Fibrous mastocytoma in a patient with generalized cutaneous mastocytosis

A 57-year-old woman with cutaneous mastocytosis of 23 years duration developed a hyperpigmented abdominal plaque composed of confluent indurated papules that enlarged for a period of 1 year to 12 x 8 cm. Biopsy showed dermal infiltration by closely packed spindle-shaped mast cells, fibroblasts, collagen, and scattered lymphocytes, predominantly T-suppressor cells. Electron microscopy showed close contact between mast cells, fibroblasts, and lymphocytes. Piecemeal mast cell degranulation and extrusion of mast cell granules was seen, with rare mast cell granules in fibroblasts, and collagen fibers in peripheral and perinuclear endoplasmic reticulum of mast cells. the term Fibrous mastocytoma is suggested for this tumor-like dermal fibrosis, possibly induced by lymphokines.     

Association of Opioid Use Disorder With 2016 Presidential Voting Patterns: Cross-sectional Study in New York State at Census Tract Level

BackgroundOpioid overdose-related deaths have increased dramatically in recent years. Combating the opioid epidemic requires better understanding of the epidemiology of opioid poisoning (OP) and opioid use disorder (OUD).ObjectiveWe aimed to discover geospatial patterns in nonmedical opioid use and its correlations with demographic features related to despair and economic hardship, most notably the US presidential voting patterns in 2016 at census tract level in New York State.MethodsThis cross-sectional analysis used data from New York Statewide Planning and Research Cooperative System claims data and the presidential voting results of 2016 in New York State from the Harvard Election Data Archive. We included 63,958 patients who had at least one OUD diagnosis between 2010 and 2016 and 36,004 patients with at least one OP diagnosis between 2012 and 2016. Geospatial mappings were created to compare areas of New York in OUD rates and presidential voting patterns. A multiple regression model examines the extent that certain factors explain OUD rate variation.ResultsSeveral areas shared similar patterns of OUD rates and Republican vote: census tracts in western New York, central New York, and Suffolk County. The correlation between OUD rates and the Republican vote was .38 (P<.001). The regression model with census tract level of demographic and socioeconomic factors explains 30% of the variance in OUD rates, with disability and Republican vote as the most significant predictors.ConclusionsAt the census tract level, OUD rates were positively correlated with Republican support in the 2016 presidential election, disability, unemployment, and unmarried status. Socioeconomic and demographic despair-related features explain a large portion of the association between the Republican vote and OUD. Together, these findings underscore the importance of socioeconomic interventions in combating the opioid epidemic.     

Managing access to primary care clinics using scheduling templates

Health Care Management Science - An important challenge confronting healthcare is the effective management of access to primary care. Appointment scheduling policies/templates can help strike an...     

Twenty consecutive cases of endograft repair of traumatic aortic disruption: lessons learned

OBJECTIVES: Endograft repair holds considerable promise in the treatment of traumatic disruption of the thoracic aorta because patients often have multiple coexisting injuries further complicating traditional open repair. In addition, patients are often young, with an aortic anatomy dissimilar to those with atherosclerotic aneurysms. As a result, techniques for endograft repair have to be refined accordingly. METHODS: The records of 20 consecutive cases of traumatic aortic disruption treated by endograft repair at a single institution were reviewed. RESULTS: Mean patient age was 40 years (range, 17 to 88 years), and 17 (85%) of 20 patients were men. All cases were completed. There were no procedure related deaths, but four (20%) patients died of their co-injuries. Only two (10%) of 20 required a graft >28 mm in diameter, and nine (45%) aortas were small enough to require use of 23-mm abdominal cuffs. Six (30%) of 20 cases required complete or partial coverage of the left subclavian artery. Placement of a proximal extension was required in one patient for a type I endoleak. A graft collapse occurred in one patient that required surgical removal and aortic repair. CONCLUSIONS: Endovascular repair of traumatic aortic disruption can be accomplished in most cases. Compared with atherosclerotic aneurysms, the proximal thoracic aorta tends to be smaller and the arch angle tighter in an aorta 19mm in diameter. This frequently necessitates the use of smaller devices and less stiff wires. Surgeons should be prepared to cover the left subclavian artery if needed, have a wide range of device sizes in stock to avoid over-sizing, and show restraint if the anatomy appears unsuitable.     

A computer model for evaluating the osteotomy parameters of Chiari pelvic osteotomy

This study was conducted to evaluate the effect of the various osteotomy parameters on the biomechanical aspects of the hip joint on a computerised model. The data of the radiographs and a three-dimensional (3D) CT scan of six patients with coverage deficient hip joint were used to construct a 3D computer model. Then Chiari type osteotomies were simulated using various heights, angles and fibrocartilage thicknesses. A new angle called the mid acetabular center edge (MACE) angle was defined in a mid coronal CT cut. The optimum displacement for obtaining the maximum coverage averaged 73%. The angle and height of the osteotomy had a significant effect on the MACE angle (P value < 0.01). Our findings of these Chiari parameters may change the results of the osteotomy. The probability of adapting the proximal osteotomy segment to a deformed femoral head was explained by the model and a modified osteotomy “multiple height osteotomy” was proposed.     

Reconstruction of Chest Wall Using a Two-Layer Prolene Mesh and Bone Cement Sandwich

Wide surgical resection is the most effective treatment for the vast majority of chest wall tumors. This study evaluated the clinical success of chest wall reconstruction using a Prolene mesh and bone cement prosthetic sandwich. The records of all patients undergoing chest wall resection and reconstruction were reviewed. Surgical indications, the location and size of the chest wall defect, diaphragm resection, pulmonary performance, postoperative complications, and survival of each patient were recorded. From 1998 to 2008, 43 patients (27 male, 16 female; mean age of 48 years) underwent surgery in our department to treat malignant chest wall tumors: chondrosarcoma (23), osteosarcoma (8), spindle cell sarcoma (6), Ewing''s sarcoma (2), and others (4). Nine sternectomies and 34 antero-lateral and postero-lateral chest wall resections were performed. Postoperatively, nine patients experienced respiratory complications, and one patient died because of respiratory failure. The overall 4-year survival rate was 60 %. Chest wall reconstruction using a Prolene mesh and bone cement prosthetic sandwich is a safe and effective surgical procedure for major chest wall defects.     

LigaSure在阴式子宫切除术中的应用

目的探讨LigaSure在阴式子宫切除术中的临床应用效果。方法2007年1月～2008年1月,应用LigaSure行阴式子宫全切术200例。子宫肌瘤86例,子宫增大如孕10～14周;子宫腺肌病73例,子宫增大如孕8～11周;宫颈上皮内瘤变Ⅲ级10例;子宫脱垂Ⅱ～Ⅲ度15例;子宫内膜不典型增生6例;功能失调性子宫出血10例。用LigaSure钳夹、电凝、切断骶韧带、主韧带、子宫血管、圆韧带、输卵管及卵巢固有韧带。结果200例手术全部顺利完成。手术时间20～50min,术中出血量15～150ml,术后住院时间3～5d,无严重并发症发生。200例均术后3个月复诊,检查阴道残端无线头及肉芽组织生成,愈合良好。结论应用LigaSure行阴式子宫切除术,手术操作步骤简化,手术难度系数降低,手术时间短,术中出血少。     

观察不同温度下停循环选择性脑灌注在急性I期Stanford A型主动脉夹层中的应用效果

目的观察不同温度下停循环选择性脑灌注在急性I型Stanford A型主动脉夹层中的应用效果。方法以2010年10月至2019年1月在该院就诊的51例进行急性I型Stanford A型主动脉夹层手术的患者为研究对象,根据手术温度差异将患者分为A组(18~22℃,20例)和B组(23~28℃,31例),观察两组患者手术过程中和术后情况。结果B组患者的体外循环时间、主动脉阻断时间、深低温停循环时间、术中出血量及总住院时间均比A组降低(P<0.05),术后永久性神经损伤的发生情况减少(P<0.05)。结论急性I型Stanford A型主动脉夹层术中停循环选择性脑灌注时的不同温度,中低温(23~28℃)显示出更少体外循环机工作时间和术后永久性神经损伤的发生情况,提高手术安全性。     

Inkjet printing and UV-LED curing of photochromic dyes for functional and smart textile applications

Health concerns as a result of harmful UV-rays drive the development of UV-sensors of different kinds. In this research, a UV-responsive smart textile is produced by inkjet printing and UV-LED curing of a specifically designed photochromic ink on PET fabric. This paper focuses on tuning and characterizing the colour performance of a photochromic dye embedded in a UV-curable ink resin. The influence of industrial fabrication parameters on the crosslinking density of the UV-resin and hence on the colour kinetics is investigated. A lower crosslinking density of the UV-resin increases the kinetic switching speed of the photochromic dye molecules upon isomerization. By introducing an extended kinetic model, which defines rate constants k_colouration, k_decay and k_{decolouration}, the colour performance of photochromic textiles can be predicted. Fabrication parameters present a flexible and fast alternative to polymer conjugation to control kinetics of photochromic dyes in a resin. In particular, industrial fabrication parameters during printing and curing of the photochromic ink are used to set the colour yield, colouration/decolouration rates and the durability, which are important characteristics towards the development of a UV-sensor for smart textile applications.

Tuned performance of an inkjet-printed and UV-LED cured smart textile UV-sensor based on a photochromic dye using fabrication parameters.