Evaluation of the therapeutic effect of micro-plasma radio frequency on hypertrophic scars in rabbit ears

Abstract

To evaluate the therapeutic effect of micro-plasma radio frequency on hypertrophic scars in rabbit ears to provide an experimental basis and theoretical foundation for the treatment of hypertrophic scars. Hypertrophic scars were established on the ventral surface of the ears of six New Zealand white rabbits. Left and right ears were randomly divided into two groups: experimental group treated with micro-plasma radio frequency and control group with no treatment. H&E staining and CD34 labeling of microvessels were performed to analyze ear specimens, and immunohistochemical staining was conducted to detect IL-8 and MCP-1 in the scars. Compared with the control group, scar tissue in the experimental group was improved by color and texture. H&E-stained collagen fiber bundles were more organized after treatment as assessed by optical microscopy. The number of microvessels in the experimental group was decreased compared with that in the control group. Microvascular density was significantly reduced in the experimental group compared with the control group (27.16 ± 5.64 and 48.75 ± 8.25 mm², respectively; P < 0.01). The mean optical densities of IL-8 and MCP-1 were significantly reduced in the experimental group compared with the control group (IL-8 0.016 ± 0.011 and 0.078 ± 0.023, respectively; MCP-1 0.018 ± 0.016 and 0.054 ± 0.038, respectively; both P < 0.01). The micro-plasma radio-frequency technique has a therapeutic effect on hypertrophic scars in rabbit ears.

https://ift.tt/2urpTht

Targeting the IL-23/IL-17 Pathway in Psoriasis: the Search for the Good, the Bad and the Ugly

Abstract

New promising treatments have been developed for psoriasis that target different parts of the interleukin (IL)-23/IL-17 pathway. This approach is believed to be more disease specific, and sparing the T helper 1 pathway might prevent serious long-term adverse events. Moreover, superior Psoriasis Area and Severity Index improvements are observed, which has redefined treatment goals in psoriasis. The new molecules can be divided into different categories, according to the target: blocking agents can target the upstream cytokine IL-23 or the downstream IL-17. In the latter, a variety of targets exist, such as the ligands IL-17A and IL-17F, or a combination thereof, or a subunit of the receptor, IL-17RA. Each target seems to have its own set of advantages and pitfalls, which will impact the treatment decision in clinical practice. In this review, we summarize the current knowledge on the different inhibitors of the IL-23/IL-17 pathway. Furthermore, we briefly discuss the role of IL-17 in other diseases and comorbidities. Finally, we discuss how comprehensive knowledge is needed for the prescribing physician in order to make the most appropriate therapeutic choice for each individual patient.

https://ift.tt/2L4IkTl

Gonadotrophin‐inhibitory hormone and its mammalian orthologue RFamide‐related peptide‐3: Discovery and functional implications for reproduction and stress

Journal of Neuroendocrinology, Volume 30, Issue 7, July 2018.


https://ift.tt/2JhIthl

Effects of prenatal stress on anxiety‐ and depressive‐like behaviours are sex‐specific in prepubertal rats

Journal of Neuroendocrinology, Volume 30, Issue 7, July 2018.


https://ift.tt/2L9xE6h

Role of oxytocin in parental behaviour

Journal of Neuroendocrinology, Volume 30, Issue 7, July 2018.


https://ift.tt/2JhbE4b

Issue Information

Journal of Neuroendocrinology, Volume 30, Issue 7, July 2018.


https://ift.tt/2L47rWs

Maternal regulation of the infant's hypothalamic‐pituitary‐adrenal axis stress response: Seymour ‘Gig’ Levine's legacy to neuroendocrinology

Journal of Neuroendocrinology, Volume 30, Issue 7, July 2018.


https://ift.tt/2Jhbw4H

Low-level laser therapy (830 nm) on orthodontic pain: blinded randomized clinical trial

Abstract

The objective of this research was to compare the effect single low-level laser therapy (LLLT) irradiation on pain perception in patients having fixed appliance treatment in the clinic of orthodontics. Sixty-two patients were recruited to participate in this randomized, double-blinded, placebo-controlled study. The patients were assigned to four groups: group I—laser on the right side; group II—placebo on the right side; group III—laser on the left side; group IV—placebo on the left. The laser or placebo was applied before separation, 24 and 48 h after separation of their first permanent molars in the lower arch. Just after the separation, the average of the pain for the placebo group was 1.6, significantly greater than the average of 1.1 registered for the laser group (p = 0.013). After 24 h and before the new irradiation, the values registered among the different groups did not show any differences. In relation to the gender, only after the first irradiation in placebo group, the female had a level of pain (0.1) significantly higher (p = 0.04) compared to male, and after 48 h, the group where the laser was applied had a difference (p = 0.04) among the gender with a value of lower pain for men (0.6) than for women (1.6).

The laser irradiation to minimize the pain was only effective when applied immediately after treatment and separation. In general way, there were no differences between the genders, except after the first placebo group irradiation in which the female had a significantly higher level of pain compared to male and after 48 h. The pain cycle observed in this study had its peak in 24 h, both for laser's and placebo's group.

https://ift.tt/2ztPJHj

Development of immunochromatographic assays for the detection of imidacloprid in soil chemical barrier

Abstract

A soil chemical barrier is the most important and common way to control termites; fast and on-site detection methods are significant tools to verify pesticide content meeting the standard requirements. In this study, conventional and enhanced immunochromatographic assays (ICAs) containing two test lines (TLs) were developed to semi-quantitatively detect imidacloprid in soil chemical barrier, and detection results were quantified by a smart phone. According to the results, the disappearance concentrations of first TL (TL-1) and second TL (TL-2) in an enhanced ICA and conventional ICA were 5 and 20 ng/mL and 20 and 80 ng/mL with the naked eye. The sensitivity of TL-2 was four times that of TL-1 in both ICAs, consistent with the maximum and minimum concentration differences for imidacloprid in Jiangsu province's "the technical regulation of assay and evaluation on chemical soil barrier of termite prevention treatment in buildings". The results of TLs can be used to judge whether the amount of imidacloprid in soil chemical barrier meets the standard. Enhanced and conventional ICAs were available for further quantitative testing with a smart phone, and the limit of detection (LOD) was 0.74 and 3.17 ng/mL, respectively. Moreover, some soil chemical barrier samples from several areas in Wuxi, Jiangsu province, were used to test by ICAs and high-performance liquid chromatography (HPLC), and the results of ICAs correlated well with HPLC.

https://ift.tt/2ufZDqW

S-incorporated TiO 2 coatings grown by plasma electrolytic oxidation for reduction of Cr(VI)-EDTA with sunlight

Abstract

The plasma electrolytic oxidation (PEO) technique was used to prepare photocatalytic S-TiO₂ coatings on Ti sheets; the incorporation of the S ions was possible from the electrolyte for modifying the structural and optics characteristics of the material. In this work, substrates of Ti (ASME SB-265 of 20 × 20 × 1 mm) were used in a PEO process in 10 min, using constant voltage pulses of 340 V with frequency of 1 kHz and duty cycles of 10% and of 30%. Solutions with H₂SO₄ (0.1 M) and CH₄N₂S (52 and 79 mM) were used as electrolytes. X-ray diffraction, scanning electron microscopy, and energy dispersive spectroscopy (EDS) were utilized to analyze the surface morphology, crystalline phase, and chemical composition of the samples. According to the results, the catalyst coatings had microporous structure and contained anatase-rutile TiO₂ nanocrystalline mixture, until 73.2% rutile and 26.8% anatase in the samples grown with 30% duty cycle and the lowest concentration of CH₄N₂S. From the EDS measurements, the incorporation of sulfur ions to the coatings was 0.08 wt%. 99.5% reduction efficiency of Cr(VI)-EDTA with sunlight was observed after 2 h; it was determined by diphenyl carbazide spectrophotometric method. These coatings have potential for effective sunlight heterogeneous photoreduction of this toxic, cumulative, and non-biodegradable heavy metal that contaminates the soil and water and is a serious risk to sustainability, ecosystems, and human health.

https://ift.tt/2zxMI8U

Irradiation Delays Tissue Growth but Enhances Osteogenic Differentiation in Vascularized Constructs

J reconstr Microsurg
DOI: 10.1055/s-0038-1667048

Background Regenerative medicine is still deficient in the reconstruction after cancer due to impaired vascularization after radiotherapy and due to the need to substitute larger defects after tumor excision. Aiming at introducing regenerative medicine for reconstruction after cancer, we tested an axially vascularized bone construct in an experimental setting that mimics the clinical situation after tumor resection and adjuvant radiotherapy. Methods Twenty bone constructs were axially vascularized using microsurgically created arteriovenous loops and were implanted subcutaneously in Lewis rats. After 2 weeks, the animals were randomly allocated either to receive a clinically relevant single dose of external beam irradiation or not (n = 10 for each group). The animals were sacrificed either after 1 week or 10 weeks after irradiation (n = 5 for each time point). The constructs were tested for vascularization, tissue growth, cellular proliferation, cellular apoptosis, and osteogenic differentiation via histomorphometric, immunohistochemical, and polymerase chain reaction (PCR) analysis. One construct per group was subjected at 10 weeks to qualitative micro-computed tomography (CT) imaging. Results Tissue generation and cellular proliferation were significantly reduced at 1 week after irradiation, but no longer significantly different after 10 weeks.No significant differences in vascularization were detected at any time point. Apoptosis did not show any statistically significant differences between both groups at both time points. At the late time point, mature bone was considerably more in the irradiated group, but the results were not statistically significant. PCR analysis showed a significantly enhanced expression of osteocalcin in the irradiated group at 1 week. Micro-CT imaging showed that both constructs were adequately vascularized with no evident morphologic differences regarding vascular density or vascular distribution. Conclusions Axially vascularized bone constructs can withstand clinically relevant doses of irradiation and retain their angiogenic and osteogenic potential in the long term. Irradiation led to a delayed tissue generation with a comparatively enhanced osteogenic differentiation within the constructs.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

https://ift.tt/2ubVEf6

Developing a Three-Layered Synthetic Microsurgical Simulation Vessel

J reconstr Microsurg
DOI: 10.1055/s-0038-1657791

Background Microsurgery is increasingly relevant, and is difficult to learn. Simulation is relied upon ever more in microvascular training. While living models provide the ultimate physiological feedback, we are ethically obliged to optimize non-living models to replace, refine, and reduce the use of animals in training. There is currently no three-layered synthetic vessel available for microsurgical training. Methods A three-layered synthetic vessel was designed with a simulation company. One anastomosis was performed by 14 microsurgical experts at one center. The realism of the vessel was assessed via user questionnaires and the construct validity using objective, validated task scores to assess the anastomosis performance and the final product. Videos were obtained, which were anonymized and marked remotely by a consultant plastic surgeon. Results The synthetic vessel intima and media displayed reasonable realism, while the adventitia was less realistic. Areas for improvement were identified. Both the task specific assessment score and the final product assessment appropriately identified experts. Conclusion A three-layered synthetic model for microvascular training is a hygienic and useful intermediate-level alternative to commonly used synthetic and ex vivo alternatives.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

https://ift.tt/2zvqOmN

Sink into the Epigenome: Histones as Repositories That Influence Cellular Metabolism

Publication date: Available online 11 July 2018

Source: Trends in Endocrinology & Metabolism

Author(s): Cunqi Ye, Benjamin P. Tu

Epigenetic modifications on chromatin are most commonly thought to be involved in the transcriptional regulation of gene expression. Due to their dependency on small-molecule metabolites, these modifications can relay information about cellular metabolic state to the genome for the activation or repression of particular sets of genes. In this review we discuss emerging evidence that these modifications might also have a metabolic purpose. Due to their abundance, the histones have the capacity to store substantial amounts of useful metabolites or to enable important metabolic transformations. Such metabolic functions for histones could help to explain the widespread occurrence of particular modifications that may not always be strongly correlated with transcriptional activity.

https://ift.tt/2L68iWH

Mitteilungen DGKFO

https://ift.tt/2NFFEKu

Colloidal mobilization from soil and transport of uranium in (sub)-surface waters

Abstract

An analytical methodology was developed to characterize the colloidal distribution of trace elements of interest in environmental waters sampled in a same site and enables the different colloidal distributions from waters to be compared. The purpose was to provide consistent information related to the origin and nature of colloids responsible for the transport of trace element(s). The work was motivated by the observed enhanced mobility of uranium in soil. The colloidal size continuum was investigated by a multi-technique approach involving asymmetric flow field-flow fractionation (AF4) coupled with ultraviolet spectroscopy (UV), multi angle light scattering (MALS), and atomic mass spectrometry (ICPMS). To take into consideration the size and shape variability specific to each sample, the size distributions were established from the gyration radii measured from MALS, also considering the size information from standard nanospheres fractionated by AF4. A new parameter called "shape index" was proposed. It expresses the difference in hydrodynamic behavior between analytes and spherical particles taken as reference. Under AF4 diffusion conditions, it can be considered as an evaluator of the deviation from the sphericity of the fractionated analytes. AF4-UV-MALS-ICPMS enabled the dimensional and chemical characteristics of the colloidal size continuum to be obtained. As a "proof of concept", the developed methodology was applied at a field scale, in a reference study site. In order to have a "dynamic understanding", the investigation was based on the joint characterization of colloids from surface waters and soil leachates from static and dynamic processes. In the water samples of the study site, the continuum of gyration radius ranged from a few nanometers up to 200 nm. Colloids containing iron, aluminum, and organic carbon were involved in the uranium transport in the soil column and surface waters. The colloidal uranium concentration in the surface water increased from the upstream location (approximately 13 ng (U) L⁻¹) to the downstream location (approximately 60 ng (U) L⁻¹).

https://ift.tt/2zvl7oV

Comparison of the clinical performance of upper abdominal PET/DCE-MRI with and without concurrent respiratory motion correction (MoCo)

Abstract

Purpose

To compare the clinical performance of upper abdominal PET/DCE-MRI with and without concurrent respiratory motion correction (MoCo).

Methods

MoCo PET/DCE-MRI of the upper abdomen was acquired in 44 consecutive oncologic patients and compared with non-MoCo PET/MRI. SUVmax and MTV of FDG-avid upper abdominal malignant lesions were assessed on MoCo and non-MoCo PET images. Image quality was compared between MoCo DCE-MRI and non-MoCo CE-MRI, and between fused MoCo PET/MRI and fused non-MoCo PET/MRI images.

Results

MoCo PET resulted in higher SUVmax (10.8 ± 5.45) than non-MoCo PET (9.62 ± 5.42) and lower MTV (35.55 ± 141.95 cm³) than non-MoCo PET (38.11 ± 198.14 cm³; p < 0.005 for both). The quality of MoCo DCE-MRI images (4.73 ± 0.5) was higher than that of non-MoCo CE-MRI images (4.53±0.71; p = 0.037). The quality of fused MoCo-PET/MRI images (4.96 ± 0.16) was higher than that of fused non-MoCo PET/MRI images (4.39 ± 0.66; p < 0.005).

Conclusion

MoCo PET/MRI provided qualitatively better images than non-MoCo PET/MRI, and upper abdominal malignant lesions demonstrated higher SUVmax and lower MTV on MoCo PET/MRI.

https://ift.tt/2L3KWAY

A Comprehensive Review of Immune-Mediated Dermatopathology in Systemic Lupus Erythematosus

Publication date: Available online 11 July 2018

Source: Journal of Autoimmunity

Author(s): Qianwen Li, Haijing Wu, Wei Liao, Ming Zhao, Vera Chan, Linfeng Li, Min Zheng, Genhui Chen, Jianzhong Zhang, Chak-Sing Lau, Qianjin Lu

Abstract

Lupus erythematosus (LE) is an autoimmune disease with a broad clinical spectrum ranging from cutaneous lesions to severe systemic manifestations. The pathogenesis of the disease and the immunological mechanisms for the heterogeneities in lupus remain unclear. The LE-specific cutaneous manifestations are generally divided into three categories: acute cutaneous LE (ACLE), subacute cutaneous LE (SCLE) and chronic cutaneous lupus erythematosus (CCLE). Clinically, lupus patients with skin lesions can be divided into two subsets based on the organs involved: cutaneous LE, such as DLE and SCLE, which appears only as a skin manifestation, and systemic lupus erythematosus (SLE), e.g., ACLE, which involves other organs, such as kidneys, joints, and the hematopoietic system. However, lupus is an aggressive disease, and cutaneous lupus and systemic lupus partially overlap. Fewer than 5% of DLE patients and approximately 50% of SCLE patients might develop major organ damage and then develop SLE in subsequent years. Furthermore, there are no predictive biomarkers in clinical use. To the best of our knowledge, increasing evidence from clinical trials has revealed that early intervention can either reduce or delay the onset of severe manifestations. Therefore, identification of certain biomarkers in skin lesions or circulation from patients with skin lesions to predict future flares and advise treatment is an unmet need. In this review, we comprehensively describe the subtypes of LE with pathological criteria and clinical manifestations; summarize the up-to-date evidence on certain cell distributions, such as keratinocytes, neutrophils, dendritic cells, T cells and B cells, in skin and peripheral blood; and discuss their pathogenic roles and their potential roles in predictive diagnosis and as therapeutic targets.

https://ift.tt/2uqGoub

CME Part II Psoriasis: Which Therapy for Which Patient Focus on special populations and chronic infections

Publication date: Available online 11 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Shivani B. Kaushik, Mark G. Lebwohl

Abstract

Despite the availability of several new systemic agents for psoriasis treatment, it can be challenging to choose the right therapy in certain patient populations. There are few up-to-date reviews on systemic drugs for moderate to severe psoriasis in pregnant and pediatric patients and in patients with concomitant chronic infections such as hepatitis, HIV and latent tuberculosis. These groups are usually excluded from clinical trials and much of the available evidence is based on anecdotal case reports and case series. Being a chronic disease, psoriasis requires long-term treatment and there are concerns of adverse maternal-fetal outcomes, long term side-effects in children and reactivation of latent infections with use of systemic agents in these patients. Part 2 of this CME article will provide insights for choosing appropriate systemic agents for treating moderate-to-severe psoriasis in pregnant and pediatric patients and in the setting of chronic infections such as hepatitis, HIV and latent tuberculosis.

https://ift.tt/2NKj5En

CME Part I Psoriasis: Which Therapy for Which Patient Psoriasis comorbidities and preferred systemic agents

Publication date: Available online 11 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Shivani B. Kaushik, Mark G. Lebwohl

Abstract

Psoriasis is a systemic inflammatory disease associated with increased risk of comorbidities such as psoriatic arthritis, Crohn disease, malignancy, obesity and cardiovascular diseases. All these factors have a significant impact on the decision to use one therapy over another. The past decade has seen a paradigm shift in our understanding of the pathogenesis of psoriasis which has led to identification of new therapeutic targets. Several new drugs have gained FDA approval, expanding the psoriasis armamentarium but still a large number of patients continue to be untreated or undertreated. Treatment regimens for psoriasis patients should be tailored to meet specific needs based on disease severity, impact on quality of life, response to previous therapies and presence of comorbidities. Part 1 of this CME article will focus on specific comorbidities and provide insights to choose appropriate systemic treatment in patients with moderate to severe psoriasis.

https://ift.tt/2LapDKM

Detection, extinguishing, and monitoring of a coal fire in Xinjiang, China

Abstract

Coal fire is a global catastrophe. Xinjiang suffers the most severe coal fire in China and even in the world. Coal firefighting work has been being conducted for decades in Xinjiang. In this paper, coal fire detection, extinguishing, and monitoring approaches that were derived from coal firefighting experience are introduced in detail by taking the Fifth Fire Area (FFA) of the Heshituoluogai coal fire for instance. We first introduce the geology and fire situation in the FFA. Before developing efficient strategies to extinguish it, magnetic and self-potential methods are adopted to delineate the extent of the fire. A composite index is proposed to better indicate the fire. The comprehensive coal firefighting method is illustrated in detail, which consists of surface cooling, excavation and leveling, borehole drilling, borehole water injection and grouting, and loess backfill. The subsequent temperature and CO monitoring records show that the fire is extinguished successfully without burnback. The methodology presented here provides guidance and reference for putting out other coal fires around the world.

https://ift.tt/2L6MkiV

Enhanced biodiesel industry wastewater treatment via a hybrid MBBR combined with advanced oxidation processes: analysis of active microbiota and toxicity removal

Abstract

In the present study, a multistage route is proposed for the treatment of biodiesel industry wastewater (BWW) containing around 1000 mg L⁻¹ of total organic carbon (TOC), 3500 mg L⁻¹ of chemical oxygen demand (COD), and 1325 mg L⁻¹ of oil and grease. Initially, BWW aerobic biodegradability was assessed via Zhan-Wellens biodegradability test to confirm the appropriate treatment route. Then, a hybrid moving bed bioreactor (MBBR) system was chosen as the first treatment stage. The hybrid MBBR achieved 69 and 68% removal of COD and TOC removals, respectively, and provided great conditions for biomass growth. The bacterial community present in the hybrid MBBR was investigated by PCR-DGGE and potential biodegraders were identified such as: members of Desulfuromonadales, Nocardioidaceae and Pseudomonadaceae. Since biodegradation in the hybrid MBBR alone was unable to meet quality requirements, advanced oxidation processes, such as Fenton and photo-Fenton, were optimized for application as additional treatment stages. Physicochemical properties and acute toxicity of BWW were analyzed after the multistage routes: hybrid MBBR + Fenton, hybrid MBBR + photo-Fenton and hybrid MBBR + UV-C_254nm/H₂O₂. Hybrid MBBR + Fenton or photo-Fenton showed overall COD removal efficiencies greater than 95% and removed acute toxicity, thus being appropriate integrated routes for the treatment of real BWW.

Graphical abstract

ᅟ

https://ift.tt/2uqFgqx

Physical property investigation of contemporary glass ionomer and resin-modified glass ionomer restorative materials

Abstract

Objectives

The objective of this study was to investigate selected physical properties of nine contemporary and recently marketed glass ionomer cement (GIC) and four resin-modified glass ionomer cement (RMGI) dental restorative materials.

Materials and methods

Specimens (n = 12) were fabricated for fracture toughness and flexure strength using standardized, stainless steel molds. Testing was completed on a universal testing machine until failure. Knoop hardness was obtained using failed fracture toughness specimens on a microhardness tester, while both flexural modulus and flexural toughness was obtained by analysis of the flexure strength results data. Testing was completed at 1 h, 24 h, 1 week, and then at 1, 3, 6, and 12 months. Mean data was analyzed with Kruskal-Wallis and Mann-Whitney (p = 0.05).

Results

Physical properties results were material dependent. Physical properties of the GIC and RMGI products were inferior at 1 h compared to that at 24 h. Some improvement in selected physical properties were noted over time, but development processes were basically concluded by 24 h. A few materials demonstrated improved physical properties over the course of the evaluation.

Conclusions

Under the conditions of this study:

1. GIC and RMGI physical property performance over time was material dependent;

2. Polyalkenoate maturation processes are essentially complete by 24 h;

3. Although differences in GIC physical properties were noted, the small magnitude of the divergences may render such to be unlikely of clinical significance;

4. Modest increases in some GIC physical properties were noted especially flexural modulus and hardness, which lends support to reports of a maturing hydrogel matrix;

5. Overall, GIC product physical properties were more stable than RMGI;

6. A similar modulus reduction at 6 months for both RMGI and GIC produced may suggest a polyalkenoate matrix change; and

7. Globally, RMGI products demonstrated higher values of flexure strength, flexural toughness, and fracture toughness than GIC materials.

Clinical relevance

As compared to RMGI materials, conventional glass ionomer restorative materials demonstrate more stability in physical properties.

https://ift.tt/2um3FgX

Efficacy of Nd-YAG laser for treatment of pyogenic granuloma on the fingers and toes

Abstract

Pyogenic granuloma (PG) is a common benign vascular proliferation which often occurs on the head, neck, hands, and feet. Among the various treatment options for PG, surgical excision is the most effective treatment which offers the lowest overall recurrence rates and also provides the exact diagnosis. However, it could have difficulties to do the surgery when lesions are located on the fingers and toes, especially very near to the nails, so laser may be a very good alternative choice. In this article, we evaluated the clinical efficacy and safety of neodymium-yttrium aluminum garnet (Nd:YAG) laser for treatment of PG located on the fingers and toes. Twenty-one patients with 21 PGs located on the fingers and toes were treated by multispot Nd-YAG laser. We chose monopulse (pulse width 10.5–13.5 ms; energy 100–125 J/cm²); treatment interval was 3–4 weeks. All lesions disappeared after one or two treatments. There was no apparent scar formation, no impact on the function of the fingers and toes, no damage to nail growth, and no recurrence in more than 12-month follow-up. Nd-YAG is an effective and safety treatment option for treatment of PG located on the fingers and toes.

https://ift.tt/2L9zlNu

Water quality guideline values for aluminium, gallium and molybdenum in marine environments

Abstract

Revised water quality guideline values (WQGVs) are presented for the metals aluminium (Al), gallium (Ga) and molybdenum (Mo) in receiving marine environments. These elements are commonly found in elevated concentrations in alumina refinery waste streams, yet current WQGVs fail to accurately assess the environmental risk. Here, chronic biological effects data we have generated over the course of several years were combined with toxicity data from the open literature to construct species sensitivity distributions (SSDs) which enabled the computation of revised WQGVs for Al, Ga and Mo in marine environments. These procedures are in accordance with internationally recommended derivation procedures, and newly computed WQGVs may be incorporated in regulatory frameworks aimed at sustainable exploitation of environmental resources and ongoing protection of the marine estate. Where the available datasets allowed such distinction, separate SSDs were constructed for temperate and tropical environments and zone-specific WQGVs derived. Extrapolated from the SSDs, WQGVs of 56 μg Al L⁻¹, 800 μg Ga L⁻¹ and 3.88 mg Mo L⁻¹ (in the 0.45-μm filtered fraction) for 95% species protection were recommended for implementation in both temperate and tropical receiving environments. Currently, there is insufficient validation to separate the tropical from the temperate data and in most cases, application of the generic WQGVs is recommended.

https://ift.tt/2NHoyvK

Single center experience of biotinidase deficiency: 259 patients and six novel mutations

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


https://ift.tt/2usCLnI

Sequential measurements of IGF-I serum concentrations in adolescents with Laron syndrome treated with recombinant human IGF-I (rhIGF-I)

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


https://ift.tt/2ucFouq

Mitteilungen DGKFO

https://ift.tt/2NFFEKu

Six natural ways to whiten teeth

Teeth inevitably begin to yellow with age, but a range of strategies can slow the process and even reverse it. In this article, learn how to whiten teeth naturally at home using baking soda, oil pulling, hydrogen peroxide, and other techniques. We also look at which strategies to avoid to prevent damage to the teeth.

https://ift.tt/2N31lmH

223 Ra-Dichloride in castration-resistant metastatic prostate cancer: improving outcomes and identifying predictors of survival in clinical practice

Abstract

Purpose

We first assessed whether the pattern of referrals to a nuclear medicine clinic improved as experience with ²²³Ra-dichloride increased, and whether referral patterns affected patient outcomes, and second assessed the value of bone scintigraphy, total alkaline phosphatase (tALP) and lymphadenopathy as prognostic factors in patients receiving ²²³Ra-dichloride.

Methods

A total of 57 patients eligible to receive ²²³Ra-dichloride over a 2-year period (March 2014 to March 2016) were retrospectively assessed and prospectively followed (median follow up 298 days). ²²³Ra-Dichloride was administered at 4-week intervals for a maximum of six injections. The numbers of patients in years 1 and 2 referred in relation to extent of bone disease (EOBD) category and overall survival (OS) were determined. The prognostic factors EOBD category, baseline tALP (tALP_BL), tALP response, greatest percentage reduction in tALP from baseline in any treatment cycle (ALP_max; among patients with elevated ALP_BL), and the presence of lymphadenopathy were assessed as predictors of OS.

Results

The proportion of patients with EOBD1 was higher in year 2 than in year 1 (29% and 4%, respectively), and in year 2 there was a lower rate of symptomatic skeleton-related events, a higher proportion of patients completing six cycles, and longer (albeit nonsignificant) OS (p = 0.55). There were significant differences in OS between EOBD4 patients and those in all other groups and between EOBD1 and EOBD3 patients (p < 0.05). OS was longer in patients with normal tALP_BL than in those with elevated tALP_BL (p = 0.01), in ALP responders than in nonresponders (p < 0.05), and in patients without lymphadenopathy than in those with lymphadenopathy (p = 0.29). OS was correlated with ALP_max (r² = 0.24).

Conclusion

A collaborative multidisciplinary referrals pathway, together with increased experience with ²²³Ra-dichloride, led to improved outcomes. In patients with elevated tALP_BL, tALP dynamics may be useful for monitoring response and predicting OS. Imaging and prognostic markers may therefore be of value for individualizing ²²³Ra-dichloride treatment and planning retreatment; however, further studies are required.

https://ift.tt/2uaHFGq

Scholar : Communication Research and Practice, Volume 4, Issue 3, September 2018 is now available online on Taylor & Francis Online

The online platform for Taylor & Francis Online content Communication Research and Practice, Volume 4, Issue 3, September 2018 is now available online on Taylor & Francis Online. Special Issue: Food/media: eating, cooking, and provisioning in a digital world. Guest Editors: Tania Lewis and Michelle Phillipov This new issue contains the following articles: Editorial Food/media: eating, cooking, and provisioning in a digital world Tania Lewis & Michelle Phillipov Pages: 207-211 | DOI: 10.1080/22041451.2018.1482075 Articles Digital food: from paddock to platform | Tania Lewis Pages: 212-228 | DOI: 10.1080/22041451.2018.1476795 Celebrities, credibility, and complementary frames: raising the agenda of sustainable and other 'inconvenient' food issues in social media campaigning Judith Friedlander & Chris Riedy Pages: 229-245 | DOI: 10.1080/22041451.2018.1448210 Why would we believe them? Meat consumers' reactions to online farm animal welfare activism in Australia Emily A. Buddle, Heather J. Bray & Rachel A. Ankeny Pages: 246-260 | DOI: 10.1080/22041451.2018.1451209 'Restaurant reviews aren't what they used to be': digital disruption and the transformation of the role of the food critic Morag Kobez Pages: 261-276 | DOI: 10.1080/22041451.2018.1476797 Integrating digital media into everyday culinary practices Katherine Kirkwood Pages: 277-290 | DOI: 10.1080/22041451.2018.1451210 Everyday digital engagements: using food selfies on Facebook to explore eating practices Bhavna Middha Pages: 291-306 | DOI: 10.1080/22041451.2018.1476796 Contemporary food imagery: food porn and other visual trends Nathan Taylor & Megan Keating Pages: 307-323 | DOI: 10.1080/22041451.2018.1482190 To update which email alerts you receive, manage your alerts within the My Account area. Unsubscribe from new content alerts for this journal (both new issue and latest article notifications) with one click. If you need any further help, please contact us at support@tandfonline.com Please do not reply to this email. To ensure that you receive your alerts and information from Taylor & Francis Online, please add "alerts@tandfonline.com" and "info@tandfonline.com" to your safe senders list. Taylor & Francis, an Informa business. Taylor & Francis is a trading name of Informa UK Limited, registered in England under no. 1072954. Registered office: 5 Howick Place, London, SW1P 1WG.

Scholar : Autophagy, Volume 14, Issue 5, 2018 is now available online on Taylor & Francis Online

The online platform for Taylor & Francis Online content Autophagy, Volume 14, Issue 5, 2018 is now available online on Taylor & Francis Online. This new issue contains the following articles: Editor' Corner Why do we need autophagy? A cartoon depiction Daniel J. Klionsky Pages: 739-742 | DOI: 10.1080/15548627.2018.1446628 Brief Report - Basic Science Systematic analysis of ATG13 domain requirements for autophagy induction | Nora Wallot-Hieke, Neha Verma, David Schlütermann, Niklas Berleth, Jana Deitersen, Philip Böhler, Fabian Stuhldreier, Wenxian Wu, Sabine Seggewiß, Christoph Peter, Holger Gohlke, Noboru Mizushima & Björn Stork Pages: 743-763 | DOI: 10.1080/15548627.2017.1387342 Research Paper - Basic Science Atg9a deficiency causes axon-specific lesions including neuronal circuit dysgenesis | Junji Yamaguchi, Chigure Suzuki, Tomohisa Nanao, Soichirou Kakuta, Kentarou Ozawa, Isei Tanida, Tatsuya Saitoh, Takehiko Sunabori, Masaaki Komatsu, Keiji Tanaka, Shigeki Aoki, Kenji Sakimura & Yasuo Uchiyama Pages: 764-777 | DOI: 10.1080/15548627.2017.1314897 Research Paper - Translational Necroptosis promotes autophagy-dependent upregulation of DAMP and results in immunosurveillance Sheng-Yen Lin, Sung-Yuan Hsieh, Yi-Ting Fan, Wen-Chi Wei, Pei-Wen Hsiao, Dai-Hua Tsai, Tzong-Shoon Wu & Ning-Sun Yang Pages: 778-795 | DOI: 10.1080/15548627.2017.1386359 Research Paper - Basic Science The autophagy-inducing kinases, ULK1 and ULK2, regulate axon guidance in the developing mouse forebrain via a noncanonical pathway Bo Wang, Rekha Iyengar, Xiujie Li-Harms, Joung Hyuck Joo, Christopher Wright, Alfonso Lavado, Linda Horner, Mao Yang, Jun-Lin Guan, Sharon Frase, Douglas R. Green, Xinwei Cao & Mondira Kundu Pages: 796-811 | DOI: 10.1080/15548627.2017.1386820 MTA1 is a novel regulator of autophagy that induces tamoxifen resistance in breast cancer cells | Min-Ho Lee, Dahae Koh, Hyelin Na, Na-Lee Ka, Seungsu Kim, Hyeon-Ji Kim, Sungyoul Hong, Young Kee Shin, Je Kyung Seong & Mi-Ock Lee Pages: 812-824 | DOI: 10.1080/15548627.2017.1388476 Crosstalk between lysine methylation and phosphorylation of ATG16L1 dictates the apoptosis of hypoxia/reoxygenation-induced cardiomyocytes Huiwen Song, Xing Feng, Min Zhang, Xian Jin, Xiangdong Xu, Lin Wang, Xue Ding, Yunmei Luo, Fengqin Lin, Qin Wu, Guiyou Liang, Tian Yu, Qigong Liu & Zhiyong Zhang Pages: 825-844 | DOI: 10.1080/15548627.2017.1389357 Piperlongumine restores the balance of autophagy and apoptosis by increasing BCL2 phosphorylation in rotenone-induced Parkinson disease models | Jia Liu, Weijin Liu, Yongquan Lu, Hao Tian, Chunli Duan, Lingling Lu, Ge Gao, Xia Wu, Xiaomin Wang & Hui Yang Pages: 845-861 | DOI: 10.1080/15548627.2017.1390636 CPTP: A sphingolipid transfer protein that regulates autophagy and inflammasome activation Shrawan Kumar Mishra, Yong-Guang Gao, Yibin Deng, Charles E. Chalfant, Edward H. Hinchcliffe & Rhoderick E. Brown Pages: 862-879 | DOI: 10.1080/15548627.2017.1393129 PINK1-PRKN/PARK2 pathway of mitophagy is activated to protect against renal ischemia-reperfusion injury Chengyuan Tang, Hailong Han, Mingjuan Yan, Shiyao Zhu, Jing Liu, Zhiwen Liu, Liyu He, Jieqiong Tan, Yu Liu, Hong Liu, Lin Sun, Shaobin Duan, Youming Peng, Fuyou Liu, Xiao-Ming Yin, Zhuohua Zhang & Zheng Dong Pages: 880-897 | DOI: 10.1080/15548627.2017.1405880 The exoribonuclease Xrn1 is a post-transcriptional negative regulator of autophagy Elizabeth Delorme-Axford, Emma Abernathy, Nicholas J. Lennemann, Amélie Bernard, Aileen Ariosa, Carolyn B. Coyne, Karla Kirkegaard & Daniel J. Klionsky Pages: 898-912 | DOI: 10.1080/15548627.2018.1441648 Autophagic Punctum Mitochondria promote septin assembly into cages that entrap Shigella for autophagy Sina Krokowski, Damián Lobato-Márquez & Serge Mostowy Pages: 913-914 | DOI: 10.1080/15548627.2016.1228496 BNIP3L/NIX-dependent mitophagy regulates cell differentiation via metabolic reprogramming Lorena Esteban-Martínez & Patricia Boya Pages: 915-917 | DOI: 10.1080/15548627.2017.1332567 Commentary Endomembrane remodeling in autophagic membrane formation Min Zhang, Yu Wang & Liang Ge Pages: 918-920 | DOI: 10.1080/15548627.2018.1425053 Letter to the Editor Induction of autophagy by depolarization of mitochondria Konstantin G. Lyamzaev, Artem V. Tokarchuk, Alisa A. Panteleeva, Armen Y. Mulkidjanian, Vladimir P. Skulachev & Boris V. Chernyak Pages: 921-924 | DOI: 10.1080/15548627.2018.1436937 To update which email alerts you receive, manage your alerts within the My Account area. Unsubscribe from new content alerts for this journal (both new issue and latest article notifications) with one click. If you need any further help, please contact us at support@tandfonline.com Please do not reply to this email. To ensure that you receive your alerts and information from Taylor & Francis Online, please add "alerts@tandfonline.com" and "info@tandfonline.com" to your safe senders list. Taylor & Francis, an Informa business. Taylor & Francis is a trading name of Informa UK Limited, registered in England under no. 1072954. Registered office: 5 Howick Place, London, SW1P 1WG.

Cervical-Cranial Dry Needling vs. Orthopedic Manual Therapy for Cervicogenic Headache

Condition:   Cervicogenic Headache
Interventions:   Other: Cervical-cranial dry needling;   Other: Orthopedic manual therapy;   Other: Thoracic Manipulation;   Other: Exercise;   Other: Patient Education
Sponsors:   Youngstown State University;   Franklin Pierce University
Not yet recruiting

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Efficacy of Physiotherapy in Patients With Bruxism.

Condition:   Temporomandibular Dysfunction (TMD)
Interventions:   Other: Manual therapy;   Other: Regular treatment control.
Sponsor:   University of Valencia
Recruiting

https://ift.tt/2NKz6do

Scholar : These new articles for The American Journal of Family Therapy are available online

The online platform for Taylor & Francis Online content New for The American Journal of Family Therapy and online now on Taylor & Francis Online: Original Articles Goal Effectiveness and Family Functioning Phillip Klever Pages: 1-18 | DOI: 10.1080/01926187.2018.1461581 To update which email alerts you receive, manage your alerts within the My Account area. Unsubscribe from new content alerts for this journal (both new issue and latest article notifications) with one click. If you need any further help, please contact us at support@tandfonline.com Please do not reply to this email. To ensure that you receive your alerts and information from Taylor & Francis Online, please add "alerts@tandfonline.com" and "info@tandfonline.com" to your safe senders list. Taylor & Francis, an Informa business. Taylor & Francis is a trading name of Informa UK Limited, registered in England under no. 1072954. Registered office: 5 Howick Place, London, SW1P 1WG.

ACPA mediates the interplay between innate and adaptive immunity in rheumatoid arthritis

Publication date: Available online 11 July 2018

Source: Autoimmunity Reviews

Author(s): Xiwen Dong, Zhaohui Zheng, Yue Zhai, Yan Zheng, Jin Ding, Jianli Jiang, Ping Zhu

Abstract

The production of anti-citrullinated peptide antibodies (ACPAs) requires the participation of both innate immunity and adaptive immunity. On the one hand, activated innate immunity is able to produce citrullinated auto-antigens that fuel autoimmunity and provide an inflammatory environment that facilitates the breach of self-tolerance, proliferation of self-reactive T/B cells and the production of ACPAs. On the other hand, after their production by plasma B cells, ACPAs are also able to interact with innate immunity to exacerbate the manifestation and chronicity of rheumatoid arthritis (RA). This article discusses the roles of citrullinated peptides and ACPA played in innate immunity and autoimmunity. In addition, we emphasise the relationships between environmental factors and innate immunity, as well as the pathogenic function of ACPAs per se. In doing so, we hope to provide fundamental knowledge of RA pathogenesis and reveal potential therapeutic targets in RA treatment.

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Support of precision medicine through risk-stratification in autoimmune liver diseases – histology, scoring systems, and non-invasive markers

Publication date: Available online 11 July 2018

Source: Autoimmunity Reviews

Author(s): Lars Bossen, Alessio Gerussi, Vasiliki Lygoura, George F. Mells, Marco Carbone, Pietro Invernizzi

Abstract

Autoimmune liver diseases (AILDs) are complex conditions, which arise from the interaction between a genetic susceptibility and unknown environmental triggers. They represent a relevant cause of liver failure and liver transplantation worldwide. As a testimony of our progress in understanding the biology of AILDs and the disease progression is the overall median survival which has increased over the last decade. However, there are still major challenges such as the lack of therapies and surveillance strategies in primary sclerosing cholangitis (PSC), the management and treatment of non-responders to first-line therapies in primary biliary cholangitis (PBC) and the need for tailoring immunosuppressive drugs in autoimmune hepatitis (AIH). The different disease course and treatment response in patients with AILDs might be related to a heterogeneous genetic background between individuals which translates in a heterogeneous clinical phenotype. Thus, it becomes essential to personalise management and treatment based on specific risk profiles, e.g. low-risk and high-risk, based on genetic and molecular signatures.

It is now possible, thanks to the development of large-scale AILDs patient cohorts, that such diseases can be analysed using various high-throughput methods like gene expression profiling, next generation sequencing and other omics technologies to identify unique fingerprints based on which a personalised or tailor-made management and therapy can be developed. The final aim being to facilitate treatment decision-making that balances patient-specific risks and preferences. This is critical especially now with the current and forthcoming availability of more efficacious medications. To reach this point we need specific interventions such as creating bigger biobanks, sequencing more genomes and linking biological information to health-related data.

We have already identified subsets of patients with different risk profiles among patients with PBC, PSC and AIH by using clinical tools such as liver histology, laboratory investigation and non-invasive methods. In this manuscript, we review the clinical features and investigations that already enable us to individualize the care of PBC patients and that might support the development of precision medicine (PM) in AILDs.

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Monitoring chemotherapy‐induced alopecia with trichoscopy

Journal of Cosmetic Dermatology, EarlyView.


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The evaluation of psychiatric comorbidity, self‐injurious behavior, suicide probability, and other associated psychiatric factors (lonileness, self‐esteem, life satisfaction) in adolescents with acne: A clinical pilot study

Journal of Cosmetic Dermatology, EarlyView.


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Locoregional control and survival after lymph node SBRT in oligometastatic disease

Abstract

Stereotactic body radiotherapy (SBRT) has emerged as an effective option in oligo-metastatic cancer patients affected by lymph node metastases, but its use might be questioned due to risk of regional and distant dissemination through the lymph node chain. The primary aim of our study was to assess the loco-regional control following SBRT in this setting. Ninety-one patients undergoing SBRT for at least one lymph node metastasis from miscellaneous primary tumors were retrospectively evaluated for patterns of failure and toxicity. locoregional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS) at 4 years were 79 and 44%. Repeated use of local therapy after progression resulted in a median interval of 17 months until allocation to systemic therapy or supportive care. Forty-three percent of patients were alive at 4 years. Local failure, occurring in 15% of patients, was the only predictor of poor survival (HR: 3.06). Tumor diameter ≥ 30 mm and urothelial primary tumor predicted for impaired local control (HR: 4.59 and 5.43, respectively). Metastases from pulmonary cancer showed a significant earlier distant dissemination (HR: 3.53). Only acute and late grade 1–2 toxicities were reported except for 1 case of G3 dysphagia. Loco-regional failure risk is low (18%) and justifies the use of local therapies for patients with oligometastatic disease. Durable disease remission can be achieved by iterative use of local approaches. Local control is correlated to improved OS. Diameter and primary tumor type may affect response to SBRT and risk for early metastatic dissemination.

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An atypical persistent eruption of Adult‐onset Still’s disease with Neutrophilic Urticarial Dermatosis‐like dermal features: a case report and review of the literature

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.


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Two multicenter Phase I randomized trials to compare the bioequivalence and safety of a generic doxorubicin hydrochloride liposome injection with Doxil ® or Caelyx ® in advanced ovarian cancer

Abstract

Purpose

To compare the pharmacokinetic bioequivalence and safety of a generic pegylated liposomal doxorubicin formulation (SPIL DXR hydrochloride liposome injection) with that of the reference products, Caelyx or Doxil.

Methods

Two open-label, two-way reference crossover studies were conducted in patients with ovarian cancer. C_max, AUC_0 − t, and AUC_0−∞, V_d, and Cl for total, free, and encapsulated DXR were evaluated in 18 blood samples taken pre-dose (t = 0), at increasing time intervals over the following 14 days. A washout period of 28 days was observed before crossing over.

Results

Studies 1 and 2 were completed by 24/29 and 41/60 patients, respectively. Pharmacokinetic data from 24 patients from each study established bioequivalence for free DXR in study 2, and for total and encapsulated DXR in both studies. Data from 29 and 54 patients, respectively, were included in the safety evaluation. Of these, 37 patients experienced 81 post-dose adverse events (40 related to the test product and 41 related to the reference product). In study 1, four patients were withdrawn owing to adverse events. Eleven patients experienced serious adverse events and one death occurred in study 2.

Conclusions

Bioequivalence between the test and the reference products was established for total and encapsulated DXR in both studies, and for free DXR in the study with the larger sample size (study 2). There were no significant differences between the safety profiles of the generic formulation and the reference products. No correlation was found between drug level and adverse events.

Trial registration

Study 1 was registered retrospectively; registration number is NCT03055143, dated February 15, 2017. Study 2 registration number is NCT00862355, dated March 13, 2009.

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Biochemistry, Physiology, and Tissue Interactions of Contemporary Biodegradable Injectable Dermal Fillers

BACKGROUND Injectable dermal fillers are becoming increasingly popular for soft tissue augmentation and rejuvenation. Most contemporary biodegradable products are derived from hyaluronic acid, calcium hydroxylapatite, or poly-L-lactic acid. Achievement of desired cosmetic outcomes is largely dependent on selection of the optimal injectable product based on the chemical composition, the physiologic interactions with surrounding tissue, product longevity, and a thorough understanding of potential adverse reactions. OBJECTIVE To review and describe the biochemistry, physiology, and tissue interactions of the most commonly used contemporary biodegradable dermal fillers. METHODS A thorough review of the literature was performed with additional review of pertinent clinical cases and corresponding histopathology. RESULTS This article provides a comprehensive review of the biochemistry, physiology, and potential tissue interactions of the most commonly used biodegradable dermal fillers. The underlying biochemical properties of each product and how they contribute to specific physiologic and adverse tissue reactions is described. CONCLUSION Understanding of the innate differences in the physical properties, and physiologic responses to soft tissue fillers allows clinicians to achieve desired aesthetic outcomes with fewer adverse events. Address correspondence and reprint requests to: Rachel K. Hoffmann, MD, MSEd, Department of Dermatology, New York University School of Medicine, 240 East 38th Street 11th Floor, New York, NY 10016, or e-mail: RachelKHoffmann@gmail.com The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Commentary on Patient Preferences for the Treatment of Basal Cell Carcinoma and Squamous Cell Carcinoma—A Mapping Review of Discrete Choice Experiments

No abstract available

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Review of the Evaluation and Treatment of Vasovagal Reactions in Outpatient Procedures

BACKGROUND A vasovagal reaction is a commonly encountered event in outpatient procedures. There is a paucity of discussion on vasovagal reactions (VVRs) in the dermatologic surgery literature. However, recent investigations in the physiology, evaluation, and treatment of VVRs have been reported in other specialties. OBJECTIVE A comprehensive review of the physiology, evaluation, treatment, and prevention of VVRs. MATERIALS AND METHODS A search as performed using the PubMed/MEDLINE databases. Search terms included "vasovagal," "vasovagal reaction," "syncope," "reflex syncope," "neurocardiogenic syncope," and "fainting." RESULTS Studies demonstrate greater understanding in the physiology of a vasovagal reaction. Although permanent sequelae are uncommon, it is important to respond in a prompt manner. A variety of treatment and prevention options are presented. CONCLUSION Vasovagal reactions should be carefully evaluated. Additional studies may provide greater data in understanding and managing vasovagal reactions. Address correspondence and reprint requests to: Leonard H. Goldberg, MD, DermSurgery Associates, 7515 S Main Street, Suite 240, Houston, TX 77030, or e-mail: goldb1@dermsurgery.org The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Cosmetic and Functional Outcomes of Second Intention Healing for Mohs Defects of the Lips

BACKGROUND The lips are a common location for skin cancer and thus for Mohs micrographic surgery (MMS). There are few studies looking at second intention healing of Mohs defects of the lips, and none have used a scar assessment scale. OBJECTIVE To evaluate the acceptability of second intention healing of the vermilion lips following MMS using a patient questionnaire and the Patient and Observer Assessment Scale (POSAS). METHODS Eligible patients were found through chart review. A patient questionnaire and the patient scale of the POSAS were performed over the phone. For patients who were able to come to clinic, the observer scale of the POSAS was performed. RESULTS Forty-seven phone interviews and 21 clinic assessments were performed. Overall, patients noted excellent functional outcomes, and good to excellent cosmetic outcomes, and were satisfied with healing time. There was not a significant difference between the patient and observer total scores (p = .63) or overall scores (p = .59). CONCLUSION Second intention healing can have satisfactory functional and cosmetic outcomes and healing times with few complications and should be considered for surgical defects on the vermilion lips as large as 2.8 cm2 even when there is involvement of the cutaneous lip and muscular layer. Address correspondence and reprint requests to: Jessica M. Donigan, MD, Dermatology Resident, 30 North 1900 East, 4A330 School of Medicine, Salt Lake City, UT 84132, or e-mail: jessica.donigan@gmail.com The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Estimation of Prognosis in Invasive Cutaneous Melanoma: An Independent Study of the Accuracy of a Gene Expression Profile Test

BACKGROUND Cutaneous melanomas (CMs) with similar clinical and histopathologic features can harbor differing capacities for metastasis. A validated gene expression profile (GEP) test offers prognostic information by classifying CMs as low risk (Class 1A/1B) or high risk (Class 2A/2B) for metastasis. OBJECTIVE The authors sought to perform an independent study of the predictive accuracy of the GEP test, to determine what clinical and histopathologic features predict high-risk classification, and to evaluate how intermediate classes (1B & 2A) performed clinically. MATERIALS AND METHODS Using our institution's prospectively collected melanoma registry, the authors identified patients who had been treated for CM within the last 5 years and undergone GEP testing. Clinical, histopathologic, and outcomes data were analyzed. A subcohort of patients with known metastatic disease were identified and tested. RESULTS The GEP test accurately identified 77% of metastatic CMs as high risk (Class 2). The GEP had a negative predictive value of 99% for Class 1 CMs. Class 2 CMs were 22 times more likely to metastasize. CONCLUSION The GEP test's performance in our independent cohort corresponded with previous industry-sponsored studies and proved to be a helpful clinical prognostic tool with the potential to direct patient care protocols. Address correspondence and reprint requests to: Bradley N. Greenhaw, MD, 516 Pegram Drive, Tupelo, MS 38801, or e-mail: bgreenhaw@gmail.com The authors have indicated no significant interest with commercial supporters. The study received IRB exemption for patients who had previously undergone the GEP test. IRB approval was obtained to test patients with known metastatic disease. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Enhancement of Photodynamic Therapy for Bowen's Disease Using Plum-Blossom Needling to Augment Drug Delivery

BACKGROUND Bowen's disease (BD) is treated effectively with 5-aminolevulinic acid (ALA)-photodynamic therapy (ALA-PDT). Plum-blossom needling (PBN) may enhance topical drug delivery. OBJECTIVE To compare the effects of and adverse reactions to PBN and ALA-PDT of BD with those associated with ALA-PDT alone. MATERIALS AND METHODS Forty-three lesions from 24 patients were randomly assigned to 2 groups. The PBN-ALA-PDT group underwent vertical skin tapping with PBN before applying 10% ALA cream and narrow-band light-emitting diode irradiation (λ = 633 ± 10 nm; 100–200 J/cm2). The ALA-PDT group received ALA cream and irradiation only. RESULTS At 6 weeks, the PBN-ALA-PDT and ALA-PDT groups achieved complete response (CR) rates of 77.78% (14/18 lesions) and 40% (7/20 lesions), respectively, (p

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Hyaluronic Acid After Subcutaneous Injection—An Objective Assessment

BACKGROUND Hyaluronic acid (HA) fillers are the preferred injectable products for aesthetic correction of skin depressions and restoration of facial volume. OBJECTIVE To investigate the subcutaneous distribution of 3, biophysically distinct, CE-marked and FDA-approved HA fillers. MATERIALS AND METHODS BELB, JUVV, and RESL were injected ex vivo in porcine and human skin. Immediately after injection, the skin samples were snap-frozen, cross-sectioned, and visualized using stereomicroscopy and full-field optical coherence tomography. Images were compared with histological sections after hematoxylin and eosin staining. RESULTS Hyaluronic acid fillers were distributed as homogeneous bolus in the ex vivo skin. The injection bulks were found to preserve the fibrous trabecular network, shift the fat lobules, and displace the adjacent adipocyte layers independently of the formulation injected. CONCLUSION For the first time, the subcutaneous injection of 3 HA fillers with markedly different biophysical properties was systematically investigated by complementary visualization techniques. Despite their different properties, no difference in distribution was found after subcutaneous injection. The global preservation of the hypodermis structure observed was consistent with the good tolerability seen in clinical practice after implantation of the HA fillers in the subcutaneous skin layer. Address correspondence and reprint requests to: Denis Salomon, MD, CIDGE International Dermatology Clinic, 14 Quai du Seujet, 1201 Geneva, Switzerland, or e-mail: denis.salomon@cidge.ch The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Repair of a Large Sternal Notch Defect

No abstract available

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Increasing nerve autograft length increases senescence and reduces regeneration

Background: Nerve grafting with an autograft is considered the gold standard. However, the functional outcomes of long (>3cm) nerve autografting are often poor. We hypothesized that a factor contributing to these outcomes is the graft microenvironment, where long compared to short autografts support axon regeneration to different extents. Methods: A rat sciatic nerve defect model was used to compare regeneration within short (2cm) and long (6cm) isografts. Axon regeneration and cell populations within grafts were assessed using histology, retrograde labeling of neurons regenerating axons, immunohistochemistry, qRT-PCR, and electron microscopy at 4 and/or 8 weeks. Results: At 8 weeks for distances of both 1 and 2cm from the proximal coaptation (equivalent regenerative distance), long isografts had reduced numbers of regenerated fibers compared to short isografts. Similarly, the number of motoneurons regenerating axons was reduced in the presence of long isografts compared to short isografts. Considering the regenerative microenvironments between short and long isografts, cell densities and general populations within both short and long isografts were similar. However, long isografts had significantly greater expression of senescence markers, which included senescence associated β-galactosidase, p21, and p16, as well as distinct chromatin changes within Schwann cells. Conclusions: This study shows that axon regeneration is reduced within long compared to short isografts, where long isografts contained an environment with an increased accumulation of senescent markers. While autografts are considered the "gold standard" for grafting, these results demonstrate that we must continue to strive for improvements in the autograft regenerative environment. Financial Disclosure Statement: The authors have the following to disclose: None Presented at: American Society for Surgery of the Hand 2016 meeting in Austin, Tx and the Plastic Surgery Research Council 2017 meeting in Durham, NC. Disclosures: 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 in part by the National Institutes of Neurological Disorders and Stroke of the National Institutes of Health (NIH) under award number R01 NS086773 to Washington University and in part by the Plastic Surgery Foundation under award ID 346670 to Wood through Washington University. The content is solely the responsibility of the authors and does not represent the views of the NIH, the Plastic Surgery Foundation, or Washington University. Corresponding author: Matthew D. Wood, PhD, Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Campus Box 8238, 660 South Euclid Avenue, St. Louis, MO 63110, USA. woodm@wudosis.wustl.edu ©2018American Society of Plastic Surgeons

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Outcomes of Corticosteroid Treatment for Trigger Finger by Stage.

Background: While steroid injection remains a common first-line treatment of trigger fingers, clinical experience suggests that not all trigger fingers respond the same. The purpose of this study was to utilize a classification system for trigger finger that is simple, reproducible, and produces clearly definable, clinically relevant cutoff points to determine if responsiveness to steroid injection correlates to clinical staging. Methods: This was a prospectively-collected longitudinal study of trigger finger patients separated into four stages of severity. Each subject received a single injection of 6 mg dexamethasone acetate. One-month outcomes were analyzed to evaluate efficacy of steroid injection. These outcomes were further stratified based on baseline characteristics and stage of triggering Results: A total of 99 digits and 69 subjects were included. Two variables were found to be significant in predicting response to initial injection: 1. multiple affected digits, and 2. stage severity. Patients with multiple involved fingers were 5.8 times more likely to have no resolution of symptoms compared with those with a single affected finger. For every level of stage increase, the odds doubled for having no resolution of symptoms. Conclusions: Steroid injection remains a viable first-line option for patients presenting with mild triggering (Stage 1 and 2). For more severe triggering (Stage 3 and 4) or multiple affected digits, success of steroid injection is significantly lower at one month. For the latter patients, surgery may be a more reasonable initial treatment. Presented at: The American Association of Plastic Surgeons Annual Meeting, Austin, TX, 2017 Financial Disclosure Statement: Funded by a 2012 PSF/AAHS research grant Products Mentioned: N/A Corresponding Author: Robert A. Weber, MD, 2401 S. 31st St. Temple, TX, USA. E-mail address: Robert.Weber@BSWHealth.org ©2018American Society of Plastic Surgeons

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Treatment of Apert hand syndrome: Strategies for achieving a 5-digit hand

Background: Apert hand reconstruction requires complex surgical planning. The purpose of this study is to describe our 8 year surgical experience with Apert syndrome hand reconstruction, and provide specific surgical strategies for achieving a 5-digit hand in Upton type I and II hands. Methods: A retrospective analysis of consecutive Apert patients who underwent web space releases between 2007 and 2015 was performed. Demographic, surgical, and outcome data were verified through medical records, clinical photographs, radiographic images, and patient interviews. Results: A total of 41 Apert patients (23 [56.1%] male and 18 [43.9%] female) were treated at our Hospital since 2007. A 5-digit hand was achieved in all patients (100%) with Upton type I and II hands, and in 8 patients (72.7%) with Upton type III hands. A 4-digit hand was obtained in 3 of 11 patients (27.3%) with Upton type III hands. Four (25%) of 20 patients with Upton type I hands, 3 (30%) of 10 patients with Upton type II hands, and 6 (54.5%) of 11 patients with Upton type III hands, required subsequent revision for aesthetic reasons. Conclusion: Upton type III hands have demonstrated higher revision rates than type I and II hands, regardless of whether a 4 or 5-digit hand is obtained. Treatment strategies for Apert hands based on hand type are offered to guide 4-web-space release in all patients with Upton type I and II hands. Funding: None Conflict of interest: The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article. Corresponding author: Cassio Eduardo Raposo-Amaral, MD, PhD, Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av. Adolpho Lutz, 100, Caixa Postal: 6028, Campinas, São Paulo 13084-880, Brazil. E-mail: cassioraposo@hotmail.com ©2018American Society of Plastic Surgeons

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Aesthetic Comparison of Two Different Types of Webspace Reconstruction for Finger Syndactyly

Background: Syndactyly reconstruction incorporates techniques of applying skin grafts or dorsal advancement flaps without the use of skin grafts. Comparative outcome studies of these two approaches are lacking. Our study compares the long-term aesthetic outcomes of these two flap techniques. Methods: Forty-five patients were included in our study. The methods of reconstruction used were a dorsally-based rectangular flap with skin graft from the groin and a dorsal pentagonal advancement flap without skin grafting. Eighteen independent raters completed a Visual Analogue Scale (VAS) as well as a unique classification scale to subjectively assess aesthetic outcomes. We used univariate analyses to determine which variables significantly influenced the outcome score. We then used multivariable regression models to compare the two flap types. Results: Dorsally-based rectangular flaps with skin graft had statistically significantly better VAS scores and greater odds of receiving an 'Excellent' rating when compared to dorsal pentagonal advancement flaps. Conclusions: Despite the use of skin graft and their associated donor-site morbidity, dorsal rectangular flaps may offer better overall aesthetic outcomes for patients. Future comparative studies should incorporate functional and patient-reported outcomes to better assess the optimal reconstruction type. Financial Disclosure Statement: This publication was supported in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (2 K24-AR053120-06). The consent is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Corresponding Author: Kevin C. Chung MD, MS, Section of Plastic Surgery, University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5340, Kecchung@med.umich.edu, Phone 734-936-5885, Fax 734-763-5354 ©2018American Society of Plastic Surgeons

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Re-establishment of Lymphatic Drainage after Vascularized Lymph Node Transfer in a Rat Model

Background: Vascularized lymph node transfer (VLNT) has recently received attention as a potential surgical treatment for lymphedema. Despite good results in some series, the mechanism and benefits of VLNT have yet to be fully understood. This study aimed to investigate the re-establishment of drainage into transferred lymph nodes following VLNT in a rat model. Methods: Seven rats underwent VLNT. The operation performed on each rat consisted of two parts. First, the left groin lymph node basin with superficial epigastric vessels was harvested as a free flap. Second, the flap was re-attached in the left groin of the rat via end-to-end microvascular anastomoses. Anastomosis patency was assessed immediately post-op and at the time of animal sacrifice. The rats were evaluated for re-establishment of lymphatic flow into the transplanted nodes at 1 month intervals for at least 6 months post-op. This was accomplished non-invasively by injecting the rats in their flanks with fluorescent indocyanine green (ICG) which was detected using a PDE infrared camera. Results: Anastomoses were patent in all 7 rats immediately postop. No ICG uptake was seen in the transplanted lymph node basins in the first 2 months post-op in any of the rats. In 5 of 7 rats, however, ICG uptake was demonstrated in the transplanted lymph node basin by 6 months (average 13 weeks). Conclusions: We report uptake of ICG in 5 of 7 rats at an average of 13 weeks following lymph node transplantation, consistent with the re-establishment of lymphatic drainage into the transplanted nodes. Financial Disclosure Statement: None of the authors have any conflicts of interest nor disclosures. No funding was received for this article. Portions presented at: American Society for Reconstructive Microsurgery (ASRM) 2017 in Waikoloa, Hawaii Northeastern Society of Plastic Surgeons (NESPS) 2016 in Baltimore, MD Acknowledgments: We would like to thank Yanping Sun, PhD and Christopher Damoci from the Small Animal Imaging Shared Resource (SAISR) division of the Herbert Irving Comprehensive Cancer Center at Columbia University for their assistance in obtaining our MRI studies. Corresponding author: Jeffrey A. Ascherman, MD, Herbert Irving Pavilion, 161 Fort Washington Avenue Suite: 511, New York, NY 10032, jaa7@cumc.columbia.edu ©2018American Society of Plastic Surgeons

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Facial implants; controversies an d criticism, a comprehensive review of the current literature.

BACKGROUND: Polyethylene (Medpor) and Silicone are two of the most popular materials used today for facial skeleton implantation. Previous studies have identified common complications with the use of these implants, but patient follow up has been short. This review of literature examines complications and patient follow up in cases using Medpor and Silicone implants for reconstructive and aesthetic surgeries of the mid and lower face over the last 20 years. METHOD: A literature search was conducted through the PUBMED database. Key words used were ("Mandible Implants" or "Malar Implants" or "Chin Implants") AND ("Reconstruction" or "Augmentation") AND ("Medpor" or "Silicone"). RESULT: There were 9 studies with 626 patients in the Medpor group and 5 studies with 365 patients for Silicone. Silicone had a higher incidence of infections and displacements. Medpor showed a higher incidence of prominence problems. Exposure/extrusion rates were low for both implants. Chin and mandibular implants were the safest, while malar implants had a high incidence of prominence problems. The average follow up for Medpor was 36.6 months and 24 months for Silicone. There were wide ranges of follow up times, from 2 weeks up to 15 years. A limited number of articles included an averaged time within their ranges. Reported follow ups were not linked to specific complications. CONCLUSION: Medpor implantation is more common than Silicone. Complications rates are low with the use of both materials. Patient follow up is deficient and hasn't improve in the last 20 years, raising questions on the reliability of complications rates. FD - None of the authors have financial disclosures. Corresponding author: Yoel Rojas, MD1, Department of Plastic Surgery, Nassau University Medical Center, East Meadow, NY 11554 ©2018American Society of Plastic Surgeons

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