Background: The Estlander flap is a technique utilising a lip switch flap to reconstruct large defects with a low risk of necrosis due to the abundant blood supply of the lip. This poses an alternative to the Abbe flap and is particularly effective for commissure defects. We present 2 cases demonstrating the success of the Estlander flap in the reconstruction of significant commissure defects.
Microgreens are gaining popularity as a new superfood salad green, but little is known about the best methods for growing each type. The purpose of this study was to investigate the quality and yield of Helianthus annuus (Grey Striped Sunflower) microgreens grown hydroponically in a greenhouse. Variables included the time of soaking and sanitation the seeds, the type of root substrate, and the time to cover seeds during germination. For the experiment, the seeds were weighed and divided into three groups, which were soaked for 24 hours, 8 hours, or 0 hours. Afterward, the seeds were sown into hydroponic channels that were lined with burlap or biofelt mats as the root substrate. Insulation boards were then used to cover the seeds during germination. The channels were uncovered after three days and the seedlings were left to grow until being harvested at 7 days. To harvest, the substrate was shaken vigorously by hand to remove the seed hulls and stunted or unsprouted seeds. After cutting the microgreens, samples were measured for length to determine growth rate and were counted for the percentage of microgreens with the seed hull still attached. The microgreens and unsprouted seeds that fell during shaking were collected and weighed as well. This procedure was repeated for a second experiment, with an additional quick soak of the seeds in a 100 ppm sodium hypochlorite solution (diluted household bleach) for sanitation, to prevent mold. The cover time was increased to promote even the length of the microgreens and efficient removal of the seed hull from the cotyledons.
The results demonstrated that the type of root substrate had little effect on yield or the percentage of microgreens that fall during shaking. There was also no large distinction between the germination rates of the microgreens whose seeds were soaked for different times. In addition, mold growth was observed on all of the root substrates, except during the second trial where the seeds were sanitized before soaking, which allowed for a noticeable increase in germination rate and a decrease in mold growth. The results of these experiments show that sanitizing seeds is important for growing Grey Striped Sunflower microgreens in a hydroponic system. Soaking the seeds is not necessary, and covering the seeds during germination for several days does not help with consistent lengths or removal of the seed hulls.
This qualitative study explores dance as a therapeutic coping mechanism used by those affected by change due to a stressful life event. This research identifies key components of dance as a holistic approach to control stressful life events. It adds to the existing body of knowledge of more healthy ways to manage an individual’s wellness.This investigation is divided into three parts. Research on dance professionals, Joan Skinner, Erick Hawkins, Ohad Naharin, and Anna Halprin, provide a background of incorporating dance as a coping mechanism. Interviews of pre-professional, professional, and recreational dancers demonstrate how dance has been used to relieve stress and an adjustment tool to life change. Using key components identified by dance professionals and interviewed participants, along with a personal stressful life event experience, I create and present an abstract dance concert, FLUX. Themes that emerged from all parts of this study include a strengthened sense of identity as well as sense of heightened awareness and mind body connections, which could contribute as advantageous to an individual’s mental and physical well-being.
A 22-year-old female with sickle cell disease presented with fevers, bilateral knee pain, and lethargy. Laboratory data revealed a leukocytosis and lactic acidosis. Blood and synovial fluid cultures grew a non-toxin-producing strain of Clostridium difficile. This case highlights the fact that nontoxigenic Clostridium difficile can cause significant disease.
Abstract Alternative antibiotics for surgical prophylaxis are associated with increased adverse events and surgical site infection compared to cefazolin. In a sample of perioperative inpatients from 100 hospitals in the United States, cefazolin was 9-fold less likely to be used in patients with a documented β-lactam allergy whereas clindamycin was 45-fold more likely.
Abstract Background C.difficile Toxin Polymerase Chain Reaction (C.diff PCR) and C.difficile Toxin Enzyme Immunoassays (toxin EIA) are commonly used tests to diagnose Clostridoides difficile infection (CDI). C.diff PCR cannot differentiate between colonization and infection, leading to a higher false-positive diagnosis of CDI. Toxin EIA has low sensitivity leading to a missed diagnosis of CDI. In patients with C.diff PCR positive(+) and Toxin EIA negative(-), clinical judgment is often needed regarding the decision to treat or not to treat. C.diff cytotoxic assay (CCA), is a more sensitive method to detect the toxin but is time-consuming and not readily available. Methods Between 6/2019 and 12/2019, 83 patients who were admitted to the hospital, met our inclusion criteria (C.diff PCR+/EIA-). Clinicians who cared for these patients were contacted and surveyed with a predesigned questionnaire evaluating the rationale of treatment. Also, a simultaneous medical records review was done to ensure consistency. Along with this C.diff PCR+/EIA- stool samples were sent to ARUP laboratories for CCA. The CCA results were not available for clinicians and did not impact clinical care. Average cost for a CCA assay was $29 Results Demographics of the clinicians were variable (Table 1). Several parameters were considered when making decisions regarding treatment and GI/ID were frequently involved (figure 1). Among the 83 patients, 41(49%) were CCA (+) and 42(51%) were CCA (-). 48 of 83 (58%) patients received treatment for CDI. 25 of 48 (52%) patients who were treated were CCA positive while 23 of 48 (48%) patients were CCA negative. Among the untreated patients, 16/35 (46%) were CCA+ while 19/35(54%) were CCA-. There was no statistically significant correlation between clinical judgment and CCA assay results (p: 0.56 on the Chi test). Demographics of the clinicians Clinician survey responses CDI Treatment and by CCA positivity Conclusion Clinicians regardless of their background and training face challenges with the treatment of C.diff PCR+/EIA- patients. Patient outcomes based on the incorporation of CCA assay into an algorithm for C.diff PCR+/EIA- patients, need to be evaluated. But it has a potential role in stopping unnecessary CDI treatment as well as avoidance of missed treatment opportunities while possibly also being cost-effective. Disclosures Ank E. Nijhawan, MD, MPH, Gilead (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)
There is an increased risk of infection in patients with cancer that results in higher morbidity and mortality. Several risk factors can predispose these patients to infectious complications. Some such factors include immunocompromised states like neutropenia, allogeneic hematopoietic cell transplantation, and graft-versus-host disease, while others include immunosuppressive agents like corticosteroids, purine analogs, monoclonal antibodies, and other emerging cancer therapeutics like CAR T-cell therapy. The NCCN Guidelines for the Prevention and Treatment of Cancer-Related Infections address infection concerns that may be observed in these immunocompromised populations and characterize the major pathogens to which patients with cancer are susceptible, with a focus on the prevention, diagnosis, and treatment of major common and opportunistic infections. This paper highlights 2 recently updated sections of the guidelines, namely, infection concerns related to CAR T-cell therapy and antimicrobial prophylaxis recommendations, including vaccination, in patients at high-risk for infections.
