Genetic characterization of phenicol-resistant Escherichia coli and role of wild-type repressor/regulator gene ( acrR ) on phenicol resistance

Abstract

The genetic basis for phenicol resistance was examined in 38 phenicol-resistant clinical Escherichia coli isolates from poultry. Out of 62 isolates, 38 showed resistance for chloramphenicol and nine for florfenicol, respectively. Each strain also demonstrated resistance to a variety of other antibiotics. Molecular detection revealed that the incidence rates of the cat1, cat2, flo, flo-R, cmlA, and cmlB were 32, 29, 18, 13, 0, and 0%, respectively. Nineteen strains were tolerant to organic solvents. PCR amplification of the complete acrR (regulator/repressor) gene of five isolates revealed the amino acid changes in four isolates. DNA sequencing showed the non-synonymous mutations which change the amino acid, silent mutation, and nucleotide deletion in four isolates. MY09C10 showed neither deletion nor mutation in nucleotide. The AcrA protein of the AcrAB multidrug efflux pump was overexpressed in these strains. Complementation with a plasmid-borne wild-type acrR gene reduced the expression level of AcrA protein in the mutants and partially restored antibiotic susceptibility one- to fourfold. This study shows that mutations in acrR are an additional genetic basis for phenicol resistance.

Issue Information

Comments concerning ‘Meta-analysis of the association between vitiligo and the level of superoxide dismutase or malondialdehyde’

Photochemistry and Photophysics of Shinorine Dimethyl Ester

Abstract

The photostability and photophysical properties of the dimethyl ester of the mycosporine-like amino acid shinorine have been experimentally evaluated in aqueous solution and in the presence of direct micelles prepared with a cationic or an anionic detergent, respectively. In comparison with shinorine, the ester molecule increases the photostability, the fluorescence quantum yield and the fluorescence lifetime in water as well as in the micellar solutions. The effects are more pronounced in sodium dodecyl sulfate solutions and suggest that the electrostatic attractions with the micellar interface contribute to limit the movement of the molecules and influence the relative rate of their deactivation channels. However, the predominance of the non-radiative decay is maintained together with the UV photoprotective ability of this atypical mycosporine species.

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Identification of a Pyranocoumarin Photosensitizer that is a Potent Inhibitor of Keratinocyte Growth

Abstract

Photosensitizers are used in the treatment of epidermal proliferation and differentiation disorders such as psoriasis and vitiligo. In the present studies, a ring-expanded carbon homologue of the linear psoralen (furo[3,2-g]benzopyran-7-one) class of photosensitizers, 4,10-dimethyl-2H,8H-benzo[1,2-b:5,4-b']dipyran-2-one (NDH2476), was synthesized and analyzed for biological activity. Following activation by ultraviolet light (UVA, 320-400 nm), NDH2476 was found to be a potent inhibitor of keratinocyte growth (IC₅₀ = 9 nM). Similar derivatives methylated in the pyrane ring, or containing a saturated pyrane ring structure, were markedly less active or inactive as photosensitizers. NDH2476 was found to intercalate and damage DNA following UVA light treatment as determined by plasmid DNA unwinding and nicking experiments. Taken together, these data demonstrate that an intact furan ring in psoralen photosensitizers is not required for keratinocyte growth inhibition or DNA damage. Our findings that low nanomolar concentrations of a benzopyranone derivative was active as photosensitizer indicates that this or a structurally related compound may be useful in the treatment of skin diseases involving aberrant epidermal cell growth and differentiation.

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KLICK syndrome: an unusual phenotype

Erythrokeratoderma refers to a group of rare inherited disorders with both clinical and genetic heterogeneities.¹ Lesions usually start in infancy and are characterized by localized and well-demarcated erythematous and hyperkeratotic plaques, sometimes with a migratory nature. Erythrokeratoderma is often inherited as an autosomal dominant trait caused by mutations in the genes GJB3, GJB4, or GJA1, encoding connexins 31, 30.3, and 43, respectively. Erythrokeratoderma may be associated with neurological anomalies and can be caused by ELOVL4.² Recently, mutations in KDSR (3-ketodihydrosphingosine reductase), encoding an enzyme in the ceramide pathway were also demonstrated to lead to erythrokeratoderma.³

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Striate palmoplantar keratoderma resulting from a missense mutation in DSG1

palmoplantar keratodermas (PPKs, OMIM #144200) refer to a large phenotypically and genetically heterogeneous group of keratinisation disorders characterised by marked hyperkeratosis on the surface of the palms and soles.

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Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a critical appraisal

Summary

Aim

Blauvelt et al. (The Lancet 2017; 389: 2287-303) aimed to compare the long-term efficacy and safety of dupilumab with medium-potency topical corticosteroids (TCS) versus placebo with TCS in adults with moderate-to-severe atopic dermatitis (AD).

Setting and design

This multicentre randomised, double-blinded, placebo-controlled trial was conducted in hospitals, clinics and academic institutions across 161 sites in 14 countries.

Study exposure

Adults with moderate-to-severe AD were randomly assigned (3:1:3) to receive subcutaneous dupilumab 300mg once weekly (qw) plus TCS, dupilumab 300mg every 2 weeks (q2w) plus TCS, or placebo plus TCS until week-52.

Primary outcome measures

Co-primary efficacy endpoints were patients (%) achieving Investigator's Global Assessment (IGA) 0/1 and 2-points or higher improvement from baseline, and Eczema Area and Severity Index 75% improvement from baseline (EASI-75) at week-16.

Results

740 patients were included in the trial: 319 were randomly assigned to dupilumab qw, 106 to dupilumab q2w and 315 to the placebo arm. At week-16, more patients in the dupilumab groups achieved the co-primary endpoints: IGA 0/1 (39% [125 patients] qw dosing, 39% [41 patients] q2w dosing vs 12% [39 patients] receiving placebo; p<0.0001) and EASI-75 (64% [204] and 69% [73] vs 23% [73]; p<0.0001). Whilst no new safety signals were identified, adverse effects (AEs) were noted in 261 (83%) in those receiving dupilumab qw plus TCS, 97 (88%) dupilumab q2w plus TCS and 266 (84%) for placebo plus TCS. Rates of conjunctivitis, injection site reactions and local herpes simplex infections were higher in the dupilumab groups compared with placebo.

Conclusions

Blauvelt et al. concluded that dupilumab treatment added to TCS improved AD up to week-52 compared with TCS alone, and also demonstrated acceptable safety.

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Different residue behaviors of four pesticides in mushroom using two different application methods

Abstract

Pesticide residue in mushrooms is less known. In this study, the risks of beta-cypermethrin, pyriproxyfen, avermectin, and diflubenzuron in oyster and shiitake mushrooms were evaluated using two different treatments: substrate mixture and surface spraying. Almost all the concentrations of these pesticides at day 90 were higher than 80% of the initial concentrations, while it was less than 45% for all cases within 35 days by spraying. For surface spraying, the residues of beta-cypermethrin were 0.0843–1.22 mg kg⁻¹ in shiitake mushrooms and below 0.005 mg kg⁻¹ in oyster mushrooms; the residues of pyriproxyfen, avermectin, and diflubenzuron were 0.122–4.84, 0.00501–0.111, and 0.0681–1.91 mg kg⁻¹, respectively. The residues of beta-cypermethrin, pyriproxyfen, and diflubenzuron in oyster mushrooms (in shiitake mushrooms) at interval of 0, 3, 5 days (1, 5, 7 days) were below their MRLs in China or Japan. The residue of avermectin in both mushrooms was lower than its limit of detection. These results provide information to safe and proper use of the pesticides in oyster and shiitake mushrooms.

Combination effect of sponge iron and calcium nitrate on severely eutrophic urban landscape water: an integrated study from laboratory to fields

Abstract

In this study, the in situ restoration of urban landscape water through the combined application of sponge iron (SI) and calcium nitrate (CN) was conducted in the Xi'an Moat of China. The combination effect of SI and CN on the phosphorus (P) control was explored through laboratory and field experiments. Results showed that the optimum mass ratio of SI and CN was 4:1, and the optimum dosage of combined SI and CN was 1.4 g/L for controlling eutrophication in the water body at Xi'an Moat. The field experiment demonstrated that SI and CN efficiently controlled P concentration in overlying and interstitial water and obtained a maximum efficiency of 88.6 and 65.2% in soluble reactive P locking, respectively. The total P, organic P, and Ca-bound P contents in sediment simultaneously increased by 7.7, 15.2, and 2.4%, respectively, after 56 days. Therefore, the combined application of SI and CN achieved the goal of transferring the P from overlying and interstitial water to the sediment. Considering the environmental effect and economic investment, the combined application of SI and CN at a mass ratio of 4:1 and dosage of 1.4 g/L is an excellent choice for the in situ rehabilitation of eutrophic water with a high internal P load.

Characterization of atmospheric emission sources in lichen from metal and organic contaminant patterns

Abstract

Lichen samples from contrasted environments, influenced by various anthropic activities, were investigated focusing on the contaminant signatures according to the atmospheric exposure typologies. Most of the contaminant concentrations measured in the 27 lichen samples, collected around the industrial harbor of Fos-sur-Mer (France), were moderate in rural and urban environments, and reached extreme levels in industrial areas and neighboring cities (Al up to 6567 mg kg⁻¹, Fe 42,398 mg kg⁻¹, or ΣPAH 1417 μg kg⁻¹ for example). At the same time, a strong heterogeneity was noticed in industrial samples while urban and rural ones were relatively homogeneous. Several metals could be associated to steel industry (Fe, Mn, Cd), road traffic, and agriculture (Sb, Cu, Sn), or to a distinct chemical installation (Mo). As well, PCDFs dominated in industrial samples while PCDDs prevailed in urban areas. The particularities observed supported the purpose of this work and discriminated the contributions of various atmospheric pollution emission sources in lichen samples. A statistical approach based on principal component analysis (PCA) was applied and resolved these potential singularities into specific component factors. Even if a certain degree of mixing of the factors is pointed out, relevant relationships were observed with several atmospheric emission sources. By this methodology, the contribution of industrial emissions to the atmospheric metal, PAH, PCB, and PCDD/F levels was roughly estimated to be 60.2%, before biomass burning (10.2%) and road traffic (3.8%). These results demonstrate that lichen biomonitoring offers an encouraging perspective of spatially resolved source apportionment studies.

Application of magnetic nanoparticles coated with sodium dodecyl sulfate and modified with 2-(5-bromo-2-pyridylazo)-5-diethyl aminophenol as a novel adsorbent for dispersive-magnetic solid-phase extraction and determination of palladium in soil samples

Abstract

A rapid, sensitive, precise, and accurate dispersive-magnetic solid-phase extraction technique combined with flame atomic absorption spectrometry was established for pre-concentration and separation of Pd (II) in soil samples. In the developed system, 5-amine-1,10-phenanthroline was used as synergistic complexant; sodium dodecyl sulfate and 2-(5-bromo-2-pyridylazo)-5-diethyl aminophenol ligand coated on magnetic nanoparticles were synthesized by a chemical precipitation method, and then employed as the efficient magnetic adsorbent with good magnetic properties and dispersibility. Various operational parameters affecting the extraction efficiency has been studied and optimized in details. Under the optimum experimental conditions, the detection limit of the mentioned method for palladium ions was 0.12 μg/L, while the relative standard deviation was 1.8%. Finally, the developed method was applied for the analysis of palladium ions in three kinds of soil samples and quantitative recoveries were achieved over the range of 96.7–104.0%. It can be a powerful alternative applied to the determination of traces of Pd ions from various real samples in further researches.

Detection of human papillomavirus type 52 in a case of gluteal squamous cell carcinoma

Case of successfully switching from nivolumab to vemurafenib with oral corticosteroids

Two cases of Japanese spotted fever infected in Rokko mountain near urban area of southern Hyogo Prefecture

Dabrafenib and trametinib combination therapy safely performed in a patient with metastatic melanoma after severe liver toxicity due to vemurafenib

A study on residue levels of fungicides and insecticides applied according to the program of raspberry protection

Abstract

This paper presents surveys on residue levels of fungicides and insecticides applied according to the raspberry protection program. The field trials were conducted in 2013–2014 on a plantation of raspberry of the Laszka variety dessert raspberry very popular in Poland. Laboratory samples were collected starting from a day of the first fruit picking to the end of harvest. The highest mean residue levels were found for boscalid and pyraclostrobin (2.395 mg/kg and 0.732 mg/kg, respectively), in both cases they were at a level of about 24% of their maximum residue levels (MRLs); and for cypermethrin (0.235 mg/kg; i.e. close to 50% of its MRL). The long-term dietary intakes of those substances by Polish adult consumers were also at low levels of 0.52, 0.22, and 0.04% of acceptable daily intake (ADI), respectively. Therefore, the results obtained indicated that even on day zero of picking ripe raspberries, the pesticide residues not only were well below their corresponding MRLs, but also their daily intakes did not even approach 1% of the ADI. In 2013, pesticide residues in ripe fruit evolved according to a pattern different than in a subsequent year; while in 2014 they changed at a constant exponential rate.

Investigating the sorption behavior of cadmium from aqueous solution by potassium permanganate-modified biochar: quantify mechanism and evaluate the modification method

Abstract

In this work, a KMnO₄-modified-biochar-based composite material with manganese oxide produced at 600 °C was fabricated to investigate the sorption mechanism of Cd(II) and to comprehensively evaluate the effect of the modification on biochar properties. Cd(II) adsorption mechanisms were mainly controlled by interaction with minerals, complexation with oxygen-containing functional groups, and cation-π interaction. The sorption capacity was significantly reduced after a deash treatment of biochar, almost shrunk by 3 and 3.5 times for pristine biochar (PBC) and modified biochar (MBC). For deashed PBC, oxygen-containing functional groups were the main contributor toward Cd(II) adsorption while interaction with minerals was significantly compromised and became negligible. The sorption capacity was also apparently decreased after the deash treatment of MBC; however, for deashed MBC, interaction with minerals still was the main contributor to the sorption ability, which could be attributed to the mechanism of interaction of Cd(II) with loaded MnO_x on biochar. Cation-π interaction in MBC was notably enhanced compared to PBC due to the oxidation of KMnO₄ on biomass. Also, sorption performance by oxygen-containing functional groups was also enhanced. Hence, the modification by KMnO₄ has a significant effect on the Cd(II) sorption performance of biochar.

Wintertime carbonaceous aerosols over Dhauladhar region of North-Western Himalayas

Abstract

Carbonaceous aerosols play an important role in affecting human health, radiative forcing, hydrological cycle, and climate change. As our current understanding about the carbonaceous aerosols, the source(s) and process(es) associated with them in the ecologically sensitive North-Western Himalayas are limited; this systematic study was planned to understand inherent dynamics in the mass concentration and source contribution of carbonaceous aerosols in the Dhauladhar region. During four winter months (January 2015–April 2015), 24-h PM₁₀ samples were collected every week simultaneously at the rural site of Pohara (32.19° N, 76.20° E; 750 m amsl) and the urban location of Dharamshala (32.20° N, 76.32° E; 1350 m amsl). These samples were analyzed by using thermal/optical carbon analyzer for different carbon forms. Organic carbon (OC) dominated over elemental carbon (EC) and was found to be 59.3 and 64.1% in total carbon (TC) at Pohara and Dharamshala, respectively. The respective mass concentrations of OC and EC were higher at Pohara (6.8 ± 2.3 and 4.8 ± 2.0 μg.m⁻³) in comparison to that observed in Dharamshala (5.0 ± 3.1 and 2.5 ± 0.6 μg.m⁻³). The OC/EC ratio at Pohara (1.51 ± 0.41) indicates the dominance of fossil fuel combustion (coal and vehicular exhaust), while at Dharamshala, an OC/EC of 2.01 ± 1.07 signified additional contribution from secondary organic carbon (SOC). Diagnostic ratios (OC/EC and char-EC/soot-EC) suggested dominance of emissions from fossil fuel combustion sources over biomass burning sources in the region. Estimated non-sea salt (nss)K⁺/OC and nssK⁺/EC ratios indicated heterogeneity within the biomass burning sources over low and high altitude locations. A strong correlation between nssK⁺ and SOC over a high altitude urban location further suggested possible conversion of gaseous precursors to carbonaceous particles during coniferous wood burning.

Giant congenital melanocytic nevus with vascular malformation and epidermal cysts associated with a somatic activating mutation in BRAF

Summary

Giant congenital melanocytic nevi may be symptomatically isolated, or syndromic. Associations with capillary malformations are exceptional, and development of epidermal cysts has not been described. A 71-year old patient with a giant congenital melanocytic nevus of the lower back, buttocks and thighs was asymptomatic except for unexpected hemorrhage during partial surgical excision years before. Blunt trauma at age 64 initiated recurrent, severe pain under the nevus; multiple large epidermal cysts then developed within it. Imaging and biopsy showed a large, non-pulsatile venous malformation intermingled with the deep nevus. A low-abundance, heterozygous BRAF c.1799T>A (p.V600E) mutation was present in both gluteal and occipital congenital nevi; additional mutations in NRAS, GNAQ, GNA11, HRAS or PIK3CA were undetectable. This is the first demonstration of a recurrent BRAF mutation in multiple large congenital nevi from the same individual, confirming that this malformation can have multiple genetic origins. Early constitutive activation of BRAF can therefore cause unusual associations of giant nevi with vascular malformations, indicating that both pigment and endothelial cell physiology may be affected by mosaic RASopathies.

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Patient-specific estimation of detailed cochlear shape from clinical CT images

Abstract

Purpose

A personalized estimation of the cochlear shape can be used to create computational anatomical models to aid cochlear implant (CI) surgery and CI audio processor programming ultimately resulting in improved hearing restoration. The purpose of this work is to develop and test a method for estimation of the detailed patient-specific cochlear shape from CT images.

Methods

From a collection of temporal bone \(\mu \) CT images, we build a cochlear statistical deformation model (SDM), which is a description of how a human cochlea deforms to represent the observed anatomical variability. The model is used for regularization of a non-rigid image registration procedure between a patient CT scan and a \(\mu \) CT image, allowing us to estimate the detailed patient-specific cochlear shape.

Results

We test the accuracy and precision of the predicted cochlear shape using both \(\mu \) CT and CT images. The evaluation is based on classic generic metrics, where we achieve competitive accuracy with the state-of-the-art methods for the task. Additionally, we expand the evaluation with a few anatomically specific scores.

Conclusions

The paper presents the process of building and using the SDM of the cochlea. Compared to current best practice, we demonstrate competitive performance and some useful properties of our method.

Isotopic response

Assessment of a visual risk communication aid used to support patients with psoriasis in deciding about biological therapy

Exploring the effect of 5-Fluorouracil on conformation, stability and activity of lysozyme by combined approach of spectroscopic and theoretical studies

Publication date: February 2018
Source:Journal of Photochemistry and Photobiology B: Biology, Volume 179
Author(s): Sabera Millan, Lakkoji Satish, Krishnendu Bera, Monidipa Konar, Harekrushna Sahoo
In this present work, a detailed investigation of the effect of an anticancer drug, 5-Fluorouracil (5-FU), on conformation, stability and activity of lysozyme (Lyz) was reported. The interaction between Lyz and 5-FU was reflected in terms of intrinsic fluorescence quenching and change in secondary structure of Lyz. The mode of quenching mechanism involved was evaluated by the steady-state and time-resolved fluorescence measurements. Synchronous and Circular Dichroism (CD) results revealed the conformational changes induced in Lyz upon complexation with 5-FU. Additionally, the effect of temperature and chemical denaturant on the stability of Lyz-5FU complex was carried out. As well as the activity of Lyz in the absence and presence of 5-FU were measured using Micrococcus luteus strain. To support our experimental findings, in vitro interaction between Lyz and 5-FU was done by theoretical studies. The current study will provide a better understanding on the nature of the interactions possible between proteins and drug molecules, which might create a bench mark in medical science in terms of the toxic effect or biological benefits of drug molecules on protein structure and conformation.

Dermatomyositis: A Diagnostic Dilemma

Fluorescence microscopy for the evaluation of elastic tissue patterns within fibrous proliferations of the skin on hematoxylin-eosin-stained slides

Diagnosis of fibrous tumors can be challenging and expensive due to the use of special stains.

Reply to “Serious infections among a large cohort of subjects with systemically treated psoriasis”

Comment on “Association of bullous pemphigoid with malignancy: A systematic review and meta-analysis”

Standard chemoradiation in combination with VEGF targeted therapy for glioblastoma results in progressive gray and white matter volume loss

brain atrophychemoradiationglioblastomaneuroimagingneurotoxicity

Never too old to regenerate? Wound induced hair follicle neogenesis after secondary intention healing in a geriatric patient?

Publication date: Available online 4 January 2018
Source:Journal of Tissue Viability
Author(s): Tak-Wah Wong, Michael Hughes, Szu-Han Wang
Wound healing is a natural process to restore the structure and function of injured or diseased tissues. Repair of a skin wound usually leads to a scar while regeneration implies fully recovery of function and structure of the damaged tissue. Adult skin wound usually heals with scar while fetal skin heals scarless. Hair regeneration in elderly scalp wound has never been observed. We reported an 80-year-old patient with a large wound on the scalp after excision of a basal cell carcinoma healed by secondary intention wound healing. The patient's wound healed very well aesthetically. Interestingly, on approximate post wound day 180, a hair was observed to be growing towards the surface and eventually erupted in the center of the wound. The hair remained black at 42-month follow-up. This case demonstrated that neogenesis of hair is possible even in geriatric patient. To the best of our knowledge, this is the first report of hair regrow in human skin after wound healing.

Progression of undiagnosed cutaneous lymphoma after anti-tumor necrosis factor alpha therapy

Publication date: Available online 4 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Maria Estela Martinez-Escala, Alba L. Posligua, Heather Wickless, Audrey Rutherford, Kimberly A. Sable, Belen Rubio-Gonzalez, Xiaolong A. Zhou, Jason B. Kaplan, Barbara Pro, Jaehyuk Choi, Christiane Querfeld, Steven T. Rosen, Joan Guitart
BackgroundCutaneous lymphoma (CL) diagnosed after anti-tumor necrosis factor (TNF)α therapy has been reported in the literature, yet a clear link between both events remains elusive.ObjectiveTo review our experience with CL diagnosed during or after the use of anti-TNFα therapies.MethodsThis is a multicenter retrospective study and a literature review.ResultsTwenty-two cases, including 20 cutaneous T-cell lymphomas (CTCL) and 2 cutaneous B-cell lymphomas (CBCL), were identified. In the CTCL group, 75% of the patients received an anti-TNFα agent for a presumed inflammatory skin condition. Mycosis fungoides and Sézary syndrome were the most common subtypes of CTCL diagnosed. Advanced disease (IIB – IVA) was commonly seen at time of diagnosis requiring aggressive therapy, including stem cell transplant in three patients. Two patients diagnosed with CBCL had an indolent course. A total of 31 cases were gathered from a literature search.LimitationsThis is a retrospective study.ConclusionsOur findings suggest that most of the identified patients were misdiagnosed as having psoriasis or eczema; therefore, a comprehensive morphological and molecular review of skin biopsies and peripheral blood should be considered prior to initiation of anti-TNFα therapy in patients with poorly defined dermatitis or atypical presentations of "psoriasis".

Predictive value of basal cell carcinoma biopsies with negative margins: A retrospective cohort study

Publication date: Available online 4 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Hal Bret Willardson, Jamie Lombardo, Matt Raines, Tina Nguyen, Jisuk Park, Scott Dalton, Simon Ritchie
BackgroundPathology reports of basal cell carcinoma (BCC) biopsies often contain comments of positive or negative margins, with only 1-2% of the margin evaluated. The negative predictive value (NPV) of biopsy margin status on residual BCC is unknown.ObjectiveThe purpose of this study was to determine the NPV of BCC biopsy margin status on the absence of residual BCC in the corresponding excision.MethodsFrom our institution's archives, we collected BCC biopsies with negative margin readings that had subsequent excisions. For excisions read as negative for residual BCC, the excision blocks were sectioned at 150 μm intervals until exhausted.ResultsWe collected 143 cases that met criteria. 34 (24%) were found to contain residual BCC in the corresponding excision leading to a NPV of 76%; in 31/34 (91%) of the cases the residual histologic subtype was superficial.LimitationsOur sectioning technique did not evaluate 100% of the excision specimens.ConclusionsNegative margins in a BCC biopsy are a poor predictor of residual disease in the patient. We recommend that clinicians treat these lesions, and that pathologists who comment on margin status of BCC biopsies consider adding a caveat to reflect these findings.

The Vitiligo Extent Score (VES) and the VESplus are responsive instruments to assess global and regional treatment response in patients with vitiligo

Publication date: Available online 4 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Nanja van Geel, Marcel Bekkenk, Janny E. Lommerts, Khaled Ezzedine, John Harris, Iltefat Hamzavi, Viktoria Eleftheriadou, Mauro Picardo, Alain Taieb, Cecilia AC. Prinsen, Albert Wolkerstorfer, Reinhart Speeckaert

Lost in Translation: Caring for Limited English Proficiency Patients

Publication date: Available online 4 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Michael Tassavor, Amy Y-Y. Chen

The effect of lyophilization and storage time on the survival rate and hydrolytic activity of Trichoderma strains

Abstract

The study evaluates the survivability and storage stability of seven Trichoderma strains belonging to the species: T. harzianum (1), T. atroviride (4), and T. virens (2) after the lyophilization of their solid state cultures on wheat straw. Biomass of Trichoderma strains was freeze-dried with and without the addition of maltodextrin. Furthermore, in order to determine the ability of tested Trichoderma strains to preserve selected technological features, the biosynthesis of extracellular hydrolases (cellulases, xylanases, and polygalacturonases) after a 3-month storage of lyophilizates was investigated. Strains of T. atroviride (except TRS40) and T. harzianum TRS85 showed the highest viability after lyophilization process (up to 100%). After 3 months of storage, T. atroviride TRS14 exhibited the highest stability (95.23%); however, the number of active conidia remained at high level of 10⁶–10⁷ cfu/g for all tested T. atroviride strains and T. harzianum TRS85. Interestingly, after a 3-month storage of lyophilized formulations, most of the tested Trichoderma strains exhibited higher cellulolytic and xylanolytic activities compared to the control, i.e., before freeze-drying process. The highest activities of these enzymes exhibited the following: T. atroviride TRS14–2.37 U/g and T. atroviride TRS25–21.47 U/g, respectively, whereas pectinolytic activity was weak for all tested strains, with the highest value of 0.64 U/g registered for T. virens TRS109.

Regulated ploidy of Bacillus subtilis and three new isolates of Bacillus and Paenibacillus

Abstract

Bacteria were long assumed to be monoploid, maintaining one copy of a circular chromosome. In recent years it became obvious that the majority of species in several phylogenetic groups of prokaryotes are oligoploid or polyploid. The present study aimed at investigating the ploidy inGram-positive aerobic endospore-forming bacteria. First, the numbers of origins and termini of the widely-used laboratory strain Bacillus subtilis 168 were quantified. The strain was found to be mero-oligoploid in exponential phase (5.9 origins, 1.2 termini) and to down-regulate the number of origins in stationary phase. After inoculation of fresh medium with stationary phase cells the onset of replication preceded the onset of mass increase. For the analysis of the ploidy in fresh isolates, three strains were isolated from soil, which were found to belong to the genera of Bacillus and Paenibacillus. All three strains were found to be mero-oligoploid in exponential phase and exhibit a growth-phase dependent down-regulation of the ploidy level in stationary phase. Taken together, these results indicate that mero-oligoploidy as well as growth phase-dependent copy number regulation might be widespread in and typical for Bacillus and related genera.

Treatment of Soft Tissue Filler Complications: Expert Consensus Recommendations

Abstract

Background

Dermal fillers have been increasingly used in minimally invasive facial esthetic procedures. This widespread use has led to a rise in reports of associated complications. The aim of this expert consensus report is to describe potential adverse events associated with dermal fillers and to provide guidance on their treatment and avoidance.

Methods

A multidisciplinary group of experts in esthetic treatments convened to discuss the management of the complications associated with dermal fillers use. A search was performed for English, French, and Spanish language articles in MEDLINE, the Cochrane Database, and Google Scholar using the search terms "complications" OR "soft filler complications" OR "injectable complications" AND "dermal fillers" AND "Therapy". An initial document was drafted by the Coordinating Committee, and it was reviewed and modified by the experts, until a final text was agreed upon and validated.

Results

The panel addressed consensus recommendations about the classification of filler complications according to the time of onset and about the clinical management of different complications including bruising, swelling, edema, infections, lumps and bumps, skin discoloration, and biofilm formation. Special attention was paid to vascular compromise and retinal artery occlusion.

Conclusions

Clinicians should be fully aware of the signs and symptoms related to complications and be prepared to confidently treat them. Establishing action protocols for emergencies, with agents readily available in the office, would reduce the severity of adverse outcomes associated with injection of hyaluronic acid fillers in the cosmetic setting. This document seeks to lay down a set of recommendations and to identify key issues that may be useful for clinicians who are starting to use dermal fillers. Additionally, this document provides a better understanding about the diagnoses and management of complications if they do occur.

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.

Effects of cadmium on oxidative stress activities in plasma of freshwater turtle Chinemys reevesii

Abstract

Cadmium (Cd) has been recently found in high concentrations in the aquatic environment. This study was designed to examine the effects of Cd on the oxidative stress activities in plasma of freshwater turtle Chinemys reevesii. Experimental turtles were exposed to Cd at the concentration of 15 mg/kg by intraperitoneal injection, and redox status was investigated. Compared to the controls, superoxide dismutase (SOD) and catalase activities in plasma of the treated animals significantly decreased in week 1, week 2, and week 4. However, SOD activities gradually increased from week 4 to week 8. The treated animals had higher content of MDA and lower content of GSH in plasma over the observation period. In conclusion, our results showed that Cd decreased the antioxidant capacity and increased the level of oxidative damage product in plasma, which suggest that Cd causes oxidative stress and damage in the animal under the experimental conditions.

Occurrence and risk assessment of fluoroquinolones and tetracyclines in cultured fish from a coastal region of northern China

Abstract

Occurrence and levels of 11 fluoroquinolones (FQs) and four tetracyclines (TC) in 14 cultured fish species from a coastal city in the northern China were investigated. Five FQs (ofloxacin, enoxacin, ciprofloxacin, enrofloxacin, and sarafloxacin) and oxytetracycline were detected. Lower detection frequencies of antibiotics were observed in the marine fish. The concentrations of ΣFQs ranged from not detectable (nd) to 130 ng/g wet weight (ww) (median, 7.2 ng/g ww), and the concentration range of ΣTCs was nd to 200 ng/g ww (median, nd ng/g ww). The Chinese snakehead contained the highest concentrations of ΣFQs (130 ng/g ww) and the small yellow croaker accumulated the highest concentrations of ΣTCs (200 ng/g ww), respectively. Although the calculated estimated daily intakes (EDI) suggested that the consumption of these cultured fish from this region was not associated with significant human health risks, this study provides useful information that will be helpful in the appropriate antibiotic use in aquaculture. To our knowledge, this can be the first report on the occurrence and levels of antibiotics in cage-cultured marine fish from the Bohai Rim region, China.

Indications for Trans-Nasal Flexible Laryngo-Oesophagoscopy in a head and neck clinic, our experience in 194 patients

Abstract

Lamm introduced fibre-optic imaging in 1930s ¹. In the following decades it has been utilized in otolaryngology as an alternative to indirect mirror laryngoscopy. In its present form it allows for image capture and video recording when connected to a camera, it also allows for manoeuvring around anatomical structures due to its flexibility and articulation. It now forms an essential part of any head and neck examination especially when assessing for suspected cancer.

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Lead bioaccumulation in Texas Harvester Ants ( Pogonomyrmex barbatus ) and toxicological implications for Texas Horned Lizard ( Phrynosoma cornutum ) populations of Bexar County, Texas

Abstract

Uptake of lead from soil was examined in order to establish a site-specific ecological protective concentration level for the Texas Horned Lizard (Phrynosoma cornutum) at the Former Humble Refinery in San Antonio, Texas. Soils, harvester ants, and rinse water from the ants were analyzed at 11 Texas Harvester Ant (Pogonomyrmex barbatus) mounds. Soil concentrations at the harvester ant mounds ranged from 13 to 7474 mg/kg of lead dry weight. Ant tissue sample concentrations ranged from < 0.82 to 21.17 mg/kg dry weight. Rinse water concentrations were below the reporting limit in the majority of samples. Two uptake models were developed for the ants. A bioaccumulation factor model did not fit the data, as there was a strong decay in the calculated value with rising soil concentrations. A univariate natural log-transformed regression model produced a significant regression (p < .0001) with a high coefficient of determination (0.82), indicating a good fit to the data. Other diagnostic regression statistics indicated that the regression model could be reliably used to predict concentrations of lead in harvester ants from soil concentrations. Estimates of protective levels for P. cornutum were developed using published sub-chronic toxicological findings for the Western Fence Lizard that were allometricly adapted and compared to the Dose_oral equation, which estimated lead consumed through ants plus incidental soil ingestion. The no observed adverse effect level toxicological limit for P. cornutum was estimated to be 5500 mg/kg.

Effect of water cadmium concentration and water level on the growth performance of Salix triandroides cuttings

Abstract

The growth performance of Salix triandroides cuttings at three water cadmium (Cd) concentrations (0, 20, and 40 mg L⁻¹) and three water levels (− 40 cm, water level 40 cm below the soil surface; 0 cm, water level even with the soil surface; and 40 cm, water level 40 cm above soil surface) was investigated to evaluate its potential in phytoextraction strategies. Compared to cuttings in the − 40 or 0 cm water levels, cuttings in the 40 cm water level showed significantly lower biomass, height, and adventitious root length and significantly fewer leaves and adventitious roots. However, these growth and morphological parameters were not different among the three water Cd concentrations. Water level decreased stomatal conduction and transpiration rate but showed no significant effects on chlorophyll concentration or photosynthetic rate. Chlorophyll concentration and stomatal conductance were higher at 40 mg L⁻¹ Cd treatment than at 0 or 20 mg L⁻¹ Cd treatment; yet, photosynthetic rate and transpiration rate were not different. Cd concentration in the leaves and stems increased as the water level increased, but the highest Cd concentration in the roots occurred in the 0 cm water level. As water Cd concentration increased, Cd concentration in the leaves, stems, and roots increased in all three water levels, except in stems in the − 40 cm water level. Under Cd stress, cuttings in the − 40 or 0 cm water levels were characterized by a higher bioaccumulation coefficient, but a lower translocation factor, than those in the 40 cm water level. However, the bioaccumulation coefficient increased with increasing water Cd concentration in all three water levels, as did the translocation factor in the 40 cm water level. The tolerance index for the cuttings was the same among all water levels and water Cd concentrations. The results clearly indicated that the low water level increased plant growth and Cd accumulation in underground parts, while the high water level decreased plant growth but increased Cd accumulation in aboveground parts.

Fractional erbium-doped yttrium aluminum garnet laser-assisted drug delivery of hydroquinone in the treatment of melasma

Lymphangioma circumscriptum of the tongue, a case with marked haemorrhagic component

Abstract

Lymphangioma circumscriptum (LC) is considered a superficial variant of lymphangioma with characteristic small lymphatic channels. Diagnosis is routinely made through histopathology in addition to immunostaining. An unusual case of LC presenting as a painless overgrowth of the tongue in a middle-aged male is reported with emphasis on the clinical and histopathological differential diagnosis.

Vitamin D and the Pathophysiology of Inflammatory Skin Diseases

Background: Vitamin D is a secosteroid, which was initially known for its skeletal role; however, in recent years, its functions in different organs have been increasingly recognized. In this review, we will provide an overview of vitamin D functions in the skin physiology with specific focus on its role in certain inflammatory skin conditions such as psoriasis and atopic dermatitis. Methods: A comprehensive literature search was carried out in PubMed and Google Scholar databases using keywords like "vitamin D," "skin," "atopic dermatitis," and "psoriasis." Only articles published in English and related to the study topic were included in this review. Results: Vitamin D is integrally connected to the skin for its synthesis, metabolism, and activity. It regulates many physiological processes in the skin ranging from cellular proliferation, differentiation, and apoptosis to barrier maintenance and immune functions. Vitamin D deficiency is associated with the risk of psoriasis and atopic dermatitis, and several clinical/observational studies have suggested the beneficial effect of vitamin D in the therapy of these 2 inflammatory skin disorders. Conclusions: Vitamin D exerts a pleiotropic effect in the skin and could be an important therapeutic option for psoriasis and atopic dermatitis.
Skin Pharmacol Physiol 2018;31:74-86

The Role of the Clinical History in Drug Allergy Prediction

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1
Author(s): Kimberly G. Blumenthal

Cover 1

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1

Table of Contents

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1

Highlights Page

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1

Editorial Board

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1

Information for Readers

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1

Allergists' opinions on anaphylaxis and epinephrine administration—a case-based survey

Publication date: Available online 4 January 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Jay A. Lieberman, Phil Lieberman, Julie Wang

Practice Notes from the AAAI

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1

Continuing Medical Education Calendar

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1

Home Environmental Interventions for House Dust Mite

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1
Author(s): Jeffrey M. Wilson, Thomas A.E. Platts-Mills
It has been 50 years since the dust mite was first appreciated to be a major source of allergen in house dust, and by extension a key trigger of allergic respiratory disease. Since that time a number of protein allergens have been identified and characterized, mainly from mite feces, and standardized mite extracts and IgE assays have been developed. Insights into the lifecycle of dust mites and aspects of mite allergen biology have shed light on the mechanisms that lead to respiratory disease and to the development of interventions that can minimize dust mite allergen exposure. It is now clear that dust mite allergy is a key contributor to asthma in many parts of the world, and that long-term avoidance can be effective for preventing sensitization and minimizing the development and severity of respiratory disease. Here, we discuss the evidence linking dust mites with respiratory disease, outline studies that support the efficacy of home environmental interventions, and highlight practical methods that have been shown to be effective as part of a multifaceted approach to dust mite avoidance.

CME Exam: Home Environmental Interventions for House Dust Mite

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1

Indoor Environmental Interventions for Furry Pet Allergens, Pest Allergens, and Mold: Looking to the Future

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1
Author(s): Sharon K. Ahluwalia, Elizabeth C. Matsui
Over the last 2 to 3 decades, significant advances have been made in understanding the role that indoor allergen exposures play with regard to respiratory health. Multiple studies have confirmed that sensitization and exposure to indoor allergens can be a risk factor for asthma morbidity. Environmental interventions targeting key indoor allergens have been evaluated with the aims of examining their causal effects on asthma-related outcomes and identifying clinically efficacious interventions to incorporate into treatment recommendations. Historically, it appeared that the most successful intervention, as performed in the Inner-City Asthma Study, was individually tailored, targeting multiple allergens in a predominantly low-income, minority, and urban pediatric population. Recent studies suggest that single-allergen interventions may be efficacious when targeting the most clinically relevant allergen for a population. In this article, we review recent literature on home environmental interventions and their effects on specific indoor allergen levels and asthma-related outcomes.

On the Road to Improving Asthma Outcomes in Older Adults: The Phenotyping of Asthma in Older Adults

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1
Author(s): Sameer K. Mathur, David I. Bernstein

CME Exam: Indoor Environmental Interventions for Furry Pet Allergens, Pest Allergens, and Mold: Looking to the Future

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1

The Paradox of Antihistamine Hypersensitivity

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1
Author(s): Krzysztof Rutkowski, Philip H. Li, Annette Wagner

School Environmental Intervention Programs

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1
Author(s): Perdita Permaul, Wanda Phipatanakul
Exposure to indoor allergens and pollutants plays a significant part in the development of asthma and its associated morbidity. Inner-city children with asthma are disproportionately affected by these exposures with increased asthma morbidity. Although years of previous research have linked exposures in the urban home environment with significant childhood asthma disease, many of these allergens are also present in inner-city school environments. Therefore, evaluation of the school environment of patients with asthma is also essential. School-based environmental interventions may offer benefit for this problem and has the potential to help many children with asthma at once in a cost-effective manner. It is important that environmental health researchers continue to assess which interventions are most practical and result in the greatest measurable improvements.

Correlation or Causation?

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1
Author(s): Anne L. Fuhlbrigge

CME Exam: School Environmental Intervention Programs

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1

Reducing Environmental Allergic Triggers: Policy Issues

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1
Author(s): Stuart L. Abramson
The implementation of policies to reduce environmental allergic triggers can be an important adjunct to optimal patient care for allergic rhinitis and allergic asthma. Policies at the local level in schools and other public as well as private buildings can make an impact on disease morbidity. Occupational exposures for allergens have not yet been met with the same rigorous policy standards applied for exposures to toxicants by Occupational Safety and Health Administration. Further benefit may be obtained through policies by local, county, state, and national governments, and possibly through international cooperative agreements. The reduction of allergenic exposures can and should be affected by policies with strong scientific, evidence-based derivation. However, a judicious application of the precautionary principle may be needed in circumstances where the health effect of inaction could lead to more serious threats to vulnerable populations with allergic disease. This commentary covers the scientific basis, current implementation, knowledge gaps, and pro/con views on policy issues in reducing environmental allergic triggers.

Environmental Control: The First Tenet of Allergy

Publication date: January–February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 1
Author(s): Marissa Hauptman, David Peden, Wanda Phipatanakul

Topical oxygen therapy & micro/nanobubbles: a new modality for tissue oxygen delivery

Up to 15 billion dollars of US health care expenditure each year is consumed by treatment of poorly healing wounds whose etiologies are often associated with aberrancies in tissue oxygenation. To address this issue, several modes of tissue oxygen delivery systems exist, including Hyperbaric Oxygen Therapy (HBOT) and Topical Oxygen Therapy (TOT), but their efficacies have yet to be fully substantiated. Micro/nanobubbles (MNBs), which range anywhere from 100 μm to <1 μm in diameter and are relatively stable for hours, offer a new mode of oxygen delivery to wounds. The aim of this article is to systematically review literature examining the use of TOT for wound healing and use of MNBs for tissue oxygenation using the MEDLINE database. The search yielded 87 articles (12 MNB articles and 75 TOT articles), of which 52 met the inclusion criteria for this literature review (12 MNB articles and 40 TOT articles). Additionally, we present an analysis on the efficacy of our MNB generating technology and propose its use as a wound healing agent.

Electrochemical mineralization and detoxification of naphthenic acids on boron-doped diamond anodes

Abstract

Electrochemical oxidation (ELOX) with boron-doped diamond (BDD) anodes was successfully applied to degrade a model aqueous solution of a mixture of commercial naphthenic acids (NAs). The model mixture was prepared resembling the NA and salt composition of oil sands process-affected water (OSPW) as described in the literature. The initial concentration of NAs between 70 and 120 mg/L did not influence the electrooxidation kinetics. However, increasing the applied current density from 20 to 100 A/m² and the initial chloride concentration from 15 to 70 and 150 mg/L accelerated the rate of NA degradation. At higher chloride concentration, the formation of indirect oxidative species could contribute to the faster oxidation of NAs. Complete chemical oxygen demand removal at an initial NA concentration of 120 mg/L, 70 mg/L of chloride and applied 50 A/m² of current density was achieved, and 85% mineralization, defined as the decrease of the total organic carbon (TOC) content, was attained. Moreover, after 6 h of treatment and independently on the experimental conditions, the formation of more toxic species, i.e. perchlorate and organochlorinated compounds, was not detected. Finally, the use of ELOX with BDD anodes produced a 7 to 11-fold reduction of toxicity (IC₅₀ towards Vibrio fischeri) after 2 h of treatment.

Toxic Epidermal Necrolysis: A Review of 20 Years of Data

Abstract

Toxic epidermal necrolysis (TEN) is a rare, yet life-threatening immune-mediated mucocutaneous disorder often occurring in the context of a newly administered medication. The cutaneous manifestations are characterized by extensive epidermal detachment, mucosal surface erosion, and multi-organ damage (1-2).

This article is protected by copyright. All rights reserved.

Participation of the Th17 response in the pathogenesis of oral lichen planus

Abstract

Lichen planus is a chronic noninfectious inflammatory mucocutaneous disease that affects the skin, nails and mucosae, including the oral mucosa.¹ Although the etiology of oral liquen planus (OLP) remains not fully elucidated, it is recognized that its pathogenesis arises from an immune-mediated response and many authors suggest the disease to be an autoimmune process.^2-5 Despite the high prevalence and well-defined cytotoxic activity of CD8+ T lymphocytes against keratinocytes of the basal layer of the epithelium in OLP, helper CD4+ T lymphocytes also play an important role in the pathogenesis of this disease.⁶

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Examination of the melanocytes of the Nevus of Ota with in vivo reflectance confocal microscopy: 15 cases

Abstract

The Nevus of Ota (NO) is a bluish or greyish hyperpigmentation caused by an accumulation of dermal melanocytes that typically extend to the innervated parts of the ophthalmic and maxillary divisions of the trigeminal nerve, involving the facial skin, the uvea, the iris and the sclera (Figure 1).

This article is protected by copyright. All rights reserved.

Eruptive nevi under tocilizumab: first case report and data analysis

Abstract

we would like to draw attention to an unusual side effect of tocilizumab (TOC), a humanized monoclonal antibody directed against the interleukin 6 (IL-6) receptor, approved for the treatment of rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA).

This article is protected by copyright. All rights reserved.

Erasmus syndrome associated with an immune thrombocytopenic purpura

Abstract

We report the observation of a 57-year-old patient followed for an Erasmus syndrome (a systemic sclerosis developing secondary to silica exposure) (1) diagnosed in 2002 after being exposed as a dental technician, for whom a severe thrombocytopenia was discovered. He suffered from a pulmonary fibrosis, polyarthralgia, esophageal dysphagia and cutaneous involvement such as finger ulcerations and sclerodactylia. The treatment was made of nifedipine 30mg/day, esomeprazole 20mg/day and bosentan 25 mg twice a day.

This article is protected by copyright. All rights reserved.

The limitations of dermoscopy: false positive and false negative tumors

Abstract

Dermoscopy has been documented to increase the diagnostic accuracy of clinicians evaluating skin tumors, improving their ability to detect skin cancer and better recognize benign moles. However, dermoscopically "false positive" and "false negative" tumors do exist. False positive diagnosis usually leads to unnecessary excisions. False negative diagnosis is much more dangerous, since it might result in overlooking a cancer, with severe undesirable consequences for the patient and the physician. Therefore, management strategies should mainly focus on addressing the risk of dermoscopically false negative tumors.

The most frequent benign tumors that might acquire dermatoscopic characteristics suggestive of malignancy are seborrheic keratosis (SK), including solar lentigo, melanoacathoma, irritated, clonal and regressive SK, angioma (mainly thrombosed angioma and angiokeratoma), dermatofibroma, benign adnexal tumors and nevi (Clark, Spitz, recurrent, combined, sclerosing). The most useful clues to recognize these tumors are the following: solar lentigo-broad network; melanoacanthoma-sharp border; irritated SK-regularly distributed white perivascular halos; clonal SK-classic SK criteria; regressive SK-remnants of SK; targetoid hemosiderotic angioma-dark center and reddish periphery; thrombosed angioma-sharp demarcation; angiokeratoma-dark lacunae; atypical dermatofibromas-palpation; follicular tumors-white color; sebaceous tumors-yellow color; Clark nevi-clinical context; Spitz/Reed nevi-age; combined nevi-blue central area; recurrent nevi-pigmentation within the scar; sclerosing nevi-age and location on the upper back; blue nevi-history

Malignant tumors that might mimic benign ones and escape detection are melanoma (in-situ, nevoid, spitzoid, verroucous, regressive, amelanotic), squamous cell carcinoma (mainly well-differentiated variants) and rarely basal cell carcinoma (non-pigmented variants). The most useful clues to recognize the peculiar melanoma subtypes are: melanoma in situ-irregular hyperpigmented areas; nevoid melanoma-history of growth; spitzoid melanoma-age; verrucous melanoma: blue-black sign; regressive melanoma-peppering or scar-like depigmentation; amelanotic melanoma-pink color, linear irregular vessels, dotted vessels.

In this paper we summarized the most frequent dermoscopic variations of common skin tumors that are often misinterpreted, aiming to assist clinicians to reduce the number of false diagnoses.

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Improvement of the Gluteal Contour

Buttock enlargement with lipoinjection is a procedure that has had a very high demand in the last 5 years. Changes in aesthetics have made more patients request greater volume in their buttocks and hips. The procedure requires not only liposuction, in which the fat is obtained, but also a systematization off the fat injection process in the buttock to obtain the appropriate aesthetic results according to the characteristics of each patient. The procedure achieves very satisfactory results because it can transform the patient's physical appearance significantly.

Practice-Based Patient Management Strategies in Gluteal Augmentation with Implants

This article focuses on practice-based recommendations for surgeons performing gluteal augmentation with implants (GAI). Preoperative planning, including the indications, precautions, and contraindications to GAI, is discussed. Advantages and disadvantages of subfascial and intramuscular implantation are addressed along with recommendations for implant size, shape, and position. Recommendations for patient management before and after surgery along with operative and nonoperative strategies for postoperative complications, including wound dehiscence, infection, and seroma, are included. Aesthetic concerns and recommendations for the management of poor results are addressed. A comprehensive literature review is included along with illustrative preoperative and postoperative photos.