Abstract
Surgery represents the only chance of cure for patients with gastroesophageal adenocarcinoma; however surgery alone does not cure most patients. Over the past decade, several multimodality adjunctive treatments have improved survival for patients with operable gastroesophageal adenocarcinoma who are undergoing surgical resection; these include peri-operative chemotherapy, neoadjuvant chemoradiotherapy, adjuvant chemotherapy and adjuvant chemoradiotherapy. More recently, the results of several large randomised trials are leading to a shift in the peri-operative treatment of gastroesophageal cancer, away from anthracycline-based and towards taxane-based chemotherapy regimens. Emerging data supports an increased focus on patients who are at high risk for poor operative outcomes such as R1 resection, and on patients who are at high risk for relapse following surgery such as those with lymph node metastases (N1+). Future developments may include use of fluorodeoxyglucose-positron emission tomography (FDG-PET) to inform a switch to non-cross resistant chemotherapy pre-operatively and substitution of alternative treatments for chemotherapy in high risk postoperative node positive patients. Conversely, in molecularly selected subgroups such as microsatellite unstable gastroesophageal cancer, peri-operative or adjuvant chemotherapy may not be helpful, and treatments such as immunotherapy may be considered. In this review the most up-to-date clinical trials and translational research in the field of operable gastroesophageal cancer are discussed; with a focus on how best to risk stratify patients with operable disease for peri-operative treatment plus surgery, and how novel therapies might be integrated into standard treatments in order to improve survival outcomes in this patient group.Τρίτη 15 Μαΐου 2018
The reactivity of Fe/Ni colloid stabilized by carboxymethylcellulose (CMC-Fe/Ni) toward chloroform
Abstract
The use of stabilizers can prevent the reactivity loss of nanoparticles due to aggregation. In this study, carboxymethylcellulose (CMC) was selected as the stabilizer to synthesize a highly stable CMC-stabilized Fe/Ni colloid (CMC-Fe/Ni) via pre-aggregation stabilization. The reactivity of CMC-Fe/Ni was evaluated via the reaction of chloroform (CF) degradation. The effect of background solution which composition was affected by the preparation of Fe/Ni (Fe/Ni precursors, NaBH4 dosage) and the addition of solute (common ions, sulfur compounds) on the reactivity of CMC-Fe/Ni was also investigated. Additionally, the dried CMC-Fe/Ni was used for characterization in terms of scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS). The experimental results indicated that CMC stabilization greatly improved the reactivity of Fe/Ni bimetal and CF (10 mg/L) could be completely degraded by CMC-Fe/Ni (0.1 g/L) within 45 min. The use of different Fe/Ni precursors resulting in the variations of background solution seemed to have no obvious influence on the reactivity of CMC-Fe/Ni, whereas the dosage of NaBH4 in background solution showed a negative correlation with the reactivity of CMC-Fe/Ni. Besides, the individual addition of external solutes into background solution all had an adverse effect on the reactivity of CMC-Fe/Ni, of which the poisoning effect of sulfides (Na2S, Na2S2O4) was significant than common ions and sulfite.
Primary cutaneous aspergillosis at the site of cyanoacrylate skin adhesive in a neonate
Pediatric Dermatology, EarlyView.
EURAPS Editorial: BIA-ALCL, a brief overview
The history of breast implants includes important technological breakthroughs, but also safety controversies such as the 1992 FDA moratorium against silicone, the 2010 PIP implant scandal, and the 2015 Silimed ban.1–3 Nevertheless, the popularity of breast augmentation continues to grow, and millions of patients receive breast implants each year.4
A Common Variation in the Caveolin 1 Gene Is Associated with High Serum Triglycerides and Metabolic Syndrome in an Admixed Latin American Population
Metabolic Syndrome and Related Disorders, Ahead of Print.
Multidisciplinary management of periocular tumour excision repair
Australasian Journal of Dermatology, EarlyView.
Effect of near‐infrared photobiomodulation therapy in a cellular wound healing model
Photodermatology, Photoimmunology &Photomedicine, EarlyView.
Introduction to the Hot Topics in Aesthetic Surgery Supplement
The Aesthetic Surgery Journal is pleased to publish a Supplement highlighting 4 presentations given at "Hot Topics" at the 50th Annual Meeting of the American Society for Aesthetic Plastic Surgery. It is important for the reader to understand what "Hot Topics" is, its origin, and why it is important to plastic surgeons, their patients, and the media.
Prediction of Treatment Outcomes for Neck Rejuvenation Utilizing a Unique Classification System of Treatment Approach Using a 1440-nm Side-Firing Laser
Abstract
Background
The appearance of a youthful neck is lost with age causing excessive skin laxity, a loss of subcutaneous fat, prominence of platysmal banding, and jowling. In view of the success obtained with laser treatment for neck rejuvenation, the authors have recently taken an algorithmic approach to developing a 7-category classification system of the aging conditions throughout the anatomic spectrum of three areas: skin, fat, and muscle. This system will correlate with specific treatment options. Objective
The objective of the study was to confirm the 7-category classification system and treatment approaches based on clinical outcome data for treatment of the mandibular and submandibular areas, specifically for skin tightening and laser lipolysis after a single 1440-nm laser treatment. Methods
Patients were treated with a single treatment of PrecisionTX™ 1440-nm wavelength laser on their necks. Baseline and posttreatment photographs were taken and evaluated by 3 blinded reviewers using the Cervicomental Angle Scale (CAS). Results
Subjects were rated grades II-III (2.9 ± 0.8) on average at baseline and grades I-II (1.3 ± 0.5) at follow-up. The average improvement was a mean score of 1.5 ± 0.07. Patients, 23/25 (92%), showed at least a 1 score improvement. Conclusions
This study confirms a new minimally invasive treatment approach based on a unique classification system with no adverse events reported and high patient satisfaction. Level of Evidence: 4
Soft Tissue Contraction in Body Contouring With Radiofrequency-Assisted Liposuction: A Treatment Gap Solution
Abstract
Radiofrequency-assisted liposuction is a relatively new concept in energy-assisted body contouring techniques and has received instrument approval. This supplemental article reviews the clinical application of electromagnetic energy via the BodyTite (InMode Corporation, Toronto, Canada) device on soft tissues during suction lipectomy, its effect on soft tissue contraction, and its use in aesthetic body contouring in various clinical scenarios.Adsorption performance and mechanism of magnetic reduced graphene oxide in glyphosate contaminated water
Abstract
In this study, the magnetic reduced graphene oxide (RGO/Fe3O4), with easy separation and high adsorption performance, was prepared and used to treat glyphosate (GLY) contaminated water. GLY adsorption performance of RGO/Fe3O4 was investigated, and influences of pH, adsorption time, temperature, contaminant concentration, and competing anions were analyzed. Moreover, the adsorption mechanism was discussed in the light of several characterization methods, including scanning electron microscopy (SEM), energy dispersive spectrum (EDS), Fourier-transform infrared spectroscopy (FTIR), and X-ray photoelectron spectroscopy (XPS). The results demonstrated that the RGO/Fe3O4 presented a significant GLY adsorption capacity and acid condition was beneficial for this adsorption. The pseudo-second-order kinetic model and the Langmuir model correlated satisfactorily to the experimental data, indicating that this process was controlled by chemical adsorption and monolayer adsorption. Thermodynamic studies revealed that the adsorption of glyphosate onto RGO/Fe3O4 was spontaneous, endothermic, and feasible process. High temperatures were beneficial to GLY adsorption. The GLY adsorption mechanism of RGO/Fe3O4 was mainly attributed to hydrogen-bond interaction, electrostatic interaction, and coordination. Therefore, the RGO/Fe3O4 investigated in this research may offer an attractive adsorbent candidate for treatment of glyphosate contaminated water and warrant further study as a mechanism for glyphosate efficient removal.
Effects of fouling on separation performance by forward osmosis: the role of specific organic foulants
Abstract
In this study, forward osmosis (FO) membranes and fouling solutions were systematically characterized to elucidate the effects of organic fouling on the rejection of two pharmaceutically active compounds, namely, sulfamethoxazole and carbamazepine. Municipal wastewater resulted in a more severe flux decline compared to humic acid and sodium alginate fouling solutions. This result is consistent with the molecular weight distribution of these foulant solutions. Liquid chromatography with organic carbon detection analysis shows that municipal wastewater consists of mostly low molecular weight acids and neutrals, which produce a more compact cake layer on the membrane surface. By contrast, humic acid and sodium alginate consist of large molecular weight humic substances and biopolymers, respectively. The results also show that membrane fouling can significantly alter the membrane surface charge and hydrophobicity as well as the reverse salt flux. In particular, the reverse salt flux of a fouled membrane was significantly higher than that under clean conditions. Although the rejection of sulfamethoxazole and carbamazepine by FO membrane was high, a discernible impact of fouling on their rejection could still be observed. The results show that size exclusion is a major rejection mechanism of both sulfamethoxazole and carbamazepine. However, they respond to membrane fouling differently. Membrane fouling results in an increase in sulfamethoxazole rejection while carbamazepine rejection decreases due to membrane fouling.
The role of heat shock protein 70 in oxidant stress and inflammatory injury in quail spleen induced by cold stress
Abstract
The aim of this study was to investigate the role of heat shock protein 70 (Hsp70) in oxidative stress and inflammatory damage in the spleen of quails which were induced by cold stress. One hundred ninety-two 15-day-old male quails were randomly divided into 12 groups and kept at 12 ± 1 °C to examine acute and chronic cold stress. We first detected the changes in activities of antioxidant enzymes in the spleen tissue under acute and chronic cold stress. The activities of glutathione peroxidase (GSH-Px) fluctuated in acute cold stress groups, while they were significantly decreased (p < 0.05) after chronic cold stress. The activities of superoxide dismutase (SOD), inducible nitric oxide synthase (iNOS), and nitric oxide (NO) content were decreased significantly (p < 0.05) in both of the acute and chronic cold stress groups. Malondialdehyde (MDA) content was significantly increased (p < 0.05) under cold stress except the 0.5 h group of acute cold stress. Besides, histopathological analysis showed that quail's spleen tissue was inflammatory injured seriously in both the acute and chronic cold stress groups. Additionally, the inflammatory factors (cyclooxygenase-2 (COX-2), prostaglandin E synthase (PTGES), iNOS, nuclear factor-kappa B (NF-κB), and tumor necrosis factor-a (TNF-α)) and Hsp70 mRNA levels were increased in both of the acute and chronic cold stress groups compared with the control groups. These results suggest that oxidative stress and inflammatory injury could be induced by cold stress in spleen tissues of quails. Furthermore, the increased expression of Hsp70 may play a role in protecting the spleen against oxidative stress and inflammatory damage caused by cold stress.
Comparative study on adsorption of crude oil and spent engine oil from seawater and freshwater using algal biomass
Abstract
Efficiency of a biosorbent prepared from the green macroalga Enteromorpha intestinalis biomass for decontamination of seawater and freshwater polluted by crude oil and engine spent oil was compared. The effect of different experimental conditions including contact time, pH, particle size, initial oil concentration, and biosorbent dose on the oil biosorption was studied in the batch method. The biosorbent was characterized by CHNOS, FTIR, and SEM analysis. The experimental data were well fitted to the pseudo-second-order kinetic model and the Langmuir adsorption isotherm model. Based on the obtained results, the adsorption of spent oil with higher viscosity was better than crude oil. The biosorption of oil hydrocarbons from seawater was more efficient than freshwater. The algal biomasses which are abundantly available could be effectively used as a low-cost and environmentally friendly adsorbent for remediation of oil spill in the marine environments or in the water and wastewater treatment.
Proteome-wide changes in primary skin keratinocytes exposed to diesel particulate extract—A role for antioxidants in skin health
Air pollution is one of the major environmental risk factors known to adversely affect human health. Outdoor air pollution has been classified as carcinogenic to humans in a 2013 assessment report by the International Agency for Research on Cancer (IARC) [1]. The most common sources of outdoor air pollution include industrial and automobile emissions. Emissions from fuel combustion that include carbon monoxide, nitrogen oxides, ozone, sulfur dioxide and particulate matter (PM), are known to cause various lung ailments and cardiomyopathies [2,3].
Cl-initiated photo-oxidation reactions of methyl propionate in atmospheric condition
Abstract
Cl-initiated photo-oxidation reaction of methyl propionate was investigated experimentally using relative rate method. Gas chromatography/mass spectrometry (GC-MS) and GC/infrared spectroscopy (GC-IR) were used as analytical tools to follow the concentrations of reactants and products during reaction. The gas-phase kinetics of methyl propionate with Cl atoms was measured over the temperature range of 263–363 K at 760 Torr in N2 atmosphere using C2H6 and C2H4 as reference compounds. The temperature-dependent rate coefficient for the reaction of methyl propionate with Cl atom was obtained as k(T) = [(3.25 ± 1.23) × 10−16] T2 exp [− (33 ± 4) / T] cm3 molecule−1 s−1. Theoretical calculations were also performed at CCSD(T)/cc-pVDZ//B3LYP/6-31G(d,p) level of theory, and the rate coefficients for H abstraction reactions were evaluated using canonical variational transition state theory (CVT/SCT) with interpolated single point energy (ISPE) method over the temperature range of 200–400 K. The rate coefficients over the studied temperature range yielded the Arrhenius expression k(T) = (7.22 × 10−16) T1.5 exp (466 / T) cm3 molecule−1 s−1. The reaction mechanism based on product analysis, thermochemistry, branching ratios, atmospheric implications, degradation pathways, and cumulative lifetime of methyl propionate is also presented in this manuscript.
Graphical abstract
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Solid waste management of small island developing states—the case of the Seychelles: a systemic and collaborative study of Swiss and Seychellois students to support policy
Abstract
Solid waste management (SWM) is a significant challenge for the Seychelles. Waste generation, fueled by economic development and tourism, increases steadily, while landfilling continues to be the main disposal path, thus exacerbating the island nation's specific weaknesses. Due to the small scale of the Seychelles economy, there is little capital available to stimulate innovations in SWM and generate the knowledge for setting priorities and guiding SWM action. Students from ETH Zurich and UniSey conducted a transdisciplinary case study (tdCS) to fill this knowledge gap and gain insights into the obstacles and opportunities related to sustainable SWM. The tdCS approach allowed students to gain comprehensive and in-depth knowledge about the SWM system required to set priorities for action and next steps. The government should streamline the different financial frameworks according to a clear principle (e.g., polluter pays principle). Specific biogenic waste streams represent a potential source of energy and fertilizers. Expanding the scope and densifying the network of collection points could help raise recycling rates of other waste fractions. Diverting biogenic waste and recycling more glass, metals, paper, and plastics would also significantly reduce landfilling rates. Regardless of future amounts of waste ending up on landfills, the latter must be reengineered before the surrounding environment suffers major adverse impacts. All these actions imply a government-driven approach which integrates the views of stakeholders and consumers alike.
The indoor-outdoor characteristics of water-soluble ion in PM 2.5 in Tianjin wintertime
Abstract
The indoor and outdoor PM2.5 mass concentration, water-soluble ion by filter sampler was analyzed on December 3–21, 2015 during wintertime in Tianjin, China. The results indicate that high humidity conditions result in the accumulation of atmospheric pollutants and reduce atmosphere visibility. The I/O ratio for PM2.5 concentration in dormitory and lab are less than 1 in haze days. Indoor PM2.5 concentration increases rapidly with outdoor PM2.5 concentration increasing in haze days. The filtration factors of the dormitory and lab indicate nearly half of the outdoor PM2.5 enters indoor environment. The human activities in dormitory could cause more the formation of PM2.5 than those in lab. The concentration of SO42− is the highest ion in water-soluble ion for outdoor PM2.5. The SO42−, NO3−, NH4+, and Cl− are generated mainly by outdoor sources; however, the Na+, Ca2+, and Mg2+ are generated mainly by indoor sources. The NH4NO3, (NH4)2SO4, and NH4Cl accounts for 20.2~41.8%, 32.0~51.4%, and 6.4~10.6% of the total water-soluble ion in different indoor-outdoor environment. The total secondary aerosols including NH4NO3, (NH4)2SO4, and NH4Cl in PM2.5 are 28.3, 42.1, 28.2, 31.0, and 33.9% in outdoor environment for haze days, outdoor environment for non-haze days, dormitory for haze days, dormitory for non-haze days, and lab for haze days, respectively.
Total penile reconstruction: A systematic review
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): A. Yao, M.J. Ingargiola, C.D. Lopez, P. Sanati-Mehrizy, N.M. Burish, E.M. Jablonka, P.J. Taub
BackgroundPhalloplasty poses a unique challenge to the plastic and reconstructive surgeon. The development of advanced microsurgical techniques has greatly augmented the range of surgical approaches available.MethodsA systematic review of the MEDLINE and Cochrane databases was performed to identify clinical studies of total penile reconstruction published within the last 10 years using the search algorithm: "(phallus or penis or penile) and (reconstruction or phalloplasty or transplant)".ResultsThe primary literature search retrieved 1400 articles. After applying inclusion and exclusion criteria, 30 studies were selected for review. The radial forearm free flap is the preferred technique for total phalloplasty; however, other techniques including the fibular osteocutaneous flap, anterolateral thigh flap, latissimus dorsi flap, scapular free flap, and abdominal flap are described. Background, indications, and preoperative and postoperative care are also discussed.ConclusionsTotal penile reconstruction can provide functional, aesthetic, and psychosocial benefits to the patient. Use of the radial forearm free flap has been proposed as the gold standard; however, the wide range of potential complications associated with phalloplasty warrants an individualized approach to each patient.
An analysis of the breast reduction mammaplasty research pipeline
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): Jake X. Checketts, Alaina Simpson, Jared Scott, Lacy Brame, Laurie Duckett, Matt Vassar
EURAPS Editorial: BIA-ALCL, a brief overview
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): Fabio Santanelli di Pompeo, Michail Sorotos
Response to: Studying the blood pressures of antegrade and retrograde internal mammary vessels: Do they really work as recipient vessels? Tomioka YK, Uda H, Yoshimura K, Sunaga A, Kamochi H, Sugawara Y. J Plast Reconstr Aesthet Surg. 2017 Oct;70(10):1391–1396
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): J.D. Martin-Smith, S.P. Mackey, K.W. Ramsey
Intralesional cryotherapy versus excision with corticosteroid injections or brachytherapy for keloid treatment: Randomised controlled trials
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): Eveline Bijlard, Reinier Timman, Gerda M. Verduijn, Frank B. Niessen, Steven E.R. Hovius, Marc A.M. Mureau
BackgroundKeloids are a burden for patients due to physical, aesthetic and social consequences. Treatment remains a challenge due to therapy resistance and high recurrence rates. The main goals of treatment are to improve scar appearance and symptoms and patients' quality of life (QoL).MethodsTwo multicentre, randomised controlled open trials that compared 1) intralesional cryotherapy with excision and corticosteroid injections for primary keloids, and 2) intralesional cryotherapy with excision and brachytherapy for therapy resistant keloids. Primary outcome was scar appearance assessed with the Patient and Observer Scar Assessment Scale. Secondary outcomes were patient reported QoL (Skindex-29, SF-36, EQ-5D-5L), recurrence rates and scar volume reduction. For analysis, a linear mixed model was used. Power analysis indicated 33 patients in each group were needed.ResultsThe trial was prematurely terminated after inclusion of 26 patients due to unexpectedly inferior outcomes after intralesional cryotherapy. For primary keloids no convincing difference between treatments was found, but surgery improved scar appearance while cryotherapy did not. For resistant keloids, excision followed by brachytherapy improved scar appearance (POSAS) and scar symptoms (itch and pain) significantly (p < 0.001, p < 0.001 and p = 0.006 respectively) while cryotherapy did not. Neither of the treatments caused indisputable improvements in QoL.ConclusionsIntralesional cryotherapy is inferior to keloid excision followed by brachytherapy for resistant keloids. In primary keloids, intralesional cryotherapy reduced keloid volume and, therefore, may be used in these patients and specific cases. Primary keloid group size was too small to draw valid conclusions, further research on the efficacy of intralesional cryotherapy for primary keloids is warranted.
Factors predicting health-related quality of life following necrotizing fasciitis
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): J.P. Gawaziuk, R. Strazar, N. Cristall, S. Logsetty
BackgroundNecrotizing fasciitis (NF) is a debilitating soft tissue infection that results in disfiguring scars and often amputations. While mortality rates have improved, long-term outcomes in survivors of NF are poorly understood.ObjectivesThe objective of this study is to analyze the impact of NF on survivors' health-related quality of life (HRQoL) influenced by age, sex, comorbidities, %TBSA, and confidence with appearance.MethodsWe surveyed 56 adult patients with NF treated at either of two regional referral centers in Manitoba, Canada, between January 1, 2004, and December 31, 2014. Necrotizing soft tissue infections involving the fascial planes were identified during surgical debridement. HRQoL was measured by the Medical Outcomes Short Form-36. Derriford Appearance Scale-24, age, sex, comorbidities, and %TBSA were recorded, and group comparisons and stepwise regression models were developed for the mental and physical component scores separately.ResultsMean Mental Component Score (MCS) was 44.5 ± 14.3 and mean Physical Component Score (PCS) was 36.5 ± 11.5; both means were lower than the Canadian population norm of 50. Although stepwise linear regression analyses with block entry indicated influence from age, sex, and comorbid conditions for the MCS and PCS, the only factors that were statistically significant in the final models were confidence with appearance for the MCS and %TBSA for the PCS.ConclusionsNF has long-term impact on mental and physical health-related quality of life. Distress regarding confidence with appearance affects mental quality of life, whereas the size of the injured area impacted physical quality of life. These findings can help guide targeted interventions that could potentially improve recovery from NF.
Coverage of the dorsal surface of a digit based on a pedicled free-style perforator flap concept
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): Satoshi Usami, Kohei Inami, Yuichi Hirase
BackgroundReconstruction of the finger and thumb dorsum has been considered difficult because of the need for a thin and flexible flap, and the surrounding tissue is sometimes insufficient for a local flap. The purpose of this report is to describe our concept for finger and thumb dorsum reconstruction with free-style perforator flaps and our clinical experience with transfer of various perforator flaps.MethodsThirty-two finger dorsum defects in 32 patients were covered with pedicled free-style perforator flaps. The perforator origin was a digital artery perforator in 22 cases and a dorsal metacarpal artery perforator in 10 cases. The flap style was advancement type in 11 cases, rotation in 2, propeller in 14, and adipofascial in 5.ResultsThe mean size of the digital artery perforator flap was 3.4 cm2 and that of the dorsal metacarpal artery perforator flap was 7.9 cm2. All flaps, except for two propeller flaps with 180 degrees rotation, survived completely. These flaps were of elongated style, and the length-to-width ratios were approximately 3:1 and 3.5:1, respectively.ConclusionsThere are multiple perforators in the finger and thumb dorsum region from the proper digital artery, which are suitable for pedicled free-style perforator flaps. These perforators increase flap flexibility and reliability in clinical applications.
Routine closure of the donor site with a second dorsal metacarpal artery flap to avoid the use of a skin graft after harvest of a first dorsal metacarpal artery flap
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): Zhenglin Chi, Damu Lin, Yiheng Chen, Jixin Xue, Shi Li, Tinggang Chu, Zhijie Li
AimClosure of the donor site on the index finger after raising a first dorsal metacarpal artery (DMA) flap harvest is challenging. The conventional choice is to use a full-thickness skin graft. However, this procedure is associated with several complications and a second donor site to harvest the skin graft is inevitable. The aim of this study was to design a modified incision to allow harvest of a first DMA flap without skin graft.MethodsFrom 2015 to 2016, 18 patients with a soft tissue defect of the thumb had reconstruction of the defect using a first DMA flap. A modified incision was used and a relaying perforator flap pedicled on the second DMA was raised through the same incision to cover the donor site. Patient satisfaction, appearance of the injured hand, and the active range of motion (ROM) were assessed. The sensitivity was evaluated by the 2-point discrimination (2-PD) test.ResultsAll flaps survived completely without complications. Good coverage was obtained with only one linear scar in the dorsum of the hand and no skin grafts. All patients recovered full range of movement in their fingers and regained sensitivity of the flaps. All patients were satisfied with their hand function according to the Michigan Hand Outcomes Questionnaire (MHQ). The mean cosmetic score for the appearance of the injured hand was 8.2 out of 10.ConclusionsUsing our modified incision, it was possible to harvest a second DMA flap at the same time as a first DMA flap allowing simultaneous coverage of the donor defect on the index finger. This prevented the need for a skin graft with all of the associated disadvantages.
A retrospective study of closed extension block pinning for mallet fractures: Analysis of predictors of postoperative range of motion
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): Satoshi Usami, Sanshiro Kawahara, Hayato Kuno, Hiroshi Takamure, Kohei Inami
BackgroundExtension block pinning is a simple and reliable technique for mallet fractures, but poor results are sometimes obtained. The predictors of postoperative range of motion after extension block pinning of mallet fingers were investigated.MethodsThe outcomes for postoperative active motion of the distal interphalangeal (DIP) joint, such as flexion angle, extension loss, and total range of motion, were examined. Predictors such as age, gender, finger, fragment size, joint subluxation, the time from injury to operation, procedure, fixation angle, the time from operation to wire removal, and joint step-off were evaluated statistically.ResultsWith a mean 12.2-month follow-up, according to Crawford's criteria, 49 of 116 fingers (42%) had an excellent result, 37 (32%) had a good result, 29 (25%) had a fair result, and 1 (1%) had a poor result. The mean flexion angle was 62.9 ± 13.2°, extension loss was −6.6 ± 7.3°, and total range of motion was 55.8 ± 17.0° in the DIP joint. Pin tract infections were confirmed in 7 fingers with poor results. There were no complaints about nail deformity or skin abnormality. On multivariate analysis, significant predictors of poor postoperative motion were increased age chronic case, remained joint step-off, excess flexed fixation angle, and long-term wire placement.ConclusionsExtremely flexed fixation and chronic case easily causes extension loss in the DIP joint. In closed extension block pinning, joint fixation with an extreme flexion angle should be avoided and the pinning wire should be removed as soon as possible after confirming bony union.
Reduction of the DIEP flap donor site morbidity through a minimally invasive pedicle harvest with Jacob's ladder incisions
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): Laurenz Weitgasser, Amro Amr, Franziska Leandra Reutzsch, Thomas Schoeller
The pedicled internal pudendal artery perforator (PIPAP) flap for ischial pressure sore reconstruction: Technique and long-term outcome of a cohort study
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): Catherine M. Legemate, Monique van der Kwaak, David Gobets, Menno Huikeshoven, Paul P.M. van Zuijlen
BackgroundThe ischial region is the site most affected by pressure sores and has the highest recurrence and complication rates compared to other affected sites. We developed a practical and safe pedicled flap for reconstruction of ischial pressure sores based on the rich available perforators from the internal pudendal artery and the surplus of skin at the infragluteal fold.MethodsA retrospective cohort study was conducted in all patients who underwent ischial pressure ulcer reconstruction using the PIPAP flap between March 2010 and March 2017. The skin flap was designed along the gluteal fold. The skin perforators of the pudendal artery were marked with a Doppler probe in the medial region of the gluteal fold. Surgery was performed in the jackknife position, and flaps were elevated in the suprafascial plane. Patients were assessed for minor (requiring no additional surgery) and major complications (requiring additional surgery).ResultsTwenty-seven patients (34 flaps) were identified. The median follow-up period was 38 months (IQR 37). Primary closure of the donor-site was achieved in all procedures, only one flap required muscle flap transposition in order to fill the dead space. The mean operating time was 60 ± 21 minutes. In six flaps (9%) wound healing problems were noted that did not require an additional operative procedure. Among the nine flaps (27%) that required a second procedure, 3 (9%) were necessary due to recurrent ulcers.ConclusionsThe PIPAP flap is a safe and reliable alternative for ischial pressure sore reconstruction, certainly when compared to available techniques. Moreover, it has significant advantages over other techniques including minimal donor-site morbidity, preservation of posterior thigh skin, buttock-line integrity and reliable vascularity.
Time course of improvement after re-repair procedure for VPI management
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): Ahmed Elsherbiny, Meghan Amerson, Laura Sconyers, John H. Grant
ObjectivesPalatal re-repair aims to improve velar function by retro-positioning the levator veli palatini muscles. The surgery includes extensive dissection, leading to tissue edema and scar formation which may need time to remodel. Together with the change of muscle orientation and tension, it is expected that a period of time is needed to reach the final functional performance. This study attempts to determine how much time is required to reach the optimum performance of the palate after re-repair.MethodsA retrospective chart review identified consecutive cleft patients with VPI who underwent palate re-repair procedure by a single surgeon from 2000 to 2015 and achieved normal or borderline normal VP function. Only patients who had regular postoperative follow-up visits for speech assessments until resolution of speech abnormalities were included. The percent of patients cured at each time point following surgery was recorded.ResultsForty-five patients met the inclusion criteria. The mean age at surgery was 6.6 ± 3.2 years. Speech abnormalities had resolved in 44.5% of patients within the first 6 months after surgery, 62.2% after up to 1 year, 75.6% after up to 2 years and 88.9% after up to 3 years post re-repair palatoplasty. The remaining 11.1% continued to improve after 3 years up to 6 years.ConclusionsRe-repair procedures may take a longer time than previously thought for the final outcome to manifest. Close monitoring of improvement with continued speech therapy is recommended before deciding to move to the next surgical step in management.
Response to “Letter to the editor: Predictors of internal mammary vessel diameter: A computed tomographic angiography-assisted anatomic analysis”, Madada-Nyakauru, et al.
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): Julia A. Cook, Sunil S. Tholpady, Arash Momeni, Michael W. Chu
Reply – Preventing the cheese-wire effect by combining Steri-Strips™ and sutures for the management of lacerations in thin-skinned individuals. January 2017 Volume 70, Issue 1, Pages 134–136.
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): Mahmoud K. Nassar, Daniel J. Jordan, Alex Munnoch
Influence of dressing application time after breast augmentation on cutaneous colonization: A randomized clinical trial
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): D.A. Mendes, D.F. Veiga, J. Veiga-Filho, A.B.A.T. Loyola, L.F. Paiva, N.F. Novo, M. Sabino-Neto, L.M. Ferreira
Concepts regarding the best way to treat a surgical wound vary, in literature, ranging from no dressing use to dressing maintenance for 24 to 48 hours or until suture removal. This study aimed to evaluate the influence of the length of dressing maintenance after breast augmentation with implants on cutaneous colonization and surgical site infection. This is a two-arm, parallel group, randomized clinical trial. Eighty patients who were candidates for augmentation mammoplasty with silicone implants were randomly allocated to two groups, in which the dressing was removed on postoperative day 1 (group A, n = 40) or postoperative day 6 (group B, n = 40). Cutaneous colonization was examined by culturing samples collected before and after dressing removal. The criteria defined by the Centers for Disease Control and Prevention were used to assess surgical site infection. No significant difference regarding cutaneous colonization was observed between groups before dressing application. On postoperative day 6, significantly more bacterial growth was observed in group A (p = 0.01). No surgical site infection occurred. We concluded that maintaining the dressing for 6 days led to a lower cutaneous colonization but did not influence surgical site infection rates.
‘Abdominal reanimation’ and massive flank hernias: Moving towards a more functional reconstruction
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): Parviz Sadigh, Josh Burke, Dariush Nikkhah, Cinzia Sammartino, Carmelo Puliatti, Rajesh Sivaprakasam, Charles Knowles
Surgical treatment of axillary bromhidrosis by combining suction-curettage with subdermal undermining through a miniature incision
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): Jinguang He, Tao Wang, Yi Zhang, Jiasheng Dong
The suction-curettage technique has been widely applied in the treatment of axillary bromhidrosis. However, it can only moderately eradicate the malodor. From 2011 to 2013, we performed the suction-curettage procedure alone in 91 patients with primary axillary bromhidrosis (group A). From 2014 to 2016, we refined the suction-curettage technique by performing wide subdermal scissors undermining through a miniature incision in 80 patients (group B). Through a miniature incision at the inferior pole of the central axillary crease, the entire subcutaneous tissues containing apocrine glands were initially dissected with scissors within the axillary area and then the undermined apocrine glands were removed by suction-curettage. In group B, 87.5 percent of axillae (140/160) showed significant malodor eradication postoperatively, which was higher than the 33 percent of axillae (60/182) associated with the group A (p < 0.01). Accordingly, patients in group B had a higher satisfaction about the procedure and life quality improvement (p < 0.01). The overall complication rate for the group B was 13.7 percent, which was significantly higher than the 4.4 percent complication rate in the group A (p < 0.01). By combining the suction-curettage with subdermal undermining through a miniature incision, we could achieve a higher curative effect for primary axillary bromhidrosis in comparison to the suction-curettage technique alone. The complication rate was significantly higher than the suction-curettage alone but the final result was acceptable to the patients.
Is flucloxacillin monotherapy sufficient for the treatment of skin and soft tissue infections in plastic surgery?
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): Andrew R. McKean, Dinesh Aggarwal, Jana Torres-Grau, Ted Welman, Luke S.P. Moore, Isabel Jones
Targeted muscle reinnervation: Advances and opportunities
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): Norbert Kang, Alexander C.S. Woollard
Lymphaticovenular anastomosis for breast cancer treatment-related lymphedema: Three-line strategy for an optimal outcome
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 6
Author(s): Yukio Seki, Takumi Yamamoto, Akiyoshi Kajikawa
An improved export coefficient model to estimate non-point source phosphorus pollution risks under complex precipitation and terrain conditions
Abstract
To control non-point source (NPS) pollution, it is important to estimate NPS pollution exports and identify sources of pollution. Precipitation and terrain have large impacts on the export and transport of NPS pollutants. We established an improved export coefficient model (IECM) to estimate the amount of agricultural and rural NPS total phosphorus (TP) exported from the Luanhe River Basin (LRB) in northern China. The TP concentrations of rivers from 35 selected catchments in the LRB were used to test the model's explanation capacity and accuracy. The simulation results showed that, in 2013, the average TP export was 57.20 t at the catchment scale. The mean TP export intensity in the LRB was 289.40 kg/km2, which was much higher than those of other basins in China. In the LRB topographic regions, the TP export intensity was the highest in the south Yanshan Mountains and was followed by the plain area, the north Yanshan Mountains, and the Bashang Plateau. Among the three pollution categories, the contribution ratios to TP export were, from high to low, the rural population (59.44%), livestock husbandry (22.24%), and land-use types (18.32%). Among all ten pollution sources, the contribution ratios from the rural population (59.44%), pigs (14.40%), and arable land (10.52%) ranked as the top three sources. This study provides information that decision makers and planners can use to develop sustainable measures for the prevention and control of NPS pollution in semi-arid regions.
Seasonal variations and relationships between environmental parameters and heavy metal concentrations in tissues of Crassostrea species and in its ambience from the tropical estuaries
Abstract
This study aimed to evaluate the relationship between physicochemical parameters and heavy metal (Cu, Ni, Pb, and Cd) concentrations from sediment, seawater, and its accumulation in tissues of oyster species (Crassostrea madrasensis and C. gryphoides) from the three sites (Chicalim Bay (CB), Nerul Creek (NC), Chapora Bay (ChB)) along the Goa coast (India). Results showed enrichment of Cu and Ni in sediment exceeding the effect range low (ERL) level. The higher concentrations of Cu and Ni in sediments and in suspended particulate matter (SPM) from all the study sites are indicative of severe contamination of estuarine and associated habitats. Moreover, particulate Ni (at all the sites), Cu (at NC and ChB), Pb (at NC), and Cd (at CB and NC) concentrations were recorded more than its total loadings in surface sediment. Concentration of Cu and Cd in oyster tissue was several folds higher than its concentration in ambience. Further, this study showed that the levels of metal in oysters and their ambient environment were higher during the monsoon season. Hence, the consumption of oysters needs to be considered carefully with respect to the health hazards posed by the elevated levels of metal contaminants in certain seasons. The present study concludes that metals associated with the particulate matter in water column are the main source of metal accumulation in oyster. It is also suggested that concentration of metal pollutants in coastal and estuarine water bodies should be monitored regularly to ensure the acceptable limits of metal concentrations.
Naringin protects against cyclophosphamide-induced hepatotoxicity and nephrotoxicity through modulation of oxidative stress, inflammation, apoptosis, autophagy, and DNA damage
Abstract
Cyclophosphamide (CP) is a common chemotherapeutic agent that is effective against a wide variety of tumors. The associated hepatotoxicity and nephrotoxicity, however, limit its therapeutic use. Naringin (NG) is a natural flavanone glycoside that has pharmacological and therapeutic activities, such as anti-inflammation, anti-apoptotic, and antioxidant properties. Therefore, the present study was undertaken to evaluate the protective effect of NG against CP-induced hepatotoxicity and nephrotoxicity in rats. Rats were pre-treated with NG (50 and 100 mg/kg b.w.) for 7 days before administering a single dose of CP (200 mg/kg b.w.) on the seventh day. CP-induced hepatotoxicity and nephrotoxicity were associated with an increase in serum toxicity markers and a decrease in antioxidant enzyme activities. CP also induced inflammatory responses by increasing the levels of tumor necrosis factor-α (TNF-α), nuclear factor kappa B (NF-κB), interleukin-6 (IL-6), and interleukin-1β (IL-1β), and activities of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2). Moreover, it activated the apoptotic and autophagic pathway by increasing cysteine aspartate-specific protease-3 (caspase-3) expression and light chain 3B (LC3B) level and also increased the expression of 8-hydroxy-2′-deoxyguanosine (8-OHdG), which is the marker of oxidative DNA damage. Pre-treatment with NG (50 and 100 mg/kg), however, significantly decreased serum toxicity markers, increased antioxidant enzyme activities, and regulated inflammation, apoptosis, autophagy, and oxidative DNA damage in hepatic and renal tissues. These results indicated that NG was an effective protectant against CP-induced hepatotoxicity and nephrotoxicity.
Modeling and multi-objective optimization for ANAMMOX process under COD disturbance using hybrid intelligent algorithm
Abstract
Anaerobic ammonium oxidation (ANAMMOX) has been regarded as an efficient process to treat nitrogen-containing wastewater. However, the treatment process is not fully understood in terms of reaction mechanisms, process simulation, and control. In this paper, a multi-objective control strategy mixed soft-sensing model (MCSSM) is developed to systematically design the operating variations for multi-objective control by integrating the developed model, a least square support vector machine optimized with principal component analysis (PCA-LSSVM) and non-dominated sorting genetic algorithm-II (NSGA-II). The results revealed that the PCA-LSSVM model is a feasible and efficient tool for predicting the effluent ammonia nitrogen concentration ( \( {C}_{NH_4^{+}-N, eff} \) ) and the total nitrogen removal concentration (CTN, rem ) with determination coefficients (R2) were 0.997 for \( {C}_{NH_4^{+}-N, eff} \) and 0.989 for CTN, rem , and gives us the reasonable solutions in influent by using NSGA-II. To achieve a better removal effect, the influent pH should be kept between 7.50 and 7.52, the COD/TN ratio is suggested to maintain at 0.15 and the NH4+-N/NO2−-N ratio is suggested to maintain at 0.61. The developed MCSSM approach and its general modeling framework have a high potential of applicability and guidance to bioprocess in wastewater treatment, and numerical models can be structured for predicting and optimization and experiments can be conducted for data acquisition and model establishment.
Faktenblatt: Epidemiologie des malignen Melanoms in Deutschland
Zusammenfassung
Dieses Faktenblatt bietet eine Übersicht über die Epidemiologie zum malignen Melanom in Deutschland, dabei wird für beide Geschlechter die Inzidenz und Mortalität sowie das 10-Jahres-Überleben für das maligne Melanom insgesamt und für einzelne histologische Subtypen dargestellt.
MRI Characteristics of Primary Tumors and Metastatic Lesions in Molecular Subgroups of Pediatric Medulloblastoma: A Single-Center Study [PEDIATRICS]
BACKGROUND AND PURPOSE:
Molecular grouping of medulloblastoma correlates with prognosis and supports the therapeutic strategy. We provide our experience with the imaging features of primary and metastatic disease in relation to the molecular groups.
MATERIALS AND METHODS:One hundred nineteen consecutive patients (mean age, 7.3 ± 3.8 years at diagnosis; male, 79 [66.4%]) with a confirmed diagnosis of medulloblastoma and interpretable pretreatment MRIs were retrieved from our data base from January 2000 to December 2016. Each patient was assigned to wingless, sonic hedgehog, group 3, or group 4 molecular groups. Then, we determined the imaging features of both primary and metastatic/recurrent disease predictive of molecular groups.
RESULTS:In addition to recently reported predictors based on primary tumor, including cerebellar peripheral location for sonic hedgehog (adjusted odds ratio = 9, P < .0001), minimal enhancement of primary group 4 tumor (adjusted odds ratio = 5.2, P < .0001), and cerebellopontine angle location for wingless (adjusted odds ratio = 1.4, P = .03), ependymal metastasis with diffusion restriction and minimal postcontrast enhancement ("mismatching pattern") (adjusted odds ratio = 2.8, P = .001) for group 4 and spinal metastasis for group 3 (adjusted odds ratio = 1.9, P = .01) also emerged as independent predictors of medulloblastoma molecular groups. Specifically, the presence of a metastasis in the third ventricular infundibular recess showing a mismatching pattern was significantly associated with group 4 (P = .02).
CONCLUSIONS:In addition to imaging features of primary tumors, some imaging patterns of metastatic dissemination in medulloblastoma seem characteristic, perhaps even specific to certain groups. This finding could further help in differentiating molecular groups, specifically groups 3 and 4, when the characteristics of the primary tumor overlap.
Randomized Assessment of the Safety and Efficacy of Intra-Arterial Infusion of Autologous Stem Cells in Subacute Ischemic Stroke [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
Stroke is a debilitating illness for which treatment window is limited. Most patients present to the healthcare facility beyond that window. Autologous stem cells have shown some promise for this group of patients. This study was performed to evaluate the safety and the efficacy of intra-arterial infusion of bone marrow–derived mononuclear cells in patients with middle cerebral artery ischemic stroke.
MATERIALS AND METHODS:A prospective, randomized, open-label, blinded–end point study was performed from July 2015 to June 2016. Of 229 patients with acute stroke who presented to the hospital during this period, 20 patients who satisfied the inclusion/exclusion criteria were included and randomized into the control and intervention groups. Intra-arterial stem cell infusion into the ipsilateral MCA was performed in the patients in the intervention group at 8–15 days post-stroke ictus. Final analysis at 6 months was performed for primary (safety) and secondary outcomes (efficacy).
RESULTS:When we compared the primary end point of the study, no procedure-related mortality, complication, new infarct, or symptomatic intracranial hemorrhage was seen in the intervention group. When we compared the secondary end point of good clinical outcome, 8 (80%) patients in the intervention group showed good clinical outcome (modified Rankin Scale score < 2) with 4 (40%) patients in the control group achieving this (95% confidence interval for good outcome in patients with stem cell infusion, 49.03–94.3, and without stem cell infusion, 16.82–68.73; P = .068).
CONCLUSIONS:Intra-arterial infusion of stem cells can be carried out safely in the subacute stage of ischemic stroke. Improved clinical outcomes were observed with intra-arterial stem cell therapy; however, studies with larger cohorts are needed to validate the results.
Evaluation of the Normal Cochlear Second Interscalar Ridge Angle and Depth on 3D T2-Weighted Images: A Tool for the Diagnosis of Scala Communis and Incomplete Partition Type II [HEAD & NECK]
BACKGROUND AND PURPOSE:
Cochlear malformations may be be subtle on imaging studies. The purpose of this study was to evaluate the angle and depth of the lateral second interscalar ridge or notch in ears without sensorineural hearing loss (normal ears) and compare them with ears that have a documented incomplete type II partition malformation.
MATERIALS AND METHODS:The second interscalar ridge notch angle and depth were measured on MR imaging in normal ears by a single experienced neuroradiologist. The images of normal and incomplete partition II malformation ears were then randomly mixed for 2 novice evaluators to measure both the second interscalar ridge notch angle and depth in a blinded manner. For the mixed group, interobserver agreement was calculated, normal and abnormal ear measurements were compared, and receiver operating characteristic curves were generated.
RESULTS:The 94 normal ears had a mean second interscalar ridge angle of 80.86° ± 11.4° and depth of 0.54 ± 0.14 mm with the 98th percentile for an angle of 101° and a depth of 0.3 mm. In the mixed group, agreement between the 2 readers was excellent, with significant differences for angle and depth found between normal and incomplete partition type II ears for angle and depth on average (P < .001). Receiver operating characteristic cutoffs for delineating normal from abnormal ears were similar for both readers (depth, 0.31/0.34 mm; angle, 114°/104°).
CONCLUSIONS:A measured angle of >114° and a depth of the second interscalar ridge notch of ≤0.31 mm suggest the diagnosis of incomplete partition type II malformation and scala communis. These measurements can be accurately made by novice readers.
The Importance of Flexion MRI in Hirayama Disease with Special Reference to Laminodural Space Measurements [SPINE]
BACKGROUND AND PURPOSE:
Hirayama disease is a benign focal amyotrophy of the distal upper limbs involving C7, C8, and T1 segmental myotomes with sparing of the brachioradialis and proximal muscles of the upper limb innervated by C5–6 myotomes. The objective of the present study was to study the utility of MR imaging in young patients presenting with weakness and wasting of the distal upper extremity and to evaluate the importance of the laminodural space during flexion cervical MR imaging.
MATERIALS AND METHODS:This was a prospective cross-sectional study conducted from January 2014 to July 2017 in a tertiary care center from Northeast India. Forty-five patients with clinically definite Hirayama disease underwent electrophysiologic evaluation followed by MR imaging of the cervical spine.
RESULTS:The mean age at recruitment was 22.8 ± 5.5 years. Forty patients (88.9%) had unilateral and 5 (11.1%) had bilateral upper extremity involvement. Cervical cord T2-weighted hyperintensities were demonstrated in 16 patients (35.6%), of which 15 (33.3%) had anterior horn cell hyperintensities. Flexion MR imaging showed loss of the posterior dural attachment, forward shifting of the posterior dural sac with postcontrast enhancement, and prominent posterior epidural venous plexus in all patients. The laminodural space at maximum forward shifting of the posterior dural sac ranged from 3 to 9.8 mm, with a mean distance of 5.99 mm (95% confidence interval, 5.42–6.57 mm).
CONCLUSIONS:Flexion cervical MR imaging is a very useful investigation in diagnosing Hirayama disease. The increase in the laminodural space and the presence of cervical cord flattening during flexion are essential for diagnosis.
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.
Aneurysmal Parent Artery-Specific Inflow Conditions for Complete and Incomplete Circle of Willis Configurations [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
Hemodynamics are thought to play a role in intracranial aneurysm growth and rupture. Computational fluid dynamics is frequently performed to assess intra-aneurysmal hemodynamics, using generalized flow waveforms of healthy volunteers as inflow boundary conditions. The purpose of this study was to assess differences in inflow conditions for different aneurysmal parent artery locations and variations of circle of Willis configurations.
MATERIALS AND METHODS:In a series of 96 patients with 103 aneurysms, velocity measurements were acquired using 2D phase-contrast MR imaging perpendicular to the aneurysmal parent arteries in the circle of Willis. Circle of Willis configurations were inspected for variations using multiple overlapping thin-slab-acquisition MRAs. Flow rates, velocity magnitudes, and pulsatility indices were calculated for each parent artery location in subgroups of complete and incomplete circle of Willis configurations.
RESULTS:Flow rates, velocity magnitudes, and pulsatility indices were significantly different among aneurysmal parent arteries. Incomplete circle of Willis configurations were observed in 24% of the cases. Significantly lower basilar artery flow rates were observed in configurations with hypoplastic P1 segments. Significantly higher A1 flow rates were observed in configurations with a hypoplastic contralateral A1 segment.
CONCLUSIONS:Inflow conditions vary substantially between aneurysmal parent arteries and circle of Willis configurations. We have created a collection of parent artery–specific inflow conditions tailored to the patient-specific circle of Willis configuration that can be used in future computational fluid dynamics studies analyzing intra-aneurysmal hemodynamics.
Vertebroplasty and Kyphoplasty for Osteoporotic Vertebral Fractures: What Are the Latest Data? [SPINE]
SUMMARY:
Osteoporotic vertebral compression fractures frequently result in significant morbidity and health care resource use. For patients with severe and disabling pain, vertebral augmentation (vertebroplasty and kyphoplasty) is often considered. Although vertebroplasty was introduced >30 years ago, there are conflicting opinions regarding the role of these procedures in the treatment of osteoporotic vertebral compression fractures. This review article updates clinicians on the published prospective randomized controlled data, including the most recent positive trials that followed initial negative trials in 2009. Analysis of multiple national claim datasets has also provided further insight into the utility of these procedures. Finally, we considered the recent recommendations of national organizations and medical societies that advise on the use of vertebral augmentation procedures for osteoporotic vertebral compression fractures.
Brain Diffusion Abnormalities in Children with Tension-Type and Migraine-Type Headaches [PEDIATRICS]
BACKGROUND AND PURPOSE:
Tension-type and migraine-type headaches are the most common chronic paroxysmal disorders of childhood. The goal of this study was to compare regional cerebral volumes and diffusion in tension-type and migraine-type headaches against published controls.
MATERIALS AND METHODS:Patients evaluated for tension-type or migraine-type headache without aura from May 2014 to July 2016 in a single center were retrospectively reviewed. Thirty-two patients with tension-type headache and 23 with migraine-type headache at an average of 4 months after diagnosis were enrolled. All patients underwent DWI at 3T before the start of pharmacotherapy. Using atlas-based DWI analysis, we determined regional volumetric and diffusion properties in the cerebral cortex, thalamus, caudate, putamen, globus pallidus, hippocampus, amygdala, nucleus accumbens, brain stem, and cerebral white matter. Multivariate analysis of covariance was used to test for differences between controls and patients with tension-type and migraine-type headaches.
RESULTS:There were no significant differences in regional brain volumes between the groups. Patients with tension-type and migraine-type headaches showed significantly increased ADC in the hippocampus and brain stem compared with controls. Additionally, only patients with migraine-type headache showed significantly increased ADC in the thalamus and a trend toward increased ADC in the amygdala compared with controls.
CONCLUSIONS:This study identifies early cerebral diffusion changes in patients with tension-type and migraine-type headaches compared with controls. The hypothesized mechanisms of nociception in migraine-type and tension-type headaches may explain the findings as a precursor to structural changes seen in adult patients with chronic headache.
Parent Artery Reconstruction for Large or Giant Cerebral Aneurysms Using the Tubridge Flow Diverter: A Multicenter, Randomized, Controlled Clinical Trial (PARAT) [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
Although flow diverters have been reported with favorable clinical and angiographic outcomes in various literatures, randomized trials determining their true effectiveness and safety are still in lack. The Parent Artery Reconstruction for Large or Giant Cerebral Aneurysms Using the Tubridge Flow Diverter (PARAT) trial was designed to evaluate the safety and efficacy of the Tubridge flow diverter in the treatment of large or giant aneurysms in comparison with Enterprise stent-assisted coiling.
MATERIALS AND METHODS:This prospective, multicenter, randomized trial was conducted at 12 hospitals throughout China. Enrolled adults with unruptured large/giant intracranial aneurysms were randomly assigned (1:1) to receive either Enterprise stent-assisted coiling or Tubridge flow diverter implantation. The primary end point was complete occlusion at 6-month follow-up, while secondary end points included technical success, mortality, target vessel–related stroke, aneurysm bleeding, in-stent stenosis, parent artery occlusion, and the frequency of all adverse events.
RESULTS:Among 185 enrolled subjects, 41 withdrew before procedure initiation. Overall, 82 subjects underwent Tubridge implantation, and 62 subjects were primarily treated with stent-assisted coiling. The results of 6-month follow-up imaging included complete occlusion rates of 75.34% versus 24.53% for the Tubridge and stent-assisted coiling groups, respectively, with a calculated common odds ratio of 9.4 (95% confidence interval, 4.14–21.38; P < .001). There was a higher, nonsignificant frequency of complications for Tubridge subjects. Multivariate analysis showed a decreased stroke rate at the primary investigational site, with a marginal P value (P = .051).
CONCLUSIONS:This trial showed an obviously higher rate of large and giant aneurysm obliteration with the Tubridge FD over Enterprise stent-assisted coiling. However, this higher obliteration rate came at the cost of a nonsignificantly higher rate of complications. Investigational site comparisons suggested that a learning curve for flow-diverter implantation should be recognized and factored into trial designs.
Prenatal Brain MR Imaging: Reference Linear Biometric Centiles between 20 and 24 Gestational Weeks [PEDIATRICS]
BACKGROUND AND PURPOSE:
Evaluation of biometry is a fundamental step in prenatal brain MR imaging. While different studies have reported reference centiles for MR imaging biometric data of fetuses in the late second and third trimesters of gestation, no one has reported them in fetuses in the early second trimester. We report centiles of normal MR imaging linear biometric data of a large cohort of fetal brains within 24 weeks of gestation.
MATERIALS AND METHODS:From the data bases of 2 referral centers of fetal medicine, accounting for 3850 examinations, we retrospectively collected 169 prenatal brain MR imaging examinations of singleton pregnancies, between 20 and 24 weeks of gestational age, with normal brain anatomy at MR imaging and normal postnatal neurologic development. To trace the reference centiles, we used the CG-LMS method.
RESULTS:Reference biometric centiles for the developing structures of the cerebrum, cerebellum, brain stem, and theca were obtained. The overall interassessor agreement was adequate for all measurements.
CONCLUSIONS:Reference biometric centiles of the brain structures in fetuses between 20 and 24 weeks of gestational age may be a reliable tool in assessing fetal brain development.
Localized Marked Elongation of the Distal Internal Carotid Artery with or without PHACE Syndrome: Segmental Dolichoectasia of the Distal Internal Carotid Artery [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Segmental intracranial dolichoectasia of the distal ICA is a feature of PHACE syndrome or a sporadic phenomenon. We evaluated the relationship between intracranial dolichoectasia of the distal ICA and PHACE syndrome and illustrated the characteristic radiologic findings of the lesions.
MATERIALS AND METHODS:Intracranial dolichoectasia of the distal ICA was identified in 20 patients at our institution from 2005 to 2016 through a review of diagnostic cerebral angiography results. All radiologic images were reviewed to determine the vascular morphologic dispositions around the distal ICA, including dysplasia, mural calcification, vessel wall enhancement, lumen narrowing, and aneurysm formation. Medical records were reviewed to determine the symptoms of PHACE syndrome. Subsequently, the correlation between radiologic findings and PHACE syndrome was assessed.
RESULTS:In this cohort, which had a strong female predominance (male/female ratio= 2:18), intracranial dolichoectasia had a more ipsilateral vascular morphologic disposition. Mural calcification was detected more frequently in elderly patients, whereas vessel wall enhancement was detected more frequently in younger patients. Follow-up images showed a slow progression of the lesions. However, no significant differences in the vascular morphologic disposition and brain structural changes were observed between patients with (n = 11) and without (n = 9) PHACE syndrome.
CONCLUSIONS:The striking elongation and tortuosity of the distal ICA generally appeared to be a type of congenital lesion occurring early in embryogenesis as either a sporadic phenomenon or an arterial change associated with PHACE syndrome. Imaging findings revealed various mural abnormalities with a benign clinical course.
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.
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.
Diagnosing Early Ischemic Changes with the Latest-Generation Flat Detector CT: A Comparative Study with Multidetector CT [ADULT BRAIN]
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.
Consensus guidelines for the use and interpretation of angiogenesis assays
Abstract
The formation of new blood vessels, or angiogenesis, is a complex process that plays important roles in growth and development, tissue and organ regeneration, as well as numerous pathological conditions. Angiogenesis undergoes multiple discrete steps that can be individually evaluated and quantified by a large number of bioassays. These independent assessments hold advantages but also have limitations. This article describes in vivo, ex vivo, and in vitro bioassays that are available for the evaluation of angiogenesis and highlights critical aspects that are relevant for their execution and proper interpretation. As such, this collaborative work is the first edition of consensus guidelines on angiogenesis bioassays to serve for current and future reference.
Migration and leaching characteristics of base cation: indicating environmental effects on soil alkalinity in a karst area
Abstract
In karst areas, rock dissolution often results in the development of underground networks, which act as subterranean pathways for rapid water and nutrient (and possibly soil) loss during precipitation events. Loss of soluble nutrients degrades surface soils and decreases net primary productivity, so it is important to establish flow pathways and quantify nutrient loss during rainfall events of different magnitudes. We conducted a simulated rainfall experiment in karst and nonkarst areas to compare the concentration of nutrients in surface and subsurface flow water and effects on soil alkalinity in three lithologic soil formations under five different rainfall intensity treatments. Compared with the nonkarst area, the runoff in subsurface flows and the proportion of nutrient loss in the subsurface flow are larger in the karst area and less affected by rain intensity. The maximum loss loads of calcium (Ca2+) and magnesium (Mg2+) ions were 32.9 and 19.8 kg ha−1, respectively. With the estimate of base cation loss loads in the China southern karst area under the rainfall intensity of 45 mm h−1, more than 80% of the base cation loss load occurred in the limestone karst area. Although the alkalinity leaching value in nonkarst was similar to that in the karst area under simulated rainfall conditions, its impact on the ecological environment was quite different.
Effect of titanium dioxide nanoparticles on the accumulation and distribution of arsenate in Daphnia magna in the presence of an algal food
Abstract
The impact of titanium dioxide nanoparticles (nano-TiO2) on the bioavailability of metals in aquatic filter-feeding organisms has rarely been investigated, especially in the presence of algae as a food source. In this study, we quantified the accumulation and subcellular distribution of arsenate (AsV) in Daphnia magna in the presence of nano-TiO2 and a green alga (Scenedesmus obliquus) food source. Results showed that S. obliquus significantly increased the accumulation of total arsenic (As) and titanium (Ti) in D. magna. The presence of this food source increased As in metal-sensitive fractions (MSF) and as biologically detoxified metals (BDM), while it decreased Ti levels in MSF but increased levels as BDM. The difference in the subcellular distribution of As and Ti demonstrates the dissociation of As from nano-TiO2 during digestion at subcellular partitioning irrespective of food availability. In turn, the presence of algae was shown to increase metal-based toxicity in D. magna due to the transfer of As from BMD to MSF. Furthermore, S. obliquus significantly increased the concentration of As and Ti in soluble fractions, indicating that As and nano-TiO2 ingested by D. magna could be transferred more readily to their predators in the presence of S. obliquus. Our study shows the potential of algae to increase the toxicity and biomagnification of AsV . Furthermore, it highlights food as an important factor in the toxicity assessment of nanomaterials and co-existing pollutants.
Solid-liquid separation: an emerging issue in heavy metal wastewater treatment
Abstract
Solid-liquid separation (SLS) plays a dominant role in various chemical industries. Nowadays, low efficiency of SLS also become a significant problem in heavy metal (HM) wastewater treatment, affecting the effluent quality (HM concentration and turbidity) and overall process economy. In this context, we summarize here the occurrence of solids in HM wastewater, as well as typical SLS operations used in HM wastewater treatment, including sedimentation, flotation, and centrifugation. More important, this article reviews the improvement of the SLS operations by some technologies, including coagulation, flocculation, ballasted method, seeding method, granular sludge strategy, and external field enhancement. It is noted that abiological granular sludge strategy and magnetic field enhancement often possess higher SLS efficiency (faster settling velocity or shorter separation time) than other methods. Hence, the two strategies stand out as promising tools for improving SLS in HM wastewater treatment, but further research is required regarding scalability, economy, and reliability.
Distribution of linear alkylbenzenes as a domestic sewage molecular marker in surface sediments of International Anzali Wetland in the southwest of the Caspian Sea, Iran
Abstract
Due to directly receiving high volume of untreated urban and industrial sewage and in turn transferring the pollutants to fish and back to humans, the International Anzali Wetland has been considered to be urgently registered in the Montreux Record. Hence, the present study was aimed to determine the spatial distribution of the linear alkylbenzenes (LABs) in surface sediments of the wetland and its sewage contamination situation. The surface sediments (sampling stations = 167) were collected from the western, eastern, southwest, and central regions of the wetland. The samples were extracted, fractioned, and then analyzed using gas chromatography–mass spectrometry (GC-MS). The concentration of LABs in the sediment samples revealed a range from 394.12 to 109,305.26 ng g−1 dw. The concentrations of ΣLABs in the eastern region were significantly higher than that in the other regions. The occurrence of low ratio of internal to external isomers (I/E ratio) of LABs (from 0.65 to 1.30) and D% (from − 0.07 to 24.13) implied effluent row or poorly untreated sewage into the wetland. No correlation was observed between the detected LAB concentrations with total organic carbon (TOC) and grain size. Taken together, regional anthropogenic inputs are the controlling factors for the observed spatial distributions of ∑LABs in the International Anzali Wetland. The findings suggested that LABs are powerful indicators to trace anthropogenic sewage contamination and also highlighted the necessity of sewage treatment plants to be founded around the International Anzali Wetland, especially in the vicinity of the eastern and central regions.
Nicht metastasiertes Rektumkarzinom
Zusammenfassung
Die Chirurgie nimmt die Schlüsselrolle in der kurativen Therapie des Rektumkarzinoms ein. Bei Niedrigrisikokarzinomen genügt die Vollwandexzision. Fortgeschrittenere oder biologisch aggressivere Karzinome im Stadium I werden im Sinne einer total mesorektalen Exzision operiert. Karzinome im Stadium II/III des oberen Drittels werden meist wie Kolonkarzinome behandelt. Bei ausgedehntem lymphogenem Befall oder organüberschreitendem Wachstum ist eine neoadjuvante Radiochemotherapie (RCTX) vor der Operation sinnvoll. Karzinome im Stadium II/III des unteren/mittleren Drittels werden multimodal behandelt. Dabei ist die neoadjuvante RCTX effektiver als die adjuvante, bei gleichzeitig besserer Verträglichkeit. Die Operation erfolgt nach einem Intervall von 6 bis 8 Wochen. In frühen Tumorstadien mit klinisch unsicherem Lymphknotenbefall kann der Verzicht auf die neoadjuvante RCTX gerechtfertigt sein. Bei kleinen Tumoren ohne Lymphknotenmetastasen ist alternativ auch ein organerhaltendes Vorgehen möglich.
Dynamic hydrogen-bond networks in bacterial protein secretion
Abstract
The Sec protein secretion machinery includes proteins whose reaction coordinates involve large-scale conformational changes. Dynamic hydrogen-bond networks can provide structural plasticity required by the SecA protein motor and the SecY protein translocon. Here we discuss hydrogen-bond networks of these two Sec proteins from crystal structures and molecular simulations, and the usefulness of molecular simulations approaches to studying dynamic hydrogen bonds and their role in bacterial protein secretion.Alternative strategies for lignocellulose fermentation through lactic acid bacteria: state-of-the-art and perspectives
Abstract
Lactic acid bacteria (LAB) have a long history in industrial processes as food starters and biocontrol agents, but also as producers of high-value compounds. Lactic acid, their main product, is among the most requested chemicals owing to its multiple applications including synthesis of biodegradable plastic polymers. Moreover, LAB are attracting candidates for production of ethanol, polyhydroalkanoates, sweeteners, exopolysaccharides, etc.. LAB generally have complex nutritional requirements. Moreover, they cannot directly ferment inexpensive feedstocks such as lignocellulose. This significantly increases the cost of LAB fermentation and hinders its application to produce high-volume low-cost chemicals. Different strategies have been explored to extend LAB fermentation to lignocellulosic biomass. Fermentation of lignocellulose hydrolysates by LAB has most often been reported and is the most mature technology. However, current economic constraints of this strategy have driven research for other alternative approaches. Co-cultivation of LAB with native cellulolytic microorganisms may allow to reduce the high cost of exogenous-cellulase supplementation. Special attention will be given here to construction of recombinant cellulolytic LAB by metabolic engineering which may generate strains able to directly ferment plant biomass. The present review will illustrate the state-of-the-art of these strategies and perspectives towards their application to industrial 2nd generation biorefinery processes.CRISPR/Cas9/sgRNA-mediated targeted gene modification confirms the cause-effect relationship between gyrA mutation and quinolone resistance in Escherichia coli
Abstract
Quinolones are broad-spectrum antibiotics that have been used for decades in treating bacterial infections in humans and animals, and subsequently bacterial resistance to these agents has increased. While studies indicated the relationship between gyrA mutations and bacterial resistance to quinolones, CRISPR/Cas9 was used in this study to investigate causal role of gyrA mutation in the quinolone resistance. In this study, 818 clinical Escherichia coli isolates were analyzed for gyrA mutations and their resistance to quinolones. The CRISPR/Cas9 system was used to generate gyrA mutations in quinolone-susceptible E. coli ATCC 25922, and quinolone-resistant clinical E. coli. The antimicrobial resistance prevalence rate in E. coli against nalidixic acid, ciprofloxacin and enrofloxacin was 77.1% (631/818), 51.1% (418/818) and 49.8% (407/818), respectively. The gyrA mutations were identified in nucleotide positions 248, 255, 259, 260, 261, 273 and 300, and mutations at positions 248 and 259 resulting in amino acid changes at positions 83 and 87 were associated with quinolone resistance. Double-site amino acid mutations increase resistance to quinolones. The gyrA mutations causing changes at amino acids 83 and 87 reversed the features of quinolone resistance in ATCC and clinical strains, verifying the causal role of gyrA mutation in the quinolone resistance of E. coli.Ultrastructural observation in a case of mucinous nevus
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.
Cutaneous leishmaniasis: PCR of filter paper blots from an ulcer base is an alternative to biopsy
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.
Lymphomatoid papulosis with folliculotropism, eccrinotropism and neurotropism
Journal of Cutaneous Pathology, EarlyView.
Ecological efficiency in China and its influencing factors—a super-efficient SBM metafrontier-Malmquist-Tobit model study
Abstract
Ecological problem is one of the core issues that restrain China's economic development at present, and it is urgently needed to be solved properly and effectively. Based on panel data from 30 regions, this paper uses a super efficiency slack-based measure (SBM) model that introduces the undesirable output to calculate the ecological efficiency, and then uses traditional and metafrontier-Malmquist index method to study regional change trends and technology gap ratios (TGRs). Finally, the Tobit regression and principal component analysis methods are used to analysis the main factors affecting eco-efficiency and impact degree. The results show that about 60% of China's provinces have effective eco-efficiency, and the overall ecological efficiency of China is at the superior middling level, but there is a serious imbalance among different provinces and regions. Ecological efficiency has an obvious spatial cluster effect. There are differences among regional TGR values. Most regions show a downward trend and the phenomenon of focusing on economic development at the expense of ecological protection still exists. Expansion of opening to the outside, increases in R&D spending, and improvement of population urbanization rate have positive effects on eco-efficiency. Blind economic expansion, increases of industrial structure, and proportion of energy consumption have negative effects on eco-efficiency.
Exploring innovative techniques for identifying geochemical elements as fingerprints of sediment sources in an agricultural catchment of Argentina affected by soil erosion
Abstract
Identification of hot spots of land degradation is strongly related with the selection of soil tracers for sediment pathways. This research proposes the complementary and integrated application of two analytical techniques to select the most suitable fingerprint tracers for identifying the main sources of sediments in an agricultural catchment located in Central Argentina with erosive loess soils. Diffuse reflectance Fourier transformed in the mid-infrared range (DRIFT-MIR) spectroscopy and energy-dispersive X-ray fluorescence (EDXRF) were used for a suitable fingerprint selection. For using DRIFT-MIR spectroscopy as fingerprinting technique, calibration through quantitative parameters is needed to link and correlate DRIFT-MIR spectra with soil tracers. EDXRF was used in this context for determining the concentrations of geochemical elements in soil samples. The selected tracers were confirmed using two artificial mixtures composed of known proportions of soil collected in different sites with distinctive soil uses. These fingerprint elements were used as parameters to build a predictive model with the whole set of DRIFT-MIR spectra. Fingerprint elements such as phosphorus, iron, calcium, barium, and titanium were identified for obtaining a suitable reconstruction of the source proportions in the artificial mixtures. Mid-infrared spectra produced successful prediction models (R2 = 0.91) for Fe content and moderate useful prediction (R2 = 0.72) for Ti content. For Ca, P, and Ba, the R2 were 0.44, 0.58, and 0.59 respectively.
Biomonitoring of chlorpyrifos exposure and health risk assessment among applicators on rice farms in Ghana
Abstract
Chlorpyrifos is a neurotoxic insecticide that is widely used in the agricultural sector of Ghana. The main objective of this study was to evaluate the levels of chlorpyrifos exposure and health risk among applicators (n = 21) on irrigated rice farms in Ghana, based on a typical application event. Pre- and post-application urine samples (24-h) were collected from the applicators and analysed for 3,5,6-trichloro-2-pyridinol (TCP), using LC-MS/MS. The levels of chlorpyrifos-absorbed dose with the applicators were estimated from the urinary TCP levels. Prior to application, the median absorbed dose of chlorpyrifos (background exposure) with the applicators was 0.2 μg/kg/day (range 0.05 to 2 μg/kg/day). Following application, the median absorbed dose of chlorpyrifos (application exposure) increased 30-fold to 6 μg/kg/day (range 0.7 to 74 μg/kg/day). The mean elimination half-life (t1/2) of chlorpyrifos was calculated to be 50 h. Hazard quotient (HQ) values (HQ > 1) obtained with the chronic (10 μg/kg/day) and acute (100 μg/kg/day) guideline values of the WHO suggested no risk of chronic or acute health effects, respectively, among both the median and 5% highly exposed groups. However, HQ values (HQ > 1) obtained with the chronic (0.3 μg/kg/day) and acute (5 μg/kg/day) guideline values of the USEPA suggested risk of chronic and acute health effects, respectively, among both the median and 5% highly exposed groups. The quantity of chlorpyrifos formulation applied, spraying duration, and the number of spray tanks applied significantly correlated with the absorbed dose levels of chlorpyrifos from application exposure. Therefore, these factors suggest means to reduce exposure and consequent health risk among the applicators.
Partitioning of particulate matter and elements of suburban continental aerosols between fine and coarse modes
Abstract
The results presented in this work demonstrate for the first time a distribution of elements in the spectral analysis of aerosols in the suburban continental Balkan Peninsula. Samples were collected in the suburban area of Belgrade (Serbia) in the period from March 2012 till December 2013. Results presented here are from long-term measurements of masses of size-segregated aerosols and macro- and microelements in the range of PM0.27–16. The following elements were analyzed: Al, Ag, As, Ba, Ca, Cd, Co, Cr, Cu, Fe, K, Mg, Mn, Mo, Na, Ni, Pb, Sb, Ti, Tl, V, and Zn; levels of Be, Hg, and Se were under the detection limits in all samples. Average concentrations and time and seasonal variations of particulate matter (PM) as well as element contents and their percentage shares are given. The results showed the domination of particle content around the accumulation mode in the range of 0.53 < Dp < 1.06 μm, but the fractional distribution of elements showed maximal average concentrations in different fractions depending on the origin of each element. Crustal elements (Al, Ca, Fe, Mg, Mn, Ti, etc.) dominated in coarse mode, while anthropogenic elements (As, Cd, Cu, Pb, Sb, etc.) were mainly distributed in fine mode fractions. Some elements, such are As and Ni, were detected in investigated aerosols only occasionally, while others, such as Ca, Fe, and Mg, were detected in all analyzed samples. The application of multivariate analysis (PCA) demonstrated the connection between the elements of similar origin, in fine fractions mainly of anthropogenic origin, while in coarse mode of crustal origin, indicating the resuspension with contribution of about 40%. The contents of some measured elements were compared with their contents in aerosols in some European suburban areas.
Fertilität und Schwangerschaft nach Krebserkrankung im Kindes- und Jugendalter
Zusammenfassung
Hintergrund
Die Kinderwunscherfüllung kinderonkologischer Patienten kann aufgrund ihrer Erkrankung und deren Therapie im Erwachsenenalter eingeschränkt und mit Komplikationen verbunden sein.
Fragestellung
Prävalenz von und Risikofaktoren für Fertilitätsstörungen, Schwangerschaftskomplikationen und Gesundheitsbeeinträchtigung der Nachkommen. Darstellung möglicher fruchtbarkeitserhaltender Maßnahmen und einer umfassenden ärztlichen Betreuung während der Schwangerschaft.
Material und Methode
Auswertungen der aktuellen Literatur und Leitlinien zur kinderonkologischen Nachsorge.
Ergebnisse
Nach Chemo- und/oder Strahlentherapie ist die Fruchtbarkeit bei etwa einem Drittel der Patienten beeinträchtigt, nach einer Stammzelltransplantation sind über zwei Drittel betroffen. Fruchtbarkeitserhaltende Maßnahmen für Patienten und Patientinnen stehen jedoch zur Verfügung. Tritt eine Schwangerschaft ein, verlaufen diese und die Geburt in der Regel unkompliziert. Komplikationen, wie Fehlgeburten, Frühgeburtlichkeit und niedriges Geburtsgewicht, treten insbesondere nach uteriner Strahlenbelastung auf. Patientinnen, die mit kardiotoxischen Zytostatika (v. a. Anthrazykline) therapiert wurden, können sich peripartal kardial verschlechtern. Die Nachkommen ehemaliger Patienten haben kein erhöhtes Risiko für Malformationen, genetische oder nichthereditäre maligne Erkrankungen.
Diskussion
Kinderwunsch und Kinderwunscherfüllung ehemaliger kinderonkologischer Patienten sollten durch eine frühzeitige und umfassende Aufklärung über das individuelle Risiko für Fruchtbarkeitsstörungen und fertilitätserhaltende Maßnahmen unterstützt werden. Den Betroffenen und ihren Familien soll eine selbstbestimmte Entscheidung in der Familienplanung ermöglicht werden.
Timing of radiotherapy in newly diagnosed glioblastoma: no need to rush?
Radiotherapy is a cornerstone of treatment of newly diagnosed glioblastoma. It has convincingly proven its value as part of the optimal management of glioblastoma in randomized trials, and is usually started within 6 weeks after surgery.1 It was initially tested as monotherapy after surgery but, since the publication of the phase III trial by the European Organisation for Research and Treatment of Cancer/National Cancer Institute of Canada in 2005, is universally given in combination with temozolomide chemotherapy.2 With the current approach, the overall prognosis of newly diagnosed glioblastoma remains, however, poor, with a 2-year survival rate of less than 30%.2
Genome-wide association analysis identifies a meningioma risk locus at 11p15.5
Abstract
BACKGROUND
Meningioma are adult brain tumors originating in the meningeal coverings of the brain and spinal cord, with significant heritable basis. Genome-wide association studies (GWAS) have previously identified only a single risk locus for meningioma, at 10p12.31. METHODS
To identify a susceptibility locus for meningioma, we conducted a meta-analysis of two GWAS, imputed using a merged reference panel of 1,000 Genomes and UK10K data, with validation in two independent sample series totaling 2,138 cases and 12,081 controls. RESULTS
We identified a new susceptibility locus for meningioma at 11p15.5 (rs2686876, odds ratio = 1.44, P = 9.86 × 10-9). A number of genes localize to the region of linkage disequilibrium encompassing rs2686876, including RIC8A, which plays a central role in the development of neural crest-derived structures, such as the meninges. CONCLUSIONS
This finding advances our understanding of the genetic basis of meningioma development and provides additional support for a polygenic model of meningioma.
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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
