DSpace Collection:https://hdl.handle.net/10171/189102024-03-29T13:04:01Z2024-03-29T13:04:01ZBreast implant capsule: A murine model comparing capsular contracture susceptibility among six breast implants available in the markethttps://hdl.handle.net/10171/687952024-02-12T06:06:26Z2023-01-01T00:00:00ZTitle: Breast implant capsule: A murine model comparing capsular contracture susceptibility among six breast implants available in the market
Abstract: Background
Breast implant capsule development and behavior are mainly determined by implant surface combined with other external factors such as intraoperative contamination, radiation or concomitant pharmacologic treatment. Thus, there are several diseases: capsular contracture, breast implant illness or Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), that have been correlated with the specific type of implant placed. This is the first study to compare all major implant and texture models available in the market on the development and behave of the capsules. Through a histopathological analysis, we compared the behavior of different implant surfaces and how different cellular and histological properties give rise to different susceptibilities to develop capsular contracture among these devices.
Methods
A total of 48 Wistar female rats were used to implant 6 different types of breast implants. Mentor®, McGhan®, Polytech polyurethane®, Xtralane®, Motiva® and Natrelle Smooth® implants were employed; 20 rats received Motiva®, Xtralane® and Polytech polyurethane®, and 28 rats received Mentor®, McGhan® and Natrelle Smooth® implants. The capsules were removed five weeks after the implants placement. Further histological analysis compared capsule composition, collagen density and cellularity.
Results
High texturization implants showed the highest levels of collagen and cellularity along the capsule. However, polyurethane implants capsules behaved differently regarding capsule composition, with the thickest capsules but fewer collagen and myofibroblasts than expected, despite being generally considered as a macrotexturized implant. Nanotextured implants and microtextured implants histological findings showed similar characteristics and less susceptibility to develop a capsular contracture compared with smooth implants.
Conclusions
This study shows the relevance of the breast implant surface on the definitive capsules’ development, since this is one of the most differentiated factors that determine the incidence of capsular contracture and probably other diseases like BIA-ALCL. A correlation of these findings with clinical cases will help to unify implant classification criteria based on their shell and their estimated incidence of capsule-associated pathologies. Up to this point, the establishment of additional groups is recommended as nanotexturized implants seem to behave differently to pure smooth surfaces and polyurethane implants present diverse features from macro- or microtextured implants.
No Level Assigned
This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors2023-01-01T00:00:00ZPneumatocele formation following COVID-19 pneumoniahttps://hdl.handle.net/10171/667972024-02-06T11:11:16Z2023-01-01T00:00:00ZTitle: Pneumatocele formation following COVID-19 pneumonia
Abstract: A 61-year-old man with no significant medical history presented to the emergency department with worsening dyspnea a week after close con-tact with someonewhohad COVID-19. Hewas unvaccinated. He washypoxemic, and the chest radiograph showed bilateralopacities consistent withCOVID-19 pneumonia and tested positive for RNA from SARS-CoV-2. Blood tests showed raised inflammatory markers. Computed tomography (CT)of the chest demonstrated bilateralground-glass opacities. Thepatient washospitalized andtreated with high-flow nasaloxygentherapy, dexameth-asone, and sarilumab. His clinical status improved, and hewas discharged home after 1 week of hospitalization.Three weekslater, hepresented againwith worsening dyspnea, fever, and pleuritic chest pain. A CT pulmonary angiography ruled out pulmonary embolism (Fig. 1A, B) but demonstrated athin-walled cystic lesion with an air–fluid level (Fig. 1A, arrowheads) that suggested an infected pneumatocele. The patient was managed conserva-tively with amoxicillin/clavulanic acid for 3 weeks. During the follow-up, the patient reported the disappearance of symptomatology.2023-01-01T00:00:00ZGeneralized erythematous scaly rash after glucocorticoidshttps://hdl.handle.net/10171/664192023-06-05T05:10:04Z2022-01-01T00:00:00ZTitle: Generalized erythematous scaly rash after glucocorticoids
Abstract: A 65-years-old woman with a medical history of idiopathic throm-
bocytopenic purpura and psoriasis in treatment with topical glucocor-
ticoids presented with a three-month history of burning, generalized
erythematous, scaly rash, and chills. A few weeks before the rash, the
patient presented petechiae on her thighs due to a low platelet count
(28.000 platelets per microliter), for which she started treatment with
prednisone 25 mg/week. The rash was initially treated with topical
ointments including clobetasol, urea, salicylic acid, ammonium lactate,
and propylene glycol without improvement. The physical examination
showed generalized erythroderma (Fig. 1A) from neck to feet (Fig. 1B),
with thick silvery desquamation respecting the face and back of the legs
(Fig. 1C), involving more than 90% of the patient’s body surface area
and erythematous scaly plaques on the scalp. Laboratory test results
were normal. A punch biopsy specimen obtained from an arm area
showed increased keratinization at the level of the corneal layer with
compact parakeratosis with abundant polymorphonuclear cells. The
epidermis presented psoriasiform hyperplasia with significant spongio-
sis. What is the diagnosis?2022-01-01T00:00:00ZEfficacy of extended infusion of β-lactam antibiotics for the treatment of febrile neutropenia in haematologic patients: protocol for a randomised, multicentre, open-label, superiority clinical trial (BEATLE)https://hdl.handle.net/10171/662202024-01-29T07:56:35Z2020-01-01T00:00:00ZTitle: Efficacy of extended infusion of β-lactam antibiotics for the treatment of febrile neutropenia in haematologic patients: protocol for a randomised, multicentre, open-label, superiority clinical trial (BEATLE)
Abstract: Background: Febrile neutropaenia (FN) is a very common complication in patients with haematological
malignancies and is associated with considerable morbidity and mortality. Broad-spectrum antipseudomonal βlactam antibiotics (BLA) are routinely used for the treatment of cancer patients with FN. However, the clinical
efficacy of BLA may be diminished in these patients because they present with pathophysiological variations that
compromise the pharmacokinetic (PK) parameters of these antibiotics. Optimised administration of BLA in
prolonged infusions has demonstrated better clinical outcomes in critically ill patients. However, there is a paucity
of data on the usefulness of this strategy in patients with FN.
The aim of this study is to test the hypothesis that the administration of BLA would be clinically more effective by
extended infusion (EI) than by intermittent infusion (II) in haematological patients with FN.
Methods: A randomised, multicentre, open-label, superiority clinical trial will be performed. Patients with haematological
malignancies undergoing chemotherapy or haematopoietic stem-cell transplant and who have FN and receive empirical
antibiotic therapy with cefepime, piperacillin-tazobactam or meropenem will be randomised (1:1) to receive the antibiotic
by EI (during half the time of the dosing interval) in the study group, or by II (30 min) in the control group.
The primary endpoint will be clinical efficacy, defined as defervescence without modifying the antibiotic treatment
administered within the first 5 days of therapy. The primary endpoint will be analysed in the intention-to-treat population.
The secondary endpoints will be pharmacokinetic/pharmacodynamic (PK/PD) target achievement, bacteraemia clearance,
decrease in C-reactive protein, overall (30-day) case-fatality rate, adverse events and development of a population PK model of the BLA studied.
Discussion: Data on the usefulness of BLA administration in patients with FN are scant. Only three clinical studies
addressing this issue have been published thus far, with contradictory results. Moreover, these studies had some
methodological flaws that limit the interpretation of their findings. If this randomised, multicentre, phase IV, open-label,
superiority clinical trial validates the hypothesis that the administration of BLA is clinically more effective by EI than by II in
haematological patients with FN, then the daily routine management of these high-risk patients could be changed to
improve their outcomes.
Trial registration: European Clinical Trials Database: EudraCT 2018–001476-37.
ClinicalTrials.gov, ID: NCT04233996.2020-01-01T00:00:00Z