Ιατρικά Άρθρα

Πέμπτη 16 Αυγούστου 2018

Emergence delirium in children is related to epileptiform discharges during anaesthesia induction: An observational study

BACKGROUND Epileptiform discharges frequently occur in children during induction of anaesthesia. However, studies analysing the impact of epileptiform discharges on postoperative emergence delirium in children are still scarce. The aim of this study is to correlate the incidence of epileptiform activity during anaesthesia induction with the occurrence of emergence delirium during stay in the recovery room. OBJECTIVES Prospective, observational cohort study in children 0.5 to 8 years old undergoing planned surgery. Bifrontal electroencephalogram electrodes were placed before induction of anaesthesia. Visual electroencephalogram analysis was performed from start of anaesthetic agent administration until intubation with regard to epileptiform patterns: rhythmic polyspikes; periodic epileptiform discharges; delta with spikes; and suppression with spikes. Emergence delirium was assessed during stay in the recovery room using the Pediatric Assessment of Emergence Delirium Score. DESIGN Prospective, observational cohort study. SETTING University hospital – Germany/Berlin. Children were included between September 2015 and February 2017. PATIENTS A total of 62 Children, aged 0.5 to 8 years old undergoing planned surgery were included. MAIN OUTCOME MEASURES Primary outcome was emergence delirium. Secondary outcomes, peri-operative Electroencephalography (EEG) data analysis. The presented study analysed an association between emergence delirium and the occurrence of epileptiform discharges during anaesthesia induction. RESULTS A total of 43.5% of the children developed emergence delirium and 56.5% did not. Epileptiform discharges were observed more often in children developing emergence delirium (63%) compared with children not developing emergence delirium (43%). But only the occurrence of interictal spike events – such as rhythmic polyspikes; periodic epileptiform discharges and delta with spikes – were significantly related to emergence delirium (emergence delirium-group 48% vs. nonemergence delirium-group 14%, OR = 5.6 [95% CI: 1.7 to 18.7]; P = 0.004). CONCLUSION Emergence delirium in children is significantly related to interictal spike events occurring during induction of anaesthesia. CLINICAL TRIAL NCT02481999. Correspondence to Susanne Koch, Department of Anaesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Campus Charité Mitte and Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany Tel: +49 30 450 651 078; fax: +49 30 450551019; e-mail: susanne.koch@charite.de Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Low-dose ketamine infusion reduces postoperative hydromorphone requirements in opioid-tolerant patients following spinal fusion: A randomised controlled trial

BACKGROUND The current opioid epidemic highlights the urgent need for effective adjuvant therapies to complement postoperative opioid analgesia. Intra-operative ketamine infusion has been shown to reduce postoperative opioid consumption and improve pain control in opioid-tolerant patients after spinal fusion surgery. Its efficacy for opioid-naïve patients, however, remains controversial. OBJECTIVE We hypothesised that low-dose ketamine infusion after major spinal surgery reduces opioid requirements in opioid-tolerant patients, but not in opioid-naïve patients. DESIGN Randomised placebo-controlled prospective study. SETTING Single-centre, tertiary care hospital, November 2012 until November 2014. PATIENTS A total of 129 patients were classified as either opioid-tolerant (daily use of opioid medications during 2 weeks preceding the surgery) or opioid-naïve group, then randomised to receive either ketamine or placebo; there were thus four groups of patients. All patients received intravenous hydromorphone patient-controlled analgesia postoperatively. INTERVENTION Patients in the ketamine groups received a ketamine infusion (bolus 0.2 mg kg−1 over 30 min followed by 0.12 mg kg−1 h−1 for 24 h). Patients in the placebo groups received 0.9% saline. MAIN OUTCOME MEASURES The primary outcome was opioid consumption during the first 24 h postoperatively. The secondary outcome was numerical pain scores during the first 24 h and central nervous system side effects. RESULTS Postoperative hydromorphone consumption was significantly reduced in the opioid-tolerant ketamine group, compared with the opioid-tolerant placebo group [0.007 (95% CI 0.006 to 0.008) versus 0.011 (95% CI 0.010 to 0.011) mg kg−1 h−1, Bonferroni corrected P

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“A Review of Validated QOL PROMs in Pediatric Plastic Surgery.”

Background: There has been an exponential increase in the number of patient reported outcome measures, PROMs, in plastic surgery. This study aims to review the reliability, validity, and practicality of the most frequently used PROMs in pediatric plastic surgery research. Methods: A review of the literature from January 2010 - June 2015 was conducted to identify PROMs in pediatric plastic surgery. PROMs used in 5 articles with 2 validation studies were included for analysis and classified as generic, disease specific, and mental health. The type of validation used and reliability scores were compared across each class of PROMs. The practicality of each PROM was determined by the frequency of use and the number of items and cost. Results: Of the 173 unique PROMs identified, 14 were included for analysis and classified as: generic (7), disease specific (4), and mental health (3). The majority of all PROMs used construct validity. Disease specific PROMs had the highest distribution of domains related to physical functioning - the same domain also found to have the highest reliability scores. A PROM's frequency of use was not associated with its number of items or cost. Conclusions: This review found that generic PROMs were used most often, construct validity was used most frequently, physical functioning domains had the highest reliability, and the number of items or cost of a PROM was not related to its frequency of use. Taken together, this information may inform the future development or selection of PROMs in pediatric plastic surgery. Financial Disclosure Statement: The authors have nothing to disclose. Presented at (if applicable): Western Regional Student and Resident Medical Research Forum (WRSRMR) 2016 in Carmel, California and University of British Columbia's Chung Research Day 2017 in Vancouver, BC Acknowledgements: The authors would like to thank Marija Bucevska MD CCRP, for her continued guidance and feedback throughout this study. Corresponding Author: Douglas J. Courtemanche MD MS FRCSC, Division of Plastic Surgery, BC Children's Hospital, 4480 Oak Street, Vancouver BC , V6H 3V4 Canada. douglas.courtemanche@ubc.ca ©2018American Society of Plastic Surgeons

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“Combined Carpal Tunnel Release and Palmar Fasciectomy for Dupuytren’s Contracture Does Not Increase the Risk for Complex Regional Pain Syndrome”

Background: Hand surgery dogma suggests that simultaneous surgical treatment of carpal tunnel syndrome (CTS) and Dupuytren's contracture (DC) results in an increased incidence of Complex Regional Pain Syndrome (CRPS). As a result, many surgeons do not perform surgery for the two conditions concurrently. Our goal was to determine the extent of this association. Methods: We identified all patients undergoing surgical treatment for CTS, DC, or both between April 1982 and March 2017 using the Indiana Network for Patient Care (INPC), a large, multi-institutional, statewide information exchange. Demographics, comorbidities, and 1-year post-operative incidence of CRPS were recorded. Results: A total of 51,739 (95.6%) patients underwent carpal tunnel release (CTR) only, 2,103 (3.9%) underwent palmar fasciectomy (PF) only, and 305 (0.6%) underwent concurrent CTR and PF. There was no difference in the likelihood of developing CRPS (p=0.163) between groups. Independent risk factors for developing CRPS were younger age, anxiety, depression, epilepsy, gout, and history of fracture of the radius, ulna, or the carpus. Conclusions: Concurrent CTR and PF is not associated with an increased risk for developing CRPS. Patient demographics, medical comorbidities, and a history of upper extremity trauma are associated with the development of CRPS after surgery and should be discussed preoperatively as potential risk factors. Financial Disclosures: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. No funding was received for this article. Presented at: The 2018 Annual Meeting of the American Association of Hand Surgery Acknowledgements: The authors would like to acknowledge Katie Bickett from the Regenstreif Institute for her role in building the database from the Indiana Network for Patient Care used for this investigation and Lava Timsina for his help with the statistics. Corresponding author: Joshua M. Adkinson, M.D., Division of Plastic Surgery, Department of Surgery, 545 Barnhill Drive, Emerson Hall (EH), Suite 232, Indianapolis, IN 46202, (317) 880-8580, jadkinso@iu.edu ©2018American Society of Plastic Surgeons

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Intracranial Volume and Head Circumference in Children with Unoperated Syndromic Craniosynostosis

Objective: When analysing intracranial volume gain due to operative intervention in craniosynostosis, it is necessary to understand the underlying growth. We sought to create comprehensive intracranial volume (ICV) and occipitofrontal circumference (OFC) growth charts, as measured on unoperated craniosynostotic children. Furthermore, we aimed to investigate whether ICV and OFC could act as a proxy measure for each other. Methods: All pre-operative Great Ormond Street Hospital (GOSH) patients with a diagnosis of Apert, Crouzon-Pfeiffer or Saethre-Chotzen syndrome from 2004 onwards were considered for this study. A control group of unaffected GOSH patients were also measured. ICV and OFC were measured on the same scans. To study correlation between IVC and OFC, logarithmic fits were assessed. Results: 147 craniosynostotic children with 221 preoperative scans were included (81 Apert, 81 Crouzon, 31 Pfeiffer, and 28 Saethre-Chotzen). The control group comprised 56 patients with 58 scans. Apert ICV curves were significantly larger than other syndromes from 206 days onwards, OFC curves were not significantly different. The correlation coefficient between ICV and OFC for all syndromes combined was R2 = 0.87, for the control group R2 = 0.91. Conclusions: Apert children have a larger intracranial volume than other syndromic craniosynostotic conditions and unaffected children but maintain a similar occipitofrontal circumference. This study demonstrates high correlation between intracranial volume and OFC with clinical care implications. Reference growth curves have been created which can be used to monitor intracranial volume change over time and correct operative change for underlying growth. Author Contributions: RWFB, PGMK, GJ, NUOJ and SS designed the study, contributed to data acquisition, analysis and interpretation before drafting the manuscript. AB, NRF, JOH and DJD critically revised the manuscript. Acknowledgements: This research was supported by Great Ormond Street Hospital Children's Charity FaceValue programme (no. 12SG15), The Royal College of Surgeons of England, and the EPSRC (EP/N02124X/1). This report incorporates independent research from the National Institute for Health Research Biomedical Research Centre Funding Scheme. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. None of the authors has a financial interest in any of the products, devices or drugs mentioned in this manuscript This paper was presented at the 17th Congress of the International Society of Craniofacial Surgery on October 27th 2017 in Cancun, Mexico Corresponding Author: William Breakey, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, WC1N 1EH, London, UK. +44 20 7242 9789, William.breakey@ucl.ac.uk ©2018American Society of Plastic Surgeons

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Mechanical loading improve engineered tendon formation with muscle derived cells: an in vivo analysis

Background: Our previous study showed that muscle-derived cells could regenerate strong engineered tendon with better tissue structure. However, little was known about the mechanism of neo-tendon built by muscle-derived cells, and the development and maturation of the cells. We hypothesized that mechanical loading modulated this process. The aim of this study is to investigate whether mechanical loading could regulate muscle-derived cells engineered tendon formation and maturation. Methods: Muscle-derived cells were isolated, expanded and seeded on polyglycolic acid (PGA) fibers that formed a cell-scaffold complex. After in vitro culture for 2 weeks, half of them were implanted without loading and the other half were sutured to mouse fascia that could provide a natural dynamic loading. At 12 weeks and 24 weeks after implantation, histological examinations, ultrastructure and biomechanical characteristics were evaluated. Results: Gross observation results showed that under mechanical loading neo-tendon tissue could be generated with muscle-derived cells and the tissue structure became more mature with the increase of culture time. Well-organized aligned collagen fibers and elongated morphological cells were observed in histology under mechanical loading. In contrast, the non-load group failed to form neo-tendon, but formed disorganized fibrous tissue with significantly worse mechanical properties and poor collagen fibril structure. Conclusions: This study demonstrates that mechanical loading is indispensable in tendon tissue engineering with muscle-derived cells. Although muscle-derived cells have a potential advantage in neo-tendon regeneration, stress deprivation resulted in a distinctly inferior maturity level of engineered tendon. 1 Authors who contributed equally Disclosure: The authors have no commercial associations that might pose or create a conflict of interest with the information presented in this article. ACKNOWLEDGMENTS: This study was supported by National Natural Science Foundation of China (31300807), Beijing Natural Science Foundation (7144239) and Research Fund for the Doctoral Program of Higher Education of China (20131106120015). Corresponding author: Yuanbo Liu, M.D., Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 33 Ba-Da-Chu Road, Beijing 100144, PR China. E-mail addresses: ybpumc@sina.com (Yuanbo Liu) ©2018American Society of Plastic Surgeons

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Validity of Tinel sign and prevalence of tibial nerve entrapment at the tarsal tunnel in both diabetic and non-diabetic subjects: a cross-sectional study

Background: Nerve entrapments like carpal tunnel syndrome are more prevalent in patients with diabetes, especially in those with diabetic polyneuropathy. Our study aim was to investigate the validity of the Tinel sign in diagnosing tibial neuropathy and determine the prevalence of tibial nerve entrapment in both a diabetic and non-diabetic population. Methods: 240 non-neuropathic subjects with diabetes and 176 diabetic subjects with neuropathy participating in the prospective Rotterdam Diabetic Foot Study and 196 reference subjects without diabetes and without neuropathy complaints were evaluated. All subjects underwent sensory testing of the feet and complaints were assessed using the Michigan Neuropathy Screening Instrument. The Tinel sign was defined as discriminative valid to diagnose tibial nerve entrapment when the nerve related MNSI sub-score of neuropathic symptoms differed at least 5% between the Tinel positive and Tinel negative subjects. When valid, prevalence estimates of tibial nerve entrapment at the tarsal tunnel were calculated. Results: Significantly more neuropathic symptoms (p

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Cephalic Rotation of the Nasal Tip

The position of the nasal tip holds important aesthetic significance. Cephalic rotation of the nasal tip is a frequent motivating factor for patients seeking rhinoplasty. The position of the nasal tip is a complex interplay of the size, morphology, and position of several anatomic components of the lower one-third of the nose. Cephalic rotation can be achieved by way of six different methods. The indirect methods promote passive cephalic rotation and include cephalic trim of the lower lateral cartilages, caudal trim of the upper lateral cartilages, and caudal septal trim. Direct methods involve precise repositioning of the domes and include shortening the lateral crura, lateral domal relocation, and the tip rotation suture. Used alone or in combination, these techniques and their subtle variations, represent comprehensive and effective methods to achieve cephalic rotation of the nasal tip. Disclosure: Dr. Rohrich is a volunteer member of the Allergan Alliance for the Future of Aesthetics and receives instrument royalties from Eriem Surgical, Inc., and book royalties from Taylor and Francis Publishing. No funding was received for this article. Corresponding Author: Paul N. Afrooz, MD, Institute of Aesthetic Medicine, 3225 Aviation Avenue, Suite 100, Coconut Grove, FL 33133, Paul.Afrooz@gmail.com ©2018American Society of Plastic Surgeons

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Simultaneous Reconstruction of The Lower Lip with Gracilis Functioning Free Muscle Transplantation (FFMT) for Facial Reanimation: Comparison of Different Techniques

Background: Functioning free muscle transplantation (FFMT) is currently the gold standard for the reconstruction of facial paralysis, focusing more on the upper lip reconstruction rather than the lower lip. This study aimed to compare different lower lip reconstructive methods when performing FFMT for facial reanimation. Materials and Methods: Retrospective review of FFMT for facial reanimation from 2007 to 2015 was performed. Patients were divided into three groups: Group 1 (n=15), a free plantaris tendon graft anchored to the gracilis muscle was passed into the lower lip to create a loop within; Group 2 (n=12), an aponeurosis tail of the gracilis muscle was attached to the lower lip; Group 3 (n=18), no suspension of lower lip was performed. All patients had at least two years of follow-up. Outcomes were assessed by photos and videos, including subjective evaluation of midline deviation and horizontal tilt and objective analysis of smile dimensions and area. Results: A total of 45 patients were included. Results from the subjective evaluation demonstrate group 1 patients having the best improvement (overall score: p=0.004 & 0.005, Fisher's exact test). The objective evaluation showed group 1 and 2 patients with better results compared to group 3 (Horizontal component p=0.009, vertical component p=0.004, and area distribution p

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Discussion: Simultaneous Reconstruction of the Lower Lip with Gracilis Functioning Free Muscle Transplant (FFMT) For Facial Reanimation Comparison of Different Techniques

No abstract available

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Book Review: The Art of Body Contouring: A Comprehensive Approach Ed. By Aly and Nahas

No abstract available

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Outcome and Complications Following Vertical Rectus Abdominis (VRAM) Flaps to Reconstruct Sacrectomy Defects

Introduction: The vertical rectus abdominis (VRAM) flaps has been used to reliably reconstruct posterior soft tissue defects following resection of high sacral tumors, providing skin and soft tissue bulk to fill the potential space following sacral resection. Current literature examining the use of the VRAM flap for high sacral reconstruction is limited. The purpose of this study was to report our institutions outcome on the use of the VRAM flap to reconstruct a high sacral defect following an oncologic resection. Method: 87 (29 females, 58 males) patients underwent a VRAM flap to reconstruct a posterior wound following high sacral tumor resection from 1994 to 2016. The mean age and BMI were 52 years and 27.8 kg/m2. The mean follow-up was 6 years. Forty-seven patients had a history of neoadjuvant radiotherapy and twenty-eight had intraoperative radiotherapy. Results: 68 (79%) patients sustained a complication, most commonly a wound complication (n=41, 47%). 20 (23%) patients sustained a donor site wound complication, most commonly a wound dehiscence (n=10). Complications resulted in a reoperation in 44 (51%) patients, with total flap failure occurring in 1 (1%). Preoperative radiotherapy and obesity were found to increase the risk of wound complications (P=0.004, P=0.02) and deep infection (P=0.03, P=0.02). Conclusion: Complications including flap failure following VRAM were common. Patients with obesity and preoperative radiotherapy should be cautioned on their increased risk of complications. Currently the VRAM has is our preferred means of soft tissue reconstruction following high sacral tumor resection. ¥ Co-First Authors COI: No conflicts of interest are declared by any author on this study. Source of funding: No disclosures of funding were received for this work from NIH, Welcome Trust, or HHMI. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research § Corresponding Author ©2018American Society of Plastic Surgeons

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Nasoseptal Perforations: Endoscopic Repair Techniques. By Isam Alobid and Paolo Castelnuovo. Pp. 181. Thieme, New York, NY, 2017. Price $109.99

No abstract available

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Where Do We Look? Assessing Gaze Patterns in Breast Reconstructive Surgery with Eye-Tracking Technology

No abstract available

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“Autologous Gluteal Flaps for Gluteal Augmentation in a Circumferential Lower Body Lift: Differences and Refinements”

No abstract available

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Reply: Minimally Invasive Laparoscopically Dissected Deep Inferior Epigastric Artery Perforator Flap An Anatomical Feasibility Study and a First Clinical Case.

No abstract available

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Response to - Letter to the editor regarding "The comparison of Strattice and SurgiMend in Acellular Dermal Matrix-Assited Implant-Based Immediate Breast Reconstruction"

No abstract available

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Comments on “Lower body lift in the massive weight loss patient: A new classification and algorithm for gluteal augmentation.”

No abstract available

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Totally Extra Peritoneal (TEP) DIEP Flap Harvest Assisted by Robot: A Cadaver Study and a First Clinical Case.

No abstract available

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Nipple-Areola Complex Reconstruction

No abstract available

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Response: Where Do We Look? Assessing Gaze Patterns in Reconstructive Surgery with Eye Tracking Technology

No abstract available

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Vascular Endothelial Growth Factor Enhances Proliferation of Human Tenocytes and Promotes Tenogenic Gene Expression

Background: In obtaining human tenocytes in a sufficient number for tendon tissue engineering, low proliferation rate and phentoype loss during passaging is a problem. It was our aim to evalute the influence of VEGF on human tenocyte growth and gene expression. Materials and Methods: Human tenocytes were obtained from surgical specimens and exposed to human VEGF in various concentrations (5ng/ml, 10ng/ml, 20ng/ml) for 5 days. Cell proliferation was counted and expression of tendon-related genes (Col1, Col3, TSC, SCX and ELN) was analyzed. Results: Tenocyte count was 1.4x105/ml, 2.7x105/ml, 2.3x105/ml and 3.7x105/ml for 0ng, 5ng/ml, 10ng/ml and 20ng/ml VEGF respectively. Gene expression of Col1 was upregulated 6.4x±4.2x, 60.1x±21.6x and 15.8x±10.2x for 5ng/ml, 10ng/ml and 20ng/ml VEGF, all differences were significant with p

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Τετάρτη 15 Αυγούστου 2018

Effects of Cutaneous Negative Pressure Application on Perforator Artery Flow in Healthy Volunteers: A Preliminary Study

J reconstr Microsurg
DOI: 10.1055/s-0038-1668157

Introduction The creation of skin flaps based on small perforator vessels is an increasingly popular procedure nowadays; the optimization of their blood supply enhances surgical success. This study evaluates the effects on the flowmetries of 7 days' negative pressure application on the skin surface overlying the muscle fascia emergence of periumbilical perforators of the deep inferior epigastric artery (DIEA). Methods Ten volunteer participants were enrolled. In each subject, one periumbilical perforator of the DIEA was identified on each side of the abdomen using an eco-color-Doppler. One of them was used as the control group, while the other (the study group) underwent 80 mm Hg negative pressure for 7 days. The flowmetries of both perforators were measured before and after the application of negative pressure wound therapy. Results After the application of negative pressure, randomly applied on the skin surface over one of the two selected periumbilical perforators, an increase in the flowmetries was observed in both groups of perforators (2.74 cm/s; p < 0.0001). The relative flowmetry increase in the control group was 9.55% (2.735 cm/s), while in the study group it was 44.03% (8.748 cm/s). Conclusion The application of negative pressure system on the skin surface over the muscle fascia emergence of the selected periumbilical perforators showed an increase in flowmetry. Although this is a preliminary study, this simple and economical procedure before surgery could be usefully employed to increase the rate of success in microsurgical procedures.
[...]

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

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

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Unilateral Autologous Breast Reconstruction with Bi-pedicled, Conjoined Deep Inferior Epigastric Perforator Flaps

J reconstr Microsurg
DOI: 10.1055/s-0038-1668161

Background The abdomen remains the most popular and reliable donor site for autologous breast reconstruction. Some patients, however, lack sufficient tissue to recreate an aesthetic breast mound using a single-pedicle, deep inferior epigastric perforator (DIEP) flap, particularly when matching a contralateral native breast. The amount of abdominal skin and/or soft tissue reliably supplied by one vascular pedicle is frequently insufficient to adequately restore the breast skin envelope and "footprint." This study summarizes our experience with using bipedicled DIEP flaps to improve the aesthetic results of unilateral breast reconstruction in such patients. Methods Consecutive patients undergoing unilateral breast reconstruction with bi-pedicled, conjoined DIEP flaps over a 4-year period were retrospectively reviewed. Primary and secondary flap microvascular anastomoses were performed to the antegrade internal mammary (IM) vessels and to either the retrograde IM vessels or a primary DIEP pedicle side branch, respectively. Clinical characteristics and outcomes were recorded. Results Sixty-three patients underwent immediate (n = 29) or delayed (n = 34) reconstruction, with age and body mass index of 54.1 ± 8.4 years and 26.6 ± 4.7, respectively. Mean follow-up was 14.1 months. Twenty-eight (44.4%) patients received prereconstruction radiation therapy. All patients had preoperative abdominal imaging, including 57 (90.5%) using magnetic resonance angiography. There were no flap losses with three operative interventions for flap salvage. Conclusions Unilateral breast reconstruction with bipedicled, conjoined DIEP flaps is safe and reliable. These procedures can be performed with a complication profile similar to single-pedicle DIEP flaps. The additional skin and soft tissue available with bi-pedicled flaps allows for greater flexibility in matching the shape and projection of a woman's contralateral breast, and in some cases is necessary to achieve an aesthetically acceptable reconstruction. With growing expectations among breast reconstruction patients, conjoined bi-pedicled flaps represent a tool for meeting their reconstructive needs and exceeding the status quo for aesthetic outcomes.
[...]

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

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

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Photodegradation using TiO 2 -activated borosilicate tubes

Abstract

This study examines the photocatalytic activity of titanium dioxide (TiO₂) semiconductor supported on borosilicate tubes (cut-off 290 nm) towards removal of a mix of persistent organic pollutants (POPs) from water. For this purpose, two widely used analgesic and anti-inflammatory drugs (NSAIDs), ibuprofen (IBU) and mefenamic acid, along with MCPA sodium monohydrate, which is a common herbicide frequently used in the agricultural activities, were selected as a case study. Borosilicate tubes were coated with titanium oxide through two different approaches: sol-gel dip-coating and a hybrid nanoparticle dip-coating and plasma-enhanced chemical vapour deposition (PECVD) process. The photochemical reactor that hosts the titania-coated tubes was designed to permit continuous throughput of liquid feed stream. The photodegradation experiments were performed in laboratory conditions under artificial irradiation simulating solar light. The efficiency of direct photolysis and heterogeneous photocatalysis (TiO₂) was investigated, and the performance of each coating method was evaluated. Kinetic studies for each experiment were accomplished, the overall results showed poor efficiency and insufficient removal for NSAIDs through direct photolysis, whereas applying heterogeneous photacatalysis with TiO₂ coated on borosilicate tubes was found to accelerate their degradation rate with complete decomposition. Concomitantly, kinetic experimental results showed a critical difference of performance for the two coating methods used; in particular, the degradation rates of pollutants by the sol-gel-coated tubes were much faster than the degradation by the nanoparticle/PECVD-coated tubes. Using TiO₂ supported on borosilicate tubes appears to be a promising alternative to conventional TiO₂ suspension and avoid post-separation stages. The results achieved in this study can be used to optimise large-scale applications, and expanding the study to cover a wide range of pollutants will lead to achieve more representative results.

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Enthesitis and Dactylitis in Psoriatic Disease: A Guide for Dermatologists

Abstract

Psoriatic arthritis (PsA) is an inflammatory arthritis that is estimated to affect approximately 30% of patients with psoriasis. Enthesitis and dactylitis, two hallmarks of PsA, are associated with radiographic peripheral/axial joint damage and severe disease. Clinical symptoms of enthesitis include tenderness, soreness, and pain at entheses on palpation, whereas dactylitis is recognized by swelling of an entire digit that is different from adjacent digits. Both ultrasound and magnetic resonance imaging can be used to diagnose enthesitis and dactylitis, especially in patients in whom symptoms may be difficult to discern. Delayed treatment of PsA can result in irreversible joint damage and reduced quality of life. Thus, it is recommended that dermatologists monitor patients with psoriasis for these two early and important manifestations of PsA.

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Ecological risk assessment of potentially toxic elements (PTEs) in the soil-plant system after reclamation of dredged sediment

Abstract

The Shayinghe River is an important tributary of the Huaihe River in China. The concentrations of potential toxic elements (PTEs), such as As, Hg, Pb, Cu, Zn, Cr, and Cd in soils and dominant vegetation from mud-dumping areas reclaimed with dredged sediments, and areas without mud-dumping (non-mud-dumping areas) adjacent to the Shayinghe River were investigated. The potential ecological risk index (ERI) and transfer coefficient (TC) were calculated and evaluated. The results showed that the potential toxic element concentrations in all sampling areas decreased in the order of (Zn, Cr) > (Cu, Pb) > As>Cd > Hg. Additionally, the total concentrations of the PTEs significantly increased from mud-dumping to the non-mud-dumping areas. Ecological risk assessment of soils showed that all the elements did not exhibit apparent ecological risks (except for As). This element exhibited a moderate ecological risk, implying that the dredging of sediments could increase the potential ecological risk of individual PTEs. Additionally, the PTEs in some of dominant plants in mud-dumping areas did not increase, indicating no apparent accumulation. The principal component analysis (PCA) showed that the principal components of the PTEs in plants from dredged sediments were different from those in the agricultural soil, indicating the influence of dredging on PTEs. Finally, Cd, Zn, and Hg had higher transfer coefficients (up to 6), even if their concentrations were relatively low, suggesting potential ecological risks to the plants.

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Research on the ecological efficiency of the Yangtze River Delta region in China from the perspective of sustainable development of the economy-energy-environment (3E) system

Abstract

Balancing the relationship between economic development, energy utilization, and environmental protection has become an important task in China's Strip Planning and Construction. This article takes the annual panel data from 2005 to 2015 as the research object firmly grasps the research basis of the Economy-Energy-Environment (3E) System, and focuses on building a new research framework from both internal and external perspectives of the eco-efficiency index to achieve the exploratory research on regional ecological efficiency changes and influencing factors. First of all, it uses super-efficient slacks-based measure (SBM) model which introduces undesired outputs to measure eco-efficiency at different levels. Then, it applies Malmquist index to calculate total factor productivity and structural efficiencies. Finally, it selects six indicators and uses the STIRPAT regression model to analyze external factors. The results indicate that (1) the overall ecological efficiency is effective and maintaining a good momentum of development. Among all the cities and provinces, Shanghai and Zhejiang provinces play the role of "stabilizers," while Jiangsu and Anhui provinces act as "accelerators." (2) All 41 prefecture-level cities can be divided into four different types, i.e., "high-high", "low-high", "low-low," and "high-low" cities, and there is an obvious phenomenon of spatial clustering; (3) pure technical efficiency and scale efficiency is the core driving force for the improvement of ecological efficiency. (4) Anhui and Jiangsu provinces show a U-shaped relationship, while Zhejiang province shows an inverted U-shaped relationship.

Graphical abstract

The structure of introduction-body paragraphs-conclusion carbon

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Multipurpose efficacy of the lyophilized cell-free supernatant of Salmonella bongori isolated from the freshwater fish, Devario aequipinnatus: toxicity against microbial pathogens and mosquito vectors

Abstract

Presently, the discovery of effective drugs and pesticides from eco-friendly biological sources is an important challenge in the field of life sciences. The present research was aimed for standardizing an innovative approach in the evaluation of the biological potentiality of the metabolites of fish-associated bacteria. We have identified 17 skin-associated bacteria from the freshwater fish, giant danio, Devario aquipinnatus. They were screened through biofilm forming and extracellular enzyme producing ability. The results of preliminary antibacterial evaluation of the bacterial supernatants underlined the importance of three potential strains (BH8, BH10 and BH11) for further applied research. Hence, such strains were subsequently subjected to a novel extraction procedure to overcome the difficulties found in polar solvents mixed with the supernatant. The lyophilized cell-free supernatant (LCFS) of 3 isolates were individually extracted by using methanol. During the testing of LCFS's methanolic extract (LCFS-ME) of 3 isolates, only the extract of BH11-strain exhibited potent inhibitory activity against the pathogenic bacteria and fungi. Furthermore, the larvicidal and mosquitocidal assays on the filariasis vector, Culex quinquefasciatus also showed its potent toxicity on both the adults and developmental instars of mosquito. Through molecular and phylogenetic analyses, the BH11 strain was identified as Salmonella bongori (KR350635). The present finding emphasized that the S. bongori could be an important novel source of effective antimicrobials and mosquitocidal agents.

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14 ways to lose weight without diet or exercise

Strict diets can be challenging to follow, and people may not always have the time or ability to exercise. However, a variety of simple lifestyle changes can help people lose weight and improve their health. These include taking probiotics, getting enough sleep, and thoroughly chewing food. Learn more here.

https://ift.tt/2nF09v1

A lower energetic, protein and uncooked cornstarch intake is associated with a more severe outcome in glycogen storage disease type III: an observational study of 50 patients

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

https://ift.tt/2PcNvzZ

Evolution of adjuvant treatment in endometrial cancer—no evidence and new questions?

Abstract

Purpose

For endometrial cancer (EC), clinical and pathological risk factors are taken to triage patients and estimate their prognosis. Lymph node involvement (pN+), lymphovascular space involvement (LSVI), grading, age of the patients, and T classification are internationally accepted parameters for treatment decisions.

Materials and methods

Studies on adjuvant radiation, chemotherapy, and chemoradiation are discussed against the background of risk stratification and clinical decision-making in early-to-advanced stage endometrial cancer. Recent publications on adjuvant treatment in high-risk disease and its implications for the patients with regard to expected oncologic benefit and treatment-related toxicity are discussed.

Results

Surgery is the mainstay of treatment of EC patients. Well-differentiated tumors and early disease (FIGO IA) should be followed up without further treatment. In FIGO I stage without risk factors, VBT remains the standard treatment after surgery. FIGO I, II patients with one or more risk factors (MI ≥ 50%, Grading[G]3, age >60 years, LVSI) benefit from external beam radiotherapy (EBRT) in terms of survival. There are no data of acceptable quality demonstrating that chemotherapy is superior to radiation in locally advanced carcinomas. Therefore, even in locally advanced disease (FIGO III, IV), EBRT remains the standard of care after surgery. EBRT contributes to the very low rate of local relapses and better DFS in these patients and should not be replaced by chemotherapy only. Whether and which subgroups of patients benefit from an additional (concomitant and/or adjuvant) chemotherapy in terms of disease-free survival remains a controversial issue. The recently published PORTEC-3 trial could not create clear evidence. With a high rate of isolated tumors cells and micrometastases in the specimens, the increasing use of unvalidated sentinel concepts in endometrial cancer raises more questions with regard to indications for adjuvant treatment.

Summary and perspectives

In the future, integrated genomic characterization of tumors might be helpful for treatment individualization in the adjuvant setting.

https://ift.tt/2nGWRY6

Characterization and Outcomes of Disease Progression in 52 Patients Treated with BRAF-V600 + MEK Inhibitors for Advanced Melanoma

Background: Combined treatment with BRAF-V600 and MEK inhibitors has significantly improved progression-free and overall survival of patients with BRAF-mutated melanoma. Pattern of disease progression and outcomes in patients have not been fully characterized. Methods: We conducted a single-center, retrospective, descriptive analysis of a cohort of 52 patients treated with BRAF-V600 + MEK inhibitors for advanced melanoma over a 12-month period. The aim of this study was to characterize disease progression, defined as metastatic pattern, disease kinetics, and response to subsequent therapies, in melanoma patients treated with BRAF-V600 + MEK inhibitors. Results: Disease progression was observed in 31/52 (59.6%) patients treated with BRAF-V600 + MEK inhibitors. Relapse of melanoma involved the CNS for 22/31 (70.9%) patients with disease progression, including 18/31 (58%) patients who had exclusive intracranial metastases. Sixteen patients died from disease progression. Among the 31 patients who had disease progression, the median time until a relapse was 8 months, and the median survival time after disease progression was 2 months. Conclusion: Our study shows that, for patients treated with BRAF-V600 + MEK inhibitors who lose response, disease progression was aggressive and had poor outcomes. Most patients had CNS metastases and low rates of therapeutic response to any subsequent therapy.
Dermatology

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Association between Atopic Dermatitis and the Metabolic Syndrome: A Systematic Review

Atopic dermatitis (AD) may be associated with the metabolic syndrome and by that carry an increased risk of cardiovascular disease. Our objective was to provide an update on current knowledge of the association between AD and metabolic syndrome, including each component of the metabolic syndrome. A systematic literature review was performed to identify studies investigating the association between metabolic syndrome and AD from PubMed, Embase, and the Cochrane Library in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A total of 14 studies, investigating the association between AD and the metabolic syndrome or AD and components of metabolic syndrome fulfilled the inclusion criteria and were included. It seems unlikely that the association between AD and metabolic syndrome is causal. However, women with AD tended to have components of metabolic syndrome more often than women without AD. There was a positive association between AD and central obesity measured as waist circumference, and this association was stronger for women than men. Despite conflicting results regarding hypertension, the association between hypertension and AD also appeared stronger for women. On the other hand, the association between AD and hyperglycemia appears unlikely, and the association between AD and cholesterol levels was inconsistent. In conclusion, it remains unclear whether AD is a risk factor for metabolic syndrome and its components. However, data indicate that central obesity is associated with AD and that the association is stronger for women than men.
Dermatology

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