Creating a Great Patient Experience: Improving Care with Food and Nutrition Services

Publication date: Available online 6 April 2017
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Christina Rollins, Stephanie Dobak




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Differences in Mothers’ and Children’s Dietary Intake during Physical and Sedentary Activities: An Ecological Momentary Assessment Study

Publication date: Available online 6 April 2017
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Sydney G. O'Connor, Carol Koprowski, Eldin Dzubur, Adam M. Leventhal, Jimi Huh, Genevieve Fridlund Dunton
BackgroundPhysical activity and diet are major modifiable health behaviors contributing to obesity risk. Although patterns of these behaviors tend to cluster within individuals and within family units, it is unknown to what extent healthy and unhealthy dietary intake might differentially accompany sedentary and physical activities in mothers compared with their children.ObjectiveOur goal was to examine differences in co-occurrence of activities and dietary intake between mothers and children, as measured in real time using ecological momentary assessment.Participants/settingThis study examined cross-sectional data from 175 mothers and their children aged 8 to 12 years.Main outcome measuresParticipants completed 8 days of ecological momentary assessment surveys, reporting on whether the following activities had occurred during the past 2 hours: sedentary screen activity, physical activity, and intake of healthy (ie, fruits and vegetables) and unhealthy (ie, fast food, chips/fries, pastries/sweets, and soda/energy drinks) foods.Statistical analyses performedMultilevel logistic regression models estimated the adjusted odds of consuming healthy and unhealthy dietary intake for mothers and children during time periods reporting physical activity (vs no physical activity) or sedentary screen activity (vs no sedentary screen activity). Post hoc tests compared estimates for mothers vs children.ResultsChildren were significantly more likely than their mothers to consume unhealthy foods during 2-hour windows that included physical activity (odds ratio [children] 1.85, 95% CI 1.47 to 2.31; odds ratio [mothers] 0.83, 95% CI 0.58 to 1.20; Pdiff <0.05), but not sedentary screen activity (Pdiff=0.067). In addition, children and their mothers did not differ in their likelihood of consuming healthy foods during 2-hour windows with sedentary screen activity (Pdiff =0.497) or physical activity (Pdiff =0.170).ConclusionsResults indicate that the consumption of unhealthy foods may be more likely to co-occur within a 2-hour window including physical activity in children as compared to their mothers. Future research should examine reasons for this difference, and potential areas for intervention.



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Contrasting effects of nitrogen addition on soil respiration in two Mediterranean ecosystems

Abstract

Increased atmospheric nitrogen (N) deposition is known to alter ecosystem carbon source-sink dynamics through changes in soil CO₂ fluxes. However, a limited number of experiments have been conducted to assess the effects of realistic N deposition in the Mediterranean Basin, and none of them have explored the effects of N addition on soil respiration (R _s ). To fill this gap, we assessed the effects of N supply on R _s dynamics in the following two Mediterranean sites: Capo Caccia (Italy), where 30 kg ha⁻¹ year⁻¹ was supplied for 3 years, and El Regajal (Spain), where plots were treated with 10, 20, or 50 kg N ha⁻¹ year⁻¹ for 8 years. Results show a complex, non-linear response of soil respiration (R _s ) to N additions with R _s overall increasing at Capo Caccia and decreasing at El Regajal. This suggests that the response of R _s to N addition depends on dose and duration of N supply, and the existence of a threshold above which the N introduced in the ecosystem can affect the ecosystem's functioning. Soil cover and seasonality of precipitations also play a key role in determining the effects of N on R _s as shown by the different responses observed across seasons and in bare soil vs. the soil under canopy of the dominant species. These results show how increasing rates of N addition may influence soil C dynamics in semiarid ecosystems in the Mediterranean Basin and represent a valuable contribution for the understanding and the protection of Mediterranean ecosystems.

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Estrogen receptor beta mediates hepatotoxicity induced by perfluorooctane sulfonate in mouse

Abstract

Perfluorooctane sulfonate (PFOS), an artificial fluorosurfactant and global contaminant, is used widely in various consumer products. In this study, we investigated the function of estrogen receptor β (ERβ) in PFOS-induced bile acid and cholesterol metabolism disorders and gut microbiome using ERβ knockout mice that were exposed to PFOS by gavage. Our results showed that a daily dose of 5 mg PFOS/kg significantly induced hydropic degeneration and vacuolation in hepatic cells, reduced bile acid, and cholesterol levels in liver tissue, and influenced the abundance and composition of gut microbiota. Notably, ERβ deficiency not only ameliorated morphological alterations of hepatocytes but also relieved disorders in bile acids and cholesterol metabolism caused by PFOS. Furthermore, the changes in the gut microbiome by PFOS were also modulated. The relative transcript abundance of key genes involved in bile acid and cholesterol metabolism exhibited similar changes. In HepG2 cells, PFOS increased ERβ expression, which could be blocked by adding PHTPP (a selective antagonist of ERβ). Our study thus provides new evidence that ERβ mediates PFOS-induced hepatotoxicity.

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Long-term simulated nitrogen deposition alters the plant cover dynamics of a Mediterranean rosemary shrubland in Central Spain through defoliation

Abstract

Nitrogen (N) deposition due to anthropogenic pollution is a major driver of the global biodiversity loss. We studied the effect of experimental N and phosphorus (P) fertilization (0, 10, 20, and 50 kg N ha⁻¹ year⁻¹ and 14 kg P ha⁻¹ year⁻¹ over the background deposition levels) on plant cover dynamics of a rosemary (Rosmarinus officinalis L.) shrubland after 8 years of nutrient addition in a semiarid Mediterranean ecosystem from Central Spain. We specifically aimed at testing whether N deposition has the potential to influence the observed expanding trend of woody vegetation into areas dominated by grassland, biological soil crusts, and bare soil. Our results show that N addition loads above 10 kg N ha⁻¹ year⁻¹ reverted the cover dynamics of shrubs. Under N addition conditions, N was no longer a limiting nutrient and other elements, especially P and calcium, determined the seasonal growth of young twigs. Interestingly, N fertilization did not inhibit the growth of young shoots; our estimates point to a reduced rosemary leaf lifespan that is driving individuals to death. This may be triggered by long-term accumulation of N compounds in leaves, suggesting the need to consider the old organs and tissues in long-lived perennial plants, where N toxicity effects could be more mediated by accumulation processes. Shrublands are a widely distributed ecosystem type in biodiverse Mediterranean landscapes, where shrubs play a key role as nurse plants. Therefore, the disappearance of shrublands may accelerate the biodiversity loss associated with other global change drivers, hamper the recruitment of seedlings of woody species, and, as a consequence, accelerate desertification.

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Long-term broiler litter amendments can alter the soil’s capacity to sorb monensin

Abstract

Monensin is a common antiparasitic drug given to poultry that contaminates poultry manure and bedding material (broiler litter). As broiler litter is commonly applied to agricultural fields as fertilizer, monensin could be released beyond the farm if it is not retained or degraded in the soil. This study aimed to assess the impact of long-term surface application of broiler litter (i.e., 17 years) on the capacity of pasture soil to sorb monensin. The soils were exposed to a range of monensin concentrations (0.18 to 1.81 μmol L⁻¹), solution pH (pH 4–9), and temperatures (15, 25, and 35 °C) and monensin was measured as loss from solution (i.e., sorption). Soils receiving long-term litter applications were hypothesized to retain more monensin than unamended soils because they have higher organic matter concentrations. However, soils from broiler litter-amended fields sorbed 46% less monensin than soils from unamended fields, likely because broiler litter also increased soil pH. The sorption of monensin to soil was strongly influenced by pH, with an order of magnitude greater sorption at pH 4 than at pH 9. Both soils had similar capacity to sorb monensin under similar solution pH, despite differences in organic carbon content (with the broiler litter-amended having 25% greater relative to the unamended soil). Temperature did not significantly impact monensin sorption for either soil. Our findings suggest increasing soil pH, for instance through liming, could enhance mobility of monensin.

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Environmental analysis of a potential district heating network powered by a large-scale cogeneration plant

Abstract

Among the solutions for the achievement of environmental sustainability in the energy sector, district heating (DH) with combined heat and power (CHP) systems is increasingly being used. The Italian city of Turin is in a leading position in this field, having one of the largest DH networks in Europe. The aim of this work is the analysis of a further development of the network, addressed to reduce the presence of pollutants in a city that has long been subject to high concentration levels. The environmental compatibility of this intervention, especially in terms of nitrogen oxides (NO_x) and particulate matter (PM) emissions, is evaluated. The pollutants dispersion is estimated using the CALPUFF model. The forecasting scenario is created firstly by simulating the energy production of the main generation plants in response to the estimated heat demand, and secondly by investigating the amount and the dispersion of pollutants removed due to the elimination of the centralized residential heaters. The results show a future reduction in ground level average NO_x concentration ranging between 0.2 and 4 μg/m³. The concentration of PM remains almost unchanged. Measures are then taken to lower the uncertainty in the simulation scenarios. This study provides important information on the effects of a change of the energy configuration on air quality in an urban area. The proposed methodological approach is comprehensive and repeatable.

http://ift.tt/2o3NpO7

Effect of earthworms on growth, photosynthetic efficiency and metal uptake in Brassica juncea L. plants grown in cadmium-polluted soils

Abstract

The present study has been carried out to examine the role of earthworms in phytoremediation of Cd and its effect on growth, pigment content, expression of genes coding key enzymes of pigments, photosynthetic efficiency and osmoprotectants in Brassica juncea L. plants grown under cadmium (Cd) metal stress. The effect of different Cd concentrations (0.50, 0.75, 1.0, 1.25 mM) was studied in 30 and 60-day-old plants grown in soils containing earthworms. It was observed that earthworm inoculation showed stimulatory effect on phytoremediation capacity and Cd uptake has increased by 49% (in 30-day-old plants) and 35% (in 60-day-old plants) in shoots and 13.3% (in 30-day-old plants) and 10% (in 60-day-old plants) in roots in 30 and 60-day-old plants in Cd (1.25 mM) treatments. Plant growth parameters such as root and shoot length, relative water content and tolerance index were found to increase in the presence of earthworms. Recovery in photosynthetic pigments (chlorophyll and carotenoid) and gas exchange parameters, i.e. net photosynthetic rate (P _n ), stomatal conductance (G _s ), intercellular CO₂ concentration (C _i ) and transpiration rate (E _t ), was observed after earthworm's supplementation. Modulation in expression of key enzymes for pigment synthesis, i.e. chlorophyllase, phytoene synthase, chalcone synthase and phenylalanine ammonia lyase, was also observed. The results of our study revealed that earthworms help to mitigate the toxic effects produced by Cd on plant growth and photosynthetic efficiency along with enhanced phytoremediation capacity when co-inoculated with Cd in soil.

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Soil physicochemical factors as environmental filters for spontaneous plant colonization of abandoned tailing dumps

Abstract

Abandoned tailing dumps (ATDs) offer an opportunity to identify the main physicochemical filters that determine colonization of vegetation in solid mine wastes. The current study determined the soil physicochemical factors that explain the compositional variation of pioneer vegetal species on ATDs from surrounding areas in semiarid Mediterranean-climate type ecosystems of north-central Chile (Coquimbo Region). Geobotanical surveys—including physicochemical parameters of substrates (0–20 cm depth), plant richness, and coverage of plant species—were performed on 73 ATDs and surrounding areas. A total of 112 plant species were identified from which endemic/native species (67%) were more abundant than exotic species (33%) on ATDs. The distribution of sampling sites and plant species in canonical correspondence analysis (CCA) ordination diagrams indicated a gradual and progressive variation in species composition and abundance from surrounding areas to ATDs because of variations in total Cu concentration (1.3%) and the percentage of soil particles <2 μm (1.8%). According to the CCA, there were 10 plant species with greater abundance on sites with high total Cu concentrations and fine-textured substrates, which could be useful for developing plant-based stabilization programs of ATDs in semiarid Mediterranean-climate type ecosystems of north-central Chile.

http://ift.tt/2o8NrFM

Effect of salinity stress on growth, lipid productivity, fatty acid composition, and biodiesel properties in Acutodesmus obliquus and Chlorella vulgaris

Abstract

Two microalgae strains including Chlorella vulgaris and Acutodesmus obliquus were grown on BG11 medium with salinity stress ranging from 0.06 to 0.4 M NaCl. Highest lipid content in C. vulgaris and A. obliquus was 49 and 43% in BG11 amended with 0.4 M NaCl. The microalgal strains C. vulgaris and A. obliquus grow better at 0.06 M NaCl concentration than control condition. At 0.06 M NaCl, improved dry biomass content in C. vulgaris and A. obliquus was 0.92 and 0.68 gL⁻¹, respectively. Stress biomarkers like reactive oxygen species, antioxidant enzyme catalase, and ascorbate peroxidase were also lowest at 0.06 M NaCl concentration revealing that both the microalgal strains are well acclimatized at 0.06 M NaCl concentration. The fatty acid composition of the investigated microalgal strains was also improved by increased NaCl concentration. At 0.4 M NaCl, palmitic acid (37%), oleic acid (15.5%), and linoleic acid (20%) were the dominant fatty acids in C. vulgaris while palmitic acid (54%) and stearic acid (26.6%) were major fatty acids found in A. obliquus. Fatty acid profiling of C. vulgaris and A. obliquus significantly varied with salinity concentration. Therefore, the study showed that salt stress is an effective stress that could increase not only the lipid content but also improved the fatty acid composition which could make C. vulgaris and A. obliquus potential strains for biodiesel production.

http://ift.tt/2o46ShC

Interaction of TiO 2 nanoparticles with proteins from aquatic organisms: the case of gill mucus from blue mussel

Abstract

To better understand the mechanisms of TiO₂ nanoparticle (NP) uptake and toxicity in aquatic organisms, we investigated the interaction of NPs with the proteins found in gill mucus from blue mussels. Mucus is secreted by many aquatic organisms and is often their first line of defense against pathogens, xenobiotics, and other sources of environmental stress. Here, five TiO₂ NPs and one SiO₂ NP were incubated with gill mucus and run out on a one-dimensional polyacrylamide gel for a comparative qualitative analysis of the free proteins in the mucosal solution and the proteins bound to NPs. We then used nanoscale liquid chromatography coupled with tandem mass spectrometry to identify proteins of interest. Our data demonstrated dissimilar protein profiles between the crude mucosal solution and proteins adsorbed on NPs. In particular, extrapallial protein (EP), one of the most abundant mucus proteins, was absent from the adsorbed proteins. After thermal denaturation experiments, this absence was attributed to the EP content in aromatic amino acids that prevents protein unfolding and thus adsorption on the NP. Moreover, although the majority of the protein corona was qualitatively similar across the NPs tested here (SiO₂ and TiO₂), a few proteins in the corona showed a specific recruitment pattern according to the NP oxide (TiO₂ vs SiO₂) or crystal structure (anatase TiO₂ vs rutile TiO₂). Therefore, protein adsorption may vary with the type of NP.

Graphical abstract

Proteins with adsorption selectivity as identified from isolated bands

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Alleviative effect of selenium on inflammatory damage caused by lead via inhibiting inflammatory factors and heat shock proteins in chicken testes

Abstract

The aim of this study was to investigate ameliorative effect of selenium (Se) on lead (Pb)-induced inflammatory damage in chicken testes. One hundred eighty 7-day-old male chickens were randomly assigned into the control group, the Se group, the Pb group, and the Pb/Se group. Lead acetate was added in drinking water (350 mg/L Pb). Sodium selenite was added in the standard commercial diet (1 mg/kg Se). On the 30th, 60th, and 90th days of the experiment, 15 chickens of each group were euthanized. Inductively coupled plasma mass spectrometry, hematoxylin and eosin staining, real-time quantitative PCR, and Western blot were used. The results indicated that excess Pb increased nitric oxide content; inducible nitric oxide synthase (iNOS) activity; nuclear factor-kappa B (NF-κB), tumor necrosis factor-α, cyclooxygenase-2, prostaglandin E synthases, and iNOS mRNA levels in a time-dependent manner; NF-κB, iNOS, heat shock protein (HSP) 60, HSP70, and HSP90 protein levels; and Pb concentration. Excess Pb decreased Se concentration and induced histological changes. Se-alleviated Pb caused all of the above changes. Se improved Pb-caused inflammatory damage by decreasing the expression of inflammatory factors and heat shock proteins in the chicken testes. Our results provided theoretical basis of an alleviative effect of Se on Pb-induced bird testis damage.

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Photosynthetic pigments and peroxidase activity of Lepidium sativum L. during assisted Hg phytoextraction

Abstract

The study was conducted to evaluate metabolic answer of Lepidium sativum L. on Hg, compost, and citric acid during assisted phytoextraction. The chlorophyll a and b contents, total carotenoids, and activity of peroxidase were determined in plants exposed to Hg and soil amendments. Hg accumulation in plant shoots was also investigated. The pot experiments were provided in soil artificially contaminated by Hg and/or supplemented with compost and citric acid. Hg concentration in plant shoots and soil substrates was determined by cold vapor atomic absorption spectroscopy (CV-AAS) method after acid mineralization. The plant photosynthetic pigments and peroxidase activity were measured by standard spectrophotometric methods. The study shows that L. sativum L. accumulated Hg in its aerial tissues. An increase in Hg accumulation was noticed when soil was supplemented with compost and citric acid. Increasing Hg concentration in plant shoots was correlated with enhanced activation of peroxidase activity and changes in total carotenoid concentration. Combined use of compost and citric acid also decreased the chlorophyll a and b contents in plant leaves. Presented study reveals that L. sativum L. is capable of tolerating Hg and its use during phytoextraction assisted by combined use of compost and citric acid lead to decreasing soil contamination by Hg.

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Antimicrobial activity of aqueous extracts from four plants on bacterial isolates from periodontitis patients

Abstract

Four aqueous extracts of different plant organs are the following: Artemisia herba-alba, Opuntia ficus-indica, Camellia sinensis and Phlomis crinita were evaluated against two bacterial strains: Porphyromonas gingivalis and Prevotella intermedia, which are implicated in periodontal diseases. By using a disc method, these plant extracts demonstrated powerful bacterial activity against these Gram-negative strains. The minimum inhibitory concentration values of the four plant extracts varied between 0.03 and 590.82 mg/ml for the microbes. Another assay using commercial antibiotics and antibacterials as positive controls was also conducted. Values obtained after statistical analysis of inhibition diameters of all plant extracts demonstrated that for P. gingivalis, the aqueous extracts of A. herba-alba and O. ficus-indica were most effective, followed by those of C. sinensis and P. crinita. For P. intermedia, aqueous extracts of O. ficus-indica and C. sinensis appeared to be more efficient with significantly different (P > 0.05) inhibition diameters, followed by those of O. ficus-indica and P. crinita. In summary, the statistical results reveal that these plant extracts exert stronger antibacterial activity on P. intermedia germ as compared to P. gingivalis.

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Cheap non-toxic non-corrosive method of glass cleaning evaluated by contact angle, AFM, and SEM-EDX measurements

Abstract

Glass surface cleaning is the very first step in advanced coating deposition and it also finds use in conserving museum objects. However, most of the wet chemical methods of glass cleaning use toxic and corrosive chemicals like concentrated sulfuric acid (H₂SO₄), piranha (a mixture of concentrated sulfuric acid and 30% hydrogen peroxide), and hydrogen fluoride (HF). On the other hand, most of the dry cleaning techniques like UV-ozone, plasma, and laser treatment require costly instruments. In this report, five eco-friendly wet chemical methods of glass cleaning were evaluated in terms of contact angle (measured by optical tensiometer), nano-scale surface roughness (measured by atomic force microscopy or AFM), and elemental composition (measured by energy dispersive x-ray spectroscopy or SEM-EDX). These glass cleaning methods are devoid of harsh chemicals and costly equipment, hence can be applied in situ in close proximity with plantation such as greenhouse or upon subtle objects such as museum artifacts. Out of these five methods, three methods are based on the chemical principle of chelation. It was found that the citric acid cleaning method gave the greatest change in contact angle within the hydrophilic regime (14.25° for new glass) indicating effective cleansing and the least surface roughness (0.178 nm for new glass) indicating no corrosive effect. One of the glass sample showed unique features which were traced backed to the history of the glass usage.

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Mantle Cell Lymphoma: Contemporary Diagnostic and Treatment Perspectives in the Age of Personalized Medicine

Publication date: Available online 6 April 2017
Source:Hematology/Oncology and Stem Cell Therapy
Author(s): Jose Sandoval-Sus, Eduardo M. Sotomayor, Bijal D. Shah
Mantle cell lymphoma is a clinically heterogeneous disease occurring within a heterogeneous patient population, highlighting a need for personalized therapy to ensure optimal outcomes. It is therefore critical to understand the benefits and risks associated with both intensive and deintensified approaches. In the following review we provide a therapeutic roadmap to strategically guide treatment for newly diagnosed and relapsed/refractory patients highlighting pivotal and recently published results involving known and novel therapies.



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Busulfan Drug Monitoring is Needed in Patients Undergoing Allogeneic Stem Cell Transplantation

Publication date: Available online 6 April 2017
Source:Hematology/Oncology and Stem Cell Therapy
Author(s): Bushra Salman, Mohammed Al-Zaabi, Mohammed Al-Huneini, David Dennison, Abdulhakeem Al-Rawas, Salam Al-Kindi, Khalil Al-Farsi, Melanie Tauro, Murtadha Al-Khabori
Busulfan (Bu)-based preparative regimens in hematopoietic stem cell transplantation are commonly used. Previous studies have shown that Bu at a fixed dose of 3.2 mg/kg/day (FBD) given intravenously decreases variability in drug pharmacokinetics and this decreases the dependency on therapeutic drug monitoring (TDM) of Bu. We compared the Bu dose given using TDM with the FBD of 3.2 mg/kg/day. Seventy-three patients with acute leukemia, myelodysplasia, chronic myeloid leukemia, thalassemia major, and sickle cell disease were included. The mean age at transplant was 15 years (range 2–55 years) with 57% adults. Indication for transplantation was leukemia/myelodysplastic syndrome in 46% of the patients, while the remaining 54% were transplanted for inherited blood disorders. We found that the median FBD was lower than the median TDM dose by 39 mg/day with a statistically significant difference (p < .001) even after adjusting for the weight (median total FBD of 349 mg, median TDM dose of 494 mg, p < .0001). Age and underlying condition (malignant vs. nonmalignant) were the main factors affecting Bu clearance (p < .001 and p < .07, respectively). TDM remains an important tool for the appropriate dosing of Bu in preparative regimens of hematopoietic stem cell transplantation, especially in populations with genetic admixture.



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Hydroxyurea For Non-Transfusion Dependent β-Thalassemia: A Systematic Review and Meta-Analysis

Publication date: Available online 6 April 2017
Source:Hematology/Oncology and Stem Cell Therapy
Author(s): Ali H. Algiraigri, Nicola A.M. Wright, Elizabeth Oddone Paolucci, Aliya Kassam
Nontransfusion-dependent β-thalassemia (NTDβT) syndromes consist of β-thalassemia intermedia and moderate hemoglobin E/β thalassemias. They are characterized by varying degrees of chronic anemia and a wide spectrum of complications due to ineffective erythropoiesis and iron overload from chronic transfusions. Hydroxyurea (HU), an oral chemotherapeutic drug, is anticipated to decrease disease severity. We performed a meta-analysis to evaluate the clinical efficacy and safety of HU in NTDβT patients of any age. MEDLINE, EMBASE, Cochrane databases, and major conference proceedings for studies that assessed HU in NTDβT patients were searched. Qualities of eligible studies were assessed by National Institutes of Health tools. Seventeen studies, collectively involving 709 patients, fulfilled the eligibility criteria. HU was associated with a significant decrease in transfusion need in severe NTDβT with complete and overall (≥ 50%) response rates of 42% and 79%, respectively. For mild NTDβT, HU was effective in raising hemoglobin by 1 g/L in 64% of patients. HU appears to be effective, well tolerated, and associated with mild and transient adverse events. NTDβT patients may benefit from a trial of HU, although large randomized clinical trials assessing its efficacy should be conducted to confirm the findings of this meta-analysis and to assess its long-term toxicity and response sustainability.



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“Metabolic and cardiovascular response to exercise in patients with type 1 diabetes”

Abstract

Purpose

Physical activity is an effective therapeutic tool for cardiovascular risk prevention. However, exercise aerobic capacity of patients with type 1 diabetes (T1DM) has not been thoroughly investigated. Aim of the present study is to evaluate exercise aerobic capacity in patients with T1DM compared to a normal control population.

Methods

This observational study included 17 T1DM patients and 17 matched healthy volunteers. Cardiopulmonary exercise test (CPET) was conducted on an electronically-braked cycle ergometer. Blood samples were collected for evaluation of glycemia and lactate levels.

Results

Mean oxygen uptake at peak exercise (VʹO_2,peak) was significantly lower in T1DM subjects (V′O_2,peak T1DM 2200 ± 132ml/min vs VʹO_2,peak Healthy subjects of 2659 ± 120 ml/min p = 0.035). Cardiovascular response analysis did not show statistically significant differences. Respiratory exchange ratio (RER) was significantly higher in healthy subjects at peak exercise and at the first minute of recovery (p = 0.022, p = 0.024). Peak exercise lactate levels were significantly higher in healthy subjects. There was no statistical correlation between CPET results and diabetes-related parameters.

Conclusions

Patients affected by T1DM have a worse exercise tolerance than normal subjects. The two groups differed by RER which can be greatly influenced by the substrate type utilized to produce energy. Because of the impaired carbohydrate utilization, T1DM subjects may use a larger amount of lipid substrates, such hypothesis could be strengthened by the lower lactate levels found in T1DM group at peak exercise. The lack of correlation between exercise tolerance and disease-related variables suggests that the alterations found could be independent from the glycemic levels.

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Design and optimization of a biodegradable porous zein conduit using microtubes as a guide for rat sciatic nerve defect repair

Publication date: July 2017
Source:Biomaterials, Volume 131
Author(s): Guo-Wu Wang, Hui Yang, Wei-Feng Wu, Ping Zhang, Jin-Ye Wang
Various degradable biomaterials have been used to bridge injured peripheral nerve defect; however, drawbacks such as poor mechanical properties, inappropriate degradation rate, and toxic degradation products continue to limit the application of them in nerve repair. Considering the unique properties of zein, such as its biocompatibility, biodegradability and ease of fabrication, we report the use of zein conduits to repair injured rat sciatic nerves with a 10-mm defect. Three-dimensional zein conduits were designed with/without pores, and with/without microtubes including in the lumen of conduits. Zein conduit with microtubes yielded satisfactory results in sciatic function index (SFI), proximal compound muscle action potentials, density of myelinated nerve fibres and myelin thickness, which were not inferior to autograft but slightly superior to the hollow conduit at the 4th month post-implantation. The conduits degraded almost completely within two months, which was shorter than the suggested period of four months. Thus, the use of a porous conduit with microtubes inside as the guidance may play important roles in successful repair. Notably, the regulatory body will more likely approve designs employing a single component, such as the natural polymer zein.

Graphical abstract

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Partial anomalous pulmonary venous return: Scimitar vein

Timothy Heinke, Scott R Stewart, Toby Steinberg, William R Hand, James H Abernathy

Annals of Cardiac Anaesthesia 2017 20(2):259-261

Scimitar syndrome is a rare association of congenital cardiopulmonary anomalies characterized by partial anomalous pulmonary venous return, in which an abnormal right pulmonary vein drains into the inferior vena cava. This case exemplifies the role of transesophageal echocardiography in perioperative management and surgical decision-making.

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High blood tacrolimus and hyperkalemia in a heart transplant patient

Manoj Kumar Sahu, Sarvesh Pal Singh, Anupam Das, Atul Abraham, Balram Airan, Intekhab Alam, Ramesh Menon, V Devagourou, Anish Gupta

Annals of Cardiac Anaesthesia 2017 20(2):270-271



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Anger: An enemy of heart, raj yoga meditation is heart friendly

Usha Kiran, Suruchi Ladha

Annals of Cardiac Anaesthesia 2017 20(2):127-128



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Inverted left atrial appendage masquerading as a left atrial mass

Suresh Kumaran, Gladdy George, AV Varsha, Raj Sahajanandan

Annals of Cardiac Anaesthesia 2017 20(2):248-249

An inverted left atrial appendage after cardiac surgery is a rare finding and can be misinterpreted as a thrombus, mass, or vegetation. We report a case where intraoperative transesophageal echocardiography assisted in making an accurate diagnosis.

http://ift.tt/2o3I0X5

Artificial intelligence in mitral valve analysis

Jelliffe Jeganathan, Ziyad Knio, Yannis Amador, Ting Hai, Arash Khamooshian, Robina Matyal, Kamal R Khabbaz, Feroze Mahmood

Annals of Cardiac Anaesthesia 2017 20(2):129-134

Background: Echocardiographic analysis of mitral valve (MV) has become essential for diagnosis and management of patients with MV disease. Currently, the various software used for MV analysis require manual input and are prone to interobserver variability in the measurements. Aim: The aim of this study is to determine the interobserver variability in an automated software that uses artificial intelligence for MV analysis. Settings and Design: Retrospective analysis of intraoperative three-dimensional transesophageal echocardiography data acquired from four patients with normal MV undergoing coronary artery bypass graft surgery in a tertiary hospital. Materials and Methods: Echocardiographic data were analyzed using the eSie Valve Software (Siemens Healthcare, Mountain View, CA, USA). Three examiners analyzed three end-systolic (ES) frames from each of the four patients. A total of 36 ES frames were analyzed and included in the study. Statistical Analysis: A multiple mixed-effects ANOVA model was constructed to determine if the examiner, the patient, and the loop had a significant effect on the average value of each parameter. A Bonferroni correction was used to correct for multiple comparisons, and P = 0.0083 was considered to be significant. Results: Examiners did not have an effect on any of the six parameters tested. Patient and loop had an effect on the average parameter value for each of the six parameters as expected (P < 0.0083 for both). Conclusion: We were able to conclude that using automated analysis, it is possible to obtain results with good reproducibility, which only requires minimal user intervention.

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Erratum: Percutaneous tracheostomy in patients on anticoagulants

Annals of Cardiac Anaesthesia 2017 20(2):282-282



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Forbidden word entropy of cerebral oximetric values predicts postoperative neurocognitive decline in patients undergoing aortic arch surgery under deep hypothermic circulatory arrest

Anna Dubovoy, Peter Chang, Carol Persad, Wei Lau, Elizabeth Jewell, Daniel Cox, Milo Engoren

Annals of Cardiac Anaesthesia 2017 20(2):135-140

Purpose: Up to 53% of cardiac surgery patients experience postoperative neurocognitive decline. Cerebral oximetry is designed to detect changes in cerebral tissue saturation and therefore may be useful to predict which patients are at risk of developing neurocognitive decline. Methods: This is a retrospective analysis of a prospective study originally designed to determine if treatment of cerebral oximetry desaturation is associated with improvement in postoperative cognitive dysfunction in patients undergoing aortic reconstruction under deep hypothermic circulatory arrest. Cognitive function was measured, preoperatively and 3 months postoperatively, with 15 neuropsychologic tests administered by a psychologist; the individual test scores were summed and normalized. Bilateral cerebral oximetry data were stored and analyzed using measures of entropy. Cognitive decline was defined as any decrease in the summed normalized score from baseline to 3 months. Results: Seven of 17 (41%) patients suffered cognitive decline. There was no association between baseline cerebral oximetry and postoperative cognitive dysfunction. Nor were changes in oximetry values associated with cognitive decline. However, cognitive decline was associated with loss of forbidden word entropy (FwEn) (correlation: Rho ρ = 0.51, P = 0.037 for left cerebral oximetry FwEn and ρ = 0.54, P = 0.025 for right cerebral oximetry FwEn). Conclusion: Postoperative cognitive decline was associated with loss of complexity of the time series as shown by a decrease in FwEn from beginning to end of the case. This suggests that regulation of cerebral oximetry is different between those who do and those who do not develop cognitive decline.

http://ift.tt/2o3Cioh

An analysis of the factors producing multiple ventricular arrhythmias during pulmonary artery catheterization

Hajime Satoh, Yuka Miyata, Tomohiko Hayasaka, Tsutomu Wada, Yukio Hayashi

Annals of Cardiac Anaesthesia 2017 20(2):141-144

Background: The development of arrhythmias during placement of a pulmonary artery catheter (PAC) is common. Aims: This study was designed to examine factors influencing development of ventricular arrhythmias in adult patients undergoing cardiovascular operations during the catheter placement. Settings and Designs: Prospective, observational, cohort study. Methods: We prospectively studied 174 patients undergoing cardiovascular operations. A PAC was inserted through the right internal jugular vein by staff anesthesiologists. Electrocardiography tracings were recorded as the catheter was advanced from the right atrium to the pulmonary artery. Arrhythmias were classified as absent, single, or multiple (two or more consecutive) ventricular arrhythmias. We examined risk factors to produce ventricular arrhythmias during the placement. Statistical Analysis: The data were analyzed using logistic regression analysis to assess factors for the occurrence of ventricular arrhythmias after univariate analyses. Results: Ventricular arrhythmias (single and multiple) occurred in 149 patients (85.6%) and multiple arrhythmias were observed in 78 patients (44.8%). There were no factors to facilitate the ventricular arrhythmias (single and multiple), whereas it showed that valvular diseases (P = 0.049) and the placement time (P < 0.001) are significant factors to produce multiple arrhythmias. Conclusion: Both valvular diseases and long placement time were significant risk factors to produce multiple ventricular arrhythmias during placement of a PAC.

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Importance of 3D real time perioperative tee in ASD device embolisation

MS Sarvana Babu, Neelam Aggarwal, A Asha, Digraje Sunita Ashok, Thomas Koshy

Annals of Cardiac Anaesthesia 2017 20(2):278-278



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Carotid artery disease and periprocedural stroke risk after transcatheter aortic valve implantation

Parthasarathy D Thirumala, Sruthi Muluk, Reshmi Udesh, Amol Mehta, John Schindler, Suresh Mulukutla, Vinodh Jeevanantham, Lawrence Wechsler, Thomas Gleason

Annals of Cardiac Anaesthesia 2017 20(2):145-151

Objective/Background: To examine the role of carotid stenosis (CS) and other independent risk factors of perioperative stroke, following transcatheter aortic valve implantation (TAVI). Materials and Methods: Using data from the National Inpatient Sample database for analysis, patients who underwent TAVI were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Various preoperative and perioperative risk factors and their association with perioperative strokes were studied. Results: Data on 7566 patients who underwent a TAVI procedure from 2012 to 2013 were extracted. The average age of the patient population was 81.2 ± 0.32 years. The overall perioperative stroke rate in our patient cohort was 2.79%. Majority (94.6%) of the strokes were ischemic. Multivariate analysis showed the following independent risk factors for perioperative strokes after TAVI: female gender odds ratio (OR) = 2.25 (95% confidence interval [CI], 1.42–3.57), higher van Walraven score OR = 6.6 (95% CI = 3.71–11.73), bilateral CS OR = 4.46 (95% CI = 2.03–9.82), and TAVI with a cardiac procedure done under cardiopulmonary bypass OR = 2.84 (95% CI = 1.57–5.14). Conclusion: Bilateral carotid disease is a significant risk factor for perioperative strokes following TAVI. Preoperative screening with carotid Doppler to identify high-risk patients appears to be warranted. In addition, patients of female gender were found to have an increased risk for carotid disease.

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Transthoracic echocardiography versus transesophageal echocardiography for rupture sinus of Valsalva aneurysm

Ira Dhawan, Vishwas Malik, Kamal Prakash Sharma, Neeti Makhija, Neha Pangasa

Annals of Cardiac Anaesthesia 2017 20(2):245-246

We report a rare case of sinus of Valsalva aneurysm of both right and left coronary sinus (LCS), with perforation of the LCS opening into the left ventricle. The LCS aneurysm with its perforation was undiagnosed on transthoracic echocardiography emphasizing the role of transesophageal echocardiography in delineating the anatomy.

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Impact of dexmedetomidine on hemodynamic changes during and after coronary artery bypass grafting

Morteza Hashemian, Mehdi Ahmadinejad, Seyed Amir Mohajerani, Alireza Mirkheshti

Annals of Cardiac Anaesthesia 2017 20(2):152-157

Objective: To determine the effect of dexmedetomidine (Dex) on hemodynamic changes during cardiopulmonary pump and postoperative period in coronary artery bypass grafting (CABG). Methods and Design: This study is designed as a double-blinded, randomized clinical trial. Setting: University hospital and single center. Participants: patients candidate for elective CABG. Intervention: Dex 0.5 μg/kg/h or placebo was infused from the initiation of anesthesia up to extubation in Intensive Care Unit (ICU). Measurements: Heart rate (HR) and blood pressure (BP), pain score, and total morphine dose requirement were monitored and compared during cardiac pump up to 12 h postoperative in ICU. Results: Mean arterial pressure was significantly higher in Dex group in postoperation period at 1 (P = 0.010) and 2 h (P = 0.002) compared to control group. HR was significantly lower in Dex group in postcardiopulmonary bypass (CPB) time at 0 h (P = 0.001), 1 h (P = 0.0016), and 2 h (P = 0.001), and then in postoperative period in ICU at 1 h (P = 0.025), 2 h (P = 0.0012), and 4 h (P = 0.0025) compared to control group. Postoperative pain score was significantly lower during 12 h after surgery. Conclusion: Dex could effectively blunt hemodynamic response to surgical stress, particularly during CPB pump and afterward. Infusion of Dex maintains BP at higher range and HR at lower range compared to placebo.

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Mechanical cause for acute left lung atelectasis after neonatal aortic arch repair with arterial switch operation: Conservative management

Madan Mohan Maddali, Pranav Subbaraya Kandachar, Said Al-Hanshi, Mohammed Al Ghafri, John Valliattu

Annals of Cardiac Anaesthesia 2017 20(2):252-255

Respiratory complications due to mechanical obstruction of the airways can occur following pediatric cardiac surgery. Clinically significant intrathoracic vascular compression of the airway can occur when extensive dissection and mobilization of arch and neck vessels is involved as in repair of interrupted aortic arch. This case report describes a neonate who underwent interrupted aortic arch repair along with an arterial switch operation and developed a left lung collapse immediately after tracheal extubation. Fiber-optic bronchoscopy revealed vascular compression as the real culprit. The child was successfully managed conservatively.

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The role of Rajyoga meditation for modulation of anxiety and serum cortisol in patients undergoing coronary artery bypass surgery: A prospective randomized control study

Usha Kiran, Suruchi Ladha, Neeti Makhija, Poonam Malhotra Kapoor, Minati Choudhury, Sambhunath Das, Parag Gharde, Vishwas Malik, Balram Airan

Annals of Cardiac Anaesthesia 2017 20(2):158-162

Introduction: Rajyoga meditation is a form of mind body intervention that is promoted by the Brahma Kumaris World Spiritual University. This form of meditation can be easily performed without rituals or mantras and can be practiced anywhere at any time. The practice of Rajyoga meditation can have beneficial effects on modulating anxiety and cortisol level in patients undergoing major cardiac surgery. Materials and Methods: A prospective randomized control study was carried out in a single tertiary care center. One hundred and fifty patients undergoing elective coronary artery bypass surgery were enrolled in the study. The patients were randomized in two groups namely, Group 1 (Rajyoga group) and Group 2 (Control Group). Anxiety was measured on a visual analog scale 1–10 before the start of Rajyoga training or patient counseling (T1), on the morning of the day of surgery (T2), on the 2nd postoperative day (T3), and on the 5th postoperative day (T4). The serum cortisol level was measured in the morning of the day of surgery (T1), on the 2nd postoperative day (T2) and on the 5th postoperative day (T3), respectively. Results: In the study, it was seen that the anxiety level of the patients before the surgery (T1) and on the day of surgery (T2) were comparable between the two groups. However on the 2nd postoperative day (T3), the patients who underwent Rajyoga training had lower anxiety level in comparison to the control group (3.12 ± 1.45 vs. 6.12 ± 0.14, P < 0.05) and on the 5th postoperative day (T4) it was seen that Rajyoga practice had resulted in significant decline in anxiety level (0.69 ± 1.1 vs. 5.6 ± 1.38, P < 0.05). The serum cortisol level was also favorably modulated by the practice of Rajyoga meditation. Conclusion: Mindbody intervention is found to effective in reducing the anxiety of the patients and modulating the cortisol level in patients undergoing wellknown stressful surgery like coronary artery bypass surgery.

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Modified blalock-taussig shunt and levosimendan for left ventricular preparation in a child with transposition of great arteries and regressed ventricle undergoing rapid 2 stage arterial switch operation

Manoj Kumar Sahu, Anish Gupta, Intekhab Alam, Sarvesh Pal Singh, Ramesh Menon, V Devagouru

Annals of Cardiac Anaesthesia 2017 20(2):265-267

Rapid two-stage arterial switch operation (ASO) is very relevant as many patients of transposition of great arteries (TGA) present late to the hospital when primary switch either is not possible or carries a high risk of morbidity and mortality. Hence, other means apart from the traditional methods of left ventricle preparedness should be tried to help this category of patients, who are to undergo rapid two-stage ASO. We successfully used levosimendan and continuous positive airway pressure after 1st stage operation in a patient with dTGA and regressed ventricle, which helped in left ventricular preparedness, and the child underwent rapid two-stage ASO uneventfully.

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Conscious sedation for balloon mitral valvotomy: A comparison of fentanyl versus sufentanil

Shailendra Deochandra Modak, Deepa G Kane

Annals of Cardiac Anaesthesia 2017 20(2):163-168

Context: Analgesia and sedation are required for the comfort of patient and the cardiologist during balloon mitral valvotomy. Aims: In this study, efficacy of analgesia, sedation, and patient satisfaction with sufentanil was compared with fentanyl. Settings and Design: Single-centered, prospective single-blind study of sixty patients. Materials and Methods: Patients between 15 and 45 years of rheumatic mitral stenosis with valve area of 0.8–1 cm2 undergoing elective balloon mitral valvotomy, randomly divided to receive bolus injection fentanyl 1 mcg/kg (Group 1, n = 30) followed by infusion at 1 mcg/kg/h or bolus of injection sufentanil 0.1 mcg/kg (Group 2, n = 30) followed by continuous infusion at 0.1 mcg/h. Both the groups received injection midazolam bolus 0.02 mg/kg followed by infusion at 15 mcg/kg/h. Pain intensity (by visual analog score [VAS]), level of sedation (by Ramsay sedation scale), overall patient and operator's satisfaction, effect on cardiorespiratory parameters, and discharge score (by modified Aldrete score) were assessed. Statistical Analysis Used: Statistical analysis used Student's unpaired t-test and Chi-square test. P < 0.05 was considered statistically significant. Results: Mean number of bolus doses in fentanyl group was 0.9 versus 0.13 in sufentanil group (P < 0.01). The mean value of mean blood pressure in fentanyl group was 83.52 mmHg versus 88 mmHg in sufentanil group (P < 0.05), but the value was within normal range in both the groups. The mean VAS – patient's opinion in fentanyl group was 8.97 versus 9.53 in sufentanil group (P < 0.05). Mean discharge score in fentanyl group was 17.87 versus 18.23 in sufentanil group (P < 0.05). No statistically significant difference was found with respect to heart rate, respiratory rate, oxygen saturation, PaCO2values, and anxiety scores. Conclusion: Sufentanil was found to be better with respect to analgesia, patient satisfaction, and recovery however not cost-effective for continuous infusion technique.

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Role of MicroRNA in cardiac anesthesia: An innovative consequences and new possibility

Mayadhar Barik, Abhay Kumar, Pravash Ranjan Mishra, Poonam Malhotra Kapoor

Annals of Cardiac Anaesthesia 2017 20(2):274-275



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Serial semi-invasive hemodynamic assessment following pericardiectomy for chronic constrictive pericarditis

Ujjwal Kumar Chowdhury, Poonam Malhotra Kapoor, Adil Rizvi, Vishwas Malik, Sandeep Seth, Rajiv Narang, Mani Kalaivani, Sarvesh Pal Singh, Sathiya Selvam

Annals of Cardiac Anaesthesia 2017 20(2):169-177

Objectives: This study was designed to prospectively investigate the effects of pericardiectomy via median sternotomy on intra- and postoperative hemodynamics by a new semi-invasive device (Flotrac/VigileoTM monitor) using arterial pressure waveform analysis. Patients and Methods: Thirty consecutive patients aged 15 to 55 years (mean+SD, 31.73 + 13.53 years), who had undergone total pericardiectomy via median sternotomy underwent serial hemodynamic evaluation. FlotracTM Sensor – derived stroke volume, stroke volume variation, systemic vascular resistance index (SVRI), cardiac index and right atrial pressure were measured just before and after pericardiectomy, at 12 hours, 24 hours, 48 hours, 72 hours and at discharge postoperatively. Results: Majority of patients (73.33%) exhibited statistically significant reduction of right atrial pressure and SVRI along with improvement in cardiac index and oxygen delivery in the immediate and late postoperative period. However, the stroke volume and stroke volume variation did not increase proportionately on completion of surgery. Patients with low cardiac output syndrome exhibited persistently high central venous pressure with reduced cardiac index and echocardiographically abnormal diastolic filling characteristics. Conclusions: We conclude that there is early normalization of hemodynamics following pericardiectomy via median sternotomy and the adequacy of pericardiectomy can be accurately assessed by the new semi-invasive arterial pressure waveform analysis device. Stroke volume variation is a non-predictor of fluid requirement during and after pericardiectomy.

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Erratum: Annals of Cardiac Anesthesia: Beacon journey toward excellence: 2015–2017

Annals of Cardiac Anaesthesia 2017 20(2):280-280



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Methylene blue for postcardiopulmonary bypass vasoplegic syndrome: A cohort study

Michael Mazzeffi, Benjamin Hammer, Edward Chen, Mark Caridi-Scheible, James Ramsay, Christopher Paciullo

Annals of Cardiac Anaesthesia 2017 20(2):178-181

Background: Methylene blue (MB) has been used to treat refractory hypotension in a variety of settings. Aims: We sought to determine whether MB improved blood pressure in postcardiopulmonary bypass (CPB) vasoplegic syndrome (VS) in a complex cardiac surgery population. Furthermore, to determine variables that predicted response to MB. Setting and Design: This was conducted in a tertiary care medical center; this study was a retrospective cohort study. Materials and Methods: Adult cardiac surgery patients who received MB for post-CPB VS over a 2-year period were studied. Mean arterial blood pressure (MAP) and vasopressor doses were compared before and after MB, and logistic regression was used to model which variables predicted response. Results: Eighty-eight patients received MB for post-CPB VS during the study period. MB administration was associated with an 8 mmHg increase in MAP (P = 0.004), and peak response occurred at 2 h. Variables that were associated with a positive drug response were deep hypothermic circulatory arrest during surgery and higher MAP at the time of drug administration (P = 0.006 and 0.02). A positive response had no correlation with in-hospital mortality (P = 0.09). Conclusions: MB modestly increases MAP in cardiac surgery patients with VS. Higher MAP at the time of drug administration and surgery with deep hypothermic circulatory arrest predict a greater drug response.

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Luminescence properties of La2O2S:Tb3+ phosphors and phosphor-embedded polymethylmethacrylate films

Publication date: 5 July 2017
Source:Materials & Design, Volume 125
Author(s): Lixi Wang, Xiaojuan Yang, Qitu Zhang, Bo Song, Chingping Wong
La2O2S:Tb³⁺ phosphors were synthesized by a one-step K2CO3/Na2CO3 flux method and phosphor-embedded polymethylmethacrylate (PMMA) films were fabricated by spin coating. Effects of calcination temperature and flux on the crystal structure, morphology and luminescence performance were evaluated by X-ray diffraction, field emission scanning electron microscopy, transmission electron microscopy, photoluminescence and calculation of CIE color coordinates. In the emission spectra, several emission peaks corresponding to ⁵D4→⁷F6, ⁵D4→⁷F5, ⁵D4→⁷F4, and ⁵D4→⁷F3 transitions appeared, with the ⁵D4→⁷F3 green emission being the dominant emission. The energy band gap, quantum efficiency, fluorescence decay curves, and thermal stability were also investigated with the aim of exploring the potential applicability of the synthesized phosphors in optical devices.

Graphical abstract

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Temperature dependence of plastic instability in Al alloys: A nanoindentation study

Publication date: 5 July 2017
Source:Materials & Design, Volume 125
Author(s): Henry Ovri, Erica T. Lilleodden
An elevated temperature nanoindentation based method for characterizing the thermal dependence of plastic instability and assessing the activation energies associated with the phenomenon in Al alloys is presented in this work. The method exploits the nanoscale force–displacement resolution capabilities of the Nanoindenter, precludes the ambiguities inherent in the uniaxial testing based methods and offers increased reliability because of the statistical significance of the data achieved. The activation energies estimated for an Al—Mg and an Al—Li alloy with the proposed method were found to be 0.59±0.07eV and 0.72±0.01eV, respectively, and are consistent with values derived with other methods. The rate controlling mechanisms associated with these activation energies are described in terms of existing models for plastic instability in these alloy systems.

Graphical abstract

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Using laser cutting as a source of molten droplets for additive manufacturing: A new recycling technique

Publication date: 5 July 2017
Source:Materials & Design, Volume 125
Author(s): Ramiz S.M. Samarjy, Alexander F.H. Kaplan
A new variant of additive manufacturing is proposed which involves transferring molten droplets via a laser beam to a substrate. The droplets are generated by laser remote fusion cutting of a supply sheet that could be a waste material, for recycling purposes. The laser-induced ablation pressure at the cutting front continuously drives melt downwards below the supply sheet in the form of a liquid column. Droplets separate from the column and solidify as a track on a substrate below. The droplets, surrounded by vapour, had in this case an average diameter of 500μm and a speed of 2m/s, with deviations up to 50%. Sound clad tracks were generated on steel and aluminium substrates. In the case of a copper substrate discontinuous clad tracks were produced as a result of poor wetting. The droplet jet had a small divergence of about 5°, which is suitable for controlled deposition. The transmitted part of the laser beam interacted with the clad track but did not affect the process result. High speed imaging was found to be a suitable tool for qualitative and quantitative analysis of the technique.

Graphical abstract

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Ultrasonic-assisted soldering of fine-grained 7034 aluminum alloys using ZnAl filler metals

Publication date: 5 July 2017
Source:Materials & Design, Volume 125
Author(s): Weibing Guo, Tianmin Luan, Jingshan He, Jiuchun Yan
Fine-grained aluminum alloys are very heat sensitive and overheating can reduce the strength of the material. Filler metals of Zn-5Al and Zn-5Al-3Cu alloys were used to join fine-grained 7034 aluminum alloy pieces by ultrasonic-assisted soldering at 420°C. We observed excellent dissolution of the filler metal to the base metal. For the Zn-5Al solder, the Al content of the bond layer increased from 25 to 54at.% when the ultrasound time increased from 5 to 60s, resulting in a decrease of the volume fraction of the eutectic phase from 60% to 15%. The maximum tensile strength of the joints reached 208±8MPa and all fractures occurred in the brittle eutectic phase. For the Zn-5Al-3Cu solder, η-Zn and α-Al phases were identified in the bond layer. The maximum tensile strength of the joints was 249±12MPa, which was ~80% of the base metal after the same soldering thermal cycle. In this case, fracture occurred in the η-Zn phase. The higher strength is attributed to the absence of the eutectic phase. When the ultrasonic treatment time was increased to 60s, the volume fraction of α-Al in the bond layer increased to 93%. The strength of the joints decreased as the brittle ZnAl eutectoid phase crystals appeared inside the α-Al phase in the bond layer.

Graphical abstract

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Magnetron-sputtering fabrication of noble metal nanodots coated TiO2 nanoparticles with enhanced photocatalytic performance

Publication date: 5 July 2017
Source:Materials & Design, Volume 125
Author(s): Yixiang Zhang, Han Ma, Min Yi, Zhigang Shen, Xiaozheng Yu, Xiaojing Zhang
Magnetron-sputtering deposition of coatings onto a flat surface is well established, but coating metal on the curved surface of nanoparticles (NPs) is still challenging. Herein, by using a magnetron sputtering system in which a vibration generator with variable frequency is applied to the sample stage to maintain NPs' dispersity and movability, we successfully deposit noble metal (Au, Ag, Pt) nanodots onto the surface of TiO2 NPs. It is found that the metal nanodots are of a size of 1–6nm and they are firmly bonded to the TiO2 NPs' surface. The photocatalytic activity of Ag/TiO2 is demonstrated to be 2.7 times that of pure TiO2 under simulated sunlight irradiation. This study creates new opportunities for fabricating excellent NP composite catalysts by liquid-free methods.

Graphical abstract

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Digital holographic microscopy as a new technique for quantitative measurement of microstructural corrosion in austenitic stainless steel

Publication date: 5 July 2017
Source:Materials & Design, Volume 125
Author(s): P. Asgari, Y. Pourvais, P. Abdollahi, A.R. Moradi, R. Khamedi, A. Darudi
The aim of this paper is to introduce reflective digital holographic microscopy (rDHM) as a new method for quantitative evaluation of corrosion. Despite the commonly-used evaluation methods, rDHM does not require scanning, while it measures the microstructural height profile of the corroded sample surface within a macroscale area. Based on the height profile across the corroded grain boundaries, a quantitative criterion is suggested to distinguish between intergranular and transgranular corrosion. The experimental results show the capability of rDHM to analyse the microstructural corrosion in AISI 304 stainless steel. The presented method can also be applied as a surface characterization method for analysis of a variety of metallurgic effects such as crystal elasticity and crystal orientation.

Graphical abstract

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Evaluation of the mechanical anisotropy and the deformation mechanism in a multi-pass friction stir processed Al-Zn-Mg-Cu alloy

Publication date: 5 July 2017
Source:Materials & Design, Volume 125
Author(s): Alberto Orozco-Caballero, Marta Álvarez-Leal, David Verdera, Pilar Rey, Oscar A. Ruano, Fernando Carreño
Multi-pass friction stir processing (MP-FSP) can produce extensive bulk nanostructured areas in various metallic materials, such as the Al 7075 alloy (Al-Zn-Mg-Cu), providing fine and highly misoriented grains. This allows obtaining superplastic deformations by the activation of grain boundary sliding (GBS) mechanism at certain strain rate and temperature window, crucial for performing a further superplastic forming (SPF). The superplastic performance of the MP-FSP Al 7075 alloy in two uniaxial testing directions was evaluated and compared to that of a single pass FSP (SP-FSP), reporting a mechanical anisotropy in the MP-FSP attributed to the heterogeneous crystallographic orientation distribution along the transverse testing direction. The operative deformation mechanism was determined by uniaxial tensile test and small punch test (SPT), the former a test with biaxial with radial symmetry. GBS was corroborated as the main operative deformation mechanism in the SP-FSP and MP-FSP, reporting high strain rate superplasticity in the temperature range 350–400°C at 10⁻²s⁻¹, and maximum elongation values between 290–540% at 400°C depending on the testing direction. The Al 7075 alloy processed by MP-FSP showed a great potential for a further SPF as GBS remains as the global deformation mechanism under biaxial testing conditions.

Graphical abstract

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Antifungal activity and cytotoxicity of extracts and triterpenoid saponins obtained from the aerial parts of Anagallis arvensis L.

Publication date: 5 May 2017
Source:Journal of Ethnopharmacology, Volume 203
Author(s): José R. Soberón, Melina A. Sgariglia, Ana C. Pastoriza, Estela M. Soruco, Sebastián N. Jäger, Guillermo R. Labadie, Diego A. Sampietro, Marta A. Vattuone
Ethnopharmacological relevanceAnagallis arvensis L. (Primulaceae) is used in argentinean northwestern traditional medicine to treat fungal infections. We are reporting the isolation and identification of compounds with antifungal activity against human pathogenic yeast Candida albicans, and toxicity evaluation.Aim of the studyto study the antifungal activity of extracts and purified compounds obtained form A. arvensis aerial parts, alone and in combinations with fluconazole (FLU), and to study the toxicity of the active compounds.Materials and methodsDisk diffusion assays were used to perform an activity-guided isolation of antifungal compounds from the aerial parts of A. arvensis. Broth dilution checkerboard and viable cell count assays were employed to determine the effects of samples and combinations of FLU + samples against Candida albicans. The chemical structures of active compounds were elucidated by spectroscopic analysis. Genotoxic and haemolytic effects of the isolated compounds were determined.ResultsFour triterpenoid saponins (1–4) were identified. Anagallisin C (AnC), exerted the highest inhibitory activity among the assayed compounds against C. albicans reference strain (ATCC 10231), with MIC-0 =1µg/mL. The Fractional Inhibitory Concentration Index (FICI=0.129) indicated a synergistic effect between AnC (0.125µg/mL) and FLU (0.031µg/mL) against C. albicans ATCC 10231. AnC inhibited C. albicans 12–99 FLU resistant strain (MIC-0 =1µg/mL), and the FICI=0.188 indicated a synergistic effect between AnC (0.125µg/mL) and fluconazole (16µg/mL). The combination AnC+ FLU exerted fungicidal activity against both C. albicans strains. AnC exerted inhibitory activity against C. albicans ATCC 10231 sessile cells (MIC50=0.5µg/mL and MIC80=1µg/mL) and against C. albicans 12–99 sessile cells (MIC50=0.75µg/mL and MIC80=1.25µg/mL). AnC exerted haemolytic effect against human red blood cells at 15µg/mL and did not exerted genotoxic effect on Bacillus subtilis rec strains.ConclusionsThe antifungal activity and lack of genotoxic effects of AnC give support to the traditional use of A. arvensis as antifungal and makes AnC a compound of interest to expand the available antifungal drugs.

Graphical abstract

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hSSB1 Phosphorylation Is Dynamically Regulated By DNA-PK and PPP-Family Protein Phosphatases

Publication date: Available online 6 April 2017
Source:DNA Repair
Author(s): Nicholas W. Ashton, Nicolas Paquet, Sally L. Shirran, Emma Bolderson, Ruvini Kariawasam, Christine Touma, Azadeh Fallahbaghery, Roland Gamsjaeger, Liza Cubeddu, Catherine Botting, Pamela M. Pollock, Kenneth J. O'Byrne, Derek J. Richard
The maintenance of genomic stability is essential for cellular viability and the prevention of diseases such as cancer. Human single-stranded DNA-binding protein 1 (hSSB1) is a protein with roles in the stabilisation and restart of stalled DNA replication forks, as well as in the repair of oxidative DNA lesions and double-strand DNA breaks. In the latter process, phosphorylation of threonine 117 by the ATM kinase is required for hSSB1 stability and efficient DNA repair. The regulation of hSSB1 in other DNA repair pathways has however remained unclear. Here we report that hSSB1 is also directly phosphorylated by DNA-PK at serine residue 134. While this modification is largely suppressed in undamaged cells by PPP-family protein phosphatases, S134 phosphorylation is enhanced following the disruption of replication forks and promotes cellular survival. Together, these data thereby represent a novel mechanism for hSSB1 regulation following the inhibition of replication.



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Regulation of stem cell aging by SIRT1 – Linking metabolic signaling to epigenetic modifications

Publication date: Available online 6 April 2017
Source:Molecular and Cellular Endocrinology
Author(s): An Yu, Weiwei Dang
In mammals, profound changes in the population and functions of adult stem cells occur with age and these changes are thought to underlie functional decline and pathophysiology at the tissue and organismal levels associated with aging. SIRT1, a member of the conserved sirtuin family, functions as an anti-aging regulator for adult stem cells. Mediated through its regulatory roles in AMPK and mTORC1 pathways as well as gene expression, SIRT1 modulate the activities of genes maintaining stem cell functions and delays cellular senescence. Further investigation of the cross-talk between SIRT1 and other longevity target genes under different physiological conditions of stem cells may help us better design intervention strategies to antagonize stem cells aging.



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Further evidence supporting the need for improved risk stratification of thin melanoma

We read with interest the points raised by Piscioli1 and Dunne2 regarding the histological subtyping and risk of metastasis in thin melanomas (tM).

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Patients with low-risk cutaneous squamous cell carcinoma do not require extended out-patient follow-up

Cutaneous squamous cell carcinoma (cSCC) are amongst the most common cancers with metastatic potential. Specific clinical and pathological "high-risk" features are used to determine the risk of loco-regional recurrence1-4. Current national guidelines recommend that patients with "high-risk" disease receive specialist follow-up for 2-3 years1. Whilst guidance on what constitutes "high-risk" disease appears consistent and evidence-based1, guidance on what constitutes "low-risk" disease is comparatively vague (despite good evidence suggesting minimal risk in the absence of "high-risk" factors2), which could result in unnecessary follow-up regimens that are more reflective of local preferences.

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Follistatin and the Breast Implant Capsule

Background: Breast capsular contracture remains an elusive problem faced by plastic surgeons and is the leading long-term complication after breast implantation. Follistatin (Fst) is a protein with known anti-inflammatory and antifibrotic properties and has the potential to limit the severity of diseases associated with inflammation and fibrosis such as capsular contracture. The aim of this study was to examine the effect of Fst288 on capsular fibrosis around silicone implants in a mouse model. Methods: BALB/c mice were implanted subcutaneously with untreated silicone implants (baseline control). In the experimental group, immediately after silicone implant insertion, the implant pocket received either a single injection of 1 µg Fst288 or normal saline (internal control). The animals were killed at 3, 5, 7, 14, 28, and 90 days after surgery, and serum, implants, and the surrounding tissue were removed for histological and immunohistochemical analyses. Results: Fst288 treatment resulted in significant decreases in capsule thickness at 28 days (P

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Segmental Humeral Reconstruction with a Pedicled Radius Bone Flap in Congenital Amyoplasia

The clinical case of a patient with a segmental humeral defect, in the context of an arthrogryposis congenita multiplex and morbid obesity, reconstructed with a pedicled segmental radial bone flap is reported. The use of the pedicled vascularized diaphyseal radial bone flap may be a useful technique for humerus reconstruction in patients with contraindication for microvascular bone transfers and an already injured or severely handicapped upper limb.

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The Aesthetic Items Scale: A Tool for the Evaluation of Aesthetic Outcome after Breast Reconstruction

Background: Valid tools to assess aesthetic outcomes after breast reconstructive surgery are scarce. Previously a professional aesthetic assessment scale was introduced, the Aesthetic Items Scale (AIS). We aim to determine if this method is a valid and reliable tool to assess aesthetic outcome after breast reconstructive surgery. Methods: The study population was consenting women who underwent prophylactic mastectomy with subsequent implant-based breast reconstruction. The aesthetic outcome with regard to breast volume, shape, symmetry, scars, and nipple areola complex was rated on a 5-point scale using standardized photographs to give a summed total score. Photographs were evaluated by the patient, 5 plastic surgeons, and 3 mammography nurses. An overall rating of aesthetic outcome on a 1–10 scale was given separately. We determined the intraclass correlation coefficient and assessed interobserver agreement. To assess validity, we calculated the correlation between total score and overall rating of aesthetic outcome. Results: Interobserver reliability was highest between plastic surgeons for the subitem and overall scores and ranged between 0.56 and 0.82. The summed score of the AIS correlates strongly with the overall rating in professionals but not in patients. Conclusions: The AIS is a valid and reliable method for evaluating aesthetic outcome of breast reconstruction by plastic surgeons. The results indicate that patients judge aesthetic outcome differently, taking into account factors that are not represented in the AIS. Professionals can use this method to evaluate surgical results, but other measurements are needed to map satisfaction of the patient with her breasts.

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S-shaped Wound Closure Technique for Dumbbell-shaped Keloids

Summary: Dog-ear collection, Z-plasty, and W-plasty are often performed for excision of dumbbell-shaped keloids; however, these procedures require additional incisions or excision of normal skin. Thus, an S-shaped wound closure technique was performed. The keloid lesions were extralesionally excised above the deep fascia, and the wound edges were shifted in opposite directions along the major axis to form an S-shape. The incision was closed by applying deep fascial sutures, subcutaneous sutures, and superficial sutures. Postoperative external beam radiation therapy was started within 6 hours after surgery at a dose of 20 Gy applied in 4 fractions. All wounds were covered with silicone-gel sheeting and fixed with tape after suture removal. No intralesional corticosteroid injection or oral tranilast was administered. Corticosteroid tape was applied in cases with suspected postoperative recurrence. Scoring was performed using the Manchester Scar Scale. A total of 8 lesions were treated. Temporary erythema and scar elevation were observed in 2 chest lesions; however, both were flattened and turned white using corticosteroid tape. Other than these 2 lesions, there was no recurrence or complication. The mean score improved from 15.8 to 7.2. The S-shaped wound closure technique has 3 advantages. First, no additional incision or excision is required, and additional scarring and keloid recurrence can be avoided. Second, aesthetic results are good, and noticeably long and zigzag-shaped scars can be avoided. Third, dispersion of tension on the scar can be expected. Although the S-shaped wound closure technique has limited application, it is a useful option for keloid treatment.

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Pretrimmed versus Direct Nonshaven Follicular Unit Extraction

Background: Shaving the donor area is one of the major deterrents preventing hair transplant patients from selecting follicular unit extraction (FUE). A minimal shaved donor area is possible in strip surgery, but the strip method is not applicable if the patient wishes to avoid a linear donor scar, wishes to minimize postoperative pain, or has insufficient scalp laxity. In these cases, nonshaven FUE (NS-FUE) is potentially a very good choice. Methods: A total of 42 patients were enrolled. Both pretrimmed and direct NS-FUE were performed during a single session in each patient. The 2 methods were compared regarding the time taken to punch 50 grafts, transection rate, and calculated density (number of hairs per graft). Results: The mean time taken to punch 50 grafts was significantly longer in the pretrimmed method than the direct method (3.4 minutes versus 2.6 minutes; P 0.05). The mean calculated density was significantly higher in the pretrimmed method than the direct method (2.23 hairs per graft versus 2.15 hairs per graft; P

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Morel-Lavallée Lesion Contour Deformity: Quilting Sutures to Prevent Recurrent Seroma after Resection

No abstract available

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Various Types of Minor Trauma to Hair Follicles During Follicular Unit Extraction for Hair Transplantation

Background: When performing follicular unit extraction (FUE), various types of minor hair follicle trauma unapparent during follicular unit strip surgery are likely to occur. However, no studies have examined such damage. Methods: In total, 100 grafts were randomly selected from each of 42 patients who underwent FUE with a 1-mm-diameter sharp punch. A ×5.5 magnifying loupe and a ×60 magnifying binocular microscope were used. The transection rate (TR), paring, fractures of and damage to the dermal papilla (DP) areas, and hair bulb partial injury were assessed. Results: Observation with the magnifying loupe revealed an average TR of 7.40%, and 4.31, 1.90, 1.52, and 0.43 hair follicles per 100 grafts exhibited paring, fracture, DP partial injury, and hair bulb partial injury, respectively. An average of 9.21 telogen hairs were observed. Microscopic examination revealed a TR of 6.34%, and 9.07, 1.95, 0.79, and 1.24 hair follicles per 100 grafts exhibited paring, fracture, DP injury, and hair bulb partial injury, respectively. An average of 16.62 telogen hairs were observed. Conclusions: Various types of minor hair follicle damage occur during FUE as shown by loupe and microscopic examination of the grafts. Especially paring and hair bulb injury were more apparent under microscopic examination. These minor hair follicle injuries should be considered when choosing operative method or surgical techniques.

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Improved Outcomes with Pedicled Nipple-sparing Mastectomies Using a New Surgical Delay: Mastectomy through Wise Incisions

Summary: Nipple-sparing mastectomy (NSM) is challenging in patients with significant ptosis and skin excess. We previously described the first use of a surgical delay (a supraareolar incision with undermining off the breast mound) to facilitate a second-stage pedicled NSM and reconstruction. Here, we present an improvement in our surgical delay technique—a total skin and NSM through Wise incisions. This technique obviates concerns regarding delays in cancer care and more aggressively delays the nipple, allowing for more reliable and extreme NAC transpositions. This strategy also delays the Wise pattern flaps resulting in better wound healing, which is critical in implant-based reconstructions.

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Left Ventricular Assist Device Salvage with Omental Flap

Summary: A large number of people are affected with heart failure annually and require left ventricular assist device placement as a bridge to heart transplant or as destination therapy. When these devices become infected, it is a challenge to eradicate the infection. Failure ultimately results in a significant morbidity and mortality. Source control along with debridement and antibiotics can eradicate the infection of the patient, but many times there is a large defect that needs soft-tissue coverage. Many options for soft-tissue coverage have been suggested, but omentum may be an excellent choice due to its vascularity, bulk, and immunological properties. In this case report, the omental flap is employed for salvage of the left ventricular assist device with excellent results.

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Successful Arthroplasty Using Cadaveric Meniscus for Osteochondral Defects in the Wrist and Hand Joints

Background: Osteochondral defects of the radiocarpal, metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints often necessitate joint arthrodesis or mechanical arthroplasty, which has a limited lifespan. In severely arthritic wrist and finger joints, we propose a novel adjunct for joint salvage using cadaveric meniscus for joint resurfacing as an off-the-shelf alternative to address osteochondral defects and restore normal intraarticular contact stress. Methods: A total of 14 patients with osteochondral defects in 5 radiocapitate, 5 MCP, 3 PIP, and 1 carpometacarpal joints received cadaveric meniscus to facilitate arthroplasty. Patient demographic, perioperative pain, range of motion, and complications were examined. Results: Patients aged 17 to 73 years old (average, 54.6 years old) underwent joint reconstruction for scaphoid nonunion (n = 1), scaphoid-lunate advanced collapse (n = 4), or osteoarthritis of MCP/carpometacarpal (n = 6) or PIP (n = 3) joints. Successful arthroplasty with joint space preservation occurred in all joints. Patients had a significant reduction in average pain scale score (P

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Pediatric Melanoma: A 35-year Population-based Review

Background: Melanoma is a rare neoplasm in the pediatric population. Recent publications suggest a possible increase in incidence over the past few decades. The purpose of this study was to analyze trends in pediatric patients diagnosed with malignant melanoma in British Columbia (BC) in the past 35 years. Methods: A retrospective review was performed. All patients in BC diagnosed with melanoma before 18 years of age from 1979 to 2014 were included. Patient demographics, melanoma description, treatment details, and survival data were collected. Results: Seventy-eight subjects were identified for the study. Patients were equally distributed by sex. Sixty-one (78%) of the subjects were diagnosed in the postpubertal age (≥12 years old). The most common sites of occurrence were the extremities (n = 33) and the trunk (n = 27), with the location on the trunk showing the highest mortality rate (22%). All patients were surgically treated and some had additional chemotherapy (12) and/or radiotherapy (12). Fatal outcome was recorded in 12 of the 78 subjects, 10 of whom had postpubertal diagnosis. The average time from date of diagnosis to date of death was 9.3 years. Conclusions: The incidence of melanoma in the pediatric population remains exceedingly rare: less than 2.5 per million children younger than 18 years. The diagnosis is rarely made before puberty; the incidence is equal in males and females and has not changed over a 35-year time period in BC. Our study shows 85% survival with the majority of patients having had surgical excision only.

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Craniofacial Fellowship at the Chang Gung Memorial Hospital: Review of an 8-month Fellowship Experience

No abstract available

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Cleft Palate Repair without Lateral Relaxing Incision

Background: The goals of successful palate repair include optimization of speech and feeding, avoidance of fistula formation, and mitigation of adverse maxillary growth. However, the effects of scar formation on maxillary growth have not been discussed in detail. Methods: Between November 2010 and December 2011, the palateplasty was performed for 24 patients with cleft palate (median age, 12 months; range, 11–18 months). In the velum, a symmetrical intravelar veloplasty with mucosal Z-plasty was performed on both the nasal and oral sides. In the hard palate, instead of lateral relaxing incisions, a 1-line mucoperiosteal incision along the cleft margins was designed with subperiosteal undermining in the entire palatine bone. The palatal mucoperiosteum was sutured together in the middle of the cleft, and the cleft was directly closed without lateral relaxing incisions. The patients were monitored for 6 months to 1.6 years. Results: None of the cases had issues concerning flap viability, and all palate repairs healed well. Postoperative results were satisfactory, without any complications such as dehiscence, perforation, or palatal fistula. Conclusions: The method presented in this article was effective, with successful palatal closure and without scar formation or mucosal defects along the alveolus. We conclude that minimum contracture of the hard palate was useful for not only mitigating adverse maxillary growth but also for orthodontics.

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Preoperative Radiotherapy Is Not Associated with Increased Post-mastectomy Short-term Morbidity: Analysis of 77,902 Patients

Background: Neoadjuvant radiotherapy (NRT) enhances breast-conserving surgery outcomes, reducing local recurrence of breast cancer and increasing median survival. However, its effect on postoperative morbidity remains under-studied. We sought to assess the impact of NRT on 30-day postoperative morbidity after mastectomy. Methods: We analyzed data from women undergoing mastectomy (with or without immediate reconstruction) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) 2005–2011 datasets. ACS-NSQIP is a prospective, risk-adjusted, outcomes-based registry. Data included demographic and perioperative factors. Outcomes studied included surgical site (wound and prosthesis/flap complications), systemic (cardiac, respiratory, neurological, urinary, and venous thromboembolism events), and overall morbidity. Logistic regression was used to estimate the unadjusted odds ratio (uOR) and adjusted odds ratio (aOR) between NRT and postoperative 30-day morbidity. Results: The study population included 77,902 women, of which 61,039 (78.4%) underwent mastectomy only and 16,863 (21.6%) underwent mastectomy with immediate breast reconstruction. NRT was administered to 266 (0.4%) mastectomy-only and 75 (0.4%) immediate breast reconstruction patients. In the mastectomy-only group, there were no significant differences in the rates of postoperative surgical site morbidity (aOR = 1.41; 95% confidence interval (CI): 0.76–2.63; P = 0.276), systemic morbidity (aOR = 0.72; 95% CI: 0.40–1.26; P = 0.252), and overall morbidity (aOR = 0.85; 95% CI: 0.54–1.33; P = 0.477) between NRT and control groups. Similarly, no significant differences were found for these three outcomes in the immediate breast reconstruction population. Statistical power for every comparison was >80%. Conclusions: This study suggests that NRT is not associated with significantly higher 30-day postoperative complications among breast cancer patients undergoing mastectomy with or without immediate breast reconstruction.

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Current Risk Stratification Systems Are Not Generalizable across Surgical Technique in Midline Ventral Hernia Repair

Background: Current ventral hernia repair risk estimation tools focus on patient comorbidities with the goal of improving clinical outcomes through improved patient selection. However, their predictive value remains unproven. Methods: Outcomes of patients who underwent midline ventral hernia repair with retrorectus placement of mid-weight soft polypropylene mesh between 2010 and 2015 were retrospectively reviewed and compared with predicted wound-related complication risk from 3 tools in the literature: Carolinas Equation for Determining Associated Risk, the Ventral Hernia Working Group (VHWG) grade, and a modified VHWG grade. Results: A total of 101 patients underwent hernia repair. Mean age was 56 years and mean body mass index was 29 m/kg2 (range, 18–51 m/kg2). We found no significant relationship between the risk estimated by Carolinas Equation for Determining Associated Risk (B = 1.45, P = 0.61) and actual wound-related complications. VHWG grades >1 were not statistically different with regard to rate of wound complication compared with VHWG grade 1 (grade 2: B = 0.05, P = 0.95; grade 3: B = −0.21, P = 0.86; grade 4: B = 2.57, P = 0.10). Modified VHWG grades >1 were not statistically different with regard to rate of wound complication compared with modified VHWG grade 1 (grade 2: B = 0.20, P = 0.80; grade 3: B = 1.03, P = 0.41). Conclusions: Current risk stratification tools overemphasize patient factors, ignoring the importance of technique in minimizing complications and recurrence. We attribute our low complication rate to retrorectus placement of a narrow, macroporous polypropylene mesh with up to 45 suture fixation points for force distribution in contrast to current strategies that employ wide meshes with minimal fixation.

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Psychoactive Drugs in Plastic Surgery

Background: Psychoactive drug use is on the rise in the United States, with plastic surgery patients a potentially susceptible group. This study aimed to determine the incidence of cosmetic and reconstructive patients in our practice taking psychoactive drugs and to compare those values with the national average. Furthermore, we discuss the patient safety concerns when patients withhold their medical history information over the course of their treatment. Methods: Urban private plastic practice patients who underwent surgery in a closed practice from 2009 to 2016 were divided into cosmetic and reconstructive cohorts. Review for drug use was medical scripts, history, and Surescripts drug reporting. Extracted information includes age, race, procedure, psychoactive medications, and whether or not they stated a mental health diagnosis on their medical history forms. Only patients with complete records were included. Results: A total of 830 patients were included in statistical analysis. Due to minimal cohort number, 70 men were excluded, as there were no comparative national data. Our analysis found that 33.6% cosmetic patients and 46.3% reconstructive patients used at least one psychoactive drug. Conclusion: There is a statistically significant difference between psychoactive drug use at our practice compared with the general population and a significantly larger percentage of reconstructive patients taking drugs compared with the cosmetic cohort.

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Improving Pressure Ulcer Reconstruction: Our Protocol and the COP (Cone of Pressure) Flap

Background: Surgical treatment of pressure ulcers is challenging for high recurrence rates. Deepithelialized flaps have been used previously with the aim to eliminate shearing forces and the cone of pressure (COP) effect. The goal of this study is to adopt a standardized protocol and evaluate if 2 different flap techniques affect outcomes. Methods: The novel COP flap is illustrated. Twenty patients were prospectively treated with flap coverage over a 36-month period. According to the flap type, patients were assigned to 2 groups: group 1 with 11 patients treated with the COP flap and group 2 with 9 patients treated with conventional flap without anchoring technique. We adopted a standardized protocol of debridement, tissue cultures, and negative-pressure wound therapy. Rotation fasciocutaneous flaps were used for both groups and mean follow-up was 19 months. The COP flap is a large deepithelialized rotation flap inset with transcutaneous nonabsorbable bolster sutures. The 2 groups were comparable for demographics and ulcer location and size (P

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