Τρίτη 10 Απριλίου 2018
Differential Proteomic Analysis of Actinic Keratosis, Bowen’s Disease and Cutaneous Squamous Cell Carcinoma by Label-Free LC-MS/MS
Cutaneous SCC (cSCC) and its precursor lesions Actinic Keratosis (AK) and Bowen's Disease (BD) are common types of non-melanoma skin cancer (NMSC) originating from an uncontrolled growth of abnormal squamous keratinocytes in the epidermis layer of the skin.
RIPK1 downregulation in keratinocyte enhances TRAIL signaling in psoriasis
Psoriasis, a common inflammatory skin disorder characterized by scaly erythemas and plaques, affects around 2% of the population [1]. Dysregulated interactions of innate and adaptive immunities are deeply involved in the pathomechanism. Complexes of epidermis-derived antimicrobial peptide, LL-37, and host DNA are thought to act as an initiating factor via stimulating IFN-α-production from dermal plasmacytoid dendritic cells [2]. Consequently, activated myeloid dendritic cell (DC) populations release TNF-α and IL-23, and stimulate Th1 cells and T helper cell 17 (Th17) to produce IFN-γ, IL-17 and IL-22 [3,4].
Neural architecture in lymphoid organs: Hard‐wired antigen presenting cells and neurite networks in antigen entrance areas
Immunity, Inflammation and Disease, EarlyView.
Leaching of metals from end-of-life solar cells
Abstract
The issue of recycling waste solar cells is critical with regard to the expanded use of these cells, which increases waste production. Technology establishment for this recycling process is essential with respect to the valuable and hazardous metals present therein. In the present study, the leaching potentials of Acidithiobacillus thiooxidans, Acidithiobacillus ferrooxidans, Penicillium chrysogenum, and Penicillium simplicissimum were assessed for the recovery of metals from spent solar cells, with a focus on retrieval of the valuable metal Te. Batch experiments were performed to explore and compare the metal removal efficiencies of the aforementioned microorganisms using spent media. P. chrysogenum spent medium was found to be most effective, recovering 100% of B, Mg, Si, V, Ni, Zn, and Sr along with 93% of Te at 30 °C, 150 rpm and 1% (w/v) pulp density. Further optimization of the process parameters increased the leaching efficiency, and 100% of Te was recovered at the optimum conditions of 20 °C, 200 rpm shaking speed and 1% (w/v) pulp density. In addition, the recovery of aluminum increased from 31 to 89% upon process optimization. Thus, the process has considerable potential for metal recovery and is environmentally beneficial.
Efficacy and Safety of Ixekizumab Over 4 Years of Open-Label Treatment in a Phase 2 Study in Chronic Plaque Psoriasis
Interleukin-17A is a critical cytokine involved in psoriasis pathogenesis., The efficacy of ixekizumab, an interleukin-17A monoclonal antibody, was maintained for up to 4 years without apparent increases in health risks or safety issues in moderate-to-severe psoriasis patients., Long-term ixekizumab treatment is an option for moderate-to-severe psoriasis patients.
Improving classification of melanocytic nevi: BRAF V600E expression associated with distinct histomorphologic features
BRAF V600E mutation is a common genetic driver of melanocytic nevi and melanoma. BRAF V600E is associated with distinct histomorphologic features in melanocytic nevi, including dermal and congenital growth patterns. Understanding the genetic-morphologic correlates in melanocytic nevi may facilitate a more accurate classification and improved diagnosis of melanocytic neoplasms.
Diversity in Dermatology: Roadmap for Improvement
The American Academy of Dermatology (AAD) has taken an active stance in addressing the lack of racial and ethnic diversity in the specialty. At the AAD President's Conference on Diversity in Dermatology held August 5, 2017, key action items were identified in three main areas in order to increase the number of practicing, board-certified dermatologists who are underrepresented in medicine (UIM). These include: increasing the pipeline of UIM students applying to medical school; increasing the exposure and level of interest of UIM medical students in dermatology; and increasing the number of UIM students recruited into dermatology residency programs.
Neutrophilic dermatoses. Part I. Pathogenesis, Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet’s disease
Neutrophilic dermatoses are a heterogeneous group of inflammatory skin disorders that present with unique clinical features, but are unified by the presence of a sterile, predominantly neutrophilic infiltrate on histopathology. The morphology of cutaneous lesions associated with these disorders is heterogeneous, which renders diagnosis challenging. Moreover, a thorough evaluation is required to exclude diseases that mimic these disorders and to diagnose potential associated infectious, inflammatory, and neoplastic processes.
Neutrophilic dermatoses. Part II. Pyoderma gangrenosum and other bowel and arthritis associated neutrophilic dermatoses
Neutrophilic dermatoses are a heterogeneous group of inflammatory skin disorders that present with unique clinical features, but are unified by the presence of a sterile, predominantly neutrophilic infiltrate on histopathology. The morphology of cutaneous lesions associated with these disorders is heterogeneous, which renders diagnosis challenging. Moreover, a thorough evaluation is required to exclude diseases that mimic these disorders and to diagnose potential associated infectious, inflammatory, and neoplastic processes.
Technological Environmentality: Conceptualizing Technology as a Mediating Milieu
Abstract
After several technological revolutions in which technologies became ever more present in our daily lives, the digital technologies that are currently being developed are actually fading away from sight. Information and Communication Technologies (ICTs) are not only embedded in devices that we explicitly "use" but increasingly become an intrinsic part of the material environment in which we live. How to conceptualize the role of these new technological environments in human existence? And how to anticipate the ways in which these technologies will mediate our everyday lives? In order to answer these questions, we draw on two approaches that each offers a framework to conceptualize these new technological environments: Postphenomenology and Material Engagement Theory. As we will show, each on their own, these approaches fail to do justice to the new environmental role of technology and its implications for human existence. But by bringing together Postphenomenology's account of technological mediation and Material Engagement Theory's account of engaging with environments, it becomes possible to sufficiently account for the new environmental workings of technology. To do justice to these new workings of environmental technologies, we introduce and develop the concept of "Technological Environmentality."
Application of vermiculite-derived sustainable adsorbents for removal of venlafaxine
Abstract
Removal of emerging pollutants, such as pharmaceuticals, from wastewater is a challenge. Adsorption is a simple and efficient process that can be applied. Clays, which are natural and low-cost materials, have been investigated as adsorbent. In this work, raw vermiculite and its three modified forms (expanded, base, and acid/base treated) were tested for removal of a widely used antidepressant, venlafaxine. Adsorption kinetics followed Elovich's model for raw vermiculite while the pseudo-2nd order model was a better fit in the case of other materials. Equilibrium followed Langmuir's model for the raw and the acid/base-treated vermiculite, while Redlich-Peterson's model fitted better the expanded and the base-treated materials. The adsorption capacity of vermiculite was significantly influenced by the changes in the physical and chemical properties of the materials caused by the treatments. The base-treated, raw, and expanded vermiculites showed lower maximum adsorption capacities (i.e., 6.3 ± 0.5, 5.8 ± 0.7, 3.9 ± 0.2 mg g−1, respectively) than the acid/base-treated material (33 ± 4 mg g−1). The acid/base-treated vermiculite exhibited good properties as a potential adsorbent for tertiary treatment of wastewater in treatment plants, in particular for cationic species as venlafaxine due to facilitation of diffusion of the species to the interlayer gallery upon such treatment.
Graphical abstract
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Metameric Whiteness and Absence of Causal Factors
Abstract
Olaf Müller presents a supposedly empirically equivalent theory to Newtonian optics, which in his view is therefore threatened by underdetermination. This threat could even be expanded to modern physics, since this branch of physics is partly based on Newton's theory. In this paper, I will show that Müller's alternative theory contains an ill-defined concept, viz. the definition of whiteness as the absence of optical causal factors. This results from a fundamental property of whiteness: for every source of white light there exist metameric sources. I further argue that this cannot be reconciled by borrowing other concepts from modern physics, as is, I will show, tacitly presupposed in Müller's argument. As a consequence, his alternative theory is not empirically equivalent to Newtonian optics and his argument in favour of underdetermination fails.
Interspecies conflict affects RNA expression
Abstract
Predation is an extreme form of competition between bacteria, involving the secretion of antimicrobial substances by predators, often packaged within outer membrane vesicles (OMVs). Recent studies into the Myxococcus xanthus/Escherichia coli predator/prey relationship have illuminated transcriptional changes during predation, identifying likely targets of predatory attack in the prey and nutrient assimilation strategies of the predator. Abundant non-coding RNAs can be observed in the predator and prey transcriptomes, with evidence of predation-dependent regulation of RNA levels. Given the observed secretion of regulatory RNAs within OMVs by bacteria, it will next be exciting to test whether the intercellular trafficking of regulatory RNAs is employed by predator and/or prey in their survival struggles.Type i secretion system – It takes three and a substrate
Abstract
Type I secretion systems are wide-spread in Gram-negative bacteria and mediate the one step translocation of a large variety of proteins serving for diverse purposes, including nutrient-acquisition or bacterial virulence. Common to most substrates of Type I secretion systems is the presence of a C-terminal secretion sequence that is not cleaved during or after translocation. Furthermore, these protein secretion nanomachineries are always composed of an ABC transporter, a membrane fusion protein, both located in the inner bacterial membrane, and a protein of the outer membrane. These three membrane proteins transiently form a 'tunnel-channel' across the periplasmic space in the presence of the substrate. Here we summarize the recent findings with respect to structure, function and application of Type I secretion systems.Direct loop-mediated isothermal amplification assay for on-site detection of Staphylococcus aureus
Abstract
Staphylococcus aureus (S. aureus) is a major human pathogen which may produce a variety of toxins and cause staphylococcal food poisoning. In the present study, a direct loop-mediated isothermal amplification (LAMP) assay was developed and validated to detect S. aureus in food samples. Without prior cultural enrichment and DNA extraction steps, bacterial DNA was released by heating at 100°C for 5 min and directly subjected to LAMP assay. Using a set of LAMP primers recognizing six distinct regions of nuc gene, the developed direct LAMP assay was highly specific, and the analytical sensitivity was determined to be 7.6 × 102 CFU/mL. Moreover, with the pre-mixed LAMP reagents stored at -20°C, the entire assay should be finished within 40 min. These features greatly simplified the operating procedure and made the direct LAMP a powerful tool for rapid and on-site detection of S. aureus in food samples.Co-translational protein targeting in bacteria
Abstract
About 30% of all bacterial proteins execute their function outside of the cytosol and have to be transported into or across the cytoplasmic membrane. Bacteria use multiple protein transport systems in parallel, but the majority of proteins engage two distinct targeting systems. One is the co-translational targeting by two universally conserved GTPases, the signal recognition particle (SRP) and its receptor FtsY, which deliver inner membrane proteins to either the SecYEG translocon or the YidC insertase for membrane insertion. The other targeting system depends on the ATPase SecA, which targets secretory proteins, i.e. periplasmic and outer membrane proteins, to SecYEG for their subsequent ATP-dependent translocation. While SRP selects its substrates already very early during their synthesis, the recognition of secretory proteins by SecA is believed to occur primarily after translation termination, i.e. post-translationally. In this review we highlight recent progress on how SRP recognizes its substrates at the ribosome and how the fidelity of the targeting reaction to SecYEG is maintained. We furthermore discuss similarities and differences in the SRP-dependent targeting to either SecYEG or YidC and summarize recent results that suggest that some membrane proteins are co-translationally targeted by SecA.Normal Values of Magnetic Relaxation Parameters of Spine Components with the Synthetic MRI Sequence [SPINE]
BACKGROUND AND PURPOSE:
SyMRI is a technique developed to perform quantitative MR imaging. Our aim was to analyze its potential use for measuring relaxation times of normal components of the spine and to compare them with values found in the literature using relaxometry and other techniques.
MATERIALS AND METHODS:Thirty-two spine MR imaging studies (10 cervical, 5 dorsal, 17 lumbosacral) were included. A modified multiple-dynamic multiple-echo sequence was added and processed to obtain quantitative T1 (millisecond), T2 (millisecond), and proton density (percentage units [pu]) maps for each patient. An ROI was placed on representative areas for CSF, spinal cord, intervertebral discs, and vertebral bodies, to measure their relaxation.
RESULTS:Relaxation time means are reported for CSF (T1 = 4273.4 ms; T2 = 1577.6 ms; proton density = 107.5 pu), spinal cord (T1 = 780.2 ms; T2 = 101.6 ms; proton density = 58.7 pu), normal disc (T1 = 1164.9 ms; T2 = 101.9 ms; proton density = 78.9 pu), intermediately hydrated disc (T1 = 723 ms; T2 = 66.8 ms; proton density = 60.8 pu), desiccated disc (T1 = 554.4 ms; T2 = 55.6 ms; proton density = 47.6 ms), and vertebral body (T1 = 515.3 ms; T2 = 100.8 ms; proton density = 91.1 pu). Comparisons among the mean T1, T2, and proton density values showed significant differences between different spinal levels (cervical, dorsal, lumbar, and sacral) for CSF (proton density), spinal cord (T2 and proton density), normal disc (T1, T2, and proton density), and vertebral bodies (T1 and proton density). Significant differences were found among mean T1, T2, and proton density values of normal, intermediately hydrated, and desiccated discs.
CONCLUSIONS:Measurements can be easily obtained on SyMRI and correlated with previously published values obtained using conventional relaxometry techniques.
Modeling Early Postnatal Brain Growth and Development with CT: Changes in the Brain Radiodensity Histogram from Birth to 2 Years [PEDIATRICS]
BACKGROUND AND PURPOSE:
The majority of brain growth and development occur in the first 2 years of life. This study investigated these changes by analysis of the brain radiodensity histogram of head CT scans from the clinical population, 0–2 years of age.
MATERIALS AND METHODS:One hundred twenty consecutive head CTs with normal findings meeting the inclusion criteria from children from birth to 2 years were retrospectively identified from 3 different CT scan platforms. Histogram analysis was performed on brain-extracted images, and histogram mean, mode, full width at half maximum, skewness, kurtosis, and SD were correlated with subject age. The effects of scan platform were investigated. Normative curves were fitted by polynomial regression analysis.
RESULTS:Average total brain volume was 360 cm3 at birth, 948 cm3 at 1 year, and 1072 cm3 at 2 years. Total brain tissue density showed an 11% increase in mean density at 1 year and 19% at 2 years. Brain radiodensity histogram skewness was positive at birth, declining logarithmically in the first 200 days of life. The histogram kurtosis also decreased in the first 200 days to approach a normal distribution. Direct segmentation of CT images showed that changes in brain radiodensity histogram skewness correlated with, and can be explained by, a relative increase in gray matter volume and an increase in gray and white matter tissue density that occurs during this period of brain maturation.
CONCLUSIONS:Normative metrics of the brain radiodensity histogram derived from routine clinical head CT images can be used to develop a model of normal brain development.
Intraoperative Conebeam CT for Assessment of Intracochlear Positioning of Electrode Arrays in Adult Recipients of Cochlear Implants [HEAD & NECK]
BACKGROUND AND PURPOSE:
Intraoperative conebeam CT has been introduced into the operating room and provides quick radiologic feedback. This study aimed to investigate its utility in the assessment of the positioning of the electrode array after cochlear implantation.
MATERIALS AND METHODS:This was a retrospective study of 51 patients (65 ears) with intraoperative imaging by conebeam CT (O-arm) after cochlear implantation between 2013 and 2017. Correct placement into the cochlea was immediately identified. Positioning assessments were later analyzed with OsiriX software.
RESULTS:Intraoperative imaging was quickly performed in all cases. No misplacement into the vestibule or semicircular canals was found. A foldover of the implanted array was identified in 1 patient. Secondary analysis by 2 raters showed excellent agreement on insertion depth angle (intraclass correlation = 0.96, P < .001) and length of insertion of the electrode array (intraclass correlation coefficient = 0.93, P = .04) measurements. The evaluation of the number of extracochlear electrodes was identical between the 2 raters in 78% of cases (Cohen = 0.55, P < .001). The scalar position was inconsistent between raters. When we compared O-arm and high-resolution CT images in 14 cases, the agreement was excellent for insertion depth angle (intraclass correlation coefficient = 0.97, P < .001) and insertion length (intraclass correlation coefficient = 0.98, P < .001), good for the number of extracochlear electrodes (Cohen = 0.63, P = .01), but moderate for the scalar position (Cohen = 0.59, P = .02).
CONCLUSIONS:Intraoperative conebeam CT using the O-arm is a safe, rapid, easy, and reliable procedure to immediately identify a misplacement or foldover of an electrode array. The insertion depth angle, insertion length, and number of electrodes inserted can be accurately assessed.
Melanoma of the Sinonasal Tract: Value of a Septate Pattern on Precontrast T1-Weighted MR Imaging [HEAD & NECK]
BACKGROUND AND PURPOSE:
Various tumors of the sinonasal tract can exhibit high signal intensity on T1WI. The purpose of this study was to determine the value of a septate pattern on precontrast T1WI for diagnosing sinonasal melanoma.
MATERIALS AND METHODS:Retrospectively, 3 observers independently reviewed MR images of 31 histologically proved sinonasal melanomas with special attention to the presence or absence of a septate pattern on precontrast T1WI, defined as alternating hyperintense and hypointense striations on precontrast T1WI. For comparison, we evaluated the prevalence of a septate pattern on precontrast T1WI in 106 nonmelanomatous sinonasal malignant tumors with 16 different histologic types. We also tried to identify the histopathologic features responsible for the septate pattern on precontrast T1WI.
RESULTS:Twenty-seven (87.1%) of 31 sinonasal melanomas showed hyperintense foci on T1WI, among which a septate pattern on precontrast T1WI was seen in 23 (74.2%), while 22 (20.8%) of 106 nonmelanomatous malignant tumors demonstrated hyperintense foci on T1WI, among which only 3 (2.8%) showed a septate pattern on precontrast T1WI. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of a septate pattern on precontrast T1WI for the diagnosis of sinonasal melanoma were 74%, 97%, 88%, 93%, and 92%, respectively. Although limited due to the retrospective nature, 4 of 23 histologically reviewed sinonasal melanomas revealed an uneven distribution of melanin with alternating melanin and fibrous bands within the tumors.
CONCLUSIONS:A septate pattern on precontrast T1WI might be an adjunctive imaging finding for the diagnosis of sinonasal melanoma. This might be attributed histologically to an uneven distribution of melanin and hemorrhage within the tumors.
Clinical Validation of a Predictive Model for the Presence of Cervical Lymph Node Metastasis in Papillary Thyroid Cancer [HEAD & NECK]
BACKGROUND AND PURPOSE:
Ultrasound is a standard technique to detect lymph node metastasis in papillary thyroid cancer. Cystic changes and microcalcifications are the most specific features of metastasis, but with low sensitivity. This prospective study compared the diagnostic accuracy of a predictive model for sonographic evaluation of lymph nodes relative to the radiologist's standard assessment in detecting papillary thyroid cancer metastasis in patients after thyroidectomy.
MATERIALS AND METHODS:Cervical lymph node sonographic images were reported by a radiologist (R method) per standard practice. The same images were independently evaluated by another radiologist using a sonographic predictive model (M method). A test was considered positive for metastasis if the R or M method suggested lymph node biopsy. The result of lymph node biopsy or surgical pathology was used as the reference standard. We estimated relative true-positive fraction and relative false-positive fraction using log-linear models for correlated binary data for the M method compared with the R method.
RESULTS:A total of 237 lymph nodes in 103 patients were evaluated. Our analysis of relative true-positive fraction and relative false-positive fraction included 54 nodes with pathologic results in which at least 1 method (R or M) was positive. The M method had a higher relative true-positive fraction of 1.46 (95% CI, 1.12–1.91; P = .006) and a lower relative false-positive fraction of 0.58 (95% CI, 0.36–0.92; P = .02) compared with the R method.
CONCLUSIONS:The sonographic predictive model outperformed the standard assessment to detect lymph node metastasis in patients with papillary thyroid cancer and may reduce unnecessary biopsies.
MRI with DWI for the Detection of Posttreatment Head and Neck Squamous Cell Carcinoma: Why Morphologic MRI Criteria Matter [HEAD & NECK]
BACKGROUND AND PURPOSE:
Although diffusion-weighted imaging combined with morphologic MRI (DWIMRI) is used to detect posttreatment recurrent and second primary head and neck squamous cell carcinoma, the diagnostic criteria used so far have not been clarified. We hypothesized that precise MRI criteria based on signal intensity patterns on T2 and contrast-enhanced T1 complement DWI and therefore improve the diagnostic performance of DWIMRI.
MATERIALS AND METHODS:We analyzed 1.5T MRI examinations of 100 consecutive patients treated with radiation therapy with or without additional surgery for head and neck squamous cell carcinoma. MRI examinations included morphologic sequences and DWI (b=0 and b=1000 s/mm2). Histology and follow-up served as the standard of reference. Two experienced readers, blinded to clinical/histologic/follow-up data, evaluated images according to clearly defined criteria for the diagnosis of recurrent head and neck squamous cell carcinoma/second primary head and neck squamous cell carcinoma occurring after treatment, post-radiation therapy inflammatory edema, and late fibrosis. DWI analysis included qualitative (visual) and quantitative evaluation with an ADC threshold.
RESULTS:Recurrent head and neck squamous cell carcinoma/second primary head and neck squamous cell carcinoma occurring after treatment was present in 36 patients, whereas 64 patients had post-radiation therapy lesions only. The Cohen for differentiating tumor from post-radiation therapy lesions with MRI and qualitative DWIMRI was 0.822 and 0.881, respectively. Mean ADCmean in recurrent head and neck squamous cell carcinoma/second primary head and neck squamous cell carcinoma occurring after treatment (1.097 ± 0.295 x 10–3 mm2/s) was significantly lower (P < .05) than in post-radiation therapy inflammatory edema (1.754 ± 0.343 x 10–3 mm2/s); however, it was similar to that in late fibrosis (0.987 ± 0.264 x 10–3 mm2/s, P > .05). Although ADCs were similar in tumors and late fibrosis, morphologic MRI criteria facilitated distinction between the 2 conditions. The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios (95% CI) of DWIMRI with ADCmean < 1.22 x 10–3 mm2/s and precise MRI criteria were 92.1% (83.5–100.0), 95.4% (90.3–100.0), 92.1% (83.5–100.0), 95.4% (90.2–100.0), 19.9 (6.58–60.5), and 0.08 (0.03–0.24), respectively, indicating a good diagnostic performance to rule in and rule out disease.
CONCLUSIONS:Adding precise morphologic MRI criteria to quantitative DWI enables reproducible and accurate detection of recurrent head and neck squamous cell carcinoma/second primary head and neck squamous cell carcinoma occurring after treatment.
Altered Regional Homogeneity in Chronic Insomnia Disorder with or without Cognitive Impairment [FUNCTIONAL]
BACKGROUND AND PURPOSE:
Many studies have shown that insomnia is an independent factor in cognitive impairment, but the involved neurobiological mechanisms remain unclear. We used regional homogeneity to explore the specific neurobiologic indicators of chronic insomnia disorder with mild cognitive impairment.
MATERIALS AND METHODS:Thirty-nine patients with insomnia were divided into a group with and without cognitive impairment; we also included a control group (n = 28). Abnormalities in brain functional activity were identified by comparing the regional homogeneity values for each brain region among the groups.
RESULTS:Subjective insomnia scores were negatively correlated with cognitive impairment after controlling for age, sex, and educational effects. Regions with significant differences in regional homogeneity values in the 3 groups were concentrated in the right medial prefrontal cortex, the right superior frontal gyrus, and the left superior occipital gyrus. Meanwhile, subjective insomnia scores were negatively correlated with the strength of the decreased regional homogeneity in the right medial prefrontal cortex. The increased regional homogeneity value in the right superior frontal gyrus was positively correlated with the Montreal Cognitive Assessment score in patients.
CONCLUSIONS:Our results indicate that decreased regional homogeneity values in the medial prefrontal cortex and increased regional homogeneity values in the cuneus may be important neurobiologic indicators of chronic insomnia disorder and accompanying cognitive impairment. Overall, our study described the regional homogeneity of the whole brain in chronic insomnia disorder with mild cognitive impairment and could be the basis for future studies.
A Patient Dose-Reduction Technique for Neuroendovascular Image-Guided Interventions: Image-Quality Comparison Study [PATIENT SAFETY]
BACKGROUND AND PURPOSE:
The ROI–dose-reduced intervention technique represents an extension of ROI fluoroscopy combining x-ray entrance skin dose reduction with spatially different recursive temporal filtering to reduce excessive image noise in the dose-reduced periphery in real-time. The aim of our study was to compare the image quality of simulated neurointerventions with regular and reduced radiation doses using a standard flat panel detector system.
MATERIALS AND METHODS:Ten 3D-printed intracranial aneurysm models were generated on the basis of a single patient vasculature derived from intracranial DSA and CTA. The incident dose to each model was reduced using a 0.7-mm-thick copper attenuator with a circular ROI hole (10-mm diameter) in the middle mounted inside the Infinix C-arm. Each model was treated twice with a primary coiling intervention using ROI-dose-reduced intervention and regular-dose intervention protocols. Eighty images acquired at various intervention stages were shown twice to 2 neurointerventionalists who independently scored imaging qualities (visibility of aneurysm-parent vessel morphology, associated vessels, and/or devices used). Dose-reduction measurements were performed using an ionization chamber.
RESULTS:A total integral dose reduction of 62% per frame was achieved. The mean scores for regular-dose intervention and ROI dose-reduced intervention images did not differ significantly, suggesting similar image quality. Overall intrarater agreement for all scored criteria was substantial (Kendall = 0.62887; P < .001). Overall interrater agreement for all criteria was fair ( = 0.2816; 95% CI, 0.2060–0.3571).
CONCLUSIONS:Substantial dose reduction (62%) with a live peripheral image was achieved without compromising feature visibility during neuroendovascular interventions.
Radiation Dosimetry of 3D Rotational Neuroangiography and 2D-DSA in Children [PATIENT SAFETY]
BACKGROUND AND PURPOSE:
The benefit-risk assessment concerning radiation use in pediatric neuroangiography requires an extensive understanding of the doses delivered. This work evaluated the effective dose of 3D rotational angiography in a cohort of pediatric patients with complex neurovascular lesions and directly compared it with conventional 2D-biplane DSA.
MATERIALS AND METHODS:Thirty-three 3D rotational angiography acquisitions were acquired in 24 pediatric patients (mean age, 10.4 years). When clinically indicated, following 2D-biplane DSA, 3D rotational angiography was performed with 1 of 3 technical protocols (2 subtracted, 1 unsubtracted). The protocols consisted of 1 factory and 2 customized techniques, with images subsequently reconstructed into CT volumes for clinical management. Raw projections and quantitative dose metrics were evaluated, and the effective dose was calculated.
RESULTS:All 3D rotational angiography acquisitions were of diagnostic quality and assisted in patient management. The mean effective doses were 0.5, 0.12, and 0.06 mSv for the factory-subtracted, customized-subtracted, and customized-unsubtracted protocols, respectively. The mean effective dose for 2D-biplane DSA was 0.9 mSv. A direct intraprocedural comparison between 3D and 2D acquisitions indicated that customized 3D rotational angiography protocols delivered mean relative doses of 9% and 15% in unsubtracted and subtracted acquisitions, respectively, compared with biplane DSA, whereas the factory subtracted protocol delivered 68%.
CONCLUSIONS:In pediatric neuroangiography, the effective dose for 3D rotational angiography can be significantly lower than for 2D-biplane DSA and can be an essential adjunct in the evaluation of neurovascular lesions. Additionally, available 3D rotational angiography protocols have significant room to be tailored for effectiveness and dose optimization, depending on the clinical question.
HARMless: Transient Cortical and Sulcal Hyperintensity on Gadolinium-Enhanced FLAIR after Elective Endovascular Coiling of Intracranial Aneurysms [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
Cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR has been increasingly recognized after iodinated contrast medium exposure during angiographic procedures. The goal of this study was to assess the relationship of cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR against various variables in patients following elective endovascular treatment of intracranial aneurysms.
MATERIALS AND METHODS:We performed a retrospective review of 58 patients with 62 MR imaging studies performed within 72 hours following endovascular treatment of intracranial aneurysms. Patient demographics, aneurysm location, and vascular territory distribution of cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR were documented. Analysis of cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR with iodinated contrast medium volume, procedural duration, number of angiographic runs, and DWI lesions was performed.
RESULTS:Cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR was found in 32/62 (51.61%) post-endovascular treatment MR imaging studies, with complete resolution of findings in all patients on the available follow-up studies (27/27). Angiographic iodinated contrast medium injection and arterial anatomy matched the vascular distribution of cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR. No significant association was found between cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR with iodinated contrast medium volume (P = .56 value) and the presence of DWI lesions (P = .68). However, a significant association was found with procedural time (P = .001) and the number of angiographic runs (P = .019). No adverse clinical outcomes were documented.
CONCLUSIONS:Cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR is a transient observation in the arterial territory exposed to iodinated contrast medium during endovascular treatment of intracranial aneurysms. Cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR is significantly associated with procedural time, and the frequency of angiographic runs suggesting a potential technical influence on the breakdown of the BBB, but no reported adverse clinical outcome or association with both iodinated contrast medium volume and DWI lesions was found. Recognition of cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR as a benign incidental finding is vital to avoid unnecessary investigation.
7T Brain MRS in HIV Infection: Correlation with Cognitive Impairment and Performance on Neuropsychological Tests [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Validated neuroimaging markers of HIV-associated neurocognitive disorder in patients on antiretroviral therapy are urgently needed for clinical trials. The purpose of this study was to explore the relationship between cognitive impairment and brain metabolism in older subjects with HIV infection. It was hypothesized that MR spectroscopy measurements related to neuronal health and function (particularly N-acetylaspartate and glutamate) would be lower in HIV-positive subjects with worse cognitive performance.
MATERIALS AND METHODS:Forty-five HIV-positive patients (mean age, 58.9 ± 5.3 years; 33 men) underwent detailed neuropsychological testing and brain MR spectroscopy at 7T. Twenty-four subjects were classified as having asymptomatic cognitive impairment, and 21 were classified as having symptomatic cognitive impairment. Single-voxel proton MR spectra were acquired from 5 brain regions and quantified using LCModel software. Brain metabolites and neuropsychological test results were compared using nonparametric statistics and Pearson correlation coefficients.
RESULTS:Differences in brain metabolites were found between symptomatic and asymptomatic subjects, with the main findings being lower measures of N-acetylaspartate in the frontal white matter, posterior cingulate cortex, and precuneus. In the precuneus, glutamate was also lower in the symptomatic group. In the frontal white matter, precuneus, and posterior cingulate cortex, NAA and glutamate measurements showed significant positive correlation with better performance on neuropsychological tests.
CONCLUSIONS:Compared with asymptomatic subjects, symptomatic HIV-positive subjects had lower levels of NAA and glutamate, most notably in the frontal white matter, which also correlated with performance on neuropsychological tests. High-field MR spectroscopy offers insight into the pathophysiology associated with cognitive impairment in HIV and may be useful as a quantitative outcome measure in future treatment trials.
MRI Features of Aquaporin-4 Antibody-Positive Longitudinally Extensive Transverse Myelitis: Insights into the Diagnosis of Neuromyelitis Optica Spectrum Disorders [SPINE]
BACKGROUND AND PURPOSE:
Longitudinally extensive transverse myelitis is a well-documented spinal manifestation of neuromyelitis optica spectrum disorders, however, other forms of nontumorous myelopathy can also manifest as longitudinally extensive transverse myelitis. Our aim was to evaluate the MR imaging features of aquaporin-4 antibody–positive longitudinally extensive transverse myelitis, which is strongly associated with neuromyelitis optica spectrum disorders.
MATERIALS AND METHODS:We evaluated cervicomedullary junction involvement, cord expansion ratios, bright spotty lesions, the number of involved segments, skipped lesions, enhancement patterns, and axial distribution patterns using spinal MR imaging of 41 patients with longitudinally extensive transverse myelitis who underwent aquaporin-4 antibody testing. Univariate logistic regression analysis was performed to identify factors associated with aquaporin-4 antibody seropositivity, which were then used to develop a scoring system for diagnosing aquaporin-4 antibody–positive longitudinally extensive transverse myelitis. Interrater reliability for cord expansion ratio measurement and bright spotty lesions was determined using intraclass correlation coefficients and values, respectively.
RESULTS:Fifteen patients with longitudinally extensive transverse myelitis were aquaporin-4 antibody–positive. Sex (female), cervicomedullary junction involvement, a cord expansion ratio of >1.4, and bright spotty lesions were significantly associated with aquaporin-4 antibody seropositivity. The sensitivity and specificity of the scoring system were 73.3% and 96.2%, respectively. The interclass correlation value for the cord expansion ratio was 0.78, and the value for bright spotty lesions was 0.61.
CONCLUSIONS:Our scoring system, based on cervicomedullary junction involvement, higher cord expansion ratio, bright spotty lesions, and female sex, can facilitate the timely diagnosis of neuromyelitis optica spectrum disorders.
Brain Imaging in Cases with Positive Serology for Dengue with Neurologic Symptoms: A Clinicoradiologic Correlation [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Dengue is a common arboviral disease, which uncommonly involves the brain. There has been a recent surge in dengue cases and dengue-related deaths in tropical countries. The aim of this study was to describe brain imaging findings in patients with dengue infection having neurologic symptoms.
MATERIALS AND METHODS:Thirty-five patients with positive serology for dengue with CNS symptoms undergoing imaging of the brain were included in the study. Clinical, laboratory, and imaging parameters were assessed and correlated to poor outcome.
RESULTS:A Glasgow Coma Scale score of ≤12 at presentation, clinical classification of severe-type dengue, and the presence of acute renal failure were associated with poor outcome. Imaging parameters associated with poor outcome were involvement of the thalami and cerebellar peduncles and the presence of diffusion restriction and hemorrhagic foci in the brain parenchyma.
CONCLUSIONS:Although not specific, dengue infection has imaging findings that can be used to narrow down the differential list and help in prognostication.
Quantification of Intracranial Aneurysm Volume Pulsation with 7T MRI [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
Aneurysm volume pulsation is a potential predictor of intracranial aneurysm rupture. We evaluated whether 7T MR imaging can quantify aneurysm volume pulsation.
MATERIALS AND METHODS:In Stage I of the study, 10 unruptured aneurysms in 9 patients were studied using a high-resolution (0.6-mm, isotropic) 3D gradient-echo sequence with cardiac gating. Semiautomatic segmentation was used to measure aneurysm volume (in cubic millimeters) per cardiac phase. Aneurysm pulsation was defined as the relative increase in volume between the phase with the smallest volume and the phase with the largest volume. The accuracy and precision of the measured volume pulsations were addressed by digital phantom simulations and a repeat image analysis. In Stage II, the imaging protocol was optimized and 9 patients with 9 aneurysms were studied with and without administration of a contrast agent.
RESULTS:The mean aneurysm pulsation in Stage I was 8% ± 7% (range, 2%–27%), with a mean volume change of 15 ± 14 mm3 (range, 3–51 mm3). The mean difference in volume change for the repeat image analysis was 2 ± 6 mm3. The artifactual volume pulsations measured with the digital phantom simulations were of the same magnitude as the volume pulsations observed in the patient data, even after protocol optimization in Stage II.
CONCLUSIONS:Volume pulsation quantification with the current imaging protocol on 7T MR imaging is not accurate due to multiple imaging artifacts. Future studies should always include aneurysm-specific accuracy analysis.
Whole-Tumor Histogram and Texture Analyses of DTI for Evaluation of IDH1-Mutation and 1p/19q-Codeletion Status in World Health Organization Grade II Gliomas [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Prediction of the isocitrate dehydrogenase 1 (IDH1)-mutation and 1p/19q-codeletion status of World Health Organization grade ll gliomas preoperatively may assist in predicting prognosis and planning treatment strategies. Our aim was to characterize the histogram and texture analyses of apparent diffusion coefficient and fractional anisotropy maps to determine IDH1-mutation and 1p/19q-codeletion status in World Health Organization grade II gliomas.
MATERIALS AND METHODS:Ninety-three patients with World Health Organization grade II gliomas with known IDH1-mutation and 1p/19q-codeletion status (18 IDH1 wild-type, 45 IDH1 mutant and no 1p/19q codeletion, 30 IDH1-mutant and 1p/19q codeleted tumors) underwent DTI. ROIs were drawn on every section of the T2-weighted images and transferred to the ADC and the fractional anisotropy maps to derive volume-based data of the entire tumor. Histogram and texture analyses were correlated with the IDH1-mutation and 1p/19q-codeletion status. The predictive powers of imaging features for IDH1 wild-type tumors and 1p/19q-codeletion status in IDH1-mutant subgroups were evaluated using the least absolute shrinkage and selection operator.
RESULTS:Various histogram and texture parameters differed significantly according to IDH1-mutation and 1p/19q-codeletion status. The skewness and energy of ADC, 10th and 25th percentiles, and correlation of fractional anisotropy were independent predictors of an IDH1 wild-type in the least absolute shrinkage and selection operator. The area under the receiver operating curve for the prediction model was 0.853. The skewness and cluster shade of ADC, energy, and correlation of fractional anisotropy were independent predictors of a 1p/19q codeletion in IDH1-mutant tumors in the least absolute shrinkage and selection operator. The area under the receiver operating curve was 0.807.
CONCLUSIONS:Whole-tumor histogram and texture features of the ADC and fractional anisotropy maps are useful for predicting the IDH1-mutation and 1p/19q-codeletion status in World Health Organization grade II gliomas.
A photon recycling approach to the denoising of ultra-low dose X-ray sequences
Abstract
Purpose
Clinical procedures that make use of fluoroscopy may expose patients as well as the clinical staff (throughout their career) to non-negligible doses of radiation. The potential consequences of such exposures fall under two categories, namely stochastic (mostly cancer) and deterministic risks (skin injury). According to the "as low as reasonably achievable" principle, the radiation dose can be lowered only if the necessary image quality can be maintained.
Methods
Our work improves upon the existing patch-based denoising algorithms by utilizing a more sophisticated noise model to exploit non-local self-similarity better and this in turn improves the performance of low-rank approximation. The novelty of the proposed approach lies in its properly designed and parameterized noise model and the elimination of initial estimates. This reduces the computational cost significantly.
Results
The algorithm has been evaluated on 500 clinical images (7 patients, 20 sequences, 3 clinical sites), taken at ultra-low dose levels, i.e. 50% of the standard low dose level, during electrophysiology procedures. An average improvement in the contrast-to-noise ratio (CNR) by a factor of around 3.5 has been found. This is associated with an image quality achieved at around 12 (square of 3.5) times the ultra-low dose level. Qualitative evaluation by X-ray image quality experts suggests that the method produces denoised images that comply with the required image quality criteria.
Conclusion
The results are consistent with the number of patches used, and they demonstrate that it is possible to use motion estimation techniques and "recycle" photons from previous frames to improve the image quality of the current frame. Our results are comparable in terms of CNR to Video Block Matching 3D—a state-of-the-art denoising method. But qualitative analysis by experts confirms that the denoised ultra-low dose X-ray images obtained using our method are more realistic with respect to appearance.
Diagnostic accuracy of bioimpedance spectroscopy in patients with lymphedema: A retrospective cohort analysis
Publication date: Available online 9 April 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Evelyn S. Qin, Mindy J. Bowen, Wei F. Chen
BackgroundBioimpedance spectroscopy (BIS) is used by healthcare specialists to diagnose lymphedema. BIS measures limb fluid content by assessing tissue resistance to the flow of electric current. However, there is debate regarding the validity of BIS in diagnosing early lymphedema. Indocyanine green (ICG) lymphography has been established as the most accurate diagnostic modality to date for lymphedema diagnosis. In this retrospective study, we test the sensitivity, specificity, and diagnostic accuracy of BIS in diagnosing lymphedema by referencing its results with ICG lymphography.MethodsPatients presented to the University of Iowa Lymphedema Center from 2015 to 2017 were evaluated with a standardized protocol that included history and physical examination, a validated lymphedema-specific quality-of-life assessment (LYMQOL), circumference –measurement-based index, BIS, and ICG lymphography. Diagnostic accuracy of BIS was assessed using ICG lymphography as a reference test.ResultsFifty-eight patients had positive ICG lymphography results, which confirmed the diagnosis of lymphedema. ICG lymphographic findings consistently correlated with clinical examination, LYMQOL evaluation, and lymphedema indices. By contrast, BIS demonstrated a false-negative rate of 36% – 21 out of 58 patients had normal BIS readings, but a positive ICG lymphography result. The 21 false-negative results occurred in patients with early-stage disease. Sensitivity and specificity for BIS were 0.64 and 1, respectively.ConclusionBIS carries an excessively high rate of false-negative results to be dependably used as a diagnostic modality for lymphedema. ICG lymphography highly correlates with other tracking modalities, and it remains the most reliable tool for diagnosing lymphedema.
Wound outcomes in negative pressure dressings (wound) study – a randomised trial in lower limb skin cancer
Publication date: Available online 9 April 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Ryash Vather, Helen Ker, Gill Rolfe, Hisham Hammodat, Katherine Gale, Richard Martin
The “Positive Argument” for Constructive Empiricism and Inference to the Best Explanation
Abstract
In this paper, I argue that the "positive argument" for Constructive Empiricism (CE), according to which CE "makes better sense of science, and of scientific activity, than realism does" (van Fraassen in The scientific image, Clarendon Press, Oxford, 1980, 73), is an Inference to the Best Explanation (IBE). But constructive empiricists are critical of IBE, and thus they have to be critical of their own "positive argument" for CE. If my argument is sound, then constructive empiricists are in the awkward position of having to reject their own "positive argument" for CE by their own lights.
Diversity in Dermatology: Roadmap for Improvement
Publication date: Available online 10 April 2018
Source:Journal of the American Academy of Dermatology
Author(s): Ellen N. Pritchett, Amit G. Pandya, Nkanyezi N. Ferguson, Shasa Hu, Alex G. Ortega-Loayza, Henry W. Lim
The American Academy of Dermatology (AAD) has taken an active stance in addressing the lack of racial and ethnic diversity in the specialty. At the AAD President's Conference on Diversity in Dermatology held August 5, 2017, key action items were identified in three main areas in order to increase the number of practicing, board-certified dermatologists who are underrepresented in medicine (UIM). These include: increasing the pipeline of UIM students applying to medical school; increasing the exposure and level of interest of UIM medical students in dermatology; and increasing the number of UIM students recruited into dermatology residency programs.
Efficacy and Safety of Ixekizumab Over 4 Years of Open-Label Treatment in a Phase 2 Study in Chronic Plaque Psoriasis
Publication date: Available online 10 April 2018
Source:Journal of the American Academy of Dermatology
Author(s): Claus Zachariae, Kenneth Gordon, Alexandra Kimball, Mark Lebwohl, Andrew Blauvelt, Craig Leonardi, Daniel Braun, Missy McKean-Matthews, Russel Burge, Gregory Cameron
BackgroundIxekizumab has demonstrated improvement in moderate-to-severe psoriasis patients by selectively targeting interleukin-17A, a pro-inflammatory cytokine important in psoriasis pathogenesis.ObjectiveTo report 4-year efficacy and safety results from the open-label extension (OLE) of this phase 2 trial.MethodsAnalysis was by last observation carried forward. Patients received ixekizumab 120 mg then 80 mg subcutaneously once every 4 weeks.ResultsNinety-three percent of patients who completed the randomized placebo-controlled trial entered the OLE. A 75% reduction on the Psoriasis Area Severity Index was reported in 82% of patients at OLE Week 208. A static Physician's Global Assessment score of 0 or1 was reported in 64% and a score of 0 was reported in 45% at Week 208. Dermatology Life Quality Index and Itch Visual Analog Scale scores decreased when compared to baseline. Improvements were observed in other efficacy and health outcome measures. Serious adverse events were observed in 16.7% of patients, and 87% had ≥1 treatment-emergent adverse event. Three patients had serious infections. One patient reported 2 major cardiovascular events.LimitationsThe study was unblinded and lacked a placebo or active comparator.ConclusionsEfficacy was shown to be maintained for up to 4 years of ixekizumab treatment.
Teaser
Interleukin-17A is a critical cytokine involved in psoriasis pathogenesis., The efficacy of ixekizumab, an interleukin-17A monoclonal antibody, was maintained for up to 4 years without apparent increases in health risks or safety issues in moderate-to-severe psoriasis patients., Long-term ixekizumab treatment is an option for moderate-to-severe psoriasis patients.Bevacizumab plus hypofractionated radiotherapy versus radiotherapy alone in elderly patients with glioblastoma: the randomized, open-label, phase II ARTE trial
Abstract
Background
The addition of bevacizumab to temozolomide-based chemoradiotherapy (TMZ/RT→TMZ) did not prolong overall survival (OS) in patients with newly diagnosed glioblastoma in phase III trials. Elderly and frail patients are underrepresented in clinical trials, but early reports suggested preferential benefit in this population. Patients and Methods
ARTE was a 2:1 randomized, multi-center, open-label, non-comparative phase II trial of hypofractionated RT (40 Gy in 15 fractions) with bevacizumab (10 mg/kg x 14 days) (arm A, N = 50) or without bevacizumab (arm B, N = 25) in patients with newly diagnosed glioblastoma aged ≥65 years. The primary objective was to obtain evidence for prolongation of median OS by the addition of bevacizumab to RT. Response was assessed by RANO criteria. Quality of life (QoL) was monitored by the EORTC QLQ-C30/BN20 modules. Exploratory studies included molecular subtyping by 450k whole methylome and gene expression analyses. Results
Median PFS was longer in arm A than in arm B (7.6 and 4.8 months, P = 0.003), but OS was similar (12.1 and 12.2 months, P = 0.77). Clinical deterioration was delayed and more patients came off steroids in arm A. Prolonged PFS in arm A was confined to tumors with the receptor tyrosine kinase (RTK) I methylation subtype (HR 0.25, P = 0.014) and proneural gene expression (HR 0.29, P = 0.025). In a Cox model of OS controlling for established prognostic factors, associations with more favorable outcome were identified for age <70 years (HR 0.52, P = 0.018) and Karnofsky performance score (KPS) 90-100% (HR 0.51, P = 0.026). Including molecular subtypes into that model identified an association of the RTK II gene methylation subtype with inferior OS (HR 1.73, P = 0.076). Conclusion
Efficacy outcomes and exploratory analyses of ARTE do not support the hypothesis that the addition of bevacizumab to RT generally prolongs survival in elderly glioblastoma patients. Molecular biomarkers may identify patients with preferential benefit from bevacizumab. Clinical trial registration number
NCT01443676Early evolutionary divergence between papillary and anaplastic thyroid cancers
Abstract
Background
Papillary thyroid cancer (PTC) is the most common thyroid carcinoma and exhibits an almost uniformly good prognosis, while anaplastic thyroid cancer (ATC) is less frequent and is one of the most aggressive cancers usually resistant to conventional treatment. Current hypothesis posits that ATC derives from PTC through the progressive acquisition of a discrete number of genomic alterations and implies that the mutational landscape of ATC resembles that of PTC. However, the clinical behaviour of ATC and PTC is radically different. We decided to address the disconnection between the clinical behaviour of ATC and PTC and the proposed model of the progressive development of ATC from PTC. Patients and Methods
We performed exome sequencing of DNA from 14 ATC specimens including 3 cases of concomitant ATC and PTC as well as their corresponding normal DNA from 14 patients. The sequencing results were validated using ddPCR. We performed immunohistochemistry and immunofluorescence studies of the concomitant ATC and PTC cases. In addition, we integrated our sequencing results with the existing TCGA data. Results
Most of the somatic mutations identified in the ATC component differed from the ones in PTC in the cases of concomitant ATC and PTC. The trunks of the phylogenetic trees representing the somatic mutations were short with long branches. In one case of concomitant PTC and ATC specimens, we observed an infiltration of PTC cells within the ATC component. Moreover, we integrated our results with data obtained from TCGA and observed that the most frequent mutations found in ATC presented high cancer cell fraction values and were significantly different from the PTC ones. Conclusion
ATC diverge from PTC early in tumour development and both tumour types evolve independently. Our work allows the understanding of the relationship between ATC and PTC facilitating the clinical management of these malignancies.The inefficacy objection to consequentialism and the problem with the expected consequences response
Abstract
Collective action problems lie behind many core issues in ethics and social philosophy—for example, whether an individual is required to vote, whether it is wrong to consume products that are produced in morally objectionable ways, and many others. In these cases, it matters greatly what we together do, but yet a single individual's 'non-cooperative' choice seems to make no difference to the outcome and also seems to involve no violation of anyone's rights. Here it is argued that—contrary to influential arguments by Peter Singer, Alastair Norcross, Shelly Kagan, Derek Parfit, and Allan Gibbard—an appeal to the expected consequences of acts cannot deliver plausible verdicts on many of these cases, because individuals often have a probability of making a difference that is sufficiently small to ensure that 'non-cooperation' is the option with the greatest expected value, even when consequentialists themselves agree that 'cooperation' is required. In addition, an influential argument by Singer, Norcross, and Kagan is shown to be unsound for the claim that in the collective action situations at issue, the expected effect of one individual's action equals the average effect of everyone's similar actions. These results have general implications for normative theory, because they undermine the sort of consequentialist explanation of collective action cases that is initially attractive from many theoretical points of view, consequentialist and otherwise.
Amniotic Band Syndrome: A Review of 2 Cases
Amniotic band syndrome is a rare congenital disorder caused by entrapment of fetal parts (usually a limb or digits) in fibrous amniotic bands while in utero that presents with complex multisystem anomalies. The authors report 2 children with amniotic band syndrome who presented to the ophthalmic unit of the authors' pediatric hospital. One of them presented with telecanthus, syndactyly, amputated toes, and unilateral epiphora diagnosed as congenital nasolacrimal duct obstruction. She was managed conservatively with lacrimal sac massage and provided with refractive correction while she simultaneously underwent multiple surgeries for correction of clubfoot and craniosynostosis. The second patient presented with cleft lip, cleft palate, multiple constriction bands in upper limbs and fingers with unilateral microphthalmos, microcornea, typical iris coloboma, and retinochoroidal coloboma, very similar to a case reported in literature. These 2 cases provide an overview of the clinical spectrum of ophthalmic manifestations along with their staged optimum rehabilitation. Accepted for publication February 6, 2018. Consent for photographs: Obtained and archived from the parents of the patients for printing identifiable photographs of their children. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Zia Chaudhuri, M.S., F.R.C.S. (Glasg), F.I.C.O., Department of Ophthalmology, Lady Hardinge Medical College, University of Delhi, PGIMER, Dr RML Hospital, New Delhi, India. E-mail: ziachaudhuri2@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
A Prospective Randomized Comparative Clinical Trial to Analyze Pain and Surgical Outcomes Between Frontal Nerve Blocks and Subconjunctival Anesthesia for Conjunctival Mullerectomy Resection
Purpose: Conjunctival Muller's muscle resection (CMMR) is a posterior approach surgical technique to correct blepharoptosis. The purpose of this study is to compare patient-reported pain scores and surgical outcomes for patients who received 2 different anesthetic techniques during CMMR, frontal nerve block and subconjunctival injection. Methods: A prospective randomized comparative clinical trial enrolled 33 CMMR subjects from one tertiary eye center. Patients undergoing unilateral CMMR were randomized to receive either frontal nerve block or subconjunctival injection. For patients undergoing bilateral CMMR, each side was randomized to one of the injection techniques. Upper eyelid margin reflex distance was measured and recorded for each eye before and after surgery. Patients' pain scores were quantified using the Wong Baker Pain Scale. Subjects quantified their pain during, immediately after, 12 and 24 hours after surgery. Results: Twenty-four bilateral and 9 unilateral cases were enrolled in the study. Twenty-two (92%) subjects were female, and the mean patient age was 69 ± 12 years. The mean margin reflex distance was 1.1 mm preoperatively, which increased to 3.5 and 3.6 mm 2 months postoperatively in frontal nerve block and subconjunctival injection groups, respectively (p value
Distribution of Adrenergic Receptor Subtypes and Responses to Topical 0.5% Apraclonidine in Patients With Blepharoptosis
Purpose: To determine the relationship between the distribution of adrenergic receptors in the human eyelid and the eyelid elevation after topically instilling 0.5% apraclonidine in blepharoptosis patients. Methods: A total of 26 blepharoptotic patients (30 eyelids) were included in the experimental study. Marginal reflex distance 1 was measured before and after topical instillation of 0.5% apraclonidine. Eyelids were divided into 2 groups according to the responses to topical 0.5% apraclonidine. Patients who positively responded to apraclonidine were classified as group A and those that negatively responded to it were classified as group B. Müller's muscle was obtained during the blepharoptotic surgery, followed by immunohistochemical staining and scoring. This study was approved by the Institutional Review Board of Kim's Eye Hospital and the study protocol adhered to the tenets of the Declaration of Helsinki. Results: α-1D staining intensity was significantly higher in group A than in B (p
An Individualized 3-Dimensional Designed and Printed Conformer After Dermis Fat Grafting for Complex Sockets
Purpose: To introduce a novel technique to design individually customized conformers for postenucleation sockets with dermis fat implants. Methods: We use a 3-dimensional scan of the frontal face/orbit and eyelid contour to design an individualized conformer. This polymethylmetacrylate printed conformer is adapted to patients' socket, palpebral fissures, horizontal eyelid aperture, curvature of the eyelids, and mean diameter of patients' contralateral eye. Sutures through holes in the inferior part of the conformer and in the extension can be placed to fixate the conformer and anchor fornix deepening sutures. Results: A correct fitting conformer can be printed and attached to the socket and eyelids. The shape of this conformer can be used subsequently postsurgically to design the ocular prosthesis. Conclusion: Presurgical planning is important to anticipate for a functional socket to adequately fit an artificial eye. The presented technique using 3-dimensional imaging, designing, and printing promises to prevent conformer extrusion and forniceal shortening. Accepted for publication February 15, 2018. Supported by ODAS Foundation, Delft, The Netherlands. The sponsor or funding organization had no role in the design or conduct of this research. The authors have no financial or conflicts of interest to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.op-rs.com.). Ms. Mourits and Mr. Remmers contributed equally to this article. Address correspondence and reprint requests to Department of Ophthalmology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. E-mail: D.mourits@vumc.nl © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Herpes Zoster Ophthalmicus With Orbital Findings Preceding Skin Rash
The authors describe 2 patients who presented with orbital findings and later developed vesicular lesions that were positive for varicella zoster virus and consistent with Herpes Zoster ophthalmicus. One case is the first to involve dacryoadenitis and orbital myositis preceding disseminated Herpes Zoster. In the other case, a patient developed zoster orbital syndrome leading to elevated intraocular pressure, loss of vision, and afferent pupillary defect. Canthotomy and cantholysis were required to restore vision. In both cases, the orbital syndrome developed prior to the vesicular rash. These cases highlight the need to consider Herpes Zoster ophthalmicus in patients with orbital syndrome not responding to conventional treatment. Accepted for publication February 14, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Elizabeth Chiang, M.D., Ph.D., Southside Eye Care, 3206 Churchland Blvd., Chesapeake, VA 23321. E-mail: echiangmdphd@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Ophthalmic Pyogenic Granulomas Treated With Topical Timolol—Clinical Features of 17 Cases
Purpose: Topical timolol has been increasingly demonstrated to be an effective treatment for pyogenic granulomas (PG). The authors review the treatment outcomes of 17 patients with ocular PG treated with topical timolol. Methods: Retrospective interventional study of 17 patients with ocular PGs treated with timolol 0.5% solution. Patient demographics, clinical features, treatment response, and recurrence were noted. Results: Nine females and 8 males with a mean age of 23 years (range, 3–67 years) were included. Mean duration of disease prior to treatment was 3.81 months (range, 0.25–11 months). Etiologies included chalazia (12 cases, 71%), postsurgical (4, 24%) and trauma (1, 6%). Five patients (29%) had treatment with topical steroids prior to presentation. Fifteen patients (88%) had PG located on the palpebral conjunctiva and 2 (12%) involving the bulbar conjunctiva. Mean lesion size was 5.06 × 6.06 mm (range, 3–8 × 3–18 mm). Fifteen patients (88%) had complete lesion resolution with a mean treatment duration of 3.07 weeks (range, 2–5 weeks) and no adverse events or recurrences with a mean follow up of 9.47 months (range, 6–27 months). Two patients (12%) underwent lesion excision after 6 weeks of timolol failed to yield resolution. Conclusion: Topical timolol appears to be a well-tolerated nonsurgical treatment of ocular PG in both children and adults. Clinicians may wish to consider topical timolol to treat PG as opposed to topical steroids, given the inherent risk of steroid response ocular hypertension and the difficulty to measure intraocular pressure in younger children who require general anesthesia for excision. Accepted for publication February 15, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Roman Shinder, M.D., F.A.C.S., Department of Ophthalmology, SUNY Downstate Medical Center, 451 Clarkson Ave, E bldg, 8th Fl, Suite C, Brooklyn, NY 11203. E-mail: shinder.roman@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Eye-Preserving Surgery Followed by Adjuvant Radiotherapy for Lacrimal Gland Carcinoma: Outcomes in 37 Patients
Purpose: To describe the clinical outcomes of eye-preserving surgery followed by adjuvant radiotherapy in patients with lacrimal gland carcinoma. Methods: Thirty-seven patients with lacrimal gland carcinoma who underwent eye-preserving surgery were studied. Results: At last follow up, 32 patients were alive without disease, 3 patients were alive with disease with distant metastasis, 1 patient had died of disease, and 1 patient had died of other cause. The 5-year recurrence-free survival rate was worse in patients without than in patients with adjuvant radiotherapy (p = 0.001) and worse in patients with T3-T4 tumors than in patients with T1-T2 tumors (p = 0.027). At last follow up, 25 patients (68%) had visual acuity of 20/40 or better. Conclusions: In patients with lacrimal gland carcinoma, eye-preserving surgery and adjuvant radiotherapy is associated with reasonable local control rates and visual and ocular function. Postoperative adjuvant radiotherapy seems to enhance local control rates. Accepted for publication February 7, 2018. Presentation at the American Academy of Ophthalmology Annual Meeting, October 2016, Chicago, IL. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Bita Esmaeli, M.D., Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1488, Houston, TX 77030. E-mail: besmaeli@mdanderson.org and Yoon-Duck Kim, MD, Department of Ophthalmology, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea. E-mail: ydkimoph@skku.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Does CBD Oil Lower Blood Pressure? This article was originally published at SundayScaries." Madeline Taylor POSTED ON January 13, 20...
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Publication date: Available online 28 September 2017 Source: Actas Dermo-Sifiliográficas Author(s): F.J. Navarro-Triviño
