Online education improves pediatric residents’ understanding of atopic dermatitis

Abstract

Background/Objectives

Pediatricians manage skin conditions such as atopic dermatitis (AD) but report that their dermatologic training is inadequate. Online modules may enhance medical education when sufficient didactic or clinical teaching experiences are lacking. We assessed whether an online module about AD improved pediatric residents' knowledge and changed their clinical management of AD.

Methods

Target and control cohorts of pediatric residents from two institutions were recruited. Target subjects took a 30-question test about AD early in their residency, reviewed the online module, and repeated the test 6 months and 1 year later. The control subjects, who had 1 year of clinical experience but had not reviewed the online module, also took the test. The mean percentage of correct answers was calculated and compared using two-sided, two-sample independent t tests and repeated-measures analysis of variance. For a subset of participants, clinical documentation from AD encounters was reviewed and 13 practice behaviors were compared using the Fisher exact test.

Results

Twenty-five subjects in the target cohort and 29 subjects in the control cohort completed the study. The target cohort improved from 18.0 ± 3.2 to 23.4 ± 3.4 correctly answered questions over 1 year (P < .001). This final value was greater than that of the control cohort (20.7 ± 4.5; P = .01). Meaningful differences in practice behaviors were not seen.

Conclusion

Pediatric residents who reviewed an online module about AD demonstrated statistically significant improvement in disease-specific knowledge over time and had statistically significantly higher scores than controls. Online dermatology education may effectively supplement traditional clinical teaching.

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Surgical treatment options following chemotherapy plus cetuximab or bevacizumab in metastatic colorectal cancer—central evaluation of FIRE-3

Publication date: January 2018
Source:European Journal of Cancer, Volume 88
Author(s): D.P. Modest, T. Denecke, J. Pratschke, I. Ricard, H. Lang, M. Bemelmans, T. Becker, M. Rentsch, D. Seehofer, C.J. Bruns, B. Gebauer, H.I. Modest, S. Held, G. Folprecht, V. Heinemann, U.P. Neumann
BackgroundThe FIRE-3 trial investigated combination chemotherapy plus either cetuximab or bevacizumab in patients with untreated metastatic colorectal cancer (mCRC) not scheduled for upfront surgery. We aimed to determine the number of patients who present with potentially resectable disease during systemic first-line therapy and to compare the findings with study reports concerning resections and outcome.Patients and methodsThis evaluation of 448 patients was performed as central review blinded for treatment, other reviewers' evaluations and conducted interventions. Resectability was defined if at least 50% of the reviewers recommended surgical-based intervention. Overall survival was assessed by Kaplan–Meier method.ResultsResectability increased from 22% (97/448) at baseline before treatment to 53% (238/448) at best response (P < 0.001), compared with an actual secondary resection rate for metastases of 16% (72/448). At baseline (23% versus 20%) and best response (53% versus 53%), potential resectability of metastases in this molecular unselected population was similar in cetuximab-treated patients versus bevacizumab-treated patients and not limited to patients with one-organ disease. The actual resection rate of metastases was significantly associated with treatment setting (P = 0.02; university hospital versus hospital/practice). Overall survival was 51.3 months (95% confidence interval [CI] 35.9–66.7) in patients with resectable disease who received surgery, 30.8 months (95% CI 26.6–34.9) in patients with resectable disease without surgery and 18.6 months (95% CI 15.8–21.3) in patients with unresectable disease (P < 0.001).ConclusionsOur findings illustrate the potential for conversion to resectability in mCRC, certain reluctance towards metastatic resections in clinical practice and the need for pre-planned and continuous evaluation for metastatic resection in high-volume centres.ClinicalTrials.gov-identifierNCT00433927.



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A case report of brown tumor in a patient with chronic renal failure and renal cell carcinoma

We report a case of a 72 year old male with hyperparathyroidism secondary to end stage diabetic renal disease and coexisting bilateral chromophobe renal cell carcinomas. The patient presented with back and groin pain, right pelvic hemorrhage, and multiple lytic bone lesions concerning for metastatic renal cell carcinoma. Fine needle aspiration cytology demonstrated benign appearing osteoclasts and spindled cells. A concurrent core biopsy showed foci of spindled cell proliferation populated by osteoclast-like giant cells with stromal hemorrhage without evidence of metastatic carcinoma. The cytologic and histologic findings, in correlation with the clinical history, radiographic features, markedly increased parathyroid hormone levels and other serologic studies, were diagnostic of the reactive lesion seen in brown tumor of hyperparathyroidism secondary to chronic renal failure.

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Functional implications of novel ADAM10 mutations in reticulate acropigmentation of Kitamura

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Induction of DNA double-strand breaks in human gingival fibroblasts by eluates from titanium dioxide modified glass ionomer cements

Publication date: Available online 27 November 2017
Source:Dental Materials
Author(s): Arunee Laiteerapong, Franz-Xaver Reichl, Yang Yang, Reinhard Hickel, Christof HÖgg
Objectives(1) To investigate the genotoxicity of a glass ionomer cement (GIC) and GIC incorporated with titanium dioxide nanopoarticle (TiO2NPs) and with microparticle (TiO2MPs) on DNA double-strand breaks of human gingival fibroblast cells (HGFs). (2) To compare the genotoxic differences between GIC and two modified cements.MethodsTiO2NPsGIC and TiO2MPsGIC were prepared by adding 10% w/w of TiO2NPs and TiO2MPs to the GIC powder and hand-mixed followed the manufacturer instruction. Dulbecco's Minimum Essential Medium (DMEM) was used as a culture medium for HGFs and eluate preparation. Eluates from all groups were collected for XTT cell viability assay to obtain EC50 values. γ-H2AX immunofluorescence assay was performed to detect DNA double-strand breaks (DSBs) of HGFs.ResultsEC50 values were from 38% to 60% and eluate concentrations at 20% and 5% were selected for γ-H2AX immunofluorescence assay. At both concentrations, HGFs exposed to eluates from all cements groups had fewer mean foci per cell and higher percentage of free foci cells than H2O2 (p<0.05). At 20% concentration, cells exposed to eluates from both TiO2NPsGIC and TiO2MPsGIC groups had fewer mean foci per cell and higher percentage of free foci cell than GIC and culture medium (p<0.05).SignificanceNeither GIC nor 10% TiO2-modified GICs had a genotoxic effect on HGFs. Both TiO2NPsGIC and TiO2MPsGIC demonstrated less genotoxic effect than GIC. When comparing between the two modified cements, there was no genotoxic difference between the modified cements from different particle sizes (nanoparticle and micro-particle) of TiO2.



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Bisphenol A release from an orthodontic resin composite: A GC/MS and LC/MS study

Publication date: Available online 26 November 2017
Source:Dental Materials
Author(s): Marc Deviot, Isabelle Lachaise, Christof Högg, Jürgen Durner, Franz-Xaver Reichl, Jean-Pierre Attal, Elisabeth Dursun
ObjectivesFirst, to analyse the in vitro release of BPA and Bis-GMA from an orthodontic resin composite (Transbond XT, 3M Unitek), stored in various conditions, by gas chromatography/mass spectrometry (GC/MS) and liquid chromatography/mass spectrometry (LC/MS); then to extrapolate the data to the clinical situation. Secondly, to explore the thermal stability of Bis-GMA.MethodsCylinders of resin composite were prepared and stored according to 3 different protocols: (1) they were light-cured 20s, then placed in artificial saliva; (2) they were light-cured 2s, then placed in acetonitrile; (3) they were light-cured 2s, then placed in methanol. For each group, BPA and Bis-GMA release were determined with GC/MS and/or LC/MS at least after one week. Besides, 120 brackets (10 of each type) were bonded over metal teeth, then debonded, and the weight and the surface of resin composite residues were measured. BPA and Bis-GMA release of adhesive residues were extrapolated from the data obtained with the cylinders. Besides, BPA release from a heated Bis-GMA solution was measured.ResultsWith GC/MC, BPA was detected in all samples. With LC/MS, BPA was detected only from samples immersed in MeOH; Bis-GMA was detected, in varying amount according to the extraction media and the light-curing time. BPA was found after heating of the Bis-GMA solution.SignificanceContamination risk and the heat applied in GC/MS may overestimate the BPA release from resin composite. Based on the LC/MS results, the risk of BPA release after orthodontic bonding would be more than 42000 times lower than the TDI for a 30-kg child.



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Using glass-graded zirconia to increase delamination growth resistance in porcelain/zirconia dental structures

Publication date: Available online 26 November 2017
Source:Dental Materials
Author(s): Herzl Chai, Adam J. Mieleszko, Stephen J. Chu, Yu Zhang
ObjectivePorcelain fused to zirconia (PFZ) restorations are widely used in prosthetic dentistry. However, their tendency to delaminate along the P/Z interface remains a practical problem so that assessing and improving the interfacial strength are important design aspects. This work examines the effect of modifying the zirconia veneering surface with an in-house felspathic glass on the interfacial fracture resistance of fused P/Z.MethodsThree material systems are studied: porcelain fused to zirconia (control) and porcelain fused to glass-graded zirconia with and without the presence of a glass interlayer. The specimens were loaded in a four-point-bend fixture with the porcelain veneer in tension. The evolution of damage is followed with the aid of a video camera. The interfacial fracture energy GC was determined with the aid of a FEA, taking into account the stress shielding effects due to the presence of adjacent channel cracks.ResultsSimilarly to a previous study on PFZ specimens, the fracture sequence consisted of unstable growth of channel cracks in the veneer followed by stable cracking along the P/Z interface. However, the value of GC for the graded zirconia was approximately 3 times that of the control zirconia, which is due to the good adhesion between porcelain and the glass network structure on the zirconia surface.SignificanceCombined with its improved bonding to resin-based cements, increased resistance to surface damage and good esthetic quality, graded zirconia emerges as a viable material concept for dental restorations.



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Effects of different sterilization methods on surface characteristics and biofilm formation on zirconia in vitro

Publication date: Available online 26 November 2017
Source:Dental Materials
Author(s): Aifang Han, James K.H. Tsoi, Jukka P. Matinlinna, Yu Zhang, Zhuofan Chen
ObjectiveThe current laboratory study was to investigate the effect of different sterilization treatments on surface characteristics of zirconia, and biofilm formation on zirconia surface after exposure to these sterilization treatments.MethodsCommercially available zirconia discs (Cerconbase, Degu-Dent, Hanau, Germany) were prepared and polished to the same value of surface roughness. The discs were treated with one of the following sterilization methods steam autoclave sterilization, dry heat sterilization, ultraviolet C (UVC) irradiation, and gamma (γ) ray irradiation. The characteristics of zirconia surfaces were evaluated by scanning electron microscopy (SEM), surface roughness, surface free energy (SFE), X-ray photoelectron spectroscopy (XPS), and X-ray diffraction (XRD) measurements. Then, Staphylococcus aureus (S.a.) and Porphyromonas gingivalis (P.g.) bacteria were used and cultured on the respective sterilized zirconia surfaces. The amount of biofilm formation on zirconia surface was quantified by colony forming unit (CFU) counts.ResultsSignificant modifications were detected on the colour and SFE of zirconia. The colour of zirconia samples after UVC irradiation became light yellow whilst dark brown colour was observed after gamma ray irradiation. Moreover, UVC and gamma ray irradiation increased the hydrophilicity of zirconia surface. Overall, dry heat sterilized samples showed the significantly lowest amount of bacteria growth on zirconia, while UVC and gamma ray irradiation resulted in the highest.SignificanceIt is evident that various sterilization methods could change the surface which contribute to different biofilm formation and colour on zirconia.



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Effect of tribochemical treatments and silane reactivity on resin bonding to zirconia

Publication date: Available online 26 November 2017
Source:Dental Materials
Author(s): Raphael Pilo, Maria Dimitriadi, Anna Palaghia, George Eliades
ObjectiveThe aim of the study was to assess the roughness, structure and bond strength with zirconia of four grit-blasting treatments combined with three silane types, the reactivity of which was evaluated, as well.MethodsThe grit-blasted treatments performed on zirconia (Lava) were alumina (ALU), CoJet (COJ), SilJet (SLJ) and SilJet Plus (SJP, with silica-encapsulated silane). The other two silanes selected were the S-Bond (SB, prehydrolyzed) and Clearfil Ceramic Primer Plus (CP, prehydrolyzed with 10-MDP). The activity of the silanols in the silanes was evaluated by FTIR spectroscopy. Optical profilometry and Raman microspectroscopy were used for the assessment of roughness (Sa, Sz, Sdr parameters) and structure (monoclinic volume-Vm) of zirconia, before (REF) and after grit-blasting, and a shear bond strength (SBS) with a flowable resin composite, for the investigation of the bonding capacity of the treatments.ResultsOnly SB demonstrated reactive silanols. CP and the SJP silanes were mostly in a polymerized siloxane state. Roughness was increased after grit-blasting as follows: ALU>SLJ,SJP>COJ>REF (Sa,Sz) and ALU>SLJ,COJ,SJP>REF (Sdr). ALU demonstrated the highest Vm (7.52%) from all other treatments (4.16–4.81%) and the REF (0%). COJ and SLJ showed the highest SBS (14–15.94MPa) regardless of the silane type used. SJP showed no significant differences from SLJ-SB and COJ-SB. Weibull analysis showed a reliability (β) ranking of COJ, SJP, SLJ, ALU-CP>ALU-SB>REF and a characteristic life (η) ranking of COJ, SLJ, ≥SLJ-SB, SJP, ALU≥ALU-SB,REF-CP>REF-SB.SignificanceThe reactivity of the silanes used showed great variations to support a predictable effect in all treatments. CP with deactivated silanols demonstrated a) the most reliable and strongest treatment with a silica-rich powder (COJ), despite the lowest Sa,Sz substrate values and b) high strength with a low-silica powder (SLJ) with higher Sa,Sz substrate values. Therefore, it may be concluded that 10-MDP greatly contributes to the bonding mechanism of the silane containing primers.



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The effect of chewing simulation on surface roughness of resin composite when opposed by zirconia ceramic and lithium disilicate ceramic

Publication date: Available online 27 November 2017
Source:Dental Materials
Author(s): Ting Khee Ho, Julian D. Satterthwaite, Nikolaos Silikas
ObjectiveTo assess the change in surface roughness of nanohybrid resin composite (Tetric EvoCeram) after antagonist wear against monolithic zirconia and lithium disilicate ceramics through a simulated chewing test using a three-dimensional (3D) profilometer.MethodsA total of 40 Tetric EvoCeram™ resin composite specimens against either a Lava™ Plus zirconia antagonist (n=20) or IPS e.max Press lithium disilicate antagonist (n=20) were prepared for the study. The surface roughness profiles of each resin composite before and after an in-vitro simulated chewing test were analysed using a 3D profilometer and Talymap software. After the simulated chewing, the surface profiles of representative Tetric EvoCeram specimens from each group were analysed using scanning electron microscopy. Independent t-test and paired t-test were used for statistical analysis.ResultsFor both lithium disilicate and zirconia groups, all surface roughness parameters (Ra, Rt, Sa, Sq,) of Tetric EvoCeram were significantly higher post-chewing compared to pre-chewing (p<0.05); the post-chewing surface roughness parameters of Tetric EvoCeram for the lithium disilicate group were significantly higher (p<0.05) than in the zirconia group.SignificanceThis chewing simulation test showed that Tetric EvoCeram composites exhibited a rougher surface when opposing lithium disilicate ceramic compared to opposing zirconia ceramic.



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Dentin bonding systems: From dentin collagen structure to bond preservation and clinical applications

Publication date: Available online 26 November 2017
Source:Dental Materials
Author(s): Lorenzo Breschi, Tatjana Maravic, Sandra Ribeiro Cunha, Allegra Comba, Milena Cadenaro, Leo Tjäderhane, David H. Pashley, Franklin R. Tay, Annalisa Mazzoni
ObjectivesEfforts towards achieving durable resin–dentin bonds have been made for decades, including the understanding of the mechanisms underlying hybrid layer (HL) degradation, manufacturing of improved adhesive systems, as well as developing strategies for the preservation of the HL.MethodsThis study critically discusses the available peer-reviewed research concerning the formation and preservation of the HL, the mechanisms that lead to the degradation of the HL as well as the strategies to prevent it.ResultsThe degradation of the HL occurs through two main mechanisms: the enzymatic degradation of its collagen fibrils, and the leaching of the resin from the HL. They are enabled by residual unbound water between the denuded collagen fibrils, trapped at the bottom of the HL. Consequently, endogenous dentinal enzymes, such as the matrix metalloproteinases (MMPs) and cysteine cathepsins are activated and can degrade the denuded collagen matrix. Strategies for the preservation of the HL over time have been developed, and they entail the removal of the unbound water from the gaps between the collagen fibrils as well as different modes of silencing endogenous enzymatic activity.SignificanceAlthough there are many more hurdles to be crossed in the field of adhesive dentistry, impressive progress has been achieved so far, and the vast amount of available research on the topic is an indicator of the importance of this matter and of the great efforts of researchers and dental material companies to reach a new level in the quality and longevity of resin–dentin bonds.



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Effect of titania content and biomimetic coating on the mechanical properties of the Y-TZP/TiO2 composite

Publication date: Available online 26 November 2017
Source:Dental Materials
Author(s): Ranulfo Benedito de Paula Miranda, Walter Gomes Miranda, Dolores Ribeiro Ricci Lazar, Valter Ussui, Juliana Marchi, Paulo Francisco Cesar
ObjectiveTo investigate the effect of titania addition (0, 10 and 30mol%) on the microstructure, relative density, Young's modulus (E), Poisson's ratio (υ), mechanical properties (flexural strength, σf, and Weibull modulus, m) of a Y-TZP/TiO2 composite. The effect of the presence of a biomimetic coating on the microstructure and mechanical properties was also evaluated.MethodsY-TZP (3mol% of yttria) and Y-TZP/TiO2 composite (10 or 30mol% of titania) were synthesized by co-precipitation. The powders were pressed and sintered at 1400°C/2h. The surfaces, with and without biomimetic coating, were characterized by X-ray diffraction analysis and scanning electron microscopy. The relative density was measured by the Archimedes' principle. E and υ were measured by ultrasonic pulse-echo method. For the mechanical properties the specimens (n=30 for each group) were tested in a universal testing machine.ResultsTitania addition increased the grain size of the composite and caused a significant decrease in the flexural strength (in MPa, control 815.4^a; T10 455.7^b and T30 336.0^c), E (in GPa, control 213.4^a; T10 155.8^b and T30 134.0^c) and relative density (control 99.0%^a; T10 94.4%^c and T30 96.3%^b) of the Y-TZP/TiO2 composite. The presence of 30% titania caused substantial increase in m and υ. Biomimetic coating did not affect the mechanical properties of the composite.SignificanceThe Y-TZP/TiO2 composite coated with a layer of CaP has great potential to be used as implant material. Although addition of titania affected the properties of the composite, the application of a biomimetic coating did not jeopardize its reliability.



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Cross-linking effect on dentin bond strength and MMPs activity

Publication date: Available online 24 November 2017
Source:Dental Materials
Author(s): Annalisa Mazzoni, Valeria Angeloni, Allegra Comba, Tatjana Maravic, Milena Cadenaro, Arzu Tezvergil-Mutluay, David H. Pashley, Franklin R. Tay, Lorenzo Breschi
ObjectiveThe objectives of the study were to evaluate the ability of a 1-ethyl-3 (3-dimethylaminopropyl) carbodiimide (EDC)-containing primer to improve immediate bond strength of either self-etch or etch-and-rinse adhesive systems and to stabilize the adhesive interfaces over time. A further objective was to investigate the effect of EDC on the dentinal MMPs activity using zymographic analysis.MethodsFreshly extracted molars (n=80, 20 for each group) were selected to conduct microtensile bond strength tests. The following groups were tested, immediately or after 1-year aging in artificial saliva: G1: Clearfil SE (CSE) primer applied on unetched dentin, pretreated with 0.3M EDC water-solution for 1min and bonded with CSE Bond; G2: as G1 but without EDC pre-treatment; G3: acid-etched (35% phosphoric-acid for 15s) dentin pretreated with 0.3M EDC, then bonded with XP Bond (XPB); Group 4 (G4): as G3 without EDC pre-treatment. Further, gelatinase activity in dentin powder treated with CSE and XPB with and without EDC pre-treatment, was analyzed using gelatin zymography.ResultsThe use of 0.3M EDC-containing conditioner did not affect the immediate bond strength of XPB or CSE adhesive systems (p>0.05), while it improved the bond strength after 1year of aging (p<0.05). Pre-treatment with EDC followed by the application of CSE resulted in an incomplete MMPs inactivation, while EDC pretreatment followed by the application of XPB resulted in an almost complete inactivation of dentinal gelatinases.SignificanceThe μTBS and zymography results support the efficacy of EDC over time and reveal that changes within the dentin matrix promoted by EDC are not adhesive-system-dependent.



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An interproximal model to determine the erosion-protective effect of calcium silicate, sodium phosphate, fluoride formulations

Publication date: Available online 24 November 2017
Source:Dental Materials
Author(s): Natalie J. Wood, Siân Bodfel Jones, Nick Chapman, Andrew Joiner, Carole J. Philpotts, Nicola X. West
ObjectivesPrevious work has shown the effectiveness of a newly developed interproximal model to differentiate between the amount of remineralization caused by toothpastes used with or without a dual-phase gel treatment system containing calcium silicate, sodium phosphate salts and fluoride to repair acid-softened enamel. The aim of this study was to utilize the same interproximal model to identify how effective calcium silicate phosphate toothpastes are at reducing surface softening in the early stages of erosion. The model was also used to identify the effect of increasing the frequency of acid exposure on the reduction in surface hardness.MethodsHuman enamel specimens were prepared and mounted in an interproximal face-to-face arrangement and exposed to a cycling regime of whole human saliva, treatment, artificial saliva and 1% citric acid pH 3.75. Specimens were measured by surface microhardness at baseline and after three and seven days. The frequency of acid exposure was increased from 2 to 4 cycles a day for the second part of the study.ResultsThe results showed that specimens treated with the calcium silicate phosphate toothpastes softened less than those treated with control fluoridated or non-fluoride toothpastes at each time point and following an increase in the frequency of acid exposure.SignificanceThis work has demonstrated how an interproximal model can also be successfully used to determine differences in the erosion protection of various treatments as well as determining how they perform when the frequency of acid exposure is increased.



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Mechanism of bioactive molecular extraction from mineralized dentin by calcium hydroxide and tricalcium silicate cement

Publication date: Available online 24 November 2017
Source:Dental Materials
Author(s): Xue-qing Huang, John Camba, Li-sha Gu, Brian E. Bergeron, Domenico Ricucci, David H. Pashley, Franklin R. Tay, Li-na Niu
ObjectivesThe objective of the present study was to elucidate the mechanism of bioactive molecule extraction from mineralized dentin by calcium hydroxide (Ca(OH)2) and tricalcium silicate cements (TSC).Methods and resultsTransmission electron microscopy was used to provide evidence for collagen degradation in dentin surfaces covered with Ca(OH)2 or a set, hydrated TSC for 1–3 months. A one micron thick collagen degradation zone was observed on the dentin surface. Fourier transform-infrared spectroscopy was used to identify increases in apatite/collagen ratio in dentin exposed to Ca(OH)2. Using three-point bending, dentin exposed to Ca(OH)2 exhibited significant reduction in flexural strength. Using size exclusion chromatography, it was found that the small size of the hydroxyl ions derived from Ca(OH)2 enabled those ions to infiltrate the intrafibrillar compartment of mineralized collagen and degrade the collagen fibrils without affecting the apatite minerals. Using ELISA, TGF-β1 was found to be extracted from dentin covered with Ca(OH)2 for 3 months. Unlike acids that dissolve the mineral component of dentin to release bioactive molecules, alkaline materials such as Ca(OH)2 or TSC released growth factors such as TGF-β1 via collagen degradation.SignificanceThe bioactive molecule extraction capacities of Ca(OH)2 and TSC render these dental materials excellent for pulp capping and endodontic regeneration. These highly desirable properties, however, appear to be intertwined with the untoward effect of degradation of the collagen matrix within mineralized dentin, resulting in reduced flexural strength.



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Hierarchical microcrack model for materials exemplified at enamel

Publication date: Available online 23 November 2017
Source:Dental Materials
Author(s): H. Özcoban, E.D. Yilmaz, G.A. Schneider
ObjectiveThis article investigates the mechanical properties of a material with hierarchically arranged microcracks.MethodsHierarchically structured biomaterials such as enamel exhibit superior mechanical properties as being stiff and damage tolerant at the same time. The common mechanical explanation for this behavior is based on the hierarchically structured arrangement of hard minerals and soft organics and their cooperative deformation mechanisms. In situ mechanical experiments with mm-sized bovine enamel bending bars an scanning electron microscope reveal that enamel is able to withstand mechanical loading even if it contains microcracks on different lengths scales. To clarify this issue an analytical hierarchical microcrack model of non-interacting cracks is presented.Results and SignificanceThe model predicts a decrease of the elastic modulus and the fracture strength with increasing levels of hierarchy. The fracture strain on the other hand may decrease or increase with the number of hierarchical levels, depending on the microcrack density. This simple hierarchical microcrack model is able to explain already published experiments with focused ion beam prepared μm-sized enamel cantilevers on different hierarchical levels. In addition it is shown that microcracking during loading in hierarchical materials may lead to substantial pseudoplastic behavior.



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Light irradiance through novel CAD–CAM block materials and degree of conversion of composite cements

Publication date: Available online 21 November 2017
Source:Dental Materials
Author(s): Diogo Pedrollo Lise, Annelies Van Ende, Jan De Munck, Kumiko Yoshihara, Noriyuki Nagaoka, Luiz Clovis Cardoso Vieira, Bart Van Meerbeek
ObjectiveTo assess light irradiance (LI) delivered by two light-curing units (LCU's) and to measure the degree of conversion (DC) of three composite cements, when cured through different thicknesses of two novel CAD–CAM block materials.Methods100-μm-thick films of a dual-curable composite cement (G-CEM LinkAce, GC), a light-curable flowable resin-based composite (RBC) (G-ænial Universal Flo, GC) and a micro-hybrid RBC (G-ænial Posterior, GC) were investigated as luting agents. Two 'polymer–ceramic' CAD–CAM blocks (Cerasmart, GC; Enamic, Vita Zahnfabrik) were sectioned in slabs with different thicknesses (1, 3 and 5mm). LI at the bottom of the specimens was measured using a calibrated spectrometer, while being light-cured through the CAD–CAM block slabs for 40s with a low- (±500mW/cm²) or high- (±1,600mW/cm²) irradiance LCU (n=5). After light-curing, micro-Raman spectra of the composite films were acquired to determine DC at 5min, 10min, 1h and 24h. LI data were statistically analyzed by Kruskal–Wallis followed by post-hoc comparisons, while a linear mixed-effect model was applied for the DC analysis. In addition, the CAD–CAM blocks ultrastructure was characterized upon argon-ion slicing using scanning transmission electron microscopy (STEM). Finally, light transmission (LT) through each CAD–CAM block material was assessed using a spectrophotometer.ResultsCuring-light attenuation and DC were significantly influenced by thickness and type of the overlying material. LCU only had a significant effect on DC of the micro-hybrid RBC. DC significantly increased over time for all composite cements. CAD–CAM block structural analysis revealed a relatively small and homogenous filler configuration (mean filler size of 0.2–0.5μm) for Cerasmart, while Enamic contained ceramic grains varying in shape and size (1–10μm), which were interconnected by the polymer-based network. LT was much higher at a wavelength range of 300–800nm for Cerasmart than for Enamic.SignificanceLight-curable composite cements can be cured through a restoration up to 2.7-mm thickness, depending on the kind of CAD–CAM material. A high-irradiance LCU only has a limited effect on the maximum thickness of the polymer–ceramic CAD–CAM material that can be cured through.



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Free flap reconstruction for trauma in the early post-partum period

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Rebecca A. Rollett, Helen E. Douglas, Philippa Jackson, Jonathan D. Wiper
We present the case of a patient who suffered significant polytrauma, fracturing her pelvis, femur and tibia and requiring emergency caesarian section of her 36-week old foetus. Forty eight hours later she underwent free flap reconstruction of her open tibial fracture. The issues involved in performing free flap surgery in the early postpartum period and specific surgical and pharmacological measures taken to overcome the physiological hypercoagulable state of post-partum patients are described along with a summary of the literature.



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Silicone lip implant for augmentation in cleft lip

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): A. Paddle, M. Wordsworth, D. Atherton
Patients with a history of cleft lip repaired in childhood commonly present requesting upper lip revision to improve deficiency in the volume of the upper lip vermillion and disharmony with respect to the volume of the lower lip. There are a number of techniques available to address this issue, however some of these carry the risk of potential donor site morbidity and the longevity of the volume of enhancement achieved is often unpredictable. We describe six successful cleft lip augmentation cases using a silicone lip implant, a technique only previously reported in the aesthetic augmentation population, and show how in the right patient, this can be a rewarding reconstructive option.



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Robotic nipple-sparing mastectomy with immediate reconstruction by robotically harvested latissimus dorsi muscle in a single position: cadaveric study

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Samuel Struk, Nicolas Leymarie, Jean-François Honart, Antoine Missistrano, Frédéric Kolb, Françoise Rimareix, Benjamin Sarfati




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Review of follow-up requirements of low-risk squamous cell carcinomas after surgical excision

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Priyanka Chadha, Nihull Jakharia-Shah, Jenny Geh




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Refining the cross-finger flap: considerations of flap insetting, aesthetics and donor site morbidity

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Chew-Wei Chong, Cheng-Hung Lin, Yu-Te Lin, Chung-Chen Hsu, Shih-Heng Chen
We described a laterally based cross-finger flap for reconstruction of soft tissue defects in the fingers. This modification enables coverage of volar or dorsal soft tissue defects at the distal, middle or proximal phalanx. From March 2015 to January 2017, a total of 12 patients (13 fingers) underwent soft tissue reconstruction of the fingers with a laterally based cross-finger flap. The flap dimensions ranged from 13 x 7 mm to 43 x 13 mm. Eleven of the 13 flaps survived completely. The two flap failures were attributed to injuries in the donor fingers, rendering the blood supply of the flaps unreliable. All donor sites were closed primarily without the need for skin grafting, negating the problem of donor site morbidity that is associated with skin graft harvesting. The laterally based cross-finger flap is a versatile flap with less donor site morbidity and better aesthetics than a conventional cross-finger flap. We described the design of the flap, as well as the advantages and disadvantages, in doing a laterally based cross-finger flap.



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Analysis of the Correlation between Deformational Plagiocephaly and Neurodevelopment delay: methodological issues

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Saeid Safiri, Salman Khazaei, Erfan Ayubi




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Long-term functional outcome in case series of tibial osteomyelitis reconstruction with free tissue transfer

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Keisuke Takanari, Kazuhiro Toriyama, Miki Kambe, Ryota Nakamura, Yutaka Nakamura, Hideyoshi Sato, Katsumi Ebisawa, Satoshi Tsukushi, Yoshihiro Nishida, Yuzuru Kamei




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Short correspondence: reverse lymphatic mapping without radioisotope in the surgical treatment of lymphedema

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Rachel E. Aliotta, Graham Schwarz




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Post-operative care of VRAM flaps for perineal reconstruction

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): David Boccara, Kevin Serror, Samuel Levy, Maurice Mimoun, Marc Chaouat




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The use of a ‘pocket’ printer to improve documentation and patient care

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): John A.G. Gibson, Thomas D. Dobbs, Emman J. Combellack, Iain S. Whitaker




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Spreader graft placement: location, location, location

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Marc A. Seifman, Andrew L. Greensmith




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Surgical-site infection following lymph node excision indicates susceptibility for lymphedema: a retrospective cohort study of malignant melanoma patients

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Mads Gustaf Jørgensen, Navid Mohamadpour Toyserkani, Jørn Bo Thomsen, Jens Ahm Sørensen
Background and ObjectivesCancer-related lymphedema is a common complication following lymph node excision. Prevention of lymphedema is essential, as treatment options are limited. Known risk factors are firmly anchored to the cancer treatment itself; however potentially preventable factors such as seroma and surgical-site infection (SSI) have yet to be asserted.MethodsAll malignant melanoma patients treated with sentinel lymph node biopsy (SNB) and/or complete lymph node dissection (CLND) in the axilla or groin between January 2008 and December 2014 were retrospectively identified. Identified patients were followed until March 2017 for the incidence of lymphedema.ResultsWe identified 70 cases of extremity lymphedema following 640 SNB/CLND. SSI was an independent risk factor for developing lymphedema (HR 8.46, 95%CI 4.37-16.36, p < 0.001), whilst seroma was an independent risk factor for developing SSI (OR 6.92, 95%CI 4.11-12.54, p < 0.001). In addition, the risk of lymphedema was significantly larger following inguinal incisions compared to axillary incisions (HR 2.49, 95%CI 1.36-4.55, p < 0.05).ConclusionSSI was the greatest independent risk factor for developing lymphedema. Additionally, patients' that developed postoperative seroma were at an increased risk of also developing SSI. Future studies should examine if lymphedema can be prevented, by reducing seroma and SSI.



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Analysis of the correlation between deformational plagiocephaly and neurodevelopment delay: methodological issues

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Mohammed Ahmed Hussein, Jinae Lee, Yong Oock Kim




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Bleeding on the cutting edge; a systematic review of anticoagulant and antiplatelet continuation in minor cutaneous surgery

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Alexander Isted, Lilli Cooper, R. James Colville
BackgroundAnticoagulant and antiplatelet (AC/AP) use is common and practice surrounding AC/AP continuation or cessation peri-operatively for minor cutaneous surgery lacks evidence-based consensus.ObjectiveTo determine the risks of haemorrhagic and thromboembolic complications associated with the continuation or cessation of AC/AP therapy in minor cutaneous surgery.MethodsA systematic literature search was conducted using PubMed, MEDLINE, Embase and CENTRAL, to identify all articles involving the use of AC/AP in patients undergoing minor cutaneous surgery, including skin grafts and local flaps. Eligible studies were randomised control trials, prospective studies and retrospective studies in the English language. Studies investigating free-flap repairs, oculoplastic surgery and hand surgery were excluded.Results30 studies included data from over 14,000 patients, of which more than 5,000 took regular AC/AP therapy. Thromboembolic events were rare but carry high morbidity and even mortality, and in these studies three events were associated with cessation of AC/AP. There was no increase in haemorrhagic complications in patients taking aspirin monotherapy, but evidence is conflicting regarding warfarin and clopidogrel monotherapy, which show a small increase in rate of bleeding complications. However, no increase in wound dehiscence, graft failure, wound infection or cosmetic outcome was seen. Too few studies investigated DOAC use to draw reliable conclusions. Data are sparse in comparing multiple versus single AC/AP regimens. Use of skin grafts or local flaps may have a greater complication rate than direct closure in patients on one or more AC/AP, but evidence is limited.ConclusionA case-by-case risk assessment is warranted in all patients but where possible, clinicians should prioritise meticulous haemostasis over cessation of agents.



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Immediate nipple reconstruction during skin-sparing mastectomy utilising the nipple sharing technique and harvesting the nipple graft from the mastectomy specimen

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Agata Plonczak, Demitrios J. Hadiminas, Francis P. Henry, Simon H. Wood




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Outcome measurement in plastic surgery

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Justin C.R. Wormald, Jeremy N. Rodrigues
Outcome measurement in plastic surgery is often surgeon-centred, and clinician-derived. Greater emphasis is being placed on patient-reported outcomes (PROs), in which the patient's perspective is measured directly from them. Numerous patient-reported outcome measures (PROMs) have been developed in a range of fields, with a number of good quality PROMs in plastic surgery. They can be deployed to support diagnosis, disease severity determination, referral pathways, treatment decision-making, post-operative care and in determining cost-effectiveness. In order to understand the impact of disease and health interventions, appropriate PROMs are a logical choice in plastic surgery, where many conditions involve detriment of function or cosmesis. PROMS can be classified as disease-specific, domain-specific, dimension-specific, population-specific and generic. Choosing the correct outcome and measure can be nebulous. The two most important considerations are: is it suitable for the intended purpose? and how valid is it? Measurement that combines being patient-centred and also aligns with clinicians' understanding is achievable, and can be studied scientifically. Rational design of new PROMs and considered choice of measures is critical in clinical practice and research. There are a number of tools that can be employed to assess the quality of PROMs that are outlined in this overview. Clinicians should consider the quality of measures both in their own practice and when critically appraising evidence. This overview of outcome measurement in plastic surgery provides a tool set enabling plastic surgeons to understand, implement and analyse outcome measures across clinical and academic practice.



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Aesthetic day surgery safety in a UK facility- a 4 year retrospective study and discussion of the literature

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): B. Strong, D. Sainsbury, P. Hodgkinson, M. Ragbir, N. Williams




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Sentinel node biopsy in desmoplastic thin melanoma: histogenetic reccomandations

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Pusiol Teresa




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A prospective, randomized-controlled pilot study comparing closed suction versus negative pressure drains for panniculectomy patients

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Marc E. Walker, Cynthia Tsay, P. Niclas Broer, Victor Z. Zhu, Tracy Sturrock, Reuben Ng, Leslie M. Scoutt, J. Grant Thomson, Stephanie L. Kwei




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Serial excision with power-stretching of the skin in giant melanocytic nevi therapy

Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Hans-Martin Häfner, Helmut Breuninger




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Injection Guide for Botulinum Toxin and Injectable Fillers

This article describes techniques for the cosmetic application of botulinum toxin and injectable fillers in the targeted treatment of the upper face.
Plastic and Reconstructive Surgery

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Image analysis of interarytenoid area to detect cases of Laryngopharyngeal Reflux: An objective method

Publication date: Available online 28 November 2017
Source:American Journal of Otolaryngology
Author(s): Anindya Nayak, Sunil Kumar, Rubeena Arora, Gautam Bir Singh
PurposeTo diagnose Laryngopharyngeal Reflux by observing colour (Red, Green, Blue) at the interarytenoid area during 70° laryngeal endoscopy.Materials and methodsEndoscopic images from 50 normal controls and 50 patients of LPR were obtained in this observational study. LPR patients were selected on the basis of RSI and RFS. Images were analysed using ImageJ, a free image analysis software, developed by the National Institute of Health (NIH). Colour changes in the form of RGB (red, green, blue) values were calculated and analysed at the interarytenoid area. The values in the normal and patient group were compared and correlated with RSI and RFS.ResultsRGB values of the LPR group and the normal group were statistically different (P value<0.01). Strong correlation was also found between R and G values and both RFS and RSI. However, no correlation was seen with B values.ConclusionImage analysis is an easy, economical and objective method to diagnose LPR.



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Letter to the editor

Publication date: Available online 28 November 2017
Source:American Journal of Otolaryngology
Author(s): Satvinder Singh Bakshi




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How to Write a Research Proposal in Vascular Surgery: The Basics and Details Not to Forget

Publication date: Available online 28 November 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Rodrigo Rial, Francisco J. Serrano




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Pretreatment C-reactive protein/albumin ratio is associated with poor survival in patients with stage IB-IIA cervical cancer

Abstract

Previous studies have shown that the C-reactive protein/albumin ratio (CAR) is a prognostic indicator in multiple types of carcinomas. This study is the first to evaluate the prognostic significance of CAR in stage IB-IIA cervical cancer patients treated with radical surgery, as well as that of several other inflammation-based factors, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and prognostic nutritional index (PNI). A total of 235 patients were enrolled in this study. The optimal cut-off values of CAR and other inflammation-based factors were determined by receiver operating characteristic curves. The Kaplan–Meier method and Cox regression model analysis were performed to determine the independent predictors of progression-free survival (PFS) and overall survival (OS). At a cut-off value of 0.15, patients with a high CAR had significantly shorter PFS and OS than those with a lower CAR (P < 0.001). A higher CAR was significantly associated with elevated scores of NLR and PLR and a decreased PNI (P < 0.001). Univariate analyses showed that elevated CAR preoperatively was significantly associated with poor survival; a similar trend was also noted for the NLR, PLR, and PNI. Multivariate analyses demonstrated that only CAR was an independent indicator for PFS (hazard ratio [HR]: 5.164; 95% confidence interval [CI]: 2.495–10.687; P < 0.001) and OS (HR: 4.729; 95% CI: 2.263–9.882; P < 0.001). In conclusion, preoperative CAR is a novel and superior predictor of poor survival in patients with stage IB-IIA cervical cancer.

This paper intends to elaborate the relationship between C-reactive protein/albumin ratio (CAR) and prognosis of stage IB-IIA cervical cancer and found that the preoperativeCAR is a novel and superior prognostic factor in stage IB-IIA cervical cancer patients who undergo radical hysterectomy.

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An investigation of survivorship clinic attendance among childhood cancer survivors living in a five-state rural region

Abstract

Purpose

Cancer survivorship clinics manage cancer-related health complications and are available primarily in urban areas. We examine how demographic, clinical, and geographic-based characteristics are associated with attendance at the only pediatric survivorship clinic in a largely rural, multistate region.

Methods

One thousand eight hundred sixteen cancer survivors were diagnosed at age ≤ 25 from 1986 to 2005 while living in the region. Cox models incorporating death as a competing risk and generalized estimating equations calculated hazards ratios (HR) for characteristics measured at the clinic's opening. Subjects were followed from the clinic opening their first visit, death, emigration from the catchment area, or December 31, 2014.

Results

Five percent of survivors visited the clinic. Attendance is positively associated with a leukemia or lymphoma diagnosis (HR = 3.32, 95% confidence interval [CI] = 1.72–6.78 vs CNS tumors), previous relapse (HR = 1.78, 95% CI = 1.00–3.19), and residing >100 mi from the clinic (HR = 2.05, 95% CI 1.03–4.10). Survivors aged ≥ 31 years at clinic opening (HR = 0.19, 95% CI = 0.07–0.54) are less likely to attend than younger survivors. Residence between 16 and 100 mi had an inverse association with attendance, although not significant.

Conclusion

Survivorship clinics are not widely attended by survivors in this catchment region. Efforts should be made to recruit survivors aged ≥ 31 and diagnosed with CNS tumors. Distance has a complex association with attendance, which could be attributed to the limited availability of preventative services in regions > 100 mi from the clinic.

Implications for Cancer Survivors

Survivors living in this catchment region may not be receiving care necessary to prevent severe late effects.

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Apigenin, by activating p53 and inhibiting STAT3, modulates the balance between pro-apoptotic and pro-survival pathways to induce PEL cell death

Apigenin is a flavonoid widely distributed in plant kingdom that exerts cytotoxic effects against a variety of solid and haematological cancers. In this study, we investigated the effect of apigenin against pr...

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ALX4, an epigenetically down regulated tumor suppressor, inhibits breast cancer progression by interfering Wnt/β-catenin pathway

ALX4 is a paired-like homedomain transcription factor mainly expressed in the mesenchymal compartment of variety of developing tissues, but its functions, regulation mechanisms and clinical values in breast ca...

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Drug repurposing for the treatment of glioblastoma multiforme

Glioblastoma Multiforme is the deadliest type of brain tumor and is characterized by very poor prognosis with a limited overall survival. Current optimal therapeutic approach has essentially remained unchanged...

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Site-specific selection reveals selective constraints and functionality of tumor somatic mtDNA mutations

Previous studies have indicated that tumor mitochondrial DNA (mtDNA) mutations are primarily shaped by relaxed negative selection, which is contradictory to the critical roles of mtDNA mutations in tumorigenes...

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Comparison of atopy patch testing to skin prick testing for diagnosing mite-induced atopic dermatitis: a systematic review and meta-analysis

Atopic dermatitis (AD) can occur after contact with aeroallergens like house dust mites, pollen, and animal dander. Despite its controversial diagnostic value, the atopy patch test (APT) has been used as an im...

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TEM8/ANTXR1-specific CAR T cells as a targeted therapy for triple-negative breast cancer

Triple-negative breast cancer (TNBC) is an aggressive disease lacking targeted therapy. In this study, we developed a CAR T cell-based immunotherapeutic strategy to target TEM8, a marker initially defined on endothelial cells in colon tumors that was discovered recently to be upregulated in TNBC. CAR T cells were developed that upon specific recognition of TEM8 secreted immunostimulatory cytokines and killed tumor endothelial cells as well as TEM8-positive TNBC cells. Notably, the TEM8 CAR T cells targeted breast cancer stem-like cells, offsetting the formation of mammospheres relative to non-transduced T cells. Adoptive transfer of TEM8 CAR T cells induced regression of established, localized patient-derived xenograft tumors (PDX) as well as lung metastatic TNBC cell line-derived xenograft tumors, by both killing TEM8+ TNBC tumor cells and targeting the tumor endothelium to block tumor neovascularization. Our findings offer a preclinical proof of concept for immunotherapeutic targeting of TEM8 as a strategy to treat TNBC.

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Gait performance and foot pressure distribution during wearable robot-assisted gait in elderly adults

A robotic exoskeleton device is an intelligent system designed to improve gait performance and quality of life for the wearer. Robotic technology has developed rapidly in recent years, and several robot-assist...

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-017-0333-z

Post-operative care of VRAM flaps for perineal reconstruction

Dear Editor,

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Aging of the bony orbit is a major cause of age-related intraorbital fat herniation

We evaluated the relationship between infraorbital fat herniation and age-related changes in the bony orbit and orbital fat density using computed tomography. Two hundred and sixty-five patients were enrolled (60 patients were evaluated for changes in the bony orbit and 205 for changes in orbital fat density). Five measurements using parasagittal sections and 1 measurement using three-dimensional images were obtained. Intraorbital fat herniation length was positively correlated with orbital rim inclination.

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A prospective, randomized-controlled pilot study comparing closed suction versus negative pressure drains for panniculectomy patients

Panniculectomy following massive weight loss has a reported complication rate of 31-76% with seroma formation 14-28%.(1) The authors performed a prospective, randomized study comparing seroma formation with standard bulb drains (BD) versus internal drains attached to continuous negative pressure (NP) following panniculectomy. NP drains were placed on continuous powered-suction at -125mmHg via Renasys*GO drain device (Smith&Nephew, Memphis,TN).

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Aesthetic day surgery safety in a UK facility- a 4 year retrospective study and discussion of the literature

Widespread uptake day case surgery has been relatively slow, with concerns about its safety, and perceived liability for complications should the patient be discharged "too soon". The literature has since demonstrated safety for select procedures, leading to an increase in day surgery popularity over the last 25 years1. Aesthetic day surgery procedures are widespread across the United States, where the healthcare system allows for practitioners to set up their own surgical facilities. Day surgery has benefits for both patients and providers in terms of convenience and financial burden.

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Updated anatomy of the buccal space and its implications for plastic, reconstructive and aesthetic procedures

The buccal space an integral deep facial space which is involved in a variety of intra- and extra-oral pathologies and provides a good location for the harvest of the facial artery. The age-related anatomy of this space was investigated and compared to previous reports.

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Immediate nipple reconstruction during skin-sparing mastectomy utilising the nipple sharing technique and harvesting the nipple graft from the mastectomy specimen

Nipple reconstruction is an integral part of the breast reconstructive process. Studies have described the positive psychological impact of nipple reconstruction as part of post-mastectomy breast reconstruction. Timing of nipple reconstruction does make a difference; it was shown that a longer interval between mound and nipple reconstruction decreases patient satisfaction1. Losken et al.2 demonstrated that the average time to completion of reconstruction was 12.25 months but this was significantly influenced by type of reconstruction and risk factors such as postoperative chemotherapy and radiation therapy.

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Surgical-site infection following lymph node excision indicates susceptibility for lymphedema: a retrospective cohort study of malignant melanoma patients

Cancer-related lymphedema is a common complication following lymph node excision. Prevention of lymphedema is essential, as treatment options are limited. Known risk factors are firmly anchored to the cancer treatment itself; however potentially preventable factors such as seroma and surgical-site infection (SSI) have yet to be asserted.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://www.jprasurg.com/article/S1748-6815(17)30492-8/fulltext?rss=yes

Serial excision with power-stretching of the skin in giant melanocytic nevi therapy

Giant Congenital Melanocytic Nevi (GCMN) are defined as being at least 20 centimetres in diameter in adulthood. Thus, for newborns, a GCMN is defined as being nine centimetres on the head and six centimetres on the trunk and extremities1. GCMN cause an aesthetic burden in affected children. Efficient treatment is controversial2. The main treatment options include serial resections, skin grafting/flaps or skin expander-techniques. Normally, they are used in children older than two years of age2. Because the skin of newborns and infants has a pronounced capacity to recover from trauma, we developed a surgical method that takes advantage of the high skin-elasticity and the small absolute size of GCMNs in very young children.

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Free flap reconstruction for trauma in the early post-partum period

We present the case of a patient who suffered significant polytrauma, fracturing her pelvis, femur and tibia and requiring emergency caesarian section of her 36-week old foetus. Forty eight hours later she underwent free flap reconstruction of her open tibial fracture. The issues involved in performing free flap surgery in the early postpartum period and specific surgical and pharmacological measures taken to overcome the physiological hypercoagulable state of post-partum patients are described along with a summary of the literature.

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Split-sciatic Nerve surgery: a new microsurgical model in experimental nerve repair

Sciatic experimental surgery in rat often leads to hindlimb autophagy, with considerable ethical and research issues. In this work, the distal part of the sciatic nerve was split following the natural bifurcation between tibial and peroneal branches, before applying regenerative stem cells in a fibrin conduit on the peroneal segment.The new microsurgical model was tested in terms of animal morbidity and consistency of research outcomes, particularly comparing to the standard total sciatic axotomy procedure.

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Bleeding on the cutting edge; a systematic review of anticoagulant and antiplatelet continuation in minor cutaneous surgery

Anticoagulant and antiplatelet (AC/AP) use is common and practice surrounding AC/AP continuation or cessation peri-operatively for minor cutaneous surgery lacks evidence-based consensus.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://www.jprasurg.com/article/S1748-6815(17)30490-4/fulltext?rss=yes

Liposuction as an effective treatment for lower extremity lymphoedema: a single surgeon's experience over nine years

Lymphoedema is a chronic, debilitating condition caused by a compromised lymphatic system. In recent years, the success of treating upper extremity lymphoedema with liposuction has been translated to patients with lower extremity lymphoedema (LEL), yet there remains a paucity of clinical evidence firmly supporting its use within this patient group.

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Robotic nipple-sparing mastectomy with immediate reconstruction by robotically harvested latissimus dorsi muscle in a single position: cadaveric study

Dear Editor,

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Refining the cross-finger flap: considerations of flap insetting, aesthetics and donor site morbidity

We described a laterally based cross-finger flap for reconstruction of soft tissue defects in the fingers. This modification enables coverage of volar or dorsal soft tissue defects at the distal, middle or proximal phalanx. From March 2015 to January 2017, a total of 12 patients (13 fingers) underwent soft tissue reconstruction of the fingers with a laterally based cross-finger flap. The flap dimensions ranged from 13 x 7 mm to 43 x 13 mm. Eleven of the 13 flaps survived completely. The two flap failures were attributed to injuries in the donor fingers, rendering the blood supply of the flaps unreliable.

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Long-term functional outcome in case series of tibial osteomyelitis reconstruction with free tissue transfer

Dear Sir,

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Sentinel node biopsy in desmoplastic thin melanoma: histogenetic reccomandations

Dunne et al have performed a full systematic literature review of sentinel lymph node biopsy (SLNB) in patients affected by desmoplastic melanoma (DM). Sixteen studies were included in the review and 1519 patients with SLNB were identified with nodal positivity in 99 cases (65%). Instead, the number of SLNB in desmoplastic thin melanoma (DTM) has been not reported. The authors believe that further research should be undertaken to establish if all patients with DTM should be offered SLNB based on stratification using clinico-pathological features (1).

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The use of a ‘pocket’ printer to improve documentation and patient care

Photography provides an unsurpassed method of communicating accurate visual pathologies to both patients and colleagues1. It has become the standard of practice for documenting pre-operative, operative and post-operative clinical findings in a number of medical specialities, including Plastic and Reconstructive Surgery. In some areas of the World, electronic notes systems are commonly used to incorporate photographs and to create clinical letters, however in our experience this is not the norm. Digital technology has revolutionised photography, simplifying the process of capturing and recording images.

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Short correspondence: reverse lymphatic mapping without radioisotope in the surgical treatment of lymphedema

Lymphatic mapping of the extremity using lymphoscintigraphy incorporates injection of radioisotope (technetium) into the web space of the hand or foot to assess lymphatic transit and drainage pathways. Reverse lymphatic mapping (RLM), a technique originally described for selective axillary lymphadenectomy in cancer and subsequently adopted for vascularized lymph node transfer procedures, utilizes a dual tracer approach to delineate lymphatic drainage pathways from individual anatomic regions in order to reduce incidence of iatrogenic lymphedema (1-2).

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Analysis of the correlation between deformational plagiocephaly and neurodevelopment delay: methodological issues

Dear editors

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Letter to the editor

This is in reference to a very well written article titled 'Effects of surgical treatment of hypertrophic turbinates on the nasal obstruction and the quality of life' by Katharina Stölzel et al. [1]. The study has been well planned and tackles an important and clinically relevant condition, namely inferior turbinate hypertrophy. However there are some concerns regarding the methodology which I would like to bring out.

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Image analysis of interarytenoid area to detect cases of Laryngopharyngeal Reflux: An objective method

To diagnose Laryngopharyngeal Reflux by observing colour (Red, Green, Blue) at the interarytenoid area during 70° laryngeal endoscopy.

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Prevalence and Progression Rate of Diabetic Retinopathy in Type 2 Diabetes Patients in Correlation with the Duration of Diabetes

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-120570

Aims We examined prevalence and progression of retinopathy in dependence on diabetes duration in order to estimate the probability of progression. Patients/Methods In a retrospective cohort-analysis from an academic outpatient department of endocrinology and metabolic diseases we analyzed 17461 consultations of 4513 patients with DM2 from 1987 to 2014. 50.3% of the patients (n=2272) had at least one documented result of funduscopy. Results 25.8% of the patients had retinopathy (20.2% non-proliferative, 4.7% proliferative, 0.7% were not classified, 0.1% blindness). The prevalence of retinopathy in dependence on diabetes duration was 1.1% at diagnosis, 6.6% after 0<5 years, 12% after 5<10 years, 24% after 10<15 years, 39.9% after 15<20 years, 52.7% after 20<25 years, 58.7% after 25<30 years and 63% after ≥30 years. In a subset of 586 (25.7%) patients with retinal photography of 3 consecutive years 7.0% showed deterioration after one and 12.2% after two years; 2.6% improved after one and 2.8% after two years. 201 (34.3%) of this group had<10 years diabetes and lower deterioration (4.5% worsened after one and 9.5% after two years). Their retinopathy mainly transformed from no retinopathy to non-proliferative. Four patients (2.0%) developed proliferative retinopathy. Conclusions/Interpretations Within the first 10 years of diabetes duration, the prevalence of retinopathy is low and the progression infrequent. Most patients have a non-proliferative form which can be reversible and rarely requires interventions. Patients with DM2 without retinopathy and good glycaemic control do not run into additional risk from expanding funduscopy intervals to biennial.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

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Relation of Carotid Artery Plaque to Coronary Heart Disease and Stroke in Chinese Patients: Does Hyperglycemia Status Matter?

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0042-124420

Objective To examine the association of carotid artery plaque with the incident coronary heart disease and stroke events in Chinese patients and explore whether the association differs between patients with and without hyperglycemia. Methods We evaluated plaque, and blood pressure, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting serum insulin, fasting plasma glucose, 2 h postprandial glucose and Homeostasis model assessment of insulin resistance in 253 Chinese patients. T-test and X2 test were used to compare the clinical characteristics and Binary logistic regression was applied to analyze the association of coronary heart disease and stroke between patients with and without hyperglycemia. Results Among 253 patients, 162 patients had hyperglycemia (i. e., diabetes, impaired glucose regulation and stress induced hyperglycemia) and 155 (61.3%) patients had plaque. Fasting plasma glucose, 2 h postprandial glucose and Homeostasis model assessment of insulin resistance, triglycerides, plaque were significantly higher in the hyperglycemia group than non-hyperglycemia. The incident coronary heart disease and stroke events in patients with plaque were 2.254 (95%CI,1.203–4.224) and 2.437 (95%CI,1.042–5.701) times higher than those without plaque, respectively. Among hyperglycemia subgroup, plaque was an independent risk factor for coronary heart disease (OR,3.075,95%CI,1.353–6.992) and stroke (OR,3.571,95%CI,1.460–8.737). The slopes (associations between coronary heart disease/stroke and plaque) were steeper in the hyperglycemia group than those in the non-hyperglycemia group (coronary heart disease OR,3.075 vs. 2.614; stroke OR,3.571 vs. 3.307). Conclusions The incident coronary heart disease and stroke events in patients with plaque were higher than those without plaque, and this difference was more pronounced for patients with hyperglycemia vs. those without hyperglycemia.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

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Monogenic Diabetes Not Caused By Mutations in Mody Genes: A Very Heterogenous Group of Diabetes

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-120571

Monogenic diabetes represents a heterogeneous group of disorders resulting from a single gene defect leading to disruption of insulin secretion or a reduction in the number of beta cells. Despite the classification of monogenic diabetes into neonatal diabetes or maturity onset diabetes of the young (MODY) according to age of onset, not every case can be classified into those 2 groups. We evaluated patients with monogenic diabetes diagnosed during the last 10 year period. Type 1 DM, MODY, and patients with negative autoantibodies and no mutation in a known gene were excluded from the study. Thirteen patients were diagnosed with monogenic diabetes in Department of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey. Five of them were diagnosed after 6 months of age. Five had a KATP channel defect. Mutations in genes resulting in destruction of beta cells were detected in 7 patients, with 4 cases having a WFS, 2 an LRBA, and one a IL2RA mutation. Additional systemic findings were seen in 6/13 patients, with 5/6 having severe immune system dysfunction. Treatment with sulphonylurea was successful in two patients.. The other patients were given insulin in differing doses. Four patients died during follow-up, three of which had immune system dysfunction. Monogenic diabetes can be diagnosed after 6 months of age, even with positive autoantibodies. Immune dysfunction was a common feature in our cohort and should be investigated in all patients with early-onset monogenic diabetes. Mortality of patients with monogenic diabetes and additional autoimmunity was high in our cohort and is likely to reflect the multisystem nature of these diseases.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

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Impact of robust treatment planning on single- and multi-field optimized plans for proton beam therapy of unilateral head and neck target volumes

Proton beam therapy is promising for the treatment of head and neck cancer (HNC), but it is sensitive to uncertainties in patient positioning and particle range. Studies have shown that the planning target vol...

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Unconscious physiological response of healthy volunteers to dynamic respiration-synchronized couch motion

Intrafractional motion can be a substantial uncertainty in precision radiotherapy. Conventionally, the target volume is expanded to account for the motion. Couch-tracking is an alternative, where the patient i...

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Leaflets and continual educational offerings led to increased coverage rate of newborn hearing screening in Akita

Newborn hearing screening (NHS) has been actively performed in Japan since 2001. The NHS coverage rate has increased each year in Akita Prefecture. We analyzed the details of the NHS program and how the Akita leaflets and the many educational offerings about the importance of NHS led to the high NHS coverage rate.

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Marriage and risk of dementia: systematic review and meta-analysis of observational studies

You don't have to be demented to be married, but it sure helps

This JNNP meta-analysis, which included 15 studies with 812 047 participants, showed an elevated dementia risk in lifelong single (42%) and widowed (20%) but not divorced persons compared with those who were married1. Although one study from Sweden contributed the vast majority (92%) of participants, the other studies were also broadly in agreement and, importantly, came from a wide range of countries across the world: Europe (France, Germany, Italy, Sweden), North and South America (Brazil, USA) and Asia (China, Japan, South Korea, Taiwan). Furthermore, the robustness of the association was shown by sensitivity analyses for demographic factors (sex, whether study subjects were born before or after 1927) and study methodology (type, quality). However, the association with dementia subtypes was not significant likely due to the much smaller number of participants in the studies that reported these outcomes....

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Marriage and risk of dementia: systematic review and meta-analysis of observational studies

Background

Being married is associated with healthier lifestyle behaviours and lower mortality and may reduce risk for dementia due to life-course factors. We conducted a systematic review and meta-analysis of studies of the association between marital status and the risk of developing dementia.

Methods

We searched medical databases and contacted experts in the field for relevant studies reporting the relationship, adjusted for age and sex, between marital status and dementia. We rated methodological quality and conducted random-effects meta-analyses to summarise relative risks of being widowed, divorced or lifelong single, compared with being married. Secondary stratified analyses with meta-regression examined the impact of clinical and social context and study methodology on findings.

Results

We included 15 studies with 812 047 participants. Compared with those who are married, lifelong single (relative risk=1.42 (95% CI 1.07 to 1.90)) and widowed (1.20 (1.02 to 1.41)) people have elevated risk of dementia. We did not find an association in divorced people.

Further analyses showed that less education partially confounds the risk in widowhood and worse physical health the elevated risk in lifelong single people. Compared with studies that used clinical registers for ascertaining dementia diagnoses, those which clinically examined all participants found higher risk for being unmarried.

Conclusions

Being married is associated with reduced risk of dementia than widowed and lifelong single people, who are also underdiagnosed in routine clinical practice. Dementia prevention in unmarried people should focus on education and physical health and should consider the possible effect of social engagement as a modifiable risk factor.

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Impact of tumour histology on survival in advanced cervical carcinoma: an NRG Oncology/Gynaecologic Oncology Group Study

Impact of tumour histology on survival in advanced cervical carcinoma: an NRG Oncology/Gynaecologic Oncology Group Study

Impact of tumour histology on survival in advanced cervical carcinoma: an NRG Oncology/Gynaecologic Oncology Group Study, Published online: 28 November 2017; doi:10.1038/bjc.2017.400

Impact of tumour histology on survival in advanced cervical carcinoma: an NRG Oncology/Gynaecologic Oncology Group Study

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Variation in ‘fast-track’ referrals for suspected cancer by patient characteristic and cancer diagnosis: evidence from 670 000 patients with cancers of 35 different sites

Variation in 'fast-track' referrals for suspected cancer by patient characteristic and cancer diagnosis: evidence from 670 000 patients with cancers of 35 different sites

Variation in 'fast-track' referrals for suspected cancer by patient characteristic and cancer diagnosis: evidence from 670 000 patients with cancers of 35 different sites, Published online: 28 November 2017; doi:10.1038/bjc.2017.381

Variation in 'fast-track' referrals for suspected cancer by patient characteristic and cancer diagnosis: evidence from 670 000 patients with cancers of 35 different sites

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Citation for the 2016 Down Surgical Prize – Michael Thomas Simpson

I am honoured to give the supporting citation for Michael Thomas Simpson for the 2016 BAOMS Downs Prize. The Prize is awarded to a colleague for outstanding services to Oral and Maxillofacial Surgery throughout his or her career. While it is impossible to do justice to a lifetime of service in a few minutes, I hope to show you why Mike is a worthy recipient of the Downs Prize.

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ASPS/PSF Sponsored Symposia and Workshops

No abstract available

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The Impact of Two Operating Surgeons on Microsurgical Breast Reconstruction

No abstract available

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Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits

Background: Acellular dermal matrix has gained widespread acceptance in immediate expander/implant reconstruction because of perceived benefits, including improved expansion dynamics and superior aesthetic results. Although previous investigators have evaluated its risks, few studies have assessed the impact of acellular dermal matrix on other outcomes, including patient-reported measures. Methods: The Mastectomy Reconstruction Outcomes Consortium Study used a prospective cohort design to evaluate patients undergoing postmastectomy reconstruction from 10 centers and 58 participating surgeons between 2012 and 2015. The analysis focused on women undergoing immediate tissue expander reconstruction following mastectomies for cancer treatment or prophylaxis. Medical records and patient-reported outcome data, using the BREAST-Q and Numeric Pain Rating Scale instruments, were reviewed. Bivariate analyses and mixed-effects regression models were applied. Results: A total of 1297 patients were evaluated, including 655 (50.5 percent) with acellular dermal matrix and 642 (49.5 percent) without acellular dermal matrix. Controlling for demographic and clinical covariates, no significant differences were seen between acellular dermal matrix and non–acellular dermal matrix cohorts in overall complications (OR, 1.21; p = 0.263), major complications (OR, 1.43; p = 0.052), wound infections (OR, 1.49; p = 0.118), or reconstructive failures (OR, 1.55; p = 0.089) at 2 years after reconstruction. There were also no significant differences between the cohorts in the time to expander/implant exchange (p = 0.78). No significant differences were observed in patient-reported outcome scores, including satisfaction with breasts, psychosocial well-being, sexual well-being, physical well-being, and postoperative pain. Conclusions: In this multicenter, prospective analysis, the authors found no significant acellular dermal matrix effects on complications, time to exchange, or patient-reported outcome in immediate expander/implant breast reconstruction. Further studies are needed to develop criteria for more selective use of acellular dermal matrix in these patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

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Application of Posterior Thigh Three-Dimensional Profunda Artery Perforator Perforasomes in Refining Next-Generation Flap Designs: Transverse, Vertical, and S-Shaped Profunda Artery Perforator Flaps

No abstract available

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Clinical and Quantitative Isokinetic Comparison of Abdominal Morbidity and Dynamics following DIEP versus Muscle-Sparing Free TRAM Flap Breast Reconstruction

Background: The deep inferior epigastric perforator (DIEP) flap, which is a modification of the muscle-sparing free transverse rectus abdominis musculocutaneous (TRAM) flap, is being more frequently used in an effort to reduce postoperative abdominal morbidity. However, there is no consensus as to which of these flaps is superior. The authors aimed to compare quantitative measurements of abdominal function obtained with an isokinetic dynamometer after DIEP and muscle-sparing free TRAM flap elevation. Methods: Patients who underwent unilateral single-pedicled DIEP (n = 42) or muscle-sparing free TRAM flap (n = 36) breast reconstruction performed by a single surgeon were included in this study. Preoperative and postoperative trunk flexion parameters were measured prospectively using an isokinetic dynamometer in all patients. The occurrence of postoperative pain, stiffness, and bulging along with patient activity level were also investigated. Results: At 3 months postoperatively, abdominal functions were decreased in both groups, with a larger decline in the muscle-sparing free TRAM flap group. However, at 6 months postoperatively, abdominal muscle function recovered to preoperative levels in both groups. These findings were consistent with the absence of a statistically significant difference in patient postoperative abdominal pain and stiffness, activity level, and the incidence of bulging between the two groups at 6 months postoperatively. Conclusion: From these results, we propose that the surgeon can select the muscle-sparing free TRAM flap, without hesitation or concern regarding abdominal morbidity, when a thick and reliable perforator does not exist and multiple thin perforators must be incorporated. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Primary Septal Cartilage Graft for the Unilateral Cleft Rhinoplasty

No abstract available

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Revisiting the Fundamental Operative Principles of Plastic Surgery

No abstract available

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Discussion: Revisiting the Abdominal Donor Site Introducing a Novel Nomenclature for Autologous Breast Reconstruction

No abstract available

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Reply: Direct-to-Implant Breast Reconstruction without the Use of an Acellular Dermal Matrix Is Cost Effective and Oncologically Safe

No abstract available

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The Impact of Autologous Breast Reconstruction on Body Mass Index Patterns in Breast Cancer Patients: A Propensity-Matched Analysis

Background: Weight gain is common in breast cancer patients and increases the risk of recurrence and mortality. The authors assessed the impact of autologous breast reconstruction on body mass index patterns after diagnosis in mastectomy patients. Methods: Women undergoing therapeutic mastectomy at the authors' institution from 2008 to 2010 were identified. Patients undergoing no breast reconstruction or autologous breast reconstruction were propensity-matched by age at diagnosis, baseline obesity, mastectomy laterality, and adjuvant therapies. Multivariable regression was used to estimate covariate associations with percentage body mass index change and percentage body mass index change greater than 5.0 percent at 1 to 4 years after diagnosis. Results: Of 524 total patients, 80 propensity-matched pairs were identified. In multivariable regression, women undergoing immediate autologous breast reconstruction had reduced body mass index changes after diagnosis, compared with nonreconstruction patients, at 1 year (β = −5.25 percent; p

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Why Women Request Labiaplasty

No abstract available

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Evidence-Based Performance Measures: Quality Metrics for the Care of Patients Undergoing Breast Reconstruction

Summary: The American Society of Plastic Surgeons commissioned the Breast Reconstruction Performance Measure Development Work Group to identify and draft quality measures for the care of patients undergoing breast reconstruction surgery. Two outcome measures were identified. The first desired outcome was to reduce the number of returns to the operating room following reconstruction within 60 days of the initial reconstructive procedure. The second desired outcome was to reduce flap loss within 30 days of the initial reconstructive procedure. All measures in this report were approved by the American Society of Plastic Surgeons Breast Reconstruction Performance Measures Work Group and the American Society of Plastic Surgeons Executive Committee. The Work Group recommends the use of these measures for quality initiatives, Continuing Medical Education, Maintenance of Certification, American Society of Plastic Surgeons' Qualified Clinical Data Registry reporting, and national quality reporting programs.

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Reply: Simplifying the Forehead Flap for Nasal Reconstruction A Review of 420 Consecutive Cases

No abstract available

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Prospective Controlled Study of Chin Augmentation by Means of Fat Grafting

Background: Although fat grafting is a valuable tool for different areas of plastic surgery, its use in the chin area has never been evaluated. A variety of methods are available for adjusting suboptimal chin morphology, and they each present drawbacks. Methods: A prospective controlled study was performed to evaluate whether fat grafting increases the chin volume and sagittal projection and to determine the magnitude and nature of the observed changes. Forty-two consecutive patients underwent chin augmentation by means of fat grafting between October of 2014 and January of 2016. All patient images were analyzed using a software program (Fiji package of ImageJ), which creates a three-dimensional version of the chin that is used to produce reliable estimates of the volume and gain in sagittal projection. Results: All 42 patients showed an increase in the sagittal projection and total volume at 4 weeks and 6 months after surgery. The sagittal projection increased from 4 mm to 12 mm (average, 8.9 mm) and from 3 mm to 11 mm (average, 7 mm) after 4 weeks and 6 months, respectively. The total volume increase ranged from 3 to 11 ml (average, 8 ml) after 4 weeks and from 3 to 8 ml (average, 7.4 ml) after 6 months. Conclusion: Fat grafting to the chin area is a reliable method for improving chin volumes (to a maximum of approximately 10 cc in our study) and sagittal projections (to a maximum of approximately 11 mm in our study). CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Trends and Predictors of National Institutes of Health Funding to Plastic Surgery Residency Programs

Background: Recent studies have demonstrated low levels of National Institutes of Health funding for surgical research. The authors compared the funding in plastic surgery with the funding for other surgical specialties. Methods: A query of National Institutes of Health grants awarded to departments of surgical specialties was performed using the National Institutes of Health RePORTER database (2008 to 2016). Trends in funding were compared by specialty and adjusted for the number of active physicians in each specialty. Plastic surgery residency program characteristics were correlated with funding procurement. Results: Eight hundred eighty-nine faculty at 94 plastic surgery residency programs were queried. Forty-eight investigators (5.4 percent) at 23 programs (24.4 percent) had National Institutes of Health funding. From 2008 to 2016, a total of $84,142,138 was awarded through 81 grants. Funding supported translational (44.6 percent), clinical (26.4 percent), basic science (27.2 percent), and educational (1.7 percent) research. In 2016, plastic surgery received the least amount of National Institutes of Health funding per active physician ($1,530) relative to orthopedic surgery ($3124), obstetrics and gynecology ($3885), urology ($5943), otolaryngology ($9999), general surgery ($11,649), ophthalmology ($11,933), and neurologic surgery ($20,874). Plastic surgery residency program characteristics associated with National Institutes of Health funding were high ranking and had more than 10 clinical faculty (p

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Mentor Contour Profile Gel Implants: Clinical Outcomes at 10 Years

Background: Contour Profile Gel/MemoryShape breast implants consist of a textured silicone elastomer shell filled with silicone gel. The objective of this clinical study was to assess the safety and effectiveness of Contour Profile Gel/MemoryShape breast implants in women who were undergoing primary breast augmentation, primary breast reconstruction, or revision surgery (revision-augmentation or revision-reconstruction). Methods: This was a prospective, open-label, multicenter clinical study involving Contour Profile Gel/MemoryShape breast implants in 955 female subjects, including 572 primary augmentation, 124 revision-augmentation, 190 primary reconstruction, and 69 revision-reconstruction subjects. Safety was assessed based on the incidence, severity, and method of resolution of all complications. Endpoints were examined on both a per-subject and a per-implant basis. Results: For the primary augmentation, revision-augmentation, primary reconstruction, and revision-reconstruction cohorts, the Kaplan-Meier estimated 10-year cumulative incidence rates for the key complications at the subject level were as follows: Baker grade III/IV capsular contracture, 3.6 (primary augmentation), 15.5 (revision-augmentation), 14.3 (primary reconstruction), and 16.4 (revision-reconstruction) percent; infection, 0.7 (primary augmentation), 1.9 (revision-augmentation), 1.6 (primary reconstruction), and 2.9 (revision-reconstruction) percent; explantation with or without replacement, 9.2 (primary augmentation), 25.9 (revision-augmentation), 34.1 (primary reconstruction), and 49.0 (revision-reconstruction) percent; explantation with replacement with study device, 4.0 (primary augmentation), 10.8 (revision-augmentation), 16.7 (primary reconstruction), and 27.9 (revision-reconstruction) percent; and any reoperation, 22.3 (primary augmentation), 35.0 (revision-augmentation), 52.7 (primary reconstruction), and 59.7 (revision-reconstruction) percent. Conclusion: The results of this study demonstrate that Contour Profile Gel/MemoryShape breast implants are safe and effective for primary and revision breast augmentation and reconstruction for women at least 22 years old.

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Orthognathic Surgery: Principles, Planning and Practice

No abstract available

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Prospective, Double-Blind Evaluation of Umbilicoplasty Techniques Using Conventional and Crowdsourcing Methods

Background: Umbilical reconstruction is an important component of deep inferior epigastric perforator (DIEP) flap breast reconstruction. This study evaluated the aesthetics of three different umbilical reconstruction techniques during DIEP flap breast reconstruction. Methods: From January to April of 2013, a total of 29 consecutive patients undergoing DIEP flap breast reconstruction were randomized intraoperatively to receive one of three umbilicoplasty types: a diamond, an oval, or an inverted V incision. Independent plastic surgeons and members of the general public, identified using an online "crowdsourcing" platform, evaluated aesthetic outcomes in a blinded fashion. Reviewers were shown postoperative photographs of the umbilicus of all patients and a four-point Likert scale was used to rate the new umbilicus on the size, scar formation, shape, localization, and overall appearance. Results: Results for the focus group of independent plastic surgeons and 377 members of the public were retrieved (n = 391). A total of 10 patients (34.5 percent) were randomized into having the diamond incision, 10 (34.5 percent) had the oval incision, and nine (31.0 percent) had the inverted V incision. Patients were well matched in terms of overall characteristics. The general public demonstrated a significant preference for the oval incision in all five parameters. There was no preference identified among surgeons. Conclusion: This study provides evidence that a sample of the U.S. general public prefers the aesthetics of the oval umbilicoplasty incision, which contrasted with the lack of preference identified within this focus group of plastic surgeons. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

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Current Perspective on Actinic Keratosis: A Review

This comprehensive overview of actinic keratoses discusses controversies surrounding their definition and classification. How should they be approached and treated?
The British Journal of Dermatology

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Impact of tumour histology on survival in advanced cervical carcinoma: an NRG Oncology/Gynaecologic Oncology Group Study

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Variation in ‘fast-track’ referrals for suspected cancer by patient characteristic and cancer diagnosis: evidence from 670 000 patients with cancers of 35 different sites

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Quality of life outcomes after endoscopic approaches to intracranial tumors

Purpose of review To review the literature on quality of life (QOL) in endoscopic approaches to anterior and central intracranial skull-base disease. As endoscopic surgical techniques have gained widespread acceptance and complications and morbidity remain low and comparable with microscopic and open approaches, a shift to focusing on patients' perception of their own well being as an important outcome parameter has been made. In addition to the traditional measurements of surgical outcomes (extent of resection, recurrence rate, morbidity, survival, and complication rate), the success of a surgery can now be assessed using QOL measures. Recent findings The main tools for assessing QOL in endoscopic skull-base surgery (anterior skull-base questionnaire and 22-item sinonasal outcome test) were not specifically designed for endoscopic skull-base approaches, and recently, a new tool was introduced and validated, the skull-base inventory, adding to our armamentarium, but it has not yet been widely employed. Endoscopic skull-base surgery leads to improved or sustained long-term QOL overall but it is significantly influenced by tumor disease. Specific endoscopic surgical technique (such as nasoseptal flap closure) appears to have less impact on QOL. Summary It is becoming critical to assess therapeutic interventions in terms of impact on a patient's QOL. QOL can be useful in comparing efficacy of surgical interventions, and in the future, it will likely become a reportable indicator of surgical outcome and guide our surgical technique recommendations. Large-scale prospective multicenter trials would be beneficial. Correspondence to Assistant Prof Madeleine R. Schaberg, MD, MPH, Department of Otorhinolaryngology Head and Neck Surgery, The New York Eye and Ear Infirmary of Mount Sinai, The Icahn School of Medicine at Mount Sinai, 310 East 14th Street 6th Floor, New York NY 10003, USA. Tel: +1 646 943 7931; e-mail: mschaberg@nyee.edu Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Ultrasound examination of the antrum to predict gastric content volume in the third trimester of pregnancy as assessed by MRI: A prospective cohort study

BACKGROUND Ultrasound examination of the gastric antrum allows reliable pre-operative assessment of gastric contents and volume in adult patients. However, during pregnancy, the change in the anatomical position of the stomach due to the gravid uterus leads to a change in the measured value of the antral area. Therefore, current mathematical models predicting gastric content volume (GCV) in the adult may not apply in term pregnant women. OBJECTIVE To propose a mathematical model which is predictive of GCV in pregnant women and to assess the performance of an ultrasound qualitative grading scale (0 to 2) for the diagnosis of clear fluid volumes more than 0.8 and 1.5 ml kg−1. DESIGN Prospective cohort study. SETTING Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon and Assistance Publique – Hôpitaux de Marseille, Hôpital Nord, Marseille, France. PATIENTS Pregnant women in the third trimester of pregnancy. MAIN OUTCOME MEASURES Comparison of the GCV as measured by MRI and the ultrasound measured antral cross-sectional area, and an assessment of gastric contents according to a 0 to 2 qualitative grading scale. RESULTS Data from 34 women were analysed. A linear model predictive of GCV was constructed with a 95% agreement band of ±95 ml, with a mean polar angle of −8.7°. Performance of the qualitative grading scale to detect fluid volumes >0.8 and >1.5 ml kg−1 was improved when used in a composite scale including a 505 mm2 antral area cut-off value in the semirecumbent supine position. CONCLUSION We report a new mathematical model predictive of GCV in women in the third trimester of pregnancy. Furthermore, the combination of the qualitative and the quantitative ultrasound examination of the gastric antrum might be useful to assess gastric fluid volume in pregnant women. TRIAL REGISTRATION ANSM Register N°2015-A00800-49 Correspondence to Lionel Bouvet, MD, PhD, Department of Anaesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, Boulevard Pinel, Bron, 69500 Lyon, France Tel: +33 4 72 12 97 63; e-mail: lionel.bouvet@chu-lyon.fr © 2017 European Society of Anaesthesiology

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