Mutations in the leptin gene (LEP) can alter the secretion or interaction of leptin with its receptor, leading to extreme early-onset obesity. The purpose of this work was to estimate the prevalence of heteroz...
Παρασκευή 3 Νοεμβρίου 2017
Estimated prevalence of potentially damaging variants in the leptin gene
Transcatheter atrial septal defect closure in an infant (body weight 6.4 kg) using the GORE CARDIOFORM septal occluder (GCSO)
Transcatheter closure has become the treatment of choice for secundum atrial septal defects (ASD II), but particularly in small children, there is concern regarding procedure-related complications.
An overview of cytokines and heat shock response in polytraumatized patients
Abstract
Early after injury, local tissue damage induces a local and systemic inflammatory response that activates the immune system and leads to the development of systemic inflammatory response syndrome (SIRS). This post-traumatic response often results in uncontrolled release of inflammatory mediators and over-activation of the immune system, which occasionally results in multiple organ dysfunction syndrome (MODS). In parallel, a state of immunosuppression develops. This counter-regulating suppression of different cellular and humoral immune functions has been termed "compensatory anti-inflammatory response syndrome (CARS)." Both SIRS and CARS occur simultaneously even in the initial phase after injury. Pro- and anti-inflammatory cytokines have been suggested to play a major role in development of SIRS, although the degree of involvement of the different cytokines is quite disparate. While TNF-α and IL-1β are quite irrelevant for predicting organ dysfunction, IL-6 is the parameter that best predicts mortality. The hyperinflammatory state seems to be the cause of post-traumatic immunosuppression and heat shock proteins (HSPs), which have been proposed as one of the endogenous stimuli for the deterioration of the immune system acting as danger-associated molecular patterns (DAMPs). Extracellular HSPA1A released from injured tissues increase up to ten times immediately after trauma and even more in patients with MODS. It has powerful immune properties that could contribute to post-traumatic immunosuppression through several mechanisms that have been previously described, so HSPs could represent trauma-associated immunomodulatory mediators. For this reason, HSPA1A has been suggested to be a helpful early prognostic biomarker of trauma after severe injury: serial quantification of serum HSPA1A and anti-Hsp70 concentrations in the first hours after trauma is proposed to be used as a predictive biomarker of MODS and immunosuppression development in polytraumatized patients.
Extirpación eco-guiada mínimamente invasiva del tumor glómico digital
Publication date: Available online 3 November 2017
Source:Actas Dermo-Sifiliográficas
Author(s): J. Domínguez-Cruz, A. Ortiz-Prieto, P. Martín-Carrasco, J. Conejo-Mir
Dermatitis alérgica de contacto por acrilatos en esmaltes permanentes
Publication date: Available online 3 November 2017
Source:Actas Dermo-Sifiliográficas
Author(s): M.E. Gatica-Ortega, M.A. Pastor-Nieto, J.F. Silvestre-Salvador
Los primeros casos de dermatitis alérgica de contacto por acrilatos en procedimientos de manicura se describieron hace décadas en relación con la aplicación de uñas de porcelana. Recientemente se ha incrementado la frecuencia de sensibilización secundariamente a la implantación de los llamados esmaltes permanentes que contienen acrilatos UV curables, predominantemente entre las esteticistas que los aplican y en menor medida en usuarias. La reciente comercialización de kits de uso doméstico podría precipitar un aumento en la frecuencia aún mayor. En este artículo describimos su técnica de aplicación, la clínica, el diagnóstico, el tratamiento y la prevención. Los acrilatos están presentes en una amplia variedad de fuentes, incluidos múltiples materiales médicos. Una sensibilización desencadenada por un procedimiento puramente estético podría llegar a tener una importante repercusión en la salud, por lo que se imponen políticas restrictivas por parte de las autoridades que limiten su uso a profesionales cualificados y prohíban la venta indiscriminada de kits caseros.The first reported cases of allergic contact dermatitis from acrylates in manicure procedures in relation to the application of porcelain nails were published decades ago. The frequency of sensitization has increased due to the introduction of the so-called permanent nail polish containing photo-bonded acrylates, mainly involving the beauticians who apply them, and to a lesser extent, the consumers. The recent commercialized permanent polish kits for domestic use could trigger even higher degrees of sensitization. In this article, the clinical features, diagnostic procedures, treatment and preventive measures are described. Acrylates are present in a wide range of sources including multiple medical materials. Sensitization caused by a merely aesthetic procedure might end up having an eventual important impact in the future consumer's health which is why restrictive policies should be implemented limiting its use to qualified professionals and banning the indiscriminate sale of domestic kits.
Graphical abstract
Subclinical Sensitization with Diphenylcyclopropenone is Sufficient for the Treatment of Alopecia Areata: Retrospective Analysis of 159 Cases
Conventional diphenylcyclopropenone contact immunotherapy has been used in the treatment of extensive alopecia areata, but can be associated with severe adverse effects (AEs).Even without an eczematous reaction after sensitization, sufficient therapeutic responses were achieved without severe AEs.Sensitization to induce an eczematous reaction may not be required for successful contact immunotherapy.
Hydrological conditions and phytoplankton community in the Lesina lagoon (southern Adriatic Sea, Mediterranean)
Abstract
The Lesina lagoon (southern Adriatic Sea, Mediterranean) is a coastal lagoon located in a highly intensified farming and tourist area. A monthly sampling was carried out in 1998 in five stations, representative of different hydrological features, in order to analyse phytoplankton composition and its relation to environmental parameters. Our results showed high spatial variability of abiotic variables. Phytoplankton abundances and biomass trends showed marked seasonality, with annual peaks occurring in late winter–early spring and summer periods. Phytoplankton blooms were due to the diatom Thalassiosira pseudonana and the dinoflagellate Prorocentrum cordatum. Statistical analyses showed that salinity and nutrients were the main factors affecting phytoplankton abundance and biomass. Phytoplankton dynamics was associated both to seasonality and the hydrodynamic regime of the system. Moreover, chemical–physical data were analysed together with those collected in the same stations in 2007, to compare their dynamics under different hydrological regimes. The two periods corresponded to the closure and opening, respectively, of canals connecting the lagoon to the sea. In general, abiotic variables (salinity, dissolved oxygen, pH, nitrate, phosphate and silicate concentrations) were significantly affected by the hydrodynamic regime. These data could provide a useful basis to complement the knowledge gained through current monitoring within the framework of the European Directives, as well as to implement conservation and management strategies of these transitional waters.
Synthetic olive mill wastewater treatment by Fenton’s process in batch and continuous reactors operation
Abstract
Degradation of total phenol (TPh) and organic matter, (expressed as total organic carbon TOC), of a simulated olive mill wastewater was evaluated by the Fenton oxidation process under batch and continuous mode conditions. A mixture of six phenolic acids usually found in these agro-industrial wastewaters was used for this purpose. The study focused on the optimization of key operational parameters of the Fenton process in a batch reactor, namely Fe2+ dosage, hydrogen peroxide concentration, pH, and reaction temperature. On the assessment of the process efficiency, > 99% of TPh and > 56% of TOC removal were attained when [Fe2+] = 100 ppm, [H2O2] = 2.0 g/L, T = 30 °C, and initial pH = 5.0, after 300 min of reaction. Under those operational conditions, experiments on a continuous stirred-tank reactor (CSTR) were performed for different space-time values (τ). TOC and TPh removals of 47.5 and 96.9%, respectively, were reached at steady-state (for τ = 120 min). High removal of COD (> 75%) and BOD5 (> 70%) was achieved for both batch and CSTR optimum conditions; analysis of the BOD5/COD ratio also revealed an increase in the effluent's biodegradability. Despite the high removal of lumped parameters, the treated effluent did not met the Portuguese legal limits for direct discharge of wastewaters into water bodies, which indicates that coupled chemical-biological process may be the best solution for real olive mill wastewater treatment.
The integrative effect of periphyton biofilm and tape grass ( Vallisneria natans ) on internal loading of shallow eutrophic lakes
Abstract
The response of periphyton biofilm and the submerged macrophyte tape grass (Vallisneria natans) to internal loading from eutrophic lake sediments were evaluated in microcosms. The sediments from the littoral zone and center of a lake were selected to carry out the microcosm experiment. To determine how the differences in the periphyton biofilm and V. natans growth alone or in combination, we measured changes in water quality, growth, and TP in the periphyton biofilm and V. natans in microcosms containing these sediments. The results showed that the average daily TN and TP removal rates were 32.6 and 35.4%, respectively, in the microcosms containing the lake center sediments by V. natans and the periphyton biofilm. The presence of the periphyton biofilm and V. natans increased the pH, dissolved oxygen, and redox potential and decreased the conductivity in the overlying water in all treatments. Compared to the state before the treatments, V. natans grew well, with a significant increase in biomass (3.1- to 5.5-fold growth) and TP amount (5.1- to 8.8-fold) in all treatments after 48 days. However, the growth of V. natans that combined with the periphyton biofilm was better than that of V. natans alone, as reflected by the dry weight, chlorophyll a content, malondialdehyde content, and TP amount. In conclusion, the periphyton biofilm was beneficial for the growth of V. natans, and the appropriate combination of V. natans and periphyton biofilm would be a potential method for the ecological restoration of eutrophic lakes.
Will elevated atmospheric CO 2 boost the growth of an invasive submerged macrophyte Cabomba caroliniana under the interference of phytoplankton?
Abstract
The growth of most submerged macrophytes is likely to be limited by the availability of carbon resource, and this is especially true for the obligatory carbon dioxide (CO2) users. A mesocosm experiment was performed to investigate the physiological, photophysiological, and biochemical responses of Cabomba caroliniana, an invasive macrophyte specie in the Lake Taihu Basin, to elevated atmospheric CO2 (1000 μmol mol−1); we also examined the possible impacts of interferences derived from the phytoplankton proliferation and its concomitant disturbances on the growth of C. caroliniana. The results demonstrated that elevated atmospheric CO2 significantly enhanced the biomass, relative growth rate, and photosynthate accumulation of C. caroliniana. C. caroliniana exposed to elevated atmospheric CO2 exhibited a higher relative maximum electron transport rate and photosynthetic efficiency, compared to those exposed to ambient atmospheric CO2. However, the positive effects of elevated atmospheric CO2 on C. caroliniana were gradually compromised as time went by, and the down-regulations of the relative growth rate (RGR) and photosynthetic activity were coupled with phytoplankton proliferation under elevated atmospheric CO2. This study demonstrated that the growth of C. caroliniana under the phytoplankton interference can be greatly affected, directly and indirectly, by the increasing atmospheric CO2.
Hematological, hepatic enzymes’ activity and oxidative stress responses of gray mullet ( Mugil cephalus ) after sub-acute exposure to copper oxide
Abstract
Given the importance of assessing potential toxicity of heavy metals in valuable species of aquatic animals, the goal of the present research was to assess the sub-acute effects of copper oxide on hematological, enzymological, and oxidative stress responses of gray mullet to measure toxicity of copper oxide pollution in this significant fish. The median lethal concentration (LC50) value of copper oxide to gray mullet was detected at 3.15 ± 0.039 mg/L for 96 h, and 25 and 50% of the 96-h LC50 values were selected as sub-acute concentrations. The fish were exposed to (0.79 and 1.57 mg/L) copper oxide for 21 days. At the end of 21 days, the results showed that hemoglobin (Hb), hematocrit (Hct), red blood cells (RBC) count, MCV, MCH, and MCHC levels were found to be decreased in copper oxide treated fish, whereas white blood cells (WBC) count increased in copper-treated fish. Plasma aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) activity increased in treated groups; however, copper oxide in both groups of sub-acute exposure significantly decreased plasma alkaline phosphatase (ALP) activity compared to the control group. Superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH) levels significantly declined in copper oxide-treated fish. These findings indicated the deleterious effects of copper oxide on gray mullet, even at low concentrations, and offered that hematological and hepatic enzyme activity and antioxidants are suitable tools for evaluating heavy metals toxicity.
Reassessment of heavy metal pollution in riverine sediments of Hainan Island, China: sources and risks
Abstract
Riverine sediment samples from Hainan Island were collected in 2013 to assess the heavy metal pollution levels, sources, and associated environmental risks. The concentrations of Cr, Ni, Cu, Zn, As, Cd, and Pb measured in this study were 31.6–128.8 mg kg−1, 9.8–70.3 mg kg−1, 18.3–210.8 mg kg−1, 49.3–314.2 mg kg−1, 2.3–69.2 mg kg−1, 0.3–1.5 mg kg−1, and 23.2–113.4 mg kg−1, respectively. The results indicate that the sediment quality of Hainan Island has been obviously influenced by heavy metals. Based on the effect range classification, the heavy metals in Hainan riverine sediments likely have adverse biological effects on local ecosystems. The enrichment factor (EF), geoaccumulation index (Igeo), contamination factor (CF), and pollution load index (PLI) clearly reflect significant metal pollution in this region. The most significant pollution was observed in the northern and eastern parts of Hainan Island. The pollution levels of the three largest rivers on Hainan Island (i.e., the Nandu, Changhua, and Wanquan Rivers) were notably high. The results of this research will be useful in assessing and managing environmental pollution in this region. In the future, greater attention and further investigation should focus on the metal sources linked to further economic development on Hainan Island.
A two-step leaching method designed based on chemical fraction distribution of the heavy metals for selective leaching of Cd, Zn, Cu, and Pb from metallurgical sludge
Abstract
For selective leaching and highly effective recovery of heavy metals from a metallurgical sludge, a two-step leaching method was designed based on the distribution analysis of the chemical fractions of the loaded heavy metal. Hydrochloric acid (HCl) was used as a leaching agent in the first step to leach the relatively labile heavy metals and then ethylenediamine tetraacetic acid (EDTA) was applied to leach the residual metals according to their different fractional distribution. Using the two-step leaching method, 82.89% of Cd, 55.73% of Zn, 10.85% of Cu, and 0.25% of Pb were leached in the first step by 0.7 M HCl at a contact time of 240 min, and the leaching efficiencies for Cd, Zn, Cu, and Pb were elevated up to 99.76, 91.41, 71.85, and 94.06%, by subsequent treatment with 0.2 M EDTA at 480 min, respectively. Furthermore, HCl leaching induced fractional redistribution, which might increase the mobility of the remaining metals and then facilitate the following metal removal by EDTA. The facilitation was further confirmed by the comparison to the one-step leaching method with single HCl or single EDTA, respectively. These results suggested that the designed two-step leaching method by HCl and EDTA could be used for selective leaching and effective recovery of heavy metals from the metallurgical sludge or heavy metal-contaminated solid media.
Preventing and Responding to Teen Dating Violence: A National Study of School Principals' Perspectives and Practices
Violence and Gender , Vol. 0, No. 0.
Comparison of the Efficacy of Homologous and Autologous Platelet-Rich Plasma (PRP) for Treating Androgenic Alopecia
Abstract
Background
Androgenetic alopecia (AGA), the most common cause of hair loss in both sexes, accounts for 95% of all cases of hair loss. Although the literature has suggested that both nonactivated (n-PRP) and activated autologous (a-PRP) PRP can be used to treat AGA, we did not find any study investigating the use of homologous PRP (h-PRP) for this purpose. Also, to the best of our knowledge, there are no studies comparing the efficacy of h-PRP, a-PRP, or n-PRP on AGA therapy.
Objectives
The aim of this study was to compare the increase in hair density, average number of platelets, complications, preparation, and duration of application in the treatment of AGA using a-PRP, n-PRP, and h-PRP.
Methods
Between 2014 and 2015, we studied male patients who had experienced increased hair loss in the last year. Patients were divided into three groups: Group 1 received n-PRP, Group 2 received active PRP, and Group 3 received h-PRP. For Group 1, PRP was prepared by a single centrifugation prepared from the patient's own blood. For Group 2, the PRP was prepared from the patient's own blood, but a second centrifugation was applied for platelet activation with calcium chloride. For Group 3, the PRP was prepared from pooled platelets with the same blood group as the patient from the blood center. PRP was injected at 1, 2, and 6 months. The hair density (n/cm2) of each patient before and after injection was calculated. Each patient was assigned a fixed evaluation point at the time of application to calculate hair density.
Results
At 2, 6, and 12 months after the first treatment, the increase in hair density was calculated as 11.2, 26.1, and 32.4%, respectively, in Group 1; 8.1, 12.5, and 20.8%, respectively, in Group 2; and 16.09, 36.41, and 41.76%, respectively, in Group 3. The increase in hair density was statistically significantly greater in Group 1 than in Group 2 and more so in Group 3 than in both groups among all controls (p < 0.05).
Conclusion
The efficacy of both PRPs was determined in AGA treatment in our study. However, it was determined statistically that the increase in hair density with h-PRP was greater than with autologous PRP groups. We believe that h-PRP therapy can be used in patients with AGA presenting with hair loss.
Level of Evidence II
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 http://ift.tt/18t7xNj.
Male-to-Female Sex Reassignment Surgery using the Combined Vaginoplasty Technique: Satisfaction of Transgender Patients with Aesthetic, Functional, and Sexual Outcomes
Abstract
Background
Currently available patient-reported outcome measures are limited in the field of sex reassignment surgery (SRS). Standardized questionnaires deliver high evidence data on satisfaction of male-to-female (MTF) transgender patients but do not allow any modification in their clinical application. We therefore designed a prospective study using self-developed indication-specific questionnaires to evaluate the aesthetic, functional, and sexual outcomes of MTF patients undergoing SRS.
Methods
Forty-nine adult MTF transgender patients who underwent two-stage SRS were eligible for study inclusion between September 2012 and January 2014. Forty patients (= N) ultimately filled out both parts of the questionnaire sets: 1 day before the first stage (T0) and 6 months after the second stage of SRS (T1). These questionnaires focused on demographic characteristics, the satisfaction with aesthetic and functional results, and sexuality.
Results
Patients rated their surgical satisfaction of most items with mean scores above 7 on a 0–10-point scale. Many items evaluating everyday life activities improved significantly after SRS compared to T0 (p < 0.01). All but one patient (97.5%) reported no regrets about having undergone surgery, and the majority recommended it to other patients with gender dysphoria. Femininity and sexual activity increased significantly postoperatively (p < 0.01). Satisfaction with intercourse and orgasm was high: 6.70 and 8.21, respectively, on a 0–10 scale.
Conclusion
Satisfaction with the cosmetic outcome, as well as the functional and sexual outcomes, reveal positive effects of SRS using the combined technique on transgender patient lives. Nevertheless, standardized and validated SRS-specific questionnaires are lacking.
Level of Evidence IV
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 http://ift.tt/18t7xNj.
Anaplastic Large-Cell Lymphoma Associated with Breast Implants: A Case Report of a Transgender Female
Abstract
Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare peripheral T cell lymphoma. BIA-ALCL is a disease of the fibrous capsule surrounding the implant and occurs in patients after both breast reconstruction and augmentation. More than 300 cases have been reported so far, including two in a transgender patient. Here we describe BIA-ALCL presented with a mass in a transgender patient and the first case of BIA-ALCL in the Czech Republic. In 2007, a 33-year-old transgender male to female underwent bilateral breast augmentation as a part of his transformation to female. In June 2014, the patient developed a 5-cm tumorous mass in her left breast. Magnetic resonance imaging of the chest revealed a ruptured implant and a tumorous mass penetrating into the capsule and infiltrating the pectoral muscle. An R0 surgery was indicated—the implant, silicone gel and capsule were removed, and the tumorous mass was resected together with a part of the pectoral muscle. Histology revealed anaplastic large-cell lymphoma. The patient underwent standard staging procedures for lymphoma including a bone marrow trephine biopsy, which confirmed stage IE. The patient was treated with the standard chemotherapy for systemic ALCL—6 cycles of CHOP-21. The patient was tumor-free at the 2-year follow-up. BIA-ALCL has been reported mostly in women who received implants for either reconstructive or aesthetic augmentation. This is the third report of BIA-ALCL in a transgender person, the first in the Czech Republic.
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 http://ift.tt/18t7xNj.
Polyurethane Foam Wound Dressing Technique for Areola Skin Graft Stabilization and Nipple Protection After Nipple–Areola Reconstruction
Abstract
We describe a new wound management technique using a soft dressing material to stabilize the areola skin graft and protect the nipple after nipple–areola reconstruction at the final stage of breast reconstruction. We introduced a center-fenestrated multilayered hydrocellular polyurethane foam dressing material that provides adequate pressure and retains a moist environment for a smooth skin graft "take." Moreover, the reconstructed nipple can be monitored at any time through the fenestrated window for adequate blood circulation. Altogether, this simple and inexpensive wound dressing technique improves the clinical outcome.
Level of Evidence IV 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 Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
Drivers of Hospital Costs in the Self-Pay Facelift (Rhytidectomy) Patient: Analysis of Hospital Resource Utilization in 1890 Patients
Abstract
Introduction
Rhytidectomy is one of the most commonly performed cosmetic procedures by plastic surgeons. Increasing attention to the development of a high-value, low-cost healthcare system is a priority in the USA. This study aims to analyze specific patient and hospital factors affecting the cost of this procedure.
Methods
We conducted a retrospective cohort study of self-pay patients over the age of 18 who underwent rhytidectomy using the Healthcare Utilization Cost Project National Inpatient Sample database between 2013 and 2014. Mean marginal cost increases patient characteristics, and outcomes were studied. Generalized linear modeling with gamma regression and a log-link function were performed along with estimated marginal means to provide cost estimates.
Results
A total of 1890 self-pay patients underwent rhytidectomy. Median cost was $11,767 with an interquartile range of $8907 [$6976–$15,883]. The largest marginal cost increases were associated with postoperative hematoma ($12,651; CI $8181–$17,120), West coast region ($7539; 95% CI $6412–$8666), and combined rhinoplasty ($7824; 95% CI $3808–$11,840). The two risk factors associated with the generation of highest marginal inpatient costs were smoking ($4147; 95% CI $2804–$5490) and diabetes mellitus ($5622; 95% CI $3233–8011). High-volume hospitals had a decreased cost of − $1331 (95% CI − $2032 to − $631).
Conclusion
Cost variation for inpatient rhytidectomy procedures is dependent on preoperative risk factors (diabetes and smoking), postoperative complications (hematoma), and regional trends (West region). Rhytidectomy surgery is highly centralized and increasing hospital volume significantly decreases costs. Clinicians and hospitals can use this information to discuss the drivers of cost in patients undergoing rhytidectomy.
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 http://ift.tt/18t7xNj.
Modifications of Z-Epicanthoplasty Combined with Double-Eyelid Blepharoplasty in Asians
Abstract
Background
Epicanthoplasty combined with double-eyelid blepharoplasty is one of the most popular cosmetic procedures in Asians. However, the postoperative medial canthal scar is a concerned issue. Here the authors adopted some modifications of Z-epicanthoplasty to minimize the canthal scar.
Methods
Modifications of Z-epicanthoplasty were mainly in three aspects. First, supratarsal creases were created before epicanthoplasty to prevent the impact of tension variation on epicanthal incisions, caused by elevating and tightening of the upper eyelid skin. Second, one triangle flap was determined according to the transposition of another one in Z-plasty, and hence, it can be guaranteed that the incisions were closed free of tension with more accuracy and less injury to surrounding tissues. Third, linear scar contracture was avoided by adopting discontinuous incisions, and the resulting skin bulge was eliminated by making an additional stitch to anchor the pretarsal skin on the tarsal plate. The follow-up interval was 1 month to 2 years, with a median of 6.5 months.
Results
From January 2012 to December 2015, 237 female and 4 male patients received the surgery. Except five (2.07%) patients, who were not satisfied with the color of incision scars in medial canthal area, none complained about scars 6 months after surgery. The appearance of the supratarsal crease was natural, and the medial canthal scar was inconspicuous in close observation at 2 years.
Conclusion
The modifications of Z-epicanthoplasty are safe and effective. It is potentially helpful to minimize postoperative medial canthal scars.
Level of Evidence IV
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 http://ift.tt/18t7xNj.
Measurement of the Area of Corneal Exposure Using Digital Image and Its Application During Assessment for Blepharoplasty
Abstract
Background
The normal morphological and functional values of orbits vary according to race, sex, and age. We measured the palpebral fissure using the marginal reflex distance (MRD1), marginal limbal distance (MLD), and vertical height of the palpebral fissure (VHPF). Unfortunately, these measurements are all one-dimensional figures that measure the distance between two points; they have limitations when it comes to measuring the three-dimensional ocular surface. Therefore, this study used the area of corneal exposure (ACE), which shows a two-dimensional area, to measure changes between the sizes of eyes according to age.
Materials and Methods
This study was conducted using preoperative photographs of Koreans in Daegu city, Korea, who underwent plastic surgery in our department except for eyelid surgery. We divided the subjects into eight groups, including ten males and ten females in each decade of age, from age 10 to over 80 years. A total of 160 people were recruited who were followed up for photograph analysis using Adobe Photoshop 7.0 software.
Results
In terms of the mean value, the ACEs were 73.3 ± 2% in male subjects and 77.1 ± 2% in female subjects, and values for female subjects were greater than those for male subjects (p < 0.05). Significant differences in ACEs were observed according to age. The peak level of growth in the ACE was reached between 20 and 29 years of age. After the 20 s, a gradual decrease was observed (p < 0.05).
Conclusion
The peak level of growth in the ACE was reached between 20 and 29 years of age. The growth pattern can be classified as continuously decreasing after reaching the peak level. The data from this study are significant in that they can be used as comprehensive data for normal eyelid values according to age.
Level of Evidence IV
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 Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
Early clinical experiences with nintedanib in three UK tertiary interstitial lung disease centres
Nintedanib has been shown to slow disease progression in patients with idiopathic pulmonary fibrosis (IPF). It was approved by the National Institute for Health and Care Excellence (NICE) in January 2016 for I...
Deletion of Cdc42 in embryonic cardiomyocytes results in right ventricle hypoplasia
Cdc42 is a member of the Rho GTPase family and functions as a molecular switch in regulating cytoskeleton remodeling and cell polarity establishment. Inactivating Cdc42 in cardiomyocytes resulted in embryonic ...
Fine chalk dust induces inflammatory response via p38 and ERK MAPK pathway in rat lung
Abstract
Chalk teaching is widely used in the world due to low cost, especially in some developing countries. During teaching with chalks, a large amount of fine chalk dust is produced. Although exposure to chalk dust is associated with respiratory diseases, the mechanism underlying the correlation between chalk dust exposure and adverse effects has not fully been elucidated. In this study, inflammation and its signal pathway in rat lungs exposed to fine chalk dust were examined through histopathology analyses; pro-inflammatory gene transcription; and protein levels measured by HE staining, RT-PCR, and western blot analysis. The results demonstrated that fine chalk dust increased neutrophils and up-regulated inflammatory gene mRNA levels (TNF-α, IL-6, TGF-β1, iNOS, and ICAM-1), and oxidative stress marker (HO-1) level, leading to the increase of inflammatory cell infiltration and inflammatory injury on the lungs. These inflammation responses were mediated, at least in part, via p38 and extracellular regulated proteinase (ERK) mitogen-activated protein kinase (MAPK) signaling mechanisms. In contrast, N-acetyl-L-cysteine (NAC) supplement significantly ameliorated these changes in inflammatory responses. Our results support the hypothesis that fine chalk dust can damage rat lungs and the NAC supplement may attenuate fine chalk dust-associated lung inflammation.
New Assessment Table for Establishing Severity in Psoriasis
Publication date: Available online 3 November 2017
Source:Actas Dermo-Sifiliográficas (English Edition)
Author(s): D. Vidal
Effect of long-term exposure to ambient particulate matter on prevalence of type 2 diabetes and hypertension in Iranian adults: an ecologic study
Abstract
Air pollution is considered as an environmental risk to health worldwide. Current evidence is mostly from Western populations exposed to lower levels of pollutants. This study was to explore the association of type 2 diabetes (T2D) and hypertension prevalence with exposure to high levels of air pollution in Iranian adults. The air pollution data were obtained from the air quality monitoring stations of five large cities in Iran from 2006 to 2011. The air quality monitoring stations could only detect ambient particulate matter_10 (PM10) during the study period; therefore, the average PM10 concentration was considered for comparison. We grouped the cities as group 1 (Tehran, Shiraz) with PM10 concentration < 100 μg/m3, and group 2 (Kermanshah, Ahwaz, Esfahan) with PM10 concentration > 100 μg/m3. Data from the Surveillance of Risk Factors of Non-Communicable Disease (SuRFNCD) study were used to calculate the prevalence of T2D and hypertension. We assessed the association between air pollution and the prevalence of T2D using logistic regression models. Odds ratios (ORs) with 95% CI for each outcome were calculated after adjusting for age, sex, BMI, physical activity, and other covariates. The 5-year average of PM10 concentration was higher in group 2 (120.15 ± 6.81 μg/m3) compared to group 1 (83.95 ± 7.81 μg/m3). The prevalence of T2D in group 2 was 13.8%, while it was 10.7% in group 1 (p = 0.01), OR = 1.32 (95% CI 1.03–1.69). Similarly, hypertension was more prevalent in group 2 (15.7 vs. 11.9%, p = 0.005, OR = 1.55, 95% CI 1.20–1.99). PM10 is associated with higher prevalence of T2D and hypertension in Iranian adults.
Occurrence of organotins in the aquatic environment during an operating cycle of the Three Gorges Reservoir, China
Abstract
Organotins (OTs) pollution in the aquatic environment of the Three Gorges Reservoir (TGR) was assessed during the reservoir's operating cycle. Butyltins (BTs) and phenyltins (PhTs) in the water phase and suspended particulate matter (SPM) at different water levels were analysed. It was found that the distribution of OTs in the surface and bottom water phases were similar, with the dominant OTs being BTs at the low water level and PhTs at the high water level. The detection rates and concentrations of OTs in the water phase at the high water level were both higher than those at the low water level, with most OTs being monobutyltin (MBT) at the low water level and monophenyltin (MPhT) at the high water level. The concentrations of OTs in SPM at the low water level were higher than those at the high water level, and BTs, especially dibutyltin (DBT) and tributyltin (TBT), were the predominant OTs whether surface or bottom layer at each water level. The BTs and SPM concentrations had a significant positive relationship in all samples, indicating that the SPM concentration would determine the distribution of BTs in the aquatic environment of the TGR region (TGRR). The difference in the distribution of OTs at the different water levels indicated that the hydrological and hydraulic behaviour of the TGR influences OTs transport in the aquatic environment of the TGRR.
Nickel, vanadium, and lead as indicators of sediment contamination of marina, refinery, and shipyard areas
Abstract
Metallic elements found in the aquatic environment may originate in areas where petroleum is refined and vessels are maintained and repaired. This study aims to assess contamination caused by nickel (Ni), lead (Pb), and vanadium (V) in sediment of the Lagoa dos Patos estuary (RS, Brazil) and to evaluate them as indicators of areas under the influence of petroleum products and antifouling paints. Surface sediments were collected in summer and in winter in areas of marinas, shipyards, refinery, and a control station. High Pb and V concentrations in shipyards and at the Yacht Club showed that some organisms may be affected by toxicity. High Pb results of the index of geoaccumulation (Igeo) were found at the Yacht Club and shipyards. Al, Ni, and V had similar distribution in the sediment in both seasons. Ni and V had high relation in winter at the Yacht Club and at the Santos Shipyard, thus suggesting that these elements come mainly from petroleum products. The same happened to the relations between Pb and V, as well as Pb and Ni at the Santos Shipyard. These elements are employed as useful tools as indicators to identify places with moderate to high localized anthropogenic inputs of petroleum derivatives and antifouling paints.
An X-ray-free method to accurately identify the elbow flexion–extension axis for the placement of a hinged external fixator
Abstract
Purpose
Identifying the elbow flexion–extension (F–E) movement axis is important for placing a hinged elbow external fixator. An X-ray fluoroscopy-based method is widely used in clinical practice, exposing the patient and surgeons to high doses of radiation. Additionally, the accuracy and repeatability of the fluoroscopy-based method are very low and affected by subjective factors.
Methods
To solve this problem, an X-ray-free method based on kinematics analysis was proposed to identify the elbow F–E movement axis, and a navigation system was built to guide the placement of the elbow external fixator.
Results
Our X-ray-free navigation method is more repeatable than the current X-ray fluoroscopy method used clinically. Both our algorithm and the NIST (National Institute of Standards and Technology) algorithm showed high accuracy and repeatability to identify the axis.
Conclusions
The method proposed in this study is very promising to avoid a large dose of X-ray radiation and increases the repeatability and performance of identifying the elbow F–E movement axis for the placement of the hinged elbow external fixator.
Willingness to accept capitation payment system under the Ghana National Health Insurance Policy: do income levels matter?
This research was set to examine the factors influencing the willingness and the likelihood of Ghanaians to accept the capitation payment system under the National Health Insurance Scheme. Data was collected t...
The impact of sewage sludge and compost on winter triticale
Abstract
There is an increasing interest in the agricultural application of organic waste such as soil amendment, due to the possibility of recycling valuable components, organic matter, and nutrient elements necessary for plant growth. The present study was carried out to evaluate the effects of sewage sludge, and green waste compost application, on a forage crop, triticale "X Triticosecale Wittmack" compared to unfertilized control. The experimental design was installed in the glasshouse conditions at the Regional Field Crop Research Center in Beja, Tunisia. Sewage sludge and green waste compost were added by four rates (0, 5, 10, and 20 t/ha) in soil, 15 days before triticale sowing. The main results showed that plant response differs depending on the type of adding fertilizer. Indeed, compost inputs decreased shoot length and production of triticale, among all sewage sludge rates, by average values of 26 and 60% respectively at final harvest, as compared to unamended soil. However, amendment with different rates of sewage sludge significantly (p < 0.05) increased different plant growth and yield attributes.
Vulture mortality resulting from illegal poisoning in the southern Balkan Peninsula
Abstract
A study was carried out to determine the incidents of illegal poisoning of griffon vulture (Gyps fulvus), Egyptian vulture (Neophron percnopterus), black vulture (Aegypius monachus), and bearded vulture (Gypaetus barbatus) in the southern Balkan Peninsula between 1982 and 2017. A total of 38 poisoning cases affecting 224 vultures were analyzed to identify their causes and the primary target species for poisoning. Nine different compounds were used in these incidents and the most frequently applied were strychnine, carbamate, and organophosphoros compounds. The poison used to kill gray wolf had the most significant collateral damage to the vulture populations in comparison to the other investigated reasons. It was the primary cause of 60% of all registered vulture poisoning events in the southern Balkan Peninsula during the last 36 years. Establishing permanent feeding sites for vultures in areas with wolves appears to be an effective way to minimize the risk of poisoning. There is a pressing need for the development of an appropriate conservation practice taking into consideration relationships among the main and casual target species for poisoning as an essential element in conjunction with the human activities.
Multimarker Assessment of Diastolic Dysfunction in Metabolic Syndrome Patients
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
Analysis of chromium status in the revegetated flora of a tannery waste site and microcosm studies using earthworm E. fetida
Abstract
Chromium from tannery waste dump site causes significant environmental pollution affecting surrounding flora and fauna. The primary aims of this study were to survey vegetation, investigate the degree of soil pollution occurring near tannery waste dump site and make a systematic evaluation of soil contamination based on the chromium levels found in plants and earthworms from the impacted areas. This paper presents the pollution load of toxic heavy metals, and especially chromium, in 10 soil samples and 12 species of plants. Soil samples were analysed for heavy metals by using ICP-MS/ICP-OES method. Results indicated that Cr in soils exceeded soil quality guideline limits (SQGL). The total chromium present in the above ground parts of plants ranged from 1.7 mg kg−1 in Casuarina sp. to 1007 mg kg−1 in Sonchus asper. The Cr bioaccumulation in Eisenia fetida from tannery waste soil ranged from 5 to 194 mg kg−1. The high enrichment factor of Cr in S. asper and bioaccumulation factor in earthworms indicate that there is a steady increase of toxic chromium risk in this area, which could be correlated with the past dumping activity. Emphasis needs to be put on control measures of pollution and remediation techniques in such areas to achieve an ecologically sustainable industrialisation.
Towards a better understanding of the therapeutic applications and corresponding mechanisms of action of honey
Abstract
Honey is a bee-derived supersaturated solution composed of complex contents mainly glucose, fructose, amino acids, vitamins, and minerals. Composition of honey may vary due to the difference in nectar, season, geography, and storage condition. Honey has been used since times immemorial in folk medicine and has recently been rediscovered as an excellent therapeutic agent. In the past, honey was used for a variety of ailments without knowing the scientific background and active ingredients of honey. Today, honey has been scientifically proven for its antioxidant, regulation of glycemic response, antitumor, antimicrobial, anti-inflammatory, and cardiovascular potentiating agent. It can be used as a wound dressing and healing substance. Honey is different in color, flavor, sensory perception, and medical response. Apart from highlighting the nutritional facts of honey, we collected the finding of the published literature to know the mechanism of action of honey in different diseases. This review covers the composition, physiochemical characteristics, and some medical uses.
A national assessment of the effect of intensive agro-land use practices on nonpoint source pollution using emission scenarios and geo-spatial data
Abstract
China's intensive agriculture has led to a broad range of adverse impacts upon ecosystems and thereby caused environmental quality degradation. One of the fundamental problems that face land managers when dealing with agricultural nonpoint source (NPS) pollution is to quantitatively assess the NPS pollution loads from different sources at a national scale. In this study, export scenarios and geo-spatial data were used to calculate the agricultural NPS pollution loads of nutrient, pesticide, plastic film residue, and crop straw burning in China. The results provided the comprehensive and baseline knowledge of agricultural NPS pollution from China's arable farming system in 2014. First, the nitrogen (N) and phosphorus (P) emission loads to water environment were estimated to be 1.44 Tg N and 0.06 Tg P, respectively. East and south China showed the highest load intensities of nutrient release to aquatic system. Second, the amount of pesticide loss to water of seven pesticides that are widely used in China was estimated to be 30.04 tons (active ingredient (ai)). Acetochlor was the major source of pesticide loss to water, contributing 77.65% to the total loss. The environmental impacts of pesticide usage in east and south China were higher than other parts. Third, 19.75% of the plastic film application resided in arable soils. It contributed a lot to soil phthalate ester (PAE) contamination. Fourth, 14.11% of straw produce were burnt in situ, most occurring in May to July (post-winter wheat harvest) in North China Plain and October to November (post-rice harvest days) in southeast China. All the above agricultural NPS pollution loadings were unevenly distributed across China. The spatial correlations between pollution loads at land unit scale were also estimated. Rising labor cost in rural China might be a possible explanation for the general positive correlations of the NPS pollution loads. It also indicated a co-occurred higher NPS pollution loads and a higher human exposure risk in eastern regions. Results from this research might provide full-scale information on the status and spatial variation of various agricultural NPS pollution loads for policy makers to control the NPS pollution in China.
Profil der Kaposi-Sarkom-Patienten im Kompetenznetz HIV/AIDS
Zusammenfassung
Hintergrund
Das Kaposi-Sarkom (KS) stellt die häufigste der Neoplasien dar, die das „acquired immune deficiency syndrome" (AIDS) definieren. Es wurden nur wenige Studien über den Verlauf und die Behandlung des mit dem „human immunodeficiency virus" (HIV) assoziierten KS in Deutschland durchgeführt.
Ziel der Arbeit
Im Rahmen dieser Studie wurde der Verlauf des HIV-assoziierten KS bei Patienten aus der Kohortendatenbank des Kompetenznetz HIV/AIDS beobachtet.
Material und Methoden
Von HIV-positiven Patienten mit KS aus 9 deutschen Schwerpunktzentren wurden Daten des Zeitraum 1987–2011 retrospektiv erhoben. Kaplan-Meier-Kurven für die Rezidiv- und Überlebenswahrscheinlichkeit wurden berechnet.
Ergebnisse
Bei 222 Patienten wurde ein KS im medianen Lebensalter von 38,5 ± 10,1 Jahren diagnostiziert. Es waren nahezu ausschließlich Männer betroffen (97,7 %). Die HI-Viruslast zum Diagnosezeitpunkt lag bei 7,4 % unter 50 Kopien/ml. Es entwickelten 55,5 % der Patienten ein KS bei CD4-Zellzahlen unter 200 Zellen/µl und 9,5 % bei über 500 Zellen/µl. Bei 68 Patienten bestand die KS-Therapie ausschließlich in der Optimierung bzw. der Einleitung der antiretroviralen Therapie (ART). Zusätzlich wurden 71 Patienten mit pegyliertem liposomalem Doxorubicin behandelt. Während der medianen Follow-up-Dauer von 8,9 ± 4,9 Jahren traten bei 80,2 % der Patienten keine KS-Rezidive auf. Die Überlebenswahrscheinlichkeiten nach 5 und 10 Jahren betrugen 96,8 % und 91,3 %.
Schlussfolgerung
Auch bei gutem Immunstatus traten HIV-assoziierte KS auf. Eine effektive ART stellte die wichtigste Therapiesäule dar. Bei angemessener Therapie zeigten HIV-positive Patienten mit KS eine gute Überlebensrate.
Computational modeling of abdominal hernia laparoscopic repair with a surgical mesh
Abstract
Purpose
Although new techniques and prostheses have been introduced in ventral hernia surgery, abdominal hernia repair still presents complications, such as recurrence, pain, and discomfort. Thus, this work implements a computational method aimed at evaluating biomechanical aspects of the abdominal hernia laparoscopic repair, which can support clinical research tailored to hernia surgery.
Methods
A virtual solid model of the abdominal wall is obtained from MRI scans of a healthy subject. The mechanical behavior of muscular and fascial tissues is described by constitutive formulations with specific parameters. A defect is introduced to reproduce an incisional hernia. Laparoscopic repair is mimicked via intraperitoneal positioning of a surgical mesh. Numerical analyses are performed to evaluate the mechanical response of the abdominal wall in healthy, herniated and post-surgery configurations, considering physiological intra-abdominal pressures.
Results
During the deformation of the abdominal wall at increasing pressures, a percentage displacement increment up to 6% is found in the herniated condition, while the mechanical behavior of the repaired abdomen is similar to the healthy one. In the pressure range between 8 mmHg and 55 mmHg, the herniated abdomen shows an incremental stiffness differing of 7% with respect to the healthy condition, while the post-surgery condition shows an increase of the incremental stiffness up to 58%.
Conclusions
This computational approach may be exploited to investigate different aspects of abdominal wall surgical repair, including mesh mechanical characteristics and positioning. Numerical modeling offers a helpful support for selecting the best-fitting prosthesis for customize pre-surgery planning.
Biomarkers related to bullous pemphigoid activity and outcome
Abstract
Bullous pemphigoid (BP) is the most common autoimmune sub-epidermal blistering disease of the skin. Investigation of the BP-associated pathophysiological processes during the last decades showed that the generation of auto-antibodies directed against the hemidesmosome proteins BP180 and BP230, a hallmark of the BP-associated autoimmune response, leads to the recruitment of inflammatory immune cells at the dermal-epidermal junction, and subsequently to the release of a large amount of inflammatory molecules involved in blister formation. Analysis in transversal and longitudinal studies of autoantibodies and inflammatory molecules production both at time of diagnosis and under treatment was mainly performed within the serum but also in the blister fluid. Some autoimmune or inflammatory molecules expression was related to the presence of clinical signs, while others were mere bystanders. In this review, we focused on the autoimmune and inflammatory molecules that have been identified as potential biomarkers of BP development and outcome.
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Pertussis Vaccination Among Childcare Center Staff, Administrators, and Parents: Uptake, Policies, and Beliefs
Abstract
Introduction Little is known about childcare staff's and parents' uptake of and attitudes towards pertussis vaccine. Methods Questionnaires were distributed to St. Louis parents and childcare staff in fall, 2014. Parents versus staff and vaccinated versus unvaccinated individuals' beliefs regarding pertussis vaccine were compared using chi square tests. Multivariate logistic regressions were run to develop predictive models for staff's and parents' vaccine uptake. Results Overall, 351 parents and staff from 23 agencies participated (response rate = 32%). Parents were more likely than staff to have received pertussis vaccine (66.5 vs. 45.8%, X 2 = 12.5, p < .001). Predictors for staff vaccination included willingness to get vaccinated even if there was a cost (OR 6.6; CI 1.8–24.6; p < .01), awareness of vaccination recommendations (OR 5.2; CI 1.2–22.8; p < .05), and healthcare provider recommendation (OR 4.2; CI 1.2–15.1; p < .05). Parents' predictors of vaccination included perceived importance of vaccination (OR 9.9; CI 4.1–23.8; p < .001), healthcare provider recommendation (OR 4.6; CI 1.7–12.6; p < .01), believing vaccination is effective (OR 4.4; CI 1.1–18.0; p < .05), and knowing where to get vaccine (OR 3.5; CI 1.5–8.1; p < .01). Among unvaccinated staff (n = 52), 74.5% (n = 38) and 70.0% (n = 35) would receive pertussis vaccine if it were offered free of charge and onsite, respectively. Conclusions for Practice Childcare staff's and parents' pertussis vaccine uptake was higher than overall U.S. rates, though significantly lower than the Global Pertussis Initiative target. Implementing an education campaign and providing free vaccine on-site are likely to result in increased vaccine uptake.
Developing Collaborative Maternal and Child Health Leaders: A Descriptive Study of the National Maternal and Child Health Workforce Development Center
Abstract
Purpose An assessment of the National Maternal and Child Health Workforce Development Center (the Center) was conducted to describe (1) effects of the Center's training on the use of collaborative leadership practices by MCH leaders, and (2) perceived barriers to collaboration for MCH leaders. The Center provides services to strengthen MCH professionals' skills in three core areas: Change Management/Adaptive Leadership, Evidence-Based Decision Making, and Systems Integration. Description This descriptive qualitative study compares eight interview responses from a sample of the Center's participants and findings from a document review of the training curriculum against an existing framework of collaborative leadership themes. Assessment Systems thinking tools and related training were highly referenced, and the interviewees often related process-based leadership practices with their applied learning health transformation projects. Perceived barriers to sustaining collaborative work included: (1) a tendency for state agencies to have siloed priorities, (2) difficulty achieving a consensus to move a project forward without individual partners disengaging, (3) strained organizational partnerships when the individual representative leaves that partnering organization, and (4) difficulty in sustaining project-based partnerships past the short term. Conclusion The findings in this study suggest that investments in leadership development training for MCH professionals, such as the Center, can provide opportunities for participants to utilize collaborative leadership practices.
Sunscreen formulations do not interfere with sweat cooling during exercise
Abstract
Objective
Sweating plays a critical role in maintaining thermal balance and keeping skin cool during exercise. People often wear sunscreens on hot summer days for sun protection. Most recreational sunscreens are designed to be water and sweat resistant, so that sweating will not remove or compromise the protection. The objective of this study was to determine whether wearing sweat-resistant sunscreen might impede natural sweating, potentially interfering with thermal regulation and resulting in the elevation of skin temperature.
Methods
We conducted a controlled, randomized, split-face, and split-arm clinical study with 24 female subjects wearing an SPF 70 lotion sunscreen on half of the face and an SPF 70 spray sunscreen on one of the forearms at a dosage of 2 mg/cm2. Following sunscreen application, subjects participated in two sessions of indoor exercise to induce clearly visible sweating.
Results
We found that both skin temperatures and sweat evaporation rates were significantly elevated after each session, yet there were no significant differences in either skin temperatures or sweat rates between the treated and untreated control sites at any time point for any of the skin sites measured.
Conclusion
We conclude that the application of tested sweat resistant sunscreen lotions and sprays does not have any measurable effects on skin cooling by natural sweating process. People should continue to use these sunscreens during recreational activities.
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Ombilicoplastie en aile de mouette : technique et satisfaction ; à propos de 96 cas
Source:Annales de Chirurgie Plastique Esthétique
Author(s): R. Merle, K. Serror, O. Marco, M. Chaouat, S. Teissier, M. Mimoun, D. Boccara
But de l'étudeL'ombilic a un rôle majeur dans l'esthétique de la paroi abdominale antérieure. De nombreuses publications portent sur les dermolipectomies abdominales, mais peu se focalisent sur les ombilicoplasties. Celles-ci sont pourtant essentielles dans l'appréciation du résultat esthétique. L'ombilicoplastie en aile de mouette utilisée dans notre service est fiable et facilement reproductible. Dans cet article, nous évaluons la satisfaction des patientes ayant eu une dermolipectomie abdominale avec cette technique de transposition.Matériel et méthodeUne étude rétrospective a été réalisée dans le service de chirurgie plastique de l'hôpital Saint-Louis à Paris, elle concernait les patientes opérées d'une dermolipectomie abdominale avec transposition de l'ombilic, entre le 1er janvier 2012 et le 31 décembre 2012. Toutes les patientes ont été opérées selon notre technique d'ombilicoplastie : désinsertion de l'ombilic en V, réinsertion de l'ombilic en « aile de mouette », un dégraissage périombilical associé à une plicature de la tige ombilicale. Les complications recensées dans les dossiers médicaux des patients et la satisfaction ont été évaluées par un questionnaire téléphonique.RésultatsQuatre-vingt-seize patientes ont été incluses. Aucune patiente n'a présenté de souffrance ou de nécrose ombilicale. Le résultat global de la transposition ombilicale était jugé de bon à excellent pour 92,7 % des patientes.ConclusionL'ombilicoplastie en aile de mouette présente de nombreux avantages : c'est une technique simple, facilement reproductible, fiable, dont les patientes sont pour la plupart très satisfaites.Goal of the studyThe umbilicus has a major role in the aesthetics of the anterior abdominal wall. Many publications deal with abdominal dermolipectomies but few focus on umbilicoplasty. However, these are essential in assessing the aesthetic result. Umbilicoplasty in "aile de mouette" used in our service is reliable and easily reproducible. In this article, we evaluate the satisfaction of patients with abdominal dermolipectomy with this technique of transposition.Materials and methodIn the plastic surgery department of the Saint-Louis Hospital in Paris, we carried out a retrospective study of patients undergoing abdominal dermolipectomy with transposition of the umbilicus, between 1 January 2012 and 31 December 2012. All patients were operated according to our technique of umbilicoplasty: disinsertion of the umbilicus in V, reinsertion of the umbilic in "aile de mouette", a degreasing periumbilical associated with a plication of the umbilical stem. The complications identified in patients medical records and satisfaction were assessed by a telephone questionnaire.ResultsNinety-six patients were included. No patient presented umbilical necrosis. The overall result of umbilical transposition was considered good to excellent for 92.7% of patients.ConclusionUmbilicoplasty in gull wing has many advantages: it is a simple, easily reproducible, reliable technique, the patients of which are for the most part very satisfied.
Development and Evaluation of Lipid Nanoparticles Containing Natural Botanical Oil for Sun Protection: Characterization and in vitro and in vivo Human Skin Permeation and Toxicity
The use of sunscreen products is widely promoted by schools, government agencies, and health-related organizations to minimize sunburn and skin damage. In this study, we developed stable solid lipid nanoparticles (SLNs) containing the chemical UV filter octyl methoxycinnamate (OMC). In parallel, we produced similar stable SLNs in which 20% of the OMC content was replaced by the botanical urucum oil. When these SLNs were applied to the skin of human volunteers, no changes in fluorescence lifetimes or redox ratios of the endogenous skin fluorophores were seen, suggesting that the formulations did not induce toxic responses in the skin. Ex vivo (skin diffusion) tests showed no significant penetration. In vitro studies showed that when 20% of the OMC was replaced by urucum oil, there was no reduction in skin protection factor (SPF), suggesting that a decrease in the amount of chemical filter may be a viable alternative for an effective sunscreen, in combination with an antioxidant-rich vegetable oil, such as urucum. There is a strong trend towards increasing safety of sun protection products through reduction in the use of chemical UV filters. This work supports this approach by producing formulations with lower concentrations of OMC, while maintaining the SPF. Further investigations of SPF in vivo are needed to assess the suitability of these formulations for human use.
Skin Pharmacol Physiol 2018;31:1-9
Higher-Order Thought, Self-Identification, and Delusions of Disownership
Abstract
David Rosenthal's higher-order thought (HOT) theory says that for a mental state to be conscious, it must be accompanied by a higher-order thought about that state. One objection to Rosenthal's account is that HOTs do not secure what Sydney Shoemaker has called 'immunity to error through misidentification' (IEM). I will argue that Rosenthal's discussion of dissociative identity order fails to salvage his account from this objection and that his thin immunity principle is in tension with cases of somatoparaphrenia. Rather than showing that self-awareness consists in identification, an examination of the delusions of disownership found in dissociative identity disorder and somatoparaphrenia lends support to IEM and highlights an important distinction between perspectival ownership and personal ownership.
Ecotoxicological efficiency of advanced ozonation processes with TiO 2 and black light used in the degradation of carbamazepine
Abstract
The aim of the present study was to evaluate the ecotoxicological efficiency of two advanced ozonation processes (AOzPs), the catalytic ozonation (O3/TiO2) and the photocatalytic ozonation (O3/TiO2/black light), in the remotion of carbamazepine. The ecotoxicological efficiency was assessed through the use of lethal and sublethal assays with species Vibrio fischeri and Daphnia magna. Results demonstrated that the AOzPs presented an efficiency of carbamazepine removal higher than 99% (carbamazepine < 2 μg/L) after 12 min of treatment. Relatively to ecotoxicological evaluation, application of acute assay to V. fischeri and chronic assay to D. magna allowed us to highlight that these technologies may form some transformation products that induce toxicity in the bacteria and the crustacean, once these organisms exposed to the undiluted solutions (100%) showed a decrease in the bioluminescence (vibrio) and end up dying before and during the first reproduction (daphnia). Despite that, when the chronic results obtained with the diluted solutions (50 and 25%; important to assess a more realistic scenario considering the dilution factor at the environment) were analyzed, no mortality at the mothers was observed. Compared to a carbamazepine solution (200 μg/L), diluted solutions improved of the reproduction parameters, and no toxic effects in the juvenoid system and in the embryonic development were observed. Relatively to the ecdysteroid effect of a carbamazepine solution (200 μg/L), only the photocatalytic ozonation treatment was able to remove the action of the drug. These results highlight the importance of complementing chemical analysis with ecotoxicological bioassays to assess the best technology to improve the surface water and effluent quality.
Mast cells partially contribute to mucosal adjuvanticity of surfactin in mice
Abstract
Introduction
Surfactin (SF) is a cyclic lipopeptide that has potent mucosal adjuvant properties. However, immunological mechanisms of SF adjuvant action have not yet been elucidated. As some cyclic lipopeptides, such as polymyxin, can stimulate histamine release from mast cells, we hypothesized that mast cell activation is critical for SF adjuvanticity.
Methods/Results
We observed that following intranasal immunization with ovalbumin (OVA) plus SF, the titers of the OVA-specific antibody (Ab) in the mucosal secretions and plasma of mast cell-deficient mice were significantly lower than those in congenic normal mice, although OVA-specific Ab did not entirely disappear from mast cell-deficient mice. SF induced degranulation of mast cells and release of histamine in vitro. To investigate whether SF stimulated mast cells in vivo, we measured body temperature of mice immunized intranasally with OVA plus SF because histamine level affects body temperature. Following immunizations, body temperature of immunized congenic normal mice transiently decreased, whereas body temperature of mast cell-deficient mice did not change. Plasma levels of OVA-specific IgE Ab were not significantly different in mast cell-deficient and congenic normal mice. These findings suggest that SF directly affected mast cells in an IgE Ab-independent fashion. Furthermore, we analyzed the effects of SF on MC/9 mast cells cultured in vitro. MC/9 cells stimulated by SF released not only histamine but also leukotriene B4 and prostaglandin D2. Moreover, SF up-regulated mRNA expression levels of Tnf, Ccr5, and Il4 genes in mast cells. These cytokines may play a facilitating role in OVA-specific immune responses in mice.
Conclusion
Overall, our results showed that mast cell activation partially mediated SF adjuvanticity.
Surfactin is a cyclic lipopeptide that has potent mucosal adjuvant properties. In experiments in vivo, using mast cell deficient W/Wv mice, as well as in tests using cultured MC/9 mast cells, we observed that exposure to surfactin directly activated mast cells and augmented immune responses in vivo and increased expression levels of several important cytokines in vitro.
Transcriptional and translational-uncoupling in regulation of the CXCL12 and its receptors CXCR4, 7 in THP-1 monocytes and macrophages
Abstract
Introduction
The chemokine CXCL12 and its receptors CXCR4 and 7 play crucial roles in the immune system. In the present study, regulation of this pathway was further examined using the in-vitro model of undifferentiated human THP-1 monocytes (u-THP-1) and phorbol 12-myristate 13-acetate (PMA)-differentiated THP-1 macrophages (d-THP-1), to assess the effects of differentiation and the TLR4 ligand lipopolysaccharide (LPS) on the pathway.
Methods/Results
Differentiation did not affect the CXCR4, 7 mRNA levels. Interestingly, the CXCL12 and CXCR7 proteins but not CXCR4 were found to be up-regulated during differentiation. LPS, through CD14-dependent pathway, induced CXCL12 and CXCR4, 7 mRNA levels to a greater magnitude in d- than u-THP-1. The induction effect on CXCL12 stimulated by LPS was confirmed using ELISA. Increased migration of u-THP-1 was observed using conditioned medium from LPS-treated d-THP-1. Additionally, d-THP-1, although expressed higher CXCR7 protein levels, failed to migrate toward CXCL12. In contrast, LPS did not affect CXCR4, 7 protein levels.
Conclusion
Hence, this study indicated that CXCL12, CXCR4, and CXCR7 were differentially expressed and regulated in u-THP-1 and d-THP-1 cells in response to external stimuli. Importantly, we reported here a novel observation that uncoupling exists between transcriptional and translational regulation of CXCR4, 7 expressions by differentiation and TLR stimuli.
CXCL12 and CXCR4, 7 are differentially expressed and regulated in u-THP-1 and d-THP-1 cells in response to external stimuli. A disconnect between transcriptional and translational regulation of CXCR4, 7 expressions by differentiation and TLR stimuli exists.
1,3-Di-n-butylimidazolium tribromide [BBim]Br3: An efficient recyclable catalyst mediated synthesis of N-substituted azepines and their biological evaluation-interaction study with human serum albumin
Publication date: Available online 2 November 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Swetha K. Maddili, Rakhi Chowrasia, Vijaya Kumar Kannekanti, Himabindu Gandham
A majority of previously reported methods suffer from insufficient yields as well as more complicated experimental procedures, a smaller amount of isolated yields involving time-consuming and tiresome work-up with the use of metal catalyst and restricted scope of substrates. To overcome these issues, an environmentally benign, ionic liquid endorsed multi-component protocol to N-substituted azepines has been exploited by means of coupling aromatic amines, dimethyl/diethyl acetylene dicarboxylate, 2,5-dimethoxytetrahydrofuran using 1,3-Di-n-butylimidazolium tribromide [BBim]Br3. The catalyst can be recycled and reused for subsequent reactions. The reactivated ionic liquid could be further reused twice as an accelerator All the synthesized compounds were further screened for their antimicrobial properties against three gram positive, four gram negative, and five fungal strains with chloromycin, norflaxacin, and fluconazole as reference drugs. Most of the tested compounds presented significant potency, especially, compound 4e displayed significant antibacterial activity (MIC=1–16μg/mL) whereas compound 4k showed momentous antifungal efficacy (MIC=2–32μg/mL). In addition binding behavior of compound 4e was investigated by binding study between calf thymus DNA and compound 4e by UV–Visible absorption spectroscopy and further research about HSA interactions were carried out. The observed wavelength showed a constancy thus revealing the occurrence of non-covalent π-π stacking interactions of compound 4e and HSA.
Graphical abstract
An extended sequence specificity for UV-induced DNA damage
Publication date: Available online 2 November 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Long H. Chung, Vincent Murray
The sequence specificity of UV-induced DNA damage was determined with a higher precision and accuracy than previously reported. UV light induces two major damage adducts: cyclobutane pyrimidine dimers (CPDs) and pyrimidine(6–4)pyrimidone photoproducts (6–4PPs). Employing capillary electrophoresis with laser-induced fluorescence and taking advantages of the distinct properties of the CPDs and 6–4PPs, we studied the sequence specificity of UV-induced DNA damage in a purified DNA sequence using two approaches: end-labelling and a polymerase stop/linear amplification assay. A mitochondrial DNA sequence that contained a random nucleotide composition was employed as the target DNA sequence. With previous methodology, the UV sequence specificity was determined at a dinucleotide or trinucleotide level; however, in this paper, we have extended the UV sequence specificity to a hexanucleotide level. With the end-labelling technique (for 6–4PPs), the consensus sequence was found to be 5′-GCTC*AC (where C* is the breakage site); while with the linear amplification procedure, it was 5′-TCTT*AC. With end-labelling, the dinucleotide frequency of occurrence was highest for 5′-TC*, 5′-TT* and 5′-CC*; whereas it was 5′-TT* for linear amplification. The influence of neighbouring nucleotides on the degree of UV-induced DNA damage was also examined. The core sequences consisted of pyrimidine nucleotides 5′-CTC* and 5′-CTT* while an A at position "1" and C at position "2" enhanced UV-induced DNA damage.
Peptide transporter YjiY influences the expression of the virulence gene mgtC to regulate biofilm formation in Salmonella
Abstract
Biofilm is one of the coping strategies of Salmonella against antimicrobial environmental stresses including nutrient starvation. However, channeling of the cue of starvation towards biofilm formation is not understood well. Our study shows that a carbon starvation gene, yjiY, coding for a peptide transporter, influences the expression of a virulence associated gene, mgtC, in Salmonella, to regulate biofilm formation. We demonstrate here that the mutant strain, ΔyjiY, is unable to form biofilm due to the increased expression of mgtC. The upregulation of mgtC in ΔyjiY strain correlates with the downregulation of biofilm master regulator gene csgD and reduced levels of ATP. Our work further indicates that yjiY coded peptide transporter may regulate the expression of mgtC by transporting proline peptides.An automatic markerless registration method for neurosurgical robotics based on an optical camera
Abstract
Purpose
Current markerless registration methods for neurosurgical robotics use the facial surface to match the robot space with the image space, and acquisition of the facial surface usually requires manual interaction and constrains the patient to a supine position. To overcome these drawbacks, we propose a registration method that is automatic and does not constrain patient position.
Methods
An optical camera attached to the robot end effector captures images around the patient's head from multiple views. Then, high coverage of the head surface is reconstructed from the images through multi-view stereo vision. Since the acquired head surface point cloud contains color information, a specific mark that is manually drawn on the patient's head prior to the capture procedure can be extracted to automatically accomplish coarse registration rather than using facial anatomic landmarks. Then, fine registration is achieved by registering the high coverage of the head surface without relying solely on the facial region, thus eliminating patient position constraints.
Results
The head surface was acquired by the camera with a good repeatability accuracy. The average target registration error of 8 different patient positions measured with targets inside a head phantom was \(1.39\pm 0.33\,\hbox {mm}\) , while the mean surface registration error was \(0.35\,\hbox {mm}\) .
Conclusion
The method proposed in this paper achieves automatic markerless registration in multiple patient positions and guarantees registration accuracy inside the head. This method provides a new approach for establishing the spatial relationship between the image space and the robot space.
Curcumin dietary supplements and everolimus-based cancer treatment.
curcumineverolimuspharmacokineticsbreast cancerCYP3A4drug-drug interaction
Effect of docetaxel duration on clinical outcomes: exploratory analysis of CLEOPATRA, a phase III randomized controlled trial
Abstract
Background
Combination pertuzumab, trastuzumab, and docetaxel (D) is considered standard first-line treatment for human epidermal growth factor receptor 2 (HER2)–positive metastatic breast cancer (MBC). This post hoc, exploratory analysis of CLEOPATRA study data evaluated the clinical effects of D treatment duration within this regimen. The clinical benefits of pertuzumab and trastuzumab by different durations of D treatment were also evaluated. Patients and methods
Patients with HER2-positive MBC received trastuzumab and D plus pertuzumab or placebo. Clinical outcomes were analyzed by the number of D cycles that patients received (<6D, 6D, or > 6D). Progression-free survival (PFS) and overall survival (OS) for each treatment arm within each D cycle group were estimated using the Kaplan–Meier approach. Time-dependent, multivariate Cox regression was applied to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for HER2-targeted therapy and D cycle groups. Results
Overall, 804 patients received <6D (n=119), 6D (n=210), or > 6D (n=475) cycles. After adjusting for pertuzumab benefits versus placebo (PFS HR = 0.61, 95% CI 0.51–0.74, P<0.0001; OS HR = 0.60, 95% CI, 0.49–0.74, P<0.0001), >6D versus 6D cycles was not associated with statistically significant improvements in PFS (HR = 0.80, 95% CI 0.63–1.01, P=0.0640) or OS (HR = 0.88, 95% CI 0.69–1.12, P=0.3073). Consistent improvements in PFS and OS were observed with pertuzumab versus placebo, irrespective of D duration. The HRs for PFS were 0.395, 0.615, and 0.633 for <6D, 6D, and >6D cycles, respectively (P<0.05 for all D cycle groups). Corresponding HRs for OS were 0.577, 0.700, and 0.612, respectively (P<0.05 for <6D and >6D). Conclusions
After accounting for pertuzumab benefits, more than 6 cycles of D treatment was not associated with significant improvements in either PFS or OS compared with 6 cycles. The addition of pertuzumab to trastuzumab improved clinical outcomes versus trastuzumab plus placebo, regardless of D treatment duration.ClinicalTrials.gov identifier: NCT00567190Circulating tumor DNA predicts survival in patients with resected high risk stage II/III melanoma
Abstract
Background
Patients with high-risk stage II/III resected melanoma commonly develop distant metastases. At present, we cannot differentiate between patients who will recur or those who are cured by surgery. We investigated if circulating tumor DNA (ctDNA) can predict relapse and survival in patients with resected melanoma. Patients and methods
We performed droplet digital polymerase chain reaction to detect BRAF and NRAS mutations in plasma taken after surgery from 161 stage II/III high-risk melanoma patients enrolled in the AVAST-M adjuvant trial. Results
Mutant BRAF or NRAS ctDNA was detected (≥1 copy of mutant ctDNA) in 15/132 (11%) BRAF mutant patient samples and 4/29 (14%) NRAS mutant patient samples. Patients with detectable ctDNA had a decreased disease-free interval (DFI; hazard ratio [HR] 3.12; 95% confidence interval [CI] 1.79-5.47; P<0.0001) and distant metastasis-free interval (DMFI; HR 3.22; 95% CI 1.80-5.79; P<0.0001) versus those with undetectable ctDNA. Detectable ctDNA remained a significant predictor after adjustment for performance status (PS) and disease stage (DFI HR 3.26, 95% CI 1.83-5.83, P<0.0001; DMFI HR = 3.45, 95% CI 1.88-6.34, P<0.0001). Five year overall survival (OS) rate for patients with detectable ctDNA was 33% (95% CI 14-55%) versus 65% (95% CI 56-72%) for those with undetectable ctDNA. OS was significantly worse for patients with detectable ctDNA (HR 2.63; 95% CI 1.40-4.96); P=0.003) and remained significant after adjustment for PS (HR 2.50, 95% CI 1.32-4.74, P=0.005). Conclusion
CtDNA predicts for relapse and survival in high-risk resected melanoma and could aid selection of patients for adjuvant therapy. Clinical trial number
ISRCTN 81261306Advances in the Management of Melanoma
Abstract
Purpose of Review
Stage IV melanoma is an aggressive malignancy with the median survival historically being less than 1 year. Approximately 50% of melanomas contain an activating mutation in a targetable component of the mitogen-activated protein kinase (MAPK) pathway called BRAF. Melanoma growth is modulated by activating and inhibitory immune checkpoints. Advances in the management of distantly metastatic and stage III melanoma are reviewed.
Recent Findings
Targeting BRAF signaling in patients with metastatic V600 BRAF mutated melanoma and modulation of immune checkpoints confer survival benefit to patients with distantly metastatic melanoma. CTLA-4 blockade confers survival benefit as adjuvant therapy in patients with stage III melanoma.
Summary
The efficacy of systemic therapy to treat stage IV melanoma is improving. Advances are being made to improve efficacy of adjuvant therapy for high-risk stage III melanoma patients and to determine optimal surgical management of patients with sentinel lymph node-positive melanoma.
Pharmacokinetics and Pharmacodynamic Target Attainment of Benzylpenicillin in an Adult Severely ill Sub-Saharan African Patient Population
Abstract
Background
In intensive care (ICU) patients, systemic exposure of β-lactam antibiotics can be altered, and positive clinical outcome is associated with increasing fT>MIC ratios. In sub-Saharan African (SSA) hospitals, benzylpenicillin (PEN) is frequently used for the empirical treatment of severe pneumococcal infections. Pharmacokinetic data for non-ICU hospitalized populations are lacking. Methods
We performed a population pharmacokinetic (PPK) study in an adult Mozambican hospital population treated intravenously with PEN from October 2014-November 2015. Four blood samples/patient were collected for total PEN (PENt) and unbound PEN (PENu) concentration measurement. We developed a PPK model through non-linear mixed effect analysis and performed simulations for different patient variable, dosing, and pharmacodynamic target scenarios. Results
112 participants yielded 387 PENt and 53 PENu concentrations. The median (range) body mass index was 18.3 (10.5-31.3) and the median albumin concentration and creatinine clearance (CLCR) were 29 (12-44) g/L and 80 (3-195) mL/min, respectively. In a one-compartment model, CLCR was positively correlated with PENt CL. For infections with a microorganism with an MIC of 1 mg/L, simulations demonstrated that with 3 million IU (1.8 g) q6h, 74.1% would have a PENu concentration >MIC during half of the dosing interval (fT>MIC=50%), while this was 24.8% for the fT>MIC=100% target. For pathogens with an MIC of 0.06 mg/L, these percentages were 98.2% and 72.3%. Conclusions
Severely ill adult non-ICU SSA patients may be at high risk for underexposure to PENu during routine intermittent bolus dosing, especially when their renal function is intact and when infected with pathogens with intermediate susceptibility.Interventions to reduce the incidence of hospital-onset Clostridium difficile infection: An agent-based modeling approach to evaluate clinical effectiveness in adult acute care hospitals
Abstract
Background
Despite intensified efforts to reduce hospital-onset Clostridium difficile infection (C. difficile; HO-CDI), its clinical and economic impacts continue to worsen. Many institutions have adopted bundled interventions that vary considerably in composition, strength of evidence, and effectiveness. Considerable gaps remain in our knowledge of intervention effectiveness and disease transmission, which hinders HO-CDI prevention. Methods
We developed an agent-based model of C. difficile transmission in a 200-bed adult hospital using studies from the literature, supplemented with primary data collection. The model includes an environmental component and four distinct agent types: patients, visitors, nurses, and physicians. We used the model to evaluate the comparative clinical effectiveness of nine single-interventions and eight multiple-intervention bundles at reducing HO-CDI and asymptomatic C. difficile colonization. Results
Daily cleaning with sporicidal disinfectant and C. difficile screening at admission were the most effective single-intervention strategies, reducing HO-CDI by 68.9% and 35.7%, respectively (both, p<0.001). Combining these interventions into a two-intervention bundle reduced HO-CDI 82.3% and asymptomatic hospital-onset colonization 90.6% (both, p<0.001). Adding patient hand hygiene to healthcare worker hand hygiene reduced HO-CDI rates an additional 7.9%. Visitor hand hygiene and contact precaution interventions did not reduce HO-CDI, compared to baseline. Excluding those strategies, healthcare worker contact precautions was the least effective intervention at reducing hospital-onset colonization and infection. Conclusions
Identifying and managing the vast hospital reservoir of asymptomatic C. difficile by screening and daily cleaning with sporicidal disinfectant are high yield strategies. These findings provide much needed data regarding which interventions to prioritize for optimal C. difficile control.Grand convergence in wound healing - The imperative for collaboration in research, innovation and quality improvement
Publication date: Available online 1 November 2017
Source:Journal of Tissue Viability
Author(s): Ray Samuriwo
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Publication date: Available online 25 July 2018 Source: Journal of Photochemistry and Photobiology B: Biology Author(s): Marco Ballestr...
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Editorial AJR Reviewers: Heartfelt Thanks From the Editors and Staff Thomas H. Berquist 1 Share + Affiliation: Citation: American Journal...
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Publication date: Available online 28 September 2017 Source: Actas Dermo-Sifiliográficas Author(s): F.J. Navarro-Triviño
