Regional Cerebral Oxygen Saturation Changes After Decompressive Craniectomy for Malignant Cerebral Venous Thrombosis: A Prospective Cohort Study

Background: Decompressive craniectomy (DC) is a life-saving intervention for malignant cerebral venous thrombosis (CVT). Earlier studies have shown increase in cerebral oxygenation after DC in traumatic brain injury but similar studies are lacking in CVT. We hypothesized that regional cerebral (tissue) oxygen saturation (rSO2) on the side of CVT is lower than the contralateral side and improves after DC. Materials and Methods: In this prospective cohort study, rSO2 was monitored using near-infrared spectroscopy technique, before and after DC on both cerebral hemispheres. Data regarding factors likely to affect rSO2 such as systolic blood pressure, partial pressure of oxygen and carbon dioxide in blood (PaO2 and PaCO2), and hemoglobin were simultaneously collected. The primary outcome measure was pre-post change in rSO2 on the ipsilateral cerebral hemisphere. The secondary outcomes were in-hospital mortality and duration of postoperative hospital stay. Results: Seventeen patients underwent DC during the 6-month study period. Their mean age was 39.2±12.4 years. The pre-post DC change in rSO2 on the hemisphere with CVT was significant (mean difference=3.6%; 95% confidence interval, 1.5-5.7; P=0.002). One patient died in the hospital. There was no difference in the duration of postoperative hospital stay (10 d [range, 6 to 21 d] vs. 14 d [range, 1 to 30 d], P=0.92) between patients with preoperative ipsilateral rSO2 60%. There was no correlation between PaO2, PaCO2, systolic blood pressure, and hemoglobin with rSO2. Conclusions: Patients with malignant CVT had a lower rSO2 on ipsilateral side of the lesion, which improved significantly after DC. Preoperative rSO2 was not correlated with the duration of hospital stay. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Kamath Sriganesh, DM, Department of Neuroanaesthesia and Neurocritical Care, 3rd Floor, Neurosciences Faculty Block, NIMHANS, Hosur Road, Bengaluru 560029, India (e-mail: drsri23@gmail.com). Received November 7, 2017 Accepted January 25, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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In vivo optical coherence tomography imaging in a case of mucous membrane pemphigoid and a negative Nikolsky's sign

Abstract

There is currently a growing interest in new diagnostic tools of the oral cavity and mucosa which are non-invasive, repeatable and reliable. A diagnosis of a suspected, autoimmune pathology was made regarding a 57-year-old patient with desquamative gingivitis. However, a negative Nikolsky's sign did not seem to indicate a diagnosis of mucous membrane pemphigoid neither was there any indication as to the optimum location for an incisional biopsy. As an imaging method, the use of optical coherence tomography (OCT) has enabled the obtaining of tomographic (cross-sectional) scans of tissue. Such images are acquired prior to and after verifying Nikolsky's sign, thereby enabling the clinician to identify the presence (or not) of subepithelial bullae. Thereafter, an assessment of changes in the subepithelium (the split) can be performed, even in the absence of a suitable clinical picture, such as, for example, a negative Nikolsky's sign. Histological analysis and the use of indirect immunofluorescence have facilitated a diagnosis of mucous membrane pemphigoid, an autoimmune pathology, which can be confirmed with the appearance of subepithelial bullae. OCT was found to be a valid, non-invasive, auxiliary diagnostic device, capable of revealing in vivo and real-time bullae, which were hitherto clinically undetectable.

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Phacomatosis pigmentovascularis type 2b (phacomatosis cesioflammea) with double superior vena cava, abdominal varicosities, and natal tooth: Novel associations

Abstract

Phacomatosis pigmentovascularis is characterized by coexistent extensive cutaneous vascular (capillary) and pigmentary anomalies. We describe a 2-month-old infant presenting with classic features of phacomatosis pigmentovascularis 2b (phacomatosis cesioflammea). He was also found to have hitherto unreported associations in the form of extensive venous anomalies presenting as striking abdominal wall varicosities and persistent left superior vena cava and natal tooth.

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Retronychia a little-known cause of paronychia: A report of two cases in adolescent patients

Abstract

Retronychia is a clinical condition resulting from embedding of the nail plate into the proximal nail fold. We report two adolescent girls, 14 and 16 years of age, with a history of chronic proximal paronychia of the great toe, one of them developing osteomyelitis. After failure of treatment with several systemic antibiotics, nail avulsion was performed, leading us to the diagnosis of retronychia and with rapid and complete resolution of symptoms in both cases. Delay in diagnosis of retronychia can lead to local complications and prolonged discomfort.

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Nipple adenoma in a 2-year-old boy

Abstract

Nipple adenoma is an uncommon proliferative process of the breast and predominantly occurs in women aged 40-50. Its incidence is extremely low in men, and it has not been reported in a boy. Although nipple adenoma is rare and benign, being familiar with it is important because it clinically resembles Paget disease and histologically adenocarcinoma. We report a case of nipple adenoma in a boy.

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Efficacy and safety of topical application of 15% and 10% potassium hydroxide for the treatment of Molluscum contagiosum

Abstract

Background/Objectives

Molluscum contagiosum is the most common skin infection in children. One topical treatment used for Molluscum contagiosum is potassium hydroxide. The objective of this study was to compare the efficacy of potassium hydroxide topical treatment at different concentrations with that of placebo in terms of complete clearing of Molluscum contagiosum lesions and to assess the safety and tolerance of potassium hydroxide topical treatment.

Methods

This was a double-blind randomized clinical trial of three treatments (potassium hydroxide 10%, potassium hydroxide 15%, placebo) applied once daily up to complete clearing of lesions (maximum duration 60 days) in 53 children aged 2-6 years in primary health care pediatric offices in Catalonia, Spain.

Results

In the intention-to-treat analysis, potassium hydroxide 10% (58.8%, P = .03) and potassium hydroxide 15% (64.3%, P = .02) had efficacy superior to that of placebo (18.8%). The number of Molluscum contagiosum lesions was significantly reduced with potassium hydroxide 10% and 15%. The main efficacy outcome was achieved in 58.8% of children in the potassium hydroxide 10% group (P = .03 vs placebo) and in 64.3% of children in the potassium hydroxide 15% group (P = .02 vs placebo). Potassium hydroxide 10% and 15% were not significantly different in efficacy from each other. Potassium hydroxide 10% and placebo were better tolerated than potassium hydroxide 15%. No adverse events were reported during the study period.

Conclusions

Potassium hydroxide 10% and 15% demonstrated high rates of efficacy in clearing Molluscum contagiosum lesions, with potassium hydroxide 10% being better tolerated.

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The report of two cases with multiple sulfatase deficiency resulting from a rare similar gene mutation

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Clinical characteristics and management of patients with rosacea in a tertiary dermatology center in Singapore from 2009 to 2013

Abstract

Introduction

Rosacea is a common chronic facial skin disease. A multiethnic society such as Singapore provides an opportunity to evaluate the demographic characteristics and their impact on clinical outcome in rosacea.

Aims

The aim of this study was to evaluate characteristics and outcome of rosacea in a multiracial population in Singapore.

Methods

Records of all rosacea patients between January 2009 and December 2013 were retrospectively retrieved from the electronic medical records (EMR). Descriptive analysis was performed to understand the characteristics of patients with rosacea. Multivariate logistic regression was used to evaluate the associations between the various variables and types of rosacea as well as the clinical outcome.

Results

A total of 1340 patients were identified. The mean age at presentation was 42.8 years with a female predominance (65%). Most of the patients had erythematotelangiectatic rosacea (ETR) (56.3%) followed by papulopustular rosacea (PPR) (37%). With multinomial logistic regression, controlling for age, gender, and known triggers, Indians and Caucasians were more likely to have PPR compared to ETR (OR: 3.4, P = 0.01 and OR: 2.1, P = 0.01 respectively). Patients who had phymatous rosacea are also more likely to be older males (OR: 3.82 95% CI 1.64–8.92, P = 0.002).

Conclusion

The epidemiology and outcome of rosacea among local patients were studied. Rosacea is more common among certain racial groups such as Chinese, Caucasian, and other races. The clinical subtypes also seem to be related to races of certain skin colors and might be related to varied natural intrinsic responses to the sun among different racial groups.

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Clinical profile of dermatological emergencies and intensive care unit admissions in a tertiary care center – an Indian perspective

Abstract

Background

Although dermatology is largely considered as an outpatient specialty, dermatological conditions comprise 5–8% of cases presenting to the emergency department. The need for a dermatological intensive care unit is widely acknowledged due to the increasing incidence of acute skin failure. Very few studies have been done to characterize the common conditions seen in the emergency department and intensive care units. We undertook this study to analyze the spectrum of dermatological conditions presenting to the emergency department and the clinical profile of patients admitted to the intensive care unit.

Methods

A prospective study was conducted for 9 months. Patients requiring primary dermatological consultation in the emergency department and patients admitted in the dermatology intensive care unit were examined, and their clinical variables were statistically analyzed.

Results

A total of 248 cases were seen in the emergency department, out of which 72 (29.1%) cases were admitted and 176 (70.9%) were treated in the emergency department on an outpatient basis. The most common condition seen in non-admitted patients was acute urticaria (28.9%). The most common cause for admission in patients presenting to the emergency department was erythroderma (23.6%). Sixty-two patients were admitted to the intensive care unit, the most common diagnosis being erythroderma (40.3%).

Conclusions

This prospective study aimed to provide an insight into the types of cases evaluated in the emergency department by dermatologists in a large tertiary care hospital in coastal Karnataka in South India.

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Is HPV vaccination of pregnant women really safe?

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Spinal Cord Stimulation 50 Years Later: Clinical Outcomes of Spinal Cord Stimulation Based on Randomized Clinical Trials—A Systematic Review

To assess the efficacy of spinal cord stimulation (SCS) for each indication, one must critically assess each specific clinical outcome to identify outcomes that benefit from SCS therapy. To date, a comprehensive review of clinically relevant outcome-specific evidence regarding SCS has not been published. We aimed to assess all randomized controlled trials from the world literature for the purpose of evaluating the clinical outcome-specific efficacy of SCS for the following outcomes: perceived pain relief or change pain score, quality of life, functional status, psychological impact, analgesic medication utilization, patient satisfaction, and health care cost and utilization. Interventions were SCS, without limitation to the type of controls or the type of SCS in the active arms. For each study analyzed, a quality assessment was performed using a validated scale that assesses reporting, external validity, bias, confounding, and power. Each outcome was assessed specific to its indication, and the primary measure of each abovementioned outcome was a summary of the level of evidence. Twenty-one randomized controlled trials were analyzed (7 for trunk and limb pain, inclusive of failed back surgery syndrome; 8 for refractory angina pectoris; 1 for cardiac X syndrome; 3 for critical limb ischemia; 2 for complex regional pain syndrome; and 2 for painful diabetic neuropathy). Evidence assessments for each outcome for each indication were depicted in tabular format. Outcome-specific evidence scores were established for each of the abovementioned indications, providing both physicians and patients with a summary of evidence to assist in choosing the optimal evidence-based intervention. The evidence presented herein has broad applicability as it encompasses a breadth of patient populations, variations of SCS therapy, and comparable controls that, together, reflect comprehensive clinical decision making. Accepted for publication October 22, 2017. Address correspondence to: Nagy Mekhail, MD, PhD, Cleveland Clinic, C25, 9500 Euclid Ave, Cleveland, OH 44195 (e-mail: mekhain@ccf.org). The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Altered density, composition and microanatomical distribution of infiltrating immune cells in cutaneous squamous cell carcinoma of organ transplant recipients

Summary

Background

The inflammatory tumor microenvironment is crucial for effective tumor control and long-term immunosuppression has been identified as a major risk factor for skin carcinogenesis. In solid organ transplant recipients (OTR) undergoing long-term pharmacologic immunosuppression an increased incidence of cutaneous squamous cell carcinoma (SCC) and more aggressive tumor growth compared to immunocompetent patients (IC) has been reported.

Objectives

To determine the density and phenotype of immune cells infiltrating SCC and surrounding skin in OTR, and to characterize the microanatomical distribution patterns in comparison to IC.

Methods

We analyzed immune cell infiltrates within SCC and at defined regions of interest (ROI) of tumor- surrounding skin in formalin-fixed paraffin-embedded (FFPE) tissue of 20 renal transplant patients and 18 carefully matched IC by high-resolution semi-automated microscopy on complete tissue sections stained for CD4, CD8, CD20 and CD68.

Results

The overall immune cell density of SCC arising in OTR was significantly reduced compared to IC. Particularly CD4+ infiltrates at the directly invasive margin and tumor vicinity, intratumoral CD8+ T cell densities and the overall density of CD20+ tumor-infiltrating B cells (TIL-B) were significantly reduced in tissue of OTR.

Conclusions

Immune cells infiltrates within SCC and at defined ROI of tumor-surrounding skin in OTR differ markedly in their composition and microanatomical distribution compared to tumors arising in IC. Our findings substantially broaden the understanding of how long-term systemic immunosuppression modulates the local inflammatory microenvironment in the skin and at the site of invasive SCC.

This article is protected by copyright. All rights reserved.

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Simplified Access for Reduction and Fixation of a Frontal Bone Fracture

The frontal bone fractures occur very often in service units in oral and maxillofacial surgery. Bicoronal access is the most common for the surgical treatment of frontal bone fractures. However, patients are surprised when they receive notice that such invasive access will be made. This approach allows adequate visualization of the fracture site, but may be associated with complications, which can be avoided by the use of less invasive techniques. We describe an alternative approach that aims to minimize the complications of a coronal incision. Address correspondence and reprint requests to Willian Ricardo Pires, DDS, MSc, Department of Oral and Maxillofacial Surgery and Integrated Clinic, Araçatuba Dental School, UNESP, Rua José Bonifácio, 1193, Araçatuba, São Paulo16015-050, Brazil; E-mail: willian_ricardo_p@hotmail.com Received 11 April, 2017 Accepted 31 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Virtual Surgical Planning for Correction of Delayed Presentation Scaphocephaly Using a Modified Melbourne Technique

Background: Late treatment of scaphocephaly presents challenges including need for more complex surgery to achieve desired head shape. Virtual surgical planning for total vault reconstruction may mitigate some of these challenges, but has not been studied in this unique and complex clinical setting. Methods: A retrospective chart review was conducted for patients with scaphocephaly who presented to our institution between 2000 and 2014. Patients presenting aged 12 months or older who underwent virtual surgical planning-assisted cranial vault reconstruction were included. Patient demographic, intraoperative data, and postoperative outcomes were recorded. Pre- and postoperative anthropometric measurements were obtained to document the fronto-occipital (FO) and biparietal (BP) distance and calculate cephalic index (CI). Virtual surgical planning predicted, and actual postoperative anthropometric measurements were compared. Results: Five patients were identified who fulfilled inclusion criteria. The mean age was 50.6 months. One patient demonstrated signs of elevated intracranial pressure preoperatively. Postoperatively, all but one needed no revisional surgery (Whitaker score of 1). No patient demonstrated postoperative evidence of bony defects, bossing, or suture restenosis. The mean preoperative, simulated, and actual postoperative FO length was 190.3, 182, and 184.3 mm, respectively. The mean preoperative, simulated, and actual postoperative BP length was 129, 130.7, and 131 mm, respectively. The mean preoperative, simulated, and actual postoperative CI was 66, 72, and 71.3, respectively. Conclusions: Based on our early experience, virtual surgical planning using a modified Melbourne technique for total vault remodeling achieves good results in the management of late presenting scaphocephaly. Address correspondence and reprint requests to Amir H. Dorafshar, MBChB, FACS, FAAP, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, JHOC 8150, 600 North Wolfe Street, Baltimore, MD 21287; E-mail: adorafs1@jhmi.edu Received 27 July, 2017 Accepted 10 November, 2017 This study was presented as an oral presentation at the American Association of Plastic Surgery Annual Meeting 2016. AM and JL equally contributed to this work. Dr. Amir Dorafshar receives indirect research support and is entitled to royalties from KLS Martin. Dr. Amir Dorafshar also receives research support from De Puy Synthes. The remaining authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Short-Blunt Injury in Child Resulting From Pet Bite

The frequency of accidents due to dog bite in children is high, and in the most cases, the child already knows the aggressor dog. Patient, 3 years, female, melanoderm, victim of pet dog attack on the right side of the face region. After the physical examination, conscious sedation was performed with the supplementation of oxygen by pediatrics and the suture by oral and maxillofacial surgeon, under local anesthesia with adrenergic vasoconstrictor, with internal points in the muscles using vicryl 4-0 and in the skin with 5-0 nylon; the lesser number of stitches were performed in the lower region of the wound, allowing spontaneous drainage spaces. The immediate wounds closure of dog bites on the face is safe, even in cases after several hours of the injury. Address correspondence and reprint requests to Valthierre Nunes de Lima, MSc, Department of Surgery and Integrated Clinic, Aracatuba Dental School, University Estadual Paulista (UNESP), Rua José Bonifácio 1193, Araçatuba, São Paulo, CEP 16015-050, Brazil; E-mail: valthierre@gmail.com Received 19 September, 2017 Accepted 12 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Single-Piece Titanium Plate Cranioplasty Reconstruction of Complex Defects

Background: Different methods have been described for the reconstruction of cranial defects and orbital defects. The complex contouring between the orbital roof and frontal bone creates significant design challenges for prefabricated cranio-orbital reconstructions. In describing the first reported patient of combined skull and orbital roof reconstruction with a single-piece titanium plate cranioplasty, the authors present a new method of combined complex cranio-orbital reconstruction. Methods: A 63-year-old lady presented with a large, right-sided frontal en–plaque meningioma involving the right orbit and sphenoid wing. Complete resection would require reconstruction of both the skull and the orbital roof. Surgical preplanning involved marking resection margins on a three-dimensional (3D) printed acrylonitrile-butadiene-styrene model. This margin was used to virtually resect the tumor and generate a repaired surface. A titanium plate was then fabricated using hydrostatic pressing into a 3D-printed mold and the orbital roof portion (a reentrant surface) was hand-finished. Lateral canthus and temporalis muscle suspension holes were prefabricated into the cranioplasty plate. Results: The patient underwent hemicraniectomy and tumor resection guided by a custom-made 3D-printed cutting guide. The surgical defect was reconstructed with the prefabricated titanium plate achieving a good functional and cosmetic result. Conclusion: Single-piece titanium plate cranioplasty is an effective novel reconstruction method for complex cranio-orbital defects. Address correspondence and reprint requests to Dr David Anthony Morrison, PhD, Department of Medical Engineering and Physics, Royal Perth Hospital, Wellington Street, Perth, Western Australia 6000, Australia; E-mail: david.morrison@health.wa.gov.au Received 3 May, 2017 Accepted 11 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Postpartum Depression in Mothers of Infants With Cleft Lip and/or Palate

This study describes postpartum depression rates and risk factors for mothers with infants with cleft lip and/or palate as postpartum depression has been associated with a range of negative maternal and child outcomes. A retrospective chart review from August 2009 to May 2015 included medical diagnoses, demographics, receipt of prenatal diagnosis, and the Edinburgh Postnatal Depression Scale (EPDS). Mothers (N = 206) had infants (59.2% male; mean age in weeks 5.1 ± 6.9) with isolated cleft lip (18%), cleft palate (22.8%), or cleft lip and palate (59.2%). Mothers ranged from 16 to 45 years old (mean age 29 ± 6.2) and half had received a prenatal diagnosis. Patients mostly had public insurance (57.8%) and represented diverse ethnicities. Based on the EPDS, 11.7% of mothers met the depression cutoff of 10 or higher. The majority endorsed self-blame (68.9%), difficulty coping (59.2%), and feeling anxious (57.3%). Mothers of infants with cleft lip or cleft lip and palate who did not receive a prenatal diagnosis had higher total EPDS scores, anxiety, and incidence of feeling scared. Higher EPDS scores were predicted by not having a prenatal diagnosis and by older maternal age. Mothers of infants with a cleft had similar rates of postpartum depression as the general population; however, those who were older and who did not receive a prenatal diagnosis endorsed more symptoms. Prenatal diagnosis may contribute to positive maternal postpartum adjustment. Providers should incorporate screening for risk factors into their evaluation and treatment planning. Address correspondence and reprint requests to Alexis L. Johns, PhD, ABPP, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop 96, Los Angeles, CA 90027; E-mail: ajohns@chla.usc.edu Received 12 September, 2017 Accepted 13 November, 2017 Portions of this article were presented at: 73rd Annual American Cleft Palate-Craniofacial Association Conference in April 2016 in Atlanta, GA; 74th Annual American Cleft Palate-Craniofacial Association Conference in March 2017 in Colorado Springs, CO. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Respiratory Obstruction Due to Richards Type 4 Fracture

Facial fractures can be potentially fatal in polytraumatized patients due to retropositioning tissues to upper airway obstruction. In the first aids, this situation can be reversed using a tracheostomy procedure to break out the airways. However, fractures leading to airway obstruction are rare and according to Richards Classification can be classified into 5 types. The purpose of this article is to report a clinical patient with a bilateral condylar and mandibular symphysis fractures that resulted in airway obstruction and severe mandibular rear projection. Address correspondence and reprint requests to Willian Ricardo Pires, DDS, MSc, Department of Oral and Maxillofacial Surgery and Integrated Clinic, Araçatuba Dental School, UNESP, Rua José Bonifácio, 1193, Araçatuba, São Paulo 16015-050, Brazil; E-mail: willian_ricardo_p@hotmail.com Received 13 April, 2017 Accepted 26 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Anatomical and Radiological Investigation of Dry Bone Adult Mandibles Having Impacted Third Molar Teeth

Objective: To investigate the incidence of the impacted mandibular third molars in dry bones adult mandibles. Methods: The 198 dry bones adult mandibles gathered from the bone collections in Laboratory of the Anatomy Department of Dokuz Eylul University School of Medicine were macroscopically examined for the presence of impacted mandibular third molars. The genders of the adult bones were unknown. The adult mandibles having impacted third molars were photographed with Canon 400B (55 mm objective). The mandibles having impacted third molars were also radiographically examined with orthopantomography (a dental radiographic technique, kV 60, mA 2.0) in radiology unit of Faculty of Dentistry, Ege University. The impacted teeth were grouped according to their position and degree of impaction. Results: The each of 2 of 198 adult mandibles (2/198; 1.01%) was having an impacted 3rd molar teeth. These 2 molar teeth were belonged to class 1, B and partially buried, vertically oriented. The first impacted 3rd molar teeth was located on the left side of the one mandible and the second one on the right side of the other mandible. Conclusion: The present study provides information about impacted mandibular 3rd molar in dry bones. Address correspondence and reprint requests to Sibel Cirpan, MD, Department of Anatomy, School of Medicine, Dokuz Eylul University, 35340 Inciralti, Izmir, Turkey; E-mail: cirpansibel@hotmail.com Received 16 July, 2017 Accepted 20 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Contour Restoration of Over-Resected Mandibular Angle and Lower Border by Reduction Mandibuloplasty Using Three-Dimensional Planning and Computer-Aided Design and Manufacturing Custom-Made Titanium Implants

Objective: The purpose of this clinical report was to introduce a new methodology for contour restoration of the over-resected mandible by reduction mandibuloplasty using 3-dimensional (3D) planning and computer-assisted design and manufacturing (CAD-CAM) custom-made titanium implants. Patient and method: A 20-year-old male patient had undergone reduction of the zygoma and mandibular angle and lower border for esthetic reason 1 year ago at a private clinic. However, he was not satisfied with surgical outcome and wanted to restore his original facial volume and contour. To assess the volume and dimension of resected bone, 3D-computed tomography (3D-CT) data at the original stage was superimposed with postsurgical CT. For restoration of the malar prominence, porous polyethylene malar implants with extensions into the lateral malar region (Medpor) were placed and fixed with microscrews. Custom-made titanium implants were fabricated for contour restoration of the mandibular angle and lower border using CAD-CAM technology (iDDA, Daegu, South Korea). Two-piece design per each titanium implant was adopted for easy placement and avoidance of tissue damage during placement. Thin buccal extension was incorporated for placement of screw holes. Location, direction, and length of bicortical screws were planned to avoid damage of the inferior alveolar nerve. Result: With the help of 3D planning and CAD-CAM technology, rigid fixation of the custom-made titanium implants into the mandibular angle and lower border successfully restored the contour of over-resected mandible to the original state. Conclusion: When over-resection by reduction mandibuloplasty becomes an issue, this method may be an effective treatment option for contour restoration of over-resected mandibular angle and lower border. Address correspondence and reprint requests to Dr Jin-Young Choi, DDS, PhD, Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, Seoul National University, 101 Daehakno, Jongno-Gu, Seoul 03080, South Korea; E-mail: jinychoi@snu.ac.kr Received 21 July, 2017 Accepted 12 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Review of “Sensitizing Surgeons to Their Outcome Has No Measurable Short-term Benefit” by Cauchy F, Farges O, Vibert E, Boleslawski E, Pruvot FR, Regimbeau JM, Mabrut JY, Scatton O, Adham M, Laurent C, Grégoire E, Delpero JR, Bachellier P, Soubrane O in Ann Surg 266: 884–889, 2017

No abstract available

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Retracted or Withdrawn Publications in Journals Relating to Plastic Surgery

The aim of this study was to determine how many papers have been retracted or withdrawn, and for what reason, in journals relating to plastic surgery. PubMed and SCOPUS were used, with the search terms (retracted OR withdrawn) AND (article OR publication OR paper) AND {(plastic surgery) OR (cosmetic surgery) OR (maxillofacial surgery) OR (craniofacial surgery)}. The papers were analyzed and classified according to the reason for retraction or withdrawal, journal name, publication year, and author. In the PubMed and SCOPUS, 227 and 114 titles were found, respectively, from which 34 duplicate titles were removed. An additional 261 titles which did not include "retracted" or "withdrawn" were removed, leaving 46 papers and 6 mined papers were added. The 52 full texts (42 "retracted" and 10 "withdrawn") were analyzed. The most frequent reason for retraction or withdrawal was duplication (17, 32.7%) followed by the author's request (9, 17.3%), plagiarism (7, 13.5%), and lack of permission (5, 9.6%). Retraction was most common in Plast Reconstr Surg (6, 12%) followed by Aesthetic Plast Surg (4, 7.9%), Ann Plast Surg (2, 3.9%), J Plast Reconstr Aesthet Surg (2, 3.9%), and Surg Res (2, 3.9%). Most authors retracted a paper just once; however, 6 authors retracted a paper twice or more. The first retraction was found in 1991, and the number of retractions showed a tendency to increase over time. However, the duplication rate did not change over time (R2 = 0.178, P = 0.117). Journal reviewers, as well as production editors, should check for duplication, plagiarism, or permission-related problems. Address correspondence and reprint requests to Kun Hwang, MD, PhD, Department of Plastic Surgery, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 22332, Korea; E-mail: jokerhg@inha.ac.kr Received 18 June, 2017 Accepted 20 November, 2017 This study was supported by a grant from National Research Foundation of Korea (NRF-2017R1A2B4005787). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Early Tarsorrhaphy in Conjunctival Chemosis After Orbit Bone Reconstruction

Objective: Chemosis is a common occurrence after orbital reconstruction surgery by the transconjunctival approach. The authors propose an early tarsorrhaphy approach for treating severe conjunctival chemosis following orbital fracture repair. Methods: All severe conjunctival chemosis patients following orbital fracture repair were divided into 2 groups: tarsorrhaphy performed immediately when the eyelids could not close completely due to prominent conjunctival edema (early tarsorrhaphy, n = 10); and tarsorrhaphy performed 3 days after the appearance of severe chemosis (delayed tarsorrhaphy, n = 10). Once the conjunctiva subsided, the sutures were immediately removed. The duration of conjunctival edema was recorded. Results: The average time to resolution of severe chemosis was significantly shorter in the early versus delayed tarsorrhaphy group (3.5 ± 0.5 versus 7.2 ± 1.73 days, P 

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Autologous Bone Marrow Concentrates and Concentrated Growth Factors Accelerate Bone Regeneration After Enucleation of Mandibular Pathologic Lesions

Stem cell therapy is a revolutionary new way to stimulate mesenchymal tissue regeneration. The platelets concentrate products started with platelet-rich plasma (PRP), followed by platelet-rich fibrin (PRF), whereas concentrated growth factors (CGF) are the latest generation of the platelets concentrate products which were found in 2011. The aim of the present study was to evaluate the potential of combining autologous bone marrow concentrates and CGF for treatment of bone defects resulting from enucleation of mandibular pathologic lesions. Twenty patients (13 males and 7 females) with mandibular benign unilateral lesions were included, and divided into 2 groups. Group I consisted of 10 patients who underwent enucleation of the lesions followed by grafting of the bony defects with autologous bone marrow concentrates and CGF. Group II consisted of 10 patients who underwent enucleation of the lesions without grafting (control). Radiographic examinations were done immediately postoperative, then at 1, 3, 6, and 12 months, to evaluate the reduction in size and changes in bone density at the bony defects. Results indicated a significant increase in bone density with respect to the baseline levels in both groups (P 

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Active Intracystic Negative Pressure Could Induce Osteogenesis

Based on previous findings, the author introduces the term "sugosteogenesis," a biological phenomenon that occurs by using the Evocyst, a device that exerts active intracystic negative pressure. The term "sugosteogenesis" comes from the Latin word "sugo-," meaning "suck," and Greek words "osteo-," meaning "bone," and genesis, "origin." Address correspondence and reprint requests to Dr Jaime Castro-Núñez, Division of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky, 800 Rose Street, Lexington, KY 40536; E-mail: jaime.castro@uky.edu Received 21 October, 2017 Accepted 20 December, 2017 The authors report no conflicts of interest © 2018 by Mutaz B. Habal, MD.

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Autologous Free Fat Grafting for Management of the Facial Contour Asymmetry

Background: The purposes of this study were to report autologous free fat grafting as the workhorse procedure to augment the facial soft-tissue envelope and restore facial contour symmetry of patients with asymmetric facial malformations; to detail the SOBRAPAR Hospital algorithm for soft-tissue reconstruction of patients with facial contour asymmetry; and to assess facial symmetry after fat grafting. Methods: A retrospective analysis of consecutive patients (n = 178) who underwent fat grafting to restore the facial contour symmetry according to the SOBRAPAR Hospital algorithm between 2009 and 2016 was conducted. Computerized photogrammetric quantitative and qualitative facial symmetry analyses were performed. Results: There were significant (all P 

http://ift.tt/2sUyuLV

Clinical Efficacy Evaluation for Treating Trigeminal Neuralgia Using a Personalized Digital Guide Plate-Assisted Temperature-Controlled Radiofrequency

The aim of this study was to explore the application and efficacy of personalized digital guiding plate-aided radiofrequency in treating trigeminal neuralgia (TN). A total of 117 cases (93 patients) of TN from January 2015 to December 2016 were divided into the study group (n = 53) and the traditional group (n = 64). Patients in the study group were treated by the radiofrequency through a personalized digital guiding plate, whereas those in the traditional group were treated by the traditional method. We found that no significant difference between these 2 groups in age, sex, and divisions affected (V2, V3). However, the values for operation time, recurrence rate, and patient's satisfaction in the plate assisted group were significantly improved compared with those in the traditional group. Therefore, the personalized digital guiding plate-assisted radiofrequency has higher application value than traditional method. Address correspondence and reprint requests to Xing Long, PhD MD, Department of Oral and Maxillofacial Surgery, State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education (KLOBM), School and Hospital of Stomatology, 237 Luoyu Road, Wuhan, Hubei province 430079, China; E-mail: longxing@whu.edu.cn; Jin KE, PhD, MD, Wuhan University, State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education (KLOBM), School and Hospital of Stomatology, 237 Luoyu Road, Wuhan, Hubei province 430079, China; E-mail: kejin@whu.edu.cn Received 8 November, 2017 Accepted 20 December, 2017 SZ and MD contributed equally in this article. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Suitability of Wrist External Fixator for Treatment of Mandibular Fracture

The mandibular fracture is one of the most commonly fractures of the facial bones. In high-energy traumas, a comminuted mandible fracture may occur. The closed reduction with external fixator is an interesting alternative for these types of fractures. The aim of this article is to report the case of a patient with comminuted fracture in the right mandibular body, whose surgical treatment was the noninvasive reduction of fracture and stabilization using a Colles' wrist external fixator. After 1 year of follow-up, the patient is without complaints, with satisfactory dental occlusion, adequate contour, and mandibular alignment. External fixation with wrist orthopedic fixators adapted to the mandible provides many advantages owing to its versatility and simplicity of use. Therefore, this method should be remembered as a valid and affordable option for the treatment of complex lesions when indicated correctly. Address correspondence and reprint requests to Marília Gabriela Mendes de Alencar, School of Dentistry, University of Pernambuco, 1650 General Newton Cavalcanti Avenue, Recife, PE, 54.753-220, Brazil; E-mail: mariliagma@gmail.com Received 8 December, 2017 Accepted 23 December, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Outcome of Conventional Adipose Tissue Grafting for Contour Deformities of Face and Role of Ex Vivo Expanded Adipose Tissue-Derived Stem Cells in Treatment of Such Deformities

Objectives: To evaluate the outcomes of conventional fat grafting for facial contour deformities and to describe clinical outcome of a patient with contour deformity of face treated with ex vivo expanded adipose tissue-derived mesenchymal stem cells (ASCs) enriched fat graft. Place and Duration of Study: The Department of Plastic Surgery and Tissue Engineering and Regenerative Medicine Laboratory, King Edward Medical University/Mayo Hospital, Lahore, from September 2015 to September 2017. Methods: Patients with contour deformities of face requiring soft tissue augmentation were included. Fat was harvested, processed, and injected following a standard protocol. Both subjective and objective assessments were performed and complications were also noted. Results: Twenty-five patients underwent 51 fat-grafting sessions over a period of 24 months. Eighteen (72%) patients underwent multiple fat-grafting sessions. Mean (standard deviation) soft tissue thickness after 72 hours and 6 months of first fat graft session was 18.62 (7.2) and 12.88 (6.21) mm, respectively, which corresponds to 30.77 (13)% reduction of transplanted fat. Physician and patient assessment scores were 3.42 (0.92) and 4 (1.04), respectively. Few minor complications were observed. In the patient undergoing ex vivo expanded ASCs enriched fat graft, there was minimal decrease in soft tissue thickness of treated area (44 mm vs 42 mm) 6 months postoperatively and patient was highly satisfied with the outcome after the single session. Conclusion: Conventional fat grafting is safe for correction of facial contour deformities. However, procedure needs to be repeated multiple times to produce satisfactory results. Beneficial effects of ex vivo expanded ASCs enriched fat grafting have a potential to alter the current treatment paradigm of fat grafting for soft tissue reconstruction. Address correspondence and reprint requests to Dr Mahmood S. Choudhery, PhD, Assistant Professor, Tissue Engineering and Regenerative Medicine Laboratory, Department of Biomedical Sciences, King Edward Medical University, Lahore, Pakistan; E-mail: drmahmood@kemu.edu.pk Received 24 October, 2017 Accepted 18 December, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Removal of the Residual Roots Displaced Into the Maxillary Sinus via Endoscopy

Minimally invasive endoscopic surgery has been developed for various indications in the craniomaxillofacial area.1 The case report presented in this article is focused on the possibility of removing the residual roots displaced into the maxillary sinus by means of an endoscopic technique. When planning endoscopic surgery to access the residual roots displaced in the maxillary sinus, we performed 2 different approaches into the maxillary sinus, a transnasal approach through the middle or inferior turbinate and transoral approach via the anterior maxillary sinus wall. The endoscopic surgical approach described is reliable and minimally invasive for removing the residual roots displaced into the maxillary sinus. Therefore, we concluded that the application of this clinical procedure is worth promoting. Correspondence to Zhiquan Huang, MD, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107th Yanjiang Xi Road, Guangzhou, Guangdong 510120, China; E-mail: zhiquanhuang1978@126.com Received 23 August, 2017 Accepted 20 December, 2017 XW and SL contributed equally to this work. This study received funding from the National Science Foundation of China (no. 81772892), the Fundamental Research Funds for the Central Universities (no. 16ykjc17), the Guangdong Province Natural Science Foundation (no. 2016A030313348). Approval was received from the Ethical Committee of Sun Yat-sen Memorial Hospital, Sun Yat-sen University. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Spring-Assisted Surgery in the Treatment of Complex Craniosynostosis

Multisutural nonsyndromic craniosynostosis is a rare group of malformations, whose frequency has been reported between 3% and 7% of all craniosynostosis. The clinical diagnosis can be difficult and computed tomography is usually required. Surgical treatment is challenging and staged procedures are performed in up to 80% of patients. The aim of the present study was to determine the reoperation rate and to evaluate the surgical outcomes by measuring intracranial volume (ICV) preoperatively and at follow-up, and comparing it to a control group. Perioperative variables and reoperation rate were recorded. Fifty-one patients presented with a complex pattern of synostosis without a recognizable syndrome (5% of cases of total patients evaluated). Fifteen patients have been treated with spring-assisted surgery, either alone or in combination with a foreheadplasty. The mean follow-up was 6.2 years. The mean preoperative ICV of the patients was smaller, but not significantly, than in the normal population (P = 0.13). Postoperatively, the mean ICV was similar to that of the control group at 1 year (P = 0.92), while at 3 years it was appreciably smaller, although not significantly different (P = 0.06). Five patients (33%) went through a secondary skull expansion for either raised intracranial pressure or cosmetic reasons. Spring-assisted surgery seems to temporarily expand ICV in children with complex synostosis and lower the reoperation rate, thus reducing the need for a second procedure. A longer follow-up would be necessary to further investigate the effects of springs over time. Address correspondence and reprint requests to Ruggero Bevilacqua, MD, University of Gothenburg, Sahlgrenska Academy, Department of Plastic Surgery, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden; E-mail: ruggero.bevilacqua@vgregion.se Received 1 February, 2017 Accepted 1 December, 2017 The authors report no conflict of interest. © 2018 by Mutaz B. Habal, MD.

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Surgical Treatment Outcomes of Vocal Process Granuloma After Endotracheal Intubation

Introduction: The objective of this study was to review the clinical characteristics and surgical treatment outcomes of the vocal process granuloma after the endotracheal intubation. Methods: A retrospective chart review was performed at Chonnam National University Hwasun Hospital from January 2008 to December 2015. Results: Twenty-one vocal process granulomas after endotracheal intubation were diagnosed in 13 patients. The most common symptom was hoarseness. Among 13 patients, bilateral vocal process granulomas were in 8 patients. For the remaining 5 patients, their unilateral vocal process granulomas were all left-sided. All the cases of vocal process granulomas after the endotracheal intubation were treated by laryngoscope microsurgery under general anesthesia. Recurrence of vocal process granulomas was identified in 1 lesion. Conclusion: This study suggests that surgery for vocal process granuloma after endotracheal intubation is a good treatment option for a rapid resolution of lesions and the associated symptoms, along with having low recurrence rates. Address correspondence and reprint requests to Joon Kyoo Lee, MD, PhD, Department of Otolaryngology—Head and Neck Surgery, Chonnam National University Medical School and Hwasun Hospital, 160 Ilsimri, Hwasun, Jeonnam 519-809, South Korea; E-mail: joonkyoo@jnu.ac.kr Received 7 August, 2017 Accepted 30 December, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Neuraxial Anesthesia During Cesarean Delivery for Placenta Previa With Suspected Morbidly Adherent Placenta: A Retrospective Analysis

BACKGROUND: General anesthesia (GA) is often selected for cesarean deliveries (CD) with placenta previa and suspected morbidly adherent placenta (MAP) due to increased risk of hemorrhage and hysterectomy. We reviewed maternal outcomes and risk factors for conversion to GA in a cohort of patients undergoing CD and hysterectomy under neuraxial anesthesia (NA). METHODS: We performed a single-center, retrospective cohort study of parturients undergoing nonemergent CD for placenta previa with suspected MAP from 1997 to 2015. Patients were classified according to whether they received GA, NA, or intraoperative conversion from NA to GA. The primary outcome measure was postoperative acuity, defined as the need for intensive care unit admission, arterial embolization, reoperation, or ongoing transfusion with ≥3 units packed red blood cells. We additionally identified variables positively associated with intraoperative conversion from NA to GA during hysterectomy. Confounding was controlled with logistic regression models. RESULTS: Of 129 patients undergoing nonemergent CD for placenta previa with suspected MAP, 122 (95%) received NA as the primary anesthetic. NA was selected in the majority of patients with a body mass index ≥40 kg/m2 (9 of 10, 90%), a history of ≥3 prior CDs (18 of 20, 90%), suspected placenta increta or percreta (29 of 35, 83%), and Mallampati classification ≥3 (19 of 21, 90%). Of 72 patients with NA at the time of delivery who required hysterectomy, 15 (21%) required conversion to GA intraoperatively. Converted patients had a higher rate of major packed red blood cell transfusion (60% vs 25%; P = .01), with similar rates of massive transfusion (9% vs 7%; P = 1.0). Converted patients also had a higher incidence of postoperative acuity (47% vs 4%; P

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Point-of-Care Fibrinogen Testing in Pregnancy

Agreement between estimated fibrinogen concentration via thromboelastography and traditional assays is not established in the parturient. We therefore recruited 56 parturients and performed Clauss and functional fibrinogen level (FLEV) tests. Mean difference of measurements was 36.8 mg/dL (95% CI, 21.8–51.9) with a standard deviation of 52.8 mg/dL. Calculated limits of agreement were 140.2 mg/dL (95% CI, 166.3–114.6) and −66.6 mg/dL (95% CI, −40.8 to −92.5), within the maximum allowable difference of 165 mg/dL. We therefore conclude that while most measurements fell within the limits of agreement, more work is needed to clearly define the role of this test in the obstetric population. Accepted for publication December 29, 2017. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Summary Statement: In this study, the relationship between formal laboratory Clauss and thromboelastography-derived fibrinogen counts is examined. Reprints will not be available from the authors. Address correspondence to Daniel Katz, MD, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1010 KCC 8th Floor, New York, NY 10029. Address e-mail to Daniel.Katz@mountsinai.org. © 2018 International Anesthesia Research Society

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Pupillary Dilation Reflex Measurement: Ideal Time—Pre- or Postsurgery?

No abstract available

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Treatment of Chronic Pain Conditions: A Comprehensive Handbook

No abstract available

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Analgesic Effects of Oxycodone Relative to Those of Sufentanil, in the Presence of Midazolam, During Endoscopic Injection Sclerotherapy for Patients With Cirrhosis and Esophageal Varices

BACKGROUND: We evaluated the efficacy and gastroenterologist/patient satisfaction of midazolam combined with oxycodone, relative to that of midazolam combined with sufentanil, for anesthesia during endoscopic injection sclerotherapy (EIS) in patients with cirrhosis and esophageal varices. METHODS: Patients with cirrhosis (20–69 years of age), body mass index, 18–25 kg/m2, American Society of Anesthesiology patient classification physical status I–II who underwent elective EIS were randomly assigned to 1 of 2 groups. In this prospective, double-blinded, randomized controlled trial, 1 group received midazolam and oxycodone (n = 64), and the other group received midazolam and sufentanil (n = 63). Primary and secondary outcome measures were compared between groups. The primary outcome measure was the incidence of hypoxia. Secondary outcome measures included perioperative limb movement, need for rescue analgesics, need for additional sedative propofol, specified adverse reactions (postoperative myoclonus, nausea, vomiting, dizziness, and drowsiness), gastroenterologist satisfaction, and patient satisfaction with postoperative analgesia. RESULTS: Patients in the midazolam–oxycodone group had 32% fewer episodes of hypoxia than did those in the midazolam–sufentanil group (95% confidence interval [CI], –45% to –18%; P

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Perioperative Temperature Management

No abstract available

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Inflammation Triggered by the Use of Blood Products

No abstract available

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In Response

No abstract available

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Does A Low 6-Minute Walk Distance Predict Elevated Postoperative Troponin?

Our study of 100 major vascular and renal transplant patients evaluated the 6-minute walk test (6MWT) as an indicator of perioperative myocardial injury, using troponin as a marker. Using logistic regression and the area under the receiving operator characteristic curve, we compared the 6MWT to the Revised Cardiac Risk Index and metabolic equivalents. Only the 6MWT was associated with elevated postoperative troponins (95% CI, 0.98–0.99). However, the 6MWT area under the receiving operator characteristic curve (0.71 [95% CI, 0.57–0.85]) was not different from the Revised Cardiac Risk Index (P = .23) or metabolic equivalents (P = .14). The 6MWT may have a role in cardiac risk stratification in the perioperative setting. Accepted for publication January 16, 2018. Funding: None. The authors declare no conflicts of interest. Institutional review board contact information: 310-825-5344; webIRBHelp@research.ucla.edu. Reprints will not be available from the authors. Address correspondence to Dana L. Russell, MPH, Department of Anesthesiology, David Geffen School of Medicine, University of California Los Angeles, 757 Westwood Pl, Los Angeles, CA 90095. Address e-mail to danarussell@mednet.ucla.edu. © 2018 International Anesthesia Research Society

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The Migration of Caudally Threaded Thoracic Epidural Catheters in Neonates and Infants

BACKGROUND: The migration of pediatric thoracic epidural catheters via a thoracic insertion site has been described. We assessed the migration of caudally threaded thoracic epidural catheters in neonates and infants at our institution. METHODS: The anesthesia records and diagnostic imaging studies of neonates and infants who had caudal epidural catheters placed during a 26-month period at our hospital were analyzed. Imaging studies were reviewed for changes in epidural catheter tip position. RESULTS: Eighty-five patients 1–325 days of age (median, 51 days; interquartile range, 39–78 days) and weights of 2.5–9.5 kg (median, 5 kg; interquartile range, 4.3–5.8 kg) met the study criteria. Fifty-four (64%) of the patients (95% CI, 52%–73%) experienced catheter migration of 1 or more vertebral levels (range, 3 levels caudad [outward] to 3 levels cephalad [inward]), and 23 (27%) of the patients (95% CI, 18%–38%) experienced catheter migration to the T4 level or higher. Migration of 2 or more vertebral levels occurred only in children who weighed

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Beyond the “E” in OSCE

No abstract available

http://ift.tt/2sWbbS0

Correlation Coefficients: Appropriate Use and Interpretation

Correlation in the broadest sense is a measure of an association between variables. In correlated data, the change in the magnitude of 1 variable is associated with a change in the magnitude of another variable, either in the same (positive correlation) or in the opposite (negative correlation) direction. Most often, the term correlation is used in the context of a linear relationship between 2 continuous variables and expressed as Pearson product-moment correlation. The Pearson correlation coefficient is typically used for jointly normally distributed data (data that follow a bivariate normal distribution). For nonnormally distributed continuous data, for ordinal data, or for data with relevant outliers, a Spearman rank correlation can be used as a measure of a monotonic association. Both correlation coefficients are scaled such that they range from –1 to +1, where 0 indicates that there is no linear or monotonic association, and the relationship gets stronger and ultimately approaches a straight line (Pearson correlation) or a constantly increasing or decreasing curve (Spearman correlation) as the coefficient approaches an absolute value of 1. Hypothesis tests and confidence intervals can be used to address the statistical significance of the results and to estimate the strength of the relationship in the population from which the data were sampled. The aim of this tutorial is to guide researchers and clinicians in the appropriate use and interpretation of correlation coefficients. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Accepted for publication January 11, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Patrick Schober, MD, PhD, MMedStat, Department of Anesthesiology, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands. Address e-mail to p.schober@vumc.nl. © 2018 International Anesthesia Research Society

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Treatment Patterns and Clinical Outcomes in Neonates Diagnosed With Respiratory Distress Syndrome in a Low-Income Country: A Report From Bangladesh

Respiratory distress syndrome remains a leading cause of neonatal mortality worldwide. This retrospective study describes practice patterns for respiratory distress syndrome in a resource-limited setting and seeks to identify both risk factors for mortality and beneficial treatment modalities. Health, demographic, and treatment data were collected. Potential associations were analyzed using univariable and multivariable logistic regression. Of 104 children included for analysis, 38 died. Although most children were initially treated with noninvasive respiratory support, 59 progressed to invasive ventilation. Requirement for invasive ventilation was associated with death. A clear trend toward improved survival in mechanically ventilated patients was seen with surfactant administration. Accepted for publication January 11, 2018. Funding: This study was supported in part by the National Institutes of Heath (NIH) Building Interdisciplinary Research Careers in Women's Health (BIRCWH) NIH K12HD043441 scholar funds to G.L. The project described was supported by NIH through grant number UL1TR001857. Support for data collection on-site in Bangladesh ($650 total) was provided via the crowd-funding website https://experiment.com/. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Richard M. Hubbard, MD, 710 Beaver St, Sewickley, PA 15143. Address e-mail to rhubbardmd@gmail.com. © 2018 International Anesthesia Research Society

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Research Needs Assessment for Children With Obstructive Sleep Apnea Undergoing Diagnostic or Surgical Procedures

Recent concerns have been raised about the quality and safety of adenotonsillectomy, a common surgery performed to treat obstructive sleep apnea (OSA) in children. OSA is a risk factor for opioid-related perioperative respiratory complications including those associated with anoxic brain injury or death. Our objective was to identify controversial issues related to the care of children with OSA. A standardized Delphi consensus technique involving an interdisciplinary group of 24 pediatric OSA experts identified 3 key issues: "postoperative disposition, preoperative screening, and pain management." These topics are prime candidates for future systematic reviews and will guide Society of Anesthesia and Sleep Medicine–related research endeavors. Accepted for publication December 19, 2017. Funding: This study was supported solely by institutional and/or departmental sources. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Kimmo T. Murto, MD, FRCPC, Department of Anesthesiology and Pain Medicine, Children's Hospital of Eastern Ontario-Ottawa Children's Treatment Center, University of Ottawa, 401 Smyth Rd, Ottawa, ON K1H 8L1, Canada. Address e-mail to kmurto@cheo.on.ca. © 2018 International Anesthesia Research Society

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Opioid Omission Is Not Opioid Sparing. Response to “Surgery-Induced Opioid Dependence: Adding Fuel to the Fire?”

No abstract available

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Development and Initial Evaluation of a Novel, Ultraportable, Virtual Reality Bronchoscopy Simulator: The Computer Airway Simulation System

BACKGROUND: Virtual reality (VR) simulation is an effective and safe method of teaching bronchoscopic skills. Few VR bronchoscopy simulators exist; all are expensive. The present study aimed to describe the design, development, and evaluation of a new, affordable, VR bronchoscopy simulator. METHODS: Anesthesiologists and engineers collaborated to design and develop the Computer Airway Simulation System (CASS), an iPad-based, high-fidelity, VR bronchoscopy simulator. We describe hardware and software development, as well as the technical and teaching features of the CASS. Twenty-two senior anesthesiologists evaluated various aspects of the simulator (using a 5-point Likert scale) to assess its face validity. RESULTS: Anesthesiologists performed a simulated bronchoscopy (mouth to carina) with a median (range) procedural time of 66 seconds (30–96). The simulator's ease of use was rated 4.3 ± 0.8 and the bronchoscope proxy's handling 4.0 ± 0.7. Criticisms included that excessive system reactivity created handling difficulties. Anatomical accuracy, 3-dimensional bronchial segmentation, and mucosal texture were judged to be very realistic. The simulator's usefulness for teaching and its educational value were highly rated (4.9 ± 0.3 and 4.8 ± 0.4, respectively). CONCLUSIONS: We describe the design, development, and initial evaluation of the CASS—a new, ultraportable, affordable, VR bronchoscopy simulator. The simulator's face validity was supported by excellent assessments from senior anesthesiologists with regard to anatomical realism, quality of graphics, and handling performance, even though some future refinements are required. All the practitioners agreed on the significant educational potential of the CASS. Accepted for publication December 29, 2017. Funding: Cardiocentro Ticino's Department of Cardiac Anesthesia and Intensive Care in Lugano, Switzerland, employs Gabriele Casso and Tiziano Cassina. This institution received financial support for the CASS research and development project from the Foundation for Cardiological Research and Education and the FLAVA Foundation (Fondation Latine des Voies Aériennes), both charitable (not-for-profit) organizations. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Gabriele Casso, MD, Department of Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland. Address e-mail to gabriele.casso@cardiocentro.org. © 2018 International Anesthesia Research Society

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Follicular Thyroid Carcinoma in a Country of Endemic Iodine Deficiency (1994–2013)

Background. Follicular thyroid cancer (FTC) has historically been linked to iodine deficiency. Although Ghana is among the iodine deficient regions of the world, the proportions, trends, and the clinical features of FTCs have not been studied as a single disease entity. The aim of this study was to determine the relative frequencies, trends, and the clinicopathological characteristics of FTCs among all thyroid malignancies in our institution. Materials and Methods. This was a retrospective study from January 1994 to December 2013. Data were analysed using SPSS software version 23 (Chicago) and Graph pad prism version 5.00. Results. Follicular thyroid cancer was the second thyroid malignancy (35.0%) and showed a gradual rise in relative proportions over the period. The male-female ratio was 1 : 1.5. The mean ages were 46.9 (SD ±17.3) for males and 46.4 (SD ±13.3) years for females. Enlarged palpable anterior neck swelling was the commonest symptom in males (86.7%) and females (91.3%) (). Hurthle cell carcinoma was the commonest variant of FTC, with 26.7% males and 10.6% females (). Distant spread was found in 23.3% of males compared to 19.1% of females (). The common sites of distant spread were bones (57.2%) in males and cervical lymph nodes (44.4%) in females (). Conclusion. Follicular thyroid cancer was the second common thyroid malignancy (35.0%) with a gradual rise in trend over the study period and male-female ratio of 1.5 : 1. Large anterior neck swelling was the commonest clinical presentation of FTC.

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Laparoscopic repair of vesicovaginal fistulae with a transperitoneal approach at Universitas Gadjah Mada Urological Institute: a case report

A vesicovaginal fistula is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault. In addition, the sequelae f...

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Editorial Board

Publication date: March 2018
Source:Autoimmunity Reviews, Volume 17, Issue 3





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Value of the PET/CT 3D Visualization of Head and Neck Squamous Cell Carcinoma extended to Mandible

Publication date: Available online 24 February 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): R. Lopez, P. Gantet, A. Julian, A. Hitzel, B. Herbault-Barres, S. Alshehri, P. Payoux
PurposeTo study an original 3D visualization of head and neck squamous cell carcinoma extending to the mandible by using [18F]-NaF PET/CT and [18F]-FDG PET/CT imaging along with a new innovative FDG and NaF image analysis using dedicated software. The main interest of the 3D evaluation is to have a better visualization of bone extension in such cancers and that could also avoid unsatisfying surgical treatment later on.Patients and MethodsA prospective study was carried out from November 2016 to September 2017. Twenty patients with head and neck squamous cell carcinoma extending to the mandible (stage 4 in the UICC classification) underwent [18F]-NaF and [18F]-FDG PET/CT. We compared the delineation of 3D quantification obtained with [18F]-NaF and [18F]-FDG PET/CT. In order to carry out this comparison, a method of visualisation and quantification of PET images was developed. This new approach was based on a process of quantification of radioactive activity within the mandibular bone that objectively defined the significant limits of this activity on PET images and on a 3D visualization. Furthermore, the spatial limits obtained by analysis of the PET/CT 3D images were compared to those obtained by histopathological examination of mandibular resection which confirmed intraosseous extension to the mandible.ResultsThe [18F]-NaF PET/CT imaging confirmed the mandibular extension in 85% of cases and was not shown in [18F]-FDG PET/CT imaging. The [18F]-NaF PET/CT was significantly more accurate than [18F]-FDG PET/CT in 3D assessment of intraosseous extension of head and neck squamous cell carcinoma. This new 3D information shows the importance in the imaging approach of cancers. All cases of mandibular extension suspected on [18F]-NaF PET/CT imaging were confirmed based on histopathological results as a reference.ConclusionsThe [18F]-NaF PET/CT 3D visualization should be included in the pre-treatment workups of head and neck cancers. With the use of a dedicated software which enables objective delineation of radioactive activity within the bone, it gives a very encouraging results. The [18F]- FDG PET/CT appears insufficient to confirm mandibular extension. This new 3D simulation management is expected to avoid under treatment of patients with intraosseous mandibular extension of head and neck cancers. However, there is also a need for a further study that will compare the interest of PET/CT and PET/MRI in this indication.



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Differences and similarities in early vocabulary development between children with hearing aids and children with cochlear implant enrolled in 3-year auditory verbal intervention

Publication date: May 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 108
Author(s): Lone Percy-Smith, Maria Hallstrøm, Jane Lignel Josvassen, Jeanette Hølledig Mikkelsen, Lena Nissen, Eveline Dieleman, Per Cayé-Thomasen
ObjectiveThe overall objective of this study was to evaluate the implementation of a Nordic Auditory Verbal (AV) intervention for children with all degrees and types of hearing impairment (HI) using all kinds of hearing technology. A first specific objective was to identify differences and similarities in early vocabulary development between children with cochlear implant (CI) compared with children with hearing aids (HAs)/Bone anchored hearing aids (Bahs) enrolled in a 3-year AVprogram, and to compare the group of children with HI to a control group of children with normal hearing (NH). A second specific objective was to study universal neonatal hearing screening (UNHS) using the 1-3-6 Early Hearing Detection and Intervention (EHDI) guidelines.IntroductionEffect of AV intervention for children with HI using different hearing technology is not thoroughly studied. It is relevant to question, whether children with mild to moderate HI encounter the same intensive need for AV intervention as children with congenital deafness.MethodsA longitudinal and comparative study design was used involving two cohorts of children, i.e. 36 children with CI and 19 children with HA/Bahs. The children were the first in Denmark to receive a 3-year AV intervention by formally trained AV-practitioners. Children were tested annually with standardized speech and language tests, i.e. Peabody Picture Vocabulary test, Reynell test and a Danish test for active vocabulary, Viborgmaterialet. Categorical variables were compared using Fischer's exact test and continuous variables were compared using Wilcoxon-Mann-Whitney test, as data was not normally distributed.ResultsMedian age of diagnosis was 6 months and median age at intervention was 13 and 12 months respectively. There was no statistically significant difference between the two groups in terms of scores according to age equivalency for the three tests. However, there was a significant difference between children with HI regardless of hearing technology and children with NH.ConclusionChildren with HI progressed over a three-year period, but they did not reach the same level as children with NH. The high completion rate of 98,2% of families over a three-year period indicates the relevance of AV practice in a Nordic country. Children were diagnosed later than 3 months and intervention also started later than recommended. A result that warrants further investigation.



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Effectiveness of Systemic Treatments for Pyoderma Gangrenosum:A Systematic Review of Observational Studies & Clinical Trials

Summary

Background

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis with substantial morbidity. Currently, there is no consensus on gold-standard treatments.

Objectives

Our primary objective was to review the effectiveness of systemic therapy for PG.

Methods

We searched Cochrane Central, Cochrane DSR, EMBASE, MEDLINE, PubMed, and Web of Science for 24 systemic therapies for PG. Primary outcomes were complete healing and clinical improvement; secondary outcomes were time-to-healing and adverse effects.

Results

We found 3,326 citations, of which 375 articles underwent full-text review, and 41 studies met inclusion criteria. There were 704 participants amongst 26 retrospective cohort studies, 3 prospective cohort studies, 7 case series, 1 case-control study, 2 open-label trials, and 2 randomized controlled trials (RCT). Systemic corticosteroids were the most studied (n=32 studies), followed by cyclosporine (n=21), biologics (n=16), and oral dapsone (n=11). One RCT (STOP-GAP, n=121) showed that prednisolone and cyclosporine were similar, with 15-20% complete healing at 6-weeks and 47% at 6-months. Another RCT (n=30) found that infliximab was superior to placebo at 2-weeks (46% vs. 6% response), with 21% complete healing rate at 6-weeks. Two uncontrolled trials showed 60% and 37.5% healing in four months with canakinumab and infliximab, respectively; other data suggest that patients with concurrent IBD may benefit from biologics. The remaining studies were of poor quality and small sample sizes, though supported the use of corticosteroids, cyclosporine, and biologics.

Conclusions

Systemic corticosteroids, cyclosporine, infliximab, and canakinumab had the most evidence in treating PG. However, current literature is limited to small and lower-quality studies with substantial heterogeneity.

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Use of emollients and topical glucocorticoids among adolescents with eczema – datafrom the population-based birth cohort BAMSE

Summary

Background

Knowledge regarding how adolescents treat their eczema is sparse.

Objectives

To explore the use of emollients and topical glucocorticoids in adolescents with eczema in relation to sex and disease severity, and to study dispensing patterns of topical glucocorticoids.

Methods

Questionnaire-based data on symptoms of eczema, eczema severity and treatment with emollients and topical glucocorticoids were obtained from 3,108 adolescents in the Swedish population-based birth cohort BAMSE. Severity of reported eczema was evaluated with the BAMSE Eczema Severity Score (BESS) in a questionnaire and with the Patient-Oriented Eczema Measure in clinically examined subjects with current eczema (n = 247). Information on dispensed topical glucocorticoids was obtained from the Swedish Prescribed Drug Register.

Results

In all, 10% reported eczema in the preceding year: 73% mild, 17% moderate and 10% severe according to BESS. Almost all used emollients, whereas use of topical glucocorticoids was reported by 55%, with no significant difference between sexes. The likelihood of treatment with emollients and topical glucocorticoids increased when the adolescents had symptoms of current eczema (OR_Adj 5.95, 95% CI 1.90-18.8), but not if they had more severe eczema compared to mild eczema (OR_Adj 1.57, 95% CI 0.58-4.25). Among those with reported eczema, 24% had a topical glucocorticoid dispensed in the preceding year and among those with moderate to severe current eczema 25% had dispensed a potent topical glucocorticoid.

Conclusions

This population-based study indicates that adolescents with eczema are undertreated or completely untreated, even those with severe eczema.

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Novel in vivo observations of scrotal Nannizzia gypsea infection

Abstract

Tinea cruris is a common dermatophytosis, which usually firstly involved the intertriginous fold near the scrotum. Although dermatophytes may colonize the scrotum, they typically do not infect scrotal skin. However, tinea of scrotum is seldom reported as a specific type of Microsporum gypseum infection, presenting as white-paint-dot appearance, scutular-like or pseudomembranous-like lesions in immunocompromised or immunocompetent patients^1-6. According to the newest taxonomy, M. gypseum is now called Nannizia gypsea⁷. Herein we report novel in vivo observations of five cases of scrotal tinea caused by N. gypsea (formerly Microsporum gypseum) in immunocompetent patients.

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Association between childhood atopic dermatitis, cutaneous, extracutaneous and systemic infections

Abstract

Atopic dermatitis (AD) is associated with higher risk of skin infections. US population-based studies found that childhood AD is associated with increased risk of caregiver-reported extra-cutaneous infections. We sought to confirm whether AD in childhood is associated with increased rates of healthcare diagnosed cutaneous and extra-cutaneous infections.

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Unique clinical and serological features of bullous pemphigoid associated with dipeptidyl peptidase-4 inhibitors

Abstract

Recently, several cases of bullous pemphigoid (BP) associated with the use of a dipeptidyl peptidase-4 (DPP-4) inhibitor, a type of antihyperglycemic drug, have been reported (DPP4i-BP).^1,2 Béné reported a strong association between DPP-4 inhibitor use and the risk of BP.³ The juxtamembranous extracellular non-collagenous 16a (NC16a) domain of type XVII collagen (COL17, also termed BP180) is a major target epitope of autoantibodies in BP.⁴ A recent study found that BP cases whose autoantibodies bound to BP180 at regions other than NC16a exhibited a non-inflammatory phenotype with fewer erythemas. Intriguingly, half of these cases had taken DPP-4 inhibitors at the time of development of BP.⁵ In this study, we explored whether DPP4i-BP exhibited any unique clinical and serological features as suggested by the previous study.

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Tanning Addiction: Conceptualisation, Assessment, and Correlates

Abstract

Background

Research into problematic tanning (or 'tanning addiction') has markedly increased over the past few years. Although several excessive tanning instruments exist, most of these are psychometrically poor, not theoretically anchored, and have mainly been used on small samples.

Objective

Against this background, a new tanning addiction scale was developed based on a specific theoretical approach utilising core addiction criteria.

Methods

A scale comprising seven items (i.e. salience/craving, mood modification, tolerance, withdrawal, conflict, relapse/loss of control, and problems) was administered online to a cross-sectional convenience sample of 23,537 adults (M_age=35.8 years, SD=13.3), together with an assessment of demographic factors, the five-factor model of personality, and symptoms of obsessive-compulsive disorder, anxiety and depression.

Results

A confirmatory factor analysis showed that a one-factor model showed an optimal fit with the data collected (RMSEA=.050 [90% CI=.047–.053], CFI=.99, TLI=.99). High factor loadings (.781–.905, all p<.001) and coefficient omega indicator of reliability (ω=.941 [95% CI=.939–.944]) were also found using the new scale. In a multiple linear regression analysis, tanning addiction was positively associated with being female, not being in a relationship, extroversion, neuroticism, anxiety and obsessive-compulsiveness. It was also found that educational level, intellect/openness and depression were inversely associated with tanning addiction.

Conclusions

The new scale, Bergen Tanning Addiction Scale (BTAS), showed good psychometric properties, and is the first scale to fully conceptualise tanning addiciton within a contemporary addiction framework. Given this, the BTAS may potentially assist future clinical practice in providing appropriate patient care, prevention and disease management.

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Incidence and Prevalence of Rosacea: A Systematic Review and Meta-Analysis

Abstract

Background

The exact prevalence and incidence of rosacea remain unknown, although it is a common condition associated with severe non-cutaneous diseases. We performed a systematic review of published literature to examine the global incidence and prevalence of rosacea.

Methods

A systematic review of population-based studies reporting the incidence and/or prevalence of rosacea was performed using three electronic medical databases, PubMed, EMBASE, and Web of Science. Data were extracted, and a proportion meta-analysis was performed to obtain pooled proportions.

Results

A total of 32 studies were included examining a total of 41 populations with 26,519,836 individuals. 22 populations were from Europe, three from Africa, four from Asia, nine from North America, and three from South America. The pooled proportion of rosacea was 5.46% (95% CI 4.91-6.04) in the general population and 2.39% (95% CI 1.56-3.39) among dermatology outpatients. Self-reported rosacea gave higher prevalence estimates than rosacea diagnosed by clinical examination, suggesting a low specificity of questionnaires based on symptoms. Rosacea affected both women (5.41%, (CI 95% 3.85-7.23)) and men (3.90% (CI 95% 3.04-4.87)), and mostly those aged 45-60 years.

Conclusion

We estimated the global prevalence of rosacea based on published data and found that 5.46% of the adult population is affected. However, the prevalence of rosacea depended on the diagnostic method with higher estimates in questionnaire studies and lower estimates in health registries.

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Incidence of Sexual Dysfunction Among Patients with Hidradenitis Suppurativa: a population based retrospective analysis

Abstract

Given the devastating psychological impact of hidradenitis suppurativa (HS), and since the disease process commonly affects intimate body regions, patients with the disease may be at risk for sexual dysfunction (SD). While SD has been established among HS patients through qualitative studies using instruments not validated for this context,the burden of SD has not been described in a population of HS patients.

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Dysplastic features relevant to malignant transformation in atrophic epithelium of oral submucous fibrosis: a preliminary study

Abstract

Background

The grading of oral epithelial dysplasia (OED) is not applicable to oral submucous fibrosis (OSMF) cases due to the presence of atrophic epithelium. The mucosal margins associated with resected OSCC specimens are often closely related to transformed cells. In this study, we compared the histomorphological alterations (dysplastic features) in the atrophic epithelium of OSMF patients with the mucosal margins of OSCC associated with OSMF (OSCC-OSMF).

Methods

We evaluated 17 dysplastic features in 37 patients with OSMF (biopsy site: buccal mucosa) and 37 patients with OSCC-OSMF (mucosal margins involving buccal mucosa) using histopathological staining.

Results

Dysplastic features, such as keratin pearls within rete ridges, nuclear pleomorphism, and atypical mitotic figures, were not observed in the epithelium of the OSMF or OSCC-OSMF groups. Basal cell hyperplasia (p=0.016), abnormal superficial mitosis (p=0.010), increased nuclear-cytoplasmic ratio (p=0.034), and hyperchromasia (p=0.031) were predominantly seen in the OSCC-OSMF group. We found no statistically significant differences in the following parameters: irregular epithelial stratification (p=1.00), loss of basal cell polarity (p=0.237), presence of drop-shaped rete ridges (p=0.077), increased number of mitotic figures (p=0.154), premature keratinization in single cells (p=0.499), anisonucleosis (p=0.289), anisocytosis (p=0.079), cellular pleomorphism (p=0.317), and increased number and size of nucleoli (p=0.129).

Conclusion

Increased basal cell layer hyperplasia, abnormal superficial mitosis, increased nuclear-cytoplasmic ratio, and hyperchromasia are high-risk features for OSMF, and affected patients should be followed on a priority basis for the early detection of OSCC.

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Altered epigenetic pathways and cell cycle dysregulation in healthy appearing skin of patients with koebnerized squamous cell carcinomas following skin surgery

Abstract

Background

Koebnerized non-melanoma skin cancer following skin trauma represents a rare and obscure event.

Objectives

To study molecularpathological parameters in koebnerized squamous cell carcinomas (K-SCCs) occurring after complete tumour removal.

Methods

We assessed two patients with multiple sclerosis who were on treatment with dimethylfumarate (DMF) preceded by long-term azathioprine therapy. Both patients rapidly developed several K-SCCs following histopathologically proven complete excision of cutaneous SCCs. We performed immunohistochemistry for p53, p16, Ki-67, TET-2, IDH-2, 5-hmc, and 5-mc. PCR was carried out for the detection of human papilloma viruses. Mutation analysis was performed for BRAF, K-RAS, and EGFR.

Results

All lesions investigated were negative for HPV DNA. Mutations were not detected. Healthy appearing skin of both patients showed relatively high Ki-67, p16, and p53 expression which was comparable to the expression observed in primary SCCs as well as K-SCCs. Protein expression of Ki-67, p16, and mutant p53 was barely detected in the specimens of the healthy controls. A decreased protein expression of TET-2 enzyme was seen in all tumours and healthy appearing skin when compared to the skin of healthy controls.

Conclusions

We observed two patients with K-SCCs developing under DMF treatment. In healthy appearing skin of patients with K-SCCs, wound healing processes, including induction of proliferation and growth factor release, might promote the growth of pre-neoplastic keratinocytes and cancer formation on the basis of pre-existing altered epigenetic pathways and cell cycle dysregulation. Although fumarates can reduce TET-2 expression, the role of DMF intake in the development of K-SCCs remains unclear.

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The measurement of drug-induced interferon-γ releasing cells and lymphocyte proliferation in severe cutaneous adverse reactions

Abstract

Background

The lymphocyte transformation test (LTT) is a standard laboratory method to identify culprit drugs in patients with a history of drug-induced non-immediate hypersensitivity and is mainly performed during the recovery phase. The measurement of drug-specific interferon-γ (IFN-γ)-releasing cells has been introduced to confirm culprit drugs, even during the acute phase of drug allergy.

Objectives

This study aimed to evaluate the capability of the enzyme-linked immunospot assay (ELISpot) to detect drug-specific IFN-γ-releasing cells during the acute phase and the capability of LTT to identify culprit drugs during the recovery phase in patients presenting with severe cutaneous adverse reactions (SCARs).

Methods

Peripheral blood mononuclear cells (PBMCs) from 23 SCAR patients were collected during the acute and recovery phases and assayed for drug-specific IFN-γ-releasing cells and lymphocyte proliferation, respectively.

Results

Drug-specific IFN-γ releasing cells were detectable in 73.9% of SCAR subjects (55.6% and 85.7% in patients who were and were not taking systemic steroids, respectively), whereas LTT results were positive in 52.2% of SCAR subjects. The frequencies of drug-specific IFN-γ-releasing cells were significantly higher in patients with positive LTT than in those with negative LTT (260.1 ± 110.0 and 46.6 ± 20.7 cells/10⁶ PBMCs, P = 0.01). A significant correlation between the results of the IFN-γ ELISpot assay and LTT was demonstrated (r = 0.65, P value < 0.01).

Conclusion

The IFN-γ ELISpot assay could be a useful tool to identify culprit drugs in SCAR patients when culprit drug identification is urgently needed during the acute phase of drug allergy.

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CYLD mutations differentially affect splicing and mRNA decay in Brooke-Spiegler syndrome

Abstract

Brooke-Spiegler syndrome (BSS; OMIM 605041), also known as familial cylindromatosis (OMIM 132700), is an autosomal dominant tumour predisposition disorder characterised by the occurrence of cylindromas, trichoepitheliomas, and spiradenomas.BSS is caused by heterogenous mutations in the CYLD gene. To date, different CYLD mutations have been reported, most of them resulting in a premature termination codon (PTC).² Among these, thirteen splice site mutations have been described. However, it remains largely elusive how such mutations affect splicing.

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Papulopustular rosacea and rosacea-like demodicosis: two phenotypes of the same disease?

Abstract

Background

Papulopustular rosacea and rosacea-like demodicosis have numerous similarities but they are generally considered as two distinct entities, mainly because the causal role of the Demodex mite in the development of rosacea is not yet widely accepted. Several clinical characteristics are traditionally considered to differentiate the two conditions; for example, papulopustular rosacea is typically characterised by central facial papulopustules and persistent erythema, whereas small superficial papulopustules and follicular scales rather suggest rosacea-like demodicosis. However, none of these characteristics is exclusive to either entity.

Objective

To explore differences in Demodex densities according to clinical characteristics traditionally associated with these two conditions.

Methods

Retrospective, observational, case-control study of 242 patients with central face papulopustules. Demodex densities were measured on two consecutive standardised skin surface biopsies.

Results

In the whole cohort, Demodex densities were greater in patients with persistent erythema than in those without. In 132 patients without recent treatment or other facial dermatoses, 120 (91%) had persistent erythema, 119 (90%) small superficial papulopustules, and 124 (94%) follicular scales; 116 (88%) simultaneously had clinical characteristics traditionally associated with both papulopustular rosacea and rosacea-like demodicosis. Higher Demodex densities were linked to the presence of follicular scales, but not to papulopustules size, nor to the presence/absence of persistent erythema.

Conclusion

Our observations highlight the difficulty differentiating between these entities and suggest that rosacea-like demodicosis and papulopustular rosacea should no longer be considered as two separate entities, but rather as two phenotypes of the same disease.

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Influence of cigarette smoking on pemphigus:a systematic review and pooled analysis of the literature

Abstract

Epidemiological evidence suggests that smoking cigarettes may be beneficial in pemphigus, but no systematic evaluation exists to corroborate this assumption. Therefore, a systematic literature review with pooled data analysis of the smoking status in pemphigus patients was conducted. Electronic searches using PubMed from inception to November 2017 identified 13 reports meeting predetermined inclusion and exclusion criteria. Most were case-control studies partly reporting that pemphigus vulgaris and foliaceus occurred less frequently in current and former smokers. Studies also indicated that duration of smoking and number of cigarettes smoked was lower in pemphigus patients than controls and that remission may be achieved sooner in those who smoke. However, although a generally low prevalence of smoking was demonstrated in pemphigus patients, which was lower than in controls by pooled analysis, some investigations found no difference regarding the smoking status compared with non-pemphigus subjects. One study demonstrated more severe mucosal involvement in non-smoking pemphigus patients, whereas another observed no difference in the rate of cutaneous or mucosal lesions between smokers and non-smokers with pemphigus. This review indicates that smoking may be a possible protective factor in pemphigus, although some compromised study methodologies yet hinder any firm conclusion. Further investigations with a refined quality design are required to resolve the so far partly conflicting results in this area.

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Alternative test models for skin aging research

Abstract

Increasing ethical concerns regarding animal experimentation have led to the development of various alternative methods based on the 3Rs (Refinement, Reduction, and Replacement), first described by Russell and Burch in 1959. Cosmetic and skin aging research are particularly susceptible to concerns related to animal testing. In addition to animal welfare reasons, there are scientific and economic reasons to reduce and avoid animal experiments. Importantly, animal experiments may not reflect findings in humans mainly because of the differences of architectures and immune responses between animal skin and human skin. Here we review the shift from animal testing to the development and application of alternative non-animal based methods and the necessity and benefits of this shift. Some specific alternatives to animal models are discussed, including biochemical approaches, two-dimensional and three-dimensional cell cultures, and volunteer studies, as well as future directions, including genome-based research and the development of in silico computer simulations of skin models. Among the in vitro methods, three-dimensional reconstructed skin models are highly popular and useful alternatives to animal models however still have many limitations. With careful selection and skillful handling, these alternative methods will become indispensable for modern dermatology and skin aging research.

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