The Generalized Theory of Evolution, January 31–February 3, 2018, Dusseldorf

Newton, Goethe and the Alleged Underdetermination of Ray Optics

Abstract

Did Goethe devise an empirically viable theory of classical ray optics? Or can we at least make use of his ideas to propose one? And if so, does this confront us with an intriguing case of theory underdetermination? In this paper, which is mainly a comment on the recent work of Olaf Müller, I shall address these three questions and argue for 'no, yes, no'. This is in contrast to Müller, who has recently launched a vivid defense of Goethe-style ray optics (Müller in "Mehr Licht. Goethe mit Newton im Streit um die Farben." Fischer, Frankfurt a.M., 2015a; Z Philos Forsch 69(4):569–573, 2015b; Z Philos Forsch 69(4):588–598, 2015c; Br J Hist Philos 24(2):322–346, 2016). Müller aims to give an almost positive answer to all three questions: 'perhaps, yes, yes'. My overall line of argument will be that the rather restricted regime of classical geometrical optics of spectral colors (or ray optics, for short) allows at best for a weak form of transient theory underdetermination that, in turn and more straightforwardly, also allows for a structuralist reading in terms of two structurally equivalent formulations of one and the same theory. However, extending any of the rivaling models of ray optics other than Newton's beyond the mentioned regime and embedding them into physics in total—especially in view of thermodynamics—leads to a contradiction. Hence, Newton's theory is confirmed as the only consistent theoretical interpretation of ray optics.

Interaction Should Guide Management Decisions [LETTERS]

Reply: [LETTERS]

Anatomic Malformations of the Middle and Inner Ear in 22q11.2 Deletion Syndrome: Case Series and Literature Review [HEAD & NECK]

BACKGROUND AND PURPOSE:

The 22q11.2 deletion syndrome is characterized by a heterogenic phenotype, including hearing loss. The underlying cause of hearing loss, especially sensorineural hearing loss, is not yet clear. Therefore, our objective was to describe anatomic malformations in the middle and inner ear in patients with 22q11.2 deletion syndrome.

MATERIALS AND METHODS:

A retrospective case series was conducted in 2 tertiary referral centers. All patients with 22q11.2 deletion syndrome who had undergone CT or MR imaging of the temporal bones were included. Radiologic images were evaluated on predetermined parameters, including abnormalities of the ossicular chain, cochlea, semicircular canals, and vestibule.

RESULTS:

There were 26 patients (52 ears) with a CT or MR imaging scan available. A dense stapes superstructure was found in 18 ears (36%), an incomplete partition type II was suspected in 12 cochleas (23%), the lateral semicircular canal was malformed with a small bony island in 17 ears (33%), and the lateral semicircular canal and vestibule were fused to a single cavity in 15 ears (29%).

CONCLUSIONS:

Middle and inner ear abnormalities were frequently encountered in our cohort, including malformations of the lateral semicircular canal.

Brain Diffusion Abnormalities in Children with Tension-Type and Migraine-Type Headaches [PEDIATRICS]

BACKGROUND AND PURPOSE:

Tension-type and migraine-type headaches are the most common chronic paroxysmal disorders of childhood. The goal of this study was to compare regional cerebral volumes and diffusion in tension-type and migraine-type headaches against published controls.

MATERIALS AND METHODS:

Patients evaluated for tension-type or migraine-type headache without aura from May 2014 to July 2016 in a single center were retrospectively reviewed. Thirty-two patients with tension-type headache and 23 with migraine-type headache at an average of 4 months after diagnosis were enrolled. All patients underwent DWI at 3T before the start of pharmacotherapy. Using atlas-based DWI analysis, we determined regional volumetric and diffusion properties in the cerebral cortex, thalamus, caudate, putamen, globus pallidus, hippocampus, amygdala, nucleus accumbens, brain stem, and cerebral white matter. Multivariate analysis of covariance was used to test for differences between controls and patients with tension-type and migraine-type headaches.

RESULTS:

There were no significant differences in regional brain volumes between the groups. Patients with tension-type and migraine-type headaches showed significantly increased ADC in the hippocampus and brain stem compared with controls. Additionally, only patients with migraine-type headache showed significantly increased ADC in the thalamus and a trend toward increased ADC in the amygdala compared with controls.

CONCLUSIONS:

This study identifies early cerebral diffusion changes in patients with tension-type and migraine-type headaches compared with controls. The hypothesized mechanisms of nociception in migraine-type and tension-type headaches may explain the findings as a precursor to structural changes seen in adult patients with chronic headache.

Randomized Assessment of the Safety and Efficacy of Intra-Arterial Infusion of Autologous Stem Cells in Subacute Ischemic Stroke [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Stroke is a debilitating illness for which treatment window is limited. Most patients present to the healthcare facility beyond that window. Autologous stem cells have shown some promise for this group of patients. This study was performed to evaluate the safety and the efficacy of intra-arterial infusion of bone marrow–derived mononuclear cells in patients with middle cerebral artery ischemic stroke.

MATERIALS AND METHODS:

A prospective, randomized, open-label, blinded–end point study was performed from July 2015 to June 2016. Of 229 patients with acute stroke who presented to the hospital during this period, 20 patients who satisfied the inclusion/exclusion criteria were included and randomized into the control and intervention groups. Intra-arterial stem cell infusion into the ipsilateral MCA was performed in the patients in the intervention group at 8–15 days post-stroke ictus. Final analysis at 6 months was performed for primary (safety) and secondary outcomes (efficacy).

RESULTS:

When we compared the primary end point of the study, no procedure-related mortality, complication, new infarct, or symptomatic intracranial hemorrhage was seen in the intervention group. When we compared the secondary end point of good clinical outcome, 8 (80%) patients in the intervention group showed good clinical outcome (modified Rankin Scale score < 2) with 4 (40%) patients in the control group achieving this (95% confidence interval for good outcome in patients with stem cell infusion, 49.03–94.3, and without stem cell infusion, 16.82–68.73; P = .068).

CONCLUSIONS:

Intra-arterial infusion of stem cells can be carried out safely in the subacute stage of ischemic stroke. Improved clinical outcomes were observed with intra-arterial stem cell therapy; however, studies with larger cohorts are needed to validate the results.

Endovascular Treatment of Very Large and Giant Intracranial Aneurysms: Comparison between Reconstructive and Deconstructive Techniques--A Meta-Analysis [INTERVENTIONAL]

BACKGROUND:

The safety and efficacy of reconstructive and deconstructive endovascular treatments of very large/giant intracranial aneurysms are not completely clear.

PURPOSE:

Our aim was to compare treatment-related outcomes between these 2 techniques.

DATA SOURCES:

A systematic search of 3 data bases was performed for studies published from 1990 to 2017.

STUDY SELECTION:

We selected series of reconstructive and deconstructive treatments with >10 patients.

DATA ANALYSIS:

Random-effects meta-analysis was used to analyze occlusion rates, complications, and neurologic outcomes.

DATA SYNTHESIS:

Thirty-nine studies evaluating 894 very large/giant aneurysms were included. Long-term occlusion of unruptured aneurysms was 71% and 93% after reconstructive and deconstructive treatments, respectively (P = .003). Among unruptured aneurysms, complications were lower after parent artery occlusion (16% versus 30%, P = .05), whereas among ruptured lesions, complications were lower after reconstructive techniques (34% versus 38%). Parent artery occlusion in the posterior circulation had higher complications compared with in the anterior circulation (36% versus 15%, P = .001). Overall, coiling yielded lower complication and occlusion rates compared with flow diverters and stent-assisted coiling. Complication rates of flow diversion were lower in the anterior circulation (17% versus 41%, P < .01). Among unruptured lesions, early aneurysm rupture (within 30 days) was slightly higher after reconstructive treatment (5% versus 0%, P = .08) and after flow diversion alone compared with flow diversion plus coiling (7% versus 0%).

LIMITATIONS:

Limitations were selection and publication biases.

CONCLUSIONS:

Parent artery occlusion allowed high rates of occlusion with an acceptable rate of complications for unruptured, anterior circulation aneurysms. Coiling should be preferred for posterior circulation and ruptured lesions, whereas flow diversion is relatively safe and effective for unruptured anterior circulation aneurysms.

Evaluation of the Normal Cochlear Second Interscalar Ridge Angle and Depth on 3D T2-Weighted Images: A Tool for the Diagnosis of Scala Communis and Incomplete Partition Type II [HEAD & NECK]

BACKGROUND AND PURPOSE:

Cochlear malformations may be be subtle on imaging studies. The purpose of this study was to evaluate the angle and depth of the lateral second interscalar ridge or notch in ears without sensorineural hearing loss (normal ears) and compare them with ears that have a documented incomplete type II partition malformation.

MATERIALS AND METHODS:

The second interscalar ridge notch angle and depth were measured on MR imaging in normal ears by a single experienced neuroradiologist. The images of normal and incomplete partition II malformation ears were then randomly mixed for 2 novice evaluators to measure both the second interscalar ridge notch angle and depth in a blinded manner. For the mixed group, interobserver agreement was calculated, normal and abnormal ear measurements were compared, and receiver operating characteristic curves were generated.

RESULTS:

The 94 normal ears had a mean second interscalar ridge angle of 80.86° ± 11.4° and depth of 0.54 ± 0.14 mm with the 98th percentile for an angle of 101° and a depth of 0.3 mm. In the mixed group, agreement between the 2 readers was excellent, with significant differences for angle and depth found between normal and incomplete partition type II ears for angle and depth on average (P < .001). Receiver operating characteristic cutoffs for delineating normal from abnormal ears were similar for both readers (depth, 0.31/0.34 mm; angle, 114°/104°).

CONCLUSIONS:

A measured angle of >114° and a depth of the second interscalar ridge notch of ≤0.31 mm suggest the diagnosis of incomplete partition type II malformation and scala communis. These measurements can be accurately made by novice readers.

European Multicenter Study for the Evaluation of a Dual-Layer Flow-Diverting Stent for Treatment of Wide-Neck Intracranial Aneurysms: The European Flow-Redirection Intraluminal Device Study [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Endoluminal reconstruction with flow-diverting stents represents a widely accepted technique for the treatment of complex intracranial aneurysms. This European registry study analyzed the initial experience of 15 neurovascular centers with the Flow-Redirection Intraluminal Device (FRED) system.

MATERIALS AND METHODS:

Consecutive patients with intracranial aneurysms treated with the FRED between February 2012 and March 2015 were retrospectively reviewed. Complications and adverse events, transient and permanent morbidity, mortality, and occlusion rates were evaluated.

RESULTS:

During the defined study period, 579 aneurysms in 531 patients (median age, 54 years; range, 13–86 years) were treated with the FRED. Seven percent of patients were treated in the acute phase (≤3 days) of aneurysm rupture. The median aneurysm size was 7.6 mm (range, 1–36.6 mm), and the median neck size 4.5 mm (range, 1–30 mm). Angiographic follow-up of >3 months was available for 516 (89.1%) aneurysms. There was progressive occlusion witnessed with time, with complete occlusion in 18 (20%) aneurysms followed for up to 90 ± 14 days, 141 (82.5%) for 180 ± 20 days, 116 (91.3%) for 1 year ± 24 days, and 122 (95.3%) aneurysms followed for >1 year. Transient and permanent morbidity occurred in 3.2% and 0.8% of procedures, respectively. The overall mortality rate was 1.5%.

CONCLUSIONS:

This retrospective study in real-world patients demonstrated the safety and efficacy of the FRED for the treatment of intracranial aneurysms. In most cases, treatment with a single FRED resulted in complete angiographic occlusion at 1 year.

The Importance of Flexion MRI in Hirayama Disease with Special Reference to Laminodural Space Measurements [SPINE]

BACKGROUND AND PURPOSE:

Hirayama disease is a benign focal amyotrophy of the distal upper limbs involving C7, C8, and T1 segmental myotomes with sparing of the brachioradialis and proximal muscles of the upper limb innervated by C5–6 myotomes. The objective of the present study was to study the utility of MR imaging in young patients presenting with weakness and wasting of the distal upper extremity and to evaluate the importance of the laminodural space during flexion cervical MR imaging.

MATERIALS AND METHODS:

This was a prospective cross-sectional study conducted from January 2014 to July 2017 in a tertiary care center from Northeast India. Forty-five patients with clinically definite Hirayama disease underwent electrophysiologic evaluation followed by MR imaging of the cervical spine.

RESULTS:

The mean age at recruitment was 22.8 ± 5.5 years. Forty patients (88.9%) had unilateral and 5 (11.1%) had bilateral upper extremity involvement. Cervical cord T2-weighted hyperintensities were demonstrated in 16 patients (35.6%), of which 15 (33.3%) had anterior horn cell hyperintensities. Flexion MR imaging showed loss of the posterior dural attachment, forward shifting of the posterior dural sac with postcontrast enhancement, and prominent posterior epidural venous plexus in all patients. The laminodural space at maximum forward shifting of the posterior dural sac ranged from 3 to 9.8 mm, with a mean distance of 5.99 mm (95% confidence interval, 5.42–6.57 mm).

CONCLUSIONS:

Flexion cervical MR imaging is a very useful investigation in diagnosing Hirayama disease. The increase in the laminodural space and the presence of cervical cord flattening during flexion are essential for diagnosis.

Localized Marked Elongation of the Distal Internal Carotid Artery with or without PHACE Syndrome: Segmental Dolichoectasia of the Distal Internal Carotid Artery [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Segmental intracranial dolichoectasia of the distal ICA is a feature of PHACE syndrome or a sporadic phenomenon. We evaluated the relationship between intracranial dolichoectasia of the distal ICA and PHACE syndrome and illustrated the characteristic radiologic findings of the lesions.

MATERIALS AND METHODS:

Intracranial dolichoectasia of the distal ICA was identified in 20 patients at our institution from 2005 to 2016 through a review of diagnostic cerebral angiography results. All radiologic images were reviewed to determine the vascular morphologic dispositions around the distal ICA, including dysplasia, mural calcification, vessel wall enhancement, lumen narrowing, and aneurysm formation. Medical records were reviewed to determine the symptoms of PHACE syndrome. Subsequently, the correlation between radiologic findings and PHACE syndrome was assessed.

RESULTS:

In this cohort, which had a strong female predominance (male/female ratio= 2:18), intracranial dolichoectasia had a more ipsilateral vascular morphologic disposition. Mural calcification was detected more frequently in elderly patients, whereas vessel wall enhancement was detected more frequently in younger patients. Follow-up images showed a slow progression of the lesions. However, no significant differences in the vascular morphologic disposition and brain structural changes were observed between patients with (n = 11) and without (n = 9) PHACE syndrome.

CONCLUSIONS:

The striking elongation and tortuosity of the distal ICA generally appeared to be a type of congenital lesion occurring early in embryogenesis as either a sporadic phenomenon or an arterial change associated with PHACE syndrome. Imaging findings revealed various mural abnormalities with a benign clinical course.

Arterial Spin-Labeling Improves Detection of Intracranial Dural Arteriovenous Fistulas with MRI [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Intracranial dural arteriovenous fistulas carry a risk of substantial neurologic complications but can be difficult to detect on structural MR imaging and TOF-MRA. The purpose of this study was to assess the accuracy and added value of 3D pseudocontinuous arterial spin-labeling MR imaging for the detection of these lesions.

MATERIALS AND METHODS:

This retrospective study included 39 patients with a dural arteriovenous fistula and 117 controls who had undergone both DSA and MR imaging with pseudocontinuous arterial spin-labeling. Two neuroradiologists blinded to the DSA results independently assessed MR imaging with and without pseudocontinuous arterial spin-labeling. They recorded specific signs, including venous arterial spin-labeling signal, and the likelihood of a dural arteriovenous fistula using a 5-point Likert scale. Logistic regression and receiver operating characteristic analyses were performed to determine the accuracy of specific signs and the added value of pseudocontinuous arterial spin-labeling. Interobserver agreement was determined by using statistics.

RESULTS:

Identification of the venous arterial spin-labeling signal had a high sensitivity (94%) and specificity (88%) for the presence a dural arteriovenous fistula. Receiver operating characteristic analysis showed significant improvement in diagnostic performance with the addition of pseudocontinuous arterial spin-labeling in comparison with structural MR imaging (area under the receiver operating characteristic curve = 0.179) and a trend toward significant improvement in comparison with structural MR imaging with time-of-flight MRA (area under the receiver operating characteristic curve = 0.043). Interobserver agreement for the presence of a dural arteriovenous fistula improved substantially and was almost perfect with the addition of pseudocontinuous arterial spin-labeling ( = 0.92).

CONCLUSIONS:

Venous arterial spin-labeling signal has high sensitivity and specificity for the presence of a dural arteriovenous fistula, and the addition of pseudocontinuous arterial spin-labeling increases confidence in the diagnosis of this entity on MR imaging.

MRI Characteristics of Primary Tumors and Metastatic Lesions in Molecular Subgroups of Pediatric Medulloblastoma: A Single-Center Study [PEDIATRICS]

BACKGROUND AND PURPOSE:

Molecular grouping of medulloblastoma correlates with prognosis and supports the therapeutic strategy. We provide our experience with the imaging features of primary and metastatic disease in relation to the molecular groups.

MATERIALS AND METHODS:

One hundred nineteen consecutive patients (mean age, 7.3 ± 3.8 years at diagnosis; male, 79 [66.4%]) with a confirmed diagnosis of medulloblastoma and interpretable pretreatment MRIs were retrieved from our data base from January 2000 to December 2016. Each patient was assigned to wingless, sonic hedgehog, group 3, or group 4 molecular groups. Then, we determined the imaging features of both primary and metastatic/recurrent disease predictive of molecular groups.

RESULTS:

In addition to recently reported predictors based on primary tumor, including cerebellar peripheral location for sonic hedgehog (adjusted odds ratio = 9, P < .0001), minimal enhancement of primary group 4 tumor (adjusted odds ratio = 5.2, P < .0001), and cerebellopontine angle location for wingless (adjusted odds ratio = 1.4, P = .03), ependymal metastasis with diffusion restriction and minimal postcontrast enhancement ("mismatching pattern") (adjusted odds ratio = 2.8, P = .001) for group 4 and spinal metastasis for group 3 (adjusted odds ratio = 1.9, P = .01) also emerged as independent predictors of medulloblastoma molecular groups. Specifically, the presence of a metastasis in the third ventricular infundibular recess showing a mismatching pattern was significantly associated with group 4 (P = .02).

CONCLUSIONS:

In addition to imaging features of primary tumors, some imaging patterns of metastatic dissemination in medulloblastoma seem characteristic, perhaps even specific to certain groups. This finding could further help in differentiating molecular groups, specifically groups 3 and 4, when the characteristics of the primary tumor overlap.

The Retinoid X Receptor Agonist, 9-cis UAB30, Inhibits Cutaneous T-cell Lymphoma Proliferation Through the SKP2-p27kip1 Axis

Cutaneous T-cell lymphomas (CTCLs) are characterized by the localization of neoplastic T lymphocytes in the skin. The most common forms of CTCLs are mycosis fungoides (MF) and Sézary syndrome (SS), which account for 65% of CTCLs [1]. The clinical features of MF are erythematous patches, plaques, and, in severe cases, pruritus and tumor formation [2]. SS is an advanced form of CTCL that includes skin lesions with neoplastic CD4+ T lymphocytes in the blood. In the United States, there are ∼1500 new cases reported each year, and the incidence is increasing [3,4].

UV-Induced DNA Methyltransferase 1 Promotes Hypermethylation of Tissue Inhibitor of Metalloproteinase 2 in the Human Skin

Ultraviolet (UV) radiation is a major risk factor for the induction of skin aging [1]. Prolonged UV exposure accelerates the process of aging by degrading the structural integrity of the dermal extracellular matrix (ECM), resulting in the wrinkled appearance of the skin. The disintegration of each dermal ECM protein is implemented by a large number of proteinases known as matrix metalloproteinases (MMPs). In photoaged skin, an overproduction of MMPs such as MMP1 (interstitial collagenase), MMP3 (stormelysin-1), and MMP9 (gelatinase) and an insufficient amount of collagen synthesis were observed [2–4].

Confucian Culture as Determinants of Consumers' Food Leftover Generation: Evidence from Chengdu, China

Abstract

Food waste is a worldwide problem due to its effects on carbon emission, water pollution, and arable lands. Previous studies of food waste generation and reduction focus on demographic, psychological, and situational factors, whereas the effects of culture in different countries have been ignored. This paper investigates the influence of Confucian culture on behaviors that waste food, considering additional factors of face saving and group conformity. We used an integrated behavioral intention model combining the TPB model and Lee's modified Fishbein model. The results show that including the constructors of Confucian culture increases the predictive power of the model. Face saving and group conformity are found to significantly influence attitude toward food waste reduction. Face saving can greatly reduce the intention to pack leftovers, and group conformity has a significant effect on the ordering of small portion sizes. Based on these results, we give a discussion and put forward with suggestions to the government and the catering industry. Limitations and implications for future research are provided accordingly.

Treating isotretinoin-associated cheilitis with hydrocortisone-containing lip balm

A novel technique using Lidocaine 2% topical gel for peristomal dermatitis

Physical evolution of the Three Gorges Reservoir using advanced SVM on Landsat images and SRTM DEM data

Abstract

The Three Gorges Reservoir (TGR) is one of the largest hydropower reservoirs in the world. However, changes of the important physical characteristics of the reservoir covering pre-, during-, and post- dam have not been well studied. This study analyzed the lengths and water surface areas of the TGR using advanced support vector machine method (SVM) combined Landsat images with the Shuttle Radar Topography Mission (SRTM) digital elevation model (DEM), which showed an increasing trend of lengths and surface areas with variable growth rates from pre-dam period to post-dam period. The highest water level (ca. 171.5 m) was reported in 1st Jan, 2015, with the longest length of 687.8 km and largest water surface area of 1106.2 km² during the study period. The lowest increasing magnitude of the reservoir length occurred in the first stage (2000–2005) but with the fastest magnitude of water surface area increase. The third stage (2010–2015) showed highest increase magnitude of length and lowest increase magnitude of water surface area. Meanwhile, the increased reservoir areas were mainly from cultivated land, forest land, and building land, with the biggest increase rate of cultivated land regardless of periods. Specifically, cultivated land contributed 39.1–46.0% to increased reservoir water area; the proportions were 22.6–29.6%, 22.1–24.1%, and 5.6–9.4% for forest, building land, and grassland, respectively. The study provides important data for the TGR physical evolution in the Holocene.

Assessment of biochemical alterations in the neotropical fish species Phalloceros harpagos after acute and chronic exposure to the drugs paracetamol and propranolol

Abstract

Over time, many pollutants of anthropogenic origin have caused the contamination of aquatic ecosystems. Among several characteristics, these compounds can reach the trophic chain, causing deleterious interactions with the biota. Pharmaceutical substances can be included in this scenario as emerging contaminants that reach the aquatic environment because of direct human and veterinary usage, and release by industrial effluents, as well as through domestic dumping of surplus drugs. The effects of these compounds on exposed organisms have been studied since the 1990s, but ecotoxicological data for such chemicals are still scarce especially concerning aquatic organisms from tropical regions. Paracetamol and propranolol were selected for this study since they are frequently found in surface waters. Paracetamol is a drug used as analgesic and antipyretic, while propranolol, a β-blocker, is used in the treatment of hypertension. The objective of this study was to assess the toxic effects of these substances on the neotropical freshwater fish Phalloceros harpagos after acute (96 h) and chronic (28 days) exposures. In order to understand the effects of these drugs on P. harpagos, biochemical markers were selected, including the enzymes involved in oxidative stress, xenobiotic metabolism, and neurotransmission (catalase, glutathione-S-transferase, and cholinesterase activities, respectively). After acute exposure, no significant alterations were observed for catalase activity, suggesting the absence of oxidative stress. On the contrary, significant alterations in glutathione-S-transferases activity were described for the higher concentrations of both pharmaceuticals after acute exposure. In addition, acute exposure to paracetamol caused a significant increase of cholinesterase activity. None of the tested pharmaceuticals caused significant changes in catalase or cholinesterase activities after chronic exposure. Glutathione S-transferases activity was significantly increased for propranolol following chronic exposure, indicating the potential involvement of phase II detoxification pathway.

“Photodermatology and Photomedicine: Meeting Calendar”

Issue Information

Recent updates on phthalate exposure and human health: a special focus on liver toxicity and stem cell regeneration

Abstract

Phthalates have been blended in various compositions as plasticizers worldwide for a variety of purposes. Consequently, humans are exposed to a wide spectrum of phthalates that needs to be researched and understood correctly. The goal of this review is to focus on phthalate's internal exposure pathways and possible role of human digestion on liver toxicity. In addition, special focus was made on stem cell therapy in reverting liver toxicity. The known entry of higher molecular weight phthalates is through ingestion while inhalation and dermal pathways are for lower molecular weight phthalates. In human body, certain phthalates are digested through phase 1 (hydrolysis, oxidation) and phase 2 (conjugation) metabolic processes. The phthalates that are made bioavailable through digestion enter the blood stream and reach the liver for further detoxification, and these are excreted via urine and/or feces. Bis(2-ethylhexyl) phthalate (DEHP) is a compound well studied involving human metabolism. Liver plays a pivotal role in humans for detoxification of pollutants. Thus, continuous exposure to phthalates in humans may lead to inhibition of liver detoxifying enzymes and may result in liver dysfunction. The potential of stem cell therapy addressed herewith will revert liver dysfunction and lead to restoration of liver function properly.

Impact of cadmium on forage kale ( Brassica oleracea var. viridis cv “Prover”) after 3-,10- and 56-day exposure to a Cd-spiked field soil

Abstract

Cadmium (Cd) is a highly toxic element for living organisms and is widespread in metal-contaminated soils. As organisms which can grow up on these polluted areas, plants have some protection mechanisms against Cd issues. Among the plant kingdom, the Brassicaceae family includes species which are known to be able to tolerate and accumulate Cd in their tissues. In this study, Brassica oleracea var. viridis cv "Prover" was exposed to a range of artificially Cd-contaminated soils (from 2.5 up to 20 mg kg⁻¹) during 3, 10, and 56 days and the effects on life traits, photosynthesis activity, antioxidant enzymatic activities were studied. Metal accumulation was quantified, as well as DNA damage, by means of the comet assay and immunodetection of 8-OHdG levels. Globally, B. oleracea was relatively tolerant to those Cd exposures. However, comet assay and detection of 8-OHdG revealed some DNA damage but which are not significant. According to metal accumulation analysis, B. oleracea var. viridis cv Prover could be a good candidate for alternative growing in contaminated areas.

Carbon dioxide emissions, economic growth, energy use, and urbanization in Saudi Arabia: evidence from the ARDL approach and impulse saturation break tests

Abstract

This study investigates the existence of long-run relationship between CO₂ emissions, economic growth, energy use, and urbanization in Saudi Arabia over the period 1971–2014. The autoregressive distributed lag (ARDL) approach with structural breaks, where structural breaks are identified with the recently impulse saturation break tests, is applied to conduct the analysis. The bounds test result supports the existence of long-run relationship among the variables. The existence of environmental Kuznets curve (EKC) hypothesis has also been tested. The results reveal the non-validity of the EKC hypothesis for Saudi Arabia as the relationship between GDP and pollution is positive in both the short and the long run. Moreover, energy use increases pollution both in short and long run in the country. On the contrary, the results show a negative and significant impact of urbanization on carbon emissions in Saudi Arabia, which means that urban development is not an obstacle to the improvement of environmental quality. Consequently, policy-makers in Saudi Arabia should consider the efficiency enhancement, frugality in energy consumption, and especially increase the share of renewable energies in the total energy mix.

Issue Information

Repair of the Lateral Nasal Wall in Nasal Airway Obstruction

This systematic review and meta-analysis examines the effectiveness of lateral wall repair in patients with nasal airway obstruction.

Automated Facial Measurements in Facial Palsy

This Observation describes Emotrics, a software platform that uses machine learning techniques to enable automatic facial landmark localization and computation of facial measurements for use in the treatment of facial palsy.

Length of Stay for Free Tissue Transfer to Head and Neck Defects

This database review evaluates patient and surgical factors associated with length of stay and reoperation following surgical procedures for malignant neoplasm of the head and neck involving microvascular free tissue transfer reconstruction.

Nostril Sill Repair by Muscle Tension Line Group Reconstruction

This Surgical Pearl describes the technique of nostril sill repair to restore the first auxiliary tension line group in patients with cleft lip.

Analysis and Classification of the Nasal Base Using a Parametric Model

This study assesses using an equation to quantitatively describe nasal base shape and tests it against subjective categorization.

Masseteric Nerve Transfer for Facial Nerve Paralysis

This systematic review with meta-analysis examines masseteric nerve transfer for treatment of patients with facial paralysis.

March-April Issue Highlights

Repair of Lateral Wall Insufficiency

This case-control study examines and compares the outcomes of septorhinoplasty to repair lateral wall insufficiency to determine the most appropriate treatment approach.

Assessing Cosmetic Rhinoplasty Outcomes

Developing effective methods to evaluate surgical outcomes is more important than ever. Peers, patients, and payers increasingly judge the quality of surgical procedures based on measurable outcomes. The government, health care review websites, and others are actively seeking benchmarks to compare our individual surgical results with those of other surgeons across the country and around the world. It is in our best interest to identify equitable methods of measuring our outcomes, and cosmetic surgery outcomes are among the most difficult to measure. Rating cosmetic results in rhinoplasty—with wide variability in what is considered ideal or is even possible for a given patient—is particularly challenging. Prior studies have examined patients' and surgeons' perceptions following rhinoplasty. However, both patients and surgeons have inherent biases that interfere with objective analyses of rhinoplasty outcomes. Unbiased casual observers are better suited to independently rate improvement following cosmetic rhinoplasty.

Patient Value Systems and Physician and Practice Attributes Available Online

This data analysis of survey examines the relative value from the patient perspective of specific facial plastic surgeon personal and practice attributes available online.

Peak Nasal Inspiratory Flow as an Objective Measure

This study assesses the utility of peak nasal inspiratory flow as an objective diagnostic and outcome measure for functional septorhinoplasty in combination with the Nasal Obstruction Symptom Evaluation scale.

Mohs Reconstructive Surgery Timing and Postoperative Complications

This cohort study explores whether delaying Mohs reconstructive surgery increases the risk of postoperative complications.

Condensed Nanofat Combined With Fat Grafts to Treat Atrophic Scars

This case series evaluates the use of condensed nanofat combined with fat grafts to treat atrophic facial scars.

Rhinoplasty and Social Perceptions of Attractiveness and Health

This survey study measures naive observers' perceptions of attractiveness, success, and overall health of patients who have undergone rhinoplasty.

Autologous Costal Cartilage Harvesting and Donor-Site Pain in Rhinoplasty

This comparative cohort study examines the postoperative donor-site pain associated with either a muscle-cutting or muscle-sparing technique in autologous costal cartilage grafting for patients undergoing rhinoplasty.

Combining Rhinoplasty With Upper Lip–Lift Using a Single Incision Line

This Surgical Pearl describes a procedure that combines the columellar incision with the incision for the upper lip–lift, resulting in harmonious nasolabial proportions and a smaller surgical scar.

Botulinum Neuromodulators in Facial Synkinesis Management

This randomized clinical trial evaluates the effectiveness of 3 commercially available botulinum toxin neuromodulators in the treatment of facial synkinesis.

Early Outcomes After Surgical Repair of Orbital Floor Fractures

This database analysis uses the American College of Surgeons National Surgical Quality Improvement Program Participant User File to characterize the epidemiologic, surgical, and hospitalization patterns and postoperative complications in patients undergoing repair of orbital floor fracture.

Nasolabial Incision Technique for Facial Paralysis Management

This case series compares the preoperative and postoperative facial function of patients who underwent a nasolabial fold creation procedure using the minimal nasolabial incision technique.

JAMA Facial Plastic Surgery

Mission Statement: JAMA Facial Plastic Surgery is a multispecialty journal whose key mission is to provide facial plastic surgeons the most accurate and innovative information available to enhance their patients' quality of life.

Skin microneedling for acne scars associated with pigmentation in patients with dark skin

Summary

Background

Acne is very common skin condition. Most patients with acne will have a degree of scarring as a result of their acne. In patients with darker skin color the scarring can be further complicated by hyperpigmentation. Several treatment options can be used to improve acne scarring, however the problem of post acne hyperpigmentation is not often addressed. This study especially focus on the treatment of pigmented post acne scarring using skin microneedling.

Aims

The primary objective is to assess the improvement of pigmentation of acne scarring in patients with dark skin using microneedling. Secondary objectives include evaluation of post acne scarring improvement and the safety of microneedling in pigmented skin.

Materials & Methods

39 Patients with darker skin colors (types 3, 4 and 5) completed study. Baseline evaluation for both acne scars and pigmentation scores performed using "post acne hyperpigmentation index" (PAHPI) and Goodman-Baron scales (GB scale). Microneedling treatment done and subsequently patients reviewed at 2 weeks for initial assessment and then after at least 4 weeks from date of initial assessment using same scoring methods for both scars and pigmentation. Baseline photographs were taken and again at final assessment.

Results

Both PAHPI and Goodman-Baron scales showed statistically significant improvement from baseline following microneedling treatment. Side effects were minor and of transient nature. None of our patients showed worsening of pigmentation.

Conclusion

Microneedling is an effective treatment for both acne scars and associated pigmentation in patients with dark skin color. The treatment appears to be safe apart from transient redness, mild dryness, and small hematomas, however additional treatments may be needed in some patients to achieve more improvement in pigmentation.

Improvement of skin barrier dysfunction by Scutellaria baicalensis GEOGI extracts through lactic acid fermentation

Summary

Background

The development of an alternative medicine to treat atopic dermatitis (AD) from natural sources is necessary.

Aims

To improve skin barrier dysfunction by enhancing the differentiation of human keratinocytes with the fermented Scutellaria baicalensis.

Methods

Scutellaria baicalensis was fermented with Lactobacillus plantarum and extracted with 70% ethanol (FE). Antioxidant activities and the regulation of the gene expression related to keratinocyte differentiation were measured as well as its proliferation.

Result

This work first proved that the FE had multiple activities, both increasing keratinocyte differentiation and proliferation: The FE greatly up-regulated expression of the genes of keratinocyte differentiation such as involucrin, keratin 10, and transglutaminase-1 (TG-1) up to 4.06-fold, which was 3 times higher than the 2 other extracts. The effect of baicalein on keratinocyte differentiation was also first found; however, its efficacy was lower than that of the fermented extract. The FE proved to effectively accelerate keratinocyte differentiation, rather than to initiate the differentiation, and also showed an ability of stimulating keratinocyte proliferation up to 2.8 × 10⁶ viable cells/mL as well as 70.24 ng/mL of collagen production in fibroblasts. High efficacy of the FE was confirmed by synergistic effects of large amounts of various bioactive substances in the extracts as baicalein alone did not show remarkable effects and even positive controls had not much better activities than the FE.

Conclusion

The fermented extract was able to improve skin barrier dysfunction, and the ointment with 1%-5% (v/v) of the extract be directly used for skin clinical trials to treat AD.

Semi-automatic tumour volume measurements on MR-imaging using Smartbrush® in oropharyngeal carcinomas; our experience in 5 patients

Abstract

Head and neck cancer is worldwide the sixth most common cancer. Prognosis is linked to tumour (primary tumours, nodal stage and distant metastasis) and general patients' characteristics. Currently, the TNM-staging system is the most used staging system in the world. Beside this TNM-staging system, other prognostic factors are used to select the best treatment for each individual patient.

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Transoral endoscopic base of tongue mucosectomy for investigation of unknown primary cancers of head and neck

Abstract

Cancer of the unknown primary (CUP) makes up 2-4% of new head and neck squamous cell carcinoma (SCC) diagnoses. This scenario is recognised as a diagnostic challenge for head and neck surgeons. For all patients with proven cervical lymph node metastatic SCC without a clinically apparent primary site, the current UK guidelines recommends PET-CT, panendoscopy with directed biopsies and bilateral tonsillectomy as a standard of care.

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A web-based prediction score for head and neck cancer referrals

Abstract

Objective

Following the announcement of the NHS Cancer Plan in 2000, anyone suspected of having cancer has to be seen by a specialist within two weeks of referral. Since this introduction, studies have shown that only 6.3-14.6% of 2-week referrals were diagnosed with a head and neck cancer and that majority of the cancer diagnoses were via other referral routes. These studies suggest that the referral scheme is not currently cost effective. Our aim is to develop a scoring system that determines the risk of head and neck cancer in a patient, which can then be used to aid GP referrals.

Design

Retrospective data was collected from 1075 patients with 2-week head and neck cancer referrals from general practitioners. The retrospective data collected included patients' demographics, risk factors and relevant investigations. The data was used as input into a logistic regression to arrive at our model. Our approach included data analysis, machine learning techniques, statistical inference and model validation metrics to arrive at the best performing model. The model was then tested with more data from 235 prospective patients.

Results

Using our results from the logistic regression, we created a web-based tool that GPs can use to calculate their patient's probability of cancer and use this result to assist in their decision regarding referral. Our prototype can be seen in Figure 2.

Conclusion

We have created a prototype scoring system that can be hosted online to assist GPs with their referrals with a sensitivity of 31% and specificity of 92%. While we acknowledge that there are several limitations to our model, we believe we have created a novel preliminary scoring system that has the potential to be improved dramatically with further data and be very helpful for GPs in a long run.

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Gender/Sex Differences in the Relationship between Psychosocial Work Exposures and Work and Life Stress

Abstract

Objectives

Stress is an important factor affecting the health of working population. While work exposures are determinants of levels of work and life stress, we do not know whether similar or different exposures are related to stress levels for men and women. This study aimed to formally examine male/female differences in the relationships between psychosocial work exposures and work and life stress in a representative sample of Canadian labour market participants.

Methods

We used data from 2012 cycle of the Canadian Community Health Survey (CCHS), a representative population-based survey conducted by Statistics Canada. The sample was restricted to employed labour force participants working 15+ hours per week (N = 8328, 48% female). To examine the relationship between work exposures and work and life stress, we conducted path analyses. Psychosocial work exposures included social support, job insecurity, job control, and job strain. Differences between estimates for men and women were explored using multigroup analyses, constraining paths between male and female models to be equivalent and examining the impact on change in model fit.

Results

Male/female differences were observed in the relationships between supervisor support and work stress levels as well as between job control, job insecurity, job strain, and life stress levels. Higher levels of supervisor support at work were associated with lower work stress among women, but not among men. Low job control had a direct protective effect on life stress for men but not for women, while high job strain had a direct adverse effect on life stress among women but not among men. Higher job insecurity was more strongly associated with higher life stress among men compared with women. The relationship between work stress and life stress was similar among men and women.

Discussion

The findings of this study suggest that the relationships between psychosocial exposures and work and life stress differ for men and women. Our study also raised important questions about which work exposures are considered when assessing work stress, with level of job control not related to work stress but associated with levels of life stress among men.

Conclusion

Our study highlights the role of psychosocial work environment for both work and life stress and suggests differences in the importance of specific psychosocial work dimensions for feelings of stress among men and women, and for work stress versus life stress. Future study designs should ensure that measures are included to better disentangle the relative contribution of social and biological factors in explaining these differences among men and women.

Gender differences in functional connectivities between insular subdivisions and selective pain-related brain structures

The incidence of pain disorders in women is higher than in men, making gender differences in pain a research focus. The human insular cortex is an important brain hub structure for pain processing and is divid...

The effect of oral immunotherapy treatment in severe IgE mediated milk, peanut, and egg allergy in adults

Abstract

Introduction

The standard care of severe food allergy in both adults and children means avoidance of allergens. In recent years promising results of oral immunotherapy (OIT) have been reported in children. In adults, information on OIT in severe food allergy is very limited.

Objective

We aimed to study if OIT is possible in adults.

Methods

We report OIT results in 10 adult patients with milk OIT, nine adult patients with peanut OIT, and four adult patients with egg OIT. The allergy was confirmed with allergen specific IgE tests and oral food challenges (open in milk allergy and double-blind in peanut and egg allergy). The OIT was performed as open.

Results

The median dose of protein that led to discontinuation of allergen challenge because of symptoms was 7.5 mg in milk allergy, 25 mg in peanut allergy, and 15 mg in egg allergy. The median period of OIT was 515 days. Currently on OIT are 6/10 milk allergic patients, 4/9 peanut allergic patients and 3/4 egg allergic patients. The median dose of milk protein increased by 60-fold during OIT compared to the allergen challenge dose. In peanut OIT the median dose increased by eightfold and in egg allergy the dose increased with OIT by 35-fold. Local itching was the most common side effect of OIT (73.9% of the patients), four patients reported having used epinephrine autoinjector and three patients having needed emergency room treatment.

Conclusions and Clinical Relevance

OIT can be given in adult patients with severe milk, peanut, or egg allergy only in selected cases. OIT leads into desensitization but it is not clear whether persistent tolerance can be achieved. Mild adverse events during OIT are common.

In adults with oral immunotherapy (OIT) for severe milk, peanut, or egg allergy, the median dose of tolerated milk protein increased by 60-fold during OIT compared to the situation before OIT. In peanut OIT, the median dose increased by eightfold and in egg allergy the dose increased with OIT by 35-fold. Local itching was the most common side effect of OIT (74% of the patients), four patients (17%) reported having used epinephrine autoinjector and three patients (13%) having needed emergency room treatment.

Pathways of airway oxidant formation by house dust mite allergens and viral RNA converge through myosin motors, pannexons and Toll-like receptor 4

Abstract

Introduction

Intracellular reactive oxidant species (ROS) are generated in human airway epithelial cells by the prothrombinase action of Group 1 house dust mite (HDM) allergens and by ligation of viral RNA sensor Toll-like receptors (TLRs). We explored signaling convergence between HDM allergens and TLRs in ROS generation because epithelial cells form the primary barrier against inhaled substances and dictate host responses to allergens and viruses.

Methods

ROS formation by Calu-3 human airway cells was studied by measuring dihydrorhodamine 123 oxidation after activation by polyinosinic:polycytidylic acid (to activate TLR3), CL097 (to activate TLR7), a natural mixture of HDM allergens, or BzATP.

Results

TLR4 activation was identified as an indispensable response element for all stimuli, operating downstream from myosin motor activation, pannexon gating for ATP release and the endogenous activation of prothrombin. Exogenous prothrombin activation by HDM allergens was prevented by SGUL 1733, a novel inhibitor of the proteolytic activity of Group 1 HDM allergens, which thus prevented TLR4 from being activated at source.

Conclusions

Our data identify for the first time that endogenously-generated prothrombin and TLR4 form a shared effector mechanism essential to intracellular ROS generation activated by a group 1 HDM allergen (itself a prothrombinase) or by ligation of viral RNA-sensing TLRs. These stimuli operate a confluent signaling pathway in which myosin motors, gating of pannexons, and ADAM 10 lead to prothrombin-dependent activation of TLR4 with a recycling activation of pannexons.

Signaling mechanisms activated by house dust mite allergen Der p1 or through ligation of TLR3 and TLR7 converge via the myosin motor-dependent gating of pannexons to generate intracellular reactive oxidants in airway epithelial cells. The ligation of TLR4, which is indispensible in causing allergy to house dust mites, is an essential downstream component of the convergent pathways. These results shed new light on how allergens and respiratory viruses interact to trigger disease exacerbations.

Observation of optical properties and sources of aerosols at Buddha’s birthplace, Lumbini, Nepal: environmental implications

Abstract

For the first time, aerosol optical properties are measured over Lumbini, Nepal, with CIMEL sunphotometer of the Aerosol Robotic Network (AERONET) program. Lumbini is a sacred place as the birthplace of Lord Buddha, and thus a UNESCO world heritage site, located near the northern edge of the central Indo-Gangetic Plains (IGP) and before the Himalayan foothills (and Himalayas) to its north. Average aerosol optical depth (AOD) is found to be 0.64 ± 0.38 (0.06–3.28) over the sampling period (January 2013–December 2014), with the highest seasonal AOD during the post-monsoon season (0.72 ± 0.44). More than 80% of the daily averaged AOD values, during the monitoring period, are above 0.3, indicating polluted conditions in the region. The levels of aerosol load observed over Lumbini are comparable to those observed at several heavily polluted sites in the IGP. Based on the relationship between AOD and Ångstrom exponent (α), anthropogenic, biomass burning, and mixed aerosols are found to be the most prevalent aerosol types. The aerosol volume-size distribution is bi-modal during all four seasons with modes centered at 0.1–0.3 and 3–4 μm. For both fine and coarse modes, the highest volumetric concentration of ~ 0.08 μm⁻³ μm⁻² is observed during the post-monsoon and pre-monsoon seasons. As revealed by the single-scattering albedo (SSA), asymmetry parameter (AP), and refractive index (RI) analyses, aerosol loading over Lumbini is dominated by absorbing, urban-industrial, and biomass burning aerosols.

How to assess the feeding activity in ecotoxicological laboratory tests using enchytraeids?

Abstract

The risk assessment of pesticides on soil fauna is an issue to protect agroecosystem sustainability. Enchytraeids are recognized as relevant soil bioindicators of chemical stress in agroecosystems. In laboratory, the reproduction test was found to be sensitive to reveal chemical impacts on enchytraeids. However, it does not allow to assess the impacts on ecological functions in which enchytraeids are involved. The objectives of this study were (i) to explore the feasibility of the bait-lamina test with enchytraeids under laboratory conditions and (ii) to compare its sensitivity with the Enchytraeid Reproduction Test. We exposed individuals of Enchytraeus albidus to two commercial formulations of fungicides widely used in Europe. The EC50 reproduction for the Swing^® Gold (50 g L⁻¹ epoxiconazole and 133 g L⁻¹ dimoxystrobin) and the Cuprafor micro^® (50% copper oxychloride) were respectively estimated at 1.66 ± 0.93 times the recommended dose and > 496 mg kg⁻¹ of copper. However, no impact was found on the feeding activity of enchytraeids. The bait-lamina test thus appeared less sensitive than the Enchytraeid Reproduction Test to the tested fungicides. Despite that, this test which is achievable under laboratory conditions and allows assessing indirect effects of pesticides is quick, cheap, and easy to perform. It would deserve to be used to explore longer-exposure effects through the repeated addition of bait-lamina sticks.

Accumulation, fractionation, and risk assessment of mercury and arsenic in the soil-wheat system from the wastewater-irrigated soil in Baiyin, northwest China

Abstract

Wastewater irrigation can increase metal concentrations in soil and wheat, thereby posing metal-associated health risk via food ingestion. We investigated levels of mercury (Hg) and arsenic (As) in roots, husks, stems, leaves, and grains of wheat and their fractionations in farmland soil from Baiyin City, an industrial and mining city, northwest China. Results show that the mean concentrations of Hg in soils from Dongdagou and Xidagou stream in Baiyin were 8.5 times and three times higher than local soil background values, respectively. Those of As were 4.5 times and 1.6 times higher, respectively. Most Hg and As were mainly accumulated in wheat leaves. The spatial distributions of As in soils and grains exhibit a very similar pattern, which suggest that As pollution in soils might be predicted by its level in wheat grains. Residual fractions for Hg (RES-Hg) and As (RES-As) are the highest compared to other fractions, indicating weak mobility of Hg and As in soil. The crop oral intake hazard quotients of both Hg and As for children were approximately two times higher than that for adults, indicating that children have higher exposure risks to Hg- and As-contaminated wheat. The crop oral intake was the main route of exposure causing non-carcinogenic and carcinogenic risk for local residents.

Mineralization of humic acids (HAs) by a solar photo-Fenton reaction mediated by ferrioxalate complexes: commercial HAs vs extracted from leachates

Abstract

The mineralization of bio-recalcitrant humic acids (HAs) by a solar photo-Fenton (SPF) process was investigated in aqueous system, in order to understand its abatement in real high-HA content matrices, such as sanitary landfill leachates. SPF reactions were performed in tubular photoreactors with CPCs at lab-scale (simulated solar light) and pilot-scale (natural sunlight). Considering the experimental conditions selected for this work, the formation of insoluble HA-Fe³⁺ complexes was observed. Thus, to avoid HA precipitation, oxalic acid (Ox) was added, since Fe³⁺-Ox complexes present a higher stability constant. The effect of different process variables on the performance of SPF reaction mediated by ferrioxalate complexes (SPFF) was assessed with excess of H₂O₂ (50–250 mg L⁻¹), at lab-scale: (i) pH (2.8–4.0); (ii) initial iron concentration (20–60 mg Fe³⁺ L⁻¹); (iii) iron-oxalate molar ratio (Fe³⁺-Ox of 1:3 and 1:6); (iv) temperature (20–40 °C); (v) UV irradiance (21–58 W_UV m⁻²); and (vi) commercial-HA concentration (50–200 mg C L⁻¹). At the best lab conditions (40 mg Fe³⁺ L⁻¹, pH 2.8, 30 °C, 1.6 Fe³⁺-Ox molar ratio, 41 W_UV m⁻²), commercial HAs' mineralization profile was also compared with HAs extracted from a sanitary landfill leachate, achieving 88 and 91% of dissolved organic carbon removal, respectively, after 3-h irradiation (8.7 kJ_UV L⁻¹). Both reactions followed the same trend, although a 2.1-fold increase in the reaction rate was observed for the leachate-HA experiment, due to its lower humification degree. At pilot-scale, under natural sunlight, 95% HA mineralization was obtained, consuming 42 mM of H₂O₂ and 5.9 kJ_UV L⁻¹ of accumulated UV energy. However, a pre-oxidation during 2.8 kJ_UV L⁻¹ (12 mM H₂O₂) was enough to obtain a biodegradability index of 89%, showing the strong feasibility to couple the SPFF process to a downstream biological oxidation, with low chemicals and energetic demands.

Graphical abstract

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Is a high concentration of hexavalent chromium in Indian cement causing an increase in the frequency of cement dermatitis in India?

Cumulative risk of skin tumours in patients with Lynch syndrome

Lynch syndrome (LS) is an autosomal-dominant disorder characterized by a predisposition to colorectal cancer and extracolonic malignancies. LS is caused by a germline mutation in one of the four DNA mismatch repair (MMR) genes (MLH1, MSH2, MSH6 and PMS2) or loss of expression of MSH2 due to deletion in the EPCAM gene. Muir-Torre syndrome (MTS) is considered a variant of LS, in which patients present with sebaceous neoplasms and/or keratoacanthomas. A few studies and case reports suggest a relation between LS and other benign and (pre)-malignant skin tumours. Currently only patients presenting with sebaceous carcinoma are advised to be referred to a dermatologist for surveillance.

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