Thank you for allowing us to respond to the letter by Arshad and colleagues1 on a topical and important issue. We agree that this is an important subject that should not be overlooked.
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Πέμπτη 22 Νοεμβρίου 2018
Reply to: BAPRAS and BAAPS Scientific Meetings: Are we sticking are noses up at Rhinoplasty
Response to letter commenting on the use of blue dye in sentinel lymph node biopsy
We read with interest the reply from Rudman and colleagues1 to our publication2 but disagree with their assertion that blue dye must be used to increase the accuracy of sentinel lymph node biopsy (SLNB) for melanoma. In our series, the use of blue dye did not improve the sensitivity of intra-operative sentinel node identification but increased the number of nodes harvested by 5%. Our findings correspond with a meta-analysis performed by Niebling et al in 2016,3 where pooled analysis of 66 studies showed a 99% SLN identification rate using radiocolloid without blue dye.
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Double Barrel Lymphaticovenular Anastomosis
With improvements in the super-micro surgical technique, lymphaticovenular anastomosis (LVA) has become an effective treatment for obstructive lymph edema1. Recently, indocyanine green (ICG) dye lymphography makes it possible to visualize lymph vessels. LVA requires specific veins in the field. However veins come in a variety of sizes, and options for anastomosis i.e. end to end, end to side and side to end are chosen to deal with the discrepancies between lymph vessels and veins2. On the other hand, lymph vessels are sometimes bunched.
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Response to ‘Sentinel lymph node biopsy in melanoma: which hot nodes should be harvested and is blue dye really necessary?’
We read with great interest Ranson et als' recent publication, 'Sentinel lymph node biopsy in melanoma: which hot nodes should be harvested and is blue dye really necessary?'.1 This article retrospectively analysed 42 nodal basins in which greater than one node had been harvested, comparing the overall sensitivity of their blue dye and radiocolloid procedures with the sensitivity that might have be achieved had, theoretically, cold blue nodes been left in situ. They state that this approach could have resulted in a 5% reduction in the number of nodes harvested with no apparent change in sensitivity.
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Healing and maturation of the free Gracilis flap in extremity reconstruction: A patient perspective
Advancements in lower extremity reconstruction have made free tissue transfer for open lower limb fractures the gold standard of care in many units.1–2 Decisions regarding the use of fasciocutaneous versus muscle flaps are both surgeon and patient dependent. Muscle flaps are specifically unsightly to patients in the early stages of their reconstruction. However, the free Gracilis flap is quick to raise, with predictable anatomy, minimal donor site morbidity and is the workhorse flap for lower extremity reconstruction in our unit.
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FIRST DORSAL METACARPAL FLAP REFINEMENT FOR COVERAGE OF THUMB DEFECTS
Thumb defects after crush injury or amputation are common. The first dorsal metacarpal flap or Foucher flap is an island flap that was described as an alternative in the coverage of the distal stump or any other tissue loss in the thumb.1 The donor site is the skin from the dorsal aspect of the proximal phalanx of the index finger and second metacarpal head, which is usually grafted.
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Pre-operative masseter muscle EMG activation during smile predicts synchronicity of smile development in facial palsy patients undergoing reanimation with the masseter nerve – a prospective cohort study
Synchronicity of the oral commissure movement of a bilateral smile is a significant goal for reconstruction in facial reanimation and may only be guaranteed with use of the facial nerve as a donor nerve. Yet over the years several studies report some degree of spontaneity in certain patients when using a non-facial donor nerve, which indicates that synchronous initiation of the smile might be achievable with other donor nerves. We designed a prospective cohort study to evaluate whether pre-operative involuntary activation of the masseteric nerve during smile predicts development of a synchronous smile development when using the masseteric nerve for reanimation.
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ALT flap with vascularized fascia lata for one-stage functional patellar tendon reconstruction
Composite Antero-Lateral Thigh (ALT) flap with vascularized fascia lata can reconstitute patellar tendon integrity and knee soft tissue coverage in one stage. However, long term evidence of outcomes is lacking. This work analyses long term functional results, comparing subtotal and total reconstruction of patellar tendon, and respective function of the extensor apparatus.
https://ift.tt/2PLbCcW
Aerosol-related thermal injuries: a simple approach to managing a frosty problem.
Invented over 80 years ago, aerosol cans are now part of our everyday life. Body deodorants and air fresheners are readily available in any supermarket. Aerosol-related frostbites are being seen more often over last two decades and many cases are seen following deliberate self-harm from readily-available deodorant cans. 'Frosting is a practice increasingly seen in paediatric and adolescent patients.1 Although occasional aerosol-related frostbites have been reported widely, no treatment guidelines have been proposed to date.
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Cracking the Combination: Gut Hormones for the Treatment of Obesity and Diabetes
Abstract
Obesity and type 2 diabetes are a veritable global pandemic. There is an imperative to develop new therapies for these conditions that can be delivered at scale to patients, which deliver effective and titratable weight loss, amelioration of diabetes, prevention of diabetic complications and improvements in cardiovascular health. Although agents based on glucagon‐like peptide‐1 (GLP‐1) are now in routine use for diabetes and obesity, the limited efficacy of such drugs means that newer agents are required. By combining the effects of GLP‐1 with other gut and metabolic hormones such as glucagon (GCG), oxyntomodulin, glucose‐dependent insulinotropic peptide (GIP) and peptide YY, we may obtain improved weight loss, increased energy expenditure and improved metabolic profiles. Drugs based on dual agonism of GLP1R/GCGR and GLP1R/GIPR are being actively developed in clinical trials. Triple agonism, for example with GLPR1/GCGR/GIPR unimolecular agonists or using GLP‐1/oxyntomodulin/peptide YY, is also being explored. Multi‐agonist drugs seem set to deliver the next generation of therapies for diabetes and obesity soon.
This article is protected by copyright. All rights reserved.
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Gray matter differences associated with age and sex hormone levels between premenopausal and perimenopausal women, a voxel‐based morphometry study
Abstract
Purpose
To explore brain morphological alterations associated with age and sex hormone levels between premenopausal and perimenopausal women using magnetic resonance imaging (MRI) T1‐weighted structural images.
Materials and Methods
Thirty‐two premenopausal women with a mean age of 47.75 years (S.D. = 1.55 years) and twenty‐five recently perimenopausal women with a mean age of 51.60 years (S.D. = 1.63 years) were evaluated for sex hormone levels, including prolactin (PRL), follicle‐stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), free testosterone (free‐T), and progesterone (P). A 3.0 Tesla MRI scanner was utilized to acquire T1 images. Voxel‐based morphometry (VBM) was used to evaluate changes in gray matter volume between the two groups. The general linear model was applied with false discovery rate (FDR) correction for between group voxel‐wise statistics. Spearman partial correlation analyses were conducted between age, sex hormone levels and regions of gray matter volume showing significant differences between the two groups.
Results
Compared with premenopausal women, perimenopausal women showed decreased gray matter volume in the left putamen, right pallidum, right inferior parietal gyrus (IPG), right superior frontal gyrus (SFG) (orbital part) and right postcentral gyrus (PG) (p < 0.05, FDR corrected). The gray matter volume in the left putamen and right pallidum were negatively correlated with age among the 57 enrolled women. The levels of FSH and LH were positively correlated with gray matter volume changes in the right pallidum.
Conclusion
The VBM analysis revealed that age and menopause per se lead to gray matter volume reduction in certain brain structures. These structural changes might be potential causes of sexual dysfunction, nervous system degeneration and depression, which need to be examined in future studies. Our findings might provide evidence and guide future research in understanding the menopausal transition.
This article is protected by copyright. All rights reserved.
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Ghrelin receptor deletion reduces binge‐like alcohol drinking in rats
Abstract
Ghrelin is a gastric hormone that has been implicated in the neurobiology of alcohol drinking. We have recently developed a ghrelin receptor (GHSR) knockout (KO) rat model, which exhibits reduced food consumption and body weight. In addition, recent preliminary work suggests that the gut‐microbiome, which appears to interact with the ghrelin system, may modulate alcohol drinking. Here, we investigated the effects of GHSR deletion on alcohol consumption utilizing GHSR KO and wild type (WT) rats in three separate alcohol consumption paradigms: 1. operant self‐administration (30 min sessions); 2. drinking in the dark (DID; 4 h sessions); 3. intermittent access (24 h sessions). These paradigms model varying degrees of alcohol consumption. Furthermore, we sought to investigate the gut‐microbiome composition of GHSR KO and WT rats before and after alcohol exposure. We found that the GHSR KO rats self‐administered significantly less alcohol compared with WT rats in the operant paradigm, and consumed less alcohol than WT in the initial stages of the DID paradigm. No genotype differences were found in the intermittent access test. In addition, we found a significant decrease in gut‐microbial diversity after alcohol exposure in both genotypes. Thus, the present results indicate that the ghrelin system may be involved in drinking patterns that result in presumably increased alcohol exposure levels and that GHSR may constitute a potential pharmacological target for the reduction of binge‐alcohol consumption. The potential functional role of the gut‐microbiome in alcohol drinking, and interaction with the ghrelin system, is an interesting topic for further investigation.
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Cover Image, Volume 89, Issue 6
The cover image is based on the Original Article A dense mapping study of six European AITD susceptibility regions in a large Chinese Han Cohort of Graves' disease by Wei Liu et al., DOI: 10.1111/cen.13847. Design Credit: Qianyue Zhang.
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Ustekinumab use in patients with severe psoriasis co‐infected with hepatitis B and/or C
Abstract
Exacerbation or reactivation of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) in persons infected with psoriasis during treatment with biologics is a documented concern with use of tumor necrosis factor (TNF) inhibitors. Much less is known, however, about these risks in relation to newer biologic drugs including ustekinumab (interleukin (IL)‐12/23 inhibition).
This article is protected by copyright. All rights reserved.
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Publication date: September 2017 Source: Free Radical Biology and Medicine, Volume 110 Author(s): Lucía Fernández-del-Río, Anish Nag, Elen...
