Αναζήτηση αυτού του ιστολογίου

Δευτέρα 11 Δεκεμβρίου 2017

Radiofrequency-assisted subcision for postacne scars

Subcision is a commonly performed procedure for depressed rolling scars of acne.1 Breaking up the fibrotic strands mechanically with a blade or needle leads to neocollagenosis and hematoma formation, resulting in elevation of the depressed scars. However, the excessive mechanical force often leads to trauma to the surrounding tissue, excessive bleeding, and large hematoma formation and fibrosis.

Trends in US sunscreen formulations: Impact of increasing spray usage

To the Editor: Sunscreen is an important component of sun protection. Almost all dermatologists believe that sunscreen is safe, effective, and can reduce the risk of skin cancer.1 In the United States, many different sunscreen formulations exist, including balms, sprays, lotions, sticks, creams, foams, gels, and oils.

Editorial Board



Table of Contents



Botulinum toxin type A for the treatment of localized recalcitrant chronic pruritus

To the Editor: Localized chronic pruritus is a common condition that significantly affects health-related quality of life. A variety of diseases result in localized chronic itch, which can be broadly classified as dermatologic, neuropathic, or psychogenic in nature. For patients with chronic pruritus that is refractory to conventional therapy, the burden of disease is substantial.

Cantharidin for treatment of facial molluscum contagiosum: A retrospective review

To the Editor: Molluscum contagiosum (MC) papules are self-limited, resolving within months to years. Active nonintervention is a common management approach in children; caregivers, however, often seek treatment owing to the contagious nature of the virus, itch, embarrassment, pain, or other reasons (Fig 1). Cantharidin is a common treatment for pediatric MC, although some discourage its use on the face. We present caregiver-reported outcomes of cantharidin treatment for facial molluscum in our practice.

Micromelanomas identified with time-lapse total body photography and dermoscopy

To the Editor: Secondary prevention efforts to detect malignant melanoma focus on lesions at an initial growth phase with diameters <6 mm; earlier detection correlates with improved survival rates.1 Two photographic approaches provide critical and complementary information in the differential diagnosis of malignant melanoma. Total body photography (TBP) traditionally provides baseline images from which macroscopic lesion changes can be detected, whereas digital epiluminescence (dermoscopic) microscopy reveals subtle changes in preexisting nevi.

Romance, love, and sex in the dermatology department and residency program

Many businesses and academic organizations have policies that address the issue of workplace amorous relationships. Virtually all such policies forbid relationships between supervisors and those whom they supervise, or between employees of significantly different rank. Some even go so far as to prohibit relationships between employees in different departments or those reporting to different supervisors. The basis for such policies is to prohibit relationships that may affect the work environment for other employees, the productivity of the company, and to prevent the company from becoming entangled in sexual harassment suits.

Vitamin D deficiency in patients with alopecia areata: A systematic review and meta-analysis

Alopecia areata (AA) is a T cell–mediated autoimmune disease that causes nonscarring hair loss.1 Some autoimmune diseases are associated with a vitamin D deficiency, including inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, and vitiligo.2,3 Previous studies that evaluated vitamin D levels in patients with AA have reached inconsistent conclusions. This study aimed to perform a systematic review and meta-analysis on the association between vitamin D levels and AA.

Innovative modification of the USB dermatoscope for mucoscopy

There have been a number of technological advancements in dermoscopy of cutaneous lesions1; However, dermoscopy of mucosae remains a challenge, primarily because existing dermatoscopes are not well designed to explore them. Contact magnifying endoscopes and oral mucoscopes have been used in the past for contact and noncontact mucoscopy.2 But the lack of availability and versatility of these instruments and lack of expertise in handling them make them unsuitable for routine use by dermatologists in clinical practice.

Health care utilization for psoriasis in the United States differs by race: An analysis of the 2001-2013 Medical Expenditure Panel Surveys

To the Editor: Racial/ethnic differences in general health care utilization exist in the United States.1 Little is known about health care utilization among racial/ethnic groups for skin diseases, including for psoriasis, the most prevalent immune-mediated disease.2 We aimed to evaluate health care utilization for psoriasis by race/ethnicity using population-based data derived from the Medical Expenditure Panel Surveys, the most complete source of information on health care utilization, cost, and health insurance coverage in the United States.

Hidradenitis suppurativa burden of disease tool: Pilot testing of a disease-specific quality of life questionnaire

To the Editor: Hidradenitis suppurativa (HS) is a chronic inflammatory condition affecting intertriginous areas of the body that dramatically impairs quality of life (QoL) and has a substantial psychosocial burden.1,2 Full remission of HS is rare, making improvements in QoL a critical goal of therapy. Currently, when investigating the impact of HS, we are limited to generic QoL questionnaires, none of which are specific for HS. We propose a disease-specific tool that would better capture the unique burden of disease caused by HS, which is necessary to determine the impact of therapeutic interventions in clinical trials and in the clinical setting.

Iotaderma #287



Andrews' diseases of the skin clinical atlas

Andrews' Diseases of the Skin Clinical Atlas by William James, Dirk Elston, and Patrick McMahon is the first published atlas from the writers of Andrews' Diseases of the Skin, a renowned comprehensive dermatological text. It not only serves as a wonderful accompaniment to the Andrews text but also is a strong standalone atlas benefitting any reader, from student to practicing clinician. For a specialty that relies heavily on the physical exam, this text provides wonderful depictions of thousands of entities that help the reader learn the morphology and distribution of each diagnosis.

Cancer risks among patients with alopecia areata: A population-based case-control study in Korea

To the Editor: Studies have shown the reduced incidence of skin cancer in patients with autoimmune dermatologic diseases, including alopecia areata (AA) and vitiligo.1,2 The aim of this study was to investigate the association between AA and several types of cancer. This study was a retrospective case-control study from the National Health Insurance Service–National Sample Cohort.3 Age, sex, location, income, and diagnostic codes based on the International Classification of Diseases, 10th edition were retrieved.

Reply to: “Updated diagnostic criteria for frontal fibrosing alopecia”

To the Editor: We thank Vaño-Galvan et al for their letter regarding criteria for frontal fibrosing alopecia (FFA).1 The differential diagnosis of FFA is broad, and diagnostic criteria can aid in identifying this entity. We agree with many of the suggestions to our diagnostic criteria proposed in our article on the Mayo Clinic cohort of FFA patients.2

Decreased risk of vitiligo in organ transplant recipients: A population-based cohort study

To the Editor: Vitiligo remains a major challenge in dermatology because there is no definitive cure.1 The autoimmune nature of vitiligo has been described,2 and the involvement of T cells in pathogenesis of vitiligo has also been shown in previous reports.3 While the therapeutic potential of immunosuppressants has often been raised, their role has not been well examined.

Vitiligo-like lesions in patients receiving anti–programmed cell death-1 therapies are distinct from spontaneously occurring active vitiligo

To the Editor: We would like to thank Fukuda and Harris for their interest in our manuscript.1 Clinically, we have voluntarily characterized vitiligo-like lesions induced by anti–programmed cell death-1 (PD-1) as "multiple flecked depigmented macules" to differ from the description reported for active lesions in spontaneously occurring vitiligo (referred to as vitiligo). Indeed, in vitiligo, active lesions are associated with hypomelanotic appearance and poorly defined borders2 (as shown in Fukuda et al, Fig 1), a clinical sign completely absent in vitiligo-like lesions under anti–PD-1.

Trends in Medicare spending on topical immunomodulators and chemotherapies

To the Editor: Actinic keratoses (AKs) and in situ/superficial carcinomas are common and costly dermatologic conditions that account for ≥5.2 million visits and $920 million in annual spending.1,2 Topical therapies are often used as field therapy for these conditions. In this study, we evaluate recent national trends in topical therapy use and costs for precancerous and in situ/superficial carcinomas in the Medicare population.

Acknowledging the pseudo “fringe sign” in frontal fibrosing alopecia has diagnostic and prognostic implications

To the Editor: A frontal band of scarring alopecia with eyebrow involvement in postmenopausal women (ie, frontal fibrosing alopecia [FFA]) evolved from a "recently described disease" to the status of "a growing epidemic" in less than 2 decades. Since the first report by Kossard,1 additional features and variants not contemplated in the original description have been incorporated into the clinical picture. For such, I read with great interest the paper by Rossi et al reporting 3 unusual clinical patterns of FFA.

A potpourri of dermatologic writings

Publication date: January–February 2018
Source:Clinics in Dermatology, Volume 36, Issue 1
Author(s): Lawrence Charles Parish




Issue Information



Larva migrans cutánea facial de origen autóctono en España

Publication date: Available online 11 December 2017
Source:Actas Dermo-Sifiliográficas
Author(s): C. Durán-Vian, I. Vilanova-Udaniz, B. Castro-Gutierrez, M.A. González-López




A Cost-Effective, In-House, Positioning and Cutting Guide System for Orthognathic Surgery

Abstract

Introduction

Technological advances in 3D printing can dramatically improve orthognathic surgical planning workflow. Custom positioning and cutting guides enable intraoperative reproduction of pre-planned osteotomy cuts and can result in greater surgical accuracy and patient safety.

Objectives

This short paper describes the use of freeware (some with open-source) combined with in-house 3D printing facilities to produce reliable, affordable osteotomy cutting guides.

Methods

Open-source software (3D Slicer) is used to visualise and segment three-dimensional planning models from imported conventional computed tomography (CT) scans. Freeware (Autodesk Meshmixer ©) allows digital manipulation of maxillary and mandibular components to plan precise osteotomy cuts. Bespoke cutting guides allow exact intraoperative positioning. These are printed in polylactic acid (PLA) using a fused-filament fabrication 3D printer. Fixation of the osteotomised segments is achieved using plating templates and four pre-adapted plates with planned screw holes over the thickest bone. We print maxilla/ mandible models with desired movements incorporated to use as a plating template.

Results

A 3D printer capable of reproducing a complete skull can be procured for £1000, with material costs in the region of £10 per case. Our production of models and guides typically takes less than 24 hours of total print time. The entire production process is frequently less than three days. Externally sourced models and guides cost significantly more, frequently encountering costs totalling £1500–£2000 for models and guides for a bimaxillary osteotomy.

Conclusion

Three-dimensional guided surgical planning utilising custom cutting guides enables the surgeon to determine optimal orientation of osteotomy cuts and better predict the skeletal maxilla/mandible relationship following surgery. The learning curve to develop proficiency using planning software and printer settings is offset by increased surgical predictability and reduced theatre time, making this form of planning a worthy investment.



Central Mound Mastopexy for the Correction of Tuberous/Tubular Breast Deformity

imageSummary: Tuberous and tubular breast deformity are well-recognized abnormalities in the plastic surgery community that incur severe physical and psychological consequences in affected patients. Current reconstructive options for the tuberous and tubular breasts favor the use of prosthetic implants and soft-tissue manipulation. We present a case of tuberous and tubular breast deformity treated with a central mound reduction technique and mastopexy with imbricating sutures without the use of prosthetic implants. The patient remained extremely pleased with her results at long-term follow-up. This represents a unique case of successful reconstruction in a patient with a tuberous and tubular breast deformity using a central mound reduction technique with mastopexy and without a prosthetic device.

Gluteal Black Market Silicone–induced Renal Failure: A Case Report and Literature Review

imageSummary: Very few cases of successful surgical treatment for renal failure due to gluteal silicone injections have been reported in the literature. The silicone toxicity and subsequent renal failure seem to follow repetitive silicone injections and silicone injections in large quantities. This is a case of a 31-year-old woman who developed renal failure after 6 years of gluteal silicone injections who underwent radical resection of bilateral gluteal regions in an attempt to mitigate her impending complete renal failure. A systematic review of the literature was conducted using PubMed database and with assistance from medical library staff to conduct keyword searches for "Silicone," "Renal failure," "Silicone emboli syndrome," "Silicone granuloma," and "Silicone end organ toxicity." The search results were reviewed by the authors and selected based on the relevance to the case report presented. Extensive literature relating to silicone granulomas and their systemic effects supports the use of steroids for immediate treatment and eventual surgical resection for cure of the various silicone-related end-organ toxicities including renal failure.

Fertilizer effects of composted materials from different sources on cultivating Impatiens balsamina L. in municipal solid waste management

Abstract

At different stages of municipal solid waste management, several technologies such as home composting, industrial composting, and landfill mining could be used to recycle organic matters. Assessing the quality of composted material is crucial for determining where and how for recycling the organic fractions of municipal solid waste (OFMSW). Current studies mainly focused on comparing their biochemical characteristics and environmental impacts; however, comprehensive effects on cultivating plants were rarely compared with composted materials from different sources. Here, the final composting products from home composting (HC), industrial composting (IC), and landfill mining (LM), with different mixing ratios between OFMSW and soil (25, 50, 75, and 100%), were applied for cultivating Impatiens balsamina L. to examine the growing and flowering features under 195 days of observation. We found that all types of composted materials showed positive effects on growth of impatiens; however, their individual profiles were significant different. Generally, compost from HC showed the best comprehensive effects on the plant. Impatiens' dry weight biomass and maximum number of leaves and flowers of HC were1.5 and 2.8 times, 1.1 and 1.6 times, and 1.8 and 4.2 times than those of IC and LM, respectively. Compost from IC was superior in prolonging leaf-growing phase and increasing photosynthesis pigment contents of impatiens. Although comprehensive effect of fine fraction from landfill mining was much lower than HC and IC compost, it still improved impatiens growth and flowering compared to normal sandy soil. The results suggest that direct comprehensive effect on plants growth, flowering, and physiological influences could be introduced as an indicator when we compare different approach to recycle organics from MSW. Comprehensive effect on plants growth, flowering, and physiological influences could be introduced as a direct indicator for assessing organic waste recycling.



Environmental exposure to cadmium—a risk for health of the general population in industrialized countries and preventive strategies

Abstract

Cadmium (Cd) is a heavy metal belonging to the group of the main chemical pollutants of the natural and occupational environment in economically developed countries. The forecasts indicate that contamination of the environment with this toxic metal, and thus the exposure of the general population, will increase. Food (particularly plant products) is the main source of the general population exposure to this element. Moreover, an important, and often the main, source of intoxication with Cd is habitual tobacco smoking. Recent epidemiological studies have provided numerous evidence that even low-level environmental exposure to this toxic metal, nowadays occurring in numerous economically developed countries, creates a risk for health of the general population. The low-level lifetime exposure to this metal may lead to the damage to the kidneys, liver, skeletal system, and cardiovascular system, as well as to the deterioration of the sight and hearing. Moreover, it has been suggested that environmental exposure to this xenobiotic may contribute to the development of cancer of the lung, breast, prostate, pancreas, urinary bladder, and nasopharynx. Taking the above into account, the aim of this review article is to draw more attention to Cd as an environmental risk factor for the health of the general population and the need to undertake preventive actions allowing to reduce the risk of health damage due to a lifetime exposure to this toxic metal.



Response of energy microalgae Chlamydomonas reinhardtii to nitrogen and phosphorus stress

Abstract

Microalgae can effectively absorb nitrogen (N) and phosphorus (P) in wastewater, while growth characteristics can be affected by such nutrients. The influences of the N and P concentration on growth, biomass yield, protein yield, and cell ultrastructure of Chlamydomonas reinhardtii (C. reinhardtii) were investigated in this study. The results showed that, in the optimum conditions (24–72 mg/L for N and 4.5–13.5 mg/L for P), the final biomass and protein content of C. reinhardtii could reach maximum value, and the cell organelles (chloroplast, mitochondria,etc.) showed good structures with larger chloroplasts, and more and neater thylakoids. However, if the concentration of nutrients was much higher or lower than the optimal value, it would cause adverse effects on the growth of C. reinhardtii, especially in high nitrogen (1000 mg/L) and low phosphorus (0.5 mg/L) conditions. Under these extreme conditions, the ultrastructure of the cells was also damaged significantly as follows: the majority of the organelles were deformed, the chloroplast membrane became shrunken, and the mitochondria became swollen, even partial disintegrated (differing slightly under high-N and low-P conditions); furthermore, it is found that C. reinhardtii was more sensitive to low-P stress. On the basis of these results, our findings have general implications in the application of wastewater treatment.



Can you tell the difference: round vs anatomical implants – a real-time global ballot

Publication date: Available online 11 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): A. Mohan, M. See, J. Farhadi




The aetiopathogenesis of capsular contracture: a systematic review of the literature

Publication date: Available online 11 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Yara Bachour, Stephan P. Verweij, Susan Gibbs, Johannes C.F. Ket, Marco J.P.F. Ritt, Frank B. Niessen, Margriet G. Mullender
BackgroundCapsular contracture is the most frequent complication after breast augmentation or reconstruction with breast implants. The immune system plays a prominent role in capsular contracture formation, albeit to an unknown extent. Bacterial contamination in situ has been hypothesized to be causative for capsular contracture. How this relates to the immunological processes involved is unknown. This article aims to provide an overview of immunological and bacterial factors involved in development of capsular contracture.MethodsWe undertook a systematic literature review focused on immunological factors and microbiota in relation to capsular contraction around implants. This systematic review was performed in accordance with the PRISMA guidelines. PubMed, EMBASE, and the Cochrane databases were searched from inception up to October 2016. Included studies were assessed for the following variables: subject characteristics, number of capsules, primary indication for surgery, surgical procedure, follow-up or implant duration, study methods, type of antibiotics or medical therapies and outcomes related to microbiota and immunological factors.ResultsData on immunological factors and bacterial contamination was retrieved from 64 included studies. Notably the presence of macrophages and Staphylococcus epidermidis within capsules were often associated with capsular contracture.ConclusionThis review provides a clear overview of the immunological factors associated with capsular contracture and provides a hypothetical immunological model for development of the disease. Furthermore, an overview of bacterial contamination and associations with capsular contracture has been provided. Follow-up research may result in clinical recommendations to prevent capsular contracture. CLINICAL QUESTION



Fibula osteomyocutaneous free flap in mandibular reconstruction: clinical experience in a community-based hospital

Abstract

Background

The fibula free flap (FFF) constitutes the gold standard surgical approach for mandibular reconstruction. Mandible reconstruction is routinely performed in high-volume academic centers. To our best knowledge, this is the first case series exclusively dedicated on FFF conducted in community hospitals. This study evaluates our 10-year experience with FFF mandible reconstruction in two community hospitals.

Methods

This is a retrospective review of all 12 patients who underwent partial or total mandibulectomy with concomitant mandible reconstruction using FFF from September 2005 through February 2015.

Results

The majority of the patients were men (75%) with a mean age of 61 years. Eleven (91.7%) patients had malignancies of the head and neck, and 10 (83.3%) received preoperative XRT. Overall flap survival was 100%, with no arterial/venous thrombosis or malunion. Partial flap failure (with skin paddle necrosis) was reported in only 1 patient, but the bone was viable and survived. Recipient-site wound infection, hardware exposure, and orocutaneous fistula occurred among previously irradiated patients, and in those who were suffering from osteoradionecrosis.

Conclusions

Our FFF outcomes were non-inferior to those reported in specialized university hospitals and are evidence that successful results can be obtained outside of high-volume academic centers. FFF represents a reliable surgical approach for mandible reconstruction in university and community hospitals.

Level of Evidence: Level IV, therapeutic study.



The aetiopathogenesis of capsular contracture: a systematic review of the literature

Capsular contracture is the most frequent complication after breast augmentation or reconstruction with breast implants. The immune system plays a prominent role in capsular contracture formation, albeit to an unknown extent. Bacterial contamination in situ has been hypothesized to be causative for capsular contracture. How this relates to the immunological processes involved is unknown. This article aims to provide an overview of immunological and bacterial factors involved in development of capsular contracture.

Can you tell the difference: round vs anatomical implants – a real-time global ballot

Round and anatomical implants are used throughout the world for breast augmentation. However, controversy persists as to which provides the most aesthetically pleasing results, with a paucity of evidence comparing the cosmetic outcome of the two shapes. Many argue that in the majority of patients it is impossible to tell whether augmentation has been carried out using anatomical or round implants. We performed a live global ballot at the London Breast Meeting 2016 to determine whether delegates from around the world could determine the shape of implants used to augment 50 patients.

MicroRNA 143-5p regulates alpaca melanocyte migration, proliferation, and melanogenesis

Abstract

microRNAs (miRNAs) have been shown to be closely involved in the control of melanogenesis and hair colour in mammals. Previous data also indicate that miR-143 regulates cell growth in melanoma. Here, we aimed to investigate the role of miR-143-5p in alpaca melanocytes. We found that miR-143-5p was highly expressed in the cytoplasm of alpaca melanocytes as demonstrated by an in situ hybridization assay. Prediction analysis revealed that miR-143-5p could regulate TGF-β-activated kinase 1 (TAK1) expression, which we confirmed by luciferase reporter assay, indicating that miR-143-5p controls TAK1 expression by directly targeting its 3′ untranslated region (UTR). miR-143-5p overexpression decreased TAK1 expression, which led to increased melanocyte migration and proliferation, and downregulation of microphthalmia-associated transcription factor (MITF), which regulates melanin production. These results support a functional role for miR-143-5p in regulating alpaca melanocyte migration, proliferation, and melanogenesis through direct targeting of TAK1.

This article is protected by copyright. All rights reserved.



Preparation and assessment of carboxylate polyelectrolyte as draw solute for forward osmosis

Abstract

Reverse draw solute diffusion not only reduces the water flux in forward osmosis (FO), but also contaminates the feed solution and eventually increases the regeneration cost of draw solution. In the present study, a new polyelectrolyte was synthesized as FO draw solute to address this problem. Acrylic acid and sodium p-styrenesulfonate monomers with hydrophilic group were used to fabricate carboxylate polyelectrolyte through free radical polymerization reaction. Results demonstrated that the osmotic pressure of carboxylate polyelectrolyte solution had a good linear relationship with concentration, and the viscosity of 0.18 g/mL solution was less than 5.4 cP. Active layer facing draw solution produced the initial water flux of 11.77 LMH and active layer facing feed solution yielded the initial water flux of 6.68 LMH when the concentration of draw solution was 0.18 g/mL. The reverse solute flux was around 1 gMH, and specific reverse solute flux of 0.18 g/mL carboxylate polyelectrolyte draw solution was 0.11 g/L which was much lower than that of traditional inorganic salts. Finally, diluted draw solution was regenerated via ultrafiltration, and the recovery efficiency of 94.78% was achieved. So, carboxylate polyelectrolyte can be suitable draw solute for FO.



Investigating monsoon and post-monsoon variabilities of bacterioplankton communities in a mangrove ecosystem

Abstract

In mangrove environments, bacterioplankton communities constitute an important component of aquatic biota and play a major role in ecosystem processes. Variability of bacterioplankton communities from Sundarbans mangrove, located in the Indian subcontinent in South Asia and sits on the apex of Bay of Bengal, was investigated over monsoon and post-monsoon seasons. The study was undertaken in two stations in Sundarbans using 16S rRNA clone library and Illumina MiSeq approaches with focus on the functionally important members that participate in coastal biogeochemical cycling. Out of 544 sequenced clones, Proteobacteria dominated the study area (373 sequences) with persistence of two major classes, namely, Gammaproteobacteria and Alphaproteobacteria across both monsoon and post-monsoon seasons in both stations. Several sequences belonging to Sphingomonadales, Chromatiales, Alteromonadales, Oceanospirillales, and Bacteroidetes were encountered that are known to play important roles in coastal carbon cycling. Some sequences showed identity with published uncultured Planctomycetes and Chloroflexi highlighting their role in nitrogen cycling. The detection of two novel clades highlighted the existence of indigenous group of bacterioplankton that may play important roles in this ecosystem. The eubacterial V3–V4 region from environmental DNA extracted from the above two stations, followed by sequencing in Illumina MiSeq system, was also targeted in the study. A congruency between the clone library and Illumina approaches was observed. Strong variability in bacterioplankton community structure was encountered at a seasonal scale in link with precipitation. Drastic increase in sediment associated bacteria such as members of Firmicutes and Desulfovibrio was found in monsoon hinting possible resuspension of sediment-dwelling bacteria into the overlying water column. Principal component analysis (PCA) revealed dissolved ammonium and dissolved nitrate to account for maximum variation observed in the bacterioplankton community structure. Overall, the study showed that a strong interplay exists between environmental parameters and observed variability in bacterioplankton communities as a result of precipitation which can ultimately influence processes and rates linked to coastal biogeochemical cycles.



Available forms of nutrients and heavy metals control the distribution of microbial phospholipid fatty acids in sediments of the Three Gorges Reservoir, China

Abstract

The construction of the Three Gorges Reservoir (TGR) as well as the development of local industry and agriculture not only had tremendous impacts on the environment but also affected human health. Although water, soil, and air in the TGR have been well studied for environmental risk assessment, very little information is available on benthic sediments and microorganisms. In this study, sedimentary samples were collected along the main stream of the TGR to examine microbial phospholipid fatty acids (PLFA) and relevant variables (e.g., nutrients and heavy metals) after the full operation of the TGR. The results showed that there were prominent trends (increase or decrease) of sedimentary PLFAs and properties from downstream to upstream. Bacteria-specific PLFA decreased toward the dam, while fungi-specific PLFA did not show any significant trend. The PLFA ratio of fungi to bacteria (F/B) increased along the mainstream. The total PLFA concentration, which represents the microbial biomass, decreased significantly toward the dam. Upstream and downstream sampling points were clearly distinguished by PLFA ordination in the redundancy analysis (RDA). That finding showed microbial PLFAs to have an obvious distribution pattern (increase or decrease) in the TGR. The PLFA distribution was markedly controlled by nutrients and heavy metals, but nutrients were more important. Moreover, among nutrients, Bio-P, NH4+-N, NO3-N, and DOC were more important than TP, TN, TOC, and pH in controlling PLFA distribution. For heavy metals, Tl, V, Mo, and Ni were more important than Zn, Cu, Cd, and Pb. These findings suggested that Tl, V, Mo, and Ni should not be ignored to guard against their pollution in the TGR, and we should pay attention to them and make them our first priority. This study highlighted that the construction of the TGR changed riverine environments and altered microbial communities in sediments by affecting sedimentary properties. It is a reminder that the microbial ecology of sediment as an indicator should be considered in assessing the eco-risk of the TGR.



Cancer nanomedicine: a review of recent success in drug delivery

Cancer continues to be one of the most difficult global healthcare problems. Although there is a large library of drugs that can be used in cancer treatment, the problem is selectively killing all the cancer c...

Risk perception of aquatic pollution originated from chemical industry clusters in the coastal area of Jiangsu province, China

Abstract

According to "the Layout Scheme of the Chemical Industry in Jiangsu Province From 2016 to 2030" and "the Development Planning in the Coastal Area of Jiangsu Province, China," several chemical industry clusters will be located in the coastal area of Jiangsu province, China, and the risk of surface water pollution will be inevitably higher in the densely populated region. To get to know the risk acceptance level of the residents near the clusters, public perception was analyzed from the five risk factors: the basic knowledge about the pollution, the negative effects on aquatic environment imposed by the clusters, the positive effects brought by the clusters, the trust of controlling aquatic pollution, and the acceptance of the clusters. Twenty-four statements were screened out to describe the five factors, and about 600 residents were covered in three typical clusters surveyed. On the whole, the youth showed a higher interest on the survey, and middle-aged people were likely to be more concerned about aquatic pollution incident. There was no significant difference on risk perception of the three clusters. The respondents investigated had good knowledge background on aquatic pollution and the residents identified with the benefits brought by the clusters. They were weak in risk awareness of pollution originated from the chemical enterprises' groups. Although the respondents regarded that chemical industry clusters did not expose all points of pollutants' generation to the public, they inclined to trust the administration agencies on controlling the pollution and welcome the construction of chemical clusters in their dwelling cities. Besides, risk perception showed obvious spatial distribution. The closer were the samples' sites to the clusters and the rivers receiving pollutants, the higher were the residents' perceived risk, benefit, and trust. However, there was no identical spatial difference on risk acceptance, which might be comprehensively influenced by various factors. Demographic variables on diverse risk acceptance levels were further illustrated, and some useful conclusions might be provided for managing the response of residents to aquatic pollution and helping identify effective precautionary measures in the vicinity of chemical industry clusters.



Keystone Flap zur Deckung großer Weichteildefekte des Handrückens



Hochdosierte intravenöse Immunglobuline bei dermatologischen Autoimmunerkrankungen

Zusammenfassung

Hochdosierte intravenöse Immunglobuline (IVIg) werden aufgrund ihrer immunmodulatorischen Eigenschaften erfolgreich zur Behandlung dermatologischer Autoimmunkrankheiten eingesetzt. Hierbei stellen der Pemphigus vulgaris und die Dermatomyositis klassische Indikationen dar. Bei den bullösen Autoimmundermatosen kann der adjuvante Einsatz von IVIg als Zweit- oder Drittlinientherapie nach Versagen einer kombinierten immunsuppressiven Therapie erfolgen, während in der Behandlung der Dermatomyositis IVIg bereits als adjuvante Zweitlinientherapie nach Versagen einer Steroidmonotherapie eingesetzt werden können. Aufgrund mangelnder Therapiealternativen können IVIg bei schweren Verläufen des Skleromyxödems als Erstlinientherapie eingesetzt werden. In therapierefraktären Fällen einer schweren systemischen Vaskulitis kann die Anwendung von IVIg erwogen werden. Ebenso stellen schwere Fälle eines systemischen Lupus erythematodes eine mögliche Indikation zum Einsatz von IVIg dar. Auch zur Behandlung der toxischen epidermalen Nekrolyse können IVIg bei frühzeitigem und hochdosiertem Einsatz indiziert sein. Häufigere, gut zu behandelnde Nebenwirkungen stellen Kopfschmerzen, Übelkeit, Fatigue und eine febrile Infusionsreaktion dar. Sehr selten kommt es zum Auftreten schwerer Nebenwirkungen wie thromboembolischen Ereignissen, anaphylaktischem Schock oder akutem Nierenversagen. Das Risiko einer viralen Transmission ist sehr gering. Hypothesen zur Wirkweise sind die Hochregulation inhibitorischer Fc-Rezeptoren, eine reduzierte Halbwertszeit von körpereigenen Immunglobulinen durch Verdrängung aus protektiven Rezeptorbindungen, die direkte Neutralisierung körpereigener Antikörper durch antiidiotypische Antikörper, sowie die Inhibierung der Komplementkaskade.



Calcific prepatellar bursitis in a patient with limited cutaneous systemic sclerosis



High-dose intravenous immunoglobulins for the treatment of dermatological autoimmune diseases

Summary

Based on their immunomodulatory properties, high-dose intravenous immunoglobulins (IVIGs) are successfully used in the treatment of various dermatological autoimmune diseases, in particular pemphigus vulgaris and dermatomyositis. In autoimmune bullous diseases, IVIGs can be used in an adjuvant setting (second- or third-line therapy) once combined immunosuppressive regimens have failed. In dermatomyositis, IVIGs may already be employed as an adjuvant second-line therapy after failure of corticosteroid monotherapy. In scleromyxedema, IVIGs may be considered as first-line treatment, given the lack of effective and safe alternatives. Other potential indications for IVIGs may include severe recalcitrant cases of systemic vasculitis and systemic lupus erythematosus. Toxic epidermal necrolysis may be an indication for high-dose IVIGs if administered early. Common, readily manageable side effects include nausea, headache, fatigue, and febrile infusion reactions. Severe adverse events such as thromboembolic events, anaphylaxis, and acute renal failure are very uncommon. The risk of viral transmission is very low. Potential mechanisms of action include upregulation of inhibitory Fc receptors, reduction of the half-life of endogenous immunoglobulins due to displacement from protective receptor sites, neutralization of autoantibodies by anti-idiotypic antibodies, as well as inhibition of complement activation.



Qualität von Sachverständigengutachten zum berufsbedingten Hautkrebs durch natürliches UV-Licht



Persistente Ulzera durch Crack-Konsum



Das Interesse an Solarien und Sonnenschutz im deutschsprachigen Raum

Zusammenfassung

Hintergrund

Die steigende Inzidenz nahezu aller Hautkrebsarten lässt sich durch eine zunehmende Exposition gegenüber natürlicher und künstlicher ultravioletter Strahlung (UV) erklären. Präventionsrelevante Statistiken über Risikoverhalten oder Sonnenschutz sind jedoch rar.

Methodik

Wir analysierten das Suchverhalten mit der Suchmaschine Google® nach Solarium und Sonnencreme bzw. Sonnenschutz in Deutschland, Österreich und der Schweiz im weltweiten Vergleich von 2004 bis 2016. Dabei werden „Normalized Search Volumes" (NSV) für die Suchanfragen berechnet und die zugehörigen Polynomfunktionen untereinander und im zeitlichen Verlauf verglichen.

Ergebnisse

Global nehmen die Suchanfragen nach Solarium seit 2011 deutlich ab und nach Sonnencreme stetig zu. Im deutschsprachigen Raum hingegen können seit Jahren durchgehend mehr Suchanfragen zu Solarium als zu Sonnencreme verzeichnet werden. Hier ist innerhalb eines Jahres ist eine Periodizität der Suchanfragen zu beobachten mit höchsten NSV für Solarium zwischen März und Mai und für Sonnencreme in den Sommermonaten um Juni. Innerhalb Deutschlands zeigen vor allem die Stadtstaaten Hamburg und Berlin besonders hohe NSV für Solarium.

Schlussfolgerungen

In deutschsprachigen Ländern zeigt sich im weltweiten Vergleich ein auffallend ungünstiges Suchverhalten. Es besteht weiterhin ein hoher Aufklärungs- und Präventionsbedarf von Sonnenschutz und Karenz gegenüber künstlicher UV-Exposition.



Das infantile Hämangiom: Pathogenese und Wirkmechanismus von Propranolol

Zusammenfassung

Das infantile Hämangiom (IH) ist der häufigste gutartige Tumor im Kindesalter. Die Prävalenz beträgt 4 % bis 10 %. Es ist gekennzeichnet durch eine proliferative schnelle Wachstumsphase, die nach wenigen Lebenswochen beginnt, gefolgt von einer langsamen Regressionsphase. Bei den IH-Fällen, bei denen eine Entstellung oder lebensbedrohlicher Verlauf zu befürchten ist (10 % bis 15 % aller Fälle), sollte unverzüglich eine systemische Therapie eingeleitet werden.

Datenquelle

Die vorliegende Studie gibt einen Überblick über die publizierten wissenschaftlichen Artikel in zuverlässigen elektronischen Datenbanken. Wir wählten alle Studien aus, welche die Pathogenese des IH und den Wirkmechanismus von Propranolol untersuchten.

Ergebnisse

Die Pathogenese des IH wurde noch nicht vollständig aufgeklärt. Wie Studien zeigen, liegt in der Proliferationsphase des IH ein Ungleichgewicht der angiogenen Faktoren vor. Darüber hinaus steigen die Spiegel des vaskulären endothelialen Wachstumsfaktors (VEGF) und der Matrix-Metalloproteinasen 2 und 9 an. In der Regressionsphase nehmen die Konzentrationen dieser Faktoren ab, während die Spiegel der anti-angiogenen Faktoren, darunter die der Gewebeinhibitoren der Matrix-Metalloproteinasen, zunehmen. Seit 2008 stellt die Behandlung mit Propranolol das Mittel der ersten Wahl dar. Dieses Arzneimittel beeinflusst den Gefäßtonus, die Angiogenese und die Apoptose. Die derzeitigen Kenntnisse über die Pathogenese des IH ermöglicht die Entwicklung neuer therapeutischer Strategien.



Erfolgreiche Behandlung einer Cheilitis granulomatosa mit Infliximab bei Kindern



Journal-Club



Regional healthcare delivery and demographic change in Germany – scenarios for dermatological care in 2035

Summary

Background

The 'demand planning guidelines' issued by the Federal Joint Committee are meant to ensure nationwide delivery of healthcare in Germany. The calculatory variable used to reflect the actual care situation in relation to a given geographical entity is referred to as 'adjusted supply rate'. Against the backdrop of demographic change and already existing problems in replacing retiring physicians, the question arises as to how future dermatological care will evolve at the regional level.

Methods

Using current 'demand planning guidelines' as well as nationwide data on the location of dermatologists and current and projected population figures at the county level, the adjusted supply rate – in terms of dermatological care – was calculated for the year 2035 based on three possible scenarios (scenario 1: 100 % replacement of retiring dermatologists; scenario 2: non-replacement of one dermatologist per planning area; and scenario 3: non-replacement of two dermatologists in rural areas).

Results

While scenario 1 shows an actual improvement in regional dermatological care in certain areas between 2014 and 2035 (n = 3 no longer undersupplied), the more likely scenarios 2 and 3 are potentially associated with considerable regional undersupply.

Conclusions

Taking demographic change into account, it is safe to assume that the geographical heterogeneity of dermatological care will increase. This requires greater effort not only in terms of demand planning but also with regard to offering alternative methods of delivering healthcare and intercommunal cooperation. In this context, the objective will be to adapt healthcare delivery to changes both in demography as well as in the plans young physicians have for their own lives.



Therapierefraktäres Exanthem eines sechs Monate alten Säuglings



Regionale fachärztliche Versorgung und demographischer Wandel in Deutschland – Szenarien zur dermatologischen Versorgung im Jahr 2035

Zusammenfassung

Hintergrund

Mithilfe der Bedarfsplanungsrichtlinie des Gemeinsamen Bundesausschusses soll die medizinische Versorgung in Deutschland flächendeckend sichergestellt werden. Kalkulatorische Größe zur Abbildung der räumlichen Versorgungssituation ist der „korrigierte Versorgungsgrad". Vor dem Hintergrund des demographischen Wandels und bereits heute existenter Wiederbesetzungsschwierigkeiten steht die Frage, wie sich die dermatologische Versorgung kleinräumig entwickeln wird.

Methodik

Mit bundesweiten Daten zu Hautarztstandorten sowie aktuellen und prognostizierten Bevölkerungszahlen auf Kreisebene wurde auf Basis der aktuellen Bedarfsplanungsrichtlinie der korrigierte Versorgungsgrad in drei Wiederbesetzungsszenarien (Szenario 1: 100%ige Wiederbesetzung, Szenario 2: Wegfall eines Arztsitzes je Planungsbereich, Szenario 3: Wegfall von zwei Arztsitzen in ländlichen Planungsbereichen) für das Prognosejahr 2035 exemplarisch berechnet.

Ergebnisse

Während sich in Szenario 1 die Versorgungssituation von 2014 auf 2035 in einigen Teilräumen sogar verbessern würde (n = 3 nicht mehr unterversorgt), zeigen die wahrscheinlicheren Szenarien 2 und 3 mit dem Wegfall einzelner Arztstandorte und dem altersselektiven Wanderungsverhalten, dass ganze Regionen in die Unterversorgung gelangen könnten.

Schlussfolgerungen

Es ist davon auszugehen, dass die räumliche Heterogenität der dermatologischen Versorgung unter Berücksichtigung des demographischen Wandels zunehmen wird. Weitere Anstrengungen in der Bedarfsplanung, aber auch hinsichtlich kreativer Versorgungsmodelle und interkommunaler Kooperation sind erforderlich, um die Versorgung dem demographischen Wandel sowie veränderten Lebensentwürfen junger Mediziner anzupassen.



Nachruf für Prof. Dr. Heinz Flegel (geb. 26.10.1923 – gest. 28.10.2017)



S2k-Leitlinie – Kutane Lymphome Update 2016 – Teil 1: Klassifikation und Diagnostik (ICD10 C82 - C86)



Unerwarteter Nachweis eines neu aufgetretenen Melanoms mittels PET-CT bei einer Patientin mit lymphogen metastasiertem malignen Melanom



Lymphangiosarkom der Hüfte in einem nicht bestrahlten kongenitalen Lymphangiom



27. Deutscher Hautkrebskongress der ADO in Mainz ging erfolgreich zu Ende



Erythematös-livide Plaques an beiden Unterschenkeln



Tagungsbericht der Jahrestagung des Arbeitskreises Psychosomatische Dermatologie (APD) am 30.09.2017 in Bonn



Electrochemical and optical biosensors for early-stage cancer diagnosis by using graphene and graphene oxide

Conventional instruments for cancer diagnosis including magnetic resonance imaging, computed tomography scan, are expensive and require long-waiting time, whilst the outcomes have not approached to the success...

Validating a continental-scale groundwater diffuse pollution model using regional datasets

Abstract

In this study, we assess the validity of an African-scale groundwater pollution model for nitrates. In a previous study, we identified a statistical continental-scale groundwater pollution model for nitrate. The model was identified using a pan-African meta-analysis of available nitrate groundwater pollution studies. The model was implemented in both Random Forest (RF) and multiple regression formats. For both approaches, we collected as predictors a comprehensive GIS database of 13 spatial attributes, related to land use, soil type, hydrogeology, topography, climatology, region typology, nitrogen fertiliser application rate, and population density. In this paper, we validate the continental-scale model of groundwater contamination by using a nitrate measurement dataset from three African countries. We discuss the issue of data availability, and quality and scale issues, as challenges in validation. Notwithstanding that the modelling procedure exhibited very good success using a continental-scale dataset (e.g. R 2 = 0.97 in the RF format using a cross-validation approach), the continental-scale model could not be used without recalibration to predict nitrate pollution at the country scale using regional data. In addition, when recalibrating the model using country-scale datasets, the order of model exploratory factors changes. This suggests that the structure and the parameters of a statistical spatially distributed groundwater degradation model for the African continent are strongly scale dependent.



Expression and enzyme activity of Cytochrome P450 enzymes CYP3A4 and CYP3A5 in human skin and tissue engineered skin equivalents

Abstract

CYP3A4 and CYP4A5 share specificity for a wide range of xenobiotics with the CYP3 subfamily collectively involved in the biotransformation of approximately 30% of all drugs. CYP3A4/5 mRNA transcripts have been reported in the skin yet knowledge of their protein expression and function is lacking. In this study, we observed gene and protein expression of CYP3A4/5 in both human skin and tissue-engineered skin equivalents (TESE), and enzyme activity was detected using the model substrate benzyl-O-methyl-cyanocoumarin. Mass spectrometric analysis of TESE lysates following testosterone application revealed a time-dependent increase in metabolite production, confirming the functional expression of these enzymes in skin.

This article is protected by copyright. All rights reserved.



The impact of allergy on asthma in the clinical practice



Bipolar Vessel Sealing System Versus Suture Ligation in Selective Neck Dissection

Abstract

Aim

To evaluate whether the use of electrothermal bipolar vessel sealing system reduces the blood loss and operating time, with lesser complications as compared to suture ligation in selective neck dissection in patients with oral cancer.

Materials and Methods

The study was conducted in the Department of Oral and Maxillofacial Surgery of our institute from January 2015 to December 2016. The sample consisted of 60 patients, divided into Groups I and II with 30 subjects in each. In Group I electrothermal bipolar vessel sealer and in Group II suture ligation were used. The outcome measures recorded were: blood loss, operating time, quality of surgical field, postoperative pain on days 1, 2, and 3, drainage volume at 24, 48, and 72 h, edema, complications, and duration of hospital stay.

Results

There were 36 males and 24 females with a mean age of 50.76 ± 12.6 years. Blood loss was significantly less for Group I than for Group II (p = 0.001); the operating time was significantly less in Group I than in Group II (p = 0.001); Group I had better quality of surgical field (p = 0.001); less pain on postoperative evening, day 2 and day 3 (p < 0.05); and less drainage volume at 24 and 48 h (p < 0.05). Postoperative edema, complications, need for perioperative blood transfusion, and duration of hospital stay postsurgery were similar in both groups.

Conclusion

The electrothermal bipolar vessel sealer was efficacious in terms of reducing blood loss and operating time while providing a better surgical field and patient compliance without increasing the perioperative morbidity.



Follicular papules and pustules in a patient with pulmonary symptoms



Abundance of Naegleria fowleri in roof-harvested rainwater tank samples from two continents

Abstract

Roof-harvested rainwater (RHRW) has been used as an alternative source of water in water scarce regions of many countries. The microbiological and chemical quality of RHRW has been questioned due to the presence of bacterial and protozoan pathogens. However, information on the occurrence of pathogenic amoeba in RHRW tank samples is needed due to their health risk potential and known associations with opportunistic pathogens. Therefore, this study aims to determine the quantitative occurrence of Naegleria fowleri in RHRW tank samples from Southeast Queensland (SEQ), Australia (AU), and the Kleinmond Housing Scheme located in Kleinmond, South Africa (SA). In all, 134 and 80 RHRW tank samples were collected from SEQ, and the Kleinmond Housing Scheme, Western Cape, SA, respectively. Quantitative PCR (qPCR) assays were used to measure the concentrations of N. fowleri, and culture-based methods were used to measure fecal indicator bacteria (FIB) Escherichia coli (E. coli) and Enterococcus spp. Of the 134 tank water samples tested from AU, 69 and 62.7% were positive for E. coli, and Enterococcus spp., respectively. For the SA tank water samples, FIB analysis was conducted for samples SA-T41 to SA-T80 (n = 40). Of the 40 samples analyzed from SA, 95 and 35% were positive for E. coli and Enterococcus spp., respectively. Of the 134 water samples tested in AU, 15 (11.2%) water samples were positive for N. fowleri, and the concentrations ranged from 1.7 × 102 to 3.6 × 104 gene copies per 100 mL of water. Of the 80 SA tank water samples screened for N. fowleri, 15 (18.8%) tank water samples were positive for N. fowleri and the concentrations ranged from 2.1 × 101 to 7.8 × 104 gene copies per 100 mL of tank water. The prevalence of N. fowleri in RHRW tank samples from AU and SA thus warrants further development of dose-response models for N. fowleri and a quantitative microbial risk assessment (QMRA) to inform and prioritize strategies for reducing associated public health risks.



10,000 attentive hours, rapid learning, dissemination of knowledge and the future of experience-based care in germ cell tumors



Why the US Centers for Medicare and Medicaid Services (CMS) should have required a randomized trial of Foundation Medicine (F1CDx) prior to paying for it



A randomized trial of induction docetaxel-cisplatin-5FU followed by concomitant cisplatin-RT versus concomitant cisplatin-RT in nasopharyngeal carcinoma (GORTEC 2006-02)

Abstract
Background
concomitant CT-RT is a standard of care in locally advanced nasopharyngeal carcinoma (NPC) and a role for induction CT is not established.
Methods
patients with locally advanced NPC, WHO type 2 or 3, were randomized to induction TPF plus concomitant cisplatin -RT or concomitant cisplatin -RT alone. The TPF regimen consisted of 3 cycles of Docetaxel 75 mg/m2 Day 1; cisplatin 75 mg/m2 Day 1; 5FU 750 mg/m2/d Day 1-5. RT consisted of 70 Gy in 7 weeks plus concomitant cisplatin 40 mg/m2 weekly.
Results
83 patients were included in the study . Demographics and tumor characteristics were well balanced between both arms. Most of the patients (95%) in the TPF arm received 3 cycles of induction CT. The rate of grade 3-4 toxicity and the compliance (NCI-CTCAE v3) during cisplatin-RT were not different between both arms. With a median follow-up of 43.1 months, the 3 years PFS rate was 73.9% in the TPF arm versus 57.2% in the reference arm (HR = 0.44; 95% CI: 0.20-0.97, p = 0.042). Similarly the 3 years overall survival rate was 86.3% in the TPF arm versus 68.9% in the reference arm (HR = 0.40; 95% CI: 0.15-1.04, p = 0.05).
Conclusion
In conclusion, several important aspects can be emphasized: the compliance to induction TPF was good and TPF did not compromise the tolerance of the concomitant RT-cisplatin phase. The improved PFS and overall survival rates needs to be confirmed by further trials.

Relationship between patient-reported outcomes and clinical outcomes in metastatic castration-resistant prostate cancer: post-hoc analysis of COU-AA-301 and COU-AA-302

Abstract
Background
Patient-reported outcomes (PROs) are used to assess benefit-risk in drug development. The relationship between PROs and clinical outcomes is not well understood. We aimed to elucidate the relationships between changes in PRO measures and clinical outcomes in metastatic castration-resistant prostate cancer (mCRPC).
Patients and methods
We investigated relationships between changes in self-reported fatigue, pain, functional well-being (FWB), physical well-being (PWB) and prostate cancer-specific symptoms with overall survival (OS) and radiographic progression-free survival (rPFS) after 6 and 12 months of treatment in COU-AA-301 (N = 1195) or COU-AA-302 (N = 1088). Eligible COU-AA-301 patients had progressed after docetaxel and had Eastern Cooperative Oncology Group performance status (ECOG PS) ≤2. Eligible COU-AA-302 patients had no prior chemotherapy and ECOG PS 0 or 1. Patients were treated with abiraterone acetate (1000 mg/day) plus prednisone (10 mg/day) or prednisone alone daily. Association between self-reported fatigue, pain and functional status, and OS and/or rPFS, using pooled data regardless of treatment, was assessed. Cox proportional hazard regression modeled time to death or radiographic progression.
Results
In COU-AA-301 patients, PRO improvements were associated with longer OS and longer time to radiographic progression versus worsening or stable PROs (P < 0.0001). In multivariate models, all except pain intensity remained associated with OS. Pain intensity, PWB and FWB improvements remained associated with rPFS. In COU-AA-302 patients, worsening PROs were associated with higher likelihood of radiographic progression (P ≤ 0.025) compared with improved or stable PROs. In multivariate models, worsening PWB remained associated with worse rPFS. The 12-month analysis confirmed the 6-month results.
Conclusions
PROs are significantly associated with clinically relevant time-to-event efficacy outcomes in clinical trials and may complement and help predict traditional clinical practice methods for monitoring patients for disease progression.

Pharmacogenomics: Time to re-think its role in Precision Medicine.

colorectal cancergermline polymorphismspredictive biomarkerspharmacogenomicsTYMSERCC1

Actikerall: an alternative to curettage for some seborrhoeic keratoses?



Pollution evaluation of total and acid-leachable trace elements in surface sediments of Hooghly River Estuary and Sundarban Mangrove Wetland (India)

Abstract

The present work investigated the spatial distribution and ecological risk assessment of total and mild acid-leachable trace elements in surface sediments (top 0–10 cm; grain size ≤ 63 μm) along the Hooghly (Ganges) River Estuary and Sundarban Mangrove Wetland, India. The trace elements, analyzed by ICPMS, showed wide range of variations with the following descending order (mean values expressed in milligrams per kilogram): Fe (25,050 ± 4918) > Al (16,992 ± 4172) > Mn (517 ± 102) > Zn (53 ± 18) > Cu (33 ± 11) > Cr (29 ± 7) > Ni (27 ± 6) > Pb (14 ± 3) > As (5 ± 1) > Se (0.37 ± 0.10) > Cd (0.17 ± 0.13) > Ag (0.16 ± 0.19) > Hg (0.05 ± 0.10). In the acid-leachable fraction, Cd (92%) is dominated followed by Pb (81%), Mn (77%), Cu (70%), and Se (58%) indicating their high mobility, imposing negative impact on the adjacent benthos. The sediment pollution indices (both enrichment factor and contamination factor) suggested severe pollution by Ag at the sampling site Sajnekhali, a wildlife sanctuary in Sundarban. The mean probable effect level quotient indicated that surface sediments in the vicinity of the studied region have 21% probability of toxicity to biota. The result of multivariate analyses affirms lithogenic sources (e.g., weathering parent rocks, dry deposition) for As, Pb, Cr, Cu, and Ni, whereas Cd and Hg originated from anthropogenic activities (such as urban and industrial activities). Both human-induced stresses and natural processes controlled trace element accumulation and distribution in the estuarine system, and remedial measures are required to mitigate the potential impacts of these hazardous trace elements.



Aggressive cutaneous squamous cell carcinoma arising from a human papillomavirus-infected epidermoid cyst of the conchal bowl



Pembrolizumab beim fortgeschrittenen Ösophaguskarzinom



Air exposure may be associated with the histological differentiation of a cultured epidermal autograft (JACE)



HLA-B*1502 haplotype screening prior to carbamazepine administration in individuals of south-east Asian ancestry nears cost-effectiveness in preventing severe cutaneous adverse drug reactions



Proportion of melanoma excisions performed by different specialties in Australia



Knowledge requires commitment (instead of belief)

Abstract

I argue that S knows that p implies that S is properly committed to the truth of p, not that S believes that p. Belief is not required for knowledge because it is possible that one could know that there are no beliefs. Being 'properly committed' to the truth of a proposition is a matter of having a certain normative status, not occupying a particular psychological state. After arguing that knowledge requires commitment instead of belief, I go on to demonstrate the theoretical utility of this hypothesis.



Effects of organochlorine pesticides on plant growth-promoting traits of phosphate-solubilizing rhizobacterium, Paenibacillus sp. IITISM08

Abstract

The study aimed to identify an effective phosphate-solubilizing and organochlorine pesticide-tolerant bacterial strain(s). A total of 50 phosphate-solubilizing bacterial (PSB) strains were isolated from pesticide-stressed soil. Ten isolates showing higher solubilization were selected for organochlorine pesticides (endosulfan, aldrin, and lindane) tolerance. The strain IITISM08 showed the maximum potential of phosphorous solubilization in Pikovaskya agar medium (solubilization index = 3.2) and in broth medium (348 ± 2 μg mL−1) and tolerated up to 250 μg mL−1 of organochlorine pesticides. During phosphorous solubilization, the presence of functional group and organic acid production were also observed using FT-IR and HPLC. The plant growth-promoting (PGP) traits of the strain IITISM08 was highly inhibited in presence of endosulfan among the three organochlroine pesticides. The strain IITISM08 degraded aldrin (79%), lindane (68%), and endosulfan (51%) at a concentration of 50 μg mL−1. The strain IITISM08 was identified using 16S rDNA gene sequencing as Paenibacillus sp. (IITISM08). The study revealed that the strain IITISM08 can be used as PGP candidate even under organochlorine pesticide-stressed condition.



Seltene maligne Raumforderung im Bereich der linken Oberlippe