Breach procedure for axillary hyperhidrosis.

Dear Editor, We read with interest the communication on ‘A simple and practical method for axillary osmidrosis resection’ by Liu X, Mao T, Lei Z, Fan D appeared on JPRAS 2009.1 We found the description of the technique very useful with the support of intra-operative pictures. The use of artery clips to evert the skin flaps can be easily reproduced. However it is surprising that the Authors did not consider and mention in the References a paper by Mr N Breach appeared in the Annals of the Royal College of Surgeons of England in the late 70ies,2 when he was Senior Registrar at the Plastic Surgery Department of the Queen Victoria Hospital, East Grinstead, UK. Since then this latter procedure for surgical treatment of axillary hyperhidrosis has been widely adopted, [3], [4] and [5] especially in the Western world and in the UK where is known as the ‘Breach’ procedure. The main difference with the technique described in the paper by Liu X et al. consists in the number of incisions that has now been minimized

Are Ohio's Nursing Homes Ready for an Emergency?

On any given day in Ohio's nursing homes, there are nearly 78,000 residents with physical or cognitive impairments. This means that nursing homes may be vulnerable during emergencies that require either evacuation or necessitate sheltering in place. A module regarding preparedness and planning in Ohio nursing homes was included in the 2013 Biennial Long-term Care Survey administered by the Scripps Gerontology Center. Findings and implications are discussed

PONENCIA: CAPACITAR PARA EL TRABAJO

En los tiempos de crisis que vive la Sociedad Latinoamericana La Universidad tiene la obligación y sobre todo la Universidad pública de contribuir en la reinserción laboral de los sectores que quedaron fuera del sistema productivo. Decimos que sobre todo tiene una obligación moral el sistema educativo público por que el sostenimiento del mismo se logra con el aporte solidario de todos los componentes de una sociedad, y sobre todo por que muchos de los que pretendemos reinsertar fueron parte activa de estos aporte y hoy son los que están fuera del sistema. La ponencia que estamos presentando no solo esta basada en la obligación moral de la Universidad sino también en la abundante normativa que hay dentro de las mismas universidades. A modo de ejemplo tomamos la Universidad Nacional de Lomas de Zamora, que es la Universidad a la que pertenecemos, además de tomar leyes de orden nacional. El programa trata sobre la reinserción dentro del circulo productivo de las personas que quedaron fuera de él, por medio de la capacitación en otras actividades que pueden no ser las que hasta ese momento desarrollo el sujeto y de este modo cambiar la actitud meramente asistencialista del Estado a través de un plan social, por la de una formación para la producción que podrá estar acompañada o no por un plan de asistencia social . Lo novedoso de nuestro plan de trabajo es que la capacitación es dada por los mismos integrantes de su circulo social, ya que el primer paso que tiene este plan es la captación y capacitación de los integrantes de su comunidad que sepan un oficio y estén desocupados, entonces a esa persona desocupada pero preparada en alguna actividad, la formamos para formar, es decir, la capacitamos para enseñar y esa persona va a estar preparada para transmitir su conocimiento no solo durante la realización del presente plan sino siempre que se le requiera. Es importante destacar que con este sistema no solo tendemos a reinsertar a la persona desocupada sino que también valorizamos a la que posee un conocimiento y no lo puede desarrollar, ya que partimos de la premisa básica que todos saben algo y que a su vez lo pueden transmitir, y que debemos ser parte de ese proceso cognitivo. Además el que recibe esa instrucción siente que se la da uno de ellos y no uno de afuera que viene solo a realizar una obra de caridad. Por ultimo la Universidad y las entidades que en ese momento trabajen con ella, como es el caso del que tenemos vigente, la ONG casas de la Comunidad y el BID, realizarán un acompañamiento hasta que la persona se reinserte en alguna actividad productiva o lleve adelante su propio microemprendimiento que le permita realizarse como persona por medio de la producción. Ya que partimos de la premisa básica que el trabajo y no solo los ingresos, dignifican a la persona en su condición de tal

Ambulant vacuum-assisted closure of skin-graft dressing in the lower limbs using a portable mini-VAC device

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Vision Care Utilization and Insurance Coverage Prior to and Following Medicaid Expansion in Ohio

Background: Increased access and utilization of vision care services has the potential to reduce preventable vision loss. The state of Ohio has been uniquely proactive when collecting vision-oriented data through population health surveys, including the Behavioral Risk Factor Surveillance System (BRFSS). These data can be used to better understand vision care utilization patterns and access to insurance. Methods: Responses to 3 items administered in the Ohio BRFSS that assess vision care utilization and insurance coverage were compared between 2 different administration periods, 2005-2011 and 2018-2019, using chi-square tests. Comparable data from 2 items assessing eye care utilization were available in 2005-2011 and 2019. Comparable data for insurance coverage were available in 2005-2011 and in 2018-2019. Responses were further stratified by population characteristics, including age, gender, household income, and education level. Results: The percentages of those reporting eye exams in the previous year were not significantly different between 2005-2011 and 2019 (chi-square, p = 0.06). In Ohio, the primary reason for not seeing a vision care provider in the past 12 months was “No reason to go” in 2005-2011 and in 2019. The second most common reason for not seeing a vision care provider in the past 12 months was “Cost/insurance,” which decreased between 2005-2011 and 2019 (chi-square, p <0.001). Insurance coverage for eye care increased between 2005-2011 and 2018-2019 (chi-square, p <0.001). Important differences were found within the demographic stratification. Conclusion: Population health surveillance data provide useful insight into vision care utilization and insurance coverage. Despite the increase in insurance coverage, eye care provider utilization remains relatively stable

Poly(adenosine diphosphate-ribose) polymerase 1 expression in malignant melanomas from photoexposed areas of the head and neck region.

Summary The family of the poly(adenosine diphosphate-ribose) polymerase (PARP) proteins is directly involved in genomic stability, DNA repair, and apoptosis by DNA damage. In this study, we evaluated the role of PARP-1 in melanoma and its prognostic importance. We studied by immunohistochemistry and Western blot analysis PARP-1 expression in a selected series of 80 primary melanoma of the head and neck region. The results were correlated with tumor thickness and patient’s outcome. A follow-up of at least 3 years was available. Fifteen cases of benign melanocytic nevi were used as controls. Normal melanocytes showed only scattered, focal nuclear positivity and were considered as negative for PARP-1 expression by immunohistochemistry (score, 0). Thirty cases of melanoma (37.5%) showed nuclear expression of PARP-1 in both radial and vertical growth phases. Western blot analysis showed the presence of a high signal for full-length PARP-1 only in the cases with high immunohistochemical (nuclear) expression of protein (score, ++/+++) in both radial and vertical growth phase. A significant correlation was present between PARP-1 expression in vertical growth phase and the thickness of tumor lesion ( P = .014); all but one tumor measuring less than 0.75 mm showed no or low PARP-1 expression. No correlation was found between PARP-1 expression in radial growth phase and tumor thickness ( P = .38, data not shown). These data suggest that PARP-1 overexpression is a potential novel molecular marker of aggressive cutaneous malignant melanoma and a direct correlation between PARP-1–mediated inhibition of the apoptosis and biologic behavior of cutaneous malignant melanoma

A new resorbable device for ligation of blood vessels - A pilot study

<p>Abstract</p> <p>Background</p> <p>During surgery, controlled haemostasis to prevent blood loss is vital for a successful outcome. It can be difficult to ligate vessels located deep in the abdomen. A device that is easy to use and enables secure ligatures could be beneficial. Cable ties made of nylon have been used for ligation but the non-resorbable material caused tissue reactions. The objective of this study was to use a resorbable material to construct a device with a self-locking mechanism and to test its mechanical strength and ligation efficiency.</p> <p>Methods</p> <p>The device was manufactured by injection moulding of polydioxanone, a resorbable polymer used for suture materials. Polydioxanone with inherent viscosities of 1.9 dL/g and 1.3 dL/g were tested. The device consisted of a perforated flexible band which could be pulled through a case with a locking mechanism. After a first version of the device had been tested, some improvements were made. The locking case was downsized, corners were rounded off, the band was made thicker and the mould was redesigned to produce longer devices. Tensile tests were performed with the second version.</p> <p>The first version of the device was used to ligate the ovarian pedicle in a euthanized dog and to test echogenicity of the device with ultrasound. Compression of vessels of the ovarian pedicle was examined by histology. Both versions of the device were tested for haemostasis of and tissue grip on renal arteries in six anaesthetised pigs.</p> <p>Results</p> <p>The tensile strength of the flexible band of the devices with inherent viscosity of 1.9 dL/g was 50.1 ± 5.5 N (range 35.2-62.9 N, <it>n </it>= 11) and the devices with inherent viscosity of 1.3 dL/g had a tensile strength of 39.8 ± 8.1 N (range 18.6-54.2 N, <it>n </it>= 11). Injection moulding of the polymer with lower inherent viscosity resulted in a longer flow distance.</p> <p>Both versions of the device had an effective tissue grip and complete haemostasis of renal arteries was verified. The device attached to the ovarian pedicle could be seen with ultrasound, and vessel compression and occlusion were verified by histology.</p> <p>Conclusions</p> <p>Tests of functionality of the device showed complete haemostasis and good tissue grip. Devices with a band of sufficient length were easily applied and tightened in tissue.</p