Foreign body granulomas after injection of Bio-alcamid for lip augmentation

Bio-alcamid is one of the newest agents on the market for soft tissue augmentation. Seven studies were documented in the medical literature that examined the safety of Bio-alcamid (Polymekon, Brindisy, Italy); all reported no cases of tissue migration, foreign body granulomas, allergenicity, or interference with the control of cell proliferation. On 2 separate occasions, a woman who had recently undergone lip augmentation presented at our hospital with submucosal nodules of the lip. Histologic examination revealed multiple foreign body–type granulomas composed of giant cells, epithelioid cells, and chronic inflammation of the lip. Efforts to produce a cosmetic material that fulfills all the criteria as an “ideal” agent has not yet been found because all injectable foreign agents have the potential to induce adverse reactions. Caution must be exercised in all cases and the risks explained to the patient before its use.     

Das Image der haus?rztlichen Profession in einer sich wandelnden Gesellschaft

Zusammenfassung Hintergrund und Ziel:   Mit einem – je nach Region – bereits bestehenden oder prognostizierten Mangel an Haus?rzten steht die Gesundheitsversorgung in Deutschland vor einem ernsthaften Problem. Neben den politischen Rahmenbedingungen und Problemen der Aus-/Weiterbildung beeinflussen gesellschaftliche Wandlungsprozesse die Attraktivit?t der haus?rztlichen T?tigkeit und somit auch die Nachwuchsentwicklung. Ziel dieser Studie war es zu untersuchen, welches Image aus Sicht der Haus?rzte über ihre Profession existiert und in welcher Weise soziale Ver?nderungsprozesse das haus?rztliche Image beeinflussen. Methodik:   Es wurden Interviews mit 16 Haus?rzten geführt. Die Auswertung erfolgt inhaltsanalytisch mit dem Computerprogramm Atlas.ti. Ergebnisse:   Aus haus?rztlicher Perspektive besteht bei Menschen aus l?ndlichen Regionen und der ?lteren Generation ein positives Image, w?hrend bei der jüngeren Generation und Menschen aus dem st?dtischen Gebiet ein zunehmend negatives Image von Haus?rzten zu finden ist. Das Image wird aus Sicht der Haus?rzte durch folgende gesellschaftliche Wandlungsprozesse beeinflusst: abnehmende soziale Kompetenz, nachlassende Verbindlichkeit und Verantwortung, zunehmende Technisierung, Spezialisierung statt Generalisierung, zunehmende Distanz zu Krankheiten und Erkrankten sowie eine steigende Flexibilit?t. Schlussfolgerung:   Da insbesondere jüngere Menschen ein negatives Bild von Haus?rzten haben und Jungmediziner dieser Zielgruppe angeh?ren, besteht die Gefahr, dass das Fach Allgemeinmedizin wenig attraktiv auf den Nachwuchs wirkt und daher selten als erstrebenswerte berufliche Zukunftsperspektive gesehen wird. Gesellschaftliche Wandlungsprozesse, die einen Einfluss auf die Berufswahl haben, sollten als wichtige Anknüpfungspunkte für die Entwicklung von L?sungsans?tzen gegen den haus?rztlichen Nachwuchsmangel Berücksichtigung finden.      

PINCH1 regulates Akt1 activation and enhances radioresistance by inhibiting PP1α

Tumor cell resistance to ionizing radiation and chemotherapy is a major obstacle in cancer therapy. One factor contributing to this is integrin-mediated adhesion to ECM. The adapter protein particularly interesting new cysteine-histidine-rich 1 (PINCH1) is recruited to integrin adhesion sites and promotes cell survival, but the mechanisms underlying this effect are not well understood. Here we have shown that PINCH1 is expressed at elevated levels in human tumors of diverse origins relative to normal tissue. Furthermore, PINCH1 promoted cell survival upon treatment with ionizing radiation in vitro and in vivo by perpetuating Akt1 phosphorylation and activity. Mechanistically, PINCH1 was found to directly bind to protein phosphatase 1α (PP1α) — an Akt1-regulating protein — and inhibit PP1α activity, resulting in increased Akt1 phosphorylation and enhanced radioresistance. Thus, our data suggest that targeting signaling molecules such as PINCH1 that function downstream of focal adhesions (the complexes that mediate tumor cell adhesion to ECM) may overcome radio- and chemoresistance, providing new therapeutic approaches for cancer.     

Three-dimensional power Doppler ultrasound in ovarian cancer and its correlation with histology

Purpose  

The aim of this study was to evaluate and quantify intraovarian blood flow with 3D power Doppler histogram analysis before surgical intervention in women suspected of having ovarian carcinoma and to determine the correlation with histology findings.     

Clinicians' experiences of participating in an action research study

The objective of this paper is to share our experiences of participating in an action research project designed to improve the care of older people at risk of delirium. The setting for the study and the subject of this paper was a busy medical ward in a 550 bed regional tertiary referral hospital located in New South Wales, Australia. The participants for the project and the authors of this paper include clinical nursing and allied health staff based on the ward at the time of the study. In the discussion that follows we outline details of the study, participatory action research (PAR), what we were asked to do to participate, our reasons for agreeing to participate, our expectations of the project, the group process, the PAR cycles: look, think and act, and the benefits and challenges of participating in the project. In conclusion we highlight the gains of participating in PAR and we make recommendations for the future.     

How do hypertrophic cardiomyopathy mutations affect myocardial function in carriers with normal wall thickness? Assessment with cardiovascular magnetic resonance

Background

Clinical data on myocardial function in HCM mutation carriers (carriers) is sparse but suggests that subtle functional abnormalities can be measured with tissue Doppler imaging before the development of overt hypertrophy. We aimed to confirm the presence of functional abnormalities using cardiovascular magnetic resonance (CMR), and to investigate if sensitive functional assessment could be employed to identify carriers.

Results

28 carriers and 28 controls were studied. Global left atrial (LA) and left ventricular (LV) dimensions, segmental peak systolic circumferential strain (SCS) and peak diastolic circumferential strain rate (DCSR), as well as the presence of late Gadolinium enhancement (LGE) were determined with CMR. Septal and lateral myocardial velocities were measured with echocardiographic tissue Doppler imaging. lv mass and volumes were comparable between groups. Maximal septal to lateral wall thickness ratio (SL ratio) was larger in carriers than in controls (1.3 ± 0.2 versus 1.1 ± 0.1, p < 0.001). Also, LA volumes were larger in carriers compared to controls (p < 0.05). Both peak SCS (p < 0.05) and peak DCSR (p < 0.01) were lower in carriers compared to controls, particularly in the basal lateral wall. Focal LGE was present in 2 carriers and not in controls. The combination of a SL ratio >1.2 and a peak DCSR <105%.s^-1 was present in 45% of carriers and in none of the controls, yielding a positive predictive value of 100%. Two carriers and 18 controls had a SL ratio < 1.2 and peak DCSR >105%.s^-1, yielding a negative predictive value of 90%. With multivariate analysis, HCM mutation carriership was an independent determinant of reduced peak SCS and peak DCSR.

Conclusions

HCM mutation carriership is an independent determinant of reduced peak SCS and peak DCSR when LV wall thickness is within normal limits, and is associated with increased LA volumes and SL ratio. Using SL ratio and peak DCSR has a high accuracy to identify carriers. However, since carriers also display structural abnormalities and focal LGE, we advocate to also evaluate morphology and presence of LGE when screening for carriers.     

Measuring organizational attributes in primary care: a validation study in Germany

Objective Models for the structured delivery of care rely on organizational attributes of practice teams. The Survey of Organizational Attributes for Primary Care (SOAPC) is known to be a valid instrument to measure this aspect in the primary care setting. The aim of this study was to determine the validity of a translated and culturally adapted German version of the SOAPC. Methods The SOAPC was translated and culturally adapted according to established standards. The external validity of the German SOAPC was assessed using the German version of the Warr‐Cook‐Wall scale. A total of 200 practices randomly selected from a conference database were asked to participate in the validation study. Practice, clinicians and staff characteristics were determined via short‐form questionnaires. We used standardized statistical procedures to reveal the psychometric properties of the SOAPC. Results A total of 54 practice teams participated by returning 297 completed questionnaires (297/425, response rate 69.8%). All four domains of the SOAPC (communication, decision making, stress/chaos, history of change) could be approved by factor analysis. Internal consistency is underlined by a Cronbach's alpha of 0.70 or higher in all categories. We show strong correlation with the Warr‐Cook‐Wall scale in all corresponding categories indexing high external validity. Conclusions The German SOAPC is a reliable and valid instrument for the assessment of organizational attributes of practice teams as the providers of quality of care. Moreover, the tool makes it possible to map the state of implementation of quality management and practice organization. The availability of the German SOAPC encourages further research on this topic in German‐speaking countries.