Background Primary cardiac tumors in infants and children are extremely rare; hence, there is very little literature available, and most knowledge is based on collections of case reports. This report ...is a comprehensive review of our 26-year experience with primary cardiac tumors in children with emphasis on surgical indications, strategies, and long-term outcome. Methods Between 1986 and 2012, 47 children (mean age 5.9 ± 2.4 months; range, 1 day to 17 years) underwent either subtotal or total resection of cardiac tumors (rhabdomyoma, 13; fibroma, 12; teratoma, 9; myxoma, 8; hemangioma, 2; rhabdomyosarcoma, 1; non-Hodgkin’s lymphoma, 1; lymphangioma, 1). The majority were diagnosed by echocardiography (n = 33). Clinical patterns were varied: 40 had an atypical heart murmur and 6 were asymptomatic. Outflow tract obstruction of more than 30 mm Hg was present in 11 children. Three patients had abnormal coronary arteries secondary to pressure from tumor bulk. Indications of resection were hemodynamic/respiratory compromise, severe arrhythmia, and a significant embolization risk. Strategy of resection varied according to location and hemodynamic status without damage to adjacent structures. Results Morbidity included bleeding in a patient and a transient low output state in another. A 5-month-old infant with left ventricular fibroma underwent left ventricular assist device implantation secondary to failure from weaning off cardiopulmonary bypass, and she eventually underwent heart transplantation 17 days later. Early mortality (n = 2, 4.2%) included a 5-month-old infant who underwent complete resection of rhabdomyoma located in the left ventricle, with concomitant pulmonary valve replacement; unfortunately, he underwent left ventricular assist device implantation for postoperative heart failure and died on the 13th postoperative day. An 8-month-old child with 3 cm × 4 cm fibroma obstructing the right ventricular outflow tract compressing the right coronary artery died of severe right-side heart failure on the 13th postoperative day. One late death (2.1%) occurred; a 16-year-old with non-Hodgkin’s lymphoma died 7 months after the surgery. Mean duration of follow-up is 11.6 ± 3.5 years. All survivors (93.4%) are well, free of tumor-related symptoms and tumor recurrence/progression, even when resection was incomplete. Conclusions This study illustrates that although primary cardiac tumors in infants and children have a wide and unusual spectrum of clinical presentation, an individualized approach to tumor resection allows restoration of an adequate hemodynamic function and satisfactory long-term, tumor-free outcome.
Cocoa beans are susceptible to fungal contamination and often contain substantial amounts of ergosterol, the precursor to vitamin D
. We hypothesized that sun-drying the fermented cocoa beans might ...lead to the conversion of ergosterol to vitamin D
. We quantified vitamin D in cocoa and cocoa-based foods by liquid chromatography-tandem mass spectrometry. Here, we show that cocoa beans from different growing regions contain vitamin D
. Particularly high vitamin D
content was found in cocoa powder and butter. Among the chocolates, dark chocolate had the highest vitamin D
content (ranging from 1.90 to 5.48 µg/100 g), white chocolate had the lowest vitamin D
content (ranging from 0.19 to 1.91 µg/100 g), and chocolate nut spreads had a comparatively low vitamin D
content, with an average of 0.15 µg/100 g. Thus, cocoa and chocolate are clearly a dietary source of vitamin D, therefore, it is necessary to update food composition databases.
A History of Burn Care Kamolz, Lars-Peter; Hartmann, Bernd
Medicina (Kaunas, Lithuania),
05/2021, Volume:
57, Issue:
6
Journal Article
Peer reviewed
Open access
Burn injuries are still one of the most common and devastating injuries in humans and the treatment of major burns remains a major challenge for physicians worldwide ...
•Cocoa and cocoa-based foods are sources of vitamin D2.•Cocoa butter and dark chocolate have the highest vitamin D2 content.•There is a high variation in the vitamin D2 content in each product group.
...Cocoa beans are susceptible to fungal contamination and often contain substantial amounts of ergosterol, the precursor to vitamin D2. We hypothesized that sun-drying the fermented cocoa beans might lead to the conversion of ergosterol to vitamin D2. We quantified vitamin D in cocoa and cocoa-based foods by liquid chromatography-tandem mass spectrometry. Here, we show that cocoa beans from different growing regions contain vitamin D2. Particularly high vitamin D2 content was found in cocoa powder and butter. Among the chocolates, dark chocolate had the highest vitamin D2 content (ranging from 1.90 to 5.48 µg/100 g), white chocolate had the lowest vitamin D2 content (ranging from 0.19 to 1.91 µg/100 g), and chocolate nut spreads had a comparatively low vitamin D2 content, with an average of 0.15 µg/100 g. Thus, cocoa and chocolate are clearly a dietary source of vitamin D, therefore, it is necessary to update food composition databases.
Wound healing is a complex process that is still not fully understood despite extensive research. To address this, we aimed to design and characterize a standardized porcine model for the evaluation ...of wound healing, dressings, cell therapies, and pharmaceutical agents. Using a standardized approach, we examined the wound healing process in 1.2 mm-deep dermatome wounds at defined positions in 11 female pigs. Unlike previous studies that have only described/analyzed selected punch biopsies, we performed and described histological analyses along the complete wound length using quantitative morphometric methods. All animals remained fully healthy following surgery and showed no signs of infection. Our histopathological evaluation using a predetermined grading score and quantitative manual morphometry demonstrated the impact of different tissue sampling methods, sampling sites, and residual dermis thickness on wound healing. Our study presents a reproducible model for wound healing evaluation and demonstrates the usefulness of porcine models for assessing dermal and epidermal wound healing. The use of histological analyses over the complete wound length provides advantages over previous studies, leading to the possibility of a deeper understanding of the wound healing process. This model could potentially facilitate future research on novel wound dressings and local wound healing therapies.
Over time, we have come to recognize a very complex network of physiological changes enabling wound healing. An immunological process enables the body to distinguish damaged cells and begin a ...cleaning mechanism by separating damaged proteins and cells with matrix metalloproteinases, a complement reaction, and free radicals. A wide variety of cell functions help to rebuild new tissue, dependent on energy provision and oxygen supply. Like in an optimized “bio-reactor,” disturbance can lead to prolonged healing. One of the earliest investigated local factors is the pH of wounds, studied in close relation to the local perfusion, oxygen tension, and lactate concentration. Granulation tissue with the wrong pH can hinder fibroblast and keratinocyte division and proliferation, as well as skin graft takes. Methods for influencing the pH have been tested, such as occlusion and acidification by the topical application of acidic media. In most trials, this has not changed the wound’s pH to an acidic one, but it has reduced the strong alkalinity of deeper or chronic wounds. Energy provision is essential for all repair processes. New insights into the metabolism of cells have changed the definition of lactate from a waste product to an indispensable energy provider in normoxic and hypoxic conditions. Neovascularization depends on oxygen provision and lactate, signaling hypoxic conditions even under normoxic conditions. An appropriate pH is necessary for successful skin grafting; hypoxia can change the pH of wounds. This review describes the close interconnections between the local lactate levels, metabolism, healing mechanisms, and pH. Furthermore, it analyzes and evaluates the different possible ways to support metabolism, such as lactate enhancement and pH adjustment. The aim of wound treatment must be the optimization of all these components. Therefore, the role of lactate and its influence on wound healing in acute and chronic wounds will be assessed.
Background Extracorporeal shock wave therapy may enhance revascularization and repair of healing soft tissue. Methods Between January 2006, and September 2007, 28 patients with acute traumatic wounds ...and burns requiring skin grafting were randomly assigned in a 1:1 fashion to receive standard topical therapy (nonadherent silicone mesh Mepitel, Mölnlycke Health Care and antiseptic gel polyhexanide/octenidine) to graft donor sites with (n = 13) or without (n = 15) defocused extracorporeal shock wave therapy (ESWT, 100 impulses/cm2 at 0.1 mJ/mm2 ) applied once to the donor site, immediately after skin harvest. The randomization sequence was computer generated, and the patients were blinded to treatment allocation. The primary endpoint was time to complete donor site epithelialization and was determined by an independent blinded observer. Results Statistical tests indicated no unbalanced distribution of subject characteristics across the two study groups. Mean times to complete graft donor site epithelialization for patients who did and did not undergo ESWT were 13.9 ± 2.0 days and 16.7 ± 2.0 days, respectively (p = 0.0001). Conclusions For centers that apply nonadherent gauze dressings and topical antiseptics to skin graft donor sites, application of a single defocused shock wave treatment immediately after skin graft harvest can significantly accelerate donor site epithelialization.
Der Beitrag geht der aktuellen Frage nach, ob die Gleichwertigkeit der Lebensverhältnisse im Bundesgebiet nur ein selbstgestecktes politisches Ziel oder der Bund bereits von Verfassungs wegen zur ...Gewährleistung jener Gleichwertigkeit der Lebensverhältnisse verpflichtet ist. Hierzu sind zunächst die Aussagen des Grundgesetzes mit Blick auf die Lebensverhältnisse im Bundesgebiet Untersuchungsgegenstand. Sodann unternimmt die Abhandlung den Versuch, jenes Verfassungsgebot aus dem Bundesstaatsprinzip unter Berücksichtigung bundesstaatstheoretischer und rechtsvergleichender Überlegungen abzuleiten. Der Bundesstaat ist eine Symbiose aus Einheit und Vielfalt. Daher können einheitliche Lebensverhältnisse im ganzen Bundesgebiet kein Verfassungsziel sein. Andererseits dürfte aus gesamtstaatlicher Sicht ein Auseinanderfallen der Lebensverhältnisse in den verschiedenen Ländern nur bis zu einem gewissen Grad verkraftbar sein. Der Beitrag kommt daher zu dem Schluss, dass die genannten Gegensätze der Bundesstaatlichkeit in Bezug auf die Lebensverhältnisse im Bundesgebiet mit der Forderung nach ihrer Gleichwertigkeit zum Ausgleich gebracht werden können. In Fortführung dessen wird abschließend unter Verallgemeinerung finanzverfassungsrechtlicher Überlegungen die Reichweite des Verfassungsgebots und somit die verfassungsrechtliche Pflicht des Bundes zur Gewährleistung gleichwertiger Lebensverhältnisse näher entfaltet.
Osteoarthritis of the hip (OA) is a common degenerative disorder of the joint cartilage that presents a major public health problem worldwide. While intrinsic risk factors (e.g, body mass and ...morphology) have been identified, external risk factors are not well understood. In this systematic review, the evidence for workload as a risk factor for hip OA is summarized and used to derive recommendations for prevention and further research.
Epidemiological studies on workload or occupation and osteoarthritis of the hip were identified through database and bibliography searches. Using pre-defined quality criteria, 30 studies were selected for critical evaluation; six of these provided quantitative exposure data.
Study results were too heterogeneous to develop pooled risk estimates by specific work activities. The weight of evidence favors a graded association between long-term exposure to heavy lifting and risk of hip OA. Long-term exposure to standing at work might also increase the risk of hip OA.
It is not possible to estimate a quantitative dose-response relationship between workload and hip OA using existing data, but there is enough evidence available to identify job-related heavy lifting and standing as hazards, and thus to begin developing recommendations for preventing hip OA by limiting the amount and duration of these activities. Future research to identify specific risk factors for work-related hip OA should focus on implementing rigorous study methods with quantitative exposure measures and objective diagnostic criteria.
Multiple myeloma (MM) is characterized by serial relapses, necessitating the application of sequential lines of therapy (LoT). Reports on attrition rates (ARs) vary widely. The present study analysed ...ARs from the Austrian Myeloma Registry. Attrition was defined as being either deceased, progressive without having received another LoT, or lack of follow-up for ≥5 years. A total of 571 patients diagnosed between January 2009 and August 2021 were included (median age: 72 years; median follow-up: 50.8 months). Some 507 patients received at least one LoT. Of the total, 43.6% underwent autologous stem cell transplantation (SCT, transplant eligible = TE)) with primarily VRd (Bortezomib/Lenalidomide/Dexamethasone) given as induction (26.5%), followed by lenalidomide maintenance in 55.7% of cases. Transplant-ineligible (NTE) patients were predominantly treated with Vd (Bortezomib/Dexamethasone, 21.6%), receiving maintenance in 27.1%. A total of 37.5% received a second LoT. ARs across one to five LoTs were 16.7-27%. Frontline induction/ SCT followed by maintenance reduced ARs associated with age and achievement of deep remission in the frontline. Deep remission prolongs follow-up and time-to-next-treatment (TTNT), while high-risk-cyctogenetics negatively affected these outcomes. Our results demonstrate considerably lower ARs for MM patients within the AMR data versus other healthcare systems. Young age and the achievement of significant remissions after optimal frontline therapy resulted in particularly low ARs. These promising results support a key role for the ease of drug access and reimbursement policies in governing long-term MM patient outcomes.
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