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Δευτέρα 20 Αυγούστου 2018

Fluorene oxidation by solar-driven photo-Fenton process: toward mild pH conditions

Abstract

Polycyclic aromatic hydrocarbons (PAHs) are on the list of priority pollutants to be eliminated from the environment due to their carcinogenic and mutagenic action, chemical stability, and resistance to biodegradation. The aim of this study was to evaluate the degradation of fluorene, a well-known PAH, in aqueous solutions (0.03 and 0.08 mg L−1), by means of a solar-driven conventional (PF) and modified photo-Fenton mediated by ferrioxalate complexes (PFF). Photolysis was also employed for comparison purposes. PF reaction was evaluated at different pH values (2.8, 3.5, and 4.0) and iron concentrations (2, 5, 10, and 20 mg L−1). On the other hand, PFF studies were conducted at mild pH conditions (4.0, 5.0, and 6.0) and iron content of 2 mg L−1, keeping initial iron/oxalate molar ratio at 1:3. In both PF and PFF, the initial hydrogen peroxide/iron molar ratio was maintained at 5. In the presence of methanol as cosolvent for fluorene dissolution, the PF reaction was hampered and no consumption of H2O2 was observed during the reaction carried out at constant pH (2.8). This led to low degradation rates, similar to those achieved by photolysis. Under the same pH but using acetonitrile as cosolvent for fluorene dissolution, fluorene degradation was found to be proportional to the iron content used in the PF experiments. On the other hand, at an invariable iron concentration of 5 mg Fe2+ L−1, the increase in pH was accompanied by a decrease in the molar fraction of the most photoactive iron complex (FeOH2+) and ferric hydroxides precipitation, leading to a reduction in the fluorene degradation rate. With regard to the PFF tests, similar fluorene degradation performance was achieved at pH 4 and 5, while at pH 6 iron precipitation became relevant and the degradation rate was slightly slower. PFF has shown to be more efficient than the PF under the same pH (4) and iron concentration (2 mg L−1). Moreover, even at near neutral pH (6), fluorine degradation was shown to be feasible by using ferrioxalate complexes.



Antony Charles Harington Watson MB,ChB,FRCSEd. (Tony)

Publication date: Available online 20 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s):



Effects of compost containing oxytetracycline on enzyme activities and microbial communities in maize rhizosphere soil

Abstract

Veterinary antibiotics can enter agricultural fields via the application of livestock manure containing antibiotics. However, the response of soil microorganisms to compost containing antibiotics is not well understood. A 120-day pot experiment was conducted to investigate the impact of compost containing oxytetracycline (OTC) on the enzyme activities and microbial communities in maize rhizosphere soil. Swine manure was artificially spiked with OTC at four concentrations, 35, 70, 105, and 140 mg kg−1, and combined with straw to produce compost. The compost products were applied to soil planted with maize. Rhizosphere soil samples were collected on days 1, 15, 30, 60, and 120. The results indicated that the urease activities first increased and then declined, while in contrast, the alkaline phosphatase activities first decreased and then increased slightly. Catalase exhibited dose-related activation during the maize growth period. At the end of the experiment, the soil enzyme activities were similar to their initial values, indicating that the soil enzymes showed a level of recovery. The carbon metabolic activity levels were higher in the soils with high OTC concentrations than in the control, whereas the Shannon diversity index was higher in the control soil. The results of principal component analysis (PCA) indicated that the application of compost containing OTC shifted the structure of the soil microbial community and negatively affected its stability. These results suggest that the compost containing OTC exerted selective pressure on enzyme activities and microbial communities in maize rhizosphere soil and decreased their resilience to antibiotic pollution.



Bullous erythroderma: novel association of pityriasis rubra pilaris with bullous pemphigoid

Clinical and Experimental Dermatology, EarlyView.


The potential for constructed wetland mechanisms to treat alkaline bauxite residue leachate: carbonation and precipitate characterisation

Abstract

Leachates emanating from bauxite residue disposal areas are alkaline and require neutralisation prior to discharge. The use of passive technologies such as constructed wetlands has received increasing interest as possible treatments for alkaline leachates, including bauxite residues. Mechanisms proposed for wetland effectiveness have included calcite precipitation but it is not clear if such a pathway is feasible in the relatively low Ca residue leachates. Carbonation of Ca-spiked residue leachate treatments was conducted to observe rates of pH decrease and precipitate formation. For all treatments, carbonation effectively decreased pH to ca. 10.5 which remained stable following aeration. Decreases in Al content of 83–93% were also observed. Precipitates retrieved from carbonation experiments and from a constructed wetland trial were characterised using XRD, SEM, XPS and EDX. Calcium carbonates formed in Ca-spiked treatments and dawsonite precipitation occur in the absence of Ca. Rinsing of precipitates removes surface calcium indicating soluble forms adsorbed on precipitates. The results demonstrate that carbonation of bauxite residue leachate is an important component of passive treatments and neutralisation.



A framework to rank genomic alterations as targets for cancer precision medicine: the ESMO Scale for Clinical Actionability of molecular Targets (ESCAT)

Abstract
Background
In order to facilitate implementation of precision medicine in clinical management of cancer, there is a need to harmonise and standardise the reporting and interpretation of clinically relevant genomics data.
Methods
The European Society for Medical Oncology (ESMO) Translational Research and Precision Medicine Working Group (TR and PM WG) launched a collaborative project to propose a classification system for molecular aberrations based on the evidence available supporting their value as clinical targets. A group of experts from several institutions was assembled to review available evidence, reach a consensus on grading criteria and present a classification system. This was then reviewed, amended and finally approved by the ESMO TR and PM WG and the ESMO leadership.
Results
This first version of the ESMO Scale of Clinical Actionability for molecular Targets (ESCAT) defines six levels of clinical evidence for molecular targets according to the implications for patient management: tier I, targets ready for implementation in routine clinical decisions; tier II, investigational targets that likely define a patient population that benefits from a targeted drug but additional data are needed; tier III, clinical benefit previously demonstrated in other tumour types or for similar molecular targets; tier IV, preclinical evidence of actionability; tier V, evidence supporting co-targeting approaches; and tier X, lack of evidence for actionability.
Conclusions
The ESCAT defines clinical evidence-based criteria to prioritise genomic alterations as markers to select patients for targeted therapies. This classification system aims to offer a common language for all the relevant stakeholders in cancer medicine and drug development.

Efficacy and safety of ixekizumab, an interleukin-17A monoclonal antibody, in real-world patients with psoriasis: 12-week results from a Canadian multicenter retrospective study

Background: The discovery of targeted therapies that selectively bind to interleukin (IL)-17A and neutralize the bioactivity of this cytokine has led to the development of the next generation of biologic treatments for psoriasis. Most recently, ixekizumab, an IL-17A monoclonal antibody was approved for the treatment of moderate to severe plaque psoriasis in adult patients. Current efficacy and safety data are limited to results from phase III randomized controlled trials (RCT). Although these studies have shown unprecedented outcomes, how dermatologist prescribe and monitor ixekizumab in the real world is based on results obtained from patients enrolled in clinical trials.

Hydroa vacciniforme–like lymphoma in an adult resident of the United States

Introduction: Hydroa vacciniforme–like lymphoproliferative disorders (HVLPDs) are a spectrum of diseases resulting from chronic Epstein-Barr virus (EBV) infection of T cells and natural killer cells. These include classic hydroa-vacciniforme (HV), severe HV, and HV-like lymphoma (HVLL). The latter 2 conditions rarely occur outside Asian and Latin American youth. Here we present an unusual case of adult-onset HVLPD in the United States.

Consistency of response by weight across subgroups of patients with psoriasis treated with guselkumab: Results from the VOYAGE 1 and 2 trials

Objective: To evaluate the consistency of response of guselkumab (GUS) across predetermined weight quartile subgroups of psoriasis patients.

Is apremilast a promising treatment for psoriasis and psoriatic arthritis?

Introduction and objective: Apremilast (APR), is a small molecule that selectively inhibits the phosphodiesterase 4 (PDE-4) which modulates the release of pro- and antiinflammatory mediators. it was approved in February 2015 in Italy for the treatment of moderate-to-severe psoriasis and psoriatic arthritis (PsA) in adults. The aim of the authors is to assess the efficacy as well as the safety of the PDE-4 inhibitor apremilast both in PsA and psoriasis (Pso).

Evaluation of the protection of a broad-spectrum SPF50+ sunscreen against DNA damage

Introduction and objectives: UV exposure causes many skin damages. UV damages DNA, proteins, and lipids, which can result in harmful consequences, such as carcinogenesis and skin aging. Formation of DNA photoproducts caused by UV exposure needs to be investigated in vivo to assess sunscreens' level of protection against solar genotoxicity. The objective of the present study was to evaluate how the tested broad-spectrum sunscreen protect against the formation of photoproducts.

Dermatology boot camp: A model for initiating new residents into dermatology clinical care

Entering dermatology residency is an immersive experience requiring specialty-specific skills that are not routinely emphasized in medical school and internship training. To provide a practical introduction to dermatologic clinical care emphasizing ACGME dermatology milestones, we developed a concentrated 8-hour curriculum for first-year dermatology residents that encompasses 3 pillars of patient care: clinical visit competencies, procedural techniques, and professionalism and collegiality. A variety of diverse teaching approaches are employed, emphasizing respect for one another and patients, to allow instruction in pertinent practical and intellectual skills.

Improvement of chin profile with the use of calcium hydroxylapatite with integral lidocaine

Background and objective: Adequate chin projection is associated with strength in the male jawline, balance to a female face, and a harmonious balance with the nose. The criterion standard to improve the chin profile is surgical placement of a solid implant. However, the emergence of fillers to shape and improve facial features provides new options to achieve immediate results with minimal downtime. Calcium hydroxylapatite plus integral lidocaine (CaHA(+); Merz North America, Inc.) is a filler that provides immediate volume improvement and lasts for ≥1 year.

Gender differences for those who have second primary malignancies within the first year of survival after malignant melanoma diagnosis: A United States population-based study

Introduction: Little has been reported about gender differences in those with second primary malignancies (SPM) within 1 year of melanoma (MM) diagnosis. The aim of this study is to explore gender differences as evidenced by tumor type within the first year of MM survival status using the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) database.

Endoglin is highly expressed in human mast cells

Background: CD 105 is a glycoprotein of cell membrane, for which an immunohistochemical antibody has been used as marker of endothelial cells from capillaries in proliferation. Mast cells originate from hematopoietic stem cells located in the bone marrow and migrate through the blood stream to target tissues. These cells are a component of normal tissue, though they play an important role in the regulation of several processes, including inflammation, allergy and neoplasia. The aim of this study was to evaluate the use of CD105 as a biologic marker of mast cells compared with the criterion standard stain.

Disseminated pruritic papules

A 60-year-old Arabic man with a medical history of diabetes mellitus was admitted to the hospital for an unprovoked deep vein thrombosis with pruritus, nonproductive cough, and abdominal pain. His pruritus had been ongoing over the preceding four months and he has developed diffuse erythematous to hyperpigmented papules with some having a central keratotic core and others with hemorrhagic crusting. He had minimal to no improvement in his pruritus on mid-potency topical corticosteroids in combination with antihistamines.

Cutaneous nontuberculous mycobacteria infection: A retrospective study of 78 cases

Introduction: The incidence of cutaneous nontuberculous Mycobacteria (NTM) infection is increasing in both immunosuppressed and immunocompetent patients. These infections are often misdiagnosed due to nonspecific presentation.

Köhlmeier-Degos disease: Does the benign form really exist?

A 46-year-old woman was referred to us for evaluation of asymptomatic erythematous papules with central umbilication and atrophy in trunk and extremities. Histologic features were compatible with Degos disease. She had no systemic manifestations and the laboratory and the radiologic findings were no significant. 6 years after the diagnosis the patient complained of headache and weakness. Initial evaluation revealed a subdural hygroma on CT. Then she developed a hemiparesis, and MRI showed a subacute ischemia in the territory supplied by the middle cerebral artery.

Infantile myofibromatosis: A diagnostic conundrum

A 2-day-old boy was referred to dermatology with a history of skin lesions present since birth. He was born at 39+6 weeks by cesarean section owing to failure to progress to a primiparous mother with gestational diabetes. On examination, he had 6 firm, tumid, red-violaceous nodules on the body. The largest was on the left side of the neck which had reportedly grown since birth; ultrasound did not reveal any Doppler flow. In addition, similar lesions were noted on the torso, with smaller nodules on the groin, lower abdomen and calf.

Impact of genital lichen sclerosus treatments on occurrence of vulvar neoplasms in 275 adult women

Background: Lichen sclerosus (LS) is a chronic inflammatory disease most commonly affecting the genital area of women. LS-associated vulvar neoplasms are known to occur. Treatment of LS is thought to reduce malignancy risk. A recent report showed reduction in vulvar neoplasms in those compliant with maintenance therapy. We performed a single-institution, retrospective chart review to identify vulvar neoplasm occurrence in women with biopsy-proven genital LS and to determine whether a correlation exists between LS treatments and vulvar neoplasm occurrence.

Hallopeau’s continuous acrodermatitis: Management

Introduction: Hallopeau's continuous acrodermatitis (ACH) is a chronic inflammatory disease affecting the fingers and/or toes, characterized by an erythematous-desquamative plaque with sterile pustular eruptions. It is a rare or perhaps underdiagnosed and more frequent pathology in middle-aged women, according to the few cases reported.

Familial aplasia cutis congenita: A case report

Introduction: Aplasia cutis congenita is a rare congenital disorder. The incidence has been estimated at 1 per 10,000 live births. It is characterized by the absence of certain layers of the skin. At birth, it commonly presents as a solitary well localized lesion on the scalp. Infrequently, a widespread area can be involved. The etiology remains unclear. Genetic factors, environmental causes and teratogens have been implicated.

Erlotinib-induced erosive pustular dermatosis of the scalp complicated by MRSA infection

Introduction: Erosive pustular dermatosis (EPD) of the scalp is a rare entity characterized by erosive, follicular, papulopustular eruptions with nonspecific chronic inflammatory findings on histopathology. EPD of the scalp has been associated with epidermal growth factor receptor (EGFR) inhibitor therapy such as gefitinib or erlotinib with only a few reported cases. Herein, we report an impressive presentation of EPD of the scalp complicated by secondary methicillin-resistant Staphlococcus aureus (MRSA) infection during treatment with erlotinib for stage IV lung cancer.

Efficacy of sinecatechins 10% as proactive sequential therapy of external and perianal genital warts after laser therapy: An exploratory trial

Background: External genital warts (EGW) are the most common viral sexually transmitted infection. Ablative treatments like cryotherapy, curettage and CO2 laser therapy offer rapid onset of effect, fast clearance, and reduction of virus load. However, these procedures are associated with high recurrence rates (RR) of 20%-77% in the short and medium term and do not provide sustained clearance. After laser therapy removal of EGW a RR up to 60% has been reported. Topical sinecatechins 10% is a patient-applied regimen for the treatment of EGW with a low RR (6.5%) at 3 months after completion of the therapy in the pivotal trials conducted so far.

Eccrine poroma: An unusual presentation and evaluation with the use of dermoscopy and optical-coherence tomographic imaging

Eccrine poromas (EP) are benign cutaneous adnexal neoplasms that commonly present as solitary plaques, papules, or nodules on the lower extremities. Both clinically, and on dermoscopy, EP can be hard to distinguish from other skin tumors, including amelanotic melanoma and eccrine porocarcinoma. Dermoscopy and optical-coherence tomography (OCT) are 2 noninvasive imaging devices that can increase the diagnostic accuracy of benign and malignant cutaneous diseases. Thus, understanding the dermoscopic features of EP and characterizing it on OCT imaging may help improve diagnostic accuracy.

Diagnosis and management of childhood psoriasis: A prospective study

Retrospective studies show that approximately one third of adults with psoriasis recall onset in childhood however the true prevalence in children remains unknown. It affects 2.0%-3.5% of the population worldwide and has been reported as high as 8.5% depending on the population studied. Psoriasis can have a significant impact on quality of life in both children and adolescents by impacting self-esteem, family and social relations and school. Children suffering from psoriasis also have higher prevalence of obesity, hypertension, diabetes mellitus, rheumatoid arthritis, Crohn's disease and psychiatric disorders.

An integrated modelling framework and a modified method for evaluating non-carcinogenic health risks from nonylphenol-contaminated food consumption in Long An, Vietnam

Abstract

This study proposed an integrated modelling framework and a modified method for evaluating non-carcinogenic health risks from nonylphenol (NP)-contaminated food consumption. First, a fugacity-based multimedia model and a food web bioaccumulation model were adopted to predict the distribution of NP in the Can Giuoc river and the bioaccumulative concentrations in biota. Next, local people's exposure to NP was quantified using the accumulative concentrations and the data of fishery products intake from a questionnaire survey distributed among 203 local people. Then, human health risk was evaluated in terms of fishery products intake and intake frequency which were each derived from the same survey. The study revealed that human health risk would exist, although the obtained bioaccumulation factors for the consumed organisms were lower than the bioaccumulation criteria. Consuming 141 g or more per serving of riverine food products resulted in an average NP intake exceeding 0.005 mg/kg of body weight per day among 45–73% of the local adults, of whom pregnant women or young and potential mothers accounted for 10–21%. Seventy-nine percent was the highest rate of the population to be at risk under medium river flow rate when food-intake amount and intake frequency were taken into account. Ingesting 70 g per serving of more contaminated species, such as whiteleg shrimp and small fish, less frequently could lead to less risk exposure than ingesting 267 g per serving of less contaminated species, such as sand goby and climbing pearch, more frequently. By coupling food intake with intake frequency, the modified method enables the studying of human health risk from NP-contaminated food consumption to be conducted with more care, and so benefits risk communication at local level.



A cost compensation model for construction and demolition waste disposal in South China

Abstract

Construction and demolition waste (C&D waste) is a worldwide issue that concerns the sustainable development of the construction industry. In this paper, detailed formulas are listed for calculating the costs of four typical kinds of disposal routes of C&D waste. They are illegal dumping, controlled dumping (landfill), centralized recycling, and on-site recycling. Through the specific formulas, the costs of the new construction project in Guangzhou are also estimated. Then, a cost compensation model of construction waste disposal is constructed, which serves to calculate the amount of compensation that the government shall make to the contractor's disposal cost. The results of this study include the following: (1) steps taken to ensure the appropriate measures for C&D waste disposal sites and recycling centers; (2) the on-site recycling will become the future trend of C&D waste disposal due to its lowest cost; (3) the brick cement mortar and scattered concrete take a relatively larger proportion in the total C&D waste generated during the new construction project, and their disposal costs are higher; (4) we find that the cost of illegal dumping is the lowest among four varieties of waste treatment options if only the direct cost of waste treatment is taken account. However, the cost of on-site recycling becomes the lowest if the total cost is considered; (5) according to the case study, the full estimated cost of construction waste disposal is 9074.56 CNY and the total cost compensation is 15,084.21 CNY. The amount of compensation is greater than the disposal cost and contractors make a profit, thus stimulating them to recycle and reuse construction waste. Based on the empirical findings, we make several policy proposals. The research puts forward some operational advice as a reference for decision-makers of C&D waste management.



Antony Charles Harington Watson MB,ChB,FRCSEd. (Tony)

1936–2018

Analyzing the significant environmental factors on the spatial and temporal distribution of water quality utilizing multivariate statistical techniques: a case study in the Balihe Lake, China

Abstract

The assessment of surface water quality is significant to the management of aquatic ecosystem. In this research, in Balihe Lake which is an agricultural watershed lake, 11 environmental parameters (pH, water temperature, water depth, turbidity, DO, COD, TN, NH4+-N, NO3-N, TP, Chl-a) are monitored at 45 sampling sites in four seasons (winter of 2016, spring, summer, and autumn of 2017). With these monitoring data, two kinds of multivariate statistical methods including cluster analysis (CA) and principal component analysis (PCA) are applied to evaluate the spatial and temporal characteristics of the surface water quality. The results reveal that the spatial clusters (less, moderately, and highly polluted sections) of 45 sampling sites classified by the CA method are exactly consistent with the geographical distribution of these sampling sites, which rely on water quality meliorating downstream. From the perspective of time scale, the correlations between environmental parameters generated by the PCA method reveal that the main factors affecting the surface water quality are different in the four seasons. For the whole study period, which is a longer time scale rather than season, the main factors are also different to that of any season. Large time scale may weaken the effect and potential risk of nutrients on water quality, and it is therefore reasonable to select seasonal scale for the study of water quality in an agricultural watershed by using PCA. The results of this research may demonstrate significance to the identification of the main pollution factors and water quality assessment in freshwater lake with multivariate statistical methods.



Effect of vitamin A and vitamin C on attenuation of ivermectin-induced toxicity in male Wistar rats

Abstract

An in vivo study was performed to assay the effects of ivermectin on adult male Wistar rats. Twenty-five male Wistar rats aged 6 to 8 weeks and weighing 150–250 g were divided into five groups of five animals each for the purpose of this study. The groups received ivermectin; a mixture of ivermectin and vitamin A; a mixture of ivermectin and vitamin C; and a mixture of ivermectin, vitamin A, and vitamin C, respectively. One group served as the control group and was treated with double-distilled water. The treatment was carried out once a week for 3 weeks. The results of the study revealed that the animals were less affected as detected by slight changes in the body weight, stress oxidative parameters, serum levels of liver enzymes, kidney function indexes, cell blood counts, and sperm analysis upon exposure to ivermectin. Nevertheless, the use of vitamins A and C might have a promising effect against oxidant-antioxidant imbalance. Although, the administration of free ivermectin has fewer reactions on mammals, use of the drug supplemented with antioxidants such as vitamins A and C moderates its effects.



A review on the direct effect of particulate atmospheric pollution on materials and its mitigation for sustainable cities and societies

Abstract

Particulate matter (PM) has gained significant attention due to the increasing concerns related to their effects on human health. Although several reviews have shed light on the effect of PM on human health, their critical adverse effect on material's structure and sustainability was almost neglected. The current study is an attempt to fill this gap related to PM impact on structural materials under the overall consideration of sustainability. More specifically, this review highlights the existing knowledge by providing an overview on PM classification, composition, and sources in different locations around the world. Then, it focuses on PM soiling of surfaces such as solar panels due to an increasing need to mitigate the impact of soiling on reducing photovoltaic (PV) power output and financial competitiveness in dusty regions. This topic is of critical importance for sustainable deployment of solar energy in arid and desert areas around the world to help in reducing their impact on overall climate change and life quality. In addition, this review summarizes climate change phenomena driven by the increase of PM concentration in air such as radiative forcing and acid rain deposition due to their impact on human health, visibility and biodiversity. To this end, this work highlights the role of process management, choice of fuel, the implementation of clean technologies and urban vegetation as some possible sustainable mitigation policies to control PM pollution in cities and urban regions. This research is designed to conduct a comprehensive narrative literature review which targets broad spectrum of readers and new researchers in the field. Moreover, it provides a critical analysis highlighting the need to fill main research gaps in this domain. The findings of this review paper show that PM pollution imposes severe adverse impacts on materials, structures and climate which directly affect the sustainability of urban cities. The advantages of this review include the value of the extensive works that elaborate on the negative impacts of PM atmospheric pollution towards high level of public awareness, management flexibility, stakeholder's involvements, and collaboration between academy, research, and industry to mitigate PM impact on materials and human welfare.



Potential sources and meteorological factors affecting PM 2.5 -bound polycyclic aromatic hydrocarbon levels in six main cities of northeastern Italy: an assessment of the related carcinogenic and mutagenic risks

Abstract

A yearlong sampling campaign (2012–2013) was conducted in six major cities of the Veneto region to investigate the spatial-temporal trends and the factors affecting the polycyclic aromatic hydrocarbon (PAHs) variations and identify the local sources. Sixty samples per city were collected for analyses in every alternate month (April, June, August, October, December, and February): 10 samples per sampling site in 10 consecutive days of the months selected. Samples were ultrasonically extracted with acetonitrile and processed through high-performance liquid chromatography. Total Σ-PAH concentrations ranged from 0.19 to 70.4 ng m−3 with a mean concentration of 11.5 ng m−3. The mean benzo[a]pyrene (BaP) concentration reached 2.0 ng m−3, which is two-times higher than the limit set by the European Union. BaP contributed for 17.4% to the total concentration of PAHs, which showed the same pattern across the region with maxima during cold months and minima in the warm period. In this study, PAHs showed an inverse relationship with temperature, solar radiation, wind speed, and ozone. According to this study, biomass burning for household heating and cooking, followed by gaseous PAHs absorption on particles due to low atmospheric temperature, were the main reasons for increasing PAHs concentration in winter. Health risk, evaluated as lifetime lung cancer risk (LCR), showed a potential carcinogenic risk from the airborne BaPTEQ six-fold higher in the cold season than in the warm one. Diagnostic ratios and conditional probability functions were used to locate the sources, and results confirmed that local emission, overall domestic heating, and road transport exhausts were responsible for higher concentration rates of PAHs as well as of PM2.5.



Treating MTBE-contaminated water using sewage sludge-derived activated carbon

Abstract

In this study, sewage sludge-derived activated carbon (SDAC) was synthesized, characterized, and tested for its potential as an adsorbent of methyl tert-butyl ether (MTBE). The SDAC was produced by activating the sludge with zinc chloride and subsequently subjected to various ranges of pyrolytic temperatures. It was then characterized using SEM/EDX, BET, and TGA. The SEM-EDX analyses showed that impurities like Fe, Al, Mg, Mn, Ca, and Na of the raw sludge were removed by the higher pyrolytic temperature and acid-washing procedures. TGA showed the thermal stability of the produced material. Results of the BET revealed a significant increase in surface area of the sludge from 1.5 m2/g to 385 m2/g after acid washing. The MTBE removal efficiency of 70% was achieved after 60 min with 2 g/L of SDAC at pH 6, and initial MTBE concentration of 1 ppm. The adsorption kinetics of SDAC fitted into pseudo-second-order reactions. This work demonstrated a beneficial use of a bio-waste material (sewage sludge) in water treatment technologies.



GBM Drug Bank—a new resource for glioblastoma drug discovery and informatics research

The availability of open access chemical databases associating compounds with their biological activities impacts fundamentally the early stages of modern drug discovery.1 The increasing interest in both drug repurposing2 and drug combination3 also necessitates the development of databases detailing compounds and mechanisms that have been explored previously.

Erstlinientherapie des mRCC: ein Update

Zusammenfassung

Hintergrund

Neue medikamentöse Perspektiven lassen auf Fortschritte in der Erstlinientherapie des metastasierten Nierenzellkarzinoms (mRCC) hoffen.

Fragestellung

Die aktuelle First-Line-Therapie beim mRCC, Erweiterung der Therapieoptionen durch Tivozanib und Cabozantinib und zukünftig erwartete Substanzen werden diskutiert.

Material und Methode

Aktuelle DGHO-Empfehlungen, Diskussion pivotaler Studien zur Erstlinientherapie des mRCC.

Ergebnisse

Derzeit sind 6 zielgerichtete Wirkstoffe in der Erstlinie des mRCC relevant: Bevacizumab plus Interferon-α (INF-α), Pazopanib, Sunitinib, Tivozanib, Cabozantinib und Temsirolimus. Die Substanzen werden risikostratifiziert eingesetzt. Ein neuer zugelassener Wirkstoff ist Tivozanib. In der zulassungsrelevanten Studie war der Tyrosinkinaseinhibitor (TKI) einer Therapie mit Sorafenib hinsichtlich des progressionsfreien Überlebens (PFS) überlegen (11,9 vs. 9,1 Monate; HR 0,797). Die Verträglichkeit von Tivozanib erwies sich als gut mit weniger Hand-Fuß-Syndromen und Diarrhö: Off-Target-Effekte im Vergleich zu anderen VEGFR-TKI könnten hier einen Therapievorteil bedeuten. Eine Zulassungserweiterung für Cabozantinib ergänzt die Optionen in der Erstlinientherapie für Patienten mit intermediärem und hohem Risiko. Die sich abzeichnende Einführung der Immunkombinationstherapie aus Nivolumab plus Ipilimumab könnte künftig eine wichtige Rolle spielen: Ergebnisse der CheckMate-214-Studie bestätigen die Verbesserung der Ansprechrate und die Verlängerung des Gesamtüberlebens gegenüber Sunitinib beim mRCC mit intermediärem oder hohem Risiko.

Schlussfolgerungen

Tivozanib ergänzt die Erstlinientherapie des mRCC um eine wirksame und gut verträgliche Substanz. Auch für Cabozantinib folgte eine Zulassungserweiterung für die Erstlinie. Mit Nivolumab plus Ipilimumab wird die erste Immunkombinationstherapie in der Erstlinie erwartet.



Endokrine Spätfolgen nach onkologischer Therapie im Kindesalter

Zusammenfassung

Hintergrund

Da die Überlebensraten nach einer Krebserkrankung im Kindesalter während der letzten Jahrzehnte kontinuierlich zunahmen, steigt die Anzahl der Langzeitüberlebenden stetig. Viele dieser Patienten haben ein erhöhtes Risiko, im Laufe ihres Lebens Spätfolgen zu entwickeln, die durch die Krebsbehandlung verursacht wurden. Deren Auftreten hängt von der erhaltenen Behandlung ab und kann verschiedene Organe betreffen. Endokrine Spätschäden gehören zu den häufigsten Spätfolgen.

Fragestellung

Im vorliegenden Übersichtsartikel werden die verschiedenen endokrinen Spätfolgen sowie das empfohlene Vorgehen zu ihrer Diagnose und Behandlung dargestellt.

Ergebnisse

Endokrine Spätfolgen betreffen bis zu 50 % der Langzeitüberlebenden nach einer Krebserkrankung im Kindesalter und treten insbesondere nach einer Bestrahlung auf. Sie beinhalten sowohl Funktionsstörungen als auch sekundäre Malignome, die, abhängig von der erhaltenen Therapie, in unterschiedlicher Häufigkeit auftreten. Insbesondere die Schilddrüse, die Gonaden und die Hypophyse sind von Spätfolgen betroffen, wobei auch das Risiko für seltenere endokrine Erkrankungen nach einer onkologischen Behandlung erhöht ist. Durch die unspezifische Symptomatik dieser Erkrankungen beruht die Diagnose auf laborchemischen Untersuchungen, die in manchen Fällen durch Stimulationstests oder weiterführende bildgebende Diagnostik ergänzt werden müssen.

Diskussion

Viele endokrine Spätkomplikationen einer onkologischen Therapie im Kindesalter können gut behandelt werden, wenn sie rechtzeitig erkannt werden. In nationalen und internationalen Leitlinien werden daher risikoadaptierte Vorsorgeuntersuchungen empfohlen, die in spezialisierten Nachsorgezentren lebenslang durchgeführt werden sollten.



Neurophysiological correlates of clinical improvement after greater occipital nerve (GON) block in chronic migraine: relevance for chronic migraine pathophysiology

Therapeutic management of Chronic Migraine (CM), often associated with Medication Overuse Headache (MOH), is chiefly empirical, as no biomarker predicting or correlating with clinical efficacy is available to ...

Anodal frontal tDCS for chronic cluster headache treatment: a proof-of-concept trial targeting the anterior cingulate cortex and searching for nociceptive correlates

Percutaneous occipital nerve stimulation (ONS) is effective in refractory chronic cluster headache (rCCH) patients. Responders to ONS differ from non-responders by greater glucose metabolism in subgenual anter...

Anatomy, Animation and Visual Effects: the Reciprocal Tools of Biology and Film-Making

Abstract
Locomotion studies, biomechanics, and particularly vertebrate paleontology have had a deep influence on the development of motion pictures, animation, and computer generated visual effects. Biologically straightforward concepts such as morphological correlates of diet, sexual dimorphism, and ontogenetic change are powerful tools for animators and visual effects artists. Despite this deep debt to the ever-increasing role of science and technology in film making, scientists often forget to mine the communication strategies of their science-savvy entertainment industry kin. Further, many of the tools of the film industry are making a direct impact on basic research or have the potential to do so. It is becoming increasingly clear as part of the overall outreach for science, technology, engineering, and mathematics ("STEM"), scientists must inform and engage with the public. Significantly, many of the concepts and stories we offer as useful to film makers are compelling stories to offer to our own students. And these can be as compelling to the public as the entertainment they often facilitate. Whereas STEM is critically important, adding "A" – art – as in the artistic strategies from the fields of animation and visual effects to produce "STEAM" helps to build a potentially unstoppable tool for science communication and the public good.

Immunotherapeutic maintenance treatment with toll-like receptor 9 agonist lefitolimod in patients with extensive-stage small-cell lung cancer: Results from the exploratory, controlled, randomized, international phase 2 IMPULSE study

Abstract
Background
The immune surveillance reactivator lefitolimod (MGN1703), a DNA-based TLR9 agonist, might foster innate and adaptive immune response and thus improve immune-mediated control of residual cancer disease. The IMPULSE phase 2 study evaluated the efficacy and safety of lefitolimod as maintenance treatment in extensive-stage small-cell lung cancer (ES-SCLC) after objective response to first-line chemotherapy, an indication with a high unmet medical need and stagnant treatment improvement in the last decades.
Patients and methods
103 patients with ES-SCLC and objective tumor response (as per RECIST 1.1) following 4 cycles of platinum-based first-line induction therapy were randomized to receive either lefitolimod maintenance therapy or local standard of care at a ratio of 3:2 until progression or unacceptable toxicity.
Results
From 103 patients enrolled, 62 were randomized to lefitolimod, 41 to the control arm. Patient demographics and response patterns to first-line therapy were balanced. Lefitolimod exhibited a favorable safety profile and pharmacodynamic assessment confirmed the mode-of-action showing a clear activation of monocytes and production of interferon-gamma-induced protein 10 (IP-10). While in the ITT population no relevant effect of lefitolimod on progression-free and overall survival (OS) could be observed, two pre-defined patient subgroups indicated promising results, favoring lefitolimod with respect to OS: in patients with a low frequency of activated CD86+ B cells (hazard ratio, HR 0.53, 95%CI 0.26-1.08; n = 38 of 88 analyzed) and in patients with reported chronic obstructive pulmonary disease (COPD) (HR 0.48, 95%CI 0.20-1.17, n = 25 of 103).
Conclusions
The IMPULSE study showed no relevant effect of lefitolimod on the main efficacy endpoint OS in the ITT, but (1) the expected pharmacodynamic response to lefitolimod, (2) positive OS efficacy signals in two pre-defined subgroups and (3) a favorable safety profile. These data support further exploration of lefitolimod in SCLC.

Normalcy, justification, and the easy-defeat problem

Abstract

Recent years have seen the rise of a new family of non-probabilistic accounts of epistemic justification. According to these views—we may call them Normalcy Views—a belief in P is justified only if, given the evidence, there exists no normal world in which S falsely beliefs that P. This paper aims to raise some trouble for this new approach to justification by arguing that Normalcy Views, while initially attractive, give rise to problematic accounts of epistemic defeat. As we will see, on Normalcy Views seemingly insignificant pieces of evidence turn out to have considerable defeating powers. This problem—I will call it the Easy-Defeat Problem—gives rise to a two-pronged challenge. First, it shows that the Normalcy View has counterintuitive implications and, second, it opens the door to an uncomfortable skeptical threat.



Dermoscopy improves diagnostic accuracy for clinically amelanotic nodules

Australasian Journal of Dermatology, EarlyView.


Facial angiofibromas treated by rapamycin 0.05% ointment and a combined laser therapy

Journal of Cosmetic Dermatology, EarlyView.


Pathomorphological criteria of use efficiency of resorbable and permanent implants in aesthetic medicine and cosmetic dermatology

Journal of Cosmetic Dermatology, EarlyView.


Structural changes of hair shaft after application of chemical hair straighteners: Clinical and histopathological study

Journal of Cosmetic Dermatology, EarlyView.


Morphology and Navigational Landmarks of the Cranio-orbital Foramen in a Portuguese Population

Purpose: The cranio-orbital and accessory foramina are located in the lateral wall of the orbit and adjacent to the superior orbital fissure. In the literature, there is a lack of consistency concerning the location and morphology of these foramina in different populations. Therefore, considering its clinical importance during orbital surgeries, it was the authors' aim to determine the incidence, location, and number of cranio-orbital and accessory foramina in a Portuguese population and compare the findings with data from other studies. Methods: A total of 310 orbits from 155 dry skulls from the collection of the Museum of Anatomy of the Faculty of Medicine of Porto were studied. The characterization of both cranio-orbital and accessory cranio-orbital foramina was performed. Results: The cranio-orbital foramen was present in at least 1 orbit per skull in 58.17% with a median diameter of 0.60 ± 0.33 mm. No relation was found between the presence of this foramen and the gender of the individuals or a tendency for laterality. However, it was found that the presence of 1 or more accessory foramina was related to higher diameters of the cranio-orbital foramen. Conclusions: There might be a relationship between the localization, diameter, and communication of foramina with the cranial fossae. Foramina located on the greater wing of the sphenoid bone presented a larger diameter and communicated with the middle cranial fossa. High diameters of the main vessel in the cranio-orbital foramen may imply more developed branches and collateral irrigation of the orbital structures using 1 or more accessory foramina. Surgeons should be aware of the location of the cranio-orbital foramen to reduce potential sources of hemorrhage during orbital dissections. Accepted for publication June 17, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to José Paulo Andrade, M.D., Ph.D., Department of Biomedicine, Unit of Anatomy, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal. E-mail: jandrade@med.up.pt © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Third-Nerve Palsy Presenting 16 Years After Resection of Pituitary Adenoma

No abstract available

Distinguishing IgG4-Related Ophthalmic Disease From Graves Orbitopathy

Purpose: The authors aimed to determine key features of IgG4-related ophthalmic disease (IgG4-ROD) and Graves orbitopathy (GO) to aid in diagnosis. Methods: The authors retrospectively identified ophthalmology patients seen between June 2009 and November 2013 with clinical overlap of GO and IgG4-ROD. Patient findings were reviewed to characterize the 2 conditions. Results: Among 8 patients (7 male and 1 female), the mean age was 45.8 years. Time between diagnoses of GO and IgG4-ROD ranged from 1 month to 8 years. Imaging showed enlarged extraocular muscles in all patients. Enlarged infraorbital nerves were seen in 4 patients. Tissue biopsy showed CD20+ lymphocytes with a large proportion of IgG4 plasma cells in 7 of 8 orbital specimens. Six patients had a ratio of IgG4:IgG cells >40%. Discussion: No pathognomonic clinical findings for GO or IgG4-ROD have been reported, but some key features can help distinguish the conditions. GO is likely if findings include increased thyrotropin receptor antibodies, lid retraction/lid lag, and enlarged extraocular muscles with typical tendon-sparing morphology. Findings suggestive of IgG4-ROD include history of asthma and progressive orbital disease in patients with previous diagnosis of GO, disproportionately large lateral rectus muscle, and enlarged infraorbital nerves. Increased serum IgG4 level and biopsy showing >10 IgG4+ plasma cells/high-power field and IgG4:IgG ratio >40% will support the diagnosis of IgG4-ROD. Conclusions: GO and IgG4-ROD are complicated inflammatory processes affecting the orbit and present diagnostic challenges. The authors recommend biopsy for patients who do not follow the usual clinical course of GO or have clinical characteristics of IgG4-ROD. Accepted for publication June 27, 2018. Supported by Research to Prevent Blindness (New York, NY). The funding organization had no role in the design or conduct of this research. The authors have no financial or conflicts of interest to disclose. Presented at the Annual Meeting of the Association for Research in Vision and Ophthalmology on May 7–11, 2017 in Baltimore, MD, U.S.A. and at Women in Ophthalmology Symposium on August 10–13, 2017 in San Diego, CA, U.S.A. Address correspondence and reprint requests to James A. Garrity, M.D., Department of Ophthalmology, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail: garrity.james@mayo.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Orbital Apex Syndrome in Pseudomonas Sinusitis After Functional Endoscopic Sinus Surgery

Sinusitis complicated by orbital apex syndrome is rare. The majority of cases are due to mucormycosis in immunocompromised patients. The authors report a case of orbital apex syndrome secondary to Pseudomonas sinusitis. The patient was a 79-year-old Type 2 diabetic woman who underwent left-sided functional endoscopic sinus surgery. Three months postprocedure, she presented with a 3-week history of gradual vision loss and constant temporal headache on the ipsilateral side. Examination revealed light perception vision, a relative afferent pupillary defect, absent corneal reflex, and disc pallor. Imaging revealed opacification of the posterior ethmoidal air cells extending to involve the orbital apex. Urgent orbital and sinonasal decompression was performed. Intraoperative specimens grew Pseudomonas aeruginosa. The patient was treated with liposomal amphotericin B, posaconazole, and piperacillin/tazobactam. The patient recovered with no visual sequelae. Pseudomonas is an important mimicker to consider in sinusitis causing orbital apex syndrome, and it may occur following functional endoscopic sinus surgery. Accepted for publication June 22, 2018. The authors have no financial or conflicts of interest to disclose. Portions of this work were presented, in abstract form, at the Annual Scientific Congress of the Royal Australian and New Zealand College of Ophthalmologists on October 28–November 1, 2017 in Perth, Australia. Address correspondence and reprint requests to Vannessa Leung, B.Med., M.D., Royal North Shore Hospital, Reserve Rd St Leonards, NSW 2065, Australia. E-mail: vannessa.leung@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Prevalence of a Histologic Change of Ocular Adnexal Lymphoma in Patients With a History of Lymphoma

Purpose: The authors examined the prevalence of a histologic change of ocular adnexal lymphoma (OAL) grade in patients with a history of lymphoma in nonocular sites. Methods: In this retrospective study, the authors reviewed the clinical and pathological data of 209 patients with OAL treated by the senior author during 2000 to 2017. Results: Of 209 patients with OAL, 65 (31%) had a history of lymphoma. In 54 of the 65 patients (83%), the original lymphoma and OAL were of the same histologic type. In 8 of the 65 patients (12.3%), the OAL was more indolent than the original lymphoma: 6 patients with a history of diffuse large B-cell lymphoma, one of mantle cell lymphoma, and one of grade 3 follicular lymphoma had biopsy-proven extranodal marginal-zone lymphoma in the orbital area. Two additional patients (3%) with a history of chronic lymphocytic leukemia developed OAL: diffuse large B-cell lymphoma in one patient and extranodal marginal-zone lymphoma in the other. One patient (1.5%) with a history of a low-grade follicular lymphoma relapsed as a different low-grade histology of extranodal marginal-zone lymphoma. Lower-grade OAL than the original lymphoma was more common than higher-grade OAL than the original lymphoma (p = 0.048). Conclusions: In this cohort of 209 patients with OAL, the authors found that nearly one third had a history of lymphoma, 17% of whom had a different histologic type of lymphoma in the orbit, more commonly a more indolent type. This underscores the importance of biopsy of OAL even in patients with a known history of lymphoma to determine the histologic subtype of orbital lymphoma and to help guide appropriate treatment. Accepted for publication July 10, 2018. 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 © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

The Relationship Between Eyebrow and Eyelid Position in Patients With Ptosis, Dermatochalasis and Controls

Purpose: The purpose of this study is to explore mechanical and co-innervational factors involved in both voluntary and involuntary brow elevation among people affected by ptosis and dermatochalasis. Methods: In this prospective cohort study of normal controls and eyelids with ptosis or dermatochalasis, marginal reflex distance (MRD1) and brow height were measured under the following conditions: neutral position, involuntary mechanical brow elevation, voluntary brow elevation, and maximal eyelid opening. The primary outcome measure was change in MRD1. Secondary outcome measures included brow height and coupling (mm brow height change per mm MRD1 change). Analysis of variance and t tests were performed for intra- and intercondition comparisons, respectively. Results: Mechanical (involuntary) brow elevation significantly raised MRD1 in control eyelids and eyelids with dermatochalasis, but not in eyelids with ptosis. Voluntary brow elevation produced significantly greater brow height than maximal eyelid opening in controls and eyelids with dermatochalasis, but not in eyelids with ptosis. Maximal eyelid opening increased MRD1 greater than voluntary brow elevation significantly in control eyelids, but not in eyelids with dermatochalasis or ptosis. Coupling of the brow and eyelid margin during maximal eyelid opening was significantly greater in eyelids with ptosis relative to controls. Conclusions: In eyelids with ptosis, mechanical brow elevation does not change eyelid position; however, voluntary brow elevation raises eyelid position to a similar position as maximal eyelid opening. These results argue against the contention that the brow is elevated to mechanically lift the eyelid in ptosis and instead suggest that the brow elevation is driven by efforts to raise the eyelid, possibly via co-innervation. Accepted for publication June 5, 2018. The authors have no financial or conflicts of interest to disclose. Presented at ASOPRS 2016 Spring Scientific Symposium on June 5, 2016, in Ojai, CA. The authors alone are responsible for the content and writing of the article. Address correspondence and reprint requests to Daniel B. Rootman, M.D., M.S., Division of Orbital and Oculoplastic Surgery, Doheny and Stein Eye Institutes, David Geffen School of Medicine at UCLA, 300 Stein Plaza, University of California, Los Angeles, Los Angeles, CA 90095. E-mail: rootman@jsei.ucla.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Preventing Postoperative Atypical Mycobacterial Infection

Purpose: To report a recent outbreak of atypical mycobacterial infection following upper eyelid surgery and the results of a prevention protocol that was successfully instituted to dramatically reduce the infection rate. Methods: This is a multicenter retrospective nonrandomized comparative interventional case series. A chart review of 7 patients who developed atypical mycobacterium infection after undergoing blepharoplasty was conducted. Preventative intervention included exchanging ice compresses for reusable gel packs and substituting tap water with bottled or distilled water for facial cleaning during postoperative care. The main outcome measure was disease incidence. Results: Of the 368 patients who underwent upper eyelid blepharoplasty and/or blepharoptosis repair from December 2014 to May 2015, 7 people developed cutaneous atypical mycobacterium infection with an incidence of 1.9%. Eighty-six percent of patients received clarithromycin as part of their treatment with average treatment length of 2.8 months. Debridement was performed in 71% of the patients. Biopsy was performed in all patients, and all had histopathology showing granulomatous inflammation. A prevention protocol was developed to reduce potential inoculation in the immediate postoperative period, which successfully reduced the infection rate from 1.9% to 0.06% (p = 0.019). Conclusions: Atypical mycobacterium infection, although rare, should be considered as a possible diagnosis in a blepharoplasty patient with delayed development of nodular lesions. Long-term clarithromycin therapy and debridement have shown good outcomes for these patients; however, the best treatment for any infection is prevention. This study provides the first evidence based approach within the ophthalmic literature for reducing the mycobacterium infection rate in blepharoplasty patients. Accepted for publication July 8, 2018. The authors have no financial or conflicts of interest to disclose. Presented, in part, at the ASOPRS 48th Annual Fall Scientific Symposium on November 9–10, 2017 in New Orleans, LA. Address correspondence and reprint requests to Alan E. Oester, Jr, M.D., Wilmington Eye, 1729 New Hanover Medical Park Dr, Wilmington, NC 28403. E-mail: coester@wilmingtoneye.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Soft Tissue Chondroma of the Eyelid

A 54-year-old woman presented with a 2-year history of a slow-growing subcutaneous nodule of the medial right lower eyelid adjacent to the inferior canaliculus. The patient reported right-sided epiphora suggesting lacrimal outflow obstruction. The surgically excised nodule was consistent with a chondroma. A rare tumor, soft tissue chondroma, is most often seen in the extremities, but has also been observed in the head and neck region. To their knowledge, this is the first reported case of a soft tissue chondroma of the eyelid. Accepted for publication June 27, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to R. Patrick Yeatts, M.D., Department of Ophthalmology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157. E-mail: pyeatts@wakehealth.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Workflow for Pediatric Midface and Orbital Reconstruction With a Patient-Specific Autogenous Bone Graft

Extensive midface and orbital reconstruction is challenging, especially in a pediatric population. A 13-year-old patient was diagnosed with fibrous dysplasia of the midface, which required complete resection of the zygomatic bone and orbital floor. The authors present a complete midface and orbital reconstruction, using a patient-specific autologous bone graft, in a growing pediatric patient. Postoperative analysis showed a symmetric orbital floor and good clinical outcome. After 12 months of follow up, no bone resorption was observed. Patient-specific autologous bone grafts have a clear role in the treatment algorithm of patients with large skull bone defects, with emphasis on the pediatric patient. The advantages can be even greater in a pediatric population, because they can benefit more from the minimal invasive approach. Furthermore, this technique allows single-stage complex reconstructive surgeries with a decreased operating time. Accepted for publication July 8, 2018. The authors have no financial or personal relationship with organizations that could inappropriately influence or bias this work. The authors have no conflict of interest to declare from the following organizations: National Institutes of Health (NIH), Welcome Trust, Howard Hughes Medical Institute (HHMI), Research Council UK, and other(s). Address correspondence and reprint requests to Yasmin Opdenakker, M.D., Department of Maxillo-Facial Surgery, University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. E-mail: yasmin.opdenakker@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Predominant Contribution of Superior Rectus–Levator Complex Enlargement to Optic Neuropathy and Inferior Visual Field Defects in Thyroid Eye Disease

Purpose: To compare extraocular muscle volumes in thyroid eye disease patients with and without compressive optic neuropathy. Methods: A retrospective review of 44 orbital CT scans (28 orbits without compressive disease and 16 orbits with compressive optic neuropathy) was conducted. The extraocular muscle volumes, summated soft tissue volumes, and optic nerve volumes were calculated at a section in the posterior 1/3 of the orbit. The visual fields of the orbits with compressive optic neuropathy were analyzed. Results: The mean combined extraocular muscle/summated soft tissue volume ratio and the mean superior rectus–levator complex/summated soft tissue volume ratio were greater in those with compressive optic neuropathy than in those without compressive optic neuropathy (p = 0.02, 0.008, respectively). The ratio of the mean inferior, medial, or lateral rectus/summated soft tissue volume did not differ significantly between patients with or without compressive optic neuropathy (p values of 0.315, 0.615, and 0.254, respectively). Visual field analysis of the compressive optic neuropathy group demonstrated that 58% of the orbits with visual field defects had inferior field defects. Conclusions: When measured at a section near the orbital apex, the mean combined muscle/summated soft tissue volume ratio and the mean superior rectus–levator complex/summated soft tissue volume ratio are greater in those with compressive disease than those without. This suggests that the specific enlargement of the superior rectus–levator complex makes a significant contribution to thyroid eye disease-compressive optic neuropathy and may explain the inferior visual field deficits classically found in this group of patients. Accepted for publication July 27, 2018. The authors have no financial or conflicts of interest to disclose. Presented at the 48th Annual ASOPRS Fall Scientific Symposium on November 9–10, 2017, in New Orleans, LA, U.S.A. Address correspondence and reprint requests to Michael Kazim, MD, Edward S. Harkness Eye Institute, Columbia University Medical Center, 635 West 165th Street, New York, NY 10032. E-mail: mk48@columbia.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Cutaneous adverse drug reaction after apomorphine infusion, possibly caused by a systemic type IV hypersensitivity reaction to sodium metabisulfite: Report of 2 cases

Contact Dermatitis, EarlyView.


Aluminium sensitization in a French paediatric patch test population

Contact Dermatitis, EarlyView.