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The aim of this study was to describe the 3D planning process used in our two composite face transplantations and to analyze the accuracy of a virtual transplantation in predicting the end-result of face transplantation. The study material consists of two bimaxillary composite face transplantations performed in the Helsinki University Hospital in 2016 and 2018. Computed tomography (CT) scans of the recipient and donor were used to define the osteotomy lines and perform the virtual face transplantation and to 3D print customized osteotomy guides for recipient and donor. Differences between cephalometric linear and angular measurements of the virtually simulated and the actual postoperative face transplantation were calculated. No changes to the planned osteotomy lines were needed during surgery. The differences in skeletal linear and angular measurements of the virtually simulated predictions and the actual postoperative face transplantations of the two patients varied between 0.1–5.6 mm and 0.7°–4°. The postoperative skeletal relationship between maxilla and mandible in both patients were almost identical in comparison to the predictions. 3D planning is feasible and provides close to accurate bone reconstruction in face transplantation. Preoperative virtual transplantation assists planning and improves the outcome in bimaxillary face transplantation. [ABSTRACT FROM AUTHOR]

En los albores del siglo XXI y en el ámbito geográfico del Caribe, la estructura urbana de San Juan de Puerto Rico refleja herencias culturales del pasado y transformaciones económicas y sociales reciente derivadas de la globalización. San Juan aparece como una mancha urbana compuesta por varios municipios e integrada por áreas diferenciadas desde los puntos de vista morfológico, social y funcional. Su estructura y paisajes urbanos son el resultado de modelos culturales y sistemas productivos distintos que se han sucedido a través del tiempo sobre un mismo espacio. Hoy, la administración y los responsables del planteamiento se esfuerzan por corregir los problemas heredados, por resolver las carencias estructurales y por hacer de San Juan una aglomeración capaz de haer compatible desarrollo sostenible y calidad de vida de sus habitantes.In the beginnings of the XXI century and in the geographical environment of the Caribbean, the urban structure of San Juan from Puerto Rico reflects cultural inheritances of the past and derived recent economic and social transformations of the globalization. San Juan appears like an urban stain composed by several municipalities and integrated by áreas that differ greatly from the morphological, social and functional points of view. Their structure and urban landscapes are the result of cultural models and different productivo Systems that have been developing through time in the same space. Today, the administration and those responsible for the planning make an effort to correct the inherited problems, to solve the structural déficits and to make of San Juan a mass able to make compatible sustainable development and quality of their inhabitants' Ufe.

Objectives: Oral health and balanced occlusion are important aspects of a well-functioning face transplant. This study describes the oral and dental status, dental management, and sialoendoscopy of the first 2 patients in Helsinki who underwent face transplantations.Study Design: Two patients received near-full face transplantations in 2016 and 2018, respectively. The transplanted tissues included a Le Fort type II maxilla, angle-to-angle mandible, all oral mucosa, ventral tongue tissue, and the muscles of the floor of the mouth. Comprehensive oral examinations and all required dental treatment, including follow-up examinations, were performed for both patients after the transplantations.Results: Both patients rehabilitated well, and their quality of life improved. Stable, functioning dentition and occlusion were achieved for both patients. Hyposalivation and dental caries were issues for both patients. Patient 1 also experienced infections in the jaws. Implants were placed in the transplanted jaws of patient 2 with successful osseointegration.Conclusions: We report successful tooth-bearing face transplantations in 2 patients. Patient selection, particularly regarding oral health, is crucial in avoiding posttransplantation complications. Moreover, the oral and dental status of the donor should be examined by a dentist before transplantation, and regular follow-up dental examinations should be performed after transplantation. [ABSTRACT FROM AUTHOR]

Micropropagation of rhubarb (Rheum rhabarbarum L.) on MS medium with sucrose 20 g/l and agar 8 g/l, supplemented with benzylaminopurine (BAP) 1 mg/1 and indolebutyric acid (IBA) 1 mg/l for initiation and multiplication, was studied with cv. Victoria and clone AF. With clone AF, the effects of rooting method (direct rooting, direct rooting with Floramon A or in vitro rooting) and propagule size (height 1.5-2.0, 2.1-5.0 or 5.1-10.0 cm) on weaning survival and plant size were examined. Further growth was recorded over a 3-year period in field studies. The medium gave a multiplication rate of 3.2/4 weeks for clone AF. For cv. Victoria, the medium did not seem suitable because of high occurrence of callus and vitrification. The multiplication rate of cv. Victoria was, however, increased from 2.8 to 5.4/4 weeks by using propagules from non-sprouting instead of sprouting buds. The weaning survival of clone AF averaged 86%. Rooting method did not affect either weaning survival or plant size. Propagule size affected plant size, but not weaning survival or further growth in the field.

Purpose: Studies of the effects of perioperative dexamethasone (DEX) during oncologic surgery are scarce. The first aim of the present study was to clarify whether perioperative DEX affects the short-term mortality in patients with head and neck cancer (HNC). The second aim was to analyze the causes of death and predictors affecting long-term mortality.Patients and Methods: The present prospective, double-blind randomized, controlled study included patients with HNC who had undergone microvascular reconstruction from 2008 through 2013. The patients were randomized into 2 groups: the receipt of perioperative DEX for 3 days (study group) or no DEX (control group). The patients' data and cause of death were registered until the end of 2017. The primary cause of death was used in the analyses.Results: A total of 93 patients were included in the present study: 51 in the DEX group (study group) and 42 in the NON-DEX group (control group). Altogether 38 patients died during a median follow-up period of 5.3 years. During the first year, more deaths had occurred in the DEX group than in the NON-DEX group: at 1 month, 4% versus 0%; at 6 months, 14% versus 0%; and at 12 months, 22% versus 5% (P = .043). The overall survival rate for all patients was 59%. HNC was the primary cause of death for most of the patients who died. On univariate analysis, the deceased patients had more advanced disease (higher T classification, P = .002; higher stage, P = .008), a greater need for a gastrostoma (P = .002), more often received postoperative chemotherapy (P = .005), and more often had locoregional (P = .025) or distal (P < .001) metastases. In the multivariate Cox model, the most important long-term predictors of death were the presence of distant metastases (P < .001), a Charlson comorbidity index (CCI) of 5 to 9 (P < .001), and the use of perioperative DEX (P = .004).Conclusions: The use of perioperative DEX was associated with higher short-term mortality after reconstructive HNC surgery. The most important long-term predictors of death were the receipt of DEX, the presence of distant metastases, and a CCI of 5 to 9. These findings do not encourage the routine use of perioperative DEX for these patients. [ABSTRACT FROM AUTHOR]

The Makkasan Train Factory, opened 110 years ago, is the first industrial estate in Thailand and used to be the biggest hub for train production in Southeast Asia. Nowadays, this huge land of 80 hectares, with direct access from the Savarnabhumi airport rail link, is considered a golden land right in the business center of Bangkok, that attracts real estate investors. A third of the land set aside at the end of last year for the development of a mixed use commercial project as a part of the High Speed Train project. As this land is the last big area of public land in the capital, civic groups for urban heritage conservation and the environment tried to point out its tangible and intangible heritage value hoping that there wouldbe a proper master plan to preserve these values for future generations. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess the levels, kinetics, and prognostic value of growth differentiation factor 15 (GDF-15) in cardiogenic shock (CS).Methods and Results: Levels of GDF-15 were determined in serial plasma samples (0-120 h) from 177 CS patients in the CardShock study. Kinetics of GDF-15, its association with 90-day mortality, and incremental value for risk stratification were assessed. The median GDF-150h level was 9647 ng/L (IQR 4500-19,270 ng/L) and levels above median were significantly associated with acidosis, hyperlactatemia, renal dysfunction, and higher 90-day mortality (56% vs 28%, P < .001). Serial sampling showed that non-survivors had significantly higher GDF-15 levels at all time points (P < .001 for all). Furthermore, non-survivors displayed increasing and survivors declining GDF-15 levels during the first days in CS. Higher levels of GDF-15 were independently associated with mortality. A GDF-1512h cutoff >7000 ng/L was identified as a strong predictor of death (OR 5.0; 95% CI 1.9-3.8, P = .002). Adding GDF-1512h >7000 ng/L to the CardShock risk score improved discrimination and risk stratification for 90-day mortality.Conclusions: GDF-15 levels are highly elevated in CS and associated with markers of systemic hypoperfusion and end-organ dysfunction. GDF-15 helps to discriminate survivors from non-survivors very early in CS. [ABSTRACT FROM AUTHOR]

Abstract Aim We herein describe the establishment of the Helsinki Vascularized Composite Allotransplantation (VCA) program and its execution in the first two face transplant cases. Methods & patients The Helsinki VCA program initially required the fulfillment of legal, hospital, financial, and ethical requirements. Thereafter, the assembling of a multidisciplinary team commenced. A team of Plastic, maxillofacial and ENT surgeons comprise the facial VCA team. The protocol involves collaboration with the Solid Organ Transplant (SOT) team, transplant immunology, immunosuppression, microbiology, psychiatric evaluation, well-defined VCA indications and informed consent. Between 2011 and 2017 two patients were selected for transplantation. Both patients had a severe composite facial deformity involving the maxilla and mandible following earlier ballistic injury. Results Patient 1 was a 35 year-old male who underwent successful near total face transplantation in February 2016 and at 30 months he has a good aesthetic outcome with symmetrical restoration of the central face and good sensory and symmetrical motor functional outcomes. Patient 2 was a 58 year-old male who underwent full face transplantation in March 2018 and at 5 months he has recovered without major problems. Conclusion A successful facial VCA program requires a well-prepared research protocol, experts from multiple specialties and careful patient selection. The establishment of the Helsinki VCA program required long and thorough planning and resulted in the first two Nordic face transplantation cases. This protocol now forms the platform (as a proof of concept) for other types of vascularized composite allotransplantations. [ABSTRACT FROM AUTHOR]

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