Head and Neck Diseases by Alexandros G.Sfakianakis: 02/06/19

Aflatoxin is a potent toxin produced by Aspergillus flavus Link:Fr, an opportunistic ear-rot pathogen of maize (Zea mays L. subsp. Mays). Prior to the discovery of aflatoxin, A. flavus was considered a minor pathogen and was not a priority for maize breeders or pathologists. Aflatoxin was discovered in England in 1961 following an epidemic in poultry. By the early 1970s, surveys of agricultural commodities in the USA found that maize produced in the Southeast was especially vulnerable to aflatoxin contamination. Aflatoxin contamination was initially treated as a post-harvest issue, but pre-harvest contamination was proven by 1975. Pre-harvest contamination meant that genetically based host-plant resistance was a possible solution. The potential magnitude of the problem became apparent in 1977 when the southeastern US maize crop suffered epidemic aflatoxin contamination. The first experiment demonstrating the heritability of host-plant resistance to aflatoxin accumulation was published in 1978. These events combined to make breeding for reduced aflatoxin contamination both a high priority and a rational breeding objective. This review surveys the early scientific literature in order to place research on the genetics of aflatoxin accumulation in maize into historical context. It tells the story of how multi-disciplinary research began with veterinary diseases of unknown etiology and resulted in host-plant resistance to a previously minor plant pathogen becoming a central public sector breeding objective.

http://bit.ly/2SxA6Xz

High-Flow Nasal Oxygen Improves Safe Apnea Time in Morbidly Obese Patients Undergoing General Anesthesia: A Randomized Controlled Trial

BACKGROUND: Morbidly obese patients undergoing general anesthesia are at risk of hypoxemia during anesthesia induction. High-flow nasal oxygenation use during anesthesia induction prolongs safe apnea time in nonobese surgical patients. The primary objective of our study was to compare safe apnea time, between patients given high-flow nasal oxygenation or conventional facemask oxygenation during anesthesia induction, in morbidly obese surgical patients. METHODS: Research ethics board approval was obtained. Elective surgical patients ≥18 years with body mass index ≥40 kg·m−2 were included. Patients with severe comorbidity, gastric reflux disease, known difficult airway, or nasal obstruction were excluded. After obtaining informed consent patients were randomized. In the intervention (high-flow nasal oxygenation) group, preoxygenation was provided by 100% nasal oxygen for 3 minutes at 40 L·minute−1; in the control group, preoxygenation was delivered using a facemask with 100% oxygen, targeting end-tidal O2 >85%. Anesthesia was induced with propofol, remifentanil, and rocuronium. Bag-mask ventilation was not performed. At 2 minutes after rocuronium, videolaryngoscopy was performed. If the laryngoscopy grade was I or II, laryngoscope was left in place and the study was continued; if grade III or IV was observed, the patient was excluded from the study. During the apnea period, high-flow nasal oxygenation patients received nasal oxygen at 60 L·minute−1; control group patients received no supplemental oxygen. The primary outcome, safe apnea time, was reached when oxygen saturation measured by pulse oximetry (SpO2) fell to 95% or maximum 6 minutes of apnea. The patient was then intubated. T tests and χ2 analyses were used to compare groups. P

http://bit.ly/2SjuqBh

A Multivariable Model Predictive of Unplanned Postoperative Intubation in Infant Surgical Patients

BACKGROUND: Unplanned postoperative intubation is an important quality indicator, and is associated with significantly increased mortality in children. Infant patients are more likely than older pediatric patients to experience unplanned postoperative intubation, yet the literature provides few characterizations of this outcome in our youngest patients. The objective of this study was to identify risk factors for unplanned postoperative intubation and to develop a scoring system to predict this complication in infants undergoing major surgical procedures. METHODS: In this retrospective cohort study, The National Surgical Quality Improvement Program-Pediatric database was surveyed for all infants who underwent noncardiac surgery between January 1, 2012 and December 31, 2015 (derivation cohort, n = 56,962) and between January 1 and December 31, 2016 (validation cohort, n = 20,559). Demographic and perioperative clinical characteristics were examined in association with our primary outcome of unplanned postoperative intubation within 30 days of surgery. Risk factors were analyzed in the derivation cohort (2012–2015 data) using multivariable logistic regression with stepwise selection. Parameters from the final model were used to create a scoring system for predicting unplanned postoperative intubation. Data from the validation cohort were utilized to assess the performance of the scoring system using the area under the receiver operating characteristic curve. RESULTS: In the derivation cohort, 2.2% of the infants experienced unplanned postoperative intubation within 30 days of surgery. Of the 14 risk factors identified in multivariable analysis, 10 (age, prematurity, American Society of Anesthesiologists physical status, inpatient status, operative time >120 minutes, cardiac disease, malignancy, hematologic disorder, oxygen supplementation, and nutritional support) were included in the final multivariable logistic regression model to create the risk score. The area under the receiver operating characteristic curve of the final model was 0.86 (95% CI, 0.85–0.87) for the derivation cohort and 0.83 (95% CI, 0.82–0.85) for the validation cohort. CONCLUSIONS: About 1 in 50 infants undergoing major surgical procedures experiences unplanned postoperative intubation. Our scoring system based on routinely collected perioperative assessment data can predict risk in infants with good accuracy. Further investigation should assess the clinical utility of the scoring system for risk stratification and improvement in perioperative care quality and patient outcomes. Accepted for publication December 20, 2018. Funding: L.D.E. is supported by an institutional training grant from the National Institutes of Health, T32GM008464-26. M.K. is supported by the National Center for Advancing Translational Sciences, National Institutes of Health through Grant Number KL2TR001874. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://bit.ly/KegmMq). Reprints will not be available from the authors. Address correspondence to Lisa D. Eisler, MD, Department of Anesthesiology, Columbia University Medical Center, 622 W 168th St, PH 5, Suite 505C, New York, NY 10032. Address e-mail to LDL2113@cumc.columbia.edu. © 2019 International Anesthesia Research Society

http://bit.ly/2Sdi263

Cataract Surgery: When the Eyes Are Bigger Than the Stomach

No abstract available

http://bit.ly/2GuFpRw

Effectiveness of Magnesium in Preventing Shivering in Surgical Patients: A Systematic Review and Meta-analysis

BACKGROUND: Clinical trials regarding the antishivering effect of perioperative magnesium have produced inconsistent results. We conducted a systematic review and meta-analysis with Trial Sequential Analysis to evaluate the effect of perioperative magnesium on prevention of shivering. METHODS: We searched PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and 2 registry sites for randomized clinical trials that compared the administration of magnesium to a placebo or no treatment in patients undergoing surgeries. The primary outcome of this meta-analysis was the incidence of shivering. The incidence of shivering was combined as a risk ratio with 95% CI using a random-effect model. The effect of the route of administration was evaluated in a subgroup analysis, and Trial Sequential Analysis with a risk of type 1 error of 5% and power of 90% was performed. The quality of each included trial was evaluated, and the quality of evidence was assessed using the Grading of Recommendation Assessment, Development, and Evaluation approach. We also assessed adverse events. RESULTS: Sixty-four trials and 4303 patients (2300 and 2003 patients in magnesium and control groups, respectively) were included. The overall incidence of shivering was 9.9% in the magnesium group and 23.0% in the control group (risk ratio, 0.42; 95% CI, 0.33–0.52). Subgroup analysis revealed that the incidence of shivering was lower with IV (risk ratio, 0.29; 95% CI, 0.29–0.54; Grading of Recommendation Assessment, Development, and Evaluation, moderate), epidural (risk ratio, 0.24; 95% CI, 0.13–0.43; Grading of Recommendation Assessment, Development, and Evaluation, low), and intrathecal administration (risk ratio, 0.64; 95% CI, 0.43–0.96; Grading of Recommendation Assessment, Development, and Evaluation, moderate). Only trials with low risk of bias were included for Trial Sequential Analysis. The Z-cumulative curve for IV magnesium crossed the Trial Sequential Analysis monitoring boundary for benefit even though only 34.9% of the target sample size had been reached. The Z-cumulative curve for epidural or intrathecal administration did not cross the Trial Sequential Analysis monitoring boundary for benefit. No increase in adverse events was reported. CONCLUSIONS: Perioperative IV administration of magnesium effectively reduced shivering and Trial Sequential Analysis suggested that no more trials are required to confirm that IV magnesium effectively reduces shivering. Accepted for publication December 12, 2018. Funding: This study was supported by funding from the Department of Anesthesiology, Yokohama City University, Yokohama, Japan. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://bit.ly/KegmMq). Trial registry number: CRD42018083337 (PROSPERO). URL: http://bit.ly/2Gu1mjl. Reprints will not be available from the authors. Address correspondence to Hiromasa Kawakami, MD, Department of Anesthesiology, Yokohama City University Medical Center, Urafunecho 4-57 Minamiku Yokohama, Kanagawa 232-0024, Japan. Address e-mail to hiro.k210@gmail.com. © 2019 International Anesthesia Research Society

http://bit.ly/2Sc7hka

Editorial by US Food and Drug Administration Attorney Fails to Address Core and Ongoing Issues Seen With Vasopressin Market

No abstract available

http://bit.ly/2SgG6Vl

Perioperative Care for Adolescents Undergoing Major Surgery: A Biopsychosocial Conceptual Framework

No abstract available

http://bit.ly/2GqT9MU

American Society for Enhanced Recovery and Perioperative Quality Initiative-4 Joint Consensus Statement on Persistent Postoperative Opioid Use: Definition, Incidence, Risk Factors, and Health Care System Initiatives

Persistent postoperative opioid use is thought to contribute to the ongoing opioid epidemic in the United States. However, efforts to study and address the issue have been stymied by the lack of a standard definition, which has also hampered efforts to measure the incidence of and risk factors for persistent postoperative opioid use. The objective of this systematic review is to (1) determine a clinically relevant definition of persistent postoperative opioid use, and (2) characterize its incidence and risk factors for several common surgeries. Our approach leveraged a group of international experts from the Perioperative Quality Initiative-4, a consensus-building conference that included representation from anesthesiology, surgery, and nursing. A search of the medical literature yielded 46 articles addressing persistent postoperative opioid use in adults after arthroplasty, abdominopelvic surgery, spine surgery, thoracic surgery, mastectomy, and thoracic surgery. In opioid-naive patients, the overall incidence ranged from 2% to 6% based on moderate-level evidence. However, patients who use opioids preoperatively had an incidence of >30%. Preoperative opioid use, depression, factors associated with the diagnosis of substance use disorder, preoperative pain, and tobacco use were reported risk factors. In addition, while anxiety, sex, and psychotropic prescription are associated with persistent postoperative opioid use, these reports are based on lower level evidence. While few articles addressed the health policy or prescriber characteristics that influence persistent postoperative opioid use, efforts to modify prescriber behaviors and health system characteristics are likely to have success in reducing persistent postoperative opioid use. Accepted for publication October 16, 2018. The authors declare no conflicts of interest. Funding: The PeriOperative Quality Initiative (POQI)-4 consensus conference was supported by unrestricted educational grants from the American Society for Enhanced Recovery (ASER) and the POQI, which have received grants from Baxter, Bev MD, Cadence, Cheetah Medical, Edwards, Heron Pharmaceutical, Mallinckrodt, Medtronic, Merck, Pacira, and Trevena. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://bit.ly/KegmMq). Please see Supplemental Digital Content, Appendix 1, http://bit.ly/2GxzQ4N, for a list of the POQI-4 Workgroup members. Reprints will not be available from the authors. Address correspondence to Michael L. Kent, MD, Department of Anesthesiology, Duke University Medical Center, 3094 #4, Durham, NC 27710. Address e-mail to Michael.kent@duke.edu. © 2019 International Anesthesia Research Society

http://bit.ly/2Sdhq0f

I Tweet, Therefore I Learn: An Analysis of Twitter Use Across Anesthesiology Conferences

BACKGROUND: Twitter in anesthesiology conferences promotes rapid science dissemination, global audience participation, and real-time updates of simultaneous sessions. We designed this study to determine if an association exists between conference attendance/registration and 4 defined Twitter metrics. METHODS: Using publicly available data through the Symplur Healthcare Hashtags Project and the Symplur Signals, we collected data on total tweets, impressions, retweets, and replies as 4 primary outcome metrics for all registered anesthesiology conferences occurring from May 1, 2016 to April 30, 2017. The number of Twitter participants, defined as users who contributed a tweet, retweet, or reply 3 days before through 3 days after the conference, was collected. We also collected influencer data as determined by mentions (number of times a user is referenced). Two authors independently verified the categories for influencers assigned by Symplur. Conference demographic data were obtained by e-mail inquiries. Associations between meeting attendees/registrants and Twitter metrics, between Twitter participants and the metrics, and between physician influencers and Twitter participants were tested using Spearman rho. RESULTS: Fourteen conferences with 63,180 tweets were included. With the American Society of Anesthesiologists annual meeting included, the correlations between meeting attendance/registration and total tweets (rs = 0.588; P = .074), impressions (rs = 0.527; P = .117), and retweets (rs = 0.539; P = .108) were not statistically significant; for replies, it was moderately positive (rs = 0.648; P = .043). Without the American Society of Anesthesiologists annual meeting, total tweets (rs = 0.433; P = .244), impressions (rs = 0.350; P = .356), retweets (rs = 0.367; P = .332), and replies (rs = 0.517; P = .154) were not statistically significant. Secondary outcomes include a highly positive correlation between Twitter participation and total tweets (rs = 0.855; P

http://bit.ly/2Gpo10p

Contemplating Our Maternity Care Crisis in the United States: Reflections of an Obstetrician Anesthesiologist

No abstract available

http://bit.ly/2GuFnJo

Questions About the Study by Said Et Al

No abstract available

http://bit.ly/2GxzLy1

High tibial osteotomy in combination with arthroscopic abrasion arthroplasty and autologous adipose-derived mesenchymal stem cell therapy in the treatment of advanced knee osteoarthritis

Osteoarthritis is a progressive and debilitating condition. An increasing number of total knee replacements are being performed under the age of 65. Improved understanding of the action of mesenchymal stem cells (MSC) has seen renewed interest in their role in cartilage repair. A 43-year-old man presented with grade IV medial compartment knee osteoarthritis. The patient underwent high tibial osteotomy (HTO) and arthroscopic abrasion arthroplasty in combination with adipose-derived MSC therapy. The patient reported improvement in pain and function as measured by validated outcome scores. Repeat MRI including T2 mapping techniques showed hyaline-like cartilage regeneration. This case highlights the potential benefit of surgical interventions including HTO in combination with MSC therapy in early-onset severe osteoarthritis. This technique may considerably delay or prevent the need for total knee replacement in young patients. Further controlled trials are needed to confirm the reproducibility of this outcome.

http://bit.ly/2SDmwSy

Arterial thrombosis as primary presentation of endogenous Cushings syndrome

Cushing's syndrome is known to present with a characteristic set of clinical manifestations and complications, well described in literature. However, hypercoagulability remains an under recognised entity in Cushing's syndrome. A 31-year-old woman from Southern India presented with history of fever, left upper quadrant pain and progressive breathing difficulty for 3 weeks. Clinical examination revealed discriminatory features of Cushing's syndrome. Laboratory investigations showed biochemical features of endogenous ACTH-dependent Cushing's syndrome. Imaging of the abdomen revealed splenic collection, left-sided empyema and extensive arterial thrombosis. Gadolinium enhanced dynamic MRI of the pituitary gland revealed no evidence of an adenoma while a Ga-68 DOTATATE positron emission tomography CT scan ruled out an ectopic Cushing's. A diagnosis of endogenous Cushing's syndrome causing a prothrombotic state with extensive arterial thrombosis was made. She was initiated on oral anticoagulation and oral ketoconazole for medical adrenal suppression. She subsequently underwent bilateral adrenalectomy and was well at follow-up.

http://bit.ly/2Gpjmvr

Intramural oesophageal abscess: an unusual complication of tonsillitis

Tonsillitis is an extremely common condition, usually it is self-limiting, of viral origin, and managed conservatively in general practice. Rarely patients require inpatient management, usually when bacterial infection is present or when the cause is virulent organisms such as Epstein Barr virus. Complications can be divided into non-suppurative; sepsis, scarlet fever, rheumatic fever, glomerulonephritis and Lemierres disease, and suppurative; quinsy, parapharyngeal abscess and retropharyngeal abscess, respectively. Anecdotally, there is concern that modern medical practice that counsels vigilance against overuse of antibiotics, could lead to increased complications of tonsillitis. We report a case of an otherwise healthy man who presented with dysphagia, odynophagia and neck pain following a sore throat. Despite antibiotic treatment he developed an intramural oesophageal abscess, to our knowledge, an unreported complication of tonsillitis.

http://bit.ly/2GqF3em

Pneumomediastinum, ST elevation and urgent cardiac catheterisation: a crucial triad?

Pneumomediastinum (PNMD) entails the presence of air or other gas in the mediastinum and is also known as mediastinal emphysema. PNMD may cause a wide variety of signs and symptoms, as well as ECG abnormality, including ST segment changes. We present a 56-year-old man admitted to our hospital after a facial trauma. After undergoing tracheostomy, he complained of chest discomfort. A chest X-ray in the posteroanterior view showed PNMD, and an ECG was suggestive of inferior-lateral wall myocardial infarction. An urgent cardiac catheterisation identified a critical obstruction at the origin of the right coronary artery. Following a balloon angioplasty, chest discomfort continued; and the ECG ST segments did not show any dynamic change during the subsequent 72 hours. We urge clinicians to perform a comprehensive workup for every patient presenting with PNMD and ST segment changes, to prevent unnecessary invasive procedures.

http://bit.ly/2SvOzU9

Pins and needles in the groin: an incidental finding of retained needle fragments in an intravenous drug user

A female intravenous drug user was reviewed in A&E following a deliberate overdose. After claiming to have swallowed a razor blade, an abdominal radiograph was performed; this showed a linear metallic density projected over the right side of the pelvis, eventually identified as a needle fragment. Subsequent CT imaging revealed three additional needles situated within the groin. Duplex assessment also identified bilateral arteriovenous fistulae. The patient remained asymptomatic and was managed conservatively. She could recall several occasions when a needle had broken while injecting. This scenario was more likely if the needle had been used many times previously, causing it to become blunt and bent. There are cases reported of adverse patient outcomes secondary to broken needle fragments but awareness among medical professionals remains poor.

http://bit.ly/2GraZiU

Uptake kinetics and interaction of selenium species in tomato ( Solanum lycopersicum L.) seedlings

Abstract

Selenite and selenate are two main selenium (Se) forms absorbed by plants. The comparative effects of selenite and/or selenate on Se uptake and translocation in plants in spite of their coexistence in the environment are still unclear. Therefore, tomato (Solanum lycopersicum L.) seedlings were grown in a hydroponic solution with exogenous selenite, selenate, or selenite and selenate mixed, and Se concentrations in shoots, roots, and xylem sap were measured after harvest. Results showed that selenite (> 0.1 mg Se L⁻¹) could cause phytotoxicity more easily than selenate (> 1 mg Se L⁻¹) under hydroponic conditions. And the absorbability rate of tomato to selenate was higher than that to selenite when Se application level was 0.0175–0.2998 mg L⁻¹, while the opposite result was observed in other Se concentrations. More Se accumulated in roots and Se(VI) in the xylem sap decreased when both Se forms supplied. This study demonstrated that the difference between selenite and selenate on Se uptake and translocation in tomatoes depended on exogenous Se concentration. And selenite could inhibit the absorption and translocation of selenate when supplied with both Se forms.

http://bit.ly/2TzpHYJ

Emission characteristics for co-combustion of leather wastes, sewage sludge, and coal in a laboratory-scale entrained flow tube furnace

Abstract

Four different mixed fuels consisted of leather waste, coal, and sewage sludge were combusted in a lab-scale entrained flow fluidized bed furnace. The influence of blending ratio on emission characteristics of SO₂, NO_x, HCl, particulate matter (PM), heavy metals, and polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/Fs) was studied. Results showed that the mixing of coal with sewage sludge had a complex effect on the emission characteristics. On the one hand, with more sewage sludge blending in the mixed fuel, the acid gas pollutant (SO₂, NO_x) decreased a lot, and the recovery of volatile heavy metals (Cd, Pb) increased at the same time. Furthermore, the leaching toxicity of Cr in the fly ash and bottom ash went down below the national standard with the adding of sewage sludge. On the other hand, the mixing of sewage sludge which consisted of more ash content resulted in the increase of the PM emission. Moreover, the high content of Cu and chlorine in the sewage sludge can promote the formation of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/Fs) when the fuel 3 and 4 were combusted. Most importantly, the concentration of toxic PCDD/Fs in the flue gas produced from fuel 3 and fuel 4 was successfully controlled down below 0.20 ng I-TEQ/Nm³ by the active carbon.

http://bit.ly/2BoDHgO

Synchronous multifocal necrotizing soft tissue infections: a case report and literature review

Abstract

Necrotizing soft tissue infections are a group of conditions with a common pathophysiological basis, affecting any or all layers of the soft tissue compartment. They are rare, life-threatening diseases that require a high index of suspicion for early detection as well as urgent surgical debridement. Rarely, they can occur in more than one non-contiguous site of the body ('multifocal' disease), and this is associated with a much higher mortality than monofocal disease. Here, we present the case of a 46-year-old male with bilateral upper limb necrotizing soft tissue infection following an unclear history of trauma. The patient developed septic shock necessitating transfer to the intensive care unit following emergency surgery. Microbiological tests yielded Streptococcus pyogenes, Staphylococcus aureus and opportunistic Candida spp. and Actinomyces infections. A total of seven surgical debridements were performed; fortunately, the patient survived. We discuss the presentation, diagnosis and management of this case including primary reconstruction of the soft tissue defects, and review the literature on necrotizing soft tissue infections as a clinical entity, incorporating clinical updates from the latest guidelines worldwide.

Level of Evidence: Level V, therapeutic study.

http://bit.ly/2BoRxjv

Evaluation of hydrocar efficiency for simultaneous removal of diclofenac and ibuprofen from aqueous system using surface response methodology

Abstract

Parmaceutically active compounds like diclofenac (DFS), ibuprofen (IBP), and other drugs that persist in the environment are listed as emerging contaminants. These escape from normal wastewater treatment plants and find their way to water streams; therefore, alternate treatment processes are needed. Herein, a sorbent material is reported that is prepared throug hydrotermal carbonization from dried fruit powder of Zizipus mauritiana L. (TC-ZM) and applied for simultaneous removal of DFS and IBP. Carbonized material (TC-ZM) was found as agglomerates of approximately 1 μm particle size with surface area of 1160 m²/g having oxygen functional groups (e.g., COO, O, C=O) on surface. Simultaneous removal of IBP and DFS onto TC-ZM was studied using response surface methodology with a set of 18 experiments using factors such as pH, amount of sorbent, contact time, and sorbate concentration. Maximum removal efficiency was obtained 88% and 97% for DFS and for IBP, respectively, with adsorption capacity of 2.03 mmol g⁻¹ for DFS and 2.54 mmol g⁻¹ for IBP. Kinetics modeling and "mean free energy" values predicted that sorption is mainly governed by pysical interactions followed by "pore filling" mechanism for uptake of DFS and IBP.

http://bit.ly/2SwrgJH

Sharp Foreign Bodies of the Aero-Digestive Tract: Endoscopic Removal by the ‘Kangaroo’ Technique

Abstract

Removal of sharp foreign bodies in the aero-digestive tract may inflict iatrogenic damage to the esophagus, trachea or other vital structures in case of impalement. We describe the 'Kangaroo' technique for safe and effective removal of sharp objects from the upper aero-digestive tracts. Index Case 1: 1-year old boy presented to us with an open (un)safety-pin lodged in the upper esophagus. The technique of removal of the pin by the Kangaroo technique, along-with the mechanics of en-pouching the (un)safety-pin has been described. Index Case 2: 8 years old boy presented with accidental aspiration of a razor blade. The removal of the blade from his trachea was executed by the Kangaroo technique. The Kangaroo technique is described for safe endoscopic extraction of sharp foreign body from the aero-digestive tract while protecting the surrounding tissues, to maintain control of the object during extraction and to avoid causing iatrogenic damage by enclosing the foreign body in a 'kangaroo pouch'. The advantages and limitations of the technique have been discussed. The Kangaroo technique is safe, effective and reproducible way to effect removal of sharp object from the aerodigestive tract while preventing iatrogenic injury to the surrounding organs.

http://bit.ly/2UPs8a5

Laminin-511 Supplementation Enhances Stem Cell Localization with Suppression in the Decline of Cardiac Function in Acute Infarct Rats

Background. The extracellular matrix (ECM), in particular, basement membrane components such as laminins (LMs), is essential for stem cell differentiation and self-renewal. LM511 and LM221 are the main ECM components of the epicardium, where stem cells were abundant. Here, we examined whether LMs affected the regeneration process by modulating stem cell activities. Methods. In vitro, adhesive and proliferative activities of mesenchymal stem cells (MSCs) were evaluated on LM511 and LM221. To examine the effects of LMs in vivo, we established an acute myocardial infarction (MI) model by ligation of the proximal part of the left anterior descending artery at the height of the left atrial appendage and then placed atelocollagen sheets with or without LM511 and LM221 over the anterolateral surface of the left ventricular wall. Four or eight weeks later, cardiac function, histology, and cytokine expressions were analyzed. Results. MSCs showed greater proliferation and adhesive properties on LM511 than on LM221. In vivo, at four weeks, isolectin B4 (ILB4)-positive cells were significantly higher in the LM511-transplanted group than in the control group. Moreover, some ILB4-positive cells expressed both platelet-derived growth factor receptor α and CD90, suggesting that LM511 enhanced MSC recruitment and attachment at the implanted site. After eight weeks, these cells were more abundant than at 4 weeks. Transplantation with LM511-conjugated sheets increased the expression of cardioprotective and angiogenic factors. Conclusion. Transplantation with LM511-conjugated sheets enhanced MSC localization to the implantation site and modulated stem cells activities, leading to angiogenesis in acute MI rat models. Disclosures: The authors disclose no conflict of interest. Funding: This study was supported in part by the New Energy and Industrial Technology Development Organization. *Corresponding author: Professor Yoshiki Sawa, Chairman for Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. Phone: +81-6-6879-3154, Fax: +81-6-6879-3163, E-mail: sawa-p@surg1.med.osaka-u.ac.jp Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2Sgb6oD

Feasibility Assessment of Using the Complete Patient‐Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO‐CTCAE) Item Library

AbstractThe patient‐reported outcomes version of the Common Terminology Criteria for Adverse Events (PRO‐CTCAE) complements capture of symptomatic adverse events (AEs) by clinicians. Previous trials have typically used a limited subset of relevant symptomatic AEs to reduce patient burden. We aimed to determine the feasibility of administering all 80 AEs included in the PRO‐CTCAE library by approaching consecutive patients enrolled in a large academic phase I program at three points in time. Here, we report a preplanned analysis after enrolling the first 20 patients. All items were answered on 51 of 56 potential visits (adherence 91%). Three (5%) additional PRO‐CTCAE assessments were partially completed, and two (4%) were missed because of conflicting appointments. No patient withdrew consent or chose not to complete the assessments once enrolled on study. Future trials of experimental drugs that incorporate the PRO‐CTCAE should consider using this unselected approach to identify adverse events more completely.

http://bit.ly/2RHkMmU

Efficacy of Split Schedule Versus Conventional Schedule Neoadjuvant Cisplatin‐Based Chemotherapy for Muscle‐Invasive Bladder Cancer

AbstractNeoadjuvant cisplatin‐based chemotherapy (NAC; 70 mg/m2) is standard of care for muscle‐invasive bladder carcinoma (MIBC). Many patients (pts) cannot receive cisplatin because of renal impairment, and administration of cisplatin 35 mg/m2 on day 1 + 8 or 1 + 2 (i.e., split schedule) is a commonly used alternative. In this retrospective analysis, we compared complete (pT0) and partial (<pT2) pathologic response rates between split schedule (SS) and conventional schedule (CS) pts, after 1:1 matching on chemotherapy regimen, number of cycles, tumor histology, and clinical stage. Eighty matched pts were identified. pT0 rates were 17.5% (95% confidence interval [CI], 7%–33%) and 32.5% (95% CI, 19%–49%) in SS and CS cisplatin pts, respectively (p = .21), corresponding to an odds ratio for pT0 of 0.45 (95% CI, 0.16–1.31) with SS cisplatin. Split schedule cisplatin was associated with numerically but not statistically significant lower pathologic response rates relative to full dose.

http://bit.ly/2WM9Zvv

Sharp Foreign Bodies of the Aero-Digestive Tract: Endoscopic Removal by the ‘Kangaroo’ Technique

Abstract

http://bit.ly/2UPs8a5

Treatment of Refractory Vitiligo With a Vellus Hair Punch Graft

No abstract available

http://bit.ly/2TAsyAV

Safety Studies in the Field of Liposuction: A Systematic Review

BACKGROUND There is an increasing demand for safety standards for cosmetic treatments. With regard to liposuction, interdisciplinary consensus is lacking, especially regarding treatment setting and physician specialty. OBJECTIVE A solid, independent interpretation of scientific data on safety requires a systematic approach, which is the aim of this study. METHODS A systematic literature search was conducted for safety studies about liposuction through April 2017. Fatalities and/or reported serious adverse events served as outcome measures for safety. RESULTS Twenty-four studies were included. Factors that contributed to increased serious complication and mortality risk were: use of the (super)wet technique; use of systemic anesthetics, especially general anesthesia and intravenous sedation; execution by a plastic surgeon; execution in an operating room; and combination with other procedures. CONCLUSION Liposuction using tumescent local anesthesia has been shown to be the safest method of fat removal, especially if no or only minimal systemic anesthesia is used. Performance of this technique in an office-based setting has been proven to be safe beyond doubt. When systemic anesthesia is used, an outpatient or ambulatory surgery facility seems also safe. Regardless of the physician specialty, knowledge and training on the execution of the tumescent procedure are vital to ensure optimal safety.

http://bit.ly/2TD2mFG

Evolution of the Picosecond Laser: A Review of Literature

BACKGROUND Picosecond pulse duration lasers (PS) have altered the field of dermatology. PS were initially used in tattoo removal, to optimize efficacy and reduce side effects with nanosecond domain lasers. More recently, they have been demonstrated to be effective in the treatment of pigmentary disorders, acne scarring, and photoaging. OBJECTIVE In this article, we critically analyze the published data on the many uses of picosecond lasers in dermatology. MATERIALS AND METHODS A systematic review of PubMed was conducted using the following search terms: "picosecond," "picosecond laser," "picosecond laser dermatology," "picosecond laser pigment/pigmentation," and "picosecond laser tattoo removal." Articles ranged from 1988 until 2017. RESULTS Forty-one articles were identified, and 27 met inclusion criteria for review. Indications for the PS included a variety of dermatologic applications include tattoo removal, benign pigmented lesions/pigmentary disorders, acne scarring, and photoaging. Most studies demonstrated safe and effective treatment. CONCLUSION The development of the picosecond pulse duration is a breakthrough innovation in laser technology, changing the scope of laser treatment. Encouraging findings in tattoo pigment clearance spurred the use of PS in a wider array of dermatologic issues. The increasingly positive results and low incidence of adverse effects further substantiates PS efficacy for a variety of dermatologic uses.

http://bit.ly/2ULOdpI

Acitretin-Altered Squamous Cell Carcinoma: A Pitfall in Diagnosis

No abstract available

http://bit.ly/2TF17WI

Noninvasive Atrophic Acne Scar Treatment in Asians With a 755-nm Picosecond Laser Using A Diffractive Optic Lens—A Retrospective Photographic Review

BACKGROUND The diffractive lens of the picosecond laser is relatively new, and there are few reports on its efficacy in treating atrophic acne scars, especially in Asian populations. OBJECTIVE Evaluating the efficacy of diffractive lens 755-nm picosecond laser for atrophic acne scar treatment in Asians. PATIENTS AND METHODS Forty-two patients who were treated for facial atrophic acne scars at a private dermatological clinic were enrolled in this retrospective analysis. Mean session count was 4.28. Before and after photographs were assessed by 2 blinded dermatologists, who rated the amount of overall skin quality improvement on a 5-point scale. RESULTS All patients experienced improvements in scar texture and overall skin quality after 2 to 6 sessions, with scores of +1.4, 1.45, 1.7, 1.33, 2.3, and 1.66 points after 2, 3, 4, 5, 6, and >6 treatments, respectively. There were no obvious adverse effects after treatment. The postinflammatory hyperpigmentation (PIH) risk was 4.7% (2 of 42, both spontaneously resolved). CONCLUSION The 755-nm diffractive lens picosecond laser showed good efficacy and low PIH rates when treating atrophic acne scars in darker skin–type patients. In addition to treatment results, additional improvements in overall skin quality and pigmentation make the picosecond laser an effective and desirable treatment option for Asians.

http://bit.ly/2tayNj5

Anatomy of the Superficial Venous Structures of the Neck: A Cadaveric Study to Guide Superficial Injections

BACKGROUND Minimally invasive aesthetic procedures of the neck are becoming more popular. However, anatomical studies on the venous structures of the neck in relation to these procedures are lacking. OBJECTIVE The aims of this study were to identify the locations and communication patterns of the anterior jugular vein and external jugular vein (AJV and EJV) and the communicating vein (CV) based on superficial anatomical landmarks and to determine dangerous areas for dermal filler injections into the neck. MATERIALS AND METHODS Thirty sides of the neck from Korean adult cadavers were dissected for this study. RESULTS Four anatomical variants were identified. In Type Ia, the CV ran along the anterior border of the sternocleidomastoid muscle (SCM) (33.4%); in Type Ib, a single vein was observed connecting the CV and the EJV at the level of laryngeal prominence (23.3%); in Type Ic, the CV proceeded separately from the medial side of the anterior border of the SCM (13.3%); and in Type II, the CV was absent while the EJV and AJV were observed (30%). CONCLUSION Given the 4 anatomical variants identified in this study, the authors recommend exerting caution when performing dermal filler injections approximately 10, 30, and 60 mm lateral to the midsagittal line to avoid iatrogenic side effects.

http://bit.ly/2taYd0c

Use of Eye Shields for Mohs Micrographic Surgery of the Eyelids and Periorbital Area

BACKGROUND Internal eye shields are designed for use in periorbital procedures, but their use in Mohs micrographic surgery (MMS) of the eyelids has rarely been reported in the literature. OBJECTIVE The authors aim to discuss different types of internal eye shields as well as their indication, proper use, and potential complications. MATERIALS AND METHODS The authors performed a literature search on PubMed with the keywords "internal eye shield," "corneal shield," "scleral shield," and "periorbital Mohs micrographic surgery" with no restriction on publication time frame due to the scarcity of relevant literature. RESULTS Experts seem to agree that use of eye shield for MMS of the eyelids is a reasonable measure to undertake to prevent operative injuries. Although either plastic or stainless steel eye shield can be used, plastic eye shields are often preferred and recommended in procedures where electrosurgical devices need to be used. CONCLUSION Although the authors recommend the use of internal eye shields for MMS of the eyelids for preventing operative injuries, this recommendation (Grade C) is based on very limited evidence (Level 5). More research and higher-powered studies are needed for conclusive evidence and to establish clear guidelines for providers.

http://bit.ly/2t9Ku9Z

Commentary on Safety of Perfluorodecalin-Infused Silicone Patch in Picosecond Laser-Assisted Tattoo Removal

No abstract available

http://bit.ly/2ULNzZk

Vascular Injury After Deoxycholic Acid Injection

No abstract available

http://bit.ly/2ULNvsy

Outcomes for Invasive Melanomas Treated With Mohs Micrographic Surgery: A Retrospective Cohort Study

BACKGROUND Mohs micrographic surgery (MMS) has been used effectively to treat invasive melanoma. OBJECTIVE To further study the safety and efficacy of MMS in the treatment of invasive melanoma. METHODS AND MATERIALS A retrospective cohort study evaluated 123 melanomas excised using MMS with MART-1 immunostain. Local recurrence, metastasis, overall survival, and disease-free survival rates were calculated. These were compared with historical controls. RESULTS Among included patients, 78 were men (63%) and 45 were women (37%), with a mean age of 66.48 years. Mean follow-up time was 1,273 days (3.49 years). Local recurrence was identified in 2/123 (1.63%; 95% confidence interval, 0.20%–5.75%) lesions. Local recurrence was identified in 1/70 (1.43%; 95% confidence interval, 0.04%–7.70%) of head and neck cases. Tumor location was head and neck in 70 lesions (56.9%). Overall survival was 95.12% and disease-specific survival was 100%. CONCLUSION Mohs micrographic surgery is an effective treatment method for invasive melanoma, as evidenced by low recurrence rates and high rates of disease-free survival.

http://bit.ly/2t7ks77

BRCA1-Associated Protein-1 Tumor Predisposition Syndrome in a Patient With Numerous Basal Cell Carcinomas

No abstract available

http://bit.ly/2ULNsNo

Randomized Controlled Trial of Preoperative Topical Decolonization to Reduce Surgical Site Infection for Staphylococcus aureus Nasal Swab–Negative Mohs Micrographic Surgery Patients

BACKGROUND Surgical site infection (SSI) is mainly due to endogenous bacteria. Topical decolonization is a preoperative intervention currently advised for proven nasal carriers of Staphylococcus aureus (S. aureus). OBJECTIVE The authors assessed whether topical decolonization could be of benefit for patients who are not nasal carriers of S. aureus. METHODS AND MATERIALS The authors performed a randomized controlled trial of S. aureus nasal swab–negative patients. Five days before Mohs surgery topical decolonization with nasal mupirocin and chlorhexidine, body wash was started. The control group had no intervention. RESULTS In the week after Mohs surgery, the infection rate in the intervention group was 2% (n = 661, 14) and that of the control group was 4% (n = 689, 29). CONCLUSION Topical decolonization reduces SSI in nasal swab–negative Mohs surgery patients.

http://bit.ly/2tbsSKC

The Sterility of Partially Used Hyaluronic Acid Fillers After Long Storage: ERRATUM

No abstract available

http://bit.ly/2UNukPj

Factors Associated With Patient-Initiated Communication After Mohs Micrographic Surgery

BACKGROUND Despite extensive counseling, patients commonly call with postoperative concerns after Mohs micrographic surgery (MMS). OBJECTIVE We sought to determine the incidence, reasons, and patient and surgical characteristics that lead to patient-initiated communication after MMS. MATERIALS AND METHODS A retrospective chart review of 1,531 patients who underwent MMS during the observational period was conducted. Demographics and perioperative characteristics of patients who initiated communication were compared with a random sample of matched controls. RESULTS Of the 1,531 patients who underwent MMS, 263 patients (17.2%) initiated 412 communication encounters within 90 days of surgery. Top reasons for patient-initiated communication included wound concerns, bleeding, and postoperative pain. Female patients and those with a larger surgical defect size (cm2) were more likely to call postoperatively. Patients who underwent second intention healing, grafts, and interpolation flaps were more likely to initiate communication compared to patients repaired with a linear closure. CONCLUSION This study identifies the incidence, reasons, and patient and surgical factors predictive of patient-initiated communication after MMS, which may allow for targeted improvements in postoperative counseling, ameliorating patient anxiety, augmenting patient satisfaction, and improved efficiency for the health care team.

http://bit.ly/2ti4R4V

Preoperative Ultrasound for Evaluation of Hidradenitis Suppurativa

No abstract available

http://bit.ly/2UG0P1y

Commentary on Factors Associated With Patient-Initiated Communication Following Mohs Micrographic Surgery

No abstract available

http://bit.ly/2ti4LKB

Treatment of Corticosteroid-Induced Hypopigmentation Using Fractional Carbon Dioxide Laser

No abstract available

http://bit.ly/2ULMYXA

Patient-Centered Outcomes for Skin Cancer Management: Utilization of a Patient Delphi Process to Identify Important Treatment Themes

BACKGROUND Patient-reported outcomes are critical to research directed at maximizing patient benefit. The outcomes patients consider most relevant in the treatment of skin cancer have not been directly investigated. OBJECTIVE To develop a ranked list of outcomes deemed most important by patients with skin cancer through a proctored Delphi process. METHODS Twenty-one patients with a history of skin cancer volunteered to participate in the patient summit. The patient members participated in a guided discussion to generate a long list of potentially relevant outcomes. The list was then condensed and ranked through 2 rounds of a proctored Delphi process. RESULTS Patients were diverse in their skin cancer histories and complexities, ages, and states of residence. Twelve themes were rated as highly important by 70% or more of participants. Most of these themes related to patient education and the collaborative nature of the physician–patient relationship. Fear of recurrence and cosmetic outcome were also highly rated. Limitations include a preponderance of older patients and patients from the midwest and northeast. CONCLUSION Patients with skin cancer overwhelmingly prioritize a shared decision-making process, in which they are actively engaged and value detailed education regarding their disease. This should inform future research directed at skin cancer treatment and current physician–patient interactions.

http://bit.ly/2ti4F5H

Concentrations of particulate matter, carbon dioxide, VOCs and risk assessment inside Korean taxis and ships

Abstract

The objective of this study was to investigate the concentration distribution of indoor air pollutants in taxis and ships (passengers) which are frequently used for public transportation and recreational activities in South Korea. In addition, it aimed to assess air quality factors to establish and evaluate the health risks of exposure to polluted indoor air. Particulate matter (PM₁₀) concentrations were not affected by the number of passengers, time of day, and driving characteristics because there were only a few passengers (2 to 4 people) and the space was confined. In the ships, indoor air pollutants responded more sensitively to the operation characteristics depending on the time of sailing (i.e., anchoring and departure, movement of vehicles on the ship, movement of passengers, combustion in the shop, and ventilation) than to the number of people boarding and alighting. The carbon dioxide concentrations in different ship rooms did not vary according to season and degree of congestion; however, there were differences between different ships. These differences may result from the size, type, and operating characteristics of the ships. Volatile organic compounds (VOCs) and aldehydes in new taxis exceeded the standard levels during summer. VOC concentrations in ships were particularly high during summer when the outdoor temperature was high. Similar observations were made for other means of transportation. The risk assessment depended on the means of transportation and demonstrated that mortality risks due to PM₁₀ and excess carcinogenic and non-carcinogenic risks from VOCs and aldehydes were within safety levels.

http://bit.ly/2Swzku4

Seawater intrusion vulnerability in the coastal aquifers of southern India—an appraisal of the GALDIT model, parameters’ sensitivity, and hydrochemical indicators

Abstract

An appraisal of seawater intrusion into the coastal aquifers is one of the major issues for groundwater resource management. The GALDIT model applies to the analysis of multiple parameters using systematic GIS techniques for mapping and assessment of seawater intrusion vulnerability. It demarcates the mapping of potential vulnerability that shows a higher vulnerability to seawater intrusion in various parts of the coast and the estimated vulnerability index value of 7.50 and 9.64. An area of 33.0 km² spread in the low-lying coastal area comprising estuaries, salt marshes, and saltpans shows the high vulnerability condition with an estimated vulnerability value of 6.42–7.50. An area of 73.20 km² spread over coastal and alluvial plains experiences moderate vulnerability (temporal salinity in the groundwater sources) with an estimated vulnerability index value of 5.46–6.42. Aquifers underlying coastal uplands (hard rock formations) and some parts of accretionary beaches (2.05 km²) are relatively protected fresh groundwater sources, wherein the estimated vulnerability index is 4.55–5.46. The vulnerability mapping of the GALDIT model using hydrochemical analysis of primary groundwater parameters such as TDS, Cl⁻, HCO₃, and Cl⁻/HCO₃ ratio is validated. Higher concentration of TDS (2637–4162 mg/l) and Cl⁻ (1268–2347 mg/l) is taken for the areas falling under higher vulnerability to seawater intrusion, especially in the placer mining sites and coastal areas facing erosion. Similarly, the groundwater sources of the low-lying areas including estuaries, salt marshes, saltpans, and backwater were noted to have higher values of Cl⁻/HCO₃ with a rationality of 9.87–12.18. Hydrological facies shows the highest concentration of NaCl in the groundwater sources within the proximity of eroded beaches, saltwater bodies, and sand mining areas. A hydrochemical facies evolution (HFE) diagram represents the hydrochemical facies of groundwater elements that shows an intrusion of seawater into the coastal aquifers underlying the very high vulnerable zones. Higher bicarbonate concentration (233–318 mg/l) is noticed in the upland areas and some parts of dunes and accreted beaches, sandy coasts, and uplands. Vulnerability analysis reveals that those areas near saltwater bodies and eroding coasts are prone to lateral and vertical diffusion of saltwater. The geodatabase developed through such modeling studies can help in planning and developing activities for sustainable groundwater resource management in coastal areas.

http://bit.ly/2DgLQnH

External and internal diameters of the facial artery relevant to intravascular filler injection

Background: Vision loss and skin necrosis caused by an accidental intra-arterial embolism or vascular compression are rare but devastating complications when injecting filler materials into the face. Accurate knowledge of the vascular anatomy of the anterior face is crucial for performing safe cosmetic procedures. Methods: Seventy-two facial arteries were harvested from 41 formalin-embalmed cadavers. After removing connective tissues attached to the arterial wall under stereomicroscope observation, the external and internal diameters and wall thicknesses of the facial artery and its branches were measured at various levels along where the arterial courses on the anterior face. Results: The diameter and thickness of the facial artery exhibited significant interregional differences. The external and internal diameters of the facial artery were 1.9±0.4 and 1.2±0.3 mm (mean±SD), respectively, at the inferior border of the mandible, 1.7±0.3 and 1.2±0.3 mm in the vicinity of the inferior labial artery, 1.5±0.3 and 1.0±0.3 mm at the mouth corner, 1.4±0.3 and 0.9±0.2 mm in the vicinity of the superior labial artery, and 1.1±0.2 and 0.7±0.2 mm in the vicinity of the lateral nasal artery. The external and internal diameters at the proximal parts of the inferior labial artery, superior labial artery, and lateral nasal artery were 1.0±0.3 and 0.6±0.2 mm, 0.9±0.3 and 0.6±0.2 mm, and 0.8±0.2 and 0.5±0.2 mm, respectively. Conclusions: Morphometric examinations of the facial artery under stereomicroscope observation as performed in the present study are expected to be more accurate than direct measurements made during cadaveric dissection or conventional histological evaluations. Financial disclosures: This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2015R1D1A1A01057983). Ethics: This study conformed to the World Medical Association Declaration of Helsinki (June 1964) and subsequent amendments. Conflict of interest statement: The authors have no conflicts of interest to report Correspondence to: Wu-Chul Song, MD, PhD, Department of Anatomy, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea, Telephone: +82 2 2030 7819, Fax: +82 2 2030 7845, E-mail: anatomy@konkuk.ac.kr ©2019American Society of Plastic Surgeons

http://bit.ly/2ShQXP5

Fenestration Improves Acellular Dermal Matrix Biointegration: An Investigation of Revascularization with Photoacoustic Microscopy.

Background: Acellular dermal matrices (ADMs) have revolutionized alloplastic breast reconstruction. Furthering our knowledge of ADM biointegration will allow for improved design of these biomaterials. The ideal ADM for breast reconstruction would provide durable soft tissue augmentation while undergoing rapid biointegration to promote physiologic elasticity and reduced infectious complications. The inclusion of fenestrations in the design of ADMs is thought to promote the process of biointegration; however, the mechanisms underlying this theory have not been evaluated. Methods: Biointegration of standard and fenestrated ADMs was assessed with serial photoacoustic microscopy (PAM) imaging, in a murine dorsal skin-fold window chamber model that is specifically designed to recapitulate the microenvironment of ADM–assisted alloplastic breast reconstruction. PAM allows for a serial, real-time noninvasive assessment of hemoglobin content and oxygen saturation in living tissues; generating high-resolution, three-dimensional maps of the nascent microvasculature within ADMs. Confirmatory histology and immunohistochemical assessments were performed at the terminal time point. Results: Fenestrated ADMs demonstrated increased fibroblast and macrophage lineage host cell infiltration, greater mean percent surface area vascular penetration (21% vs 11%, p=0.08), and greater mean oxygen saturation (13.5% vs 6.9%, p

http://bit.ly/2Sgk4ly

Complication Profiles by Mastectomy Indication in Tissue Expander Breast Reconstruction

Background: Two-stage implant breast reconstruction is the most commonly performed breast reconstruction procedure. Limited data exists regarding reconstruction complication rates examined by mastectomy indication. Methods: Patients who underwent two-stage implant breast reconstruction at Yale New Haven Hospital from 2011-2017 were included in the study. Peri-operative complications were compared. T-tests, Chi-square analysis, and Fisher's exact tests were used to determine significant associations. A binary logistic regression was used to determine variables with a significant impact on the likelihood of mastectomy flap necrosis. Results: Between 2011 and 2017, complete perioperative records were available for 141 patients who underwent 226 mastectomies followed by two-stage tissue expander/permanent implant reconstruction. Of the 226 mastectomies, 134 were therapeutic and 92 were prophylactic. On regression analysis, there were no significant differences in demographics, comorbidities, or mastectomy and reconstructive details between the two breast groups except for there being more modified radical mastectomies in therapeutic breasts (p=.003). When comparing complications, there was a significantly higher risk of mastectomy flap necrosis in the therapeutic group (p=0.017). Therapeutic mastectomies had a 9.5 times higher risk of mastectomy flap necrosis than prophylactic mastectomies when adjusted for confounding variables. There were no significant differences in other reconstructive complications between the two groups. Conclusions: Patients undergoing therapeutic mastectomies have a significantly higher risk of mastectomy flap necrosis than prophylactic mastectomies. Although the underlying etiology still needs to be determined, differences in technique may be related to mastectomy flap necrosis. Financial Disclosure Statement: None of the authors have anything to disclose. No funding was received for this article. Corresponding Author: Michael Alperovich, MD, MSc, Assistant Professor of Plastic Surgery, Yale University School of Medicine, Section of Plastic and Reconstructive Surgery, 330 Cedar St. Boardman Bld 3rd fl. New Haven, CT 06510, Michael.Alperovich@yale.edu ©2019American Society of Plastic Surgeons

http://bit.ly/2Dan9Jy

Mythbusting the DIEP Flap and An Introduction to the Abdominal Perforator Exchange (APEX) Breast Reconstruction Technique: A Single-Surgeon Retrospective Review

Background: Anatomic variations in perforator arrangement may impair the surgeon's ability to effectively avoid rectus muscle transection without impairing flap perfusion in the DIEP flap. Methods: A single surgeon's experience was reviewed with consecutive patients undergoing bilateral abdominal perforator flap breast reconstruction over 6 years, incorporating flap standardization, pedicle disassembly, and algorithmic vascular rerouting when necessary. Unilateral reconstructions were excluded to allow for uniform comparison of operative times and donor site outcomes. 364 flaps in 182 patients were analyzed. Operative details, and conversion rates from DIEP to APEX arms of the algorithm were collected. Patients with standardized DIEP flaps served as the controlling comparison group and outcomes were compared to those who underwent "APEX" (Abdominal Perforator Exchange) conversion. Results: APEX conversion rate from planned DIEP was 41.5%. Mean additional operative time to employ APEX pedicle disassembly was 34 minutes per flap. Early postsurgical complications were of low incidence and similar among the groups. 1 DIEP flap failed and there were no APEX failures. 1 abdominal bulge occurred in the DIEP group. There were no abdominal hernias in either group. Fat necrosis rates (2.4% APEX/3.4%DIEP) were significantly lower than that historically reported for both TRAM and DIEP flaps. Conclusions: This study revealed no added risk when employing pedicle disassembly to spare muscle/nerve structure during abdominal perforator flap harvest. Abdominal bulge/hernia was nearly completely eliminated. Fat necrosis rates were extremely low, suggesting benefit to pedicle disassembly and vascular routing exchange when required. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Financial Disclosure Statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. No funding was received for this article. Presented at: The 4th Annual London Breast Meeting, Royal College of Physicians Regents Park, London, UK September 8, 2017 and the American Society for Reconstructive Microsurgery Annual Scientific Meeting, Phoenix, AZ January 15, 2017. Corresponding Author: Frank J. DellaCroce, MD, FACS, Center For Restorative Breast Surgery, Dept. Plastic Surgery, 1717 St. Charles Avenue, New Orleans, LA 70130, Fax: (504) 899-2700, Phone: (504) 899-2800, Email: fjdellacroce@gmail.com / drd@breastcenter.com ©2019American Society of Plastic Surgeons

http://bit.ly/2Sku9yg

Fat Grafting into Younger Recipients Improves Volume Retention in an Animal Model

Background: Soft tissue deficits associated with various craniofacial anomalies can be addressed by fat grafting, although outcomes remain unpredictable. Furthermore, consensus does not exist for timing of these procedures. While some advocate approaching soft tissue reconstruction after the underlying skeletal foundation has been corrected, other studies have suggested earlier grafting may exploit a younger recipient niche that is more conducive for fat graft survival. As there is a dearth of research investigating effects of recipient age on fat graft volume retention, this study compared the effectiveness of fat grafting in younger versus older animals through a longitudinal, in vivo analysis. Methods: Human lipoaspirate from three healthy female donors was grafted subcutaneously over the calvarium of immunocompromised mice. Volume retention over 8 weeks was evaluated using micro-computed tomography in three experimental ages – 3-weeks old, 6-months old, and 1-year old. Histology was performed on explanted grafts to evaluate graft health and vascularity. Recipient site vascularity was also evaluated by confocal microscopy. Results: Greatest retention of fat graft volume was noted in the youngest group compared to both older groups (*p

http://bit.ly/2Dan0G0

“A Cost Minimization Analysis Evaluating the Use of Liposomal Bupivacaine in Reconstructive Plastic Surgery Procedures.”

Postsurgical pain management is critical to patient satisfaction and value. Several studies have evaluated liposomal bupivacaine (LB) in postoperative pain management protocols, however its economic feasibility remains undefined. This study analyzes the economic impact of LB using a national claims database to assess postoperative clinical and financial outcomes in plastic and reconstructive procedures. Methods: The Vizient Clinical Database/Resource Manager™ electronic database was reviewed for plastic surgery procedures (abdominoplasty, abdominal wall reconstruction, mastectomy with immediate tissue expander placement, mastectomy with direct-to-implant reconstruction, autologous breast reconstruction, and augmentation mammoplasty) at participating hospitals from July 1, 2016-July 1, 2017. The main outcome measures were the length of stay (LOS), 7-, 14-, and 30-day readmission rates, and direct and total costs observed. Results: During the study period, 958 total cases met inclusion criteria. LB was used in 239 (25%) cases. Compared to cases that did not utilize LB, LB cases had a decreased LOS (9.2 days vs. 5.8 days), decreased cost (total cost $39,531 vs. $28,021, direct cost $23,960 vs. $17,561), and lower 30-day readmission rates 4% vs. 0%. The 14- and 7-day readmission rates were similar between the two groups. Conclusion: The use of LB may contribute to a reduction in LOS, hospital costs, and 30-day readmission rates for abdominal and breast reconstructive procedures, which could contribute to a favorable economic profile from a system view. Focusing on the measurement and improvement of value in the context of whole, definable, patient processes will be important as we transition to value-based payments. Disclosures: Dr. Janis is has served a prior consultant for Pacira Pharmaceuticals, LifeCell, Bard, Daiichi Sankyo, and Allergan within the last 12 months, but has no active affiliations. He receives royalties from Thieme Publishing. Dr. Janis Keller and Ramshaw have received consulting fees and speaker fees from Pacira Pharmaceuticals, which produces and sells liposomal bupivacaine (Exparel). Drs Little and Brower have nothing to disclose. No funding was received for this article. Corresponding Author: Jeffrey E. Janis, MD, FACS, Professor of Plastic Surgery, Neurosurgery, Neurology, and Surgery, Department of Plastic Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Rd, Columbus, OH 43212, Phone: (614) 293-8566, Fax: (614) 293-9024, Email: jeffrey.janis@osumc.edu ©2019American Society of Plastic Surgeons

http://bit.ly/2Se3lzr

“Asian Blepharoplasty and the Eyelid Crease”, 3rd edition

No abstract available

http://bit.ly/2Djkayv

Facial Reconstruction after Mohs Surgery.

No abstract available

http://bit.ly/2ScVHFJ

Optimizing Perforator Selection: A Multivariable Analysis of Predictors for Fat Necrosis and Abdominal Morbidity in DIEP Flap Breast Reconstruction.

No abstract available

http://bit.ly/2Di0sn1

Structural Gender-Dimorphism and the Biomechanics of the Gluteal Subcutaneous Tissue – Implications for the Pathophysiology of Cellulite

Objective: To investigate gender differences in gluteal subcutaneous architecture and biomechanics to better understand the pathophysiology underlying the mattress-like appearance of cellulite. Materials and Methods: 10 males and 10 female body donors (mean age: 76 ± 16.47 years; range: 36–92 years; mean BMI: 25.27 ± 6.24 kg/m2; range: 16.69-40.76) were used to generate full-thickness longitudinal and transverse gluteal slices. In the superficial and deep fatty layers, fat lobule number, height, and width were investigated. The force needed to cause septal breakage between the dermis and superficial fascia was measured using biomechanical testing. Results: Increased age was significantly related to decreased dermal thickness, independent of gender (OR 0.997, 95% CI [0.996 – 0.998], p

http://bit.ly/2Sj31zp

Fill the acquired contour deformities

No abstract available

http://bit.ly/2DePUoA

Discussion: Management of High Output Chyle Leak After Harvesting of Vascularized Lymph Node Transfer

No abstract available

http://bit.ly/2Schf5f

Optimizing Perforator Selection in DIEP Flap Breast Reconstruction

No abstract available

http://bit.ly/2DbTIqF

Flow-controlled ventilation during ear, nose and throat surgery: A prospective observational study

BACKGROUND Flow-controlled ventilation (FCV) is a new mechanical ventilation mode that maintains constant flow during inspiration and expiration with standard tidal volumes via cuffed narrow-bore endotracheal tubes. Originating in manually operated 'expiratory ventilation assistance', FCV extends this technique by automatic control of airway flow, monitoring of intratracheal pressure and control of peak inspiratory pressure and end-expiratory pressure. FCV has not yet been described in a clinical study. OBJECTIVE The aim of this study was to provide an initial assessment of FCV in mechanically ventilated patients undergoing ear, nose and throat surgery and evaluate its potential for future use. DESIGN An observational study. SETTING Two German academic medical centres from 24 November 2017 to 09 January 2018. PATIENTS Consecutive patients (≥ 18 years) scheduled for elective ear, nose and throat surgery. Exclusion criteria were planned laser surgery, intended fibreoptic awake intubation, emergency procedures, increased risk of aspiration, American Society of Anesthesiologists (ASA) physical status more than III and chronic obstructive pulmonary disease classified as GOLD stage more than II. INTERVENTION Peri-operative use of FCV provided by a new type of ventilator (Evone) via a narrow-bore endotracheal tube (Tritube). MAIN OUTCOME MEASURES Minute volume, respiratory rate, intratidal tracheal pressure amplitude (Δp) and end-tidal CO2 (PetCO2) were recorded every 5 min. All adverse events were noted. Data are presented as median [IQR]. RESULTS Sixteen patients provided 15 evaluable data sets. A minute volume of 5.0 [4.4 to 6.4] l min−1 and a respiratory rate of 9 [8 to 11] min−1 generated a PetCO2 of 4.9 [4.8 to 5.0] kPa. Δp was 10 [9 to 12] cmH2O. Five adverse events were recorded: a tube obstruction due to airway secretions and four tube dislocations (two attributed to coughing, two not study-related). CONCLUSION FCV achieves adequate PetCO2 levels with minute volume and Δp in the normal range. Tritube's high flow resistance may increase the likelihood of tube dislocations if the patient coughs. Although further evaluation is necessary, FCV provides a new option for short-term mechanical ventilation. The successful operation of FCV with narrow-bore tubes contributes to the armamentarium for airway management. TRIAL REGISTRATION DRKS00013312 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://bit.ly/OBJ4xP Correspondence to Dr. Johannes Schmidt, Department of Anaesthesiology and Critical Care, Medical Centre – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany Tel: +49 761 270 26390; e-mail: johannes.schmidt@uniklinik-freiburg.de Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://bit.ly/2ylyqmW). © 2019 European Society of Anaesthesiology

http://bit.ly/2SsAarR

Pre-operative assessment of 30-day mortality risk after major surgery: the role of the quick sequential organ failure assessment: A retrospective observational study

BACKGROUND The quick Sequential Organ Failure Assessment (qSOFA) is intended for the assessment of the prognosis and risk of sepsis. It may also help predict the mortality risk of nonseptic patients. OBJECTIVE This study investigated the relationship between pre-operative qSOFA scores and 30-day mortality after major surgery. It also evaluated the predictive value of qSOFA scores combined with the American Society of Anesthesiologists (ASA) physical status and Charlson comorbidity index (CCI). DESIGN A retrospective observational study. SETTING Single tertiary academic hospital. PATIENTS Medical records of patients who underwent major surgery (estimated blood loss >500 ml; surgery time >2 h) between January 2010 and December 2017 were examined. MAIN OUTCOME MEASURES The qSOFA score was measured within 24 h before surgery, and its association with 30-day mortality was analysed using multivariable logistic regression. A receiver-operating characteristic curve analysis was used to investigate the predictive power of the pre-operative qSOFA scores combined with the ASA physical status and with CCI. RESULTS A total of 6336 patients were included in the final analysis, and 91 (1.4%) died within 30 days. The multivariable logistic regression analysis including all covariates indicated that 30-day mortality was 2.43-times higher for the score 1 group than for the score 0 group (P = 0.002), and it was 3.54-times higher for the score at least 2 group than for the score 0 group (P

http://bit.ly/2ROfFl6

‘May you live in interesting times’: blessing or curse for an intensivist?

No abstract available

http://bit.ly/2GtB94y

Pre-operative assessment of 30-day mortality risk after major surgery: the role of the quick sequential organ failure assessment: A retrospective observational study

Flow-controlled ventilation during ear, nose and throat surgery: A prospective observational study

Collision of Subungual Neurofibroma and Onychomatricoma: S100 Positivity as a Clue

Abstract: We present a 41-year-old man with a hemionychodystrophy of the first toe, appearing as a longitudinal thickening of the nail plate, overcurved and with holes in its thickened free margin, thus leading to the clinical diagnosis of onychomatricoma. Complete excision showed typical nail plate of onychomatricoma and, underlying it, curvy disorganized neural-looking fascicles without atypia and with diffuse positivity for S100, interpreted as subungual neurofibroma (NF). Subungual NF is a very rare tumor, with only 12 previous cases reported. Its diagnosis is based on histopathology, as the tumor presents waves or whorls of disorganized neural-looking cells positive for S100. Regarding onychomatricoma, it is characterized by typical glove finger digitations (which were present in our case) and an underlying stroma composed by a cellular superficial layer (this layer expresses CD34 but not CD99) and a more sclerotic and deeper area. As we did not find information on S100 expression in the stroma of onychomatricoma, we have stained 4 typical cases, and all were negative with S100 and positive with CD34, as expected. In conclusion, as "subungual NF" is so rare and, in our case, seems to collide with a typical onychomatricoma, we recommend adding S100 staining to properly characterize tumors involving nail plate, to detect underlying neural tumors, as has happened in our case. Correspondence: Mar Llamas-Velasco, MD, Hospital Universitario de La Princesa, C/Diego de León, 62, Madrid CP28006, Spain (e-mail: mar.llamasvelasco@gmail.com). The authors declare no conflicts of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2Bkm95C

Skin-Colored Nodule on the Cutaneous Lip: Challenge

No abstract available

http://bit.ly/2TClJ1M

Retiform Purpura After Percutaneous Angioplasty: Challenge

No abstract available

http://bit.ly/2BypmyP

Spontaneous Hair Repigmentation in an 80-Year-Old Man: A Case of Melanoma-Associated Hair Repigmentation and Review of the Literature

Abstract: Spontaneous hair repigmentation of physiologically white or gray hair is a rare occurrence that may be associated with melanoma in elderly individuals. We present the first case of this phenomenon in a man. A gray-haired, 80-year-old man presented to dermatology clinic with a 3-cm lock of black hair on his vertex scalp that developed over 1 year. Punch biopsies showed an increase in junctional dendritic melanocytes with rare pagetoid cells and extension along the follicular outer root sheath epithelium and interfollicular epidermis, associated with prominent dendritic melanocytic hyperplasia and pigment-containing melanocytes within the hair bulbs. Although the findings on the biopsies were not diagnostic of melanoma in situ, an irregular interfollicular distribution of melanocytes was concerning for an adjacent atypical process. A complete excision was performed and revealed melanoma in situ, lentigo maligna type. Rare reports describe spontaneous hair repigmentation as a harbinger of lentigo maligna in women. Repigmentation can occur in the setting of proliferation of malignant pigment-producing melanocytes or by paracrine stimulation of benign bulbar melanocytes through receptor tyrosine kinase KIT activation. Presence of prominent dendritic melanocytic hyperplasia and pigment-containing melanocytes within the hair bulbs in our patient's biopsies was suggestive of paracrine or physiologic stimulation of bulbar melanocytes. Given the importance of early melanoma detection and the low visibility of the scalp, this report raises awareness of an extraordinary presentation of lentigo maligna and exemplifies the importance of close clinicopathologic correlation to ensure optimal clinical management and patient outcome. Correspondence: Shabnam Momtahen, MD, Assistant Professor of Pathology and Laboratory Medicine, Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756 (e-mail: shabnam.momtahen@hitchcock.org). The authors declare no conflicts of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2TvGImJ

Differential Diagnosis in Dermatology

No abstract available

http://bit.ly/2BmADlm

A Unique and Rare Case of Extramammary Paget Disease With Concomitant Herpes Simplex

Abstract: We describe a rare and unique case of extramammary Paget disease in the genitals with concomitant histological features of herpes virus infection. This is a very rare and interesting association that has only been reported in 1 article in the literature so far. Correspondence: Valencia Long, MBBS, Department of Dermatology, National Skin Centre, 1 Mandalay Road Singapore 308205, Singapore (e-mail: valencialong@gmail.com). The authors declare no conflicts of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2TASBYG

Enhancement in combustion, performance, and emission characteristics of a diesel engine fueled with diesel, biodiesel, and its blends by using nanoadditive

Abstract

This article presents the results of investigations carried out to evaluate the improvement in combustion, performance, and emission characteristics of a diesel engine fueled with neat petro-diesel (PD), soybean biodiesel (SB), and 50% SB blended PD (PD50SB) by using carbon nanotube (CNT) as an additive. The acid–alkaline-based transesterification process with sodium hydroxide (NaOH) as a catalyst was applied to derive the methyl ester of SB. A mass fraction of 100 ppm CNT nanoparticle was blended with base fuels by using an ultrasonicator and the physiochemical properties were measured based on EN standards. The measured physiochemical properties are in good agreement with standard limits. The experimental evaluations were carried out under varying brake mean effective pressure (BMEP) conditions in a single-cylinder, four-stroke, and natural aspirated research diesel engine at a constant speed of 1500 rpm. The results reveal that the SB and its blend promote shorter ignition delay period (IDP) that is resulting in lower in-cylinder pressure (ICP) and net heat release rate (NHR) compared to PD. The SB and its blend increase the brake specific fuel consumption (BSFC), and reduce the brake specific energy consumption (BSEC) and exhaust gas temperature (EGT), due to lower heating value, and efficient combustion, respectively. As far as the emission characteristics are concerned, the SB and its blend promote lower magnitude of hydrocarbon (HC), carbon monoxide (CO), carbon dioxide (CO₂), and smoke emissions compared to PD except for oxides of nitrogen (NO_x) emission. The CNT nanoparticle inclusion with base fuels significantly improves the combustion, performance, and emissions level irrespective of engine load conditions.

http://bit.ly/2TB7JoS

Green sol–gel synthesis of novel nanoporous copper aluminosilicate for the eradication of pathogenic microbes in drinking water and wastewater treatment

Abstract

We used a green sol–gel synthesis method to fabricate a novel nanoporous copper aluminosilicate (CAS) material. Nanoporous CAS was characterized using X-ray powder diffraction (XRD), field emission transmission and scanning electron microscopies (FE-TEM/FE-SEM), Fourier transform infrared (FTIR) spectroscopy, and optical analyses. The CAS was also evaluated for use as a promising disinfectant for the inactivation of waterborne pathogens. The antimicrobial action and minimum inhibitory concentration (MIC) of this CAS disinfectant were determined against eight microorganisms (Escherichia coli, Salmonella enterica, Pseudomonas aeruginosa, Listeria monocytogenes, Staphylococcus aureus, Enterococcus faecalis, Candida albicans, and Aspergillus niger). An antimicrobial susceptibility testing of CAS was measured. Results of disc diffusion method pointed out that the diameters of the zone using well diffusion were wider than disc diffusion methods, and the findings also showed that the MIC of the CAS disinfectant against E. coli, S. enterica, and P. aeruginosa was 100 mg/L within 20 min of contact time. Meanwhile, the MIC of the CAS disinfectant was 100 mg/L within 40 min of contact time for the other strains. The efficacy of antimicrobial action (100%) reached within 20 to 40 min against all tested microbes. Herein, the antimicrobial susceptibility testing of CAS disinfectant showed no toxicity for human and bacterial cells. It can be concluded that nanoporous CAS is a promising, economically, and worthy weapon for water disinfection.

http://bit.ly/2SedJHj

Contamination status and potential release of trace metals in a mangrove forest sediment in Ho Chi Minh City, Vietnam

Abstract

Can Gio district is located in the coastal area of Ho Chi Minh City, southern Vietnam. Discharge of wastewater from Ho Chi Minh City and neighboring provinces to the rivers of Can Gio has led to concerns about the accumulation of trace metals (As, Cu, Cr, Ni, Pb, and Zn) in the coastal sediments. The main objective of this study was to assess the distribution of As, Cu, Cr, Ni, Pb, and Zn in surface and core sediments and to evaluate the contamination status in relation to local background values, as well as the potential release of these selected trace metals from sediments to the water environment. Sediment characteristization, including determination of fine fraction, pH, organic matter, and major elements (Al, Fe, Ca, K, Mg, and S), was carried out to investigate which parameters affect the trace metal enrichment. Fine fraction and Al contents were found to be the controlling proxies affecting the distribution of trace metals while other sediment characteristics did not show any clear influence on trace metals' distribution. Although As concentrations in the sediments were much higher compared to its reference value in other areas, the enrichment factor based on local background values suggests minor contamination of this element as well as for Cr, Cu, and Pb. Risk assessment suggested a medium to very high risk of Mn, Zn, and Ni under acidification. Of importance is also that trace metals in sediments were not easily mobilized by organic complexation based on their low extractabilities by ammonium-EDTA extraction.

http://bit.ly/2HXKzrz

Microbiological dynamics of red complex bacteria following full-mouth air polishing in periodontally healthy subjects—a randomized clinical pilot study

Abstract

Objectives

Suppression of periodontal pathogens in the oral cavity of periodontally healthy individuals may lower the risk for periodontal or periimplant diseases. Therefore, the present study aimed to analyze the effect of supragingival debridement (SD) with adjunctive full mouth glycine powder air polishing (FM-GPAP) on the prevalence of periodontal pathogens in periodontally healthy individuals.

Materials and Methods

Eighty-seven systemically and periodontally healthy intraoral carriers of red complex bacteria, i.e., Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola or other periodontal pathogens including Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Eikenella corrodens were enrolled into the study and randomly assigned to receive SD with adjunctive FM-GPAP (test, n = 42) or SD alone (control, n = 45). In the first observation period, microbiological samples were obtained prior to, and 2, 5, and 9 days following intervention. If one of these periodontal pathogens could still not be identified, additional microbial sampling was performed after 6 and 12 weeks.

Results

The prevalence of red complex bacteria was significantly reduced in the test compared to the control group following treatment (p = 0.004) and at day 9 (p = 0.031). Intragroup comparison showed a significant (test, p < 0.001; control, p ≤ 0.01) reduction in the mean prevalence in both groups from BL through day 9 with an additional significant intergroup difference (p = 0.048) at day 9. However, the initial strong reduction returned to baseline values after 6 and 12 weeks.

Conclusion

In periodontally healthy carriers of periodontal pathogens, FM-GPAP as an adjunct to SD transiently enhances the suppression of red complex bacteria.

Clinical relevance

Whether the enhanced suppression of red complex bacteria by adjunctive FM-GPAP prevents the development of periodontitis in periodontally healthy carriers requires further investigations.

http://bit.ly/2Sg7Pp6

Editorial

I would like to extend my warmest New Year's greetings to all our readers as we commence the 31st volume and 30th year of publishing International Immunology. As we acknowledge and celebrate this particular milestone in the journal's history, I am very glad to be able to report on some good news from an eventful 2018. Last year saw International Immunology's Impact Factor rise to 5.189; the journal's highest Impact Factor to date and the first time it has risen above five. Several of the most highly cited papers which contributed to the Impact Factor were from our Special Issue on Antibody-Targeted Therapy, highlighting the global attention that this exciting field of research is currently receiving (1).

http://bit.ly/2DWyazY

In This Issue

m_dxy08001.jpeg?Expires=1549585890&Signa

http://bit.ly/2Grn9bz

Vancomycin-associated Drug-Induced Hypersensitivity Syndrome (DIHS)

While hypersensitivity reactions are well-characterized for certain medications, vancomycin-associated drug-induced hypersensitivity syndrome (DIHS), or drug reaction with eosinophilia and systemic symptoms (DRESS), has yet to be defined.

http://bit.ly/2Gq0i02

Corrigendum to 'Abstract 7058' [J Am Acad Dermatol (2018) AB112]

http://bit.ly/2DWwYwu

Reply to: Comment on “Oral diabetes medications other than dipeptidyl peptidase-4 inhibitors are not associated with bullous pemphigoid: A Finnish nationwide case control study” and a case report of glucagon-like peptide-1 receptor agonist induced bullous pemphigoid

http://bit.ly/2DWxISd

Disposable paper cup as a cheap and ready to use stencil for spot cryo treatment

http://bit.ly/2GtSyKA

Overall and Subgroup Prevalence of Pyoderma Gangrenosum Among Patients with Hidradenitis Suppurativa: a population based analysis in the United States

Hidradenitis suppurativa (HS) and pyoderma gangrenosum (PG) are reported to coexist, although prevalence of PG among HS patients has not been systematically evaluated.

http://bit.ly/2DWwTca

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Τετάρτη 6 Φεβρουαρίου 2019

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Objectives

Materials and Methods

Results

Conclusion

Clinical relevance

Αρχειοθήκη ιστολογίου