Reply to Letter: Patient-reported outcome measures following rhinoplasty

No abstract available

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Reversible pisa syndrome related to the interaction between lithium and clotiapine: Case report

Publication date: Available online 28 June 2018
Source:The Kaohsiung Journal of Medical Sciences
Author(s): Sheng-Yun Huang, Min-Wei Huang, Shih-Yen Tseng, Li-Chung Huang




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In vivo identification of novel TGIF2LX target genes in colorectal adenocarcinoma using the cDNA-AFLP method

Publication date: Available online 28 June 2018
Source:Arab Journal of Gastroenterology
Author(s): Gholam Reza Mobini, Arefeh Ghafari, Saeid Amanpour, Roohollah Fateh, Mohammad Hossein Ghahremani, Samad Muhammadnejad, Ahmad Reza Dehpour, Abolfazl Akbari, Seyed Mojtaba Hoseiniharouni, Elham Kazemirad, Manzar Bolhassani, Mansour Heidari
Background and study aimsHomeobox-containing genes are composed of a group of regulatory genes encoding transcription factors involved in the control of developmental processes. The homeodomain proteins could activate or repress the expression of downstream target genes. This study was conducted to in vivo identify the potential target gene(s) of TGIF2LX in colorectal adenocarcinoma.MethodsA human colorectal adenocarcinoma cell line, SW48, was transfected with the recombinant pEGFPN1-TGIF2LX. The cells were injected subcutaneously into the flank of the three groups of 6-week-old female athymic C56BL/6 nude mice (n = 6 per group). The transcript profiles in the developed tumours were investigated using the cDNA amplified fragment length polymorphism (cDNA-AFLP) technique.ResultsThe real-time RT-PCR and DNA sequencing data for the identified genes indicated that the N-terminal domain-interacting receptor 1 (Nir1) gene was suppressed whereas Nir2 and fragile histidine triad (FHIT) genes were upregulated followed by the overexpression of TGIF2LX gene.ConclusionDownregulation of Nir1 and upregulation of Nir2 and FHIT genes due to the overexpression of TGIF2LX suggests that the gene plays an important role as a suppressor in colorectal adenocarcinoma.



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Screening of microalgae for treating Garcinia cambogia wash water with potential lipid production

Abstract

The microalgae-based water treatment is gaining importance in recent years as it serves multiple purposes of which includes water treatment and biofuel production. Garcinia cambogia, a Malabar tamarind is a tropical fruit and the active ingredient hydroxycitric acid is popularly used as a weight-loss supplement. After extraction of the hydroxycitric acid, the wash water of G. cambogia is considered as an effluent. The potential microalgal species that can grow and treat G. cambogia wash water were isolated and identified as Dicloster acuatus BVR1 and Kalenjenia gelanitosa BVR2. Both the microalgal species adapted to G. cambogia wash water and entered exponential phase after sixth day with maximum specific growth rate of 0.310 day⁻¹ for D. acuatus and 0.296 day⁻¹ for K. gelanitosa during tenth day. The biomass productivity of D. acuatus was 0.03 g L⁻¹ day⁻¹ which is 58% higher than K. gelanitosa with 0.019 g L⁻¹ day⁻¹. The microalgal strains besides water treatment were subsequently subjected for lipid extraction and lipid productivity determination. The lipid productivity of D. acuatus was 2.68 mg L⁻¹ day⁻¹ which is lesser compared to 3.38 mg L⁻¹ day⁻¹ for K. gelatinosa. Both the microalgal isolates were promising for G. cambogia wash water treatment and lipid production. Hence, an environment friendly approach of water treatment with simultaneous lipid production for biofuel conversion is conducted.

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Simultaneous removal of NO and SO 2 from flue gas using vaporized H 2 O 2 catalyzed by nanoscale zero-valent iron

Abstract

To remove NO and SO₂ from flue gas simultaneously, a heterogeneous catalytic oxidation system was developed with the nanoscale zero-valent iron (nZVI), vaporized H₂O₂, and sodium humate (HA-Na) acting as the catalyst, oxidant, and absorbent, respectively. The experimental results indicated that the desulfurization was mainly influenced by the absorption, and the denitrification was significantly affected by the catalytic oxidation parameters. Under the optimal conditions, the simultaneous removal efficiencies of SO₂ and NO were 100 and 88.4%, respectively. The presence of ^·OH during the removal process was proved by the scavenger tests, and the production of ^·OH with and without nZVI was indirectly evaluated by the electron paramagnetic resonance (EPR) and methylene blue experiments. Moreover, the fresh and aged nZVI were characterized by a series of techniques and the results suggested that the redox pair Fe²⁺/Fe³⁺ released by nZVI could react with H₂O₂ to provide the sustainable ^·OH, which was important for the oxidation from NO and SO₂ to NO₃⁻ and SO₄²⁻. The removal mechanism was proposed preliminarily based on the correlative experiments, characterizations, and references.

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Beta oscillatory power modulation reflects the predictability of pitch change

Publication date: Available online 28 June 2018
Source:Cortex
Author(s): Andrew Chang, Dan J. Bosnyak, Laurel J. Trainor
Humans process highly dynamic auditory information in real time, and regularities in stimuli such as speech and music can aid such processing by allowing sensory predictions for upcoming events. Auditory sequences contain information about both the identity of sounds (what) and their timing (when they occur). Temporal prediction in isochronous sequences is reflected in neural oscillatory power modulation in the beta band (∼20 Hz). Specifically, power decreases (desynchronization) after tone onset and then increases (resynchronization) to reach a maximum around the expected time of the next tone. The current study investigates whether the predictability of the pitch of a tone (what) is also reflected in beta power modulation. We presented two isochronous auditory oddball sequences, each with 20% of tones at a deviant pitch. In one sequence the deviant tones occurred regularly every fifth tone (predictably), but in the other sequence they occurred pseudorandomly (unpredictably). We recorded the electroencephalogram (EEG) while participants listened passively to these sequences. The results showed that auditory beta power desynchronization was larger prior to a predictable than an unpredictable pitch change. A single-trial correlation analysis using linear mixed-effect models further showed that the deeper the pre-deviant beta desynchronization depth, the smaller the event-related P3a amplitude following the deviant, and this effect only occurred when the pitch change was predictable. Given that P3a is associated with attentional response to prediction error, larger beta desynchronization depth indicates better prediction of an upcoming deviant pitch. Thus, these findings suggest that beta oscillations reflect predictions for what in additional to when during dynamic auditory information processing.



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Association between pre-operative biological phenotypes and postoperative pulmonary complications: An unbiased cluster analysis

BACKGROUND Biological phenotypes have been identified within several heterogeneous pulmonary diseases, with potential therapeutic consequences. OBJECTIVE To assess whether distinct biological phenotypes exist within surgical patients, and whether development of postoperative pulmonary complications (PPCs) and subsequent dependence of intra-operative positive end-expiratory pressure (PEEP) differ between such phenotypes. SETTING Operating rooms of six hospitals in Europe and USA. DESIGN Secondary analysis of the 'PROtective Ventilation with HIgh or LOw PEEP' trial. PATIENTS Adult patients scheduled for abdominal surgery who are at risk of PPCs. INTERVENTIONS Measurement of pre-operative concentrations of seven plasma biomarkers associated with inflammation and lung injury. MAIN OUTCOME MEASURES We applied unbiased cluster analysis to identify biological phenotypes. We then compared the proportion of patients developing PPCs within each phenotype, and associations between intra-operative PEEP levels and development of PPCs among phenotypes. RESULTS In total, 242 patients were included. Unbiased cluster analysis clustered the patients within two biological phenotypes. Patients with phenotype 1 had lower plasma concentrations of TNF-α (3.8 [2.4 to 5.9] vs. 10.2 [8.0 to 12.1] pg ml−1; P 

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Recent advances in the metamaterial-inspired biosensors

Publication date: 15 October 2018
Source:Biosensors and Bioelectronics, Volume 117
Author(s): Ahmed Salim, Sungjoon Lim
Metamaterials (MM)-inspired microwave biosensors are a valuable addition to the field of diagnostic approaches and prognostic tools. The fundamental principle behind these biosensors is unique dielectric signatures corresponding to healthy/diseased tissues. Relying on nonionizing radiation and offering an increased resolution with accuracy comparable to that of ultrasound devices, they are an attractive solution for noninvasive and label-free biosensing applications. High-quality-factor MM-inspired resonators are integrated with microfluidics to accelerate the lab-on-chip and point-of-care diagnostic approaches owing to the small detection volume and overall compact size of these devices. A variety of biomolecular detection, glucose detection and hyperthermia treatment using state-of-the-art MM-inspired biosensors have been discussed. Optical transduction techniques (e.g., surface plasmon resonance) which enhance the sensitivity in terms of limit-of-detection and resolution, have also been outlined. Utilization of microwave biosensors as therapeutic agents is at its initial stages owing to lack of required sensitivity and reliability in recently proposed MM-inspired biosensors.



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Randomized controlled study comparing simultaneous modulated accelerated radiotherapy versus simultaneous integrated boost intensity modulated radiotherapy in the treatment of locally advanced head and neck cancer

Publication date: Available online 28 June 2018
Source:Journal of the Egyptian National Cancer Institute
Author(s): Sarthak Tandon, Munish Gairola, Parveen Ahlawat, Sheh Rawat, Archana Aggarwal, Kanika Sharma, Sandeep Tiwari, Ahmad M. Karimi, Vinayakumar Muttagi, Nishtha Sachdeva, Manindra Bhushan
ObjectivesComparison of two fractionation schedules of intensity modulated radiotherapy (IMRT) for locally advanced head and neck cancer – simultaneous integrated boost (SIB-IMRT) and simultaneous modulated accelerated radiotherapy (SMART) boost in terms of toxicity and survival end-point measures.Patients and methodsSixty patients with locally advanced head and neck cancer were randomized in two treatment arms (SIB-IMRT [control arm] and SMART boost arm [study arm]). In the control arm, patients received 70, 63 and 56 Gy in 35 fractions to clinical target volumes (CTV) 1, 2 and 3, respectively. In the study arm, patients received 60 and 50 Gy to CTV 1 and CTV 3, respectively. Toxicities, progression free survival (PFS) and overall survival (OS) were compared between both arms.ResultsBaseline patient-related characteristics were comparable between the arms except for primary site of tumour. No significant differences were noted in acute toxicities between the arms except for fatigue which was statistically higher for control arm. No significant differences in 2-year late toxicities were observed. The median follow-up duration was 25.5 (range, 1.8–39.9) months. The 2-year PFS was 53.3% and 80.0% (p = 0.028) for control and study arm, respectively. The 2-year OS was 60.0% and 86.7% (p = 0.020) in control and study arms, respectively. Multivariate analysis showed clinical stage and site to be significant predictors for OS and PFS, respectively.ConclusionsThe SMART boost technique can be a feasible alternative fractionation schedule that reduces the overall treatment time, maintaining comparable toxicity and survival compared with SIB-IMRT.



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Time-Dependent Molecular Responses Differ between Gastric Bypass and Dieting but Are Conserved Across Species

Publication date: Available online 28 June 2018
Source:Cell Metabolism
Author(s): Danny Ben-Zvi, Luca Meoli, Wasif M. Abidi, Eirini Nestoridi, Courtney Panciotti, Erick Castillo, Palmenia Pizarro, Eleanor Shirley, William F. Gourash, Christopher C. Thompson, Rodrigo Munoz, Clary B. Clish, Ron C. Anafi, Anita P. Courcoulas, Nicholas Stylopoulos
The effectiveness of Roux-en-Y gastric bypass (RYGB) against obesity and its comorbidities has generated excitement about developing new, less invasive treatments that use the same molecular mechanisms. Although controversial, RYGB-induced improvement of metabolic function may not depend entirely upon weight loss. To elucidate the differences between RYGB and dieting, we studied several individual organ molecular responses and generated an integrative, interorgan view of organismal physiology. We also compared murine and human molecular signatures. We show that, although dieting and RYGB can bring about the same degree of weight loss, post-RYGB physiology is very different. RYGB induces distinct, organ-specific adaptations in a temporal pattern that is characterized by energetically demanding processes, which may be coordinated by HIF1a activation and the systemic repression of growth hormone receptor signaling. Many of these responses are conserved in rodents and humans and may contribute to the remarkable ability of surgery to induce and sustain metabolic improvement.

Graphical abstract

Teaser

Using an integrative, interorgan view of organismal physiology, Ben-Zvi et al. compared RYGB gastric bypass and dieting in mouse and humans. Although dieting and RYGB can bring about the same degree of weight loss, the molecular signature of surgery highlights an essential role for metabolic regulators and the circadian clock.


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Pan-Cancer Metabolic Signature Predicts Co-Dependency on Glutaminase and De Novo Glutathione Synthesis Linked to a High-Mesenchymal Cell State

Publication date: Available online 28 June 2018
Source:Cell Metabolism
Author(s): Anneleen Daemen, Bonnie Liu, Kyung Song, Mandy Kwong, Min Gao, Rebecca Hong, Michelle Nannini, David Peterson, Bianca M. Liederer, Cecile de la Cruz, Dewakar Sangaraju, Allan Jaochico, Xiaofeng Zhao, Wendy Sandoval, Thomas Hunsaker, Ron Firestein, Sheerin Latham, Deepak Sampath, Marie Evangelista, Georgia Hatzivassiliou
The enzyme glutaminase (GLS1) is currently in clinical trials for oncology, yet there are no clear diagnostic criteria to identify responders. The evaluation of 25 basal breast lines expressing GLS1, predominantly through its splice isoform GAC, demonstrated that only GLS1-dependent basal B lines required it for maintaining de novo glutathione synthesis in addition to mitochondrial bioenergetics. Drug sensitivity profiling of 407 tumor lines with GLS1 and gamma-glutamylcysteine synthetase (GCS) inhibitors revealed a high degree of co-dependency on both enzymes across indications, suggesting that redox balance is a key function of GLS1 in tumors. To leverage these findings, we derived a pan-cancer metabolic signature predictive of GLS1/GCS co-dependency and validated it in vivo using four lung patient-derived xenograft models, revealing the additional requirement for expression of GAC above a threshold (log2RPKM + 1 ≥ 4.5, where RPKM is reads per kilobase per million mapped reads). Analysis of the pan-TCGA dataset with our signature identified multiple indications, including mesenchymal tumors, as putative responders to GLS1 inhibitors.

Graphical abstract

Teaser

Daemen et al. address the current unmet need for diagnosing responders to glutaminase (GLS1) cancer therapy. They identify co-dependency of GLS1 and gamma-glutamylcysteine synthetase (GCS) inhibitors, suggesting that redox balance is a key function of GLS1 in tumors, and validate a predictive pan-cancer metabolic signature for GLS1/GCS co-dependency in vivo.


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Etomoxir Inhibits Macrophage Polarization by Disrupting CoA Homeostasis

Publication date: Available online 28 June 2018
Source:Cell Metabolism
Author(s): Ajit S. Divakaruni, Wei Yuan Hsieh, Lucía Minarrieta, Tin N. Duong, Kristen K.O. Kim, Brandon R. Desousa, Alexander Y. Andreyev, Caitlyn E. Bowman, Kacey Caradonna, Brian P. Dranka, David A. Ferrick, Marc Liesa, Linsey Stiles, George W. Rogers, Daniel Braas, Theodore P. Ciaraldi, Michael J. Wolfgang, Tim Sparwasser, Luciana Berod, Steven J. Bensinger, Anne N. Murphy
Long-chain fatty acid (LCFA) oxidation has been shown to play an important role in interleukin-4 (IL-4)-mediated macrophage polarization (M(IL-4)). However, many of these conclusions are based on the inhibition of carnitine palmitoyltransferase-1 with high concentrations of etomoxir that far exceed what is required to inhibit enzyme activity (EC90 < 3 μM). We employ genetic and pharmacologic models to demonstrate that LCFA oxidation is largely dispensable for IL-4-driven polarization. Unexpectedly, high concentrations of etomoxir retained the ability to disrupt M(IL-4) polarization in the absence of Cpt1a or Cpt2 expression. Although excess etomoxir inhibits the adenine nucleotide translocase, oxidative phosphorylation is surprisingly dispensable for M(IL-4). Instead, the block in polarization was traced to depletion of intracellular free coenzyme A (CoA), likely resulting from conversion of the pro-drug etomoxir into active etomoxiryl CoA. These studies help explain the effect(s) of excess etomoxir on immune cells and reveal an unappreciated role for CoA metabolism in macrophage polarization.

Graphical abstract

Teaser

The CPT-1 inhibitor etomoxir has been used to suggest long-chain fatty acid (LCFA) oxidation is necessary for alternative macrophage activation. Divakaruni and colleagues now show that LCFA oxidation is dispensable. They demonstrate multiple off-target effects of etomoxir and show that depletion of coenzyme A by etomoxir blocks M(IL-4) differentiation.


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Inosine Monophosphate Dehydrogenase Dependence in a Subset of Small Cell Lung Cancers

Publication date: Available online 28 June 2018
Source:Cell Metabolism
Author(s): Fang Huang, Min Ni, Milind D. Chalishazar, Kenneth E. Huffman, Jiyeon Kim, Ling Cai, Xiaolei Shi, Feng Cai, Lauren G. Zacharias, Abbie S. Ireland, Kailong Li, Wen Gu, Akash K. Kaushik, Xin Liu, Adi F. Gazdar, Trudy G. Oliver, John D. Minna, Zeping Hu, Ralph J. DeBerardinis
Small cell lung cancer (SCLC) is a rapidly lethal disease with few therapeutic options. We studied metabolic heterogeneity in SCLC to identify subtype-selective vulnerabilities. Metabolomics in SCLC cell lines identified two groups correlating with high or low expression of the Achaete-scute homolog-1 (ASCL1) transcription factor (ASCL1^High and ASCL1^Low), a lineage oncogene. Guanosine nucleotides were elevated in ASCL1^Low cells and tumors from genetically engineered mice. ASCL1^Low tumors abundantly express the guanosine biosynthetic enzymes inosine monophosphate dehydrogenase-1 and -2 (IMPDH1 and IMPDH2). These enzymes are transcriptional targets of MYC, which is selectively overexpressed in ASCL1^Low SCLC. IMPDH inhibition reduced RNA polymerase I-dependent expression of pre-ribosomal RNA and potently suppressed ASCL1^Low cell growth in culture, selectively reduced growth of ASCL1^Low xenografts, and combined with chemotherapy to improve survival in genetic mouse models of ASCL1^Low/MYC^High SCLC. The data define an SCLC subtype-selective vulnerability related to dependence on de novo guanosine nucleotide synthesis.

Graphical abstract

Teaser

Huang et al. identify ASCL1-high and -low metabolic subtypes in small cell lung cancer (SCLC), linked to de novo guanosine nucleotide synthesis. Using a clinically available inhibitor of the purine biosynthetic pathway, they demonstrate reduced growth of ASCL1^Low SCLC tumors and favorable combination with chemotherapy in in vivo models.


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Etomoxir Actions on Regulatory and Memory T Cells Are Independent of Cpt1a-Mediated Fatty Acid Oxidation

Publication date: Available online 28 June 2018
Source:Cell Metabolism
Author(s): Brenda Raud, Dominic G. Roy, Ajit S. Divakaruni, Tatyana N. Tarasenko, Raimo Franke, Eric H. Ma, Bozena Samborska, Wei Yuan Hsieh, Alison H. Wong, Philipp Stüve, Catharina Arnold-Schrauf, Melanie Guderian, Matthias Lochner, Shakuntala Rampertaap, Kimberly Romito, Joseph Monsale, Mark Brönstrup, Steven J. Bensinger, Anne N. Murphy, Peter J. McGuire, Russell G. Jones, Tim Sparwasser, Luciana Berod
T cell subsets including effector (Teff), regulatory (Treg), and memory (Tmem) cells are characterized by distinct metabolic profiles that influence their differentiation and function. Previous research suggests that engagement of long-chain fatty acid oxidation (LC-FAO) supports Foxp3⁺ Treg cell and Tmem cell survival. However, evidence for this is mostly based on inhibition of Cpt1a, the rate-limiting enzyme for LC-FAO, with the drug etomoxir. Using genetic models to target Cpt1a specifically in T cells, we dissected the role of LC-FAO in primary, memory, and regulatory T cell responses. Here we show that the ACC2/Cpt1a axis is largely dispensable for Teff, Tmem, or Treg cell formation, and that the effects of etomoxir on T cell differentiation and function are independent of Cpt1a expression. Together our data argue that metabolic pathways other than LC-FAO fuel Tmem or Treg differentiation and suggest alternative mechanisms for the effects of etomoxir that involve mitochondrial respiration.

Graphical abstract

Teaser

Using genetic models of Cpt1a deficiency, Raud et al. demonstrate that long-chain fatty acid oxidation is largely dispensable for T cell activation and generation of CD8⁺ T memory (Tmem) cells and CD4⁺ Treg cells, and observe that, at high concentrations, the Cpt1 inhibitor etomoxir presents off-target effects on cell metabolism.


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Color Doppler ultrasonography targeted reconstruction using pedicled perforator flaps—a systematic review and meta-analysis

Abstract

Background

Flaps are increasingly popularized in reconstructive surgery and there is need to test and increase their reliability. Color Doppler ultrasound has been stated to be valuable in flap planning. The aim of this study was to conduct a systematic review and meta-analysis of the literature of Color Doppler ultrasound targeted pedicled perforator flaps and provide information on outcomes and complication rates.

Method

A systematic review and meta-analysis were conducted for articles published until April 2017 in PubMed and Embase. We aimed to include randomized clinical trials, meta-analysis, prospective studies, case-control studies, and cohort studies written in English. We included studies where CDU was used to identify the perforator(s) prior to surgery. We evaluated the quality of the included studies using checklists recommended by the Cochrane group.

Results

From the initial 219 studies, only 12 studies using Color Doppler targeted pedicled perforator flaps in 252 cases met the inclusion and exclusion criteria. Eleven of these were case series and one a prospective study. The incidence of major complications was 8% (21/252) and minor complications was 14%, comprising of mostly necrosis 8% (24/252) and venous congestion 8% (21/252).

Conclusions

The reconstructive success rate following pedicled perforator flap reconstruction targeted by CDU appears to be high and the procedure provides a wide scope of applications and margin of safety. It is evident that the risk of venous congestion is 11 times greater in the lower extremities than the truncus, a finding that needs further attention in future studies.

Level of Evidence: Level IV, risk/prognostic study

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SH2B3 aberrations enriched in iAMP21 B lymphoblastic leukemia

Publication date: October 2018
Source:Cancer Genetics, Volumes 226–227
Author(s): LB Baughn, MM Meredith, L Oseth, TA Smolarek, B Hirsch
Acute lymphoblastic leukemia (ALL) represents the most common childhood malignancy. Although survival for pediatric B-ALL has approached 90%, variability in outcome among and within cytogenetically defined subgroups persists. While G-banding and fluorescence in situ hybridization (FISH) have been used to characterize leukemic clones, there is added value of chromosomal microarray and next generation sequencing in screening genome-wide for copy number aberrations, copy neutral loss of heterozygosity and nucleotide variations. Evaluation of novel genetic aberrations can provide information about the biologic mechanisms of cytogenetically defined subgroups associated with poor prognosis, explain heterogeneity in patient outcome and identify novel targets for therapeutic intervention. The high risk B-ALL intrachromosomal amplification of chromosome 21, (iAMP21), subtype is characterized by amplification of a region of chromosome 21 that typically encompasses the RUNX1 gene and is associated with poor prognosis. Analysis of chromosomal microarray and FISH data revealed that deletions of SH2B3, encoding a negative regulator of multiple tyrosine kinase and cytokine signaling pathways, are enriched among leukemias harboring iAMP21. Enrichment of SH2B3 aberrations in the iAMP21 subtype may indicate that loss of SH2B3 contributes to disease progression and raises the possibility that these leukemias may be sensitive to tyrosine kinase inhibitors.



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A custom positioning aid for an auricular prosthesis: A clinical report

Publication date: Available online 28 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Joy K. Wang, Patricia C. Montgomery, Mark S. Chambers
This report describes the treatment of a 68-year-old man with basosquamous cell carcinoma of the left auricular area. His oncologic treatment resulted in the loss of his left ear and much of the left temporal bone. The loss of a significant portion of the temporal bone precluded the use of extraoral implants. Owing to the lack of anatomic landmarks after his surgical treatment, positioning his auricular prosthesis proved challenging. The fabrication of his prosthesis and a custom positioning aid are described.



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Surgical extrusion with an atraumatic extraction system: A clinical study

Publication date: Available online 28 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Ralf Krug, Thomas Connert, Sebastian Soliman, Benno Syfrig, Thomas Dietrich, Gabriel Krastl
Statement of problemClinical studies evaluating the feasibility of a novel technique for the surgical extrusion of nonrestorable teeth with subgingival caries are lacking.PurposeThe purpose of this clinical study was to investigate the success rate and incidence of biological and technical complications after tooth extrusion with an atraumatic extraction system (AES).Material and methodsParticipants were recruited from 61 consecutive patients initially referred to a specialist oral surgery practice. Fifty-one participants who underwent surgical extrusion with an AES followed by endodontic treatment and coronal restoration could be re-evaluated clinically and radiographically.ResultsThe mean observation period was 3.1 years (range: 0.8 to 6.5 years). The participants varied in age between 24.8 and 86.3 years. The amount of extrusion was between 2.5 and 5.0 mm (mean 3.2 mm). At recall, 92.2% (47 of 51) of the extruded teeth were considered successful. All extruded teeth were asymptomatic, without clinical signs of inflammation. Percussion appeared normal and did not differ from that of the adjacent teeth, indicating absence of ankylosis. Transient resorption with a slightly altered root contour was detected in 5 of the 51 teeth. Minor reduction of the bone level (less than 10%) was detected in 8 of the 51. In a further 2 teeth, bone loss amounted to 25% and 30%. Periapical periodontitis at recall was seen in 4 of the 51 teeth, and a preexisting periapical lesion healed in 10 of 13. Root perforation was identified in 3 of the 51, and a further 3 of 11 were not available for recall. Thus, the technical complication rate was 9.7% (6 of 62).ConclusionsThe AES may be successfully used for surgical extrusion to save apparently nonrestorable teeth, irrespective of patient age.



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Immediate placement of dental implants into infected versus noninfected sites in the esthetic zone: A systematic review and meta-analysis

Publication date: Available online 28 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Haida Chen, Guoxing Zhang, Paul Weigl, Xinhua Gu
Statement of problemImmediate implantation has been established to shorten waiting time before definitive restoration, offering the ability to deliver a predictable esthetic and functional outcome for patients. However, this approach remains controversial for a tooth with a periodontal or periapical lesion.PurposeThe purpose of this systematic review was to analyze the treatment outcomes of immediate implant placement into extraction sockets with or without infection of periodontal or periapical origin in the esthetic zone and to provide treatment protocols based on current studies.Material and methodsAn electronic search was performed in PubMed, ISI Web of Knowledge, and the Cochrane Library between January 2009 and October 2017. A subsequent manual search included all clinical studies published in the English language and excluded any reviews or animal studies. An article quality assessment scale, Newcastle-Ottawa Scale (NOS), was used to evaluate the quality of studies enrolled. The implant survival rate was expressed as risk ratio, whereas bone level changes and gingiva level changes were expressed as mean differences in millimeters with 95% confidence intervals. The meta-analysis was conducted by using commercial software.ResultsThe search initially found 1171 references. The manual search of the reference lists of identified articles yielded additional papers. Altogether, 9 studies were identified within the selection criteria, with NOS scores between 5 and 8. Compared with the healthy sites, immediate implant placement in infected sites in the esthetic zone showed similar survival rates (97.6% vs. 98.4%, respectively; risk ratio [RR], 0.99; 95% confidence interval [CI], 0.97 to 1.00; P=.138). No statistically significant differences were found in bone level changes (mean difference [MD], 0.03; 95%CI, −0.09 to 0.14; P=.667) or in gingiva level changes (MD, −0.06; 95% CI, −0.13 to 0.01; P=.070) between the 2 groups.ConclusionsMeta-analysis showed that immediate implant placement into infected sites and noninfected sites in esthetic zone had similar survival rates, bone level changes, and gingiva level changes.



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Retrofitting a foundation restoration to an existing ceramic crown after endodontic treatment: A dental technique

Publication date: Available online 28 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Jenn-Hwan Chen, Georgios Maroulakos
This article describes the fabrication of a foundation restoration after endodontic treatment using a preexisting ceramic prosthesis and polytetrafluoroethylene (PTFE) tape as a barrier. This technique presents a solution if the prosthesis and marginal integrity are to be maintained.



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Effect of layered manufacturing techniques, alloy powders, and layer thickness on mechanical properties of Co-Cr dental alloys

Publication date: Available online 28 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Yurdanur Ucar, Orhun Ekren
Statement of problemThe popularity of direct metal laser sintering (DMLS) and melting (DMLM) has increased in dental practice. The layered manufacturing device, the alloy powder, and the layer thickness may affect the mechanical properties of layer-fabricated metals.PurposeThe purpose of this in vitro study was to evaluate the mechanical, fractographic, and compositional properties of metals fabricated by using different layered manufacturing techniques (DMLS and DMLM), cobalt-chromium (Co-Cr) alloy powders, and layer thicknesses.Material and methodsA total of 90 dumbbell-shaped test specimens (n=15/group) were fabricated by using either DMLS or DMLM. Powder alloys used were EOS Co-Cr SP-2 and Keramit NP-S, each with layer thicknesses of 20 and 30 μm; their mechanical properties were evaluated by using a test for tensile strength. Three-way ANOVA, Student t test, and 1-way analysis of variance, followed by the Tukey honest significant differences test were used for statistical analysis (α=.05). The fracture surface was analyzed by using scanning electron microscopy, and energy dispersive spectroscopy was used for compositional evaluation.ResultsDifferent layered manufacturing equipment affected the mechanical properties of the final objects, but the powder and layer thickness did not affect mechanical properties.ConclusionsThe powder and layer thickness did not affect mechanical properties of the layered manufactured alloy, but different manufacturing methods did affect the mechanical properties of the final product.



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The accuracy of virtual interocclusal registration during intraoral scanning

Publication date: Available online 28 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Faraj Edher, Alan G. Hannam, David L. Tobias, Chris C.L. Wyatt
Statement of problemEvidence on the accuracy and reproducibility of the virtual interocclusal registration procedure and recommendations as to how to make a virtual interocclusal record are lacking.PurposeThe purpose of this in vitro study was to assess whether virtual interocclusal registration records made at different locations around the arch affect the alignment of virtual casts, and to assess whether quadrant and complete arch scans have different effects on cast alignment when they are articulated with virtual interocclusal records.Material and methodsThree sites of close proximity (SCPs) and 3 sites of clearance (SCs) were identified in each sextant of mounted zirconia master models. The SCPs and SCs were confirmed by using shimstock foil and the transillumination of an interocclusal impression. Complete-arch and quadrant scans of the master models were made with an intraoral scanner and registered with different virtual interocclusal registration records. The SCPs and SCs indicated by the scanner's software and by independent software were compared according to the sensitivity, specificity, and predictive values of each method.ResultsChanged locations of SCPs were found depending on the location of the virtual interocclusal registration record. The intraoral scanner's software contacts had a higher sensitivity of 92.86% and a negative predictive value of 84.21% than the contacts revealed by the independent software that exhibited a sensitivity of 69.05% and a negative predictive value of 70.45%. However, the intraoral scanner software had a lower specificity of 41.03% and a positive predictive value of 62.90% compared with the independent software, which exhibited a specificity of 79.49% and a positive predictive value of 78.38%. The quadrant scans had a higher sensitivity than did the complete-arch scans.ConclusionsDifferent occlusal contacts are obtained from interocclusal registration scans in different segments of the dental arch. The difference is more obvious in complete-arch scans, where a tilting effect toward the site of the interocclusal registration scan was observed. Occlusal contacts obtained from interocclusal registration scans for quadrant scans had a higher sensitivity than did those for complete-arch scans.



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Evaluation of the trueness and tissue surface adaptation of CAD-CAM mandibular denture bases manufactured using digital light processing

Publication date: Available online 28 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Hyung-In Yoon, Hyun-Ji Hwang, Chikahiro Ohkubo, Jung-Suk Han, Eun-Jin Park
Statement of problemStudies assessing the trueness and tissue surface adaptation of computer-aided design and computer-aided manufacturing (CAD-CAM) mandibular complete denture bases fabricated using digital light processing (DLP) are lacking.PurposeThe purpose of this in vitro study was to evaluate the trueness of DLP–generated denture bases and to compare the tissue surface adaptation of DLP with milling and pack and press.Material and methodsThe mandibular denture bases were virtually designed on a reference cast and were fabricated using DLP. Their intaglio surfaces were scanned and superimposed on the reference CAD denture base to evaluate the trueness. The reference cast was duplicated to create 10 identical master casts that were scanned to design 10 virtual denture bases. Twenty denture bases were fabricated with DLP and milling (10 specimens per technique). In addition, 10 denture bases were fabricated with the pack and press technique. The intaglio surfaces of the denture bases were scanned and superimposed on the corresponding master casts to compare tissue surface adaptation among the 3 techniques. The Mann-Whitney test and Kruskal-Wallis analysis of variance (α=.05) were used for statistical analyses.ResultsFor trueness, the milled denture base was better than the DLP denture base (P<.001). However, no statistically significant difference was detected with respect to tissue surface adaptation of the denture base, regardless of the fabrication technique (P>.05). The DLP denture base showed comparable tissue surface adaptation with the milled base, one with a small interquartile range.ConclusionsThe intaglio surfaces of DLP and milled denture bases corresponded within a 100-μm accuracy compared with the master cast. Although the DLP denture base exhibited tissue compression on the ridge crest, it showed comparable tissue adaptation to the milled denture base.



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Contour correction for stock titanium healing abutments

Publication date: Available online 28 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Roger Solow




https://ift.tt/2Km21qw

Effect of silica-containing glass–ceramic liner treatment on zirconia coping retention

Publication date: Available online 28 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Eun-Suk Lee, Yoon-Hyuk Huh, Chan-Jin Park, Lee-Ra Cho
Statement of problemZirconia prostheses show a high rate of retention loss, and more information is needed regarding the treatment of the intaglios of zirconia prostheses to improve the bond strength between zirconia and resin cement.PurposeThe purpose of this in vitro study was to evaluate the retention of titanium abutments and zirconia prostheses treated with silica-containing glass–ceramic liners. The effect of the abutment convergence angle on retention force was also examined.Material and methodsTitanium abutments and zirconia copings (n=90) were fabricated with 3 different convergence angles (6, 12, and 24 degrees). Specimens were divided into 2 groups according to surface treatment: an airborne-particle-abraded control group and a group that was coated with a silica-containing glass–ceramic liner after airborne-particle abrasion (liner group). The thickness of the liner was measured, and the inner spacing of the zirconia coping was modified in the liner group. The coping was cemented, and the retention was evaluated with a tensile bond strength test by using a universal testing machine. Retention was analyzed by using a 2-way analysis of variance. Modes of failure were evaluated by examining the fracture surface. Elemental analysis of the interface was also performed.ResultsThe liner group showed a significantly higher retention force for the zirconia prosthesis (P<.05). Regardless of surface treatment, the retention force at a convergence angle of 6 degrees was higher than that at 24 degrees (P<.05). The control group showed mostly adhesive type failures, whereas the liner group exhibited mostly mixed type failures.ConclusionsSilica-containing glass–ceramic liner treatment increased the retention compared with airborne-particle abrasion treatment alone. Tensile bond strength increased with decreasing abutment convergence angle.



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The effect of extended glaze firing on the flexural fatigue strength of hard-machined ceramics

Publication date: Available online 28 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Iana Lamadrid Aurélio, Catina Prochnow, Luís Felipe Guilardi, Gabriela Freitas Ramos, Marco Antonio Bottino, Liliana Gressler May
Statement of problemIt is unclear whether an extended glaze firing could improve the long-term mechanical performance of densely sintered CAD-CAM ceramics.PurposeThe purpose of this in vitro study was to analyze the effect of an extended glaze firing on the flexural fatigue strength (FFS) of densely sintered milled (hard-machined) leucite-based (LEU) and lithium disilicate-based (DIS) ceramics.Material and methodsDisks were machined from ceramic blocks and divided into 6 groups (n=20) according to the material, LEU or DIS, and to the applied glaze firing: manufacturer-recommended glaze (G group), extended glaze (EG group), and control/no firing (C group). The surface roughness of the disks was measured before and after firing by using a contact profilometer, and data were compared by paired sample tests. Specimens were submitted to fatigue by using the staircase test design in water (piston-on-3 balls; 500 000 cycles, 20 Hz, and sinusoidal loading). Mean (±SD) FFS values were then calculated and analyzed by using 1-way analysis of variance and post hoc Tukey test (α=.05).ResultsSurface roughness did not change after the firing (P>.05). The highest FFS value in both ceramics was obtained after EG firing (LEU-EG=80.52 ±6.3 MPa; DIS-EG=147.25 ±10.5 MPa), which was statistically superior to G firing (LEU-G=73 ±6.8 MPa, P=.003; DIS-G=134.34 ±15.6 MPa; P=.023) and C group (LEU-C=61.94 ±6.3 MPa; P<.001; DIS-C=134.13 ±17.3 MPa; P=.023).ConclusionsEG firing optimized the biaxial flexural fatigue strength of hard-machined leucite and lithium disilicate ceramics compared with conventional glaze firing.



https://ift.tt/2Kx6ghY

Digital design and 3D printing of an implant-supported prosthetic stent for protecting complete arch soft tissue grafts around dental implants: A dental technique

Publication date: Available online 28 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Jimmy Londono, Marko Tadros, Martin Salgueiro, Philip S. Baker
A method for digital fabrication of an implant-supported soft tissue graft stent to protect, shape, and ensure intimate adaptation of the complete arch graft to the periosteum surrounding dental implants is described. To fabricate the stent, an extraoral scanner was used to convert the implant cast into digital data. Dental design software was then used to fabricate the stent, which is produced by 3-dimensional (3D) printing. Due to the lack of long-term biocompatible 3D printing material, the stent was duplicated in bisacryl resin. The patient reported more comfort and stability with the implant-supported stent than the conventional stent received following a previous debulking surgical procedure.



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De-noising of 3D multiple-coil MR images using modified LMMSE estimator

Publication date: October 2018
Source:Magnetic Resonance Imaging, Volume 52
Author(s): Nima Yaghoobi, Reza P.R. Hasanzadeh
De-noising is a crucial topic in Magnetic Resonance Imaging (MRI) which focuses on less loss of Magnetic Resonance (MR) image information and details preservation during the noise suppression. Nowadays multiple-coil MRI system is preferred to single one due to its acceleration in the imaging process. Due to the fact that the model of noise in single-coil and multiple-coil MRI systems are different, the de-noising methods that mostly are adapted to single-coil MRI systems, do not work appropriately with multiple-coil one. The model of noise in single-coil MRI systems is Rician while in multiple-coil one (if no subsampling occurs in k-space or GRAPPA reconstruction process is being done in the coils), it obeys noncentral Chi (nc-χ). In this paper, a new filtering method based on the Linear Minimum Mean Square Error (LMMSE) estimator is proposed for multiple-coil MR Images ruined by nc-χ noise. In the presented method, to have an optimum similarity selection of voxels, the Bayesian Mean Square Error (BMSE) criterion is used and proved for nc-χ noise model and also a nonlocal voxel selection methodology is proposed for nc-χ distribution. The results illustrate robust and accurate performance compared to the related state-of-the-art methods, either on ideal nc-χ images or GRAPPA reconstructed ones.



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Content-aware compressive magnetic resonance image reconstruction

Publication date: October 2018
Source:Magnetic Resonance Imaging, Volume 52
Author(s): Daniel S. Weller, Michael Salerno, Craig H. Meyer
This paper describes an adaptive approach to regularizing model-based reconstructions in magnetic resonance imaging to account for local structure or image content. In conjunction with common models like wavelet and total variation sparsity, this content-aware regularization avoids oversmoothing or compromising image features while suppressing noise and incoherent aliasing from accelerated imaging. To evaluate this regularization approach, the experiments reconstruct images from single- and multi-channel, Cartesian and non-Cartesian, brain and cardiac data. These reconstructions combine common analysis-form regularizers and autocalibrating parallel imaging (when applicable). In most cases, the results show widespread improvement in structural similarity and peak-signal-to-error ratio relative to the fully sampled images. These results suggest that this content-aware regularization can preserve local image structures such as edges while providing denoising power superior to sparsity-promoting or sparsity-reweighted regularization.



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Metformin and Colorectal Cancer – A Systematic Review.

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0621-8830

Objectives Colorectal cancer (CRC) is the second leading cause of cancer-related deaths. The development of preventive strategies in CRC has been the subject of much research. Multiple studies have shown an association between diabetes and CRC. In addition to its glucose-lowering properties, metformin might have an additional role in the prevention and treatment of CRC. Our objective was to summarize findings on role of metformin in colorectal cancer. Methods We conducted a systematic review of the PubMed and Cochrane databases from January 2005 to December 2017 in search for studies on the association between metformin and CRC. Results Of the total of 189 studies identified by the search, we excluded 123 studies and reviewed the remaining 66 studies on cell lines, animals, patients with diabetes, and healthy subjects. In vitro and animal studies have shown a protective effect of metformin use on the incidence of CRC and amplification of the therapeutic effects of CRC chemotherapy. Studies on patients with type 2 diabetes treated with metformin analyzed data on total of 146 496 patients. The results of those studies on the role of metformin in CRC suggest risk reduction and potential applications within therapeutic regimens, although some of those are conflicting. Conclusion Further studies are warranted to define the role of metformin in both prevention and treatment of CRC.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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TRIF deficiency protects non-obese diabetic mice from type 1 diabetes by modulating the gut microbiota and dendritic cells

Publication date: Available online 28 June 2018
Source:Journal of Autoimmunity
Author(s): Elke Gülden, Chen Chao, Ningwen Tai, James A. Pearson, Jian Peng, Monika Majewska-Szczepanik, Zhiguang Zhou, F. Susan Wong, Li Wen
The incidence of type 1 diabetes (T1D) is determined by both genetic and environmental factors. In recent years, the gut microbiota have been identified to be an important environmental factor that could modify diabetes susceptibility. We have previously shown that Myeloid differentiation primary response gene 88 (MyD88), a major adaptor protein downstream of most innate immune Toll-like receptor (TLR) signaling, is important for mediating diabetes susceptibility in the non-obese diabetic (NOD) mouse model of human T1D. Here we report the role of TIR-domain-containing adapter-inducing interferon-β (TRIF) in T1D development, as TRIF is an important adaptor protein downstream of TLR3 and TLR4 signaling. We found that TRIF-deficient (TRIF^−/-) NOD mice were protected from development of diabetes, but only when housed with TRIF-deficient (TRIF^−/-) NOD mice. When housed with TRIF-sufficient wild type (WT, i.e., TRIF^+/+) NOD mice, the mice developed diabetes. We further investigated the gut microbiota as a potential cause for the altered diabetes development. Interestingly, TRIF^−/−NOD mice had a different microbiota composition compared to WT NOD mice, only if they were housed with TRIF^−/−NOD mice. However, the composition of gut microbiota in the TRIF^−/−NOD mice was indistinguishable from WT NOD mice, if they were housed with WT NOD mice. The difference in the gut microbiota in TRIF^−/−NOD mice, due to cohousing, accorded with the diabetes development in TRIF^−/−NOD mice. Comparing the gut microbiota in TRIF^−/- and WT NOD mice, we identified changes in percentage of Sutterella, Rikenella and Turicibacter species. Moreover, bacteria from WT NOD mice induced significantly stronger inflammatory immune responses in vitro compared to those from TRIF^−/−NOD mice. Further immunological analysis revealed impaired function of dendritic cells and reduced T cell activation and proliferation in TRIF^−/−NOD mice. Our data show that TRIF-deficiency protects NOD mice from diabetes development through alteration of the gut microbiota and reduced immune cell activation; however, that protection is over-ridden upon exposure to WT NOD bacteria. Therefore exposure to different microbiota can modify disease susceptibility determined by genetic factors related to innate immunity.



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Traditional medicines used by Q’eqchi’ Maya to treat diabetic symptoms and their antiglycation potential

Publication date: 5 October 2018
Source:Journal of Ethnopharmacology, Volume 224
Author(s): J. Ferrier, A. Saleem, A. Carter Ramirez, R. Liu, E. Chen, T. Pesek, V. Cal, M. Balick, J.T. Arnason
Ethnopharmacological relevanceBecause of the recent increase in type 2 diabetes and the need for complementary treatments in remote communities in many parts of the world, we undertook a study of treatments for diabetic symptoms used by traditional Q'eqchi' Maya healers of Belize. We used quantitative ethnobotany to rank culturally important taxa and subsequent pharmacological and phytochemical studies to assess bioactivity.Materials and methodsAntidiabetic plants identified in field interviews with traditional healers were ranked by syndromic importance value (SIV) based on 15 symptoms of diabetes. Species ranked with high SIV were tested in an assay relevant to many diabetes complications, the advanced glycation endproduct (AGE) inhibition assay. Active principles were identified by phytochemical analysis and bioassay.ResultsWe collected over 70 plant species having a promising SIV score. The plants represented a broad range of neotropical taxa. Selected Q'eqchi' antidiabetic plants with high SIV were collected in bulk and tested in the advanced glycation endproduct (AGE) inhibition assay. All plant extracts showed AGE inhibition and the half maximal inhibitory concentration (IC50) ranged from 40.8 to 733 µg/mL, while the most active species was Tynanthus guatemalensis Donn (Bignoniaceae). A linear regression showed a significant relationship between 1/ IC50 and SIV. Phytochemical analysis revealed the presence of verbascoside, as a major component and active principle of the T guatemalensis which had an IC50 = 5.1 µg/mL, comparable to the positive control quercetin.ConclusionThe results reveal a rich botanical tradition of antidiabetic symptom treatments among the Q'eqchi'. Study of highly ranked plants revealed their activity in AGE inhibition correlated with SIV. T. guatemalensis was identified as a promising species for further evaluation and local use.

Graphical abstract

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Sustainable harvest, people and pandas: Assessing a decade of managed wild harvest and trade in Schisandra sphenanthera

Publication date: 5 October 2018
Source:Journal of Ethnopharmacology, Volume 224
Author(s): J.A. Brinckmann, W. Luo, Q. Xu, X. He, J. Wu, A.B. Cunningham
Ethnopharmacological relevanceEndemic to China, the distribution of Schisandra sphenanthera Rehder & E.H. Wilson includes giant panda (Ailuropoda melanoleuca David, 1869) habitats in forests of the Minshan and Qinling Mountains, both inside and outside conservation areas. The fruit is used in indigenous medicines of the Qiang, Tibetan and Yi ethnic minorities of Sichuan. Also used in traditional Chinese medicine (TCM), indications for use are prescribed in the Chinese Pharmacopoeia. For continued access and medical use, survival of healthy populations depends on forests. Biodiversity conservation programmes implemented in forests within the panda landscapes that also benefit rural and indigenous communities, link future access to wild medicinal plants with survival of the panda and resilient rural economies.Aims of the studyThis study aimed at assessing the project activities, institutional-level outcomes and achievements, 10 years on, of the 5-year (2007–2011) UNDP- and WWF- supported EU-China Biodiversity Programme for sustainable, "panda-friendly" schisandra.Materials and methodsOur study combined analysis of quantitative data such as purchase records coupled with qualitative data obtained from field work, project documents, site-visit reports, certification documents and published articles about the project.ResultsAt start of project, interested companies were identified to support economic viability of the sustainable wild harvesting and a "panda friendly" pro-conservation model that provided an incentive to maintain habitat outside formal protected areas. Criteria of relevant sustainability standards, the Organic Wild-crop Harvesting Practice Standard and FairWild Standard, were applied while a new standard was drafted, the Giant Panda Friendly Products Standard. The initial pilot project involving 1 village determined feasibility leading to formation of the Pingwu Shuijing TCM Cooperative which, by 2016, scaled out to membership of 22 villages. From the cooperative's first commercial sale of S. sphenanthera Rehder & E.H.Wilson fruits of 0.5 MT in 2009, annual quantities steadily increased up to 30 MT sold in 2017. The cooperative achieved organic certification in 2012. In 2016, governmental authorisation for the certification of Chinese operations implementing the FairWild Standard was granted. In 2017, the Giant Panda Friendly Products Standard became an official Chinese standard with the cooperative becoming the first panda-friendly certified operation in 2018.ConclusionsA decade after the project first started, there is strong evidence for the pro-conservation micro- and small enterprise model. For example, through the establishment of a TCM cooperative with members in 22 villages engaged in sustainable resource management, harvesting and equitable trade of TCM ingredients with organic and panda-friendly branding. The project benefited from multi-disciplinary collaboration of experts in ethnoecology, TCM, panda biology and habitat, nature conservation, sustainability standards and international trade. Inviting interested companies at the start enabled a transition from a funded-project to annual contracts for sustainably harvested TCM herbal drugs. At end of project (2011), the companies and NGOs remained engaged and motivating for completion of activities started during the project. Major eventual outcomes rooted in the initial project included Chinese government authorisation of the FairWild Standard (2016) and Giant Panda Friendly Products Standard (2017).



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Efficacy and safety of Xuebijing injection (a Chinese patent) for sepsis: A meta-analysis of randomized controlled trials

Publication date: 5 October 2018
Source:Journal of Ethnopharmacology, Volume 224
Author(s): Chengyu Li, Ping Wang, Li Zhang, Min Li, Xiang Lei, Si Liu, Zhiqiao Feng, Yongming Yao, Bai Chang, Baoshan Liu, Hongcai Shang
Ethnopharmacological relevanceXuebijing injection (XBJ), a Chinese patent medicine that was approved for treating sepsis in China in 2004, consists of Carthamus tinctorius L. (Carthami Flos, hong hua), Paeonia lactiflora Pall. (Paeoniae Radix Rubra, chi shao), Ligusticum chuanxiong Hort. (Chuanxiong Rhizoma, chuan xiong), Salvia miltiorrhiza Bge. (Salviae Miltiorrhizae Radix Et Rhizoma, dan shen) and Angelica sinensis (Oliv.) Diels (Angelicae Sinensis Radix, dang gui).Aim of the studyThis study aimed to assess the efficacy and safety of XBJ combined with routine treatment (RT) for treating sepsis through systematic review and meta-analysis.Materials and methodsDatabases including Embase, PubMed, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Journal Database (VIP) and the Wanfang database were searched from inception to June 6, 2017 to collect relevant RCTs comparing XBJ combined with RT and RT alone for sepsis. The primary clinical outcomes were 28-day mortality and mortality during treatment. The secondary outcomes of our study included APACHE Ⅱ scores, WBC counts, body temperature, and adverse events or reactions. We excluded low-quality studies (Jadad score < 3) and calculated risk ratios (RR) for primary outcomes with fixed effects models. We assessed quality of evidence using the grading of recommendations assessment, development, and evaluation (GRADE) approach.ResultsWe identified 1602 records, and 16 RCTs (1144 patients) were included. Moderate-quality evidence suggested that combined therapy reduced 28-day mortality (934/1144, RR 0.62, 95% CI 0.51–0.76 P < 0.000 01, I² = 0%), APACHE Ⅱ scores (792/1144, MD −3.53, 95% CI −4.49 to −2.54; P < 0.000 01, I² = 59%) and body temperature (362/1144, MD −0.43, 95% CI −0.55 to −0.31; P < 0.000 01, I² = 0%). Very low-quality evidence showed that WBC count improved with combined medication at high dosages (one study included, 40/1144, MD −8.00, 95% CI −10.18 to −5.82), but there was no reduction at moderate dosages (230/1144, MD −2.38, 95% CI −5.01 to 0.25; P = 0.08, I² = 70%). However, moderate-quality evidence indicated positive results with low dosages (142/1144, MD −2.88, 95% CI −3.79 to −1.96; P < 0.000 01, I² = 0%). Nevertheless, due to the insufficient number of studies and the poor quality of the current evidence, more studies of dose-effect relationships and safety concerns of XBJ are needed. Low-quality evidence showed no risk difference for mortality during treatment (210/1144, RR 0.65, 95% CI 0.36–1.17; P = 0.15, I² = 0%).ConclusionsThis study suggested that supplementation with XBJ in addition to regular treatment may improve the 28-day mortality rate, APACHE Ⅱ scores, WBC count and body temperature of sepsis patients without serious adverse events, but it may not reduce mortality during treatment, revealing a specific, remote effect of traditional Chinese medicine. However, given the high risk of bias and the low quality of the included trials, we may be unable to draw any conclusions about its routine use. Rigorously designed, multicentre, large-scale, methodologically sound trials are warranted.

Graphical abstract

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The rise of medicalization of plants in Brazil: A temporal perspective on vernacular names

Publication date: 5 October 2018
Source:Journal of Ethnopharmacology, Volume 224
Author(s): Bruno V.L. Siqueira, Cássia M. Sakuragui, Bruno E. Soares, Danilo R. de Oliveira
Ethnopharmacological relevanceBrazilian plant species used in folk medicine have acquired several popular names related to commercial medicines in recent decades. This fact has directly effect to the medicalization process.Aim of the studyEvaluate the rise of medicalized popular names of medicinal plants in Brazil.Materials and methodsMedicalized popular names of medicinal plants were recorded from 314 ethnobotanical articles in eleven scientific journals published between 1980 and 2017.ResultsThe review included 141 ethnobotanical articles containing medicalized names from 314 articles consulted. The presence of medicalized names in Brazilian ethnobotanical studies has increased significantly since the 2000s. A total of 85 medicalized popular names were recorded according with phonetic and graphical similarity. The most cited medicalized names were Anador, Insulin, Terramycin, Vick, Novalgin and Penicillin. The prevalence of medicalized name citations in ethnobotanical surveys over non-medicalized names for several species indicates the existence of medicalized plant species.ConclusionSince the 2000s, an increasing number of ethnobotanical studies revealed the appropriation of drug names by folk medicine through the changes of vernacular names of medicinal plants. This medicalization process is mostly related to the expansion of the Brazilian Unified Health System, pharmaceutical industry marketing and Non-Governmental Organizations in the last decades.

Graphical abstract

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Distally Based Peroneus Brevis Muscle Flap for Large Leg, Ankle, and Foot Defects: Anatomical Finding and Clinical Application

J reconstr Microsurg
DOI: 10.1055/s-0038-1661366

Background Peroneus brevis muscle flap is a distinguished, distally based safe flap that can be manipulated to cover small defects in the leg and ankle. For large-sized defects, a more distal, larger flap is required either locally or distantly. Methods Forty-two distally based peroneus brevis muscle flaps were elevated in 42 patients (30 males and 12 females) with major lower leg, ankle, and proximal foot defects of 6 to 15 cm in length and 6 to 12 cm in width. Anatomical findings were recorded as number, size, and sources of blood supply, entry sites, the lowermost two arterial supplies, internal distribution of blood supply to the muscle, the relationship between external and internal distribution of the blood vessels, the length of the muscle, the entry site of the main artery, and the splitting of the proximal portion of the peroneus brevis muscle to increase its width to sufficiently cover large defects. Results The anatomical findings suggested that the muscle can be safely extended to cover a large defect in the leg, ankle, or proximal foot. In addition, the longitudinal splitting of the muscle increases its width by up to three times, making it an excellent long-surviving flap to cover a large defect. Conclusion A distally based peroneus brevis muscle flap has a rich blood supply and safely reaches the proximal foot, with a secure splitting to cover large defects in the leg, ankle, and proximal foot.
[...]

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Oxytocinergic modulation of brain activation to cues related to reproduction and attachment: Differences and commonalities during the perception of erotic and fearful social scenes

Publication date: Available online 28 June 2018
Source:International Journal of Psychophysiology
Author(s): Carina Sauer, Christian Montag, Martin Reuter, Peter Kirsch
In animal research, the neuropeptide oxytocin (OT) has been known for its role in reproduction and attachment for a longer time. There is strong evidence for an involvement of the mesolimbic dopaminergic system for these effects of OT. In contrast, human research rather concentrated on more human concepts of social cognition and behavior (e.g. trust or processing of fearful faces) and mainly focused on the amygdala as the main neurobiological substrate. To extend this view, we wanted to gain more insight into the neurobiological effects of OT in the context of reproduction and attachment in humans and compare these effects to its well-known effects on fear processing.In a double-blind placebo-controlled fMRI study, we investigated 55 healthy young men using intranasal OT administration. During fMRI, participants saw attachment-related erotic scenes and fearful social scenes.Over all participants, OT had a differential effect on processing of erotic and fearful scenes. While OT administration led to a relative increase of neural activation in mesolimbic structures during processing of erotic stimuli, it decreased amygdala activation for fearful stimuli. On the individual level, we observed significant positive correlations between OT induced activation changes across different brain regions and under different stimulus conditions.Our findings extend the already existing animal literature and provide evidence for a similar involvement of the mesolimbic dopaminergic system for OT effects in the context of reproduction and attachment in humans.



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The psychophysiology of stress and adaptation: Models, pathways, and implications

Publication date: Available online 28 June 2018
Source:International Journal of Psychophysiology
Author(s): Brian M. Hughes, Patrick R. Steffen, Julian Thayer




https://ift.tt/2NaH2Eu

Oxytocin for learning calm and safety

Publication date: Available online 28 June 2018
Source:International Journal of Psychophysiology
Author(s): Monika Eckstein, Ana C. Almeida de Minas, Dirk Scheele, Ann-Kathrin Kreuder, René Hurlemann, Valery Grinevich, Beate Ditzen
The appropriate discrimination between safe and dangerous situations and the subsequent decrease of fear expression in the presence of safety signals are crucial for survival and mental health.Learning of safety associations is often studied in terms of fear extinction, that is re-learning of a previously conditioned stimulus which is now no longer positively associated with danger. Numerous studies investigated neurobiological processes of fear extinction and provide a valid picture of the underlying neural structures and endocrine processes involved.However, a formerly neutral conditioned stimulus (CS) can also predict the non-occurrence of an aversive, potentially dangerous, unconditioned stimulus (US) from the very beginning and thus can serve as a safety stimulus. This process has been termed safety learning. Although safety learning has been known for almost a century, there has been little research on its underlying neurobiological mechanisms, in contrast to the more prominent Pavlovian fear conditioning and fear extinction.In this review, we propose that the well-known action of the hypothalamic neuropeptide oxytocin (OXT) in the regulation of fear and stress responses is complementary to safety learning. We summarize the literature focused on OXT signaling and safety learning in animals and humans, from the first studies of fear extinction and conditioned inhibition of fear to the most recent findings in molecular and behavioral research on initial social safety stimuli. At the end, we discuss the application of OXT as a therapeutic agent to psychopathologies related to deficits in safety learning.



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Medical students' perceptions regarding the use of patient photographs integrated with medical imaging studies

Publication date: Available online 23 May 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Diane T. Siegel, Ariadne K. DeSimone, Carson A. Wick, Srini Tridandapani, Kimberly E. Applegate




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Making Sense of MACRA: A Guide for Diagnostic Radiologists

Publication date: Available online 23 May 2018
Source:Current Problems in Diagnostic Radiology
Author(s): David Sadowsky, Tianyang Li, Usama Hasan, Christopher Harnain, Anthony Gilet, Perry Gerard
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law on April 16, 2015, fundamentally altering the way clinicians are reimbursed for the treatment of Medicare patients starting in 2017. Under this new pay-for-performance model, reimbursement will be tied to multiple metrics related to quality and cost of care. A scaled scoring system will require providers to compete for positive reimbursement adjustments, while also penalizing poor performers with negative adjustments. A firm understanding of this new system will be essential for all physicians looking to maximize their reimbursement, particularly diagnostic radiologists and members of other highly focused fields where special considerations lead to alterations in the scoring system.



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#Radiology: A 7-Year Analysis of Radiology-Associated Hashtags

Publication date: Available online 17 April 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Jacob J. Bundy, Anthony N. Hage, Jeffrey Forris Beecham Chick, Rajiv N. Srinivasa, Nishant Patel, Evan Johnson, Joseph J. Gemmete, Ravi N. Srinivasa
PurposeTo describe the radiology-related Twitter network through the analysis of the most commonly used radiology-associated hashtags.Materials and MethodsA total of 959,366 tweets containing the hashtags from the 9 most commonly used radiology-associated hashtags composed by 66,568 Twitter users from October 13, 2010 to February 22, 2018 were analyzed. Twitter activity metrics, engagement, user characteristics, content analysis, and network analysis were obtained using the health care social media analytics platform, Symplur Signals.ResultsThe number of tweets containing the most commonly used radiology hashtags increased by 198% during 2011. Regarding tweet content, 246,949 (46.9%) tweets were related to patients, 140,562 (26.7%) tweets were cancer related, 47,704 (9.1%) tweets were related to research, and 26,994 (5.1%) tweets were related to radiation. As for engagement, there were 374,082 retweets (39%), 512,919 mentions (53.5%), and 12,919 replies (1.3%). Health care organizations not directly involved with patient care, physicians, and patients authored 283,698 (29.6%), 217,152 (22.6%), and 27,595 (2.9%) tweets, respectively. Network analysis demonstrated health care organizations not directly involved with patient care, physicians, media organizations, and individuals working in the health care industry in nonclinical roles to be the users most active on the radiology-related hashtags on Twitter.ConclusionRadiology-related hashtag use has grown substantially over the years, with a majority of the discussions involving physicians and health care organizations not directly involved with patient care.



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Chest radiographic appearance of minimally invasive cardiac implants and support devices: What the radiologist needs to know✯

Publication date: Available online 24 May 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Scott Cressman, Matthew Rheinboldt, Chad Klochko, Jeffrey Nadig, David Spizarny
Minimally invasive implantable cardiac devices used in valve repair and replacement, cardiovascular support, and partial chamber and appendageal occlusion represent a burgeoning area of both bioengineering and clinical innovation. In addition to familiarizing the reader with the radiographic appearance of the most commonly utilized and encountered newer devices, this review will also address the relevant clinical and pathophysiological indications for usage and deployment as well as potentially encountered complications.



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Trends in Interventional Radiology Publications Through the Eye of the Journal of Vascular and Interventional Radiology: A 27-Year History

Publication date: Available online 23 May 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Jacob Bundy, Anthony N. Hage, Jeffrey Forris Beecham Chick, Joseph J. Gemmete, Rajiv N. Srinivasa, Eunjee Lee, Evan Johnson, Jawad Hussain, Michael Cline, Nishant Patel, Ravi N. Srinivasa
PurposeTo report the quantity, manuscript types, geographic distribution of publications, and published content trends in a major interventional radiology journal over 27 years.Materials and MethodsAvailable publication data from the JVIR was collected via Scopus from November 1990 to November 2017. Quantity, manuscript type, geographic distribution, number of citations, and publication content were analyzed.Results6,925 papers were published in JVIR during the study period. The number of publications increased by 234% from an average of 103 publications/year in the first 5 years to 344 publications/year in the last 5 years. Manuscript types included 4,891 original articles (70.6%), 987 letters (14.3%), 360 review articles (5.2%), 324 notes (4.7%), 167 conference papers (2.4%), 102 editorials (1.5%), 61 errata (0.9%), 23 articles in press (0.3%), and 10 short surveys (0.1%). The majority of publications originated in the United States with 3,945 articles (57.0%), followed by Canada with 366 articles (5.3%), and Japan and South Korea with 360 (5.2%) and 340 articles (4.9%), respectively. As for article content, arterial disease and interventions were discussed in 2,256 publications (32.6%), followed by venous (1,237; 17.9%), miscellaneous (1,072; 15.5%), oncology (1,006; 14.5%), genitourinary (758; 10.9%), portal (337; 4.9%), neurovascular (253; 3.7%), gastrointestinal (232; 3.4%), biliary (210; 3.0%), pediatric (130; 1.9%), clinical trials (119; 1.7%), and guideline development (119; 1.7%).ConclusionThere has been a marked increase in the number of publications in JVIR over 27 years. JVIR has shown continued growth since its inception and has strengthened its international reputation with more global research than ever before.



https://ift.tt/2KvNynR

Molecular Imaging in Diagnosis of Tumor Induced Osteomalacia,

Publication date: Available online 27 June 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Ming Yang, Krupa B. Doshi, Michael C. Roarke, Ba D. Nguyen




https://ift.tt/2tFkLqp

Imaging of Intracystic Papillary Carcinoma,,✯✯✯,✯✯✯✯,✯✯✯✯✯

Publication date: Available online 22 May 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Megan E. Speer, Beatriz E. Adrada, Elsa M. Arribas, Kenneth R. Hess, Lavinia P. Middleton, Gary J. Whitman




https://ift.tt/2KwHyLx

The Financial Burden of Missed Appointments: Uncaptured Revenue Due to Outpatient No-Shows in Radiology

Publication date: Available online 12 June 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Rebecca J. Mieloszyk, Joshua I. Rosenbaum, Christopher S. Hall, Usha Nandini Raghavan, Puneet Bhargava




https://ift.tt/2N9jgJe

Diagnostic Features of Emphysematous Osteomyelitis

Publication date: Available online 1 June 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Juan E. Small, Pauley Chea, Nehal Shah, Kirstin M. Small
ObjectiveEmphysematous osteomyelitis (EO) is a rare, aggressive and potentially fatal variant of osteomyelitis related to gas forming organisms. Imaging plays a vital role in diagnosis. The purpose of this study was to describe a novel and distinct imaging sign of EO, by analysis of the imaging characteristics of 3 newly identified cases of EO as well as all reported cases in the literature.Study DesignLiterature review and retrospective study in two tertiary care medical centers.MethodsDuring the course of clinical care over the last year, we have observed two cases of EO. An IRB approved one year systematic retrospective review of our institutional radiology information system identified one additional case of EO. We conducted a MEDLINE literature search to identify all published EO case reports using key phrases. The imaging in all published cases was reviewed. To address the specificity of imaging characteristics, we identified cases demonstrating variants of intraosseous gas that were not caused by emphysematous osteomyelitis.ResultsWe identified 3 cases of emphysematous osteomyelitis (EO) at our institutions. We found 31 individual case reports of EO via MEDLINE search. Of the published cases, 25 of the 31 cases contained images of sufficient extent and quality for image analysis. Including our 3 cases, a total of 34 cases were identified. Of the 34 cases, 28 had images of sufficient quality and extent to determine the presence or absence of the "pumice stone" pattern. The "pumice stone" sign13 was identified in 27 out of 28 cases (96%). The most commonly affected sites of infection include the pelvic bones (38%; 13 out of 34), vertebral bodies (32%; 11 out of 34), and femurs (24%; 8 out of 34). Adjacent soft tissue inflammation and emphysema was evident in 23 out of 29 cases (79%). Cortical destruction, a key diagnostic feature of traditional osteomyelitis, was absent in 79% of cases of emphysematous osteomyelitis.ConclusionWe describe as the "pumice stone sign" as a radiological sign to identify emphysematous osteomyelitis. We found it present in 96% of all currently known cases of emphysematous osteomyelitis. EO commonly involves the pelvic bones (38%) vertebral bodies (32%), and femur (24%). Key features also include adjacent soft tissue emphysema, (79%) and absence of cortical destruction (79%).



https://ift.tt/2Naduab

“Inferior vena cava filter strut penetration into the vertebral column: A case of 10 year clinical follow up.”

Publication date: Available online 18 April 2018
Source:Current Problems in Diagnostic Radiology
Author(s): David A. Petrov, Aakash Chauhan, Sean Fitzpatrick, Daniel T. Altman, Casagranda Bethany




https://ift.tt/2KuqPbD

Impact of early radiology research experiences on medical student perceptions of radiology and research: a pilot study

Publication date: Available online 24 May 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Preya Shah, Mike Sheng, David A. Mankoff, Scott O. Trerotola, Maya Galperin-Aizenberg, Sharyn I. Katz, Eduardo J.M. Barbosa, Arun C. Nachiappan
Rationale and ObjectivesTo promote opportunities for medical students to gain early exposure to radiology and research, our institution has initiated programs which fund summer radiology research projects for rising second-year medical students. This study assesses the impact of these faculty-mentored summer research experiences on medical student perceptions of radiology and research, in terms of both knowledge and interest.Materials and MethodsA voluntary, anonymous survey was administered to students both before and after the summer research period. Both the pre-survey and post-survey included 7-point Likert-scale questions (1=strongly disagree; 7=strongly agree) to evaluate students' perceptions about research and students' perceptions about radiology as a specialty. Faculty mentors were sent an analogous post-summer survey that included an evaluation of their student's research skills.ResultsThe surveys were completed by 9/11 students and 10/11 mentors. Students' perceived knowledge of radiology as a specialty improved (p=0.02) between the pre-survey and post-survey. Similarly, there was an increase in students' perceived knowledge of research skills (p=0.02) between the pre-survey and post-survey, with student ratings of research skills consistent with those of mentors. High student interest in both radiology and research was maintained over the course of the program.ConclusionOur pilot study suggests that summer research experiences can improve knowledge of radiology and research among medical students. Continued evaluation of this annual program will allow us to enhance the benefit to medical students and bolster interest in academic radiology.



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Multi-Modality Imaging Evaluation of the Whole-Organ Pancreas Transplant,,✯✯✯

Publication date: Available online 24 May 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Nicholas Voutsinas, Ayushi P. Singh, Sara Lewis, Ally Rosen
Pancreas transplants are an important treatment options for patients with severe diabetes mellitus and other medical conditions. Multiple imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound (US) are available to evaluate the pancreas transplants and their vascular supply, with the graft having a characteristic appearance on each modality. Complications of the graft and its vascular supply present interesting challenges to the clinicians and radiologists caring for this patient population. Being able to identify the imaging appearance of normal and abnormal pancreas transplants is necessary to ensure these patients are provided optimal care.



https://ift.tt/2IAmYrM

Radiation Dose Associated With Over Scanning in Neck CT

Publication date: Available online 24 May 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Mohamed Khaldoun Badawy, Hannah Lane, Michael Galea
The increasing utilisation of computed tomography scans exposes patients to significant amounts of radiation. One of the factors that can result in unnecessary radiation dose is scanning beyond the clinically indicated anatomical region. This study aims to assess the optimisation in overscan frequency, scan length and radiation dose following targeted educational talks aimed to address a routinely over scanned protocol; the CT Neck. A targeted radiation awareness talk regarding scan adherence as a method of radiation dose optimisation was delivered to all medical imaging technologists employed at a large teaching hospital. An audit of the radiation dose associated with CT Neck protocols was conducted in the month before, a month after and one year after the awareness talk. Results show that following the radiation awareness talks there was a 15% reduction in overscan frequency, an average over scan length reduction of 33% and a 20% reduction in overall radiation dose. The targeted nature of the talk, explicitly addressing scan range in the neck region, significantly reduced radiation dose to the patients. The results of this study are effective in illustrating the potential clinical radiation dose saving from strict adherence to scan range.



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Forehead Reconstruction After Resection of Squamous Cell Carcinoma

No abstract available

https://ift.tt/2tE7m1H

Deoxycholic Acid–Induced Skin Necrosis: Prevention and Management

No abstract available

https://ift.tt/2tOuTwa

Aggressive Digital Papillary Adenocarcinoma: Population-Based Analysis of Incidence, Demographics, Treatment, and Outcomes

BACKGROUND As a rare cutaneous malignancy, epidemiologic and outcomes data for aggressive digital papillary adenocarcinoma (ADPA) are limited and no treatment guidelines exist. OBJECTIVE To provide a population-based study of ADPA incidence and outcomes with a subgroup comparison of patients with localized versus regional disease. METHODS Data from 18 registries within the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program were examined for patients with ADPA (1995–2013) to provide demographic- and cancer-related information, and to calculate race- and age-specific rate ratios, incidence, and mortality. Patients were stratified by the stage for further comparison. RESULTS Ninety-four cases of ADPA were identified. Overall, ADPA incidence was 0.08 per 1,000,000 person-years, 4 times higher in males than in females (0.13 vs 0.03, p

https://ift.tt/2tEtI3d

A Multiple Recurrent Keratoacanthoma of the Lower Leg After Repeated Wide-Excision and Mohs Micrographic Surgery

No abstract available

https://ift.tt/2tKFo3R

Treatment for Lentigo Maligna of the Head and Neck: Survey of Practices in Ontario, Canada

BACKGROUND Lentigo maligna is an in situ form of cutaneous melanoma that commonly arises on the head and neck. Various surgical and nonsurgical treatment options are available but no randomized trials exist to guide practice. OBJECTIVE To determine the current treatment practices for lentigo maligna of the head and neck in Ontario, Canada. MATERIALS AND METHODS Cross-sectional survey of dermatologists, plastic surgeons, and head and neck surgeons. RESULTS The response rate was 35% (190/542). Wide excision with immediate reconstruction was the most commonly recommended treatment for tumors on the cheek (69%), whereas staged excision with margin control was recommended most often for tumors on the nasal ala (60%). Overall, 5 mm was the most frequently recommended initial surgical margin (69%); 26.5% of respondents recommended margins wider than 5 mm. For tumors on the nasal ala, eyelid, and ear helix, more than 30% of respondents recommended an initial margin narrower than 5 mm. CONCLUSION Although surgical excision is the predominant treatment modality for lentigo maligna on the head and neck, practices vary considerably in terms of the type of excision and the initial margin used. Potential response bias and the geographic restriction of our sample may limit the generalizability of our results.

https://ift.tt/2tCjxfp

Web App– and Text Message–Based Patient Education in Mohs Micrographic Surgery—A Randomized Controlled Trial

BACKGROUND Consent and wound care (WC) videos are used for education in Mohs micrographic surgery (MMS). Postoperative text messaging is poorly studied. OBJECTIVE Develop and evaluate perioperative resources for MMS patients—video modules (DermPatientEd.com) and postoperative text messaging (DermTexts.com). MATERIALS AND METHODS A study was conducted on 90 MMS patients. Patients were randomized 1:1:1:1 to videos with text messages, videos-only, text messages-only, or control. Primary outcomes included preoperative anxiety and knowledge of MMS and postoperative care. The secondary outcome included helpfulness/preference of interventions. RESULTS Patients experienced a 19% reduction in anxiety as measured by a visual analog scale after the MMS video (p = .00062). There was no difference in knowledge after the WC video (p = .21498). Patients were more likely to report the WC video "very helpful" when compared with the pamphlet in understanding postoperative WC (p = .0016). Patients in text messaging groups were not more likely to report the service as "very helpful" when compared with the pamphlet (p = .3566), but preferred to receive WC instructions by text message for future visits (p = .0001). CONCLUSION These resources proved helpful and effective in reducing preoperative anxiety. Patients prefer text message–based WC instructions over pamphlets after experiencing the service, but do not find them more helpful.

https://ift.tt/2tz0sLl

Diagnostic Change From Atypical Intraepidermal Melanocytic Proliferation to Melanoma is More Likely When Clinically Visible Residual Pigment Remains After Biopsy

No abstract available

https://ift.tt/2yRYJWF

Evaluation of MITF, SOX10, MART-1, and R21 Immunostaining for the Diagnosis of Residual Melanoma In Situ on Chronically Sun-Damaged Skin

BACKGROUND Melanocytic immunostains can assist in margin evaluation of melanoma in situ (MIS) excisions; however, their accuracy and reliability relative to hematoxylin & eosin (H&E) is yet to be determined. OBJECTIVE The objective of this study was to evaluate the sensitivity, specificity, and concordance of 4 melanocyte-specific immunostains for diagnosing MIS occurring on chronically sun-damaged skin. MATERIALS AND METHODS Serial permanent sections from representative areas of negative margin and residual tumor were stained using H&E, MITF, MART-1, SOX10, and R21 and examined in a blinded fashion. The study set included 100 digital microscopy images from 10 cases of MIS excisions from the face. Two board-certified dermatopathologists, 4 fellowship-trained Mohs surgeons, 2 Mohs fellows, and 2 dermatology residents independently reviewed the 100 images. RESULTS The average melanocyte density was 11 versus 28 melanocytes per 0.5 mm for chronically sun-damaged skin versus residual MIS on H&E, respectively. Statistically significantly higher melanocyte densities were observed using MITF, MART-1, and SOX10 on negative margins. The sensitivity and interobserver concordance was highest using MITF and SOX10. The intraobserver agreement on 4 duplicate images was 85%. CONCLUSION In conclusion, the nuclear immunostains (MITF and SOX10) show the most promise for improving the diagnosis of MIS in chronically sun-damaged skin.

https://ift.tt/2N7e8oM

A Dermatologic Approach to a Recurrent Auricular Seroma

No abstract available

https://ift.tt/2yTblMV

First Safety and Performance Evaluation of T45K, a Self-Assembling Peptide Barrier Hemostatic Device, After Skin Lesion Excision

BACKGROUND The self-assembling peptide barrier T45K (SAPB-T45K) is an oligopeptide that rapidly forms a biocompatible hemostatic barrier when applied to wounds. OBJECTIVE Evaluate safety and performance of SAPB-T45K in cutaneous surgery. MATERIALS AND METHODS In this single-blind study, after sequential shave excision of 2 lesions, wounds were randomized (intrapatient) to SAPB-T45K or control treatment. Safety was assessed at treatment, Day 7, and Day 30. Performance was evaluated using time to hemostasis (TTH) and ASEPSIS wound scores, with a subgroup analysis for patients with or without antiplatelet therapy. RESULTS Each of 46 patients (10 [22%] with antiplatelet therapy) received randomized SAPB-T45K or control treatment for 2 wounds. Safety assessments were similar, and ASEPSIS scores reflected normal healing in both wound groups. SAPB-T45K demonstrated significantly faster median TTH (24.5 [range, 7–165] seconds) compared with control (44 [10–387] seconds), for a 41% median TTH reduction (18 [95% confidence interval, 7–35] seconds, p

https://ift.tt/2N7e34s

Review of Nonmelanoma Skin Cancer in African Americans, Hispanics, and Asians

BACKGROUND Skin cancer has traditionally been studied in Caucasian skin. Although it does occur with increased relative frequency in Caucasians, patients with skin of color suffer from elevated morbidity and mortality when diagnosed with skin cancer. OBJECTIVE To detail the unique demographic and clinical features of nonmelanoma skin cancer (NMSC) in patients with skin of color, including Hispanic, African American, and Asian patients. MATERIALS AND METHODS A complete PubMed search was conducted spanning dates from 1947 to June 2017 yielding a total of 185 manuscripts, from which 45 were included in this review. RESULTS Relative to Caucasians, NMSC, comprised squamous cell carcinoma and basal cell carcinoma, has unique demographic and clinical features in African Americans, Hispanics, and Asians. CONCLUSION Familiarization with these unique presentations of skin cancer in skin of color is imperative to accurate identification and treatment of cutaneous malignancies in these populations and ultimately to improved disease-related outcomes.

https://ift.tt/2tNOpsK

A Review of the Use of Ultrasound for Skin Tightening, Body Contouring, and Cellulite Reduction in Dermatology

BACKGROUND Ultrasound (US) technology uses acoustic waves to heat tissue, resulting in thermal damage and coagulative necrosis leading to the renewal of skin elasticity, body contouring, and destruction of cellulite. OBJECTIVE This review will discuss the use of US for skin tightening, body contouring/sculpting, and cellulite reduction. MATERIALS AND METHODS A literature search identified studies using US for skin tightening, body contouring/sculpting, and cellulite reduction. RESULTS Two hundred thirty-one studies were identified using US technology. Twenty studies each were identified addressing body contouring/sculpting and skin tightening, and 2 studies for cellulite reduction. Ultrasound is efficacious for skin rejuvenation, body contouring, and reduction of cellulite of the face, décolletage, abdomen, and thighs. Ultrasound lipolysis results in a 2- to 4.6-cm decrease in abdominal circumference. Ultrasound is safe and can be used in all skin types with minimal concern for postinflammatory hyperpigmentation. CONCLUSION Ultrasound seems to be an efficacious, effective, and safe modality for correction of skin laxity, lipolysis, and decrease the appearance of cellulite. Adverse effects are minimal including procedural pain, postprocedure erythema, and swelling. Clinicians and patients are both satisfied with results after treatment. In this review, the authors will provide an update on the use of US in the dermatologic field.

https://ift.tt/2tAMyIK

Donor Site Assessment for Female Hairline Restoration in Southeast Asians

BACKGROUND Female hairline restoration has increasingly been in demand for the past decade. However, no reports address the correlation between characteristics of hair at the hairline and at the donor area. OBJECTIVE To assess follicular characteristics at the hairline and at the donor area including hair density, diameter, and their correlation. MATERIALS AND METHODS One hundred one randomly selected Southeast Asian female volunteers were assessed for hairline and donor area characteristics. Data from the donor sites, including the temporal, parietal, occipital, and neck region were compared with that of the hairline. RESULTS Hairline density was 135.2 hair/cm2 with a diameter of 80.07 μm in midline, 112.95 hair/cm2 with 73.96 μm at the frontotemporal area, 69.82 hair/cm2 with 72.09 μm at temple peak, and 74.26 hair/cm2 with 72.35 μm at sideburns. The donor hair density was 98.89 to 152.19 hairs/cm2 and hair diameter was 76.80 to 81.11 μm. Aging was shown to affect hair density and diameter at the donor area. CONCLUSION All donor sites are suitable for hairline restoration of the midfrontal region except in the neck region. The suitable donor area for the frontotemporal area, temple peak, and sideburns is the nape. Hair density and diameter declined with age at some donor sites.

https://ift.tt/2yTbaBf