The Use of Integra Dermal Regeneration Template Versus Flaps for Reconstruction of Full-Thickness Scalp Defects Involving the Calvaria: A Cost-Benefit Analysis.

BACKGROUND: INTEGRA® Dermal Regeneration Template is a well-known and widely used acellular dermal matrix. Although it helps to solve many challenging problems in reconstructive surgery, the product cost may make it an expensive alternative compared to other reconstruction procedures. This retrospective study aims at comparing INTEGRA-based treatment to flap surgery in terms of cost and benefit. PATIENTS AND METHODS: We considered only patients treated for scalp defects with bone exposure in order to obtain two groups as homogeneous as possible. We identified two groups of patients: 17 patients treated with INTEGRA and 18 patients treated with flaps. All patients were admitted in our institution between 2004 and 2010, and presented a defect of the scalp following trauma or surgery for cancer, causing a loss of the soft tissues of the scalp with bone exposure without pericranium. To calculate the cost in constant euros of each treatment, three parameters were evaluated for each patient: cost of the surgical procedure (number of doctors and nurses involved, surgery duration, anesthesia, material used for surgery), hospitalization cost (hospitalization duration, dressings, drugs, topical agents), and outpatient cost (number of dressing changes, personnel cost, dressings type, anti-infective agents). The statistical test used in this study was the Wilcoxon Mann-Whitney (α = 0.05). RESULTS: No significant difference was characterized between the two groups for gender, age, presence of diabetes, mean defect size, and number of surgical procedures. All patients healed with good quality and durable closure. The median total cost per patient was €11,121 (interquartile range (IQR) 8327-15,571) for the INTEGRA group and €7259 (IQR 1852-24,443) for the flap group (p = 0.34). A subgroup of patients (six patients in the INTEGRA group and five patients in the flap group) showing defects larger than 100 cm2 were considered in a second analysis. Median total cost was €11,825 (IQR 10,695-15,751) for the INTEGRA group and €23,244 (IQR 17,348-26,942) for the flap group. CONCLUSION: Both treatments led to a good healing of the lesions with formation of soft and resistant tissue. No significant difference was characterized between the two groups for days of hospitalization and costs. In cases of patients with defects larger than 100 cm2 for whom major surgery is needed, the treatment with INTEGRA seemed to be less expensive than the treatment with free flaps or pedicle flaps. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A5 online Instructions to Authors. www.springer.com/00266 .

Exploration of cluster structure-activity relationship analysis in efficient high-throughput screening.

Sequential screening has become increasingly popular in drug discovery. It iteratively builds quantitative structure-activity relationship (QSAR) models from successive high-throughput screens, making screening more effective and efficient. We compare cluster structure-activity relationship analysis (CSARA) as a QSAR method with recursive partitioning (RP), by designing three strategies for sequential collection and analysis of screening data. Various descriptor sets are used in the QSAR models to characterize chemical structure, including high-dimensional sets and some that by design have many variables not related to activity. The results show that CSARA outperforms RP. We also extend the CSARA method to deal with a continuous assay measurement.

Gigantomastia during pregnancy: a case report.

Gigantomastia during pregnancy is a rare occurrence that is usually resolved by postpartum involution or surgical reduction. The authors present a patient that illustrates rapid enlargement of the breast that caused decreased fetal growth and skin breakdown, and ultimately resulted in total surgical removal of the breast tissue and reconstruction.

Crude extracts of asteraceous weeds : Growth inhibitors for variegated cutworm.

Petrol and ethanolic extracts of six asteraceous weeds were added to artificial diets to screen for growth inhibition and mortality of the variegated cutworm,Peridroma saucia (Hbn). Petrol and ethanolic extracts ofArtemisia tridentata andChamomilla suaveolens and ethanolic extracts ofChrysothamnus nauseosus andCentaurea diffusa severely inhibited larval growth at five times the natural concentrations. The twoC. suaveolens extracts and the ethanol extract ofA. tridentata were active at the natural concentration (100%) and were further examined at 20, 40, 60, and 80% of this level. Inhibition of larval growth was directly related to concentration for each of the three extracts tested. EC50s (effective concentration to inhibit growth by 50% relative to controls) for the three extracts were 36-42% of the naturally occurring level in the plants. Nutritional indices were calculated for secondinstarP. saucia feeding on the activeA. tridentata EtOH extract and the petrol extract fromC. suaveolens. Addition of the activeA. tridentata EtOH or theC. suaveolens petrol extract to the diet resulted in significant reduction in the relative growth rate of larvae, although theA. tridentata extract was much more inhibitory. Dietary utilization was significantly lower for larvae fed theA. tridentata EtOH extract.

Comparison of tissues adjacent to different mechanical stress areas from patients with clinically failed implants.

Implants consisting of metallic and polymeric components are used to treat musculoskeletal diseases. At revision surgery, significant wear products maybe recovered from tissues adjacent to failed implants. The failing implant is clinically associated with pain, and radiographic analysis demonstrates deterioration of the bone surrounding the implant. There is concern that areas of high contact stresses and articulating surfaces lead to the generation of wear particles that trigger a biological response that mediates the lysis of bone. This study compares the tissues retrieved from various areas exposed to different mechanical stresses. Tissues were processed for biochemical and immunohistochemical factors (cytokines) responsible for bone resorption. The results from this study showed by both quantitative enzyme linked immunoassay and qualitatively by immunohistology a marked increase in cytokines, interleukin-1 and tumor necrosis factor, in areas of articulation compared to other areas. Evaluation of tissues histochemically demonstrated the presence of fibroblast, macrophages, and multinucleated giant cells. Overall, the results indicate that the generation of wear particles lead to the production of biological mediators responsible for the failure of the implants.