Correction to: The mineralization of oxalic acid and bio-treated coking wastewater by catalytic ozonation using nickel oxide

Abstract

In Table 1, "SO^2-4" and "NO^-3" should be corrected to " \( \mathrm{S}{\mathrm{O}}_4^{2-} \) " and " \( \mathrm{N}{\mathrm{O}}_3^{-} \) ", respectively. The original article was corrected.

Fouling mitigation and cleanability of TiO 2 photocatalyst-modified PVDF membranes during ultrafiltration of model oily wastewater with different salt contents

Abstract

In the present study, TiO₂-coated ultrafiltration membranes were prepared and used for oily water filtration (droplet size < 2 μm). The aim of this work was to investigate the effect of different salt contents on fouling and filtration properties of neat and TiO₂-coated membranes during oil-in-water emulsion filtration. The effect of the TiO₂ coating on the flux, surface free energy, and retention values was measured and compared with the neat membrane values. The cleanability of the fouled TiO₂-coated membranes by UV irradiation was also investigated by measuring flux recovery and contact angles, and the chemical changes during cleaning were characterized by ATR-IR. It was found that increasing the salt content of the model wastewaters, oil-in-water emulsions, increased the zeta potential and the size of the droplets. The presence of the TiO₂ coating decreases the membrane fouling during oily emulsion filtration compared to the neat membrane, due to the hydrophilicity of the coating regardless of the salt content of the emulsions. The neat and coated membrane oil retention was similar, 96 ± 2%. The coated membrane can be effectively cleaned with UV irradiation without additional chemicals and a significant flux recovery can be achieved. Monitoring of the cleaning process by following the membrane surface wettability and ATR-IR measurements showed that the recovery of flux does not mean the total elimination of the oil layer from the membrane surface.

Tinea faciei in a central Portuguese hospital: A 9-year survey

Summary

Tinea faciei is a relatively uncommon dermatophytosis that affects the glabrous skin of the face. The aim of this study was to analyse the epidemiologic, clinical and mycological features of tinea faciei cases diagnosed at the Dermatology and Venereology Department of Hospital Santo António dos Capuchos (Lisbon, Portugal). Consecutive cases diagnosed between 2008 and 2016 were studied retrospectively. A total of 72 tinea faciei cases have been diagnosed, involving 37 male and 35 female, aged between 8 months and 86 years. The majority were observed in patients younger than 12 years of age (59.72%). Anthropophilic isolates (mainly Microsporum audouinii, Trichophyton soudanense and Trichophyton rubrum) accounted for 75.7% of the identified dermatophytes. One quarter of the patients were also affected by dermatophytosis in other areas, such as the scalp. Only 10 cases were previously treated with topical steroids due to misdiagnosis. Most patients were treated with topical and systemic antifungal therapy with total resolution of skin lesions, without relapse or side effects. In contrast to other European studies, anthropophilic dermatophytes were the main causative agents of tinea faciei. As previously described to tinea capitis, this result is probably due to changes in the epidemiology of dermatophytes worldwide.

Widespread papular eruption in an infant

Association of the CYP17 MSP AI (T-34C) and CYP19 codon 39 (Trp/Arg) polymorphisms with susceptibility to acne vulgaris

Summary

The aim of this study was to detect the association of the cytochrome P450 (CYP) 17 T-34C and CYP19 T<C polymorphisms with the risk of acne vulgaris (AV). The study enrolled 198 patients with AV (mild, moderate and severe) and 195 unrelated age-matched healthy controls from western Iran who had Kurdish ethnic background. The presence of the CYP17 TC genotype significantly increased the risk of mild, moderate and severe AV by 2.68, 2.28 and 2.94 times, respectively, while the presence of the CYP19 TC genotype significantly elevated the risk of overall AV and mild AV by 2.1 and 3.2 times, respectively. There was a synergy between the CYP 17 TC and CYP19 TT genotypes, which increased the risk of AV by 2.45-fold (P < 0.001). To our knowledge, this is the first study showing that the CYP17 T-34C and CYP19 T<C variants and their synergy are associated with susceptibility to AV in an Iranian population.

Association but not Recognition: an Alternative Model for Differential Imitation from 0 to 2 Months

Abstract

Skepticism toward the existence of neonatal differential imitation is fostered by views that assign it an excessive significance, making it foundational for social cognition. Moreover, a misleading theoretical framework may generate unwarranted expectations about the kinds of findings experimentalists are supposed to look for. Hence we propose a theoretical analysis that may help experimentalists address the empirical question of whether early differential imitation really exists. We distinguish three models of early imitation. The first posits automatic visuo-motor links evolved for sociocognitive functions and we call it Genetically Programmed Direct Matching (GPDM). The second is Meltzoff and Moore's Active Intermodal Matching (AIM), which postulates a comparison between the acts of self and other. The third is the alternative we propose and we call it "Association by Similarity Theory" (AST), as it relies on the tacit functioning of this domain-general process. AST describes early imitation merely as the differential induction or elicitation of behaviors that already tend to occur spontaneously. We focus on the contrast between AIM and AST, and argue that AST is preferable to AIM for two reasons. First, AST is more parsimonious and more plausible, especially because it does not require infants to be able to recognize self-other similarities. Second, whereas the extant findings tend to disqualify AIM, AST can account for them adequately. Furthermore, we suggest that AST has the potential to give new impulse to empirical research because it discriminates promising lines of inquiry from unproductive ones.

Evaluation of topical liposome incorporated clove oil in the treatment of idiopathic palmar hyperhidrosis: Single-blinded placebo-controlled study

Summary

Introduction

Palmar hyperhidrosis is of great concern to patients because of its physical, occupational, and psychological impact on quality of life. Topical clove oil has been used in many conditions due to its major component Eugenol that exerts blocking effect on nerve transmission.

Aim of the work

To assess the efficacy of topical liposome incorporated clove oil in decreasing the rate of sweating among patients with idiopathic palmar hyperhidrosis.

Patients and method

Forty patients with palmar hyperhidrosis were treated with clove oil 45% in liposome and another twenty patients were treated as a control group with 0.9% saline solution and evaluation was carried out before and after treatment through gravimetry testing and hyperhidrosis disease severity scale (HDSS).

Result

The gravimetry testing among clove oil-treated group showed that the mean sweating rate before treatment was 80.5 ± 41.85 (SD) mg/min which decreased significantly after treatment to 52.98 ± 37.94(SD) mg/min (P value < .001). On the other hand, the placebo-treated group,(control) the mean sweating rate before treatment was 77.40 ± 29.29(SD) which did not show significant improvement after placebo application 77.35 ± 28.29(SD; P value = .957).

Conclusion

The topical application of 45% clove oil in liposome twice daily for 2 weeks showing promising result evidenced by declining in the rate of palmar sweating among patients with idiopathic palmar hyperhidrosis.

Tattoos: Evaluation of knowledge about health complications and their prevention among students of Tricity universities

Summary

Introduction

Tattooing is a very popular form of body modification among young people. However, this kind of procedure entails the risk of various health complications. The objective of the study was to evaluate the students' knowledge about contraindications, complications, and health risks that skin tattooing may cause. Additionally, the purpose of the study was to assess how the profile of education (medical vs nonmedical) impacts on the knowledge of the respondents.

Methods

We surveyed a group of 1199 people, of which 326 (27%) had tattoos. The base of the study is an anonymously filled, author's online survey consisting of 25 questions.

Results

Eighty six percent of the students from the Medical University of Gdańsk indicated the risk of HCV virus infection during tattooing, while only 34% of students from other Tricity universities were aware of this danger. Sixty seven percent of people with tattoos felt that having them does not affect any diagnostic and therapeutic procedures. Most of respondents mentioned the tattoo artist (79%) and the Internet (73%) as a source of information before having a tattoo, while only 5% and 8% respondents asked a doctor or read medical literature about it. Fourty nine percent of respondents reported that before the procedure, tattooist failed to ask them about their health condition and medications.

Conclusions

Knowledge of students about safety, contraindications, and complications associated with the performance of tattooing is insufficient. As a result, a need for a better education on the topic for both people who are getting tattoos and tattooists appears evident.

MR Imaging Criteria for the Detection of Nasopharyngeal Carcinoma: Discrimination of Early-Stage Primary Tumors from Benign Hyperplasia [HEAD & NECK]

BACKGROUND AND PURPOSE:

MR imaging can detect nasopharyngeal carcinoma that is hidden from endoscopic view, but for accurate detection carcinoma confined within the nasopharynx (stage T1) must be distinguished from benign hyperplasia of the nasopharynx. This study aimed to document the MR imaging features of stage T1 nasopharyngeal carcinoma and to attempt to identify features distinguishing it from benign hyperplasia.

MATERIALS AND METHODS:

MR images of 189 patients with nasopharyngeal carcinoma confined to the nasopharynx and those of 144 patients with benign hyperplasia were reviewed and compared in this retrospective study. The center, volume, size asymmetry (maximum percentage difference in area between the right and left nasopharyngeal halves), signal intensity asymmetry, deep mucosal white line (greater contrast enhancement along the deep tumor margin), and absence/distortion of the adenoidal septa were evaluated. Differences were assessed with logistic regression and the ² test.

RESULTS:

The nasopharyngeal carcinoma center was lateral, central, or diffuse in 134/189 (70.9%), 25/189 (13.2%), and 30/189 (15.9%) cases, respectively. Nasopharyngeal carcinomas involving the walls showed that a deep mucosal white line was present in 180/183 (98.4%), with a focal loss of this line in 153/180 (85%) cases. Adenoidal septa were absent or distorted in 111/111 (100%) nasopharyngeal carcinomas involving the adenoid. Compared with benign hyperplasia, nasopharyngeal carcinoma had a significantly greater volume, size asymmetry, signal asymmetry, focal loss of the deep mucosal white line, and absence/distortion of the adenoidal septa (P < .001). Although size asymmetry was the most accurate criterion (89.5%) for nasopharyngeal carcinoma detection, use of this parameter alone would have missed 11.9% of early-stage T1 nasopharyngeal carcinomas.

CONCLUSIONS:

MR imaging features can help distinguish stage T1 nasopharyngeal carcinoma from benign hyperplasia in most cases.

Clinical and Radiologic Characteristics of Deep Lumbosacral Dural Arteriovenous Fistulas [SPINE]

BACKGROUND AND PURPOSE:

Spinal dural arteriovenous fistulas located in the deep lumbosacral region are rare and the most difficult to diagnose among spinal dural arteriovenous fistulas located elsewhere in the spinal dura. Specific clinical and radiologic features of these fistulas are still inadequately reported and are the subject of this study.

MATERIALS AND METHODS:

We retrospectively evaluated all data of patients with spinal dural arteriovenous fistulas treated and/or diagnosed in our institution between 1990 and 2017. Twenty patients with deep lumbosacral spinal dural arteriovenous fistulas were included in this study.

RESULTS:

The most common neurologic findings at the time of admission were paraparesis (85%), sphincter dysfunction (70%), and sensory disturbances (20%). Medullary T2 hyperintensity and contrast enhancement were present in most cases. The filum vein and/or lumbar veins were dilated in 19/20 (95%) patients. Time-resolved contrast-enhanced dynamic MRA indicated a spinal dural arteriovenous fistula at or below the L5 vertebral level in 7/8 (88%) patients who received time-resolved contrast-enhanced dynamic MRA before DSA. A bilateral arterial supply of the fistula was detected via DSA in 5 (25%) patients.

CONCLUSIONS:

Clinical symptoms caused by deep lumbosacral spinal dural arteriovenous fistulas are comparable with those of spinal dural arteriovenous fistulas at other locations. Medullary congestion in association with an enlargement of the filum vein or other lumbar radicular veins is a characteristic finding in these patients. Spinal time-resolved contrast-enhanced dynamic MRA facilitates the detection of the drainage vein and helps to localize deep lumbosacral-located fistulas with a high sensitivity before DSA. Definite detection of these fistulas remains challenging and requires sufficient visualization of the fistula-supplying arteries and draining veins by conventional spinal angiography.

Cervical Cord Atrophy and Long-Term Disease Progression in Patients with Primary-Progressive Multiple Sclerosis [SPINE]

BACKGROUND AND PURPOSE:

Cervical cord atrophy has been associated with clinical disability in multiple sclerosis and is proposed as an outcome measure of neurodegeneration. The aim of this study was to quantify the development of cervical cord atrophy and to evaluate its association with disability progression in patients with primary-progressive multiple sclerosis.

MATERIALS AND METHODS:

Thirty-one patients with primary-progressive multiple sclerosis underwent 1.5T brain and spinal cord MR imaging at baseline and 6–7 years later. The cervical spinal cord from C1 to C5 was segmented to evaluate the normalized overall cross-sectional area and the cross-sectional area of C2–C3, C3–C4, and C4–C5. The annualized rates of normalized cross-sectional area loss were also evaluated. To estimate clinical progression, we determined the Expanded Disability Status Scale score at baseline and at 2 and 14 years after baseline to compute the normalized area under the curve of the Expanded Disability Status Scale and the Expanded Disability Status Scale changes from baseline to the follow-up time points. Associations between the cord cross-sectional area and brain MR imaging and clinical measures were also investigated. Finally, the value of all these measures for predicting long-term disability was evaluated.

RESULTS:

Some normalized cross-sectional area measurements showed moderate correlations with the normalized area under the curve of the Expanded Disability Status Scale, ranging from –0.439 to –0.359 (P < .05). Moreover, the annualized rate of the normalized mean cross-sectional area loss and the baseline Expanded Disability Status Scale were independent predictors of long-term disability progression.

CONCLUSIONS:

These data indicate that development of cervical cord atrophy is associated with progression of disability and is predictive of this event in patients with primary-progressive MS.

Cerebrovascular Manifestations of Neurosarcoidosis: An Underrecognized Aspect of the Imaging Spectrum [REVIEW ARTICLE]

SUMMARY:

Involvement of the central nervous system by sarcoidosis, also referred to as neurosarcoidosis, is seen clinically in about 5% of patients with systemic disease. CNS involvement most frequently affects the leptomeninges and cranial nerves, though the ventricular system, brain parenchyma, and pachymeninges may also be involved. Even though the involvement of the intracranial vascular structures is well-known on postmortem studies, there is scant literature on imaging manifestations secondary to the vessel wall involvement, being confined mostly to isolated case reports and small series. The authors present a review of various cerebrovascular manifestations of neurosarcoidosis, along with a brief synopsis of the existing literature.

Spinal Arteriovenous Vascular Malformations in Patients with Neural Tube Defects [SPINE]

BACKGROUND AND PURPOSE:

Neural tube defects, such as tethered cord, intradural lipoma, or myelomeningocele may coexist with spinal vascular malformations. The coexistence of these 2 rare entities is suggestive of a causal relationship between them, which may lead to further understanding of their pathogenesis. We present a series of 6 patients with epidural spinal arteriovenous fistulas associated with neural tube defects.

MATERIALS AND METHODS:

We retrieved cases of spinal vascular malformations associated with neural tube defects seen at our institution. The clinical presentation, MR imaging/MRA and angiographic imaging, treatment outcomes, and long-term neurologic outcomes were analyzed. Descriptive statistical analyses are reported.

RESULTS:

Six patients with epidural arteriovenous fistulas and neural tube defects were included in this study. The mean age at presentation was 42 years, and the most common presenting symptoms were lower extremity weakness followed by sensory disturbances and bladder/bowel dysfunction. In most cases (5/6), the fistulas were located at the sacral level. All cases were fed by the lateral sacral artery (6/6). Four patients had prior spine surgery, but the fistula was in the operative bed in 2 cases. All fistulas were extradural with secondary intradural venous drainage. Five patients underwent transarterial embolization with Onyx, and 1 patient had a treatment-related complication.

CONCLUSIONS:

It is conceivable that there is a pathophysiologic link between neural tube defects and development of spinal vascular malformations. Delayed neurologic deterioration or high conus signal in a patient with a neural tube defect should suggest the possibility of such an association.

Noninvasive Assessment of Intracranial Pressure Status in Idiopathic Intracranial Hypertension Using Displacement Encoding with Stimulated Echoes (DENSE) MRI: A Prospective Patient Study with Contemporaneous CSF Pressure Correlation [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Intracranial pressure is estimated invasively by using lumbar puncture with CSF opening pressure measurement. This study evaluated displacement encoding with stimulated echoes (DENSE), an MR imaging technique highly sensitive to brain motion, as a noninvasive means of assessing intracranial pressure status.

MATERIALS AND METHODS:

Nine patients with suspected elevated intracranial pressure and 9 healthy control subjects were included in this prospective study. Controls underwent DENSE MR imaging through the midsagittal brain. Patients underwent DENSE MR imaging followed immediately by lumbar puncture with opening pressure measurement, CSF removal, closing pressure measurement, and immediate repeat DENSE MR imaging. Phase-reconstructed images were processed producing displacement maps, and pontine displacement was calculated. Patient data were analyzed to determine the effects of measured pressure on pontine displacement. Patient and control data were analyzed to assess the effects of clinical status (pre–lumbar puncture, post–lumbar puncture, or control) on pontine displacement.

RESULTS:

Patients demonstrated imaging findings suggesting chronically elevated intracranial pressure, whereas healthy control volunteers demonstrated no imaging abnormalities. All patients had elevated opening pressure (median, 36.0 cm water), decreased by the removal of CSF to a median closing pressure of 17.0 cm water. Patients pre–lumbar puncture had significantly smaller pontine displacement than they did post–lumbar puncture after CSF pressure reduction (P = .001) and compared with controls (P = .01). Post–lumbar puncture patients had statistically similar pontine displacements to controls. Measured CSF pressure in patients pre– and post–lumbar puncture correlated significantly with pontine displacement (r = 0.49; P = .04).

CONCLUSIONS:

This study establishes a relationship between pontine displacement from DENSE MR imaging and measured pressure obtained contemporaneously by lumbar puncture, providing a method to noninvasively assess intracranial pressure status in idiopathic intracranial hypertension.

Cutaneous polyarteritis nodosa: Diagnosis lies skin deep

Raghavendraswami Amoghimath, Rajwanti K Vaswani, Chandrahas T Deshmukh, Chhaya Divecha

Indian Journal of Paediatric Dermatology 2018 19(1):71-73

Cutaneous polyarteritis nodosa (CPAN) is an uncommon form of cutaneous vasculitis. Definitive diagnosis is based on skin biopsy. We present a rare case of CPAN in a 2-year-old male child who presented with a history of fever, cutaneous ulcers, and digital gangrene. He was treated with steroids and skin lesions had resolved completely. CPAN needs to be differentiated from systemic polyarteritis nodosa for specific prognosis and management. We report this case to highlight the need of early diagnosis for faster recovery with favorable outcome.

Stevens-Johnson syndrome and toxic epidermal necrolysis in children

Sudip Das, Ramkumar Ramamoorthy

Indian Journal of Paediatric Dermatology 2018 19(1):9-14

SJS and TEN are diseases characterised by epidermal detachment and necrolysis predominantly of drug induced etiology. SJS/TEN begins with a prodrome of fever, malaise, anorexia, pharyngitis, and headache lasting for 2-3 days, at times, extending to 10-11 days. Mucosal lesions usually precede skin lesion. Usually, two mucosal membranes are involved, most commonly conjunctiva and oral mucosa. Oral mucosal involvement is seen in 90% of SJS and almost all patients diagnosed with TEN. In SJS, mucosal involvement is widespread and confl uent in contrast to erythema multiforme where it is focal and seen in only 25%-60% of cases. The exact pathogenesis of SJS and TEN is not fully elucidated. In view of the paucity of T-cell infiltrate,keratinocyte apoptosis could be the result of autocrine or paracrine interaction between Fas, a death receptoron keratinocyte and Fas Ligand (FasL) produced by the keratinocytes along with the substantial contributionof soluble FasL from peripheral mononuclear cells. FasL upregulation in keratinocytes is nitric oxide-dependent anddriven by T-cell derived tumor necrosis factor (TNF) alpha and Interferon-gamma.The management revplves around immediate stoppage of drug and.,supportive care .IVIG,corticosteroids and cyclosporine are all effective drugs but no RCT is available for any of them

Vascular birthmarks: A hidden world behind a word

Carlo Gelmetti

Indian Journal of Paediatric Dermatology 2018 19(1):1-8

A confusing nomenclature concerning the subject of vascular birthmark and angiomas lead (and leads!) to the consequence that parents with children affected by this kind of disorders become medical nomads, and therefore, the best treatment, when available, is frequently postponed. The concept of maternal imprint that began to crumble in the XVIII century is, unfortunately, still widespread. While a maternal responsibility as it has been conceived in the past has been definitively excluded, the pivotal classification proposed by John Mulliken that divides vascular anomalies in vascular tumors and vascular malformations is practically very useful. The rapid progress of genetic studies has explained to medical community a huge number of genotype-phenotype correlations, and it will individuate new forms in the next future. Understanding the biology of vascular birthmarks is a fundamental step forward to implement effective and specific drugs for specific forms. Discoveries by serendipity occur but are rare.

Prevalence of dermatoses among the tribal children studying in residential schools of South Chhattisgarh, India

Yasha Upendra, Sampreeti Sendur, Naveen Keswani, Abhishek Pallava

Indian Journal of Paediatric Dermatology 2018 19(1):15-20

Introduction: Dermatoses are common among schoolgoing children and lead to significant morbidity. Objective: The present study was conducted to find the prevalence of various dermatoses in children studying in residential schools of remote tribal areas. Materials and Methods: A cross-sectional study was conducted on 1943 children studying in eight residential government schools over a period of 2 months (August and September 2016). Diagnosis of various dermatoses was made on the basis of detailed clinical examination and necessary investigations. Data analysis done by SPSS version 21.0 and Chi-square test was used to analyze categorical variables. Results: The prevalence of dermatoses was 72.1%. Majority had single skin lesion. Among infections and infestations, scabies (13.6%), pediculosis capitis (9.2%), and pyoderma (7.5%) were most prevalent. Among the noninfective conditions, xerosis (32.63%), pityriasis alba (18.9%), acne (8.6%), and atopic dermatitis were most prevalent. The prevalence of pyoderma, tinea corporis, pityriasis versicolor, scabies, and xerosis was higher in boys while pediculosis capitis and pityriasis alba were more prevalent in girls. The prevalence of xerosis, pityriasis alba, and phrynoderma was higher in primary school students while tinea corporis, scabies, acne, and pediculosis capitis were more prevalent in high school students. Conclusions: The burden of dermatoses in residential school children is very high. Health education of children, teachers, and caregivers regarding signs and symptoms of dermatoses is warranted for early detection and timely intervention. There is urgent need to address dermatoses under school health program.

Hoyeraal–Hreidarsson syndrome: A rare dyskeratosis congenita phenotype

Mansoor C Abdulla

Indian Journal of Paediatric Dermatology 2018 19(1):83-84

Effect of occurrence of vitiligo in children over quality of life of their families: A hospital-based study using family dermatology life quality index

Pratik Gahalaut, Sandhya Chauhan, Amit Shekhar, Madhur Kant Rastogi, Nitin Mishra

Indian Journal of Paediatric Dermatology 2018 19(1):21-25

Introduction: Vitiligo in an adult patient has a profound effect on the quality of life (QoL) of that particular patient. Although it is known that vitiligo in adult patient affects QoL in their family, very little information is available regarding QoL in a family having children suffering from vitiligo. Materials and Methods: This is a cross-sectional, hospital-based study to ascertain the effect children suffering from vitiligo have on the QoL of their respective families. Study participants were fifty healthy parent/immediate caregivers of fifty corresponding children suffering from vitiligo. The QoL in the family of these vitiliginous children was assessed with the help of Family Dermatology Life Quality Index (FDLQI). Results: There was significantly more impairment of FDLQI among respondents if vitiliginous child was female compared to male. The total FDLQI showed a significant negative correlation with duration of vitiligo in children. Analysis of individual items in FDLQI revealed emotional distress as the most impaired facet of FDLQI and housework as the least affected item. Conclusion: Presence of vitiligo in children affects the QoL of that particular child and his/her family. This impairment of FDLQI is more if the child suffering from vitiligo is female. Treatment of vitiligo in pediatric age group should include psychological counseling and support for the child as well as their parents/caregivers.

Recurrent pilomatricoma of the thigh: An unusual site of presentation

Vanlalhriatpuii Hmar, Nandakishore Thokchom, Sandhyarani Kshetrimayum

Indian Journal of Paediatric Dermatology 2018 19(1):65-67

Pilomatricoma is a benign tumor of the hair matrix. It is also known as calcifying epithelioma of Malherbe and is commonly located in head, neck, and upper extremities. A 10-year-old female patient presented with a solitary skin-colored firm nodule on her left mid-thigh which progressed to 1.5 cm diameter within 4 months. Surgical excision had been conducted 1 year ago at the same site. Clinical examination revealed a single, firm, well-circumscribed, non-tender, freely mobile nodule with irregular surface and hyperpigmented borders including surrounding skin. Histopathological examination showed dermis displaying benign adnexal tumor tissue with sheets of ghost cells, clusters of basaloid cells, and extensive areas of dystrophic calcification. Histopathological confirmation prior excision should be ideally performed. Although the tumor is most common in head and neck region, clinicians should be aware that tumors can arise rarely in the lower limbs as well.

Childhood leprosy in the postelimination era: A vision achieved or a concern growing at large

Ashwini Babu, M Ramesh Bhat, Jyothi Jayaraman

Indian Journal of Paediatric Dermatology 2018 19(1):26-30

Background: The proportion of childhood leprosy has been gaining importance of late as a performance indicator of the National Leprosy Eradication Program. A sizable proportion of the newly detected cases comprises children. The prevalence rate has been used as a measure of existence of infection though leprosy has attained elimination levels in the country. Materials and Methods: A retrospective descriptive study was conducted. Case records of children newly diagnosed with leprosy aged <15 years between April 2005 and October 2015 were studied and included in the study. Findings such as patches, nerve thickness, spectrum of leprosy, grade of deformity, smear status, presence of reaction, histopathological diagnosis, and treatment history were noted. Results: The percentage of childhood leprosy among the newly diagnosed cases in our study was found to be 11.2%. A solitary skin lesion was the most frequent manifestation in 64.4% children. The second most common finding seen in these patients included the presence of thickened nerves in 46.6% children. Smear showed acid-fast bacilli in 8.8% cases. Conclusion: There is an urgent need for improving clinical acumen in diagnosing childhood leprosy. The importance of appropriate and complete treatment along with meticulous surveillance in endemic areas and looking for household contacts needs to be stressed on.

Dermatopathia pigmentosa reticularis

Gauri Vats, Rohit Kataria, Durgesh Sonare, Vinod Jain

Indian Journal of Paediatric Dermatology 2018 19(1):77-79

Dermatopathia pigmentosa reticularis (DPR) is a rare disorder with characteristic triad of generalized reticulate hyperpigmentation, noncicatricial alopecia, and onychodystrophy. A 12-year-old Indian boy presented with classical features of the triad along with adermatoglyphia, hyperhidrosis, punctate hyperkeratosis of palm, and sole along with keratosis pilaris. Histopathology suggested a diagnosis of DPR with a differential of Naegeli–Franceschetti–Jadassohn syndrome and dyskeratosis congenita.

Unusual presentations and associations of hyper IgE Syndrome: Retrospective analysis of ten cases at tertiary care institute – With review of indian published reports

Nayan H Patel, Jigna K Padhiyar, Yogesh B Shah, Trusha P Gajjar, Mansi D Buch

Indian Journal of Paediatric Dermatology 2018 19(1):31-36

Background: Job syndrome also known as hyper IgE syndrome (HIES) is primary immunodeficiency syndrome. Autosomal dominant variant caused by mutation in signal transducer and activator of transcription-3 gene is characterized by recurrent staphylococcal skin infections, sinopulmonary infections, eczema, recurrent bone fractures, and coarse facial features. Autosomal recessive (AR) variant is because of mutation in DOCK8 gene which lacks the skeletal and dental involvement but manifest with severe viral infection and develop neurological complications. Aims: This study aims to evaluate variable presentations and associations of job syndrome. Methods: Analysis of ten cases, presented at our department between October 2015 and September 2016, with suspected HIES was done retrospectively. All cases were studied for their presentations and associations and were investigated accordingly for the same. Score for HIES was counted as per National Institutes of Health (NIH) scoring system. Indian published reports were found by internet search engine and were reviewed for unusual presentations. Results: NIH scoring was indeterminate in two patients and was highly likely for autosomal dominant-HIES in five patients. Three patients were diagnosed as AR-HIES. Two of our patients had multiple endocrinopathy, one had pyoderma gangrenosum and two patients had autoimmune disorders. Limitations: Genetic analysis was not done because of nonavailability of testing in our state and poor financial conditions of patients. It is a retrospective study. Conclusion: Our patients had unusual association in the form of multiple endocrinopathy, pyoderma gangrenosum, dermatomyositis, and all were diagnosed very much late in life. Hence, a vigilant eye for suspicion at a younger age might benefit patients.

Legius syndrome

Manoj Kumar Sharma, Ramesh Kumar, Savera Gupta, Suresh Kumar Jain

Indian Journal of Paediatric Dermatology 2018 19(1):86-88

Cutaneous leishmaniasis in children: A case series

Mrinal Gupta

Indian Journal of Paediatric Dermatology 2018 19(1):37-39

Background: Cutaneous leishmaniasis (CL) is a protozoal disease usually caused by Leishmania major and Leishmania tropica and transmitted by the bite of a sandfly. It is usually characterized by a single, polymorphous lesion located in an uncovered area. Aims: This study aimed to evaluate the clinico-epidemiological characteristics of CL among children. Materials and Methods: It was a retro-prospective study carried out over a period of 18 months in our center, in which the clinico-epidemiological features of children presenting with CL were assessed. Results: A total of 10 children (male:female - 7:3) were included in the study with the age range of 1–15 years, with a mean age of 8.8 years. Face was the most commonly affected site (n = 8), followed by neck and hands (1 each), and nodulo-ulcerative was the most common clinical type seen in nine patients. Skin smears for Leishman–Donovan (LD) bodies were positive in five patients while the skin biopsy, which was done in four cases, showed the presence of LD bodies in only one patient. Conclusion: CL is a common presentation among children, especially in the endemic areas, and the clinical features are similar to the adult onset disease.

Ecthyma gangrenosum as the presenting clinical feature of autoimmune lymphoproliferative syndrome

Aniruddha Ghosh, Rashmita Das, Partha Pratim Halder, Sandipan Dhar

Indian Journal of Paediatric Dermatology 2018 19(1):62-64

Ecthyma gangrenosum (EG) is a severe invasive cutaneous infection caused classically by Pseudomonas aeruginosa typically affecting immunocompromised patients especially those with neutropenia. We report the case of a 2-year-old boy with autoimmune lymphoproliferative syndrome presenting with solitary EG on the forehead. Blood culture, as well as culture from the lesion both, showed growth of P. aeruginosa. Pseudomonal sepsis responded well to piperacillin-tazobactam and amikacin therapy. Prompt diagnosis of the lesion is crucial as failure to start timely appropriate therapy may lead to fatal outcome.

Study of physiological and pathological skin changes in neonates: An east indian perspective

Binodini Behera, Yatra Kavadya, Prasenjit Mohanty, Dipanweeta Routray, Subhra Ghosh, Lina Das

Indian Journal of Paediatric Dermatology 2018 19(1):40-47

Background: Numerous dermatological conditions are prevalent in neonatal period, i.e., first 28 days of life with varied presentations ranging from transient self-limiting lesions to serious dermatosis requiring clinical attention. Due to lack of complete knowledge, it is distressing for both parents and treating physician. Objectives: This study was done in eastern part of India to record various dermatosis, and their prevalence compared with other part of country and find association between skin conditions and parameters, namely, sex, parity, gestational age, mode of delivery, and birth weight. Materials and Methods: This descriptive cross-sectional study was done in tertiary care hospital entailed recording of 400 neonates having any kind of dermatosis and statistically evaluated using Chi-square test (SPSS) and significance (P < 0.05). Results: Mongolian spot followed by sebaceous gland hyperplasia and epstein pearls were the common dermatologic findings. Physiological desquamation, acrocyanosis, and sebaceous gland hyperplasia were more prevalent in males and was statistically significant while erythema toxicum neonatorum significantly high in females. Epstein pearls, physiological scaling was also significantly high in term babies. Physiological scaling in cesarean patients and acrocyanosis in vaginal delivery was also significantly associated. Some atypical cases such as phakomatosis pigmentovascularis, plantar keratoderma, collodion baby, and congenital whorled hypermelanosis were also present in our study group. Conclusion: Physiological skin lesions are very common in neonates and appreciation of these lesions are important.

The use of suction blisters to measure sunscreen protection against UVR-induced DNA damage

Publication date: February 2018
Source:Journal of Photochemistry and Photobiology B: Biology, Volume 179
Author(s): Gwendal Josse, Thierry Douki, Jimmy Le Digabel, Eleonore Gravier, Emmanuel Questel
The formation of DNA photoproducts caused by solar UVR exposure needs to be investigated in-vivo and in particular in order to assess sunscreens' level of protection against solar genotoxicity. The study's purposes were: i) to evaluate if the roof of suction blisters is an appropriate sampling method for measuring photoproducts, and ii) to measure in-vivo sunscreen protection against cyclobutane pyrimidine dimers. Skin areas on the interior forearms of eight healthy volunteers were exposed in-vivo to 2 MED of simulated solar radiation (SSR) and to 15 MED on a sunscreen protected area. After irradiation, six suction blisters were induced and the blister roofs were collected. Analysis of SSR-induced CPDs was performed by two independent methods: a chromatography coupled to mass spectroscopy (HPLC-MS/MS) approach and a 3D–imaging of CPD immunostaining by multiphoton microscopy on floating epidermal sheets. HPLC-MS/MS analyses showed that SSR-unexposed skin presented no CPD dimers, whereas 2 MED SSR-exposed skin showed a significant number of TT-CPD. The sunscreen covered skin exposed to 15 MED appeared highly protected from DNA damage, as the amount of CPD-dimers remained below the detection limit. The multiphoton-immunostaining analysis consistently showed that no CPD staining was observed on the non-SSR-exposed skin. A significant increase of CPD staining intensity and number of CPD-positive cells were observed on the 2 MED SSR-exposed skin. Sunscreen protected skin presented a very low staining intensity and the number of CPD-positive cells remained very close to non-SSR-exposed skin. This study showed that suction blister samples are very appropriate for measuring CPD dimers in-vivo, and that sunscreens provide high protection against UVR-induced DNA damage.

Cryptococcosis and cryptococcal meningitis — new predictors and clinical outcomes at a united states academic medical center

Summary

Since the diagnosis of cryptococcosis is challenging in low prevalence settings, uncovering predictive factors can improve early diagnosis and timely treatment. The aim of the study was to relate clinical outcomes to predictive variables for the presence of cryptococcosis. A retrospective case-control study matching by collection date, age, and gender at a 1:2 ratio (55 cases and 112 controls) was performed in case patients diagnosed with Cryptococcus infection at the University of Colorado Hospital between 2000 and 2017 (n=167). A bivariate and a forward, stepwise multivariable logistic regression model was performed to identify predictors of cryptococcosis. In an adjusted multivariable model; cryptococcal infection was significantly associated with the presence of respiratory symptoms, hyponatremia, lung disease, or corticosteroids. Additionally; cryptococcal meningitis was associated with headaches, corticosteroids, or increased CSF protein. Conversely, a reduced risk of cryptococcosis was associated with hypertension or peripheral monocytosis. Cryptococcal meningitis lead to subsequent hearing impairment (16% vs. 4% (control), p=0.013), muscle weakness (40 vs. 20%, p=0.021), cognitive deficits (33% vs. 6%, p=0.0001) or any adverse outcome (84% vs. 29%, p=0.0001). We uncovered novel clinical predictors for the presence of cryptococcal infection or cryptococcal meningitis. This study in patients at a low prevalence US medical center underscores the importance of early diagnosis in this population.

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Significance of perithyroidal lymph nodes in benign thyroid diseases

Abstract

Purpose

The incidences of perithyroidal lymph nodes (PTLNs) in benign thyroid diseases were investigated.

Methods

A total of 108 patients were divided into 36 with benign thyroid nodules, 33 with Hashimoto's thyroiditis, 14 with Graves' disease, 10 with hypothyroidism of undetermined etiology, nine with silent thyroiditis, and six with subacute thyroiditis. We assessed the relationships among PTLNs and these groups, thyroid volume, thyroid parenchyma echogenicity, and anti-thyroid-stimulating hormone receptor, anti-thyroglobulin, and anti-thyroid peroxidase antibodies (TRAb, TgAb, and TPOAb).

Results

The PTLN-positive rates in Hashimoto's thyroiditis (69.7%), subacute thyroiditis (83.8%), silent thyroiditis (77.8%), and Graves' disease (35.7%) groups were significantly higher than those in benign thyroid nodules (5.6%) and hypothyroidism of unknown etiology (0%) groups. The PTLN-positive rates were significantly higher in cases with TgAb and/or TPOAb (P < 0.01) and in those with lower parenchyma echogenicity (P < 0.01).

Conclusion

PTLNs were seen in inflammatory thyroid diseases, but were rarely detected in other thyroid diseases. These findings indicate that PTLNs are an indicator for differentiating inflammation of the thyroid. Lower echogenicity of the thyroid, known to correspond to inflammation, showed a correlation with the positive rate of PTLNs. PTLNs in cases of Graves' disease may be due to coexisting thyroiditis related to TgAb and/or TPOAb.

Twofold minimum variance beamforming for enhanced ultrasound imaging

Abstract

Purpose

To calculate the optimal weights of a minimum variance (MV) beamformer, the covariance matrix of the received data should be estimated. In ultrasound imaging, it is done through spatial smoothing. However, this technique reduces the effective aperture and consequently limits the attainable resolution. To mitigate this effect, we propose a new configuration for applying an adaptive beamforming method.

Methods

The method is based on applying MV in a twofold configuration such that the outputs of the subarrays are combined through an adaptive MV-like beamformer, instead of simply summing them. In this way, a fully adaptive beamformer is obtained.

Results

Applying the method on a phantom containing point targets has shown that off-axis signals are attenuated more in comparison to MV. This results in a lowered mainlobe width and decreased sidelobe levels. Moreover, simulation results of a cyst phantom confirm the superiority of the method over the MV in terms of contrast.

Conclusion

The method yields significant improvement in the resolving capability and the contrast compared with the conventional MV. At the presence of the steering vector errors, these superiorities were achieved at a cost of slightly more errors in estimating the reflectivity coefficients.

Diagnostic ultrasound widespread

Comparison of carotid artery ultrasonography findings between acute coronary syndrome and atherothrombotic cerebral infarction

Abstract

Background and purpose

Although risk factors for acute coronary syndrome (ACS) and atherothrombotic cerebral infarction (ACI) are common, it is unknown if the risk factors for these two conditions are similar. The purpose of our study was to elucidate differences in carotid artery atherosclerotic features between ACS and ACI.

Methods

We measured carotid artery ultrasound-based atherosclerotic parameters in 61 ACS and 33 ACI patients. In the ACS patients, 31 had single-vessel coronary artery disease (SVD) and 30 had multivessel coronary artery disease (MVD).

Results

The maximum intima–media thickness (IMT) of the common carotid artery was higher in ACS patients with MVD than in ACS patients with SVD (P < 0.05), and tended to be higher than that in ACI patients (P = 0.085). The values in ACS patients with SVD and ACI patients were similar. The maximum IMT of the carotid artery bulb in ACS patients with MVD was similar to that in both ACS patients with SVD and ACI patients. The plaque score was higher in ACS patients with MVD than in ACS patients with SVD (P < 0.01), but similar to that in ACI patients.

Conclusion

ACS and ACI show common atherosclerotic features as assessed by carotid artery ultrasonography.

Breast adenoid cystic carcinoma: report of a case with emphasis on routine sonographic findings and shear wave elastography

Abstract

Adenoid cystic carcinoma (ACC) of the breast is a rare malignant tumor. Its sonographic characteristics have been described in some reports, but there are few such reports available that describe the sonoelastographic findings of this tumor and provide additional information about the nature of the lesion. In this case report, we describe the routine sonographic findings and shear wave elastography findings of a breast adenoid cystic carcinoma in a 53-year-old woman.

Diagnosis of umbilical cord entanglement in a monochorionic diamniotic twin pregnancy with spontaneous septostomy of the dividing membranes using dual-gate Doppler imaging

Abstract

Umbilical cord entanglement is the leading cause of fetal mortality in monoamniotic twin pregnancies and a pseudo monoamniotic environment. Published methods for detecting this complication include color Doppler and pulsed Doppler sonography; however, no method provides an absolute diagnosis. In this case, we report the diagnosis of umbilical cord entanglement using dual-gate Doppler imaging. A 35-year-old woman was referred to our hospital at 28 weeks of gestation for prenatal management because of diagnosis of a monochorionic diamniotic twin pregnancy with spontaneous septostomy of the dividing membranes. Each fetus displayed normal fetal growth without obvious discordance and anatomical abnormalities. However, the dividing membrane was not detected, and an entangled cord was suspected. Dual-gate Doppler examination was carried out. Two regions of interest were considered at different areas of the umbilical arteries, and when each Doppler image showed two different heart rates at the same time, we considered this to be evidence of umbilical cord entanglement. Cesarean section was performed at 32 weeks of gestation and twins were delivered. The delivered umbilical cords had sixfold entanglement. In this case, dual-gate Doppler seems to have been more accurate than conventional single-gate Doppler for the diagnosis of cord entanglement because we confirmed two different heart rates at the same time with dual-gate Doppler.

Variations of placental migration in patients with early third trimester malposition

Abstract

Aim

This study aimed to investigate the impact of placental migration on the definitive prepartum diagnosis of patients with placenta previa (PP) and low-lying placenta (LLP) after late preterm.

Methods

This was a retrospective cohort study of singleton pregnancies with PP and LLP diagnosed at 30–33 weeks of gestation. We assessed the rate of changes in transvaginal ultrasonographic measurements of placental position during the period from 34 to 38 weeks of gestation.

Results

A total of 127 cases (82 of PP, 45 of LLP) were included. The PP group comprised 34 cases with complete PP and 48 with partial and marginal PP. The diagnosis of complete PP was changed to partial or marginal PP in two (5.9%) cases. Concerning cases with partial and marginal PP, 14 (29.2%) were eventually revised to LLP and four (8.3%) ultimately normalized. Among the patients with LLP, placental position was normalized in 23 (51.1%). Overall, a revision in diagnosis after late preterm was required in 48 cases (37.8%). Among the 93 patients who did not have complete PP, 46 (49.5%) needed revisions of their placental diagnosis.

Conclusions

Repeated evaluations of placental position by ultrasonography after late preterm could be of significant value in selecting the most appropriate mode of delivery.

Quantitative assessment of muscle stiffness with acoustic radiation force impulse elastography after botulinum toxin A injection in children with cerebral palsy

Abstract

Purpose

Our objective in this study was to assess the changes in medial gastrocnemius muscle (GCM) stiffness after botulinum toxin A (BTA) injection in children with cerebral palsy (CP) by using acoustic radiation force impulse (ARFI) elastography and to research the usability of this technique in clinical practice.

Materials and methods

Twenty-four spastic lower extremities of 12 children with CP were assessed. BTA injection treatment was applied to the medial GCM. Muscle stiffness was measured with the ARFI technique before the procedure and a month after the procedure. The patients were assessed with the modified Ashworth scale (MAS) in the physiotherapy department at about the same time. Shear wave velocity (SWV) values and MAS scores before and after the treatment were compared.

Results

Mean SWV values were measured as 3.20 ± 0.14 m/s before BTA and as 2.45 ± 0.21 m/s after BTA, and the difference between them was found to be statistically significant (p < 0.001). Mean MAS score (2.33 ± 0.70) after BTA decreased significantly when compared to the score before BTA (2.96 ± 0.62) (p = 0.001). SWV values positively correlated with MAS scores (ρ = 0.578, p = 0.003). The interobserver agreement expressed as interclass correlation coefficient (ICC) was 0.65 (95% CI 0.33–0.84, p < 0.001).

Conclusion

ARFI elastography for identifying structural changes that occur in the spastic muscle after BTA injection in children with CP can yield more valuable information with combined use of MAS.

Is color Doppler a reliable method for the diagnosis of malrotation?

Abstract

Purpose

The gold standard for the diagnosis of malrotation is barium contrast study of the upper gastrointestinal system (UGCS), while color Doppler ultrasonography (CDUS) is another method used in the diagnosis. We investigated the value of CDUS for the diagnosis of malrotation in this study.

Methods

UGCS images, CDUS images, plain abdominal images, demographic data, and symptoms of 82 patients who were investigated for presumed malrotation during a 7-year period were evaluated, retrospectively.

Results

All patients underwent CDUS, and 18% of these patients were diagnosed with malrotation as the superior mesenteric vein was seen to be on the left of the superior mesenteric artery. We found that 16% of the 75 patients who underwent UGCS were diagnosed with malrotation. The sensitivity and specificity of CDUS in the diagnosis of malrotation was found to be 93.8 and 100%, respectively. The respective values for UGCS were 91.7 and 98.4%.

Conclusion

Current data in the literature and our results underline that UGCS may yield false-positive and false-negative results. Although CDUS was found to be a reliable method for the diagnosis of malrotation in our study, the limitations of UGCS are also recognized for CDUS. Prospective studies are needed to determine the more valuable method.

Real-time ultrasound elastography of the Achilles tendon in patients with cerebral palsy: is there a correlation between strain ratio and biomechanical indicators?

Abstract

Purpose

Our aim was to comparatively investigate the strain ratio and thickness of the Achilles tendon in children with cerebral palsy (CP), and to elucidate whether there is a correlation between biomechanical features of the Achilles tendon and strain ratio.

Methods

A total of 155 participants (72 CP patients and 83 healthy controls) who underwent real-time elastography of both Achilles tendons were studied. A linear transducer (4.8–11.0 MHz) was used to obtain the images. Correlation analysis between age, length, and thickness of the Achilles tendon, and strain ratio (SR) was performed by means of Pearson correlation and Spearman's rho tests.

Results

Comparison of results obtained from CP patients and controls showed that the length of the Achilles tendon was shorter (p < 0.001) and SR was higher (p < 0.001) in CP patients. In CP patients, there was a positive correlation between SR and age and between SR and the thickness and length of the Achilles tendon (p < 0.001 for all). Furthermore, the length of the tendon and age were positively associated (p < 0.001). ROC analysis revealed that the cut-off value for SR was 1.89.

Conclusion

The results of the present study demonstrated that real-time elastography can constitute a simple, practical, and noninvasive method for evaluation of the elasticity of the Achilles tendon in children with CP.

Usefulness of end-diastolic ratio in carotid ultrasonography for the screening of dural arteriovenous fistula: a case series

Abstract

We report three cases in which carotid ultrasonography was useful for the diagnosis of dural arteriovenous fistula (dAVF). In all cases, dAVFs were fed by branches of the external carotid artery (ECA) and had retrograde leptomeningeal venous drainage. Carotid ultrasonography revealed high end-diastolic ratio (ED ratio) of the common carotid artery (CCA) (1.49–2.16) and low resistance index (RI) of the ECA (0.59–0.66). They were normalized after endovascular treatment (ED ratio of CCA 1.02–1.06, RI of ECA 0.75–0.87). In conclusion, high ED ratio of the CCA and low RI of the ECA might be a useful indicator for both screening and follow-up of dAVF.

Differential diagnosis between benign and malignant soft tissue tumors utilizing ultrasound parameters

Abstract

Purpose

Preoperative discrimination between benign and malignant soft tissue tumors is critical for the prevention of excess application of magnetic resonance imaging and biopsy as well as unplanned resection. Although ultrasound, including power Doppler imaging, is an easy, noninvasive, and cost-effective modality for screening soft tissue tumors, few studies have investigated reliable discrimination between benign and malignant soft tissue tumors.

Methods

To establish a modality for discrimination between benign and malignant soft tissue tumors using ultrasound, we extracted the significant risk factors for malignancy based on ultrasound information from 40 malignant and 56 benign pathologically diagnosed soft tissue tumors and established a scoring system based on these risk factors.

Results

The maximum size, tumor margin, and vascularity evaluated using ultrasound were extracted as significant risk factors. Using the odds ratio from a multivariate regression model, a scoring system was established. Receiver operating characteristic analyses revealed a high area under the curve value (0.85), confirming the accuracy of the scoring system.

Conclusion

Ultrasound is a useful modality for establishing the differential diagnosis between benign and malignant soft tissue tumors.

Presence of enthesopathy in patients with primary Sjogren’s syndrome: ultrasonographic study of a local cohort

Abstract

Background

Musculoskeletal findings in Sjögren's syndrome are arthralgia, arthritis, myalgia, myositis, fibromyalgia, and chronic fatigue. Enthesis zones are important in the formation of pain in the musculoskeletal system. Musculoskeletal ultrasound (US) may show subclinical enthesitis in the synovial joints and in the axial skeleton before joint swelling in inflammatory diseases characterized by arthritis.

Objective

In this study, we aimed to determine the presence of enthesopathy using the Madrid sonographic enthesitis index (MASEI) in patients with primary Sjögren's syndrome (PSS).

Patients and methods

Consecutive patients with PSS and age-matched healthy controls were included in this study. All the patients met the 2002 American College of Rheumatology/European League against Rheumatism classification criteria for PSS. The demographic characteristics of the patients were recorded. Six enthesis sites were evaluated using gray-scale and Doppler US with a linear transducer, and they were scored using the MASEI. They were assessed by the EULAR Sjögren's syndrome disease activity index (ESSDAI).

Results

We evaluated 40 patients with PSS (average age 48.67 ± 11.23 years) and 30 healthy controls (average age 45.40 ± 8.24 years). Patients with PSS had significantly higher MASEI scores than the healthy controls. Plantar fascia, Achilles tendon, and distal patellar tendons were significantly thicker in the PSS group than in the healthy controls. The MASEI total score had a positive correlation with age. There was no correlation between MASEI total score and BMI and ESSDAI.

Conclusion

In this study, it was shown that the MASEI scores assessed by US were significantly higher in patients with PSS than in healthy controls. Plantar fascia, Achilles tendon, and distal patellar tendon were significantly thicker in the PSS group than in the healthy controls. This result suggests that PSS may be one of the causes of musculoskeletal pain that can be seen in patients with PSS. Our study was the first study to use an enthesis index ultrasonographically in patients with PSS. In addition, it is the first study to investigate the relationship between the presence of enthesopathy and disease activity by means of US.

A case of successful transluminal drainage of walled-off necrosis under contrast-enhanced harmonic endoscopic ultrasonography guidance

Abstract

We report a case of successful transluminal drainage of walled-off necrosis (WON) under contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) guidance. Recently, EUS-guided transluminal drainage (EUS-TD) of WON has been increasingly used as a minimally invasive treatment option with reportedly high technical and clinical success rates; however, B-mode EUS occasionally fails to depict the target lesion and its margins, particularly in cases where the target shows a heterogeneous echogenicity. In our case, EUS-TD was attempted for infected WON, but visualization using B-mode EUS imaging was poor. Thus, CH-EUS was performed to enhance the contrast between the targeted WON and its surrounding tissues. Immediately after injecting a sonographic contrast agent, WON and its margins were clearly identified as an avascular area and were punctured under CH-EUS guidance. CH-EUS enables the assessment of the microvasculature and hemodynamics of the target lesion in real time. It may also provide valuable information and could be a useful modality for EUS-TD to clearly visualize target lesions and their margins and to decisively puncture them, even when they could not be identified using B-mode EUS.

Verification of recall criteria for masses detected on ultrasound breast cancer screening

Abstract

Purpose

Mammography is the only modality for breast cancer screening demonstrated to reduce the mortality rate. However, ultrasonographic screening is already being widely performed as opportunistic screening in Japan. The recall criteria for masses are very important as quality controls. The purpose of this study was to verify these criteria at multiple institutions.

Methods

Screening was performed by five institutions in various regions in Japan. The total number of cases screened at all five institutions was 10,519.

Results

The findings that could be concluded to be benign were a cystic pattern and three features of a solid pattern. The cystic pattern was noted in 6512 cases, typical fibroadenoma in 1483 cases, and typical complicated cyst in 70 cases. Only three of these 8065 cases were cancers, so the negative predictive value was 99.9%. The solid pattern with obvious malignant features, i.e., masses with an echogenic halo and/or interruption of the interface and masses with multiple echogenic foci, were noted in 33 cases. Twenty of the 33 cases were malignancy, resulting in a positive predictive value of 66.7%.

Conclusion

Although some parts of the criteria should be considered further for verification and revision, the current recall criteria are mostly valid.

IRF-2 haploinsufficiency causes enhanced imiquimod-induced psoriasis-like skin inflammation

Psoriasis is a T-cell-mediated immunologic skin disease with a complex pathogenesis where both genetic and environmental factors are involved [1–4]. Although the mechanism of psoriasis has not been fully understood, it has been reported that psoriasis can be induced or exacerbated by IFN-α treatment [5–10]. More direct evidence for the involvement of type I IFN in development of psoriasis comes from studies on interferon regulatory factor (IRF)-2 knockout mice. IRF-2 protein binds the same regulatory sequences as IRF-1, which suppresses transcription of IFN-inducible genes [11].

Effectiveness of Non-Steroidal Anti-Inflammatory Drugs among patients with Primary Hypertrophic Osteoarthropathy: a systematic review

Primary hypertrophic osteoarthropathy (PHO), also known as pachydermoperiostosis is a rare genetic disease which predominantly affects skin, bone and soft connective tissue. It is characterized by the triad of pachydermia, digital clubbing and periostosis of long bones. Arthralgia or arthritis is also present in most of the cases. Genetic studies have identified the impaired PGE2 metabolism as a culprit for hypertrophic osteoarthropathy in PHO cases. We conducted a systematic review to examine the effectiveness of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), a PGE2 synthesis blocker to reduce the symptoms among PHO patients.

Characterization of migraineurs presenting interictal widespread pressure hyperalgesia identified using a tender point count: a cross-sectional study

Migraineurs exhibit pain hypersensitivity throughout the body during and between migraine headaches. Migraine is classified as a central sensitivity syndrome, typified by fibromyalgia showing widespread pressu...

Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review

Sphenopalatine ganglion is the largest collection of neurons in the calvarium outside of the brain. Over the past century, it has been a target for interventional treatment of head and facial pain due to its e...

The burden of headache is associated to pain interference, depression and headache duration in chronic tension type headache: a 1-year longitudinal study

To investigate variables associated at one year (longitudinal design) with the physical or emotional component of burden in chronic tension type headache (CTTH).

The enigma of site of action of migraine preventives: no effect of metoprolol on trigeminal pain processing in patients and healthy controls

Beta-blockers are a first choice migraine preventive medication. So far it is unknown how they exert their therapeutic effect in migraine. To this end we examined the neural effect of metoprolol on trigeminal ...

Characteristics and diagnoses of acute headache in pregnant women – a retrospective cross-sectional study

Acute headache is one of the most frequent neurological symptoms in pregnant women. The early diagnosis of underlying secondary conditions has a major influence on patient outcome, especially in emergency sett...

Open Cancellous Bone Grafting for Recalcitrant Palatal Fistula: Repurposing the Papineau Technique

Summary: Cleft palate fistula is defined as a breakdown in the primary surgical repair of the palate resulting in oronasal communication, which can create symptomatic regurgitation for fluids/solids and affect speech, manifested by airflow escape during phonation. With the reported postoperative occurrence rate of 33–37% postfistula repair, it remains a challenging problem. The primary aim of this study was to describe our experience in the management of 7 consecutive cases of recalcitrant palatal fistula, all secondary to primary cleft palate repair. Pure cancellous bone graft was harvested in a standard fashion in sufficient quantity based on size of fistula from the iliac crest and was morselized and was kept mixed with the patient's blood. After flap turnover for nasal closure, the graft was packed over the raw surface on the oral aspect and was secured by placing an oxidized regenerated cellulose sheet fixed to the surrounding mucosa. As per the Papineau technique, no oral closure was performed. Six-month follow-up showed complete epithelization of the oral raw surface in 6 of the 7 patients. In the diverse spectra of cleft surgeries, management of recalcitrant cleft palate fistula remains a surgical challenge. Repurposing Papineau's concept of open cancellous bone grafting in cleft palate fistula is a novel attempt with a sound scientific basis. In our experience, this technique has proved to be very effective in managing recalcitrant palatal fistulae.

Designing a Fibular Flow-Through Flap with a Proximal Peroneal Perforator-Free Flap for Maxillary Reconstruction

Summary: Reconstruction of a composite maxillary defect is frequently performed with a fibular osteocutaneous free flap to address both the bony and mucosal defect. If during the harvest of the fibula a distal skin perforator is not present due to vascular variations, reconstruction can potentially be done using the soleus muscle for filling of the palatal mucosal defect. An additional challenge arises when the accompanying skin paddle that has been harvested is not perfused, but the fibula remains viable. This case report describes salvage following loss of the skin paddle in an osteocutaneous fibular free flap by designing a fibular flow-through flap using a proximal peroneal perforator free flap. The use of this second free flap allows a skin paddle to be positioned on the distal fibular segment, provides a surgical backup, and limits the donor sites to the same extremity.

Impact of Evolving Radiation Therapy Techniques on Implant-Based Breast Reconstruction

No abstract available

Why the p Value Alone Is Not Enough: The Need for Confidence Intervals in Plastic Surgery Research

Background: The p value is one of the most used descriptors in statistical analysis; however, when reported in isolation, it does not convey the effect size of a treatment. The reporting of confidence intervals is an essential adjunct to determine the clinical value of treatment, as it permits an assessment of the effect size. The authors assessed the reporting of confidence intervals in clinical trials within the plastic surgery literature. Methods: The seven highest impact plastic surgery journals were screened using MEDLINE for clinical trials in the years 2006, 2009, 2012, and 2015. Studies were randomized based on a predetermined sample size, and various characteristics (e.g., Jadad quality score, reporting of statistical significance, journal impact factor, and participation of an individual with formal research training) were documented. Results: Two independent reviewers analyzed 135 articles. There was substantial interrater agreement (kappa = 0.78). Although 86.7 percent of studies reported a p value, only 25.2 percent reported confidence intervals. Of all journals assessed, Plastic and Reconstructive Surgery most frequently reported confidence intervals. The quality of the studies had a median Jadad score of 2 of 5. Bivariate analysis revealed that higher Jadad score and involvement of an individual with formal research training were associated with reporting of confidence intervals. Multivariate analysis revealed similar findings, whereas journal impact factor, year of publication, and statistical significance were not correlated with confidence interval reporting. Conclusions: Confidence intervals are underreported in the plastic surgery literature. To improve reporting quality of clinical trials, results should always include the confidence intervals to avoid misinterpretation of the effect size of a statistically significant result.

The Expanded Use of Autoaugmentation Techniques in Oncoplastic Breast Surgery

Background: Autoaugmentation techniques have been applied to oncoplastic reductions to assist with filling larger, more remote defects, and to women with smaller breasts. The purpose of this report is to describe the use of autoaugmentation techniques in oncoplastic reduction and compare the results with those of traditional oncoplastic reduction. Methods: The authors queried a prospectively maintained database of all women who underwent partial mastectomy and oncoplastic reduction between 1994 and October of 2015. The autoaugmentation techniques were defined as (1) extended primary nipple autoaugmentation pedicle, and (2) primary nipple pedicle and secondary autoaugmentation pedicle. Comparisons were made to a control oncoplastic group. Results: There were a total of 333 patients, 222 patients (67.7 percent) without autoaugmentation and 111 patients (33 percent) with autoaugmentation (51 patients with an extended autoaugmentation pedicle, and 60 patients with a secondary autoaugmentation pedicle). Biopsy weight was smallest in the extended pedicle group (136 g) and largest in the regular oncoplastic group (235 g; p = 0.017). Superomedial was the most common extended pedicle, and lateral was the most common location. Inferolateral was the most common secondary pedicle for lateral and upper outer defects. There were no significant differences in the overall complication rate: 15.5 percent in the regular oncoplastic group, 19.6 percent in the extended pedicle group, and 20 percent in the secondary pedicle group. Conclusions: Autoaugmentation techniques have evolved to manage complex defects not amenable to standard oncoplastic reduction methods. They are often required for lateral defects, especially in smaller breasts. Autoaugmentation can be performed safely without an increased risk of complications, broadening the indications for breast conservation therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Reply: Ibuprofen May Not Increase Bleeding Risk in Plastic Surgery A Systematic Review and Meta-Analysis

No abstract available

Discussion: The Expanded Use of Autoaugmentation Techniques in Oncoplastic Breast Surgery

No abstract available

Not All Gustilo Type IIIB Fractures Are Created Equal: Arterial Injury Impacts Limb Salvage Outcomes Correction

No abstract available

Bovine Acellular Dermal Matrix in Immediate Breast Reconstruction: A Retrospective, Observational Study with SurgiMend

Background: Acellular dermal matrices can be combined with implant-based breast reconstruction to help optimize outcomes. SurgiMend PRS is a fetal bovine dermis–derived acellular dermal matrix composed of type I collagen and approximately 30 percent type III collagen, sharing many of the properties of human cadaveric acellular dermal matrix. Methods: This was a retrospective, single-center analysis of 111 adult patients (147 breasts) undergoing one-stage (83.7 percent) or two-stage (16.3 percent) immediate breast reconstruction after mastectomy. The aims were to characterize the safety profile of SurgiMend and investigate associations between risk factors and complications. Results: The mean age of the patients was 47.9 years and the mean body mass index was 24.7 kg/m2. After a median follow-up of 24.3 months, the overall rates of minor and major complications were 25.2 percent (n = 37 of 147) and 12.9 percent (n = 19 of 147), respectively. The most common major complications were seroma [n = 12 (8.2 percent)] and necrosis [n = 9 (6.1 percent)]. All occurred within 3 months after surgery. The rate of capsular contracture was 2.7 percent (n = 4). A total of 2.7 percent of implanted breasts (n = 4) required explantation. In a univariate analysis, smokers had a greater risk of major complications (p = 0.013), and postoperative radiation therapy and obesity were associated with an increased risk of capsular contracture (p = 0.006) and explantation (p = 0.006), respectively. In a multivariate analysis, several factors were associated with complications or explantation, including obesity (p

Reply: Public Perception of Cosmetic Surgeons versus Plastic Surgeons Increasing Transparency to Educate Patients

No abstract available

Microbial Evaluation in Capsular Contracture of Breast Implants

Background: Capsular contracture around breast implants is a severe and unpredictable complication experienced by up to 50 percent of patients after breast augmentation and reconstruction, and represents a major cause leading to reoperation. Several lines of evidence point to the involvement of subclinical infections and of bacterial biofilm formation. Methods: To reduce the incidence of capsular contracture following mammaplasty, the authors studied the correlation between contamination by exogenous and endogenous bacterial flora and the capacity to develop bacterial biofilm in mammary implants. The authors performed a microbiological study assessing microbial growth of swabs from breast skin, nipple-areola complex, and mammary gland biopsy specimens. Furthermore, the authors compared the results with the data resulting from cultural experiments from biopsy specimens of periprosthetic capsule, contracted or not, and from the surfaces of the relative prosthesis. Results: Between July of 2012 and July of 2013, a series of 65 female patients from the area of Naples, Italy, and its province, who underwent breast plastic surgery with the use of implants for aesthetic or reconstructive reasons, were included in the study. The authors noticed that there is a greater tendency for capsular contracture to form in oncologic patients who received radiotherapy, patients with precedent capsular contracture, and patients with cutaneous contamination by biofilm-producing microbes. Conclusions: Although all of the new technical procedures tend to reduce the amount of bacterial charge that comes into contact with the prosthesis at the time of its introduction, a minimal amount must always be taken for granted. This is the rationale for a preventative personalized antibiotic therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Patient-Reported Outcomes following Breast Conservation Therapy and Barriers to Referral for Partial Breast Reconstruction

Background: The purpose of this study was to evaluate the self-reported aesthetic outcome of breast conservation therapy in a generalized sample of patients, and to describe potential barriers to referral for partial breast reconstruction. Methods: Consecutive breast conservation therapy patients completing radiotherapy over a 1-year period at a regional cancer center were identified. Eligible patients were contacted by means of mail/e-mail and invited to participate. Participants completed the BREAST-Q breast conservation therapy module along with a questionnaire examining feelings about breast reconstruction. Multiple regression analysis was performed using the satisfaction with breasts scale as the dependent variable. Results: Surveys were completed by 185 of 592 eligible participants (response rate, 31.3 percent; mean age, 61 years) an average of 38 months after lumpectomy. The mean score for the BREAST-Q satisfaction with breasts scale was 59 of 100. Younger age (p = 0.038), lumpectomy reexcision (p = 0.018), and lumpectomy at a nonacademic center (p = 0.026) were significantly associated with lower satisfaction. Bra size, months from lumpectomy, and tumor quadrant/size were not significantly associated with satisfaction (p > 0.05). The most common statements regarding reconstruction were "I don't feel the need for it" (60.0 percent), "I don't like the thought of having breast implants" (22.7 percent), and "I don't want any more surgeon/doctor visits" (22.2 percent). Before lumpectomy, only 1.6 percent had a consultation for reconstruction, and only 22.7 percent were aware of this option. If offered, 33.1 percent of patients would have attended this consultation. Conclusion: There is an unmet demand for partial breast reconstruction, with an opportunity to advocate and increase awareness on behalf of patients undergoing breast conservation therapy.

22 Cases of Breast Implant–Associated ALCL: Awareness and Outcome Tracking from the Italian Ministry of Health

Background: To date, 359 cases of anaplastic large cell lymphoma (ALCL) in women with breast implants (breast implant–associated ALCL [BIA-ALCL]) worldwide have been reported among more than 10 million patients who have received implants, but health care authorities suspect this is a possible underestimation, and the limited number of cases makes it difficult to clarify its cause. The General Directorate of Medical Devices and Pharmaceutical Services of the Italian Ministry of Health has examined and studied the Italian BIA-ALCL cases. Methods: An official document has been diffused to all medical associations, aiming at encouraging all physicians to notify each BIA-ALCL case. A retrospective study has been performed on the notified BIA-ALCL cases collected in the database named Dispovigilance. Results: Research on Dispovigilance returns a list of 22 BIA-ALCL cases. The mean patient age was 49.6 years (range, 30 to 71 years). The average time to the onset of the symptoms was 6.8 years (range, 1 to 22 years). The average time to diagnosis was 7.8 years (range, 4 to 22 years). The estimated incidence of the Italian BIA-ALCL cases related to 2015 is 2.8 per 100,000 patients. Conclusions: The pathogenesis of BIA-ALCL remains unknown. The establishment of a national breast implant registry is needed to better understand some aspects of this disease. Future genetic studies on the population affected could clarify why only some patients with implants develop this disease.

Defining Outcomes Articles for the Journal

No abstract available

Outcome Analysis of Free Flap Salvage in Outpatients Presenting with Microvascular Compromise

Background: Extensive flap salvage attempts are routinely performed in patients with late-onset flap vascular crisis despite low flap survival rates. A knowledge gap exists in management of compromised free flaps in patients who present with perfusion-related complications after hospital discharge. Methods: A retrospective review of 7443 free flaps used in 7128 cancer patients at a single institution from January of 2001 to March of 2015 was performed. Results: Of 7443 free flap reconstructions, 856 patients (12 percent) were taken back to the operating room. Also, 261 patients (4 percent) suffered from microvascular compromise, of whom 110 (1 percent) experienced total flap loss. The authors identified 17 patients (10 breast cancer patients and seven head and neck cancer patients) who had vascular flap compromise and underwent reoperation after hospital discharge (median, 10 days; range, 4 to 107 days) after free flap reconstruction. Of these 17 patients, nine breast cancer patients and two head and neck cancer patients underwent flap salvage attempts. Salvage procedures included thrombectomy, thrombolytic and heparin injections, and reanastomoses (11 patients); vein grafting (four patients); vein supercharging with cephalic turndown (two patients); and change of recipient vessels (two patients). Sixteen of the 17 patients (94 percent) experienced total flap loss, and one patient (6 percent) had partial flap loss requiring long-lasting wound treatment. Conclusions: Outpatient free flap salvage has a low success rate regardless of flap type, recipient site, or patient population. The authors' study suggests that immediate second-line reconstruction is more effective for late-onset flap vascular crisis than extensive flap salvage procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Global Adverse Event Reports of Breast Implant-Associated ALCL: An International Review of 40 Government Authority Databases

No abstract available

Minimally Invasive Laparoscopically Dissected Deep Inferior Epigastric Artery Perforator Flap: An Anatomical Feasibility Study and a First Clinical Case

Summary: The deep inferior epigastric perforator (DIEP) flap is a workhorse of breast reconstruction. Risks of herniation derive from violation of the rectus abdominis muscle anterior rectus sheath and might be reduced by minimally invasive laparoscopic dissection ("MILD") of the deep inferior epigastric vessels. The authors performed a feasibility study on five anatomical subjects and performed a secondary right breast reconstruction on a 67-year-old woman. A 30-degree laparoscope was used with laparoscopy ports inset to preserve the flap. Blunt preperitoneal dissection followed by carbon dioxide insufflation allowed the deep inferior epigastric pedicle to be dissected and clip-sectioned. The anterior rectus sheath was opened around the perforating vessels, and the flap was anastomosed on the internal mammary vessels. The length of incision in the anterior rectus sheath was compared between laparoscopic and conventional approaches. The mean incision length in the anterior rectus sheath was 3 cm versus 12 cm in the classic approach. Average duration of laparoscopic flap harvest was 50 minutes, including a mean of 30 minutes for deep inferior epigastric dissection. Adhesions led to a 1-cm peritoneal laceration in our first anatomical subject. There were no preoperative or postoperative complications in the clinical case. The clinical procedure duration was 8 hours 15 minutes, with the anterior rectus sheath incision reduced from the conventional 12 cm to 5 cm. Flap ischemia lasted 50 minutes. The patient was discharged on postoperative day 5. This anatomical study and first successful laparoscope-assisted DIEP flap harvest prove that reduced trauma to the anterior rectus sheath is feasible and promising.

The Importance of an Academic Approach to Patient-Oriented Aesthetic Outcome Research: Reply to Comment on “Validating Facial Aesthetic Surgery Results with the FACE-Q”

No abstract available

MBN 2016 Aesthetic Breast Meeting BIA-ALCL Consensus Conference Report

Summary: Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon neoplasia occurring in women with either cosmetic or reconstructive breast implants. The actual knowledge about BIA-ALCL deriving from the literature presents several limits, and it remains difficult to make inferences about BIA-ALCL epidemiology, cause, and pathogenesis. This is the reason why the authors decided to organize an evidence-based consensus conference during the Maurizio Bruno Nava (MBN 2016) Aesthetic Breast Meeting held in Milan in December of 2016. Twenty key opinion leaders in the field of plastic surgery from all over the world have been invited to express and discuss their opinion about some key questions on BIA-ALCL, trying to reach a consensus about BIA-ALCL cause, pathogenesis, diagnosis, and treatment in light of the actual best evidence.

Reply: The Split Pectoralis Flap Combining the Benefits of Pectoralis Major Advancement and Turnover Techniques in One Flap

No abstract available

Septum-Based Nasal Tip Plasty: A Comparative Study between Septal Extension Graft and Double-Layered Conchal Cartilage Extension Graft

Background: The septal extension graft is currently the most commonly used primary and secondary rhinoplasty technique in Asia because it provides maximal tip projection and rotational controllability. The authors compared the tip projection amount and rotational controllability of the tip support between the septal extension graft based on the L-strut septum and double-layer conchal cartilage graft based on the full septum at the nasal tip. Methods: Twenty-seven consecutive patients who underwent nasal tip plasty with the septal extension graft or double-layer conchal cartilage graft for purely aesthetic reasons between March of 2014 and July of 2016 were included. The nasal tip projection and columellar labial angle preoperatively (time 0), immediately postoperatively (time 1, an average of 2 weeks after the operation), and postoperatively (time 2, an average of 7 months after the operation) were analyzed with clinical photography. Results: Fourteen patients (group A) underwent septal extension graft surgery and 13 (group B) underwent double-layer conchal cartilage graft surgery. Changes of 61 and 74 percent in tip projection ratio were immediately achieved and were maintained after surgery for groups A and B, respectively (time 2 versus time 0 dividing time 1 versus time 0; p = 0.722 for groups A and B). Therefore, the relapse ratio of this technique was 39 and 26 percent for groups A and B, respectively. Conclusions: This comparative study between the septal extension graft and double-layer conchal cartilage graft showed that both nasal tip plasties are similar in terms of stability. Considering the fact that the double-layer conchal cartilage graft could preserve septal support, this technique could become an effective and safe alternative option for rhinoplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Deoxycholic Acid Injection as an Effective Treatment for Reduction of Posterior Upper Torso Brassiere Strap Adiposity

No abstract available

Frederic E. Mohs, M.D. and the history of zinc-chloride

Publication date: Available online 28 December 2017
Source:Clinics in Dermatology
Author(s): Charles DePaolo
The history of ZnCl2 therapy prior to and including Frederic E. Mohs' (1910–2002) early contributions to dermatologic oncology is presented. In 1932, Mohs devised a method of cutaneous surgery that employed zinc-chloride paste (ZCP) to devitalize basal (BCC) or squamous (SCC) cell carcinoma. Because ZnCl2 coagulates malignant tissue without destroying cellular architecture, he described the surgery and its preservative effect as the fixed-tissue method. This method involved the serial removal of devitalized malignant tissue and the freezing and histologic examination of each layer; the process was continued until a cancer-free plane was reached. In 1953, a modified version of the micrographic system, the fresh-tissue method, was introduced. For improved efficiency, Mohs retained the systematic mapping of a neoplasm but eliminated the chemical escharotic. While the fresh-tissue method has become the preferred treatment mode, ZCP therapy remains in use today. Although the history of Mohs micrographic surgery is well documented, its background has not received sufficient attention. This paper surveys the chemical synthesis of ZnCl2, the formulation of ZCP as a cutaneous escharotic, and the extent to which Mohs' method compares to those of nineteenth and of early-twentieth-century predecessors.

Pesticide dichorvos induces early solid Ehrlich tumoral development associated with a non-protective pro-inflammatory response

Abstract

Prolonged exposure to dichlorvos (DDVP), a common pesticide used for food crops, has been related to the development of infections and malignancies. Macrophages are used as bioindicators of immunotoxicity; thus, evaluation of their activity in solid Ehrlich tumor-bearing mice (TBM) may be useful to evaluate the influence of pesticides on human health. To investigate the effects of low DDVP doses, Swiss mice were divided into the following groups: the DDVP group, composed of mice fed diets containing 10 mg/kg of DDVP; the TBM group, consisting of mice subcutaneously inoculated with 10⁷ tumor cells/100 μl and fed a basal diet; the DDVP-TBM group, consisting of mice previously fed DDVP-containing diets for 28 days and then subcutaneously inoculated with tumor cells; and the control (CTRL) group, composed of mice fed a basal diet. After 7 and 21 days of tumor inoculation, the mice were euthanized; and after necroscopic examination, the neoplastic mass, organs, and intraperitoneal fluid were collected. Adherent peritoneal cells were cultivated to determine the production of H₂O₂ and TNF. Altogether, our results indicate that even at low doses, the intake of DDVP caused weight loss and increased tumor mass, which were associated with H₂O₂ production and high levels of TNF, a pro-inflammatory cytokine. These data are important as the exposure to pesticides, even at low doses, could potentially hinder the immune response against tumors and, consequently, create favorable conditions for their development.

Phthalate esters in surface water of Songhua River watershed associated with land use types, Northeast China

Abstract

The ubiquitous presence of phthalate esters (PAEs) in the environment and their potential role as endocrine disruptors of marine organisms has attracted much attention. The presence of PAEs in different water sources collected from the Songhua River mainstream and its tributaries has been determined in this study. The total concentration of the seven PAEs (∑PAEs) detected was found to range from 1.153 to 7.867 μg L⁻¹_, with di(2-ethylhexyl) phthalate (DEHP) present as the predominate PAE congener. Dimethyl phthalate (DMP), diethyl phthalate (DEP), di-n-butyl phthalate (DBP), and DEHP were present in all of the water samples analyzed. The concentration of ∑PAEs in the Songhua River mainstream was shown to decrease initially, with a subsequent increase being detected due to inflow from branch tributaries contaminated with higher concentrations of PAEs. Analysis of land type usage, in this agriculture-dominated river watershed, also revealed an increase in ∑PAE concentration in waters flowing through forested area. The concentration of ∑PAEs in river waters also had a significant positive correlation with both agricultural and urban areas (p < 0.05); however, anthropogenic activities were not the only determining factor determining the ∑PAE concentration in this river watershed. Ecological risk assessment revealed that the levels of DMP and DEP in all waters were generally low, representing a relatively low ecological risk to marine organisms; however, DBP was present at medium or high risk levels, whilst DEHP also displayed high risk levels.

Formation of a lead-insoluble phase, pyromorphite, by hydroxyapatite during lead migration through the water-unsaturated soils of different lead mobilities

Abstract

This study combined the original unsaturated-column-percolation test with X-ray diffraction (XRD) analysis to understand how lead is transformed into lead-insoluble phase and immobilized by hydroxyapatite during lead migration in the water-unsaturated soil of different lead mobilities. The amounts of lead migrated from the soils without hydroxyapatite ranged from 4 to 46%, depending on the lead mobilities of soils. On the other hand, those of soils with hydroxyapatite were greatly suppressed by > 95% as compared with those without hydroxyapatite. The XRD analysis showed that the amounts of lead transformed into pyromorphite were compatible with those of lead migrated from the soil irrespective of the different lead mobilities. To the best of our knowledge, this study provides the first experimental evidence that lead migration can induce lead to transform into pyromorphite in the water-unsaturated soil. In addition, this study quantitatively demonstrates that the amount of lead migrated is almost equal to that of lead formed into pyromorphite. Thus, it was found that even if soluble lead remains after the application of immobilization material, it would be immobilized by the material during the lead migration as long as adequate material is applied to the soil.

Silicon alleviates cadmium toxicity in wheat seedlings ( Triticum aestivum L.) by reducing cadmium ion uptake and enhancing antioxidative capacity

Abstract

Cadmium (Cd) is a toxic element that poses a great threat to human health, while silicon (Si) is a beneficial element and has been shown to have a mitigation effect on plants under Cd toxicity. However, the mechanisms underlying the role of Si in alleviating Cd toxicity are still poorly understood in wheat. Therefore, growth status, photosynthesis parameters, root morphology, antioxidant system, and Cd²⁺ uptake and flux under Cd toxicity were studied through hydroponic experiment, aiming to explore the mitigation of Si on Cd toxicity in wheat seedlings. The results showed that Si supply improved plant biomass as well as photosynthetic but had little effects on root morphology of seedlings under Cd stress. Si addition decreased Cd contents both in shoots and roots. In situ measurements of Cd²⁺ flux showed that Si significantly inhibited the net Cd²⁺ influx in roots of wheat. Si also mitigated the oxidative stress in wheat leaves by decreasing malondialdialdehyde (MDA) and hydrogen peroxide (H₂O₂) contents as well as by increasing superoxide dismutase (SOD) and guaiacol peroxidase (POD) activity. Overall, the results revealed that Si could alleviate Cd toxicity in wheat seedlings by improving plant growth and antioxidant capacity and by decreasing Cd uptake and lipid peroxidation.

Activated carbons from avocado seed: optimisation and application for removal of several emerging organic compounds

Abstract

In this study, avocado seed was successfully used as raw material for producing activated carbons by conventional pyrolysis. In order to determine the best condition to produce the activated carbons, a 2² full-factorial design of experiment (DOE) with three central points was employed by varying the temperature and time of pyrolysis. The two evaluated factors (temperature and time of pyrolysis) strongly influenced the S_BET, pore volumes, hydrophobicity–hydrophilicity ratio (HI) and functional groups values; both factors had a negative effect over S_BET, pore volumes and functional groups which means that increasing the values of factors leads to decrease of these responses; on the other hand, with regards to HI, both factors caused a positive effect which means that increasing their values, the HI has an enhancement over its values. The produced activated carbon exhibited high specific surface areas in the range of 1122–1584 m² g⁻¹. Surface characterisation revealed that avocado seed activated carbons (ASACs) have hydrophilic surfaces and have predominantly acidic groups on their surfaces. The prepared ASACs were employed in the adsorption of 25 emerging organic compounds such as 10 pharmaceuticals and 15 phenolic compounds which presented high uptake values for all emerging pollutants. It was observed that the activated carbon prepared at higher temperature of pyrolysis (700 °C), which generated less total functional groups and presented higher HI, was the activated carbon with higher sorption capacity for uptaking emerging organic contaminants. Based on results of this work, it is possible to conclude that avocado seed can be employed as a raw material to produce high surface area and very efficient activated carbons in relation to treatment of polluted waters with emerging organic pollutants.

Photocatalytic reduction of carbon dioxide over Cu/TiO 2 photocatalysts

Abstract

The photocatalytic reduction of CO₂ with H₂O was investigated using Cu/TiO₂ photocatalysts in aqueous solution. For this purpose, Cu/TiO₂ photocatalysts (with 0.2, 0.9, 2, 4, and 6 wt.% of Cu) have been synthesized via sol-gel method. The photocatalysts were extensively characterized by means of inductively coupled plasma optical emission spectrometry (ICP-OES), N₂ physisorption (BET), XRD, UV-vis DRS, FT-IR, Raman spectroscopy, TEM-EDX, and photoelectrochemical measurements. The as-prepared photocatalysts contain anatase as a major crystalline phase with a crystallite size around 13 nm. By increasing the amount of Cu, specific surface area and band gap energy decreased in addition to the formation of large agglomeration of CuO. Results revealed that the photocatalytic reduction of CO₂ decreased in the presence of Cu/TiO₂ in comparison to pure TiO₂, which might be associated to the formation of CuO phase acting as a recombination center of generated electron-hole pair. Decreasing of photoactivity can also be connected with a very low position of conduction band of photocatalysts with high Cu content, which makes H₂ production necessary for CO₂ reduction more difficult.

Effectiveness of narrow grass hedges in reducing atrazine runoff under different slope gradient conditions

Abstract

Atrazine is frequently detected in surface runoff and poses a potential threat to the environment. Grass hedges may minimize runoff loss of atrazine from crop fields. Therefore, the effectiveness of two grass hedges (Melilotus albus and Pennisetum alopecuroides) in controlling atrazine runoff was investigated using simulated rainfall on lands at different slope gradients (15 and 20%) in northern China. Results showed that a storm (40 mm in 1 h), occurring 4 h after atrazine application, caused a loss of 3% of the applied amount. Atrazine loss under 20% slope was significantly greater than that under 15% slope in control plots. Atrazine exports associated with the water fraction accounted for the majority of total loss. Pennisetum hedges were more efficient in controlling atrazine loss with runoff compared to Melilotus hedges. No significant difference in the capacity of grass hedges to reduce atrazine exports was observed between 15 and 20% slopes. These findings suggest grass hedges are effective in minimizing atrazine runoff in northern China, and Pennisetum hedges should be preferentially used on sloping croplands in similar climatic regions.

Heavy metal enrichment in roadside soils in the eastern Tibetan Plateau

Abstract

The effects of human activities on heavy metal pollution in soil have been less investigated on the Tibetan Plateau. The present study was designed to assess the effects of highway traffic on Cu, Zn, Pb, and Cd enrichments in the 0–60-cm soil profile in the eastern Tibetan Plateau. Soils were sampled at four transects (with an altitude range of 2643–2911 m) across the G212 highway and five transects (3163–3563 m) across the G213 highway. Background concentrations of Cu, Zn, Pb, and Cd to the 60-cm soil depth (measured at each transect 400 m away from highways) varied greatly among transects and between highways. However, this spatial variation in the heavy metal concentrations was not related to the altitude of the investigated areas. On each the left and right sides of G212 or G213, Cu, Zn, and Pb concentrations to the 60-cm depth, at 5, 10, 20, and 50 m away from the highway, were all generally greater than the respective metal background concentrations. Cd concentrations to the 20 cm on G212 or 60-cm soil depth on G213 increased prominently within a distance of 20 m away from the highways, compared to background values in different depths. From the curb to 400 m away from highways, concentrations of Cu, Zn, Pb, and Cd were generally higher in the upper than in the lower soil layers. This may suggest that other factors such as atmospheric deposition were also contributable to the accumulation of heavy metals in soil. The contamination factor (C_f ) calculation showed that roadside soils to the 60-cm depth, within a distance of 50 m from the curbs of both G212 and G213, were moderately (1 ≤ C_f  < 3) contaminated with Cu, Zn, and Pb. The contamination from Cd mainly occurred (1 ≤ C_f  < 8) in the top 20 cm soil with a closer distance from the highways. Our results indicated that traffic effects in enriching heavy metals reached 60-cm depth in roadside soils on the eastern Tibetan Plateau. For assessment of heavy metal pollutions in soil in mountainous areas, it is necessary to in situ identify the background values.

Dynamics and sources of pharmaceutically active compounds in a coastal Mediterranean river during heavy rains

Abstract

Concentrations of pharmaceutically active compounds (PACs) in freshwater systems depend on numerous factors such as land use and hydrometeorological conditions. In the Mediterranean, heavy rain events are of particular importance as they highly influence the concentration of micropollutants found in freshwater and are a source of recurrent first foul flushes due to combined sewer overflows (CSOs). In this study, we seek to assess the dynamics of pharmaceuticals during storm events in coastal Mediterranean rivers at a fine scale and to determine their contribution to multicontamination phenomena owing to CSOs. Our results showed that, while dissolved PACs followed the same trend as other contaminants, i.e., they increased significantly during CSOs, PACs in the total fraction did not peak yet maintained their already high concentrations for slightly longer due to their release via CSOs. Pharmaceutical concentrations for both the dissolved and the total fraction were dramatically diluted during the peak river flow. A fine-scale follow-up of PACs dynamics in the total fraction, including the differentiation of sewer overflows from both the right and left river banks, as well as the analyses of a large amount of PACs molecules, allowed us to clearly identify their major sources. While domestic inputs were dominated by nicotine and caffeine, the use of gadolinium (an MRI contrast agent) as a marker, attributed the main source of medical drugs such as tramadol, ibuprofen, and diclofenac to the major public hospital of the region. Thus, identifying major sources of PACs and implementing adapted water treatments directly at those sources would be the most cost-efficient alternative to cope with pharmaceutical drugs in coastal Mediterranean aquatic environments. Moreover, PACs behavior differed depending on the molecules considered and the source of these molecules, but we could not establish a direct link between their behavior and their chemical or physical properties. Our study highlights the importance of monitoring at strategic locations and with a high frequency sampling in order to better understand fate, sources, and behavior of pharmaceuticals in aquatic environments.

Algorithm-Based Levator Aponeurectomy

To the Editor We read with great interest the article titled "Role of algorithm-based levator aponeurectomy in small-incision external ptosis surgery for involutional ptosis" by Repp et al. The authors clearly described a new surgical algorithm for treatment of involutional ptosis considering the biomechanical property of the superior levator complex. Aponeurotic ptosis is the most common type of acquired ptosis, resulting from involutional changes of the levator aponeurosis as a consequence of its gradual stretching or attenuation of its strength. We congratulate Repp et al for the new technique proposed to control the aponeurosis to standardize the amount of stress placed on it among different patients. The algorithm is very interesting because it allows calculation of the amount of aponeurosis resection needed, minimizing the variable depending on the operator, and thus standardizing the method of surgical correction.