Validation of 3D skin imaging for objective repeatable quantification of severity of atrophic acne scarring

Abstract

Background

One major sequelae of acne is atrophic scarring, yet objective tools to assess scars are lacking. Neither depth nor volume of atrophic scars is readily evaluable clinically and standard 2D photography is significantly affected by lighting and shadows. The aim of our study was to define and evaluate parameters of 3D imaging that can be used to assess severity of atrophic acne scarring.

Methods

Single center study of 31 patients with acne scarring. A target area of 3 × 3 cm was defined on the face. The global severity of atrophic acne scarring in the target area was evaluated by 5 dermatologists and scars were counted and categorized by size (scars < 2 mm, 2-4 mm, and > 4 mm in diameter). Three dimensional images of the target area were acquired with the LifeViz Micro^® system and analysis was performed using MountainsMaps^® software. An algorithm was developed to quantify the scar volume loss: shape removal step, with an order 5 polynomial, and to calculate the Valley void volume 80% (Vvv 80%) defined in the ISO-25178 standard for 3D surface texture.

Results

Correlation coefficient of the Vvv parameter to mean global severity at the target area rating was 0.77. The volume of scars evaluated with the Vvv parameter was mainly impacted by scars > 2 mm. The evaluations demonstrated good repeatability (with an intra-class correlation coefficient ICC = 0.98).

Conclusions

We demonstrate convergent validation to clinical assessment and repeatability of 3D skin imaging in atrophic acne scarring. Image analysis is straightforward and can be integrated into an automated workflow.

Changes in filaggrin degradation products and corneocyte surface texture by season

Summary

Background

During the winter in northern countries, the risk of dermatitis is increased due to low temperature and humidity. Dermatitis is particularly common on weather-exposed skin such as the cheeks and hands. Recently, increased numbers of unidentified nanosized protrusions on the corneocyte surface were associated with dermatitis and deficiency of natural moisturizing factor (NMF).

Objectives

To investigate the effect of season on NMF levels and corneocyte surface texture in cheek and hand skin of healthy adults.

Methods

Eighty healthy volunteers (40 male and 40 female) were recruited: 40 aged 18–40 years and 40 aged ≥ 70 years. Cheek and dorsal hand skin was tape stripped in the winter and summer. Analysis for NMF and corneocyte surface texture was done (Dermal Texture Index, DTI). Potential confounders were registered and adjusted for.

Results

In cheek skin, NMF levels were reduced and DTI elevated during the winter compared with the summer. Older participants had higher NMF levels than younger participants. In the summer, DTI level was dependent on self-reported ultraviolet exposure. In hand skin, NMF levels were higher during the winter than in the summer, and female participants had higher NMF levels than male participants.

Conclusions

Seasonal effects on NMF and DTI on the cheeks and hands were found, suggesting an influence of climatic factors at the biochemical and ultrastructural levels. Significant variations were also observed regarding age and sex, making it difficult to draw firm conclusions. Our study adds new pieces to the puzzle of seasonal differences in xerosis and dermatitis.

Bullous pemphigoid with the deposition of IgG2 but not IgG1, IgG3 nor IgG4 autoantibodies at the basement membrane zone

Bullous pemphigoid (BP) is the most common subepidermal autoimmune blistering skin disease, characterized by tense bullae and urticarial erythema with a generalized distribution. BP is induced by autoantibodies to structural proteins of the basement membrane zone (BMZ) such as BP180 and BP230¹. Because the majority of BP skin shows complement deposition², complement activation is considered to be important for blister formation. Among IgG subclasses, IgG1 have a high ability to activate complements, whereas IgG2 and IgG4 have a low and no ability, respectively.

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Mucocutaneous manifestations of cocaine abuse: a review

Abstract

Cocaine is an alkaloid extracted from the leaves of the Erythroxylum coca plant that emerged in the 1970s as a fashionable drug among members of certain social backgrounds. Cocaine abuse is a problem of current interest, which is mostly hidden and under-diagnosed, but dramatically widespread among all socioeconomic strata, and with an incidence which is increasing at an alarming rate. There are 1.5 million cocaine consumers in the USA. In Spain, the prevalence of consumption among the population between 15 and 65 years-old is higher, reaching 3.1%. Because of this, it seems important to understand and recognize all the mucocutaneous manifestations of cocaine abuse which have been reported in the literature in order to clarify and help dermatologists in their daily practice.

In this article, we describe the principal mucocutaneous manifestations of cocaine abuse and we review isolated case reports which have been published in the literature. Because the dermatologist may deal with an unknown problem as well as with an already well-known history of cocaine abuse, it seems logical to separate the mucocutaneous manifestations into those which are frequent and highly suggestive, such as those caused by vascular injury, damage to mucosal membranes, infectious diseases or neutrophilic dermatosis, especially when suffered by young people and in consonance with other systemic manifestations and, those which have been reported in the literature as isolated case reports. We also summarize the main aspects of its pathogeny, principal pharmacodynamic and pharmacokinetic characteristics, and diagnostic tools.

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Lichen planus hypertrophicus-inversus occurring in a patient with Bannayan–Riley–Ruvalcaba syndrome

Case of pityriasis rubra pilaris with focal acantholytic dyskeratosis

Angiosarcoma arising in a traumatic scar

Persistent pruritus in psoriatic patients during administration of biologics

Tufted angioma of the finger: A case of an uncommon location with unique dermoscopic features

Color-transition sign: A useful trichoscopic finding for differentiating alopecia areata incognita from telogen effluvium

Effectiveness of and factors associated with clinical response to methotrexate under daily life conditions in Asian patients with psoriasis: A retrospective cohort study

Abstract

Given the relative scarcity of data concerning the efficacy of methotrexate under daily life conditions in psoriasis, this study aimed to investigate the effectiveness of methotrexate in Asian psoriatic patients and to identify factors associated with clinical response. This observational retrospective cohort study included adult psoriatic patients who had been treated with or were going to start methotrexate. Psoriasis Area and Severity Index (PASI) scores at baseline and at 3, 6 and 12 months were recorded. At 3 months, patients achieving 50% or more reduction from baseline PASI score were defined as responders. One hundred, 74 and 61 patients were followed for 3, 6 and 12 months, respectively. Mean follow-up time was 15.3 ± 10.2 months. A reduction in PASI score of at least 75% was achieved in 26%, 32.5% and 45.2% at 3, 6 and 12 months, respectively. At 12 and 24 months, Kaplan–Meier analysis showed 68.7% and 52.1% probability of drug survival, respectively. Male sex, body mass index (BMI) of less than 25 kg/m² and absence of abdominal obesity were factors associated with response to treatment in univariate analysis. Male sex was the only significant factor in multivariate analysis. The effectiveness of methotrexate in clinical practise seemed to be lower than in clinical trials, but effectiveness increased with longer duration of treatment. Problems associated with methotrexate use in clinical practise may be due to medication adherence rather than lack of medication effectiveness. Female sex, abdominal obesity and BMI of 25 kg/m² or more might decrease response to methotrexate.

Sustainable environmental chemistry and technology with focus on the Mediterranean area

“Dermohscopy” mapping: Correlating dermoscopic findings with histology in Mohs micrographic surgery

Mohs micrographic surgery (MMS) is the treatment of choice for high-risk basal cell carcinoma.^1,2 The technique combines tissue conservation with complete microscopic margin control, leading to superior cure rates while minimizing deformity.³ MMS involves several steps that should be meticulously followed to achieve this high cure rate.⁴

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Psoriasis/Inflammatory Bowel Diseases: A time to solve the liaison

I read with interest a prospective single center study by Kou et al.¹ published recently in the journal of European Academy of Dermatology and Venereology. The authors investigated the prevalence of mucocutaneous manifestations of inflammatory bowel disease (IBDs) in Chinese patients.

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Risk of developing pressure sore in ALS patients: a nationwide cohort study

Abstract

Background

Prior investigations with few cases have disclosed lack of pressure sore (PrS) formation was characteristic in amyotrophic lateral sclerosis (ALS) patients. However, studies with larger samples are lacking to ascertain this concept.

Objective

To investigate whether patients with ALS have higher risk of PrS.

Methods

Utilizing a Taiwan National Insurance claims dataset with 23 million participants, we extracted 514 ALS patients and 2,056 controls from January 1, 2000, to December 31, 2008. Both groups were followed up until PrS occurrence during study period (2000-2011). The PrS risk was calculated with Cox proportional regression model.

Results

The ALS patients had a greater PrS risk (adjusted hazard ratio [aHR] = 8.82, 95% confidence interval [CI] = 4.90–15.9, P < 0.001) than the controls did. PrS risk was much higher in ALS women (aHR = 26.6, 95% CI = 9.05–78.2, P < 0.001) than in ALS men (aHR = 4.38, 95% CI = 1.99–9.68, P < 0.001). Besides, in people aged 20–54, ALS was linked with a much greater PrS risk (aHR = 27.7, 95% CI = 5.79–132, P < 0.001) than in those aged ≥55 (aHR = 6.10, 95% CI = 3.10–12.0, P < 0.001).

Conclusions

ALS is discovered to be correlated with an enhanced PrS risk. For PrS prevention, it is needed to pay more attention to the management of the ALS patients, particularly in women and those with relatively younger age. Further investigations are needed to confirm the findings in this study.

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Isotretinoin treatment and peanut allergy: a new case report and review of the literature

Isotretinoin is a common and effective retinoid drug that remains the gold standard for the treatment of severe acne. The package leaflet clearly mentions its contraindication in patients with peanut and/or soya allergy. As isotretinoin is solubilized in refined soya oil, it is contraindicated in patients with soya IgE mediated allergy. Because of possible cross-reactivity, concerns have been raised about giving the drug to patients presenting with peanut allergy.

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Patient-reported symptoms and signs of moderate-to-severe psoriasis treated with guselkumab or adalimumab: results from the randomized VOYAGE 1 trial

Abstract

Background

How patients experience the symptoms/signs of psoriasis is highly relevant for assessing treatment response.

Objectives

Compare outcomes with guselkumab, placebo, and adalimumab utilizing the novel, validated Psoriasis Symptoms and Signs Diary (PSSD).

Methods

VOYAGE 1 is an on-going, phase III, double-blinded, controlled trial of patients with moderate-to-severe psoriasis. Patients were randomized to guselkumab 100 mg every-8-weeks; placebo-to-guselkumab 100 mg every-8-weeks; or adalimumab 40 mg every-2-weeks. The PSSD was self-administered to assess symptoms (i.e., itch, skin tightness, burning, stinging, pain) and signs (i.e., dryness, cracking, scaling, shedding/flaking, redness, bleeding) of psoriasis (0-10 [absent-to-worst-imaginable]) every 24-hours. Symptom and sign summary scores were derived (0-100) based on average scores of the individual symptoms and signs. Proportions of patients with clinically meaningful improvements and symptom- and sign-free scores of 0 were evaluated across treatment groups at weeks 16, 24, and 48.

Results

At baseline, 652/837 randomized patients had PSSD scores. The proportion of patients achieving clinically meaningful improvements in PSSD summary scores was significantly higher in the guselkumab group compared with the placebo group at week 16 (p<0.001) and compared with the adalimumab group at weeks 24 (p=0.002) and 48 (p<0.001). The proportions of patients achieving PSSD symptom and sign summary scores of 0 (i.e., symptom- and sign-free) were significantly higher for guselkumab vs. placebo at week 16 and vs. adalimumab at weeks 24 and 48 (all p<0.001).

Conclusions

Based on PSSD scores, greater improvements in symptoms and signs of psoriasis were reported by patients treated with guselkumab compared with placebo at week 16 or adalimumab through 48 weeks.

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The Clinical phenotype and a novel COL7A1 mutation in a Chinese family with dystrophic epidermolysis bullosa pruriginosa

Distrophic epidermolysis bullosa pruriginosa(DEB-Pr, OMIM#604129) is a rare subtype of epidermolysis bullosa dystrophica. It is characterized by recurrent vesicles and erosions on the extensor of the limbs at birth or shortly thereafter and pruriginosa papules and nodules accompanied with intense itching and nail dystrophy in adult stage¹. Histology reveals hyperkeratosis, mild acanthosis and a subepidermal blister formation². Electron microscopic studies showed alterations in the number and ultrastructure of anchoring fibrils in lesional, perilesional and non-lesional skin³.Previous studies have revealed that DEB-Pr is due to mutations in the COL7A1 gene located on chromosome 3p21 region, which encodes the collagen VII^2,4.

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Improvement in Itch and Other Psoriasis Symptoms With Brodalumab in Phase 3 Randomized Controlled Trials

Abstract

Background

Patients with psoriasis have lesional symptoms, including itch, which can reduce quality of life. The efficacy and safety of brodalumab, an interleukin-17 receptor A antagonist, in treating moderate-to-severe psoriasis have been reported in 3 randomized, controlled, phase 3 trials (AMAGINE-1/-2/-3).

Objective

The effect of brodalumab on lesional symptoms was assessed using the psoriasis symptom inventory (PSI), a validated patient-reported instrument.

Methods

Patients were randomized to receive brodalumab (140 or 210 mg every 2 weeks [Q2W]), placebo (AMAGINE-1/-2/-3), or ustekinumab (AMAGINE-2/-3) during a 12-week induction phase, followed by a maintenance phase through week 52. Patients electronically rated the severity of PSI items (itch, burning, stinging, pain, redness, scaling, cracking, and flaking) during the previous 24 hours on a scale of 0 (not at all severe) to 4 (very severe). At each visit, the PSI total score responder status was assessed, with responders defined as having an average weekly total inventory score ≤8 with no item score >1 at week 12.

Results

Across AMAGINE-1/-2/-3, brodalumab was associated with improvements in PSI total scores and itch scores vs placebo from week 2 through week 12 (P<0.001 in both domains). In AMAGINE-2/-3, brodalumab 210 mg Q2W demonstrated faster onset of PSI total score and itch responses (week 2, 22.1% and 36.4%, respectively) vs ustekinumab (week 2, 6.9% and 17.1%, respectively), and was associated with improved itch responses vs ustekinumab after 52 weeks of constant treatment.

Conclusion

Brodalumab demonstrated rapid, robust improvements in symptoms assessed by the PSI, including itch, vs placebo and ustekinumab.

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The role of the dermatologist in Raynaud's Phenomenon: a clinical challenge

Abstract

Raynaud's phenomenon (RP) is a functional vascular disorder involving extremities. In his practice, the dermatologist may frequently encounter RP which affects mainly women and is categorized into a primary benign form and a secondary form associated with different diseases (infections, drugs, autoimmune and vascular conditions, hematologic, rheumatologic and endocrinologic disorders). Still today, the differential diagnosis is a clinical challenge. Therefore, a careful history and a physical examination, together with laboratory tests and nailfold capillaroscopy are mandatory. RP is generally benign but a scheduled follow-up for primary RP patients should be established, due to risk of evolution to secondary RP.

A combination of conservative measures and medications can help in the management of RP. The importance of avoiding all potential physical, chemical and emotional triggers, as well as quitting smoking should be strongly suggested to the patient. As first line treatment, dihydropyridine Calcium Channel Blockers should be used. If this approach is not sufficient, prostacyclin derivatives, phosphodiesterases inhibitors and endothelin receptor antagonists can be considered as second line treatment. In cases of acute ischemia nifedipine and intravenous prostanoidsare helpful. In refractory cases, botulinum injections have shown a significant benefit. The approach to the RP patients requires therefore a coordinated care of specialists together with the primary care physician.

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The Author's Reply to Comment on Psoriasis/Inflammatory Bowel Diseases: A time to solve the liaison

I would like to sincerely thank Abdelmaksoud¹ for sharing several valuable suggestions about my study². At the following, the points mentioned by the author will be discussed.

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Utility of whole exome sequencing in detecting novel compound heterozygous mutations in COL7A1 among families with severe recessive Dystrophic Epidermolysis Bullosa in India - implications on diagnosis, prognosis and prenatal testing

Epidermolysis Bullosa (EB) encompasses a number of genetic conditions caused by mutations in genes involved in the formation of basement membrane resulting in blistering of the epidermis on trauma or pressure. At least 18 genes and 30 distinct subtypes of the disease are presently known[1]. Here-in, we report two un-related children with recessive dystrophic EB (RDEB) with novel compound heterozygous variations in collagen VII, one of whom had a fatal outcome and the other with a better sequel.

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Underdiagnosed and undertreated psoriasis: Nuances of treating psoriasis affecting the scalp, face, intertriginous areas, genitals, hands, feet, and nails

Abstract

Psoriasis of the scalp, face, intertriginous areas, genitals, hands, feet, and nails is often underdiagnosed, and disease management can be challenging. Despite the small surface area commonly affected by psoriasis in these locations, patients have disproportionate levels of physical impairment and emotional distress. Limitations in current disease severity indices do not fully capture the impact of disease on a patient's quality of life, and, combined with limitations in current therapies, many patients do not receive proper or adequate care. In this review, we discuss the clinical manifestations of psoriasis in these less commonly diagnosed areas and its impact on patient quality of life. We also examine clinical studies evaluating the effectiveness of therapies on psoriasis in these regions. This article highlights the need to individualize treatment strategies for psoriasis based on the area of the body that is affected and the emerging role of biologic therapy in this regard.

NO 3 − /NH 4 + proportions affect cadmium bioaccumulation and tolerance of tomato

Abstract

With the growth of the world population, cadmium (Cd) concentration in the environment has increased considerably as a result of human activities such as foundry, battery disposal, mining, application of fertilizers containing toxic elements as impurities, and disposal of metal-containing waste. Higher plants uptake N as ammonium (NH₄⁺), nitrate (NO₃⁻ ), and many other water-soluble compounds such as urea and amino acids, and nourishing plants with N, providing part of it as NH₄⁺, is an interesting alternative to the supply of this nutrient in the exclusive form of NO₃⁻ under Cd toxicity. The objective was to evaluate the influence of NO₃⁻ /NH₄⁺ proportions on the development and tolerance of tomato plants grown under the presence of Cd in the culture medium. The experiment was conducted in a completely randomized block design in a 3 × 3 factorial arrangement consisting of three Cd rates (0, 50, and 100 μmol L⁻¹) and three NO₃⁻/NH₄⁺ proportions (100/0, 70/30, and 50/50) in the nutrient solution. To this end, we quantified the responses of the antioxidant enzymatic system and productive and functional changes in Solanum lycopersicum var. esculentum (Calabash Rouge). Shoot biomass production decreased with the maximum Cd rate (100 μmol L⁻¹) tested in the growth medium, whereas the NO₃⁻ /NH₄⁺ proportions and other Cd rates did not significantly influence this variable. The lowest SPAD values were observed at the 100/0 NO₃⁻ /NH₄⁺ proportion and in plants exposed to Cd. The largest accumulation of the metal occurred in the shoots at the NO₃⁻ /NH₄⁺ proportion of 70/30 and at 100 μmol L⁻¹ Cd and in the roots at 100/0 NO₃⁻/NH₄⁺ and with 50 and 100 μmol L⁻¹ Cd. The concentration and accumulation of NO₃⁻ were highest at the NO₃⁻/NH₄⁺ proportion of 100/0 in the shoots and at 50/50 NO₃⁻/NH₄⁺ in the roots, whereas for NH₄⁺, values were higher as the proportion of N supplied in the form of NH₄⁺ was increased. The nitrate reductase enzyme activity decreased with the Cd supply in the nutrient solution. The antioxidant system enzymes were activated as we increased the NO₃⁻/NH₄⁺ proportion and/or Cd rates added to the nutrient solution in both shoots and roots of the tomato plant, except for ascorbate peroxidase. Based on the results obtained, if the plant is to be used as a food source as is the case of tomato, the 100/0 NO₃⁻/NH₄⁺ proportion is the better alternative because it resulted in higher Cd accumulation in the root system over the translocation to the shoots and consequently to the fruit.

TRPV2 channel inhibitors attenuate fibroblast differentiation and contraction mediated by keratinocyte-derived TGF-β1 in an in vitro wound healing model of rats

The wound healing process in skin proceeds sequentially in three phases, namely, inflammation, proliferation, and scar maturation, and involves sequential interactions of different cell types [1]. In granulation tissue, fibroblasts called myofibroblasts [1,2] obtain a contractile phenotype through the expression of α-smooth muscle actin (α-SMA) [3,4]. Such differentiation of dermal fibroblasts is believed to be involved in pathogenic scarring and fibrosis [5]. Thus, pharmacological intervention in the differentiation of fibroblasts may be beneficial for the prevention of hypertrophic scar formation and contractures.

Mercury in the feathers of bird scavengers from two areas of Patagonia (Argentina) under the influence of different anthropogenic activities: a preliminary study

Abstract

Mercury (Hg) is a global pollutant that bioaccumulates and biomagnifies in food chains and is associated with adverse effects in both humans and wildlife. We used feather samples from bird scavengers to evaluate Hg concentrations in two different areas of Northern Patagonia. Hg concentrations were analyzed in feathers obtained from turkey vultures (Cathartes aura), Black Vultures (Coragyps atratus), and southern crested caracaras (Caracara plancus) from the two areas of Northern Patagonia (Argentina): Bariloche and El Valle. Hg was detected in all the samples analyzed, but the concentrations can be considered low for the three species in both sampling areas. The mean concentration of Hg in Bariloche was 0.22 ± 0.16 mg/kg dry weight (d.w.) in black vulture, 0.13 ± 0.06 mg/kg d.w. in turkey vulture, and 0.13 ± 0.09 mg/kg d.w. in southern crested caracara; in El Valle, the mean concentration of Hg was 1.02 ± 0.89 mg/kg d.w. in black vulture, 0.53 ± 0.82 mg/kg d.w. in turkey vulture, and 0.54 ± 0.74 mg/kg d.w. in southern crested caracara. Hg concentrations in feathers were explained by the sampling area but not by the species. The concentrations of Hg contamination were comparable to those obtained in other studies of terrestrial raptors and aquatic bioindicator raptors. The species of the present study occur throughout much of North and South America. Thus, they may be appropriate bioindicators across the species' range, which is particularly useful as a surrogate, especially in distribution areas shared with endangered scavengers such as the California condor (Gymnopsys californianus) and the Andean Condor (Vultur gryphus).

Patient-reported Outcomes in Immediate and Delayed Breast Reconstruction with Deep Inferior Epigastric Perforator Flap

No abstract available

Lubricating the Insertion Funnel with Autologous Fat Tissue for Inserting Breast Implants

No abstract available

Management of Severely Atrophic Maxilla in Ectrodactyly Ectodermal Dysplasia-cleft Syndrome

Background: Ectrodactyly ectodermal dysplasia-cleft syndrome is a rare genetic syndrome with an incidence of 1/90,000 live births, characterized by cleft lip and palate, severely hypoplastic maxilla, and hypodontia. Patients diagnosed with ectrodactyly ectodermal dysplasia-cleft syndrome suffer from a severely hypoplastic maxilla that is highly difficult to treat using traditional orthognathic methods. In this study, we propose using distraction osteogenesis to achieve a major advancement while maintaining good stability and minimal relapse. To our knowledge, this is the first description of patients with this syndrome treated using distraction osteogenesis. Methods: Five patients diagnosed with ectrodactyly ectodermal dysplasia-cleft syndrome were included in the study. All patients had been operated on according to the well-established protocol of cleft lip and palate reconstruction before maxillary distraction osteogenesis. Hard and soft-tissue changes were evaluated by cone beam computed tomography and lateral cephalograms before distraction osteogenesis (T1), at the postdistraction point (T2) and after 1 year of follow-up (T3). Results: Examination revealed marked maxillary advancement in all our patients with a significant mean difference in hard tissue parameters (condylion to A point = 18 mm; nasion-sella line to A point = 15.2 degrees) and a notable improvement in facial convexity (20.9 degrees). One year follow-up measurements demonstrated mild relapse rates of 6% in the horizontal plane. Conclusions: We conclude that despite the challenging anatomic and physiological features of ectrodactyly ectodermal dysplasia-cleft patients, by enhancing current surgical techniques, there is promising potential for improved patient outcomes, achieving normognathic facial appearance with implant supported rehabilitation.

Reconstruction of Anterior Neck Scar Contracture Using A Perforator-Supercharged Transposition Flap

Summary: Reconstruction of the anterior neck requires attention to both aesthetic and functional outcomes. In general, skin grafts are not suitable for anterior neck reconstruction in Asian patients, even when artificial dermis is used before skin grafting. Therefore, we have employed various types of thin flaps for anterior neck reconstruction, including the cervico-pectoral flap. However, we have realized that, to fully release neck contractures and therefore achieve the full range of neck extension, the skin pedicle must be sufficiently wide. Therefore, we have started reconstructing anterior neck scar contractures using wide, thin, and long flaps that are harvested from the anterior chest wall. In this article, we describe the case of a 71-year-old man who presented with a neck contracture and tracheal fistula after receiving extensive burns. A transposition flap bearing the internal mammary artery perforator was harvested from the anterior chest wall to repair the neck wounds that were left after removing the scar. At the same time, the tracheal fistula was covered by the flap. The aesthetic and functional results were acceptable. The effectiveness of supercharged transposition flaps from the anterior chest wall for reconstructing anterior neck scar contraction is discussed.

Associated Malformations in Children with Orofacial Clefts in Portugal: A 31-Year Study

Background: Orofacial clefts are among the most common congenital craniofacial malformations and may be associated with other birth defects. However, the proportion and type of additional anomalies vary greatly between studies. This study assessed the prevalence and type of associated congenital malformations in children with orofacial clefts, who attended the largest cleft lip and palate tertiary referral center in Portugal. Methods: Consecutive children with orofacial clefts who attended at least 1 consultation in our Clefts Unit between 1981 and 2012 were studied. Demographic and clinical data regarding the number and type of associated malformations were retrospectively collected and analyzed. Results: Of the 701 patients studied, 219 (31.2%) had associated congenital malformations. These malformations were more frequent in children with cleft palate (43.4%) than in children with cleft lip and palate (27.5%) or with cleft lip only (19.4%). Within the group with associated anomalies, 73 cases (33.3%) had conditions related with known chromosomal defects, monogenic syndromes or sequences, and 146 cases (66.7%) had multiple congenital anomalies of unknown origin. From those, head and neck malformations were the most common (60.3%), followed by malformations in the cardiovascular (28.3%) and musculoskeletal systems (26%). Conclusions: The overall prevalence of associated malformations of nearly 1 in 3 children with orofacial clefts stressed the need for a comprehensive evaluation of these patients by a multidisciplinary cleft team. Moreover, one-third of the children had multiple congenital anomalies of known origins. Thus, early routine screening for other malformations and genetic counseling might be valuable for orofacial clefts management.

Porcine Model for Internal Mammary Vessels Harvesting: Anatomy and Technique

No abstract available

Surgical Treatment for Kirner’s Deformity—Single Osteotomy through a Palmar Approach

Background: Patients with Kirner's deformity often seek medical attention for aesthetic improvement when they reach the age of approximately 10 years, when the deformity becomes evident. The operative technique described in textbooks is the palmar opening-wedge with multiple osteotomies through a mid-lateral incision, which is technically demanding. The purpose of this article was to introduce our surgical technique of a single transverse osteotomy through a palmar approach and to present the short-term outcomes of this technique. Methods: The surgical outcomes of 7 digits in 4 children were retrospectively reviewed. The deformed distal phalanx was approached with an oblique incision of the pulp, and the palmar cortex was incised at the apex of the curvature. The dorsal cortex was only partially incised and broken manually when correcting the deformity by a palmar opening-wedge. The dorsal aspect of the phalanx was not exposed, and the nail plate was left intact. The fragments were fixed with Kirschner wires. Results: There was no postoperative complication, and the osteotomy sites all healed uneventfully. None of the patients complained about scar pain or hypersensitivity of the finger pulp. The patients and their parents were satisfied with the aesthetic results. Conclusions: A single palmar opening-wedge osteotomy at the apex sufficiently corrected the main curvature, and the subtle curvature remaining at the tip of the phalanx did not affect the appearance. This technique is simple and easy; therefore, it is recommended as a reliable procedure for patients with Kirner's deformity who are approaching puberty.

Patient-reported Outcomes after ADM-assisted Implant-based Breast Reconstruction: A Cross-sectional Study

Background: Although the use of acellular dermal matrices (ADMs) in implant-based reconstruction increases, there is a lack of studies evaluating patient-reported outcome measures after this reconstruction method. We aim to evaluate the patient satisfaction after ADM-assisted implant-based breast reconstruction (IBBR) in 1 of the largest series of patients undergoing ADM-assisted IBBR. Methods: Patients with ADM-assisted IBBR were invited to fill out the BREAST-Q, a validated and standardized questionnaire to measure patient satisfaction after a breast reconstruction. A retrospective chart review was performed to identify patient and surgical characteristics. Results: In total, 208 patients (38.4%) responded and reported a mean satisfaction of 70.6 ± 20.2 with their breasts and 78.0 ± 20.5 with the outcome. An overall complication rate of 7.7% was noted, with 1.5% severe complications leading to hospital readmission (0.5%) and implant removal (0.5%). Patients with complications and unilateral reconstruction for oncological reasons reported overall less satisfaction rates compared with patients with bilateral, preventive surgery, and an uncomplicated postoperative course. Strongly related domains indicate the importance of patient satisfaction with their breasts and outcome on psychosocial and sexual functioning and satisfaction with information on satisfaction with breasts, outcome, and surgeon. Conclusion: There is an increased demand for patient-reported outcome measures in a changing practice to which the opinion of the patient assumes a larger role. With high satisfaction rates, ADM-assisted IBBR is a valuable reconstruction method, provided that complication rates remain low. Hence, it should only be performed in a selected group of women.

Single Lymphaticovenular Anastomosis for Early-Stage Lower Extremity Lymphedema Treated by the Superior-Edge-of-the-Knee Incision Method

Background: Surgical treatment of lower extremity lymphedema (LEL) remains challenging. Application of the superior-edge-of-the-knee incision method for lymphaticovenular anastomosis (LVA) is reported to have a strong therapeutic effect in patients with LEL because lymph-to-venous flow at the anastomosis is enhanced by knee joint movement during normal walking. We investigated whether a single LVA created by this method is adequate for early LEL. Methods: The study involved 10 patients with LEL characterized by stage 2 or 3 leg dermal backflow and treated by a single LVA at the thigh via the superior-edge-of-the-knee incision method. The lymphatic vessel and direction of flow were assessed intraoperatively, and reduction in lymphedema volume was assessed postoperatively. Results: Use of our incision method yielded a single anastomosis in all patients with stage 2 leg dermal backflow and in all patients with stage 3 leg dermal backflow. The lymphatic vessel was 0.65 ± 0.08 mm in diameter (0.65 ± 0.09 and 0.65 ± 0.09 mm, respectively; P = 1.000). No venous reflux occurred in any patient. Mean follow-up was 7.70 ± 3.30 months (9.60 ± 3.29 and 5.80 ± 2.17 months, respectively; P = 0.068). Mean reduction in the LEL index was 20.160 ± 9.892 (22.651 ± 12.272 and 17.668 ± 7.353, respectively; P = 0.462). Conclusion: A single LVA created by the superior-edge-of-the-knee incision method can be expected to have a strong therapeutic effect in patients with stage 2 or 3 leg dermal backflow.

A New Integrated Approach for the Treatment of Complicated Ulcers

No abstract available

Flat Incision Technique for Reconstructive Brow Surgery: A Wound Healing Model and Clinical Evaluation

Background: Skin incision is considered to be placed at 90° in reference to the skin to get perfect wound edge adaptation. The incision on hair-bearing tissues, as the scalp, is considered to be bevelled at 45° to promote hair growth through the scar. There is no consensus about the preferred incision angle on the brow. The aim of this article was to demonstrate the feasibility of the "flat incision technique" for brow repositioning, where brow deformation results after forehead reconstruction. A wound-healing model for the bevelled incision is presented. Methods: Brow incisions are bevelled with an angle of 20°. The lower incision is placed inside the brow so that the upper 2 rows of hair are included; the dermis is completely transected and dissection is continued into the subdermal plane. The procedure is presented in a patient who underwent resection of the forehead due to melanoma. Results: The bevelled incision increases the surface area of dermal layer by a factor of 2 compared with the standard vertical skin incision at 90°. Loss of the dermal tissue integrity and continuity due to trauma hinders the recovery of cell migration and function, resulting in a more prominent scar formation. It appears reasonable that with the increased surface area of the dermal layers in the wound edges, the scar quality improves. The case study demonstrates the feasibility of the procedure. Conclusion: The bevelled 20° incision for brow repositioning and reshaping showed to be a viable and predictable procedure.

Porcine Model for Deep Superior Epigastric Artery Perforator Flap Harvesting: Anatomy and Technique

No abstract available

A Systematic Review and Meta-analysis of Free-style Flaps: Risk Analysis of Complications

Background: Free-style flaps allow surgeons to overcome anatomical variations and raise perforator flaps wherever a pulsatile signal can be detected. We performed a systematic review and meta-analysis to identify the risk factors for complications and indications for free-style flaps in soft-tissue defect reconstructions. Methods: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The databases of MEDLINE, PubMed, ScienceDirect, and Cochrane Library were searched from January 1991 to January 2017 for original articles describing free-style flaps in soft-tissue defect reconstruction. Results: A total of 17 articles met the inclusion criteria, representing 453 free-style flaps. The percentage of free-style flaps conducted after primary oncologic resection was 54.4% (246/453). Free-style flaps were mostly used in the head and neck region (35.5%), and most of them were designed as pedicled perforator flaps (96.7%). Complete flap survival was accomplished in 91.8% of the free-style flaps. Complications were found in 13.5% of cases, and 2 risk factors were identified: extremity defects (risk ratio, 2.39; P = 0.006) and single perforator flaps (risk ratio, 4.93; P = 0.002). No significant differences were found among the criteria including patients aged greater than 60 years, female gender, chronic etiology, flap size over 100 cm2, flap rotation, or perforator skeletonization. Conclusions: Free-style flaps are both reliable and advanced forms of perforator flaps for use in soft-tissue defect reconstructions. Defects located on the extremities and flaps with single perforators are risk factors for flap failure and complications.

Porcine Model for Gluteal Artery Perforator Flap: Anatomy and Technique

No abstract available

Pork Belly: A Simulation Training Model for Intramuscular Perforator Dissection

Background: Free tissue transfer has evolved from muscle flaps to fasciocutaneous flaps. Dissection of the intramuscular course of feeding vessels is technically challenging. Simulation-based microsurgery skills acquisition is moving toward nonliving training models. Living porcine model or human cadavers are currently cost-ineffective methods for the early learning curve in teaching intramuscular dissection. The aim of this study was to validate an inexpensive ex vivo porcine model simulating harvest of the deep inferior epigastric artery perforator (DIEAP) flap, specifically including perforator intramuscular dissection. Methods: An initial needs analysis and anatomical dissections (characteristics of vascular anatomy) established the necessity and surgical design (step-by-step) of the ex vivo DIEAP flap harvesting model. A pilot study utilizing objective assessment methodology (time to complete flap raising and hand motion analysis) demonstrated the surgeons' performance. A detailed feedback questionnaire was used to assess the participants' perception of this model. Results: Fifty-seven participants completed the initial needs analysis. Fifteen pork bellies were dissected and the vascular anatomical characteristics of the inferior epigastric vessels are presented. Eight surgeons performed the step-by-step flap design demonstrating construct validity in flap raising and intramuscular dissection. All surgeons completed the ex vivo DIEAP harvesting and they recommend this model as the first step in training for intramuscular dissection. Conclusions: The pork belly simulation is a cheap, easy, ethically considerate, and high-fidelity simulation model for intramuscular dissection for the DIEAP free flap. This study guides future validation trials to explore if the absence of physiological blood flow affects skills acquisition in the intramuscular dissection learning curve. The pork belly could be the first step in perforators dissection before progressing to the in vivo porcine model.

Beyond Serendipity to an Algorithmic Approach

No abstract available

Expression and Localization of Cathepsins B, D, and G in Dupuytren’s Disease

Background: The pathogenesis of Dupuytren's disease (DD) remains unclear. An embryonic stem cell (ESC)–like population in the endothelium of the microvessels around tissues that expresses components of the renin-angiotensin system (RAS) has been reported. This study investigated if this primitive population expresses cathepsins B, D, and G, that contribute to RAS bypass loops. Methods: 3,3-Diaminobenzidine immunohistochemical (IHC) staining for cathepsins B, D, and G was performed on sections of formalin-fixed paraffin-embedded DD cords (n = 10) and nodules (n = 10). Immunofluorescence IHC staining was utilized to demonstrate co-expression of these cathepsins with ESC markers. Protein and gene expression of these cathepsins was investigated in snap-frozen DD cords (n = 3) and nodules (n = 3) by Western blotting and NanoString analysis, respectively. Enzymatic activity of these cathepsins was investigated by enzymatic activity assays. Results: 3,3-Diaminobenzidine IHC staining demonstrated expression of cathepsins B, D, and G in DD cords and nodules. Gene expression of cathepsins B, D, and G was confirmed by NanoString analysis. Western blotting confirmed expression of cathepsins B and D, but not cathepsin G. Immunofluorescent IHC staining demonstrated high abundance of cathepsins B and D on the OCT4+/angiotensin converting enzyme+ endothelium and the smooth muscle layer of the microvessels. Cathepsin G was localized to trypase+ cells within the stroma in DD cords and nodules with limited expression on the microvessels. Enzyme activity assays demonstrated functional activity of cathepsins B and D. Conclusions: Cathepsins B, D, and G were expressed in the DD tissues, with cathepsins B and D localized to the primitive population in the endothelium of the microvessels, whereas cathepsin G was localized to phenotypic mast cells, suggesting the presence of bypass loops for the RAS.

Spindle Cell Lipoma of the Thumb

Summary: We report the case of a 34-year-old man who presented with a 4-year history of a soft tissue on the palmar aspect of the thumb. Magnetic resonance imaging demonstrated the presence of a mass with heterogeneous high intensities on T1-weighted images and high intensities on T2-weighted images. We performed excisional biopsy. Histologically, the tumor was composed of mature adipocytes and spindle cells in a collagen background. Immunohistochemically, the tumor cells showed strong expression of CD34. Therefore, we diagnosed it as spindle cell lipoma. To the best of our knowledge, only 2 cases of spindle cell lipoma of the thumb have previously been reported.

The Impact of Recipient Site External Expansion in Fat Grafting Surgical Outcomes

Background: The fat grafting process includes the 4 phases of tissue harvesting, processing, recipient-site preparation, and reinjection. Among them, the preparation of the recipient site has never been exhaustively reviewed. We aim to provide a comprehensive overview of the methods to prepare the recipient site through external expansion with the resulting outcomes. Methods: PubMed/Medline database was searched for studies on fat grafting recipient site preparation by applying the following algorithm: ((fat grafting) OR (lipofilling) OR (lipograft) AND (recipient site)). A priori criteria were used to review the resulting articles and identify those dealing with external expansion. Results: Fourteen studies published from 2008 through 2016 met inclusion criteria (4 case reports, 6 retrospective, and 4 prospective studies), representing 1,274 treated patients. Two devices for preexpansion were used with different protocols: BRAVA system and Kiwi VAC-6000M with a PalmPump. The 13 studies that applied the BRAVA system reported large fat volume transplantation to the breast (average > 200 cc). The most common complications were localized edema (14.2%), temporary bruising, and superficial skin blisters (11.3%), while the most serious was pneumothorax (0.5%). The majority of the studies reported enhancement of fat graft survival, which ranged between 53% and 82% at 6 months to 1 year follow-up, and high satisfaction of patients and surgeon. Conclusions: External expansion and fat grafting is a promising technique for breast reconstruction and augmentation. However, due to the overall low level of evidence of the available studies, further research is needed to validate the procedure.

Oncoplastic Breast Volume Replacement with the Use of Lateral Intercostal Artery Perforator Flaps

No abstract available

Classification of facial vitiligo: A cluster analysis of 473 patients

Summary

Vitiligo has a substantial negative impact on quality of life in affected patients, especially those with involvement of the face. However, the current system can barely distinguish between specific patterns of facial involvement except for the segmental type when focusing only on facial lesions. We classified facial vitiligo into three distinct subtypes using cluster analysis based on facial topography (n = 473): centrofacial vitiligo (72.9%), panfacial vitiligo (18.0%), and hairline vitiligo (9.1%). Centrofacial vitiligo was the most common type and is thought to comprise the typical facial involvement of generalized vitiligo. Panfacial vitiligo was a distinct subtype with onset in old age and less involvement of other body parts. Hairline vitiligo was another distinct subtype with onset in old age and a poor response to conventional phototherapy. A relevant classification system could help us to explore the causes, anticipate the prognosis, and manage the condition in vitiligo patients.

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The unique hues and the argument from phenomenal structure

Abstract

Hardin's (Color for philosophers: unweaving the rainbow, Hackett, Indianapolis, 1988) empirically-grounded argument for color eliminativism has defined the color realism debate for the last 30 years. By Hardin's own estimation, phenomenal structure—the unique/binary hue distinction in particular—poses the greatest problem for color realism. Examination of relevant empirical findings shows that claims about the unique hues which play a central role in the argument from phenomenal structure should be rejected. Chiefly, contrary to widespread belief amongst philosophers and scientists, the unique hues do not play a fundamental role in determining all color appearances. Among the consequences of this result is that greater attention should be paid to certain proposals for putting the structure of phenomenal color into principled correspondence with surface reflectance properties. While color realism is not fully vindicated, it has much greater empirical plausibility than previously thought.

A short-term in vivo model for Merkel Cell Carcinoma

Abstract

In vivo tumour models are essential for studying the biology of cancer, identifying tumour targets and evaluating anti-tumour drugs. Considering the request for the minimization of animal experiments and following the „3R"-rule („replacement", „refinement", „reduction"), it has become crucial to develop alternative experimental models in cancer biology. Several studies have already described the avian chorioallantoic membrane (CAM) model as an alternative to rodents, suitable to investigate growth, progression and metastasis of various types of cancer. In the present work, we grafted three Merkel Cell Carcinoma (MCC) cell lines onto the avian CAM and monitored tumour growth and development of solid tumour nodules. Morphology of xenograft was characterized histologically and immunohistochemically. Our results demonstrate CAM assay as a useful tool to study MCC pathophysiology.

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Myosin 10 is involved in murine pigmentation

Abstract

Myosins are molecular motors that are well known for their role in cell movement and contractile functions. Although extensively studied in muscle physiology, little is known about the function of myosins in mammalian skin. As part of the Sanger Institute Mouse Genetic Project, we have identified a role for Myo10 in pigmentation, with a phenotype unlike those of Myo5a or Myo7a. Adult mice homozygous for a disrupted Myo10 allele on a C57BL/6N background displayed a high degree of penetrance for white patches on their abdomen and dorsal surface. Fore- and hind paw syndactyly was also observed in these mice. Tail epidermal wholemounts showed a complete lack of melanocytes in the hair follicles and interfollicular epidermis. Myo10 previously been implicated in human pigmentation. Our current study reveals involvement of Myo10 in murine pigmentation.

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Capsaicin induces atopic dermatitis-like manifestations through dysregulation of proteolytic system and alteration of filaggrin processing in rats

Abstract

Atopic dermatitis (AD) is a complex disease featuring pruritic skin inflammation. Many animal models have been developed. In a rat model, subcutaneous capsaicin injection within 48 hours after birth induces AD-like skin manifestations of dermatitis and scratching behavior 3 weeks after the injection. When 2-4-week-old rats were injected with capsaicin, the lag period was shortened and the severity of skin manifestations was significantly reduced, suggesting influences of postnatal development. Lgr6 is an epidermal stem cell marker that is normally restricted to the isthmus area of hair follicles at postnatal 2 weeks. Lgr6 persisted in the interfollicular epidermis of capsaicin-injected rats beyond 3 weeks after birth, indicating that capsaicin-induced skin manifestations were influenced by postnatal epidermal development. Capsaicin injection induced alteration of proteolytic processing of filaggrin and corneodesmosin, suggesting epidermal barrier dysfunction. Inappropriate degradation of matriptase was observed. Degrees of proteolysis of these proteins were co-related with the severity of manifestations, suggesting that inappropriate proteolysis might be a possible cause of the skin manifestations. The results strongly suggest that capsaicin may dysregulate the protease system, resulting in alteration of profilaggrin and corneodesmosin proteolysis and skin manifestations. These events may be influenced by postnatal epidermal development.

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The Frequency and Clinical Features of Hypersensitivity Reactions to Antiepileptic Drugs in Children: A Prospective Study

Publication date: Available online 6 March 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Hakan Guvenir, Emine Dibek Misirlioglu, Ersoy Civelek, Muge Toyran, Betul Buyuktiryaki, Tayfur Ginis, Murat Capanoglu, Esra Gurkas, Alev Guven, Can Naci Kocabas
BackgroundAntiepileptic drugs (AEDs) can cause hypersensitivity reactions during childhood. Studies report a wide clinical spectrum of reactions with AED use, ranging from a mild rash to severe cutaneous reactions.ObjectiveThe present study aims to determine the prevalence and clinical features of AED hypersensitivity reactions during childhood.MethodsPatients who were prescribed an AED for the first time in our hospital during November 2015 and November 2016 were followed and children who developed skin rash during this period were evaluated.ResultsTotally 570 patients were evaluated. The median age of the patients was 8.86 [(interquartile range (IQR): (4.2-13.7)] years, and 55.8% of patients (318/570) were male. Most frequently used AEDs were valproic acid (42%; n=285) and carbamazepine (20.4%; n=116). Hypersensitivity reactions against AEDs developed in 5.4% of patients. Of these patients 71% (n=29) had cutaneous drug reaction and 29% (n=9) had severe cutaneous drug reaction; 61.3% (n=19) were using aromatic type of AED, and the leading suspected AED was carbamazepine (45.2%). Comparison of patients who did and did not develop AED hypersensitivity showed that hypersensitivity was more frequent among patients who were younger than 12 years old, who used aromatic AED, or who used multiple AED. In addition, according to regression analysis results, aromatic AED use significantly increased the risk of AED hypersensitivity (p<0.001).ConclusionAlthough allergic reactions against antiepileptic drugs are rare, they are of significance as they can cause life-threatening severe cutaneous drug reactions. Therefore, patients receiving AEDs, especially aromatic AEDs, must be monitored closely.

A retrospective analysis of mepolizumab in subjects with aspirin-exacerbated respiratory disease

Publication date: Available online 6 March 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Katherine L. Tuttle, Kathleen M. Buchheit, Tanya M. Laidlaw, Katherine N. Cahill

Recombinant thrombomodulin ameliorates experimental autoimmune encephalomyelitis by suppressing HMGB1 and inflammatory cytokines

SUMMARY

Recombinant thrombomodulin (rTM) has pleiotropic properties including anti-coagulation and anti-inflammation; however, its effectiveness as a treatment for multiple sclerosis (MS) has not been fully evaluated. High mobility group box 1 (HMGB1) and pro-inflammatory cytokines, working as an inflammatory mediator, are reportedly involved in the inflammatory pathogenesis of MS. The aim of this study was to determine whether rTM can be a potential therapeutic agent for experimental autoimmune encephalomyelitis (EAE). EAE mice received rTM treatment (1 mg or 0.1 mg/kg/day) from days 11 to 15 after immunization. The clinical variables, plasma levels of inflammatory cytokines and HMGB1, and pathological findings in EAE were evaluated. rTM administration ameliorated the clinical and pathological severity of EAE. An immunohistochemical study of the spinal cord showed weaker cytoplasmic HMGB1 staining in the rTM-treated EAE mice than in the untreated EAE mice. Plasma levels of inflammatory cytokines and HMGB1 were suppressed by rTM treatment. In conclusion, rTM suppressed inflammatory mediators in the peripheral circulation and prevented HMGB1 release from nuclei in the central nervous system, suppressing EAE-related inflammation. rTM could have a novel therapeutic potential for patients with multiple sclerosis. This article is protected by copyright. All rights reserved.

Total mercury concentration in two marine fish species, mackerel ( Scomberomorus sp.) and snapper ( Lutjanus sp.), from several Mexican fishing ports

Abstract

Mercury and methylmercury concentrations were evaluated in two marine fish species captured and consumed in Mexico, snapper (Lutjanus sp.) and mackerel (Scomberomorus sp.), obtained from several fish ports on the Pacific Ocean and the Gulf of Mexico. Significant differences were found between the median total mercury concentrations in snapper and mackerel, which were 0.187 and 0.125 μg/g (ww), respectively. Differences in the total mercury concentration in snapper were observed between the different oceans; snappers from the Gulf of Mexico registered a higher median mercury concentration (0.233 μg/g) than those caught in the Pacific Ocean (0.150 μg/g). Ninety-three percent of all samples presented had mercury concentrations that did not exceed the maximum limit (0.5 μg/g) specified by Mexican regulations, although 21% exceeded the US EPA limit of 0.3 μg/g, and three samples had mercury concentrations that were above the FDA recommended limit of 1 μg/g. Mackerel and snapper collected in the ports of Tampico and Mazatlan (economically important industrial cities and fishing sites) had the highest concentrations of total mercury, compared with those obtained from Acapulco and Ensenada (important touristic centers), which showed the lowest values. Recommendations should be made for the maximum allowed consumption of these fish in Mexico, especially for populations settled in shorelines where fish is essential for the daily diet.

Solar light-driven photocatalysis using mixed-phase bismuth ferrite (BiFeO 3 /Bi 25 FeO 40 ) nanoparticles for remediation of dye-contaminated water: kinetics and comparison with artificial UV and visible light-mediated photocatalysis

Abstract

Mixed-phase bismuth ferrite (BFO) nanoparticles were prepared by co-precipitation method using potassium hydroxide as the precipitant. X-ray diffractogram (XRD) of the particles showed the formation of mixed-phase BFO nanoparticles containing BiFeO₃/Bi₂₅FeO₄₀ phases with the crystallite size of 70 nm. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) revealed the formation of quasi-spherical particles. The BFO nanoparticles were uniform sized with narrow size range and with the average hydrodynamic diameter of 76 nm. The band gap energy of 2.2 eV showed its ability to absorb light even in the visible range. Water contaminated with Acid Yellow (AY-17) and Reactive Blue (RB-19) dye was treated by photocatalysis under UV, visible, and solar light irradiation using the BFO nanoparticles. The BFO nanoparticles showed maximum photocatalytical activity under solar light as compared to UV and visible irradiations, and photocatalysis was favored under acidic pH. Complete degradation of AY-17 dyes and around 95% degradation of RB-19 could be achieved under solar light at pH 5. The kinetics of degradation followed the Langmuir–Hinshelhood kinetic model showing that the heterogeneous photocatalysis is adsorption controlled. The findings of this work prove the synthesized BFO nanoparticles as promising photocatalysts for the treatment of dye-contaminated industrial wastewater.

3 tesla MRI assisted detection of compression points in ulnar neuropathy at the elbow in correlation with intraoperative findings

Publication date: Available online 6 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Alina Hold, Michael S. Mayr-Riedler, Thomas Rath, Igor Pona, Patrick Nierlich, Julia Breitenseher, Gregor Kasprian
IntroductionReleasing the ulnar nerve from all entrapments is the primary objective of every surgical method in ulnar neuropathy at the elbow (UNE). The aim of this retrospective diagnostic study was to validate preoperative 3 Tesla MRI results by comparing the MRI findings with the intraoperative aspects during endoscopic-assisted or open surgery.MethodsPreoperative MRI studies were assessed by a radiologist not informed about intraoperative findings in request for the exact site of nerve compression. The localizations of compression were then correlated with the intraoperative findings obtained from the operative records. Percent agreement and Cohen's kappa values were calculated.ResultsFrom a total of 41 elbows, there was a complete agreement in 27 (65.8%) cases and a partial agreement in another 12 (29.3%) cases. Cohen's kappa showed fair to moderate agreement.ConclusionHigh-resolution MRI cannot replace thorough intraoperative visualization of the ulnar nerve and its surrounding structures but may provide valuable information in ambiguous cases or relapses.

‘Investigation of the activation of temporalis and masseter muscles in voluntary and spontaneous smile production.’

Publication date: Available online 6 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Jessica E. Steele, Ian R. Woodcock, Adrian D. Murphy, Monique M. Ryan, Tony J. Penington, Christopher J. Coombs
IntroductionMasticatory muscles or their nerve supply are options for facial reanimation surgery but their ability to create spontaneous smile has been questioned. This study assessed the percentage of healthy adults who activate temporalis and masseter during voluntary and spontaneous smile.MethodsHealthy volunteer adults underwent electromyography (EMG) studies of temporalis and masseter muscles during voluntary and spontaneous smile. Responses were repeated three times and recorded as negative, weakly positive or strongly positive according to activity observed. The best response was used for analysis.ResultsThirty healthy adults (median age 34 years, range 25-69 years) participated. Overall, 92% of masseter muscles were activated during voluntary smile (22% strong, 70% weak). Seventy seven percent of masseter muscles were activated in spontaneous smile (12% strong, 65% weak). Temporalis muscle was activated in 62% of responses in voluntary smile (15% strong, 47% weak) and in 45% of responses in spontaneous smile (13% strong, 32% weak). No significant difference was found for males vs females or closed vs open mouth smiles. There was no significant difference in responses between voluntary and spontaneous smile for temporalis and masseter, and use in voluntary smile did not predict activity in spontaneous smile.ConclusionsOur study has shown that masseter and temporalis are active in a high proportion of healthy adults during voluntary and spontaneous smile. Further work is required to determine the relationship between pre-operative donor muscle activation and post-operative spontaneous smile, and whether masticatory muscle activity can be up-regulated with appropriate training.

PACAP in hypothalamic regulation of sleep and circadian rhythm: importance for headache

The interaction between sleep and primary headaches has gained considerable interest due to their strong, bidirectional, clinical relationship. Several primary headaches demonstrate either a circadian/circannu...

No-Go Theorems and the Foundations of Quantum Physics

Abstract

In the history of quantum physics several no-go theorems have been proved, and many of them have played a central role in the development of the theory, such as Bell's or the Kochen–Specker theorem. A recent paper by F. Laudisa has raised reasonable doubts concerning the strategy followed in proving some of these results, since they rely on the standard framework of quantum mechanics, a theory that presents several ontological problems. The aim of this paper is twofold: on the one hand, I intend to reinforce Laudisa's methodological point by critically discussing Malament's theorem in the context of the philosophical foundation of quantum field theory; secondly, I rehabilitate Gisin's theorem showing that Laudisa's concerns do not apply to it.

Ecotoxicological impacts of surface water and wastewater from conventional and advanced treatment technologies on brood size, larval length, and cytochrome P450 (35A3) expression in Caenorhabditis elegans

Abstract

Anthropogenic micropollutants and transformation products (TPs) negatively affect aquatic ecosystems and water resources. Wastewater treatment plants (WWTP) represent major point sources for (micro)pollutants and TPs in urban water cycles. The aim of the current study was to assess the removal of micropollutants and toxicity during conventional and advanced wastewater treatment. Using wild-type and transgenic Caenorhabditis elegans, the endpoint reproduction, growth, and cytochrome P450 (CYP) 35A3 induction (via cyp-35A3::GFP) were assessed. Samples were collected at four WWTPs and a receiving surface water. One WWTP included the advanced treatments: ozonation followed by granular activated carbon (GAC) or biological filtration (BF), respectively. Relevant micropollutants and WWTP parameters (n = 111) were included. Significant reproductive toxicity was detected for one WWTP effluent (31–83% reduced brood size). Three of four effluents significantly promoted the growth of C. elegans larvae (49–55% increased lengths). This effect was also observed for the GAC (34–41%) and BF (30%) post-treatments. Markedly, significant cyp-35A3::GFP induction was detected for one effluent before and after ozonation, being more pronounced for the ozonated samples (5- and 7.4-fold above controls). While the advanced treatments decreased the concentrations of most micropollutants, the observed effects may be attributed to effects of residual target compounds and/or compounds not included in the target chemical analysis. This highlights the need for an integrated assessment of (advanced) wastewater treatment covering both biological and chemical parameters.

Disciplinary differences of the altmetric impact

Abstract

The main objective of this article is to group altmetric indicators according to their relationships and detect disciplinary differences in a set of 3,793 research articles published in 2013 with regard to their altmetric impact. Three of the most representative altmetric providers (Altmetric, PlumX and CrossRef Event Data (CED)) and Scopus were used to extract information about these publications and their metrics. Principal Component Analysis (PCA) was used to summarize the information of these metrics and detect groups of indicators. Results show that these metrics can be grouped in three components: Social media gathers metrics from social networks and online media, Usage includes metrics on downloads and views, and finally, Citations and saves group metrics related to research impact and saves in bookmarking sites. According to disciplinary differences, articles in General category attract more attention of Social media, Social Sciences indicate higher usage than Physical Sciences and General articles are more cited and saved than Health Sciences and Social Sciences.

Epithelial cell lysates induce ExoS expression and secretion by Pseudomonas aeruginosa

Abstract

The type three secretion system (T3SS) is important for the intracellular survival of Pseudomonas aeruginosa. Known T3SS inducers include low Ca²⁺, serum, or host cell contact. Here, we used corneal epithelial cell lysates to test if host cytosolic factors could also induce the T3SS. Invasive P. aeruginosa strain PAO1 was exposed to cell lysates for 16 h, and expression of T3SS effectors determined by q-PCR and Western immunoblot. Lysate exposure reduced PAO1 growth (∼5-fold) versus trypticase soy broth (TSB), but also resulted in appearance of a protein in culture supernatants, but not bacteria cell pellets, that reacted with antibody raised against ExoS. T3SS inducing media (TSBi) caused the expression and secretion of ExoS and ExoT. Heat-treated lysates induced the protein; 1:3 diluted lysates did not. The protein that bound anti-ExoS antibody was found in supernatants of lysate-exposed exoT mutants, but not exoS or pscC mutants, suggesting a secreted form of ExoS, albeit slightly larger than that induced by TSBi. Lysate-exposed strain PAK expressed the same protein. Lysates caused PAO1 exoS and exoT gene expression, but only ∼20% and ∼6% of TSBi respectively. T3SS-induction by epithelial cell lysates could help explain T3SS expression by internalized P. aeruginosa.

Purification and characterisation of a quorum quenching AHL-lactonase from the endophytic bacterium Enterobacter sp. CS66

Abstract

The quorum quenching (QQ) activity of endophytic bacteria associated with medicinal plants was explored. Extracts of the Gram-negative Enterobacter sp. CS66 possessed potent N-acylhomoserine lactone (AHL) hydrolytic activity in vitro. Using degenerate primers, we PCR-amplified an open reading frame (denoted aiiE) from CS66 that was 96% identical to the well-characterised AHL-lactonase AiiA from Bacillus thuringiensis, but only 30% identical to AHL-lactonases from other Gram-negative species. This confirms that close AiiA homologs can be found in both Gram-positive and Gram-negative bacteria. Purified AiiE exhibited potent AHL-lactonase activity against a broad range of AHLs. Furthermore, aiiE was able to reduce the production of secreted plant cell wall-degrading hydrolytic enzymes when expressed in trans in the economically-important plant pathogen, Pectobacterium atrosepticum. Our results indicate the presence of a novel AHL-lactonase in Enterobacter sp. CS66 with significant potential as a biocontrol agent.

Comparative assessment of serum 25-hydroxyvitamin D patterns in dermatological diseases: a Moroccan retrospective study

A comparative review of the isotretinoin pregnancy risk management programs across four continents

Abstract

Isotretinoin has revolutionized the treatment of severe acne vulgaris, a condition which if left untreated may result in significant socio-psychological implications for those affected. Timely access to isotretinoin therapy is important to avoid the risks of potential physical and emotional scarring. However, due to its high risks of teratogenicity, isotretinoin must be used with care in females of childbearing potential. Since isotretinoin's introduction, numerous risk management programs have been implemented across the world in an attempt to prevent isotretinoin use in pregnancy. This paper aims to provide an evidence-based review of the risk management programs for isotretinoin in Australia, Europe, Singapore, New Zealand, and the United States of America. The effectiveness of these programs and the factors leading to isotretinoin exposure in pregnancy are critically analyzed in an effort to inform the future direction with respect to designing the ideal regulatory program. Stringent risk management programs, such as the iPLEDGE in the US and Pregnancy Prevention Program (PPP) in Europe, may not be effective in reducing the risks of fetal exposure to isotretinoin when used alone. There is evidence that such strenuous regulation results in increased fear of teratogenic risks but does not translate into a reduced rate of pregnancies exposed to isotretinoin. A successful program must prioritize education about effective contraception, while minimizing any extraneous requirements, to ensure that women are not inadvertently undertreated for acne.

Physiological and Molecular Effects of in vivo and ex vivo Mild Skin Barrier Disruption

The success of topically applied treatments on skin relies on the efficacy of skin penetration. In order to increase particle or product penetration, mild skin barrier disruption methods can be used. We previously described cyanoacrylate skin surface stripping as an efficient method to open hair follicles, enhance particle penetration, and activate Langerhans cells. We conducted ex vivo and in vivo measurements on human skin to characterize the biological effect and quantify barrier disruption-related inflammation on a molecular level. Despite the known immunostimulatory effects, this barrier disruption and hair follicle opening method was well accepted and did not result in lasting changes of skin physiological parameters, cytokine production, or clinical side effects. Only in ex vivo human skin did we find a discrete increase in IP-10, TGF-β, IL-8, and GM-CSF mRNA. The data underline the safety profile of this method and demonstrate that the procedure per se does not cause substantial inflammation or skin damage, which is also of interest when applied to non-invasive sampling of biomarkers in clinical trials.
Skin Pharmacol Physiol 2018;31:115-124

Biofabrication of silver nanoparticles and their combined effect with low intensity ultrasound for treatment of lung cancer

Publication date: Available online 6 March 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Xiaohong Zhang, Can Xiao
Ablation treatments are the minimally invasive surgical procedures that are used to treat early stage cancers. High intensity ultrasonic treatments that are used to treat solid cancers are not much successful in differentiating between healthy and cancerous cells. In this study, a method of combining ultrasound treatment with Garcinia mangostana bark extract mediated silver nanoparticles (AgNPs) was extended by making use of human lung epithelial cells, that could preferentially destruct the cancerous cells. Flow cytometry analysis is used to study the effect of ultrasound and AgNPs on cancerous (A549) cell lines and healthy (BEAS-2B) lung cells by means of counting viable cells (Q4). These experimental data showed a minor decline in the percentage of living cells from (66.8 ± 3.2) to (56 ± 6.2) % after the addition of bark extract synthesized AgNPs to the US-treated normal BEAS- 2B cell lines. However, the percentage of live A549 cancer cells presented a significant reduction from (61.4 ± 4.2) % for US-treated cells to (28.7 ± 6.4) % for the combination treatment of US with AgNPs. This study conducted against various cell lines denoted that nanoparticle-assisted ultrasound therapy (NAUT) could serve as an effective novel means for targeted destruction of cancer cells.

Graphical abstract

Development of ionic liquid assisted-synthesized nano‑silver combined with vascular endothelial growth factor as wound healing in the care of femoral fracture in the children after surgery

Publication date: Available online 6 March 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Xingli Li, Maohua Liu, Qun Wang, Chuanna Miao, Shumei Ju, Fang Liu
This investigation aimed to develop the silver (Ag) nanoparticles incorporated vascular endothelial growth factor (VEGF) for the improvement wound healing and reduce Aseptic necrosis in treatment of femoral fracture healing. The spherical shaped Ag nanoparticles with improved morphology have been effectively synthesized via microwave assisted method using ionic liquids 1-dodecyl-3-methylimidazolium chloride. The morphological structure and crystalline properties of Ag nanoparticles are analyzed by using UV, XRD and TEM-EDX analytical methods. The average grain size of the Ag nanoparticles is 20 nm, which was observed by defining the width of the (111) Bragg reflection with the Debye–Scherer formula and TEM results. The biological analyses confirmed that the Ag nanoparticles with VEGF molecules are promoted the cell adhesion and proliferation of Human mesenchymal stem cells (MSCs) cells. Ag NPs at appropriate concentrations have favorable biocompatibility to encourage cell activation properties like cell proliferation, cytokines release and chemotaxis. In the present study, our experimental results indicated that Ag NPs incorporated VEGF material are highly favorable to fracture healing and mainly as blood vessel repair. The surface morphology improved synthetic Ag NPs using ionic liquids has shown advantageous for cell activity and also improve the materials performances with VEGF for the regeneration of femoral fractures.

Graphical abstract

Visible light-induced insulin aggregation on surfaces via photoexcitation of bound thioflavin T

Publication date: Available online 6 March 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Karim Chouchane, Isabelle Pignot-Paintrand, Franz Bruckert, Marianne Weidenhaupt
Insulin is known to form amyloid aggregates when agitated in a hydrophobic container. Amyloid aggregation is routinely measured by the fluorescence of the conformational dye thioflavin T, which, when incorporated into amyloid fibers, fluoresces at 480 nm. The kinetics of amyloid aggregation in general is characterized by an initial lag-phase, during which aggregative nuclei form on the hydrophobic surface. These nuclei then lead to the formation of fibrils presenting a rapid growth during the elongation phase. Here we describe a novel mechanism of insulin amyloid aggregation which is surprisingly devoid of a lag-time for nucleation. The excitation of thioflavin T by visible light at 440 nm induces the aggregation of thioflavin T-positive insulin fibrils on hydrophobic surfaces in the presence of strong agitation and at physiological pH. This process is material surface-induced and depends on the fact that surface-adsorbed insulin can bind thioflavin T. Light-induced insulin aggregation kinetics is thioflavin T-mediated and is based on an energy transfer from visible light to the protein via thioflavin T. It relies on a constant supply of thioflavin T and insulin from the solution to the aggregate. The growth rate increases with the irradiance and with the concentration of thioflavin T. The supply of insulin seems to be the limiting factor of aggregate growth. This light-induced aggregation process allows the formation of local surface-bound aggregation patterns.

Graphical abstract

Evaluation of membrane fluidity of multidrug-resistant isolates of Escherichia coli and Staphylococcus aureus in presence and absence of antibiotics

Publication date: Available online 5 March 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Lucinda J. Bessa, Mariana Ferreira, Paula Gameiro
In the face of the serious problem of antimicrobial resistance and the global dissemination of multidrug-resistant (MDR) bacteria, it is relevant to deeply study such bacteria both genetically and phenotypically. It is well known that bacteria have the ability to modify the biophysical properties of their cytoplasmic membranes, namely fluidity, in order to survive and thrive in hostile environments. The aim of this study was to assess and compare the membrane fluidity among multidrug-resistant (MDR) isolates of Escherichia coli and Staphylococcus aureus in absence and in presence of antibiotics (ceftazidime or ciprofloxacin). The membrane fluidity was monitored at 24-h intervals up to three days and at the sixth day, by measuring the anisotropy of 1,6-diphenyl-1,3,5-hexatriene (DPH) and the generalized polarization (GP) of Laurdan (6-dodecanoyl-2-dimethylaminonaphthalene). The anisotropy values as well as the Laurdan excitation GP (GPexc) values obtained from all three E. coli strains (two MDR isolates and one susceptible reference strain) were quite similar and indicative of a very alike membrane phospholipid composition, regardless harboring or not resistance to multiple antimicrobials. Nonetheless, in the case of S. aureus, the anisotropy values were more increased in methicillin-resistant S. aureus (MRSA) isolates in comparison to the reference strain, meaning they have a less fluid membrane. Equally, GPexc values were statistically different among the three S. aureus strains and showed that the two MRSA isolates had more rigid membranes than the susceptible strain. The exposition of MDR isolates of both E. coli and S. aureus to subinhibitory concentrations of ceftazidime or ciprofloxacin did not affect neither the anisotropy values nor the GPexc values, therefore, not altering membrane fluidity. Membrane integrity, assessed by the Live/Dead staining, of all strains and conditions studied was maintained over the six days. Thus, these preliminary studies on membrane properties of MDR isolates demonstrate that i) MRSA seem to have a more rigid membrane that susceptible S. aureus and ii) the presence of subinhibitory concentrations of antibiotics does not alter membrane fluidity of both E. coli and S. aureus, regardless being MDR or susceptible.

Purification of arsenic-contaminated water with K-jarosite filters

Abstract

The high toxicity and potential arsenic accumulation in several environments have encouraged the development of technologies for its removal from contaminated waters. However, the arsenic released into aquatic environment comes mainly from extremely acidic mining effluents, making harder to find stable adsorbents to be used in these conditions. In this work, K-jarosite particles were synthesized as a stable adsorbent in acidic medium for eliminating arsenic from contaminated water. The adsorption capacities of K-jarosite for As³⁺, As⁵⁺, and monomethylarsonic acid were 9.45, 12.36, and 8.21 mg g⁻¹, respectively. Most arsenic in water was adsorbed within the first 10 min, suggesting the fast arsenic adsorption kinetics of K-jarosite particles. Because of that, a K-jarosite filter was constructed for purifying water at a constant flow. The K-jarosite filter was highly efficient to treat arsenic-contaminated water from a Brazilian river, reducing the concentration of arsenic in water to near zero. These data suggest the K-jarosite filter can be used as a low-cost technology for purifying arsenic-contaminated water in acidic medium.

Occurrence of sweet refuse at disposal sites: rainwater retention capacity and potential breeding opportunities for Aedes aegypti

Abstract

Nectar is the staple diet of adult mosquitoes in the wild, but its availability is inconsistent and can be affected by rainfall. In urban centers, Aedes vectors commonly use man-made containers as their major habitat; however, they can colonize any items replenished by rainfall. Garbage output has increased significantly in recent years, at a time when collection frequency is reducing. Such garbage usually includes organic components, some of which are sweet and can be fed upon by other animals or become can containers for rainwater. Despite evidence that Aedes larvae can thrive in containers comprised of organic waste material, which can be produced by rodents gnawing on fruits or vegetables, and that adults can survive on sweet waste fluids, the capacity of organic waste materials to accumulate rainwater and act as egg deposition sites has not been examined. It is also unknown for how long sweet extracts can sustain the life of adult vectors. Here, we investigated the abundance of sweet leftovers at garbage sites and the rainwater retention capacity of some organic materials through a field survey and laboratory bioassays. We also examined whether sweet waste fluids impact egg hatching success and longevity of Aedes aegypti. The results of this study indicated that sweet products with leftovers are highly prevalent in garbage. When exposed to rain, food items (BAFrc, banana fruit resembling container; and BSPrc, boiled sweet potato resembling container) and the packaging of sweet foods (SMIc, sweetened condensed milk can) retained water. When provided an opportunity to oviposit in cups containing BAF extract (BAFex), BSP extract (BSPex), and SMI extract (SMIex), eggs were deposited in all media. Egg maturation in the BAFex environment resulted in similar larval eclosion success to that resulting from embryo development in a water milieu. Adults maintained on sweet waste extracts had long lifespans, although shorter than that of their sugar solution (SUS)-fed counterparts. Taken together, these results indicated that sweet waste materials are useful to dengue mosquitoes, acting both as oviposition sites and energy sources.

Seasonal drought effects on the water quality of the Biobío River, Central Chile

Abstract

Quantifying the effect of droughts on ecosystem functions is essential to the development of coastal zone and river management under a changing climate. It is widely acknowledged that climate change is increasing the frequency and intensity of droughts, which can affect important ecosystem services, such as the regional supply of clean water. Very little is understood about how droughts affect the water quality of Chilean high flow rivers. This paper intends to investigate the effect of an, recently identified, unprecedented drought in Chile (2010–2015), on the Biobío River water quality, (36°45′–38°49′ S and 71°00′–73°20′ W), Central Chile. This river is one of the largest Chilean rivers and it provides abundant freshwater. Water quality (water temperature, pH, dissolved oxygen, electrical conductivity, biological oxygen demand, total suspended solids, chloride, sodium, nutrients, and trace metals), during the drought (2010–2015), was compared with a pre-drought period (2000–2009) over two reaches (upstream and downstream) of the river. Multivariate analysis and seasonal Mann-Kendall trend analyses and a Theil-Sen estimator were employed to analyze trends and slopes of the reaches. Results indicated a significant decreased trend in total suspended solids and a slightly increasing trend in water temperature and EC, major ions, and trace metals (chrome, lead, iron, and cobalt), mainly in summer and autumn during the drought. The reduced variability upstream suggested that nutrient and metal concentrations were more constant than downstream. The results evidenced, due to the close relationship between river discharge and water quality, a slightly decline of the water quality downstream of the Biobío River during drought period, which could be attenuated in a post-drought period. These results displayed that water quality is vulnerable to reductions in flow, through historical and emerging solutes/contaminants and induced pH mobilization. Consequently, seasonal changes and a progressive reduction of river flow affect the ecosystem functionality in this key Chilean river. The outcomes from this research can be used to improve how low flow conditions and the effects of a reduction in the river volume and discharge are assessed, which is the case under the scenario of more frequent drought periods.

Hand eczema and wet work: dose–response relationship and effect of leaving the profession

Summary

Background

Wet work is an important risk factor for occupational hand eczema.

Objectives

To examine the effect of job change in workers with occupational hand eczema caused by wet work, and to evaluate the dose–response relationship between intensity of wet work and eczema.

Method

The study is based on a subgroup (n = 954) from a descriptive, registry-based study including all participants with occupational hand eczema caused by wet work recognized by the Danish Labour Market Insurance Authority in 2010 and 2011. A follow-up questionnaire was sent out 4–5 years later (response 58%).

Results

Change of profession and being outside the labour market had a positive effect on healing and improvement of hand eczema. Inverse dose–response relationships were found between the amount of time spent with wet hands at work and healing (p = 0.001) and improvement (p < 0.001), and between the frequency of hand washing at work and healing (p = 0.013) and improvement (p < 0.001).

Conclusions

Leaving the profession has a positive effect on eczema; however, even minor changes in exposure to wet work were associated with healing and improvement. This information has implications with respect to advice given to patients with occupational hand eczema caused by wet work.

Correction to: Can in vivo surface dental enamel microbiopsies be used to measure remote lead exposure?

Abstract

To accomplish the aim A, lead from 90 bovine incisor crowns was determined by graphite furnace atomic absorption spectrometer as a function of exposure time and lead concentration.