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Δευτέρα 19 Μαρτίου 2018

Non-point source pollution of glyphosate and AMPA in a rural basin from the southeast Pampas, Argentina

Abstract

We measured the occurrence and seasonal variations of glyphosate and its metabolite, aminomethylphosphonic acid (AMPA), in different environmental compartments within the limits of an agricultural basin. This topic is of high relevance since glyphosate is the most applied pesticide in agricultural systems worldwide. We were able to quantify the seasonal variations of glyphosate that result mainly from endo-drift inputs, that is, from direct spraying either onto genetically modified (GM) crops (i.e., soybean and maize) or onto weeds in no-till practices. We found that both glyphosate and AMPA accumulate in soil, but the metabolite accumulates to a greater extent due to its higher persistence. Knowing that glyphosate and AMPA were present in soils (> 93% of detection for both compounds), we aimed to study the dispersion to other environmental compartments (surface water, stream sediments, and groundwater), in order to establish the degree of non-point source pollution. Also, we assessed the relationship between the water-table depth and glyphosate and AMPA levels in groundwater. All of the studied compartments had variable levels of glyphosate and AMPA. The highest frequency of detections was found in the stream sediments samples (glyphosate 95%, AMPA 100%), followed by surface water (glyphosate 28%, AMPA 50%) and then groundwater (glyphosate 24%, AMPA 33%). Despite glyphosate being considered a molecule with low vertical mobility in soils, we found that its detection in groundwater was strongly associated with the month where glyphosate concentration in soil was the highest. However, we did not find a direct relation between groundwater table depth and glyphosate or AMPA detections. This is the first simultaneous study of glyphosate and AMPA seasonal variations in soil, groundwater, surface water, and sediments within a rural basin.



Repeatability of n-octanol/water partition coefficient values between liquid chromatography measurement methods

Abstract

The n-octanol/water partition coefficient (KOW) is a physical/chemical property that is extensively used for regulatory and environmental risk and exposure assessments. The KOW value can estimate various chemical properties such as water solubility, bioavailability, and toxicity using quantitative structure-activity relationships which demands an accurate knowledge of this property. The present investigation aims to compare outcomes of three commonly cited methods of KOW measurement in the literature for six hydrophobic chemicals with insecticidal functions as well as highly volatile petroleum constituents. This measurement has been difficult to obtain for the selected pyrethroid insecticides, cypermethrin, and bifenthrin and is a novel measurement for the latter: polycyclic aromatic sulfur heterocycles, dibenzothiophene (DBT), and three of its alkyl derivatives except for DBT. The KOW values were obtained using two liquid chromatographic methods with isocratic and gradient programming, and the slow-stirring method following OECD 117 and 123 guidelines, respectively. The mean log KOW values of bifenthrin, cypermethrin, DBT, methyl-DBT, dimethyl-DBT, and diethyl-DBT were 8.4 ± 0.1, 6.0 ± 0.3, 4.8 ± 0.0, 5.4 ± 0.1, 6.0 ± 0.1, and 6.8 ± 0.0 using the HPLC method with gradient programing. The KOW values were significantly reproducible within a method, however, not between the methods. Results suggest assessing a chemical's property and environmental risk and exposure solely based on the KOW value should be practiced with caution.



Managing complex trauma injuries in the elderly: a case report of a free flap and circular frame in a 95-year old patient with an open IIIB tibial fracture

Abstract

In an ageing population, increasing numbers of patients over the age of 70 are sustaining severe trauma. These patients require careful multidisciplinary team (MDT) management with careful consideration of existing co-morbidities, as such their treatment should be individually tailored. We present the case of a patient believed to be the oldest documented patient treated in a trauma setting with free flap and circular frame fixation to an open tibial fracture. A 95-year-old male presented to the Level 1 Major Trauma Centre (MTC) with multiple injuries after a pedestrian vs car incident. His injury severity score (ISS) was 22. For treatment of his open tibial fracture, he required soft tissue coverage with a free anterolateral thigh (ALT) flap, and circular frame application. Microsurgery was performed after consultation with the MDT and was uneventful. The circular frame was removed after 10 months and the patient went on to regain pre-injury mobility. Use of free tissue transfer in elderly patients is well documented in the elective setting, but less so in trauma. This case demonstrates that careful patient selection, attention to detail and MDT working can result in an excellent outcome for the patient. The challenges faced in treating this patient will be described in detail.

Level of Evidence: Level V, therapeutic study.



Predictive significance of breast-specific gamma imaging for upstaging core-needle biopsy-detected ductal carcinoma in situ to invasive cancer

Abstract

Objective

We evaluated the significance of breast-specific gamma imaging (BSGI) for determination of upstaging to invasive cancer from preoperative ductal carcinoma in situ (DCIS).

Methods

This study enrolled 168 patients with 175 breast lesions diagnosed as DCIS on core-needle biopsy that subsequently underwent preoperative BSGI between September 2011 and October 2017. Both qualitative and quantitative analyses using tumor-to-normal background ratio (TNR) and coefficient of variation (COV) were performed, and the predictive significance for upstaging to invasive cancer was investigated. We also sought to identify clinicopathological factors associated with upstaging and their relation to BSGI findings.

Results

Fifty-eight lesions (33.1%) were confirmed to be invasive breast cancer after the final surgical approach. On univariate analysis, tumor size based on ultrasonography (US), hormone status, histologic grade, Breast Imaging Reporting and Data System category, comedo-necrosis, Ki-67 expression, and BSGI findings were associated with upstaging to invasive cancer. Tumor size > 2.0 cm (p = 0.005), Ki-67 expression > 8% (p < 0.001), qualitative BSGI findings (p = 0.020), and COV > 30.44 (p = 0.022) were independently associated with upstaging after multiple regression analysis.

Conclusion

BSGI is a useful imaging modality for predicting upstaging to invasive breast cancer from DCIS on core-needle biopsy in conjunction with US tumor size and Ki-67 expression.



CT-based attenuation correction and resolution compensation for I-123 IMP brain SPECT normal database: a multicenter phantom study

Abstract

Objective

Statistical image analysis of brain SPECT images has improved diagnostic accuracy for brain disorders. However, the results of statistical analysis vary depending on the institution even when they use a common normal database (NDB), due to different intrinsic spatial resolutions or correction methods. The present study aimed to evaluate the correction of spatial resolution differences between equipment and examine the differences in skull bone attenuation to construct a common NDB for use in multicenter settings.

Methods

The proposed acquisition and processing protocols were those routinely used at each participating center with additional triple energy window (TEW) scatter correction (SC) and computed tomography (CT) based attenuation correction (CTAC). A multicenter phantom study was conducted on six imaging systems in five centers, with either single photon emission computed tomography (SPECT) or SPECT/CT, and two brain phantoms. The gray/white matter I-123 activity ratio in the brain phantoms was 4, and they were enclosed in either an artificial adult male skull, 1300 Hounsfield units (HU), a female skull, 850 HU, or an acrylic cover. The cut-off frequency of the Butterworth filters was adjusted so that the spatial resolution was unified to a 17.9 mm full width at half maximum (FWHM), that of the lowest resolution system. The gray-to-white matter count ratios were measured from SPECT images and compared with the actual activity ratio. In addition, mean, standard deviation and coefficient of variation images were calculated after normalization and anatomical standardization to evaluate the variability of the NDB.

Results

The gray-to-white matter count ratio error without SC and attenuation correction (AC) was significantly larger for higher bone densities (p < 0.05). The count ratio error with TEW and CTAC was approximately 5% regardless of bone density. After adjustment of the spatial resolution in the SPECT images, the variability of the NDB decreased and was comparable to that of the NDB without correction.

Conclusion

The proposed protocol showed potential for constructing an appropriate common NDB from SPECT images with SC, AC and spatial resolution compensation.



The Presence of Rape Myths in the Virtual World: A Qualitative Textual Analysis of the Steubenville Sexual Assault Case

Violence and Gender, Ahead of Print.


Psychological Abuse in the Context of Social Media

Violence and Gender, Ahead of Print.


An Exploratory Evaluation of Bystander Intervention Training for Resident Assistants

Violence and Gender, Ahead of Print.


Safety and efficacy of different systemic treatment modalities for acute pain of herpes zoster: A pilot study

Sanjiv Choudhary, Shivani Dhande, Sachin Kharat, AL Singh

Indian Dermatology Online Journal 2018 9(2):101-104

Background: Herpes zoster is a viral infection of skin caused by Varicella Zoster virus. The most important symptom for which the patient seeks medical advice is pain, which is perceived before the development of rash and lasts even after its resolution. The pain during the first 30 days after onset of herpes zoster is known as acute herpetic neuralgia. The aim of this study was to compare the efficacy and side-effects of different systemic treatment modalities for acute herpes zoster neuralgia. Materials and Methods: This was a randomized, single-blind, parallel control study. Forty-five patients of herpes zoster within 72 hours of onset were enrolled after considering various inclusion and exclusion criteria over a duration of 1 year. Pain severity was assessed after sequential distribution and allotment of patients in three groups using verbal rating scale (VRS). Patients in Group A (control group), were treated with Tab.valacyclovir (1 g tds × 7 days), Group B–Tab.valacyclovir (1 g tds × 7 days) + Cap. Pregabalin (75 mg bd × 1 month), and Group C –Tab.valacyclovir (1 g tds × 7 days) +Cap. Pregabalin (75 mg bd × 1 month) + Tab.methylprednisolone (0.64 mg/kg body weight in two divided doses × 7 days). Patients were followed up at 1, 4, 6 weeks. Complete resolution of acute pain and side-effects were noted. Results: At the end of 4 weeks, reduction in acute pain was statistically significant (P < 0.05) in all the three groups individually compared to the baseline value. At the end of 6 weeks, percentage of patients with persistence of pain was more in Group A and B compared to Group C, which was statistically significant (P = 0.0001). In group A, postherpetic neuralgia was observed in more patients compared to group B and C. No significant side-effects were observed in any group except vomiting, somnolence, and dizziness. Limitations: Sample size of this study was limited. Further studies with large sample size are required to further validate the findings of the present study. Conclusions: Combination therapy with valacyclovir, methylprednisolone, and pregabalin has better efficacy compared to valacyclovir and pregabalin and valacyclovir alone in the management of acute herpes zoster neuralgia. No significant side-effects were observed

Pityriasis rosea in a mother and her daughter: A case report

Mehrdad Ashayer, Mina Mirnezami, Hoda Rahimi

Indian Dermatology Online Journal 2018 9(2):131-132



Current situation of leprosy in India and its future implications

P Narasimha Rao, Sujai Suneetha

Indian Dermatology Online Journal 2018 9(2):83-89

The global leprosy situation has changed significantly over the last four decades after the introduction of multidrug therapy (MDT) in 1982 with a reduction in prevalence from over 5 million cases in the mid-1980s to less than 200,000 at the end of 2016. The programme in India also saw a reduction from a prevalence rate of 57.8/10,000 in 1983 to less than 1/10,000 by the end of 2005 when India declared to have reached the World Health Organization (WHO) target of elimination as a public health problem. Post 2005, major changes in the programme were made by the National leprosy eradication programme (NLEP) and the global leprosy programme, which may have affected the new case detection (NCD), disability, and child leprosy trends, which continue to show no appreciable regression. This article reviews the current global and Indian leprosy scenario to bring out its achievements and successes, including the impact of Leprosy Case Detection Campaigns (LCDC) on leprosy numbers. The basis and expected benefits of recent introduction of chemo and immune-prophylaxis in the programme are also discussed. It also discusses the shortcomings, the areas of concern, and the need for an inclusive strategy in the Indian leprosy programme that includes an intersectoral collaboration within the country for reaching the desired goal of leprosy eradication.

Is antifungal resistance a cause for treatment failure in dermatophytosis: A study focused on tinea corporis and cruris from a tertiary centre?

Kabir Sardana, Ravinder Kaur, Pooja Arora, Ritu Goyal, Sneha Ghunawat

Indian Dermatology Online Journal 2018 9(2):90-95

Background: Dermatophytoses are one of the most common skin diseases that have been largely simple to treat. However, in recent years, these infections have become recalcitrant to treatment which can possibly be due to antifungal resistance. Aim: To analyze the resistance pattern of patients with recalcitrant dermatophytoses. Materials and Methods: A cross-sectional evaluation was undertaken of 40 consecutive patients with recalcitrant tinea corporis/cruris/both who had taken systemic antifungal treatment and did not respond completely to therapy or had recurrent lesion within 1 month of stopping the therapy. Terbinafine, fluconazole, itraconazole, ketoconazole, amphotericin B, and voriconazole were the antifungals tested using broth microdilution assay for antifungal susceptibility testing of dermatophytes, and MIC50, 90 values were recorded. Results: KOH mount was positive in 18 (45%) patients, culture was positive in 28 (70%) patients. Trichophyton mentagrophytes (35%) and T. rubrum (27.5%) were the predominant isolates. Overall, activity of terbinafine and itraconazole were significantly higher than the other drugs tested. For terbinafine, both T. mentagrophytes and T. rubrum were inhibited at MIC90of 0.125 μg/ml. Itraconazole-inhibited T. mentagrophytes and T. rubrum at MIC90of 0.0625 and 0.25 μg/ml, respectively. All isolates had reduced susceptibility to fluconazole. Conclusion: While MIC seen were higher than western data, in-vitro resistance (>1 μg/ml) to antifungals was not seen and probably may not be a cause of treatment failure. Possibly, treatment failure lies in the intricate host fungal interaction and virulence of species which help it to evade host immune response.

Use of filters in dermatoscopy to capture better images

Balakrishnan Nirmal

Indian Dermatology Online Journal 2018 9(2):137-138



Nonvenereal penile dermatoses: A retrospective study

Ana Marcos-Pinto, Luís Soares-de-Almeida, João Borges-Costa

Indian Dermatology Online Journal 2018 9(2):96-100

Context: A variety of nonvenereal diseases can affect the penis and diminish quality of life. Many present similar clinical features and a cutaneous biopsy may be necessary to clarify the diagnosis. Aims: To characterize nonvenereal penile dermatoses with histological confirmation in a southwestern Europe hospital during a 9-year period. Materials and Methods: A retrospective study was conducted. We reviewed all penile biopsies performed between January 1, 2007 and December 31, 2015 and studied the causes of the nonvenereal penile dermatoses. Results: The sample included a total of 108 patients, aged 62.9 (±17.8) years, between 16 years and 96 years of age. Eighteen dermatoses were identified. Inflammatory diseases were present in 65. 7% of patients (71/108) and neoplastic dermatoses in 34. 3% (37/108). Concerning inflammatory dermatoses, the most frequent were Zoon balanitis (27.8%, 30/108), followed by lichen sclerosus (15.7%, 17/108), psoriasis (11.1%, 12/108), and lichen planus (4.6%, 5/108). In patients with psoriasis, 10 had lesions only in the penis, similarly to all patients with lichen planus. The most frequent malignant tumor was squamous cell carcinoma (SCC) (15.7%, 17/108). The most common in-situ tumor was erythroplasia of Queyrat (8.3%, 9/108). A case of basal cell carcinoma (BCC) was found. Kaposi sarcoma and mycosis fungoides on penis were also diagnosed, as an additional form of presentation to their generalized disease. Conclusions: In this study, inflammatory diseases were the most frequently diagnosed dermatoses, while SCC was the most common malignant tumor found. In the majority of psoriasis and lichen planus cases, clinical lesions were only present in the genital area.

Blaschkoid angioma serpiginosum: A dermoscopic diagnosis

Preema Sinha, Prince Y Singh, Aradhana Sood, Reena Bharadwaj

Indian Dermatology Online Journal 2018 9(2):127-129



Through the lens: Cryoglobulinemia

Shekhar Neema, D Banerjee, SK Pramanik

Indian Dermatology Online Journal 2018 9(2):135-135



Nail transillumination combined with dermoscopy for enhancing diagnosis of subungual hematoma

Feroze Kaliyadan, Karalikkattil T Ashique

Indian Dermatology Online Journal 2018 9(2):105-106



Dermoscopy of angiokeratoma

Abhijeet K Jha, Sidharth Sonthalia, Deepak Jakhar

Indian Dermatology Online Journal 2018 9(2):141-142



Multispectral dermatoscopic features of chemical leucoderma with pigmented contact dermatitis

Balakrishnan Nirmal, Borra Santhikiran, Sramana Mukhopadhyay

Indian Dermatology Online Journal 2018 9(2):107-109

Chemical leukoderma is characterized by pigment loss on constant exposure to chemical agents. Its association with pigmented contact dermatitis is rare. Here, we report a 40-year-old female presenting with depigmented macule with surrounding hyperpigmentation over the upper forehead. We used a multispectral dermatoscope by which decreased pigment network was better visualized with blue light, and gray granular dots were better appreciated with yellow light. Shorter wavelengths delineate epidermal features better whereas longer wavelengths highlight dermal features in multispectral dermatoscopy.

Nasal mucosal dysplasia induced by topical corticosteroids with benzalkonium chloride

Funda Tamer, Erol Koc, Taylan Gun, Can Ergin

Indian Dermatology Online Journal 2018 9(2):126-127



Clinical spectrum of autoerythrocyte sensitization syndrome: A series of five cases

Nandakishore Singh Thokchom, D Pradeepa, NA Bishurul Hafi, Kapila Verma

Indian Dermatology Online Journal 2018 9(2):110-113

Autoerythrocyte sensitization syndrome (Gardner Diamond syndrome or GDS) is a rare syndrome characterized by painful and spontaneous purpura commonly affecting adult women, and is mostly associated with psychiatric illness. Diagnosis is mainly based on clinical presentation, exclusion of other simulating diseases, and psychiatric evaluation. Only few cases have been reported till date. We report five cases of spontaneous purpura with a normal investigation profile, except for iron deficiency anemia in 1 patient, of which three had associated underlying psychiatric illness. Autoerythrocyte sensitization test was positive in all our cases. Patients presenting with painful bruises without significant medical history such as underlying bleeding disorder or drug history or history of trauma should be considered for autoerythrocyte sensitization syndrome, and managed accordingly. The present study is a case series of patients with characteristic features of autoerythrocyte sensitization syndrome, considering the rarity of the reports on its clinical spectra.

Verrucous disseminated discoid lupus erythematosus with plantar and oral lesions in the absence of systemic lupus erthyematosus

Sruthy Manikkath, Raman Balakrishna Venkatta, Sukumaran Pradeep Nair, Gopinathan Nanda Kumar

Indian Dermatology Online Journal 2018 9(2):129-131



Olmsted syndrome with lateral supraciliary madarosis and clubbing: A rare case report

Md Zeeshan, Abhijeet K Jha, R. K. P Chaudhary

Indian Dermatology Online Journal 2018 9(2):114-116

Olmsted syndrome (OS) is a rare congenital, mutilating palmoplantar keratoderma first described by Olmsted in 1927. It starts in the neonatal period or in childhood, and has a slow but progressive disabling course. We report the case of a 16-year-old boy who presented with keratoderma of the palm and soles since childhood with lateral supraciliary madarosis and clubbing. The patient was started on oral retinoids and topical keratolytics and had partial improvement in 2 months. Keratoderma of the palms and soles along with lateral supraciliary madarosis and clubbing in our case is a very rare finding, and to the best of our knowledge, has not been reported so far.

SkIndia Quiz 44: Growing asymptomatic nodule on the ear

Alyssa Miceli, Ann Church, Sarah Ferrer-Bruker

Indian Dermatology Online Journal 2018 9(2):133-134



Granuloma annulare skin lesions in a case of sarcoidosis

Ajay Chopra, Debdeep Mitra, Loknandini Sharma, Reetu Agarwal

Indian Dermatology Online Journal 2018 9(2):117-119

We report the case of a 32-year- old man with a short 3-week history of erythematous, annular, non scaly plaques on palmar and dorsal aspect of his hands, who was concurrently diagnosed as a case of sarcoidosis on the basis of findings of generalized lymphadenopathy and radiological and histological features of pulmonary sarcoidosis. His skin biopsy was consistent with the diagnosis of granuloma annulare. Sarcoidosis and granuloma annulare are two separate diseases, which involve the skin and have a mononuclear histiocytic cellular reaction, although their aetiology is still unknown. Granuloma annulare has been associated with the concomitant diagnosis of sarcoidosis in only two more case reports and this association can be evaluated further to study a common link in the aetipathogenesis of these two granulomatous skin diseases.

An “Abnormal” hair through the dermoscope: Arthropod body part mimicking a hair

Feroze Kaliyadan

Indian Dermatology Online Journal 2018 9(2):136-136



Antifungal efficacy of amphotericin b against dermatophytes and its relevance in recalcitrant dermatophytoses: A commentary

Surabhi Sinha, Kabir Sardana

Indian Dermatology Online Journal 2018 9(2):120-122



Dermoscopy of hailey hailey disease

Payal Chauhan, Dilip Meena, Neirita Hazarika

Indian Dermatology Online Journal 2018 9(2):139-140



Automatic bladder segmentation from CT images using deep CNN and 3D fully connected CRF-RNN

Abstract

Purpose

Automatic approach for bladder segmentation from computed tomography (CT) images is highly desirable in clinical practice. It is a challenging task since the bladder usually suffers large variations of appearance and low soft-tissue contrast in CT images. In this study, we present a deep learning-based approach which involves a convolutional neural network (CNN) and a 3D fully connected conditional random fields recurrent neural network (CRF-RNN) to perform accurate bladder segmentation. We also propose a novel preprocessing method, called dual-channel preprocessing, to further advance the segmentation performance of our approach.

Methods

The presented approach works as following: first, we apply our proposed preprocessing method on the input CT image and obtain a dual-channel image which consists of the CT image and an enhanced bladder density map. Second, we exploit a CNN to predict a coarse voxel-wise bladder score map on this dual-channel image. Finally, a 3D fully connected CRF-RNN refines the coarse bladder score map and produce final fine-localized segmentation result.

Results

We compare our approach to the state-of-the-art V-net on a clinical dataset. Results show that our approach achieves superior segmentation accuracy, outperforming the V-net by a significant margin. The Dice Similarity Coefficient of our approach (92.24%) is 8.12% higher than that of the V-net. Moreover, the bladder probability maps performed by our approach present sharper boundaries and more accurate localizations compared with that of the V-net.

Conclusion

Our approach achieves higher segmentation accuracy than the state-of-the-art method on clinical data. Both the dual-channel processing and the 3D fully connected CRF-RNN contribute to this improvement. The united deep network composed of the CNN and 3D CRF-RNN also outperforms a system where the CRF model acts as a post-processing method disconnected from the CNN.



Deltamethrin-induced nuclear erythrocyte alteration and damage to the gills and liver of Colossoma macropomum

Abstract

Deltamethrin is one of the most commonly used pyrethroids in the world, and it has a high toxic potential, mainly on aquatic organism. Thus, the purpose of this study was to evaluate LC50 values of deltamethrin on tambaqui (Colossoma macropomum) fingerlings and to investigate genotoxic effects and histopathological responses. Fish were exposed to different concentrations of deltamethrin (0, 6.16 × 10−3; 6.44 × 10−2; 1.34 × 10−1, and 1.93 × 10−1 mg L−1) for 96 h. In addition, a genotoxicity analysis was carried out on peripheral blood erythrocytes and histopathological changes were classified by the severity degree of damage and organ functioning. The 96 h LC50 value for tambaqui was estimated at 5.56 × 10−2 mg L−1 using a static test system. Nuclear abnormalities in exposed fish included micronuclei, blebbed, notched, 8-shaped, and binucleated nuclei forms. Deltamethrin significantly induced a notched nucleus compared to other abnormalities. A histopathological examination showed hepatic lesions and gill damage. Deltamethrin was found to be highly toxic; it induced genotoxicity and caused liver and gill inflammation in tambaqui.



Cadmium exposure and early renal effects in the children and adults living in a tungsten-molybdenum mining areas of South China

Abstract

Adverse health effects related to accumulative cadmium (Cd) exposure have aroused widespread attention from the public in China. Knowledge on the relationships between Cd exposure and early renal effects is particularly limited for children, who are more susceptible to absorbing metals than adults. A typical Cd-polluted area of South China was selected to determine the Cd exposure and related early renal effects of the general population, including children. In total, 211 children and 806 adults were enrolled in the study. The urinary levels of Cd (U-Cd), β2-microglobulin (U-BMG), retinol binding protein (U-RBP), and N-acetyl-β-d-glucosaminidase (U-NAG) were measured. The relationship between U-Cd and ranked indicators of early renal effects was examined by multiple regression analysis. The average U-Cd ranged from 7.01 μg/g creatinine (boys) to 13.55 μg/g creatinine (women) in the Cd-polluted areas. These values are much higher than those of the control group and those that have been reported by other countries. In agreement with previous studies, environmental Cd pollution resulted in elevated Cd accumulation in the bodies of children, and it increased the concentration of NAG in their urine. Similarly, environmental Cd pollution increased NAG and BMG in the urine of adults. Multivariate models showed that the urinary excretion of BMG, RBP, and NAG was positively associated with Cd levels in the urine of both children and adults. The reference thresholds of U-Cd in relation to elevated U-BMG, U-RBP, and U-NAG were higher in children than adults after standardization for other covariates. These results reinforce the need to control and regulate the sources of environmental Cd contamination and to promote more effective risk management measures, especially for vulnerable groups.



Infections cutanées à corynébactéries

Publication date: Available online 24 February 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A. Osio




Editorial board

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Publication date: February 2018
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 2





Stomatite bulleuse hémorragique (Angina bullosa haemorragica). Pré-test

Publication date: Available online 7 March 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): F. Plantier




Melanocitosis dérmica agminada en el territorio del nevus de Ota

Publication date: Available online 17 March 2018
Source:Actas Dermo-Sifiliográficas
Author(s): L. Diluvio, M. Mazzeo, L. Bianchi, E. Campione




Liquen escleroso extragenital inducido por radioterapia

Publication date: Available online 19 March 2018
Source:Actas Dermo-Sifiliográficas
Author(s): M. Bonfill-Ortí, L. Martínez-Molina, R.M. Penín, J. Marcoval




Item 167 – UE 6 Ectoparasitoses cutanées : gale et pédiculose

Publication date: Available online 15 February 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): CEDEF




La gangrène périphérique symétrique : à propos de 4 cas

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Publication date: February 2018
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 2
Author(s): F. Smaoui, M. Koubaa, K. Rekik, Y. Mejdoub, S. Mezghani, I. Maaloul, A. Hammami, C. Marrakchi, M. Ben Jemaa
IntroductionLa gangrène périphérique symétrique (GPS) est une lésion ischémique distale symétrique touchant au moins deux extrémités, en l'absence d'obstruction artérielle proximale et de vasculite. C'est une entité clinique rare et sévère. Nous avons souhaité étudier les signes cliniques, les agents étiologiques et la prise en charge de la GPS à travers une série de quatre cas.Malades et méthodesNous rapportons tous les cas de GPS hospitalisés dans notre centre entre 2000 et 2014. Les critères d'inclusion étaient : la présence d'une lésion ischémique distale et symétrique sur deux sites ou plus, en l'absence d'obstruction des vaisseaux de gros calibre.RésultatsIl s'agissait de 2 hommes et 2 femmes, d'âge moyen 43,2±12 ans. Tous avaient des lésions de nécrose cutanée au niveau des pulpes des doigts et des orteils. Trois ont présenté un état de choc septique. Deux avaient un antécédent de splénectomie. L'affection sous-jacente était une bactériémie à Streptococcus pneumoniae dans 2 cas et une forme maligne de la fièvre boutonneuse méditerranéenne (FBM) dans 2 cas. En plus du traitement antibiotique spécifique, nous avons utilisé un vasodilatateur (iloprost) dans 2 cas et une héparinothérapie curative dans 2 cas. L'évolution était favorable dans 3 cas, avec régression des lésions nécrotiques. Un cas a nécessité le recours à une amputation de tous les orteils et des doigts non perfusés.ConclusionLa GPS peut compliquer rarement une FBM. Un examen cutané minutieux et répété est indispensable pour évoquer et traiter à temps la GPS afin d'améliorer son pronostic.BackgroundSymmetric peripheral gangrene (SPG) is a symmetrical distal ischemic lesion on at least 2 or more extremities in the absence of proximal arterial obstruction and vasculitis. It is a rare and severe clinical entity. The aim of this study was to describe clinical symptoms, etiological agents and the management of SPG through a series of 4 cases.Patients and methodsWe included all cases of SPG hospitalized between 2000 and 2014. The inclusion criterion was the presence of distal ischemic damage at two or more sites in the absence of large vessel obstruction.ResultsFour patients (2 men and 2 women) were included. The mean age was 43.2±12 years. Two patients had a history of splenectomy. All patients had blackening of the tips of the fingers and toes. Three patients presented with septic shock. The etiology was bacteremia involving Streptococcus pneumoniae in two cases and a malignant form of Mediterranean spotted fever (MSF). In addition to specific antibiotics, we used a potent vasodilator (iloprost) in two cases and curative heparin therapy in two cases. The outcome was favorable in 3 cases, with regression of necrotic lesions. One case required the amputation of non-perfused necrotic fingers and toes.ConclusionSPG can complicate MSF in some rare cases. Thorough and repeated skin examinations are essential to ensure timely diagnosis and treatment of GPS in order to improve the prognosis.



Angiosarcome sur lymphœdème primaire du membre inférieur : une complication rare

Publication date: Available online 9 March 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M.-M. Farhat, A. Le Guern, C. Peugniez, F. Dabouz, J.-F. Quinchon, P. Modiano
IntroductionLes lymphœdèmes chroniques se compliquent classiquement d'épisodes récidivants de dermo-hypodermite. Les dégénérescences sous forme d'angiosarcome (syndrome de Stewart-Treves) sont plus rares. Elles surviennent surtout aux membres supérieurs, dans les suites du traitement chirurgical ou radiothérapeutique de néoplasies mammaires. Nous rapportons l'observation exceptionnelle d'un syndrome de Stewart-Treves (STS) du membre inférieur compliquant un lymphœdème congénital.ObservationUne femme de 69 ans, suivie pour lymphœdème bilatéral des membres inférieurs évoluant depuis 30 ans, développait des lésions nécrotiques douloureuses du membre inférieur gauche. La biopsie d'une lésion nodulaire permettait le diagnostic d'angiosarcome. Une exérèse chirurgicale n'étant pas envisageable devant l'étendue des lésions, une chimiothérapie par paclitaxel à la posologie de 175mg/m2 tous les 21jours était proposée. L'évolution était rapidement défavorable ; la patiente décédait à son domicile au décours de sa troisième cure.DiscussionL'angiosarcome est une complication exceptionnelle des lymphœdèmes primitifs ; le traitement est mal codifié et le pronostic mauvais.BackgroundChronic lymphoedema is classically complicated by recurring episodes of cellulitis. Degeneration to the angiosarcoma form (Stewart-Treves syndrome) is much less common. It occurs mainly in the upper limbs following surgery or radiotherapy for mammary neoplasia. Herein we report a rare case of Stewart-Treves syndrome (STS) of the lower limb as a complication of congenital lymphoedema.Patients and methodsA 69-year-old woman treated for bilateral lower-limb oedema present for 30years developed painful necrotic lesions in her left lower limb. A diagnosis of angiosarcoma was made based on biopsy of a nodular lesion. Since surgical excision was precluded by the extent of the lesions, chemotherapy was initiated with paclitaxel 175mg/m2 every 21days. The outcome was rapidly unfavourable and the patient died at her home during the third course of treatment.DiscussionAngiosarcoma is an extremely rare complication of primary lymphoedema; treatment is poorly codified and the prognosis is unfavourable.



Item 109 – UE 4 Dermatoses faciales : acné, rosacée, dermatite séborrhéique

Publication date: Available online 9 February 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): CEDEF




Calciphylaxie chez l’insuffisant rénal dialysé : 8 malades traités par thiosulfate de sodium

Publication date: Available online 8 March 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): S. Devey, A. Valois, G. Cazajous, J. Beaume, S. Abed, I. Okhremchuk, S. Spadoni, T. Boyé, J.-J. Morand




Item 113 – UE 4 Prurit

Publication date: Available online 16 February 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): CEDEF




Stomatite bulleuse hémorragique (angina bullosa haemorragica)

Publication date: Available online 7 March 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): F. Plantier




Compléments en ligne

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Publication date: Available online 12 February 2018
Source:Annales de Dermatologie et de Vénéréologie





Hypertrichose diffuse révélant une hyperplasie congénitale des surrénales de forme non classique

Publication date: Available online 7 March 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Berthin, P. Sibilia, J. Martins-Hericher, A. Donzeau, L. Martin
IntroductionL'hyperplasie congénitale des surrénales non classique (HCS-NC) est une maladie autosomique récessive causée par un déficit des enzymes de la stéroïdogenèse surrénalienne. Elle est à distinguer de l'HCS classique, virilisante pure ou avec perte de sel, diagnostiquée en période néonatale, responsable d'anomalies de la différenciation sexuelle, potentiellement létale. L'HCS-NC se présente par un tableau clinique plus fruste, peu spécifique. Nous rapportons deux cas chez des jumelles consultant pour une hypertrichose diffuse.ObservationDeux jumelles de 5 ans étaient amenées en consultation pour une pilosité accrue des quatre membres, sans pilosité faciale ni synophrys, et des comédons du menton. Leur développement staturopondéral et psychomoteur était normal, sans avance pubertaire ni hypertrophie clitoridienne. Les taux de 17OH-P et SDHA étaient élevés, FSH et LH basses, IGF1 et TSH normaux. L'analyse du gène CYP21 associé à l'HCS-NC trouvait les mutations p.V281L et IVS2-13A/C>G. La mutation p.V281L était présente à l'état hétérozygote, associée à une hyperpilosité modérée sans hirsutisme ni acné, chez la grande sœur et le père. Aucune mutation n'était trouvée chez la mère, en faveur d'une apparition de novo de la mutation IVS2-13A/C>G chez les jumelles ou d'une mosaïque germinale chez la mère.DiscussionNous avons retenu la responsabilité de l'HCS-NC dans la survenue d'une hypertrichose diffuse chez ces jumelles. Cette maladie n'est pas rare, sa prévalence est de 1/1000 à 1500 dans la population d'ascendance européenne. Son diagnostic est souvent tardif car il n'y a pas de dépistage néonatal systématique. Dans certains cas, l'HCS-NC est asymptomatique. L'apparition de poils pubiens vers 5 à 7 ans constitue le premier motif de consultation, notamment chez un dermatologue. L'hyperandrogénie est variable, associant hirsutisme, acné, troubles de la fertilité et avance de l'âge osseux. Les taux de cortisol et d'aldostérone sont souvent normaux. Le risque d'insuffisance surrénalienne aiguë est extrêmement faible. Les diagnostics différentiels sont les tumeurs ovariennes, surrénaliennes ou le syndrome des ovaires polykystiques. Le déficit en 21-OH entraîne un défaut de synthèse du cortisol et de l'aldostérone et donc une augmentation de l'ACTH, responsable de l'augmentation de la sécrétion d'androgènes surrénaliens. L'apparition précoce des caractères sexuels secondaires est en lien avec l'accumulation progressive de 17-OHP. Suivant la sévérité, un traitement par hydrocortisone ou par anti-androgènes peut être proposé ou en cas d'inefficacité un traitement esthétique par épilation ou décoloration.ConclusionL'apparition de poils pubiens et l'hirsutisme sont souvent les premiers motifs de consultation, y compris par les dermatologues, chez les enfants atteint d'HCS-NC. Mais une hypertrichose peut être isolée. Ces anomalies ne doivent pas être méconnues, afin de permettre un diagnostic précoce et l'introduction rapide d'un traitement simple et facilement accessible.BackgroundNon-classical congenital adrenal hyperplasia (NC-CAH) is a recessive autosomal disease caused by a deficiency of adrenal steroidogenesis enzymes. It must be distinguished from classical CAH, either simple virilising or salt-wasting, diagnosed during the neonatal period and responsible for potentially lethal disorders of sexual differentiation. NC-CAH presents a simpler and less specific clinical picture. Herein, we present two cases comprising twin girls consulting for diffuse hypertrichosis.Patients and methodsTwo 5-year-old twin girls were seen at our consultation for increased pilosity on all four limbs, but with no facial pilosity or synophrys, as well as comedones on the chin. Their height and weight and psychomotor development was normal, with no signs of precocious puberty and no clitoral hypertrophy. Levels of 17OH-P and SDHA were high, while FSH and LH were low and IGF1 and TSH were normal. Analysis of gene CYP21 associated with NC-CAH showed mutations p.V281L and IVS2-13A/C>G. Mutation p.V281L was present in the heterozygous state in the older sister and the father, together with moderate hyperpilosity but without hirsutism or acne. No mutations were found in the mother, indicating either de novo appearance of mutation IVS2-13A/C>G in the twins or germline mosaicism in the mother.DiscussionWe diagnosed NC-CAH as the cause of diffuse hypertrichosis in these twins. This disease is not rare, with a prevalence of 1/1000 to 1500 among peoples of European descent. It is often diagnosed late since routine neonatal screening is not performed. In some cases, NC-CAH remains asymptomatic. The appearance of pubic hair at around 5 to 7 years is the initial reason for consultation, particularly with a dermatologist. Hyperandrogenism varies, involving hirsutism, acne, fertility disorders and premature ageing of bone. Cortisol and aldosterone levels are generally normal. The risk of acute adrenal insufficiency is extremely low. Differential diagnosis concerns ovarian or adrenal tumors and polycystic ovary syndrome. 21-OH deficiency results in defective cortisol and aldosterone synthesis, and thus in raised ACTH, leading to increased adrenal androgen secretion. The early appearance of secondary sexual characteristics is associated with a gradual accumulation of 17-OHP. Depending on severity, hydrocortisone or anti-androgens may be given, or where treatment fails, aesthetic measures such as epilation or hair discolouration may be performed.ConclusionIn children presenting NC-CAH, the appearance of pubic hair and hirsutism often constitute the initial reasons for consultation, including with dermatologists. However, hypertrichosis may occur in isolation. It is important that these abnormalities be clearly known to enable early diagnosis and rapid initiation of simple and readily accessible treatment.



Stomatite bulleuse hémorragique (Angina bullosa haemorragica). Réponses au pré-test

Publication date: Available online 7 March 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): F. Plantier




Brûlure du cuir chevelu induite par les décolorations capillaires

Publication date: Available online 15 March 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): P. Bouschon, A.-C. Bursztejn, J. Waton, F. Brault, J.-L. Schmutz
IntroductionLes décolorations capillaires sont des procédures de plus en plus souvent réalisées dans les salons de coiffure. Les produits utilisés sont du peroxyde d'hydrogène et des persulfates, agents chimiques actifs mélangés en milieu basique. Rarement publiée, la brûlure secondaire à la procédure de décoloration capillaire est un effet indésirable traumatisant qui reste peu connu des professionnels de santé.ObservationNous rapportons le cas d'une jeune fille de 15 ans qui présentait une plaque d'alopécie cicatricielle séquellaire du vertex. Cette lésion résultait d'une brûlure profonde faisant suite à une procédure de décoloration capillaire qu'elle avait fait réaliser chez son coiffeur habituel. La cicatrisation avait duré environ quatre mois, occasionnant un mal-être chez la patiente.DiscussionIl s'agit d'un cas rare d'alopécie cicatricielle consécutive à une brûlure chimique basique du cuir chevelu. La réaction d'oxydation induite par le mélange de peroxyde d'hydrogène et de persulfates, préparé en milieu basique, provoque la décoloration des pigments mélaniques des cheveux. La présentation clinique à type d'ulcération unique, bien limitée, suintante, douloureuse, située au niveau du vertex, est similaire aux autres observations publiées dans la littérature. Le mécanisme de brûlure chimique est le plus souvent retenu. Cependant, la procédure étant toujours couplée à l'utilisation d'une source de chaleur, une brûlure thermique peut être associée. L'apparition retardée de la lésion serait due au fait que le mélange de peroxyde d'hydrogène et de persulfates forme des tensioactifs qui favorisent la dissolution lente des composés oxydants au sein de la couche cornée.BackgroundHair bleaching is increasingly being carried out in hairdressing salons. The products used are a mixture of hydrogen peroxide and persulfates, both active chemical agents. Scalp burns secondary to hair bleaching are a traumatic adverse effect rarely discussed in publications that continue to be little known among healthcare professionals.Patients and methodsWe report the case of a 15-year-old girl with a plaque of scarring alopecia on the vertex. This lesion resulted from a deep burn following a hair-bleaching procedure. Healing took around 4 months, resulting in discomfort for our patient.DiscussionThis is a rare case of scarring alopecia following a basic chemical burn to the scalp. The oxidation reaction induced by the mixture of hydrogen peroxide and persulfates, prepared in a basic medium, causes bleaching of the melanin pigments in hair. The clinical presentation of a single, well limited, painful, oozing ulceration located at the vertex was similar to the other cases published in the literature. Although a chemical burning mechanism is most often incriminated, the procedure is always coupled with use of a heat source and associated thermal burn may occur. The delayed appearance of the lesion appears to be caused by the forming of surfactants by the hydrogen peroxide/persulfate mixture, resulting in slow dissolution of the oxidizing compounds within the stratum corneum.



Item 111 – UE 4 Hémangiomes et malformations vasculaires cutanées

Publication date: Available online 16 February 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): CEDEF




Item 237 – UE 8 Acrosyndromes. Phénomène de Raynaud, érythermalgie, acrocyanose, engelures, ischémie digitale

Publication date: Available online 14 February 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): CEDEF




Caractéristiques cliniques et évolutives de la kératodermie aquagénique de l’enfant : étude rétrospective de 12 cas

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Publication date: Available online 24 February 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Denos, I. Dreyfus, C. Chiaverini, C. Labreze, C. Abasq, A. Phan, S. Mallet, L. Monteil, J. Mazereeuw-Hautier
IntroductionLa kératodermie aquagénique (KA) est caractérisée par l'apparition de papules blanchâtres, d'un aspect fripé et d'une desquamation des mains au contact avec l'eau. En dehors du contexte de la mucoviscidose, la KA semble rare (13 cas) et mal connue chez l'enfant. De plus, l'association à la mucoviscidose est source de peurs chez les parents et les médecins. L'objectif de ce travail est de décrire les caractéristiques et de discuter la prise en charge de la KA de l'enfant.Matériel et méthodeÉtude rétrospective, multicentrique, incluant les enfants de moins de 16 ans atteints de KA.RésultatsChez les 12 enfants inclus, l'âge médian de début était de 9,25 ans (20 mois–15 ans). L'aspect clinique et le mode de survenue étaient classiques ; l'atteinte des paumes était plus sévère que celle des plantes. Des signes fonctionnels étaient associés dans six cas. Le retentissement médian était de 1,5 sur une échelle de 10. Le test de la sueur était négatif chez deux patients. L'analyse moléculaire du gène CFTR, réalisée chez trois patients, était négative chez un et montrait une mutation hétérozygote dans les deux autres cas. L'évolution se faisait vers la stabilité chez huit patients, l'aggravation chez deux autres, la guérison et l'amélioration chacune dans un cas.DiscussionC'est à notre connaissance la première série de KA de l'enfant. Les caractéristiques cliniques ne diffèrent pas significativement de celles de l'adulte ; le retentissement est modéré et l'évolution variable. Un bilan systématique visant à éliminer une mucoviscidose ne semble pas justifié chez l'enfant puisque à ce jour aucune mucoviscidose n'a été diagnostiquée devant une KA isolée.ConclusionLa KA est rare chez l'enfant ; elle ne doit pas inquiéter à tort et peut évoluer vers l'amélioration ou la guérison.IntroductionAquagenic keratoderma (AK) is a rare condition characterized by wrinkled and edematous appearance of the skin of the hands occurring within minutes of immersion in water. Other than in a setting of cystic fibrosis, AK has rarely been reported in children, with only 13 clinical cases on record. Many clinicians are unfamiliar with AK and have fears relating to the association with cystic fibrosis The aim of this study is to describe the characteristics and to discuss management of the disease.MethodsRetrospective, multicentre study, including children aged under 16 years presenting AK.Results12 children were included. KA started at a mean age of 9.25 years (range: 20 months to 15 years). Clinical appearance and mode of onset were classical, with the palms being more severely affected than the soles. Pruritus or pain were reported in six cases. The median impact on daily life was 1.5/10. Some of the children underwent investigations: two had a negative sweat test, three had molecular analysis of the gene CFTR: one was negative and two had a heterozygote mutation. The course of the disease was variable: eight stabilizations, two exacerbations, one cure and one improvement.DiscussionThis is the first series on childhood KA. Clinical characteristics were similar to those seen in adults. Impact was moderate and the disease course was variable. Systematic medical check-up for cystic fibrosis does not appear warranted in children since to date, cystic fibrosis has not been diagnosed in any patients presenting AK alone.ConclusionAK is rare in children and should not cause erroneous concern, and improvement can occur.



Guide de la carrière hospitalo-universitaire en dermatologie. Programme GRENT (Graines Engrais Tuteurs)

Publication date: Available online 12 February 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Gaudy-Marqueste, M. Samimi, A. Soria, S. Aractingi, C. Bodemer, O. Chosidow, B. Cribier, J.P. Lacour, C. Paul, M.A. Richard, M. Beylot-Barry, B. Dreno




Inhibition of proinflammatory pathways by bioactive fraction of Tinospora cordifolia

Abstract

Tinospora cordifolia (Willd.) Miers ex Hook. f. & Thomson, a known immunomodulatory agent extensively used in ayurveda, has not been effectively validated for the mechanisms involved in immunomodulation and the identification of the active principles. The bioactive fraction of T. cordifolia (TBF) in methanol was used for nitric oxide (NO) radical scavenging activity, lipoxygenase (LOX) and cyclooxygenase (COX) dual inhibition and cytotoxicity studies. Production of the proinflammatory cytokines, tumour necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in dendritic cell (DC) suspensions treated with lipopolysaccharide (LPS) was also studied. The bioactive principles involved were identified with ultra-performance liquid chromatography-quadrupole-time of flight mass spectrometric (UPLC-Q-ToF MS/MS) system. The results indicate significantly higher potency of TBF as compared to positive standards for LOX/COX inhibition with moderate NO radical scavenging activity and the fraction was also found to be non-cytotoxic to monocyte cells. A significant inhibition was also observed in TNF-α and IL-1β production in LPS-treated DC suspensions as compared to standards, rolipram and dexamethasone, respectively. 11 compounds were identified from TBF by MS/MS system. The potent inhibition of LOX and COX enzymes with moderate NO scavenging was indicative of a free radical scavenging-independent mechanism of immunomodulation. Further investigations into the active principles identified would result in the development of lead candidates with potent therapeutic implications.



PPARα/γ antagonists reverse the ameliorative effects of osthole on hepatic lipid metabolism and inflammatory response in steatohepatitic rats

Abstract

Our previous studies have indicated that osthole may ameliorate the hepatic lipid metabolism and inflammatory response in nonalcoholic steatohepatitic rats, but the underlying mechanisms remain unclear. This study aimed to determine whether the effects of osthole were mediated by the activation of hepatic peroxisome proliferator-activated receptor α/γ (PPARα/γ). A rat model with steatohepatitis was induced by orally feeding high-fat and high-sucrose emulsion for 6 weeks. These experimental rats were then treated with osthole (20 mg/kg), PPARα antagonist MK886 (1 mg/kg) plus osthole (20 mg/kg), PPARγ antagonist GW9662 (1 mg/kg) plus osthole (20 mg/kg) and MK886 (1 mg/kg) plus GW9662 (1 mg/kg) plus osthole (20 mg/kg) for 4 weeks. The results showed that after osthole treatment, the hepatic triglycerides, free fatty acids, tumor necrosis factor-α, monocyte chemotactic protein-1, interleukin-6 (IL-6), IL-8 and liver index decreased by 52.3, 31.0, 32.4, 28.9, 36.3, 29.3 and 29.9%, respectively, and the score of steatohepatitis also decreased by 70.0%, indicating that osthole improved the hepatic steatosis and inflammation. However, these effects of osthole were reduced or abrogated after simultaneous addition of the specific PPARα antagonist MK886 or/and the PPARγ antagonist GW9662, especially in the co-PPARα/γ antagonists-treated group. Importantly, the osthole-induced hepatic expressions of PPARα/γ proteins were decreased, and the osthole-regulated hepatic expressions of lipogenic and inflammatory gene proteins were also reversed by PPARα/γ antagonist treatment. These findings demonstrated that the ameliorative effect of osthole on nonalcoholic steatohepatitis was mediated by PPARα/γ activation, and osthole might be a natural dual PPARα/γ activator.



CCR2 contributes to the recruitment of monocytes and leads to kidney inflammation and fibrosis development

Abstract

Chemokines are a large family of proteins that, once associated to its receptor on leukocytes, stimulate their movement and migration from blood to tissues. Once in the tissue, immune cells trigger inflammation that, when uncontrolled, leads to fibrosis development. Among the immune cells, macrophages take a special role in fibrosis formation, since macrophage depletion reflects less collagen deposition. The majority of tissue macrophages is derived from monocytes, especially monocytes expressing the chemokine receptor CCR2. Here, we investigated the role of infiltrating CCR2+ cells in the development of fibrosis, and specifically, the dynamic of infiltration of these cells into kidneys under chronic obstructive lesion. Using liposome-encapsulated clodronate, we observed that macrophage depletion culminated in less collagen deposition and reduced chemokines milieu that were released in the damaged kidney after obstructive nephropathy. We also obstructed the kidneys of CCL3−/−, CCR2−/−, CCR4−/−, CCR5−/−, and C57BL/6 mice and we found that among all animals, CCR2−/− mice demonstrated the more robust protection, reflected by less inflammatory and Th17-related cytokines and less collagen formation. Next we evaluated the dynamic of CCR2+/rfp cell infiltration and we observed that they adhere onto the vessels at early stages of disease, culminating in increased recruitment of CCR2+/rfp cells at later stages. On the other hand, CCR2rfp/rfp animals exhibited less fibrosis formation and reduced numbers of recruited cells at later stages. We have experimentally demonstrated that inflammatory CCR2+ cells that reach the injured kidney at initial stages after tissue damage are responsible for the fibrotic pattern observed at later time points in the context of UUO.



A 36-Year-Old Woman From West Africa With Newly Diagnosed AIDS and a Spinal Cord Mass

(See page 1147 for the Photo Quiz.)

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A 36-Year-Old Woman From West Africa With Newly Diagnosed AIDS and a Spinal Cord Mass

(See pages 1148–9 for the Answer to the Photo Quiz.)

Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)

Abstract
A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults. The update, which has incorporated recommendations for children (following the adult recommendations for epidemiology, diagnosis, and treatment), includes significant changes in the management of this infection and reflects the evolving controversy over best methods for diagnosis. Clostridium difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States. Moreover, C. difficile has established itself as an important community pathogen. Although the prevalence of the epidemic and virulent ribotype 027 strain has declined markedly along with overall CDI rates in parts of Europe, it remains one of the most commonly identified strains in the United States where it causes a sizable minority of CDIs, especially healthcare-associated CDIs. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management.

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Kinetics and efficiency of ozone for treatment of landfill leachate including the effect of previous microbiological treatment

Abstract

The application of conventional physicochemical and microbiological techniques for the removal of organic pollutants has limitations for its utilization on wastewaters as landfill leachates because of their high concentration of not easily biodegradable organic compounds. The use of ozone-based technologies is an alternative and complementary treatment for this type of wastewaters. This paper reports the study of the degradation of landfill leachates from different stages of a treatment plant using ozone and ozone + UV. The experimental work included the determination of the temporal evolution of COD, TOC, UV254, and color. Along the experimental runs, the instantaneous off-gas ozone concentration was measured. The reaction kinetics follows a global second order expression with respect to COD and ozone concentrations. A kinetic model which takes into account the gas liquid mass transfer coupled with the chemical reaction was developed, and the corresponding parameters of the reacting system were determined. The mathematical model is able to appropriately simulate COD and ozone concentrations but exhibiting limitations when varying the leachate type. The potential application of ozone was verified, although the estimated efficiencies for COD removal and ozone consumption as well as the effect of UV radiation show variations on their trends. In this sense, it is interesting to note that the relative ozone yield has significant oscillations as the reaction proceeds. Finally, the set of experimental results demonstrates the crucial importance of the selection of process conditions to improve ozone efficiencies. This approach should consider variations in the ozone supply in order to minimize losses as well as the design of exhaustion methods as multiple stage reactors using chemical engineering design tools.



Robust trace analysis of polar (C 2 -C 8 ) perfluorinated carboxylic acids by liquid chromatography-tandem mass spectrometry: method development and application to surface water, groundwater and drinking water

Abstract

A simple and robust analytical method for the determination of perfluorinated carboxylic acids (PFCAs) with C2 to C8 chains, based on solid-phase extraction (SPE) and liquid chromatography-tandem mass spectrometry (LC-MS/MS), was developed, validated and applied to tap water, groundwater and surface water. Two stationary phases for LC (Obelisc N and Kinetex C18) and two materials with weak anion-exchange properties for SPE (Strata X-AW and Oasis WAX) were evaluated. Robust separation and retention was achieved with the reversed phase column and an acidic eluent. Quantitative extraction recoveries were generally achieved for PFCAs with C > 3, but extraction efficiencies were different for the two shortest chained analytes: 36 to 114% of perfluoropropanoate (PFPrA) and 14 to 99% of trifluoroacetate (TFA) were recovered with Strata X-AW, while 93 to 103% of PFPrA and 40 to 103% of TFA were recovered with Oasis WAX. The sample pH was identified as a key parameter in the extraction process. One-step elution-filtration was introduced in the workflow, in order to remove sorbent particles and minimise sample preparation steps. Validation resulted in limits of quantification for all PFCAs between 0.6 and 26 ng/L. Precision was between 0.7 and 15% and mean recoveries ranged from 83 to 107%. In groundwater samples from sites impacted by per- and polyfluoroalkyl substances (PFASs), PFCA concentrations ranged from 0.056 to 2.2 μg/L. TFA and perfluorooctanoate were the predominant analytes. TFA, however, revealed a more ubiquitous occurrence and was found in concentrations between 0.045 and 17 μg/L in drinking water, groundwater and surface water, which were not impacted by PFASs.



Arsenic availability and uptake by edible rape ( Brassica campestris L.) grown in contaminated soils spiked with carboxymethyl cellulose-stabilized ferrihydrite nanoparticles

Abstract

This study investigated arsenic (As) availability and uptake by rape (Brassica campestris L.) during two harvest periods of carboxymethyl cellulose (CMC)-stabilized ferrihydrite (HFO) nanoparticles for in situ treatment As-contaminated soil. Application of modified HFO nanoparticles in soils not only provided a larger specific surface area but also markedly improved stability against aggregation and recrystallization. For 90-day incubation, bare HFO particles were gradually converted to the crystalline Fe(III) oxide form, although this was not observed for the 0.5% CMC-HFO nanoparticles. CMC-modified HFO nanoparticles could be more effective in lowering the As uptake by rape and available As in soils than bare HFO particles. Compared the control without amendments, As contents in rape and available As in soils decreased 69.7 and 59.0%, respectively, during the second harvest when soils were amended with 0.5% HFO nanoparticles. And the soil-solution distribution coefficient (Kd ) increased by 2.6 and 2.8 times for the first and second harvest. Furthermore, the ratio of amorphous and free Fe-oxides (Feo/Fed) showed significant negative linear correlations with Asplant (P < 0.01), available As (P < 0.05), and nonspecifically sorbed As in soil (P < 0.01). In contrast, Feo/Fed was positively correlated with Kd and amorphous crystalline Fe/Al oxide-sorbed As, which suggests that a larger amount of As is associated with Fe(hydr)oxide in the amorphous phase or smaller particles.



Comparative performance of novel magnetic ion-imprinted adsorbents employed for Cd 2+ , Cu 2+ and Ni 2+ removal from aqueous solutions

Abstract

Novel magnetic ion-imprinted polymer was prepared by use of SBA-15 as functional monomer, ethylene glycol dimethacrylate as cross linker, diphenylcarbazide as ligand, and Cd2+, Cu2+, and Ni2+ as the template of ion source. The adsorption capacity of the synthesized adsorbent was 111, 95, and 87 mg g−1, respectively for cadmium, copper, and nickel. The selectivity of the adsorbents examined in the presence of different cations including Na+, K+, Ca2+, Mg2+, Zn2+, Co2+, Fe2+, Mn2+, Hg2+, and Pb2+ indicated that the synthesized ion-imprinted adsorbents were highly selective for the appropriate cations. Kinetic studies indicated that the adsorption process was very fast and the equilibrium was established within 5 min and followed the pseudo-second-order kinetic model. The used ion-imprinted adsorbent was readily regenerated by elution with 2 M HNO3, and the regenerated adsorbent retained most of its initial capacity. The calculated thermodynamic parameters indicated that the adsorption process was spontaneous and endothermic.



Sources and levels of particulate matter in North African and Sub-Saharan cities: a literature review

Abstract

In order to assess the significance of PM in ambient air, it is necessary to evaluate their physical and chemical characteristics as well as identify their major emission sources. On a global scale, particulate matter in the atmosphere arises mainly from the combustion process of motorized vehicles, but natural sources are still considered as the major contributors. In Africa, PM emissions differ from those in developed countries; human activities such as biomass burning in households, poor household waste management, and the high number of diesel-powered vehicles are the predominant anthropogenic sources. Natural contributions are also observed. Saharan dust and savanna fires are the most common atmospheric natural sources of particulate matter. The present literature review gives an overview of the status of air quality in African cities and highlights the various sources of particulate matter emissions and local human activities specific to each African region. This could likely serve as a reference to evaluate the current air quality in this region and will be a useful tool in the future to develop pollution mitigation strategies at the source. Recommendations are proposed in the conclusion in order to reduce emissions from their sources, taking into account the low-income African countries.



Faktenblatt: Epidemiologie der Hodgkin-Lymphome in Deutschland

Zusammenfassung

Dieses Faktenblatt bietet eine Übersicht zum Hodgkin-Lymphom in Deutschland. Dabei werden für beide Geschlechter die Inzidenz und Mortalität sowie das Fünfjahresüberleben für Hodgkin-Lymphome insgesamt und teilweise für einzelne histologische Subtypen dargestellt.