Use of Needle Localization in the Surgical Management of Non-seroma, Mass-forming BIA-ALCL.

Outcomes related to the treatment of breast implant-associated anaplastic large cell lymphoma, a rare extranodal T-cell lymphoma associated with textured breast implants, are largely dependent on the successful resection to negative margins via en bloc capsulectomy and resection of any associated masses. To date, the use of needle localization, a common technique used in breast surgery, to assist in the complete removal of breast implant-associated anaplastic large cell lymphoma has not been described. We present the case report of a 66-year-old woman, with a previous medical history of left-sided invasive ductal carcinoma, who presented 7 years after textured breast implant placement with a left-sided mass without peri-implant seroma. Biopsy demonstrated breast implant-associated anaplastic large cell lymphoma and the associated breast mass extended beyond the capsule borders. The present report describes the novel use of needle localization in this patient to facilitate the complete removal of the malignancy-associated mass with maximal preservation of the overlying soft tissue envelope.

The In Vitro Evaluation of Preosteoblast Migration From 3-D-printed Scaffolds to Decontaminated Smooth and Minimally Rough Titanium Surfaces: A Pilot Study.

In vitro evaluations are essential to gaining a better understanding of re-osseointegration, while reducing animal use and the overall costs of peri-implantitis studies. This pilot study evaluated preosteoblast migration from 3-D-printed scaffolds to decontaminated titanium microimplants, creating a system that tries to mimic the bone-implant interface. Smooth (S) and minimally rough (R) titanium microimplants were incubated in Escherichia coli cultures and divided into six groups according to the decontamination protocol applied: EDTA gel (EDTA); chlorhexidine (CHL); chlorhexidine-soaked gauze (GCHL); scaling (SC); titanium brush (TiB); and implantoplasty (IP). Pristine S and R microimplants were used as the controls (C). After the decontamination procedures, the microimplants were inserted in 3-D-printed polyurethane-based scaffolds previously inoculated with preosteoblast cell cultures. Cellular migration was assessed after 24, 72 and 120 hours by ATP quantification. At the 120-hour time point, there was no statistically significant difference between S-C, S-EDTA, S-CHL, S-GCHL and S-SC (p > 0.05), and between R-C, R-EDTA and R-GCHL (p > 0.05). The in vitro model developed in this pilot study successfully demonstrated cell migration on the different decontaminated surfaces. This methodology suggests that on smooth microimplants, EDTA, GCHL, SC and TiB decontamination may have a reduced impact on preosteoblast migration, while on minimally rough microimplants, EDTA and GCHL decontamination affected cell migration the least. However, when selecting a decontamination protocol, the effectiveness of the decontamination per se must also be considered.

Effectiveness and surface changes of different decontamination protocols at smooth and minimally rough titanium surfaces.

BACKGROUND: The objective of this study is to evaluate titanium decontamination after different protocols while assessing changes in surface roughness, chemical composition, and wettability. METHODS: Ninety-six smooth (S) and 96 minimally rough (R) titanium microimplants were used. Pristine microimplants were reserved for negative control (S-nC/R-nC, n = 9), while the remaining microimplants were incubated in Escherichia coli culture. Non-decontaminated microimplants were used as positive control (S-pC/R-pC, n = 3). The other microimplants were divided into seven different decontamination protocols (12 S/R per group): 24% EDTA, 2% chlorhexidine (CHL), gauze soaked in 2% chlorhexidine (GCHL), gauze soaked in ultrapure water (GMQ), scaling (SC), titanium brush (TiB), and implantoplasty (IP). Contaminated areas were assessed by scanning electron microscope images, chemical composition by energy dispersive X-ray spectroscopy, wettability by meniscus technique, and roughness by an optical profiler. RESULTS: Higher residual bacteria were observed in R-pC compared with S-pC (P <0.0001). When comparing S and R with their respective pC groups, the best results were obtained with GCHL, SC, TiB, and IP, with no difference between these protocols (P >0.05). Changes in surface roughness were observed after all treatments, with S/R-IP presenting the smoother and a less hydrophilic surface (P <0.05). Apart from IP protocol, all the other groups presented a more hydrophilic surface in R than in S microimplants (P <0.003). All decontamination protocols resulted in a lower percentage of superficial Ti when compared with S/R-nC (P <0.002). CONCLUSIONS: All decontamination protocols resulted in changes in roughness, wettability, and chemical composition, but GCHL, SC, TiB, an IP presented the best decontamination outcomes.

Pneumopericardium Complicating Per-Oral Endoscopic Myotomy Due to Inadvertent Use of Air Instead of Carbon Dioxide.

Per-oral endoscopic myotomy (POEM) is a relatively novel endoscopic technique for the treatment of achalasia. POEM has been shown to have outcomes comparable to those with Heller myotomy, but it is less invasive and has fewer complications. A 72-year-old man with progressive solid and liquid dysphagia underwent POEM, but soon after the procedure went into cardiac arrest; spontaneous circulation returned after 10 minutes of CPR. He was subsequently found to have tension pneumopericardium as a result of the inadvertent use of air instead of carbon dioxide during the procedure. He had a prolonged hospitalization that required an extended stay in the medical intensive care unit. Although rare, POEM can lead to critical, life-threatening complications.

Social network targeting to maximise population behaviour change: a cluster randomised controlled trial.

BACKGROUND: Information and behaviour can spread through interpersonal ties. By targeting influential individuals, health interventions that harness the distributive properties of social networks could be made more effective and efficient than those that do not. Our aim was to assess which targeting methods produce the greatest cascades or spillover effects and hence maximise population-level behaviour change. METHODS: In this cluster randomised trial, participants were recruited from villages of the Department of Lempira, Honduras. We blocked villages on the basis of network size, socioeconomic status, and baseline rates of water purification, for delivery of two public health interventions: chlorine for water purification and multivitamins for micronutrient deficiencies. We then randomised villages, separately for each intervention, to one of three targeting methods, introducing the interventions to 5% samples composed of either: randomly selected villagers (n=9 villages for each intervention); villagers with the most social ties (n=9); or nominated friends of random villagers (n=9; the last strategy exploiting the so-called friendship paradox of social networks). Participants and data collectors were not aware of the targeting methods. Primary endpoints were the proportions of available products redeemed by the entire population under each targeting method. This trial is registered with ClinicalTrials.gov, number NCT01672580. FINDINGS: Between Aug 4, and Aug 14, 2012, 32 villages in rural Honduras (25-541 participants each; total study population of 5773) received public health interventions. For each intervention, nine villages (each with 1-20 initial target individuals) were randomised, using a blocked design, to each of the three targeting methods. In nomination-targeted villages, 951 (74·3%) of 1280 available multivitamin tickets were redeemed compared with 940 (66·2%) of 1420 in randomly targeted villages and 744 (61·0%) of 1220 in indegree-targeted villages. All pairwise differences in redemption rates were significant (p<0·01) after correction for multiple comparisons. Targeting nominated friends increased adoption of the nutritional intervention by 12·2% compared with random targeting (95% CI 6·9-17·9). Targeting the most highly connected individuals, by contrast, produced no greater adoption of either intervention, compared with random targeting. INTERPRETATION: Introduction of a health intervention to the nominated friends of random individuals can enhance that intervention's diffusion by exploiting intrinsic properties of human social networks. This method has the additional advantage of scalability because it can be implemented without mapping the network. Deployment of certain types of health interventions via network targeting, without increasing the number of individuals targeted or the resources used, could enhance the adoption and efficiency of those interventions, thereby improving population health. FUNDING: National Institutes of Health, The Bill & Melinda Gates Foundation, Star Family Foundation, and the Canadian Institutes of Health Research.

Treatment of gingival recession defects with xenogenic collagen matrix: a histologic report.

The connective tissue graft (CTG) in conjunction with a coronally advanced flap is still regarded as the gold standard treatment for gingival recession defects. Increased surgical morbidity as well as limited tissue availability continues to spur interest in alternatives to the CTG. The current case report examines a porcine-derived, double-layer collagen matrix as an alternative to the CTG in managing Miller Class I and II recession defects. A long junctional epithelial attachment as well as connective tissue adhesion were noted when collagen matrix was used in conjunction with a coronally advanced flap in recession treatment protocols. The results suggest that it is possible to obtain root coverage without harvesting connective tissue.

Functional significance of cytosolic endothelial nitric-oxide synthase (eNOS): regulation of hyperpermeability.

Endothelial NOS (eNOS)-derived NO is a key factor in regulating microvascular permeability. We demonstrated previously that eNOS translocation from the plasma membrane to the cytosol is required for hyperpermeability. Herein, we tested the hypothesis that eNOS activation in the cytosol is necessary for agonist-induced hyperpermeability. To study the fundamental properties of endothelial cell monolayer permeability, we generated ECV-304 cells that stably express cDNA constructs targeting eNOS to the cytosol or plasma membrane. eNOS-transfected ECV-304 cells recapitulate the eNOS translocation and permeability properties of postcapillary venular endothelial cells (Sánchez, F. A., Rana, R., Kim, D. D., Iwahashi, T., Zheng, R., Lal, B. K., Gordon, D. M., Meininger, C. J., and Durán, W. N. (2009) Proc. Natl. Acad. Sci. U.S.A. 106, 6849-6853). We used platelet-activating factor (PAF) as a proinflammatory agonist. PAF activated eNOS by increasing phosphorylation of Ser-1177 and inducing dephosphorylation of Thr-495, increasing NO production, and elevating permeability to FITC-dextran 70 in monolayers of cells expressing wild-type and cytosolic eNOS. PAF failed to increase permeability to FITC-dextran 70 in monolayers of cells transfected with eNOS targeted to the plasma membrane. Interestingly, this occurred despite eNOS Ser-1177 phosphorylation and production of comparable amounts of NO. Our results demonstrate that the presence of eNOS in the cytosol is necessary for PAF-induced hyperpermeability. Our data provide new insights into the dynamics of eNOS and eNOS-derived NO in the process of inflammation.

Toll-like receptor 4-dependent activation of dendritic cells by a retrovirus.

Mouse mammary tumor virus (MMTV) is a milk-borne retrovirus that exploits the adaptive immune system. It has recently been shown that MMTV activates B cells via Toll-like receptor 4 (TLR4), a molecule involved in innate immune responses. Here, we show that direct virus binding to TLR4 induced maturation of bone marrow-derived dendritic cells and up-regulated expression of the MMTV entry receptor (CD71) on these cells. In vivo, MMTV increased the number of dendritic cells in neonatal Peyer's patches and their expression of CD71; both these effects were dependent on TLR4. Thus, retroviral signaling through TLRs plays a critical role in dendritic-cell participation during infection.