Peristomal psoriasis: an intriguing new subset of psoriasis

Delusional infestation caused by pramipexole

Efficacy of perilesional and intralesional triamcinolone acetonide injections in pemphigus vulgaris lesions of the scalp: an effective therapeutic option

Summary

The scalp is a common location for pemphigus vulgaris (PV), and scalp lesions may be resistant to standard treatment. Perilesional/intralesional triamcinolone acetonide (TA) injections have been used successfully to treat oropharyngeal and ocular involvement in PV. Data on the efficacy of perilesional and intralesional triamcinolone acetonide injections in scalp lesions in PV are lacking. We report two patients with immunopathologically and histopathologically confirmed PV and residual scalp lesions resistant to standard treatment, who were treated with perilesional and intralesional injections of TA 10 mg/mL. Clearance of scalp lesions was achieved after one after, respectively, one and two perilesional and intralesional injections. Perilesional and intralesional TA injections may serve as an effective and safe treatment for recalcitrant scalp lesions in pemphigus.

First-line treatment in lymphomatoid papulosis: a retrospective multicentre study

Summary

Background

Data regarding response to treatment in lymphomatoid papulosis (LyP) are scarce.

Aim

To assess the daily clinical practice approach to LyP and the response to first-line treatments.

Methods

This was a retrospective study enrolling 252 patients with LyP.

Results

Topical steroids, methotrexate and phototherapy were the most common first-line treatments, prescribed for 35%, 20% and 14% of the patients, respectively. Complete response (CR) was achieved in 48% of treated patients. Eczematous lesions significantly increased relative risk (RR) of not achieving CR (RR = 1.76; 95% CI 1.16–2.11). Overall median time to CR was 10 months (95% CI 6–13 months), and 78% of complete responders showed cutaneous relapse; both results were similar for all treatment groups (P > 0.05). Overall estimated median disease-free survival (DFS) was 11 months (95% CI 9–13 months) but DFS for patients treated with phototherapy was 23 months (95% CI 10–36 months; P < 0.03). Having the Type A LyP variant (RR = 2.04; 95% CI 0.96–4.30) and receiving a first-line treatment other than phototherapy (RR = 5.33; 95% CI 0.84–33.89) were significantly associated with cutaneous early relapse. Of the 252 patients, 31 (13%) had associated mycosis fungoides unrelated to therapeutic approach, type of LyP or T-cell receptor clonality.

Conclusions

Current epidemiological, clinical and pathological data support previous results. Topical steroids, phototherapy and methotrexate are the most frequently prescribed first-line treatments. Although CR and cutaneous relapse rates do not differ between them, phototherapy achieves a longer DFS. Presence of Type A LyP and use of topical steroid or methotrexate were associated with an increased risk of early relapse.

Self-reported minor infections in patients with hidradenitis suppurativa and healthy controls

Summary

Background

Patients with hidradenitis suppurativa (HS) often report opportunistic infections such as herpes and urinary tract infections.

Aim

To compare opportunistic infections in patients with HS against a group of healthy controls (HCs).

Methods

In total, 99 patients with HS and 109 HCs were recruited at random to this retrospective case–control study. We devised a questionnaire to explore the frequency of minor infections, general practitioner (GP) visits and sick days experienced during the past 6 months. Additionally, participants were asked if they felt unwell more often compared with their peers.

Results

Patients with HS felt unwell more often than did HCs (26.3% vs. 7.3%, P < 0.001). Although there was no difference between the groups in five of the seven diseases studied, patients with HS had a higher frequency of the common cold (P < 0.01) and genital herpes (P < 0.01). Number of pack-years of smoking did not affect risk of infections (Pearson correlation, P = 0.51). Subgroup analysis of nonsmokers found the same differences in frequency of minor infections, common cold and genital herpes between patients with HS and controls.

Conclusions

Patients with HS appear to experience more frequently symptoms compatible with minor infections in general, and the common cold and genital herpes specifically. This results in more GP visits and more sick days. Further research is needed to determine if this is caused by an immunological hyper-reactive state in these patients or a reduced threshold for minor infections.

Eruptive melanocytic naevi secondary to azathioprine: case report and review of the literature

Ultraviolet filters in hair-care products: a possible link with frontal fibrosing alopecia and lichen planopilaris

Expanded version pedicled free-style perforator flaps in clinical practice: a need for a more comprehensive classification system

Abstract

Background

The evolution of the angiosome concept into the perforasome theory as we increasingly move towards the distal end of the microvascular tree for reconstructive options has allowed us to design ad hoc perforator flaps.

Methods

In a retrospective sample of more than 60 pedicled perforator flaps over a 36-month period, a variety of defects in all regions of the body were reconstructed. Pre-operative planning was based on either Doppler vascular studies or CT angiography.

Results

The overall complete flap survival rate was 89%, with a tip necrosis rate of 8.1% and a partial flap necrosis rate of 3.3%. The risk factors identified were smoking, nicotine patches, vasopressor use and pro-thrombotic states.

Conclusions

It is feasible to perform the many variations of perforator flaps provided; the microsurgical anatomy of the area is well defined, aided by imaging studies as necessary. Risk stratification also needs to be taken into account when planning these flaps. Based on our results and observations, an alternative pedicled perforator flap classification is put forward.

Level of Evidence: Level IV, therapeutic study.

Hearing objects and events

Abstract

Through hearing we learn about source events: events in which objects move or interact so that they vibrate and produce sound waves, such as when they roll, collide, or scrape together. It is often claimed that we do not simply hear sounds and infer what event caused them, but hear source events themselves, through hearing sounds. Here I investigate how the idea that we hear source events should be understood, with a focus on how hearing an event relates to hearing the objects involved in that event. I argue that whereas we see events such as rollings and collisions by seeing objects move through space, this cannot be how we hear them, and go on to examine two other possible models. On the first, we hear events but not their participant objects. On the second, to hear an event is to hear the appearance of an object to change. I argue that neither is satisfactory and endorse a third option: to hear a source event is to hear an object as extending through time.

Involvement of mitochondrial pathway in environmental metal pollutant lead-induced apoptosis of chicken liver: perspectives from oxidative stress and energy metabolism

Abstract

This study aimed to investigate the possible mechanisms of environmental metal pollutant lead (Pb)-induced apoptosis in chicken. Forty 8-day-old healthy chickens were randomly assigned to two groups (n = 20/group) after raising standard commercial diet and drinking water for 1 week: including control group and Pb group ((CH₃COO)₂Pb 350 mg/L of drinking water); the chickens were given euthanasia and collected livers at 90 days. A significant increase of apoptosis rate were found in Pb group and Pb induced obvious ultrastructural changes of chicken liver. The mRNA levels of glycometabolism key enzymes were significantly lower in Pb group than those in controls. Higher levels of malondialdehyde (MDA) and nitric oxide (NO) were observed in Pb group; the activities of antioxidant enzymes and ATPases were significantly lower in Pb group than those in controls, while the inducible nitric oxide synthase (iNOS) activity was on the contrary. The mRNA and protein levels of pro-apoptotic genes were all lower in Pb group than those in controls. Altogether, Pb-induced mitochondrial swelling and nuclear chromatin condensation, oxidative stress, energy metabolism disorder, thereby lead to apoptosis via mitochondrial pathway in chicken liver, suggesting that Pb-induced mitochondrial pathway apoptosis plays an important role in the mechanisms of Pb cytotoxicity to chicken liver.

Relapsing polychondritis, an underestimated dermatological urgency: case report and literature review

Abstract

Background

Relapsing polychondritis is an autoimmune multisystemic disease with primary chondral involvement. Its high mortality and morbidity make it a real clinical challenge.

Case description

A 32-year-old woman with a history of relapsing polychondritis, refractory to multiple treatments, with multisystem compromise, imminent risk of death due to severe tracheobronchial damage and difficult ventilatory support, and successful treatment with infliximab.

Discussion and evaluation

Several treatments have been described in the literature, such as nonsteroidal anti-inflammatory drugs, corticosteroids, dapsone, azathioprine, cyclosporine, cyclophosphamide, and methotrexate. However, the cases refractory to conventional therapy may lead to chronicity, irreversibility, and death. As a result, a third-line therapy could improve the prognosis of these patients.

Conclusions

Biological therapy is a good option for disease control and quality of life improvement. In addition, the physician should consider these treatments to avoid the chronicity and risk of death of these patients.

Surgical management of apocrine hidrocystoma on the penile shaft

Macrophage subtypes in recurrent nodular basal cell carcinoma after Mohs micrographic surgery

Abstract

Background

The macrophages associated with solid tumors are related to the progression or regression of tumors, depending on the differentiation in M1 or M2. M2 subtype promotes angiogenesis, remodeling, and tissue repair (tumor proliferation). In contrast, M1 produces toxic mediators and presents antigens, destroying microorganisms and tumor cells. The microenvironment of most aggressive forms of basal cell carcinoma (BCC) shows an increase in macrophages due to M2 phenotype compared to noninvasive forms. The treatment of nodular BCC by Mohs micrographic surgery (MMS) provides high cure rates, but relapses can occur.

Aims

To compare the total population of macrophages and their subpopulations M1 and M2 in cases of recurrent and nonrecurrent nodular BCC after excision by MMS.

Materials & Methods

Histological sections obtained from paraffin blocks of nine cases of recurrent nodular BCC after MMS and 18 cases of nonrecurrent nodular BCC operated by MMS were immunostained for iNOS, CD204, CD163, and CD68. The expression of these markers was analyzed by image analysis.

Results

No significant differences were found between the groups in relation to the average percentage of M1 cells, M2 cells, and total cells.

Discussion and Conclusion

A relationship was not seen between tumor-associated macrophages (TAM) and tumor recurrence.

Intraoperative instillation of ropivacaine during the placement of sub-muscular cosmetic breast implants: Is there a clinical benefit?

Publication date: Available online 9 October 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): F. Picard, J. Niddam, A. De Runz, M. Chaouat, M. Mimoun, D. Boccara
IntroductionThe sub-muscular placement of cosmetic breast implants leads to substantial pain due to the muscular distention. The aim of this study was to assess the efficiency of intraoperative ropivacaine instillation to reduce postoperative pain the day after surgery.Material and methodsWe conducted a prospective, controlled, single-blinded study comparing the intraoperative instillation of 7.5mg of ropivacaine through Redon drains with the standard procedure in 72 patients undergoing sub-muscular cosmetic breast augmentation for the first time.ResultsPain at the awakening on postoperative day 1 was 4.8 on a simple numeric pain scale in the treatment group and 5.1 in the control group (P>0.05). On postoperative day 3, pain at awakening was 3.7 in both groups (P>0.05), and on postoperative day 5, pain was 2.8 in the treatment group and 2.7 in the control group (P>0.05).ConclusionLocal instillation of ropivacaine in the implant pocket during surgery did not decrease postoperative pain on day 1, day 3 and day 5. From now on, we are able to tell to patients that the postoperative pain after sub-muscular cosmetic breast implants surgery is about 5/10 on postoperative day 1, 4/10 at day 3 and 3/10 at day 5.Level of evidenceLevel II.

The anterolateral thigh perforator flap in pharyngo-esophageal reconstruction

Publication date: Available online 9 October 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): M.K. De Frémicourt, S. Temam, F. Janot, F. Kolb, Q. Qassemyar
Today's customary techniques for pharyngo-esophageal reconstruction are jejunum and radial forearm free flaps. In this type of reconstruction, the jejunum flap is considered as the reference, but when its harvesting is not possible, the radial forearm flap is used. Since perforator flaps have begun to be developed, the anterolateral thigh flap (ATF) has become increasingly prominent in pharyngo-esophageal reconstruction. The aim of our study was to describe the use of the anterolateral perforator flap in pharyngo-esophageal reconstruction (indications, harvesting method, flap design) and to discuss its advantages and drawbacks as regards oral feeding and esophageal speech.

Positive experiences related to living with tinnitus: A cross-sectional survey

Abstract

Objective

The aim of this study was to gain insights related to positive experiences reported by adults with tinnitus living in the UK.

Design

A cross-sectional survey design was used in a sample of adults with tinnitus who were interested in undertaking an Internet-based intervention for tinnitus.

Setting

The study was UK wide and data collection was online.

Participants

Participants consisted of 240 adults (137 males, 103 females), with an average age of 48.16 years and average tinnitus duration of 11.52 years (SD: 11.88).

Main outcome measures

Tinnitus severity was measured by means of the Tinnitus Functional Index. To evaluate the secondary effects of tinnitus, the Insomnia Severity Index, the Hearing Handicap Inventory for Adults-Screening Version and the Cognitive Failures Questionnaires were administered. Positive experiences related to tinnitus were explored using an open-ended question format.

Results

Around a third of participants (32.5%) reported positive experiences associated with tinnitus. The number of positive responses ranged from one to eight responses per participant, although there were fewer participants with more than one positive response. The predominant themes concerned: (1) coping; (2) personal development; (3) support, and to a lesser extent (4) outlook. Younger participants, those with a lower hearing disability and those with fewer cognitive failures were more likely to report positive experiences associated with having tinnitus.

Conclusions

This study has identified that personal development and a positive outlook is possible despite experiencing tinnitus. Ways to facilitate positive experiences related to tinnitus should be promoted, as these may reduce the negative consequences associated with tinnitus.

The most prevalent positive theme was the ability to cope with tinnitus. Positive experiences were also drawn from having clinical and other support networks. This highlights the importance of providing tinnitus interventions that can assist people in coping with tinnitus, particularly to those less likely to relate tinnitus to any positive experiences. Those most likely to be helped include those who are older with greater cognitive difficulties and a greater hearing disability.

This article is protected by copyright. All rights reserved.

Measurement and reporting of pressure ulcer related harm in NHS Hospitals in England

Publication date: Available online 9 October 2017
Source:Journal of Tissue Viability
Author(s): Ray Samuriwo

On the interactions among zinc availability and responses to ozone stress in durum wheat seedlings

Abstract

Seedlings of durum wheat [Triticum turgidum subsp. durum (Desf.) Husn] were exposed to zinc nutrition and to ozone (O₃) in a factorial combination: adequate (+Zn treatment) or no Zn (−Zn) in the nutrient solution, followed by exposure to either ozone-free air (filtered air, FA) or to 150 nL L⁻¹ ozone (O₃) for 4 h. Although omitting Zn from the nutrient solution failed to impose a genuine Zn deficiency, −Zn*FA durum wheat seedlings showed a typical deficiency behaviour, i.e. Zn mobilisation from root to shoot. Such inter-organ Zn redistribution, however, did not occur in −Zn*O₃ plants. Exposure to each stress singly decreased the activity and the protein amount of foliar plasma membrane H⁺-ATPase, but not stress combination, which even increased the H⁺-ATPase expression with respect to control. In the −Zn*O₃ plants, moreover, the foliar activities of the plasma membrane-bound NAD(P)H-dependent superoxide synthase and of Cu,Zn-superoxide dismutase, and the transcripts abundance of the luminal binding protein and of the protein disulphide isomerase, were also stimulated. It is proposed that, even in the absence of actual Zn starvation, the perception of deficiency conditions could trigger changes in redox homoeostasis at the plasma membrane level, helpful in compensating an O₃-dependent oxidative damage.

Assessing value in breast reconstruction - a systematic review of cost-effectiveness studies

Breast reconstruction is one of the most common procedures performed by plastic surgeons and is achieved through various choices in both technology and method. Cost-effectiveness analyses are increasingly important in assessing differences in value between treatment options, which is relevant in a world of confined resources. A thorough evaluation of the cost-effectiveness literature can assist surgeons and health systems evaluate high value care models.

The tenting technique: A novel filler technique in the danger zones

The 'Y' technique: An attempt to standardize nail dressing

Clinical and dermoscopic characterization of pediatric and childhood melanomas. Multicenter study of 52 cases

Knowledge regarding the morphologic spectrum of pediatric melanoma (PM) is sparse and this may in part contribute to delay in detection and thicker tumors.

Trends in US dermatology residency and fellowship programs and positions, 2006 to 2016

Due Diligence in the Open-Access Explosion Era: Choosing a Reputable Journal for Publication

open accesspredatory journalspredatory publisherscharacteristics of ethical and unethical publishing practicesdue diligence activities for selecting reputable journals

Neonatal lupus erythematosus presenting as Stevens-Johnson syndrome

Publication date: Available online 9 October 2017
Source:Dermatologica Sinica
Author(s): Ren-Feng Liu, Wen-Hung Chung, Chin-Yi Yang, Fang-Ying Wang, Chun-Bing Chen
Neonatal lupus erythematosus (NLE) is a rare acquired condition caused by the transplacental passage of maternal autoantibodies. It is characterized by cutaneous, cardiac, hepatobiliary, hematological and neurological involvement. Cutaneous findings of NLE are variable, but few reports in the literature describe the presence of erosions or epidermal loss in NLE. Herein, we describe the case of an infant with NLE presenting as Stevens-Johnson syndrome (SJS), with cardiac, hematologic, hepatobiliary and neurologic abnormalities. The characteristic features by which to differentiate SJS-like NLE from infant SJS include subacute course, cardiac abnormalities, positive serology tests and direct immunofluorescence, histopathologic findings with melanin incontinence, periadnexal infiltrates, and mucin deposit. Though rare, it is important to consider lupus erythematosus as a potential cause of acute syndrome with focal epidermal necrosis or pan-epidermolysis.

Présentation atypique d’un lymphome du manteau

Publication date: Available online 6 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): L. Orgeolet, F. Staroz, M. Acquitter, P. Plantin, C. Fleuret

Cosmétiques et médicaments topiques dans l’acné : où est la frontière ?

Publication date: Available online 6 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): F. Poli, J.-P. Claudel, N. Auffret, M.-T. Leccia, B. Dréno
L'acné est une maladie chronique pouvant induire des séquelles telles que des cicatrices atrophiques ou hypertrophiques, ou de l'hyperpigmentation postinflammatoire. Les médicaments topiques ou systémiques ayant une activité pharmacologique et une autorisation de mise sur le marché sont les acteurs clés du traitement de l'acné. Ces traitements topiques ou systémiques induisent souvent des effets secondaires en lien avec l'altération de la barrière cutanée. Ils doivent donc être associés à des cosmétiques qui viseront à protéger la barrière cutanée. Avec l'arrivée sur le marché de produits cosmétiques contenant des ingrédients actifs évalués en laboratoire sur des cultures cellulaires ou des échantillons de tissus, et testés cliniquement sur un nombre souvent très limité de sujets, le monde des cosmétiques a changé. En utilisant le terme « dermo-cosmétique » et avec l'introduction d'ingrédients actifs dans les formulations, les cosmétiques se présentant aujourd'hui comme adaptés à une pathologie cutanée ne se limitent plus à l'entretien et l'hygiène de la peau, mais visent à apporter aux personnes souffrant de cette pathologie cutanée un produit complémentaire, voire une alternative aux médicaments. Le but de cet article est de mieux comprendre et clarifier le rôle respectif des médicaments topiques et des cosmétiques dans la prise en charge de l'acné.Acne is a chronic disease that may cause sequels such as atrophic or hypertrophic scars or post-inflammatory hyperpigmentation. Topical and systemic medications with proven pharmacologic activity and which have received marketing authorization are the key actors in the treatment of acne. However, these topical or systemic treatments frequently cause adverse effects related to impairment of the skin barrier, and cosmetics must therefore be used in combination to help protect the skin barrier. Nowadays, new cosmetic products containing active ingredients tested in vitro or in a small number of subjects have changed the world of cosmetics. In being described as "dermo-cosmetic" and in integrating active ingredients in their formulations, these cosmetics are now being presented as being specifically adapted for a given disease, and no longer limited to skin care and hygiene but suitable as an adjunctive or even an alternative to current medications. The aim of this article is to provide a better understanding of the respective roles of medications and cosmetics in the management of acne.

Les syndromes d’Ehlers-Danlos

Publication date: Available online 9 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): D.-P. Germain
Les syndromes d'Ehlers-Danlos (SED) sont un groupe de maladies génétiques du tissu conjonctif caractérisées par une hyperélasticité cutanée, une hyperlaxité articulaire et une fragilité des tissus. Au-delà de ces caractéristiques communes, ils se distinguent les uns des autres par la présence ou l'absence de cicatrices cutanées, la variabilité des atteintes organiques et des variants génétiques différents. Il s'agit de maladies génétiques complexes, souvent invalidantes. La classification de Villefranche, établie en 1997, a défini 6 sous-types de SED mais de nombreuses autres formes rares ont été décrites depuis. À côté des classiques altérations de la synthèse du collagène sont à présent décrites des anomalies de la synthèse des glycosaminoglycanes ou de l'organisation de la matrice extracellulaire dues à des déficits enzymatiques et de nombreux SED rares ou apparentés sont de facto des maladies métaboliques. Il n'existe pas de traitement curatif des SED mais il importe de porter un diagnostic précoce pour une prise en charge symptomatique optimale des patients et une prévention des complications évitables. Une approche multidisciplinaire, dans un centre de référence, un centre de compétence, un service de dermatologie ou un service de génétique médicale, est souhaitable. Nous présentons un état actuel des connaissances sur ces pathologies que la génétique a permis de démembrer au fil des années.Ehlers-Danlos syndromes (EDS) are a heterogeneous group of inheritable connective tissue disorders characterized by skin hyperextensibility, joint hypermobility and cutaneous fragility with delayed wound healing. Over and above these common features, they differ in the presence or absence of various organ and tissue abnormalities, and differences in genetic causal mechanisms and degree of severity. They are complex and multisystem diseases, with the majority being highly disabling because of major joint problems and neurosensory deficiencies, and in some cases, they may be life-threatening due to associated complications, especially vascular disorders. In 1997, the Villefranche classification defined 6 subtypes of EDS. However, many other new variants have been described over the last years. The "historical" EDS were characterized by abnormalities in fibrillar collagen protein synthesis. More recently, disorders of synthesis and organization of the extracellular matrix have been shown to be responsible for other types of EDS. Thus, many EDS are in fact metabolic diseases related to enzymatic defects. While there is no curative treatment for any type of EDS, early diagnosis is of utmost importance in order to optimize the symptomatic management of patients and to prevent avoidable complications. Patients must be treated and monitored by multidisciplinary teams in highly specialized reference centers. In this article, we present the current state of knowledge on these diseases that continue to be elucidated thanks to new molecular genetic techniques.

Polybrominated diphenyl ethers (PBDEs) in background air around the Aegean: implications for phase partitioning and size distribution

Abstract

The occurrence and atmospheric behavior of tri- to deca-polybrominated diphenyl ethers (PBDEs) were investigated during a 2-week campaign concurrently conducted in July 2012 at four background sites around the Aegean Sea. The study focused on the gas/particle (G/P) partitioning at three sites (Ag. Paraskevi/central Greece/suburban, Finokalia/southern Greece/remote coastal, and Urla/Turkey/rural coastal) and on the size distribution at two sites (Neochorouda/northern Greece/rural inland and Finokalia/southern Greece/remote coastal). The lowest mean total (G + P) concentrations of ∑₇PBDE (BDE-28, BDE-47, BDE-66, BDE-99, BDE-100, BDE-153, BDE-154) and BDE-209 (0.81 and 0.95 pg m⁻³, respectively) were found at the remote site Finokalia. Partitioning coefficients, K _P, were calculated, and their linear relationships with ambient temperature and the physicochemical properties of the analyzed PBDE congeners, i.e., the subcooled liquid pressure (P _L°) and the octanol-air partition coefficient (K _OA), were investigated. The equilibrium adsorption (P _L°-based) and absorption (K _OA-based) models, as well as a steady-state absorption model including an equilibrium and a non-equilibrium term, both being functions of log K _OA, were used to predict the fraction Φ of PBDEs associated with the particle phase. The steady-state model proved to be superior to predict G/P partitioning of BDE-209. The distribution of particle-bound PBDEs across size fractions < 0.95, 0.95–1.5, 1.5–3.0, 3.0–7.2, and > 7.2 μm indicated a positive correlation between the mass median aerodynamic diameter and log P _L° for the less brominated congeners, whereas a negative correlation was observed for the high brominated congeners. The potential source regions of PBDEs were acknowledged as a combination of long-range transport with short-distance sources.

Tempo-spatial dynamics of water quality and its response to river flow in estuary of Taihu Lake based on GOCI imagery

Abstract

Knowledge of tempo-spatial dynamics of water quality and its response to river flow is important for the management of lake water quality because river discharge associated with rainstorms can be an important source of pollutants to the estuary. Total phosphorus (TP), chlorophyll a (Chl-a), and total suspended matter (TSM) are important indexes of water quality and important factors influencing eutrophication and algal blooms. In this study, remote sensing was used to monitor these indexes to investigate the effects of river discharge on the estuary of Taihu Lake by the largest inflow river which is Chendong River using a total of 136 Geostationary Ocean Color Images (GOCI). In situ datasets collected during the four cruise experiments on Taihu Lake between 2011 and 2015 were used to develop the TP, Chl-a, and TSM inversion models based on simple empirical algorithms: 154 points for TP (mg/L), 114 for Chl-a (μg/L), and 181 for TSM (mg/L). The spatial and temporal changes of the concentration of the three parameters in the Chendong River estuary were analyzed by combining the GOCI data, the flow of the Chendong River, and meteorological data throughout the year in 2014. The several key findings are as follows: (1) In summer and autumn, TP, Chl-a, and TSM contents were significantly higher than in winter and spring. TP and Chl-a have a few similar distribution characteristics. And organic suspended matter in summer was the main reason for the increase of the TSM concentration. (2) The severe surface erosion in the rivers cannot be ignored; the high erodibility is an important factor in the increase of TP and TSM concentrations in the estuary. The concentration of the water quality parameter showed exponential decay with distance from the shore. The concentration decreased slowly after 12 km and then remained essentially constant. (3) TP content in the Chendong River estuary decreased under steady flow inputs and dramatically increased when the flow became large. The increase in Chl-a content was linked to higher levels of TP and good weather conditions after the rain event. Higher flow rates mainly play a dilution role for the Chl-a concentration. Erosion of the surface soil via rainfall is a major source of TSM to the estuary. This paper firstly analyzes tempo-spatial dynamics of water quality and its response to river flow in estuary of Taihu Lake, helps to further understand the impact of river input on lake water quality, and is important for lake eutrophication.

What Surgical Education the Speciality Offers? Perception of Role of Oral and Maxillofacial Surgery by 1200 Healthcare Professionals, Students and the General Public in Hyderabad, India

Abstract

Aim

To investigate the perception of Oral and maxillofacial surgery by healthcare professionals, students and general public.

Materials and Methods

A questionnaire form was created that listed ten clinical situations, and given by hand to 1200 individuals, divided into six groups: group 1, medical professionals; group 2, Specialties of dentistry; group 3, general dentists; group 4, medical students; group 5, dental students; and group 6, general public, each comprising 200 individuals. Respondents were asked to indicate who they would expect to treat them if they had one of the specified conditions listed in the questionnaire. We present the results and current awareness levels of this simple questionnaire. The present study addresses the common issue raised by many authors, 'What surgical education the speciality offers?' especially to medical professionals, medical students and general public to enhance an appropriate referral.

Results

Most of the respondents in groups 2, 3 and 5 agreed that specific conditions listed in the questionnaire were within the domain of oral and maxillofacial surgery, but such response was not seen in groups 1, 4 and 6 (p < 0.001). An overall awareness level of oral and maxillofacial surgery was found to be 50.2%.

Conclusion

The onus of creating and improving the awareness and perception of our specialty lies on oral and maxillofacial surgeon. Unified efforts at individual as well as global level will help achieve this goal.

Impact of Moringa oleifera seed aqueous extract on some biological, biochemical, and histological aspects of Biomphalaria alexandrina snails

Abstract

Schistosomiasis is one of the neglected tropical diseases. It is a snail-borne trematode infection, and Biomphalaria alexandrina snails are the intermediate host of Schistosoma mansoni in Egypt. The objective of this study is to evaluate the molluscicidal activity of the aqueous seed extract of Moringa oleifera against B. alexandrina snails. The results showed that this aqueous extract was lethal for B. alexandrina snails (LC₅₀ 0.27 g/l; LC₉₀ 0.41 g/l). Exposure of snails to the sublethal concentrations of this aqueous extract caused a considerable reduction in survival rates and hatchability rates of eggs of these snails. Moreover, it negatively affected some biochemical aspects, where it increased the levels of transaminases (ALT and AST), while it decreased the concentrations of total protein, albumin, and globulin concentration. Histological examinations of the digestive gland of snails exposed to the sublethal concentrations of aqueous seed extract of M. oleifera revealed severe damage in the digestive cells, where they lost their tips and some were degenerated, while the secretory cells increased in number. Regarding the hermaphrodite gland, there were losses of connective tissues and irregular sperms, and the eggs were degenerated. These findings prove the potent activity of aqueous seed extract of M. oleifera against the intermediate hosts of Schistosoma mansoni and provide a considerable scope in exploiting local indigenous resources for snails' molluscicidal agents.

Virtuelle Techniken in der Traumatologie

Zusammenfassung

Hintergrund

Durch die Entwicklung moderner bildgebender Verfahren und der computerassistierten Chirurgie mit virtueller Planung, intraoperativer Navigation und Herstellung patientenspezifischer Implantate eröffnet sich dem Mund‑, Kiefer- und Gesichtschirurgen eine virtuelle Welt mit zahlreichen neuen Möglichkeiten insbesondere für die Traumatologie und die Rekonstruktion sekundärer Deformitäten.

Ziel

Ziel der Arbeit war es, anhand der Rekonstruktion posttraumatischer Jochbein- und Orbitadeformitäten die Möglichkeiten virtueller Techniken im Bereich Traumatologie der MKG-Chirurgie exemplarisch aufzuzeigen.

Material und Methoden

Anhand klinischer Beispiele für primäre und sekundäre posttraumatische Deformitäten werden der Einsatz unterschiedlicher virtueller Techniken sowie der Arbeitsablauf bei der virtuellen Planung, der späteren Herstellung und dem navigationsgestützten Einbringen patientenspezifischer Implantate demonstriert. Auch die Anwendung der intraoperativen Röntgenbildgebung wird aufgezeigt, die mit der intraoperativen Navigation direkt kombiniert werden kann. Der Arbeitsablauf bei der Korrektur posttraumatischer Deformitäten unter Zuhilfenahme virtueller Techniken gliedert sich in 4 Phasen: Analyse, Planung, Umsetzung und Qualitätskontrolle. In allen Phasen kommen virtuelle Techniken maßgeblich zum Einsatz.

Diskussion

Das Ausschöpfen aller Möglichkeiten der virtuellen Welt ist mit einem hohen apparativen Aufwand verbunden. Der Einsatz virtueller Techniken erhöht jedoch die intraoperative Präzision, reduziert intraoperative Manipulationen, verkürzt die Operationszeit und verringert die Anzahl von Revisionseingriffen.

Intra- and inter-specific variations in chitin in lichens along a N-deposition gradient

Abstract

The mechanisms of nitrogen (N) tolerance in lichens are not yet fully understood. Here, we investigated how the increase of chitin content is related with N excess at inter- and intra-specific levels, by using species with differing ecological N tolerances (the tolerant Xanthoria parietina and Parmotrema hypoleucinum and the sensitive Evernia prunastri and Usnea sp.) and thalli of X. parietina and P. hypoleucinum from sites with different availabilities of N of agricultural origin (livestock), as confirmed by lichen N content and δ¹⁵N. Nitrogen, chitin (N-containing compound), and ergosterol contents were measured in lichen thalli. Nitrogen and chitin contents were higher in tolerant species than those in sensitive ones (inter-specific level) and in thalli collected from the N-polluted site than in thalli from the clean site (intra-specific level). We suggest that chitin contributes to N stress tolerance in lichens, and that excess N can be partially stored as chitin (non-toxic form) in the cell walls of tolerant species.

Ixekizumab treatment for psoriasis: Integrated efficacy analysis of three double-blinded, controlled studies (UNCOVER-1, UNCOVER-2, UNCOVER-3)

Abstract

Background

Ixekizumab, a high-affinity monoclonal antibody that selectively targets interleukin (IL)-17A, is approved for the treatment of moderate-to-severe psoriasis.

Objectives

This analysis represents an overview of the efficacy outcomes from three Phase 3 psoriasis studies.

Methods

Data were integrated from the 12-week induction period of three studies in which patients received ixekizumab 80 mg every 2 (IXE Q2W; N=1169) or 4 weeks (IXE Q4W; N=1165) after an initial 160-mg dose for both, etanercept (ETN) (50 mg biweekly; N=740; two studies), or placebo (PBO) (N=792). The co-primary endpoints were the percentages of patients with response of sPGA (0,1) and a 75% improvement in baseline psoriasis area severity index (PASI 75) at Week 12. Response rates were compared between treatments using the Cochran-Mantel-Haenszel test stratified by study. Treatment comparisons with placebo included data from three studies, whereas etanercept comparisons were based on two studies.

Results

Ixekizumab treatment was superior to placebo (p<0.001) and etanercept (p<0.001) on sPGA (0,1) and PASI 75, with significant differences in PASI improvement at Week 1. With IXE Q2W, at Week 12, the frequency of patients achieving PASI 75/90/100 was nearly 90%/70%/40%, respectively. Ixekizumab-treated patients showed significantly greater improvement versus placebo and etanercept in percent body surface area involvement and fingernail psoriasis. IXE Q2W was superior to IXE Q4W on all treatment outcomes.

Conclusions

Ixekizumab therapy at both dosing regimens demonstrated rapid onset and superior efficacy compared with placebo and etanercept, with IXE Q2W providing better outcomes than IXE Q4W during the first 12 weeks of treatment.

This article is protected by copyright. All rights reserved.

No Elevated Risk for Depression, Anxiety, or Suicidality with Secukinumab in a Pooled Analysis of Data from 10 Clinical Studies in Moderate-to-Severe Plaque Psoriasis

Abstract

Concerns have emerged over the potential for brodalumab, a monoclonal antibody that binds to the human interleukin (IL)-17 receptor A and blocks the activity of multiple IL-17 isoforms, to increase risk of suicidal ideation and behaviour. Although the validity of this association has been questioned,^1,2 brodalumab has a boxed warning regarding suicidality in its US label and is only available through a Risk Evaluation and Mitigation Strategy. Regardless of the true association between suicidality and brodalumab, the demonstrated adverse impact of psoriasis on mental health necessitates careful assessment for possible psychiatric adverse effects of psoriasis therapies, including those that inhibit the IL-17 pathway.

This article is protected by copyright. All rights reserved.

The prevalence of psychological co-morbidity in people with vitiligo: a systematic review and meta-analysis

Abstract

Background

Vitiligo is a chronic disorder causing skin depigmentation with global prevalence varying from 0.2 to 1.8%. UK guidelines recommend assessment of psychological state during clinical evaluation of vitiligo. However, the prevalence of psychological co-morbidity in people with vitiligo has not been described.

Objectives

We aimed to establish the prevalence of psychological symptoms or disorders in people with vitiligo and describe the outcome measures used.

Methods

We performed a comprehensive search of MEDLINE, Embase, CINAHL and PsychInfo to identify observational studies assessing the prevalence of psychological symptoms or disorders (December 2016). DerSimonian and Lard random-effects models were utilized to estimate the overall pooled prevalence.

Results

We identified 29 studies with 2530 people with vitiligo. Most studies included a measure of either depression (n=25) or anxiety (n=13).The commonest tools were the Hospital Anxiety and Depression Scale and the Centre for Epidemiology Studies Depression Scale. Ten studies provided information on thirteen other psychological outcomes. Pooled prevalence using depression-specific and anxiety-specific questionnaires was 0.29 (95%CI 0.21, 0.38) and 0.33 (95%CI 0.18, 0.49) respectively. Prevalence was lower for clinically diagnosed depression (0.21; 95%CI 0.15, 0.28) and anxiety (0.15; 95%CI 0.06, 0.24). When non-specific tools were used the prevalence remained similar for depression (0.27; 95%CI 0.08, 0.46) but increased for anxiety (0.46; 95% CI 0.39, 0.52). High heterogeneity was observed.

Conclusions

A range of psychological outcomes are common in people with vitiligo. The prevalence of anxiety was influenced by type of screening tool, suggesting validation of psychological outcome screening tools in the field of dermatology.

This article is protected by copyright. All rights reserved.

Low dose naltrexone: a novel treatment for Hailey-Hailey disease

Summary

Hailey-Hailey disease (chronic benign familial pemphigus) is a rare inherited dermatosis typically characterised by erosions at intertriginous sites preceded by minor trauma or stress. We report a case of treatment resistant Hailey-Hailey disease, having failed topical and oral steroids, prophylactic acyclovir and doxycycline, and systemic therapies including dapsone, acitretin and ciclosporin. Low dose naltrexone (LDN) 4.5mg one daily was commenced following an incidental benefit in this patient's similarly affected sister. The clinical and psychological response to date has been considerable.

This article is protected by copyright. All rights reserved.

Involvement of Zizimin2/3 in the age-related defect of peritoneal B-1a cells as a source of anti-bacterial IgM

Abstract

Zizimin2 (Ziz2), also known as dedicator of cytokinesis 11 (DOCK11), is a guanine nucleotide exchange factor that is predominantly expressed in lymphoid tissues. Recent findings demonstrated that Ziz2 is involved in the development of B cells, including germinal centre B cells and marginal zone B cells. However, limited information is currently available on the roles of Ziz2 in B-1 cells, a B-cell subset that resides in body cavities and contributes to protection against foreign pathogens in a T cell-independent manner. We herein show that Ziz2 and its widely-expressed isoform Ziz3 (also known as DOCK10) may be involved in defective production of anti-bacterial IgM by aged B-1a cells, a CD5 ⁺ subset of B-1 cells. Natural IgM against typical bacterial epitopes was defectively produced by peritoneal B-1a cells from aged mice. The down-regulation of Ziz2/3 in B-1a cells appeared to be responsible for this defective IgM production, as demonstrated by Ziz2/3 double knockout mice. Mechanistically, lower levels of basal AKT phosphorylation did not allow for the differentiation of Ziz2/3-deficient B-1a cells into plasma cells. Defective production of anti-bacterial IgM was not fully rescued by immunization, resulting in slightly weaker protection in Ziz2/3-deficient mice. Thus, the down-regulation of Ziz2/3 in B-1a cells may at least partly account for defective protection in aged mice.

Tracheal Tube Blockage by Fractured Middle Turbinate During Nasal Intubation: A Rare Airway Complication

Tympanosclerosis

Items: 35

1.

Figure 4. From: Tympanosclerosis Presenting as Mass: Workup and Differential.

Endoscopic view of typical appearing tympanosclerosis in a right ear. Note the white plaque present within the substance of the eardrum. The middle ear is aerated (image courtesy of Dr. Abraham Jacob, MD).

Jonnae Y. Barry, et al. Case Rep Otolaryngol. 2016;2016:9821493.

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2.

FIG. 8. From: A Mosaicking Approach for In Vivo Thickness Mapping of the Human Tympanic Membrane Using Low Coherence Interferometry.

Mosaicking results for a TM with tympanosclerosis. A Video-otoscope image of the TM showing a chalky white patch with irregular boundaries, characteristic of tympanosclerosis. B Mosaicked image obtained over the region enclosed by orange dashed box in (A). C Thickness distribution map overlaid on the mosaicked image (thickness values in μm).

Paritosh Pande, et al. J Assoc Res Otolaryngol. 2016 Oct;17(5):403-416.

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3.

Figure 1. Figure 1a: Central defect of the ear drum on a right ear in a 14-year-old child with tympanosclerosisat the anterior portion (*); b: Intraoperative removal of plaques from the eardrum; c: Reconstruction of the eardrum in underlay technique with cartilage-perichondrium-transplant. From: Diseases of the middle ear in childhood.

Amir Minovi, et al. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2014;13:Doc11.

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4.

Fig. 20. From: External and middle ear diseases: radiological diagnosis based on clinical signs and symptoms.

Chronic middle ear inflammation. Axial CT in bone window demonstrates focal calcifications (arrow) in the tympanic cavity, close to ossicular chain. This is called tympanosclerosis

Agnieszka Trojanowska, et al. Insights Imaging. 2012 Feb;3(1):33-48.

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5.

Fig 6. Calcification of middle ear structures (or tympanosclerosis) in Enpp1asj/asj mice.. From: Ectopic Mineralization and Conductive Hearing Loss in Enpp1asj Mutant Mice, a New Model for Otitis Media and Tympanosclerosis.

In the control mice (A), the outer ear canal is clear without any discharge. The tympanic membrane appears to be transparent and malleus (blue asterisk) is clearly visible. In the age matched mutant mice (B), surrounding bone must be removed to expose the tympanic membrane, most of which is completely covered by discharge. White patches (inside black dashed lines) were observed on the tympanic membrane of the mutant mice (B). The ossicle bones of the age matched control and mutant mice appear to have similar morphology (C-D), but malleus and incus are fused in the mutant mice (D, red arrow). M: Malleus; I: Incus; S: Stapes. Alizarin red staining reveals extensive mineralization in the stapedial artery wall (green asterisk) in Enpp1as/asjj mice (F), but not in the control mice (E).

Cong Tian, et al. PLoS One. 2016;11(12):e0168159.

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6.

Figure 12. From: Ear-Canal Reflectance, Umbo Velocity and Tympanometry in Normal Hearing Adults.

Examples of power reflectance and umbo velocity for subjects with normal audiograms but with tympanometric or anatomical abnormalities: (a & c) hypermobile TM with static compliances of 4 cc (S002 Left) and 3.4 cc (S002 Right), plus 2 measurements from ; (b & d) Three ears with tympanosclerosis and normal hearing.

John J Rosowski, et al. Ear Hear. ;33(1):19-34.

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7.

Figure 2. From: Assessment of Ear Disorders Using Power Reflectance.

(A) Right and left ears from one subject () (Reprinted with permission from Rosowski, J.J., et al., Ear and Hearing, 33, 19–34. Copyright (2012)) and 2 ears presented by (Reprinted with permission from Feeney, M.P., et al., Journal of Speech, Language and Hearing Research, 46, 901–911. Copyright (2003). These ears had normal audiograms but abnormally compliant tympanograms. (B) Three ears with tympanosclerosis and normal audiograms. In both plots, comparison is made to the shaded area representing one standard deviation above and below the mean PR of 58 normal ears. This figure was published in (Reprinted with permission from Rosowski, J.J., et al., Ear and Hearing, 33, 19–34. Copyright (2012).

Hideko Heidi Nakajima, et al. Ear Hear. ;34(7 0 1):48s-53s.

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8.

Figure 1. From: Experience with the Vibrant Soundbridge RW-Coupler for round window Vibroplasty with tympanosclerosis.

Round window (RW)-Coupler. The RW-Coupler was provided by MED-EL Co.

Satoshi Iwasaki, et al. Acta Otolaryngol. 2012 Jun;132(6):676-682.

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9.

Fig. 2. A: Intraoperative findings. Tegmen (black arrow) and a well-cleavable mass (white arrow) in the epitympanum. B: Incus (white arrow) aggregating massive tympanosclerotic plaque (white arrowhead) in the mesotympanum.. From: Neuroglial Choristoma of the Middle Ear with Massive Tympanosclerosis: A Case Report and Literature Review.

Hyun Joon Shim, et al. J Audiol Otol. 2016 Dec;20(3):179-182.

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10.

Figure 2. From: Experience with the Vibrant Soundbridge RW-Coupler for round window Vibroplasty with tympanosclerosis.

Otoscopic findings of tympanic membrane. The right external auditory canal was expanded (A) and sclerotic lesion was found in the left tympanic membrane (B).

Satoshi Iwasaki, et al. Acta Otolaryngol. 2012 Jun;132(6):676-682.

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11.

Figure 3. From: Experience with the Vibrant Soundbridge RW-Coupler for round window Vibroplasty with tympanosclerosis.

Pure-tone audiogram. (A) Bilateral mixed hearing loss was present. (B) Left hearing level was not changed after the VSB surgery.

Satoshi Iwasaki, et al. Acta Otolaryngol. 2012 Jun;132(6):676-682.

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12.

Figure 1. From: Tympanosclerosis Presenting as Mass: Workup and Differential.

(a) View of the right tympanic membrane and lesion (arrow) utilizing the operating microscope. (b) Intraoperative view of the lesion (long arrow) within the lifted tympanic membrane (asterisk) and the underlying malleus (short arrow) (images courtesy of Dr. Abraham Jacob, MD).

Jonnae Y. Barry, et al. Case Rep Otolaryngol. 2016;2016:9821493.

CitationFull text

13.

Figure 6. From: Experience with the Vibrant Soundbridge RW-Coupler for round window Vibroplasty with tympanosclerosis.

Floating mass transducer (FMT) with round window (RW)-Coupler placement in the RW. The FMT attached with RW-Coupler was placed in the RW (A) after good fitting of the RW-Coupler (arrow) was confirmed (B). The FMT was wrapped in perichondrium (C).

Satoshi Iwasaki, et al. Acta Otolaryngol. 2012 Jun;132(6):676-682.

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14.

Figure 7. From: Experience with the Vibrant Soundbridge RW-Coupler for round window Vibroplasty with tympanosclerosis.

X-P finding of floating mass transducer (FMT) placement after VSB surgery. Good placement of the FMT with the round window (RW)-Coupler was confirmed. Scheme of X-P is shown. Lscc, lateral semicircular canal; Sscc, superior semicircular canal.

Satoshi Iwasaki, et al. Acta Otolaryngol. 2012 Jun;132(6):676-682.

CitationFull text

15.

Figure 4. From: Experience with the Vibrant Soundbridge RW-Coupler for round window Vibroplasty with tympanosclerosis.

CT scan of region of the round window (RW) in our case. (A) Right ear, (B) left ear, and (C) control case. The RW in our case was remarkably small compared with the control case. The diameter of the RW is shown as arrowheads in the schematic representation.

Satoshi Iwasaki, et al. Acta Otolaryngol. 2012 Jun;132(6):676-682.

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16.

Figure 1.Polymerase Chain Reaction Positivity for Helicobacter pylori. From: Correlation Between Tympanosclerosis and Helicobacter pylori.

L = ladder (100 bp), P = positive control, Lanes are numbered in the following order from 1 to 2: case H. Pylori-positive (286 bp), case H. Pylori-negative.

Nader Saki, et al. Jundishapur J Microbiol. 2015 Oct;8(10):e16069.

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17.

Figure 2.Polymerase Chain Reaction Positivity for Helicobacter pylori. From: Correlation Between Tympanosclerosis and Helicobacter pylori.

L = ladder (100 bp), P = positive control, Lanes are numbered in the following order from 1 to 3: case H. Pylori-positive (630 bp), negative control, case H. Pylori-negative.

Nader Saki, et al. Jundishapur J Microbiol. 2015 Oct;8(10):e16069.

CitationFull text

18.

Figure 5. From: Experience with the Vibrant Soundbridge RW-Coupler for round window Vibroplasty with tympanosclerosis.

Warble tone threshold level. Compared with the threshold level of the conventional hearing aid (A), the threshold level of the VSB at the first fitting was improved at the high frequencies (B). After refitting, amplification at the low frequencies was elevated (C).

Satoshi Iwasaki, et al. Acta Otolaryngol. 2012 Jun;132(6):676-682.

CitationFull text

19.

Fig. 1. A: Axial temporal bone computed tomography demonstrates soft tissue density with massive calcification in the middle ear (black arrow). B: Coronal temporal bone computed tomography demonstrates bony erosion of the tegmen tympani (white arrow).. From: Neuroglial Choristoma of the Middle Ear with Massive Tympanosclerosis: A Case Report and Literature Review.

Hyun Joon Shim, et al. J Audiol Otol. 2016 Dec;20(3):179-182.

CitationFull text

20.

Figure 3. From: Tympanosclerosis Presenting as Mass: Workup and Differential.

(a) Hematoxylin and eosin stained light microscopy obtained from the right ear mass (10x). Fibrous infiltrate, hyaline degeneration, and calcification (arrow) without presence of squamous epithelium are seen. (b) 20x view with black arrows demonstrating giant cell reaction (images courtesy of Sarah Tang, PSF).

Jonnae Y. Barry, et al. Case Rep Otolaryngol. 2016;2016:9821493.

CitationFull text

21.

Figure 2. From: Tympanosclerosis Presenting as Mass: Workup and Differential.

(a) Axial bone windowed temporal bone CT scan showing a 3-4 mm hyperdense lesion (arrow); the middle ear is aerated. (b) Coronal bone windowed temporal bone CT scan showing a 3-4 mm lesion lateral to the neck of the malleus (arrow). The scutum (lateral wall of epitympanum) is free of bone erosion (images courtesy of Banner University Medical Center).

Jonnae Y. Barry, et al. Case Rep Otolaryngol. 2016;2016:9821493.

CitationFull text

22.

Figure 8. From: Experience with the Vibrant Soundbridge RW-Coupler for round window Vibroplasty with tympanosclerosis.

Diameter of the round window (RW) by radiologic evaluation of CT scan. The diameter was measured on the inferior edge of the RW in the transverse slice in the left ear. This case (black square) was remarkably small compared with control cases (black circles). Patients with sensorineural hearing loss were measured as control cases.

Satoshi Iwasaki, et al. Acta Otolaryngol. 2012 Jun;132(6):676-682.

CitationFull text

23.

Figure 5. Calcium depositions in the middle ear mucosa.. From: Combining Use of Captopril and Losartan Attenuates the Progress of Streptococcus pneumoniae-Induced Tympanosclerosis through the Suppression of TGF-β1 Expression.

Original magnification, ×400. No obvious calcium deposition is shown in the normal middle ear mucosa of guinea pigs (A) and rats (D). Calcium depositions are appeared as brown yellow granules in TS middle ear mucosa of guinea pigs (B) and rats (E). After captopril and losartan treated, calcium deposition is selodom displayed in guinea pigs (C) and in rats (F). Arrow: calcium deposition.

Wenqing Yan, et al. PLoS One. 2014;9(10):e111620.

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24.

Fig. 3. Histologic features of the lesion. A: The frozen biopsy specimen comprising scattered mononuclear cells of various sizes and shapes against a fibrillary background (H&E, ×200). B: Immunohistochemical staining revealed immunopositivity for glial fibrillary acidic protein staining (×200). C: Calcific lesion with woven bone formation and fibrous area (H&E, ×40).. From: Neuroglial Choristoma of the Middle Ear with Massive Tympanosclerosis: A Case Report and Literature Review.

Hyun Joon Shim, et al. J Audiol Otol. 2016 Dec;20(3):179-182.

CitationFull text

25.

Figure 3. Morphological changes of middle ear mucosa in guinea pigs.. From: Combining Use of Captopril and Losartan Attenuates the Progress of Streptococcus pneumoniae-Induced Tympanosclerosis through the Suppression of TGF-β1 Expression.

Hematoxylin and eosin, original magnification, A, B, C: ×100 and D, E, F: ×400. Normal morphological structure of middle ear mucosa is shown in (A, D). (B, E): In TS group, significantly increased thickness, inflammatory cell infiltration, fibroblast proliferation and vascularization are illuminated. (C, F): In captopril and losartan treated group, the stroma is much thinner and vascularization is reduced than that in the TS group. Double-headed arrow: membrane thickness; arrow: vascularization.

Wenqing Yan, et al. PLoS One. 2014;9(10):e111620.

CitationFull text

26.

Fig 5. Scanning electron micrographs of epithelium lining the middle ear cavity.. From: Ectopic Mineralization and Conductive Hearing Loss in Enpp1asj Mutant Mice, a New Model for Otitis Media and Tympanosclerosis.

Compared with littermate controls (A), the middle ear epithelium in 1-month-old Enpp1asj mutant mice (B) shows an increased number of goblet cells (red asterisks). Scattered goblet cells (green asterisks) and cilia are seen in the mucociliary epithelia of control mice at 6-months of age (C); however, a layer of mucin obscures most cilia and goblet cells (arrows) in age-matched Enpp1asj mutant mice (D). Scale bars = 25μm.

Cong Tian, et al. PLoS One. 2016;11(12):e0168159.

CitationFull text

27.

Figure 6. IHC determination of TGF-β1 in the middle ear mucosa.. From: Combining Use of Captopril and Losartan Attenuates the Progress of Streptococcus pneumoniae-Induced Tympanosclerosis through the Suppression of TGF-β1 Expression.

Original magnification, ×400. Few positive cells are observed in normal middle ear mucosa of the guinea pigs (A) and rats (D). Only some positive cells are seen in epithelial cells. In the TS group of the guinea pigs (B) and the rats (E), numerous positive cells are displayed in fibroblasts and inflammatory cells, and mainly locate in cytoplasm of fibroblasts and inflammatory cells. Only few positive cells could be seen in captopril and losartan treated group of guinea pigs (C) and rats (F). Arrow: positive cells.

Wenqing Yan, et al. PLoS One. 2014;9(10):e111620.

CitationFull text

28.

Figure 4. Morphological changes of middle ear mucosa in rats.. From: Combining Use of Captopril and Losartan Attenuates the Progress of Streptococcus pneumoniae-Induced Tympanosclerosis through the Suppression of TGF-β1 Expression.

Hematoxylin and eosin, original magnification, A, B, C: ×100 and D, E, F: ×400 (A, D). Normal morphological structure is displayed in control group. (B, E) In TS group, inflammatory cell infiltration, fibroblast proliferation and vascularization can be seen, as well as significantly increased membrane thickness. (C, F) The two panels show that, in captopril and losartan treated group, not only inflammatory cells, neovascularization and collagen fibers are decreased, but also the stroma is much thinner than that of the TS group. Double-headed arrow: membrane thickness; arrow: vascularization.

Wenqing Yan, et al. PLoS One. 2014;9(10):e111620.

CitationFull text

29.

Figure 2. The role of captopril and losartan on auditory function in rat models.. From: Combining Use of Captopril and Losartan Attenuates the Progress of Streptococcus pneumoniae-Induced Tympanosclerosisthrough the Suppression of TGF-β1 Expression.

(A) In control group, normal hearing threshold can be seen at 10 dB. (B) The hearing threshold is evidently increased in TS group with strong response at 60 dB. (C) After captopril and losartan treated, obvious improvement of hearing threshold is displayed, as clear waveforms shown at 35 dB. (D) This graph shows ABR thresthold amplitudes in rats of three different groups. Each bar represents the mean ± SEM, n = 19 (each of the three groups). *p<0.05, **p<0.01 as conducted.

Wenqing Yan, et al. PLoS One. 2014;9(10):e111620.

CitationFull text

30.

Fig 4. Increased density of goblet cells in Enpp1asj/asj mice.. From: Ectopic Mineralization and Conductive Hearing Loss in Enpp1asj Mutant Mice, a New Model for Otitis Media and Tympanosclerosis.

Mayer's mucincarmine method was used to visualize goblet cells (stained red) in the epithelia lining the Eustachian tube (A, B) and middle ear cavity (C, D) of mutant and control mice. A, B: Few goblet cells are seen in the epithelia lining the Eustachian tube of littermate control mice (A, empty arrow points to Eustachian tube, insert shows higher magnification of the Eustachian tube epithelia). By contrast, goblet cells are present at high density in the epithelium lining the Eustachian tube of Enpp1asj mutant mice (B, empty arrow points to Eustachian tube, magnified inset shows goblet cells, marked by arrows, in the Eustachian tube epithelia). C, D: More goblet cells are present in the epithelia in the middle ear cavity (MEC) of the asj mutant mouse (arrows in D) than in the control (C). Scale bars: A, B = 200 μm, C, D = 50 μm, A and B inserts = 20 μm.

Cong Tian, et al. PLoS One. 2016;11(12):e0168159.

CitationFull text

31.

Figure 7. Westeron blot and qRT-PCR detetion of TGF-β1 in the middle ear mucosa.. From: Combining Use of Captopril and Losartan Attenuates the Progress of Streptococcus pneumoniae-Induced Tympanosclerosisthrough the Suppression of TGF-β1 Expression.

Expression changes of TGF-β1 in protein level are obviously observed in all groups of guinea pig (A) and rat (B). (C) In guinea pig group, statistic analysis reveals that TGF-β1 is increased in TS group, decreased in captopril and losartan treated group but still higher than that of the control group. The same tendency also can be seen in rats group (D). (E) Expression of TGF-β1 in RNA level increases in TS group, and decreases in captopril and losartan treated group at the end of week 6. Each bar represents the mean percent ± SEM, n = 19 (each of the three groups). *p<0.05, **p<0.01 as conducted.

Wenqing Yan, et al. PLoS One. 2014;9(10):e111620.

CitationFull text

32.

Figure 1. The effect of captopril and losartan on the hearing ability in guinea pig models of TS.. From: Combining Use of Captopril and Losartan Attenuates the Progress of Streptococcus pneumoniae-Induced Tympanosclerosis through the Suppression of TGF-β1 Expression.

The X-axis represents time in milliseconds and Y-axis represents amplitude of the action potentials in microvolts. Each waveform, at a declining dB level to examine response, is stacked onto the same graph. (A) ABR threshold from the control group recorded at week 6. This panel displays a much stronger response to the stimulus and clear waveforms at 10 dB. (B) In TS group, no strong response is shown even at 60 dB. (C) Obvious response can be seen at 30 dB in a guinea pig of the captopril and losartan treated group. The graph in (D) shows ABR thresthold amplitudes in guinea pigs of three different groups. Each bar represents the mean ± standard error of the mean (SEM), n = 19 (the control group), n = 17 (the TS group), n = 19 (the captopril and losartan treated group). *p<0.05, **p<0.01 as conducted.

Wenqing Yan, et al. PLoS One. 2014;9(10):e111620.

CitationFull text

33.

Fig 1. Progressive hearing loss in Enpp1asj/asj mice.. From: Ectopic Mineralization and Conductive Hearing Loss in Enpp1asj Mutant Mice, a New Model for Otitis Media and Tympanosclerosis.

ABR threshold means are shown for Enpp1asj/asj mice and littermate control mice, tested at the ages of 3 (n = 6 mutant ears/8 control ears), 6 (n = 10/10), 8 (n = 6/6), 12 (n = 22/16), 18 (n = 8/6), 26 (n = 10/8), and 30 (n = 12/14) weeks. Starting from 6 weeks of age, the mutant mice exhibit significantly higher mean ABR threshold values at all the stimulus frequencies tested (click, 8 kHz, 16 kHz, 32 kHz) compared to those of the littermate controls. Thresholds of mutant mice continue to increase with age and by 18 weeks most of the Enpp1asj/asj mice are profoundly hearing impaired. The increase in 32 kHz ABR thresholds of the control mice is due to the B6 background, a strain known to exhibit age-related hearing loss starting at high frequencies. Error bars indicate standard errors of the mean.

Cong Tian, et al. PLoS One. 2016;11(12):e0168159.

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34.

Fig 2. Otitis media in Enpp1asj/asj mice.. From: Ectopic Mineralization and Conductive Hearing Loss in Enpp1asj Mutant Mice, a New Model for Otitis Media and Tympanosclerosis.

A, B: Representative images of pathological changes in the middle ears of Enpp1asj mutant mice (B) compared with controls (A) at the age of 5 months. The middle ear cavity (MEC) of Enpp1asj mutant mice is filled with effusions (black asterisk), fibroblastic and amorphous tissue masses (long arrows), and inflammatory cells (arrow head). Ectopic mineralization of the otic capsule is also evident in mutant mice (open arrow in B). Control mice show a clear middle ear cavity without fibroblastic proliferation (A). C, D: The thickness of the middle ear epithelium (double headed arrows) is greater in Enpp1asj mutant mice (D) than controls (C). E, F: The stapedial artery wall (arrows) is thicker in Enpp1asjmutant mice (F) than controls (E). G, H: Representative images of discharge in mutant mice (H) and littermate controls (G) at the age of 5 months. The external ear cavity of the mutant mice is filled with discharge (red asterisk), while control mice have a clear external ear canal and easily observable tympanic membrane (black asterisk). Scale bars: A, B = 200μm, C, D = 50μm, E, F = 80 μm.

Cong Tian, et al. PLoS One. 2016;11(12):e0168159.

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35.

Fig 3. Development of otitis media in Enpp1asj/asj mice.. From: Ectopic Mineralization and Conductive Hearing Loss in Enpp1asj Mutant Mice, a New Model for Otitis Media and Tympanosclerosis.

A-D: 6–12 week time course of middle ear pathology of Enpp1asj mutant mice (B, C, D) compared with a 12-week-old control (A). At 6 weeks of age (B), an aqueous effusion (black asterisk) and a slightly thickened epithelium (arrow) are observed in the middle ear cavity of the Enpp1asj mutant mice. At 8 weeks (C), the middle ear cavity of the Enpp1asjmutant mouse is filled with an aqueous effusion (black asterisk) and contains amorphous tissue masses (green asterisk). The middle ear epithelium is much thickened (arrow), and the otic capsule exhibits regions of ectopic mineralization (arrowhead) with adjacent fibroblastic proliferation. At 12 weeks (D), the middle ear cavity of mutant mice is filled with pus-like secretions (black asterisk), a thickened epithelium (arrows), and an amorphous tissue mass (green asterisk). E, F: Eustachian tube morphology of mutant (F) and control (E) mice at 12 weeks of age. In mutant mice, an amorphous tissue mass (green asterisk) is present near the orifice of the Eustachian tube (empty arrow), which may impede Eustachian tube function and lead to an accumulation of effusion in the middle ear cavity. G, H: Cochlear morphology and round window membranes of mutant (H) and control (G) mice. Cochlear morphology is grossly normal in Enpp1asjmutant mice compared with controls; however, the round window membrane (black arrow) of mutant mice is thicker. MEC: middle ear cavity. Scale bars: A, B, C, D, E, F = 200μm, G, H = 100μm.

Cong Tian, et al. PLoS One. 2016;11(12):e0168159.

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