Bacterial fluorescence imaging as a predictor of skin graft integration in burn wounds.

BACKGROUND: Split-thickness skin graft (STSG)1 integration rates are susceptible to improvement. Infection and/or biofilm should be appropriately addressed prior to grafting to improve the likelihood of graft-take. Incorporating technological aids such as fluorescence (FL)2 imaging (MolecuLight®), which accurately locates areas of bacterial loads above 104 CFU/gr, for graft site assessment and preparation could yield better outcomes. METHODS: This single-center, prospective observational study included adult burn patients with previously infected wounds that had been deemed clinically and microbiologically clean and were therefore candidates for grafting. Prior to grafting, a FL imaging assessment (blinded to the surgical team) localized areas positive for moderate-high bacterial loads (>104 CFU/gr). Intra-operatively, a standard swab sample from the recipient site was collected by the surgical team. Postoperatively, areas positive/negative for FL and areas of graft take and failure were overlapped and measured (cm2) over a 2D schematic. The performance and accuracy of FL imaging and swab sampling in relation to graft outcomes were assessed. RESULTS: 38 patients were enrolled in the study. The mean total body surface area (TBSA)3 involvement was 14.5 ± 12.4 % [range 0.8 - 40.2 %]. 25/38 of the subjects enrolled had complete graft take while 13 had partial graft losses. There were no total losses. FL-imaging was positive in 100 % of losses versus 31 % (4/13) of the swab microbiology. FL-imaging was found to have a sensitivity of 86 %, specificity of 98 %, PPV of 72 %, NPV of 99 %, and an accuracy of 94 % for predicting any type or range of graft loss in the entire cohort. Meanwhile, the sensitivity of microbiology from swab samples was 30 %, with a specificity of 76 %. CONCLUSIONS: FL imaging is an accurate method for assessing recipient sites and predicting the outcome of a skin graft among burn patients. These findings suggest that FL imaging can inform better decision-making surrounding grafts that may lead to better outcomes. LEVEL OF EVIDENCE: Level IIA, Therapeutic study.

General neurology: Current challenges and future implications.

BACKGROUND AND PURPOSE: In the coming decades, the world will face an increasing burden of neurological disorders (ND) and an urgent need to promote brain health. These challenges contrast with an insufficient neurological workforce in most countries, as well as decreasing numbers of general neurologists and neurologists attracted to work in general neurology (GN). This white paper aims to review the current situation of GN and reflect on its future. METHODS: The European Academy of Neurology (EAN) task force (TF) met nine times between November 2021 and June 2023. During the 2023 EAN annual meeting, attendees were asked to answer five questions concerning the future of GN. The document was sent for suggestions and eventually approval to the board and the presidents of the 47 national societies of the EAN. RESULTS: The TF first identified four relevant current and future challenges related to GN: (i) definition, (ii) practice, (iii) education, and (iv) research. The TF then identified seven initiatives to further develop GN at both the academic and community level. Finally, the TF formulated 16 recommendations to promote GN in the future. CONCLUSIONS: GN will remain essential in the coming decades to provide rapid, accessible, and comprehensive management of patients with ND that is affordable and cost-effective. There is also a need for research, education, and other initiatives aiming to facilitate improved working conditions, recognition, and prestige for those pursuing a career in GN.

Association of children's oral health and school environment on academic performance in 12-year-old schoolchildren of Quito, Ecuador.

OBJECTIVES: The primary aim of this study was to evaluate if children's oral health and oral health-related quality of life (OHRQoL) were associated with school performance. Moreover, the study aimed to examine whether school environment factors influenced this association. METHODS: This cross-sectional study was based on a population-based sample of 998 12-year-old schoolchildren from 31 public schools in Quito, Ecuador. Trained and calibrated examiners conducted clinical exams for dental caries, dental trauma and malocclusion. Furthermore, children completed the Spanish version of the Child Perception Questionnaire (CPQ11-14 ), and their parents answered questions about socio-economic status. School coordinators provided information on the physical environment, promotion of health practices and the occurrence of negative episodes in the school. There were three outcomes: grades obtained in Spanish language and mathematics and the number of missed school days. Multilevel linear and Poisson regression models were conducted using a hierarchical approach to include the variables guided by a previously created direct acyclic graph. RESULTS: Children with dental trauma and higher CPQ11-14 scores showed lower grades and school attendance. Schoolchildren from schools with episodes of vandalism had more school days missed. CONCLUSION: The school performance of 12-year-old children is affected by dental trauma and by a worse OHRQoL, as well as a negative school environment. Therefore, supportive environments and promoting health measures in schools could overcome this worse academic performance in children with oral health problems.

Abdominal Hypertension after Abdominal Plication in Postbariatric Patients: The Consequence in the Postoperative Recovery.

Background Abdominoplasty with abdominal plication increases intra-abdominal pressure (IAP) and has been previously associated with limited diaphragmatic excursion and respiratory dysfunctions. Many factors found in abdominoplasties and among postbariatric patients predispose them to a higher occurrence. This study aims to evaluate the impact of abdominal plication among postbariatric patients, assess whether the plication increases their IAP, and analyze how these IAP correlate to their postoperative outcome. Methods This prospective study was performed on all patients who underwent circumferential Fleur-De-Lis abdominoplasty. For this intended study, the IAP was measured by an intravesical minimally invasive approach in three stages: after the initiation of general anesthesia, after a 10-cm abdominal wall plication and skin closure, and 24 hours after the procedure. Results We included 46 patients, of which 41 were female and 5 were male. Before the bariatric procedure, these patients had an average maximum weight of 121.4 kg and an average maximum body mass index of 45.78 kg/m 2 ; 7 were grade I obese patients, 10 were grade II, and 29 were grade III. Only three patients were operated on with a gastric sleeve and 43 with gastric bypass. We presented six patients with transitory intra-abdominal hypertension in the first 24 hours, all of them from the grade I obesity group, the highest presented was 14.3 mm Hg. We presented 15% (7/46) of complication rates, which were only four seroma and five dehiscence; two patients presented both seroma and wound dehiscence. Conclusion Performing a 10-cm abdominal wall plication or greater represents a higher risk for intra-abdominal hypertension, slower general recovery, and possibly higher complication rate in patients who presented a lower degree of obesity (grade I) at the moment of the bariatric surgery.

Equivalence in Color-coded Duplex Sonography Parameters before Complex Microsurgery.

Background: Color-coded duplex sonography (CCDS) is a widely proposed noninvasive diagnostic tool in microsurgery. CCDS has been applied to lower extremity salvage cases to define appropriate blood flow velocity criteria for achieving arterial success in diabetic foot and complex microsurgery cases. This study aimed to compare the success ratio of free flaps when using CCDS versus cases where CCDS was not used. Methods: We included complex microsurgery cases from 2019 to 2021. These cases were subsequently categorized into two groups: group A consisted of cases where CCDS parameters were applied, whereas group B comprised cases where CCDS was not performed at all. Results: The study encompassed 14 cases (11 men and three women). The age range varied from 23 to 62 years, with an average age of 42. Using CCDS analysis and planning demonstrated improved outcomes in comparison with cases where CCDS was not performed, albeit without statistical significance (P = 0.064). Conclusions: The application of CCDS proves to be beneficial in the realm of microsurgery. Although not achieving statistical significance, our data imply that CCDS utilization holds promise for enhancing microsurgical procedures.

Comparison of Nasal Analysis by Photographs (2D) against Low-cost Surface Laser Imaging (3D) and against Computed Axial Tomography Imaging.

Introduction In aesthetic surgery, we have a few evaluation tools that numerically and objectively measure the changes we make in patients. This article aimed to evaluate the nasal systematic analysis and compare findings between the three systems of nasal evaluation: photographs 2D, 3D surface imaging with the Kinect system, and 3D CT scan imaging. Methods We designed a longitudinal and descriptive prospective study with simple non-blind randomization. To compare the systematic nasal analysis between the three methods. If the findings are similar, all three methods would be useful in independent clinical scenarios. Results A total of 42 observations were included finding a minimum age of 21 with a mean of 28 years old. Also, 64% were female, 93% had adequate facial proportions, and 50% were Fitzpatrick III. For outcome statistics, we found differential nasal deviation between 3D images with a mean of 6.53 mm. While when comparing the nasal dorsum length, we found a statistical significance of p = 0.051. When comparing the nasal dorsum length index, we found no significant difference p = 0.32. Also, we did not find statistical significance when comparing the nasofrontal angle and tip rotation angle p = 1 for both. Conclusion We found that the population we serve has characteristics of Hispanic mestizo nose. The three methods seem to evaluate systematic nasal analysis in a very similar way, and any of them can be used depending on the scenario and the needs of plastic surgeons.

Global synergistic actions to improve brain health for human development.

The global burden of neurological disorders is substantial and increasing, especially in low-resource settings. The current increased global interest in brain health and its impact on population wellbeing and economic growth, highlighted in the World Health Organization's new Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders 2022-2031, presents an opportunity to rethink the delivery of neurological services. In this Perspective, we highlight the global burden of neurological disorders and propose pragmatic solutions to enhance neurological health, with an emphasis on building global synergies and fostering a 'neurological revolution' across four key pillars - surveillance, prevention, acute care and rehabilitation - termed the neurological quadrangle. Innovative strategies for achieving this transformation include the recognition and promotion of holistic, spiritual and planetary health. These strategies can be deployed through co-design and co-implementation to create equitable and inclusive access to services for the promotion, protection and recovery of neurological health in all human populations across the life course.

The Intersectoral Global Action Plan (IGAP): A unique opportunity for neurology across the globe.

The World Health Assembly (WHA) approved the Intersectoral Global Action Plan (IGAP) in 2022. This ambitious project, formally called the Intersectoral Global Action Plan for Epilepsy and Other Neurological Disorders, is a 10-year plan to enhance neurology implementation worldwide and to raise the status of brain health and neurology services for patients with neurological diseases. The IGAP has 5 important components: relation with policy makers, therapy, prophylaxis, research, and public health. The implementation of IGAP is a challenge, not only for the specialty of neurology but for the whole neurological community, encompassing patients, carers, healthcare providers, and the public. The lack of a unified definition of neurology and the great variety of health systems, as well as the dependency on socioeconomic status, will necessitate custom-made solutions in all regions.

Preliminary Analysis of Unsaturated Fatty Acid Profiles of Coffea arabica L., in Samples with a Denomination of Origin and Speciality of Oaxaca, Mexico.

In February 2020, Coffea arabica L. grown on the coast and in the Southern Sierra Madre of the state of Oaxaca, Mexico obtained the denomination of origin. Which does not have data on color and chemical composition, the first associated with the degree of roasting and the second with lipids (17-18%), as the group of compounds responsible, in part, for flavor, consistency, and may contribute to health benefits. In the present work, color was determined on the CIE L*a*b* scale and the unsaturated fatty acids by Nuclear Magnetic Resonance (NMR) of 1H and 13C in samples of medium roasted specialty coffee from the "Pluma" coffee-growing region, Oaxaca, Mexico. The average value of L* luminosity in ground coffee was 42.1 ± 0.1 reported for a light roast. Unsaturated fatty acids were quantified from the lipid fraction of the gr1 ound grain by NMR 1H and 13C, obtaining on average the highest abundance of linoleic (41.7 ± 0.5 by 1 H and 41.24 ± 0.5 by 13C), followed by oleic (9.2 ± 0.2 by 1H and 7.4 ± 0.2 by 13C) and linolenic (1.5 ± 0.1 by H and 1.1 ± 0.2 by 13C). This study indicates that 1H and 13C NMR spectroscopy is a useful tool for the quantification of linolenic, linoleic, and oleic fatty acids by the method of key signal shifts of these acids found in lipid samples in roasted coffee grains.

The Role of B Cell and T Cell Glycosylation in Systemic Lupus Erythematosus.

Glycosylation is a post-translational modification that affects the stability, structure, antigenicity and charge of proteins. In the immune system, glycosylation is involved in the regulation of ligand-receptor interactions, such as in B-cell and T-cell activating receptors. Alterations in glycosylation have been described in several autoimmune diseases, such as systemic lupus erythematosus (SLE), in which alterations have been found mainly in the glycosylation of B lymphocytes, T lymphocytes and immunoglobulins. In immunoglobulin G of lupus patients, a decrease in galactosylation, sialylation, and nucleotide fucose, as well as an increase in the N-acetylglucosamine bisector, are observed. These changes in glycoisolation affect the interactions of immunoglobulins with Fc receptors and are associated with pericarditis, proteinuria, nephritis, and the presence of antinuclear antibodies. In T cells, alterations have been described in the glycosylation of receptors involved in activation, such as the T cell receptor; these changes affect the affinity with their ligands and modulate the binding to endogenous lectins such as galectins. In T cells from lupus patients, a decrease in galectin 1 binding is observed, which could favor activation and reduce apoptosis. Furthermore, these alterations in glycosylation correlate with disease activity and clinical manifestations, and thus have potential use as biomarkers. In this review, we summarize findings on glycosylation alterations in SLE and how they relate to immune system defects and their clinical manifestations.

Nutritional Composition and Bioactive Compounds of Quelites Consumed by Indigenous Communities in the Municipality of Juquila Vijanos, Sierra Norte of Oaxaca, Mexico.

The indigenous communities of Mexico have a long tradition of consuming quelites. In this research, eight species of quelites that are traditionally consumed by indigenous communities of the Sierra Norte of Oaxaca, Mexico, were characterized: Eryngium foetidum L., Galinsoga parviflora Cav., Calceolaria mexicana Benth., Andinocleome magnifica (Briq.) Iltis & Cochrane, Cleoserrata speciosa (Raf.) H.H. Iltis, Phytolacca icosandra L., Cestrum nocturnum L. and Solanum nigrescens M.Martens & Galeotti. The ethnobotanical information of these species was recorded and the proximate composition, mineral content, and total phenolic and flavonoid content were determined. The antioxidant capacity of the samples was also investigated using ABTS (2,2'-Azinobis-(3-ethylbenzothiazoline-6-sulfonic acid), DPPH (2,2-di(4-tert-octylphenyl)-1-picrylhydrazyl), and ORAC (oxygen radical absorption capacity) methods. Quelites are available in the dry and rainy season. Quelites were found to have low energy contents while being good sources of fiber, of which A. magnifica possessed the highest concentration (8.61 ± 0.35 g/100 g fresh weight FW). Quelites were also found to provide essential minerals, with the primary contributions being potassium (4097.35 ± 12.28 mg/100 g FW) in C. mexicana, calcium (2418.63 ± 22.91 mg/100 g FW) in S. nigrescens, magnesium (1021.83 ± 10.58 mg/100 g FW) in E. foetidum, among others. C. speciosa and C. mexicana exhibited the highest concentration of phenols and flavonoids, which were found to be associated with higher antioxidant capacity. The quelites analyzed in this study are a potential source of accessible, nutritious, and healthy food, and can potentially help improve food security and health.

Comparison of wire versus Nylon in Bonny-Mallet Finger treated with pull-out surgery.

INTRODUCTION: Zone I extensor tendon lesion accompanies an avulsion fracture of the bone insertion. A common complication of traditional pull-out is the necrosis of the site of the button in the finger pad. Zhang described an alternative way of anchoring the cerclage to the Kirschner Wire (K-wire) to relieve the pressure in the finger pad. He describes the use of wire cerclage, for fracture reduction. The objective of this paper is to perform a comparison between wire and nylon using Zhang pull-out technique. MATERIAL AND METHODS: We performed a cohort study comparing Nylon versus Wire in Zhang technique. Comparing cosmetic satisfaction, stiffness, residual pain, and Crawford scale. RESULTS: When comparing the outcomes between both groups, we found no statistical difference in cosmetic satisfaction (p = 0.285), stiffness (p = 0.460), and residual pain (p =1.000), overall complications (p = 1.000), or Crawford scale (p = 1.000). We only found a significant statistical difference in pain when removing the cerclage, being greater in Group B (p = 0.008). CONCLUSIONS: We found no significant outcome difference between nylon and wire cerclage. However, at the time of removing it, patients experience less pain.

INTRODUCCIÓN: Una complicación común del pull-put tradicional es la necrosis del sitio del botón en la yema del dedo. Zhang describió una forma alternativa de anclar el cerclaje al clavo de Kirschner para aliviar la presión en la yema del dedo. Describe el uso de cerclaje de alambre para la reducción de fracturas. El objetivo de este trabajo es realizar una comparación entre el alambre y el nailon utilizando la técnica de extracción de Zhang. MATERIAL Y MÉTODOS: Realizamos un estudio de cohorte comparando la técnica de nailon versus alambre en Zhang. Comparación de satisfacción cosmética, rigidez, dolor residual y escala de Crawford. RESULTADOS: Al comparar los resultados entre ambos grupos, no encontramos diferencias estadísticas en la satisfacción cosmética (p = 0.285), rigidez (p = 0.460) y dolor residual (p = 1.000), complicaciones generales (p = 1.000) o escala de Crawford (p = 1.000). Solo encontramos una diferencia estadística significativa en el dolor al retirar el cerclaje, siendo mayor en el Grupo B (p = 0.008). CONCLUSIONES: No encontramos diferencias significativas en los resultados entre el cerclaje de nailon y el cerclaje con alambre. Pero, al momento de retirarlo, los pacientes experimentan menos dolor. Tipo de estudio: terapéutico Nivel de evidencia III.

Auricular Total Reconstruction with Radial Forearm Prelaminated Flap Assisted by 3D Surface Imaging and 3D Printing.

The anatomic position of the auricle leaves it vulnerable to traumatic lesions. In most cases, the best reconstructive outcome is accomplished using a temporoparietal flap with a costal cartilage frame and a partial thickness skin graft. Exceptional cases may require different approaches because the reconstructive goals could be more structural than aesthetic. An important factor in this regard is the mechanical properties of the skin that will provide coverage. This study aimed to share a particular case of total auricular reconstruction assisted by 3D surface imaging and 3D printing in a radial forearm free flap. We present a 58-year-old man with a history of having tympanic barotrauma causing hearing loss, burdening him with the use of auricular devices for hearing assistance. Seven days before presenting for the initial treatment, he sustained ear trauma while performing mechanical reparations in a car. The wheel was activated, causing a total amputation of the right ear. He first went to another hospital' where they performed primary closure and then referred him to our unit. The team performed a prelaminated radial forearm free flap assisted by 3D scanning and planning. A detailed comparison between the left ear and the result of the reconstruction was measured and described. The radial forearm prelaminated free flap is a viable structural alternative with the disadvantage of poor auricular definition in some cases.

Characterization and Evaluation of Composite Biomaterial Bioactive Glass-Polylactic Acid for Bone Tissue Engineering Applications.

The limitations associated with the clinical use of autographs and allografts are driving efforts to develop relevant and applicable biomaterial substitutes. In this research, 3D porous scaffolds composed of bioactive glass (BG) obtained through the sol-gel technique and polylactic acid (PLA) synthesized via lactic acid (LA) ring-opening polymerization were prepared by the gel-pressing technique. Two different weight compositions were evaluated, namely, BG70-PLA30 and BG30-PLA70. The structure and morphology of the resulting scaffolds were analysed by FTIR, XRD, SEM, and under ASTM F1635 standard characterizations. The results confirmed that BG promotes the formation of a hydroxy-carbonated apatite (HAp) layer on composites when immersed in simulated body fluid (SBF). Biodegradability evaluations were carried out according to the ISO 10993-13:2010 standard. In addition, electrochemical evaluations were performed in both Hank's and SBF solutions at 37 °C in order to analyse the degradation of the material. This evaluation allowed us to observe that both samples showed an activation mechanism in the early stages followed by pseudo-passivation due to physical bioactive glass characteristics, suggesting an improvement in the formation of the HAp nucleation. The described composites showed excellent resistance to degradation and outstanding suitability for bone tissue engineering applications.

Evaluación de la microencapsulación de ácidos húmicos y fúlvicos para ser empleados en la fertilización de liberación controlada para plantas de ornato con alto valor comercial / Evaluation of the microencapsulation of humic and fulvic acids to be used in controlled release fertilization for ornamental plants with high commercial value

El objetivo del presente trabajo es evaluar la microencapsulación de ácidos humícos y fúlvicos para ser empleados en la fertilización a través de la liberación controlada para plantas de ornato con un alto valor comercial, con ello se busca generar una alternativa de reducción en el impacto ambiental provocado por otros tipos de fertilizantes para los mismos fines, es importante mencionar que la producción de plantas de ornato es considerada como una industria que requiere de costos elevados durante su iniciación y mantenimiento, destacando el incremento de costos debido a la utilización de materiales importados tales como: vermiculitas, lana roca, turbas, muzgos, nitrato de potasio, nitrato de calcio y fosfonitratos, se debe tomar en cuenta que los productos comerciales más utilizados para la fertilización han demostrado poseer propiedades fisicoquímicas adecuadas para el desarrollo de los cultivos por lo tanto, el desarrollo de fertilizantes alternativos a los tradicionales habrán de cuidar de manera especial dichos aspectos, además de no ocasionar daño al suelo evitando así la generación de contaminantes residuales.(AU)

The objective of this work is to evaluate the microencapsulation of humic and fulvic acids to be used in fertilization through controlled release for ornamental plants with a high commercial value, thereby seeking to generate an alternative to reduce the impact environmental caused by other types of fertilizers for the same purposes, it is important to mention that the production of ornamental plants is considered as an industry that requires high costs during its initiation and maintenance, highlighting the increase in costs due to the use of imported materials such as: vermiculites, rock wool, peat, muzgos, potassium nitrate, calcium nitrate and phosphonitrate, it should be taken into account that the most used commercial products for fertilization have shown to have adequate physicochemical properties for the development of crops, therefore, the development of alternative fertilizers to the traditional ones will have to take special care of these aspects, in addition to not causing damage to the soil, thus avoiding the generation of residual contaminants.(AU)

Stack Splinting Versus Kirschner Wire Treatment in Acute Closed Mallet Finger Doyle I.

Introduction: Mallet injuries are common and usually treated conservatively. Various systematic reviews have found a lack of evidence regarding the best management, and it is still unclear. Objective: To evaluate the treatment efficacy of Stack Splinting compared to a Kirschner wire immobilization of acute closed mallet finger Doyle I. Methods: From March 2019 to February 2020, 41 patients with acute close mallet finger Doyle I were treated; 19 patients were treated with Kirschner wire and 22 with Stack splinting for a mean of 6 weeks. The average patient age at the time of the injury was 43 years. Results: Twenty-eight males and 13 females were in this study. Among them, 17 patients were injured in the little finger, 15 in the middle finger, and 9 in the ring finger. Twenty-seven of injuries suffered an aggression, 11 from falling, and 3 from sports injuries. All the fingers had typical mallet malformation. Seventeen patients treated with Kirschner wire completed the treatment with full recovery, only 7 patients treated with Stack splint completed the treatment and 15 treated with Stack splint had relapse on mallet injury. Conclusion: Kirschner wire treatment is a simple procedure, and proves in this study that has better results in patients with acute closed mallet finger Doyle I compared to Stack splint.

Introduction: Les doigts à gâchette (ou à ressaut) sont courants et généralement traités avec prudence. Diverses analyses systématiques ont constaté un manque de données probantes sur la prise en charge optimale, qui n'est pas toujours claire. Objectif: Évaluer l'efficacité du traitement par attelle de Stack par rapport à l'immobilisation par broches de Kirschner en cas de doigt à gâchette fermé en phase aiguë correspondant à la classification 1 de Doyle. Méthodologie: Entre mars 2019 et février 2020, 41 patients d'un âge moyen de 43 ans au moment de la lésion ont présenté un doigt à gâchette fermé en phase aiguë correspondant à la classification 1 de Doyle et ont été traités. Ainsi, 19 ont été traités par une broche de Kirschner et 22, par une attelle de Stack, pendant une période moyenne de six semaines. Résultats: Au total, 28 hommes et 13 femmes ont participé à cette étude. De ce nombre, 17 patients ont subi une blessure de l'auriculaire, 15, du majeur, et neuf, de l'annulaire. Une agression avait causé 27 des blessures, une chute en avait causé 11 et des blessures sportives, trois. Tous les doigts présentaient la malformation à gâchette classique. Au total, 17 patients traités par une broche de Kirschner ont terminé le traitement et se sont pleinement rétablis, mais seulement sept patients ayant eu une attelle de Stack ont terminé le traitement, et 15 d'entre eux ont vécu une rechute. Conclusion: Le traitement par broche de Kirschner est une intervention simple, et la présente étude démontre qu'il donne de meilleurs résultats que l'attelle de Stack chez les patients ayant un doigt à gâchette fermé en phase aiguë correspondant à la classification 1 de Doyle.