Σάββατο 24 Μαρτίου 2018
Praxiswebsites oft juristisch angreifbar
Die meisten Praxiswebsites erfüllen nicht die gesetzlichen Anforderungen. Das lassen zumindest die Ergebnisse einer aktuellen Studie vermuten, in der 400 Homepages von Ärzten untersucht wurden. Sie zeigt, wo am häufigsten Fehler passieren.
Plattenepithelkarzinom: Fluorouracil als Prophylaxe
Forscher aus den USA sind der Frage nachgegangen, ob eine topische Fluorouracil-Behandlung Hochrisikopatienten vor weiteren Basalzell- oder Plattenepithelkarzinomen der Haut schützen kann.
Dornwarzen: Needling nicht besser als Kürettage
Was Needling bei Plantarwarzen bringt, hat ein Team aus Großbritannien in einer randomisierten Studie untersucht.
Melanom: Erfolg moderner Therapien trotz Hirnmetastasen
Ein Team aus internationalen Onkoligen untersuchte in einer retrospektiven Kohortenstudien das Risiko für Hirnmetastasen und die Überlebendauer nach Beginn der systemischen Therapie bei Melanompatienten im nicht resezierbaren AJCC-Stadium (American Joint Committee on Cancer) III/IV.
Besenreiser: Vorteile durch Polidocanol in 70%iger Glukoselösung
Die Sklerotherapie setzt zum Veröden kleinkalibriger Varizen unterschiedliche Substanzen ein. Dermatologen aus Brasilien verglichen die Wirksamkeit des nicht ionischen Detergens Polidocanol (Lauromacrogol) in Glukoselösung und der hypertonen Lösung allein.
Psoriasis: Höheres Suizidrisiko unter Brodalumab?
Psoriasispatienten sind im Vergleich zur Allgemeinbevölkerung stärker suizidgefährdet. Ist das die Erklärung für die während der Entwicklungsphase des monoklonalen Antikörpers Brodalumab beobachteten Selbsttötungen?
Stelarc: Zwischen Biologie und Technik
Im Jahr 1984 demonstrierte der Film Terminator das ungeheure Faszinationspotenzial des Cyborg, des Mensch-Maschine-Hybriden. Längst wird aus Science-Fiction Wirklichkeit. Der Medien- und Performance-Künstler Stelarc nutzt Robotik, Prothetik und Virtual-Reality-Systeme, um die Beziehung zwischen Körper und Technologie neu zu konfigurieren.
Melanom: Welche Folgen hat ein Immuntherapieabbruch?
Etwa 40 % der Melanompatienten brechen eine Kombinationstherapie mit den Checkpointhemmern Ipilimumab und Nivolumab aufgrund der Nebenwirkungen ab. Wie sicher ist ein solcher Immuntherapieabbruch?
Molekulare Schnelldiagnose beschleunigt Therapie von metastasierten Melanomen
„New generation sequencing" und mutationsspezifische Immunhistochemie sind in der Diagnostik von BRAF- und NRAS-Mutationen metastasierter Melanome durchaus hilfreich. Doch bis ein Ergebnis vorliegt, kann es dauern. Es geht aber auch schneller.
Viele Muttermale im Kindesalter — Hautkrebsrisiko erhöht?
Gibt es einen Zusammenhang zwischen der Anzahl von Muttermalen und dem Risiko später gehäuft (atypische) Nävi zu entwickeln? Dieser Frage gingen Forscher aus den USA in einer prospektiven Longitudinalstudie nach.
Chronische Urtikaria bei Kindern: Marker für die Krankheitsdauer entdeckt
Eine chronische Urtikaria bei Kindern ist sehr hartnäckig. In einer kanadischen Studie zeigte sich, dass zwei Biomarker Anhaltspunkte für die voraussichtliche Dauer der Plage mit den juckenden Quaddeln liefern können.
Offenheit zwischen Arzt und Patient hilft weiter
Das Internet macht die Beziehung zwischen Arzt und Patient kompliziert. Das Problem: Der Arzt weiß nicht, wie gut sein Patient über das Netz informiert ist. Und der Patient fürchtet oft, der Arzt könnte seine Recherchen missbilligen. Eine Studie hat versucht, Licht ins Dunkel zu bringen.
Effect of the masseter muscle injection of botulinum toxin A on the mandibular bone growth of developmental rats
Abstract
Background
The objective of this study was to evaluate the influence of masticatory muscle injection of botulinum toxin type A (BTX-A) on the growth of the mandibular bone in vivo.
Methods
Eleven Sprague-Dawley rats were used, and BTX-A (n = 6) or saline (n = 5) was injected at 13 days of age. All injections were given to the right masseter muscle, and the BTX-A dose was 0.5 units. All of the rats were euthanized at 60 days of age. The skulls of the rats were separated and fixed with 10% formalin for micro-computed tomography (micro-CT) analysis.
Results
The anthropometric analysis found that the ramus heights and bigonial widths of the BTX-A-injected group were significantly smaller than those of the saline-injected group (P < 0.05), and the mandibular plane angle of the BTX-A-injected group was significantly greater than in the saline-injected group (P < 0.001). In the BTX-A-injected group, the ramus heights II and III and the mandibular plane angles I and II showed significant differences between the injected and non-injected sides (P < 0.05). The BTX-A-injected side of the mandible in the masseter group showed significantly lower mandibular bone growth compared with the non-injected side.
Conclusion
BTX-A injection into the masseter muscle influences mandibular bone growth.
Drug Treatment for Androgenetic Alopecia: First Italian Questionnaire Survey on What Dermatologists Think about Finasteride
Abstract
Introduction
Treatment with finasteride 1 mg/day represents the therapy of choice for androgenetic alopecia (AGA). We investigated how Italian dermatologists approach use of finasteride for treatment of AGA and common side effects reported by patients.
Methods
A tablet-based survey was conducted from February 2017 to January 2018 in Italy to investigating use of 1 mg/day finasteride in the treatment of AGA. Approximately 1153 Italian dermatologists were surveyed about prescription frequency, therapy duration, treatment practices, and side effects eventually reported.
Results
Dermatologists considered treatment with 1 mg/day finasteride to be the most efficacious treatment for AGA, as reflecting by its long-term (5 years) prescription. Data on sexual side effects from our survey are in line with previous scientific evidence, especially regarding loss of libido, erectile dysfunction, and problems with ejaculation, but also in the psychological sphere and regarding physical impairments such as myalgia and loss of muscle tone.
Conclusions
This is the first preliminary observational study on how Italian dermatologists approach use of finasteride to treat AGA. Although side effects have been reported, especially in the sexual sphere, lack of alternative treatments with the same efficacy leads dermatologists to prescribe 1 mg/day finasteride with a tendency to prolong therapy in the long term.
Funding
Giuliani S.p.A.
Crystallization of microporous TiO 2 through photochemical deposition of Pt for photocatalytic degradation of volatile organic compounds
Abstract
The photocatalytic mineralization efficiency of volatile organic compounds (VOCs) is determined by adsorption of reactants, separation of charge carriers, and reaction activity of catalyst surface. Herein, we provide a strategy to synthesize a novel catalyst, namely, PhPt-Micro, which is characterized by high adsorption ability, charge separation efficiency, and surface reaction activity. Toluene was chosen as the model VOC. The effects of photochemical deposition of Pt on the physical properties of microporous amorphous TiO2 (Micro) and toluene mineralization were studied using N2 adsorption/desorption, transmission electron microscopy, X-ray diffraction, X-ray photoelectron spectroscopy, GC-flame ionization detection, and surface photovoltage spectroscopy (SPS) analyses. After photochemical treatment, the structure of Micro was optimized, and Pt nanoparticles were successfully deposited at the outlet of electrons on the catalyst surface. SPS result proved that the optimized structure enhanced the separation efficiency of charge carriers and the migration of photo-generated electrons to the PhPt-Micro surface. The quasi-equilibrium adsorption amount of toluene over PhPt-Micro was two times higher than that with commercial nano TiO2 (P25). The micropores concentrated toluene on the catalyst surface and hindered intermediate desorption. The mineralization efficiency of toluene over PhPt-Micro was 2.4 and 5.9 times higher than those over Micro and P25, respectively.
Environmental asbestos exposure and mesothelioma cases in Bari, Apulia region, southern Italy: a national interest site for land reclamation
Abstract
Asbestos is an environmental carcinogen, and asbestos-related diseases are a global-scale public health issue. We report three cases (one male and two females) of pleural malignant mesothelioma (PMM) caused by environmental asbestos exposure reported by the Apulia Regional Operating Centre (COR) to the National Mesothelioma Registry (ReNaM). The patients revealed no history of asbestos exposure even after detailed assessment. The environmental (neighborhood) asbestos exposure for each of the three cases was due to both the residential history of the subjects and their workplace, close to a military barracks, at a distance of between 45 and 100 m. Moreover, in addition to this new source of pollution, an asbestos cement factory was located in the urban area of Bari municipality, in the Apulia region, southern Italy. Environmental-residential/neighborhood asbestos exposure in the city of Bari, a contaminated area classified as a site of national concern for land reclamation, is discussed also with reference to the military barracks.
Effects of monoterpenes on mortality, growth, fecundity, and ovarian development of Bactrocera zonata (Saunders) (Diptera: Tephritidae)
Abstract
The peach fruit fly (PFF), Bactrocera zonata, is a serious insect pest infesting fruits and vegetables. The insecticidal activity of three monoterpenes, namely, (R)-camphor, (R)-carvone, and (1R,2S,5R)-menthol, was evaluated on the second-instar larvae of B. zonata. In addition, the latent effects of monoterpenes on pupation, adult emergence, deformation, oviposition, adult longevity, and ovarian development were also examined. The three tested monoterpenes showed pronounced insecticidal activity against B. zonata larvae with (R)-carvone being the most potent toxicant. When the second-instar larvae of B. zonata were treated with monoterpenes at concentrations of 20, 50, and 70 mg/kg for 72 h, significant reduction in pupation and adult emergence was observed. The three monoterpenes caused complete suppression of adult emergence at 100 mg/kg. Moreover, monoterpenes induced complete inhibition of egg deposition at all tested concentrations. Some adult deformations were also noticed at 20, 50, and 70 mg/kg. However, (R)-carvone was more effective than (1R,2S,5R)-menthol and (R)-camphor on the examined biological parameters. On the other hand, histological examination of the ovaries of emerged females from larvae that fed on diet treated with (R)-carvone, (1R,2S,5R)-menthol, and (R)-camphor at 20 and 50 mg/L indicated that both concentrations caused retardation in the development of ovarioles. It is clear that all the egg chambers are empty; the germarium region is constricted at base due to the failure of oocyte formation. Many vacant spaces were present between ovarioles.
Characteristics of arsenic in humic substances extracted from natural organic sediments
Abstract
The stability and dispersion of naturally occurring As have been receiving increasing attention, because As is toxic and its contamination is a widespread problem in many countries. This study investigated As fractionation and speciation in organic sediments collected from different depositional settings to elucidate the existence of stable As in humic substances. Eleven organic sediment samples were collected from marine and terrestrial alluvial regions in Hokkaido prefecture, Japan, and the chemical fraction of As and species of humic substances were identified by sequential extraction. In addition, stable As bound in organic matter was evaluated by FT-IR spectroscopy. The As fraction mainly comprised inorganic substances, especially sulfur, iron, and manganese, and terrestrial sediments (lacustrine and inland deposits) were rich in sulfides and Fe and Al (hydr)oxides. When the residual fraction was excluded, the organic fraction of As was higher in seawater sediments than in terrestrial sediments. Among humic substances, cellulose, humic acid, and hydrophilic fulvic acid were clearly associated with As accumulation, and As speciation showed that the As was of organic origin. Cellulose, an organic compound of plant origin, was abundant in As=S and As (III)=O bonds, and As accumulation was higher in sulfur-rich peat sediments, corresponding with the physiological activities of As in plants. Hydrophilic fulvic acid and humic acid in these sediments, originating from small animals and microorganisms in addition to plants, denote higher As contents and abound in As (III, V)=C and C–H, CH3 bonds even in sulfur-rich sediments. The methylated As bonds reflect the ecological transition of organisms.
Aqueous multivariate phototransformation kinetics of dissociated tetracycline: implications for the photochemical fate in surface waters
Abstract
Antibiotics are ubiquitous pollutants in aquatic systems and can exist as different dissociated species depending on the water pH. New knowledge of their multivariate photochemical behavior (i.e., the photobehavior of different ionized forms) is needed to improve our understanding on the fate and possible remediation of these pharmaceuticals in surface and waste waters. In this study, the photochemical degradation of aqueous tetracycline (TC) and its dissociated forms (TCH20, TCH−, and TC2−) was investigated. Simulated sunlight experiments and matrix calculations indicated that the three dissociated species had dissimilar photolytic kinetics and photooxidation reactivities. TC2− photodegraded the fastest due to apparent photolysis with a kinetic constant of 0.938 ± 0.021 min−1, followed by TCH− (0.020 ± 0.005 min−1) and TCH20 (0.012 ± 0.001 min−1), whereas TCH− was found to be the most highly reactive toward •OH (105.78 ± 3.40 M−1 s−1), and TC2− reacted the fastest with 1O2 (344.96 ± 45.07 M−1 s−1). Water with relatively high pH (e.g., ~ 8–9) favors the dissociated forms of TCH− and TC2− which are most susceptible to photochemical loss processes compared to neutral TC. The calculated corresponding environmental half-lives (t1/2,E) in sunlit surface waters ranged from 0.05 h for pH = 9 in midsummer to 3.68 h for pH = 6 in midwinter at 45° N latitude. The process was dominated by apparent photolysis (especially in summer, 62–91%), followed by 1O2 and •OH oxidation. Adjusting the pH to slightly alkaline conditions prior to UV or solar UV light treatment may be an effective way of enhancing the photochemical removal of TC from contaminated water.
Graphical abstract
Aqueous multiple photochemical behavior of dissociated tetracycline (TCH20, TCH−, and TC2−) is first comprehensively reported on revealing the phototransformation kinetics and implications for the fate in surface waters.
Fine particulate matter (PM 2.5 ) in a compost facility: heavy metal contaminations and health risk assessment, Tehran, Iran
Abstract
The aim of this study was to evaluate the concentration of PM2.5 particles, potential sources, and determination of health risk assessment of heavy metals in various parts of composting facilities of Tehran's Kahrizak. A total of 60 PM2.5 particle samples were collected every 3 days from January to March 2016. To analyze the heavy metals, inductively coupled plasma atomic emission spectroscopy (ICP-AES) was applied. SEM-EDX analysis indicated that metals of Al, Si, Mg, Na, Au, S, Ca, K, and Co were dominant in the structure of particles. The concentration of PM2.5 was found to be the highest in the final processing site (c), followed by primary processing site (a) and the aerated site (b). The mean concentrations of Al and Fe in all sampling sites of a, b, and c were 7.46 ± 2.73, 1.48 ± 0.59, 24.30 ± 8.23 μg/m3 and 4.97 ± 2.83, 1.33 ± 0.48, 16.48 ± 7.36, respectively. The enrichment factor order of the trace elements was as follows: Cd > As > Pb > Zn > Cu > V > Cr > Ni > Mn > Fe > Al, with the highest EF value exceeding 10,000 for Cd at the a site. For all sampling sites in composting facilities, the cancer risk was more than > 1 × 10−4 as posed by the total of five carcinogenic metals (Pb, Cr, As, Ni, and Cd), indicating that risk factors were not negligible.
Enhanced effect of EDDS and hydroxylamine on Fe(II)-catalyzed SPC system for trichloroethylene degradation
Abstract
This study presents a performance comparison of Fe(II)-catalyzed sodium percarbonate (SPC), Fe(II)-EDDS-catalyzed SPC, and of the innovative hydroxylamine hydrochloride (HA)-Fe(II)-EDDS-catalyzed SPC for the degradation of trichloroethylene (TCE) in water. TCE degradation was greater in the Fe(II)-EDDS-catalyzed SPC system compared to the Fe(II)-catalyzed SPC system, indicating the effectiveness of adding EDDS as an enhancement factor for the removal of TCE. Moreover, TCE degradation was faster in the HA-Fe(II)-EDDS-catalyzed SPC system compared to the Fe(II)-EDDS-catalyzed SPC system, illustrating that HA can play a synergistic role in TCE degradation. Analysis of iron distribution in the three systems demonstrated that EDDS addition maintained iron in soluble form, and that the generation of soluble ferrous from ferric iron was expedited with addition of HA. Studies using nitrobenzene and carbon tetrachloride probes provided insights on the generation of hydroxyl radical (HO•) and superoxide anion radical (O2•−) in the three systems. A gradual increasing contribution of O2•− to TCE removal in Fe(II)-catalyzed SPC, Fe(II)-EDDS-catalyzed SPC, and HA-Fe(II)-EDDS-catalyzed SPC systems was verified through free-radical scavenger tests. Finally, monitoring of Cl− concentrations manifested the complete dechlorination of TCE. A possible mechanism of TCE degradation involving two pathways of HO• oxidation and O2•− reaction was proposed.
Suitable flow pattern increases the removal efficiency of nitrogen in gravity sewers: a suitable anoxic and aerobic environment in biofilms
Abstract
The sewers have the function of carbon removal, which has been proven. But if the effect of nitrogen removal can be enhanced at the same time of carbon removal, it can lay a foundation for the realization of "sewer's working as a reactor." This paper investigated the effects of shear stress and C/N ratio on nitrogen removal through biofilms on the sewer inner wall and nitrogen transfer. The main conclusions are as follows: (1) nitrogen could be partially removed in sewers after a series of reactions; (2) the anaerobic, anoxic, aerobic environment and some bacteria related to nitrogen metabolism, which exist in the biofilm, promote the nitrification and denitrification; (3) a total of 722 functional genes involved in nitrogen metabolism were detected in the biofilm (C/N ratio of 10, shear stress of 1.4 Pa), accounting for 0.67% of all genes, and the functional genes related to denitrification were dominant.
Graphical abstract
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Aliphatic and aromatic biomarkers for fingerprinting of weathered chemically dispersed oil
Abstract
This study evaluated the applicability of eight types of biomarkers namely, adamantanes, diamantanes, sesquiterpanes, steranes, terpanes, TA-steranes, MA-steranes, and alkylated PAHs, to characterize chemically dispersed oil (CDO) after the 60-day weathering. The stability of diagnostic ratios of the selected biomarkers was evaluated and summarized. The results indicated that the concentrations of biomarkers with low molecular weight, such as adamantanes, diamantanes, and sesquiterpanes, in CDO were markedly affected by weathering and the associated diagnostic ratios were changed extensively. Most of the alkylated PAHs were degraded during weathering as well. These biomarkers thus were not recommended for characterizing CDO. The majority of the terpanes, steranes, TA-steranes, and MA-steranes could be used for weathered CDO fingerprinting due to the relatively stable diagnostic ratios. The findings could help to identify applicable biomarkers for fingerprinting of weathered dispersed oil.
Colon Cancer Screening Programs: Impact of an Organized Screening Strategy Assessed by the EDIFICE Surveys
Abstract
Background
The aim of EDIFICE surveys is to improve insight into the behavior of the French population with regard to cancer prevention and participation in screening programs. Via the colorectal cancer screening program, all average-risk individuals in the 50–74-year age group are invited every 2 years to do a guaiac-based or, since April 2015, an immunochemical fecal occult blood test.
Methods
The fifth edition of the nationwide observational survey was conducted by phone interviews using the quota method. A representative sample of 1299 individuals with no history of cancer (age, 50–74 years) was interviewed between 22 November and 7 December 2016. The present analysis focuses on minimum lifetime uptake of screening tests, compliance to recommended repeat-screening intervals, and reasons for non-participation.
Results
In 2016, 64% survey participants had been screened at least once and 38% had been screened in the previous 2 years, suggesting a trend towards increasing participation rates, particularly in the younger age categories and among men. The 2016 data also suggest that the newly implemented FIT-based screening program has been well perceived by the population. Up to one in four individuals cited "no risk factors" as the reason for not undergoing screening. This reveals ignorance of the fact that the colorectal cancer screening program actually targets all average-risk individuals in a given age group, without individual risk factors.
Conclusion
We suggest the next step should be dedicated to educational approaches to explain exactly what screening involves and to persuasive messages targeting those who to date have remained unreceptive to information campaigns.
Systemic Treatment Options for Advanced-Stage Mycosis Fungoides and Sézary Syndrome
Abstract
Purpose of Review
Cutaneous T-cell lymphoma (CTCL) is a rare form of non-Hodgkin lymphoma. Globally, the most common subtypes of CTCL are mycosis fungoides and Sézary syndrome. CTCL can confer significant morbidity and even mortality in advanced disease. Here we review the current and potential future treatments for advanced-stage CTCL.
Recent findings
Heterogeneity of treatment choice has been demonstrated both in US and non-US centers. Systemic treatment choice is currently guided by prognostic features, incorporating stage, immunophenotypic and molecular findings, and patient-specific factors such as age and comorbidities. Randomized controlled studies are uncommon, and the literature is composed predominantly of retrospective, cohort, and early-phase studies. International consensus guidelines are available; however, the lack of comparative trials means that there is no clear algorithmic approach to treatment.
Summary
This review article reports on the systemic treatment options in current use for advanced CTCL, and on the possible future therapies, acknowledging that an algorithmic approach is not yet forthcoming to guide treatment prioritization.
Electronic Health Information Exchange Opportunities for Self-management of Care: Responses from Older Adults With and Without Cancer History in the United States
Abstract
Purpose of Study
Of 15.5 million US cancer survivors, 80% are ≥ 55 years. Supporting older patients in care self-management through electronic health information (EHI) exchange may enhance recovery. We assessed: (1) perceived importance of EHI access to adults ≥ 55 years (incl survivors) and (2) age-related preferences for EHI exchange.
Recent Findings
Older adults are one of the fastest-growing user groups for internet/technologies. Most older adults 55–64 years are active internet users, and use among adults ≥ 65 years is growing quickly as baby boomers mature. Understanding EHI patient-provider exchange preferences may provide opportunities for older patients but also begin to address the future needs of other patient populations, including cancer survivors.
Summary
We observed a "digital divide" for perceived importance of EHI access and EHI exchange interests. Engaging older adults (i.e., ≥ 75 years) to improve comfort/experience with technologies may support EHI use in self-management. Survivors may have distinct EHI needs/preferences than older adults without cancer history.
Mucosal Melanoma: a Literature Review
Abstract
Purpose of review
Mucosal melanoma is of great interest due to its aggressive behavior and less favorable prognosis. The literature is mainly case reports and case series. Here, we will collect the knowledge on mucosal melanoma from the last decade and review the literature. The main focus is being site-specific clinical features, treatment, and prognosis.
Recent findings
The use of immunotherapy gain ground as for others subsets of melanoma. Anti-CTLA-4 and anti-PD-1/ PD-L1 blockade in mucosal melanoma have been evaluated in recent studies. Clinical trials are ongoing.
Summary
The etiology of mucosal melanomas remains unknown. Head and neck mucosal melanomas are most common. Wide excision surgery is the treatment of choice. The effect of adjuvant therapy on survival remains questionable due to the limited knowledge. Radiotherapy seems to give better local control. The overall five-year survival rate for mucosal melanomas is 0–45%. Recent data indicates that this may be improved by the immunotherapy in the years to come.
Integrated Behavioral Medicine in Cancer Care: Utilizing a Training Program Model to Provide Psychological Services in an Urban Cancer Center
Abstract
Psycho-oncology has come of age as its own unique subspecialty under the umbrella of oncology, vastly refining our knowledge regarding the psychosocial impact of cancer and fostering acceptance of the psychological underpinnings of the cancer experience, in turn improving the overall quality of cancer care. The importance of integrating psychological practice into the comprehensive treatment of cancer has become readily apparent, and psychosocial support services are increasing in quantity and breadth. It is the aim of this article to present a cogent argument for the proliferation of Integrated Behavioral Medicine (IBM) programs in both inpatient and outpatient clinical cancer treatment centers via an in-depth discussion of a successful IBM program including analysis of program structure, service delivery model and description of clinical services provided, and a longitudinal review of referral trends.
Melanoma and Immune Checkpoint Inhibitors
Abstract
Purpose of Review
Prognosis of patients with advanced melanoma is dismal with a median overall survival of about 8 months and 5-year overall survival from a diagnosis of metastatic disease of roughly 10%. However, immune checkpoint inhibitors have brought indispensable benefits to melanoma patients. Here we will review the recent clinical efficacy and adverse events of immune checkpoint inhibitors for melanoma patients.
Recent Findings
The immune checkpoint inhibitors increase confirmed objective response and prolong progression-free and overall survival of the afflicted patients in association with maintaining their quality of life. Although diverse immune-related adverse events occur, most of them are manageable by appropriate immunomodulating agents. Clinical efficacy of immune checkpoint inhibitors continues even after discontinuation of drugs.
Summary
Compared with conventional therapeutic options, the immune checkpoint inhibitors appear to prolong the survival of patients with advanced melanoma. Further clinical trials are warranted to determine whether their combinatory use with other treatment options may augment benefits or not.
Development and Application of Liquid Biopsies in Metastatic Prostate Cancer
Abstract
Purpose of Review
Metastatic prostate cancer is a lethal and highly heterogeneous malignancy, associated with a broad spectrum of potentially actionable molecular alterations. In the past decade, disease profiling has expanded to include not only traditional tumor tissue, but also liquid biopsies of cells and genetic material circulating in the blood. These liquid biopsies offer a minimally invasive, repeatable source of tumor material for longitudinal disease profiling but also raise new technical and biological challenges. Here we will summarize recent advances in liquid biopsy strategies and the role they have played in biomarker development and disease management.
Recent Findings
Technologies for analysis of circulating tumor cells (CTCs) continue to evolve rapidly, and the latest high content scanning platforms have underscored the phenotypic heterogeneity of CTC populations. Among liquid biopsies, CTC enumeration remains the most extensively validated prognostic marker to date, but other clinically relevant phenotypes like androgen receptor (AR) localization or presence of AR-V7 splice variant are important new predictors of therapy response. Serial genomic profiling of CTCs or circulating tumor DNA (ctDNA) is helping to define primary and acquired resistance mechanisms and helping to guide patient selection for targeted therapies such as poly(adenosine diphosphate [ADP] ribose) polymerase (PARP) inhibition.
Summary
The era of liquid biopsy-based biomarkers has arrived, driven by powerful new enrichment and analysis techniques. As new blood-based markers are identified, their biological significance as disease drivers must be elucidated to advance new therapeutic strategies, and their clinical impact must be translated through assay standardization, followed by analytical and clinical validation. These efforts, already ongoing on multiple fronts, constitute the critical steps toward more effective precision management of advanced prostate cancer.
How Do We Approach Benign Proliferative Lesions?
Abstract
Purpose of Review
The aim of this review is to summarize recently published literature addressing atypical ductal hyperplasia (ADH), lobular neoplasia (atypical lobular hyperplasia [ALH] and classic lobular carcinoma in situ [C-LCIS]), non-classic lobular carcinoma in situ (NC-LCIS), papillary lesions, and flat epithelial atypia (FEA).
Recent Findings
While ADH, ALN, and C-LCIS are well-established markers of an increased risk of future breast cancers, the risk implications are less clear for papillary lesions and FEA. NC-LCIS is the least well-characterized lesion, with scant published literature on its natural history and surgical management when encountered on needle biopsy.
Summary
Recent data suggest that lobular neoplasia on core biopsy of a BI-RADS ≤ 4 concordant lesion does not require an excision, while ADH, atypical papillomas, and NC-LCIS should be excised. Evidence on FEA and papillomas without atypia suggests a low risk of upgrade on excision, and prospective studies on the upgrade of these lesions are ongoing.
Marginal Zone Lymphoma: Clinicopathologic Variations and Approaches to Therapy
Abstract
Purpose of Review
The purpose of the study is to summarize the current conundrums in the management of marginal zone lymphomas (MZL).
Recent Findings
In 2017, the US Food and Drug Administration (FDA) approved ibrutinib, a first in class Bruton Tyrosine Kinase inhibitor, for the treatment of relapsed/refractory MZL based on pivotal open-label phase II trial demonstrating an overall response rates of 48%. Clinical trials design utilizing chemotherapy-free regimens for relapsed/refractory disease are gaining popularity. Recent studies have identified multiple genetic biomarkers that helped characterize and prognosticate different subtypes of MZL.
Summary
MZLs are heterogeneous, mostly indolent, malignancies derived from B lymphocytes. Three disease subtypes are recognized, extranodal, nodal, and splenic. The disease characteristics, clinical picture, and treatment algorithms vary considerably based on subtype and site of involvement. Recent discoveries have enhanced our knowledge of the pathogenesis of MZLs leading to development of more accurate prognostic models as well as novel targeted systemic therapies.
Exercise Training and Cardiovascular Health in Cancer Patients
Abstract
Purpose of Review
Cancer patients nearly universally experience a decline in quality of life, with fatigue and reduced exercise tolerance as cardinal reflections. A routine exercise program can improve these signs and symptoms as well as overall outcomes. The review provides an updated overview of the field and its translation to clinical practice.
Recent Findings
A wealth of clinical studies have documented the safety and benefits of exercise after and during cancer therapy, and pilot and larger-scale studies are currently ongoing to integrate exercise into the treatment program for cancer patients undergoing active therapy (EXACT pilot, OptiTrain, and TITAN study). More recently, efforts have emerged to commence exercise programs before the start of cancer therapy, so-called pre-habilitation. The concept of increasing the cardiovascular reserve beforehand is intuitively attractive. In agreement, preclinical studies support exercise as an effective preventive means before and during cardiotoxic drug exposure. Assuming that a pronounced drop in exercise tolerance will occur during cancer therapy, pre-habilitation can potentially curtail or raise the nadir level of exercise tolerance. Furthermore, such efforts might serve as pre-conditioning efforts in reducing not only the nadir, but even the magnitude of drop in cardiovascular reserve. Initiated beforehand, cancer patients are also more likely to continue these efforts during cancer therapy. Finally, an active exercise routine (≥ 150 min/week moderate intensity or ≥ 75 min/week vigorous intensity or combination) in conjunction with the other six American Heart Association's cardiovascular health metrics (BMI < 25 kg/m2, blood pressure < 120/80 mmHg, fasting plasma glucose < 100 mg/dL, total cholesterol < 200 mg/dL, 4–5 component healthy diet, no smoking) reduces not only the cardiovascular but also the cancer disease risk.
Summary
Exercise can reduce the risks of developing cancer, the detrimental effects of its treatment on the cardiovascular system, and overall morbidity and mortality. Exercise should become an integral part of the care for every cancer patient.
Electronic Assessment of Physical Decline in Geriatric Cancer Patients
Abstract
Purpose of Review
The purpose of this review is to explore state-of-the-art remote monitoring and emerging new sensing technologies for in-home physical assessment and their application/potential in cancer care. In addition, we discuss the main functional and non-functional requirements and research challenges of employing such technologies in real-world settings.
Recent Findings
With rapid growth in aging population, effective and efficient patient care has become an important topic. Advances in remote monitoring and in its forefront in-home physical assessment technologies play a fundamental role in reducing the cost and improving the quality of care by complementing the traditional in-clinic healthcare. However, there is a gap in medical research community regarding the applicability and potential outcomes of such systems.
Summary
While some studies reported positive outcomes using remote assessment technologies, such as web/smart phone-based self-reports and wearable sensors, the cancer research community is still lacking far behind. Thorough investigation of more advanced technologies in cancer care is warranted.
Current Information and Recommendations on the Discontinuation of TKI Inhibitors in Chronic Myeloid Leukemia
Abstract
Purpose of Review
Discontinuation of tyrosine kinase inhibitors (TKIs) in chronic phase chronic myeloid leukemia (CP-CML) patients has become a reality. Treatment-free remission (TFR) is the term that identifies success after discontinuation.
Recent Findings
Several trials have demonstrated that with imatinib about 40% of patients discontinuing treatment in deep and stable molecular response remain disease-free. Second-generation TKIs have improved the rate of deep molecular responses and allowed to increase the percentage of patients attempting treatment discontinuation.
Summary
We hereby review the current information based on the available published data and discuss the current suggestions on how to move TFR into the clinical practice.
Using Information Technology in the Assessment and Monitoring of Geriatric Oncology Patients
Abstract
Purpose of Review
Older adults with cancer have complex medical needs and often experience higher rates of treatment-related toxicities compared to their younger counterparts. The advent of health information technologies can address multiple gaps in the care of this population. We review the role of existing and emerging technologies in facilitating the use of comprehensive geriatric assessment (CGA) in routine clinics, promoting symptom reporting, and monitoring medication adherence.
Recent Findings
Increasingly, studies demonstrate the feasibility of implementing electronic CGA in routine oncology practices. Evidence also suggests that electronic symptom reporting can improve outcomes in patients with cancer. In addition, technology devices can be used to promote adherence to cancer therapy.
Summary
There are many opportunities for information technology to be integrated into the management and treatment of older adults with cancer. However, further evaluation of these technologies is needed to ensure that they meet the needs of the targeted end users.
Incidence and Management of Immune-Related Adverse Events in Patients Undergoing Treatment with Immune Checkpoint Inhibitors
Abstract
Purpose of Review
The unleashing of the immune system in an effort to fight cancer has proven to be an incredible advance in the war on cancer. However that breakthrough has come with a price in the form of serious and potentially fatal immune-related adverse events (irAEs).
Recent Findings
Rapid recognition and early intervention is imperative to avoid significant morbidity and mortality. Additionally, providers need to be aware that there are still new, rare, and long-term emerging irAEs that were not previously reported in clinical trials.
Summary
Because of the significant difference between irAEs and those caused by chemotherapy and/or targeted therapy, providers must have a thorough understanding of which events would be considered immune related and require treatment. This review will cover descriptions of the most common and uncommon but serious irAEs experienced by patients on immunotherapy, as well as management of these irAEs.
Perception of Lung Cancer Risk: Impact of Smoking Status and Nicotine Dependence
Abstract
Background
The general population is nowadays well aware that tobacco smoking dramatically increases the risk of developing lung cancer. We hypothesized that a personal history of smoking and the level of nicotine dependence in current smokers may affect the perception of this risk among healthy individuals.
Methods
The fourth French nationwide observational survey, EDIFICE 4, was conducted by telephone among a representative sample of individuals (N = 1602) aged between 40 and 75 years. Interviewees were asked about their smoking habits, perception of the risk of lung cancer, and nicotine dependence (Fagerström test).
Results
Regardless of their smoking status or level of nicotine dependence, the majority (96%) of our study population (N = 1463) acknowledged that tobacco smoking is a major risk factor for lung cancer. For 34% of all respondents, smoking ≤ 10 cigarettes per day does not carry any risk of lung cancer. Only half the current smokers considered themselves to be at higher risk of lung cancer than the average-risk population. The majority of current cigarette smokers with a nicotine dependence considered themselves to be at higher risk for lung cancer while only 37% of non-nicotine-dependent individuals had the same perception (P < 0.01). Current smokers were more likely to consider a screening examination than former smokers and never-smokers. However, the intention to undergo screening was not significantly affected by the level of nicotine dependence.
Conclusions
Awareness campaigns may first have to overcome misconceptions about light smoking and, secondly, to target specific populations (heavy smokers, those with a long history, highly dependent smokers).
Awareness and Misconceptions of Breast Cancer Risk Factors Among Laypersons and Physicians
Abstract
Background
Primary prevention of cancer relies on awareness of and consequent identification of risk factors. We investigated knowledge of breast cancer risk factors not only among laywomen but also among female physicians.
Methods
The EDIFICE 4 nationwide observational survey was conducted by phone interviews of a representative female population (737 laywomen and 105 female physicians) aged 40–75 years, using the quota method. This analysis focuses on spontaneous replies to the question "In your opinion, what are the five main risk factors that increase the risk of breast cancer?".
Results
Heredity/Family history of breast cancer was the most widely recognized risk factor in both study populations (98.1% physicians vs. 54.2% laywomen; P ≤ 0.01). Smoking (19.0 and 17.5%) and alcohol consumption (3.8 and 5.5%) were among the lifestyle risk factors that were cited by similar proportions of physicians and laywomen, respectively. Other established risk factors were however very rarely cited by either physicians or laywomen, e.g., Exposure to medical radiation (4.8 vs. 0.4%, respectively; P ≤ 0.05) or not cited at all, i.e., Benign mastopathy and Personal history of breast cancer.
Conclusion
This survey highlights a number of misconceptions relating to behavioral risk factors for breast cancer, including the relative impact of alcohol and tobacco consumption and the importance of menopausal status. The limited awareness of the risk related to Exposure to medical radiation, Benign mastopathy, or Personal history raises concern regarding compliance with national screening recommendations.
Decline in Cancer Screening in Vulnerable Populations? Results of the EDIFICE Surveys
Abstract
Background
We studied cancer screening over time and social vulnerability via surveys of representative populations.
Methods
Individuals aged 50–75 years with no personal history of cancer were questioned about lifetime participation in screening tests, compliance (adherence to recommended intervals [colorectal, breast and cervical cancer]) and opportunistic screening (prostate and lung cancer).
Results
The proportion of vulnerable/non-vulnerable individuals remained stable between 2011 and 2016. In 2011, social vulnerability had no impact on screening participation, nor on compliance. In 2014, however, vulnerability was correlated with less frequent uptake of colorectal screening (despite an organised programme) and prostate cancer screening (opportunistic), and also with reduced compliance with recommended intervals (breast and cervical cancer screening). In 2016, the trends observed in 2014 were substantiated and even extended to breast, colorectal and cervical cancer screening uptakes. Social vulnerability has an increasingly negative impact on cancer screening attendance. The phenomenon was identified in 2014 and had expanded by 2016.
Conclusion
Although organised programmes have been shown to ensure equitable access to cancer screening, this remains a precarious achievement requiring regular monitoring. Further studies should focus on attitudes of vulnerable populations and on ways to improve cancer awareness campaigns.
Fluctuating Behavior of the French Population in Cancer Screening: 5th Edition of the EDIFICE Survey
Abstract
Background
The EDIFICE surveys have assessed cancer screening behavior in the French population since 2005.
Methods
The 2016 edition was conducted among a representative sample of 1501 individuals (age, 50–75 years). The current analysis focuses on breast, colorectal, prostate, lung, and cervical cancer screening.
Results
The rate of women (50 to 74 years) declaring having had at least one breast cancer screening test in their lifetime remained stable and high between 2005 and 2016. Compliance with recommended screening intervals improved between 2005 and 2011 from 75 to 83%, respectively, then decreased significantly to 75% in 2016 (P = 0.02). Uptake of at least one lifetime colorectal cancer screening test procedure declared (individuals aged 50–74 years) increase from 25% in 2005 to 59% in 2011, stabilized at 60% in 2014, then reached 64% in 2016. Opportunistic prostate cancer screening (men aged 50–75 years) rose between 2005 and 2008 from 36 to 49%, plateaued until 2014 then dropped to 42% in 2016. The proportion of women aged 50–65 declaring having undergone one cervical cancer screening test dropped significantly between 2014 and 2016 from 99 to 94% (P < 0.01). Lastly, 11% of our survey population in 2014 and 2016 (55–74 years) declared having already undergone lung cancer screening.
Conclusion
Cancer screening behavior fluctuates in France, regardless of the context, i.e., organized programs or opportunistic screening. This observation highlights the need for constant analysis of population attitudes to optimize public awareness campaigns.
Immunotherapy for Head and Neck Squamous Cell Carcinoma
Abstract
Purpose of Review
Discussion of current strategies targeting the immune system related to solid tumors with emphasis on head and neck squamous cell carcinoma (HNSCC).This review will outline the current challenges with immunotherapy and future goals for treatment using these agents.
Recent Findings
Agents targeting immune checkpoint receptors (IR) such as program death 1 (PD1) have been used in the clinical realm for melanoma and non-small cell lung cancer (NSCLC), and the use of these agents for these malignancies has provided crucial information about how and why patients respond or not to inhibitory checkpoint receptor blockade therapy (ICR). The anti PD1 agent, nivolumab, was recently approved by the FDA as a standard of care regimen for patients with platinum refractory recurrent/metastatic (R/M) HNSCC. Molecular pathways leading to resistance are starting to be identified, and work is underway to understand the most optimal treatment regimen with incorporation of immunotherapy.
Summary
ICR has renewed interest in the immunology of cancer, but resistance is not uncommon, and thus understanding of these mechanisms will allow the clinician to appropriately select patients that will benefit from this therapy.
Meaningful Assessment of Robotic Surgical Style using the Wisdom of Crowds
Abstract
Objective
Quantitative assessment of surgical skills is an important aspect of surgical training; however, the proposed metrics are sometimes difficult to interpret and may not capture the stylistic characteristics that define expertise. This study proposes a methodology for evaluating the surgical skill, based on metrics associated with stylistic adjectives, and evaluates the ability of this method to differentiate expertise levels.
Methods
We recruited subjects from different expertise levels to perform training tasks on a surgical simulator. A lexicon of contrasting adjective pairs, based on important skills for robotic surgery, inspired by the global evaluative assessment of robotic skills tool, was developed. To validate the use of stylistic adjectives for surgical skill assessment, posture videos of the subjects performing the task, as well as videos of the task were rated by crowd-workers. Metrics associated with each adjective were found using kinematic and physiological measurements through correlation with the crowd-sourced adjective assignment ratings. To evaluate the chosen metrics' ability in distinguishing expertise levels, two classifiers were trained and tested using these metrics.
Results
Crowd-assignment ratings for all adjectives were significantly correlated with expertise levels. The results indicate that naive Bayes classifier performs the best, with an accuracy of \(89\pm 12\) , \(94\pm 8\) , \(95\pm 7\) , and \(100\pm 0\%\) when classifying into four, three, and two levels of expertise, respectively.
Conclusion
The proposed method is effective at mapping understandable adjectives of expertise to the stylistic movements and physiological response of trainees.
High performance of 3D porous graphene/lignin/sodium alginate composite for adsorption of Cd(II) and Pb(II)
Abstract
A novel adsorbent, three-dimensional porous graphene/lignin/sodium alginate nanocomposite (denoted as 3D PG/L/SA) was fabricated by hydrothermal polymerization of lignin and sodium alginate in the presence of graphene oxide (GO) in an aqueous system. Fourier transform infrared spectra, thermo-gravimetric analysis, scanning electron microscopy, and X-ray photoelectron spectroscopy were employed to characterize the morphology and structure of this novel functional PG/L/SA nanocomposite. A series of adsorption experiments for cleanup of Cd(II) and Pb(II) were conducted to investigate the effects of lignin and sodium alginate on the graphene structure. It was found that PG/L/SA showed a significant increase in adsorption capacity contrast to porous graphene (PG). The as-prepared material achieved the adsorption capacity for Cd(II) and Pb(II) of 79.88 and 226.24 mg/g, respectively. Meanwhile, the adsorption process matched well with the Langmuir isotherm model and the pseudo-second-order kinetic model. Studies were also conducted to demonstrate the applicability of the sorbent to the removal of heavy metal ions from metal smelting wastewater.
Quantitative structure–activity relationship for the partition coefficient of hydrophobic compounds between silicone oil and air
Abstract
The silicon oil-air partition coefficients (KSiO/A) of hydrophobic compounds are vital parameters for applying silicone oil as non-aqueous-phase liquid in partitioning bioreactors. Due to the limited number of KSiO/A values determined by experiment for hydrophobic compounds, there is an urgent need to model the KSiO/A values for unknown chemicals. In the present study, we developed a universal quantitative structure–activity relationship (QSAR) model using a sequential approach with macro-constitutional and micromolecular descriptors for silicone oil-air partition coefficients (KSiO/A) of hydrophobic compounds with large structural variance. The geometry optimization and vibrational frequencies of each chemical were calculated using the hybrid density functional theory at the B3LYP/6-311G** level. Several quantum chemical parameters that reflect various intermolecular interactions as well as hydrophobicity were selected to develop QSAR model. The result indicates that a regression model derived from logKSiO/A, the number of non-hydrogen atoms (#nonHatoms) and energy gap of ELUMO and EHOMO (ELUMO–EHOMO) could explain the partitioning mechanism of hydrophobic compounds between silicone oil and air. The correlation coefficient R2 of the model is 0.922, and the internal and external validation coefficient, Q2LOO and Q2ext , are 0.91 and 0.89 respectively, implying that the model has satisfactory goodness-of-fit, robustness, and predictive ability and thus provides a robust predictive tool to estimate the logKSiO/A values for chemicals in application domain. The applicability domain of the model was visualized by the Williams plot.
Sustained remission of recalcitrant cutaneous lymphoid hyperplasia after thalidomide treatment
Cutaneous lymphoid hyperplasia (CLH) is a benign lymphoid infiltrate thought to represent an exaggerated response to antigenic stimulation.1-3 Treatment includes trigger avoidance and both pharmacologic and surgical modalities.3 We present a case of recalcitrant CLH with durable clinical regression after treatment with thalidomide.
Correction
Moon DS, Choi WY, Yoon N-R, Kim D-M. Granulomatous hepatitis in a healthy adult after bacillus Calmette–Guérin injection into a plantar wart. JAAD Case Reports. 2017;3(6):566-569.
Commentary on response to remission of hidradenitis suppurativa after bariatric surgery
To the Editor: We are grateful to Dr Golbari and colleagues from the Stony Brook University School of Medicine for their interest in our recently published article.1
Response to: Remission of hidradenitis suppurativa after bariatric surgery
To the Editor: We recently read with interest the article Remission of hidradenitis suppurativa after bariatric surgery by Gallagher et al.1 Obesity is an established risk factor for hidradenitis suppurativa (HS), and we appreciate the authors' work on this relevant piece. Weight loss is thought to improve HS symptoms by decreasing friction, microbial colonization, and inflammation associated with obesity.2 Patients often inquire about the association between HS and obesity and the possibility of disease abatement with weight loss.
Acrodermatitis continua of Hallopeau and geographic tongue are variants of pustular psoriasis
To the Editor: A recent article by Barron1 reported the successful use of secukinumab to treat acrodermatitis continua of Hallopeau (ACH) and oral psoriasis. The author described a patient with pustulation of the distal fingertips and an erosive mucositis predominantly affecting the tongue, also involving the hard and soft palate and gingiva, which she distinguishes from geographic tongue (GT).
Recurrent breast cellulitis from a nipple fissure
Bacterial superinfections are a common complication in atopic dermatitis (AD) because of increased Staphylococcus aureus colonization.1,2 However, a nipple fissure as a source for cellulitis has not been described in this population. We describe a case of a nonlactating patient with chronic atopic dermatitis with recurrent breast cellulitis and fever caused by an inconspicuous nipple fissure.
A case of metastatic basal cell carcinoma treated with continuous PD-1 inhibitor exposure even after subsequent initiation of radiotherapy and surgery
Advanced basal cell carcinomas (BCCs) resistant to Smoothened inhibitor (SI) therapy represent a treatment challenge.1 Recently, case reports showed that BCCs can be responsive to systemic immunotherapy,2-4 specifically programmed cell death protein-1 (PD-1) inhibitors. These cases are highly encouraging as salvage therapy after resistance to SI therapy. In 2 metastatic BCC cases, shrinkage of all lesions occurred, specifically lung lesions3 in one and liver lesions in the other.4 Currently, it is unknown whether metastatic BCC can exhibit differential response or resistance to PD-1 inhibitors.
Clinicopathologic findings of guttate leukoderma in Darier disease: A helpful diagnostic feature
Darier disease (DD), also known as keratosis follicularis or Darier-White disease, is a rare autosomal dominant genodermatosis attributed to a mutation in the ATP2A2 gene. DD affects both males and females worldwide, with high penetrance (95%) and variable expressivity, allowing for varied clinical manifestations and disease severity among affected families and individuals.1 The characteristic feature of DD is the presence of firm, greasy, skin-colored to yellow-brown, hyperkeratotic papules distributed in seborrheic areas, such as the scalp, face, and trunk.
Acute pustular eruption following a Jarisch-Herxheimer reaction in the treatment of syphilis
The Jarisch-Herxheimer reaction (JHR) is an acute febrile inflammatory reaction that sometimes follows the treatment of syphilis and other spirochete infections with antibiotics. Although first described over a century ago, relatively little is still known about this adverse event. It is thought that antimicrobial therapy renders the dividing spirochetes susceptible to phagocytosis, with consequent release of lipoproteins, cytokines, and immune complexes.1 Symptoms present within 2 hours of antimicrobial administration and include fever, chills, vasodilation with flushing, tachycardia, mild hypotension, and possible worsening of skin lesions.
Erosive oral lichen planus after pegylated-interferon therapy for chronic hepatitis B
Lichen planus (LP) and other skin conditions have been reported in association with chronic hepatitis infections, specifically hepatitis C. However, this association is controversial, with comparative studies finding no significant difference in prevalence.1-3
A case of pediatric keratosis lichenoides chronica with unusual presentation of severe oral erosions
Keratosis lichenoides chronica (KLC) is a rare, chronic disorder of keratinization that typically affects adults.1 The adult-onset disease commonly presents with linear or reticular keratotic papules and plaques over the trunk and extremities, rosacea, or seborrheic dermatitis–like rash on the face and oral ulcers. Pediatric-onset KLC is rare with different clinical characteristics.2 Pediatric cases initially present with purpuric macules on the face, more commonly with alopecia of the forehead and eyebrows and less commonly affecting oral mucosa.
Exacerbation of mycosis fungoides leading to the diagnosis of chronic myelomonocytic leukemia
Patients with mycosis fungoides (MF) are at a greater risk (relative risk, 1.73; range, 1.32-2.4) to have secondary malignancies than healthy subjects, and co-occurrence of cutaneous T-cell lymphoma with other hematoproliferative diseases has been reported.1,2 Chronic myelomonocytic leukemia (CMML) is a rare myeloproliferative disease with features of myelodysplastic syndrome and myeloproliferative disorders leading to monocytosis in the peripheral blood.3 Cutaneous manifestations of CMML have been reported and seem to be associated with a poor prognosis and more likely progression to acute myeloid leukemia.
Giant annular lichenoid drug eruption caused by efavirenz therapy
Lichen planus (LP) is a common inflammatory dermatosis, which involves the skin, mucosa, and nails. The clinical presentation is highly variable with over 20 distinct morphologic forms described.1 Annular LP, which presents with circinate lesions with elevated borders, is a rare form of LP, comprising 7%-10% of LP cases.2 Annular LP has been reported in association with Sneddon syndrome, Crohn disease, and HIV infection.2,3 Drug-induced annular LP has not been described. Here, we report the first case of efavirenz-induced giant annular LP in a patient with HIV.
Facial pilomatrix carcinomas treated with Mohs micrographic surgery
Pilomatrix carcinoma is a rare cutaneous malignancy with follicular matrix origin. Since the term pilomatrix carcinoma was first coined in 1980, more than 130 cases have been reported.1 The condition is also known as pilomatrical carcinoma, matrical carcinoma, malignant pilomatricoma, malignant pilomatrixoma, and calcifying epithelial carcinoma of Malherbe. In contrast to pilomatrixomas, pilomatrix carcinomas have locally aggressive behavior with a tendency toward recurrence and metastasis. Management options include surgery or radiation with close long-term follow-up.
An aberrant reaction to Candida albicans antigen used for recalcitrant warts successfully treated with oral prednisone
Cutaneous papillomavirus infections are a common cause of morbidity.1,2 Although many treatment regimens for common warts are available, no single form of therapy is the clear method of choice. Immunotherapy with Candida albicans antigen injections is an accepted method that can be effective, with few side effects reported. The immunotherapeutic Candida antigen (CA), is used intralesionally for the treatment of recalcitrant warts.3-5 Candida antigen induces a delayed hypersensitivity reaction in healthy patients such that the cell-mediated immune response enhances the immune system's identification of the viral infection.
Acquired idiopathic generalized anhidrosis in a young Austrian patient
Acquired idiopathic generalized anhidrosis (AIGA) is a rare disease with approximately 100 reported cases worldwide, many of which occurred in Asia, especially in Japan.1
Flagellate erythema in systemic sclerosis: A case report
Flagellate erythema is characterized by linear erythematous streaks with hyperpigmentation. The condition is a characteristic side effect of bleomycin, an antineoplastic sulphur-containing antibiotic developed in the 1960s, and might also occur after consumption of raw or undercooked shiitake mushrooms.1 Moreover, it is less frequently associated with dermatomyositis or adult-onset Still disease.2 Precise mechanisms for the formation of these lesions are unknown and seem to vary by etiology. We report the first described case of flagellate erythema associated with systemic sclerosis.
Hiperqueratosis acral focal: correlación clínica, histopatológica y ecográfica
Publication date: Available online 23 March 2018
Source:Actas Dermo-Sifiliográficas
Author(s): J. Company-Quiroga, B. Echeverría, J.C. Tardío, C. Martínez-Morán
Toxicity evaluation of 4,4′-di-CDPS and 4,4′-di-CDE on green algae Scenedesmus obliquus : growth inhibition, change in pigment content, and oxidative stress
Abstract
Polychlorinated diphenyl sulfides and polychlorinated diphenyl ethers are two types of dioxin-like pollutants, which are prevalent in aquatic environments. However, to date, limited information is available regarding their toxicity to green algae. In this study, growth inhibition, effect on pigment content, and oxidative stress potentials of 4,4′-di-CDPS and 4,4′-di-CDE on green algae Scenedesmus obliquus were investigated. The results indicate that the EC50 values of 4,4′-di-CDPS after 24, 48, 72, and 96 h of exposure were 1.736, 1.172, 0.994, and 0.820 mg/L, while the corresponding values for 4,4′-di-CDE were 0.697, 1.087, 0.833, and 0.327 mg/L. As compared to the control group, most of the measured pigment content in algal cells significantly decreased after 96-h exposure to these two chemicals, suggesting their suppressive capability on the photosynthesis process in algal cells. Additionally, oxidative stress occurred as demonstrated by the significantly inhibited activities of the antioxidant enzymes (total superoxide dismutase (T-SOD), catalase (CAT), and glutathione peroxidase (GPx)), and high increases in malondialdehyde (MDA) content in all 4,4′-di-CDE-treated groups and some moderate-dose and high-dose treatments with 4,4′-di-CDPS. Acute toxicity tests and biochemical analysis showed that 4,4′-di-CDE was more toxic than 4,4′-di-CDPS on S. obliquus.
Better than
Abstract
It is commonly held that rational preferences must be acyclic. There have, however, been cases that have been put forward as counterexamples to this view. This paper focuses on the following question: If the counterexamples are compelling and rational preferences can be cyclic, what should we conclude about the presumed acyclicity of the "better than" relation? Building on some revisionary suggestions concerning acyclicity and betterness, I make a case for hanging on to the presumption that "better than" is acyclic even if "is rationally preferred to" is not. As I explain, the divergence my view makes room for does not threaten to make "better than" judgments less relevant to choice than judgments about rational preference. To the contrary, it makes them more relevant. Toward the end of the paper, I extend my results to the relation "is morally better than" in light of the possibility that there might be moral preferability cycles.
History of plastic surgery: art, philosophy, and rhinoplasty
Publication date: Available online 23 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Valdas Macionis
The two-hundredth anniversary of K. F. Graefe's "Rhinoplasty", E. Zeis' naming of the specialty of plastic surgery in 1838, and the continuing discussion on what is plastic surgery have prompted this historical-conceptual review with an analytic semantic insight into the meaning of the word "plastic". A literature search has revealed that this term has a dual content composed of an artistic and a philosophic aspect. Progressive development of these two connotations can be traced from their birth in the ceramics and myths of the ancient Greece to their metamorphoses in the fine arts, science, and plasticity philosophy of our days. Although the names of plastic procedures and the title of the specialty carry both features, the philosophical notion is less evident. This article underlines the importance of etymological history in interpretation of the concept of plastic surgery.
Heat Strain and Hydration of Japanese Construction Workers during Work in Summer
Abstract
Objectives
The aim was to ascertain hydration and heat strain of construction workers in Japan during the summer who are at the highest risk of heat-related disorders. Methods
The subjects were 23 construction workers, whose average age was 41, average weight was 69 kg, and average height was 170 cm. We measured thermal working conditions with a wet bulb globe temperature (WBGT) measurement instrument affixed to the helmet of each worker, at fixed points outdoors in the sun and indoors. Heat strain was evaluated for water intake, urine specific gravity (Usg), urine temperature (UT), heart rate (HR), and body weight during work. Results
The average WBGT measured on the worker helmets over 3 consecutive days was 28.0 ± 0.7, 27.6 ± 0.8, and 27.6 ± 1.1°C. The average water intake was 2.6 l during a work shift. The average Usg, UT, and % HR reserve were the highest in the first half of afternoon work. Seventy-eight percent of the subjects exceeded at least one of the ACGIH TLV physiological guidelines for heat strain in terms of HR and weight loss or a clinically dehydrated level of Usg. Conclusions
Heat strain was the highest in the first half of afternoon work. The number of dehydrated workers increased during this shift because of insufficient water intake. Adequate hydration is required to decrease the risk of heat-related disorders among construction workers in the summer.Anaerobic Phototrophic Processes of Hydrogen Production by Differents Strains of Microalgae Chlamydomonas sp.
Abstract
Hydrogen is an abundant element and a non-polluting fuel which can be biologically produced by microalgae. The aim of this research was to investigate biological hydrogen production by Chlamydomonas reinhardtii (CC425) and Chlamydomonas moewusii (SAG 24.91) by direct biophotolysis in batch cultures. Strains were cultivated in TAP growth medium (pH 7.2) in two phases: in the first stage, cultures were maintained in an aerobic condition until the middle of the exponential phase; in the second stage, the biomass was transferred to closed anaerobic photobioreactors under sulfur deprived. Gas chromatography and Gompertz model were used to measure the hydrogen production and hydrogen production rate, respectively. We noticed that maximum hydrogen production by biomass of C. reinhardtii was 5.95 ± 0.88 μmol mg−1 and the productivity was 17.02 ± 3.83 μmol L−1 h−1, with hydrogen production five times higher than C. moewusii, approximately, though, C. moewusii obtained a higher ethanol yield compared to C. reinhardtii. The hydrogen production method, with the cultivation of strains in two different phases and sulfur deprivation, was effective for obtaining of biohydrogen for Chlamydomonas, however it depends on the species, strain and growth conditions.Transcriptional and Post-translational Regulation of AccD6 in Mycobacterium smegmatis
Abstract
AccD6 is an important component of acetyl-CoA/propionyl-CoA carboxylase, which acts as a key role in mycolic acid synthesis and short chain fatty acyl-coenzyme A metabolism. In this study, we demonstrated that AccD6 of Mycobacterium smegmatis associates with AccA3 (α subunit of acetyl-CoA carboxylase, MSMEG_1807) and AccE (ε subunit, MSMEG_1812) to form the acetyl-CoA (propionyl-CoA) carboxylase. Results showed that the MSMEG_4331 subunit is a regulator that interacts with the promoter region of accD6 to inhibit its transcription. Transcription of accD6 was reduced by 50% in the mutant M. smegmatis strain overexpressing MSMEG_4331. Moreover, the activity of AccD6 was inhibited by acylation (such as acetylation and propionylation). These results demonstrate that AccD6 of M. smegmatis is regulated at both the transcriptional and post-translational levels. Our findings highlight the novel regulatory mechanism underlying mycolic acid biosynthesis in mycobacteria.Quantitative Imaging and Spectroscopic Technologies for Microbiology
Abstract
Light microscopy has enabled the observation of the structure and organization of biofilms. Typically, the contrast in an image obtained from light microscopy is given by the time-averaged intensity that is effective in visualizing the overall structure. Technological advancements in light microscopy have led to the creation of techniques that not only provide a static intensity image of the biofilm, but also enable one to quantify various dynamic physicochemical properties of biomolecules in microbial biofilms. Such light microscopy based techniques can be grouped into two main classes, those that are based on luminescence and those that are based on scattering. Here we review the fundamentals and applications of luminescence and scattering based techniques, specifically, Fluorescence Lifetime Imaging (FLIM), Förster Resonance Energy Transfer (FRET), Fluorescence Correlation Spectroscopy (FCS), Fluorescence Recovery after Photobleaching (FRAP), Single Particle Tracking (SPT), Transient State Imaging (TRAST), Brillouin and Raman microscopy. These techniques provide information about the abundance, interactions and mobility of various molecules in the biofilms and also properties of the local microenvironment at optical resolution. Further, one could use any of these techniques to probe the real-time changes in these physical parameters upon the addition of external agents or at different stages during the growth of biofilms.Amyotrophic lateral sclerosis and exposure to diesel exhaust in a Danish cohort
Abstract
Previous studies have suggested an increased risk of amyotrophic lateral sclerosis (ALS) and other motor neuron diseases for those in occupations commonly exposed to diesel exhaust (DE). In this study, we investigated the association between occupational exposures to DE and odds of ALS. ALS cases were identified from the Danish National Patient Registry 1982 to 2013 and individually matched to 100 controls per case based on birth year and sex. Using occupational history since 1964 from the Danish Pension Fund, Cumulative DE exposures were estimated using a job exposure matrix. Associations were evaluated using conditional logistic regression analyses and stratified by sex. DE exposure at 10-year lag periods was positively associated with ALS in men ever exposed (aOR: 1.20; 95% CI: 1.05, 1.38). For men with > 50% probability of DE exposure, we observed a positive association with ALS and the highest quartile exposures during the 5-year lag period (aOR: 1.40; 95% CI: 1.11, 1.78) and 10-year lag period (aOR: 1.41; 95% CI: 1.11, 1.79). Our study suggests an association between consistently higher exposures to DE and ALS in men but not in women. These findings support those of previously reported associations between ALS and commonly DE exposed occupations.Dietary Protein and Preservation of Physical Functioning Among Middle-aged and Older Adults in the Framingham Offspring Study
Abstract
Dietary protein may help prevent age-related declines in strength and functional capacity. This study examines the independent relation between dietary protein and longitudinal changes in physical functioning among Framingham Offspring Study adults from Exams 5 (1991-1995) to 8 (2005-2008). Protein intakes were derived from three-day diet records during exams 3 and 5; functional status was determined over 12 years using seven items selected from standardized questionnaires. Multivariable models were used to adjust for age, sex, education, physical activity, smoking, height, and energy intake. Functional tasks that benefitted most from a higher-protein diet (≥1.2 vs.<0.8 g/kg/day) were doing heavy work at home, walking ½ mile, going up and down stairs, stooping/kneeling/crouching, and lifting heavy items. Those with higher protein intakes were 41% less likely (95% CI: 0.43, 0.82) to become dependent in one or more of the functional tasks over follow-up. Higher physical activity and lower body mass index were both independently associated with less functional decline. The greatest risk reductions were found among those with higher protein intakes combined with either higher physical activity, more skeletal muscle mass, or lower BMI. This study demonstrates that dietary protein intakes above the current RDA may slow functional decline in older adults.A Ten Year Immunopersistence Study of Hepatitis E Antibodies in Rural Bangladesh
Abstract
Hepatitis E virus (HEV) is a major cause of acute, viral hepatitis in Southeast Asia. Several studies have suggested that antibody persistence after HEV infection may be transient, possibly increasing the risk of re-infection and contributing to the frequency of outbreaks in HEV endemic regions. The specific conditions under which antibodies to HEV are lost, or "sero-reversion" occurs, are poorly understood. Here, one hundred participants from population-based studies in rural Bangladesh were revisited in 2015, ten years after a documented HEV infection to examine long-term antibody persistence. Twenty percent (95% confidence interval: 12.0, 28.0) no longer had detectable antibodies at follow-up, suggesting that antibodies generally persist for at least a decade after infection in rural Bangladesh. Those who were seronegative at follow-up were generally younger at infection than those who remained positive (14.4 years versus 33.6 years, P > 0.0001). This age-dependent antibody loss could partially explain cross-sectional sero-prevalence data from South East Asia where children have reportedly low antibody prevalence. The results of this study provide new insight into the immunological persistence of HEV infection in a micronutrient deficient rural population of South Asia, highlighting the importance of age at infection in the ability to produce long-lasting antibodies against HEV.Landmark Models for Optimizing the Use of Repeated Measurements of Risk Factors in Electronic Health Records to Predict Future Disease Risk
Abstract
The benefits of using electronic health records for disease risk screening and personalized heathcare decisions are becoming increasingly recognized. We present a computationally feasible statistical approach to address the methodological challenges in utilizing historical repeat measures of multiple risk factors recorded in electronic health records to systematically identify patients at high risk of future disease. The approach is principally based on a two-stage dynamic landmark model. The first stage estimates current risk factor values from all available historical repeat risk factor measurements by landmark-age-specific multivariate linear mixed-effects models with correlated random-intercepts, which account for sporadically recorded repeat measures, unobserved data and measurements errors. The second stage predicts future disease risk from a sex-stratified Cox proportional hazards model, with estimated current risk factor values from the first stage. Methods are exemplified by developing and validating a dynamic 10-year cardiovascular disease risk prediction model using electronic primary care records for age, diabetes status, hypertension treatment, smoking status, systolic blood pressure, total and high-density lipoprotein cholesterol from 41,373 individuals in 10 primary care practices in England and Wales contributing to The Health Improvement Network (1997-2016). Using cross-validation, the model was well-calibrated (Brier score = 0.041 [95%CI: 0.039, 0.042]) and had good discrimination (C-index = 0.768 [95%CI: 0.759, 0.777]).Antiretroviral Therapy and Mortality in Rural South Africa: A Comparison of Causal Modeling Approaches
Abstract
Estimation of causal effects from observational data is a primary goal of epidemiology. The use of multiple methods with different assumptions relating to exchangeability improves causal inference by demonstrating robustness across assumptions. We estimate the effect of antiretroviral therapy (ART) on mortality in rural KwaZulu-Natal, South Africa from 2007-2011 using two methods with substantially different assumptions: the regression discontinuity design (RDD), and inverse probability weighting of marginal structural models (IPW). The RDD analysis took advantage of a CD4 count-based threshold for ART initiation (200 cells/μl). The two methods yielded consistent but non-identical results for the effect of immediate initiation of ART (RDD intention-to-treat hazards ratio (HR) 0.66, 95% CI 0.35 to 1.26; RDD HR 0.56, 95% CI 0.41 to 0.77; IPW HR 0.49, 95% CI 0.42 to 0.58). Although RDD and IPW estimates had distinct identifying assumptions, strengths, and limitations in terms of internal and external validity, results in this application were similar. The differences in modeling approaches and external validity of each method may explain the minor differences in effect estimates, but the consistency of the results lends support for causal inference of the effect of ART and mortality from these data.Muscular disorder related to immune checkpoint inhibitors: forewarned is forearmed
We would like to bring to the attention of the medical community the emergence of a serious acquired muscular disorder arising from immune checkpoint inhibitors (ICIs) that are now widely used in anticancer treatment. This is of particular interest to neurologists and oncologists, as they will have a pivotal role in the management of such cases.
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Publication date: Available online 25 July 2018 Source: Journal of Photochemistry and Photobiology B: Biology Author(s): Marco Ballestr...
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Editorial AJR Reviewers: Heartfelt Thanks From the Editors and Staff Thomas H. Berquist 1 Share + Affiliation: Citation: American Journal...
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Publication date: Available online 28 September 2017 Source: Actas Dermo-Sifiliográficas Author(s): F.J. Navarro-Triviño
