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Acne Keloidalis Nuchae: A Staged Reconstruction. Cureus 2021; 13:e18173. [PMID: 34692352 PMCID: PMC8526067 DOI: 10.7759/cureus.18173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/28/2022] Open
Abstract
Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis that affects the occipital area. It is characterized by papule and pustule formation which eventually leads to tumor-like mass. Early cases can be managed by medical treatment that may require months, and, usually, lesions recur. In more severe cases, surgical excision is the mainstay of treatment. In our case, we proposed a staged approach when dealing with advanced stages of AKN. This includes deep excision of the lesion down to deep subcutaneous tissue with application of negative-pressure wound therapy (NPWT) for a week followed by resurfacing of the resultant defect with a split-thickness skin graft and NPWT for another week. This approach achieved quicker wound healing with no recurrence compared with other techniques such as healing by secondary intention. To our knowledge, this case is one of the most extensive cases published in the literature.
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878 Optimizing Follow Up for Melanoma Patients: Are We Meeting NICE Guidance? Br J Surg 2021. [DOI: 10.1093/bjs/znab259.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
St. George’s University Hospitals NHS Foundation Trust is a designated tertiary referral Centre for all skin cancers serving a population of 3.5 million in and around South West London. It has an international reputation for its management of melanoma cases. All melanoma patients need frequent follow up visits for a long period of time which may extend to more than 10 years. Many aspects should be included when following up these patients including clinical assessment, laboratory, and radiological evaluation.
Aim
The aim of this project is to assess the quality of laboratory follow up of melanoma patients focusing on optimizing vitamin D level.
Method
We performed a retrospective review of cutaneous melanoma patients in 2019. Laboratory standards for follow up of vitamin D level was identified from NICE guidance 2015. After introduction of a condensed guide, a second review was performed in 2020.
Results
In the first cycle, 63 patients were included. Only 47% of them had their Vitamin D levels checked at time of diagnosis. Follow up check for vitamin D level was only done in 36%. Following introduction of guidance, 36 patients have been included. Significant improvement in both parameters with rate of 65% and 96% respectively.
Conclusions
Although we managed to improve our adherence to NICE guidance, more effort is still needed to improve all patients' care. We are willing to conduct a qualitative survey asking staff to explore their obstacles.
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3
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35 Refined phenotyping methods for the equine cardiac startle response. J Equine Vet Sci 2021. [DOI: 10.1016/j.jevs.2021.103498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Systematic functional analysis of Leishmania protein kinases identifies regulators of differentiation or survival. Nat Commun 2021; 12:1244. [PMID: 33623024 PMCID: PMC7902614 DOI: 10.1038/s41467-021-21360-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/13/2021] [Indexed: 01/31/2023] Open
Abstract
Differentiation between distinct stages is fundamental for the life cycle of intracellular protozoan parasites and for transmission between hosts, requiring stringent spatial and temporal regulation. Here, we apply kinome-wide gene deletion and gene tagging in Leishmania mexicana promastigotes to define protein kinases with life cycle transition roles. Whilst 162 are dispensable, 44 protein kinase genes are refractory to deletion in promastigotes and are likely core genes required for parasite replication. Phenotyping of pooled gene deletion mutants using bar-seq and projection pursuit clustering reveal functional phenotypic groups of protein kinases involved in differentiation from metacyclic promastigote to amastigote, growth and survival in macrophages and mice, colonisation of the sand fly and motility. This unbiased interrogation of protein kinase function in Leishmania allows targeted investigation of organelle-associated signalling pathways required for successful intracellular parasitism.
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Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Aggressive digital papillary adenocarcinoma and sentinel node biopsy: A case report and literature review. JPRAS Open 2020; 24:43-46. [PMID: 32373694 PMCID: PMC7195495 DOI: 10.1016/j.jpra.2020.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/05/2020] [Indexed: 02/02/2023] Open
Abstract
Aggressive digital papillary adenocarcinomas (ADPA) are malignant tumours of the sweat gland. Due to the high tendency to recur and metastasise, wide local resection of the lesion is recommended. However, there are a limited number of cases reporting the use of sentinel node biopsy in the management of ADPA, thus its effectiveness remains unclear. We present a case of ADPA of the right middle finger treated with digital amputation and sentinel node biopsy, and review the current literature focusing on the usefulness of sentinel node biopsy.
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Climate adaptation for rural water and sanitation systems in the Solomon Islands: A community scale systems model for decision support. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 714:136681. [PMID: 31986388 DOI: 10.1016/j.scitotenv.2020.136681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 01/12/2020] [Accepted: 01/12/2020] [Indexed: 06/10/2023]
Abstract
Delivering water and sanitation services are challenging in data poor rural settings in developing countries. In this paper we develop a Bayesian Belief Network model that supports decision making to increase the availability of safe drinking water in five flood-prone rural communities in the Solomon Islands. We collected quantitative household survey data and qualitative cultural and environmental knowledge through community focus group discussions. We combined these data to develop our model, which simulates the state of eight water sources and ten sanitation types and how they are affected by season and extreme events. We identify how climate and current practices can threaten the availability of drinking water for remote communities. Modelling of climate and intervention scenarios indicate that water security could be best enhanced through increased rainwater harvesting (assuming proper installation and maintenance). These findings highlight how a systems model can identify links between and improve understanding of water and sanitation, community behaviour, and the impacts of extreme events. The resultant BBN provides a tool for decision support to enhance opportunities for climate resilient water and sanitation service provision.
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Release of extracellular vesicle miR-494-3p by ARPE-19 cells with impaired mitochondria. Biochim Biophys Acta Gen Subj 2020; 1865:129598. [PMID: 32240720 DOI: 10.1016/j.bbagen.2020.129598] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/31/2020] [Accepted: 03/09/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Mitochondrial function in retinal pigmented epithelial (RPE) cells and extracellular vesicle (EV) formation/release are related through the lysosomal and exocytotic pathways that process and eliminate intracellular material, including mitochondrial fragments. We propose that RPE cells with impaired mitochondria will release EVs containing mitochondrial miRNAs that reflect the diminished capacity of mitochondria within these cells. METHODS We screened ARPE-19 cells for miRNAs that localize to the mitochondria, exhibit biological activity, and are present in EVs released by both untreated cells and cells treated with rotenone to induce mitochondrial injury. EVs were characterized by vesicle size, size distribution, presence of EV biomarkers: CD81, CD63, and syntenin-1, miRNA cargo, and number concentration of EVs released per cell. RESULTS We found that miR-494-3p was enriched in ARPE-19 mitochondria. Knockdown of miR-494-3p in ARPE-19 cells decreased ATP production and mitochondrial membrane potential in a dose-dependent manner, and decreased basal oxygen consumption rate and maximal respiratory capacity. Increased number of EVs released per cell and elevated levels of miR-494-3p in EVs released from ARPE-19 cells treated with rotenone were also measured. CONCLUSIONS ARPE-19 mitochondrial function is regulated by miR-494-3p. Elevated levels of miR-494-3p in EVs released by ARPE-19 cells indicate diminished capacity of the mitochondria within these cells. GENERAL SIGNIFICANCE EV miR-494-3p is a potential biomarker for RPE mitochondrial dysfunction, which plays a central role in non-neovascular age-related macular degeneration, and may be a diagnostic biomarker for monitoring the spread of degeneration to neighboring RPE cells in the retina.
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Current role of sentinel lymph node biopsy in the management of cutaneous melanoma: A UK consensus statement. J Plast Reconstr Aesthet Surg 2020; 73:36-42. [DOI: 10.1016/j.bjps.2019.06.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 06/09/2019] [Indexed: 10/26/2022]
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10
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Cartilage-like composition of keloid scar extracellular matrix suggests fibroblast mis-differentiation in disease. Matrix Biol Plus 2019; 4:100016. [PMID: 33543013 PMCID: PMC7852214 DOI: 10.1016/j.mbplus.2019.100016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 02/08/2023] Open
Abstract
Following wound damage to the skin, the scarring spectrum is wide-ranging, from a manageable normal scar through to pathological keloids. The question remains whether these fibrotic lesions represent simply a quantitative extreme, or alternatively, whether they are qualitatively distinct. A three-way comparison of the extracellular matrix (ECM) composition of normal skin, normal scar and keloids was performed using quantitative discovery-based proteomics. This approach identified 40 proteins that were significantly altered in keloids compared to normal scars, and strikingly, 23 keloid-unique proteins. The major alterations in keloids, when functionally grouped, showed many changes in proteins involved in ECM assembly and fibrillogenesis, but also a keloid-associated loss of proteases, and a unique cartilage-like composition, which was also evident histologically. The presence of Aggrecan and Collagen II in keloids suggest greater plasticity and mis-differentiation of the constituent cells. This study characterises the ECM of both scar types to a depth previously underappreciated. This thorough molecular description of keloid lesions relative to normal scars is an essential step towards our understanding of this debilitating clinical problem, and how best to treat it.
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11
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Risk of cardiovascular disease in women with and mutations. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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12
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Surveillance testing and cancer outcomes among endometrial cancer patients with Lynch syndrome. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Lynch syndrome in women with endometrial cancer: Comparison of universal and age-based strategies in a California healthcare system. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Racial disparities in physician directed decision making to perform immunohistochemistry testing among women with endometrial cancer. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Quality of life in women with mutations. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Characteristics and management of women with CHEK2 truncating versus missense mutations after hereditary breast and ovarian cancer gene testing. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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The successful treatment of metastatic androgen receptor-positive tumours of parotid origin with androgen receptor blockade and immunotherapy. Eur J Cancer 2019; 113:14-18. [PMID: 30954882 DOI: 10.1016/j.ejca.2019.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/12/2019] [Accepted: 03/08/2019] [Indexed: 11/26/2022]
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18
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Risk stratification of sentinel node positive melanoma patients defines surgical management and adjuvant therapy treatment considerations. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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19
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Friends/family in the abortion procedure room (fair): assessing pain level, patient, staff and support person satisfaction with support person in abortion procedure room: a randomized controlled trial. Contraception 2018. [DOI: 10.1016/j.contraception.2018.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Plaque-like Myofibroblastic Tumor: 2 Cases of This Unusual Dermal Tumor Which Occurs in Infancy and Early Childhood. Pediatr Dev Pathol 2018; 21:444-448. [PMID: 29224420 DOI: 10.1177/1093526617746807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Plaque-like myofibroblastic tumor (PLMT) is a rare dermal spindle cell tumor which occurs in infancy or childhood within the first 4 years of life. The tumor is often pruritic and mostly presents on the lower back. We describe 2 cases with characteristic clinical and histological features of this entity, thus adding to the 10 cases which have so far been reported. Histologically, the lesion resembles a dermatofibroma. However, diffuse and uniform immunohistochemical staining with smooth muscle actin favors a myofibroblastic lineage. PLMT should be considered in the differential diagnosis of a dermal spindle cell tumor in the pediatric age-group.
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21
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Salpingectomy for ovarian cancer prevention at the time of cesarean delivery: Comparison of outcomes of surgical technique. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Collection of fallopian tube cytology using a novel hysteroscopic tubal catheter. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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23
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Does the addition of vaginal brachytherapy to adjuvant chemotherapy for stage I-II uterine serous carcinoma improve recurrence-free and overall survival? Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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24
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Option grids in melanoma: An underused tool. J Plast Reconstr Aesthet Surg 2017; 71:763-764. [PMID: 29233506 DOI: 10.1016/j.bjps.2017.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
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25
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Optimizing Second Line Chemotherapy in Germline BRCA Positive Patients with Platinum Sensitive Recurrent Ovarian Cancer. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.07.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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26
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Impact of Intra-peritoneal Chemotherapy and Bevacizumab in Front Line Chemotherapy for Ovarian Cancer Among gBRCA and wtBRCA Patients: A Multi-Institutional, Frequency Matched, Case Control Study. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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RISK-ADAPTED THERAPY IN ADULTS WITH BURKITT LYMPHOMA: UPDATED RESULTS OF a MULTICENTER PROSPECTIVE PHASE II STUDY OF DA-EPOCH-R. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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The influence of citrate and oxalate on 99Tc VII, Cs, Np V and U VI sorption to a Savannah River Site soil. JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2017; 172:130-142. [PMID: 28351009 DOI: 10.1016/j.jenvrad.2017.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/07/2017] [Accepted: 03/11/2017] [Indexed: 06/06/2023]
Abstract
Batch sorption experiments were conducted with 0.5-50 ppb 99Tc, 133Cs, 237Np and U in the presence and absence of citrate and/or oxalate in a 25 g/L Savannah River Site (SRS) soil suspension. Citrate and oxalate were the ligands of choice due to their relevancy to plant exudates, the nuclides were selected for their wide range of biogeochemical behavior, and the soil from SRS was selected as a model Department of Energy (DOE) site soil. Batch samples were continually mixed on a rotary shaker and maintained at a pH of approximately 5. Analysis via ICP-MS indicated that sorption of 237Np increased with ligand concentration compared to baseline studies, as did sorption of 99Tc although to a lesser extent. The increased sorption of 237Np is proposed to be due to a combination of factors that are dependent on the ligand(s) present in the specific system including, ligand dissolution of the soil by citrate and formation of tertiary soil-oxalate-Np complexes. The increased 99Tc sorption is attributed to the dissolution of the soil by the ligands, leading to an increase in the number of available sorption sites for 99Tc. Uranium sorption decreased and dissolution of native uranium was also observed with increasing ligand concentration, thought to be a result of the formation of strong U-ligand complexes remaining in the aqueous phase. The majority of these effects were observed at the highest ligand concentrations of 50 mgC/L. No notable changes were observed for the 133Cs system which is ascribed to the minimal interaction of Cs+ with these organic ligands.
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Electrochemotherapy in the treatment of metastatic malignant melanoma: a prospective cohort study by InspECT. Br J Dermatol 2017; 176:1475-1485. [DOI: 10.1111/bjd.15340] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 12/16/2022]
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30
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B-25The Impact of Traumatic Brain Injury and Heavy Weapons Blast Exposure on Neuropsychological Functioning in the Military. Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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31
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Are U.S. physicians performing salpingectomy? Experience with incorporation of opportunistic salpingectomy in a large community-based health system. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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32
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A-60The Interaction between Gender and PTSD on the Outcome From Military Related Mild Traumatic Brain Injury. Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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33
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Long-term outcomes in BRCA1/2 carriers who undergo risk-reducing salpingo-oophorectomy. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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34
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Is VTE prophylaxis overkill? A comparison of VTE incidence in robotic and laparoscopic surgeries for endometrial cancer. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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35
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36
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Risk management options elected by women after testing positive for a BRCA1 or BRCA2 variant of unknown significance mutation. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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37
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To Mohs or not to Mohs. J Plast Reconstr Aesthet Surg 2014; 67:23-6. [DOI: 10.1016/j.bjps.2013.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/24/2013] [Accepted: 08/28/2013] [Indexed: 10/26/2022]
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38
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Hot or not? The 10% rule in sentinel lymph node biopsy for malignant melanoma revisited. J Plast Reconstr Aesthet Surg 2013; 67:316-9. [PMID: 24290978 DOI: 10.1016/j.bjps.2013.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/03/2013] [Accepted: 11/12/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The surgeon needs a practical rule to follow when deciding whether to excise a lymph node during sentinel node biopsy (SLNB). The "10% rule" dictates that all nodes with a radiation count of greater than 10% of the hottest node and all blue nodes should be removed, and this study observes the effects of following this rule in SLNB in melanoma. METHODS We reviewed the records of 665 patients with primary melanoma who underwent sentinel lymph node over a 5-year period (2007-2011). RESULTS 2064 nodes were identified in 898 nodal basins in 665 patients. 141 (21%) patients had at least one positive sentinel node. 105 positive nodal basins were identified in which more than one sentinel node was removed. In 18 of these, a less radioactive node was positive for tumour when the most radioactive node was negative. Of 175 positive nodes 157 (90%) contained blue dye staining. For cases in which the positive sentinel node was not the hottest node, the positive node had apparent blue dye staining in all 18 cases (100%), and was the second hottest node in the basin. CONCLUSION In this series removing just the hottest node and all blue nodes would not have missed a single positive basin and would have resulted in a 38% reduction in the number of nodes removed compared to those taken following the 10% rule, without changing the staging in any patient.
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Biomechanical evaluation of fixation properties of fibrin glue for ventral incisional hernia repair. Hernia 2013; 19:161-6. [DOI: 10.1007/s10029-013-1163-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 09/14/2013] [Indexed: 11/28/2022]
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40
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Comparing coordinated versus sequential salpingo-oophorectomy for BRCA1 and BRCA2 mutation carriers with breast cancer. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Objectives: The objective of the article is to explore the surgical practices and views in the treatment of melanoma within members and non-members of the EORTC Melanoma Group (MG) during the years 2003–2005. Methods: An e-mail questionnaire (see appendix) developed within the EORTC MG was sent to all melanoma units (MUs) of the EORTC (180) and to selected international centres between 2003 and 2005. The questionnaire investigated the different practices regarding surgical management of melanoma patients at all stages. Results: A total of 75 questionnaires were returned from centres in Europe (70), Israel (3), Australia (1) and the United States (1). Resection margins on primary melanoma vary according to AJCC 2002 staging. Sixty three of 75 MUs perform Sentinel node biopsy. Modified radical neck dissection is performed in 82% of MUs for macrometastases and in 80% of MUs for micrometastases. Most MUs surveyed perform all three levels of Berg axillary dissection whether for macrometastases (79%) or micrometastases (62%). An ilio inguinal-obturator dissection is proposed with macrometastases (41% of MUs), whereas 33% of MUs perform a pelvic dissection only if the Cloquet node is positive. Twenty five of 75 MUs perform an isolated limb perfusion with a therapeutic indication; three also as an adjuvant. The majority of MUs perform surgery for distant metastases including superficial (53 of 75 [71%]) or solitary visceral metastases (52 of 75[69%]) or for palliation (58 of 75[77%]). Conclusion: The adequacy of surgery appears to be the most important milestone in the therapeutic approach of melanoma. Even if surgery is fundamental in the different stages of the disease, there is quite a variability concerning the extension of the surgical treatment related to primary and lymphnodal disease. Phase III randomised trials have shown that wide margins, elective lymph node dissections, and prophylactic isolated limb perfusions have not improved survival and cannot be considered the standard of care in the routine management of primary melanoma. The surgical subgroup of the EORTC Melanoma Group is developing a new version of the surgical survey questionnaire including new treatment modalities like isolated limb infusion and electrochemotherapy, which were not frequently in use some years ago, to obtain new data to be compared to the nearly ten-year-old data.
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The diagnostic role of procalcitonin in quinine-induced disseminated intravascular coagulation. Anaesth Intensive Care 2013; 41:131-132. [PMID: 23362913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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When should pelvic sentinel lymph nodes be harvested in patients with malignant melanoma? J Plast Reconstr Aesthet Surg 2012; 65:85-90. [DOI: 10.1016/j.bjps.2011.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Accepted: 08/11/2011] [Indexed: 10/17/2022]
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Technique and outcomes of isolated limb infusion for locally advanced malignant melanoma — A radiological perspective. Clin Radiol 2011; 66:1175-80. [DOI: 10.1016/j.crad.2011.07.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 07/11/2011] [Accepted: 07/18/2011] [Indexed: 10/17/2022]
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Dental examiners consistency in applying the ICDAS criteria for a caries prevention community trial. COMMUNITY DENTAL HEALTH 2011; 28:238-242. [PMID: 21916361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM To examine dental examiners' one-year consistency in utilizing the International Caries Detection and Assessment System (ICDAS) criteria after baseline training and calibration. METHODS A total of three examiners received baseline training/calibration by a "gold standard" examiner, and one year later re-calibration was conducted. For the baseline training/calibration, subjects aged 8-16 years, and for the re-calibration subjects aged five to six years were recruited for the study. The ICDAS criteria were used to classify visual caries lesion severity (0-6 scale), lesion activity (active/inactive), and presence of filling material (0-9 scale) of all available tooth surfaces of permanent and primary teeth. The examination used a clinical light, mirror and air syringe. Kappa (weighted: Wkappa, unweighted: Kappa) statistics were used to determine inter-and intra-examiner reliability at baseline and re-calibration. RESULTS For lesion severity and filling criteria, the baseline calibration on 35 subjects indicated an inter-rater Wkappa ranging from 0.69-0.92 and intra-rater Wkappa ranging from 0.81-0.92. Re-calibration on 22 subjects indicated an inter-rater Wkappa of 0.77-0.98 and intra-rater Wkappa ranged from 0.93-1.00. The Wkappa for filling was consistently in the excellent range, while lesion severity was in the good to excellent range. Activity kappa was in the poor to good range. All examiners improved with time. CONCLUSIONS The baseline training/calibration in ICDAS was crucial to maintain the stability of the examiners reliability over a one year period. The ICDAS can be an effective assessment tool for community-based clinical trials.
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The digital age: a new trick. Ann R Coll Surg Engl 2011. [PMID: 21477455 DOI: 10.1308/003588411x12851639107395m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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The digital age: a new trick. Ann R Coll Surg Engl 2011; 93:264. [DOI: 10.1308/rcsann.2011.93.3.264b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
The authors present two patients referred by colleagues after traumatic hand injury. However, upon closer inspection, both patients had pigmented lesions under the nail bed, which upon biopsy showed proven subungual malignant melanoma. The authors wish to emphasise the importance of this diagnosis, especially in emergency care.
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Abstract
BACKGROUND To optimise predictive models for sentinal node biopsy (SNB) positivity, relapse and survival, using clinico-pathological characteristics and osteopontin gene expression in primary melanomas. METHODS A comparison of the clinico-pathological characteristics of SNB positive and negative cases was carried out in 561 melanoma patients. In 199 patients, gene expression in formalin-fixed primary tumours was studied using Illumina's DASL assay. A cross validation approach was used to test prognostic predictive models and receiver operating characteristic curves were produced. RESULTS Independent predictors of SNB positivity were Breslow thickness, mitotic count and tumour site. Osteopontin expression best predicted SNB positivity (P=2.4 × 10⁻⁷), remaining significant in multivariable analysis. Osteopontin expression, combined with thickness, mitotic count and site, gave the best area under the curve (AUC) to predict SNB positivity (72.6%). Independent predictors of relapse-free survival were SNB status, thickness, site, ulceration and vessel invasion, whereas only SNB status and thickness predicted overall survival. Using clinico-pathological features (thickness, mitotic count, ulceration, vessel invasion, site, age and sex) gave a better AUC to predict relapse (71.0%) and survival (70.0%) than SNB status alone (57.0, 55.0%). In patients with gene expression data, the SNB status combined with the clinico-pathological features produced the best prediction of relapse (72.7%) and survival (69.0%), which was not increased further with osteopontin expression (72.7, 68.0%). CONCLUSION Use of these models should be tested in other data sets in order to improve predictive and prognostic data for patients.
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Abstract
PURPOSE To use gene expression profiling of formalin-fixed primary melanoma samples to detect expression patterns that are predictive of relapse and response to chemotherapy. EXPERIMENTAL DESIGN Gene expression profiles were identified in samples from two studies (472 tumors). Gene expression data for 502 cancer-related genes from these studies were combined for analysis. RESULTS Increased expression of DNA repair genes most strongly predicted relapse and was associated with thicker tumors. Increased expression of RAD51 was the most predictive of relapse-free survival in unadjusted analysis (hazard ratio, 2.98; P = 8.80 × 10(-6)). RAD52 (hazard ratio, 4.73; P = 0.0004) and TOP2A (hazard ratio, 3.06; P = 0.009) were independent predictors of relapse-free survival in multivariable analysis. These associations persisted when the analysis was further adjusted for demographic and histologic features of prognostic importance (RAD52 P = 0.01; TOP2A P = 0.02). Using principal component analysis, expression of DNA repair genes was summarized into one variable. Genes whose expression correlated with this variable were predominantly associated with the cell cycle and DNA repair. In 42 patients treated with chemotherapy, DNA repair gene expression was greater in tumors from patients who progressed on treatment. Further data supportive of a role for increased expression of DNA repair genes as predictive biomarkers are reported, which were generated using multiplex PCR. CONCLUSIONS Overexpression of DNA repair genes (predominantly those involved in double-strand break repair) was associated with relapse. These data support the hypothesis that melanoma progression requires maintenance of genetic stability and give insight into mechanisms of melanoma drug resistance and potential therapies.
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