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AIMS: This study concentrates on microbiological data collection of deep sternal wounds to delineate early and correct antibiotic therapy. BACKGROUND: Deep sternal wound infection, mediastinitis and sternal osteomyelitis are devastating and life-threatening complications of median-sternotomy incisions after cardiac surgical procedures. The incidence of surgical wound infection in sternotomies should be similar to that in any clean surgical procedure (i.e. approximately 2%). Nonetheless, the infection rates are higher among heart disease patients, due to the fact that these patients are burdened with a high number of risk factors in comparison with the general population. RESULTS: In line with other publications, the most commonly cultured organism from deep sternal wound and blood cultures was found to be Staphylococcus. In comparison, the most commonly cultured Gram-negative organisms were Pseudomonas and all gram-negative organisms combined together represented approximately 50% of all cultures. Three dominant organisms were isolated from wound and blood cultures: Staphylococcus, Pseudomonas and Acinetobacter. We found that 40% of blood cultures were identical to prior wound cultures, in comparison to 30% of bone cultures. Furthermore, 20% of the organisms isolated from the wound and 13% of the organisms isolated from the bone later on cross over to involve the blood. CONCLUSIONS: Empiric antibiotic regimen should be broad spectrum and cover both gram-positive as well as gramnegative organisms. We demonstrate that antibiotic regimen during sepsis may rely partially on preliminary wound cultures. Furthermore, antibiotic treatment for a relatively short period of two weeks is adequate, alongside thorough surgical revision with debridement of all foreign bodies, and reconstruction with vascularized soft tissue flap (pectoral major).

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Systemic growth and branching stimuli, and appropriate interactions with the host stroma are essential for the development of foreign epithelia in the mammary gland of immunodeficient mice. These factors were manipulated to promote and investigate the generation of representative bovine epithelial morphology in the transplanted mouse mammary stroma. The bovine mammary epithelium is unique in its commitment to rapid proliferation and high rate of differentiation. Its morphological organization within a fibrotic stroma resembles that of the human breast, and differs significantly from the rudimentary ductal network that penetrates a fatty stroma in mice. Transplantation of bovine mammary epithelial cells into the cleared mammary fat pad of NOD-SCID mice led to continuous growth of epithelial structures. Multilayered hollow spheres developed within fibrotic areas, but in contrast to mice, no epithelial organization was formed between adipocytes. The multilayered spheres shared characteristics with the heifer gland's epithelium, including lumen size, cell proliferation, cytokeratin orientation, estrogen/progesterone receptor expression and localization, and milk protein synthesis. However, they did not extend into the mouse fat pad via ductal morphology. Pre-transplantation of fibroblasts increased the number of spheres, but did not promote extension of bovine morphology. The bovine cells preserved their fate and rarely participated in chimeric mouse-bovine outgrowths. Nevertheless, a single case of terminal ductal lobuloalveolar unit (TDLU) development was recorded in mice treated with estrogen and progesterone, implying the feasibility of this representative bovine morphology's development. In vitro extension of these studies revealed paracrine inhibition of bovine epithelial mammosphere development by adipocytes, which was also generalized to breast epithelial mammosphere formation. The rescue of mammosphere development by fibroblast growth factor administration evidences an active equilibrium between inhibitory and supportive effects exerted by the adipose and fibrotic regions of the stroma, respectively, which determines the development of foreign epithelium.

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INTRODUCTION: Patient demand for non-surgical, non-invasive, and no-downtime wrinkle reduction treatment procedures has grown dramatically over the past decade as new treatments and technologies have been introduced. This study was performed in order to evaluate the safety and efficacy of the TriPollar radiofrequency (RF) technology and intended for wrinkle reduction treatment. METHODS: Thirty-seven Subjects were recruited in two sites and were treated for the reduction of facial wrinkles and rhytides and followed for 3 months after the last treatment. The safety of using the TriPollar system was established by the physicians' assessments and observations of adverse events after each treatment. To evaluate treatment efficacy, pre- and post-treatment photos were assessed using a blinded evaluation by two uninvolved physicians. RESULTS: No unexpected adverse side effects were detected or reported. All subjects participating in the study reported no pain or mild pain during the treatments. The photographic analysis of pre- and post-treatment by the two blinded physicians revealed improvement (downgrade of at least 1 score according to the Fitzpatrick scale) in 94% (according to first reviewer) and 97% (according to second reviewer) of study subjects. All patients (100%) were satisfied from treatment results to a different extent. CONCLUSIONS: The results of this study clearly indicate that the TriPollar system offers a non-invasive, effective, safe and virtually painless wrinkle and rhytides reduction treatment.

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Basal cell carcinoma (BCC) is the most common skin tumor in Caucasians. Loss of heterozygosity (LOH) of chromosome 9 (9q22.3) is common in BCCs, and indirectly implies their monoclonal origin. Although BCCs are considered monoclonal tumors, the clonal origin of anatomically distinct tumors in the same patient was rarely investigated. Forty-one anatomically distinct BCCs from 15 female patients were genotyped for LOH at chromosome 9q22.3, and the inactivation pattern of X-chromosome using the androgen receptor polymorphic site. Overall, 11 women with 30 tumors were heterozygous (informative) with either one of the two 9q markers or the androgen receptor polymorphism. LOH of 9q was detected in 20 tumors from seven patients, and in all tumors derived from the same patient, the same allele was lost. An identical X-chromosome inactivation pattern was noted in all four tumors taken from one patient, and in another informative patient, one tumor demonstrated LOH and the other retained it. In five tumors from two patients, there was no evidence of monoclonality using either technique. We conclude that the majority of anatomically distinct BCCs are monoclonal neoplasms and may represent expansion of the same clone.

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UNLABELLED: Coronary revascularization reduces cardiac complications associated with noncardiac surgery in patients with severe coronary disease. However, patients undergoing emergency noncardiac surgery soon after coronary bypass operations may still be vulnerable to ischemic myocardial events. We prospectively evaluated the incidence of myocardial ischemia in 82 consecutive patents scheduled for sternectomy in the first (Group 1; 35 patients) or second (Group 2; 47 patients) week after coronary artery bypass graft (CABG) surgery. The interval between CABG surgery and sternectomy in Groups 1 and 2 was 6 days (range, 4-7 days) and 11 days (range, 8-14 days), respectively. Electrocardiographic (ECG) changes consistent with myocardial ischemia were assessed with a two-channel Holter system for 48 h. There were no between-group differences in updated Acute Physiology and Chronic Health Evaluation score, use of beta-blockers, or perioperative hemodynamic changes. The incidence of ECG changes consistent with myocardial ischemia was fivefold more frequent in Group 1 (22.85% versus 4.25%; P < 0.05). Of the ischemic patients in Group 1, 25% experienced a perioperative acute myocardial infarction (one was fatal). There were no infarcts in Group 2. Thus, patients appear to be prone to coronary events during sternectomy performed early after CABG surgery. Although the incidence of ischemia did not differ from that previously reported after CABG surgery alone, further investigation is required to determine whether the findings obtained in this high-risk population are generalizable to patients undergoing noncardiac surgery soon after uneventful CABG surgery. IMPLICATIONS: This study demonstrates an increased incidence of myocardial ischemia when sternectomy for mediastinitis is performed within one week of coronary artery bypass graft surgery, and this ischemia is associated with a 25% incidence of myocardial infarction.

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