Τρίτη 13 Φεβρουαρίου 2018
Chronic inducible urticarias in children
Publication date: Available online 14 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Maddalena Napolitano, Matteo Megna, Claudia Costa, Nicola Balato, Cataldo Patruno
Food-dependent exercise-induced anaphylaxis due to almond in a PR-10–sensitized patient
Publication date: Available online 13 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): A.S. Senders, A. Ruiz Oropeza, B. Kristensen, E. Eller, H.F. Kjaer, C. Bindslev-Jensen, C.G. Mortz
Patients Taking β-Blockers Do Not Require Increased Doses of Epinephrine for Anaphylaxis
Publication date: Available online 13 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Jennifer L. White, Katie C. Greger, Sangil Lee, Robert J. Kahoud, James T. Li, Christine M. Lohse, Ronna L. Campbell
Backgroundβ-Blocker use has been associated with increased anaphylaxis severity.ObjectiveWe aimed to assess for an association between β-blocker use and requirement for more than 1 dose of epinephrine for anaphylaxis management.MethodsWe conducted a retrospective observational study of patients seen in our emergency department for anaphylaxis between April 2008 and January 2015. The primary outcome measure was the number of doses of epinephrine. Associations with repeat epinephrine administration (>1 vs ≤1 dose of epinephrine) and associations with any epinephrine administration (>0 vs 0 dose) were evaluated using logistic regression models and summarized as odds ratio (OR) and 95% CIs. The study was powered to detect a 10% or greater difference in need for repeat epinephrine administration between patients who were and were not taking β-blocker medications.ResultsOf 789 patient visits with a documented medication history included in the study, 63 (8%) required more than 1 epinephrine dose and 83 (11%) were on β-blocker therapy. Among patients who required more than 1 epinephrine dose, 8 (13%) were taking a β-blocker, compared with 75 patients (10%) who received 0 or 1 dose of epinephrine (OR, 1.26; 95% CI, 0.58-2.75). Among patients who required at least 1 epinephrine dose, 41 (9%) were taking a β-blocker, compared with 42 patients (12%) who received no epinephrine (OR, 0.73; 95% CI, 0.46-1.14).Conclusionsβ-Blocker use may not be clinically significant with regard to the need for epinephrine dosing among emergency department patients with anaphylaxis.
Spirometry and Impulse Oscillometry in Preschool Children: Acceptability and Relationship to Maternal Smoking in Pregnancy
Publication date: Available online 13 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Meyer Kattan, Leonard B. Bacharier, George T. O'Connor, Robyn Cohen, Ronald L. Sorkness, Wayne Morgan, Peter J. Gergen, Katy F. Jaffee, Cynthia M. Visness, Robert A. Wood, Gordon R. Bloomberg, Susan Doyle, Ryan Burton, James E. Gern
BackgroundComparisons of the technical acceptability of spirometry and impulse oscillometry (IOS) and clinical correlations of the measurements have not been well studied in young children. There are no large studies focused on African American and Hispanic children.ObjectivesWe sought to (1) compare the acceptability of spirometry and IOS in 3- to 5-year-old children and (2) examine the relationship of maternal smoking during pregnancy to later lung function.MethodsSpirometry and IOS were attempted at 4 sites from the Urban Environmental and Childhood Asthma Study birth cohort at ages 3, 4, and 5 years (472, 471, and 479 children, respectively). We measured forced expiratory flow in 0.5 s (forced expiratory volume in 0.5 seconds [FEV0.5]) with spirometry and area of reactance (AX), resistance and reactance at 5 Hz (R5 and X5, respectively) using IOS.ResultsChildren were more likely to achieve acceptable maneuvers with spirometry than with IOS at age 3 (60% vs 46%, P < .001) and 5 years (89% vs 84%, P = .02). Performance was consistent among the 4 study sites. In children without recurrent wheeze, there were strong trends for higher FEV0.5 and lower R5 and AX over time. Maternal smoking during pregnancy was associated with higher AX at ages 4 and 5 years (P < .01 for both years). There was no significant difference in FEV0.5 between children with and without in utero exposure to smoking.ConclusionThere is a higher rate of acceptable maneuvers with spirometry compared with IOS, but IOS may be a better indicator of peripheral airway function in preschool children.
The Dietary Inflammatory Index and Current Wheeze Among Children and Adults in the United States
Publication date: Available online 14 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Yueh-Ying Han, Erick Forno, Nitin Shivappa, Michael D. Wirth, James R. Hébert, Juan C. Celedón
BackgroundA proinflammatory diet may increase allergic airway inflammation by affecting innate and adaptive immune responses.ObjectiveIn this study, we examine the relation between the diet's inflammatory potential, measured by the Dietary Inflammatory Index (DII), and current asthma, current wheeze, and lung function in U.S. children and adults.MethodsWe analyzed data from 8,175 children (aged 6-17 years) and 22,294 adults (aged 18-79 years) who participated in the 2007-2012 National Health and Nutrition Examination Survey. The DII was calculated by nutrient intake based on 24-hour dietary recalls, and normalized as per 1,000 calories of food consumed to account for total energy intake. Multivariable regression models were used for the analysis of the DII and current asthma, current wheeze, and lung function measures.ResultsHigher DII (a proinflammatory diet) was associated with current wheeze among adults (eg, odds ratio [OR] for quartile 4 vs 1, OR = 1.41, 95% confidence interval [CI] = 1.17-1.70; Ptrend < .01) and among children with high fractional exhaled nitric oxide (a marker of eosinophilic airway inflammation; OR = 2.38, 95% CI = 1.13-5.02; Ptrend = .05). The DII also was associated with decreased forced expiratory volume in 1 second and forced vital capacity in adults without asthma or wheezing. The DII was not associated with lung function in children or current asthma in either age group.ConclusionsOur findings suggest that a proinflammatory diet, assessed by the DII, increases the odds of current wheeze in adults and children with allergic (atopic) wheeze. These results further support testing dietary interventions as part of the management of asthma.
Photoenzymes and Related Topics: An Update
Abstract
Photoenzymes are enzymes that catalyze photochemical reactions. For a long time it was believed that only two types of photoenzymes exist: Light-dependent NADPH:protochlorophyllide oxidoreductase and photolyase. However, other photoenzymes have now been discovered, most recently fatty acid photodecarboxylase.
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Characterization of oily mature skin by biophysical and skin imaging techniques
Abstract
Background
The skin is a complex biological system and may suffer change according to the environmental factors, as higher temperatures can increase sebum excretion, presenting oiliness and acne. These alterations can persist during the aging and provoke more changes in aged skin. In this study we evaluated the mature oily skin characteristics using biophysical and skin imaging techniques.
Material and methods
Sixty healthy female subjects, aged between 39 and 55 years old were recruited and separated into 2 groups according to their skin type: normal/dry and oily skin. The skin was evaluated in terms of stratum corneum water content, transepidermal water loss (TEWL) sebum content, dermis thickness and echogenicity, skin microrelief, and pores content.
Results
The mature oily skin presented no significant differences when compared to the normal/dry skin on the stratum corneum water content and TEWL parameters. The sebum content was significantly higher on the oily skin group. The microrelief analysis showed an increase of skin roughness values in the oily skin and increase of scaliness in the normal/dry skin. The oily skin showed lower dermis echogenicity mainly in the frontal region and higher dermis thickness when compared to normal/dry skin.
Conclusion
The mature oily skin showed different characteristics from normal/dry skin in terms of sebum content, microrelief parameters, and dermis thickness. This way, the characterization of mature oily skin in an objective way is very important to development of dermocosmetic products for more effective treatments focused specially on this type of skin.
H Syndrome: A case report and review of literature
Dilip Meena, Payal Chauhan, Neirita Hazarika, Naveen Kumar Kansal
Indian Journal of Dermatology 2018 63(1):76-78
H syndrome is a rare autosomal recessive syndrome characterised by constellation of clinical features and systemic manifestations including cutaneous hyperpigmentation, hypertrichosis, hepatosplenomegaly, hearing loss, heart anomalies, hypogonadism, hyperglycaemia, low height, and hallux valgus. We report a case of this syndrome with typical clinical findings. We report this case citing the rarity of this uncommon entity.
Indian Journal of Dermatology 2018 63(1):76-78
H syndrome is a rare autosomal recessive syndrome characterised by constellation of clinical features and systemic manifestations including cutaneous hyperpigmentation, hypertrichosis, hepatosplenomegaly, hearing loss, heart anomalies, hypogonadism, hyperglycaemia, low height, and hallux valgus. We report a case of this syndrome with typical clinical findings. We report this case citing the rarity of this uncommon entity.
Quest for excellence: The journey continues
Dwijendra Nath Gangopadhyay
Indian Journal of Dermatology 2018 63(1):1-1
Indian Journal of Dermatology 2018 63(1):1-1
Consensus statement for the diagnosis and treatment of urticaria: A 2017 update
Kiran Godse, Abhishek De, Vijay Zawar, Bela Shah, Mukesh Girdhar, Murlidhar Rajagopalan, DS Krupashankar
Indian Journal of Dermatology 2018 63(1):2-15
This article is developed by the Skin Allergy Research Society of India for an updated evidence-based consensus statement for the management of urticaria, with a special reference to the Indian context. This guideline includes updated definition, causes, classification, and management of urticaria. Urticaria has a profound impact on the quality of life and causes immense distress to patients, necessitating effective treatment. One approach to manage urticaria is by identification and elimination of the underlying cause(s) and/or eliciting trigger(s) while the second one is by treatment for providing symptomatic relief. This guideline recommends the use of second-generation nonsedating H1-antihistamines as the first-line treatment. The dose can be increased up to four times to meet the expected results. In case patients still do not respond, appropriate treatment options can be selected depending on the associated medical condition, severity of the symptoms, affordability of the drugs, and accessibility of modern biologics such as omalizumab.
Indian Journal of Dermatology 2018 63(1):2-15
This article is developed by the Skin Allergy Research Society of India for an updated evidence-based consensus statement for the management of urticaria, with a special reference to the Indian context. This guideline includes updated definition, causes, classification, and management of urticaria. Urticaria has a profound impact on the quality of life and causes immense distress to patients, necessitating effective treatment. One approach to manage urticaria is by identification and elimination of the underlying cause(s) and/or eliciting trigger(s) while the second one is by treatment for providing symptomatic relief. This guideline recommends the use of second-generation nonsedating H1-antihistamines as the first-line treatment. The dose can be increased up to four times to meet the expected results. In case patients still do not respond, appropriate treatment options can be selected depending on the associated medical condition, severity of the symptoms, affordability of the drugs, and accessibility of modern biologics such as omalizumab.
Generalised lichenoid drug eruption accompanied by hand-foot syndrome due to capecitabine
Funda Tamer, Mehmet Eren Yuksel
Indian Journal of Dermatology 2018 63(1):83-84
Indian Journal of Dermatology 2018 63(1):83-84
Recent advances in severe cutaneous adverse drug reaction
Sudip Das, Abhishek De
Indian Journal of Dermatology 2018 63(1):16-17
Indian Journal of Dermatology 2018 63(1):16-17
Aceclofenac-induced erythema annulare centrifugum
Dilip Meena, Payal Chauhan, Neirita Hazarika, Naveen Kumar Kansal, Arvind Gupta
Indian Journal of Dermatology 2018 63(1):70-72
Erythema annulare centrifugum (EAC) is characterised by slowly enlarging annular erythematous lesions and is thought to represent a clinical reaction pattern to infections, medications, and rarely, underlying malignancy. Causative drugs include chloroquine, cimetidine, gold sodium thiomalate, amitriptyline, finasteride, etizolam etc. We present a case of 40-year-old woman who presented to us with a 10 days history of nonpruritic, peripherally growing annular erythematous eruption. She had a history of recent onset of joint pain, for which she was taking aceclofenac 90 mg once a day for 5 days prior to the onset of the rash. This was confirmed on biopsy as EAC. The rash promptly subsided after stopping the drug. We report this case as there was no previous report of aceclofenac induced EAC.
Indian Journal of Dermatology 2018 63(1):70-72
Erythema annulare centrifugum (EAC) is characterised by slowly enlarging annular erythematous lesions and is thought to represent a clinical reaction pattern to infections, medications, and rarely, underlying malignancy. Causative drugs include chloroquine, cimetidine, gold sodium thiomalate, amitriptyline, finasteride, etizolam etc. We present a case of 40-year-old woman who presented to us with a 10 days history of nonpruritic, peripherally growing annular erythematous eruption. She had a history of recent onset of joint pain, for which she was taking aceclofenac 90 mg once a day for 5 days prior to the onset of the rash. This was confirmed on biopsy as EAC. The rash promptly subsided after stopping the drug. We report this case as there was no previous report of aceclofenac induced EAC.
Causality or Relatedness assessment in adverse drug reaction and its relevance in dermatology
Sushil Pande
Indian Journal of Dermatology 2018 63(1):18-21
Causality assessment essentially means finding a causal association or relationship between a drug and drug reaction. Identifying the culprit drug or drugs can be lifesaving or helpful in preventing the further damage caused by the drug to our body systems. In dermatology practice, when it comes to cutaneous adverse drug reaction, this is much more important and relevant because many aetiologies can produce a similar cutaneous manifestation. There are multiple criteria or algorithms available as of now for establishing a causal relationship in cases of adverse drug reaction (ADR), indicating that none of them is specific or complete. Most of these causality assessment tools (CATs) use four cardinal principles of diagnosis of ADR such as temporal relationship of drug with the drug reaction, biological plausibility of the drug causing a reaction, dechallenge, and rechallenge. The present study reviews some of the established or commonly used CATs and its implications or relevance to dermatology in clinical practice.
Indian Journal of Dermatology 2018 63(1):18-21
Causality assessment essentially means finding a causal association or relationship between a drug and drug reaction. Identifying the culprit drug or drugs can be lifesaving or helpful in preventing the further damage caused by the drug to our body systems. In dermatology practice, when it comes to cutaneous adverse drug reaction, this is much more important and relevant because many aetiologies can produce a similar cutaneous manifestation. There are multiple criteria or algorithms available as of now for establishing a causal relationship in cases of adverse drug reaction (ADR), indicating that none of them is specific or complete. Most of these causality assessment tools (CATs) use four cardinal principles of diagnosis of ADR such as temporal relationship of drug with the drug reaction, biological plausibility of the drug causing a reaction, dechallenge, and rechallenge. The present study reviews some of the established or commonly used CATs and its implications or relevance to dermatology in clinical practice.
Critical comment on “Vitamin D level in alopecia areata”
Radha Saini, Kanica Kaushal
Indian Journal of Dermatology 2018 63(1):82-82
Indian Journal of Dermatology 2018 63(1):82-82
Acute generalised exanthematous pustulosis: An update
Abhishek De, Sudip Das, Aarti Sarda, Dayamay Pal, Projna Biswas
Indian Journal of Dermatology 2018 63(1):22-29
Acute generalised exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction and is attributed to drugs in more than 90% of cases. It is a rare disease, with an estimated incidence of 1–5 patients per million per year. The clinical manifestations characterised by the rapid development of sterile pustular lesions, fever and leucocytosis. Number of drugs has been reported to be associated with AGEP, most common being the antibiotics. Histopathologically there is intraepidermal pustules and papillary dermal oedema with neutrophilic and eosinophilic infiltrations. Systemic involvement can be present in more severe cases. Early diagnosis with withdrawal of the causative drug is the most important step in the management. Treatment includes supportive care, prevention of antibiotics and use of a potent topical steroid.
Indian Journal of Dermatology 2018 63(1):22-29
Acute generalised exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction and is attributed to drugs in more than 90% of cases. It is a rare disease, with an estimated incidence of 1–5 patients per million per year. The clinical manifestations characterised by the rapid development of sterile pustular lesions, fever and leucocytosis. Number of drugs has been reported to be associated with AGEP, most common being the antibiotics. Histopathologically there is intraepidermal pustules and papillary dermal oedema with neutrophilic and eosinophilic infiltrations. Systemic involvement can be present in more severe cases. Early diagnosis with withdrawal of the causative drug is the most important step in the management. Treatment includes supportive care, prevention of antibiotics and use of a potent topical steroid.
Utility of a multispectral dermatoscope in onychomycosis
Balakrishnan Nirmal
Indian Journal of Dermatology 2018 63(1):87-88
Indian Journal of Dermatology 2018 63(1):87-88
Drug reaction with eosinophilia and systemic symptoms: An update and review of recent literature
Abhishek De, Murlidhar Rajagopalan, Aarti Sarda, Sudip Das, Projna Biswas
Indian Journal of Dermatology 2018 63(1):30-40
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, is also known as drug induced hypersensitivity syndrome and by various other names. It is now recognised as one of the severe cutaneous adverse reaction (SCAR) and can be potentially life-threatening. Historically, it was most frequently linked with phenytoin and was initially described as phenytoin hypersensitivity syndrome. However, it was later found to be caused by various other medications. Anticonvulsants and sulfonamides are the most common offender. Characteristically DRESS has a latent period of 2 to 6 weeks. The pathophysiology remains incompletely understood but involves reactivation of viruses and activation of lymphocyte. It is manifested most commonly with a morbilliform cutaneous eruption with fever and lymphadenopathy. The severity of this syndrome is related to the systemic involvement, which can result in multi-organ failure. Most important step in the management of DRESS is early diagnosis and immediate cessation of the suspected offending drug. Patients of DRESS syndrome should be managed in an intensive care set up for appropriate supportive care and infection control. Topical corticosteroids can give symptomatic relief, but systemic therapy with steroid and other immunosuppressant is usually required.
Indian Journal of Dermatology 2018 63(1):30-40
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, is also known as drug induced hypersensitivity syndrome and by various other names. It is now recognised as one of the severe cutaneous adverse reaction (SCAR) and can be potentially life-threatening. Historically, it was most frequently linked with phenytoin and was initially described as phenytoin hypersensitivity syndrome. However, it was later found to be caused by various other medications. Anticonvulsants and sulfonamides are the most common offender. Characteristically DRESS has a latent period of 2 to 6 weeks. The pathophysiology remains incompletely understood but involves reactivation of viruses and activation of lymphocyte. It is manifested most commonly with a morbilliform cutaneous eruption with fever and lymphadenopathy. The severity of this syndrome is related to the systemic involvement, which can result in multi-organ failure. Most important step in the management of DRESS is early diagnosis and immediate cessation of the suspected offending drug. Patients of DRESS syndrome should be managed in an intensive care set up for appropriate supportive care and infection control. Topical corticosteroids can give symptomatic relief, but systemic therapy with steroid and other immunosuppressant is usually required.
Omalizumab for management of refractory urticaria: Experience of a tertiary care centre in Eastern India
Shekhar Neema, Manas Chatterjee
Indian Journal of Dermatology 2018 63(1):66-69
Aim: To study the effects of omalizumab in chronic spontaneous urticaria in Indian patients. Setting and Design: The study was conducted in a tertiary care centre and it was retrospective and descriptive in nature. Material and Methods: We analysed the data of patients who were administered omalizumab between June 2014 and June 2015 for the management of refractory chronic spontaneous urticaria at our centre. Omalizumab was used in those patients who did not respond to updosing of antihistaminics and cyclosporine. Omalizumab was used in dose of 300 mg per month for 3 doses. Results: Twenty-four patients were administered omalizumab during the study period. Average age of the patients was 36.54 years, female:male ratio was 1.4:1, mean duration of disease was 20.66 months, and autologous serum skin test was positive in 33% of studied individuals. Ninety six percent of cases showed response to treatment in our study. Remission was seen in 25% of patients, 50% showed satisfactory response, and 20.83% showed partial response. Average UAS7 scoring before starting omalizumab in preceding week was 24.4. Average UAS7, 2 weeks after starting omalizumab was 4 in responsive patients. Conclusion: Omalizumab is safe and effective treatment for the management of chronic spontaneous urticaria. It can be used in Indian setting after failure to other third-line therapies such as addition of montelukast and cyclosporine due to high cost of treatment.
Indian Journal of Dermatology 2018 63(1):66-69
Aim: To study the effects of omalizumab in chronic spontaneous urticaria in Indian patients. Setting and Design: The study was conducted in a tertiary care centre and it was retrospective and descriptive in nature. Material and Methods: We analysed the data of patients who were administered omalizumab between June 2014 and June 2015 for the management of refractory chronic spontaneous urticaria at our centre. Omalizumab was used in those patients who did not respond to updosing of antihistaminics and cyclosporine. Omalizumab was used in dose of 300 mg per month for 3 doses. Results: Twenty-four patients were administered omalizumab during the study period. Average age of the patients was 36.54 years, female:male ratio was 1.4:1, mean duration of disease was 20.66 months, and autologous serum skin test was positive in 33% of studied individuals. Ninety six percent of cases showed response to treatment in our study. Remission was seen in 25% of patients, 50% showed satisfactory response, and 20.83% showed partial response. Average UAS7 scoring before starting omalizumab in preceding week was 24.4. Average UAS7, 2 weeks after starting omalizumab was 4 in responsive patients. Conclusion: Omalizumab is safe and effective treatment for the management of chronic spontaneous urticaria. It can be used in Indian setting after failure to other third-line therapies such as addition of montelukast and cyclosporine due to high cost of treatment.
Cutaneous adverse reactions of chemotherapy in cancer patients: A clinicoepidemiological study
Saumita Ghosh Biswal, Rajesh Datt Mehta
Indian Journal of Dermatology 2018 63(1):41-46
Background: The diagnosis of cutaneous adversities in the cancer patient is especially difficult, given the complexity of their illness and combination protocols used for the treatment. The present study was undertaken to know the spectrum of cutaneous adversities in patients undergoing chemotherapy and the drug(s) most commonly associated with it. Materials and Methods: A total of 1000 patients with malignancies under chemotherapy in the oncology ward and outpatient department were screened in this observational study from January 2013 to February 2015. Relevant investigations for diagnosis of malignancies under chemotherapy and dermatological disorders were carried out. Results: Three hundred and eighty-four patients presented with cutaneous adversities of chemotherapy. The most common was anagen effluvium (78.6%), followed by xerosis (4.4%), thrombophlebitis (3.1%), generalised pruritus (2.9%), melanonychia (2.9%), hand-foot syndrome (2.6%), extravasation reactions (1.8%), flagellate dermatosis (1.3%), prurigo nodularis (0.8%), exfoliation (0.5%), ichthyosis (0.5%), papulopustular rash (0.3%), bullous photodermatitis (0.3%), and Sweet's syndrome (0.3%). Chemotherapeutic drugs were mostly given in combinations. Most common drugs to cause anagen effluvium were alkylating agents in combinations, hand-foot syndrome by taxanes (docetaxel), flagellate dermatoses by antitumour antibiotics (bleomycin), and exfoliation by antimetabolites (methotrexate). The limitation of this study was to imply a specific drug as the causation of the cutaneous adversities since the chemotherapy mostly consisted of combination protocols. Therefore, we have tried to associate the drug combination itself. Conclusion: Chemotherapeutic drugs produce a range of cutaneous adversities, certain specific adversities pertaining to drugs, and their combinations have been implicated which should be looked for and managed accordingly. Knowledge of the adverse effects of anticancer drugs will help reduce the psychological trauma and improve the quality of life.
Indian Journal of Dermatology 2018 63(1):41-46
Background: The diagnosis of cutaneous adversities in the cancer patient is especially difficult, given the complexity of their illness and combination protocols used for the treatment. The present study was undertaken to know the spectrum of cutaneous adversities in patients undergoing chemotherapy and the drug(s) most commonly associated with it. Materials and Methods: A total of 1000 patients with malignancies under chemotherapy in the oncology ward and outpatient department were screened in this observational study from January 2013 to February 2015. Relevant investigations for diagnosis of malignancies under chemotherapy and dermatological disorders were carried out. Results: Three hundred and eighty-four patients presented with cutaneous adversities of chemotherapy. The most common was anagen effluvium (78.6%), followed by xerosis (4.4%), thrombophlebitis (3.1%), generalised pruritus (2.9%), melanonychia (2.9%), hand-foot syndrome (2.6%), extravasation reactions (1.8%), flagellate dermatosis (1.3%), prurigo nodularis (0.8%), exfoliation (0.5%), ichthyosis (0.5%), papulopustular rash (0.3%), bullous photodermatitis (0.3%), and Sweet's syndrome (0.3%). Chemotherapeutic drugs were mostly given in combinations. Most common drugs to cause anagen effluvium were alkylating agents in combinations, hand-foot syndrome by taxanes (docetaxel), flagellate dermatoses by antitumour antibiotics (bleomycin), and exfoliation by antimetabolites (methotrexate). The limitation of this study was to imply a specific drug as the causation of the cutaneous adversities since the chemotherapy mostly consisted of combination protocols. Therefore, we have tried to associate the drug combination itself. Conclusion: Chemotherapeutic drugs produce a range of cutaneous adversities, certain specific adversities pertaining to drugs, and their combinations have been implicated which should be looked for and managed accordingly. Knowledge of the adverse effects of anticancer drugs will help reduce the psychological trauma and improve the quality of life.
Multiple cutaneous and uterine leiomyomatosis with renal involvement: Report of a rare association
Gunjan Gupta, Rahul Sudan, Sabha Mushtaq
Indian Journal of Dermatology 2018 63(1):73-75
Cutaneous leiomyomas (CLs) are uncommon benign smooth muscle tumours characterised by solitary or multiple painful nodules. Based on origin, three types are recognised, namely piloleiomyoma, dartoic leiomyoma, and angioleiomyoma, with piloleiomyomas being the commonest one. Reed's syndrome also known as multiple cutaneous and uterine leiomyomatosis (MCULs) is characterised by CLs in men and CLs and uterine fibroids in women. Association of Reed's syndrome with renal cell carcinoma is labelled as hereditary leiomyomatosis and renal cell carcinoma (HLRCC). Both MCUL and HLRCC are caused by a heterozygous mutation in the fumarate hydratase gene. Besides renal cell carcinoma, there were extremely rare reports of association of MCUL with benign renal lesions. We report a case of a 55-year-old female with segmental tender papulonodular lesions suggestive of leiomyoma associated with uterine leiomyomas and unilateral renal cyst. The case is reported here for its rarity and uncommon association with asymptomatic benign renal cyst.
Indian Journal of Dermatology 2018 63(1):73-75
Cutaneous leiomyomas (CLs) are uncommon benign smooth muscle tumours characterised by solitary or multiple painful nodules. Based on origin, three types are recognised, namely piloleiomyoma, dartoic leiomyoma, and angioleiomyoma, with piloleiomyomas being the commonest one. Reed's syndrome also known as multiple cutaneous and uterine leiomyomatosis (MCULs) is characterised by CLs in men and CLs and uterine fibroids in women. Association of Reed's syndrome with renal cell carcinoma is labelled as hereditary leiomyomatosis and renal cell carcinoma (HLRCC). Both MCUL and HLRCC are caused by a heterozygous mutation in the fumarate hydratase gene. Besides renal cell carcinoma, there were extremely rare reports of association of MCUL with benign renal lesions. We report a case of a 55-year-old female with segmental tender papulonodular lesions suggestive of leiomyoma associated with uterine leiomyomas and unilateral renal cyst. The case is reported here for its rarity and uncommon association with asymptomatic benign renal cyst.
Clinical and Histopathological response to multidrug therapy in paucibacillary leprosy at the end of 6 Months: A prospective observational study from eastern India
Indrashis Podder, Abanti Saha, Debabrata Bandyopadhyay
Indian Journal of Dermatology 2018 63(1):47-52
Background: At present, the WHO recommends fixed duration multidrug therapy (FD-MDT) for the treatment of leprosy, in which treatment is provided for a fixed duration regardless of clearance of skin lesions or bacterial status of the patient. There is divided opinion regarding the efficacy of FD-MDT; especially for paucibacillary Hansen's disease, in which treatment is provided for 6 months. In addition, there is a paucity of literature on clinical and histopathological features of treated leprosy. Objectives: The objectives of this study were to prospectively observe the effects of MDT on clinical and histopathological features in paucibacillary leprosy and to assess the efficacy, safety and tolerability of MDT-paucibacillary (PB) regimen. Materials and Methods: A total of 52 new cases of PB leprosy diagnosed by clinicopathological correlation and slit skin smear were administered standard WHO PB-MDT for 6 months. Patients were reviewed at 3rd month and 6th month of therapy and 3 months posttherapy for their clinical and histopathological assessment. Results: Among 52 new cases of PB-leprosy 43 patients (mean age 31.74 ± 12.2 years, m:f 1.53:1) completed the study as per protocol. Fourteen percent patients recovered completely, 76.7% patients had a residual patch at the end. Number of lesions reduced significantly 2nd follow-up onwards while the lesional size showed significant decrease 1st follow-up onward. Nerve palpability also reduced significantly at treatment completion. Histological improvement was appreciable; lymphocytic infiltration reduced significantly 2nd follow-up onward and presence of granuloma 1st FU onward. Only four patients complained of occasional, uneventful epigastric pain during the study. Conclusion: Although the frequency of persistence of lesions after completion of therapy was high, histological evidence of activity was present in a minority (7%). Thus, the standard WHO MDT-PB regimen was found to be effective, safe and well-tolerated.
Indian Journal of Dermatology 2018 63(1):47-52
Background: At present, the WHO recommends fixed duration multidrug therapy (FD-MDT) for the treatment of leprosy, in which treatment is provided for a fixed duration regardless of clearance of skin lesions or bacterial status of the patient. There is divided opinion regarding the efficacy of FD-MDT; especially for paucibacillary Hansen's disease, in which treatment is provided for 6 months. In addition, there is a paucity of literature on clinical and histopathological features of treated leprosy. Objectives: The objectives of this study were to prospectively observe the effects of MDT on clinical and histopathological features in paucibacillary leprosy and to assess the efficacy, safety and tolerability of MDT-paucibacillary (PB) regimen. Materials and Methods: A total of 52 new cases of PB leprosy diagnosed by clinicopathological correlation and slit skin smear were administered standard WHO PB-MDT for 6 months. Patients were reviewed at 3rd month and 6th month of therapy and 3 months posttherapy for their clinical and histopathological assessment. Results: Among 52 new cases of PB-leprosy 43 patients (mean age 31.74 ± 12.2 years, m:f 1.53:1) completed the study as per protocol. Fourteen percent patients recovered completely, 76.7% patients had a residual patch at the end. Number of lesions reduced significantly 2nd follow-up onwards while the lesional size showed significant decrease 1st follow-up onward. Nerve palpability also reduced significantly at treatment completion. Histological improvement was appreciable; lymphocytic infiltration reduced significantly 2nd follow-up onward and presence of granuloma 1st FU onward. Only four patients complained of occasional, uneventful epigastric pain during the study. Conclusion: Although the frequency of persistence of lesions after completion of therapy was high, histological evidence of activity was present in a minority (7%). Thus, the standard WHO MDT-PB regimen was found to be effective, safe and well-tolerated.
Autosomal-Recessive Hyper-IgE syndrome
Mohapatra Liza, Dash Gaurav, Mohanty Prasenjeet, Jena Swapna, Behera Binodini
Indian Journal of Dermatology 2018 63(1):79-81
The hyper-IgE syndrome (HIES) is a rare group of primary immunodeficiency characterised by recurrent infections, eczema, and elevated serum levels of IgE. Autosomal dominant HIES is caused by mutations in transcription factor – signal transducer and activator of transcription-3. Autosomal-recessive (AR) HIES was described in 2004 due to mutation of tyrosine kinase 2 gene, and subsequently, another mutation in dedicator of cytokinesis 8 gene was discovered in 2009. Although both the forms have many common clinical features, few characteristic findings help in differentiating them. AR-HIES is characterized by recurrent bacterial and viral infections, atopic eczema, and raised serum IgE levels. We report a case of a 4-year-old girl presenting with the features of AR-HIES to highlight the presentation of this rare disease.
Indian Journal of Dermatology 2018 63(1):79-81
The hyper-IgE syndrome (HIES) is a rare group of primary immunodeficiency characterised by recurrent infections, eczema, and elevated serum levels of IgE. Autosomal dominant HIES is caused by mutations in transcription factor – signal transducer and activator of transcription-3. Autosomal-recessive (AR) HIES was described in 2004 due to mutation of tyrosine kinase 2 gene, and subsequently, another mutation in dedicator of cytokinesis 8 gene was discovered in 2009. Although both the forms have many common clinical features, few characteristic findings help in differentiating them. AR-HIES is characterized by recurrent bacterial and viral infections, atopic eczema, and raised serum IgE levels. We report a case of a 4-year-old girl presenting with the features of AR-HIES to highlight the presentation of this rare disease.
A comparative study of efficacy and safety of eberconazole versus terbinafine in patients of tinea versicolor
Jyoti Sharma, Jyoti Kaushal, Kamal Aggarwal
Indian Journal of Dermatology 2018 63(1):53-56
Background: Tinea versicolor (TV) is characterised by the appearance of maculosquamous lesions sometimes associated with mild erythema and pruritus in characteristic areas of the body. Eberconazole and terbinafine though drugs of different classes provide both mycological and clinical cure. Aim: This study aims to compare the efficacy and safety of eberconazole versus terbinafine in patients of TV. Materials and Methods: An open-label, randomised, comparative clinical trial was conducted on 60 patients. The patients were randomly divided into two study groups. Group A: Eberconazole 1% cream once daily and Group B: Terbinafine 1% cream once daily for 2 weeks. Efficacy assessment was done by observing signs and symptoms, i.e., Physician assessment 4-point scale, microscopic KOH examination, Wood's lamp examination, global clinical response assessment, and patient's assessment on visual analog scale at the end of 2 weeks and subsequently patients were reassessed at the end of 4 and 8 weeks to check any relapse. Safety assessment was also done. Results: There was a significant improvement in all the parameters in both groups over a period of 2 weeks. Both the treatment groups, i.e., eberconazole and terbinafine were found to be safe and efficacious at the end of 2 weeks, and no statistically significant difference was observed between the two groups regarding complete cure, i.e., mycological and clinical cure (80% vs. 63.33%), respectively. However, early response (at the end of week 1) was observed with eberconazole. No relapse was seen with eberconazole, but one patient had relapse at 8 weeks with terbinafine. Both drugs had similar safety profile. Conclusion: Although both the drugs cured the disease, eberconazole showed better response as clinical cure and mycological cure were observed earlier and no patient relapsed in the follow-up.
Indian Journal of Dermatology 2018 63(1):53-56
Background: Tinea versicolor (TV) is characterised by the appearance of maculosquamous lesions sometimes associated with mild erythema and pruritus in characteristic areas of the body. Eberconazole and terbinafine though drugs of different classes provide both mycological and clinical cure. Aim: This study aims to compare the efficacy and safety of eberconazole versus terbinafine in patients of TV. Materials and Methods: An open-label, randomised, comparative clinical trial was conducted on 60 patients. The patients were randomly divided into two study groups. Group A: Eberconazole 1% cream once daily and Group B: Terbinafine 1% cream once daily for 2 weeks. Efficacy assessment was done by observing signs and symptoms, i.e., Physician assessment 4-point scale, microscopic KOH examination, Wood's lamp examination, global clinical response assessment, and patient's assessment on visual analog scale at the end of 2 weeks and subsequently patients were reassessed at the end of 4 and 8 weeks to check any relapse. Safety assessment was also done. Results: There was a significant improvement in all the parameters in both groups over a period of 2 weeks. Both the treatment groups, i.e., eberconazole and terbinafine were found to be safe and efficacious at the end of 2 weeks, and no statistically significant difference was observed between the two groups regarding complete cure, i.e., mycological and clinical cure (80% vs. 63.33%), respectively. However, early response (at the end of week 1) was observed with eberconazole. No relapse was seen with eberconazole, but one patient had relapse at 8 weeks with terbinafine. Both drugs had similar safety profile. Conclusion: Although both the drugs cured the disease, eberconazole showed better response as clinical cure and mycological cure were observed earlier and no patient relapsed in the follow-up.
Authors' reply to critical comment on “Vitamin D level in alopecia areata”
Yasmeen Jabeen Bhat, Inam Ul Haq, Iffat Hassan, Peerzada Sajad, Insha Latif
Indian Journal of Dermatology 2018 63(1):82-83
Indian Journal of Dermatology 2018 63(1):82-83
Palmoplantar lesions of lichen planus
Surabhi Sinha, Rashmi Sarkar, Vijay Kumar Garg
Indian Journal of Dermatology 2018 63(1):57-61
Introduction: Palmoplantar lesions of lichen planus (LP) are uncommon and may not always have classical clinical features of LP. A variety of morphological types has been described in literature. Aim and Objectives: The aim was to study and classify the clinical variants into distinct easily recognisable categories for quick recognition and early treatment initiation. Methods: All patients diagnosed with LP over a period of 5 years were evaluated for palmoplantar lesions in our hospital. The clinical and histopathological features of the palmoplantar lesions were then studied. Results: Out of 424 patients of LP, 55 (12.9%) had palmoplantar lesions. Histopathology was consistent or at least compatible with LP in 44/55 patients. For the purpose of assessment, only patients with histopathology consistent with LP were included (n = 44) in the study. Just over half of the patients were male, with most patients (43.2%) having had LP lesions elsewhere for 6 months before palmoplantar lesions were noticed. Soles were more frequently involved than palms. The sites most often involved were the centre of the palms (45.2%), and the instep of the soles (63.9%). The predominant morphological presentation was psoriasiform (47.7%). One patient had ulcerative lesions of LP on both his soles which is a very rare variant. Notably, nearly half of the patients (20/44) had mucosal (mostly oral) lesions characteristic of LP. This was significant as typical oral lesions of LP help in identifying palmoplantar lesions that do not have classical lichenoid morphology. Conclusion: LP lesions on palms and soles need to be identified keeping a high index of suspicion and differentiated from other papulosquamous conditions so that specific treatment can be initiated early.
Indian Journal of Dermatology 2018 63(1):57-61
Introduction: Palmoplantar lesions of lichen planus (LP) are uncommon and may not always have classical clinical features of LP. A variety of morphological types has been described in literature. Aim and Objectives: The aim was to study and classify the clinical variants into distinct easily recognisable categories for quick recognition and early treatment initiation. Methods: All patients diagnosed with LP over a period of 5 years were evaluated for palmoplantar lesions in our hospital. The clinical and histopathological features of the palmoplantar lesions were then studied. Results: Out of 424 patients of LP, 55 (12.9%) had palmoplantar lesions. Histopathology was consistent or at least compatible with LP in 44/55 patients. For the purpose of assessment, only patients with histopathology consistent with LP were included (n = 44) in the study. Just over half of the patients were male, with most patients (43.2%) having had LP lesions elsewhere for 6 months before palmoplantar lesions were noticed. Soles were more frequently involved than palms. The sites most often involved were the centre of the palms (45.2%), and the instep of the soles (63.9%). The predominant morphological presentation was psoriasiform (47.7%). One patient had ulcerative lesions of LP on both his soles which is a very rare variant. Notably, nearly half of the patients (20/44) had mucosal (mostly oral) lesions characteristic of LP. This was significant as typical oral lesions of LP help in identifying palmoplantar lesions that do not have classical lichenoid morphology. Conclusion: LP lesions on palms and soles need to be identified keeping a high index of suspicion and differentiated from other papulosquamous conditions so that specific treatment can be initiated early.
Serum Omentin-1 in psoriasis
Ola Ahmed Bakry, Shawky El Farargy, Naglaa Ghanayem, Somia Galal
Indian Journal of Dermatology 2018 63(1):85-87
Indian Journal of Dermatology 2018 63(1):85-87
Role of solid lipid nanoparticles as photoprotective agents in cosmetics
Summary
Background
Novel drug delivery systems have gained popularity since last two decades because of its advantages over conventional dosage forms. Effect of UV radiation on skin can cause either acute or chronic damage to our skin. Solid lipid nanoparticles (SLNs) were developed as novel carrier over the conventional carrier systems like liposomes and emulsions. The SLNs were selected as a carrier for the formulation because of its ability to protect the labile drug particles, the ability to make the drug release in a controlled manner, and occlusive property of the SLNs.
Objective
The current review is an attempt to focus on the characteristics of solid lipid nanoparticles, methods for the preparations, and their cosmetic applications along with some future perspectives of the nanodrug delivery systems.
Methods
A review of the current literature of solid lipid nanoparticles (SLNs) as novel carrier showed better photoprotection in sunscreens.
Results and conclusions
The disadvantages of conventional sunscreens can be overcome by incorporation of solid lipid nanoparticles. On comparing the lipid nanobased systems with traditional cosmetic products, the occlusion can be achieved without the use of paraffin and other greasy oils. The film formed by lipid nanoparticles will be smooth as compared to the inflexible films formed by the paraffin. Newer approaches may lead to even better results. They also possess excellent UV-blocking activity and showed better photoprotection.
Impact of oxytetracycline and bacterial bioaugmentation on the efficiency and microbial community structure of a pesticide-degrading biomixture
Abstract
An experimental study evaluating the effect of bioaugmentation and antibiotic (oxytetracycline) application on pesticide degradation and microbial community structure of a biomixture used in a biopurification system (BPR) was conducted. The bioaugmentation employed a carbofuran-degrading bacterial consortium. The non-bioaugmented biomixture showed excellent performance for removal of atrazine (t1/2: 9.9 days), carbendazim (t1/2: 3.0 days), carbofuran (t1/2: 2.8 days), and metalaxyl (t1/2: 2.7 days). Neither the addition of oxytetracycline nor bioaugmentation affected the efficiency of pesticide removal or microbial community (bacterial and fungal) structure, as determined by DGGE analysis. Instead, biomixture aging was mainly responsible for microbial population shifts. Even though the bioaugmentation did not enhance the biomixtures′ performance, this matrix showed a high capability to sustain initial stresses related to antibiotic addition; therefore, simultaneous elimination of this particular mixture of pesticides together with oxytetracycline residues is not discouraged.
Halimeda jolyana (Bryopsidales, Chlorophyta) presents higher vulnerability to metal pollution at its lower temperature limits of distribution
Abstract
Seaweeds living at their temperature limits of distribution are naturally exposed to physiological stressors, facing additional stress when exposed to coastal pollution. The physiological responses of seaweeds to environmental conditions combining natural and anthropogenic stressors provide important information on their vulnerability. We assessed the physiological effects and ultrastructural alterations of trace metals enrichment at concentrations observed in polluted regions within the temperature ranges of distribution of the endemic seaweed Halimeda jolyana, an important component of tropical southwestern Atlantic reefs. Biomass yield and photosynthetic performance declined substantially in samples exposed to metal, although photosynthesis recovered partially at the highest temperature when metal enrichment was ceased. Metal enrichment caused substantial ultrastructural alterations to chloroplasts regardless of temperatures. The lack of photosynthetic recovery at the lower temperatures indicates a higher vulnerability of the species at its temperature limits of distribution in the southwestern Atlantic.
Lymphaticovenular anastomosis for breast cancer treatment-related lymphedema: three-line strategy for an optimal outcome
The approach to lymphaticovenular anastomosis (LVA) for breast cancer treatment-related lymphedema should differ from that performed for secondary lower extremity lymphedema (LEL) because upper extremity lymphedema (UEL) and LEL differ in terms of the areas affected, imaging features, and postoperative improvements.
Aesthetic and functional outcomes of radial forearm flap donor site reconstruction with biosynthetic skin substitutes
The radial forearm fasciocutaneous flap (RFFF) is a workhorse flap in reconstructive microsurgery that is favoured for its thinness, reliable vascularity, consistent anatomy, and ability to be harvested concurrently during oncologic resection (1). Despite its popularity, RFFF elevation may lead to wound healing complications, wrist stiffness, weakened grip, sensory impairment, and a visible, potentially stigmatizing forearm scar (2). Various strategies have been investigated to reduce donor site morbidity, including suprafascial dissection, full thickness skin grafting, primary closure with local flaps, and the use of alternative flaps (3).
Bis(μ-chloro) bridged 1D CuI and CuII coordination polymer complex and mononuclear CuII complex: Synthesis, crystal structure and biological properties
Publication date: Available online 13 February 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Thangavel Thirunavukkarasu, Hazel A. Sparkes, Chandrasekar Balachandran, S. Awale, Karuppannan Natarajan
A novel one-dimensional coordination polymer containing Cu(I)Cu(II) core with chloro bridge on Cu(I) and ligand bridge on Cu(II) ions (1) and a mononuclear Cu(II) complex (2) have been synthesized from the reactions of 3- and 4-methoxy-3-quinolin-3-ylimino-methyl-2-phenol with [CuCl2(PPh3)2]. The ligands and the complexes have been characterized by spectral and analytical methods. In addition, the structures of both the ligands and the copper complexes were confirmed by single crystal X-ray diffraction studies. In both complexes, the phenolic oxygen and azomethine nitrogen atom of the ligand coordinate to the copper ions in a monobasic bidentate manner resulting in an approximately square planar geometry around the copper ion. In the polymeric complex, the N atom of the quinoline ring is coordinated to Cu(I) in addition to the phenolic oxygen and azomethine nitrogen atom coordinating to Cu(II) ion, thus bridging Cu(I) and Cu(II) ions in the complex. The interactions of the compounds with calf thymus DNA (CT-DNA) have been followed by absorption and emission titration methods, which revealed that the compounds interact with CT-DNA through intercalation. Further, the interactions of the compounds with bovine serum albumin (BSA) were also investigated using UV–visible, fluorescence spectroscopic methods. The results indicated that complex 1 exhibited a stronger binding to CT-DNA and BSA than the free ligands and complex 2. In addition, the in vitro cytotoxicity experiment showed that complexes 1 and 2 exhibit potent cytotoxic properties against PANC-1and Hela cells. Moreover, while complex 1 showed prominent cytotoxic activity against both PANC-1 and Hela cells with IC50 of 17.91 and 11.67 μM, complex 2 showed moderate cytotoxic activities with IC50 of 25.13 and 16.41 μM in PANC-1 and Hela cells. Further, apoptosis was confirmed by fluorescence image using EB/AO reagent.
Graphical abstract
Synthesis and characterization of Ag/Bi 2 WO 6 /GO composite for the fast degradation of tylosin under visible light
Abstract
Ag/Bi2WO6/graphene oxide composite with excellent photocatalytic properties was successfully prepared by hydrothermal-photoreduction synergistic method and is applied in antibiotics degradation. The structure and properties of as-prepared photocatalysts were characterized by Fourier infrared spectrum (FTIR), X-ray photoelectron spectroscopy (XPS), specific surface area analyzer (BET), scanning electron microscopy (SEM), X-ray diffraction (XRD), and atomic force microscope (AFM). The results indicated that Ag and Bi2WO6 were uniformly loaded on the surface of graphene oxide. In addition, graphene oxide with conjugated carbon network structures has been applied as a photocatalyst supporter for the high electronic conductivity and the large reactive sites. Compared with the pure graphene oxide, the as-prepared Ag/Bi2WO6/graphene oxide catalyst exhibited excellent degradation efficiency and stability for degrading tylosin under Xe lamp irradiation. Under simulated sunlight irradiation, the photodegradation efficiency of tylosin by Ag/Bi2WO6/graphene oxide achieved at 98% within 2 h, compared to 50% by pure graphene oxide. The excellent photodegradation ability is caused by the synergetic effect of Ag, Bi2WO6, and graphene oxide nanoparticles.
Lead-induced changes of cytoskeletal protein is involved in the pathological basis in mice brain
Abstract
Lead poisoning is a geochemical disease. On the other hand, lead is highly carcinogenic and exhibits liver and kidney toxicity. This element can also cross the blood-brain barrier, reduce learning and memory ability and damage the structure of the cerebral cortex and hippocampus. To further investigate the mechanism of lead neurotoxicity, 4-week-old Kunming mice were used to explore the effects of different concentrations of Pb2+ (0, 2.4, 4.8 and 9.6 mM) for 9 days. In this study, pathological and ultrastructural changes in brain cells of the treated group were related to damages to mitochondria, chromatin and the nucleus. Lead content in blood was tested by atomic absorption spectroscopy, which showed high lead concentrations in the blood with increasing doses of lead. Distribution of lead in nerve cells was analysed by transmission electron microscopy with energy dispersive spectroscopy. Data showed the presence of lead in nucleopores, chromatin and nuclear membrane of nerve cells in the treatment groups, whereas lead content increased with increasing doses of lead acetate. Finally, microtubule-associated protein 2 (MAP2) mRNA and protein expression levels were detected by real-time PCR and Western blotting, which showed a reduction in MAP2 expression with increasing lead doses in the mouse brain. These findings suggest that acute lead poisoning can cause significant dose-dependent toxic effects on mouse brain function and can contribute to better understanding of lead-induced toxicity.
Effect of H 2 O on the NO emission characteristics of pulverized coal during oxy-fuel combustion
Abstract
The NO emission characteristics of Datong bituminous coal and Yangquan anthracite in O2/H2O/CO2 atmospheres were investigated by using a fixed-bed reactor system, and the emission characteristics were compared with the experimental results from O2/N2 and O2/CO2 atmospheres, especially at low O2 concentrations and high temperatures. The results showed that NO emissions of pulverized coal in O2/CO2 environments were less than those in the O2/N2 environments, regardless of the O2 concentration and the furnace temperature. Adding H2O decreased the possibility of reactions between the reductive groups (NH) and the oxygen radical during devolatilization, which led to a decrease in NO emissions at 1000 °C. However, as the furnace temperature increased, "additional" nitrogen precursors (HCN and NH3) generated by enhanced char-H2O gasification were quickly oxidized to generate a large amount of NO during char oxidation that exceeded the amount of NO reduced by NH during devolatilization. Thus, the NO emissions in O2/CO2/H2O atmosphere were higher than those in O2/CO2 atmosphere at a low O2 concentration. However, as the O2 concentration increased, the NO emissions in O2/CO2/H2O atmosphere became lower than those in O2/CO2 atmosphere because the effect of H2O gasification became weaker. The NO emissions of Yangquan anthracite (YQ) were higher than those of DT, but the changing trend of YQ was similar to that of DT.
Nanofibers of resorcinol–formaldehyde for effective adsorption of As (III) ions from mimicked effluents
Abstract
In the present study, the core–shell structured RF/PVA nanofibers have been developed and used for the adsorption of As3+ ions from the mimicked liquid effluents. Efficient-facile fabrication of the structured nanofibers (300–417 nm diameter) was accomplished using facile electrospinning technique. Chi parameter (χ = 25.56) and free energy of mixing (Emix = 17.19 kcal/mol) calculated via molecular dynamics simulations depicted compatibility of the polymeric system resulting supermolecular core–shell nanofibers, whose adsorption results were also supported by the FE-SEM, FT-IR, and UV-VIS spectroscopy analysis. The adsorption analysis was performed using both linear and non-linear regression methods, for kinetic models and adsorption isotherms. The developed nanofibers demonstrated an adsorption capacity of 11.09 mg/g at a pH of 7, and an adsorption efficiency of 97.46% on protracted exposure, which is even adaptable at high temperatures with 93.1% reclamation. FE-SEM analysis and FT-IR spectra confirm the adsorption of As (III) ions on RF/PVA nanofibers and the presence of embedded hydrophilic oxygen sites for metal ion adsorption. The developed RF/PVA nanofibers demonstrate scalability in fabrication, low-cost, recycling, and less solid waste generation, depicting the large-scale applicability in removing arsenic ions from effluent waste.
Graphical Abstract
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Protective effects of an extract of the freshwater microalga Scenedesmus rubescens on UV-irradiated skin cells
Abstract
Background
Skin aging results from intrinsic but also extrinsic factors of which UV-irradiation is a main cause. It is hence of interest to have means to protect skin from UV -irradiation induced damage. We selected an extract of the freshwater microalga Scenedesmus rubescens and assessed its potential to protect skin from photoaging caused by UV-irradiation.
Methods
Skin cells in-vitro and ex-vivo were analyzed for markers of UV-irradiation induced photodamage such as decreased viability, decreased collagen content, hyperpigmentation, and sunburn cells.
Results
We found that a dry extract of the microalga Scenedesmus rubescens was able to suppress cellular signs of ageing induced by UV-irradiation. It enhanced dermal fibroblast viability, rescued dermal collagen content, inhibited the formation of sunburn cells, and inhibited tyrosinase activity.
Conclusion
An extract of Scenedesmus rubescens showed broad activity against markers of UV-irradiation induced cutaneous ageing. It may therefore be used as a preventive or regenerative agent for anti-ageing strategies.
This article is protected by copyright. All rights reserved.
Shifting the Focus: The Primary Role of IL-23 in Psoriasis and other Inflammatory Disorders
Abstract
Insights into the pathophysiology of autoimmune inflammatory diseases including psoriasis have advanced considerably in recent years, and in parallel, so too have the available treatment options. Current clinical paradigms for the treatment of psoriasis have evolved to include targeted biologic therapies, starting with tumor necrosis factor-alpha (TNF-α) inhibitors and later, agents targeting interleukin (IL)-12/23 and IL-17. The most recent evidence suggests that IL-23 might be an even more potent target for the effective treatment of psoriasis and other autoimmune inflammatory disorders. This review will describe recent developments leading to the current understanding of the key role of IL-23 as a 'master regulator' of autoimmune inflammation, and the clinical evidence for agents that specifically target this modulator in the context of treating psoriasis, spondyloarthropathy, and inflammatory bowel disease.
This article is protected by copyright. All rights reserved.
Optic Nerve Measurement on MRI in the Pediatric Population: Normative Values and Correlations [PEDIATRICS]
BACKGROUND AND PURPOSE:
Few articles in the literature have looked at the diameter of the optic nerve on MR imaging, especially in children, in whom observations are subjective and no normative data exist. The aim of this study was to establish a data base for optic nerve diameter measurements on MR imaging in the pediatric population.
MATERIALS AND METHODS:This was a retrospective study on the MR imaging of pediatric subjects (younger than 18 years of age) at the Department of Diagnostic Radiology at the American University of Beirut Medical Center, Beirut, Lebanon. The optic nerve measurements were obtained by 3 raters on axial and coronal sections at 3 mm (retrobulbar) and 7 mm (intraorbital) posterior to the lamina cribrosa.
RESULTS:Of 211 scans of patients (422 optic nerves), 377 optic nerves were measured and included. Ninety-four patients were female (45%) and the median age at MR imaging was 8.6 years (interquartile range, 3.9–13.3 years). Optic nerves were divided into 5 age groups: 0–6 months (n = 18), 6 months–2 years (n = 44), 2–6 years (n = 86), 6–12 years (n = 120), and 12–18 years (n = 109). An increase in optic nerve diameter was observed with age, especially in the first 2 years of life. Measurements did not differ with eye laterality or sex.
CONCLUSIONS:We report normative values of optic nerve diameter measured on MR imaging in children from birth to 18 years of age. A rapid increase in optic nerve diameter was demonstrated during the first 2 years of life, followed by a slower increase. This was independent of sex or eye laterality.
Leukoaraiosis Attenuates Diagnostic Accuracy of Large-Vessel Occlusion Scales [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
Prehospital stroke scales may help identify patients likely to have large-vessel occlusion to facilitate rapid triage to thrombectomy-capable stroke centers. Scale misclassification may result in inaccurate decisions and possible harm. Pre-existing leukoaraiosis has been shown to attenuate the association between deficit type and stroke severity. We sought to determine whether leukoaraiosis affects the predictive ability of 5 commonly used large-vessel occlusion scales.
MATERIALS AND METHODS:We retrospectively analyzed 274 consecutive patients with stroke with available brain MR imaging and vessel imaging. We used the following large-vessel occlusion scales: the 3-Item Stroke Scale; Field Assessment Stroke Triage for Emergency Destination; Rapid Arterial Occlusion Evaluation; Vision, Aphasia, Neglect score; and Cincinnati Prehospital Stroke Severity Scale. For diagnostic scale accuracy, we assessed sensitivity, specificity, positive predictive value, negative predictive value, and . Multivariable logistic regression was used to determine the predictive ability of the scales after adjustment for leukoaraiosis and potential confounders.
RESULTS:In unadjusted analyses, all scales predicted the presence of large-vessel occlusion (n = 46, P < .01 each), though diagnostic accuracy was attenuated among patients with moderate-to-severe leukoaraiosis. After adjustment, the Field Assessment Stroke Triage for Emergency Destination (OR = 3.2; 95% CI, 1.1–9.5; P = .033) and Rapid Arterial Occlusion Evaluation (OR = 3.7; 95% CI, 1.3–10.8; P = .015), but not the 3-Item Stroke Scale (OR = 5.4; 95% CI, 0.86–33.9; P = .073), Vision, Aphasia, Neglect score (OR = 2.5; 95% CI, 0.8–7.2), and Cincinnati Prehospital Stroke Severity Scale (OR = 2.8; 95% CI, 1.0–8.0), predicted large-vessel occlusion.
CONCLUSIONS:The diagnostic accuracy of the tested large-vessel occlusion scales was attenuated in the presence of moderate-to-severe leukoaraiosis. This information that may aid the design of future studies that require large-vessel occlusion scale screening of patients who are likely to have concomitant leukoaraiosis.
Feasibility of Brain Atrophy Measurement in Clinical Routine without Prior Standardization of the MRI Protocol: Results from MS-MRIUS, a Longitudinal Observational, Multicenter Real-World Outcome Study in Patients with Relapsing-Remitting MS [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Feasibility of brain atrophy measurement in patients with MS in clinical routine, without prior standardization of the MRI protocol, is unknown. Our aim was to investigate the feasibility of brain atrophy measurement in patients with MS in clinical routine.
MATERIALS AND METHODS:Multiple Sclerosis and Clinical Outcome and MR Imaging in the United States (MS-MRIUS) is a multicenter (33 sites), retrospective study that included patients with relapsing-remitting MS who began treatment with fingolimod. Brain MR imaging examinations previously acquired at the baseline and follow-up periods on 1.5T or 3T scanners with no prior standardization were used, to resemble a real-world situation. Brain atrophy outcomes included the percentage brain volume change measured by structural image evaluation with normalization of atrophy on 2D-T1-weighted imaging and 3D-T1WI and the percentage lateral ventricle volume change, measured by VIENA on 2D-T1WI and 3D-T1WI and NeuroSTREAM on T2-fluid-attenuated inversion recovery examinations.
RESULTS:A total of 590 patients, followed for 16 months, were included. There were 585 (99.2%) T2-FLAIR, 425 (72%) 2D-T1WI, and 166 (28.2%) 3D-T1WI longitudinal pairs of examinations available. Excluding MR imaging examinations with scanner changes, the analyses were available on 388 (65.8%) patients on T2-FLAIR for the percentage lateral ventricle volume change, 259 and 257 (43.9% and 43.6%, respectively) on 2D-T1WI for the percentage brain volume change and the percentage lateral ventricle volume change, and 110 (18.6%) on 3D-T1WI for the percentage brain volume change and percentage lateral ventricle volume change. The median annualized percentage brain volume change was –0.31% on 2D-T1WI and –0.38% on 3D-T1WI. The median annualized percentage lateral ventricle volume change was 0.95% on 2D-T1WI, 1.47% on 3D-T1WI, and 0.90% on T2-FLAIR.
CONCLUSIONS:Brain atrophy was more readily assessed by estimating the percentage lateral ventricle volume change on T2-FLAIR compared with the percentage brain volume change or percentage lateral ventricle volume change using 2D- or 3D-T1WI in this observational retrospective study. Although measurement of the percentage brain volume change on 3D-T1WI remains the criterion standard and should be encouraged in future prospective studies, T2-FLAIR–derived percentage lateral ventricle volume change may be a more feasible surrogate when historical or other practical constraints limit the availability of percentage brain volume change on 3D-T1WI.
Intranasal Esthesioneuroblastoma: CT Patterns Aid in Preventing Routine Nasal Polypectomy [HEAD & NECK]
BACKGROUND AND PURPOSE:
Esthesioneuroblastoma is a neuroectodermal tumor that commonly arises in the nasal cavity olfactory recess and, when isolated to the intranasal cavity, can be indistinguishable from benign processes. Because lesional aggressiveness requires a more invasive operation for resection than polypectomy, patients with isolated intranasal lesions were studied to define distinguishing CT characteristics.
MATERIALS AND METHODS:Patients with intranasal esthesioneuroblastoma and controls without esthesioneuroblastoma with olfactory recess involvement were identified by using a report search tool. Studies demonstrating skull base invasion and/or intracranial extension were excluded. The imaging spectrum of these lesions was reviewed on both CT and MR imaging, and CT findings were compared with those of controls without esthesioneuroblastoma. Two blinded readers assessed subjects with esthesioneuroblastomas and controls without esthesioneuroblastoma and, using only CT criteria, rated their level of suspicion for esthesioneuroblastoma in each case.
RESULTS:Eight histologically proved cases of intranasal esthesioneuroblastoma were reviewed. All cases had CT demonstrating 3 main findings: 1) an intranasal polypoid lesion with its epicenter in a unilateral olfactory recess, 2) causing asymmetric olfactory recess widening, and 3) extending to the cribriform plate. Twelve patients with non-esthesioneuroblastoma diseases involving the olfactory recess were used as controls. Using these 3 esthesioneuroblastoma CT criteria, 2 blinded readers evaluating patients with esthesioneuroblastoma and controls had good diagnostic accuracy (area under the curve = 0.85 for reader one, 0.81 for reader 2) for predicting esthesioneuroblastoma.
CONCLUSIONS:Esthesioneuroblastoma can present as a well-marginated intranasal lesion that unilaterally widens the olfactory recess. CT patterns can help predict esthesioneuroblastoma, potentially preventing multiple operations by instigating the correct initial operative management.
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.
Combining Quantitative Susceptibility Mapping with Automatic Zero Reference (QSM0) and Myelin Water Fraction Imaging to Quantify Iron-Related Myelin Damage in Chronic Active MS Lesions [ADULT BRAIN]
BACKGROUND AND PURPOSE:
A hyperintense rim on susceptibility in chronic MS lesions is consistent with iron deposition, and the purpose of this study was to quantify iron-related myelin damage within these lesions as compared with those without rim.
MATERIALS AND METHODS:Forty-six patients had 2 longitudinal quantitative susceptibility mapping with automatic zero reference scans with a mean interval of 28.9 ± 11.4 months. Myelin water fraction mapping by using fast acquisition with spiral trajectory and T2 prep was obtained at the second time point to measure myelin damage. Mixed-effects models were used to assess lesion quantitative susceptibility mapping and myelin water fraction values.
RESULTS:Quantitative susceptibility mapping scans were on average 6.8 parts per billion higher in 116 rim-positive lesions compared with 441 rim-negative lesions (P < .001). All rim-positive lesions retained a hyperintense rim over time, with increasing quantitative susceptibility mapping values of both the rim and core regions (P < .001). Quantitative susceptibility mapping scans and myelin water fraction in rim-positive lesions decreased from rim to core, which is consistent with rim iron deposition. Whole lesion myelin water fractions for rim-positive and rim-negative lesions were 0.055 ± 0.07 and 0.066 ± 0.04, respectively. In the mixed-effects model, rim-positive lesions had on average 0.01 lower myelin water fraction compared with rim-negative lesions (P < .001). The volume of the rim at the initial quantitative susceptibility mapping scan was negatively associated with follow-up myelin water fraction (P < .01).
CONCLUSIONS:Quantitative susceptibility mapping rim-positive lesions maintained a hyperintense rim, increased in susceptibility, and had more myelin damage compared with rim-negative lesions. Our results are consistent with the identification of chronic active MS lesions and may provide a target for therapeutic interventions to reduce myelin damage.
Feasibility of Permanent Stenting with Solitaire FR as a Rescue Treatment for the Reperfusion of Acute Intracranial Artery Occlusion [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
The Solitaire FR can be used not only as a tool for mechanical thrombectomy but also as a detachable permanent stent. Our aim was to assess the feasibility and safety of permanent stent placement with the Solitaire FR compared with other self-expanding stents for intracranial artery recanalization for acute ischemic stroke.
MATERIALS AND METHODS:From January 2011 through January 2016, we retrospectively selected 2979 patients with acute ischemic stroke. Among them, 27 patients who underwent permanent stent placement (13 patients with the Solitaire FR [Solitaire group] and 14 patients with other self-expanding stents [other stent group]) were enrolled. The postprocedural modified TICI grade and angiographic and clinical outcomes were assessed. The safety and efficacy of permanent stent placement of the Solitaire FR for acute large-artery occlusion were evaluated.
RESULTS:Stent placement was successful in all cases. Modified TICI 2b–3 reperfusion was noted in 84.6% of the Solitaire group and in 78.6% of the other stent group. Procedural time was significantly shorter in the Solitaire group than in the other stent group (P = .022). Shorter procedural time was correlated with favorable outcome ( = 0.46, P = .035). No significant differences were found in the modified TICI grade, NIHSS score, mRS, and hemorrhagic transformation rate between the 2 groups. The acute in-stent thrombosis rate at discharge was significantly lower when a glycoprotein IIb/IIIa inhibitor was injected during the procedure (P = .013).
CONCLUSIONS:Permanent stent placement with the Solitaire FR compared with other self-expanding stents appears to be feasible and safe as a rescue tool for refractory intra-arterial therapy.
Radiomics in Brain Tumor: Image Assessment, Quantitative Feature Descriptors, and Machine-Learning Approaches [ADULT BRAIN]
SUMMARY:
Radiomics describes a broad set of computational methods that extract quantitative features from radiographic images. The resulting features can be used to inform imaging diagnosis, prognosis, and therapy response in oncology. However, major challenges remain for methodologic developments to optimize feature extraction and provide rapid information flow in clinical settings. Equally important, to be clinically useful, predictive radiomic properties must be clearly linked to meaningful biologic characteristics and qualitative imaging properties familiar to radiologists. Here we use a cross-disciplinary approach to highlight studies in radiomics. We review brain tumor radiologic studies (eg, imaging interpretation) through computational models (eg, computer vision and machine learning) that provide novel clinical insights. We outline current quantitative image feature extraction and prediction strategies with different levels of available clinical classes for supporting clinical decision-making. We further discuss machine-learning challenges and data opportunities to advance radiomic studies.
Semiautomated Middle Ear Volume Measurement as a Predictor of Postsurgical Outcomes for Congenital Aural Atresia [HEAD & NECK]
BACKGROUND AND PURPOSE:
Middle ear space is one of the most important components of the Jahrsdoerfer grading system (J-score), which is used to determine surgical candidacy for congenital aural atresia. The purpose of this study was to introduce a semiautomated method for measuring middle ear volume and determine whether middle ear volume, either alone or in combination with the J-score, can be used to predict early postoperative audiometric outcomes.
MATERIALS AND METHODS:A retrospective analysis was conducted of 18 patients who underwent an operation for unilateral congenital aural atresia at our institution. Using the Livewire Segmentation tool in the Carestream Vue PACS, we segmented middle ear volumes using a semiautomated method for all atretic and contralateral normal ears on preoperative high-resolution CT imaging. Postsurgical audiometric outcome data were then analyzed in the context of these middle ear volumes.
RESULTS:Atretic middle ear volumes were significantly smaller than those in contralateral normal ears (P < .001). Patients with atretic middle ear volumes of >305 mm3 had significantly better postoperative pure tone average and speech reception thresholds than those with atretic ears below this threshold volume (P = .01 and P = .006, respectively). Atretic middle ear volume incorporated into the J-score offered the best association with normal postoperative hearing (speech reception threshold ≤ 30 dB; OR = 37.8, P = .01).
CONCLUSIONS:Middle ear volume, calculated in a semiautomated fashion, is predictive of postsurgical audiometric outcomes, both independently and in combination with the conventional J-score.
John Nash and the Organization of Stroke Care [research-article]
SUMMARY:
The concept of Nash equilibrium, developed by John Forbes Nash Jr, states that an equilibrium in noncooperative games is reached when each player takes the best action for himself or herself, taking into account the actions of the other players. We apply this concept to the provision of endovascular thrombectomy in the treatment of acute ischemic stroke and suggest that collaboration among hospitals in a health care jurisdiction could result in practices such as shared call pools for neurointervention teams, leading to better patient care through streamlined systems.
Temporal Lobe Malformations in Achondroplasia: Expanding the Brain Imaging Phenotype Associated with FGFR3-Related Skeletal Dysplasias [PEDIATRICS]
SUMMARY:
Thanatophoric dysplasia, achondroplasia, and hypochondroplasia belong to the fibroblast growth factor receptor 3 (FGFR3) group of genetic skeletal disorders. Temporal lobe abnormalities have been documented in thanatophoric dysplasia and hypochondroplasia, and in 1 case of achondroplasia. We retrospectively identified 13 children with achondroplasia who underwent MR imaging of the brain between 2002 and 2015. All children demonstrated a deep transverse temporal sulcus on MR imaging. Further common neuroimaging findings were incomplete hippocampal rotation (12 children), oversulcation of the mesial temporal lobe (11 children), loss of gray-white matter differentiation of the mesial temporal lobe (5 children), and a triangular shape of the temporal horn (6 children). These appearances are very similar to those described in hypochondroplasia, strengthening the association of temporal lobe malformations in FGFR3-associated skeletal dysplasias.
MR Perfusion to Determine the Status of Collaterals in Patients with Acute Ischemic Stroke: A Look Beyond Time Maps [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Patients with acute stroke with robust collateral flow have better clinical outcomes and may benefit from endovascular treatment throughout an extended time window. Using a multiparametric approach, we aimed to identify MR perfusion parameters that can represent the extent of collaterals, approximating DSA.
MATERIALS AND METHODS:Patients with anterior circulation proximal arterial occlusion who had baseline MR perfusion and DSA were evaluated. The volume of arterial tissue delay (ATD) at thresholds of 2–6 seconds (ATD2–6 seconds) and >6 seconds (ATD>6 seconds) in addition to corresponding values of normalized CBV and CBF was calculated using VOI analysis. The association of MR perfusion parameters and the status of collaterals on DSA were assessed by multivariate analyses. Receiver operating characteristic analysis was performed.
RESULTS:Of 108 patients reviewed, 39 met our inclusion criteria. On DSA, 22/39 (56%) patients had good collaterals. Patients with good collaterals had significantly smaller baseline and final infarct volumes, smaller volumes of severe hypoperfusion (ATD>6 seconds), larger volumes of moderate hypoperfusion (ATD2–6 seconds), and higher relative CBF and relative CBV values than patients with insufficient collaterals. Combining the 2 parameters into a Perfusion Collateral Index (volume of ATD2–6 secondsx relative CBV2–6 seconds) yielded the highest accuracy for predicting collateral status: At a threshold of 61.7, this index identified 15/17 (88%) patients with insufficient collaterals and 22/22 (100%) patients with good collaterals, for an overall accuracy of 94.1%.
CONCLUSIONS:The Perfusion Collateral Index can predict the baseline collateral status with 94% diagnostic accuracy compared with DSA.
Carotid Artery Wall Imaging: Perspective and Guidelines from the ASNR Vessel Wall Imaging Study Group and Expert Consensus Recommendations of the American Society of Neuroradiology [EXTRACRANIAL VASCULAR]
SUMMARY:
Identification of carotid artery atherosclerosis is conventionally based on measurements of luminal stenosis and surface irregularities using in vivo imaging techniques including sonography, CT and MR angiography, and digital subtraction angiography. However, histopathologic studies demonstrate considerable differences between plaques with identical degrees of stenosis and indicate that certain plaque features are associated with increased risk for ischemic events. The ability to look beyond the lumen using highly developed vessel wall imaging methods to identify plaque vulnerable to disruption has prompted an active debate as to whether a paradigm shift is needed to move away from relying on measurements of luminal stenosis for gauging the risk of ischemic injury. Further evaluation in randomized clinical trials will help to better define the exact role of plaque imaging in clinical decision-making. However, current carotid vessel wall imaging techniques can be informative. The goal of this article is to present the perspective of the ASNR Vessel Wall Imaging Study Group as it relates to the current status of arterial wall imaging in carotid artery disease.
On the Reproducibility of Inversion Recovery Intravoxel Incoherent Motion Imaging in Cerebrovascular Disease [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Intravoxel incoherent motion imaging can measure both microvascular and parenchymal abnormalities simultaneously. The contamination of CSF signal can be suppressed using inversion recovery preparation. The clinical feasibility of inversion recovery–intravoxel incoherent motion imaging was investigated in patients with cerebrovascular disease by studying its reproducibility.
MATERIALS AND METHODS:Sixteen patients with cerebrovascular disease (66 ± 8 years of age) underwent inversion recovery–intravoxel incoherent motion imaging twice. The reproducibility of the perfusion volume fraction and parenchymal diffusivity was calculated with the coefficient of variation, intraclass correlation coefficient, and the repeatability coefficient. ROIs included the normal-appearing white matter, cortex, deep gray matter, white matter hyperintensities, and vascular lesions.
RESULTS:Values for the perfusion volume fraction ranged from 2.42 to 3.97 x10–2 and for parenchymal diffusivity from 7.20 to 9.11 x 10–4 mm2/s, with higher values found in the white matter hyperintensities and vascular lesions. Coefficients of variation were <3.70% in normal-appearing tissue and <9.15% for lesions. Intraclass correlation coefficients were good to excellent, showing values ranging from 0.82 to 0.99 in all ROIs, except the deep gray matter and cortex, with intraclass correlation coefficients of 0.66 and 0.54, respectively. The repeatability coefficients ranged from 0.15 to 0.96 x 10–2 and 0.10 to 0.37 x 10–4 mm2/s for perfusion volume fraction and parenchymal diffusivity, respectively.
CONCLUSIONS:Good reproducibility of inversion recovery–intravoxel incoherent motion imaging was observed with low coefficients of variation and high intraclass correlation coefficients in normal-appearing tissue and lesion areas in cerebrovascular disease. Good reproducibility of inversion recovery–intravoxel incoherent motion imaging in cerebrovascular disease is feasible in monitoring disease progression or treatment responses in the clinic.
Protective effect of Uncaria tomentosa extract against oxidative stress and genotoxicity induced by glyphosate-Roundup® using zebrafish ( Danio rerio ) as a model
Abstract
Oxidative stress and DNA damage are involved in the glyphosate-based herbicide toxicity. Uncaria tomentosa (UT; Rubiaceae) is a plant species from South America containing bioactive compounds with known beneficial properties. The objective of this work was to evaluate the antioxidant and antigenotoxic potential of UT extract in a model of acute exposure to glyphosate-Roundup® (GR) in zebrafish (Danio rerio). We showed that UT (1.0 mg/mL) prevented the decrease of brain total thiols, the increase of lipid peroxidation in both brain and liver, and the decrease of liver GPx activity caused after 96 h of GR (5.0 mg/L) exposure. In addition, UT partially protected against the increase of micronucleus frequency induced by GR exposure in fish brain. Overall, our results indicate that UT protects against damage induced by a glyphosate-based herbicide by providing antioxidant and antigenotoxic effects, which may be related to the phenolic compounds identified in the extract.
Hypertension prevalence and living conditions related to air pollution: results of a national epidemiological study in Lebanon
Abstract
Hypertension is a risk factor of several diseases, linked to high mortality and morbidity, particularly in developing countries. Some studies have linked indoor and outdoor pollution exposure items to hypertension, but results were inconsistent. Our objective was to assess the association of living conditions related to air pollution to hypertension in Lebanon, a Middle Eastern country. A national cross-sectional study was conducted all over Lebanon. Blood pressure and its related medications were assessed to be able to classify participants as hypertensive or not. Moreover, in addition to living conditions related to air pollution exposure, we assessed potential predictors of hypertension, including sociodemographic characteristics, self-reported health information and biological measurements. Furthermore, we assessed dose-effect relationship of air pollution items in relation with hypertension. Living conditions related to indoor and outdoor air pollution exposures were associated with hypertension, with or without taking biological values into account. Moreover, we found a dose-effect relationship of exposure with risk of disease (15% increase in risk of disease for every additional pollution exposure item), after adjustment for sociodemographics and biological characteristics (Ora = 1.15 [1.03–1.28]). Although additional studies would be necessary to confirm these findings, interventions should start to sensitize the population about the effect of air pollution on chronic diseases. The work on reducing pollution and improving air quality should be implemented to decrease the disease burden on the population and health system.
Mechanism of UV Driven Photoelectrocatalytic Degradation Berberine Chloride Form Using the ESR Spin-trapping Method
Abstract
Photoelectrocatalytic (PEC) system greatly improves the migration of photo-excited charges, retards the fast recombination of electron–hole and increases the lifetime of photo-generated holes. In this paper, we constructed a novel PEC system to degrade Berberine chloride form (BCF). XRD patterns indicated ageing time was an important condition for the crystal type of TiO2 and the best proportion of anatase/rutile was 80/20. The band gap energy of the TiO2 was 3.01 eV. We demonstrated that a synergistic effect existed between photocatalysis (PC) and electrocatalysis (EC). Besides we discussed the influence of pH, current density, the amount of catalyst and initial BCF concentration on the degradation of BCF. Electron spin resonance (ESR) through spin trap 5, 5-dimethyl-1-pyrroline-N-oxide (DMPO) and the scavenging experiments suggested that the reactive oxygen species (ROS) were superoxide radicals (O2•−), hydroxyl radicals (·OH) and sulfate radical (SO4•−) in PEC system. Furthermore, we compared the two pathway of formation DMPO-SO4 adducts, and found that SO4·- was the most major oxidized species in degrading BCF. We proposed a plausible reaction mechanism. Intriguingly, even under lower current and weaker light conditions, the PEC process maintained its effectiveness, demonstrating the feasibility of the PEC approach.
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Kinetic Control in the Regioselective Alkylation of Pterin Sensitizers: A Synthetic, Photochemical, and Theoretical Study
Abstract
Alkylation patterns and excited state properties of pterins were examined both experimentally and theoretically. 2D NMR spectroscopy was used to characterize the pterin derivatives, revealing undoubtedly that the decyl chains were coupled to either the O4 or N3 sites on the pterin. At a temperature of 70 °C the pterin alkylation regioselectively favored the O4 over the N3. The O4 was also favored when using solvents in which the reactants had increased solubility, namely N,N-dimethylformamide and N,N-dimethylacetamide, rather than solvents in which the reactants had very low solubility (tetrahydrofuran and dichloromethane). Density functional theory (DFT) computed enthalpies correlate to regioselectivity being kinetically driven because the less stable O-isomer forms in higher yield than the more stable N-isomer. Once formed these compounds did not interconvert thermally or undergo a unimolecular "walk" rearrangement. Mechanistic rationale for the factors underlying the regioselective alkylation of pterins is suggested, where kinetic rather than thermodynamic factors are key in the higher yield of the O-isomer. Computations also predicted greater solubility and reduced triplet state energetics thereby improving the properties of the alkylated pterins as 1O2 sensitizers. Insight on thermal and photostability of the alkylated pterins is also provided.
This article is protected by copyright. All rights reserved.
IL-27 – a double agent in the IL-6 family
Abstract
The cytokine interleukin (IL)-6 is a major therapeutic target for the treatment of various inflammatory and autoimmune diseases. While IL-6 receives considerable attention in studies of innate and adaptive immunity, the IL-6-related family member IL-27 is increasingly recognized for its effects on cellular proliferation, differentiation and leukocyte effector functions. Both cytokines activate responses in myeloid and stromal tissue cells where they direct the transition from innate to adaptive immunity. However, they are frequently identified as lymphokines that control responses in T cells and B cells. In this regard, IL-27 often opposes the action of IL-6. Here, we will review the role of IL-6 and IL-27 in inflammation, with a particular focus on inflammatory arthritis, and discuss their importance in the diagnosis, stratification and treatment of autoimmune disease. This article is protected by copyright. All rights reserved.
Exposure-lag-response in Longitudinal Studies: Application of Distributed Lag Non-linear Models in an Occupational Cohort
Abstract
Prolonged exposures can have complex relationships with health outcomes, as timing, duration, and intensity of exposure are all potentially relevant. Summary measures such as cumulative exposure or average intensity of exposure may not fully capture these relationships. We applied penalized and unpenalized distributed lag non-linear models (DLNMs) with flexible exposure-response and lag-response functions in order to examine the association between crystalline silica exposure and mortality from lung cancer and non-malignant respiratory disease in a cohort study of 2,342 California diatomaceous earth workers, followed 1942-2011. We also assessed associations using simple measures of cumulative exposure assuming linear exposure-response and constant lag-response. Measures of association from DLNMs were generally higher than from simpler models. Rate ratios from penalized DLNMs corresponding to average daily exposures of 0.4 mg/m3 during lag years 31-50 prior to the age of observed cases were 1.47 (95% confidence interval (CI) 0.92, 2.35) for lung cancer and 1.80 (95% CI: 1.14, 2.85) for non-malignant respiratory disease. Rate ratios from the simpler models for the same exposure scenario were 1.15 (95% CI: 0.89-1.48) and 1.23 (95% CI: 1.03-1.46) respectively. Longitudinal cohort studies of prolonged exposures and chronic health outcomes should explore methods allowing for flexibility and non-linearities in the exposure-lag-response.Years of life lost due to influenza-attributable mortality in older adults in the Netherlands: a competing risks approach
Abstract
We estimated the influenza mortality burden in adults 60 years of age and older in the Netherlands in terms of years of life lost, taking into account competing mortality risks. Weekly laboratory surveillance data for influenza and other respiratory pathogens and weekly extreme temperature served as covariates in Poisson regression models fitted to weekly age-group specific mortality data for the period 1999/2000 through 2012/13. Burden for age-groups 60-64 through 85-89 years was computed as years of life lost before age 90 (YLL90) using restricted mean lifetimes survival analysis and accounting for competing risks. Influenza-attributable mortality burden was greatest for persons aged 80-84 years, at 914 YLL90 per 100,000 persons (95% uncertainty interval:867, 963), followed by 85-89 years (787 YLL90/100,000; 95% uncertainty interval:741, 834). Ignoring competing mortality risks in the computation of influenza-attributable YLL90 would lead to substantial over-estimation of burden, from 3.5% for 60-64 years to 82% for persons aged 80-89 years at death. Failure to account for competing mortality risks has implications for accuracy of disease burden estimates, especially among persons aged 80 years and older. As the mortality burden borne by the elderly is notably high, prevention initiatives may benefit from being redesigned to more effectively prevent infection in the oldest age-groups.Sensitivity Analyses for Misclassification of Cause of Death in the Parametric G-Formula
Abstract
Cause-specific mortality is an important outcome in studies of interventions to improve survival, yet causes of death can be misclassified. Here, we present an approach to perform sensitivity analyses for misclassification of cause of death in the parametric g-formula. The g-formula is useful method to estimate effects of interventions in epidemiologic research because it appropriately accounts for time-varying confounding affected by prior treatment and can estimate risk under dynamic treatment plans. We illustrate our approach using an example comparing acquired immune deficiency syndrome (AIDS)-related mortality under immediate and delayed treatment strategies in a cohort of therapy-naïve adults entering care for human immunodeficiency virus in the United States. In the standard g-formula approach, 10-year risk of AIDS-related mortality under delayed treatment was 1.73 (95% CI: 1.17, 2.54) times the risk under immediate treatment. In a sensitivity analysis assuming that AIDS-related death was measured with sensitivity of 95% and specificity of 90%, the 10-year risk ratio comparing AIDS-related mortality between treatment plans was 1.89 (95% CI: 1.13, 3.14). When sensitivity and specificity are unknown, this approach can be used to estimate the effects of dynamic treatment plans under a range of plausible values of sensitivity and specificity of the recorded event type.Correction to: Baseline and annual repeat rounds of screening: implications for optimal regimens of screening
Abstract
The original version of this article unfortunately contained a mistake. The conflict of interest was incorrect.
Differences among Thai Agricultural Workers’ Health, Working Conditions, and Pesticide Use by Farm Type
Abstract
More than 11 million Thai people (38%) work in agriculture, but since most are in the informal sector, government enforcement and support are very limited. As a result, working conditions on Thai farms vary greatly, putting the health of many agricultural workers at risk. A cross-sectional study in three Thai provinces collected information on the work activities and conditions of 424 farmers representing five farm types: rice, vegetable, flower, rice/vegetable, and flower/vegetable. The agricultural workers were mainly women (60%); their average age was 53 but ranged from 18 to 87 years. More than 64% worked more than 5 days/week. Seventy-four percent of them had only primary school education. A number of the health and hazardous working conditions surveyed were significantly different by farm type. Rice farmers were found to have the highest prevalence of allergies, nasal congestion, wheezing, and acute symptoms after pesticide use, while flower farmers had the lowest prevalence of these health outcomes. Rice farmers reported the highest prevalence of hazardous working conditions including high noise levels, working on slippery surfaces, sitting or standing on a vibrating machine, spills of chemicals/pesticides, and sharp injuries. The lowest prevalence of these working conditions (except noise) was reported by flower farmers. Vegetable farmers reported the highest prevalence knee problems, while rice farmers had the lowest prevalence. Among these farmers, more than 27 different types of pesticides were reported in use during the past year, with the majority reporting use once a month. The flower/vegetable farming group reported the highest frequency of good exposure prevention practices during pesticide use. They were the most likely to report using cotton or rubber gloves or a disposable paper masks during insecticide spraying. Those farmers who only grew vegetables had the lowest frequency of good exposure prevention practices, including use of personal protective equipment. The economic cost of work-related injuries and illnesses among informal sector agricultural workers in Thailand is unknown and in need of study. Gaps in the regulations covering pesticide sales allow farmers to purchase pesticides without adequate training in their safe use. Training targeted to farm type regarding safe pesticide use and the prevention of accidents and musculoskeletal disorders is needed. Studies of chronic health effects among Thai farmers are needed, with special emphasis on respiratory, metabolic disease and cancer.Survival of LA-MRSA in Dust from Swine Farms
Abstract
Dust is suspected to be an important factor in transmission of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) between pigs and pig farmers and their families. The aim of this study was to determine the rate of decay for Staphylococcus aureus and LA-MRSA in dust from swine farms. Electrostatic dust fall collectors (EDCs) were used for passive sampling of settling airborne dust in 11 stable sections from six swine farms. Extraction, plating, identification, and enumeration of cultivable S. aureus and LA-MRSA from the EDCs were performed after storage for 0–30 days postsampling. The survival of S. aureus was measured in 196 dust samples from all farms, and data were used to estimate the decay constant λ according to a model for exponential decay: N(t) = N0 × e−λt. The number of S. aureus colonies was up to 600-fold higher than the number of LA-MRSA colonies on MRSA selective agar. The data showed a good fit to the model (λ = 0.13, r2 = 0.86) even with a large difference in initial concentrations of S. aureus between stables. The loads of S. aureus and LA-MRSA in the dust were significantly reduced by storage time, and the half-life was 5 days for both S. aureus and LA-MRSA. In dust samples with high initial concentrations, LA-MRSA and S. aureus could still be cultivated 30 days after sampling. On all farms MRSA isolates belonged to the clonal complex (CC) 398, and at one farm some isolates also belonged to CC30. A screening for other Staphylococcus species in the farm dust revealed 13 different species numerically dominated by Staphylococcus equorum. Based on the exponential decay model, S. equorum had a half-life of 4 days. In conclusion, the presence of MRSA in airborne dust from five of six farms indicates that dust might be an important vehicle for transmission of LA-MRSA. LA-MRSA and S. aureus was found to survive well in farm dust with half-lives of 5 days, and dependent on the initial concentration they could be found in farm dust for weeks. The 99.9% die-off rate was 66 days for LA-MRSA. Thus, farm dust can pose an exposure risk for humans in the farm environment, but also when transported to other environments. On the other hand, the risk will decrease by time. These results provide important knowledge to diminish spread from farm environments to other environments on, e.g., tools or clothing, and in relation to cleaning of emptied LA-MRSA-positive stables.Estimation of Lead Exposure Prevalence in Korean Population through Combining Multiple Experts’ Judgment based on Objective Data Sources
Abstract
Objective
Estimating carcinogen exposure prevalence is important for preventing occupational cancers. To develop the Korean version of CARcinogen EXposure (CAREX), a carcinogen surveillance system used in many countries, we estimated lead exposure prevalence in the Korean working population. Methods
We used three Korean nationwide data sources to obtain objective database-derived prevalences of lead exposure across industries: airborne lead measurement data from the work environment measurement database (WEMD), blood lead measurement data from the special health examination database (SHED), and lead exposure prevalence computed using data from the work environment condition survey (WECS), which is a nationwide occupational exposure survey. We also asked a panel of 52 experts with ≥20 years of experience in industrial hygiene practice for their judgment about lead exposure prevalence across industries after they reviewed the database-derived prevalences computed from the three exposure databases. We developed and compared various estimation methods for combining the experts' judgments. The 2010 census was used as the reference population to estimate the number of lead-exposed workers in 228 industries by multiplying the exposure prevalence by the number of workers in each industry. Results
The database-derived prevalences of lead exposure in the 228 industries were calculated using data collected between 2009 and 2011 from the WEMD and SHED and from the 2009 WECS. From the various estimation methods assessed, the median values of experts' responses were selected as our estimates of lead exposure prevalence in each industry. As a result, it was estimated that 129,250 Korean workers were exposed to lead in 2010. Conclusions
Based on objective databases, we developed a method for estimating exposure prevalence for the CAREX system by combining experts' judgments. This work may offer an unbiased approach to the development process that accounts for the uncertainty in exposure.Examining Exposure Assessment in Shift Work Research: A Study on Depression Among Nurses
Abstract
Introduction
Coarse exposure assessment and assignment is a common issue facing epidemiological studies of shift work. Such measures ignore a number of exposure characteristics that may impact on health, increasing the likelihood of biased effect estimates and masked exposure–response relationships. To demonstrate the impacts of exposure assessment precision in shift work research, this study investigated relationships between work schedule and depression in a large survey of Canadian nurses. Methods
The Canadian 2005 National Survey of the Work and Health of Nurses provided the analytic sample (n = 11450). Relationships between work schedule and depression were assessed using logistic regression models with high, moderate, and low-precision exposure groupings. The high-precision grouping described shift timing and rotation frequency, the moderate-precision grouping described shift timing, and the low-precision grouping described the presence/absence of shift work. Final model estimates were adjusted for the potential confounding effects of demographic and work variables, and bootstrap weights were used to generate sampling variances that accounted for the survey sample design. Results
The high-precision exposure grouping model showed the strongest relationships between work schedule and depression, with increased odds ratios [ORs] for rapidly rotating (OR = 1.51, 95% confidence interval [CI] = 0.91–2.51) and undefined rotating (OR = 1.67, 95% CI = 0.92–3.02) shift workers, and a decreased OR for depression in slow rotating (OR = 0.79, 95% CI = 0.57–1.08) shift workers. For the low- and moderate-precision exposure grouping models, weak relationships were observed for all work schedule categories (OR range 0.95 to 0.99). Conclusions
Findings from this study support the need to consider and collect the data required for precise and conceptually driven exposure assessment and assignment in future studies of shift work and health. Further research into the effects of shift rotation frequency on depression is also recommended.Response to Cherrie Letter, ‘How to Quantitatively Assess Dermal Exposure to Volatile Organic Compounds’
Editorial Note. Letters to the Editor are peer reviewed to ensure that the arguments are reasonable and clearly expressed. However, letters may express a particular opinion rather than a balanced interpretation. Authors of papers commented on are invited to reply, but neither the journal nor peer reviewers should be assumed to support the arguments made.
Identification of Sources of Endotoxin Exposure as Input for Effective Exposure Control Strategies
Abstract
Objective
Aim of the present study is to investigate the levels of endotoxins on product samples from potatoes, onions, and seeds, representing a relevant part of the agro-food industry in the Netherlands, to gather valuable insights in possibilities for exposure control measures early in the process of industrial processing of these products. Methods
Endotoxin levels on 330 products samples from companies representing the potato, onion, and seed (processing) industry (four potato-packaging companies, five potato-processing companies, five onion-packaging companies, and four seed-processing companies) were assessed using the Limulus Amboecyte Lysate (LAL) assay. As variation in growth conditions (type of soil, growth type) and product characteristics (surface roughness, dustiness, size, species) are assumed to influence the level of endotoxin on products, different types, and growth conditions were considered when collecting the samples. Additionally, waste material, rotten products, felt material (used for drying), and process water were collected. Results
A large variation in the endotoxin levels was found on samples of potatoes, onions, and seeds (overall geometric standard deviation 17), in the range between 0.7 EU g−1 to 16400000 EU g−1. The highest geometric mean endotoxin levels were found in plant material (319600 EU g−1), followed by soil material (49100 EU g−1) and the outer side of products (9300 EU g−1), indicating that removal of plant and soil material early in the process would be an effective exposure control strategy. The high levels of endotoxins found in the limited number of samples from rotten onions indicate that these rotten onions should also be removed early in the process. Mean endotoxin levels found in waste material (only available for seed processing) is similar to the level found in soil material, although the range is much larger. On uncleaned seeds, higher endotoxin levels were found than on cleaned seeds, indicating that cleaning processes are important control measures and also that the waste material should be handled with care. Conclusions
Although endotoxin levels in batches of to–be-processed potatoes, onions, and seeds vary quite dramatically, it could be concluded that rotten products, plant material, and waste material contain particularly high endotoxin levels. This information was used to propose control measures to reduce exposure to endotoxins of workers during the production process.Carbon Monoxide Off-Gassing From Bags of Wood Pellets
Abstract
Wood pellets are increasingly used for space heating in the United States and globally. Prior work has shown that stored bulk wood pellets produce sufficient carbon monoxide (CO) to represent a health concern and exceed regulatory standards for occupational exposures. However, most of the pellets used for residential heating are sold in 40-pound (18.1 kg) plastic bags. This study measured CO emission factors from fresh, bagged-wood pellets as a function of temperature and relative humidity. CO concentrations increased with increasing temperature and moisture in the container. CO measurements in a pellet mill warehouse with stored pallets of bagged pellets had 8-h average CO concentrations up to 100 ppm exceeding occupational standards for worker exposure. Thus, manufacturers, distributors, and home owners should be aware of the potential for CO in storage areas and design facilities with appropriate ventilation and CO sensors.How to Quantitatively Assess Dermal Exposure to Volatile Organic Compounds
Creta et al. (2017) present a method to assess dermal exposure to volatile organic compounds (VOCs) using activated charcoal cloth (ACC Perma-TecTM pads). They clearly demonstrate that in a controlled environmental chamber charcoal cloth patches adsorb vapour in the same way as organic vapour monitors (3MTM 3500). There was a high degree of linearity between the response of the two measurement systems when tested against 181 different VOCs. However, the authors did not undertake any field tests of their system and, surprisingly for a sampler designed to measure dermal exposure, they did not test it using a liquid challenge. They also do not report the mass of VOC required to saturate the adsorbent—a key issue for effective quantification of dermal exposure. Finally, they did not consider how their measurements might relate to dermal uptake, which presumably is the purpose of the sampling system.
A Novel Adjustable Concept for Permeable Gas/Vapor Protective Clothing: Balancing Protection and Thermal Strain
Abstract
Armed forces typically have personal protective clothing (PPC) in place to offer protection against chemical, biological, radiological and nuclear (CBRN) agents. The regular soldier is equipped with permeable CBRN-PPC. However, depending on the operational task, these PPCs pose too much thermal strain to the wearer, which results in a higher risk of uncompensable heat stress. This study investigates the possibilities of adjustable CBRN-PPC, consisting of different layers that can be worn separately or in combination with each other. This novel concept aims to achieve optimization between protection and thermal strain during operations. Two CBRN-PPC (protective) layers were obtained from two separate manufacturers: (i) a next-to-skin (NTS) and (ii) a low-burden battle dress uniform (protective BDU). In addition to these layers, a standard (non-CBRN protective) BDU (sBDU) was also made available. The effect of combining clothing layers on the levels of protection were investigated with a Man-In-Simulant Test. Finally, a mechanistic numerical model was employed to give insight into the thermal burden of the evaluated CBRN-PPC concepts. Combining layers results in substantially higher protection that is more than the sum of the individual layers. Reducing the airflow on the protective layer closest to the skin seems to play an important role in this, since combining the NTS with the sBDU also resulted in substantially higher protection. As expected, the thermal strain posed by the different clothing layer combinations decreases as the level of protection decreases. This study has shown that the concept of adjustable protection and thermal strain through multiple layers of CBRN-PPC works. Adjustable CBRN-PPC allows for optimization of the CBRN-PPC in relation to the threat level, thermal environment, and tasks at hand in an operational setting.On the Identification of Culturable Microorganisms for the Assessment of Biodiversity in Bioaerosols
Abstract
The Annals of Work Exposures and Health recently published two interesting studies combining the use of culture and molecular methods. The method involves the cultivation of bioaerosol samples on agar media and the pick-up of grown colonies 16S rRNA gene amplification, subsequent cloning, sequencing, and identification of bacterial isolates through the assignment against known gene databases. The aim of the present paper is to discuss the contribution of the proposed method in regards with the already proposed approaches used for identification of cultured bacteria. It details the new proposed method and discusses its contribution to the existing culture-based identification methods. Such methods include macroscopic and microscopic observations, miniature biochemical tests (API® trips, VITEK 2® etc.), chemical methods such as the Fatty Acid Methyl Ester (FAME) and the Matrix-assisted laser desorption/ionization time off light (MALDI-TOF) analysis as well polymerase chain reaction (PCR) followed by sequencing. The proposed method supplements the panel of existing biodiversity ones for cultivated bacteria, especially useful for infectious microorganisms, as well as culture-independent ones. As both culture-based and culture-independent methods could therefore be used for the characterization of the occupational environmental microbiome, further applications in other occupational environments as well as additional comparisons with both culture-based and culture-independent methods would complete its characterization.Development of a Job Exposure Matrix for Noise in the Swedish Soft Tissue Paper Industry
Abstract
Objectives
Noise exposure is a common occupational hazard, but has not been sufficiently characterized in paper mills. We developed a job-exposure matrix (JEM) for noise exposure for use in estimating exposures among Swedish soft tissue paper mill workers. Methods
We used a combination of area and personal dosimetry noise exposure measurements made at four soft tissue paper mills by industry and research staff between 1977 and 2013 to estimate noise exposures by department, location, and job title. We then utilized these estimates, in conjunction with information on process and facility changes and use of hearing protection collected via focus groups, to create a seven-category, semi-quantitative JEM for all departments, locations, and job titles spanning the years 1940–2010. Results
The results of the 1157 area and personal dosimetry noise measurements indicated that noise levels have generally declined in Swedish paper mills over time, though these changes have been neither uniform nor monotonic within or across the four mills. Focus group results indicated that use of hearing protection has generally increased over time. The noise JEM totals 1917 cells, with each cell representing a unique combination of operation, job title, and single year. We estimated that ~50% of workers at the four mills assessed were exposed at or above the Swedish 8-h average noise exposure limit of an 85 dBA at the conclusion of the study period in 2010. Conclusions
Our results highlight the continuing need for hearing loss prevention and noise control efforts at these and similar mills, and the completed JEM now represents a tool for use in epidemiological studies of noise-related health outcomes.
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Publication date: Available online 28 September 2017 Source: Actas Dermo-Sifiliográficas Author(s): F.J. Navarro-Triviño
