Objective The objective of this review is to examine the reliability and measurement error of devices that measure transepidermal water loss (TEWL). Introduction TEWL is a physiological property of skin which increases when the epidermis is damaged. It is, therefore, a commonly utilised measure of skin barrier integrity. Devices measuring TEWL are available as open, semi‐open or closed chamber. Studies of reliability examine the consistency of measurement, and/or responsiveness whereas measurement error scores in absolute terms the amount of error due to sources of variation. Inclusion criteria Studies examining the reliability and/or measurement error of TEWL measurement devices were included. Studies that only report on measurement of TEWL outcomes without examination of reliability and/or measurement error were excluded. Methods The search strategy aimed to locate published and unpublished studies. Databases searched included PubMed, Embase, CINAHL and Web of Science, utilising identified keywords and limited to studies in English. Grey literature sources were searched to identify any unpublished documents. Study selection using the inclusion criteria was then assessed by two reviewers for methodological quality utilising the COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias tool to assess the reliability and measurement error of outcome measurement instruments. Results A total of 22 devices were examined in the 38 included studies. The quality of study design was on average rated as ‘Adequate’ however reliability and measurement error statistical methods were on average rated as ‘Doubtful’. Discussion and conclusion TEWL measurement devices were found to demonstrate good reliability and frequently correlated with other devices. However, measurement error was highly variable but improves under in vitro conditions. Future research should consider risk of bias factors when designing studies.
Background: Traditionally, liposuction is performed on the deeper layer of fat. However, in 1983, Illouz described a liposuction technique targeting the superficial layer of fat. High-definition liposuction (HDL) is an advanced technique of liposuction that generates a desirable profile of anatomical area while promoting skin retraction. Although the safety profile of basic or traditional liposuction has been extensively studied, data relevant to HDL are limited. A systematic review to determine the effectiveness and complications was conducted. Methods: Across the 21 articles included in the synthesis, a total of 6964 patients underwent HDL procedures. Of the cases where gender was reported, 44% were female patients (n = 1241) and 56% were male patients (n = 1556). The average age of patients was 38 years (range, 15 to 76 years) and body mass index was 25 kg/m2 (range, 18 to 38 kg/m2). Results: An overall complication rate of 14.4% (n = 994) was calculated, with only 0.2% (n = 13) of complications classified as major. Transient hyperpigmentation was the most frequently reported complication, affecting 260 patients (3.8%), followed by seroma in 231 (3.3%) and transient soft-tissue fibrosis in 185 (2.7%). Despite an absence of uniform reporting, satisfaction rates of 92.6% (n = 1497) were reported. Conclusions: There is a high demand for HDL surgery globally, and this systematic review illustrates the safety and efficacy of HDL. Major complication rates across the entirety of the literature reviewed were 0.2%, with minor complications seen in 14.2% across the 6964 cases reported. High patient satisfaction of 92.6% from HDL procedures was achieved, indicating the efficacy of this procedure.
Massive pure gastric yolk sac tumour: a unique presentation of a rare pathology An 86-year-old lady presented to our emergency department with a large central abdominal mass growing in size over a 4-month period, associated with a decreasing appetite and weight loss. She reported no pain, was tolerating oral intake and passing bowel motions daily. Her past medical history was significant for colorectal cancer in 2012, for which she had a right hemicolectomy and remained in remission.Observations were stable, and focussed abdominal examination revealed a central, firm and immobile mass, measuring approximately 20 cm in diameter and palpable throughout the entire abdomen. The abdomen was not tender to palpation.Computed tomography (CT) scan of the abdomen and pelvis revealed a 20 × 16.5 × 13 cm irregular central abdominal mass with smooth contours (Fig. 1). It appeared to arise from the gastric antrum, and had peripheral enhancement with a central hypo-dense component suggesting necrotic change. Mass effect was demonstrated on the surrounding bowel, mesenteric vessels and the inferior vena cava in particular. The remaining CT findings were normal with no evidence to suggest recurrence of the patient's previous malignancy. Serum alpha-fetoprotein (AFP) was elevated to 6590 IU/mL.The patient consented to a laparotomy and resection. Intraoperatively, the tumour was found to arise from the gastric antrum, but was adherent to the posterior rectus sheath, first part of the duodenum, proximal Jejunum, pancreas and serosa of the transverse colon (Fig. 2). Given the patient's age and frailty, we elected not to pursue an R0 multivisceral resection, and luckily we were able to mobilize the tumour from these structures. A distal gastrectomy followed by a gastro-jejunostomy (Billroth II procedure) was performed. The patient recovered well and was discharged 1 week post-operatively.
Introduction TEWL is a physiological property of skin which increases when the epidermis is damaged. It is, therefore, a commonly utilised measure of skin barrier integrity. Devices measuring TEWL are available as open, semi-open or closed chamber. Studies of reliability examine the consistency of measurement, and/or responsive whereas measurement error scores in absolute terms the amount of error due to sources of variation. Methods The search strategy aimed to locate published and unpublished studies. Databases searched included PubMed, Embase, CINAHL and Web of Science, utilising identified keywords and limited to studies in English. Grey literature sources were searched to identify any unpublished documents. Study selection using the inclusion criteria was then assessed by two reviewers for methodological quality utilising the COSMIN risk of bias tool to assess the reliability and measurement error of outcome measurement instruments. Studies examining the reliability and/or measurement error of TEWL measurement devices were included. Studies that only report on measurement of TEWL outcomes without examination of reliability and/or measurement error were excluded. Results A total of 22 devices were examined in the 38 included studies. The quality of study design was on average rated as ‘Adequate’ however reliability and measurement error statistical methods were on average rated as ‘Doubtful’. Conclusions TEWL measurement devices were found to demonstrate good reliability and often correlated with other devices. However, measurement error was highly variable but improves under in-vitro conditions.
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