Challenges in heart transplantation: now and the future

Little more than 30 years after the first human operation, heart transplantation continues to be the gold standard treatment for heart failure disease. During these years, surgical procedures and immunosuppressive treatment have improved and the survival rate continues to improve despite transplanting older and sicker patients. However, there are still many challenges that we are currently facing. Regarding organ shortage, donor heart acceptance criteria have been reconsidered. Better donor management could increase the organ pool, maximizing the use of hearts recovered from cadaveric donors. Concerning organ allocation, recent improvements in medical treatment could restrict transplantation procedures to the patients at greatest risk of dying. Controlling allograft rejection, vasculopathy, and malignancies are current challenges. Cyclosporine, azathioprine, and corticosteroids have been the mainstay of immunosuppression, but carry severe adverse systemic effects. Today, new pharmacologic agents have become available and hold the possibility to improve the length and quality of recipient life.     

Hair transplantation producing arteriovenous fistulization

Arteriovenous fistula formation is a rare complication of the punch graft technique of hair transplantation. This report describes a large donor site arteriovenous fistula that was clearly demonstrated on arteriography. Operative correction was guided by precise directional Doppler ultrasound localization of the fistulous communication, thus avoiding a large disfiguring incision. Supported in part by the Conrad Jobst Foundation, the Seabury Foundation and the Northwestern Vascular Foundation.     

Minimally invasive surgical training: Challenges and solutions

Treatment options for urological malignancies continue to increase and include endoscopic, laparoscopic, robotic, and image-guided percutaneous techniques. This ever expanding array of technically demanding management options coupled with a static training paradigm introduces challenges to training the urological oncologist of the future. Minimally invasive learning opportunities continue to evolve, and include an intensive experience during residency, postgraduate short courses or mini-apprenticeships, and full time fellowship programs. Incorporation of large animal surgery and surgical simulators may help shorten the necessary learning curve. Ultimately, programs must provide an intense hands-on experience to trainees in all minimally invasive surgical aspects for optimal training.     

Surgical considerations in infant lung transplantation: Challenges and opportunities

Lung transplantation is a crucial component in the treatment of end-stage lung disease in infants. Traditionally, most lung transplants have been performed in older children and adults, resulting in a scarcity of data for infant patients. To address the challenges unique to this age group, novel strategies to provide the best preoperative, intraoperative, and postoperative care for these youngest patients are paramount. We review recent advances in bridge-to-transplantation therapy, including the use of a paracorporeal lung assist device, and differences in surgical technique, including bronchial artery revascularization, for incorporation into the overarching treatment strategy for infants undergoing lung transplantation.     

瘢痕上自体毛发移植782例

目的 运用自体毛发移植术将头发毛胚在头部瘢痕上进行移植。观察在瘢痕上头发移植的特点及移植后的效果。方法 1998～2002年对782例因不同原因引起头部瘢痕的患者运用自体毛发移植术进行修复。结果 移植的头发均生长良好。但因形成瘢痕原因的不同，所造成的瘢痕深度的不同和血运状态的不同，引起头发生长的速度及状态亦不同。结论 自体毛发移植术可以应用于头部瘢痕性脱发的修复，对感染、烫伤及火轻中度烧伤而引起的瘢痕均可实施手术，且术后效果均较理想；对于头皮撕脱伤、电击伤及火深度烧伤者，手术后，头发生长速度较慢。     

Challenges of organ transplantation

Organ transplantation has developed in the past 50 years from a primitive therapeutic attempt to an accepted and much sought after form of treatment. During the same period, bone marrow transplantation, a form of cell transplantation, also has become established with similar successes provided the donor and recipient are well matched. The next challenges in transplantation are to overcome the donor shortage and to devise new ways of treating diseases that at present have unsuccessful management. The transplantation of cells programmed to produce essential proteins is an important goal, especially if the cells were autologous, for example, adult stem cells persuaded to produce insulin and act as surrogate beta cells. In this short article, I have reviewed some of the progress and difficulties of cell transplantation, which is currently a popular and intense area of research worldwide.     

Challenges after pediatric transplantation

In this review we address the current challenges facing the pediatric transplant caregiver. We focus most of our discussion on recent developments that have resulted in improved graft survival in renal allograft recipients. We discuss the issue of growth failure posttransplant and the realization that it is time to reassess strategies that optimize the immunosuppression and growth after pediatric transplantation. Lastly, we discuss some recent findings suggesting that these issues are also of critical importance for success after pediatric liver transplantation.     

Challenges in pulmonary fibrosis: 7--Novel therapies and lung transplantation

The spectrum of diseases collectively known as pulmonary fibrosis does not have reliable therapeutic options. Many treatment protocols have been the subject of clinical trials, resulting in few significant improvements in outcome. Recently, cellular mechanisms have been the focus of investigations in progenitor cell studies, suggesting an immunomodulatory role for mesenchymal stem cells. The possible role of fibrogenic cytokines and the use of antagonist molecules are promising for future therapies. A range of anti-inflammatory treatments, including macrolide antibiotics, may also hold promise. When medical therapy has been unsuccessful in altering the course of the disease, lung transplantation may offer a significant survival advantage. Improvement in pre-transplant assessment and postoperative care, combined with more effective immunosuppressive regimes, has seen survival rates of 40% after 5 years. New options for therapy will lead to improved survival in coming years.     

Hair transplantation for male pattern baldness: aesthetic considerations and current status

The multiple punch technique of hair transplantation, utilizing the principle of donor dominance, has proven to be a cosmetically acceptable procedure in properly selected patients in the presenter's 24-year experience. Careful planning with attention to aesthetic principles, especially in frontal hairline placement, in donor site selection and with regard to the ratio between the donor supply and the existing or potential future extent of baldness, together with meticulous surgical technique, are essential for satisfactory results. Scalp reduction, in which bald areas of crown and midscalp are serially excised, with extensive subgaleal undermining is a highly useful adjunct to grafting in many patients with moderately extensive male pattern baldness who have adequate scalp mobility by enabling the available donor supply to be concentrated and thus provide more effective coverage in the frontal scalp.     

Hair transplantation in women: A practical new classification system and review of technique

Alopecia in women is often overlooked as a major cosmetic problem. For women with hair loss, the psychological effects are often more severe than for men. Advances in modern hair transplantation have allowed successful hair restoration in many cases of female alopecia that might not have been possible to treat with older techniques. A classification of female hair loss patterns into 5 different categories is proposed. On the basis of these categories, a variety of techniques are demonstrated to restore alopecia. Careful preoperative patient evaluation, including analysis of the donor and recipient features, is emphasized. In addition, women's psychological reactions to hair loss and the expectations for hair restoration are discussed. (Aesthetic Surg J 2002;22:247-259.)     

Global road traffic injury statistics: Challenges, mechanisms and solutions

High-quality data are the foundation to monitor the progress and evaluate the effects of road traffic injury prevention measures. Unfortunately, official road traffic injury statistics delivered by governments worldwide, are often believed somewhat unreliable and invalid. We summarized the reported problems concerning the road traffic injury statistics through systematically searching and reviewing the literature.The problems include absence of regular data, under-reporting, low specificity, distorted cause spectrum of road traffic injury, inconsistency, inaccessibility, and delay of data release. We also explored the mechanisms behind the problematic data and proposed the solutions to the addressed challenges for road traffic statistics.     

Methods to Overcome Poor Response and Challenges of Facial Laser Hair Reduction

Unwanted facial hair is a relatively common problem that can be emotionally distressing. Laser hair reduction has become the treatment of choice for removal of facial hair, replacing more traditional methods of hair removal. To achieve maximum treatment efficacy while minimizing side effects, clinicians must practice proper patient selection and counseling, proper laser procedure, and posttreatment care. The treatment parameters should be individualized for each patient depending on various factors. A favorable treatment outcome depends on three major factors: proper patient selection, use of a suitable laser system, and an experienced laser operator. The aim of this article is to review the factors responsible for possible poor outcomes of laser hair reduction in the facial area and to describe steps that should be followed to minimize side effects and enhance results following facial hair reduction by laser.     

Dealing with heterogeneous populations in randomized wound trials: Challenges and potential solutions

Chronic wounds have a great variety of etiologies and manifestations that influence wound healing. Such heterogeneity potentially threatens the validity and clinical usefulness of trials if not considered appropriately. In 82 randomized wound trials retrieved from 10 Cochrane reviews, we assessed if and how authors considered wound and other prognostically important characteristics in the conduct and analysis of wound trials. We assessed whether these characteristics were discussed, reflected in the eligibility criteria, used for prestratification or for adjustments to ensure comparability of treatment groups, and whether subgroup analyses were conducted to identify heterogeneity of treatment effects. Nine percent of all trials explicitly discussed characteristics that influence wound healing in the introduction and 43% in the Discussion section. Ninety percent of trials had at least one prognostically important characteristic as eligibility criterion. Only 11% of trials used prestratification, and 6% adjusted the results for imbalances between treatment groups. Twenty‐seven percent performed subgroup analyses with prognostically important characteristics defining subgroups. Chronic wound trials use simple randomization, but rarely adapt the study design and analysis to take the heterogeneity of patients into consideration. Collaborative multicenter trials would overcome many of the limitations and provide statistical power to detect important treatment effects both overall and in subgroups.