Heterogeneity in retinoblastoma: a tale of molecules and models

Retinoblastoma, an intraocular pediatric cancer, develops in the embryonic retina following biallelic loss of RB1. However, there is a wide range of genetic and epigenetic changes that can affect RB1 resulting in...

Response to “Providing dermatological care in resource-limited settings: barriers and potential solutions” – reply from authors

We thank Drs. Mahé and Faye for their interest in our article. We applaud them for their tremendous work in improving the delivery of dermatologic care through their programme with healthcare professionals in Mali.

This article is protected by copyright. All rights reserved.

Psychological stress and psoriasis. A systematic review and meta-analysis

Abstract

Background

Psychological stress has long been linked with psoriasis exacerbation/onset. However, it is unclear if they are associated.

Objective

To determine if antecedent psychological stress and psoriasis exacerbation/onset are associated.

Methods

A comprehensive search of Pubmed, PsycINFO, Cochrane library, and clinicaltrials. gov databases was performed. Studies investigating the association between preceding psychological stress and psoriasis exacerbation/onset were classified as cross-sectional, case-control or cohort. Surveys evaluating beliefs regarding stress-reactivity were analysed separately. Suitable studies were meta-analysed.

Results

Thirty-nine studies were included evaluating 32,537 patients: 19 surveys, 7 cross-sectional, 12 case-controls and 1 cohort. Based on surveys and cross-sectional studies, 46% of patients believed their disease was stress-reactive and 54% recalled preceding stressful events. Case-control studies evaluating stressful events rates prior to psoriasis exacerbation (N=6) or onset (N=6) varied in time lag to recollection (≤9 month to ≥ 5 years). Pooling 5 studies evaluating stressful events preceding psoriasis onset yielded an OR of 3.4 (95%CI, 1.8-6.4, I² =87%), however the only study evaluating documented stress disorder diagnosis reported similar rates (OR 1.2, 95%CI, 0.8-1.8) between patients and controls. Four studies evaluating stressful events prior to psoriasis exacerbation reported comparable rates with controls, while 2 found more frequent/severe preceding events among psoriasis patients. A small prospective cohort study reported a modest association between stress-levels and psoriasis exacerbation (r = 0.28, p < 0.05).

Conclusions

The association between preceding stress and psoriasis exacerbation/onset is based primarily on retrospective studies with many limitations. No convincing evidence exists that preceding stress is strongly associated with psoriasis exacerbation/onset.

This article is protected by copyright. All rights reserved.

Response to “Providing dermatological care in resource-limited settings: barriers and potential solutions”

We read with interest the paper from Chang et al (1). However, the authors overlooked certain solutions that were developed by our team to improve on a large scale the problem of skin diseases (SD) in resource limited settings (RLS), through an organized, public health approach (2-4).

This article is protected by copyright. All rights reserved.

Metal availability, soil nutrient, and enzyme activity in response to application of organic amendments in Cd-contaminated soil

Abstract

The study investigated the effects of organic amendments: green tea amendment (GTA) and oil cake amendment (OCA) on Cd bioavailability, soil nutrients, and soil enzyme activity in Cd-contaminated soil. The amendments were added to the soil at the doses of 1, 3, and 5% and were incubated for 45 days. Then, pakchoi cabbage was planted to test the remediation effect of the above two organic amendments. The diethylenetriaminepentaacetic acid (DTPA)-extractable Cd in GTA and OCA treatments was reduced by 14.69–27.51 and 13.75–68.77%, respectively, compared to no amendment-applied treatment. The application of GTA and OCA notably decreased the proportion of exchangeable fraction of Cd, but increased the percentage of oxide and organic-bound fraction of Cd, thereby suppressing the uptake by pakchoi cabbage. Cd concentration of aboveground parts decreased by 8.21–18.05 and 7.77–35.89% in GTA and OCA treatments, respectively. Relative to the no amendment-applied treatment, both GTA and OCA had enhanced soil nutrients and enzyme activities largely. Redundancy analysis showed that organic matter, total P, available N, and DTPA-extractable Cd significantly affected the enzyme activities. Furthermore, the application of OCA at the dose of 5% was more effective in reducing bioavailable Cd, enhancing soil available nutrients and urease and catalase activities in contaminated soil. These results indicated that oil cake should be used to immobilize metal and improve fertility and quality of Cd-contaminated soil.

Diffusion-Weighted Imaging of the Head and Neck: Influence of Fat-Suppression Technique and Multishot 2D Navigated Interleaved Acquisitions [HEAD & NECK]

BACKGROUND AND PURPOSE:

DWI of the head and neck can reveal valuable information, but the effects of fat suppression and multishot acquisition on image quality have not been thoroughly investigated. We aimed to comprehensively compare the quality of head and neck DWI at 3T using 2 fat-suppression techniques, STIR, and spectral presaturation with inversion recovery, which were used with both single- and multishot EPI.

MATERIALS AND METHODS:

Sixty-five study participants underwent 3 DWI sequences of single-shot EPI–STIR, single-shot EPI–spectral presaturation with inversion recovery, and multishot EPI–spectral presaturation with inversion recovery of the head and neck. In multiple anatomic regions, 2 independent readers assessed 5-point visual scores for fat-suppression uniformity and image distortion, and 1 reader measured the contrast-to-noise ratio and ADC.

RESULTS:

The mean visual score for fat-suppression uniformity was higher in single-shot EPI–STIR than in other sequences (all regions except for the orbital region, P < .05). The mean visual score for image distortion was higher in multishot EPI–spectral presaturation with inversion recovery than in single-shot EPI sequences (all regions, P < .001). Contrast-to-noise ratio was mostly lower in single-shot EPI–STIR than in other sequences (P < .001), and ADC was significantly higher in multishot EPI–spectral presaturation with inversion recovery than in single-shot EPI sequences (P ≤ .001).

CONCLUSIONS:

Overall, multishot EPI–spectral presaturation with inversion recovery provided the best image quality, with relatively homogeneous fat suppression, less image distortion than single-shot EPI sequences, and higher contrast-to-noise ratio than single-shot EPI–STIR. The measured ADC values can be higher in multishot EPI–spectral presaturation with inversion recovery, which necessitates cautious application of the previously reported ADC values to clinical settings.

Semiautomated Evaluation of the Primary Motor Cortex in Patients with Amyotrophic Lateral Sclerosis at 3T [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Amyotrophic lateral sclerosis is a neurodegenerative disease involving the upper and lower motor neurons. In amyotrophic lateral sclerosis, pathologic changes in the primary motor cortex include Betz cell depletion and the presence of reactive iron-loaded microglia, detectable on 7T MR images as atrophy and T2*-hypointensity. Our purposes were the following: 1) to investigate the signal hypointensity-to-thickness ratio of the primary motor cortex as a radiologic marker of upper motor neuron involvement in amyotrophic lateral sclerosis with a semiautomated method at 3T, 2) to compare 3T and 7T results, and 3) to evaluate whether semiautomated measurement outperforms visual image assessment.

MATERIALS AND METHODS:

We investigated 27 patients and 13 healthy subjects at 3T, and 19 patients and 18 healthy subjects at 7T, performing a high-resolution 3D multiecho T2*-weighted sequence targeting the primary motor cortex. The signal hypointensity-to-thickness ratio of the primary motor cortex was calculated with a semiautomated method depicting signal intensity profiles of the cortex. Images were also visually classified as "pathologic" or "nonpathologic" based on the primary motor cortex signal intensity and thickness.

RESULTS:

The signal hypointensity-to-thickness ratio of the primary motor cortex was greater in patients than in controls (P < .001), and it correlated with upper motor neuron impairment in patients ( = 0.57, P < .001). The diagnostic accuracy of the signal hypointensity-to-thickness ratio was high at 3T (area under the curve = 0.89) and even higher at 7T (area under the curve = 0.94). The sensitivity of the semiautomated method (0.81) outperformed the sensitivity of the visual assessment (0.56–0.63) at 3T.

CONCLUSIONS:

The signal hypointensity-to-thickness ratio of the primary motor cortex calculated with a semiautomated method is suggested as a radiologic marker of upper motor neuron burden in patients with amyotrophic lateral sclerosis. This semiautomated method may be useful for improving the subjective radiologic evaluation of upper motor neuron pathology in patients suspected of having amyotrophic lateral sclerosis.

MR Imaging of the Superior Cervical Ganglion and Inferior Ganglion of the Vagus Nerve: Structures That Can Mimic Pathologic Retropharyngeal Lymph Nodes [PERIPHERAL NERVOUS SYSTEM]

BACKGROUND AND PURPOSE:

The superior cervical ganglion and inferior ganglion of the vagus nerve can mimic pathologic retropharyngeal lymph nodes. We studied the cross-sectional anatomy of the superior cervical ganglion and inferior ganglion of the vagus nerve to evaluate how they can be differentiated from the retropharyngeal lymph nodes.

MATERIALS AND METHODS:

This retrospective study consists of 2 parts. Cohort 1 concerned the signal intensity of routine neck MR imaging with 2D sequences, apparent diffusion coefficient, and contrast enhancement of the superior cervical ganglion compared with lymph nodes with or without metastasis in 30 patients. Cohort 2 used 3D neurography to assess the morphology and spatial relationships of the superior cervical ganglion, inferior ganglion of the vagus nerve, and the retropharyngeal lymph nodes in 50 other patients.

RESULTS:

All superior cervical ganglions had homogeneously greater enhancement and lower signal on diffusion-weighted imaging than lymph nodes. Apparent diffusion coefficient values of the superior cervical ganglion (1.80 ± 0.28 x 10^–3mm²/s) were significantly higher than normal and metastatic lymph nodes (0.86 ± 0.10 x 10^–3mm²/s, P < .001, and 0.73 ± 0.10 x 10^–3mm²/s, P < .001). Ten and 13 of 60 superior cervical ganglions were hypointense on T2-weighted images and had hyperintense spots on both T1- and T2-weighted images, respectively. The latter was considered fat tissue. The largest was the superior cervical ganglion, followed in order by the retropharyngeal lymph node and the inferior ganglion of the vagus nerve (P < .001 to P = .004). The highest at vertebral level was the retropharyngeal lymph nodes, followed, in order, by the inferior ganglion of the vagus nerve and the superior cervical ganglion (P < .001 to P = .001). The retropharyngeal lymph node, superior cervical ganglion, and inferior ganglion of the vagus nerve formed a line from anteromedial to posterolateral.

CONCLUSIONS:

The superior cervical ganglion and the inferior ganglion of the vagus nerve can be almost always differentiated from retropharyngeal lymph nodes on MR imaging by evaluating the signal, size, and position.

Long-Term Effectiveness of Direct CT-Guided Aspiration and Fenestration of Symptomatic Lumbar Facet Synovial Cysts [SPINE]

BACKGROUND AND PURPOSE:

Lumbar facet synovial cysts are commonly seen in facet degenerative arthropathy and may be symptomatic when narrowing the spinal canal or compressing nerve roots. The purpose of this study was to analyze the safety, effectiveness, and long-term outcomes of direct CT-guided lumbar facet synovial cyst aspiration and fenestration for symptom relief and for obviating an operation.

MATERIALS AND METHODS:

We retrospectively reviewed the medical records and imaging studies of 64 consecutive patients between 2006 and 2016 who underwent 85 CT-guided lumbar facet synovial cyst fenestration procedures in our department. We recorded patient demographics, lumbar facet synovial cyst imaging characteristics, presenting symptoms, change in symptoms after the procedure, and whether they underwent a subsequent operation. We also assessed long-term outcomes from the medical records and via follow-up telephone surveys with patients.

RESULTS:

Direct CT-guided lumbar facet synovial cyst puncture was technically successful in 98% of procedures. At first postprocedural follow-up, 86% of patients had a complete or partial symptomatic response. During a mean follow-up of 49 months, 56% of patients had partial or complete long-term relief without the need for an operation; 44% of patients underwent an operation. Patients with calcified, thick-rimmed, or low T2 signal intensity cysts were less likely to respond to the procedure and more likely to need an operation.

CONCLUSIONS:

CT-guided direct lumbar facet synovial cyst aspiration and fenestration procedures are safe, effective, and minimally invasive for symptomatic treatment of lumbar synovial facet cysts. This procedure obviates an operation in a substantial number of patients, even at long-term follow-up, and should be considered before surgical intervention.

Effect of an Arm Traction Device on Image Quality and Radiation Exposure during Neck CT: A Prospective Study [HEAD & NECK]

BACKGROUND AND PURPOSE:

The image quality of neck CT is frequently disturbed by streak artifact from the shoulder girdles. Our aim was to determine the effects of an arm traction device on image quality and radiation exposure in neck CT.

MATERIALS AND METHODS:

Patients with lymphoma with complete remission who were scheduled to undergo 2 consecutive follow-up neck CT scans for surveillance within a 1-year interval were enrolled in this prospective study. They underwent 2 consecutive neck CT scans (intervention protocol: patients with an arm traction device; standard protocol: no positioning optimization) on the same CT system. The primary outcome measures were image noise in the lower neck and dose-length product. Secondary outcomes were streak artifacts in the supraclavicular fossa, volume CT dose index, and the extent of the biacromial line shift.

RESULTS:

Seventy-three patients were enrolled and underwent 2 consecutive CT scans with a mean interval of 155 days. In the intervention protocol, a mean noise reduction in the lower neck of 25.2%–28.5% (P < .001) was achieved, and a significant decrease in dose-length product (413 versus 397, P < .001) was observed. The intervention protocol significantly decreased streak artifacts (P < .001) and volume CT dose index (13.9 versus 13.4, P < .001) and could lower the biacromial line an average of 2.1 cm.

CONCLUSIONS:

An arm traction device can improve image quality and reduce radiation exposure during neck CT. The device can be simply applied in cooperative patients with suspected lower neck lesions, and the approach offers distinct advantages over the conventional imaging protocol.

Spinal Cord Gray Matter Atrophy in Amyotrophic Lateral Sclerosis [SPINE]

BACKGROUND AND PURPOSE:

There is an emerging need for biomarkers to better categorize clinical phenotypes and predict progression in amyotrophic lateral sclerosis. This study aimed to quantify cervical spinal gray matter atrophy in amyotrophic lateral sclerosis and investigate its association with clinical disability at baseline and after 1 year.

MATERIALS AND METHODS:

Twenty-nine patients with amyotrophic lateral sclerosis and 22 healthy controls were scanned with 3T MR imaging. Standard functional scale was recorded at the time of MR imaging and after 1 year. MR imaging data were processed automatically to measure the spinal cord, gray matter, and white matter cross-sectional areas. A statistical analysis assessed the difference in cross-sectional areas between patients with amyotrophic lateral sclerosis and controls, correlations between spinal cord and gray matter atrophy to clinical disability at baseline and at 1 year, and prediction of clinical disability at 1 year.

RESULTS:

Gray matter atrophy was more sensitive to discriminate patients with amyotrophic lateral sclerosis from controls (P = .004) compared with spinal cord atrophy (P = .02). Gray matter and spinal cord cross-sectional areas showed good correlations with clinical scores at baseline (R = 0.56 for gray matter and R = 0.55 for spinal cord; P < .01). Prediction at 1 year with clinical scores (R² = 0.54) was improved when including a combination of gray matter and white matter cross-sectional areas (R² = 0.74).

CONCLUSIONS:

Although improvements over spinal cord cross-sectional areas were modest, this study suggests the potential use of gray matter cross-sectional areas as an MR imaging structural biomarker to monitor the evolution of amyotrophic lateral sclerosis.

Prediction of IDH1-Mutation and 1p/19q-Codeletion Status Using Preoperative MR Imaging Phenotypes in Lower Grade Gliomas [ADULT BRAIN]

BACKGROUND AND PURPOSE:

WHO grade II gliomas are divided into three classes: isocitrate dehydrogenase (IDH)-wildtype, IDH-mutant and no 1p/19q codeletion, and IDH-mutant and 1p/19q-codeleted. Different molecular subtypes have been reported to have prognostic differences and different chemosensitivity. Our aim was to evaluate the predictive value of imaging phenotypes assessed with the Visually AcceSAble Rembrandt Images lexicon for molecular classification of lower grade gliomas.

MATERIALS AND METHODS:

MR imaging scans of 175 patients with lower grade gliomas with known IDH1 mutation and 1p/19q-codeletion status were included (78 grade II and 97 grade III) in the discovery set. MR imaging features were reviewed by using Visually AcceSAble Rembrandt Images (VASARI); their associations with molecular markers were assessed. The predictive power of imaging features for IDH1-wild type tumors was evaluated using the Least Absolute Shrinkage and Selection Operator. We tested the model in a validation set (40 subjects).

RESULTS:

Various imaging features were significantly different according to IDH1 mutation. Nonlobar location, larger proportion of enhancing tumors, multifocal/multicentric distribution, and poor definition of nonenhancing margins were independent predictors of an IDH1 wild type according to the Least Absolute Shrinkage and Selection Operator. The areas under the curve for the prediction model were 0.859 and 0.778 in the discovery and validation sets, respectively. The IDH1-mutant, 1p/19q-codeleted group frequently had mixed/restricted diffusion characteristics and showed more pial invasion compared with the IDH1-mutant, no codeletion group.

CONCLUSIONS:

Preoperative MR imaging phenotypes are different according to the molecular markers of lower grade gliomas, and they may be helpful in predicting the IDH1-mutation status.

List of reviewers 2017

Trendy Tattoos—Maybe a Serious Health Risk?

Abstract

Background

The literature reports many cases of cutaneous malignancy in the setting of skin tattoos. In this study, we review the reported incidence of and risk factors for tattoo-associated skin cancer.

Methods

A PubMed literature review was performed for all cases of tattoo-associated skin cancer, including squamous cell carcinoma, basal cell carcinoma, malignant melanoma, keratoacanthoma, and other rare skin malignancies (source: PubMed/until June 2017).

Results

The authors identified 51 publications and 63 total cases of tattoo-associated skin cancer. We also report on a single new case of tattoo-associated skin cancer observed at one of our co-authors' institutions. Among these 64 total cases, 58% were associated with black and blue inks and 34% were associated with red ink.

Conclusions

Overall, while the strength of association remains unclear, the literature reports many cases of tattoo-associated skin cancer. Among these cases, black, blue, and red inks were particularly worrisome for their carcinogenic potential.

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.

Use of the BREAST-Q™ Survey in the Prospective Evaluation of Reduction Mammaplasty Outcomes

Abstract

Introduction

BREAST-Q™ is a patient-reported outcomes survey instrument with a specific module that evaluates breast reduction surgery. It allows assessment of patient's satisfaction with received treatment and evaluates the impact of surgery on different aspects of the patient's quality of life. This article aims to assess the satisfaction and quality of life of patients who underwent reduction mammaplasty.

Materials and Methods

Women aged between 18 and 60 years, with a body mass index ranging from 19 to 30 kg/m², who were already scheduled for reduction mammaplasty, were included in the study. The Brazilian version of the BREAST-Q™ Reduction/Mastopexy Module (preoperative 1.0 and postoperative 1.0 versions) was self-applied preoperatively and 1 and 6 months after the operation.

Results

One hundred and seven patients were included in the study and completed the 6-month follow-up. The median age was 33 years, and the median preoperative body mass index was 25 kg/m². The superomedial pedicle was used in 96.3% of the cases, and the total median weight of the resected breast was 1115 g. There was a significant improvement in the scores of the scales: Psychosocial well-being, Sexual well-being, Physical well-being, and Satisfaction with the breasts compared to the preoperative assessment (p < 0.0001). The scales Satisfaction with the NAC and Satisfaction with the outcome, available only in the postoperative version, demonstrated high satisfaction rates at the two postoperative periods evaluated.

Conclusion

Reduction mammaplasty improved the quality of life and provided high levels of patient satisfaction with outcomes 1 and 6 months postoperatively.

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.

Usefulness of Cross-Linked Human Acellular Dermal Matrix as an Implant for Dorsal Augmentation in Rhinoplasty

Abstract

Background

Asian noses are relatively small and flat compared to Caucasians; therefore, rhinoplasty procedures often focus on dorsal augmentation and tip projection rather than reduction in the nasal framework. Various autologous and alloplastic implant materials have been used for dorsal augmentation. Recently, human acellular dermal matrices have been introduced as an implant material for dorsal augmentation, camouflaging autologous implants without an additional donor site. Here, we introduce a cross-linked human acellular dermal matrix as an implant material in augmentation rhinoplasty and share the clinical experiences.

Methods

Eighteen patients who underwent augmentation rhinoplasty using acellular dermal matrix from April 2014 to November 2015 were reviewed retrospectively. Clinical outcomes and complications were assessed at the outpatient clinic during the follow-up period ranging from 8 to 38 months. Contour changes were assessed through comparison of preoperative and postoperative photographs by two independent plastic surgeons. Patient satisfaction was assessed at the outpatient clinic by six questions regarding aesthetic and functional aspects.

Results

Postoperative photographs demonstrated the height of the nasal dorsum did not decrease over time except two patients whose ADM was grafted into a subperiosteal pocket. Others who underwent supraperiosteal implantation showed acceptable maintenance of dorsal height. No major complication was reported. Overall, patient satisfaction scored 81.02 out of 100.

Conclusions

Cross-linked human ADM has advantages of both autogenous and alloplastic materials. The surgical results remain stable without complications. Therefore, it is a suitable alternative implant material for dorsal augmentation in rhinoplasty.

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.

Environmental impacts the of production and use of biodiesel

Abstract

Biodiesel as renewable, environmental friendly, less toxic, and biodegradable is an attractive alternative to fossil fuels and is produced mainly from vegetable oils and animal fats. It is expected, globally, that the use of renewable biofuels, in general, will increase rapidly in the near future. The growing biodiesel production and usage have encouraged assessment of its impact on the environment. The present paper reviews various aspects of biodiesel production using commercial processing technology and biodiesel use through evaluation and analysis of the studies concerning environmental impacts of biodiesel. As a general conclusion, it can be said that biodiesel has the potential to offer a series of perceived benefits such as political, economical, and agricultural, as well as environmental (due to its biodegradability, less toxicity, renewability) and health (greenhouse gas-saving, less harmful exhaust emissions).

Usefulness of Ultrasound in the Diagnosis and Follow-up of Pyoderma Gangrenosum

Publication date: Available online 9 November 2017
Source:Actas Dermo-Sifiliográficas (English Edition)
Author(s): M. Pousa-Martínez, D. Sánchez-Aguilar, C. Aliste, H. Vázquez-Veiga

Moderate Psoriasis: A Proposed Definition

Publication date: Available online 8 November 2017
Source:Actas Dermo-Sifiliográficas (English Edition)
Author(s): M. Llamas-Velasco, P. de la Cueva, J. Notario, L. Martínez-Pilar, A. Martorell, D. Moreno-Ramírez
IntroductionThe Psoriasis Area Severity Index (PASI) is the most widely used scale for assessing the severity of psoriasis and for therapeutic decision making. On the basis of the PASI score, patients have been stratified into 2 groups: mild disease and moderate-to-severe disease.ObjectiveTo draft a proposal for the definition and characterization of moderate psoriasis based on PASI and Dermatology Life Quality Index (DLQI) scores.Material and methodsA group of 6 dermatologists with experience in the treatment of psoriasis undertook a critical review of the literature and a discussion of cases to draft a proposal.ResultsIn order of priority, PASI, DLQI, and body surface area (BSA) are the parameters to be used in daily practice to classify psoriasis as mild, moderate, or severe. Severity should be assessed on the basis of a combined evaluation and interpretation of the PASI and DLQI. And 3, PASI and DLQI should carry equal weight in the determination of disease severity. On this basis, psoriasis severity was defined using the following criteria: mild, PASI<7 and DLQI<7; moderate, PASI=7-15 and DLQI=5-15 (classified as severe when difficult-to-treat sites are affected or when there is a significant psychosocial impact); severe, PASI >15, independently of the DLQI score.ConclusionsA more precise classification of psoriasis according to disease severity will improve the risk-benefit assessment essential to therapeutic decision making in these patients.

Ultrasound Characterization of Psoriasis of the Nails: A Case-Control Study

Publication date: Available online 9 November 2017
Source:Actas Dermo-Sifiliográficas (English Edition)
Author(s): D. Vidal, F. Alfageme, R. Ruiz-Villaverde, S. Arias-Santiago, A. Martorell

Reductive Augmentation of the Breast

Abstract

Aim

Although breast reduction surgery plays an invaluable role in the correction of macromastia, it almost always results in a breast lacking in upper pole fullness and/or roundness. We present a technique of breast reduction combined with augmentation termed "reductive augmentation" to solve this problem. The technique is also extremely useful for correcting breast asymmetry, as well as revising significant pseudoptosis in the patient who has previously undergone breast augmentation with or without mastopexy.

Methods

An evolution of techniques has been used to create a breast with more upper pole fullness and anterior projection in those patients desiring a more round, higher-profile appearance. Reductive augmentation is a one-stage procedure in which a breast augmentation is immediately followed by a modified superomedial pedicle breast reduction. Often, the excision of breast tissue is greater than would normally be performed with breast reduction alone.

Results

Thirty-five patients underwent reductive augmentation, of which 12 were primary surgeries and 23 were revisions. There was an average tissue removal of 255 and 227 g, respectively, per breast for the primary and revision groups. Six of the reductive augmentations were performed for gross asymmetry. Fourteen patients had a previous mastopexy, and 3 patients had a previous breast reduction. The average follow-up was 26 months.

Conclusions

Reductive augmentation is an effective one-stage method for achieving a more round-appearing breast with upper pole fullness both in primary breast reduction candidates and in revisionary breast surgery. This technique can also be applied to those patients with significant asymmetry.

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.

Complications and Treatment Strategy After Breast Augmentation by Polyacrylamide Hydrogel Injection: Summary of 10-Year Clinical Experience

Abstract

From 1997 to 2006, polyacrylamide hydrogel (PAAG) was approved for use in China as a permanent filler for breast augmentation, and it is estimated that 200,000 women have undergone PAAG injection since then. After injection, complications such as pain, mass, hematoma, asymmetry, migration, infection, and even cancer continue to emerge. Because of the potential toxicity and unstable nature of the material and the nonstandardized injection layers, complications after PAAG injection breast augmentation are often complex and difficult to treat. The only treatment for these complications is debridement surgery, which includes PAAG evacuation, capsule remove, lesion excision, and mastectomy. Currently, although there are a variety of surgical methods for complications after PAAG injection, there is a lack of consensus regarding the diagnosis and treatment. We systematically review the literature and summarize our experience of diagnosis and treatment of complications after PAAG injection in our hospital over the past 10 years. To date, this is the first attempt to propose a diagnostic classification for PAAG injection breast augmentation and to set out a treatment strategy based on this classification. Although the China Food and Drug Administration withdrew its approval in 2006, PAAG is still being used illegally in some areas, and the patient population is widespread. This study aims to provide a more comprehensive understanding of PAAG complications to drive the standard diagnosis and treatment based on clinical classification, and to provide references for the future development of safer injectable products.

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.

“The Chignon Mastopexy”: A Double Glandular Suspended Flaps for an Auto-Augmentation Effect

Abstract

Background

Many mastopexy techniques have been described in the literature focusing on the new nipple areolar complex position and the breast deflation treatment, but only few of them detailed the glandular volume redistribution to avoid the use of implants. We describe a mastopexy procedure that brings the maximum of the volume to the central part of the breast. We compare the procedure to a "chignon" hair style way to vulgarize the technique and simplify its comprehension.

Methods

Breast volume is reshaped by the use of a vertical mastopexy and two deepithelized glandular flaps sutured for the first one to the pectoralis major fascia and for the second one to the contralateral flap. A lateral release of two fasciocutaneous flaps allows the final vertical suture.

Results

From January 2011 to January 2016, 30 patients, between 85 operated on for ptotic breasts, were treated with this technique. The follow-up period is from 6 months to 5 years. Esthetic improvement in the breast shape and its projection were achieved in 90%. The illusion of augmentation of the final volume was noticed in 70% of the cases. No complications were noticed during this study.

Conclusion

We describe an easy and reliable technique for breast lift, based on a mastopexy method that changes the architecture of the breast to bring the maximum of its volume to the central part. The technique is rewarding for moderate volumes when the ptosis is more related to a glandular sagging than to a cutaneous looseness and breast deflation.

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 Online Instructions to Authors http://ift.tt/18t7xNj.

An Alternative Rhinoplasty Technique: Rotational Spreader Flap (“Rabbit Flap”)

Abstract

Background

In modern rhinoplasty, septal cartilage is the most commonly used graft material. It is a big challenge if septal cartilage is insufficient. We present an alternative technique named the "rabbit flap," created from the cephalic portion of the lower lateral cartilage to show its effectiveness on nasolabial angle, nasal axis deviation, and nasal dorsal line.

Methods

An alternative flap, called a "rabbit flap," is constituted from the cephalic portion of the lower lateral cartilage (LLC). The key for this flap's success is in not cutting the connection between the lateral and medial crus of the alar cartilage. The flap is rotated and placed between the upper lateral cartilage and the septum to ensure a spreader graft effect; it can also be moved forward and backward to adjust the nasal tip rotation. Patients whose minimum width of LLC was 12 mm were included in this study. We subjectively evaluated the results of this technique for 24 patients who completed the rhinoplasty outcomes evaluation (ROE) questionnaire and objectively by measuring the nasal axis and nasolabial angles in the preoperative and postoperative first-year periods.

Results

There were significant improvements in ROE, nasal axis deviation, and nasolabial angle scores when preoperative and postoperative first-year controls were compared (p < 0.001). We also observed no complications.

Conclusions

With this technique, we can correct both a nasal tip rotation and a mild nasal axis deviation. Moreover, we can achieve a proper nasal dorsal line and prevent an inverted V deformity. By expanding the internal nasal valve, a functionally effective surgery can be performed. However, the LLC must be strong enough to avoid alar collapse. In light of our results, we believe that the technique we call the "rabbit flap" can be used as an alternative rhinoplasty technique.

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.

Regional disparities in medical equipment distribution in the Slovak Republic – a platform for a health policy regulatory mechanism

This study aims to examine the localisation of selected parameters in the deployment and use of medical equipment in the Slovak Republic and to verify potential regional disparities. The study evaluates the be...

Characteristics of radiocesium contaminations in mushrooms after the Fukushima nuclear accident: evaluation of the food monitoring data from March 2011 to March 2016

Abstract

The monitoring inspection of food after the Fukushima nuclear accident (2011) was essential for ensuring food safety in Japan and reducing the adverse health effects due to incorporation of inacceptable amounts of radionuclides, in particular radiocesium (¹³⁴Cs and ¹³⁷Cs). In this study, the mushroom fraction of the governmental data set of the first 5 years after the accident has been analyzed for contamination levels in mushrooms, in particular time trends and radioecological characteristics as well as associated health risks. The analyses show that mycorrhiza mushrooms are much more sensitive for radionuclide uptake than saprobiontic mushrooms (the latter of which include the very popular shiitake mushrooms (Lentinula edodes)). The maximum value reached 31,000 Bq/kg in a sample of apricot milkcaps in 2012. Analysis of the origin of the samples revealed that the origin (in terms of prefecture) of the mushrooms was a less determining factor for the contamination level than the type of mushrooms, as most exceedances in 2012 and thereafter were found outside Fukushima Prefecture. Several dose models were applied to the data to evaluate both worst case and realistic effective committed dose scenarios. The doses were generally rather low due to low consumption rates in the Japanese food basket. In any case, the analysis proved that the food monitoring campaign was highly effective in cutting doses to the public by more than a factor of 10 compared with a hypothetical scenario in which no monitoring had been conducted.

Spatial trends and pollution assessment for mercury in the surface soils of the Nansi Lake catchment, China

Abstract

Surface soil samples collected from Nansi Lake catchment were analyzed for mercury (Hg) to determine its spatial trends and environmental impacts. Results showed that the average soil Hg contents were 0.043 mg kg⁻¹. A positive correlation was shown between TOC and soil Hg contents. The main type of soil with higher TOC contents and lower pH values showed higher soil Hg contents. Soil TOC contents and CV values were both higher in the eastern catchment. The eastern part of the catchment, where the industry is developed, had relatively high soil Hg contents and a banding distribution of high Hg contents was corresponded with the southwest-northeast economic belt. Urban soils had higher Hg contents than rural soils. The urbanization pattern that soil Hg contents presented a decreasing trend from city center to suburb was shown clearly especially in the three cities. Soil Hg contents in Jining City showed a good consistency with the urban land expansion. The spatial trends of soil Hg contents in the catchment indicated that the type and the intensity of human activities have a strong influence on the distribution of Hg in soils. Calculated risk indices showed that the western part of the catchment presented moderately polluted condition and the eastern part of the catchment showed moderate to strong pollution level. The area with high ecological risk appeared mainly along the economic belt.

Emotional Awareness and Responsible Agency

Abstract

This paper aims to further examine the relationship between self-awareness and agency by focusing on the role that emotional awareness plays in prominent conceptions of responsibility. One promising way of approaching this task is by focusing on individuals who display impairments in emotional awareness and then examining the effects (if any) that these impairments have on their apparent responsibility for the actions that they perform. Individuals with autism spectrum disorder (ASD) as well as other clinical groups who evince high degrees of the personality construct known as alexithymia, I will argue, do, in fact, display impairments in emotional self-awareness, and, so, may provide some insight into the relationship between this awareness and the capacity for responsible agency. More specifically, individuals with ASD may provide us with evidence that robust emotional self-awareness is not a necessary condition for responsible agency or that lacking such a capacity could undermine some otherwise plausible sufficient conditions for responsibility. The aim of the paper, then, is twofold. First, it will aim to show that ASD ought to be understood, in part, as a disorder of emotional self-awareness. Section 2 presents evidence relating to the emotional profile characteristic of individuals with ASD and argues that the most striking feature of this profile is the way in which the individual seems to be separated from his or her emotions in an important sense. Second, the paper aims to show that this distinctive feature of the emotions in ASD casts serious doubt on some prominent accounts of moral responsibility. To this end, section 3.1 presents a challenge to some widely accepted "subjective conditions" for responsibility, namely those articulated by John Martin Fischer and Ravizza (1998) and makes a case, based on the empirical data regarding autism, that these conditions actually are not necessary for one's being a responsible agent. Section 3.2 then presents a challenge for theories of responsible agency which assign primary importance to the connection between an agent's actions and her judgment-sensitive attitudes. I argue there that the evidence from autism suggests that these theories fail in their efforts to provide sufficient conditions for responsibility.

Contents

Future and recent issues

Editorial Board

Information for authors

Masthead

Bootstrap rolling window estimation approach to analysis of the Environment Kuznets Curve hypothesis: evidence from the USA

Abstract

This study aims to examine the validity of inverted U-shaped Environmental Kuznets Curve by investigating the relationship between economic growth and environmental pollution for the period from 1966 to 2013 in the USA. Previous studies based on the assumption of parameter stability and obtained parameters do not change over the full sample. This study uses bootstrap rolling window estimation method to detect the possible changes in causal relations and also obtain the parameters for sub-sample periods. The results show that the parameter of economic growth has increasing trend in 1982–1996 sub-sample periods, and it has decreasing trend in 1996–2013 sub-sample periods. Therefore, the existence of inverted U-shaped Environmental Kuznets Curve is confirmed in the USA.

The mineralization of oxalic acid and bio-treated coking wastewater by catalytic ozonation using nickel oxide

Abstract

Coking wastewater after biological treatment still possesses potential environmental risk and should be mineralized further. This work focused on the mineralization of bio-treated coking wastewater using catalytic ozonation by NiO. First, oxalic acid, the typical by-product of advanced oxidation process (AOPs), was used to test the catalytic performance of NiOs, prepared by modified hydrothermal methods upon addition of different surfactants. This demonstrated that NiO upon addition of hexadecyltrimethylammonium (CTAB) had the best catalytic activity, due to its high concentration surface hydroxyl density and strong stability. Moreover, the best NiO was applied for the catalytic ozonation of bio-treated coking wastewater. Under our experimental conditions, the total organic carbon (TOC) removal reached 100% after 420 min. In addition, the spectroscopic analysis suggested that compounds with conjugated structures could be significantly removed by both ozonation and catalytic ozonation. Some of these substances were transformed into by-products with aliphatic C–C and O=C–O groups such as organic acids that can inhibit further mineralization.

List of reviewers 2017

Publication date: December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 70, Issue 12

The journey of adult psoriasis patients towards biologics: past and present. Results from the BioCAPTURE registry

Abstract

Background

A considerable disease period often precedes initiation of a biologic in patients with psoriasis. Little is known about this important period in patients' lives. Evaluation of this 'journey' can reveal important insights and opportunities for physicians and health care decision makers.

Objectives

(1) To describe patient and treatment characteristics until the start of biologic treatment in patients with severe psoriasis, (2) to assess shifts in early (2005-2009) versus established (2010-2015) biologics prescription periods, (3) to assess changes in hospital/day care admissions before vs. after starting biologics.

Methods

Explorative, retrospective study on the treatment characteristics of the period until first biologic presented with descriptive statistics of patients included in the BioCAPTURE registry. Journeys of 2005-2009 and 2010-2015 were compared with statistical tests to identify important shifts.

Results

Median TUS (time until conventional systemic) was 11.0 years and median TUB (time until biologic) was 18.9 years for all patients treated from 2005-2015. Most patients received 3 different conventional antipsoriatic systemic therapies. We noticed a small trend towards a shorter journey (TUB) with only 2 conventional systemic agents instead of 3 before initiating a biologic in later years (2010-2015, vs. 2005-2009). We also noticed a significant decrease of (day care) admissions comparing the two years before, versus the two first years after starting biologic treatment (17.7 versus 8.6 admissions/100 follow-up years, p<0.001). Cyclosporine, intensive topical treatment (dithranol), retinoids and PUVA therapy lost popularity in recent years.

Conclusion

The 'journey' of patients with psoriasis towards a biologic is still long and characterized by many different treatments. Shifts towards fewer conventional drugs before biologic initiation and a clear decrease of hospital and day care admissions before vs. after a biologic are seen. Improvement of this journey, especially in young or recently diagnosed patients can decrease negative influences on patients' lives and reduce societal impact.

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Comparison between snowmelt-runoff and rainfall-runoff nonpoint source pollution in a typical urban catchment in Beijing, China

Abstract

As a climate-driven event, nonpoint source (NPS) pollution is caused by rainfall- or snowmelt-runoff processes; however, few studies have compared the characteristics and mechanisms of these two kinds of NPS processes. In this study, three factors relating to urban NPS, including surface dust, snowmelt, and rainfall-runoff processes, were analyzed comprehensively by both field sampling and laboratory experiments. The seasonal variation and leaching characteristics of pollutants in surface dust were explored, and the runoff quality of snowmelt NPS and rainfall NPS were compared. The results indicated that dusts are the main sources of urban NPS and more pollutants are deposited in dust samples during winter and spring. However, pollutants in surface dust showed a low leaching ratio, which indicated most NPS pollutants would be carried as particulate forms. Compared to surface layer, underlying snow contained higher chemical oxygen demand, total suspended solids (TSS), Cu, Fe, Mn, and Pb concentrations, while the event mean concentration of most pollutants in snowmelt tended to be higher in roads. Moreover, the TSS and heavy metal content of snowmelt NPS was always higher than those of rainfall NPS, which indicated the importance of controlling snowmelt pollution for effective water quality management.

The variation of cloud amount and light rainy days under heavy pollution over South China during 1960–2009

Abstract

The ground observation data was used to analyze the variation of cloud amount and light precipitation over South China during 1960–2009. The total cloud cover (TCC) decreases in this period, whereas the low cloud cover (LCC) shows the obvious opposite change with increasing trends. LCP defined as low cloud cover/total cloud cover has increased, and small rainy days (< 10 mm day⁻¹) decreased significantly (passing 0.001 significance level) during the past 50 years, which is attributed to the enhanced levels of air pollution in the form of anthropogenic aerosols. The horizontal visibility and sunshine duration are used to depict the anthropogenic aerosol loading. When horizontal visibility declines to 20 km or sunshine duration decreases to 5 h per day, LCC increases 52% or more and LCP increases significantly. The correlation coefficients between LCC and horizontal visibility or sunshine duration are − 0.533 and − 0.927, and the values between LCP and horizontal visibility or sunshine duration are − 0.849 and − 0.641, which pass 0.001 significance level. The results indicated that aerosols likely impacted the long-term trend of cloud amount and light precipitation over South China.

Green-fabrication of gold nanomaterials using Staphylococcus warneri from Sundarbans estuary: an effective recyclable nanocatalyst for degrading nitro aromatic pollutants

Abstract

Microbial synthesis of gold nanoparticles (GNPs) has attracted considerable attention in recent times due to their exceptional capability for the bioremediation of industrial wastes and also for the treatment of wastewater. A bacterial strain Staphylococcus warneri, isolated from the estuarine mangroves of Sundarbans region produced highly stable GNPs by reducing hydrogen auric chloride (HAucl₄) salt using intracellular protein extract. The nanoparticles were characterized utilizing ultraviolet-visible spectrophotometry, transmission electron microscopy, scanning electron microscopy, atomic force microscopy, X-ray diffraction, and surface enhanced Raman scattering. Highly dispersed, spherically shaped GNPs varied around 15–25 nm in size and were highly crystalline with face-centered cubic structures. Recyclable catalytic activity of as-synthesized GNPs was evidenced by complete degradation of nitro aromatic pollutants like 2-nitroaniline, 4-nitroaniline, 2-nitrophenol and 4-nitrophenol. Our GNPs show excellent and efficient catalytic activity with significantly high rate constant (10⁻¹ order) and high turnover frequency (10³ order) in recyclable manner up to three times. To our knowledge, this is the first report of Staphylococcus warneri in the production of gold nanoparticles. This green technology for bioremediation of toxic nitro aromatic pollutants is safe and economically beneficial to challenge the development and sustainability issue.

Foliar application with nano-silicon reduced cadmium accumulation in grains by inhibiting cadmium translocation in rice plants

Abstract

Nano-silicon (Si) may be more effective than regular fertilizers in protecting plants from cadmium (Cd) stress. A field experiment was conducted to study the effects of nano-Si on Cd accumulation in grains and other organs of rice plants (Oryza sativa L. cv. Xiangzaoxian 45) grown in Cd-contaminated farmland. Foliar application with 5~25 mM nano-Si at anthesis stage reduced Cd concentrations in grains and rachises at maturity stage by 31.6~64.9 and 36.1~60.8%, respectively. Meanwhile, nano-Si application significantly increased concentrations of potassium (K), magnesium (Mg), and iron (Fe) in grains and rachises, but imposed little effect on concentrations of calcium (Ca), zinc (Zn), and manganese (Mn) in them. Uppermost nodes under panicles displayed much higher Cd concentration (4.50~5.53 mg kg⁻¹) than other aerial organs. After foliar application with nano-Si, translocation factors (TFs) of Cd ions from the uppermost nodes to rachises significantly declined, but TFs of K, Mg, and Fe from the uppermost nodes to rachises increased significantly. High dose of nano-Si (25 mM) was more effective than low dose of nano-Si in reducing TFs of Cd from roots to the uppermost nodes and from the uppermost nodes to rachises. These findings indicate that nano-Si supply reduces Cd accumulation in grains by inhibiting translocation of Cd and, meanwhile, promoting translocation of K, Mg, and Fe from the uppermost nodes to rachises in rice plants.

Large-scale geographic patterns of mercury contamination in Morocco revealed by freshwater turtles

Abstract

Mercury (Hg) is a toxic contaminant present in most aquatic ecosystems. High concentrations pose serious threats to organisms and to human health. Because previous studies focused on few countries, environmental hazard due to Hg contamination remains obscure in many geographic areas, and for example limited information is available in North Africa. We examined total Hg contamination in 13 sites in Morocco (12 rivers and one lake) spread over a large area, 400 km north–south and 350 km west–east, that encompasses different biogeographic zones separated by the Atlas Mountains. Due to their longevity and sedentary habits, we used freshwater turtles as biological probes to monitor Hg exposure. Keratinized tissues reflect long-term Hg exposure; thus, we assayed Hg concentration in the claws of > 200 individuals and supplemented these data with blood Hg concentrations of > 60 individuals (a tissue that provides shorter term Hg exposure integration). The results provide the first large-scale picture of Hg contamination in the aquatic freshwater systems of Morocco. Comparisons with previous studies revealed that some of the sites were highly contaminated (e.g. mean Hg concentrations were above 5 μg g⁻¹, a very high level in keratinized tissues) whereas other sites presented moderate or baseline levels. Unexpectedly, all highly contaminated sites were found in less densely populated areas, while more densely urbanized northern sites, even the sewers of large cities, were not highly contaminated. We hypothesize that silver mining activities in the southern High Atlas and in the Anti-Atlas contaminate rivers of the catchment basins over long distances. These findings indicate that fish, water consumption and contamination levels in local people should be further scrutinized.

D-tyrosine negatively regulates melanin synthesis by competitively inhibiting tyrosinase activity

Summary

Although L-tyrosine is well known for its melanogenic effect, the contribution of D-tyrosine to melanin synthesis was previously unexplored. Here, we reveal that, unlike L-tyrosine, D-tyrosine dose-dependently reduced the melanin contents of human MNT-1 melanoma cells and primary human melanocytes. In addition, 500 μM of D-tyrosine completely inhibited 10 μM L-tyrosine-induced melanogenesis, and both in vitro assays and L-DOPA staining MNT-1 cells showed that tyrosinase activity is reduced by D-tyrosine treatment. Thus, D-tyrosine appears to inhibit L-tyrosine-mediated melanogenesis by competitively inhibiting tyrosinase activity. Furthermore, we found that D-tyrosine inhibited melanogenesis induced by α-MSH treatment or UV irradiation, which are the most common environmental factors responsible for melanin synthesis. Finally, we confirmed that D-tyrosine reduced melanin synthesis in the epidermal basal layer of a 3D human skin model. Taken together, these data suggest that D-tyrosine negatively regulates melanin synthesis by inhibiting tyrosinase activity in melanocyte-derived cells.

This article is protected by copyright. All rights reserved.

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Examining Delivery Method and Infant Feeding Intentions between Women in Traditional and Non-Traditional Prenatal Care

Abstract

Introduction The purpose of the study is to evaluate delivery method and breastfeeding initiation in women enrolled in group prenatal care (CenteringPregnancy) and in traditional prenatal care. Methods Data were obtained from medical records of a hospital-based midwifery practice in south central Connecticut that offered both types of prenatal care programs. Medical information from 307 women enrolled in this practice was included in the analysis. Out of the 307, 80 were enrolled in group prenatal care. Socio-demographic, lifestyle, and previous and current obstetrical information from medical records formed the basis of comparison. Bivariate and logistic regression analyses were carried out. Results Women in Centering had fewer planned cesarean sections (1.3 vs. 12.8%) and had a higher breastfeeding initiation (88.7 vs. 80.0%). However, Centering women were found to have a higher portion of unplanned cesarean sections (27.5 vs. 11.0%). Both the unadjusted and the adjusted odds ratios of having a cesarean planned delivery were lower in the group care. Women in Centering had 2.44 (95% CI 1.05, 5.66) times the odds of breastfeeding initiation compared to the odds for women in traditional prenatal care after adjusting for maternal age, smoking status, gestation and race. Discussion CenteringPregnancy can have positive impact for the woman and baby. This program implementation saw lower rates of elective cesarean sections and increased breastfeeding compared to women in traditional care.

Laboring Until Labor: The Prevalence and Correlates of Antenatal Maternity Leave in the United States

Abstract

Introduction Most women in the U.S. are employed during pregnancy and work until the month of childbirth. For many, working throughout pregnancy poses little threat to their health; however, women experiencing difficult pregnancies and/or working in strenuous or inflexible jobs may benefit from taking time from work as they approach childbirth, but almost no empirical evidence examines antenatal leave (ANL). Methods Using a national survey of English-speaking women, this paper offers the first national description of ANL and examines state policy predictors of uptake. Results Thirty-seven percent of employed women worked until the week their baby was due. After controlling for characteristics of women and their jobs, living in a state with any or multiple leave laws increased the probability of ANL by 14 and 23% points, respectively. Women living in states with multiple leave laws stopped work almost 2 weeks earlier than women in states without a policy. Discussion Paid leave policies currently being considered at the federal, state, and local levels should consider the potential impact on antenatal leave, in addition to postnatal leave, and how they influence population health.

Opioid Use After Rhinoplasty

This case series examines patient use of an opioid-based drug after rhinoplasty to establish an optimal pain management regimen that also mitigates the misuse or diversion of physician-prescribed opioid medications.

Characteristics, Diagnosis, and Management of Ehlers-Danlos Syndromes

This review summarizes characteristics, assessment, and management of Ehlers-Danlos syndromes, which can be associated with surgical complications and should be identified preoperatively to facilitate optimal treatment.

Ultrasound findings in idiopathic facial aseptic granuloma: Case series and literature review

Abstract

Idiopathic facial aseptic granuloma is an inflammatory nodule commonly located on the cheeks and eyelids in young children. Despite its prolonged course, it tends toward spontaneous resolution, so invasive diagnostic procedures should be avoided. Cutaneous ultrasound is a noninvasive modality that has been found to improve the diagnostic accuracy of nodular skin lesions. We report five children with idiopathic facial aseptic granuloma in whom high-resolution ultrasound examination provided distinctive findings.

RASA1 mutation in a family with capillary malformation–arteriovenous malformation syndrome: A discussion of the differential diagnosis

Abstract

We describe a family who presented with several scattered, vascular, cutaneous lesions and was found to have a novel mutation in RASA1, diagnostic of capillary malformation–arteriovenous malformation syndrome. Our patient was initially given a presumptive clinical diagnosis of hereditary hemorrhagic telangiectasia. Capillary malformation–arteriovenous malformation syndrome shares several features with hereditary hemorrhagic telangiectasia and hereditary benign telangiectasia, but it can be distinguished clinically according to its morphologic appearance and distribution of cutaneous vascular lesions, the presence of internal fast-flow lesions, and genetic analysis.

Sarin Exposures in A Cohort of British Military Participants in Human Experimental Research at Porton Down 1945–1987

Abstract

Background

The effects of exposure to chemical warfare agents in humans are topical. Porton Down is the UK's centre for research on chemical warfare where, since WWI, a programme of experiments involving ~30000 participants drawn from the UK armed services has been undertaken.

Objectives

Our aim is to report on exposures to nerve agents, particularly sarin, using detailed exposure data not explored in a previous analysis.

Methods

In this paper, we have used existing data on exposures to servicemen who attended the human volunteer programme at Porton Down to examine exposures to nerve agents in general and to sarin in particular.

Results

Six principal nerve agents were tested on humans between 1945 and 1987. Of all 4299 nerve agent tests recorded, 3511 (82%) were with sarin, most commonly in an exposure chamber, with inhalation being the commonest exposure route (85%). Biological response to sarin exposure was expressed as percentage change in cholinesterase activity and, less commonly, change in pupil size. For red blood cell cholinesterase, median inhibition for inhalation tests was 41% (interquartile range 28–51%), with a maximum of 87%. For dermal exposures the maximum inhibition recorded was 99%. There was a clear association between increasing exposure to sarin and depression of cholinesterase activity but the strength and direction of the association varied by exposure route and the presence of chemical or physical protection. Pupil size decreased with increased exposure but this relationship was less clear when modifiers, such as atropine drops, were present.

Conclusions

These results, drawn from high quality experimental data, offer a unique insight into the effects of these chemical agents on humans.

Maternal Health Behaviors and Outcomes in a Nomadic Tibetan Population

Abstract

Introduction Despite significant global improvements in maternal health, large disparities persist. In China, rural women and women who live in western regions experience lower rates of maternal healthcare utilization and higher rates of maternal mortality than women elsewhere in the country. This paper examines maternal health care-seeking among nomadic Tibetan women in rural western China, a particularly understudied group. Methods Secondary data analysis was conducted with survey data collected in 2014 in Qinghai Province, China. Participants (rural, nomadic, adult women) provided birth histories and information on care received during antenatal, intrapartum and/or postpartum period(s). Using bivariate and multivariable logistic regression models, these outcomes were explored in relation to maternal characteristics (e.g., educational attainment and parity), use of health insurance, and time. Results Approximately half of all women had ever used antenatal care, institutional delivery, and/or skilled birth attendance. The utilization of these services has increased over time, from 10% of births prior to the year 2000, to approximately 50% since 2000. Utilization increased by year (odds ratios ranging from 1.1 to 1.3) even after controlling for covariates. Women with health insurance coverage were significantly more likely to use these services than women without insurance, although less than 20% of women reported that insurance paid for any antenatal and/or childbirth care. Discussion Utilization of maternal care is improving among this population but rates remain low in comparison to other women in rural, western China. Further targeted interventions may be needed to reach and adequately address the maternal health needs of this unique population.

Development of photoprotective, antiphototoxic, and antiphotogenotoxic formulations of ocular drugs with fluoroquinolones

Publication date: Available online 9 November 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Anna Zgadzaj, Joanna Kornacka, Anita Jastrzębska, Andrzej Parzonko, Sylwester Sommer, Grzegorz Nałęcz-Jawecki
The development of innovative solutions in photosafety of photolabile pharmaceutical products may help to reduce the adverse effects of these products, caused by light exposure. Providing new data in this area of study is particularly important in case of drugs applied topically on sensitive organs such as eyes. The main goal of this research is to investigate whether two potential excipients, namely: p-coumaric acid and benzophenone-4, affect the photodegradation, phototoxicity and photogenotoxicity of water solutions of four fluoroquinolones: ciprofloxacin, lomefloxacin, fleroxacin and clinafloxacin. We conducted a set of bioassays combined with the application of high-performance liquid chromatography and mass spectrometry techniques. The significant reduction of phototoxic and photogenotoxic abilities was evaluated in mixtures with ciprofloxacin and p-coumaric acid by using the umu test with Salmonella typhimurium TA1535/pSK1002, the methylthiazol tetrazolium reduction assay, and the micronucleus assay with the V79 cell line. In the bacterial assay the opposite effect was observed for the formulation with lomefloxacin and p-coumaric acid. This may be explained by the significant differences in the profile of the lomefloxacin photodegradation products. Further, the photoprotective and antiphotomutagenic abilities of ciprofloxacin mixed with benzophenone-4 were assessed. Promising results obtained in compositions with ciprofloxacin may be a basis for further research. Nevertheless, the increase in the DNA damage potential in mixtures with p-coumaric acid and two other antibiotics shows the importance of the safety evaluation of such innovative combinations.

Enhanced anticancer effect of fabricated gallic acid/CdS on the rGO nanosheets on human glomerular mesangial (IP15) and epithelial proximal (HK2) kidney cell lines - Cytotoxicity investigations

Publication date: Available online 8 November 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Wei Peng, Pengcheng Luo, Dingwen Gui, Weidong Jiang, Haixia Wu, Jie Zhang
In spite of the technological innovation in the biomedical science, cancer remains a critical disease. In this study, we designed a gallic acid/cadmium sulfide (GA/CdS) nanocomposite fabricated on the reduced graphene oxide (GA/CdS-rGO) nanosheets for the treatment system of human kidney cancer cells. The GA/CdS-rGO nanosheets have been prepared using gallic acid as a reducing agent. The characterization of nanocomposites was studied using UV–Vis spectroscope, FT-IR, XRD, SEM and TEM. The microscopic images showed the spherical shape and nano-scaled CdS nanoparticles on the sheet like rGO nanomaterials. These structural and morphology investigations show that excellent properties of as-prepared GA/CdS-rGO has ability to treat the human glomerular mesangial (IP15) cancer cells at 50μg/ml as an IC50 value, without affecting the epithelial proximal (HK-2) normal cells. In vitro cytotoxicity results showed that the variability of toxic effects after CdS exposure was strongly associated to the cellular Cd content. Release of Cd²⁺ from nanocomposites depended to solubility and particle degradation of CdS nanoparticles were considered to be the main cause of these cytotoxicity. The in vitro analysis results indicated that heterogeneity of Cd and gallic acid toxicity that was highly dependent on the physico-chemical properties of the nanocomposites. The cytotoxicity results suggested that the prepared nanomaterials were toxic and inhibitory efficiency to human kidney cancer cells.

Graphical abstract

Atropisomers of 2,2′,3,3′,6,6′-hexachlorobiphenyl (PCB 136) exhibit stereoselective effects on activation of nuclear receptors in vitro

Abstract

PCB 136 is an environmentally relevant chiral PCB congener, which has been found in vivo to be present in form of rotational isomers (atropisomers). Its atropselective biotransformation or neurotoxic effects linked with sensitization of ryanodine receptor suggest that it might interact also with other intracellular receptors in a stereospecific manner. However, possible atropselective effects of PCB 136 on nuclear receptor transactivation remain unknown. Therefore, in this study, atropselective effects of PCB 136 on nuclear receptors controlling endocrine signaling and/or expression of xenobiotic and steroid hormone catabolism were investigated. PCB136 atropisomers were found to exert differential effects on estrogen receptor (ER) activation; (+)-PCB 136 was estrogenic, while (−)-PCB 136 was antiestrogenic. In contrast, inhibition of androgen receptor (AR) activity was not stereospecific. Both PCB136 stereoisomers induced the constitutive androgen receptor (CAR)-dependent gene expression; however, no significant stereospecificity of PCB 136 atropisomers was observed. PCB136 was a partial inducer of the pregnane X receptor (PXR)-dependent gene expression. Here, (−)-PCB 136 was a significantly more potent inducer of PXR activity than (+)-PCB 136. Taken together, the present results indicate that at least two nuclear receptors participating in endocrine regulation or metabolism, ER and PXR, could be regulated in an atropselective manner by chiral PCB 136. The enantioselective enrichment of PCB atropisomers in animal and human tissues may thus have significant consequences for endocrine-disrupting effects of chiral ortho-substituted PCB congeners.

Use of endoscopic balloon dilation for benign esophageal stenosis in children: our 11 year experience

Abstract

Endoscopic balloon dilation (EBD) is an established therapy for esophageal stenosis. To assess its usefulness in children, we reviewed 11 years of pediatric cases of EBD in our hospital. Over the last 11 years, EBD was performed on 14 pediatric patients (10 boys and four girls; 7 months–11 years) at our hospital. All EBD sessions were performed under general anesthesia and fluoroscopic monitoring. The sessions were repeated every week or alternate weeks until resolution of dysphagia or development of smooth endoscope passage. Stenosis was resolved in 14 of 14 patients (100%). None of the patients (0%) showed recurrence of stenosis. As for postoperative complications, mediastinitis occurred only in one patient (7.1%). The median number of session repeats for an individual patient was three (range 1–10). EBD is a safe and effective therapeutic modality for esophageal stenosis in children.

How Not to Critique the Critique of Progress: A Reply to Payrow Shabani

Analysis of factors controlling soil phosphorus loss with surface runoff in Huihe National Nature Reserve by principal component and path analysis methods

Abstract

Phosphorus (P) loss with surface runoff accounts for the P input to and acceleration of eutrophication of the freshwater. Many studies have focused on factors affecting P loss with surface runoff from soils, but rarely on the relationship among these factors. In the present study, rainfall simulation on P loss with surface runoff was conducted in Huihe National Nature Reserve, in Hulunbeier grassland, China, and the relationships between P loss with surface runoff, soil properties, and rainfall conditions were examined. Principal component analysis and path analysis were used to analyze the direct and indirect effects on P loss with surface runoff. The results showed that P loss with surface runoff was closely correlated with soil electrical conductivity, soil pH, soil Olsen P, soil total nitrogen (TN), soil total phosphorus (TP), and soil organic carbon (SOC). The main driving factors which influenced P loss with surface runoff were soil TN, soil pH, soil Olsen P, and soil water content. Path analysis and determination coefficient analysis indicated that the standard multiple regression equation for P loss with surface runoff and each main factor was Y = 7.429 – 0.439 soil TN − 6.834 soil pH + 1.721 soil Olsen-P + 0.183 soil water content (r = 0.487, p < 0.01, n = 180). Soil TN, soil pH, soil Olsen P, and soil water content and the interactions between them were the main factors affecting P loss with surface runoff. The effect of physical and chemical properties of undisturbed soils on P loss with surface runoff was discussed, and the soil water content and soil Olsen P were strongly positive influences on the P loss with surface runoff.

Authorship

Publication date: Available online 9 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Dirk M. Elston

Study design and statistical analysis

Publication date: Available online 9 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Dirk M. Elston

Getting the most out of on-line literature searches – More on Boolean logic

Publication date: Available online 8 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Dirk M. Elston

An extemporaneous approach for optimizing acitretin dosing in pediatric patients

Publication date: Available online 8 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Sidharth Sonthalia, Deepak Jakhar, Abhijeet Kumar Jha

Ethics and fairness during the review and publication process

Publication date: Available online 9 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Dirk M. Elston

Getting the most out of on-line literature searches Tips for advanced searches

Publication date: Available online 8 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Dirk M. Elston
Thorough and efficient literature searches are important to authors and practicing physicians alike, and modern search engines have many tools to expedite the process. In databases such as PubMed, new logic, or natural language, is set up to answer questions by simply typing them in.

Successful treatment of moderate-to-severe alopecia areata improves health-related quality of life

Publication date: Available online 8 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Lucy Y. Liu, Brittany G. Craiglow, Brett A. King

Responding to reviewers: Advice to young (and some older) authors

Publication date: Available online 8 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Dirk M. Elston

Psoriasis and the Risk of Diabetes: A Prospective Population-Based Cohort Study.

Publication date: Available online 8 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Marilyn T. Wan, Daniel B. Shin, Rebecca A. Hubbard, Megan H. Noe, Nehal N. Mehta, Joel M. Gelfand
BackgroundData evaluating the impact of objectively measured psoriasis severity on type 2 diabetes mellitus (T2DM) risk are lacking.ObjectiveTo determine the risk of T2DM in patients with psoriasis compared to adults without psoriasis, stratified by categories of directly assessed body surface area (BSA) affected by psoriasis.MethodsA prospective, population-based, cohort study from the UK. 8,124 adults with psoriasis and 76,599 adults without psoriasis were followed prospectively for approximately 4 years.Results280 (3.44%) incident cases of diabetes in the psoriasis group and 1867 (2.44%) incident cases of diabetes in those without psoriasis. After adjusting for age, sex and body mass index, the hazard ratios (95%CI) for developing incident diabetes were 1.21 (1.01-1.44), 1.01 (0.81-1.26), and 1.64 (1.23-2.18) in the ≤2BSA, 3-10%BSA, and >10%BSA groups compared to those without psoriasis, respectively (p=0.004 for trend). Worldwide, we estimate an additional 125,650 new diagnoses of T2DM per year in patients with psoriasis as compared to those without.LimitationsRelatively short-term follow-up and exclusion of prevalence cases which may have masked associations in patients with less extensive psoriasis.ConclusionClinicians may measure BSA affected by psoriasis in order to target diabetes prevention efforts for patients with psoriasis.

Advice for reviewers (and authors and readers)

Publication date: Available online 8 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Dirk M. Elston

Writing a better research paper: Advice for young authors

Publication date: Available online 8 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Dirk M. Elston

Duplicate publication

Publication date: Available online 8 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Dirk M. Elston

Common reasons why manuscripts are rejected: Advice for young investigators

Publication date: Available online 8 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Dirk M. Elston

Correction

Publication date: Available online 3 November 2017
Source:Journal of the American Academy of Dermatology

Sample size

Publication date: Available online 8 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Dirk M. Elston

Correcting the literature

Publication date: Available online 8 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Dirk M. Elston
We make important therapeutic decisions based on the best available evidence and it is important to correct the literature when results are in question. Appropriate actions may include publication of a correction, links to previously cited data to avoid double counting of outcomes, expressions of concern about study methods or integrity, and retraction of a published article. Corrections should be published as soon as possible, appear in a prominent position on a numbered page in the journal that originally published the article, and include the complete original citation to help ensure that an appropriate reference to the published erratum will be added to the MEDLINE citation. A retracted work should still be searchable, but should bear a clear indication that it was retracted and a statement regarding why the retraction occurred. As others may have acted upon the published data, it is important that corrections are appropriately visible and that the work doesn't simply disappear from literature searches.

Planning better research projects: Advice for young researchers

Publication date: Available online 8 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Dirk M. Elston

Presentation of data

Publication date: Available online 8 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Dirk M. Elston

Misclassification of Study Designs in the Dermatology Literature

Publication date: Available online 8 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Jungyoon Ohn, Sang Jun Eun, Do-Yeop Kim, Hyun-sun Park, Soyun Cho, Hyun-Sun Yoon
BackgroundThe appropriate classification of study designs is important for review and assessment of the relevant scientific literature as a basis for decision-making. However, little is known about whether study designs have been appropriately reported in the dermatology literature.ObjectiveWe aimed to validate the study designs in the dermatology literature and investigate discrepancies between author-reported and actual study designs.MethodsWe reviewed all issues of three major dermatology journals from January to December 2016. A total of 295 original articles investigating associations between exposures and health outcomes were included for analysis. We used a validated algorithm to classify the study designs.ResultsAmong the 295 articles, 174 (59.0%) clearly mentioned the study design in the text. All interventional studies were correctly classified based on the study design (n=42); however, 35 (26.5%) of 132 observational studies showed discrepancies between the author-reported and the actual study design. When the author-reported design was a prospective cohort, retrospective cohort, or case-control study (n=61), approximately half these studies were misclassified by the authors (n=30).LimitationsWe analyzed only three journals in the dermatology field.ConclusionsOur findings revealed substantial discrepancies between author-reported and actual study designs in the dermatologic literature, particularly among observational studies.

Objective Outcome Measures: Collecting Meaningful Data on Alopecia Areata

Publication date: Available online 8 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Elise A. Olsen, Janet Roberts, Leonard Sperling, Antonella Tosti, Jerry Shapiro, Amy McMichael, Wilma Bergfeld, Valerie Callender, Paradi Mirmirani, Ken Washenik, David Whiting, George Cotsarelis, Maria Hordinsky
BackgroundAlthough alopecia areata is a common disorder, it has no FDA approved treatment and evidence-based therapeutic data is lacking.ObjectiveTo develop guidelines for the diagnosis, evaluation, assessment, response criteria and endpoints for alopecia areata.MethodsLiterature review and expert opinion of a group of dermatologists specializing in hair disorders.ResultsStandardized methods of assessing and tracking hair loss and growth including new scoring techniques, response criteria and endpoints in alopecia areata are presented.LimitationsThe additional time to perform the assessments is the primary limitation to use of the methodology in clinical practice.ConclusionUse of these measures will facilitate collection of standardized outcome data on therapeutic agents used in alopecia areata both in clinical practice and in clinical trials.

Cosmopolitan Duty and Legitimate State Authority

Abstract

In this paper I apply a suitably developed version of Joseph Raz's service conception of authority to the debate over the legitimacy of state action aiming to fulfill cosmopolitan moral obligations. I aim to advance two interrelated theses. First, viewed from the perspective of Raz's service conception of authority, citizens' moral duties to non-compatriots are an appropriate ground for authoritative intervention by agents of the state. Second, international law based on these duties can also enjoy moral authority over government decision makers. An important source of the moral force of international law is derived from the power of international law to improve officials' ability to recognize and conform to the totality of their reasons, which contributes to their states' legitimacy.

Solitary Fibrous Tumor of the Tongue: An Uncommon Cause of Obstructive Sleep Apnea

Abstract

Introduction

Solitary fibrous tumor is an uncommon mesenchymal neoplasm that may be found in any location. To date, only a few cases of solitary fibrous tumor involving the tongue have been reported.

Case Summary

We present the case of a 31-year-old man with a history of progressively worsening snoring and daytime sleepiness. Polysomnography revealed severe obstructive sleep apnea. An attempt to treat sleep apnea by continuous positive airway pressure and oral appliance led to a poor clinical response. CT and MRI scans findings revealed a large mass in the tongue base partially obstructing the airway. After the excision of the mass all symptoms, included daytime somnolence, disappeared and a polysomnographic examination showed the normalization of the somnographic parameters.

Discussion

Although OSA is rarely caused by tumors, each patient with sleep disorders breathing should be examined carefully for the potential presence of an upper aero-digestive tract neoplasm that may contribute to obstruction.

Maternal Hypertension, Antihypertensive Medication Use, and Small for Gestational Age Births in the National Birth Defects Prevention Study, 1997–2011

Abstract

Background Small for gestational age (SGA) birth is associated with poor long-term health outcomes. It is unclear whether maternal antihypertensive medication increases risk of SGA independently of maternal hypertension. Methods We analyzed associations between maternal hypertension and antihypertensive medication use and SGA among non-malformed singleton controls in the National Birth Defects Prevention Study. We defined SGA as birthweight < 10th percentile for a given gestational age, sex, race/ethnicity, and parity. We included 1045 SGA and 10,019 non-SGA births. We used logistic regression to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs). We assessed interaction between hypertension, antihypertensive use, and maternal race/ethnicity and age. Results Overall, 122 (11.7%) SGA and 892 (8.9%) non-SGA mothers reported hypertension and 21 (2.0%) SGA and 154 (1.5%) non-SGA mothers reported antihypertensive use. The most commonly reported medications were centrally-acting antiadrenergics, β-blockers, calcium channel blockers, and diuretics. Compared to normotensive pregnancies, maternal hypertension, regardless of treatment (AOR, 1.49 [95% CI, 1.20, 1.86]), and untreated maternal hypertension [AOR, 1.46 (95% CI, 1.15, 1.86)] were associated with SGA. We observed a positive, but not significant, association between antihypertensive use and SGA. SGA risk varied by maternal race/ethnicity, being highest among Hispanic mothers, and age, being highest among mothers ≥ 35 years, but statistical tests for interaction were not significant. Conclusions Consistent with the literature, our findings suggest that maternal hypertension slightly increases SGA risk. We did not observe an appreciably increased SGA risk associated with antihypertensive medication use beyond that of the underlying maternal hypertension.

The evolution of public health ethics frameworks: systematic review of moral values and norms in public health policy

Abstract

Given the evolution of the public health (PH) and the changes from the phenomenon of globalization, this area has encountered new ethical challenges. In order to find a coherent approach to address ethical issues in PH policy, this study aimed to identify the evolution of public health ethics (PHE) frameworks and the main moral values and norms in PH practice and policy. According to the research questions, a systematic search of the literature, in English, with no time limit was performed using the main keywords in databases Web of Science (ISI) and PubMed. Finally, the full text of 56 papers was analyzed. Most of the frameworks have common underpinning assumptions and beliefs, and the need to balance PH moral obligation to prevent harm and health promotion with respect for individual autonomy has been specified. As such, a clear shift from liberal values in biomedical ethics is seen toward the community's collective values in PHE. The main moral norms in PH practice and policy included protecting the population against harm and improving PH benefits, utility and evidenced-based effectiveness, distributive justice and fairness, respect for all, privacy and confidentiality, solidarity, social responsibility, community empowerment and participation, transparency, accountability and trust. Systematic review of PHE frameworks indicates utilization of the aforementioned moral norms through an practical framework as an ethical guide for action in the PH policy. The validity of this process requires a systematic approach including procedural conditions.

Impaired expression of CXCL5 and matrix metalloproteinases in the lungs of mice with high susceptibility to Streptococcus pneumoniae infection

Abstract

Introduction

Streptococcus pneumoniae colonizes the nasopharynx of healthy individuals establishing a commensal relationship with the host. In some conditions, bacteria invade the lower respiratory tract and innate immune responses are crucial to avoid diseases such as pneumonia, sepsis, or meningitis.

Methods

Here, we compared the susceptibility to pneumococcal respiratory infection of two outbred mouse lines, AIRmin and AIRmax, selected for low or high acute inflammatory responses, respectively.

Results

AIRmin mice showed increased susceptibility to infection with different pneumococcal serotypes, when compared to AIRmax. Significant higher numbers of alveolar macrophages expressing the CD206 mannose receptor were observed in AIRmin mice when compared to AIRmax mice. Despite this difference, secretion of several cytokines and chemokines in the respiratory tract of AIRmin and AIRmax mice, after infection, was similar. The only exception was CXCL5, which was highly induced after pneumococcal infection in AIRmax mice but not in AIRmin mice. Reduced expression of the matrix metalloproteinases (MMP) 2, 3, 8, and 9, as well as reduced activities of MMPs were also observed in the lungs of AIRmin mice, after infection. Such impaired responses may have contributed to the low influx of neutrophils observed in the airways of these mice. Finally, high percentages of macrophages and neutrophils in apoptosis or necrosis, at the site of infection, were also observed in AIRmin mice, suggesting that leukocyte functionality is also compromised.

Conclusions

Our results indicate that CXCL5 and MMPs contribute to the resistance to pneumococcal infection in mice.

In this work we have compared the susceptibility to pneumococcal respiratory infection of two outbred mouse lines, AIRmin and AIRmax, selected for low or high acute inflammatory responses, respectively. Our results indicate that CXCL5 and MMPs contribute to the resistance to pneumococcal infection in mice.

A Molecular Cascade Modulates MAP1B and Confers Resistance to mTOR Inhibition in Human Glioblastoma

Abstract

Background

Clinical trials of therapies directed against nodes of the PI3K/AKT/mTOR signaling axis in Glioblastoma (GBM) have had disappointing results. Resistance to mTOR inhibitors limits their efficacy.

Methods

To determine mechanisms of resistance to chronic mTOR inhibition, we performed tandem screens on patient-derived GBM cultures.

Results

An unbiased phosphoproteomic screen quantified phosphorylation changes associated with chronic exposure to the mTOR inhibitor rapamycin and our analysis implicated a role for GSK3B attenuation in mediating resistance that was confirmed by functional studies. A targeted shRNA screen and further functional studies both in vitro and in vivo demonstrated that MAP1B, a protein previously associated predominantly with neurons, is a downstream effector of GSK3B mediated resistance. Furthermore, we provide evidence that chronic rapamycin induces microtubule stability in a MAP1B-dependent manner in GBM cells. Additional experiments explicate a signaling pathway wherein combinatorial ERK/mTOR targeting abrogates inhibitory phosphorylation of GSK3B, leads to phosphorylation of MAP1B, and confers sensitization.

Conclusions

These data portray a compensatory molecular signaling network that imparts resistance to chronic mTOR inhibition in primary, human GBM cell cultures and points towards new therapeutic strategies.

Exercise Ameliorates Neurocognitive Impairments in a Translational Model of Pediatric Radiotherapy

Abstract

Background

While CRT is an effective treatment, healthy areas surrounding irradiation sites are negatively affected. Frontal lobe functions involving attention, processing speed and inhibition control are impaired. These deficits appear months to years after CRT and impair quality-of-life. Exercise has been shown to rejuvenate the brain and aid in recovery post-injury through its effects on neurogenesis and cognition.

Methods

We developed a juvenile rodent CRT model that reproduces neurocognitive deficits. Next, we utilized the model to test whether exercise ameliorates these deficits. Fischer rats (31-days old) were irradiated with a fractionated dose of 4Gy x 5 days, trained and tested at 6, 9, and 12 months post-CRT using 5-Choice Serial Reaction Time Task. After testing, fixed rat brains were imaged using diffusion tensor imaging and immunohistochemistry.

Results

CRT caused early and lasting impairments in task acquisition, accuracy, and latency to correct response, and also caused stunting of growth, changes in brain volume and diffusion. Exercising after irradiation improved acquisition, behavioral control, processing speed, mitigated the stunting of brain size, and increased brain fiber numbers compared to sedentary CRT values. Further, exercise partially restored global connectome organization including assortativity and characteristic path length, and while it did not improve the specific regional connections that were lowered by CRT, it appeared to remodel these connections by increasing connectivity between alternate regional pairs.

Conclusions

Our data strongly suggests that exercise may be useful in combination with interventions aimed at improving cognitive outcome following pediatric CRT.

An update of the Worldwide Integrated Assessment (WIA) on systemic insecticides. Part 2: impacts on organisms and ecosystems

Abstract

New information on the lethal and sublethal effects of neonicotinoids and fipronil on organisms is presented in this review, complementing the previous Worldwide Integrated Assessment (WIA) in 2015. The high toxicity of these systemic insecticides to invertebrates has been confirmed and expanded to include more species and compounds. Most of the recent research has focused on bees and the sublethal and ecological impacts these insecticides have on pollinators. Toxic effects on other invertebrate taxa also covered predatory and parasitoid natural enemies and aquatic arthropods. Little new information has been gathered on soil organisms. The impact on marine and coastal ecosystems is still largely uncharted. The chronic lethality of neonicotinoids to insects and crustaceans, and the strengthened evidence that these chemicals also impair the immune system and reproduction, highlights the dangers of this particular insecticidal class (neonicotinoids and fipronil), with the potential to greatly decrease populations of arthropods in both terrestrial and aquatic environments. Sublethal effects on fish, reptiles, frogs, birds, and mammals are also reported, showing a better understanding of the mechanisms of toxicity of these insecticides in vertebrates and their deleterious impacts on growth, reproduction, and neurobehaviour of most of the species tested. This review concludes with a summary of impacts on the ecosystem services and functioning, particularly on pollination, soil biota, and aquatic invertebrate communities, thus reinforcing the previous WIA conclusions (van der Sluijs et al. 2015).

Downhill exercise alters immunoproteasome content in mouse skeletal muscle

Abstract

Content of the immunoproteasome, the inducible form of the standard proteasome, increases in atrophic muscle suggesting it may be associated with skeletal muscle remodeling. However, it remains unknown if the immunoproteasome responds to stressful situations that do not promote large perturbations in skeletal muscle proteolysis. The purpose of this study was to determine how an acute bout of muscular stress influences immunoproteasome content. To accomplish this, wild-type (WT) and immunoproteasome knockout lmp7 ^−/−/mecl1 ^−/− (L7M1) mice were run downhill on a motorized treadmill. Soleus muscles were excised 1 and 3 days post-exercise and compared to unexercised muscle (control). Ex vivo physiology, histology and biochemical analyses were used to assess the effects of immunoproteasome knockout and unaccustomed exercise. Besides L7M1 muscle being LMP7/MECL1 deficient, no other major biochemical, histological or functional differences were observed between the control muscles. In both strains, the downhill run shifted the force-frequency curve to the right and reduced twitch force; however, it did not alter tetanic force or inflammatory markers. In the days post-exercise, several of the proteasome's catalytic subunits were upregulated. Specifically, WT muscle increased LMP7 while L7M1 muscle instead increased β5. These findings indicate that running mice downhill results in subtle contractile characteristics that correspond to skeletal muscle injury, yet it does not appear to induce a significant inflammatory response. Interestingly, this minor stress activated the production of specific immunoproteasome subunits that if knocked out were replaced by components of the standard proteasome. These data suggest that the immunoproteasome may be involved in maintaining cellular homeostasis.

Dispositional and categorical properties, and Russellian Monism

Abstract

This paper has two main aims. The first is to present a general approach for understanding "dispositional" (or "structural") and "categorical" properties; the second aim is to use this approach to criticize Russellian Monism. On the approach I suggest, what are usually thought of as "dispositional" and "categorical" properties are really just the extreme ends of a spectrum of options. The approach allows for a number of options between these extremes, and it is plausible, I suggest, that just about everything of scientific interest falls in this middle ground. I argue that Russellian Monism depends for its plausibility on the unarticulated assumption that there are no properties in the middle ground.

Cross-cultural adaptation and validation of the Spanish version of the Paediatric Throat Disorders Outcome Test (T-14)

Abstract

Objectives

The Paediatric Throat Disorders Outcome Test (T-14) is a disease-specific questionnaire that parents are requested to complete; it aims to assess the quality of life related to tonsil and adenoid disease or its treatment in children with throat disorders. The aim of this study was to validate the Spanish adaptation of the T-14, thus allowing comparison across studies and facilitating international multicentre projects.

Design, setting and participants

This was a multicentre prospective instrument validation study. Guidelines for the cross-cultural adaptation process from the original English-language scale into a Spanish-language version were followed. The psychometric properties (reproducibility, reliability, validity, responsiveness) of the Spanish version ("T-14-s" for "T-14-Spanish") were assessed in 50 consecutive children undergoing adeno/tonsillectomy (both before and six months after surgery) and in a separate cohort of 50 unaffected children in a comparable age range .

Main outcome measures and results

Test-retest reliability (γ = 0.83) and internal consistency reliability (α = 0.94) were adequate. The T-14-s demonstrated satisfactory construct validity (r > 0.40). The instrument showed excellent between-group discrimination (P < 0.0001) and a high responsiveness to change (effect size = 2.09).

Conclusions

The Spanish version of the T-14 (T-14-s) is a valid tool for measuring the subjective severity of throat disorders, and its use is recommended.

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