Safety and Efficacy of Deoxycholic Acid Injection for Hypogastric Fat Reduction: A Pilot Study.

BACKGROUND: Although deoxycholic acid (DCA) has been proposed for use in other areas, it is used primarily for treating moderate-to-severe fat in the submental area. OBJECTIVE: To evaluate the safety and efficacy of DCA for fat reduction in the hypogastric region. MATERIALS AND METHODS: A prospective, longitudinal, nonrandomized, open-label, interventional pilot study was performed. Deoxycholic acid was transcutaneously injected in upper right, upper left, lower right, and lower left hypogastric zones. Fat thickness was assessed using calipers, ultrasound, and 3-dimensional scanning. The primary end point safety was evaluated by laboratory tests and the incidence of adverse events. RESULTS: Fourteen patients (54 treatment sessions) were included. The mean total volume administered was 26.6 mL. The main local adverse events were edema (94.4%), bruising (90.7%), and erythema (79.6%), all being self-limited (the mean duration 9.6, 7, and 2 days, respectively). A DCA dose was significantly associated with erythema duration (p = .0421) but not with edema duration (p = .1611) or bruising incidence (p = .1013). Measurement using calipers, ultrasound, and 3-dimensional scanning revealed significant fat thickness reduction. Patient-reported outcome measure scores revealed a significant improvement in patient satisfaction. CONCLUSION: Deoxycholic acid may be a safe and effective option for reducing fat thickness in the hypogastric region, although given the cost/benefit ratio probably should be reserved for small deposits.

Effects of Silicone Implants on the Mammary Gland: Ultrasonographic and 3D Study.

BACKGROUND: Breast implants may be responsible for secondary deformities produced by parenchymal atrophy. However, few studies in the literature have reported changes in breast tissue after augmentation surgery. In this study, the breast thickness of patients undergoing breast augmentation was monitored by ultrasound, and correlations with surface, volume and projection measurements were examined. METHODS: We studied the parenchymal thickness at the lower pole of the breast with ultrasound in 36 women (72 breasts). In another group of 33 patients (66 breasts), we studied the thickness at the upper and lower poles along the meridian of each breast by ultrasound and measured the anthropometric metrics, volume and projection of the breast with a 3D camera. RESULTS: Midline measurements close to the areola showed reduced thickness at the lower pole, with 31.8% at the midpoint of the lower pole and 42% at the infra-areolar level (p < 0.0001). At the upper pole, there was a decrease of 14.6% (p < 0.001), but the thickness was increased by 6% and 38% at more cranial levels. No correlations with volume were found. Anatomical implants produced more atrophy at the lower pole, and round implants at the upper pole. More atrophy was found with subfascial than submuscular augmentation. Compared with the expected values, the final volume was very similar, but the projection was 29% less. Surface measurements changed significantly up to 4 months postoperatively and remained stable thereafter. CONCLUSIONS: Implants affect significatively the thickness of the glandular tissue. All changes occur very soon postoperatively but stabilize after 4 months. LEVEL OF EVIDENCE IV: 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 online Instructions to Authors www.springer.com/00266 .

Recurrent desmoplastic small round cell tumor responding to an mTOR inhibitor containing regimen.

Desmoplastic small round cell tumor (DSRCT) is a rare mesenchymal tumor that typically presents with multiple abdominal masses. Initial treatment is multimodal in nature. Patients with relapsed DSRCT have a poor prognosis, and there are no standard therapies. We report our experience with five patients treated with vinorelbine, cyclophosphamide, and temsirolimus (VCT). Median number of VCT courses delivered was 7 (range 4-14 courses), and partial response was observed in all patients. Median time to progression or relapse was 8.5 months (range 7-16 months). Neutropenia and mucositis were most common toxicities (n = 4 each).

Evaluation of a new adipocytolytic solution: adverse effects and their relationship with the number of vials injected.

Adipocytolytic therapies have always raised the interest of aesthetic medicine physicians, mainly because of the great potential to achieve spectacular results in localized adiposities reduction. In the last few decades, these results have been severely compromised due to the improper or reckless injection of these products, to the extent of some of them being banned in many countries. Today, there is a new adipocytolytic solution that has been approved, is effective, and has theoretic and empiric consensus regarding its safety. The aim of this study for which 331 therapeutic sessions were retrospectively analyzed is to provide evidence of its safety and efficacy.

Date (Phoenix dactylifera L. cv. Medjool) Seed Flour, a Potential Ingredient for the Food Industry: Effect of Particle Size on Its Chemical, Technological, and Functional Properties.

The objective of this work was to evaluate the effect of particle size on the chemical composition, fatty acid and polyphenol profile, physicochemical and techno-functional properties, and antioxidant capacity of flour obtained from date seeds. The date seed flours obtained had a high content of total dietary fiber (67.89-76.67 g/100 g), and the reduction in particle size decreased the moisture and protein contents, while the fat, mineral (Ca, Fe, Zn, and Mg), and fatty acid contents were significantly increased, with oleic acid being the highest. Water activity increased with decreasing particle size, and the finest flour (<210 mm) tended to be yellowish and reddish. The water- and oil-holding capacities decreased in the flours with the smallest particle size compared to the largest sizes. The main polyphenolic compounds in all the samples were catechin, epicatechin, and epigallocatechin-3-gallate. The antioxidant activity significantly improved with reductions in the particle size of the date seed flour, with the ABTS, DPPH, and FRAP values ranging between 8.99 and 20.68, 0.66 and 2.35, and 1.94 and 4.91 mg Trolox equivalent/g of date seed flour. The results of the present study suggest that the flour obtained from date seeds cv. Medjool can be a valuable co-product for the food industry due to its fiber content, essential fatty acids, and bioactive compounds that can help reduce the amount of waste generated, promoting the circular economy in the food chain.

In-person and virtual adaptation of an interprofessional palliative care communications skills training course for pediatric oncology clinicians.

Purpose: Effective, empathic communication is crucial for pediatric oncology clinicians when discussing palliative and end-of-life (PC/EOL) care with parents of children with cancer. Unfortunately, many parents report inadequate communication at these distressing times. This study evaluates the communication skills training (CST) clinicians received to deliver a PC/EOL communication intervention as part of a multi-site randomized-controlled trial (RCT). Methods: Clinicians from eight sites formed dyads (one physician and one nurse [RN] or advanced practice provider [APP]) and were trained over 3 days (in-person or virtually). Training was adapted from VitalTalk™ and included didactic instruction, videos, visual aids, and dedicated time to practice with simulated patients. Study participants completed a confidential, post-training online evaluation survey. A self-reported quality assurance checklist was used to measure fidelity to the communication protocol when delivered to parents during the RCT. Results: Thirty clinicians completed training; 26 completed post-training surveys including twelve (46.1%) physicians, 8 (30.8%) RNs and 6 (23.1%) APPs. Most were female (65.4%); white (80.8%), not Latinx (88.5%); 40-50 years old (53.9%); and in practice over 10 years (65.4%). Nine (34.6%) trained in-person; the rest trained virtually. Ninety-two percent reported the course was valuable or very valuable for developing their PC/EOL communication skills and 96% reported learning something new. Dyads trained virtually had similar fidelity to those trained in-person (95% and 90% respectively) when delivering the PC/EOL communication intervention to parents. Conclusion: This PC/EOL CST was valuable for improving pediatric oncology clinicians' communication skills, successfully implemented in-person and virtually, and translated effectively into practice.

Quality Characteristics of Fresh Date Palm Fruits of "Medjoul" and "Confitera" cv. from the Southeast of Spain (Elche Palm Grove).

The quality characteristics (physical, techno-functional, and chemical) of date fruits (at the tamar stage) of two cultivars ("Confitera", autochthonous and unknown vs. "Medjoul", widely distributed and well-known), grown in the Southeast of Spain (Elche palm grove) were evaluated in order to reinforce decisions aimed at organizing the production of fresh dates from Elche by selecting the most profitable cultivar. Morphologically, Confitera dates were longer and with higher pulp yield than Medjoul dates (4.58 cm vs. 3.88 cm, and 84% vs. 78%, respectively) (p < 0.05). Nutritionally, both dates are a good source of carbohydrates (total sugars (43-48%) and dietary fiber (20-22%)), with small amounts of fat and proteins. The main free sugars in dates from both cultivars were glucose and fructose (reducing sugars). The most abundant mineral found in both date fruits were K, followed by Ca or Mg (depending on the cultivar; Ca in Medjoul and Mg in Confitera). Confitera dates showed a higher total antioxidant activity than Medjoul, corresponding with their higher (p < 0.05) content in polyphenolic compounds, mainly flavonoids (catechin and epicatechin predominantly). Confitera dates should be promoted in this region not only for their contribution to sustainable agricultural development and biodiversity, but also for their higher overall quality.

Strategies to Mitigate Chemotherapy and Radiation Toxicities That Affect Eating.

BACKGROUND: Cancer and its therapy is commonly associated with a variety of side effects that impact eating behaviors that reduce nutritional intake. This review will outline potential causes of chemotherapy and radiation damage as well as approaches for the amelioration of the side effects of cancer during therapy. METHODS: Information for clinicians, patients, and their caregivers about toxicity mitigation including nausea reduction, damage to epithelial structures such as skin and mucosa, organ toxicity, and education is reviewed. RESULTS: How to anticipate, reduce, and prevent some toxicities encountered during chemotherapy and radiation is detailed with the goal to improve eating behaviors. Strategies for health care professionals, caregivers, and patients to consider include (a) the reduction in nausea and vomiting, (b) decreasing damage to the mucosa, (c) avoiding a catabolic state and muscle wasting (sarcopenia), and (d) developing therapeutic alliances with patients, caregivers, and oncologists. CONCLUSIONS: Although the reduction of side effects involves anticipatory guidance and proactive team effort (e.g., forward observation, electronic interactions, patient reported outcomes), toxicity reduction can be satisfying for not only the patient, but everyone involved in cancer care.

Assessment of a suction-assisted cartilage shaver plus liposuction for the treatment of gynecomastia.

BACKGROUND: The development of feminized breasts in men may cause significant emotional distress and embarrassment, particularly in young men and adolescents. Numerous techniques have been described for the correction of gynecomastia, many of which include the removal of fat and glandular tissue. OBJECTIVE: The authors assess the utility of combining vibroliposuction with the use of a power-assisted arthroscopic-endoscopic cartilage shaver to correct gynecomastia and suggest a treatment algorithm for patients with gynecomastia. METHODS: Forty consecutive patients with a median age of 32 years (range 19-57 years) and with varying degrees of gynecomastia underwent a combined approach that included vibroliposuction (power-assisted tumescent liposuction) for the removal of fatty tissue, followed by the removal of fibrous tissue with the use of a power-assisted cartilage shaver. Follow-up periods ranged in duration from six to 18 months. RESULTS: All patients had satisfactory results. However, expansive hematomas requiring surgical drainage developed in three patients. Other complications included one case of insufficient resection requiring reoperation and three cases of hyperpigmentation and skin irregularities in patients with grade I gynecomastia. CONCLUSIONS: Combination treatment using vibroliposuction and a power-assisted arthroscopic-endoscopic cartilage shaver is an effective treatment for gynecomastia, but the technique has a learning curve. This procedure is most appropriate for patients with grades II and III gynecomastia, or as a first-stage treatment for patients with grade IV gynecomastia.

Survey of Biosynthetic Gene Clusters from Sequenced Myxobacteria Reveals Unexplored Biosynthetic Potential.

Coinciding with the increase in sequenced bacteria, mining of bacterial genomes for biosynthetic gene clusters (BGCs) has become a critical component of natural product discovery. The order Myxococcales, a reputable source of biologically active secondary metabolites, spans three suborders which all include natural product producing representatives. Utilizing the BiG-SCAPE-CORASON platform to generate a sequence similarity network that contains 994 BGCs from 36 sequenced myxobacteria deposited in the antiSMASH database, a total of 843 BGCs with lower than 75% similarity scores to characterized clusters within the MIBiG database are presented. This survey provides the biosynthetic diversity of these BGCs and an assessment of the predicted chemical space yet to be discovered. Considering the mere snapshot of myxobacteria included in this analysis, these untapped BGCs exemplify the potential for natural product discovery from myxobacteria.

[Characteristics of communication systems of suspected occupational disease in the Autonomous Communities, Spain]. / Características de los sistemas de comunicación de las sospechas de enfermedad profesional en las Comunidades Autónomas.

BACKGROUND: There are several initiatives to develop systems for the notification of suspected occupational disease (OD) in different autonomous communities. The objective was to describe the status of development and characteristics of these systems implemented by the health authorities. METHODS: A cross-sectional descriptive study was carried out on the existence of systems for the information and surveillance of suspected OD, their legal framework, responsible institution and availability of information. A specific meeting was held and a survey was designed and sent to all autonomous communities and autonomous cities (AACC). Information was collected on the existence of a regulatory standard, assigned human resources, notifiers, coverage and number of suspected OD received, processed and recognized. RESULTS: 18 of 19 AACC responded. 10 have developed a suspected OD notification system, 3 of them supported by specific autonomic law. The notifiers were physicians of the public health services, physicians of the occupational health services and, in 2 cases, medical inspectors. 7 AACC had specific software to support the system. The OD recognition rate of suspected cases was 53% in the Basque Country; 41% in Castilla-La Mancha; 36% in Murcia; 32.6% in the Valencian Community and 31% in La Rioja. CONCLUSIONS: The study has revealed an heterogeneous development of suspected OD reporting systems in Spain. Although the trend is positive, only 55% of the AACC have some type of development and 39% have specific software supporting it. Therefore unequal OD recognition rates have been obtained depending on the territory.

OBJETIVO: En algunas comunidades autónomas existen diversas iniciativas de sistemas para la comunicación de las sospechas de enfermedades profesionales (EP). El objetivo de este trabajo fue describir su grado de desarrollo y características de los sistemas puestos en marcha desde las administraciones sanitarias a nivel autonómico. METODOS: Se realizó un estudio descriptivo transversal sobre la existencia de sistemas de información y vigilancia de las enfermedades laborales, marco legal, institución responsable y disponibilidad de la información. Se celebró una reunión y se diseñó una encuesta que se remitió a todas las comunidades y ciudades autónomas (CCAA). Se recogió información sobre existencia de normas reguladoras, recursos humanos asignados, responsables de la notificación, cobertura y número de sospechas de EP recibidas, tramitadas y reconocidas. RESULTADOS: Respondieron 17 CCAA y 1 ciudad autónoma. Tenían desarrollados sistemas de comunicación de sospecha de EP 10 de ella, de los cuales 3 se apoyaban en norma legal autonómica específica. Las personas responsables de la notificación fueron médicos de los servicios públicos de salud, de los servicios de prevención y, en 2 casos, médicos inspectores. 7 CCAA disponían de aplicación informática para dar soporte al sistema. La tasa de reconocimiento de EP de las sospechas tramitadas fue del 53% en el País Vasco; 41% en Castilla-La Mancha; 36% en Murcia; 32,6% en la Comunidad Valenciana y 31% en La Rioja. CONCLUSIONES: El estudio pone de manifiesto un desarrollo desigual de los sistemas de declaración de sospecha de EP en España. Aunque la tendencia es positiva, sólo la mitad de las CCAA tienen algún sistema de comunicación aunque no todos disponen de una aplicación informática que lo soporte, obteniéndose tasas de reconocimiento EP desiguales según la comunidad autónoma.

A Natural Product Telomerase Activator Lengthens Telomeres in Humans: A Randomized, Double Blind, and Placebo Controlled Study.

TA-65 is a dietary supplement based on an improved formulation of a small molecule telomerase activator that was discovered in a systematic screening of natural product extracts from traditional Chinese medicines. This study summarizes the findings on telomere length (TL) changes from a randomized, double blind, placebo controlled study of TA-65 over a 1 year period. The study was conducted on 117 relatively healthy cytomegalovirus-positive subjects aged 53-87 years old. Subjects taking the low dose of TA-65 (250 U) significantly increased TL over the 12 months period (530 ± 180 bp; p = 0.005), whereas subjects in the placebo group significantly lost TL (290 ± 100 bp; p = 0.01). The high dose of TA-65 (1000 U) showed a trend of improvements in TL compared with that of the placebo group; however, the improvements did not reach statistical significance. TL changes in the low-dose group were similar for both median and 20th percentile TLs. The findings suggest that TA-65 can lengthen telomeres in a statistically and possibly clinically significant manner.

Conservative treatment for complex neonatal ovarian cysts: a long-term follow-up analysis.

OBJECTIVE: We aimed to investigate safety and effectiveness of a conservative approach for complex neonatal ovarian cysts and its long term impact on fertility. STUDY DESIGN: Neonates with congenital complex ovarian cysts were conservatively managed and followed from the perinatal period to adolescence. Statistical analysis included Student's t-test, Mann-Whitney U-test, the Kaplan-Meier method, and the receiver operating characteristic curve. RESULTS: The post-natal progressive dimensional reduction of diagnosed ovarian cyst was statistically significant. The Kaplan-Meier survival curves revealed the probability of persistence of the cyst was up to 5% at the age of 25 months. Long term follow-up revealed both ovaries visible at US in 60% of adolescent patients. CONCLUSION: Conservative management of asymptomatic complex neonatal ovarian cysts can be safely undertaken. As far as the chances of the ovarian tissue to survive conservative treatment are concerned, the results are not encouraging.

Degradação de óleos e gorduras de fritura de pastelarias da região centro-sul de Belo Horizonte, MG / Degradation levels of frying oils of pastries in the center-south region of Belo Horizonte, MG

O processo de fritura é uma operação importante por conferir aos alimentos características sensoriais que os tornam mais atraentes, entretanto, óleos e gorduras oxidados podem trazer implicações nutricionais e riscos à saúde. Determinar quando um óleo deve ser descartado não é fácil, entretanto, a medida de ácidos graxos livres pode ser uma opção simples para avaliar a qualidade. Este trabalho foi conduzido com o objetivo de determinar o nível de degradação dos óleos de fritura de pastelarias da região centro-sul de Belo Horizonte. Paralelamente, foi aplicado nas 17 pastelarias, um questionário sobre práticas de controle de qualidade. A temperatura foi aferida e o nível de degradação avaliado através de um monitor de Óleos e Gorduras. Verificou-se que 41,2% dos estabelecimentos descartam o óleo usado entre 4 a 6 dias e 17,6% descartam com mais de 7 dias. 53,0% utilizam o mesmo óleo para fritar pastéis e salgados empanados e 17,6% ainda fritam outros tipos de salgados. Em apenas 17,6% dos estabelecimentos a temperatura do óleo estava abaixo de 180ºC. Quanto ao nível de degradação dos óleos de fritura, verificou-se que em apenas 10,0% das pastelarias não houve alteração. Em 40,0% e 45,0% dos estabelecimentos houve presença de 2,0% e 3,5% de ácidos graxos livres (AGL), respectivamente, o que sinaliza 90% de inadequação em relação aos valores recomendados pela AOCS (1% de AGL). Verifica-se, portanto, a necessidade de desenvolvimento e aperfeiçoamento de métodos de controle da qualidade do óleo de fritura, visando a proteção da saúde da população.