Screening for maternal syphilis has been an essential component of routine antenatal screening tests in most countries for many years. This is not only because of the virulence of the spirochete which causes the infec...Screening for maternal syphilis has been an essential component of routine antenatal screening tests in most countries for many years. This is not only because of the virulence of the spirochete which causes the infection but also because of its vertical transmission rate and the potential severe adverse complications/morbidity that can result from its transmission to the fetus. Although the incidence of maternal syphilis and its fetal sequalae in low-income countries has been considerable for several years, the disease has been almost non-existent in high income countries with wide antenatal screening coverage and effective treatment programmes for Syphilis. The recent alarming increase in the incidence of maternal syphilis in high income countries has spawned a renewed public health interest in the infection, with several countries updating and strengthening public health guidance in an attempt to stem this dramatic trend. This is a short clinical update for the practising obstetrician on how to manage the antenatal patient with a positive syphilis screening test.展开更多
Cancer treatments are rapidly changing.Curative treatment for oesophageal adenocarcinoma currently involves surgery and cytotoxic chemotherapy or chemoradiotherapy.Outcomes for both regimes are generally poor as a res...Cancer treatments are rapidly changing.Curative treatment for oesophageal adenocarcinoma currently involves surgery and cytotoxic chemotherapy or chemoradiotherapy.Outcomes for both regimes are generally poor as a result of tumor recurrence.We have reviewed the key signalling pathways associated with oesophageal adenocarcinomas and discussed the recent trials of novel agents that attempt to target these pathways.There are many trials underway with the aim of improving survival in oesophageal cancer.Currently,phase 2 and 3 trials are focused on MAP kinase inhibition,either through inhibition of growth factor receptors or signal transducer proteins.In order to avoid tumor resistance,it appears to be clear that targeted therapy will be needed to combat the multiple signalling pathways that are in operation in oesophageal adenocarcinomas.This may be achievable in the future with the advent of gene signatures and a combinatorial approach.展开更多
Barrett's esophagus (BE) confers a significant increased risk for development of esophageal adenocarcinoma (EAC), with the pathogenesis appearing to progress through a "metaplasia-dysplasia-carcinoma" (M...Barrett's esophagus (BE) confers a significant increased risk for development of esophageal adenocarcinoma (EAC), with the pathogenesis appearing to progress through a "metaplasia-dysplasia-carcinoma" (MDC) sequence. Many of the genetic insults driving this MDC sequence have recently been characterized, providing targets for candidate biomarkers with potential clinical utility to stratify risk in individual patients. Many clinical risk factors have been investigated, and associations with a variety of genetic, specific gastrointestinal and other modifiable factors have been proposed in the literature. This review summarizes the current understanding of the mechanisms involved in neoplastic progression of BE to EAC and critically appraises the relative roles and contributions of these putative risk factors from the published evidence currently available.展开更多
AIM:To identify if methylene tetra-hydrofolatereductase(MTHFR)C677T polymorphisms are associated with oesophageal adenocarcnomas in a Caucasian population and to test whether folic acid and homocysteine levels are lin...AIM:To identify if methylene tetra-hydrofolatereductase(MTHFR)C677T polymorphisms are associated with oesophageal adenocarcnomas in a Caucasian population and to test whether folic acid and homocysteine levels are linked with cancer risk.METHODS:A case control study comprising of 58 non cancer and 48 cancer patients,MTHFR C667T genotyping was made and serum folate,homocysteine and vitamin B12 levels were made.Tumour stage,differentiation and survival was recorded.A P value of less than0.05 was taken to be significant.Theχ2 used to compare discrete variables and the Mantel-Cox was used to compare survival.A P value less than 0.05 was deemed to be significant.RESULTS:MTHFR polymorphisms is associated with an increased risk of several cancers.A link between MTHFR C677T polymorphisms and oesophageal squamous cell carcinoma and gastric cardia adenocarcinoma has been demonstrated in at risk Chinese populations.In a Western European population the role of the MTHFR gene has not previously been investigated in the setting of oesophageal adenocarcinoma.No association between folic acid levels and cancer patients was found.The unstable MTHFR 667 TT genotype occurred in 11%cancers and 7%controls,but statistical significance was not reached,homocysteine levels and folic acid levels were not affected,cancer patients with TT genotype displayed a trend for a shorter survival 7 mo vs 20 mo.Serum vitamin B12 levels were higher in the cancer group.The MTHFR 667 TT genotype is much lower than previous population studies.CONCLUSION:We conclude that serum folic acid and MTHFR polymorphisms are not associated with an increased risk of oesophageal adenocarcinoma,although cancers with unstable TT genotype may indicate a more aggressive disease course.展开更多
BACKGROUND: The management of complex pattern of bleeding associated with pelvic trauma remains a big challenge for trauma surgeons. We aimed to conduct a comprehensive meta-analysis to compare the outcomes of angioem...BACKGROUND: The management of complex pattern of bleeding associated with pelvic trauma remains a big challenge for trauma surgeons. We aimed to conduct a comprehensive meta-analysis to compare the outcomes of angioembolisation and pelvic packing in patients with pelvic trauma.METHODS: We conducted a systematic search of electronic information sources, including MEDLINE; EMBASE; CINAHL; the CENTRAL; the World Health Organization International Clinical Trials Registry; Clinical Trials.gov; ISRCTN Register, and bibliographic reference lists. The primary outcome was defined as mortality. Combined overall effect sizes were calculated using randomeffects models. Results are reported as the odds ratio(OR) and 95% confidence interval(CI).RESULTS: We identified 3 observational studies reporting a total of 120 patients undergoing angioembolisation(n=60) or pelvic packing(n=60) for pelvic trauma. Reporting of the Injury Severity Score(ISS) was variable, with higher ISS in the pelvic packing group. The risk of bias was low in two studies, and moderate in one. The pooled analysis demonstrated that angioembolisation did not significantly reduce mortality in patients with pelvic trauma compared to surgery(OR=1.99; 95% CI= 0.83–4.78, P=0.12). There was mild between-study heterogeneity(I^2=0%, P=0.65).CONCLUSION: Our analysis found no significant difference in mortality between angioembolisation and pelvic packing in patients with traumatic pelvic haemorrhage. The current level of evidence in this context is very limited and insufficient to support the superiority of a treatment modality. Future research is required.展开更多
AIM To establish how neonatal units in England and Wales currently confirm longline tip position, immediately after insertion of a longline.METHODS We conducted a telephone survey of 170 neonatal units(37 special care...AIM To establish how neonatal units in England and Wales currently confirm longline tip position, immediately after insertion of a longline.METHODS We conducted a telephone survey of 170 neonatal units(37 special care baby units, 81 local neonatal units and 52 neonatal intensive care units) across England and Wales over the period from January to May 2016. Data was collected on specifically designed proformas. We gathered information on the following: Unit Level designation; whether the unit used longlines and specific type used? Modality used to confirm longline tip position? Whether guide wires were routinely removed and contrast injected to determine longline position? The responders were primarily senior nurses.RESULTS We had 100% response rate. Out of the total neonatal units surveyed(170) in England and Wales, 141 units(83%) used longlines. Fifty-five out of 81 local neonatal units(68%) using longlines, used ones that came with guide wires; a similar percentage of neonatal intensive care units, i.e., 31 out of 52 units(60%) did the same. All of those units used radiography, plain X-rays, to establish longline tip position. Out of 55 local neonatal units usinglonglines with guide wires, 42(76%) were not removing wire to use contrast while this figure was 58%(18 out of 31 units) for neonatal intensive care units. Overall, only 49 out of 141 units(35%) of the units using longlines were using contrast. However it was interesting to note that use of contrast increased as one moved from special care baby units(25%, 2 out of 8 units) to local neonatal units(28%, 23 out of 81 units) and neonatal intensive care units level(46%, 24 out of 52 units) designation. CONCLUSION Neonatal units in England and Wales are overwhelmingly relying on plain radiographs to assess longline tip position immediately after insertion. Despite evidence of its usefulness, and in the absence of perhaps more accurate methods of assessing longline tip position in a reliable and consistent way, i.e., ultrasonography, contrast is only used in a third of units.展开更多
Technological advances, a deeper understanding of disease processes and increased sophistication of therapeutic methods have all led to better outcomes in rare diseases which previously had devastating effects on many...Technological advances, a deeper understanding of disease processes and increased sophistication of therapeutic methods have all led to better outcomes in rare diseases which previously had devastating effects on many women’s lives. The inevitable result of this progress is that women, who in the past did not contemplate pregnancy because of significant morbidity, now get to adulthood and are reasonably “disease free” enough to have their own families. The ever expanding, but relatively new specialty of Obstetric medicine seeks to further improve the outcome in pregnant women with intercur</span><span style="font-family:"">r</span><span style="font-family:"">ent disease by enhancing the literature base, thereby contributing to the creation of appropriate guidance in the management of these patients. This article is a brief but useful guide for the busy obstetrician who may have limited experience in dealing with multiple sclerosis in pregnant women.展开更多
Tendon autografts play an important role in upper limb reconstruction and a working knowledge of tendon autograft options is essential for the surgeon. Although palmaris longus is often the first choice, other options...Tendon autografts play an important role in upper limb reconstruction and a working knowledge of tendon autograft options is essential for the surgeon. Although palmaris longus is often the first choice, other options like plantaris, extensor Hallucis longus, flexor carpi radialis are readily available. Advantages of autografts include easy availability, satisfactory biomechanical properties and the human body tends to accept its own tendons than from a donor. This review highlights the various options available and their anatomical and surgical considerations in procuring grafts for upper limb reconstructive work.展开更多
The human dermis presents an ongoing problem for regenerative medicine. Current medical management uses various acellular dermal matrices on wound sites. The challenge for scientists is to examine, then to question ac...The human dermis presents an ongoing problem for regenerative medicine. Current medical management uses various acellular dermal matrices on wound sites. The challenge for scientists is to examine, then to question accepted conventional wisdom and to present new concepts. In this paper, Autologous Cell Therapy will be described by using cell culture of autologous dermal fibroblasts and their extracellular matrix as a foundation for rebuilding the dermis in conditioned wound beds. This proposal seems to create a conflict with the medical approach to keeping a wound bed “moist”.展开更多
This paper in a medical sense can be described as a case report. The diabetic foot wounds of a relative, over 70 years of age, with Type I diabetes were so grievous and the medical treatment was so protracted that suc...This paper in a medical sense can be described as a case report. The diabetic foot wounds of a relative, over 70 years of age, with Type I diabetes were so grievous and the medical treatment was so protracted that success could not be assured. There was a danger of amputation. The one outstanding feature was that the private application of an antifungal spray, between the toes of both feet without prescribed oral mycologic agents, seemed to make an inexplicable difference to the final outcome. In addition, a viewpoint drawn was that the efficacy of antibiotic therapies may be compromised by the presence of invisible fungal etiology.展开更多
Regenerative medicine has brought about refreshing new thinking about age old problems. However, some problems remain mostly untouched and are not being addressed. A point in question is the track of scar tissue left ...Regenerative medicine has brought about refreshing new thinking about age old problems. However, some problems remain mostly untouched and are not being addressed. A point in question is the track of scar tissue left behind post-operatively, which reveals the surgeon’s line of invasive incision. This confers on the patient an adverse psychological reminder and burden for the rest of his/her life. Most patients cannot afford corrective plastic surgery to ameliorate this skin defect. This paper seeks to ask whether biomedical scientists could play a role in arriving at a more pleasing cosmetic result, using a simple cell culture procedure of isolating un-manipulated autologous primary epidermal and dermal cells from a small skin tissue segment in close proximity to the surgeon’s incision line.展开更多
This paper sets out to demonstrate that scraping of the flat dorsal surface of human dermis with a scalpel blade and cell plating without centrifugation can lead to the recognition and identification of the individual...This paper sets out to demonstrate that scraping of the flat dorsal surface of human dermis with a scalpel blade and cell plating without centrifugation can lead to the recognition and identification of the individual packing micro pattern of dermal reticular fibroblasts at confluence. The characteristic alignment of papillary and reticular fibroblasts at right angles to each other led to the positive identification of reticular fibroblasts. A non-enzymatic means of sub-culturing (passaging), which yields fully functional, healthy cells with normal, phenotypic morphology is also described. Implications for published subcutaneous wound healing studies are discussed as well as the confluent reticular fibroblast configuration, interpreted as ananatomic site identity code,which may be the address of a specific fibroblast gene pattern expression.展开更多
Skin grafts have remained relatively unchanged since their introduction as a medical treatment for burns/wounds. This paper seeks to open an academic discussion as to whether their use-by date has now been passed. A s...Skin grafts have remained relatively unchanged since their introduction as a medical treatment for burns/wounds. This paper seeks to open an academic discussion as to whether their use-by date has now been passed. A skin graft substitute is described in a paradigm using fine leaf gelatine sheets which inherently possess several distinct advantages including, discarding the harvest of autologous tissue from patient donor sites. A clinical study will be needed to determine its suitability taken together with the understanding that experimental animal studies may not provide unequivocal answers to its in situ modus operandi.展开更多
Objectives:Multiple treatments are described in the literature for the treatment of chronic Eustachian tube dysfunction but high-level quality evidence seems missing to support these treatments.This systematic review ...Objectives:Multiple treatments are described in the literature for the treatment of chronic Eustachian tube dysfunction but high-level quality evidence seems missing to support these treatments.This systematic review aimed to determine and compare the safety and efficacy of Laser Eustachian tuboplasty and Microdebrider Eustachian tuboplasty as a treatment for long-term Eustachian tube dysfunction.Data sources:A total of 12 electronic databases were searched up to April 2018 for published and unpublished literature in the English language.References of included studies were checked.Methods:A systematic review was undertaken.Outcomes assessed were:primary outcomes-subjective improvement in symptoms(ETDQ-7),audiometric improvement of hearing,improvement of negative middle ear pressure noticed in tympanometry,objective improvement of tympanic membrane retraction.Secondary outcomes were-the ability to auto-insufflate Eustachian tube i.e.Valsalva manoeuvre,improved quality of life,passive tubal opening,tubomanometry,swallowing test,reduction in mucosal inflammation of Eustachian tube orifice in the nose,complications from the procedure,the need for further procedures.Results are reported in a narrative synthesis as a meta-analysis was not possible due to heterogeneous data.Results:Three studies were included.All included studies were small-scale case series(13-38 par-ticipants).Studies were conducted outside the UK.Subjective and objective improvement of Eustachian tube function was reported in all studies.But all included studies were at high risk of bias and subject to multiple limitations.No major complications were reported in either study.Conclusions:Based on current evidence,it is not possible to recommend the clinical use of either of these two interventions i.e.Laser or Microdebrider Eustachian tuboplasty.Lack of controlled studies was identified as a gap in the evidence.Future research should be directed toward designing randomised controlled trials.These trials should use strict standard methodology and reporting criteria.Future trials should make use of consensus statement document about Eustachian tube dysfunction definition,diagnostic methods,and outcome assessment criteria to design clinical trials.展开更多
文摘Screening for maternal syphilis has been an essential component of routine antenatal screening tests in most countries for many years. This is not only because of the virulence of the spirochete which causes the infection but also because of its vertical transmission rate and the potential severe adverse complications/morbidity that can result from its transmission to the fetus. Although the incidence of maternal syphilis and its fetal sequalae in low-income countries has been considerable for several years, the disease has been almost non-existent in high income countries with wide antenatal screening coverage and effective treatment programmes for Syphilis. The recent alarming increase in the incidence of maternal syphilis in high income countries has spawned a renewed public health interest in the infection, with several countries updating and strengthening public health guidance in an attempt to stem this dramatic trend. This is a short clinical update for the practising obstetrician on how to manage the antenatal patient with a positive syphilis screening test.
基金Supported by UK National Institute of Health Research/Cancer Research Network (UK NIHR/UKCRN) and Research and Development Department of Wrightington Wigan and Leigh NHS Foundation Trust (to Ang YS)R Keld WrightingtonWigan and Leigh NHS Foundation Trust Cancer Therapy Fund(to Keld RR,in part)
文摘Cancer treatments are rapidly changing.Curative treatment for oesophageal adenocarcinoma currently involves surgery and cytotoxic chemotherapy or chemoradiotherapy.Outcomes for both regimes are generally poor as a result of tumor recurrence.We have reviewed the key signalling pathways associated with oesophageal adenocarcinomas and discussed the recent trials of novel agents that attempt to target these pathways.There are many trials underway with the aim of improving survival in oesophageal cancer.Currently,phase 2 and 3 trials are focused on MAP kinase inhibition,either through inhibition of growth factor receptors or signal transducer proteins.In order to avoid tumor resistance,it appears to be clear that targeted therapy will be needed to combat the multiple signalling pathways that are in operation in oesophageal adenocarcinomas.This may be achievable in the future with the advent of gene signatures and a combinatorial approach.
文摘Barrett's esophagus (BE) confers a significant increased risk for development of esophageal adenocarcinoma (EAC), with the pathogenesis appearing to progress through a "metaplasia-dysplasia-carcinoma" (MDC) sequence. Many of the genetic insults driving this MDC sequence have recently been characterized, providing targets for candidate biomarkers with potential clinical utility to stratify risk in individual patients. Many clinical risk factors have been investigated, and associations with a variety of genetic, specific gastrointestinal and other modifiable factors have been proposed in the literature. This review summarizes the current understanding of the mechanisms involved in neoplastic progression of BE to EAC and critically appraises the relative roles and contributions of these putative risk factors from the published evidence currently available.
基金Supported by Endowment funds of the Wrightington,Wigan and Leigh NHS Foundation TrustAng Y received support from Comprehensive Local Research Network of Greater Manchester and Cheshire,United Kingdom(flexibility and sustainability grant)
文摘AIM:To identify if methylene tetra-hydrofolatereductase(MTHFR)C677T polymorphisms are associated with oesophageal adenocarcnomas in a Caucasian population and to test whether folic acid and homocysteine levels are linked with cancer risk.METHODS:A case control study comprising of 58 non cancer and 48 cancer patients,MTHFR C667T genotyping was made and serum folate,homocysteine and vitamin B12 levels were made.Tumour stage,differentiation and survival was recorded.A P value of less than0.05 was taken to be significant.Theχ2 used to compare discrete variables and the Mantel-Cox was used to compare survival.A P value less than 0.05 was deemed to be significant.RESULTS:MTHFR polymorphisms is associated with an increased risk of several cancers.A link between MTHFR C677T polymorphisms and oesophageal squamous cell carcinoma and gastric cardia adenocarcinoma has been demonstrated in at risk Chinese populations.In a Western European population the role of the MTHFR gene has not previously been investigated in the setting of oesophageal adenocarcinoma.No association between folic acid levels and cancer patients was found.The unstable MTHFR 667 TT genotype occurred in 11%cancers and 7%controls,but statistical significance was not reached,homocysteine levels and folic acid levels were not affected,cancer patients with TT genotype displayed a trend for a shorter survival 7 mo vs 20 mo.Serum vitamin B12 levels were higher in the cancer group.The MTHFR 667 TT genotype is much lower than previous population studies.CONCLUSION:We conclude that serum folic acid and MTHFR polymorphisms are not associated with an increased risk of oesophageal adenocarcinoma,although cancers with unstable TT genotype may indicate a more aggressive disease course.
文摘BACKGROUND: The management of complex pattern of bleeding associated with pelvic trauma remains a big challenge for trauma surgeons. We aimed to conduct a comprehensive meta-analysis to compare the outcomes of angioembolisation and pelvic packing in patients with pelvic trauma.METHODS: We conducted a systematic search of electronic information sources, including MEDLINE; EMBASE; CINAHL; the CENTRAL; the World Health Organization International Clinical Trials Registry; Clinical Trials.gov; ISRCTN Register, and bibliographic reference lists. The primary outcome was defined as mortality. Combined overall effect sizes were calculated using randomeffects models. Results are reported as the odds ratio(OR) and 95% confidence interval(CI).RESULTS: We identified 3 observational studies reporting a total of 120 patients undergoing angioembolisation(n=60) or pelvic packing(n=60) for pelvic trauma. Reporting of the Injury Severity Score(ISS) was variable, with higher ISS in the pelvic packing group. The risk of bias was low in two studies, and moderate in one. The pooled analysis demonstrated that angioembolisation did not significantly reduce mortality in patients with pelvic trauma compared to surgery(OR=1.99; 95% CI= 0.83–4.78, P=0.12). There was mild between-study heterogeneity(I^2=0%, P=0.65).CONCLUSION: Our analysis found no significant difference in mortality between angioembolisation and pelvic packing in patients with traumatic pelvic haemorrhage. The current level of evidence in this context is very limited and insufficient to support the superiority of a treatment modality. Future research is required.
文摘AIM To establish how neonatal units in England and Wales currently confirm longline tip position, immediately after insertion of a longline.METHODS We conducted a telephone survey of 170 neonatal units(37 special care baby units, 81 local neonatal units and 52 neonatal intensive care units) across England and Wales over the period from January to May 2016. Data was collected on specifically designed proformas. We gathered information on the following: Unit Level designation; whether the unit used longlines and specific type used? Modality used to confirm longline tip position? Whether guide wires were routinely removed and contrast injected to determine longline position? The responders were primarily senior nurses.RESULTS We had 100% response rate. Out of the total neonatal units surveyed(170) in England and Wales, 141 units(83%) used longlines. Fifty-five out of 81 local neonatal units(68%) using longlines, used ones that came with guide wires; a similar percentage of neonatal intensive care units, i.e., 31 out of 52 units(60%) did the same. All of those units used radiography, plain X-rays, to establish longline tip position. Out of 55 local neonatal units usinglonglines with guide wires, 42(76%) were not removing wire to use contrast while this figure was 58%(18 out of 31 units) for neonatal intensive care units. Overall, only 49 out of 141 units(35%) of the units using longlines were using contrast. However it was interesting to note that use of contrast increased as one moved from special care baby units(25%, 2 out of 8 units) to local neonatal units(28%, 23 out of 81 units) and neonatal intensive care units level(46%, 24 out of 52 units) designation. CONCLUSION Neonatal units in England and Wales are overwhelmingly relying on plain radiographs to assess longline tip position immediately after insertion. Despite evidence of its usefulness, and in the absence of perhaps more accurate methods of assessing longline tip position in a reliable and consistent way, i.e., ultrasonography, contrast is only used in a third of units.
文摘Technological advances, a deeper understanding of disease processes and increased sophistication of therapeutic methods have all led to better outcomes in rare diseases which previously had devastating effects on many women’s lives. The inevitable result of this progress is that women, who in the past did not contemplate pregnancy because of significant morbidity, now get to adulthood and are reasonably “disease free” enough to have their own families. The ever expanding, but relatively new specialty of Obstetric medicine seeks to further improve the outcome in pregnant women with intercur</span><span style="font-family:"">r</span><span style="font-family:"">ent disease by enhancing the literature base, thereby contributing to the creation of appropriate guidance in the management of these patients. This article is a brief but useful guide for the busy obstetrician who may have limited experience in dealing with multiple sclerosis in pregnant women.
文摘Tendon autografts play an important role in upper limb reconstruction and a working knowledge of tendon autograft options is essential for the surgeon. Although palmaris longus is often the first choice, other options like plantaris, extensor Hallucis longus, flexor carpi radialis are readily available. Advantages of autografts include easy availability, satisfactory biomechanical properties and the human body tends to accept its own tendons than from a donor. This review highlights the various options available and their anatomical and surgical considerations in procuring grafts for upper limb reconstructive work.
文摘The human dermis presents an ongoing problem for regenerative medicine. Current medical management uses various acellular dermal matrices on wound sites. The challenge for scientists is to examine, then to question accepted conventional wisdom and to present new concepts. In this paper, Autologous Cell Therapy will be described by using cell culture of autologous dermal fibroblasts and their extracellular matrix as a foundation for rebuilding the dermis in conditioned wound beds. This proposal seems to create a conflict with the medical approach to keeping a wound bed “moist”.
文摘This paper in a medical sense can be described as a case report. The diabetic foot wounds of a relative, over 70 years of age, with Type I diabetes were so grievous and the medical treatment was so protracted that success could not be assured. There was a danger of amputation. The one outstanding feature was that the private application of an antifungal spray, between the toes of both feet without prescribed oral mycologic agents, seemed to make an inexplicable difference to the final outcome. In addition, a viewpoint drawn was that the efficacy of antibiotic therapies may be compromised by the presence of invisible fungal etiology.
文摘Regenerative medicine has brought about refreshing new thinking about age old problems. However, some problems remain mostly untouched and are not being addressed. A point in question is the track of scar tissue left behind post-operatively, which reveals the surgeon’s line of invasive incision. This confers on the patient an adverse psychological reminder and burden for the rest of his/her life. Most patients cannot afford corrective plastic surgery to ameliorate this skin defect. This paper seeks to ask whether biomedical scientists could play a role in arriving at a more pleasing cosmetic result, using a simple cell culture procedure of isolating un-manipulated autologous primary epidermal and dermal cells from a small skin tissue segment in close proximity to the surgeon’s incision line.
文摘This paper sets out to demonstrate that scraping of the flat dorsal surface of human dermis with a scalpel blade and cell plating without centrifugation can lead to the recognition and identification of the individual packing micro pattern of dermal reticular fibroblasts at confluence. The characteristic alignment of papillary and reticular fibroblasts at right angles to each other led to the positive identification of reticular fibroblasts. A non-enzymatic means of sub-culturing (passaging), which yields fully functional, healthy cells with normal, phenotypic morphology is also described. Implications for published subcutaneous wound healing studies are discussed as well as the confluent reticular fibroblast configuration, interpreted as ananatomic site identity code,which may be the address of a specific fibroblast gene pattern expression.
文摘Skin grafts have remained relatively unchanged since their introduction as a medical treatment for burns/wounds. This paper seeks to open an academic discussion as to whether their use-by date has now been passed. A skin graft substitute is described in a paradigm using fine leaf gelatine sheets which inherently possess several distinct advantages including, discarding the harvest of autologous tissue from patient donor sites. A clinical study will be needed to determine its suitability taken together with the understanding that experimental animal studies may not provide unequivocal answers to its in situ modus operandi.
文摘Objectives:Multiple treatments are described in the literature for the treatment of chronic Eustachian tube dysfunction but high-level quality evidence seems missing to support these treatments.This systematic review aimed to determine and compare the safety and efficacy of Laser Eustachian tuboplasty and Microdebrider Eustachian tuboplasty as a treatment for long-term Eustachian tube dysfunction.Data sources:A total of 12 electronic databases were searched up to April 2018 for published and unpublished literature in the English language.References of included studies were checked.Methods:A systematic review was undertaken.Outcomes assessed were:primary outcomes-subjective improvement in symptoms(ETDQ-7),audiometric improvement of hearing,improvement of negative middle ear pressure noticed in tympanometry,objective improvement of tympanic membrane retraction.Secondary outcomes were-the ability to auto-insufflate Eustachian tube i.e.Valsalva manoeuvre,improved quality of life,passive tubal opening,tubomanometry,swallowing test,reduction in mucosal inflammation of Eustachian tube orifice in the nose,complications from the procedure,the need for further procedures.Results are reported in a narrative synthesis as a meta-analysis was not possible due to heterogeneous data.Results:Three studies were included.All included studies were small-scale case series(13-38 par-ticipants).Studies were conducted outside the UK.Subjective and objective improvement of Eustachian tube function was reported in all studies.But all included studies were at high risk of bias and subject to multiple limitations.No major complications were reported in either study.Conclusions:Based on current evidence,it is not possible to recommend the clinical use of either of these two interventions i.e.Laser or Microdebrider Eustachian tuboplasty.Lack of controlled studies was identified as a gap in the evidence.Future research should be directed toward designing randomised controlled trials.These trials should use strict standard methodology and reporting criteria.Future trials should make use of consensus statement document about Eustachian tube dysfunction definition,diagnostic methods,and outcome assessment criteria to design clinical trials.
