Presence of varicella zoster virus in zosteriform leukaemia cutis

Summary

Leukaemia cutis is a relatively rare manifestation in chronic lymphocytic leukaemia, characterized by a diverse morphology of skin lesions. We report two patients who developed zosteriform skin symptoms; however, the histological analysis revealed leukaemia infiltration as the cause of their symptoms. Contrary to previous reports, varicella zoster virus DNA was detectable in the lesions. These findings suggest that varicella zoster virus plays an active role in the development of zosteriform leukaemia cutis.

http://bit.ly/2RjBY6O

Impact of smoking on imiquimod response in patients with vulval intraepithelial neoplasia

Summary

Background

Vulval intraepithelial neoplasia (VIN) is a precancerous condition that may progress to invasive malignancy. VIN is associated with human papillomavirus (HPV) infection in most cases, and with inflammatory skin disorders in a smaller proportion of patients. Treatment of VIN has traditionally been surgical excision; however, topical treatments, including imiquimod cream, are becoming increasingly used. Patient factors influencing response to imiquimod therapy, in particular smoking, have not yet been published.

Aim

To assess the impact of smoking and other patient characteristics that may influence the treatment response to topical imiquimod for VIN.

Methods

This was a retrospective cohort study of 46 women treated with topical imiquimod for VIN in a single centre dermatology unit from January 2011 to July 2017.

Results

Complete clinical resolution of VIN was observed in 28 of 46 patients (61%), but was significantly reduced in the smoking cohort.

Conclusions

Smoking may impair response to imiquimod for VIN, and should be considered when discussing VIN treatment options with patients.

http://bit.ly/2C8VmJ8

Two cases of perniosis in a free flap and a graft site of the hands

http://bit.ly/2H4koiq

Assessing climate change impacts on pearl millet under arid and semi-arid environments using CSM-CERES-Millet model

Abstract

Climate change adversely affects food security all over the world, especially in developing countries where the increasing population is confronting food insecurity and malnutrition. Crop models can assist stakeholders for assessment of climate change in current and future agricultural production systems. The aim of this study was to use of system analysis approach through CSM-CERES-Millet model to quantify climate change and its impact on pearl millet under arid and semi-arid climatic conditions of Punjab, Pakistan. Calibration and evaluation of CERES-Millet were performed with the field observations for pearl millet hybrid 86M86. Mid-century (2040–2069) climate change scenarios for representative concentration pathway (RCP) 4.5 and RCP 8.5 were generated based on an ensemble of selected five general circulation models (GCMs). The model was calibrated with optimum treatment (15-cm plant spacing and 200 kg N ha⁻¹) using field observations on phenology, growth and grain yield. Thereafter, pearl millet cultivar was evaluated with remaining treatments of plant spacing and nitrogen during 2015 and 2016 in Faisalabad and Layyah. The CERES-Millet model was calibrated very well and predicted the grain yield with 1.14% error. Model valuation results showed that there was a close agreement between the observed and simulated values of grain yield with RMSE ranging from 172 to 193 kg ha⁻¹. The results of future climate scenarios revealed that there would be an increase in T_min (2.8 °C and 2.9 °C, respectively, for the semi-arid and arid environment) and T_max (2.5 °C and 2.7 °C, respectively, for the semi-arid and arid environment) under RCP4.5. For RCP8.5, there would be an increase of 4 °C in T_min for the semi-arid and arid environment and an increase of 3.7 °C and 3.9 °C in T_max, respectively, for the semi-arid and arid environment. The impacts of climate changes showed that pearl millet yield would be reduced by 7 to 10% under RCPs 4.5 and 8.5 in Faisalabad and 10 to 13% in Layyah under RCP 4.5 and 8.5 for mid-century. So, CSM-CERES-Millet is a useful tool in assessing the climate change impacts.

http://bit.ly/2Cf06Nt

The effect of various primers improving adhesiveness of gel polish hybrids on pH, TOWL and overall nail plates condition

Summary

Background

Hybrid manicure is now a popular method of nail care and nail art, which is associated with its durability. Unfortunately, it has an adverse effect on pH, TOWL and overall nail plates condition and has not been investigated in detail so far.

Aims

The aim of this study was to compare the pH and TOWL of the hand nails after using different primers. The effect of application time, breaks between applications and the method of curing and removal on those parameters and overall nail plates condition were evaluated.

Patients/Methods

An evaluation survey was conducted among 116 women. pH and TOWL measurements of the nail plate in 35 women were taken using the Courage & Khazaka. Clinical photos were made using the Fotomedicus system.

Results

The measured pH values of the nail plate in the test group with gel polish hybrid on the nails were from 5.50 to 6.65, while after removal of the gel polish hybrid, the values ranged from 5.63 to 6.68. TOWL of the nail plate covered with gel polish hybrid ranged from 2.9 to 33.2 g/m²/h, whereas after removal of hybrids—from 1.9 to 45.7 g/m²/h.

Conclusion

Different forms of acid‐free primers maintain a lower pH of the nail plate covered with a gel polish hybrid, while the acidic primer maintains higher values of the nail plate pH. The significant decrease in the nail plate TOWL following the application of gel polish hybrid indicates a reduced loss of water from the surface of the nail to the atmosphere.

http://bit.ly/2FnnRWD

Combined influence of external nitrogen and soil contact on plant residue decomposition and indications from stable isotope signatures

Abstract

External nitrogen (N) supply has been testified to exert important impacts on plant residue decomposition. The influence of N may be interactive with soil contact in terrestrial ecosystems. However, the joint mechanisms of decomposition of plant residues driven by soil contact and N addition remain incomplete. Using contrasting residues, including needles of Chinese fir (Cuninghamia lanceolata) (Cl) (relatively hard to degrade) vs. leaves of eucalyptus (Eucalyptus urophylla) (Eu) (relatively easy to degrade), a full factorial experiment was conducted by 360-day experiment to investigate the combined effect of N addition and soil contact on residue decay. As the microbe-manipulated decomposition could leave an imprint on the residue carbon (C) and N stable isotope, variations of the two signatures (δ¹³C and δ¹⁵N) were synchronously monitored. Our results firstly showed that added N sped up initial decomposition, while it played an opposite role in subsequent stage, and soil contact always stimulated decay. Under soil contact condition, we found a markedly more accelerating effect of N addition on decay of Cl than without soil contact. Linking with residue N dynamics, we thought that although N immobilized from soil could not completely meet microbial needs for decay of Cl, this N limitation was just relieved by added N, leading to this synergistic effect. At late decay stage, the N inhibiting influence was partly offset under soil contact condition, and this phenomenon was more dramatic for Eu. Our results lastly revealed that the ¹³C and ¹⁵N signatures mirrored and explained the underlying mechanisms of the above interactions. Overall, we concluded that external N and soil contact could interactively affect decay, depending on plant residue decomposability. These results would be used to accurately predict C sequestration for terrestrial ecosystems under heightened N scenario in the future.

http://bit.ly/2QAwaQW

Glycolytic Inhibitor 2-Deoxy-D-Glucose at Chronic Low Dose Mimics Calorie Restriction in Rats Through Mitohormetic Induction of Reactive Oxygen Species

Rejuvenation Research, Ahead of Print.


http://bit.ly/2RjlU50

A Big Thank You to Our Reviewers in The Past Year!

Exp Clin Endocrinol Diabetes 2019; 127: 5-7
DOI: 10.1055/a-0795-1114

© Georg Thieme Verlag KG Stuttgart · New York

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http://bit.ly/2VGTIHG

Selenoprotein P in Patients with Nonalcoholic Fatty Liver Disease

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0811-9136

Objective Main aim of this study was to evaluate circulating selenoprotein P (SEPP) levels in patients with simple steatosis (SS) and nonalcoholic steatohepatitis (NASH) compared with healthy controls. Methods Thirty-one patients with biopsy-proven NAFLD (15 with SS, 10 with borderline NASH, 6 with definite NASH) and 27 matched controls without NAFLD were enrolled. Serum SEPP levels and liver function tests plus biochemical parameters were measured with ELISA and standard methods, respectively. Homeostatic model of assessment - insulin resistance (HOMA-IR) was calculated. Results SEPP levels were statistically different between groups (p-value for trend=0.043). In pairwise comparisons, SEPP was lower in definite NASH compared with controls (p=0.029), but not SS (p=0.18) or borderline NASH (p=0.35). SEPP was not different between controls, SS and borderline NASH. The unadjusted trend between the controls, SS and NASH patients remained essentially unchanged after adjustment for age, sex, log(ALT) and waist circumference, but it marginally lost significance when log(HOMA-IR) entered into the model. SEPP levels were not different between groups of different severity of steatosis, fibrosis, hepatocellular ballooning, lobular and portal inflammation. Conclusions Lower SEPP levels were observed in patients with definite NASH compared with controls, a finding warranting larger studies.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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http://bit.ly/2QBvZoD

Effects of dietary fluoranthene on nymphs of Blaptica dubia S. (Blattodea: Blaberidae)

Abstract

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous environmental pollutants which exert detrimental effects on living beings. Considering the health risk associated with exposure to these pollutants, their presence in food increases efforts to establish early-warning indicators of pollution. We aimed to examine the effects of environmentally relevant concentrations of fluoranthene (0.2 ng and 18 ng/g dry weight of diet) on the activities of midgut antioxidant and detoxification enzymes in Blaptica dubia. Significant changes of superoxide dismutase and catalase activities, recorded at the higher fluoranthene concentration regardless of the exposure time, suggest that they may be used as biomarkers of PAH pollution. Increased GST activity and decreased total GSH content, detected upon acute exposure to the lower concentration, indicate processes of detoxification. Reorganization of B. dubia mechanisms of defense in response to oxidative stress caused by exposure to dietary PAH point to the necessity for further examination of fluoranthene actions.

http://bit.ly/2CYOiAj

Real-time monitoring and quantification of organic by-products and mechanism study of acetone decomposition in a dielectric barrier discharge reactor

Abstract

Non-thermal plasma (NTP) degradation of low-concentration acetone was investigated in a cylindrical dielectric barrier discharge reactor. The effects of oxygen content and flow rate on the removal efficiency at various discharge powers were examined in real-time. The acetone removal efficiency decreases drastically and then remains stable or increases gradually as the O₂ content increases from 0 to 25%, and further to 50%. The organic by-products were characterized and quantified using a real-time proton transfer reaction time-of-flight mass spectrometry (PTR-TOF-MS) instrument. The observed organic compounds, with concentrations about ppbv/ppmv by volume, were mainly formaldehyde, methanol, ketene, acetaldehyde, formic acid, acetone, and acetic acid. The discharge power was a critical factor affecting the concentration of the organic by-products and the selectivity toward CO₂. The mechanism study based on the by-product monitor in real-time showed that acetone firstly fragments into methyl radicals, acetyl radicals, and H; then, the methyl and acetyl radicals are oxidized by O or OH radicals into acetaldehyde, methanol, and other compounds. It seems that acetaldehyde could be an intermediate in acetone decomposition. Firstly, most of the acetone molecules were decomposed into acetaldehyde molecules; then, the acetaldehyde molecules continued to be decomposed and oxidized into other compounds, such as acetic acid and formaldehyde. These investigations not only proposed a detail decomposition mechanism for acetone in dielectric barrier discharge reactor, but also provided a potential way to analyze and evaluate the practicability of NTP removal of VOCs.

http://bit.ly/2TCa6Y7

Microsurgical Reconstruction of the Plantar Foot: Long-Term Functional Outcomes and Quality of Life

J reconstr Microsurg
DOI: 10.1055/s-0038-1677038

Background When faced with plantar defects, reconstruction of the weight-bearing areas presents unique surgical challenges. Several free flap modalities have been described in this respect, but there remains debate regarding the best-suited flap modality. Aim of this study was to compare free muscle and non-neurotized fasciocutaneous flaps for plantar reconstruction with respect to long-term functional outcomes. Methods Overall, 89 patients received 100 free flaps (anterolateral thigh [ALT] n = 46; gracilis n = 54) for plantar reconstruction. The data were screened for patients' demographics, as well as perioperative details. Postoperative complications were accounted for and the two groups compared accordingly. All patients were contacted for a long-term follow-up examination. Results There were no significant differences between the two groups regarding major (24 vs. 17%; p = 0.366) and minor surgical complications (61 vs. 70%; p = 0.318). However, the ALT group showed a significantly higher need for secondary surgeries (39 vs. 19%; p = 0.022). Sixty-eight patients (76%) returned for long-term follow-up evaluation (mean: 51.2 months, range: 13–71 months). The ALT group showed significantly less pain at the recipient (p = 0.0004) and donor (p = 0.010) sites, and scar assessment revealed significantly better results (p < 0.001). Additionally, the ALT group showed better depth (p = 0.017) and superficial (p = 0.007) sensation and enabled better shoe provision (p = 0.014). Conclusions Both the free ALT and gracilis flaps are well suited for plantar reconstruction, yielding overall similar functional outcomes. However, the ALT flap produces less scarring and pain, while showing better recovery of sensation and enabling better shoe provision. The ALT flap thus presents our preferred option.
[...]

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The Impact of Age on Perioperative Complications after Extremity Reconstruction with the Free Gracilis Flap: A Retrospective Cohort Study Involving 153 Patients

J reconstr Microsurg
DOI: 10.1055/s-0038-1677455

Background The need for plastic and reconstructive surgery on elderly patients has been on the rise due to an increase in life expectancy in the past decades. Therefore, a study was conducted on young and elderly patients following microsurgical extremity reconstructions with free gracilis muscle flaps with the primary aim to investigate the influence of age and the American Society of Anesthesiologists (ASA) score on the general outcome, as well as surgical and medical complications. Methods A retrospective analysis of 153 patients receiving free gracilis muscle flaps for extremity reconstructions between November 2009 and January 2018 was performed at two partner institutions specialized in microsurgical reconstructions. A logistic regression analysis was performed to correlate age and the ASA score with postoperative complication probability. Patients younger than 70 years were directly compared with elderly patients with respect to age, gender, ASA score, preexisting comorbidities, localization, and postoperative medical and surgical complications. Results Age turned out to be not significantly associated with major flap complications (p = 0.925) but with higher ASA scores (p = 0.016). However, an age-related significant increase in minor flap complications could be observed in the elderly (p = 0.008). A significant correlation between minor medical complications and age could be observed (p = 0.001) in contrast to ASA score (p = 0.912). Conclusion An increased minor flap, as well as minor and major medical complications, must be expected in extremity reconstructions with free gracilis flaps in elderly patients. Higher ASA scores correlate with a higher incidence of major flap complications. Septuagenarians are more prone to develop perioperative major medical complications than patients younger than 70 years. Age and general medical condition, coupled with the performance of each patient, should be thoroughly assessed individually to facilitate a tailored reconstructive approach using risk assessment tools and established scoring systems.
[...]

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

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http://bit.ly/2SO41b2

Microvascular Anastomotic Coupler: An Unexpected Adverse Event

J reconstr Microsurg
DOI: 10.1055/s-0038-1677036

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

Article in Thieme eJournals:
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http://bit.ly/2ADBG09

Sex differences in [ 11 C]ABP688 binding: a positron emission tomography study of mGlu5 receptors

Abstract

Purpose

The purpose of this study was to assess, in a large sample of healthy young adults, sex differences in the binding potential of [¹¹C]ABP688, a positron emission tomography (PET) tracer selective for the metabotropic glutamate type 5 (mGlu5) receptor.

Methods

High resolution [¹¹C]ABP688 PET scans were acquired in 74 healthy volunteers (25 male, 49 female, mean age 20 ± 3.0). Mean binding potential (BP_ND = f_ND * (B_avail / K_D)) values were calculated in the prefrontal cortex, striatum, and limbic regions using the simplified reference tissue model with cerebellar grey matter as the reference region.

Results

[¹¹C]ABP688 BP_ND was significantly higher in men compared to women in the prefrontal cortex (p < 0.01), striatum (p < 0.001), and hippocampus (p < 0.05). Whole-brain BP_ND was 17% higher in men. BP_ND was not related to menstrual phase in women.

Conclusions

Binding availability of mGlu5 receptors as measured by PET [¹¹C]ABP688 is higher in healthy men than women. This likely represents a source of variability in [¹¹C]ABP688 studies and could have relevance for sex differences in cognitive-behavioral functions and neuropsychiatric disorders.

http://bit.ly/2AGje71

Cortical atrophic-hypometabolic dissociation in the transition from premanifest to early-stage Huntington’s disease

Abstract

Purpose

Huntington's disease (HD) is a fatal neurodegenerative disorder with no effective treatment currently available. Although the pathological hallmark of HD is massive striatal atrophy, it has been suggested that cortical deterioration may concomitantly occur and play a major role in the patient's functional independence. Our objective was to characterize cortical structural and metabolic neurodegeneration in the transition from premanifest to early-stage Huntington's disease (HD).

Methods

Using a surface-based neuroimaging approach, we compared cortical thickness and intracortical FDG-PET uptake in 19 early-symptomatic HD patients with respect to 21 premanifest HD individuals.

Results

Early-HD patients showed significant cortical atrophy and intracortical hypometabolism when compared to premanifest subjects (p < 0.05, corrected for multiple comparisons). However, whereas the atrophy pattern was restricted to precentral and parieto-occipital regions, a pronounced frontotemporal hypometabolism was observed. Importantly, structural changes correlated with motor and cognitive performance, and metabolic changes were associated with the presence and severity of apathy in this population, a core neuropsychiatric feature of this disorder.

Conclusion

Our findings reveal an asynchronous neuronal loss and metabolic compromise across the cerebral cortex in early HD. Hence, the use of structural and metabolic imaging indicators to characterize disease progression in this population should take into consideration the dissociation which occurs between cortical atrophy and hypometabolism.

http://bit.ly/2SO0KZi

Can Facial Proportions Provide an Objective Assessment of Prominent Ears? A survey of healthcare professionals

Evaluation of facial aesthetics is inherently subjective, though for centuries we have tried to objectify these assessments by using measures such as the 'Golden Ratio'. This study aims to make similar descriptions of prominent ears using a simple ratio observed in standard anterior pre-operative clinical photographs.1

http://bit.ly/2H3i2jJ

Management of Median and Paramedian Craniofacial Clefts

Median and paramedian craniofacial clefts are associated with hypertelorism, anterior encephalocele, positional abnormalities of the maxilla and nasal deformity. Cleft lip and palate, eyelid coloboma and widow's peak are frequently present.

http://bit.ly/2RC3mMG

Treatment of fingertip avulsion injuries using two periposition pedicled flaps

We described a treatment of fingertip avulsion injury by two periposition pedicled flaps, the reversed pedicle island flap of dorsal branch of proper digital artery and the cross-finger flap. From February 2009 to January 2017, 22 patients (22 fingers) with fingertip avulsion injury were treated with two periposition pedicled flaps, 14 male and 8 female, aged from 17 to 47 years (mean 32±9 years). All of the patients were followed up more than 6 months after operations (mean 9.6±2.6 months). All flaps survived completely.

http://bit.ly/2H3hkmz

“Surgical Outcomes of VRAM versus Gracilis Flaps for the Reconstruction of Pelvic Defects following Oncologic Resection”

Pelvic reconstruction following abdominoperineal resection or pelvic exenteration is associated with signification surgical site morbidity. Immediate pelvic reconstruction with a muscle flap is now the gold standard, associated with reduced perineal morbidity compared to primary closure alone.2,3 The purpose of the present study was to directly compare outcomes of VRAM and gracilis flap pelvic reconstruction following oncologic resection.

http://bit.ly/2RD0WNO

PART 2: CAN IMPROVEMENT IN OUTCOME MEASUREMENT IN PLASTIC SURGERY BE ACHIEVED IN TODAY'S HEALTH SYSTEMS?

Being able to accurately measure relevant constructs is particularly valuable in plastic surgery, where the objective of treatment may range across improving hand function, identifying satisfaction with breast reconstruction, or establishing quality of life changes from surgery. This matters in research applications such as clinical trials, and for quality assurance of surgery through routine data collection in clinical practice. The technical aspects of refining measurement to ensure that it is accurate and the process for selecting outcome measures have both been described in recent articles in this journal.

http://bit.ly/2H4ONwO

A Novel Modification of Keystone Flap for Superficial Defects Repair

In 2003, Behan1 was the first to report the Keystone Design Perforator Island Flap (KDPIF). The KDPIF has the advantages of simple design, convenient operation, certain perforator blood supply, adjacent tissue, good appearance and nearby texture. Therefore, it has been widely applied to repairing skin soft tissue defects caused by trauma, tumor resection, and scars.2,3 However, the KDPIF has certain issues such as excessive tension, constraint on the closure of the donor area,4,5 and skin contractures due to straight line scars across the joints in repairing large-size defects of the trunk, the joints or other moving areas.

http://bit.ly/2Ryb7Dl

Long-term pre- and postconditioning with low doses of erythropoietin protects critically perfused musculo-cutaneous tissue from necrosis

It has been shown that pre- and postconditioning of ischemically challenged tissue with erythropoietin (EPO) is able to reduce necrosis in a dose-dependent manner. The aim of this study was to determine the tissue-protective effects of different EPO dosages and administration regimes.Three groups of six C57Bl/6-mice each were analyzed. 1. Pre- and postconditioning with initial high doses of EPO (starting at 2500 I.U./kg bw i.p.) followed by low doses of EPO (125 I.U./kg bw i.p.) (EPO-high-dose); 2.

http://bit.ly/2GZUgoG

Relationship between the expression of PD-1/PD-L1 and 18 F-FDG uptake in bladder cancer

Abstract

Purpose

Immunotherapy aimed at inhibiting the PD-1/PD-L1 immune checkpoint has been approved and used successfully for the treatment of bladder cancer. The identification of markers predictive of response to immune checkpoint inhibitors is critical to advancing the success of this therapy. ¹⁸F-FDG PET/CT is a molecular imaging technique that can provide phenotypic information on malignant tumours. It is currently unknown whether there is a relationship between ¹⁸F-FDG uptake and expression of PD-1/PD-L1 in bladder cancer. In this study, we investigated whether PD-1/PD-L1 expression is associated with ¹⁸F-FDG uptake in bladder cancer, and whether ¹⁸F-FDG PET/CT imaging can be used to predict the PD-1/PD-L1 status of bladder cancer.

Methods

A retrospective analysis was performed in 63 patients with bladder cancer who had undergone ¹⁸F-FDG PET/CT before surgical resection. Maximum standardized uptake values (SUVmax) were determined.

Results

SUVmax was significantly higher in PD-1-positive patients than in PD-1-negative patients (33.0 ± 13.9 and 19.6 ± 14.2, respectively; P = 0.032), and in PD-L1-positive patients than in PD-L1-negative patients (29.1 ± 15.6 and 15.8 ± 11.4, respectively; P < 0.0001). In a multivariate analysis SUVmax was significantly associated with both PD-1 expression and PD-L1 expression (P = 0.021 and P = 0.003, respectively). Using a SUVmax cut-off value of 22.7, PD-1 status and PD-L1 status could be predicted with accuracies of 71.4% and 77.8%, respectively.

Conclusion

Higher ¹⁸F-FDG uptake by bladder cancer is associated with elevated PD-1/PD-L1 expression. ¹⁸F-FDG PET/CT may be useful for predicting the PD-1/PD-L1 status of bladder cancer and for determining the optimal therapeutic strategy.

http://bit.ly/2FokAGv

A New Molecular Taxonomy to Predict Immune Checkpoint Inhibitor Sensitivity in Prostate Cancer

http://bit.ly/2FlacR1

Brain Metastases and Place of Antiangiogenic Therapies in Alveolar Soft Part Sarcoma: A Retrospective Analysis of the French Sarcoma Group

AbstractBackground.Alveolar soft part sarcoma (ASPS) is a rare sarcoma characterized by a slow evolution, brain metastasis (BM), and resistance to doxorubicin. Antiangiogenic therapies (AAT) have shown clinical activity, but little is known about the optimal therapeutic strategy, specifically considering BM.Subjects, Materials, and Methods.We performed a retrospective analysis of all patients with ASPS treated in three referral centers of the French Sarcoma Group. We aimed to describe factors associated with overall survival (OS) and the impact of BM on outcome of patients treated by AAT.Results.We identified 75 patients between 1971 and 2012 (median age = 23, range: 5–96 years). Median follow‐up was 74 months. Patients with localized (n = 44, 59%) and metastatic (n = 31, 41%) diseases had a 10‐year OS of 69% and 25%, respectively. Only surgical incomplete resection was associated with shorter OS in localized disease (hazard ratio [HR] = 5.2, 95% confidence interval [CI] 1.2–22.4, p = .02). Fifty‐two (69%) patients developed lung metastasis (LM; baseline: n = 31, [41%]; de novo: n = 21, [28%]). Thirteen patients developed BM, all occurring after LM. Tumor size ≥5 cm was associated with poorer BM‐free survival (HR = 8.4, 95% CI 2.1–33.9, p = .002). Median OS post‐BM was 17 months (95% CI 15 to not assessable). Overall, 12 patients were treated with AAT (sunitinib n = 10): 5 patients had BM and achieved poor outcomes compared with patients without, with median progression‐free‐survivals of 2 versus 11 months, respectively.Conclusion.Baseline larger tumors were associated with increased risk of brain metastasis in patients with ASPS. Patients with BM seem to have little benefit from AAT, suggesting the need to develop antineoplastic agents with high central nervous system penetrance in this setting.Implications for Practice.Alveolar soft part sarcoma (ASPS) is an extremely rare subtype of sarcoma that is particularly resistant to conventional therapies. Antiangiogenic therapies (AAT) have shown promising results. However, patients with ASPS still die of tumor evolution. This study highlights the prognostic shift induced by brain metastasis (BM), identifying this event as a major contributor to the death of patients with ASPS, and observes a striking lack of effectiveness of AAT in patients who had previously developed BM. This observation is of interest for the therapeutic development in ASPS, highlighting the need to develop strategies dedicated to BM, such as radiosurgery or high‐central nervous system penetrance tyrosine kinase inhibitors.

http://bit.ly/2FocfTd

Lack of consensus on the peri-operative management of patients with diabetes mellitus

No abstract available

http://bit.ly/2FlnWtW

Thromboprophylaxis in the obese surgical patient

No abstract available

http://bit.ly/2FhRv0e

Relevance of peripheral cholinesterase activity on postoperative delirium in adult surgical patients (CESARO): A prospective observational cohort study

BACKGROUND The cholinergic system is considered to play a key role in the development of postoperative delirium (POD), which is a common complication after surgery. OBJECTIVES To determine whether peri-operative acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) activities are associated with the development of POD in in-hospital surgical patients, and raise hypotheses on cholinergic regulatory mechanisms in POD. DESIGN A prospective multicentre observational study by the Peripheral Cholinesterase-activity on Neurocognitive Dysfunctions in Surgical Patients (CESARO) study group. SETTING Nine German hospitals. PATIENTS Patients of at least 18 years of age scheduled for inpatient elective surgery for a variety of surgical procedures. A total of 650 patients (mean age 61.5 years, 52.8% male) were included. METHODS Clinical variables, and peripheral AChE and BuChE activities, were assessed throughout the peri-operative period using bedside point-of-care measurements (one pre-operative and two postoperative measurements). POD screening was conducted postoperatively for at least 24 h and up to the third postoperative day using a validated screening tool (nursing delirium screening scale). RESULTS In all, 179 patients (27.5%) developed POD within the early postoperative phase. There was a lower BuChE activity in patients with delirium compared with patients without delirium pre-operatively (Cohen's r = 0.07, P = 0.091), on postoperative day 1 (Cohen's r = 0.12, P = 0.003) and on postoperative day 2 (Cohen's r = 0.12, P = 0.002). In contrast, there was a significantly higher AChE activity in patients with delirium compared with patients without delirium pre-operatively (Cohen's r = 0.10, P = 0.012), on postoperative day 1 (Cohen's r = 0.11, P = 0.004) and on postoperative day 2 (Cohen's r = 0.13, P = 0.002). After adjusting for covariates in multiple logistic regression, a significant association between both BuChE and AChE activities and POD was not found. However, in the multivariable analysis using the Generalized Estimating Equation, cholinesterase activities showed that a decrease of BuChE activity by 100 U L−1 increased the risk of a delirium by approximately 2.1% (95% CI 1.6 to 2.8%) and for each 1 U g−1 of haemoglobin increase in AChE activity, there was a 1.4% (95% CI 0.6 to 2.2%) increased risk of POD. CONCLUSION Peri-operative peripheral cholinesterase activities may be related to the development of POD, but the clinical implications remain unclear. Further studies, in homogeneous patient groups with a strict protocol for measurement time points, are needed to investigate the relationship between cholinesterase activities and POD. TRIAL REGISTRATION www.clinicaltrials.gov. Identifier NCT01964274.

http://bit.ly/2FmpKmy

Intra-operative heart rate and postoperative outcomes – rowing against the tide?

No abstract available

http://bit.ly/2FnNfvl

Noninvasive continuous arterial pressure monitoring with Clearsight during awake carotid endarterectomy: A prospective observational study

BACKGROUND Continuous noninvasive blood pressure (CNBP) measurement using the volume-clamp method is a less invasive alternative compared with invasive intra-arterial monitoring for awake patients during carotid endarterectomy (CEA) under regional anaesthesia. OBJECTIVE We investigated the agreement of blood pressure (BP) recorded with invasive and CNBP methods during awake CEA. DESIGN A prospective observational study for assessing agreement with Bland–Altman plots, agreement-tolerability indices (ATI), concordance and interchangeability. SETTING Azienda Ospedaliera Universitaria G. Martino, Messina, a University tertiary referral centre in Italy. PATIENTS In 30 consecutive patients, we recorded continuously ipsilateral invasive and noninvasive BPs, from 3 min before carotid cross-clamping to 5 min after unclamping. MAIN OUTCOME MEASURES Primary outcome was bias, 95% limits of agreement, ATI, concordance and interchangeability for mean arterial pressure (MAP). Secondary outcomes were agreements for systolic arterial pressure and diastolic arterial pressure. Tracking of changes was assessed with four-quadrant polar plots and the trend interchangeability method. Optimal bias was defined as 5 mmHg or less. RESULTS A total of 2672 invasive and CNBP paired measurements (93% of overall data) were analysed, with a median of 92 readings per patient [IQR 76 to 100]. Mean (SD) bias for MAP, systolic arterial pressure and DAP were −6.8 (6.7), −3.0 (9.7) and −9.0 (5.4) mmHg, respectively. The ATIs were 0.88, 0.95 and 0.71, respectively, where ATI of 1.0 or less and at least 2.0 defined acceptable, marginal and unacceptable agreements. The four-quadrant plot analysis for beat-to-beat differences showed concordance rates of 97.3%, 99.98% and 96.4%, respectively. Polar plot analysis showed 95% limits of agreement of −3 to 3, −2 to 2 and −2 to 2 mmHg respectively. Trend interchangeability method showed an interchangeability rate of 95% for MAP. CONCLUSION During CEA performed under regional anaesthesia, CNBP offers a less invasive approach for BP monitoring. We found acceptable agreement for MAP defined by an ATI of 0.88 and an excellent 95% global interchangeability rate. A suboptimal bias of 7 mmHg was found with CNBP for MAP.

http://bit.ly/2Fib7Bs

Development of a prediction model for postoperative pneumonia: A multicentre prospective observational study

BACKGROUND Postoperative pneumonia is associated with increased morbidity, mortality and costs. Prediction models of pneumonia that are currently available are based on retrospectively collected data and administrative coding systems. OBJECTIVE To identify independent variables associated with the occurrence of postoperative pneumonia. DESIGN A prospective observational study of a multicentre cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe database). SETTING Sixty-three hospitals in Europe. PATIENTS Patients undergoing surgery under general and/or regional anaesthesia during a 7-day recruitment period. MAIN OUTCOME MEASURE The primary outcome was postoperative pneumonia. Definition: the need for treatment with antibiotics for a respiratory infection and at least one of the following criteria: new or changed sputum; new or changed lung opacities on a clinically indicated chest radiograph; temperature more than 38.3 °C; leucocyte count more than 12 000 μl−1. RESULTS Postoperative pneumonia occurred in 120 out of 5094 patients (2.4%). Eighty-two of the 120 (68.3%) patients with pneumonia required ICU admission, compared with 399 of the 4974 (8.0%) without pneumonia (P 

http://bit.ly/2FmgCOU

Six-minute walk test in pre-operative evaluation of patients for upper abdominal surgery

No abstract available

http://bit.ly/2FhZ9rt

Intra-operative tachycardia is not associated with a composite of myocardial injury and mortality after noncardiac surgery: A retrospective cohort analysis

BACKGROUND Myocardial injury after noncardiac surgery (MINS) is a major contributor to peri-operative morbidity and mortality with a reported incidence of about 8%. Tachycardia increases myocardial oxygen demand, and decreases oxygen supply, and is therefore a potential cause of MINS. OBJECTIVE We tested the hypothesis that there is an association between intra-operative area above a heart rate (HR) of 90 bpm and a composite of MINS and in-hospital all-cause mortality. DESIGN Retrospective analyses. SETTING Major tertiary care hospital, Cleveland, USA. PATIENTS Adults having elective or nonelective noncardiac surgery and scheduled troponin monitoring during the first 3 postoperative days between 2010 and 2015. MAIN OUTCOME MEASURES All-or-none composite of myocardial injury (MINS), defined by a peak postoperative generation 4 troponin T concentration at least 0.03 ng ml−1, and in-hospital all-cause mortality. RESULTS Among 2652 eligible patients, 123 (4.6%) experienced MINS within 7 days after surgery and 6 (0.2%) died before discharge. Intra-operative area above HR more than 90 bpm was not associated with the all-or-none composite of MINS and in-hospital mortality, with an estimated odds ratio (95% confidence interval) of 0.99 (0.97 to 1.01) per 1 h bpm increase in area above HR more than 90 bpm. Secondary outcomes were also unrelated to the composite, with estimated odds ratios (98.3% confidence interval) of 0.99 (0.98 to 1.00) for area above HR more than 80, 0.98 (0.92 to 1.04) for area above HR more than 100 bpm, and 0.96 (0.88 to 1.05) for maximum HR. CONCLUSION There was no apparent association between various measures of tachycardia and a composite of MINS and death, a result that contradicts previously reported associations between other measures of intra-operative tachycardia and MINS/mortality.

http://bit.ly/2FjGr21

Postoperative pneumonia: Can this important complication be predicted and anticipated?

No abstract available

http://bit.ly/2FiaRCu

Goal-directed therapy during transthoracic oesophageal resection does not improve outcome: Randomised controlled trial

BACKGROUND Goal-directed therapy (GDT) is expected to be of highest benefit in high-risk surgery. Therefore, GDT is recommended during oesophageal resection, which carries a high risk of postoperative complications. OBJECTIVES The aim of this study was to confirm the hypothesis that GDT during oesophageal resection improves outcome compared with standard care. DESIGN A randomised controlled study. SETTING Two Swedish university hospitals, between October 2011 and October 2015. PATIENTS Sixty-four patients scheduled for elective transthoracic oesophageal resection were randomised. Exclusion criteria included colonic interposition and significant aortic or mitral valve insufficiency. INTERVENTION A three-step GDT protocol included stroke volume optimisation using colloid boluses as assessed by pulse-contour analysis, dobutamine infusion if cardiac index was below 2.5 l min−1 m−2 and norepinephrine infusion if mean arterial blood pressure was below 65 mmHg. MAIN OUTCOME MEASURE The incidence of complications per patient at 5 and 30 days postoperatively as assessed using a predefined list. RESULTS Fifty-nine patients were available for analysis. Patients in the intervention group received more colloid fluid (2190 ± 875 vs. 1596 ± 759 ml, P 

http://bit.ly/2Fhax73

Orthostatic intolerance following hip arthroplasty: incidence, risk factors and effect on length of stay: A prospective cohort study

BACKGROUND Early postoperative mobilisation is important for enhanced recovery, but can be hindered by orthostatic intolerance, characterised by dizziness, nausea, vomiting, feeling of heat, blurred vision and ultimately syncope. Although the incidence of orthostatic intolerance following total hip arthroplasty has been identified, few studies have yet investigated potential risk factors for developing orthostatic intolerance after hip arthroplasty. OBJECTIVES The aim of this study was to assess the incidence of orthostatic intolerance on the first postoperative day after total hip arthroplasty, potential predisposing risk factors for developing orthostatic intolerance and its effect on length of stay. DESIGN A prospective observational study. SETTING Tertiary hospital, Auckland, New Zealand, May to September 2015. PATIENTS One hundred and seventeen consecutive patients undergoing unilateral total hip arthroplasty. Patients were excluded if they had revision surgery. MAIN OUTCOME MEASURES Incidence of orthostatic intolerance during mobilisation on the first postoperative day. Significant peri-operative risk factors for developing orthostatic intolerance were identified using logistic regression. Length of stay was compared between orthostatic intolerant and orthostatic tolerant patients using the Mann–Whitney U-test. RESULTS On the first postoperative day, 22% of patients failed mobilisation due to orthostatic intolerance. Factors independently associated with orthostatic intolerance were female sex; OR (95% CI), 3.11 (1.01 to 9.57), postoperative use of gabapentin; OR 3.55 (1.24 to 10.15) and high peak pain levels (≥5/10) during mobilisation; OR 4.05 (1.30 to 12.61). Overall, 78% of patients were correctly identified. The model was more accurate at predicting those who would not get orthostatic intolerance (89% correct), compared with those who did have orthostatic intolerance (39% correct). Length of stay was longer in patients with orthostatic intolerance (P = 0.019). CONCLUSION Orthostatic intolerance is common after total hip arthroplasty. Optimising pain control prior to mobilisation and limiting gabapentin use may modify the risk of developing postoperative orthostatic intolerance. Although personalised recovery pathways appear attractive, at present, the ability to predict at-risk individuals is still limited.

http://bit.ly/2FmpJPw

Reply to: thromboprophylaxis in the obese surgical patient

No abstract available

http://bit.ly/2FhZ8DV

Peri-operative endothelial dysfunction in patients undergoing minor abdominal surgery: An observational study

BACKGROUND Myocardial injury after noncardiac surgery is common and associated with major adverse cardiac events. Surgery induces acute endothelial dysfunction, which might be central in the pathophysiology of myocardial injury; however, the relationship between surgical stress and endothelial function remains incompletely understood. OBJECTIVES This study aimed to assess the acute peri-operative changes in endothelial function after minor elective abdominal surgery. DESIGN A prospective, observational, single-centre study. SETTING A university hospital from February 2016 to January 2017. PATIENTS Sixty patients undergoing elective minor abdominal surgery. MAIN OUTCOME MEASURES The change in endothelial function, expressed as the reactive hyperaemia index (RHI), was assessed by non-invasive digital pulse tonometry. RHI, biomarkers of nitric oxide bioavailability and oxidative stress were assessed prior to and 4 h after surgery. RESULTS RHI decreased significantly from 1.93 [95% confidence interval (95% CI 1.78 to 2.09)] before surgery to 1.76 (95% CI 1.64 to 1.90), P = 0.03, after surgery. The nitric oxide production, L-arginine/asymmetric dimethylarginine, decreased significantly from a ratio of 213.39 (95% CI 188.76 to 241.2) to a ratio of 193.3 (95% CI 171.82 to 217.54), P = 0.03. Plasma biopterins increased significantly after surgery, while the ratio between tetrahydrobiopterin and dihydrobiopterin was unchanged. Total ascorbic acid decreased significantly after surgery (P 

http://bit.ly/2FllVOq

Anaesthesiology residents have no significant effect on anaesthesia or procedure times

No abstract available

http://bit.ly/2Fhayb7

Monitoring haemodynamic response to fluid-challenge in ICU: comparison of pressure recording analytical method and oesophageal Doppler: A prospective observational study

BACKGROUND The ability of the pressure recording analytical method (PRAM) in tracking change in cardiac output (ΔCO) after a fluid challenge in ICU needs to be evaluated with the most contemporary comparison methods recommended by experts. OBJECTIVE Our objective was to report the trending ability of PRAM in tracking ΔCO after a fluid challenge in ICU and to compare this with oesophageal Doppler monitoring (ODM). DESIGN Prospective, observational study. SETTING Hôpital Lariboisière and Hôpital Européen George Pompidou, Paris, France, from April 2016 to December 2017. PATIENTS Critically ill patients admitted to ICU with monitoring of CO monitored by ODM and invasive arterial pressure. INTERVENTION ΔCO after fluid challenge was simultaneously registered with ODM and PRAM connected to the arterial line. MAIN OUTCOME MEASURE Polar statistics (mean angular bias, radial limits of agreement and polar concordance rate) and clinical concordance evaluation (error grid and clinical concordance rate). Predictors of bias were determined. RESULTS Sixty-eight fluid challenge were administered in 49 patients. At the time of fluid challenge, almost all were mechanically ventilated (99%), with 85% receiving norepinephrine. Admission diagnosis was septic shock in 70% of patients. Patients had a Sequential Organ Failure Assessment score of 10 [7 to 12] and a median Simplified Acute Physiology Score II of 61 [49 to 69]. Relative ΔCO bias was 7.8° (6.3°) with radial limits of agreement of ±41.7°, polar concordance rate 80% and clinical concordance rate 74%. ΔCO bias was associated with baseline bias (P = 0.007). Baseline bias was associated with radial location of the arterial line (P = 0.03). CONCLUSION When compared with ODM, PRAM has insufficient performance to track ΔCO induced by fluid challenge in ICU patients. Baseline bias is an independent predictor of trending bias. TRIAL REGISTRATION IRB 00010254-2016-033.

http://bit.ly/2Flbz0Z

European paediatric anaesthesia e-learning platform pearls and challenges

No abstract available

http://bit.ly/2Fj3sCO

Unilateral Thalamic Deep Brain Stimulation for Voice Tremor

Background: Voice tremor (VT) is the involuntary and rhythmical phonatory instability of the voice. Recent findings suggest that unilateral deep brain stimulation of the ventral intermediate nucleus (Vim-DBS) can sometimes be effective for VT. In this exploratory analysis, we investigated the effect of Vim-DBS on VT and tested the hypothesis that unilateral thalamic stimulation is effective for patients with VT. Methods: Seven patients with VT and previously implanted bilateral Vim-DBS were enrolled in the study. Each patient was randomized and recorded performing sustained phonation during the following conditions: left thalamic stimulation, right thalamic stimulation, bilateral thalamic stimulation (Bil-ON), and no stimulation (Bil-OFF). Perceptual VT ratings and an acoustic analysis to find the rate of variation of the fundamental frequency measured by the standard deviation of the pitch (f0SD) were performed in a blinded manner. For the purposes of this study, a "dominant" side was defined as one with more than twice as much reduction in VT following Vim-DBS compared to the contralateral side. The Wilcoxon signed-rank test was performed to compare the effect of the dominant side stimulation in the reduction of VT scores and f0SD. The volume of activated tissue (VAT) of the dominant stimulation side was modelled against the degree of improvement in VT to correlate the significant stimulation cluster with thalamic anatomy. Finally, tractography analysis was performed to analyze the connectivity of the significant stimulation cluster. Results: Unilateral stimulation was beneficial in all 7 patients. Five patients clearly had a "dominant" side with either benefit only seen following stimulation of one side or more than twice as much benefit from one side compared to the other. Two patients had similar benefit with unilateral stimulation from either side. The Wilcoxon paired test showed significant differences between unilateral dominant and unilateral nondominant stimulation for VT scores (p = 0.04), between unilateral dominant and Bil-OFF (p = 0.04), and between Bil-ON and unilateral nondominant stimulation (p = 0.04). No significant differences were found between Bil-ON and unilateral dominant condition (p = 0.27), or between Bil-OFF and unilateral nondominant (p = 0.23). The dominant VAT showed that the significant voxels associated with the best VT control were located in the most ventral and medial part of the Vim nucleus and the ventralis caudalis anterior internus nucleus. The connectivity analysis showed significant connectivity with the cortical areas of the speech circuit. Conclusions: Unilateral dominant-side thalamic stimulation and bilateral thalamic stimulation were equally effective in reducing VT. Nondominant unilateral stimulation alone did not significantly improve VT.
Stereotact Funct Neurosurg

http://bit.ly/2FgiGZn

BRCA Exchange aggregates data on thousands of BRCA variants to inform understanding of cancer risk

The BRCA Exchange, a global resource that includes data on thousands of inherited variants in the BRCA1/BRCA2 genes, is available to the public through a website and new smartphone app.

http://bit.ly/2FgO75W

Premaxillary–maxillary suture development in the first trimester

Abstract

Purpose

Our study was designed to investigate premaxillary–maxillary suture growth in fetuses from the first trimester of pregnancy using the B‑ultrasound technique in order to determine the suture fusion time.

Methods

We selected 169 healthy Han singleton pregnancies as subjects. All subjects received routine pregnancy tests and were divided into three groups based on the gestational age of the fetus: group 1, the 11th gestational week; group 2, the 12th gestational week; and group 3, the 13th gestational week. Fetal biometric measurements were recorded during consecutive prenatal ultrasonographic examinations. These measurements included nuchal translucency thickness, crown–rump length, and premaxillary–maxillary length. Intergroup comparisons were performed using analysis of variance (ANOVA).

Results

The premaxillary–maxillary suture grows gradually and its measured length at the 11th, 12th and 13th week was 0.54 cm, 0.65 cm, and 0.74 cm, respectively. We observed a significant linear correlation between the premaxillary–maxillary length and the week of gestation in the first trimester. The growth rate of the maxilla at the 11th, the 12th and the 13th week are significantly different with a descending order of growth rates being week 12, week 11 and week 13, with the 12th week rate being the most rapid.

Conclusion

The premaxillary and maxillary growth at 11 and 12 gestational weeks in the first trimester steadily accelerated, peaking at the 12th week. The rate of growth slows down after week 12 which may be associated with the fusion of the premaxillary–maxillary suture.

http://bit.ly/2TBJs1y

Photocatalytic degradation of pharmaceutical micro-pollutants using ZnO

Abstract

This research paper presents the results of an experimental investigation of the degradation of three different contaminants including progesterone (PGS), ibuprofen (IBU), and naproxen (NAP) using ZnO as the photocatalyst and ultraviolet (UV) light as a source for catalysts activation. Two operating parameters, namely, catalyst loading and initial concentration of contaminants, were tested in a batch photocatalytic reactor. To demonstrate the large-scale applications, experiments were also conducted in a submerged membrane photocatalytic reactor. It has proven that ZnO photocatalyst degraded the three contaminants very efficiently under almost all the studied experimental conditions, with efficiency rates of 92.3, 94.5, and 98.7 % for PSG, IBU, and NAP, respectively. The photodegradation kinetics study was performed to calculate the reaction rate constant, which is found to follow pseudo-first order kinetics. The membrane photocatalytic reactor was efficient to remove pollutants and it is observed that the degradation rate increases with increasing the membrane oscillation frequency approaching that of the stirred reactor.

http://bit.ly/2H5ettj

Complications, patient-reported outcomes, and aesthetic results in immediate breast reconstruction with a dermal sling: a systematic review and meta-analysis

An inferior dermal flap ("sling") can be used to cover an implant with two layers of tissue following Wise pattern skin-reducing mastectomies. Here, we performed a systematic review of the risks and benefits of this technique, specifically regarding complications, patient-reported outcomes, and aesthetic outcomes. PubMed and other relevant databases were searched using specific key words, with inclusion criteria comprising studies of dermal sling use involving ≥5 patients and performance according to the PICO framework.

http://bit.ly/2LY8cOM

PARTIALLY TUBULIZED U-SHAPED SUPRACLAVICULAR FLAP: AN EXCELLENT OPTION FOR RECONSTRUCTION OF CIRCUMFERENTIAL PHARYNGEAL DEFECTS.

Supraclavicular flap is a versatile flap in head and neck reconstruction but few data have been published about its use for circumferential pharyngeal defects.

http://bit.ly/2sgHZC6

PORCINE MODEL FOR TRAINING IN ONCOPLASTIC BREAST SURGERY TECHNICAL DESCRIPTION AND RESULTS OF ITS APPLICATION IN A TRAINING COURSE IN ONCOPLASTIC AND RECONSTRUCTIVE TECHNIQUES IN BREAST SURGERY

Breast surgeons need specific training in oncoplastic and reconstructive procedures for planning a surgery specific to the breast and the tumor.1 The porcine model provides an option for this training need thanks to its anatomical similarity to humans, manageability of young specimens and relative low cost.2,3 The objective of this report is to describe a porcine model for performing latissimus dorsi muscle flaps (LDMF) and transverse rectus abdominis muscle (TRAM) flaps, as well as their evaluation by some of the students to learn about their strengths and weaknesses.

http://bit.ly/2M2jCB4

Laser-assisted hatching and clinical outcomes in frozen-thawed cleavage-embryo transfers of patients with previous repeated failure

Abstract

Assisted hatching (AH) is initially developed to provide an artificial manipulation of the zona pellucida (ZP) to help embryos hatch and improve the capacity of the embryos to implant. However, these effects remain unclear and controversial because of variation in patient characteristics, and it is critical to ascertain the indications for AH and to identify those patients who might benefit from AH. Here, this study aimed to assess the effect of laser-assisted zona thinning hatching technology (LAH) during the frozen-thawed D3 embryos on pregnancy outcomes in patients with previous repeated failures in vitro fertilization-embryo transfer (IVF-ET). To the best of our knowledge, these relationships have not been previously investigated. A retrospective cohort analysis was carried out. Infertility patients with previous repeated failure who underwent assisted reproductive therapy at our in vitro fertilization (IVF) center from May 2014 to May 2016 were enrolled. A total of 415 cleavage FET cycles (225 in the LAH group and 190 in the control group) were analyzed. Clinical outcomes including clinical pregnancy, implantation, live birth, miscarriage, and multiple gestation rates after transfer were compared between the LAH and control groups. The clinical pregnancy (49.3% versus 38.9%) and implantation rates (31.2% versus 24.6%) were significantly higher for the LAH group than the control group (P < 0.05). The live birth (44.8% versus 35.8%), multiple pregnancy (32.4% versus 31.0%), preterm birth (22.8% versus 17.1%), miscarriage (7.2% versus 5.4%), and ectopic rates (1.9% versus 0%) did not differ significantly between the two groups (P > 0.05). This study showed that LAH via zona pellucida (ZP) thinning significantly improves clinical outcomes, particularly clinical pregnancy and implantation rates, associated with FET cycles among patients with previous repeated failure.

http://bit.ly/2TCff2f

Premaxillary–maxillary suture development in the first trimester

Abstract

Purpose

Our study was designed to investigate premaxillary–maxillary suture growth in fetuses from the first trimester of pregnancy using the B‑ultrasound technique in order to determine the suture fusion time.

Methods

We selected 169 healthy Han singleton pregnancies as subjects. All subjects received routine pregnancy tests and were divided into three groups based on the gestational age of the fetus: group 1, the 11th gestational week; group 2, the 12th gestational week; and group 3, the 13th gestational week. Fetal biometric measurements were recorded during consecutive prenatal ultrasonographic examinations. These measurements included nuchal translucency thickness, crown–rump length, and premaxillary–maxillary length. Intergroup comparisons were performed using analysis of variance (ANOVA).

Results

The premaxillary–maxillary suture grows gradually and its measured length at the 11th, 12th and 13th week was 0.54 cm, 0.65 cm, and 0.74 cm, respectively. We observed a significant linear correlation between the premaxillary–maxillary length and the week of gestation in the first trimester. The growth rate of the maxilla at the 11th, the 12th and the 13th week are significantly different with a descending order of growth rates being week 12, week 11 and week 13, with the 12th week rate being the most rapid.

Conclusion

The premaxillary and maxillary growth at 11 and 12 gestational weeks in the first trimester steadily accelerated, peaking at the 12th week. The rate of growth slows down after week 12 which may be associated with the fusion of the premaxillary–maxillary suture.

http://bit.ly/2TBJs1y

Searching variables to assess recreational water quality: the presence of infectious human enterovirus and its correlation with the main variables of water pollution by multivariate statistical approach in Córdoba, Argentina

Abstract

Surface waters are used by local populations for different purposes, such as recreational activities, water source for human and animal consumption, and irrigation among others, which lead to the need for management strategies on water health and associated risks. During this study, we investigated physicochemical parameters, fecal coliform bacteria, and infectious human enterovirus detection to determine the water quality in different beaches (categorized as an urban area, non-urban areas, and an intermediate position) from San Roque Dam, in Argentina. Multivariate techniques were applied. Principal component analysis allowed identification of subgroup of variables responsible for the water quality. A cluster analysis and multivariate analysis of variance showed the urban beach as the highest pollution area. The following variables (measured at the urban beach) would be enough to describe the quality of the aquatic body: nitrites, fecal coliforms, total phosphorous, and infectious human enterovirus. The infectious human enterovirus was an independent variable detected in 69.1% of the samples showing a steady frequency of detection during the whole period studied and could identify human fecal contaminations as a source of water pollution. The selected variables would contribute to water quality regarding the risk for human health using San Roque dam waters for recreational propose.

http://bit.ly/2D00ReE

Cigarette smoking reduces the efficacy of intralesional vitamin D in the treatment of warts

Abstract

Cigarette smoking may decrease serum levels of vitamin D and reduce its efficacy. We aimed to evaluate the safety and efficacy of intralesional vitamin D in the treatment of warts and to investigate the effect of smoking on its efficacy in these cases. The study included 20 patients with verruca vulgaris and deep palmoplantar warts. The wart to be injected was cleaned by alcohol and then injected with 0.1 mL of prilocaine (20 mg/mL). 0.2 mL of vitamin D3 (7.5 mg/mL) solution was slowly injected into the base of each wart. The maximum total amount of vitamin D3 injected into a patient in 1 session was 7.5 mg. The injection was done at 4 weeks interval until clearance or for a maximum of two sessions.Clinical and dermoscopic follow‐up of the treated and distant warts was carried out. Forty percent of the treated lesions showed complete clearance and the rate of distant wart response was 17.65%. Among different demographic and clinical variables in the studied patients, smoking and older age seemed to decrease the therapeutic response Intralesional vitamin D is effective in the treatment of warts, however, smoking and ageing may reduce its efficacy.

This article is protected by copyright. All rights reserved.

http://bit.ly/2M1gLIF

Mucosal involvement is a risk factor for poor clinical outcomes and relapse in patients with pemphigus treated with rituximab

ABSTRACT

Many studies have reported the outcome of rituximab use in pemphigus but studies regarding the clinical risk factors for poor clinical outcomes or relapse are lacking. To clarify the risk factors for poor clinical outcomes or relapse in patients with pemphigus treated with rituximab, a retrospective chart analysis was performed on patients with pemphigus who were treated with rituximab in the dermatology clinic of Seoul National University Hospital. Forty patients with pemphigus were treated with rituximab, of which 39 (97.5%) experienced remission and 19 (48.7%) experienced relapse. Patients with mucosal lesions demonstrated poor clinical outcomes. The risk for relapse was 4.626 (confidence interval: 1.126‐19.001, P = 0.034) times higher in patients with mucosal lesions than in those without lesions. In patients with pemphigus treated with rituximab, the presence of mucosal lesions resulted in poor clinical outcomes and frequent recurrence.

This article is protected by copyright. All rights reserved.

http://bit.ly/2sj6m1X

The role of serum lactate dehydrogenase (LDH) level as a prognostic indicator in resected, high risk melanoma

http://bit.ly/2M6HN1D

Metabolic Syndrome in Dermatology: Treatment and Management for Dermatologists

http://bit.ly/2sj6jDj

Anti interleukin 12/23 in the treatment of erythema nodosum and Crohn disease: A case report

Abstract

Erythema nodosum is one of the most common dermatologic conditions associated with Inflammatory Bowel Disease (IBD) such as Crohn disease and it is characterized by hypodermic connectival septs inflammation. Crohn disease is an IBD that may interest any part of the gastrointestinal tract from mouth to anus. Nowadays biological drugs as anti tumor necrosis factor alpha (adalimumab) and more recently, anti interleukin 12/23 (ustekinumab) antibodies are utilized in the treatment of IBD with good results. We present a case of a 43 y.o. woman affected by Crohn disease with extra intestinal manifestations (Erythema nodosum) treated with ustekinumab. The patient showed a complete remission of both the dermatological and gastroenterological symptoms.

This article is protected by copyright. All rights reserved.

http://bit.ly/2LZ07cQ

Issue Information

http://bit.ly/2sjb1Bi

Optimization of the dermal wrap in inferior pedicle reduction mammoplasty: An Egyptian experience

Abstract

Background

Reduction mammoplasty using the inferior pedicle technique has been used for more than five decades. Without doubt, it has many advantages, especially in patients with moderate to severe macromastia. Although the esthetic outcome of reduction mammoplasty in the early postoperative period is usually satisfactory, typical esthetic drawbacks appear during the first year. These drawbacks include bottoming out, loss of superior fullness, box-shaped breasts, poor definition of the infra-mammary fold (IMF), elongation of the vertical scar, star gazing of the nipple-areola complex (NAC) and, of course, the scar burden. Parenchymal reshaping and suspension have been introduced as an additional step to eliminate the drawbacks of the inferior pedicle procedure.

Methods

This is a prospective study done in a period from March 2016 to March 2018 in Kasr Al-Ainy Hospital (Cairo University hospitals) by the senior author and his team of co-authors. Reduction mammoplasty (Wise pattern) with the inferior pedicle and dermal wrap technique (using two dermal wings) was performed in 20 patients. The distance from the suprasternal notch (SSN) to the NAC was > 30 cm.

Results

The patients' ages ranged from 28 to 55 years (average age, 39 years). Body mass index (BMI) ranged from 27 to 35 kg/m² (average BMI, 33.3 kg/m²). The distance between the SSN and NAC ranged from 33 to 45 cm (average distance, 40 cm).

The nipples were lifted by 11 to 19.5 cm. The distance from the nipple to the IMF ranged from 18 to 24 cm. This distance was reduced postoperatively to between 9 and 11.5 cm (p value < 0.001).

Conclusions

Follow-up of the patients revealed that suspension of the breast parenchyma and plication of the dermal flap improved the esthetic results following inferior pedicle breast reduction.

The addition of volumetric and geometric adjustment "preoperatively" may significantly improve the results and minimize the operative time of this relatively lengthy procedure (4–6 h for both breasts).

Level of Evidence: Level IV, terapeutic study.

http://bit.ly/2RkT04r

Modified earlobe reconstruction technique following wide local excision of melanoma that facilitates sentinel lymph node biopsy

Abstract

The earlobe represents an important element in the aesthetic appearance of the entire ear. Reconstruction of the earlobe is challenging. The authors present a reconstructive option following wide excision of melanoma of the earlobe that facilitates sentinel lymph node biopsy from the neck without further incision. We report satisfactory results obtained using this technique for immediate earlobe reconstruction. We present two cases of malignant melanoma of the earlobe. Both cases were treated with a 1-cm wide local excision of melanoma scar of the ear lobe and reconstruction with double opposing local transposition flaps and sentinel lymph node biopsy (SLNB) of the neck via the skin flap incisions without further need for incision extension. This is a technique for earlobe reconstruction that provides satisfactory results that can be performed in a single stage procedure simultaneously allowing access for sentinel lymph node biopsy from the cervical, pre- and post-auricular lymph node basins. We feel this technique is an option to be considered when treating melanoma of the earlobe requiring SLNB.

Level of Evidence: Level V, therapeutic study.

http://bit.ly/2C9k1xa

Aquatic beetles Cercyon unipunctatus as bioindicators of pollution in Lake Edku and Mariut, Egypt

Abstract

The lakes of the North Delta give a rich and imperative territory for marine fish and its regeneration, and have dependably been major areas of fish creation in Egypt, 75% of the production was collected from them. As of late, many difficulties are confronting these lakes and prompt the exhaustion of fish production from them. The aim of the present study is to evaluate different inorganic pollutants in Coleopterons aquatic insect (Cercyon unipunctatus) taken from both Lake Edku and Mariut and also, to estimate their effect on oxidative stress markers and chromosomal aberrations. The average concentrations of heavy metals differ in the two locations. The concentration of (Pb, Cd, Fe, Co, Cu, Zn, and Mn) was significantly higher in water samples of Lake Mariut than those of Lake Edku. Also, the present work, showed the physical and chemical characters of the two lakes water. In the current study, the obtained results showed that there was a significant increase in (Pb, Cd, Fe, Co, Cu, Zn, and Mn) concentrations in C. unipunctatus tissues which were collected from Lake Mariut. The biochemical parameters of oxidative stress have been affected by the pollution in Lake Mariut water. Significant increases in the activity level of aspartate aminotransferase, alanine aminotransferase, and malondialdehyde concentration were recorded, while there were significant decreases in (total protein content, GSH content, and GPx activity). The result of chromosomal aberration test showed that there were different types of aberrations as binucleate cell, lagging chromosome, and abnormal distribution of chromosomes. The obtained data showed that C. unipunctatus highly affected by environmental stressors in water. So we suggest that these beetles could be a suitable monitor for ecotoxicological studies.

http://bit.ly/2CZEl5J

Natural latex‐glycerol dressing to reduce nipple pain and healing the skin in breastfeeding women

Abstract

Background

Nipple pain is the second most common reason for early weaning, exceeded only by the insufficient milk supply. Nipple fissures can bring other problems, acting also as a portal for bacteria and leading to mastitis. This work proposes the breast protector composite development using materials with tissue repair and moisturizing properties, aligned with a low‐cost procedure, aiming not only to relieve pain, but also to heal the nipple fissures caused by breastfeeding.

Materials and methods

For the dressings, production was used Natural Latex extracted from the rubber tree and glycerol. The Samples were evaluated chemically and physically by the techniques of Scanning Electron Microscopy, Fourier transform infrared spectroscopy, mechanical traction, and contact angle. The samples were also biologically evaluated by the hemolytic and cytotoxic activity assays.

Results

From the physical‐chemical assays, the matrix with glycerol has high pore density; the natural latex and glycerol do not covalently interact, indicating that the glycerol can be released; the glycerol addition makes the matrix more elastic but fragile, and increase the wettability. From the biological assays, both materials showed no hemolytic effects; and the cytotoxicity results showed that glycerol did not present cytotoxicity in the fibroblasts, but show a dose‐dependent influence in the keratinocytes.

Conclusion

The material developed for application in breast fissures has mechanical properties similar to those found for materials for dermal applications, present high wettability and pore density. Furthermore, the material showed no cytolytic activity and the tests with skin cell cultures demonstrated the biocompatibility.

http://bit.ly/2Qzj1Yk

Reflectance confocal microscopy in Darier disease: A case series with dermoscopic and histologic correlation

http://bit.ly/2VGRgkg

Contaminated Sharps Injuries: A Survey Among Dermatology Residents

Publication date: Available online 8 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Kimberly M. Ken, Nicholas J. Golda

http://bit.ly/2TF8VXX

Severity of disease and quality of life in parents of children with alopecia areata, totalis, and universalis: a prospective, cross-sectional study

Publication date: Available online 8 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Elana Putterman, Deepa P. Patel, Gabriela Andrade, Katya L. Harfmann, Marcia Hogeling, Carol E. Cheng, Carolyn Goh, Rachel S. Rogers, Leslie Castelo-Soccio

Abstract

Background

Caregiver-oriented quality of life research (QoL) in alopecia areata is limited. No study has used a parent-tailored survey to examine the relationship between QoL and severity of alopecia as measured by SALT scores.

Objectives

This is a prospective study that describes QoL in parents of pediatric patients with all subtypes of alopecia areata and investigates the relationship between QoL and severity of disease, duration of disease, and age of patients.

Methods

Pediatric patients and their parents were invited to participate during clinic visits. Participating parents completed the Quality of Life in a Child's Chronic Disease Questionnaire (QLCCDQ) and the Family Dermatology Life Quality Index (FDLQI). A subset of children completed the Children's Dermatologic Life Quality Index (CDLQI). Severity of alopecia tool (SALT) scores at time of survey completion were recorded.

Results

153 patients were included. Significant mild to moderate negative correlations were found between SALT scores and FDLQI scores, QLCCDQ scores, and QLCCDQ emotional domain scores. Age of child correlated negatively with QLCCDQ scores but not FDLQI scores. No significant correlation was found between duration of disease and FDLQI scores, QLCCDQ scores, or QLCCDQ emotional domain scores.

Limitations

This study is limited by its small sample size and cross-sectional design.

Conclusions

Impaired parental QoL may be associated with increasing severity of disease and age of affected child but not duration of disease. Providers should tailor counseling accordingly and help parents set realistic expectations for long-term experience with the disease.

http://bit.ly/2CZm6xi

Appropriate use of Mohs surgery in immunocompromised patients is high and published indications for Mohs decrease inappropriate use

Publication date: Available online 8 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Thuzar M. Shin, Victoria O'Malley, Scott Tuttle, Nicole Howe, Jeremy R. Etzkorn, Joseph F. Sobanko, David J. Margolis, Christopher J. Miller

http://bit.ly/2TF8FrX

The free innervated latissimus dorsi flap for functional reconstruction following soft tissue sarcoma resection of the posterior compartment of the thigh

Abstract

Background

Soft tissue sarcoma (STS) surgery has evolved significantly over the last half a century. From amputation to limb-salvage and limb-sparing surgery, reconstructive demands have continuously increased in an effort to provide the best function-preserving disease-free outcome. Given STS typically affect the limbs more so than any other region of the body, restoration of function whilst not important oncologically is critical to incorporate in the reconstructive plan of any onco-plastic team. The use of loco-regional flaps as well as free flaps provides the mainstay of reconstructive options. The next advance in the reconstructive journey in this clinical area is the use of innervated flaps to restore function.

Methods

Between 2011 and 2016, all patients who  underwent sarcoma extirpation from the  posterior thigh and reconstruction  using a free innervated latissimus dorsi flap were prospectively identified and a  case note review  was performed.

Results

In this series, 7 patients have undergone free flap reconstruction of the thigh posterior compartment achieving MRC (medical research council, UK) grade M5 power restoration in 6/7 patients.

Conclusions

The authors believe this technique to be hugely valuable in the surgical armamentarium of the reconstructive plastic surgeon in order to achieve the best functional outcomes in such a cohort of patients.

Level of Evidence: Level IV, therapeutic study.

http://bit.ly/2H5kPJc

Biosorption of dysprosium (III) using raw and surface-modified bark powder of Mangifera indica : isotherm, kinetic and thermodynamic studies

Abstract

In this paper, we have used HDTMA-Br- and NaOH-treated bark powder of Mangifera indica as bio-sorbents for the removal of dysprosium (III) from its aqueous solution. The adsorption process was investigated at different experimental parameters such as contact time, temperature, pH, adsorbent dose, and initial metal concentration. The amount of chemically modified bark powder required was almost two times lesser than raw bark to get a higher percentage removal of the metal ion. The kinetics results revealed the adsorption process follows the nonlinear form a pseudo-second-order model. The negative values of Gibbs free energy change (∆G°) indicated the spontaneity of the adsorption process. The enthalpy change (∆H°) and entropy change (∆S°) of adsorption were 60.97 kJ/mol and 0.48 J/mol K, respectively signified it as an endothermic process. The maximum adsorption capacity was found to be 55.04 mg/g for sorption of Dy (III) on NaOH-treated bark powder and was better fitted to Langmuier model. It was confirmed to follow physisorption process and the activation energy of the system was found to be 41.07 kJ/mol. The possibility of adsorbent and adsorbate interactions were indicated by the FTIR and SEM/EDX analysis.

http://bit.ly/2FkiV4Q

Assessing the socio-economic impact of climate change on wheat production in Khyber Pakhtunkhwa, Pakistan

Abstract

This study involves the climate change impact assessment of wheat producers in Khyber Pakhtunkhwa, Pakistan. An extensive farm survey of 150 farms was designed. From study area, three districts, namely, Chitral, D.I. Khan, and Peshawar, were selected through multistage sampling process. Yield simulation from Crop model DSSAT (Decision Support System for Agro Technology Transfer) was used for socio-economic impact assessment. Future climate scenarios were generated by selecting five GCMs from latest CMIP5 family with two RCPs 4.5 and 8.5, at two carbon concentrations of 499 ppm and 571 ppm, respectively. Yield simulations were analyzed for each GCM. Results of crop model revealed that wheat yield will increase in district Chitral, while in D.I. Khan and Peshawar, yields would be reduced due to climate change. For socio-economic impact assessment, TOA-MD (Trade-Off Analysis for Multi-Dimensional Impact Assessment) version 6 was used. Climate change impacts on poverty, net farm returns, and per capita income were calculated for different scenarios. The analysis was carried out on per-farm basis. The economic model results revealed that climate change has negative impact on wheat producers in D.I. Khan and Peshawar while making wheat producers better off in Chitral. The number of losers ranged from 54 to 66.21% and 50 to 61.99% in D.I. Khan and Peshawar, respectively. Losers are the farmers who would be economically worse off under perturbed climate. With current climate, the observed poverty rate would be 34 to 49 in D.I. Khan while 21.26 to 34.03 in Peshawar. The study recommended need for adaptation strategies to overcome the vulnerabilities of climate change.

http://bit.ly/2FhCKe3

Environmental performance of Chinese listing manufacturing enterprise: from investment perspective

Abstract

With decades of high-speed economic miracle, China inevitably encountered with environmental pressure and sustainable development problem. As the main carrier of the environmental responsibility, Chinese government set series of regulations and standards to supervise and guide enterprise to fulfill this challenge emission reduction task. Based on data envelopment analysis (DEA) approach, this paper focuses on air pollutant highly emission manufacturing tycoons to figure out "whether the yearly billions environmental input really worth it?" during 2014 to 2016. Unlike previous studies mainly from consumption perspective and got macro-regional evidence, we choose micro-enterprise to analyze individual environmental performance and draw general conclusions. Possible suggestions are also proposed for various industries and some salient enterprises.

http://bit.ly/2FlQK5B

Effect of diesel-methanol-nitromethane blends combustion on VCR stationary CI engine performance and exhaust emissions

Abstract

The continuous rise in cost of fossil fuels and environmental pollution has attracted research in the area of clean alternative fuels for improving the performance and emission of internal combustion engines. In the present work, methanol and nitromethane were treated as a biofuel and investigations have been made to evaluate the feasibility of replacing diesel with a suitable diesel-methanol-nitromethane blend. For this, experimental investigations were carried out on a VCR diesel engine using diesel-methanol-nitromethane blends to determine the most favorable blending ratio and engine operating parameters for enhancing performance and reduce emissions. The best results of performance and emissions were observed with D-M5-NM2.5 blend (diesel 92.5%, methanol 5%, nitromethane 2.5%) at standard engine parameters. The improvement in engine performance (13% increment in BTE and 19.5% decrement in BSFC) and reduction in emission (smoke 26.47%, NOx 21.66%, and CO 14.28%) was found using D-M5-NM2.5 blend as compared to pure diesel at full load condition; however, HC emission was slightly increased by 10.71%. To find out the best suitable value of CR for D-M5-NM2.5 blend, experiments were further performed on different compression ratios by which higher compression ratio of 19.5 was found better under similar operating conditions. By increasing CR from 18.5 (standard) to 19.5, improvement in engine performance (BTE increased 3.8% and BSFC decreased 3.4%) and reduction in emission (smoke 10%, CO 16.67%, and HC 61.29%) were observed using D-M5-NM2.5 blend; however, NOx was found to be on slightly higher side with tolerable increment of 6.38%.

http://bit.ly/2Ffpd6J

A lute player peasant with nodular goiter by Bartolomeo Passarotti (1529–1592)

http://bit.ly/2AF2EV3

Local ablative therapy of oligoprogressive TKI-treated thyroid cancer

Abstract

Metastatic cancer patients generally respond well to treatment with tyrosine kinase inhibitors (TKIs). However, TKI resistance occurs in almost all cases and often leads to a change in treatment. Recent guidelines, including thyroid cancer, raised the possibility of locally treating TKI-resistant oligoprogressive disease, i.e., one or a few progressing lesions in an otherwise treatment-responsive metastatic cancer, thereby obviating the need to change the ongoing TKI. To determine the benefits of this intervention, we reviewed studies on the use of LAT for TKI-treated oligoprogressive cancers. We found that in non-small cell lung cancer at least, LAT prolongs disease control and the duration of exposure to a TKI irrespective of the LAT used. Moreover, we reviewed the local ablative therapies (LATs) that are feasible for the local control of oligoprogressive thyroid cancer. Lastly, we report two illustrative cases of patients with oligoprogressive thyroid cancer treated with two different LATs while on therapy with TKIs. Both LATs extended the duration of disease control and the time of exposure to the ongoing TKI, thereby indicating that LAT is a favorable option for TKI-treated oligoprogressive thyroid cancer. Prospective randomized studies are needed to verify the benefit of LATs in terms of progression-free and overall survival in this increasingly frequent clinical setting.

http://bit.ly/2SFiqGq

Delayed breast reconstruction in idiopathic granulomatous mastitis

Abstract

Background

Idiopathic granulomatous mastitis is an exceptionally rare, chronic benign inflammatory disease of the breast, more common in developing countries and infrequently seen bilaterally. The symptoms can mimic many other breast conditions, including inflammatory breast carcinoma, and the diagnosis is one of exclusion. The management includes non-surgical treatments, such as broad spectrum antibiotics, steroids and methotrexate, and surgical options, comprising of wide local excision and even simple mastectomy.

Methods

The case notes of patients with idiopathic granulomatous mastitis referred to our Breast Unit were reviewed and data was collected on patients demographics, medical and surgical treatments and subsequent outcomes.

Results

Four patients were treated in our unit, all Caucasian women, three of whom were bilateral cases. Three of the patients were reconstructed using oncoplastic techniques whilst the fourth patient awaits reonstruction.

Conclusions

Oncoplastic breast reconstructive techniques play a fundamental role in the management of these patients, as they give the surgeon the freedom to perform a wider resection, thus reducing the rate of recurrence, whilst at the same time, knowing that there are reconstructive options to restore any breast aesthetics. As such, the value of a multidisciplinary team cannot be underestimated.

Level of Evidence: Level V, therapeutic study.

http://bit.ly/2CcCFEv

Adipocyte expression of glucose transporter 1 and 4 in PCOS: Relationship to insulin‐mediated and noninsulin‐mediated whole‐body glucose uptake

Summary

Background

PCOS is a highly prevalent endocrine‐metabolic disorder associated with insulin resistance (IR). In IR states noninsulin‐mediated glucose uptake (NIMGU) may increase to compensate for declining insulin‐mediated glucose uptake (IMGU), although this does not appear to be the case in PCOS. The underlying molecular mechanisms for this deficiency remains unclear.

Objectives

To compare adipocyte glucose transporter 1 and 4 (GLUT‐1 and GLUT‐4) gene expression in PCOS women and matched controls, and to determine whether changes in GLUT‐1 and GLUT‐4 are associated with concomitant alterations in whole‐body glucose uptake.

Research Design And Methods

In this prospective cross‐sectional study, 23 women with PCOS (by NIH 1990 criteria) and 23 matched controls were studied for subcutaneous abdominal adipocyte GLUT‐1 and GLUT‐4 mRNA expression (by real‐time PCR), and basal whole body IR (by HOMA‐IR) and insulin secretion (by HOMA‐β%). A subset of 6 PCOS women and 6 matched controls also underwent an mFSIVGTT to determine dynamic state glucose uptake (by insulin sensitivity index [Si] and glucose effectiveness [Sg]) and insulin secretion (by the acute insulin response to glucose [AIRg] and the disposition index [Di]).

Results

For similar adiposity (BMI and waist‐hip ratio), PCOS women tended to have higher HOMA‐IR and lower Di and Si, and higher HOMA‐β% and lower GLUT‐4 than controls while GLUT‐1 was similar. GLUT‐1 was positively associated with Sg (reflecting NIMGU) and GLUT‐4 positively with Si (reflecting IMGU). GLUT‐4 was associated negatively with HOMA‐IR and HOMA‐β% and positively with Di for the entire cohort but not with AIRg. Both GLUT‐1 and GLU‐4 were negatively associated with BMI, but not with each other.

Conclusion

Our results suggest that IR secondary to a lower IMGU and enhanced insulin secretion in PCOS is in part attributable to a reduction in adipocyte GLUT‐4 expression that is not accompanied by a compensatory increase in GLUT‐1 expression.

This article is protected by copyright. All rights reserved.

http://bit.ly/2SKQkJY

Apremilast as a new treatment option for Acrodermatitis continua of Hallopeau

http://bit.ly/2QBc757

Heerfordt syndrome developing in a patient with cutaneous sarcoidosis

http://bit.ly/2VDGHyv

Issue Information

http://bit.ly/2TCqU0W

Ibrutinib‐associated T‐cell pseudolymphoma

http://bit.ly/2QvqSGo

Paediatric vulval lichen sclerosus: a retrospective study

Summary

Background

Lichen sclerosus (LS) is a chronic inflammatory dermatosis with a predilection for the anogenital region, which mainly affects prepubertal girls and postmenopausal women. The cause is unknown, but a number of potential aetiological factors have been identified.

Aim

To examine a cohort of patients with prepubertal‐onset vulval LS (VLS) and assess baseline characteristics, clinical presentation, potential precipitating and predisposing factors, and response to treatment.

Methods

Data were collected from case notes on patients aged < 18 years diagnosed with prepubertal‐onset VLS attending a specialist vulval dermatology service. Data included clinical presentation, comorbidities, family history, therapy and response to treatment.

Results

In total, 26 paediatric patients were identified. The median age at onset of symptoms was 5 years (range 2–8.5 years). Many previously identified potential aetiological factors for the development of VLS were identified, including family history, trauma, autoimmune disease and hormonal factors. A significant proportion of patients had a history of urinary tract symptoms, including incontinence and urinary tract infection. Most patients responded well to a standard course of induction topical therapy followed by maintenance therapy, but some, including three patients with ongoing urinary incontinence and three postpubertal patients, continued to have active disease.

Conclusion

A detailed assessment is essential in patients with VLS so that potential predisposing factors and comorbidities can be identified and managed. Urinary incontinence may be implicated in the development of paediatric VLS and may prevent adequate disease control. Paediatric VLS can persist through puberty, thus long‐term follow‐up is advised.

http://bit.ly/2VErHAo

Prevention of peritendinious adhesions in zone II primary flexor tendon repair using a vein patch graft: A comparative study

Abstract

Background

Adhesion after intrasynovial tendon injury is a major clinical problem. Here we assess autogenous vein graft over the primary flexor tendon repair to prevent postoperative peritendinious adhesions.

Methods

Twenty-six patients (30 digits) had an acute flexor tendon injury in zone II. Primary tenorrhaphy was done using the traditional Kessler repair technique. Patients were divided into two groups according to the management of tendon sheath defects. In group I (n = 15 digits), a patch of a marked forearm vein was harvested, divided and sutured to the tendon sheath window. In group II (n = 15 digits), the tendon sheath was left untreated. Patients were evaluated using the second Buck-Gramcko scale at 8 weeks and 6 months.

Results

We detected no statistically significant difference between the groups. For the vein graft group, excellent results were achieved in four digits, five digits with very good results, five digits with good results and one digit with fair results. Using the traditional technique, excellent results were achieved in three digits, very good results were achieved in four digits, good results were achieved in six digits and fair results were achieved in two digits.

Conclusions

The use of autologous vein graft has many advantages; it is inexpensive, autologous and will not affect tendon healing. Comparing autologous vein graft to the conventional tendon repair technique, we detected no statistically significant difference. Clinically, less adhesion formation and fewer joint contractures were noted when using the autologous vein graft.

Level of Evidence: Level I, therapeutic study.

http://bit.ly/2QysUp5

Primary Cutaneous Anaplastic Lymphoma Kinase–Positive Large B-Cell Lymphoma

Abstract: Large B-cell lymphomas include several subtypes. Recently, anaplastic lymphoma kinase (ALK)-positive large B-cell lymphoma has been delineated as a distinct entity involving mostly lymph nodes and rarely affecting extranodal sites. We describe the first case of a primary cutaneous ALK-positive large B-cell lymphoma in a 48-year-old man with a solitary nodule on the back, and describe the histologic and phenotypic features. Accurate staging confirmed the absence of other lesions, and so surgical excision and postoperative local radiation therapy were initiated and resulted in complete remission. Two years later, extracutaneous spread with involvement of axillary lymph nodes occurred. Complete remission was achieved again by multiagent chemotherapy. Our case demonstrates that a primary cutaneous form of ALK-positive large B-cell lymphoma exists. The immunophenotypic analysis of cutaneous large B-cell lymphomas affecting the skin primarily or secondarily should include the assessment of ALK expression. Correspondence: Werner Kempf, MD, Kempf und Pfaltz, Histologische Diagnostik, CH-8050 Zürich, Switzerland (e-mail: werner.kempf@uzh.ch). The authors declare no conflicts of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2C8C0E8

Primary Orbital Synovial Sarcoma Mimicking a Periocular Cyst

Abstract: Synovial sarcoma (SS) is a high-grade soft-tissue sarcoma occurring predominantly in older children and young adults. Only approximately 7% occur in the head and neck region, with SS representing less than 0.1% of all head and neck cancers. Orbital location is exceedingly rare with only 8 cases reported so far in the literature. It is noted for its propensity for late local recurrences and metastases. Histologically, SS is monophasic, biphasic, or poorly differentiated and harbors a specific chromosomal translocation t(X;18)(p11.2;q11.2) in >95% of cases. In this article, we describe a case of monophasic SS primarily arising in the left supero-nasal orbital region in a 24-year-old woman, clinically mistaken for a periocular cyst. The case is peculiar for its highly unusual location and for its clinical deceptively benign appearance. Correspondence: Francesca Portelli, MD, Histopathology and Molecular Diagnostics, Department of Health Sciences, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy (e-mail: portellif@aou-careggi.toscana.it). The authors declare no conflicts of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2ReiZu6

Adipose Infiltration of the Dermis, Involving the Arrector Pili Muscle, and Dermal Displacement of Eccrine Sweat Coils: New Histologic Observations in Frontal Fibrosing Alopecia

Background: Frontal fibrosing alopecia (FFA) is an irreversible scarring alopecia, and its incidence has reached epidemic size. Immune privilege collapse of the bulge and epithelial mesenchymal transition play a role in the pathogenesis. We have noted adipose tissue in the dermis in several specimens from FFA. Objective: Our primary objective was to verify the presence of adipose tissue at the isthmus level in biopsies from FFA. Additional objectives included the presence of deep inflammation and position of the sweat coils. Methods: Eighty-three histologic specimens of FFA diagnosed at the Dermatopathology Laboratory at the Department of Dermatology, University of Miami, within 3 years were evaluated retrospectively. All biopsies were bisected horizontally and assessed at several levels. Sixty biopsies from androgenetic alopecia served as controls. Statistical analysis was performed using the χ2 test. A P value of 0.05 or less was considered significant. Results: Sixty specimens met the inclusion criteria for optimal quality and classic diagnostic features. Seventy percent demonstrated fat tissue infiltration at the isthmus level as clusters of cells or small globules versus 23% of the controls. The fat infiltration in the arrector pili muscle (APM) was present in 55% versus 15% of the controls, and the sweat coils were positioned in the reticular dermis in 43% versus 1.7% of the controls. All results were statistically significant (P

http://bit.ly/2C9mnw3

High‐frequency (20‐MHz) high‐intensity focused ultrasound (HIFU) system for dermal intervention: Preclinical evaluation in skin equivalents

Abstract

Background

High‐intensity focused ultrasound (HIFU) for non‐invasive treatment of a range of internal pathologies including cancers of major organs and cerebral pathologies is in exponential growth. Systems, however, operate at relatively low frequencies, in the range of 200‐2000 kHz as required for deep axial penetration of the body. HIFU utilizing frequencies in excess of 15 MHz has so far not been explored, but presents an opportunity to extend the HIFU modality to target specific dermal lesions and small animal research.

Materials and methods

A new 20‐MHz HIFU system (TOOsonix ONE‐R) with narrow focus corresponding to the dermis was studied in acoustic skin equivalents, for example, in a tissue‐mimicking gel and in bovine liver. HIFU lesion geometry, depth, and diameter were determined. The temperature increase in the focal point was measured as a function of acoustic power and the duration of HIFU exposure.

Results

The system produces highly reproducible ultrasound lesions with predictable and configurable depths of 1‐2 mm, thus corresponding to the depth of the human dermis. The lesion geometry was elongated triangular and sized 0.1‐0.5 mm, convergent to a focal point skin deep. Focal point temperature ranged between 40 and 90°C depending on the chosen setting. Observations were confirmed ex vivo in bovine liver and porcine muscle. Variation of acoustic power and duration of exposure produced linear effects in the range of the settings studied. Thus, effects could be adjusted within the temperature interval and spatial field relevant for clinical therapy and experimental intervention targeting the dermal layer of human skin.

Conclusion

The tested 20‐MHz HIFU system for dermal applications fulfilled key prerequisite of narrow‐field HIFU dedicated to cutaneous applications regarding reproducibility, geometry, and small size of the applied ultrasound lesions. Controlled adjustment of acoustic lesions within the temperature range 40‐90°C qualifies the system for a range of non‐ablative and ablative applications in dermatological therapy.

http://bit.ly/2VDhAMh

A study of skin characteristics according to humidity during sleep

Abstract

Introduction

During sleep, the skin is exposed to various environments for example low or high humidity and temperature. And the average of 7‐8 hours of sleeping in those situations can affect skin condition. Therefore, the objective of this study was to determine skin characteristics according to humidity during sleep.

Method

Eleven healthy women in their ages of 20s and 30s were controlled. They slept more than 7 hours at lower than 30% relative humidity (RH) environment on the first day and at higher than 70% on the second day. The room temperature was controlled to 22 ± 5°C. Three measurement points were (a) before for sleep (after wash), (b) after 7 hours sleep (morning), and (c) after wash. Skin hydration, sebum secretion, and trans‐epidermal water loss (TEWL) were measured. The statistical significance was determined at P < 0.05.

Result

After 7 hours of sleep in 30% RH condition, skin hydration decreased by 24.23% significantly, but there was no significant difference after sleeping in 70% RH. The sebum level was increased after sleep at 30% RH. The TEWL did not show differences according to the humidity during sleep but significantly increased after facial cleansing in 30% RH sleeping condition.

Discussion

In this study, we confirmed that the changes in skin characteristics may be affected by humidity during sleep. When sleeping in dry environment, skin hydration decreases but the amount of sebum increases to compensate for skin dryness. Therefore, this study might suggest how to care the skin before sleep depending on the room humidity.

http://bit.ly/2QxbAkD