Αναζήτηση αυτού του ιστολογίου

Σάββατο 11 Νοεμβρίου 2017

Algorithmic Decision-Making Based on Machine Learning from Big Data: Can Transparency Restore Accountability?

Abstract

Decision-making assisted by algorithms developed by machine learning is increasingly determining our lives. Unfortunately, full opacity about the process is the norm. Would transparency contribute to restoring accountability for such systems as is often maintained? Several objections to full transparency are examined: the loss of privacy when datasets become public, the perverse effects of disclosure of the very algorithms themselves ("gaming the system" in particular), the potential loss of companies' competitive edge, and the limited gains in answerability to be expected since sophisticated algorithms usually are inherently opaque. It is concluded that, at least presently, full transparency for oversight bodies alone is the only feasible option; extending it to the public at large is normally not advisable. Moreover, it is argued that algorithmic decisions preferably should become more understandable; to that effect, the models of machine learning to be employed should either be interpreted ex post or be interpretable by design ex ante.



In vivo assessment of polydatin, a natural polyphenol compound, on arsenic-induced free radical overproduction, gene expression, and genotoxicity

Abstract

Arsenic (As) is a well-known contaminant of global groundwater. Its exposure causes several hazardous effects on animals and human via oxidative stress. The present study examined the effect of polydatin (PD) on free radical overproduction in rats exposed to As. Thirty-five male rats randomly allocated into five equal groups. To the control group, physiological saline was given orally and to the second group only 100 mg/L As was given by drinking water for 60 days. The other groups were treated with As (100 mg/L) and PD orally at 50, 100, and 200 mg/kg/day, respectively. Treatment with As enhanced malondialdehyde level but decreased glutathione level in blood, liver, kidney, brain, lung, and heart of rats. Also, As decreased superoxide dismutase and catalase activities of erythrocyte, liver, kidney, brain, lung, and heart in rats. Furthermore, As treatment gave rise to increased DNA damage and gene expressions of interleukin 1 beta (IL-1β), nuclear factor kappa beta (NFκB), p53, and tumor necrosis factor-α (TNF-α) in the lung, brain, kidney, and liver. However, treatment of PD ameliorated As-exposed lipid peroxidation, antioxidant enzymes activities, DNA damage, gene expressions, and histopathological changes in tissues. In conclusion, PD has a dose-dependent protective effect on lipid peroxidation and antioxidant defense mechanism in rats against As exposure.



Heavy metal distribution in Tiaoxi River’s sediment

Abstract

According to current study, seven surface sediments and three sediment cores were collected from three typical areas of Tiaoxi River, which were living area, agricultural area, and industrial area. The water quantity into the Lake Taihu from the Tiaoxi River accounted for almost one third of the total water quantity by all rivers into the Lake Taihu. To study geochemical features and pollution history of heavy metals in three typical areas of Tiaoxi River, total content and chemical fractionations of Cu, Pb, Cd, Cr, Mn, Zn, Fe, As, and Hg were analyzed for surface and core sediments using the speciation extraction procedure, proposed by the Commission of the European Communities Bureau of Reference (BCR), together with grain size and organic carbon measurements. The results showed that the concentration of nine heavy metals and the variation characteristics of Zn, Cu, Fe, Mn, and Cr are different among five cores, which has shown that the river responses to natural and anthropogenic activities were dissimilar in various areas. BCR sequential extraction showed contents of Cr, Fe, and Cu were dominated in the remaining parts. Non-residual fractions for Zn and Mn contained major portions. Based on RAC (risk assessment core), the risk of Mn was high to very high in the three typical areas, and the risk of Zn was medium in the three typical areas.



Impact of on-site sanitation systems on groundwater sources in a coastal aquifer in Chennai, India

Abstract

On-site sanitation is the most preferred mode of sanitation due to expensive off-site sanitation. The increasing population especially in the peri-urban areas has led to increasing use of on-site sanitation systems in India. However, the habitations in the vicinity of these systems do not have centralised water supply and are dependent on groundwater sources. However, there is concern about leaching of faecal coliforms and nitrate from the septic tanks to the underlying aquifer. The present study is attempted at two sites in the coastal city of Chennai where on-site sanitation is prevailing. The sample locations (16 nos.) are selected in such a way that groundwater sources are situated in the vicinity of on-site sanitation systems. The groundwater sources are the bore wells installed by the private agencies. It is observed that parameters considered key parameters to study the impact of the on-site sanitation systems, namely Na2+, Cl, NO3, faecal coliform and total dissolved solids, exceed the concentration limits recommended by the Bureau of Indian Standards. The piper diagram analysis identifies that the predominant cations and anions are respectively Na+, and Cl, SO4 and HCO3.The Gibbs plot shows ground water quality is dominated by the evaporation process in both the seasons. The Cl/HCO3 ratio in many samples confirms the seawater intrusion in the study area. Elevated concentrations of faecal coliforms in all the samples (16 nos.) confirm the significant amount of groundwater pollution from the on-site sanitation systems. It is desired that policy planners and implementation agencies should undertake detailed scientific and hydrogeological studies of the region in order to examine the feasibility of implementing on-site sanitation systems.



Distinctive accumulation patterns of heavy metals in Sardinella aurita (Clupeidae) and Mugil cephalus (Mugilidae) tissues

Abstract

The present study assessed the impact of metal pollution on two widely consumed types of wild fish Sardinella aurita and Mugil cephalus captured from the Gulf of Gabes (Tunisia) which is currently experiencing acute environmental problems. A study of the Cd, Cu, Zn, and Pb levels present in the studied site and vital in fish tissues (gills, liver, gonad, and muscle) was undertaken. As expected, muscle, liver, and gonad tissues contained the highest concentrations of all metals except for Zn. The metal levels showed a significant variation of accumulation between species with overall effects of the tested tissues. In addition, the results address the significant effects of the species/tissue interaction. Liver sections showed structural alterations consisting mainly of a significant desquamation of the tissue, a fibroblast proliferation, and a lipid droplet accumulation in both species. Additionally, the presence of skeletal abnormalities affecting the vertebral column was observed in the M. cephalus specimens. As a whole, our data provide the first evidence of distinctive metal accumulation patterns in vital fish tissues as well as the interspecific difference that can be correlated with the biological habits of the two selected models, S. aurita and M. cephalus, known respectively as pelagic and benthopelagic species.



Granuloma Annulare Possibly Secondary to Oral Treatment With Topiramate

Publication date: Available online 11 November 2017
Source:Actas Dermo-Sifiliográficas (English Edition)
Author(s): S. Heras-González, T. Piqueres-Zubiaurre, A. Martínez de Salinas-Quintana, R. González-Pérez




Microscopy in addition to chemical analyses and ecotoxicological assays for the environmental hazard assessment of coal tar-polluted soils

Abstract

Chemical analysis of soils contaminated with coal tar indicated that most organic compounds, and particularly PAHs, were contained in coarser particles (> 200 μm). Microscopic observations of this fraction, carried out on polished sections, reported the presence of organic particles in addition to mineral particles. Some organic particles had a very low porosity, and their microstructure did not evolve during biotreatment. Alternatively, other organic particles had a large porosity composed of an interconnected pore network that was open to coal tar surface and thus in contact with soil water. Interconnected porosity seemed to increase during biotreatment in relation to a decrease in the amount of organic compounds. The amount of open porosity in contact with soil water was expected to increase the desorption rate of PAHs. Consequently, the environmental hazard could depend on the amount of open porosity in addition to chemical properties of organic particles, such as their concentration in PAHs. Thus, microscopy can be complementary to chemical analysis and ecotoxicological assays to assess the best strategy for remediation but also to follow the advancement of a biotreatment.



Malathion-induced spermatozoal oxidative damage and alterations in sperm quality of endangered trout Salmo coruhensis

Abstract

The use of pesticides has been increased along with increasing the farming activities and has caused environmental impacts deleteriously. In particular, non-target organisms including fish can be affected by toxic effects of pesticides. Therefore, the impacts of malathion (MTN) on oxidative stress and sperm quality were investigated in vitro. The MTN concentrations used on this study were 0 (control), 75, 100, and 125 μg/L. Lipid peroxidation (MDA), non-enzymatic (GSH), and enzymatic (SOD, GSH-Px, and CAT) activities in spermatozoa were examined for determination of oxidative stress status. Our findings showed that motility rate and period of sperm cells significantly decreased with exposure to MTN. Biochemical assays revealed that CAT activity and levels of MDA, GSH increased in spermatozoa based on concentration while activity of GSH-Px and SOD decreased. Consequently, spermatozoa were highly sensitive to MTN exposure. MTN has disruptive effects on sperm quality and caused to oxidative stress in spermatozoa.



Racial disparities and insurance status: an epidemiologic analysis of Ohio melanoma patients



Determining the impact of intraoperative smoke evacuation on the patient experience during outpatient surgery: A Randomized Controlled Trial



Pityrosporum Folliculitis: A Retrospective Review of 110 Cases

Pityrosporum folliculitis has clinical and pathophysiologic similarities to acne vulgaris, and may be underrecognized.Pruritic, fine monomorphic papules and pustules on the face and back in patients previously treated with antibiotics suggest a diagnosis of Pityrosporum folliculitis.Pityrosporum folliculitis responds to treatment with topical or oral azole antifungal agents.

The diagnostic value and histologic correlate of distinct patterns of shiny white streaks for the diagnosis of melanoma: a retrospective, case-control study

Shiny white streaks (SWS) are visible on polarized dermoscopy in melanoma and Spitz nevi but are infrequent in dysplastic nevi. They correlate histopathologically with dermal fibrosis.When observed in melanocytic lesions, SWS are highly specific and predictive for melanoma.Polarized dermoscopy to identify shiny white streaks is integral to the evaluation of melanocyticlesions.

Topical Calcipotriol Prior to Ablative Fractional Laser-Assisted Photodynamic Therapy Enhances Treatment Outcomes for Actinic Keratosis in Fitzpatrick grades III-V skin: A Prospective Randomized Clinical Trial



Is the DLQI appropriate for medical decision-making in psoriasis patients?

Abstract

Dermatology Life Quality Index (DLQI) is the most commonly applied measure of health-related quality of life (HRQoL) in psoriasis patients. It is among defining criteria of moderate-to-severe psoriasis and present in treatment guidelines. Our objective was to estimate preference-based HRQoL values (i.e., utilities) for hypothetical health states described by the 10 items of the DLQI in psoriasis patients. Moreover, we compare results to findings of a similar study previously conducted among the general public. A cross-sectional survey was carried out among 238 psoriasis patients. Seven hypothetical DLQI-defined health states with total scores of 6, 11, and 16 (3–3 and 1 states, respectively) were evaluated by time trade-off method. The difference in DLQI scores between hypothetical health states was set at 5 points, as it exceeds the minimal clinically important difference (MCID). Utility scores were found to be homogenous across the seven hypothetical health states (range of means for the 6-point states 0.85–0.91, range of means for the 11-point states 0.83–0.85, and mean of 0.84 for the 16-point state). Overall, mean utilities assessed by psoriasis patients were higher for all seven states compared with the general public (mean difference 0.16–0.28; p < 0.001). In 11 out of the 15 comparisons between health states with DLQI scores differing larger than the MCID, there was no statistically significant difference in utility. Thus, in clinical settings, patients with DLQI scores differing more than the MCID may have identical HRQoL. Improving the definition of moderate-to-severe disease and reconsideration of the DLQI in clinical assessment of psoriasis patients are suggested.



Employing Community Voices: Informing Practice and Programming through Camden Healthy Start Focus Groups

Abstract

Objectives Women living in communities with low-socioeconomic status, substandard healthcare, and ongoing exposure to social disparities encounter barriers to healthcare, often making it difficult to access health services. Barriers may stem from provider interactions with clients, conditions of the healthcare facility, or even language barriers. This prompts a call for providers to be keenly aware of the obstacles women encounter when attempting to access services. Methods In an effort to facilitate better access to services, Camden Healthy Start conducted six focus groups. Thirty-nine women between the ages of 22–56 participated. A total of 39 questions were posed to participants about health behavior, health services, pregnancy, reproductive health, and barriers to accessing services. Each 2 h session was audio recorded, translated and transcribed. Following the format of the Women's Health: Attitudes and Practices in North Carolina Focus Group Research, responses were analyzed and themes emerged. Results This article discusses characteristics of healthcare services and cultural insensitivity that impact women's access and act as barriers to care. The results signal the need for Healthy Start to apply a more relational engagement when providing services. Consideration for Practice Relational engagement includes getting to know the client as a person first, respecting their rights to autonomy in the decision making process, and demonstrating an understanding of the client's culture and inclusion of their voices in the conversation.



Infant Mortality Lessons Learned from a Fetal and Infant Mortality Review Program

Abstract

Objective To review fetal and infant deaths from women enrolled in Indianapolis Healthy Start using the National Fetal and Infant Mortality Review (FIMR) methods to provide strategies for prevention. Methods: Marion County Public Health Department (MCPHD) FIMR staff identified and reviewed 22 fetal and infant deaths to Indianapolis Healthy Start program participants between 2005 and 2012. Trained FIMR nurses completed 13 of 20 maternal interviews and compiled case summaries of all deaths from the MCPHD FIMR database.. Results Case review teams identified a total of 349 family strengths, 219 contributing factors, and made 220 recommendations for future pregnancies. FIMR deliberation values for Healthy Start program participant deaths were similar to other infant deaths in Marion County during the same time period. Common themes that emerged from the reviews included lack of social support, absence of paternal involvement, substance abuse, non-compliance, and poor health behaviors leading to chronic health conditions that complicated many pregnancies. Conclusions A number of the infant deaths in this review could have been prevented with preconception and inter-conception education and by improving the quality and content of prenatal care.



Sino-Nasal Outcome Test-22 quality of life patterns in patients presenting with nasal septal perforation

Abstract

Objectives

To assess the impact of nasal septal perforation on quality of life.

Design

Retrospective cohort study.

Setting

Rhinology clinics from two hospitals in Liverpool, United Kingdom.

Participants

Patients diagnosed with nasal septal perforation (NSP).

Main outcome measures

Patients (n=26) diagnosed with NSP completed the Sino-Nasal Outcome Test-22 (SNOT-22). The collated data was compared with SNOT-22 scores from a cohort of healthy volunteers (n=34) and a cohort of patients (n=30) diagnosed with chronic rhinosinusitis (CRS).

Results

The mean total SNOT-22 score of NSP and CRS cohorts were higher than that observed in healthy volunteers. The mean total SNOT-22 score in the CRS cohort (57.2, standard deviation SD 10.3) was the higher than NSP (50.2, SD 23.5), although this difference did not achieve statistical significance. The mean score for the rhinologic-specific domains (rhinologic symptoms, extra-nasal rhinologic symptoms), ear/facial symptoms and psychological dysfunction domain were higher in the CRS cohort compared to NSP, although statistical significance was only observed in the extranasal rhinologic symptoms domain (11.2, SD 2.4 vs. 6.4, SD 4.1). Conversely, the mean sleep dysfunction domain score for NSP (12.7, SD 7.5) was higher than CRS (10.0, SD 4.9 respectively) although this was not statistically significant.

Conclusions

The present study has assessed the clinimetric and psychometric properties of patients suffering with symptomatic NSP. Future reports should consider inclusion of SNOT-22 data but with the addition of perforation-specific symptoms (nasal crusting, epistaxis, whistling noise).

This article is protected by copyright. All rights reserved.



Creation of a 3Mn/1Fe cluster in the oxygen-evolving complex of photosystem II and investigation of its functional activity

Publication date: Available online 11 November 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): B.К. Semin, L.N. Davletshina, M. Seibert, A.B. Rubin
Extraction of Mn cations from the oxygen-evolving complex (OEC) of Ca-depleted PSII membranes (PSII[-Ca,4Mn]) by reductants like hydroquinone (H2Q) occurs with lower efficiency at acidic pH (2Mn/reaction center [RC] are extracted at pH5.7) than at neutral pH (3Mn/RC are extracted at pH6.5) [Semin et al. Photosynth. Res. 125 (2015) 95]. Fe(II) also extracts Mn cations from PSII(-Ca,4Mn), but only 2Mn/RC at pH6.5, forming a heteronuclear 2Mn/2Fe cluster [Semin and Seibert, J. Bioenerg. Biomembr. 48 (2016) 227]. Here we investigated the efficiency of Mn extraction by Fe(II) at acidic pH and found that Fe(II) cations can extract only 1Mn/RC from PSII(-Ca,4Mn) membranes at pH 5.7, forming a 3Mn/1Fe cluster. Also we found that the presence of Fe cations in a heteronuclear cluster (2Mn/2Fe) increases the resistance of the remaining Mn cations to H2Q action, since H2Q can extract Mn cations from homonuclear Mn clusters of PSII(-Ca,4Mn) and PSII(-Ca,2Mn) membranes but not from the heteronuclear cluster in PSII(-Ca,2Mn,2Fe) membranes. H2Q also cannot extract Mn from PSII membranes obtained by incubation of PSII(-Ca,4Mn) membranes with Fe(II) cations at pH5.7, which suggests the formation of a heteronuclear 3Mn/1Fe cluster in the OEC. Functional activity of PSII with a 3Mn/1Fe cluster was investigated. PSII preparations with a 3Mn/1Fe cluster in the OEC are able to photoreduce the exogenous electron acceptor 2,6-dichlorophenolindophenol, possibly due to incomplete oxidation of water molecules as is the case with PSII(-Ca,2Mn,2Fe) samples. However, in the contrast to PSII(-Ca,2Mn,2Fe) samples PSII(-Ca,3Mn,1Fe) membranes can evolve O2 at a low rate in the presence of exogenous Ca2+ (at about 27% of the rate of O2 evolution in native PSII membranes). The explanation for this phenomenon (either water splitting and production of molecular O2 by the 3Mn/1Fe cluster or apparent O2 evolution due to minor contamination of PSII(3Mn,1Fe) samples with PSII(-Ca,4Mn) membranes) is discussed.



Microwave-assisted photocatalysis of neurotoxin compounds using metal oxides quantum dots/nanosheets composites: Photocorrosion inhibition, reusability and antibacterial activity studies

Publication date: January 2018
Source:Journal of Photochemistry and Photobiology B: Biology, Volume 178
Author(s): Ali Fakhri, Mona Azad, Leila Fatolahi, Shiva Tahami
Water pollution caused by different pollutants is one of the challenging tasks for the scientific community. We have prepared and characterized a material for removal of pollutant compounds. ZnO quantum dots decorated CuO nanosheets and TiO2 quantum dots decorated WO3 nanosheets composites have been prepared using a hydrothermal method. The as synthesized catalysts were characterized by various techniques. The crystallite sizes of CuO NSs and WO3 NSs were to be obtained 12.5 and 13.25nm and when dopped with ZnO and TiO2 size reduces to 3.2 and 3.9nm, respectively. The energy band gap of the CuO NSs, WO3 NSs, ZnO QDs/CuO NSs and TiO2 QDs/WO3 NSs composite are calculated to be 2.01, 2.61, 1.86 and 2.32eV, respectively. The prepared catalysts are efficiently utilized for the photocatalytic degradation of two neurotoxin compounds under UV and UV coupled with microwave irradiation. The prepared catalyst composites reveal excellent photocatalytic degradation of neurotoxin compound by degrading it up to 75% under UV and UV/microwave irradiation. The photocalysis efficiency in UV/microwave system is higher than UV system. The result shows that the ZnO QDs/CuO NSs and TiO2 QDs/WO3 NSs composites have excellent photocorrosion inhibition and reusability properties. Thus, prepared samples with positive surface potential upon interaction with negative surface potential of Enterococcus faecalis and Micrococcus luteus.



Non-thermal near-infrared exposure photobiomodulates cellular responses to ionizing radiation in human full thickness skin models

Publication date: January 2018
Source:Journal of Photochemistry and Photobiology B: Biology, Volume 178
Author(s): Anke König, Nadja Zöller, Stefan Kippenberger, August Bernd, Roland Kaufmann, Paul G. Layer, Anja Heselich
Ionizing and near-infrared radiation are both part of the therapeutic spectrum in cancer treatment. During cancer therapy ionizing radiation is typically used for non-invasive reduction of malignant tissue, while near-infrared photobiomodulation is utilized in palliative medical approaches, e.g. for pain reduction or impairment of wound healing. Furthermore, near-infrared is part of the solar wavelength spectrum. A combined exposure of these two irradiation qualities – either intentionally during medical treatment or unintentionally due to solar exposure – is therefore presumable for cancer patients. Several studies in different model organisms and cell cultures show a strong impact of near-infrared pretreatment on ionizing radiation-induced stress response. To investigate the risks of non-thermal near-infrared (NIR) pretreatment in patients, a human in vitro full thickness skin models (FTSM) was evaluated for radiation research. FTSM were pretreated with therapy-relevant doses of NIR followed by X-radiation, and then examined for DNA-double-strand break (DSB) repair, cell proliferation and apoptosis. Double-treated FTSM revealed a clear influence of NIR on X-radiation-induced stress responses in cells in their typical tissue environment. Furthermore, over a 24h time period, double-treated FTSM presented a significant persistence of DSBs, as compared to samples exclusively irradiated by X-rays. In addition, NIR pretreatment inhibited apoptosis induction of integrated fibroblasts, and counteracted the radiation-induced proliferation inhibition of basal keratinocytes. Our work suggests that cancer patients treated with X-rays should be prevented from uncontrolled NIR irradiation. On the other hand, controlled double-treatment could provide an alternative therapy approach, exposing the patient to less radiation.



Efficacy of subcutaneous injection of platelet-rich plasma in alopecia: A clinical and histological pilot study on a rat model with a six-month long-term follow-up experience

Summary

Purpose

To assess the potential of platelet-rich plasma (PRP) subcutaneous injection of to treat alopecia and to evaluate local toxicity.

Materials-Methods

Twelve Hairless rats were used. At D0, we performed systematic clinical examination and divided the rat back into four quadrants (Q). We initiated subcutaneous injection using either PRP in PRPQ+, platelet-poor plasma (PPP) in PPPQ+, physiological serum (PS) in PSQ+, or no treatment (Q4). At D7, D14, D21, and D28 but also second month (M2), M3, M4, M5, rats had exactly the same injection procedure. Follow-up with PRP efficacy and toxicity at D28 and M6 using clinical and histological evaluation was performed.

Results

Hair density was significantly improved at D28 and at M6 for PRPQ+ vs PSQ+ (respectively, P = .0156 and P = .0313), PPPQ+ (respectively, P = .042 and P = .046). Significant histological improvement was observed between D28 and M6, for PRPQ+ vs PPPQ+ and PSQ+ for vessels (respectively, P = .0160 and P = .021), collagen (respectively, P = .0036 and P = .032), and epithelium (respectively, P = .0138 and P = .022) with no local toxicity.

Conclusion

Our study suggests that subcutaneous PRP injections using controlled concentration of platelets and leukocytes improve hair growth.



Filling the periorbital hollows with hyaluronic acid gel: Long-term review of outcomes and complications

Summary

Introduction

Hyaluronic acid gel has been used for rejuvenation of the periorbital tissues since 2004. The in-office, nonsurgical procedural nature has resulted in the growing popularity of the use of fillers. The periorbital region poses unique challenges to the cosmetic surgeon. Malar edema, blue-gray dyschromia, and contour irregularities are well reported short-term complications. We present a long-term follow-up review of complications associated with periocular injection of hyaluronic acid gel fillers.

Methods

Retrospective review of 147 patients with at least a 5-year follow-up period since the first injection. Five senior masked reviewers were asked to grade photographs of patients in comparison with preinjection photographs. Grading was based on a reference photographic key looking specifically at the presence and severity of malar edema, blue-gray dyschromia, and contour irregularity.

Results

Malar edema (11%), blue-gray dyschromia (31.3%), and contour irregularities (30.5%) continue to be problems in longer term follow-up of patients. The vast majority (90%) of these complications were mild and required no intervention. There is no statistically significant difference in the mean volumes injected by severity grading of each measured complication.

Conclusion

Hyaluronic acid gel fillers of the periorbital region are well tolerated in our long-term follow-up experience. The vast majority of cases of malar edema, blue-gray dyschromia, and contour irregularities are mild and do not require intervention. Conservative treatment and tailored treatment approaches, in terms of volume and frequency of injections, may decrease the tendency of these adverse effects to occur.



Nasal Duplication Combined with Cleft Lip and Palate: Surgical Correction and Long-Term Follow-Up

imageBackground: Diprosopus dirrhinus, or nasal duplication, is a rare entity of partial craniofacial duplication. Methods: The case we present is the first report of diprosopus dirrhinus associated with complete cleft lip and palate. The baby was born in Cambodia at full term by normal vaginal delivery with no significant perinatal and family history. Physical examination revealed significant facial deformity due to the duplicated nose and the left complete cleft lip/palate on the right subset. Results: There were 4 nostrils; both medial apertures including the cleft site were found to be 10–15 mm deep cul-de-sac structures without communication to the nasopharynx. The upper third of the face was notable for hypertelorism with a duplication of the soft-tissue nasion and glabella. Between the 2 nasal dorsums, there was a small cutaneous depression with a lacrimal fistula in the midline. Surgical treatment included the first stage of primary lip and nose repair and the second stage of palatoplasty. Conclusions: The patient was followed up at the age of 10 years showing satisfactory results for both aesthetic and functional aspects. Further management in the future will be required for the hypertelorism and nasal deformity.

A case of mucous membrane pemphigoid with IgG antibodies against the β3 and γ2 subunits of laminin-332, and the C-terminal domain of BP180



Graft versus host disease in a pediatric multiple organ transplant recipient with trichohepatoenteric syndrome – a unique case report



Flat-topped papules arising in a young woman's tattoo



Longitudinal observational study of hidradenitis suppurativa: impact of surgical intervention with adjunctive biologic therapy

Abstract

Background

Hidradenitis supppurativa (HS) is a chronic inflammatory disease of the apocrine sweat glands affecting 1–4% of the population. While surgical excision is a mainstay of therapy, lesions often recur. Biologic therapies, including tumor necrosis factor-α and IL-12/23 inhibitors, are effective for mild to moderate HS. However, longitudinal studies investigating biologic therapy in conjunction with surgery are limited. The purpose of this analysis was to investigate impact of surgery and biologic therapy on HS disease activity.

Methods

Data from 68 HS patients were analyzed. Outcome measures included hidradenitis suppurativa Sartorius Score (HSS), active nodule (AN) count, Hurley stage, and probability of achieving 75% reduction in active nodule count (AN75).

Results

Mean age was 40 ± 14 years; 66% were female and 72% were African American. Mean disease duration was 10 years, and Hurley stage III disease was seen in 63% of patients. Patients who received biologics had a larger drop in HSS and AN count than those who never received biologics (P = 0.002). Biologic treatment was associated with average reduction in 22 (15–29) HSS points (P < 0.0001). The effect of biologics was greater in patients who also underwent surgery (P = 0.013). Timing of biologics relative to surgery did not impact efficacy. Patients who received HS surgery with biologic therapy were most likely to achieve the AN75 (P = 0.017).

Conclusions

In this diverse cohort of patients with severe HS, biologic therapy was associated with a more rapid decline in disease activity, with the greatest effect in patients who also underwent HS surgery.



Antidesmoglein 1 and 3 antibodies in healthy subjects of a population in the Peruvian high amazon

Abstract

Background

The objective of this study was to determine the presence of anti-Dsg1 and Dsg3 antibodies in healthy subjects of the high Peruvian Amazon (Tuemal, Rodriguez de Mendoza province, department of Amazonas) to establish the theoretical presence of environmental factors or triggers in the area.

Materials and methods

Cross-sectional study. The study population included persons of any age or gender, clinically healthy, who were evaluated by a dermatologist to confirm the absence of blistering diseases. Blood samples were analyzed by indirect immunofluorescence (IIF), immunoprecipitation (IP), anti-Dsg1 IgM antibody (Ab) enzyme-linked immunosorbent assay (ELISA), as well as anti-Dsg1 and anti-Dsg3 IgG Ab ELISA.

Results

Participants included 21 healthy subjects comprised of 61.9% males and 38.1% females; 47.6% had a positive anti-Dsg1 Ab ELISA for total IgG (or any subclasses). IIF detected antibodies against intercellular spaces in one subject. Anti-Dsg1 Ab IP was mildly positive in 33.3% of the subjects. Anti-Dsg1 IgG subclasses found positive were: IgG1 (19.0%), IgG2 (33.3%), and IgG3 (28.6%); none of the samples were positive for anti-Dsg1 Ab IgM ELISA, and 23.8% of the subjects were positive for anti-Dsg3 Ab ELISA. The age distribution was similar for subjects positive for anti-Dsg1 and anti-Dsg3 Ab ELISA, with higher frequencies found among the 20–29 and 40–49 year-old age groups.

Conclusion

A fraction of healthy subjects of the high Peruvian Amazon developed anti-Dsg1 and anti-Dsg3 antibodies, demonstrating the possible presence of environmental factors for endemic pemphigus (EP) at a higher altitude than previously described.



The Akkermansia-muciniphila is a gut microbiota signature in psoriasis

Abstract

Psoriasis is an immune-mediated chronic inflammatory skin disease. Although its pathogenesis is not fully understood, Th17 cells and the cytokines they produce, such as IL-17, IL-22 and IL-23, play critical roles in the pathogenesis of psoriasis. Evidence has demonstrated that psoriasis has some common features, including immune responses (due to Th17 cells) and inflammatory cytokine profiles, with systematic diseases including inflammatory bowel diseases (IBDs) and obesity. Recently, studies have demonstrated that the gut microbiota plays a crucial role in host homeostasis and immune response, particular in Th17 cells, but the role of the gut microbiota in psoriasis remains unclear. To study the relationship between gut microbiota and psoriasis, we analyzed microbiota profiles in psoriasis using a 16S rDNA sequencing platform, and we found that the abundance of Akkermansia muciniphila was significantly reduced in psoriatic patients. Akkermansia muciniphila is believed to have an important function in the pathogenesis of IBD and obesity; therefore, Akkermansia muciniphila, which is an indicator of health status, may be a key node for psoriasis as well as IBD and obesity. Taken together, our study identified that gut microbiota signature and function are significantly altered in the gut of psoriatic patients, which provides a novel angle to understanding the pathogenesis of psoriasis.

This article is protected by copyright. All rights reserved.



Health risk assessment of instant noodles commonly consumed in Port Harcourt, Nigeria

Abstract

The current study investigated the levels of some heavy metals [lead (Pb), arsenic (As), nickel (Ni), mercury (Hg), copper (Cu), cadmium (Cd), aluminum (Al), and chromium (Cr)] and polycyclic aromatic hydrocarbons (PAHs) in six brands of instant noodles (CFN, GFC, NGP, GAA, CUN, and FCS) commonly consumed in Port Harcourt, Nigeria. Risks of consumption of contaminated noodles were also assessed. Heavy metal content and PAHs were determined using flame atomic absorption spectrophotometer and gas chromatography, respectively. Concentrations of heavy metals as Pb, Ni, Cu, Al, and Cr were detected while As, Hg, and Cd were not detected in noodles. High average concentrations (mean ± SD mg/kg) of Pb were observed in brands CFN (3.163 ± 0.21) and GFC (1.022 ± 0.08) which were significantly higher (P ≤ 0.05) than in NGP (0.043 ± 0.15) and GAA (0.276 ± 0.18), although all were above WHO permissible limits (0.025 mg/kg). Target Hazard Quotient and Hazard Index for Pb were > 1 in brands CFN and GFC indicating unacceptable risk. Results of PAHs showed brands had total PAHs (mg/kg) in the order CFN > CUN > GAA > NGP > FCS > GFC. Although carcinogenic risks associated with these noodles are within permissible range, consumption of CFN and GFC could pose greater health risk to consumers. Long-term consumption of brands CUN, CFN, and GAA may have higher probability of carcinogenesis among consumers. We therefore recommend more diligent regulatory policies and monitoring by relevant government agencies (WHO, NAFDAC, CPC, and SON) to ensure wholesome noodles get to consumers.



Effects of biochar on phytotoxicity and translocation of polybrominated diphenyl ethers in Ni/Fe bimetallic nanoparticle-treated soil

Abstract

In this study, soil culture experiments were conducted to explore the effects of biochar-supported Ni/Fe nanoparticles on the accumulation and translocation of polybrominated diphenyl ethers (PBDEs) in soil-plant system and its phytotoxicity to Brassica chinensis. Compared with those in BDE209 contaminated soils (S 1) and Ni/Fe nanoparticle-treated soil (S 3), the plant biomass, root, and shoot lengths in biochar-supported Ni/Fe nanoparticle-treated soil (S 4) were increased by 23 mg, 1.35 cm, and 2.08 cm and 27.2 mg, 1.75 cm, and 2.52 cm, respectively, suggesting that the phytotoxicity in S 4 treatment was significantly decreased. Moreover, in all treatments, the contents of BDE209, the total PBDEs, Ni, and Fe in sample plant tissues of S 4 were the lowest. In addition, the superoxide dismutase, peroxidase, and catalase activities in S 4 treatment were found to decrease by 33.8, 47.2, and 24.1%, respectively, compared to those in S 3. Results also showed that biochar addition not only reduced the uptake of PBDEs and heavy metals but also effectively improve soil fertility and reduce the leachability of Ni and Fe caused by Ni/Fe. Finally, the translocation factors (TFs) of PBDEs in four treatments followed the orders as S 1 > S 3 > S 4 > S 2, indicating that biochar has an inhibition effects on PBDE translocation in the plants. In summary, all of the results suggested that the phytotoxicity, translocation of PBDEs, and the negative effects caused by neat Ni/Fe nanoparticles in B. chinensis were decreased as a result of the effects of the biochar.



Cultural competence for the 21st century dermatologist practicing in the United States

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6
Author(s): Jacqueline McKesey, Timothy G. Berger, Henry W. Lim, Amy J. McMichael, Abel Torres, Amit G. Pandya
Significant health disparities exist among under-represented minorities in the Unites States, which can partially be accounted for by the quality of patient-physician interaction. A distinguishing factor of this interaction is the ability of the provider to demonstrate cultural competence, or address the social, cultural, and community influences on healthcare behaviors and incorporate these elements into patient care. However, this practice has yet to be universally implemented in our healthcare system. These factors become even more important as the racial, ethnic and cultural distribution of the United States population changes. Multiple studies have suggested that cultural competence of the health care provider and staff leads to improved patient adherence, satisfaction, and ultimately, health outcome. Cultural competence in the workplace also leads to efficient and cost-effective healthcare and better community integration into healthcare systems. The purpose of this review is to help dermatologists understand the benefits of culturally competent care for their patients and themselves and identify methods and resources to achieve this goal.



Subject index

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6





Table of Contents

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6





Willingness to pay and quality of life in alopecia areata

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6
Author(s): Jean-Phillip Okhovat, Tristan Grogan, Lewei Duan, Carolyn Goh




Information for Readers

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6





JAAD Case Reports Article List

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6





Association between pemphigus and psoriasis: A population-based large-scale study

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6
Author(s): Khalaf Kridin, Shira Zelber-Sagi, Doron Comaneshter, Arnon D. Cohen




Journal Based CME Instructions and Information

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6





Progressive reticulate skin pigmentation and anonychia in a patient with bone marrow failure

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6
Author(s): Suzanne C. Ward, Sharon A. Savage, Neelam Giri, Blanche P. Alter, Edward W. Cowen
Key teaching points• DC is a TBD associated with bone marrow failure and the classic clinical triad of reticulate hyperpigmentation, nail dystrophy, and oral leukoplakia. Patients may not manifest all features of the triad, or they may present with other mucocutaneous findings, including epiphora, loss of dermatoglyphics, palmoplantar hyperkeratosis, early graying and/or hair loss, and hyperhidrosis.• HH syndrome is a severe variant of DC characterized by additional findings of IUGR, microcephaly, cerebellar hypoplasia, developmental delay, and immunodeficiency.• DC may be suggested by detection of very short telomeres and confirmed by genetic testing when positive. Early diagnosis aids in the initiation of lifestyle interventions, treatment of bone marrow failure, screening for malignancies, HCT donor selection, and genetic counseling for family members.



Lymphedema

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6
Author(s): Ayman A. Grada, Tania J. Phillips
Lymphedema is a localized form of tissue swelling resulting from excessive retention of lymphatic fluid in the interstitial compartment. It is caused by impaired lymphatic drainage. Lymphedema is a chronic progressive disease with serious physical and psychosocial implications. It can be challenging to diagnose, especially in obese patients and in those with coexisting venous disease. We performed PubMed and Google Scholar searches of the English-language literature (1966-2017) using the terms lymphedema, lymphedema management, and lymphatic complications. Relevant publications were manually reviewed for additional resources. There are currently no standard guidelines for the diagnosis of lymphedema. There is no cure yet for lymphedema, and the objective for management is to limit disease progression and prevent complications.



Editorial Board

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6





CME examination

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6





Reference values for skin microanatomy: A systematic review and meta-analysis of ex vivo studies

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6
Author(s): Haoming Xu, Maira Fonseca, Zachary Wolner, Esther Chung, Xinyuan Wu, Shamir Geller, Stephen W. Dusza, Antonio P. DeRosa, Ashfaq A. Marghoob, Klaus J. Busam, Allan C. Halpern, Michael A. Marchetti
BackgroundFew studies have characterized reference values of normal human skin microanatomy parameters.ObjectiveTo quantify histologic measurements of epidermal thickness, melanocyte density, hair follicle density, and eccrine gland density as a function of age and anatomic site.MethodWe searched the PubMed, Embase, Web of Science, and Cochrane databases for articles published through May 25, 2017. Two reviewers independently screened 2016 articles; 327 relevant articles and 151 additional articles found via forward or reference citations underwent full-text review by 1 of 4 reviewers for relevance, data extraction, and critical appraisal. Weighted averages, meta-analysis, and meta-regression were used in statistical analysis.ResultsA total of 56 articles were included; when all anatomic locations were used, the overall estimates for epidermal thickness, melanocyte density, hair follicle density, and eccrine gland density were 99.75 μm (95% confidence interval [CI], 83.25-116.25), 955.05 cells/mm2 (95% CI. 880.89-1029.21), 1.40 hairs/mm2 (95% CI. 0.91-1.89), and 1.28 glands/mm2 (95% CI. 0.91-1.64), respectively.LimitationsThere was significant data heterogeneity across studies, possibly because of differences in histological techniques and absence of standardized microanatomy definitions.ConclusionsWe established summary estimates for normal human skin microanatomy parameters.



Answers to CME examination

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6





Identifying gaps in consumer knowledge about sunscreen

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6
Author(s): Lucy X. Chao, Sarah L. Sheu, Betty Y. Kong, Alfred W. Rademaker, Roopal V. Kundu




Lymphedema

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6
Author(s): Ayman A. Grada, Tania J. Phillips
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. Relevant publications were manually reviewed for additional resources. This progressive chronic disease has serious implications on patients' quality of life. It is often misdiagnosed because it mimics other conditions of extremity swelling. There is no definitive cure for lymphedema. However, with proper diagnosis and management, its progression and potential complications may be limited.



Assessing clinical response and defining minimal disease activity in plaque psoriasis with the Physician Global Assessment and body surface area (PGA × BSA) composite tool: An analysis of apremilast phase 3 ESTEEM data

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6
Author(s): Alice B. Gottlieb, Joseph F. Merola, Rongdean Chen, Eugenia Levi, Kristina Callis Duffin




CME examination

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6





Declining care to unvaccinated patients: Ethical and legal considerations

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6
Author(s): Kishore L. Jayakumar, Jules B. Lipoff




Answers to CME examination

Publication date: December 2017
Source:Journal of the American Academy of Dermatology, Volume 77, Issue 6





Factors Associated with a Prolonged Length of Hospital Stay in Patients with Diabetic Foot: A Single-Center Retrospective Study.

Factors Associated with a Prolonged Length of Hospital Stay in Patients with Diabetic Foot: A Single-Center Retrospective Study.

Arch Plast Surg. 2017 Nov 10;:

Authors: Choi SK, Kim CK, Jo DI, Lee MC, Kim JN, Choi HG, Shin DH, Kim SH

Abstract
Background: We conducted this study to identify factors that may prolong the length of the hospital stay (LHS) in patients with diabetic foot (DF) in a single-institution setting.
Methods: In this single-center retrospective study, we evaluated a total of 164 patients with DF, and conducted an intergroup comparison of their baseline demographic and clinical characteristics, including sex, age, duration of diabetes, smoking status, body mass index, underlying comorbidities (e.g., hypertension or diabetic nephropathy), wound characteristics, type of surgery, the total medical cost, white blood cell (WBC) count, C-reactive protein (CRP) levels, erythrocyte sedimentation rate, and albumin, protein, glycated hemoglobin, and 7-day mean blood glucose (BG) levels.
Results: Pearson correlation analysis showed that an LHS of >5 weeks had a significant positive correlation with the severity of the wound (r=0.647), WBC count (r=0.571), CRP levels (r=0.390), DN (r=0.020), and 7-day mean BG levels (r=0.120) (P<0.05). In multiple regression analysis, an LHS of >5 weeks had a significant positive correlation with the severity of the wound (odds ratio [OR]=3.297; 95% confidence interval [CI], 1.324-10.483; P=0.020), WBC count (OR=1.423; 95% CI, 0.046-0.356; P=0.000), CRP levels (OR=1.079; 95% CI, 1.015-1.147; P=0.014), albumin levels (OR=0.263; 95% CI, 0.113-3.673; P=0.007), and 7-day mean BG levels (OR=1.018; 95% CI, 1.001-1.035; P=0.020).
Conclusions: Surgeons should consider the factors associated with a prolonged LHS in the early management of patients with DF. Moreover, this should also be accompanied by a multidisciplinary approach to reducing the LHS.

PMID: 29121708 [PubMed - as supplied by publisher]



Reconstruction of Medial Orbital Wall Fractures without Subperiosteal Dissection: The "Push-Out" Technique.

Reconstruction of Medial Orbital Wall Fractures without Subperiosteal Dissection: The "Push-Out" Technique.

Arch Plast Surg. 2017 Nov 10;:

Authors: Kim YH, Lee JH, Park Y, Kim SE, Chung KJ, Lee JH, Kim TG

Abstract
Background: Various surgical methods for repairing medial orbital wall fractures have been introduced. The conventional technique requires total separation of the displaced orbital bones from the orbital soft tissues. However, subperiosteal dissection around the fracture can cause additional damage. The aim of the present study is to introduce a method of reconstructing medial orbital wall fractures without subperiosteal dissection named the "push-out" technique.
Methods: Six patients with post-traumatic enophthalmos resulting from an old medial orbital wall fracture and 10 patients with an acute medial orbital wall fracture were included. All were treated with the push-out technique. Postoperative computed tomography (CT) was performed to assess the correct positioning of the implants. The Hertel scale and a comparison between preoperative and postoperative orbital volume were used to assess the surgical results.
Results: Restoration of the normal orbital cavity shape was confirmed by examining the postoperative CT scans. In the old fracture group, the median orbital volume of the fractured side was 29.22 cm3 preoperatively, and significantly improved postoperatively to a value of 25.13 cm3. In the acute fracture group, the median orbital volume of the fractured side was 28.73 cm3 preoperatively, and significantly improved postoperatively to a value of 24.90 cm3. Differences on the Hertel scale also improved, from 2.13 mm preoperatively to 0.25 mm postoperatively in the old fracture group and from 1.67 mm preoperatively to 0.33 mm postoperatively in the acute fracture group.
Conclusions: The push-out technique can be considered a good alternative choice for old medial orbital wall fractures with posttraumatic enophthalmos, acute medial orbital wall fractures including large fractured bone segments, and single-hinged greenstick fractures.

PMID: 29121707 [PubMed - as supplied by publisher]



Recommendations for volume augmentation and rejuvenation of the face and hands with the new generation polycaprolactone-based collagen stimulator (Ellansé®)



Calendar of Events

Publication date: November 2017
Source:Journal of Tissue Viability, Volume 26, Issue 4





Multidisciplinary Clinic Approach Improves Overall Survival Outcomes of Patients with Metastatic Germ Cell Tumors

Abstract
Background
To report our experience utilizing a multidisciplinary clinic (MDC) at Indiana University (IU) since the publication of the International Germ Cell Cancer Collaborative Group (IGCCCG), and to compare our overall survival to that of the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program.
Patients and Methods
We conducted a retrospective analysis of all patients with metastatic germ cell tumor (GCT) seen at IU from 1998-2014. 1,611 consecutive patients were identified, of whom 704 patients received an initial evaluation by our MDC (including medical oncology, pathology, urology and thoracic surgery) and started first-line chemotherapy at IU. These 704 patients were eligible for analysis. All patients in this cohort were treated with cisplatin-etoposide based combination chemotherapy. We compared the progression-free survival (PFS) and overall survival (OS) of patients treated at IU with that of the published IGCCCG cohort. OS of the IU testis cancer primary cohort (n = 622) was further compared to the SEER data of 1283 patients labeled with "distant" disease. The Kaplan-Meier method was used to estimate progression-free survival and overall survival.
Results
With a median follow-up of 4.4 years, patients with good, intermediate, and poor risk disease by IGCCCG criteria treated at IU had 5-year PFS of 90%, 84%, and 54% and 5-year OS of 97%, 92%, and 73% respectively. The 5-year PFS for all patients in the IU cohort was 79% (95%CI, 76% to 82%). The 5-year OS for the IU cohort was 90% (95% CI, 87% to 92%). IU testis cohort had 5-year OS 94% (95% CI, 91% to 96%) vs. 75% (95% CI, 73% to 78%) for the SEER "distant" cohort between 2000-2014, P-value <0.0001.
Conclusion
The MDC approach to GCT at high-volume cancer center associated with improved overall survival outcomes in this contemporary dataset. OS is significantly higher in the IU cohort compared to the IGCCCG and SEER "distant" cohort.

Liver fibrosis: noninvasive assessment using supersonic shear imaging and FIB4 index in patients with non-alcoholic fatty liver disease

Abstract

Purpose

Shear wave elastography (SWE) has been validated in chronic hepatitis C and B; however, limited data are available in non-alcoholic fatty liver disease (NAFLD). This study aimed to evaluate the accuracy of SWE and FIB4 index for the diagnosis of fibrosis in a cohort of consecutive patients with biopsy-proven NAFLD, and to evaluate the effects of other histologic parameters on SWE measurement.

Methods

Written informed consent was obtained from all patients, and this study was approved by our internal review board and ethics committee. Seventy-one patients with histologically proven NAFLD (mean age 50.8 years ± 15.7) were examined. All patients underwent SWE (Aixplorer™; SuperSonic Imagine) and FIB4 index (based on age, aspartate aminotransferase and alanine aminotransferase levels, and platelet counts) measurements. SWE measurements were compared with the histologic features based on the NAFLD activity score and FIB4 index.

Results

The area under the ROC curve for the diagnosis of hepatic fibrosis stage 3 or higher was 0.821 (optimal cut-off value 13.1 kPa, sensitivity 62.5%, specificity 57.4%) for SWE and 0.822 (optimal cut-off value 1.41, sensitivity 71.9%, specificity 53.9%) for FIB4 index. The median liver stiffness values measured using SWE showed a stepwise increase with increasing hepatic fibrosis stage (P < 0.001), inflammation score (P = 0.018), and ballooning score (P < 0.001), and showed a stepwise decrease with increasing hepatic steatosis stage (P = 0.046).

Conclusions

SWE and FIB4 index are useful noninvasive tools for estimating the severity of fibrosis in NAFLD patients. However, the presence of severe steatosis may affect the liver stiffness measurement, resulting in underestimations of liver fibrosis.



Editorial for innovative clinical investigations: example of a framework for determining the stages of innovation in surgery or other interventional procedures



“Multicentre study of patient-reported and clinical outcomes following immediate and delayed Autologous Breast Reconstruction And Radiotherapy (ABRAR study)”

alertIcon.gif

Publication date: Available online 10 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Kathryn H. Steele, R. Douglas Macmillan, Graham R. Ball, Malin Akerlund, Stephen J. McCulley
BackgroundTiming 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.MethodsThis retrospective UK multi-centre study grouped patients into three categories: immediate reconstruction with post-operative radiotherapy (IBR); delayed reconstruction after radiotherapy (DBR); control group of immediate reconstruction without radiotherapy (noRT). Data collection utilised clinician questionnaire, patient questionnaire (BreastQ) and medical examination. Examination assessed fat necrosis, texture, symmetry and overall result.Results412 patients were recruited (IBR 104; DBR 119; noRT 189) with median follow-up time of 57 months. Post-operative complications were higher in IBR & noRT (p < 0.001). Total number of operations for completion of reconstruction was similar in all groups. Completion of reconstruction after mastectomy was three years longer in DBR versus IBR. BreastQ domain scores were lower in IBR versus DBR and noRT (p < 0.01) but all scores were within acceptable range (satisfaction with outcome: IBR 71; DBR 85; noRT 81). Examination scores were similar for IBR and DBR but lower than noRT (p < 0.01). Correlation between BreastQ and examination scores was poor.ConclusionsAcceptable results are observed with either IBR or DBR, with high rates of patient and clinician satisfaction, low rates of complications, and a similar number of operations to complete reconstruction in all groups suggesting all options should be considered for patients.