First-time-use-of-integra-dermal-graft-as-an-alternative-for-buccal-mucosal-graft-urethroplasty-a-rare-case-report

The use of buccal mucosa grafts in urethral reconstruction for complex anterior urethral strictures has gained popularity over the years with very good outcomes reported in literature. Simultaneously newly launched integra dermal graft is been used as Onlay flap for postoperative hypospadias urethro-cutaneous fistula closure as reported in world wide literature. The aim of this case report is to compare pros and cons of use of Integra Dermal Graft as an alternative to staged Buccal mucosal graft urethroplasty in case of 13 years old boy with multiple postoperative hypospadias fistulae.

Comparation of HPLC fingerprints of Lagotis integra and Lagotis brevituba between different origins / 中草药

Objective: To establish HPLC fingerprints of Lagotis integra and Lagotis brevituba which were contained in National Drug Standard and compared to Lagotis ramalana, Lagotis alutacea and Lagotis brachystachya by the established method. Methods: The similarity of HPLC fingerprints of L. integra and L. brevituba was low, so the HPLC fingerprint methods were established for both. The HPLC analysis was performed on Waters X-Bridge C18 (250 mm × 4.6 mm, 5 μm), using acetonitrile and 0.2% formic acid solution as the mobile phase at a flow rate of 1.0 mL/min, the detection wave-length was 328 nm and column temperature was 35 ℃ (L. integra) and 25 ℃ (L. brevituba). Results: There were 14 common peaks in the fingerprint of L. integra, and plantamajoside, hemiphroside B, 10-O-trans-p-methoxycinnamoyl-catalpol and 10-O-[(E)-3,4-dimethoxycinna moyl]-catalpol were standardized. There were 13 common peaks in the fingerprint of L. brevituba, and echinacoside, plantamajoside and acteoside were standardized. The similarity of HPLC fingerprint was more than 0.9 between L. integra and L. alutacea, but the others had low similarity with them. The similarity of HPLC fingerprint was more than 0.9 between L. brevituba from different batches and L. ramalana, while the others had low similarity with them. Conclusion: The established method could effectively identify L. brevituba, L. integra and L. alutacea were advised to be recorded in Medical Standards of the Ministry of Health. Lagotis ramalana could be used as a new base for "Honglian" (origin: Lagotis brevituba).

Uso de dermis artificial (Integra®) en reparación de lesiones traumáticas extensas de cuero cabelludo / Use of artificial dermis (INTEGRA®) in repair of extensive traumatic scalp injuries

Resumen Objetivo: Presentar 4 casos clínicos en los cuales el uso de dermis artificial Integra® resultó ser una solución segura y confiable para defectos de cuero cabelludo. Materiales y Método: Revisión de fichas clínicas de pacientes ingresados al Departamento de Cirugía Plástica y Quemados del Hospital del Trabajador de Santiago con diagnóstico de lesión traumática extensa de cuero cabelludo entre los años 2005-2013 que se resolvieron con uso de Integra®. Resultados: 4 pacientes de sexo femenino con lesión traumática que comprometían entre 70-98% de la superficie de cuero cabelludo, tiempo promedio entre aplicación de Integra® e injerto dermoepidérmico fue 18 días con 100% de cobertura; solo hubo complicaciones menores (ulceración crónica de vertex y dolor neuropático). El tiempo promedio de alta laboral fue 368 días, usando órtesis capilar. Discusión: La cobertura inmediata del tejido es fundamental para la reconstrucción exitosa del cuero cabelludo. Aparte del tejido autólogo, la dermis artificial constituye una alternativa para la reconstrucción rápida del cuero cabelludo con excelentes resultados. Conclusiones: Integra® es una solución segura y confiable para reconstruir defectos complejos del cuero cabelludo.

Aim: To present 4 clinical cases in which the use of artificial dermis (Integra®) turned out to be a safe and reliable solution for scalp defects. Materials and Method: review of clinical records of patients admitted to the Department of Plastic Surgery and Burns of the Hospital of the Worker of Santiago with a diagnosis of extensive traumatic injury of the scalp between the years 2005-2013 that were resolved with use of Integra®. Results: 4 female patients with traumatic injury that compromised between 70-95% of the surface of scalp, average time between application of integra and dermoepidermal graft was 18 days with 100% coverage; there were only minor complications (chronic vertex ulceration and neuropathic pain). The average time of high labor was 368 days, using capillary orthosis. Discussion: The immediate coverage of the tissue is essential for the successful reconstruction of the scalp. Apart from autologous tissue, the artificial dermis is an alternative for rapid reconstruction of the scalp with excellent results. Conclusions: Integra is a safe and reliable solution to reconstruct complex defects of the scalp.

Preliminary Investigation of the Anti-asthmatic Potential of Kalanchoe integra Leaf Extract Using a Model of Allergic Airway Inflammation.

Objective: Kalanchoe integra is known to possess antihistaminic and mast cell stabilizing effect. Inflammatory mediators, such as histamine and eicosanoids have been implicated in the pathophysiology of allergen-induced asthma including bronchospasm, vasodilation, increased vascular permeability, perivascular and peribronchial oedema, acute functional changes in the lungs and diarrhea due to increased intestinal motility. This study is to ascertain the anti-inflammatory effect of Kalanchoe integra aqueous leaf extract (KILE) on bronchial hyper-responsiveness in ovalbumin-sensitized guinea-pigs. Method: Bronchial asthma was induced in guinea pigs using Ovalbumin. In vivo skin tests were carried out on all guinea pigs using ovalbumin and histamine as allergens. The diameters of wheals were recorded and the means determined. OA-sensitized guineapigs were challenged with 2% OA aerosols after 1 hour per os of drugs (KILE or prednisolonefor the treated groups) for two weeks. A piece of excised trachea was suspended in a tissue bath and challenged with histamine in the presence and absence of KILE, as well as Prednisolone (2.5 mg/kg). The results were reported as mean ±S.E.M. Statistical analysis was performed using one-way ANOVA and Bonferroni’s post hoc test. Results: Biological assaying of KILE showed significant dose-dependent reduction in histamine induced vasodilation of cutaneal blood vessels (P<0.05 in all groups at all times of wheal measurements) and contractile responses of isolated trachea to histamine. KILE generally reduced the effect of histamine in all groups. Conclusion: This study has shown that KILE has the potential of alleviating signs of bronchial hyper-responsiveness and skin allergies in ovalbumin-sensitized guinea pigs with the female models been more sensitive than the male counterparts.

Contractura axilar por quemadura tratada con Integra® / Axillary burn contracture treated with Integra®

Introduction: Severe axillary burn is an unusual accident that frequently evolves to contracture generating important cosmetic and functional deficiencies. Contracture scars in this region are difficult to treat because of the anatomic characteristics of the area that has multiple power vectors. Functional restoration has to be one of the main goals in the management of burns in the axilla and flaps have shown high rate of morbidity. Integra® provides satisfactory elasticity and dermal resistance which results in positive functional results. Objective: Analyze the results of the use of Integra® in axillary burn contracture scars at a specialized Burns Center. Materials and Methods: There were 4 patients who underwent reconstructive surgery using Integra® for axillary burn contractures between January 2002 and March 2006. Follow-up was divided into perioperative and late. Early follow-up checked general post-operative evolution and late follow-up was focused on functionality and patient independence evaluated using Barthel's index of daily living activities. Results: There were 3 males and 1 female, average age 27 (18-41) with a minimum follow up of 9 months. There were no perioperative complications and good or very good range of motion results. Conclusions: Our results are similar to artificial skin substitutes used in other anatomical regions.

Las quemaduras axilares severas son un accidente infrecuente que evolucionan a la retracción generando deficiencias cosméticas y funcionales. Estas cicatrices son difíciles de tratar por las características anatómicas del área, donde la corrección de un vector de movimiento puede alterar otro. Objetivo: Mostrar nuestros resultados utilizando el sustituto cutáneo Integra® en el tratamiento de cicatrices retráctiles axilares por quemadura. Pacientes y Métodos: Se recolectaron antecedentes médicos y fotográficos de pacientes portadores de cicatrices retráctiles axilares por quemadura entre enero de 2002 y marzo de 2006 en el Hospital del Trabajador de Santiago. Se evaluó pre y postoperatoriamente a los pacientes en forma subjetiva por fisiatra y con el Test de Barthel. Resultados: Se incluyeron 4 pacientes en el estudio (3 mujeres y 1 hombre), edad media 27 años (18-41). Todas las quemaduras fueron producidas por fuego. Índice de Barthel preoperatorio fue de 87,5 (levemente dependiente para las actividades de la vida diaria) y rango de movimiento moderadamente afectado. En el postoperatorio los pacientes fueron catalogados como independientes según el Test de Barthel y el rango de movimiento fue descrito como bueno o muy bueno por el fisiatra. No hubo complicaciones peri operatorias, Integra® prendió adecuadamente en todos los casos. Los pacientes fueron seguidos en promedio 16 meses (9-22). Conclusiones: Los sustitutos dérmicos han sido usados para la corrección de cicatrices de quemaduras con buenos resultados, pero no hay reportes en la axila. El pequeño número de pacientes que presentamos tienen un excelente resultado funcional, lo que nos estimula a seguir trabajando en este rumbo.

Comparison of HbA(1c) Analyzers: D-10, Variant II Turbo, Cobas Integra 800, and Afinion AS100 / 대한진단검사의학회지

BACKGROUND: The purpose of this study was to evaluate the performance and agreement among HbA(1c) values measured using selected analyzers certified by the National Glycohemoglobin Standardization Program (NGSP) and standardized by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). METHODS: HbA(1c) determined using D-10 (Bio-Rad, USA), Variant II Turbo (Turbo; Bio-Rad, USA), Cobas Integra 800 (Integra; Roche, Switzerland) and Afinion AS100 (Afinion; Axis-Shield, Norway) were compared with each other. Precision and method comparisons with Deming regression were evaluated according to CLSI recommendations. We also compared the HbA(1c) values obtained with each analyzer using either IFCC or NGSP methods by correlation analysis and kappa statistics. RESULTS: The repeatability and method/device precisions of D-10 and Afinion were acceptable. The correlation coefficients of HbA(1c) were 0.986 for D-10 vs. Afinion, 0.997 for D-10 vs. Turbo, 0.988 for D-10 vs. Integra, and 0.991 for Integra vs. Afinion. The average biases of HbA(1c) Afinion (IFCC) and HbA(1c) Integra (IFCC) against HbA(1c) D-10 (NGSP) were -1.90% and -1.79%, respectively. Kappa agreement statistics for the three diabetic control group HbA(1c) values of "less than 6.5%," "6.5%-7.5%," and "greater than 7.5%" for D-10 vs. Turbo, D-10 vs. Integra, and D-10 vs. Afinion were 0.872, 0.836, and 0.833, respectively. CONCLUSIONS: The strong correlations and good clinical agreements of HbA(1c) between each analyzer expressed in terms of either NGSP or IFCC-derived NGSP indicate that these analyzers can be used interchangeably.

Evaluation of HbA1c on COBAS INTEGRA 800 Closed Tube System Compared with Variant II Turbo / 임상검사와정도관리

BACKGROUND: We evaluated the HbA1c assay on COBAS INTEGRA 800 Closed Tube System (Roche Diagnostics, USA). METHODS: Precision was determined following Clinical and Laboratory Standards Institute (CLSI) EP5-A2 using the Lyphochek Diabetes Control (Bio-Rad Laboratories, Canada). Two levels of QC materials were assayed in duplicates at two separate times per day for 20 days. The within-run, between-run and between-day precisions were evaluated. We compared the HbA1c of COBAS INTEGRA 800 Closed tube system using Tina quant Hemoglobin A1c Gen.2 (Roche Diagnostics, Germany) reagent with Variant II Turbo (Bio-Rad Laboratories, USA). Bias was determined following CLSI EP9-A2. RESULT: The HbA1c assay on COBAS INTEGRA 800 Closed Tube System showed excellent precision performance: at a level of 5.9%, total, between run, and between day CVs were 1.8%, 0.5%, and 1.6%, respectively. At a level of 9.6%, total, between run, and between day CVs were 1.4%, 0.3%, and 1.1%, respectively. The assay correlated well with the Variant II Turbo (y=0.9x+0.53, r2=0.9857). Mean bias against Variant II Turbo was -0.2%. Compared with Variant II Turbo, the estimate of the predicted bias at a given medical decision level (HbA1c at 6% and 9%) was -0.1% and -0.31%, respectively. CONCLUSIONS: The COBAS INTEGRA 800 Closed Tube System HbA1C assay was precise and equivalent to Variant II Turbo.

Uso de sustituto dérmico en niños con secuelas de quemaduras: tres casos clínicos / Dermis cutaneous substitute for burn sequel: 3 case-reports

Background: In COANIQUEM, burn sequel ambulatory reconstructive surgeries in paediatric patients are performed during their rehabilitation treatments. One of these surgeries is the traditional technique of post burn contracture release and split-thickness skin grafting. A new alternative has been the appearance of a dermis substitute (Integra, Dermal Regeneration Template). There is no previous experience in Chile with this artificial skin applied in children with burn sequel. Objective: Evaluate the ambulatory utilization of this dermis substitute in paediatric patients with burn sequel and their evolution during two years. Case-reports: Surgeries carried out during 2004 in three patients 9 to 13 years-old, with upper extremity esthetic - functional sequel. 24 months after surgery, a life- quality test (BSHS) and a rehabilitation protocol were applied. Results: There were no surgical complications in the three patients; the grafting attachment percentage varied between 75 and 100 percent. All of them needed compression therapy for 13 months. The elasticity and folding were similar to normal skin two years after evolution, with absence of fibrosis and graft contraction. BSHS was favourable. One case presented mild infection. Conclusion: Dermis cutaneous substitute Integra constitutes a good treatment alternative and its ambulatory use is possible without surgical complications.

Introducción: En COANIQUEM se realizan cirugías reconstructivas de secuelas de quemaduras en forma ambulatoria, en pacientes pediátricos durante su tratamiento de rehabilitación. Una de estas cirugías es la técnica tradicional del desbridamiento más injerto dermo-epidérmico. Una nueva alternativa ha sido la aparición del sustituto dérmico Integra (Dermal Regeneration Témplate). En Chile, no existe experiencia con este sustituto dérmico aplicado en forma ambulatoria en niños con secuelas de quemaduras. Objetivo: evaluar la utilización de un sustituto dérmico en forma ambulatoria, en pacientes pediátricos con secuelas de quemadura y su evolución a dos años plazo. Casos clínicos: cirugías realizadas durante 2004 en tres pacientes de 9 a 13 años de edad, con secuelas estético-funcionales de extremidad superior. Se aplicó protocolo de evaluación de rehabilitación a 24 meses y administración de test de calidad de vida (BSHS). Resultados: No hubo complicaciones quirúrgicas en los tres pacientes; el porcentaje de prendimiento varió entre 75 y 100 por ciento. Todos requirieron presoterapia por 13 meses. La elasticidad y plegabilidad fue similar a la piel normal a los dos años de evolución, con ausencia de fibrosis y contracción del injerto. BSHS resultó favorable. Hubo presencia de infección leve en un caso. Conclusión: El sustituto dérmico Integra® es una buena alternativa de tratamiento y es posible su uso en forma ambulatoria sin mayores complicaciones quirúrgicas.

Acceleration of Integra Incorporation in Reconstruction of Burn Scar Contracture with the Vacuum-Assisted Closure(VAC)

PURPOSE: Negative pressure therapy has been used in various conditions to promote wound healing. It has also been used to secure a skin graft by improving microcirculation and improving tight adhesion between the graft and the recipient bed. To reduce post burn scar contracture and improve aesthetical result, many types of dermal substitutes have been invented and used widely. The goal of this study is to evaluate usefulness of the VAC(Kinetic concepts Inc., San Antonio, TX) in improving the take rate and time to incorporation of Integra(R) in reconstruction of burn scar contracture. METHODS: A retrospective study was performed from October, 2006 to December, 2008. The VAC was utilized for 11 patients. The patient's ages ranged from 5 to 27 with an average of 19.7 years. The surface area ranged from 24 to 1,600cm2 with an average of 785cm2. The burn scars were excised deep into normal subcutaneous tissue to achieve complete release of the scar, Integra(R) was sutured in place with skin staple and Steri-strip(R). Then slit incisions were made on silicone sheet only with No.11 blade for effective drainage. The VAC was used as a bolster dressing over Integra(R). Negative-Pressure ranging from 100 to 125mm Hg was applied to black polyurethane foam sponge trimmed to the appropriate wound size. An occlusive seal over the black polyurethane foam sponge was maintained by a combination of the occlusive dressing, OP-site(R). The VAC dressing changes were performed every 3 or 4 days until adequate incorporation was obtained. The neodermis appeared slightly yellow to orange color. When the Integra(R) deemed clinically incorporated, The VAC was removed and take was estimated with visual inspection. Very thin STSG(0.006-0.008 inches) was performed after silicone sheet removal. RESULT: The mean time for clinically assessed incorporation of Integra(R) was 10.00 days(range 9-12). The mean dressing change was 3.5 times until take was obtained. In All patients, Integra(R) had successful incorporation in tissue without serious complications. CONCLUSION: Integra(R) in combination with Vacuum- Assisted Closure(VAC) may be incorporated earlier than conventional dressing method.

Evaluation of Hemoglobin A1c on the Cobas Integra 800 Immunoassay and Tosoh HLC-723 G8 HPLC Analyzer / 임상검사와정도관리

BACKGROUND: Hemoglobin A1c (HbA1c) is a good marker for the monitoring of glycemic control in patients with diabetes mellitus and various methods are used for determination of HbA1c. We evaluated the analytical performance of ion-exchange high-performance liquid chromatography system, standard mode (G8 SM) and variant mode (G8 VM) of Tosoh HLC-723 G8 (Tosoh Corporation, Japan) and Cobas Integra 800 (Roche Diagnostics, Germany) using new reagent (Tina-quant Hemoglobin A1c Gen.2, Roche Diagnostics) for immunoassay. METHODS: G8 SM, G8 VM, and Cobas Integra 800 were evaluated for linearity, precision, comparison of method, and speed. Variant II Turbo (Bio-Rad Laboratories, USA) was used for comparison test for above three analyzers. RESULTS: Three instruments showed within-run precision (CVs) of 0.52-1.12% in low level and 0.39-0.90% in high level control material. Total run precision (CVs) were in 0.95-1.26% in low level and 0.60-0.94% in high level control material. The linearity was good for the range of 4-15% and comparison with Variant II turbo was excellent with 0.9878-0.9977 of correlation coefficient. Analytical speed was 2 min/1 min in G8 SM, 3.5 min/1.5 min in G8 VM, and 14.7 min/18 sec in Cobas Integra 800, respectively. CONCLUSIONS: HLC-723 G8 SM and VM, and Cobas Integra 800 were showed excellent linearity, precision, and comparison with other instrument. We should consider the characteristics including analytical method and speed in each instrument when clinical laboratory is planning to introduce different equipment for HbA1c determination.

Evaluation of Cobas Integra 700 and Distribution of High Sensitivity C-reactive Protein Levels in Koreans / 대한진단검사의학회지

BACKGROUND: Prospective studies suggest that C-reactive protein (CRP) is a novel and indepen-dent risk factor of coronary heart disease. High-sensitivity methods for CRP (hs-CRP) measurement are needed for this purpose. In this study, we evaluated the performance of Cobas Integra 700 (Roche Diagnostics, Basel, Switzerland) and aimed to establish the distribution of serum CRP concentrations in healthy Koreans with the hs-CRP method. METHODS: The subjects of this study were 853 males (age; 45.9 +/- 9.8 years) and 546 females (age; 45.7 +/- 10.8 years) who visited the Health Promotion Center of the Asan Medical Center for routine health checks. Hs-CRP was measured with the Cobas Integra 700. The within-day precision, the between-day precision, the degree of correlation, the linearity, and the detection limit of hs-CRP were also analyzed with the Cobas Integra 700. RESULTS: The within-day coefficients of variation (CVs) were 0% and 1.3%. The between-day CVs were 4.0% and 3.0%. The percentage of relative nonlinearity was 0.78%. The correlation coefficient of the Cobas Integra 700 with the Behring Nephelometer was 0.994. The lower detection limit was 0.064 mg/L and the functional detection limit was 0.472 mg/L. The geometric mean concentration of CRP in Koreans was 0.69 mg/L. The mean CRP of the male population was 0.79 mg/L, which was higher than that of Korean females (0.54 mg/L) (P<0.0001). There was a significant trend to higher CRP values with increasing age (P<0.05). CONCLUSIONS: The linearity, the precision, the correlation, the detection limit of the Cobas Integra 700 were satisfactory. The age and sex-specific guidelines for hs-CRP would make the early intervention for coronary heart disease possible.

Histologic Changes of Various Artificial Dermis Graft in Rabbit

A full-thickness skin defect was made on the back of rabbits to evaluate the characteristics of commonly used artificial dermis. The artificial dermis used in this experiment was Alloderm , Integra and Terudermis . The Integra and Terudermis are bilayer membranes composed of bovine collagen matrix and silastic membrane which functions as the epidermis. Alloderm is acellular dermal matrix obtained from human cadaveric skin. These artificial dermis were applied to the full-thickness skin defect on the back of rabbits and the histologic changes were evaluated 3 days, 1 week, 10 days, 2 weeks and 4 weeks after its application. Thin split-thickness skin graft taken from the abdomen was applied on the artificial dermis immediate after Alloderm graft and 2 weeks after Terudermis and Integra graft. The process of skin graft "take" was evaluated on the 3 rd, 5 th, and 7 th day after split-thickness skin graft. The formation of new collagen and capillaries, and infiltration of fibroblasts were found earliest and most remarkably in case of Alloderm , latest and least remarkably in case pf Integra . The arrangement of collagen fibers was most regular in Alloderm but there was no significant difference between Terudermis and Integra . The original structure of the artificial dermis disappeared 1 week after Terudermis graft but the structure remained until 4 th week after Integra graft, which means the cross-link of Integra is stronger than the other artificial dermis. The thickness of artificial dermis decreased from initial 0.43 mm to 0.34 mm(79.7% of initial thickness) on the 4 th week in Alloderm , from 1.22 mm to 0.89 mm(73.0%) in Terudermis , from 1.34 mm to 1.13 mm(84.3%) in Integra . The decrease of thickness was statistically significant in all artificial dermis. In conclusion, Alloderm has best cellular affinity to the host: the skin graft over the Alloderm turns out to be the best, but Alloderm is the thinnest among artificial dermis. Terudermis has better cellular affinity to the host than Integra , which means better vascularity and more collagen fibers in Terudermis . However, Intra keeps thicker volume than Terudermis . Best artificial dermis will be chosen according to the clinical conditions.