A case report of extremely severe 93% total body surface area burns in a 5-year-old boy.

BACKGROUND: Large surface area burns with concurrent severe burn sepsis are a rare phenomenon, particularly when the wounds are closed in a short timeframe. CASE REPORT: This study describes a 5-year-old patient with 93% total body surface area (TBSA) burns and severe burn sepsis, who was managed through the use of a 54-day brickwork-mixed graft of self-allogeneic skin operation. The mechanisms of skin healing, in this case, are also discussed. CONCLUSIONS: The brickwork-mixed graft of self-allogeneic skin may be an effective treatment option for patients with large surface area burns and severe burn sepsis. Further research is required to establish the generalizability of these findings. Early wound management and anti-infection measures are crucial in treating severe burns, and the clinical outcomes of the patient and the impact of the chosen treatment method on the patient's recovery and prognosis should be assessed.

Osteogenic Treatment Initiating a Tissue-Engineered Cartilage Template Hypertrophic Transition.

Hypertrophic chondrocytes play a critical role in endochondral bone formation as well as the progress of osteoarthritis (OA). An in vitro cartilage hypertrophy model can be used as a platform to study complex molecular mechanisms involved in these processes and screen new drugs for OA. To develop an in vitro cartilage hypertrophy model, we treated a tissue-engineered cartilage template, living hyaline cartilaginous graft (LhCG), with osteogenic medium for hypertrophic induction. In addition, endothelial progenitor cells (EPCs) were seeded onto LhCG constructs to mimic vascular invasion. The results showed that osteogenic treatment significantly inhibited the synthesis of endostatin in LhCG constructs and enhanced expression of hypertrophic marker-collagen type X (Col X) and osteogenic markers, as well as calcium deposition in vitro. Upon subcutaneous implantation, osteogenic medium-treated LhCG constructs all stained positive for Col X and showed significant calcium deposition and blood vessel invasion. Col X staining and calcium deposition were most obvious in osteogenic medium-treated only group, while there was no difference between EPC-seeded and non-seeded group. These results demonstrated that osteogenic treatment was of the primary factor to induce hypertrophic transition of LhCG constructs and this model may contribute to the establishment of an in vitro cartilage hypertrophy model.

First Report of Phytophthora palmivora Causing Root Rot of Cassava in China.

Cassava (Manihot esculenta) is an economically important crop grown widely in South China. Seventy percent of the cassava grown is used for starch and ethanol production and it has become the foundation of local food and bioenergy systems. In November 2010, a new root rot disease was found on cv. HuaNan205 from a cassava plantation in Danzhou, Hainan Province. Disease occurred on 30% or less of the plants. Initially, the upper leaves wilted at noon and recovered in the evening. Eventually, infected plants no longer recovered and the whole plant wilted and died. Root rot symptoms consisting of irregular brown patches occurred on the tuberous roots. Symptomatic root rot tissue was cut into 1-cm pieces, washed in distilled water, and soaked in a solution of 1% sodium hypochlorite for 3 min. A subsection was cut from each sterilized piece, placed on a plate of V8 agar medium, and incubated at 28°C for 7 days. Pathogenicity was established by following Koch's postulates. In July 2011, 10 plants of cassava cv. HuaNan205 were selected from a disease-free plantation in Danzhou. The pathogen was cultivated on V8 agar at 28°C for 14 days. Four holes were established 15 cm from the base of the cassava plants. Five plants were inoculated with 100 mL of the mycelial suspension in each of the four spots and covered by soil. The other five plants were treated with sterile water as control. Plants were maintained for 4 months. All five of the inoculated plants wilted and two died, while the control plants grew normally. Symptoms similar to the original root lesions were observed on tuberous roots of inoculated plants, while only scars formed on tuberous roots of control plants. The pathogen was reisolated from the lesions of inoculated plants. Microscopic examination showed the sporangia as papillate and ovoid with the widest part close to the base. They were easily washed off and each detached sporangium contained a short pedicel 1.2 to 6.9 µm long, average 2.9 µm. Chlamydospores were readily observed on diseased roots and observed in pure cultures on V8 agar. Morphological characteristics of the specimen were similar to the descriptions for Phytophthora palmivora (2). Genomic DNA of this isolate was extracted with a cetyltrimethylammoniumbromide protocol (3) from mycelium and used as a template for amplification of the internal transcribed spacer (ITS) region of rDNA with primer pair ITS1/ITS4 (1). The sequence (GenBank Accession No. HE580279) exactly matched several sequences (e.g., GenBank Accession Nos. HQ237481.1, AY745750, and AY745751) of P. palmivora. To our knowledge, this is the first report of root rot caused by P. palmivora on cassava in China. References: (1) D. E. L. Cooke et al. Fungal Genet. Biol. 30:17, 2000. (2) D. C. Erwin and O. K. Ribeiro. Phytophthora Diseases Worldwide. The American Phytopathological Society, St. Paul, MN, 1996. (3) J. R. Xu et al. Genetics 143:175, 1996.

Mix-mode technique of feeding arrays of dipole microwave antennae.

A 4-element array of coherently driven dipole microwave antennae produces a hot spot in the central region of the implanted volume and cold spots in the peripheral regions of the implant. Conversely, an incoherently driven array of antennae predominantly heats peripheral (along the antennae) regions of the implant. These two modes of feeding the antennae are complementary in a sense that the cold zones obtained with the coherently driven antennae coincide with the hot zones obtained with the incoherently driven antennae and vice versa. The SAR distributions resulting from mixing these modes of feeding (mixed-mode technique) were studied theoretically and experimentally. A theoretical model that allowed calculation of SAR distributions of a 4-element array of microwave antennae fed coherently, incoherently or using a mixed-mode technique was developed in this work. The goal of the theoretical study was to determine the proper mix of the coherent and incoherent modes of feeding the antennae such that the adequately (enclosed within a 50% isoSAR surface) heated volume was maximized. In experimental studies, the antennae were driven in a cyclical manner with a duty cycle equal to the weight of the coherent mode in the mix. The duty cycle was defined as the ratio of the time the antennae were driven coherently to the total duration of the cycle. To facilitate the periodical change from the coherent to incoherent feeding, a special electromechanical switch was developed. This switch allowed a wide range of variation of the duty cycle and cycle period. Theoretical and experimental studies have demonstrated that, if the relative weight of the coherent feeding in the mix-mode technique was 30% (duty cycle = 0.3), the adequately heated volume was significantly larger and the SAR distribution was more uniform than those obtained with either the coherent or incoherent mode of feeding.

Dosimetry of very-small (5-10 mm) and small (12.5-40 mm) diameter cones and dose verification for radiosurgery with 6-MV X-ray beams.

The dosimetry and dose verification for 6-MV X-rays were performed for radiosurgery cones of 5- to 40-mm diameter. The total scatter factors decrease slowly from 0.936 (40-mm cone) to 0.893 (10-mm cone; a variation of 5%), but they fall to 0.83 (7.5-mm cone) and 0.67 (5-mm cone). The dmax increases from about 12.9 (5-mm cone) to 16.3 mm (40-mm cone). The full width half maximum (FWHMs) of the beam profiles, measured at 5 cm depth, agree with the cone diameters within 1 mm. The 10-90% beam penumbra/FWHM ratio is 0.23 +/- 0.03 (> or = 20-mm cones); for the smaller-diameter cones this ratio increases reaching 0.84 (5-mm cone). New tissue maximum ratios (TMRs) are reported for the 5-, 7.5-, 32.5-, and 37.5-mm-diameter cones. TMRs for the other diameter cones are consistent with published data. The measured doses in two verification studies using the 12 cones with diameters > or = 12.5 mm with a single 360 degrees arc agreed to 2% with the planned doses, and to about 10% for the three smaller cones. In a simulated treatment neglecting tissue heterogeneties (skull bone), the measured doses for two five arc studies (22.5-mm cone) were within 4% of the calculated dose to isocenter.

Theoretical limits of SAR distributions of a four-element square array of dipole-type antennas.

Four-element dipole microwave antenna arrays with square insertion patterns are commonly used clinically for interstitial hyperthermia. One major disadvantage with this type of antenna array is the presence of a large dead length at the tips because the current gradually decreases from maximum at the junctions to zero at the tips. This dead length is usually 1.5-2 cm along the central axis of a 2 x 2 cm array of regular dipole antennas. Many attempts to improve the performance of dipole antenna arrays have been made by designing antennas with increased current at the tips. While some dipole antennas of new design show negligible dead lengths at close proximity in the single-antenna configuration, phantom experiments have demonstrated that these antennas exhibit at least 1.1 cm dead space along the central axis of the four-antenna array. Therefore, there seems to be a limit to which the array dead length can be reduced by the improvements in the dipole-type antenna design. The goal of this work is to find the theoretical minimum of the array dead length. This was done by assuming a uniform current distribution along the entire antenna. The specific absorption rate (SAR) patterns were calculated for an array with an insertion depth of 7 cm (resonant length for 915 MHz) and a variable spacing between antennas (1-3 cm). It was found that there is a dead length of 6 mm along the central axis of the 2 x 2-cm array with the uniform current distribution, which can be considered as the theoretical limit of the dead length for this array.(ABSTRACT TRUNCATED AT 250 WORDS)

Phantom evaluation of heating of superficial tissues located above interstitial microwave antennas.

PURPOSE: A technique that improves heating of superficial tissues above an implant of microwave interstitial antennas is presented. METHODS AND MATERIALS: Adequate heating of tumor margins is achieved by extending an implant of microwave antennas beyond the tumor boundary by 1-2 cm. When the tumor infiltrates the superficial tissues including the skin, the implant cannot even reach the superficial margin of the tumor since it requires tissue to support the catheters. This may yield cold spots in the tissues above the implant. Measurements in a phantom with varying thickness of the superficial layer above the implant demonstrated inadequate Specific Absorption Rates of energy distribution in this layer. A method that improves these distributions in the superficial layers was developed and tested in this work. This method requires placing a deionized water bolus on the phantom (patient) surface. Additional microwave antennas are placed on top of the bolus above and parallel to the implanted antennas. The Specific Absorption Rates distributions were evaluated for the thicknesses of superficial layer ranging from 1.5 mm to 16 mm and two bolus thicknesses (5 and 10 mm). RESULTS: The adequate Specific Absorption Rates distributions were achieved for all tested thicknesses of the superficial layer (1.5, 4, 8, 12, and 16 mm). The use of the 5 mm bolus versus 10 mm bolus is discussed. The use of additional antennas did not significantly increase stray radiation. CONCLUSION: This method has the potential to optimize heating of superficial tissues located above a microwave antenna implant.

Steroid induced exophthalmos. A case report.

A case of steroid induced exophthalmos in a patient with systemic lupus erythematosus with renal involvement is described. Computed Tomography was used to demonstrate the increased retro-orbital fat.

Subdural spinal lipoma with posterior fossa extension.

A case is described of subdural spinal lipoma with posterior fossa extension and the world literature is reviewed. A high proportion of high cervical lipomas extend into the posterior cranial fossa. Many cases were probably missed in the pre-computed tomography era. Those cases with posterior fossa growth are more likely to be found in infants or those cases with symptoms dating from birth; most present with quadriparesis. All cases of high cervical lipoma demonstrated by myelography should be submitted to brain computed tomography in order to exclude posterior fossa extension and demonstrate the presence of hydrocephalus.