Fat Grafting in Facial Palsy: A Secondary Revision Technique to Improve the Facial Aesthetics

We report our experience of using autologous fat grafting (AFG) as an adjunct to dynamic and static facial reanimation surgical techniques in patients with facial palsy. A consecutive series of patients with facial palsy (congenital or acquired) treated by AFG between September 2007 and October 2017 were reviewed. Multiple strategies for initial dynamic facial reanimation have been utilized. Indications for AFG included asymmetry, volume deficiency, and visible muscle tethering. Standard AFG technique was used with fat harvested from the lower abdomen or thigh and injected into multiple affected areas. Fat grafting was repeated as necessary. Two-dimensional analysis was performed using standardized pre- and postoperative photographs to assess facial symmetry. Patient, surgeon, and independent evaluator satisfaction was recorded using a five-point Likert scale (0–4). Thirty-two patients with a mean age of 43 ± 15.5 years were treated with AFG following facial reanimation. A mean of 1.7 ± 1.4 secondary procedures were performed following initial dynamic reanimation before fat grafting. The average number of AFG episodes was 2.2 ± 1.4 with a mean volume of 12.9 ± 6.0 ml. Minimal complications were seen in either the donor or the recipient sites. There was significant improvement (P ≤ 0.001) of postoperative quantitative facial symmetry following fat grafting. At one-year follow-up, surgeon, patient, and independent evaluator were mostly satisfied (3.06 ± 0.62, 3.31 ± 0.59, and 3.16 ± 0.57, respectively). We report a positive experience of correction of facial asymmetry, contour abnormality and visible muscle pull with fat transplantation following dynamic facial reanimation. The procedure has been shown to be quick and simple, with few complications

Predicting Death in Chronic Heart Failure: Electrocardiographic, Autonomic and Neuroendocrine Risk Assessment

Chronic heart failure is a common condition with an adverse prognosis. Despite optimal treatment, ambulant patients with mild symptoms have an annual mortality of more than 15%. Clinical, exercise, echocardiographic and haemodynamic variables are known to carry prognostic information, but accurate identification of those most likely to die remains difficult. This work assessed abnormalities of ventricular activation and repolarisation respectively using the signal-averaged electrocardiogram and interlead QT interval variability of the standard 12-lead electrocardiogram. Disordered autonomic function is common in cardiac failure. This was assessed by 24 hour heart rate variability and baroreflex sensitivity. Plasma noradrenaline and plasma atrial and brain natriuretic peptide levels were used to assess neuroendocrine activation, a hallmark of chronic heart failure. These measures were determined prospectively and compared with known prognostic variables in a chronic heart failure population. Original Hypotheses 1. Sudden cardiac death in patients with heart failure is caused predominantly by malignant ventricular arrhythmias. These may be predicted by non-invasive markers of the arrhythmogenic substrate i.e. signal-averaged ECG, QT dispersion; triggers i.e. non-sustained ventricular tacycardia, and autonomic modulators i.e. heart rate variability and baroreflex sensitivity. This assessment will provide additional independent prognostic information on mortality risk in patients with chronic heart failure. 2. Markers of neuroendocrine activation and autonomic dysfunction would predict progression of chronic heart failure, and all-cause and progressive heart failure death. Discussion Chronic heart failure is a common, growing and major public health care burden. Identifying high-risk patients suitable for aggressive intervention, optimisation of treatment and prevention of death is of great importance. Despite extensive study by many investigators, identification of those patients who are most likely to deteriorate and die remains difficult. In this well-characterised cohort of patients with chronic heart failure, neuroendocrine activation assessed by plasma BNP or plasma Noradrenaline predicted cardiovascular death. This information was additive to and independent of other powerful prognostic variables including NYHA class, age, left ventricular ejection fraction, peak VO2 and presence/absence of bundle branch block. However, plasma BNP may be measured from a simple venous blood sample, and has been proven to be stable at room temperature over 72 hours. It is inexpensive, and requires no specialised equipment at the bedside. Direct assay kits are now available which both simplify and lessen the cost of its measurement. This has implication for its more widespread use. Interestingly, a positive SAECG, the presence of non-sustained ventricular tachycardia and depressed baroreflex sensitivity all identified a patient cohort at high risk of sudden death. Linking this data with the prognostic importance of depressed baroreflex sensitivity in the study cohort with recent data on "electrical storms" in patients with implantable cardioverter-defibrillators, it suggests that these markers might be used to identify patients who would benefit from these devices. (Abstract shortened by ProQuest.)

Extreme energy, ‘fracking’ and human rights: a new field for human rights impact assessments?

This article explores the potential human rights impacts of the ‘extreme energy’ process, specifically focussing on the production of shale gas, coal-bed methane (CBM) and ‘tight oil’, known colloquially as ‘fracking’. The article locates the discussion within a broader context of resource depletion, the ‘limits to growth’ and the process of extreme energy itself. Utilising recent secondary data from the United States and Australia, combined with the preliminary findings of our ethnographic fieldwork in the United Kingdom, the article outlines a prima facie case for investigating ‘fracking’ development through a human rights lens. Indeed, based on considerable emerging evidence we argue that ‘fracking’ development poses a significant risk to a range of key human rights and should thus form the subject of a multitude of comprehensive, interdisciplinary human rights impact assessments (HRIAs) as a matter of urgency. Finally, given the close relationships between government and extractive industries, we argue that these impact assessments must do more than bolster corporate social responsibility (CSR) statements and should be truly independent of either government or industry influence

The Effect Of Draw-Up Volume On The Accuracy Of Electrolyte Measurements From Neonatal Arterial Lines

Objectives: Contamination by infusate of blood samples withdrawn from arterial lines has been recognized but not well documented for neonates. The aim of this study was to investigate, using in vitro and in vivo studies, the effects of different draw-up volumes (withdrawn from the line prior to the sample being taken) on the concentration of sodium. Methods: In-vitro study: The tip of an umbilical artery catheter (dead space 0.6 mL), infused with half normal saline containing 1 unit/mL of heparin was placed in a beaker of normal saline. The line was flushed with 1 mL of this infusate just before each sample was taken. Volumes from 0.5 mL to 2.0 mL of infusate/normal saline were withdrawn in 0.1 mL increments from a three-way tap and discarded. A sample was then taken from the line into a blood gas syringe for analysis of the sodium concentration by the 860 Blood Gas Analyzer (Chiron Diagnostics, Bayer, Scoresby). Control samples were taken from the beaker. In-vivo study: A 22 gauge intravenous catheter was inserted into a vein of an adult male volunteer. The dead space was also 0.6 mL. The line was flushed with 5 mL of half-normal saline immediately before sampling. Draw-up volumes of 0.6, 0.9, 1.3, and 1.6 mL were withdrawn and discarded. 10 mL was used as a control. A 0.5-mL blood sample was then taken and the electrolyte concentrations analysed immediately. Results: In-vitro: A minimum draw-up volume of 1.3 mL was required before the sodium concentration was not significantly different from the control samples. In-vivo: A minimum draw-up volume of 1.6 mL was required before the sodium concentration was not significantly different from the control samples. There were similar trends in the effect of draw-up volume for glucose, calcium, potassium, chloride and lactate. Conclusion: A minimum volume of 1.6 mL should be withdrawn from neonatal arterial lines (dead space 0.6 mL) before taking blood for analysi

Bacterial Colonization of Toys in Neonatal Intensive Care Cots

Objectives. To investigate the bacteria and fungi contaminating toys in neonatal intensive care unit (NICU) cots, the colonization rates, and factors that influence them. Methods. A cross-sectional, longitudinal bacteriologic survey of all toys in the cots of infants in an NICU. All the toys in an infant's cot were cultured weekly for 4 weeks. Data were collected on the infant's postnatal age, the type of cot, whether humidity was added, characteristics of the toy, and any infant infections. Results. Over the 4-week period, there were 86 cultures from 34 toys of 19 infants. Bacteria were grown from 84/86 (98%): 84 of the cultures grew coagulase-negative Staphylococcus, 50 Micrococcus sp, 21 Bacillus sp, 13 methicillin-resistant Staphylococcus aureus, 12 diphtheroids, 4 group B streptococcus, 3 S aureus, 3 nonhemolytic streptococci, 3 group D streptococci, 4 -hemolytic streptococci, and 2 coliforms. None grew fungi. The colonization rate did not differ with cot type, presence of humidity, size of the toy, toy fiber length, or the fluffiness score. Eight (42%) of the infants had positive blood culture results and 5/8 of the isolates (63%) were of the same type as that colonizing their corresponding toy. Implications. With time, all the toys in NICU cots became colonized with bacteria. Many were potentially pathogenic. Toys may be reservoirs for potential infantile nosocomial sepsis

Prolonged PR interval, first-degree heart block and adverse cardiovascular outcomes: a systematic review and meta-analysis

Objective: First-degree atrioventricular block is frequently encountered in clinical practice and is generally considered a benign process. However, there is emerging evidence that prolonged PR interval may be associated with adverse outcomes. This study aims to determine if prolonged PR interval is associated with adverse cardiovascular outcomes and mortality. Methods: We searched MEDLINE and EMBASE for studies that evaluated clinical outcomes associated with prolonged and normal PR intervals. Relevant studies were pooled using random effects meta-analysis for risk of mortality, cardiovascular mortality, heart failure, coronary heart disease, atrial fibrillation and stroke or transient ischaemic attack (TIA). Sensitivity analyses were performed considering the population type and the use of adjustments. Results: Our search yielded 14 studies that were undertaken between 1972 and 2011 with 400 750 participants. Among the studies that adjusted for potential confounders, the pooled results suggest an increased risk of mortality with prolonged PR interval risk ratio (RR) 1.24 95% CI 1.02 to 1.51, five studies. Prolonged PR interval was associated with significant risk of heart failure or left ventricular dysfunction (RR 1.39 95% CI 1.18 to 1.65, three studies) and atrial fibrillation (RR 1.45 95% CI 1.23 to 1.71, eight studies) but not cardiovascular mortality, coronary heart disease or myocardial infarction or stroke or TIA. Similar observations were recorded when limited to studies of first-degree heart block. Conclusions: Data from observational studies suggests a possible association between prolonged PR interval and significant increases in atrial fibrillation, heart failure and mortality. Future prospective studies are needed to confirm the relationships reported, consider possible mechanisms and define the optimal monitoring strategy for such patients

Hereditary complement factor I deficiency

Summary We describe four cases (from three families) of hereditary factor I deficiency, bringing the total number of cases now reported to 23. In one family there are two affected siblings: one has suffered recurrent pyogenic infections; the other is asymptomatic. In the second family, the patient had recurrent pyogenic infections and a self-limiting vasculitic illness; in the third family, the patient suffered recurrent pyogenic and neisserial infections. All four patients had markedly reduced concentrations of C3 in the serum (family 1 propositus: 28%; family 1 asymptomatic sibling: 15%; family 2: 31%; and family 3: 31 % normal human serum) which was in the form of C3b. Low lgG2 levels may occur in primary C3 deficiency, and reduction in lgG2 concentration to 1.14 g/l (normal: 1.30-5.90 g/l) was found in the patient from family 2. Using radioligand binding assays, we demonstrated increased binding of C3b to erythrocytes in a patient with factor I deficiency. This C3b could not be cleaved by autologous serum but could be cleaved by normal serum or purified factor I. We review and compare the published cases of C3, factor H and factor I deficienc

Production of metal-free diamond nanoparticles

In this paper, the controlled production of high-quality metal-free diamond nanoparticles is demonstrated. Milling with tempered steel is shown to leave behind iron oxide contamination which is difficult to remove. Milling with SiN alleviates this issue but generates more nondiamond carbon. Thus, the choice of milling materials is critically determined by the acceptable contaminants in the ultimate application. The removal of metal impurities, present in all commercially available nanoparticles, will open new possibilities toward the production of customized diamond nanoparticles, covering the most demanding quantum applications

Integrated Mapping of Establishment Risk for Emerging Vector-Borne Infections: A Case Study of Canine Leishmaniasis in Southwest France

BACKGROUND: Zoonotic visceral leishmaniasis is endemic in the Mediterranean Basin, where the dog is the main reservoir host. The disease's causative agent, Leishmania infantum, is transmitted by blood-feeding female sandflies. This paper reports an integrative study of canine leishmaniasis in a region of France spanning the southwest Massif Central and the northeast Pyrenees, where the vectors are the sandflies Phlebotomus ariasi and P. perniciosus. METHODS: Sandflies were sampled in 2005 using sticky traps placed uniformly over an area of approximately 100 by 150 km. High- and low-resolution satellite data for the area were combined to construct a model of the sandfly data, which was then used to predict sandfly abundance throughout the area on a pixel by pixel basis (resolution of c. 1 km). Using literature- and expert-derived estimates of other variables and parameters, a spatially explicit R(0) map for leishmaniasis was constructed within a Geographical Information System. R(0) is a measure of the risk of establishment of a disease in an area, and it also correlates with the amount of control needed to stop transmission. CONCLUSIONS: To our knowledge, this is the first analysis that combines a vector abundance prediction model, based on remotely-sensed variables measured at different levels of spatial resolution, with a fully mechanistic process-based temperature-dependent R(0) model. The resulting maps should be considered as proofs-of-principle rather than as ready-to-use risk maps, since validation is currently not possible. The described approach, based on integrating several modeling methods, provides a useful new set of tools for the study of the risk of outbreaks of vector-borne diseases

Better Health than Health Care: moving up, down and out

SUMMARY Promoting health is still widely equated with merely building up the health care system. Health services in Idcs, based on originally imported models, continue above all to benefit the elites, although the PHC approach emphasises equity. This article discusses three mechanisms, widely encouraged in theory but much less put into practice, which could help overcome such distortions: community participation, decentralisation and intersectoral collaboration. RESUMEN Preferible salud que atención de salud. Impulsar la participación comunitaria, la descentralización y la colaboración intersectorial La promoción de salud aún es ampliamente considerada como equivalente de la creación de un sistema de atención de salud. Los servicios de salud en los países en desarrollo, continúan privilegiando a las elites, pese a que el enfoque de la atención primaria de salud enfatiza la igualdad. Este artículo examina tres mecanismos — en teoría muy estimulados, pero escasamente puestos en práctica — que podrían contribuir a superar tales distorsiones: participación de la comunidad, descentralización y colaboración intersectorial. RESUMES Mieux vaut avoir la santé que se soigner La promotion de la santé n'est pas seulement une question de renforcer le système des soins médicaux. Les services médicaux dans les pays en voie de développement, basés sur des modèles d'origine importée, continuent, au dessus de tous, à faire bénéficier les élites, bien que l'assistance médicale primaire insiste sur l'équité. Cet article traite de trois mécanismes, largement encouragés en théorie, mais beaucoup moins essayés en pratique, qui pourraient aider à surmonter de telles distortions, à savoir — participation communautaire; décentralisation; collaboration intersectorale