The classification of brain tumors has classically been dependent on histology. However, with the additional understanding of the genetic basis of tumorigenesis, molecular parameters have also now become integrated with histology in the 2016 World Health Organization (WHO) classification of brain tumors.1 This concept has been integrated in the classification of the diffuse gliomas. For lower-grade gliomas (LGGs; WHO grades II and III), it is known that mutations in isocitrate dehydrogenase genes (IDH1/2) occur in high proportion, and the detection of these mutations has diagnostic, prognostic, and therapeutic implications.2–4 Mutations in IDH1/2 lead to reduction of alpha-ketoglutarate and to the production of oncometabolite 2-hydroxyglutarate. This gain of function phenotype can be incurred via multiple different mutations. Mutations in codon 132 resulting in substation of arginine to histidine (R132H) is the most common of these mutations (termed "canonical"), accounting for up to 90% of all IDH mutations.2 The development of R132H-specific anti-IDH1 antibodies allows for screening of canonical mutations by immunohistochemistry (IHC). In cases where IDH screening by IHC indicates the absence of R132H mutation, genetic sequencing of IDH may be performed to screen for noncanonical mutations. Although genetic sequencing allows for screening of both canonical and noncanonical mutations, the cost associated with testing as well as time constraints can be issues. Nevertheless, in the setting of a diffuse adult LGG that is negative by R132H-IHC, testing for a noncanonical IDH mutation is expected to conform within an integrated histomolecular diagnosis. In the absence of a complete evaluation for noncanonical IDH mutations in these cases, the "NOS" designation may be warranted for diffuse gliomas.
Παρασκευή 10 Νοεμβρίου 2017
Author index∗∗July, pp. 1-196; August, pp. 197-390; September, pp. 391-590; October, pp. 591-794; November, pp. 795-994; December, pp. 995-1252.
Aboul-Fettouh N, Hinojosa J, Tovar-Garza A, Pandya AG. The majority of patients presenting with vitiligo have a clinical sign of activity. 2017;77:774-5 (Research letter)
Topical 15% resorcinol for hidradenitis suppurativa: An uncontrolled prospective trial with clinical and ultrasonographic follow-up
To the Editor: Boer and Jemec first described the use of topical 15% resorcinol for hidradenitis suppurativa (HS) in a small retrospective study in 2010,1 reporting a marked decrease in pain and mean duration of the lesions. In this study we assessed the effects of resorcinol in a prospective open trial in HS by using both clinical measures and ultrasonography. Ultrasound examination in HS provides anatomic information that is clinically unavailable and may be helpful for follow-up.2,3 We recruited participants with Hurley stage I and II HS.
The water-drop test for the diagnosis of koilonychia
Koilonychia is a common concave nail dystrophy in which the nail plate is depressed centrally and elevated laterally.1 The term has Greek origins, with koilos meaning spoon. The pathophysiology of koilonychia, or spoon nails, is poorly understood. It has been associated with dermatologic disorders such as alopecia areata, psoriasis, and lichen planus; endocrinopathies such as hypothyroidism, hyperthyroidism, and diabetes mellitus; nutritional deficiencies, notably iron deficiency anemia; genodermatoses; and traumatic and occupational exposures.
Doctors' mental health, burnout, and suicidality: Professional and ethical issues in the workplace
This case scenario engenders multiple ethical and professional issues for practicing dermatologists and dermatology residents, the most central of which are mental health and suicidality among physicians. When a physician's mental health is compromised, so may the safety and quality of the medical care provided. If a physician's mental state deteriorates to the point that his or her practice becomes impaired and professional obligations cannot be safely carried out, and the physician refuses to seek help, there is an ethical responsibility for a colleague(s) to report the impaired practitioner to an appropriate body or licensing authority.
Circumventing iPLEDGE: Circumventing ethical responsibility?
Prescribing isotretinoin in the United States is regulated through iPLEDGE, a program aimed at reducing the risk for fetal exposure to isotretinoin. Isotretinoin is a pregnancy category X medication and is associated with major birth defects affecting 4%-28% of exposed fetuses.1,2 This Food and Drug Administration—approved program strives to ensure that no woman of child-bearing potential starts the medication while pregnant or becomes pregnant while on the medication. It is a centralized pregnancy risk management program requiring registration from all parties involved in the chain of distribution: wholesalers, prescribers, pharmacies, and patients.
Injection of filler for volume replacement of the whole face using a single-entry method
Many practitioners use the standard approach of injecting fillers through multiple points into the area of a defect. In the midface, physicians will inject the cheeks and the tear troughs through different sets of entry points. Although the results of this method are acceptable, the risk of bruising is high.
Lymphedema
Lymphedema is a localized form of tissue swelling resulting from excessive retention of lymphatic fluid in the interstitial compartment and caused by impaired lymphatic drainage. Lymphedema is classified as primary or secondary. Primary lymphedema is caused by developmental lymphatic vascular anomalies. Secondary lymphedema is acquired and arises as a result of an underlying systemic disease, trauma, or surgery. We performed PubMed and Google Scholar searches of the English-language literature (1966-2017) using the terms lymphedema, cancer-related lymphedema, and lymphatic complications.
A novel clinical sign to aid in the diagnosis of superficial basal cell carcinoma
Basal cell carcinoma (BCC) is the most common type of skin cancer worldwide.1 The diagnosis of BCC is often made clinically and confirmed histologically. Superficial BCCs, which represent a common histologic subtype, characteristically present as bright pink plaques or patches with variable scale.2 Even for experienced dermatologists, some superficial BCCs might elude early detection because of their variable color, ranging from skin-colored to bright pink. Early superficial BCCs are easier to treat and associated with less morbidity.
Inpatient dermatology consultations: Motivation and practice of requesting providers
To the Editor: Given limited access to inpatient dermatology services, inpatient dermatologic management is handled by primary teams.1-4 These teams (eg, medicine, intensive care services, surgery) must decide when it is necessary to request dermatologic expert opinion, though many hospitals lack access to inpatient dermatology consults.4 When available, the decision to call a consult is unique and complex, shaped by patient-driven and provider-driven factors. Our aim was to survey inpatient providers prospectively to capture the factors that inform their decision to request dermatology consults and to characterize the perceived utility of the inpatient consult service.
The hungry caterpillar flap: A variant of the V-to-Y island pedicle flap
Subcutaneous and myocutaneous island pedicle flaps are versatile closure options that are able to close large surgical defects with robust vascular supply.1 However, one of the shortcomings of these closures is the formation of triangular scars. Straight lines are visually arresting and the triangular scars created by island pedicle flaps can be distinctly conspicuous.
Correction of vermilion lip retraction after mucosal advancement flap: A countertraction technique
Squamous cell carcinoma of the lip accounts for a third of all oral cavity cancers in the United States, and the lower lip is the most frequent site of occurence.1 Surgical resection is the mainstay of treatment. Several size-dependent options can be utilized for repair: a small defect can be closed with a simple primary closure, whereas a local flap or skin graft is required for massive tissue loss. The mucosal advancement flap is a useful method with satisfactory results for large vermilion lip defects.
High-risk category for early annual ophthalmology screening of patients receiving hydroxychloroquine
To the Editor: Although the recent article "Updated recommendations on the use of hydroxychloroquine in dermatologic practice" by Fernandez was overall both excellent and timely,1 I wish to offer a comment of clarification on the use of annual screening among hydroxychloroquine users. In the article, the author states, "Annual ocular toxicity screening is recommended to begin only after 5 years of use unless patients are considered high-risk or develop ophthalmologic symptoms." However, there are 2 caveats to this statement.
Reply to: Comment on “Efficacy and safety of etanercept and adalimumab with and without a loading dose for psoriasis: A systematic review”
To the Editor: We would like to thank Dr Asahina and Dr Nakagawa1 for taking interest in our publication entitled "Efficacy and safety of etanercept and adalimumab with and without a loading dose for psoriasis: A systematic review."2 In our initial assessment of their clinical trial report (M04-688; NCT00338754), we were not able to infer any statistical difference in efficacy between the 2 dosing regimens, 40 mg every other week (EOW) and 80-mg loading dose followed by 40 mg EOW.3 However, we are pleased to learn that a statistical analysis directly comparing the efficacy of the 2 groups was completed and established a more rapid improvement of psoriatic plaques with the regimen including a loading dose.
Potential of the strain Raoultella sp. KDF8 for removal of analgesics
Abstract
The bacterial strain KDF8 capable of growth in the presence of diclofenac and codeine analgesics was obtained after chemical mutagenesis of nature isolates from polluted soils. The strain KDF8 was identified as Raoultella sp. based on its morphology, biochemical properties, and 16S rRNA gene sequence. It was deposited in the Czech Collection of Microorganisms under the number CCM 8678. A growing culture efficiently removed diclofenac (92% removal) and partially also codeine (about 30% degradation) from culture supernatants within 72 h at 28 °C. The degradation of six analgesics by the whole cell catalyst was investigated in detail. The maximum degradation of diclofenac (91%) by the catalyst was achieved at pHINI of 7 (1 g/L diclofenac). The specific removal rate at high concentrations of diclofenac and codeine increased up to 16.5 mg/gCDW per h and 5.1 mg/gCDW per h, respectively. HPLC analysis identified 4′-hydroxydiclofenac as a major metabolite of diclofenac transformation and 14-hydroxycodeinone as codeine transformation product. The analgesics ibuprofen and ketoprofen were also removed, albeit to a lower extent of 3.2 and 2.0 mg/gCDW per h, respectively. Naproxen and mefenamic acid were not degraded.
Transversalis fascia scoring: a new adjunct to anterior component separation technique
Abstract
Background
Abdominal wall hernia is a significant cause for reoperation following laparotomy. Anterior component separation (ACS) is a widely used technique for closure of large abdominal wall defects. We propose that adding scoring of transversalis fascia to ACS can provide additional midline advancement of the anterior rectus sheath.
Methods
Open ACS was performed in eight cadavers. The medial advancement of the anterior rectus sheath was recorded at three points bilaterally during application of constant load, and again following scoring of the transversalis fascia. This technique was then used on two patients with recurrent, complex ventral hernias which could not be closed with ACS alone.
Results
In the cadaver model, transversalis fascia scoring provides additional 34.01, 27.12, and 25.05% advancement at each point compared to ACS. Results were significant. In both patients, primary fascial closure of defects over 20 cm width at midline was achieved.
Conclusions
Adding transversalis fascia scoring in a controlled standard fashion to ACS may help surgeons achieve closure of abdominal wall defects when ACS alone is not sufficient.
Level of Evidence: Level V, therapeutic study.
Technical, hygiene, economic, and life cycle assessment of full-scale moving bed biofilm reactors for wastewater treatment in India
Abstract
Moving bed biofilm reactor (MBBR) is a highly effective biological treatment process applied to treat both urban and industrial wastewaters in developing countries. The present study investigated the technical performance of ten full-scale MBBR systems located across India. The biochemical oxygen demand, chemical oxygen demand, total suspended solid, pathogens, and nutrient removal efficiencies were low as compared to the values claimed in literature. Plant 1 was considered for evaluation of environmental impacts using life cycle assessment approach. CML 2 baseline 2000 methodology was adopted, in which 11 impact categories were considered. The life cycle impact assessment results revealed that the main environmental hot spot of this system was energy consumption. Additionally, two scenarios were compared: scenario 1 (direct discharge of treated effluent, i.e., no reuse) and scenario 2 (effluent reuse and tap water replacement). The results showed that scenario 2 significantly reduce the environmental impact in all the categories ultimately decreasing the environmental burden. Moreover, significant economic and environmental benefits can be obtained in scenario 2 by replacing the freshwater demand for non-potable uses. To enhance the performance of wastewater treatment plant (WWTP), there is a need to optimize energy consumption and increase wastewater collection efficiency to maximize the operating capacity of plant and minimize overall environmental footprint. It was concluded that MBBR can be a good alternative for upgrading and optimizing existing municipal wastewater treatment plants with appropriate tertiary treatment.
Graphical abstract
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Dysregulation of autophagy in melanocytes contributes to hypopigmented macules in tuberous sclerosis complex
The tuberous sclerosis complex (TSC) was initially described about 150 years ago as an autosomal dominant genetic disorder marked by progressive involvement of multiple systems. TSC results from mutations of either the TSC1 or TSC2 gene [1,2]. In patients afflicted, uncontrolled protein synthesis and cell growth due to constitutive mammalian target of rapamycin (mTOR) activation promote benign tumor proliferation at various sites [3,4]; and some non-tumorous symptoms, such as epilepsy and hypopigmented macules, are also observed [5,6].
Stabilization of Visual Function After Optic Nerve Sheath Fenestration for Optic Nerve Meningocele
A 10-year-old boy with bilateral colobomatous cavitary disc anomalies presented with a 3-month history of vision loss in his right eye. MRI of the head and orbit revealed bilateral tubular cystic enlargement of the optic nerve/optic sheath complex with thickening of the optic nerves without inflammation or neoplasm, suggestive of bilateral optic nerve meningocele. An optic nerve sheath fenestration was performed OD, and he experienced an improvement and stabilization of vision in his right eye during a 1-year follow-up period. The authors recommend that surgical decompression, particularly optic nerve sheath fenestration, should be considered in cases with progressive vision loss due to optic nerve meningocele.
Transcanalicular Laser-Assisted Dacryocystorhinostomy With Endonasal Augmentation in Primary Nasolacrimal Duct Obstruction: Our Experience
Purpose: To evaluate and compare the success rate of transcanalicular laser-assisted dacryocystorhinostomy with endonasal augmentation, with and without intubation, in patients suffering from primary acquired nasolacrimal duct obstruction, at 1 year of follow up. Methods: A prospective, randomized interventional pilot study was conducted at a tertiary care center, in accordance with the guidelines of Declaration of Helsinki. Sixty eyes of 60 adult patients with primary acquired nasolacrimal duct obstruction were included. The participants were divided randomly into 2 equal groups (A and B-without and with bicanalicular intubation, respectively). An osteotomy was first created using 980 nm diode laser (set at 8W continuous mode) transcanalicularly and then enlarged intranasally using Blakesley's nasal forceps, followed by bicanalicular silicon intubation in group B patients. The tubes were removed at the end of 8 weeks. The ostium size was assessed endoscopically at 8 weeks and again at the end of follow up, at 1 year. A successful outcome was defined in terms of ostium patency at the end of 1 year. The results were analyzed at the end of a follow up of 1 year, using various statistical tests (pImaging the Canaliculops With Ultrasound Biomicroscopy and Anterior Segment Ocular Coherence Tomography
Canaliculops is a noninflammatory and noninfectious ectasia of the canaliculus with serous fluid accumulation. Currently, the etiology is uncertain. To the best of the authors' knowledge only 6 confirmed cases have been published earlier; however, the imaging features were not described. The authors report the ultrasound biomicroscopic and ocular coherence tomography features of a histopathologically proven canaliculops.A Novel Method to Measure Artificial Eye Motility
Purpose: To measure objectively, reproducibly, and noninvasively artificial eye motility, a fundamental aspect in the (cosmetic) outcome of enucleation. Method: A gaze- and pupil-tracking system, the "iView X," was implemented to measure horizontal eye motility. The system, with adjusted software, was tested with patients wearing 1 prosthetic eye after enucleation for retinoblastoma. Measurements were repeated 5 times in every patient and analyses were performed twice by 2 independent observers. Reproducibility was tested via linear mixed models. After the implementation of the method, more data were obtained, including more patients with a history of enucleation for the treatment of retinoblastoma for eye tracker measurement, and differences in motility percentages between implant types and sizes were analyzed via Mann-Whitney U tests. Results: The intraclass correlation coefficient of the interobserver variable in the patient test group (n = 27, 6–53 years) was 0.98 and 0.96 for measurement of left gaze and right gaze, respectively. Intraobserver variation wasDermatofibroma of the Eyelid: Immunohistochemical Diagnosis
A 66-year-old man developed a painless 2 mm to 3 mm recurrent nodule at the left upper eyelid margin. Excision disclosed a spindle cell lesion without frank atypia or mitotic activity growing in a twisted fascicular pattern often referred to as storiform. All the surgical margins were involved with tumor. Immunohistochemistry demonstrated that many of the constituent spindle and dendritic tumor cells were CD34−, factor XIIIa+, and CD 163+, the latter 2 being biomarkers for monocytic lineage. The lesion was diagnosed as a dermatofibroma rather than a fibrous histiocytoma, a term that should be reserved for more aggressive lesions of deeper fascial planes. Facial dermatofibromas are rarer and more likely than those of the extremities to recur and therefore deserve wider local excision at first surgery with careful and frequent clinical follow ups. Eyelid dermatofibroma has probably often been misdiagnosed as another tumor in the past. Immunohistochemistry can supply valuable biomarker criteria for diagnosis.Validation of CADS Grading Scale: An Ophthalmic Specific Grading Instrument for Facial Nerve Palsy
Purpose: To evaluate the inter- and intraobserver reliability of the CADS score, a previously described facial nerve grading instrument for ophthalmic grading of facial nerve palsy. Methods: This is a cross-sectional validation study. Two clinicians independently assessed and graded each patient on the same day, masked to each other's grading. Four parameters are assessed in the CADS scale: Cornea (0–3, ±a), static Asymmetry (0–2), Dynamic function (0–3), and Synkinesis (0–2). One clinician reassessed the patients and performed the grading again at a minimum time interval of 1 hour later. A weighted κ analysis was performed to determine inter- and intraobserver reliability using 95% bootstrapped bias-corrected and accelerated (BCa) confidence intervals (CIs). Results: Thirty-three patients (27 women, mean age 51.7, range 23–80 years) with unilateral facial nerve palsy were graded. The overall interobserver reliability was 0.80 (95% BCa CI: 0.68–0.91) for cornea, 0.93 for resting asymmetry (95% BCa CI: 0.55–1.00), 0.80 for dynamic function (95% BCa CI: 0.50–0.96), and 0.88 (95% BCa CI: 0.71–0.96) for synkinesis. The overall intraobserver reliability was 0.93 for cornea (95% BCa CI: 0.83–0.98), 0.82 for resting asymmetry (95% BCa CI: 0.53–0.96), 0.92 for dynamic function (95% BCa CI: 0.72–1.00), and 0.98 for synkinesis (95% BCa CI: 0.84–1.00). Conclusion: The CADS grading scale demonstrates good interobserver reliability and very good intraobserver reliability. It incorporates all ophthalmic complications for facial nerve palsy and remains easy to use and refer to.Orbital Perivenous Abscess Complicating the Diagnosis and Management of Orbital Cellulitis
An 11-year-old female presented with orbital cellulitis, bacterial sinusitis, enlarged left superior ophthalmic vein, dural venous sinuses, and internal jugular vein. The patient underwent endoscopic sinus surgery and was started on intravenous antibiotics and anticoagulation with limited improvement in orbital signs and symptoms. A magnetic resonance imaging/magnetic resonance venography of the orbits and brain revealed a dilated left superior ophthalmic vein with absence of flow but no clearly discernible orbital abscess. Intravenous corticosteroids resulted in dramatic improvement of pain, hypoglobus, proptosis, and extraocular motility, all of which rapidly recurred on discontinuation. Serial imaging revealed progression of what eventually manifested as a well-defined, rim-enhancing peri-superior ophthalmic vein abscess, which was incised and drained with prompt resolution of orbital cellulitis and complete visual recovery.Non-Exenteration Management of Sino-Orbital Fungal Disease
Purpose: To describe the non-exenteration management of sino-orbital fungal infection, a life-threatening condition for which orbital exenteration is generally considered a first-line treatment. Methods: A retrospective case series is presented of 7 orbits in 6 consecutive patients admitted and treated at 2 major metropolitan tertiary teaching hospitals in Sydney, New South Wales, Australia. Results: Seven orbits in 6 consecutive patients with sino-orbital fungal infection were treated conservatively with surgical debridement and intravenous antifungal agents. Four patients were immunosuppressed and the other 2 patients were otherwise healthy. All presented with pain, proptosis, or loss of vision. Causative organisms found were Mucormycoses, Aspergillus, and Scedosporium prolificans. Exenteration was avoided in all patients as part of their planned management and 5 patients, including 1 with bilateral disease, survived their disease without exenteration. Medical treatment included intravenous liposomal amphotericin B or voriconazole. A single immunosuppressed patient deteriorated and as a last resort, exenteration was performed, but this made no difference to his clinical course and in retrospect could have been avoided as he died of multiple cerebral metastases diagnosed shortly after his deterioration. Conclusion: The authors recommend that patients with sino-orbital fungal disease preferably be treated conservatively, without orbital exenteration.
Comparison of Colorado Microdissection Needle Versus Scalpel Incision for Aesthetic Upper and Lower Eyelid Blepharoplasty
Purpose: Traditionally, eyelid skin incisions with electro-cautery devices have been avoided due to the concerns of aesthetically unacceptable scar formation. The purpose of this study is to compare ecchymosis, cosmesis, and histologic tissue damage of incisions made with a scalpel or Colorado needle in patients undergoing upper and lower aesthetic blepharoplasty. To the best of authors' knowledge, no previous study has been performed before to compare these 2 modalities in aesthetic blepharoplasty surgery. Methods: This is a multicenter, prospective, interventional, comparative case series. The study protocol was approved by Institutional Review Board in each institution. Patients underwent bilateral upper and/or transcutaneous lower blepharoplasty with 1 side randomly selected for skin incision with the scalpel, the other side with the Colorado needle. Ecchymosis was evaluated using a 10-point Likert scale and the wounds using a Hollander score. The margins of excised tissues were evaluated histologically. Results: A total of 254 eyelids of 101 patients were included in the study. No significant difference was observed in ecchymosis on postoperative day 1 and 7 and scar cosmesis on day 30 and 180 between the 2 techniques. Histologically, necrosis was noted only with the Colorado needle sides (p = 0.001). No adverse events occurred on the Colorado needle side at any time after surgery. Conclusions: No clinical difference is noted between Colorado needle and scalpel incisions in terms of ecchymosis and scar cosmesis after aesthetic blepharoplasty.Chronic Eyelid Edema Following Periocular Hyaluronic Acid Filler Treatment
A 54-year-old woman received multiple injections of hyaluronic acid filler to the brow region to address volume loss over a 21-month period. She then developed significant pitting edema of both upper eyelids, which persisted for 6 years. Hyaluronidase (Hyalase) was injected into the subcutaneous brows and resulted in complete resolution of the edema within 2 days. This confirms that the hyaluronic acid injected into the brows was responsible for this patient's chronic eyelid edema. This case illustrates an unusual long-term complication of periocular hyaluronic acid filler.Long-Term Results for Entropion Repair by Tarsal Margin Rotation With Posterior Lamella Superadvancement
Purpose: To report the long-term stability of tarsal margin rotation and posterior lamellar superadvancement (TMR PLS) for the repair of upper eyelid cicatricial entropion. Methods: A retrospective chart review was performed from January 2000 through December 2014 to identify all patients who had TMR PLS at the authors' institution. Charts were reviewed for demographic information, recurrence of entropion or trichiasis, and surgical complications. Failure was defined as return of entropion. Patients with greater than 24 months of follow up were included. Results: A total of 30 TMR PLS procedures were performed during the review period. Nineteen cases from 14 patients were included in the final analysis. None of the 19 cases demonstrated recurrence of entropion over an average follow-up period of 78.3 months. Eight cases demonstrated trichiasis after TMR PLS, 5 of which required treatment. Conclusion: This case series suggests that TMR PLS for the treatment of upper eyelid cicatricial entropion has excellent long-term stability.Dacryoadenitis as the Initial Presentation of a Natural Killer T-Cell Lymphoma
Primary orbital natural killer T-cell lymphoma (NKTCL) is a rare condition with only a few published cases in the literature. Over 1 month, an 81-year-old man developed progressive left periocular inflammation unresponsive to treatment. Clinical examination and imaging studies demonstrated a left lacrimal gland enlargement. Bilateral anterior uveitis and erythematous nontender cutaneous lesions were also found. Biopsies of the skin and lacrimal gland on the back revealed histopathologic and immunohistochemical findings confirming Epstein–Barr virus-positive NKTCL. Metastatic work up disclosed multifocal involvement in the pancreas, stomach, and chest wall. Palliative treatment consisting of nonanthracycline-based chemotherapy and radiation was instituted, but the patient died 5 months after the onset of symptoms. This is the first example of acute dacryoadenitis, and the second of bilateral anterior uveitis, in the setting of NKTCL. Absence of naso-sinus involvement in the current case is rare in NKTCL. Despite treatment, the prognosis remains dismal. Orbital specialists should include NKTCL in the differential diagnosis of lacrimal gland/orbital masses and perform an incisional biopsy if the clinical scenario so dictates.The Latino Eyelid: Anthropometric Analysis of a Spectrum of Findings
Purpose: Published anthropometric measurements of the Latino eyelid are limited. This study describes features spanning the morphologic range from non-Latino whites to East Asians in the spectrum of the Latino eyelid. Methods: A cross-sectional study of 68 people (32 Latinos, 18 non-Latino whites, and 18 East Asians, ages 18–39), approved by the Institutional Review Board and HIPAA-compliant, was performed. Saliva samples determined genetic components. Indirect anthropometric measurements were performed with ImageJ software. Eyelid measurements included margin reflex distance, palpebral fissure height, eyelid crease height, orbital height, horizontal fissure length, inner and outer canthal distances, medial and lateral canthal angles, and lateral canthal angle of inclination. Additionally, exophthalmometry and epicanthal folds were recorded. Results: Analysis of 184 markers from HumanExome Chip data revealed distinct clustering patterns. Genetically, the Asian participants were in 1 group, the whites in another group, and the Latinos spanned the spectrum between these 2 groups. In Latinos, the inner canthal distance and lateral canthal angle of inclination were similar to Asians, whereas the eyelid crease spanned the range from Asians to whites. Half of the Latinos had epicanthal folds. Conclusions: Latinos possess a spectrum of eyelid features spanning the morphologic characteristics from those of non-Latino whites to those of East Asians. These normative data on Latinos from Texas and Mexico aid in the diagnoses of Latino eyelid disorders and are a reference for optimizing oculofacial surgery outcomes.Multifocal Ocular Surface Squamous Neoplasia
A 64-year-old healthy female presented with a papillomatous limbal lesion involving 6 clock hours of superior limbus and diffuse involvement of upper tarsal conjunctiva of left eye of 6 months duration. Excision of superior limbal lesion on histopathology showed carcinoma in situ with focal breach in basement membrane and moderate degree of differentiation. The surgical base and margins were uninvolved. The tarsal lesion was initially treated with subconjunctival interferon alpha 2b (IFN alpha 2b) (3 cycles of IFN alpha 2b) with poor response. Subsequently treatment with topical mitomycin C 0.04% showed a dramatic response in the upper eyelid tarsal lesion. A small residual lesion needed excision. One year after treatment, she was completely tumor-free. In multifocal ocular surface squamous neoplasia, multimodal treatment with excision and topical mitomycin C may be effective in cases refractory to immunotherapy.Customized Minimally Invasive Orbital Decompression Surgery Improves Lower Eyelid Retraction and Contour in Thyroid Eye Disease
Purpose: To investigate the outcome of a customized approach with targeted zygomatic basin bone removal orbital decompression in lower eyelid retraction and contour of patients with thyroid eye disease. Methods: In a comparative case series, clinical charts and photos of a consecutive sample of 92 patients with thyroid eye disease submitted to different types orbital decompression were studied. Exophthalmos, midpupil to lower eyelid margin distances (MRD2) at 11 meridians, and globe position were measured and compared according to the types of decompression. Each eyelid was also labeled as within or outside normal limits regarding both contour pattern analysis and MRD2 compared with a control normal range. Eyelid contour and globe position from patients with orbital decompression with zygomatic basin removal were compared with those without basin removal. Results: A total of 105 orbits from 57 patients met the study inclusion criteria. Ninety-eight orbits had lateral orbital wall decompression and in 53% of these cases, bone in the zygomatic basin was removed. Removal of the zygomatic basin did not significantly enhance decrease in proptosis, but significantly induced vertical globe descent and improved MRD2 (pSpontaneous Resolution of Optic Neuropathy in Sphenoid Wing Meningioma
The authors describe herein a case of optic neuropathy in progesterone receptor positive sphenoid wing meningioma of the greater wing which demonstrated spontaneous recovery with conservative management.Porous Versus Nonporous Orbital Implants After Enucleation for Uveal Melanoma: A Randomized Study
Purpose: To compare hydroxyapatite with acrylic implants after enucleation for uveal melanoma with respect to eyelid position, ocular motility, implant complications, and patient satisfaction. Methods: Patients undergoing primary enucleation for uveal melanoma between May 2005 and November 2012 at the Liverpool Ocular Oncology Centre, United Kingdom, were randomized between hydroxyapatite and acrylic implants. Questionnaires were sent to patients and ocularists to comment on the main outcomes. Results: A total of 416 patients were recruited in the study, of whom 281 were included, with 49.5% (139/281) and 50.5% (142/281) receiving a hydroxyapatite (HA) or acrylic (AC) implant. Mailed questionnaires completed at ≥18 months by patients showed no significant differences between the groups in eyelid position, prosthetic motility, socket complications, and patient satisfaction. Complications included implant extrusion (1% vs 4%), enophthalmos (26% vs 26%), and superior sulcus deformity (24% vs 24%) with HA and AC implants, respectively, (Fisher exact test p > 0.0125 in all, Bonferroni correction). Questionnaires completed by ocularists indicated no significant differences in eyelid opening, prosthetic motility, and other complications at 6 months (Fisher exact test, p > 0.05 in all); there was a higher prevalence of ptosis with AC than HA implants (46% vs 25%, p = 0.03) and a greater need for ocularists' treatment with HA than AC (50% vs 28%, p = 0.03). Conclusions: Patient-reported outcomes after enucleation for uveal melanoma indicate no major differences between hydroxyapatite and acrylic implants in surgical outcomes and patient satisfaction. There was a higher prevalence of ptosis with AC and a greater need of ocularists' visits with HA at around 6 months observed by ocularists.Syndromic and Nonsyndromic Systemic Associations of Congenital Lacrimal Drainage Anomalies: A Major Review
Purpose: To review and summarize the syndromic, nonsyndromic, and systemic associations of congenital lacrimal drainage anomalies. Methods: The authors performed a PubMed search of all articles published in English on congenital lacrimal anomalies (1933–2016). Patients of these articles were reviewed along with the literature of direct references to syndromes and other systemic associations. Data reviewed included syndromic descriptions, systemic details, demographics, lacrimal presentations, management, and outcomes. Results: Syndromic and systemic associations with congenital lacrimal drainage disorders are not known to be common. Although familial presentations have been reported, the inheritance patterns are unclear for most anomalies. There is an increasingly growing evidence of a genetic basis to many lacrimal anomalies. However, few syndromes have either widespread or are frequently associated with lacrimal anomalies. Few sequences of distinct lacrimal presentations and intraoperative findings are seen. Surgical challenges in these patients are distinct and a thorough pre and intraoperative anatomical assessment, detailed imaging when indicated, and assessment and correction of associated periocular and facial abnormalities may facilitate good outcomes. Conclusions: Lacrimal drainage anomalies associated with syndromic and nonsyndromic systemic conditions have certain unique features of their own and their surgical and anesthesia challenges are distinct. Diagnosis of congenital lacrimal drainage anomalies should prompt consideration of the possible presence of associated systemic abnormalities.Retinal Vessel Oxygen Saturation and Vessel Diameter in Inactive Graves Ophthalmopathy
Purpose: To investigate whether inactive thyroid-associated ophthalmopathy (TAO) affects retinal oxygen saturation and/or vessel diameter. Methods: Via an observational case–control study, retinal circulation was measured in patients with inactive TAO (mild, moderate, and severe) and normal subjects by retinal oximetry. Complete ophthalmologic examination, including noncontact tonometry and Hertel exophthalmometry, was performed; history of smoking and dysthyroid disease were recorded. Analysis of variance or the Kruskal–Wallis test was used to compare oximetry values between TAO and controls. Simple linear regression was used to analyze the correlation of Hertel, smoking, and intraocular pressure with oximetry values. Results: Seventy-six eyes were enrolled: 19 controls, and 17 mild, 21 moderate, and 19 severe inactive TAO. Retinal oxygen saturation did not change significantly in inactive TAO versus controls; arteriole saturation: severe, 95.7% ± 7.0%; moderate, 93.2% ± 3.9%; mild, 90.3% ± 4.8%; and controls, 93.1% ± 6.4%; vein saturation: severe, 57.4% ± 7.1%; moderate, 59.0% ± 7.0,; mild, 56.3% ± 7.9%; and controls, 58.5% ± 6.5%; arteriovenous saturation: severe, 38.3% ± 8.0%; moderate, 34.2% ± 7.1%; mild, 33.9% ± 6.8%; and controls, 34.6% ± 5.9%. However, retinal venous diameter with severe TAO (137.3 ± 12.5 μm) significantly decreased in comparison with controls (148.8 ± 10.2 μm, p = 0.017). Otherwise, no significant change in vessel diameter was found between TAO and controls. No statistically significant correlations were found between Hertel values or intraocular pressure and oximetry values. However, there was a positive significant correlation between smoking and arteriovenous oxygen saturation (p = 0.017, β = 4.61). Conclusions: In inactive TAO versus controls, retinal oxygen saturation fluctuated and could be affected by smoking; however, the retinal venous diameter only decreased significantly for severe TAO. This implies that TAO may affect retinal circulation; this effect could be accelerated by smoking.Unrelated immunodeficiency states may impact outcomes and immune checkpoint molecule expression in patients with mycosis fungoides: A clinicopathologic case-control study
Immunodeficiency (ID) correlates with worse outcomes and decreased immune checkpoint molecule expression in melanoma. The impact of ID in mycosis fungoides (MF) is unknown.
“Multicentre study of patient-reported and clinical outcomes following immediate and delayed Autologous Breast Reconstruction And Radiotherapy (ABRAR study)”
Timing of autologous breast reconstruction in patients requiring adjuvant radiotherapy remains contentious. The primary objective of this study was to assess clinical and patient reported outcomes in immediate reconstruction with radiotherapy compared to delayed reconstruction after radiotherapy, the two relevant clinical pathways for patients who need radiotherapy.
When Does Race Matter?
Public consciousness of race in American society has been greatly heightened over the past few years with the revelation of black deaths during police actions, the rise of the Black Lives Matter movement, and by various utterances, as well as policies against Mexicans and other immigrant groups by the current US President. The importance of race has long been observed by social epidemiologists studying wide disparities in health among race groups in the USA (US CDC, 2013). A key component of these disparities, and likely on the causal pathway between race and health, are the large and widening disparities in income, wealth, and educational attainment among racial groups, leading to unequal opportunities for high-quality employment (Burgard and Lin, 2013). At the same time, there is wide consensus among biologists and geneticists that race has little, if any biological importance (Lee et al., 2008). For instance, the degree of inter-individual variability in genotypes vastly outweighs variability between groups of humans (Race Ethnicity and Genetics Working Group, 2005). As a result, the concept of race is now thought of as a 'social construction,' that is, a set of norms and assumptions largely agreed upon by a population. The social construction of race is affirmed by the fact that the definition of race changes over time and varies by country. For instance, the US defines race (White, Black, Asian, American Indian, Hawaiian, or Pacific Islander) and ethnicity (Hispanic, non-Hispanic) separately (NIH, 2001), South Africa defines race using historical legacies (African, Asian, Coloured, White), and France has long required "colour-blind" or race-neutral policies and practices.
Assessment of Environmental Contamination with Pathogenic Bacteria at a Hospital Laundry Facility
Abstract
Little is known about exposure to pathogenic bacteria among industrial laundry workers who work with soiled clinical linen. To study worker exposures, an assessment of surface contamination was performed at an industrial laundry facility serving hospitals in Seattle, WA, USA. Surface swab samples (n = 240) from the environment were collected during four site visits at 3-month intervals. These samples were cultured for Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE). Voluntary participation of 23 employees consisted of nasal swabs for detection of MRSA, observations during work, and questionnaires. Contamination with all three pathogens was observed in both dirty (laundry handling prior to washing) and clean areas (subsequent to washing). The dirty area had higher odds of overall contamination (≥1 pathogen) than the clean area (odds ratio, OR = 18.0, 95% confidence interval 8.9–36.5, P < 0.001). The odds of contamination were high for each individual pathogen: C. difficile, OR = 15.5; MRSA, OR = 14.8; and VRE, OR = 12.6 (each, P < 0.001). The highest odds of finding surface contamination occurred in the primary and secondary sort areas where soiled linens were manually sorted by employees (OR = 63.0, P < 0.001). The study substantiates that the laundry facility environment can become contaminated by soiled linens. Workers who handle soiled linen may have a higher risk of exposure to C. difficile, MRSA, and VRE than those who handle clean linens. Improved protocols for prevention and reduction of environmental contamination were implemented because of this study.Occupational Exposure to Manganese and Fine Motor Skills in Elderly Men: Results from the Heinz Nixdorf Recall Study
Abstract
Objectives
Exposure to manganese (Mn) may cause movement disorders, but less is known whether the effects persist after the termination of exposure. This study investigated the association between former exposure to Mn and fine motor deficits in elderly men from an industrial area with steel production. Methods
Data on the occupational history and fine motor tests were obtained from the second follow-up of the prospective Heinz Nixdorf Recall Study (2011–2014). The study population included 1232 men (median age 68 years). Mn in blood (MnB) was determined in archived samples (2000–2003). The association between Mn exposure (working as welder or in other at-risk occupations, cumulative exposure to inhalable Mn, MnB) with various motor functions (errors in line tracing, steadiness, or aiming and tapping hits) was investigated with Poisson and logistic regression, adjusted for iron status and other covariates. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated for substantially impaired dexterity (errors >90th percentile, tapping hits <10th percentile). Results
The median of cumulative exposure to inhalable Mn was 58 µg m–3 years in 322 men who ever worked in at-risk occupations. Although we observed a partly better motor performance of exposed workers at group level, we found fewer tapping hits in men with cumulative Mn exposure >184.8 µg m–3 years (OR 2.15, 95% CI 1.17–3.94). MnB ≥ 15 µg l–1, serum ferritin ≥ 400 µg l–1, and gamma-glutamyl transferase ≥74 U l–1 were associated with a greater number of errors in line tracing. Conclusions
We found evidence that exposure to inhalable Mn may carry a risk for dexterity deficits. Whether these deficits can be exclusively attributed to Mn remains to be elucidated, as airborne Mn is strongly correlated with iron in metal fumes, and high ferritin was also associated with errors in line tracing. Furthermore, hand training effects must be taken into account when testing for fine motor skills.Nano-object Release During Machining of Polymer-Based Nanocomposites Depends on Process Factors and the Type of Nanofiller
Abstract
We tested the nanomaterial release from composites during two different mechanical treatment processes, automated drilling and manual sawing. Polyurethane (PU) polymer discs (1-cm thickness and 11-cm diameter) were created using different nanomaterial fillers: multiwall carbon nanotubes (MWCNT), carbon black (CB), silicon dioxide (SiO2), and an unfilled PU control. Drilling generated far more submicron range particles than sawing. In the drilling experiments, none of the tested nanofillers showed a significant influence on particle number concentrations or sizes, except for the PU/MWCNT samples, from which larger particles were released than from control samples. Higher drilling speed and larger drill bit size were associated with higher particle counts. Differences between composites were observed during sawing: PU/CB released higher number concentrations of micro-sized particles compared to reference samples. When sawing PU/SiO2 more nanoparticle agglomerates were observed. Furthermore, polymer fumes were released during sawing experiments, which was attributed to the process heat. For both drilling and sawing, the majority of the aerosolized particles were polymer matrix materials containing nanofillers (or protruding from their surface), as evidenced by electron microscopic analysis. Results suggest that: (i) processes associated with higher energy inputs are more likely to result in higher particle release in terms of number concentration; (ii) nanofillers may alter release processes; and (iii) other types of released particles, in particular polymer fumes from high-temperature processes, must also be considered in occupational exposure and risk assessments.Occupational Exposure to Inhalable Manganese at German Workplaces
Abstract
Due to mounting evidence of neurotoxic effects of manganese (Mn) already at low concentrations, occupational exposure limits (OELs) have been adopted. We analyzed 5771 personal measurements of inhalable manganese (Mn) together with information on sampling conditions and job tasks from the German exposure database Messdaten zur Exposition gegenüber Gefahrstoffen am Arbeitsplatz (MEGA) to assess exposure levels in welders and other occupations between 1989 and 2015. Geometric means (GMs) of exposure to Mn were estimated for various occupational settings adjusted for 2-h sampling duration and analytical method, centered at 2009. Measurements below the limit of quantification (LOQ) were multiply imputed. The median concentration was 74 µg m−3 (inter-quartile range 14–260 µg m−3) in welders and 8 µg m−3 (inter-quartile range <LOQ–31 µg m−3) in other occupations. Every third measurement was higher than 100 µg m−3, 20% exceeded 200 µg m−3, and 5% of welders inhaled concentrations ≥1000 µg m−3. GMs >100 µg m−3 were observed in gas metal and flux-cored arc welders and in shielded metal arc welders using consumables of high Mn content (>5%). Tungsten inert gas welding, laser welding and working in other occupations such as foundry worker, electroplater, or grinder were associated with GMs <10 µg m−3. A shorter sampling duration was associated with higher Mn concentrations. High-emission welding techniques require protective measures to cope with adopted OELs. Results of this study are useful to assess cumulative Mn exposure in community-based studies on neurotoxic effects.Daily Shoulder Pain Among Flight Baggage Handlers and its Association With Work Tasks and Upper Arm Postures on the Same Day
Abstract
Objectives
This study of flight baggage handlers aimed at examining the extent to which shoulder pain developed during single work shifts, and whether a possible development was associated with biomechanical exposures and psychosocial factors during the same shift. Methods
Data were collected during, in total, 82 work shifts in 44 workers. Right and left shoulder pain intensity was rated just before and just after the shift (VAS scale 0–100 mm). Objective data on 'time in extreme' and 'time in neutral' upper arm postures were obtained for the full shift using accelerometers, and the baggage handlers registered the number of 'aircrafts handled' in a diary. During half of the shift, workers were recorded on video for subsequent task analysis of baggage handling. 'Influence' at work and 'support' from colleagues were measured by use of Copenhagen Psychosocial Questionnaire (COPSOQ). Associations between exposures and the increase in pain intensity during the shift ('daily pain') were analysed for the right and left shoulder separately using Generalized Estimating Equations (GEE). Results
'Daily pain' was observed in approximately one third of all shifts. It was significantly associated with the number of 'aircrafts handled' for both the right and left shoulder. In multivariate models including both biomechanical exposures and the psychosocial factors 'influence' at work and 'support' from colleagues, 'aircrafts handled' was still significantly associated with 'daily pain' in both shoulders, and so was 'influence' and 'support', however in opposite directions. Conclusions
'Daily pain' was, in general, associated with biomechanical exposures during the same shift and with general 'influence' and 'support' in the job. In an effort to reduce pain among flight baggage handlers, it may therefore be justified to consider a reduction of biomechanical exposures during handling of aircrafts, combined with due attention to psychosocial factors at work.Occupational Noise Exposure and the Risk for Work-Related Injury: A Systematic Review and Meta-analysis
Abstract
Objectives
Occupational noise exposure has been linked to work-related injuries. Strategies to control occupational hazards often rely on dose-response relationships needed to inform policy, but quantitative synthesis of the relevant literature has not been done so far. This study aimed to systematically review the epidemiological literature and to perform meta-analysis of the risk for work-related injury due to occupational noise exposure. Methods
PRISMA and MOOSE guidelines were followed. PubMed, ScienceDirect, and Google Scholar were searched up until 15 December 2016 in English, Russian, and Spanish. Reference lists, grey literature, and expert archives were searched as well. The risk of bias was assessed for each study and incorporated into the meta-analysis weights using the quality effects model. Results
Overall, 21 studies were included at the qualitative review stage: 9 cross-sectional, 6 case-control, 4 cohort, 1 case-crossover, and 1 ecological. Noise exposure was assessed objectively in 13 studies. Information on occupational injuries was elicited from medical records/registry in 13 studies. Meta-analyses showed RR = 1.22 (95% CI: 1.15, 1.29) (n = 59028) per 5 dB increase in noise exposure (Cochran's Q = 27.26, P < 0.001, I2 = 67%) and RR = 2.16 (95% CI: 1.61, 2.90) (n = 96023) in the most exposed group (>90–95 dB) compared with the least exposed group (Cochran's Q = 180.46, P < 0.001, I2 = 90%). Subgroup analysis with meta-regression revealed an overall robust pooled risk per 5 dB. Conclusions
There is a dose-response association between occupational noise exposure and work-related injury risk. However, the quality of evidence is 'very low'; therefore, the magnitude of this association should be interpreted with caution.First Metagenomic Survey of the Microbial Diversity in Bioaerosols Emitted in Waste Sorting Plants
Abstract
Waste sorting activities are source of occupational bioaerosol exposures that are associated with several health disorders. New analytical tools, based on next-generation sequencing (NGS) technologies, provide powerful methods to assess the microbial composition of bioaerosols. The objectives of the study were (i) to assess the feasibility and the repeatability of NGS-based biodiversity measurements and (ii) to study the microbial biodiversity using NGS in bioaerosols emitted in a waste sorting plant (WSP). Three stationary parallel samples were collected in a sorting cabin using closed-face cassettes equipped with polycarbonate membranes. Bacterial and fungal diversity was assessed by sequencing 16S and 18S rDNA genes using either Illumina sequencing or 454 pyrosequencing methods. At sampling point, airborne bacteria were dominated by Proteobacteria, Firmicutes, and Actinobacteria with prevailing genera assigned to unclassified Enterobacteriaceae, Staphylococcus, Acinetobacter, Leuconostoc, Pseudomonas, and Lactobacillus. Airborne fungi were dominated by Ascomycota with prevailing genera assigned to Penicillium, Aspergillus, Rhizopus, Wallemia, and Hemicarpenteles. The NGS biodiversity measurements revealed a higher biodiversity bioaerosols that previously reported for WSP in studies carried out using culture methods followed by identification of microorganisms. These results provide the first survey about taxonomic biodiversity in bioaerosols from WSPs using high-throughput sequencing.Quantitative Respirator Fit, Face Sizes, and Determinants of Fit in South African Diagnostic Laboratory Respirator Users
Abstract
Objectives
Respirators are widely used in health care settings but there is scant information on adequacy of fit and its determinants, particularly in resource-constrained settings. The aim of the study is to describe the proportion of South African diagnostic laboratory respirator users with adequate quantitative respirator fit while wearing their currently selected respirators which were generally supplied without regard to face size, and to identify determinants of fit test pass and fail. Methods
This was a cross-sectional study with 562 participants. Quantitative respirator fit testing was conducted using a PortaCount fit testing machine. Four facial dimensions were taken using callipers and a tape measure. STATA 14 was used to perform descriptive and inferential statistics. The effect of the independent variables including face dimensions, race, smoking, respirator make and size, and age group was explored using multiple logistic regression stratified by sex. Results
Ninety one percent of the respirators supplied were medium-sized. Seventy eight percent of respirator users failed fit testing and were thus probably not protected by their currently supplied respirator. Multiple logistic regression analysis showed that face length in mm (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.00–1.09), nasal root breadth in mm (OR = 1.16, 95% CI = 1.06–1.28), and respirator shape (OR = 0.56, 95% CI = 0.39–0.78) were significant predictors of overall fit for all subjects and for women alone, but these factors explained only a small percentage of fit test outcomes. Conclusion
A large proportion of diagnostic laboratory employees were using poorly fitting respirators. This creates a false impression of protection. Fit testing of respirators is therefore important and recommended. The determinants evaluated described only a small portion of the variability in fit; important determinants were absent from the models.Combining Lead Exposure Measurements and Experts’ Judgment Through a Bayesian Framework
Abstract
Objectives
CARcinogen EXposure (CAREX) is a carcinogen-surveillance system employed in many countries. To develop Korean CAREX, the intensity of exposure to lead, as an example, was estimated across industries. Methods
Airborne-lead measurement records were extracted from the work-environment measurement database (WEMD), which is a nationwide workplace-monitoring database. Lead measurements were log-transformed; then, the log-transformed geometric means (LGMs) and log-transformed geometric standard deviations (LGSDs) were calculated for each industry. However, the data of many industries was limited. To address this shortcoming, experts' judgments of the lead exposure levels across industries were elicited. Experts provided their estimates of lead exposure levels as the boundary of the 5th and 95th percentiles, and it is assumed that these estimates are based on the log-normal distributions of exposure levels. Estimates of LGM and LGSD were extracted from each expert's response and then combined to quantify the experts' prior distribution. Then, the experts' prior distributions for each industry were updated with the corresponding LGMs and LGSDs calculated from the WEMD data through a Bayesian framework, yielding posterior distributions of the LGM and LGSD. Results
The WEMD contains 83035 airborne-lead measurements that were collected between 2002 and 2007. A total of 17 occupational-hygiene professionals with >20 years of experience provided lead exposure estimates. In industries where measurement data were abundant, the measurement data dominated the posterior exposure estimates. For example, for one industry, 'Manufacture of Accumulator, Primary Cells, and Primary Batteries,' 1152 lead measurements [with a geometric mean (GM) of 14.42 µg m−3 and a geometric standard deviation (GSD) of 3.31] were available and 15 experts' responses (with a GM of 7.06 µg m−3 and a GSD of 4.15) were collected, resulting in a posterior exposure estimate of 14.41µg m−3 as the GM with a GSD of 3.31. For industries with a limited number of measurements available in the WEMD, experts' decisions played a significant role in determining the posterior exposure estimates. For example, for the 'Manufacture of Weapons and Ammunition' industry, 15 lead measurements (with a GM of 6.45 µg m−3 and a GSD of 3.37) were available and seven experts' responses (with a GM of 3.28 µg m−3 and a GSD of 4.54) were obtained, resulting in a posterior exposure estimate of 5.42 µg m−3 as the GM with a GSD of 3.73. Conclusions
The proposed method for estimating the intensity of exposure to carcinogens may introduce an unbiased approach to the development process by simultaneously utilizing both prior knowledge of experts and measurement data. In addition, it supplies a framework for future updates.Field Measurements of Inadvertent Ingestion Exposure to Metals
Abstract
The determinants of inadvertent occupational ingestion exposure are poorly understood, largely due to a lack of available exposure measurement data. In this study, perioral exposure wipes were used as a surrogate for inadvertent ingestion exposure to measure exposure to eight metals (chromium, nickel, aluminium, cobalt, lead, arsenic, manganese, and tin) among 38 workers at 5 work sites in the UK. This work was done alongside a previously reported observational study of hand/object-to-mouth contact frequency. Systematic wipes of the perioral area, and of both hands were taken with proprietary cellulose wipes pre-moistened with deionized water. Measurements were taken at the beginning, middle and end of the shift. Mixed-effect models of exposure measurements were built with area of skin sampled, time during shift, and job group entered as fixed effects and worker identification as a random effect. Linear regression modelling was used to study the effect of hand/object-to-mouth contact frequency on perioral exposure, adjusting for the measured exposure on the hand and observed respirator use. Hand and perioral exposure measurements were correlated with one another (r = 0.79) but mass per unit area exposure was significantly higher on the perioral area than on the hands for seven of the metals (at P < 0.05). There were no significant differences between measurements taken at the middle or the end of the shift for five of the metals suggesting that dermal loading may remain relatively constant for much of the workday. This applies to both hand and perioral measurements. In linear regression modelling there was no relationship between hand/object-to-mouth contact frequency and perioral exposure, but hand exposure was significantly positively related to perioral exposure and workers who used respirators had significantly higher perioral exposure than those who did not. The results suggest the levels of exposure on the hand and respirator use are important determinants of potential inadvertent ingestion exposure. The results did not demonstrate a relationship between perioral exposure and hand-to-mouth contact frequency. Perioral wipe sampling may be a useful surrogate measure for exposure by the inadvertent ingestion route, but further research is required to confirm the link between perioral levels and actual exposure, measured using biological monitoring.Monocyte-Derived Procoagulant Microvesicles Induced by High Glucose Can Be Attenuated by the Antioxidant N-Acetyl-L-Cysteine, Partly Through the P38/MAPK Pathway
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
Lesiones purpúricas en la infancia
Publication date: Available online 10 November 2017
Source:Piel
Author(s): Minia Campos-Domínguez, Ana Martín-Santiago, Ángela Hernández-Martín, Ricardo Suárez-Fernández
Electroquimioterapia en el tratamiento del cáncer cutáneo
Publication date: Available online 10 November 2017
Source:Piel
Author(s): Lara Ferrándiz, Almudena Fernández-Orland, David Moreno-Ramírez
“Lower Body Lift in the Massive Weight Loss Patient: A New Classification and Algorithm for Gluteal Augmentation”
Background: An often neglected part of the lower body lift procedure is the gluteal region. The objective of this study is to classify the massive weight loss (MWL) patients undergoing a body lift procedure and provide a safe, standardized approach for gluteal augmentation. Methods: A retrospective review of all body lift procedures performed between January 2012 and January 2017 was conducted. Patients undergoing a lower body lift with or without gluteal augmentation were included for analysis. Patients were classified as follow: type I, minimal lower and upper back fat and deflated buttock; type II, substantial lower back fat, minimal upper back fat and deflated buttock; type III, substantial lower and upper back fat and deflated buttock; type IV, good buttock projection. Type I patients had gluteal implants, type II patients had autologous flap augmentation, type III patients had gluteal lipofilling and type IV patients did not have any gluteal augmentation. Results: 280 patients were included for analysis. 238 underwent concomitant gluteal augmentation (85%): 213 had autologous flaps (76%), 13 had gluteal implants (5%) and 12 had large volume lipofilling (4%). Forty-two patients underwent a body lift with no gluteal augmentation (15%). Gluteal augmentation did not increase the rate of complication. In both groups no skin necrosis, venous thrombosis or pulmonary embolism were reported. Patients who had a sleeve gastrectomy had significantly lower odd of complications when compared to gastric bypass (OR= 0.45, p=0.017). Conclusion: A standardized algorithmic approach for gluteal augmentation may optimize the result without increasing the complication rate. Financial Disclosure Statement: All the authors have nothing to disclose. No funding was received for the article. Corresponding author: Samer Jabbour, MD, 191 Rue Saint Charles, Paris, France. samermed@gmail.com ©2017American Society of Plastic Surgeons
Inhibition of Skin Wound Contraction by Nanofibrillar Cellulose Hydrogel
Background: Although wound contraction is an essential part of healing, excessive contraction can compromise healing through induction of scarring and fibrosis. This in turn leads to development of wound contractures that limit elasticity and function. Major research efforts have focused on development of novel therapeutic approaches to gain inhibitory control over wound contraction. Despite these efforts, the need for cost-effective, clinically feasible and effective agents to inhibit wound contraction remains. Methods: In this study, we investigated the effect of nanofibrillar cellulose (NFC) hydrogel on wound contraction both in vitro and in vivo. Two different porcine full thickness wounds (8mm punch-biopsy wounds and 4 x 4cm wounds covered with a 1:3-meshed split thickness skin graft) were treated with or without nanofibrillar cellulose or carboxymethylcellulose (Purilon® hydrogel), which was used as a reference treatment. Wound contraction was observed macroscopically, and histological sections were taken at 14 days' follow-up. Results: Nanofibrillar cellulose hydrogel inhibited 70% of punch-biopsy wound contraction whereas the carboxymethylcellulose hydrogel was ineffective. Importantly, application of nanocellulose on split thickness skin grafts did not inhibit epithelialization of the interstices or cell migration from the graft. Conclusions: Our results, although preliminary, indicate a potential for nanofibrillar cellulose hydrogel as a novel material for controlling excessive wound contraction. Financial disclosure statement: The study was funded by UPM New Business and Development unit. All authors declare no conflicts of interest. Acknowledgements: The skillful technical assistance of Lahja Eurajoki is greatly appreciated. We would also like to thank Veikko Huusko and Olli Valtanen from the animal facility of Helsinki University Central Hospital. In addition, Panu Taipale and Janne Ruokonen from National Nanomicroscopy Center (Aalto University, Finland) are gratefully acknowledged for taking cryo-TEM. Martina Lille from VTT Technical Research Centre of Finland is also thanked for conducting rheology measurements. Corresponding author: Kristo Nuutila, MSc, PhD, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, knuutila@bwh.harvard.edu ©2017American Society of Plastic Surgeons
Deferoxamine Preconditioning of Irradiated Tissue Improves Perfusion and Fat Graft Retention
Background: Radiation therapy is a mainstay in the treatment of many malignancies, but collateral damage to surrounding tissue, with resultant hypovascularity, fibrosis, and atrophy, can be difficult to reconstruct. Fat grafting has been shown to improve the quality of irradiated skin, but volume retention of the graft is significantly decreased. Deferoxamine (DFO) is a FDA-approved iron-chelating medication for acute iron intoxication and chronic iron overload that has also been shown to increase angiogenesis. The present study evaluates the effects of DFO treatment on irradiated skin and subsequent fat graft volume retention. Methods: Mice underwent irradiation to the scalp followed by treatment with deferoxamine or saline and perfusion and were analyzed using laser Doppler analysis (LDA). Human fat grafts were then placed beneath the scalp and retention was also followed up to eight weeks radiographically. Finally, histologic evaluation of overlying skin was performed to evaluate effects of deferoxamine preconditioning. Results: Treatment with DFO resulted in significantly increased perfusion, as demonstrated by LDA and CD31 immunofluorescent staining (*p 0.05). Importantly, fat graft volume retention was significantly increased when the irradiated recipient site was preconditioned with DFO (*p
“Comparing efficacy and costs of four facial fillers in HIV-associated lipodystrophy: a clinical trial.”
Background: The objective was to evaluate and compare safety and effectiveness of four different dermal fillers in the treatment of facial lipoatrophy secondary to Human Immunodeficiency Virus (HIV). Methods: We conducted a clinical trial including 147 patients suffering from HIV-induced lipoatrophy treated with Sculptra® (poly-L-lactic acid), Radiesse® (calcium hydroxylapatite), Aquamid® (polyacrylamide) or autologous fat. Objective and subjective changes were evaluated during a 24-monthfollow-up. Number of sessions, total injected volume and overall costs of treatment were also analyzed. A comparative cost-effectiveness analysis of the treatment options was performed. Results: Objective improvement in facial lipoatrophy, assessed by the surgeon in terms of changes from baseline using the published classification of Fontdevila, was reported in 53% of the cases. Patient self-evaluation showed a general improvement after the use of facial fillers. Patients referred to be satisfied with the treatment and with the reduced impact of lipodystrophy on their quality of life. Despite the non-significant differences observed in number of sessions and volume, autologous fat showed significantly lower costs than all synthetic fillers (p
Vertical Skin Paddle Orientation for the Latissimus Dorsi Flap in Breast Reconstruction: A Modification to Simultaneously Correct Inferior Pole Constriction and Improve Projection
Summary: The latissimus dorsi myocutaneous flap (LDMF) is a reliable and frequently used option to bring vascularized skin and soft tissue to improve the stability and aesthetic result in breast reconstruction. Standard techniques with skin paddle inset in a horizontal or oblique fashion preferentially improve anterior projection (when inset at the mastectomy scar) or lower pole and infra-mammary fold (IMF) constriction (when inset into the IMF). Here, we describe a modification for inset of the LDMF that improves both anterior projection and lower pole/IMF constriction, while also allowing the latissimus muscle to fan out and provide complete implant coverage. The vertical inset modification brings new skin and soft tissue into both the inferior pole and the central mastectomy scar, allowing simultaneous improvement in both areas and full utilization of the latissimus muscle to cover the implant or expander. Financial Disclosures: None Corresponding Author: Neil Fine, MD, FACS, 676 N St Clair St #1575, Chicago, IL 60611, 312-266-6240, n-fine@northwestern.edu ©2017American Society of Plastic Surgeons
Evaluation of Preoperative and Postoperative Patient Satisfaction and Quality of Life in Patients Undergoing Rhinoplasty: A Systematic Review and Meta-analysis
Objectives: Improvement of nasal aesthetics via rhinoplasty is a highly sought-after procedure and leads to increased patient confidence. The aim of the study was to provide a quantitative synthesis of existing data regarding the ability of cosmeto-functional rhinoplasty to improve patient satisfaction and quality of life (QoL) measured by the Rhinoplasty Outcomes Evaluation (ROE) scale. Methods: Electronic databases were searched for studies evaluating QoL following aesthetic rhinoplasty. Study results were pooled and analyzed using a random effects model. Effect size was estimated using standardized mean difference (SMD) at a 95% confidence interval (CI). Heterogeneity and benefit were assessed and reported using the I2 and standard mean difference (SMD). Subgroup analyses were performed based on follow-up period and age group segregation. Results: A total of 377 articles were retrieved, of which 8 studies were included in the final analysis. Overall, patient satisfaction analyzed by pooling 8 observational studies improved following cosmeto-functional rhinoplasty (SMD of 5.87; 95% CI: 3.55-8.19; I2 = 100%). In addition, further subgroup analyses revealed that maximum benefit was derived by younger patients (SMD = 6.69; 95% CI: 3.65-9.74; I2 = 99%) compared with older patients (SMD = 3.48; 95% CI: 3.01-3.96; I2 = 0%). Postoperative patient satisfaction levels showed maximum improvement during a follow-up period of 6 to 12 months (SMD = 11.07; 95% CI: -8.79 to 32.12; I2 = 100%). Conclusion: Cosmeto-functional rhinoplasty improves patients' QoL as evidenced by an improvement in ROE scores. Financial Disclosure Statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. AUTHORS' CONTRIBUTIONS: YZ, FY, YL, HZ, YL and HC contributed in conceptualizing and design of this study. All the authors were involved in data analysis and interpretation. YL was involved in drafting the manuscript. All the authors finalized and approved the study manuscript. CONFLICT OF INTEREST: The authors have no conflicts of interest to declare. *Corresponding Author: Dr. Yin Liu, Ph.D. Department of Plastic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China – 650103, M: +8613658882652, E-Mail: Yinliu317@gmail.com ©2017American Society of Plastic Surgeons
Single and combined metal contamination in coastal environments in China: current status and potential ecological risk evaluation
Abstract
With the development of industrialization and urbanization, metal and metalloid pollution is one of the most serious environmental problems in China. Current contamination status of metals and metalloid and their potential ecological risks along China's coasts were reviewed in the present paper by a comprehensive study on metal contents in marine waters and sediments in the past few decades. The priority metals/metalloid cadmium (Cd), mercury (Hg), chromium (Cr), lead (Pb), and arsenic (As), which were the target elements of the designated project "Comprehensive Prevention and Control of Heavy Metal Pollution" issued by the Chinese government in 2011, were selected considering their high toxicity, persistence, and prevalent existence in coastal environment. Commonly used environmental quality evaluation methods for single and combined metals were compared, and we accordingly suggest the comprehensive approach of joint utilization of the Enrichment Factor and Effect Range Median combined with Pollution Load Index and Mean Effect Range Median Quotient (EEPME); this battery of guidelines may provide consistent, internationally comparable, and accurate understanding of the environment pollution status of combined metals/metalloid and their potential ecological risk.
Technical-financial evaluation of rainwater harvesting systems in commercial buildings–case ase studies from Sonae Sierra in Portugal and Brazil
Abstract
Water is an essential and increasingly scarce resource that should be preserved. The evolution of the human population and communities has contributed to the global decrease of potable water availability and the reduction of its consumption is now compulsory. Rainwater harvesting systems (RWHS) are emerging as a viable alternative source for water consumption in non-potable uses. The present study aims to contribute to the promotion of water efficiency, focusing on the application of rainwater harvesting systems in commercial buildings, and comprises four stages: (i) development of a technical evaluation tool to aid the design of RWHS and support their financial evaluation; (ii) validation of the tool using operational data from an existing RWHS installed at Colombo Shopping Center, in Lisbon, Portugal; (iii) assessment of the sensibility of the technical evaluation tool results to the variation of the inputs, namely the precipitation and consumption, through a parametric analysis for the Colombo Shopping Center; and (iv) comparison of the performance and financial feasibility of hypothetical RWHS in two existing commercial buildings. The technical tool was applied to two Sonae Sierra's shopping centers, one in Portugal and one in Brazil. The installation of a 200-m3 tank is advised for the first case study, allowing non-potable water savings of 60% but a payback period of about 19 years. In the Brazilian shopping, the implementation of a tank with a capacity ranging from 100 to 400 m3 leads to non-potable savings between 20 and 50%, but with smaller payback period, under 2 years, due to the relatively lower investment costs and higher water fees.
Reactivation and reuse of TiO 2 -SnS 2 composite catalyst for solar-driven water treatment
Abstract
One of the most important features of photocatalytic materials intended to be used for water treatment is their long-term stability. The study is focused on the application of thermal and chemical treatments for the reactivation of TiO2-SnS2 composite photocatalyst, prepared by hydrothermal synthesis and immobilized on the glass support using titania/silica binder. Such a catalytic system was applied in solar-driven treatment, solar/TiO2-SnS2/H2O2, for the purification of water contaminated with diclofenac (DCF). The effectiveness of studied reactivation methods for retaining TiO2-SnS2 activity in consecutive cycles was evaluated on basis of DCF removal and conversion, and TOC removal and mineralization of organic content. Besides these water quality parameters, biodegradability changes in DCF aqueous solution treated by solar/TiO2-SnS2/H2O2 process using simply reused (air-dried) and thermally and chemically reactivated composite photocatalyst through six consecutive cycles were monitored. It was established that both thermal and chemical reactivation retain TiO2-SnS2 activity in the second cycle of its reuse. However, both treatments caused the alteration in the TiO2-SnS2 morphology due to the partial transformation of visible-active SnS2 into non-active SnO2. Such alteration, repeated through consecutive reactivation and reuse, was reflected through gradual activity loss of TiO2-SnS2 composite in applied solar-driven water treatment.
Vocal fold augmentation under local anesthesia using autologous fascia
Abstract
Vocal fold augmentation by injection of autologous fascia has been used since the 1990s with excellent safety record in 500 operations done under general anaesthesia. It is safe from risks arising from allergic or other foreign body adverse reactions. Fascia provides long-term augmentation and remains stable 3-10 years after injection.
Vocal fold augmentation under local anaesthesia is excellent alternative for those unfit for general anaesthesia, providing aid to fragile and weak persons with vocal fold paralysis. However, all of available synthetic materials resorb within 6-24 months.
Fascia injection under local anaesthesia provides the possibility for a long-term vocal fold medialization while avoiding risk of general anaesthesia. Fascia lata harvesting and processing is easily done (as shown in video) followed by injection into the vocal fold. The whole procedure is done under local anaesthesia. Procedure offers long-term vocal fold medialization, fine tuning the amount of the medialization by immediate feedback from the patient's voice. Operation time is one hour.
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Immobilisation of metals in a contaminated soil with biochar-compost mixtures and inorganic additives: 2-year greenhouse and field experiments
Abstract
Besides carbon sequestration and improvement of soil properties, biochar (BC) has increasingly been studied as an amendment to immobilise heavy metals in contaminated soils. In a 2-year experiment, we analysed the effects of poplar BC (P-BC, mixed with compost) and gravel sludge with siderite-bearing material (GSFe) on a Cd-, Pb- and Zn-contaminated soil and on metal concentration in Miscanthus × giganteus shoots under greenhouse and field conditions. In the greenhouse, 1% (m/m) P-BC addition reduced NH4NO3-extractable Cd, Pb and Zn concentrations by 75, 86 and 92%, respectively, at the end of the study. In the leachates, P-BC (1%) could significantly reduce Cd and Zn in both years. In the field, P-BC (3%) induced a reduction of extractable Cd by 87% whereas a combination of P-BC + GSFe reduced Pb by 82% and Zn by 98% in the first year and by 83 and 96% in the second year. In contrast, the metal immobilisation in the soil was hardly reflected in the shoots of Miscanthus × giganteus which generally showed metal concentrations close to control. While Cd was not influenced in both years, Pb and Zn were slightly reduced. Our study confirmed that Miscanthus is an efficient metal excluder, corroborating its suitability for the production of renewable biomass on metal-contaminated soils.
Release of nutrients and heavy metals from biochar-amended soil under environmentally relevant conditions
Abstract
Biochar is a potential amendment for improving soil fertility due to its richness of nutrients, P, K, Ca, and Mg. However, soil amended with metal-rich biochars may pose a risk of heavy metal release to the environment. Biochars derived from pig manure and sewage sludge (PM-biochar and SS-biochar) were investigated for their nutrient and heavy metal release in two soils (acidic and alkaline soil) under simulated landfill and acid rain conditions. Results showed that under both environmental conditions, adding PM-biochar into the soil increased K, P, and Mg release significantly by about 40–50 times, while only 2–4 times increase of the nutrients was observed in the SS-biochar-amended soil. The Ca release was higher in the SS-biochar-amended soil than in the PM-biochar-amended soil. Higher P, Ca, and Mg nutrient release was observed in alkaline soil than in acidic soil under the two environmental conditions though K release was not significant in both soils. A kinetic study in solution illustrated that the release of nutrients from biochar was initially via desorption and diffusion under environmental conditions and then through slow dissolution of insoluble species. More release of nutrients and heavy metals was observed in the biochar-amended soil under the landfill condition than under the acid rain condition. Although this release was limited under the acid rain condition, leaching of Fe and Mn exceeded the limitations of the groundwater standard value of China. Overall, biochar could be utilized as a prospective soil fertilizer by supplying nutrients such as P, K, Ca, and Mg, while the release of Fe and Mn should be paid more attention due to the risk of these metals impacting groundwater.
Insights into doxycycline adsorption onto graphene nanosheet: a combined quantum mechanics, thermodynamics, and kinetic study
Abstract
Recently, pharmaceutically active compounds including antibiotics have been detected in drinking water at very low levels, mostly nanogram/liter concentrations, proposing that these materials were unaffected by water treatment processes. Adsorption processes were suggested to play a significant role in the removal of antibiotics. In this study, the adsorption behavior of doxycycline (DC) in aqueous solution was evaluated. The four factors influencing the adsorption of DC onto graphene nanosheet (GNS) were studied. The results showed that initial pH ∼ 6 to 7 and contact time ∼ 200 min are optimum. The monolayer adsorption capacity was reduced with the increasing temperature from 25 to 45 °C. Nonlinear regressions were carried out to define the best fit model for every system. Among various models, the Hill isotherm model represented the equilibrium adsorption data of antibiotics while the kinetic data were well fitted by the Elovich kinetic model. The maximum adsorption capacity (q max) was 110 mg.g−1, obtained from the Hill equation. Semiempirical molecular orbital theory was used to investigate the molecular interaction of the adsorption system. The experiments and semiempirical computation have systematically demonstrated that DC could be adsorbed onto GNS by π- π and electrostatic interactions. It was shown that there is a good compromise with the experimental results.
Graphical abstract
Insights into doxycycline adsorption onto graphene nanosheet: quantum mechanics, thermodynamics, and kinetic study.
The Joint Effects of Antenatal Steroids and Gestational Age on Improved Outcomes in Neonates
Abstract
Objectives
Antenatal corticosteroids are standard of care for women at risk of a preterm birth and demonstrated to be protective against poor outcomes in neonates including respiratory disorders, mortality and intraventricular hemorrhage (IVH). Its benefits may vary by gestational age, and accurate estimation is needed in a single-center population to account for practice variation.
Methods
A retrospective cohort of infants admitted to the hospital's neonatal intensive care unit, 1997–2015. Using Poisson regression, we separately modeled the incidence rate ratio of death, grade III or IV intraventricular hemorrhage (IVH), and moderate to severe bronchopulmonary dysplasia (BPD) testing the moderating effects of gestation on antenatal steroids, controlling for potential confounding.
Results
Among 5314 infants admitted, death occurred in 298 (6%), severe IVH in 244 (5%), and BPD in 527 (10%). Antenatal steroids were protective of death and BPD in the adjusted analysis, and there was multiplicative interaction where each week increase in gestational age combined with steroid therapy resulted in 13% reduced incidence for each outcome.
Conclusions for Practice
Antenatal steroids are protective against severe IVH and moderate to severe BPD, and when combined with gestational age, steroids are associated with greater protective benefits in older neonates. There is likely an ideal window to maximize the benefits of antenatal steroids, and future etiologic research should consider the joint effects with gestational age.
Epidural abscess caused by Schizophyllum commune: a rare case of rhinogenic cranial complication by a filamentous basidiomycete
Summary
Central nervous system (CNS) infections due to filamentous basidiomycetes are extremely rare. We encountered a case of epidural abscess due to Schizophyllum commune that extended from sinusitis. A 53-year-old Japanese man presented at our hospital with a headache. Computed tomography (CT) of the cranium and sinuses showed ethmoid and sphenoid sinusitis with no intracranial abnormalities. The patient was diagnosed with acute sinusitis and underwent antibiotic treatment. However, the symptoms deteriorated, and the patient came to our hospital again with consciousness disturbance. CT scan of the cranium and sinuses showed no improvement of sinusitis after antibiotic therapy and an epidural abscess emerged in the middle cranial fossa. Therefore, emergency craniotomy and endoscopic sinus fenestration were performed. Filamentous fungal elements were observed in both rhinorrhoea and epidural abscess. The symptoms improved after the operation and administration of liposomal amphotericin B. The clinical isolate was identified as S. commune by a molecular-based method. To our knowledge, this is the first report of epidural abscess due to this fungus. Although rare, clinicians should be aware that S. commune could be a causative agent of CNS infections.
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Primary prophylaxis of invasive fungal infections with posaconazole or itraconazole in patients with acute myeloid leukemia or high-risk myelodysplastic syndromes undergoing intensive cytotoxic chemotherapy: a real world comparison
Abstract
This is an observational-retrospective study comparing the real-world outcomes associated with posaconazole vs. itraconazole as prophylaxis treatments. Two hundred and ninety-three patient admissions attributable to 174 patients were included in the study. Patients were treated with itraconazole (n = 114 admissions; 39%) or posaconazole (n = 179; 61%). Antifungal prophylaxis failure (APF) due to treatment-related adverse events (in 34 out of 293 patient admissions; 11.6%) was more frequent in the posaconazole group (6.1% vs. 15.1%; P = 0.024). There were 9 patient admissions for episodes of APF due to probable/proven breakthrough fungal infection (primary endpoint): 6 and 3 in the itraconazole and posaconazole group, respectively (5.3% vs. 1.7%; P = 0.095). All of them were associated with invasive pulmonary aspergillosis (IPA). APF was more frequent with itraconazole (65% vs. 30%; P < 0.001), along with failure due to possible/probable/proven IPA (25% vs. 10%; P = 0.002) and overall failure by any of the three different causes of prophylaxis failure (70% vs. 38%; P < 0.001). In agreement with clinical trial data, this real-world evidence supports the use of posaconazole over itraconazole in AML or MDS patients undergoing intensive chemotherapy.
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A Cross-sectional Epidemiological Study of Hidradenitis Suppurativa in an Irish Population
Abstract
Background
Hidradenitis suppurativa (HS), a chronic inflammatory disease that affects apocrine gland–bearing skin, has a significant impact on patient quality of life. Estimates of the epidemiologic prevalence of HS are highly variable, and clinical data on disease characteristics and patient burden of disease remain limited.
Objective
The primary objective of this study was to determine the number of patients with HS attending dermatology clinics in a hospital setting in Ireland (within a 6-month time period). Secondary objectives included the assessment of disease characteristics and the collection of patient responses on disease burden and work productivity.
Methods
This was an epidemiologic, non-interventional, cross-sectional study across 4 dermatology clinics in Ireland over a 6-month time period. The disease prevalence was estimated by calculating the percentage of total patients with a diagnosis of HS (the primary population) across the selected sites. Secondary analyses were performed using the full analysis set, which consisted of eligible adults (≥18 years of age) from the primary population who provided informed consent. Data from these analyses are presented as descriptive summary statistics, with the use of an analysis of covariance for continuous endpoints.
Results
The prevalence of HS across the 4 selected sites was estimated at 1.4% (95% CI, 1.24–1.62). One hundred fifty eligible patients comprised the full analysis set. The majority of participants were white (95%), female (70%), cigarette smokers (56%), and overweight or obese (body mass index ≥25 kg/m2, 82%). Most patients presented with Hurley stage II (45%), and more than a third had a relative with HS (35%). Questionnaire responses revealed a profound impact on quality of life, including diminished work productivity and various psychological comorbidities.
Conclusion
This study offers insight into the clinical features and disease burden of hidradenitis suppurativa in an Irish population.
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Milker's nodule:an occupational infection and threat to the immunocompromised
Abstract
Milker's nodule virus, also called paravaccinia virus is a DNA virus of the parapoxvirus genus transmitted from infected cows to humans. It results from contact with cattle, cattle byproducts, or fomites. Classified as an occupational disorder, those at risk of exposure include farmers, butchers, and agricultural tourists. The viral infection begins 5-15 days after inoculation as an erythematous-purple, round nodule with a clear depressed center, and a surrounding erythematous ring. While familiar to those in farming communities, the presence of the nodule may be concerning to others, particularly the immunosuppressed. Milker's nodules are self-limited in immunocompetent individuals and heal without scarring within 8 weeks.
Another member of the Parapoxvirus genus, the orf virus, is also transmitted from animals to humans by direct-contact. While complications are rare, hematopoietic stem cell transplant recipients are at risk of graft-versus-host disease, as the parapoxvirus may trigger these complications in immunocompromised individuals. In addition, paravaccinia may serve as the antigen source for the development of erythema multiforme.
The unique structure and replication process of viruses in the Poxvirus family, while includes the Parapoxvirus genus, have been a focus for treatment of infections and cancer. Manipulation of these viruses has demonstrated promising therapeutic possibilities as vectors for vaccines and oncologic therapy.
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Integration of dermoscopy and reflectance confocal microscopy for distinguishing melanomas from nevi of the breast area
Abstract
Background
Nevi of special sites encompass a class of benign lesions characterized by the presence of atypical clinical and histopathologic features that can be difficult to distinguish from melanoma. Dermoscopy and reflectance confocal microscopy may improve the clinical assessment of melanocytic lesions in order to avoid unnecessary excisions.
Objectives
The aim of this study was to assess the value of specific dermoscopic and confocal criteria in distinguishing melanomas from nevi of the breast area.
Methods
Dermoscopic and confocal images from consecutive patients with at least 1 clinically and/or dermoscopically equivocal melanocytic skin lesion of the breast area were retrospectively evaluated. In this case-control study, only histopathologically-proven melanomas (cases) and nevi (controls) were included. Spearman's coefficients were first calculated to flag significant correlation; then univariate and multivariate logistic regression analysis were performed to assess which factors were independently associated with the histopathological diagnosis. Finally, a mixed dermoscopic/confocal score was created to distinguish nevi from melanomas on the breast area.
Results
The study population included 55 skin lesions of the breast area, 34 (61.8%) nevi and 21 (38.2%) melanomas. Among dermoscopic criteria, atypical network and irregular pigmentation resulted independently associated with melanoma diagnosis (OR: 11.1; 95%CI 1.0-119.9; P:.048 and OR: 6.5; 95%CI 1.1-37.5; P:.037, respectively). Furthermore, on RCM examination the presence of pagetoid cells was an independent positive predictor for melanoma (OR: 38.5; 95%CI 3.9-379.6; P:.002). The mixed score showed high levels of sensitivity and specificity, 95.2% and 82.4%, respectively, which were higher than dermoscopic and confocal evaluations alone.
Conclusion
The combined use of dermoscopy and confocal microscopy in the triage of pigmented lesions of the breast area may help in increasing the diagnostic accuracy and avoiding unnecessary excisions.
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Expression of Janus Kinase 1 in vitiligo & psoriasis before and after narrow band UVB: a case–control study
Abstract
Janus kinases (JAKs) are non-receptor protein tyrosine kinases that are expressed in many tissues. Once the JAKs are activated, a cascade of further signaling events is triggered involving phosphorylation of selected receptor chain tyrosines, binding of signal transducer and activator of transcription (STAT) proteins and phosphorylation of these STATs. Due to their ability to selectively modulate immune function, targeted JAK inhibitors are promising candidates for some skin diseases such as psoriasis and atopic dermatitis. The aim of this study was to assess the level of JAK1 in both vitiligo and psoriasis patients before and after treatment with NB-UVB which is considered a gold standard therapy for both diseases. This study was conducted on 10 patients with psoriasis, 10 patients with vitiligo and 10 controls. JAK1 levels before and after treatment with NB-UVB 311 nm (36 sessions) were measured using Western blot assay. The level of JAK1 was significantly higher in vitiligo and psoriasis patients than controls. There was a decline in the level of JAK1 after treatment, which was statistically significant. VASI and PASI scores of patients decreased after treatment with NB-UVB. In psoriatic patients, the JAK1 level positively correlated with the female participants, disease duration and PASI change. It was concluded that JAK1 plays a role in the pathogenesis of both vitiligo and psoriasis based on its upregulated level before treatment and downregulated level after treatment. This raises the possibility of using the JAK1 inhibitors as targeted immunotherapy for vitiligo and psoriasis.
Estradiol Levels Are Altered in Human Immunodeficiency Virus–Infected Pregnant Women Randomized to Efavirenz-Versus Lopinavir/Ritonavir-Based Antiretroviral Therapy
Abstract
Background
Combination antiretroviral therapy (cART) use in pregnancy has been associated with hormonal dysregulation. We performed a secondary retrospective analysis of longitudinal progesterone and estradiol levels in pregnancy using specimens from the Protease Inhibitors to Reduce Malaria Morbidity in HIV-infected Pregnant Women study, which randomized Ugandan human immunodeficiency virus (HIV)–infected ART-naive women to initiate either lopinavir/ritonavir (LPV/r)–based or efavirenz (EFV)–based cART. Methods
Three hundred twenty-six women (160 randomized to the EFV arm and 166 women to the LPV/r arm) with at least 1 plasma sample collected during pregnancy were included. Enrollment samples collected prior to cART initiation were used as a cART-naive comparator group. Hormone levels were quantified by enzyme-linked immunosorbent assay. Results
Estradiol levels were differentially affected by the 2 cART regimens. Exposure to LPV/r was associated with an increase in estradiol (P < .0001), whereas exposure to EFV was associated with a decrease in estradiol (P < .0001), relative to the cART-naive gestationally matched comparator group. Lower estradiol levels correlated with small for gestational age (SGA) (P = .0019) and low birth weight (P = .019) in the EFV arm, while higher estradiol levels correlated with SGA in the LPV/r arm (P = .027). Although progesterone levels were similar between treatment arms, we observed an association between SGA and lower progesterone in the LPV/r arm (P = .04). No association was observed between hormone levels and preterm birth in either arm. Levels of progesterone and estradiol were lower in cases of stillbirth, and levels of both hormones declined immediately prior to stillbirth in 5 of 8 cases. Conclusions
Combination ART regimens differentially affect estradiol levels in pregnancy, a hormone critical to the maintenance of a healthy pregnancy. Identifying cART regimens that minimize perinatal HIV transmission without contributing to hormonal dysregulation represents an urgent public health priority. Clinical Trials Registration
NCT00993031.
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Publication date: Available online 25 July 2018 Source: Journal of Photochemistry and Photobiology B: Biology Author(s): Marco Ballestr...
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Editorial AJR Reviewers: Heartfelt Thanks From the Editors and Staff Thomas H. Berquist 1 Share + Affiliation: Citation: American Journal...
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Publication date: Available online 28 September 2017 Source: Actas Dermo-Sifiliográficas Author(s): F.J. Navarro-Triviño
