[Pay attention to burn rehabilitation assessment].

With the vigorous development of burn rehabilitation, many burn units in China are paying more and more attention to the application of burn rehabilitation treatment methods in burn patients. However, the development of burn rehabilitation assessment cannot be ignored in the process of burn rehabilitation treatment. Burn rehabilitation assessment is characterized with a long assessment time span and a large and complex assessment contents, resulting in the inability to develop a standardized assessment form that is suitable for all burn patients. In addition, factors including the shortage of professionals in burn rehabilitation assessment in some domestic burn units, relatively small number of objective assessment instruments and various institutional limitations, have also led to insufficient motivation and low quality of burn rehabilitation assessment. Based on those, this article analyzes the characteristics and main contents of burn rehabilitation assessment in China, and puts forward some suggestions in view of the shortcomings of burn rehabilitation assessment, in order to provide a reference for burn rehabilitation practitioners.

Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel.

BACKGROUND: A transition from a subtyping to a phenotyping approach in rosacea is underway, allowing individual patient management according to presenting features instead of categorization by predefined subtypes. The ROSacea COnsensus (ROSCO) 2017 recommendations further support this transition and align with guidance from other working groups. OBJECTIVES: To update and extend previous global ROSCO recommendations in line with the latest research and continue supporting uptake of the phenotype approach in rosacea through clinical tool development. METHODS: Nineteen dermatologists and two ophthalmologists used a modified Delphi approach to reach consensus on statements pertaining to critical aspects of rosacea diagnosis, classification and management. Voting was electronic and blinded. RESULTS: Delphi statements on which the panel achieved consensus of ≥ 75% voting 'Agree' or 'Strongly agree' are presented. The panel recommends discussing disease burden with patients during consultations, using four questions to assist conversations. The primary treatment objective should be achievement of complete clearance, owing to previously established clinical benefits for patients. Cutaneous and ocular features are defined. Treatments have been reassessed in line with recent evidence and the prior treatment algorithm updated. Combination therapy is recommended to benefit patients with multiple features. Ongoing monitoring and dialogue should take place between physician and patients, covering defined factors to maximize outcomes. A prototype clinical tool (Rosacea Tracker) and patient case studies have been developed from consensus statements. CONCLUSIONS: The current survey updates previous recommendations as a basis for local guideline development and provides clinical tools to facilitate a phenotype approach in practice and improve rosacea patient management. What's already known about this topic? A transition to a phenotype approach in rosacea is underway and is being recommended by multiple working groups. New research has become available since the previous ROSCO consensus, necessitating an update and extension of recommendations. What does this study add? We offer updated global recommendations for clinical practice that account for recent research, to continue supporting the transition to a phenotype approach in rosacea. We present prototype clinical tools to facilitate use of the phenotype approach in practice and improve management of patients with rosacea.

Barriers to Kidney Transplantation as a Choice of Renal Replacement Therapy.

Brunei Darussalam has a live related kidney transplant program since 2013. Uptake of transplant remains poor in the country despite full government subsidy for health care. This study aims to assess barriers and factors affecting patients' preference toward dialysis over transplant as their choice of renal replacement therapy. It is hoped that the study can provide a better insight into the poor uptake of transplant in the country. METHODS: The target population was all patients with end-stage renal disease undergoing dialysis in Brunei Darussalam who are fit enough to undergo kidney transplant. The shortlisted patients were approached during their hemodialysis sessions or while waiting for clinical reviews in peritoneal dialysis clinics and were given self-administered structured questionnaires. RESULTS: Out of 348 eligible patients in the country, 226 (64.9%) agreed to participate in the study. The majority of patients (71.2%), especially the unmarried patients (81.5%), cited "lack of donor" as their main reason for not choosing transplant. "Happy with dialysis" (31.9%), "inadequate information" (21.2%), "unwilling to take risk" (26.5%), and "financial problems" (18.1%) were the other common factors identified. A total of 51.8% of the respondents had considered transplant, and 42.5 % of patients had considered the option of commercialization through foreign black market channels. Younger patients (<40 years) on dialysis for less than 5 years with higher education were more likely to consider transplant (P < .05). Likewise, patients who were younger, highly educated, and employed were more likely to choose commercialization (P < .05). CONCLUSION: Lack of donor and poor knowledge were the main barriers to patients receiving kidney transplant in the country. Religio-cultural barriers, lack of reimbursement, poor knowledge, and stringent donor criteria contributed to the limited donor pool. Despite universal health coverage for the population, financial and social security factors were still important determinants that influenced recipients' and donors' decisions to reject transplant.

Behavioral Assessment and Blood Oxidative Status of Aging Sprague Dawley Rats through a Longitudinal Analysis.

BACKGROUND: Cognitive frailty emerges as one of the threats to healthy aging. It is in continuum with advancing of age with uncertain indicator between pathological and physiological changes. Alterations in pathways associated with the aging process have been observed including oxidative stress, lipid metabolism, and inflammation. However, the exact mechanisms leading to cognitive decline are still unclear. OBJECTIVE: This study was sought to assess the level of cognitive functions and linked with blood oxidative status during normal aging in rats. METHODS: A longitudinal study using male Sprague Dawley rats was performed starting from the age of 14 months old to 27 months old. Cognitive functions tests such as open field, Morris water maze and object recognition were determined at the age of 14, 18, 23, and 27 months old and were compared with group 3 months old. Blood was collected from the orbital venous sinus and oxidative status was determined by measuring the level of DNA damage, lipid peroxidation, protein oxidation and antioxidant enzymes activity. RESULTS: Aged rats showed declining exploratory behavior and increased in the level of anxiety as compared to the young rats. The level of DNA damage increased with increasing age. Interestingly, our study found that both levels of malondialdehyde and plasma carbonyl content decreased with age. In addition, the level of superoxide dismutase activity was significantly decreased with age whereas catalase activity was significantly increased from 18 months of age. However, no significant difference was found in glutathione peroxidase activity among all age groups. CONCLUSION: The progressions of cognitive impairment in normal aging rats are linked to the increment in the level of DNA damage.

Development of an atrophic acne scar risk assessment tool.

BACKGROUND: Acne is a chronic dermatological disease predominantly afflicting young adults and is often associated with the development of scars. Acne scarring is usually avoidable when acne is managed early and effectively. However, acne patients often fail to seek early treatment. New and innovative tools to raise awareness are needed. OBJECTIVE: This study presents the development and assessment of a tool aiming to assess the risk of atrophic acne scars. METHODS: A systematic literature review of clinical risk factors for acne scars, a Delphi-like survey of dermatological experts in acne and secondary data analysis, were conducted to produce an evidence-based risk assessment tool. The tool was assessed both with a sample of young adults with and without scars and was assessed via a database cross-validation. RESULTS: A self-administered tool for risk assessment of developing atrophic acne scars in young adults was developed. It is a readily comprehensible and practical tool for population education and for use in medical practices. It comprises of four risk factors: worst ever severity of acne, duration of acne, family history of atrophic acne scars and lesion manipulation behaviours. It provides a dichotomous outcome: lower vs. higher risk of developing scars, thereby categorizing nearly two-thirds of the population correctly, with sensitivity of 82% and specificity of 43%. CONCLUSION: The present tool was developed as a response to current challenges in acne scar prevention. A potential benefit is to encourage those at risk to self-identify and to seek active intervention of their acne. In clinical practice, we expect this tool may help clinicians identify patients at risk of atrophic acne scarring and underscore their requirement for rapid and effective acne treatment.

Updating the diagnosis, classification and assessment of rosacea: recommendations from the global ROSacea COnsensus (ROSCO) panel.

BACKGROUND: Rosacea is currently diagnosed by consensus-defined primary and secondary features and managed by subtype. However, individual features (phenotypes) can span multiple subtypes, which has implications for clinical practice and research. Adopting a phenotype-led approach may facilitate patient-centred management. OBJECTIVES: To advance clinical practice by obtaining international consensus to establish a phenotype-led rosacea diagnosis and classification scheme with global representation. METHODS: Seventeen dermatologists and three ophthalmologists used a modified Delphi approach to reach consensus on statements pertaining to critical aspects of rosacea diagnosis, classification and severity evaluation. All voting was electronic and blinded. RESULTS: Consensus was achieved for transitioning to a phenotype-based approach to rosacea diagnosis and classification. The following two features were independently considered diagnostic for rosacea: (i) persistent, centrofacial erythema associated with periodic intensification; and (ii) phymatous changes. Flushing, telangiectasia, inflammatory lesions and ocular manifestations were not considered to be individually diagnostic. The panel reached agreement on dimensions for phenotype severity measures and established the importance of assessing the patient burden of rosacea. CONCLUSIONS: The panel recommended an approach for diagnosis and classification of rosacea based on disease phenotype.

The burden of filial piety: A qualitative study on caregiving motivations amongst family caregivers of patients with cancer in Singapore.

OBJECTIVE: This study explores (1) the motivations and challenges facing family caregiving for cancer in Singapore and (2) suggests a possible framework to guide culturally sensitive future work on caregivers. DESIGN: Twenty caregivers of patients being treated for cancer at a public hospital in Singapore were interviewed. A semi-structured interview format and inductive thematic analysis were used to analyse the data. Caregivers were asked about their motivations for caregiving and the challenges they faced. RESULTS: Caregivers' motivations grouped into three categories: personal value and fulfilment, giving care because of societal expectations such as filial piety, and practical need. Challenges were grouped into interpersonal challenges, disclosure and finding balance. Caregivers with different primary motivations varied in their responses to these challenges. More autonomous caregivers cited learning points and reprioritised more effectively than less autonomous caregivers, who reported more internal conflict and less control over their situation. CONCLUSIONS: In Singapore and Asia, sociocultural values of family caregiving are not uniformly experienced as positive, and may be burdensome for caregivers who give care primarily for extrinsic motivations. As family caregiving needs increase, targeted psychosocial support for caregivers with less autonomous behavioural orientations may pre-empt caregiver burnout and burden.

Consensus conference on best practices in live kidney donation: recommendations to optimize education, access, and care.

Live donor kidney transplantation is the best treatment option for most patients with late-stage chronic kidney disease; however, the rate of living kidney donation has declined in the United States. A consensus conference was held June 5-6, 2014 to identify best practices and knowledge gaps pertaining to live donor kidney transplantation and living kidney donation. Transplant professionals, patients, and other key stakeholders discussed processes for educating transplant candidates and potential living donors about living kidney donation; efficiencies in the living donor evaluation process; disparities in living donation; and financial and systemic barriers to living donation. We summarize the consensus recommendations for best practices in these educational and clinical domains, future research priorities, and possible public policy initiatives to remove barriers to living kidney donation.

Application of high-throughput, high-resolution and cost-effective next generation sequencing-based large-scale HLA typing in donor registry.

Next generation sequencing (NGS)-based human leukocyte antigen (HLA) typing was used for ultra large-scale genotyping of registry donors for the China Marrow Donor Program (CMDP). More than 79,000 samples were subjected to HLA genotyping at 4-digit allelic level without ambiguities for HLA-A, -B, -C, DRB1 and DQB1 loci, with throughput up to 2068 samples per lane in a HiSeq flow cell (eight lanes per run), and cost reduced by 95% compared with that of Sanger-based typing. Two percent of randomly selected samples were quality control (QC) tested at 4-digit allelic level by the CMDP QC laboratory, yielded a concordance of 99.72%. These results demonstrate that NGS is a cost effective and valuable tool for HLA typing of registry donors.

Investigation of the spectral reflectance and bidirectional reflectance distribution function of sea foam layer by the Monte Carlo method.

Spectral properties of sea foam greatly affect ocean color remote sensing and aerosol optical thickness retrieval from satellite observation. This paper presents a combined Mie theory and Monte Carlo method to investigate visible and near-infrared spectral reflectance and bidirectional reflectance distribution function (BRDF) of sea foam layers. A three-layer model of the sea foam is developed in which each layer is composed of large air bubbles coated with pure water. A pseudo-continuous model and Mie theory for coated spheres is used to determine the effective radiative properties of sea foam. The one-dimensional Cox-Munk surface roughness model is used to calculate the slope density functions of the wind-blown ocean surface. A Monte Carlo method is used to solve the radiative transfer equation. Effects of foam layer thickness, bubble size, wind speed, solar zenith angle, and wavelength on the spectral reflectance and BRDF are investigated. Comparisons between previous theoretical results and experimental data demonstrate the feasibility of our proposed method. Sea foam can significantly increase the spectral reflectance and BRDF of the sea surface. The absorption coefficient of seawater near the surface is not the only parameter that influences the spectral reflectance. Meanwhile, the effects of bubble size, foam layer thickness, and solar zenith angle also cannot be obviously neglected.

Online colour training system for dental students: a comprehensive assessment of different training protocols.

The purpose of this study was to evaluate the training effect and to determine the optimal training protocol for a recently developed online colour training system. Seventy students participated in the evaluation. They first completed a baseline test with shade guides (SGT) and the training system (TST), and then trained with one of the three system training methods (Basic colour training for group E1, Vitapan Classical for E2, and Vitapan 3D-Master for E3) or shade guides (group C1) for 4 days. The control group (C2) received no training. The same test was performed after training and they finally completed a questionnaire. The correct matches after training increased in three experimental groups and group C1. Among experimental groups, the greatest improvement of correct matching number was achieved by group E3 (4·00 ± 1·88 in SGT, 4·29 ± 2·73 in TST), followed by E2 (2·29 ± 2·73 in SGT, 3·50 ± 3·03 in TST) and E1 (2·00 ± 2·60 in SGT, 1·93 ± 2·96 in TST). The difference between E3 and E1 was statistically significant (P = 0·036 in SGT, 0·026 in TST). The total average training time was shorter in group E2 (15·39 ± 4·22 min) and E3 (17·63 ± 5·22 min), with no significant difference between them. Subjective evaluations revealed that self-confidence in colour matching were improved greater in group C1 and E3. In conclusion, all tested sections of the system effectively improved students' colour-matching ability. Among system training methods, Vitapan 3D-Master showed the best performance; it enabled greater shade-matching improvement, it saved time and was superior in subjective evaluations.

Solid-organ transplantation in older adults: current status and future research.

An increasing number of patients older than 65 years are referred for and have access to organ transplantation, and an increasing number of older adults are donating organs. Although short-term outcomes are similar in older versus younger transplant recipients, older donor or recipient age is associated with inferior long-term outcomes. However, age is often a proxy for other factors that might predict poor outcomes more strongly and better identify patients at risk for adverse events. Approaches to transplantation in older adults vary across programs, but despite recent gains in access and the increased use of marginal organs, older patients remain less likely than other groups to receive a transplant, and those who do are highly selected. Moreover, few studies have addressed geriatric issues in transplant patient selection or management, or the implications on health span and disability when patients age to late life with a transplanted organ. This paper summarizes a recent trans-disciplinary workshop held by ASP, in collaboration with NHLBI, NIA, NIAID, NIDDK and AGS, to address issues related to kidney, liver, lung, or heart transplantation in older adults and to propose a research agenda in these areas.

Assessment of the innate and adaptive immune system in proliferative vitreoretinopathy.

PURPOSE: Proliferative vitreoretinopathy (PVR) is the leading cause of failure of surgery for rhegmatogenous retinal detachment. Although indirect evidence suggests that this disease might be autoimmune in nature, direct proof for this hypothesis is lacking. The purpose of this study was to determine in a murine model whether PVR can develop in the absence of T- or B-cell immunity. METHODS: Four- to six-week-old Rag-1 gene knockout (KO) and congenic wild-type mice (WT) on the C57.Bl/6 background were studied. PVR was induced by intravitreal injection of 3 µl dispase at the concentration of 0.2 U/µl. PVR development was monitored by electroretinograms, the macroscopic observation of hemorrhage, cataract, retinal folds, and of an uneven iris, as well as the histological detection of epiretinal membranes on haematoxylin-eosin stained tissue. Additionally, immunofluorescence analysis was performed. These manifestations of PVR were assessed 1, 2, 4, 6, and 8 weeks after the intravitreal injection. RESULTS: The data showed that the immune-deficient Rag-1 KO mice developed PVR with similar kinetics and severity as did the fully immune competent congenic WT mice. Carboxyfluorescein diacetate succinimidyl ester-labeled T cells that are specific for ovalbumin were detected in the inflamed vitreous and retina showing that T cells that are not specific for autoantigens present in the eye can migrate to PVR lesions. Therefore, the mere presence of T cells in PVR lesions does not imply an autoimmune pathogenesis. CONCLUSION: This study suggests that T- and B-cell immunity is not essential for the induction of PVR.

Two for the price of one: recycling a free flap.

Free flaps are now an established, successful, method of reconstruction for complex soft tissue defects. Improvements in microsurgical techniques, anatomical understanding and instruments have resulted in the evolution of free flap surgery to now encompass synchronous double free flap surgery and "free style" type flaps based on perforators. Although there have been reports of a single free flap split in two to reconstruct a defect at a single site, we report what we believe to be the first case of a single free groin flap used to reconstruct two distant and separate defects sequentially.

Readiness for organisational change among general practice staff.

BACKGROUND: Increasing demands on general practice to manage chronic disease may warrant organisational change at the practice level. Staff's readiness for organisational change can act as a facilitator or barrier to implementing interventions aimed at organisational change. OBJECTIVES: To explore general practice staff readiness for organisational change and its association with staff and practices characteristics. METHODS: This is a cross-sectional study of practices in three Australian states involved in a randomised control trial on the effectiveness of an intervention to enhance the role of non-general practitioner staff in chronic disease management. Readiness for organisational change, job satisfaction and practice characteristics were assessed using questionnaires. RESULTS: 502 staff from 58 practices completed questionnaires. Practice characteristics were not associated with staff readiness for change. A multilevel regression analysis showed statistically significant associations between staff readiness for organisational change (range 1 to 5) and having a non-clinical staff role (vs general practitioner; B=-0.315; 95% CI -0.47 to -0.16; p<0.001), full-time employment (vs part-time; B=0.175, 95% CI 0.06 to 0.29; p<0.01) and lower job satisfaction (B=-0.277, 95% CI -0.40 to -0.15; p<0.001). CONCLUSIONS: The results suggest that different approaches are needed to facilitate change which addresses the mix of practice staff. Moderately low job satisfaction may be an opportunity for organisational change.

Resource use and cost analysis of managing abnormal Pap smears: a retrospective study in five countries.

OBJECTIVE: To evaluate and compare treatment patterns and related resource use and costs in women with abnormal cervical smears in five countries. METHODS: Data from patient charts were collected for a minimum of 24 months, starting from the first recorded abnormal cervical smear. Costs, from the public health perspective, were calculated based on country-specific unit costs per procedure and expressed in euros. RESULTS: A total of 3,380 patient charts were reviewed. Subjects with suspected or detectable cervical cancer were excluded from the analysis (n = 380). A significant age difference of 1.8-2.6 years was observed between the lowest and highest severity of cytological and histological types (p < 0.05). The correlation between cytology and histology results was weak overall (35.8%) and varied widely between countries (ranging from 48% for Australia to 29.7% for the UK). As expected, countries with an organised screening programme (UK, Australia) diagnosed and initiated treatment at earlier disease stages. These countries demonstrated a much lower and narrower cost band for more advanced histological types. In contrast, other countries (Germany, Italy, Spain) followed an opportunistic screening programme in which advanced disease was diagnosed and treated at much higher and more varied costs. Histological, not cytological, results were the main factor underlying the cost differences per type. CONCLUSION: Costs and treatment patterns in women with abnormal cervical smears differ among countries due to the type of screening programme (organised versus opportunistic) and, consequently, the histological type. These results need to be taken into consideration when designing cost-effectiveness studies which include cervical cancer screening data.

Excimer laser assisted angioplasty for complex infrainguinal peripheral artery disease: a 2008 update.

Conventional percutaneous transluminal angioplasty (PTA) for complex or long segment infrainguinal occlusive arterial disease is limited by elastic recoil, dissection and restenosis, with high rates of intermediate and long term restenosis . Debulking with excimer laser has been advocated as a useful adjunctive strategy to improve procedural success and long term patency. This paper reviews the technological development of excimer laser, the studies supporting its use in infrainguinal arterial disease, effective and safe lasing techniques, its advantages, limitations and disadvantages. Case examples will be presented to illustrate its use in infrainguinal arterial disease. Although randomized controlled trials are lacking, existing registry and case series studies suggest efficacy of the excimer laser-assisted PTA for complex infrainguinal arterial disease, including patients with critical limb ischemia.

Assessment of 2 cervical screening methods in Mongolia: cervical cytology and visual inspection with acetic acid.

OBJECTIVE: The aim of the study was to evaluate the test parameters of visual inspection with acetic acid (VIA) and cervical cytology in 3 Mongolian aimags. METHODS: From February 18, 2002, to December 12, 2004, sexually active women, 30 years or older who had never been screened, underwent cervical cytology and VIA in the aimags' central hospital. Women with abnormal test results and 5% of women with normal results were recommended to have colposcopy with or without biopsy. RESULTS: Two thousand nine women underwent both tests. Visual inspection with acetic acid was abnormal in 254 (12.6%); Pap smear showed atypical squamous cells of undetermined significance or worse in 3%. Using cervical intraepithelial neoplasia 2 or higher disease on biopsy as the end point, the test parameters for VIA are sensitivity of 82.9% (95% CI = 81.3%-84.5%), specificity of 88.6% (95% CI = 87.2%-90.0%), positive predictive value of 12.2% (95% CI = 10.8%-13.6%), and negative predicative value of 99.7% (95% CI = 99.5%-99.9%). The test parameters for Pap smear are sensitivity of 88.6% (95% CI = 87.2%-90.0%), specificity of 98.5% (95% CI = 98.0%-99.0%), positive predictive value of 51.7% (95% CI = 49.5%-53.9%), and negative predicative value of 99.8% (95% CI = 99.6%-100%). CONCLUSION: Visual inspection with acetic acid has an acceptable test parameter for population-based cervical screening in Mongolia.

Cartilage injury and repair: assessment with magnetic resonance imaging.

Articular cartilage damage plays a major role in joint degeneration and dysfunction. Accurate assessment of the morphology and degree of cartilage wear is important in diagnosis, prognosis and management, particularly as many of these patients are young or participate in high-performance sports. Magnetic resonance imaging is able to directly evaluate such injuries, due to its high spatial resolution and excellent soft-tissue contrast resolution. This pictoral essay aims to demonstrate normal and damaged articular cartilage on MR imaging, as well as surgically-repaired cartilage.