Publication date: Available online 5 January 2018
Source:Actas Dermo-Sifiliográficas
Author(s): A. Alegre-Sánchez, D. Buendía-Castaño, P. Fernández-González, B. Pérez-García
Πέμπτη 4 Ιανουαρίου 2018
Eritema postimplantación asociado a implante mamario tratado con láser de colorante pulsado
Dermoscopy of arteriovenous tumour: A morphological study of 39 cases
Abstract
Background/Objectives
Arteriovenous tumour is a distinct, benign, acquired vascular lesion that can be misdiagnosed.
Methods
A dermoscopic examination of 39 cases of arteriovenous tumours collected from four Spanish hospitals was performed to evaluate specific dermoscopic criteria and patterns.
Results
The most common structures found were vascular, 95% of cases (37/39); 90% (35/39) were non-arborising telangiectasia. All the lesions except two (95%) had a homogeneous pigmentation background that was red in 30 cases (77%), bluish-red in three (8%), brown in two (5%) and blue or multicoloured in one case each. Lacunae were seen in only three cases (8%). Non-arborising telangiectasia on a reddish background was identified in 72% of cases.
Conclusions
Dermoscopy is helpful in improving the diagnosis of arteriovenous tumours and allows the observer to differentiate them from other cutaneous lesions such as other vascular tumours, basal cell carcinomas and melanomas.
Programmed cell death 1 blockade-induced cutaneous sarcoid-like epithelioid granulomas in advanced melanoma: A case report
Abstract
Sarcoidosis is a chronic, systemic inflammatory disorder of unknown etiology that is characterized by the formation of noncaseating granuloma in affected organs, most commonly the lung.1 In pulmonary sarcoidosis patients, the T helper 1 (Th1) cytokine profile of CD4+ as well as CD8+ T cells was demonstrated in bronchoalveolar lavage fluid.2 However, there has been no detailed description of a lymphocyte profile in cutaneous sarcoid-like epithelioid granulomas. Here, we report a case of sarcoid-like epithelioid granulomas induced by nivolumab in a patient with advanced melanoma and we performed functional lymphocyte analysis of the granuloma lesions. All studies were performed in accordance with the ethical principles of the Declaration of Helsinki.
This article is protected by copyright. All rights reserved.
Mosaic NRASopathy n a child with giant melanocytic congenital naevus, epidermal hamartoma and bilateral nephroblastomatosis: clinical implication for follow-up
Abstract
Various nevoid proliferations result from postzygotic mutation in genes within the RAF/RAS/MAPK pathway, supporting the term "mosaic RASopathy"(1). Giant congenital melanocytic naevus (GCMN) and neurocutaneous melanosis are rare mosaic RASopathies mainly known to be at risk for the development of melanoma and skeletal anomalies are variably recorded (2,3).
This article is protected by copyright. All rights reserved.
Neutrophilic superficial eccrine ductitis: Proposal of a new disease concept
Abstract
A 3-year-old Japanese boy presented with a 3-month history of itchy erythematous papules on his trunk and forearms, the histologic findings of which were characterized by predominantly neutrophilic inflammation within and around the eccrine sweat ducts and obliteration and disruption of the superficial eccrine sweat ducts. Although the skin disorder had some clinical and histopathologic similarity to miliaria and neutrophilic eccrine hidradenitis, it was ultimately conformed to be neither disorder. Based on this and a case report in the Japanese literature of a 1-year-old boy with erythematous eruptions whose clinical and histopathologic findings were similar to those in our case, we propose the skin disorder in our case, referred to as "neutrophilic superficial eccrine ductitis," as a unique entity.
Vascular Anomalies of the Head and Neck Region
Abstract
Vascular anomalies of the head and neck region are a complex group of lesions that challenge the head and neck physicians. From the very understanding of the difference between its two distinct forms, hemangiomas and vascular malformations to its management remain confusing. The review of this anomaly attempts at comprehensively understanding the disease. Vascular anomalies are easily diagnosed by their clinical presentation, but choice of imaging and management for this spectrum of lesions is varied. The author attempts to categorize the required imaging for the lesion with suggestions on the management of both hemangiomas and vascular malformations. The available treatment options are discussed, and a comprehensive algorithm for management is suggested. Further research in developing drugs that could restrict the growth of these lesions would be the future of the management of vascular lesions.
Diffusion-Weighted Imaging of Brain Metastasis from Lung Cancer: Correlation of MRI Parameters with the Histologic Type and Gene Mutation Status [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Development of noninvasive imaging biomarkers indicating the histology and the gene mutation status of brain metastasis from lung cancer is important. We aimed to investigate diffusion-weighted imaging parameters as predictors of the histology and gene mutations of brain metastasis from lung cancer.
MATERIALS AND METHODS:DWI data for 74 patients with brain metastasis from lung cancer were retrospectively reviewed. The patients were first grouped according to the primary tumor histology (adenocarcinoma, small-cell lung cancer, squamous cell carcinoma), and those with adenocarcinoma were further divided into epidermal growth factor receptor (EFGR) mutation–positive and wild type groups. Sex; age; number, size, and location of brain metastasis; DWI visual scores; the minimum ADC; and the normalized ADC ratio were compared among groups using 2 and ANOVA. Multiple logistic regression analysis was performed to determine independent predictors of the EGFR mutation.
RESULTS:The minimum ADC was lower in the small-cell lung cancer group than in the other 2 groups, though the difference was not significant. Furthermore, minimum ADC and the normalized ADC ratio were significantly lower in the EGFR mutation–positive group than in the wild type group (P = .021 and .014, respectively). Multivariate analysis revealed that minimum ADC and the normalized ADC ratio were independently associated with the EGFR mutation status (P = .028 and .021, respectively).
CONCLUSIONS:Our results suggest that DWI parameters (minimum ADC and normalized ADC ratio) for the solid components of brain metastasis from lung cancer are not correlated with their histology, whereas they can predict the EGFR mutation status in brain metastasis from lung adenocarcinoma.
What Have We Learned from MR Imaging in Multiple Sclerosis? [REVIEW ARTICLE]
SUMMARY:
Using MR imaging, perfusion can be assessed either by dynamic susceptibility contrast MR imaging or arterial spin-labeling. Alterations of cerebral perfusion have repeatedly been described in multiple sclerosis compared with healthy controls. Acute lesions exhibit relative hyperperfusion in comparison with normal-appearing white matter, a finding mostly attributed to inflammation in this stage of lesion development. In contrast, normal-appearing white and gray matter of patients with MS has been mostly found to be hypoperfused compared with controls, and correlations with cognitive impairment as well as fatigue in multiple sclerosis have been described. Mitochondrial failure, axonal degeneration, and vascular dysfunction have been hypothesized to underlie the perfusion MR imaging findings. Clinically, perfusion MR imaging could allow earlier detection of the acute focal inflammatory changes underlying relapses and new lesions, and could constitute a marker for cognitive dysfunction in MS. Nevertheless, the clinical relevance and pathogenesis of the brain perfusion changes in MS remain to be clarified.
Addition of Amide Proton Transfer Imaging to FDG-PET/CT Improves Diagnostic Accuracy in Glioma Grading: A Preliminary Study Using the Continuous Net Reclassification Analysis [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Amide proton transfer imaging has been successfully applied to brain tumors, however, the relationships between amide proton transfer and other quantitative imaging values have yet to be investigated. The aim was to examine the additive value of amide proton transfer imaging alongside [18F] FDG-PET and DWI for preoperative grading of gliomas.
MATERIALS AND METHODS:Forty-nine patients with newly diagnosed gliomas were included in this retrospective study. All patients had undergone MR imaging, including DWI and amide proton transfer imaging on 3T scanners, and [18F] FDG-PET. Logistic regression analyses were conducted to examine the relationship between each imaging parameter and the presence of high-grade (grade III and/or IV) glioma. These parameters included the tumor-to-normal ratio of FDG uptake, minimum ADC, mean amide proton transfer value, and their combinations. In each model, the overall discriminative power for the detection of high-grade glioma was assessed with receiver operating characteristic curve analysis. Additive information from minimum ADC and mean amide proton transfer was also evaluated by continuous net reclassification improvement. P < .05 was considered significant.
RESULTS:Tumor-to-normal ratio, minimum ADC, and mean amide proton transfer demonstrated comparable diagnostic accuracy in differentiating high-grade from low-grade gliomas. When mean amide proton transfer was combined with the tumor-to-normal ratio, the continuous net reclassification improvement was 0.64 (95% CI, 0.036–1.24; P = .04) for diagnosing high-grade glioma and 0.95 (95% CI, 0.39–1.52; P = .001) for diagnosing glioblastoma. When minimum ADC was combined with the tumor-to-normal ratio, the continuous net reclassification improvement was 0.43 (95% CI, –0.17–1.04; P = .16) for diagnosing high-grade glioma, and 1.36 (95% CI, 0.79–1.92; P < .001) for diagnosing glioblastoma.
CONCLUSIONS:Addition of amide proton transfer imaging to FDG-PET/CT may improve the ability to differentiate high-grade from low-grade gliomas.
Multiparametric Analysis of Permeability and ADC Histogram Metrics for Classification of Pediatric Brain Tumors by Tumor Grade [PEDIATRICS]
BACKGROUND AND PURPOSE:
Accurate tumor grading is essential for treatment planning of pediatric brain tumors. We hypothesized that multiparametric analyses of a combination of permeability metrics and ADC histogram metrics would differentiate high- and low-grade tumors with high accuracy.
MATERIALS AND METHODS:DTI and dynamic contrast-enhanced MR imaging using T1-mapping with flip angles of 2°, 5°, 10°, and 15°, followed by a 0.1-mmol/kg body weight gadolinium-based bolus was performed on all patients in addition to standard MR imaging. Permeability data were processed and transfer constant from the blood plasma into the extracellular extravascular space, rate constant from the extracellular extravascular space back into blood plasma, extravascular extracellular volume fraction, and fractional blood plasma volume were calculated from 3D tumor volumes. Apparent diffusion coefficient histogram metrics were calculated for 3 separate tumor volumes derived from T2-FLAIR sequences, T1 contrast-enhanced sequences, and permeability maps, respectively.
RESULTS:Results from 41 patients (0.3–16.76 years of age; mean, 6.22 years) with newly diagnosed contrast-enhancing brain tumors (16 low-grade; 25 high-grade) were included in the institutional review board–approved retrospective analysis. Wilcoxon tests showed a higher transfer constant from blood plasma into extracellular extravascular space and rate constant from extracellular extravascular space back into blood plasma, and lower extracellular extravascular volume fraction (P < .001) in high-grade tumors. The mean ADCs of FLAIR and enhancing tumor volumes were significantly lower in high-grade tumors (P < .001). ROC analysis showed that a combination of extravascular volume fraction and mean ADC of FLAIR volume differentiated high- and low-grade tumors with high accuracy (area under receiver operating characteristic curve = 0.918).
CONCLUSIONS:ADC histogram metrics combined with permeability metrics differentiate low- and high-grade pediatric brain tumors with high accuracy.
Pediatric psoriasis: Evolving perspectives
Abstract
Background/Objectives
Childhood-onset psoriasis is a common skin disorder that has recently received increasing attention, particularly because of its significant medical, social, financial, and psychological burdens and its associated comorbidities. With limited data available and lack of standardized management guidelines for pediatric psoriasis, an expert panel desired to provide an updated critical overview and practical guidance for management of the affected population.
Methods
A panel of pediatric dermatologists with extensive experience in pediatric psoriasis defined and prioritized a core set of topics, performed an English-language literature review, prepared critical evaluations and presentations of topic areas, and carried out a consensus meeting and follow-up consensus manuscript.
Results
The summation of evolving perspectives in pediatric psoriasis includes epidemiology and natural history of the disease, precipitating factors and comorbidities, quality of life and burden of disease, clinical features and disease presentation, differential diagnosis, pathogenesis and treatment, including topical, photo, and systemic therapies.
Conclusion
Pediatric psoriasis is an important immune-mediated inflammatory skin disease with potential for significant impact on affected individuals and their caregivers. Current state-of-the-art care is based primarily on experience and expert consensus, but pediatric data are accumulating and therapeutic options are rapidly evolving.
Resonance Raman scattering of β-carotene solution excited by visible laser beams into second singlet state
Publication date: February 2018
Source:Journal of Photochemistry and Photobiology B: Biology, Volume 179
Author(s): Luyao Lu, Lingyan Shi, Jeff Secor, Robert Alfano
This study aimed to use self-absorption correction to determine the Raman enhancement of β-carotene. The Raman spectra of β-carotene solutions were measured using 488nm, 514nm, 532nm and 633nm laser beams, which exhibited significant resonance Raman (RR) enhancement when the laser energy approaches the electronic transition energy from S0 to S2 state. The Raman intensity and the actual resonance Raman gain without self-absorption from S2 state by β-carotene were also obtained to evaluate the effect of self-absorption on RR scattering. Moreover, we observed the Raman intensity strength followed the absorption spectra. Our study found that, although 488nm and 514nm pumps seemed better for stronger RR enhancement, 532nm would be the optimum Raman pump laser with moderate RR enhancement due to reduced fluorescence and self-absorption. The 532nm excitation will be helpful for applying resonance Raman spectroscopy to investigate biological molecules in tissues.
Photobiomodulation at 660nm stimulates proliferation and migration of diabetic wounded cells via the expression of epidermal growth factor and the JAK/STAT pathway
Publication date: Available online 4 January 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Sandy Winfield Jere, Nicolette Nadene Houreld, Heidi Abrahamse
Photobiomodulation (PBM) modulates cellular processes to enhance diabetic wound healing. The photon energy activates wounded cells to proliferate and migrate. However, the signalling pathways responsible for these observations remain unknown. This study aimed to determine if PBM stimulates cellular proliferation and migration via the expression of epidermal growth factor (EGF) and activation of the Janus kinase/Signal transducer and activators of transcription (JAK/STAT) signalling pathway. Normal, wounded, diabetic and diabetic wounded cell models were exposed to PBM at a wavelength of 660nm and fluence of 5J/cm2 and incubated for 48h. Non-irradiated cells (0J/cm2) and cells exposed to exogenous EGF (rh EGF) served as controls. Cellular migration was determined microscopically at 0, 24 and 48h. Flow cytometry (BrdU) was used to determine cell proliferation, while the Trypan blue exclusion assay and adenosine triphosphate (ATP) luminescence was used to determine cell viability. The enzyme linked immunosorbent assay (ELISA) was used to analyse EGF expressed in the culture media, and phosphorylated (p-) EGF receptor (p-EGFR), p-JAK2, p-STAT1 and p-STAT5 in cells. Irradiated diabetic wounded cells showed a significant increase in EGF, and activation of its receptor (p-EGFR) and JAK/STAT (p-JAK2, p-STAT1 and p-STAT5). PBM at 660nm and 5J/cm2 is able to modulate cellular autocrine signalling, particularly the EGF/EGFR loop leading to activation of the JAK/STAT pathway which in turn stimulates cell proliferation and migration.
Improved conductivity and antibacterial activity of poly(2-aminothiophenol)-silver nanocomposite against human pathogens
Publication date: January 2018
Source:Journal of Photochemistry and Photobiology B: Biology, Volume 178
Author(s): P. Boomi, J. Anandha Raj, S.P. Palaniappan, G. Poorani, S. Selvam, H. Gurumallesh Prabu, P. Manisankar, J. Jeyakanthan, V.K. Langeswaran
A rapid and simple chemical synthesis of poly(2-aminothiophenol)‑silver (P2ATP-Ag) nanocomposite using conductive and electroactive silver nanoparticles (AgNPs) is reported. The AgNPs was synthesized by chemical reduction method using tri‑sodium citrate as reducing agent and poly(N-vinyl-2-pyrrolidone) (PVP) as stabilizing agent. P2ATP-Ag nanocomposite was synthesized by using potassium peroxodisulphate as oxidant and the samples were characterized. The presence of AgNPs in the composite was confirmed from UV–Vis, FTIR and X-ray diffraction studies. Morphology of the P2ATP and its composite were investigated by SEM. HR-TEM images show spherical, trigonal and rod like morphologies with sizes of Ag nanoparticles and its composite. Thermal analysis revealed that the thermal stability of the P2ATP-Ag nanocomposite is improved when compared with pure P2ATP. The synthesized AgNPs, pure P2ATP and P2ATP-Ag nanocomposite were screened for antibacterial activity test against human pathogen such as Gram positive (Bacillus subtilis, ATCC-6051) and Gram negative (Vibrio cholerae, ATCC-14035), carried out by agar-well diffusion method at micro molar concentration. The result shows that P2ATP-Ag nanocomposite has excellent antibacterial activity due to the presence of Ag nanoparticles. The electrical conductivity of the P2ATP-Ag nanocomposite is better than that of pure P2ATP. The reported nanocomposite will be a potential material for electrocatalysis, sensors and biomedical applications.
A new insight into the interaction of ZnO with calf thymus DNA through surface defects
Publication date: January 2018
Source:Journal of Photochemistry and Photobiology B: Biology, Volume 178
Author(s): Sumita Das, Sabyasachi Chatterjee, Srikrishna Pramanik, Parukuttyamma Sujatha Devi, Gopinatha Suresh Kumar
Experimental evidences on the binding interaction of ZnO and Calf Thymus (CT) DNA using several biophysical techniques are the centre of interest of the present study. The interaction of ZnO with CT DNA has been investigated in detail by absorption spectral study, fluorescence titration, Raman analysis, zeta potential measurement, viscometric experiment along with thermal melting study and microscopic analysis. Steady-state fluorescence study revealed the quenching (48%) of the surface defect related peak intensity of ZnO on interaction with DNA. The optimized concentration of ZnO and DNA to obtain this level of quenching has been found to be 0.049mM and 1.027μM, respectively. Additional fluorescence study with 8-hydroxy-5-quinoline (HQ) as a fluorescence probe for Zn2+ ruled out the dissolution effect of ZnO under the experimental conditions. DNA conjugation on the surface of ZnO was also supported by Raman study. The quantitative variation in conductivity as well as electrophoretic mobility indicated significant interaction of ZnO with the DNA molecule. Circular dichroism (CD) and viscometry titrations provided clear evidence in support of the conformational retention of the DNA on interaction with ZnO. The binding interaction was found to be predominantly entropy driven in nature. The bio-physical studies presented in this paper exploring ZnO-CT DNA interaction could add a new horizon to understand the interaction between metal oxide and DNA.
Graphical abstract
Photoprotective potential of metabolites isolated from algae-associated fungi Annulohypoxylon stygium
Publication date: January 2018
Source:Journal of Photochemistry and Photobiology B: Biology, Volume 178
Author(s): Olívia Maria Campanini Maciel, Renata Spagolla Napoleão Tavares, Daniela Ricardo Engracia Caluz, Lorena Rigo Gaspar, Hosana Maria Debonsi
Natural products, or secondary metabolites, obtained from fungal species associated with marine algae have been widely used in sunscreens due to their antioxidant activity and protective potential against solar radiation. The endophytic fungus isolated from Bostrychia radicans algae collected in the Rio Escuro mangrove, São Paulo State, Brazil, Annulohypoxylon stygium (Xylariaceae family) was studied to evaluate the photoprotective potential of its metabolites. The Annulohypoxylon genus can produce secondary metabolites with interesting cytotoxic, antibacterial and antioxidant properties and was never isolated before from a marine alga or had its metabolites studied for UV protection. The fungal culture (code As) extracted with dichloromethane: methanol (2:1) yielded 9 fractions (Asa to Asi) which were submitted to different chromatographic methodologies to obtain pure compounds, and to spectroscopic methodologies to elucidate their structures. Also, a screening was conducted to evaluate the qualitative production of the metabolites, besides the absorption in the UVA/UVB range, their photostability and phototoxicity potential using the 3T3 NRU phototoxicity test (OECD TG 432). This study led to the isolation of a novel compound, 3-benzylidene-2-methylhexahydropyrrolo [1,2-α] pyrazine-1,4-dione (1), from fractions Ase3 and Asf3; Ase1 was identified as 1-(1,3-Benzodioxol-5-yl)-1,2-propanediol (2), two metabolites were isolated as diastereomers (1S,2R)-1-phenyl-1,2-propanediol (3) from Asd2 and (1R,2R)-1-phenyl-1,2-propanediol (4) from Asd3, and Ase1 and 1,3-benzodioxole-5-methanol (5) from Asc1. The results obtained showed a great potential source of new molecules to be used as UVB filters in sunscreens, since substances 1–2 presented UVB absorption, had no phototoxic potential and were considered photostable. In conclusion, these compounds can be considered as a potential new class of molecules for photoprotection, since their photosafety and non-cytotoxicity were predicted using in vitro methods for topical use. Meanwhile, further efficacy assays shall be conducted for the establishment of their Sun Protection Factor (SPF). Also, this work provided new information concerning the metabolic profile of A. stygium, since it was possible to obtain two enantiomer compounds (3) and (4). One of them belonged to the same skeleton, but with a methylenedioxy moiety, showing the richest enzymatic pattern for this microorganism.
Graphical abstract
Green synthesis of highly fluorescent nitrogen – Doped carbon dots from Lantana camara berries for effective detection of lead(II) and bioimaging
Publication date: January 2018
Source:Journal of Photochemistry and Photobiology B: Biology, Volume 178
Author(s): Rajkumar Bandi, Ramakrishna Dadigala, Bhagavanth Reddy Gangapuram, Veerabhadram Guttena
Here, we developed a simple green approach for the synthesis of highly fluorescent nitrogen doped carbon dots (NCDs) using Lantana camara berries. Optical and physicochemical properties of as synthesized NCDs were extensively studied by using various analytical techniques. NCDs exhibited bright fluorescence with Quantum yield as high as 33.15%, which is stable to various effects like heat, pH, ionic strength and continuous irradiation. Furthermore, the NCDs presented highly selective and sensitive fluorescence response towards Pb2+ which explored their potential to serve as a label-free fluorescent probe for the effective detection of Pb2+. As developed NCDs based probe exhibited a great linear response (R2=0.998) towards Pb2+ in the concentration range of 0–200nM with a detection limit of 9.64nM. The probe further presented high precision without any interference and was successfully applied for the detection of Pb2+ in the real water and human sera (serum and urine) samples. Cytotoxicity studies on both cancerous (human breast adenocarcinoma MCF-7) and normal (Human embryonic kidney HEK-293) cell lines revealed their excellent biocompatibility. With their low cytotoxicity, strong fluorescence and excitation-dependent emission, NCDs were successfully applied as multi-colour bioimaging agents and Pb2+ detection capabilities were further evaluated in live cells.
Graphical abstract
The extended production of UV-induced reactive oxygen species in L929 fibroblasts is attenuated by posttreatment with Arrabidaea chica through scavenging mechanisms
Publication date: January 2018
Source:Journal of Photochemistry and Photobiology B: Biology, Volume 178
Author(s): Fabianne Martins Ribeiro, Hélito Volpato, Danielle Lazarin-Bidóia, Vânia Cristina Desoti, Rebeca Oliveira de Souza, Maria José Vieira Fonseca, Tânia Ueda-Nakamura, Celso Vataru Nakamura, Sueli de Oliveira Silva
Ultraviolet radiation (UVR) exposure causes various injurious effects to human skin by generating reactive oxygen species (ROS). Excessive ROS production can lead to oxidative stress which may damage cellular components like lipids and proteins and causing photoaging. The use of natural photochemopreventive agents with antioxidant properties is an important alternative to improve the effectiveness of sunscreens and reduce skin photodamage. A crude extract (CE) from the leaves of Arrabidaea chica underwent partition by a liquid-liquid method. The hexane fraction (FH), chloroform fraction (FC), and ethyl acetate fraction (FEA) were obtained. The antioxidant capacity of the CE, FH, FC, and FEA was studied in a cell-free system using the 2,2-diphenyl-1-picrylhydrazyl (DPPH) method and the xanthine/luminol/xanthine oxidase system. The FC had the best antioxidant activity. We also evaluated the photochemoprotective effect of A. chica in protecting L929 fibroblasts against UV-A- and UV-B-induced cell damage. A. chica inhibited the extended production of ROS up to 3h. Posttreatment with the CE and FC attenuated UV-induced cell damage through scavenging mechanisms, including the quenching of intracellular ROS and mitochondrial O2− and preventing lipid peroxidation. These results suggest that A. chica may be a promising non-sunscreen photoprotector that can improve the effectiveness of commercial sunscreens.
Approach to the jewelry aficionado
Abstract
Children's and teens' frequent use of inexpensive "costume" jewelry exposes them to a variety of contact allergens. Greater use heightens the risk of developing allergic contact dermatitis, especially in the setting of body piercings. Several clinical pearls, prevention strategies, and avoidance alternatives are provided in this article to guide clinicians and patients in the management of jewelry-related allergic contact dermatitis.
Vitiligoid variant of lichen sclerosus in young girls with darker skin types
Abstract
Background/Objectives
Vitiligo and lichen sclerosus are autoimmune disorders characterized by white discoloration, and both frequently affect the anogenital region. Vitiligoid lichen sclerosus refers to a superficial variant of lichen sclerosus in which the lesion appears clinically to be vitiligo based on the predominant presentation of depigmentation and minimal inflammation and sclerosis but histologically is consistent with lichen sclerosus. A limited number of reports have described vitiligoid lichen sclerosus, and from these reports, it appears to primarily affect darker-skinned people.
Methods
We retrospectively reviewed the records of 7 girls with darker skin types seen in our pediatric dermatology clinic who presented with a clinical overlap of vitiligo and lichen sclerosus. All had primarily well-demarcated, depigmented patches characteristic of vitiligo, but the lesions were symptomatic (pruritus, pain, bleeding, constipation), a presentation more consistent with lichen sclerosus.
Results
The girls were all treated with high-potency topical steroids, calcineurin inhibitors, or both. The associated symptoms improved or resolved, but most had minimal improvement of the depigmentation.
Conclusions
The girls presented in this series appear to have had vitiligoid lichen sclerosus, given the clinical overlap of lichen sclerosus and vitiligo affecting the anogenital region, particularly given that they did not have depigmented patches elsewhere on their body. Previous cases of vitiligoid lichen sclerosus have been reported in darker skin types, and our findings support this possible predisposition. It is important for clinicians to assess patients presenting with genital depigmentation for overlapping features of vitiligo and lichen sclerosus and determine appropriate management.
Potassium iodide in refractory, recurrent pediatric Sweet syndrome: Guidance in dosing and monitoring
Abstract
We describe a 5-month-old boy with clinical and histopathologic presentation of Sweet syndrome. He responded to systemic corticosteroids, with multiple flares on tapering; potassium iodide was added, which provided complete resolution of Sweet syndrome. Potassium iodide has been used in only a few cases, and no standard dosage has been established in children. We discuss calculation of a pediatric dosage for potassium iodide in Sweet syndrome.
Isotretinoin-induced acne fulminans without systemic symptoms with concurrent exuberant granulation tissue
Abstract
Acne fulminans is a severe form of acne characterized by painful, inflammatory nodules that progress into ulcers and concurrent systemic symptoms. Treatment of acne with isotretinoin can precipitate a syndrome called isotretinoin-induced acne fulminans without systemic symptoms. An exuberant granulation tissue response, another known adverse event associated with isotretinoin, can occur concurrently, inhibiting wound repair and complicating treatment. We report a case of isotretinoin-induced acne fulminans without systemic symptoms with exuberant granulation tissue response that was treated successfully with topical clobetasol ointment.
Acral pigmented Spitz nevus in a child with transepidermal migration of melanocytes: Dermoscopic and reflectance confocal microscopic features
Abstract
Acral pigmented Spitz nevi are seldom reported in the literature. We report a new case on the palm of a 4-year-old girl that demonstrated correlation between features observed on dermoscopy and reflectance confocal microscopy (RCM). Histopathology revealed a benign intraepidermal Spitz nevus with transepidermal elimination of melanocytes that showed on RCM as focal atypical bright cells concerning for malignancy. This case is one of few reports in the literature combining dermoscopy, reflectance confocal microscopy, and histology for an acral Spitz nevi, which are rarely evaluated by RCM given the thickness of the stratum corneum in acral sites.
Clinical features and nail clippings in 52 children with psoriasis
Abstract
Background/Objectives
Nail clipping, the act of cutting the distal portion of a nail for microscopic analysis, can complement the diagnosis of skin diseases with nail involvement, such as psoriasis. This study aimed to describe histopathologic findings on 81 nails from 52 children and adolescents with skin psoriasis and to determine whether these changes correlated with the severity of skin and nail involvement.
Methods
Children with psoriasis were enrolled in this cross-sectional study to obtain Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI) scores. The most altered nails were processed using periodic acid-Schiff with diastase staining.
Results
Fifty-two patients with a median age of 10.5 years were included. The median Nail Psoriasis Severity Index score of the 20 nails from these patients was 17 (range 3-80). The most common findings were pitting (94.2%), leukonychia (73.0%), and longitudinal ridges (63.5%). Eighty-one nail fragments were collected by clipping. Neutrophils were found in 6 samples (7.6%) and serous lakes in 15 (19%). Median nail plate thickness was 0.3 mm (range 0.1-0.63 mm). Patients whose nails had neutrophils had a higher median PASI score (6.1 vs 2.0, P = .03). Patients whose nails had serous lakes had higher median PASI (5.3 vs 1.9, P = .008) and NAPSI (median 45.0 vs 18.0, P = .006) scores.
Conclusion
There seems to be a correlation between some microscopic nail features in children with psoriasis and their PASI and NAPSI scores, so nail clippings from children with suspected psoriasis may help with diagnosis, especially in the presence of neutrophils, and in excluding onychomycosis.
Delayed-type hypersensitivity to vaccine aluminum adjuvant causing subcutaneous leg mass and urticaria in a child
Abstract
A 3-year-old girl presented with a 7-month history of a waxing and waning left thigh mass associated with pruritus and erythema at the site of two previous DTaP-HepB-IPV vaccinations. Patch testing was positive to aluminum chloride, supporting a diagnosis of vaccine granuloma secondary to aluminum allergy; her symptoms had been well controlled with antihistamines and topical steroids. Injection site granulomas are a benign but potentially bothersome reaction to aluminum-containing immunizations that can be supportively managed, and we encourage strict adherence to the recommended vaccine schedule in this setting. Patch testing is a sensitive, noninvasive diagnostic tool for patients presenting with this clinical finding, and dermatologist awareness can prevent unnecessary medical examination and provide reassurance.
Development of an indicator for characterizing particle size distribution and quality of stormwater runoff
Abstract
Stormwater particles washed from road-deposited sediments (RDS) are traditionally characterized as either turbidity or total suspended solids (TSS). Although these parameters are influenced by particle sizes, neither of them characterizes the particle size distribution (PSD), which is of great importance in pollutant entrainment and treatment performance. Therefore, the ratio of turbidity to TSS (Tur/TSS) is proposed and validated as a potential surrogate for the bulk PSD and quality of stormwater runoff. The results show an increasing trend of Tur/TSS with finer sizes of both RDS and stormwater runoff. Taking heavy metals (HMs, including Cu, Pb, Zn, Cr, and Ni) as typical pollutants in stormwater runoff, the concentrations (mg/kg) were found to vary significantly during rainfall events and tended to increase significantly with Tur/TSS. Therefore, Tur/TSS is a valid parameter to characterize the PSD and quality of stormwater. The high negative correlations between Tur/TSS and rainfall intensity demonstrate that stormwater with higher Tur/TSS generates under low intensity and, thus, characterizes small volume, finer sizes, weak settleability, greater mobility, and bioavailability. Conversely, stormwater with lower Tur/TSS generates under high intensity and, thus, characterizes large volume, coarser sizes, good settleability, low mobility, and bioavailability. These results highlight the need to control stormwater with high Tur/TSS. Moreover, Tur/TSS can aid the selection of stormwater control measures with appropriate detention storage, pollution loading, and removal effectiveness of particles.
A rare presentation of congenital syphilis: Pemphigus syphiliticus in a newborn infant with extensive desquamation of the extremities
Abstract
Congenital syphilis is an infection transmitted from mother to fetus and can present with early but variable cutaneous manifestations. In rare situations, a bullous eruption known as pemphigus syphiliticus may develop. We present an unusual case of broad desquamation of the extremities in a newborn infant who was found to have congenital syphilis. Pemphigus syphiliticus should be considered in the differential diagnosis of neonatal bullous eruptions and erosions.
Wound infection after inpatient pediatric skin biopsy
Abstract
Punch and shave biopsies are important dermatologic procedures in the inpatient setting but have a risk of wound infection. Data on the incidence of infection in this setting are limited and conflicting. This retrospective study of 127 pediatric inpatients at two tertiary care centers who underwent biopsy demonstrated a low overall risk of infection (n = 1, 0.8%). Twenty-five (19.7%) were neutropenic, and 51 (40.2%) were not taking systemic antibiotics at the time of biopsy; none of these patients developed a wound infection. The overall low rate of infection should reassure physicians who are balancing the risks and benefits of performing a skin biopsy in children in the inpatient setting and suggests that physicians should not defer clinically indicated biopsies because of concern about infection.
Rapid, successful treatment of atopic dermatitis recalcitrant to topical corticosteroids
Abstract
Atopic dermatitis is responsive to midpotency topical corticosteroids, which are the mainstay of treatment, yet many patients have disease that is "resistant" to triamcinolone prescribed for outpatient use. Such resistance is often due to poor adherence, but patients and caregivers may remain adamant that the steroid was ineffective and assure the physician that it was applied as recommended. We describe the case of a young girl with a 2-year history of atopic dermatitis resistant to triamcinolone whose condition rapidly improved with continued use of triamcinolone. Our case raises the ethical dilemma of whether physicians should base treatment plans on what patients report or what evidence on adherence suggests.
Correction to: Influence of pyrolysis temperature and production unit on formation of selected PAHs, oxy-PAHs, N-PACs, PCDDs, and PCDFs in biochar—a screening study
Abstract
The correct presentation of Figs. 1, 3 and Table 3 are shown in this paper.
PAK1 overexpression promotes cell proliferation in cutaneous T cell lymphoma via suppression of PUMA and p21
Cutaneous T cell lymphoma (CTCL) represents a heterogeneous group of skin-homing T cell tumors [1–3]. CTCL accounts for approximately two-thirds of all primary cutaneous lymphomas, of which mycosis fungoides (MF) is the most common subtype [4,5]. During the last decades, the incidence of CTCL has steadily risen in several regions [6], which has resulted in heavy health and financial burdens. However, determining the etiology, diagnosis, and treatment of CTCL are difficult for dermatologists; early stage CTCL, in particular, is often misdiagnosed as benign inflammatory dermatoses (BID) [7].
Experiment on the treatment of acid mine drainage with optimized biomedical stone particles by response surface methodology
Abstract
The immobilized particles were used to treat acid mine drainage (AMD) in the study, which owns the characteristics of serious pollution and high managing cost. The immobilized particles were prepared with sulfate reducing bacteria (SRB) and medical stones. In order to investigate the interactive influence of medical stones on the particle properties, the salt modification condition, content, and size of the medical stone were taken as the influential factors. At the same time, the removal rate of SO42− and Mn2+, the release of total irons (TFe) and chemical oxygen demand (COD) and pH value were taken as the response values in the experiment. On the basis of the orthogonal experimental research, a response surface model was established. The experimental analysis showed that the particles can get the best treatment effect, when using the salt-modified medical stone with the content of 15% and particle size of 200~300 mesh. At this time, the removal rates of Mn2+ and SO42− in wastewater were 83.10 and 96.22%, respectively. The release contents of TFe and COD were 2.99 mg L−1 and 1828.54 mg L−1, respectively, and the pH value was 7.05. Then, biological medical stone particles were prepared according to the optimal ratio in the response surface experiment. The adaptability of biomedical stone particles was studied at different concentrations of SO42−, Mn2+ and pH value. The results showed that the high concentration of SO42− inhibited the metabolism of SRB, while Mn2+ had a less effect. The biomedical stone particles could regulate pH value very well.
Effects of earthworm casts on sorption-desorption, degradation, and bioavailability of nonylphenol in soil
Abstract
Up to hundreds of milligrams per kilogram (dry weight) of nonylphenol (NP) reportedly entered the soil and sediment through the agricultural reuse of biosolids, pesticide application, etc. Organic pollutants in soil could not only further trigger groundwater contamination via leaching (that highly depends upon sorption-desorption and degradation phenomena) but also harm food safety by crop uptake (that mainly rests with the bioavailability of pollutants in soil). Thus, we first investigated the effects of earthworm casts (EWCs) on the sorption-desorption, degradation, and bioavailability of NP in soil under laboratory microcosm conditions, and then, analyzed the FT-IR spectra of EWC and soil samples (with and without EWC). The application of EWC could notably increase the sorption capacity of soils for NP and in turn significantly inhibited the desorption of NP from soil; responsively lengthened the half-time of NP in the soil; and reduced the uptake and translocation of NP in tomato seedlings and promoted their growth during the first 3 weeks. Finally, FT-IR spectra of EWC and soil samples indicated that the application of EWC increased the content of N, P, and organic matter in soil.
Progression of undiagnosed cutaneous lymphoma after anti-tumor necrosis factor alpha therapy
Cutaneous lymphoma (CL) diagnosed after anti-tumor necrosis factor (TNF)α therapy has been reported in the literature, yet a clear link between both events remains elusive.
Predictive value of basal cell carcinoma biopsies with negative margins: A retrospective cohort study
Pathology reports of basal cell carcinoma (BCC) biopsies often contain comments of positive or negative margins, with only 1-2% of the margin evaluated. The negative predictive value (NPV) of biopsy margin status on residual BCC is unknown.
Subsequent non-melanoma skin cancers and impact of immunosuppression in liver transplant recipients
Non-melanoma skin cancers (NMSC) are the most frequent cancers in solid organ transplant recipients, with a high rate of subsequent tumors.
The association between dermoscopic features and BRAF mutational status in cutaneous melanoma: significance of the blue-white veil
The genetic basis of melanoma affects its clinicopathological characteristics and increasingly influences its management. BRAF-mutated melanoma may present with specific dermoscopic features.
Complications and Reoperations in Mandible Angle Fractures
This cohort study compares the use of transcervical and transoral techniques to repair mandible fractures in patients.
Supraclavicular Artery Island Flap in Patients With Ports or Pacemakers
This case report examines the technique and safety of supraclavicular artery island flap harvest in patients with subclavian devices such as pacemakers and ports.
Noninvasive monitoring of plant-based formulations on skin barrier properties in infants with dry skin and risk for atopic dermatitis
Dry skin and the associated impaired epidermal barrier function are postulated to constitute a major element in the development of atopic dermatitis.
The intelligibility of metaphysical structure
Abstract
Theories that posit metaphysical structure are able to do much work in philosophy. Some, however, find the notion of 'metaphysical structure' unintelligible. In this paper, I argue that their charge of unintelligibility fails. There is nothing distinctively problematic about the notion. At best, their charge of unintelligibility is a mere reiteration of previous complaints made toward similar notions. In developing their charge, I clarify several important concepts, including primitiveness, intelligibility, and the Armstrong-inspired "ontologism" view of the world. I argue that, ultimately, their charge is best understood as an objection whose central premise is that the notion of 'structure' runs contrary to an important presupposition of contemporary metaphysics. But that central premise is, on closer inspection, implausible. I respond to the objection by identifying three popular metaphysical theories that violate the alleged presupposition but are still generally regarded as intelligible. The objection thus fails to show that a theory that posits metaphysical structure is unintelligible.
Heavy metals in handloom-dyeing effluents and their biosorption by agricultural byproducts
Abstract
The Madhabdi municipality in the Narsingdi district of Bangladesh is a well-known area for textile, handloom weaving, and dyeing industries. These textile industries produce a considerable amount of effluents, sewage sludge, and solid waste materials every day that they directly discharge into surrounding water bodies and agricultural fields. This disposal poses a serious threat to the overall epidemic and socio-economic pattern of the locality. This research entailed the collection of 34 handloom-dyeing effluent samples from different handloom-dyeing industries of Madhabdi, which were then analyzed to determine the contents of the heavy metals iron (Fe), zinc (Zn), copper (Cu), chromium (Cr), manganese (Mn), lead (Pb), and cadmium (Cd). Average concentrations of Fe, Cr, Cu, Pb, Mn, and Zn were 3.81, 1.35, 1.70, 0.17, 0.75, and 0.73 mg L−1, respectively, whereas Cd content was below the detectable limit of the atomic adsorption spectrophotometer. The concentrations of Fe, Cr, Cu, Pb, and Mn exceed the industrial effluent discharge standards (IEDS) for inland surface water and irrigation water guideline values. A biosorption experiment of the heavy metals (Fe, Cr, Cu, Mn, and Zn) was conducted without controlling for any experimental parameters (e.g., pH, temperature, or other compounds present in the effluent samples) by using four agricultural wastes or byproducts, namely rice husk, sawdust, lemon peel, and eggshell. Twenty grams of each biosorbent was added to 1 L of effluent samples and stored for 7 days. The biosorption capacity of each biosorbent is ranked as follows: eggshell, sawdust, rice husk, and lemon peel. Furthermore, the biosorption affinity of each metal ion was found in the following order: Cu and Cr (both had similar biosorption affinity), Zn, Fe, Mn. The effluents should not be discharged before treatment, and efficient treatment of effluents is possible with eggshell powder or sawdust at a rate of 20 g of biosorbent per liter of effluents.
The effects of different aeration strategies on the performance of constructed wetlands for phosphorus removal
Abstract
The effects of different aeration methods such as tidal flow (TF), effluent recirculation (ER), and artificial aeration (AA) on the performance of vertical-flow constructed wetland (VFCW), horizontal-flow constructed wetland (HFCW), and hybrid constructed wetland (HCW) are extensively and critically evaluated in this review paper. Aerated constructed wetlands (CWs) demonstrate superior performance compared with non-aerated systems. The removal of total phosphorus (TP) showed substantial variation among different types of CWs and aeration strategies, with mean and standard deviation of 68 ± 20% estimated from all reviewed studies on aerated systems. The TF-VFCW designated the highest removal efficiency and removal rate of 88 ± 6% and 2.6 ± 2.5 g m−2 day−1, respectively, followed by the ER-HCW with values of 79 ± 18% and 1.3 ± 0.7 g m−2 day−1, respectively. The superior performance of TF-VFCW could be attributed to a positive effect of TF in rejuvenating the wetland with fresh air, thus enhancing dissolved oxygen (DO) in the system, and augmenting phosphorus precipitation and adsorption to the substrate. A positive correlation of TP and orthophosphate (PO43--P) with DO indicates that the improvement in DO levels due to redox manipulation with aeration strategies facilitates the phosphorous removal processes (e.g., through precipitation and adsorption to the substrate). The conflicting results on the impact of AA and ER reported by many studies need the cautious interpretation of their impact and require further studies. Only few studies have examined the impact of oxidation-reduction potential on phosphorous removal, which requires more attention in future research, as it appears as an important factor in enhancing the phosphorus removal.
The Inclusion of Orbicularis Oculi Muscle in the SMAS Flap in Asian Facelift: Anatomical Consideration of Orbicularis Muscle and Zygomaticus Major Muscle
Abstract
Background
In the malar region, the SMAS flap can be thin and tear easily, making it difficult to securely fix it. And the surgical anatomy of the region may be unclear and confusing. The authors performed an anatomical study on the location of the lateral margin of the orbicularis oculi muscle (OOM) and the origin of the zygomaticus major muscle (ZMM) when using a high-SMAS facelift with finger-assisted spaces dissection technique, which included elevation of the SMAS flap with OOM.
Methods
One hundred twenty-one Asian patients underwent this facelift procedure. Of those, the distances between the posterior margin of tragus and the lateral margin of the OOM and the center of the origin of the ZMM were measured in 20 patients.
Results
The mean age of the initial 121 patients was 50.9 years. In all cases, improvement was seen in soft tissue sagging of the midface and lower face. There was no functional impairment of the OOM. In 20 patients of them, the lateral margin of the OOM and the center of the origin of the ZMM were located at mean distances of 50.6 (range 48–53 mm) and 61.0 mm (range 60–65 mm) from the posterior margin of the tragus.
Conclusions
The SMAS flap with the OOM is sufficiently strong enough so that it can maintain the pulling force and also helps to securely fix it. The authors hope that these anatomical findings would be useful when performing it and aid in the understanding of the relationship between the muscles in the malar area.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
Quantifying Dynamic Deformity After Dual Plane Breast Augmentation
Abstract
Background
Dynamic breast deformity (DBD) is characterized by visible distortion and deformity of the breast due to contraction of the pectoralis major muscle after submuscular breast augmentation; fortunately, in most cases, this is not a clinically significant complaint from patients. The purpose of this study is to present a simple method for objectively measuring DBD in patients submitted to dual plane breast augmentation (DPBA).
Methods
We studied 32 women, between 18 and 50 years old, who underwent primary DPBA with at least 1 year of follow-up. Anthropometric landmarks of the breast were marked, creating linear segments. Standardized photographs were obtained both during no pectoralis contraction (NPC) and during maximum pectoralis muscle contraction (MPC); measurements of the linear segments were taken through ImageJ imaging software, and both groups were compared.
Results
We found statistically significant differences in all analyzed segments when comparing measurements of the breasts during NPC and MPC (p < 0.001).
Conclusion
Our study proposes a novel, standardized method for measuring DBD after DPBA. This technique is reproducible, allowing for objective quantification of the deformity in any patient, which can be valuable for both patients and surgeons, as it allows for a more thorough discussion on DBD, both pre- and postoperatively, and may help both patients and surgeons to make more informed decisions regarding potential animation deformities after breast augmentation.
Level of Evidence V
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
Color Change After Paramedical Pigmentation of the Nipple–Areola Complex
Abstract
Background
Reconstruction of the nipple–areola complex is the final process in breast reconstruction. Local flaps and paramedical pigmentation is one of the major procedures for this. However, fading after paramedical pigmentation leads to a color difference between the selected pigment and its color in the skin. The aim of this study is to make a proposition in color choice of paramedical pigmentation for nipple–areola complex.
Methods
Our research focused on investigating the color changes over time after unilateral nipple–areola complex reconstruction using paramedical pigmentation in 25 patients to propose suitable color selections. We measured the color by spectrometer and conducted comparisons using the hue, saturation, and value (HSV) color space and the color space defined by the Commission International de L'eclairage based on one channel for luminance (lightness) (L) and two color channels (a and b) (L*a*b*).
Results
A comparison of the hue, value, and saturation of the reconstructed areola compared to the normal areolae was conducted using HSV color space; the value and saturation were satisfactory after 3 months and beyond, but the reconstructed areola tended to have stronger red hues. The color difference (ΔE00) calculated in L*a*b* color space showed slow fading after the scab was peeled off.
Conclusions
This result indicates that a color with less redness and more yellowness, particularly 4–5 degrees of yellowness on the color wheel, than the normal side is the most appropriate color selection for this technique.
Level of Evidence V
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
A New Human-Derived Acellular Dermal Matrix for Breast Reconstruction Available for the European Market: Preliminary Results
Abstract
Introduction
The introduction of acellular dermal matrices (ADMs) contributed to the growing diffusion of direct-to-implant breast reconstruction (DTI-BR) following mastectomy for breast cancer. According to specific legislations, European specialists could not benefit from the use of human-derived ADMs, even though most evidence in the literature are available for this kind of device, showed optimal outcomes in breast reconstruction. The Skin Bank of the Bufalini Hospital (Cesena, Italy) obtained in 2009 the approval for the production and distribution of a new human cadaver-donor-derived ADM (named with the Italian acronym, MODA, for matrice omologa dermica acellulata) from the Italian National Transplant Center and National Health Institute. We report preliminary results of MODA application in direct-to-implant breast reconstruction following nipple–areola complex (NAC)-sparing mastectomy for breast cancer treatment.
Materials and Methods
We prospectively enrolled all women undergoing NAC-sparing mastectomy for breast cancer and DTI-BR in our breast surgical unit from June 2015 to January 2017. We enrolled a selected population without previous chest wall irradiation, not being heavy tobacco smokers or diabetic, with a BMI < 30 kg/m2 and requiring less than 550 cc silicone implants. We assessed short-term outcomes, defined as postoperative complications presenting in the first 30 postoperative days and long-term outcomes at 6 and 12 months.
Results
From June 2015 to January 2017, we treated 56 breasts. At a mean follow-up of 14 months, we observed only two minor complications described as limited wound dehiscences, conservatively managed with complete resolution without implant exposure or re-intervention.
Conclusions
Our preliminary results show very good performance of MODA in direct-to-implant breast reconstruction following NAC-sparing mastectomy for breast cancer treatment. This is particularly relevant for the European market, where no other human-derived devices are available for breast reconstruction due to regulatory restrictions.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
The Effects of Platelet-Rich Plasma and Adipose-Derived Stem Cells on Neovascularization and Fat Graft Survival
Abstract
Background
Adipose-derived stem cell (ADSCs)-assisted and platelet-rich plasma (PRP)-assisted lipofilling aim to enhance angiogenesis and cell proliferation and are promising techniques for lipofilling. This study aimed to compare the outcomes of ADSCs-assisted and PRP-assisted lipofilling.
Methods
Adipose tissue and human venous blood were obtained from women with early breast cancer. Human ADSCs were isolated and amplified in vitro. PRP was extracted through double centrifugation. The effect of PRP on ADSCs proliferation was evaluated. In the in vivo study, 1 ml of adipose tissue with saline (control group), PRP (PRP group), or ADSCs (ADSCs group) was injected subcutaneously into the dorsum of nude mice. At 2, 4, 8, and 12 weeks after injection, tissues were assessed for volume retention and ultrasound abnormality. For histological assessment, hematoxylin and eosin staining were performed.
Results
Cytokines in PRP and blood were comparable. Regarding the in vitro assay, PRP significantly improved ADSCs proliferation, and the effect was dose-dependent. Concerning the in vivo study, for each time point, ADSCs-assisted lipofilling showed superior volume maintenance. Similarly, the PRP group showed improved angiogenesis and fat survival, as compared with the control group. The angiogenic effect of PRP was inferior to that of ADSCs at most time points. No significant difference was observed at 12 weeks after lipofilling. Complication rates were comparable between the PRP group and ADSCs group.
Conclusions
PRP-assisted and ADSCs-assisted lipofilling can significantly improve the cosmetic results of grafted fat. PRP-assisted lipofilling, which is considered convenient and clinically available, is a promising technique to improve neovascularization and fat survival.
No Level Assigned
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
Dermatology faculty and residents’ perspectives on the dermatology residency application process: A nationwide survey
Publication date: Available online 4 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Nathan W. Rojek, Kanade Shinkai, Nicole Fett
Subsequent non-melanoma skin cancers and impact of immunosuppression in liver transplant recipients
Publication date: Available online 4 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Pamela Funk-Debleds, Emilie Ducroux, Olivier Guillaud, José Ursic-Bedoya, Evelyne Decullier, Mélanie Vallin, Sylvie Euvrard, Georges-Philippe Pageaux, Olivier Boillot, Jérôme Dumortier
BackgroundNon-melanoma skin cancers (NMSC) are the most frequent cancers in solid organ transplant recipients, with a high rate of subsequent tumors.ObjectivesTo describe subsequent NMSC in a large cohort of liver transplant recipients (LTR) with long follow-up, and to analyze the factors influencing it, including immunosuppressive regimen.MethodsNinety-eight LTR (76 male) with a personal post-transplant history of squamous-cell carcinoma (SCC), basal-cell carcinoma (BCC) or Bowen's disease were included, with a median follow-up of 12.4 years (range: 1.5-27.8) after liver transplantation.ResultsMedian follow-up after first NMSC was 6.4 years (range: 0.17-22.1). Fifty-two (53.1%) patients developed 141 subsequent NMSC with a BCC/SCC ratio of 1.8:1. The actuarial risk of developing a second NMSC was 13.7% at 1 year, 28.4% at 2 years, 49.4% at 5 years, 65.7% at 10 years, and 88.4% at 15-years. Multivariate analysis found that phototype I-II (vs. III-IV) was a significant risk factor for second NMSC (HR: 2.556, 95%CI [1.45; 4.48], p=0.001), whereas withdrawal of calcineurin inhibitors (CNI) was significantly protective (HR: 0.358, 95%CI [0.142; 0.902], p=0.029).LimitationsRetrospective analysis.ConclusionsSubsequent NMSC are very frequent in LTR and conversion from CNI-based immunosuppressive regimen to mTORi/antimetabolite-based immunosuppressive regimen can reduce subsequent NMSC.
Combination of ligation and timolol before surgical excision of pyogenic granuloma
Publication date: Available online 4 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Yoo Sang Baek, Seung Hwi Kwon, Jiehyun Jeon
The association between dermoscopic features and BRAF mutational status in cutaneous melanoma: significance of the blue-white veil
Publication date: Available online 4 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): M. Armengot-Carbó, E. Nagore, Z. García-Casado, R. Botella-Estrada
BackgroundThe genetic basis of melanoma affects its clinicopathological characteristics and increasingly influences its management. BRAF-mutated melanoma may present with specific dermoscopic features.ObjectivesTo identify the dermoscopic features associated with BRAF mutation in cutaneous melanoma and to evaluate a model capable of predicting BRAF mutations based on dermoscopic and clinicopathological features easily accessible in normal clinical practice.MethodsA prospective, cross-sectional, observational, and descriptive study was performed. Ninety-three cutaneous melanomas with dermoscopic images from 93 patients were included. BRAF mutational status was determined by genetic analysis using two methods: cobas 4800 BRAF V600 Mutation Test and Sanger sequencing. Clinicopathological data were collected; dermoscopic images were analyzed by two independent blind observers.ResultsBlue-white veil in dermoscopy was significantly associated with BRAF mutations (OR: 4.3; 95% CI: 1.6-11.5; p=0.003). Patients with BRAF-mutated melanomas were significantly younger than those with wild-type melanomas (OR: 0.96; 95% CI: 0.93-0.99; p=0.008). Based on these two variables, it was possible to predict BRAF mutational status in melanoma with 73% accuracy.LimitationsHistological data were obtained from pathology reports. The accuracy of the predictive model has not been tested with a new dataset.ConclusionsBlue-white veil in dermoscopy is associated with BRAF mutations in cutaneous melanoma.
“Sweetheart, you should have that looked at”: Ethical Implications of Treating Family Members
Publication date: Available online 4 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Solomiya Grushchak, Jane M. Grant-Kels
Efficacy and safety of switching to ixekizumab in secukinumab non-responders with plaque psoriasis: a multicenter retrospective study of interleukin (IL)-17A antagonist therapies
Publication date: Available online 4 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Jorge R. Georgakopoulos, Michelle Phung, Arvin Ighani, Jensen Yeung
Management Strategies of Academic Pigmented Lesion Clinic Directors in the United States
Publication date: Available online 4 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Kelly C. Nelson, Douglas Grossman, Caroline C. Kim, Suephy C. Chen, Clara N. Curiel-Lewandrowski, James M. Grichnik, John M. Kirkwood, Sancy A. Leachman, Ashfaq A. Marghoob, Susan M. Swetter, Suraj S. Venna, Michael E. Ming
Is there a doctor onboard? The ethical conundrum of a specialist asked to provide in-flight medical assistance
Publication date: Available online 4 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Sunil H. Adwani, Preeti Jhorar, Jane M. Grant-Kels
Malignancy-associated Dermatomyositis: Retrospective Case-Control Study From a Single Tertiary Care Center
Publication date: Available online 4 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Laura Kooistra, Claudia Ricotti, Fabrizio Galimberti, Carmen Gota, Anthony P. Fernandez
Cultural Sensitivity: Response to Review of Cutaneous Flushing
Publication date: Available online 3 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Darlene Gou
Teaching & Learning Tips 3: Active learning strategies
Abstract
Challenge: It takes practice and thoughtful planning to inspire trainees to actively process new information instead of passively receive it. In fact, research suggests "active teaching" does not always lead to "active learning," so what are some general principles to encourage trainees to engage in active learning in any teaching context?
What's new in atopic eczema? An analysis of systematic reviews published in 2015. Part 1: epidemiology and methodology
Summary
This review forms part of a series of annual updates that summarize the evidence base for atopic eczema (AE), providing a succinct guide for clinicians and patients. It provides a summary of key findings from 15 systematic reviews that were published during 2015, and focuses on the epidemiology and methodology issues of AE. For systematic reviews on the prevention and treatment of AE, see Part 2 of this update. The worldwide prevalence of AE during childhood has been calculated to be 7.89% (95% CI 7.88–7.89), based on studies of 1 430 329 children from 102 countries. Children with AE are four times more likely than controls to have allergic rhinitis and asthma [relative risk (RR) = 4.24, 95% CI 3.75–4.79]. Twin studies show the heritability of AE to be about 75%. AE is more prevalent in patients with vitiligo and alopecia, and is positively associated with a high body mass index in America and Asia but not in Europe. Possible relationships between AE and exercise, maternal folate supplementation, maternal stress and autism spectrum disorder (ASD) have been assessed, but more high-quality studies are needed for definitive conclusions. The Harmonising Outcomes Measures for Eczema (HOME) Initiative is developing a core set of outcome measures for AE trials. Suitable instruments for measuring quality of life are yet to be agreed, and use of Investigator Global Assessment in trials requires standardization. Transparent reporting of AE trials remains problematic.
Vitamin D levels in asthmatic patients with and without allergic bronchopulmonary aspergillosis
Abstract
Vitamin D deficiency is believed to a pathogenetic factor in patients with allergic bronchopulmonary aspergillosis (ABPA) and cystic fibrosis. Whether vitamin D deficiency is also prevalent in ABPA complicating asthma, remains unknown. Herein, we evaluate vitamin D levels in asthmatic patients with and without ABPA.
In a prospective study, plasma vitamin D (25[OH]D) levels were measured in consecutive subjects with asthma (n=75), ABPA (n=158) and healthy volunteers (n=50). Vitamin D levels <20 ng/mL were considered as vitamin D deficiency.
There was no difference in mean (95% CI) vitamin D levels between healthy controls (15.3 [12.7-17.9]), asthmatics (19.2 [16.3-22.1]) and subjects with ABPA (18.9 [16.9-20.8]) (p=0.22). Vitamin D deficiency was encountered in 70%, 64% and 65% of the healthy controls, asthmatics and ABPA subjects, respectively, and was not different between the groups (p=0.79). There was no difference in the asthma control, pulmonary function, immunological findings and the severity of bronchiectasis, in patients with ABPA, with and without vitamin D deficiency.
Vitamin D deficiency is equally prevalent in asthmatic patients with or without ABPA in the Indian subcontinent, and does not appear to play a major role in the pathogenesis of ABPA complicating asthma.
This article is protected by copyright. All rights reserved.
Epidemiology of Dermatophyte Infections among School Children in Menoufia Governorate, Egypt
Abstract
Background
Most superficial mycotic infections of human skin are due to dermatophytes. Children are frequently affected due to different predisposing factors, particularly overcrowding in classrooms.
Objectives
To estimate the prevalence of dermatophytes infections and their related risk factors among school children in Menoufia Governorate, Egypt.
Subjects and Methods
Six public primary and preparatory schools were randomly selected and their pupils (n= 3464) were asked to complete a predesigned questionnaire covering both personal data and suspected risk factors for superficial dermatophyte infections. The children were also examined for dermatological diseases. Any suspected lesions were biopsied for mycological examination.
Results
The prevalence of clinically suspected dermatophytes infections was (1.41%) while the prevalence of culture confirmed cases was (0.98%). The most common clinical type was tinea capitis with a prevalence of (1.01%). Microsporum canis was the only isolated organism from the suspicious lesions with a 69.4% positivity rate. A higher prevalence was observed among boys, low socio-economic pupils and those with a family history of dermatophyte infections. Pet contact and sharing towels and caps among pupils were significant risk factors.
Conclusions
Dermatophyte infection is still prevalent among basic school pupils. Fortunately, it is related to preventable risk factors. We recommend regular screening and use of educational health programs for kids to control it.
This article is protected by copyright. All rights reserved.
Xanthelasma palpebrarum - a brief review.
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Xanthelasma palpebrarum - a brief review.
Clin Cosmet Investig Dermatol. 2018;11:1-5
Authors: Nair PA, Singhal R
Abstract
Xanthelasma palpebrarum is the most common cutaneous xanthoma, characterized by yellowish plaques over eyelids - most commonly, over the inner canthus of the upper lid. It is triggered by hyperlipidemia, thyroid dysfunction, and diabetes mellitus. Xanthelasma results from perivascular infiltration of mono- and multinucleated foam cells within lipid-laden cytoplasmic vacuoles in the superficial reticular dermis. Different modalities of treatment, such as simple surgical excision, cryotherapy, chemical peeling with trichloroacetic acid, radiofrequency, and laser, are used in the treatment of xanthelasma palpebrarum. A brief review of current treatment strategies is presented here.
PMID: 29296091 [PubMed]
Innovations in Maternal and Child Health: Pairing Undergraduate and Graduate Maternal and Child Health Students in Summer Practica in State Title V Agencies
Abstract
Objective As part of the National MCH Workforce Development Center, an innovative internship program placed MCH undergraduate and graduate students in summer practica in state Title V agencies. Graduate student mentoring of undergraduates and leadership and professional development training and support are key features of the program. The objective of this paper is to report on the results of the evaluation of the MCH Paired Practica Program in its pilot years, 2014–2016. Methods Students completed pre and post internship questionnaires which included closed as well as open-ended questions. In addition, the Title V state health agency preceptors completed a questionnaire at the end of each summer. Results Over the 3-year pilot project, a total of 17 teams participated. Students were from 6 of the 13 graduate Centers of Excellence in MCH programs in Schools of Public Health and two undergraduate MCH Pipeline Programs. There were 11 participating states. After the practicum experience, there was a significant increase in students' confidence in a number of measures related to working in complex, dynamic environments and in their ability to contribute to improvements in MCH population health. Students reported having more confidence in their ability to function effectively as an informal/formal MCH leader (p = 0.02), more confidence in their ability to contribute to improvements in MCH population health (p = 0.04), and being more prepared to enter the workforce after the practicum experience (p = 0.07), although there was no significant change in students' (n = 22) interest in seeking a job in a Title V agency or a community based organization with a MCH focus. Nearly 60% of the students did state at the posttest that they would likely seek additional education in MCH. Overall, the Title V preceptors (n = 14) were very positive about the program although in some instances there was less confidence in the knowledge and skills of the undergraduate students. Conclusion The MCH Paired Practica Program is a unique effort to go beyond the academic training of undergraduate and graduate MCH students to provide them with direct exposure to the field, as well as leadership, mentorship, and professional development training. While some challenges emerged related to differences in skills between undergraduates and graduate MCH students, participating students demonstrated clear improvements in their leadership skills including increased confidence in their ability to take initiative, provide opinions and feedback, to function informally or formally as leaders, and to contribute to improvements in MCH population health.
Digital epidemiology: what is it, and where is it going?
Abstract
Digital Epidemiology is a new field that has been growing rapidly in the past few years, fueled by the increasing availability of data and computing power, as well as by breakthroughs in data analytics methods. In this short piece, I provide an outlook of where I see the field heading, and offer a broad and a narrow definition of the term.
Laser- und Lichttherapie zur Behandlung der Strahlendermatitis
Zusammenfassung
Strahlendermatitis (SD) ist eine entzündliche Hauterkrankung, die als ungewollte Nebenwirkung der medizinischen Strahlentherapie (ST) auftreten kann, am häufigsten bei Patienten, die im Rahmen einer Krebserkrankung der HNO- bzw. Anal- und Vulvaregion behandelt werden. Die Nebenwirkungen an der Haut und Schleimhaut treten innerhalb von wenigen Wochen nach der Einleitung von ST auf, späte Nebenwirkungen können sich Monate bis Jahre nach der ST entwickeln. Therapeutisch kommen verschiedene Behandlungsansätze in Betracht wie Pentoxifillin, hyperbare Sauerstofftherapie, Lasertherapie und Photobiomodulationstherapie (PBMT). Um die verminderte Lebensqualität von Patienten mit ST-induzierter Fibrose zu begrenzen, ist eine unterstützende Pflege aus Schmerztherapie, psychologischer Unterstützung und Wundversorgung notwendig.
Downward mobility and Rawlsian justice
Abstract
Technological and societal changes have made downward social and economic mobility a pressing issue in real-world politics. This article argues that a Rawlsian society would not provide any special protection against downward mobility, and would act rightly in declining to provide such protection. Special treatment for the downwardly mobile can be grounded neither in Rawls's core principles—the basic liberties, fair equality of opportunity, and the difference principle—nor in other aspects of Rawls's theory (the concept of legitimate expectations, the idea of a life plan, the distinction between allocative and distributive justice, or the distinction between ideal and nonideal theory). Instead, a Rawlsian society is willing to sacrifice particular individuals' ambitions and plans for the achievement of justice, and offers those who lose out from justified change no special solicitude over and above the general solicitude extended to all. Rather than guaranteeing the maintenance of any particular individual or group's economic position, it provides all of its members—the upwardly mobile, the downwardly mobile, and the immobile—a form of security that is at once more generous and more limited: that they will receive the liberties, opportunities, and resources promised by the principles of justice.
Association between bullous pemphigoid and malignancy: A meta-analysis
Abstract
It has been suggested that bullous pemphigoid is associated with an increased risk of malignancy, but the evidence is inconsistent. Therefore, a meta-analysis was conducted to explore this association. PUBMED and Embase were searched for studies investigating the association between bullous pemphigoid and malignancy. This meta-analysis included 16 studies with a total of 9398 cases of bullous pemphigoid. The rate of malignancy in patients with bullous pemphigoid was 11% (95% CI: 9–14, P < 0.001); 9% (95% CI: 6–13, P < 0.003) for women and 13% (95% CI: 9–18, P < 0.03) for men, with a statistically insignificant higher risk in men (OR = 1.30, 95% CI: 0.99–1.71, P = 0.06). The event rate was 9% (95% CI: 5–14, P < 0.001) in the Asian population and 13% (95% CI: 10–17, P < 0.001) in the European population, with a statistically significant lower risk in the Asians population (OR = 0.69, 95% CI: 0.57–0.84; P < 0.001). The event rate of malignancy was higher in patients with bullous pemphigoid than in matched controls (OR = 2.08, 95% CI: 1.22–3.55; P = 0.005). The overall event rate of malignancy was higher in the bullous pemphigoid group than in matched controls. Caution is required when interpreting these results, as potential confounding variables were not controlled for.
Hyperkeratotic hand eczema compared to other subgroups of hand eczema – a retrospective study with a follow-up questionnaire
Summary
Background
Only a few clinical trials on hand eczema have included further classification into subtypes, and there is a need for studies evaluating the present classifications.
Objectives
To examine differences in demographic factors, lifestyle factors and severity between subgroups of hand eczema patients, with a focus on hyperkeratotic hand eczema.
Methods
This was a retrospective study including hand eczema patients referred to the outpatient dermatological clinic, Bispebjerg Hospital, between January 2013 and July 2014. The study comprises information on subdiagnoses, treatment and foot eczema from patient files, as well as a follow-up questionnaire.
Results
A total of 120 patients were included, 10 of whom were diagnosed with hyperkeratotic hand eczema. A significantly higher proportion of the patients with hyperkeratotic hand eczema were male (p = 0.002) and received systemic or ultraviolet (UV) treatment (p = 0.026). The frequency of tobacco smoking was significantly higher in patients with hyperkeratotic hand eczema (p = 0.016), as well as in the other subgroups combined (p = 0.049), than in the background population.
Conclusions
Studies evaluating the subdiagnoses of hand eczema are needed, to further validate the classification system, and to provide more detailed information about demographic factors, severity and possible risk factors for different subgroups of hand eczema.
Polycaprolactone facial volume restoration of a 46-year-old Asian women: A case report
Summary
A 46-year-old Asian women was treated with a next-generation bioresorbable biostimulatory polycaprolactone (PCL)-based dermal filler to restore facial volume loss. Before- and after (12 weeks of follow-up)-treatment photographs were analyzed and compared. In addition, before- and after-treatment contour images were recorded using the Vectra®XT 3D imaging system (Canfield Scientific, Inc.). Improvement of facial volume in multiple tissue layers was observed at 4 and 12 weeks of follow-up. Total facial rejuvenation to correct descending soft tissue with a PCL-based dermal filler was achieved through volume restoration in multiple tissue layers of the face.
Toxic heavy metals in human blood in relation to certain food and environmental samples in Kerala, South India
Abstract
Toxic heavy metals such as arsenic (As), lead (Pb), and mercury (Hg) are systemic toxicants that are hazardous to human health. However, as these elements are increasing in the environment due to fast urbanization, industrialization, and chemicalized agricultural activities, accumulation of the same in human body anywhere in the world is quite interesting to global assessment of environment quality. In this connection, random examination of blood samples of human population in Kerala, South India, was carried out to assess the threat of heavy metal contamination to humans in this part of the globe, especially in relation to the amount of such metals in food and other environmental samples. Except pure vegetarians, people of Kerala consume rice as the staple food with a lot of fish. Therefore, the amount of these three heavy metals in drinking water, fish, rice, and paddy soils was done. Heavy metals in the blood were examined in relation to age, gender, and dietary habits such as frequency of fish eating or vegetarianism. Influence of dental amalgam fillings on blood mercury levels was also analyzed. Quantitative assessment of metals in samples was done by inductively coupled plasma-mass spectrometry (ICP-MS). The levels of arsenic, lead, and mercury were found well below the reference values, though diet seemed to pull them up as the amount of metals in blood showed significant differences between vegetarians and non-vegetarians. Evidence to the influence of dental amalgam fillings on blood mercury levels could not be established with the present samples.
Predictors of Obstructive Sleep Apnea in Consecutive Patients with Metabolic Syndrome
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
Association between allergic diseases and ophthalmologic diseases, including cataracts and glaucoma, using the Korean National Health and Nutrition Examination Survey 2010–2012: A STROBE-compliant article
Abstract
This study investigated the association between allergic diseases and comorbid ophthalmologic diseases. We enrolled 14 776 participants who were at least 19 years of age. Multiple logistic regression analyses were used to evaluate the odds ratios for cataracts and glaucoma according to the presence of allergic diseases. Atopic dermatitis was not associated with the development of cataracts and glaucoma. However, asthma and allergic rhinitis were significantly associated with cataracts (hazard ratio [HR] = 1.511, 95% confidence interval [CI] = 1.120–2.039 and HR = 1.565, 95% CI = 1.192–2.054, respectively). This study examined a nationwide, population-based survey, and concluded that cataracts were significantly associated with asthma and allergic rhinitis but not with atopic dermatitis. Efforts should be made to reduce the risk of ophthalmologic complications when treating patients with allergic diseases.
Survival Impact of Postoperative Radiotherapy Timing in Pediatric and Adolescent Medulloblastoma
Abstract
Background
Radiation therapy (RT) remains a critical component of multimodality treatment for medulloblastoma. Traditionally, clinicians strive to start RT within 4-5 weeks of surgery, but the optimal timing after surgery remains unclear. Methods
Using the National Cancer Database, we identified pediatric and adolescent patients with medulloblastoma treated with curative-intent surgery, RT, and chemotherapy. Factors associated with early or delayed RT were identified using Pearson chi-squared tests. Overall survival (OS) differences based on RT timing were compared using the Kaplan-Meier estimator with log-rank tests. Patient, tumor, and treatment characteristics associated with OS were analyzed with univariate and multivariate Cox proportional hazard models. Results
Among the 1338 patients analyzed, early RT (defined as initiation ≤3 weeks after surgery) was associated with younger age, M1-3 disease, and subtotal resection. Patients who initiated RT early had decreased five-year OS compared with patients who initiated RT 3.1-4, 4.1-5, or >5 weeks after surgery (72.5%, 80.5%, 79.4%, and 77.8%, respectively; p=0.019), but there was no significant difference in OS among the latter three groups (p=0.788). On multivariate analysis, early RT versus the 3.1-4-week interval was significantly associated with poorer OS (adjusted HR 1.72; 95% CI 1.19-2.48; p=0.004), while time to RT of >5 weeks but within 90 days of surgery did not adversely impact OS (p=0.563). Conclusions
In this large national database analysis, delaying RT within 90 days of surgery was not associated with inferior outcomes. Although clinical judgment remains paramount, postoperative RT timing should allow for healing and the development of an optimal treatment plan.Extent of surgery in low-grade gliomas: an old question in a new context
See the article by Wijnenga et al on pages XXX-XXX
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Publication date: Available online 28 September 2017 Source: Actas Dermo-Sifiliográficas Author(s): F.J. Navarro-Triviño
