No abstract available
https://ift.tt/2TXzQ1U
Τετάρτη 28 Νοεμβρίου 2018
Simple method to attain symmetry for rib cartilage graft
Rhinoplasty is one of the most craft-worthy procedures in plastics surgery. It requires precise symmetry to ensure a satisfactory surgical outcome. Here we introduce a simple, economical yet efficient method designed to enhance and perfect autologous rib graft symmetry for nasal implants. There are no sources of financial support for this paper. ©2018American Society of Plastic Surgeons
https://ift.tt/2TXzMiG
https://ift.tt/2TXzMiG
Proliferative Lesions Found at Reduction Mammoplasty: Incidence and Implications in 995 Breast Reductions
PURPOSE: Reduction mammoplasty relieves symptomatic macromastia. Pathology specimens occasionally reveal unsuspected proliferative lesions or carcinoma. Few studies examine incidence, risk factors, and outcomes in this population. METHODS: Retrospective review was performed between 2000 and 2012. Pathology was categorized as benign, proliferative, or cancer (DCIS or invasive). RESULTS: Five hundred seventy-two patients had 995 reduction mammoplasties (85% bilateral, 15% unilateral). Cancer was detected in 23 (2.3%) specimens and proliferative lesions in 137 (13.8%). Compared to patients with benign pathology, patients with proliferative lesions or cancer were older (p0.5). Forty-one percent of patients with proliferative lesions and no history of cancer had a change in management with increased surveillance, hormones, radiation, chemotherapy, or surgery. If there was a history of cancer, fifty-four percent had a change in management. Of patients with DCIS or cancer, all received oncologic treatment. CONCLUSIONS: Proliferative lesions of the breast may be more common that previously reported. Age and a history of breast cancer increase risk for proliferative lesions. All should be referred to oncology as nearly half of these patients will have a change in management. Presented at the American Association of Plastic Surgeons Meeting in Austin, Tx 2017. Financial Disclosure Statement: The authors have no relevant financial relationships to disclose. This work was not supported by any sources of external funding. This work has not previously been published. All authors agree on the content of this manuscript and have contributed to its production. Corresponding Author: Amy S. Colwell, MD, Associate Professor Harvard Medical School, Massachusetts General Hospital , 55 Fruit Street, WACC 435, Boston, MA 02214, acolwell@mgh.harvard.edu ©2018American Society of Plastic Surgeons
https://ift.tt/2TTGO8l
https://ift.tt/2TTGO8l
Assessing the Quality of Microvascular Breast Reconstruction Performed in the Urban Safety-Net Setting – A Doubly Robust Regression Analysis
Background: Safety-Net Hospitals (SNH) serve vulnerable populations, however, care delivery may be of lower quality. Microvascular IBR, relative to other IBR subtypes, is sensitive to the performance of SNH with regards to clinical outcomes and an important quality marker. Our aim is to assess the quality of care associated with the SNH setting. Methods: The 2012-2014 National Inpatient Sample (NIS) was used to identify patients who underwent microvascular IBR after mastectomy. SNH were defined by the proportion of Medicaid patients. Primary outcomes of interest were rates of medical, surgical inpatient complications and prolonged length of stay (pLOS). A doubly-robust approach i.e. propensity score and multivariate regression, was used to analyze the impact of patient and hospital-level characteristics on outcomes. Results: A total of 858 patients comprised our analytic cohort following propensity matching. There were no significant differences in the odds of surgical and medical inpatient complications among SNH patients relative to their matched counterparts. Black (OR 2.95, p
https://ift.tt/2Av6a3l
https://ift.tt/2Av6a3l
Cost-Effectiveness Analysis of Silicone vs. Saline Implant-Based Breast Reconstruction Using the BREAST-Q
Background: The most common type of breast reconstruction is implant-based breast reconstruction. Implant type has been reported to impact quality of life outcomes. Therefore, we sought to evaluate the cost-effectiveness of saline implants versus silicone. Methods: We retrospectively reviewed data from patients who underwent breast reconstruction with saline or silicone implants at our institution. This included type of procedure, Acellular Dermal Matrix (ADM) use, complications, and number of revisions. Costs were estimated using the Center for Medicare and Medicaid Services physician fee schedule and hospital costs. Effectiveness was measured using Breast-Q-adjusted life years (Breast-QALY), a measure of years of perfect breast health, based on Breast-Q data collected before mastectomy and reconstruction and at 12-months after final reconstruction. The incremental cost-effectiveness ratio (ICER) was obtained for silicone and saline reconstruction. Results: We identified 134 women, among which 77 (57%) underwent silicone and 57 (43%) underwent saline breast reconstruction. The cost of saline reconstruction was $1,288.23 less compared to silicone. Breast-QALYs were 28.11 for saline versus 23.57 for silicone, demonstrating higher cost-effectiveness for saline. The ICER for saline was (-)$283.48, or $283.48 less per year of perfect breast-related health post-reconstruction than silicone. Conclusion: Our results indicate that saline breast reconstruction may be more cost-effective compared with silicone at 12 months post-final reconstruction. Silicone was both more expensive and less effective than saline. However, given the relatively small cost difference, surgeon and patient preference may be important in determining type of implant used. Financial Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Funding: None. Presentations: The study was presentated at the annual meeting of the American Society of Reconstructive Microsurgery (January 13-16, 2018, Phoenix, AZ) and was accepted for presentation at the American Society of Breast Surgeons (May 2-6, 2018, Orlando, FL). Ethical Approval: This study was approved by the Johns Hopkins Medicine Institutional Review Board under protocol #IRB00046361. This study conforms to the Declaration of Helsinki ethical principles for medical research. Corresponding author: Carisa M. Cooney, MPH, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 North Caroline Street, Baltimore, MD 21287, Email: Ccooney3@jhmi.edu, Phone: 443-287-4629 ©2018American Society of Plastic Surgeons
https://ift.tt/2TUSYOo
https://ift.tt/2TUSYOo
Locational Relationship Between the Lateral Border of the Frontalis Muscle and the Superior Temporal Line
Background: The frontalis is a representative target muscle for botulinum neurotoxin type A injections aimed at treating horizontal wrinkles in the forehead region. However, a lack of information regarding the shape and thickness of the frontalis may lead to unexpected side effects. Methods: This study dissected hemifaces of 44 embalmed Korean and Thai cadavers and performed ultrasound examinations on 20 healthy Korean volunteers. Two anatomical types were identified: (1) the lateral portion of the frontalis covered the superior temporal line (STL) in type I, and (2) the lateral border of the frontalis (LF) and the STL almost coincided in type II. A horizontal line was drawn laterally from the midpoint between the metopion and the glabella while landmarks F1, F2, and F3 were defined as points where this horizontal reference line intersected with vertical lines from the midpoint of the pupil, the lateral canthus, and the lateral orbital rim, respectively. Results: Type I was more common than type II [84% (37/44) vs 16% (7/44)]. When the LF ran along the border, there were no cases in which the STL was not visible. The mean minimum distance in type I was 10.53 mm. The muscle thicknesses at F1, F2, and F3 were 1.80±0.44 mm (mean±SD), 1.61±0.37 mm, and 0.11±0.04 mm, respectively. Conclusions: This study yielded data on the location and thickness of the LF. An anatomical-study-based ultrasound-guided injection technique can achieve reliable results when noninvasive treatment is applied to the forehead area. Financial Disclosure Statement: None of the authors have financial supports from commercial, academic, or political organizations or people regarding this study. The institutional ethics committee approved the study, and the participants provided written informed consents after the study had been fully explained to them (IRB No. 2-2017-0023). Corresponding author: Hee-Jin Kim, DDS, PhD, Room 601, Department of Oral Biology, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Rep. of Korea, hjk776@yuhs.ac ©2018American Society of Plastic Surgeons
https://ift.tt/2AySSmD
https://ift.tt/2AySSmD
Predictable Location of Breast Sensory Nerves for Breast Re-innervation
Background: The sensory innervation to the breast originates from the medial and lateral cutaneous branches of the third to fifth intercostal nerves, which are at risk for injury or loss during a mastectomy. Providing re-innervation after mastectomy was introduced almost 20 years ago, but it is not widely performed, perhaps due to the difficulty of locating a recipient nerve. We have performed cadaveric dissections to allow for precise anatomical localization of the lateral intercostal branch providing breast sensation. Materials and Methods: Bilateral chest dissections were performed on 10 female cadavers. The lateral intercostal nerve providing sensation to breast tissue was identified. The distance from sternum, mid-clavicular line, and lateral pectoralis minor, as well as nerve diameter, was measured. Results: The nerve was successfully identified bilaterally in all cadavers. The majority of nerves (16/20) exited from under the 4th rib. The average distance from the sternum was 13.1cm (range 10-15cm, standard deviation 1.3cm) and from the mid-clavicular line was 11.8cm (range 8-16cm, standard deviation 2.2cm). The nerve exited at the lateral border of the pectoralis minor or within 2cm from the lateral border for all cadavers. The diameter of the nerve was consistently 2mm. The nerve traveled under the thoracodorsal vessels, aiding in identification. Conclusion: We provide the predictable location of the lateral intercostal nerve providing sensation to the breast. We hope that by enabling surgeons to locate this nerve, more well-done studies will be performed investigating technqiues and outcomes for breast re-innervation. Disclosures: none Corresponding Author: Risal Djohan, MD, Cleveland Clinic Foundation, Crile Building, Mail Code A60, 2049 East 100th Street, Cleveland, OH 44195, Email: Djohanr@ccf.org, Phone: 216-445-2433 ©2018American Society of Plastic Surgeons
https://ift.tt/2TVhn6o
https://ift.tt/2TVhn6o
Letter To The Editor- Sentinel lymph node biopsy in melanoma: Which hot nodes should be harvested and is blue dye really necessary?
We read with great interest the review by dr. Ranson and collegues about sentinel lymph node biopsy in melanoma, which hot nodes should be harvested and whether blue dye is really necessary. First of all, we congratulate the author on an excellent paper, but we also feel that there are some issues that need to be addressed.
https://ift.tt/2KGhqyO
LATISSIMUS DORSI BREAST RECONSTRUCTION WITH OR WITHOUT IMPLANTS: A COMPARISON BETWEEN OUTCOME AND PATIENT SATISFACTION
The Latissimus Dorsi (LD) flap is largely used in breast reconstruction. The aim of this study is to evaluate the advantage of the LD flap in association with implant compared to LD breast reconstruction in association with lipofilling to add additional volume, by assessing the number of revision procedures, the length of hospitalization, the complication rate and patient satisfaction.
https://ift.tt/2BEgwQk
Cartilage exposure following autologous microtia reconstruction: an algorithmic treatment approach
Successful reconstruction of microtia involves fabrication of a cartilaginous framework and provision of thin, durable, soft tissue cover. Vascular compromise of this skin envelope can lead to exposure of the underlying cartilage, resulting in cartilage resorption and distortion of the final form of the ear construct. We describe our algorithm for management of this complication.
https://ift.tt/2KGh1fM
From stem cells protection to skin microbiota balance: Orobanche rapum extract, a new natural strategy
Summary
Background
Healthy skin is a delicate balance between skin renewal and microbiota homeostasis, and its imbalance promotes premature aging and dermatological disorders. Skin stem cells are key actors in this process but their sensitivity to aging and external stressors such as UV reduces the skin renewal power. The skin microbiota has been recently described as active in the healthy skin, and its imbalance could trigger some disorders.
Aims
We hypothesized that reactivation of stem cells and maintenance of microbiota could be a disruptive strategy for younger and healthier skin. We thus developed a new plant extract that restores the entire skin renewal process by sequential activation from stem cells stimulation to microbiota protection.
Methods
We studied stem cells comportment in the presence of Orobanche rapum extract by survivin immunocytochemistry and caspases 3 and 9 dosages. We also analyzed epidermal differentiation markers by immunohistochemistry and lipids organization by GC/MS At the clinical level, we investigated the impact of O. rapum extract on microbiota and on skin aspect.
Results
We demonstrated an active protection of skin stem cells through the maintenance of their clone‐forming capacity and resistance to UV through the overexpression of survivin coupled to caspases inhibition. Furthermore, we showed the restoration of epidermal differentiation markers and ceramide biosynthesis favorable to orthorhombic organization. Clinical studies, including microbiota analysis, showed an active skin surface renewal coupled with microbiota protection.
Conclusion
We evidenced that our active ingredient is able to stimulate skin rejuvenation while protecting the cutaneous microbiota, creating healthier skin and thereby beauty.
https://ift.tt/2zukycu
Scholar : These new articles for Canadian Art Therapy Association Journal are available online
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Inhibitory effects of Sanguisorba officinalis root extract on HYBID (KIAA1199)‐mediated hyaluronan degradation and skin wrinkling
Abstract
Objectives
Hyaluronan (HA), an important constituent of extracellular matrix in the skin, has many biological activities such as hydration that contributes to firmness and bounciness of the skin. We have reported that reduction of HA in the papillary dermis and overexpression of HYBID (HYaluronan Binding protein Involved in hyaluronan Depolymerization, alias KIAA1199 or CEMIP), a key molecule for HA degradation in skin fibroblasts, are implicated in facial skin wrinkling in Japanese and Caucasian women. However, little or no information is available for substances which inhibit the HYBID‐mediated HA degradation.
Methods
Inhibition of Sanguisorba officinalis root extract and ziyuglycoside I, one of the components of Sanguisorba officinalis root extract, to the HYBID‐mediated HA degradation was assessed by size‐exclusion chromatography of HA depolymerized by stable transfectants of HYBID in HEK293 cells (HYBID/HEK293 cells) or normal human skin fibroblasts (Detroit 551 cells and NHDF‐Ad cells). The HYBID mRNA and protein expression was examined by quantitative real‐time PCR and immunoblotting in the skin fibroblasts treated with Sanguisorba officinalis root extract, and size distribution of newly produced HA was evaluated by preparing metabolically radiolabeled HA. A double‐blind, randomized, and placebo‐controlled study was carried out in the 21 healthy Japanese women, who were topically treated with the formulation containing Sanguisorba officinalis root extract or the placebo on each side of the face including crow's foot area.
Results
Sanguisorba officinalis root extract, but not ziyuglycoside I, abolished HYBID‐mediated HA degradation by HYBID/HEK293 cells. Sanguisorba officinalis root extract also inhibited HYBID‐mediated HA degradation in skin fibroblasts by down‐regulating HYBID mRNA and protein expression. Although control untreated skin fibroblasts produced polydispersed HA, the cells treated with Sanguisorba officinalis root extract produced only high‐molecular‐weight HA. Treatment with Sanguisorba officinalis root extract‐formulated lotion significantly improved skin elasticity, and reduced skin wrinkling scores at the outer eye corner compared with the placebo formulation.
Conclusion
Sanguisorba officinalis root extract showed an anti‐HYBID‐mediated HA degradation activity and anti‐wrinkle activity on human facial skin, which is accompanied by the improvement in elasticity. Our study provides the possibility of a new strategy to inhibit HYBID‐mediated HA degradation for anti‐wrinkle care.
This article is protected by copyright. All rights reserved.
https://ift.tt/2FMUwqF
A High-Intensity Jump-Based Aquatic Exercise Program Improves Bone Mineral Density and Functional Fitness in Postmenopausal Women
Rejuvenation Research, Ahead of Print.
https://ift.tt/2DN4gyt
Scholar : These new articles for Journal of Dance Education are available online
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Self-Reported Skin Changes by a Selected Number of Astronauts after Long-Duration Mission on ISS as Part of the Skin B Project
Background: One of the most challenging and important factors of manned space missions is to keep astronauts healthy on orbit. In a study on 46 ISS crew members who were on 6-month (average) missions, skin rashes were the most self-reported event. Furthermore, among notable events, 40% were classified as skin rashes/hypersensitivities. Thus, especially skin conditions during space travel are of major clinical interest and require further research. Aims: The aim of the study was to determine skin conditions in space flight among US and European astronauts, especially taking into account the terrestrial skin conditions as well as on-orbit skin care habits. Methods: A preflight questionnaire was given to the astronauts asking about their terrestrial skin care habits and skin conditions/atopy before launch. In addition, they were asked to fill out a postflight questionnaire asking about their on-orbit skin care routine and whether any special observations regarding the skin were made during flight. Results: A total of 23 skin symptoms were recorded by 8 nonatopic astronauts (mean age: 41 years) during the mission. The symptoms were peeling (21.74%), rash (17.39%), dryness (13.04%), severe dryness (8.70%), reddening (8.70%), itchiness (8.70%), bruising (4.35%), skin sensitivity (4.34%), bumps (4.35%), acne (4.35%) and slow healing of contusions and lacerations (4.35%). Especially the hands and feet were affected by skin problems. As a result of this examination, it was shown that the skin symptoms correlate with poor hygiene on orbit, whereas the factor "environment" on the ISS plays a minor role. Surprisingly, 2 astronauts even experienced positive effects on their skin. Conclusion: Based on these preliminary data, it is important to pay more attention to skin hygiene and maintenance in space.
Skin Pharmacol Physiol 2019;32:52–57
https://ift.tt/2AulH3E
Skin Pharmacol Physiol 2019;32:52–57
https://ift.tt/2AulH3E
Current Data on Effects of Long-Term Missions on the International Space Station on Skin Physiological Parameters
Background: Skin reaction to spaceflight has not really been studied yet, although the skin has a very important barrier function to protect the body and can contribute to a more general understanding of physiology. It is proposed here to make a more thorough investigation of the skin during long-term spaceflight, using noninvasive techniques. Aims: The aim of the present Skin-B study is to investigate the kinetics and range of possible skin modifications during long-duration spaceflights and their recovery. Methods: In order to investigate the effect on skin physiological parameters during spaceflight, measurements were carried out on 6 astronauts with respect to skin hydration, transepidermal water loss/barrier function, and surface evaluation of the living skin in orbit. Additional measured parameters on the ground were skin elasticity, skin density and thickness, as well as microcirculation. Results: Data from the Skin-B subjects (n = 6) contradict the results obtained in the previous pilot study SkinCare (n = 1 subject). In the present study, no deterioration of the skin was found but rather an improvement in skin hydration and skin barrier function, and no changes or improvement in the appearance of the skin surface. Furthermore, the skin density and skin thickness as well as skin elasticity values were unchanged from pre-flight values. Conclusion: In conclusion, we found that spaceflight under present conditions has no negative impact on skin physiological parameters.
Skin Pharmacol Physiol 2019;32:43–51
https://ift.tt/2TTNTpu
Skin Pharmacol Physiol 2019;32:43–51
https://ift.tt/2TTNTpu
Pancreatic Progenitors: There and Back Again
Publication date: Available online 28 November 2018
Source: Trends in Endocrinology & Metabolism
Author(s): Juan Domínguez-Bendala, Mirza Muhammad Fahd Qadir, Ricardo Luis Pastori
Adult pancreatic regeneration is one of the most contentious topics in modern biology. The long-held view that the islets of Langerhans can be replenished throughout adult life through the reactivation of ductal progenitor cells has been replaced over the past decade by the now prevailing notion that regeneration does not involve progenitors and occurs only through the duplication of pre-existing mature cells. Here we dissect the limitations of lineage tracing (LT) to draw categorical conclusions about pancreatic regeneration, especially in view of emerging evidence that traditional lineages are less homogeneous and cell fates more dynamic than previously thought. This new evidence further suggests that the two competing hypotheses about regeneration are not mutually exclusive.
https://ift.tt/2QnFxqZ
Robustly reconstructing magnetic resonance images via structure decomposition
Publication date: Available online 28 November 2018
Source: Magnetic Resonance Imaging
Author(s): Xiaomei Yang, Wen Xu, Ruisen Luo, Xiujuan Zheng, Kai Liu
Abstract
In magnetic resonance (MR) imaging, for highly under-sampled k-space data, it is typically difficult to reconstruct images and preserve their original texture simultaneously. The high-degree total variation (HDTV) regularization handles staircase effects but still blurs textures. On the other hand, the non-local TV (NLTV) regularization can preserve textures, but will introduce additional artifacts for highly-noised images. In this paper, we propose a reconstruction model derived from HDTV and NLTV for robust MRI reconstruction. First, an MR image is decomposed into a smooth component and a texture component. Second, for the smooth component with sharp edges, isotropic second-order TV is used to reduce staircase effects. For the texture component with piece-wise constant background, NLTV and contourlet-based sparsity regularizations are employed to recover textures. The piece-wise constant background in the texture component contributes to accurately detect non-local similar image patches and avoid artifacts introduced by NLTV. Finally, the proposed reconstruction model is solved through an alternating minimization scheme. The experimental results demonstrate that the proposed reconstruction model can effectively achieve satisfied quality of reconstruction for highly under-sampled k-space data.
https://ift.tt/2RjQTcV
Dual-contrast pCASL using simultaneous gradient-echo/spin-echo multiband EPI
Publication date: Available online 27 November 2018
Source: Magnetic Resonance Imaging
Author(s): Ke Zhang, Volker J. Sturm, Lukas R. Buschle, Artur Hahn, Seong Dae Yun, N. Jon Shah, Martin Bendszus, Sabine Heiland, Heinz-Peter Schlemmer, Christian H. Ziener, Felix T. Kurz
Abstract
A 2D gradient-echo EPI is commonly employed for arterial spin labeling (ASL) readout to achieve fast whole brain coverage measurements. However, such a readout suffers from susceptibility artifacts induced by magnetic field inhomogeneities. To reduce these susceptibility effects, single–shot spin-echo EPI was proposed to be used for acquisitions in continuous ASL (CASL). To minimize functional and physiological variations, a gradient-echo (GE)/spin-echo (SE) dual-echo EPI readout of the CASL sequence is needed for a comparison between GE- and SE-based determination of cerebral blood flow (CBF). In this study, we employed a simultaneous GE/SE multiband EPI as the readout of a pseudo-CASL (pCASL) sequence. Motor cortex activations derived from a finger-tapping task and functional networks from resting state fMRI were compared for both GE and SE contrasts. Direct comparison of SE and GE contrasts revealed that GE ASL provides an improved sensitivity of functional activity in finger-tapping and in resting-state imaging. SE ASL, on the other hand, suffered less from susceptibility artifacts induced by magnetic field inhomogeneities and pulsatile flow artifacts.
https://ift.tt/2Q38J7B
Clindamycin versus clindamycin plus rifampicin in Hidradenitis Suppurativa treatment: clinical and ultrasound observations
Publication date: Available online 28 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Raffaele Dante Caposiena Caro, Maria Vittoria Cannizzaro, Elisabetta Botti, Cosimo Di Raimondo, Eleonora Di Matteo, Roberta Gaziano, Luca Bianchi
Abstract
Background
Antibiotics are recognized as first-line treatments for Hidradenitis Suppurativa (HS), but there is limited data on their efficacy.
Objective
Evaluate the efficacy of oral clindamycin versus clindamycin plus rifampicin in HS patients.
Methods
Sixty mild to moderate-severe HS patients classified according IHS4 and Hurley scores, were subdivided into two groups of 30 patients each (Group A receiving clindamycin+rifampicin and Group B treated with clindamycin alone), and retrospectively studied. The main outcome was to evaluate and compare the clinical and ultrasound response between groups after 8 weeks of treatment according to Hidradenitis Suppurativa Clinical Response (HiSCR).
Results
After the treatment, 17/30 patients in Group A and 19/30 in Group B met the primary outcome. Both groups showed a similar improvement of IHS4, while DLQI and Pain VAS improved more in Group B. In particular, nodules and abscesses count reduction was similar between the two groups. Whereas, the number of draining tunnels decreased more in Group B. The factors significantly associated with HiSCR were age, BMI, IHS4 and absence of axillary involvement. The disease free survival was similar between the two groups.
Limitations
The study was not randomized or placebo-controlled.
Conclusion
Clindamycin may be a useful treatment alternative to antibiotic combination regardless of HS clinical stage.
https://ift.tt/2P91mGi
A Four-Year Retrospective Assessment of Post-Operative Complications in Immunosuppressed Patients Following Mohs Micrographic Surgery
Publication date: Available online 28 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Pallavi Basu, Alina Goldenberg, Natasha Cowan, Robert Eilers, Jennifer Hau, Shang I. Brian Jiang
Abstract
Background
Many patients undergoing Mohs micrographic surgery for basal and squamous cell carcinomas are immunocompromised, yet post-operative complications associated with different types of immunosuppression are largely unstudied.
Objective
To determine the incidence and nature of post-operative complications in immunosuppressed patients undergoing Mohs surgery.
Methods
A retrospective cross-sectional chart review of patient characteristics, clinical characteristics, and complications.
Results
Compared to immunocompetent cases, univariable analysis showed immunosuppression was associated with 9.6 times the odds of post-operative complication (p=0.003). Solid organ transplant recipients had 8.824 higher odds (p=0.006) and immunosuppressive therapy use displayed 5.775 higher odds (p=0.021). Surgical site infection (2.5%) and dehiscence (0.51%) were more prevalent among immunosuppressed patients, with an overall complication rate of 5.4% in this population. Multivariable analysis of the association between immunosuppression and post-operative complication closely trended toward, but did not meet, significance (p=0.056).
Limitations
This was a single-center, retrospective study. Other limitations include lack of non-solid organ transplants, limited medication data on non-transplant patients, and exclusion of cases with double transplants or multiple sources of immunosuppression.
Conclusions
Immunosuppression overall, particularly solid organ transplant and immunosuppressive therapy use, places patients at higher risk for post-operative complications including surgical site infection and wound dehiscence following MMS.
https://ift.tt/2zuQFsx
Cutaneous extranodal natural killer/T-cell lymphoma: Clinical implications of whole blood Epstein-Barr virus DNA
Publication date: Available online 28 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Se Jin Oh, Ji-Hye Park, Jong Hee Lee, Dong-Youn Lee
https://ift.tt/2P7zjqJ
Response to tofacitinib therapy of eyebrows and eyelashes in alopecia areata
Publication date: Available online 28 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Lucy Y. Liu, Brett A. King
https://ift.tt/2zvzS8F
Psoriasis and Hidradenitis Suppurativa: A Large-scale Population-based Study
Publication date: Available online 28 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Khalaf Kridin, Michal Shani, Yochai Schonmann, Shani Fisher, Guy Shalom, Doron Comaneshter, Erez Batat, Arnon D. Cohen
Abstract
Background
The coexistence of psoriasis and hidradenitis suppurativa (HS) has been described, but the association between these conditions is yet to be firmly established.
Objectives
To study the association between psoriasis and HS using a large-scale real-life computerized database.
Methods
A cross-sectional study was conducted comparing the prevalence of HS among patients with psoriasis and among age-, sex- and ethnicity-matched control subjects.
Results
A total of 68,836 patients with psoriasis and 68,836 controls were included in the study. The prevalence of HS was increased in patients with psoriasis as compared to the control group (0.3% vs. 0.2%, respectively; OR, 1.8; 95% CI, 1.5-2.3; P<0.001). In a multivariate analysis adjusting for smoking, obesity, and other comorbidities, psoriasis was still associated with HS (OR, 1.8; 95% CI, 1.4-2.2; P<0.001). Patients with coexistent psoriasis and HS were significantly younger (39.0±15.7 vs. 42.6±21.2 years; P=0.015) and had a higher prevalence of obesity (35.1% vs. 25.3%; P=0.001) and smoking (58.5% vs. 37.3%; P<0.001) as compared to patients with psoriasis alone.
Limitations
Retrospective data collection.
Conclusions
A positive association was observed between HS and psoriasis. Further longitudinal observational studies are necessary to establish these findings in other study populations.
https://ift.tt/2P9Gv5T
Human Oncoviruses: Mucocutaneous Manifestations, Pathogenesis, Therapeutics, and Prevention (Part I: Papillomaviruses and Merkel cell polyomavirus)
Publication date: Available online 28 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Christopher T. Haley, Uyen Ngoc Mui, Ramya Vangipuram, Peter L. Rady, Stephen K. Tyring
Abstract
In 1964, the first human oncovirus, Epstein-Barr virus (EBV), was identified in Burkitt lymphoma cells. Since then, six other human oncoviruses have been identified: human papillomavirus (HPV), Merkel cell polyomavirus (MCPyV), hepatitis B and C viruses (HBV and HCV), human T-cell lymphotropic virus-1 (HTLV-1), and human herpesvirus-8 (HHV-8). These viruses are causally linked to 12% of all cancers, many of which have mucocutaneous manifestations. Additionally, oncoviruses are associated with multiple benign mucocutaneous diseases. Research regarding the pathogenic mechanisms of oncoviruses as well as virus-specific treatment and prevention is rapidly evolving. Preventative vaccines for HPV and HBV are already available. This review discusses the mucocutaneous manifestations, pathogenesis, diagnosis, treatment, and prevention of oncovirus-related diseases. Part I of the review focuses on diseases associated with HPV and MCPyV, while part II focuses on diseases associated with HBV, HCV, HTLV-1, HHV-8, and EBV.
https://ift.tt/2zsL2LG
Alopecia Areata and Poliosis: A Retrospective Analysis of 258 Cases
Publication date: Available online 28 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Young Bin Lee, Myungsoo Jun, Won-Soo Lee
https://ift.tt/2P1LSUx
A Cross-Sectional Survey and Analysis of Dermatology Foundation Career Development Award Recipients
Publication date: Available online 28 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Chris Boris, George Cotsarelis, Janet A. Fairley, Bruce U. Wintroub, Kim B. Yancey
Abstract
Background
The Dermatology Foundation (DF) has a comprehensive Career Development Award (CDA) Program.
Objective
To assess the impact of this Program, a cross-sectional survey of recipients receiving support between 1990 and 2012 was performed.
Methods
Award recipients completed a questionnaire concerning their career status and record of research funding. To verify self-reported funding data, information about each awardee was extracted from the NIH RePORTER database and used to define funding acquired by CDA recipients.
Results
84% of CDA recipients responded to the survey. 213 awardees (79%) hold full- or part-time positions in academic medicine. Approximately 70% of award recipients in academic medicine have received federal research funding. The NIH RePORTER database and other sources indicated that funding acquired by CDA recipients through 2015 and 2017 was approximately $365.4 M and $451.8 M, respectively. Each dollar of DF CDA funding through 2015 (i.e., $36.2 M) was linked to over $10 of grant support through 2015 and $12 through 2017.
Limitations
This cross-sectional survey was retrospective and (in part) self-reported.
Conclusions
The DF has succeeded in supporting the career development of basic, translational, and clinical investigators and fostered the promotion and retention of these individuals in academic medicine.
https://ift.tt/2zvzQO5
Compulsive exercise in eating disorders: proposal for a definition and a clinical assessment
Abstract
Background
Compulsive exercise has been recognized as a highly prevalent symptom in eating disorders (ED) for over 100 years and is associated with poor short-term and long-term treatment outcome. Progress in understanding and treatment of compulsive exercise will remain limited as long as no consensus framework for definition and assessment of compulsive exercise exists, as results cannot be compared across clinical studies.
Based on existing literature, it was our aim to propose a transdiagnostic definition and a clinical assessment for compulsive exercise, that can be applied to adolescent and adult patients with ED.
Method
During a series of meetings of experienced clinicians at a highly specialized hospital for eating disorders, we elaborated a transdiagnostic definition of compulsive exercise in ED. Additionally, we derived a clinical interview for the assessment of compulsive exercise and its different subtypes.
Results
The core criterion when defining and assessing compulsive exercise is a pathologically increased exercise pattern characterized by 1) excessive exercise that a patient feels driven to perform in response to an obsession or according to rules that must be applied rigidly, and 2) exercise that is aimed at preventing or reducing distress or at preventing some dreaded consequence. A second necessary criterion is the physical or psychological burden caused by compulsive exercise, i.e., that it is time-consuming, significantly interferes with the patient's daily routine, occupational functioning or social relationships or is continued despite medical injury, illness, or lack of enjoyment. Insight that compulsive exercise is excessive or unreasonable was added as an optional criterion.
Compulsive exercise manifests itself in three different subtypes: 1) vigorous exercise, 2) marked increase in daily movement, or 3) motor restlessness.
The above criteria must be met during the past 6 months, together with one of the three subtypes of compulsive exercise.
Conclusions
The proposed criteria aim to foster the discussion around definition and assessment of compulsive exercise with the goal of reaching an international consensus in the near future.
Providing a consistent framework for researchers and clinicians would considerably advance understanding and treatment of compulsive exercise in ED patients.
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GSTP1 gene methylation and AHR rs2066853 variant predict resistance to first generation somatostatin analogs in patients with acromegaly
Abstract
Purpose
Biomarkers of clinical and therapeutic outcome in acromegaly are needed. Polymorphisms or epigenetic changes of detoxification genes, such as those coding for the aryl hydrocarbon receptor (AHR) and the glutathione-S-transferase-P1 (GSTP1), could have a role in GH secreting pituitary tumors' pathophysiology and clinical expression. In this study, we assessed the contribution of GSTP1 gene promoter methylation status, per se or in combination with the occurrence of the AHR gene rs2066853 variant, on clinical features and response to somatostatin analogs (SSA) treatment in acromegaly patients.
Methods
This is an observational, retrospective study, carried out in the Endocrine Unit of an Italian University Hospital. We enrolled 77 wild-type AIP gene acromegaly patients, who have been screened for germline AHR rs2066853 variant and GSTP1 gene promoter methylation. Clinical and biochemical parameters were compared after patients' stratification according to GSTP1 methylation status and the presence of AHR rs2066853. We also evaluated the response to SSA treatment in 71 cases.
Results
17 patients carried the AHR rs2066853 variant and 26 had methylated GSTP1 (GSTP1-methyl) gene promoter. GSTP1-methyl patients showed a higher prevalence of diabetes mellitus (p = 0.01), colonic polyps (p = 0.05), and were more resistant to SSA (p = 0.02) as compared to GSTP1 unmethylated patients (GSTP1-unmethyl). Patients GSTP1-unmethyl and AHR wild-type were the most sensitive to SSA treatment, while those with both GSTP1-methyl and AHR rs2066853 variant were all resistant to SSA (p = 0.01).
Conclusions
In acromegaly, GSTP1 gene methylation associates with resistance to SSA treatment, especially in patients carrying also the AHR rs2066853 variant, and with increased prevalence of colonic polyps and diabetes mellitus.
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