Decoupling between sulfate reduction and the anaerobic oxidation of methane in the shallow methane seep of the Black sea

ABSTRACT

Methane seepages are widespread in the Black Sea. However, microbiological research has been carried out only at the continental shelf seeps. The present work dealt with coastal gas seepages of the Kalamit Bay (Black Sea). High-throughput 16S rRNA gene sequencing and radiotracer analysis (¹⁴С and ³⁵S) were used to determine the composition of the microbial community and the rates of microbial sulfate reduction and methane oxidation. The phylum Proteobacteria, represented mainly by sulfate reducers of the class Deltaproteobacteria, was the predominant in sequence dataset. Bacteroidetes and Planctomycetes were other numerous phyla. Among archaea, the phylum Woesearchaeota and Marine Benthic Group B were predominant in the upper horizons. Relative abundance of Euryarchaeota of the families Methanomicrobiaceae and Methanosarcinaceae (including ANME-3 archaea) increased in deeper sediment layers. Sulfate reduction rate (up to 2.9 mmol/L × day) was considerably higher than the rate of anaerobic methane oxidation (up to 43.4 μmol/L × day), which indicated insignificant contribution of anaerobic methane oxidation to the total sulfide production.

Volatile phenols are produced by strains of Dekkera bruxellensis under Brazilian fuel ethanol industry-like conditions

ABSTRACT

Dekkera bruxellensis is a spoilage yeast in wine and fuel ethanol fermentations able to produce volatile phenols from hydroxycinnamic acids by the action of the enzymes cinnamate decarboxylase (CD) and vinyphenol reductase (VR) in wine. However, there is no information about this ability in the bioethanol industry. This work evaluated CD and VR activities and 4-ethylphenol production from p-coumaric acid by three strains of D. bruxellensis and PE-2, an industrial Saccharomyces cerevisiae strain. Single and multiple-cycle batch fermentations in molasses and sugarcane juice were carried out. Dekkera bruxellensis strains showed similar CD activity but differences in VR activity. No production of 4-ethylphenol by S. cerevisiae in any fermentation system or media was observed. The concentrations of 4-ethylphenol peaked during active growth of D. bruxellensis in single-cycle fermentation but they were lower than in multiple-cycle fermentation. Higher concentrations were observed in molasses with molar conversion (p-coumaric acid to 4-ethylphenol) ranging from 45% to 85%. As the first report on 4-ethylphenol production in sugarcane musts by D. bruxellensis in industry-like conditions, it opens up a new avenue to investigate its effect on the viability and fermentative capacity of S. cerevisiae as well as to understand the interaction between the yeasts in the bioethanol industry.

Late Onset Complications Secondary to Polyacrylamide Hydrogel-Based Filler for Rehabilitation of HIV-Related Facial Lipoatropy

In 2015 we reported our experience of a 5-year follow-up study regarding the utilization of polyacrylamide hydrogel-based filler for rehabilitation of HIV-related facial lipoatropy.¹ The outcomes of this study confirmed the safety and efficacy of this noninvasive treatment as already stated in an earlier report of 18-month follow-up period for that study population.²

The Launch of ASJ Open Forum Brings Changes to ASJ

I am pleased to announce that Aesthetic Surgery Journal Open Forum will launch in early 2019 and I am taking the opportunity to explain the effect this will have on the Aesthetic Surgery Journal (ASJ).

Congenital Oculonasal Synkinesis: Botulinum Toxin A in the Treatment of a Pure Facial Synkinesis

Oculonasal synkinesis (ONS) refers to involuntary contractions of the orbicularis oculi and the compressor narium minor muscles (CNMM). In this phenomenon, blinking triggers simultaneous depression of alar complex. The etiology of congenital type ONS is unknown and has not been investigated in depth. Anomalous connections between zygomatic and buccal branches of the facial nerve are attributed to the etiology.^1,2

Filler Rhinoplasty: Evidence, Outcomes, and Complications

Rhinoplasty is one of the most popular facial aesthetic procedures but also one of the most technically challenging, with revision rates after surgical rhinoplasty ranging from 5% to 20%.¹ The popularity of nonsurgical alternatives has been steadily increasing, especially that of injectable filler rhinoplasty using hyaluronic acid (HA), which offers reduced financial and anaesthetic impact, immediate aesthetic results, and rapid recovery.² This is often demonstrated on video posts on social media platforms, which show immediate postprocedure results but often no further follow-up.³ Although fillers are predominantly used for aesthetic rhinoplasty, the technique has also been utilized to address functional issues including internal valve collapse.⁴

Tele-Interview in the Aesthetic Fellowship Selection Process

Aesthetic surgery fellowships traditionally select applicants for an in-person interview in the facility where the fellowship will occur. Most fellowship applicants are preselected by evaluation of the application package, which includes medical school and residency records, a personal statement, and letters of recommendation.

A treatise on topical corticosteroids in dermatology. Use, misuse and abuse

Debabrata Bandyopadhyay

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):761-762

Histoid leprosy presenting with figurate lesions: A unique and rare presentation

Angoori Gnaneshwar Rao, Amit Kolli, Syeda Saba Farheen, Uday Deshmukh Reddy, Aparna Karanam, Kranthi Jagadevapuram, Ruhi Haqqani

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):736-739

N-acetylcysteine in dermatology

Mohammad Adil, Syed Suhail Amin, Mohd Mohtashim

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):652-659

N-acetylcysteine is a mucolytic drug which is commonly used as an antidote for acetaminophen toxicity. It is a thiol compound, which acts as a donor of cysteine, leading to replenishment of glutathione and thus acts as an antioxidant. It also has anti-inflammatory effects, alters the levels of neurotransmitters, inhibits proliferation of fibroblasts and keratinocytes and causes vasodilatation. Due to these actions, n-acetylcysteine has found use in several dermatologic conditions in systemic and topical form. The drug has been used as an adjuvant in the management of conditions such as toxic epidermal necrolysis, drug hypersensitivity syndrome, trichotillomania, skin picking disorders and onychotillomania, ichthyoses, contact dermatitis, atopic dermatitis, melasma, pseudoporphyria, connective tissue diseases, wound healing and alopecia. It also has a role in protection from radiation-induced skin damage including photo-ageing, photocarcinogenesis and radiation dermatitis. Most indications in dermatology are supported by case reports, small case series and small trials. Higher quality of evidence is needed for its wider use. The drug is cheap and is generally safe with few adverse effects. Thus a greater role is possible for use of n-acetylcysteine in various skin conditions. This review explores the various uses of n-acetylcysteine in the field of dermatology, the evidence supporting the same, the possible mechanisms of action and the adverse effects of the drug.

Differential expression of capecitabine-induced hand foot syndrome on paretic limb

Tapaswini Tripathy, Bhabani STP Singh, Debasmita Behera, Bikash Ranjan Kar

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):720-722

18F-fluorodeoxyglucose positron emission tomography-based evaluation of systemic and vascular inflammation and assessment of the effect of systemic treatment on inflammation in patients with moderate-to-severe psoriasis: A randomized placebo-controlled pilot study

Sharonjeet Kaur, Nusrat Shafiq, Sunil Dogra, BR Mittal, Savita Verma Attri, Ajay Bahl, Tarun Narang, Keshavamurthy Vinay, Sujit Rajagopalan, Samir Malhotra

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):660-666

Background: Psoriasis is a systemic inflammatory disorder associated with an increased risk of cardiovascular disease. Objective: To evaluate the utility of [[18]F]-fluorodeoxyglucose positron emission tomography/computed tomography in identifying vascular and systemic inflammation in psoriasis patients with moderate-to-severe disease and to analyze its usefulness in assessing the effect of systemic treatment. Methods: This was a randomized, double-blind pilot study conducted in a tertiary care center. Baseline standardized uptake value score was estimated by18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with moderate-to-severe psoriasis and compared with historical controls. Patients were then randomized using computer-generated randomization list into methotrexate or placebo (with or without pioglitazone) groups.18F-fluorodeoxyglucose positron emission tomography/computed tomography was repeated at 12 weeks and composite standardized uptake value score determined. The correlation between Psoriasis Activity and Severity Index and SUVmax was assessed. Results: A total of 16 patients were randomized to different treatment groups. Significant increase in mean SUVmax was observed in the ascending aorta in psoriasis patients as compared to historical controls (2.03 ± 0.53 vs 1.51 ± 0.36, P < 0.03). There was no difference in composite standardized uptake value score after 12 weeks of treatment in any of the treatment groups (P = 0.82), although an improvement in Psoriasis Activity and Severity Index score in the methotrexate arm was observed. No correlation was found between mean SUVmax and Psoriasis Activity and Severity Index scores in various aortic segments (r = 0.3–0.7). Limitations: Small sample size, short follow-up, historical controls, exclusion of patients with comorbid conditions and lack of surrogate markers of systemic inflammation. Conclusion: 18F-fluorodeoxyglucose positron emission tomography imaging showed higher vascular inflammation in ascending aorta of psoriasis patients as compared to historical controls. Systemic treatment with methotrexate and pioglitazone did not influence the vascular inflammation in the short term.

Four views of trichomycosis axillaris: Clinical, Wood's lamp, dermoscopy and microscopy

Vishal Gupta, Vinod Kumar Sharma

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):748-749

A study of prevalence of autoantibodies in patients with lichen planus from Mumbai, India

Kinjal Deepak Rambhia, Vidya Kharkar, Vandana Pradhan, Manisha Patwardhan, Kanjaksha Ghosh, Uday S Khopkar

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):667-671

Background: Lichen planus is a common chronically relapsing autoimmune skin condition with poorly understood etiology. Apart from cellular immunity, presence of various antibodies has been hypothesized. Various studies have found the presence of serum anti-nuclear antibody, anti-mitochondrial antibody, anti-desmoglein 1 and 3 antibodies, anti-keratinocyte antibody and anti-thyroglobulin antibody in patients of cutaneous and oral lichen planus. Aim: To study the prevalence of autoantibodies and the clinical spectrum of disease in an Indian patient subpopulation with lichen planus. Methods: A cross-sectional epidemiological study comprising 100 lichen planus patients was conducted in the dermatology outpatient department of Seth G.S Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India. Serum concentrations of circulating anti-nuclear antibodies, anti-desmoglein 1 antibody, anti-desmoglein 3 antibody, anti-keratinocyte antibodies, anti-mitochondrial antibodies and anti-thyroglobulin antibodies were determined by indirect immunofluorescence. Pairs of groups were compared using "Student's t-test" for normally distributed continuous data. The "χ2-test" was used for the categorical variables as needed. Statistical significance was set at P < 0.05. Results: It was found that 65 (65%) patients showed the presence of at least one of the six autoantibodies that we studied, while 35 (35%) tested negative for all six of them. Positivity of anti-keratinocyte antibody in 26 (26%), anti-nuclear antibody in 22 (22%), anti-desmoglein 1 antibody in 19 (19%), anti-desmoglein 3 antibody in 16 (16%), anti-mitochondrial antibody in 9 (9%) and anti-thyroglobulin antibody in 6 (6%) patients was detected. It was observed that 55 (71.4%) patients of cutaneous lichen planus, 6 (46.1%) patients of mucosal lichen planus and 4 (40%) patients of cutaneous and mucosal lichen planus overlap showed presence of at least one autoantibody. Conclusion: This study provides the serological parameters of a population of lichen planus from western India. Presence of autoantibodies in lichen planus suggests the possible role of humoral immunity in lichen planus. Identifying antibodies linked to lichen planus may help in identifying suitable diagnostic tests and therapeutic targets. Well-controlled studies with larger sample size are the need of the hour to confirm the role of humoral immunity in lichen planus. Limitations: Studies with a larger number of patients as well as controls should be undertaken to further evaluate the role of autoantibodies in lichen planus.

Medical journalism and social media: A boon and a bane?

Saumya Panda

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):647-651

Proposed global drooping and wrinkles classification and scoring system for aging face with validation and experience on 54 Indian subjects

Suruchi Garg, Nishat Khan, Shyamkumar Makadia

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):672-677

Background: Aging is an inevitable biological change, but understanding the process of aging of face is important to customize the treatment options for facial rejuvenation. Evidence-based estimation of global facial aging is necessary for the validation of various treatment modalities. Aims: Classification and implementation of a scoring system for aging face based upon volume loss and surface changes as evident by drooping of different areas of the face and appearance of fine and deep wrinkles, respectively, and to apply this drooping–wrinkles classification on 54 participants to evaluate and understand the validity of scoring. Methods: An observational study was conducted, and scores were calculated based on 13 parameters (7 areas of drooping and 6 areas of wrinkles on the face) at Aura Skin Institute, Chandigarh, India. Accordingly, age was divided in different age groups followed by clinical estimation of facial age and calculation of scores. Results: According to our classification and scoring system, 61% (33 out of 54) of the participants were correlated with their chronological age group. Out of the remaining 21 (39%) participants who were aging faster, 13 (24%) were in the age group of 25–35 years. Approximately one-fourth of the patients in the age groups 36–45 and 46–55 years were aging faster. Only 1 patient had scores showing younger age in comparison to chronological age. Overall, there was a good correlation between the calculated score and the chronological age of patients. Moreover, a gradual increase in scores was noticed with increasing age groups. Conclusions: This is a new clinical classification and scoring system for facial age which is much easier to apply in daily clinical practice for easy calculation of baseline scores and customizing their antiaging treatment options. Moreover, it will also make it easier to compare the efficacy of treatment in their future follow-ups. The limitation of this study is that it has been proposed for all skin types but validation has been done only for Indian participants.

Dermatoscopy of multiple piloleiomyomas with disseminated and segmental distribution

Mirjana Popadić, Dimitrije Brasanac, Mirjana Milinković, Danijela Milčić

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):726-729

A prospective study of the epidemiological and clinical patterns of recurrent dermatophytosis at a tertiary care hospital in India

Sucheta Pathania, Shivaparkash M Rudramurthy, Tarun Narang, Uma N Saikia, Sunil Dogra

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):678-684

Background: Recurrent and clinically unresponsive dermatophytosis is being increasingly encountered in our country. It runs a protracted course with exacerbations and remissions. However, there is little information regarding the extent of the problem and the characteristics of recurrent dermatophytosis in published literature. Aims: We sought to determine the prevalence, risk factors and clinical patterns of recurrent dermatophytosis in our institution. We also investigated the causative dermatophyte species and antifungal susceptibility patterns in these species. Methods: One hundred and fifty patients with recurrent dermatophytosis attending the outpatient department of the Postgraduate Institute of Medical Education and Research, Chandigarh, India were enrolled in the study conducted from January 2015 to December 2015. A detailed history was obtained in all patients, who were then subjected to a clinical examination and investigations including a wet preparation for direct microscopic examination, fungal culture and antifungal susceptibility tests. Results: Recurrent dermatophytosis was seen in 9.3% of all patients with dermatophytosis in our study. Trichophyton mentagrophytes was the most common species identified (36 patients, 40%) samples followed by T. rubrum (29 patients, 32.2%). In-vitro antifungal susceptibility testing showed that the range of minimum inhibitory concentrations (MIC) on was lowest for itraconazole (0.015–1), followed by terbinafine (0.015–16), fluconazole (0.03–32) and griseofulvin (0.5–128) in increasing order. Limitation: A limitation of this study was the absence of a suitable control group (eg. patients with first episode of typical tinea). Conclusion: Recurrence of dermatophytosis was not explainable on the basis of a high (MIC) alone. Misuse of topical corticosteroids, a high number of familial contacts, poor compliance to treatment over periods of years, and various host factors, seem to have all contributed to this outbreak of dermatophytosis in India.

Congenital alopecia of eyebrow

Deepak Jakhar, Chander Grover

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):743-744

Acral angioosteoma cutis: A rare case

Senay Erdogan-Durmus, Selver Ozekinci, Enver Yarikkaya, Nurhan Erzurumluoglu

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):685-686

Acral angioosteoma cutis is a rare and benign cutaneous lesion clinically characterized by an exophytic growth resembling pyogenic granuloma on the acral skin; first described in 2006. Its pathogenesis is still unclear while well-formed capillaries, pale stroma, bland fibroblast-like cells, and multiple tiny spicules of woven bone constitute the histological hallmarks. Here, we present a case of acral angioosteoma cutis in a 34-year-old man to increase awareness regarding this rare condition.

Transepidermal elimination: Historical evolution, pathogenesis and nosology

Hiral Shah, Anup Kumar Tiwary, Piyush Kumar

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):753-757

Bilateral “turkey ear” as a cutaneous manifestation of lupus vulgaris

Yingjie Lu, Hongmiao Wang, Hua Zheng, Xiao Li

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):687-689

Lupus vulgaris is a common form of cutaneous tuberculosis in China, mostly involving the head and neck region. Turkey ear is a clinically descriptive term, used for a massively enlarged earlobe with bluish-red or violaceous indurated plaques and nodules, which can be a sign of lupus vulgaris. A 47-year-old female presented with edema and reddish ulcerated lesions on both ears which was diagnosed as lupus vulgaris by conventional laboratory investigations and the patient showed good response to antituberculous therapy. Occurrence of turkey ears in lupus pernio (sarcoidosis) should also be mentioned here as this presentation was originally described in this condition. Two case reports of turkey ear have been reported with cutaneous tuberculosis (not bilateral). However, occurrence of bilateral turkey ears in cutaneous tuberculosis has not been described so far in the literature.

Reversible twisted and rolled hairs due to manual twisting: Two case reports

Di-Qing Luo, Juan-Hua Liu, Rashmi Sarkar, Yu-Kun Zhao, Fang Wang, Hui-Hui Wu

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):763-763

Revisiting the role of the slit-skin smear in the diagnosis of Indian post-kala-azar dermal leishmaniasis

Aradhana Bhargava, V Ramesh, Sandeep Verma, Poonam Salotra, Manju Bala

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):690-695

Background: Post kala azar dermal leishmaniasis (PKDL) is a neglected dermatosis that develops as a sequel to kala azar after apparent complete treatment. Being a non life threatening condition, patients often delay treatment thereby maintaining a reservoir of infection. The diagnosis of PKDL rests on the demonstration of the parasite in tissue smears, immune diagnosis by detection of parasite antigen or antibody in blood, or detection and quantitation of parasite DNA in tissue specimens. Sophisticated molecular tests are not only expensive but also need skilled hands and expensive equipment. To be useful, diagnostic methods must be accurate, simple and affordable for the population for which they are intended. Aims: This study was designed to assess functionality and operational feasibility of slit-skin smear examination. Methods: Sensitivity and specificity was evaluated by performing slit-skin smear and histo-pathological examination in 46 PKDL patients and the results were compared with the parasite load in both the slit aspirate and tissue biopsy specimens by performing quantitative Real-time PCR (Q-PCR). Results: The slit-skin smear examination was more sensitive than tissue biopsy microscopy. The parasite loads significantly differed among various types of clinical lesions (P < 0.05). The threshold of parasite load for detection by SSS microscopy was 4 parasites/μl in slit aspirate and 60 parasites/μg tissue DNA in tissue biopsy while that for tissue microscopy was 63 parasites/μl and 502 parasites/μg tissue DNA respectively. As detection of Leishmania donovani bodies may be challenging in inexperienced hands, the microscopic structure of these has been detailed along with a comprehensive discussion of pre analytical, analytical and post analytical variables affecting its identification. To facilitate the diagnosis of PKDL, some scenarios have been suggested taking into consideration the clinical, epidemiological, immunological and microscopic aspects. Conclusion: Such evidence based medicine helps minimize intuition, systematize clinical experience and provides a diagnostic rationale as sufficient grounds for a clinical decision.

Adverse cutaneous events after laser epilation in patients with photodermatosis

Laura Cubells Sánchez, Blanca Ferrer Guillén, José Luis Sánchez Carazo, Amparo Pérez Ferriols

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):718-720

Study of the relation between two common cyclooxygenase 2 gene polymorphisms with risk of developing and subtypes of vitiligo in Egyptian patients

Samar Abdallah M Salem, Dalia Gamal Aly, Khalda Sayed Amr, Mahmound Fawzy Abdel-Hamid

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):696-700

Background/Purpose: Genetic factors play an important role in the pathogenesis of vitiligo. Cyclooxygenase 2 (COX2) gene induced by ultraviolet radiation controls the synthesis of prostaglandins, which are are found to be beneficial in treating vitiligo. COX2 gene polymorphism has been previously evaluated in Chinese population. We aimed to study the relation between two common COX2 gene polymorphisms with vitiligo and its subtypes amongEgyptian patients. Patients and Methods: This study included 200 participants (100 vitiligo patients and 100 healthy controls). COX2-765G/C and -1195A/G gene polymorphism was studied by restriction fragment length polymorphism polymerase chain reaction analysis and the results were compared between the two groups and among different subtypes of vitiligo. Results: Frequency of COX2-1195 AA, AG, GG genotypes showed no significant association among patients with vitiligo (P = 0.626, 0.321, 0.08, respectively); those with generalized vitiligo (P = 0.739, 0.291, 0.101, respectively) and those with segmental vitiligo (P = 0.410, 1.00, 0.676, respectively) compared to the control group. Regarding COX2-765G/C genotypes, GG genotype was more frequent among patients with vitiligo [84 (84%)] compared to controls [63 (63%)] (P = 0.001). GC genotype was significantly less frequent [15 (15%)] among patients compared to controls [32 (32%)] (P = 0.005). Generalized and segmental types of vitiligo also showed no significant difference in the frequency of COX2-765G/C genotypes compared with controls. Limitations: Being a pilot study, a relatively small number of participants were included. Conclusion: COX2-1195A/G gene polymorphism is not associated with the risk of developing vitiligo or with vitiligo subtypes. COX2-765 GG genotype is associated with vitiligo, especially of the generalized type.

Docetaxel induced pellagroid dematitis

Preema Sinha, Aradhana Sood, Sukriti Baveja, Vikas Pathania

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):723-725

Endoscopic Management of Subperiosteal Orbital Abscesses

While the progression of acute rhinosinusitis to orbital infections has decreased in the modern antibiotic era, they still occur, particularly in the pediatric population. Infection may spread from the nasal cavity and sinuses via direct extension into the orbit through the thin lamina papyracea or through the valveless veins in the bony orbital wall.1 Congenital dehiscence and trauma also allow for direct extension of the infection to the orbit.1 Most of these orbital infections originate in the ethmoid sinuses and subperiosteal abscesses most commonly occur along the medial orbital wall.

Increasing Frequency and Share of Dermatologic Procedures Billed by Non-Physician Clinicians from 2012-2016

Review of Human Hair Follicle Biology: Dynamics of Niches and Stem Cell Regulation for Possible Therapeutic Hair Stimulation for Plastic Surgeons

Abstract

Plastic surgeons are frequently asked to manage male- and female-pattern hair loss in their practice. This article discusses the epidemiology, pathophysiology, and current management of androgenetic alopecia and emphasizes more recent knowledge of stem cell niches in hair follicles that drive hair cycling, alopecia, and its treatment. The many treatment programs available for hair loss include newer strategies that involve the usage of growth factors, platelet-rich plasma, and fat to stimulate follicle growth. Future research may clarify novel biomolecular mechanisms that target specific cells that promote hair regeneration.

Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The Persistent Signal from Television Viewing in Childhood on Overweight and Obesity Throughout the Life Course

Abstract

Few studies address the association between television (TV) viewing in childhood and overweight/obesity across the life course. Among 30,921 mother-daughter dyads from the Nurses' Mothers' Cohort (2001) and the Nurses' Health Study II (1989 and 1991), the following information was collected: daughter's TV viewing and physical activity (PA) at ages 3─5 and 5─10, somatotype at ages 5 and 10, and body mass index at age 18 and in adulthood (ages 26─45). Using multivariable-adjusted logistic regression models, TV viewing for ≥4 hours/day versus no TV at ages 3─5 was associated with odds ratios of overweight/obesity of 1.61 (95% confidence interval (CI): 1.20, 2.17) at age 5, 1.46 (95% CI: 1.14, 1.86) at age 10, 1.31 (95% CI: 1.00, 1.70) at age 18 and 1.32 (95% CI: 1.10, 1.59) in adulthood. A composite variable of high TV/low PA versus low TV/high PA at ages 3─5 was associated with odds ratios of overweight/obesity ranging from 3.22 (95% CI: 2.23, 4.65) at age 5 to 1.82 (95% CI: 1.36, 2.45) in adulthood. Similar findings appeared when the exposures were assessed at ages 5─10. Long hours of TV viewing in childhood alone and in combination with low PA were consistently associated with overweight/obesity throughout life.

Misclassification in Assessment of First Trimester In-Utero Exposure to Drugs used Proximally to Conception - The Example of Letrozole Utilization for Infertility Treatment

Abstract

Letrozole is an aromatase inhibitor with an unapproved use for ovulation induction with infertility. Because of the proximity of this use to conception, we selected letrozole to explore the effect of imperfect estimation in the pregnancy start on misclassification in measurement of first-trimester exposure. Using electronic health data from the United States Sentinel database (2001-2015), we identified live-birth pregnancies conceived through in-vitro fertilization or intrauterine insemination. The pregnancy start was calculated using 1) a validated algorithm to estimate the last menstrual period (LMP), 2) LMP+14 days (i.e. conception estimate), and 3) the fertility procedure date. We identified 47,628 live-births after intrauterine insemination (n=24,962) and in-vitro fertilization (n=22,666), 2,458 (5.3%) of which received letrozole. The algorithm-based conception estimate occurred within ±14 days of the fertility procedure for 78.3% of pregnancies. Defining pregnancy start as LMP (45.7/1000 pregnancies) or LMP+14 days (12.7/1000 pregnancies) overestimated letrozole exposure during pregnancy by 8.4-fold and 2.3-fold, respectively, compared to the fertility procedure (5.5/1000 pregnancies). While most pregnancy utilization studies use LMP as the conventional pregnancy start, this introduced substantial exposure misclassification in the example of letrozole. LMP+14 was less biased. Researchers should carefully consider the impact of pregnancy start date selection on potential for exposure misclassification.

Chirurgische Therapie im Stadium I und II des nichtkleinzelligen Lungenkarzinoms

Zusammenfassung

Hintergrund

In den vergangenen Jahrzehnten hat sich die Prognose des Lungenkarzinoms trotz moderner Diagnostik und multimodaler Therapiestrategien kaum verbessert. Ein großer Anteil der Patienten mit einem nichtkleinzelligen Lungenkarzinom (NSCLC; 57 %) haben zum Zeitpunkt der Diagnose Fernmetastasen und nur etwa 40 % der Patienten sind in einem potenziell operablen Tumorstadium.

Material und Methoden

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed sowie eigenen Erfahrungen zum Thema des Artikels.

Ergebnisse

Für Patienten in einem frühen Tumorstadium, Stadium I und II nach der Klassifikation der Tumorstadien in der 8. Ausgabe der Union for International Cancer Control (UICC), ist die chirurgische anatomische Tumorresektion in Kombination mit einer systematischen mediastinalen und hilären Lymphknotendissektion das Therapieverfahren der Wahl. Mit dem klassischen Resektionsverfahren der Lobektomie (Bilobektomie, Pneumonektomie) in Verbindung mit einer systematischen Lymphadenektomie lassen sich Fünfjahresüberlebensraten von über 80 % im Frühstadium IA bzw. 48 % im Stadium II erzielen. Neben der offenen chirurgischen Resektion konnten weltweit minimal-invasive, videoassistierte thorakoskopische Resektionsverfahren (VATS, „video-assisted thoracic surgery") im Stadium I und II erfolgreich etabliert werden. Im Stadium II kann eine adjuvante Chemotherapie das Überleben positiv beeinflussen.

Diskussion

Ob zielgerichtete Krebstherapien (sog. „targeted therapies") oder eine Immuntherapie im neoadjuvanten oder adjuvanten Therapiekonzept beim NSCLC im Frühstadium das Überleben der Patienten verbessern, wird momentan in Studien untersucht.

Staphylococcus aureus alpha toxin activates Notch in vascular cells

Abstract

Staphylococcus aureus infection is one of the leading causes of morbidity in hospitalized patients in the United States, an effect compounded by increasing antibiotic resistance. The secreted agent hemolysin alpha toxin (Hla) requires the receptor A Disintegrin And Metalloproteinase domain-containing protein 10 (ADAM10) to mediate its toxic effects. We hypothesized that these effects are in part regulated by Notch signaling, for which ADAM10 activation is essential. Notch proteins function in developmental and pathological angiogenesis via the modulation of key pathways in endothelial and perivascular cells. Thus, we hypothesized that Hla would activate Notch in vascular cells. Human umbilical vein endothelial cells were treated with recombinant Hla (rHla), Hla-H35L (genetically inactivated Hla), or Hank's solution (HBSS), and probed by different methods. Luciferase assays showed that Hla (0.01 µg/mL) increased Notch activation by 1.75 ± 0.5-fold as compared to HBSS controls (p < 0.05), whereas Hla-H35L had no effect. Immunocytochemistry and Western blotting confirmed these findings and revealed that ADAM10 and γ-secretase are required for Notch activation after inhibitor and siRNA assays. Retinal EC in mice engineered to express yellow fluorescent protein (YFP) upon Notch activation demonstrated significantly greater YFP intensity after Hla injection than controls. Aortic rings from Notch reporter mice embedded in matrix and incubated with rHla or Hla-H35L demonstrate increased Notch activation occurs at tip cells during sprouting. These mice also had higher skin YFP intensity and area of expression after subcutaneous inoculation of S. aureus expressing Hla than a strain lacking Hla in both EC and pericytes assessed by microscopy. Human liver displayed strikingly higher Notch expression in EC and pericytes during S. aureus infection by immunohistochemistry than tissues from uninfected patients. In sum, our results demonstrate that the S. aureus toxin Hla can potently activate Notch in vascular cells, an effect which may contribute to the pathobiology of infection with this microorganism.

Appropriateness of the institute certification system for esophageal surgeries by the Japan Esophageal Society: evaluation of survival outcomes using data from the National Database of Hospital-Based Cancer Registries in Japan

Abstract

Background

Since 2013, The Japan Esophageal Society has been certifying "Authorized Institute for Board Certified Esophageal Surgeon (AIBCES)" to contribute to improving national medical care by enhancing the professional knowledge and skills of esophageal surgeons. However, the appropriateness on this certification system has not yet been verified. Our aim was to assess the appropriateness of the institute certification system for esophageal surgeries used by the medical society.

Methods

Using data from the National Database of Hospital-based Cancer Registries, we analyzed the 5-year overall survival rates among 2135 patients with thoracic esophageal cancer who underwent an esophagectomy at 53 AIBCES or 141 non-AIBCES.

Results

There were 1343 (63%) patients who underwent surgery at an AIBCES and 792 (37%) who underwent surgery at a non-AIBCES. Registered patients were followed up for a median of 53 (range 1–88) months. Over the followed-up period examined, 670 (50%) patients treated at an AIBCES died and 455 (57%) treated at a non-AIBCES died. Comparison of the Kaplan–Meier survival curves indicated that patients with cStage II or cStage III disease treated at an AIBCES had significantly better 5-year survival rates than those treated at a non-AIBCES (55.4% vs. 44.9% and 38.0% vs. 30.3%, respectively). Univariate and multivariate analyses stratified based on stages and adjuvant therapies revealed that institute certification (AIBCES vs. non-AIBCES) is a significant independent factor for 5-year survival.

Conclusions

The institute certification system used by the Japan Esophageal Society may be appropriate, as indicated by improved 5-year survival outcomes. The institute certification system has the potential to contribute to a more appropriate medical delivery system in the future.

Enzymes in the Seafood Industry: Time for Health Studies with High-Quality Exposure Assessment

Enzymes are biocatalysts that increase the rate of most reactions within cells and are crucial for the function of humans and other living creatures. In addition, the use of enzymes in industry and everyday products largely of bacterial or fungal origin has increased in recent years. Food and beverages, detergent, perfume, pharmaceutical, textile, and chemical industries are increasingly using enzymes to improve fragrance, taste, and flavour (Budnik et al., 2017). A classic example is improver enzymes such as α-amylase, routinely added to accelerate, modify, and control dough making (Jones et al., 2016). Although the detrimental effects of these added active or inactive enzymes on the development of allergy and respiratory health are recognized (Baur, 2005; Jones et al., 2016), detailed exposure characterization and data to conduct dose–response relations for enzymes are lacking with the exception of a few agents such as α-amylase (Houba et al., 1996).

Comment on “Validation of the diagnosis of mesothelioma and BAP1 protein expression in a cohort of asbestos textile workers from Northern Italy”

Sexuell übertragbare Infektionen in den Tropen

Zusammenfassung

Sexuell übertragbare Infektionen (STI) sind weltweit häufig; allein die Inzidenz für Chlamydien-Infektionen, Gonorrhö, Syphilis und Trichomoniasis wird auf 500 Mio. Fälle/Jahr geschätzt. Drei Viertel dieser Infektionen entfallen auf tropische Länder in Lateinamerika, Subsahara-Afrika sowie Süd- bzw. Südostasien. Unter „tropischen Geschlechtskrankheiten" werden die bakteriellen Infektionen Ulcus molle, Lymphogranuloma venereum und Granuloma inguinale zusammengefasst. Diese treten vornehmlich in den Ländern zwischen den Wendekreisen auf – Regionen, die zum einen durch ein feucht-heißes Klima, zum anderen vielfach durch Armut und Unterentwicklung gekennzeichnet sind. Die 3 Erkrankungen gehen primär mit Ulzera einher; ihr Vorliegen stellt daher ein erhöhtes Risiko für die Übertragung von HIV und anderen STI dar. Wie bei allen STI gilt auch für die Tropeninfektionen, dass Risikominimierung durch Verzicht auf riskante Sexualpraktiken und Kondombenutzung essenziell sind.

Supratotal Resection in Glioma: A Systematic Review

Abstract

Background

Emerging evidence suggests survival benefit from resection beyond all MRI abnormalities present on T1-enhanced and T2-FLAIR modalities in glioma (supratotal resection); however, the quality of evidence is unclear. We addressed this question via systematic review of the literature.

Methods

EMBASE, MEDLINE, Scopus, and Web of Science databases were queried. Case studies, reviews or editorials, non-English, abstract-only, brain metastases, and descriptive works were excluded. All others were included.

Results

309 unique references yielded 41 studies for full-text review, with 7 included in the final analysis. Studies were mostly of Oxford Center for Evidence-Based Medicine Level 4 quality. A total of 88 patients underwent supratotal resection in a combined cohort of 492 patients (214 males and 278 females, age 18 to 82 years). Fifty-one supratotal resections were conducted on high-grade gliomas, and 37 on low-grade gliomas. Karnofsky Performance Status, overall survival, progression-free survival, neurological deficits post-operatively, and anaplastic transformation were the main measured outcomes. No randomized controlled trials were identified. Preliminary low-quality support was found for supratotal resection in increasing overall survival and progression-free survival for both low-grade and high-grade glioma.

Conclusions

The literature suggests insufficient evidence for carte blanche application of supratotal resection, particularly in lower grade gliomas where neurological deficits can result in long-term disability. While the preliminary studies discussed here, containing data from only a few centers, have reported increased progression-free and overall survival, these claims require validation in prospective research studies involving larger patient populations with clearly defined appropriate outcome metrics in order to reduce potential bias.

Indeterminate dendritic cell neoplasm accompanied by eosinophilic pneumonia successfully treated by systemic steroid therapy: Report of the first case with muscular and parotid involvement and review of published work

The Journal of Dermatology, EarlyView.

Japanese familial anetoderma: A report of two cases and review of the published work

The Journal of Dermatology, EarlyView.

Extracellular proteoglycan decorin maintains human hair follicle stem cells

The Journal of Dermatology, EarlyView.

Cutaneous phaeohyphomycosis caused by Microsphaeropsis arundinis in a Japanese patient with cardiac sarcoidosis

The Journal of Dermatology, EarlyView.

Monitoring treatment response in patients affected by actinic keratosis: dermoscopic assessment and metalloproteinases evaluation after piroxicam 0.8% and sunfilter cream

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

Host MyD88 signaling protects against acute graft‐versus‐host disease after allogeneic bone marrow transplantation

Clinical &Experimental Immunology, EarlyView.

Pretarsal roll augmentation with dermal hyaluronic acid filler injection

Abstract

Pretarsal roll augmentation with dermal hyaluronic acid filler injection focuses on restoring pretarsal fullness. This study aimed to introduce a method of pretarsal roll augmentation with dermal hyaluronic acid filler injection and establish the level of difficulty, safety, and effectiveness of this method. Eighty female patients were enrolled in this study. Hyaluronic acid filler was used to perform pretarsal roll augmentation. Physician and patient satisfaction at 1 month and 4 months after surgery was investigated. The level of satisfaction was graded from points 1 to 5. The patient satisfaction and physician scores were 4.7 ± 1.1 (mean ± standard deviation) points at 1 month and 4.8 ± 0.9 points at 4 months and 4.6 ± 0.9 points at 1 month and 4.8 ± 1.0 points at 4 months, respectively. No major complications were observed. Our technique provided a natural and younger appearance with pretarsal fullness. This technique was easy to perform for the restoration of pretarsal fullness, and it improved periorbital contouring, rejuvenated the pretarsal roll, and provided excellent esthetic results.

Level of Evidence: Level V, therapeutic study.

Long‐term efficacy and safety of ixekizumab in Japanese patients with erythrodermic or generalized pustular psoriasis: Subgroup analyses of an open‐label, phase 3 study (UNCOVER‐J)

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

Association between psoriasis, psoriatic arthritis and gout: A nationwide population‐based study

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

Systemic corticosteroid use in psoriasis: a national survey of board‐certified dermatologists

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

Picosecond laser for atrophic surgical scars treatment: in vivo monitoring of results by means of reflectance confocal microscopy

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

Initial results of ixekizumab efficacy and safety in real‐world plaque psoriasis patients: A multicenter retrospective study

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

Socket Reconstruction With Bleomycin, Gentamicin, and Gelatin Sponges Following Eyelid-Sparing Orbital Exenteration for a Colobomatous Macrocyst in an Infant

Microphthalmia is defined by a globe axial length greater than or equal to 2 standard deviations below the age-adjusted mean and can occur as part of a broader syndrome. The presence of a colobomatous cyst with microphthalmia signifies failure of the embryonic neuroectodermal fissure to close appropriately during development of the globe, creating a protuberant globular appendage that inhibits normal growth and development of the eye itself. Cystic reaccumulation of fluid is common after aspiration or surgical removal. Here, the authors describe a case of a young boy with a colobomatous cyst who underwent eyelid-sparing orbital exenteration followed by reconstruction with absorbable gelatin sponge (Gelfoam, Pfizer, Inc.) and the chemotherapeutic agent bleomycin to promote scarring, achieving the equivalent of a biointegrated implant and facilitating satisfactory placement of an ocular prosthesis. A 2-year follow-up MRI revealed adequate volume in the posterior orbit. Accepted for publication August 23, 2018. All authors attest that they meet the current ICMJE criteria for Authorship. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Alon Kahana, M.D., Ph.D., Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, 1000 Wall St., Ann Arbor, MI. E-mail: akahana@med.umich.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Study on the Aging Dynamics of the Periorbital Region: From Observation to Knowledge of Physiopathology

Purpose: Several anatomical and physio-pathologic studies of eyelid region have allowed the creation of theories on facial tissues aging dynamics, which have not been clarified yet. We assessed the signs of aging in the region over the time by observing the characteristics in the same person at different times of his/her life. Methods: We compared the position of the main anatomical landmarks of the eyelid region of 80 patients by overlaying their photographs when they were 20, 40, and 60 years old. Then we made comparisons in the group of men (40 people) and in the group of women (40 people) and between men and women. Results: The medial portion of the eyebrow was higher in the photograph taken at 60 years of age than in the one taken at 20 years old in 56.2% of cases; it was higher in 47.5% of cases when comparing the images at 20 and 40. The lateral portion of the eyebrow was seen higher in women in the 20 to 40 group, and it was seen lower in men at 60 years in statistical significance. In more than half of the patients observed, there was not a real descent of the eyebrow and the presence of a more or less accentuated form of upper eyelid's ptosis in the photograph at 60 (globally 47.5%, 55.0% of women and 40.0% of men). This condition was observed in 27.5% of the photographs at 40. There were changes in the horizontal dimension of the palpebral fissure (shortening in 53.7%, preserved in 33.7%, and increased in 12.5% of cases at 60 years old). The position of lateral canthus appeared lower in 40.0% of patients photographed at 60, but it was stable in those photographed at 40. The herniation of the upper eyelid bags was observed in 31.2% of the patients photographed at 60 years old but only in 13.7% at 40. Dermatochalasis of the upper eyelid was present in 67.5% of the people at 60 years old and in 55.0% of those seen when they were 40. Comparing men and women groups 20 to 40, dermatochalasis is more present in men than women at 40 years old with statistical significance. The eyelid-cheek junction was seen to be lower in 75.0% of cases at 60 and in 48.7% of cases at 40, and it is more represented in men than in women. Conclusion: We have highlighted some interesting elements, partly agreeing with the data already recorded by other authors', and our data suggest an important role of the eyelid structures senescence and its impact on the surrounding structures. Accepted for publication August 25, 2018. All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationship, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this artilce. Address correspondence and reprint requests to Nicola Zingaretti, M.D, Department of Plastic Reconstructive Surgery, c/o Ospedale "S. Maria della Misericordia", piazzale santa maria della misericordia 15, 33100 Udine, Italy. E-mail: zingarettin@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Septate Dermoid Cyst Mimicking Septate Lacrimal Sac Diverticulum

No abstract available

A Case of Diprosopus Tetraophthalmos: Ocular Findings and Surgical Treatment of Exposure Keratopathy

Diprosopus is a rare variation of conjoined twinning. In this report, ophthalmic findings in an infant with diprosopus tetraophthalmos are presented. A male infant who was born at 33 weeks of gestation to a nonconsanguineous 42-year-old mother and 47-year-old father was examined for orbital abnormalities. The infant had a large head, 2 faces, and 4 eyes, of which 2 were placed laterally and 2 were fused in the midline. In the laterally placed eyes, the pupils were unresponsive to light, and the optic discs were hypoplastic. In the fused eyes, the lower and upper eyelids were also fused, horizontally wide, vertically short, and immobile, resulting in a progressive exposure keratopathy. On the 33rd day of life, a modified total tarsorrhaphy was performed with the use of inhalational mask anesthesia. The patient died due to pneumonia and septicemia on the 45th day of life. Accepted for publication August 14, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Bulent Yazici, M.D., Izmir Yolu Senyurt Is Merk, no: 87/4, 16110 Bursa, Turkey. E-mail: byazici@uludag.edu.tr © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Pituitary Adenoma Apoplexy of the Orbit, Diagnosis, and Management With Presurgical Embolization

Orbital invasion of pituitary adenomas has been previously reported. In this report, the authors describe a 71-year-old female with a prolactinoma that presented with invasion of and apoplexy within the orbit. The patient underwent exenteration, followed by rapid tumor recurrence and growth. Given the hemorrhagic nature of the tumor, she subsequently underwent preoperative embolization and surgical resection. This case is notable in that it illustrates both apoplexy of a pituitary tumor within the orbit and the benefit of presurgical embolization. Accepted for publication August 15, 2018. The authors have no financial or conflicts of interest to disclose. Presented at Spring ASOPRS 2018, May 31 to June 2, 2018, Austin, TX. Address correspondence and reprint requests to Timothy J. McCulley, M.D., Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD. E-mail: Tmccull5@jhmi.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Orbitocerebral Mucormycosis in a Patient With Central Nervous System Lymphoma

A 61-year-old man with well-controlled diabetes mellitus type 2, cirrhosis from hepatitis C, alcohol abuse, and portal hypertension presented with painful vision loss and left orbital swelling. Imaging showed diffuse orbital, perineural, and pachymeningeal inflammation. He was initially diagnosed with neurosarcoidosis. However, cerebrospinal fluid analysis revealed central nervous system lymphoma, and lacrimal gland biopsy showed fungal organisms consistent with mucormycosis. The authors describe a case of Mucorales infection lacking sinonasal involvement and discuss the differential diagnosis and management of patients presenting with orbital and central nervous system inflammation from this uncommon fungal infection. Accepted for publication August 1, 2018. Supported in part by National Eye Institute Vision Core Grant P30EY010608 and the Hermann Eye Fund. No authors declare no conflicts of interest. Previously presented in part at the North American Neuro-Ophthalmology Society 43rd Annual Meeting on April 1–6, 2017 in Washington, DC. Address correspondence and reprint requests to Ore-ofe O. Adesina, M.D., Robert Cizik Eye Clinic, 6400 Fannin St, Suite 1800, Houston, TX 77030. E-mail: ore-ofeadesina@cizikeye.org © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Nontraumatic Orbital Hemorrhage During Uncomplicated Labor

No abstract available

A Case of Hyaluronic Acid Induced Blindness With Ophthalmoplegia and Ptosis

Hyaluronic acid injection can lead to skin necrosis, visual loss, and other complications. The blindness with ophthalmoplegia and ptosis is a rare, but terrible and devastating complication. The disfigured appearance usually has significant impact on patient's social life. There is no standard treatment. A patient with hyaluronic acid induced blindness, ophthalmoplegia, and ptosis is reported. Six days after the onset, peribulbar/retrobulbar injections of high dosage hyaluronidase were performed. The orbital edema and ptosis immediately improved. The ophthalmoplegia and ptosis improved significantly within a month and resolved completely within 3 months, although the right vision remained blind. Peribulbar/retrobulbar injection of hyaluronidase is a potential rescue therapy for the hyaluronic acid induced ophthalmoplegia and ptosis. Accepted for publication August 9, 2018. Supported by the National Basic Research Program of China (973 Program, No. 2015CB554100), National Natural Science Foundation of China (No. 81271035/H1205), and Foundation for Returned Personals Studying Abroad of Sichuan Province in 2015. The authors have no financial or conflicts of interest to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.op-rs.com.). Hui Chen and Huan Wang are co-authors. Address correspondence and reprint requests to Hui Chen, M.D., Ophthalmology Department, Sichuan Provincial People's Hospital, No. 32, 1st Ring Road, 2nd West Section, Chengdu City, Sichuan 610072, People's Republic of China. E-mail: 540685790@qq.com; Zhenglin Yang, Ph.D., Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Provincial People's Hospital, No. 32, 1st Ring Road, 2nd West Section, Chengdu City, Sichuan 610072, People's Republic of China. E-mail: zliny@yahoo.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Septic Cavernous Sinus Thrombosis Associated With Orbital Cellulitis: A Report of 6 Cases and Review of Literature

Purpose: To describe risk factors, clinical parameters, treatment, and prognosis for patients with septic cavernous sinus thrombosis presenting with orbital cellulitis. Methods: Retrospective case series of 6 patients identified with septic cavernous sinus thrombosis and orbital cellulitis confirmed by magnetic resonance imaging at a tertiary care center from January 1980 to December 2016. Medical records were reviewed for demographics, risk factors, symptoms, etiology, radiographic diagnosis, complications, treatments, and outcomes. In addition, a literature review was performed from 2005 to 2018, and 119 cases of septic cavernous sinus thrombosis confirmed by imaging were included for aggregate comparison. This study adheres to the tenets of the Declaration of Helsinki, and institutional review board approval was obtained. Results: All 6 cases presented with headache, fever, ocular motility deficit, periorbital edema, and proptosis. The primary source of infection included sinusitis (n = 4) and bacteremia (n = 2). Identified microorganisms included methicillin resistant Staphylococcus aureus (n = 3) and Streptococcus anginosus (n = 1). All cases were treated with broad-spectrum intravenous antibiotics and anticoagulation, and one case underwent endoscopic sinus surgery. The mean time between initial presentation to diagnosis of cavernous sinus thrombosis was 2.8 days, and the average length of hospital admission was 21 days. The mortality rate was 0%, but 4 cases were discharged with neurological deficits including vision loss (n = 1) and ocular motility disturbance (n = 3). Literature review produced an additional 119 cases. Conclusions: Early diagnostic imaging with contrast-enhanced CT or MRI should be initiated in patients with risk factors and ocular symptoms concerning for cavernous sinus thrombosis. Treatment entails early administration of broad-spectrum intravenous antibiotics, anticoagulation, and surgical drainage when applicable. Accepted for publication July 31, 2018. The authors have no financial or conflicts of interest to disclose. Presented as a poster at the American Academy of Ophthalmology Annual Meeting on October 16, 2016 in Chicago, IL. Address correspondence and reprint requests to R. Patrick Yeatts, M.D., Wake Forest University Eye Center, Janeway Clincal Science Building, 6th flr, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: pyeatts@wakehealth.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Response to critical appraisal of LIBERTY AD CHRONOS

British Journal of Dermatology, EarlyView.

Response to Critical appraisal of LIBERTY AD CHRONOS: reply from authors

British Journal of Dermatology, EarlyView.