The objective of trainee recruitment is to identify candidates likely to perform well as trainees and subsequent faculty. The effectiveness of this process has not been established. The goal of this study was to identify trainee selection criteria predictive of excellent performance.
Transoral robotic surgery (TORS) has emerged as a technique that allows head and neck surgeons to safely resect large and complex oropharyngeal tumors without dividing the mandible or performing a lip-split incision. These resections provide a reconstructive challenge because the cylinder of the oropharynx remains closed and both physical access and visualization of oropharyngeal anatomy is severely restricted. Transoral robotic reconstruction (TORRS) of such defects allows the reconstructive surgeon to inset free flaps or perform adjacent tissue transfer while seeing what the resecting surgeon sees. Early experience with this technique has proved feasible and effective. Robotic reconstruction has many distinct advantages over conventional surgery, and offers patients a less morbid surgical course. In this review, we discuss the clinical applicability of transoral robotic surgery in head and neck reconstruction, highlighting the benefits and limitations of such an approach, and outlining the guidelines for its utilization.
Harvest of the rectus abdominis muscle requires an abdominal incision as well as violation of the anterior rectus sheath, creating the potential for significant surgical-site morbidity (bulges, hernias, infections, seromas). Laparoscopic or endoscopic techniques, although feasible, have not become popular among plastic surgeons due to multiple technical shortcomings. Robotic surgery on the other hand has an easier learning curve, enhanced precision, tremor elimination, motion scaling, high resolution, three-dimensional optics and an intuitive interface. As a result of these advantages, robotic surgery has permeated into the plastic surgery specialty, assuming a role in the harvest of the latissimus dorsi muscle flap and other reconstructive procedures. In this review, the authors discuss its applicability in the harvest of the rectus abdominis muscle.
Patients with sickle cell disease are known to have recurrent lower extremity ulcers that have a high pain score and are resistant to conventional means of wound therapy. This study reports the successful use of synthetic heparan sulphate (Cacipliq20(®) , OTR3, Paris, France) in the treatment of a sickle cell ulcer that had failed to respond to several other means of treatment. Therapeutic success was assessed by complete wound coverage and vast improvement in pain score. This is the first study to report use of heparan sulphate in sickle cell ulcers.
Tocochromanols are recognized for nutritional content, plant stress response, and seed longevity. Here we present a systems biological approach to characterize and develop predictive assays for genes affecting tocochromanol variation in barley. Major QTL, detected in three regions of a SNP linkage map, affected multiple tocochromanol forms. Candidate genes were identified through barley/rice orthology and sequenced in genotypes with disparate tocochromanol profiles. Gene-specific markers, designed based on observed polymorphism, mapped to the originating QTL, increasing R2 values at the respective loci. Polymorphism within promoter regions corresponded to motifs known to influence gene expression. Quantitative PCR analysis revealed a trend of increased expression in tissues grown at cold temperatures. These results demonstrate utility of a novel method for rapid gene identification and characterization, and provide a resource for efficient development of barley lines with improved tocochromanol profiles.
Stem cells are "big business" throughout medical technology, and their potential application in cosmetic procedures is no exception. One of the latest nonsurgical facial treatments (and new catchphrases) in plastic surgery is the "stem cell facelift." It is evident from the currently available scientific literature that the use of stem cell therapy for facial rejuvenation is limited to the theoretical induction of skin tightening and can in no way be equated to a facelift. In fact, what is advertised and promoted as a new and original technique of stem cell facelifting is mostly stem cell-enriched lipofilling. Despite encouraging data suggesting that adult stem cells hold promise for future applications, the data from clinical evidence available today do not substantiate the marketing and promotional claims being made to patients. To claim that the "stem cell facelift" is a complete facial rejuvenation procedure surgery is unethical.
A physically anchored consensus map is foundational to modern genomics research; however, construction of such a map in oat (Avena sativa L., 2n?=?6x?=?42) has been hindered by the size and complexity of the genome, the scarcity of robust molecular markers, and the lack of aneuploid stocks. Resources developed in this study include a modified SNP discovery method for complex genomes, a diverse set of oat SNP markers, and a novel chromosome-deficient SNP anchoring strategy. These resources were applied to build the first complete, physically-anchored consensus map of hexaploid oat. Approximately 11,000 high-confidence in silico SNPs were discovered based on nine million inter-varietal sequence reads of genomic and cDNA origin. GoldenGate genotyping of 3,072 SNP assays yielded 1,311 robust markers, of which 985 were mapped in 390 recombinant-inbred lines from six bi-parental mapping populations ranging in size from 49 to 97 progeny. The consensus map included 985 SNPs and 68 previously-published markers, resolving 21 linkage groups with a total map distance of 1,838.8 cM. Consensus linkage groups were assigned to 21 chromosomes using SNP deletion analysis of chromosome-deficient monosomic hybrid stocks. Alignments with sequenced genomes of rice and Brachypodium provide evidence for extensive conservation of genomic regions, and renewed encouragement for orthology-based genomic discovery in this important hexaploid species. These results also provide a framework for high-resolution genetic analysis in oat, and a model for marker development and map construction in other species with complex genomes and limited resources.
Advances in microsurgical techniques and immunomodulatory protocols have contributed to the expansion of vascularized composite allotransplantation (VCA) with very encouraging immunological, functional, and cosmetic results. Rejection remains however a major hurdle that portends serious threats to recipients. Rejection features in VCA have been described in a number of studies, and an international consensus on the classification of rejection was established. Unfortunately, current available diagnostic methods carry many shortcomings that, in certain cases, pose a great diagnostic challenge to physicians especially in borderline rejection cases. In this review, we revisit the features of acute skin rejection in hand and face transplantation at the clinical, cellular, and molecular levels. The multiple challenges in diagnosing rejection and in defining chronic and antibody-mediated rejection in VCA are then presented, and we finish by analyzing current research directions and novel concepts aiming at improving available diagnostic measures.
Congenital hemidysplasia with ichthyosiform nevus and limb defects (CHILD) syndrome is a rare X-linked hereditary disorder. Presentation varies from ichthyosiform nevus to complete limb amelia. We present a 17-year-old adolescent girl who presented with a 16-cm exophytic mass of the right foot that had been growing for 7 years as well as knee contracture. Deformed nails with onychorrhexis were noted bilaterally. History of multiple nonlinear erythematous skin lesions covered by dry waxy scales involving multiple body folds with sharp midline demarcation was obtained. The patients family history was negative for consanguinity and similar conditions. Radiography showed right leg hypoplasia and osteopenia. These findings fulfill the diagnosis of CHILD syndrome. Microscopically, psoriasiform epidermal hyperplasia with marked orthohyper-keratosis and neutrophilic exocytosis were noted. The papillary dermis was packed with foamy macrophages consistent with xanthomatous changes, namely verruciform xanthoma. Verruciform xanthoma, although rarely found in other conditions, is a characteristic finding.
Scars hypertrophy and widen when stretching mechanical forces are applied to resilient newly formed collagen before it reaches final maturity marring the final result of many surgical procedures and resulting in a clinical problem for many patients. Scar revision by surgical excision remains the traditional treatment for hypertrophic or widespread scars. It relies upon recruitment of local tissues for closure of the ensuing defect. Providing tension-free skin closure is the best option to avoid recurrence. Although tissue expansion procedure is a valuable and reliable technique for scar revision, it has its own disadvantages and potential complications. We describe an alternative method for scar revision that may be applicable in certain situations. Instead of expanding the soft tissues to make available additional skin, deflation by liposuction may be affected to relax the skin envelope thus indirectly providing additional skin for scar revision. We call this method reverse tissue expansion.
The project SAMPLE evaluated methods for measuring particle properties in the exhaust of aircraft engines with respect to the development of standardized operation procedures for particulate matter measurement in aviation industry. Filter-based off-line mass methods included gravimetry and chemical analysis of carbonaceous species by combustion methods. Online mass methods were based on light absorption measurement or used size distribution measurements obtained from an electrical mobility analyzer approach. Number concentrations were determined using different condensation particle counters (CPC). Total mass from filter-based methods balanced gravimetric mass within 8% error. Carbonaceous matter accounted for 70% of gravimetric mass while the remaining 30% were attributed to hydrated sulfate and noncarbonaceous organic matter fractions. Online methods were closely correlated over the entire range of emission levels studied in the tests. Elemental carbon from combustion methods and black carbon from optical methods deviated by maximum 5% with respect to mass for low to medium emission levels, whereas for high emission levels a systematic deviation between online methods and filter based methods was found which is attributed to sampling effects. CPC based instruments proved highly reproducible for number concentration measurements with a maximum interinstrument standard deviation of 7.5%.
Delayed hematoma associated with breast implants, whether for reconstructive or aesthetic purposes, is a rare entity. Most reported cases have been intracapsular. Although several mechanisms for delayed hematoma have been proposed, its exact etiology and mechanism of formation are not yet fully understood. The authors present a unique case of hematoma formation 5 years after breast reconstruction with a textured anatomic cohesive gel breast implant. The patient experienced severe thrombocytopenia secondary to chemotherapy, which most probably was the triggering etiologic factor. The hematoma was both intra- and extracapsular. The authors speculate that the retrocapsular hematoma component was due to firm adhesion of the textured prosthetic membrane to the posterior capsule and propose that for breast reconstruction with prosthetic implants in patients likely to receive chemotherapy, a smooth implant might be better indicated.
The attenuation coefficient of the water body is not directly retrievable from measurements of unpolarized water-leaving radiance. Based on extensive radiative transfer simulations using the vector radiative transfer code RayXP, it is demonstrated that the underwater degree of linear polarization (DoLP) is closely related to the attenuation-to-absorption ratio (c/a) of the water body, a finding that enables retrieval of the attenuation coefficient from measurements of the Stokes components of the upwelling underwater polarized light field. The relationship between DoLP and the c/a ratio is investigated for the upwelling polarized light field for a complete set of viewing geometries, at several wavelengths in the visible part of the spectrum; for varying compositions of the aquatic environment, whose constituents include phytoplankton, non-algal particles, and color dissolved organic matter (CDOM); and for varying microphysical properties such as the refractive index and the slope of the Junge-type particle size distribution (PSD). Consequently, this study reveals the possibility for retrieval of additional inherent optical properties (IOPs) from air- or space-borne DoLP measurements of the water-leaving radiation.
Trichilemmal cysts are common benign soft tissue tumors that occur in hairy areas, especially the scalp, where they present themselves as solitary masses that could be easily treated by surgical excision followed by pathologic identification. It is unusual to find these benign masses in very large numbers in 1 scalp. In the current article, we describe a 43-year-old woman who presented with 51 scalp masses, some of which recurred after repetitive excisions somewhere else by different surgeons under local anesthesia. These masses involved only the scalp and spared all the face. The patient presented to our clinic for a radical solution to clear her scalp from the unaesthetic look and appearance that forbid her from exposing her head and for hygienic reasons relating to the foul smell of repeated previous recurrences and infections. Her clinical presentation is described, and the suggested differential diagnosis and management for such a patient is discussed.
Despite the availability of antiretroviral therapy (ART), suboptimal treatment outcomes have been observed among HIV-seropositive illicit drug users. As there is an urgent need to improve responses to antiretroviral therapy among this population, we undertook this study to evaluate the role of physician experience on rates of plasma HIV-1 RNA suppression following initiation of ART.
This case report describes a complication caused by cooling pads used for therapeutic hypothermic resuscitation. The authors hope to highlight and emphasize the importance of a thorough evaluation of all skin surfaces that are in direct contact with such cooling pads. Skin injury from the cooling pads used for therapeutic hypothermia should be recognized as a potential complication of treatment.
The optimal concentration of mafenide acetate solution for use in the treatment of burns is unknown. Despite data supporting the use of a 2.5% solution, 5% formulation is traditionally used, and has been the highest-costing medication on formulary. The aim of the current study is to evaluate cost and patient outcomes associated with a new policy implementing the use of 2.5% solution in burn patients and restricting the 5% formulation to specific indications only. A retrospective review of all patients receiving mafenide acetate solution at a single pediatric burn hospital was performed before and after the initiation of the new policy on the use of 5 vs 2.5% solution. Duration of therapy, adverse events, cost, incidence of wound infection, and bacteremia were analyzed. In 2009, 69 patients were treated with 5% mafenide acetate solution for a total cost of $125,000 ($1811 per patient). In 2010, after the initiation of the policy, 48 patients were treated: 19 received 5% mafenide acetate solution with appropriate indication, whereas the remaining 29 received 2.5% solution for a total cost of $38,632 ($804 per patient). There were no significant changes in the incidence of bacteremia or wound infection. No side effects of either solution were noted. Under certain conditions, a 2.5% mafenide acetate solution appears sufficient. In this multinational pediatric burn hospital, the use of a 2.5% solution was not associated with increased bacteremia or wound infection, and proved to be more cost-effective.
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