Myocardium segmentation from DE MRI with guided random walks and sparse shape representation

Abstract

Purpose

For patients with myocardial infarction (MI), delayed enhancement (DE) cardiovascular magnetic resonance imaging (MRI) is a sensitive and well-validated technique for the detection and visualization of MI. The myocardium viability assessment with DE MRI is important in diagnosis and treatment management, where myocardium segmentation is a prerequisite. However, few academic works have focused on automated myocardium segmentation from DE images. In this study, we aim to develop an automatic myocardium segmentation algorithm that targets DE images.

Methods

We propose a segmentation framework based on both prior shape knowledge and image intensity. Instead of the strong request of the pre-segmentation of cine MRI in the same session, we use the sparse representation method to model the myocardium shape. Data from the Cardiac MR Left Ventricle Segmentation Challenge (2009) are used to build the shape template repository. The method of guided random walks is used to integrate the shape model and intensity information. An iterative approach is used to gradually improve the results.

Results

The proposed method was tested on the DE MRI data from 30 MI patients. The proposed method achieved Dice similarity coefficients (DSC) of 74.60 ± 7.79% with 201 shape templates and 73.56 ± 6.32% with 56 shape templates, which were close to the inter-observer difference (73.94 ± 5.12%). To test the generalization of the proposed method to routine clinical images, the DE images of 10 successive new patients were collected, which were unseen during the method development and parameter tuning, and a DSC of 76.02 ± 7.43% was achieved.

Conclusion

The authors propose a novel approach for the segmentation of myocardium from DE MRI by using the sparse representation-based shape model and guided random walks. The sparse representation method effectively models the prior shape with a small number of shape templates, and the proposed method has the potential to achieve clinically relevant results.

Correction to: RF-ablation pattern shaping employing switching channels of dual bipolar needle electrodes: ex vivo results

The original version of this article was published without funding note. The funding note is given below.

Clinical use of an opto-nuclear probe for hybrid sentinel node biopsy guidance: first results

Abstract

Introduction

Guidelines advocate the use of combined detection techniques to achieve optimal results for sentinel node (SN) biopsy. The fluorescent and radioactive (dual-) tracer ICG-^99mTc-nanocolloid has been shown to facilitate SN biopsy in several indications. It was reported that an opto-nuclear probe permitted the detection of near-infrared fluorescence and gamma-rays. The aim of the current study was to evaluate this device in a large patient group and to test it in both open and laparoscopic surgery implications.

Methods

Thirty-three patients scheduled for SN biopsy with the dual-tracer were retrospectively analyzed. Pre-operative lymphoscintigraphy was performed in all patients; in 18 patients (55%), a SPECT/CT scan was also performed. Radioactive and fluorescent signatures in the SNs were assessed in vivo and ex vivo using the opto-nuclear probe.

Results

One or more SNs were identified in all patients (identification rate 100%). Planar lymphoscintigraphic images revealed 95 hot spots that were considered as SNs. This number increased to 103 SNs when SPECT/CT was used. During surgery, 106 SNs were excised. In vivo, the fluorescence mode of the opto-nuclear probe was able to locate 79 SNs (74.5%). When the gamma-ray detection option of the same probe was used, this number increased to 99 SNs (93.3%). Ex vivo analysis revealed fluorescence in 93.3% of the excised nodes and radioactivity in 95.2%.

Conclusions

This study underlines the feasibility of using the dual-tracer/opto-nuclear probe combination for SN resections. The use of the opto-nuclear technology has been extended to laparoscopic surgery. This study also underlines the fluorescence tracing can complement traditional radio-tracing approaches.

Laparoscopic ultrasound manipulator with a spring-based elastic mechanism

Abstract

Purpose

Image guidance is a key technology that can improve the outcome of laparoscopic surgery. However, due to the large deformation caused by digestive organs, a computer-aided navigation system based on preoperative imaging data cannot indicate the correct target position of the lesion (e.g., liver tumors and vessels invisible from the organ surface). To overcome this issue, we developed a laparoscopic ultrasound manipulator with two motorized degrees of freedom at the tip, allowing for the performance of a dexterous ultrasound scan in a confined laparoscopic surgical area.

Method

The developed manipulator consists of a compact and elastic structure using springs, enabling a safe ultrasound scan and avoiding excess force on the inspected organs. The manipulator is a handheld device equipped with four buttons at the handle, which the surgeon directly grasps to send a motion command to the tip structure. The developed prototype realizes two motorized degree-of-freedom motion at the tip. The size of prototype is 15.0 mm in diameter that is usable in conventional laparoscopy. The tip of the manipulator was carefully designed by considering the kinematic model and the results of the finite element analysis.

Results

To assess the prototype, accuracy and rigidity were measured by using a motion processing microscope. The accuracy test showed that the proposed device has a fairly accurate characteristic as a handheld device. This was supposedly caused by the nature of compliant mechanism, which does not have mechanical play in motion. In addition, the intrinsic elastic structure (approximately 2.0 N/mm in most of the range of motion) allowed the ultrasound probe to adequately fit on the curved organ surface without extra effort of manipulation during the inspection. In the in vivo experiment, the yaw motion was found to be effective for investigating the vascular network because the manipulator allows the probe to be rotated while maintaining the same position.

Conclusion

The mechanical evaluation and in vivo test results showed high feasibility of the prototype. We are currently working on further mechanical improvement for commercialization and development of a real-time navigation system that can perform three-dimensional reconstruction of ultrasonographic images by implementing a magnetic position sensor at the tip of the manipulator.

Multistage segmentation model and SVM-ensemble for precise lung nodule detection

Abstract

Purpose

Lung cancer detection at its initial stages increases the survival chances of patients. Automatic detection of lung nodules facilitates radiologists during the diagnosis. However, there is a challenge of false positives in automated systems which may lead to wrong findings. Precise segmentation facilitates to accurately extract nodules from lung CT images in order to improve performance of the diagnostic method.

Methods

A multistage segmentation model is presented in this study. The lung region is extracted by applying corner-seeded region growing combined with differential evolution-based optimal thresholding. In addition to this, morphological operations are applied in boundary smoothing, hole filling and juxtavascular nodule extraction. Geometric properties along with 3D edge information are applied to extract nodule candidates. Geometric texture features descriptor (GTFD) followed by support vector machine-based ensemble classification is employed to distinguish actual nodules from the candidate set.

Results

A publicly available dataset, namely lung image database consortium and image database resource initiative, is used to evaluate performance of the proposed method. The classification is performed over GTFD feature vector and the results show 99% accuracy, 98.6% sensitivity and 98.2% specificity with 3.4 false positives per scan (FPs/scan).

Conclusion

A lung nodule detection method is presented to facilitate radiologists in accurately diagnosing cancer from CT images. Results indicate that the proposed method has not only reduced FPs/scan but also significantly improved sensitivity as compared to related studies.

Towards computer-assisted TTTS: Laser ablation detection for workflow segmentation from fetoscopic video

Abstract

Purpose

Intrauterine foetal surgery is the treatment option for several congenital malformations. For twin-to-twin transfusion syndrome (TTTS), interventions involve the use of laser fibre to ablate vessels in a shared placenta. The procedure presents a number of challenges for the surgeon, and computer-assisted technologies can potentially be a significant support. Vision-based sensing is the primary source of information from the intrauterine environment, and hence, vision approaches present an appealing approach for extracting higher level information from the surgical site.

Methods

In this paper, we propose a framework to detect one of the key steps during TTTS interventions—ablation. We adopt a deep learning approach, specifically the ResNet101 architecture, for classification of different surgical actions performed during laser ablation therapy.

Results

We perform a two-fold cross-validation using almost 50 k frames from five different TTTS ablation procedures. Our results show that deep learning methods are a promising approach for ablation detection.

Conclusion

To our knowledge, this is the first attempt at automating photocoagulation detection using video and our technique can be an important component of a larger assistive framework for enhanced foetal therapies. The current implementation does not include semantic segmentation or localisation of the ablation site, and this would be a natural extension in future work.

Assessing the response of morphea and limited scleroderma to tranilast: a small prospective study comparing topical corticosteroids to a combination of topical corticosteroids and tranilast

FR - Inhibidores del factor de crecimiento epidérmico y toxicidad cutánea: en busca de un protocolo de manejo

Publication date: Available online 9 July 2018

Source: Actas Dermo-Sifiliográficas

Author(s): J.J. Andrés-Lencina, R. Aragón-Miguel, A. Calleja-Algarra

Photographie clinique par smartphone en chirurgie plastique et protection des données personnelles : développement d’une plateforme sécurisée et application sur 979 patients

Publication date: Available online 9 July 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): J. Djian, A.G. Lellouch, C. Botter, J. Levy, A. Burgun, M. Hivelin, L. Lantieri

Résumé

Objectifs

La photographie clinique en chirurgie plastique et reconstructrice a connu une révolution numérique. Le stockage des données en ligne, les moyens d'analyse massive tels que les algorithmes de reconnaissance faciale posent le problème de la protection des données personnelles. Nous évaluons l'intérêt d'une plateforme, en lien avec le dossier médical informatisé, permettant d'indexer et de centraliser de manière sécurisée et intelligente ce contenu photographique.

Patients et méthode

Nous avons interrogé 300 plasticiens français sur leur usage des smartphones dans leur pratique quotidienne. Nous avons parallèlement développé une suite logicielle appelée Surgeon^©, permettant de manière sécurisée d'indexer, trier, envoyer à partir d'un smartphone, des photographies sur le serveur sécurisé de notre hôpital universitaire. Chaque séquence photographique était qualifiée grâce à un formulaire dédié. Nous avons étudié prospectivement, entre le 1^er mai 2017 et le 30 mars 2018, le nombre de patients photographiés, le nombre de séquences et photographies prises, le nombre moyen de séquences par patient.

Résultats

Sur 86 plasticiens répondants, 81 ne pourraient se passer de leur smartphone. Les photographies étaient stockées dans leur smartphone (50 %) ou synchronisées vers des stockages en ligne (25,6 %). Ils étaient une majorité (80,2 %) à être favorable à l'utilisation d'une application sécurisée dédiée. Notre application a permis de photographier 979 patients, soit 2345 séquences et 8112 photographies, avec une moyenne de 2,28 séquences par patient.

Conclusion

L'ergonomie et la sécurité de cette plateforme sur site, qui ont autorisé son implantation dans un service hospitalier, permettent d'envisager une diffusion large.

Summary

Background

The clinical photography in plastic and reconstructive surgery has known a numerical breakthrough. The storage of online data, massive means of analysis such as facial recognitions algorithms poses a serious issue when it comes to the protection of personal data. We will assess a platform's benefits in connection with the computerized medical record, which will allow keeping the photos filed and centralized in a smart and secure manner.

Method

We interviewed 300 plastic surgeons about the role of smartphone in their clinical practice. Concomitantly, we developed an innovative platform called Surgeon^©, a secure way to index, file and send photographs with a smartphone on our hospital's server. Each photographic sequence was qualified using a specific form. We then collected prospectively, between May 1st 2017 and March 30th 2018, the number of patients photographed, the number of sequences and photographs taken and the average number of sequences per patient.

Results

Out of 86 French plastic surgeons surveyed, 81% say that they could not go on with their daily practice today without their smartphone. Photographs taken were stored in their smartphones (50%) or synced with virtual storage (25.6%). A majority (80.2%) would use a dedicated secured smartphone application. Our application allowed us to photograph 979 patients, or 2345 sequences and 8112 photographs, with an average of 2.28 sequences per patient.

Conclusion

Thanks to its ergonomics and security, this platform can be set up in a hospital ward and beyond.

Beyond JAAD - October 2018

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Andrew Bronin, Robert Phelps, Robert Sidbury

Methotrexate for alopecia areata: a systematic review and meta-analysis

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Kevin Phan, Vignesh Ramachandran, Deshan Frank Sebaratnam

Abstract

Background

Methotrexate has been used both as an adjunct for low-risk maintenance therapy after initiation with corticosteroids for alopecia areata (AA) and as standalone therapy in some investigations, based on a lack of definitive evidence/guidelines.

Objective

To (1) determine the efficacy and risks associated with methotrexate therapy for AA (2) determine differences efficacy of combination with corticosteroids versus standalone treatment, and (3) determine relative efficacy of methotrexate in adult versus pediatric populations.

Methods

A systematic review and meta-analysis was performed according to recommended PRISMA guidelines.

Results

Methotrexate has reasonable effectiveness in patients with severe AA, and that adults appear to be more responsive to methotrexate treatment compared to pediatric cases. Methotrexate in conjunction with corticosteroids result in higher good/complete response rates compared to those treated with methotrexate alone. A large proportion of recurrence rates occurred in the setting of tapering treatment. Complication rates were acceptable and similar between adults and pediatric cases.

Limitations

Studies reviewed were retrospective observational studies with heterogeneity between centers in terms of dosages/protocols for methotrexate use in AA, and adjunctive treatments with a lack of data beyond one year.

Conclusion

Methotrexate is an effective monotherapy or adjunct to corticosteroid in the treatment of severe AA.

Surgical Pearl: A Granny Sliding Knot for High Tension Closures

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Jeffrey F. Scott, Mona Ascha, Whitney Pollard, Jeremy S. Bordeaux

Ustekinumab treatment for neutrophilic dermatoses associated with Crohn’s disease: a multicenter-retrospective study

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Tullia de Risi-Pugliese, Philippe Seksik, Jean-David Bouaziz, François Chasset, Philippe Moguelet, Jean-Marc Gornet, Anne Bourrier, Aurélien Amiot, Laurent Beaugerie, Camille Francès, Sarah Guégan, Ustek-CDND study group

Drug-Induced Phototoxicity: A Systematic Review

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Whan B. Kim, A.J. Shelley, K. Novice, J. Joo, H.W. Lim, S.J. Glassman

Abstract

Background

Phototoxicity has been attributed to numerous oral drugs over the past 60 years.

Objective

Determine the quality of evidence supporting suspected phototoxicity from oral drugs

Methods

MEDLINE and EMBASE databases were searched for all studies containing original data for drug-induced phototoxicity published between May 1959 and December 2016. Study quality was assessed using a modified GRADE scale.

Results

The review included 240 eligible studies with a total of 2466 subjects. There were 1134 cases of suspected phototoxicity associated with 129 drugs. Most associations were supported by either very low-quality or low-quality evidence (89.1% of the studies). Medications supported by stronger evidence were vemurafenib, non-steroidal anti-inflammatory drugs (NSAIDs), and antibiotics, specifically fluoroquinolones and tetracyclines. The most frequently reported drugs were: vemurafenib, voriconazole, doxycycline, hydrochlorothiazide, amiodarone, and chlorpromazine. Photobiologic evaluation was performed in only 56 studies (23.3%), while challenge-rechallenge was done in 10% of cases.

Limitations

Only English-language publications were reviewed. Phototoxicity cases incorrectly termed photoallergy would not have been included.

Conclusions

Most purported associations between oral drugs and phototoxicity are not supported by high-quality evidence. Despite the variable quality of data, clinicians should be aware of the possible consequences of chronic use of culprit drugs.

The ALT-70 Predictive Model Outperforms Thermal Imaging for the Diagnosis of Lower Extremity Cellulitis: A Prospective Evaluation

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): David G. Li, Anna K. Dewan, Fan Di Xia, Hasan Khosravi, Cara Joyce, Arash Mostaghimi

Abstract

Background

We previously demonstrated dermatology consultation to substantially reduce cellulitis misdiagnosis rates; however, broad implementation is impractical due to existing practice patterns and reimbursement systems. Meanwhile, efforts to improve diagnostic accuracy have culminated in point-of-care tools, including the ALT-70 predictive model for lower extremity cellulitis and thermal imaging.

Objective

To prospectively evaluate the performance of ALT-70 and thermal imaging in diagnosing lower extremity cellulitis in a head-to-head comparison.

Methods

We collected ALT-70 and thermal imaging data from patients with presumed lower extremity cellulitis and compared classification measures and accuracy for ALT-70, thermal imaging, and combination testing (ALT-70 plus thermal imaging).

Results

We enrolled 67 patients with ALT-70 and thermal imaging data. ALT-70 conferred the highest sensitivity (97.8%) and negative predictive value (90.9%), while combination testing had the highest specificity (71.4%) and positive predictive value (86.6%). ALT-70 had improved classification measures compared to thermal imaging. Combination testing conferred a marginal benefit to ALT-70 alone.

Limitations

Single-center design may limit generalizability.

Conclusion

ALT-70 outperformed thermal imaging in diagnosing lower extremity cellulitis. The accuracy of the ALT-70 was high and consistent with previously published reports. Broad implementation of ALT-70 into clinical practice may decrease misdiagnosis rates of lower extremity cellulitis.

Mohs micrographic surgery (MMS) with MART-1 immunostaining for atypical intraepidermal melanocytic proliferation (AIMP)

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Jeremy R. Etzkorn, Olivia S. Jew, Thuzar M. Shin, Joseph F. Sobanko, Donald E. Neal, Christopher J. Miller

Abstract

Background

The efficacy of Mohs micrographic surgery (MMS) for atypical intraepidermal melanocytic proliferation (AIMP) is unknown.

Objective

To ascertain the frequency of diagnostic change to melanoma (upstaging) and the frequency of local recurrence after MMS for AIMP. A secondary outcome was the frequency of subclinical spread (defined as the requirement for greater than one stage of MMS to achieve tumor-free margins).

Methods

Retrospective, cross-sectional study of 223 AIMP (with 92.4% located on the head, neck, hand, foot, or pretibial leg) treated with MMS with MART-1 immunostaining.

Results

Upstaging to unequivocal MIS or invasive melanoma was identified in 18.8% (42/223) of all AIMP. The local recurrence rate was 0% (0/223) with a mean follow-up time of 2.7 years (998 days). Subclinical spread was present in 23.8% (53/223) of AIMP.

Limitations

Single site, retrospective design, observational study, lack of objective criteria to diagnose AIMP

Conclusion

MMS with MART-1 immunostaining achieves excellent local control of specialty-site AIMP and permits definitive removal of subclinical spread prior to reconstruction. The central debulking excision should be evaluated with formalin-fixed paraffin-embedded sections, since a significant percentage of AIMP are reclassified as MIS or invasive melanoma.

Pigmentation of basal cell carcinoma is inversely associated with tumor aggressiveness in Asian patients

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Hye-Rim Moon, Tae Jun Park, Ki Woong Ro, Hwa Jung Ryu, Soo Hong Seo, Sang Wook Son, Il-Hwan Kim

Intralesional Immunotherapy for the Treatment of Warts: A Network Meta-analysis

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Samar Salman, Mohamed Shehata Ahmed, Ahmed Mohamed Ibrahim, Omar Mohamed Mattar, Hassan El-Shirbiny, Sameh Sarsik, Ahmed M. Afifi, Ruba Marwan Anis, Nadim Aiman Yakoub Agha, Abdelrahman Ibrahim Abushouk

Abstract

Background

Without clear evidence, selecting among the existing immunotherapeutic options for warts remains challenging.

Objective

Through network meta-analyses, we aimed to evaluate the comparative efficacy of different intralesional immunotherapeutic modalities.

Methods

We included randomized controlled trials (RCTs) comparing intralesional immunotherapeutic modalities to cryotherapy, placebo or imiquimod. All outcomes were presented as odds ratio (OR) with 95% confidence-interval. Both conventional and network meta-analyses (with a frequentist approach) were conducted on R software. The P-score was used to rank different treatments.

Results

Network meta-analysis of 17 RCTs (1676 patients) showed that PPD (OR=39.56), MMR (OR=17.46) and INF-β (OR=15.55) had the highest efficacy in terms of complete recovery at the primary site, compared to placebo. Regarding complete recovery at the distant site, autoinoculation (OR=79.95), PPD (OR=42.95) and MMR (OR=15.39) were all statistically superior to placebo. According to the P-score, MMR was more effective than other modalities in reducing recurrence rate at the same site.

Limitations

Relatively-small sample size in some comparisons and variability in baseline characteristics.

Conclusion

PPD and MMR were the most effective in achieving complete primary and distant recovery (along with autoinoculation for distant recovery) and reducing the recurrence rate at the same site, compared to cryotherapy and other immunotherapeutic modalities.

Efficacy, Safety, and Comparison of Sonic Hedgehog Inhibitors in Basal Cell Carcinomas: A Systematic Review and Meta-Analysis

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Pingxing Xie, Philippe Lefrançois

Abstract

Background

Sonic Hedgehog Inhibitors (SHHi) provide an additional treatment option for basal cell carcinomas (BCC), especially for metastatic or locally advanced BCC. However, studies have been heterogeneous and lacking direct comparisons between molecules.

Objective

To determine the efficacy and safety of SHHi, as a class of molecules, for treating BCC, and to compare them individually.

Methods

We performed a PRISMA-compliant systematic review of studies followed by a meta-analysis.

Results

Eighteen articles were included in our meta-analysis; sixteen articles were combined for efficacy and sixteen for safety. In locally advanced BCC, Overall Response Rates (ORR) were similar for vismodegib and sonidegib (69% vs. 57%), but not Complete Response Rates (31% vs. 3%). In metastatic disease, the ORR of vismodegib was 2.7-fold higher than the ORR of sonidegib (39% vs. 15%). For side effects affecting a majority of patients, combined prevalences were 67.1%, 54.1% and 57.7% for muscle spasms, dysgeusia, and alopecia, respectively, in similar proportions for sonidegib and vismodegib. Patients receiving sonidegib experienced more upper GI distress than patients receiving vismodegib.

Conclusions

SHHi as a class lead to partial responses for locally advanced BCC disease. Side effects are similar across molecules, common, associated with high discontinuation rates, and warrant discussion beforehand.

Topical Glycopyrronium Tosylate for the Treatment of Primary Axillary Hyperhidrosis: Results from the ATMOS-1 and ATMOS-2 Phase 3 Randomized Controlled Trials

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Dee Anna Glaser, Adelaide A. Hebert, Alexander Nast, William P. Werschler, Lawrence Green, Richard Mamelok, Janice Drew, John Quiring, David M. Pariser

Abstract

Background

Glycopyrronium tosylate (GT) is a topical anticholinergic developed for once-daily treatment of primary axillary hyperhidrosis.

Objective

Assess the efficacy and safety of GT for primary axillary hyperhidrosis.

Methods

ATMOS-1 and ATMOS-2 were replicate randomized, double-blind, vehicle-controlled, 4-week phase 3 trials. Patients were randomized 2:1 to GT 3.75% or vehicle applied once daily to each axilla for 4 weeks. Coprimary endpoints were responder rate (≥4-point improvement from Baseline) on Item 2 (sweating severity) of the Axillary Sweating Daily Diary (ASDD), a newly developed patient-reported outcome, and absolute change from Baseline in axillary gravimetric sweat production at Week 4. Safety evaluation included treatment-emergent adverse events (TEAEs).

Results

Pooled data, consistent with individual trial results show significantly more GT-treated patients achieved ASDD Item 2 response versus vehicle (59.5% vs 27.6%) and had reduced sweat production from Baseline (-107.6mg/5min vs -92.1mg/5min) at Week 4 (P<0.001 for both coprimary endpoints). Most TEAEs were mild or moderate and infrequently led to discontinuation.

Limitations

Short trial duration and inherent challenges in gravimetrically assessing sweat production.

Conclusions

Daily, topically-applied GT over 4 weeks reduced sweating severity as measured by ASDD-Item 2, reduced sweat production as measured gravimetrically, and was generally well tolerated in primary axillary hyperhidrosis patients.

Antiandrogen therapy with spironolactone for the treatment of hidradenitis suppurativa

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Nicole M. Golbari, Martina L. Porter, Alexa B. Kimball

Abstract

Background

Hormonal therapy is a potential treatment for hidradenitis suppurativa (HS). However, little data exists describing the efficacy of spironolactone in HS treatment.

Objective

To assess whether spironolactone treatment improves HS disease severity and patient reported pain.

Methods

We performed a single center chart review of female HS patients treated with spironolactone between 2000 and 2017. Primary outcome measurements included the HS Physician Global Assessment (HSPGA), Hurley Staging, inflammatory lesion count, fistula count, and a numeric rating scale for pain.

Results

Subjects on average were exposed to 75mg of spironolactone daily over a 7.1-month follow-up period. Patients achieved significant disease improvement with regards to pain (Δ-1.5, P=.01), inflammatory lesions (Δ-1.3, P=.02), and HSPGA (Δ-0.6, P<.001). As expected, no change was found for Hurley stage (Δ0, P=.32) or fistulas (Δ0, P=.73). There was no difference in improvement between subjects who received less than 75mg daily (n= 25, average 45mg/day) and those who received greater than 100mg daily (n=21, average 112mg/day).

Limitations

Retrospective nature, limited sample size, and variations in severity measures documented were limiting factors.

Conclusions

Management of HS with spironolactone reduces lesion count, HSPGA and pain. Lower doses appear to be effective and may be an appropriate option for patients with tolerability concerns.

“Comparing the eighth and the seventh editions of the ajcc staging system and the brigham and women’s hospital alternative staging system for cutaneous squamous cell carcinoma: implications for clinical practice”

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): J. Cañueto, J. Burguillo, D. Moyano-Bueno, A. Viñolas-Cuadros, A. Conde-Ferreirós, Luis Antonio Corchete-Sánchez, J. Pérez-Losada, C. Román-Curto

Abstract

Background

The new 8^th edition of the American Joint Committee on Cancer (AJCC) staging system incorporates changes regarding cutaneous squamous cell carcinoma (CSCC).

Objectives

We aimed to compare the 8^th edition of the AJCC (AJCC-8) staging system with the previous 7^th edition (AJCC-7) and the Brigham and Women's Hospital alternative staging system, to identify their usefulness and the utility of their risk factors in defining prognostic groups in CSCC.

Methods

A series of 186 CSCCs of the head and neck was retrospectively collected. All three staging systems were compared in their ability to predict poor prognosis. Binary logistic regression models were built to determine which risk factors were most relevant.

Results

Poor prognosis was mainly associated with T2-AJCC-7, with T2b/T3-BWH's and with T3-AJCC-8. The AJCC-8 and the BWH's staging systems displayed overlap between each other in predicting poor prognosis and both were superior to the AJCC-7. The new risk factors incorporated into the AJCC-8 and the poor degree of differentiation were independently associated with poor outcome.

Limitations

Retrospective study and few cases with bone invasion.

Conclusions

The AJCC-8 is more distinctive, monotonous and homogeneous than the AJCC-7 and shows some overlap in the stratification of tumors with the BWH's system.

The joint toxicity effect of five antibiotics and dibutyl phthalate to luminescent bacteria ( Vibrio fischeri )

Abstract

Antibiotics and phthalate esters are two kinds of emerging pollutants and are ubiquitous in the aquatic ecosystem. To date, few studies analyzed the combined toxicity of the mixtures of antibiotics and phthalate esters, and their joint toxicity effect mode remains unknown. Here, we investigated the single and joint toxicity of dibutyl phthalate (DBP) and five antibiotics, namely, oxytetracycline hydrochloride (OTC), chlortetracycline hydrochloride (CTC), sulfamethazine (SMZ), sulfamerazine (SMR), and sulfadiazine (SD), to luminescent bacteria of Vibrio fischeri. The median effect concentration (EC₅₀) values of the test chemicals were ranked as CTC (6.67 mg/L) > OTC (25.12 mg/L) > SD (67.61 mg/L) > SMR (141.51 mg/L) > DBP (148.38 mg/L) > SMZ (245.07 mg/L). The joint toxicities of the binary mixtures of antibiotics and DBP were evaluated by the concentration addition (CA) and independent action (IA) models. The joint toxicity effects of CTC-DBP, OTC-DBP, SMZ-DBP, SMR-DBP, and SD-DBP all appeared to be synergism. Our study revealed that sulfonamides combined with DBP could be as toxic as or even more toxic than tetracycline. Thus, the joint toxicity effect should be considered when assessing the ecological risks of binary or multicomponent pollutants.

Several newly discovered Mo-enriched plants with a focus on Macleaya cordata

Abstract

Phytoremediation as an alternative strategy has been a widespread attention. The screening of enriched plants and hyperaccumulators is the key of the strategy. So this study examined the status of heavy metal pollution in molybdenum (Mo) mine soils, metal accumulation in plants growing on mine, and their tolerance strategies. The analysis of 14 soils and 27 plant samples in mining area showed that Mo, zinc (Zn), and cadmium (Cd) concentrations exceeded soil safety standards and their levels varied in 27 plant samples. Mo was the heavy pollution with an average total content of 256.1 mg/kg in soils. As Mo-enriched plants, Mo concentrations of Macleaya cordata (Willd.) R. Br. and Morus australis Poir. were 704.4 and 772.4 mg/kg, respectively. M. cordata was selected as the research material, due to its high biomass. Molybdenum significantly decreased the biomass and photosynthesis of M. cordata at high concentration (> 200 μmol/L), but its biomass and photosynthesis reached the maximum after 50 μmol/L Mo treatment, respectively. Analysis of the subcellular distribution and chemical speciation showed that Mo was distributed a certain way in the extracts and that this suggested that it may be present in cell wall and soluble fraction of roots (51.9–63.9%; 26.1–44.7%) or shoots (30.0–44.4%; 47.3–56.0%) and complexed to organic acid, pectate, oxalate, and protein. This might be responsible for the adaptation of M. cordata to Mo stress. Therefore, M. cordata could serve as a potential plant to utilize for the phytoremediation of Mo-contaminated soil.

Emerging contaminants removal by granular activated carbon obtained from residual Macauba biomass

Abstract

The removal of emergent contaminants via adsorption on granular activated carbon, prepared from Macauba palm, has been studied, contributing to the recovery of the residual biomass, endocarp, obtained in the Macauba palm oil extraction process. The material was characterized by different techniques, such as Raman spectroscopy, thermal analysis, adsorption/desorption of N₂, zeta potential, and scanning electron microscopy. The N₂ adsorption studies showed that the material presents wide micropores and narrow mesopores, and has a surface area of 907.0 m² g⁻¹. Its maximum adsorption capacity towards the three main emerging contaminants (bisphenol A, ethinylestradiol, and amoxicillin) is much higher than that obtained with benchmark adsorbents (0.148, 0.104, and 0.072 mmol g⁻¹, respectively). The influence of temperature and pH on the adsorption was also analyzed, allowing an improved description of the adsorption mechanism and showing very promising results.

Lipedematous scalp and alopecia: Report of two cases with a brief review of literature

Efsun Kilinc, Sibel Dogan, Hande Akinci, Aysen Karaduman

Indian Journal of Dermatology 2018 63(4):349-353

Lipedematous scalp (LS) and lipedematous alopecia (LA) are both rare conditions with an unknown etiology. LS is characterized by boggy swelling under the skin as a result of hyperplasia of subcutaneous layer. LA is basically LS associated with hair growth abnormalities such as alopecia and short broken hair. Herein, we present two patients who were diagnosed with LS and LA where case with LA had a new diagnosis of systemic lupus erythematosus.

Fixed-drug eruptions: What can we learn from a case series?

Ratinder Jhaj, Deepa Chaudhary, Dinesh Asati, Balakrishnan Sadasivam

Indian Journal of Dermatology 2018 63(4):332-337

Background: A fixed-drug eruption (FDE) is a unique cutaneous adverse drug effect in the form of recurrent lesions at the same site after re-exposure to the offending agent. Aim: The aim of the study was to identify changes in trends in fixed drug eruptions with regard to causative drug or patient risk factors. Methods: Cases of FDEs encountered between March 2014 to May 2017 during routine pharmacovigilance activities were analyzed. Results: FDEs made up 8.4% of total adverse drug reactions and 11.1% of cutaneous reactions. Majority of the patients were adults between 18 and 45 years old. The average lag period between drug intake and appearance of FDE was 2.04 days. Commonly affected sites were extremities, lips, head and neck, and genitalia. Number of FDE lesions varied from 1 to > 6, with nearly half the patients (46%) presenting with a single lesion. Antimicrobials (80.6%) and nonsteroidal anti-inflammatory drugs (20.8%) were most frequent drugs implicated. Route of administration was oral for all causative drugs. History of an FDE was positive in 26 (50.2%) of the cases. Majority of the patients (21 out of 25 or 84%) whose lesions appeared within minutes to hours of suspected drug intake had a history of FDE. Furthermore, 66.7% of patients with multiple lesions had a history of FDE while only 34.8% of patients with a single lesion had such a history. Conclusion: FDEs are common cutaneous reactions with antimicrobials and anti-inflammatory agents, with increased likelihood of extensive and multiple lesions in patients with a history of FDE.

Knowledge and attitude of general population toward effects of sun exposure and use of sunscreens

Shweta Bharat Agarwal, Kiran Godse, Sharmila Patil, Nitin Nadkarni

Indian Journal of Dermatology 2018 63(4):285-291

Background: Sun exposure causes extensive intrinsic as well as extrinsic changes in the skin. Pathogenic effects of sun exposure such as tanning, melasma, skin cancer, and aggravation of various photodermatoses such as systemic lupus erythematosus (SLE) may be prevented by the use of sunscreens. We conducted the present study to assess the knowledge and attitudes regarding sun exposure and use of sunscreens. Methods: Two thousand and thirty-seven volunteers answered the questionnaire over a period of 2 years. All adults aged 18 years and above who voluntarily agreed to participate in the study after written informed consent were included. Results: Out of 2037 volunteers, 1242 volunteers had no knowledge of sunscreens. Sixty-eight percent of the volunteers from the upper class of society knew about sunscreens, and 86% of the volunteers from the lower middle class did not know about sunscreens. Eight-one percent of the volunteers did not suffer from sunburns. Eight-four percent of the volunteers were aware that sun exposure caused darkening, but awareness about other effects of sun exposure such as wrinkling, melasma, allergy, and photo-induced cancers was less. Most of the volunteers agreed that sunscreens protected against sun damage and tanning. Fifty-eight percent of the volunteers applied sunscreen before venturing out, and 78% of the volunteers applied sunscreen only on the face. Prevention of tanning was the most common reason for the usage of sunscreens. Cosmetic appeal and irritant potential were the prominent deciding factors in choosing sunscreens. Conclusion: Awareness about protective spectrum of sunscreens, their correct method of application, and misconceptions need to be focused on. Better product development keeping in mind the Indian conditions would help in increasing the usage of sunscreens.

Secondary ossification associated with seborrheic keratosis adjacent to basal cell carcinoma

Masato Ishikawa, Takenobu Ohashi, Toshiyuki Yamamoto

Indian Journal of Dermatology 2018 63(4):357-359

Correlating impairment of quality of life and severity of melasma: A cross-sectional study of 141 patients

Preeti Kothari, Yugal Kishor Sharma, Milind A Patvekar, Aayush Gupta

Indian Journal of Dermatology 2018 63(4):292-296

Background: The relationship between impaired quality of life (QoL) due to melasma and its clinical severity remains equivocal despite several studies. Aim: The aim was to study the correlation, if any, between the clinical severity and the impairment in QOL due to melasma. Methods: This cross-sectional, questionnaire-based study was conducted on a cohort of 141 patients of melasma attending the outpatient department of our referral hospital. A physician measured the severity of melasma using the melasma area and severity index (MASI), while melasma-related QoL (MELASQOL) score was calculated utilizing the validated Hindi version of the MELASQOL questionnaire filled by the patients. Correlations of these two scores with each other and with components of the demographic data were attempted using the Statistical Package for the Social Sciences, version 20. Results: Significantly greater impairment in QoL was found in patients with a history of prior use of triple combination therapy and in patients with hirsutism and/or polycystic ovarian disease. The severity of melasma was found to be significantly higher in patients with a history of recurrence and tobacco chewing. Limitations: The sample size could have been larger. Ultrasonography could have been carried out in all cases of hirsutism. Conclusion: The severity of melasma does not correlate with the impairment in QoL.

A case of an indolent CD8-Positive lymphoid proliferation of the ear

Banavasi Shanmukha Girisha, Teerthanath Srinivas, Tonita Mariola Noronha, Akshata C Alva, Ashok Menon

Indian Journal of Dermatology 2018 63(4):342-345

A lady presented with indolent slowly spreading erythematous nodule on the left external ear which on histopathology showed dense monomorphic lymphoid cells in the dermis. No epidermotropism or angioinvasion was seen. Immunohistochemistry showed that the infiltrating lymphoid cells were CD8+ but CD4-. Majority of the cases of cutaneous T-cell lymphomas have a CD4+, CD8− T-cell expression. Few cases have been reported with similar CD8-positive lymphoid proliferation with a curious ear tropism.

The measurement of serum tumor necrosis factor-alpha levels in patients with lichen planus

Yesim Akpinar Kara

Indian Journal of Dermatology 2018 63(4):297-300

Background: Lichen planus is a common mucocutaneous inflammatory skin disease with a multifactorial etiology. Cytokines have a key role in its pathogenesis. In our study, we aimed to investigate the relationship between the disease severity and levels of the tumor necrosis factor alpha (TNF-α) cytokine which was considered as a primary cytokine that initiates the cytotoxicity. Materials and Methods: A total of 34 patients with lichen planus who were 18 year or older and gender-matched healthy controls were included in the study. Serum TNF-α levels were measured by human TNF-α enzyme-linked immunosorbent assay test kits and the values in the two groups were statistically compared. Results: The mean serum TNF-α levels were higher in the patient group than that in the control group. Serum TNF-α levels were not associated with oral mucosal involvement and gender. However, it was observed that the level of TNF-α was higher in older ages, both in patient and in control groups. Conclusion: It is thought that TNF-α, a proinflammatory cytokine, may have an important role in the pathogenesis of lichen planus.

Authors' Reply

Indrashis Podder, Abanti Saha, Debabrata Bandyopadhyay

Indian Journal of Dermatology 2018 63(4):354-355

Cutaneous bacteriological profile in patients with pemphigus

KC Kiran, J Madhukara, Anil Abraham, S Muralidharan

Indian Journal of Dermatology 2018 63(4):301-304

Background: Pemphigus is an autoimmune blistering disease. The common cause of death in pemphigus is septicemia which is usually secondary to cutaneous bacterial infection. Aim: The aim was to study the cutaneous bacteriological profile in patients with pemphigus. Materials and Methods: Pus for culture and sensitivity was collected from clinically infected lesions of pemphigus patients in the Department of Dermatology, St. John's Medical College Hospital, Bengaluru, from June 2013 to June 2014. Results: Of the 49 patients included in the study, 44 were suffering from pemphigus vulgaris, 4 from pemphigus foliaceus and one had pemphigus vegetans. There were 31 male and 18 female patients. The mean age of the group was 35.51 year. Mean Autoimmune Bullous Disorder Intensity Score was 17.36. About 32.7% were diabetic. About 40.81% showed the growth of Staphylococcus aureus, 12.24% of Pseudomonas aeruginosa, 6.12% of Proteus mirabilis, 4.08% of β-hemolytic streptococci and nonfermenting Gram-negative bacilli, and 2.04% of Proteus vulgaris, Staphylococcus saprophyticus, Enterococcus species, and Klebsiella species. S. aureus showed 100% sensitivity to antibiotics – tetracycline, amikacin, chloramphenicol, and netilmicin; 90% resistance was found for penicillin and 55% resistance was found for ciprofloxacin and erythromycin. Methicillin-resistant S. aureus was 30%. P. aeruginosa showed 100% sensitivity to ciprofloxacin, amikacin, gentamicin, piperacillin, piperacillin + tazobactam, and netilmicin. Conclusion: S. aureus was the most common organism showing sensitivity to tetracycline, amikacin, chloramphenicol, and netilmicin and resistance to penicillin, ciprofloxacin, and erythromycin.

Vitiligo and psychiatric morbidity: A profile from a vitiligo clinic of a rural-based tertiary care center of Eastern India

Somenath Sarkar, Tanusree Sarkar, Arnab Sarkar, Swagata Das

Indian Journal of Dermatology 2018 63(4):281-284

Background: Vitiligo is an idiopathic acquired progressive de/hypopigmentary disorder of skin and mucosae. In Indian skin depigmentaion is very much obvious and can cause psychological distress, low self esteem and social stigmatization. Aims: The primary objective of this study was to evaluate the psychiatric morbidity in vitiligo patients and secondary objective was to assess the morbidity in all eight dimensions of psychosocial and physical aspects, i.e. cognitive, social, discomfort, limitations, depression, fear, embarrassment and anger. Materials and Methods: An institution based case-control study with sixty-one patients of vitiligo and equal number of healthy age and sex matched controls was undertaken. The self-reporting questionnaire-24 (SRQ-24) and skindex (A 61-item survey questionnaire) were used to assess the psychiatric morbidity in both the groups. Results: The SRQ-assessed psychiatric morbidity in the study group was 63.93%, compared with 24.59% in the control group (P<0.0001). Acral vitiligo had maximum association with psychiatric morbidity (86.67%) followed by vitiligo vulgaris (68%), mucosal vitiligo (62.5%) and others. According to the skindex, the most common psychiatric morbidity in vitiligo patients was depression (62.29%) followed by embarrassment (55.73%), social problem (54.09%), cognitive impairment (50.81%), physical limitation (47.54%), discomfort (40.98%), anger (36.06%) and fear (24.59%). The difference in Skindex scoring that marked the psychiatric morbidity among the case and control groups was statistically significant for depression, discomfort, social problem, cognitive impairment, embarrassment (P<0.0001) and physical limitation (P=0.0044). Conclusion: Vitiligo has a high degree of psychiatric morbidity.

Simple markers for systemic inflammation in pediatric atopic dermatitis patients

Sehra Birgul Batmaz

Indian Journal of Dermatology 2018 63(4):305-310

Background: Atopic dermatitis is a dermatological disease characterized by chronic inflammation. In recent years, systemic inflammation is also mentioned along with local inflammation for its pathogenesis. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and mean platelet volume (MPV) are nonspecific indicators of systemic inflammation, and they were shown to be associated with the disease and its prognosis in allergic or nonallergic diseases. Aims and Objectives: The aim of this study was to evaluate the values of NLR, PLR, and MPV in atopic dermatitis patients and also to investigate the associations of them with the atopic dermatitis disease severity and duration. Materials and Methods: Two hundred and fifty-two atopic dermatitis patients and 75 control group individuals were included in the study. Mean/median values of NLR, PLR, and MPV were compared among patients and controls, severity groups classified according to SCORing Atopic Dermatitis (SCORAD) and intrinsic and extrinsic groups. Correlation of disease duration and SCORAD with NLR, PLR, and MPV values were examined. Disease duration and its association with NLR were evaluated by correlation and linear regression analysis. Results: Mean NLR and median PLR values of atopic dermatitis patients were higher than those of controls (0.97 ± 0.69 and 80.86 [59.86–108.23], respectively). NLR and PLR values were found to be positively correlated with disease duration and NLR was positively associated with disease duration after adjustment. NLR value was also higher in the extrinsic group than the intrinsic group. Conclusion: Presence of systemic inflammation in the pathogenesis of atopic dermatitis was considered to be associated with increased NLR and PLR values. These parameters were also associated with disease duration and might vary between subtypes of atopic dermatitis. NLR and PLR were cheaper and easily accessible alternatives to the systemic inflammation biomarkers that were expensive and not accessible for all laboratories, particularly in economically disadvantaged countries.

Vegetating plaques in the groin: A manifestation of metastatic crohn's disease

Chetana Jagatgere Math, Anju George

Indian Journal of Dermatology 2018 63(4):338-341

Crohn's disease (CD) is a type of inflammatory bowel disease that can affect any part of the gut from mouth to anus. It also may occur at contiguous sites, like, lip, perineal or peristomal regions or may occur at sites separated from the bowel by normal tissue referred to as metastatic CD. The condition is relatively rare and may mimic or coexist with other dermatoses. The presence of noncaseating granuloma on histopathological examination confirms the diagnosis. Here, we report a case of metastatic CD with cutaneous symptoms of long duration and presenting with vegetating plaques in the lower abdomen, groins, and vulva. The gastrointestinal disease was under remission. The diagnosis was confirmed by histopathological examination and patient responded well to topical as well as systemic steroids.

Common allergens prevalent in and around Ambala, Haryana: An intradermal study among patients with asthma and allergic rhinitis and atopic dermatitis

Dinesh Mehta, Abinav Dagar, Jai Kishan, Parwinder Singh, Tushar Nehra, Himanshu Sharma

Indian Journal of Dermatology 2018 63(4):311-316

Objective: Identification of allergens by intradermal test in patients with asthma, allergic rhinitis, and eczema. Materials and Methods: Intradermal test was performed in 100 patients of Ambala over an 8-year period to identify the common allergens. A total of 197 allergens including 50 types of pollen, 19 fungi, 17 insects, 14 types of dust, 6 animal dander, 7 types of fabric and feather and 82 types of foods, dust mite, and parthenium were tested. Results: In this study, the major allergens were pollen (51%) followed by foods (28.9%), insects (26.9%), fungus (12.6%), dusts (6.7%). Among pollen allergens, Brassica campestris (8%) was a major allergen followed by Ageratum conyzoides (7%) and Artemisia scoparia (6%) Cannabis sativa, Cynodon dactylon and Maerua arenaria (5%). Among the fungal group, Alternaria tenuis, Aspergillus flavus, Aspergillus fumigates, Candida albicans, Penicillium sp., Rhizopus nigricans (3%), Fusarium solani (2%) were found. In the insect group, mosquito (7%), ant (6%), grasshopper (5%), locust (male), moth, and house fly (4%) were the major allergens. Among the dust allergens, grain dust rice (3%), straw dust, house dust, and grain dust bajra (2%) were found. Among the food allergens, prawn (5%), almonds, Baker's yeast, Bengal gram (3%) and mushroom, mango ripe, rajma, cinnamon, chocolate, beans fresh, and areca nut (2%) were found. Conclusion: It can be said that the knowledge may help to create a mapping of allergens in this area and help to treat patients by immunotherapy or avoidance strategy.

Concurrence of multiple cutaneous malignancies on sun-exposed vitiligo skin of a patient: A case report and review of the literature

Xiao Ting Zhang, Xin Hua Ma, Wan Wan Jin, Shi Sheng Chen, Hai Ting Xu

Indian Journal of Dermatology 2018 63(4):346-348

There are very few published studies in the literature examining the association between vitiligo and skin cancers and only some anecdotal reports about phototherapy-associated nonmelanoma skin carcinoma (NMSC) in patients with vitiligo. Herein, we report a case of an 84-year-old male with widespread vitiligo with concurrent onset of two primary cutaneous malignancies in sun-exposed vitiligo skin. The association between vitiligo and NMSC deserves further assessment. Chronic sun damage might be a possible causative factor for the development of NMSC in the vitiligo patient.

Allergy to peanuts in atopic dermatitis patients 14 year or older and the association with food hypersensitivity, inhalant allergens, asthma bronchiale and rhinitis

Jarmila Celakovska, Josef Bukač, Karel Ettler, Jaroslava Vaneckova, Kvetuse Ettlerova

Indian Journal of Dermatology 2018 63(4):317-322

Background: In adult patients suffering from atopic dermatitis (AD), studies investigating the co-prevalence of AD and food allergy are still scarce, and exact data are not available. Aims and Objectives: To evaluate the occurrence of food allergy to peanuts in significant relation to food hypersensitivity, inhalant allergy and to asthma bronchial and rhinitis. Materials and Methods: Altogether 332 patients of AD 14 year or older were included in the study. The complete dermatological and allergological examinations were performed in all included patients (including examination of specific immunoglobulin E, skin prick test to different food and inhalant allergens, anamnestic data about food reactions, evaluation of allergic rhinitis, and allergic asthma bronchiale). We evaluated whether there was some relation between the food allergy to peanuts and followed parameters. Pairs of these categories were entered in the contingency tables, and the Chi-square test for the relationship of these variables was performed with the level of significance set to 5%. Results: Altogether 332 persons suffering from AD were included in the study of which 120 were male and 212 were female; the average age was 27.2 year. The significant relation between the allergy to peanuts and the occurrence of food hypersensitivity (FH) reactions to tomatoes, kiwi, apples, oranges, carrot and to the sensitization to grass, trees, mites, and the occurrence of rhinitis was found. Conclusion: The significant relation between the allergy to peanuts and the occurrence of FH reactions and the sensitization to inhalant allergens and rhinitis was found. The future studies may show if the decrease in food allergy to peanuts can lead to the decrease of the occurrence of other FH reactions and sensitization to inhalant allergens and rhinitis in AD patients.

Cutaneous manifestation of Alpha-1 antitrypsin deficiency: A case of panniculitis

Sofia Lopes, Carla Damas, Filomena Azevedo, Alberto Mota

Indian Journal of Dermatology 2018 63(4):355-357

Clinical and histopathological response to multidrug therapy in paucibacillary leprosy at the end of 6 months: A prospective observational study from Eastern India - A comment

Pragya Ashok Nair, Kira Pariath

Indian Journal of Dermatology 2018 63(4):354-354

Plasma thiol levels are associated with disease severity in nonsegmental vitiligo

Gulsen Akoglu, Salim Neselioglu, Eda Karaismailoglu, Akin Aktas, Ozcan Erel

Indian Journal of Dermatology 2018 63(4):323-327

Background: Vitiligo is a depigmenting cutaneous disorder with complex pathogenesis. Thiol compounds are well-known organic structures that play a major role in melanogenesis. Aim: The aim of this study was to determine the association between plasma thiol level and disease severity in patients with nonsegmental vitiligo. Methods: A total of 73 patients with nonsegmental vitiligo (57 generalized and 16 localized type) and age- and sex-matched 69 healthy controls were enrolled in the study. Plasma levels of native thiols, disulfides, and total thiols were measured by a novel and automated assay. Disease severity of vitiligo was assessed with Vitiligo Area Scoring Index (VASI) score. The extent, stage, and spread of vitiligo of patients were evaluated according to the Vitiligo European Task Force (VETF) system. Results: The native and total thiol levels of vitiligo patients were higher than those of healthy control group (P≤0.001 and 0.001, respectively). The median VASI score of patients was 0.7 (0.02–28.30). Univariate analyses showed that plasma native thiol levels, VETF spread score, disease duration, and vitiligo type significantly correlated with VASI scores (r=0.237, P=0.043; r=0.458, P<0.001; and P<0.001, respectively). Stepwise multivariate analysis revealed that disease duration (β=0.017; P=0.005) and spread score (β=1.301; P=0.001) were found statistically significant as independent factors on VASI score. Conclusion: Although plasma native thiol level significantly correlated with VASI scores of patients, it is not a predictive factor for vitiligo severity.

Factors aggravating or precipitating acne in Indian adults: A hospital-based study of 110 cases

Rani Maria George, Rajiv Sridharan

Indian Journal of Dermatology 2018 63(4):328-331

Background: Although acne is principally a disorder of adolescence, the number of adult patients with acne is increasing. Adult acne is defined as the presence of acne beyond the age of 25 years. There is relatively few data on the prevalence and studies of acne in adult population. Aim and Objectives: To analyze the various factors that aggravate or precipitate acne vulgaris in Indian adults. Materials and methods: The study was done at the Department of Dermatology at a tertiary care center in Kerala for a period of 1 year. A total of 110 patients above the age of 25 year diagnosed clinically as acne vulgaris were included in the study. A detailed history regarding age of onset, duration, type of acne, family history, whether there was any exacerbation related to food, cosmetics, drugs, emotional stress, seasonal variation, sunlight, sweating, pregnancy, menstruation and smoking was taken. Results: Majority of patients with adult acne were in the age group 26-30 years and there was a clear female preponderance. Persistent acne was more common than late onset acne. Food items and cosmetics were attributed to exacerbation by 47.3% and 40% of patients respectively; 32.7% patients had exacerbations during stress, 26.4% following sun exposure and 23.6% after sweating. About 48% patients had first degree relatives with present or past history of acne. Most of the female patients had premenstrual flare of acne, which was much more common among patients with persistent acne. Pregnancy had no effect on acne in majority of patients. Seasonal variation was observed in 44.5% patients, most of them showing exacerbation in summer months. Conclusion: Acne as a disease lasts longer, persists into adulthood and requires treatment well into the forties. Unlike teenage acne, where males tend to be affected more commonly, post adolescent acne mainly affects females. It is therapeutically rewarding to identify the concerned triggers and aggravating factors and be able to deal with them.

Aquagenic syringeal acrokeratoderma: Report of a case with dermoscopic findings

Bengu Cevirgen Cemil, Muzeyyen Gonul, Aysun Gokce, Goknur Bilen

Indian Journal of Dermatology 2018 63(4):359-360

Concentrations of PCDD/Fs in the neighborhood of a hazardous waste incinerator: human health risks

Abstract

In 1996–1998, a wide surveillance program was initiated in the vicinity of a new hazardous waste incinerator (HWI) placed in Constantí (Catalonia, Spain), which started its regular operations in 1999. The program was aimed at assessing the environmental impact of the facility on the surrounding environment, as well as to evaluate the potential risks for the population living in the neighborhood. Since then, among other measurements, the concentrations of polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs) have been periodically determined in soil and herbage samples. This study shows the results, corresponding to the period 2013–2016. Data were compared with those obtained in the baseline survey (1996–1998), as well as with those of the previous survey (2011–2012). The median PCDD/F concentrations in soils were 0.44 and 0.33 ng toxic equivalent (I-TEQ)/kg in 2015 and 2016, respectively, with a significant decrease in relation to the baseline survey, and a non-significant decrease between 2015 and 2016. In turn, PCDD/F levels in vegetation showed some fluctuations over time, being the concentrations of PCDD/Fs in 2013 very similar to those found in 2012 (1.11 and 1.23 ng I-TEQ/kg, respectively). These concentrations notably decreased along the three last campaigns (0.16, 0.23, and 0.17 ng I-TEQ/kg in 2014, 2015, and 2016, respectively). These changes would be more related to a number of environmental factors rather than to a variation of PCDD/F emissions by the HWI. With respect to human health risks, exposure to PCDD/Fs in the area under potential influence of the HWI is not of concern, as the current environmental concentrations of PCDD/Fs do not mean additional carcinogenic or non-carcinogenic risks for the local population.

Valorization of biochars from pinewood gasification and municipal solid waste torrefaction as peat substitutes

Abstract

Gasification and torrefaction have both gained significant interest as bioenergy techniques. During biomass gasification together with fuel gas, carbon-rich solid substances are produced, whereas torrefaction process is mainly used to prepare a final product with higher calorific value and carbon content than the feedstock, through a low temperature pyrolysis. Both materials (carbon wastes from gasification and torrefied product) could be classified as alternatives to biochar obtained from slow pyrolysis of biomass. The use of biochar, typically from the slow pyrolysis of biomass, as soil amendment and, more recently, as growing media components has been widely researched. However, to our knowledge, no studies have compared the use of biochar from gasification and torrefaction as growing media component for growing media formulation. The objective of this work was to study the effect of two biochars on peat-based growing media: a pinewood gasification biochar (BG) and a biochar (BT) obtained by torrefaction of the organic fraction of municipal solid waste. Growing media mixing PT (peat) with 50%vol of BG or BT were prepared and characterized according to their chemical, thermal and hydrophysical properties. Phytotoxic experiments and growth of Lolium perenne were also performed. Results indicated that peat substitution in growing media by BG and BT at a 50%vol ratio improved their hydrophysical properties. Specifically, bulk density increased more than 50%, air space increased by 43%, the increment of the total porosity was 20%, and, finally, the water holding capacity increased by 18.3%. Significantly, a positive effect on plant biomass production (yield increment: 274%) was observed after addition of BT, whereas no significant differences were observed after addition of BG biochar. Therefore, it can be concluded that both BT and BG could be used as peat substitutes in growing media formulation.

Comparative effect of organic amendments on physio-biochemical traits of young and old bean leaves grown under cadmium stress: a multivariate analysis

Abstract

The current study investigated the influence of organic amendments on cadmium (Cd) uptake and its effects on biochemical attributes of young and old leaves of bean. Bean seedlings were exposed to two levels of Cd (25 and 100 μM) in the presence and absence of different levels of ethylenediaminetetraacetic acid (EDTA) and citric acid (CA). An increase in Cd concentration in growth medium significantly enhanced Cd accumulation in bean roots and shoot. Cadmium stress increased the production of H₂O₂ which resulted in lipid peroxidation and decreased chlorophyll contents. The presence of organic amendments significantly affected Cd accumulation and toxicity to bean plants. Application of EDTA alleviated Cd toxicity in terms of chlorophyll contents, H₂O₂ contents, and lipid peroxidation possibly by chelating toxic Cd ions, and as such forming Cd-EDTA complexes. The presence of CA decreased Cd toxicity by decreasing its uptake. The biochemical responses (H₂O₂ contents, lipid peroxidation, and chlorophyll contents) of bean plants were more severely affected by Cd treatments in old leaves compared to young leaves. This study shows that the effect of CA and EDTA on biochemical behavior of Cd varies greatly with applied levels of Cd and amendments as well as the age of leaves. Based on the results, it is proposed that the presence of organic amendments can greatly affect biogeochemical behavior of Cd in the soil-plant system (ecosystem).

Antiandrogen therapy with spironolactone for the treatment of hidradenitis suppurativa

Antiandrogen therapy has been reported as an effective treatment for hidradenitis suppurativa. This study evaluated both physician and patient reported hidradenitis suppurativa severity outcomes for patients treated with spironolactone. Antiandrogen therapy with spironolactone may be a useful treatment option for reducing inflammatory lesions and pain for female patients with HS.

Surgical Pearl: A Granny Sliding Knot for High Tension Closures

Topical Glycopyrronium Tosylate for the Treatment of Primary Axillary Hyperhidrosis: Results from the ATMOS-1 and ATMOS-2 Phase 3 Randomized Controlled Trials

Current treatment options for hyperhidrosis are limited. The topical anticholinergic, glycopyrronium tosylate, results in significant reductions in sweating severity/production and favorable tolerability in two phase 3, randomized, vehicle-controlled trials in primary axillary hyperhidrosis. These results suggest glycopyrronium tosylate may provide a non-invasive, once-daily, topical treatment option for primary axillary hyperhidrosis.

Efficacy, Safety, and Comparison of Sonic Hedgehog Inhibitors in Basal Cell Carcinomas: A Systematic Review and Meta-Analysis

Sonic hedgehog inhibitors are systemic treatments for locally advanced and metastatic basal cell carcinomas. In locally advanced disease, overall response rate is similarly significant for sonidegib and vismodegib; complete response rate is significant for vismodegib only. Rates of major side effects do not differ between vismodegib and sonidegib. Patients should expect partial responses in locally advanced disease.

Ustekinumab treatment for neutrophilic dermatoses associated with Crohn’s disease: a multicenter-retrospective study

Intralesional Immunotherapy for the Treatment of Warts: A Network Meta-analysis

Although intralesional immunotherapy is commonly used for wart treatment, selection among existing immunotherapeutic modalities remains challenging. PPD and MMR are the most effective modalities for lesion clearance at primary and distant sites (along with autoinoculation), and also reduce recurrence. PPD and MMR may be considered as first-line treatments for warts.

Methotrexate for alopecia areata: a systematic review and meta-analysis

There is lack of synthesised data regarding methotrexate in AA, Good response was observed in 63% of patients and complete response in 36% of patients, Initial regrowth is observed after 3 months of treatment and takes 6-12 months to achieve complete regrowth, The pooled recurrence rate of AA was 47.7%

The ALT-70 Predictive Model Outperforms Thermal Imaging for the Diagnosis of Lower Extremity Cellulitis: A Prospective Evaluation

Point-of-care diagnostic tools may decrease misdiagnosis rates and unnecessary care associated with lower extremity cellulitis. In our prospective study, the ALT-70 predictive model for lower extremity cellulitis outperformed thermal imaging in diagnostic accuracy. The high negative predictive value of ALT-70 effectively allows clinicians to rule out lower extremity cellulitis.

Pigmentation of basal cell carcinoma is inversely associated with tumor aggressiveness in Asian patients

Drug-Induced Phototoxicity: A Systematic Review

Numerous oral drugs are implicated in phototoxicity; however, the level of evidence for most has not been assessed. Vemurafenib, NSAIDs, and antibiotics (fluoroquinolones, tetracyclines) have strongest evidence for phototoxicity. Most associations are not supported by robust evidence. Improved documentation of phototoxicity testing is required before labelling oral drugs as phototoxic.

“Comparing the eighth and the seventh editions of the ajcc staging system and the brigham and women’s hospital alternative staging system for cutaneous squamous cell carcinoma: implications for clinical practice”

The new 8th edition of the American Joint Committee on Cancer (AJCC) staging system incorporates changes regarding cutaneous squamous cell carcinoma (CSCC).

Mohs micrographic surgery (MMS) with MART-1 immunostaining for atypical intraepidermal melanocytic proliferation (AIMP)

Surgical outcomes for AIMP are unknown. Upstaging to unequivocal melanoma was identified in 18.8% of AIMP. No local recurrences occurred with a mean follow-up of 2.7 years. 23.8% of AIMP required greater than one stage of MMS. MMS may be an effective treatment option for AIMP.

Beyond JAAD - October 2018

Immunosenescence-like state is accelerated by constant light exposure and counteracted by melatonin or turmeric administration through DJ-1/Nrf2 and P53/Bax pathways

Publication date: Available online 9 July 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Hanan A. El-Bakry, Ismail Ahmed Ismail, Safaa S. Soliman

Abstract

The awareness of the interrelationship between immunosenescence and constant light exposure can provide new insights into the consequences of excessive exposure to light at night due to light pollution or shift work. Here, we investigated whether constant light exposure (LL) acts as an inducer of immunosenescence. We also determined the role of melatonin or turmeric in reversing the putative effects of constant light and explored for the first time the underlying molecular mechanisms. Young (3–4-month-old) rats were exposed daily to LL alone or in combination with each of melatonin and turmeric for 12 weeks. A group of aged rats (18-months old; n = 6) was used as a reference for natural immunosenescence. Constant light exposure resulted in remarkable pathophysiological alterations resembling those noticed in normal aged rats, manifested as apparent decreases in antioxidant activities as well as Nrf2 and DJ-1 expressions, striking augmentation in oxidative stress, proinflammatory cytokines and expression of TNFα, Bax, and p53 genes, and deleterious changes of lymphoid organs, Co-administration of melatonin or turmeric was able to reverse all alterations induced by LL through upregulation of Nrf2/DJ-1 and downregulation of p53/Bax pathways. These data suggest that LL accelerates immunosenescence via oxidative stress and apoptotic pathways. They also demonstrate for the first time that turmeric is comparable to melatonin in boosting the immune function and counteracting the LL-associated immunosenescence. These effects suggest that turmeric supplementation can be used as an inexpensive intervention to prevent circadian disruption-related immunosenescence. However, to validate the effects of turmeric on humans further studies are warranted.

In vivo photoinduced [4 + 2] dimerization of a neo-clerodane diterpene in Baccharis flabellata. ROS and RNS scavenging abilities

Publication date: Available online 9 July 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Matías Funes, Carlos E. Tonn, Marcela Kurina-Sanz

Abstract

Secondary metabolites play a major role in the adaptation of plants to the environment. Furan neo-clerodane diterpenes are characteristic secondary metabolites in Baccharis flabellata Hook. & Arn. var. flabellata. One of the main compounds is the diene ent-15,16-epoxy-19-hydroxy-1,3,13(16),14-clerodatetraen-18-oic acid (DAC). In this work a new dimeric compound (DACD) has been isolated and identified by NMR and MS techniques. The presence of other minor dimers was also observed in the same plant methanolic extracts. Assuming that they may be the products of [4 + 2] condensation of two monomeric moieties, the formation of adducts by photochemical dimerization was checked by inducing the in vitro [4 + 2] cycloaddition of DAC. Moreover, the DAC and DACD accumulation rates in aerial parts of B. flabellata specimens were analyzed monthly during a complete phenological cycle. The accumulation of monomer depends on the plant phonological stage; meanwhile the dimer proportion arises in detriment of the monomer as the solar UV radiation increases. Since plants exposed to strong UV intensities produce radical species, the scavenger properties of these compounds toward reactive nitrogen species (RNS), and reactive oxygen species (ROS), were analyzed. Albeit DAC and DACD show significant superoxide radical scavenger activities, the monomer proved to be more effective than the dimer toward ROS, while DACD was an excellent RNS scavenger.

Graphical Abstract

“No Drain, No Gain”: Simultaneous Seroma Drainage and Tissue Expansion in Pre-pectoral Tissue Expander-Based Breast Reconstruction

Abstract

Seromas represent the most frequent complication following immediate breast reconstruction surgery, in particular when acellular dermal matrix or synthetic meshes are used to add coverage to implants. Little information regarding breast seroma management is available in the literature. When seroma becomes clinically significant, current methods for its management consist of repeated needle aspiration. We report a fast, efficient, easy and riskless technique to perform serum aspiration in patients who underwent breast reconstruction with a tissue expander that allows simultaneous drainage and expansion of the implant at once. This procedure is safe, painless, does not need special supplies or additional costs and can be easily performed in ambulatory setting to manage breast seromas.

Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Ideals of Facial Beauty Amongst the Chinese Population: Results from a Large National Survey

Abstract

Surgical and non-surgical aesthetic treatments are very popular throughout Asia and in particular in China. With the globalisation and immigration of Chinese people to other countries where many seek treatment from Western-trained doctors, it is important to understand the ideals of beauty amongst Chinese people so as to achieve optimal results. We conducted an online survey to understand the preference of Han Chinese laypersons for facial shape, profile (straight, convex, concave), jaw angle and shape, and shape of the chin, nose, and lips. In addition, the participants were asked about their educational level, geographic location, likelihood to have cosmetic surgery, preference for surgical or non-surgical cosmetic procedures and whether "being beautiful" would affect their daily life. A total of 1417 responses were collected from 599 male and 818 female participants, the majority of them who were 25–35 years old (58.93%). The responses showed that the majority of participants preferred an oval face shape, with a smoothly tapered jaw angle for both men and women, round and pointy chin for both genders, straight to concave nose profile and full lips with well-defined cupid's bow. Most responders indicated they were not willing to undergo cosmetic surgery; however, when given a choice between surgical and non-surgical cosmetic procedures, 82.22% of the participants preferred non-surgical procedures. The majority of respondents (83%) thought that being beautiful has an effect on daily life and improves quality of life.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Correction to: Buttock Lifting Using Elastic Thread (Elasticum ® ) with a New Classification of Gluteal Ptosis

The original version of this article unfortunately contained a mistake. On page 8, in Table 2, the superscripts for the vertical and horizontal axes are incorrect. The correct information is shown below.

Muscle Insertion and Strength of the Muscle Contraction as Guidelines to Enhance Duration of the Botulinum Toxin Effect in the Upper Face

Abstract

Background

In this series of patients the cutaneous insertion and strength of voluntary contraction of the muscles in the upper third of the face were used as guidelines for botulinum toxin application named "BTA Codes."

Method

Anatomical dissection of fresh cadavers identified the shape and cutaneous insertions of the muscles in the upper third of the face. Patient voluntary contraction of the muscles in the upper third of the face created different patterns of skin lines classified by the 4-grade Facial Wrinkle Scale. For botulinum toxin application injections points followed the muscle cutaneous insertion and dose the 4-grade Facial Wrinkle Scale.

Results

Injection points ranged from 3 to 23 points per patient, average of 9.4 points. Dose per point varied from 2.5 to 7.5 U, ranging from 12.5 to 72.5 U per patient, average of 33.82 U. Skin lines resulting from the voluntary contraction of the muscle prior to toxin application were stated as baseline 1. The absence of skin lines and muscle activity on day fifteen after toxin application defined baseline 2. Skin lines resulting from the recovered voluntary contraction of the muscle after toxin application like those of baseline 1 established baseline 3. The botulinum toxin effect was the time elapsed between baselines 2 and 3, ranging from 171 to 204 days, average of 183.72 days, greater than the 3 or 4 months reported in the literature.

Conclusion

"BTA Codes" is a set of rules to apply botulinum toxin supported by muscle anatomy and degree of voluntary contraction to enhance the duration of its effect.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Chahal et al. Respond to “Physical Exertion and Placental Abruption: Public Health Implications and Future Directions”

Physical Exertion Immediately Prior to Placental Abruption: A Case-Crossover Study

Physical Exertion and Placental Abruption: Public Health implications and Future Directionss

Abstract

Chahal et al (Am J Epidemiol. XXXX;XXX(XX):XXXX–XXXX)) assessed the risk of placental abruption due to physical exertion using a case-crossover design. The authors found an increased risk of placental abruption following increased physical exertion in the hour prior to the abruption. The risk was greater among women who were primarily sedentary during pregnancy or prior to being pregnant compared to those who were more physically active. The authors utilize a case-crossover design to assess the association of an intermittent exposure on an acute event. Chahal et al address the limitations of the study including the inability to control for time-varying confounders as well as the potential for recall bias. The public health implications of the study must be carefully evaluated given that physical activity during and prior to pregnancy can lead to healthy outcomes and are likely recommended. While the current study is unable to determine the type of physical exertion associated with placental abruption, future studies are recommended to determine the type of activity that presents increased risk. Additionally, studies among larger samples and in other countries will help determine the generalizability of the results.

Maternal Exposure to DDT and Pyrethroids and Birth Outcomes Among Residents of an Area Sprayed for Malaria Control Participating in the VHEMBE Birth Cohort Study

Abstract

Although effective in controlling malaria, Indoor Residual Spraying results in elevated exposure to insecticides such as dichlorodiphenyltrichloroethane (DDT) and pyrethroids. These chemicals cross the placenta but no studies have examined their associations with birth outcomes in populations residing in indoor residual spraying areas. We investigated this question in the Venda Health Examination of Mothers, Babies and their Environment (VHEMBE), a birth cohort study of 751 South African children born between 2012 and 2013. We measured maternal peripartum serum DDT and urine pyrethroid metabolite concentrations and collected data on birth weight, length, head circumference and gestational duration. We analyzed data using marginal structural models with inverse probability of treatment weights, generalized propensity scores and standard conditional linear regression. p,p'-DDT, o,p'-DDT and, to a lesser extent, p,p'-dichlorodiphenyldichloroethylene were related to elevated birth weight, length and head circumference among girls only, using all three analytical methods. Changes in gestational duration did not mediate this relation, suggesting exposures accelerate fetal growth, which is consistent with the known estrogenic properties of o,p'-DDT and p,p'-DDT. No associations were found with pyrethroid metabolites. Results suggest prenatal exposure to DDT is related to elevated birth size. Further studies are needed to elucidate the implications of these findings.

Prevalence and Patterning of Mental Disorder in Three Cohorts of Black and White Americans Through Adolescence

Abstract

The tendency for Blacks to report similar or lower rates of mental disorder than Whites is well-established. However, whether these disparities are stable across cohorts of Black and White Americans is not well understood. In the current study, we examined Black-White differences in the lifetime prevalence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mood, anxiety, impulse control, substance use and any disorders across 3 cohorts of Blacks and Whites aged 4 to 18. Using merged data from the National Comorbidity Survey Replication (2001-2003) and the National Comorbidity Survey Adolescent Supplement (2001-2004), we observed a change in the Black-White patterning of mental disorder between 1957 and 2004. Blacks born between 1957-1969 reported lower rates of anxiety disorders relative to their White counterparts (odds ratio (OR)=0.69, 95% confidence interval (CI): 0.52-0.91), Blacks born between 1970-1982 reported no difference in the rates of anxiety disorders relative to Whites (OR=0.97, 95% CI: 0.76-1.25), and Blacks born between 1983-1991 reported higher rates of anxiety disorders relative to Whites (OR=1.30, 95% CI: 1.18-1.43). Similar but less distinct trends were observed for mood, impulse control, and any disorders. Our results suggest that the Black-White patterning of mental disorder has changed across cohorts, to the disadvantage of Black Americans.

Why Choose the Septum-Supero-Medial (SSM)-Based Mammaplasty in Patients with Severe Breast Ptosis: An Anatomical Point of View

Abstract

Nipple–areola complex (NAC) loss is one of the most devastating complications of mastopexy or breast reduction, and it requires revisional procedures with poor aesthetic outcome. In high-risk patients, a free nipple graft could be a choice, but it is associated with the same aesthetic concerns for both patients and surgeons. We report our experience with the septum-supero-medial-based mammaplasty to treat 22 patients with severe breast ptosis (nipple-to-sternal-notch distance > 40 cm). No NAC loss was observed. The study highlights surgical technical details and discusses anatomical considerations to justify the successful result.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Spreading the message of antimicrobial resistance: A detailed account of a successful public engagement event

Abstract

The increase in Antimicrobial resistance (AMR) microorganisms has been exacerbated by exposure to antimicrobial drugs (e.g. antibiotics). A solution to AMR may require academic researchers to not only contribute to the drug discovery pipeline through laboratory research, but also to engage and inform non-specialist audiences using a variety of interventions in order to change behaviour towards our use of antibiotics. In this paper, the authors describe a hands-on public engagement event focusing on AMR. 'A Spoonful of Soil', was created by drawing on the past experiences of the delivering team (also described), with planning focusing on clear concise messages, selection of an appropriate audience and ensuring the event would be of significant interest to the audience. The event had a significant footfall of over 300 visitors. Key messages which aimed to raise awareness of AMR and educate visitors on the actions and behaviours that can help address the global issue of AMR were delivered by appropriate experts successfully, however success in reaching audience cannot be concluded from the feedback and evaluation gathered.

Discussion of Shue et al. “Fat Injection: A Systemic Review of Injection Volumes by Facial Subunit”

Empirical moral rationalism and the social constitution of normativity

Abstract

Moral rationalism has long been an attractive position within moral philosophy. However, among empirical-minded philosophers, it is widely dismissed as scientifically untenable. In this essay, I argue that moral rationalism's lack of uptake in the empirical domain is due to the widespread supposition that moral rationalists must hold that moral judgments and actions are produced by rational capacities. But this construal is mistaken: moral rationalism's primary concern is not with the relationship between moral judgments and rational capacities per se, but rather with developing a conception objectivity normativity that avoids Platonism. In light of this, I develop an alternative approach to translating moral rationalism into the empirical domain that builds on the common rationalist view that normative requirements are explained by the relationship between agents and the social structures and practices in which they are embedded. I propose that this social conception of normativity can be translated into a scientific framework by interpreting it as a claim about the importance of constraint-based explanation when accounting for norm-governed behavior. In order to develop this point more concretely and show that it is empirically tractable, I turn to research on macaque social organization that highlights the ways in which (proto)normative standards are generated by empirically observable social structures. The insights garnered from the macaque case allow me to then locate moral rationalism's core claims about the relationship between morality and the standards of practical rationality within an empirically plausible framework.

Global and Widespread Local White Matter Abnormalities in Juvenile Neuronal Ceroid Lipofuscinosis [PEDIATRICS]

BACKGROUND AND PURPOSE:

Juvenile neuronal ceroid lipofuscinosis is a progressive neurodegenerative lysosomal storage disease of childhood. It manifests with loss of vision, seizures, and loss of cognitive and motor functions leading to premature death. Previous MR imaging studies have reported cerebral and cerebellar atrophy, progressive hippocampal atrophy, thalamic signal intensity alterations, and decreased white matter volume in the corona radiata. However, conventional MR imaging findings are usually normal at younger than 10 years of age. The purpose of our study was to investigate whether diffusion MR imaging could reveal changes in white matter microstructure already present at a younger age.

MATERIALS AND METHODS:

We investigated global and local white matter abnormalities in 14 children with juvenile neuronal ceroid lipofuscinosis (mean age, 9.6 ± 3.4 years; 10 boys) and 14 control subjects (mean age, 11.2 ± 2.3 years; 7 boys). Twelve patients underwent follow-up MR imaging after 2 years (mean age, 11.4 ± 3.2 years; 8 boys). We performed a global analysis using 2 approaches: white matter tract skeleton and constrained spherical deconvolution–based whole-brain tractography. Then, we investigated local microstructural abnormalities using Tract-Based Spatial Statistics.

RESULTS:

We found globally decreased anisotropy (P = .000001) and increased diffusivity (P = .001) in patients with juvenile neuronal ceroid lipofuscinosis. In addition, we found widespread increased diffusivity and decreased anisotropy in, for example, the corona radiata (P < .001) and posterior thalamic radiation (P < .001). However, we found no differences between the first and second acquisitions.

CONCLUSIONS:

The patients with juvenile neuronal ceroid lipofuscinosis exhibited global and local abnormalities in white matter microstructure. Future studies could apply more specific microstructural models and study whether these abnormalities are already present at a younger age.

Endovascular Treatment of Dural Arteriovenous Fistulas Using Transarterial Liquid Embolization in Combination with Transvenous Balloon-Assisted Protection of the Venous Sinus [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Sinus-preserving endovascular embolization was described as a promising treatment technique for dural arteriovenous fistulas. Our aim was to report our single-center experience in patients with dural arteriovenous fistulas who were treated with transarterial liquid embolization in combination with transvenous balloon-assisted protection of the affected venous sinus.

MATERIALS AND METHODS:

A retrospective analysis of a prospectively collected data base was performed. Demographic and clinical data, angiographic features of the dural arteriovenous fistulas, procedural parameters, complications, treatment success, follow-up imaging, and clinical outcome were assessed.

RESULTS:

Twenty-two patients were treated in 25 procedures. All patients were symptomatic, of whom 81.8% presented with tinnitus; 9.1%, with ocular symptoms; and 9.1%, with headache. Most fistulas were located at the transverse and/or sigmoid sinus. The most frequent fistula type was Cognard IIa+b (40.9%), followed by Cognard I (31.8%) and Cognard IIa (27.3%)/Borden I (59.1%), followed by Borden II (40.9%). The affected sinus could be preserved in all except for 1 patient in whom it was sacrificed in a second treatment procedure by coil embolization. The overall complete occlusion rate was 86.4%. The overall complication rate was 20%, with transient and permanent morbidity and mortality of 8%, 0%, and 0%, respectively. After a mean follow-up of 18 months, most patients (68.2%) achieved complete symptom remission, 27.3% showed symptom relief, and 4.6% had stable symptoms.

CONCLUSIONS:

Transarterial liquid embolization of dural arteriovenous fistulas in combination with transvenous balloon-assisted protection of the venous sinus is feasible and safe and offers high rates of occlusion and of symptom remission.

REPLY: [reply]

Extent of Microstructural Tissue Damage Correlates with Hemodynamic Failure in High-Grade Carotid Occlusive Disease: An MRI Study Using Quantitative T2 and DSC Perfusion [EXTRACRANIAL VASCULAR]

BACKGROUND AND PURPOSE:

Chronic hemodynamic impairment in high-grade carotid occlusive disease is thought to cause microstructural abnormalities that might be subclinical or lead to subtle symptoms including cognitive impairment. Quantitative MR imaging allows assessing pathologic structural changes beyond macroscopically visible tissue damage. In this study, high-resolution quantitative T2 mapping combined with DSC-based PWI was used to investigate quantitative T2 changes as a potential marker of microstructural damage in relation to hemodynamic impairment in patients with unilateral high-grade carotid occlusive disease.

MATERIALS AND METHODS:

Eighteen patients with unilateral high-grade ICA or MCA stenosis/occlusion were included in the study. T2 values and deconvolved perfusion parameters, including relative CBF, relative CBV, and the relative CBF/relative CBV ratio as a potential indicator of local cerebral perfusion pressure, were determined within areas with delayed TTP and compared with values from contralateral unaffected areas after segmentation of normal-appearing hypoperfused WM and cortical regions. Hemispheric asymmetry indices were calculated for all parameters.

RESULTS:

Quantitative T2 was significantly prolonged (P < .01) in hypoperfused tissue and correlated significantly (P < .01) with TTP delay and relative CBF/relative CBV reduction in WM. Significant correlations (P < .001) between TTP delay and the relative CBF/relative CBV ratio were found both in WM and in cortical areas.

CONCLUSIONS:

Quantitative T2 can be used as a marker of microstructural tissue damage even in normal-appearing GM and WM within a vascular territory affected by high-grade carotid occlusive disease. Furthermore, the extent of damage correlates with the degree of hemodynamic failure measured by DSC perfusion parameters.

Neuroimaging in Dengue Seropositive Cases [letter]

MSVAT-SPACE-STIR and SEMAC-STIR for Reduction of Metallic Artifacts in 3T Head and Neck MRI [HEAD & NECK]

BACKGROUND AND PURPOSE:

The incidence of metallic dental restorations and implants is increasing, and head and neck MR imaging is becoming challenging regarding artifacts. Our aim was to evaluate whether multiple-slab acquisition with view angle tilting gradient based on a sampling perfection with application-optimized contrasts by using different flip angle evolution (MSVAT-SPACE)-STIR and slice-encoding for metal artifact correction (SEMAC)-STIR are beneficial regarding artifact suppression compared with the SPACE-STIR and TSE-STIR in vitro and in vivo.

MATERIALS AND METHODS:

At 3T, 3D artifacts of 2 dental implants, supporting different single crowns, were evaluated. Image quality was evaluated quantitatively (normalized signal-to-noise ratio) and qualitatively (2 reads by 2 blinded radiologists). Feasibility was tested in vivo in 5 volunteers and 5 patients, respectively.

RESULTS:

Maximum achievable resolution and the normalized signal-to-noise ratio of MSVAT-SPACE-STIR were higher compared with SEMAC-STIR. Performance in terms of artifact correction was dependent on the material composition. For highly paramagnetic materials, SEMAC-STIR was superior to MSVAT-SPACE-STIR (27.8% smaller artifact volume) and TSE-STIR (93.2% less slice distortion). However, MSVAT-SPACE-STIR reduced the artifact size compared with SPACE-STIR by 71.5%. For low-paramagnetic materials, MSVAT-SPACE-STIR performed as well as SEMAC-STIR. Furthermore, MSVAT-SPACE-STIR decreased artifact volume by 69.5% compared with SPACE-STIR. The image quality of all sequences did not differ systematically. In vivo results were comparable with in vitro results.

CONCLUSIONS:

Regarding susceptibility artifacts and acquisition time, MSVAT-SPACE-STIR might be advantageous over SPACE-STIR for high-resolution and isotropic head and neck imaging. Only for materials with high-susceptibility differences to soft tissue, the use of SEMAC-STIR might be beneficial. Within limited acquisition times, SEMAC-STIR cannot exploit its full advantage over TSE-STIR regarding artifact suppression.

REPLY: [reply]

Efficacy and Safety of Percutaneous Microwave Ablation and Cementoplasty in the Treatment of Painful Spinal Metastases and Myeloma [SPINE]

BACKGROUND AND PURPOSE:

Painful spinal metastases are a common cause of cancer-related morbidity. Percutaneous ablation presents an attractive minimally invasive alternative to conventional therapies. We performed a retrospective review of 69 patients with 102 painful spinal metastases undergoing microwave ablation and cementoplasty to determine the efficacy and safety of this treatment.

MATERIALS AND METHODS:

Procedures were performed between January 2015 and October 2016 with the patient under general anesthesia using image guidance for 102 spinal metastases in 69 patients in the following areas: cervical (n = 2), thoracic (n = 50), lumbar (n = 34), and sacral (n = 16) spine. Tumor pathologies included the following: multiple myeloma (n = 10), breast (n = 27), lung (n = 12), thyroid (n = 6), prostate (n = 5), colon (n = 4), renal cell (n = 3), oral squamous cell (n = 1), and adenocarcinoma of unknown origin (n = 1). Procedural efficacy was determined using the visual analog scale measured preprocedurally and at 2–4 weeks and 20–24 weeks postprocedure. Tumor locoregional control was assessed on follow-up cross-sectional imaging. Procedural complications were recorded to establish the safety profile.

RESULTS:

The median ablation time was 4 minutes 30 seconds ± 7 seconds, and energy dose, 4.1 ± 1.6 kJ. Median visual analog scale scores were the following: 7.0 ± 1.8 preprocedurally, 2 ± 1.6 at 2–4 weeks, and 2 ± 2.1 at 20–24 weeks. Eight patients died within 6 months following the procedure. Follow-up imaging in the surviving patients at 20–24 weeks demonstrated no locoregional progression in 59/61 patients. Two complications were documented (S1 nerve thermal injury and skin burn).

CONCLUSIONS:

Microwave ablation is an effective and safe treatment technique for painful spinal metastases. Further studies may be helpful in determining the role of microwave ablation in locoregional control of metastases.

Common Origin of Brachiocephalic and Left Common Carotid Arteries: Proposal of New Terminology [letter]

Clinical Significance of Intraplaque Hemorrhage in Low- and High-Grade Basilar Artery Stenosis on High-Resolution MRI [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Intraplaque hemorrhage within intracranial atherosclerotic plaques identified by high-resolution MR imaging has been studied as a potential marker of stroke risk. However, previous studies only examined intracranial arteries with high-grade stenosis (degree of stenosis, >50%). This study aimed to ascertain the clinical relevance of intraplaque hemorrhage in patients with low- and high-grade stenotic basilar artery plaques.

MATERIALS AND METHODS:

Patients with basilar artery stenosis (n = 126; mean age, 62 ± 10 years; 66 symptomatic and 60 asymptomatic) underwent high-resolution MR imaging. The relationship between imaging findings (intraplaque hemorrhage, contrast enhancement, degree of stenosis, minimal lumen area, and plaque burden) and symptoms was analyzed.

RESULTS:

Intraplaque hemorrhage was identified in 22 patients (17.5%), including 21 (31.8%) symptomatic patients and 1 (1.7%) asymptomatic patient. Multivariate analysis showed that intraplaque hemorrhage was the strongest independent marker of symptomatic status (odds ratio, 27.5; 95% CI, 3.4–221.5; P = .002). Contrast enhancement was also independently associated with symptomatic status (odds ratio, 9.9; 95% CI, 1.5–23.6; P = .016). Stenosis, minimal lumen area, and plaque burden were not correlated with symptoms (P > .05). Intraplaque hemorrhage was present in both low- and high-grade stenotic basilar arteries (11.3% versus 16.3%, P = .63). Diagnostic performance values of intraplaque hemorrhage for patients with acute/subacute symptomatic stroke were the following: specificity, 98.3%; sensitivity, 31.8%; positive predictive value, 95.5%; and negative predictive value, 56.7%.

CONCLUSIONS:

Intraplaque hemorrhage is present in both low- and high-grade stenotic basilar artery plaques and is independently associated with symptomatic stroke status. Intraplaque hemorrhage may identify high-risk plaque and provide new insight into the management of patient with stroke without significant stenosis.

[other]

Abnormal Blood Oxygen Level-Dependent Fluctuations in Focal Cortical Dysplasia and the Perilesional Zone: Initial Findings [FUNCTIONAL]

BACKGROUND AND PURPOSE:

Focal cortical dysplasia is a common cause of intractable epilepsy for which neurosurgery is an option. Delineations of a focal cortical dysplasia lesion on structural brain images may not necessarily reflect the functional borders of normal tissue. Our objective was to determine whether abnormalities in spontaneous blood oxygen level–dependent fluctuations arise in focal cortical dysplasia lesions and proximal regions.

MATERIALS AND METHODS:

Fourteen patients with focal cortical dysplasia–related epilepsy and 16 healthy controls underwent structural and resting-state functional MR imaging. Three known blood oxygen level–dependent measures were determined, including the fractional amplitude of low-frequency fluctuations, regional homogeneity, and wavelet entropy. These measures were evaluated in the lesion and perilesional zone and normalized to the contralateral cortex of patients with focal cortical dysplasia and healthy controls.

RESULTS:

Patients showed significantly decreased fractional amplitude of low-frequency fluctuations and increased wavelet entropy in the focal cortical dysplasia lesion and the perilesional zone (≤2 cm) relative to the contralateral homotopic cortex and the same regions in healthy controls. Regional homogeneity was significantly increased in the focal cortical dysplasia lesion compared with the contralateral homotopic cortex and healthy controls.

CONCLUSIONS:

Abnormalities in spontaneous blood oxygen level–dependent fluctuations were seen up to 2 cm distant from the radiologically visible boundary. It was demonstrated that functional boundaries go beyond structural boundaries of focal cortical dysplasia lesions. Validation is required to reveal whether this information is valuable for surgical planning and outcome evaluation of focal cortical dysplasia lesions and comparing current results with electrophysiologic analysis.