A 2014 online survey of the American Society of Cataract and Refractive Surgery members indicated increasing use of intracameral antibiotic injection prophylaxis compared with a comparable survey ...from 2007. Forty-seven percent of respondents already used or planned to adopt this measure. One half of all surgeons not using intracameral prophylaxis expressed concern about the risks of noncommercially prepared antibiotic preparations. Overall, the large majority (75%) said they believe it is important to have a commercially available antibiotic approved for intracameral injection. Assuming reasonable cost, the survey indicates that commercial availability of Aprokam (cefuroxime) would increase the overall percentage of surgeons using intracameral antibiotic injection prophylaxis to nearly 84%. Although the majority used topical perioperative antibiotic prophylaxis, and gatifloxacin and moxifloxacin were still the most popular agents, there was a trend toward declining use of fourth-generation fluoroquinolones (60%, down from 81% in 2007) and greater use of topical ofloxacin and ciprofloxacin (21%, up from 9% in 2007).
The Color of the Landbrings the histories of Creek Indians, African Americans, and whites in Oklahoma together into one story that explores the way races and nations were made and remade in conflicts ...over who would own land, who would farm it, and who would rule it. This story disrupts expected narratives of the American past, revealing how identities--race, nation, and class--took new forms in struggles over the creation of different systems of property.Conflicts were unleashed by a series of sweeping changes: the forced "removal" of the Creeks from their homeland to Oklahoma in the 1830s, the transformation of the Creeks' enslaved black population into landed black Creek citizens after the Civil War, the imposition of statehood and private landownership at the turn of the twentieth century, and the entrenchment of a sharecropping economy and white supremacy in the following decades. In struggles over land, wealth, and power, Oklahomans actively defined and redefined what it meant to be Native American, African American, or white. By telling this story, David Chang contributes to the history of racial construction and nationalism as well as to southern, western, and Native American history.
Cancer stem cells are critical for cancer initiation, development, and treatment resistance. Our understanding of these processes, and how they relate to glioblastoma heterogeneity, is limited. To ...overcome these limitations, we performed single-cell RNA sequencing on 53586 adult glioblastoma cells and 22637 normal human fetal brain cells, and compared the lineage hierarchy of the developing human brain to the transcriptome of cancer cells. We find a conserved neural tri-lineage cancer hierarchy centered around glial progenitor-like cells. We also find that this progenitor population contains the majority of the cancer's cycling cells, and, using RNA velocity, is often the originator of the other cell types. Finally, we show that this hierarchal map can be used to identify therapeutic targets specific to progenitor cancer stem cells. Our analyses show that normal brain development reconciles glioblastoma development, suggests a possible origin for glioblastoma hierarchy, and helps to identify cancer stem cell-specific targets.
Pancreatic cancer has become the third leading cause of cancer-related death, with little improvement in outcomes despite decades of research. Surgery remains the only chance of cure, yet only 20% of ...patients will be alive at 5 years after pancreatic resection. Few chemotherapeutics provide any improvement in outcome, and even then, for approved therapies, the survival benefits are marginal. Genomic sequencing studies of pancreatic cancer have revealed a small set of consistent mutations found in most pancreatic cancers and beyond that, a low prevalence for targetable mutations. This may explain the failure of conventional clinical trial designs to show any meaningful survival benefit, except in small and undefined patient subgroups. With the development of next-generation sequencing technology, genomic sequencing and analysis can be performed in a clinically meaningful turnaround time. This can identify therapeutic targets in individual patients and personalize treatment selection. Incorporating preclinical discovery and molecularly guided therapy into clinical trial design has the potential to significantly improve outcomes in this lethal malignancy. In this review, we discuss the findings of recent large-scale genomic sequencing projects in pancreatic cancer and the potential relevance of these data to therapeutic development.
To prospectively compare the early rotational stability of AcrySof SN60T toric intraocular lenses (IOLs) with that in a retrospective series of AA4203 toric IOLs.
Private practice, Los Altos, ...California, USA.
One hundred consecutive eyes with an AcrySof SN60T(3, 4, or 5) toric IOL were compared with a consecutive series of 90 AA4203 (TL or TF) toric IOLs. The same surgeon performed all IOL implantations using an identical surgical technique. In addition to deviation from the desired axis, the change in refractive cylinder was measured 1 month postoperatively.
Although surgery was performed during different time periods, the 2 populations had a similar distribution of patient age, axial lengths, and spherical IOL powers. In the AcrySof SN60T group, 90%, 99%, and 100% of the IOLs were aligned at or within 5, 10, and 15 degrees, respectively, of the desired axis and in the AA4203 group, 70%, 90%, and 97%, respectively. The mean IOL rotation was 5.56 degrees +/- 8.49 (SD) in the AA4203 group and 3.35 +/- 3.41 degrees in the AcrySof SN60T group (P = .0232). One AcrySof SN60T IOL (1%) and 8 AA4203 IOLs (8.9%) were 15 degrees or more off axis (P = .01). No AcrySof SN60T IOL and 3.3% of AA4203 IOLs required surgical repositioning.
Both toric IOLs had good rotational stability and were effective in reducing preexisting corneal astigmatism. Based on the mean axis deviation and the number of IOLs rotating 15 degrees or more, the AcrySof SN60T toric IOL showed statistically better rotational stability.
Lymph node dissection is often performed as a part of surgical treatment for breast cancer and malignant melanoma to prevent malignant cells from traveling via the lymphatic system. Currently little ...is known about postoperative lymphatic drainage pattern alterations. This knowledge may be useful for management of recurrent cancer and prevention of breast cancer related lymphedema. We mapped the complete superficial lymphatic system of a dog and used this canine model to perform preliminary studies of lymphatic architectural changes in postoperative condition.
Lymphatic territories (lymphosomes) were mapped with 4 female mongrel carcasses using an indocyanine green (ICG) fluorescent lymphography and a radiographic microinjection technique. Two live dogs were then subjected to unilateral lymph node dissection of lymph basins of the forelimb, and ICG lymphography and lymphangiogram were performed 6 months after the surgery to investigate lymphatic changes. Lymphatic patterns in the carcass were then compared with postoperative lymphatic patterns in the live dogs.
Ten lymphosomes were identified, corresponding with ten lymphatic basins. Postoperative fluorescent lymphographic images and lymphangiograms in the live dogs revealed small caliber lymphatic network fulfilling gaps in the surgical area and collateral lymphatic vessels arising from the network connecting to lymph nodes in the contralateral and ipsilateral neck in one dog and the ipsilateral subclavicular vein in another dog.
Our canine lymphosome map allowed us to observe lymphatic collateral formations after lymph node dissection in live dogs. This canine model may help clarify our understanding of postoperative lymphatic changes in humans in future studies.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Lymphovenous bypass (LVB) is a form of physiological lymphedema surgery, which was described decades ago, but recently it is gaining popularity with improved microsurgical technology available. ...Benefits of the procedure are its effectiveness in treating early stage lymphedema of either the upper or lower extremity and having low complication profile. In the following article, the history of the procedure, mechanism, and details of various LVB techniques, and outcomes will be discussed.
To analyze the posterior capsule rupture (PCR) rates among staff and trainee cataract surgeons, and the postoperative endophthalmitis (POE) rates in uncomplicated and complicated eyes both with and ...without intracameral moxifloxacin prophylaxis (ICMP).
Ten regional Aravind Eye Hospitals in India.
Retrospective multicenter clinical registry within a single hospital network.
POE rates with and without ICMP were statistically compared for all eyes and separately for trainees versus staff, for phacoemulsification versus manual small-incision cataract surgery (M-SICS), and for a subgroup of eyes complicated by PCR or requiring secondary surgery.
All cataract surgeries (2 062 643) performed during the 8-year period from 2011 to 2018 at the 10 regional Aravind Eye hospitals were included in the analysis. With ICMP, the overall POE rate declined from 692 (0.07%) of 993 009 eyes to 185 (0.02%) of 1 069 634 eyes (P < .001). This was independently significant for phacoemulsification and for M-SICS (P < .001). The overall PCR rate was 28 352 (1.37%) of 2 062 643 eyes, and it was statistically higher for trainees irrespective of surgical method (P < .001). Both staff and trainee surgeons had higher PCR rates with phacoemulsification than with M-SICS (P < .001). Absent ICMP, PCR increased the overall POE rate by more than 7-fold to 63 (0.43%) of 14 505 eyes. ICMP reduced the POE rate after PCR to 25 (0.18%) of 13 847 eyes (P = .002). This ICMP benefit was separately significant for both M-SICS (0.54% vs 0.26%, P = .01) and phacoemulsification (0.29% vs 0.06%, P = .005). The POE rate was especially high after secondary IOL implantation (0.90% without ICMP vs 0.34% with ICMP; P = .10).
ICMP reduced the POE rate overall, with phacoemulsification, with M-SICS, and in eyes with PCR.
Lymphedema: Surgical and Medical Therapy Chang, David W; Masia, Jaume; Garza, Ramon ...
Plastic and reconstructive surgery (1963),
2016-September, Letnik:
138, Številka:
3S Current Concepts in Wound Healing: Update 2016
Journal Article
Recenzirano
BACKGROUND:Secondary lymphedema is a dreaded complication that sometimes occurs after treatment of malignancies. Management of lymphedema has historically focused on conservative measures, including ...physical therapy and compression garments. More recently, surgery has been used for the treatment of secondary lymphedema.
METHODS:This article represents the experience and treatment approaches of 5 surgeons experienced in lymphatic surgery and includes a literature review in support of the techniques and algorithms presented.
RESULTS:This review provides the reader with current thoughts and practices by experienced clinicians who routinely treat lymphedema patients.
CONCLUSION:The medical and surgical treatments of lymphedema are safe and effective techniques to improve symptoms and improve quality of life in properly selected patients.
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