Principal component analysis of three-dimensional face shape: Identifying shape features that change with age

Abstract

Background

The types of shape feature that constitutes a face have not been comprehensively established, and most previous studies of age-related changes in facial shape have focused on individual characteristics, such as wrinkle, sagging skin, etc. In this study, we quantitatively measured differences in face shape between individuals and investigated how shape features changed with age.

Methods

We analyzed three-dimensionally the faces of 280 Japanese women aged 20-69 years and used principal component analysis to establish the shape features that characterized individual differences. We also evaluated the relationships between each feature and age, clarifying the shape features characteristic of different age groups.

Results

Changes in facial shape in middle age were a decreased volume of the upper face and increased volume of the whole cheeks and around the chin. Changes in older people were an increased volume of the lower cheeks and around the chin, sagging skin, and jaw distortion.

Conclusion

Principal component analysis was effective for identifying facial shape features that represent individual and age-related differences. This method allowed straightforward measurements, such as the increase or decrease in cheeks caused by soft tissue changes or skeletal-based changes to the forehead or jaw, simply by acquiring three-dimensional facial images.

Case of alopecia induced by sorafenib, possible mechanism similar to alopecia areata

Pigmented poroma on the temporal region dermoscopically mimicking basal cell carcinoma: A report of two cases

Epstein–Barr virus-positive mucocutaneous ulcer in a patient with polycythemia vera treated with oral hydroxyurea

Two cases of infundibular squamous cell carcinoma on the nose with aggressive clinical behavior: Case report and review of the published work

Abstract

Case 1 was a 75-year-old Japanese man who presented with a poorly demarcated, dark-red nodule with a destructive defect in the center, measuring 3 cm × 2 cm on the right wing of his nose. The histological diagnosis was a common form of infundibular squamous cell carcinoma. Atypical neoplastic cells radiated from the wall of a follicular infundibulum. The majority of neoplastic cells were positive for AE1/AE3 and 34βE12. Cytokeratin 17 expression was seen in the suprabasal cells of the deeply situated neoplastic components. Case 2 was a 73-year-old Japanese man who presented with a poorly demarcated, dark-red nodule with an irregularly shaped ulcer in the center, measuring 3 cm × 2 cm on the left wing of his nose. The histological diagnosis was a crater form of infundibular squamous cell carcinoma. Atypical neoplastic cells radiated from the broad base of the central keratin-filled crater, continuous with two infundibular canals. In both cases, some of the more deeply situated aggregations were composed of neoplastic keratinocytes with eosinophilic glassy or pale cytoplasm. In addition, no atypical keratinocytes could be seen in the interfollicular epidermis. In case 1, a hematogenous metastasis to the vocal cord and the forehead occurred in addition to a lymph node metastasis. In case 2, a local recurrence occurred with an intralymphatic dissemination. We describe two cases of infundibular squamous cell carcinoma on the nose with aggressive clinical behavior, one of which was accompanied by a hematogenous metastasis while another revealed a local recurrence.

Digital pebbles without evidence of diabetes: A case report

Gardner diamond syndrome: A psychogenic purpura

K Vivekanandh, Gaurav Dash, Prasenjeet Mohanty

Indian Dermatology Online Journal 2017 8(6):521-522

Acquired smooth muscle hamartoma of foot: A rare entity

Chirag Desai, Palak Sheth, Sharmila Patil

Indian Dermatology Online Journal 2017 8(6):505-507

Evidence-based review, grade of recommendation, and suggested treatment recommendations for melasma

Nilendu Sarma, Sayantani Chakraborty, Shital A Poojary, Sanjay Rathi, Sendhil Kumaran, Balakrishnan Nirmal, Joan Felicita, Rashmi Sarkar, Prashansa Jaiswal, Paschal D'Souza, Nagaraju Donthula, Sumit Sethi, Pallavi Ailawadi, Bebisha Joseph

Indian Dermatology Online Journal 2017 8(6):406-442

Treatment of melasma is known to be less satisfactory, often incomplete, and relapse is frequent. Although many treatment options are available, they are either known to be unsafe on long-term use or their long-term safety profile is unknown. Patients often use various drugs, even topical steroid-based preparation without any medical supervision for long period of time, making the skin unsuitable for many of the drugs available. Thus, there has been gross disparity among the treating physician about what drugs and what regimen are best suitable for various categories of melasma patients and in different situations. With this background, numerous newer drugs, mostly combinations of some proprietary molecules or even unknown plant extracts, have flooded the market for the management of melasma. Information on efficacy or safety of these products are almost unknown. Studies on Asian people, especially Indian population, are far less commonly available. Therapeutic guideline for use on Indian patients with melasma is almost missing. Extrapolation of data from Caucasian people for use on Asian people may not be scientifically justifiable because Caucasian and Asian people are known to have inherent difference in their response as well as tolerance to the drugs used for melasma. With this background, we have extensively evaluated, following a strict, scientifically designed protocol, all the available studies on melasma management till May 2016 and prepared this document on level of evidence, grade of recommendation and suggested therapeutic guideline for melasma as per the method proposed by Oxford Centre of Evidence-Based Medicine. Various ethical, social, logical, regional, and economic issues in the context of Indian and similar populations were given due importance while preparing the suggested therapeutic recommendation.

Blaschko-linear syringocystadenoma papilliferum: A peculiar presentation

Tirthankar Gayen, Anupam Das, Gobinda Chatterjee, Ishad Aggarwal

Indian Dermatology Online Journal 2017 8(6):497-499

Identification of genotypes and allelic frequencies of vitamin D receptor gene polymorphism (TaqI) in egyptian melasma patients

Iman Seleit, Ola Ahmed Bakry, Eman Masoud, Shaimaa Nabil

Indian Dermatology Online Journal 2017 8(6):443-448

Background: Melasma is a characteristic pattern of facial hyperpigmentation, occurring primarily on the forehead, cheeks, and chin, in a mask-like distribution. The pathogenesis of melasma is not fully understood. Vitamin D plays a role in skin pigmentation. It exerts its effect through vitamin D receptor (VDR), which is expressed in variable cells including normal melanocytes. Aim and Objective: The aim of the current work was to investigate if VDR gene polymorphism (TaqI) confers susceptibility to melasma in Egyptian patients. Materials and Methods: A total of 45 female patients with melasma were recruited and 50 healthy subjects that were matched on age, sex, body mass index, and skin phototype, were included as a control group.TaqI polymorphism was investigated using restriction fragment length polymorphism polymerase chain reaction (RFLP PCR). Results: Presence of (t) allele and (tt) genotype was significantly associated with melasma cases compared with control group (P < 0.001 for both). No significant association was found between (tt) genotype or (t) allele and clinical data of the studied cases. Conclusion: TaqI polymorphism is associated with melasma. Further, large-scale studies are recommended to underscore and validate the current findings. It is also necessary for future studies to extend the research to other populations and ethnicities. Investigating other VDR gene polymorphisms in melasma is also warranted. Since melasma is a multifactorial disease, gene–gene and gene–environment interactions should be considered in future genetic-epidemiologic researches to apply more comprehensive insight into the role of VDR gene in its pathogenesis.

Noise removal in dermoscopic images using a novel software

Parameshwar R Hegde, Manjunarh M Shenoy, BH Shekar

Indian Dermatology Online Journal 2017 8(6):513-514

Pattern of skin diseases and occupational dermatoses in veterinarians and veterinary workers of Kashmir

Sumaya Zeerak, Iffat Hassan, Farhan Rasool, Yasmeen J Bhat, Safia Bashir

Indian Dermatology Online Journal 2017 8(6):449-453

Background: Across the globe, skin disorders represent a frequent occupational concern for many health professionals including veterinarians and there is a serious impact of skin diseases on their lives and careers. But little is known about the prevalence and distribution of skin diseases (especially occupational) within this important professional group across Asia, especially India. Materials and Methods: The study was a cross-sectional study carried out over a period of one year in which veterinarians and veterinary workers of Kashmir valley were screened for various skin diseases and occupational dermatoses. Results: The study group comprised 910 veterinarians and associated workers working across the valley with the majority being males; 846 workers (93%). The mean age of the group was 38.53 years. Out of these, 267 veterinarians and associated workers (29.3%) were found to have skin lesions. Of the 267 cases, 165 (61.80%) had non-infectious lesions, while the rest had 102 (38.20%) had infectious skin diseases. The main non-infectious lesions included friction-related disorders, eczemas, pigmentary disorders, papulosquamous disorders, and many others; while the infectious lesions were of fungal, bacterial, viral, and parasitic etiology. Fungal infections, eczemas, and melasma were more common in them, indicating an occupational etiology. Conclusion: A huge group of skin diseases was seen in veterinarians and veterinary workers, with some diseases showing an occupational nature. To reduce the burden of skin diseases in this particular group, proper prevention measures need to be instituted at work places by veterinary governing bodies of the state.

Approach to a child with primary immunodeficiency made simple

Dhrubajyoti Sharma, Ankur K Jindal, Amit Rawat, Surjit Singh

Indian Dermatology Online Journal 2017 8(6):391-405

Primary immunodeficiency disorders (PIDs) are a group of disorders affecting the capability to fight against infection. These include defects in T cells and B cells affecting cell-mediated and humoral immunity, respectively, combined humoral and cell-mediated immunodeficiency, defects in phagocytosis, complement defects, and defects in cytokine or cytokine signalling pathways which are detrimental for immune function. Depending upon the type and severity, age at onset of symptoms can vary from neonatal period to late childhood. Clinically, this group of disorders can involve any organ system of an individual such as respiratory system, gastrointestinal system, skin and mucous membrane, bone and joints, endocrine organs, and nervous system. Common dermatological manifestations include eczema, warts, molluscum contagiosum, mucocutaneous candidiasis, recurrent nonhealing ulcers, skin abscesses, erythroderma, petechiae, and nail changes. The common skin manifestations of various PIDs include eczema (seen in Wiskott–Aldrich syndrome and autosomal dominant hyper IgE syndrome); erythroderma (in Omen syndrome); viral warts or molluscum contagiosum (in autosomal recessive hyper IgE syndrome); chronic mucocutaneous candidiasis (in hyper IgE syndrome, autoimmune polyendocrinopathy candidiasis ectodermal dysplasia syndrome, Th17 cell defects); recurrent nonhealing ulcers (in leucocyte adhesion defect); skin abscesses (in antibody defects, hyper IgE syndrome, and chronic granulomatous disease); petechial or purpuric spots (in Wiskott–Aldrich syndrome).

Clinic-based group multi-professional education causes significant decline in psoriasis severity: A randomized open label pilot study

Shubh Mohan Singh, Tarun Narang, Keshavamurthy Vinay, Aditi Sharma, Ashirbad Satapathy, Sanjeev Handa, Sunil Dogra

Indian Dermatology Online Journal 2017 8(6):454-459

Background: The evidence for efficacy of psychoeducational interventions in psoriasis is not well researched. Objective: The objective of this study was to assess the benefits of a group, multi-professional, psychoeducational training in psoriasis. Materials and Methods: Adults with moderate-to-severe psoriasis were randomized into psychoeducational intervention plus treatment (intervention arm [IA]) and treatment as usual alone (control arm [CA]) groups using random number tables. The primary efficacy measures were mean changes in Psoriasis Area Severity Index (PASI) and Dermatology Life Quality Index (DLQI) at 6months from the end of intervention. The secondary efficacy measures were the mean changes in the WHO-5 well-being index (WHO-5) and the subsets of the patient health questionnaire (PHQ), namely, PHQ-9, generalized anxiety disorder (GAD)-7, andPHQ-15. Datawere analyzed by intention-to-treat analysis. Results: One-hundred and three participants were randomized into IA (n = 54) and CA (n = 49). The prevalence of psychiatric disorders in the entire population was 26.2% and was similar in both groups.Following intervention, there was statistically significant improvement in the mean scores in PASI, DLQI, and WHO-5 in the IA unlike that seen in the CA. There was statistically significant improvement in PHQ-9 scores in IA and CA. The scores on PHQ-15 and GAD-7 did not show any change. Intergroup comparisons showed that PASI was reduced significantly in IA as compared to CA. More participants in CA dropped out of the study than in the IA. Limitations: Modest sample size and lack of blinding of the participants and the administrators were the limitations of this study. Conclusion: Group psychoeducational intervention resulted in overall improvement in both clinical and psychological outcome measures in psoriasis patients.

Symmetric drug-related intertriginous and flexural exanthema due to itraconazole: An uncommon side effect of a commonly used drug

Madhuchhanda Mohapatra, Maitreyee Panda, Bikash R Kar, Chinmoy Raj

Indian Dermatology Online Journal 2017 8(6):501-503

Platelet-rich plasma by single spin process in male pattern androgenetic alopecia: Is it an effective treatment?

Azin Ayatollahi, Hamed Hosseini, Majid Shahdi, Saman AhmadNasrollahi, Mansour NassiriKashani, Somaye Yadangi, Farid H Firooz, Alireza Firooz

Indian Dermatology Online Journal 2017 8(6):460-464

Introduction and Objective: Platelet-rich plasma (PRP) is an autologous preparation of platelets in concentrated plasma. The platelet is a natural source of different growth factors and cytokines. These growth factors act on stem cells in the bulge area of the follicles and stimulate the development of new follicles, and promote neovascularization. The aim of this study was to investigate the efficacy and safety of PRP injections in androgenetic alopecia (AGA) in men. Patients and Methods: Fifteen male patients (mean age: 39 ± 9.7 years) with AGA grades III–VI were enrolled in the study. Five injections of 2–4 ml PRP (Regenlab PRP Kit-RegenACR®, Le Mont-sur-Lausanne Switzerland) by single spin process were administered every 2 weeks. Standard photographs, trichogram, and measurement of hair density and diameter in an area marked with a tattoo (with digital photographic hair analyzer) were done at baseline and 3 months after the last injection. In addition, patients completed a patient satisfaction questionnaire at each visit on a −2 to +2 score (−2: much worse, −1: slightly worse, 0: without change, +1: slightly better, +2: much better). Results: Thirteen patients completed the study. The number of hairs increased slightly from 149.62 ± 49.56 to 168.46 ± 43.703/cm2, however, this increase was not statistically significant (P = 0.24). On the other hand, the thickness of hairs decreased from 0.051 ± 0.105 to 0.045 ± 0.011 mm, which was also not significant (P = 0.37). There was a significant decrease in anagen hairs and increase in telogen hairs, and anagen/telogen ratio decreased significantly from 6.38 ± 4.57 to 2.67 ± 1.87 (P = 0.003). Conclusion: Our study could not show any benefit from PRP injections in the treatment of male AGA. There is a strong need for well-designed, randomized controlled trials with large sample size, proper control group, standard treatment protocols (concerning the amount, number and interval of PRP injections, method of preparation and activation, etc.), and long follow-up periods to evaluate the safety and efficacy of PRP in the treatment of male AGA.

Necrotic erythema nodosum leprosum healing with extensive scars

Chandra S Sirka, Maitreyee Panda, Swetalina Pradhan, Manas R Baisakh

Indian Dermatology Online Journal 2017 8(6):509-511

Platelet-rich plasma by single-spin process in male pattern androgenetic alopecia: Is it an effective treatment?

Arshdeep

Indian Dermatology Online Journal 2017 8(6):465-467

SkIndia quiz 42: Multiple slow-growing papulonodular lesions over the nose

CR Kamini, P. V. S. Prasad, PK Kaviarasan, P Viswanathan

Indian Dermatology Online Journal 2017 8(6):518-519

Mean platelet volume: A reliable marker of inflammation in recurrent apthous stomatitis and behçet disease?

Engin Senel, Bilal Acar, Emre Demir

Indian Dermatology Online Journal 2017 8(6):468-470

Background: Mean platelet volume (MPV) is an indicator of platelet activation and aggregation. MPV has been found to be related with the inflammation of certain disorders in recent studies. Aims: We sought to investigate whether MPV could be an indicator of inflammation in patients with Behçet disease (BD) and recurrent apthous stomatitis (RAS). Materials and Methods: Our study was designed as a retrospective case-control study and data was retrieved from our institutional database. We randomly generated a total of three study groups from our clinical archive. All controls were sex and age-matched and randomly selected by computer. Eighty-five patients with BD, 82 patients with RAS, and 721 healthy controls were included for the study design. We compared mean MPV values in the patient groups and controls. Results: We found no difference in the mean MPV value between BD group and BD-control group. The mean MPV value was significantly higher in patients with RAS than that in the RAS-control group (9.11 ± 1.01 fL vs. 8.76 ± 1.15 fL, P = 0.045). There was no difference in mean MPV level between BD and RAS group. Conclusion: The association between MPV and inflammatory skin diseases such as BD and RAS should be investigated prospectively in case-control studies. Limitations: Retrospective study design.

Dermoscopy of melasma

Sidharth Sonthalia, Abhijeet K Jha, Sonali Langar

Indian Dermatology Online Journal 2017 8(6):525-526

Subungual melanoma is not so rare: Report of four cases from India

Archana Singal, Deepika Pandhi, Priyanka Gogoi, Chander Grover

Indian Dermatology Online Journal 2017 8(6):471-474

Subungual melanoma (SUM) is an uncommon form of acral melanoma that arises within the nail matrix. The incidence for acral melanomas is similar worldwide, however, the proportion is higher in dark-skinned individuals. The subungual form represents approximately 2% of cutaneous non-sun-induced melanomas in the western world and up to 75% in Africans, 10% in Japanese, and 25% in the Chinese. No specific figures are available from the Indian subcontinent; however, the authors could trace three anecdotal case reports published over the last two decades. A general reluctance to biopsy a nail lesion to confirm the diagnosis may be contributing to the missed diagnosis. We report four cases of SUM of the big toenails seen over a period of 2.5 years. They were three women and one man with an age ranging from the 4th to 7th decade and disease duration of 6–18 months. The lesion involved the big toe in all and two patients had liver and lymph node metastasis at the time of presentation. Awareness among dermatologists regarding clinical manifestations, high index of suspicion for acral pigmented lesions, and nail bed biopsy may help in the early diagnosis and management and can prevent mortality.

Dermatofibrosarcoma protuberans

Shashikant Malkud, Veeresh Dyavannanavar

Indian Dermatology Online Journal 2017 8(6):495-497

Lymphocutaneous sporotrichosis treated with potassium iodide with development of subclinical hypothyroidism: wolff-chaikoff effect?

Pooja Arora, M Raihan, Asha Kubba, Ram K Gautam

Indian Dermatology Online Journal 2017 8(6):475-477

Sporotrichosis is a subcutaneous mycotic infection caused by Sporothrix schenckii that is acquired by traumatic implantation. The diagnosis is established by demonstration of fungal elements on histopathology and culture. Potassium iodide, azole antifungals, and terbinafine are the treatment options available. In this article, we report a 60-year-old female with lymphocutaneous sporotrichosis that responded well to potassium iodide. However, subclinical hypothyroidism (Wolff–Chaikoff effect) was encountered as a side effect of therapy which was managed with thyroxine replacement. Knowledge about the Wolff-Chaikoff effect (WCE) is important for the dermatologist and reinforces the need for screening and monitoring of thyroid stimulating hormone (TSH) in patients where long duration therapy is being planned.

Immunofluorescence and immunohistochemistry in macular amyloidosis: An observational study

Anuja Yadav, Taru Garg, AK Mandal, Ram Chander, Amit Yadav

Indian Dermatology Online Journal 2017 8(6):499-501

„Enge zahnärztliche Kooperation aufbauen!“

Druckdolenter Strang unterhalb der Brustwarze

Januskinsase-Inhibitoren bei atopischer Dermatitis

NMSC: immer mehr Neuerkrankungen

Weltweit steigt die Zahl der nicht melanozytären Hautkrebsdiagnosen von Jahr zu Jahr — auch in Deutschland. Und es ist keine Trendwende in Sicht.

Muskel- und Gelenkbeschwerden bei Checkpointinhibitoren

Spezialist und Dienstleister in Weiß

Die Versorgungslandschaft wird sich noch gewaltig verändern. Davon sind junge Ärzte überzeugt. Eine aktuelle Studie der apoBank zeigt recht detailliert, was Heilberufler umtreibt.

Friseurgranulom

Melanom: Was tun bei Virusinfektionen?

Fassaden als organische Gebäudehülle

Die Haut dient dem menschlichen Körper als Schutz — sie ist aber auch Medium der sinnlichen Wahrnehmung und wichtige Mittlerin zwischen dem Innen und Außen. Sie regelt den Wärmehaushalt des Körpers, absorbiert Sauerstoff und reproduziert sich selbst. All das sollen zunehmend auch moderne Gebäudefassaden leisten.

Inhaltsverzeichnis

Schweißdrüsenkarzinome: schwer zu erkennen

Isotretinointherapie: kein Störfaktor für viele weitere Maßnahmen

Bis heute wird empfohlen, Isotretinoin vor einem dermatologischen Eingriff abzusetzen oder die Wirkung des Medikaments über sechs bis zwölf Monate abklingen zu lassen. Hautärzte aus den USA haben jetzt die Berechtigung für diese Vorsichtsmaßnahme anhand der Studienlage neu überprüft.

PDT: ALA-Inkubation mit Mikronadeln verkürzen

Mit einem mit Mikronadeln gespickten Roller soll die Einwirkzeit der Aminolävulinsäure für die photodynamische Therapie der aktinischen Keratose verkürzt und die Prozedur für die Patienten erträglicher werden.

Lymphknotenbiopsie bei T1-Melanom?

Antidepressiva verfügen über eine immunmodulatorische und antiphlogistische Wirkung. Inwieweit sich dieser Effekt für die Behandlung entzündlicher Dermatosen nutzen lässt, war Gegenstand eines aktuellen Reviews.

Melanom: schlechte Prognose bei NRAS-Mutation

Eine retrospektive Untersuchung mit außerhalb von Studien versorgten Melanompatienten gibt Aufschluss über den Zusammenhang von Mutationsstatus und Prognose.

Mit Antidepressiva Hautkrankheiten behandeln?

Antidepressiva verfügen über eine immunmodulatorische und antiphlogistische Wirkung. Inwieweit sich dieser Effekt für die Behandlung entzündlicher Dermatosen nutzen lässt, war Gegenstand eines aktuellen Reviews.

Junge Ärzte kämpfen gegen Vorurteile älterer Kollegen

Dass Nachwuchsmediziner ihr Bedürfnis nach Freizeit über die Nöte ihrer Patienten stellen und zu hohe Anforderungen an Ausbilder und künftige Arbeitgeber haben, ist reines Schubladendenken, finden junge Ärzte — und fordern ein neues Arbeitsklima.

Neurodermitis: ab wann systemisch behandeln?

Die Umstände, die für die Umstellung von Neurodermitspatienten auf eine systemische Therapie sprechen, gehen aus den Leitlinien nicht klar hervor. Daher hat ein internationales Expertengremium entsprechende Empfehlungen verfasst, die Ärzte und Patienten bei der Entscheidung unterstützen sollen.

Wählen und gewinnen!

Kinder mit Psoriasis früh auf Komorbidität screenen

Bei pädiatrischen Psoriasispatienten sollten schon früh Risikofaktoren beachtet werden, die künftige Komorbiditäten ankündigen können. US-Mediziner haben zusammengetragen, worauf es hierbei ankommt.

The Reconstruction of the Donor Site of DP Flap Using Thoracodorsal Artery Perforator Flap

Summary: We performed a new procedure for reconstruction of donor site of a deltopectoral (DP) flap. A 58-year-old man presented with a wide subcutaneous abscess, which was caused by acute mandibular osteomyelitis due to dental caries. On admission, the patient received a neck incision for drainage. However, necrosis of the neck skin was observed after drainage. The patient had an 8 × 10 cm skin and soft-tissue defect, which we covered with a DP flap (15 × 7 cm). The DP flap donor site was reconstructed using a 16 × 8 cm pedicled thoracodorsal artery perforator (TDAP) flap. There was no flap necrosis, abscess formation, or scar contracture of the DP region. Debulking of the TDAP flap was not required. The pedicled TDAP flap is useful for the reconstruction of the donor site of DP flap. In this report, we describe our operative procedure.

Long-Term Patency of Twisted Vascular Pedicles in Perforator-Based Propeller Flaps

Background: Propeller flaps require torsion of the vascular pedicle of up to 180 degrees. Contrary to free flaps, where the relevance of an intact vascular pedicle has been documented, little is known regarding twisted pedicles of propeller flaps. As secondary surgeries requiring undermining of the flap are common in the extremities, knowledge regarding the necessity to protect the pedicle is relevant. The aim of this study was a long-term evaluation of the patency of vascular pedicle of propeller flaps. Methods: In a retrospective clinical study, 22 patients who underwent soft-tissue reconstruction with a propeller flap were evaluated after 43 months. A Doppler probe was used to locate and evaluate the patency of the vascular pedicle of the flap. Results: The flaps were used in the lower extremity in 19 cases, on the trunk in 3 cases. All flaps had healed. In all patients, an intact vascular pedicle could be found. Flap size, source vessel, or infection could therefore not be linked to an increased risk of pedicle loss. Conclusions: The vascular pedicle of propeller flaps remains patent in the long term. This allows reelevation and undermining of the flap. We therefore recommend protecting the pedicle in all secondary cases to prevent later flap loss.

Herpes zoster in hospitalized adults: Practice gaps, new evidence, and remaining questions

Herpes zoster can present many uncertainties for consulting dermatologists. We review the current guidelines and recent literature on important issues that arise in the care of hospitalized patients with herpes zoster, including infection control isolation practices, treatment courses for zoster and acute zoster-associated pain, and indications for long-term prophylaxis. We present the findings of an inpatient zoster management practices survey of the membership of the Society of Dermatology Hospitalists, an expert resource group of the American Academy of Dermatology, and discuss directions for future investigation and potential opportunities for management improvements in light of these collective data.

Age-induced and photoinduced changes in gene expression profiles in facial skin of Caucasian females across 6 decades of age

Intrinsic and extrinsic factors, including ultraviolet irradiation, lead to visible signs of skin aging.

Autophagy’s Paradoxical Role in ALS

By Yoskaly Lazo-Fernandez, PhD

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, is a progressive neurological disease that affects the motor neuron system and thus voluntary control of muscle movement. This disease belongs to a broader group of disorders known as motor neuron diseases, characterized by progressive degeneration and death of motor neurons. There are two types of motor neurons, including upper- and lower-motor neurons, based on the position of their somas within the CNS. Upper motor neuron somas are located in the motor cortex and their axons descend to the spinal cord where they activate the lower motor neurons. Lower motor neurons have somas within the spinal cord and extend their axons peripherally to innervate skeletal muscles. In ALS patients, both upper and lower motor neurons degenerate and die, causing muscular atrophy and eventually, paralysis. As disease progresses, the diaphragm is also affected, thus ultimately the majority of ALS patients die from respiratory failure within 5 years after the first symptoms¹.

Currently, there is limited understanding of the etiology of ALS, and there is no cure or effective treatment for this disease, which occurs in approximately 5 per 100, 000 individuals in the United States^1,2. In general, it is recognized that ALS results from the adverse interaction of numerous environmental and genetic factors. In recent years it's been recognized that factors that affect autophagy have particular prominence in the etiology of ALS. In fact, 12 out of the 25 genes that are currently known to cause familial ALS are implicated in protein homeostasis¹. In addition, an important selective autophagy receptor, p62, is commonly present in the protein aggregates that are a pathological signature in ALS affected neurons^7,8.

Several studies in transgenic models support that dysfunctional autophagy contributes to the development of ALS. Activation of autophagy had beneficial effects on ALS disease progression in some cases^3,5, but negative in others^4,5. A better understanding of the molecular mechanisms by which altered autophagy influences the development of ALS is essential for our ability to develop new therapies for this disease.

ATG7 participates in ubiquitin like conjugation complexes that are critical for the elongation of the phagophore and formation of the mature autophagosome. The ATG7/ATG3 complex, together with ATG4, participate in the lipidation of LC3 and association of LC3II to the phagophore membrane.

A recent article by Rudnick et al. provides new light on the complicated relationship between autophagy and ALS⁸. This group studied a transgenic mouse model expressing a mutant form of superoxide dismutase (SOD1), a genotype that leads to familial ALS in human patients, and a transgenic mouse with Atg7 deletion in motor neurons. ATG7 is an E1-like enzyme required for autophagosome biogenesis and absence of ATG7 is known to inhibit autophagy.

The study⁸ showed that inhibition of autophagy in the motor neurons of ALS model mice accelerated the onset of the disease, suggesting that stimulation of autophagy may play a beneficial role early in ALS progression. A particular subset of fast motor neurons was more sensitive to impaired autophagy. Fast motor neurons, which stimulate larger muscle groups, are the first cells affected in ALS. Surprisingly, inhibition of autophagy alleviated the pathology of ALS late in the progression of the disease, which suggests that pharmacological activation of autophagy could be damaging to ALS patients once the disease has surpassed the initial stage of focalized muscular tremors. The cause of these opposing effects of autophagy on ALS is still not completely understood. The results from this and other studies suggest that autophagy function is important to protect fast motor neurons from the damage caused by p62 containing protein aggregates, particularly in their presynaptic terminals. However, autophagy has also been implicated in exosome secretion⁹, as a mechanism that can spread toxic proteins and cause neurodegeneration. This could be a process by which misfolded protein aggregates spread to other cell types in ALS and cause cellular damage beyond fast motor neurons.

In summary, the development of autophagy-stimulating drugs to promote the degradation of protein aggregates in ALS patients could be an effective approach to treat ALS and other neurodegenerative diseases. However, recent scientific results indicate that this strategy might only be effective very early in the ALS progression. Autophagy stimulation at later stages could accelerate the progression of the disease. More research is needed to understand the mechanisms by which autophagy influences the pathophysiology of ALS and other neurodegenerative disorders.

Learn more about autophagy in neurodegeneration

Yoskaly Lazo Fernandez, PhD
Emory University, Department of Medicine/Renal Division
Dr. Lazo-Fernandez is interested in understanding the dietary factors that contribute to the development of hypertension and other chronic diseases.

References

1. Brown & Al-Chalabi. Amyotrophic Lateral Sclerosis. The New England Journal of Medicine 377, 162–172 (2017). DOI: 10.1056/NEJMra1603471.
2. Marin et al. Variation in worldwide incidence of amyotrophic lateral sclerosis: a meta-analysis. International Journal of Epidemiology dyw061 (2016). DOI: 10.1093/ije/dyw061
3. Mizushima, Yoshimori & Ohsumi. The Role of Atg Proteins in Autophagosome Formation. Cell and Developmental Biology 27, 107–132 (2011). DOI: 10.1146/annurev-cellbio-092910-154005.
4. Mizuno et al. Immunoreactivities of p62, an ubiqutin-binding protein, in the spinal anterior horn cells of patients with amyotrophic lateral sclerosis. Journal of the Neurological Sciences 249, 13–18 (2006). DOI: 10.1016/j.jns.2006.05.060
5. Castillo et al. Trehalose delays the progression of amyotrophic lateral sclerosis by enhancing autophagy in motoneurons. Autophagy 9, 1308–1320 (2013). DOI: 10.4161/auto.25188.
6. Li et al. Trehalose decreases mutant SOD1 expression and alleviates motor deficiency in early but not end-stage amyotrophic lateral sclerosis in a SOD1-G93A mouse model. Neuroscience 298, 12–25 (2015). DOI: 10.1016/j.neuroscience.2015.03.061.
7. Zhang et al. Rapamycin treatment augments motor neuron degeneration in SOD1(G93A) mouse model of amyotrophic lateral sclerosis. Autophagy 7, 412–25 (2011). DOI: 10.4161/auto.7.4.14541.
8. Rudnick et al. Distinct roles for motor neuron autophagy early and late in the SOD1G93A mouse model of ALS. Proceedings of the National Academy of Sciences 114, E8294–E8303 (2017). DOI: 10.1073/pnas.1704294114.
9. Baixauli, López-Otín & Mittelbrunn. Exosomes and Autophagy: Coordinated Mechanisms for the Maintenance of Cellular Fitness. Frontiers in Immunology 5, 403 (2014). DOI: 10.3389/fimmu.2014.00403.

 

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Pilomatrixom in einem Tattoo

Zusammenfassung

Bei einem 31-jährigen Patienten entwickelte sich am rechten Oberarm innerhalb einer schwarzen Tätowierung ein schnell wachsender Tumor, der histopathologisch als Pilomatrixom eingeordnet werden konnte. Während das Alter des Patienten und das schnelle Wachstum des Tumors nicht als typische Befunde der Pilomatrixome angesehen werden können, zählt die Lokalisation am Oberarm zu deren Prädilektionsstellen. Trotz der in den letzten Jahrzehnten weiten Verbreitung von Tattoos wird nur selten über eine Tumorentstehung in tätowierter Haut berichtet. Ob die Inhaltsstoffe der Tätowiermittel für die Tumorinduktion verantwortlich sein können, ist dabei umstritten.

Ensuring Implementation Fidelity of a 10-Week Home Visiting Program in Two Randomized Clinical Trials

Abstract

Introduction Implementation fidelity is a challenge for the adoption of evidence-based programs within social service broadly and child welfare specifically. However, implementation fidelity is critical for maintaining the integrity of clinical trials and for ensuring successful delivery of services in public health settings. Methods Promoting First Relationships ^® (PFR), a 10-week home visiting parenting intervention, was evaluated in two randomized clinical trials with populations of families in child welfare. Seven providers from community agencies participated in the trials and administered PFR. Fidelity data collected included observational measures of provider behavior, provider records, and input from clients to assess training uptake, adherence to content, quality of delivery, program dosage, and participant satisfaction. Results In mock cases to assess training uptake, providers demonstrated an increase in PFR verbalization strategies and a decrease non-PFR verbalizations from pre to post PFR training, and overall this was maintained a year later (Mann–Whitney U's = 0, p's < .01). Adherence to content in actual cases was high, with M = 97% of the program elements completed. Quality of delivery varied across providers, indicated by PFR consultation strategies (Wilks' Lambda F = 18.24, df = 15, p < .001) and global ratings (F = 13.35, df = 5, p < .001). Program dosage was high in both trials (71 and 86% receiving 10 sessions), and participant satisfaction was high (M = 3.9, SD = 0.2; 4 = greater satisfaction). Discussion This system of training and monitoring provides an example of procedures that can be used effectively to achieve implementation fidelity with evidence-based programs in social service practice.

The Sociotype in Dermatology

Skin diseases can be the cause of a significant psychosocial burden for those who suffer them. A number of studies have considered issues such as a lower quality of life, increased anxiety, depression, suicidal ideation and other psychological disorders^1-3. However, adequate means for evaluating social interaction difficulties, diminished social networks, and the impoverished conversational exchanges that affect the wellbeing and mental health of the individual have not been sufficiently developed.

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Efficacy and safety of tofacitinib for moderate-to-severe plaque psoriasis: a systematic review and meta-analysis of randomized controlled trials

Abstract

The effects of tofacitinib in treating moderate-to-severe plaque psoriasis were unclear. We aimed to assess the effects of tofacitinib in treating moderate-to-severe plaque psoriasis. We searched PubMed, Cochrane Central Register of Controlled Trials, and EMBASE for relevant randomised controlled trials (RCTs), and conducted a systematic review and meta-analysis. Four RCTs with 2,724 participants were included. Compared to placebo, tofacitinib significantly improved psoriasis (≥ 75% reduction in the Psoriasis Area and Severity Index score: 5 mg BID: risk difference (RD) 0.32 (95% confidence interval (CI) 0.28-0.35), 10 mg BID: RD 0.51 (95% CI 0.43-0.58); ≥ 90% reduction in the Psoriasis Area and Severity Index score: 5 mg BID: RD 0.19 (95% CI 0.17-0.22), 10 mg BID: RD 0.36 (95% CI 0.31-0.42); Physician's Global Assessment 0/1: 5 mg BID: RD 0.31 (95% CI 0.27-0.35), 10 mg BID: RD 0.48 (95% CI 0.44-0.53)) and participants' life quality (Dermatology Life Quality Index 0/1: 5 mg BID: RD 0.24 (95% CI 0.20-0.2), 10 mg BID: RD 0.36 (95% CI 0.33-0.40)). Tofacitinib was associated with an increase in minor adverse events (upper respiratory tract infection: 5 mg BID: RD 0.02 (95% CI 0.00-0.03), 10 mg BID: RD 0.02 (95% CI 0.00-0.04); hypercholesterolaemia: 5 mg BID: RD 0.02 (95% CI 0.01-0.04), 10 mg BID: RD 0.02 (95% CI 0.01-0.04)). In conclusion, tofacitinib may be a treatment option for moderate-to-severe plaque psoriasis that is unresponsive to other therapies and patients who are intolerable to other therapies or prefer oral medications.

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Comments to: Compound heterozygotes for filaggrin gene mutations do not always show severe atopic dermatitis

recent paper by Akiyama and coworkers questions one more time about role of FLG in A.D.Since first reports of heterozygous mutations of FLG in A.D. patients (1) replicated in northern European populations (2-3-4) and therefore in other populations worldwide (5), genetic studies of patient with I.V. /intrinsic A.D. of different populations of different ancestry as African American (6), and Ethiopian (7) make clear that haploinsufficiency of other structural proteins of epidermis are pathogenic for this phenotype and confirmed the Elias et al. "Outside-to-Inside and back to outside" hypothesis, previously pointed out by permeability studies of stratum corneum of A.D. patients (8).

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Patient and physician satisfaction in an observational study with methyl aminolevulinate daylight-photodynamic therapy in the treatment of multiple actinic keratoses of the face and scalp in 6 European countries

Abstract

Background

Guidelines recommend treating actinic keratoses (AK) as they are recognized as precursors of invasive squamous cell carcinoma.

Objective

The objective of this study was to collect real-world clinical data on the use of methyl aminolevulinate daylight-photodynamic therapy (MAL DL-PDT) for the treatment of face and scalp AK in Europe.

Methods

A prospective, multicenter, non-interventional study was conducted in 6 European countries in patients receiving a single treatment of MAL DL-PDT for face and/or scalp AK. Patient-reported outcomes were assessed by patient questionnaires at baseline and at 3 months after treatment, efficacy was assessed at 3 months using a 6-point global improvement scale, and adverse events (AE) were recorded at each visit.

Results

Overall, 325 patients were enrolled from 52 investigational centers, 314 of whom attended the 3-month visit. Most patients had multiple lesions (58.4% had >10 lesions) with lesions mainly located on the scalp (60.0%) and/or forehead (54.2%). AK were predominantly grade I (39.4%) or grade II (33.2%) and 10.5% of patients had grade III lesions. The proportions of patients and physicians that were overall satisfied to very satisfied with the MAL DL-PDT treatment were 80.4% and 90.3%, respectively. The vast majority of patients (90.0%) would consider using MAL DL-PDT again if needed. Physician-assessed efficacy at 3 months was at least much improved in 83.5% of patients, with 45.9% of patients requiring no retreatment. Related AEs were reported in 15% of patients.

Conclusion

Use of MAL DL-PDT for multiple face and/or scalp AK resulted in high levels of patient and physician satisfaction in clinical practice in Europe, reflecting the good efficacy and high tolerability of this convenient procedure.

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Chromosome 9 mutations reported absent in some patients with Basal Cell Carcinoma Nevus Syndrome

Basal Cell Carcinoma Nevus Syndrome (BCCNS), also known as Gorlin syndrome, is a rare autosomal dominant condition with a substantial disease burden, thought to occur secondary to chromosome 9 mutation evoking a Hedgehog (Hh) signaling aberration that leads to early development of numerous basal cell carcinomas (BCCs). Individuals with BCCNS also present with keratocystic odontogenic tumors, medulloblastomas, and palmar or plantar pits1. This condition demonstrates variable expressivity, leading to differing phenotypes, even within the same family2. BCCNS diagnosis requires meeting two major or one major and two minor criteria (Table 1) or presence of Chromosome 9 and/or PTCH1 mutations1.

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Scalp melanoma after anti hair loss mesotherapy

Scalp melanoma comprises 3-5% of all cutaneous melanomas. The median age of the patients is 53 years and males are more frequently affected. The scalp melanomas tend to have nodular histology with a higher mitotic rate (>3/mm) and poorer prognosis (1). The risk factors for development of this tumor are still not defined but UV light and baldness may play a significant role (2-4). Mesotherapy is a non-surgical procedure currently being used to combat hair loss and promote hair growth. Usually a mixture of vitamins, minerals, growth factors, DHT blockers and/or stem cells extracts is injected into the dermal layer of skin (5,6). Although it is a widely used method, the safety profile of this procedure hasn′t been studied yet (7,8).

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Spatiotemporal patterns and source attribution of nitrogen pollution in a typical headwater agricultural watershed in Southeastern China

Abstract

Excessive nitrogen (N) discharge from agriculture causes widespread problems in aquatic ecosystems. Knowledge of spatiotemporal patterns and source attribution of N pollution is critical for nutrient management programs but is poorly studied in headwaters with various small water bodies and mini-point pollution sources. Taking a typical small watershed in the low mountains of Southeastern China as an example, N pollution and source attribution were studied for a multipond system around a village using the Hydrological Simulation Program-Fortran (HSPF) model. The results exhibited distinctive spatio-seasonal variations with an overall seriousness rank for the three indicators: total nitrogen (TN) > nitrate/nitrite nitrogen (NO_x⁻-N) > ammonia nitrogen (NH₃-N), according to the Chinese Surface Water Quality Standard. TN pollution was severe for the entire watershed, while NO_x⁻-N pollution was significant for ponds and ditches far from the village, and the NH₃-N concentrations were acceptable except for the ponds near the village in summer. Although food and cash crop production accounted for the largest source of N loads, we discovered that mini-point pollution sources, including animal feeding operations, rural residential sewage, and waste, together contributed as high as 47% of the TN and NH₃-N loads in ponds and ditches. So, apart from eco-fertilizer programs and concentrated animal feeding operations, the importance of environmental awareness building for resource management is highlighted for small farmers in headwater agricultural watersheds. As a first attempt to incorporate multipond systems into the process-based modeling of nonpoint source (NPS) pollution, this work can inform other hydro-environmental studies on scattered and small water bodies. The results are also useful to water quality improvement for entire river basins.

Extended Spectrum Beta-Lactamase (ESBL)-producing bacteria isolated from hospital wastewaters, rivers and aquaculture sources in Nigeria

Abstract

Untreated wastewater is a risk factor for the spread of antibiotic resistance in the environment. However, little is known about the contribution of untreated wastewater to the burden of antibiotic resistance in the Nigerian environment. In this study, a total of 143 ceftazidime-/cefpodoxime-resistant bacteria isolated from untreated wastewater and untreated wastewater-contaminated surface and groundwater in Nigeria were screened for extended-spectrum β-lactamase (ESBL) genes, integrons and integron gene cassettes by PCR. The genetic environment of bla _CTX-M-15 was mapped by PCR and potentially conjugative plasmids were detected among the isolates by degenerate primer MOB typing (DPMT). ESBL production was confirmed in 114 (79.7%) isolates and ESBL genes (bla _SHV, bla _CTX-M-15 and bla _TEM) were detected in 85 (74.6%) ESBL-producing isolates. bla _CTX-M-15 was associated with ISEcp1 and with orf477 in 12 isolates and with ISEcp1, IS26 and orf477 in six others. To the best of our knowledge, this is the first report of bla _CTX-M-15 in hand-dug wells and borehole serving as sources of drinking water and a first report of the genetic environment of bla _CTX-M-15 in environmental bacteria from Nigeria. The results of this study confirm untreated wastewater as an important medium for the spread of ESBL-producing bacteria within the Nigerian environment. Hence, the widespread practice of discharging untreated wastewater into the aquatic ecosystem in Nigeria is a serious risk to public health.

Investigation of the effects of slow-release fertilizer and struvite in biodegradation in filter drains and potential application of treated water in irrigation of road verges

Abstract

Filter drains are usually laid along the margins of highways. Highway runoffs are polluted with hydrocarbons and high levels of total dissolved solids. Therefore, effective pollution removal mechanism is necessary in order to avoid contamination of surrounding soils and groundwater. Biodegradation is amongst pollution removal mechanisms in filter drains, but it is a relatively slow process which is dependent on wide range of factors including the type of pollutant and availability of nutrients. This paper reports on a study conducted to investigate the impact of slow-release fertilizer and struvite in enhancement of biodegradation of hydrocarbon in filter drains. Filter drain models incorporated with geotextile were challenged with cumulative oil loading of 178 mg/m²/week with a view to comparing the efficiency of these two nutrient sources under high oil pollution loading and realistic rainfall conditions of 13 mm/week. Nutrients and street dust were applied at one-off rate of 17 g/m² and 1.55 g/rig to provide nutrient enhancement and simulate field conditions respectively. The impact of the nutrients was studied by monitoring bacterial and fungal growth using nutrient agar, Rose Bengal Agar media and CO2 evolution. EC, pH, heavy metals, TPH, elemental analysis and SAR were used to investigate water quality of effluent of filter drains for potential application as irrigation fluid for trees and flowers planted on road verges. The results show that nutrient application encouraged microbial activities and enhanced biodegradation rates with differences in type of nutrient applied. Also, it was observed that incorporation of geotextiles in filter drains improved pollution retention efficiency and there is a potential opportunity for utilization of struvite in SuDS systems as sustainable nutrient source.

Genome-wide association study identifies GALC as susceptibility gene for mucous membrane pemphigoid

Abstract

Background

Mucous membrane pemphigoid (MMP) is a rare, chronic, and often aggressive subepidermal autoimmune blistering disease potentially affecting several mucous membranes with blisters and secondary erosions and scars. The pathogenesis of MMP is poorly understood, and the contribution of genetic predispositions, other than HLA class II allele variants to MMP, is unknown.

Objectives

The objective of this study is to identify susceptibility genes for MMP in a British cohort of MMP patients.

Methods

A GWAS was conducted in a British cohort of 106 MMP patients. Publicly available genotypes of 2,900 blood donors of the UK Blood Service and of 6,740 individuals of the 1958 British Birth Cohort served as control. Subsequently, putative susceptibility genes were independently replicated in a German cohort of 42 MMP patients.

Results

The GWAS found 38 SNPs in 28 haploblocks with an odds ratio >2 reaching genome-wide significance (p<5.7x10^-7). Replication confirmed an association of MMP with SNPs in rs17203398 (OR: 3.9), located intronically in the β-galactocerebrosidase gene (GALC) on chromosome 14, and with recessive polymorphisms in rs9936045 (OR: 3.1) in the intergenic region between CASC16 and CHD9 on chromosome 16.

Conclusions

The risk of developing MMP is partially genetically determined. SNPs in GALC enhance the risk for MMP, indicating that β-galactocerebrosidase may be involved in the pathogenesis of MMP. Likewise, impacts of polymorphisms in the intergenic region between CASC16 and CHD9 on the activity of neighboring genes may facilitate the emergence of MMP. The putative role of both polymorphisms requires functional studies in the future.

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Author's response to the comment to ‘Compound heterozygotes for filaggrin gene mutations do not always show severe atopic dermatitis’

FLG mutations play a causal role in the development of ichthyosis vulgaris (IV) and are known to be a predisposing factor for atopic dermatitis (AD) in European and Asian populations. However, it remains a matter of debate how loss of function of filaggrin leads to AD. Skin barrier dysfunction due to the loss of structural proteins in the epidermis makes it easy for allergens to invade, and sensitization to the allergens, increases in serum IgE, and dermatitis follow. In addition, loss of filaggrin results in increased pH in the stratum corneum, increased serine protease activity and hyper-activation of cytokine cascades.

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Identification and functional analysis of potential prophage-derived recombinases for genome editing in Lactobacillus casei

Abstract

Numerous LAB bacteriophage genomes have been sequenced, while the functional genes are yet to be exploited. In this study, a λ Red-like recombinase operon LCABL_13040–50-60 was identified from a prophage PLE3 in Lactobacillus casei BL23 genome, and its recombination function was confirmed by replacement of a 167 bp galK fragment with chloramphenicol-resistant gene (cat) in the L. casei BL23 genome. Further functional analysis showed that LCABL_13040 and LCABL_13060 were analogs to the host nuclease inhibitor (Redγ) and 5'-3' exonuclease (Redα/RecE), respectively. After optimization of recombineering conditions, including induction, homology length, recovery time and double-strand DNA (dsDNA) substrates quantity, the recombineering efficiency reached ∼2.2 × 10⁻⁷. Subsequently, combining cre-lox technology, the optimal LCABL_13040–50-60 proteins could catalyze markerless deletion of a 167 bp galK fragment and insertion of the gfp gene as well as precision point mutation of rpoB gene in the L. casei BL23 genome, suggesting the LCABL_13040–50-60 operon encoded for three recombineering proteins. Moreover, with the assistance of Redγ, the LCABL_13040–50-60 proteins also showed recombinase activity in six other L. casei strains, L. paracasei OY and L. plantarum WCSF1. All the results demonstrated that the prophage-associated recombinases LCABL_13040–50-60 have great potential to be used for genome editing in LAB.

The Differential Effects of HIV and HCV on Bone Micro-Architecture and Fracture risk

Abstract

Background

HIV/HCV co-infected subjects have a significantly greater osteoporotic fracture risk than HIV-infected, despite the fact that HIV/HCV co-infection has not been associated with lower bone mineral density (BMD) than HIV or HCV alone. We evaluated if changes in bone microarchitecture , measured by trabecular bone score (TBS) could explain these differences.

Design

We performed a prospective, cross-sectional cohort study of virologically suppressed HIV, untreated HCV, HIV/HCV co-infected and non-infected controls.

Methodology

We enrolled 532 male subjects : 57 HIV/HCV, 174 HIV, 123 HCV and 178 controls. We conducted analysis of covariance comparing BMD and TBS between groups, controlling for age, race, BMI and smoking. We used linear regression to evaluate predictors of BMD and TBS and evaluated the effects of severity of HCV infection and Tenofovir (TDF) use.

Results

Despite both infections being associated with decreased BMD, only HCV, but not HIV was associated with lower TBS score. Also, HIV/HCV co-infected subjects had lower TBS scores than HIV mono-infected, HCV mono-infected and uninfected subjects. Neither the use of TDF, , HCV viremia nor the severity of HCV liver disease were associated with lower TBS.

Conclusions

HCV infection is associated with micro-architectural changes at the lumbar spine as assessed by the low TBS score, suggesting that microstructural abnormalities underlie some of the higher fracture risk in HCV infection. TBS might improve fracture risk prediction in HCV infection.

Observed pneumococcal carriage among Alaska Native children who received reduced dose schedules of PCV 13 between 2010 and 2012

The Changing Paradigm of Management of Liver Abscesses in Chronic Granulomatous Disease

Abstract

Background

Chronic granulomatous disease (CGD) is a rare genetic disorder causing recurrent infections. Over one quarter of patients develop hepatic abscesses and liver dysfunction. Recent reports suggest disease-modifying treatment with corticosteroids is effective for these abscesses. Comparison of corticosteroid therapy to traditional invasive treatments has not been performed.

Methods

Records of 268 patients with CGD treated at the National Institutes of Health (NIH) from 1980 to 2014 were reviewed. Patients with liver involvement and complete records were included. We recorded residual reactive oxygen intermediate (ROI) production by neutrophils, NADPH oxidase germline mutation status, laboratory values, imaging characteristics, time to repeat hepatic interventions, and overall survival among three treatment cohorts: open liver surgery (OS), percutaneous liver-directed interventional radiology therapy (IR), and high-dose corticosteroid management (CM).

Results

88 of 268 patients with CGD suffered liver involvement. 26 patients with median follow-up of 15.5 years (8.5-32.9) had complete records and underwent 100 standard interventions, 42 IR and 58 OS. Eight patients received high-dose corticosteroids only. There were no differences in NADPH genotype, size, or number of abscesses between patients treated with OR, IR, or CM. Time to repeat intervention was extended in OS compared to IR (18.8 vs. 9.5 months; p=0.04) and further increased in CM alone (median time to recurrence not met). Impaired macrophage and neutrophil function measured by ROI production correlated with shorter time to repeat intervention (r=0.6; p=0.0019).

Conclusions

Treatment of CGD-associated liver abscesses with corticosteroids was associated with fewer subsequent hepatic interventions and improved outcome compared to invasive treatments.

Rifaximin fails to prevent campylobacteriosis in the human challenge model: a randomized, double-blind, placebo-controlled trial

Abstract

Background

Campylobacter species are a leading cause of diarrheal disease globally with significant morbidity. Primary prevention efforts have yielded limited results. Rifaximin chemoprophylaxis decreases travelers' diarrhea rates and may be suitable for high risk persons. We assessed the efficacy of rifaximin in the controlled human infection model (CHIM) for Campylobacter jejuni.

Methods

Twenty-eight subjects were admitted to an inpatient facility and randomized to a twice daily dose of 550 mg rifaximin or placebo. The following day subjects ingested 1.7x10 ⁵ colony forming units of C. jejuni strain CG8421. Subjects continued prophylaxis for 3 additional days, were followed for campylobacteriosis for 144 hours and subsequently treated with azithromycin and ciprofloxacin. Samples were collected to assess immunologic responses to CG8421.

Results

There was no difference (p=1.0) in the frequency of campylobacteriosis in those receiving rifaximin (86.7%) or placebo (84.6%). Additionally, there were no differences in the clinical signs and symptoms of C. jejuni infection to include abdominal pain/cramps (p=1.0), nausea (p=1.0), vomiting (p=0.2) or fever (p=1.0) across study groups. Immune responses to the CG8421 strain were comparable across treatment groups.

Conclusions

Rifaximin did not prevent campylobacteriosis in this CHIM. Given the morbidity associated with Campylobacter infection, primary prevention efforts remain a significant need.

Seasonal influenza vaccine effectiveness in preventing laboratory-confirmed influenza in primary care in Israel 2016-2017 season: insights into novel age-specific analysis

Abstract

Background

The 2016-2017 influenza season in Israel was dominated by the circulation of influenza A(H3N2). Influenza vaccine is recommended for the entire population in Israel over the age of six months. The inactivated influenza vaccine was chosen for use this season.

Methods

We estimated the 2016-2017 end-of-season influenza vaccine effectiveness (VE) in preventing influenza-like illness (ILI) due to influenza A(H3N2), using the test-negative design. Age-specific VE was estimated using a moving age window and weekly analysis.

Results

During the 2016-2017 season 1267 samples were collected; 467 (36.9%) were positive for influenza, with 97.9% A(H3N2), 0.2% A(H1N1)pdm09, and 1.9% B.  A total of 1088 individuals were found eligible to be included in VE assessment. All vaccinated individuals included in the VE assessment received the inactivated influenza vaccine. Adjusted VE against influenza A(H3N2) was 29.0% [95% confidence interval (CI) 0.3% to 49.5%]. Age group-specific adjusted VE demonstrated VE of 69.2 [95% CI 19.4 to 88.3] for children aged 5-17, and VE of 58.8 [95% CI 0.81 to 82.9] for adults ages 45- 64. Other age groups demonstrated lower VE estimates that were not statistically significant. Adjusted VE estimates using a moving window of 15 years and weekly VE analyses provided a more defined understanding of age-specific VE during the 2016-2017 season.

Conclusion

Estimating VE using a moving age window, and weekly VE analysis may provide more detailed information regarding the relationship between VE and age.

Commentary on: Incidence and Predictors of Venous Thromboembolism in Abdominoplasty

Among healthcare providers, we all agree that collecting data is essential to document our current approach to patient care and learn how to optimize and improve this. However, if data are merely collected and never analyzed, it serves no real purpose. We congratulate the authors of this excellent paper¹ for "looking into the box" and uncovering some interesting observations through analysis of the Internet Based Quality Assurance Program (IBQAP) database that lends insight into the enigma of venous thromboembolism (VTE) occurring in patients undergoing abdominoplasty.

Effect of Botulinum Toxin A on Muscle Healing and its Implications in Aesthetic and Reconstructive Surgery

Abstract

Background

Muscle activity contributes to the enhancement of facial aging deformity, blepharospasm, cerebral palsy spasticity, trismus, torticollis, and other conditions. Myotomy of the involved muscles in order to reduce the deformity has variable success rates due to muscle healing and regeneration of activity.

Objectives

The goal of this study was to investigate whether blocking striated muscle activity with Botulinum toxin (BtxA) during the healing time after myotomy alters the healing process and reduces long-term muscle activity.

Methods

Eighteen Sprague Dawley rats where divided into 3 groups: group A (n = 7) underwent myotomy of their Latisimus Dorsi muscle; group B (n = 7) underwent myotomy and injection of BtxA into their severed muscle; group C (n = 4) injection of BtxA only. Muscle strength was tested periodically using a grip test.

Results

Starting at week 16 and until the termination of study at week 22, group B (Myotomy + BtxA) showed significant reduction in muscle power compared to the two control groups.

Conclusions

Addition of BtxA injection into a muscle immediately after myotomy may interfere with muscle healing and contribute to a more successful long-term result.

Commentary on: Paradoxical Adipose Hypertrophy (PAH) After Cryolipolysis

Paradoxical adipose hypertrophy (PAH) after cryolipolysis is a common and concerning complication associated with cryolipolysis body contouring. Body contouring, or body sculpting, procedures are the fastest growing procedures in aesthetic medicine. According to the American Society for Dermatologic Surgery (ASDS), approximately 387,000 body sculpting treatments were performed in the United States in 2016.¹ The number of body sculpting treatments has risen 68% since 2015, which was the largest year-to-year growth of all cosmetic procedures.¹ Within body sculpting procedures, cryolipolysis, or "fat-freezing," accounted for 177,000 treatments or 45.7% of all body contouring treatments. In fact, cryolipolysis surpassed the growth rate of body sculpting treatments by increasing 76% from 2015 to 2016.¹

Paradoxical Adipose Hypertrophy (PAH) After Cryolipolysis

Abstract

Background

Cryolipolysis is a minimally invasive technique used to decrease local adipose tissue by thermal cooling. Paradoxical adipose hypertrophy (PAH) is a rare complication of cryolipolysis with important aesthetic consequences.

Objectives

The objective of this study was to describe four cases of PAH after a cryolipolysis treatment.

Methods

Between January 2014 and January 2017, all patients who had undergone a cryolipolysis treatment in a single center were reviewed. The device used was a CoolSculpting device and the same operator performed all the cryolipolysis treatments. We retrospectively included all patients who had a suspicion of PAH.

Results

In our study, 398 patients underwent a session of cryolipolysis. Four patients presented with a voluminous painless swelling in the treated area, between 2 and 4 months after the cryolipolysis session. One patient was treated with liposuction. Histological analysis of the adipose tissue in this patient revealed a nonspecific panniculitis. The other three patients did not receive any additional treatment, and their symptoms stabilized after several months.

Conclusions

Although cryolipolysis generally yields good results, it can be complicated with PAH, which tends to occur a few months after the cryolipolysis treatment. Patients should be informed of the possibility of developing this complication and encouraged to attend regular follow up for at least 6 months, so that this condition can be readily detected. Surgical treatment should be offered if there is no spontaneous improvement of the symptoms.

Level of Evidence: 5

Commentary on: Do Not Fear an Implant’s Shape: A Single Surgeon’s Experience of Over 1200 Round and Shaped Textured Implants in Primary Breast Augmentation

It is with great pleasure that we discuss "Do Not Fear an Implant's Shape: A Single Surgeon's Experience of Over 1200 Round and Shaped Textured Implants in Primary Breast Augmentation" by Montemurro et al.¹ In this article, the authors reviewed their 6-year experience using textured, anatomically shaped and round silicone gel implants in 648 patients for primary breast augmentation. They specifically examined the complication rate for both types of implants. All implants were placed through an inframammary incision into a dual plane pocket, except for 2 patients who had implants placed in a subglandular pocket. A total of 581 patients had anatomically shaped implants with an overall complication rate of 9.0% while 67 patients had round implants with an overall complication rate of 11.9%. Rotation (3.6%) was the most common complication to occur with anatomically shaped implants while bottoming out (7.5%) was the most common complication after round implants. The difference in overall complication rate was not statistically significant (P = 0.505). The authors conclude that "a single, ideal implant that is suitable for every primary breast augmentation does not exist and one implant shape is not, by itself, aesthetically superior to another." Although we would agree with this statement, there are several important issues requiring further discussion.

Quimp (QUality of life IMPairment): an addition to the Quality of Life lexicon

There has been a constant growth in the number of publications each year concerning "quality of life (QoL)" and "dermatology," since the publication of the Dermatology Life Quality Index in 1994. Numerous dermatology and disease-specific QoL instruments have since been created. Quality of life is frequently assessed in clinical trials, educational activities and epidemiologic studies. QoL assessment is included in many national guidelines in dermatology. QoL assessment scores, together with disease severity measures, are used as guideline criteria for the use of biologics in dermatology and other clinical fields in many countries, and even for treatment reimbursement decisions. QoL assessment in dermatology is considered of benefit for routine clinical use. The European Academy of Dermatology and Venereology Task Force on QoL and Patient Oriented Outcomes (PO) is actively working to facilitate appropriate use of

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Keystone flap for covering large soft tissue defects of the dorsum of the hand

Quality of expert medical opinions on occupational skin cancer caused by natural UV light

Recalcitrant rash in a six-month-old infant

Benzamide porphyrins with directly conjugated and distal pyridyl or pyridinium groups substituted to the porphyrin macrocycles: Study of the photosensitising abilities as inducers of apoptosis in cancer cells under photodynamic conditions

Publication date: Available online 13 November 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Devashish Sengupta, Zeaul Hoque Mazumdar, Avinaba Mukherjee, Debdulal Sharma, Amit Kumar Halder, Samita Basu, Tarun Jha
Amphiphilic porphyrin photosensitisers (PSs) having combinations of directly substituted pyridyl group(s) at the meso-position of a porphyrin macrocycle, and/or indirectly linked pyridyl groups as benzamide derivatives are reported. The compounds 5,10,15,20-tetrakis-(4-pyridylbenzamide)porphyrin (A.2), 5,10,15,20-tetra[N-(pyridine-4-yl)benzamidium] porphyrin (A.3), 5-mono-(4-pyridyl)-10,15,20-tris-(4-pyridylbenzamide)porphyrin (B.2) and 5-mono-(4-methylpyridinium)-10,15,20-tris-(4-pyridiniumbenzamide)porphyrin (B.3) were synthesised. The compounds were successfully characterised through UV–Vis, Emission, ¹H NMR, and ESI-HRMS techniques. To evaluate the effect of this combination of directly conjugated and non-conjugated pyridyl/cationic pyridinium groups on the porphyrin macrocycle, the efficacy of the synthesised compounds was compared to a known standard 5,10,15,20-tetrakis(1-methylpyridinium-4-yl)porphyrin (TMPyP). These compounds show better efficacy (IC50's ranging between 0.66±0.04μM to 3.71±1.01μM) against A549 (human epithelial adenocarcinoma lung cancer) cell line under in vitro photodynamic conditions in comparison to MDA-MB-231 (breast cancer) (IC50's ranging between 3.7±0.087μM to 12.1±0.12μM) and Pa-1 (ovarian cancer) (IC50's ranging between 17.9±0.01μM to 42.45±0.02μM) cell lines. It was found that B.3, having a pyridinium group attached to the meso-position of the macrocycle along with three distal cationic pyridinium groups, independent of the porphyrinic electron delocalisation cycle, showed better photocytotoxic efficacy (IC50=0.66±0.04μM, A549 lung cancer cell line) and higher potential to promote apoptosis and hence better efficacy as PS towards cancer photodynamic therapy (PDT). The PDT activity of B.3 was further verified and established by various biological assays, viz. Annexin V assay, cell cycle assay, and reactive oxygen species (ROS) activity assay.

Photodynamic inactivation of Escherichia coli – Correlation of singlet oxygen kinetics and phototoxicity

Publication date: Available online 13 November 2017
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Alexander Müller, Annegret Preuß, Beate Röder
Photodynamic inactivation (PDI) of bacteria may play a major role in facing the challenge of the ever expanding antibiotic resistances. Here we report about the direct correlation of singlet oxygen luminescence kinetics and phototoxicity in E. coli cell suspension under PDI using the widely applied cationic photosensitizer TMPyP. Through direct access to the microenvironment, the time resolved investigation of singlet oxygen luminescence plays a key role in understanding the photosensitization mechanism and inactivation pathway. Using the homemade set-up for highly sensitive time resolved singlet oxygen luminescence detection, we show that the cationic TMPyP is localized predominantly outside the bacterial cells but in their immediate vicinity prior to photodynamic inactivation. Throughout following light exposure, a clear change in singlet oxygen kinetics indicates a redistribution of photosensitizer molecules to at least one additional microenvironment. We found the signal kinetics mirrored in cell viability measurements of equally treated samples from same overnight cultures conducted in parallel: A significant drop in cell viability of the illuminated samples and stationary viability of dark controls. Thus, for the system investigated in this work – a Gram-negative model bacteria and a well-known PS for its PDI – singlet oxygen kinetics correlates with phototoxicity. This finding suggests that it is well possible to evaluate PDI efficiency directly via time resolved singlet oxygen detection.

Identification of compounds from Palicourea rigida leaves with topical anti-inflammatory potential using experimental models

Abstract

Palicourea rigida Kunth is traditionally used for the treatment of skin diseases, kidney pains and ovarian inflammation. Based on these traditional uses, this study evaluated the topical anti-inflammatory activity of the ethanol extract from P. rigida leaves (EEPR) and identified bioactive compounds. Ear edema was induced in Swiss mice by the topical application of Croton oil, arachidonic acid, phenol and capsaicin. Histopathological analysis and myeloperoxidase and N-acetyl-β-d-glucosaminidase activities were determined. EEPR was characterized by UHPLC–UV–MS HPLC and the isolated compound was identified through ¹H and ¹³C nuclear magnetic resonance and mass fragmentation. Interaction profiles between quercetin 3-O-β-d-glucoside and cyclooxygenase-1 and -2 were established by molecular docking. EEPR significantly inhibited ear edema induced by Croton oil (p < 0.001), arachidonic acid (p < 0.01), phenol (p < 0.001) and capsaicin (p < 0.01 or p < 0.001). Histopathological analysis showed a reduction of edema, inflammatory cell infiltration and vasodilation. Additionally, the myeloperoxidase and N-acetyl-β-d-glucosaminidase activities were decreased (p < 0.001). From spectroscopic data, quercetin 3-O-β-d-glucoside was the identified compound. This compound can to interact with cyclooxygenase-1 and -2 through van der Waals interactions and dipole–dipole and hydrogen bonding's, demonstrating inhibition of these enzymes. The results indicate that EEPR is a source of active compounds with topical anti-inflammatory activity, justifying the traditional use of P. rigida and showing that this species has a therapeutic potential to treat skin inflammatory processes.

Mitteilungen der ÖWAW

The Ineliminability of the Idea of Progress

The sense of incredibility in ethics

Abstract

It is often said that normative properties are "just too different" to reduce to other kinds of properties. This suggests that many philosophers find it difficult to believe reductive theses in ethics. I argue that the distinctiveness of the normative concepts we use in thinking about reductive theses offers a more promising explanation of this psychological phenomenon than the falsity of Reductive Realism. To identify the distinctiveness of normative concepts, I use resources from familiar Hybrid views of normative language and thought to develop a Hybrid view of normative concepts. In addition to using this new Hybrid view to explain why reductive theses are difficult to believe, I show how to preserve several patterns of inference involving normative concepts that, intuitively, it is possible to make, and hence answer an important recent challenge to Hybrid views from Mark Schroeder.

Transition: Message from the Editor-in-Chief

With this issue I will step down as Editor-In-Chief of Neuro-Oncology. My recent election as President of the Society for Neuro-Oncology precludes me from holding both positions at the same time. I will always be grateful for the tremendous privilege of serving as Editor-In-Chief for the past four years. With the support of the neuro-oncology community, the Society for Neuro-Oncology (SNO), the European Association of Neuro-Oncology (EANO), and the Japanese Society for Neuro-Oncology (JSNO) the journal has flourished. Neuro-Oncology has increasingly become a forum for important research in the field, with the impact factor rising to 7.786 and submissions on track to exceed 900 this year. This success would not be possible without the dedication and hard work of our Managing Editor, Elizabeth Martinson, the team at Oxford University Press led by Phil Bishop, and the support and invaluable guidance of our Executive Editors (Kenneth Aldape, Ryo Nishikawa, and Riccardo Soffietti), our Associate Editors (Terri Armstrong, Karla Ballman, E. Antonio Chiocca, Frank Furnari, Monika Hegi, Koichi Ichimura, Mark Kieran, Minesh Mehta, Whitney Pope, David Schiff, and Wolfgang Wick), and our Editorial Board. I will always be indebted to them.

Clinical significance of CD73 in triple-negative breast cancer: multiplex analysis of a phase III clinical trial

Abstract

Background

CD73 is an ecto-enzyme that promotes tumor immune escape through the production of immunosuppressive extracellular adenosine in the tumor microenvironment. Several CD73 inhibitors and adenosine receptor antagonists are being evaluated in phase I clinical trials.

Patients and methods

Full-face sections from formalin-fixed paraffin-embedded primary breast tumors from 122 samples of triple-negative breast cancer from the BIG 02-98 adjuvant phase III clinical trial were included in our analysis. Using multiplex immunofluorescence and image analysis, we assessed CD73 protein expression on tumor cells, tumor-infiltrating leukocytes and stromal cells. We investigated the associations between CD73 protein expression with disease-free survival, overall survival and the extent of tumor immune infiltration.

Results

Our results demonstrated that high levels of CD73 expression on epithelial tumor cells were significantly associated with reduced disease-free survival, overall survival and negatively correlated with tumor immune infiltration (Spearman's R= -0.50, p < 0.0001). Patients with high levels of CD73 and low levels of tumor-infiltrating leukocytes had the worse clinical outcome.

Conclusions

Taken together, our study provides further support that CD73 expression is associated with a poor prognosis and reduced anti-tumor immunity in human triple-negative breast cancer and that targeting CD73 could be a promising strategy to reprogram the tumor microenvironment in this breast cancer subtype.

Genotype-based selection of treatment for patients with advanced colorectal cancer (SETICC): a pharmacogenetic-based randomized phase II trial

Abstract

Background

There has been little progress toward personalized therapy for patients with metastatic colorectal cancer (mCRC). TYMS-3′ untranslated region (UTR) 6 bp ins/del and ERCC1-118C/T polymorphisms were previously reported to facilitate selecting patients for fluoropyrimidine-based treatment in combination with oxaliplatin as first-line therapy. We assessed the utility of these markers in selecting therapy for patients with mCRC.

Patients and methods

This randomized, open-label phase II trial compared bevacizumab plus XELOX (control) versus treatment tailored according to TYMS-3'UTR 6 bp ins/del and ERCC1-118C/T polymorphisms. Patients randomized to the experimental treatment received bevacizumab plus FUOX, FUIRI, XELIRI, or XELOX depending on their combination of favorable polymorphisms for FUOX treatment (TYMS-3′UTR ins/del or del/del; ERCC1-118T/T). Progression-free survival (PFS) was the primary endpoint.

Results

Overall, 195 patients were randomized (control n=65; experimental n=130). The primary objective was not met: median PFS was 9.4 months in the control group and 10.1 months in the experimental group (P=0.745). Median overall survival was similar in both groups (16.5 versus 19.1 months, respectively; P=0.797). Patients in the experimental group had a significantly higher overall response rate (ORR; 65% versus 47% in the control group; P=0.042) and R0 resection rate (86% versus 44%, respectively; P=0.018). Neuropathy, hand-foot syndrome, thrombocytopenia, and dysesthesia were significantly less common in the experimental group.

Conclusions

This study did not show survival benefits after treatment personalization based on polymorphisms in mCRC. However, the improved overall response rate and R0 resection rate and fewer disabling toxicities suggest that tailoring therapy by TYMS-3′UTR and ERCC1-118 polymorphisms warrants further investigation in patients with mCRC. ClinicalTrials.gov: NCT01071655.

Outcome prediction in patients with localized soft tissue sarcoma: Which tool is the best?

Human papillomavirus (HPV) and somatic EGFR mutations are essential, mutually exclusive oncogenic mechanisms for inverted sinonasal papillomas and associated sinonasal squamous cell carcinomas

Abstract

Background

Inverted sinonasal papilloma (ISP) is a locally aggressive neoplasm often associated with sinonasal squamous cell carcinoma (SNSCC). While the etiology of ISP is not well understood, human papillomavirus (HPV) has been detected in a subset of cases. Our group recently identified activating somatic EGFR mutations in the majority of ISP and ISP-associated SNSCC. However, the relationship between EGFR mutations and HPV infection has not been explored.

Patients and Methods

We evaluated 58 ISP and 22 ISP-associated SNSCC (including 13 patients with matched ISP/SNSCC samples), as well as 14 SNSCC without clinical or pathologic evidence of an associated ISP. Formalin-fixed, paraffin-embedded samples were evaluated for EGFR mutations using Sanger sequencing and for HPV infection using GP5+/GP6+ PCR. HPV subtyping based on the L1 sequence was done for HPV positive cases including temporally distinct tumors for four patients. Clinicopathologic data including progression free survival was also analyzed.

Results

All ISP and ISP-associated SNSCC demonstrated either an EGFR mutation or HPV infection. HPV and EGFR mutation were mutually exclusive in all cases of ISP-associated SNSCC and all but one ISP; this case was only weakly HPV positive, and analysis of a prior temporally distinct ISP specimen from this patient failed to show HPV infection, suggesting transient infection/incidental colonization. HPV subtypes in ISP and ISP-associated SNSCC were predominantly low-risk, in contrast with SNSCC without ISP association, which showed frequent high-risk HPV. All paired ISP and associated SNSCC samples demonstrated concordant HPV status and EGFR genotypes. ISP progression to SNSCC was significantly associated with the presence of HPV infection and the absence of an EGFR mutation (log-rank = 9.620, P = 0.002).

Conclusions

Collectively our data show that EGFR mutations and HPV infection represent essential, alternative oncogenic mechanisms in ISP and ISP-associated SNSCC.

Gewässerentwicklungs- und Risikomanagementkonzepte als Planungsinstrument für ein integratives Flussraummanagement

Zusammenfassung

Flussräume bestehen aus dem Gewässer selbst und dem durch das Gewässer und dessen Hochwässern geprägten Umland. Sie sind in Österreich einer Vielzahl unterschiedlicher Nutzungen ausgesetzt. Insbesondere der Schutz von Siedlungsräumen vor Naturgefahren sowie die Landgewinnung für land- und forstwirtschaftliche Produktion haben unsere Flusslandschaften über Jahrhunderte geprägt und nachhaltig verändert. Traditionelle schutzwasserwirtschaftliche Baumaßnahmen führen zu einer Vielzahl an Belastungen für die Gewässerökosysteme und sind in Österreich die Hauptursache für die Verfehlung der ökologischen Ziele der Wasserrahmenrichtlinie in mehr als 50 % unserer Fließgewässer.

Um die Ziele und Maßnahmenprogramme des Nationalen Gewässerbewirtschaftungsplans mit jenen des Nationalen Hochwasserrisikomanagementplans abstimmen und gleichzeitig auch andere Nutzungen und Anforderungen an das Gewässer berücksichtigen zu können, bedarf es eines integrativen Flussraummanagements. Nur durch eine gesamtheitliche, sektorenübergreifende Betrachtung aller gewässerrelevanten Aspekte ist es möglich, Konflikte zu erkennen, Synergien zu identifizieren und in einem integrativen, partizipativen Prozess die bestmöglichen Lösungen für das Gewässer zu erarbeiten.

Mit dem Gewässerentwicklungs- und Risikomanagementkonzept (GE-RM) wurde ein Planungsinstrument für integratives Flussraummanagement entwickelt. Der GE-RM-Planungsprozess erfolgt für längere Gewässerstrecken bzw. ganze Einzugsgebiete, stärkt die Zusammenarbeit zwischen den zuständigen Fach- und Verwaltungsbereichen und führt zur Definition eines integrativen Leitbildes, welches in weiterer Folge als Grundlage für die Erstellung konkreter schutzwasserwirtschaftlicher und ökologischer Maßnahmenkonzepte dient. Die Identifizierung von Synergien zwischen den verschiedenen Fachbereichen steht dabei im Vordergrund.

Der 2016 veröffentlichte Leitfaden für Gewässerentwicklungs- und Risikomanagementkonzepte soll in den kommenden Jahren in der Praxis erprobt, evaluiert und entsprechend den konkreten Erfahrungen überarbeitet werden.

Prospective Epidemiological Research Studies in IrAN (The PERSIAN Cohort): Rationale, Objectives and Design

ABSTRACT

Non-communicable diseases (NCDs) account for 76% of deaths in Iran and this number is on the rise, parallel to global rates. Many risk factors associated with NCDs are preventable; however it is first necessary to conduct observational studies to identify relevant risk factors, and the most appropriate approach to control them. Iran is a multi-ethnic country, therefore the Ministry of Health and Medical Education sought to launch a nationwide cohort study—the Prospective Epidemiological Research Studies in IrAN (PERSIAN)—in order to identify the most prevalent NCDs among Iranian ethnicities, and to investigate effective methods of prevention. The PERSIAN cohort consists of four population-based cohorts, the adult component, presented in this article, is a prospective cohort including 180,000 individuals aged 35-70 years, from 18 distinct areas of Iran. Upon joining, participants respond to interviewer-administered questionnaires. Blood, urine, hair and nail samples are collected and stored. To ensure consistency, centrally-purchased equipment is sent to all sites, and the same team trains all personnel. Routine visits and quality assurance/control measures are taken to ensure protocol adherence. Participants are followed for 15 years post-enrollment. The PERSIAN cohort is currently in the enrollment phase; cohort profiles will soon emerge.

Kanalsanierungsrobotik

Excessive use of nitrogenous fertilizers: an unawareness causing serious threats to environment and human health

Abstract

Farmers occasionally need to add nitrogen fertilizer to their farms and gardens to make available just the precise nutrients for their plants' growth. The applications of inorganic nitrogen fertilizers to various crops have been continuously increasing since last many decades globally. Although nitrogen fertilizer contributes substantially to yield enhancement, but excessive use of this manure has posed serious threats to environment and human health. Rate of nitrogen fertilizers application has a close relationship with nitrate accumulation in surrounding environment, groundwater, as well as leafy and root vegetables. Consumption of diets having high nitrate contents has contributed to endogenous nitrosation, which could lead to thyroid condition, various kinds of human cancers, neural tube defects (during fetus development), and diabetes. In this short review, the authors have tried to create awareness among general public, farming community, health practitioners, and agricultural scientists for the risk involved with excessive use of nitrogen fertilizers to human health. Carcinogenic activity and other adverse effects of N-nitroso compounds might be prevented by consuming vitamin C and antioxidants containing fruits and vegetables.

Certolizumab Pegol in the Treatment of Psoriasis and Psoriatic Arthritis: Preliminary Real-Life Data

Abstract

Introduction

We present the results of real-life tests conducted in adults affected by psoriatic arthritis (PsA) with mild cutaneous involvement to evaluate the efficacy of certolizumab pegol (CZP), an anti-tumor necrosis factor-alpha agent approved in Europe for the treatment of rheumatoid arthritis and PsA.

Methods

Assessments included an evaluation of the Psoriasis Area and Severity Index (PASI) and the Disease Activity Score computed on 44 joints (DAS-44) correlated to the erythrocyte sedimentation rate (ESR) (DAS44-ESR). A total of 41 patients (16 men, 25 women; mean age 59.8 ± 8 years) completed the study. Of these, 36 patients were affected by both PsA and psoriasis, and five patients were affected only by PsA. A total of 32 patients (group A) completed 3 months of treatment (W12), and 12 patients completed 6 months of treatment (W24) (group B).

Results

The clinical efficacy of CZP was consistent on both the cutaneous and rheumatic components of the treatment. The mean PASI score decreased from 4.4 ± 4.7 at baseline (BL) to 2.3 ± 3.7 at W12 (group A), and from 5.1 ± 5.7 at BL to 0.8 ± 1.2 at W24 (group B). The DAS44-ESR decreased from 4.4 ± 0.6 at BL to a mean of 2.2 ± 0.9 at W12 (group A) and from 4.1 ± 0.6 at BL to a mean of 1.9 ± 0.5 at W24 (group B). No adverse events were reported.

Conclusion

Our results demonstrate that CZP can be used safely and effectively to treat both the cutaneous and joint components of PsA. However, long-term data are needed to confirm our preliminary observations.