Excision pathways for keratinocyte cancers diagnosed by teledermatology: a retrospective review.

Introduction The New Zealand population has one of the highest incidences of skin cancer in the world. Hospital waiting lists for surgical excision of keratinocytic skin cancers (basal cell carcinoma and squamous cell carcinoma) are lengthy, and increasingly, excisions are undertaken in primary care. Teledermatology, in response to general practitioners' electronic referrals (e-referrals), can improve clinical communication between general practitioners and dermatologists. Aim The aim of this study was to evaluate an excision pathway for keratinocytic cancers diagnosed by teledermatology. Methods A retrospective observational descriptive review of a 3-month cohort of primary care e-referrals was undertaken. Results Three hundred and fifty eight suspected keratinocytic cancers (KCs) were diagnosed by teledermatology; histology reports confirmed KC in 201 of 267 excisions (75%). The majority (77.2%) were excised by general practitioners an average of 25 days after the dermatologist's recommendation. The rest were excised by plastic surgeons in private (3.4%) or at a public hospital (19.5%) after an average of 40 or 134 days, respectively. Discussion E-referral pathways are now widely implemented. However, the ideal workflow for skin cancer management is unknown. We have demonstrated in New Zealand that surgery can be undertaken in primary care within a month of a teledermatology diagnosis and excision recommendation. Conclusion This study reports prompt excision of KCs by general practitioners after an e-referral and a teledermatology response.

Proposing a sustainable urban 3D model to minimize the potential risk associated with green infrastructure by applying engineering tools.

The goal of this study is to estimate the potential risk of exposure to urban green infrastructure by calculating and improving of AIROT index, adding meteorological factors as wind direction and updating the index to be more accurate for smaller urban green areas. To achieve this objective, BIM methodology has been applied by creating a 3D BIM model from the reality capture of a street with LiDAR. The BIM model contains the parametric data needed to apply AIROT index and it allows to map results in a graphic environmental sustainability study. The importance of location of green infrastructure is one of main conclusions obtained in order to minimize aerobiological risks in future new buildings or even in maintenance tasks of urban green infrastructure. A valuable result obtained from the developed methodology are walk simulations in the 3D model with the aim to identify high risk of potential exposure of urban green infrastructure with allergenic interest for allergic patients in order to supply health itineraries of pedestrians in a proposal of Smart City.

Efficacy of manual lymph drainage and myofascial therapy in patients with fibromyalgia : A systematic review.

INTRODUCTION: Fibromyalgia is a chronic disease of unknown origin characterized by widespread pain, fatigue, disordered sleep and joint stiffness among other symptoms. OBJECTIVE: To compare outcomes of manual lymph drainage and myofascial therapy in patients with fibromyalgia. METHODS: This was a systematic review. The databases PubMed/MEDLINE, CINAHL, SCOPUS, ScieLo, PEDro, Dialnet, Web of Science, and Elsevier were searched for articles in English or Spanish examining the efficacy of myofascial therapy and/or manual lymph drainage to treat fibromyalgia. Of 356 articles extracted, sixteen articles and one doctoral thesis fulfilled the criteria established for inclusion. RESULTS: The methodological quality of the studies reported in the articles was good (PEDro score 7.49 ± 1.47). The studies included compared different treatments with lymph drainage and/or myofascial therapy. Outcomes indicated improved quality of life for both therapies in all the studies. CONCLUSIONS: Myofascial therapy and lymph drainage may be effective in patients with fibromyalgia. Further work is needed as the scientific evidence available is still insufficient.

ΔNp73 status in peritoneal and ovarian dissemination of appendicular adenocarcinoids (goblet cells).

INTRODUCTION: Goblet cell carcinoma (GCC) is an appendicular neoplasia representing less than 5% of all appendicular tumors, found in 0.3-0.9% of the appendectomies, 35-58% of all appendicular neoplasms, and less than 14% of malign appendix tumors. The most frequent clinical presentation is abdominal pain associated with a picture of acute appendicitis. MATERIALS AND METHODS: We present 3 clinical cases of appendix GCC, 2 subjected to cytoreductory surgery plus intraperitoneal hyperthermic chemotherapy and a third, who is currently receiving neoadjuvant treatment with a good response to chemotherapy and who will be offered the same treatment as the first two patients. Given the unpredictable behavior of these tumors, the use of molecular markers could help us to predict their behavior and prognosis. In this context, the TP73 gene would make an interesting putative marker. ∆Np73 has been described as overexpressed in a great variety of tumor types including colon cancer and this up-regulation is associated with a poor prognosis. To evidence its role in this malignancy, we evaluate here the status of ∆Np73 in the primary tumor and normal counterpart tissues, in the metastatic implants and in healthy areas of the peritoneum from the appendicular GCC patients. In addition, we checked the expression levels of this p73 variant in the tumor and normal tissue of 26 patients with colon cancer. RESULTS: Remarkably, 2 patients showed significant ∆Np73 down-regulation in both the primary tumor and the implants. Case 1 presented a fourfold decrease of levels in the primary tumor and 20-fold decrease in the implants. Case 2 showed a seven- and fourfold down-regulation in the primary tumor and implants, respectively. However, Case 3 showed an up-regulation of 53- and threefold in the primary tumor and implants, respectively. CONCLUSION: Goblet cell carcinoma of the appendix is very rate. It tends to seed throughout the peritoneum, making aggressive surgical cytoreduction and chemotherapy viable treatment options. Investigation into the molecular basis of these tumors may improve the diagnosis, prognosis and therapeutic decisions regarding these patients. ∆Np73 seems a good candidate for further analysis in longer series.

Beam-induced oxidation of mixed-valent Fe (oxyhydr)oxides (green rust) monitored by STEM-EELS.

Analytical transmission electron microscopy (TEM) is often used to investigate morphologies, crystal structures, chemical compositions and oxidation states of highly reactive mixed-valent mineral phases. Of prime interest, due to its potential role in toxic metal remediation, is green rust sulphate (GRSO4) an FeII-FeIII layered double hydroxide. In this study, we quantified the effects that TEM analysis has on GRSO4 in order to ensure the measured material properties are a result of synthesis and reaction kinetics, and not due to sample preparation and analysis technique. To do this, we compared two sample preparation techniques (anoxic drop-cast with drying, and frozen-hydrated cryogenic) and exposed samples to the electron beam for several minutes, acquiring fluence series between ca. 40 e- Å-2 and 10,000 e- Å-2. TEM imaging and electron diffraction showed that the hexagonal plate-like morphology and crystal structure of GRSO4 were largely unaffected by sample preparation and analysis technique. However, quantitative analysis of a series of monochromated Fe L3,2-edge electron energy loss spectra (EELS) showed that electron irradiation induces oxidation. We measured an Fe(II)/Fe(III) ratio of 1.94 (as expected for GRSO4) at 50 e- Å-2. However, above this fluence, the ratio logarithmically decreased and dropped to ca. 0.5 after 1000 e- Å-2. This trend was approximately the same for both sample preparation techniques implying that it is the beam alone which causes valence state changes, and not exposure to oxygen during transfer into the TEM or the vacuum of the TEM column. Ultimately this work demonstrates that GR valence can be quantified by EELS provided that the sample is not over exposed to electrons. This also opens the possibility of quantifying the effect of redox-sensitive toxic metals (e.g., As, Cr, Se) on Fe oxidation state in GR phases (relevant to the treatment of contaminated soils and water) with a higher spatial resolution than other techniques (e.g., Mössbauer spectroscopy).

Synthesis and characterization of microparticles based on poly-methacrylic acid with glucose oxidase for biosensor applications.

In the line of the applicability of biocompatible monomers pH and temperature dependent, we assayed poly-methacrylic acid (p-MAA) microparticles as immobilization system in the design of enzymatic biosensors. Glucose oxidase was used as enzyme model for the study of microparticles as immobilization matrices and as biological material in the performance of glucose biosensors. The enzyme immobilization method was optimized by investigating the influence of monomer concentration and cross-linker content (N',N'-methylenebisacrylamide), used in the preparation of the microparticles in the response of the biosensors. The kinetics of the polymerization and the effects of the temperature were studied, also the conversion of the polymerization was determinates by a weight method. The structure of the obtained p-MAA microparticles were studied through scanning electron microscopy (SEM) and differential scanning microscopy (DSC). The particle size measurements were performed with a Galai-Cis 1 particle analyzer system. Furthermore, the influence of the swelling behavior of hydrogel matrix as a function of pH and temperature were studied. Analytical properties such as sensitivity, linear range, response time and detection limit were studied for the glucose biosensors. The sensitivity for glucose detection obtained with poly-methacrylic acid (p-MAA) microparticles was 11.98mAM(-1)cm(-2) and 10µM of detection limit. A Nafion® layer was used to eliminate common interferents of the human serum such as uric and ascorbic acids. The biosensors were used to determine glucose in human serum samples with satisfactory results. When stored in a frozen phosphate buffer solution (pH 6.0) at -4°C, the useful lifetime of all biosensors was at least 550 days.

Association of the FTO gene SNP rs17817449 with body fat distribution in Mexican women.

Polymorphisms in the FTO gene are associated with obesity, body mass index, hip circumference, and visceral and subcutaneous fat area. The objective of this study was to analyze the association of the FTO rs17817449 genetic variant (T>G polymorphism) with body fat distribution patterns in women. We included 65 women and 71 healthy subjects in this study. Anthropometric parameters were determined and laboratory studies were performed. The polymorphism was detected by a PCR-RFLP method. The groups were categorized by type of body fat distribution: gynoid (N = 29) and android (N = 36). We found that the FTO gene polymorphism was not associated with body fat distribution according to the type of obesity (P > 0.05). The contribution of G and T alleles among groups indicated no statistically significant differences between the reference and gynoid group [P = 0.93; odds ratio (OR) = 0.97; 95% confidence interval (CI) = 0.46-2.02] and the reference and android group (P = 0.56; OR = 1.20; 95%CI = 0.54-2.82). Thorax circumference and thorax breast circumference were significantly different between the two groups (P = 0.009 and 0.021, respectively) with the genotype TT. We conclude that the FTO rs17817449 TT genotype predisposes individuals to fat deposition in the thoracic and breast region; individuals carrying this genotype had a decrease in thoracic and breast dimensions indirectly causing the gynoid phenotype in Mexican women.

Potencial de remineralización ultraestructural del vidrio bioactivo versus fluoruro estañoso / Ultrastructural remineralization potential of stannous fluoride versus bioactive glass

Esta investigación fue determinar el potencial de remineralización a nivel ultraestructural del vidrio bioactivo (VBio) en comparación al producido por el fluoruro estañoso (FSn). Se recolectaron 10 molares humanos del servicio CAMIULA. Se dividieron en 4 partes con sierra de precisión: Grupo A (Superficie no tratada control), Grupo B (Superficie desmineralizada control), Grupo C (Superficie con VBio), Grupo D (Superficie con FSn). Los grupos B, C, D fueron sometidos a desmineralizaron en una solución acuosa de metilcelulosa al 8% (1500cP, 63 kDa) cubierta con un volumen igual de 0.1 mol/1 de acido láctico, pH ajustado con KOH; por un periodo de 5 días a un pH de 4.6 a 37 ºC. Posteriormente el Grupo C fue sometido a régimen de remineralización con Biogran® (Biomet 3iTM) a una concentración de 5wT% 2 veces al día por 15 días; igualmente el Grupo D se sometió de fluoruro estañoso Gel Kam (Colgate Palmolive®) al 0,4% 2 veces al día por 15 días. Las muestras de cada grupo fueron preparadas para SEM y para el análisis de elementos mediante EDS (O, P, Ca, Sn y Si). Los datos del EDS se analizaron con ANOVA Univariante para la diferencia en el porcentaje de elementos en 2 niveles (Elementos, Tratamiento). Los datos del SEM para las variables disminución de poros (DP) y espacios (DE) en función del tratamiento con prueba del chi-cuadrado (X2) , del paquete estadístico SPSS 19. El valor de alfa fue establecido en 0.05. La diferencia en el porcentaje de elementos promedio de cada elemento y la desviación estándar (±SD) se muestran a continuación: Grupo VBio: O= -0,89 (6,19); P= -0,39 (1,26); Ca 0,99 (5,19); Si 0,07 (0,09) y Grupo FSn: O= -5,97 (8,4); P= -1,16 (1,4); Ca -5,14 (3,95); Sn 12,19 (5,66). El ANOVA, nivel Tratamiento p= 0,977, sin diferencias significativas. El nivel Elementos el valor de p= 0,000, con diferencias significativas. La variable DP con IC: 95%= 34,65 - 93,5% en ambos tratamientos, el X2 p=1 sin diferencias significativas...

To determine the potential for remineralization at an ultraestructural level of Bioactive glass (VBio) when compared to stannous fluoride (FSn). 10 human molars were collected from CAMIULA (a dentistry service of the University of Los Andes, Venezuela). The teeth were divided in four parts with a precision saw: Group (untreated surface - control), Group B (demineralized surface - control), Group C (Surface with VBio), Group D (Surface with FSn). Groups B, C and D were submitted to demineralization in a 8% metilcelulose aqueous solution (1500cP, 63 kDa) covered with an equal volume of 0.1 mol/1 of lactic acid, with an adjusted pH with KOH at 4.6 a 37 ºC for a 5-days period. Later, Group C was exposed to a remineralization regime with Biogran® (Biomet 3iTM) at a 5wT% concentration twice a day 2 for 15 days. Likely, Group D was exposed to a regime with stannous fluoride Gel Kam (Colgate Palmolive®) at 0,4% 2 twice a day for 15 days. The samples from each group were prepared for SEM and the elements analysis through EDS (O, P, Ca, Sn y Si). Data from EDS were analyses with Univariant ANOVA for the difference in the percentage of elements at two levels (Elements, Treatment). Data from SEM for the variables porosity diminish and spaces (DP and DE, respectively) in relation to treatment with Chi Squared X2 , by using the statistics package SPSS 19. Significance level was established at 0.05. Differences in the percentage of average elements of each element and standard deviation (±SD) were as follow: VBio Group: O= -0,89 (6,19); P= -0,39 (1,26); Ca 0,99 (5,19); if 0,07 (0,09) and FSn Group: O= -5,97 (8,4); P= -1,16 (1,4); Ca -5,14 (3,95); Sn 12,19 (5,66). ANOVA results showed treatment level p= 0,977, with no statistically significant differences. The Elements there were statistically significant differences (p= 0,000). The variable DP with IC: 95%= 34, 65 - 93,5% for both treatment; X2 p=1 showed no statistically significant differences....

[Blast lung injuries]. / Lésions pulmonaires liées aux explosions.

In armed conflicts and during terrorist attacks, explosive devices are a major cause of mortality. The lung is one of the organs most sensitive to blasts. Thus, today it is important that every GP at least knows the basics and practices regarding treatment of blast victims. We suggest, following a review of the explosions and an assessment of the current threats, detailing the lung injuries brought about by the explosions and the main treatments currently recommended.

Amperometric glucose biosensor based on biocompatible poly(dimethylaminoethyl) methacrylate microparticles.

Glucose oxidase (GOx) has been immobilized within poly(dimethylamino) ethyl methacrylate (p-DMAEM) microparticles which were subsequently used as biological material in the fabrication of a glucose biosensor. The enzyme immobilization method was optimized in relation with the monomer concentration and cross-linker content. It was found that the best biosensor response corresponds to microparticles synthesized with 1.19M monomer and 0.37% cross-linking content. Furthermore, the influence on the biosensor response of parameters such as working potential, pH, temperature, and loaded enzyme were investigated. In addition, analytical properties such as sensitivity, linear range, response time, and detection limit were determined. The biosensor was used to analyze glucose in human serum samples with satisfactory results. The useful lifetime of the biosensor is at least 520 days.

[Assessment of the usefulness to use a software supervising continuous infusion rates of drugs administered with pumps in ICU and estimation of the frequency of rate of administration errors]. / Description de la prévention et estimation de la fréquence des erreurs de programmation de vitesse d'administration en continu des médicaments en réanimation par une application informatique.

OBJECTIVES: To assess the usefulness and the feasibility to use a software supervising continuous infusion rates of drugs administered with pumps in ICU. STUDY DESIGN: Follow-up of practices and inquiry in three intensive care units. MATERIAL: Guardrails software(TM) of reassurance of the regulations of the rates of pumps (AsenaGH, Alaris). METHODS: First, evaluation and quantification of the number of infusion-rates adjustments reaching the maximal superior limit (considered as infusion-rate-errors stopped by the software). Secondly, appreciate the acceptance by staffs to such a system by a blinded questionnaire and a quantification of the number of dataset pumps programs performed with the software. RESULTS: The number of administrations started with the pumps of the study in the three services (11 beds) during the period of study was 63,069 and 42,694 of them (67.7 %) used the software. The number of potential errors of continuous infusion rates was 11, corresponding to a rate of infusion-rate errors of 26/100,000. KCl and insulin were concerned in two and five cases, respectively. Eighty percent of the nurses estimated that infusion-rate-errors were rare or exceptional but potentially harmful. Indeed, they considered that software supervising the continuous infusion rates of pumps could improve safety. CONCLUSION: The risk of infusion-rate-errors of drugs administered continuously with pump in ICU is rare but potentially harmful. A software that controlled the continuous infusion rates could be useful.

Encapsulation of glucose oxidase within poly(ethylene glycol) methyl ether methacrylate microparticles for developing an amperometric glucose biosensor.

Poly(ethylene glycol) methyl ether methacrylate (PEGMEM) microparticles were synthesized and glucose oxidase (GOx) was immobilized within the microparticles. An amperometric biosensor was fabricated using the microparticles with GOx as biological component. The enzyme immobilization method was optimized by investigating the influence of monomer concentration and cross-linker content used in the preparation of the microparticles in the response of the biosensor. The best analytical results were obtained with the microparticles prepared with 0.21 M PEGMEM and 0.74% cross-linking. Furthermore, we have investigated the influence on the biosensor behaviour of parameters such as working potential, pH, temperature and enzymatic load. In addition, analytical properties such as sensitivity, linear range, response time and detection limit were determined. The biosensor was used to determine glucose in human serum samples and to avoid common interferents present in human serum such as uric and ascorbic acids. A Nafion layer was deposited on the electrode surface with satisfactory results. The useful lifetime of the biosensor was at least 520 days.

[Thrombotic thrombocytopenic purpura: a case report]. / Le purpura thrombotique thrombocytopénique: à propos d'un cas.

We report a case of thrombotic thrombocytopenic purpura (TTP) in a 60 years-old woman with Sjogren's syndrome. Symptomatology on admission leads to evoke the diagnosis of TTP. Biological results allow to set the diagnosis. Actually, association of haemolytic anaemia, schizocytes and thrombocytopenia are in favour of TTP. Undetectable ADAMTS 13 activity (below 5%) confirms the diagnosis. In congenital TTP, plasma ADAMTS 13 is absent or severely reduced as a consequence of mutations in the two ADAMTS 13 gene. In acquired TTP, circulating antibodies inhibit plasma ADAMTS 13 activity. In those cases, further biological studies are needed to find a cause of TTP. Follow-up implies standard laboratory tests. Plasma exchanges are progressively tapered after normalization of platelets count.

[Mamba envenomation in mainland France: management of exotic envenomations needs rethinking]. / Envenimation cobraïque en France métropolitaine : repenser la prise en charge des envenimations exotiques.

We report a case of accidental green mamba (Dendroaspis viridis) envenomation in the suburbs of Paris. Although moderate, neurotoxic symptoms were clearly present. Immunotherapy with polyvalent serum FAV-Afrique was decided, but logistical problems prevented reasonably quick serum delivery to the hospital. Despite a spontaneously favourable outcome probably due to minimal envenomation, this case exemplifies a near-miss of the care system. Given the increasing incidence of potentially life-threatening exotic envenomations, management of similar cases should be improved. Besides breeders and health care professionals' information, we suggest that victims of an exotic envenomation be referred to a facility with experienced staff and ready access to a limited bank of carefully chosen antivenins.

[Paraspecific antivenins and exotic bites of snakes: about two case reports]. / Antivenins paraspécifiques et morsures de serpents exotiques : à propos de deux cas cliniques.

Envenomation from bite of exotic snakes is rare in France and represent a serious therapeutic problem: only an adapted antivenom is effective and obtaining such a treatment is a real difficulty. The authors report two clinical cases of envenomation with defibrination after bite by pit vipers from South America. The two patients were treated with nonspecific antivenom therapy with divergent results. The use of the paraspecific effects of antivenom can allow an effective treatment in the absence of specific antivenom, but requires to be known better.

[How the drug allergy risk in the intensive care software is considered? About a comparative study]. / Comment est pris en compte le risque allergique dans les logiciels spécifiques à la réanimation ? A propos d'une étude comparative.

The aim of this study was to evaluate the way the drug allergy risk was considered in five intensive care software available for the French market. It is an observational study conducted by a survey with the five firms asked during the 26th International Symposium on Intensive Care and Emergency Medicine in Brussels (March 2006). The drug allergic risk is documented to various degrees among the software selections. However, no software proposes an alternative or blocking of the prescription in case of allergy to a drug.

[Use of rFVIIa (Novoseven) in the case of a patient with mitral valvular prothesis and anticoagulant accident]. / Utilisation du rFVIIA (Novoseven) lors d'un accident des anticoagulants chez une patiente porteuse d'une prothèse valvulaire mitrale.

We report the case of an haemorrhagic shock observed in a woman who received heparin for a cardiac valve in mitral position, efficiently treated with rFVIIa. The haemorrhagic complications under anticoagulation treatment remain rare, but can lead to real therapeutic dilemma. The use of rFVIIa has been evaluated in different clinical situations, including traumatic or post-operative haemorrhagic shock. The use of rFVIIa in the treatment of haemorrhagic complication under anticoagulation treatment is discussed.

[Treatment of a septic shock due to multiresistant Acinetobacter baumannii with tigecycline in combination]. / Traitement d'un choc septique à Acinetobacter baumannii multirésistant par tigécycline en association.

We report a case of pulmonary and bloodstream infection due to multiresistant Acinetobacter baumannii six days after a severe trauma. Clinical condition transiently improved following antimicrobial treatment with ticarcillin-clavulanate and rifampicin. However, a septic shock developed on the fourth day due to the emergence of a strain only sensible to cotrimoxazole, colistin and tigecycline. Cure was achieved after a two week treatment with piperacillin-tazobactam, cotrimoxazole and tigecycline. This case shows that combined antimicrobial therapy including tigecycline can be relevant in some severe pulmonary infections due to multiresistant A. baumannii.