“I Fear for My Safety, but Want to Show Bravery for Others”: Violence and Discrimination Concerns Among Transgender and Gender-Nonconforming Individuals After the 2016 Presidential Election

Violence and Gender , Vol. 0, No. 0.

Epidermotropic Presentation by Splenic B-cell Lymphoma: The Importance of Clinical-Pathologic Correlation

Abstract

There are exceedingly rare reports of patients with epidermotropic B-cell lymphomas. A subset presented with intermittent, variably pruritic papular eruptions and involvement of their spleens, peripheral blood, and bone marrow at the time of diagnosis. Furthermore, some experienced an indolent course despite dissemination of their lymphomas. We report a 66-year-old woman with a 12-year history of intermittent eruptions of nonpruritic salmon-colored papules on her torso and proximal extremities that occurred in winter and resolved with outdoor activity in spring. Skin biopsy revealed an epidermotropic B-cell lymphoma with a non-specific B-cell phenotype and heavy chain class switching with IgG expression. On workup, our patient exhibited mild splenomegaly and low-level involvement of her peripheral blood and bone marrow by a kappa-restricted B-cell population. A splenic B-cell lymphoma was diagnosed. Considering her longstanding history and absences of cytopenias, our patient has been followed without splenectomy or systemic therapy. Furthermore, the papules have responded dramatically to narrowband UVB. Our case and a review of similar rare reports aim to raise awareness among dermatopathologists and dermatologists of a clinically distinct and indolent subset of epidermotropic splenic lymphomas with characteristic clinical and histologic findings.

A quantitative comparison between SOX10 and MART-1 immunostaining to detect melanocytic hyperplasia in chronically sun-damaged skin

Abstract

Histologic differentiation of melanoma in situ (MIS) from solar keratosis on chronically sun-damaged skin is challenging. The first-line immunostain is usually MART-1/Melan-A, which can exaggerate the epidermal melanocytes, causing a diagnostic pitfall for MIS. By comparing MART-1 and SOX10 immunostaining, we scored the percentage of epidermal melanocytes per 2-mm diameter fields in pigmented actinic keratosis (n=16), lichenoid keratosis (n=7), junctional melanocytic nevus (n=6), keratosis with atypical melanocytic proliferation (AMP, n=17) and MIS (n=10). These cases represented an older population (68 years median age) and the head and neck (50%) was the most common anatomic site. MART-1 score was significantly higher than SOX10 (P value < 0.05) in solar keratoses, but showed no difference in detecting melanocytic proliferations, demonstrating their equal detection rate of melanocytes. The sensitivity of both MART-1 and SOX10 was 100% while their specificities were 17% and 96%, respectively. These results show SOX10 is more specific than MART-1 in distinguishing epidermal melanocytes on sun-damaged skin by avoiding over diagnosis of melanoma.

Cooking oil fume-derived PM 2.5 induces apoptosis in A549 cells and MAPK/NF-кB/STAT1 pathway activation

Abstract

Cooking oil fumes (COFs) are the major sources of indoor air pollution in Asia. It is well known that alveolar cells are key participants in the development of respiratory system; however, it still remains unknown whether alveolar cells are affected by COFs. Therefore, the present study investigated the effects of COFs on alveolar cells (A549 cells) and illuminated its apoptotic mechanism in response to COF-PM_2.5 exposure. When A549 cells were exposed to COF-PM_2.5, cell viability was substantially decreased, while the generation of ROS increased, and LDH levels and CCK-8 levels gradually changed within a dose-dependent manner. The nitrite concentration in the supernatants was augmented, while the SOD activity and GSH recycling were decreased upon COF-PM_2.5. Moreover, COF-PM_2.5 treatment increased mRNA levels of COX-2, inducible NO synthase, and TNF-α, and Elisa assay suggested that secretory proteins IL-6 and TNF-α were also increased. Furthermore, the Bax/Bcl-2 mRNA ratio was increased, and cleaved caspase-3 protein was activated in the A549 cells. Strikingly, COF-PM_2.5 induced the phosphorylation of STAT1 at Tyr701/Ser727 and activation of NF-кB and ERK1/2, p38, and JNK of the MAPK pathway. In short, our study suggested that COF-PM_2.5 resulted in inflammation, apoptosis, and cell damage in A549 cells, which might be modulated via the activation of MAPK/NF-кB/STAT1 pathway.

Protective effect of melatonin on cadmium-induced changes in some maturation and reproductive parameters of female Prussian carp ( Carassius gibelio B.)

Abstract

The aim of this study was to determine whether melatonin (Mel), which is a known antioxidant and free radical scavenger, could perform the role of a preventive agent against the toxic effects of cadmium (Cd²⁺) on mortality, fish growth, gonadosomatic index (GSI), luteinizing hormone (LH) secretion, the response to hormonal stimulation of spawning, and also tissue accumulation of Cd in Prussian carp females. These females received melatonin implants and were exposed to 0.4 or 4.0 mg/L of Cd (as CdCl₂·2.5H₂O) over either a 5- or 3-month period, followed by further 2 months of purification in clear water. Negative changes caused by exposure to cadmium in the water were as follows: higher fish mortality, lower body weight, increased accumulation of cadmium in the brain and ovary, lowered GSI, impaired spontaneous LH secretion during exposure, and impaired LH secretion during stimulation of spawning. All of these effects were observed in the group of fish exposed to 0.4 and/or 4.0 mg Cd/L but did not occur or were less pronounced in the groups exposed to cadmium in the presence of melatonin released from the implants. During depuration, in the group of fish which had been exposed to the highest Cd concentration, we observed a significant improvement in fish survival rate, body growth, inhibition of further cadmium accumulation in tissues, and gradual return of spontaneous LH secretion as well as normalization of the GSI value to the control group levels. In conclusion, these findings indicate that melatonin can be a preventive agent for some toxic effects on fish reproduction induced by environmental cadmium contamination.

Effects of dissolved organic matter leaching from macrophyte litter on black water events in shallow lakes

Abstract

In recent years, the black water phenomenon has become an environmental event in eutrophic shallow lakes in China, leading to deterioration of lake ecosystems and potable water crises. Decomposition of macrophyte debris has been verified as a key inducement for black water events. In this study, the effects of the decomposition of dissolved organic matter (Kottelat et al., WASP 187:343–351, 2008) derived from macrophyte leachate on the occurrence of black water events are investigated to clarify the detailed mechanisms involved. Results show that dissolved organic matter (DOM) is composed of a trace of chromophoric DOM and mostly non-chromophoric dissolved organic matter (CDOM). DOM decomposition is accompanied by varied concentration of CDOM components, generation of organic particles, and increased microbial concentrations. These processes increase water chroma only during initial 48 h, so the intensified water color cannot be maintained by DOM decomposition alone. During DOM decomposition, microorganisms first consume non-CDOM, increasing the relative CDOM concentration and turning the water color to black (or brown). Simultaneously, tryptophan and aromatic proteins, which are major ingredients of CDOM, enhance UV light absorption, further aggravating the macroscopic phenomenon of black color. Our results show that DOM leached from decayed macrophytes promotes or even triggers the occurrence of black water events and should be taken more seriously in the future.

Commentary on: “Comparison of the Effect of Dexamethasone and Tranexamic Acid, Separately or in Combination on Post-rhinoplasty and Edema and Ecchymosis”

Pressure pain thresholds over the cranio-cervical region in headache: a systematic review and meta-analysis

Sensitivity of tissues can be measured by algometry. Decreased pressure pain thresholds over the cranio-cervical area are supposed to reflect signs of sensitization of the trigemino-cervical nucleus caudalis. ...

Toxicity of aqueous mixture of phenol and chlorophenols upon photosensitized oxidation initiated by sunlight or vis-lamp

Abstract

It is well established that aquatic wildlife in marine and freshwater of the European Union is exposed to natural and synthetic endocrine disruptor compounds (EDCs) which are able to interfere with the hormonal system causing adverse effects on the intact physiology of organisms. The traditional wastewater treatment processes are inefficient on the removal of EDCs in low concentration. Moreover, not only the efficiency of treatment must be considered but also toxicological aspects. Taking into account all these aspects, the main goal of the study was to investigate the photochemical decomposition of hazardous phenolic compounds under simulated as well as natural sunlight from the toxicity point of view. The studies were focused on photodegradation of 2,4-dichlorophenol as well as mixture of phenol, 2-chlorophenol and 2,4-dichlorophenol. Photosensitized oxidation process was carried out in homogeneous and heterogeneous system. V. fischeri luminescence inhibition was used to determine the changes of toxicity in mixture during simulated and natural irradiation. The photodegradation was carried out in three kinds of water matrix; moreover, the influence of presence of inorganic matter on the treatment process was investigated. The experiments with natural sunlight proved applicability of photosensitive chitosan for visible-light water pollutant degradation. The results of toxicity investigation show that using photosensitive chitosan for visible-light, the toxicity of reaction mixture towards V. fischeri has significantly decreased. The EC₅₀ was found to increase over the irradiation time; this increase was not proportional to the transformation of the parent compounds.

Just War, Cyber War, and the Concept of Violence

Abstract

Recent debate on the relationship between cyber threats, on the one hand, and both strategy and ethics on the other focus on the extent to which 'cyber war' is possible, both as a conceptual question and an empirical one. Whether it can is an important question for just war theorists. From this perspective, it is necessary to evaluate cyber measures both as a means of responding to threats and as a possible just cause for using armed kinetic force. In this paper, I shift the focus away from 'war' as such in order to ask whether some cyber threats might justifiably be characterized as a form of 'violence.' Some theorists argue that the term violence ought to be defined so as to encompass things like 'structural' harm or harm by neglect and thereby question implicitly the focus of just war theorists on armed force. This paper draws on a theory of violence I developed elsewhere as a defence of just war theory's narrow understanding of violence. According to the 'Double-Intent' theory, a distinctive form of 'Violent Agency' is the factor uniting the category of violence while partly accounting for the peculiar moral connotations of the term. Here, I argue that the resulting definition of violence reshapes the category in a way that includes some forms of cyber-attack. This may help us to see where cyber might fit in relation to just war theory and the ethics of kinetic attack.

Rhizospheric effects on the microbial community of e-waste-contaminated soils using phospholipid fatty acid and isoprenoid glycerol dialkyl glycerol tetraether analyses

Abstract

We performed the study of rhizospheric effects on soil microbial community structure, including bacteria, fungi, actinomycete, and archaea, at an electronic waste (e-waste) recycling site by analyzing the phospholipid fatty acid (PLFA) and isoprenoid glycerol dialkyl glycerol tetraether (GDGT) contents. By comparing PLFA and isoprenoid GDGT profiles of rhizospheric and surrounding bulk soils of 11 crop species, we observed distinct microbial community structures. The total PLFA concentration was significantly higher in rhizospheric soils than in non-rhizospheric soils, whereas no obvious difference was found in the total isoprenoid GDGT concentrations. The microbial community structure was also different, with higher ratios of fungal-to-bacterial PLFAs (F/B) and lower relative abundance of Gram-positive bacteria in rhizospheric soils. The extent of rhizospheric effects varied among plant species, and Colocasia esculenta L. had the greatest positive effects on the total microbial biomass. Dissolved organic carbon and pH were the main environmental factors affecting the microbial community represented by PLFAs, while the archaeal community was influenced by copper and zinc in all soils. These results offer a comprehensive view of rhizospheric effects on microbes in heavy metal and persistent organic pollutant co-contaminated soil, and provide fundamental knowledge regarding microbial ecology in e-waste-contaminated soils.

Aktuelle medikamentöse Behandlung von Sarkomen

Zusammenfassung

Hintergrund

Der Part der Systemtherapie am Gesamtkonzept ist im Einzelfall im interdisziplinären Kontext zu eruieren. Beim lokal fortgeschrittenen Sarkom können verschiedene Therapieziele definiert werden, um einerseits bei Irresektabilität den Ansatz einer vollständigen Resektion zu erreichen, häufig in Kombination mit Strahlentherapie, oder um andererseits bei gegebener Operabilität die Fernmetastasierungsrate zu senken und die lokale Kontrolle zu verbessern. Dieser Ansatz trifft auch auf die postoperative Systemtherapie zu. Des Weiteren ist in der metastasierten Ausgangslage dieser Ansatz Standard.

Ziel, Material, Methoden

Die Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed mit den Suchwörtern „soft tissue sarcoma, GIST, locally advanced, metastatic, chemotherapy, targeted therapy, phase 2, phase 3".

Ergebnisse und Schlussfolgerungen

Für Patienten mit fortgeschrittenen Hochrisiko-Weichteilsarkomen im UICC-Stadium III (d. h. Größe >5 cm, tiefe Lokalisation, Grading > II nach FNCLCC [Fédération Nationale des Centres de Lutte Contre le Cancer]) können präoperative/neoadjuvante Therapieverfahren unter Einschluss von Anthrazyklinen und Ifosfamid (IFO) erwogen werden. Dies gilt also für alle High-grade-Sarkome, bei denen nicht zuverlässig ein ausreichender Sicherheitsabstand (>5–10 mm, Faszie) erreicht werden kann. Idealerweise sollte die Systemtherapie mit einer Radiatio kombiniert werden. Im neoadjuvanten Therapiekonzept ist eine höhere Dosisintensität erreichbar als postoperativ. Die komplette pathologische Response ist prognostisch bedeutsam. Die adjuvante Chemotherapie nach Resektion eines Sarkoms ist mit einer Verbesserung des erkrankungsfreien und des Gesamtüberlebens verbunden. Diese sollte nach detaillierter Aufklärung über die Risiken und unter Beachtung von Allgemeinzustand, Alter, Lokalisation, histologischem Subtyp, Organfunktion und Komorbidität auf Hochrisikopatienten begrenzt werden. In der palliativen Erstlinie bleibt eine Adriamycin(ADM)-basierte Therapie weiterhin Standard. Erstmals steht mit Olaratumab ein monoklonaler Antikörper in Kombination zur Verfügung („conditional approval"). Nachfolgende Linien werden entsprechend histologischem Subtyp, Allgemeinzustand und Organfunktion individuell adaptiert. Zugelassen ist bei refraktärer Erkrankung neben Pazopanib und Trabectedin nun auch Eribulin, begrenzt auf Liposarkome. Lokalisierte Hochrisiko-GIST (GIST gastrointestinale Stromatumoren) werden derzeit 3 Jahre mit Imatinib adjuvant behandelt. Die Dauer der Therapie ist Gegenstand von Untersuchungen. In der metastasierten Situation stehen drei Therapielinien zur Verfügung, mit denen ca. 20 % der Patienten ein Zehnjahresüberleben erreichen.

Moderne Radiotherapie beim Hodgkin-Lymphom

Zusammenfassung

Hintergrund

Die Behandlung der zumeist jungen Patienten mit einem Hodgkin-Lymphom (HL) führt in den meisten Fällen zu einer dauerhaften Heilung. Durch kontinuierliche Behandlung der Patienten in klinischen Studien konnte wie bei keiner anderen Erkrankung eine Therapieoptimierung erfolgen. Anfängliche Großfeldbestrahlung wurde nach und nach ebenso wie die Bestrahlungsdosis reduziert, und durch die Hinzunahme der Chemotherapie wurde die „combined modality" etabliert.

Methoden

Es erfolgte eine selektive Literaturrecherche in der Datenbank Pubmed zum Thema Hodgkin-Lymphom und Radiotherapie.

Ergebnisse

Aktuell prägen technische Fortschritte und neue Zielvolumenkonzepte die Planung und Durchführung der Bestrahlung wie nie zuvor. Aufgrund der exzellenten Prognose der Patienten spielen akute, aber v. a. Langzeitnebenwirkungen eine wesentliche Rolle. Lungenfibrose, Herzinfarkt und sekundäre Malignome sind mögliche Nebenwirkungen, deren Risiko durch sorgfältige Bestrahlungsplanung und Bestrahlungsdurchführung beeinflusst werden kann. Aus diesem Grund spielen Entwicklungen, wie die Bestrahlung in tiefer Inspiration (DIBH) und moderne Bestrahlungstechniken wie z. B. intensitätsmodulierte Radiotherapie (IMRT) und bildgeführte Radiotherapie (IGRT), eine ebenso herausragende Rolle im strahlentherapeutischen Alltag wie die neuen Zielvolumenkonzepte der International Lymphoma Radiation Oncology Group (ILROG).

Schlussfolgerung

Durch die Verwendung moderner Techniken in der Bestrahlungsplanung und Bestrahlungsdurchführung kann eine erhöhte Präzision erreicht werden. Ebenso zeigen aktuelle Auswertungen, dass mit hoher Wahrscheinlichkeit auch ein positiver Einfluss auf die akuten und Langzeitnebenwirkungen genommen werden kann.

Geochemical characteristics of n -alkanes and isoprenoids in coal seams from Zhuji coal mine, Huainan coalfield, China, and their relationship with coal-forming environment

Abstract

Ten coal seams in Upper Shihezi Formation, Lower Shihezi Formation, and Shanxi Formation from the Zhuji mine, Huainan coalfield, China, were analyzed for n-alkanes and isoprenoids (pristine and phytane) using gas chromatography-mass spectrometry (GC-MS), with an aim of reconstructing the coal-forming plants and depositional environments along with organic carbon isotope analyses. The total n-alkane concentrations ranged from 34.1 to 481 mg/kg. Values of organic carbon isotope (δ¹³C_org) ranged from − 24.6 to − 23.7‰. The calorific value (Q_b,d), maximum vitrinite reflectance (Ro_max), proximate, and ultimate analysis were also determined but showed no correlation with n-alkane concentrations. Carbon Preference Index (CPI) values ranged from 0.945 to 1.30, suggesting no obvious odd/even predominance of n-alkane. The predominance of C₁₁ and C₁₇n-alkanes implied that the coal may be deposited in the fresh and mildly brackish environment. According to the contrary changing trend of pristine/phytane (Pr/Ph) ratio and boron concentrations, Pr/Ph can be used as an indicator to reconstruct the marine transgression-regression in sedimentary environment of coal formation. The influence of marine transgression may lead to the enrichment of pyrite sulfur in the coal seam 4-2. C3 plants (− 32 to − 21‰) and marine algae (− 23 to − 16‰) were probably the main coal-forming plants in the studied coal seams. No correlation of the n-alkane concentration and redox condition of the depositional environment with organic carbon isotope composition were found.

Bony Regrowth After Deep Lateral Orbital Decompression

Purpose: To report on 2 cases of late bony regrowth with clinically apparent proptosis after deep lateral orbital decompression for thyroid orbitopathy. Methods: A retrospective review of 2 cases identified by the authors as having late bony regrowth. The authors review the clinical, historical, radiologic, and anatomical findings and discuss the significance thereof. Results: Bony regrowth with bowing toward the middle cranial fossa is observed at postoperative month 8 in the first case. Cortical bone and marrow was observed to regrow at 2 years postoperatively in the second case. Both patients underwent successful repeat deep lateral orbital decompression with resolution of proptosis and clinical symptoms. Conclusions: Late bony regrowth should be considered as a possible cause of recurrent proptosis after orbital decompression in thyroid eye disease. Accepted for publication January 2, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Sathyadeepak Ramesh, M.D., Division of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute, 300 Stein Plaza, Los Angeles, CA 90095. E-mail: sathyadeepak.ramesh@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Interlamellar Autogenous Tarsal Graft for the Correction of Lower Eyelid Trichiasis Associated With Eyelid Margin Thinning

Purpose: To evaluate the use of autogenous tarsal graft for surgical correction of lower eyelid trichiasis associated with eyelid thinning. Methods: A total of 23 eyelids of 19 consecutive patients with trichiasis were operated with a variant of the Van Millingen procedure. The surgery consisted of interposing a 3-mm high fragment of autogenous ipsilateral upper eyelid tarsus corresponding to the trichiasis segment between the pretarsal anterior lamella and the lower tarsal plate. Preoperative assessment included quantification of eyelid thickness on the midpoint of the segment with trichiasis, biomicroscopy of the eyelid margin and location of the trichiasis. All patients were examined at 1, 3, 6, and 12 months after surgery. Eyelid thickness was measured at 1 month and 12 months of follow up. Results: Preoperatively the mean thickness of the eyelid margin was 0.99 mm ± 0.06 standard error. One month postoperatively eyelid thickness increased to 2.08 ± 0.28 standard error, decreasing over time to reach 1. 48 mm ± 0.18 standard error 1 year after surgery, a value that did not differ from that of the control group. Small granulomas were diagnosed only in the early phases of the postoperative period. Trichiasis recurrence was seen in just 1 eyelid. Isolated abnormal lashes lateral or medial to the graft were present in 5 eyelids at the end of the study. Conclusions: Autogenous tarsal grafts placed parallel to the lower tarsus are a good option both to correct misdirected eyelashes and to restore normal lower eyelid thickness. Accepted for publication December 18, 2017. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Patricia M. S. Akaishi, M.D., Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Hospital das Clínicas-Campus, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14049 São Paulo, Brazil. E-mail: patriciamitiko@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

The Individualized Facelift Technique in Improving Facial Asymmetry for Asian Patients

Purpose: Among multiple influential factors affecting facial symmetry, the role of soft tissue is often overlooked. Skin and skeletal differences between Asian and Caucasian people also require the adaptation of current techniques for Asian patients. This article aimed to explore the ability of individual facelift techniques to improve facial symmetry and reset youthful eye in Asian people, while a new method, called the grid method, was tried to evaluate the improvement in facial symmetry. Methods: The authors conducted a review of 58 consecutive facelifts, which were all performed by a single surgeon between April 2009 and December 2016 following institutional review board approval. Among them, 21 patients underwent lower eyelid blepharoplasty. The original frontal photograph of each patient was evaluated by the grid method. Five independent plastic surgeons reviewed the facial asymmetry of the images before and after the operations using a visual analog scale to analyze the facial asymmetry of the patients. Results: In the preoperative group evaluated by the grid, the mean facial asymmetry score was 4.11, while in the postoperative group, the mean score was 1.07, which was significantly lower than the mean score before the operation (p

Idiopathic Canalicular Inflammatory Disease: New Disease Description of Clinical Patterns, Investigations, Management, and Outcomes

Purpose: The objective of this perspective is to present a separate disease description of "idiopathic canalicular inflammatory disease" and outline the diagnostic criteria and early experiences with its investigations and management. Methods: Retrospective case series of 44 canaliculi of 22 eyes of 11 patients presenting at a tertiary care Dacryology service over a period of 2 years with typical clinical patterns of inflammatory canaliculitis and its outcomes were studied. All the patients underwent microbiological work-up with culture and sensitivity, dacryoendoscopy imaging, serial Fourier domain ocular coherence tomography, and collagen vascular profiles. Stages in the evolution of the disease were studied. All patients were treated initially with topical steroids followed by punctal dilatation and placement of mini-monoka stents. Five patients in addition had a small biopsy from the inflamed portion of the vertical canaliculus. Stents were extubated at 6 weeks. Results: Forty-four canaliculi were diagnosed to have idiopathic canalicular inflammatory disease during the study period. There was a female preponderance (81.8%, 9/11) and the mean age at presentation was 57 years. All patients presented with unilateral epiphora without any discharge, pain, or swelling. Collagen vascular profiles and screening for autoimmune diseases were negative. Clinical picture ranged from stages 1 to 5, consisting of edema, progressive centripetal vascularization, pouting of vascularized mucosa, membrane formation, and progressive scarring. The presentation begins in 1 eye and usually involves the other eye at a mean of 6 months. Ocular coherence tomography and dacryoendoscopy were of adjunctive value in the diagnosis. Histopathological examination was suggestive of a chronic inflammation. All patients had relentless progression to end-stage disease, although delayed significantly by steroids and monoka intubation. Conclusion: Idiopathic canalicular inflammatory disease has a distinct and typical clinical behavior and the current study proposed diagnostic features and disease staging. The use of topical and systemic immunosuppressive agents needs to be explored to formulate effective protocols for its management. Accepted for publication December 8, 2017. Mohammad Javed Ali received support from the Alexander von Humboldt Foundation for his research and he also receives royalties from Springer for the textbook "Principles and Practice of Lacrimal Surgery' and Atlas "Atlas of Lacrimal Drainage Disorders". The authors have no conflicts of interest to disclose. Address correspondence and reprint requests to Mohammad Javed Ali, F.R.C.S., Govindram Seksaria Institute of Dacryology, L.V.Prasad Eye Institute, Road No. 2, Banjara Hills, Hyderabad-34, India. E-mail: drjaved007@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.