Challenging Dogmas in Plastic Surgery.

In medicine, dogmas are subject to evolution and refinement as new research and technologies emerge. The aim of this study was to search for dogmas which were challenged and potentially revised in the plastic surgery field. A search on PubMed for "dogma and plastic surgery" yielded 80 papers. The queries "surgical dogma and craniofacial surgery" and "surgical dogma and flap" returned 9 and 21 papers, respectively. "Surgical dogma and hand" and "surgical dogma and wound healing" produced 41 and 25 papers, respectively. Removing 35 duplicate papers, 141 abstracts were reviewed. Of these, 78 were excluded, leaving 63 papers for analysis. The dogmas being challenged within the field of plastic surgery were classified into various categories. The distribution of these challenged dogmas was as follows: wound healing: 14.29%, epinephrine use: 9.52%, flap surgery: 7.94%, breast reconstruction: 6.35%, rhinoplasty: 7.94%, hand surgery: 4.76%, pressure sores: 4.76%, chemical peel: 4.76%, and hand injuries: 3.17%. The widespread focus on improving wound healing techniques indicates a need for more effective treatments and faster recovery times. Significant attention has been directed toward the use of epinephrine, particularly in fingers, which may reflect ongoing debates about its safety. Innovations and improvements in flap surgery could lead to better reconstructive outcomes. Challenging existing dogma is a vital process and a driving force in the advancement of clinical science. These challenges and potential revisions reflect the dynamic nature of plastic surgery, where ongoing research, patient outcomes, and evolving societal norms drive continuous improvement and adaptation in practices and principles.

Metamorphosis of a Tall and Ugly Woman Through Plastic Surgery During a 7-Year Period: An Analysis of The Life and Loves of a She-Devil.

The aim of this study is to analyze the process of metamorphosis of a tall and ugly woman through plastic surgery as depicted in The Life and Loves of a She-Devil (1983) of Fay Weldon. The process of plastic surgeries and the psychology of the protagonist of this novel were analyzed. A highly unattractive woman (Ruth, 185 cm) takes revenge on her husband (Bobbo, 175 cm) and his attractive lover (Mary Fisher, 160 cm). To transform her appearance, Ruth remodels her jaw, has her teeth extracted (2-jaw surgery or facial contouring surgery), straightens and trims her nose (corrective rhinoplasty), flattens her cheekbones (reduction malarplasty), reduces her breast size (reduction mammoplasty), and shortens both her arms and legs (limb reduction surgery). Following the series of surgeries, Ruth ultimately made herself look identical to Mary Fisher, her husband's lover. She believes her inadequacies stem from her body's failure to meet societal beauty standards, prompting her decision to "remake" herself. She declares, "I will be what I want, not what God ordained." Ruth's aspiration is not to acquire a new face but to attain the face of Mary Fisher. When confronted with pain and harm, Ruth does not waver but acknowledges it. "Of course it hurts. Andersen's little mermaid wanted legs instead of a tail. And, like her, I welcome it. I don't complain." In this study, we derived insights into why patients who want to change their entire bodies undergo plastic surgery, what these patients really want, and patients' attitudes toward the pain caused by surgical procedures.

Sinusitis Following Reduction Malarplasty.

The aim of this paper was to search for reported cases of sinus infection following reduction malarplasty and present guidelines for the prevention of sinusitis. Two cases of maxillary sinusitis that developed after reduction malarplasty has been reported, which were treated with endoscopic sinus surgery. Histologically, thickness of the mucosal lining of the maxillary sinus (Schneiderian membrane) was 0.41 mm at sinus floor, and 0.38 mm at 2 mm above the floor. In functional endoscopic sinus surgery (FESS), the uncinate process is removed, exposing the hiatus semilunaris. The anterior ethmoid air cells are opened, allowing better ventilation but leaving the bone covered with mucosa. FESS improves the function of the osteomeatal complex and therefore provides better ventilation of the sinuses. In odontogenic maxillary sinusitis, regeneration of the mucosal lining (ciliated epithelium regeneration and bone healing) was achieved in 1.4±1.2 years after modified endoscopic sinus surgery. In in zygomatic implant surgery, 12.3% patients presented maxillary sinusitis, and the most common treatment was antibiotics alone or combined with FESS. To prevent sinusitis after reduction malarplasty, accurate osteotomy and fixation are needed, especially when using only an intraoral incision. After surgery, radiological examinations (Water's view, computed tomography if needed) should be performed as part of follow-up. Prophylactic antibiotics (macrolides) are recommended for 1 week if the sinus wall is opened. If swelling or air-fluid level persists, re-exploration and drainage should be performed. In patients with risk factors such as age, comorbidities, smoking, nasal septal deviation, or other anatomical variants, simultaneous FESS is suggested.

Intraorbital Wooden Foreign Body in a Soldier.

The authors report a case of an intraorbital wooden foreign body that was misinterpreted as a radiolucent area of retained air on a computed tomography (CT) scan. A 20-year-old soldier presented to an outpatient clinic following an impingement with a bough while cutting down a tree. He had a 1-cm-deep laceration on the inner canthal area of his right eye. A military surgeon explored the wound and suspected a foreign body, but could not find or extract anything. Thereafter, the wound was sutured and the patient was transferred. An examination revealed an acutely ill-looking man with distressing pain in the medial canthal and supraorbital area associated with ipsilateral ptosis and periorbital edema. A CT scan showed a radiolucent area suspected to be retained air in the medial periorbital area. The wound was explored. Upon removal of the stitch, yellowish pus was drained. An intraorbital piece of wood measuring 1.5 cm×0.7 cm was extracted. The patient's hospital course was uneventful. Pus culture revealed growth of Staphylococcus epidermidis . Wood has a density similar to air and fat and can be difficult to distinguish from soft tissue both on plain x-ray films and CT. In this case, the CT scan showed a radiolucent area resembling retained air. Magnetic resonance imaging is a better method of investigation in cases of a suspected organic intraorbital foreign body. Clinicians should be aware of the possibility of retention of an intraorbital foreign body in patients presenting with periorbital trauma, especially those with even a small open wound.

Teaching Models for Correct Rhombic Flaps.

The aim of this study was to introduce teaching models for correct rhombic flaps. For the line of maximal extensibility (LME) and flap design, surgical fabric (model 1), scored corrugated cardboard (model 2), and scored polyethylene sheet (model 3) were used. For choosing the correct flaps, a silicone face (model 4) was used. Seven participants in the Plastic Surgery Department were recruited for the workshop. In models 1 to 3, a 2-cm diameter circle and relaxed skin tension line were indicated. Participants were requested to design Limberg flaps. Each flap was elevated, transposed, and fixed with sutures (model 1) or cellophane tape (models 2 and 3). In model 4, a 1-cm diameter circle was indicated on the cheek. Participants were requested to design correct Limberg flaps. Although participants were not provided an article describing how to create correct Limberg flaps, they eventually created correct flaps through trial and error. Participants drew 2 parallel lines tangential to the defect and following the LME, perpendicular to the relaxed skin tension lines, which are the same as the scoring marks. They then drew 2 other sides of 2 possible parallelograms by tilting them medially and laterally with angles of 60 and 120 degrees each. Thus, 4 possible Limberg flaps to close the defect were drawn. Among the 8 possible flaps, 4 flaps that did not follow the LME were eliminated. Scored polyethylene sheet had the best extensibility and least distortion among the 3 models. Through this workshop, participants learned to design rhombic flaps correctly, using 2 parallel LMEs.

Assembling Facial Muscles in a Skull Model for Plastic Surgery Trainees.

ABSTRACT: The aim of this study was to report the results of a training workshop on assembling facial muscles in a skull model, with a focus on the depth and intermingling of the muscles.A commercially available model with facial and masticatory muscles was used and this has 33 muscle pieces removable and attachable by magnets. Seven participants were recruited for workshop. At first stage, they were asked to assemble 33 detached pieces. Atlases of facial anatomy and Google searches except scientific articles were available. The time required to complete the assembly was measured. At second stage, a review article on facial anatomy was provided and they were again asked to assemble the pieces and the time was also measured. They were asked to rate their satisfaction with the outcomes on a Likert scale.In the second stage, the time was significantly shortened (from 66.9 ±â€Š22.2 to 27.9 ±â€Š15.0 minutes, P  = 0.002). The reasons for this improvement we think are: first, repeating an activity itself shortens time, and second, reading a review article about the anatomy of the face, especially the depth and relationship of each muscle, provided participants with deeper anatomical knowledge. Upon finishing the 2-stage workshop, the participants' knowledge of the name (P = 0.019), origin and insertion of each muscle (P = 0.017), as well as the relationships of all neighboring muscles (including their depth) increased significantly (P = 0.002).This model would be useful for anatomy classes at the undergraduate level in medical schools or developing a station as part of the objective structured clinical examination for board certification.

A multicentre, randomised, open-label, parallel-group Phase 2b study of belotecan versus topotecan for recurrent ovarian cancer.

BACKGROUND: This Phase 2b study compared the efficacy and toxicity of belotecan and topotecan in recurrent ovarian cancer. METHODS: Patients with platinum-sensitive recurrent or platinum-resistant recurrent ovarian cancer (PRROC) were randomised 1:1 to receive belotecan 0.5 mg/m2 or topotecan 1.5 mg/m2 for five consecutive days every 3 weeks. The primary endpoint was overall response rate (ORR); secondary endpoints were progression-free survival (PFS), overall survival (OS), and toxicity. RESULTS: A total of 140 (belotecan, n = 71; topotecan, n = 69) and 130 patients (belotecan, n = 66; topotecan, n = 64) were included in the intention-to-treat (ITT) and per-protocol (PP) populations. ORR did not differ significantly between the belotecan and topotecan groups (ITT, 29.6% versus 26.1%; PP, 30.3% versus 25%). Although PFS did not differ between the groups, belotecan was associated with improved OS compared with topotecan in the PP population (39.7 versus 26.6 months; P = 0.034). In particular, belotecan showed longer OS in PRROC and non-high-grade serous carcinoma (non-HGSC; PP, adjusted hazard ratios, 0.499 and 0.187; 95% confidence intervals 0.255-0.977 and 0.039-0.895). Furthermore, there were no differences in toxicities between the two groups. CONCLUSIONS: Belotecan was not inferior to topotecan in terms of overall response for recurrent ovarian cancer. CLINICAL TRIAL REGISTRATION: NCT01630018.

Complete Posterior Urethral Disruption Accompanied by Complex Pelvic Fractures: Clinical Outcomes of Fluoroscopic Primary Posterior Urethral Realignment.

PURPOSE: To evaluate the clinical outcomes of fluoroscopic primary posterior urethral realignment (PPUR) for complete posterior urethral disruption (PUD) accompanied by complex pelvic fractures. MATERIALS AND METHODS: Data from 15 male patients (median age, 58 years; range, 32-76 years) with traumatic PUD treated with fluoroscopic PPUR between 2016 and 2019 at a regional trauma center were retrospectively analyzed. The technical success (continuity of the ruptured urethra in PUD by Foley catheter placement) rate of fluoroscopic PPUR, trauma mechanism, concurrent embolization for pelvic arterial hemorrhage, time from the hospital visit to the start of the procedure, procedure time, Foley catheterization duration, and delayed complications were investigated. RESULTS: Fluoroscopic PPUR was technically successful for 13 of 15 (87%) patients. Concurrent embolization for pelvic arterial hemorrhage was performed in 11 of 15 (73%) patients. The mean time between the hospital visit and procedure initiation was 181.6 minutes ± 83.2. The mean procedure time was 66.3 minutes ± 26.6. The mean Foley catheterization duration for 13 patients (technical success group) was 52.3 days ± 39.8 (median, 40 days; range, 21-177 days). Symptomatic urethral stricture developed in 9 of 13 (69.2%) patients after the procedure; 7 underwent visual internal urethrotomy, 4 required regular urethral dilatation, and 2 needed urethral stent insertion. Three of 13 (23%) patients did not have delayed complications during the 1-year follow-up. CONCLUSIONS: PPUR with fluoroscopic guidance appears safe and effective for achieving the continuity of the ruptured urethra in PUD. It enables PPUR without general anesthesia and the lithotomy position in patients with complex pelvic fractures.

Clinical Results of Distal Embolization in Grade V Splenic Injury: Four-Year Experience from a Single Regional Trauma Center.

PURPOSE: To evaluate the benefits and risks of splenic artery embolization (SAE) in patients with American Association for the Surgery of Trauma (AAST) grade V blunt spleen injury (BSI) MATERIALS AND METHODS: Medical records of 88 patients treated with SAE between April 2013 and May 2017 at a regional trauma care center were reviewed retrospectively. The BSI grade according to the AAST spleen injury scale (revised version 2018) was determined by using computed tomography (CT) images. A total of 42 patients (46.6%) had AAST grade V injury and were included in the analysis. Patient demographics, angiographic findings, embolization techniques, and technical and clinical outcomes, including splenic salvage rate and procedure-related complications, were examined. RESULTS: SAE was performed within 2 hours after admission for 78.5% of the patients. All patients underwent selective distal embolization (n = 42). Primary clinical success rate was 80.9% (n = 34), and secondary clinical success rate was 88.1% (n = 37). The clinical failure group consisted of 5 patients. Four patients underwent splenectomy, and 1 patient died due to acute respiratory distress syndrome after embolization. The splenic salvage rate was 85.7% (n = 36). No patient had sepsis at follow-up (median, 247.0 days; interquartile range, 92.0-688.0). Clinical success rates (P = .356) and spleen salvage rates (P = .197) of patients who were hemodynamically stable (n = 19) showed no significant differences from those who were unstable (n = 23). CONCLUSIONS: Distal embolization of grade V BSI is a safe and feasible procedure which is effective for successful spleen salvage.

Clinical Guidance for Point-of-Care Ultrasound in the Emergency and Critical Care Areas after Implementing Insurance Coverage in Korea.

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.

Dual anode single-photon avalanche diode for high-speed and low-noise Geiger-mode operation.

The after-pulsing effect is a common problem in high-speed and low-noise single-photon detection based on single-photon avalanche diodes (SPADs). This article presents a dual anode InGaAs/InP SPAD (DA-SPAD) with two separate anode output ports that can be utilized for discriminating relatively weak avalanche signals, providing a simple and robust configuration of the SPAD-based single-photon detection system. Weak avalanche signals with amplitudes below the amplitude of the parasitic capacitive response of the SPAD were easily detected by the DA-SPAD and a simple subtraction circuit. The gated Geiger-mode performance of the DA-SPAD was also investigated. At a gating frequency of 1 GHz, the detection efficiency was 20.4% with an after-pulse probability of 3.5% at a temperature of -20 °C.

Prognostic Accuracy of Massive Transfusion, Critical Administration Threshold, and Resuscitation Intensity in Assessing Mortality in Traumatic Patients with Severe Hemorrhage: a Meta-Analysis.

BACKGROUND: The aim of this study was to assess the prognostic value of massive transfusion (MT), critical administration threshold (CAT), and resuscitation intensity (RI) for the mortality of trauma patients with severe hemorrhage. METHODS: Seventeen relevant articles were obtained by searching the PubMed databases through February 15, 2019. The estimated mortality rates and injury severity scores were obtained through a meta-analysis. In addition, diagnostic test accuracy (DTA) reviews were conducted to obtain the sensitivity, specificity, diagnostic odds ratio, and the summary receiver operating characteristic curve. RESULTS: At 24 hours, the estimated mortality rates were 0.194, 0.126, and 0.168 in assessments using MT, CAT, and RI, respectively. In addition, the pooled sensitivity of CAT (0.89; 95% confidence interval [CI], 0.82-0.94) was significantly higher than that of MT (0.63; 95% CI, 0.57-0.68) and RI (0.69; 95% CI, 0.63-0.75). Overall, the pooled specificity of MT and CAT was 0.82 (95% CI, 0.80-0.83) and 0.85 (95% CI, 0.83-0.88), respectively, while the pooled sensitivity was 0.49 (95% CI, 0.44-0.54) and 0.50 (95% CI, 0.38-0.62), respectively. CONCLUSION: CAT may be a more sensitive predictor for 24-hour mortality than other predictors. Furthermore, RI also appears to be a useful predictor for 24-hour mortality. Both MT and CAT showed high specificity for overall mortality.

Preventable Trauma Death Rate after Establishing a National Trauma System in Korea.

BACKGROUND: This study aimed to evaluate the current overall preventable trauma death rate (PTDR) in Korea and identify factors associated with preventable trauma death (PTD). METHODS: The target sample size for review was designed to be 1,131 deaths in 60 emergency medical institutions nationwide. The panels for the review comprised trauma specialists working at the regional trauma centers (RTCs); a total of 10 teams were formed. The PTDR and factors associated with PTD were analyzed statistically. RESULTS: Of the target cases, 943 were able to undergo panel review and be analyzed statistically. The PTDR was 30.5% (6.1% preventable and 24.4% possibly preventable). Those treated at a RTC showed a significantly lower PTDR than did those who were not (21.9% vs. 33.9%; P = 0.002). The PTDR was higher when patients were transferred from other hospitals than when they directly visited the last hospital (58.9% vs. 28.4%; P = 0.058; borderline significant). The PTDR increased gradually as the time from accident to death increased; a time of more than one day had a PTDR 14.99 times higher than when transferred within one hour (95% confidence interval, 4.68 to 47.98). CONCLUSION: Although the PTDR in Korea is still high compared to that in developed countries, it was lower when the time spent from the accident to the death was shorter and the final destined institution was the RTC. To reduce PTDR, it is necessary to make an effort to transfer trauma patients to RTCs directly within an appropriate time.

Transient stretch induces cytoskeletal fluidization through the severing action of cofilin.

With every deep inspiration (DI) or sigh, the airway wall stretches, as do the airway smooth muscle cells in the airway wall. In response, the airway smooth muscle cell undergoes rapid stretch-induced cytoskeletal fluidization. As a molecular mechanism underlying the cytoskeletal fluidization response, we demonstrate a key role for the actin-severing protein cofilin. Using primary human airway smooth muscle cells, we simulated a DI by imposing a transient stretch of physiological magnitude and duration. We used traction microscopy to measure the resulting changes in contractile forces. After a transient stretch, cofilin-knockdown cells exhibited a 29 ± 5% decrease in contractile force compared with prestretch conditions. By contrast, control cells exhibited a 67 ± 6% decrease ( P < 0.05, knockdown vs. control). Consistent with these contractile force changes with transient stretch, actin filaments in cofilin-knockdown cells remained largely intact, whereas actin filaments in control cells were rapidly disrupted. Furthermore, in cofilin-knockdown cells, contractile force at baseline was higher and rate of remodeling poststretch was slower than in control cells. Additionally, the severing action of cofilin was restricted to the release phase of the transient stretch. We conclude that the actin-severing activity of cofilin is an important factor in stretch-induced cytoskeletal fluidization and may account for an appreciable part of the bronchodilatory effects of a DI.

Dual Mechanism of Action of 5-Nitro-1,10-Phenanthroline against Mycobacterium tuberculosis.

New chemotherapeutic agents with novel mechanisms of action are urgently required to combat the challenge imposed by the emergence of drug-resistant mycobacteria. In this study, a phenotypic whole-cell screen identified 5-nitro-1,10-phenanthroline (5NP) as a lead compound. 5NP-resistant isolates harbored mutations that were mapped to fbiB and were also resistant to the bicyclic nitroimidazole PA-824. Mechanistic studies confirmed that 5NP is activated in an F420-dependent manner, resulting in the formation of 1,10-phenanthroline and 1,10-phenanthrolin-5-amine as major metabolites in bacteria. Interestingly, 5NP also killed naturally resistant intracellular bacteria by inducing autophagy in macrophages. Structure-activity relationship studies revealed the essentiality of the nitro group for in vitro activity, and an analog, 3-methyl-6-nitro-1,10-phenanthroline, that had improved in vitro activity and in vivo efficacy in mice compared with that of 5NP was designed. These findings demonstrate that, in addition to a direct mechanism of action against Mycobacterium tuberculosis, 5NP also modulates the host machinery to kill intracellular pathogens.

Intersubband transition in lattice-matched BGaN/AlN quantum well structures with high absorption coefficients.

Intersubband absorption properties of lattice-matched BGaN/AlN quantum well (QW) structures grown on AlN substrate are theoretically investigated using an effective mass theory considering the nonparabolicity of the conduction band. These results are compared with those of GaN/AlN QW structures. The intersubband absorption coefficient of the BGaN/AlN QW structure is shown to be enhanced significantly, compared to that of the conventional GaN/AlN QW structure. This can be explained by the fact that the BGaN/AlN QW structure exhibits larger intersuband dipole moment and quasi-Fermi-level separation than the GaN/AlN QW structure, due to the increase in the carrier confinement by a larger internal field. We expect that the BGaN/AlN QW structure with a high absorption coefficient can be used for telecommunication applications at 1.55 µm under the lattice-matched condition, instead of the conventional GaN/AlN QW structure with the large strain.

The Predictive Value of Tumor Size, Volume, and Markers During Radiation Therapy in Patients With Cervical Cancer.

OBJECTIVES: We investigated the prognostic significance of changes in primary tumor volume and serum squamous cell carcinoma antigen (SCC-ag) levels during radiation therapy (RT) in patients with cervical cancer. METHODS: We conducted a review of 40 patients treated with RT. All patients received external beam RT and intracavitary brachytherapy. The primary tumor volume and squamous cell carcinoma antigen levels were measured pre-RT and mid-RT. Overall survival (OS) and progression free survival (PFS) were estimated, and possible prognostic factors for survival were analyzed. RESULTS: The correlation coefficient between primary tumor volume reduction rate (pTVRR) and serum squamous cell carcinoma antigen reduction rate in all patients was 0.550 (P < 0.001). In univariate analysis, stage more than II (P <0.001), pre-RT pTV of 55 cm or more (P = 0.05), mid-RT tumor size of 4 cm or more (P = 0.004), and pTVRR of 90% or less (P = 0.031) were significant unfavorable prognostic factors for PFS, whereas stage (P = 0.009) was the only significant prognostic factor for OS. Multivariable analysis revealed that none of these factors were independently associated with PFS or OS. CONCLUSIONS: There was a significant correlation between pTVRR and squamous cell carcinoma antigen reduction rate. Our findings indicate that the tumor parameters such as pre-RT pTV, mid-RT tumor size, and pTVRR are associated with PFS in women with cervical cancer.

Primary ovarian mixed strumal and mucinous carcinoid arising in an ovarian mature cystic teratoma.

A 39-year-old woman presented with low back pain lasting for several weeks. Abdominopelvic computed tomography showed an ovarian cystic mass with an enhancing solid portion, fat and internal calcification. A right salpingo-oophorectomy was performed. A 9.7 cm round multiseptated cystic mass showed pathology of mature cystic teratoma and contained a solid portion, measuring 4.2 cm, composed mainly of carcinoid cells arranged in a trabecular-insular configuration admixed with surrounding thyroid follicles containing colloid. Juxtaposed were several nests of columnar cells interspersed with goblet cells and extracellular mucin pools. In the cyst wall of the teratoma, the lining of pseudostratified columnar cells was occasionally mixed with goblet cells transforming to the carcinoid portion. Immunohistochemically, both mucinous and strumal carcinoids were positive for polyclonal carcinoembryonic antigen, caudal type homeobox 2, cytokeratin (CK)7, CK20, synaptophysin, CD56 and focally positive for chromogranin. Thyroid follicles were positive for thyroid transcription factor-1 and thyroglobulin. After gastrointestinal and respiratory tract evaluation, no evidence of primary tumor, including omentum, was observed. The mass was diagnosed as a mixed strumal and mucinous type carcinoid associated with a mature cystic teratoma.

Metabolic components and recurrence in early-stage cervical cancer.

Epidemiological evidence suggests that the metabolic syndrome (MetS) is associated with increased risk of cervical cancer. However, research on the impact of MetS on prognosis in cervical cancer is lacking. This study investigated the association between MetS and recurrence-free survival (RFS) in patients with early-stage cervical cancer. This is a retrospective study of patients diagnosed with the International Federation of Gynecology and Obstetrics (FIGO) stage I-II cervical cancer in three tertiary hospitals during 2006-2009. Cox proportional hazards model was used to estimate the association between MetS or MetS components and RFS. We were able to evaluate MetS status in 84 patients out of 127. Forty patients had MetS. RFS was not significantly different according to MetS status; however, there was no further event of recurrence in non-MetS group after 2 years from primary surgical treatment. Hypertriglyceridemia (HR 3.67, 95% CI 1.18-11.43) and impaired fasting glucose (HR 4.30, 95% CI 1.23-15.03) were independent risk factors for shorter RFS, after adjustment for age, lymph node involvement, tumor involvement of resection margin, parametrial invasion, FIGO stage at diagnosis, and adjuvant treatment. Hypertriglyceridemia and impaired fasting glucose were associated with higher risk of recurrence in patients with early-stage cervical cancer. Prospective validation in large populations and further studies on the impact of MetS treatment in patients with cervical cancer are warranted.

Synthesis and anti-tubercular activity of 2-nitroimidazooxazines with modification at the C-7 position as PA-824 analogs.

Tuberculosis (TB) is a major global health problem, and new drug targets and scaffolds need to be identified to combat the emergence of drug resistant TB. The nitroimidazooxazine PA-824 represents a new class of bio-reductive drug to treat TB. In this study we report a 2-nitroimidazooxazine derivative with modification at the C-7 position that exhibited better activity than PA-824 against Mycobacterium tuberculosis (Mtb) H37Rv strain in vitro. From 7a as a key intermediate, we functionalized with benzyl ether (8), phenyl ether (9), benzyl carbonate (10) and benzyl carbamate (11). Among the 23 compounds produced, 8a-R (MIC=0.078 µM) with trifluoromethoxy benzyl group was 5-fold more potent than PA-824 (MIC=0.390 µM) in the in vitro assays against the wild-type Mtb, and the phenyl ether compound 9g-R (MIC=0.050 µM) exhibited the most potent antimycobacterial activity.