescribed dose.ConclusionThe clinical implementation of real-time image-guided adaptive radiotherapy on a standard linear accelerator using KIM and MLC tracking is feasible. This achievement paves the way for real-time IGART to be a mainstream treatment option.
http://ift.tt/2ENZWNZ
“All-in-one” in vitro selection of collagen-binding vascular endothelial growth factor
Source:Biomaterials, Volume 161
Author(s): Shin-Hye Park, Takanori Uzawa, Fumiyuki Hattori, Shuichi Ogino, Naoki Morimoto, Satoshi Tsuneda, Yoshihiro Ito
To enhance the therapeutic effect of growth factors, a powerful strategy is to direct their localization to damaged sites. To treat skin wounds and myocardial infarction, we selected vascular endothelial growth factor (VEGF) carrying binding affinity to collagen. A simple conjugation of a reported collagen-binding sequence and VEGF did not increase the collagen-binding affinity, indicating that the molecular interaction between the two proteins abolished collagen binding activity. Here, we present a new molecular evolution strategy, "all-in-one" in vitro selection, in which a collagen-binding VEGF (CB-VEGF) was directly identified from a random library consisting of random and VEGF sequences. As expected, the selected CB-VEGFs exhibited high binding affinity to collagen and maintained the same growth enhancement activity for endothelial cells as unmodified VEGF in solution. Furthermore, the selected CB-VEGF enhanced angiogenesis at skin wounds and infarcted myocardium. This study demonstrates that "all-in-one" in vitro selection is a novel strategy for the design of functional proteins for regenerative medicine.
http://ift.tt/2BfnKdU
A human endogenous protein exerts multi-role biomimetic chemistry in synthesis of paramagnetic gold nanostructures for tumor bimodal imaging
Publication date: April 2018
Source:Biomaterials, Volume 161
Author(s): Weitao Yang, Xiaoli Wu, Yan Dou, Jin Chang, Chenyang Xiang, Jiani Yu, Jun Wang, Xiuli Wang, Bingbo Zhang
Protein-mediated biomimetic nanoparticles because of simplicity of their synthesis, subdued nonspecific adsorption, improved pharmacokinetics, and biocompatibility have been receiving increasing attention recently. Nevertheless, only a handful of proteins have been developed for biomimetic synthesis. Worse still, most of them are constrained on single-function usages in chemistry. Exploring new functional proteins, especially those with multi-dentate moieties for multi-role biomimetic chemistry, still remains a substantial challenge. Here, we report on a human endogenous protein, glutathione S-transferase (GST), with favorable amino acid motifs, that has innate talents in incubating high quality gold nanoparticles without adding reducing agents at physiological temperature, and particularly can further anchor gadolinium ions without adding extra chelators. The resultant paramagnetic AuNPs@GSTGd exhibits highly crystallization and uniform size of ca. 10 nm. Compared with clinical contrast agents (Iopamidol, Magnevist), AuNPs@GSTGd shows better imaging performance (e.g. enhanced relaxivity and larger X-ray attenuation efficiency) with clear evidence from Monte Carlo simulation and in vitro experimental results. Further in vivo imaging demonstrates good tumor targeting and clearance of AuNPs@GSTGd without obvious systemic toxicity. Particularly, low immunogenicity of AuNPs@GSTGd is certified by immunological status evaluation of T cells after stimulated with them. This study for the first time demonstrates the manipulation of a human protein for multi-role biomimetic chemistry depending on its unique amino acid motifs and its incorporation into a synthetic agent for potentially addressing some critical issues in cancer nanotheranostics such as synthetic methodology, biocompatibility, function integration, targeting, and immunogenicity.
Graphical abstract
http://ift.tt/2BKD3ME
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