Mycobacterium Ulcerans soft tissue defects: reconstructive challenges

Abstract

Background

Mycobacterium ulcerans (M. ulcerans) infection is a growing concern in Australia, with several disease hotspots in south-eastern Victoria (Guest 2016). Cases at our institution, located within one such endemic area, increasingly require reconstruction of substantial mycobacterial soft tissue deficits. This article comprises a focused literature review of flap reconstruction outcomes in significant M. ulcerans defects and the impact of antibiotic choice, duration of antimycobacterial therapy and time to reconstruction in this context, as well as a short case series.

Methods

A keyword search of Medline, Google Scholar and PubMed was conducted. In addition, four M. ulcerans flap reconstructions performed at our institution had case notes retrospectively reviewed for reconstruction indication, complications, outcomes and antibiotic therapy.

Results

Sixteen articles met inclusion criteria, of which 11 referenced flap reconstruction of M. ulcerans soft tissue defects in some manner. Antibiotic regimens, peri-operative details and flap outcomes were either only briefly mentioned or not at all and were not the focus of any of the articles. We present four cases of dorsal hand M. ulcerans defect, which were reconstructed with fasciocutaneous anterolateral thigh flaps due to extensive soft tissue loss with extensor tendon exposure. Antibiotic regimens varied. Each procedure was undertaken with minimal complication and excellent functional outcomes.

Conclusions

This review has identified the necessity of defining optimal reconstructive pathways in M. ulcerans soft tissue defects. Our cases demonstrate the successful use of fasciocutaneous flaps in refractory cases needing complex reconstruction. This paper presents the first review and case series on microvascular flap reconstruction of M. ulcerans defects. Level of Evidence Level IV, therapeutic study.

https://ift.tt/2wS1bbk

Effects of particulate matter (PM2.5) and associated acidity on ecosystem functioning: response of leaf litter breakdown

Abstract

Particulate matter (PM2.5 with the diameter ≤ 2.5 μm) as one of the most harmful and complex pollutants can reduce environment quality and affect human health. Through acidification by wet deposition, PM2.5 can cause acid rain to impact aquatic ecosystems. However, our understanding of PM2.5 effect on ecosystem functioning is highly limited. This study investigated the relationship between PM2.5 concentration, associated acidity, and leaf litter breakdown of three tree species in laboratory experimental mesocosms, which are weeping willow (Salix babylonica), camphor tree(Cinnamomum camphora), and the south magnolia (Magnolia grandiflora). We found that leaf litter breakdown was significant affected by PM2.5 and associated acidity. With the increase of acidity, the leaf breakdown rate of all three tree species decreased. With the increase of PM2.5 concentration, the leaf breakdown rates of those leaves slowed down. When considering the influence of leaf toughness, willow leaves with lower toughness had a higher breakdown rate than that of camphor tree and the south magnolia. Our study suggests that PM2.5 has significant impact on the aquatic ecosystem functioning through increasing acidification in aquatic environment. Hence, along with ecological restoration of local aquatic habitats, further freshwater ecosystem management should include reducing air pollution through regional efforts of best ecosystem management.

https://ift.tt/2CwsLRu

Financial development, globalization, and CO 2 emission in the presence of EKC: evidence from BRICS countries

Abstract

This study examines the impact of energy consumption, financial development, globalization, economic growth, and urbanization on carbon dioxide emissions in the presence of Environmental Kuznets Curve (EKC) model for BRICS economies, by using a family of econometric techniques robust to heterogeneity and cross-sectional dependence. Results from LM test, CIPS and CADF unit root test, Westerlund Cointegration test, the Dynamic seemingly unrelated regression (DSUR), and Dumitrescu-Hurlin Granger causality test show that (i) the data is cross sectionally dependent and heterogeneous; (ii) carbon dioxide emissions, energy consumption, financial development, globalization, economic growth, square of GDP and urbanization have integration of order one; (iii) the examined variables are co-integrated; (iv) energy consumption and financial development contribute to the carbon dioxide emissions whereas globalization and urbanization have negative but insignificant relationship with carbon dioxide emissions; (v) supports the EKC hypothesis in BRICS economies; (vi) bidirectional causality exists among energy consumption, financial development, economic growth and square of GDP with carbon dioxide emissions whereas globalization and urbanization have unidirectional relationship with carbon dioxide emissions. Since these panel techniques account for heterogeneity and cross-sectional dependence in their estimation procedure, the empirical results are robust and reliable for policy recommendations. Furthermore, this study also uses time series tests (ADF, P-P, and FMOLS) to find the empirical results for each of the country and finds mixed results. Empirical findings directed towards some important policy implications.

https://ift.tt/2oOaJjO

Usefulness of TSH receptor antibodies as biomarkers for Graves’ ophthalmopathy: a systematic review

Abstract

Purpose

Over the past several decades, many papers have been published about the usefulness of thyrotropin receptor antibodies (TRAbs) as biomarkers of Graves' ophthalmopathy (GO). However, results have been inconsistent. The purpose of this analysis is to determine a possible cause of these discrepancies and to examine the usefulness of TRAbs as biomarkers for GO, especially 'thyrotropin-binding inhibiting immunoglobulin (TBII)' and 'thyroid-stimulating antibody (TSAb)'.

Method

26 articles discussing the association between TRAbs and GO were selected which were then divided into three groups based on the study method and whether or not the patients had been treated for hyperthyroidism. From the results of the papers reviewed, a provisional conclusion was made and a theoretical model on the TBII–TSAb coordinate plane was developed to confirm that conclusion.

Results

TSAb is reported to be significantly or strongly associated with GO in the studies of pre- and post-treated patients for hyperthyroidism. TBII is positively correlated, negatively correlated or uncorrelated with GO in studies of pre-treated patients. However, it is generally agreed upon that TBII and GO are closely correlated in studies of post-treated patients.

Conclusion

We conclude that the level of TBII may not be a reliable indicator of the current state of GO in pre-treated patients. Whereas, in post-treated patients, due to changes in the correlation between TBII and TSAb due to the effect of hyperthyroidism treatment, the level of TBII can be a more reliable indicator of GO. Furthermore, the current level of TBII is closely associated with the onset and severity of GO in the future and it can be a valid predictor of GO. However, the TSAb level appears to be more reliable.

https://ift.tt/2M544uN

Giant Prolactinoma of Young Onset: A Clue to Diagnosis of MEN-1 Syndrome.

Related Articles

Giant Prolactinoma of Young Onset: A Clue to Diagnosis of MEN-1 Syndrome.

Case Rep Endocrinol. 2018;2018:2875074

Authors: Subasinghe CJ, Somasundaram N, Sivatharshya P, Ranasinghe LD, Korbonits M

Abstract
Multiple endocrine neoplasia (MEN) type 1 syndrome is an autosomal dominant disorder caused by germline mutations in MEN1 gene, characterized by tumours in endocrine and nonendocrine organs. Giant prolactinoma is defined as tumours larger than 40mm with very high prolactin secretion. We report two unrelated Sri Lankan patients (8-year-old boy and a 20-year-old female) who presented with giant prolactinomas with mass effects of the tumours. The female patient showed complete response to medical therapy, while the boy developed recurrent resistant prolactinoma needing surgery and radiotherapy. During follow-up, both developed pancreatic neuroendocrine tumours. Genetic analysis revealed that one was heterozygous for a nonsense mutation and other for missense mutation in MEN1 gene. Screening confirmed familial MEN-1 syndrome in their families. High clinical suspicion upon unusual clinical presentation prompted genetic evaluation in these patients and detection of MEN1 gene mutation. Pituitary adenomas in children with MEN-1 syndrome are larger tumours with higher rates of treatment resistance. This report emphasizes importance of screening young patients with giant prolactinoma for MEN-1 syndrome and arranging long-term follow-up for them expecting variable treatment outcomes. Sri Lanka requires further studies to describe the genotypic-phenotypic variability of MEN-1 syndrome in this population.

PMID: 30186640 [PubMed]

https://ift.tt/2Q9RduJ

Scalar diffusion-MRI measures invariant to acquisition parameters: A first step towards imaging biomarkers

Publication date: December 2018

Source: Magnetic Resonance Imaging, Volume 54

Author(s): Santiago Aja-Fernández, Tomasz Pieciak, Antonio Tristán-Vega, Gonzalo Vegas-Sánchez-Ferrero, Vicente Molina, Rodrigo de Luis-García

Abstract

An imaging biomarker is a biologic feature in an image that is relevant to a patient's diagnosis or prognosis. In order to qualify as a biomarker, a measure must be robust and reproducible. However, the usual scalar measures derived from diffusion tensor imaging are known to be highly dependent on the variation of the acquisition parameters, which prevents their possible use as biomarkers. In this work, we propose a new set of quantitative measures based on diffusion magnetic resonance imaging from single-shell acquisitions that are designed to be robust to the variations of several acquisition parameters (number of gradient directions, b-value and SNR) while keeping a high discrimination power on differences in the diffusion characteristics of the tissue.

These new scalar measures are analytically obtained from a generic diffusion function that does not require the calculation of a diffusion tensor. This way, on one hand, we avoid the use of a specific diffusion model and, on the other hand, we make easier the statistical characterization of the measures. Accordingly, the analysis of the measures bias is carried out and it is used to minimize their dependency with respect to the acquisition noise for different SNRs. The robustness and discrimination power of the measures are tested for different number of gradients, b-values and SNRs using a realistic phantom and three real datasets: (1) 13 control subjects and different acquisition parameters; (2) a public data set from a single subject acquired using multiple shells and (3) 32 schizophrenia patients and 32 age and sex-matched healthy controls with a varying number of gradient directions.

The proposed quantitative measures exhibit low variability to the changes of the acquisition parameters, while at the same time they preserve a discrimination power that is able to detect significant changes in the anisotropy of the diffusion.

https://ift.tt/2wSDpwN

Tofacitinib for the Treatment of Alopecia Areata in Preadolescent Children

Publication date: Available online 6 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Brittany G. Craiglow, Brett A. King

https://ift.tt/2oP7WXU

Effective phytoremediation of low-level heavy metals by native macrophytes in a vanadium mining area, China

Abstract

Heavy metal contamination, particularly vanadium contamination in mining and smelting areas, is a worldwide serious problem threatening the ecological system and human health. The contamination level of vanadium, arsenic, cadmium, chromium, mercury, and lead in sediments and waters in a vanadium mining area in China was investigated in the present study. The behavior of heavy metal uptake by 12 native aquatic macrophytes was evaluated, including 5 species of emergent aquatic plants (Acorus calamus, Scirpus tabernaemontani, Typha orientalis, Phragmites australis, and Bermuda grass), 3 species of floating plants (Marsilea quadrifolia, Nymphaea tetragona, and Eleocharis plantagineiformis), and 4 species of submerged plants (Hydrilla verticillata, Ceratophyllum demersum, Myriophyllum verticillatum, and Potamogetom crispus). Different heavy metal accumulation abilities were found across these macrophytes. Generally, they tended to accumulate higher contents of chromium, and C. demersum showed a particularly higher accumulation capacity for vanadium. The heavy metals were preferentially distributed in roots, instead of translocation into leaves and stems, indicating an internal detoxification mechanism for heavy metal tolerance in macrophytes. In 24-day laboratory hydroponic experiments, the macrophytes had a satisfied phytoremediation performance for heavy metals, when their concentrations were at the microgram per liter level. Particularly, vanadium was effectively removed by P. australis and C. demersum, the removal efficiencies of which were approximately 50%. In addition, a combination of terrestrial plant (Bermuda grass) and aquatic macrophytes (P. australis, M. quadrifolia, and C. demersum) exhibited high uptake capacity of all the six heavy metals and their residual concentrations were 95 (vanadium), 39.5 (arsenic), 4.54 (cadmium), 17.2 (chromium), 0.028 (mercury), and 7.9 (lead) μg/L, respectively. This work is of significant importance for introducing native macrophytes to remove low-level heavy metal contamination, particularly vanadium, and suggests phytoremediation as a promising and cost-effective method for in situ remediation at mining sites.

https://ift.tt/2Q9YNW2

Xanthogranuloma of the sellar region accompanied by growth hormone deficiency: case report and literature review

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


https://ift.tt/2QbDYcQ

Lateral and longitudinal variation in phosphorus fractions in surface sediment and adjacent riparian soil in the Three Gorges Reservoir, China

Abstract

Hydrological regimes have been significantly altered since the Three Gorges Dam (TGD) raised the water level of the reservoir to the maximum design level of 175 m in October 2010. This change might greatly influence the forms of phosphorus (P) in the sediment and the adjacent riparian soil. The purpose of this study was to reveal the lateral (sediment, water-level-fluctuation zone soil, and upland soil) and longitudinal (from the end of backwater area to the TGD) trends in P factions. Samples from 11 sites located along the main stem and ten sites located along eight tributaries were collected in June 2017. The P fractions were determined using the Standards, Measurements, and Testing (SMT) protocol. The results showed that the order of increase for average pH values was sediment (7.58 ± 0.62), WLFZ soil (7.44 ± 0.29), and adjacent upland soil (7.20 ± 0.68). The total organic carbon in the sediment was also highest with an average of 9.15 ± 2.97 mg·g⁻¹. The average concentrated HCl-extractable P (total P), organic P (OP), inorganic P (IP), HCl-extractable P (HCl-P), and NaOH-extractable P (NaOH-P) were 630.02 ± 212.24, 161.89 ± 90.77, 468.13 ± 194.92, 335.65 ± 159.88, and 51.40 ± 36.20 mg·kg⁻¹, respectively. The concentration of both total P and NaOH-P in the sediment of the main stem exhibited an increasing trend from the backwater area to the TGD. The average concentration of P species in the sediment was higher than those in the upland soil and the water-level-fluctuation zone (WLFZ) soil. For all the sediment and soil samples, the rank order of P species concentrations was HCl-P > OP > NaOH-P. Both IP and HCl-P were highly positively correlated with total P in the upland soil, the WLFZ soil and the sediment. However, only in the sediment, NaOH-P was positively correlated with total P and OP. All P species in the upland soil demonstrated greater spatial heterogeneity than those in the WLFZ soil and the sediment. Redundancy analysis revealed that the main variables explaining the variance in P species concentrations were Al in the upland soil and pH in the sediment.

https://ift.tt/2MTcqLA

Propofol Anesthesia Precludes LFP-Based Functional Mapping of Pallidum during DBS Implantation

Background/Aims: There are reports that microelectrode recording (MER) can be performed under certain anesthetized conditions for functional confirmation of the optimal deep brain stimulation (DBS) target. However, it is generally accepted that anesthesia affects MER. Due to a potential role of local field potentials (LFPs) in DBS functional mapping, we characterized the effect of propofol on globus pallidus interna (GPi) and externa (GPe) LFPs in Parkinson disease (PD) patients. Methods: We collected LFPs in 12 awake and anesthetized PD patients undergoing DBS implantation. Spectral power of β (13–35 Hz) and high-frequency oscillations (HFOs: 200–300 Hz) was compared across the pallidum. Results: Propofol suppressed GPi power by #x3e; 20 Hz while increasing power at lower frequencies. A similar power shift was observed in GPe; however, power in the high β range (20–35 Hz) increased with propofol. Before anesthesia both β and HFO activity were significantly greater at the GPi (χ² = 20.63 and χ² = 48.81, p #x3c; 0.0001). However, during anesthesia, we found no significant difference across the pallidum (χ² = 0.47, p = 0.79, and χ² = 4.11, p = 0.12). Conclusion: GPi and GPe are distinguishable using LFP spectral profiles in the awake condition. Propofol obliterates this spectral differentiation. Therefore, LFP spectra cannot be relied upon in the propofol-anesthetized state for functional mapping during DBS implantation.
Stereotact Funct Neurosurg

https://ift.tt/2NouzQN

Prepectoral breast reconstruction using the Braxon® porcine acellular dermal matrix: a retrospective study

Abstract

Background

Breast cancer is the leading cause of death attributable to cancer among women worldwide. Breast reconstruction has become an integrated part of breast cancer treatment due to long-term psychosexual health factors and its importance to breast cancer survivors. Muscle-sparing techniques using an acellular dermal matrix (ADM) (Braxon; DECO med s.r.l., Venice, Italy) can be considered a possible alternative to immediate reconstruction or two-step reconstruction for patients with medium breasts who want to preserve their natural breast shape.

Methods

We performed a retrospective analysis of reconstructions using a Braxon porcine-derived ADM at the Breast Unit of the University Hospital of Parma and the Breast Unit of Piacenza Hospital from January 2015 to September 2017. The objective was to evaluate the benefits and complications resulting from this technique.

Results

We treated 42 patients and performed a total of 51 muscle-sparing reconstructions using the Braxon porcine-derived ADM. The incidence of cutaneous necrosis was 4% (n = 2); the incidence of seroma was 4% (n = 2). We had to remove the implants in two cases. Natural and symmetrical breasts with good form, ptosis, and softness were achieved for most patients.

Conclusions

Good results were obtained with a high degree of esthetic and functional satisfaction for the majority of patients. A low rate of early complications compared to that reported in the international literature data was observed.

Level of Evidence: Level IV, therapeutic study

https://ift.tt/2wRc4Kr

Cytomegalovirus ulcers following radiotherapy for a Marjolin ulcer in a renal transplant recipient

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2CuwMG9

Author Index 2018

Australasian Journal of Dermatology, Volume 59, Issue S2, Page 24-24, August 2018.


https://ift.tt/2MVANs0

Issue Information

Australasian Journal of Dermatology, Volume 59, Issue S2, Page 1-2, August 2018.


https://ift.tt/2Csibe3

WCCS18 World Congress on Cancers of the Skin 2018 Sydney International Convention Centre 15‐18 August 2018

Australasian Journal of Dermatology, Volume 59, Issue S2, Page 3-23, August 2018.


https://ift.tt/2Nr4UXw

Systemic treatments for alopecia areata: A systematic review

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2Cp3Pey

Itching in a trichophytin contact dermatitis mouse model and the antipruritic effect of antifungal agents

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2M5rMHB

Clinical effectiveness of multi-wavelength photobiomodulation therapy as an adjunct to extracorporeal shock wave therapy in the management of plantar fasciitis: a randomized controlled trial

Abstract

The goal of our study was to investigate the cumulative effect of combining medium-energy extracorporeal shock wave therapy (ESWT) and photobiomodulation therapy (PBMT), as well as to compare between their relative effectiveness in the management of plantar fasciitis (PF). One hundred twenty participants with chronic PF, more than 6 months with failure to respond to conservative treatment, were randomly assigned into four equal groups. Participants received either ESWT with PBMT, ESWT (once a week), PBMT (three times a week), or sham-PBMT (three times a week) for three consecutive weeks. A home exercise program was also included for all four groups. Outcome measures included pressure pain threshold (PPT), visual analogue scale (VAS), and functional foot index disability subscale (FFI-d) that were collected prior to the first treatment session and at the end of the 3-week treatment period, as well as at a follow-up session, 12 weeks after the final treatment session. There were statistically significant improvements in post-intervention and follow-up PPT, VAS, and FFI-d values in all treatment groups (P < 0.0001). As for the sham-PBMT, no significant difference was found between the pre-, post-intervention and follow-up values (P > 0.05). Bonferroni correction test revealed that there was a significant difference between all the four groups in PPT, VAS, and FFI-d values (P < 0.0001). All active treatment groups maintained the treatment effect at the 12-week follow-up. Both ESWT and PBMT were effective in increasing PPT values, decreasing pain and increasing functional ability. Additionally, application of PBMT after ESWT was shown to be superior over ESWT and PBMT alone, and ESWT was superior over PBMT in terms of reducing pain sensitivity and increasing function.

Level of Evidence II.

https://ift.tt/2wQy1de

Addition of oral mini pulse dexamethasone to NBUVB phototherapy and topical steroids helps arrest disease activity in patients with vitiligo

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2M35d6g