Tactile sensor-based real-time clustering for tissue differentiation

Abstract

Purpose

Reliable intraoperative delineation of tumor from healthy brain tissue is essentially based on the neurosurgeon's visual aspect and tactile impression of the considered tissue, which is—due to inherent low brain consistency contrast—a challenging task. Development of an intelligent artificial intraoperative tactile perception will be a relevant task to improve the safety during surgery, especially when—as for neuroendoscopy—tactile perception will be damped or—as for surgical robotic applications—will not be a priori existent. Here, we present the enhancements and the evaluation of a tactile sensor based on the use of a piezoelectric tactile sensor.

Methods

A robotic-driven piezoelectric bimorph sensor was excited using multisine to obtain the frequency response function of the contact between the sensor and fresh ex vivo porcine tissue probes. Based on load-depth, relaxation and creep response tests, viscoelastic parameters E₁ and E₂ for the elastic moduli and η for the viscosity coefficient have been obtained allowing tissue classification. Data analysis was performed by a multivariate cluster algorithm.

Results

Cluster algorithm assigned five clusters for the assignment of white matter, basal ganglia and thalamus probes. Basal ganglia and white matter have been assigned to a common cluster, revealing a less discriminatory power for these tissue types, whereas thalamus was exclusively delineated; gray matter could even be separated in subclusters.

Conclusions

Bimorph-based, multisine-excited tactile sensors reveal a high sensitivity in ex vivo tissue-type differentiation. Although, the sensor principle has to be further evaluated, these data are promising.

Virtual downsizing for decision support in mitral valve repair

Abstract

Purpose

Various options are available for the treatment of mitral valve insufficiency, including reconstructive approaches such as annulus correction through ring implants. The correct choice of general therapy and implant is relevant for an optimal outcome. Additional to guidelines, decision support systems (DSS) can provide decision aid by means of virtual intervention planning and predictive simulations. Our approach on virtual downsizing is one of the virtual intervention tools that are part of the DSS workflow. It allows for emulating a ring implantation based on patient-specific lumen geometry and vendor-specific implants.

Methods

Our approach is fully automatic and relies on a lumen mask and an annulus contour as inputs. Both are acquired from previous DSS workflow steps. A virtual surface- and contour-based model of a vendor-specific ring design (26–40 mm) is generated. For each case, the ring geometry is positioned with respect to the original, patient-specific annulus and additional anatomical landmarks. The lumen mesh is parameterized to allow for a vertex-based deformation with respect to the user-defined annulus. Derived from post-interventional observations, specific deformation schemes are applied to atrium and ventricle and the lumen mesh is altered with respect to the ring location.

Results

For quantitative evaluation, the surface distance between the deformed lumen mesh and segmented post-operative echo lumen close to the annulus was computed for 11 datasets. The results indicate a good agreement. An arbitrary subset of six datasets was used for a qualitative evaluation of the complete lumen. Two domain experts compared the deformed lumen mesh with post-interventional echo images. All deformations were deemed plausible.

Conclusion

Our approach on virtual downsizing allows for an automatic creation of plausible lumen deformations. As it takes only a few seconds to generate results, it can be added to a virtual intervention toolset without unnecessarily increasing the pipeline complexity.

Real-time dual-modal vein imaging system

Abstract

Purpose

In this paper, we present a vein imaging system to combine reflectance mode visible spectrum images (VIS) with transmission mode near-infrared (NIR) images in real time. Clear vessel localization is achieved in this manner with combined NIR–VIS dual-modal imaging.

Methods

Transmission and reflectance mode optical instrumentation is used to combine VIS and NIR images. Two methods of displaying the combined images are demonstrated here. We have conducted experiments to determine the system's resolution, alignment accuracy, and depth penetration. Vein counts were taken from the hands of test subjects using the system and compared with vein counts taken by visual analysis.

Results

Results indicate that the system can improve vein detection in the human hand while detecting veins of a diameter < 0.5 mm at any working distance and of a 0.25 mm diameter at an optimal working distance of about 30 cm. The system has also been demonstrated to clearly detect silicone vessels with artificial blood of diameter 2, 1, and 0.5 mm diameter under a tissue depth of 3 mm. In a study involving 25 human subjects, we have demonstrated that vein visibility was significantly increased using our system.

Conclusions

The results indicate that the device is a high-resolution solution to near-surface venous imaging. This technology can be applied for IV placement, morphological analysis for disease state detection, and biometric analysis.

Conditions for reliable grip force and jaw angle estimation of da Vinci surgical tools

Abstract

Purpose

This work presents an estimation technique as well as corresponding conditions which are necessary to produce an accurate estimate of grip force and jaw angle on a da Vinci surgical tool using back-end sensors alone.

Methods

This work utilizes an artificial neural network as the regression estimator on a dataset acquired from custom hardware on the proximal and distal ends. Through a series of experiments, we test the effect of estimation accuracy due to change in operating frequency, using the opposite jaw, and using different tools. A case study is then presented comparing our estimation technique with direct measurements of material response curves on two synthetic tissue surrogates.

Results

We establish the following criteria as necessary to produce an accurate estimate: operate within training frequency bounds, use the same side jaw, and use the same tool. Under these criteria, an average root mean square error of 1.04 mN m in grip force and 0.17 degrees in jaw angle is achieved. Additionally, applying these criteria in the case study resulted in direct measurements which fell within the 95% confidence bands of our estimation technique.

Conclusion

Our estimation technique, along with important training criteria, is presented herein to further improve the literature pertaining to grip force estimation. We propose the training criteria to begin establishing bounds on the applicability of estimation techniques used for grip force estimation for eventual translation into clinical practice.

A robust method for segmenting pectoral muscle in mediolateral oblique (MLO) mammograms

Abstract

Purpose

Accurately detecting and removing pectoral muscle areas depicting on mediolateral oblique (MLO) view mammograms are an important step to develop a computer-aided detection scheme to assess global mammographic density or tissue patterns. This study aims to develop and test a new fully automated, accurate and robust method for segmenting pectoral muscle in MLO mammograms.

Methods

The new method includes the following steps. First, a small rectangular region in the top-left corner of the MLO mammogram which may contain pectoral muscle is captured and enhanced by the fractional differential method. Next, an improved iterative threshold method is applied to segment a rough binary boundary of the pectoral muscle in the small region. Then, a rough contour is fitted with the least squares method on the basis of points of the rough boundary. Last, the fitting contour is subjected to local active contour evolution to obtain the final pectoral muscle segmentation line. The method has been tested on 720 MLO mammograms.

Results

The segmentation results generated using the new scheme were evaluated by two expert mammographic radiologists using a 5-scale rating system. More than 65% were rated above scale 3. When assessing the segmentation results generated using Hough transform, morphologic thresholding methods and Unet-based model, less than 20%, 35% and 47% of segmentation results were rated above scale 3 by two radiologists, respectively. Quantitative data analysis results show that the Dice coefficient of 0.986 ± 0.005 is obtained. In addition, the mean rate of errors and Hausdorff distance between the contours detected by automated and manual segmentation are FP = 1.71 ± 3.82%, FN = 5.20 ± 3.94% and 2.75 ± 1.39 mm separately.

Conclusion

The proposed method can be used to segment the pectoral muscle in MLO mammograms with higher accuracy and robustness.

Detecting drug-resistant tuberculosis in chest radiographs

Abstract

Purpose

Tuberculosis is a major global health threat claiming millions of lives each year. While the total number of tuberculosis cases has been decreasing over the last years, the rise of drug-resistant tuberculosis has reduced the chance of controlling the disease. The purpose is to implement a timely diagnosis of drug-resistant tuberculosis, which is essential to administering adequate treatment regimens and stopping the further transmission of drug-resistant tuberculosis.

Methods

A main tool for diagnosing tuberculosis is the conventional chest X-ray. We are investigating the possibility of discriminating automatically between drug-resistant and drug-sensitive tuberculosis in chest X-rays by means of image analysis and machine learning methods.

Results

For discriminating between drug-sensitive and drug-resistant tuberculosis, we achieve an area under the receiver operating characteristic curve (AUC) of up to 66%, using an artificial neural network in combination with a set of shape and texture features. We did not observe any significant difference in the results when including follow-up X-rays for each patient.

Conclusion

Our results suggest that a chest X-ray contains information about the likelihood of a drug-resistant tuberculosis infection, which can be exploited computationally. We therefore suggest to repeat the experiments of our pilot study on a larger set of chest X-rays.

Molecular isolation and characterization of the kisspeptin system, KISS and GPR54 genes in roach Rutilus rutilus —

Abstract

The reproduction of vertebrates is regulated by endocrine and neuro-endocrine signaling molecules acting along the brain-pituitary-gonad (BPG) axis. The understanding of the neuroendocrine role played in reproductive function has been recently revolutionized since the KiSS1/GPR54 (KiSS1r) system was discovered in 2003 in human and mice. Kisspeptins, neuropeptides that are encoded by the KiSS genes, have been recognized as essential in the regulation of the gonadotropic axis. They have been shown to play key roles in puberty onset and reproduction by regulating the gonadotropin secretion in mammals while physiological roles in vertebrates are still poorly known. In order to provide new knowledge on basic reproductive physiology in fish as well as new tools to assess impacts of endocrine disrupting compounds (EDCs), the neurotransmitter system, i.e., gene/receptor, KISS/GPR54 might constitute an appropriate biomarker. This study provides new understandings on the neuroendocrine regulation of roach reproduction as well as new molecular tools to be used as biomarkers of endocrine disruption. This work completes the set of biomarkers already validated in this species.

Expansion of myeloid-derived suppressor cells in the peripheral blood and lesional skin of cutaneous lupus patients

Chitosan nanoparticles from Artemia salina inhibit progression of hepatocellular carcinoma in vitro and in vivo

Abstract

This study was conducted to evaluate the effect of chitosan nanoparticles (CNPs) isolated from Artemia salina against hepatocellular carcinoma (HCC) both in vitro (HepG2) and in vivo (diethylnitrosamine-induced HCC in rats) and to investigate the involved underlying mechanisms. Administration of CNPs decreased HCC progression as evidenced by (1) induced HepG2 cell death as detected by MTT assay; (2) induced necrosis as indicated by acridine orange/propidium iodide (AO/PI) red staining, annexin V/7-AAD positive staining (detected by flow cytometry), and upregulated expression of necrosis markers (PARP1 and its downstream target, RIP1 genes), but no effect on apoptosis as revealed by insignificant changes in caspase 3 activity and mRNA levels of Bax and AIF; (3) increased intracellular ROS and decreased mitochondrial membrane potential in HepG2; (4) decreased liver relative weight, serum levels of liver enzymes (ALT, AST, and ALP), total bilirubin, and cancer markers (AFP and GGT), number and area of GST-P positive tumor nodules; and (5) reduced oxidative stress (decrease in MDA levels) and increased activities of SOD, CAT, and GPx enzymes in rat liver. The preventive (pre-treatment) effect of CNPs was better than the therapeutic (post-treatment) effect. Collectively, administration of CNPs inhibited HCC progression in vitro and in vivo, possibly through induction of necrosis, rather than apoptosis, and induction of antioxidant enzyme activities in vivo, but with stimulation of ROS production in vitro. Thus, CNPs could be used as a promise agent for treating HCC after application of further confirmatory clinical trials.

Large International Validation of ABSIS and PDAI Pemphigus Severity Scores

The Pemphigus Disease Area Index (PDAI) and Autoimmune Bullous Skin Disorder Intensity-Score (ABSIS) scores have been proposed to provide an objective measure of pemphigus activity. These scores have been evaluated only on already treated patients mainly with mild to moderate activity. The objective was to assess the interrater reliability of ABSIS and PDAI scores and their correlation with other severity markers in a large international study.Consecutive patients with newly diagnosed pemphigus were enrolled in 31 centers.

Adsorption of ibuprofen using cysteine-modified silane-coated magnetic nanomaterial

Abstract

Industrialization and growth of the pharmaceutical companies have been a boon to the mankind in our day to day life in myriad ways. However, due to the uninhibited release of these active pharmaceutical compounds into the water systems has caused detrimental effects to the genetic pool. In this study, l-cysteine-modified 3-glycidyloxypropyltrimethoxysilane-coated magnetic nanomaterial showed a maximum removal of the efficiency of 82.90% for the nanomaterial dosage of 30 mg at an initial concentration of 50 mg L⁻¹ at pH 6.0. Further, the nanomaterial showed reusability efficiency up to 80% for three cycles. The adsorption kinetics follow the pseudo-second-order reaction and the adsorption isotherm model best fits the Langmuir isotherm proving the adsorption process to be a monolayer sorption on a monolayer surface. This magnetic nanomaterial could serve as a promising tool for the removal of pharmaceutical compounds from aqueous solutions.

Graphical abstract

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Modelling as decision support for the localisation of submarine urban wastewater outfall: Venice lagoon (Italy) as a case study

Abstract

Microbiological impact is critical in coastal areas where tourism is particularly important for both the local and regional economy. Submarine outfalls are commonly used to enhance the dispersion of treated sewage thus avoiding pollution along the coast. The Venice lagoon (North Italy) has a very sensitive ecosystem, due to the morphological and natural characteristics of the basin and the co-existence of human activities. To preserve the lagoon, the discharge from the treatment plant for urban wastewater collected from the Venezia-Mestre agglomeration, neighbouring areas and local industries (total of 400,000 population equivalent—PE) has been moved from the lagoon to the open Adriatic Sea since November 2013 by means of an approximately 20-km pipeline. Microbiological pollution inside the lagoon can affect shellfish breeding areas instead, along the coast it affects the quality of bathing waters. In this study, and for the first time, a 3D hydrodynamic SHYFEM model (shallow water finite element model) with high spatial resolution coupled with a microbiological module has been applied to the lagoon and to the Adriatic Sea, to evaluate the effectiveness of the location of the submarine outfall. Microbiological data have been produced by the control Authority according to official analytic methods and by the plant operator. The module of survival of free Escherichia coli follows a variable rate in dependence of UV radiation, temperature and salinity in the water. Two scenarios were modelled: final discharge into the lagoon before November 2013 and after into the open sea. In the latter case, two situations have been considered, one with "Bora" and the other with "Scirocco" winds. Our results indicate that the model correctly simulates microbiological decay and dispersion. The transferral of the final discharge point far from the shoreline improves pollution dispersion, thus preserving the lagoon without evidence of impacts on the bathing waters in all meteorological conditions.

Non-malignant and malignant meningioma incidence and survival in the elderly from 2005–2015 using the Central Brain Tumor Registry of the United States

Abstract

Background

Meningioma incidence increases significantly with age. In the expanding elderly population, we lack complete understanding of population-based trends in meningioma incidence/survival. We provide an updated, comprehensive analysis of meningioma incidence and survival for individuals aged over 65.

Methods

Data were obtained from the Central Brain Tumor Registry of the United States (CBTRUS) from 2005–2015 for non-malignant and malignant meningioma. Age-adjusted incidence rates per 100,000 person-years were analyzed by age, sex, race, ethnicity, location, and treatment modalities. Survival was analyzed using Kaplan-Meier and multivariable Cox proportional hazards models for a subset of CBTRUS data.

Results

Non-malignant meningioma incidence doubled from adults age 65–69 years to adults over age 85 years and was significantly greater in females than males for all ages. Malignant meningioma incidence did not differ by sex for any age grouping. Non-malignant and malignant meningioma incidence was significantly greater in Black populations versus others. Non-malignant meningioma survival was worse with age, in Black populations, and in males, including when analyzed by five-year age groups. Surgical resection and radiation did not improve survival compared to resection alone in non-malignant meningioma.

Conclusions

This study reports increasing non-malignant meningioma incidence in the elderly, increased incidence in Black populations, and in females. In contrast, malignant meningioma incidence did not differ between sexes. Risk of death was higher for Black individuals and males. Additionally, radiation did not confer a survival advantage when combined with resection for non-malignant meningioma. Thus, we identify clinically relevant discrepancies in meningioma incidence/survival that require further study.

Œdème palpébral induit par le pemetrexed (Alminta®)

Publication date: Available online 5 October 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): A. Badaoui, E. Mahé

Résumé

Introduction

Les œdèmes palpébraux induits par les médicaments sont rares. Nous rapportons une observation de patient ayant développé ce type d'œdème sous chimiothérapie.

Observation

Un homme de 56 ans consultait pour un œdème bilatéral des paupières inférieures apparu 6 mois plus tôt, après trois cycles de pemetrexed-carboplatine prescrits pour un adénocarcinome bronchique avec métastases cérébrales. L'œdème, indolore et non prurigineux, était de consistance molle et s'aggravait progressivement. En l'absence d'autre cause, le diagnostic d'œdèmes dus au pemetrexed était retenu. Compte tenu de son efficacité, et avec l'accord du patient, ce traitement était néanmoins maintenu.

Discussion

Les œdèmes palpébraux secondaires aux injections de pemetrexed sont rares ; à ce jour, seuls 22 cas en ont été rapportés dans la littérature. Il convient donc d'éliminer tous les diagnostics différentiels avant de conclure à ce diagnostic. La physiopathologie est inconnue. Certains auteurs avancent une hypothèse identique aux œdèmes sous docetaxel : fuite capillaire protéique entraînant des œdèmes cutanés et sous-cutanés et des épanchements non tumoraux. D'autres traitements tels que des inhibiteurs de tyrosine kinase (imatinib et nilotinib) ou des inhibiteurs de mTOR (sirolimus) peuvent également induire des œdèmes palpébraux. Un cas d'excision chirurgicale des tissus palpébraux lymphœdémateux a été décrit, avec un bon résultat à 6 mois de suivi.

Summary

Background

Drug-induced eyelid edemas are rare. Herein, we describe a patient who developed this type of edema under chemotherapy.

Patients and methods

A 56-year-old male patient with a history of hypertension and adenocarcinoma of the lung with brain metastases consulted for incipient non-itchy eyelid edema with progressive worsening. The swelling occurred after 3 cycles of pemetrexed-carboplatin. There was no evidence of any other cause of edema. A diagnosis of pemetrexed-induced eyelid edema was made. Given the efficacy of this treatment and the patient's consent thereto, it was maintained.

Discussion

Palpebral edemas secondary to pemetrexed are very rare, with only 22 published cases in the literature. Other differential diagnoses must be ruled out before considering this etiology. The pathogenesis of eyelid edema remains unknown. One hypothesis is capillary protein leakage inducing swelling in soft tissue and non-malignant effusion, as has been suggested for docetaxel. Other agents such as tyrosine kinase inhibitors (imatinib and nilotinib) and mTOR inhibitors (sirolimus) may also cause eyelid edema. Treatment of eyelid edema is difficult and one case of surgical treatment has been published with good results and no recurrence after 6 months.

Relaxation processes accompanying electron stabilization in the quinone acceptor part of Rb. sphaeroides reaction centers

Publication date: Available online 5 October 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): P.P. Knox, E.P. Lukashev, V.V. Gorokhov, N.Kh. Seifullina, V.Z. Paschenko

Abstract

The temperature dependence of the dark recombination rate in photooxidized bacteriochlorophyll (P) and photoreduced quinone acceptors (ubiquinones) Q_A and Q_B of photosynthetic reaction centers of purple bacteria Rhodobacter sphaeroides (Rb. sphaeroides) was studied. Photoinduced changes in the absorption were detected in the Q_x absorption band of photooxidized bacteriochlorophyll at 600 nm and in the bands corresponding to the redox changes of ubiquinones at 335 and 420–450 nm. Kinetic analysis was used to evaluate the activation energy and the characteristic time of the transient process of relaxation accompanying electron stabilization at the final quinone acceptor. A comparative study of the kinetics of oxidation-reduction reactions of photoactive bacteriochlorophyll RC purple bacteria and quinone acceptors in their individual absorption bands is an informative approach to studying the mechanisms of this stabilization. The analysis of the revealed kinetic differences makes it possible to estimate the activation energy and the characteristic times of the transition relaxation processes associated with the stabilization of the electron in the quinone acceptor part of RC. Purple bacterial reaction centers have fundamental similarities with PSII reaction centers. Such a similarity represents evolutional closeness between the two types of RC. So it is possible that the photoinduced charge separation in PSII RC, as well as in purple bacteria RC, is also accompanied by definite conformational changes. The possible role of hydrogen bonds of surrounding protein in the relaxation processes accompanying the electron transfer to quinone acceptors is discussed.

Topical formulation containing Ilex Paraguariensis extract increases metalloproteinases and myeloperoxidase activities in mice exposed to UVB radiation

Publication date: Available online 5 October 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Camila Helena Ferreira Cuelho, Georgia de Assis Dias Alves, Marina Ortiz Lovatto, Iuri França Bonilha, Fernanda Barbisan, Ivana Beatrice Manica da Cruz, Sara Marchesan Oliveira, Roselei Fachinetto, Gizele Scotti do Canto, Melânia Palermo Manfron

Abstract

Ultraviolet B radiation represents 10% of the total UV radiation that reaches the Earth's surface, being the primary responsible for the biological effects related to skin cancer and photoaging. Ilex Paraguariensis A. St. Hil., known as Yerba mate (YM), is a native tree of South America whose polyphenols in its leaves are described to exhibit photochemoprotective effect and are employed in the treatment of cancer. Additionally, the polyphenols are used to prevent lipid peroxidation and reduce the UV-induced damage, which ultimately decreases the oxidative stress. Thus, the present study aimed to characterize a new YM extract, evaluate the extract cytotoxicity and develop a formulation containing YM extract to prevent UVB-induced damage in mice skin. The YM extract showed high levels of polyphenols, flavonoids, and tannins and exhibited excellent antioxidant activity. Its main components were suggested as chlorogenic acid (1.92%) and caffeic acid (0.41%). Besides, YM extract did not exhibit cytotoxicity in fibroblasts and decreased the activity of myeloperoxidase and metalloproteinase-2 after acute UVB exposure. As a result, the formulation containing the YM extract showed a potential photochemoprotective.

Relative efficacy of systemic treatments for atopic dermatitis

Publication date: Available online 6 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Edward W. Seger, Todd Wechter, Lindsay Strowd, Steven R. Feldman

Abstract

Background

Systemic medications are often required for severe atopic dermatitis (AD) refractory to topical therapies. Biologic medications are a recent advancement in the field and a comparison to traditional systemic approaches would be beneficial.

Objective

To compare efficacies of systemic therapies for the treatment of AD

Methods

A systematic literature review was performed using Medline, Ovid and Embase. Randomized controlled trials looking at the efficacy of systemic treatments for AD in adults and children were included.

Results

A total of 41 studies met criteria and were included in our final analysis. Consistent improvements in Eczema Area and Severity Index (EASI) and Scoring Atopic Dermatitis (SCORAD) were reported with dupilumab and cyclosporine. Phase 2 clinical trials for lebrikizumab and tralokinumab were effective and would benefit from Phase 3 trials. No study reported efficacy of biologic medications in pediatric patients, however cyclosporine improved clinical severity by the greatest amount in this group.

Limitations

A lack of well controlled comparison studies make direct comparisons between the treatments difficult.

Conclusion

For treatment of severe AD, the strongest evidence currently exists for dupilumab and cyclosporine at improving clinical disease severity. Further research is required to determine long term safety and efficacy of biologic medications.

Predictors of mucosal melanoma survival in a population-based setting

Publication date: Available online 5 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Lisa Altieri, Megan Eguchi, David H. Peng, Myles Cockburn

Abstract

Background

Mucosal melanomas are rare and aggressive neoplasms, with little published population-based data on predictors of survival.

Objective

To assess the influences of race/ethnicity, sex, tumor stage, tumor thickness, and anatomic site on mucosal melanoma survival estimates.

Methods

We analyzed 132,751 cases of melanoma, including 1,824 mucosal melanomas, diagnosed between 1994 and 2015 and reported to the California Cancer Registry. Kaplan-Meier survival analysis and Cox proportional hazards regression assessed the prognostic variables.

Results

The 5-year relative survival for mucosal melanomas (27.64%, 95% confidence interval [CI] 25.42 – 29.91) was significantly lower than for cutaneous melanomas (76.28%, 95% CI 76.03 – 76.53). Stage independently influenced survival, and thickness did not predict survival for neoplasms of known depth. Less common anatomic sites conferred worse prognoses (hazard ratio [HR] 1.93, 95% CI: 1.41 – 2.64).

Limitations

Lack of a standardized staging system may have resulted in misclassification of stage for some neoplasms. The influence of genetics is unknown because our database did not contain genetic characteristics.

Conclusions

Stage and anatomic site, but not thickness (i.e. Breslow depth), race, or ethnicity, determine prognosis of mucosal melanomas. Considering the poor prognosis for all stages of mucosal melanoma, dermatologists should incorporate examination of the oropharynx and genitalia in the full body skin exam.

Approaches to limit systemic antibiotic use in acne: Systemic alternatives, emerging topical therapies, dietary modification, and laser and light-based treatments

Publication date: Available online 5 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): John S. Barbieri, Natalie Spaccarelli, David J. Margolis, William D. James

Abstract

Acne is one of the most common diseases worldwide and affects approximately 50 million individuals in the United States. Oral antibiotics are the most common systemic agent prescribed for the treatment of acne. However, their use may be associated with a variety of adverse outcomes including bacterial resistance and disruption of the microbiome. As a result, multiple treatment guidelines call for limiting the use of oral antibiotics in the treatment of acne, although actual prescribing often does not follow these guidelines. In this review, the rationale for concerns regarding the use of oral antibiotics for the management of acne is reviewed. In addition, we will discuss our approach to complying with the intent of the guidelines, with a focus on novel topical agents, dietary modification, laser and light-based modalities, and systemic medications such as spironolactone, combined oral contraceptives, and oral isotretinoin.

Comparative Clinicopathological Analysis of Cutaneous Peripheral T-cell lymphoma, Not Otherwise Specified, According to Primary Tumor Site

Publication date: Available online 5 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Mi Hye Lee, Myoung Eun Choi, Chong Hyun Won, Sung Eun Chang, Mi Woo Lee, Jee Ho Choi, Woo Jin Lee

Dipeptidyl-peptidase IV inhibitor-associated bullous pemphigoid: A systematic review and meta-analysis

Publication date: Available online 5 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Khalaf Kridin, Arnon D. Cohen

Future considerations for clinical dermatology in the setting of 21st century American policy reform: corporatization and the rise of private equity in dermatology

Publication date: Available online 5 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Sailesh Konda, Joseph Francis, Kiran Motaparthi, Jane M. Grant-Kels, Group for Research of Corporatization and Private Equity in Dermatology

Abstract

Within the last two decades, for-profit financial groups have become increasingly involved in health care. Outlier dermatology practices with high volumes of well-reimbursed procedures are attractive to consolidation backed by private equity. With fewer choices for independent or group private practice, junior dermatologists are increasingly seeking employment without ownership in private equity-backed corporate groups, whose primary fiscal responsibility lies with investors. Medicare's response to corporatization and consolidation has already changed the practice of dermatopathology. Dermatologists should be aware of this history, given the ability of corporations and private equity groups to shape the present and future of our field.

The use of topical rapamycin in the treatment of superficial lymphatic malformations

Publication date: Available online 5 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Pablo García Montero, Javier del Boz, Eulalia Baselga Torres, José Manuel Azaña Defez, Manuel Alcaraz Vera, Jesús Tercedor Sánchez, Lucero Noguera Morel, Ángel Vera Casaño

Abstract

Background

The superficial lymphatic component of vascular malformations poses a significant treatment challenge. It is responsible for the majority of symptoms presented and to date there is no consensus regarding treatment.

Objective

To evaluate the effectiveness of topical rapamycin in treating superficial lymphatic malformations (LM).

Methods

A case series study was performed of patients with superficial LM, treated with topical rapamycin. The clinical characteristics of the patients and the concentration and application mode of the drug were recorded. The changes in the signs and symptoms observed, and associated adverse effects, were then noted and analysed.

Results

The study population consisted of 11 patients, average age 10.5 years. All were treated with topical rapamycin, in six cases at 1%, in one at 0.8% and in four at 0.4%. Changes in the clinical appearance of the lesions were observed in all patients. The associated symptoms, present in 9 of the 11 patients, improved in every case. The mean follow-up time was 16.1 months.

Limitations

This study is retrospective, with a small sample size and considerable heterogeneity of lesions and treatment approaches.

Conclusions

Treatment with topical rapamycin modifies the clinical appearance and alleviates the symptoms of superficial LM.

Surgical Pearl: Achieving Eversion Utilizing Topical Tissue Adhesive

Publication date: Available online 5 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Marjon Vatanchi, Shang I Brian Jiang

Co-occurrence of infantile hemangiomas and other birthmarks

Publication date: Available online 5 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Brooke Hanson, Logan G. Spector, Christina Boull, Ingrid Polcari, Kristen Hook, Sheilagh Maguiness

Analysis of cutaneous Merkel Cell Carcinoma outcomes after different surgical interventions

Publication date: Available online 5 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Lu Yan, Ledong Sun, Zhiguang Guan, Shanshan Wei, Yanru Wang, Pengfei Li

Background

Current guidelines recommend local excision margin (EM) with 1 to 2cm on primary merkel cell carcinoma (MCC) site.

Objective

We compared survival outcomes of MCC patients treated with different surgical interventions.

Methods

A retrospective analysis of MCC cases in the SEER database was performed by Kaplan-Meier, competing risk and Cox proportional hazards regression model analyses. Influence of age, T stage, AJCC stage, adjuvant radiotherapy and other subgroups were also analyzed by pair-wise log-rank test.

Results

Our results indicated significant association between local destruction method and inferior survival, while EM>2cm showed significantly higher overall survival (OS). In addition, competing risk analysis depicted similar trend as Kaplan-Meier analysis, and considerably reduced estimated cumulative incidence. Further subgroup pair-wise analysis demonstrated that EM>2cm method had better survival in patients younger than 60 years, having smaller tumor diameters (T1 and T2) or undergone adjuvant radiotherapy (p<0.05). In contrast, different EMs did not show any significant association with survival rate in patients older than 75 years or stage III tumors.

Limitations

This study was not prospectively randomized without relapse data.

Conclusions

It is challenging to make optimal EM recommendations, as surgical options may depend on individual case situations. Further prospective randomized studies are warranted.

Allergen Extracts for In Vivo Diagnosis and Treatment of Allergy: Is There a Future?

Publication date: Available online 5 October 2018

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

Author(s): Rudolf Valenta, Alexander Karaulov, Verena Niederberger, Yury Zhernov, Olga Elisyutina, Raffaela Campana, Margarete Focke-Tejkl, Mirela Curin, Leyla Namazova-Baranova, Jiu-Yao Wang, Ruby Pawankar, Musa Khaitov

Today, in vivo allergy diagnosis and allergen-specific immunotherapy (AIT) are still based on allergen extracts obtained from natural allergen sources. Several studies analyzing the composition of natural allergen extracts have shown severe problems regarding their quality such as the presence of undefined nonallergenic materials, contaminants as well as high variabilities regarding contents and biological activity of individual allergens. Despite the increasing availability of sophisticated analytical technologies, these problems cannot be overcome because they are inherent to allergen sources and methods of extract production. For in vitro allergy diagnosis problems related to natural allergen extracts have been largely overcome by the implementation of recombinant allergen molecules that are defined regarding purity and biological activity. However, no such advances have been made for allergen preparations to be used in vivo for diagnosis and therapy. No clinical studies have been performed for allergen extracts available for in vivo allergy diagnosis that document safety, sensitivity, and specificity of the products. Only for very few therapeutic allergen extracts state-of-the-art clinical studies have been performed that provide evidence for safety and efficacy. In this article, we discuss problems related to the inconsistent quality of products based on natural allergen extracts and share our observations that most of the products available for in vivo diagnosis and AIT do not meet the international standards for medicinal products. We argue that a replacement of natural allergen extracts by defined recombinantly produced allergen molecules and/or mixtures thereof may be the only way to guarantee the supply of clinicians with state-of-the-art medicinal products for in vivo diagnosis and treatment of allergic patients in the future.

Development of novel sericin and alginate-based biosorbents for precious metal removal from wastewater

Abstract

In this study, two novel low water-soluble sericin and alginate-based biosorbents were successfully developed for precious metal removal from wastewater: sericin and alginate particles chemically crosslinked by proantocyanidins (SAPAs) and sericin, alginate and polyvinyl alcohol particles (SAPVA). The proportions of proantocynidins (PAs) or polyvinyl alcohol (PVA) added to sericin (2.5% w/v) and alginate (2.0% w/v) blend were 0.5, 1.5, 2.5 and 3.5% w/v. Among these concentrations, particles produced with 0.5% w/v of PVA or 2.5% w/v of PAs presented the lowest water solubility percentages (3.74 ± 0.05 and 3.56 ± 0.21%, respectively) and the following metallic affinity order: AuCl₄⁻ > PdCl₄²⁻ > PtCl₆²⁻ > Ag⁺. Then, gold biosorption kinetics by SAPAs was evaluated at three gold initial concentrations (72.88, 187.12, and 273.79 mg/L), and its performance was compared to activated carbon adsorbent uptake. The data modeling revealed that the process follows pseudo-first-order kinetics and is mainly controlled by external diffusion. SAPAs before and after gold biosorption (SAPAs-gold) were characterized by scanning electron microscopy coupled with energy dispersive X-ray spectroscopy, optical microscopy, helium pycnometry, mercury porosimetry, N₂ physisorption, and Fourier-transform infrared spectroscopy.

Hailey‐Hailey disease successfully treated with vitamin D oral supplementation

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

Nilotinib induction of melanogenesis via reactive oxygen species‐dependent JNK activation in B16F0 mouse melanoma cells

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

Brimonidine displays anti‐inflammatory properties in the skin through the modulation of the vascular barrier function

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

Long‐term efficacy of novel therapies in moderate‐to‐severe plaque psoriasis: a systematic review and network meta‐analysis of PASI response

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.

Position Statement – Linear Prurigo is a Subtype of Chronic Prurigo

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.

Insuline resistance, mTOR and Hidradenitis suppurativa

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.

Acute localised exanthematous pustulosis due to metronidazole

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.

mTORC1 at the crossroad of metabolism and immunity in hidradenitis suppurativa

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.

The value of dermoscopy in diagnosing eyebrow loss in patients alopecia areata and frontal fibrosing alopecia

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.

Impact of face proportions on face attractiveness

Journal of Cosmetic Dermatology, EarlyView.

Clinical evaluation of the lightening effect of cytidine on hyperpigmented skin

Journal of Cosmetic Dermatology, EarlyView.

Use of a novel 589‐nm solid‐state laser for treatment of facial erythema

Journal of Cosmetic Dermatology, EarlyView.

Undifferentiated Pleomorphic Sarcoma Metastatic to the Orbit

Undifferentiated pleomorphic sarcoma is a malignancy of mesenchymal origin, which was previously known as malignant fibrous histiocytoma. It is known to occur on rare occasion as a primary orbital tumor, but no known cases of metastatic orbital involvement have been reported since 2002, when the reclassification of these tumors took place. The authors report a patient who presented with a metastasis to the left orbit 2 years after undergoing treatment of a high-grade undifferentiated pleomorphic sarcoma of the right thigh. Histopathology of the orbital mass was similar to the primary tumor biopsy prior to neoadjuvant chemotherapy and radiation. The appearance was markedly altered in the subsequent excisional tissue, which showed treatment changes. Immunohistochemistry and genetic testing also supported the metastatic nature of the orbital lesion. The patient's tumor progressed rapidly despite systemic targeted therapy and orbital exenteration was performed. At 2 years follow up, the patient remained without evidence of tumor recurrence in the socket. Accepted for publication August 15, 2018. The authors have no relevant financial interests. Corresponding author: Raymond I. Cho, MD, FACS Work: 614-293-8116; Fax: 614-293-5315 E-mail: raymond.cho@osumc.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Low-Flow Orbital Venous Malformation Masquerading as Rhabdomyosarcoma

A 15-month-old male was referred for biopsy of presumed rhabdomyosarcoma in the setting of rapidly progressing left-sided proptosis. Examination revealed left periorbital edema and left hypoglobus. MRI revealed a soft-tissue density mass within the left lateral retrobulbar space. Several days later, he developed acute periorbital ecchymosis and increasing edema. With high suspicion for a vascular lesion, a CT scan was performed with dynamic arterial and venous imaging. Central filling was noted in the lateral retrobulbar component with increased enhancement on delayed venous imaging in the middle cranial fossa component favoring the diagnosis of a low-flow orbital venous malformation. In the setting of spontaneous orbital hemorrhage and risk of future vision loss, the decision was made to proceed with a combined neurosurgical approach treating the intracranial component and debulking the orbital component. This case highlights the importance of thorough radiographic evaluation prior to proceeding with a surgical procedure in the appropriate clinical context. Accepted for publication August 7, 2018. The authors have no financial or conflicts of interest to disclose. Presented at the American Society of Ophthalmic Plastic & Reconstructive Surgery Conference, June 24, 2017 Vancouver BC, Canada. Address correspondence and reprint requests to Michael Kazim, M.D., Edward S. Harkness Eye Institute, 635 West 165th Street, New York, NY 10032. E-mail: mk48@cumc.columbia.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) Versus Standard of Care for Postsurgical Lagophthalmos and Exposure Keratopathy: Trends in Visual Outcomes

Purpose: To compare baseline characteristics and visual acuity outcomes in patients treated with prosthetic replacement of the ocular surface ecosystem (PROSE) versus other standard-of-care (SOC) treatments for postsurgical lagophthalmos and exposure keratopathy. Methods: An institutional review board–approved, retrospective cohort study of 45 consecutive patients (53 eyes) with postsurgical lagophthalmos and exposure keratopathy following oculoplastic or skull base surgeries treated between August 2011 and August 2017 was performed. Patients treated with PROSE (22 patients, 27 eyes) were identified by referrals made to the PROSE treatment program at Weill Cornell Medical College. Patients treated with SOC treatments (23 patients, 26 eyes) were identified by International Classification of Diseases-9 and International Classification of Diseases-10 search of billing records. SOC treatments included ocular surface lubrication (artificial tears and/or punctal plugs), tape tarsorrhaphy and/or moisture chamber, or surgical correction. The primary outcome measure was best-corrected visual acuity converted to logMAR at baseline and at 1, 3, 6, and 12 months. Secondary outcome measures were subjective patient reports of improvement in vision and comfort, as well as presence of punctate epithelial erosions and/or corneal haze on slit-lamp examination before and after treatment. Results: Average age for all patients was 52 ± 22 years (range: 7–87). Twenty-eight (62%) of total patients were male. Baseline corrected logMAR visual acuity was 0.58 ± 0.40 (20/76) for PROSE and 0.27 ± 0.39 (20/37) for SOC cohorts (p

A prediction tool for hospital‐acquired pressure ulcers among surgical patients: Surgical pressure ulcer risk score

International Wound Journal, EarlyView.

Serum amyloid A levels in the blood of patients with atopic dermatitis and cutaneous T‐cell lymphoma

The Journal of Dermatology, EarlyView.

Prediction of therapeutic response before and during i.v. cyclophosphamide pulse therapy for interstitial lung disease in systemic sclerosis: A longitudinal observational study

The Journal of Dermatology, EarlyView.