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Παρασκευή 20 Οκτωβρίου 2017

Cutaneous atypical papular CD8+ lymphoproliferative disorder at acral sites in a renal transplant patient

Summary

A 20-year-old woman presented with a 2-month history of an acute symmetrical eruption, manifesting as asymptomatic ill-defined erythematous macules and hyperkeratotic papules on the palms. The patient was a renal transplant recipient, and the lesions had developed 2 months post-transplantation. Histologically, the eruption shared features of a reactive inflammatory condition called papular eruption of atypical CD8+ lymphocytes as well as primary cutaneous acral CD8+ T-cell lymphoma (a provisional indolent entity in the new World Health Organisation classification of lymphoid neoplasms, 2016). The latter disorder has been described to occur at acral sites in immunocompetent patients, whereas the former has previously been described only in patients infected with human immunodeficiency virus. The lesions in our patient healed after topical treatment with corticosteroids and alteration of immunosuppressive therapy, supporting the role of immunosuppression in this case. We classified our patient's condition as lying in the spectrum of the aforementioned two conditions, but the relationship between both diseases remains to be clarified. Awareness of these unusual conditions may prevent the use of unnecessary aggressive therapies in similar patients.



A new endoscopic technique to close big nasal septal perforations: prospective evaluation of the double meat hook technique in 19 consecutive cases

Abstract

Despite the variety of surgical techniques available to close big symptomatic septum perforations, closure rates of 30 to 70% indicate the difficulty of obtaining a good end result.

The double meat hook technique is a new endoscopically assisted technique that delivers excellent visualization and control of mucosal flap elevation, extension and suturing.

Mucosa from the nasal floor, lateral nasal wall and inferior turbinate bone are valuable donor site extensions.

There is no need for additional incisions into the nasal septal mucosa in order to perform a tension-free closure. Preservation of the structural integrity and blood supply of the mucosal flaps, possibly contributes to a high closure rate and delivers a physiological result.

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Current Use of Baseline Medical Treatment in Chronic Rhinosinusitis: Data from the National Chronic Rhinosinusitis Epidemiology Study (CRES)

Abstract

Objectives

According to clinical and comissioning guidelines for chronic rhinosinusitis (CRS), patients being referred to secondary care should have failed primary medical treatment with nasal douching (ND) and intranasal corticosteroids (INCS). The study objectives were to identify the rate of specific medical therapy in CRS patients and establish any differences in medication use, for both CRS and associated medical conditions, between CRS phenotypes.

Design and setting

Case-control study in a secondary care setting.

Methods

Participant-reported study-specific questionnaire capturing free text data on current medication use at the time of study entry. Qualitative interviews with 21 participants also explored their experience of CRS and its management.

Particpants

Patients with both without (CRSsNPs) and with polyps (CRSwNPs).

Main outcome measures

Reported use of CRS-related and non-related medications.

Results

Within a total of 1243 CRS participants, current INCS usage was low (18% in CRSwNPs, 12% in CRSsNPs); ND was being performed by only 1% of all participants. Bronchodilators and inhaled corticosteroids use was significantly higher in CRSwNPs participants (p < 0.0001). Antidepressants use was significantly higher in CRSsNPs (14% versus 7%, p < 0.0002). There were no significant regional variations in rates of INCS use, nor any significant influence of social deprivation.

Conclusions

The current use of baseline medical therapy in CRS appears to be very low, representing a combination of poor patient compliance, possible ineffectiveness of treatment and a lack of familiarity with current guidelines amongst general practitioners and some ENT specialists. Work is needed to disseminate guidelines to all practitioners involved and reduce unnecessary burden on existing healthcare resources for this common condition by ensuring timely referral and definitive management.

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Lenalidomide-Associated Thyroid-Related Eyelid Retraction.

Several antineoplastic treatments have been responsible for thyroid dysfunction and thyroid eye disease. Min, Vaidya, and Becker (2011) reported a case of euthyroid Graves orbitopathy after treatment with ipilimumab with the patient displaying proptosis and myositis in the setting of normal thyroid function tests and elevated thyroid antibodies. The authors report a case of a 76-year-old woman who developed right upper lid retraction and proptosis after 2.5 years of treatment with lenalidomide for multiple myeloma. Thyroid function tests were normal: thyroid-stimulating hormone 0.808 mIU/mL, total T3 102 ng/dL, free T4 1.48 ng/dL. Thyroid antibodies were elevated: thyrotropin receptor antibody 2.26 IU/L, thyroglobulin antibody 1043.1 IU/mL, and thyroid peroxidase antibody 38 IU/mL. A nuclear medicine thyroid scan was normal. Given the possible thyroid effects from lenalidomide, patients who receive this medication should be periodically evaluated for thyroid dysfunction and thyroid eye disease. (C) 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Investigación clínica en dermatología y venereología de centros e instituciones españolas, 2005-2014. Resultados del estudio MaINDH

Publication date: Available online 20 October 2017
Source:Actas Dermo-Sifiliográficas
Author(s): A. Molina-Leyva, M.A. Descalzo, I. García-Doval
Antecedentes y objetivoLos artículos de investigación clínica publicados en revistas científicas y los indicadores bibliométricos que de ellos derivan son un método útil para medir la cantidad y la calidad de la investigación clínica realizada. El objetivo de este estudio es conocer la cantidad, calidad y temática de la producción científica de centros e instituciones de dermatología españoles.Material y métodoEstudio bibliométrico de los artículos de investigación clínica con fecha definitiva de publicación entre el año 2005 al 2014, ambos inclusive, en las bases de datos Medline o Embase, en cuya dirección de autor de correspondencia figure un centro o institución de dermatología española y que cumplan los criterios de investigación clínica en dermatología.ResultadosDe los 8.617 artículos encontrados, 1.104 (12,81%) cumplieron los criterios de inclusión. El principal criterio de exclusión —67,37% de los artículos— fue tener un nivel de evidencia científico mayor de 4. La revista en la que se publicaron más artículos fue Actas Dermosifiliográficas con 326 artículos (29,53%). La enfermedad con un mayor número de artículos fue el melanoma, con 134artículos (12,13%).LimitacionesEl criterio para atribuir una publicación científica a una institución dermatológica española en función de la dirección del autor de la correspondencia hace que estudios en los que participan dermatólogos que trabajan en estudios dirigidos por instituciones no dermatológicas no sean incluidos.ConclusionesSolo una pequeña proporción de los artículos que publican las instituciones de dermatología españolas pueden ser considerados investigación clínica. El principal motivo es el bajo nivel de evidencia científica. La mayoría de las publicaciones son reportes de casos clínicos.Background and objectiveBibliometric indicators provide a useful measure of the number of clinical research articles published in scientific journals and their quality. This study aimed to assess the amount and quality of research carried out in Spanish dermatology centers and to describe the research topics.Material and methodBibliometric study of clinical research articles that met the inclusion criteria and had a definitive publication date between 2005 and 2014 in MEDLINE or Embase in which the corresponding author's affiliation was a Spanish hospital dermatology department or other center.ResultsOf 8,617 articles found, 1,104 (12.81%) met the inclusion criteria. The main reason for excluding articles was that they did not have an evidence level of 4 or better. The main vehicle for reporting was the journal Actas Dermosifiliográficas, which published 326 articles (29.53%). Melanoma, the disease the researchers studied most often, accounted for 134 articles (12.13%).LimitationsA limitation to bear in mind when interpreting the results is that we relied on the corresponding author's affiliation to identify articles reflecting research from a Spanish dermatology center. Thus, studies in which dermatologists participated would not be recognized if they were directed by other specialists.ConclusionOnly a small portion of articles published from Spanish dermatology centers can be considered clinical research, mainly because many publications provide a low level of scientific evidence. Most publications are case reports.

Graphical abstract

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A Technique for Reduction of Edentulous Fractures Using Dentures and SMARTLock Hybrid Fixation System

imageSummary: Establishing anatomic reduction of an edentulous mandible fracture is a frequently acknowledged challenge in craniomaxillofacial trauma surgery. In this study, we report a novel method for the reduction of the edentulous mandible fracture, via fabrication of modified Gunning splints using existing dentures and SMARTLock hybrid arch bars. This technique dramatically simplifies the application of an arch bar to dentures, obviates the need for the fabrication of impressions and custom splints, and eliminates the lag time associated with the creation of splints. Furthermore, this method may be used with or without adjunctive rigid internal fixation. The technique described herein of creating Gunning splints with SMARTLock hybrid arch bars provides surgeons with a simple, rapid, single-stage solution for reduction of mandibular fractures in the edentulous patient.

Immediate Nipple-Areolar Complex Reconstruction for Patients Undergoing Implant-Based Reconstruction or Therapeutic Mammoplasty

imageBackground: We report a technique of immediate nipple-areolar complex (NAC) reconstruction for patients undergoing skin-sparing mastectomy and implant-based breast reconstruction or therapeutic mammoplasty with central excision. Methods: Immediate nipple reconstruction is performed using a modified C-V flap planned along the edge of the incision. The areola is reconstructed using a full-thickness skin graft taken from skin usually discarded during the procedure. Immediate NAC reconstruction using this technique was performed on 32 breasts in 21 patients. This included 19 risk-reducing mastectomies, 9 therapeutic mastectomies, and 2 major revisions to existing implant reconstruction. Reconstruction was direct to implant in 29 breasts and by expander in 1 breast. The device was placed in a pre- or post-pectoral plane utilizing dermal sling and/or acellular dermal matrix as determined on a case-by-case basis. Immediate NAC reconstruction was also performed on 2 patients undergoing therapeutic mammoplasty with central excision. Results: Mean follow-up is 12 months (5–27 months), and cosmetic results have been good. There have been no significant complications, and no revisional surgery has been required. Conclusion: The application of simple techniques for NAC reconstruction in the primary procedure allows reconstruction of the whole breast in a single stage. There is an immediate focal point to the reconstruction to improve cosmesis, patient satisfaction, and psychosocial function without delay.

Characterization of Melanosomes and Melanin in Japanese Patients with Hermansky-Pudlak Syndrome Types 1, 4, 6 and 9

Abstract

Hermansky-Pudlak syndrome (HPS) is an autosomal recessive disorder characterized by oculocutaneous albinism (OCA), a bleeding tendency and ceroid deposition. Most of the causative genes for HPS encode subunits of the biogenesis of lysosome-related organelles complex (BLOC). In this study, we identified one patient each with HPS4, HPS6 and HPS9 by whole-exome sequencing. Next, we analyzed hair samples from the three patients and representative patients with HPS1 and controls using electron microscopy and chemical methods. All HPS patients had fewer, smaller and more immature melanosomes than healthy controls. Further, all patients showed reduced total melanin content and increased levels of benzothiazine-type pheomelanin. The results of this study demonstrate the impact of the dysfunctions of BLOCs on the maturation of melanosomes and melanin levels and composition through analysis of their hair samples.

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Nuances in component nasal hump reduction

Nasal hump reduction is a frequent manoeuver in rhinoplasty. Over the last years, composite hump reduction has been advocated in favour of component hump reduction. The latter allows a more controlled and stepwise approach in reducing the nasal dorsum by deprojecting the cartilaginous dorsum separately from the bony dorsum. This approach also preserves the upper lateral cartilages (ULCs) and their mucosa.

Anthropometric growth study of the ear in a chinese population

A large number of anthropometric studies of the auricle have been reported in different nations, but little data are available in the Chinese population. The aim of this study was to analyze growth changes in the ear by measuring the width and length of ears in a Chinese population.

Mammaplasty in patients with large areola: reducing the nipple-areola complex using intra-areolar incisions

Minimal incision breast reduction techniques resulting in periareolar scars are widely used. However, this technique is less suitable for patients with large areola diameters and relatively small breasts, requiring a modest reduction or lift only. As a result of the large nipple-areola-complex larger amounts of skin must be removed in order to resect the complete peripheral areola, increasing the risk of high-riding nipples, breast flattening and incomplete areola resection resulting in a rest on the vertical scar.

Post-operative care of VRAM flaps for perineal reconstruction: results of a UK practice survey and literature review

The trans-pelvic vertical rectus abdominis myocutaneous (VRAM) flap has shown considerable utility in the reconstruction of pelvic defects following abdomino-perineal excision (APE) or total pelvic exenteration (TPE) for pelvic malignancy. These patients are often nursed post-operatively on colorectal wards, or even in outlying hospitals in those Plastics units operating on a hub-and-spoke basis. Protocols for the post-operative care of free flap reconstruction patients are well established and have been shown to reduce major complications1,2.

The scrotal free flap: first successful clinical application of a free Super-Thin External Pudendal Artery (STEPA) flap for reconstruction of a foot defect

Dear Editor,

External validation of a cancer risk prediction model for suspected head and neck cancer referrals

Abstract

Head and neck cancer (HNC) affects more than 9000 new patients every year in England and Wales with an additional 1200 in Scotland. 1,2 Patients are urgently referred to head and neck clinics for further assessment when a suspicion of cancer is raised in the primary care setting. In England, the referral criteria are based on the NICE recommendations for symptoms associated with HNC. 2 A different combination of symptoms is described in the Scottish cancer referral guidelines. 3 There is currently no unified referral proforma across the different UK cancer networks.

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A review of periorbital cellulitis guidelines in Fifty-One Acute Admitting Units in the United Kingdom

Abstract

Periorbital cellulitis is an acute infection of the periorbital soft tissues with potential sight and life threatening complications that most commonly occurs in children[1]. Post-septal abscess formation can cause loss of sight; furthermore, posterior spread of infection may progress to cavernous sinus thrombosis and intracranial infection[1, 2]. In England April 2014-March 2015, 3687 patients attended hospital with periorbital cellulitis costing the National Health Service over £9.5 million per annum before considering the cost of treating its complications[3].

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Post-operative corticosteroid irrigation for chronic rhinosinusitis after endoscopic sinus surgery: a meta-analysis

Abstract

Background

Recently, topical steroid therapy delivery using high-volume sinonasal irrigations has been used more frequently, following endoscopic sinus surgery (ESS), to improve drug delivery into the paranasal sinuses.

Objective

The goal of this study was to perform a systematic review with meta-analysis of the efficacy of steroid nasal irrigation on postoperative management of CRS following ESS.

Methods

Five databases (PubMed, SCOPUS, Embase, Web of Science, and the Cochrane database) from inception to March 2017 were independently reviewed by two researchers. Studies that scored CRS endoscopic findings and CRS-related quality of life postoperatively before and after steroid nasal irrigation, and that compared the effects of steroid nasal irrigation (treatment groups) with saline alone irrigation (control group) were included in the analysis.

Results

Twelve studies (n=360) met inclusion criteria. Steroid nasal irrigation significantly reduced the endoscopic score compared with pretreatment values and also improved quality of life. Adverse effects following steroid nasal irrigation such as increased intraocular pressure and hypothalamus-pituitary-adrenal axis disturbance were not significant. However, compared with saline alone irrigation, the additional effects of steroid irrigation were not significant in the view of the endoscopic score and disease-specific quality of life.

Conclusion

Although steroid nasal irrigation would not induce adverse effects related to systemic steroid absorption, the beneficial effects of additional steroids in saline irrigation were ambiguous in regards to endoscopic score and CRS-related quality of life improvement compared with saline alone irrigation. However, further clinical trials with robust research methodologies should be conducted to confirm the results of this study.

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Influence of Backside Loading on the Floating Mass Transducer: an in vitro experimental study

Abstract

Hypothesis

The vibration of the floating mass transducer (FMT) of a single active middle-ear implant (AMEI) is distinctly influenced by the properties of the material coupled to its back side.

Background

In round window vibroplasty, the FMT needs to be padded against the surrounding bone opposite from the round window membrane. This represents one factor influencing its performance as a round window driver. Therefore, we examined the effects of different materials linked to the back side of an FMT on its vibration range.

Methods

The back side of an FMT was glued to a silicone cylinder 1.0 mm in diameter and 1.0 mm – 1.5 mm in length and of 40A, 50A or 70A Shore hardness; to cartilage of equivalent size; or to a round window soft coupler (RWSC), all firmly fixed on a steel plate. The vibrations were determined by a laser Doppler vibrometer (LDV) measuring the velocity of the centre point on the front side of the FMT.

Results

The materials on the back side of the FMT significantly influenced the vibration range of the FMT. The RWSC and silicone of 40A Shore hardness allowed for the highest detected velocities, while cartilage led to a distinct reduction similarly to 70A silicone.

Conclusion

The coupling on the back side of an FMT distinctly affects its vibration range. In this regard, the RWSC and silicone of 40A Shore hardness yield the least impairment of vibration. Thus, the RWSC may be a feasible option in round window vibroplasty when additionally connected to the FMT opposite from the round window membrane.

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Efficacy of Laryngectomy alone for Treatment of Locally Advanced Laryngeal Cancer: A Stage and Subsite Specific Survival Analysis

Abstract

Objective

Total laryngectomy is a well-established treatment for locally advanced laryngeal cancer. Evidence for the benefit of post-operative radiotherapy after laryngectomy in patients with locally advanced primaries and N0 or N1 nodal disease is limited. This study aims to determine whether total laryngectomy alone is adequate therapy for certain patient subgroups with locally advanced laryngeal cancer.

Design

We performed a retrospective survival analysis of patients in the surveillance epidemiology and end results (SEER) database with locally advanced laryngeal cancer between 2004-2012.

Outcome Measures

Primary outcome measure was overall survival.

Results

For all patients with T3-4aN0-1 tumors, overall survival was worse for those treated with laryngectomy only when compared using the Kaplan-Meier with a Log-Rank test and when accounting for demographic and tumor data using a Cox multivariate regression. Other independent predictors of poor survival included age > 65 years old, Medicaid or uninsured payor status, supraglottic primary and N1 nodal disease. Stage and subsite specific analysis revealed that patients with T4a primary tumors, N1 nodal disease and supraglottic subsite had worse overall survival when treated with laryngectomy alone. Alternatively, patients with T3 primary tumors, N0 nodal disease, glottic subsite had equivalent overall survival and disease specific survival when treated with laryngectomy alone versus laryngectomy with post-operative radiotherapy.

Conclusion

Locally advanced laryngeal cancer patients with T3 primaries, no nodal disease or primaries of the glottis may not benefit from post operative radiotherapy when treated with primary total laryngectomy.

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Age of Diagnosis, Incidence and Prevalence of Recurrent Respiratory Papillomatosis – A South African Perspective

Abstract

Objectives

To determine the distribution of the age of onset of recurrent respiratory papillomatosis (RRP) and to determine the incidence and prevalence of RRP in both adults and children in the Free State province of South Africa in order to provide data from a population in sub-Saharan African.

Design

Retrospective record review.

Participants

All patients with recurrent respiratory papillomatosis in the Free State province of South Africa between 2011 and 2015.

Main outcome measures

Distribution of the age of diagnosis of RRP and incidence and prevalence of RRP.

Results

The best fitting mixture distribution for the age of diagnosis of RRP was a two-component mixture of log-normal distributions. Within the first component (JoRRP), the age of diagnosis was significantly lower in patients with HPV11 disease (median 3.2 year) than those with HPV6 disease (median 5.6 years) (p=0.021), while in the second component (AoRRP), there was no significant difference in the age of diagnosis between HPV11 disease (30.7 year) and HPV6 disease (median 44.0 years) (p=0.0696).

The incidence and prevalence of JoRRP were 1.34/100000 population/year and 3.88/100000 population, respectively, while the incidence and prevalence of AoRRP were 0.18/100000 population/year and 0.38/100000 population, respectively.

Conclusion

RRP in the Free State province of South Africa is a disease with a predominantly juvenile onset, with AoRRP having a lower prevalence than in Europe. This is probably reflective of the situation in sub-Saharan Africa.

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Cryotherapy plus oral zinc sulfate versus cryotherapy plus placebo to treat common warts: A double blind, randomized, placebo-controlled trial

Cutaneous warts are caused by a small group of specific types of human papillomaviruses. Cryotherapy is a highly effective treatment for patients with viral warts; however, it is a painful method and usually requires several treatment sessions. Zinc is a trace element with many proven effects on the immune system.

Impact of dermatology eConsults on access to care and skin cancer screening in underserved populations: A model for teledermatology services in community health centers

The clinical outcome of teledermatology with dermoscopy in large-scale primary care networks remains unclear.

Changing antimalarial agents after inefficacy or intolerance in patients with cutaneous lupus erythematosus: A multicenter observational study

Changing from one antimalarial (AM) agent to another is often recommended in cutaneous lupus erythematosus (CLE) when the first AM agent is ineffective or poorly tolerated.

Dermoscopic technique for the evaluation of the nail unit



Dermatologist and Patient Preferences in Choosing Treatments for Moderate to Severe Psoriasis

Abstract

Introduction

The objective of the study was to determine the relative importance (RI) of treatment attributes psoriasis patients and physicians consider when choosing between biologic therapies based on psoriasis severity.

Methods

A discrete choice experiment (DCE) weighting preference for eight sets of hypothetical treatments for moderate or severe psoriasis was conducted. DCE hypothetical treatments were defined and varied on combinations of efficacy, safety, and dosing attributes [frequency/setting/route of administration (ROA)].

Results

When assuming moderate psoriasis in the patient DCE, ROA (RI 29%) and efficacy (RI 27%) drive treatment choices. When assuming severe disease in the DCE, patients preferred treatments with higher efficacy (RI 36%); ROA was relatively less important (RI 15%). From the physician perspective, ROA (RI 32%) and efficacy (RI 26%) were most important for moderate psoriasis patients. In the physician model for severe psoriasis, efficacy (RI 42%) was the predominant driver followed by ROA (RI 22%). Regardless of severity, probability of loss of response within 1 year was the least important factor.

Conclusions

The severity of disease is a critical element in psoriasis treatment selection. There are high levels of alignment between physician- and patient-derived preferences in biologic treatment choice selection for psoriasis.

Funding

Janssen Pharmaceuticals.



Nuances in component nasal hump reduction

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Publication date: Available online 20 October 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Haneen Sadick, Julian M. Rowe-Jones, Holger G. Gassner
ImportanceNasal hump reduction is a frequent manoeuver in rhinoplasty. Over the last years, composite hump reduction has been advocated in favour of component hump reduction. The latter allows a more controlled and stepwise approach in reducing the nasal dorsum by deprojecting the cartilaginous dorsum separately from the bony dorsum. This approach also preserves the upper lateral cartilages (ULCs) and their mucosa.ObjectiveTo analyse the intricacies of the anatomic transition zone between the ULCs, the rhinion, and the nasal bones as they pertain to component hump reduction.MethodAnatomic dissections with five fresh cadaveric heads were performed in this study. The cephalic extension of the ULCs beneath the nasal bones was modified and measured after component hump reduction on both sides of the rhinion.ResultsCentral detachment of the ULCs from the bony dorsum and their release from the medial undersurface of the nasal bones allows for complete preservation of the ULCs. This is achieved by inferior-medial rotation of the cephalic ends of the ULCs against the septum. If not released completely during hump reduction, a substantial loss of the ULCs may be the consequence.ConclusionsThe described manoeuver allows preservation of the cephalic components of the ULCs underneath the bony dorsum during component hump reduction. A smoother transition line at the keystone area as well as along the entire bony-cartilaginous dorsum with a straighter aesthetic dorsal profile and oblique view is the result. The present findings allowed us to present an operative algorithm with implementation into clinical practice.



Post-operative care of VRAM flaps for perineal reconstruction: results of a UK practice survey and literature review

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Publication date: Available online 20 October 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): J. Warbrick-Smith, P.J. Drew




Mammaplasty in patients with large areola: reducing the nipple-areola complex using intra-areolar incisions

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Publication date: Available online 20 October 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Anne Sophie Kruit, Margriet H.M. van Doesburg, P.Q. Ruhé, Miriam C.J. de With
Minimal incision breast reduction techniques resulting in periareolar scars are widely used. However, this technique is less suitable for patients with large areola diameters and relatively small breasts, requiring a modest reduction or lift only. As a result of the large nipple-areola-complex larger amounts of skin must be removed in order to resect the complete peripheral areola, increasing the risk of high-riding nipples, breast flattening and incomplete areola resection resulting in a rest on the vertical scar. This report describes a modified technique offering a solution to these problems. In this technique intra-areolar incisions are used to reduce areola size without resecting large volumes of breast tissue and skin. Complete peripheral areolar resection is always possible and high riding nipples are avoided.



The scrotal free flap: first successful clinical application of a free Super-Thin External Pudendal Artery (STEPA) flap for reconstruction of a foot defect

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Publication date: Available online 20 October 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Kidakorn Kiranantawat, Matthew Sze-Wei Yeo, Atsushi Imaizumi, Ngamcherd Sitpahul, Pedro Ciudad, Fabio Nicoli, Michele Maruccia, Seong Yoon Lim, Stamatis Sapountzis, Chalermpong Chatdokmaiprai




Anthropometric growth study of the ear in a chinese population

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Publication date: Available online 20 October 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Shichun Zhao, Dianguo Li, Zhenzhong Liu, Yibiao Wang, Lei Liu, Duyin Jiang, Bo Pan
BackgroundA large number of anthropometric studies of the auricle have been reported in different nations, but little data are available in the Chinese population. The aim of this study was to analyze growth changes in the ear by measuring the width and length of ears in a Chinese population.MethodsA total of 480 participants were enrolled and classified into 1 year, 3 years, 5 years, 7 years, 9 years, 12 years, 14 years and 18 years groups (half were boys and half were girls in each group). Ear length, ear width, body weight and body length were measured and recorded; ear index was calculated according to ear length and ear width. The growth of auricle and differences between genders were analyzed. Growth of ear in relation to body height and weight as well as the degree of emphasis on the length and width of the auricle were also analyzed.ResultsEar length and width were increased with age. Ear length achieved its mature size in both 14-year-old males and females. Ear width reached its mature size in males at 7 years and in females at 5 years. Different trends of ear index were shown between males and females. People in this population paid more attention to the length than the width of the auricle.ConclusionsThe data indicated that ear development followed increase in age. There were gender and ethnic difference in the development of ear. These results may have potential implications for the diagnosis of congenital malformations, syndromes and planning of ear reconstruction surgery.



Trastuzumab-Emtansin vs. Capecitabin plus Lapatinib bei Patienten mit vorbehandeltem HER2-positivem metastasierten Mammakarzinom



Effects of glutamine, taurine and their association on inflammatory pathway markers in macrophages

Abstract

The immune system is essential for the control and elimination of infections, and macrophages are cells that act as important players in orchestrating the various parts of the inflammatory/immune response. Amino acids play important role in mediating functionality of the inflammatory response, especially mediating macrophages functions and cytokines production. We investigated the influence of glutamine, taurine and their association on the modulation of inflammatory pathway markers in macrophages. The RAW 264.7 macrophage cell line was cultivated in the presence of glutamine and taurine and proliferation rates, cell viability, cell cycle phases, IL-1α, IL-6, IL-10 and TNF-α as well as H2O2 production and the expression of the transcription factor, NFκB, and its inhibitor, IκBα, were evaluated. Our results showed an increase in viable cells and increased proliferation rates of cells treated with glutamine concentrations over 2 mM, as well as cells treated with both glutamine and taurine. The cell cycle showed a higher percentage of cells in the phases S, G2 and M when they were treated with 2 or 10 mM glutamine, or with glutamine and taurine in cells stimulated with lipopolysaccharide. The pNFκB/NFκB showed reduced ratio expression when cells were treated with 10 mM of glutamine or with glutamine in association with taurine. These conditions also resulted in reduced TNF-α, IL-1α and H2O2 production, and higher production of IL-10. These findings demonstrate that glutamine and taurine are able to modulate macrophages inflammatory pathways, and that taurine can potentiate the effects of glutamine, illustrating their immunomodulatory properties.



Körper- und Selbsterleben nach minimalinvasiver Hautverjüngung

Zusammenfassung

Hintergrund

Weltweit nutzen mehr und mehr Menschen Botulinumtoxin A (BoNT-A) und Hyaluronsäurefiller zur Hautverjüngung, auch in Deutschland.

Fragestellung

Studie zu Körperbild und Selbstwerterleben von Frauen mit BoNT-A- und/oder Hyaluronsäurefillerbehandlung.

Material und Methoden

Es füllten 145 Frauen, die um eine Behandlung mit BoNT-A und/oder Hyaluronsäurefillern nachsuchten, den Body Dysmorphic Disorder Questionnaire, die Rosenberg-Selfesteem-Skala und Fragebogen zu Einstellungen und Motiven zu körperoptimierenden Maßnahmen sowie zu ihren demografischen Merkmalen aus. Anhand dieser Instrumente wurden das Körper- und Selbstbild sowie die Einstellungen und Motive für die Inanspruchnahme minimalinvasiver Hautverjüngung erhoben.

Ergebnisse

Nutzerinnen minimalinvasiver Hautverjüngung verfügen über einen hohen Bildungsgrad und ein überdurchschnittlich hohes monatliches Nettoeinkommen. Sie leben häufiger in einer Partnerschaft, im Vergleich zu in Berlin lebenden Frauen gleichen Alters. Die Nutzerinnen von BoNT-A und/oder Hyaluronsäurefillern weisen keine Auffälligkeiten in Körperbild und Selbstwerterleben auf. Sie zeigen insgesamt eine moderat-positive Einstellung zu körperoptimierenden Verfahren, und 91 % der Nutzerinnen erreichen ihr Normgewicht (Body-Mass-Index [BMI] ≤25 kg/m2) im Vergleich zu 56 % der deutschen Frauen in der gleichen Altersspanne (25 bis ≥75 Jahre).

Schlussfolgerung

In der ersten Studie mit in Deutschland lebenden Nutzerinnen von BoNT-A und/oder Hyaluronsäurefillern zu Körper- und Selbstbild wiesen die Nutzerinnen keine Hinweise auf Störungen des Körper- und Selbstbilds auf.



Headache and pregnancy: a systematic review

This systematic review summarizes the existing data on headache and pregnancy with a scope on clinical headache phenotypes, treatment of headaches in pregnancy and effects of headache medications on the child ...

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Four Saccharomyces species differ in their tolerance to various stresses though they have similar basic physiological parameters

Abstract

Saccharomyces species, which are mostly used in the food and beverage industries, are known to differ in their fermentation efficiency and tolerance of adverse fermentation conditions. However, the basis of their difference has not been fully elucidated, although their genomes have been sequenced and analyzed. Five strains of four Saccharomyces species (S. cerevisiae, S. kudriavzevii, S. bayanus, and S. paradoxus), when grown in parallel in laboratory conditions, exhibit very similar basic physiological parameters such as membrane potential, intracellular pH, and the degree to which they are able to quickly activate their Pma1 H+-ATPase upon glucose addition. On the other hand, they differ in their ability to proliferate in media with a very low concentration of potassium, in their osmotolerance and tolerance to toxic cations and cationic drugs in a growth-medium specific manner, and in their capacity to survive anhydrobiosis. Overall, S. cerevisiae (T73 more than FL100) and S. paradoxus are the most robust, and S. kudriavzevii the most sensitive species. Our results suggest that the difference in stress survival is based on their ability to quickly accommodate their cell size and metabolism to changing environmental conditions and to adjust their portfolio of available detoxifying transporters.



Influence of region-of-interest determination on measurement of signal-to-noise ratio in liver on PET images

Abstract

Objective

On 18F-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography (PET), signal-to-noise ratio in the liver (SNRliver) is used as a metric to assess image quality. However, some regions-of-interest (ROIs) are used when measuring the SNRliver. The purpose of this study is to examine the different ROIs and volumes of interest (VOIs) to obtain a reproducible SNRliver.

Methods

This study included 108 patients who underwent 18F-FDG-PET/CT scans for the purpose of cancer screening. We examined four different ROIs and VOIs; a 3-cm-diameter and a 4-cm-diameter circular ROI and a 3-cm-diameter and a 4-cm-diameter spherical VOI on the right lobe of the patients' livers. The average of SUV (SUVmean), standard deviation (SD) of SUV (SUVSD), SNRliver and SD of the SNRliver obtained using ROIs and VOIs were then compared.

Results

Although the SUVmean was not different among the ROIs and VOIs, the SUVSD was small with a 3-cm-diameter ROI. The largest SUVSD was obtained with a 4-cm-diameter spherical VOI. The SNRliver and the SD of the SNRliver with a 4-cm-diameter spherical VOI were the smallest, while those with a 3-cm-diameter circular ROI were the largest. These results suggest that a small ROI may be placed on a relatively homogeneous region not representing whole liver unintentionally.

Conclusion

The SNRliver varied according to the shape and size of ROIs or VOIs. A 4-cm-diameter spherical VOI is recommended to obtain stable and reproducible SNRliver.



The cost-effectiveness of exercise-based cardiac rehabilitation: a systematic review of the characteristics and methodological quality of published literature

This descriptive review aimed to assess the characteristics and methodological quality of economic evaluations of cardiac rehabilitation (CR) programs according to updated economic guidelines for healthcare in...

Editorial: ‘Key Topics in Philosophy of Language and Mind’



Kinetics and pathways of Bezafibrate degradation in UV/chlorine process

Abstract

UV/chlorine, as a novel disinfection method, has attracted great interest due to its effective removal for pathogenic microorganism and degradation of trace organic contaminants existed in water environment. This paper investigated the degradation kinetics and pathways of Bezafibrate (BZF), a typical antilipemic drug, during UV/chlorine process. The results showed that 92.3% of BZF was degraded after 20 min in UV/chlorine process. This indicated HO• and reactive chlorine species (RCSs) formed in UV/chlorine played the dominant role in degrading BZF. Observed rate constants of BZF degradation (k obs,BZF) in UV/chlorine process increased linearly in a wide chlorine dosage from 0.1 to 1.0 mM, which implied that ClO• generated from the reactions of chlorine with HO• and Cl• could react with BZF rapidly. The steady-state kinetic modeling result proved this deduction and the rate constant of ClO• with BZF was fitted to be 5.0 × 108 M−1 s−1. k obs,BZF was affected by Cl and HA. The total contribution of RCSs (including Cl•, Cl2, and ClO•) to the degradation of BZF was determined to be ~ 80%, which is much higher than that of HO•. Thirteen degradation products of BZF were identified by LC-MS/MS. Initial degradation products were arisen from hydroxylation, chlorine substitution and cyclization by HO• and RCSs, and then further oxidized to generate acylamino cleavage and demethylation products.



A device-specific prioritization strategy based on the potential for harm to human health in informal WEEE recycling

Abstract

In developing countries, the recovery of valuable materials from Waste Electrical and Electronic Equipment (WEEE) is carried out via uncontrolled practices, posing potentially severe risks both to human health and the environment. The assessment of the risk, which depends on both the kind and hazardous properties of the substances contained in WEEE, is currently limited as the exposure scenario for the single informal practice cannot be fully characterized for this purpose. In this context, this work proposes and evaluates a strategy to identify the relative potential harm of different kinds of WEEE by their content in metals, selected as the target substances of concern. This was based on the individual metal content, primarily located in the printed circuit boards (PCBs) of the different devices. The metal composition of the individual PCBs was identified and the dominant unregulated metal recovery practices were reviewed to identify the most suitable parameter to express the toxicity of these metals. Based on a mass-normalized cumulative toxicity, via the inhalation route, individual components were assessed from compositional variation found in the literature. The results is a semiquantitative ranking of individual components, revealing significant differences in potential harm posed by different electronic appliances and an opportunity to provide prioritization strategies in future management.



Signs for secondary buildup of heavy metals in soils at the periphery of Athens International Airport, Greece

Abstract

Emissions from civil airports are similar to those observed in industrial and urban areas. While air pollution and noise levels are regularly monitored and assessed, information on the status of heavy metals in soils close to airport facilities is limited. In this study, we monitored and assessed heavy metal distribution in soils close to Athens International Airport (AIA) in Attica, Greece. Following a grid sampling scenario, topsoil samples were collected from 86 sites at the periphery of AIA and total and available forms of Cu, Zn, Fe, Mn, Ni, Cr, Pb, and Ba concentrations were determined in aqua regia and DTPA soil extracts, respectively. Median concentration values for both metal forms are not considered as particularly high. However, 90th percentile concentration values for some metals are high, indicating soil enrichment. Evaluation of enrichment factor (EF) and availability ratio (AR) values and EFs spatial distribution have led to consistent conclusions of secondary and ongoing metal accumulation in the soils of the studied area. Tessier sequential extraction procedure was applied to 10% of the soil samples and the results showed high potential availability of Pb, Mn, Cu, and Ni, further supporting the continuous metal accumulation in the studied soils.



Historical accumulation of potentially toxic trace elements resulting from mining activities in estuarine salt marshes sediments of the Asturias coastline (northern Spain)

Abstract

The extensive extraction activity of mercury ores in Asturias (northwest Spain), also rich in As and Sb, has impacted the Nalón river estuary. The objective of this research was to assess the historical evolution of As-Hg-Sb accumulation in the salt marsh sediments of this area. For this purpose, sediment cores were collected from two different salt marshes (eastern and western river banks) in the estuarine environment to evaluate the degree of anthropogenic enrichment and the geochronology of As-Hg-Sb accumulation. Core subsampling was performed by cutting 2-cm-thick slices of sediments. The subsamples were then analysed for several physical and chemical parameters. Sedimentation rate was assessed by measuring short-lived radionuclides (excess 210Pb and 137Cs). Pre-mining levels of As-Hg-Sb were observed at core depths below 50 cm. In the less extended salt marsh (eastern river bank), maximum As-Hg-Sb concentrations of 87.48, 3.66, and 5.75 μg·g−1, respectively, were found at the core top as a consequence of long-term mining activity in the area. The vertical distribution of As-Hg-Sb was influenced by the single-point contamination sources, whereas grain-size variability and diagenetic remobilisation did not seem affected. Geochronological measurements showed that the depositional fluxes of As-Hg-Sb were influenced by anthropogenic input after 1900, when mining activity in the area was most intense. Hg mining ceased in 1969; however, the corresponding core profiles did not show a drastic decreasing trend in element fluxes, implying that the river drainage basin retains some "memory" of contamination which affects riverine sediments. A preliminary gross estimation of total As-Hg-Sb "trapped" in the Nalón river salt marsh sediments amounted to approximately 18.7, 1.0, and 0.7 t, respectively. These morphological structures suffer erosive processes, thus representing a potential source of these elements associated with sediments; consequently, management conservation and monitoring of salt marshes should be taken into consideration from this environmental point of view.



Potential diagnostic performance of contrast-enhanced ultrasound and tumor markers in differentiating combined hepatocellular–cholangiocarcinoma from hepatocellular carcinoma and cholangiocarcinoma

Abstract

Purpose

To evaluate the diagnostic performance of the combination of tumor markers [alpha-fetoprotein (AFP) and carbohydrate antigen 19-9 (CA19-9)] and imaging features in differentiating combined hepatocellular–cholangiocarcinoma (CHC) from hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC).

Methods

Forty consecutive patients with pathologically proven CHC were retrospectively evaluated with contrast-enhanced ultrasound (CEUS). Additionally, 40 HCC and 40 CC patients who were randomly selected from the same period served as a control group. Images were classified as HCC-like or CC-like pattern according to CEUS guidelines recommended by World and European Federation for Ultrasound in Medicine and Biology (WFUMB-EFSUMB). The diagnostic criteria of CHC were defined as follows: (1) both AFP and CA19-9 are simultaneously elevated (AFP > 20 ng/ml and CA19-9 > 100 units/ml); or (2) elevated AFP with a CC-like pattern on CEUS and without elevated CA19-9 level; or (3) elevated CA19-9 with an HCC-like pattern on CEUS and without elevated AFP level. The diagnostic tests were performed with calculation of the sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC).

Results

For the 40 CHC patients, the rates of elevated AFP and CA19-9 serology were 55.0 and 30.0%, respectively. Twenty-three (57.5%) patients exhibited an HCC-like pattern, and 15 (37.5%) showed a CC-like pattern. After applying the above diagnostic criteria of CHC in the 120 patients, the sensitivity, specificity, PPV, NPV, accuracy, and AUC were 32.5, 93.8, 72.2, 73.5, 73.3, and 0.631%, respectively. When the actual prevalence rate (0.4–14.3%) was taken into account, the PPV and NPV were modified from 2.1 to 46.7% and 89.3 to 99.7%, respectively.

Conclusion

The combination of enhancement patterns on CEUS and serum tumor markers (AFP and CA19-9) may be a potentially specific diagnostic method to differentiate CHC from HCC and CC.



Hierarchical evaluation of electrical stimulation protocols for chronic wound healing: an effect size meta-analysis

Abstract

Electrical stimulation (ES) has been tested for decades to improve chronic wound healing. However, uncertainty remains on the magnitude of the efficacy and on the best applicable protocol. We conducted an effect size meta-analysis to assess the overall efficacy of ES on wound healing, to compare the efficacy of the different modalities of electrical stimulation, and to determine whether efficacy differs depending on the wound etiology, size and age of the chronic wound.

Twenty-nine randomized clinical trials with 1510 patients and 1753 ulcers were selected. Overall efficacy of ES on would healing was a 0.72 SMD (95% CI: 0.48, 1) corresponding to a moderate to large effect size. We found that unidirectional high voltage pulsed current (HVPC) with the active electrode over the wound was the best evidence based protocol to improve wound healing with a 0.8 SMD (95% CI: 0.38, 1.21), while evaluation of the efficacy of direct current was limited by the small number of studies. ES was more effective on pressure ulcers compared to venous and diabetic ulcers, and efficacy trended to be inversely associated with the wound size and duration.

This study confirms the overall efficacy of ES to enhance healing of chronic wounds and highlights the superiority of HVPC over other type of currents, which is more effective on pressure ulcers, and inversely associated with the wound size and duration. This will enable to standardize future ES practices. This article is protected by copyright. All rights reserved.



The Risks and External Effects of Diabetic Foot Ulcer on Diabetic Patients: A Hospital-based Survey in Wuhan area, China

Abstract

Diabetic foot ulcer (DFU) is a common complication observed in diabetic patients and affects diabetic patients in multiple ways. Severe DFU even leads to amputation in many cases. Early detection and intervention of DFU in diabetic patients can significantly relieve the pain caused by the ulcer and also keep patients from losing limbs in severe cases. In this study, the risks of diabetic patients getting DFU were estimated through a hospital-based survey. This survey collected information from hospitalized diabetic patients in Wuhan City, Hubei Province, China, using a questionnaire. This investigation includes studies from two stages with 502 diabetic patients from 20 hospitals in Wuhan City. The results suggested that patients with a long history of diabetes are often associated with a high risk of DFU (χ2=11.428, p=0.0007), smoking (χ2=8.386, p=0.0007), diabetic complications (χ2=13.484, p<0.0001), and especially patients with diabetic foot complications (χ2=57.6621, p<0.0001). Foot lesions appeared to be important attributors to DFU since our data demonstrated close correlations between DFU and patients with calluses/corns (χ2=4.584, p=0.0323), tinea pedis (χ2=4.030, p=0.0447), and cracked skin (χ2=8.712, p=0.0032). Only a small number of patients seek for the assistance from specialists, such as trimming toenails (3.4%), removing corn or calluses (1.4%) or treating wounds (11.78%), when they are suffering from foot problems. The findings of this study can potentially be utilized to develop an early DFU diagnostic method in diabetic patients and can provide objective evidence for suggesting that patients who are suffering from foot problems should seek professional help. This article is protected by copyright. All rights reserved.



On having bad persons as friends

Abstract

Intuitively, one who counts a morally bad person as a friend has gone wrong somewhere. But it is far from obvious where exactly they have gone astray. Perhaps in cultivating a friendship with a bad person, one extends to them certain goods that they do not deserve. Or perhaps the failure lies elsewhere; one may be an abettor to moral transgressions. Yet another option is to identify the mistake as a species of imprudence—one may take on great personal risk in counting a bad person as a friend. In this paper, I argue that none of these intuitive explanations are entirely convincing; for many such proposals run contrary to widely accepted features of friendship. However, they do point us in the direction of a more satisfying explanation—one which concerns a person's moral priorities. An individual who counts a morally bad person as a friend is, I propose, one who betrays a distinct kind of defect in her values.



A randomized, double blind, placebo controlled phase 2 study of maintenance therapy with tasquinimod in patients with metastatic castration-resistant prostate cancer responsive to or stabilized during first-line docetaxel chemotherapy

Abstract
Background
This phase II study was conducted to assess clinical efficacy of tasquinimod maintenance therapy in patients with metastatic castrate-resistant prostate cancer not progressing during first-line docetaxel-based therapy.
Patients and methods
Patients were randomly assigned (1:1) to receive tasquinimod (0.25–1.0 mg/day orally) or placebo. The primary endpoint was radiologic progression-free survival (rPFS); secondary efficacy endpoints included: overall survival (OS); PFS on next-line therapy (PFS 2) and symptomatic PFS, assessed using the Brief Pain Inventory (BPI) questionnaire and analgesic use. Quality of life was measured by the Functional Assessment of Cancer Therapy - Prostate (FACT-P) questionnaire and by the EuroQol-5 Dimension Quality of Life Instrument (EQ-5D). Adverse events (AEs) were recorded.
Results
A total of 219 patients were screened and 144 patients randomized. The median duration of treatment was 18.7 weeks (range: 0.6–102.7 weeks) for the tasquinimod arm and 19.2 weeks (range: 0.4–80.0 weeks) for the placebo arm. Median (90% CI) rPFS was 31.7 (24.3, 53.7) and 22.7 (16.1, 25.9) weeks in the tasquinimod and placebo arms, respectively (HR [90% CI] 0.6 [0.4, 0.9] P = .0162). The median OS was not reached because only 14 deaths occurred by the cut-off date. No statistically significant differences between treatment arms were noted for symptomatic PFS, PFS 2, BPI score, FACT-P score, or EQ-5D. The incidence of any treatment emergent AE (TEAE) was similar in the tasquinimod and placebo arms (97.2% v 94.3%, respectively) while severe TEAEs (NCI-CTC Grade 3-5) incidence was higher in the tasquinimod group (50.7% v 27.1%).
Conclusions
Randomized trials testing new drugs as maintenance can be successfully conducted after chemotherapy in CRPC. Maintenance tasquinimod therapy significantly reduced the risk of rPFS by 40%.ClinicalTrials.gov identifier NCT01732549

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First-line systemic treatment of psoriasis: staying conventional or going biologic?



Cardiometabolic disease in atopic dermatitis: the heart of the matter



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Clinical significance of parvovirus B19 DNA in cutaneous biopsies



News and Notices



Dr Yvonne Mukasa 1977–2016



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The evolving universe of BRAF mutations in melanoma



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Plain language summaries



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Plain language summaries in Simplified Chinese



Endoscopic characteristics of oesophagus involvement in mucous membrane pemphigoid



Getting tired of psoriasis?



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Guidelines for the management of acne: recommendations from a French multidisciplinary group



Image Gallery: Nail involvement in syphilis: the great forgotten



Sequence variants in hidradenitis suppurativa: in search of the pathogenic mechanisms



Synthesis of Pb9(PO4)6/Ag3PO4 Composite Photocatalysts With Enhanced Visible Light Photocatalytic Activity

Abstract

Pb9(PO4)6/Ag3PO4 photocatalysts with different amounts of Pb9(PO4)6 were successfully synthesized by the ion exchange method. The catalysts were characterized by X-ray diffractometry (XRD), High resolution transmission electron microscopy (HRTEM), X-ray photoelectron spectroscopy (XPS), Brunauer- Emmett-Teller (BET), Fourier transform infrared spectrometry (FT-IS), and ultraviolet-visible (UV-vis) spectroscopy. All Pb9(PO4)6/Ag3PO4 photocatalysts show much higher photocatalytic activities than pure Ag3PO4 under visible light irradiation in the methyl-orange (MO) decomposition. Especially, the 3.0 wt% Pb9(PO4)6/Ag3PO4 photocatalyst shows the highest photoactivity and also high stability after five cycles. The MO degradation rate during each cycle is almost maintained at 97%. Photo-electrochemical measurement of photocatalysts verified that the enhancing photocatalytic activity was resulted from the electron-hole pair high separation. The photocatalytic activity enhancement of Pb9(PO4)6/Ag3PO4 is closely related to •OH, the main active oxygen species.

This article is protected by copyright. All rights reserved.



An Open-Label Randomized Multicenter Study Assessing the Noninferiority of a Caffeine-Based Topical Liquid 0.2% versus Minoxidil 5% Solution in Male Androgenetic Alopecia

Background: Androgenetic alopecia is a condition with a high prevalence worldwide and affects both males and females. Currently, only 2 approved treatments exist: finasteride (males only) and minoxidil 2 or 5% solution (males and females). Methods: We conducted a randomized, open-label, multicenter noninferiority study to determine whether a caffeine-based 0.2% topical liquid would be no less effective than minoxidil 5% solution in males (n = 210) with androgenetic alopecia. The primary end point was the percentage change in the proportion of anagen hairs from baseline to 6 months using a frontal and occipital trichogram. Results: At 6 months, the group of the 5% minoxidil solution showed a mean improvement in anagen ratio of the trichogram of 11.68%, and the group of the 0.2% caffeine solution had an anagen improvement of 10.59%. The difference of mean values between both groups was 1.09%. The statistical analysis was performed and reported in accordance with the CONSORT Guidelines 2010 for reporting of noninferiority and equivalence randomized trials. Conclusion: A caffeine-based topical liquid should be considered as not inferior to minoxidil 5% solution in men with androgenetic alopecia.
Skin Pharmacol Physiol 2017;30:298-305

Glycemic Control and the Prevalence of Tuberculosis Infection: A Population-based Observational Study

Abstract
Background
Several cohort studies demonstrate that diabetics are at increased risk for active tuberculosis, and poor glycemic control may exacerbate this risk. A higher prevalence of tuberculosis infection at baseline among diabetics may partially explain these results; however, no population-based studies have investigated this association. Furthermore, whether glycemic control modifies the relationship between diabetes and tuberculosis infection, as it does with active tuberculosis, is unknown.
Methods
Diabetics were diagnosed through physician evaluation and using 3 laboratory tests including hemoglobin A1C (HbA1C), fasting plasma glucose (FPG), or 2-hour plasma glucose (PG). Tuberculosis infection was diagnosed through tuberculin skin tests, and glycemic control was assessed linearly and categorically using recommended targets.
Results
Among 4215 participants, the prevalence of tuberculosis infection was 4.1%, 5.5%, and 7.6% in nondiabetic, prediabetic, and diabetic participants (Ptrend = .012). In multivariate analysis, diabetes was associated with tuberculosis infection (adjusted odds ratio [AOR], 1.5; 95% confidence interval [CI], 1.0–2.2). Compared to nondiabetics, diabetics who were undiagnosed (AOR, 2.2 and 1.2 in diagnosed diabetics), FPG >130 mg/dL (AOR, 2.6 and 1.3 in diabetics with FPG ≤130 mg/dL), or not on insulin (AOR, 1.7 and 0.8 in diabetics on insulin) had elevated tuberculosis infection rates. In a linear dose–response analysis, increasing values of FPG (AOR, 1.02 per 1-mg/dL; 95% CI, 1.01–1.03), PG (AOR, 1.02 per 1-mg/dL; 95% CI, 1.01–1.04), and HbA1C (AOR, 1.13 per 1%; 95% CI, 1.04–1.22) all predicted tuberculosis infection.
Conclusions
Our results suggest glycemic control may modify the relationship between tuberculosis infection and diabetes.