A method of evaluating facial pores using optical 2D images and analysis of age-dependent changes in facial pores in Koreans

Abstract

Background

Enlarged facial pores and changes in pore area are of concern for cosmetic reasons. To evaluate pores, measuring tools based on 3D methodology are used. Yet, these methods are limited by their measuring ranges. In this study, we performed pore analysis by measuring the whole face using 2D optical images. We further sought to understand how the pores of Korean women change with age.

Materials and Methods

One hundred sixteen Korean female subjects aged 20-60 years were recruited for this study. Facial images were taken using the VISIA-CR^® adjusted light source. Images were processed using Image-Pro Plus 9.2. Statistical significance was assumed when P < .05.

Results

The pore area, as indicated by pixel count, gradually increased in patients through their 40s, but decreased through their 50s and 60s. Facial pores generally exhibited directionality through the patients' 30s, but this isotropic feature was more prominent in their 50s. Pore elongation increased stepwise. The first increase occurred during the transition from patients' 30s to their 40s and the second increase occurred during the transition from patients' 50s to their 60s. This indicated that the pores deformed from a circular shape to a long elliptic shape over time.

Conclusion

A new evaluation method using 2D optical images facilitates the analysis of pore distribution and elongation throughout the entire cheek. This is an improvement over an analysis of pores over a narrow region of interest.

Erythema-directed digital photography for the enhanced evaluation of topical treatments for acne vulgaris

Abstract

Background

Erythema-directed digital photography is a novel method for evaluating the efficacy and tolerability of topical acne treatments. Here, we describe three case reports in which erythema-directed digital photography was used to evaluate acne before and after up to 12 weeks of treatment with clindamycin 1%/tretinoin 0.025% (Clin-RA).

Materials and methods

Erythema-directed digital photography was used to evaluate acne in three patients with mild-to-moderate facial acne, two of whom had refused to continue previous topical acne treatment (benzoyl peroxide 5% and clindamycin 1%/benzoyl peroxide 5%) due to persistent irritation. Acne lesions and erythema were evaluated using standard clinical photography and erythema-directed digital photography (VISIA-CR^™ system) before and after 8-12 weeks of treatment with Clin-RA.

Results

Erythema-directed digital photography revealed background erythema from previous topical acne treatments that was not evident from standard clinical photographs and allowed a better visualization of both inflammatory and non-inflammatory lesions. In all patients, there was a clear improvement in background erythema and a reduction in acne lesions following treatment with Clin-RA.

Conclusion

This study has demonstrated for the first time that erythema-directed digital photography can enhance the evaluation of the efficacy and tolerability of topical acne treatments. These cases show that Clin-RA was associated with improved efficacy and tolerability vs previous treatments with topical monotherapy (benzoyl peroxide 5%) or a topical fixed-dose combination (clindamycin 1%/benzoyl peroxide 5%).

High-frequency ultrasonography—New non-invasive method in assessment of skin lymphomas

Abstract

Background

Mycosis fingoides (MF) is the most common subtype of primary cutaneous T-cell lymphomas. Current evaluation of disease extent and severity is based on mSWAT scoring system, which seems to be relatively subjective. The aim of this subject was to present the usefulness of 20 MHz in objective 5-year long monitoring of response to therapy in MF patients.

Materials and methods

The 5-years long follow-up based on 19 skin USG images of patients diagnosed as early stages of MF was studied. The assessed USG parameter was the mean diameter of subepidermal low echogenic band (SLEB).

Results

In every MF patient during exacerbation within lesional skin we could observe SLEB, which thinning or complete disappearance was detected after finishing the therapy. Lack of complete absence of SLEB was related to the lack of complete remission assessed by mSWAT.

Conclusion

We present for the first time the possibility of monitoring patients' clinical state on the base of non-invasive USG imaging. We recommend additional use of 20 MHz USG to reduce intra-observer variability and to assess residual disease. USG imaging can complement evaluation of skin lesions in MF and can support clinical judgement.

RESOLVING AN APPARENT PARADOX IN DOUBLY ROBUST ESTIMATORS

Serum Metabolomic Profiling of All-Cause Mortality: A Prospective Analysis in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study Cohort

Abstract

Tobacco use, hypertension, hyperglycemia, overweight, and inactivity are leading causes of overall and cardiovascular disease (CVD) mortality worldwide, yet the relevant metabolic alterations responsible are largely unknown. We conducted a serum metabolomic analysis of 620 men in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (1985-2013). During 28 years of follow-up, there were 435 deaths (197 CVD and 107 cancer). The analysis included 406 known metabolites measured with ultra-high performance liquid chromatography/mass spectrometry-gas chromatography/mass spectrometry. Cox regression estimated mortality hazard ratios (HR) for a one standard-deviation difference in metabolite-signals, and we divided the data into training and test-sets, creating a metabolite risk score of the strongest metabolites in the former to test in the latter. The strongest associations with overall mortality were N-acetylvaline (HR=1.28; P<4.1×10^-5, below Bonferroni statistical threshold), and dimethylglycine, 7-methylguanine, C-glycosyltryptophan, taurocholate, and N-acetyltryptophan (1.23≤HR≤1.32; 5×10^-5≤P≤1×10^-4). C-Glycosyltryptophan, 7-methylguanine, and 4-androsten-3beta,17beta-diol disulfate were statistically significantly associated with CVD mortality (1.49≤HR≤1.62, P<4.1×10^-5). No metabolite was associated with cancer mortality at false discovery rate<0.1. Individuals with a one standard-deviation higher metabolite risk score had increased all-cause and CVD mortality in the test-set (HR=1.4, P=0.05; HR=1.8, P=0.003, respectively). The several serum metabolites and their composite risk score independently associated with all-cause and CVD mortality may provide potential leads regarding the molecular basis of mortality.

The Association between Pre-pregnancy Body Mass Index and Risk of Preterm Delivery in Chinese Population

Degree of European Genetic Ancestry is Associated with Serum Vitamin D Levelsin African Americans

Abstract

Circulating levels of vitamin D are generally lower in African Americans compared to U.S. whites, and one prior analysis in a small number of African Americans suggested that, within this population, vitamin D levels may be related to the degree of genetic admixture. We assessed the association of percent European ancestry with serum vitamin D levels in 2183 African American women from the Black Women's Health Study in 2013-2015, whose DNA had been genotyped for ancestry informative markers. ADMIXMAP software was used to estimate percent European versus African ancestry in each individual. In linear regression analyses with adjustment for genotype batch, age, body mass index, supplemental vitamin D use, UVB flux in state of residence, and season of blood draw, each 10% increase in European ancestry was associated with a 0.672 ng/mL increase in serum vitamin D concentration (95% confidence interval 0.173, 1.170). The association was statistically significant only among women who were not taking vitamin D supplements (beta coefficient for 10% increase in European ancestry 0.855, 95% confidence interval 0.139, 1.571). Among African Americans, use of vitamin D supplementation may help to reduce vitamin D deficiency due to genetic ancestry.

Inverse-Probability Weights for the Analysis of Polytomous Outcomes

A Penicillin Skin Testing Initiative in an Outpatient Allergy Office

Publication date: Available online 31 January 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Allison Ramsey, S. Shahzad Mustafa

Errors in the use of inhalers by healthcare professionals: a systematic review

Publication date: Available online 31 January 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Vicente Plaza, Jordi Giner, Gustavo J. Rodrigo, Myrna B. Dolovich, Joaquin Sanchis
BackgroundInefficient inhaler technique (IT) compromises the optimal delivery of medication. However, the IT knowledge of health care professionals (HCP) has received scant attention.ObjectiveTo perform a systematic review of published reports assessing the IT proficiency of HCPs in using pressurized metered dose (pMDI) and dry powder (DPI) inhalers.MethodsStudies published between 1975 and 2014 that directly assessed the IT skills of HCPs were selected according to pre-defined selection criteria.ResultsData were extracted from 55 studies involving 6,304 HCPs who performed 9,996 tests to demonstrate their IT proficiency. Overall, the IT was considered correct in 15.5% of cases (95% Confidence Interval [CI] 12-19.3), decreasing over time from 20.5% (95% CI, 14.9-26.8) from the early period (defined as 1975-1995) to 10.8% (95% CI, 7.3-14.8) during the late period (1996-2014). The most common errors in the use of pMDIs were as follows: not breathing out completely before inhalation (75%; 95% CI, 56-90), lack of coordination (64%; 95% CI, 29-92), and post-inhalation breath-hold (63%; 95% CI, 52-72). The most common errors using DPT were: deficient preparation (89%; 95% CI, 82-95), not breathing out completely before inhalation (79%; 95% CI, 68-87), and no breath-hold (76%; 95% CI, 67-84).ConclusionHealth care professionals demonstrated an inadequate knowledge of the proper use of inhalers. The poor understanding of the correct use of these devices may prevent these professionals from being able to adequately assess and teach proper inhalation techniques to their patients.

The cost of self-reported penicillin allergy: a systematic review

Publication date: Available online 31 January 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): T. Joseph Mattingly, Anne Fulton, Rachel A. Lumish, Anne M.C. Williams, SeJeong Yoon, Melissa Yuen, Emily L. Heil
BackgroundPatients who report a penicillin (PCN) allergy receive suboptimal antibiotic therapy compared to patients not reporting an allergy. However, a majority of patients who report PCN allergy are not truly allergic upon confirmatory testing. Ruling out PCN allergy by testing may improve clinical and economic outcomes for patients with reported allergies requiring antibiotic therapy.ObjectivesTo summarize clinical and economic outcomes associated with PCN allergy and provide recommendations for future cost-effectiveness analyses for PCN allergy testing.MethodsA literature search was conducted using SCOPUS, EMBASE, and PubMed, including all articles published any date through April 25, 2017 (PROSPERO Registration number 42017064112). A total of 1,518 abstracts were found during the initial search with 96 duplicates, for a total of 1,422 articles for screening. Thirty articles were included for qualitative synthesis and full data extraction.ResultsThe majority of the studies included had an observational design focusing on inpatient admissions. The most frequently measured outcome in the context of PCN allergy was optimizing antibiotic therapy. Patients with PCN allergy were found to have direct drug costs during inpatient admission ranging from no difference to an additional $609/patient compared to non-PCN allergy patients. Outpatient prescription costs were estimated from $14-$193/patient higher for PCN allergic patients. Total inpatient costs were less for non-PCN allergy patients with average savings from $1,145-$4,254/patient.ConclusionsEvaluations of clinical and economic outcomes of PCN allergy are primarily observational and focus on inpatient populations. Long-term relationships between PCN allergy and clinical and economic outcomes are unknown.

Subfascial Primary Breast Augmentation with Fat Grafting: A Review of 156 Cases

No abstract available

The Lateral Thigh Perforator Flap for Autologous Breast Reconstruction: A Prospective Analysis of 138 Flaps

Background: The septocutaneous tensor fasciae latae or lateral thigh perforator flap was previously introduced by the authors' group as an alternative flap for autologous breast reconstruction when the abdomen is not suitable as a donor site. The authors analyzed their experience with the lateral thigh perforator flap and present the surgical refinements that were introduced. Methods: A prospective study was conducted of all lateral thigh perforator flap breast reconstructions performed since September of 2012. Patient demographics, operative details, complications, and flap reexplorations were recorded. Preoperative imaging with magnetic resonance angiography was performed in all patients. Surgical refinements introduced during this study included limitation of the flap width and the use of quilting sutures at the donor site. Results: A total of 138 lateral thigh perforator flap breast reconstructions were performed in 86 consecutive patients. Median operative times were 277 minutes (range, 196 to 561 minutes) for unilateral procedures and 451 minutes (range, 335 to 710 minutes) for bilateral. Median flap weight was 348 g (range, 175 to 814 g). Two total flap losses (1.4 percent) were recorded, and 11 flaps (8.0 percent) required reexploration, which resulted in viable flaps. The incidence of donor-site complications was reduced significantly after the surgical refinements were introduced. Wound problems decreased from 40.0 percent to 6.3 percent, seroma decreased from 25.0 percent to 9.5 percent, and infection decreased from 27.5 percent to 9.5 percent. Conclusions: The lateral thigh perforator flap is an excellent option for autologous breast reconstruction, with minimal recipient-site complications. The surgical refinements resulted in a significant reduction of donor-site complications. Therefore, the lateral thigh perforator flap is currently the authors' second choice after the deep inferior epigastric artery perforator flap. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Developing, Conducting, and Publishing Appropriate Systematic Review and Meta-Analysis Articles

Summary: The volume of medical literature is growing at a rate that renders decision-making difficult without specialized summary tools. Systematic reviews and meta-analyses are important research instruments used to condense and clarify a broad scope of information into manageable summaries. When used effectively, these reports can pool cumulative data across primary studies, formulate clinical guidelines, and guide future research endeavors. However, errors in study design can result in ineffective or misleading analyses. This article presents the appropriate uses for systematic review and meta-analysis by introducing a framework for creating summary studies, and supplying specific examples of pitfalls in study design and execution.

Discussion: The Lateral Thigh Perforator Flap for Autologous Breast Reconstruction A Prospective Analysis of 138 Flaps

No abstract available

Redefining the Rectus Sheath: Implications for Abdominal Wall Repair

Background: The abdominal wall is frequently manipulated in a variety of reconstructive procedures, and its anatomy is well described. The authors' clinical observations, however, contradict the standard depiction of the components of the abdominal wall at various levels—particularly regarding the course of the transversus abdominis muscle. Therefore, the authors sought to characterize the components of the rectus sheath at various surgical landmarks to define anatomic points important to abdominal wall repair. Methods: The authors analyzed the abdominal computed tomographic studies of 100 healthy, young (age, 18 to 35 years; body mass index, 20 to 40 kg/m2) patients with suspected renal calculi. Coordinates of key landmarks were recorded at vertebral levels T12 to L5 using a specially designed computer program that scaled all values and calculated distances between various points. Results: All subjects had significant presence of the transversus abdominis within the rectus sheath (the overlap between the abdominis rectus and transversus abdominis muscles) at the costal margin plane (T12-L1, 4.2 cm). Ninety-nine percent had transversus abdominis presence within the rectus sheath at L1-L2 (3.2 cm), 86 percent at the level of the twelfth rib (L2-L3, 1.4 cm), 36 percent at the umbilicus (L3-L4), and 2 percent slightly above the posterosuperior iliac spine (L5-S1). Conclusions: These findings contradict classic teachings of abdominal wall structure and highlight the need for a cautious revisiting of the various permutations of component separation, particularly posterior component release. Furthermore, these anatomical landmarks may help predict the development or recurrence of ventral hernias, thus guiding patient selection and informing surgical technique.

Complications and Patient-Reported Outcomes after Abdominally Based Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study

Background: Abdominal flap reconstruction is the most popular form of autologous breast reconstruction. The current study compared complications and patient-reported outcomes after pedicled transverse rectus abdominis myocutaneous (TRAM), free TRAM, deep inferior epigastric perforator (DIEP), and superficial inferior epigastric artery (SIEA) flaps. Methods: Patients undergoing abdominally based breast reconstruction at 11 centers were prospectively evaluated for abdominal donor-site and breast complications. Patient-reported outcomes were measured by the BREAST-Q and Patient-Reported Outcomes Measurement Information System surveys. Mixed-effects regression models were used to assess the effects of procedure type on outcomes. Results: Seven hundred twenty patients had 1-year follow-up and 587 had 2-year follow-up. Two years after reconstruction, SIEA compared with DIEP flaps were associated with a higher rate of donor-site complications (OR, 2.7; p = 0.001); however, SIEA flaps were associated with higher BREAST-Q abdominal physical well-being scores compared with DIEP flaps at 1 year (mean difference, 4.72, on a scale from 0 to 100; p = 0.053). This difference was not significant at 2 years. Abdominal physical well-being scores at 2 years postoperatively were lower in the pedicled TRAM flap group by 7.2 points (p = 0.006) compared with DIEP flaps and by 7.8 points (p = 0.03) compared with SIEA flaps, and in the free TRAM flap group, scores were lower by 4.9 points (p = 0.04) compared with DIEP flaps. Bilateral reconstruction had significantly lower abdominal physical well-being scores compared with unilateral reconstruction. Conclusions: Although all abdominally based flaps are viable breast reconstruction options, DIEP and SIEA flaps are associated with higher abdominal physical well-being than pedicled and free TRAM flaps. Although SIEA flaps offer the advantage of not violating the fascia, higher rates of donor-site complications may diminish patient satisfaction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Jack Gunter, M.D: A Man of Passion and a True Friend—with Some of His Own Words

No abstract available

Venous Superdrainage in DIEP Flap Breast Reconstruction: The Impact of Superficial Inferior Epigastric Vein Dissection on Abdominal Seroma Formation

Background: Abdominal seroma formation after deep inferior epigastric perforator (DIEP) flap breast reconstruction is a common donor-site complication. Additional dissection of one or both of the superficial inferior epigastric veins (SIEVs) in DIEP flap breast reconstruction allows an additional anastomosis for venous superdrainage if venous congestion occurs. However, generally, SIEV dissection involves greater invasiveness into the inguinal region, which can traumatize lymphatic tissue and lead to lymph accumulation. The aim of this study was to evaluate the impact of SIEV dissection on the incidence of postoperative abdominal seroma. Methods: A series of 100 consecutive cases performed by the Department of Plastic and Reconstructive Surgery at the Medical University of Vienna from 2001 to 2016 was analyzed. Patients were divided into three groups: unilateral, bilateral, and no SIEV dissection. Abdominal seroma rates, length of hospital stay, abdominal drainage duration, and drainage fluid volumes were compared retrospectively. Results: Seromas were observed in 11.5 percent of patients without SIEV dissection, 17.2 percent of patients with unilateral SIEV dissection (p = 0.45 versus no SIEV), and 40 percent of patients with bilateral SIEV dissection (p = 0.02 versus no SIEV). The SIEV was anastomosed to salvage a congested DIEP flap twice. All seromas that developed could be treated with, on average, two fine-needle aspirations without any complications. Conclusions: Bilateral, but not unilateral, SIEV dissection increased abdominal seroma rates significantly. Venous congestion was observed rarely, but when it did occur, it endangered flap viability. Because an additional anastomosis of the SIEV can salvage a flap, unilateral SIEV dissection should be considered when raising a DIEP flap. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

The Use of Low-Profile Silicone Breast Implants in Male Breast Reconstruction

No abstract available

The Comparison of Strattice and SurgiMend in Acellular Dermal Matrix–Assisted, Implant-Based Immediate Breast Reconstruction

Background: Strattice (porcine derivative) and SurgiMend (bovine derivative) are the two most common acellular dermal matrices used in breast reconstruction in the United Kingdom. This retrospective study compared clinical outcomes in immediate implant-based breast reconstruction patients. Methods: The study, conducted across three hospitals, included all patients who underwent immediate implant-based breast reconstruction using Strattice and SurgiMend. The primary outcome measure was implant loss rate. Secondary outcome measures included acellular dermal matrix loss rate, seroma formation, and minor and major complication rates. Intergroup comparison was performed. Results: Eighty-two patients (Strattice, n = 45; SurgiMend, n = 37) underwent 97 immediate implant-based breast reconstructions (Strattice, n = 54; SurgiMend, n = 43). There were no differences between groups for age, comorbidities, specimen weight, or implant volume. Drains were used in all Strattice and 36 (84 percent) SurgiMend cases. The implant loss rate was higher for Strattice (n = 10, 20 percent) compared with SurgiMend (n = 3, 7 percent) but failed to reach statistical significance (chi-square test, p = 0.077). The acellular dermal matrix loss rate was significantly higher (Fisher's exact test, p = 0.014) in the Strattice group (n = 7, 14 percent), with no acellular dermal matrix loss with SurgiMend. The reoperation rate was also significantly higher (chi-square test, p = 0.002) in the Strattice group (n = 17, 33 percent, versus n = 3, 7 percent). The incidence of red breast was significantly higher (chi-square test, p = 0.022) in the SurgiMend group (n = 9, 21 percent, versus n = 3, 6 percent). Seroma, wound problems, and infection rates were similar. Conclusions: Clinical outcomes, including implant loss, acellular dermal matrix loss, and reoperation rates, are significantly better when using SurgiMend in immediate implant-based breast reconstruction compared with Strattice. An appropriately powered randomized trial is needed to provide further information. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Evidence-Based Medicine: Abdominoplasty

Learning Objectives: After reading this article, the participant should be able to: 1. Differentiate between techniques for standard abdominoplasty and lipoabdominoplasty. 2. Assess patients for risk associated with abdominoplasty alone and combined with other procedures. 3. Implement newer modalities for abdominoplasty perioperative pain management. 4. Better understand the implications and techniques for rectus diastasis correction by rectus sheath plication. 5. Understand the evidence for eliminating the need for drains in abdominoplasty. Summary: This update to past Maintenance of Certification articles offers new perspectives and builds on past knowledge regarding patient assessment, perioperative management, surgical execution, and complications of abdominoplasty.

Conceptual Considerations for Payment Bundling in Breast Reconstruction

Summary: Rising health care costs and quality demands have driven both the Centers for Medicare and Medicaid Services and the private sector to seek innovations in health system design by placing institutions at financial risk. Novel care models, such as bundled reimbursement, aim to boost value though quality improvement and cost reduction. The Center for Medicare and Medicaid Innovation is leading the charge in this area with multiple pilots and mandates, including Comprehensive Care for Joint Replacement. Other high-cost and high-volume procedures could be considered for bundling in the future, including breast reconstruction. In this article, conceptual considerations surrounding bundling of breast reconstruction are discussed.

Secondary Rhinoplasty by the Global Masters

No abstract available

Discussion: Conceptual Considerations for Payment Bundling in Breast Reconstruction

No abstract available

Reply: Comparison of Outcomes with Tissue Expander, Immediate Implant, and Autologous Breast Reconstruction in Greater Than 1000 Nipple-Sparing Mastectomies

No abstract available

Introducing the PRS Video Vignette Masters Series

No abstract available

Urinary Excretion of MicroRNA-126 Is a Biomarker for Hemangioma Proliferation

No abstract available

Gluteal Augmentation and Enhancement of the Female Silhouette: Analysis and Technique

Summary: Dr. Constantino Mendieta demonstrates and details his personal technique for gluteal augmentation. The video demonstration is divided into three parts: Part I, Aesthetic Analysis and Preoperative Marking; Part II, Creating the Female Silhouette with Circumferential Lipoplasty; and Part III, Autogenous Gluteal Augmentation. Artistic concepts for gluteal augmentation and contouring the female silhouette and technical considerations for patient safety are emphasized. This Master Series Video article is the first in a planned series of video vignettes.

Direct-to-Implant Breast Reconstruction in Women Older than 65 Years: A Retrospective Analysis of Complication Rate and Overall Outcomes

Background: Half of all cancers occur in women older than 65 years, yet only 4 to 14 percent of these women undergo reconstruction. Most studies on reconstruction in the elderly have focused on tissue expander/implant or autologous reconstruction. A direct-to-implant approach theoretically reduces the number of operations and postoperative visits, but has yet to be investigated in the elderly. Methods: Institutional review board approval was granted for a retrospective chart review for patients who underwent direct-to-implant reconstruction from 2012 to 2015 with any staff in the authors' department. A control cohort of patients who underwent tissue expander/implant-based reconstruction from the same period was analyzed. Results: Direct-to-implant reconstruction was performed in 24 breasts in 19 patients with at least 30-day follow-up and in 17 breasts in 14 patients with at least 1-year follow-up. A control group analysis of tissue expander/implant patients was performed for 109 breasts in 88 patients. The tissue expander/implant group was significantly younger (p = 0.001), with a lower body mass index (p = 0.004). There was no difference in the rate of seroma, hematoma, infection, necrosis, or failed reconstruction. Direct-to-implant patients had significantly reduced numbers of drain days (p

Bony/Cartilaginous Mismatch: A Radiologic Investigation into the Cause of Tension Nose Deformity

Background: Tension nose deformity is believed to be caused by an "oversized" septal quadrangular cartilage. Prior studies have shown that quadrangular cartilage size is relatively consistent in populations. The authors hypothesize that the tension nose deformity is actually caused by an external extrusion of a normal sized septal cartilage from an undersized bony septal encasement. Methods: A retrospective case-control study of sagittal computed tomographic scans was conducted, measuring the perimeter and surface area of the quadrangular cartilage and bony septal aperture in tension nose cases and controls. Statistical analysis was performed. Results: Of 23 patients enrolled in the study, 12 patients were sorted into the tension nose group, and 11 patients were considered controls. Both groups had similar perimeter and surface area of their quadrangular cartilage, without statistical difference between the two groups. However, the tension nose group had a statistically significant reduction in bony septal aperture perimeter compared with controls (p

Past and future

The New Year, or Hogmanay as it is known in these parts, is traditionally a time to reflect and to look forward in expectation of greater things to come. Our specialty has a relatively short history to reflect upon. Fifty years ago a very small number of consultants comprised the British Association of Plastic Surgeons, which published this Journal. Their training, autonomy, junior support, breadth and pattern of work would have been barely recognisable to current NHS consultants. Many of the techniques they employed would have seemed strange to us, inpatient care predominated, and sub-specialisation did not really exist.

The efficacy of bacterial species to decolourise reactive azo, anthroquinone and triphenylmethane dyes from wastewater: a review

Abstract

The industrial dye-contaminated wastewater has been considered as the most complex and hazardous in terms of nature and composition of toxicants that can cause severe biotic risk. Reactive azo, anthroquinone and triphenylmethane dyes are mostly used in dyeing industries; thus, the unfixed hydrolysed molecules of these dyes are commonly found in wastewater. In this regard, bacterial species have been proved to be highly effective to treat wastewater containing reactive dyes and heavy metals. The bio-decolourisation of dye occurs either by adsorption or through degradation in bacterial metabolic pathways under optimised environmental conditions. The bacterial dye decolourisation rates vary with the type of bacteria, reactivity of dye and operational parameters such as temperature, pH, co-substrate, electron donor and dissolved oxygen concentration. The present paper reviews the efficiency of bacterial species (individual and consortia) to decolourise wastewater containing reactive azo, anthroquinone and triphenylmethane dyes either individually or mixed or with metal ions. It has been observed that bacteria Pseudomonas spp. are comparatively more effective to treat reactive dyes and metal-contaminated wastewater. In recent studies, either immobilised cell or isolated enzymes are being used to decolourise dye at a large scale of operations. However, it is required to investigate more potent bacterial species or consortia that could be used to treat wastewater containing mixed reactive dyes and heavy metals like chromium ions.

Influence of Visible Light on Cutaneous Hyperchromias: Clinical Efficacy of Broad Spectrum Sunscreens

Abstract

Introduction

Cutaneous hyperchromias are disorders of skin pigmentation involving increased melanin production and its irregular accumulation in skin cells. The use of sunscreens is fundamental for the control of hyperchromias by reducing the stimulation of pigmentation, since melanin synthesis is mainly stimulated by solar radiation. Many studies have demonstrated that visible light can induce significant skin damage. Considering the effects of visible light, effective photoprotection should not be limited only to UV protection but should also involve visible and infrared protection.

Objective

The aim of this study was to evaluate the efficacy of UV-VIS sunscreens in protecting skin against damages caused by solar radiation and the influence of visible light on the appearance of cutaneous hyperchromias.

Methods

40 volunteers aged 18 to 39 years with skin hyperpigmentation participated in the study. In order to evaluate the efficacy of the formulations developed, the percentage of hyperpigmented area was evaluated using high resolution images - Visioface^® Quick (Courage-Khazaka, Germany) and the analysis of epidermal pigmentation was performed by RCM – Vivascope^® 1500 (Lucid, USA). Also, the melanin index was determined using the Mexameter^® M X16 colorimeter (Courage-Khazaka, Germany).

Results

The developed formulations were effective in the reduction of melanin index, epidermal pigmentation and percentage of hyperpigmented area.

Conclusion

Finally, this study discusses how the combination of UV filters and pigments can protect the skin from solar radiation and reduces skin hyperpigmentations.

This article is protected by copyright. All rights reserved.

Regenerable, innovative porous silicon-based polymer-derived ceramics for removal of methylene blue and rhodamine B from textile and environmental waters

Abstract

The presence of residual color in treated textile wastewater above the regulation limits is still a critical issue in many textile districts. Innovative, polymer-derived ceramics of the Si–C–O system were here synthesized in order to obtain porous nanocomposite materials where a free carbon phase is dispersed into a silicon carbide/silicon oxycarbide network. The sorbents were comprehensively characterized for the removal of two model water-soluble dyes (i.e., the cation methylene blue and the zwitterion rhodamine B). Adsorption is very rapid and controlled by intra-particle and/or film diffusion, depending on dye concentration. Among the nanocomposites studied, the SiOC aerogel (total capacity about 45 mg/g, is easily regenerated under mild treatment (250 °C, 2 h). Adsorption of dyes is not affected by the matrix composition: removals of 150 mg/L methylene blue from river water and simulated textile wastewater with high content of metal ions (2–50 mg/L) and chemical oxygen demand (800 mg/L) were higher than 92% and quantitative for a dye concentration of 1 mg/L.

The effect of anthropogenic and natural factors on the prevalence of physicochemical parameters of water and bacterial water quality indicators along the river Białka, southern Poland

Abstract

This study was aimed to determine the anthropogenic and natural factors affecting spatial and temporal changes in the physicochemical parameters and bacterial indicators of water quality in the river Białka. The impact of intensive development of the tourist infrastructure on the quality of river water and the potential health threats to tourists was also assessed. Water samples were collected over a period of 2.5 years, once per each month in four sites along the river. Temperature, electrolytic conductivity, pH, and water level were measured onsite; flow rate data were acquired from the Institute of Meteorology and Water Management; chemical analyses allowed to determine the amount of fourteen ions, while microbiological indicators included total and thermotolerant coliforms, total and thermotolerant Escherichia coli, and mesophilic and psychrophilic bacteria. The combination of hydrological, hydrochemical, and microbiological methods generated large amount of data, which were processed by multivariate statistical analysis. A downstream cumulative effect was observed in the contamination of the river water. Fecal coliforms and E. coli were detected in all sites, suggesting the source of fecal contamination even in the protected areas. Intensive development of a ski resort and the related infrastructure, together with the need to accommodate numerous tourists in the examined region, has an evident environmental impact. The resulting deterioration of water quality poses health risks to tourists, as water from the Białka river is used for a variety of purposes, including as a raw drinking water or for artificial snowing of ski slopes. The seasonal changes in the physicochemical parameters mainly result from varying natural factors that shape the water quality in the studied region. The differences in the number of analyzed microorganisms result from seasonal variation in touristic activity and are affected mostly by point sources of sewage inflow.

The spatio-temporal dynamic pattern of rural domestic solid waste discharge of China and its challenges

Abstract

At present, construction of rural domestic waste treatment facilities is seriously lagging, and in many cases, treatment facilities do not yet exist in some villages of China. Serious rural waste pollution has not only impacted the quality of surface water and groundwater but also the atmosphere and the living environment of farmers of China. There are relatively few studies of rural domestic waste pollution, especially with respect to the spatio-temporal dynamic pattern of rural domestic waste discharge. Using survey data and income per capita, we calculated rural domestic waste discharge per capita per day. From this, we calculated provincial rural domestic waste discharge. According to our study, rural domestic waste discharge was 1.42 × 10⁸ t/year in 2000. This number increased to 2.3 × 10⁸ t/year in 2006 and to 2.47 × 10⁸ t/year in 2010. Rural domestic waste increased dramatically while the actual rural population and the proportion of the rural population declined. When examining the eight regions, the rural domestic waste discharge of northeastern China, Qinghai-Tibet, middle China, and southwestern China had increased dramatically, while that of northern China, southern China, and eastern China increased relatively slowly. The economies of northern China, southern China, and eastern China are more developed; their rural domestic waste discharge has been high since 2000 and has continued to increase slowly. In northeastern China, Qinghai-Tibet, middle China, and southwestern China, rural domestic waste discharge was low in 2000; however, in the ten-year period from 2000 to 2010, their rural domestic waste discharge increased dramatically.

The Effect of Workforce Mobility on Intervention Effectiveness Estimates

Abstract

Background

Little is known about how mobile populations of workers may influence the ability to implement, measure, and evaluate health and safety interventions delivered at worksites.

Methods

A simulation study is used to objectively measure both precision and relative bias of six different analytic methods as a function of the amount of mobility observed in the workforce. Those six methods are then used to reanalyze a previously conducted cluster-randomized control trial involving a highly mobile workforce in the construction industry.

Results

As workforce mobility increases, relative bias in treatment effects derived from standard models to analyze cluster-randomized trials also increases. Controlling for amount of time exposed to the intervention can greatly reduce this bias. Analyzing only subsets of workers who exhibit the least amount of mobility can result in decreased precision of treatment effect estimates. We demonstrate a 59% increase in the treatment effect size from the reanalysis of the previously conducted trial.

Conclusions

When evaluating organizational interventions implemented at specific worksites by measuring perceptions and outcomes of workers present at those sites, researchers should consider the effects that the mobility of the workforce may have on the estimated treatment effects. The choice of analytic method can greatly affect both precision and accuracy of estimates.

Differences among Thai Agricultural Workers’ Health, Working Conditions, and Pesticide Use by Farm Type

Abstract

More than 11 million Thai people (38%) work in agriculture, but since most are in the informal sector, government enforcement and support are very limited. As a result, working conditions on Thai farms vary greatly, putting the health of many agricultural workers at risk. A cross-sectional study in three Thai provinces collected information on the work activities and conditions of 424 farmers representing five farm types: rice, vegetable, flower, rice/vegetable, and flower/vegetable. The agricultural workers were mainly women (60%); their average age was 53 but ranged from 18 to 87 years. More than 64% worked more than 5 days/week. Seventy-four percent of them had only primary school education. A number of the health and hazardous working conditions surveyed were significantly different by farm type. Rice farmers were found to have the highest prevalence of allergies, nasal congestion, wheezing, and acute symptoms after pesticide use, while flower farmers had the lowest prevalence of these health outcomes. Rice farmers reported the highest prevalence of hazardous working conditions including high noise levels, working on slippery surfaces, sitting or standing on a vibrating machine, spills of chemicals/pesticides, and sharp injuries. The lowest prevalence of these working conditions (except noise) was reported by flower farmers. Vegetable farmers reported the highest prevalence knee problems, while rice farmers had the lowest prevalence. Among these farmers, more than 27 different types of pesticides were reported in use during the past year, with the majority reporting use once a month. The flower/vegetable farming group reported the highest frequency of good exposure prevention practices during pesticide use. They were the most likely to report using cotton or rubber gloves or a disposable paper masks during insecticide spraying. Those farmers who only grew vegetables had the lowest frequency of good exposure prevention practices, including use of personal protective equipment. The economic cost of work-related injuries and illnesses among informal sector agricultural workers in Thailand is unknown and in need of study. Gaps in the regulations covering pesticide sales allow farmers to purchase pesticides without adequate training in their safe use. Training targeted to farm type regarding safe pesticide use and the prevention of accidents and musculoskeletal disorders is needed. Studies of chronic health effects among Thai farmers are needed, with special emphasis on respiratory, metabolic disease and cancer.

The Pathological Spectrum and Clinical Correlation of Pigmented Purpuric Dermatosis– A Retrospective Review of 107 Cases

Abstract

Background

Various pathological findings have been reported in pigmented purpuric dermatosis, but their clinical significance remains unclear.

Methods

We retrospectively reviewed demographics, clinical presentations, pathological patterns, and concurrent systemic diseases among biopsy-confirmed cases of pigmented purpuric dermatosis.

Results

A total of 107 cases were ascertained. Five major pathological patterns were identified: lichenoid (45/107, 42.1%), perivascular (40/107, 37.4%), interface (11/107, 10.3%), spongiotic (7/107, 6.5%), and granulomatous (4/107, 3.7%). Lymphocytic vasculitis was present in 17 patients (15.9%), and Langerhans cell microabscess was seen in 4 (3.7%). Nine patients had partial features mimicking mycosis fungoides but none were confirmed. The lichenoid, perivascular and spongiotic patterns correlated to lichen aureus, Schamberg's and eczematoid clinical variants, respectively. The interface pattern was associated with a higher risk of co-occurring with autoimmune diseases (18.2%, p=0.0280) and gout (27.3%, p=0.0180)

Conclusions

This study described the wide pathological spectrum of pigmented purpuric dermatosis among Asians. Physicians should be aware about the clinical and pathological variations to facilitate diagnosis.

Spotlight on… Emmanuelle Charpentier

Biographical Summary

Emmanuelle Charpentier is a French microbiologist, geneticist and biochemist. She is a Director at the Max Planck Institute for Infection Biology in Berlin, Honorary Professor at Humboldt University, Visiting Professor at Umeå University and recipient of an Alexander von Humboldt Professorship. Prior to her current appointments, she worked at several other institutions in Germany, Sweden, Austria, the US and France. Emmanuelle Charpentier's research on a bacterial immune system laid the foundation for the ground-breaking CRISPR-Cas9 genome engineering technology. She has received numerous prestigious awards and distinctions, and is an elected member of several renowned academies of sciences. She is co-founder of CRISPR Therapeutics and ERS Genomics.

The functional RNA cargo of bacterial membrane vesicles

Abstract

Bacteria secrete RNAs, some of which have effects on other cells and on other species as signalling RNAs. Prokaryotic membrane vesicles (MVs) contain a range of RNA types. The MV structure offers protection from degradation as well as receptors to facilitate delivery to target cells. Microscopic imaging and molecular biology analyses have provided evidence to demonstrate that bacterial MVs deliver their RNA into eukaryotic cells. Moreover, in some cases the RNA cargo is demonstrably functional and phenotypic changes can be identified in MV-RNA treated target cells. The challenge now is to dissect the effect of MV-RNA on target cells away from the effects of non-RNA components of the MV such as lipopolysaccharide that can co-purify with RNA.

Small RNAs in cell-to-cell communications during bacterial infection

Abstract

Intercellular communication is a widespread phenomenon in all domains of Life. Bacteria have developed many ways of communicating with one another and with other species, either prokaryotic or eukaryotic. RNA has been a key molecule since beginning of Life on Earth, and is one of the carriers of information. Given the current antibiotic crisis, understanding the way in which pathogens communicate can lead towards improved ways to control infections when antimicrobial therapy is not possible. Different subspecies of RNA, non-coding, and of small size, designated here as ncRNAs, have been in the recent years subject of a great research effort, and results have contributed to a growing field of knowledge. This review focuses on four different aspects of ncRNA involvement in cell-to-cell communications during bacterial infections: pathogen recognition by the host, alteration of host miRNA profiles, production of domestic and secreted forms of ncRNAs and subversion of the host responses. The current review article focuses on the most recent discoveries in the field and gives an integrative idea based on the discussed studies.

Deletion of PimE mannosyltransferase results in increased copper sensitivity in Mycobacterium smegmatis

Abstract

The unique cell envelope structure of Mycobacterium tuberculosis is fundamental to its pathogenesis. Phosphatidylinositol (PI)-anchored glycolipids, such as PI mannosides (PIMs), lipomannan, and lipoarabinomannan, are essential components of the cell envelope widely conserved among mycobacteria, but their roles in the cell envelope integrity are not fully understood. We previously identified PimE in Mycobacterium smegmatis, a nonpathogenic model organism, as a mannosyltransferase that catalyzes the fifth mannose transfer for the biosynthesis of hexamannosyl PIMs. Our analyses, reported here, further demonstrate that the growth of the pimE deletion mutant (ΔpimE) is defective in the presence of copper. We first found that the small colony phenotype of ΔpimE on a solid Middlebrook 7H10 agar surface was alleviated when grown on M63 agar. Comparative analysis of the two media led us to identify copper in Middlebrook 7H10 as the cause of growth retardation seen in ΔpimE. We further demonstrated that ΔpimE is sensitized to several antibiotics, but the increased sensitivities were independent of the presence of copper. We conclude that the deletion of the pimE gene does not cause growth defects under optimal growth conditions, but makes the cell envelope vulnerable to toxic compounds such as copper and antibiotics.

Evaluation of inguinal vascular surgical scars treated with closed incisional negative pressure wound therapy using three-dimensional digital imaging – a randomized controlled trial on bilateral incisions

Abstract

Purpose of the investigation: Scar formation is an important, permanent surrogate marker for wound healing. The main aim of this randomized trial was to evaluate the effects of incisional negative pressure wound therapy (iNPWT) on scar formation in uncomplicated wound healing with 3-dimensional (3D) digital imaging.

Basic procedures: Patients undergoing bilateral inguinal incisions after vascular surgery were randomized to receive iNPWT and standard dressing on separate sides. The incisional scars were documented at a median time of 808 days (range 394-1194) after surgery with 3D-photography, which were objectively evaluated by two plastic surgeons using the Stony Brook scar evaluation scale (SBSES) and a 10-point graded numeric ranking scale (NRS10). Subjective evaluation was performed with the patient observer scar assessment scale (POSAS). Patients with surgical site infection or other wound complications were excluded to minimize bias. The P-values were calculated using McNemar's and Wilcoxon signed rank test for paired nominal and paired continuous data, respectively.

Main findings: Among 33 patients, 32 patients had undergone endovascular aortic repair (EVAR) and 31 patients had transverse inguinal incisions. Objective and subjective scar evaluation showed no difference between iNPWT and standard dressing. In objective scorings, 18.8% and 21.9% received the highest possible SBSES total score in the iNPWT and standard dressing groups, while 43.8% and 37.5% received the highest possible NRS10 score, respectively. The inter-rater reliability between the two assessors for SBSES total score and NRS10 showed an intra class correlation (ICC) of 0.78 and 0.68 for NPWT and 0.70 and 0.77 for traditional dressing, respectively.

Principal conclusion: The present randomized trial showed that iNPWT and standard dressings on closed transverse inguinal incisions after EVAR resulted in equal subtle scar formation. Objective scar evaluation with 3D images showed good inter-rater agreement. This article is protected by copyright. All rights reserved.

Neural Crest-Derived Cells Migrate from Nerve to Participate in Achilles tendon Remodeling

Abstract

During tendon injuries, nerve ingrowth is one of the earliest events of tendon repair and remodeling. Since peripheral neurons and associated cells are mostly derived from neural crest (NC) cells, we sought to investigate the role of NC-derived cells in tendon regeneration. Thus, we used Sox10-Cre/ROSA26-Flox-Red Fluorescent Protein (RFP) transgenic mice to trace these cells during tendon regeneration. After 4 weeks of Achilles tendon rupture, the injured tendon tissues were harvested for immunohistological analyses, cell isolation, and phenotype identification. In addition, the tenocytes were co-cultured with RFP labeled cells to examine cellular functions. Following the injury, a significant number of RFP-labeled cells penetrated into the wound site and reached a peak (∼30% of cells) after 2 weeks, and then stabilized at a level of ∼20%. Interestingly, 36.9% RFP labeled cells in the injured area expressed Tuj1, suggesting that most of the cells are peripheral neurons. Some RFP⁺/Tuj1⁺ cells were also found adjacent to newly formed blood vessels in the tendon. Importantly, the existing Neuropeptide Y (NPY) and Neuropeptide Y receptor (NPYr) in the ingrowth nerve and blood vessels showed the direct correlation with each other. In addition, there were also RFP⁺ cells (∼30%) negative for neuron markers but positive for fibroblast markers i.e., FAP (34.7%) and Vimentin (Vmt) (27.2%), and ∼10% positive for Sox10. Indeed, many RFP⁺ cells isolated from the ruptured Achilles tendon showed long spindle shapes and expressed fibroblast phenotypic markers FSP1 and FAP. Particularly, part of the Sox10⁺RFP-labeled cells exhibited osteogenic and adipogenic differentiation ability. It is concluded that after Achilles tendon injury, nerves sprout into the wound site. The NC-derived Vmt+/FAP+ mesenchymal cells and peripheral nerves participate in tendon regeneration. This article is protected by copyright. All rights reserved.

Risk factors for recurrence of pressure ulcers after defect reconstruction

Abstract

Background: Patients suffering from pressure ulcers remain to be a challenging task for nursing staff and doctors in the daily clinical management, putting - notably in the case of recurrences - additional strain on the constantly reduced resources in public health care. We aimed to assess the risk factors for the recurrence of pressure ulcers at our institution, a tertiary referral center.

Methods: In this retrospective analysis of patients admitted to our division we identified risk factors for pressure ulcer recurrence. The hospital patient database search included all patients with a diagnosis of pressure ulcers of the torso and lower extremity.

Results: One hundred sixty-three patients were diagnosed with pressure ulcers and 55 patients with 63 pressure ulcers met our inclusion criteria. The 17 recurrences (27%) had an average follow-up of 728 days. Most presented with lesions of the ischial tuberosity (n=24). Recurrence was statistically associated with defect size (p=0.013, Cox regression analysis), and serum albumin levels (p=0.045, Spearman correlation), but no association was found for body mass index, bacterial profile, comorbidities, localization, previous surgery, or time-to-admission for reconstruction (all p>0.05).

Conclusions: Supported by the recent literature we identified factors like defect size to be associated with pressure ulcer recurrence, but not with time-to admission for reconstruction or number of previous debridements. Whether laboratory values like serum albumin levels were the cause, the result or associated with pressure ulcer recurrence warrants further investigation. This article is protected by copyright. All rights reserved.

Iron doped fibrous-structured silica nanospheres as efficient catalyst for catalytic ozonation of sulfamethazine

Abstract

Sulfonamide antibiotics are ubiquitous pollutants in aquatic environments due to their large production and extensive application. In this paper, the iron doped fibrous-structured silica (KCC-1) nanospheres (Fe-KCC-1) was prepared, characterized, and applied as a catalyst for catalytic ozonation of sulfamethazine (SMT). The effects of ozone dosage, catalyst dosage, and initial concentration of SMT were examined. The experimental results showed that Fe-KCC-1 had large surface area (464.56 m2 g⁻¹) and iron particles were well dispersed on the catalyst. The catalyst had high catalytic performance especially for the mineralization of SMT, with mineralization ratio of about 40% in a wide pH range. With addition of Fe-KCC-1, the ozone utilization increased nearly two times than single ozonation. The enhancement of SMT degradation was mainly due to the surface reaction, and the increased mineralization of SMT was due to radical mechanism. Fe-KCC-1 was an efficient catalyst for SMT degradation in catalytic ozonation system.

A retrospective case control analysis of the efficacy of Gardasil® vaccination in 28 patients with recurrent respiratory papillomatosis of the larynx

Abstract

Recurrent respiratory papillomatosis (RRP) of the larynx represents a significant disease burden to patients and the healthcare system

The use of HPV 6/11/16/18 vaccination (Gardasil^®) has previously been thought to impact on disease burden in patients with RRP.

Gardasil^® vaccination did not impact on the number of endolaryngeal surgical procedures required, the interval between procedures, or the number of patients who achieved disease remission in comparison to a control cohort.

This study indicates Gardasil^® vaccination does not appear to have any effect on disease burden in patients with RRP.

The use of a control cohort profiles the natural progression of RRP.

This article is protected by copyright. All rights reserved.

Deprivation in relation to urgent suspicion of head and neck cancer referrals in Glasgow

Abstract

Aim

To examine deprivation measured by the Scottish Index of Multiple Deprivation (SIMD) and its relation to urgent suspicion of head and neck cancer referrals. A secondary aim was to examine the symptomatology generating urgent suspicion of cancer (USOC) referrals by SIMD category.

Methods

All "Urgent Suspicion of Cancer" referrals to the GGC ENT department over a one-year period, between 2015-16, were reviewed. Information was recorded anonymously and included demographics and red flag referral symptoms.

Results: 1998 patients were assessed, 43.4% (n=867) were male. 171 (8.6%) patients had primary head and neck cancer. 61 patients had other types of cancer, giving an all cause cancer rate of 11.6%. 71.3% of primary HNC patients were male. The most common SIMD category observed was SIMD1, the most common SIMD category yielding a primary head and neck cancer diagnosis was SIMD1. Neck lump was the commonest symptom amongst all SIMD categories.

Conclusion

A link between deprivation and USOC referrals has been established. A difference in gender distribution between referrals and HNC was observed, more females are referred but a significantly higher number of HNC patients are males. Neck lump is a very strong referral indicator for HNC and intermittent hoarseness is not. The findings from this analysis could be used to refine local referral patterns and priority of referral.

This article is protected by copyright. All rights reserved.

Flat-topped papules on the face of a young boy

Extranodal natural killer/T-cell lymphoma, nasal type, in Senegal

Abstract

Introduction

The distribution of extranodal NK/T-cell lymphoma (ENKTCL) is highly inhomogeneous throughout the world. In Sub-Saharan Africa, despite the precocity of Epstein-Barr virus (EBV) infection and its endemicity, ENKTCL remains exceptionally reported. The purpose of this study was to report the epidemiological, clinical, paraclinical, and evolutionary characteristics of ENKTCL at the Aristide LeDantec University Hospital in Dakar, Senegal.

Methodology

A 5-year retrospective review of all patients with histopathological, immunohistochemical, and in situ hybridization proven cutaneous lymphomas

Results

We collected seven cases corresponding to a frequency of 1.4 cases per year. ENKTCL accounted for 10.5% of all cutaneous lymphomas, ranking second after T-cell lymphomas. Men were predominantly affected (M : F ratio of 6), and the mean age was 38.5 years ± 4.06. The mean time before consultation was 7.3 months. The lymphomas affected primarily the nasal cavity in five cases and the skin in two cases. At admission, six patients had nasal mucosa involvement, which was isolated in three cases, associated with cutaneous lesions in three cases and lymph node involvement in three cases. CD56 was positive in only one case, and Eber transcribed RNA of EBV was expressed by in situ hybridization in all patients.

Discussion

To our knowledge, we have reported the first and largest series of ENKTCL in Sub-Saharan Africa. Our study shows an intermediate prevalence between that reported from Asia, Latin America, and the West. It was also noted a young age of patients, a prolonged diagnostic delay, a frequent negativity of CD56 marker, and a very poor prognosis of the disease in our region.

The treatment outcomes and dose de-escalation of desloratadine up-dosing in chronic spontaneous urticaria

Abstract

Background

An increase in dosages up to fourfold of second generation antihistamines is recommended for recalcitrant chronic spontaneous urticaria (CSU). No regimen guidelines about dose de-escalation, however, are mentioned once the disease is controlled.

Objective

To demonstrate the treatment outcomes and dose reduction in desloratadine assessed using the urticarial activity score over 7 consecutive days.

Methods

Medical records of all patients with CSU treated with desloratadine were collected retrospectively during a period from January 2010 to December 2013.

Results

Sixty-seven (94.4%) patients had remission of the disease with variable doses of desloratadine. The patients who had CSU concomitant with antithyroid antibodies or high erythrocyte sedimentation rates had a greater tendency not to respond to the standard dose. Once the disease was completely controlled, 67 patients finished the treatment, but 63 (94%) patients had recurrent symptoms. Sixty-three patients took the same dose that induced the response for a further 4 weeks before stopping or reducing the dose, 41/63 (65.1%), however developed urticaria again. Forty-one patients took the same dose for a further 8 weeks; only 2/41 (4.9%) patients developed the rash again. The mean follow-up period after the disease was controlled was 7.5 months.

Conclusion

Most patients need higher than the standard doses to obtain remission. Once the disease is completely controlled, however, maintenance of the same dosage for at least 8 weeks before dose reduction is suggested in order to avoid recurrence of the symptoms.

Management of comedonal acne vulgaris with fixed-combination topical therapy

Summary

Background

Acne vulgaris (acne) is the most common skin disease we see in dermatology practice. Clinically, it is characterized by a combination of open and closed comedones (formally referred to as noninflammatory lesions) and inflammatory papules and pustules. Comedonal acne is more typical in young adolescents, but can occur in combination with inflammatory papules and pustules at any time. Topical retinoids have long been advocated for the treatment of comedonal acne.

Aims

Given the increasing recognition of the inflammatory nature of acne and the synergistic benefits seen with fixed combinations we review the latest clinical data to provide guidance on optimal management of comedonal acne.

Methods

An English language literature search of Medline, EMBASE, and the Web of Science using key terms (acne, comedonal, noninflammatory, clinical trials) was conducted, and relevant articles reviewed.

Results

Comparative data is sparse, but we show the importance of fixed combinations with and without retinoids, where treatment benefits are comparable. Adapalene 0.1%-benzoyl peroxide 2.5% gel has been shown to be comparable to clindamycin 1%-benzoyl peroxide 5% gel, and adapalene 0.3%-benzoyl peroxide 2.5% gel. A meta-analysis suggested that clindamycin 1.2%-benzoyl peroxide 2.5% gel was more effective than clindamycin-benzoyl peroxide 5% gel in noninflammatory lesions, and two equivalent clinical programs suggest additional benefits of higher doses of benzoyl peroxide (3.75% vs 2.5%) in this fixed combination.

Conclusions

Clindamycin 1.2%-benzoyl peroxide 3.75% gel may afford similar benefits to adapalene 0.3%-benzoyl peroxide 2.5% gel in this sometimes difficult to treat patient population.

Does cochlear implant brand influence patient satisfaction? A survey of 102 cochlear implant users

Abstract

Patients and parents in particular can find the decision regarding which device to have implanted difficult due to the amount of often complicated information that is available. The desire to choose the 'right' implant for themselves or their child takes on great importance due to the finality of the procedure.

There is some evidence that certain patient expectations may be linked to brand choice and marketing strategies.

This study showed that importance of language development was strongly linked with a MED-EL device, and speech improvement with Advanced Bionics.

Despite marketing strategies put forth by the three major cochlear implant companies claiming superiority over each other, there seems to be an equal level of patient satisfaction regardless of the device implanted.

The results of this study can also be seen as good news for industry in that all three brands seem to be at least equivalent in their desired outcomes; however, these results may also be seen as a potential catalyst for a change in marketing strategy.

This article is protected by copyright. All rights reserved.

Initial validation of the Burden of Disease in Atopic Eczema instrument, a quality of life measure for adult atopic dermatitis

Abstract

The Harmonizing Outcome Measures for Eczema (HOME) initiative identified quality of life (QoL) as a core outcome domain that should be assessed in all atopic dermatitis (AD) trials.¹ However, based on a systematic review of the measurement properties of QoL instruments, HOME could not reach consensus on which QoL instrument should be recommended for adult AD.^2,3 In response to the need for a valid QoL instrument, we developed the Burden of Disease in Atopic Eczema (BODE) instrument.

This article is protected by copyright. All rights reserved.

Issue Information

Clinical Snippets

Judgmental alternatives, empathy, and moral responsibility

Abstract

In Responsibility From the Margins, David Shoemaker distinguishes three forms of responsibility: attributability, answerability, and accountability. The introduction of various normative competence requirements lends precision to the contrasts that Shoemaker draws between these forms of responsibility. I argue, however, that these competence requirements are less well motivated than Shoemaker supposes, which raises the possibility that we cannot distinguish between forms of responsibility in the way that he hopes.

Fungi extracellular enzyme-containing microcapsules enhance degradation of sulfonamide antibiotics in mangrove sediments

Abstract

Mangroves represent a special coastal vegetation along the coastlines of tropical and subtropical regions. Sulfonamide antibiotics (SAs) are the most commonly used antibiotics. The application of white-rot fungi extracellular enzyme-containing microcapsules (MC) for aerobic degradation of SAs in mangrove sediments was investigated in this study. Degradation of three SAs, sulfamethoxazole (SMX), sulfadimethoxine (SDM), and sulfamethazine (SMZ), was enhanced by adding MC to the sediments. The order of SA degradation in batch experiments was SMX > SDM > SMZ. Bioreactor experiments revealed that SA removal rates were higher with than without MC. The enhanced SA removal rates with MC persisted with three re-additions of SAs. Thirteen bacteria genera (Achromobacter, Acinetobacter, Alcaligenes, Aquamicrobium, Arthrobacter, Brevundimonas, Flavobacterium, Methylobacterium, Microbacterium, Oligotropha, Paracoccus, Pseudomonas, and Rhodococcus) were identified to be associated with SA degradation in mangrove sediments by combination of next-generation sequencing, bacterial strain isolation, and literature search results. Results of this study suggest that MC could be used for SA removal in mangrove sediments.

Assessment of sulforaphane-induced protective mechanisms against cadmium toxicity in human mesenchymal stem cells

Abstract

Cd is a hazardous substance and carcinogen that is present in the environment; it is known to cause toxic effects in living organisms. Sulforaphane is a naturally available phytochemical with antioxidant, anti-inflammatory, and anticarcinogenic properties. However, the effects of sulforaphane on Cd toxicity in human mesenchymal stem cells (hMSCs) are unknown. In the present study, we investigated the molecular mechanisms of the effects of sulforaphane on Cd toxicity in hMSCs by using MTT assays, acridine orange/ethidium bromide staining, Hoechst staining, LysoRed staining, assessment of mitochondrial membrane potential, and gene expression analysis. Cd decreased hMSC viability in a dose-dependent manner with an IC₅₀ value of 56.5 μM. However, sulforaphane did not induce any significant reduction in cell viability. Nuclear morphological analysis revealed that Cd induced necrotic cell death. Additionally, Cd caused mitochondrial membrane potential loss in hMSCs. The treatment of Cd-exposed cells with sulforaphane (Cd-sulforaphane co-treatment) resulted in a significant recovery of the cell viability and nuclear morphological changes compared with that of cells treated with Cd only. The gene expression pattern of cells co-treated with Cd-sulforaphane was markedly different from that of Cd-treated cells, owing to the reduction in Cd toxicity. Our results clearly indicated that sulforaphane reduced Cd-induced toxic effects in hMSCs. Overall, the results of our study suggested that sulforaphane-rich vegetables and fruits can help to improve human health through amelioration of the molecular effects of Cd poisoning.

Patients with psoriasis are frequently using sunbeds

Mild phenotype of junctional epidermolysis bullosa with pyloric atresia due to a novel mutation of the ITGB4 gene

Case of bullous pemphigoid associated with teneligliptin accompanied by severe mucous membrane involvement

Acne and hidradenitis suppurativa

Summary

Acne and hidradenitis suppurativa (HS) both centre on hair follicles. They often occur together as part of the acne tetrad, but are found in distinct localizations. Acne is primarily defined by the presence of comedones and inflammatory lesions. However, in HS the intertriginous localization and chronicity play equally important roles for the diagnosis to the inflammatory lesions. Genetics, bacteria, environmental factors and innate inflammation have all been found to play a role in acne and/or HS. Surprisingly, there is little overlap between the findings so far. The genetics of acne and HS are distinct, bacteria have not been shown convincingly to play a role in HS, and the important risk factors obesity and smoking in HS cannot be easily translated to acne. The one driving factor central to both diseases is innate inflammation, most strikingly involving interleukin-1. Hence the interleukin-1 family, as already shown in autoinflammatory conditions associated with acne, could represent attractive treatment targets.

Retrospective study: Rapamycin or rapalog 0.1% cream for facial angiofibromas in Tuberous Sclerosis Complex: Evaluation of treatment effectiveness and cost

Abstract

The use of topical rapamycin or rapalog, an mTOR inhibitor, has shown promising results in treating facial angiofibromas (FA) in children with Tuberous Sclerosis Complex (TSC). Nevertheless, several issues remain: the effectiveness, stability and tolerability of ingredients; and the cost - the higher the concentration of rapamycin the more expensive the product. In this retrospective comparative study, children with TSC and FA were treated consecutively with three different topical rapalog compounds of 0.1%, the lowest concentration with crushed tablets to demonstrate an effect.

This article is protected by copyright. All rights reserved.

Shoemaker’s responsibility pluralism: reflections on Responsibility from the Margins

The future, and what might have been

Abstract

We show that five important elements of the 'nomological package'—laws, counterfactuals, chances, dispositions, and counterfactuals—needn't be a problem for the Growing-Block view. We begin with the framework given in Briggs and Forbes (in The real truth about the unreal future. Oxford studies in metaphysics. Oxford University Press, Oxford, 2012), and, taking laws as primitive, we show that the Growing-Block view has the resources to provide an account of possibility, and a natural semantics for non-backtracking causal counterfactuals. We show how objective chances might ground a more fine-grained concept of feasibility, and furnished a places in the structure where causation and dispositions might fit. The Growing-Block view, thus understood, provides the resources to explain the close link between modality and tense, so that it predicts modal change as time passes. This account lets us capture not only what the future might hold for us, and also what might have been.