Πέμπτη 7 Δεκεμβρίου 2017
Editorial Board
Source:Annales de Chirurgie Plastique Esthétique, Volume 62, Issue 6
Lower Arterial Cross-Sectional Area of Carotid and Vertebral Arteries and Higher Frequency of Secondary Neck Vessels Are Associated with Multiple Sclerosis [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Arterial and neck vessel system characteristics of patients with multiple sclerosis have not been previously investigated. Therefore, the aim of this study was to examine the frequency of neck vessels and their cross-sectional areas (in square millimeters) between patients with MS and healthy controls.
MATERIALS AND METHODS:In this study, 193 patients with MS and 193 age- and sex-matched healthy controls underwent 2D TOF venography at 3T. The main arterial (carotid and vertebral), venous (internal jugular), and secondary neck vessels were examined at 4 separate cervical levels (C2/3, C4, C5/6, and C7/T1). The ANCOVA adjusted for age, body mass index, smoking status, hypertension, and heart disease was used to compare the differences between patients with MS and healthy controls.
RESULTS:After controlling for all confounding factors, patients with MS had significantly lower cross-sectional areas of the carotid arteries at the C2/3 (P = .03), C5/6 (P = .026), and C7/T1 (P = .005) levels as well as of the vertebral arteries at the C2/3 (P = .02), C4 (P = .012), and C7/T1 (P = .006) levels, compared with healthy controls. A higher frequency of secondary neck vessels was found at all 4 levels in patients with MS: C2/3 (12.9 versus 10, P < .001), C4 (9.1 versus 7.5, P < .001), C5/6 (7.8 versus 6.8, P = .012), and C7/T1 (8.8 versus 6, P < .001). The total cross-sectional areas of secondary neck vessels were also significantly higher at all 4 levels (P < .03). No significant differences in the cross-sectional areas of jugular veins were found between patients with MS and healthy controls.
CONCLUSIONS:Patients with MS showed lower cross-sectional areas of the carotid and vertebral arteries and a higher frequency of secondary neck vessels and their cross-sectional areas compared with healthy controls.
MR Perfusion to Determine the Status of Collaterals in Patients with Acute Ischemic Stroke: A Look Beyond Time Maps [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Patients with acute stroke with robust collateral flow have better clinical outcomes and may benefit from endovascular treatment throughout an extended time window. Using a multiparametric approach, we aimed to identify MR perfusion parameters that can represent the extent of collaterals, approximating DSA.
MATERIALS AND METHODS:Patients with anterior circulation proximal arterial occlusion who had baseline MR perfusion and DSA were evaluated. The volume of arterial tissue delay (ATD) at thresholds of 2–6 seconds (ATD2–6 seconds) and >6 seconds (ATD>6 seconds) in addition to corresponding values of normalized CBV and CBF was calculated using VOI analysis. The association of MR perfusion parameters and the status of collaterals on DSA were assessed by multivariate analyses. Receiver operating characteristic analysis was performed.
RESULTS:Of 108 patients reviewed, 39 met our inclusion criteria. On DSA, 22/39 (56%) patients had good collaterals. Patients with good collaterals had significantly smaller baseline and final infarct volumes, smaller volumes of severe hypoperfusion (ATD>6 seconds), larger volumes of moderate hypoperfusion (ATD2–6 seconds), and higher relative CBF and relative CBV values than patients with insufficient collaterals. Combining the 2 parameters into a Perfusion Collateral Index (volume of ATD2–6 secondsx relative CBV2–6 seconds) yielded the highest accuracy for predicting collateral status: At a threshold of 61.7, this index identified 15/17 (88%) patients with insufficient collaterals and 22/22 (100%) patients with good collaterals, for an overall accuracy of 94.1%.
CONCLUSIONS:The Perfusion Collateral Index can predict the baseline collateral status with 94% diagnostic accuracy compared with DSA.
Semiautomated Middle Ear Volume Measurement as a Predictor of Postsurgical Outcomes for Congenital Aural Atresia [HEAD & NECK]
BACKGROUND AND PURPOSE:
Middle ear space is one of the most important components of the Jahrsdoerfer grading system (J-score), which is used to determine surgical candidacy for congenital aural atresia. The purpose of this study was to introduce a semiautomated method for measuring middle ear volume and determine whether middle ear volume, either alone or in combination with the J-score, can be used to predict early postoperative audiometric outcomes.
MATERIALS AND METHODS:A retrospective analysis was conducted of 18 patients who underwent an operation for unilateral congenital aural atresia at our institution. Using the Livewire Segmentation tool in the Carestream Vue PACS, we segmented middle ear volumes using a semiautomated method for all atretic and contralateral normal ears on preoperative high-resolution CT imaging. Postsurgical audiometric outcome data were then analyzed in the context of these middle ear volumes.
RESULTS:Atretic middle ear volumes were significantly smaller than those in contralateral normal ears (P < .001). Patients with atretic middle ear volumes of >305 mm3 had significantly better postoperative pure tone average and speech reception thresholds than those with atretic ears below this threshold volume (P = .01 and P = .006, respectively). Atretic middle ear volume incorporated into the J-score offered the best association with normal postoperative hearing (speech reception threshold ≤ 30 dB; OR = 37.8, P = .01).
CONCLUSIONS:Middle ear volume, calculated in a semiautomated fashion, is predictive of postsurgical audiometric outcomes, both independently and in combination with the conventional J-score.
The CT Swirl Sign Is Associated with Hematoma Expansion in Intracerebral Hemorrhage [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Hematoma expansion is an independent determinant of poor clinical outcome in intracerebral hemorrhage. Although the "spot sign" predicts hematoma expansion, the identification requires CT angiography, which limits its general accessibility in some hospital settings. Noncontrast CT, without the need for CT angiography, may identify sites of active extravasation, termed the "swirl sign." We aimed to determine the association of the swirl sign with hematoma expansion.
MATERIALS AND METHODS:Patients with spontaneous intracerebral hemorrhage between 2007 and 2014 who underwent an initial and subsequent noncontrast CT at a single center were retrospectively identified. The swirl sign, on noncontrast CT, was defined as iso- or hypodensity within a hyperdense region that extended across 2 contiguous 5-mm axial CT sections.
RESULTS:A total of 212 patients met the inclusion criteria. The swirl sign was identified in 91 patients with excellent interobserver agreement ( = 0.87). The swirl sign was associated with larger initial hematoma (P < .001) and earlier initial CT (P < .001) and hematoma expansion (P = .028). Multivariable regression modeling demonstrated that if one assumed similar initial hematoma volume, onset-to-first scan, and time between CT scans, the median absolute hematoma growth was 5.77 mL (95% CI, 2.37–9.18 mL; P = .001) and relative growth was 35.6% (95% CI, 18.5%–52.6%; P < .001) higher in patients with the swirl sign compared with those without.
CONCLUSIONS:The NCCT swirl sign was reliably identified and is associated with hematoma expansion. We propose that the swirl sign be included in risk stratification of intracerebral hemorrhage and considered for inclusion in clinical trials.
Intranasal Esthesioneuroblastoma: CT Patterns Aid in Preventing Routine Nasal Polypectomy [HEAD & NECK]
BACKGROUND AND PURPOSE:
Esthesioneuroblastoma is a neuroectodermal tumor that commonly arises in the nasal cavity olfactory recess and, when isolated to the intranasal cavity, can be indistinguishable from benign processes. Because lesional aggressiveness requires a more invasive operation for resection than polypectomy, patients with isolated intranasal lesions were studied to define distinguishing CT characteristics.
MATERIALS AND METHODS:Patients with intranasal esthesioneuroblastoma and controls without esthesioneuroblastoma with olfactory recess involvement were identified by using a report search tool. Studies demonstrating skull base invasion and/or intracranial extension were excluded. The imaging spectrum of these lesions was reviewed on both CT and MR imaging, and CT findings were compared with those of controls without esthesioneuroblastoma. Two blinded readers assessed subjects with esthesioneuroblastomas and controls without esthesioneuroblastoma and, using only CT criteria, rated their level of suspicion for esthesioneuroblastoma in each case.
RESULTS:Eight histologically proved cases of intranasal esthesioneuroblastoma were reviewed. All cases had CT demonstrating 3 main findings: 1) an intranasal polypoid lesion with its epicenter in a unilateral olfactory recess, 2) causing asymmetric olfactory recess widening, and 3) extending to the cribriform plate. Twelve patients with non-esthesioneuroblastoma diseases involving the olfactory recess were used as controls. Using these 3 esthesioneuroblastoma CT criteria, 2 blinded readers evaluating patients with esthesioneuroblastoma and controls had good diagnostic accuracy (area under the curve = 0.85 for reader one, 0.81 for reader 2) for predicting esthesioneuroblastoma.
CONCLUSIONS:Esthesioneuroblastoma can present as a well-marginated intranasal lesion that unilaterally widens the olfactory recess. CT patterns can help predict esthesioneuroblastoma, potentially preventing multiple operations by instigating the correct initial operative management.
Dural Arteriovenous Fistulas: A Characteristic Pattern of Edema and Enhancement of the Medulla on MRI [ADULT BRAIN]
SUMMARY:
Medullary edema with enhancement is rarely reported at initial MR imaging in intracranial dural arteriovenous fistulas. We report a series of 5 patients with dural arteriovenous fistulas, all of whom demonstrated a characteristic pattern of central medullary edema and medullary enhancement at initial MR imaging. Cognard type V dural arteriovenous fistula, defined by drainage into the perimedullary veins and the veins surrounding the brain stem, is a rare yet well-described pathologic entity. Even more rarely reported, however, is its clinical presentation with predominantly bulbar symptoms and MR imaging findings of central medullary edema with enhancement. This constellation of findings frequently leads to a convoluted clinical picture, prompting work-up for alternative disease processes and delaying diagnosis. Because an expedited diagnosis is critical in preventing poor outcomes, it is paramount to make the referring physician and neuroradiologist more cognizant of this rare-yet-characteristic imaging manifestation of dural arteriovenous fistula.
On the Reproducibility of Inversion Recovery Intravoxel Incoherent Motion Imaging in Cerebrovascular Disease [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Intravoxel incoherent motion imaging can measure both microvascular and parenchymal abnormalities simultaneously. The contamination of CSF signal can be suppressed using inversion recovery preparation. The clinical feasibility of inversion recovery–intravoxel incoherent motion imaging was investigated in patients with cerebrovascular disease by studying its reproducibility.
MATERIALS AND METHODS:Sixteen patients with cerebrovascular disease (66 ± 8 years of age) underwent inversion recovery–intravoxel incoherent motion imaging twice. The reproducibility of the perfusion volume fraction and parenchymal diffusivity was calculated with the coefficient of variation, intraclass correlation coefficient, and the repeatability coefficient. ROIs included the normal-appearing white matter, cortex, deep gray matter, white matter hyperintensities, and vascular lesions.
RESULTS:Values for the perfusion volume fraction ranged from 2.42 to 3.97 x10–2 and for parenchymal diffusivity from 7.20 to 9.11 x 10–4 mm2/s, with higher values found in the white matter hyperintensities and vascular lesions. Coefficients of variation were <3.70% in normal-appearing tissue and <9.15% for lesions. Intraclass correlation coefficients were good to excellent, showing values ranging from 0.82 to 0.99 in all ROIs, except the deep gray matter and cortex, with intraclass correlation coefficients of 0.66 and 0.54, respectively. The repeatability coefficients ranged from 0.15 to 0.96 x 10–2 and 0.10 to 0.37 x 10–4 mm2/s for perfusion volume fraction and parenchymal diffusivity, respectively.
CONCLUSIONS:Good reproducibility of inversion recovery–intravoxel incoherent motion imaging was observed with low coefficients of variation and high intraclass correlation coefficients in normal-appearing tissue and lesion areas in cerebrovascular disease. Good reproducibility of inversion recovery–intravoxel incoherent motion imaging in cerebrovascular disease is feasible in monitoring disease progression or treatment responses in the clinic.
Optic Nerve Measurement on MRI in the Pediatric Population: Normative Values and Correlations [PEDIATRICS]
BACKGROUND AND PURPOSE:
Few articles in the literature have looked at the diameter of the optic nerve on MR imaging, especially in children, in whom observations are subjective and no normative data exist. The aim of this study was to establish a data base for optic nerve diameter measurements on MR imaging in the pediatric population.
MATERIALS AND METHODS:This was a retrospective study on the MR imaging of pediatric subjects (younger than 18 years of age) at the Department of Diagnostic Radiology at the American University of Beirut Medical Center, Beirut, Lebanon. The optic nerve measurements were obtained by 3 raters on axial and coronal sections at 3 mm (retrobulbar) and 7 mm (intraorbital) posterior to the lamina cribrosa.
RESULTS:Of 211 scans of patients (422 optic nerves), 377 optic nerves were measured and included. Ninety-four patients were female (45%) and the median age at MR imaging was 8.6 years (interquartile range, 3.9–13.3 years). Optic nerves were divided into 5 age groups: 0–6 months (n = 18), 6 months–2 years (n = 44), 2–6 years (n = 86), 6–12 years (n = 120), and 12–18 years (n = 109). An increase in optic nerve diameter was observed with age, especially in the first 2 years of life. Measurements did not differ with eye laterality or sex.
CONCLUSIONS:We report normative values of optic nerve diameter measured on MR imaging in children from birth to 18 years of age. A rapid increase in optic nerve diameter was demonstrated during the first 2 years of life, followed by a slower increase. This was independent of sex or eye laterality.
Diagnostic Accuracy of Centrally Restricted Diffusion in the Differentiation of Treatment-Related Necrosis from Tumor Recurrence in High-Grade Gliomas [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Centrally restricted diffusion has been demonstrated in recurrent high-grade gliomas treated with bevacizumab. Our purpose was to assess the accuracy of centrally restricted diffusion in the diagnosis of radiation necrosis in high-grade gliomas not treated with bevacizumab.
MATERIALS AND METHODS:In this prospective study, we enrolled patients with high-grade gliomas who developed a new ring-enhancing necrotic lesion and who underwent re-resection. The presence of a centrally restricted diffusion within the ring-enhancing lesion was assessed visually on diffusion trace images and by ADC measurements on 3T preoperative diffusion tensor examination. The percentage of tumor recurrence and radiation necrosis in each surgical specimen was defined histopathologically. The association between centrally restricted diffusion and radiation necrosis was assessed using the Fisher exact test. Differences in ADC and the ADC ratio between the groups were assessed via the Mann-Whitney U test, and receiver operating characteristic curve analysis was performed.
RESULTS:Seventeen patients had re-resected ring-enhancing lesions: 8 cases of radiation necrosis and 9 cases of tumor recurrence. There was significant association between centrally restricted diffusion by visual assessment and radiation necrosis (P = .015) with a sensitivity of 75% and a specificity of 88.9%, a positive predictive value 85.7%, and a negative predictive value of 80% for the diagnosis of radiation necrosis. There was a statistically significant difference in the ADC and ADC ratio between radiation necrosis and tumor recurrence (P = .027).
CONCLUSIONS:The presence of centrally restricted diffusion in a new ring-enhancing lesion might indicate radiation necrosis rather than tumor recurrence in high-grade gliomas previously treated with standard chemoradiation without bevacizumab.
The Fine Wire Technique for Flexor Tenolysis
Background: Flexor tenolysis surgery for flexor digitorum profundus and superficialis adhesions is a common procedure performed by hand surgeons. Releasing these adhered tendons can greatly improve hand function and improve quality of life. Recent evidence, however, has shown that the outcomes of tenolysis surgeries are often suboptimal and can result in relapsing adhesions or even tendon ruptures. Methods: This article describes a new technique with potential for reduced complication rates: The Fine Wire Technique for Flexor Tenolysis (FWT). Results: Following FWT, the patient detailed in this article had an excellent recovery of function and no complications: including tendon rupture, infection, hematomas, or any other complications. She reported a major improvement from her preoperative functionality and continues to have this level of success. The wire's thinness allows for a swift tenolysis. Conclusions: The FWT is a new option available to the hand surgeon associated with good functional results. The wire is readily available to the clinician and is also inexpensive.Dynamic Model of Applied Facial Anatomy with Emphasis on Teaching of Botulinum Toxin A
Background: The use of botulinum toxin type A is considered one of the most revolutionary and promising face rejuvenation methods. Although rare, most of the complications secondary to the use of botulinum toxin A are technician dependent. Among the major shortcomings identified in the toxin administration education is unfamiliarity with applied anatomy. This article proposes the use of body painting as an innovative method of teaching the application of botulinum toxin A. Methods: Using the body painting technique, facial anatomy was represented on the face of a model showing the major muscle groups of botulinum toxin A targets. Photographic records and films were made for documentation of represented muscles at rest and contraction. Results: Using the body painting technique, each of the muscles involved in facial expression and generation of hyperkinetic wrinkles can be faithfully reproduced on the model's face. The documentation of the exact position of the points of application, the distribution of the feature points in the muscular area, the proper angulation and syringe grip, as well as the correlation of the points of application with the presence of hyperkinetic wrinkles, could be properly registered, providing professional training with information of great practical importance, development of highly effective treatments, and low complication rates. Conclusion: By making it possible to interrelate anatomy of a function, body painting is proposed in the present study as an innovative method, which in a demonstrative and highly didactic manner presents great potential as a teaching tool in the application of botulinum toxin A.The Artificial Moral Advisor. The “Ideal Observer” Meets Artificial Intelligence
Abstract
We describe a form of moral artificial intelligence that could be used to improve human moral decision-making. We call it the "artificial moral advisor" (AMA). The AMA would implement a quasi-relativistic version of the "ideal observer" famously described by Roderick Firth. We describe similarities and differences between the AMA and Firth's ideal observer. Like Firth's ideal observer, the AMA is disinterested, dispassionate, and consistent in its judgments. Unlike Firth's observer, the AMA is non-absolutist, because it would take into account the human agent's own principles and values. We argue that the AMA would respect and indeed enhance individuals' moral autonomy, help individuals achieve wide and a narrow reflective equilibrium, make up for the limitations of human moral psychology in a way that takes conservatives' objections to human bioenhancement seriously, and implement the positive functions of intuitions and emotions in human morality without their downsides, such as biases and prejudices.
New onset pemphigus foliaceus during pregnancy: A rare case
Pemphigus is a rare autoimmune disease during pregnancy. Among the different pemphigus types, pemphigus foliaceus (PF) is even rarer than pemphigus vulgaris. We present a case of PF in a 36-year-old female patient who presented with PF onset during pregnancy in the form of a disseminated, erythematosquamous rash. A diagnosis was made on the basis of histologic, immunofluorescence, and enzyme-linked immunosorbent assay results. A complete remission was recorded a month after steroid treatment initiation.
Potential vulnerability of oak forests to climate change-induced flooding: effects of mild oxygen deficiency on Quercus robur and Quercus petraea seedling physiology
Abstract
Flooding is characterized by saturation of soil pores with water, leading to hypoxic conditions which affect plant root development and metabolism. We investigated the oxygen deficiency tolerance observed in Quercus robur and Quercus petraea and seek to understand whether it can be explained by enhanced efficiency in oxygen use in the roots, as estimated through radial oxygen loss visualization in relation to growth measurements and root apex respiration. The study showed that root growth, under oxygen deficiency conditions, was significantly reduced only in Q. robur seedlings. Root respiration was maintained in Q. robur, whereas it was decreased in Q. petraea. Both species set up a barrier against radial oxygen loss, though measurement of apex oxygen leakage showed greater oxygen efficiency in Q. robur seedlings. This strategy might allow Q. robur to maintain its respiration and thus to survive longer under oxygen deficiency conditions by facilitating the seedling establishment in transient flooded soils.
Concepts for a therapeutic prolongation of nephrogenesis in preterm and low-birth-weight babies must correspond to structural-functional properties in the nephrogenic zone
Numerous investigations are dealing with anlage of the mammalian kidney and primary development of nephrons. However, only few information is available about the last steps in kidney development leading at bir...
Assessment of debris inputs from land into the river in the Three Gorges Reservoir Area, China
Abstract
Riverine debris in the Three Gorges Reservoir Area (TGRA) poses a threat to electricity generation, ship navigation, and water environment. Quantifying riverine debris inputs from land into the river is a foundation for modeling of the transport and accumulation of floating debris on the water surface in the TGRA. However, this has not been researched to date. In this study, debris inputs from land into the river in the TGRA were assessed according to the response relationship between debris inputs and surface runoff. The land-based debris inputs in the TGRA were estimated using simulated surface runoff which was simulated by the Soil and Water Assessment Tool (SWAT) model. Results showed that 15.32 × 106 kg of land-based debris was inputted into the main channel of the TGRA in 2015 which accounted for 9.74% of total debris inputs (the monitoring data of river-sourced and land-sourced debris inputs was 157.27 × 106 kg). Debris inputs varied seasonally and peaked in the summer season (July to September). Compared with monthly measured data, the average relative errors in 2015 were below 30%. In addition, areas with higher debris pollution inputs were mainly located in the upper section of the TGRA, between the Tang River Basin and the Long River Basin. The proposed method was tested and determined to be reliable; thus, it can be used to quickly estimate debris inputs from land into the river by surface runoff of the outlets in a river basin. Moreover, this method provides new insight into the estimation of land-based debris inputs into rivers.
Analysis and Classification of the Nasal Base Using a Parametric Model
This study assesses using an equation to quantitatively describe nasal base shape and tests it against subjective categorization.
Google Trends as a Resource for Informing Plastic Surgery Marketing Decisions
Abstract
Background
Celebrities have long influenced the medical decisions of the general population. By analyzing Google search data using Google Trends, we measured the impact of highly publicized plastic surgery-related events on the interest level of the general population in specific search terms. Additionally, we investigated seasonal and geographic trends around interest in rhinoplasties, which is information that physicians and small surgical centers can use to optimize marketing decisions.
Methods
Google Trends was used to access search data histories for three separate areas of interest: Kylie Jenner and lip fillers, Joan Rivers and plastic surgery, and rhinoplasty, which were then analyzed using two-tailed, two-sample equal variance t-tests.
Results
The average interest level in fillers increased by 30.31 points after Kylie Jenner announced that she received Juvéderm lip injections. The interest level in plastic surgery was decreased by 21.3% the month after Joan Rivers' death. Between January 2004 and May 2017, the average interest level for rhinoplasty was significantly different in January/December (67.91 ± 20.68) and June/July (70.12 ± 18.89) from the remaining calendar months (63.58 ± 19.67). Los Angeles, New York City, and Miami showed consistently high interest levels throughout the time period, while Tulsa, OK, showed a major interest increase between 2015 to 2016 of 65 points.
Conclusions
A noticeable impact was observed in both celebrity cases on search term volume, and a seasonal effect is apparent for rhinoplasty searches. As many surgeons already employ aggressive Internet marketing strategies, understanding and utilizing these trends could help optimize their investments, increase social engagement, and increase practice awareness by potential patients.
Level of Evidence V
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
Safety and Efficacy of Facial Fat Grafting Under Local Anesthesia
Abstract
Background
Facial fat grafting under local anesthesia has been widely performed in outpatient departments and private settings in China. The present study aimed to evaluate the safety and efficacy of facial fat grafting under local anesthesia.
Method
A retrospective study was conducted on 155 patients who underwent facial fat grafting. The clinical data were recorded. Preoperative and postoperative two-dimensional images were acquired to evaluate the effect of facial fat grafting on refining facial contouring, rejuvenation as well as deformity reconstruction. The complications were recorded to assess the safety of the approach.
Result
All the facial fat grafting procedures were performed successfully under local anesthesia. A majority of the patients who underwent one or more sessions of facial fat grafting under local anesthesia were satisfied with the cosmetic results. No severe complications occurred in these patients.
Conclusions
In the present study, remarkable and natural improvements of facial contouring, rejuvenation as well as deformity reconstruction were achieved with facial fat grafting in most patients. Thus, the procedures performed under local anesthesia by experienced surgeons are safe.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
The Bidirectional, Absorbable, No-Drain Abdominoplasty
Abstract
This article outlines the author's technique, and the concepts of Bidirectional, Absorbable, No-Drain Abdominoplasty (BAND-Abdominoplasty). The attendant advantages and disadvantages are reviewed in the context of a retrospective, 5-year, single surgeon series.
Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
The Rejuvenating Effect and Tolerability of an Auto-Cross-Linked Hyaluronic Acid on Décolletage: A Pilot Prospective Study
Abstract
Background
A novel auto-cross-linked hyaluronic acid formulation (HA-ACP) has been proposed as a treatment for skin rejuvenation. This prospective pilot study aims to assess its tolerability and performance in the treatment of skin aging of the décolletage.
Methods
Fifteen women (mean age 49.0 ± 8.0 (range 30–65)) who complained about the appearance of their décolletage were prospectively enrolled and treated with three sets of HA-ACP (IAL-SYSTEM ACP®) intradermal injections, administered three weeks apart. Control visits followed at 80 and 120 days from enrollment. The rejuvenating effect was assessed using the Beagley–Gibson and Fabi–Bolton scores. The investigators and the subjects also subjectively assessed skin appearance using a 1–10 scale. The rejuvenating effect and its persistence were assessed comparing the scores collected at the different experimental times by means of Wilcoxon rank tests. Adverse events and their duration were recorded and compared to those reported in the literature.
Results
The HA-ACP formulation provided a significant improvement according to the Beagley–Gibson score (p < 0.005) at all time points. At the 120-day follow-up, the Fabi–Bolton score was significantly improved with respect to baseline (p < 0.05). The rejuvenating effect persisted unaltered between the 80-day and the 120-day visits. At the 120-day visit, the subjects' and investigators' subjective scores were between 8 and 10 in most cases. No unexpected adverse effects were observed. All adverse effects were well tolerated and disappeared over a short period.
Conclusions
The HA-ACP treatment under investigation is safe, well tolerated, and provides effective and long-lasting décolletage rejuvenation.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
Superomedial Pedicle Vertical Scar Breast Reduction: Objective and Subjective Assessment of Breast Symmetry and Aesthetics
Abstract
Background
The superomedial vertical scar breast reduction (SVBR) described by Hall-Findlay is gaining popularity among surgeons worldwide. The aim of this study was to evaluate its long-term aesthetic outcome, the extent of quality of life improvement and the factors that influence patient satisfaction and reviewers' evaluation of aesthetic/surgical outcome.
Methods
In this historical prospective study, we included women who underwent SVBR at least one year prior to enrollment and responded to a quality of life questionnaire. Their breasts were photographed, measured and evaluated by the plastic surgery staff.
Results
A total of 40 patients responded to the questionnaire, and the breasts of 31 of them were measured and photographed. All 31 patients had good breast symmetry according to objective breast measurements. There was a clear correlation between the patients' and the reviewers' scores of breast symmetry, scar appearance and breast shape (r = 0.4–0.65, r = 0.432–0.495 and r = 0.335–0.403, respectively). The factor that most influenced reviewers' and patients' satisfaction with the overall aesthetic outcome was the breast-to-body proportion.
Conclusions
The proportions between the breast size and the patient's body habitus are pivotal to patient satisfaction and should be taken into consideration when planning a reduction mammaplasty. The SVBR technique for breast reduction provided good cosmetic outcome and symmetry over a long-term follow-up.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
Masseteric Nerve Transfer for Facial Nerve Paralysis
This systematic review with meta-analysis examines masseteric nerve transfer for treatment of patients with facial paralysis.
Peak Nasal Inspiratory Flow as an Objective Measure
This study assesses the utility of peak nasal inspiratory flow as an objective diagnostic and outcome measure for functional septorhinoplasty in combination with the Nasal Obstruction Symptom Evaluation scale.
Length of Stay for Free Tissue Transfer to Head and Neck Defects
This database review evaluates patient and surgical factors associated with length of stay and reoperation following surgical procedures for malignant neoplasm of the head and neck involving microvascular free tissue transfer reconstruction.
Tennessee’s In-State Vulnerability Assessment for a ‘Rapid Dissemination of HIV or HCV Infection’ Event Utilizing Data about the Opioid Epidemic
Abstract
Background
Knowing which factors contribute to county-level vulnerability to an HIV/Hepatitis C (HCV) outbreak, and which counties are most vulnerable, guide public health and clinical interventions. We therefore examined the impact of locally available indicators related to the opioid epidemic on prior national models of HCV/HIV outbreak vulnerability. Methods
Tennessee's 95 counties were the study sample. Predictors from 2012 and 2013 were used, mirroring prior methodology from the US Centers for Disease Control and Prevention (CDC). Acute HCV incidence was the proxy measure of county-level vulnerability. Seventy-eight predictors were identified as potentially predictive for HIV/HCV vulnerability. We used multiple dimension reduction techniques to determine predictors for inclusion and Poisson regression to generate a composite index score ranking county level vulnerability for HIV/HCV. Results
There was overlap of high-risk counties with the national analysis (25 of 41 counties). The distribution of vulnerability reinforces earlier research indicating that Eastern Tennessee is at particularly high risk, but also demonstrates that the entire state has high vulnerability. Conclusions
Prior research placed Tennessee among the top states for opioid prescribing, acute HCV infection, and greatest risk for an HIV/HCV outbreak. Given this confluence of risk, the Tennessee Department of Health expanded upon prior work to include more granular, local data, including on opiate prescribing. We also explored opioid prescribing patterns and nonfatal and fatal overdoses. The more complete statewide view of risk generated, not only in Eastern counties but also in the Western corridor, will enable local officials to monitor vulnerability and better target resources.Endometriumkarzinom
Zusammenfassung
Das Endometriumkarzinom (EC) ist in Industrienationen die häufigste Karzinomerkrankung der weiblichen Genitalorgane. Es wird histologisch unterteilt in den östrogenabhängigen Typ I (etwa 90 %) und den östrogenunabhängigen Typ II (etwa 10 %), zu dem seröse, klarzellige und auch die dedifferenzierten Karzinome wie Karzinosarkome/maligne Müller-Mischtumoren des Uterus zählen. In der Mehrzahl der Fälle wird das Endometriumkarzinom in einem frühen Stadium diagnostiziert mit einem mittleren Erkrankungsalter von 69 Jahren. Die Therapie erfolgt meist als Hysterektomie mit beidseitiger Adnexexstirpation. Bei höherem Rezidivrisiko werden zusätzlich eine pelvine und paraaortale Lymphonodektomie und ggf. eine adjuvante Chemo- und/oder Strahlentherapie empfohlen. Die Nachsorge umfasst gynäkologische Untersuchungen zur Erkennung von Frührezidiven im Scheiden‑/Beckenbereich und zur Vermeidung von Scheidenverklebungen.
Generational Influence on Patient Learning Preferences in Dermatology
Publication date: Available online 6 December 2017
Source:Journal of the American Academy of Dermatology
Author(s): Fan Di Xia, Jasmine Rana, Grace J. Young, Shinjita Das, Foorotan Alizadeh, Cara Joyce, Arash Mostaghimi
Race as a Predictor of Patient Preferences for Biopsy Result Communication
Publication date: Available online 6 December 2017
Source:Journal of the American Academy of Dermatology
Author(s): Shalini Thareja, Matthew Fink, Kuang-Ho Chen, Yuan Liu, Suephy C. Chen, Benjamin K. Stoff
A systematic review of safety and efficacy of systemic corticosteroids in atopic dermatitis
Publication date: Available online 6 December 2017
Source:Journal of the American Academy of Dermatology
Author(s): Sherry Yu, Aaron M. Drucker, Mark Lebwohl, Jonathan I. Silverberg
BackgroundSystemic corticosteroids are often used to treat atopic dermatitis (AD). However, few studies have assessed the safety and efficacy of systemic corticosteroids in AD.ObjectiveTo systematically review the literature on efficacy and safety of systemic corticosteroid use (oral, intramuscular, and intravenous) in AD.MethodsPubMed, Embase, Medline, Scopus, Web of Science, and Cochrane Library were searched. We included systematic reviews, guidelines, and treatment reviews of systemic corticosteroid use among patients of all ages with a diagnosis of AD (52 reviews and 12 studies).ResultsThere was general consensus in the literature to limit the use of systemic steroids to short courses as a bridge to steroid-sparing therapies. Systemic side effects include growth suppression in children, osteoporosis, osteonecrosis, adrenal insufficiency, Cushing syndrome, hypertension, glucose intolerance, diabetes, gastritis, gastroesophageal reflux, peptic ulcer disease, weight gain, emotional lability, behavioral changes, opportunistic infections, cataracts, glaucoma, myopathy, myalgia, dysaesthesia, pseudotumor cerebri, hyperlipidemia, malignancy, thrombosis, skin atrophy, sleep disturbance, and rebound flaring.LimitationsBaseline clinical severity, corticosteroid delivery and dose, and treatment response were reported incompletely and heterogeneously across studies.ConclusionsEvidence is not strong enough to determine optimal delivery or duration of systemic corticosteroids in AD.
Biomimetic synthesis of silver nanoparticles using flower extract of Bauhinia purpurea and its antibacterial activity against clinical pathogens
Abstract
In the present study, we have reported an eco-friendly, rapid, and simple method for the synthesis of silver nanoparticles (AgNPs) using Bauhinia purpurea flower extract as non-toxic bioreducing agent. The formation of AgNPs was confirmed by UV–visible spectroscopy, transmission electron microscopy (TEM), scanning electron microscopy and energy-dispersive spectroscopy (SEM–EDS), Fourier transform infrared spectroscopy (FT-IR), and X-ray diffraction (XRD). The synthesized AgNPs were spherical in shape with an average size of 20 nm. Furthermore, the antibacterial activities of the synthesized AgNPs (2–10 mM) against clinical pathogens, Klebsiella sp. and Staphylococcus sp., were evaluated under in vitro conditions.
Evaluation of amyloid status in a cohort of elderly individuals with memory complaints: validation of the method of quantification and determination of positivity thresholds
Abstract
Objective
Our aim is to validate the process steps implemented by the French CATI platform to assess amyloid status, obtained from 18F-Florbetapir PET scans, in a cohort of 318 cognitively normal subjects participating in the INSIGHT-preAD study. Our objective was to develop a method with partial volume effect correction (PVEC) on untransformed PET images, using an automated pipeline ("RACHEL") adapted to large series of patients and including quality checks of results.
Methods
We compared RACHEL using different options (with and without PVEC, different sets of regions of interest), to two other methods validated in the literature, referred as the "AVID" and "CAEN" methods. A standard uptake value ratio (SUVR) was obtained with the different methods for participants to another French study, IMAP, including 26 normal elderly controls (NEC), 11 patients with mild cognitive impairment (MCI) and 16 patients with Alzheimer's disease (AD). We determined two cutoffs for RACHEL method by linear correlation with the other methods and applied them to the INSIGHT-preAD subjects.
Results
RACHEL including PVEC and a combination of the whole cerebellum and the pons as a reference region allowed the best discrimination between NEC and AD participants. A strong linear correlation was found between RACHEL and the other two methods and yielded the two cutoffs of 0.79 and 0.88. According to the more conservative threshold, 19.8% of the INSIGHT-preAD subjects would be considered amyloid positive, and 27.7% according to the more liberal threshold.
Conclusions
With our method, we clearly discriminated between NEC with negative amyloid status and patients with clinical AD. Using a linear correlation with other validated cutoffs, we could infer our own positivity thresholds and apply them to an independent population. This method might be useful to the community, especially when the optimal cutoff could not be obtained from a population of healthy young adults or from correlation with post-mortem results.
Triphasic mitral inflow pattern associated with hemodynamic deterioration in anemia or mitral regurgitation: a report of two cases
Abstract
We present two cases with a mid-diastolic mitral inflow peak called an "L wave" due to underlying diseases. Case 1 was an 81-year-old woman with severe anemia (hemoglobin level of 3.9 g/dL). Pulsed Doppler echocardiography showed an L wave that disappeared after transfusion of red cell concentrates. Case 2 was a 72-year-old woman with severe mitral regurgitation due to ruptured chordae tendineae. Pulsed Doppler echocardiography showed an L wave that disappeared after mitral valve repair. The present report suggests that both severe anemia and mitral regurgitation might have contributed to L wave formation, which suggests hemodynamic deterioration.
Analysis of sensitive skin barrier function: basic indicators and sebum composition
Abstract
Sensitive skin (SS) is a condition characterised by high reactivity, low tolerance, and susceptibility to allergies of the skin. Owing to changes in the environment and marketing strategies, as well as the increasing public awareness about skin care, attention to skin condition is gradually increasing. To explore the differences in the skin barrier of SS and normal skin (NS), a questionnaire survey was conducted and basic indicators of the skin barrier were analysed. It was found that sebum secretion in the SS group was lower than that in the NS group, suggesting that the development of SS might be associated with sebum secretion and its specific components. Next, an ultra performance liquid chromatography-quadruple time-of-flight mass spectrometer was used to identify facial sebum components in female volunteers. The results showed that the sebum of female volunteers with SS had high levels of ceramides, glycerophosphoethanolamines, and diacylglycerols, and low levels of glucosylceramides, glycerophosphoserines, glycerophosphocholines, and triacylglycerols. Analysis of lipid functions suggested that the main reason for SS development in women might be a barrier dysfunction caused by excessive apoptosis and lack of water. Therefore, anti-allergy additives in cosmetic products that could inhibit apoptosis of keratinocytes and methods to maintain the stability of water molecules in the skin should be further studied.
This article is protected by copyright. All rights reserved.
Effectiveness of Platelet-rich Plasma Therapy in Wound Healing of Pilonidal Sinus Surgery: A Comprehensive Systematic Review and Meta-analysis
Abstract
Background: Pilonidal disease (PD) is a chronic situation which may cause pain, discomfort, inflammation, discharges, and inability to do daily routines. Among two main methods of surgery, open healing is preferred by surgeons since it associates with lower risk of recurrence; however, it could complicate the wound condition by delaying the healing process.
Methods: For this meta-analysis, a search in Medline, Embase and Scopus was performed in June 2017 with no restrictions placed on the publication date or languages. Then, time to healing was considered as the effect size and all the data from trials were extracted. The heterogeneity and the variation in pooled estimation were assessed by using Cochran's Q test and I-squared, respectively. Meta-regression was used to examine the relationship between the effect size and year, studies' sample sizes, proportion of male gender and age with the cause of heterogeneity.
Results: From 11 selected articles finally 4 met our inclusion and exclusion criteria with the total number of 484 patients. Using a fixed-effect model, pool effect was detected 0.642 (95%CI: 0.485-0.798). A homogeneity of pooled effect size estimate for the studies was also found (Cochran Q test, P-value=0.844, I-square=0.0%). Moreover, results of meta-regression showed no statistically significant association between the effect size and patients' mean age, year of publication, total sample size and sex proportion (0.51<P-values<0.98).
Conclusion: PRP therapy for PD wounds appeared more effective than classic wound dressing. This article is protected by copyright. All rights reserved.
Potential of autologous adipose-derived stem cells to regenerate atrophied muscle in a rat model
ABSTRACT
Muscle atrophy results in severe functional impairment and is a significant clinical problem. We examined and characterized the therapeutic effects of autologous adipose-derived stem cells (ADCSs) using an in vivo muscle atrophy rat model. To identify the effect of injected ADSCs into muscle, we developed the following two models of muscle atrophy in rats: induction of denervation by sciatic nerve defects; and nerve repair after severing the sciatic nerve. The inguinal fat pads were harvested from each rat and autologous ADSCs were cultured and ADSCs were injected in the right hind limbs as the experimental group, while normal saline was injected in the left hind limbs, which served as the control group. After 2 weeks, gross examination and histologic analyses were performed. Additionally, to investigate the survival of ADSCs in muscle tissues, we traced the injected ADSCs. The fate of injected ADSCs into muscle was investigated using a green fluorescent protein (GFP) tagging method with lentivirus transfection. The muscle weight and cross-sectional area of muscle were greater and proliferation of connective tissue was less prominent in the ADSC-injected group. Alpha-bungarotoxin binding in the neuromuscular junction was significantly increased, and neoangiogenesis was higher in the ADSCs-injected group. GFP-labeled ADSCs survived in the gastrocnemius muscle after 2 weeks. These findings could give a support in finding the role of autologous ADSCs as new therapeutic modality for regeneration of atrophied muscle. This article is protected by copyright. All rights reserved.
In vivo differentiation of common basal cell carcinoma subtypes by microvascular and structural imaging using dynamic optical coherence tomography
Abstract
Background
The subtype of basal cell carcinoma (BCC) influences the choice of treatment. Optical coherence tomography (OCT) is a non-invasive imaging tool and recent development of angiographic version of OCT has extended the application of OCT to image the cutaneous microvasculature (so called dynamic OCT, D-OCT). This study explores D-OCT's ability to differentiate the common BCC subtypes by microvascular and structural imaging.
Methods
81 patients with 98 BCC lesions, consisting of three subtypes: 27 superficial BCC (sBCC), 55 nodular BCC (nBCC) and 16 infiltrative BCC (iBCC), were D-OCT scanned at three European dermatology centres. Blinded evaluations of microvascular and structural features were performed, followed by extensive statistical analysis of risk ratio (RR) and multiple correspondence analysis (MCA).
Results
nBCC lesions displayed most characteristic structural and vascular features. Serpiginous vessels, branching vessels, vessels creating a circumscribed figure and sharply demarcated hyporeflective ovoid structures in the dermis were all associated with a higher risk of the subtype being nBCC. The presence of highly present lines and dark peripheral borders at the margin of ovoid structures were negatively associated with iBCC. Lastly, the finding of hyporeflective ovoid structures protruding from epidermis correlated with sBCC.
Conclusion
We identified various microvascular and structural D-OCT features that may aid non-invasive identification of BCC subtypes. This would allow clinicians to individualize and optimize BCC treatment as well as aid follow-up of non-surgical treatment.
This article is protected by copyright. All rights reserved.
Efficacy of Secukinumab in the Treatment of Moderate to Severe Plaque Psoriasis in the North American Subgroup of Patients: Pooled Analysis of Four Phase 3 Studies
Abstract
Introduction
Demographic and disease characteristics may impact response to psoriasis therapies. The objective of this study is to explore the safety and efficacy profile of secukinumab in North American (NA) versus non-NA patients with moderate to severe psoriasis.
Methods
Data were pooled from four phase 3 studies of secukinumab. Secukinumab (300 and 150 mg) was administered at baseline, weeks 1, 2, and 3, then every 4 weeks from week 4 to 48.
Results
Peak efficacy was observed at week 16 in NA and non-NA patients with secukinumab 300 mg and secukinumab 150 mg, and disease clearance was maintained to week 52. At week 52 with secukinumab 300 mg, Psoriasis Area and Severity Index (PASI) 90/100 response was achieved by 62.9%/37.9% of NA patients, respectively, and 70.2%/42.0% of non-NA patients, respectively. At week 52 with secukinumab 150 mg, PASI 90/100 response was achieved by 30.9%/17.5% of NA patients, respectively, and 53.9%/26.9% of non-NA patients, respectively. Response to secukinumab was rapid, and 50% reduction in mean PASI was achieved in both groups after 2.9 weeks with secukinumab 300 mg and 3.7 weeks with secukinumab 150 mg.
Conclusion
Despite differences in baseline characteristics, the efficacy and safety of secukinumab were similar among NA and non-NA patients.
Funding
Novartis Pharma AG.
Plain Language Summary
Plain language summary available for this article.
Scharfrandige Erosionen und Ulzerationen im Anschluss an ein Arzneimittelexanthem nach Sultamicillin-Gabe
Zusammenfassung
Es wird über den Fall einer Patientin mit neu aufgetretenen Erosionen und Ulzerationen im Anschluss an ein Arzneimittelexanthem durch Sultamicillin berichtet. Die Effloreszenzen traten nach topischer Behandlung mit Clobetasol und Prednicarbat sowie systemischer Gabe von Methylprednisolon auf. Im Hautabstrich wurden massiv Escherichia-coli-Bakterien nachgewiesen. Blutkulturen waren unauffällig. Ursächlich für Ecthymata gangraenosa bei unserer Patientin war eine iatrogene Immunsuppression bei transienter Bakteriämie.
Comprehensive analysis of the clinical immuno-oncology landscape
Abstract
Advances from immuno-oncology (IO) are changing the standard of care of many types of cancer, and the paradigm of cancer treatments and drug development is being rewritten on a regular basis. Moreover, an unprecedented number of new investigational agents and companies are entering the field of IO. As such, it has become challenging for oncology physicians conducting clinical trials, industry veterans developing IO drugs, and even regulators reviewing novel IO agents to keep track of the rapidly evolving landscape. To help the key stake holders in the field understand the latest IO landscape, we sought to present an unbiased, neutral, scientifically curated, and timely updated analysis of all the current IO agents in clinical development and the clinical trials testing these agents. We based our analyses on information collected from numerous trusted and publicly available sources. We have developed two databases. One database tracks 2004 IO agents (940 in clinical stage and 1064 in preclinical stage) against 303 targets, from 864 companies; the other tracks 3042 active clinical trials of these agents with a target enrollment of 577 076 patients. This report provides key analyses of these data. Furthermore, we will discuss a number of important and actionable trends in the current IO landscape: a large number of companies developing agents against the same IO targets; a rapid increase in the number of anti-PD-1/L1 combination studies, many of which are testing the same combinations and following inefficient patterns; and a significant increase in the number of small, investigator-initiated studies. For each of the findings, we speculate the causes and discuss a few initiatives that aim to address some of these challenges. Finally, by making these landscape analyses available, we aspire to inform the cancer community as they seek to strive for efficiencies and innovation while avoiding duplication.Hochwasser und Feststoffe: vom Sedimenttransport zum flussmorphologischen Raumbedarf
Zusammenfassung
Feststoffhaushalt und Sedimentdurchgängigkeit sind für viele Fragestellungen im Rahmen eines nachhaltigen Fließgewässermanagements von Bedeutung und spielen auch im Zusammenhang mit Hochwasserereignissen eine große Rolle. Sedimente werden im Hochwasserfall z. B. aus Stauräumen remobilisiert, jedoch auch in strömungsberuhigten Bereichen wie Hafeneinfahrten oder Vorländern abgelagert. Anlandungen im Flussprofil können zu früheren Ausuferungen während Hochwasserereignissen führen. Außerdem erhöhen Sedimente den Schaden im Vergleich zu Reinwasser und steigern die Kosten für Aufräumarbeiten. Dies veranschaulicht die Notwendigkeit von Strategien, um den Umgang mit Sedimenten zu optimieren. Um Maßnahmen planen, beurteilen bzw. durchführen zu können, sind Daten über den Sedimenttransport unerlässlich. Während Hochwasserereignissen ist die Erfassung von Daten etwa aufgrund der Strömungsbedingungen und des Totholztransportes eine besondere Herausforderung. Dabei sind gerade die Messdaten, die im Zuge solcher Ereignisse gewonnen werden, von großer Bedeutung, da währenddessen große Mengen an Material transportiert werden bzw. sich die Zusammensetzung der transportierten Sedimente ändern kann. Ein über alle Fachdisziplinen abgestimmtes Feststoffmanagementkonzept kann helfen, das Sedimentkontinuum wiederherzustellen und das Hochwasserrisiko sowie Schäden zu minimieren. Durch die Berücksichtigung des minimalen flussmorphologischen Raumbedarfs im Hochwassermanagement können Gebäude, Infrastruktur und sonstige anthropogene Nutzungen vor den erosiven Kräften des Flusses im Hochwasserfall geschützt und so die Schäden durch etwa Verwerfungen oder Flussbettverbreiterungen reduziert werden.
Generalized pustular psoriasis in a 92-year-old man with a homozygous nonsense mutation in IL36RN
Abstract
A 92-year-old man developed an erythematous eruption on the trunk and extremities with numerous pustules accompanied by fever. He had never experienced pustular eruption or been diagnosed with psoriasis previously. Skin biopsy revealed Kogoj's spongiform pustule, and he was diagnosed with generalized pustular psoriasis (GPP). Genomic DNA was extracted from his peripheral blood and the sequence of IL36RN gene was analyzed, which revealed a p.Arg10X homozygous mutation. Several cases of elderly-onset GPP have been reported, however, this is the oldest case of GPP. The existence of splice variants of IL36RN was suspected, but we could not detect any splice variants of IL36RN in this case or in a healthy control from peripheral blood samples.
Use of biological drugs in patients with psoriasis and psoriatic arthritis in Italy: Results from the PSONG survey
Abstract
This Italian multicenter retrospective study compared the drug survival and efficacy of different anti-TNF agents in psoriasis (PsO) and psoriatic arthritis (PsA) patients. A database of PsO/PsA patients treated with adalimumab, etanercept, and infliximab from May 2013 to May 2014 was analyzed. PASI 75, 90, and 100 was calculated at each time point to evaluate efficacy. Drug survival rate and probability of maintaining PASI response were evaluated. The impact of dependent variables on probability of PASI 75 loss was evaluated by logistic regression. 1,235 patients were included, 577 with PsO and 658 with PsA. Highest survival rates were observed with adalimumab followed by etanercept and infliximab in PsO and PsA patients. The probability of maintaining PASI response was significantly higher for adalimumab followed by infliximab. For PsO patients, the odds of losing PASI 75 was higher in etanercept-treated patients (OR: 8.1; 95% CI: 4.2–15.6, p < .001) or infliximab (OR: 6.6; 95% CI: 2.6–16.3, p < .001) vs. adalimumab. Likewise, for PsA patients the odds of losing PASI 75 was higher in etanercept-treated patients (OR: 2.3; 95% CI: 1.4–3.8, p = .01) or infliximab (OR: 2.2; 95% CI: 1.1–4.1, p = .018) vs. adalimumab. Adalimumab could be the best therapeutic option over other anti-TNF agents for the treatment of PsO and PsA patients.
Psoriasis improvement after gastric bandage in a patient partial responder to infliximab
Abstract
Patients overweight or obese have more severe psoriasis than normal weight patients. Sometimes the excessive weight is related to a lack of efficacy of systemic treatment. We report a case of a psoriatic patient that experienced a dramatic improvement of psoriasis after weight loss surgery by gastric bandage. The great weight loss was accompanied by an effectiveness gain of response to infliximab. The mechanism responsible for this association is not certain, but it is probably multifactorial, involving genetic, environmental and immune-mediated factors. It has been suggested that adipose tissue can dramatically alter the volume of drug distribution and limit drug efficacy. Moreover, a reduction of weight could favour the response to therapy and remission of the disease, inducing an improvement in patient's quality of life. Gastric bandage has a scarce rate of complications, a fast recovery and scarce life-threatening complications. It should be considered in obese patient that not shown effectiveness to therapy.
Case of thymoma-associated cutaneous graft-versus-host disease-like disease successfully improved by narrowband ultraviolet B phototherapy
Abstract
Thymoma-associated graft-versus-host disease (GVHD)-like disease is a rare paraneoplastic disease seen in patients with thymoma. Here, we describe the first case of thymoma-associated GVHD-like disease localized to the skin that was successfully improved by a combination of systemic corticosteroids and whole-body narrowband ultraviolet (UV)-B phototherapy. The patient had developed toxic epidermal necrolysis-like erosive skin lesions over the whole body. Although systemic corticosteroids were effective up to a point, we were unable to begin the steroid taper. The addition of systemic narrowband UV-B phototherapy improved the skin manifestation of this disease, allowing corticosteroids to be reduced to a third of the original dose. Histopathologically, it was confirmed that the proportion of Foxp3-positive lymphocytes in the skin increased after narrowband UV-B irradiation. We propose that whole-body narrowband UV-B phototherapy is a good therapeutic option for the skin manifestation of thymoma-associated GVHD-like disease.
Fathers Count: The Impact of Paternal Risk Factors on Birth Outcomes
Abstract
Objective To determine the contribution of paternal factors to the risk of adverse birth outcomes. Methods This is a retrospective cross-sectional analysis using birth certificate data from 2004 to 2015 retrieved from the Finger Lakes Regional Perinatal Data System. Primiparous women with singleton pregnancies were analyzed in the study. Two multivariate logistic regression models were conducted to assess potential paternal risk factors including age, race/ethnicity, and education on four birth outcomes, including preterm birth (PTB), low birthweight (LBW), high birthweight (HBW), and small for gestational age (SGA). Results A total of 36,731 singleton births were included in the analysis. Less paternal education was significantly related to an elevated risk of PTB, LBW, and SGA, even after adjustment for maternal demographic, medical, and lifestyle factors (P < 0.05). Paternal race/ethnicity was also significantly associated with all four birth outcomes (P < 0.05) while controlling for maternal factors. Older paternal age was associated with increased odds (OR 1.012, 95% CI 1.003–1.022) of LBW. Maternal race/ethnicity partially mediated the association of paternal race/ethnicity with HBW and SGA. Maternal education partially mediated the relationship between paternal education and SGA. Conclusion Paternal factors were important predictors of adverse birth outcomes. Our results support the inclusion of fathers in future studies and clinical programs aimed at reducing adverse birth outcomes.
Street foods exacerbate effects of the environmental burden of polycyclic aromatic hydrocarbons (PAHs) in Nigeria
Abstract
Polycyclic aromatic hydrocarbons (PAHs) are a large group of well-known toxicants with carcinogenic potential and other health effects including on the immune system. The high health risks of non-communicable diseases and relevant comorbidities in Africa, particularly in contaminated areas like e-waste and crude oil and gas exploration areas and for high consumers of food commodity groupings which are most critical for PAH exposure, are exacerbated by dietary exposure due to unsafe practices in commonly consumed foods, like those street vended.
In February 2016, 20 commonly consumed street foods were purchased directly from vendors at major bus stops in Benin City and Umunede in Nigeria. The concentration of 16 priority PAHs was determined. The dietary intake of B[a]P, ∑PAH, PAH4, PAH8, and ∑B(a)Peq was estimated for children, peripubertal children/adolescent, and adult using the total diet study (TDS) method. Among the analyzed PAHs, there was a predominance of chrysene (17.42 μg/kg). Roasted yam (14.15 μg/kg) and fried fish (1.40 μg/kg) had the highest levels of ∑PAH and B[a]P, respectively. The mean concentration of B[a]P, ∑PAH, PAH4, PAH8, and ∑B(a)Peq ranged from 0.65–1.40 μg/kg, 0.20–14.15 μg/kg, 0.43–5.22 μg/kg, 0.13–7.88 μg/kg, and 0.002–2.123 μg/kg, respectively. The mean concentration of B[a]P and PAH4 reported in this study was below the maximum allowable levels of 5 and 12 μg/kg for adults and above the maximum levels for young children set at 1.0 μg/kg for both B[a]P and PAH4 in food. The estimated dietary intake of B[a]P, ∑PAH, PAH4, PAH8, and ∑B(a)Peq for adult, adolescent, and children was 0.56, 0.37, and 0.31 μg/day; 17.6, 10.7, and 8.81 μg/day; 5.78, 4.01, and 3.26 μg/day; 9.22, 6.19, and 5.09 μg/day; and 1.72, 0.97, and 0.82 μg/day, respectively.
Street foods represent one important source of PAHs. The exposure occurring through street food compounds with that from home-made foods, environmental pollution, and lifestyle (tobacco smoke) is making up an aggregate daily exposure in the general population.
The incremental lifetime cancer risk for adults and children from the consumption of street food was 7.6 × 10−8 and 2.1 × 10−8, respectively. Along with initiatives to manage environmental contamination and promote healthier lifestyle, people should be empowered on healthy cooking practices and safe food cookery environments.
Flow evaluation of the leaching hazardous materials from spent nickel-cadmium batteries discarded in different water surroundings
Abstract
The leaching characteristics of hazardous materials from Ni-Cd batteries immersed in four typical water samples, i.e., water with NaCl, river water, tap water, and deionized water, were investigated to evaluate the potential environmental harm of spent Ni-Cd batteries in the water surroundings. It is shown that four water surroundings all could leach hazardous materials from the Ni-Cd batteries. The water with NaCl concentration of 66.7 mg L−1 had the highest leaching ability, the hazardous materials were leached after only approximately 50 days (average time, with a standard deviation of 4.1), while less than 100 days were needed in the others. An electrochemical corrosion is considered to be the main leaching mechanism leading to battery breakage, while the dissolution-deposition process and the powder route result in the leakage and transference of nickel and cadmium materials from the electrodes. The anions, i.e., SO42− and Cl−, and dissolved oxygen in water were demonstrated to be the vital factors that influence the leaching processes. Thus, it is proposed that spent Ni-Cd batteries must be treated properly to avoid potential danger to the environment.
MOF/graphene oxide composite as an efficient adsorbent for the removal of organic dyes from aqueous solution
Abstract
The metal-organic frameworks (MOFs) MIL-100(Fe) and graphene oxide (GO) composites were prepared by hydrothermal method and characterized by X-ray diffraction (XRD), nitrogen adsorption/desorption, thermal-gravimetric (TG) analysis, the Fourier Transform Infrared Spectroscopy (FTIR), and scanning electron microscopy (SEM). The composites were used for the adsorption of methylene blue (MB) and methyl orange (MO) in aqueous solution. The results indicated that MIL-100(Fe) and GO formed a sandwich-like structure, and the crystal structure of MIL-100(Fe) was reserved in the composites. The attachment of GO layers to the MIL-100(Fe) decreased the surface area from 1690 to 1602 m2/g, and pore volume from 0.996 to 0.770 cm3/g when 5% (w/w) GO was added, due to the coating of MIL-100(Fe) by GO sheets. The addition of 5% (w/w) GO increased the adsorption capacity for MB (from 1019 to 1231 mg/g) and MO (from 667 to 1189 mg/g). The composites showed a better thermal stability than MIL-100(Fe); the decomposition temperature increased from 280 to 350 °C. The addition of GO improved the properties of MIL-100(Fe) as an adsorbent for MO/MB from aqueous solution.
Tracking long-distance atmospheric deposition of trace metal emissions from smelters in the upper Columbia River valley using Pb isotope analysis of lake sediments
Abstract
Heavy metal discharge from mining and smelting operations into aquatic ecosystems can cause long-term biological and ecological impacts. The upper Columbia River is highly contaminated with heavy metal wastes from nearby smelting operations in Trail, British Columbia, Canada, and to a lesser extent, Northport (Le Roi smelter), Washington, USA. Airborne emissions from the Trail operations were historically and are currently transported by prevailing winds down the Columbia River canyon, where particulate metals can be deposited into lakes and watersheds. In lakes, sediment cores contain records of past environmental conditions, providing a timeline of fundamental chemical and biological relationships within aquatic ecosystems, including records of airborne metal depositions. We analyzed trace metal concentrations (Ni, Cd, Zn, As, Cu, Sb, Pb, Hg) and Pb isotope compositions of sediment cores from six remote eastern Washington lakes to assess potential sources of atmospheric heavy metal deposition. Sediment cores displayed evidence to support trace metal loading as a direct consequence of smelting operations in Trail. Smelter contamination was detected 144 km downwind of the Trail Smelter. Cd, Sb, Pb (p < 0.001), and to a lesser extent As and Hg (p < 0.05) concentrations were correlated with Pb isotope compositions, suggesting that the Trail operations were likely the main source for these trace metals.
Attractivité de la carrière hospitalo-universitaire en France : analyse de la perception des jeunes dermatologues en 2016
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A. Soria, B. Dreno, S. Aractingi, M. Beylot-Barry, C. Bodemer, O. Chosidow, B. Cribier, J.-P. Lacour, C. Paul, M.-A. Richard, C. Gaudy-Marqueste, M. Samimi
Clinical Research in Dermatology and Venereology in Spanish Research Centers in 2005 Through 2014: Results of the MaIND Study
Publication date: Available online 6 December 2017
Source:Actas Dermo-Sifiliográficas (English Edition)
Author(s): A. Molina-Leyva, M.A. Descalzo, I. García-Doval
Background and objectiveBibliometric indicators provide a useful measure of the number of clinical research articles published in scientific journals and their quality. This study aimed to assess the amount and quality of research carried out in Spanish dermatology centers and to describe the research topics.Material and methodBibliometric study of clinical research articles that met the inclusion criteria and had a definitive publication date between 2005 and 2014 in MEDLINE or Embase in which the corresponding author's affiliation was a Spanish hospital dermatology department or other center.ResultsOf 8,617 articles found, 1,104 (12.81%) met the inclusion criteria. The main reason for excluding articles was that they did not have an evidence level of 4 or better. The main vehicle for reporting was the journal Actas Dermosifiliográficas, which published 326 articles (29.53%). Melanoma, the disease the researchers studied most often, accounted for 134 articles (12.13%).LimitationsA limitation to bear in mind when interpreting the results is that we relied on the corresponding author's affiliation to identify articles reflecting research from a Spanish dermatology center. Thus, studies in which dermatologists participated would not be recognized if they were directed by other specialists.ConclusionOnly a small portion of articles published from Spanish dermatology centers can be considered clinical research, mainly because many publications provide a low level of scientific evidence. Most publications are case reports.
Slow-Growing Pink Papule
Publication date: Available online 6 December 2017
Source:Actas Dermo-Sifiliográficas (English Edition)
Author(s): J.L. Ramírez-Bellver, S. Saenz Guirado
Granuloma telangiectásico tratado con crioterapia: una alternativa terapéutica a la cirugía en casos excepcionales
Publication date: Available online 6 December 2017
Source:Piel
Author(s): Cristina Martínez, Gabriela Tapia, Isabel Jimeno, Andrea Elgueta
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Publication date: Available online 25 July 2018 Source: Journal of Photochemistry and Photobiology B: Biology Author(s): Marco Ballestr...
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Editorial AJR Reviewers: Heartfelt Thanks From the Editors and Staff Thomas H. Berquist 1 Share + Affiliation: Citation: American Journal...
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