Chlordecone consumption estimated by sewage epidemiology approach for health policy assessment

Abstract

Chlordecone is an organochlorine insecticide that was intensively used in the French West Indies to control the black weevil Cosmopolites sordidus in bananas. Its usage, however, resulted in the widespread pollution of the environment with heavy sanitary and social consequences, leading to population exposure mainly through food. Time-consuming and costly programs have been used to tackle this problem, and this study proposes to use the emerging sewage epidemiology approach to evaluate the current situation and the effect of such programs. The results determine the maximal value of chlordecone consumption, and considering the detection limit of the analytical protocol, the wastewater was found to have undetectable amounts of chlordecone. This value confirms the efficiency of the population protection strategy provided by French sanitary and environmental authorities. It also bolsters the usage of sewage epidemiology in pesticide assessment and relativizes the chlordecone risk compared to other chemicals of lesser concern.

Dianchi Lake watershed impervious surface area dynamics and their impact on lake water quality from 1988 to 2017

Abstract

The relationships between impervious surface area (ISA) patterns and characteristics have long been studied to examine the impacts of hydrological cycles, water management, surface energy balances, and biodiversity. This study assessed the Dianchi Lake watershed as a case study area to illustrate ISA change characteristics and their impacts on Dianchi Lake water quality. More than 200 Landsat images (from 1988 to 2017) were first downloaded through the US Geological Survey (USGS) online portal. Then, a series of ISA maps of the Dianchi Lake watershed at an annual resolution were built using a robust method we proposed. Then, the change characteristics of main water quality parameters were analyzed from spatial-temporal viewpoints. Finally, correlations between ISA and Lake water quality were made. The research results indicated that the ISA proportion of the Dianchi Lake watershed rapidly increased (from 1.84% in 1988 to 34.32% in 2017), the annual ISA total growth rate exceeded 21 km²/year, and the urban area encircled Dianchi Lake. The Dianchi Lake watershed has begun to adopt the "Rashly Advancing" and "Great Leap Forward" strategies of urbanization. Chlorophyll a (Chla), dissolved oxygen (DO), and transparency (Trans) showed significantly changing tendencies, whereas the values of pH, total nitrogen, and total phosphorus stayed relatively constant. The polynomial regression models and corresponding R² values indicated strong correlations between ISA and three water quality parameters (Chla, DO, and Trans). The development of better strategies for the control and reduction of water pollution without optimizing ISA spatial distribution is essential for Kunming's continued urbanization.

Comment on "Common Origin of Brachiocephalic and Left Common Carotid Arteries: Proposal of New Terminology" [LETTERS]

Reply: [LETTERS]

Integrating 3D Rotational Angiography into Gamma Knife Planning [INTERVENTIONAL]

SUMMARY:

3D rotational angiography provides remarkable spatial resolution for cerebrovascular disorders; however, it cannot be integrated directly into gamma knife planning due to the discrepancy of DICOM "tag" information, and most physicians still cannot benefit from 3D rotational angiography. Here, we describe a simple and easy technique to enable the integration of 3D rotational angiography.

MR Imaging of the Facial Nerve through the Temporal Bone at 3T with a Noncontrast Ultrashort Echo Time Sequence [HEAD & NECK]

SUMMARY:

The pointwise encoding time reduction with radial acquisition (PETRA) ultrashort echo time MR imaging sequence at 3T enables visualization of the facial nerve from the brain stem, through the temporal bone, to the stylomastoid foramen without intravenous contrast. Use of the PETRA sequence, or other ultrashort echo time sequences, should be considered in the MR imaging evaluation of certain skull base tumors and perhaps other facial nerve and temporal bone pathologies.

Intracranial Serpentine Aneurysms: Spontaneous Changes of Angiographic Filling Pattern [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Serpentine aneurysms are partially thrombosed aneurysms with an eccentrically located tortuous intra-aneurysmal vascular channel. The large size, distinctive neck anatomy, and supply of the brain parenchyma by the outflow tract pose technical challenges in treatment. The aim of this study was to discuss the endovascular treatment results and illustrate the dynamic nature of serpentine aneurysms. Spontaneous transformation of saccular and fusiform aneurysms into serpentine morphology, along with a case of serpentine-into-fusiform aneurysm transformation during follow-up, is presented.

MATERIALS AND METHODS:

A retrospective analysis from 3 institutions revealed 15 patients with serpentine aneurysms who underwent diagnostic evaluation and endovascular treatment. Nine of the 15 patients underwent endovascular occlusion of the parent vessel with detachable balloon or coils. Six of the 15 patients underwent aneurysm and parent artery occlusion with coiling.

RESULTS:

In 11 patients, improvement or resolution of symptoms was achieved by an endovascular approach without any treatment-related morbidity. Morbidity related to treatment in the immediate postoperative period was seen in 3 patients, with resolution of the deficits at long-term follow-up in 2 patients and persistence of a mild deficit in 1 patient. Endovascular treatment failed to achieve resolution of symptoms in a case with a basilar tip aneurysm treated by aneurysm coiling.

CONCLUSIONS:

Serpentine aneurysms are dynamic structures with spontaneous transformation possible from a saccular or fusiform shape into a serpentine configuration. An endovascular approach by parent vessel occlusion or intra-aneurysmal occlusion is a successful treatment technique for serpentine aneurysms.

Association between Type 1 Modic Changes and Propionibacterium Acnes Infection in the Cervical Spine: An Observational Study [SPINE]

BACKGROUND AND PURPOSE:

Research on the association between Propionibacterium acnes in the disc space and type 1 Modic changes in adjacent vertebrae is limited and has produced mixed results. The prevalence of bacteria in intervertebral discs contradicts the prior understanding that skeletal areas in the human anatomy are sterile; yet it opens new treatment possibilities. We investigated the relationship of P acnes and type 1 Modic changes in the cervical spine.

MATERIALS AND METHODS:

Over a 36-month period, we collected intraoperative biopsies of patients undergoing a routine cervical spine operation for degenerative disc diseases. The disc material was cultured aerobically and anaerobically for 7 days. All preoperative MR images were evaluated for Modic changes by a board-certified neuroradiologist. Medical records were reviewed for other spine interventions before the operation.

RESULTS:

The study population consisted of 48 patients. Of these, 14 patients tested positive for P acnes (29%) at ≥1 level. Additionally, 13 patients had type 1 Modic changes (27%) at ≥1 level; 54% (95% CI, 27%–84%) of patients who had type 1 Modic changes were also positive for P acnes compared with 20% (95% CI, 7%–33%) of patients without type 1 Modic changes. The difference between these proportions was 34% (95% CI, 4%–64%). The Fisher exact test produced a P value of .03 for the association between P acnes and MC1, and .53 for the association between P acnes and prior procedures.

CONCLUSIONS:

We conclude that P acnes was prevalent in the degenerated cervical spine and that type 1 Modic changes were predictive of a culture positive for P acnes. We also found that the prevalence of P acnes was not associated with previous interventions. If these results are validated by future studies, they could have a major impact on the standard of care for back and neck pain.

Breath-Hold Blood Oxygen Level-Dependent MRI: A Tool for the Assessment of Cerebrovascular Reserve in Children with Moyamoya Disease [FUNCTIONAL]

BACKGROUND AND PURPOSE:

There is a critical need for a reliable and clinically feasible imaging technique that can enable prognostication and selection for revascularization surgery in children with Moyamoya disease. Blood oxygen level–dependent MR imaging assessment of cerebrovascular reactivity, using voluntary breath-hold hypercapnic challenge, is one such simple technique. However, its repeatability and reliability in children with Moyamoya disease are unknown. The current study sought to address this limitation.

MATERIALS AND METHODS:

Children with Moyamoya disease underwent dual breath-hold hypercapnic challenge blood oxygen level–dependent MR imaging of cerebrovascular reactivity in the same MR imaging session. Within-day, within-subject repeatability of cerebrovascular reactivity estimates, derived from the blood oxygen level–dependent signal, was computed. Estimates were associated with demographics and intellectual function. Interrater reliability of a qualitative and clinically applicable scoring scheme was assessed.

RESULTS:

Twenty children (11 males; 12.1 ± 3.3 years) with 30 MR imaging sessions (60 MR imaging scans) were included. Repeatability was "good" on the basis of the intraclass correlation coefficient (0.70 ± 0.19). Agreement of qualitative scores was "substantial" ( = 0.711), and intrarater reliability of scores was "almost perfect" ( = 0.83 and 1). Younger participants exhibited lower repeatability (P = .027). Repeatability was not associated with cognitive function (P > .05). However, abnormal cerebrovascular reactivity was associated with slower processing speed (P = .015).

CONCLUSIONS:

Breath-hold hypercapnic challenge blood oxygen level–dependent MR imaging is a repeatable technique for the assessment of cerebrovascular reactivity in children with Moyamoya disease and is reliably interpretable for use in clinical practice. Standardization of such protocols will allow further research into its application for the assessment of ischemic risk in childhood cerebrovascular disease.

Gadolinium Deposition in Deep Brain Structures: Relationship with Dose and Ionization of Linear Gadolinium-Based Contrast Agents [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Dose-dependent association between hyperintensity in deep brain structures on unenhanced T1WIs and gadolinium-based contrast agent administrations has been demonstrated with subsequent histopathological confirmation of gadolinium deposition. Our aim was to determine whether greater exposure to linear gadolinium-based contrast agent administration is associated with higher signal intensity in deep brain structures on unenhanced T1-weighted MR imaging. Secondary objective was to compare signal intensity differences between ionic and nonionic linear gadolinium-based contrast agents.

MATERIALS AND METHODS:

Subjects with secondary-progressive MS originally enrolled in a multicenter clinical trial were studied retrospectively. Eighty subjects (high-exposure cohort) received 9 linear gadolinium-based contrast agent administrations (30 nonionic/50 ionic) between week –4 and year 1 and a tenth administration by year 2. One hundred fifteen subjects (low-exposure cohort) received 2 administrations (40 nonionic/75 ionic) between week –4 and year 1 and a third administration by year 2. Signal intensities were measured on unenhanced T1WIs by placing sample-points on the dentate nucleus, globus pallidus, caudate, thalamus, pons, and white matter, and they were normalized using the following ratios: dentate/pons, globus pallidus/white matter, caudate/white matter, and thalamus/white matter.

RESULTS:

Between week –4 and year 1, subjects in the high-exposure cohort showed increased signal intensity ratios in all regions (P < .01), while the low-exposure cohort showed only an increase in the dentate nucleus (P = .003). Between years 1 and 2, when both cohorts received only 1 additional gadolinium-based contrast agent, no significant changes were observed. In the high-exposure cohort, significantly higher changes in signal intensity ratios were observed in subjects receiving linear nonionic than in those receiving linear ionic gadolinium-based contrast agents.

CONCLUSIONS:

Hyperintensity in deep brain structures from gadolinium deposition is related to the number of doses and the type of linear gadolinium-based contrast agent (nonionic greater than ionic) administration.

Memorial: Galdino Valvassori, MD, FACR [LETTERS]

3D Black-Blood Luminal Angiography Derived from High-Resolution MR Vessel Wall Imaging in Detecting MCA Stenosis: A Preliminary Study [ADULT BRAIN]

BACKGROUND AND PURPOSE:

3D high-resolution vessel wall imaging is increasingly used for intracranial arterial diseases. This study compared the diagnostic performance of black-blood luminal angiography derived from 3D vessel wall imaging with source images of vessel wall imaging and TOF-MRA in detecting middle cerebral artery stenosis.

MATERIALS AND METHODS:

Sixty-two patients with suspected MCA atherosclerosis underwent TOF-MRA, vessel wall imaging, and CTA. Intracranial black-blood luminal angiography was created from source images of vessel wall imaging using minimum intensity projection. The degree and length of MCA stenosis were measured on source images of vessel wall imaging, TOF-MRA, and black-blood luminal angiography and compared using CTA as a reference standard.

RESULTS:

The image quality of black-blood luminal angiography was diagnostic in most patients. The intra- and interobserver agreement for both stenosis degree and length measurements was excellent for black-blood luminal angiography. It was comparable with that of source images of vessel wall imaging in grading stenosis. Compared with TOF-MRA, black-blood luminal angiography showed significantly higher sensitivity for the detection of severe stenosis (89.3% versus 64.3%, P = .039) and higher specificity for the detection of occlusion (95.4% versus 84.6%, P = .039). Lesion length estimated on source images of vessel wall imaging was significantly greater than that measured by CTA and black-blood luminal angiography (P < .001 and P = .010).

CONCLUSIONS:

Black-blood luminal angiography is better than TOF-MRA in detecting severe stenosis and occlusion of the MCA. Compared with source images of vessel wall imaging, it is more accurate in evaluating stenosis length. Black-blood luminal angiography can be produced as a derivative from vessel wall imaging and implemented as an adjunct to vessel wall imaging and TOF-MRA without extra acquisition time.

Contrast-Enhanced CISS Imaging for Evaluation of Neurovascular Compression in Trigeminal Neuralgia: Improved Correlation with Symptoms and Prediction of Surgical Outcomes [HEAD & NECK]

BACKGROUND AND PURPOSE:

Thin-section MR imaging through the posterior fossa is frequently used for trigeminal neuralgia. Typical heavily T2-weighted imaging methods yield high anatomic detail and contrast between CSF and neurovascular structures, but poor contrast between vessels and nerves. We hypothesized that the addition of gadolinium-based contrast material to 3D-constructive interference in steady-state imaging would improve the characterization of trigeminal compression.

MATERIALS AND METHODS:

Retrospective review of high-resolution MRIs was performed in patients without prior microvascular decompression. 3D-CISS imaging without contrast and with contrast for 81 patients with trigeminal neuralgia and 15 controls was intermixed and independently reviewed in a blinded fashion. Cisternal segments of both trigeminal nerves were assessed for the grade of neurovascular conflict, cross-sectional area, and degree of flattening. Data were correlated with symptom side and pain relief after microvascular decompression using the Fisher exact test, receiver operating curve analysis, and a paired t test.

RESULTS:

Contrast-enhanced CISS more than doubled the prevalence of the highest grade of neurovascular conflict (14.8% versus 33.3%, P = .001) and yielded significantly lower cross-sectional area (P = 8.6 x 10^–6) and greater degree of flattening (P = .02) for advanced-grade neurovascular conflict on the symptoms side compared with non-contrast-enhanced CISS. Patients with complete pain relief after microvascular decompression had significantly lower cross-sectional area on contrast-enhanced CISS compared with non-contrast-enhanced CISS on preoperative imaging (P = 2.0 x 10^–7). Performance based on receiver operating curve analysis was significantly improved for contrast-enhanced CISS compared with non-contrast-enhanced CISS.

CONCLUSIONS:

The addition of contrast material to 3D-CISS imaging improves the performance of identifying unilateral neurovascular compression for symptomatic trigeminal neuralgia and predicting outcomes after microvascular decompression.

A verrucous plaque on the intergluteal cleft

MD Fernández Ballesteros, E Gómez Moyano, M Ayala Blanca, S Simonsen

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):641-642

Polymorphic presentation of disseminated cutaneous rhinosporidiosis in an immunocompetent individual

Swetalina Pradhan, Chandra Sekhar Sirka, Manas Ranjan Baisakh

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):614-617

Hair manifestations of endocrine diseases: A brief review

Keshavamurthy Vinay, Gitesh U Sawatkar, Sunil Dogra

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):528-538

Hair disorders are common in clinical practice and depending upon social and ethnic norms, it can cause significant psychosocial distress. Hair growth, cycling and density are regulated by many endogenous factors, mainly circulating hormones. Thus, diseases affecting the endocrine system can cause varied changes in physiological hair growth and cycling. Diagnosis and treatment of these disorders require a multidisciplinary approach involving a dermatologist, gynecologist and an endocrinologist. In this review, we briefly discuss the influence of hormones on the hair cycle and hair changes in various endocrine disorders.

Verruciform xanthoma of the penis: A rare case with an unusual clinical morphology

Goncagul Babuna Kobaner, Ozgur Demir, Sule Ozturk Sari, Can Baykal, Nesimi Buyukbabani

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):600-602

Safety of important dermatological drugs (retinoids, immune suppressants, anti androgens and thalidomide) in reproductively active males with respect to pregnancy outcome: A brief review of literature

Piyush Kumar, Anupam Das, Niharika Ranjan Lal, Sourabh Jain, Anupama Ghosh

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):539-546

Paternally transmitted damage to offspring is recognized as a complex issue. Each parent contributes 23 chromosomes to a child; hence, it is necessary to know the effects of both maternal and paternal pre-and peri-conceptional exposure to drugs on pregnancy outcome. While there are many studies on the effects of maternal drug exposure on pregnancy outcome, literature on paternal exposure is scarce. Of late however, paternal exposure has been receiving increasing attention. We present a brief review on the safety of commonly used drugs in dermatology, focused on retinoids, immune suppressants, anti androgens and thalidomide.

Distal infection of the middle finger caused by Mycobacterium abscessus

Daniel Morgado-Carrasco, Constanza Riquelme-Mc Loughlin, Xavier Fusta-Novell, Adriana Garcia, Pilar Iranzo-Fernandez

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):626-628

The effectiveness of adding low-level light therapy to minoxidil 5% solution in the treatment of patients with androgenetic alopecia

Gita Faghihi, Samaneh Mozafarpoor, Ali Asilian, Fatemeh Mokhtari, Alireza Asemi Esfahani, Behzad Bafandeh, Saeid Nouraei, Mohammad Ali Nilforoushzadeh, Seyed Mohsen Hosseini

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):547-553

Background: Androgenetic alopecia is the commonest type of alopecia affecting over half of men and women. Low-level light therapy is a new technique for stimulating hair growth in both genders. Aims: To overcome the shortcomings of previous epidemiological studies and a lack of controlled clinical trials on the subject, this study compared the effectiveness of adding low-level light therapy to minoxidil topical solution in the treatment of androgenetic alopecia in patients presenting to two skin clinics in Isfahan, Iran during 2014–2015. Materials and Methods: This clinical trial included 50 patients aged 17–45 presenting to Khorshid and Alzahra educational centers and skin diseases research center for androgenetic alopecia during 2014–2015. The patients were randomly divided into a control and a case group. The case group received topical minoxidil 5% solution plus low-level light therapy twice per day. The control group was given the same topical solution and a laser comb system that was turned off to act as a placebo. Changes in patients' hair density and diameter and its overall regrowth as well as their satisfaction with the treatment were assessed at months 0 (baseline), 3, 6, 9 and 12. Results: The percentage of recovery from androgenetic alopecia and the patients' satisfaction with their treatment were significantly higher in the case group compared to the control group. The patients' mean hair density and diameter were found to be higher in the case group after the intervention compared to the control group. Limitations: The study limitations included patient compliance, small sample size, patient insight due to novelty of the method and clinical judgement. Conclusion: As a new method of treatment, low-level light therapy can help improve the percentage of recovery from androgenetic alopecia and increase patients' satisfaction with their treatment.

Angiospastic macules of Bier: A cause of mottled skin

Cesar Daniel Villarreal-Villarreal, Juan Carlos Robles-Mendez, Angel Eduardo Guerra-Vazquez, Jorge Ocampo-Candiani

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):645-645

End of the road for terbinafine? Results of a pragmatic prospective cohort study of 500 patients

Sanjay Singh, Prakriti Shukla

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):554-557

Background: There is a general impression among dermatologists in India that terbinafine has been losing its effectiveness in dermatophytoses over the past few years, but there are no recent data to support this. Aims: To determine the effectiveness of terbinafine in tinea corporis, tinea cruris and tinea faciei with a pragmatic prospective cohort study. Methods: A sample size of 361 patients was calculated taking a 5% margin of error and a 95% confidence level. Five hundred patients with tinea corporis, tinea cruris and tinea faciei confirmed by potassium hydroxide microscopy received oral terbinafine (5mg/kg/day) and topical terbinafine 1% applied twice daily for 4 weeks. Patients were evaluated at 2 and 4 weeks. Cure was defined as total clearance of lesions and negative microscopy. Results: Patients who came for follow-up at 2 and 4 weeks numbered 357 and 362 respectively. Ten patients were cured at 2 weeks (cure rate 2%, 95% confidence interval 1.0–3.7%, intention-to-treat analysis) and 153 patients were cured at 4 weeks (cure rate 30.6%, 95% confidence interval 26.7–34.8%). Limitations: Culture and antifungal susceptibility testing were not performed since this was a pragmatic study. There was also no follow up after completion of treatment to check for relapses, but the poor response makes this less relevant. Conclusion: The effectiveness of terbinafine in dermatophytosis was abysmal in this study.

Anti-RO 52-positive systemic sclerosis sine scleroderma with multisystem involvement and recurrent vasculitis

Angoori Gnaneshwar Rao, Syeda Saba Farheen, Uday Deshmukh Reddy, Amit Kolli, K Aparna, J Kranthi, Ruhi Haqqani, T Sandhya Rani

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):607-610

Reduced immunohistochemical expression of CCN3 in vitiligo

Adriane Reichert Faria, Juliana Elizabeth Jung, Caio Cesar Silva de Catro, Lucia de Noronha

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):558-562

Background: Defective adhesion seems to be involved in the chronic loss of melanocytes observed in vitiligo. Recent findings showed an association of genetic variants of an adhesion gene with vitiligo and reduced immunohistochemical expression of some adhesion molecules in vitiligo skin. Aims: To compare CCN3 immunohistochemical expression in lesional and non-lesional epidermis of individuals with vitiligo. Methods: A total of 66 skin specimens from 33 volunteers with vitiligo were analyzed by immunohistochemistry using anti-CCN3 antibodies. Absence of topical or systemic treatment for vitiligo over the previous 30 days and availability of an area of non-lesional skin for biopsy at least 15 cm away from any vitiliginous macules were the main inclusion criteria. Results: A significant reduction of CCN3 expression was observed in lesional skin as compared to non-lesional skin (P = 0.001). Limitations: Paraffin embedded skin samples do not allow investigation by molecular biology methods. Not all samples allowed analysis due to the lamina preparation technique. Complete clinical data was not available for all patients. Conclusion: Our results support the hypothesis of impaired cell adhesion in vitiligo suggested by genetic studies. The pattern of immunohistochemical expression suggests that vitiligo might be an epithelial disease and not just a melanocyte disorder.

Pleomorphic hyalinizing angiectatic tumor of soft parts with unusual lipoma-like clinical morphology

Zoltan Szep, Alexandra Majernikova, Boris Rychly, Juraj Majtan

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):619-621

Oral sex related knowledge and oral sex behavior among homosexual and heterosexual men in Belgrade: A cross-sectional study

Milan D Bjekic, Sandra B Sipetic-Grujicic, Hristina D Vlajinac, Aleksandra M Nikolic

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):563-568

Background: Although the risk of sexually transmitted infections is far greater during vaginal and anal sex than during oral sex, increasing practice of oral sex and low rates of barrier method use will probably increase the relative importance of oral sex as a route of transmission for genital pathogens. Aims: The aim of this study was to evaluate knowledge and attitudes about oral sex and sexually transmitted infections, as well as oral sex practices, both among heterosexuals and homosexual men and to compare those two groups. Materials and Methods: In this cross-sectional study, data were collected from consecutive sexually active male patients who ever had oral sex and who attended counselling for sexually transmitted infections at the City Institute for Skin and Venereal Diseases in Belgrade from March to June 2016. One dermatologist interviewed all participants. Results: The study included 359 men who ever had oral sex, 95 (26.5%) homosexual and 264 (73.5%) heterosexual men. In comparison with heterosexual men, homosexual men had considerably more lifetime sexual partners and oral sex partners during the past 3 months, and significantly more frequently practiced oral-anal sex. Oral-sex related knowledge of all participants was unsatisfactory [correct answers were given by 95 (26.5%) to 277 (77.2%) participants], but it was significantly better in homosexual men than in heterosexual. Frequency of condom use and human immunodeficiency virus testing was also significantly higher in the case of homosexual than heterosexual men. Limitations: The study was not performed in representative sample of population. It was restricted to the patients. Consequently it is questionable whether the results obtained could be generalized. Conclusion: Oral sex related knowledge deficits and risky oral sex practice exist in both homosexual and heterosexual men. These findings indicate a need for effective public health campaign and patient education about the risks of unprotected oral sex.

Massive cutaneous nodules in a 92-year-old man

Ferran Ballescá, Aram Boada, Carlos Ferrándiz

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):632-633

Primary cutaneous cribriform apocrine carcinoma: Case report and literature review

Jiann-Der Wu, Chih-Hsuan Changchien, Kai-Sheng Liao

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):569-572

Primary cutaneous cribriform apocrine carcinoma is a rare but distinct variant of primary cutaneous apocrine carcinoma and it is considered a low grade malignancy. We herein present a case of primary cutaneous cribriform apocrine carcinoma at the neck of a 26-year-old female. The tumor features a relatively well-circumscribed border and multiple aggregations of mildly pleomorphic epithelial cells with large ovoid nuclei, small nucleoli and abundant eosinophilic cytoplasms. Cribriform and tubular structures are the major architectural patterns. The primary differential diagnosis is cutaneous metastasis from a cribriform visceral carcinoma; others include primary secretory carcinoma of the skin, adenoid cystic basal cell carcinoma and primary cutaneous adenoid cystic carcinoma.

Identification of a novel missense mutation in the NOD2 gene in a Chinese child with early-onset sarcoidosis

Xiaopo Wang, Xiaofeng Zhang, Wei Zhang, Jianfang Sun

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):645-645

Serum macrophage migration inhibitory factor levels in leprosy patients with erythema nodosum leprosum

Frainey Bansal, Tarun Narang, Sunil Dogra, Keshavamurthy Vinay, Seema Chhabra

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):573-577

Background: Erythema nodosum leprosum is an immune-mediated complication of leprosy which causes significant morbidity. Biomarkers in the pathogenesis of erythema nodosum leprosum are not yet fully determined. Aim: To determine macrophage migration inhibitory factor levels in the sera of leprosy patients with erythema nodosum leprosum and to correlate the same with clinical parameters. Methods: This cross-sectional study included 37 consecutive leprosy patients with active erythema nodosum leprosum and 31 age- and sex-matched controls. Detailed clinical history and examination findings were recorded including the severity and frequency of erythema nodosum leprosum. Slit skin smears and histopathologic examination were done in all patients at baseline. Serum macrophage migration inhibitory factor levels were determined using an enzyme-linked immunosorbent assay. Results: Most of our patients were males (78.4%) and suffering from lepromatous leprosy (27, 73%) with a mean initial bacillary index of 3.38 ± 1.36. Recurrent and chronic patterns of erythema nodosum leprosum were seen in 15 (40.5%) and 6 (16.3%) patients, respectively. Most (86.5%) of our patients presented with moderate to severe erythema nodosum leprosum. The mean serum macrophage migration inhibitory factor level was 21.86 ± 18.7 ng/ml among patients while it was 11.78 ± 8.4 ng/ml in the control group (P < 0.01). There were no statistically significant correlations of macrophage migration inhibitory factor levels with erythema nodosum leprosum frequency or severity. Limitation: Serum macrophage migration inhibitory factor levels in leprosy patients with no erythema nodosum leprosum and in patients with other inflammatory and autoimmune conditions were not assessed. Hence, this study falls short of providing the predictive value and specificity of higher macrophage migration inhibitory factor concentrations in serum as a biomarker of erythema nodosum leprosum. Conclusion: Macrophage migration inhibitory factor levels are elevated in erythema nodosum leprosum patients as compared to controls. A larger sample size and macrophage migration inhibitory factor gene polymorphism analysis will be needed to elucidate the role of this pro-inflammatory cytokine in erythema nodosum leprosum.

IJDVL and impact factor

Saumya Panda

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):525-527

Congenital asymptomatic papule on the lower eyelid

Keshavmurthy A Adya, Aparna Palit, Arun C Inamadar

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):578-580

Excision of basal cell carcinomas smaller than 1 cm with 2 mm safety margins: Lateral margin adequacy evaluated by double-bladed scalpel method

Gabriela R Haddad, Hélio Amante Miot, Mariangela Esther Alencar Marques, Juliano Vilaverde Schmitt

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):603-606

Biomass pellets for power generation in India: a techno-economic evaluation

Abstract

Modern bioenergy is being recognized as an increasingly important low-carbon resource by policy-makers around the world to meet climate policy targets. In India also, there is a clear recognition of the significant role of bioenergy in electricity generation as well as in other applications. In this study, a preliminary attempt has been made to assess the techno-economic feasibility of biomass pellets-based power (BPBP) generation in India. Surplus availability of biomass feedstock from agriculture and forestry/wasteland sector is estimated at 242 million tonnes (Mt) for 2010–11 and is expected to rise to 281 Mt in 2030–31 due to increased crop production and associated waste/residue availability. In terms of related capacity, the potential of BPBP projects is estimated at 35 GW for 2030–31. The associated carbon dioxide mitigation potential resulting from the substitution of coal is estimated at 205 Mt in 2030–31 if the entire biomass surplus is to be diverted for power generation. The levelized cost of electricity is estimated at €0.12 per kWh for BPBP projects as compared to €0.10 per kWh for imported coal based power plants. For states with the lower tariff for biomass power, the break-even price of carbon for BPBP projects is estimated at €18 per tonne. Additionally, BPBP projects will generate employment of more than 5 million person-months in the construction of biomass power plants and over 200,000 full-time employments in the operation of BPBP plants and in the production of biomass pellets.

Analysis of metal content and vertical stratification of epiphytic mosses along a Karst Mountain highway

Abstract

Road-based transport emissions are a major source of atmospheric metal pollution. However, there have been few studies on emissions from road traffic in mountainous areas. In this study, epiphytic mosses from trees at different elevations of a highway, a typical road with extraordinary elevation change in a mountainous area of karst in Guizhou, China, were analyzed for metal content as well as the spatial distribution pattern of metals. Mosses were sampled from three sections of highway at different elevations, from 1292–1357, 1394–1441, to 1481–1548 m. Principal component analysis and heat-map clustering were used to identify the principal factors affecting metal deposition. The results show that the metals of mosses from different elevations were divided into four factors. Group 1 which included Ni, Fe, Mg, Ba, and Al was attributed to a dominantly geogenic source. Group 2 included Zn, Cu, Mn, and Cr, from vehicle-related materials including tires and brakes. Group 3, Cd, can be attributed to high Cd background levels from local origins and traffic emissions, particularly tire wear. Group 4, Pb, is associated with brake wear and historical deposition. The epiphytic moss widely distributed in the study area, Ectropothecium aneitense Broth. & Watts, was used to analyze the spatial distribution pattern of the metals. Metal content gradually decreased with increase in elevation. Levels of Ni, Fe, Mn, Ba, and Cd were all significantly correlated with elevation (p < 0.05), simultaneously affected by terrain and vertically stratified. We highlighted the vertical distribution characteristics of metal in epiphytic mosses in this study, which could improve moss application for ecological monitoring due to road-based transport emissions with elevation changes.

What new technology means for the energy demand in China? A sustainable development perspective

Abstract

This paper explores the direct impact of new technology on the energy intensity in China. The autoregressive distributed lag (ARDL) bounds test approach to cointegration is utilised over the extended period of 1985–2013. The variables found cointegrated and confirm the long-run association among all the underlying vectors. Furthermore, the results of long- and short-run analysis reveal that new technology spurs energy intensity in China. A 1% increase in technological innovation boosts energy intensity by 0.4% and 0.03% in the long and short run, respectively. The findings suggest that the establishment of smart grids and solar energy parks followed by the reforms in energy sector is yet to achieve plausible efficiency in China. The existing investment and innovation policy reforms are insufficient to assist the energy sector to cope up with the country's exceptional economic growth trend. Unlike other studies, this paper accommodates structural break in the series. During sensitivity analysis, the model is found stable. Hence, the findings possess important policy implications for China and open up new discussion in the field.

Secukinumab treatment of moderate to severe plaque psoriasis in routine clinical care: Baseline characteristics, previous therapies, and transition periods of the first 2,000 subjects in the PROSPECT study

Introduction: Secukinumab, a fully human monoclonal antibody that selectively neutralizes IL-17A, has demonstrated substantial efficacy in the treatment of moderate to severe psoriasis. The PROSPECT study was designed to assess previous and concomitant use of Pso treatments in 2,504 subjects receiving secukinumab and the duration of transition periods from previous treatments to secukinumab in real-life settings. Here we report the baseline characteristics and previous therapies in an interim analysis of the first 1,988 subjects.

The prevalence of inflammatory bowel disease in patients with hidradenitis suppurativa

Background: Hidradenitis suppurativa is a chronic inflammatory skin disease associated with many other systemic manifestations including metabolic syndrome. Multiple other inflammatory disorders have been associated with inflammatory bowel disease including psoriasis and rosacea. IBD has been reported with HS however analysis have often utilized large data pulls which rely on International Classification of Diseases (ICD) coding. This leads to the possibility of overestimating prevalence.

Sun behaviors and quality of life after first cutaneous melanoma diagnosis

Background: There is a growing population of patients living with a history of cutaneous malignant melanomas (CMM) and recent studies indicate that sun-protective behaviors may not be maintained long term. These patients are at increased risk of developing a second primary melanoma and little is known regarding barriers to successful patient education and behavioral change.

The bacteria stroke: Leclercia adecarboxylata folliculitis in a healthy swimmer—an emerging aquatic pathogen?

A 12-year-old healthy boy presented with a 2-month painful acneiform eruption. On exam erythematous follicular papules and pustules were scattered over bilateral shoulders and back. These surfaces were moderately tender to light palpation; the patient even complained that clothing in contact with his skin elicited pain. Doxycycline 75 mg po qd × 10 days was prescribed to cover common Staphylococcus aureus folliculitis. Due to the atypical presentation of significant pain, a bacterial culture was collected.

Solid persistent facial edema (Morbihan syndrome) in a young Mexican-Mestizo woman

Introduction: Morbihan syndrome (MS) is a rare entity characterized by chronic erythematous edema of the upper portion of the face, believed to be a clinical complication of acne vulgaris and/or rosacea, that mostly affects Caucasian adults. There are no laboratory abnormalities or specific histopathologic findings described and thus, MS is mainly a diagnosis of exclusion.

Role of industry funding in academic dermatology

Since 2003, the NIH Budget for research grants has diminished. As a result more academic physicians are turning to pharmaceutical and medical device companies for funding. The aim of this project was to examine the relationship between private industry funding in dermatology and the relative scholarly impact created by investigators who received this funding. The objective of this study was to compare the impact of the h-index, a weighted index of academic productivity, to the amount of industry research funding received by colleagues.

The evolution of confocal microscopy in dermatology

Reflectance confocal microscopy (RCM) is a diagnostic imaging tool used to visualize the skin in vivo at the bedside with accuracy that parallels histology. For tissue examination, RCM uses lasers to produce optical sections by illuminating the specimen and by scanning focused beams of light across the tissue. The principle of point illumination in confocal microscopy was first proposed by Marvin Minsky in 1955, and serves as the basis for all subsequent developments for this technology. In the 1970s, lasers were introduced, and shortly after that photomicrographs of histologically recognizable cells were published.

Systemic lupus erythematosus with toxic epidermal necrolysis–like lesions: An infrequent variant of acute cutaneous erythematous lupus

Introduction: Skin manifestations in systemic lupus erythematosus (SLE) are very heterogeneous. Toxic epidermal necrolysis (TEN)–like lesions are an infrequent clinical presentation of SLE that are included as diagnostic criteria and a variant of acute cutaneous lupus. It presents with photodistributed exanthema and minimal mucositis and the onset of the rash is insidious. Differential diagnosis between "TEN-like" LE and classic TEN, could be difficult especially when LE has not been previously diagnosed.

Steroid-assisted drug delivery with chemical peels for lichen amyloidosis: A case series

Cutaneous amyloidosis is a chronic dermatologic problem that can be extremely frustrating to patients and for which there are limited therapeutic options, often of inadequate efficacy. Patient quality of life is affected by the severe pruritus and cosmetic disfigurement of their lesions. First-line therapy for this condition is potent topical corticosteroids, but therapeutic efficacy is often limited by ineffective drug delivery to the target site. Intralesional kenalog can be a useful alternative for those with small, localized areas of disease involvement.

Simultaneous treatment of moderate-to-severe horizontal frontalis lines, glabellar lines, and lateral canthal lines with onabotulinumtoxinA, from the subject’s perspective: Patient-reported satisfaction and impact outcomes from a phase 3 double-blind study

Purpose: Safety and efficacy of onabotulinumtoxinA (onabotA) for simultaneous treatment of horizontal forehead lines (FHL) and glabellar complex and simultaneous treatment of upper facial lines (UFL) were assessed in a 12-month, placebo-controlled study. The primary end point was met. Secondary efficacy results (patient-reported satisfaction and treatment impacts) are presented here.

Scalp photodamage in balding men: An observational study combining a novel clinical scoring method with estimation of individual sun exposure history and risk factors

Background: Despite the fact that actinic damage is well documented, particularly in men due to balding, to our knowledge, the intensity of the relationship between scalp actinic damage and sun exposure remains to be fully elucidated.

Removal of skin tags with Erbium:YAG Laser: A simple, safe, quick, and effective technique requiring no local anesthesia

Background: Acrochordons are a one of the commonest type of benign cutaneous tumors. These are soft skin fibromas, and have been thought to represent as a cutaneous marker of metabolic syndrome. Treatments like snipping, cryotherapy, electrocautery, and radiofrequency ablation though effective, have there own limitations.

Pythriasis versicolor atypica: A difficult diagnosis

Introduction: Pityriasis versicolor is a superficial mycosis of the skin caused by Malassezia spp., a dimorphic, lipophilic yeast, which is part of the cutaneous microbiota. The most frequent topography is the trunk and is distinguished by showing plaques with fine scales on the surface, of varying shape and size that may be hypochromic, hyperchromic or erythematous, with a chronic and recurrent evolution, usually asymptomatic. The genus Malassezia, from its description, causes confusion and controversy.

The thousand faces of the Sweet syndrome

Introduction: Sweet syndrome is an acute febrile neutrophilic dermatosis described in 1964 by Robert Douglas Sweet, that primarily affects individuals in their fifth to seventh decades. It can be classified into classic or idiopathic, parainflammatory, paraneoplastic, and pregnancy associated. Etiology is unknown, but many authors proposes an unusual hypersensitivity that may be mediated by cytokines, such as interleukin-1, followed by infiltration of neutrophils. Clinically, it is characterized by the abrupt onset of multiple tender, erythematous plaques or nodules.

The importance of eyebrows in the treatment of alopecia areata: An online questionnaire

Background: Alopecia areata (AA) affects not only scalp hair, but often also involves the eyebrows. Most clinical studies focus on scalp hair regrowth as the primary outcome. Our study aims to assess the importance of eyebrows to AA patients.

The effectiveness of using 1% diclofenac gel and 20% azelaic acid cream for melasma: A single-blind, placebo-controlled, split-face study

Background: Nonsteroidal antiinflammatory drugs that inhibit the mediator of UV-induced melanogenesis (1-6) may be another alternate option for melasma as were azelaic acid.

Teledermatology: An updated overview of clinical applications and reimbursement policies

Telemedicine is an emerging field in health care that provides services from different medical specialties to patients all around the world. One of the specialties in telemedicine, teledermatology, has grown exponentially as a cost-effective way to implement dermatologic health care to underserved areas and populations. This article reviews the literature that pertains to the cost-effectiveness, reliability, public access, patient satisfaction, and reimbursement policies of teledermatology. Teledermatology has two established modalities: store-and-forward (asynchronous) and live interaction (synchronous).

Sweet syndrome induced by influenza vaccination

History: A 41-year-old Caucasian man with no significant medical history presented with a painful rash on his left neck and arm. His symptoms began one day after receiving an influenza vaccination and persisted for several months. Review of systems was positive for occasional fevers and arthralgias.

Subjective facial dynamics with the use of hyaluronic acid dermal fillers formulated for facial movement and expression

Background: Not only do patients want to look younger and more attractive, patients also want to maintain a natural look following rejuvenation treatments that don't alter their facial expressions. Hence, it becomes increasingly important to assess facial dynamics as results that appear natural at rest may appear unnatural with expression. An open-label clinical study was conducted to evaluate the perception of the naturalness of facial expressions in motion following correction of wrinkles and folds in the lower face.

Sporotrichoid chromoblastomycosis on right lower leg

Introduction: Chromoblastomycosis is a worldwide chronic fungal infection caused mainly by Fonsecaea pedrosoi or Cladophialophora carrionii affecting predominantly men in tropical and subtropical countries. Patients acquire the infection through a traumatic implantation of fungi from soil. Most common clinical manifestation is a verrucous plaque. Very few cases of sporotrichoid chromoblastomycosis have been described. We report a rare lymphangitic chromoblastomycosis on right lower leg in a young male patient.

Re: Wound outcomes in negative pressure dressings (WOUND) study - A randomised trial in lower limb skin cancer grafts

Dear Sir,

Self-Knowledge in a Predictive Processing Framework

Abstract

In this paper I propose an account of self-knowledge based on a framework of predictive processing. Predictive processing understands the brain as a prediction-action machine that tries to minimize error in its predictions about the world. For this view to evolve into a complete account of human cognition we ought to provide an idea how it can account for self-knowledge – knowledge of one's own mental states. I provide an attempt for such an account starting from remarks on introspection made by Hohwy (2013). I develop Hohwy's picture into a general model for knowledge of one's mental states, discussing how predictions about oneself can be used to capture self-knowledge. I further explore empirical predictions, and thereby argue that the model provides a good explanation for failure of self-knowledge in cases involving motor aftereffects, such as the broken escalator phenomenon. I conclude that the proposed account is incomplete, but provides a valuable first step to connect research on predictive processing with the epistemology of self-knowledge.

Hepatozelluläres Karzinom

Psychisches Wohlbefinden bei Patienten mit Leberzellkarzinom

Zusammenfassung

Hintergrund

Krebserkrankungen sowie die daraus resultierenden Folgen und Behandlungen stellen für Betroffene meist eine starke Belastung dar. Bei einem hepatozellulären Karzinom (HCC) handelt es sich um eine Krebserkrankung mit sehr schlechter Prognose. Mögliche Risikofaktoren, ein HCC zu entwickeln, nehmen in der Bevölkerung seit Jahren zu. Dennoch ist nur wenig über die psychische Belastung der Betroffenen bekannt.

Ziel der Arbeit

Ziel dieser Untersuchung war es, die psychische Belastung und Unterstützungswünsche von HCC-Patienten darzustellen.

Patienten und Methoden

In einer prospektiven Studie wurden Leberzellkarzinompatienten untersucht. Sie wurden zu Beginn und während eines Krankenhausaufenthalts, kurz vor der Entlassung aus demselben sowie 1/2 und 1 Jahr später befragt. Die psychische Belastung wurde mittels „hospital anxiety and depression scale" (HADS) erhoben. Zusätzlich wurden die Patienten gefragt, durch wen sie sich zusätzliche Betreuung wünschen. Bei der Auswertung wurde Häufigkeitsvergleiche mittels χ²-Test und Korrelationen mittels Pearson-Korrelationskoeffizient berechnet.

Ergebnisse

Insgesamt nahmen 97 Patienten an der Studie teil. Bei mehr als der Hälfte (56 %) lag der HADS-Gesamtwert zu Beginn der stationären Aufnahmen über 13, was einer überdurchschnittlichen psychischen Belastung entspricht. Über 90 % der befragten Patienten wünschten sich zu diesem Zeitpunkt psychosoziale Betreuung, zumeist durch Ärzte, Pflegekräfte und/oder Psychologen. Vor der Entlassung erhofften sich alle befragten Personen Unterstützung von Ärzten sowie Pflegekräften. Nach 1/2 Jahr wünschten sich die Betroffenen v. a. Unterstützung von Ärzten und Selbsthilfegruppen.

Diskussion

HCC-Patienten sind psychisch erheblich belastet, mit erhöhtem Betreuungsbedarf.

Routine Functional and Aesthetic Outcome Measurements in Secondary Cleft Lip Rhinoplasty and Patient Satisfaction

This cohort study describes the implementation and advantages of an automated and prospective secondary cleft lip rhinoplasty outcome system and its association with patient satisfaction.

The Modified Bullhorn Approach for the Lip-lift

This Surgical Pearl describes the lip-lift procedure and details of the modified bullhorn approach.

Adjuvant sunitinib in patients with high-risk renal cell carcinoma: safety, therapy management, and patient-reported outcomes in the S-TRAC trial

Abstract

Background

Adjuvant sunitinib has significantly improved disease-free survival versus placebo in patients with renal cell carcinoma at high risk of recurrence post-nephrectomy (hazard ratio 0.76; 95% confidence interval, 0.59–0.98; two-sided P=0.03). We report safety, therapy management, and patient-reported outcomes for patients receiving sunitinib and placebo in the S-TRAC trial.

Patients and methods

Patients were stratified by the University of California, Los Angeles Integrated Staging System and Eastern Cooperative Oncology Group performance status score, and randomized (1:1) to receive sunitinib (50 mg/day) or placebo. Single dose reductions to 37.5 mg, dose delays, and dose interruptions were used to manage adverse events (AEs). Patients' health-related quality of life, including key symptoms typically associated with sunitinib, were evaluated with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30).

Results

Patients maintained treatment for 9.5 (mean, SD 4.4) and 10.3 (mean, SD 3.7) months in the sunitinib and placebo arms, respectively. In the sunitinib arm, key AEs occurred ∼1 month (median) after start of treatment and resolved within ∼3.5 weeks (median). Many (40.6%) AEs leading to permanent discontinuation were grade 1/2, and most (87.2%) resolved or were resolving by 28 days after last treatment. Patients taking sunitinib showed a significantly lower EORTC QLQ-C30 overall health status score versus placebo, although this reduction was not clinically meaningful. Patients reported symptoms typically related to sunitinib treatment with diarrhea and loss of appetite showing clinically meaningful increases.

Conclusions

In S-TRAC, AEs were predictable, manageable, and reversible via dose interruptions, dose reductions, and/or standard supportive medical therapy. Patients on sunitinib did report increased symptoms and reduced HRQoL, but these changes were generally not clinically meaningful, apart from appetite loss and diarrhoea, and were expected in the context of known sunitinib effects.

Clinical Trial Registration

ClinicalTrials.gov, NCT00375674.

Reply to the letter to the editor “Small repeated boluses are unreliable to provide rapid analgesia with intravenous morphine titration and mislead conversion ratio to oral morphine” by Mercadante S.

Colorectal Premalignancy is Associated with Consensus Molecular Subtypes 1 and 2

Abstract

Background

Gene expression-based profiling of colorectal cancer (CRC) can be used to identify four molecularly homogeneous Consensus Molecular Subtypes (CMS) groups with unique biologic features. However, its applicability to colorectal premalignant lesions remains unknown.

Patients and methods

We assembled the largest transcriptomic premalignancy data set by integrating different public and proprietary cohorts of adenomatous and serrated polyps from sporadic (N = 311) and hereditary (N = 78) patient populations and performed a comprehensive analysis of carcinogenesis pathways using the CMS Random Forest (RF) classifier.

Results

Overall, transcriptomic subtyping of sporadic and hereditary polyps revealed CMS2 and CMS1 subgroups as the predominant molecular subtypes in premalignancy. Pathway enrichment analysis showed that adenomatous polyps from sporadic or hereditary cases (including Lynch syndrome) displayed a CMS2-like phenotype with WNT and MYC activation, whereas hyperplastic and serrated polyps with CMS1-like phenotype harbored prominent immune activation. Rare adenomas with CMS4-like phenotype showed significant enrichment for stromal signatures along with TGFβ activation. There was a strong association of CMS1-like polyps with serrated pathology, right-sided anatomic location and BRAF mutations.

Conclusions

Based on our observations made in premalignancy, we propose a model of pathway activation associated with CMS classification in colorectal carcinogenesis. Specifically, while adenomatous polyps are largely CMS2, most hyperplastic and serrated polyps are CMS1 and may transition into other CMS groups during evolution into carcinomas. Our findings shed light on the transcriptional landscape of premalignant colonic polyps and may help guide the development of future biomarkers or preventative treatments for CRC.

Induction chemotherapy (IC) followed by radiotherapy (RT) vs. cetuximab plus IC and RT in advanced laryngeal/hypopharyngeal cancer resectable only by total laryngectomy – final results of the larynx organ preservation trial DeLOS-II

Abstract

Background

The German multicenter randomized phase-II larynx-organ preservation (LOP) trial DeLOS-II was performed to prove the hypothesis that cetuximab (E) added to induction chemotherapy (IC) and radiotherapy improves laryngectomy-free survival (LFS; survival with preserved larynx) in locally advanced laryngeal/hypopharyngeal cancer (LHSCC).

Patients and methods

Treatment-naïve patients with stage III/IV LHSCC amenable to total laryngectomy (TL) were randomized to three cycles IC with TPF (docetaxel [T] and cisplatin [P] 75 mg/m²/day 1, 5-FU [F] 750 mg/m²/day days 1-5) followed by radiotherapy (69.6 Gy) without (A) or with (B) standard dose cetuximab for 16 weeks throughout IC and radiotherapy (TPFE). Response to first IC-cycle (IC-1) with ≥30% endoscopically estimated tumor surface shrinkage (ETSS) was used to define early responders; early salvage TL was recommended to non-responders. The primary objective was 24-months LFS above 35% in arm B.

Results

Of 180 patients randomized (7/2007-9/2012), 173 fulfilled eligibility criteria (A/B: larynx 44/42, hypopharynx 41/46). Because of 4 therapy-related deaths among the first 64 randomized patients, 5-FU was omitted from IC in the subsequent 112 patients reducing further fatal toxicities. Thus, IC was TPF in 61 patients and TP in 112 patients, respectively. The primary objective (24-months LFS above 35%) was equally met by arms A (40/85, 47.1%) as well as B (41/88, 46.6%). 123 early responders completed IC+RT; their overall response rates (TPF/TP) were 94.7%/87.2% in A vs. 80%/86.0% in B. The 24-months overall survival (OS) rates were 68.2% and 69.3%.

Conclusions

Despite being accompanied by an elevated frequency in adverse events, the IC with TPF/TP plus cetuximab was feasible but showed no superiority to IC with TPF/TP regarding LFS and OS at 24 months. Both early response and 24-months LFS compare very well to previous LOP trials and recommend effective treatment selection and stratification by ETSS.

Clinical trial information

NCT00508664

TP53 mutations are predictive and prognostic when co-occurring with ALK rearrangements in lung cancer

“Optimism Bias” in Contemporary National Clinical Trial Network Phase III Trials: Are We Improving?

Abstract

Background

Previous studies have found that overestimating treatment effects (i.e., "optimism bias") leads to underpowered clinical trials. The prevalence of "optimism bias" in contemporary National Clinical Trials Network (NCTN) cancer clinical trials is unknown.

Methods

We conducted a systematic review of NCTN phase III randomized trials published from January 2007 to January 2017. We compared the hypothesized vs. observed treatment effects in each trial, and examined whether trial-related factors were correlated with the study results. We also reviewed the methods of each protocol to assess whether a rationale for the hypothesized effect size was provided.

Results

We identified 161 clinical trials, of which 130 were eligible for analysis. Original protocols could not be located for 8 trials (5.0%). Twenty-eight trials (21.5%) observed a statistically significant difference in the primary endpoint favoring the experimental treatment. The median ratio of observed-to-expected HRs among trials that observed a statistically significant effect on the primary endpoint was 1.07 (range: 0.33-1.28) vs 1.32 (range: 0.86-2.02) for trials that did not, compared with 1.34 and 1.86, respectively, for National Cancer Institute (NCI) trials published between 1955 to 2006. An effect size at least as large as the one projected in the protocol trials was observed in 9.8% of trials, compared to 17% of NCI trials published from 1955 to 2006. Most trials (64.6%) provided no rationale to support the magnitude of the proposed treatment effect in the protocol.

Conclusions

Despite a reduction in "optimism bias" compared to previous eras, most contemporary NCTN phase III trials failed to establish statistically significant benefits of new cancer therapies. Better rationalization of proposed effect sizes in research protocols is needed.

Immunotherapy is not for all comers in chemotherapy-refractory advanced gastric cancer. Better predictive biomarkers are needed

FDG-PET response and outcome from anti-PD-1 therapy in metastatic melanoma

Abstract

Background

Immune checkpoint inhibitor therapy has resulted in impressive and durable clinical activity for many cancers including melanoma, however there remain few reliable predictors for long-term response. This study investigated whether FDG-PET imaging may better predict long-term outcomes compared to standard CT response criteria.

Patients and methods

Retrospective analysis of metastatic melanoma patients treated with anti-PD-1 based immunotherapy with baseline and 1-year ¹⁸F-FDG PET and CT imaging at Melanoma Institute Australia. 1-year response was determined using RECIST for CT and EORTC criteria for PET, coded as complete response (CR or CMR), partial response (PR or PMR), stable disease (SD or SMD) or progressive disease (PD or PMD). Progression-free survival (PFS) was determined from the 1-year landmark.

Results

104 patients were evaluated with median follow-up 30.1 months and 98% remain alive. Most received anti-PD-1 as monotherapy (67%) or combined with ipilimumab (31%). At 1-year, 28% had CR, 66% had PR and 6% had SD on CT, while 75% had CMR, 16% PMR and 9% SMD/PMD on PET. CMR was observed in 68% of patients with PR on CT. RECIST PFS post 1-year landmark was similar in patients with CR vs PR/SD, but improved in patients with CMR vs non-CMR (median not reached [NR] vs 12.8 mths; HR 0.06 [95% CI 0.02-0.23]; p<0.01). In patients with PR on CT, PFS was improved in patients with PR+CMR vs PR+non-CMR (median NR vs 12.8 months; HR 0.07 [95% CI 0.02-0.27]; p<0.01). In the 78 CMR patients, 78% had discontinued treatment and 96% had ongoing response.

Conclusions

Whilst only a small proportion of patients have a CR at 1-year, most patients with a PR have CMR on PET. Almost all patients with CMR at 1-year have ongoing response to therapy thereafter. PET may have utility in predicting long-term benefit and help guide discontinuation of therapy.

The state of the art in peer review

Abstract

Scholarly communication is in a perpetual state of disruption. Within this, peer review of research articles remains an essential part of the formal publication process, distinguishing it from virtually all other modes of communication. In the last several years, there has been an explosive wave of innovation in peer review research, platforms, discussions, tools, and services. This is largely coupled with the ongoing and parallel evolution of scholarly communication as it adapts to rapidly changing environments, within what is widely considered as the 'open research' or 'open science' movement. Here, we summarise the current ebb and flow around changes to peer review and consider its role in a modern digital research and communications infrastructure and suggest why uptake of new models of peer review appears to have been so low compared to what is often viewed as the 'traditional' method of peer review. Finally, we offer some insight into the potential futures of scholarly peer review and consider what impacts this might have on the broader scholarly research ecosystem. In particular, we focus on the key traits of certification and reputation, moderation and quality control, and engagement incentives, and discuss how these interact with socio-technical aspects of peer review and academic culture.

Adsorption of myo -inositol hexakisphosphate in water using recycled water treatment residual

Abstract

Dissolved organic phosphorus (DOP) in rainwater runoff or other contaminated waters can cause or aggravate eutrophication of water bodies. Water treatment residual (WTR) containing spent coagulant has been shown to provide excellent adsorption capacity for inorganic phosphorus such as orthophosphate, but little information has been available on adsorption of DOPs by WTR. In this study, the adsorption characteristics of myo-inositol-1,2,3,4,5,6-hexakisphosphate (IHP), a prototype DOP in soil and stormwater, by WTR were investigated through batch adsorption equilibrium and kinetic experiments. The influences of pH and various size fractions of WTR on the adsorption capacity were tested and analyzed, and the adsorption mechanism was elucidated based on Fourier-transform infrared spectroscopy (FTIR) analysis. The experimental results showed that WTR can effectively adsorb IHP from simulated rainwater, and the IHP uptake was favored under neutral and acidic conditions. Moreover, the 1.0–2.0-mm fraction of the WTR particles was most suitable for practical application because of the well-balanced adsorption rate and capacity. The classical Langmuir isotherm model well described the equilibrium adsorption data and the pseudo-second-order kinetic model adequately interpreted the rate data. Thermodynamic analysis revealed that the adsorption is a spontaneous, endothermic, and entropy-driven reaction. The FTIR analysis indicated that adsorption of IHP on WTR is associated with the formation of ≡Al–PO₃⁻ groups and the release of –OH from WTR. A comparison of the adsorption capacities of orthophosphate and IHP on WTR suggested that binding one IHP may take two times more sites than for orthophosphate, indicating that two of the six phosphate groups in IHP were bound to WTR. This work shows that recycled WTR may be used as a low-cost adsorbent for effective removal of organic phosphate in gray water and wastewater.

Insight into the impact of Fe 3 O 4 nanoparticles on anammox process of subsurface-flow constructed wetlands under long-term exposure

Abstract

The increasing use of Fe₃O₄ nanoparticles (NPs) had posed an emerging challenge to wastewater treatment processes, and their potential impact on anaerobic ammonium oxidation (anammox) process of unplanted subsurface-flow constructed wetlands (USFCWs) was investigated firstly under the long-term exposure of different Fe₃O₄ NP concentrations. It was found that Fe₃O₄ NP exposure could improve total nitrogen (TN) removal. The abundance of Candidatus Anammoxoglobus increased significantly at 10 mg/L Fe₃O₄ NPs, while decreased under 1 mg/L Fe₃O₄ NP exposure. Desulfosporosinus and Exiguobacterium increased to some extent at 1 mg/L Fe₃O₄ NPs, suggesting that Fe-anammox played an important role in TN removal. The ROS production increased with the increase of Fe₃O₄ NP concentration, and the integrity of cell membrane was good under Fe₃O₄ NP exposure. The functional genes that related to inorganic ion transport and metabolism and lipid transport and metabolism were upregulated, and cell motility decreased after long-term exposure of 1 mg/L Fe₃O₄ NPs.

Graphical abstract

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A systemic approach to identify signaling pathways activated during short-term exposure to traffic-related urban air pollution from human blood

Abstract

The molecular mechanisms that promote pathologic alterations in human physiology mediated by short-term exposure to traffic pollutants remains not well understood. This work was to develop mechanistic networks to determine which specific pathways are activated by real-world exposures of traffic-related air pollution (TRAP) during rest and moderate physical activity (PA). A controlled crossover study to compare whole blood gene expression pre and post short-term exposure to high and low of TRAP was performed together with systems biology analysis. Twenty-eight healthy volunteers aged between 21 and 53 years were recruited. These subjects were exposed during 2 h to different pollution levels (high and low TRAP levels), while either cycling or resting. Global transcriptome profile of each condition was performed from human whole blood samples. Microarrays analysis was performed to obtain differential expressed genes (DEG) to be used as initial input for GeneMANIA software to obtain protein-protein (PPI) networks. Two networks were found reflecting high or low TRAP levels, which shared only 5.6 and 15.5% of its nodes, suggesting specific cell signaling pathways being activated in each environmental condition. However, gene ontology analysis of each PPI network suggests that each level of TRAP regulate common members of NF-κB signaling pathway. Our work provides the first approach describing mechanistic networks to understand TRAP effects on a system level.

Comparable safety of two aspirin desensitization protocols for aspirin exacerbated respiratory disease (AERD)

Publication date: Available online 23 August 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Teresa Pelletier, Gigia Roizen, Zhen Ren, Golda Hudes, David Rosenstreich, Elina Jerschow

Direct sunlight enabled photo-biochemical synthesis of silver nanoparticles and their Bactericidal Efficacy: Photon energy as key for size and distribution control

Publication date: Available online 22 August 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): A.K. Bhardwaj, A. Shukla, S. Maurya, S.C. Singh, K.N. Uttam, S. Sundaram, M.P. Singh, R. Gopal

Abstract

It is highly desirable to discover novel green synthesis methods for cheap and scalable synthesis of nanoparticles (NPs) to reduce the negative impact on the environment. But these approaches generally impose great challenge in controlling size, shape, and homogeneity of product NPs. Here in the present study, we report a novel approach enabling direct sunlight and oyster mushroom (Pleurotus citrinopileatus) extract for the photo-biochemical synthesis of Ag NPs. Sunlight of different wavelength was used to control the size and distribution of photo-biochemically produced NPs. Interestingly, it is observed that a smaller wavelength of sunlight produces smaller sized of NPs with a narrow size distribution. For examples; blue sunlight produces colloidal silver NPs with an average diameter of ~ 3.28 nm and 0.72 nm size distribution, while full sunlight produces comparatively larger sized (7.08 nm) NPs with wider (2.92 nm) size distribution. Since present approach uses only direct sunlight, freely available renewable energy source, a cheap biological extract as reducing and capping agent and cheap sliver precursor, therefore it is an environment-friendly approach and can be used for the synthesis of NPs at industrial scale. Moreover, the size-dependent bactericidal effect has also been studied against pathogenic, Escherichia coli, bacteria. The minimum inhibitory concentration (MIC) 25 ppm and MBC 30 ppm have been observed for silver NPs of 3.28 nm average diameter.

Graphical abstract

Examen mycologique en dermatologie

Publication date: Available online 22 August 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): M. Feuilhade de Chauvin

Résumé

Les dermatomycoses sont des infections dermatologiques très fréquentes en pratique de ville puisqu'elles peuvent atteindre un tiers de la population. Cependant, leur symptomatologie est souvent commune avec d'autres affections ou infections cutanées, et peut être très atypique. Il n'est donc pas possible de poser un diagnostic de certitude par un simple examen clinique. C'est pourquoi le diagnostic mycologique est indispensable pour confirmer ou infirmer une dermatomycose, et ne se discute pas lorsqu'un antifongique systémique doit être proposé comme dans le traitement d'une teigne du cuir chevelu et de la barbe, ou d'une onychomycose. Il devient indispensable lorsqu'un traitement prescrit sur l'aspect clinique des lésions est en échec ou si les lésions cutanées récidivent. La confirmation d'une mycose permet de prescrire un traitement antifongique et la négativité de l'examen justifie d'envisager une autre cause aux lésions observées. Néanmoins, quelle que soit la technique du diagnostic mycologique, la qualité de sa réponse dépend avant tout de la qualité du prélèvement sur le site infecté, mais aussi de l'expertise du biologiste. L'examen mycologique classique demeure le plus informatif, le moins cher, et le seul examen capable d'isoler le champignon responsable quelle que soit la mycose : dermatophytose ; scytalidiose ; infection unguéale à moisissure ; candidose ; infections à Malassezia sp. C'est le seul examen capable d'identifier les variations épidémiologiques. Toutes les autres techniques récemment proposées reposent sur la simple mise en évidence d'éléments fongiques sans identification de l'espèce fongique ou sont dépendantes d'une banque de données de champignons généralement très incomplète.

Abstract

Dermatomycoses are dermatological infections very commonly encountered in private dermatological practice since they affect up to one third of the population. However, the symptoms are very often shared by other skin infections and disorders and may be highly atypical. It is thus impossible to make a diagnosis with any certainty on clinical grounds alone. For this reason, mycological diagnosis is essential to either confirm or rule out dermatomycosis, and is unavoidable when antifungal therapy is required for the treatment of ringworm of the scalp or beard, or for onychomycosis. It is also vital where therapy guided by the clinical appearance of lesions has failed or in the event of recurring skin lesions. Confirmation of mycosis enables antifungals to be initiated and a negative test warrants investigation for other underlying causes for the lesions seen. However, regardless of the mycological diagnostic technique employed, the quality of the results depends chiefly on the quality of sampling of the infected site, but also on the expertise of the microbiologist. Standard mycological testing remains the most informative, the least expensive and the sole examination capable of isolating the causative fungus irrespective of the type of mycosis, such as dermatophytosis, scytalidiosis, mould-induced ungual infection, candidiasis, or infections due to Malassezia sp. This is the only examination able to identify epidemiological variations. All other more recent techniques are either based upon simple demonstration of the fungal elements involved, without identification of the fungal species in question, or else they are reliant upon a fungal database that is generally highly incomplete.

Maladies bulleuses auto-immunes à expression gingivale : proposition d’une technique de biopsie gingivale non iatrogène

Publication date: Available online 22 August 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): S.-M. Dridi, F. Bellakhdar, N. Ortonne, K. Bayet, S. Ingen-Housz-Oro, F. Gaultier

Résumé

Introduction

L'expression gingivale des maladies bulleuses auto-immunes (MBAI) est parfois inaugurale, exclusive ou prédominante (pemphigoïde des muqueuses, pemphigus vulgaire). L'histologie et l'immunofluorescence directe sont essentielles au diagnostic. Le choix du site et la technique chirurgicale déterminent la qualité histologique des prélèvements tissulaires. Or, la gencive est souvent considérée comme un tissu fragile, facilement altérable lors de la biopsie. Nous proposons un protocole original de biopsie intéressant les papilles gingivales, simple à réaliser, non iatrogène et accessible à tous les praticiens qui prennent habituellement en charge les patients atteints de MBAI à expression gingivale isolée (dermatologue, stomatologue, odontologiste spécialiste, oto-rhino-laryngologiste).

Patients et méthodes

Nous avons mené une étude rétrospective de 2012 à 2017 recensant tous les patients atteints de MBAI à expression gingivale ayant eu, à visée diagnostique, une biopsie de gencive papillaire. Notre objectif principal était d'évaluer la performance pour le diagnostic et la tolérance de cette technique opératoire.

Résultats

Sur la période d'étude, 34 biopsies de gencive papillaire ont été réalisées chez 19 patients, 15 pour l'examen anatomopathologique et 19 pour l'immunofluorescence directe. Sur les 34 biopsies, seule une n'a pas pu être analysée correctement en raison de l'absence de l'épithélium et a imposé la réalisation d'un second prélèvement. Aucune complication post-opératoire n'a été enregistrée à court ou à long terme.

Conclusion

La biopsie des papilles gingivales est parfaitement adaptée aux examens anatomopathologiques et immunohistochimiques nécessaires au diagnostic des maladies bulleuses auto-immunes (MBAI) à expression gingivale isolée. Cette technique chirurgicale non douloureuse présente une haute efficience et une très bonne tolérance. Toutefois, des études supplémentaires sont nécessaires pour confirmer nos résultats préliminaires dont l'absence de iatrogénèse.

Summary

Background

Gingival expression of autoimmune bullous diseases (AIBD) may be inaugural, exclusive or dominant (mucous membrane pemphigoid, pemphigus vulgaris). Histology and direct immunofluorescence are essential to diagnosis. The location of the biopsy and the surgical technique determine the histological quality of the tissue sample. However, gingival tissue is often considered fragile and easily impaired during biopsy. We suggest an original biopsy protocol for the gingival papillae that is simple to perform, non-iatrogenic, and readily accessible to all practitioners who usually treat AIBD patients presenting isolated gingival expression (dermatologists, stomatologists, odontology specialists, ENT specialists).

Patients and methods

We conducted a retrospective study from 2012 to 2017 identifying all patients presenting AIBD with gingival expression for whom we performed papillary gingival biopsy for diagnostic ends. Our main objective was to determine the diagnostic efficacy and safety of this surgical technique.

Results

Over the study period, 34 papillary gingival biopsies were taken from 19 patients : 15 for histopathological examination and 19 for direct immunofluorescence. Of the 34 biopsies, only one could not be properly analyzed due to lack of epithelium and a second tissue sample was therefore necessary. No short- or long-term complications occurred during post-operative follow-up.

Conclusion

Gingival papilla biopsy is perfectly suited to the histopathological and immunohistochemical examinations needed for diagnosis of AIBD with isolated gingival expression. This surgical technique shows great efficacy and very good safety. However, additional studies are necessary to confirm our preliminary results, in particular the absence of iatrogenic effects.

Editorial board

Publication date: August–September 2018

Source: Annales de Dermatologie et de Vénéréologie, Volume 145, Issues 8–9

Author(s):

Calendrier

Publication date: August–September 2018

Source: Annales de Dermatologie et de Vénéréologie, Volume 145, Issues 8–9

Author(s):

Deux cas d’adénite cervicale à mycobactéries non tuberculeuses chez l’enfant

Publication date: August–September 2018

Source: Annales de Dermatologie et de Vénéréologie, Volume 145, Issues 8–9

Author(s): N. Sigg, S. Bailleul, J.-M. Turmel, G. Legrand, S. Kettani, L. Martin

Résumé

Introduction

L'adénite cervicale est la manifestation la plus commune des infections à mycobactéries non tuberculeuses (MNT) chez l'enfant immunocompétent. Elle est pourtant mal connue des dermatologues. Son incidence actuellement en augmentation soulève plusieurs problèmes quant à sa physiopathologie, son diagnostic et sa prise en charge.

Observations

Nous rapportons deux cas d'adénite à MNT, chez une fille de 2 ans vaccinée pour le BCG et chez un garçon de 22 mois non vacciné, dont la présentation trompeuse a entraîné un retard au diagnostic. L'évolution s'est faite vers la fistulisation et le diagnostic a été finalement posé sur des cultures de prélèvements ganglionnaires. Les délais diagnostiques étaient respectivement de 2 et 4 mois. Les enfants ont été traités par 3 semaines d'érythromycine, puis 3 semaines de clarithromycine pour la fille ; par clarithromycine d'emblée pendant 7 semaines suivies d'une excision chirurgicale complète pour le garçon.

Discussion

L'adénite à MNT concerne préférentiellement des filles de moins de 4 ans et survient plus fréquemment en hiver et au printemps. Il faut éliminer les diagnostics différentiels, notamment la tuberculose, par une radiographie pulmonaire. Le diagnostic est orienté par la clinique, une intradermo-réaction à la tuberculine (IDR) positive et la résistance aux antibiotiques classiques. Il n'est certifié que par la culture systématique ou une PCR sur prélèvement ganglionnaire avec recherche spécifique de mycobactéries atypiques. L'augmentation de l'incidence des adénites à MNT, dont les plus fréquentes appartiennent au complexe Mycobacterium avium (MAC), coïncide avec la diminution de la protection infantile par le vaccin BCG. Le traitement de référence est la prise en charge chirurgicale. Néanmoins, des traitements alternatifs (excision incomplète, antibiothérapie, abstention, etc.) sont à discuter en cas d'échec de la chirurgie ou de risque trop élevé de lésion d'une branche du nerf facial.

Conclusion

L'adénite à MNT chez l'enfant immunocompétent est une infection de plus en plus fréquente depuis l'arrêt de la vaccination par le BCG en 2007. Une meilleure connaissance de l'affection, notamment par les dermatologues, permettrait une excision chirurgicale complète à un stade précoce, avec un taux plus faible de séquelles esthétiques.

Summary

Background

Cervical lymphadenitis is the most common manifestation of infection with nontuberculous mycobacteria (NTM) in immunocompetent children. Nevertheless, it is poorly known by dermatologists. Its incidence, which is currently increasing since the cessation of BCG vaccination in 2007, raises several issues regarding its pathophysiology, diagnosis and management.

Patients and methods

We report two cases of NTM adenitis: one in a 2-year-old girl vaccinated with BCG and one in an unvaccinated 22-month-old boy, in whom a misleading presentation led to delayed diagnosis. The condition progressed to fistula formation and the diagnosis was finally made on systematic cultures of lymph node samples. The time to diagnosis was 2 and 4 months, respectively. The girl was treated with erythromycin for 3 weeks and with clarithromycin for 3 weeks; the boy received clarithromycin for 7 weeks and underwent complete surgical excision.

Discussion

NTM adenitis preferentially affects girls under 4 years and occurs more frequently in winter and spring. First, the other differential diagnoses, including tuberculosis, must be ruled out by chest radiography. The diagnosis is oriented by the clinical picture, a positive TST and resistance to conventional antibiotics. However, it is only certified by systematic culture or PCR of lymph node biopsies, with screening for atypical mycobacteria being specified. The decrease in child protection by BCG vaccination coincides with the current increase in NTM infections, of which the most frequent is Mycobacterium avium complex (MAC) for cervical adenitis. The reference treatment is surgery. However, alternative treatments (incomplete excision, antibiotics, watchful waiting, etc.) should be considered where surgery fails or there is excessive risk of injury to a branch of the facial nerve.

Conclusion

Atypical mycobacterial adenitis in immunocompetent children has become an increasingly common infection since the abandonment of BCG vaccination. Improved knowledge of this disease would result in complete surgical excision at an early stage with a lower rate of aesthetic sequelae.

Mastectomie avec reconstruction mammaire immédiate : indications et techniques, algorithme de décision d’une reconstruction immédiate

Publication date: Available online 23 August 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): F. Rimareix, B. Sarfati, N. Leymarie, H. Alkhashnam, J.F. Honart, K. Tran De Frémicourt, A. Conversano, S. Struk, J.-B. Schaff, Y. Bennis, C. Mazouni, S. Delaloge, S. Rivera, F. Kolb

Résumé

Les indications de reconstruction mammaire immédiate s'étendent aux carcinomes infiltrants, du fait de nouvelles techniques de couverture des implants par matrice et du fait du développement des lambeaux perforants. Ces techniques autorisent les traitements adjuvants. Il faut, cependant, que la décision de reconstruction immédiate soit encadrée par l'avis de la RCP oncologique et il faut aussi évaluer les bénéfices et risques au regard de la morphologie de la patiente et de ses comorbidités. Le type de mastectomie choisi : classique ou avec conservation de peau et/ou avec conservation de la plaque aréolo-mamelonnaire (PAM) dépend de la forme et du volume du sein, de la localisation de la tumeur dans le sein et par rapport à la PAM. Nous définissons un algorithme pour permettre en cas de mastectomie thérapeutique avec ou sans radiothérapie adjuvante, une reconstruction immédiate par prothèse ou lambeau libre ou pédiculé.

Summary

Immediate breast reconstruction indications extend to infiltrating carcinomas, due to new matrix implant coverage techniques and the development of perforator flaps. These techniques allow adjuvant treatments. However, the decision of immediate reconstruction must be discussed with the oncological multidisciplinary team and the benefits/risks must also be evaluated in relation to the morphology of the patients and their co-morbidities. The chosen type of mastectomy: conventional or skin sparing and/or nipple sparing depends on the shape and volume of the breast, the localization of the tumor in the breast and the distance from the nipple areola complex (NAC). We describe an algorithm to allow, in the case of therapeutic mastectomy with or without adjuvant radiotherapy, an immediate reconstruction with implants or free or pedicled flaps.

La reconstruction mammaire par TRAM

Publication date: Available online 23 August 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): B. Couturaud

Résumé

Le lambeau de grand droit de l'abdomen ou Transverse rectus abdominis musculocutaneous flap (TRAM) a été décrit pour la première fois par Hartrampf en 1982. Il consiste à prélever un lambeau musculo cutané dont la palette cutanée de plastie abdominale est centrée sur des perforantes issues des vaisseaux épigastriques supérieurs, avec pour support vasculaire le muscle grand droit de l'abdomen. Nous décrivons la technique chirurgicale pas à pas par des photos commentées sur les différents temps.

Summary

The Transverse Rectus Abominis Musculocutaneous flap or TRAM was first described by Hartrampf in 1982. It consists in raising a abdominal musculocutaneous flap whose perforators vessels come from the superior epigastric vessels. We describe the surgical technique step by step with photos commented on different times.

Algorithmes décisionnels en reconstruction mammaire immédiate

Publication date: Available online 22 August 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): B. Sarfati, F. Rimareix, J.F. Honart, H. Alkhashnam, K.T. De Frémicourt, A. Conversano, S. Struk, J.-B. Schaff, Y. Bennis, C. Mazouni, F. Kolb, N. Leymarie

Résumé

La reconstruction mammaire immédiate a montré de nombreux avantages en termes de résultats esthétiques et d'amélioration de la qualité de vie des patientes comparativement à la reconstruction mammaire secondaire. Les antécédents de radiothérapie ou la nécessité de traitement adjuvants (radiothérapie, chimiothérapie…) ne sont plus des contre-indications à la reconstruction mammaire immédiate. Il est, cependant, nécessaire de respecter certaines règles pour diminuer le risque de complications : le choix de la technique de reconstruction, la gestion de l'enveloppe cutanée en fonction de la forme du sein que l'on souhaite reconstruire, les délais entre le 1^er et le 2^e temps de reconstruction en fonction d'une éventuelle chimiothérapie ou radiothérapie adjuvante.

Summary

Immediate breast reconstruction showed many advantages in terms of aesthetic and functional results and improvement of quality of life when compared to delayed breast reconstruction. Previous radiotherapy or the use of adjuvant treatments such as radiation therapy, or chemotherapy are no longer a contraindication for immediate breast reconstruction. However, it is important to respect certain rules in order to decrease the risk of complications: the choice of reconstruction technique, the management of the skin envelope according to the breast shape you want to create, the time delay between the first and the second stage of reconstruction depending on a possible adjuvant treatment.

Leopard dermatitis of the neck—Case series of 10 patients

Contact Dermatitis, EarlyView.

Comparison of the skin sensitization potential of 3 red and 2 black tattoo inks using interleukin‐18 as a biomarker in a reconstructed human skin model

Contact Dermatitis, EarlyView.

Correction to: “Dealing with the changeable and blurry edges of living things: a modified version of property-cluster kinds”

The article "Dealing with the changeable and blurry edges of living things: a modified version of property-cluster kinds", written by María J. Ferreira Ruiz and Jon Umerez, was originally published electronically on the publisher's internet portal (currently SpringerLink) on June 29, 2018 without open access.

European position paper on drug‐induced sleep endoscopy (DISE): 2017 update

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.

Understanding the Hawthorne effect in wound research—A scoping review

International Wound Journal, EarlyView.

A confirmatory study on the efficacy of dehydrated human amnion/chorion membrane dHACM allograft in the management of diabetic foot ulcers: A prospective, multicentre, randomised, controlled study of 110 patients from 14 wound clinics

International Wound Journal, EarlyView.

Potential gains in life expectancy by eliminating deaths from cardiovascular diseases and diabetes mellitus in the working life ages among Slovak population

In recent years, high mortality from cardiovascular diseases (chronic ischemic heart disease, acute coronary syndrome, cerebrovascular diseases, atherosclerosis, hypertensive diseases) and diabetes mellitus ha...

Factors for healthcare utilization and effect of mutual health insurance on healthcare utilization in rural communities of South Achefer Woreda, North West, Ethiopia

To identify factors for healthcare utilization and to describe effect of Mutual Health Insurance on health service utilization in rural community in South Achefer, North West Ethiopia.

Regret-sensitive treatment decisions

The threshold approach to medical decision-making, in which treatment decisions are made based on whether the probability of sickness exceeds a predetermined threshold, was introduced by (Pauker and Kassirer, ...

Gelatin as a convenient surrogate protein to model the in vitro effects of advanced glycation end‐product formation

Experimental Dermatology, Volume 0, Issue ja, -Not available-.

The treatment of ingrown nail: Chemical matricectomy with NAOH versus wedge resection

Dermatologic Therapy, EarlyView.

Effect of massage therapy by VOSKIN 125+ painkiller® on inflammatory skin lesions

Dermatologic Therapy, EarlyView.

A randomized controlled clinical trial to assess the impact of motivational phone calls on therapeutic adherence in patients suffering from psoriasis

Dermatologic Therapy, EarlyView.

Complementary and integrative therapies for psoriasis: Looking forward

Dermatologic Therapy, EarlyView.

Management of complications of vitamin E injections into the face

Dermatologic Therapy, EarlyView.

Familial facial lichen planopilaris and satisfactory response to isotretinoin

Dermatologic Therapy, EarlyView.

Secukinumab reduces plasma oxidative stress in psoriasis: A case‐based experience

Dermatologic Therapy, EarlyView.

A case of microcystic lymphatic malformation successfully treated with topical sirolimus

Dermatologic Therapy, EarlyView.

Treatment of recalcitrant generalized morphea with mycophenolate mofetil and intravenous immunoglobulin

Dermatologic Therapy, EarlyView.

A case of pityriasis lichenoides: Rapid resolution with azithromycin monotherapy in 3 weeks

Dermatologic Therapy, EarlyView.

Successful treatment of multifocal pigmented basal cell carcinomas with the application of topical 5% imiquimod cream

Dermatologic Therapy, EarlyView.

Potential gains in life expectancy by eliminating deaths from cardiovascular diseases and diabetes mellitus in the working life ages among Slovak population

In recent years, high mortality from cardiovascular diseases (chronic ischemic heart disease, acute coronary syndrome, cerebrovascular diseases, atherosclerosis, hypertensive diseases) and diabetes mellitus ha...

Factors for healthcare utilization and effect of mutual health insurance on healthcare utilization in rural communities of South Achefer Woreda, North West, Ethiopia

To identify factors for healthcare utilization and to describe effect of Mutual Health Insurance on health service utilization in rural community in South Achefer, North West Ethiopia.

Systemic and stratum corneum biomarkers of severity in infant AD include markers of innate and Th‐related immunity and angiogenesis

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.

Multiple asymptomatic lesions on the lips

Clinical and Experimental Dermatology, EarlyView.

Patient education and support group for patients with cutaneous lymphoma and their caregivers

Clinical and Experimental Dermatology, EarlyView.

Cutaneous melioidosis: a review of the literature

International Journal of Dermatology, EarlyView.