Covering of large scalp defects prior to postoperative irradiation.

BACKGROUND AND OBJECTIVE: After R0 resection of extensive cutaneous squamous cell carcinoma of the scalp with indication for postoperative radiotherapy, closure techniques should be chosen that allow rapid initiation of radiotherapy. The aim of this retrospective analysis is to evaluate defect coverage by transverse transposition flap and split skin grafting of the donor site in such a scenario with regard to oncologic safety (recurrence rate) and permanence of wound closure. PATIENTS AND METHODS: Eleven patients were identified who had histologic cutaneous squamous cell carcinoma treated by microscopically controlled excision and defect coverage using a transverse transposition flap and split skin grafting of the donor site and who received postoperative radiotherapy. Patients were evaluated for recurrence, wound healing disorders and side effects of radiotherapy. RESULTS: The mean age was 81 years. Follow-up time averaged 1.4 years after the last radiotherapy session. Wound healing disorders of the transposition flap or graft necrosis were not detected. All therapy-associated side effects had resolved at follow-up. Local recurrence or metastasis did not occur. CONCLUSIONS: Combined transverse transposition flap plasty with split-skin grafting of the donor site is a safe treatment concept with few side effects for large scalp defects with exposed calvaria requiring postoperative radiotherapy.

Regional conditions shape the food-energy-land nexus of low-carbon indoor farming.

Modern greenhouses and vertical farming projects promise increased food output per unit area relative to open-field farming. However, their high energy consumption calls for a low-carbon power supply such as solar photovoltaic and wind, which adds to cost and overall land footprint. Here we use geospatial and mathematical modelling to compare open-field and two indoor farming methods for vegetable production in nine city-regions chosen globally with varying land availability, climatic conditions and population density. We find that renewable electricity supply is more costly for greenhouses per unit energy demand satisfied, which is due to the greater fluctuation in their energy demand profile. However, greenhouses have a lower energy demand per unit food output, which makes them the least land-intensive option in most of the analysed regions. Our results challenge the land-savings claims of vertical farming compared with open-field production. We also show that regionalizing vegetable supply is feasible in most regions and give recommendations based on the regional context.

Comparison of local and centralized biowaste management strategies - A spatially-sensitive approach for the region of Porto.

The increasing concern with greenhouse gas emissions and nutrients cycling creates a need for cost-effective, practical and environmentally sensible biowaste management strategies. Centralized systems have struggled to comply with those needs. Decentralized systems, treating waste at source, promise local nutrient circularity and increased resource sovereignty. The large-scale performance of decentralized systems remains unclear, especially concerning the local sink capacity to assimilate the treatment products. This study aimed to compare centralized and decentralized systems for the region of Porto and assess whether creating additional urban farms could reduce costs and environmental impacts. Spatial analysis was used to assess waste generation, potential compost bin locations, peri-urban and potential urban farmland available, and collection and transport requirements. The carbon footprint of different scenarios was determined using life-cycle assessment. The results show that local composting led to cost savings over centralized systems. However, this system encompassed positive carbon emissions and most districts evidenced limited sink capacity for compost application. Additional urban farms added significant sink capacity, however, their impact on cost and carbon footprint was insignificant. The carbon footprint of centralized systems was heavily dependent on factors influencing collection such as population density, and affected by the renewable content of the electricity grid. Anaerobic digestion was the most climate-friendly option in the urban center and local composting in remote and less dense districts. Municipalities may benefit from tailoring the treatment systems to specific districts, creating additional jobs while reducing cost and climate impacts overall.

[Andrological consultation in new systemic oncological therapies with small molecules]. / Andrologische Beratung bei neuen onkologischen Systemtherapien mit "small molecules".

Small molecules are rapidly broadening the spectrum of systemic oncologic therapies. Targets of those drugs are-among others-tyrosine and serine/threonine kinases like VEGF-R, EGF-R, Bcr-Abl, c­kit, JAK, CDK as well as BRAF and MEK. Clinical data of potential risks to male fertility are still very limited and are generally only available for older preparations. In addition, they are often multikinase inhibitors, so that even small molecules with the same (main) target are not completely comparable. For fertility protection, sperm cryopreservation should be offered to men seeking fatherhood before starting targeted therapy.

Treatment of Porokeratosis: A Systematic Review.

BACKGROUND: Porokeratosis (PK) is a rare skin disease of unknown etiology. It consists of a keratinization disorder, which may appear in several clinical forms and can undergo malignant transformation. The histopathological hallmark of PK is the cornoid lamella. While many topical, systemic, and surgical treatment modalities for PK have been described, no randomized controlled trials have been performed yet. Because of a lack of treatment standards for PK, European and international guidelines cannot be created. OBJECTIVE: The aim of this systematic review is to outline options for treating PK. METHODS: We performed a systematic literature search in an electronic database for published literature. A total of 88 articles fulfilling our inclusion criteria were found. RESULTS: There were no randomized controlled trials on the treatment of PK, but mainly case reports and case series. Porokeratosis of Mibelli showed the best outcomes after treatment with imiquimod cream and linear PK responded well to topical or systemic retinoids. Topical vitamin D acid derivatives may be the best therapeutic option for disseminated PK. Surgical interventions and cryotherapy may be preferred in areas where the use of topical agents is difficult or contraindicated. CONCLUSION: To offer patients with PK an evidence-based high-quality standardized therapy, randomized controlled trials are needed.

Primary Localized Cutaneous Amyloidosis: A Systematic Treatment Review.

BACKGROUND: Primary localized cutaneous amyloidosis (PLCA) is characterized by extracellular deposition of heterogenic amyloid proteins in the skin without systemic involvement. Lichen amyloidosis, macular amyloidosis, and (primary localized cutaneous) nodular amyloidosis are different subtypes of PLCA. OBJECTIVE: The aim of this study was to review the current reported treatment options for PLCA. METHODS: This systematic review was based on a search in the PubMed database for English and German articles from 1985 to 2016. RESULTS: Reports on the treatment of PLCA were limited predominantly to case reports or small case series. There were a few clinical trials but these lacked control groups. A variety of treatment options for PLCA were reported including retinoids, corticosteroids, cyclophosphamide, cyclosporine, amitriptyline, colchicine, cepharanthin, tacrolimus, dimethyl sulfoxide, vitamin D3 analogs, capsaicin, menthol, hydrocolloid dressings, surgical modalities, laser treatment, and phototherapy. CONCLUSION: No definitive recommendation of preferable treatment procedures can be made based on the analyzed literature. Randomized controlled trials are needed to offer patients an evidence-based therapy with high-quality standardized treatment regimens for PLCA.