Chronische Prurigo

Zusammenfassung

Chronische Prurigo ist eine Erkrankung, die mit chronischem Pruritus einhergeht und durch das Auftreten von meist hyperkeratotischen, pruritischen Papeln, Knoten und/oder Plaques gekennzeichnet ist. Patienten mit dieser schwer therapierbaren Erkrankung haben oft eine eingeschränkte Lebensqualität. Pruritische Erkrankungen unterschiedlicher Natur (dermatologisch, systemisch, neurologisch, psychiatrisch/psychosomatisch, multifaktoriell oder unbekannt) können durch wiederholtes Kratzen und das Eintreten von Sensibilisierungsprozessen zu chronischer Prurigo führen. Eine gründliche Diagnostik inklusive detaillierter Anamnese und körperlicher Untersuchung sowie gezielte komplementäre Untersuchungen sollen frühestmöglich initiiert werden. Die deutsche Leitlinie empfiehlt topische Steroide und Phototherapie als Optionen der 1. Wahl. Pimecrolimus und Capsaicin (topisch) sowie Antihistaminika, Antikonvulsiva und Immunsuppressiva (systemisch) stellen alternative Therapiemöglichkeiten dar.

Kutane Nebenwirkungen zielgerichteter Therapien

Schwere Hautreaktionen auf neue Medikamente

Zusammenfassung

Stevens-Johnson-Syndrom (SJS), toxisch epidermale Nekrolyse (TEN) sowie eine spezifische Form des Hypersensitivitätssyndroms, das heute als „drug reaction with eosinophilia and systemic symptoms" (DRESS) bezeichnet wird, zählen zu den schweren, meist arzneimittelinduzierten Hautreaktionen. Während SJS/TEN als eine Reaktionsform unterschiedlichen Schweregrades angesehen wird, muss DRESS durch eine Multiorganbeteiligung hiervon wie auch von anderen schweren Exanthemen unterschieden werden. Obwohl SJS/TEN allgemein als Arzneimittelreaktion gilt, sind insgesamt nur ca. drei Viertel der Fälle tatsächlich durch Arzneimittel ausgelöst. Nach Stellen der klinischen Diagnose gehört die Eruierung des möglichen Auslösers zu den wichtigsten Maßnahmen. Sollte es sich um medikamentöse Auslöser handeln, kommt dem Absetzen derselben eine Schlüsselrolle zu. Um das verursachende Arzneimittel identifizieren und absetzen zu können, muss eine sehr detaillierte und gründliche Medikamentenanamnese erhoben werden. Zu den Substanzen, die in pharmakoepidemiologischen Studien als Auslöser von SJS/TEN identifiziert oder bestätigt wurden, gehören Allopurinol, antibakterielle Sulfonamide, verschiedene Antiepileptika, Nevirapin sowie nichtsteroidale Antirheumatika vom Oxicam-Typ. Unter den Arzneimitteln, die DRESS induzieren, finden sich ebenfalls verschiedene Antiepileptika, aber auch Allopurinol, Sulfonamide und Minocyclin. Einzelfälle von SJS/TEN und DRESS im Zusammenhang mit der Anwendung neuer Medikamente, unter diesen auch sog. zielgerichtete Therapien und Biologika, wurden beobachtet.

Biologikanebenwirkungen bei Psoriasis

Zusammenfassung

Hintergrund

Die Einführung der Biologika hat die Therapie der mittelschweren bis schweren Plaquepsoriasis bahnbrechend verändert. Indem die biologischen Therapien der Psoriasis kontinuierlich erweitert werden, ist es besonders wichtig, die Wirksamkeit und Sicherheit der Substanzen nicht nur in klinischen Studien, sondern auch in langfristigen Anwendungsbeobachtungen im Rahmen von Registern zu ermitteln.

Ziel der Arbeit

Es erfolgt die Darstellung typischer Nebenwirkungen und signifikanter Risiken der Biologikatherapien im Rahmen der Psoriasis unter der Berücksichtigung psoriatischer Kontrollpopulationen.

Material und Methoden

Es wurde eine selektive Literatursuche in PubMed durchgeführt, und Studien zur Langzeitsicherheit im Rahmen der Psoriasisregister PsoBest, PSOLAR und BADBIR wurden ausgewertet.

Ergebnisse und Diskussion

Zur Beurteilung der langfristigen Sicherheit der Biologika ist es von besonderer medizinischer Bedeutung, die Verläufe an möglichst vielen Patienten in Langzeitregistern zu beobachten. Eine Tendenz zu verbesserten Nebenwirkungs- und Sicherheitsprofilen der neueren biologischen Medikamente scheint sich abzuzeichnen.

3D Deep Learning Angiography (3D-DLA) from C-arm Conebeam CT [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Deep learning is a branch of artificial intelligence that has demonstrated unprecedented performance in many medical imaging applications. Our purpose was to develop a deep learning angiography method to generate 3D cerebral angiograms from a single contrast-enhanced C-arm conebeam CT acquisition in order to reduce image artifacts and radiation dose.

MATERIALS AND METHODS:

A set of 105 3D rotational angiography examinations were randomly selected from an internal data base. All were acquired using a clinical system in conjunction with a standard injection protocol. More than 150 million labeled voxels from 35 subjects were used for training. A deep convolutional neural network was trained to classify each image voxel into 3 tissue types (vasculature, bone, and soft tissue). The trained deep learning angiography model was then applied for tissue classification into a validation cohort of 8 subjects and a final testing cohort of the remaining 62 subjects. The final vasculature tissue class was used to generate the 3D deep learning angiography images. To quantify the generalization error of the trained model, we calculated the accuracy, sensitivity, precision, and Dice similarity coefficients for vasculature classification in relevant anatomy. The 3D deep learning angiography and clinical 3D rotational angiography images were subjected to a qualitative assessment for the presence of intersweep motion artifacts.

RESULTS:

Vasculature classification accuracy and 95% CI in the testing dataset were 98.7% (98.3%–99.1%). No residual signal from osseous structures was observed for any 3D deep learning angiography testing cases except for small regions in the otic capsule and nasal cavity compared with 37% (23/62) of the 3D rotational angiographies.

CONCLUSIONS:

Deep learning angiography accurately recreated the vascular anatomy of the 3D rotational angiography reconstructions without a mask. Deep learning angiography reduced misregistration artifacts induced by intersweep motion, and it reduced radiation exposure required to obtain clinically useful 3D rotational angiography.

The New Low-Profile WEB 17 System for Treatment of Intracranial Aneurysms: First Clinical Experiences [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

The Woven EndoBridge (WEB) is an intrasaccular flow diverter intended to treat wide-neck aneurysms. The latest generation WEBs needed a 0.021-inch microcatheter in the small sizes. Recently, a lower profile range of WEBs compliant with a 0.017-inch microcatheter (WEB 17) has been introduced. We present the first clinical results of treatment of both ruptured and unruptured aneurysms with the WEB 17.

MATERIALS AND METHODS:

Between December 2016 and September 2017, forty-six aneurysms in 40 patients were treated with the WEB 17. No supporting stents or balloons were used. Twenty-five aneurysms were ruptured (54%). There were 6 men and 34 women (mean age, 62 years; median, 63 years; range, 46–87 years). The mean aneurysm size was 4.9 mm (median, 5 mm; range, 2–7 mm).

RESULTS:

There were 2 thromboembolic procedural complications without clinical sequelae and no ruptures. The overall permanent procedural complication rate was 0% (0 of 40; 97.5% CI, 0%–10.4%). Imaging follow-up at 3 months was available in 33 patients with 39 aneurysms (97.5% of 40 eligible aneurysms). In 1 aneurysm, the detached WEB was undersized and the remnant was additionally treated with coils after 1 week. This same aneurysm reopened at 3 months and was again treated with a second WEB. One other aneurysm showed persistent WEB filling at 3 months. Complete occlusion was achieved in 28 of 39 aneurysms (72%), and 9 aneurysms (23%) showed a neck remnant.

CONCLUSIONS:

The WEB 17 is safe and effective for both ruptured and unruptured aneurysms. The WEB 17 is a valuable addition to the existing WEB size range, especially for very small aneurysms.

Endovascular Management of Acute Stroke in the Elderly: A Systematic Review and Meta-Analysis [ADULT BRAIN]

Background:

Acute ischemic stroke occurs more frequently, presents with more severe symptoms, and has worse outcomes in elderly patients. The safety and efficacy of endovascular therapy for acute stroke in this age group has not been fully established.

Purpose:

We present the results of a systematic review and meta-analysis examining clinical, procedural, and radiologic outcomes of endovascular therapy for acute stroke in patients older than 80 years of age.

Data Sources:

We searched PubMed, MEDLINE, and EMBASE from 1992 to week 35 of 2017 for studies evaluating endovascular therapy for acute stroke in the elderly.

Study Selection:

Two independent reviewers selected studies and abstracted data. The primary end point was good functional outcome at 3 months defined as modified Rankin Scale score of ≤2.

Data Analysis:

Data were analyzed using random-effects meta-analysis.

Data Synthesis:

Seventeen studies reporting on 860 patients were included. The rate of good functional outcome at 3 months was 27% (95% CI, 21%–32%). Mortality at 3 months was 34% (95% CI, 23%–44%). Successful recanalization was achieved in 78% of patients (95% CI, 72%–85%). Procedure-related complications occurred in 11% (95% CI, 4%–17%). The incidence of intracranial hemorrhage was 24% (95% CI, 15%–32%), and for symptomatic intracranial hemorrhage, it was 8% (95% CI, 5%–10%). The mean time to groin was 251 minutes (95% CI, 224–278 minutes). Procedure time was 99 minutes (95% CI, 67–131 minutes).

Limitations:

I² values were above 50% for all outcomes, indicating substantial heterogeneity.

Conclusions:

Good functional recovery in octogenarians treated with endovascular therapy for acute stroke can be achieved in a high proportion of patients despite the higher incidence of comorbidity in this cohort. Outcomes are inferior to those reported for younger patients; however, endovascular therapy can allow at least 1 in 4 patients older than 80 years of age to regain independent function at 3 months. More research is required to improve patient selection in the elderly, but age should not be a discriminator when deciding to offer endovascular therapy for patients with acute stroke.

Transforaminal Lumbar Puncture: An Alternative Technique in Patients with Challenging Access [SPINE]

SUMMARY:

Interlaminar lumbar puncture and cervical puncture may not be ideal in all circumstances. Recently, we have used a transforaminal approach in selected situations. Between May 2016 and December 2017, twenty-six transforaminal lumbar punctures were performed in 9 patients (25 CT-guided, 1 fluoroscopy-guided). Seven had spinal muscular atrophy and were referred for intrathecal nusinersen administration. In 2, CT myelography was performed via transforaminal lumbar puncture. The lumbar posterior elements were completely fused in 8, and there was an overlying abscess in 1. The L1–2 level was used in 2; the L2–3 level, in 10; the L3–4 level, in 12; and the L4–5 level, in 2 procedures. Post-lumbar puncture headache was observed on 4 occasions, which resolved without blood patching. One patient felt heat and pain at the injection site that resolved spontaneously within hours. One patient had radicular pain that resolved with conservative treatment. Transforaminal lumbar puncture may become an effective alternative to classic interlaminar lumbar puncture or cervical puncture.

Diagnosing Early Ischemic Changes with the Latest-Generation Flat Detector CT: A Comparative Study with Multidetector CT [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

One-stop management of mechanical thrombectomy–eligible patients with large-vessel occlusion represents an innovative approach in acute stroke treatment. This approach reduces door-to-reperfusion times by omitting multidetector CT, using flat detector CT as pre-mechanical thrombectomy imaging. The purpose of this study was to compare the diagnostic performance of the latest-generation flat detector CT with multidetector CT.

MATERIALS AND METHODS:

Prospectively derived data from patients with ischemic stroke with large-vessel occlusion and mechanical thrombectomy were analyzed in this monocentric study. All included patients underwent multidetector CT before referral to our comprehensive stroke center and flat detector CT in the angiography suite before mechanical thrombectomy. Diagnosis of early ischemic signs, quantified by the ASPECTS, was compared between modalities using cross tables, the Pearson correlation, and Bland-Altman plots. The predictive value of multidetector CT– and flat detector CT–derived ASPECTS for functional outcome was investigated using area under the receiver operating characteristic curve analysis.

RESULTS:

Of 25 patients, 24 (96%) had flat detector CT with sufficient diagnostic quality. Median multidetector CT and flat detector CT ASPECTSs were 7 (interquartile range, 5.5–9 and 4.25–8, respectively) with a mean period of 143.6 ± 49.5 minutes between both modalities. The overall sensitivity was 85.1% and specificity was 83.1% for flat detector CT ASPECTS compared with multidetector CT ASPECTS as the reference technique. Multidetector CT and flat detector CT ASPECTS were strongly correlated (r = 0.849, P < .001) and moderately predicted functional outcome (area under the receiver operating characteristic curve, 0.738; P = .007 and .715; P = .069, respectively).

CONCLUSIONS:

Determination of ASPECTS on flat detector CT is feasible, showing no significant difference compared with multidetector CT ASPECTS and a similar predictive value for functional outcome. Our findings support the use of flat detector CT for emergency stroke imaging before mechanical thrombectomy to reduce door-to-groin time.

Brain MRI Characteristics of Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Their Associations with 2-Year Clinical Outcome [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Anti-N-methyl-D-aspertate receptor encephalitis is an autoimmune-mediated disease without specific brain MRI features. Our aim was to investigate the brain MR imaging characteristics of anti-N-methyl-D-aspartate receptor encephalitis and their associations with clinical outcome at a 2-year follow-up.

MATERIALS AND METHODS:

We enrolled 53 patients with anti-N-methyl-D-aspartate receptor encephalitis and performed 2-year follow-up. Brain MRIs were acquired for all patients at the onset phase. The brain MR imaging manifestations were classified into 4 types: type 1: normal MR imaging findings; type 2: only hippocampal lesions; type 3: lesions not involving the hippocampus; and type 4: lesions in both the hippocampus and other brain areas. The modified Rankin Scale score at 2-year follow-up was assessed, and the association between the mRS and onset brain MR imaging characteristics was evaluated.

RESULTS:

Twenty-eight (28/53, 53%) patients had normal MR imaging findings (type 1), and the others (25/53, 47%) had abnormal MRI findings: type 2: 7 patients (13%); type 3: seven patients (13%); and type 4: eleven patients (21%). Normal brain MRI findings were more common in female patients (P = .02). Psychiatric and behavioral abnormalities were more common in adults (P = .015), and autonomic symptoms (P = .025) were more common in pediatric patients. The presence of hippocampal lesions (P = .008, OR = 9.584; 95% CI, 1.803–50.931) and relapse (P = .043, OR = 0.111; 95% CI, 0.013–0.930) was associated with poor outcome.

CONCLUSIONS:

Normal brain MRI findings were observed in half of the patients. Lesions in the hippocampus were the most common MR imaging abnormal finding. The presence of hippocampal lesions is the main MR imaging predictor for poor prognosis in patients with anti-N-methyl-D-aspartate receptor encephalitis.

Cerebellar Growth Impairment Characterizes School-Aged Children Born Preterm without Perinatal Brain Lesions [PEDIATRICS]

BACKGROUND AND PURPOSE:

Infants born preterm are commonly diagnosed with structural brain lesions known to affect long-term neurodevelopment negatively. Yet, the effects of preterm birth on brain development in the absence of intracranial lesions remain to be studied in detail. In this study, we aim to quantify long term consequences of preterm birth on brain development in this specific group.

MATERIALS AND METHODS:

Neonatal cranial sonography and follow-up T1-weighted MR imaging and DTI were performed to evaluate whether the anatomic characteristics of the cerebrum and cerebellum in a cohort of school-aged children (6–12 years of age) were related to gestational age at birth in children free of brain lesions in the perinatal period.

RESULTS:

In the cohort consisting of 36 preterm (28–37 weeks' gestational age) and 66 term-born infants, T1-weighted MR imaging and DTI at 6–12 years revealed a reduction of cerebellar white matter volume (β = 0.387, P < .001), altered fractional anisotropy of cerebellar white matter (β = –0.236, P = .02), and a reduction of cerebellar gray and white matter surface area (β = 0.337, P < .001; β = 0.375, P < .001, respectively) in relation to birth age. Such relations were not observed for the cerebral cortex or white matter volume, surface area, or diffusion quantities.

CONCLUSIONS:

The results of our study show that perinatal influences that are not primarily neurologic are still able to disturb long-term neurodevelopment, particularly of the developing cerebellum. Including the cerebellum in future neuroprotective strategies seems therefore essential.

Factors Influencing Confidence in Diagnostic Ratings and Retreatment Recommendations in Coiled Aneurysms [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Angiographic occlusion and retreatment of coiled aneurysms are commonly used as surrogate end points in clinical trials. We aimed to evaluate the influence of aneurysm, patient, and rater characteristics on the confidence of visual evaluation of aneurysm coiling and retreatment decisions.

MATERIALS AND METHODS:

Twenty-six participants of the Advanced Course in Endovascular Interventional Neuroradiology of the European Society of Neuroradiology were asked to evaluate digital subtraction angiography examinations of patients who had undergone endovascular coiling, by determining the grade of aneurysm occlusion, the change between immediate postprocedural and follow-up angiograms, their level of confidence, the technical difficulty of retreatment, and the best therapeutic approach. The experience, knowledge, and skills of each participant were assessed. The influence of rater and case characteristics on indicated confidence in diagnostic ratings and retreatment recommendations was analyzed.

RESULTS:

Interrater reliability was moderate regarding the assessment of aneurysm occlusion grade (intraclass correlation coefficient = 0.581) and substantial regarding change (intraclass correlation coefficient = 0.776). Overall confidence in the diagnostic rating was high (median, "very certain"). Confidence was statistically significantly higher in cases that were generally rated as "worse." The odds of recommending retreatment were significantly higher in cases that were generally rated with higher mean confidence.

CONCLUSIONS:

Although overall confidence in the diagnostic rating was high, our study confirms the suboptimal interrater reliability of visual assessment of aneurysm occlusion as well as retreatment recommendations, rendering both questionable as primary outcome measures. Besides recurrence status, recommendation of retreatment is significantly influenced by patient age, aneurysm neck width, and characteristics of the therapist.

Triage in the Angiography Suite for Mechanical Thrombectomy in Acute Ischemic Stroke: Not Such a Good Idea [LETTERS]

Toward methylation-based classification of central nervous system tumors

Precise classification of nervous system tumors into coherent clinicopathologic entities is the necessary first step for the appropriate management of patients. While this has been traditionally performed by histopathology only, recent accelerations in our understanding of the molecular features of nervous system tumors have led to the integration of molecular characteristics into diagnostic criteria. The updated WHO 2016 classification of tumors of the central nervous system (CNS)¹ thus includes both histologic and molecular features—primarily mutational status of individual genes and copy number alterations—facilitating the precise diagnosis of CNS tumors. While this has led to increased objectivity and reproducibility, classification progress is still required, especially for rare and for poorly understood entities.

The Journal of Dermatology, Ahead of Print.

The Journal of Dermatology, Ahead of Print.

The Journal of Dermatology, Ahead of Print.

The Journal of Dermatology, Ahead of Print.

The relationship between urban form and air pollution depends on seasonality and city size

Abstract

Understanding how urban form is related to air pollution is important to urban planning and sustainability, but the urban form-air pollution relationship is currently muddled by inconsistent findings. In this study, we investigated how the compositional and configurational attributes of urban form were related to different air pollution measures (PM_2.5, API, and exceedance) in 83 Chinese cities, with explicit consideration of city size and seasonality. Ten landscape metrics were selected to quantify urban form attributes, and Spearman's correlation was used to quantify the urban form-air pollution relationship. Our results show that the urban form and air pollution relationship was dominated by city size and moderated by seasonality. Specifically, urban air pollution levels increased consistently and substantially from small to medium, large, and megacities. The urban form-air pollution relationship depended greatly on seasonality and monsoons. That is, the relationship was more pronounced in spring and summer than fall and winter, as well as in cities affected by monsoons. Urban air pollution was correlated more strongly with landscape composition metrics than landscape configuration metrics which seemed to affect only PM_2.5 concentrations. Our study suggests that, to understand how air pollution levels are related to urban form, city size and seasonality must be explicitly considered (or controlled). Also, in order to mitigate urban air pollution problems, regional urban planning is needed to curb the spatial extent of built-up areas, reduce the degree of urban fragmentation, and increase urban compactness and contiguity, especially for large and megacities.

Incidences of mortality of Indian peafowl Pavo cristatus due to pesticide poisoning in India and accumulation pattern of chlorinated pesticides in tissues of the same species collected from Ahmedabad and Coimbatore

Abstract

Incidences of mortality of Indian peafowl Pavo cristatus, the national bird (Schedule I Indian Wild Life Protection Act 1972), are rampant in India. Between January 2011 and March 2017, around 550 peafowl in 35 incidences were reported dead across the country. Due to the non-availability of fresh carcases, poisoning could not be confirmed. Birds which died due to kite string injuries in Ahmedabad (15) and accidents in Coimbatore (5) were tested for residues of chlorinated pesticides, namely hexachlorocyclohexane (HCH), dichloro-diphenyl-trichloroethane (DDT), endosulfan, heptachlor, dicofol, dieldrin and cholipyrifos. The liver, kidney and muscle were the tissues considered to document pesticide load. Total load ranged from BDL to 388.2 ng/g. DDT (95%) and HCH (80%) were detected more frequently. DDT (40%) and endosulfan (26%) contributed maximum to the total pesticide load followed by HCH (21%). Pesticide accumulation pattern among the organs was in the order of liver (123.9 ng/g) > kidney (91.9 ng/g) > muscle (19.5 ng/g) with significant difference (p < 0.05). Peafowl from Ahmedabad had significantly (p < 0.05) higher level of total pesticide (149.0 ng/g) than birds from Coimbatore (47.8 ng/g). Although varying levels of chlorinated pesticide were detected, they were below reported toxic limits. Nevertheless, persistence of chlorinated pesticides and poisoning due to modern pesticides across the entire distribution range of Peafowl in India is a cause for concern.

Councilor's meeting/general assembly of members at the 42nd annual general meeting of the Japanese Society for Investigative Dermatology (JSID)

A 10 Point Plan to Demonstrate the Value of Dermatology in the Health Care System

In May 2017, the American Academy of Dermatology (AAD) convened a Dermatology Specialty Summit, with representatives from 15 dermatology specialty societies, the American Board of Dermatology, and the Coalition of Skin Diseases in attendance. The Summit's goal was to identify opportunities to address and enhance the perception of dermatology in the House of Medicine, the role of data in the changing health care environment, and access to dermatologic care. Summit participants collectively identified a list of 10 action items that address opportunities in these areas of concern.

Highly cited articles in wind tunnel-related research: a bibliometric analysis

Abstract

Wind tunnels have been widely employed in aerodynamic research. To characterize the high impact research, a bibliometric analysis was conducted on highly cited articles related to wind tunnel based on the Science Citation Index Expanded (SCI-EXPANDED) database from 1900 to 2014. Articles with at least 100 citations from the Web of Science Core Collection were selected and analyzed in terms of publication years, authors, institutions, countries/territories, journals, Web of Science categories, and citation life cycles. The results show that a total of 77 highly cited articles in 37 journals were published between 1959 and 2008. Journal of Fluid Mechanics published the most of highly cited articles. The USA was the most productive country and most frequent partner of internationally collaboration. The prolific institutions were mainly located in the USA and UK. The authors who were both first author and corresponding author published 88% of the articles. The Y index was also deployed to evaluate the publication characteristics of authors. Moreover, the articles with high citations in both history and the latest year with their citation life cycles were examined to provide insights for high impact research. The highly cited articles were almost earliest wind tunnel experimental data and reports on their own research specialty, and thus attracted high citations. It was revealed that classic works of wind tunnel research was frequently occurred in 1990s but much less in 2000s, probably due to the development of numerical models of computational fluid dynamic (CFD) in recent decades.

Mancozeb exposure results in manganese accumulation and Nrf2-related antioxidant responses in the brain of common carp Cyprinus carpio

Abstract

Manganese (Mn)-containing dithiocarbamates such as Mancozeb (MZ) have been shown to induce oxidative stress-related toxicity in rodents and humans. However, little is known about the neurotoxic effects induced by MZ in fish. In this study, carp (Cyprinus carpio) were exposed to non-lethal waterborne concentrations of MZ, and oxidative stress parameters as well as metal accumulation in fish brains were evaluated. The experimental groups were as follows: control, MZ 5 mg/L, and MZ 10 mg/L. Fish were exposed for 7 days, and then brain was removed and prepared for subsequent analysis of antioxidant enzymes, reactive oxygen species (ROS), and expression of Nrf2 and phosphoNrf2. In parallel, manganese (Mn) levels were evaluated in blood and brain tissues. Mn levels were significantly increased in blood and brain of MZ-exposed carps. In addition, a concentration-dependent increase (p < 0.05) in ROS levels was observed in parallel to increments (p < 0.05) in the activity of major antioxidant enzymes, such as GPx, GR, and GST. On the other hand, significant decreases (p < 0.05) in CAT and SOD activities were observed. The expression of total and phosphorylated forms of Nrf2 was significantly (p < 0.05) upregulated in the brain of carps exposed to Mz when compared to the control, indicating an activation of the Nrf2 antioxidant pathway. Our study showed for the first time the activation of the Nrf2/ARE pathway and bioaccumulation of Mn induced by MZ exposure in fish species, highlighting important mechanisms of action and its toxicological impacts to aquatic organisms.

Australasian Journal of Dermatology, Ahead of Print.

Australasian Journal of Dermatology, Ahead of Print.

Unusual clinical manifestation of laryngeal edema in a case of DRESS syndrome

Publication date: Available online 21 March 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Da Woon Sim, Young-Il Koh

Australasian Journal of Dermatology, Ahead of Print.

Australasian Journal of Dermatology, Ahead of Print.

Punicalagin and (–)-Epigallocatechin-3-Gallate Rescue Cell Viability and Attenuate Inflammatory Responses of Human Epidermal Keratinocytes Exposed to Airborne Particulate Matter PM10

Background/Aims: Airborne particulate matter with a diameter of #x3c; 10 µm (PM10) causes oxidative damage, inflammation, and premature skin aging. In this study, we evaluated whether polyphenolic antioxidants attenuate the inflammatory responses of PM10-exposed keratinocytes. Methods: Primary human epidermal keratinocytes were exposed in vitro to PM10 in the absence or presence of punicalagin and (–)-epigallocatechin-3-gallate (EGCG), which are the major polyphenolic antioxidants found in pomegranate and green tea, respectively. Assays were performed to determine cell viability, production of reactive oxygen species (ROS), and expression of NADPH oxidases (NOX), proinflammatory cytokines, and matrix metalloproteinase (MMP)-1. Results: PM10 decreased cell viability and increased ROS production in a dose-dependent manner. It also increased the expression levels of NOX-1, NOX-2, tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, IL-8, and MMP-1. Punicalagin was not cytotoxic up to 300 μM, and (–)-EGCG was cytotoxic above 30 μM, respectively. Further, punicalagin (3–30 μM) and EGCG (3–10 μM) rescued the viability of PM10-exposed cells. They also attenuated ROS production and the expression of NOX-1, NOX-2, TNF-α, IL-1β, IL-6, IL-8, and MMP-1 stimulated by PM10. Conclusions: This study demonstrates that polyphenolic antioxidants, such as punicalagin and (–)-EGCG, rescue keratinocyte viability and attenuate the inflammatory responses of these cells due to airborne particles.
Skin Pharmacol Physiol 2018;31:134–143

Concurrent removal of elemental mercury and SO 2 from flue gas using a thiol-impregnated CaCO 3 -based adsorbent: a full factorial design study

Abstract

Mercury (Hg) emitted from coal-based thermal power plants (CTPPs) can accumulate and bio-magnify in the food chain, thereby posing a risk to humans and wildlife. The central idea of this study was to develop an adsorbent which can concurrently remove elemental mercury (Hg⁰) and SO₂ emitted from coal-based thermal power plants (CTPPs) in a single unit operation. Specifically, a composite adsorbent of CaCO₃ impregnated with 2-mercaptobenimidazole (2-MBI) (referred to as modified calcium carbonate (MCC)) was developed. While 2-MBI having sulfur functional group could selectively adsorb Hg⁰, CaCO₃ could remove SO₂. Performance of the adsorbent was evaluated in terms of (i) removal (%) of Hg⁰ and SO₂, (ii) adsorption mechanism, (iii) adsorption kinetics, and (iv) leaching potential of mercury from spent adsorbent. The adsorption studies were performed using a 2² full factorial design of experiments with 15 ppbV of Hg⁰ and 600 ppmV of SO₂. Two factors, (i) reaction temperature (80 and 120 °C; temperature range in flue gas) and (ii) mass of 2-MBI (10 and 15 wt%), were investigated for the removal of Hg⁰ and SO₂ (as %). The maximum Hg⁰ and SO₂ removal was 86 and 93%, respectively. The results of XPS characterization showed that chemisorption is the predominant mechanism of Hg⁰ and SO₂ adsorption on MCC. The Hg⁰ adsorption on MCC followed Elovich kinetic model which is also indicative of chemisorption on heterogeneous surface. The toxicity characteristic leaching procedure (TCLP) and synthetic precipitation leaching procedure (SPLP) leached mercury from the spent adsorbent were within the acceptable levels defined in these tests. The engineering significance of this study is that the 2-MBI-modified CaCO₃-based adsorbent has potential for concurrent removal of Hg⁰ and SO₂ in a single unit operation. With only minor process modifications, the newly developed adsorbent can replace CaCO₃ in the flue-gas desulfurization (FGD) system.

Validación transcultural al español de la escala Hair Specific Skindex-29: una valiosa herramienta en nuestra consulta

Publication date: Available online 22 March 2018
Source:Actas Dermo-Sifiliográficas
Author(s): E. Martínez García

Alopecia areata y pustulosis palmoplantar: informe de 4 casos

Publication date: Available online 22 March 2018
Source:Actas Dermo-Sifiliográficas
Author(s): T. Hiraiwa, T. Yamamoto

The Multivector Gracilis Free Functional Muscle Flap for Facial Reanimation

This cohort study analyzes use of a double-paddle multivector gracilis flap for treatment of patients with complete facial paralysis.

Power Area Density in Inverse Spectra

Abstract

In recent years, inverse spectra were investigated with imaging optics and a quantitative description with radiometric units was suggested (Rang in Phänomenologie komplementärer Spektren, Logos, Berlin, 2015). It could be shown that inverse spectra complement each other additively to a constant intensity level. Since optical intensity in radiometric units is a power area density, it can be expected that energy densities of inverse spectra also fulfill an inversion equation and complement each other. In this contribution we report findings on a measurement of the power area density of inverse spectra for the near ultraviolet, visible and the infrared spectral range. They show the existence of corresponding spectral regions ultra-yellow and infra-cyan in the inverted spectrum and thereby present additional experimental evidence for equivalence of inverse spectra beyond the visible range.

Improved sorption of perfluorooctanoic acid on carbon nanotubes hybridized by metal oxide nanoparticles

Abstract

Multi-walled carbon nanotubes (MWCNTs) are often used as adsorbent because of their strong adsorption capacity. However, due to the nature of MWCNTs, their ability to adsorb perfluorooctanoic acid (PFOA), a highly hydrophobic pollutant, is low. In this study, MWCNTs were modified by three nano metal oxides (nano iron oxide, copper oxide, and zinc oxide). The pristine (as the control) and modified MWCNTs were characterized by BET-N₂, TEM, FTIR, XPS, and XRD, which showed that nano metal oxides were well hybridized on the surface of MWCNTs. Radioactive-labeled PFOA (¹⁴C-PFOA) was used to quantify it at trace level. Adsorption kinetics showed that intra-particle diffusion was the control step of PFOA adsorbing on metal oxides hybridized MWCNTs (MOHCNTs). Adsorption capacity of PFOA on the MOHCNTs was higher than that on the control due to electrostatic and hydrophobic interactions. In addition, PFOA formed inner-sphere complexes with metal oxide nanoparticles via ligand exchange. The alteration of PFOA adsorption capacity by increasing ionic strength was attributed to the aggregation degree of MWCNTs, electrostatic shielding, and/or salting out effect. The presence of Ca²⁺ increased the adsorption, owing to not only its higher electrostatic shielding ability than Na⁺ but also its formation of bridge between PFOA and MOHCNTs. PFOA adsorption on MOHCNTs strongly depended on medium pH value. These results provide an innovative approach for removing trace PFOA from liquid medium.

Community-led comparative genomic and phenotypic analysis of the aquaculture pathogen Pseudomonas baetica a390T sequenced by Ion semiconductor and Nanopore technologies

Abstract

Pseudomonas baetica strain a390T is the type strain of this recently described species and here we present its high-contiguity draft genome. To celebrate the 16^th International Conference on Pseudomonas, the genome of P. baetica strain a390T was sequenced using a unique combination of Ion Torrent semiconductor and Oxford Nanopore methods as part of a collaborative community-led project. The use of high quality Ion Torrent sequences with long Nanopore reads gave rapid, high contiguity and quality, 16 contig genome sequence. Whole genome phylogenetic analysis places P. baetica within the Pseudomonas koreensis clade of the Pseudomonas fluorescens group. Comparison of the main genomic features of P. baetica with a variety of other Pseudomonas spp. suggests that it is a highly adaptable organism, typical of the genus. This strain was originally isolated from the liver of a diseased wedge sole fish and genotypic and phenotypic analyses show that it is tolerant to osmotic stress and to oxytetracycline.

Earthworms are associated with subpopulations of Gammaproteobacteria irrespective of the total soil microbiota composition and stability

Abstract

Soil represents one of the most complex microbial ecosystems on earth. It is well-known that invertebrates such as earthworms have a major impact on transformations of organic material in soil, while their effect on the soil microbiota remains largely unknown. The aim of our work was therefore to investigate the association of earthworms with temporal stability, composition and diversity in two soil microbiota experimental series. We found that earthworms were consistently associated with an increase in subgroups of Gammaproteobacteria, despite major differences in microbiota composition and temporal stability across the experimental series. Our results therefore suggest that earthworms can affect subpopulation dynamics in the soil microbiota, irrespective of the total microbiota composition. If the soil microbiota is comprised of independent microbiota components, this can contribute to our general understanding of the complexity of the soil microbiota.

Trends in phototherapy utilization among Medicare beneficiaries in the United States, 2000-2015

Phototherapy is a cost-effective treatment for many dermatoses, yet emerging alternative therapies such as biologics led many to think that phototherapy utilization was declining.

Factors Associated with Advanced Stage Merkel Cell Carcinoma at Initial Diagnosis and the Use of Radiation Therapy: Results from the National Cancer Database

The stage of disease at initial diagnosis and the use of radiation therapy (RT) are important determinants of survival in patients with Merkel cell carcinoma (MCC).

How data can deliver for dermatology

Epidermal barrier and oxidative stress parameters improve during in 311 nm narrow band UVB phototherapy of plaque type psoriasis

Psoriasis is a multi-systemic inflammatory disease that results from dysregulation between epidermal keratinocyte homeostasis and both innate and acquired immunity. Epidermal barrier defect has been described in psoriatic lesions. Furthermore an imbalance between pro-oxidative stress and antioxidant defense mechanisms are known in psoriasis patients.

In-frame Val216-Ser217 deletion of KIT in mild piebaldism causes aberrant secretion and SCF response

Piebaldism (OMIM #172800) is a rare hereditary disease of melanocyte development and is histologically characterized by the absence of melanocytes in the affected skin and hair [1,2]. A white forelock of hair, often triangular in shape, is unique and may be the only manifestation in 80%–90% of cases. Irregularly shaped white patches may be observed in the face, trunk and extremities mostly in a symmetrical distribution. Based on the depigmented patches, piebaldism is classified into three phenotypes: mild, moderate and severe forms.

From Hostility to Hospitality: Teaching About Race and Privilege in a Post-election Climate

Abstract

Now more than ever the role of the other has been put into question and marginalized in a redefinition of an "American national self-protective identity" in the current post election climate. In philosophical terms, an identity of a radical other- implies that any change, any difference, any impurity can be conceived as posing a threat to identity. If a specific group of people is identified as preventing the self from being what it ought to be, the other is identified as a security threat. One option is to willingly conform to the assigned role as a threat. The opposite option I argue in my paper is one that can be achieved through the lens of a cosmopolitan framework of hospitality. By exploring the writings of French philosopher, feminist and psychoanalyst Luce Irigary's cosmopolitan pedagogy of difference rooted in the concept of hospitality from the point of view of education, I hope put forth an alternative phenomenological pedagogy, one that connects issues of positionality with those of an embodied anti-racist philosophy of difference. By using case studies from my own classroom, I hope to elucidate how educators can implement an anti-racist pedagogy in the current post election climate, by creating spaces for dialogue where students are engaging in an authentic discourse on the nature of their positionality.

Adaption and use of a quadcopter for targeted sampling of gaseous mercury in the atmosphere

Abstract

We modified a popular and inexpensive quadcopter to collect gaseous mercury (Hg) on gold-coated quartz cartridges, and analyzed the traps using cold vapor atomic fluorescence spectrometry. Flight times averaged 16 min, limited by battery life, and yielded > 5 pg of Hg, well above the limit of detection (< 0.2 pg). We measured progressively higher concentrations upon both vertical and lateral approaches to a dish containing elemental Hg, demonstrating that the method can detect Hg emissions from a point source. Using the quadcopter, we measured atmospheric Hg near anthropogenic emission sources in the mid-south USA, including a municipal landfill, coal-fired power plant (CFPP), and a petroleum refinery. Average concentrations (± standard deviation) immediately downwind of the landfill were higher at ground level and 30 m compared to 60 and 120 m (5.3 ± 0.5 ng m⁻³, 5.4 ± 0.7 ng m⁻³, 4.2 ± 0.7 ng m⁻³, and 2.5 ± 0.3 ng m⁻³, respectively). Concentrations were also higher at an urban/industrial area (Memphis) (3.3 ± 0.9 ng m⁻³) compared with a rural/background area (1.5 ± 0.2 ng m⁻³). Due to airspace flight restrictions near the CFPP and refinery, we were unable to access near-field (stack) plumes and did not observe differences between upwind and downwind locations. Overall, this study demonstrates that highly maneuverable multicopters can be used to probe Hg concentrations aloft, which may be particularly useful for evaluating Hg emissions from remote landscapes and transient sources that are inadequately characterized and leading to uncertainties in ecosystem budgets.

Effect of Cu(II) on the stability of oxyanion-substituted schwertmannite

Abstract

Schwertmannite, a Fe(III)-oxyhydroxysulfate mineral formed in acidic (pH 3~4), iron- and sulfate-rich acid mine drainage (AMD) environments, tends to undergo phase transformations with changes in pH and redox condition, which may depend on the presence of various trace anions and cations. In the present study, the effects of Cu(II) on the stability of arsenate-, chromate-, and molybdate-substituted schwertmannite were investigated. The release of Fe(III) and sulfate from schwertmannite seems to be accelerated in the presence of Cu(II) at pH ~ 3, while Cu(II) retarded the dissolution of schwertmannite at pH ~ 5. XRD and SEM results showed that pure schwertmannite and chromate-substituted schwertmannite underwent transformation to goethite over a 2-month period, the presence of Cu(II) enhanced the stability of the mineral's structure at both pH 3 and 5. However, the structures of arsenate- and molybdate-substituted schwertmannites showed no significant changes in the presence or absence of Cu(II) at both pH 3 and 5. During the phase transformation process, the amount of released oxyanions followed the sequence of chromate > molybdate > arsenate. Moreover, the release of arsenate and chromate from schwertmannite was retarded in the presence of Cu(II) at pH 5, whereas the release of molybdate was promoted. These results have important environmental implications for the stability of schwertmannite and its potential to immobilize contaminant trace elements under AMD conditions.

Environmental and human health issues related to pesticides: from usage and environmental fate to impact

Performance modeling and valuation of snow-covered PV systems: examination of a simplified approach to decrease forecasting error

Abstract

The advent of modern solar energy technologies can improve the costs of energy consumption on a global, national, and regional level, ultimately spanning stakeholders from governmental entities to utility companies, corporations, and residential homeowners. For those stakeholders experiencing the four seasons, accurately accounting for snow-related energy losses is important for effectively predicting photovoltaic performance energy generation and valuation. This paper provides an examination of a new, simplified approach to decrease snow-related forecasting error, in comparison to current solar energy performance models. A new method is proposed to allow model designers, and ultimately users, the opportunity to better understand the return on investment for solar energy systems located in snowy environments. The new method is validated using two different sets of solar energy systems located near Green Bay, WI, USA: a 3.0-kW micro inverter system and a 13.2-kW central inverter system. Both systems were unobstructed, facing south, and set at a tilt of 26.56°. Data were collected beginning in May 2014 (micro inverter system) and October 2014 (central inverter system), through January 2018. In comparison to reference industry standard solar energy prediction applications (PVWatts and PVsyst), the new method results in lower mean absolute percent errors per kilowatt hour of 0.039 and 0.055%, respectively, for the micro inverter system and central inverter system. The statistical analysis provides support for incorporating this new method into freely available, online, up-to-date prediction applications, such as PVWatts and PVsyst.

Catalytic decomposition of PCDD/Fs on a V 2 O 5 -WO 3 /nano-TiO 2 catalyst: effect of NaCl

Abstract

The effect of NaCl addition on the properties, activity, and deactivation of a V₂O₅-WO₃/nano-TiO₂ catalyst was investigated during catalytic decomposition of gas-phase polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/Fs). The extent of deactivation relates directly to the NaCl loading of the catalyst. Poisoning by sodium neutralizes acid sites, interacts strongly with active VO_x species, and reduces the redox capacity of catalysts. In addition, NaCl is also a chlorine source and may actually accelerate the synthesis of new PCDD/Fs. Washing a catalyst with dilute sulfuric acid largely restores catalytic activity, breaking the interaction of Na⁺ ions and dispersed vanadia and removing Na from the catalyst surface. Consequently, catalyst acidity and redox capacity almost recover. Furthermore, sulfate residues react with surface adsorbed water to generate Brønsted acid sites, ensuing a surge of strong acidity of the catalysts.

Gender and Ageing at Work in Chile: Employment, Working Conditions, Work–Life Balance and Health of Men and Women in an Ageing Workforce

Abstract

Objectives

In Chile, working after retirement age has grown substantially over the last years. This, in addition to the country's current discussion about extending retirement age, motivates the need of generating evidence on the occupational health and safety of the working old, with a special focus on women, who are critically disadvantaged in Chile's labour market. The objective of this paper is to describe and compare the ageing workforce of women and men in Chile in terms of labour market participation, employment and working conditions, work–life balance, and health. The social determinants of health and employment sustainability frameworks guide this study.

Data Sources

Cross-sectional data from three publicly available sources: the Chilean Labour Force Survey, NENE (2010); the first Chilean Employment and working conditions survey, ENETS (2009–2010) and the second National Health Survey, ENS (2009).

Methods

Participation rates and employment conditions (NENE and ENETS), working conditions, occupational health and work–life balance (ENETS) and chronic health conditions (ENS) were described by 5-year age groups separately for women and men. Descriptions cover all age groups in order to identify trends and patterns characteristic of older workers.

Results

Rates of occupation decrease sharply after age 54 in women and 59 in men. Ageing women and men who continue to work are more likely to be in own-account (self-employed) work than younger workers; in the case of women, in households as domestic workers, and men, in agriculture. Social protection and workplace rights are markedly reduced in older workers. Part-time work increases from the age of 50 onwards, especially among women, but average working hours do not decrease under 30 h a week for either women or men. Interestingly, between ages 60 and 64, there is a peak increase of day and night shift-work among women, which co-occurs with a peak in domestic work, possibly corresponding to women working as caretakers of elderly people. Several workplace risks continue to be high into old age: intensive work and demanding physical work, especially in men, and the combination of paid and unpaid care work in women, which continues to be high up to the age of 70 years. The health of older workers is better than that of non-working people of the same age, a gap which is markedly larger for women than men and tends to increase among women as they age.

Conclusion

Results indicate that Chileans working into old age face precarious jobs with limited protection and several adverse working conditions. Noteworthy, women carry the double burden of paid and unpaid work into their late years. In addition, results suggest they are affected more profoundly by the healthy worker effect whereby the health condition determines the probability of finding and keeping a job—also known as a health selection mechanism—which increases as they age. These employment and working conditions indicate that working into old age is not yet sustainable in Chile and counts as evidence that needs to be taken into account in discussions about delaying the retirement age in the country, as well as incorporating support systems to alleviate the double work burden of ageing working women.