Characteristics and surgical outcomes of cleft palate in kabuki syndrome: a case series of 11 patients

Objective A significant number of patients with KS have cleft palate (CP) or submucous cleft palate (SMCP) and show delayed speech development. However, few reports have discussed the characteristics of CP in KS and the outcomes of postoperative speech development. The purpose of this study was to investigate the characteristics and surgical outcomes of CP in patients with KS, and to discuss the importance of the diagnosis of CP or SMCP. Methods We conducted a retrospective study on patients with clinically diagnosed KS who underwent palatoplasty. Clinical and surgical data were collected from patients medical records, and velopharyngeal function was evaluated using nasopharyngoscopy and speech analysis. Results In 11 cases, 5 patients had CP (45.5%) and 6 had SMCP (54.5%). Four patients who were genetically tested had a pathogenic variant of KMT2D. Seven of nine patients (77.8%) who underwent conventional palatoplasty showed velopharyngeal insufficiency and hypernasality. All patients who underwent pharyngeal flap surgery achieved velopharyngeal competency. Statistical analysis revealed a statistically significant difference in postoperative results between non-syndromic and KS patients. Conclusion Patients with SMCP may be more common than previously reported. The results showed that it is difficult to produce optimal results with conventional palatoplasty; therefore, pharyngeal flap surgery should be considered as a treatment to obtain favorable results. Pharyngeal flap surgery in patients with KS should be carefully designed based on speech evaluation and nasopharyngoscopic findings

Free Flap Coverage of Extensive Soft Tissue Defect in Cutaneous Aspergillosis: A Case Report

Isolated fungal soft-tissue infections are uncommon, but may cause severe morbidity or mortality. Aspergillosis infection is rare, but the frequency in increasing over the last two decades. Here, we present a patient with cutaneous aspergillosis of his right elbow with unusual clinical and radiological features suggestive of a malignant disease, which remained undiagnosed for an extended period of time. The patient presented with necrotic, black-colored skin ulcerations. We completely removed the skin ulcer with the surrounding erythematous skin lesion, and then we reconstructed the area with thoracodorsal perforator free flap. The biopsy specimen contained septate hyphae with dichotomous branching, which is morphologically consistent with a finding of Aspergillus. After surgery, we initiated antifungal medication therapy with amphotericin B and itraconazole. At the time of follow-up, the elbow with the reconstructed flap had fully healed, and no recurrent disease was found

Topical application of epidermal growth factor accelerates wound healing by myofibroblast proliferation and collagen synthesis in rat

Recombinant human epidermal growth factor (rhEGF) stimulates the proliferation and migration of epithelial cells in human cell culture systems and animal models of partial-thickness skin wounds. This study investigated the effect of a topical rhEGF ointment on the rate of wound healing and skin re-epithelialization in a rat full thickness wound model, and verified whether or not the rhEGF treatment affected both myofibroblast proliferation and collagen synthesis in the dermis. When rhEGF (10 µg/g ointment) was applied topically twice a day for 14 days, there was significantly enhanced wound closure from the 5th to the 12th day compared with the control (ointment base treatment) group. A histological examination at the postoperative 7th day revealed that the rhEGF treatment increased the number of proliferating nuclear antigen immunoreactive cells in the epidermis layer. In addition, the immunoreactive area of alpha-smooth muscle actin and the expression of prolyl 4-hydroxylase were significantly higher than those of the control group. Overall, a topical treatment of rhEGF ointment promotes wound healing by increasing the rate of epidermal proliferation and accelerating the level of wound contraction related to myofibroblast proliferation and collagen deposition

Two loop electroweak corrections to Bˉ→Xsγ\bar B\rightarrow X_s\gamma and Bs0→μ+μ−B_s^0\rightarrow \mu^+\mu^- in the B-LSSM

The rare decays $\bar B\rightarrow X_s\gamma$ and $B_s^0\rightarrow \mu^+\mu^-$ are important to research new physics beyond standard model. In this work, we investigate two loop electroweak corrections to $\bar B\rightarrow X_s\gamma$ and $B_s^0\rightarrow \mu^+\mu^-$ in the minimal supersymmetric extension of the SM with local $B-L$ gauge symmetry (B-LSSM), under a minimal flavor violating assumption for the soft breaking terms. In this framework, new particles and new definition of squarks can affect the theoretical predictions of these two processes, with respect to the MSSM. Considering the constraints from updated experimental data, the numerical results show that the B-LSSM can fit the experimental data for the branching ratios of $\bar B\rightarrow X_s\gamma$ and $B_s^0\rightarrow \mu^+\mu^-$. The results of the rare decays also further constrain the parameter space of the B-LSSM.Comment: 33 pages, 9 figures, Published in EPJ

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Important Aspects of Oral Lining in Unilateral Cleft Lip Repair

To achieve an aesthetic lip in cleft lip repair, central fullness and slight eversion of the vermilion are necessary. If only cutaneous anthropometric length is considered, symmetry and good vermilion contour may be obtained, but a seemingly tightness of the lip can occur. To prevent this, it is necessary to obtain sufficient central mucosal tissue of the oral lining. The authors used 2 methods to obtain adequate tissue of the central area of the oral lining. First, the mucosa of the central area of the oral lining was supplemented using a medial mucosal flap, and the amount of superfluous tissue was minimized. Second, a relaxing incision was placed at the oral lining of the lateral flap, which was subsequently centrally advanced. A total of 389 patients with a unilateral cleft lip underwent surgery using these methods and achieved satisfactory results. Occasional cases of lateral vermilion bulging were encountered during long-term follow-up, but these were easily corrected by bulging excision. Consideration of the oral lining is essential in cleft lip repair. The authors were able to reconstruct an aesthetically pleasing lip with central fullness by obtaining an adequate amount of tissue in the central area of oral lining.Sawyer AR, 2009, AESTHET PLAST SURG, V33, P497, DOI 10.1007/s00266-008-9191-1Tamada I, 2009, J PLAST RECONSTR AES, V62, P150, DOI 10.1016/j.bjps.2008.04.051Sitzman TJ, 2008, PLAST RECONSTR SURG, V121, p261E, DOI 10.1097/PRS.0b013e31816a9febChristofides E, 2006, J PLAST RECONSTR AES, V59, P380, DOI 10.1016/j.bjps.2005.04.037Seagle MB, 2004, PLAST RECONSTR SURG, V113, P1537, DOI 10.1097/01.PRS.0000111884.47294.AELosee JE, 2003, ANN PLAS SURG, V50, P594BOTTI G, 1995, AESTHET PLAST SURG, V19, P69MATSUO K, 1993, PLAST RECONSTR SURG, V91, P930AIACHE AE, 1991, PLAST RECONSTR SURG, V88, P222MILLARD DR, 1976, CLEFT CRAFT EVOLUTIO, V1ROBINSON DW, 1970, PLAST RECONSTR SURG, V46, P241

A New Condyle Repositionable Plate for Sagittal Split Ramus Osteotomy

In sagittal split ramus osteotomy (SSRO) surgery, variable methods are used to maintain the proximal segment in the anatomic position during fixation to minimize early built-in relapse. However, there is still a chance of condyle malposition. In this study, a new titanium plate, which has a sliding oval hole in its distal part, was used to enable postoperative mobility of the proximal segment. This plate makes it possible to reposition the condyle during the postoperative intermaxillary fixation period. These plates were used successfully in 23 patients who received SSRO setback surgery. All of the patients were followed up without any complications, including early relapse or temporomandibular joint problems. The authors used a new plate that enables sliding of the proximal segment after SSRO, which can minimize early relapse without any postoperative complications.Chung IH, 2008, J ORAL MAXIL SURG, V66, P446, DOI 10.1016/j.joms.2007.06.643Baek RM, 2005, ANN PLAS SURG, V55, P335, DOI 10.1097/01.sap.0000175421.18457.23CONSTANTIN A, 2003, J ORAL MAXILLOFAC SU, V61, P1423GUNTER H, 1997, J CRANIOMAXILLOFAC S, V25, P34Harada K, 1996, PLAST RECONSTR SURG, V98, P363RUBENS BC, 1988, INT J ORAL MAX SURG, V17, P371LINDQVIST C, 1988, PLAST RECONSTR SURG, V82, P707