Encuesta sobre fotografía médica: tendencias actuales e implicaciones médico-legales / Survey on medical photographs: current trends and legal and medical implications

La mejora de las aplicaciones multimedia y de las prestaciones de los teléfonos móviles junto con la comodidad de llevar estos dispositivos habitualmente en el bolsillo, son posibles causas de un aumento en la realización de fotografías médicas por parte de los facultativos. Desde el Capítulo Español de Flebología y Linfología se lanzó vía online en noviembre de 2020 una encuesta anónima entre los profesionales para conocer las últimas tendencias en este campo. Asimismo, se realizó una revisión de la legislación en materia de aspectos relacionados con la fotografía como la obtención de consentimiento informado, protección de datos, almacenaje de los archivos y el uso de las imágenes para así poder ofrecer unas pautas de actuación adecuadas.(AU)

The enhancement of multimedia applications and mobile phone features in addition to the convenience of these devices fitting in your pocket are the possible causes for the increase in medical photographs done by the medical practitioner. The Spanish Phlebology Chapter (CEFyL) conducted an online survey in November of 2020 amongst medical professionals, to identify the latest trends in this field. Furthermore, regulations around photography have been reviewed in regards to data protection, document storage and image use, thus providing suitable action guidelines.(AU)

Aluminum oxides as alternative building blocks for efficientlayer-by-layerblocking layers in dye-sensitized solar cells.

All inorganic layer-by-layer (LbL) thin films composed by TiO2nanoparticles and [Al(OH)4]-anions (TiO2/AlOx) as well as Al2O3and Nb2O5nanoparticles (Al2O3/Nb2O5) have been deposited to fluorine-doped tin-oxide coated glass (FTO) surfaces and applied as blocking layers in dye-sensitized solar cells (DSCs). Structural and morphological characterization of the LbL films by different techniques reveal that inTiO2/AlOxassembly, aluminate anions undergo condensation reactions on the TiO2surface leading to the formation of highly homogeneous films with unique optical properties. After 25 depositions transmittance losses below 10% in relation to the bare FTO substrate are observed. Electrochemical impedance spectroscopy shows thatTiO2/AlOxlayers impose an effective barrier for the charge recombination at FTO/electrolyte interface with an electron exchange time constant 50-fold higher than that for bare FTO. As a result, an improvement of 85% in the overall conversion efficiency of DSCs was observed with the employment of TiO2/AlOxblocking layers.Al2O3/Nb2O5LbL films can also work as blocking layers in DSCs but not as efficient, which is associated with the poor homogeneity of the film and its capacitive behavior. The production of cost-effective blocking layers with a low light scattering in the visible region is an important feature toward the application of DSC in other Building-integrated photovoltaic applications.

Ultraviolet A/blue light-emitting diode therapy for vulvovaginal candidiasis: a case presentation.

Vulvovaginal candidiasis (VVC) is a frequent infection of the female genitourinary tract. It is considered the second most common genital infection in women, after bacterial vaginosis. VVC is treated with oral or topical azole derivatives. However, these agents may lead to adverse reactions and their chronic use might lead to resistance to antifungal agents. Given that the ultraviolet A/blue light-emitting diode (LED) is an electromagnetic radiation source with antimicrobial properties, it is hypothesized that this resource may be a non-drug alternative to the treatment of vulvovaginitis. A technical/experimental safety test was conducted to characterize the light source spectrum and temperature generation of the device, followed by a pilot study in a 52-year-old patient with a clinical diagnosis of VVC confirmed by culture and examination of fresh vaginal samples, owing to the presence of lumpy vaginal discharge and a complaint of pruritus. The vulva and vagina were exposed to 401 ± 5 nm ultraviolet A/blue LED irradiation in a single session, divided into two applications. A reassessment was performed 21 days after the treatment. The light-emitting device had a visible spectrum, in the violet and blue ranges, and a maximum temperature increase of 7 °C. During the reassessment, the culture was found to be negative for fungus, and the signs and symptoms of the patient had disappeared. A light-emitting device with a spectrum in the range of 401 ± 5 nm could potentially be an alternative treatment modality for women with VVC, as it led to the resolution of clinical and microbiological problems in our patient.

Liquid silicone used for esthetic purposes as a potentiator for occurrence of post-radiotherapy genital lymphedema: case report.

CONTEXT:: Lymphedema consists of extracellular fluid retention caused by lymphatic obstruction. In chronic forms, fat and fibrous tissue accumulation is observed. Genital lymphedema is a rare condition in developed countries and may have primary or acquired etiology. It generally leads to urinary, sexual and social impairment. Clinical treatment usually has low effectiveness, and surgical resection is frequently indicated. CASE REPORT:: We report a case of a male-to-female transgender patient who was referred for treatment of chronic genital lymphedema. She had a history of pelvic radiotherapy to treat anal cancer and of liquid silicone injections to the buttock and thigh regions for esthetic purposes. Radiological examinations showed signs both of tissue infiltration by liquid silicone and of granulomas, lymphadenopathy and lymphedema. Surgical treatment was performed on the area affected, in which lymphedematous tissue was excised from the scrotum while preserving the penis and testicles, with satisfactory results. Histopathological examination showed alterations compatible with tissue infiltration by exogenous material, along with chronic lymphedema. CONCLUSION:: Genital lymphedema may be caused by an association of lesions due to liquid silicone injections and radiotherapy in the pelvic region. Cancer treatment decisions for patients who previously underwent liquid silicone injection should take this information into account, since it may represent a risk factor for radiotherapy complications.

Liquid silicone used for esthetic purposes as a potentiator for occurrence of post-radiotherapy genital lymphedema: case report / Silicone líquido utilizado com finalidade estética como potencializador da ocorrência de linfedema genital pós-radioterapia: relato de caso

ABSTRACT CONTEXT: Lymphedema consists of extracellular fluid retention caused by lymphatic obstruction. In chronic forms, fat and fibrous tissue accumulation is observed. Genital lymphedema is a rare condition in developed countries and may have primary or acquired etiology. It generally leads to urinary, sexual and social impairment. Clinical treatment usually has low effectiveness, and surgical resection is frequently indicated. CASE REPORT: We report a case of a male-to-female transgender patient who was referred for treatment of chronic genital lymphedema. She had a history of pelvic radiotherapy to treat anal cancer and of liquid silicone injections to the buttock and thigh regions for esthetic purposes. Radiological examinations showed signs both of tissue infiltration by liquid silicone and of granulomas, lymphadenopathy and lymphedema. Surgical treatment was performed on the area affected, in which lymphedematous tissue was excised from the scrotum while preserving the penis and testicles, with satisfactory results. Histopathological examination showed alterations compatible with tissue infiltration by exogenous material, along with chronic lymphedema. CONCLUSION: Genital lymphedema may be caused by an association of lesions due to liquid silicone injections and radiotherapy in the pelvic region. Cancer treatment decisions for patients who previously underwent liquid silicone injection should take this information into account, since it may represent a risk factor for radiotherapy complications.

RESUMO CONTEXTO: O linfedema consiste de retenção de fluido extracelular causada por obstrução linfática. Nas formas crônicas, observa-se acúmulo de tecido adiposo e fibrose. O linfedema genital é uma doença rara em países desenvolvidos e pode ter etiologia primária ou adquirida, em geral cursando com disfunções urinária e sexual, bem como com prejuízo do convívio social. O tratamento clínico é, em geral, pouco efetivo, indicando-se com frequência a abordagem cirúrgica, com excisão da área afetada. RELATO DE CASO: Relata-se o caso de paciente feminina transgênero, encaminhada para tratamento de linfedema genital crônico. Havia antecedente pessoal de tratamento de câncer de canal anal com radioterapia pélvica e de injeções de silicone líquido em glúteos e coxas com finalidade estética. Exames radiológicos mostraram tanto sinais de infiltração tecidual por silicone líquido como granulomas e linfadenopatia como de linfedema. Foi realizado o tratamento cirúrgico da área afetada, com excisão do tecido linfadenomatoso do escroto, preservando o pênis e testículos, com resultado satisfatório. A análise histopatológica mostrou achados compatíveis com infiltração tecidual por material exógeno, bem como com linfedema crônico. CONCLUSÃO: O linfedema genital pode ser causado pela associação de lesão por injeção de silicone líquido e radioterapia na região pélvica. As decisões no tratamento de neoplasias em pacientes previamente submetidos a injeção de silicone líquido devem levar em conta esse fato, já que pode representar fator de risco para complicações de tratamento radioterápico.

TEMPORAL DEPENDENCE OF THE RADIATION MONITORING INSTRUMENTS FOR AREA MONITORING USED AT RADIODIAGNOSTIC AND INTERVENTION FACILITIES.

Area monitoring is a fundamental test at radiodiagnostic facilities to maintain an acceptable level of radiation exposure for employees and members of the public. Experimental measurements were taken in an ionising radiation calibration laboratory. Four area monitor instruments were used. Dose and dose rate measurements were measured in integrated and rate operating modes. The results show that precautions are necessary where the area monitor uses exposure times of ≤2 s. When taking measurements in rate mode for times ≤2 s, the area monitors evaluated show a tendency to underestimate dose rate, the inaccuracy was 41 %, and varied between 34 and 45 % for different energies. It is highly recommendable to work in integrated mode, inaccuracy varied from 2 to 35 %. For measurements taken with exposure times of ≥3 s, the average inaccuracy was 15 % and the range was between 2 and 41 %.

Intravenously Administered Recombinant Human Type VII Collagen Derived from Chinese Hamster Ovary Cells Reverses the Disease Phenotype in Recessive Dystrophic Epidermolysis Bullosa Mice.

Recessive dystrophic epidermolysis bullosa (RDEB) is an inherited disorder characterized by skin fragility, blistering, and multiple skin wounds with no currently approved or consistently effective treatment. It is due to mutations in the gene encoding type VII collagen (C7). Using recombinant human C7 (rhC7) purified from human dermal fibroblasts (FB-rhC7), we showed previously that intravenously injected rhC7 distributed to engrafted RDEB skin, incorporated into its dermal-epidermal junction (DEJ), and reversed the RDEB disease phenotype. Human dermal fibroblasts, however, are not used for commercial production of therapeutic proteins. Therefore, we generated rhC7 from Chinese hamster ovary (CHO) cells. The CHO-derived recombinant type VII collagen (CHO-rhC7), similar to FB-rhC7, was secreted as a correctly folded, disulfide-bonded, helical trimer resistant to protease degradation. CHO-rhC7 bound to fibronectin and promoted human keratinocyte migration in vitro. A single dose of CHO-rhC7, administered intravenously into new-born C7-null RDEB mice, incorporated into the DEJ of multiple skin sites, tongue and esophagus, restored anchoring fibrils, improved dermal-epidermal adherence, and increased the animals' life span. Furthermore, no circulating or tissue-bound anti-C7 antibodies were observed in the mice. These data demonstrate the efficacy of CHO-rhC7 in a preclinical murine model of RDEB.

Evaluating and monitoring the packing behavior of process-scale chromatography columns.

The packing characteristics of process-scale chromatography columns were evaluated using the responses to conductivity-based pulse and step inputs derived from tracer experiments and in-process transitions (i.e. column equilibration and regeneration steps). Characteristics of the measured residence time distributions (RTDs) were quantified by statistical moments and using the equations derived from the Gaussian model. The first and second moments calculated from in-process step transitions for multiple runs were in good agreement with those moments calculated from the pulse-input experiments conducted immediately after column packing. This indicates that most of the time the bed behavior at the time of packing is consistent with that at the time of operation. Due to the significant resistance to protein mass transfer inside the particles, estimated plate heights for protein solutes are expected to be much greater than those observed from the experiments using saltbased tracers. Thus, the column efficiency derived from salt-based experiments can be a useful measure of packing consistency rather than a significant parameter influencing the outcome of protein separations.

Evaluation of protein-A chromatography media.

In process-scale antibody purification, protein-A affinity chromatography is commonly used as the initial purification step. In this paper, two different protein-A media were evaluated. These adsorbents have a porous glass backbone with different pore sizes: 700 A and 1000 A. Adsorption equilibrium data of human immunoglobulins on these media were measured via a batch technique and correlated using the Langmuir isotherm model. A larger static capacity was found for the smaller pore size material, which is probably a result of the larger specific surface area and associated higher ligand concentration. The protein uptake kinetics were also obtained via a stirred tank experiment using different initial protein concentrations. A surface layer model was used to represent the protein uptake by the media and to estimate values of a concentration-independent effective diffusivity within the particle. Experimental breakthrough curves were also obtained from packed beds operated under different conditions. Calculated breakthrough profiles were found to be in good agreement with the experimental results. Experimental breakthrough data were used to determine the dependence of the dynamic capacity of the media as a function of the fluid residence time. A larger dynamic capacity was also found for the smaller pore size media. The permeability of large scale packed beds was also reported and used in conjunction with the dynamic capacity to calculate the process production rate.