Moderate anemia is associated with increased mortality and morbidity, including acute kidney injury (AKI), in surgical patients. A red blood cell (RBC)-specific antibody model was utilized to determine whether moderate subacute anemia could result in tissue hypoxia as a potential mechanism of injury. Cardiovascular and hypoxic cellular responses were measured in transgenic mice capable of expressing hypoxia-inducible factor-1α (HIF-1α)/luciferase activity in vivo. Antibody-mediated anemia was associated with mild intravascular hemolysis (6 h) and splenic RBC sequestration ( day 4), resulting in a nadir hemoglobin concentration of 89 ± 13 g/l on day 4. At this time point, renal tissue oxygen tension (PO) was decreased in anemic mice relative to controls (13.1 ± 4.3 vs. 20.8 ± 3.7 mmHg, P < 0.001). Renal tissue hypoxia was associated with an increase in HIF/luciferase expression in vivo ( P = 0.04) and a 20-fold relative increase in renal erythropoietin mRNA transcription ( P < 0.001) but no increase in renal blood flow ( P = 0.67). By contrast, brain PO was maintained in anemic mice relative to controls (22.7 ± 5.2 vs. 23.4 ± 9.8 mmHg, P = 0.59) in part because of an increase in internal carotid artery blood flow (80%, P < 0.001) and preserved cerebrovascular reactivity. Despite these adaptive changes, an increase in brain HIF-dependent mRNA levels was observed (erythropoietin: P < 0.001; heme oxygenase-1: P = 0.01), providing evidence for subtle cerebral tissue hypoxia in anemic mice. These data demonstrate that moderate subacute anemia causes significant renal tissue hypoxia, whereas adaptive cerebrovascular responses limit the degree of cerebral tissue hypoxia. Further studies are required to assess whether hypoxia is a mechanism for acute kidney injury associated with anemia.

Background: Palmar hyperhidrosis (PH), a condition characterized by excess sweating of the palms, is a common concern that presents to the plastic surgeon, which can have major impacts on patient confidence and quality of life. While several studies summarize treatment options for hyperhidrosis in general, few outline the therapeutic options available specifically for PH. Method: The authors reviewed the current literature specific to the diagnostic workup and treatment of PH. Results: In this article, we show a practical approach to managing patients presenting with PH, summarize its main nonsurgical and surgical treatment options, provide a suggested treatment ladder, and outline emerging therapeutic approaches. We suggest that, after diagnosing PH and classifying its severity, nonsurgical treatments (ie, topical antiperspirants, iontophoresis, botulinum toxin A injection, and topical/oral anticholinergics) should be utilized in a stepwise manner. In patients with severe palmar hyperhidrosis who do not respond to nonsurgical treatments, surgical intervention may be warranted, generally in the form of sympathetic denervation. Conclusion: This article provides a clear overview of PH treatment options, stepwise guidelines for physicians, and educational video resources demonstrating botulinum toxin A injections with cryotherapy and nerve blocks.

Background: Expert treatment of cutaneous facial pathology requires the correct diagnosis and precise anatomic knowledge.Lip surface anatomy is complex.Case Report: This brief report reviews the clinically relevant surface anatomy of the lip.Contexte: Le traitement spé cialisé des lé sions cutané es de la face né cessite la pose du bon diagnostic et une connaissance pré cise de l'anatomie; et l'anatomie de surface des lè vres est complexe.Exposé de cas: Nous passerons en revue, dans ce court exposé , l'anatomie de surface des lè vres, jugé e pertinente sur le plan clinique.

D. Minority physicians' role in the care of underserved patients: diversifying the physician workforce may be key in addressing health disparities.