Treatment of a Severe Pediatric Lyell Syndrome with Amniotic Membrane: Case Report and Histological Findings

Background: Lyell Syndrome (TEN, Toxic epidermal necrolysis) represents a medical emergency particularly in pediatric patients in whom the massive skin damage can quickly lead to multi-organ dysfunction and death. Prompt restoration of the physiologic mucosal/cutaneous barrier is mandatory. The use of amniotic membranes has been described in the treatment of ophthalmic Lyell Syndrome, but its use has not yet been adopted for the management of larger cutaneous wounds. Study Hypothesis: Here we report the use of amniotic membranes in a pediatric case of severe Lyell Syndrome with complete skin surface, ocular and mucosal involvement with life threating presentation. Methods: A 7-year old female was admitted to our Burn Centre for severe cutaneous/mucosal exfoliation (100% Total body surface area, TBSA) as a result of an adverse reaction to ibuprofen administration. Supportive fluid administration, cardiac-pulmonary assistance and pain management were complemented by serial grafting of amniotic membranes on all affected areas to provide coverage of the exfoliated skin/mucosa. Biopsies were obtained to monitor histological skin changes. Results: The patient showed an excellent response to amniotic membrane treatment, with rapid restoration of mucosal and cutaneous layers in the grafted areas. This resulted in a decreased need for dressing changes, avoidance of additional surgeries and a reduced dependence on supportive therapy. Lower pain levels than usually expected led to a reduced need for narcotic pain medications and allowed for early physical rehabilitation and a short hospital stay. Histology confirmed evidence of topical immune-modulation in treated areas (reduction of inflammatory infiltrate). Conclusion: As we tested in numerously TEN and burn pediatric injuries Amniotic membranes with their regenerative and immune-modulatory effects may represent an life saving treatment even in the worst cases of pediatric Lyell syndrome

D-cores: Measuring collaboration of directed graphs based on degeneracy

Community detection and evaluation is an important task in graph mining. In many cases, a community is defined as a subgraph characterized by dense connections or interactions between its nodes. A variety of measures are proposed to evaluate different quality aspects of such communities-in most cases ignoring the directed nature of edges. In this paper, we introduce novel metrics for evaluating the collaborative nature of directed graphs-a property not captured by the single node metrics or by other established community evaluation metrics. In order to accomplish this objective, we capitalize on the concept of graph degeneracy and define a novel D-core framework, extending the classic graph-theoretic notion of D-cores for undirected graphs to directed ones. Based on the D-core, which essentially can be seen as a measure of the robustness of a community under degeneracy, we devise a wealth of novel metrics used to evaluate graph collaboration features of directed graphs. We applied the D-core approach on large synthetic and real-world graphs such as Wikipedia, DBLP, and ArXiv and report interesting results at the graph as well at the node level. © 2012 Springer-Verlag London Limited

Quantifying Trust Dynamics In Signed Graphs, The S-cores Approach

The paper can be viewed at: http://epubs.siam.org/doi/pdf/10.1137/1.9781611973440.77Lately, there has been an increased interest in signed networks with applications in trust, security, or social computing. This paper focuses on the issue of defining models and metrics for reciprocity in signed graphs. In unsigned directed networks, reciprocity quantifies the predisposition of network members in creating mutual connections. On the other hand, this concept has not yet been investigated in the case of signed graphs. We capitalize on the graph degeneracy concept to identify subgraphs of the signed network in which reciprocity is more likely to occur. This enables us to assess reciprocity at a global level, rather than at an exclusively local one as in existing approaches. The large scale experiments we perform on real world data sets of trust networks lead to both interesting and intuitive results. We believe these reciprocity measures can be used in various social applications such as trust management, community detection and evaluation of individual nodes. The global reciprocity we define in this paper is closely correlated to the clustering structure of the graph, more than the local reciprocity as it is indicated by the experimental evaluation we conducted

Multidisciplinary care in severe pediatric electrical oral burn.

Oral burns in pediatric patient are commonly due to electrical injuries, representing an important reconstructive issue even for functional than esthetic reason. Different classification, surgical management and even oral device were described to allow the best long-term result. In most case a multidisciplinary approach is necessary to achieve a satisfactory outcome. A severe case of pediatric oral burn with germinative teeth damage is presented, describing a multispecialist team approach that guarantee a satisfactory outcome by reconstructive surgery, careful progressive evaluation of dental and soft tissue healing and speech recovery. The use of acellular dermal substitute template within traditional reconstructive surgery had provided a good functional and esthetic result joint to valid preservation of germinative dental element as shown at long-term X-ray evaluation. Intensive rehabilitation speech program has also avoided phonetic impairment in an important speech develop period. It was so evident that the necessity of a multispecialist care in such difficult injury to achieve the best long-term result

Corticospinal Tract Injury Estimated From Acute Stroke Imaging Predicts Upper Extremity Motor Recovery After Stroke

Background and Purpose- Injury to the corticospinal tract (CST) has been shown to have a major effect on upper extremity motor recovery after stroke. This study aimed to examine how well CST injury, measured from neuroimaging acquired during the acute stroke workup, predicts upper extremity motor recovery. Methods- Patients with upper extremity weakness after ischemic stroke were assessed using the upper extremity Fugl-Meyer during the acute stroke hospitalization and again at 3-month follow-up. CST injury was quantified and compared, using 4 different methods, from images obtained as part of the stroke standard-of-care workup. Logistic and linear regression were performed using CST injury to predict ΔFugl-Meyer. Injury to primary motor and premotor cortices were included as potential modifiers of the effect of CST injury on recovery. Results- N=48 patients were enrolled 4.2±2.7 days poststroke and completed 3-month follow-up (median 90-day modified Rankin Scale score, 3; interquartile range, 1.5). CST injury distinguished patients who reached their recovery potential (as predicted from initial impairment) from those who did not, with area under the curve values ranging from 0.70 to 0.8. In addition, CST injury explained ≈20% of the variance in the magnitude of upper extremity recovery, even after controlling for the severity of initial impairment. Results were consistent when comparing 4 different methods of measuring CST injury. Extent of injury to primary motor and premotor cortices did not significantly influence the predictive value that CST injury had for recovery. Conclusions- Structural injury to the CST, as estimated from standard-of-care imaging available during the acute stroke hospitalization, is a robust way to distinguish patients who achieve their predicted recovery potential and explains a significant amount of the variance in poststroke upper extremity motor recovery