New α-glucosidase inhibitory xanthones from the fruits of Garcinia schomburgkiana.

Two previously unreported xanthones, xanthoschomes A and B (1 and 2), along with six known xanthones, α-mangostin (3), ß-mangostin (4), γ-mangostin (5), garcinone C (6), 2-(γ,γ-dimethylallyl)-1,7-dihydroxy-3-methoxyxanthone (7), and dulxanthone D (8), have been isolated from the fruits of Vietnamese Garcinia schomburgkiana. The structures of all isolated compounds were fully characterised using spectroscopic data and comparison with the previous literature. All isolated compounds were evaluated for their in vitro α-glucosidase inhibitory activity. Compounds 1-8 demonstrated effective α-glucosidase inhibition, with the IC50 ranging from 2.91 to 26.0 µM, outperforming the standard acarbose (IC50 179 µM). Among these isolated compounds, compound 8 exhibited the highest inhibitory activity against α-glucosidase, with an IC50 value of 2.91 µM.

The Applicability of the Moyers, Tanaka-Johnston, and Gross-Hasund Analysis and a New Formula for the Vietnamese Population.

Aim: Our aim is to determine the applicability of other analyses and develop a new formula appropriate for the Vietnamese population. Materials and Methods: A cross-sectional descriptive analysis was conducted on a total of 120 dental arch samples (18-25 years old, 60 males, and 60 females) with <5 mm of tooth crowding, complete teeth on the dental arch, no missing teeth, and no fillings on the mesial or distal sides. Each study sample will be imprinted and measured using conventional as well as digital methods. Result: There was a significant discrepancy between the overall mesiodistal width from canine to second premolar in the maxilla and mandibular measured with electronic calipers on the cast model and the values calculated by the Moyer, Tanaka - Johnston, Gross - Hasund formulae in the mandibular, and measured by digital scanning and results calculated by the Gross-Hasund formula for maxilla and mandibular and the Moyers, Tanaka-Johnston formula for mandibular. The values obtained were compared with those calculated using the Moyers, Tanaka-Johnston, and Gross-Hasund formulae for the mandibular. Additionally, measurements were taken by digital scanning, and the results were calculated using the Gross-Hasund formula for both the maxilla and mandibular, and the Moyers and Tanaka-Johnston formulae for the mandibular. When used to estimate space analysis in the Vietnamese population, the estimation formula for each gender had greater accuracy and reliability than other widely used methods. Conclusions: As the central incisor and first molar are the first permanent teeth to erupt, the mesiodistal width may be readily measured. This new formula may be used to predict the width in the early stages of the mixed dentition.

Evaluation of residual refractive prediction accuracy after phacoemulsification using the SRK/T formula.

PURPOSE: The purpose of this study was to determine the accuracy of residual spherical refraction predictability after phacoemulsification (Phaco) intraocular lens (IOL) implant surgery using the SRK/T formula. METHODS: A cross-sectional study was performed with a sample size of 112 patients diagnosed with cataracts and indicated for Phaco surgery. This study was conducted in Saigon Can Tho Eye Hospital, Can Tho City, Vietnam, from January 2022 to June 2022. Preoperative data and postoperative data were collected for each case. Residual refraction data were measured using the IOLMaster 500 and Anterion. RESULTS: The mean preoperative spherical refraction was 0.04 ± 0.4 diopter. The prediction of residual spherical refraction was -0.11 ± 0.17 diopter (for cases measured by IOLMaster 500: -0.02 ± 0.22 diopter; for cases measured by Anterion: 0.07 ± 0.27 diopter). The mean absolute error of prediction results value in a total of 112 eyes was 0.19 ± 0.21 diopter (for cases measured with the IOLMaster 500: 0.20 ± 0.21 diopter; for cases measured with an Anterion: 0.17 ± 0.26 diopter). CONCLUSION: The predictive result of the SRK/T formula showed relative and acceptable effectiveness and accuracy in predicting postoperative refraction using the SRK/T formula. The results of this study and those of other studies on the same topic are valuable data to help the ophthalmologist in preoperative consultation with the patient.

Surgical site identification with personal digital device: A prospective pilot study.

BACKGROUND: Various means to facilit ate accurate biopsy site identification have been proposed. OBJECTIVE: To determine the accuracy of biopsy site identification by using photographs taken with a patient's digital device by a dermatologist versus professional medical photography. METHODS: Photographs of circled biopsy sites were taken with personal digital devices by the principal investigator (PI). Another set of photographs was taken by a professional photographer. Secondary photographs were taken of the biopsy site location pointed to by the staff and PI on the basis of the personal digital device image and professional medical photography, respectively. On the basis of secondary photographs, 2 independent dermatologists determined whether the skin biopsy locations pointed out by the staff were consistent with the ones pointed out by PI. RESULTS: Per dermatologist A, the staff correctly identified all 53 biopsy sites. Per dermatologist B, the staff were correct on 51 of 53 observations. Dermatologist C, the final arbiter, concurred with dermatologist A on the 2 cases in which dermatologist B was not certain of the location of the biopsy site. LIMITATIONS: The mean interval from initial biopsy to reidentification of the site was 36.2 days. CONCLUSION: Utilizing patients' personal digital devices is a cost-effective, Health Insurance Portability and Accountability Act-compliant, and readily available means to identify skin biopsy sites.

Mohs Mapping Fidelity: Optimizing Orientation, Accuracy, and Tissue Identification in Mohs Surgery.

BACKGROUND: Mohs micrographic surgery (MMS) is a highly effective process that requires consistent accuracy in resection, mapping, and histologic interpretation. Although the general sequence in MMS is similar, there are numerous variations among Mohs surgeons as to how this process is performed. OBJECTIVE: This article aims to review the process of MMS, with the intent to identify and mitigate the potential errors at each step. Existing variations will be discussed and protocols offered to minimize error and optimize accuracy. METHODS: A Pubmed search was performed for publications on methods of tissue mapping, orienting, and processing in MMS. RESULTS: Our literature review highlights various techniques for tissue orientation, transfer, flattening, inking, mapping, and processing of later stages and multiple specimens. We discuss our system, which reduces error during tissue transfer, tissue identification in vivo and ex vivo, and tissue flattening. Furthermore, we discuss adaptations to increase the accuracy during reexcisions of subsequent Mohs layers. CONCLUSION: Variations in MMS reflects the diverse training and creativity among Mohs surgeons. Unless potential errors are addressed, however, false negatives will occur and undermine the superior cure rate of MMS.

Validity of the Stage of Exercise Scale in Children with Rheumatologic Conditions.

OBJECTIVE: To determine the face, content, and construct validity of the Stages of Exercise Scale (SOES) in children with rheumatologic conditions [juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM)], and if the validity of the SOES differs by disease type by comparing it with a disease control with a chronic respiratory illness [cystic fibrosis (CF)]. METHODS: Sixty-seven children and adolescents (43 female) ages 11 to 18 years with a diagnosis of either JDM (n = 15), JIA (n = 39), or CF (n = 13) completed the SOES; scales of sensibility, process of change, decisional balance, and self-efficacy; the Child Health Assessment Questionnaire; and patient/physician ratings of disease severity. Physical activity was measured by an accelerometer. Relationships among SOES and measured constructs were determined by ANOVA and with logistical modeling. RESULTS: SOES, decisional balance, and self-efficacy as well as behavioral and cognitive processes from the process of change demonstrated significant differences across the staging subgroups. Disease groups did not significantly differ on the scoring across the SOES. Children and adolescents in higher stages participated in more minutes of vigorous physical activity compared with those in the lower stages. CONCLUSION: The SOES demonstrated good face, content, and construct validity in children and adolescents with rheumatic disease.

Paramedian forehead flap: advances, procedural nuances, and variations in technique.

BACKGROUND: The paramedian forehead flap (PFF) is a well-established technique for reconstruction of large nasal defects. The literature has provided several technical advances and procedural nuances that expand the surgeon's options when performing this procedure. OBJECTIVE: The objective is to provide procedural nuances, technical tips, and suggestions for improving flap outcomes. Specific techniques such as extending flap length below the orbital rim, avoiding terminal scalp hair inclusion in the flap design, restoring lining to full-thickness defects, and even flap dressings and wound care are detailed here. Of particular importance, the 3-staged turnover forehead flap for wounds requiring nasal lining, with delayed flap sculpting and cartilage graft placement, has revolutionized the conceptual approach to the most complicated nasal defects, and the technique is described in detail. METHODS: This article includes the techniques and approaches from 3 different surgeons at 3 different institutions with 3 different training backgrounds, in an effort to provide a nuanced and broad overview of the subject matter. RESULTS AND CONCLUSION: The PFF technique has been refined with increasing procedural variations and nuances in technique. The nasal reconstructive surgeon, armed with knowledge of these techniques, can approach each patient with a broad knowledge base and perform reconstruction with maximum success.

Adverse events associated with mohs micrographic surgery: multicenter prospective cohort study of 20,821 cases at 23 centers.

IMPORTANCE: Detailed information regarding perioperative risk and adverse events associated with Mohs micrographic surgery (MMS) can guide clinical management. Much of the data regarding complications of MMS are anecdotal or report findings from single centers or single events. OBJECTIVES: To quantify adverse events associated with MMS and detect differences relevant to safety. DESIGN, SETTING, AND PARTICIPANTS: Multicenter prospective inception cohort study of 21 private and 2 institutional US ambulatory referral centers for MMS. Participants were a consecutive sample of patients presenting with MMS for 35 weeks at each center, with staggered start times. EXPOSURE: Mohs micrographic surgery. MAIN OUTCOMES AND MEASURES Intraoperative and postoperative minor and serious adverse events. RESULTS: Among 20 821 MMS procedures, 149 adverse events (0.72%), including 4 serious events (0.02%), and no deaths were reported. Common adverse events reported were infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events. CONCLUSIONS AND RELEVANCE: Mohs micrographic surgery is safe, with a very low rate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate. Common complications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely during MMS. We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changes would be cost-effective given the small risk reductions.

Association between type of reconstruction after Mohs micrographic surgery and surgeon-, patient-, and tumor-specific features: a cross-sectional study.

BACKGROUND: There are few data to indicate whether the type of final wound defect is associated with the type of post-Mohs repair. OBJECTIVE: To determine the methods of reconstruction that Mohs surgeons typically select and, secondarily, to assess the association between the method and the number of stages, tumor type, anatomic location, and patient and surgeon characteristics. METHODS: Statistical analysis of procedure logs of 20 representative young to mid-career Mohs surgeons. RESULTS: The number of stages associated with various repairs were different (analysis of variance, p < .001.). Linear repairs, associated with the fewest stages (1.5), were used most commonly (43-55% of defects). Primary repairs were used for 20.2% to 35.3% of defects of the nose, eyelids, ears, and lips. Local flaps were performed typically after two stages of Mohs surgery (range 1.98-2.06). Referral for repair and skin grafts were associated with cases with more stages (2.16 and 2.17 stages, respectively). Experienced surgeons were nominally more likely perform flaps than grafts. Regression analyses did not indicate any association between patient sex and closure type (p = .99) or practice location and closure type (p = .99). CONCLUSIONS: Most post-Mohs closures are linear repairs, with more bilayered linear repairs more likely at certain anatomic sites and after a larger number of stages.

Penoscrotal extramammary Paget's disease: the University of Texas M. D. Anderson Cancer Center contemporary experience.

PURPOSE: Extramammary Paget's disease is a rare intra-epithelial malignancy that is occasionally associated with an invasive adenocarcinoma component as well as other secondary cancers. We investigated a consecutive series of patients referred for extramammary Paget's disease of the penis or scrotum at a single center in the contemporary era to determine the presence of secondary cancers and treatment outcomes. MATERIALS AND METHODS: Between December 1990 and February 2009, 20 patients with extramammary Paget's disease of the scrotum and/or penis were seen. Patients were investigated with computerized tomography of the abdomen/pelvis, chest x-ray, cystoscopy, colonoscopy and serum prostate specific antigen measurement to rule out obvious secondary cancer. Clinical charts were reviewed with institutional review board approval. Mean followup of treated cases was 48 months (range 7 to 208). RESULTS: Patients were 50 to 86 years old with a history of symptoms of between 6 months and 10 years. Eight patients had invasive adenocarcinoma, of whom 2 died of the disease and 3 who had disease at 5, 7 and 40 months, respectively, were undergoing multimodal therapy. No patient with confirmed intra-epidermal disease only died of the disease. Invasive disease predicted nodal and metastatic progression. CONCLUSIONS: Surgical resection to achieve tumor-free margins resulted in durable relapse-free survival of patients with intra-epidermal extramammary Paget's disease alone. Extramammary Paget's disease with invasion was associated with regional metastatic progression. The latter scenario as well as failure to treat localized extramammary Paget's disease alone was associated with a fatal outcome. Systemic chemotherapy should be further explored in patients with invasive adenocarcinoma or lymph node positive disease.

Design and validation of a clinical instrument for spectral diagnosis of cutaneous malignancy.

We report a probe-based portable and clinically compatible instrument for the spectral diagnosis of melanoma and nonmelanoma skin cancers. The instrument combines two modalities--diffuse reflectance and intrinsic fluorescence spectroscopy--to provide complementary information regarding tissue morphology, function, and biochemical composition. The instrument provides a good signal-to-noise ratio for the collected reflectance and laser-induced fluorescence spectra. Validation experiments on tissue phantoms over a physiologically relevant range of albedos (0.35-0.99) demonstrate an accuracy of close to 10% in determining scattering, absorption and fluorescence characteristics. We also demonstrate the ability of our instrument to collect in vivo diffuse reflectance and fluorescence measurements from clinically normal skin, dysplastic nevus, and malignant nonmelanoma skin cancer.

Pilot clinical study for quantitative spectral diagnosis of non-melanoma skin cancer.

BACKGROUND: Several research groups have demonstrated the non-invasive diagnostic potential of diffuse optical spectroscopy (DOS) and laser-induced fluorescence (LIF) techniques for early cancer detection. By combining both modalities, one can simultaneously measure quantitative parameters related to the morphology, function and biochemical composition of tissue and use them to diagnose malignancy. The objective of this study was to use a quantitative reflectance/fluorescence spectroscopic technique to determine the optical properties of normal skin and non-melanoma skin cancers and the ability to accurately classify them. An additional goal was to determine the ability of the technique to differentiate non-melanoma skin cancers from normal skin. STUDY DESIGN: The study comprised 48 lesions measured from 40 patients scheduled for a biopsy of suspected non-melanoma skin cancers. White light reflectance and laser-induced fluorescence spectra (wavelength range = 350-700 nm) were collected from each suspected lesion and adjacent clinically normal skin using a custom-built, optical fiber-based clinical instrument. After measurement, the skin sites were biopsied and categorized according to histopathology. Using a quantitative model, we extracted various optical parameters from the measured spectra that could be correlated to the physiological state of tissue. RESULTS: Scattering from cancerous lesions was significantly lower than normal skin for every lesion group, whereas absorption parameters were significantly higher. Using numerical cut-offs for our optical parameters, our clinical instrument could classify basal cell carcinomas with a sensitivity and specificity of 94% and 89%, respectively. Similarly, the instrument classified actinic keratoses and squamous cell carcinomas with a sensitivity of 100% and specificity of 50%. CONCLUSION: The measured optical properties and fluorophore contributions of normal skin and non-melanoma skin cancers are significantly different from each other and correlate well with tissue pathology. A diagnostic algorithm that combines these extracted properties holds promise for the potential non-invasive diagnosis of skin cancer.

Laboratory assistive personnel in Mohs micrographic surgery: a survey of training and laboratory practice.

BACKGROUND: The success of Mohs micrographic surgery (MMS) is contingent on high-quality frozen tissue sections for histologic interpretation. Laboratory assistive personnel (LAP) are central to this process, but their training and tissue processing techniques are neither standardized nor certified for competence. OBJECTIVE: To evaluate processes used to train and laboratory techniques practiced by LAP. Letters were mailed to Mohs surgeons with a Web link to an online survey for LAP to complete. RESULTS: Response rate was 24%. Responders primarily received training on the job, but not from the surgeon. On-the-job training from other LAP was perceived to be the most helpful, and textbook to be the least helpful. On average, survey responders felt it took several months to become proficient. Wide variations in laboratory practice were noted for histology laboratory and Mohs tissue processing techniques and for quality assurance. Differences in training and practices were noted between certified and noncertified LAP. CONCLUSION: Patient care may be compromised because of variable practice of laboratory techniques, quality assurance, and quality control. Standardization of LAP training, along with demonstration and maintenance of competency, may be necessary to ensure the integrity of the MMS technique.

Precautions with gentian violet: skin marking made sterile, effective, and economical.

BACKGROUND: Surgical site infections have been caused by gentian violet (GV) marking solutions that were contaminated with Mycobaterium chelonae. GV solution is also used in surgery to mark surgical sites. It is commercially available as a solution that may not have been prepared under sterile conditions. OBJECTIVE: Our objective is to describe a skin marking method that is sterile, effective, and economical. METHODS: GV solution; microcentrifuge tubes; and round, wood toothpicks are used as an alternative to the standard surgical marker. GV (4 drops) is dispensed into a microcentrifuge tube. After capping, the tube is autoclaved. The toothpick is used as the writing instrument and dipped into the GV as needed for intraoperative skin marking. Unlike commercially available skin markers, skin moisture will not cause the writing implement (toothpick) to become ineffective; merely dry the skin before skin marking. RESULTS: Autoclaving the commercially available shelved GV solution ensures sterility. The cost of the GV, toothpicks, and microcentrifuge tubes is approximately $0.10 per operation. In contrast, commercially available surgical markers range in cost from $0.79 to $3.89 per pen (manufactured suggested retail price), a 8- to 39- fold difference. CONCLUSION: Infectious precautions should be taken with surgical site marking. Marking solutions should be prepared under sterile conditions in a pharmacy. Alternatively, commercially available nonsterile solutions can be autoclaved to ensure sterility.

Effect of a low-glycemic index or a high-cereal fiber diet on type 2 diabetes: a randomized trial.

CONTEXT: Clinical trials using antihyperglycemic medications to improve glycemic control have not demonstrated the anticipated cardiovascular benefits. Low-glycemic index diets may improve both glycemic control and cardiovascular risk factors for patients with type 2 diabetes but debate over their effectiveness continues due to trial limitations. OBJECTIVE: To test the effects of low-glycemic index diets on glycemic control and cardiovascular risk factors in patients with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS: A randomized, parallel study design at a Canadian university hospital research center of 210 participants with type 2 diabetes treated with antihyperglycemic medications who were recruited by newspaper advertisement and randomly assigned to receive 1 of 2 diet treatments each for 6 months between September 16, 2004, and May 22, 2007. INTERVENTION: High-cereal fiber or low-glycemic index dietary advice. MAIN OUTCOME MEASURES: Absolute change in glycated hemoglobin A(1c) (HbA(1c)), with fasting blood glucose and cardiovascular disease risk factors as secondary measures. RESULTS: In the intention-to-treat analysis, HbA(1c) decreased by -0.18% absolute HbA(1c) units (95% confidence interval [CI], -0.29% to -0.07%) in the high-cereal fiber diet compared with -0.50% absolute HbA(1c) units (95% CI, -0.61% to -0.39%) in the low-glycemic index diet (P < .001). There was also an increase of high-density lipoprotein cholesterol in the low-glycemic index diet by 1.7 mg/dL (95% CI, 0.8-2.6 mg/dL) compared with a decrease of high-density lipoprotein cholesterol by -0.2 mg/dL (95% CI, -0.9 to 0.5 mg/dL) in the high-cereal fiber diet (P = .005). The reduction in dietary glycemic index related positively to the reduction in HbA(1c) concentration (r = 0.35, P < .001) and negatively to the increase in high-density lipoprotein cholesterol (r = -0.19, P = .009). CONCLUSION: In patients with type 2 diabetes, 6-month treatment with a low-glycemic index diet resulted in moderately lower HbA(1c) levels compared with a high-cereal fiber diet. Trial Registration clinicaltrials.gov identifier: NCT00438698.

The effect of strawberries in a cholesterol-lowering dietary portfolio.

Effective diets reduce blood lipids and oxidative damage, both of which have been linked to the complications of diabetes and coronary heart disease. Our objective was to assess the effect of adding strawberries, as a source of antioxidants, to improve the antioxidant effect of a cholesterol-lowering diet (dietary portfolio). To this end, 28 hyperlipidemic subjects who had followed the dietary portfolio consisting of soy, viscous fiber, plant sterol, and nuts for a mean of 2.5 years were randomized to receive supplements of strawberries (454 g/d, 112 kcal) or additional oat bran bread (65 g/d, 112 kcal, approximately 2 g beta-glucan) (control) in a randomized 1-month crossover study with a 2-week washout. Strawberry supplementation resulted in a greater reduction in oxidative damage to low-density lipoprotein (LDL) measured as thiobarbituric acid-reactive substances in the LDL fraction (P = .014). At the end of the strawberry period, reductions in LDL cholesterol and in the ratio of total to high-density lipoprotein cholesterol were maintained close to 1-year values at -13.4% +/- 2.1% and -15.2% +/- 1.7%, respectively (P < .001), and were similar to the post-oat bran bread values. Strawberries also improved the palatability of the diet. We conclude that strawberry supplementation reduced oxidative damage to LDL while maintaining reductions in blood lipids and enhancing diet palatability. Added fruit may improve the overall utility of diets designed to lower coronary heart disease risk.