Clinical and Experimental Dermatology, EarlyView.
https://ift.tt/2NEK476
Τρίτη 11 Σεπτεμβρίου 2018
Spotting Zika spots: descriptive features of the rash used in 66 published cases
Rituximab for the treatment of autoimmune subepidermal blistering diseases
Dermatologic Therapy, EarlyView.
https://ift.tt/2xagT1u
Single agent efficacy of the HDAC inhibitor DATS in preclinical models of glioblastoma
Abstract
Purpose/introduction
Glioblastoma (GB) remains incurable despite aggressive chemotherapy, radiotherapy, and surgical interventions; immunotherapies remain experimental in clinical practice. Relevant preclinical models that can accurately predict tumor response to therapy are equally challenging. This study aimed to validate the effect of the naturally occurring agent diallyl trisulfide (DATS) in human GB in relevant pre-clinical models.
Methods
Ex vivo slice culture, in vivo cell line derived orthotopic xenograft and patient-derived orthotopic xenograft (PDX) animal models of GB were utilized to assess efficacy of treatment with DATS.
Results
Our results showed 72-h treatments of 25 µM DATS induced cell death in ex vivo human GB slice culture. We treated U87MG orthotopic xenograft models (U87MGOX) and patient-derived orthotopic xenograft models (PDX) with daily intraperitoneal injections of DATS for 14 days. Magnetic resonance (MR) imaging of mice treated with DATS (10 mg/kg) demonstrated reduced tumor size at 5 weeks when compared with saline-treated U87MGOX and PDX controls. Hematoxylin (H&E) staining demonstrated dose-dependent reduction in gross tumor volume with decreased proliferation and decreased angiogenesis. Western blotting showed that DATS was associated with increases in histone acetylation (Ac-Histone H3/H4) and activated caspase-3 in this novel preclinical model. Histological assessment and enzyme assays showed that even the highest dose of DATS did not negatively impact hepatic function.
Conclusions
DATS may be an effective and well-tolerated therapeutic agent in preventing tumor progression and inducing apoptosis in human GB.
https://ift.tt/2QqHAIn
Total and available metal concentrations in soils from six long-term fertilization sites across China
Abstract
Approximately 19% of agricultural soils in China are contaminated by heavy metals. However, the effects of agricultural management practices on soil contamination are not well understood. Taking advantage of six long-term (23–34 years) field sites across China, this study examined the effects of different agricultural fertilization treatments, including control (no fertilization), inorganic nitrogen, phosphorus and potassium fertilization (NPK), manure fertilization (M), and NPK plus manure fertilization (NPKM), on the total and available metal concentrations in soils. The results showed that after 23–34 years of fertilization, the M and NPKM treatments significantly increased the total concentration of cadmium (Cd), copper (Cu), and zinc (Zn) in soils compared with the concentrations measured for the control and NPK treatments. In contrast, the fertilization treatments had almost no influence on soil lead (Pb) and nickel (Ni) concentrations. The results of analysis via diffusive gradients in thin films demonstrated that long-term sheep or cattle manure fertilization increased the available metals, especially Cd, Cu, and Zn, but long-term swine manure application decreased the available metals, except for Cu and Zn, in soils. Further analysis revealed that the manure source, soil pH level, and biogeochemical properties of metals affected the availability of Cd, Cu, Pb, Zn, and Ni in soils. Collectively, organic fertilizers had the potential to reduce metal uptake by crops, but caution should be taken to reduce metal concentrations in manure.
https://ift.tt/2NHwPms
Dermal subcision of Nemoto’s ligaments as a long-lasting treatment for forehead and glabellar wrinkles
Abstract
Background
Ever since the beginning of recorded history, beauty has played a major social role. A youthful look, symmetry, and a soft, smooth skin texture, as well as an even colour, are the main characteristics and parameters of attractive and beautiful faces. The forehead is the first location in the face that shows wrinkles. Facial wrinkles show an increase in depth and severity with age in all faces, in both sexes, but usually, forehead wrinkles develop earlier in men than they do in women. The work published by Nemoto et al. in 2002 revolutionised the concepts about the aetiology and anatomy of forehead wrinkles, thus inspiring the authors to develop a new surgical technique for treatment.
Methods
Sixty-five patients participated in this study (50 females and 15 males). The age range in this series ranged from 26 to 59 years. Through stab incisions at the hairline level, a standard ENT myringotomy knife was used to cut the fibrous septae connecting between the superficial layer of the galea apponeurotica (that covers the frontalis and glabellar muscles) and the dermis.
Results
The results showed a high level of satisfaction among both patients and an objective assessor with no negative comments. Patients rated the operative results excellent in 52.3% of this series, while the operative results were rated excellent in 47.7% of patients by an independent, objective assessment. Kappa analysis showed perfect agreement between the objective and subjective assessments (K = 0.839). The mean Lamperle classification was 3.1 before surgery and 0.7 3 years after surgery. There was a significant reduction in the mean Lamperle classification 3 years after surgery.
Conclusions
The cutting (dermal subcision) of fasciocutaneous ligaments of the forehead described by Nemoto et al. is a safe, economical and effective technique for forehead and glabella rejuvenation with long-lasting results.
Level of Evidence: Level IV, therapeutic study.
https://ift.tt/2CL50Ft
Nuclear magnetic resonance-based metabolomic investigation reveals metabolic perturbations in PM 2.5 -treated A549 cells
Abstract
Exposure to PM2.5 is associated with an increased risk of lung diseases, and oxidative damage is the main reason for PM2.5-mediated lung injuries. However, little is known about the early molecular events in PM2.5-induced lung toxicity. In the present study, the metabolites in PM2.5-treated A549 cells were examined via a robust and nondestructive nuclear magnetic resonance (NMR)-based metabolic approach to clarify the molecular mechanism of PM2.5-induced toxicity. NMR analysis revealed that 12 metabolites were significantly altered in PM2.5-treated A549 cells, including up-regulation of alanine, valine, lactate, ω-6 fatty acids, and citrate and decreased levels of gamma-aminobutyric acid, acetate, leucine, isoleucine, D-glucose, lysine, and dimethylglycine. Pathway analysis demonstrated that seven metabolic pathways which included alanine, aspartate and glutamate metabolism, aminoacyl-tRNA biosynthesis, taurine and hypotaurine metabolism, arginine and proline metabolism, starch and sucrose metabolism, valine, leucine and isoleucine biosynthesis, and tricarboxylic acid cycle were mostly influenced. Our results indicate that NMR technique turns out to be a simple and reliable method for exploring the toxicity mechanism of air pollutant.
https://ift.tt/2Qo9apw
Adipose insulin resistance is associated with cardiovascular risk factors in polycystic ovary syndrome
Abstract
Purpose
The effects of adipose insulin resistance on cardiovascular risk factors in polycystic ovary syndrome (PCOS) remain largely unknown. We aimed to investigate associations between adipose insulin resistance and cardiovascular risk factors in PCOS.
Methods
A total of 207 PCOS and 47 non-PCOS women were recruited from a large reproductive medicine center in this cross-sectional study. The PCOS diagnosis was based on the Rotterdam Criteria. The subjects received a standard oral glucose tolerance test. Adipose insulin resistance was evaluated using a validated index (adipose-IR = fasting insulin × free fatty acid concentrations).
Results
The women with PCOS showed a higher adipose-IR index, and the adipose-IR index was tightly associated with the blood pressure, glucose and lipid parameters. A total of 98.0% of the women with PCOS in the highest adipose-IR quartile showed cardiovascular risk factors (obesity, hypertension, glucose intolerance or dyslipidemia), and this percentage was significantly higher than the percentage of those in the lowest quartile (32.7%). In addition, the percentages of women with three (31.4%) and four (13.7%) cardiovascular risk factors were significantly elevated in the highest adipose-IR quartile. The multivariable logistic regression analysis indicated that each 1-SD increment in the adipose-IR index resulted in higher risks of obesity (OR = 3.18, 95% CI = 2.12–4.76), hypertension (OR = 1.89, 95% CI = 1.31–2.73), glucose intolerance (OR = 2.45, 95% CI = 1.73–3.48), and dyslipidemia (OR = 2.18, 95% CI = 1.57–3.01). The C-reactive protein (CRP) level was positively associated with the adipose-IR index in women with PCOS (r = 0.45, P < 0.001).
Conclusions
The adipose-IR index was associated with cardiovascular risk factors in women with PCOS. Chronic inflammation may induce insulin resistance in the adipose tissue of women with PCOS.
https://ift.tt/2MmzaOL
Prevalence of abnormal semen analysis and levels of adherence with fertility preservation in men undergoing therapy for newly diagnosed cancer: A retrospective study in 2906 patients
Clinical Endocrinology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2N6iVdW
An observational study of skill retention and practice adoption after a workshop on ultrasound-guided neuraxial anaesthesia
No abstract availablehttps://ift.tt/2N9vmpi
Protective ventilation during anaesthesia reduces major postoperative complications after lung cancer surgery: A double-blind randomised controlled trial
BACKGROUND Thoracic surgery for lung resection is associated with a high incidence of postoperative pulmonary complications. Controlled ventilation with a large tidal volume has been documented to be a risk factor for postoperative respiratory complications after major abdominal surgery, whereas the use of low tidal volumes and positive end-expiratory pressure (PEEP) has a protective effect. OBJECTIVE To evaluate the effects of ventilation with low tidal volume and PEEP on major complications after thoracic surgery. DESIGN A double-blind, randomised controlled study. SETTING A multicentre trial from December 2008 to October 2011. PATIENTS A total of 346 patients undergoing lobectomy or pneumonectomy for lung cancer. MAIN OUTCOME MEASURES The primary outcome was the occurrence of major postoperative complications (pneumonia, acute lung injury, acute respiratory distress syndrome, pulmonary embolism, shock, myocardial infarction or death) within 30 days after surgery. INTERVENTIONS Patients were randomly assigned to receive either lung-protective ventilation (LPV group) [tidal volume 5 ml kg−1 ideal body weight + PEEP between 5 and 8 cmH2O] or nonprotective ventilation (control group) (tidal volume 10 ml kg−1 ideal body weight without PEEP) during anaesthesia. RESULTS The trial was stopped prematurely because of an insufficient inclusion rate. Major postoperative complications occurred in 23/172 patients in the LPV group (13.4%) vs. 38/171 (22.2%) in the control group (odds ratio 0.54, 95% confidence interval, 0.31 to 0.95, P = 0.03). The incidence of other complications (supraventricular cardiac arrhythmia, bronchial obstruction, pulmonary atelectasis, hypercapnia, bronchial fistula and persistent air leak) was also lower in the LPV group (37.2 vs. 49.4%, odds ratio 0.60, 95% confidence interval, 0.39 to 0.92, P = 0.02).The duration of hospital stay was shorter in the LPV group, 11 [interquartile range, 9 to 15] days vs. 12 [9 to 16] days, P = 0.048. CONCLUSION Compared with high tidal volume and no PEEP, LPV combining low tidal volume and PEEP during anaesthesia for lung cancer surgery seems to improve postoperative outcomes. TRIALS REGISTRATION ClinicalTrials.gov number: NCT00805077.https://ift.tt/2x213Ge
A comparison of the incidence of supraventricular arrhythmias between thoracic paravertebral and intercostal nerve blocks in patients undergoing thoracoscopic surgery: A randomised trial
BACKGROUND Postoperative supraventricular arrhythmias are common in patients after thoracoscopic lobectomy. Inadequate pain control has long been recognised as a significant risk factor for arrhythmias. The performance of ultrasound-guided (USG) thoracic paravertebral block (PVB) is increasing as an ideal technique for postoperative analgesia. OBJECTIVE We conducted this study to evaluate whether a single-shot USG thoracic PVB would result in fewer postoperative supraventricular tachycardias (SVT) than intercostal nerve blocks (ICNBs) after thoracoscopic pulmonary resection. DESIGN A randomised controlled study. SETTING A single university hospital. PATIENTS Sixty-eight patients undergoing thoracoscopic lobectomy were randomised into two equal groups of 34. INTERVENTIONS For postoperative pain control, all patients received a total of 0.3 ml kg−1 of a mixture containing 0.5% ropivacaine and 1/200 000 epinephrine after placement of needles for either a single thoracic PVB or two individual ICNBs, both guided by ultrasound. Data were obtained during the first 48 postoperative hours. MAIN OUTCOME MEASURES The primary outcome was the incidence of SVT after thoracoscopic pulmonary resection. RESULTS During the first 48 postoperative hours, the incidences of SVT and atrial fibrillation were lower in the USG thoracic PVB group (14.7 vs. 46.9%, P = 0.004 and 3.0 vs. 18.8%, P = 0.037, respectively). The requirement for β-receptor blockade was more frequent in the ICNBs group than in the PVB group (5.9 vs. 25%, P = 0.033). CONCLUSION After placement of the needle using ultrasound guidance, a single-shot thoracic PVB is a well tolerated and effective technique to reduce the incidences of postoperative SVT and atrial fibrillation in patients undergoing thoracoscopic pulmonary resection. TRIAL REGISTRATION https://ift.tt/2LGPFWU, registration number: ChiCTR-IOR-17010952.https://ift.tt/2N9vftS
Improved lung recruitment and oxygenation during mandatory ventilation with a new expiratory ventilation assistance device: A controlled interventional trial in healthy pigs
BACKGROUND In contrast to conventional mandatory ventilation, a new ventilation mode, expiratory ventilation assistance (EVA), linearises the expiratory tracheal pressure decline. OBJECTIVE We hypothesised that due to a recruiting effect, linearised expiration oxygenates better than volume controlled ventilation (VCV). We compared the EVA with VCV mode with regard to gas exchange, ventilation volumes and pressures and lung aeration in a model of peri-operative mandatory ventilation in healthy pigs. DESIGN Controlled interventional trial. SETTING Animal operating facility at a university medical centre. ANIMALS A total of 16 German Landrace hybrid pigs. INTERVENTION The lungs of anaesthetised pigs were ventilated with the EVA mode (n=9) or VCV (control, n=7) for 5 h with positive end-expiratory pressure of 5 cmH2O and tidal volume of 8 ml kg−1. The respiratory rate was adjusted for a target end-tidal CO2 of 4.7 to 6 kPa. MAIN OUTCOME MEASURES Tracheal pressure, minute volume and arterial blood gases were recorded repeatedly. Computed thoracic tomography was performed to quantify the percentages of normally and poorly aerated lung tissue. RESULTS Two animals in the EVA group were excluded due to unstable ventilation (n=1) or unstable FiO2 delivery (n=1). Mean tracheal pressure and PaO2 were higher in the EVA group compared with control (mean tracheal pressure: 11.6 ± 0.4 versus 9.0 ± 0.3 cmH2O, P 0.99). Minute volume was lower in the EVA group compared with control (5.5 ± 0.2 versus 7.0 ± 1.0 l min−1, P = 0.02) with normoventilation in both groups (PaCO2 5.4 ± 0.3 versus 5.5 ± 0.3 kPa, P > 0.99). In the EVA group, the percentage of normally aerated lung tissue was higher (81.0 ± 3.6 versus 75.8 ± 3.0%, P = 0.017) and of poorly aerated lung tissue lower (9.5 ± 3.3 versus 15.7 ± 3.5%, P = 0.002) compared with control. CONCLUSION EVA ventilation improves lung aeration via elevated mean tracheal pressure and consequently improves arterial oxygenation at unaltered positive end-expiratory pressure (PEEP) and peak inspiratory pressure (PIP). These findings suggest the EVA mode is a new approach for protective lung ventilation.https://ift.tt/2N44F5o
The feasibility of pressure measurement during an ultrasound-guided thoracic paravertebral block
No abstract availablehttps://ift.tt/2x9qANG
Efficacy and safety of dexmedetomidine in peripheral nerve blocks: A meta-analysis and trial sequential analysis
BACKGROUND The duration of analgesia provided by nerve blocks is limited if local anaesthetics are administered alone. Therefore, several additives, including dexmedetomidine (DEX), have been investigated in order to prolong postoperative analgesia following single-shot regional anaesthesia. OBJECTIVES The aim of this meta-analysis was to assess the efficacy and safety of the addition of perineural DEX to local anaesthetics compared with local anaesthetics alone or local anaesthetics combined with systemic administration of DEX. DESIGN A systematic review of randomised controlled trials (RCT) with meta-analysis, trial sequential analysis and assessment of the quality of evidence by the GRADE approach. DATA SOURCES The databases MEDLINE, CENTRAL and EMBASE (to May 2017) were systematically searched. ELIGIBILITY CRITERIA All RCTs investigating the efficacy and safety of perineural DEX combined with local anaesthetics compared with local anaesthetics alone or local anaesthetics in combination with systemic DEX in peripheral nerve blocks of adults undergoing surgery were included. RESULTS A total of 46 RCTs (3149 patients) were included. Patients receiving perineural DEX combined with local anaesthetics had a longer duration of analgesia than local anaesthetics alone [mean difference 4.87 h; 95% confidence interval (95% CI) 4.02 to 5.73; P https://ift.tt/2N44wyS
Ultrasound-guided single injection versus continuous sciatic nerve blockade on pain management and mobilisation after total knee arthroplasty (CoSinUS trial): A randomised, triple-blinded controlled trial
BACKGROUND Combining continuous femoral nerve blockade with single injection sciatic nerve blockade is standard peripheral nerve block practice for total knee arthroplasty (TKA) during the first 24 postoperative hours. OBJECTIVES To assess the analgesic benefits and mobilisation capability of continuous sciatic blockade in conjunction with continuous femoral nerve blockade for 72 h after arthroplasty. DESIGN Randomised, triple-blinded controlled trial. SETTING Single-Centre, German University Hospital. PATIENTS In total, 50 patients receiving continuous femoral nerve blockade (5 ml h−1 ropivacaine 0.2%) for TKA under general anaesthesia. INTERVENTIONS Patients were randomised to receive a sciatic nerve catheter with an initial dose of 10 ml ropivacaine 0.2% followed by either continuous double-blinded application of 5 ml h−1 ropivacaine 0.2% (CO) or 5 ml h−1 saline infusion (SIN). MAIN OUTCOME Measures primary endpoint: cumulative morphine consumption until 48 h postoperatively. Further endpoints included morphine consumption, pain scores, mobilisation, dynamometry until postoperative day 3. RESULTS Median [25th to 75th percentiles] cumulative morphine consumption at postoperative day 2 differed significantly between groups (CO 15 mg [11 to 25] versus SIN, 43 mg [27 to 67.5, P https://ift.tt/2x86QKx
Assessing changes in tissue oxygenation by near-infrared spectroscopy following brachial plexus block for arteriovenous fistula surgery: A prospective observational pilot study
BACKGROUND Near-infrared spectroscopy (NIRS) can be used to measure tissue oxygen saturation (StO2) in different sites and in a wide range of clinical scenarios. Peripheral regional anaesthesia induces vascular changes causing increased arterial blood flow and venodilatation, but its effect on StO2 is still under debate. This is especially so for patients undergoing arteriovenous fistula surgery, wherein latest data suggest an improved outcome under brachial plexus block (BPB) compared with local anaesthesia, but no data are available. OBJECTIVE The aim of this study was to investigate changes in StO2 following BPB prior to arteriovenous fistula surgery using NIRS. DESIGN A prospective observational study. SETTING A secondary teaching hospital from August 2016 to March 2017. PATIENTS Fifteen patients undergoing arteriovenous fistula surgery. INTERVENTION Ultrasound-guided BPB in 15 patients undergoing arteriovenous fistula surgery. OUTCOME MEASURES StO2 at baseline and compared with baseline and the contralateral arm following BPB measured using NIRS of the thenar eminence (NIRSth). RESULTS Baseline values of StO2 assessed by NIRSth were 42.6 ± 7.7% in the arteriovenous fistula arm and 42.7 ± 9.7% in the contralateral arm. There was no significant difference between the two. Five minutes after BPB, there was a significant increase in StO2 of the blocked arm, compared with the control arm expressed as difference of absolute values (7.1 ± 9.7%). At 60 min, an absolute difference of 21.0 ± 13.5% was reached. The absolute increase in StO2 of the blocked arm compared with baseline reached significance after 5 min (8.8 ± 4.6%) and increased up to 23.2 ± 8.2% after 60 min. CONCLUSION NIRSth indicates that BPB significantly increases StO2 of the arteriovenous fistula arm in patients undergoing haemodialysis. TRIAL REGISTRATION: Clinicaltrials.gov: NCT03044496https://ift.tt/2N44p6q
Removal of entrapped epidural catheter: role of muscle relaxation
No abstract availablehttps://ift.tt/2x9qAgE
Adding sufentanil to ropivacaine in continuous thoracic paravertebral block fails to improve analgesia after video-assisted thoracic surgery: A randomised controlled trial
BACKGROUND The benefit of adding opioid to a local anaesthetic for continuous thoracic paravertebral analgesia after video-assisted thoracic surgery (VATS) is unclear. OBJECTIVES To analyse the analgesic efficacy of ropivacaine and sufentanil in combination compared with ropivacaine alone after VATS. DESIGN A randomised, double-blinded, single-centre clinical trial. SETTING A tertiary university hospital between March 2010 and April 2014. PATIENTS Ninety patients were recruited, two were not included leaving 88 randomised into two groups. Eighteen patients were excluded from analysis and 70 completed the study. INTERVENTION To receive thoracic paravertebral analgesia with either 2 mg ml−1 ropivacaine and 0.25 μg ml−1 sufentanil (ropivacaine + sufentanil group) or 2 mg ml−1 ropivacaine alone (ropivacaine group) for 48 h postoperatively. Infusion rate was set at 0.15 ml kg−1 h−1 in both groups. MAIN OUTCOME MEASURES The primary endpoint was the mean total amount of self-administered morphine by the patients in each group at 48 h postoperatively. RESULTS The mean ± SD total amount of self-administered morphine was not significantly different between groups (53.1 ± 27.2 mg in the ropivacaine + sufentanil group vs. 58.8 ± 34.3 mg in the ropivacaine group; P = 0.72). No significant differences were found between the two groups in either pain scores at rest or during movement, in opioid-related adverse reactions, in patient satisfaction or length of hospital stay. CONCLUSION Adding 0.25 μg ml−1 sufentanil to 2 mg ml−1 ropivacaine in continuous thoracic paravertebral analgesia for VATS did not reduce morphine consumption or pain scores when compared with ropivacaine alone. We cannot recommend its use for routine clinical practice. Further studies analysing different concentrations and infusion rates of sufentanil are needed before a lack of efficacy can be confirmed. TRIAL REGISTRATION Clinical trial registrations: EudraCT: 2009-014832-38. ClinicalTrials.gov: NCT 01082744.https://ift.tt/2N9uSQ0
Modified half-the-air technique for continuous pressure monitoring during lumbar plexus block
No abstract availablehttps://ift.tt/2x79ZKA
Spinal anaesthesia with chloroprocaine 1% versus total intravenous anaesthesia for outpatient knee arthroscopy: A randomised controlled trial
BACKGROUND Both general and spinal anaesthesia with short-acting local anaesthetics are suitable and reliable for knee arthroscopy as an ambulatory procedure. Chloroprocaine (CP) 1% seems to be the ideal spinal local anaesthetic for this indication. OBJECTIVE The aim of this study was to compare spinal anaesthesia using CP 1% with general for outpatient knee arthroscopy with regard to procedure times, occurrence of pain, patient satisfaction and recovery, and also costs. DESIGN A randomised controlled single-centre trial. SETTING University Medical Centre Mannheim, Department of Anaesthesiology and Surgical Intensive Care Medicine, Mannheim, Germany. April 2014 to August 2015. PATIENTS A total of 50 patients (women/men, 18 to 80 years old, ASA I to III) undergoing outpatient knee arthroscopy were included. A contra-indication to an allocated anaesthetic technique or an allergy to medication required in the protocol led to exclusion. INTERVENTIONS Either general anaesthesia with sufentanil, propofol and a laryngeal mask for airway-management or spinal with 40-mg CP 1% were used. We noted procedure times, patient satisfaction/recovery and conducted a 7-day follow-up. MAIN OUTOMES Primary outcome was duration of stay in the day-surgery centre. Secondary outcomes were first occurrence of pain, patient satisfaction, quality of recovery and adverse effects. In addition, we analysed treatment costs. RESULTS Spinal had faster recovery than general anaesthesia with patients reaching discharge criteria significantly earlier [117 min (66 to 167) versus 142 min (82 to 228), P = 0.0047]. Pain occurred significantly earlier in the general anaesthesia group (P = 0.0072). Costs were less with spinal anaesthesia (cost ratio spinal: general 0.57). Patients felt significantly more uncomfortable after general anaesthesia (P = 0.0096). CONCLUSION Spinal anaesthesia with 40-mg CP 1% leads to a significantly earlier discharge and is cheaper compared with general. TRIAL REGISTRATION German Clinical Trials Register, www.drks.de, identifier: DRKS00005989.https://ift.tt/2N3iGQK
Scholar : These new articles for Alcheringa: An Australasian Journal of Palaeontology are available online
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The effect of an oral care protocol and honey mouthwash on mucositis in acute myeloid leukemia patients undergoing chemotherapy: a single-blind clinical trial
Abstract
Objectives
The purpose of the study is to evaluate and compare the effectiveness of honey mouthwash and an oral care protocol on mucositis and weight loss in patients with acute myeloid leukemia receiving chemotherapy.
Materials and methods
In this single-blind clinical trial, 53 acute myeloid leukemia (AML) patients receiving chemotherapy were randomly assigned into three groups: honey mouthwash (n = 17), oral care (n = 17), and control (n = 19). The severity of mucositis and weights was examined blindly at the baseline and 4-week follow-up.
Results
The prevalence of grades of mucositis in the study groups was significant at the end of the third (p = 0.002) and fourth (p < 0.001) weeks. The mucositis severity decreased at the end of the third and fourth weeks in the honey mouthwash group (p < 0.05), whereas it increased in the control group (p < 0.001). The difference in the weight was significant between the honey mouthwash and the control groups (p < 0.05, MD = 1.95) at the end of the third week, and between the honey mouthwash group with the control (p < 0.01, MD = 2.92) and oral care groups (p < 0.05, MD = 1.95) at the end of the fourth week.
Conclusions
Honey mouthwash is effective in preventing and reducing the severity of mucositis, and weight loss and can be recommended for patients undergoing chemotherapy.
Clinical relevance
The results of this study suggest that honey mouthwash can reduce the incidence and severity of mucositis in patients, reduce or eliminate the possibility of weight loss in them, as well as encourage some weight gain. Compared to routine oral care, honey mouthwash is also easier to use and handle.
Trial registration
IRCT2015121419919N7
https://ift.tt/2x53YOh
Markov-switching vector autoregressive neural networks and sensitivity analysis of environment, economic growth and petrol prices
Abstract
The paper aims at evaluating the nonlinear and complex relations between CO2 emissions, economic development, and petrol prices to obtain new insights regarding the shape of the environmental Kuznets curve (EKC) in the USA and in the UK in addition to introducing a newly proposed nonlinear approach. Within this respect, the paper has three purposes: the first one is to combine the multilayer perceptron neural networks (MLP) with Markov-switching vector autoregressive (MS-VAR) type nonlinear models to obtain the MS-VAR-MLP model. The second is to utilize one of the largest datasets in the literature covering the 1871–2016 period, a long span of data starting from the late eighteenth century. Since the emission, economic development, and petrol price relation is subject to nonlinearity and trajectory changes due to many historical events, the development of the MS-VAR-MLP model is a necessity to contribute to the ongoing debate regarding the shape of the EKC curve and the stability of the relation. The third purpose is to develop the MS-VAR-MLP-based regime-dependent sensitivity analysis, which eases the visual interpretation of the nonlinear causal relationships, which are allowed to have asymmetric interactions in different phases of the expansionary and recessionary periods of the business cycles. Our results provide clear deviations from the findings in the literature: (i) the shape of the EKC curve cannot be assumed to be stable and is subject to regime dependency, nonlinearity, and magnitude dependency; (ii) the forecast results suggest that incorporation of regime switching and neural networks provide significant improvement over the MS-VAR counterpart; and (iii) for both USA and UK and for the 1871–2016 period, the positive impacts of economic growth on emissions cannot be rejected for the majority of the phases of the business cycles; however, the magnitude of this effect is at various degrees. In addition, the incorporation of petrol price provides significant findings considering its effects on emission and economic growth rates. The analysis suggest clear deviations from the expected shape of the EKC curve and puts forth the necessity to utilize more complex empirical methodologies to evaluate the EKC since the emissions-economic development relation is more complex than it was assumed. Following these findings, several policy recommendations are provided. Lastly, the proposed MS-VAR-MLP methodology is compared with the MS-VAR model and various advantages and disadvantages are enumerated.
https://ift.tt/2CHGogG
Different pathways of nitrogen and phosphorus regeneration mediated by extracellular enzymes in temperate lakes under various trophic state
Abstract
Several Italian and Chinese temperate lakes with soluble reactive phosphorus concentrations < 0.015 mg L−1 were studied to estimate nitrogen and phosphorus regeneration mediated by microbial decomposition and possible different mechanisms driven by prevailing oligo- or eutrophic conditions. Leucine aminopeptidase (LAP), beta-glucosidase (GLU) and alkaline phosphatase (AP), algal, and bacterial biomass were related to trophic and environmental variables. In the eutrophic lakes, high algal and particulate organic carbon concentrations stimulated bacterial respiration (> 20 μg C L−1 h−1) and could favor the release of inorganic phosphorus. High extracellular enzyme activities and phosphorus solubilizing bacteria abundance in sediments accelerated nutrient regeneration. In these conditions, the positive GLU-AP relationship suggested the coupling of carbon and phosphorus regeneration; an efficient phosphorus regeneration and high nitrogen levels (up to 0.067 and 0.059 mg L−1 NH4 and NO3 in Italy; 0.631 and 1.496 mg L−1 NH4 and NO3 in China) led to chlorophyll a peaks of 14.9 and 258.4 μg L−1 in Italy and China, respectively, and a typical algal composition. Conversely, in the oligo-mesotrophic lakes, very low nitrogen levels (in Italy, 0.001 and 0.005 mg L−1 NH4 and NO3, respectively, versus 0.053 and 0.371 mg L−1 in China) induced high LAP, while low phosphorus (33.6 and 46.3 μg L−1 total P in Italy and China, respectively) led to high AP. In these lakes, nitrogen and phosphorus regeneration were coupled, as shown by positive LAP-AP relationship; however, the nutrient demand could not be completely met without the supply from sediments, due to low enzymatic activity and phosphorus solubilizing bacteria found in this compartment.
https://ift.tt/2NGY4gZ
The role of renewable and non-renewable energy consumption in CO 2 emissions: a disaggregate analysis of Pakistan
Abstract
The energy sector has become the largest contributor to greenhouse gas (GHG) emissions. Among these GHG emissions, most threatening is CO2 emission which comes from the consumption of fossil fuels. This empirical work analyzes the roles of renewable energy consumption and non-renewable energy consumption in CO2 emissions in Pakistan. The empirical evidence is based on an auto-regressive distributive lag (ARDL) model of data from 1970 to 2016. The disaggregate analysis reveals that renewable energy consumption has an insignificant impact on CO2 emission in Pakistan and that, in the non-renewable energy model, natural gas and coal are the main contributors to the level of pollution in Pakistan. Economic growth positively contributes to CO2 emission in the renewable energy model but not in the non-renewable energy model. Policies that emphasize the contribution of renewable energy to economic growth and that add more clean energy into the energy mix are suggested.
https://ift.tt/2CUtJY6
Optic Perineuritis Due to Tuberculosis
Abstract: A 30-year-old man experienced subacute peripheral visual field loss with preserved central vision in his right eye. He was diagnosed with optic perineuritis due to tuberculosis. Optic perineuritis is an uncommon disorder and, at times, can be difficult to distinguish from optic neuritis. The differentiation can have significant impact on diagnostic testing and patient management. Address correspondence to William B. Yates, MD, Sydney Eye Hospital, 8 Macquarie Street, Sydney, Australia; E-mail: yates.willb@gmail.com The authors report no conflicts of interest. © 2018 by North American Neuro-Ophthalmology Society
https://ift.tt/2x7sApT
https://ift.tt/2x7sApT
Effect of Vitamin D Deficiency on Hypertrophic Scarring
BACKGROUND Although many different diseases have been reported with vitamin D deficiency, the authors failed to find any studies on the association of hypertrophic scarring (HS) in the literature. OBJECTIVE The authors aimed to determine the relationship between vitamin D deficiency and HS and investigate the effect of replacement therapy on HS development in patients with vitamin D deficiency. PATIENTS AND METHODS Patients who presented to the authors' outpatient clinic with HS between 2013 and 2016 were included in the study. In the first stage, all the patients with HS complaints were assessed for vitamin D levels. In the second stage, 50 patients with a vitamin D level less than 25 ng/mL and a linear scar after at least 1 year of trauma were randomly divided into 3 groups. Group 1: patients who did not accept any medical or surgical treatment; Group 2: patients who were subjected to vitamin D replacement only; Group 3: patients who underwent surgical excision and suturation after vitamin D replacement. RESULTS A statistically significant correlation was found between HS and vitamin D levels (p
https://ift.tt/2x6wS0H
https://ift.tt/2x6wS0H
Computer-Based Video Instruction for Training Medical Students on Skin Biopsies
BACKGROUND The development of procedural skills is necessary for medical students. Computer-based video instruction (CBVI) increases knowledge and procedural skills. OBJECTIVE This pilot study's aim was to investigate the usefulness of CBVI in dermatologic procedure training for medical students and secondarily assess students' overall perception of the field of dermatology. METHODS Twenty-nine first- and second-year medical students were randomly assigned to the CVBI group or control group, in addition to in-person instructor demonstration of shave and punch biopsies using fresh cadaver tissue. Blinded evaluators graded student performances using a five-point Likert scale immediately after demonstration, and 1 week later to assess knowledge retention. RESULTS In overall performance, the CBVI group demonstrated higher scores both in shave (3.54 vs 2.59, p = .01) and punch biopsies (3.63 vs 2.88, p = .01) at immediate recall and knowledge retention (3.68 vs 2.67, p = .01; 4.00 vs 2.99, p
https://ift.tt/2NxV0DG
https://ift.tt/2NxV0DG
Efficacy, Safety, and Subject Satisfaction After AbobotulinumtoxinA Treatment of Upper Facial Lines
BACKGROUND Botulinum toxins are the treatment of choice for wrinkles in the upper third of the face. OBJECTIVE The purpose of this study was to evaluate the efficacy, safety, and subject satisfaction of abobotulinumtoxinA (ABO) for treatment of upper facial lines. MATERIALS AND METHODS Subjects aged 35 to 50 years with moderate-to-severe upper facial lines were included in this study. Subjects received a maximum of 125 s.U. ABO in at least 2 indications with optional touch-up after 2 weeks. Assessments included wrinkle severity, global aesthetic improvement, subject satisfaction, and adverse events (AEs) 1, 3, and 6 months after treatment. RESULTS At Month 1, 100, 94, and 93% of subjects were responders in dynamic glabellar, lateral canthal, and forehead lines, respectively. All subjects were improved 1 month after treatment, and the majority of the subjects were still improved after 6 months. After treatment, most subjects were satisfied with the appearance of their face, felt better about themselves, and agreed that the treatment made them look the way they feel. Seven subjects (22%) had 8 ABO-related AEs (mild–moderate); headache was most commonly reported (9%). CONCLUSION AbobotulinumtoxinA effectively treated upper facial lines, with high patient satisfaction. Treatment was generally well-tolerated. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Address correspondence and reprint requests to: Doris Hexsel, MD, Brazilian Center for Studies in Dermatology, Rua D. Pedro II 1592, 90550-141 Porto Alegre, RS, Brazil, or e-mail: doris@hexsel.com.br Galderma funded the study and provided the study products. Interim results from this study were previously presented as abstracts/posters at the International Master Course on Aging Science (IMCAS) Annual World Congress; January 26–29, 2017; Paris, France, and at the 15th Aesthetic and Anti-aging Medicine World Congress (AMWC); April 6–8, 2017; Monte Carlo, Monaco. D. Hexsel is a consultant for Galderma and Merz. P. Hedén is a consultant for Allergan, Teoxane, and Galderma. C. Skoglund and C. Edwartz are employed by Galderma. D. Rees of Zenith Healthcare Communications Ltd., provided medical writing assistance, funded by Galderma. P. Kestemont is a consultant for Allergan, Filorga, Galderma, Teoxane, Universkin, and Vivacy. The remaining 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.
https://ift.tt/2NCGURp
https://ift.tt/2NCGURp
Epidermolysis Bullosa Patients' Perception of Surgical Wound and Scar Healing
BACKGROUND There is limited evidence to suggest patients with epidermolysis bullosa (EB) have more postoperative wound complications than the general population. Despite this, the authors have noted reluctance among some surgeons to operate on these patients. OBJECTIVE A cross-sectional study was designed to investigate postoperative wound and scar healing outcomes in patients with EB. METHODS Patients were asked to complete the "Surgical Wound and Scar Healing in EB" questionnaire, and data gathered were analyzed. RESULTS Forty-six patients completed the questionnaire for a total of 94 different surgical procedures. Five patients reported blistering at the surgical wound site. All 5 had generalized forms of EB. Four patients reported wound infections, and 1 patient reported wound dehiscence. The postoperative scar healed with keloid or hypertrophic scarring after 26% of the reported surgical procedures. CONCLUSION Blistering at the postoperative site seems to be uncommon and particularly unlikely to occur in localized forms of EB. Postoperative wound infections and dehiscence are uncommon. Patients with EB may have a propensity to develop keloid or hypertrophic scarring. With these data, the authors hope clinicians have greater confidence in referring patients with EB for surgery, and surgeons more reassured about postoperative wound healing. Address correspondence and reprint requests to: Dedee F. Murrell, MA, BMBCh, FAAD, MD, FACD, FRCP(Edin), Department of Dermatology, Ground floor James Laws House, St. George Hospital, Gray Street, Sydney, NSW 2217, Australia, or e-mail: d.murrell@unsw.edu.au The Australasian Blistering Diseases Foundation funded the ethics application for this study. 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.
https://ift.tt/2x8o5uW
https://ift.tt/2x8o5uW
Randomized Controlled Trial of Preoperative Topical Decolonization to Reduce Surgical Site Infection for Staphylococcus aureus Nasal Swab–Negative Mohs Micrographic Surgery Patients
BACKGROUND Surgical site infection (SSI) is mainly due to endogenous bacteria. Topical decolonization is a preoperative intervention currently advised for proven nasal carriers of Staphylococcus aureus (S. aureus). OBJECTIVE The authors assessed whether topical decolonization could be of benefit for patients who are not nasal carriers of S. aureus. METHODS AND MATERIALS The authors performed a randomized controlled trial of S. aureus nasal swab–negative patients. Five days before Mohs surgery topical decolonization with nasal mupirocin and chlorhexidine, body wash was started. The control group had no intervention. RESULTS In the week after Mohs surgery, the infection rate in the intervention group was 2% (n = 661, 14) and that of the control group was 4% (n = 689, 29). CONCLUSION Topical decolonization reduces SSI in nasal swab–negative Mohs surgery patients. Address correspondence and reprint requests to: Harvey Smith, MD, FACD, Oxford Dermatology, First Floor Suite 4A, 416-418 Oxford Street, Mount Hawthorn, Perth 6016, Western Australia, or e-mail: reception@oxforddermatology.com.au The study was partly funded by a grant from the Australasian College of Dermatologists. 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.
https://ift.tt/2NtBJDt
https://ift.tt/2NtBJDt
Hidradenitis Suppurativa After Radical Surgery—Long-Term Follow-up for Recurrences and Associated Factors
BACKGROUND Hidradenitis suppurativa (HS) is a chronic debilitating skin disease in inverse body areas. Wide excision is recommended in Hurley Stages II to III, but the rate and symptoms of recurrences in long-term follow-up remain unclear. OBJECTIVE To analyze the allocation of recurrences regarding the operative field, the onset and quality of HS symptoms as well as factors associated with recurrences in long-term follow-up. MATERIAL AND METHODS Forty-eight patients with Hurley Stage III disease who had undergone 91 wide excisions from 2010 to 2015 were clinically examined regarding postoperative complications and allocation and quality of recurrences. To determine the risk of recurrence, possible surgery, and lifestyle-related associated factors were investigated. RESULTS Postoperative recurrences of HS were seen in 54.2%. Most recurrences (inflamed nodules) were detected in a
https://ift.tt/2x6vpHK
https://ift.tt/2x6vpHK
Mixing of Injectable Fillers: A National Survey
BACKGROUND The mixing of hyaluronic acid or calcium hydroxylapatite fillers with normal saline, plain lidocaine, or lidocaine with epinephrine before injection is a familiar practice among dermatologists. However, the frequency of this practice and rationale behind it has not been well studied. OBJECTIVE To better elucidate the clinical practice of mixing fillers with other solutions before injecting among dermatologists. METHODS A survey was electronically distributed to members of the American Society for Dermatologic Surgery. RESULTS Four hundred seventy-five dermatologists responded to the survey. Thirty-five percent of respondents mix fillers before injection. Solutions used were as follows: plain lidocaine (44%), lidocaine with epinephrine (36%), normal saline (30%), and sterile water (7%). Respondents mix filler for the following reasons: to decrease viscosity (40%), increase anesthesia (30%), decrease swelling (17%), and increase volume (13%). CONCLUSION Despite the lack of evidence, more than one-third of dermatologists surveyed mix fillers with other solutions before injection. Plain lidocaine is most commonly used. The top reason for mixing fillers is to decrease viscosity and facilitate ease of injection. More scientific data are needed to support this practice and better understand the biophysical changes that occur when mixing fillers with other solutions. Addess correspondence and reprint requests to: David Ciocon, MD, Division of Dermatology, 111 E 210th Street, Bronx, NY 10476, or e-mail: dhciocon@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.
https://ift.tt/2NtBCb1
https://ift.tt/2NtBCb1
Scholar : Journal of Tourism and Cultural Change, Volume 16, Issue 4, September 2018 is now available online on Taylor & Francis Online
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Incision Choices in Nipple-Sparing Mastectomy: A Comparative Analysis of Outcomes and Evolution of a Clinical Algorithm
Background: Nipple-sparing mastectomy (NSM) allows for preservation of the entire nipple-areola complex utilizing various incision patterns. Reconstructive trends and overall risk associated with these diverse NSM incisions have yet to be fully elucidated. Methods: All NSMs from 2006 to 2017 were identified; outcomes were stratified by type of mastectomy incision: lateral or vertical radial, inframammary fold, Wise pattern, previous, and periareolar. Results: A total of 1212 NSMs were performed with 1207 NSMs included for final analysis. Of these, 638 (52.9%) utilized an inframammary fold incision, 294 (24.4%) utilized a lateral radial incision, 161 (13.3%) used a vertical radial incision, 60 (5.0) utilized a Wise pattern incision, 35 (2.9%) used a previous incision, and 19 (1.6%) utilized a periareolar incision. The groups were heterogeneous and differed significantly with regards to various factors including age (p
https://ift.tt/2N7H1os
https://ift.tt/2N7H1os
Unplanned Emergency Department Visits within 30-Days of Mastectomy and Breast Reconstruction
Background: Unplanned emergency department (ED) visits are often overlooked as an indicator of care quality. Our objectives were to (1) determine the rate of 30-day ED visits following mastectomy with or without immediate reconstruction, (2) perform a risk analysis of potential factors associated with ED return, and (3) assess for potentially preventable visits with a focus on returns for pain. Methods: Using the Healthcare Cost and Utilization Project data, we identified adult women who underwent mastectomy with or without reconstruction. Multivariable logistic regression was performed to evaluate risk of unplanned ED visits. We identified and sorted diagnostic codes to investigate why patients were seeking ED care. Additionally, we performed a subgroup analysis on patients returning with a pain-related diagnosis to evaluate risk. Results: Of 159,275 cases of mastectomy with or without immediate reconstruction, 4,917 (3.1%) experienced an unplanned return to the ED within 30 days of operation. Being younger, having any payer type other than a private payer, or having any number of comorbid conditions resulted in increased odds of revisit to ED. A substantial proportion of those who returned (23%) presented with a pain-related diagnosis. Only 0.9% of cases with a 30-day ED return were readmitted. Conclusions: Numerous patients return to the ED within 30-days of mastectomy with or without immediate reconstruction. There is a need for policy makers and physicians to implement strategies to reduce discretionary ED utilization, specifically among younger or publically insured patients. Combining unplanned ED visits with readmission rates as a care quality indicator warrants consideration. Funding: The work was supported by a Midcareer Investigator Award in Patient-Oriented Research (2 K24-AR053120-06) to Kevin C. Chung. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additional funding for this work was supported by awards from the Chang Gung Memorial Hospital (project CORPG3G0111 and CORPG3G0161) to Ting-Ting Chung. Corresponding author: Kevin C. Chung, MD, MS, Section of Plastic Surgery, The University of Michigan Health System, 1500 E. Medical Center Drive , 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109-5340, Phone: 734-936-5885, Fax: 734-763-5354, E-mail: kecchung@med.umich.edu ©2018American Society of Plastic Surgeons
https://ift.tt/2Oa5zda
https://ift.tt/2Oa5zda
The Relationship between Bone Remodeling and the Clockwise Rotation of the Facial Skelton – A Computed Tomography Imaging based Evaluation
Objective: Changes in midfacial skeletal angles and widths have been identified to contribute to the appearance of the aging face. However, information on the onset and gender differences of these changes, as well as a complete understanding of the theory behind this clockwise rotation, remain elusive. Material and Methods: 157 Caucasian individuals (10 males and 10 females of each: 20 – 29yrs, 30 – 39yrs, 40 – 49yrs, 50 – 59yrs, 60 – 69yrs, 70 – 79yrs, 80 – 89yrs & 8 males and 9 females 90 – 98 years) were investigated. Multi-planar computed tomographic scans with standardized angle and distance measurements in all 3 anatomical axes (x, y, z) in alignment to the sella – nasion (horizontal) line were conducted. Results: Both males and females displayed an increase in orbital floor angle (p
https://ift.tt/2N2cM2p
https://ift.tt/2N2cM2p
The Stacked Hemi-Abdominal Extended Perforator (SHAEP) flap for autologous breast reconstruction
Background: Options for bilateral autologous breast reconstruction in thin women are limited. The aim of this study was to introduce a novel approach to increase abdominal flap volume with the stacked hemi-abdominal extended perforator (SHAEP) flap. We described the surgical technique and analyzed our results. Methods: A prospective study was conducted of all SHAEP flap breast reconstructions performed since February 2014. Patient demographics, operative details, complications and flap re-explorations were recorded. The bipedicled hemi-abdominal flap was designed as a combination of the deep inferior epigastric perforator (DIEP) and a second, more lateral pedicle: the deep or superficial circumflex iliac perforator vessels (DCIA/SCIA), the superficial inferior epigastric artery (SIEA), or a lumbar artery or intercostal perforator. Results: A total of 90 SHAEP flap breast reconstructions were performed in 49 consecutive patients. Median operative time was 500 minutes (range 405-797). Median hemi-abdominal flap weight that was used for reconstruction was 598 grams (range 160-1389). No total flap losses were recorded. Recipient-site complications included partial flap loss (2.2%), hematoma (3.3%), fat necrosis (2.2%), and wound problems (4.4%). Minor donor-site complications occurred in five patients (10.2%). Most flaps were harvested on a combination of the DIEP and DCIA vessels. Conclusions: This study demonstrated that the SHAEP flap is an excellent option for bilateral autologous breast reconstruction in women who require significant breast volume but have insufficient abdominal tissue for a bilateral DIEP flap. The bipedicled SHAEP flap allows for enhanced flap perfusion, increased volume, and abdominal contour improvement using a single abdominal donor site. 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. Funding: None. Trial registration: Not applicable. Acknowledgements: The authors would like to acknowledge Dr. Edward Buchel for his great work on the DCIA flap as a combined flap with the DIEP or SIEA, which was the foundation for the SHAEP flap. Corresponding author: Joshua L. Levine, M.D., Center for Breast Reconstruction, 3 Columbus Circle #1410, New York, NY 10019, United States of America. Phone: 212 – 245 – 8140. Fax: 212 – 245 – 8157. Email: info@joshualevinemd.com ©2018American Society of Plastic Surgeons
https://ift.tt/2Oa5x52
https://ift.tt/2Oa5x52
“The Constriction Arm Band Deformity in Brachioplasty Patients: Characterization and Incidence Using a Prospective Registry”
Background: Demand for post-passive weight loss (MWL) brachioplasty in the United States has seen a dramatic increase, from 338 procedures in 2000 to 17,099 in 2015. New challenges are emerging, some without clear solutions. Here we describe our series of arm band deformities not yet been described in the literature. Methods: This is a retrospective review of MWL patients undergoing brachioplasty at our institution (2000-2016). Pre- and post-operative photographs were reviewed to identify the defect. Descriptive statistics and t-test were used. Results: In our cohort of 1,090 MWL patients, 172 patients underwent brachioplasty, 25 patients (15%) were identified with the deformity. Twenty-four (96%) were female (ave 60y [36y,85y], BMI 34 at time of surgery, ave 2y since GBP, mean delta BMI 22). The bands were generally single bands (100%) found bilaterally (68%) in the distal third (74%) of the upper arm and exacerbated (50%) by brachioplasty. The average specimen weighed 1005g. We found arm banding was associated with higher current BMI, but not with maximum BMI or delta BMI. Conclusions: For MWL patients, arm band deformity is a challenging problem which can be exacerbated by brachioplasty and is not currently surgically correctable. It can be identified pre-operatively to aid in counseling. We found patients with higher current BMI to be at a higher risk for the arm band deformity after brachioplasty. Financial Disclosure Statement: The authors have no disclosures. Corresponding Author: J. Peter Rubin, MD, University of Pittsburgh Department of Plastic Surgery, 3550 Terrace Street 6B Scaife Hall, Pittsburgh, PA, 15261, USA. rubipj@upmc.edu ©2018American Society of Plastic Surgeons
https://ift.tt/2N4Xj1J
https://ift.tt/2N4Xj1J
Development of the BODY-Q Chest Module Evaluating Outcomes Following Chest Contouring Surgery
Background: Plastic surgery to improve chest appearance is becoming increasingly popular. The BODY-Q is a patient-reported outcome (PRO) instrument designed for weight loss and/or body contouring. In this paper, we describe the development of a new module for masculinizing chest contouring surgery. Methods: Qualitative methods were used to develop and refine the content of the BODY-Q Chest Module, which was subsequently field-tested in Canada, USA, Netherlands and Denmark between June 2016 and June 2017. Participants were men and trans men aged 16 years or older and seen for gynecomastia, weight loss or trans men chest surgery. Data were collected using either a web-based application or paper questionnaire. Rasch Measurement Theory (RMT) analysis was performed. Results: The sample included 739 participants (i.e., 174 gynecomastia, 224 weight loss, 341 gender confirming). RMT analysis refined a 10-item chest and 5-item nipple scale. All items had ordered thresholds and good item fit, and scales evidenced reliability, i.e., Person Separation Index and Cronbach's alpha values were 0.95 and 0.98 (chest scale) and 0.87 and 0.94 (nipple scale). Scores for both scales correlated more strongly with similar (satisfaction with the body) versus dissimilar (psychological and social function) BODY-Q scales. The mean score for the chest and nipples scales was significantly higher (p
https://ift.tt/2Oa5ruc
https://ift.tt/2Oa5ruc
“Fat Grafting for Pedal Fat Pad Atrophy in a 2-Year, Prospective, Randomized Cross-over, Single-Center Clinical Trial”
Background: By age 60, 30% of Americans suffer from fat pad atrophy of the foot. Forefoot fat pad atrophy results from long-term aggressive activity, genetics dictating foot type, multiple forefoot steroid injections, surgery and foot trauma. Methods: We present data from a two-year, prospective, randomized cross-over study performed to assess pain and disability indexes, fat pad thickness, forces and pressures of stance and gait. Group 1 underwent fat grafting with two years of follow-up, while Group 2 underwent conservative management for 1 year, then received fat grafting with 1 year of follow-up. Results: 18 subjects (14 female, 4 male) comprised Group 1. 13 subjects (9 female, 4 male) comprised Group 2. Group 1 reported the worst pain at baseline, Group 2 experienced the worst pain at 6, 12-month Standard of Care (SOC) visits; pain for both groups immediately improved following fat grafting and lasted through study follow up (p
https://ift.tt/2N90SUz
https://ift.tt/2N90SUz
Immediate Implant-Based Breast Reconstruction with Acellular Dermal Matrix: A Comparison of Sterile and Aseptic AlloDerm in 2039 Consecutive Cases
Background: Sterile, ready-to-use acellular dermal matrix (RTU ADM), introduced as an alternative to aseptic, freeze-dried acellular dermal matrix (FD ADM) for implant-based breast reconstruction (IBR), has been investigated in a limited number of studies. The purpose of this study was to compare outcomes in IBR with RTU ADM and FD ADM. Methods: We analyzed patients undergoing IBR with either FD ADM or RTU ADM, including demographics, clinical variables, and outcomes. An a priori power analysis was performed and logistic regression modeling was used to quantify the effect of ADM on outcomes while controlling for potential confounders. Results: 1285 consecutive patients undergoing 2039 immediate prosthetic breast reconstructions comprised the population: 612 (n=910 breasts) with FD ADM and 673 (n=1129 breasts) with RTU ADM. The FD ADM cohort had a significantly higher rate of explantation compared to RTU ADM cohort (18.0% versus 12.0%, p = 0.0036), but surgical site infection, wound dehiscence, mastectomy flap necrosis, seroma, and hematoma did not differ significantly between groups. On multivariate regression, patients having reconstruction with FD ADM, compared to RTU ADM, did not have higher odds of experiencing surgical site infections (OR 1.064, p = 0.7455), but did have higher odds of explantation (OR 1.570, p = 0.0161). Tobacco use (OR 2.809, p = 0.0002) and BMI (OR 1.054, p
https://ift.tt/2OcDnGn
https://ift.tt/2OcDnGn
Dominant men are faster in decision-making situations and exhibit a distinct neural signal for promptness
Abstract
Social dominance, the main organizing principle of social hierarchies, facilitates priority access to resources by dominant individuals. Throughout taxa, individuals are more likely to become dominant if they act first in social situations and acting fast may provide evolutionary advantage; yet whether fast decision-making is a behavioral predisposition of dominant persons outside of social contexts is not known. Following characterization of participants for social dominance motivation, we found that, indeed, men high in social dominance respond faster–without loss of accuracy–than those low in dominance across a variety of decision-making tasks. Both groups did not differ in a simple reaction task. Then, we selected a decision-making task and applied high-density electroencephalography (EEG) to assess temporal dynamics of brain activation through event related potentials. We found that promptness to respond in the choice task in dominant individuals is related to a strikingly amplified brain signal at approximately 240 ms post-stimulus presentation. Source imaging analyses identified higher activity in the left insula and in the cingulate, right inferior temporal and right angular gyri in high than in low dominance participants. Our findings suggest that promptness to respond in choice situations, regardless of social context, is a biomarker for social disposition.https://ift.tt/2CJn6rc
Nimotuzumab for Recurrent Nasopharyngeal Carcinoma
Condition: Recurrent Nasopharyngeal Carcinoma
Intervention: Drug: Nimotuzumab
Sponsors: Fujian Cancer Hospital; Sun Yat-sen University; Jiangxi Provincial Cancer Hospital; Zhejiang Cancer Hospital; Fujian Medical University Union Hospital
Recruiting
https://ift.tt/2x3xN1J
Intervention: Drug: Nimotuzumab
Sponsors: Fujian Cancer Hospital; Sun Yat-sen University; Jiangxi Provincial Cancer Hospital; Zhejiang Cancer Hospital; Fujian Medical University Union Hospital
Recruiting
https://ift.tt/2x3xN1J
A First-in-human Study of ILDR2 (Immunoglobulin-like Domain Containing Receptor 2) Function-blocking Antibody BAY1905254
Condition: Advanced Solid Tumor
Intervention: Drug: BAY1905254
Sponsor: Bayer
Not yet recruiting
https://ift.tt/2x1G9rJ
Intervention: Drug: BAY1905254
Sponsor: Bayer
Not yet recruiting
https://ift.tt/2x1G9rJ
Immunotherapy +/- EGFR Inhibitor In Advanced/Metastatic cSCC: Tackling Primary And Secondary Resistance
Condition: Skin Neoplasm
Interventions: Drug: Pembrolizumab; Drug: Cetuximab
Sponsors: Fondazione IRCCS Istituto Nazionale dei Tumori, Milano; Merck Sharp & Dohme Corp.
Not yet recruiting
https://ift.tt/2x91KxI
Interventions: Drug: Pembrolizumab; Drug: Cetuximab
Sponsors: Fondazione IRCCS Istituto Nazionale dei Tumori, Milano; Merck Sharp & Dohme Corp.
Not yet recruiting
https://ift.tt/2x91KxI
Pathophysiological Mechanism Behind Prolonged Whiplash Associated Disorders
Condition: Whiplash Injuries
Intervention: Other: Exercises
Sponsor: Linkoeping University
Not yet recruiting
https://ift.tt/2x0J6sA
Intervention: Other: Exercises
Sponsor: Linkoeping University
Not yet recruiting
https://ift.tt/2x0J6sA
A Safety and Tolerability Study of NC318 in Subjects With Advanced or Metastatic Solid Tumors
Conditions: Advanced or Metastatic Solid Tumors; Head and Neck Squamous Cell Carcinoma; Non-Small Cell Lung Cancer; Ovarian Cancer
Intervention: Drug: NC318
Sponsor: NextCure, Inc.
Not yet recruiting
https://ift.tt/2x91xKW
Intervention: Drug: NC318
Sponsor: NextCure, Inc.
Not yet recruiting
https://ift.tt/2x91xKW
Scholar : Research in Drama Education: The Journal of Applied Theatre and Performance, Volume 23, Issue 4, November 2018 is now available online on Taylor & Francis Online
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Uptake effects of toxic heavy metals from growth soils into jujube and persimmon of China
Abstract
Compared with other agricultural plants, information about uptake effects of toxic heavy metals from growth soils into persimmon and jujube are scarce. In this study, the single and comprehensive uptake effects of five toxic heavy metals (Pb, As, Cd, Cr, and Hg) between the two fruits and their growth soils were investigated. The results showed that the average concentrations of heavy metals in the two fruits were found to be 30 (Pb), 6.6 (As), 2.3 (Cd), 38 (Cr), and 0.33 (Hg) μg/kg, respectively. The average concentrations of heavy metals in their growth soils were 26.31 (Pb), 9.63 (As), 0.12 (Cd), 57.6 (Cr), and 0.049 (Hg) mg/kg, respectively. An uptake effect was observed for the two fruits. The values of Nemerow pollution index (NPI) in the two fruits and their growth soils were 0.10 and 0.55, respectively. The average bioconcentration factor (BCF) values of Pb, As, Cd, Cr, and Hg in the two fruits were 0.0012, 0.00075, 0.021, 0.00077, and 0.012, respectively. Based on the residue levels of toxic heavy metals in the growth soils and soil parameters, the prediction models for NPI and BCF were established, with the adjusted regression coefficients of 0.65 (NPI) and 0.81 (BCF). The contribution rates of different soil parameters to NPI were 21.7% (OC), 16.1% (Pb), 17.1% (Cr), 19.8% (Cd), and 25.4% (As), respectively. The contribution rates of different soil parameters to BCF were 10.2% (OC), 9.4% (Cr), and 80.4% (Cd), respectively.
https://ift.tt/2oVGRlQ
Role of sorption energy and chemisorption in batch methylene blue and Cu 2+ adsorption by novel thuja cone carbon in binary component system: linear and nonlinear modeling
Abstract
Functionalized thuja cone carbon (FTCC) was synthesized thermochemically. It was carried out by carbonization (250 °C) and activation (320 °C), followed by surface functionalization in 0.5 M HAN (HNO and HCl3) mixture and subsequent heating in H2SO4 (95%) at 90 °C. This was used for methylene blue (MB) adsorption in single component system (SCS) and binary component system (BCS) with Cu2+. Maximum adsorption capacity of MB (83.4 mg/g) was achieved at pH 10 at 100 mg/L of adsorbate solution. MB and Cu2+ adsorption onto FTCC obeyed pseudo-second-order model kinetics. Spontaneous and endothermic MB adsorption was noticed with negative Gibbs free energy change (− 6.34, − 9.20, and − 13.78 kJ/mol) and positive enthalpy change (133.91 kJ/mol). At low concentrations, Cu2+ adsorption increased by 14 mg/g with least reduction of MB adsorption (< 4 mg/g) in BCS. Isotherm models (Langmuir, Freundlich, Temkin, and Dubinin-Radushkevich) support the increase in Cu2+ adsorption in BCS. The sorption heat of MB shifted from 165.16 kJ/mol (SCS) to 150.85 kJ/mol in BCS (Temkin) and from 57.74 kJ/mol (SCS) to 50.50 kJ/mol in BCS (D-R), which supports the lower MB uptake in BCS due to decrease in sorption energy. The sorption heat of Cu2+ is increased (148.43 kJ/mol) in the BCS than SCS (155.36 kJ/mol), which makes the equal distribution of increased bonding energies; therefore, FTCC surface sites increased the Cu2+ uptake in the BCS. Desorption studies concluded the reusability of FTCC by 75% and 79% for MB and Cu2+ adsorption respectively. This study recommends to determine the best fit of isotherm and kinetic models to adsorption data by linear as well as nonlinear regression fit.
https://ift.tt/2O9g0xF
Volumetric and texture analysis of pretherapeutic 18 F-FDG PET can predict overall survival in medullary thyroid cancer patients treated with Vandetanib
Abstract
Purpose
The metabolically most active lesion in 2-deoxy-2-(18F)fluoro-D-glucose (18F-FDG) PET/CT can predict progression-free survival (PFS) in patients with medullary thyroid carcinoma (MTC) starting treatment with the tyrosine kinase inhibitor (TKI) vandetanib. However, this metric failed in overall survival (OS) prediction. In the present proof of concept study, we aimed to explore the prognostic value of intratumoral textural features (TF) as well as volumetric parameters (total lesion glycolysis, TLG) derived by pre-therapeutic 18F-FDG PET.
Methods
Eighteen patients with progressive MTC underwent baseline 18F-FDG PET/CT prior to and 3 months after vandetanib initiation. By manual segmentation of the tumor burden at baseline and follow-up PET, intratumoral TF and TLG were computed. The ability of TLG, imaging-based TF, and clinical parameters (including age, tumor marker doubling times, prior therapies and RET (rearranged during transfection) mutational status) for prediction of both PFS and OS were evaluated.
Results
The TF Complexity and the volumetric parameter TLG obtained at baseline prior to TKI initiation successfully differentiated between low- and high-risk patients. Complexity allocated 10/18 patients to the high-risk group with an OS of 3.3 y (vs. low-risk group, OS = 5.3 y, 8/18, AUC = 0.78, P = 0.03). Baseline TLG designated 11/18 patients to the high-risk group (OS = 3.5 y vs. low-risk group, OS = 5 y, 7/18, AUC = 0.83, P = 0.005). The Hazard Ratio for cancer-related death was 6.1 for Complexity (TLG, 9.5). Among investigated clinical parameters, the age at initiation of TKI treatment reached significance for PFS prediction (P = 0.02, OS, n.s.).
Conclusions
The TF Complexity and the volumetric parameter TLG are both independent parameters for OS prediction.
https://ift.tt/2Qg5nup
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Summary Insulinomas are rare neuroendocrine tumours that classically present with fasting hypoglycaemia. This case report discusses an un...
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The online platform for Taylor & Francis Online content New for Canadian Journal of Remote Sen...
