Concomitant Overlap Steal Tip-plasty: A Versatile Technique to Simultaneously Adjust the Rotation, Definition, Projection, and Symmetry of the Nasal Tip

Background Tip-plasty is a particularly challenging stage of aesthetic nose surgery. The diversity of nasal tip deformities has necessitated the development of numerous surgical techniques that can be difficult to master and may yield unpredictable surgical results when combined. Objectives The authors describe how concomitant overlap steal tip-plasty (COST) can enable surgeons to address all of the aesthetic characteristics of the nasal tip simultaneously. COST involves lateral crural steal followed by medial crural overlap. Methods The medical records of 1617 patients who underwent primary open septorhinoplasty with COST were evaluated in a retrospective study. Pre- and postoperative patient photographs were compared for nasal length, nasolabial angle, tip projection, and deviation of the nasal axis. Results Pre- and postoperative mean nasal lengths were 5.66 cm and 5.17 cm, respectively (P <. 05). The mean nasolabial angle was 86.95° preoperatively and 101.8° postoperatively (P <. 05). The projection of the nasal tip was reduced from 3.09 cm to 2.53 cm, and tip symmetry was achieved by decreasing the nasal axis deviation from 7.76° to 1.71° (both P <. 05). Conclusions COST does not obviate all other tip-plasty techniques for specific situations. Once mastered, however, COST can become the only procedure needed to achieve all of the aesthetic goals of the nasal tip in most cases. Level of Evidence: 4 Therapeutic. © 2015 The American Society for Aesthetic Plastic Surgery, Inc

The Application of Carrying Capacity Concept for Sustainable Development in Small Island (Case Study Kaledupa Islands, Distict Wakatobi)

The Challenge for small islands planners and managers in Indonesia right now is to develop resources and environment service of small islands for the maximum benefit and, at the same time, to maintain the sustainable capacity of ecosystems (meaning does not exceed the carrying capacity of the ecosystems). This paper applied carrying capacity concept for sustainable development of small islands. To determine carrying capacity of utility space of small islands through two aspects: (1) freshwater, and (2) spaces. Analysis result of carrying capacity for directing utility land area (settlements and agricultures), the freshwater aspects would be fullness, if annual absorption to rainy stayed at 50%. The space area of aquatic which could be utilized for marine culture, shore and marine ecotourism there were around 70%. It was 30% recommended for marine protected zone

Indole-3-carbinol suppresses NF-κB activity and stimulates the p53 pathway in pre-B acute lymphoblastic leukemia cells

B cell precursor acute lymphoblastic leukemia (BCP-ALL) is the most common type of cancer in children. Dramatic improvements in primary therapy for childhood ALL have led to an overall cure rate of 80 , providing opportunities for innovative combined-modality strategies that would increase cure rates while reducing the toxic side effects of current intensive regimens. In this study, we report that indole-3-carbinol (I3C), a natural phytochemical found in cruciferous vegetables, had anti-leukemic properties in BCP-ALL NALM-6 cells. I3C induced cell growth inhibition by G1 cell cycle arrest and triggered apoptosis in a dose- and time-dependent manner. p53, p21, and Bax proteins showed increased expression after I3C treatment. Real-time PCR analysis of pro-apoptotic p53 target genes revealed up-regulation of PUMA, NOXA, and Apaf-1. I3C also suppressed constitutive nuclear factor-κB (NF-κB) activation and inhibited the protein expression of NF-kappa B-regulated antiapoptotic (IAP1, Bcl-xL, Bcl-2, XIAP) and proliferative (c-Myc) gene products. Coadministration of I3C with the topoisomerase II inhibitor, doxorubicin, potentiates cytotoxic effects compared with either agent alone. Apoptosis induction by the drug combination was associated with enhanced caspase-9 activation and PARP cleavage. Furthermore, I3C abolished doxorubicin-induced NF-κB activity as evidenced by decreased nuclear accumulation of p65, inhibition of IκBα phosphorylation and its degradation, and decreased NF-κB DNA-binding activity. Western blot analysis revealed that doxorubicin-induced Bcl-2 protein expression was inhibited by I3C. Overall, our results indicated that using nontoxic agents, such as I3C, in combination with anthracyclines might provide a new insight into the development of novel combination therapies in childhood BCP-ALL. © 2015, International Society of Oncology and BioMarkers (ISOBM)

God Loveth Adverbs: Teaching (and Living) Christianly

In my current role as a teacher educator, I strive to help my students (pre-service teachers) understand what it means to \u27teach Christianly.\u27 If I’m honest about it, I am still striving to fully understand what this means in my own teaching practice. Posting about being a Christ-like teacher from In All Things - an online hub committed to the claim that the life, death, and resurrection of Jesus Christ has implications for the entire world. http://inallthings.org/god-loveth-adverbs-teaching-and-living-christianly

Massive repeated nose bleeding after bimaxillary osteotomy

In LeFort I surgery, the separation of the pterygomaxillary junction is done by osteotomy. Although the osteotome is positioned too close to the maxillary artery and its branches during pterygomaxillary separation, postoperative complications from vascular injuries are uncommon. We describe an unusual occurrence of a maxillary artery pseudoaneurysm after LeFort I and bilateral sagittal split osteotomies for maxillary advancement and mandibular setback as well as (anterior sliding) genioplasty. In a patient with class III occlusion and midface retrusion, the significant bleeding began 10 days postoperatively, which was controlled by anterior and posterior nasal packing. The bleeding recurred 28 days after surgery; thus, vascular anatomy in the pterygomaxillary area is reviewed, pseudoaneurysm was diagnosed on selective carotid angiography and successfully treated by embolization; and 2-year follow up was uneventful. © 2007 Muntaz B. Habal, MD

Intraocular lens power calculation in keratoconus; a review of literature

Purpose: To review the published literature regarding cataract surgery in keratoconus (KCN) patients with emphasis on challenges encountered during intraocular lens (IOL) power calculation and their solutions. Methods: A literature review was performed to investigate all the relevant articles on the advancements of IOL calculations in KCN patients. Results: Cataract surgery in keratoconic eyes can improve patients' refraction, and proper patient selection and IOL calculation methods are necessary to get the best results. The main problem in KCN patients is unreliable biometric measurements. It is more difficult to make conclusions in more advanced keratoconic corneas, as the steep keratometric values in these eyes will result in the selection of a low-power IOL. Presence of a low-power IOL will yield in extreme postoperative hyperopia, and IOL exchange might be mandatory. In cases in which keratoplasty may be needed in the future, contact lens fitting can help surgeons make a better decision preoperatively. Axial length (AL) measurements may have better repeatability and reproducibility than keratometry (K) readings in keratoconic eyes. SRK II formula may provide the most accurate IOL power in mild KCN. There is still not a comprehensive consensus of which formula is the best one in moderate and severe KCN, as the literature is limited in this subject. Conclusions: Various methods of IOL power calculation optimization and recommendations may hold the key to improve surgical outcomes in keratoconic eyes. There are multiple sources of biometric error in KCN patients, hence IOL calculation methods may not be as efficient as expected in these eyes. © 2019 Iranian Society of Ophthalmolog

Cardiac abnormalities due to multisystem inflammatory syndrome temporally associated with Covid-19 among children: A systematic review and meta-analysis

Background: Cardiac defects due to multisystem inflammatory syndrome in children (MIS-C) have been abundantly reported leading high morbidity among children affected by Covid-19. We aimed to systematically assess the incidence of such cardiac abnormalities due to MIS-C in children suffering Covid-19. Methods: The manuscript databases including Medline, Web of knowledge, Google scholar, Scopus, and Cochrane were deeply searched by the two blinded investigators for all eligible studies based on the relevant keywords. The risk of bias for each study was assessed according to QUADAS-2 tool. Statistical analysis was performed using the Comprehensive Meta Analysis (CMA) software. Results: In final, 21 articles (including 916 children) were eligible for the final analysis that all yielded good quality and none of the citation was determined to have high risk of bias. Considering studies focusing different cardiac abnormalities related to MIS-C yielded a pooled prevalence of 38.0 for significant left ventricular dysfunction, 20.0 for coronary aneurism or dilatation, 28.1 for ECG abnormalities or cardiac arrhythmias, 33.3 for raised serum troponin level and 43.6 for raised proBNP/BNP level. Conclusion: Although cardiac abnormalities among children suffering Covid-19 are uncommon, in the context of the MIS-C can be common and therefore potentially serious and life threatening. © 202

Eosinophils downregulate lung alloimmunity by decreasing TCR signal transduction

Despite the accepted notion that granulocytes play a universally destructive role in organ and tissue grafts, it has been recently described that eosinophils can facilitate immunosuppression-mediated acceptance of murine lung allografts. The mechanism of eosinophil-mediated tolerance, or their role in regulating alloimmune responses in the absence of immunosuppression, remains unknown. Using lung transplants in a fully MHC-mismatched BALB/c (H2d) to C57BL/6 (H2b) strain combination, we demonstrate that eosinophils downregulate T cell-mediated immune responses and play a tolerogenic role even in the absence of immunosuppression. We further show that such downregulation depends on PD-L1/PD-1-mediated synapse formation between eosinophils and T cells. We also demonstrate that eosinophils suppress T lymphocyte responses through the inhibition of T cell receptor/CD3 (TCR/CD3) subunit association and signal transduction in an inducible NOS-dependent manner. Increasing local eosinophil concentration, through administration of intratracheal eotaxin and IL-5, can ameliorate alloimmune responses in the lung allograft. Thus, our data indicate that eosinophil mobilization may be utilized as a novel means of lung allograft-specific immunosuppression

Canadian Burden of Skin Disease From 1990 to 2017: Results From the Global Burden of Disease 2017 Study

Background: Skin diseases can have high morbidity that can be costly to society and individuals. To date, there has been no comprehensive assessment of the burden of skin disease in Canada. Objectives: To evaluate the burden of 18 skin and subcutaneous diseases from 1990 to 2017 in Canada using the Global Burden of Disease (GBD) data. Methods: The 2017 GBD study measures health loss from 359 diseases and injuries in 195 countries; we evaluated trends in population health in Canada from 1990 to 2017 using incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs). Data are presented as rates (per 100 000), counts, or percent change with the uncertainty interval in brackets. Results: From 1990 to 2017 for all skin diseases, DALY rates increased by 8 to 971 per 100 000 (674-1319), YLD rates increased by 8 to 897 per 100 000 (616-1235), YLL rates increased by 4 to 74 per 100 000 (53-89), and death rates increased by 18 to 5 per 100 000 (3-6). DALY rates for melanoma increased by 2 to 54 per 100 000 (39-68), for keratinocyte carcinoma by 14 to 17 per 100 000 (16-19), and for skin and subcutaneous disease by 8 to 900 per 100 000 (619-1233). The observed over expected ratios were higher for skin and subcutaneous disease (1.37) and keratinocyte carcinoma (1.17) and were lower for melanoma (0.73). Conclusions: The burden of skin disease has increased in Canada since 1990. These results can be used to guide health policy regarding skin disease in Canada. © The Author(s) 2020

The global burden of childhood and adolescent cancer in 2017: an analysis of the Global Burden of Disease Study 2017

© 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Accurate childhood cancer burden data are crucial for resource planning and health policy prioritisation. Model-based estimates are necessary because cancer surveillance data are scarce or non-existent in many countries. Although global incidence and mortality estimates are available, there are no previous analyses of the global burden of childhood cancer represented in disability-adjusted life-years (DALYs). Methods: Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 methodology, childhood (ages 0–19 years) cancer mortality was estimated by use of vital registration system data, verbal autopsy data, and population-based cancer registry incidence data, which were transformed to mortality estimates through modelled mortality-to-incidence ratios (MIRs). Childhood cancer incidence was estimated using the mortality estimates and corresponding MIRs. Prevalence estimates were calculated by using MIR to model survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated by multiplying age-specific cancer deaths by the difference between the age of death and a reference life expectancy. DALYs were calculated as the sum of YLLs and YLDs. Final point estimates are reported with 95% uncertainty intervals. Findings: Globally, in 2017, there were 11·5 million (95% uncertainty interval 10·6–12·3) DALYs due to childhood cancer, 97·3% (97·3–97·3) of which were attributable to YLLs and 2·7% (2·7–2·7) of which were attributable to YLDs. Childhood cancer was the sixth leading cause of total cancer burden globally and the ninth leading cause of childhood disease burden globally. 82·2% (82·1–82·2) of global childhood cancer DALYs occurred in low, low-middle, or middle Socio-demographic Index locations, whereas 50·3% (50·3–50·3) of adult cancer DALYs occurred in these same locations. Cancers that are uncategorised in the current GBD framework comprised 26·5% (26·5–26·5) of global childhood cancer DALYs. Interpretation: The GBD 2017 results call attention to the substantial burden of childhood cancer globally, which disproportionately affects populations in resource-limited settings. The use of DALY-based estimates is crucial in demonstrating that childhood cancer burden represents an important global cancer and child health concern. Funding: Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities (ALSAC), and St. Baldrick's Foundation