The Efficacy of Negative Pressure Wound Therapy for Split-thickness Skin Grafts for Wounds on the Trunk or the Neck: A Randomized Controlled Trial.

INTRODUCTION: Skin failure may be both visually similar in appearance and can occur concomitant to a pressure injury, but it has a fundamentally different etiology. To date, no validated assessment tools or clinical indicators are available that can help definitively distinguish skin failure from a pressure injury. OBJECTIVE: The Skin Failure Clinical Indicator Scale (SFCIS), a proposed tool that uses readily available variables to assist in more definitively identifying skin failure, was developed and assessed. METHODS: A retrospective case-control study was conducted among acute care hospital patients who experienced acute skin breakdown before death. Data were extracted from the electronic medical records of deceased acute care patients who experienced acute skin breakdown prior to death between January 1, 2017, and March 1, 2019, in 2 US hospitals. Using ICD-10 coding, patients were separated into 2 groups depending on if the skin breakdown occurred at locations typical for pressure injury formation or atypical (non-pressure) locations. Patient diagnostic and clinical data were compared between the 2 groups. Univariate and multivariate data analyses were performed via backward stepwise logistic regression in order to identify significant predictors of skin failure; regression coefficients were converted into integers in order to create a tool that could assist in probable identification of skin failure. RESULTS: Of the 52 patients included in this study, 16 experienced skin breakdown at locations typical for pressure injury and 36 had skin breakdown in atypical locations, which was assumed to be indicative of skin failure. Factors found to help distinguish between skin failure and pressure injury included a serum albumin level less than 3.5 mg/dL (P = .07), impaired blood flow (P = .05), presence of sepsis/multiorgan dysfunction syndrome (P = .001), vasopressor/inotrope use (P ⟨ .001), and mechanical ventilation (P = .06), which ultimately correctly identified 83.7% as cases of probable skin failure. CONCLUSIONS: This scale may provide a means to correctly recognize and diagnose skin failure, initiate appropriate interventions, and decrease potential reimbursement penalties to facilities. Further testing will be necessary in order to validate the specificity and selectivity of this instrument.

Frontonasal dysplasia: A case report.

Frontonasal dysplasia is an uncommon congenital anomaly with diverse clinical phenotypes and highly variable clinical characteristics, including hypertelorism, a broad nasal root, median facial cleft, a missing or underdeveloped nasal tip, and a widow's peak hairline. Frontonasal dysplasia is mostly inherited and caused by the ALX genes (ALX1, ALX3, and ALX4). We report a rare case of a frontonasal dysplasia patient with mild hypertelorism, a broad nasal root, an underdeveloped nasal tip, an accessory nasal tag, and a widow's peak. We used soft tissue re-draping to achieve aesthetic improvements.

Antiobesity Effects of Purple Perilla (Perilla frutescens var. acuta) on Adipocyte Differentiation and Mice Fed a High-fat Diet.

Purple perilla (PE) is a medicinal plant that has several health benefits. In this study, the antiobesity effect of PE was studied in 3T3-L1 preadipocytes and C57BL/6J mice fed high-fat diets. Triglyceride quantification and Oil Red O staining in matured adipocytes revealed that PE reduced lipid accumulation in differentiated adipocytes by downregulating adipogenic gene and upregulating lipolytic gene expressions. Mice were fed normal diet, high-fat diet and high-fat diet supplemented with different concentrations of PE. Treatment with PE significantly prevented body weight gain, improved serum lipids, hepatic lipids and reduced the epididymal fat. Furthermore, in the adipose tissue and liver, expression of genes related to lipolysis and fatty acid ß-oxidation were upregulated in PE- treated mice. Thus, our results suggested that PE has antiobesity effects in rodents and can be effective in obesity management. PRACTICAL APPLICATION: Purple perilla, rich in polyphenols such as rosmarinic acid, showed lipid lowering in adipocyte cells and prevented body weight gain in mice. Therefore we conclude that purple perilla may be a potential candidate for the development of functional foods or nutraceuticals in managing obesity in humans.

Are more low-risk prostate cancers detected by repeated biopsy? A retrospective pilot study.

PURPOSE: We hypothesized that there might be a higher incidence of low-risk prostate cancer (PCa) in men diagnosed at a repeated biopsy. Thus, we investigated differences in clinicopathological results of PCa after primary and repeated biopsy. MATERIALS AND METHODS: We retrospectively reviewed patients diagnosed with PCa at a primary or repeated biopsy from January 2004 to April 2011. Patients were stratified into primary biopsy and repeated biopsy groups. We analyzed prostate-specific antigen, clinical stage, Gleason score (GS), positive core ratio, and low-risk group by using D'Amico classification. We also investigated GS upgrading and upstaging after radical prostatectomy (RP). RESULTS: Among 448 primary and 37 repeated biopsy PCa patients, 82 (group 1) and 25 (group 2) underwent RP. The percentage of low-risk patients did not differ significantly between the groups. The positive biopsy core ratio was significantly lower in group 2 (p=0.009). The percentages of GS upgrading and upstaging were 42.7% and 47.6% in group 1, respectively (p=0.568), and 48.0% and 52.0% in group 2, respectively (p=0.901). In the analysis of low-risk patients, GS upgrading and upstaging were not significantly different between the groups (p=0.615 and p=0.959, respectively). CONCLUSIONS: A lower positive core ratio may imply a small volume of PCa and possibly insignificant PCa in the repeated biopsy group. However, no significant differences were observed for the ratio of low-risk cancers, GS upgrading, or upstaging between the groups. Therefore, PCa diagnosed at a repeated biopsy is not an additional indication for active surveillance.

Small (<4 cm), Unclassified Renal Cell Carcinoma Presenting with Initial Bone Metastasis: A Case of a Metastatic Lesion Missed at the Initial Diagnosis.

A 49-year-old man presented with an incidentally detected right renal mass on a health examination. The abdominal computed tomography and magnetic resonance imaging showed a 3-cm right renal mass suspected of being a hypovascular tumor, such as papillary renal cell carcinoma, and an osteoblastic metastatic lesion on the right iliac bone. However, we missed a bone lesion at the time of diagnosis. A laparoscopic radical nephrectomy was performed and the final pathology confirmed unclassified renal cell carcinoma. The follow-up imaging studies showed several neck lymph nodes and multiple bone metastases at the lumbar spine, right iliac bone, and left femur. Thirteen cycles of temsirolimus were administered to the patient, but follow-up positron emission tomography showed newly developed liver and left adrenal metastasis and increased bone metastasis. It is important to note that T1a renal cell carcinoma can present with distant metastasis and thus demands scrupulous examination even though the tumor size may be small.

Isolation and characterization of antifungal substances from Burkholderia sp. culture broth.

A new antagonistic Burkholderia strain, designated MP-1 and producing antifungal activities against various filamentous plant pathogenic fungi, was isolated from the rhizoshere in the Naju area. Cultural characteristic studies strongly suggested that this strain belongs to the genus Burkholderia. The nucleotide sequence of the 16S rRNA gene (1491 pb) of strain MP-1 exhibited close similarity (99% to 100%) with other Burkholderia 16S rRNA genes. Extraction of fermentation broth of Burkholderia sp. MP-1 and various separations and purification steps led to isolation of four pure active molecules. The chemical structure of these four compounds-named phenylacetic acid, hydrocinnamic acid, 4-hydroxyphenylacetic acid, and 4-hydroxyphenylacetate methyl ester-was established on the basis on their gas chromatography-electron impact-mass spectrometry (GC-EI-MS) and trimethylsilation GC-EI-MS data. The four isolated compounds inhibited filamentous fungal growth on potato dextrose agar medium supplemented with 100 mg/L of phenylacetic acid, hydrocinnamic acid, 4-hydroxyphenylacetic acid and 4-hydroxyphenylacetate methyl ester individually.

GacS-dependent production of 2R, 3R-butanediol by Pseudomonas chlororaphis O6 is a major determinant for eliciting systemic resistance against Erwinia carotovora but not against Pseudomonas syringae pv. tabaci in tobacco.

Root colonization by a plant-beneficial rhizobacterium, Pseudomonas chlororaphis O6, induces disease resistance in tobacco against leaf pathogens Erwinia carotovora subsp. carotovora SCC1, causing soft-rot, and Pseudomonas syringae pv. tabaci, causing wildfire. In order to identify the bacterial determinants involved in induced systemic resistance against plant diseases, extracellular components produced by the bacterium were fractionated and purified. Factors in the culture filtrate inducing systemic resistance were retained in the aqueous fraction rather than being partitioned into ethyl acetate. Fractionation on high-performance liquid chromatography followed by nuclear magnetic resonance mass spectrometry analysis identified the active compound as 2R, 3R-butanediol. 2R, 3R butanediol induced systemic resistance in tobacco to E. carotovora subsp. carotovora SCC1, but not to P. syringae pv. tabaci. Treatment of tobacco with the volatile 2R, 3R-butanediol enhanced aerial growth, a phenomenon also seen in plants colonized by P. chlororaphis O6. The isomeric form of the butanediol was important because 2S, 3S-butandiol did not affect the plant. The global sensor kinase, GacS, of P. chlororaphis O6 was a key regulator for induced systemic resistance against E. carotovora through regulation of 2R, 3R-butanediol production. This is the first report of the production of these assumed fermentation products by a pseudomonad and the role of the sensor kinase GacS in production of 2R, 3R-butanediol.