Skin barrier and microbiome in acne

Abstract

Acne is an immune-mediated chronic inflammatory disease. Although several factors are involved in its pathophysiology, this process is not completely understood. Androgen hormone activity increases sebum production inside the pilosebaceous follicle, adjusting the environment for the development of Propionibacterium acnes which triggers inflammation. Knowing how others factors such as the skin barrier and microbiome are involved in acne, can help in understanding more about the disease and may help to conduct a better treatment.

Buccal Mucosal Epithelial Cells Downregulate CTGF Expression in Buccal Submucosal Fibrosis Fibroblasts

Abstract

Introduction

Oral submucosal fibrosis (OSMF) is a chronic debilitating fibrotic disease of the oral cavity and is a serious health hazard in south Asia and, increasingly, the rest of the world. The molecular basis behind various treatment modalities to treat OSMF still remains unclear. In this study, we have investigated the in vitro ability of the buccal mucosal cells to reduce the proliferation of the fibroblasts of the fibrotic area in co-culture of cells and also at the molecular levels to reduce the level of connective tissue growth factor (CTGF) in the OSMF fibroblasts (SMF-F).

Materials and Methods

The study compares isolation, morphological and proliferation kinetics of SMF-F and BMF cells with and without co-culturing with BMEs. In addition, we have compared the mRNA expression levels of CTGF in SMF-F co-cultured BME and non-co-cultured SMF-F cells using validated real-time quantitative PCR (RT-qPCR) method.

Results

The basic morphological characteristics of SMF-F were similar to BMF, but the former cells had higher proliferation rate in early passages compared to late passage state. We also observed that the CTGF expression levels in SMF-F under co-culture conditions of BME were consistently and significantly downregulated in all four different SMF-F-derived cells from four different patients.

Conclusion

Rapid proliferation and collagen synthesis in SMF-F as against BMF cells are the factors that confirm the innate nature of fibrosis fibroblasts (SMF-F). Further, the CTGF expression level in SMF-F was significantly suppressed by BME in co-culture conditions against controls (BMF). Considered together, this suggests that the cell therapeutic candidate of BME could be used in treating OSMF.

Can Arterial Spin-Labeling with Multiple Postlabeling Delays Predict Cerebrovascular Reserve? [ADULT BRAIN]

BACKGROUND AND PURPOSE:

The effect of delayed transit time is the main source of error in the quantitative measurement of CBF in arterial spin-labeling. In the present study, we evaluated the usefulness of the transit time–corrected CBF and arterial transit time delay from multiple postlabeling delays arterial spin-labeling compared with basal/acetazolamide stress technetium Tc99m-hexamethylpropylene amineoxime (Tc99m-HMPAO) SPECT in predicting impairment in the cerebrovascular reserve.

MATERIALS AND METHODS:

Transit time–corrected CBF maps and arterial transit time maps were acquired in 30 consecutive patients with unilateral ICA or MCA steno-occlusive disease (severe stenosis or occlusion). Internal carotid artery territory–based ROIs were applied to both perfusion maps. Additionally, impairment in the cerebrovascular reserve was evaluated according to both qualitative and quantitative analyses of the ROIs on basal/acetazolamide stress Tc99m-HMPAO SPECT using a previously described method. The area under the receiver operating characteristic curve was used to evaluate the diagnostic accuracy of arterial spin-labeling in depicting impairment of the cerebrovascular reserve. The correlation between arterial spin-labeling and cerebrovascular reserve was evaluated.

RESULTS:

The affected hemisphere had a decreased transit time–corrected CBF and increased arterial transit time compared with the corresponding values of the contralateral normal hemisphere, which were statistically significant (P < .001). The percentage change of transit time–corrected CBF and the percentage change of arterial transit time were independently differentiating variables (P < .001) for predicting cerebrovascular reserve impairment. The correlation coefficient between the arterial transit time and cerebrovascular reserve index ratio was –0.511.

CONCLUSIONS:

Our results demonstrate that the transit time–corrected CBF and arterial transit time based on arterial spin-labeling perfusion MR imaging can predict cerebrovascular reserve impairment.

Role of MR Neurography for the Diagnosis of Peripheral Trigeminal Nerve Injuries in Patients with Prior Molar Tooth Extraction [PERIPHERAL NERVOUS SYSTEM]

BACKGROUND AND PURPOSE:

Clinical neurosensory testing is an imperfect reference standard to evaluate molar tooth extraction related peripheral trigeminal neuropathy. The purpose was to evaluate the diagnostic accuracy of MR neurography in this domain and correlation with neurosensory testing and surgery.

MATERIALS AND METHODS:

In this retrospective study, nerve caliber, T2 signal intensity ratio, and contrast-to-noise ratios were recorded by 2 observers using MR neurography for bilateral branches of the peripheral trigeminal nerve, the inferior alveolar and lingual nerves. Patient demographics and correlation of the MR neurography findings with the Sunderland classification of nerve injury and intraoperative findings of surgical patients were obtained.

RESULTS:

Among 42 patients, the mean ± SD age for case and control patients were 35.8 ± 10.2 years and 43.2 ± 11.5 years, respectively, with male-to-female ratios of 1:1.4 and 1:5, respectively. Case subjects (peripheral trigeminal neuropathy or injury) had significantly larger differences in nerve thickness, T2 signal intensity ratio, and contrast-to-noise ratios than control patients for the inferior alveolar nerve and lingual nerve (P = .01 and .0001, .012 and .005, and .01 and .01, respectively). Receiver operating characteristic analysis showed a significant association among differences in nerve thickness, T2 signal intensity ratio, and contrast-to-noise ratios and nerve injury (area under the curve, 0.83–0.84 for the inferior alveolar nerve and 0.77–0.78 for the lingual nerve). Interobserver agreement was good for the inferior alveolar nerve (intraclass correlation coefficient, 0.70–0.79) and good to excellent for the lingual nerve (intraclass correlation coefficient, 0.75–0.85). MR neurography correlations with respect to clinical neurosensory testing and surgical classifications were moderate to good. Pearson correlation coefficients of 0.68 and 0.81 and of 0.60 and 0.77 were observed for differences in nerve thickness.

CONCLUSIONS:

MR neurography can be reliably used for the diagnosis of injuries to the peripheral trigeminal nerve related to molar tooth extractions, with good to excellent correlation of imaging with clinical findings and surgical results.

Dynamic Contrast-Enhanced MRI-Derived Intracellular Water Lifetime ({tau}i): A Prognostic Marker for Patients with Head and Neck Squamous Cell Carcinomas [HEAD & NECK]

BACKGROUND AND PURPOSE:

Shutter-speed model analysis of dynamic contrast-enhanced MR imaging allows estimation of mean intracellular water molecule lifetime (a measure of cellular energy metabolism) and volume transfer constant (a measure of hemodynamics). The purpose of this study was to investigate the prognostic utility of pretreatment mean intracellular water molecule lifetime and volume transfer constant in predicting overall survival in patients with squamous cell carcinomas of the head and neck and to stratify p16-positive patients based upon survival outcome.

MATERIALS AND METHODS:

A cohort of 60 patients underwent dynamic contrast-enhanced MR imaging before treatment. Median, mean intracellular water molecule lifetime and volume transfer constant values from metastatic nodes were computed from each patient. Kaplan-Meier analyses were performed to associate mean intracellular water molecule lifetime and volume transfer constant and their combination with overall survival for the first 2 years, 5 years, and beyond (median duration, >7 years).

RESULTS:

By the last date of observation, 18 patients had died, and median follow-up for surviving patients (n = 42) was 8.32 years. Patients with high mean intracellular water molecule lifetime (4 deaths) had significantly (P = .01) prolonged overall survival by 5 years compared with those with low mean intracellular water molecule lifetime (13 deaths). Similarly, patients with high mean intracellular water molecule lifetime (4 deaths) had significantly (P = .006) longer overall survival at long-term duration than those with low mean intracellular water molecule lifetime (14 deaths). However, volume transfer constant was a significant predictor for only the 5-year follow-up period. There was some evidence (P < .10) to suggest that mean intracellular water molecule lifetime and volume transfer constant were associated with overall survival for the first 2 years. Patients with high mean intracellular water molecule lifetime and high volume transfer constant were associated with significantly (P < .01) longer overall survival compared with other groups for all follow-up periods. In addition, p16-positive patients with high mean intracellular water molecule lifetime and high volume transfer constant demonstrated a trend toward the longest overall survival.

CONCLUSIONS:

A combined analysis of mean intracellular water molecule lifetime and volume transfer constant provided the best model to predict overall survival in patients with squamous cell carcinomas of the head and neck.

Bipolar Radiofrequency Ablation of Spinal Tumors: The Effect of the Posterior Vertebral Cortex Defect on Temperature Distribution in the Spinal Canal [LETTERS]

Deep Brain Nuclei T1 Shortening after Gadobenate Dimeglumine in Children: Influence of Radiation and Chemotherapy [PATIENT SAFETY]

BACKGROUND AND PURPOSE:

Intrinsic T1-hyperintense signal has recently been reported in the deep gray nuclei on brain MR imaging after multiple doses of gadolinium-based contrast agents. Most reports have included adult patients and excluded those undergoing radiation or chemotherapy. We investigated whether T1 shortening is also observed in children and tried to determine whether radiochemotherapy is a risk factor for this phenomenon.

MATERIALS AND METHODS:

In this single-center retrospective study, we reviewed clinical charts and images of all patients 18 years of age or younger with ≥4 gadobenate dimeglumine–enhanced MRIs for 6 years. Seventy-six children (mean age, 9.3 years; 60 unconfounded by treatment, 16 with radiochemotherapy) met the selection criteria (>4 MR imaging examinations; mean, 8). T1 signal intensity ratios for the dentate to pons and globus pallidus to thalamus were calculated and correlated with number of injections, time interval, and therapy.

RESULTS:

Among the 60 children without radiochemotherapy, only 2 had elevated T1 signal intensity ratios (n = 20 and 16 injections). Twelve of the 16 children with radiochemotherapy showed elevated signal intensity ratios. Statistical analysis demonstrated a significant signal intensity ratio change for the number of injections (P < .001) and amount of gadolinium (P = .008), but not for the interscan time interval (P = .35). There was a significant difference in the average signal intensity ratio change between those with and without radiochemotherapy (P < .001). Chart review revealed no new neurologic deficits in any patients, related to their underlying conditions and prior surgeries.

CONCLUSIONS:

Compared with published adult series, children show a similar pattern of T1 hyperintense signal changes of the dentate and globus pallidus after multiple gadobenate dimeglumine injections. The T1 signal changes in children may have a later onset but are accelerated by radiochemotherapy.

Patient-reported outcome measures following gynecomastia correction: a systematic review

Abstract

Background

A patient's perspective is usually measured by patient-reported outcome instruments, which are becoming increasingly relevant to current research on clinical outcomes. The aims of our review were to identify studies that evaluated patient satisfaction after gynecomastia correction, analyze existing questionnaires, and summarize the development, psychometric properties and content of the questionnaires.

Methods

A multistep search of the web-based PubMed database was performed. Each potential study was examined by 2 independent reviewers for adherence to inclusion/exclusion criteria. The identified studies were categorized by title, authors, date, study type, number of patients, surgical procedures, complications, mean age, mean duration of follow-up, and outcome measurements. We summarized all the questionnaires used.

Results

Our search generated a total of 711 articles; we selected 28 studies for further appraisal. Eight studies were excluded based on the content of the abstracts, and an additional 8 studies were excluded based on the content of the complete article. Thus, we performed a systematic review of the 12 remaining studies. All studies identified from the literature review were assessed to determine the type of surgery used and whether or not the questionnaire used to analyze patient satisfaction had been validated. A total of 847 patients were included in these studies, which reported more than 100 complications.

Conclusions

The rate of patient satisfaction was high, although most studies did not use validated or quantifiable evaluation methods for assessment of satisfaction. A new self-assessment tool, which should include functional, psycho-relational, and cosmetic components, is needed to measure satisfaction and quality of life in patients who have undergone gynecomastia correction.

Level of Evidence: Level III, therapeutic study

Regulatory role of XynR (YagI) in catabolism of xylonate in Escherichia coli K-12

Abstract

The genome of Escherichia coli K-12 contains ten cryptic phages, altogether constituting about 3.6% of the genome in sequence. Among more than 200 predicted genes in these cryptic phages, 14 putative transcription factor (TF) genes exist, but their regulatory functions remain unidentified. As an initial attempt to make a breakthrough for understanding the regulatory roles of cryptic phage-encoded TFs, we tried to identify the regulatory function of CP4-6 cryptic prophage-encoded YagI with unknown function. After SELEX screening, YagI was found to bind mainly at a single site within the spacer of bidirectional transcription units, yagA (encoding another uncharacterized TF) and yagEF (encoding 2-keto-3-deoxy gluconate aldolase, and dehydratase, respectively) within this prophage region. YagEF enzymes are involved in the catabolism of xylose downstream from xylonate. We then designated YagI as XynR (regulator of xylonate catabolism), one of the rare single-target TFs. In agreement with this predicted regulatory function, the activity of XynR was suggested to be controlled by xylonate. Even though low-affinity binding sites of XynR were identified in the E. coli K-12 genome, they all were inside open reading frames, implying that the regulation network of XynR is still fixed within the CR4-6 prophage without significant influence over the host E. coli K-12.

UV-based evaluation of ergosterol for monitoring the fungal exposure in Italian buffalo farms

Abstract

This study provided a reliable way to identify and estimate the ergosterol in farm environments, since it is renowned that it is a specific indicator for the occurrence of molds and yeasts. The quick valuation of exposure to airborne microorganisms is essential to assess the risk to which the health of employees is subjected in working places characterized by great humidity. From this view, it is worth estimating the total biomass of molds and yeast, including viable and non-viable forms, which may cause respiratory concerns to human. Air samples were collected with a passive method and the microbial growth was evaluated with a traditional counting method. At the same time, the ergosterol was quantified from yeasts and molds. In this way, the aerosol concentrations of molds and yeasts were compared by using the two methods, the cultivation on plates, as well as through ergosterol measurement by means of UV spectroscopy. Results showed, for the first time, a positive correlation between the amount of ergosterol and the yeast cells. Based on these outcomes, the ergosterol is a statistically significant biomarker to be used to control the air quality of indoor and outdoor farm spaces, by means of a simple and direct UV procedure.

Lesiones pruriginosas de meses de evolución en un paciente con antecedentes de micosis fungoide

Publication date: Available online 15 November 2017
Source:Piel
Author(s): Montserrat Molgó N., Paula Majluf C., Daniela Novoa C., Sergio González B.

Placas eritematosas arciformes como manifestación de hipotiroidismo

Publication date: Available online 15 November 2017
Source:Piel
Author(s): Claudia Quiroz Palominos, Julio Parra Cares, Roberto Bustos Macaya

Haartransplantation beim Mann

Zusammenfassung

Die Zahl der Haartransplantationen ist in den letzten Jahren weltweit kontinuierlich angestiegen. Der Anteil der Männer beträgt 85 %. Hauptindikation für eine Haartransplantation ist die androgenetische Alopezie. Eine qualifizierte ärztliche Beratung im Vorfeld einer Behandlung ist unabdingbar. Die Haartransplantation ist eine autologe Umverteilung Dihydrotestosteron-resistenter Haarwurzeln aus dem sog. Haarkranz in kahl gewordene Stellen. Es haben sich verschiedene Techniken etabliert. Die Resultate sind abhängig von der Ausgangssituation des Patienten und der Erfahrung des Operateurs mit seinem Team. Echte Komplikationen sind selten. Der Zufriedenheitsgrad der Patienten ist im Allgemeinen hoch.

Issue Information

A fully automatic end-to-end method for content-based image retrieval of CT scans with similar liver lesion annotations

Abstract

Purpose

The goal of medical content-based image retrieval (M-CBIR) is to assist radiologists in the decision-making process by retrieving medical cases similar to a given image. One of the key interests of radiologists is lesions and their annotations, since the patient treatment depends on the lesion diagnosis. Therefore, a key feature of M-CBIR systems is the retrieval of scans with the most similar lesion annotations. To be of value, M-CBIR systems should be fully automatic to handle large case databases.

Methods

We present a fully automatic end-to-end method for the retrieval of CT scans with similar liver lesion annotations. The input is a database of abdominal CT scans labeled with liver lesions, a query CT scan, and optionally one radiologist-specified lesion annotation of interest. The output is an ordered list of the database CT scans with the most similar liver lesion annotations. The method starts by automatically segmenting the liver in the scan. It then extracts a histogram-based features vector from the segmented region, learns the features' relative importance, and ranks the database scans according to the relative importance measure. The main advantages of our method are that it fully automates the end-to-end querying process, that it uses simple and efficient techniques that are scalable to large datasets, and that it produces quality retrieval results using an unannotated CT scan.

Results

Our experimental results on 9 CT queries on a dataset of 41 volumetric CT scans from the 2014 Image CLEF Liver Annotation Task yield an average retrieval accuracy (Normalized Discounted Cumulative Gain index) of 0.77 and 0.84 without/with annotation, respectively.

Conclusions

Fully automatic end-to-end retrieval of similar cases based on image information alone, rather that on disease diagnosis, may help radiologists to better diagnose liver lesions.

Executive summary of the 12th HHT international scientific conference

Abstract

Hereditary hemorrhagic telangiectasia is an autosomal dominant trait affecting approximately 1 in 5000 people. A pathogenic DNA sequence variant in the ENG, ACVRL1 or SMAD4 genes, can be found in the majority of patients. The 12th International Scientific HHT Conference was held on June 8–11, 2017 in Dubrovnik, Croatia to present and discuss the latest scientific achievements, and was attended by over 200 scientific and clinical researchers. In total 174 abstracts were accepted of which 58 were selected for oral presentations. This article covers the basic science and clinical talks, and discussions from three theme-based workshops. We focus on significant emergent themes and unanswered questions. Understanding these topics and answering these questions will help to define the future of HHT research and therapeutics, and ultimately bring us closer to a cure.

Harnessing the Power of Data in Facial Plastic and Reconstructive Surgery

The widespread use of electronic health records (EHRs) has created unprecedented opportunities to apply meaningful clinical data for quality improvement. Through machine learning, large data sets of patient clinical information gathered through routine clinical encounters can be analyzed for risk prediction and treatment algorithms. Although randomized clinical trials remain the criterion standard study type to show causality, the use of big data is showing promise as an alternative for discovery. This alternative is of particular significance in surgery, where randomized clinical trials are not feasible or likely.

Recreational Activity and Facial Trauma Among Older Adults

This database analysis uses the National Electronic Injury Surveillance System to collect data to evaluate the incidence of recreational activity–associated facial fractures among older adults and to further delineate injury characteristics including demographics, fracture location, and activities.

Teaching Rhinoplasty

Rhinoplasty is considered by many to be the most challenging operation that otolaryngologists do. Teaching rhinoplasty is even more challenging. In this issue of JAMA Facial Plastic Surgery, Robitschek and colleagues provide a combination of rhinoplasty analysis, science, and teaching our younger colleagues. Their study is a well-designed, prospective look at the effect of a simple teaching tool (a 10-minute slide presentation) and the thoroughness with which otolaryngology residents analyze the nose from patient photographs. The study concludes that 10 weeks after the teaching session, residents continue to perform better at rhinoplasty analysis, especially in terms of describing the position of the caudal septum.

In Memoriam: Gary Burget, MD (1941-2017)

Facial plastic surgery recently lost a dear friend, teacher, and colleague on May 31, 2017, with the passing of Gary Burget, MD. Dr Burget was born in Toledo, Ohio, on April 20, 1941, the second child of Dean E. and Marie A. Burget. His parents were schoolteachers who had grown up on small working farms in southern Ohio near West Virginia near the Appalachian foothills. His parents obtained schoolteaching jobs in the Toledo, Ohio, public school system after graduating from Bowling Green State University at the height of the Great Depression. Dr Burget attended Thomas A. DeVilbiss High School and served as president of the student council his senior year. He attended Yale University and graduated with a BA in English and then followed his older brother, Dean, to Yale Medical School, which he completed in 1967. During his fourth year of medical school, he arranged a surgical clerkship in Edinburgh, Scotland, under the direction of Andrew Logan, MD, which increased his interest in surgery. Following medical school, he pursued an internship at Columbia University College of Physicians and Surgeons in New York City and spent much of his time at Harlem Hospital. He then went to Jackson Memorial Hospital at the University of Miami as a resident in general surgery, followed by a residency in plastic surgery under D. Ralph Millard, Jr, MD. He was influenced by his older brother, Dean, who preceded him into a career in plastic surgery. Following completion of his plastic surgery residency, he was invited to join Dr Millard as an associate partner in his private practice. While honored, Dr Burget decided to enter private practice with Walter Garst, MD. After several years, Dr Burget struck out on his own and opened a practice in Miami. Henry W. Menn, MD, an early Mohs surgeon, referred a large number of patients with difficult facial defects to Dr Burget. It was during these years that Dr Burget realized the importance of the aesthetic units of the face and the need to sometimes remove additional tissue to move scars into favorable positions.

Teaching Photographic Nasal Analysis

This study evaluates the common pitfalls exhibited by otolaryngology residents in performing photographic nasal analysis and a systematic approach model for teaching photographic nasal analysis.

Partial Cost Cartilage Harvest for Rhinoplasty

To the Editor The article by Nelson and Gaball, "Technique to Reduce Time, Pain, and Risk in Costal Cartilage Harvest," recently published in JAMA Facial Plastic Surgery, nicely describes a surgical technique to harvest only the anterior two-thirds of a donor rib when autologous costal cartilage is necessary for reconstructive rhinoplasty.

Simulation Course for Evaluation and Treatment of Facial Fractures

This study assesses the value of a novel facial trauma simulation course requiring residents to practice advanced decision making.

Bony Batten Grafting to Correct Caudal Septal Deviation in Septoplasty

This cohort study evaluates the surgical outcomes of bony batten grafting for the management of caudal septal deviation in patients undergoing endonasal septoplasty.

The Columella Retraction Suture

This report presents the columella retraction suture as a way to control dead space after correction of the nasolabial and columella-tip complex.

Perception of Permanent Unilateral Facial Paralysis

This cohort study compares multiple domains of casual observer and expert perception with the actual experience of patients with permanent unilateral facial paralysis.

Review of Facial Plastic and Reconstructive Surgery

In 2001, Raza Pasha, MD, edited and published Otolaryngology–Head and Neck Surgery: A Clinical Reference Guide. This resource is currently in its fourth print edition and is ubiquitous in residency programs around the United States. The success of this book is due to its concise format and excellent overview of the specialty of Otolaryngology. Shaun Desai, MD, has borrowed some of this format for his text, Facial Plastic and Reconstructive Surgery: Clinical Reference Guide, and replicates this success with a narrower focus on the subspecialty of facial plastic and reconstructive surgery.

Costal Cartilage Warping Using Oblique Split vs Concentric Carving

This in vitro cadaveric study assesses whether the 30-degree oblique split method of preparing costal cartilage grafts produces less warping of the graft than the current standard of harvesting the central segment of a rib using the concentric carving method.

November-December Issue Highlights

Algorithm-Based Levator Aponeurectomy in Ptosis Surgery

This cohort study investigates the postoperative success of an algorithmic external levator aponeurosis resection technique in patients with aponeurotic ptosis and good levator function.

Training Current and Future Residents in Facial Plastic Surgery

In this issue of JAMA Facial Plastic Surgery, Christophel et al assess the value of a novel facial trauma simulation course given to 30 residents from 2 institutions. During this 1-day course, an impactor delivered a measurable force to create facial fractures in fresh frozen cadaver heads, which were then scanned with high-resolution computed tomography. Using each specimen's unique findings, a pair of trainees formulated and presented their theoretical treatment plan, which included airway management, fracture type, surgical approach, and type of fracture repair. Finally, the authors measured the improvement in the trainees' knowledge after the course with the Accreditation Council for Graduate Medical Education otolaryngology facial trauma residency milestone scale. This milestone is a national metric measure to monitor the resident's progress of learning; it uses a disease-based format for patient care and medical knowledge during training.

Complete Philtrum Reconstruction on the Partial-Thickness Cross-Lip Flap

This study describes the reconstruction of the philtrum in the cross-lip flap transfer using nasolabial muscle tension line group reconstruction.

Data Collection Integration to Optimize Clinical Outcomes Research

This Special Communication describes a method for prospective periodic evaluation of patients undergoing elective functional septorhinoplasty with data collection embedded into an electronic health record.

Electrochemical Therapy of Porcine Skin

This study examines the changes in optical, mechanical, and acoustic impedance properties in porcine skin after electrochemical therapy.

The Twisted Nose

A young man had functional nasal obstruction after facial trauma resulted in fractured nasal bones, had undergone a closed nasal fracture reduction but obstructive symptoms persisted, also expressed dissatisfaction with the appearance of his nose. What would you do next?

Lateral Crural Overlay Technique and Strength of Lower Lateral Cartilages

This cadaver study measures the difference in lateral crural strength and resilience after performing lateral crural overlay procedures using 2 different techniques.

Blast SMS and Enrollment for Cleft Lip and Cleft Palate Surgery in Zimbabwe

This study tested the effectiveness of a "blast" short message service text message to facilitate enrollment with a visiting surgical team in Zimbabwe.

Denguefieber

Zusammenfassung

Dengueinfektionen gehören zu den häufigsten Ursachen fieberhafter Erkrankungen im tropischen Umfeld. Die Infektion wird durch ein Flavivirus verursacht, das durch Aedes-Moskitos übertragen wird. Hauptüberträger für Dengueviren sind die weltweit in den Tropen verbreiteten Aedes-aegypti-Stechmücken. Da diese einerseits tagaktiv und andererseits sog. „container breeder" sind, bedarf es besonderer Vorbeugungs- und Bekämpfungsmaßnahmen. Die Schwere der Symptomatik variiert und kann vom milden grippeähnlichen klinischen Bild bis hin zu schweren Hämorrhagien und Schock reichen. Zu den häufigsten Symptomen bei Reisenden gehören Fieber, Muskelschmerzen, Kopfschmerzen und Hautausschlag. Zur Diagnostik kommen, in Abhängigkeit vom Stadium der Infektion, patientennah einsetzbare Schnellteste oder – in der virämischen Phase – molekulare Erregerdirektnachweise infrage. Die serologische Diagnostik ist aufgrund von serologischen Kreuzreaktionen mit anderen Flaviviren hinsichtlich ihrer Interpretation anspruchsvoll.

Phytoextraction with Salix viminalis in a moderately to strongly contaminated area

Abstract

We tested the suitability of Salix viminalis for phytoextraction with the analysis of selected elements in soil, root, and leaf, and by visual tree condition assessment in an area with varying levels of contamination. Bioconcentration factor (BCF) and translocation factor (TF) were used to assess the phytoextraction potential of willows. The middle part of the study area was strongly contaminated, while the northern and southern parts were moderately contaminated. We found increasing element concentrations toward deeper layers. Mean concentrations of elements in roots were similar among the three parts, while in leaves the highest concentrations were found in the strongly contaminated part of the study area. Tree condition scores were the lowest in the strongly contaminated part of the study area, which was caused by Al, Ca, K, Mg, Ni, Sr, and Zn concentration. These elements induced leaf disease and leaf feeders. The highest BCF values were found for Cu, Fe, Mn, and Zn in root, and for Cd and Zn in leaves, indicating that S. viminalis had high accumulation potential of these elements. Furthermore, TF values were high for Cd, Mn, Sr, and Zn. Our results also demonstrated that soil element composition has major influence on the condition of S. viminalis individuals. Furthermore, visual condition assessment was found to be a useful tool to assess the phytoextraction potential of trees.

Deciphering the growth, organic acid exudations, and ionic homeostasis of Amaranthus viridis L. and Portulaca oleracea L. under lead chloride stress

Abstract

Lead (Pb) stress adversely affects in planta nutrient homeostasis and metabolism when present at elevated concentration in the surrounding media. The present study was aimed at investigation of organic acid exudations, elemental contents, growth, and lipid peroxidation in two wild plants (Amaranthus viridis L. and Portulaca oleracea L.), exhibiting differential root to shoot Pb translocation, under Pb stress. Plants were placed in soil spiked with lead chloride (PbCl₂) concentrations of 0, 15, 30, 45, or 60 mg Pb/kg soil, in rhizoboxes supplied with nylon nets around the roots. The plant mucilage taken from root surfaces, mirroring the rhizospheric solution, was analyzed for various organic acids. Lead stress resulted in a release of basified root exudates from both plants. Exudates of P. oleracea roots showed a higher pH. In both plants, the pH rising effect was diminished at the highest Pb treatment level. The exudation of citric acid, glutamic acid (in both plants), and fumaric acid (in P. oleracea only) was significantly increased with applied Pb levels. In both plant species, root and shoot Pb contents increased while nutrients (Ca, Mg, and K) decreased with increasing Pb treatment levels, predominantly in A. viridis. At 60 mg Pb/kg soil, shoot Na content of A. viridis was significantly higher as compared to untreated control. Higher Pb treatment levels decreased plant fresh and dry masses as well as the quantity of photosynthetic pigments due to enhanced levels of plant H₂O₂ and thiobarbituric acid reactive substances in both species. Photosynthetic, growth, and oxidative stress parameters were grouped into three distinct dendrogram sections depending on their similarities under Pb stress. A positive correlation was identified between Pb contents of studied plants and secretion of different organic acids. It is concluded that Pb stress significantly impaired the growth of A. viridis and P. oleracea as a result of nutritional ion imbalance, and the response was cultivar-specific and dependent on exogenous applied Pb levels. Differential lipid oxidation, uptake of nutrients (Ca, Mg, and K) and exudation of citric acid, fumaric acid, and glutamic acid could serve as suitable physiological indicators for adaptations of P. oleracea to Pb enriched environment. The findings may help in devising strategies for Pb stabilization to soil colloids.

Dynamics of natural revegetation of hydrocarbon-contaminated soil and remediation potential of indigenous plant species in the steppe zone of the southern Volga Uplands

Abstract

The result of monitoring of natural vegetation growing on oil-contaminated (2.0–75.6 g/kg) and uncontaminated (0.04–2.0 g/kg) soils of a petroleum refinery for a period of 13 years is presented. Floristic studies showed that the families Poaceae, Asteraceae, Fabaceae, and eventually Brassicaceae were predominant in the vegetation cover of both types of soils. Over time, the projective vegetation cover of the contaminated sites increased from 46 to 90%; the species diversity increased twofold: in the ecological-cenotic structure of the flora, the number of ruderal plant species decreased; and the number of steppe, i.e., zonal, plant species increased. Using 62 dominant plant species, we conducted a field study of plant characteristics such as resistance to oil pollution, the ability to enrich the rhizosphere soil with microorganisms and bioavailable mineral nitrogen, and reduction of the concentration of petroleum hydrocarbons. The results enable us to characterize the phytoremediation potential (PRP) of the native plants and identify species that, probably, played a key role in the natural restoration of oil-contaminated soils. Statistical analysis showed correlations between the PRP constituents, and the leading role of rhizosphere microorganisms in the rhizodegradation of petroleum hydrocarbons was proven. A conditional value of PRP was proposed which allowed the investigated plants to be ranked in 11 classes. The study of a large sample of plant species showed that some plants held promise for the use in reclamation of soils in arid steppe zone, and that other species can be used for the rehabilitation of saline soils and semideserts.

Abatement of humic acid from aqueous solution using a carbonaceous conjugated microporous polymer derived from waste polystyrene

Abstract

Humic acid (HA) is a major constituent of natural organic matter (NOM) found in water systems. Although NOM generally does not have any known harmful effects to humans, it imparts repulsive organoleptic properties to water, reacts with disinfectants to produce toxic products, and interferes with the efficiency of water treatment processes. The removal of NOM and related compounds from water is therefore important to render water potable and suitable for other applications. In this work, a hitherto unreported carbonaceous conjugated microporous polymer (CCMP) prepared through the organic-polymeric-precursor-controlled carbonization of hypercrosslinked post-consumer waste polystyrene (WPS) was evaluated for its capacity to remove HA from synthetic wastewater. This advanced material retained the morphology of the precursor material, while its porosity and chemical integrity were significantly improved. The approach is an environmentally friendly way of handling WPS while at the same time remediating NOM-contaminated water. Overall, with a maximum adsorption capacity of 340 mg/g in batch experiments, and a maximum initial removal rate of 95.7% in column experiments, the results showed that CCMP can be used for the remediation of HA-contaminated water at high pH.

Opportunity mapping of natural flood management measures: a case study from the headwaters of the Warwickshire-Avon

Abstract

The use of natural flood management (NFM) measures to address severe flooding received considerable public attention during December 2015–January 2016 storms. Within the Warwickshire-Avon Catchment, UK, high arable and improved grassland land cover with small, isolated communities at risk, lead to the exploration of novel techniques that use farmland high up in flood-prone catchments to hold water and reduce outflow discharge. This paper will discuss the methodology used to identify areas in the Warwickshire-Avon, which could be used to install NFM measures to attenuate the storm peak and provide wider ecosystem services, principally addressing total phosphate and sediment entering the receiving watercourse. This involved constructing a GIS database of catchment geomorphological characteristics whilst simultaneously engaging with those significant stakeholders of farmers and landowners to capture local input and produce a model for applied NFM for future projects looking to explore the role of working with natural processes (WwNP) for flood risk reduction within the agricultural environment. The advantages, disadvantages and key lessons learnt are also presented in this paper, to recognise the benefits and limitations of communities and catchments exploring such methods for flood risk management (FRM).

Removal of fluoroquinolone from aqueous solution using graphene oxide: experimental and computational elucidation

Abstract

The environmental risks of antibiotics have attracted increasing research attention due to their prevalence and persistence in the aquatic environment. In this study, oxygen functionalized graphene, namely, graphene oxide (GO), was synthesized by modified Hummer's and Offeman's method and used as potential effective absorbent for the removal of fluoroquinolones (FQs), i.e., ciprofloxacin (CIP), norfloxacin (NOR), and ofloxacin (OFL), from aqueous solution. The as-synthesized GO was characterized by Fourier transform infrared (FTIR) spectroscopy, powder X-ray diffraction (XRD), thermogravimetric analysis (TGA), and high-resolution transmission electron microscopy (HRTEM). Out of various factors that were taken to consideration while studying the adsorption process, it was found that pH of antibiotic solution is more crucial than the other experimental parameters such as initial antibiotic concentration, contact time, and adsorbent dosage and has significant impact on FQ adsorption via the GO adsorbent. The maximum removal of FQ was observed at pH 7 for CIP and NOR, while adsorption was maximum at pH 4 for OFL. Experimental data best fitted to the pseudo-second-order model as compared to the pseudo-first-order kinetic adsorption model. Best fitting of the equilibrium experimental data to Langmuir isotherm compared to Freundlich isotherm models established that FQ adsorbs over the GO in monolayer manner. Density functional theory (DFT) calculations performed at B3LYP/6-31G(d) level of theory in order to elucidate the thermodynamic feasibility of adsorption process and nature of interactions of antibiotic molecules with the GO adsorbent.

Graphical abstract

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Dynamics of microbial biomass and community composition after short-term water status change in Chinese paddy soils

Abstract

Paddy soil experiences repeated anaerobic and aerobic changes during rice growth, the dramatic dynamics of soil water status accompanied by changes in redox condition and O₂ availability. However, the effect of rapid water status change on soil microbial biomass and community composition is not well explored. Here, we present a comprehensive study focusing on the short-term water status change in 13 Chinese paddy soils. In order to gain a reliable way to determine soil microbial biomass carbon (MBC) in flooded or water-saturated soils, we also evaluated two different procedures (nitrogen bubbled and 100 °C water bath) to remove chloroform in extracts during the fumigation process. Compared to non-flooded paddy soils, the flooded paddy soils tended to have a lower microbial biomass, and this was much clearer using adenosine 5′-triphosphate (ATP) and phospholipid fatty acid (PLFA) analysis compared to biomass measured by the fumigation method. Fungal biomass, which was indicated by both ergosterol and the PLFA 18:2ω6,9c, also decreased after short-term flooding. Changes in soil microbial community composition (determined by PLFA biomarkers) were observed after short-term flooding, but the extent varied between soils. This study indicates that the dynamics of short-term water status altered the soil microbial biomass (ATP, MBC, and total PLFA) and community composition. Finally, our results suggested that liquid fumigation combined with the nitrogen-bubbled method is the best choice for analyzing MBC concentrations in water-saturated soils.

Leachability and potential ecotoxic impact of trifluralin-impregnated mulch

Abstract

The leachability, potential ecotoxicity, and photolysis of trifluralin-impregnated mulch, a popular retail consumer gardening product, were investigated under environmentally realistic conditions. Leachability of trifluralin from impregnated mulch was low (< 1% of total extractable compound) and in the range of reported values for agricultural soils. No trifluralin transformation products were detected in mulch leachate. Yeast-based estrogenicity and androgenicity screens indicated that aqueous trifluralin is not estrogenic but is moderately androgenic at concentrations ~ 1e − 5 M. Impregnated mulch leachate was not hormonally active, even at undiluted concentrations, but it did exert nonspecific toxicity at dilutions of ~ 1:10. Photolysis of trifluralin was investigated in acetonitrile and water and on mulch surfaces. Degradation on mulch surfaces was diffusion-limited; it was ~ 17 times slower than in aqueous solution, but faster than has been reported on kaolinite. An array of trifluralin transformation products was identified, but in no case did they exceed 10% of the parent compound. Using industry-recommended application guidelines, it is estimated that as much as 1400 μg/m² of trifluralin may leach from impregnated mulch upon the first rainfall. However, provided that consumers are aware that such mulch products contain trifluralin and are properly educated about its use, the potential for direct ecotoxic impact is likely to be small.

Development of pseudoaneurysm in cesarean section scar pregnancy: a case report and literature review

Abstract

Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy. It is becoming more common, but it can lead to uterine rupture and severe hemorrhage. Here, we report a case of a 37-year-old woman with CSP complicated with pseudoaneurysm. The pseudoaneurysm emerged following focal injection of methotrexate (MTX) and potassium chloride with systemic MTX treatment. Due to a risk of sudden bleeding, uterine artery embolization (UAE) was recommended, but the patient hoped to avoid this if possible. Because the serum human chorionic gonadotropin level and the gestational sac were still persistent, dilation and curettage were performed with interventional radiologists on standby. Severe hemorrhage occurred and continued during the procedure, which necessitated emergent UAE. We reviewed six CSP case reports with vascular abnormalities, and all of them necessitated UAE, surgical excision, or hysterectomy. In the case of CSP combined with pseudoaneurysm, treatment should be planned carefully considering the risk of massive hemorrhage.

Pramāṇa as Action: A New Look at Uddyotakara’s Theory of Knowledge

Abstract

In this paper, I will suggest that the ideas of Uddyotakara, the 6th century author of the Nyāya-Vārttika, may have been largely overlooked as a result of Jitendra Nath Mohanty's and Bimal Krishna Matilal's influential works on Indian epistemology. Crucial to Mohanty's and Matilal's portrayals of Indian epistemology is the thesis that the pramāṇa theory incorporates a sort of causal theory of knowledge. The writers of pramāṇa-śastra, they argue, agreed that at the end of the day, knowledge comes down to an 'inner' occurrence, a temporally individuated cognitive episode, and that consequently—the pramāṇa—the most relevant factor affecting knowledge acquisition and the ultimate justification of knowledge acquisition—are "the cluster of phenomena that converge to bring such a cognitive episode about". I will argue, on the other hand, based on a discussion Uddyotakara conducts at the beginning of the introductory chapter of his work, which I believe to be of crucial importance, that causal factors play only a marginal role in his theory of knowledge and that he claims the pramāṇa to be dependent on samartha-pravṛtti—the habitual, customary and expected procedures or ways of attaining a goal—rather than on their causal antecedents. I will moreover suggest a reading of the pramāṇa of sense-perception, inference and analogy as action-based.

Low atrazine dosages reduce sperm quality of Calomys laucha mice

Abstract

Reproductive effects caused by the exposure to environmentally relevant dosages of atrazine on wild animals are poorly understood. This study evaluated the effects of three dosages of atrazine on sperm parameters of adult Calomys laucha males. Adult mice were orally exposed to dosages of 0 (water and vehicle control), 0.1, 1, and 10 mg/kg of animal weight for a 21-day period. Following exposure, analyses were performed to determine sperm motility parameters, plasma membrane integrity and fluidity, mitochondrial functionality, acrosome integrity, DNA damage, lipid peroxidation, and production of reactive oxygen species (ROS) in the sperm samples. Total and progressive motility were reduced in all dosages in comparison to control groups. Membrane integrity and mitochondrial functionality of sperm were reduced in all dosages, and the sperm membrane fluidity increased in the higher dosages of atrazine (1 and 10 mg/kg), in comparison with the vehicle control. A decrease in the acrosome integrity was noted at 10 mg/kg of atrazine, compared to the control groups. The integrity of DNA, ROS generation, and lipid peroxidation of sperm showed no significant differences when compared with the control groups. These results suggest that exposure to low dosages of atrazine can affect sperm parameters of Calomys laucha and therefore reduce the reproductive capacity of wild rodent species.

Cutaneous squamous cell carcinomas (SCC) associated with cosmetic skin whitening: 8 cases reported in Senegal

Publication date: Available online 15 November 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): F. Ly, P. Diousse, C. Ndiaye, A. Déme, B.A. Diatta, M.T. Ndiaye, M. Diallo, A. Diop, A.D. Kebe, F. Fall, A. Kane
BackgroundThe cosmetic use of bleaching products is common among women from sub-Saharan Africa. The most frequently used products are highly potent corticosteroids (clobetasol propionate) and hydroquinone. Herein, we report 8 cases of SCC in women using skin bleaching products for cosmetic purposes. Our aim is to describe the epidemiological, clinical and pathological aspects of the carcinomas observed during the course of skin lightening.MethodsWe conducted a descriptive multicentre study from August 2005 to January 2016 in three dermatology units in Senegal. We included all patients consulting for cutaneous squamous cell carcinoma associated with skin bleaching. Sociodemographic, clinical, paraclinical and therapeutic data were recorded.ResultsA total of 8 female patients were included. The mean age was 48.1 years (37–63 years). Topical hydroquinone and highly potent corticosteroids were the main products used over the whole body, for an average duration of 20.3 years. No pre-neoplastic skin disease was found in our patients. The clinical aspects of tumours were as follows: cauliflower-like (n=4), ulcerated (n=3) and nodular (n=1). The average development time before consultation was 6.75 months. All the cutaneous squamous cell carcinomas were localized to lichenoid lesions or exogenous ochronotic lesions on photo-exposed areas: face (n=1), neck (n=3) or upper back (n=4). The most common histopathological type was the infiltrating form and there was one case of in situ carcinoma. The outcome was favourable in six of eight patients after surgical resection. Two deaths occurred: one through tumour recurrence and the other through haemorrhagic shock.ConclusionsFrom 2005 to 2016, eight cases of cutaneous squamous cell carcinomas associated with cosmetic use of bleaching products were reported in Senegal. The mechanism was not fully elucidated and further studies are necessary. These observations provide an additional argument for combating this practice and including skin bleaching among known risk factors for squamous cell carcinoma.

Direktes Brauenlift beim Mann

Zusammenfassung

Männer können durchaus interessant und gut aussehen, wenn ihr Blick etwas verschlossen ist. Auf jeden Fall gelten hier nicht dieselben Schönheitsideale wie bei Frauen. Wenn allerdings auch das Gesichtsfeld funktionsstörend eingeschränkt ist, besteht auch bei Männern häufig der Wunsch nach einer Korrektur der Oberlider oder einem Anheben der Brauen. Bei einer hohen Stirn oder völligem Haarverlust sind allerdings die verschiedenen Optionen eines Stirnliftings deutlich reduziert. In diesen Fällen kann die direkte Exzision oberhalb der Brauen eine sehr gute Lösung des Problems sein.

Redefining face contour with a novel anti-aging cosmetic product: an open-label, prospective clinical study

Topical application of ST266 reduces UV-induced skin damage

A long-term comparative assessment of human health risk to leachate-contaminated groundwater from heavy metal with different liner systems

Abstract

The handling and management of municipal solid waste (MSW) are major challenges for solid waste management in developing countries. Open dumping is still the most common waste disposal method in India. However, landfilling also causes various environmental, social, and human health impacts. The generation of heavily polluted leachate is a major concern to public health. Engineered barrier systems (EBSs) are commonly used to restrict potentially harmful wastes by preventing the leachate percolation to groundwater and overflow to surface water bodies. The EBSs are made of natural (e.g., soil, clay) and/or synthetic materials such as polymeric materials (e.g., geomembranes, geosynthetic clay liners) by arranging them in layers. Various studies have estimated the human health risk from leachate-contaminated groundwater. However, no studies have been reported to compare the human health risks, particularly due to the leachate contamination with different liner systems. The present study endeavors to quantify the human health risk to contamination from MSW landfill leachate using multiple simulations for various EBSs. To quantify the variation in health risks to groundwater consumption to the child and adult populations, the Turbhe landfill of Navi Mumbai in India has been selected. The leachate and groundwater samples were collected continuously throughout January–September in 2015 from the landfill site, and heavy metal concentrations were analyzed using an inductively coupled plasma system. The LandSim 2.5 Model, a landfill simulator, was used to simulate the landfill activities for various time slices, and non-carcinogenic human health risk was determined for selected heavy metals. Further, the uncertainties associated with multiple input parameters in the health risk model were quantified under a Monte Carlo simulation framework.

Accounting for Time-varying Confounding in the Relation between Obesity and Coronary Heart Disease: Analysis with G-estimation, the Atherosclerosis Risk in Communities (ARIC) study

Abstract

In longitudinal studies, standard analysis may yield biased estimates of exposure effect in the presence of time-varying confounders that are also intermediate variables. We aimed to quantify the relationship between obesity and coronary heart disease (CHD) by appropriately adjusting for time-varying confounders. This study performed on a subset of the Atherosclerosis Risk in Communities Study (1987-2010). General obesity defined as body mass index ≥30 kg/m², abdominal obesity (AOB) defined as waist circumference ≥102 cm in men and ≥88 cm in women, and waist to hip ratio categorized at ≥0.9 in men and ≥0.85 in women. The effect of obesity on CHD was estimated by G-estimation and compared with accelerated failure time models using three specifications. The first model adjusted for baseline covariates excluding metabolic mediators of obesity showed increased risk of CHD for all measures of obesity. Further adjustment for metabolic mediators in the second model and time-varying variables in the third model showed negligible hazard ratios. The hazard ratios estimated by G-estimation were 1.15 (95%CI: 0.83-1.47) for General obesity, 1.65 (95%CI: 1.35-1.92) and 1.38 (95%CI: 1.13-1.99) for AOB based on waist circumference and waist to hip ratio, respectively, suggesting that AOB increased the risk of CHD. The G-estimated hazard ratio of both measures was further from the null than standard models.

A novel strategy to address unmeasured confounding when comparing opioid agonist therapies in pregnancy

Abstract

Opioid addiction in pregnancy is a growing concern that has recently received a lot of attention. When comparing recommended opioid agonist therapies, many currently published studies guiding practice may be impacted by unmeasured confounding by indication. Populations of women who receive methadone are generally different from those treated with buprenorphine. Women treated with methadone frequently have more severe and uncontrolled addiction compared with buprenorphine treated patients; however, these factors are typically unmeasured or unavailable in large observational data sets. Consequently, findings of superior perinatal outcomes with buprenorphine may in truth be a result of an overall healthier profile of women taking this medication. In this issue of the American Journal of Epidemiology, Brogly et al. describes an approach utilizing detailed data from an External Cohort (n = 113) to account for confounding by indication in a larger Medicaid population (n = 1,020) to more accurately compare opioid agonist therapies in pregnancy. Authors found that the decreased risk of preterm birth and infant length of hospitalization associated with buprenorphine compared with methadone were attenuated after accounting for the additional confounding. These authors should be commended for providing a novel method to address this bias in future studies.

Early Pregnancy Perfluoroalkyl Substance Plasma Concentrations and Birth Outcomes in Project Viva: Confounded by Pregnancy Hemodynamics?

Abstract

Associations of prenatal exposure to perfluoroalkyl substances (PFASs), ubiquitous chemicals used in stain and water resistant products, with adverse birth outcomes may be confounded by pregnancy hemodynamics. We measured plasma concentrations of four PFASs in early pregnancy (median, 9 weeks) among 1,645 women in Project Viva, a Boston-area cohort recruited 1999–2002. We fit multivariable models to estimate PFAS associations with birth weight-for-gestational age z score and gestation length adjusting for sociodemographic confounders and two hemodynamic markers: 1) plasma albumin, a measure of plasma volume expansion, and 2) plasma creatinine, used to estimate glomerular filtration rate. Perfluorooctane sulfonate (PFOS) and perfluorononanoate (PFNA) were weakly inversely associated with birth weight-for-gestational age z scores (adjusted β = −0.04 (95% confidence interval (CI): −0.08, 0.1) and −0.06 (95% CI: −0.11, −0.01) per interquartile increase, respectively). PFOS and PFNA were also associated with higher odds of preterm birth (e.g., highest vs. lowest PFOS quartile adjusted odds ratio = 2.4 (95% CI: 1.3, 4.4)). Adjusting for markers of pregnancy hemodynamics (glomerular filtration rate and plasma albumin), to the extent that they accurately reflect underlying pregnancy physiology, did not materially impact associations. These results suggest that pregnancy hemodynamics may not confound associations with birth outcomes when PFASs are measured early in pregnancy.

Associations Between Divorce and Onset of Drug Abuse in a Swedish National Sample

Rates of drug abuse are higher among divorced than married individuals, but it is not clear whether divorce itself is a risk factor for drug abuse or if the observed association is confounded by other factors. We examined the association between divorce and onset of drug abuse in a population-based Swedish cohort born 1965–1975 (n = 651,092) using Cox proportional hazard methods, with marital status as a time-varying covariate. Potential confounders (e.g., demographics, adolescence deviance, family history of drug abuse) were included as covariates. Parallel analyses were conducted for widowhood and drug abuse onset. In adjusted models, divorce was associated with a substantial increase in risk of drug abuse onset in both sexes (hazard ratios >5). Co-relative analyses were consistent with a partially causal role of divorce on drug abuse onset. Widowhood also increased risk of drug abuse onset, though to a lesser extent. Divorce is a potent risk factor for onset of drug abuse, even after adjusting for deviant behavior in adolescence and family history of drug abuse. The somewhat less pronounced association with widowhood, particularly among men, suggests that the magnitude of association between divorce and drug abuse may not be generalizable to the end of a relationship.

Exposure Biomarkers Indicate More than Just Exposure

Abstract

Biomarkers of environmental exposures have notable strengths in integrating across diverse sources and routes of exposure and providing a marker reflecting biological dose. However, the physiologic determinants of biomarker toxicokinetics and measured levels may also affect or be affected by disease determinants and thus introduce confounding. Sagiv et al. (1) sought empirical evidence on the role of renal clearance in biasing the association between perfluoroalkyl compounds measured in plasma during pregnancy and infant birth weight and found little empirical support for such bias. The risk of such bias is greater when the exposure and health outcome are assessed closely in time, when physiologic differences are large relative to variability in environmental levels, and when the physiologic determinant has diverse functions and implications. While empirical examination has value, the potential bias is difficult to measure and control when the underlying associations among exposure biomarker, health outcome, and physiologic determinant are weak.

Long Term Risk of Cardiovascular Death With Use of Clarithromycin and Roxithromycin – a Nationwide Cohort Study

Abstract

Recent studies have raised concern that macrolide antibiotics may be associated with a long-term increased risk of cardiovascular death. This study examines the one-year risk associated with treatment with clarithromycin (n = 751,543) and roxithromycin (n = 698,899) compared with penicillin V (n = 2,721,538), matched 1:4 on propensity score, in a nationwide registry-based cohort study in Danish outpatients, 1997–2011. Among clarithromycin courses, the rate ratio (RR) of cardiovascular death was 1.24; 95% CI: 0.96, 1.59). Among roxithromycin courses, the RR was 0.99 (0.86, 1.16). In analyses by time after treatment start, the RR associated with clarithromycin was 1.66 (0.98, 2.79) during days 0–7; this was attenuated in later time periods, RR days 8–89: 1.30 (0.88, 1.94) and RR days 90–364: 0.96 (0.63, 1.47). For roxithromycin, the RRs were 0.88 (0.59, 1.32) during days 0–7, 1.17 (0.92, 1.48) during days 8–89 and 0.88 (0.70, 1.10) during days 90–364. This study found no increased risk of cardiovascular death in a general outpatient population. With clarithromycin, we observed a transient increased risk during days 0–7 after treatment start, which corresponds to the period of active treatment. This association was absent in later time periods, which is consistent with no long-term toxicity resulting in cardiovascular death.

Neonatal Outcomes in a Medicaid Population With Opioid Dependence

Abstract

Confounding may account for the apparent improved infant outcomes after prenatal exposure to buprenorphine versus methadone. We used Massachusetts Medicaid Analytic eXtract (MAX) data to identify a cohort of opioid dependent mother-infant pairs (2006–2011) supplemented with confounder data from an external Boston cohort (2015–2016). Associations between prenatal buprenorphine versus methadone exposure and infant outcomes in the MAX Cohort were adjusted for measured MAX confounders, and unmeasured confounders with bias analysis using External Cohort data. 477 women in MAX were treated with methadone and 543 with buprenorphine. More buprenorphine users were white and used psychotropic medications. Adjusting for MAX confounders, risk ratios in buprenorphine versus methadone exposed infants were: preterm birth (0.45, 95% CI: 0.34, 0.61) and low birth weight for gestational age (0.75, 95% CI: 0.51, 1.11). The mean difference in infant hospitalization was −7.35 days (95% CI: −9.16, −5.55). After further adjustment with bias analysis estimates were: preterm birth (0.53, 95% CI: 0.39, 0.71), low birth weight for gestational age (1.14, 95% CI: 0.77, 1.69), and hospitalization (−3.66 days, 95% CI: −5.46, −1.87). External confounder data can be used to adjust for unmeasured confounding in studies of prenatal outcomes in women on opioid agonist therapy based on administrative databases.

Multiple annular plaques on a 9-year-old boy

Fibroadipose vascular anomaly treated with sirolimus: Successful outcome in two patients

Abstract

Fibroadipose vascular anomaly (FAVA) is a rare, complex mesenchymal malformation combining fibrofatty replacement of the affected muscles and slow-flow vascular malformation. The condition is characterized by localized swelling, severe pain, phlebectasia, and contracture of the affected limb. Treatment paradigms are not well established for this rare, recently recognized condition. We report two cases of FAVA in which treatment with sirolimus produced rapid, dramatic improvement in pain and quality of life.

Comment on “Case Series Study of the Efficacy of Compounded Antibacterial, Steroid, and Moisturizer in Atopic Dermatitis”

Considerations in surgical management of a Buschke–Lowenstein tumor in Netherton syndrome: A case report

Abstract

Netherton syndrome is an autosomal recessive ichthyosis caused by mutations in SPINK5, with the classic triad of linearis circumflexa, trichorrhexis invaginata, and atopy. There are few reports of surgical management in individuals with Netherton syndrome and clinicians may be reluctant to operate for fear of wound-healing complications. This report describes a pediatric case of a Buschke–Lowenstein tumor of the natal cleft in a patient with Netherton syndrome that had failed to respond to medical management. We reviewed the literature for previous cases of surgery in individuals with Netherton syndrome using MEDLINE and PubMed searches. Our patient underwent surgery to remove the lesion without complication. Using conventional dressings and topical negative-pressure therapy, the wound was managed and healed within a reasonable time frame despite the underlying skin condition. This case indicates that surgery and topical negative-pressure therapy is a safe and reasonable treatment for individuals with Netherton syndrome.

A 15-year-old boy with convoluted folds and furrows on the scalp

Response to “Case series study of the efficacy of compounded antibacterial, steroid, and moisturizer in atopic dermatitis”

Infantile hemangiomas with conjunctival involvement: An underreported occurrence

Abstract

Background/Objectives

Infantile hemangiomas (IHs) involving the conjunctiva are only anecdotally reported in the literature and little is known about their clinical course. In a retrospective case series we aimed to better delineate the clinical presentation, complications, and response to treatment of this uncommon subtype of IH. A classification of conjunctival IH is proposed.

Methods

Medical charts at three academic pediatric dermatology institutions were retrospectively analyzed. Data were collected on the clinical characteristics, ophthalmologic findings, treatments, and outcomes of 22 individuals with conjunctival IH.

Results

Growth characteristics of conjunctival IH closely mirrored those of their cutaneous counterparts. Ophthalmologic abnormalities were associated with the IH in six individuals (27%); in three, they were considered severe. Seventeen subjects (77%) required treatment, most commonly because of risk of ocular compromise. All treated individuals responded favorably to topical timolol or systemic propranolol.

Conclusion

Conjunctival IH have clinical characteristics similar to those of cutaneous IH and respond readily to beta-blocker treatment. Ocular complications may occur in a minority of individuals receiving treatment.

Comment on “Prevention of flares in children with atopic dermatitis with regular use of an emollient containing glycerol and paraffin: A randomised controlled study”

Acute induration of the neck in a 16-year-old girl

The triad of pruritus, xanthomas, and cholestasis: Two cases and a brief review of the literature

Abstract

When encountered in children, xanthomas are most commonly associated with a group of disorders known as familial hyperlipidemias. Aside from cosmetic concerns, these xanthomas are typically asymptomatic, but when generalized pruritus is a prominent associated symptom, clinicians should consider a different set of diagnoses that includes cholestasis of the liver. In this article we present two illustrative cases of children with cholestatic disease, pruritus, and xanthomas and discuss other disorders that may include this triad.

A 15-year-old girl with a funky-looking great toenail

Teenage boy with thickened dorsal hands and feet

Evaluation of patient satisfaction in pediatric dermatology

Abstract

Background/Objectives

There remains a lack of investigation into which factors patients and families value the most in their experience at pediatric dermatology clinics. Most of the current literature on quality improvement in dermatology does not encompass the pediatric population. To determine the drivers that are most predictive of a positive patient experience, we observed the indirect relationship between several factors of the patient experience and their role in patient satisfaction.

Methods

Patient satisfaction surveys were distributed after their visits to patients at four pediatric dermatology clinics in one children's academic health system. Data were collected and organized into the top 30 survey variables with which patients expressed satisfaction on a 5-point Likert scale. Pearson product-moment correlation coefficients (r) for each variable with regard to "likelihood of your recommending our practice to others" were calculated.

Results

A total of 516 families completed patient satisfaction surveys. Analyses of top box scores showed that the strongest predictors of patient satisfaction were the likelihood of recommending care provider (r = .77, P = <.001), cheerfulness of practice (r = .76, P = <.001), care provider spoke using clear language (r = .73, P = <.001), patient confidence in care provider (r = .70, P = <.001), and our sensitivity to patient needs (r = .70, P = <.001).

Conclusion

The patient-physician relationship, along with the environment of the practice and its sensitivity to patients' personal needs, contributes most to the patient experience in pediatric dermatology. Identifying such variables that shape patients' assessments of their experience can guide future quality improvement plans in the specialty.

Issue Information

Characterization of children with recurrent eczema herpeticum and response to treatment with interferon-gamma

Abstract

Background/Objectives

Interferon gamma (IFN-γ) has been used treat severe atopic dermatitis, with equivocal results. Recurrent eczema herpeticum is an underappreciated, therapeutically challenging complication of severe atopic dermatitis. Defects in IFN-γ and other cytokine pathways have been identified in individuals with confirmed eczema herpeticum. This suggests possible benefit from IFN-γ treatment for confirmed eczema herpeticum. The objective of the current study was to evaluate immunologic and microbial parameters and response to IFN-γ treatment in children with confirmed eczema herpeticum.

Methods

We performed a retrospective review of medical records from eight children with confirmed eczema herpeticum and two children with severe atopic dermatitis without a history of eczema herpeticum treated with subcutaneous IFN-γ.

Results

Our cohort of children with confirmed eczema herpeticum was predominantly male and had high total serum immunoglobulin E, evidence of insufficient toll-like receptor responses, and streptococcal skin and pharyngeal colonization. The duration of IFN-γ administration was 4.5-25 months. Five children had initial control and then relapse. Three had interval flares. Two had no improvement. Injections were well tolerated, without significant adverse effects. Treatment was associated with an increase in total immunoglobulin E. Poor adherence complicated therapy in five patients. All 10 discontinued IFN-γ for poor perceived efficacy.

Conclusion

Children with confirmed eczema herpeticum have evidence of impaired innate and adaptive immunity. IFN-γ did not result in dramatic improvement in either subset. Specific evaluation for IFN-γ production, function, or receptor defects may help predict response.

A 7-year-old boy with pustules on the upper eyelid

Chronic plaque on the great toe of a 10-year-old boy

Persistent pruritic subcutaneous nodules and hypopigmentation in a young boy

Patient Perspectives: What is papular urticaria?

Multiple ulcerated lesions in a child

Issue Information

Nanoparticle-based lateral flow biosensor combined with multiple cross displacement amplification for rapid, visual and sensitive detection of Vibrio cholerae

Abstract

Vibrio cholerae (V. cholerae) is an important human pathogen that is responsible for cholera, a severe acute watery diarrhea. In the current study, a multiple cross displacement amplification (MCDA) coupled with amplicon detection by chromatographic lateral flow biosensor (LFB) method (MCDA-LFB) was successfully established and evaluated for identification of V. cholerae. A set of ten primers was designed specifically to recognize ten different regions of the V. cholerae-specific gene ompW. The optimized time and temperature conditions for the MCDA were 30 min at 63˚C. The MCDA-LFB assay correctly identified 31 strains of V. cholerae but did not detect 13 non-cholerae Vibrio strains and 30 non-Vibrio strains. The sensitivity of MCDA-LFB for target pathogen detection in pure culture was 10 fg per reaction. In the case of spiked shrimp samples without enrichment, the limit of detection (LoD) was 4.1 CFU per reaction or equivalent to 4.1 × 10² CFU g⁻¹. The whole process, including shrimp homogenates processing (30 min), MCDA reaction (30 min) and results reporting (2 min), could be finished within 65 min. These results show that this assay is suitable for the rapid, sensitive and specific detection of V. cholerae in food, environmental and clinical samples.

Description of a mass poisoning in a rural district in Mozambique: The first documented bongkrekic acid poisoning in Africa

Abstract

Background

On January 9, 2015, in a rural town in Mozambique, over 230 people became sick and 75 died from an illness linked to drinking pombe, a traditional alcoholic beverage.

Methods

An investigation was conducted to identify cases and determine the cause of the outbreak. A case was defined as any resident of Chitima who developed any new or unexplained neurologic, gastrointestinal, or cardiovascular symptom from January 9 at 6:00 a.m. through January 12. We conducted medical record reviews; healthcare worker and community surveys; anthropological and toxicological investigations of local medicinal plants and commercial pesticides; and laboratory testing of the suspect and control pombe.

Results

We identified 234 cases; 75 (32%) died and 159 recovered. Overall, 61% of cases were female (n=142), and ages ranged from 1–87 years (median: 30 years). Signs and symptoms included abdominal pain, diarrhea, vomiting, and generalized malaise. Death was preceded by psychomotor agitation and abnormal posturing. The median interval from pombe consumption to symptom onset was 16 hours. Toxic levels of bongkrekic acid (BA) were detected in the suspect pombe but not in the control pombe. Burkholderia gladioli pathovar cocovenenans, the bacteria that produces BA, was detected in the flour used to make the pombe.

Conclusions

We report for the first time an outbreak of a highly lethal illness linked to BA, a deadly food-borne toxin in Africa. Given that no previous outbreaks have been recognized outside of Asia, our investigation suggests that BA might be an unrecognized cause of toxic outbreaks globally.

Seroreactivity to the C6 Peptide in Borrelia Miyamotoi Infections Occurring in the Northeastern United States

Abstract

Background

There are no Food and Drug Administration (FDA) approved diagnostic tests for Borrelia miyamotoi infection, an emerging tick-borne illness in the United States. The purpose of this study was to evaluate whether the FDA-approved C6 peptide ELISA currently used to diagnose Lyme disease may potentially serve as a diagnostic test for B. miyamotoi infections.

Methods

Serum specimens from 30 patients from the Northeastern United States with B. miyamotoi infection established by a polymerase chain reaction assay of a blood specimen were tested using the C6 ELISA. To reduce confounding with B. burgdorferi co-infection, 6 sera were excluded: 3 from patients with a positive Western immunoblot for antibodies to B. burgdorferi and 3 from patients for whom immunoblot testing had not been performed.

Results

Twenty-two (91.7%; (95% C.I. 73.0%-98.8%) of 24 evaluable B. miyamotoi patients were C6 ELISA reactive, principally on a convalescent phase serum specimen. C6 ELISA index values were often well above the positive cut-off value of 1.1, exceeding 4 in 11 (50.0%) of the 22 C6 ELISA reactive patients.

Conclusions

Although previously regarded as a highly specific test for Lyme disease, the C6 ELISA is also regularly positive on convalescent phase serum samples of patients from the Northeastern United States with B. miyamotoi infection.

Multivalent rotavirus vaccine and wild-type rotavirus strain shedding in Australian infants: a birth cohort study

Abstract

Background

Rotavirus vaccines have reduced moderate-to-severe gastroenteritis episodes in infants and young children. Nevertheless, knowledge gaps exist concerning rotavirus vaccine shedding and vaccine impact upon mild and asymptomatic wild-type infections. Our primary objective was to investigate vaccine shedding in Australian infants where the multivalent human-bovine reassortant rotavirus vaccine, RotaTeq®, was part of the routine vaccination schedule.

Methods

The Observational Research in Childhood Infectious Diseases (ORChID) birth cohort study was conducted in Brisbane, Australia, from September 2010 to October 2014. Newborn infants were enrolled progressively and followed until their second birthday. Parents recorded daily symptoms and mailed weekly stool swab samples from their infants to the laboratory where reverse transcription-polymerase chain reaction (RT-PCR) testing was performed, and rotavirus-positive samples underwent genotyping to distinguish between vaccine and wild-type strains.

Results

Rotavirus was detected in 1,068/11,139 (9.6%) stool swabs from 158 infants, and 994 (93.1%) were genotyped. RotaTeq® vaccine strains accounted for 951/994 (95.7%) of typed rotavirus-positive swabs. Proportions of infants shedding RotaTeq® after the first, second and third vaccine doses were 87.0%, 57.4% and 47.3% respectively and median (interquartile range) shedding duration after vaccine doses 1-3 was 3 (1-8), 1.5 (1-3) and 1 (1-2) weeks respectively. In contrast, the incidence rate of wild-type rotavirus episodes was 10.3 (95% confidence interval 6.8-15.6) per 100 child-years of observation.

Conclusions

RotaTeq® vaccine virus was detected in stool samples from 47-87% of infants after each vaccine dose. Genotyping is an essential tool for differentiating between rotavirus vaccine and wild-type strains and monitoring vaccine impact in children.

Long-term carriage of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in the general population in the Netherlands

Abstract

Background

This longitudinal study aimed to investigate (risk factors for) persistence of carriage and molecular characteristics of extended-spectrum and pAmpC β-lactamase-producing (ESBL/pAmpC) Escherichia coli and Klebsiella pneumoniae (ESBL-E/K) in adults in the Dutch community.

Methods

Following a cross-sectional study (ESBL-E/K prevalence 4.5%), a subset of ESBL-E/K positive (n=76) and negative (n=249) individuals volunteered to provide five monthly faecal samples and questionnaires. ESBL-E/K was cultured using selective enrichment/culture and MLSTs were determined. ESBL/pAmpC-genes were analysed using PCR and sequencing. Plasmids were characterized and subtyped by plasmid MLST. Risk factors for persistent carriage were analysed using logistic regression.

Results

Of the initially ESBL-E/K positive participants, 25/76 (32.9%) remained positive in all subsequent samples; 51/76 persons (67.1%) tested ESBL-E/K negative at some time point during follow-up of which 31 (40.8%) stayed negative throughout the longitudinal study. Carriers often carried the same ESBL-gene and plasmid, but sometimes in different ESBL-E/K strains, indicative for horizontal transfer of plasmids. Of the 249 initially ESBL-E/K negative participants, the majority (n=218, 87.6%) tested negative during eight months follow-up, whereas 31/249 (12.4%) participants acquired an ESBL-E/K. E. coli phylogenetic group B2 and D and travel to ESBL high prevalence countries were associated with prolonged carriage.

Conclusion

ESBL-E/K carriage persisted for more than eight months in 32.9% of the initially ESBL-positive individuals, while 12.4% of initially negatives acquired ESBL-E/K during the study. A single positive test result provides no accurate prediction for prolonged carriage. Acquisition/loss of ESBL-E/K does not seem to be a random process, but differs between bacterial genotypes.

Impact of Isolating Clostridium d ifficile Carriers on the Burden of Isolation Precautions: A Time Series Analysis

Abstract

Background

The isolation of asymptomatic Clostridium difficile (CD) carriers may decrease the incidence of hospital-associated C. difficile infections (CDI), but its impact on isolation precaution needs is unknown.

Methods

Time series analysis to investigate the impact of isolating CD carriers on the burden of isolation precautions from 2008 to 2016 in a Canadian hospital. To account for the changes in C. difficile infection control policies, the series was divided into three intervention periods. Period 1 (2008-2011): isolation of patients with CDI until symptom resolution; Period 2 (2011-2013): isolation of patients with CDI until discharge; and Period 3 (2013-2016): isolation of patients with CDI and CD carriers until discharge. We compared the prevalence of isolation-days for C. difficile (i.e. for either CDI or carriage) per 1,000 patient-days between study periods. Changes in trend were analyzed by segmented regression analysis.

Results

806,357 patient-days and 20,455 isolation-days were included. Isolation-day prevalence during Periods 1, 2 and 3 were 12.9, 26.2 and 37.8 isolation-days per 1,000 patient-days, respectively (p<0.001 between periods). Isolating CD carriers was associated with an increase in isolation-days prevalence compared with period 2 (Risk Ratio [RR], 1,66; p<0.001) followed by a significant decrease in trend (RR per four-week period, 0.97; p<0.001). The downward trend was mainly due to decreasing isolation needs for patients with CDI (RR per four-week period, 0.94; p<0.001) rather than for carriage (RR per four-week period, 0.996; p=0.21).

Conclusions

Isolating CD carriers led to an initial increase in isolation needs that was partially compensated by a decrease in isolation needs for CDI.

Collagen: A review on its sources and potential cosmetic applications

Summary

Collagen is a fibrillar protein that conforms the conjunctive and connective tissues in the human body, essentially skin, joints, and bones. This molecule is one of the most abundant in many of the living organisms due to its connective role in biological structures. Due to its abundance, strength and its directly proportional relation with skin aging, collagen has gained great interest in the cosmetic industry. It has been established that the collagen fibers are damaged with the pass of time, losing thickness and strength which has been strongly related with skin aging phenomena [Colágeno para todo. 60 y más. 2016. http://ift.tt/2hEKgFt.]. As a solution, the cosmetic industry incorporated collagen as an ingredient of different treatments to enhance the user youth and well-being, and some common presentations are creams, nutritional supplement for bone and cartilage regeneration, vascular and cardiac reconstruction, skin replacement, and augmentation of soft skin among others [J App Pharm Sci. 2015;5:123-127]. Nowadays, the biomolecule can be obtained by extraction from natural sources such as plants and animals or by recombinant protein production systems including yeast, bacteria, mammalian cells, insects or plants, or artificial fibrils that mimic collagen characteristics like the artificial polymer commercially named as KOD. Because of its increased use, its market size is valued over USD 6.63 billion by 2025 [Collagen Market By Source (Bovine, Porcine, Poultry, Marine), Product (Gelatin, Hydrolyzed Collagen), Application (Food & Beverages, Healthcare, Cosmetics), By Region, And Segment Forecasts, 2014 – 2025. Grand View Research. http://ift.tt/2sgOUco. Published 2017.]. Nevertheless, there has been little effort on identifying which collagen types are the most suitable for cosmetic purposes, for which the present review will try to enlighten in a general scope this unattended matter.

High plasma 25-hydroxyvitamin D and high risk of non-melanoma skin cancer: a Mendelian randomisation study of 97849 individuals

Abstract

Background

High plasma 25-hydroxyvitamin D (25 (OH)D) concentration has been associated observationally with high risk of non-melanoma skin cancer, while many studies suggest that vitamin D could have a protective effect on cancer. The true association between vitamin D and risk of skin cancer remains unclear.

Objectives

In this Mendelian randomisation study we tested the hypothesis that genetically high plasma 25(OH)D protects against non-melanoma skin cancer.

Methods

We included 103084 individuals from the Danish general population, of whom 35 298 had plasma 25(OH)D measured and 97849 were genotyped for four genetic variants near the DHCR7 and CYP2R1 genes associated with 25(OH)D concentrations. We tested the association between plasma 25(OH)D levels and non-melanoma skin cancer observationally, and between genetically determined 25(OH)D levels and non-melanoma skin cancer through an instrumental variable approach.

Results

Multivariable adjusted hazard ratios of non-melanoma skin cancer were 3.27 (95%CI: 2.22;4.84) for plasma 25(OH)D≥50 nmol/L versus <25 nmol/L. Genetic variants around DHCR7 and CYP2R1 genes were associated with up to 8.2 nmol/L higher 25(OH)D concentrations (F=314). The odds ratio for a genetically determined 20 nmol/L higher plasma 25(OH)D was 1.11 (0.91-1.35) for non-melanoma skin cancer, with a corresponding observational multivariable adjusted odds ratio of 1.13 (1.10-1.17).

Conclusion

Genetically determined high 25(OH)D did not appear to protect against non-melanoma skin cancer, while high plasma 25(OH)D concentrations were associated with high risk of non-melanoma skin cancer in observational analysis. Thus, the observational association likely reflects confounding by sun exposure rather than causality.

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Analysis of anti-TNF-induced skin lesions reveals strong Th1 activation with some distinct immunological characteristics

Abstract

Background

Psoriasiform and eczematous eruptions are the most common dermatological adverse reaction linked to anti-TNF-α therapy. Yet, a detailed characterization of their immune phenotype is lacking.

Objectives

We sought to characterize anti-TNF-α induced inflammatory skin lesions on a histopathologic, cellular and molecular level, compared to psoriasis, eczema (atopic dermatitis), and healthy control skin.

Methods

Histopathologic evaluation, gene expression (quantitative RT-PCR) and computer-assisted immunohistologic studies (TissueFAXS) were performed on 19 skin biopsies from IBD (n=17) and rheumatoid arthritis (n=2) patients with new-onset inflammatory skin lesions during anti-TNF-α-therapy.

Results

While most biopsies showed a psoriasiform and/or spongiotic (eczematous) histopathologic architecture, these lesions were inconsistent with either psoriasis or eczema on a molecular level using an established CCL27/iNOS classifier. Despite some differences in immune skewing depending on the specific histopathologic reaction pattern, all anti-TNF-α-induced lesions showed strong IFN-γ activation, at higher levels than in psoriasis or eczema. IFN-γ was most likely produced by CD3/CD4/Tbet-positive Th1 lymphocytes.

Conclusions

New-onset anti-TNF-α-induced eruptions previously classified as psoriasis or spongiotic dermatitis (eczema) exhibit a molecular profile that is different from either of these disorders.

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LncRNA RP11-670E13.6 Regulates Cell Cycle Progression in UVB Damaged Human Dermal Fibroblasts

Abstract

Long noncoding RNAs (lncRNAs) have gained extensive attention in recent years, however, their effects on ultraviolet (UV) radiation-induced skin photodamage remain to be elucidated. In this study, we performed high-throughput RNA sequencing and comprehensive bioinformatics analyses to characterize the transcriptome profiles including lncRNAs and mRNAs in UVB-irradiated primary human dermal fibroblasts (HDFs) and to explore the roles of lncRNAs in photoaging. Quantitative reverse transcription-polymerase chain reaction amplification was performed to verify the differentially expressed genes. We subsequently found that knocking down of RP11-670E13.6, an upregulated lncRNA in UVB-irradiated HDFs, promoted a robust senescence phenotype, including increased numbers of the numbers of senescence-associated β-galactosidase-positive cells, decreased cell proliferation, accumulation of cells in G0/G1 phase, and a characteristic gene expression signature of senescent cells. In addition, western blot analysis showed that knocking down of RP11-670E13.6 activated the p16-pRB senescence pathway independent of the p53-p21 pathway. Therefore, we propose that RP11-670E13.6 may delay cellular senescence in UVB damaged HDFs through the p16-pRB pathway.

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Extracellular Matrix Containing in vitro Three-dimensional Tumour Models in Photodynamic Therapy-related Research

Abstract

Three-dimensional (3D) tumour models have been intensively evaluated for their use in cancer research and there is a strong rationale behind using 3D cell cultures in photodynamic therapy (PDT)-related experimentation. In this contribution, it is explained why 3D cell cultures containing extracellular matrix (ECM) are preferred for this purpose. Results of experimental studies utilizing ECM-containing 3D cellular models in PDT research are summarized. Finally, design of in vitro 3D models that would provide clinically relevant information is discussed.

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Cell Death Pathways Associated with Photodynamic Therapy: an Update

Abstract

Photodynamic therapy (PDT) has the potential to make a significant impact on cancer treatment. PDT can sensitize malignant tissues to light, leading to a highly selective effect if an appropriate light dose can be delivered. Variations in light distribution and drug delivery, along with impaired efficacy in hypoxic regions, can reduce the overall tumor response. There is also evidence that malignant cells surviving PDT may become more aggressive than the initial tumor population. Promotion of more effective direct tumor eradication is therefore an important goal. While a list of properties for the 'ideal' photosensitizing agent often includes formulation, pharmacologic and photophysical elements, we propose that sub-cellular targeting is also an important consideration. Perspectives relating to optimizing PDT efficacy are offered here. These relate to death pathways initiated by photodamage to particular sub-cellular organelles.

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Forecasting carbon dioxide emissions based on a hybrid of mixed data sampling regression model and back propagation neural network in the USA

Abstract

The accurate forecast of carbon dioxide emissions is critical for policy makers to take proper measures to establish a low carbon society. This paper discusses a hybrid of the mixed data sampling (MIDAS) regression model and BP (back propagation) neural network (MIDAS-BP model) to forecast carbon dioxide emissions. Such analysis uses mixed frequency data to study the effects of quarterly economic growth on annual carbon dioxide emissions. The forecasting ability of MIDAS-BP is remarkably better than MIDAS, ordinary least square (OLS), polynomial distributed lags (PDL), autoregressive distributed lags (ADL), and auto-regressive moving average (ARMA) models. The MIDAS-BP model is suitable for forecasting carbon dioxide emissions for both the short and longer term. This research is expected to influence the methodology for forecasting carbon dioxide emissions by improving the forecast accuracy. Empirical results show that economic growth has both negative and positive effects on carbon dioxide emissions that last 15 quarters. Carbon dioxide emissions are also affected by their own change within 3 years. Therefore, there is a need for policy makers to explore an alternative way to develop the economy, especially applying new energy policies to establish a low carbon society.

Photovoltaic cell electrical heating system for removing snow on panel including verification

Abstract

Small photovoltaic plants in private ownership are typically rated at 5 kW (peak). The panels are mounted on roofs at a decline angle of 20° to 45°. In winter time, a dense layer of snow at a width of e.g., 10 cm keeps off solar radiation from the photovoltaic cells for weeks under continental climate conditions. Practically, no energy is produced over the time of snow coverage. Only until outside air temperature has risen high enough for a rather long-time interval to allow partial melting of snow; the snow layer rushes down in an avalanche. Following this proposal, snow removal can be arranged electrically at an extremely positive energy balance in a fast way. A photovoltaic cell is a large junction area diode inside with a threshold voltage of about 0.6 to 0.7 V (depending on temperature). This forward voltage drop created by an externally driven current through the modules can be efficiently used to provide well-distributed heat dissipation at the cell and further on at the glass surface of the whole panel. The adhesion of snow on glass is widely reduced through this heating in case a thin water film can be produced by this external short time heating. Laboratory experiments provided a temperature increase through rated panel current of more than 10 °C within about 10 min. This heating can initiate the avalanche for snow removal on intention as described before provided the clamping effect on snow at the edge of the panel frame is overcome by an additional heating foil. Basics of internal cell heat production, heating thermal effects in time course, thermographic measurements on temperature distribution, power circuit opportunities including battery storage elements and snow-removal under practical conditions are described.

Antioxidant enzyme activities of Folsomia candida and avoidance of soil metal contamination

Abstract

Induction of the antioxidant enzymes catalase (CAT), peroxidase (POD) and superoxide dismutase (SOD) and the avoidance of potentially toxic metals in soil by Folsomia candida were investigated. Both laboratory-spiked and field-polluted agricultural soils were used. Cadmium (Cd) concentrations in body tissues, animal avoidance behaviour and physico-chemical properties of the field soils were also determined. In laboratory Cd-spiked soils, the CAT and SOD activities in the Cd treatments were 71.1–94.7 and 1.31–4.55 times higher than in the control, respectively. In field-polluted agricultural soils, the CAT and POD activities generally increased with increasing pollution index (PI _Nemerow ) of soil Cd, Cu, Pb and Zn. The CAT, POD and SOD activities at different PI _Nemerow were 65.7–128, 30.1–180 and 36.5–95.8% higher than in the control, respectively. In line with the enzyme activities, Cd concentrations in the animal bodies were 8.31–15.1 and 3.21–10.0 times higher than in the control in spiked and field-polluted soils, respectively. Avoidance behaviour also increased with increasing metal concentrations in both soils. The effects of metals on CAT, POD or SOD activity were influenced by soil properties such as soil texture and pH. These results indicate that the antioxidant enzymes activities of F. candida can be induced by heavy metals and potentially used to assess the toxicity, and also that soil properties must be considered in the analysis of enzyme activities in different types of field soils.

Improvement of a yeast self-excising integrative vector by prevention of expression leakage of the intronated Cre recombinase gene during plasmid maintenance in Escherichia coli

Abstract

The use of plasmids possessing a regulatable gene coding for a site-specific recombinase together with its recognition sequences significantly facilitates genome manipulations since it allows self-excision of the portion of the genetic construct integrated into the host genome. Stable maintenance of such plasmids in Escherichia coli, which is used for plasmid preparation, requires prevention of recombinase synthesis in this host, which can be achieved by interrupting the recombinase gene with an intron. Based on this approach, Saccharomyces cerevisiae and Hansenula polymorpha self-excising vectors possessing intronated gene for Cre recombinase and its recognition sites (LoxP) were previously constructed. However, this work shows instability of the H. polymorpha vectors during plasmid maintenance in E. coli cells. This could be due to recombination between the loxP sites caused by residual expression of the cre gene. Prevention of translation reinitiation on an internal methionine codon completely solved this problem. A similar modification was made in a self-excising vector designed for S. cerevisiae. Apart from substantial improvement of yeast self-excising vectors, the obtained results also narrow down the essential part of Cre sequence.

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