Imaging and Management of Thoracic Trauma

Publication date: Available online 26 March 2018
Source:Seminars in Ultrasound, CT and MRI
Author(s): Alex Newbury, Jon D. Dorfman, Hao S. Lo
Thoracic injury results from penetrating and blunt trauma and is a major contributor to overall trauma morbidity and mortality in the United States. Modern imaging algorithms utilize ultrasound, CXR, and CT with intravenous contrast to accurately diagnose and effectively treat patients with acute thoracic trauma. This review focuses on the etiologies, signs and symptoms, imaging, and management of several life-threatening thoracic injuries including tracheobronchial rupture, pulmonary parenchymal injury, hemothorax, pneumothorax, diaphragmatic rupture, and axial skeleton injury.



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Local and remote black carbon sources in the Metropolitan Area of Buenos Aires

Publication date: June 2018
Source:Atmospheric Environment, Volume 182
Author(s): Melisa Diaz Resquin, Daniela Santágata, Laura Gallardo, Darío Gómez, Cristina Rössler, Laura Dawidowski
Equivalent black carbon (EBC) mass concentrations in the fine inhalable fraction of airborne particles (PM2.5) were determined using a 7-wavelength Aethalometer for 17 months, between November 2014 and March 2016, for a suburban location of the Metropolitan Area of Buenos Aires (MABA), Argentina. In addition to describing seasonal and diurnal black carbon (BC) cycles for the first time in this region, the relative contributions of fossil fuel and remote and local biomass burning were determined by distinguishing different carbonaceous components based on their effect on light attenuation for different wavelengths. Trajectory analyses and satellite-based fire products were used to illustrate the impact of long-range transport of particles emitted by non-local sources. EBC data showed a marked diurnal cycle, largely modulated by traffic variations and the height of the boundary layer, and a seasonal cycle with monthly median EBC concentrations (in μg/m3) ranging from 1.5 (February) to 3.4 (June). Maximum values were found during winter due to the combination of prevailingly stable atmospheric conditions and the increase of fossil fuel emissions, derived primarily from traffic and biomass burning from the domestic use of wood for heating. The use of charcoal grills was also detected and concentrated during weekends. The average contribution of fossil fuel combustion sources to EBC concentrations was 96%, with the remaining 4% corresponding to local and regional biomass burning. During the entire study period, only two events were identified during which EBC concentrations attributed to regional biomass burning accounted for over 50% of total EBC; these events demonstrate the relevance of agricultural and forestry activities that take place far from the city yet whose emissions can affect the urban atmosphere of the MABA.



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Emission characteristics and chemical components of size-segregated particulate matter in iron and steel industry

Publication date: June 2018
Source:Atmospheric Environment, Volume 182
Author(s): Jia Jia, Shuiyuan Cheng, Sen Yao, Tiebing Xu, Tingting Zhang, Yuetao Ma, Hongliang Wang, Wenjiao Duan
As one of the highest energy consumption and pollution industries, the iron and steel industry is regarded as a most important source of particulate matter emission. In this study, chemical components of size-segregated particulate matters (PM) emitted from different manufacturing units in iron and steel industry were sampled by a comprehensive sampling system. Results showed that the average particle mass concentration was highest in sintering process, followed by puddling, steelmaking and then rolling processes. PM samples were divided into eight size fractions for testing the chemical components, SO4²⁻ and NH4⁺ distributed more into fine particles while most of the Ca²⁺ was concentrated in coarse particles, the size distribution of mineral elements depended on the raw materials applied. Moreover, local database with PM chemical source profiles of iron and steel industry were built and applied in CMAQ modeling for simulating SO4²⁻ and NO3⁻ concentration, results showed that the accuracy of model simulation improved with local chemical source profiles compared to the SPECIATE database. The results gained from this study are expected to be helpful to understand the components of PM in iron and steel industry and contribute to the source apportionment researches.



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The purinergic P2X7 ion channel receptor—a ‘repair’ receptor in bone

Publication date: June 2018
Source:Current Opinion in Immunology, Volume 52
Author(s): Niklas Rye Jørgensen
A strong skeleton relies on adaptation to varying physical demands and on maintenance of the bone tissue in order to avoid accumulation of micro-damage. In bone, the purinergic P2X7 ion channel receptor is expressed on both cells of the stromal lineage such as the bone forming osteoblasts and the mechano-sensing osteocytes and on cells belonging to the immune-related monocyte–macrophage lineage, the bone resorbing osteoclasts. Recent studies have demonstrated that the receptor plays important roles in the anabolic responses to mechanical loading on bone and, together with the pannexin1 hemi-channel, in the process of initiating bone remodeling in response to micro-damage. Thus, the receptor is crucial in skeletal mechano-transduction and in the continuous repair process. However, under pathophysiological conditions such as diabetes with high glucose concentrations or glucocorticoid-treatment the receptor is downregulated thus blunting the important effects it has for maintaining a healthy and strong skeleton.



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Vaccination antigrippale et mucoviscidose. Impact d’une campagne d’incitation à la vaccination antigrippale chez les patients du Centre de ressources et de compétences de la mucoviscidose (CRCM) mixte de Dunkerque et leurs soignants

Publication date: Available online 24 March 2018
Source:Revue des Maladies Respiratoires
Author(s): M. Scalbert-Dujardin, A. Boldron, E. Leroy, J. Bazin, E. Froment-Leclercq
IntroductionL'objectif principal de ce travail est d'évaluer l'efficacité d'actions préventives contre la grippe dans les populations étudiées. L'objectif secondaire est d'analyser les mécanismes amenant à un changement de comportement vis-à-vis de la vaccination antigrippale dans ces mêmes populations.MéthodesÉtude interventionnelle, prospective, réalisée par un questionnaire anonyme portant sur la couverture vaccinale (CV) antigrippale et les motifs de vaccination et non-vaccination, proposé aux patients suivis pour mucoviscidose (n=67) du CRCM mixte de Dunkerque et leurs soignants (n=117), avant (avril 2014) et après (avril 2015) campagne d'information et d'actions de prévention primaire (vaccination sur les lieux de travail, créneaux horaires élargis).RésultatsEn 2015, le taux de couverture vaccinale (TC) du personnel soignant augmente à 65,63 % contre 27,55 % en 2014, (χ²[1]=29,17, p<0,0001). Chez les patients, enfants et adultes, aucune différence significative n'a été observée, entre 2014 et 2015 (χ²[1]=0,24, NS) dont le TC avant campagne était déjà optimum.ConclusionsSensibiliser à la vaccination antigrippale permet d'augmenter la CV du personnel de santé. Trois leviers principaux ont été identifiés : la nécessité de communiquer sur la vaccination auprès des soignants, la facilité d'accès à la vaccination et le positionnement en faveur de la vaccination des médecins et cadres de santé.IntroductionThe main aim of this study is to evaluate the effectiveness of preventive actions regarding influenza in the studied populations. The secondary objective is to analyze and understand the mechanisms which bring about a behavioural change regarding influenza vaccination.MethodsThe interventional and prospective study was undertaken in the form of an anonymous questionnaire about influenza vaccination coverage and about the reasons for vaccinating or not vaccinating. The studied populations were patients followed for cystic fibrosis (n=67) in the Dunkerque cystic fibrosis treatment centre and their health care workers (n=117), before (April 2014) and after (April 2015) an information campaign and primary prevention actions (vaccination in the workplace with expanded time slots) in collaboration with the department of occupational medicine.ResultsIn 2015, the vaccination coverage rate of health care workers rose to 65.63%, that is to say 2.38 times more than in 2014 (27.55%). This difference is significant (χ²[1]=29.17, P<0.0001). However, no significant difference between 2014 and 2015 was observed among patients (children and adults) (χ²[1]=0.24, NS) whose vaccination coverage was already optimal before the study.ConclusionsRaising awareness among health care workers about vaccination against influenza increases the coverage rate and decreases outbreaks of virus infection in the care services and among patients at risk. Three main levers were identified: the necessity of providing information on influenza vaccination to health care workers, the ease of vaccination access and the attitude towards vaccination of supervisory staff (health executives/doctors).



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Helicobacter, Volume 23, Issue 2, April 2018.

Helicobacter, Volume 23, Issue 2, April 2018.


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Skin Research and Technology, Ahead of Print.

Skin Research and Technology, Ahead of Print.


https://ift.tt/2Gqp3d2

Skin Research and Technology, Ahead of Print.

Skin Research and Technology, Ahead of Print.


https://ift.tt/2G8skdp

"Long-Term Outcomes of Smile Reconstruction in Möbius Syndrome.”

No abstract available

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“Quality of Life in Adults with Non-Syndromic Craniosynostosis”

Background: While studies have analyzed quality of life (QOL) in children with non-syndromic craniosynostosis (NSC), to date nobody has investigated long-term QOL in adults with NSC. The purpose of this study is to compare QOL in adult NSC patients with a cohort of unaffected controls. Methods: We queried our institution's prospectively maintained craniofacial registry for NSC patients 18 years and older, and administered the validated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. Responses were compared, using a two-sample t-test, to an age-matched, United States, normative database provided by the World Health Organization (WHO). Results: 151 adults met inclusion criteria: 52 were successfully contacted and 32 completed the WHOQOL-BREF. Average age of respondents was 23.0±6.1 years old (range, 18.1 to 42.1). 12 subjects had metopic synostosis, 15 had unicoronal, and 5 had sagittal. NSC patients had a superior quality of life compared to comparative norms in all domains: physical health (17.8±2.7 vs. 15.5±3.2, p0.05), while all individual subtypes maintained superior or equivalent QOL relative to controls. Demographic variables, Whitaker score, and number of surgical interventions did not correlate with differences in QOL. Conclusion: Adult patients previously treated for NSC perceive their quality of life to be high, superior to that of a normative United States sample. Future work will seek to analyze additional patients and better understand the reasons behind these findings. Financial Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Conflicts of Interest: None of the authors listed have any conflicts of interest to report. Funding source: This study did not have any funding sources. IRB: This study was granted approval by the Institutional Review Board for research at the Children's Hospital of Philadelphia. Corresponding author: Scott P. Bartlett, MD, Chief of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Colket Translational Research Building, 3501 Civic Center Blvd, 9th floor, Philadelphia, PA 19104, Email: bartletts@email.chop.edu, Telephone: 215-590-2214, Fax: 215-590-2496 ©2018American Society of Plastic Surgeons

https://ift.tt/2IQE5qL

Genetics of non-syndromic craniosynostosis

SUMMARY: Occurring once in every 2,000 live births, craniosynostosis is one of the most frequent congenital anomalies encountered by the craniofacial surgeon. Syndromic craniosynostoses account for ~15% of cases and demonstrate Mendelian patterns of inheritance with well-established genetic etiologies1,2, however non-syndromic craniosynostoses (NSC), which account for ~85% of cases2, are genetically heterogeneous and largely unexplored. NSC is sporadic in >95% of affected families3, thus surgeons have suggested for decades that NSC is likely a fluke occurrence. Contrary to this, recent studies have established that genetics underlie a substantial fraction of NSC risk. Given the predominantly sporadic occurrence of disease, parents are often bewildered by the primary occurrence of NSC or even recurrence in their own families and request genetic testing. Existing genetic testing panels are useful when the phenotype strongly resembles a known syndrome, wherein the risk of disease recurrence can be accurately predicted for future offspring of the parents as well as the future offspring of the affected child. The diagnostic utility of existing panels for NSC, however, is extremely low, while these tests are quite costly. Recent genetic studies have identified several novel genes and pathways that cause NSC, providing genetic evidence linking the pathoetiology of syndromic and non-syndromic craniosynostoses, and allowing for genotype-based prediction of risk of recurrence in some non-syndromic families. Based on analysis of exome sequence data from 384 families, we provide recommendations for a new genetic testing protocol for children with NSC, which include testing non-syndromic cases of sagittal, metopic, and coronal craniosynostosis. Financial Disclosure Statement: No authors have any disclosures. Presented at: N/A Correspondence should be addressed to: Andrew T. Timberlake PhD, John A. Persing MD, Section of Plastic and Reconstructive Surgery, Yale School of Medicine, 330 Cedar Street, 3rd Floor Boardman Building, New Haven, CT 06520, Andrew.timberlake@yale.edu, John.persing@yale.edu ©2018American Society of Plastic Surgeons

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New Developments Are Improving Flexor Tendon Repair

Summary: New developments in primary tendon repair over the past decades include stronger core tendon repair techniques, judicious and adequate venting of critical pulleys, followed by a combination of passive and active digital flexion and extension. During repair, core sutures over the tendon should have sufficient suture purchase (no shorter than 0.7 to 1 cm) in each tendon end and must be sufficiently tensioned to resist loosening, forming gaps. Slight or even modest bulkiness in the tendon substance at the repair site is not harmful, though marked bulkiness should always be avoided. To expose the tendon ends and reduce restriction to tendon gliding, the longest annular pulley in the fingers, i.e., the A2 pulley, can be vented partially with an incision over its distal or proximal sheath no longer than 1.5 to 2 cm; the annular pulley over the middle phalanx, i.e., the A4 pulley, can be vented entirely. Surgeons have not observed adverse effects on hand function after judicious and limited venting. The digital extension-flexion test to check the quality of the repair during surgery has become increasingly routine. A wide-awake surgical setting allows patient to actively move the digits. After surgery, surgeons and therapists protect patients in with a short splint, flexible wrist positioning, and are now moving towards out-of-splint freer early active motion. Improved outcomes have been reported over the last decade with minimal or no rupture during postoperative active motion and lower rates of tenolysis. Financial disclosure: None Corresponding author: Jin Bo Tang, MD, Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China; email: jinbotang@yahoo.com., Fax: 513-85110966, Phone: 86-513-85052524 ©2018American Society of Plastic Surgeons

https://ift.tt/2IRFtJI

Requirements for successful trachea transplantation; a study in the rabbit model

Background: Although creating a tracheal tube de novo might appear straightforward, the first clinical applications have shown that reconstruction of long-segment tracheal defects remains challenging. In this study, we aimed to refine the baseline requirements of successful trachea transplantation by means of three proof-of-concept models in the rabbit. Methods: In each model, one characteristic of a perfect tracheal transplant was eliminated. The first model was developed to map out the immunological response of vascularized allogenic trachea, transplanted without immunosuppression (n = 6). The second model studied the need for wrapping the transplant with a highly-vascularized flap, and the source of angiogenesis after autologous trachea-transplantation (n = 18). In the third model, we examined the importance of an inner epithelial covering (n = 12). All models were compared to a control group of heterotopically transplanted vascularized autologous tracheae (n = 6). Results: Embedded in an avascular matrix, allogenic chondrocytes were protected from an overt immune response. Orthotopic transplantation without additional external vascular wrap was successful in a well-vascularized environment. Nonetheless, an external vascular source was essential to maintain viability of the construct. Epithelial covering was necessary to prevent secondary healing. Epithelial migration from the anastomoses or graft was not sufficient to cover long-segment defects. Conclusions: These experiments provided ample evidence of the importance of baseline requirements when designing a tracheal-transplant study. This study confirmed that different tracheal cell-types possess different immunological sensitivities. External revascularization, preferably in a two-stage procedure, and fast reepithelialization were both paramount to successful transplantation. Financial disclosure: The authors of this manuscript have no conflicts to disclose as described by Plastic and Reconstructive Surgery. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Acknowledgements: This work was supported by the predoctoral fellowship of the Research Foundation Flanders (FWO; 11I0413N) of Margot Den Hondt. Corresponding Author: Margot Den Hondt, margot.denhondt@uzleuven.be, +32 494 18 64 83 ©2018American Society of Plastic Surgeons

https://ift.tt/2pG2UNr

Assessing technical performance and determining the learning curve in cleft palate surgery using a high fidelity cleft palate simulator

Introduction: Technical skills assessment can provide objective measures of surgical performance. This study assessed technical performance in cleft palate repair using a newly developed assessment tool and high fidelity cleft palate simulator through a longitudinal simulation training exercise. Methods: Three residents performed five and one resident performed nine consecutive endoscopically recorded cleft palate repairs using a cleft palate simulator. Two fellows in pediatric plastic surgery and two expert cleft surgeons also performed recorded simulated repairs. A cleft palate objective structured assessment of technical skill (CLOSATS) scoring scale and end-product score were developed to assess performance. Two blinded cleft surgeons assessed the recordings and the final repairs using the CLOSATS, end-product scores and a previously developed global rating scale. Results: The average procedure specific (CLOSATS), global and end-product scores increased logarithmically after each successive simulation session for the residents. Reliability of the CLOSATS (average item ICC=0.85±0.093) and global ratings (average item ICC=0.91±0.02) amongst the raters was high. Reliability of the end-product assessments was lower (average item ICC=0.66±0.15). Standard setting linear regression using an overall cutoff score of 7 out of 10 corresponded to a pass score for the CLOSATS, and global rating score of 44 (maximum 60) and 23 (maximum 30) respectfully. Using logarithmic best fit curves, 6.3 simulation sessions are required to reach the minimum standard. Conclusions: A high fidelity cleft palate simulator has been developed that improves technical performance in cleft palate repair. The simulator and technical assessment scores can be used to determine performance before operating on patients. Financial disclosure: The cleft palate simulator is available commercially and sold by Simulare Medical Corp. (Toronto, Ontario, Canada). Drs. Podolsky, Fisher, Wong, Drake and Forrest are each shareholders of Simulare Medical Corp. Corresponding author: Dale J Podolsky, Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, 5430-555 University Avenue, Toronto, Ontario, M5G 1X8. E-mail: dale.podolsky@mail.utoronto.ca. ©2018American Society of Plastic Surgeons

https://ift.tt/2IQDVj9

A novel small animal model of irradiated, implant based breast reconstruction

PURPOSE: There is currently a need for a clinically relevant small animal model for irradiated, implant based breast reconstruction. Present models are inadequate in terms of suboptimal location of expander placement and mode of radiation delivery, correlating poorly with the human clinical scenario. We hypothesized that by delivering fractionated radiation and placing an expander under the scalp of the animal, we would achieve histologically analogous soft tissue changes seen in human irradiated, implant based breast reconstruction. METHODS: This study consisted of eleven immunocompetent, hairless rats divided into three groups: an untreated control (n=3), tissue expanded scalps (n=4) and fractionated radiation plus tissue expansion of the scalp (n=4). At the completion of the experiment for each group, skin tissue samples were analyzed histologically for vascularity, epidermal and dermal thickness, and collagen fiber alignment or scar formation. RESULTS: Expanded rat epidermis was significantly thicker and dermis was more vascular than non-expanded skin. We observed a greater degree of collagen fiber alignment in the expanded group compared with non-expanded skin. The combination of radiation and expansion resulted in significant dermal thinning, vascular depletion and increased scar formation compared with expanded skin alone. CONCLUSIONS: We describe a novel small animal model for irradiated, implant based breast reconstruction where histologic analysis shows structural changes in the skin consistent with known effects of radiation and expansion in human skin. This model represents a significant improvement from previous ones and as such, holds the potential to be used to test new therapeutic agents to improve clinical outcomes. Financial Disclosure Statement: The authors have no disclosures. Internal funding from the University of Virginia School of Medicine Research and Development Grant was used for this research. This article has been approved by the Institutional Animal Care and Use Committee at the University of Virginia Acknowledgements: We would like to thank Quan Chen, PhD and Brian Neal, PhD for their participation in this work. Corresponding Author/Reprints: Kant Y. Lin, MD, FACS, Department of Plastic and Reconstructive Surgery, University of Virginia Health System, P.O Box 800376, Charlottesville VA, 22908, Kyl5s@hscmail.mcc.virginia.edu, Phone: 434-924-2528, Fax: 434-924-1333 ©2018American Society of Plastic Surgeons

https://ift.tt/2pHj20X

Targeted muscle reinnervation: considerations for future implementation in adolescents and younger children

Summary: Prosthetic options for patients with proximal upper limb absence are limited. Current above elbow prostheses may restore basic motor functions for crucial activities, but they are cumbersome to operate, lack sensory feedback, and are often abandoned. Targeted muscle reinnervation (TMR) is a novel surgical procedure that enhances the ability of patients with above elbow amputations to intuitively control a myoelectric prosthesis. By transferring multiple severed peripheral nerves to a robust target muscle, TMR restores physiologic continuity and enables more intuitive prosthetic control. Although reports have been limited to adults, TMR has great potential for application in a pediatric population with congenital or acquired proximal upper limb absence. In this review, we describe the rehabilitative challenges of proximal upper limb amputees and outline the objectives, techniques, and outcomes of TMR. We then discuss important considerations for adapting TMR to pediatric patients, including etiology of upper limb absence, central plasticity, timing of prosthesis fitting, role of the family, surgical feasibility, and bioethical aspects. We believe that carefully screened school-aged children and adolescents with bilateral proximal upper limb absence, as well as adolescents with unilateral proximal upper limb absence, should be seriously considered for TMR by an experienced surgical and rehabilitation team. Financial Disclosure Statement: The authors have nothing to disclose. Corresponding Author: Dr. Gregory Borschel, MD, FACS, FAAP , Associate Professor, Division of Plastic & Reconstructive Surgery, Assistant Professor, Institute of Biomaterials and Biomedical Engineering, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Room 5547, Hill Wing, Toronto, ON M5G 1X8, Tel: (416) 813-7654, ext. 228197, Fax: (416) 813-6637, Email: gregory.borschel@sickkids.ca ©2018American Society of Plastic Surgeons

https://ift.tt/2IRFeyi

Response Re: Five Step to Internal Mammary Vessel Preparation in Less than Fifteen Minutes

No abstract available

https://ift.tt/2pFFeIZ

Acellular Human Dermal Allograft as a Graft for Nasal Septal Perforation Reconstruction

Objective: Nasal septal perforations pose a troubling source of morbidity for patients and a difficult problem for the Otolaryngologist. Multiple surgical techniques have been tried with inconsistent success. Prosthetic nasal buttons also have limitations, including patient intolerance and dissatisfaction. Acellular human dermal allograft, AlloDerm™ (LifeCell Branchburg, NJ) has been previously described as an alternative material for septal perforation repair. We aim to demonstrate objective and subjective outcomes, including quantification of patient's symptoms in septal perforation repair with AlloDerm. Methods: A prospective cohort study of twelve patients with 1-2cm anterior septal perforations that were recruited from a tertiary care practice. Patients with admitted smoking or cocaine use in the previous three months, vascular or granulomatous diseases were excluded. Subjective SNOT-22 scores along with objective nasal endoscopy and acoustic rhinometry measures were collected at baseline and 2, 4, and 12 weeks postoperatively, patients were followed for re-perforation 9-20 months post operatively. Data was normalized to baseline values and analyzed using ANOVA and Bonferroni correction. Results: Successful closure of the septal perforation was obtained in 10/12 patients and confirmed with rigid nasal endoscopy. Nasal symptom scores (SNOT-22) were significantly reduced to 52.8% (95%CI[35.1%-70.5.%];p

https://ift.tt/2IQDKV1

Prophylactic Nipple-Sparing Mastectomy and Direct-to-Implant Reconstruction of the Large and Ptotic Breast: Is Preshaping of the Challenging Breast a Key to Success?

No abstract available

https://ift.tt/2pHj0Gn

RE: Macro textured breast implants with defined steps to minimize bacterial contamination around the device.

No abstract available

https://ift.tt/2IOKUsM

Re: Five Steps to Internal Mammary Vessel Preparation in Less than 15 Minutes

No abstract available

https://ift.tt/2I0jkYw

Vertical growth phase as a prognostic factor for sentinel lymph node positivity in thin melanomas: a systematic review and meta-analysis

Background: The 2010 AJCC guidelines recommended consideration of sentinel lymph node (SLN) biopsy for thin melanoma (Breslow thickness IV. Seven studies reported on VGP, which was strongly associated with SLN positivity (odds ratio 4.3; 95% CI, 2.5- 7.7). Conclusion: To date, this is the largest meta-analysis to examine predictors of SLN biopsy positivity in thin melanoma. VGP had a strong association with SLN biopsy positivity, providing support for its inclusion in standardized pathological reporting. The authors have no conflicts of interest to declare ACKNOWLEDGEMENTS: This work was supported in part by a Capital Health Trainee Research Award. The study sponsor had no role in design, collection, analysis or interpretation of the data, and writing the manuscript. The authors thank Kara Thompson and the Research Methods Unit at Dalhousie University for assistance in the meta-analysis and statistics, and Penny Logan from the Capital Health Halifax Infirmary Library for help with the literature search. The authors also wish to thank Dr. Noreen Walsh of the Division of Clinical Dermatology & Cutaneous Science, Department of Pathology, Dalhousie University, for her insightful comments and critique of this manuscript. Corresponding author: Michael Bezuhly, Division of Plastic and Reconstructive Surgery, Dalhousie University, IWK Health Centre, 5850/5980 University Avenue, PO Box 9700, Halifax, Nova Scotia, Canada, B3K 6R8; Tel: +1-902-470-8168, Fax: +1-902-470-7939; E-mail: mbezuhly@dal.ca ©2018American Society of Plastic Surgeons

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Prophylactic Nipple-Sparing Mastectomy and Direct-to-Implant Reconstruction of the Large and Ptotic Breast: Is Preshaping of the Challenging Breast a Key to Success? – Reply to Dr. Bonomi

No abstract available

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Utilizing “Black Bone” MRI in Craniofacial Virtual Surgical Planning: A Comparative Cadaver Study

Background: The use of MRI for virtual surgical planning has not yet been described. In the US, over 600,000 CT scans are performed on children annually, who are at higher risk for developing cancer caused by ionizing radiation compared to adults. The aim of this study is to demonstrate that 3D printed craniofacial surgical guides created from Black Bone MRI are comparable in accuracy to those created from CT scans. Methods: A mock craniosynostosis surgery translocating four calvarial segments was virtually planned and performed in ten cadavers. For five specimens, this planning was performed and 3D-printed guides created using Black Bone MRI scans. Five other specimens underwent standard planning using CT scans. The reconstructed skulls underwent CT scans and 3D-reconstruction. Surgical accuracy was then compared to the virtually-planned surgery. Results: The pre-op Black Bone MRI scan had an average deviation from the pre-op CT scan of 1.37mm. There was no statistically significant difference in the accuracy of guide fit between MRI versus CT-created guides. Average deviation of post-operative anatomy from pre-operative plan was within 1.5mm for both MRI and CT-created guides, with no statistically significant difference in accuracy between the two methods. Planned versus postoperative skull volume was not statistically significant different when MRI versus CT was used. Conclusion: This study demonstrates that virtual surgical planning and 3D surgical guide creation for craniofacial surgery can be performed using Black Bone MRI with comparable accuracy to CT scans. This could dramatically reduce radiation exposure for pediatric and adult craniofacial reconstruction patients. Financial Disclosure Statement: There are no financial disclosures to report. Presented at: Mayo Clinic Chang Gung Symposium in Reconstructive Surgery, Munich, Germany, October 21, 2016 Acknowledgments: This work supported by a generous gift from the Tribuno Family. We would like to thank Kyle Iverson from Mayo Clinic for help with MRI scanning, and Shelby Marks, Cyndi Hoffmeister, and Katie Weimer from 3D Systems for their support and help with scan analysis, segmentation, guide design, and postoperative analysis. We would like to acknowledge the Mayo Clinic Anatomy Department, especially Shaun Heath, Karen Mills, Andy Wilhorn, and Terry Regnier, as well as the noble generosity of the Mayo Clinic's whole body donors whose altruistic gift made this study possible. Corresponding author: Samir Mardini, MD, Professor of Surgery, Mayo Clinic College of Medicine, Program Director, Plastic Surgery, Mayo Clinic, Rochester, MN, Email: mardini.samir@mayo.edu ©2018American Society of Plastic Surgeons

https://ift.tt/2IQJiP6

Protective Effects of Micronized Purified Flavonoid Fraction (MPFF) on a Novel Experimental Model of Chronic Venous Hypertension

Publication date: Available online 24 March 2018
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Maria das Graças C de Souza, Fatima ZGA Cyrino, Jorge J de Carvalho, Vanessa Blanc-Guillemaud, Eliete Bouskela
ObjectivesTo assess protective effects of micronized purified flavonoid fraction (MPFF) on microcirculation in an original chronic model of hind limb venous hypertension with low blood flow in small animals.MethodsVein ligatures were performed on male hamsters, as follows: A-right femoral vein; A + B-right femoral vein and its right branch; A + C-right femoral vein and its left branch; A + B + C-right femoral and its right and left branches; D-external right iliac vein. In sham operated groups, similar vascular dissections were performed without ligatures. Superficial (epigastric) and central (jugular) venous pressure evaluations were made during a 10 week period. Hamsters subjected to A + B + C and D ligatures were selected for leukocyte rolling and sticking, functional capillary density (FCD), and venular and arteriolar diameter observations. D ligature was selected to evaluate pharmacological treatment efficacy. MPFF (100 mg/kg), concomitant active flavonoids of MPFF (diosmetin, hesperidin, linarin, and isorhoifolin) (10 mg/kg), diosmin (100 mg/kg) or drug vehicle were administered orally during 2 weeks before vein ligature and 6 weeks thereafter.ResultsA, A + B and A + C models maintained venous return through collaterals. From the 2^nd to the 10^th weeks after vein ligatures, A + B + C and D models elicited a progressive increase of superficial venous pressure (3.83 ± 0.65 vs. 8.56 ± 0.72 mmHg, p < .001 and 4.13 ± 0.65 vs. 9.35 ± 0.65 mmHg, p < .001, respectively) with significant changes to the microcirculation. As D model significantly increased superficial venous pressure without affecting central venous pressure, it was used to evaluate the long-term effects of treatment. Compared with vehicle, MPFF, concomitant active flavonoids of MPFF, and diosmin, significantly decreased leukocyte-endothelium interaction and prevented FCD reduction. Only MPFF significantly prevented venular enlargement as observed in the vehicle treated group.ConclusionMPFF was more effective than diosmin in improving all microvascular variables. The superiority of MPFF over diosmin alone can be explained by the synergistic beneficial effects of the association between diosmin and active flavonoids of MPFF.



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Regulation of Adipose Tissue Metabolism by the Endocannabinoid System

Publication date: Available online 24 March 2018
Source:Trends in Endocrinology & Metabolism
Author(s): Robin van Eenige, Mario van der Stelt, Patrick C.N. Rensen, Sander Kooijman
White adipose tissue (WAT) stores excess energy as triglycerides, and brown adipose tissue (BAT) is specialized in dissipating energy as heat. The endocannabinoid system (ECS) is involved in a broad range of physiological processes and is increasingly recognized as a key player in adipose tissue metabolism. High ECS tonus in the fed state is associated with a disadvantageous metabolic phenotype, and this has led to a search for pharmacological strategies to inhibit the ECS. In this review we present recent developments that cast light on the regulation of adipose tissue metabolism by the ECS, and we discuss novel treatment options including the modulation of endocannabinoid synthesis and breakdown enzymes.



https://ift.tt/2pFc6RR

Client and clinician-rated characteristics of problem gamblers with and without history of gambling-related illegal behaviors

Publication date: September 2018
Source:Addictive Behaviors, Volume 84
Author(s): Jennifer D. Ellis, Jamey J. Lister, Cara A. Struble, Molly Cairncross, Meagan M. Carr, David M. Ledgerwood
Individuals with gambling disorder are at an elevated risk for engaging in gambling-related illegal behaviors. The present study examined client (N = 88) and clinician ratings (N = 30) of client characteristics associated with a history of gambling-related illegal behaviors. We also examined client characteristics associated with history of arrest for a gambling-related crime. Gambling-related illegal behaviors and arrest were common (57.3% and 23.9%, respectively) in the present sample. Clients of younger age, and those with greater gambling-related financial consequences, lifetime alcohol problems, impulsivity, mood symptoms, and daily living role difficulties were more likely to report gambling-related illegal behaviors. Clients who had been arrested for a gambling-related crime were more likely to report daily living and role functioning difficulties and lifetime alcohol problems. Clinicians rated clients with a history of gambling-related illegal behaviors and/or gambling-related arrests as more impulsive, and clinicians also endorsed higher rates of treatment failure among these clients. Both client and clinician report suggested that clients with a history of illegal behaviors may have a variety of comorbid problems that may be a focus of clinical intervention.



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Basal Cell Carcinoma Arising at the Site of a Lip Piercing

No abstract available

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Skin and Soft Tissue Surgery in the Office Versus Operating Room Setting: An Analysis Based on Individual-Level Medicare Data

BACKGROUND The relative volume of skin and soft tissue excision and reconstructive procedures performed in the outpatient office versus facility (ambulatory surgical center or hospital) differs by specialty, and has major implications for quality of care, outcomes, development of guidelines, resident education, health care economics, and patient perception. OBJECTIVE To assess the relative volume of surgical procedures performed in each setting (office vs ambulatory surgery center [ASC]/hospital) by dermatologists and nondermatologists. METHODS A cross-sectional analytical study was performed using the Medicare public use file (PUF) for 2014, which includes every patient seen in an office, ASC, or hospital in the United States billed to Medicare part B. Data were divided by physician specialty and setting. RESULT A total of 9,316,307 individual encounters were included in the Medicare PUF. Dermatologists account for 195,001 (2.1%) of the total. Dermatologists were more likely to perform surgical procedures in an office setting only (odds ratio 5.48 [95% confidence interval 5.05–5.95], p

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Impact of Muir–Torre Syndrome on Survival in Patients With Sebaceous Carcinoma: A SEER Population-Based Study

No abstract available

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

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

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Osteosarcoma of the jaw: Challenges in the diagnosis and treatment

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Mohamed Atef ElKordy, Tarek Sherif ElBaradie, Hisham Ismael ElSebai, Ayman Abd ElWahab Amin, Sheriff Mohamed KhairAlla
PurposeOsteosarcomas rarely affect jaw bones. Patients are usually older than those who suffer long bone sarcomas, with a rare incidence of metastasis. This is suggestive of a different pattern of behavior compared with long bone sarcomas. This study aimed to present NCI, Cairo University experience in treating patients diagnosed with osteosarcomas of the jaw, including the diagnostic challenges and treatment outcome.Patients and methodsThis is a retrospective case series study of all cases of osteosarcomas of mandible and maxilla that were treated at the NCI, in the period between 2006 and 2013. Patients' data, including demographic data, various clinical presentations, results of investigations, treatment modalities performed and outcomes, were collected from hospital records kept in the Biostatistics Department at NCI.ResultsRecords showed 21 cases of osteosarcoma of the jaw. The mandible was affected in 15 cases, the maxilla in six. Two cases had sun-ray periosteal reactions. Erroneous biopsy results were found in 4 cases compared with final pathology reports of surgical resections. All cases underwent surgical resections, with 8 cases having positive margins. The median follow-up period was 19.3 months (range 0.3–98.0 months). The cumulative disease-free survival (DFS) was 27.5% and the median DFS was 72 months. The cumulative overall survival at end of the study was 77.4%.ConclusionsOsteosarcoma of the jaw is challenging both to diagnose and manage. This is due to the high incidence of mistakes in biopsy results, rare specific radiological features and difficulties in proper resection due to proximity to vital structures.



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First-line paclitaxel and cisplatin used sequentially or in combination in metastatic breast cancer: A phase II randomized study

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Mostafa M. Elserafi, Ahmed A. Zeeneldin, Ibrahim M. Abdelsalam, Hanan R. Nassar, Manar M. Moneer, Wafa H. Buhoush
IntroductionBreast cancer (BC) is the commonest cancer among females worldwide. Some patients present initially at advanced stages and more than 50% of them will develop metastasis (MBC) at some point. Compared to single agents, combination chemotherapy produces higher response rates (RR), longer progression-free survival (PFS) than single agents. This is associated with remarkably higher toxicities. At the same time, overall survival (OS) is comparable. This study aimed to compare safety and efficacy of combination and sequential chemotherapy.Patients and MethodsForty-six MBC patients were randomized to receive 6 cycles of the combination of paclitaxel (175 mg/m²) and cisplatin (70 mg/m²) (combination PC) or paclitaxel for 3 cycles followed by cisplatin for 3 cycles (sequential PC). Endpoints were RR, PFS, OS and safety.ResultsBoth combination and sequential PC produced similar RR (52% in both arms) and disease control rates (78.3% vs. 73.9%, p = .652). Responses were faster in the combination arm. Median PFS was 8.2 months in the combination compared to 5.0 months in the sequential arm (p = .064). The median OS was 16.5 and 18.8 months in the combination and sequential arms, respectively (p = .866). The combination was more toxic than sequential PC. Grade 3 toxicities were higher with combination PC than to sequential PC (48% vs. 4.3%; p < .001).ConclusionSequential agent chemotherapy may provide similar response rate and overall survival to combination chemotherapy with much lower toxicities. The former can be considered the standard practice in most instances.



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Survival outcome of intermediate risk neuroblastoma at Children Cancer Hospital Egypt

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Hossam Elzomor, Gehad Ahmed, Salma Elmenawi, Naglaa Elkinaai, Amal Refaat, Sonya Soliman, Mai Amr Abdelwahab, Mohamed Saad Zaghloul, Mohamed Fawzy
AimThe study aims to evaluate survival outcome in newly diagnosed pediatric intermediate risk neuroblastoma patients treated at the Children Cancer Hospital – Egypt and their relation to various clinical and pathological factors.MethodsThe study included stage 3 patients <1.5 years, children 1.5 years or older with stage 3 disease and favorable histopathological features, infants (<1 year) with International Neuroblastoma Staging System (INSS) stage 4 disease, stage 4 children 1–1.5 years with favorable biology, and infants stage 4 s (with unfavorable biologic features). Patients received systemic chemotherapy, in the form of etoposide and carboplatin alternating with cyclophosphamide, doxorubicin and vincristine, administered at 3-week intervals, with a total of 6 or 8 cycles guided by reaching objective overall response (complete/very good partial/partial response).ResultsThe study included 136 patients, 67 males and 69 females. 101 patients had abdominal primary tumors, 28 had mediastinal masss and 7 with masses in the neck; 68% were stage 3 and the remaining (n = 44) had metastatic disease.The three-year overall survival (OS) and event-free survival (EFS) estimates were 94% ± 2% and 90.9% ± 2.5%, respectively. OS and EFS by gender, age, pathology and INPC were all statistically not significantly different. Moreover, OS for patients having surgery versus no surgery (inoperable residual only) was statistically significant (98.4% ± 1.6% & 88.7% ± 5.3%, respectively, p = .034).ConclusionA very high rate of survival is currently achievable in patients with intermediate risk neuroblastoma by chemotherapy or chemotherapy and surgery. In addition to response, our plan is to adopt biologically-based treatment to reduce treatment-induced complications among survivors.



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Comparative study on the analgesic effect of acute ipsilateral shoulder pain after open thoracotomy between preoperative ultrasound guided suprascapular nerve block (SNB) and intraoperative phrenic nerve infiltration (PNI) in cancer lung patients

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Bassel M. Elfokery, Sahar A. Tawfic, Abdelrahman M. Abdelrahman, Dina N. Abbas, Ikramy M. Abdelghaffar
IntroductionAcute ipsilateral shoulder pain (ISP) is a common complaint in patients after thoracotomy. The incidence ranges from 21% to 97%. Unfortunately, clinical studies did not put enough focus on ISP post thoracic surgery.Aim of the workThis study was designed to compare the effectiveness of suprascapular nerve block (SNB) and phrenic nerve infiltration (PNI) for controlling ISP.Patients and methodsOne hundred and thirty-five lung cancer patients (135) scheduled for open-lung surgery were randomly allocated into three equal groups; control group: received thoracic epidural with general anesthesia, suprascapular group: (SNB) one hour before the operation with 10 ml bupivacaine plus thoracic epidural with general anesthesia and phrenic nerve group: (PNI) was performed by the operating surgeon with 10 ml bupivacaine plus thoracic epidural with general anesthesia.The visual analogue score (VAS) of ISP, rescue of ketorolac for break through shoulder pain, peak expiratory flow rate (PEFR) and arterial blood gases were measured every 6 h postoperatively for 48 h.ResultsThe VAS, rescue doses of ketorolc and PEFR were significantly lower in the phrenic nerve group (P-value <0.05). There was no statistically significant difference between the three groups postoperatively as regards arterial blood gases (P-value >0.05).ConclusionPNI is more effective than SNB for ISP.



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Radiotherapeutic factors affecting the incidence of developing hypothyroidism after radiotherapy for head and neck squamous cell cancer

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Mohamed El-Shebiney, Nehal El-mashad, Wael El-mashad, Ahmed A. El-Ebiary, Abdallah E. Kotkat
PurposeThe purpose of this study is to determine radiotherapy (RT) dose-volumetric threshold of radiation-induced hypothyroidism (HT) in head and neck squamous cell carcinoma (HNSCC) patients.Patients and methodsThe diagnosis of HT in 78 HNSCC patients treated with RT was based on a thyroid stimulating hormone (TSH) level greater than the maximum value of laboratory range. In all patients, dose-volumetric parameters were analyzed according to their relation to development of HT, and thyroid volumes spared from doses ≥10, 20, 30, 40 and 50 Gy (V10, V20, V30, V40 and V50) were analyzed from the dose volume histograms (DVHs).ResultsMedian follow-up duration was 31 months. At the end of study, 33 patients (42.3%) developed HT and the cumulative incidence of HT was 24.6%, 36.5% and 42.3% at one, two and three years, respectively. V30 of 42.1% (P = 0.005) was defined as dose-volumetric threshold of radiation-induced HT in HNSCC patients. Our analysis showed that V30 separates patients into low- and high-risk groups; the incidence of radiation-induced HT in the group with V30 < 42.1% and V30 ≥ 42.1% was 29.4% and 71.4%, respectively (P = 0.002).ConclusionsThe V30 may predict risk of developing HT after RT for HNSCC patients. V30 of 42.1%, defined as dose-volumetric threshold of radiation-induced HT, can be useful in treatment planning of HNSCC patients.



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Reinforcing the utility of chick embryo model to in vivo evaluate engraftment of human leukemic stem cells

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Arwa Farhat, Eiad Ali-Deeb, Amin Sulaiman, Majd Aljamali
Background and ObjectiveDevelopment of appropriate translational in vivo models is a prerequisite for personalized management of leukemic patients. Indeed, several immunodeficient mice models were developed for leukemias with main limitations due to their high cost, demanding management, and elongated assessment intervals. In this report, we aimed at evaluating the engraftment of CD34⁺ cells, isolated from an acute myeloid leukemia (AML) patient, in naturally immunodeficient chick embryo model.Methods and ResultsMononuclear cells or immunomagnetic sorted CD34⁺ cells were injected into chick embryo chorioallantoic membrane (CAM) veins. Seven days post-injection, human CD34 transcript was detected by reverse transcription polymerase chain reaction (RT-PCR) in blood, bone marrow (BM), spleen and liver from embryos injected with human leukemic cells. Interestingly, an amplicon of the same length has been detected in both BM and spleen from PBS injected embryos, although analysis via bioinformatics tools revealed no matches in chicken; neither in transcriptome nor in genome databases. Importantly, splenomegaly and hepatic lesions were observed in some CD34⁺ cells injected embryos.ConclusionCollectively, our data confirm the engraftment of primary human CD34⁺ leukemic cells in chick embryo liver, but other experiments are required to verify engraftment in BM and spleen, and to confirm the identity of a putative CD34 orthologous transcript in these two organs.



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Osteosarcoma subtypes: Magnetic resonance and quantitative diffusion weighted imaging criteria

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Rania Zeitoun, Ahmed M. Shokry, Sahar Ahmed Khaleel, Shaimaa M. Mogahed
IntroductionOsteosarcoma (OS) is a primary bone malignancy, characterized by spindle cells producing osteoid. The objective of this study is to describe the magnetic resonance imaging (MRI) features of different OS subtypes, record their attenuation diffusion coefficient (ADC) values and to point to the relation of their pathologic base and their corresponding ADC value.Patients and methodsWe performed a retrospective observational lesion-based analysis for 31 pathologically proven osteosarcoma subtypes: osteoblastic (n = 9), fibroblastic (n = 8), chondroblastic (n = 6), para-osteal (n = 3), periosteal (n = 1), telangiectatic (n = 2), small cell (n = 1) and extra-skeletal (n = 1). On conventional images we recorded: bone of origin, epicenter, intra-articular extension, and invasion of articulating bones, skip lesions, distant metastases, pathological fractures, ossified matrix, hemorrhage and necrosis. We measured the mean ADC value for each lesion.ResultsAmong the included OS lesions, 51.6% originated at the femur, 29% showed intra-articular extension, 16% invaded neighboring bone, 9% were associated with pathological fracture and 25.8% were associated with distant metastases. On MRI, all lesions showed ossified matrix, 35.5% showed hemorrhage and 58% showed necrosis. The mean ADC values for OS lesions ranged from 0.74 × 10⁻³ mm²/s (recorded for conventional osteoblastic OS) to 1.50 × 10⁻³ mm²/s (recorded for telangiectatic OS) with an average value of 1.16 ± 0.18 × 10⁻³ mm²/s. Conventional chondroblastic OS recorded higher values compared to the other two conventional subtypes.ConclusionOsteosarcoma has different pathologic subtypes which correspondingly vary in their imaging criteria and their ADC values.



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Parasite allergens

Publication date: Available online 24 March 2018
Source:Molecular Immunology
Author(s): Luis Caraballo, Sandra Coronado
Human IgE against helminths is a normal component of the whole protective response elicitesd during infection, when specific IgE to a great number of antigens is produced; however, few of those IgE binding components are actually allergens. In general, considering the strong Th2/IgE responses during helminth infections is intriguing that they are not usually associated with allergic symptoms, which probably (but not exclusively) depends on parasite-induced immunomodulation. However, allergic manifestations have been described during some helminth infections such as ascariasis, strongyloidiasis, anisakiasis and hydatidosis. In addition, there is evidence that helminthiases (e.g. ascariasis) can increase symptoms in allergic patients. Furthermore, allergic reactions during anti-helminth vaccination have been observed, a problem that also could be associated to the future use of parasite derived immunomodulators. Therefore, identification and characterization of helminth allergens is a matter of increasing research and a great number of IgE binding antigens have been found (www.allergen.org and www.allergome.org). Here we describe only a small group of them, for which allergenic activity (the ability to induce IgE mediated inflammation) have been clinical or experimentally demonstrated. Ascaris lumbricoides tropomyosin (Asc l 3) has strong allergenic activity; in the Tropics it has been associated with asthma and asthma severity, suggesting clinical relevance. In addition, due to its cross reactivity with mite tropomyosins this allergen could influence house dust mite (HDM) allergy diagnosis. Characterized Ascaris allergens also include the polyprotein As s 1 (ABA-1) and the Glutathione transferase As l 13. Other helminth allergens include Anisakis simplex Ani s 1, Ani s 4, Ani s 7 and Ani s 9; Necator americanus NaASP2q and Nacal1 and Schistosoma mansoni SmVAL4 and Sm22.6. Future work on helminth IgE binding antigens will help to understand several aspects of allergenicity and allergenic activity, among them the increasing finding of IgE binding molecules that not induce allergic symptoms.



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Editorial Board

Publication date: April 2018
Source:Brain Research Bulletin, Volume 138





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Mesoscale connectomics

Publication date: June 2018
Source:Current Opinion in Neurobiology, Volume 50
Author(s): Hongkui Zeng
Brain cells communicate with one another via local and long-range synaptic connections. Structural connectivity is the foundation for neural function. Brain-wide connectivity can be described at macroscopic, mesoscopic and microscopic levels. The mesoscale connectome represents connections between neuronal types across different brain regions. Building a mesoscale connectome requires a detailed understanding of the cell type composition of different brain regions and the patterns of inputs and outputs that each of these cell types receives and forms, respectively. In this review, I discuss historical and contemporary tracing techniques in both anterograde and retrograde directions to map the input and output connections at population and individual cell levels, as well as imaging and network analysis approaches to build mesoscale connectomes for mammalian brains.



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Fatigue failure load of two resin-bonded zirconia-reinforced lithium silicate glass-ceramics: Effect of ceramic thickness

Publication date: Available online 24 March 2018
Source:Dental Materials
Author(s): Jaiane Bandoli Monteiro, Hilton Riquieri, Catina Prochnow, Luís Felipe Guilardi, Gabriel Kalil Rocha Pereira, Alexandre Luiz Souto Borges, Renata Marques de Melo, Luiz Felipe Valandro
ObjectivesTo evaluate the effect of ceramic thickness on the fatigue failure load of two zirconia-reinforced lithium silicate (ZLS) glass-ceramics, adhesively cemented to a dentin analogue material.MethodsDisc-shaped specimens were allocated into 8 groups (n=25) considering two study factors: ZLS ceramic type (Vita Suprinity — VS; and Celtra Duo — CD), and ceramic thickness (1.0; 1.5; 2.0; and 2.5mm). A trilayer assembly (ϕ=10mm; thickness=3.5mm) was designed to mimic a bonded monolithic restoration. The ceramic discs were etched, silanized and luted (Variolink N) into a dentin analogue material. Fatigue failure load was determined using the Staircase method (100,000 cycles at 20Hz; initial fatigue load ∼60% of the mean monotonic load-to-failure; step size ∼5% of the initial fatigue load). A stainless-steel piston (ϕ=40mm) applied the load into the center of the specimens submerged in water. Fractographic analysis and Finite Element Analysis (FEA) were also performed.ResultsThe ceramic thickness influenced the fatigue failure load for both ZLS materials: Suprinity (716N up to 1119N); Celtra (404N up to 1126N). FEA showed that decreasing ceramic thickness led to higher stress concentration on the cementing interface.SignificanceDifferent ZLS glass-ceramic thicknesses influenced the fatigue failure load of the bonded system (i.e. the thicker the glass ceramic is, the higher the fatigue failure load will be). Different microstructures of the ZLS glass-ceramics might affect the fatigue behavior. FEA showed that the thicker the glass ceramic is, the lower the stress concentration at the tensile surface will be.



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