Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00306932607174,00302841026182,alsfakia@gmail.com
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Παρασκευή 15 Δεκεμβρίου 2017
Genetic Overview of Syndactyly and Polydactyly
Tratamiento de la enfermedad de injerto contra huésped crónica esclerodermiforme con imatinib: una perspectiva dermatológica
Publication date: Available online 15 December 2017
Source:Actas Dermo-Sifiliográficas
Author(s): P. Molés-Poveda, P. Montesinos, J. Sanz-Caballer, B. de Unamuno, J.L. Piñana, A. Sahuquillo, R. Botella-Estrada
IntroducciónLa enfermedad de injerto contra huésped crónica (EICHc) es la causa más importante de mortalidad tardía no relacionada con la recidiva del trasplante alogénico de células progenitoras hematopoyéticas. La EICHc esclerodermiforme suele ser refractaria a los corticosteroides y supone todo un reto terapéutico. Se han descrito anticuerpos activadores contra el RFCDP en pacientes con EICHc esclerodermiforme. Estos anticuerpos inducen la fosforilación del RFCDP, produciendo fibrosis. Hay cada vez más evidencias de la efectividad de imatinib, un inhibidor de la tirosina cinasa, en el tratamiento de la EICHc esclerodermiforme.ObjetivoEvaluar la respuesta de la EICHc esclerodermiforme al imatinib.Materiales y métodosEstudio retrospectivo de 18 pacientes con EICHc cutánea esclerodermiforme refractaria a inmunosupresores tratada con imatinib en un único centro. La evaluación de la respuesta al tratamiento se realizó mediante valoración clínica del dermatólogo y percepción subjetiva del paciente tras uno, 3, 6, 9, 12 y 18 meses de iniciar el tratamiento con imatinib. La respuesta fue valorada como completa, parcial, significativa, sin cambios o progresión. El descenso de la dosis de esteroides se catalogó como completo, parcial o no posible.ResultadosEn nuestra serie, 4 (22%) pacientes lograron una respuesta completa, 9 (50%) alcanzaron una respuesta parcial, 2 (11%) tuvieron un grado significativo de respuesta, 2 (11%) no presentaron ningún cambio y uno (6%) experimentó avance de la enfermedad en el último seguimiento que se llevó a cabo. El tiempo medio transcurrido desde el inicio del imatinib hasta mostrar algún grado de respuesta fue de 2,75 meses (rango 1-9 meses).ConclusionesEste estudio apoya la evidencia de la utilidad del imatinib en el tratamiento de la EICHc esclerodermiforme.IntroductionChronic graft-versus-host disease (cGVHD) is the most important cause of late non-relapse mortality after allogeneic hematopoietic stem cell transplantation. Sclerodermatous cGVHD is usually steroid refractory and remains a therapeutic challenge. Activating antibodies against the PDGFR have been reported in patients with sclerodermatous cGVHD. These antibodies induce PDGFR phosphorylation and lead to fibrosis. There is increasing evidence of successful treatment of sclerodermatous cGVHD with imatinib, a tyrosine kinase inhibitor.ObjectiveTo evaluate the response of cutaneous sclerodermatous cGVHD to imatinib.Materials and methodsRetrospective study of 18 patients with sclerodermatous cGVHD refractory to immunosuppressants treated with imatinib in a single center. Evaluation of treatment response was performed by clinicians' assessment and patients' subjective response at one, 3, 6, 9, 12 and 18 months after initiation of imatinib. Response was assessed as complete, partial, significant, no change or progression. Tapper off steroids was complete, partial or not possible.ResultsIn our series, 4 (22%) patients achieved complete response, 9 (50%) patients partial response, 2 (11%) patients significant response, 2 (11%) patients had no change and one (6%) patient progressive disease at last follow-up. Mean time from initiation of imatinib to any degree of response was 2,75 months (range 1-9 months).ConclusionsThis study provides further evidence of the role of imatinib for the treatment of steroid refractory sclerodermatous cGVHD.
High fat diet exacerbates imiquimod-induced psoriasis-like dermatitis in mice
Abstract
Psoriasis, a chronic inflammatory skin disease, is closely related to systemic metabolism. An elevated body mass index (BMI) is a risk factor for psoriasis; inflammasomes are activated by adipose tissue macrophages in obese subjects. We hypothesized that hyperlipidemia is involved in the pathogenesis of psoriasis and examined the role of a high fat diet (HFD) in the development of psoriasis in imiquimod (IMQ)-treated mice. The body weight and serum level of cholesterol were significantly higher in mice fed an HFD than a regular diet (RD). HFD mice had higher psoriasis skin scores and the number of neutrophils infiltrating into the lesional skin was elevated. IL-17A mRNA expression was significantly increased in the skin of IMQ-treated HFD mice; the expression of IL-22, IL-23, and TNF-α mRNA was not enhanced. Caspase-1 and IL-1β were activated in the skin of IMQ-treated HFD mice and their serum level of IL-17A, TNF-α, and IL-1β was significantly upregulated. Our findings strongly suggest that hyperlipidemia is involved in the development and progression of psoriasis via systemic inflammation and inflammasome activation.
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(−)-Epigallocatechin-3-gallate, the major green tea catechin, regulates the desensitization of β1 adrenoceptor via GRK2 in experimental heart failure
Abstract
Objective
We investigated the effect of (−)-epigallocatechin-3-gallate (EGCG) on cardiac function and its mechanism, which focused on the desensitization of β1-AR and GRK2 in heart failure (HF) rats.
Methods
HF was induced by abdominal aortic coarctation. Four weeks after HF induction, the rats were given EGCG (25, 50, 100 mg/kg/day). Cardiac function was assessed by measuring haemodynamic parameters. Histological changes were analyzed by HE and Masson's trichrome staining. The expression of β1-AR was detected by immunohistochemistry and immunofluorescence. The membrane expression of β1-AR and GRK2 was detected by western blot. The expression levels of β1-AR mRNA and GRK2 mRNA were evaluated by Q-PCR.
Result
Compared to the control group, the left ventricular end diastolic pressure, mean blood pressure, heart weight/body weight, and posterior wall thickness in the HF group were significantly increased, whereas the left ventricular systolic pressure, maximum rate of left ventricular pressure rise (+ dP/dt max) and maximum rate of left ventricular pressure fall (− dP/dt max) were clearly decreased. EGCG could improve cardiac function by regulating these parameters. Inflammatory cell infiltration, irregularly arranged cardiomyocytes, swelling of cardiomyocytes and myocardial fibrosis were observed in HF rats' myocardial morphology, and EGCG obviously improved the morphological signs. The expression of β1-AR was significantly decreased in the left ventricle tissue of HF rats by immunohistochemistry and immunofluorescence. The membrane expression of β1-AR decreased, whereas GRK2 increased in vivo and in vitro by western blot. EGCG could down-regulate the membrane expression of GRK2 and up-regulate the expression of β1-AR. There were no significant differences in the total expression of β1-AR mRNA and GRK2 mRNA.
Conclusions
EGCG has therapeutic effects on the heart function of HF rats. The mechanism might be related to the inhibition of the transfer membrane of GRK2 and to the reduction of the desensitization of β1-AR.
Chronic Long-Standing Temporomandibular Joint Dislocation: Report of Three Cases and Review of Literature
Abstract
Purpose
To present three cases of chronic long-standing TMJ dislocation and discuss our treatment protocol with other options in the literature.
Patients and methods
Three cases of chronic TMJ dislocation (more than 4 months) that has never been reduced previously were treated by open reduction, meniscectomy or meniscoplasty and lateral pterygoid muscle myotomy. After a short period of MMF, TMJ physiotherapy was performed.
Results
During 3 years of follow-up, the condition had not recurred at all and all patients were functional and symptom free.
Conclusion
Based on other therapeutic options in the literature, our treatment protocol seems to be an effectual operation with fewer complications.
Pityriasis rubra pilaris: Algorithms for diagnosis and treatment
Abstract
Pityriasis rubra pilaris (PRP) is a rare inflammatory skin disease that affects men and women of all ages and also children. The clinical appearance of PRP is highly variable, as is the individual prognosis. Therefore, stratifying PRP into six disease subtypes represents a first step to personalized medicine for this rare inflammatory skin disease. The next step should be to associate specific therapeutic strategies with these subtypes of PRP. However, no randomized, controlled trials on the treatment of PRP have been performed. Consequently, the actual treatment algorithm for PRP will be based on clinical experience, small case series, and case reports. The majority of published evidence is on type I PRP, whereas the treatment experience for other clinical types of PRP is still sparse and has to be gained. Nevertheless, it is now time to start developing valid algorithms as a basis for the diagnosis and treatment of PRP based on the data available.
This review makes use of algorithms developed in psoriasis and atopic eczema and puts together recent insights into the pathogenesis, diagnosis and treatment experience of PRP. The innovative intention of this appraisal is to develop a structured algorithm for PRP treatment that should be further developed going forward.
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The many faces of tuberculosis of the oral mucosa- Three cases with distinct pathomechanisms
Abstract
Tuberculosis (TB) is a chronic infectious disease caused by the acid-fast bacillus Micobacterium tuberculosis. Increased risk of infection occurs with HIV disease, intravenous drug abuse, malignancies, and treatment with immunosuppressants and immunobiologics 1
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Presenting symptoms and long term survival in Head and Neck cancer
Abstract
Objectives
To assess how type and number of symptoms are related to survival in head and neck cancer patients.
Design
Patients were followed-up for over 10 years from the Scottish Audit of Head and Neck Cancer; (national cohort of head and neck cancer patients in Scotland 1999 – 2001). September 2013, cohort was linked to national mortality data. First, second and third presenting symptoms were recorded at diagnosis.
Setting
National prospective audit – Scotland.
Participants
A subset of 1589 patients, from the original cohort of 1895, who had cancer arising from one of the four main subsites; larynx, oropharynx, oral cavity and hypopharynx.
Main outcome measures
Median survival in relation to patients' presenting symptoms.
Results
1146 (72%) males and 443 (28%) females, mean age at diagnosis 64 years (13 – 95). There was a significant difference in survival in relation to the number of the patient's presenting symptoms; one symptom had a median survival of 5.3 years compared with 1.1 years for three symptoms. Patients who presented with weight loss had a median survival of 0.8 years, compared to 4.2 years if they did not (p<0.001). Patients who presented with hoarseness had a median survival of 5.9 years compared to 2.6 years without (p<0.001). There was no significant difference in long term survival for patients who presented with an ulcer, compared to those that did not (p=0.105).
Conclusions
This study highlights the importance of patients' presenting symptoms, giving valuable information in highlighting appropriate "red flag" symptoms and subsequent treatment planning and prognosis.
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Shifts from methyl chloride sink to source functions within a coastal salt marsh in eastern China: an examination of the effects of biomass burning prohibition policies
Abstract
Our previous study found that a salt marsh in eastern China can act as a large CH3Cl sink. One striking finding of this previous study was a strong relationship between high-ambient CH3Cl concentrations and fluxes during the growing season. Moreover, the high-ambient CH3Cl concentration was likely to be related to local biomass burning. However, implementation of biomass burning prohibition policies has effectively reduced biomass burning. Therefore, we predicted that the prohibition of biomass burning would alter CH3Cl concentration and flux within the eastern Chinese coastal salt marsh. In this study, we used static flux chambers to measure CH3Cl fluxes in the early (July of 2004 and January of 2005) and middle-late stages (August and December of 2013) of biomass burning prohibition of along a creek and vegetation transects of the salt marsh. After implementation of the biomass burning prohibition, the concentration and flux of CH3Cl directly related to biomass burning changed remarkably. During the middle-late stage of prohibition, the initial CH3Cl concentration was significantly reduced compared to during the early stage of prohibition. Reductions in atmospheric CH3Cl concentration were especially apparent during the growing season, when biomass burning was prohibited and atmospheric CH3Cl concentration dropped to levels nearly as low as the Northern Hemisphere background concentration. Atmospheric CH3Cl concentration significantly varied throughout the salt marsh, with the highest concentrations appearing over the inland areas and mudflat and lower values occurring over the middle locations. This spatial distribution of CH3Cl may have been directly related to the existence and distribution of potential CH3Cl sources, such as coastal seawater, terrestrial biomass burning, and senescent and decaying aboveground biomass. These changes in initial CH3Cl concentration caused by the biomass burning prohibition may eventually lead to shift in the salt marsh from the tendency to act as a CH3Cl sink to the tendency to act as a CH3Cl source. When the initial atmospheric CH3Cl concentration was high, the vegetation stands acted as CH3Cl sinks. Conversely, they became CH3Cl sources. Therefore, we conclude that the biomass burning prohibition altered the ecosystem–atmosphere exchange of CH3Cl within the studied eastern Chinese coastal salt marsh.
Emerging Therapies for Atopic Dermatitis: TRPV1 Antagonists
Transient receptor potential (TRP) ion channels are important mediators of somatosensory signaling throughout the body. Our understanding of the contribution of TRPs to a multitude of cutaneous physiologic processes has grown substantially in the past decade. TRPV1, one of the better-understood members of this large family of ion channels, impacts multiple pathways involved in pruritus. Further, TRPV1 appears to play a role in maintaining skin barrier function. Together, these properties make TRPV1 a ripe target for new therapies in atopic dermatitis.
Interferonregulatoryfactor-8(IRF-8) regulates the expression of matrix metalloproteinase-13 (MMP-13) in chondrocytes
Abstract
Low levels of inflammation-induced expression of matrix metalloproteinase (MMP) play a crucial role in articular cartilage matrix destruction in osteoarthritis (OA) patients. Interferon regulatory factor-8 (IRF-8), an important member in the IRF family, plays a key role in regulating the inflammation-related signaling pathway. The aim of this study is to investigate the physiological roles of IRF-8 in the pathological progression of OA. We found that IRF-8 was expressed in human primary chondrocytes. Interestingly, the expression of IRF-8 was upregulated in OA chondrocytes. In addition, IRF-8 was increased in response to interleukin-1β (IL-1β) treatment, mediated by the Janus kinase 2 (JAK2) pathway. Overexpression of IRF-8 in human chondrocytes by transduction with lentiviral-IRF-8 exacerbated IL-1β-induced expression of matrix metalloproteinase-13 (MMP-13) in human chondrocytes. In contrast, knockdown of IRF-8 inhibited IL-1β-induced expression of MMP-13. Importantly, IRF-8 could bind to the promoter of MMP-13 and stimulate its activity. Additionally, overexpression of IRF-8 exacerbated IL-1β-induced degradation of type II collagen. However, silencing IRF-8 abrogated the degradation of type II collagen. Taken together, our findings identified a novel function of IRF-8 in regulating articular cartilage matrix destruction by promoting the expression of MMP-13.
Heavy metal pollution in immobile and mobile components of lentic ecosystems—a review
Abstract
With growing population and urbanization, there is an increasing exploitation of natural resources, and this often results to environmental pollution. In this review, the levels of heavy metal in lentic compartments (water, sediment, fishes, and aquatic plants) over the past two decades (1997–2017) have been summarized to evaluate the current pollution status of this ecosystem. In all the compartments, the heavy metals dominated are zinc followed by iron. The major reason could be area mineralogy and lithogenic sources. Enormous quantity of metals like iron in estuarine sediment is a very natural incident due to the permanently reducing condition of organic substances. Contamination of cadmium, lead, and chromium was closely associated with anthropogenic origin. In addition, surrounding land use and atmospheric deposition could have been responsible for substantial pollution. The accumulation of heavy metals in fishes and aquatic plants is the result of time-dependent deposition in lentic ecosystems. Moreover, various potential risk assessment methods for heavy metals were discussed. This review concludes that natural phenomena dominate the accumulation of essential heavy metals in lentic ecosystems compared to anthropogenic sources. Amongst other recent reviews on heavy metals from other parts of the world, the present review is executed in such a way that it explains the presence of heavy metals not only in water environment, but also in the whole of the lentic system comprising sediment, fishes, and aquatic plants.
Rethinking moral distress: conceptual demands for a troubling phenomenon affecting health care professionals
Abstract
Recent medical and bioethics literature shows a growing concern for practitioners' emotional experience and the ethical environment in the workplace. Moral distress, in particular, is often said to result from the difficult decisions made and the troubling situations regularly encountered in health care contexts. It has been identified as a leading cause of professional dissatisfaction and burnout, which, in turn, contribute to inadequate attention and increased pain for patients. Given the natural desire to avoid these negative effects, it seems to most authors that systematic efforts should be made to drastically reduce moral distress, if not altogether eliminate it from the lives of vulnerable practitioners. Such efforts, however, may be problematic, as moral distress is not adequately understood, nor is there agreement among the leading accounts regarding how to conceptualize the experience. With this article I make clear what a robust account of moral distress should be able to explain and how the most common notions in the existing literature leave significant explanatory gaps. I present several cases of interest and, with careful reflection upon their distinguishing features, I establish important desiderata for an explanatorily satisfying account. With these fundamental demands left unsatisfied by the leading accounts, we see the persisting need for a conception of moral distress that can capture and delimit the range of cases of interest.
The immune checkpoint molecule VISTA regulates allergen-specific Th2-mediated immune responses
Elemental composition in rainbow trout tissues from a fish farm from Patagonia, Argentina
Abstract
Rainbow trout is a salmonid specie of commercial importance raised in hatcheries in many countries. Studies over mineral requirements have being perform to guarantee the fulfillment of the nutritional needs and therefore improving the fish farm productions. The aim of this work was to investigate the performance of the elements like Ag, As, Br, Ca, Cr, Cs, Fe, Hg, K, Na, Rb, Se, and Zn, in rainbow trout from a Patagonian fish farming. Body burden of each element in relation to weight were analyzed for identifying potential bioaccumulation or dilution processes. Our results indicated that water and food were the sources for most of the elements, except Se and Ag. Selenium showed the highest value in unfertilized eggs, and Ag was detected in larvae newly after feeding. Toxic elements as Ag, Cr, and Hg were below the regulation standards for human consumption but tend to bioconcentrate in the juvenile state, and the As was during all the growth studied. The macro and micro nutrients assemble the daily requirements for the humans consume, excepting the K.
Technology acceptance perception for promotion of sustainable consumption
Abstract
Economic growth in the past decades has resulted in change in consumption pattern and emergence of tech-savvy generation with unprecedented increase in the usage of social network technology. In this paper, the technology acceptance value gap adapted from the technology acceptance model has been applied as a tool supporting social network technology usage and subsequent promotion of sustainable consumption. The data generated through the use of structured questionnaires have been analyzed using structural equation modeling. The validity of the model and path estimates signifies the robustness of Technology Acceptance value gap in adjudicating the efficiency of social network technology usage in augmentation of sustainable consumption and awareness. The results indicate that subjective norm gap, ease-of-operation gap, and quality of green information gap have the most adversarial impact on social network technology usage. Eventually social networking technology usage has been identified as a significant antecedent of sustainable consumption.
β-carotene and retinol reduce benzo[a]pyrene-induced mutagenicity and oxidative stress via transcriptional modulation of xenobiotic metabolizing enzymes in human HepG2 cell line
Abstract
Benzo[a]pyrene (B[a]P) is one of the polycyclic aromatic hydrocarbons which is formed due to smoking of foods, incomplete combustion of woods, vehicle exhausts, and cigarettes smokes. B[a]P gets entry into human and animal bodies mainly through their diets. Metabolic activation of B[a]P is required to induce mutagenesis and carcinogenesis in animal and human studies. Carotenoids and retinoids are phytochemicals that if ingested have multiple physiological interferences in the human and animal bodies. In this study, we firstly investigated the protective effects of β-carotene, β-apo-8-carotenal, retinol, and retinoic acid against B[a]P-induced mutagenicity and oxidative stress in human HepG2 cells. Secondly, we tested the hypothesis of modulating xenobiotic metabolizing enzymes (XMEs) by carotenoids and retinoids as a possible mechanism of protection by these micronutrients against B[a]P adverse effects. The obtained results declared that β-carotene and retinol significantly reduced B[a]P-induced mutagenicity and oxidative stress. Tested carotenoids and retinoids reduced B[a]P-induced phase I XMEs and induced B[a]P reduced phase II and III XMEs. Thus, the protective effects of these micronutrients are probably due to their ability of induction of phase II and III enzymes and interference with the induction of phase I enzymes by the promutagen, B[a]P. It is highly recommended to consume foods rich in these micronutrients in the areas of high PAH pollution.
Correctness of Self-Reported Task Durations: A Systematic Review
Toenail Manganese: A Sensitive and Specific Biomarker of Exposure to Manganese in Career Welders
Predicting Forearm Physical Exposures During Computer Work Using Self-Reports, Software-Recorded Computer Usage Patterns, and Anthropometric and Workstation Measurements
Solvent Transfer—Efficiency of Risk Management Measures
Sarin Exposures in A Cohort of British Military Participants in Human Experimental Research at Porton Down 1945–1987
Comparison of Respirable Mass Concentrations Measured by a Personal Dust Monitor and a Personal DataRAM to Gravimetric Measurements
Relationship Between Exposure to Second-Hand Smoke in the Workplace and Occupational Injury in the Republic of Korea
Taking Multiple Exposure Into Account Can Improve Assessment of Chemical Risks
Respiratory Symptoms in Hospital Cleaning Staff Exposed to a Product Containing Hydrogen Peroxide, Peracetic Acid, and Acetic Acid
Job Tasks as Determinants of Thoracic Aerosol Exposure in the Cement Production Industry
ART, Stoffenmanager, and TRA: A Systematic Comparison of Exposure Estimates Using the TREXMO Translation System
Efficacy and Safety of Ethanol Ablation for Branchial Cleft Cysts [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
Branchial cleft cyst is a common congenital lesion of the neck. This study evaluated the efficacy and safety of ethanol ablation as an alternative treatment to surgery for branchial cleft cyst.
MATERIALS AND METHODS:Between September 2006 and October 2016, ethanol ablation was performed in 22 patients who refused an operation for a second branchial cleft cyst. After the exclusion of 2 patients who were lost to follow-up, the data of 20 patients were retrospectively evaluated. All index masses were confirmed as benign before treatment. Sonography-guided aspiration of the cystic fluid was followed by injection of absolute ethanol (99%) into the lesion. The injected volume of ethanol was 50%–80% of the volume of fluid aspirated. Therapeutic outcome, including the volume reduction ratio, therapeutic success rate (volume reduction ratio of >50% and/or no palpable mass), and complications, was evaluated.
RESULTS:The mean index volume of the cysts was 26.4 ± 15.7 mL (range, 3.8–49.9 mL). After ablation, the mean volume of the cysts decreased to 1.2 ± 1.1 mL (range, 0.0–3.5 mL). The mean volume reduction ratio at last follow-up was 93.9% ± 7.9% (range, 75.5%–100.0%; P < .001). Therapeutic success was achieved in all nodules (20/20, 100%), and the symptomatic (P < .001) and cosmetic (P < .001) scores had improved significantly by the last follow-up. In 1 patient, intracystic hemorrhage developed during the aspiration; however, no major complications occurred in any patient.
CONCLUSIONS:Ethanol ablation is an effective and safe treatment for patients with branchial cleft cysts who refuse, or are ineligible for, an operation.
Hemodynamic Characteristics of Ruptured and Unruptured Multiple Aneurysms at Mirror and Ipsilateral Locations [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
Different hemodynamic patterns have been associated with aneurysm rupture. The objective was to test whether hemodynamic characteristics of the ruptured aneurysm in patients with multiple aneurysms were different from those in unruptured aneurysms in the same patient.
MATERIALS AND METHODS:Twenty-four mirror and 58 ipsilateral multiple aneurysms with 1 ruptured and the others unruptured were studied. Computational fluid dynamics models were created from 3D angiographies. Case-control studies of mirror and ipsilateral aneurysms were performed with paired Wilcoxon tests.
RESULTS:In mirror pairs, the ruptured aneurysm had more oscillatory wall shear stress (P = .007) than the unruptured one and tended to be more elongated (higher aspect ratio), though this trend achieved only marginal significance (P = .03, 1-sided test). In ipsilateral aneurysms, ruptured aneurysms had larger maximum wall shear (P = .05), more concentrated (P < .001) and oscillatory wall shear stress (P < .001), stronger (P < .001) and more concentrated inflow jets (P < .001), larger maximum velocity (P < .001), and more complex flow patterns (P < .001) compared with unruptured aneurysms. Additionally, ruptured aneurysms were larger (P < .001) and more elongated (P < .001) and had wider necks (P < .001) and lower minimum wall shear stress (P < .001) than unruptured aneurysms.
CONCLUSIONS:High wall shear stress oscillations and larger aspect ratios are associated with rupture in mirror aneurysms. Adverse flow conditions characterized by high and concentrated inflow jets; high, concentrated, and oscillatory wall shear stress; and strong, complex and unstable flow patterns are associated with rupture in ipsilateral multiple aneurysms. In multiple ipsilateral aneurysms, these unfavorable flow conditions are more likely to develop in larger, more elongated, more wide-necked, and more distal aneurysms.
Preoperative Cerebral Oxygen Extraction Fraction Imaging Generated from 7T MR Quantitative Susceptibility Mapping Predicts Development of Cerebral Hyperperfusion following Carotid Endarterectomy [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Preoperative hemodynamic impairment in the affected cerebral hemisphere is associated with the development of cerebral hyperperfusion following carotid endarterectomy. Cerebral oxygen extraction fraction images generated from 7T MR quantitative susceptibility mapping correlate with oxygen extraction fraction images on positron-emission tomography. The present study aimed to determine whether preoperative oxygen extraction fraction imaging generated from 7T MR quantitative susceptibility mapping could identify patients at risk for cerebral hyperperfusion following carotid endarterectomy.
MATERIALS AND METHODS:Seventy-seven patients with unilateral internal carotid artery stenosis (≥70%) underwent preoperative 3D T2*-weighted imaging using a multiple dipole-inversion algorithm with a 7T MR imager. Quantitative susceptibility mapping images were then obtained, and oxygen extraction fraction maps were generated. Quantitative brain perfusion single-photon emission CT was also performed before and immediately after carotid endarterectomy. ROIs were automatically placed in the bilateral middle cerebral artery territories in all images using a 3D stereotactic ROI template, and affected-to-contralateral ratios in the ROIs were calculated on quantitative susceptibility mapping–oxygen extraction fraction images.
RESULTS:Ten patients (13%) showed post-carotid endarterectomy hyperperfusion (cerebral blood flow increases of ≥100% compared with preoperative values in the ROIs on brain perfusion SPECT). Multivariate analysis showed that a high quantitative susceptibility mapping–oxygen extraction fraction ratio was significantly associated with the development of post-carotid endarterectomy hyperperfusion (95% confidence interval, 33.5–249.7; P = .002). Sensitivity, specificity, and positive- and negative-predictive values of the quantitative susceptibility mapping–oxygen extraction fraction ratio for the prediction of the development of post-carotid endarterectomy hyperperfusion were 90%, 84%, 45%, and 98%, respectively.
CONCLUSIONS:Preoperative oxygen extraction fraction imaging generated from 7T MR quantitative susceptibility mapping identifies patients at risk for cerebral hyperperfusion following carotid endarterectomy.
Basion-Cartilaginous Dens Interval: An Imaging Parameter for Craniovertebral Junction Assessment in Children [PEDIATRICS]
BACKGROUND AND PURPOSE:
Widening of the basion-dens interval is an important sign of cranioverterbral junction injury. The current literature on basion-dens interval in children is sparse and based on bony measurements with variable values. Our goal was to establish the normal values of a recently described new imaging parameter, the basion–cartilaginous dens interval in children.
MATERIALS AND METHODS:Three hundred healthy pediatric patients (0–10 years of age) were selected retrospectively. These patients were divided into 3 different groups: A (0–3 years), B (3–6 years), and C (6–10 years). The basion–cartilaginous dens interval was calculated on the sagittal MPR image of cervical spine CT in a soft-tissue window. The mean, SD, and the upper limit of normal (mean +2 SDs) of the 3 groups were calculated, and statistical tests were used to check for significant differences of the basion–cartilaginous dens interval among these 3 groups.
RESULTS:The upper limits of the basion–cartilaginous dens interval for the 3 groups were 5.34 mm in group A, 5.64 mm in group B, and 7.24 mm in group C. There were statistically significant differences in the basion–cartilaginous dens interval values among the 3 groups. There was no statistically significant difference in basion–cartilaginous dens interval values between groups A and B; however, values in group C were significantly different from those in both A and B. There was no statistically significant difference in the basion–cartilaginous dens interval values between males and females.
CONCLUSIONS:The basion–cartilaginous dens interval is a novel imaging parameter to assess cranioverterbral junction integrity in children, which includes the nonossified cartilage in the measurement.
Treatment of Middle Cerebral Artery Aneurysms with Flow-Diverter Stents: A Systematic Review and Meta-Analysis [INTERVENTIONAL]
BACKGROUND:
The safety and efficacy of flow-diversion treatment of MCA aneurysms have not been well-established.
PURPOSE:Our aim was to evaluate angiographic and clinical outcomes after flow diversions for MCA aneurysms.
DATA SOURCES:A systematic search of PubMed, MEDLINE, and Embase was performed for studies published from 2008 to May 2017.
STUDY SELECTION:According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we selected studies with >5 patients describing angiographic and clinical outcomes after flow-diversion treatment of MCA aneurysms.
DATA ANALYSIS:Random-effects meta-analysis was used to pool the following outcomes: aneurysm occlusion rate, procedure-related complications, rupture rate of treated aneurysms, and occlusion of the jailed branches.
DATA SYNTHESIS:Twelve studies evaluating 244 MCA aneurysms were included in this meta-analysis. Complete/near-complete occlusion was obtained in 78.7% (95% CI, 67.8%–89.7%) of aneurysms. The rupture rate of treated aneurysms during follow-up was 0.4% per aneurysm-year. The rate of treatment-related complications was 20.7% (95% CI, 14%–27.5%), and approximately 10% of complications were permanent. The mortality rate was close to 2%. Nearly 10% (95% CI, 4.7%–15.5%) of jailed arteries were occluded during follow-up, whereas 26% (95% CI, 14.4%–37.6%) had slow flow. Rates of symptoms related to occlusion and slow flow were close to 5%.
LIMITATIONS:Small and retrospective series could affect the strength of the reported results.
CONCLUSIONS:Given the not negligible rate of treatment-related complications, flow diversion for MCA aneurysms should be considered an alternative treatment when traditional treatment methods are not feasible. However, when performed in this select treatment group, high rates of aneurysm occlusion and protection against re-rupture can be achieved.
Pial Artery Supply as an Anatomic Risk Factor for Ischemic Stroke in the Treatment of Intracranial Dural Arteriovenous Fistulas [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
Although intracranial dural arteriovenous fistulas are principally supplied by dural branches of the external carotid, internal carotid, and vertebral arteries, they can also be fed by pial arteries that supply the brain. We sought to determine the frequency of neurologic deficits following treatment of intracranial dural arteriovenous fistulas with and without pial artery supply.
MATERIALS AND METHODS:One hundred twenty-two consecutive patients who underwent treatment for intracranial dural arteriovenous fistulas at our hospital from 2008 to 2015 were retrospectively reviewed. Patient data were examined for posttreatment neurologic deficits; patients with such deficits were evaluated for imaging evidence of cerebral infarction. Data were analyzed with multivariable logistic regression.
RESULTS:Of 122 treated patients, 29 (23.8%) had dural arteriovenous fistulas with pial artery supply and 93 (76.2%) had dural arteriovenous fistulas without pial arterial supply. Of patients with pial artery supply, 4 (13.8%) had posttreatment neurologic deficits, compared with 2 patients (2.2%) without pial artery supply (P = .04). Imaging confirmed that 3 patients with pial artery supply (10.3%) had cerebral infarcts, compared with only 1 patient without pial artery supply (1.1%, P = .03). Increasing patient age was also positively associated with pial supply and treatment-related complications.
CONCLUSIONS:Patients with dural arteriovenous fistulas supplied by the pial arteries were more likely to experience posttreatment complications, including ischemic strokes, than patients with no pial artery supply. The approach to dural arteriovenous fistula treatment should be made on a case-by-case basis so that the risk of complications can be minimized.
Quantitative Synthetic MRI in Children: Normative Intracranial Tissue Segmentation Values during Development [PEDIATRICS]
BACKGROUND AND PURPOSE:
Synthetic MR imaging is a new technique to create absolute R1 relaxivity (1/T1), R2 relaxivity (1/T2), and proton-density maps using a single multiple-spin-echo saturation recovery sequence. These relaxivity maps allow rapid automated intracranial segmentation of tissue types. To assess its utility in children, we created a normative data base of intracranial volume and brain parenchymal, GM, WM, CSF, and myelin volumes in a pediatric population with normal brain MRI findings using synthetic MR imaging.
MATERIALS AND METHODS:All multiple-spin-echo saturation recovery sequences containing brain MR imaging examinations performed during 34 months were retrospectively reviewed. Abnormal examination findings were excluded following a detailed radiographic and clinical chart review. The remaining normal examination findings were then quantitatively analyzed with synthetic MR imaging. Intracranial, brain parenchymal, GM, WM, CSF, and myelin volumes were plotted versus age. Qualitative assessment of segmentation accuracy was performed. Selected abnormal examination findings were compared with these normative curves.
RESULTS:One hundred twenty-two MRI examinations with normal findings were included of individuals ranging from 0.1 to 21.5 years of age (median, 11.8 years). Resulting normative data plots compared favorably with previously published data obtained using more onerous techniques. Differentiation from pathologic states was possible using quantitative values in select cases.
CONCLUSIONS:A pediatric data base of normal intracranial tissue volumes using a single sequence and rapid software analysis has been compiled and correlates with previously published data. This provides a framework for clinical interpretation of quantitative synthetic MR images during development. Improved age-based segmentation algorithms in young children are needed.
Predictive Models in Differentiating Vertebral Lesions Using Multiparametric MRI [SPINE]
BACKGROUND AND PURPOSE:
Conventional MR imaging has high sensitivity but limited specificity in differentiating various vertebral lesions. We aimed to assess the ability of multiparametric MR imaging in differentiating spinal vertebral lesions and to develop statistical models for predicting the probability of malignant vertebral lesions.
MATERIALS AND METHODS:One hundred twenty-six consecutive patients underwent multiparametric MRI (conventional MR imaging, diffusion-weighted MR imaging, and in-phase/opposed-phase imaging) for vertebral lesions. Vertebral lesions were divided into 3 subgroups: infectious, noninfectious benign, and malignant. The cutoffs for apparent diffusion coefficient (expressed as 10–3 mm2/s) and signal intensity ratio values were calculated, and 3 predictive models were established for differentiating these subgroups.
RESULTS:Of the lesions of the 126 patients, 62 were infectious, 22 were noninfectious benign, and 42 were malignant. The mean ADC was 1.23 ± 0.16 for infectious, 1.41 ± 0.31 for noninfectious benign, and 1.01 ± 0.22 mm2/s for malignant lesions. The mean signal intensity ratio was 0.80 ± 0.13 for infectious, 0.75 ± 0.19 for noninfectious benign, and 0.98 ± 0.11 for the malignant group. The combination of ADC and signal intensity ratio showed strong discriminatory ability to differentiate lesion type. We found an area under the curve of 0.92 for the predictive model in differentiating infectious from malignant lesions and an area under the curve of 0.91 for the predictive model in differentiating noninfectious benign from malignant lesions. On the basis of the mean ADC and signal intensity ratio, we established automated statistical models that would be helpful in differentiating vertebral lesions.
CONCLUSIONS:Our study shows that multiparametric MRI differentiates various vertebral lesions, and we established prediction models for the same.
Pacemakers in MRI for the Neuroradiologist [review-article]
SUMMARY:
Cardiac implantable electronic devices are frequently encountered in clinical practice in patients being screened for MR imaging examinations. Traditionally, the presence of these devices has been considered a contraindication to undergoing MR imaging. Growing evidence suggests that most of these patients can safely undergo an MR imaging examination if certain conditions are met. This document will review the relevant cardiac implantable electronic devices encountered in practice today, the background physics/technical factors related to scanning these devices, the multidisciplinary screening protocol used at our institution for scanning patients with implantable cardiac devices, and our experience in safely performing these examinations since 2010.
Financial development, income inequality, and CO 2 emissions in Asian countries using STIRPAT model
Abstract
The main purpose of this paper is to find the effects of financial development, income inequality, energy usage, and per capita GDP on carbon dioxide (CO2) emissions as well the environmental Kuznets curve (EKC) for the three developing Asian countries—Bangladesh, India, and Pakistan. Panel data during the period 1980–2014 and the Stochastic Impacts by Regression on Population, Affluence, and Technology model with fully modified ordinary least squares (FMOLS) are employed for empirical investigation. The results show that financial development has a significant negative relationship with CO2 emission in the three selected Asian countries with the exception of India. The results further reveal that income inequality in Pakistan and India reduce CO2 emission, while the result for Bangladesh is opposite. Likewise, energy usage has a significant positive effect on CO2 emission in Bangladesh, Pakistan, and India. Our empirical analysis based on long-run and short-run elasticity appraisal suggests the validation of the EKC in Pakistan and India. The study findings recommend an important policy insinuation. The study suggests introducing a motivational campaign for the inhabitant towards utilization of high-efficiency electrical appliances, constructing mutual cooperation for economic development rather involve in winning development race, and introducing effective pollution absorption measures along with big projects.
Passende Verordnungsmenge und Applikation von Topika
Zusammenfassung
Hintergrund
Die Abschätzung der notwendigen Verordnungsmenge sowie der Anwendungsmenge von Topika durch den Patienten bereitet in der Versorgung nicht selten Schwierigkeiten. Unzureichende oder unwirtschaftliche Versorgung kann die Folge sein. Um beide Fehlerbereiche zu minimieren, sind einfache Methoden und eine hinreichende Erfahrung in der Abschätzung passender Verordnungsmengen und der Vermittlung verständlicher Applikationsvorgaben wichtig.
Ziel der Arbeit
Es erfolgten die Aufzeigung des aktuellen Publikationsstandes und die Prüfung der Evidenz zur sachgerechten topischen Verordnungsmenge und deren Anwendung durch den Patienten.
Material und Methoden
Es wurde ein Literaturreview auf der Basis einer strukturierten Literaturrecherche in PubMed mit den einzeln und gepoolt eingesetzten Suchbegriffen „local therapy", „topical treatment", „prescription", „amount of ointment needed", „involved area", „BSA", „finger-tip-unit", „Rule of Hand", „calculated dosage" und „rule of nines" durchgeführt. Eingeschlossen wurden wissenschaftliche Originalarbeiten nach manuellem Screening des Titels und Abstracts hinsichtlich der Relevanz.
Ergebnisse
Die Suchstrategie identifizierte nach manueller Selektion 19 relevante Publikationen. Als Maß der genaueren Applikation wurde am häufigsten das Prinzip der Fingertip-Unit (Fingerspitzeneinheit; FTU) eingesetzt. Die sachgerechte Verordnungsmenge wird in Abhängigkeit des Bedarfs pro befallener Fläche berechnet.
Diskussion
Es besteht in Deutschland weiterhin Klärungsbedarf, inwieweit in der Versorgungsroutine optimierte Mengen verordnet und zur Anwendung empfohlen werden. Für die Patienteninstruktion ist die FTU in Verbindung mit der Handflächenregel („Rule of Hand") ein geeignetes Maß zur Selbstapplikation.
Cartilage Analogue of Fibromatosis in the Maxillary Alveolar Bone
Abstract
Cartilage analogue of fibromatosis is a relatively common tumor in the palms and soles of young children and adolescence. The characteristic histological finding of the tumor is the differentiation toward cartilage formation within a background of fibromatosis-like growth. Therefore, the tumor may cause potential diagnostic problems in the maxillofacial bones where it has not been described. The purpose of the present report is to describe the imaging characteristics, histological and immunohistochemical features of an extremely rare case of cartilage analogue of fibromatosis in the maxillary alveolar bone of a 25-year-old female.
Adjuvant everolimus in high-risk diffuse large B-cell lymphoma: final results from the PILLAR-2 randomized phase III trial
Pertuzumab, trastuzumab, and standard anthracycline- and taxane-based chemotherapy for the neoadjuvant treatment of patients with HER2-positive localized breast cancer (BERENICE): a phase II, open-label, multicenter, multinational cardiac safety study
Role of up-front autologous stem cell transplantation in peripheral T-cell lymphoma for patients in response after induction: An analysis of patients from LYSA centers
Circulating cell-free DNA as predictor of treatment failure after neo-adjuvant chemo-radiotherapy before surgery in patients with locally advanced rectal cancer
Burden of respiratory syncytial virus infection in South African HIV-infected and HIV-uninfected pregnant and post-partum women: A longitudinal cohort study
ACTG A5353: A pilot study of dolutegravir plus lamivudine for initial treatment of HIV-1-infected participants with HIV-1 RNA < 500,000 copies/mL
Surface properties of PM2.5 calcite fine particulate matter in the presence of same size bacterial cells and exocellular polymeric substances (EPS) of Bacillus mucitaginosus
Abstract
Microorganism cells and spores are the main components of PM2.5 (fine particulate matter) as well as fine mineral particles. In the microscopic system, the microorganisms will affect the minerals through attachment, charge neutralization, and dissolution related to the cell surface structure and metabolite. To explore the process and the results of microbial cells and their extracellular polymeric substances (EPS) acting on the surface properties of minerals of PM2.5 through the metabolism, a common native soil bacterium Bacillus mucitaginosus with abundant extracellular polymers was chosen as the tested strain. Meanwhile, as one of the PM2.5 common minerals, calcite fine particles were taken as the research object to explore the influence of microbial cells and extracellular polymers on its surface properties. High performance liquid chromatography (HPLC), inductively coupled plasma spectrometry (ICP), Zeta potential analysis, Fourier-transform infrared spectroscopy (FTIR), X-ray diffraction spectroscopy (XRD), and scanning electron microscopy (SEM) were used to characterize the composition of EPS, the soluble ions, surface charge, surface groups, crystal form, and surface morphology of calcite residual solid after being treated by the bacterial cells and EPS. The results revealed the EPS of B. mucitaginosus mainly consisted of protein and polysaccharides. Both the whole cell and its EPS could promote the dissolution of calcite particles into calcium ions. Due to the adhesion of organic groups on the calcite surface, the surface potential shifted significantly in the negative direction and the solution pH was clearly increased. The morphology of calcite surface was significantly changed after dissolution and re-crystallization. Experimental results also showed that the existence of the bacteria cells and EPS significantly affected the surface properties of calcite and provide a theoretical basis for the mechanism of PM fine particulate matter on human health impact for further study.
Combination of in situ spectroscopy and chemometric techniques to discriminate different types of Roman bricks and the influence of microclimate environment
Abstract
Red and yellow bricks are the wall-building materials generally used in Roman masonries. The reasons for the different coloration are not always understood, causing loss of crucial information both for the conservation and for the archaeological knowledge of the cultural sites. In this work, a combination of in situ analyses, employing portable Raman spectroscopy and handheld energy dispersive X-ray fluorescence (HH-ED-XRF) spectroscopy along with chemometric analysis, was carried out on ancient Roman bricks of the "Casa di Diana" building (Ostia Antica, Italy-130 CE). Specifically, the compounds and the characteristic elements, which describe each type of brick (red and yellow), were studied avoiding destructive or invasive sampling. The molecular analysis allowed us to identify the major and minor compounds that characterise the bricks (anatase, hematite, quartz, calcite and silicates). However, the elemental analysis gave more useful information. Thus, the complex HH-ED-XRF data matrix generated was treated by a specific principal component analysis (PCA) to identify behavioural differences of the coloured bricks. The results revealed that Ca and Fe are the discriminatory elements for the two types of bricks. The PCA outcomes suggest that the contribution of certain elements is different in the bricks (mainly Ca, P, Sr, As and S, for yellow bricks), which could indicate different raw materials. Even among bricks with the same red colour (Al, Si, Ti, K, Fe, Cr, Mn, Ni, Zn, Cu, Rb and Zr, seemed to be the elements linked to raw materials), as a function of the surface impacts (orientation and microclimate affect the salts' formation), a distinction was made. Furthermore, the PCA pointed out that the yellow bricks are those more affected by decaying processes (related with Ca, P and S), complying with the Raman spectroscopy results in which the efflorescences (gypsum) affect especially the surface of these types of bricks.
Seasonal and spatial variations of microcystins in Poyang Lake, the largest freshwater lake in China
Abstract
Poyang Lake is the largest freshwater lake in China and an important drinking water source. Since the year 2000, toxic cyanobacteria have been observed frequently in Poyang Lake. In the present study, spatial and seasonal variations of microcystins (MCs; MC-RR, MC-YR, and MC-LR) in water column were examined monthly from January to December (except the months of March, May, and November) in 2013, by using ultra-high-performance liquid chromatography-electrospray ionization tandem triple quadrupole/mass spectrometry (UPLC-MS/MS). MC-RR was the most dominant variant, followed by MC-LR, while MC-YR was detected in low concentration. Total MC concentrations (intracellular + extracellular MCs) ranged from 1.26 to 9916.05 ng/L, with an average of 469.99 ng/L, and only 3.14% (6 out of 192 samples) of the water samples contained MC concentrations that exceeded the drinking water guideline level of 1 μg/L for MC-LR proposed by the World Health Organization (WHO). MC concentrations in water column showed obvious seasonal variations in Poyang Lake. Intracellular and extracellular MCs were both at a low level from January to April but increased quickly from June to August and decreased dramatically thereafter. Intracellular MCs exhibited similar spatial distribution pattern with extracellular MCs. Both intracellular and extracellular MC concentrations in eastern bays and around Songmen Mountain of Poyang Lake were higher than other regions. Intracellular MC concentrations were positively correlated with Chl a (r = 046, P < 0.01), pH (r = 0.25, P < 0.01), cyanobacterial biomass (r = 0.40, P < 0.01), and temperature (r = 0.36, P < 0.01) but negatively correlated with TN (r = − 0.28, P < 0.01), suggesting that TN, cyanobacteria biomass, pH, and temperature might be regulating factors for MC production in Poyang Lake.
The association of windmills with conservation of pollinating insects and wild plants in homogeneous farmland of western Poland
Abstract
Loss of suitable seminatural habitats and homogenization of crop types have led to the population decline of pollinating insects in farmland. As these insects support crop production, many practical efforts aim to sustain pollinator diversity which is especially challenging in intensively managed and homogeneous farmland. However, there are ongoing changes of the farmland toward its multifunctionality that includes, for example, wind farm development. Windmills are often built within crops; thus, we examined if the noncropped area around windmills can be valuable habitats for wild plants and pollinating insects: bees, butterflies, and flies. Species richness, abundances, and species diversity index of plants and pollinators around windmills were similar to those found in grassland patches (a typical habitat for these insects) and higher than in the adjacent crops. Pollinator diversity index and species richness at windmills increased with the distance to the nearest grassland patch and windmill. The population sizes of pollinating insects were also positively associated with plant diversity. Particular groups of pollinators showed specific habitat associations: bees occurred mostly at windmills, butterflies were highly associated with grasslands, while flies occurred in a similar number at windmill and on grasslands. Since windmills are frequently built within extensive homogeneous fields, thus, they introduce pollination services into the interior of cropped areas, contrary to field margins, road verges, or seminatural grasslands. Thus, although the development of wind farms has various negative environmental consequences, they can be alleviated by the increase of the local population size and diversity of wild plants and pollinating insects at windmills.
Testing Pneumonia Vaccines in the Elderly: Determining a Case Definition for Pneumococcal Pneumonia in the Absence of a Gold Standard
Therapeutic patient education in children with moderate to severe atopic dermatitis: A multicenter randomized controlled trial in China
Abstract
Background
Therapeutic patient education is a continuous, systematic, patient-centered learning process to help patients and their families acquire and maintain the skills they need to manage their lives with a chronic disease. It has been proven effective in increasing treatment adherence and improving quality of life for patients with atopic dermatitis (AD) in Western countries. We introduce the first multicenter, randomized controlled clinical trial of therapeutic patient education in Chinese children with AD.
Objectives
To evaluate the effects of therapeutic patient education on the severity of AD, quality of life, and understanding and successful use of emollients in Chinese children with eczema.
Methods
We recruited 580 children, ages 2-14 years, with moderate to severe AD from six hospitals in China. Participants were randomized (1:1) to an intervention (n = 293) or control (n = 249) group. In addition to the severity of AD, data on quality of life and a questionnaire on family and patient knowledge of emollients were evaluated at the 6-month follow-up.
Results
On study completion, we found that the intervention group showed a significantly greater reduction in mean SCORing Atopic Dermatitis (P < .001) and Infant's Dermatology Life Quality Index (P = .030) scores than the control group. In addition, knowledge about the use of emollients improved significantly in the intervention group. There was no significant difference between groups in Children's Dermatology Life Quality Index scores.
Conclusions
The first randomized controlled trial of a therapeutic patient education program in China had positive long-term effects on decreasing eczema severity and improvement of quality of life in children 2-4 years of age with AD, as well as in promoting greater understanding of the use of emollients.
Kenneth Warren and the Great Neglected Diseases of Mankind Programme: The Transformation of Geographical Medicine in the US and BeyondBy Conrad Keating
A Decade of War: Prospective Trajectories of Posttraumatic Stress Disorder Symptoms Among Deployed US Military Personnel and the Influence of Combat Exposure
Best Practices for Gauging Evidence of Causality in Air Pollution Epidemiology
Estimating the Comparative Effectiveness of Feeding Interventions in the Pediatric Intensive Care Unit: A Demonstration of Longitudinal Targeted Maximum Likelihood Estimation
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Publication date: Available online 25 July 2018 Source: Journal of Photochemistry and Photobiology B: Biology Author(s): Marco Ballestr...
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Editorial AJR Reviewers: Heartfelt Thanks From the Editors and Staff Thomas H. Berquist 1 Share + Affiliation: Citation: American Journal...
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Publication date: Available online 28 September 2017 Source: Actas Dermo-Sifiliográficas Author(s): F.J. Navarro-Triviño