Increasing grassland degradation stimulates the non-growing season CO 2 emissions from an alpine meadow on the Qinghai–Tibetan Plateau

Abstract

The alpine meadow ecosystem is one of the major vegetation biomes on the Qinghai–Tibetan Plateau, which hold substantial quantities of soil organic carbon. Pronounced grassland degradations (induced by overgrazing/climate change and further exacerbated by the subterranean rodent activities) that have widely occurred in this ecosystem may significantly alter the non-growing season carbon turnover processes such as carbon dioxide (CO₂) efflux, but little is known about how the non-growing season CO₂ emissions respond to the degradation (particularly the exacerbated degradations by plateau zokor), as most previous studies have focused primarily on the growing season. In this study, the effects of four degradation levels (i.e., the healthy meadow (HM), degraded patches (DP), 2-year-old zokor mounds (ZM2), and current-year zokor mounds (ZM1)) on CO₂ emissions and corresponding environmental and agronomic variables were investigated over the two non-growing seasons under contrasting climatic conditions (a normal season in 2013–2014 and a "warm and humid" season in 2014–2015). The temporal variation in the non-growing season CO₂ emissions was mainly regulated by soil temperature, while increasing degradation levels reduced the temperature sensitivity of CO₂ emissions due to a reduction in soil water content. The cumulative CO₂ emissions across the non-growing season were 587–1283 kg C ha⁻¹ for all degradation levels, which varied significantly (p < 0.05) interannually. The degradation of alpine meadows significantly (p < 0.05) reduced the vegetation cover and aboveground net primary productivity as well as the belowground biomass, which are typically thought to decrease soil CO₂ emissions. However, the non-growing season CO₂ emissions for the degraded meadow, weighted by the areal extent of the DP, ZM2, and ZM1, were estimated to be 641–1280 kg C ha⁻¹, which was significantly higher (p < 0.05) as compared with the HM in the warm and humid season of 2014–2015 but not in the normal season of 2013–2014. Additionally, grassland degradation substantially increased the productivity-scaled non-growing season CO₂ emissions, which showed an exponential trend with increasing degradation levels. These results suggest that there is a strong connection between grassland degradation and soil carbon loss, e.g., in the form of CO₂ release, pointing to the urgent need to manage degraded grassland restoration that contributes to climate change mitigation.

Syndrome d’activation macrophagique secondaire à une fièvre boutonneuse méditerranéenne

Publication date: Available online 10 July 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): A.-S. Bertrand, M. Fondain, P. Rullier, C. Fontaine, B. Guillot

Résumé

Introduction

Le syndrome d'activation macrophagique (SAM) est une pathologie rare de pronostic sévère définie par des critères cliniques, biologiques et cyto-histologiques. Les infections représentent une cause classique de SAM. Les SAM secondaires à une fièvre boutonneuse méditerranéenne sont rares ; seuls quelques cas sont rapportés dans la littérature.

Observations

Nous rapportons les cas de deux hommes de 77 et 63 ans qui avaient une éruption maculo-purpurique fébrile avec escarre d'inoculation associée à des anomalies biologiques comprenant cytopénie, hyperferritinémie et hypertriglycéridémie. Une hémophagocytose était présente dans les deux cas. La sérologie et la PCR Rickettsia conorii étaient positives en faveur d'une infection récente, confirmant le diagnostic de fièvre boutonneuse méditerranéenne (FBM). Ces éléments permettaient dans les deux cas de poser le diagnostic de SAM secondaire à une FBM.

Discussion

Le premier cas de SAM a été décrit en 1979. Seize cas de SAM secondaires à une FBM sont décrits dans la littérature. La présence d'une cytopénie associée à une hyperferritinémie et une hypertriglycéridémie au cours d'une FBM est fortement évocatrice du diagnostic de SAM. Le pronostic dépend du délai diagnostique et des facteurs propres à l'hôte. L'association d'immunosuppresseurs à l'antibiothérapie peut être nécessaire pour obtenir la guérison.

Conclusion

Les rickettsioses peuvent induire un syndrome d'hémophagocytose ; la survenue possible de cette complication de mauvais pronostic mérite d'être connue.

Summary

Introduction

Haemophagocytic syndrome (HS) is a rare disease with a severe prognosis that is defined by clinical, laboratory and histopathological criteria. Infections represent the classical cause of HS. HS secondary to Mediterranean spotted fever (MSF) is rare with only a few cases being reported in the literature.

Observations

We report two cases of HS secondary to MSF in 2 men aged 77 and 63 years presenting a febrile maculo-purpuric eruption with inoculation ulcer associated with laboratory abnormalities (cytopenia, elevated ferritin, hypertriglyceridaemia). Haemophagocytosis was present in 2 cases. Serology and PCR for Rickettsia conorii were positive and militated in favour of recent infection responsible for the diagnosis of MSF.

Discussion

The first case of HS was described in 1979. Sixteen cases of HS secondary to MSF are described in the literature. Cytopenia associated with hyperferritinaemia and hypertriglyceridaemia strongly suggests MSF complicated by HS. The prognosis depends on the time elapsed since diagnosis and host-specific factors. Immunosuppressants and antibiotics may be necessary to ensure healing.

Conclusion

Rickettsioses can induce HS, and this potential complication with a severe prognosis must be known.

Binding interaction of phenazinium-based cationic photosensitizers with human hemoglobin: Exploring the effects of pH and chemical structure

Publication date: Available online 10 July 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Swagata Sen, Bijan K. Paul, Nikhil Guchhait

Abstract

The present study demonstrates a spectroscopic study on the interaction of two phenazinium-based cationic photosensitizers, namely, phenosafranin (PSF) and safranin-O (SO) with human hemoglobin (Hb) with particular emphasis on exploring the effects of pH and chemical structures of the dye molecules on the binding phenomenon. The protein (Hb) undergoes complex conformational transitions depending on the medium pH. The dye molecules exhibit a prominent fluorescence quenching following interaction with Hb under various experimental conditions (pH 3.5, 7.4, and 9.0). Our combined steady-state and time-resolved spectroscopic results provide persuasive evidence for static quenching mechanism showing that the dye:Hb interaction proceeds through ground-state complex formation. The meticulous investigations on the pH-dependence of the interaction of the dye molecules with the protein reveal a relatively strong binding of PSF as well as SO with Hb at physiological pH and alkaline pH, while the binding is weaker at acidic pH at which Hb predominantly exists as monomeric units. The binding constant for PSF:Hb interaction is K(PSF:Hb) = (1.09 ± 0.06) × 10⁶ M⁻¹ and that of SO:Hb interaction is K(SO:Hb) = (1.34 ± 0.07) × 10⁵ M⁻¹ at pH 7.4. However, at pH 3.5, the binding constant values are K(PSF:Hb) = (3.58 ± 0.18) × 10⁴ M⁻¹ and K(SO:Hb) = (4.29 ± 0.22) × 10⁴ M⁻¹ and at pH 9.0, the values are K(PSF:Hb) = (8.08 ± 0.40) × 10⁴ M⁻¹ and K(SO:Hb) = (5.07 ± 0.25) × 10⁴ M⁻¹. This depicts a much stronger binding interaction of the dyes with the native Hb at pH 7.4 compared to those at pH 3.5 and 9.0. Our results also unveil the effect of chemical structures of the dyes on the interaction phenomenon in the sense that the binding constant of PSF with Hb is found to be higher than that of SO at pH 7.4 and pH 9.0. The present study also focuses on exploring such important aspects of the interaction phenomena as the effect of binding of the dyes on the protein conformation by circular dichroism spectroscopy and probable binding location of the dyes within the protein scaffolds via micropolarity measurements and molecular docking simulation.

Graphical Abstract

Association Between Serum CK-18 Levels and the Degree of Liver Damage in Fructose-Induced Metabolic Syndrome

Metabolic Syndrome and Related Disorders, Ahead of Print.

No difference in human mast cells derived from peanut allergic versus non‐allergic subjects

Immunity, Inflammation and Disease, EarlyView.

The assessment of changes to the nontuberculous mycobacterial metabolome in response to anti-TB drugs

Abstract

Mycobacterium species can cause a range of nontuberculous infections of healthy and immunocompromised people as well as infected people during and after surgical procedures. The similarity of nontuberculous mycobacteria (NTM) to the tuberculosis bacilli (TB) could ultimately enable the use of anti-TB drugs for the genus. Hence, three NTM (Mycobacterium smegmatis, Mycobacterium phlei and Mycobacterium avium) were cultured under different lab conditions, causing two mycobacterial phenotypes (active and dormant), and treated with isoniazid (INH) and ethambutol (EMB) independently or in combination. Metabolite profiling was applied to facilitate the investigation and characterisation of intracellular targets affected by the antibiotics. Aliquots of the cell culture were taken over the treatment period and the metabolite profile of the cells analysed by gas chromatography mass spectrometry. Comparative analysis of the metabolite levels to untreated mycobacteria confirmed the successful action of the antibiotics on the metabolism of all three species. Furthermore, single metabolites and metabolite pathways affected by the antibiotics could be identified and included, besides the known target sites for INH and EMB on mycobacterial cells, changes in e.g. nucleotide and saccharide levels. The combined treatment highlighted the property of EMB to enhance the effects of INH even under hypoxic culture conditions.

Shaping Escherichia coli for recombinant membrane protein production

Abstract

The bacterium Escherichia coli has been widely used for the production of both pro- and eukaryotic membrane proteins. Usually, a set of standard strains as well as different culture setups and induction regimes are screened for to enhance production yields. However, on a limited scale, E. coli strains have been isolated for recombinant helical bundle membrane protein production using both selection- and engineering-based approaches. Here, we discuss how such approaches have been used so far to shape E. coli for the production of these recombinant membrane proteins and may be used in the future to further enhance production yields.

SecA inhibitors as potential antimicrobial agents: differential actions on SecA-only and SecA-SecYEG protein-conducting channels

Abstract

Sec-dependent protein translocation is an essential process in bacteria. SecA is a key component of the translocation machinery and has multiple domains that interact with various ligands. SecA acts as an ATPase motor to drive the precursor protein/peptide through the SecYEG protein translocation channels. As SecA is unique to bacteria and there is no mammalian counterpart, it is an ideal target for the development of new antimicrobials. Several reviews detail the assays for ATPase and protein translocation, as well as the search for SecA inhibitors. Recent studies have shown that, in addition to the SecA-SecYEG translocation channels, there are SecA-only channels in the lipid bilayers, which function independently from the SecYEG machinery. This mini-review focuses on recent advances on the newly developed SecA inhibitors that allow the evaluation of their potential as antimicrobial agents, as well as a fundamental understanding of mechanisms of SecA function(s). These SecA inhibitors abrogate the effects of efflux pumps in both Gram-positive and Gram-negative bacteria. We also discuss recent findings that SecA binds to ribosomes and nascent peptides, which suggest other roles of SecA. A model for the multiple roles of SecA is presented.

Phenotypic and lipidomic characterization of primary human epidermal keratinocytes exposed to simulated solar UV radiation

Sunlight is composed of a continuous spectrum of electromagnetic radiation which has three main wavelength regions: ultraviolet (UV), visible and infrared. UV radiation comprises UVA (320 – 400 nm), UVB (280 – 320 nm) and UVC (200 - 280 nm). Whereas UVA radiation represents 95 % of the total solar UV that reaches the earth, UVC and most of the UVB radiation are absorbed by the stratospheric ozone layer [1–2]. Skin, the outermost tissue of the body, is exposed to various environmental aggressions, among which solar ultraviolet (UV) radiation is the most significant.

Universal varicella vaccination increased the incidence of herpes zoster in the child-rearing generation as its short-term effect

Varicella zoster virus (VZV) infection causes varicella and results in latent infection of the sensory ganglia, and its reactivation causes herpes zoster (HZ). Dr. Takahashi developed the varicella vaccine [1], and introduction of universal varicella vaccination has eliminated varicella epidemics [2]. HZ increases at the age of 50 years or older, and the incidence is increasing in the epidemiologic studies [3–8]. Exposure to varicella boosts the immunity to VZV and has been reported to reduce the incidence of HZ in many epidemiologic studies [8–11].

Bio-cord plays a similar role as submerged macrophytes in harboring bacterial assemblages in an eco-ditch

Abstract

Artificial carriers are widely used to enhance the formation of biofilm and improve pollutants' removal efficiency in agricultural wastewater treatment ditches (eco-ditches), yet comprehensive insight into their bacterial community is scarce. In this study, bacterial diversities in four different habitats—the water column, surface sediments, submerged macrophytes (Myriophyllum verticillatum L.), and the artificial carriers (bio-cord)—were compared in a Chinese eco-ditch. Comparable richness and evenness of bacterial communities were observed on M. verticillatum and bio-cord, both being higher than for free-living bacteria in the water column but lower than for bacteria in the surface sediment. The highest similarity of bacterial community composition and structure also occurred between M. verticillatum and the bio-cord, dominated by α- and γ-proteobacteria, Verrucomicrobia, and Bacteroidetes. Firmicutes and Planctomycetes, respectively, were the exclusive abundant phyla in M. verticillatum and the bio-cord, probably indicating the unique interaction between M. verticillatum and their epiphytic bacteria. Some abundant genera, such as Roseomonas, Pseudomonas, and Rhodopirellula, which were exclusively observed in M. verticillatum or the bio-cord, have been reported to have the same capacity to remove nitrogen and organic matter in wastewater treatment systems. In conclusion, in the studied eco-ditch, the bio-cord was found to play a similar role as submerged macrophytes in harboring bacterial assemblages, and we therefore propose that bio-cord may be a good alternative or supplement to enhance wastewater treatment in agricultural ditches.

Production, characterization, and potential of activated biochar as adsorbent for phenolic compounds from leachates in a lumber industry site

Abstract

There is growing interest in low-cost, efficient materials for the removal of organic contaminants in municipal and industrial effluents. In this study, the efficiency of biochar and activated biochar, as promising adsorbents for phenol removal, was investigated at high (up to 1500 mg L⁻¹) and low concentrations (0.54 mg L⁻¹) in synthetic and real effluents (from wood-residue deposits in Québec), respectively. The performance of both materials was then evaluated in batch adsorption experiments, which were conducted using a low solid/liquid ratio (0.1 g:100 mL) at different phenol concentrations (C₀ = 5–1500 mg L⁻¹), and at 20 °C. Activated biochars presented higher phenol adsorption capacity compared to biochars due to their improved textural properties, higher micropore volume, and proportion of oxygenated carbonyl groups connected to their surface. The sorption equilibrium was reached within less than 4 h for all of materials, while the Langmuir model best described their sorption process. The maximum sorption capacity of activated biochars for phenol was found to be twofold relative to biochars (303 vs. 159 mg g⁻¹). Results also showed that activated biochars were more effective than biochars in removing low phenol concentrations in real effluents. In addition, 95% of phenol removal was attained within 96 h (although 85% was removed after 4 h), thus reaching below the maximum authorized concentration allowed by Québec's discharge criteria (0.05 mg L⁻¹). These results show that activated biochars made from wood residues are promising potential adsorbent materials for the efficient treatment of phenol in synthetic and real effluents.

Responses of magnetic properties to heavy metal pollution recorded by lacustrine sediments from the Lugu Lake, Southwest China

Abstract

Environmental magnetism, which is rapid, sensitive, economical, and non-destructive, has been used to assess heavy metal pollution in lake sediments based on the relationships between magnetic properties and heavy metal concentrations. We conducted a systematic environmental magnetic and heavy metal study of the sediments of the core LGS from Lugu Lake in Southwest China. The results show that the concentration-related magnetic parameters (χ, χ_ARM, and SIRM) in the core LGS showed an increasing trend from bottom to top. The results of rock magnetism indicated that the dominant magnetic particles were magnetite. Two sources of magnetic minerals can be distinguished by the correlations of χ vs. χ_fd% and χ vs. χ_ARM/χ: the surrounding catchment and anthropogenic activities. In addition, Pearson correlation analysis and principal component analysis showed that the concentration-dependent magnetic parameters have significant correlations with heavy metal (Al, Ti, Fe, Cr, Ni, Cu, Zn, and Cd) concentrations as well as the Tomlinson pollution load index (PLI), indicating that there are essential linkages of sources, deposition, and migration between magnetic particles and heavy metals. Based on previously reported ¹³⁷Cs and ²¹⁰Pb data, the historical trends of heavy metal pollution in Lugu Lake were successfully reconstructed, and the causes of heavy metal pollution were mainly agricultural practices and atmospheric metal depositions from anthropogenic sources. The significant correlations between magnetic parameters, heavy metals, and the PLI indicate that magnetic parameters can potentially be used as an index of heavy metal pollution in lacustrine deposits.

Enhancing bacterial transport with saponins in saturated porous media for the bioaugmentation of groundwater: visual investigation and surface interactions

Abstract

The success of bioaugmentation processes for the remediation of groundwater contamination relies on effective transport of the injected microorganisms in a subsurface environment. Biosurfactants potentially affect bacterial attachment and transport behavior in porous media. Although saponins as biosurfactants are abundant in nature, their influence on bacterial transport in groundwater systems remains unknown. In this research, tank visual-transport experiments, breakthrough curve monitoring, and surface property measurement were performed to evaluate the effects of saponins on the transport of Pseudomonas migulae AN-1 cells, which were used as a model bacterium in saturated sand. Results show that the 0.1% saponins could effectively facilitated the AN-1 secondary transport and the addition of saponins decreased the hydrophobicity of AN-1 and sand. The role of the promotion of saponins was more dominant than that of the inhibition of ions on AN-1 transport in a saturated porous medium when ions and saponins coexisted. The interactions between AN-1 and sand grains with saponins and ions were explained in accordance with the Derjaguin–Landau–Verwey–Overbeek theory.

Aggregate and disaggregate analysis on energy consumption and economic growth nexus in China

Abstract

This study examines the relationship between energy consumption and economic growth based on three models in China covering the period of 1982–2015. From the Ng-Perron (NP) and Zivot-Andrews (ZA) unit root test, each variable has no unit root in the first difference. Based on Johansen multivariable co-integration test and autoregressive distributed lag (ARDL) bounds test, the co-integrating relationship existed between selected variables. Moreover, dynamic ordinary least squares (DOLS), fully modified ordinary least squares (FMOLS), and ARDL estimates are used to estimate the coefficients of each variable, which presents that any increasing of each kinds of energy sources can increase China's economic growth in the long term. Additionally, the vector error correction model (VECM) Granger causality test based on three models is investigated. Some implications based on the empirical results are given.

Remote partner assisted skin self‐examination skills training of melanoma survivors and their partners

Australasian Journal of Dermatology, EarlyView.

Efficacy of Inverted “V” Release Surgery in the Correction of a Special Type of Epicanthus

Abstract

Objective

To evaluate the efficacy of a new correction method (inverted "V" release surgery) for epicanthus as a cause of congenital entropion/trichiasis in the lower eyelid.

Methods

From May 2014 to May 2017, 60 eyes of 30 patients (13 male and 17 female patients, with the age of 6.85 ± 4.52 years underwent inverted "V" release surgery to correct epicanthus. The incision in the epicanthus and entropion was continuous. Lower eyelid entropion/trichiasis was corrected by a two-layered suture. We separately assessed the width of the palpebral fissure, exposed ratio of the lacrimal caruncle, eyelash direction, and incision scar at one and 6 months after surgery.

Results

All patients were followed up for 6–18 months. At 6 months after surgery, the palpebral fissure width of all patients was extended by 3–4 mm. The ratio of the exposed lacrimal caruncle was enhanced from 0.24 ± 0.22 to 0.75 ± 0.08. All patients presented with natural inner canthal angles, and their eyelashes clearly extended outward, with a 100% total effective rate. The inner canthal incision scars in 83% of patients were invisible 6 months after surgery.

Conclusion

Based on our experience, both functionality and aesthetics can be obtained by using inverted "V" release surgery to correct a special type of epicanthus that aggravates congenital entropion/trichiasis in the lower eyelid. Thus, this technique is suitable for clinical application.

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.

Comparison of botulinum neurotoxin type A formulations in Asia

970 nm low-level laser affects bone metabolism in orthodontic tooth movement

Publication date: September 2018

Source: Journal of Photochemistry and Photobiology B: Biology, Volume 186

Author(s): Li-Fang Hsu, Meng-Huan Tsai, Bei-En Chang, Yi-Jane Chen, Chung-Chen Jane Yao

Abstract

Objective

During orthodontic tooth movement (OTM), the speed of movement depends on the rate of bone turnover. In this study, we used a rat model to investigate the effect of 970 nm low-level laser therapy (LLLT) on OTM under different dose and frequency protocols.

Methods

We first compared the OTM rates between the OTM only control and the OTM + LLLT group (1250 J/cm²) in Experiment 1 and showed that LLLT significantly increased OTM. In Experiment 2, we employed 3 different LLLT protocols: the low-dose group and the high-dose group receiving 5 doses of 750 J/cm² and 15,000 J/cm² of LLLT every 3 days, respectively, and the early high-dose group which received 5 daily doses at 15,000 J/cm² at the beginning of the experiments. The OTM-only control group received no LLLT. Tooth movement rate was measured through sequential silicone impressions. MicroCT was also performed to evaluate bone de-mineralization rate. Bone histmorphometry was used to compare the bone turnover rate between LLLT group and control group. Finally, TRAP, Osteocalcin, and VEGF expression is evaluated by immunohistochemistry (IHC) in tissue sections.

Results

When LLLT treatment was given every three days, both the 1250 J/cm² and 15,000 J/cm² groups showed significantly increased OTM compared to the control group. No significant difference was observed in the 750 J/cm² group, or in the early irradiation group, when compared with controls, although 750 J/cm² showed the same trend of accelerating OTM. The MicroCT result of rat maxilla demonstrated that LLLT increased bone remodeling and showed decreased bone mineral density and bone volume/total volume in the furcation areas of the maxillary first molars at the end of experiment. LLLT without OTM increased bone turnover as evidenced by fluorochrome incorporation. Immunohistochemistry analyses revealed high osteocalcin expression at later stages of OTM in the LLLT group, while VEGF expression was highly induced in the LLLT + OTM group at an early stage.

Conclusion

Our results suggest that the 970 nm LLLT increases the rate of OTM in a dose-sensitive and frequency-dependent manner. Further animal and human studies are needed to determine the optimal timing and dosage of LLLT for OTM acceleration.

Congenital Accessory Palpebral Fissure and Eyelid in a Newborn: A Case Report

The occurrence of an accessory palpebral fissure and eyelid is an extremely rare phenomenon. An isolated accessory palpebral fissure and eyelid have been reported only twice in the literature, and in one case as an extension of Delleman syndrome, or oculocerebrocutaneous syndrome. The authors report a case of a full-term newborn who presented with an accessory palpebral fissure and eyelid associated with microcornea, skin polyps and tags, cutis dysplasia, and hypoplasia of the corpus callosum with an otherwise normal systemic workup and negative genetic screening. Detailed surgical management and histopathological analysis of the accessory findings are also described.

Immunoglobulin G4 (IgG4)-Positive Ocular Adnexal Mucosa-Associated Lymphoid Tissue Lymphoma and Idiopathic Orbital Inflammation

Purpose: To report clinical and pathological characteristics of idiopathic orbital inflammation and ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma with immunoglobulin G4 (IgG4)-positive plasma cells. Methods: A retrospective histopathological review and clinical case series. A total of 51 biopsy samples from January 2005 to December 2015 were used in this study, including 21 cases of biopsy-confirmed idiopathic orbital inflammation and 30 cases of biopsy-confirmed ocular adnexal MALT lymphoma. Most cases of ocular adnexal lymphoma were conjunctival tissue. Retrospective immunohistochemical studies were performed to estimate the IgG4 and IgG4/IgG ratios. Histopathologic features, demographic and clinical data, radiologic findings, treatment, and follow-up information for each patient were analyzed. Results: Among idiopathic orbital inflammation, 6 (28.6%) of the 21 patients were diagnosed as "probable" ocular adnexal IgG4-related diseases and 13 (43.3%) of the 30 patients were diagnosed as MALT lymphoma with IgG4-positive plasma cells. Six cases of 13 IgG4-positive MALT lymphoma group had contralateral chronic inflammatory lesions infiltrated by IgG4-positive plasma cells, which was significantly (p = 0.007) higher than that in the IgG4-negative group. Conjunctival involvement was 69% of the IgG4-positive MALT lymphoma cases. Bilateral involvement of the ocular adnexa was significantly (p = 0.02) more frequent among IgG4-positive MALT lymphoma patients than that in IgG4-positive idiopathic orbital inflammation patients. Recurrence rate in the IgG4-positive group was higher (p = 0.05) than that in the IgG4-negative group but not significantly. Conclusions: This study presented an unusual framework of ocular adnexal IgG4-related inflammation, in conjunctiva. It is important to understand contralateral chronic inflammatory lesions and their relationship with IgG4-positive MALT lymphoma. Tissue biopsy and IgG4 immunostaining are required for all cases because IgG4-positive MALT lymphoma can arise from a pre-existing IgG4-positive chronic inflammatory lesions. This is the first study that performs IgG4 immunostaining for tissue from a relatively large number of conjunctival MALT lymphomas in a single center. Therefore, it will help to diagnose conjunctival lymphoproliferative disease.

Effect of Sibutramine on Upper Eyelid Position

No abstract available

Complications Following Enucleations and Subsequent Oculoplastic Surgeries

Purpose: To analyze the complications and subsequent type and frequency of oculoplastic surgeries after enucleation in adult patients. Methods: The authors conducted a retrospective case note review of adult patients who underwent enucleation followed by placement of an alloplastic implant wrapped in donor sclera between 2001 and 2013. The data collected included patient demographics, surgical indication, implant size, postoperative complications, and subsequent oculoplastic surgical procedures. Results: The authors included 186 patients who underwent enucleation during the study period. Malignancy was the leading cause for this operation (79.6%) followed by a blind painful eye (12.4%). Most postoperative complications were managed conservatively with an adjustment of the size of the ocular prosthesis. In most cases, the 20-mm and 22-mm implants were used, and implant size ranged from 16 to 22 mm. There was no correlation between implant size and complication rate. Twenty-six patients required subsequent surgery after enucleation (14%). In total, 9.7% (18 patients of 186) patients underwent eyelid surgery after enucleation, most frequently for blepharoptosis (7%). The interval between enucleation and eyelid surgeries was, on average, 1.9 years. Less frequently, surgery is needed for socket repair for anterior surface breakdown (1.6%), and the interval between enucleation and socket surgery was 0.9 years. Conclusions: The most frequent complications following enucleation were blepharoptosis and enophthalmos with a deep upper eyelid sulcus. About 15% of patients required subsequent oculoplastic procedures after, on average, 2 years, while surgery in the early postoperative phase was rarely indicated.

String Technique for Anterior Orbital Fish Hook Removal

Removing fish hooks is a common procedure performed by many emergency department providers. There are several techniques that are commonly employed to aid in successful removal. However, when a fish hook becomes embedded within the orbit, there are limited options as to avoid damaging vital surrounding structures. The authors report the removal of a fish hook within the anterior orbit using the string technique in a 25-year-old patient. The procedure was performed under general anesthesia with the aid of size 5 polyglactin suture wrapped around the hook. The procedure itself took less than 10 seconds and was successful in swiftly and safely removing the hook without damaging surrounding orbital structures. The patient recovered well without any permanent sequelae.

Safety Comparison of Laryngeal Mask Use With Endotracheal Intubation in Patients Undergoing Dacryocystorhinostomy Surgery

Purpose: This study will determine the safety of laryngeal mask airway (LMA) compared with endotracheal tube (ETT) in patients undergoing general anesthesia for dacryocystorhinostomy (DCR) surgery. Methods: In this retrospective cohort study, intraoperative and postoperative outcomes of patients who underwent DCR at UAB Callahan Eye Hospital using either LMA or ETT were compared. Results: Over a period of 52 months, 429 patients underwent external DCR surgery. An ETT was used in 37 patients and LMA in 392 patients. Baseline patient characteristics and anesthetic management were similar. No documented cases of blood or gastric aspiration occurred in the total cohort. Our study confirmed the findings of others that there is less cardiovascular lability on LMA placement than with ETT intubation.1 A 30% increase in heart rate from baseline after intubation (ETT 10.8%, LMA 1.8%; p = 0.010) and after incision (ETT 8.1%, LMA 1.8%; p = 0.047) occurred more frequently in the ETT group. Airway management with an LMA was also less difficult compared with an ETT (ETT 5.7%, LMA 0.5%; p = 0.035). Conclusions: The use of an LMA for airway control is safe and effective in patients undergoing general anesthesia for DCR surgery. No events of aspiration occurred with LMA use. Heart rate increase was significantly less in the LMA group. In our opinion, use of an LMA for airway control during DCR surgery is superior to use of an ETT. Airway protection, improved hemodynamics, and less difficulty in placement of the laryngeal airway device are all validated by this study.

Orbital and Ocular Ischemic Syndrome With Blindness After Facial Filler Injection

The authors herein describe a case of orbital and ocular ischemic syndrome with blindness after cosmetic hyaluronic acid filler injection. Orbital function, but not visual function, returned after treatment with orbital hyaluronidase and corticosteroids.

Clinical Outcomes in Children With Orbital Cellulitis and Radiographic Globe Tenting

Purpose: Axial displacement of the globe with tenting centered on the optic nerve-globe junction is a predictor of visual loss in adults. The purpose of this study was to determine the visual outcomes of children with orbital cellulitis and globe tenting. Methods: The records of 46 consecutive children with orbital cellulitis at a single tertiary children's hospital were reviewed retrospectively. Initial and final visual acuities were available for 34 of 46 patients (74%). Globe tenting was defined by an angle of 130° or less at the optic nerve-globe junction as derived from sagittal CT or MRI. Visual acuities of 4 children with globe tenting (mean age, 10.3 ± 3.3 years) were compared with those of 30 children without globe tenting (mean age, 10.8 ± 3.5 years). Final logarithm of the minimum angle of resolution visual acuities were analyzed. Results: The mean posterior globe angle was 124.5° ± 8.0° in patients with globe tenting, compared with 145.6° ± 7.4° in the affected eye of the patients without globe tenting (p = 0.002). Final visual acuity was logarithm of the minimum angle of resolution = 0 following treatment in patients with globe tenting and logarithm of the minimum angle of resolution = 0.02 in patients without tenting (p = 0.70). Discussion: We propose that the increased elastic compliance of the optic nerve sheath and sclera in children may contribute to better visual outcomes. Conclusions: Pediatric orbital cellulitis with globe tenting may not lead to devastating vision loss as previously seen in adults.

Esophageal Squamous Cell Carcinoma Metastatic to the Orbit

A 74-year-old man presenting with proptosis and orbital inflammation was found on magnetic resonance imaging to have a unilateral intraconal mass. Biopsy revealed a high-grade malignant tumor that was interpreted as squamous cell carcinoma. Positron emission tomography-computed tomography imaging subsequently identified a primary lesion in the esophagus. Esophageal squamous cell carcinoma is a rare cause of orbital metastasis, with only 4 previously reported cases. The authors discuss an approach to orbital malignancies of obscure origin.

Recognition and Management of Acute Dacryocystic Retention

Purpose: Acute noninfectious dacryocystic retention is an under-recognized condition heralded by painful lacrimal sac swelling, obstruction, and epiphora. This longitudinal chart review aimed to estimate the incidence of this condition in an urban Australian population, while further defining the signs and symptoms of the disease and options for management. Methods: We retrospectively reviewed the charts of 1,593 consecutive patients presenting with acquired nasolacrimal duct obstruction and epiphora between 1990 and 2015. The records of patients with acute dacryocystic retention were analyzed for age, gender, clinical features, and management. Results: Of all patients presenting with nasolacrimal duct obstruction, 20 were found to have acute dacryocystic retention. The mean age was 42.2 ± 9.3. There was an equal distribution of laterality, and only 2 cases (10%) were bilateral. There was a statistically significant female predominance, and most patients presented reporting 2 to 3 previous episodes. At presentation, 30% of patients reported spontaneous passage of a dacryolith. Despite this, 70% of affected patients required surgical management, with a 64% incidence of stones noted at the time of dacryocystorhinostomy. Conclusions: Acute dacryocystic retention is an uncommon, but even less frequently identified condition, most common in middle-aged women. Improved understanding of this condition and its natural history is likely to enhance patient counseling and avoid ineffective use of antibiotics in affected patients.

Haberland Syndrome Associated With Calvarial Exostosis

No abstract available

Effect of Optic Nerve Disinsertion During Evisceration on Nonporous Implant Migration: A Comparative Case Series and a Review of Literature

Aim: To determine whether evisceration with optic nerve disinsertion and nonporous implant placement increases the risk of implant migration. Methods: This was a single-center, retrospective consecutive comparative interventional case series including patients undergoing evisceration with nonporous implant between January and December 2014. Patients were grouped into 2 groups: group I where the optic nerve was not disinserted (n = 37) and group II with optic nerve disinsertion (n = 50). Implant migration was assessed clinically and on patient photographs. Migration was subclassified as decentration that did not affect the prosthetic outcome and displacement that affected the prosthetic outcome. The secondary outcome measures were the mean implant diameter, volume of the custom ocular prosthesis, and implant-related complications like exposure and extrusion between the 2 groups. Results: At a mean follow up of 12.5 months, none of the sockets in group I and 3 (6%) sockets in group II (p = 0.35) had evidence of implant decentration. There were no cases of implant displacement in both groups. The mean implant diameter in group I was 16.97 mm ± 0.65 mm and in group II 19.2 mm ± 0.83 mm (p = 0.0001). Implant extrusion was not different between the 2 groups. The mean custom ocular prosthesis volume in group I was 3.86 ml ± 0.52 ml and in group II 2.50 ml ± 0.68 ml (p

Aesthetic Abstracts and Citations

No abstract available

An Aesthetic Orbicularis Oculi Myectomy Technique for Blepharospasm: Use of Topical 5-Fluorouracil and Fibrin Sealant

Purpose: To describe a modified technique of orbicularis oculi myectomy for refractory blepharospasm. This technique includes removal of orbicularis muscle, reformation of the eyelid crease and pretarsal platform using fibrin sealant (Tisseel), and topical 5-fluorouracil to reduce scar formation and improve aesthetic outcome. Methods: Retrospective chart review of 7 patients who underwent bilateral orbicularis oculi myectomy with our technique from 2013 to 2016. Outcome measures were postoperative botulinum toxin dose, frequency, duration between treatments, the amount of lagophthalmos, severity of dry eye, and patient satisfaction with aesthetic and functional outcome. Results: Patients who underwent the aesthetic myectomy technique had significantly decreased botulinum toxin use with relief of symptoms postoperatively. Only 1 of 7 patients experienced mild dry eye symptoms postoperatively, managed with artificial tears. All patients were satisfied with the aesthetic and functional outcome. Conclusions: The aesthetic myectomy technique provides effective treatment for blepharospasm with good functional and aesthetic outcome.

Herpes Zoster Ophthalmicus With Orbital Findings Preceding Skin Rash

The authors describe 2 patients who presented with orbital findings and later developed vesicular lesions that were positive for varicella zoster virus and consistent with Herpes Zoster ophthalmicus. One case is the first to involve dacryoadenitis and orbital myositis preceding disseminated Herpes Zoster. In the other case, a patient developed zoster orbital syndrome leading to elevated intraocular pressure, loss of vision, and afferent pupillary defect. Canthotomy and cantholysis were required to restore vision. In both cases, the orbital syndrome developed prior to the vesicular rash. These cases highlight the need to consider Herpes Zoster ophthalmicus in patients with orbital syndrome not responding to conventional treatment.

Assessing the Accuracy of Eyelid Measurements Utilizing the Volk Eye Check System and Clinical Measurements

Purpose: The purpose of this study was to validate the accuracy of marginal reflex distance 1 (MRD1) measurements obtained by the Volk Eye Check system, a modified smartphone that measures MRD1 automatically, relative to clinical and digital measurements. Methods: In this prospective observational study of adults with normal eyelids and ptosis, MRD1 was measured clinically, digitally, and automatically with the Volk device. Eyes were divided into successful versus unsuccessful Volk trial groups; successful eyes were then subdivided into control and ptosis subgroups. The primary outcome measures were mean MRD1 obtained by the 3 modalities. Secondary outcome measures included the success rate of the device and the prevalence of ptosis within the successful and unsuccessful groups. Results: In the overall sample of 88 eyes, clinical and digital MRD1 were not significantly different. Among eyes with successful Volk trials, significant differences in MRD1 measured by the 3 modalities were as follows: in the successful group, Volk MRD1 (3.05 mm) was significantly (p

The Narrow-Lumen Jones Tube: A Novel Approach to Dry Eye Following Conjunctivodacryocystorhinostomy

Conjunctivodacryocystorhinostomy with placement of a Jones tube (JT) is the gold standard for upper lacrimal system dysfunction. However, traditional JT have been associated with various complications. In their practice, the authors have encountered challenges with postoperative dry eye in a select group of patients, with recurrence of epiphora following tube occlusion, suggesting a need for decreasing the rate of tear drainage while maintaining a patent JT. To address this issue, the senior author (J.D.N.) introduced a modified JT with a narrow lumen (reduced-flow JT) for patients who experience significant dry eye symptoms after placement of a JT. The authors describe 3 patients who experienced improvement in dry eye symptoms after the placement of reduced-flow JT.

Effect of Time to Operative Intervention on Motility Outcomes Following Orbital Floor Fracture Repair in Children

Purpose: To evaluate the relationship between time to surgical intervention and extraocular motility outcomes in children following repair of an orbital floor fracture with inferior rectus entrapment. Methods: After institution review board's approval, a retrospective, consecutive case series of 28 children with unilateral orbital floor fractures entrapping the inferior rectus muscle was conducted. Clinical examinations and CT images were performed on all children. The main outcomes measures were postoperative motility measurements. Results: Eleven patients underwent surgery within 24 hours of reported injury, while 17 patients underwent surgery after 24 hours. There was no statistically significant difference in average age at the time of surgery (p = 0.47) or average preoperative motility scores (p = 1.0) between the 2 groups. Patients who underwent surgery within 24 hours of reported injury had an improved likelihood of recovery (log hazard ratio = 0.469; 95% confidence interval, −0.42 to 1.36). Conclusions: Our exploratory study suggests that surgical reduction of inferior rectus entrapment in pediatric orbital floor fractures within 24 hours from the time of injury shows an improved, but nonstatistically significant, likelihood of recovery in motility deficits with earlier surgical intervention.

Gastrointestinal Stromal Tumor Metastasis to the Orbit

A 66-year-old woman was referred to the authors' service with a 1-week history of blurry vision in her left eye and retro-orbital ache. She had previously undergone a radical distal gastrectomy and omentectomy for gastrointestinal stromal tumor, epithelioid type, 7 years prior. Exophthalmometry confirmed 2 mm of left-sided proptosis. Computed tomography imaging revealed a solid-appearing mass straddling both the intra- and extraconal spaces and involving the superior rectus muscle. An excisional biopsy was performed. Histopathological examination revealed a relatively uniform epithelioid appearance with a high mitotic rate, and immunohistochemical analysis revealed positivity for both KIT (CD117) and CD34. To the best of the authors' knowledge, this is only the second histopathologically confirmed case of gastrointestinal stromal tumor metastasis to the orbit reported in the literature.

Change in Eyelid Position Following Muller’s Muscle Conjunctival Resection With a Standard Versus Variable Resection Length

Purpose: This study compares the use of a standard 7 mm resection length to a variable 4:1 ratio of resection length to desired elevation nomogram when performing Muller's muscle conjunctival resection surgery. Methods: In this cross-sectional case control study, 2 groups were defined. The first underwent Muller's muscle conjunctival resection surgery with a standard 7 mm resection length and the second underwent the same surgery with a variable resection length determined by a 4:1 ratio of resection length to desired elevation nomogram. Groups were matched for age (within 5 years) and sex. Pre- and postoperative photographs were measured digitally. Change in upper marginal reflex distance 1 (MRD1) and final MRD1 were the primary outcome measures. The study was powered to detect a 1 mm difference in MRD1 to a beta error of 0.95. Results: No significant preoperative differences between the groups were noted. No significant difference in final MRD1 (0.1 mm; p = 0.74) or change in MRD1 (0.2 mm; p = 0.52) was noted. Mean resection length to elevation ratios were 3.9:1 for standard group and 4.3:1 for the variable group (p = 0.54). Conclusion: The authors were not able to detect a significant difference in final MRD1 or change in MRD1 for patients undergoing Muller's muscle conjunctival resection surgery with standard or variable resection lengths. These results tend to argue against a purely mechanical mechanism for Muller's muscle conjunctival resection surgery.

Head‐to‐head trials of systemic psoriasis therapies: A systematic review of study design and maximum acceptable treatment differences

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.

Characterization and survival of patients with metastatic basal cell carcinoma in the Department of Veterans Affairs: a retrospective electronic health record review

Abstract

Available descriptive statistics for patients with metastatic basal cell carcinoma (mBCC) are limited. To describe disease characteristics, treatment patterns, survival outcomes, and prognostic factors of patients with mBCC, we conducted a retrospective review of electronic health records in the Department of Veterans Affairs (VA). The primary outcome was survival. Data were also collected on demographics, comorbidities, medications, and procedures. Median (IQR) age of patients with mBCC (n = 475) was 72.0 (17.0) years; 97.9% of patients were male. Almost two-thirds of patients received no initial therapy for mBCC. Median overall survival was 40.5 months [95% CI (confidence interval) 4.8–140.0], and was shorter in patients with distant metastases (17.1 months; 95% CI 2.8–58.0) than in those with regional metastases (59.4 months; 95% CI 17.6–140.0). Because the VA mBCC population is largely male and elderly, the generalizability of these results in other populations is limited and must be interpreted cautiously. Data from this large cohort add valuable information on a rare and poorly researched disease and refine previously wide estimates of overall survival for mBCC.

Ultraviolet radiation induces Melan-A-expressing cells in interfollicular epidermis in wild-type mice

Abstract

Adult wild-type mice are not supposed to be proper models for ultraviolet radiation (UVR)-induced melanoma since melanocytes are confined to hair follicles and cannot be sufficiently reached by UVR. On the other hand, in mutated mouse models used for melanoma research limitations, including an altered immune system and selection of affected pathways, lead to tumors phenotypically quite different from naturally occurring melanomas. We compared the distribution of epidermal melanocytes in UVR and not-UVR-exposed wild-type C57BL/6 mice. Starting at the age of 8 weeks, mice were exposed to physiologic doses of UVR three times weekly over 16 weeks. Back skin biopsies were taken 4, 8, 12 and 16 weeks after initiation of exposure, and stained for Melan-A, representing a highly selective marker for melanocytes. Surprisingly, after exposure to UVR, Melan-A positive cells were detected also in the interfollicular epidermis of C57BL/6 mice. We conclude that UVR is capable of inducing interfollicular epidermal melanocytes in wild-type mice.

CXCL13 is an activity marker for systemic, but not cutaneous lupus erythematosus: a longitudinal cohort study

Abstract

Serum levels of the IFN-regulated cytokine CXCL13 have been found to correlate with SLEDAI and renal involvement in systemic lupus erythematosus. This study investigates whether CXCL13 can also be a marker of disease activity in patients with subacute cutaneous or chronic cutaneous lupus erythematosus (SCLE, CCLE). We analysed CXCL13 levels in 60 patients' sera (18 SLE, 19 SCLE, 23 CCLE) at five time points within 1 year and correlated these levels with disease activity scores and laboratory markers. Clinical scores with no/mild, moderate or high/severe disease activity were categorized by SLEDAI in SLE, by CLASI in SCLE/CCLE. CXCL13 levels were significantly higher in SLE (median 122.5, IQR 88.0–239.0 pg/ml) than in CCLE patients (median 69.0, IQR 60.0–102.0 pg/ml) (p = 0.006). CXCL13 levels were elevated in 59% (41/70) of SLE patient visits with mild or no disease activity, but in 90% (9/10) with high disease activity. CXCL13 levels correlated with ECLAM, dsDNA-antibodies, and inversely with complement factors C3 and C4 in SLE, and with IgA and ESR in SCLE. In CCLE CXCL13 did not correlate with CLASI or laboratory markers. One SCLE and two CCLE patients with CXCL13 levels > 500 pg/ml had conversion to SLE or an underlying autoimmune disease. CXCL13 seems to be a useful marker of disease activity in SLE, but not in SCLE and CCLE. Conversion from normal to elevated CXCL13 may indicate a flare of SLE. Whether high CXCL13 levels in cutaneous LE indicate the development of SLE should be further investigated.

Up-regulation of HMGB1 and TLR4 in skin lesions of lichen planus

Abstract

Lichen planus (LP) is a chronic, mucocutaneous inflammatory disease of an unknown aetiology. The disease has been associated with certain viruses, and the factors such as DAMPs (damage-associated molecular patterns) and PAMPs (pathogen-associated molecular patterns) may also contribute to the inflammatory response in LP. HMGB1 (high mobility group box 1 protein) is one of the major DAMPs that induces inflammation and could trigger LP disease. The present study was aimed to examine TLR4, RAGE and HMGB1 production in epidermis or dermis by immunohistochemistry and the respective expression of these targets in the skin lesions of patients with LP. Moreover, we measured HMGB1 serum levels by ELISA. The results showed similar profile of expression by HMGB1 and TLR4, which are decreased at epidermis and up-regulated at dermis of skin lesions of LP patients that was sustained by intense cellular infiltration. RAGE expression was also increased in dermis of LP. Although there is increased RAGE protein levels, a decreased RAGE transcript levels was detected. Similar HMGB1 serum levels were detected in the LP and control groups. This study demonstrates that HMGB1 and TLR4 could contribute to the inflammatory LP process in skin.

Can such an animal model truly represent Henoch–Schönlein purpura?

Reply to the letter: “Can such an animal model truly represent Henoch–Schönlein purpura?”

Amelioration of lactic acid sensations in sensitive skin by stimulating the barrier function and improving the ceramide profile

Abstract

We determined whether compensating ceramides in the stratum corneum (SC) may ameliorate the impaired barrier function and subsequently attenuate the enhanced skin sensitivity. Treatment for 4 weeks with the ceramide complex cream or the placebo cream significantly ameliorated the intensity of lactic acid sensations in 39 female subjects with sensitive skin, the degree of which was attenuated to a greater extent at 1 week by the ceramide complex cream compared with the placebo cream. The amelioration of skin sensations was accompanied by a significant increase in total ceramide content in the SC elicited by the ceramide complex cream that was significantly more effective than the placebo cream at 4 weeks. Consistently, TEWL and conductance values were significantly decreased or increased at 1 and 4 weeks, respectively, to a greater extent by the ceramide complex cream than by the placebo cream. TEWL levels were significantly correlated with the increased levels of SC total ceramide in the ceramide complex cream-treated skin but not in the placebo cream-treated skin. Thus, the amelioration of lactic acid sensations by topical application of a ceramide complex cream, provides a deep insight into the pathophysiology of sensitive skin as a reduced barrier function-dependent sub-clinical sensory response.

Dimethyl fumarate (DMF) vs. monoethyl fumarate (MEF) salts for the treatment of plaque psoriasis: a review of clinical data

Abstract

Fumarates (fumaric acid esters, FAEs) are orally administered systemic agents used for the treatment of psoriasis and multiple sclerosis. In 1994, a proprietary combination of FAEs was licensed for psoriasis by the German Drug Administration for use within Germany. Since then, fumarates have been established as one of the most commonly used treatments for moderate-to-severe psoriasis in Germany and other countries. The licensed FAE formulation contains dimethyl fumarate (DMF), as well as calcium, zinc, and magnesium salts of monoethyl fumarate (MEF). While the clinical efficacy of this FAE mixture is well established, the combination of esters on which it is based, and its dosing regimen, was determined empirically. Since the mid-1990s, the modes of action and contribution of the different FAEs to their overall therapeutic effect in psoriasis, as well as their adverse event profile, have been investigated in more detail. In this article, the available clinical data for DMF are reviewed and compared with data for the other FAEs. The current evidence substantiates that DMF is the main active compound, via its metabolic transformation to monomethyl fumarate (MMF). A recent phase III randomized and placebo-controlled trial including more than 700 patients demonstrated therapeutic equivalence when comparing the licensed FAE combination with DMF alone, in terms of psoriasis clearance according to the Psoriasis Area and Severity Index (PASI) and Physician's Global Assessment (PGA). Thus, DMF as monotherapy for the treatment of psoriasis is as efficacious as in combination with MEF, making the addition of such fumarate derivatives unnecessary.

Corrigendum

Corrigendum to Levin and Ellingson. Understanding brain penetrance of anticancer drugs. Neuro Oncol (doi: https://doi.org/10.1093/neuonc/noy018) first published online 21 February 2018.

The Biota Project: A Case Study of a Multimedia, Grassroots Approach to Scientific Communication for Engaging Diverse Audiences

Synopsis

The Biota Project communicates science to populations historically ignored by the scientific community. The Biota Project is comprised of a team of young professionals from a myriad of backgrounds and locations with interests in promoting science accessibility and equity. We do this by highlighting research conducted by scientists from underrepresented groups in relatable yet underrated locations with the intention of increasing the participation of underrepresented populations in science. The Biota Project centers on the scientific definition of symbiosis as a tool for both educating and learning from its followers. We deliver stories on the environments of our own backyards by merging art and science and distributing these publicly available stories widely online through short films, media clips, drawings, paintings, blogs, and e-newsletters. This project demonstrates a fresh, transferable perspective on strengthening science communication in a way that conjoins scientific discovery with social justice through the promotion of critical thinking by its target audience. Likewise, contributors learn how to better support local communities with each new story and environment. The Biota Project thus sets a symbiotic tone for re-calibrating the balance between academics, researchers, and local communities. When science is made relevant through understanding, its quality and significance are enhanced, and public recognition of its value is increased.

Photophysical and Photoacoustic Properties of π‐extended Curcumin Dyes. Effects of the Terminal Dimethylamino Electron‐donor and the Bridging Aryl Ring

Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.

Effectiveness of submandibular duct relocation in 91 children with excessive drooling: a prospective cohort study

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.

Rhinology Future Debates 2017 by EUFOREA: Novel treatments and surgical solutions in rhinology

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.

Direct comparison of mastoidal and retrosigmoidal placement of a transcutaneous bone conduction device after canal wall down tympanoplasty

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.

Issue Information

International Journal of Dermatology, Volume 57, Issue 8, Page i-iii,883-884, August 2018.

Teaching & Learning Tips 10: Interspecialty teaching through inpatient dermatology consults

International Journal of Dermatology, Volume 57, Issue 8, Page 985-988, August 2018.

Secukinumab decreases the serum KL‐6 level in psoriasis patients with elevated serum KL‐6 level

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.

Erythema multiforme major induced by exotic wood

Contact Dermatitis, EarlyView.

Efficacy analysis of hydroxychloroquine therapy in systemic lupus erythematosus: a study on disease activity and immunological biomarkers

Abstract

Background

Hydroxychloroquine (HCQ) is a widely prescribed medication to patients with systemic lupus erythematosus (SLE), with potential anti-inflammatory effects. This study was performed to investigate the efficacy of HCQ therapy by serial assessment of disease activity and serum levels of proinflammatory cytokines in SLE patients.

Methods

In this prospective cohort study, 41 newly diagnosed SLE patients receiving 400 mg HCQ per day were included. Patients requiring statins and immunosuppressive drugs except prednisolone at doses lower than 10 mg/day were excluded. Outcome measures were assessed before commencement of HCQ therapy (baseline visit) as well as in two follow-up visits (1 and 2 months after beginning the HCQ therapy). Serum samples of 41 age-matched healthy donors were used as controls.

Results

Median levels of IL-1β (p < 0.001), IL-6 (p = 0.001), and TNF-α (p < 0.001) were significantly higher, whereas, median CH50 level was significantly lower (p < 0.001) in SLE patients compared with controls. Two-month treatment with HCQ resulted in significant decrease in SLEDAI-2K (p < 0.001), anti-dsDNA (p < 0.001), IL-1β (p = 0.003), IL-6 (p < 0.001) and TNF-α (p < 0.001) and a significant increase in CH50 levels (p = 0.012). The reductions in SLEDAI-2K and serum levels of IL-1β and TNF-α were significantly greater in the first month compared with the reductions in the second month.

Conclusion

HCQ therapy is effective on clinical improvement of SLE patients through interfering with inflammatory signaling pathways, reducing anti-DNA autoantibodies and normalizing the complement activity.

Delirium in adult cancer patients: ESMO Clinical Practice Guidelines†

Delirium is a neurocognitive syndrome that commonly occurs in older populations and people with cancer, particularly in those with advanced disease and in the last hours or days of life. While an underlying malignancy and its complications predispose a person to develop delirium, many of the treatments used in the management of cancer also increase the risk of delirium [1]. In addition to being associated with an increased risk of mortality and causing significant physical morbidity, delirium is often a severely distressing experience, not only for patients, but also for families and professional caregivers [1].

Kein erhöhtes Risiko schwerer Infektionen unter Biologikatherapie bei Psoriasis

Hautkrebsscreening und Behandlungskosten

Zusammenfassung

Hintergrund

Organtransplantierte Patienten unterliegen einem bis zu 250-fach erhöhten Hautkrebsrisiko. Mit der vorliegenden Arbeit wurden die Inanspruchnahme des Hautkrebsscreenings und die Kosten der Hautkrebsbehandlung unter den organtransplantierten Versicherten der AOK Bremen/Bremerhaven ermittelt und der Bedarf an Hautkrebspräventionsschulungen abgeleitet.

Methodik

Es wurden die Anzahl organtransplantierter Menschen (ICD Code Z94.0-4) mit und ohne Hautkrebsanamnese (ICD Code C43/C44), die Inanspruchnahme von dermatologischen Leistungen, die Kosten für Behandlungen mit der Diagnose Z94.0-4 ohne bzw. mit C43/C44-Codierung ausgewertet. Die Analysen wurden für die Jahre 2009 bis 2014 mithilfe der AOK-Abrechnungssysteme durchgeführt.

Ergebnisse

Zwischen 2009 und 2014 wurden 231 organtransplantierte Versicherte erfasst. Bis Mitte 2014 erkrankten 20 % dieser Versicherten an Hautkrebs, die mittlere Inzidenz lag bei 2,76 % pro Jahr. Im Mittel gingen 43 % mindestens 1‑mal pro Jahr zum Hautarzt. Ein Hautkrebsscreening erhielten durchschnittlich nur 15 % pro Jahr. Bei 29 % der organtransplantierten Menschen ohne Hautkrebsanamnese wurde die Haut weder von einem Hautarzt noch im Rahmen eines hausärztlichen Hautkrebsscreenings untersucht. Es wurden 17 stationäre Fälle organtransplantierter Personen mit der Hauptdiagnose C43/C44 ermittelt. Durch diese entstanden Kosten in Höhe von 54.707 € (im Mittel ca. 3200 € pro Fall).

Schlussfolgerungen

Die erhöhte Hautkrebsinzidenz und die damit verbundenen Behandlungskosten weisen auf einen Bedarf an Hautkrebspräventionsschulungen hin.

Igelpilze in einer Münchner Hautarztpraxis

Zusammenfassung

Patientin 1: Eine 50-jährige Frau mit Atopie entwickelte nach dem Kontakt zu einem mitteleuropäischen Igel (Erinaceus europaeus) eine erythrosquamöse Tinea manus an Daumen und Thenar der rechten Hand. Diesem Ereignis war eine Verbrühung mit heißem Dampf an der betroffenen Stelle vorausgegangen. Bei Igel und Patientin wurde aus Hautschuppen der zoophile Dermatophyt Trichophyton (T.) erinacei angezüchtet. Der Igel wurde antimykotisch mit 2‑wöchentlichen Zyklen Itraconazollösung (0,1 ml/kgKG) behandelt. Zusätzlich kam alle 2 Tage Enilconazollösung topisch zur Anwendung. Die Patientin erhielt eine Therapie mit Ciclopiroxolamincreme und Terbinafin (250 mg oral) über 14 Tage, die zur Heilung der Tinea führte.

Patientin 2: Eine 18-jährige Frau stellte sich in der Notfallsprechstunde mit randbetonten, papulösen, vesikulösen und erosiv-verkrusteten Hautveränderungen am Zeigefinger und einem erythrosquamösen Rundherd am Oberschenkel vor. Die Patientin arbeitete in einer Tierstation und pflegte dort Igel. Einer der Igel litt unter erheblichem Stachelausfall. Wiederum war T. erinacei kulturell nachweisbar. Ciclopiroxolaminhaltige Creme und Terbinafin (250 mg oral) über 14 Tage führten ebenfalls zur Heilung.

Die Identifizierung der 3 T.-erinacei-Isolate von beiden Patientinnen und vom Igel erfolgte durch Sequenzierung der ITS-Region (ITS: „internal-transcribed-spacer") der ribosomalen DNA und des Gens des „translation elongation factor-1α (TEF-1α)". Mithilfe der ITS-Sequenzierung ist eine Unterscheidung zwischen T.-erinacei-Stämmen von europäischen und afrikanischen Igeln möglich. T. erinacei ist ein „emerging pathogen". In Deutschland muss daher vermehrt mit diesem zoophilen Dermatophyten als Erreger von Dermatomykosen beim Menschen nach Igelkontakt gerechnet werden.

Rezepturherstellung für den Notfall – Prednisolon-Saft

Panorama Dermatologische Praxis

Qualität dermatologischer Kasuistiken in deutschsprachigen Fachzeitschriften

Stellenwert der Biopsie in der Diagnostik von Infektionserkrankungen der Haut

Zusammenfassung

Erregerbedingte Hauterkrankungen gehören zu den häufigen Problemen der dermatologischen Praxis. Neben kulturellen und/oder serologischen Nachweismethoden ist die Hautbiopsie eine mögliche diagnostische Maßnahme, insbesondere wenn das klinische Bild noch andere, nichtinfektiöse Erkrankungen differenzialdiagnostisch in Betracht ziehen lässt. Während einige Erreger bereits in der Routinefärbung (mithilfe von Hämatoxylin-Eosin) erkannt werden können (z. B. Hefepilze, Leishmanien), stehen für andere zahlreiche histochemische und immunhistochemische Nachweismethoden zur Verfügung (z. B. „Periodic acid-Schiff reaction" [PAS] und Grocott-Färbung für Hyphen und Sporen, Ziehl-Neelson- und Fite-Faraco-Färbung für Mykobakterien oder spezifische Antikörpernachweise für Treponema pallidum oder Herpesviren). In anderen Fällen kann eine Infektionserkrankung am Schnittpräparat zwar nicht sicher diagnostiziert werden, es findet sich jedoch ein Infiltratmuster („pattern"), das auf eine erregerbedingte Genese hinweist. Anhand solcher Reaktionsmuster kann der Dermatopathologe den Kliniker auf die notwendige Zusatzdiagnostik (Kultivierung, serologische Untersuchung) aufmerksam machen oder am vorhandenen Biopsiematerial einen molekularbiologischen Erregernachweis veranlassen. Im vorliegenden Beitrag werden Hautinfektionen mit ihren histopathologischen Charakteristika dargestellt, um zu verdeutlichen, inwieweit die Hautbiopsie eine sichere Diagnose ermöglichen oder durch Ausschluss von Differenzialdiagnosen oder molekularbiologische Zusatzdiagnostik hilfreich sein kann.

Histopathologie der Haut – klinisch relevant und innovativ

Dermatoskopisch-pathologische Korrelation melanozytärer Hautläsionen

Zusammenfassung

Ohne Zweifel stellt die Dermatopathologie nach wie vor die wichtigste Untersuchung zur Dignitätsabklärung melanozytärer Läsionen dar, doch ist die dermatopathologische Befundung wie alle morphologischen Untersuchungen subjektiv gefärbt. Wie eine rezente Studie zeigen konnte, gibt es eine große Variabilität bei der Befundung melanozytärer Läsionen, und falsch positive und falsch negative Befunde sind verhältnismäßig häufig. Unabhängig vom Befunder besteht auch eine Limitation der Untersuchungsmethode selbst, und man muss sich damit abfinden, dass nicht alle melanozytären Läsionen anhand einer feingeweblichen dermatopathologischen Untersuchung zweifelsfrei als gutartig oder bösartig klassifiziert werden können. In jenen Fällen, wo das nicht gelingt, kann die Einbeziehung des dermatoskopischen Befundes die Diagnosestellung erleichtern. Eine dermatoskopisch-pathologische Korrelation ist jedoch nur dann möglich, wenn ein dermatoskopisches Bild zur Verfügung steht und wenn der Pathologe mit der Interpretation dermatoskopischer Strukturen vertraut ist. Eine dermatoskopisch-pathologische Korrelation ist nicht bei allen unklaren Läsionen hilfreich, sondern bevorzugt bei flachen pigmentierten Läsionen. In diesen Fällen jedoch ist der Informationsgewinn durch die Dermatoskopie wahrscheinlich größer als durch zusätzliche molekulare Untersuchungen.

Möglichkeiten und Grenzen der Molekularpathologie in der Dermatohistologie

Zusammenfassung

Die Diagnostik von malignen Tumoren, Infektionen durch Mikroorganismen oder Genodermatosen wird zunehmend durch molekularpathologische Analyseverfahren ergänzt. Dabei spielen die Polymerasekettenreaktion (PCR), Sequenzierungsverfahren und In-situ-Hybridisierungen eine wichtige Rolle. Inwiefern Methoden wie „liquid biopsies" oder „single cell genomics" als Routineverfahren weiterentwickelt werden können, bleibt abzuwarten. Erhöhter technischer Aufwand, hohe Kosten und fehlende Möglichkeiten einer Resistenzprüfung stehen schnellen Nachweisverfahren, einer hohen Sensitivität und Spezifität gegenüber. Dabei gilt es generell, für eine korrekte Diagnose molekulargenetische Verfahren in Kombination mit dem klinischen Bild, der Histologie bzw. Immunhistologie und ggf. kulturellen Anzüchtungen zu bewerten.

Bildbasierte Computerdiagnose des Melanoms

Zusammenfassung

Zunehmend etablieren sich automatisierte Diagnosesysteme zur Melanomdiagnostik. Diese basieren auf folgenden 4 Verarbeitungsschritten: 1) Vorverarbeitung, bei der sichergestellt wird, dass störende Faktoren eliminiert werden, 2) Segmentierung, die Trennung des Bildes in die Läsion und den Hintergrund, 3) Extraktion und Auswahl jener Merkmale, die das höchste Maß an Genauigkeit bei der Diagnose bieten, und 4) Klassifizierung, bei der die Läsion einer Diagnoseklasse zugeordnet wird. In letzter Zeit fokussiert sich die computergestützte Melanomdiagnose auf Algorithmen, die auf „transfer learning" basieren. „Transfer learning" macht die Schritte 2 und 3 z. T. obsolet und liefert bessere Ergebnisse. Auch Smartphone-Applikationen im Bereich von Melanomvorsorge und -erkennung werden angeboten. Diese Anwendungen sind mit Sorge zu betrachten, denn sie sind Laien zugänglich, aber nicht in vorherigen klinischen Studien auf ihre diagnostische Leistungsfähigkeit überprüft worden.

Hyperkeratotische Papeln mit retikulärem Muster am Dekolleté

Hautbiopsie bei entzündlichen Hauterkrankungen im Kindesalter – wann ist sie sinnvoll?

Zusammenfassung

Im Vergleich zum Erwachsenenalter werden entzündliche Hauterkrankungen bei Kindern wesentlich seltener biopsiert. Neben der Invasivität der Maßnahme, der notwendigen Lokalanästhesie, Infektionsgefahr und Narbenbildung wiegt auch das psychische Trauma der Operationssituation im Kindesalter schwerer. Wenn dennoch biopsiert wird, sind die Erwartungen an den histologischen Befund verständlicherweise hoch. Die Beurteilung einer kindlichen Hautbiopsie ist jedoch oft eine besondere Herausforderung für den Histopathologen: zum einen, weil häufig nur ein sehr kleiner Stanzzylinder oder oberflächliches Shave-Material entnommen wird, zum anderen, weil die derzeit verwendeten histologischen Diagnosekriterien zumeist an Biopsien von Erwachsenen entwickelt wurden. Aufgrund der noch in Entwicklung befindlichen Reifung des Immunsystems können Hautinfiltrate einer Erkrankung im Kindesalter anders aussehen als bei Erwachsenen. Die Kenntnisse darüber sind jedoch noch sehr begrenzt. Zudem sind bei Hauterkrankungen des Kindesalters die Erstmanifestationen zahlreicher seltener Genodermatosen differenzialdiagnostisch zu berücksichtigen, zu denen teilweise kaum Erfahrungen vorliegen. Im vorliegenden Beitrag werden, ausgehend vom klinischen Befund, mögliche Differenzialdiagnosen histopathologisch erläutert, um exemplarisch die Sinnhaftigkeit oder Notwendigkeit einer Hautbiopsie im Kindesalter zu demonstrieren. Aspekte der Kommunikation mit Eltern und Kind, Methoden der Lokalanästhesie sowie auch Biopsietechniken finden ergänzend Berücksichtigung.

Pruritus im Alter – eine interdisziplinäre Herausforderung

Zusammenfassung

Aufgrund der demografischen Entwicklung mit stetig steigender Lebenserwartung und einem immer größeren Anteil an Menschen im hohen Lebensalter wird chronischer Pruritus (CP) in der klinischen Praxis zunehmend häufiger beobachtet. Neben spezifischen pruritogenen Dermatosen im Alter spielen der noduläre Typ der chronischen Prurigo („Prurigo nodularis") und Pruritus auf unauffälliger Haut eine wichtige Rolle im höheren Lebensalter. Letztgenannter stellt eine besonders große diagnostische und therapeutische Herausforderung dar. Da die Häufigkeit maligner Erkrankungen im Alter zunimmt, ist differenzialdiagnostisch bei CP im Alter immer auch an einen paraneoplastischen Pruritus zu denken. Gebrechlichkeit und eine zunehmende Einschränkung der Beweglichkeit im Alter können nahezu alle therapeutischen Maßnahmen behindern. Im Rahmen der systemischen Behandlung sind Begleiterkrankungen, häufige im Alter auftretende relevante Nebenwirkungen, wie z. B. Beeinflussung der Kognition, Müdigkeit und insbesondere Medikamentenwechselwirkungen, zu berücksichtigen, wodurch die Umsetzung und die Wirksamkeit der Therapie erschwert werden können.

Akral betonte Papeln – ein Fallbericht

Zusammenfassung

Die syringotrope Mycosis fungoides (STMF) ist eine äußerst seltene Form des kutanen T‑Zell-Lymphoms mit bis dato 51 veröffentlichten Fällen. Klinisch präsentiert sich die STMF ähnlich der follikulotropen Mycosis fungoides (MF), wobei der Krankheitsverlauf bei STMF deutlich milder ist. Histopathologisch zeigt sich ein prominenter Tropismus des T‑Zell-lymphozytären Infiltrats für das ekkrine Epithel. Wir berichten über den Fall einer 65-jährigen Patientin mit multiplen kleinen Papeln an Füßen, Schienbeinen sowie am Rücken.

S1-Leitlinie Intermittierende Pneumatische Kompression (IPK, AIK)

Zusammenfassung

Unter Federführung der Deutschen Gesellschaft für Phlebologie e. V. (DGP) wurde im Januar 2018 in Kooperation mit weiteren Fachgesellschaften eine S1-Leitlinie zur intermittierenden pneumatischen Kompression (IPK) verabschiedet. Sie ersetzt die bisher existierende Leitlinie von 3/2005. Ziel der Leitlinie ist die Optimierung der Indikation und der therapeutischen Anwendung der IPK bei Gefäß- und Ödemerkrankungen. Es erfolgte eine ausgedehnte Literaturrecherche unter Berücksichtigung von Medline, existierenden Leitlinien sowie für das Thema relevanten, aber nicht gelisteten Arbeiten. Angesichts der vielfach methodisch schwachen Studienqualität mit oft kleinen Fallzahlen und heterogenen Behandlungsprotokollen lassen sich aus den vorhandenen Daten oft nur Empfehlungen unter Hinzuziehung der guten klinischen Praxis/Expertenkonsensus ableiten. Die apparative Anwendung pneumatischer Wechseldrücke dient der Thromboembolieprophylaxe, Entstauungstherapie bei Ödemerkrankungen und der positiven Beeinflussung der arteriellen und venösen Durchblutung mit Verbesserung der klinischen Symptome und schnellerer Ulkusheilung im ambulanten und stationären Bereich. Die eingesetzten Geräte und die Therapieschemata unterscheiden sich abhängig von ihrer Indikation und Ziellokalisation. Sie können ambulant und stationär sowie bei langfristiger Indikation auch als Heimgeräte eingesetzt werden. Eine Soll-Indikation besteht bei der Thromboseprophylaxe. Bei schwerer chronisch venöser Insuffizienz im Stadium C4b bis C6, beim Extremitätenlymphödem additiv und bei peripherer arterieller Verschlusskrankheit (pAVK) mit stabiler Claudicatio intermittens oder kritischer Ischämie sollte die IPK eingesetzt werden Bei posttraumatischen Ödemen, therapieresistenten venös bedingten Ödemen, beim Lipödem und bei Hemiplegie mit sensorischer Störung und Ödem kann die IPK zum Einsatz kommen. Absolute und relative Kontraindikationen zur IPK müssen berücksichtigt und Risiken beachtet und – soweit möglich – vermieden werden. Unerwünschte Ereignisse treten bei korrekter Anwendung der IPK extrem selten auf. Sie ist bei richtiger Indikationsstellung und Anwendung – auch additiv – eine effektive und sichere Therapiemethode insbesondere in der Behandlung der beschriebenen Gefäß- und Ödemerkrankungen sowie der Thromboseprophylaxe.

Alpha-Gal-assoziierte verzögerte Anaphylaxie gegen rotes Fleisch als Berufskrankheit

Zusammenfassung

Bei einem 30-jährigen Koch mit rezidivierenden verzögerten Angioödemen konnte anamnestisch und laborexperimentell als Ursache die Sensibilisierung gegen das Kohlenhydratepitop Galactose-alpha-(1,3)-Galactose (alpha-Gal) aufgedeckt werden. Mit der Diagnose einer verzögerten Anaphylaxie bei Sensibilisierung gegen alpha-Gal erfolgte aufgrund des beruflichen Bezuges die Meldung an die Berufsgenossenschaft mittels Hautarztbericht BK 5101. Hierauf wurde dem Patienten fristlos gekündigt. Als Konsequenz zeigten wir eine Berufskrankheit an. Diese Kasuistik stellt die Bedeutung der unterdiagnostizierten, potenziell lebensbedrohlichen Allergie gegen das Disaccharid alpha-Gal des roten Fleisches als Berufskrankheit dar.

Therapie von chronischem Pruritus – was ist neu?

Zusammenfassung

Chronischer Pruritus gehört zu den häufigsten und sehr belastenden Symptomen in der Medizin. Die Therapie bleibt eine große Herausforderung, da es kaum zugelassene Therapien gibt. In der jüngsten Vergangenheit ermöglichte ein besseres Verständnis der Pathogenese, die Ergebnisse in neue Therapieformen umzusetzen. Die verschiedenen Therapien zielen auf eine Vielzahl von Punkten in der Prurituskaskade ab – von der Blockade intrazellulärer und interzellulärer Signalwege in der Haut bis zur Modulation der Neurotransmission. Dieser Beitrag gibt einen Überblick über die aktuellen Therapieoptionen, basierend auf der aktuellen S2K-Leitlinie, und über die jüngste Entwicklung der antipruritischen Therapien.

Basalzellkarzinom oder Morbus Bowen

Das „Schlupflid“ – Petitesse oder Herausforderung für den Chirurgen?

Zusammenfassung

Die Korrektur des sog. Schlupflids zählt zu den am häufigsten durchgeführten ästhetisch-plastischen Operationen. Die Komplexität des Eingriffs wird dabei oft unterschätzt. Gerade bei ästhetischen Fragestellungen, bei denen der subjektive Geschmack eine große Rolle spielt, liegen Erfolg und Misserfolg eng beieinander. Deshalb ist die Kommunikation zwischen Patient und Arzt von besonderer Wichtigkeit, um überspannte Erwartungen zu dämpfen sowie Missverständnisse und Enttäuschungen zu vermeiden. Der informierte Patient ist für den Arzt der bessere Partner. Generell ist es besser, nicht zu offensiv zu operieren. Die Gesamtkomposition des Gesichts darf nicht gestört werden. Der Patient soll nicht operiert, sondern erholt und aktiver aussehen. Überkorrekturen können nur mit hohem Aufwand und oft auch nur unbefriedigend beseitigt werden.

Risk Factors for Postoperative Complications among the Elderly after Plastic Surgery Procedures Performed under General Anesthesia

Background. The frequency of surgery involving elderly patients has been increasing. The use of free tissue transfers in the elderly has been examined previously (Howard et al., 2005, Hwang et al., 2016, Grammatica et al., 2015, Serletti et al., 2000, and Sierakowski et al., 2017), whereas there have not been any such studies of plastic surgery procedures. We evaluated the risk factors for complications after plastic surgery procedures performed under general anesthesia in patients aged ≥75 years. Methods. The cases of patients aged ≥75 years who underwent plastic surgery procedures under general anesthesia at the Department of Plastic and Reconstructive Surgery, National Hospital Organization Nagasaki Medical Center, between 2009 and 2016 were reviewed retrospectively. Multiple logistic regression analysis was used to identify the risk factors for postoperative complications. Results. Two hundred and sixty-three cases were reviewed. Complications were seen in 137 patients. Age was not predictive of complications. The risk factors included a serum albumin level of

Educational Disparities in Risk for Metabolic Syndrome

Metabolic Syndrome and Related Disorders, Ahead of Print.

Should Waist Circumference Cutoffs in the Context of Cardiometabolic Risk Factor Assessment be Specific to Sex, Age, and BMI?

Metabolic Syndrome and Related Disorders, Ahead of Print.

Pomegranate Juice Increases Sirtuin1 Protein in Peripheral Blood Mononuclear Cell from Patients with Type 2 Diabetes: A Randomized Placebo Controlled Clinical Trial

Metabolic Syndrome and Related Disorders, Ahead of Print.

Peripheral Lymphocytes, Obesity, and Metabolic Syndrome in Young Adults: An Immunometabolism Study

Metabolic Syndrome and Related Disorders, Ahead of Print.

Altered Gut Microbiota: A Link Between Diet and the Metabolic Syndrome

Metabolic Syndrome and Related Disorders, Ahead of Print.

Saxagliptin Upregulates Nesfatin-1 Secretion and Ameliorates Insulin Resistance and Metabolic Profiles in Type 2 Diabetes Mellitus

Metabolic Syndrome and Related Disorders, Ahead of Print.

Association Between the Modified Dietary Approaches to Stop Hypertension and Metabolic Syndrome in Postmenopausal Women Without Diabetes

Metabolic Syndrome and Related Disorders, Ahead of Print.

Prevalence and Risk Factors for Periodontitis Among Patients with Metabolic Syndrome

Metabolic Syndrome and Related Disorders, Ahead of Print.

Bidirectional Same-Gender and Sexual Minority Intimate Partner Violence

Violence and Gender, Ahead of Print.

Incentives of Female Offenders in Criminal Behavior: An Indian Perspective

Violence and Gender, Ahead of Print.

Readiness to Help: How Students' Sexual Assault Awareness, Responsibility, and Action Correlate with Bystander Intervention Behavior

Violence and Gender, Ahead of Print.

Social Media Use as a Tool to Facilitate or Reduce Cyberbullying Perpetration: A Review Focusing on Anonymous and Nonanonymous Social Media Platforms

Violence and Gender, Ahead of Print.

Social, Sexual, and Violent Predation: Are Psychopathic Traits Evolutionarily Adaptive?

Violence and Gender, Ahead of Print.

When is Teenage Plastic Surgery vs Cosmetic Surgery OK - Reality vs Hype? – A Systematic Review

Summary: Plastic surgery in teenagers has become popular in past decades due to an increase in self-awareness and desire to "fit in" with their peers. In 2016, over 229,551 cosmetic procedures were performed in patients who are under the age of 19 years old 1. The trend of plastic surgery in adolescents is increasing, and it is important for plastic surgeons to perform safe and appropriate procedures in this group. To this date, there is a myriad of literature on the psychological and ethical issues concerning plastic surgery in teenagers. However, studies regarding the safety of performing plastic surgery in this population are scare 2. The rationale for this review is to study this issue in depth via a systematic review. We will discuss the current indications, safety, patient satisfaction, and ethical considerations of teenage plastic surgery as well as make recommendations for future studies on this important area in plastic surgery. Financial Disclosure and Products: Rod J. Rohrich, MD receives instrument royalties from Eriem Surgical, Inc and book royalties from Thieme Medical Publishing. No funding was received for this article. Min-Jeong Cho, M.D., has no financial interest to declare in relation to the content of this article. Acknowledgements: None Corresponding Author Contact Information: Address correspondence to: Rod J. Rohrich M.D., Dallas Plastic Surgery Institute, 9101 North Central Expressway, Suite 600, Dallas, TX 75231, Rod.Rohrich@UTSouthwestern.edu ©2018American Society of Plastic Surgeons

Accuracy of three software applications for breast volume calculations from 3D surface images

Background: For many breast surgery procedures, knowing breast volumes prior to surgery helps the surgeon to obtain breast symmetry. Calculating breast volumes from 3D surface images is possible with the aid of specialized software applications. However, limited data exists concerning the accuracy of such 3D surface based volume measurements. The purpose of this study was to investigate the accuracy of breast volume calculations performed with the 3D BreAST, 3dMD Vultus-, and VECTRA software. Methods: Patients who were scheduled for a uni- or bilateral simple mastectomy were included in this study. Preoperative 3D surface images were acquired with a VECTRA XT 3D stereophotogrammetry device. Breast volumes were calculated from the 3D surface images with the three software applications. During surgery, the mastectomy specimens were weighed to derive their actual volume for comparison with the software outcomes. Results: Twenty-six subjects who underwent 44 mastectomies were enrolled in this study. For all three methods, a positive correlation between the breast volume and absolute measurement error was found (p

Adipose tissue–preserved skin graft: applicability and long-term results.

No abstract available

The "Orbital Oval Balance Principle": a Morphometric Clinical Analysis

Background: The aim of this study was to test the validity of the "Orbital Oval Balance Principle", a system of analysis and guideline that is used among aestheticians, artist and make-up artist to create and design aesthetically pleasing eyebrows for optimal upper facial appearance. According to this principle, a face is optimally attractive when the eye is centered in an "oval" defined by the lid-cheek junction and the eyebrow. Methods: One hundred participants were asked to rank digital morphed images of four female models with four different peri-orbital proportions: higher or lower lid-cheek junction versus higher or lower eyebrow position. In addition, the participants were asked to quantify seven emotions on these morphed images. Results: A higher lid-cheek junction was rated as significantly more attractive with a lower eyebrow position, and a lower lid-cheek junction was regarded far more attractive in combination with a higher eyebrow position. Moreover a higher lid-cheek junction was rated as more attractive than a lower lid-cheek junction and elevation of the lid-cheek junction improved the perceived emotions such as tiredness and sadness. Conclusion: This study lends support to the Orbital Oval Balance Principle that can provide important insight into facial attractiveness to surgeons undertaking procedures intended to improve and rejuvenate facial appearance. Moreover, this study has also shown that a high(er) lid- cheek junction is not only regarded as more youthful and attractive, but that it also may reduce the appearance of tiredness and sadness. There has been no financial support and there are no financial interests. Corresponding author: Prof dr. B. van der lei, M.D., Ph.D., University and University medical School of Groningen, The Netherlands. PO box 30.001, 9700 RB Groningen. info@berendvanderlei.nl ; b.van.der.lei@umcg.nl ©2018American Society of Plastic Surgeons

“Robotic Nipple-sparing Mastectomy with Immediate Prosthetic Breast Reconstruction: Surgical Technique.”

No abstract available

Pre-Operative Multimodal Analgesia Decreases Post-Anesthesia Care Unit Narcotic Use and Pain Scores in Outpatient Breast Surgery

Background: The opioid epidemic demands changes in perioperative pain management. Of the 33,000 deaths due to opioid overdose in 2015, half received prescription opioids. Multimodal analgesia (MMA) is a practice-altering evolution that reduces reliance on opioid medications. Ambulatory breast surgery is an ideal opportunity to implement these strategies. Methods: A retrospective review of 560 patients undergoing outpatient breast procedures was conducted. Patients received 1) no pre-operative analgesia (n=333), 2) intra-operative IV acetaminophen (n=78), 3) pre-operative oral acetaminophen and gabapentin (n=95), or 4) pre-operative oral acetaminophen, gabapentin and celecoxib (n=54). Outcomes included PACU narcotic use, pain scores, PACU length-of-stay, rescue anti-emetic use and 30-day complications. Results: Both oral MMA regimens significantly reduced PACU narcotic use (GA:14.3 +/- 1.7 and GAC:11.9 +/- 2.2 versus no drug:19.2 +/- 1.1 mg oral morphine equivalents, p=0.0006), initial pain scores (GA:3.9 +/- 0.4 and GAC:3.4 +/- 0.7 versus no drug:5.3 +/- 0.3 on a 1-10 scale, p=0.0002) and maximum pain scores (GA:4.3 +/- 0.4 and GAC:3.6 +/- 0.7 versus no drug:5.9 +/- 0.3, 1-10 scale, p