Purpose: The aim of this study was to examine the ultrastructural features of the nasolacrimal duct (NLD) openings in the inferior meatus. Methods: Five openings of the NLD in the inferior meati from 5 sagittal head sections of 3 cadavers were studied. Each of the openings were completely excised with 2 mm margins on all sides and transported to the laboratory in 2.5% glutaraldehyde. The analysis was performed using the standard protocols of scanning electron microscopy. The ends, edges, and surfaces were studied along with the mucosal folds, if any, guarding the edge of the openings. Results: Of the 5 NLD openings studied, 4 were of the sulcus variety and 1 was of the shape of a fissure. The fissure opening had a guarding anterior edge mucosal fold. The luminal surfaces of the openings were mostly smooth with focal defined glandular structures. Occasional heterogenous areas with prominent and extensive well-defined glands lined by ciliated columnar epithelium were noted. There were presence of mucosal folds on the floor of the sulci of the openings giving an appearance of a subsulcus. Conclusions: The luminal surfaces of the NLD openings in the inferior meati shows mucosal folds reflected on themselves and cavernous vessels throughout the expanse of the openings. Tear rheology at the NLD opening and the physiologic role of subsulci need to be investigated further. Accepted for publication July 3, 2018. M.J.A. receives royalties from Springer for his treatises "Principles and Practice of Lacrimal Surgery" and "Atlas of Lacrimal Drainage Disorders." The author has no conflicts of interest to disclose. Address correspondence and reprint requests to Mohammad Javed Ali, F.R.C.S., Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad 500034, Telangana, India. E-mail: drjaved007@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Παρασκευή 7 Σεπτεμβρίου 2018
Color Doppler Flow Imaging of Retrobulbar Ocular Blood Flow Changes in Retinal Artery Occlusions Caused by Cosmetic Facial Filler Injections
Purpose: This study aimed to evaluate the effects of retinal artery occlusions caused by cosmetic facial filler injections on the retrobulbar blood flow parameters. Methods: This was a retrospective, noncomparative case series. Ten consecutive patients with fundus artery occlusions caused by facial filler injections were evaluated using color Doppler flow imaging (CDFI). The peak systolic velocity and end diastolic velocity of the ophthalmic artery, central retinal artery, and posterior ciliary arteries were determined. The clinical features, including the filler material, injection site, best-corrected visual acuity, fundus fluorescein angiography, and associated ocular and systemic manifestations were also collected. Results: Injected materials included autologous fat (7 cases) and hyaluronic acid (3 cases). In 6 of the patients with ophthalmic artery occlusions, the CDFI showed no or drastic declines in the retrobulbar blood flow in the ophthalmic artery, central retinal artery, and posterior ciliary arteries. In 3 of the patients with central retinal artery occlusions, the CDFI showed no or a grossly decreased retrobulbar blood flow in the central retinal artery. In one patient with anterior ischemic optic neuropathy, the CDFI showed decreased end diastolic velocities and increased pulsatility and resistance indices in the central retinal artery, posterior ciliary arteries, and ophthalmic artery. During the follow-up period, the retrobulbar blood flow recovered to some degree. Overall, ophthalmic artery occlusion patients receiving autologous fat may have neurologic complications. Conclusions: The results suggest that the retrobulbar ocular blood flows measured with CDFI were distinctly different in the different types of ophthalmic artery occlusion. Color Doppler flow imaging could provide a practicable and convenient method for the diagnosis and follow up of retinal artery occlusions caused by cosmetic facial filler injections. Accepted for publication July 8, 2018. The authors have no financial or conflicts of interest to disclose. Dr Xue had full access to all of the data in the study, taking responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design were performed by Dr Xue, A. Liu, P. Huang, and Dr Ren. Acquisition, analysis, or interpretation of the data were carried out by Dr Xue and P. Huang. Drafting of the manuscript was done by P. Huang. Critical revision of the manuscript for important intellectual content was performed by all authors. Statistical analysis was done by P. Huang. Administrative, technical, or material support was given by P. Huang and Dr Ren. Address correspondence and reprint requests to Kang Xue, M.D., Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai 200031, China. E-mail: xuekang@foxmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Early Experience With Nonporous Polyethylene Barrier Sheet in Orbital Fracture Repair
Purpose: The aim of this study was to evaluate the efficacy of the nonporous polyethylene barrier sheet as an alternative for nylon foil (SupraFOIL) implants in repair of orbital fractures. Methods: This is a prospective, case series using the Stryker 0.4-mm-thick nonporous polyethylene barrier sheet in all patients over the age of 18 years presenting with orbital fractures from December 2014 to June 2015. Patient's age, location of fracture, etiology of injury, presence of preoperative restriction and diplopia, and postoperative diplopia and/or enophthalmos was recorded. Institutional review board approval was received, and consent was obtained from all participants. Patients were followed for at least 6 months when possible. Scanning electron microscopy was used to compare the thickness, surface characteristics, and porosity of the nonporous polyethylene barrier and nylon foil implants. Beam deflection testing was also performed to compare the biomechanical properties of each implant. Results: Forty-six patients who underwent repair of orbital fractures with the nonporous polyethylene barrier sheet were included in this series. Average age was 43.3 years (range: 18–84 years). Twenty-six of 46 patients (56.5%) were males, and 20 (43.4%) were females. The most common causes of injuries were assault (38.3%), falls (25.5%), motor vehicle accident (14.9%), and sports related (10.5%). Twenty of 46 patients (43.4%) had isolated orbital floor, and 2 patients (4.3%) had isolated medial wall fractures. Fifteen patients (32.6%) had combined floor and medial wall fractures involving the inferomedial orbital strut, and 9 (19.6%) had floor fractures associated with zygomaticomaxillary complex or lateral wall fractures. Twenty-eight patients (60.9%) had preoperative diplopia. Timing of surgery was between 3 and 55 days, with the median of 11.5 days. Five of 46 patients (10.8%) had residual diplopia at their 1-week postoperative visit, 4 of those patients' diplopia had resolved at 2 months postoperatively. One patient had residual diplopia at 6-month follow up. Electron microscopy showed that the 0.4-mm nonporous polyethylene barrier implant was thinner (0.33 mm) than expected and thinner than 0.4-mm SupraFOIL (0.38 mm). Scanning electron microscopy exhibited that the surface of the nonporous polyethylene barrier was smooth and nonporous. Beam deflection testing showed that for small forces (
Orbital Extension of Conjunctival Pseudoadenomatous Hyperplasia
A 41-year-old woman developed persistent unilateral conjunctivitis following an upper respiratory infection. A white cystic lesion of the inferior fornix was noted on computed tomography scan to extend behind the orbital septum into the anterior portion of the orbit. Following subtotal excision, histopathology showed benign pseudoadenomatous (pseudoglandular) hyperplasia. The case represents the 5th report of this lesion occurring in the conjunctiva and the only instance of its extension into the orbit.Endonasal Approach to Orbital Pathology
Purpose: Transnasal endoscopic orbital surgery in an emerging surgical field. The surgical field has expanded from orbital decompression to excision of tumours from the medial orbit and over the last 20 years. As instrumentation has improved, the nature, location and size of tumours being excised has changed. Methods: This article discusses the salient surgical considerations when approaching an orbital lesion via a transnasal endoscopic route and reviews the literature. Results: An endonasal approach offers a potential space surgeons can utilise to access the orbit, possibly providing additional exposure, illumination and magnification to the medial and apical aspects of selected lesions. Conclusions: An endonasal approach may be useful as a sole or adjunctive approach in selected cases of orbital tumour excision.Cyst Excision and Globe Preservation in a Case of Microphthalmos With a Large Orbital Cyst and Visual Potential
Congenital microphthalmos belongs to a spectrum of diseases ranging from true anophthalmos to congenital clinical anophthalmos to microphthalmos. These conditions are frequently associated with an orbitopalpebral cyst, and pathologically, this represents a failure in the closure of the embryonic fissure at the 7–14 mm stage of gestation. The cyst develops as an outpouching from the eyeball and is generally helpful as it provides a stimulus for the orbit to expand. The general management guideline is to retain the cyst till it provides a stimulus for the orbit to expand and then to consider aspiration and sclerotherapy once orbital expansion is achieved. However, in eyes that have visual potential, sclerotherapy is contraindicated. The authors present an unusual case of a mildly microphthalmic eye with visual potential and a communicating cyst that was excised with a good result. The challenges faced in the excision of the communicating cyst with a wide pedicle and the management of the case are highlighted.Paracanthal “One-Snip” Decompression in a Cadaver Model of Retrobulbar Hemorrhage
Purpose: The authors assess the effectiveness of a modified paracanthal or "one-snip" procedure compared with the traditional lateral canthotomy and inferior cantholysis in the reduction of intraocular pressure (IOP) and proptosis in a human cadaveric model of retrobulbar hemorrhage. Methods: This study comprised a comparative interventional study in a cadaveric model of retrobulbar hemorrhage. Six orbits of 3 fresh cadavers were included in the study. Baseline measurements of IOP and proptosis were recorded for all 6 orbits before and after simulation of retrobulbar hemorrhage as previously described. Right orbits (n = 3) underwent traditional lateral canthotomy and inferior cantholysis. Left orbits (n = 3) underwent modified paracanthal or "one-snip" procedure. The primary outcome measures were reduction in IOP and proptosis between the 2 techniques. Results: Following lateral canthotomy and inferior cantholysis of each right orbit, the average IOP dropped to 14 mm Hg (range of 11–18 mm Hg), corresponding to a mean decrease of 32 mm Hg. Following the "one-snip" procedure of each left orbit, the average IOP dropped to 19 mm Hg with a range of 16 to 23 mm Hg, corresponding to a mean decrease of 22 mm Hg. There was no statistically significant difference in IOP reduction (p = 0.36) or proptosis reduction (p = 0.23) between the 2 treatment groups. Conclusions: Compared with traditional lateral canthotomy xand inferior cantholysis, the modified paracanthal or "one-snip" procedure is effective for IOP reduction and led to mild improvement of proptosis in a cadaveric model of retrobulbar hemorrhage. The authors hope this study helps improve orbital compartment syndrome outcomes by providing an option that more providers will feel comfortable performing and therefore decreasing time to surgical decompression.Mild Complications or Unusual Persistence of Porcine Collagen and Hyaluronic Acid Gel Following Periocular Filler Injections
The purpose of this study was to describe the histopathologic appearance of dermal eyelid fillers that were unexpectedly encountered in ophthalmic plastic surgery samples from patients with mild eyelid disfigurements, and to review eyelid cases with complications that had previously been described in the literature. A retrospective histopathologic study with Alcian blue, elastic, and Masson trichrome stains of 2 cases that were submitted to the Ocular Pathology Department was conducted, and a critical review of previously published cases of the histopathologic characteristics of dermal filler material in the periocular region was also conducted. Two periocular tissue samples were found to contain dermal filler material. In one case, porcine collagen appeared as amorphous or indistinctly microfibrillar aggregates that stained light blue with the Masson trichrome method. In the other case, hyaluronic acid gel appeared as vivid blue amorphous pools of material in extracellular locules after staining with the Alcian blue method. An inflammatory response was not observed in either case. Patients who undergo facial filler procedures may, at a later time, require a surgical excisional procedure from which a specimen is generated. Previously injected dermal filler that the patient neglected to mention may be present in the pathologic sample, potentially perplexing the unsuspecting pathologist. Both ophthalmic plastic surgeons and ocular pathologists should be aware of the histopathologic features of dermal fillers. It is helpful if a surgeon who submits a specimen to the pathology service makes note of any known prior use of facial filler material or is alert to its possible presence when unfamiliar foreign material is discovered in the dermis of the eyelids.Significance of Early Postoperative Eyelid Position on Late Postoperative Result in Mueller’s Muscle Conjunctival Resection and External Levator Advancement Surgery
Purpose: The purpose of this study was to determine whether advancement of the levator aponeurosis in external levator resection surgery or Mueller's muscle and conjunctiva in Mueller's muscle conjunctival resection (MMCR) surgery has a differential effect on variation in eyelid position during the postoperative period. Methods: In this retrospective observational cohort study, 2 groups of patients were defined. The first underwent MMCR surgery without tarsectomy by surgeon 1. The second underwent external levator resection without dissection posterior to the levator aponeurosis by surgeon 2. Marginal reflex distance (MRD1) was calculated based on digital photographs at baseline, 1 week postoperatively and at 3-month follow up. The primary outcome measure was change in MRD1 over time. The secondary outcome was defined as the proportion of patients with minimal early postoperative change (change of MRD1 less than 0.5 mm at 1 week postoperatively). Repeated measures analysis of variance, t test, and chi-square analyses were performed. Results: Of the 114 eyes in the sample, there were 68 in the MMCR group and 46 in the external levator resection group. A significant interaction between group and time was noted (p 1 mm from the early postoperative to the late postoperative time points. Conclusions: Both external levator resection and MMCR can effectively elevate the eyelid in cases of primary involutional ptosis, and have similar late postoperative results. The authors found that MMCR cases undergo greater change between the early and late postoperative period, suggesting the process of eyelid elevation after MMCR may be dynamic, involving postoperative physiologic modification.Sino-Orbital Fungal Infection by Tilletiopsis minor, a Rare Human Pathogen, Diagnosed by Internal Transcribed Spacer Sequencing
Orbital infection can be caused by numerous pathogens, and accurate diagnosis informs appropriate therapy. The authors report a case of a 78-year-old man with well-controlled diabetes mellitus and recurrent sino-orbital infection following multiple surgical procedures with negative microbiologic results. This case presented a diagnostic and treatment challenge and was aided by the use of internal transcribed spacer sequencing for pathogen identification. The fungal pathogen, Tilletiopsis minor, has not previously been described as a human pathogen in the sinus and orbit. This report describes a novel orbital pathogen and highlights the importance of diagnostic diligence and utilizing internal transcribed spacer sequencing in the workup of atypical orbital infection.Symmetry of Upper Eyelid Contour After Unilateral Blepharoptosis Repair With a Single-strip Frontalis Suspension Technique
Purpose: To analyze the upper eyelid contour of patients with unilateral congenital ptosis who underwent single-strip frontalis suspension. Methods: The authors compared the upper eyelid shape of the right and left eyes of 10 patients who underwent unilateral frontalis suspension with a single strip of autogenous fascia. At a mean postoperative time of 10.1 ± 4.01 months, the image J software was used to measure the ratio between the nasal and temporal areas of the upper half of the palpebral fissure. The midpupil upper eyelid distance (MRD1) was also measured on the photos with the same software. The nonparametric Wilcoxon signed-rank test was used to compare the data. Results: Postoperative MRD1 ranged from 2.5 to 4.7 mm (median = 3.8) on the affected side. The MRD1 for nonoperated eyelid ranged from 1.8 to 5.0 mm (median = 3.5). On the operated side, the temporal areas ranged from 50.3 to 85.7 mm2 (median 65.2) and nasal areas ranged from 41.5 to 72.3 (the median was 60.1). In the contralateral, nonoperated palpebral fissures, the temporal areas ranged from 42.7 to 94.3 mm2 (median = 54.5) and the nasal areas ranged from 36.8 to 86.1 mm2 (median 52.3). The T/N ratio distributions were almost identical between groups, ranging from 0.9 to 1.2 (median = 1.1) in the operated eyes and from 0.9 to 1.3 (median = 1.1) in the fellow eyes. Conclusions: In autogenous fascia frontalis suspension procedures, the upper eyelid contour of the ptotic eyelids can be adequately normalized with a single area of traction on the tarsal plate.
Continuous Positive Airway Pressure Thresholds for Nasolacrimal Air Regurgitation in a Cadaveric Model
Purpose: To elucidate the mechanisms underlying nasolacrimal air regurgitation (AR) in the setting of continuous positive airway pressure therapy. Methods: Twelve nasolacrimal systems of 6 fresh female human cadavers were evaluated individually for AR using continuous positive airway pressure therapy before any nasolacrimal procedure. Cadavers were then randomly assigned to undergo nasolacrimal duct probing or endoscopic dacryocystorhinostomy and then each hemisystem was again evaluated for AR. The pressure where AR was first observed (discovery pressure) or maximum possible pressure in systems without AR was recorded. In systems that demonstrated AR, the pressure was then gradually decreased to the lowest pressure where regurgitation persisted. This pressure was recorded as the secondary threshold pressure. Results: None of the 12 unoperated nasolacrimal systems or the 6 systems that underwent nasolacrimal duct probing demonstrated AR through the maximum continuous positive airway pressure therapy (30 cm H2O). After endoscopic dacryocystorhinostomy, all 6 nasolacrimal systems demonstrated AR. The mean discovery pressure was 16.0 cm H2O (range, 14.0–18.0 cm H2O) and mean secondary threshold pressure was 7.25 cm H2O (range, 6.5–8.0 cm H2O). Conclusions: Air regurgitation during continuous positive airway pressure therapy in the setting of prior endoscopic dacryocystorhinostomy can be replicated in a cadaver model. The secondary threshold pressures required for AR in this model were similar to AR pressures reported clinically. Prior to dacryocystorhinostomy, patients using continuous positive airway pressure therapy should be counseled on AR, and physicians should consider this phenomenon when evaluating ophthalmic complaints in postoperative patients on positive airway pressure therapy.Orbital Extranodal Marginal Zone Lymphoma Following Radiotherapy: A Report of 2 Cases
Purpose: To present 2 patients in whom orbital radiation preceded the development of periorbital extranodal marginal zone lymphoma by more than a decade and to investigate the likelihood of this representing irradiation-induced malignancy. Methods: Retrospective chart review and histopathologic study with immunohistochemistry of 2 cases. Results: The first patient was a 58-year-old woman who developed an orbital mass within the vicinity of the lateral rectus muscle 17 years after external beam proton radiation therapy for an inferotemporal choroidal melanoma. The second patient was a 32-year-old woman who developed a mass in the right lacrimal gland 12 years after external beam photon radiation therapy for chronic inflammatory dacryoadenitis. Histopathologic and immunohistochemical studies confirmed orbital extranodal marginal zone lymphoma in both cases. Retrospective review of older histopathologic slides from the second patient revealed underlying immunoglobulin G4–related disease. Discussion: The unusual sequence of events in these 2 cases raises the question of whether orbital radiation may in rare instances promote the development of orbital extranodal marginal zone lymphoma. The literature pertaining to irradiation-induced secondary malignancy in the orbit is reviewed. Conclusions: Clinicians should consider the possibility of a secondary malignancy when evaluating a patient with an orbital mass and a history of prior local radiation exposure.Carboplatin and Pembrolizumab Chemoimmunotherapy Achieves Remission in Recurrent, Metastatic Sebaceous Carcinoma
A 72-year-old Caucasian woman who had recurrent sebaceous carcinoma of the right orbit with bilateral cervical lymph node involvement 24 months after orbital exenteration was treated with carboplatin (area under the curve of 5) and pembrolizumab (2 mg/kg) for 6 cycles, followed by maintenance pembrolizumab. She obtained a complete pathological remission and remains free of local, regional, and systemic disease at 15 months.Deep Orbital Sub-Q Hyaluronic Acid Filler Injection for Enophthalmic Sighted Eyes in Parry–Romberg Syndrome
Purpose: The authors present a consecutive series of deep orbital Sub-Q injections to treat enophthalmic sighted eyes in Parry–Romberg syndrome patients. Methods: Retrospective, interventional case series in 2 centers. Data were collected on patient demographics, Parry–Romberg syndrome onset age, previous orbital and eyelid surgeries, diplopia, ocular movement restriction before and after the injection, number of injections, interval between injections, indication for any top-up or dissolution of filler, and any other complications. In all cases, the hyaluronic acid gel used was Restylane Sub-Q + Lidocaine. Results: A total of 8 injections on 3 patients with Parry–Romberg syndrome, and significant enophthalmos is reported. All injections were with deep orbital Sub-Q filler. All patients were females, aged 32, 24, and 52 years old while their symptoms started at 15, 16, and 30 years old, respectively. None had orbital surgery prior to the injection. Follow up period was 2, 7, and 5 years respectively. All presented a significant enophthalmos of 4 mm which reduced to 1 mm after the injection, and duration effect was 18, 24, and 20 months, respectively. We observed a significant improvement in enophthalmos, lagophthalmos, exposure keratopathy, and even ocular motility. Lagophthalmos improved from 1, 4, and 7 mm to 0, 1, and 2 mm post injection. Ocular motility improved with no onset of new limitation or diplopia. Lower eyelid retraction increased in 1 patient after orbital injection. No other complications occurred. Conclusions: Deep orbital Sub-Q hyaluronic injection for treatment of enophthalmos in Parry–Romberg syndrome is an useful option in sighted eyes.Epithelial–Myoepithelial Carcinoma Presenting as a Pseudo Veno-Lymphatic Malformation
A 41-year-old woman presented with several days of right eye pain and blurred vision. Examination and radiologic workup were consistent with a veno-lymphatic malformation, including demonstration of cystic fluid–fluid levels on imaging. Histopathology supported the presence of cystic spaces but revealed the final diagnosis of lacrimal epithelial–myoepithelial carcinoma, a rare neoplasm typically associated with the salivary gland. This represents the first reported case of lacrimal epithelial–myoepithelial carcinoma presenting with pain and evidence of intralesional cysts on radiographic and histopathologic evaluation. Better characterization will enable recognition, complete surgical excision, and potential adjuvant radiation therapy.Gelatin-Based Hemostatic Agents: Histopathologic Differences
Purpose: To delineate the histopathologic appearance of gelatin-based hemostatic agents, Surgiflo, Gelfoam, and Floseal, which are used by ophthalmic plastic surgeons, and which may incidentally be found as foreign materials in histopathologic tissue samples. Methods: Histopathologic analysis was performed with hematoxylin-eosin, periodic acid-Schiff, Masson trichrome, and elastin staining on tissue samples in which gelatin-based agents were found. To better characterize these materials, similar analyses were performed on in vitro samples of commonly used gelatin-based hemostatic agents. Results: Surgiflo and Gelfoam are composed of small stellate pieces of gelatin with a smooth, homogeneous quality. In tissues, they are faintly positive with periodic acid-Schiff staining, amphophilic with Masson trichrome staining, and ink-black with elastin staining. Floseal has a distinctly different morphology of large rectangular sheets, yet almost identical in vitro staining properties. Discussion: While the morphology of the gelatin-based hemostatic agents is consistent under various conditions, the staining properties of these materials differ based on whether they have been in contact with human tissue. Conclusions: Gelatin-derived hemostatic agents are best identified based on their morphologic characteristics. Elastin staining highlights these materials prominently within tissue samples and may be helpful in distinguishing them from other foreign materials.Orbital Apex Syndrome in Pseudomonas Sinusitis After Functional Endoscopic Sinus Surgery
Sinusitis complicated by orbital apex syndrome is rare. The majority of cases are due to mucormycosis in immunocompromised patients. The authors report a case of orbital apex syndrome secondary to Pseudomonas sinusitis. The patient was a 79-year-old Type 2 diabetic woman who underwent left-sided functional endoscopic sinus surgery. Three months postprocedure, she presented with a 3-week history of gradual vision loss and constant temporal headache on the ipsilateral side. Examination revealed light perception vision, a relative afferent pupillary defect, absent corneal reflex, and disc pallor. Imaging revealed opacification of the posterior ethmoidal air cells extending to involve the orbital apex. Urgent orbital and sinonasal decompression was performed. Intraoperative specimens grew Pseudomonas aeruginosa. The patient was treated with liposomal amphotericin B, posaconazole, and piperacillin/tazobactam. The patient recovered with no visual sequelae. Pseudomonas is an important mimicker to consider in sinusitis causing orbital apex syndrome, and it may occur following functional endoscopic sinus surgery.Medial Buttressing in Orbital Blowout Fractures
Purpose: To study whether ethmoidectomy predisposes the orbit to medial wall fracture with lesser trauma. Methods: An interventional cadaver study of 5 heads (10 orbits); the left or right orbit was randomized to undergo endoscopic complete ethmoidectomy with the fellow orbit as control. Fractures were induced with direct globe trauma, and heads underwent CT scanning. Energy to induce fracture, peak orbital pressure at time of fracture, fracture pattern, and volume of herniated tissue were measured and analyzed. Results: Fractures were induced in both orbits of all cadavers. Experimental orbits after ethmoidectomy sustained orbital fracture at less energy required (2.14 ± 0.66 vs. 3.10 ± 0.19 J, mean difference: −0.96 ± 0.33 J, p
Fenton oxidation of municipal secondary effluent: comparison of Fe/Ce-RGO (reduced graphene oxide) and Fe 2+ as catalysts
Abstract
The advanced treatment of municipal secondary effluent by heterogeneous and homogeneous Fenton processes using Fe/Ce-RGO (reduced graphene oxide) and Fe2+ as catalysts was studied and compared. Sulfamethazine (SMT) was spiked in the effluent to examine the effectiveness of the emerging contaminant removal. The Fe/Ce-RGO catalyst was characterized using a scanning electron microscope (SEM) and cycle voltammetry curves. The removal of dissolved organic carbon (DOC), soluble chemical oxygen demand (SCOD), SMT, and ultraviolet-visible spectroscopy in 254 nm (UV254) of municipal secondary effluents was examined. The DOC removal efficiency of secondary effluent (without addition of SMT) was 36.30% and 11.74% using Fe/Ce-RGO and Fe2+ as catalysts, respectively. The removal efficiency of DOC, SCOD, and SMT in heterogeneous Fenton process was higher than that in homogeneous Fenton process. The changes of three-dimensional excitation-emission matrix (3DEEM) fluorescence, soluble microbial products (SMPs), humic acids, and UV254 were determined, and the results indicated that UV254, aromatic proteins, and humic acids decreased rapidly in both processes; however, polysaccharides and protein-like substances were difficult to degrade. Although some toxic substances produced after Fenton-like treatment, the biodegradability of the treated effluent was enhanced.
Correction to: Antimicrobial resistance and the presence of extended-spectrum beta-lactamase genes in Escherichia coli isolated from the environment of horse riding centers
The original publication of this paper contains a mistake.
Recent advances in the microbial hydroxylation and reduction of soy isoflavones
ABSTRACT
Soy isoflavones are naturally occurring phytochemicals, which are biotransformed into functional derivatives through oxidative and reductive metabolic pathways of diverse microorganisms. Such representative derivatives, ortho-dihydroxyisoflavones (ODIs) and equols, have attracted great attention for their versatile health benefits since they were found from soybean fermented foods and human intestinal fluids. Recently, scientists in food technology, nutrition and microbiology began to understand their correct biosynthetic pathways and nutraceutical values, and have attempted to produce the valuable bioactive compounds using microbial fermentation and whole-cell/enzyme-based biotransformation. Furthermore, artificial design of microbial catalysts and/or protein engineering of oxidoreductases were also conducted to enhance production efficiency and regioselectivity of products. This minireview summarizes and introduces the past year's studies and recent advances in notable production of ODIs and equols, and provides information on available microbial species and their catalytic performance with perspectives on industrial application.Stenotrophomonas maltophilia mutant lacking flagella remains virulent in DBA/2N mice but is less efficient in stimulating TNF-α expression
ABSTRACT
To understand the role of flagella of Stenotrophomonas maltophilia in lung infections, DBA/2N mice were challenged with aflagellate fliI− mutant and colonization, invasion and persistence, lung damage and inflammatory response compared, on days 1 and 3 post-exposure (p.e.), with that of the isogenic wild-type (wt). Following exposure to nebulized bacterial suspension, mice infected with wt and fliI− strains showed a comparable trend in body weight change, pulmonary persistence, lung damage and mortality rate over the study period considered. Interestingly, although on day 1 p.e. both strains colonized near all the spleens, on day 3 p.e. wt strain persisted in 40% of spleens, whereas fliI− mutant was completely cleared. No significant differences were found in MIP-2, IFN-γ and IL-6 pulmonary levels between groups over time, except for TNF-α whose levels on day 1 p.e. were significantly higher in mice infected with flagellated wt strain. Overall, our results indicate that in S. maltophilia flagella and motility might not represent virulence traits involved in the pathogenesis of lung infection. However, the evidence for a specific flagellar-induced TNF-α response warrants further study.Reply to: Letter to the editor: Evaluation of anatomical and round breast implant aesthetics and preferences in Dutch young lay and plastic surgeon cohort
We would like to thank Dr. Cheng and Dr. Cen for reading our article and for submitting their interesting points.1 All patients included in our study underwent primary aesthetic breast augmentation with either anatomical or round breast implants.2 Dr. Cheng and Dr. Cen correctly mention that a history of breast disease or surgery would have an impact on breast aesthetics due to skin compliance and breast parenchyma. For this reason, we excluded patients that underwent prior breast surgery as it may have possibly lead to malformation, which could be a reason for revision surgery.
The atopic dermatitis-like lesion and the associated MRSA infection and barrier dysfunction can be alleviated by 2,4-dimethoxy-6-methylbenzene-1,3-diol from Antrodia camphorata
Atopic dermatitis (AD) is an inflammatory skin disease with an associated barrier dysfunction and Staphylococcus aureus infection. The mainstay steroid and calcineurin inhibitor therapy shows some adverse effects. 2,4-Dimethoxy-6-methylbenzene-1,3-diol (DMD) is a benzenoid isolated from Antrodia camphorata.
Carboxytherapy-Induced Fat loss is Associated with VEGF-Mediated Vascularization
Abstract
Background
Carboxytherapy is the transcutaneous administration of CO2 gas for therapeutic purposes. Although this non-surgical procedure has been widely used for reducing localized adiposity, its effectiveness on fat loss in obese patients and its underlying mechanisms remain unclear.
Methods
C57BL/6 mice were fed with a high-fat diet for 8 weeks to generate obese animal models. Obese mice were randomly assigned to two groups: One group was administered air to both inguinal fat pads (air/air), and the other group was treated with air to the left inguinal fat pad and with CO2 to the right inguinal fat pad (air/CO2). Each group was treated every other day for 2 weeks. Morphological changes and expression levels of genes associated with lipogenesis and vascularization in fat were determined by histological and qRT-PCR analyses.
Results
Mice treated with air/CO2 showed lower body weights and blood glucose levels compared to air/air-treated mice. Paired comparison analysis revealed that CO2 administration significantly decreased adipose tissue weights and adipocyte sizes compared to air treatment. Additionally, CO2 treatment markedly increased vessel numbers and expressions of Vegfa and Fgf1 genes in adipose tissues. The expressions of Fasn and Fabp4 genes were also modestly reduced in CO2-treated adipose tissue. Moreover, Ucp1 expression, the target gene of VEGF and a key regulator in energy expenditure, was significantly increased in CO2-treated adipose tissue.
Conclusions
Carboxytherapy is effective in the reduction of localized fat in obese patients which is mechanistically associated with alteration of the vasculature involved in VEGF.
No Level Assigned
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Transcriptional regulation of the ferric aerobactin receptor gene by a GntR-like repressor IutR in Vibrio furnissii
Abstract
We found that Vibrio furnissii can utilize aerobactin (AERO) as a xenosiderophore. A homology search of its genome revealed that this bacterium possesses genes encoding an AERO-mediated iron acquisition system similar to that of Vibrio vulnificus. The system consists of the ABC transporter gene vatCDB, the GntR-type transcriptional repressor gene iutR, and the outer membrane receptor gene iutA. The functions of the vatCDB operon and iutA in V. furnissii were confirmed by the inability of the corresponding deletion mutants to utilize AERO. Reverse transcription-quantitative PCR revealed that iutA transcription under iron-limiting conditions was extensively activated by the addition of AERO to the growth medium; therefore, we focused on elucidating this phenomenon. Electrophoretic mobility shift and DNase I footprinting assays revealed that glutathione S-transferase-fused IutR (GST-IutR) bound directly to a specific palindromic sequence in the iutA promoter region. However, GST-IutR did not bind to this sequence when either AERO or ferric AERO was present in the assay mixture. These in vitro findings suggest that, under iron-limiting conditions, iutA transcription in V. furnissii is artfully regulated both by IutR, acting as a direct repressor of iutA, and by AERO, acting as an effector for IutR, leading to the derepression of iutA transcription.Photodegradation of clothianidin and thiamethoxam in agricultural soils
Abstract
Presented in this paper is a study on the photodegradation of two widely used neonicotinoid insecticides clothianidin and thiamethoxam in three soils and in solid phase. The effects of light with differing wavelengths were examined using the natural sunlight and single ultraviolet A (UVA) and ultraviolet B (UVB) light sources. The results indicated that UVB played a key role in the photodegradation of clothianidin and thiamethoxam while the effects of visible and UVA lights were negligible. The degradations of clothianidin and thiamethoxam under all the light sources followed the first-order kinetics, and the half-lives of clothianidin and thiamethoxam in the three soils under the sunlight ranged from 97 to 112 h and 88 to 103 h, respectively. When clothianidin and thiamethoxam were directly exposed to the sunlight without soil, the degradation rates were remarkably higher with half-lives being 13 and 10 h, respectively. Therefore, the insecticides fallen on the surface of soils would be degraded under sunlight much faster than those that enter the soils. The examination of the degradation products revealed four compounds from the photodegradation of clothianidin and three from thiamethoxam, and clothianidin was one of the photodegradation products of thiamethoxam.
The potential adsorption mechanism of the biochars with different modification processes to Cr(VI)
Abstract
Modified biochar has attracted wide attention due to its advantageous adsorption performance. However, the influence of modification process of biochar on adsorption capacity was seldom studied. In this study, biochar derived from corn stalks was modified through two kinds of modification processes: pre-pyrolysis (MBCpre) and post-pyrolysis (MBCpost) modification with citric acid, sodium hydroxide, ferric chloride, respectively. The results showed that the biochar modified by ferric chloride (MBC) provided better adsorption capacity for Cr(VI), and the pre-pyrolysis offered more favorable adsorption capacity for biochar than post-pyrolysis. By means of instrumental analysis, it was found that MBCpre owned highly dispersed Fe3O4 particles and larger surface area, which could be the critical role for enhancing the adsorption capacity of MBCpre. Meanwhile, MBCpost appeared more protonated oxygen-rich functional groups(C=O, –OH, etc.) and adsorbed Cr(VI) by electrostatic attraction and complexation. This study will offer a novel idea for the treatment of chromium-containing wastewater by selecting the modification processes of biochar.
Graphical abstract
Spatio-temporal variability and source identification for metal contamination in the river sediment of Indian Sundarbans, a world heritage site
Abstract
Metal pollution is a subject of growing concern as it affects the whole food chain of an ecosystem by bioaccumulation. Growing industrialization and anthropogenic intervention have put tremendous pressure on self-sustaining ecosystems worldwide. Sundarbans mangrove estuary, being a UNESCO World Heritage site, suffers severely from anthropogenic stress, urbanization, ecotourism, overexploitation of natural resources and discharges of industrial as well as municipal waste products. Our study unfolds the extent of metal pollution in the sediment of this estuarine mangrove ecosystem and also investigates the source and distribution of these metals. Extensive samplings were performed during three major seasons, namely pre-monsoon, monsoon, and post-monsoon for two consecutive years at ten sampling stations along the major river networks of the mangrove estuary. Seasonal variations of these metals, physicochemical properties, and soil texture studies were performed to explore the sediment quality of the study area. Positive correlation was observed between the pollutants and siltation. Several environmental indices were investigated to explore the degree of metal pollution which revealed contamination of Cd, Cr, and Pb to cross the permitted safe index in the study area. Pollution load index indicates the spatial as well as seasonal variation of eco toxic metal load along the course of the rivers. Statistical analyses such as principal component analysis and correlation matrix identified different sources for metal contamination. Almost 700 tannery industries are located in the upstream region of the rivers, and several small- and large-scale battery industries seem to be the main possible source for Cd, Cr, and Pb pollution. Analysis of the results indicates the alarming condition of this heritage site. The metal concentrations beyond toxicity thresholds are responsible for gradual deterioration of this estuarine mangrove which may only be protected by developing sustainable management planning.
Snobbery in Appreciative Contexts
Abstract
Matthew Kieran has recently argued that those he calls 'appreciative snobs' go wrong by valuing appreciative objects primarily because of their ability to raise the snob's social status, what I call social contagion snobbery. In this paper, I argue that there are at least two other ways that snobbery commonly manifests itself in appreciative contexts, what I call attitudinal snobbery and contextual snobbery. As it turns out, all three snobs—Kieran's social-contagion snob, the attitudinal snob, and the contextual snob—represent distinct ways that appreciative judgments can go wrong because of how socio-hierarchical elements figure into the snob's appreciative judgments.Journals Received
JTLA, Journal of the Faculty of Letters, The University of Tokyo: Prolegomena, Society for the Advancement of Philosophy, Aesthetics. University of Zagreb.
Books Received
ABBOTT, MATHEW. Michael Fried and Philosophy: Modernism, Intention, and Theatricality. (London: Routledge). 2018. pp. 267. £115 (hbk).
Notes on Contributors
ZED ADAMS is Associate Professor of Philosophy at the New School, New York. He is the author of On the Genealogy of Color: A Case Study in Historicized Conceptual Analysis (Routledge, 2016) and the co-editor of Giving a Damn: Essays in Dialogue with John Haugeland (MIT Press, 2017).
Microbial explanations for field-aged biochar mitigating greenhouse gas emissions during a rice-growing season
Abstract
Knowledge about the impacts of fresh and field-aged biochar amendments on greenhouse gas (CH4, N2O) emissions is limited. A field experiment was initiated in 2012 to study the effects of fresh and field-aged biochar additions on CH4 and N2O emissions and the associated microbial activity during the entire rice-growing season in typical rice-wheat rotation system in Southeast China. CH4 and N2O fluxes were monitored, and the abundance of methanogen (mcrA), methanotrophy (pmoA), ammonia-oxidizing archaea (AOA), ammonia-oxidizing bacteria (AOB), nitrite reductase (nirS, nirK), N2O reductase (nosZ), and potential soil enzyme activities related to CH4 and N2O were simultaneously measured throughout different rice developmental stages. There were three treatments: control (urea without biochar), fresh BC (urea with fresh biochar added in 2015), and aged BC (urea with 3-year field-aged biochar added in 2012). Results showed that field-aged biochar significantly decreased seasonal CH4 emissions by 16.8% in relation to the fresh biochar, though no significant differences were detected between biochars and control treatment. The structural equation model indicated that soil pH, microbial biomass carbon (MBC), pmoA, and mcrA were the main factors directly influenced by fresh and aged biochar amendments; aged biochar showed a negative effect while fresh biochar showed positive effects on CH4 fluxes. Both fresh and field-aged biochar obviously increased AOA and AOB abundances and reduced the (nirS+nirK)/nosZ ratio during the entire rice-growing season, although no significant effects were observed on seasonal N2O emissions. Therefore, biochar amendment produced long-term effects on total CH4 and N2O emissions through observed influences of soil pH and functional gene abundance.
The figure shows how fresh and field-aged biochar differentially affected CH4 production and oxidation and N2O production and reduction through related functional gene abundances. Blue arrows indicate suppressing while pink arrows indicate promoting effect.
Biofilter with mixture of pine bark and expanded clay as packing material for methane treatment in lab-scale experiment and field-scale implementation
Abstract
Low methane (CH4) emission reduction efficiency (< 25%) has been prevalent due to inefficient biological exhaust gas treatment facilities in mechanic biological waste treatment plants (MBTs) in Germany. This study aimed to quantify the improved capacity of biofilters composed of a mixture of organic (pine bark) and inorganic (expanded clay) packing materials in reducing CH4 emissions in both a lab-scale experiment and field-scale implementation. CH4 removal performance was evaluated using lab-scale biofilter columns under varied inflow CH4 concentrations (70, 130, and 200 g m−3) and corresponding loading rates of 8.2, 4.76, and 3.81 g m−3 h−1, respectively. The laboratory CH4 removal rates (1.2–2.2 g m−3 h−1) showed positive correlation with the inflow CH4 loading rates (4–8.2 g m−3 h−1), indicating high potential for field-scale implementation. Three field-scale biofilter systems with the proposed mixture packing materials were constructed in an MBT in Neumünster, northern Germany. A relatively stable CH4 removal efficiency of 38–50% was observed under varied inflow CH4 concentrations of 28–39 g m−3 (loading rates of 1120–2340 g m−3 h−1) over a 24-h period. The CH4 removal rate was approximately 500–700 g m−3 h−1, which was significantly higher than relevant previously reported field-scale biofilter systems (16–50 g m−3 h−1). The present study provides a promising configuration of biofilter systems composed of a mixture of organic (pine bark) and inorganic (expanded clay) packing materials to achieve high CH4 emission reduction.
Graphic abstract
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Effects of particulate matter (PM2.5) and associated acidity on ecosystem functioning: response of leaf litter breakdown
Abstract
Particulate matter (PM2.5 with the diameter ≤ 2.5 μm) as one of the most harmful and complex pollutants can reduce environment quality and affect human health. Through acidification by wet deposition, PM2.5 can cause acid rain to impact aquatic ecosystems. However, our understanding of PM2.5 effect on ecosystem functioning is highly limited. This study investigated the relationship between PM2.5 concentration, associated acidity, and leaf litter breakdown of three tree species in laboratory experimental mesocosms, which are weeping willow (Salix babylonica), camphor tree(Cinnamomum camphora), and the south magnolia (Magnolia grandiflora). We found that leaf litter breakdown was significant affected by PM2.5 and associated acidity. With the increase of acidity, the leaf breakdown rate of all three tree species decreased. With the increase of PM2.5 concentration, the leaf breakdown rates of those leaves slowed down. When considering the influence of leaf toughness, willow leaves with lower toughness had a higher breakdown rate than that of camphor tree and the south magnolia. Our study suggests that PM2.5 has significant impact on the aquatic ecosystem functioning through increasing acidification in aquatic environment. Hence, along with ecological restoration of local aquatic habitats, further freshwater ecosystem management should include reducing air pollution through regional efforts of best ecosystem management.
Financial development, globalization, and CO 2 emission in the presence of EKC: evidence from BRICS countries
Abstract
This study examines the impact of energy consumption, financial development, globalization, economic growth, and urbanization on carbon dioxide emissions in the presence of Environmental Kuznets Curve (EKC) model for BRICS economies, by using a family of econometric techniques robust to heterogeneity and cross-sectional dependence. Results from LM test, CIPS and CADF unit root test, Westerlund Cointegration test, the Dynamic seemingly unrelated regression (DSUR), and Dumitrescu-Hurlin Granger causality test show that (i) the data is cross sectionally dependent and heterogeneous; (ii) carbon dioxide emissions, energy consumption, financial development, globalization, economic growth, square of GDP and urbanization have integration of order one; (iii) the examined variables are co-integrated; (iv) energy consumption and financial development contribute to the carbon dioxide emissions whereas globalization and urbanization have negative but insignificant relationship with carbon dioxide emissions; (v) supports the EKC hypothesis in BRICS economies; (vi) bidirectional causality exists among energy consumption, financial development, economic growth and square of GDP with carbon dioxide emissions whereas globalization and urbanization have unidirectional relationship with carbon dioxide emissions. Since these panel techniques account for heterogeneity and cross-sectional dependence in their estimation procedure, the empirical results are robust and reliable for policy recommendations. Furthermore, this study also uses time series tests (ADF, P-P, and FMOLS) to find the empirical results for each of the country and finds mixed results. Empirical findings directed towards some important policy implications.
Reconstruction mammaire par lambeau dorsal épargnant le muscle grand dorsal (Muscle-Sparing Latissimus Dorsi, MSLD) associé à un lambeau d’avancement thoraco-abdominal et greffe de tissu adipeux autologue
Publication date: Available online 7 September 2018
Source: Annales de Chirurgie Plastique Esthétique
Author(s): A. Mojallal, F. Boucher
Résumé
Le lambeau de grand dorsal (Latissimus Dorsi ou LD) a été décrit pour la première fois par l'Italien Tansini en 1896 et publié en 1906 dans le cas d'une reconstruction de la paroi thoracique après amputation mammaire. L'utilisation du lambeau de grand dorsal dans toutes ses variantes est très fréquente en reconstruction mammaire. Dans ces indications, le muscle est prélevé pour permettre de vasculariser la palette cutanée et/ou apporter du volume au sein reconstruit. Lorsque le muscle est prélevé en totalité ou presque, sa fonction motrice est alors totalement perdue. Les séquelles fonctionnelles liées à la perte du muscle grand dorsal sont alors définitives. Tobin et al. ont montré que le muscle grand dorsal pouvait être séparé en deux lambeaux basés sur les divisions de l'artère thoracodorsale ; le concept d'épargne musculaire était alors posé (Muscle-Sparing Latissimus Dorsi [MSLD]). Le lambeau dorsal avec conservation du muscle (MSLD) tel que nous le prélevons n'emporte qu'une fine bandelette musculaire et préserve 95 % du muscle grand dorsal avec sa vascularisation et son innervation motrice. Cette technique est de levée rapide avec une morbidité du site donneur très faible. Les séquelles fonctionnelles et les complications postopératoires apparaissent limitées par rapport au prélèvement d'un grand dorsal complet quelle que soit la cicatrice dorsale. Le volume du sein à reconstruire est obtenu par plusieurs séances de greffe de tissu adipeux. Nous présentons ici les bases anatomiques et la technique chirurgicale du lambeau dorsal avec conservation du muscle grand dorsal associé à un lambeau thoraco-abdominal d'avancement et une greffe de tissu adipeux en reconstruction mammaire.
Summary
The Latissimus Dorsi flap (or LD flap) was first described by the Tansini in 1896 and published in 1906. It concerned a case of chest wall reconstruction after breast amputation. The use of the LD flap in all its variants is very frequent in breast reconstruction. In these indications, the muscle is harvested for skin paddle vascularization and/or for bringing volume to the reconstructed breast. When all or most of the muscle is taken, its motor function is completely lost. The functional sequelae due to the loss of the latissimus dorsi muscle are then definitive. Tobin et al. showed that the LD muscle can be separated into two flaps based on the division of the thoracodorsal artery; the concept of muscle-sparing was then posed (Muscle-Sparing Latissimus Dorsi [MSLD]). The MSLD as we perform now, concerns only a thin muscle strip and preserves 95% of the LD muscle with its vascularization and motor innervation. This technique is quick with very low donor site morbidity. The functional sequelae and postoperative complications appear limited compared to the harvest of a total LD whatever the posterior scar. The volume of the breast to be reconstructed is obtained by several sessions of fat grafting. We present here the anatomical bases and the surgical technique of the muscle-sparing latissimus dorsi associated with a thoracoabdominal advancement flap and fat grafting in breast reconstruction.
Réponse à l’article « Le portfolio de l’interne de chirurgie plastique. Un outil à la formation ». Un contexte à préciser, un point de vue à nuancer
Publication date: Available online 7 September 2018
Source: Annales de Chirurgie Plastique Esthétique
Author(s): V. Duquennoy-Martinot
Reconstruction mammaire autologue microchirurgicale par lambeau libre perforant aux dépens de l’artère epigastrique inférieure profonde (DIEP) : techniques classique et mini-invasive extra-péritonéale par laparoscopie
Publication date: Available online 7 September 2018
Source: Annales de Chirurgie Plastique Esthétique
Author(s): M. Hivelin, L. Lantieri
Résumé
Les lambeaux libres perforants permettent, avec une morbidité réduite, de reconstruire les seins avec les tissus cutanés et adipeux qui le composent, en dehors de la glande mammaire. Autologues, ces reconstructions évitent les risques d'infections sur matériels, de contractures capsulaires et de changements associés aux implants. Le lambeau libre DIEP décrit en 1994 et réduisant la morbidité sur les muscles droits des TRAM, n'utilise que la peau de la partie sous-ombilicale de l'abdomen et les vaisseaux épigastriques inférieurs profonds qui l'alimentent. Le prélèvement des vaisseaux épigastriques inférieurs profonds à leur origine nécessite au niveau des muscles droits l'ouverture de leur aponévrose sur 8 à 10 cm et leur éversion par traction, à risques de lésions de leurs nerfs moteurs et faiblesses pariétales. Nous avons développé depuis 2014 un prélèvement du DIEP mini-invasif laparoscopique rétromusculaire prépéritonéal qui permet de réduire l'ouverture de l'aponévrose des muscles droits de 70 % et évite les tractions sur leurs nerfs moteurs. Nous présentons ici la technique de prélèvement classique du lambeau DIEP puis les points spécifiques à la technique laparoscopique. Les reconstructions par DIEP requièrent une laxité abdominale suffisante pour transposer l'ombilic et sont indiqués chez toutes les patientes nécessitant un apport cutané, en particulier en reconstruction mammaire secondaire. Le volume autologue apporté par le DIEP, pérenne, suit les variations pondérales des patientes et permet une meilleure qualité de vie à long terme. La dissection laparoscopique mini-invasive du diep réduit encore la morbidité et probablement les risques à la paroi abdominale à long terme.
Summary
Perforator free flaps allow breast reconstructions « like with like » with skin and fat, excluding mammary gland, with a low morbidity. Those autologous reconstructions prevent material associated infections, capsular contracture and implant replacements, associated to breast reconstructions including implants. DIEP flap was described in 1994 to reduce the morbidity faced with TRAM flaps harvest. It only includes sub-umbilical skin and deep epigastric vessels. Deep inferior epigastric vessels harvest requires rectus abdominis muscle sheet opening and traction on rectus muscles, both associated with increased risks of abdominal bulges. Since 2014, we developed a minimally invasive DIEP harvest by totally extra-peritoneal laparoscopic dissection of epigastric vessels with a 70% reduction of aponeurosis opening and avoiding traction on rectus' motor nerves. We report both classic and minimally invasive DIEP harvest techniques. Bresat reconstructions by DIEP require that the ombilicus can be transposed and are indicated for all patients with need for skin inset, particularly secondary breast reconstructions. The reconstructed breast as a volume that follows patients weight variations and allows for improved quality of life on a long term. Its minimally invasive totally extra peritoneal harvest by laparoscopy, with or without robotic assistance, offers a reduced morbidity and might allows for reduced risks of abdominal wall weakness on a long-term.
La reconstruction mammaire par prothèse
Publication date: Available online 7 September 2018
Source: Annales de Chirurgie Plastique Esthétique
Author(s): A. Fitoussi
Résumé
La reconstruction mammaire par prothèse reste la plus utilisée dans le monde et même à tendance a de nouveau augmenter au détriment de lambeaux musculo-cutanés depuis l'utilisation quasi-systématique, depuis quelques années, des greffes adipocytaires (lipomodelage) avant et/ou après mise en place de l'implant. Cette technique, plus simple, est souvent préférée par les patientes qui souhaitent éviter les cicatrices et les douleurs à distance de la zone thoracique. L'utilisation de formes d'implants différents, de l'injection de graisse, de lambeaux d'avancement abdominal, de matrices biologiques ou synthétiques permettent d'améliorer nettement les résultats de ces reconstructions en secondaire ou en immédiat. Toutes ces techniques sont détaillées dans l'article suivant afin de montrer les différents artifices qui permettent de réaliser cette intervention avec le maximum de sécurité.
Summary
Breast reconstruction by prosthesis remains the most used in the world and even tends to increase again at the expense of musculo-cutaneous flaps since the systematic use, in recent years, of adipocytes grafts (lipofilling) before and/or after in place of the implant. This simpler technique is often preferred by patients who want to avoid scars and pain away from the chest area. The use of different implant forms, fat injection, abdominal advancement flaps, biological or synthetic matrices can significantly improve the results of these reconstructions in secondary or immediate. All these techniques are detailed in the following article to show the different devices that allow to achieve this intervention with maximum security.
Relevante Interaktionen von Analgetika und Koanalgetika mit onkologischen Systemtherapeutika – wann wird es gefährlich?
Zusammenfassung
Hintergrund
Schmerz ist ein gefürchtetes und zugleich auch das häufigste Symptom bei Krebspatienten. Gleichzeitig ist es aber etwas, für dessen Behandlung effektive und gut verträgliche Medikamente zur Verfügung stehen. Da behandlungsbedürftige Schmerzen in jeder Phase der Erkrankung auftreten können, werden Schmerztherapie und tumorgerichtete Systemtherapie häufig gleichzeitig durchgeführt. Während die Zahl der verfügbaren analgetisch wirksamen Substanzen seit Jahrzehnten stagniert (es wurden lediglich neue galenische Zubereitungen entwickelt), entwickelt sich der Markt der verfügbaren und oft hoch wirksamen Onkologika nahezu explosionsartig. Damit steigt auch die Wahrscheinlichkeit klinisch relevanter und u. U. sogar tödlicher „drug-drug-interactions". Ein Drittel aller ambulanten onkologischen Patienten soll ein Risiko für das Auftreten einer Interaktion haben. Eine Sonderstellung nimmt hierbei Methadon ein, für dessen Antitumorwirkung es bis dato keinen wissenschaftlichen Beweis gibt, wohl aber für sein hohes Risikoprofil.
Ziel
Ziel dieses Artikels ist die Sensibilisierung des Onkologen und Palliativmediziners für die Bedeutung von Interaktionen. Exemplarisch werden einzelne Interaktionen erläutert und bewertet. Keineswegs wird an dieser Stelle der Anspruch auf Vollständigkeit erhoben. Hierzu wird auf (frei verfügbare) Datenbanken verwiesen.
Material und Methoden
Dieser Beitrag wurde unter Bezug auf die wissenschaftlichen Fachinformationen der erwähnten Substanzen, klinische Erfahrungsberichte sowie unter Zuhilfenahme einschlägiger Interaktionsportale erstellt. Die Auswahl der Substanzen erfolgte auf der Basis langjähriger internistisch onkologischer Erfahrung und der S3-Leitlinie Schmerz des Leitlinienprogramms Onkologie der AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.)
Reassessing the global mortality burden of the 1918 influenza pandemic.
Abstract
Mortality estimates of the 1918 influenza pandemic vary considerably, and recent estimates have suggested that there were 50-100 million deaths worldwide. We investigated the global mortality burden using an indirect estimation approach and two publically available datasets: the Human Mortality Database (13 countries) and data extracted from the records of the Statistical Abstract for British India. The all-cause Human Mortality Database allowed us to estimate mortality annually in 1916-1921 for detailed age groups. Three different calculation methods were applied to the data (low, medium and high scenarios) and we used a multilevel regression model to control for distorting factors (e.g. war and the underlying time trend in mortality). We found that total pandemic mortality was an estimated 15 million deaths worldwide in 1918 (2.5 million in 1919), after including the rates for British India and controlling for wars and the underlying mortality trend. Our validity analysis showed that simulations of total mortality above 25 million are not realistic based on the underlying mortality rates included in Human Mortality Database and in British India. Our results suggest that the global mortality impact of the 1918 pandemic was important (17.4 million) but not as severe as most frequently cited estimates.Acetaminophen (Paracetamol) Exposure During Pregnancy and Pubertal Development in Boys and Girls From a Nationwide Puberty Cohort
Abstract
This study explored the association between exposure to acetaminophen during pregnancy and pubertal development using data from 15,822 boys and girls in the longitudinal Puberty Cohort, nested within The Danish National Birth Cohort. Use of acetaminophen was reported three times during pregnancy and six months postpartum. In total, 54% of mothers indicated use at least once during pregnancy. Between 2012 and 2017, sons and daughters provided information on a wide range of pubertal milestones, including Tanner stages, axillary hair growth and age at menarche or voice break and first ejaculation, every six months from 11 years of age until full sexual maturation. Data were analyzed by a regression model for interval-censored data, providing adjusted mean monthly differences in age at attaining the pubertal milestones according to intrauterine cumulative (weeks) and trimester specific acetaminophen exposure. Our results suggested a tendency towards slightly earlier attainment of almost all studied markers of female pubertal development with increasing number of weeks of exposure (i.e., about 1.5–3 months earlier age at pubic hair, axillary hair and acne development comparing unexposed with those prenatally exposed for more than 12 weeks). Male pubertal development had no strong association with acetaminophen exposure.Erratum zu: Europäische PanCare-Studien zu Spätfolgen nach Krebs im Kindes- und Jugendalter
Erratum zu:
Der Onkologe 2018
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Im vorletzten Abschnitt zur Überschrift „Projekte PanCareSurFup und PanCareLIFE" muss es korrekt heißen (Ergänzung in kursiv):
… Von den 25 datenbereitstellenden Einrichtungen wurden demografische, klinische (z. B. zur …
A Patch Testing Initiative for the Investigation of Allergic Contact Dermatitis in a UK Allergy Practice: A Retrospective Study
Publication date: Available online 7 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Timothy J. Watts, Sophia Watts, David Thursfield, Rubaiyat Haque
Abstract
Background
Patch testing is the gold standard diagnostic tool for investigating allergic contact dermatitis (ACD). In the United Kingdom, patch testing has been historically confined to the dermatologist's office. Furthermore, detailed studies on patch testing by allergists are significantly underrepresented at the international level.
Objective
The objective of this study was to undertake a comprehensive evaluation of a patch testing initiative from an allergy practice; reporting on various patient characteristics, prevalence and relevance data, in addition to immediate hypersensitivity testing.
Methods
We undertook a retrospective analysis of 156 patients suspected of having contact dermatitis seen in our UK allergy practice between October 2016 and April 2018.
Results
Of the 156 patients patch tested (mean age 36.9 years, female 88%, white ethnicity 71.8%, atopy 68.6%), ACD was diagnosed overall in 49% of the cohort and ACD of current relevance was assigned to 31%. Our extended British standard series alone detected the responsible allergen in 87% of patients and the remaining 13% were detected from supplementary or own material testing alone. Most prevalent contact allergens were nickel (28.2%), p-Phenylenediamine (8.3%), cobalt (8.3%), methylisothiazolinone (5.8%) and hydroperoxides of linalool (4.5%) and limonene (4.5%). A history of occupationally related dermatitis (P=.004) and initial (pre-test) diagnosis of ACD (P<.001) were both significantly associated with relevant positive patch test reactions (atopy status was not associated P>.05).
Conclusion
ACD was detected in almost 50% of assessed patients and we highlight the importance of assessing relevance. Hydroperoxides of limonene and linalool are notable additions to the prevalence data. Patch testing should be incorporated into more allergy practices, although availability of training is a limiting factor.
Implementing Health Care Technology Research into Practice to Improve Adult Asthma Management
Publication date: Available online 7 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Peter J. Cvietusa, Glenn K. Goodrich, Jo Ann Shoup, David A. Steffen, Cathy Tacinas, Nicole M. Wagner, Courtney B. Anderson, Debra P. Ritzwoller, Bruce G. Bender
Association of Child Maltreatment with South African Adults’ Wages: Evidence from the Cape Area Panel Study
Child maltreatment is a prevalent public health problem in both developed and developing countries. While many studies have investigated the relationship between violence against children and health of the vic...
“The validity of the EQ-5D-5L in measuring quality of life benefits of breast reconstruction”
Publication date: Available online 6 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Casimir A.E. Kouwenberg, Leonieke W. Kranenburg, Martijn S. Visser, Jan J. Busschbach, Marc A.M. Mureau
Summary
Background
The EuroQol EQ-5D-5L instrument is the most widely-used quality of life measure in health economic evaluations. It is unclear whether such a generic instrument is valid enough to estimate the benefits of breast reconstruction (BR), given the specific changes observed in quality of life after BR. Hence, we aimed to evaluate the validity of EQ-5D-5L in patients who had undergone postmastectomy BR.
Methods
In a 10-year cross-sectional cohort study, 463 mastectomy patients completed an online survey: 202 patients with autologous-BR (A-BR), 103 with implant-based-BR (I-BR), and 158 without BR (MAS). The results were used to evaluate the psychometric performance of EQ-5D-5L with respect to the ceiling effect and to known-group, convergent, and discriminant validity, by comparing it with the Breast-Q, the cancer-specific (EORTC-QLQ-C30), and breast cancer-specific (EORTC-QLQ-BR23) questionnaires.
Results
EQ-5D-5L was able to discriminate between patients with and without complications, MAS with or without BR and MAS versus the general population. It was, however, not able to discriminate between A-BR vs. I-BR as well as BR vs. general population. It is not clear whether this was due to the insensitivity of the instrument, insufficient sample sizes, or because there were no actual differences in QoL between these groups. Good convergent and discriminant validity of both EQ-5D-5L and its individual dimensions was demonstrated. Additional support for the instrument's validity was revealed by moderate correlations between the generic EQ-5D-5L and specific QoL aspects of BR such as sexuality and body image.
Conclusions
The results of this study support the validity of the EQ-5D-5L as an outcome measure in health economic evaluations of BR.
Effect of red light and near infrared laser on the generation of reactive oxygen species in primary dermal fibroblasts
Publication date: Available online 6 September 2018
Source: Journal of Photochemistry and Photobiology B: Biology
Author(s): Sajan George, Michael R. Hamblin, Heidi Abrahamse
Abstract
Irradiation with red light or near-infrared (NIR) lasers can bio-modulate cellular processes or revitalize injured tissues and therefore, widely been used for therapeutic interventions. Mechanistically, this cellular or biological process, referred as Photobiomodulation (PBM), is achieved by the generation of oxide free radicals in cells and tissues. This explorative study using red light (636 nm) and Near Infra-Red (NIR, 825 nm) laser at various irradiation exposures reckons the level of oxidative stress induced by these free radicals in human primary fibroblasts. Freshly isolated dermal fibroblasts were irradiated with red light and NIR at power densities of 74 and 104 mV/cm2, respectively and, at varying fluences ranging from 5 to 25 J/cm2. Cellular oxidative stress, measured by Reactive Oxygen Species (ROS) upon quantifying fluorescently labelled oxide free radicals in cells, detected considerable variations between the irradiation exposures of red light and NIR laser. The NIR laser demonstrated high levels of ROS at all fluences, except 10 J/cm2 indicating its ability in generating of two types of oxide radicals in dermal fibroblasts, often illustrated as biphasic response. Further, the responses of these cells to variable fluences of red light and NIR laser were measured to evaluate the immediate effect of PBM on cellular activity. The production of cellular energy coincides with the amount of oxidative stress, which was two-fold higher in cells irradiated with the NIR laser, as compared with the red light. This outcome indicates that the ROS production within biological systems are more dependent on the wavelength of the laser rather than its fluences. Further studies are required to avoid 'overdosing of PBM' and to analyse ROS qualitatively for making the best use of the red light and NIR laser in clinics.
Anthocyanic pigments from elicited in vitro grown shoot cultures of Vaccinium corymbosum L., cv. Brigitta Blue, as photosensitizer in natural dye-sensitized solar cells (NDSSC)
Publication date: Available online 6 September 2018
Source: Journal of Photochemistry and Photobiology B: Biology
Author(s): Simona Lucioli, Chiara Di Bari, Cinzia Forni, Aldo Di Carlo, Enrique Barrajón-Catalán, Vicente Micol, Paolo Nota, Federico Teoli, Fabio Matteocci, Andrea Frattarelli, Emilia Caboni
Abstract
We investigated the effect on anthocyanins and total phenols content and antioxidant capacity of in vitro shoot cultures of Vaccinium corymbosum L., cv. Brigitta Blue, grown on an eliciting medium supplied with 10 μM naphthalene acetic acid, in combination with reduced content of salts and organics in respect to the basal medium. After 45 days, higher content of total phenols and anthocyanins was obtained from extracts of shoots grown on the elicitation medium. Anthocyanin molecules, absent in control shoots, were identified by HPLC-MS as delphinidine-glycoside, cyanidine-glycoside, delphinidine-arabinoside, cyanidine- arabinoside and cyanidine-acetylglycoside. Chlorogenic acid, present in control shoots, was nearly absent in elicited shoots.
We exploited the anthocyanin - based raw extracts of "Brigitta Blue" shoots grown on the elicitation medium as a source of natural dye photosensitizers for Dye Sensitized Solar Cells, taking into account that such raw extracts showed antioxidant properties and photostability features. A purified dye was also prepared and the comparison of the latter with the raw one has been analysed by spectrophotometric, chromatographic and power conversion efficiency determination. The power conversion efficiencies from the raw and the purified dye were not different and they were comparable to the data obtained by other authors with anthocyanin-based dyes from in vivo grown plants.
Nécroses digitales révélant une maladie des agglutinines froides : traitement par rituximab
Publication date: Available online 7 September 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): T. Klejtman, B. Garel, P. Senet, L. Tribout, C. Bachmeyer, A. Barbaud, J.-B. Monfort
Résumé
Introduction
Les nécroses des doigts sont rares en comparaison de celles des membres inférieurs. Elles sont une urgence médico-chirurgicale. Un bilan étiologique approfondi est indispensable. La maladie des agglutinines froides est une cause rare de nécroses digitales, de diagnostic difficile et souvent non recherchée.
Observation
Nous rapportons le cas d'un homme de 57 ans qui présentait un phénomène de Raynaud de la main gauche d'apparition récente, compliqué secondairement de nécroses digitales survenues après exposition professionnelle au froid (conducteur d'un chariot de manutention). Le bilan étiologique permettait de poser le diagnostic de maladie des agglutinines froides idiopathique. Un traitement par rituximab et des soins locaux ont permis une cicatrisation complète.
Discussion
La maladie des agglutinines froides est une cause rare d'anémie hémolytique auto-immune. Les signes cliniques cutanés, paroxystiques, déclenchés par le froid, sont au premier plan. Il existe une forme idiopathique et une forme secondaire à une hémopathie lymphoïde chronique, une maladie auto-immune ou une infection ; un bilan étiologique est indispensable. Le traitement qui permet d'obtenir le meilleur taux de réponse, associé à une bonne tolérance, est à ce jour le rituximab en perfusions hebdomadaires pendant 1 mois.
Summary
Background
Digital necrosis is rarer than lower limb necrosis and constitutes a medical or surgical emergency. Etiological evaluation is required. Cold agglutinin disease is a cause of digital necrosis but diagnosis is difficult.
Patients and methods
Herein we report the case of a 57-year-old man presenting recent paroxysmal acrosyndrome of the left hand subsequently complicated by digital necrosis following occupational exposure to cold in his work as a forklift driver. After etiological evaluation, a diagnosis of primary cold agglutinin disease was made. Intravenous rituximab and topical treatment resulted in complete healing.
Discussion
Cold agglutinin disease is a rare type of auto-immune hemolytic anemia. Following exposure to cold, paroxysmal cutaneous signs are frequent. The disease may be either primary or secondary with B-cell lymphoproliferative disorder, auto-immune disease or infection. A thorough workup is required. To date, the treatment combining the best positive response rate and good safety is rituximab in weekly perfusions over a 1-month period.
Efficacité spectaculaire de l’ivermectine topique dans un cas de granulome facial aseptique idiopathique
Publication date: Available online 6 September 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): E. Blind, N. Ropars, G. Safa
Dermatitis alérgica de contacto al ácido kójico
Publication date: Available online 7 September 2018
Source: Actas Dermo-Sifiliográficas
Author(s): A. Tejera-Vaquerizo, J. García-Gavín
Tofacitinib for the Treatment of Alopecia Areata in Preadolescent Children
Publication date: Available online 6 September 2018
Source: Journal of the American Academy of Dermatology
Author(s): Brittany G. Craiglow, Brett A. King
Effective phytoremediation of low-level heavy metals by native macrophytes in a vanadium mining area, China
Abstract
Heavy metal contamination, particularly vanadium contamination in mining and smelting areas, is a worldwide serious problem threatening the ecological system and human health. The contamination level of vanadium, arsenic, cadmium, chromium, mercury, and lead in sediments and waters in a vanadium mining area in China was investigated in the present study. The behavior of heavy metal uptake by 12 native aquatic macrophytes was evaluated, including 5 species of emergent aquatic plants (Acorus calamus, Scirpus tabernaemontani, Typha orientalis, Phragmites australis, and Bermuda grass), 3 species of floating plants (Marsilea quadrifolia, Nymphaea tetragona, and Eleocharis plantagineiformis), and 4 species of submerged plants (Hydrilla verticillata, Ceratophyllum demersum, Myriophyllum verticillatum, and Potamogetom crispus). Different heavy metal accumulation abilities were found across these macrophytes. Generally, they tended to accumulate higher contents of chromium, and C. demersum showed a particularly higher accumulation capacity for vanadium. The heavy metals were preferentially distributed in roots, instead of translocation into leaves and stems, indicating an internal detoxification mechanism for heavy metal tolerance in macrophytes. In 24-day laboratory hydroponic experiments, the macrophytes had a satisfied phytoremediation performance for heavy metals, when their concentrations were at the microgram per liter level. Particularly, vanadium was effectively removed by P. australis and C. demersum, the removal efficiencies of which were approximately 50%. In addition, a combination of terrestrial plant (Bermuda grass) and aquatic macrophytes (P. australis, M. quadrifolia, and C. demersum) exhibited high uptake capacity of all the six heavy metals and their residual concentrations were 95 (vanadium), 39.5 (arsenic), 4.54 (cadmium), 17.2 (chromium), 0.028 (mercury), and 7.9 (lead) μg/L, respectively. This work is of significant importance for introducing native macrophytes to remove low-level heavy metal contamination, particularly vanadium, and suggests phytoremediation as a promising and cost-effective method for in situ remediation at mining sites.
Comparison of wounds’ infection rate between tap water and normal saline cleansing: A meta‐analysis of randomised control trials
International Wound Journal, EarlyView.
Type 1 Laryngeal Cleft and feeding and swallowing difficulties in infants and toddlers: A Review
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
Lateral and longitudinal variation in phosphorus fractions in surface sediment and adjacent riparian soil in the Three Gorges Reservoir, China
Abstract
Hydrological regimes have been significantly altered since the Three Gorges Dam (TGD) raised the water level of the reservoir to the maximum design level of 175 m in October 2010. This change might greatly influence the forms of phosphorus (P) in the sediment and the adjacent riparian soil. The purpose of this study was to reveal the lateral (sediment, water-level-fluctuation zone soil, and upland soil) and longitudinal (from the end of backwater area to the TGD) trends in P factions. Samples from 11 sites located along the main stem and ten sites located along eight tributaries were collected in June 2017. The P fractions were determined using the Standards, Measurements, and Testing (SMT) protocol. The results showed that the order of increase for average pH values was sediment (7.58 ± 0.62), WLFZ soil (7.44 ± 0.29), and adjacent upland soil (7.20 ± 0.68). The total organic carbon in the sediment was also highest with an average of 9.15 ± 2.97 mg·g−1. The average concentrated HCl-extractable P (total P), organic P (OP), inorganic P (IP), HCl-extractable P (HCl-P), and NaOH-extractable P (NaOH-P) were 630.02 ± 212.24, 161.89 ± 90.77, 468.13 ± 194.92, 335.65 ± 159.88, and 51.40 ± 36.20 mg·kg−1, respectively. The concentration of both total P and NaOH-P in the sediment of the main stem exhibited an increasing trend from the backwater area to the TGD. The average concentration of P species in the sediment was higher than those in the upland soil and the water-level-fluctuation zone (WLFZ) soil. For all the sediment and soil samples, the rank order of P species concentrations was HCl-P > OP > NaOH-P. Both IP and HCl-P were highly positively correlated with total P in the upland soil, the WLFZ soil and the sediment. However, only in the sediment, NaOH-P was positively correlated with total P and OP. All P species in the upland soil demonstrated greater spatial heterogeneity than those in the WLFZ soil and the sediment. Redundancy analysis revealed that the main variables explaining the variance in P species concentrations were Al in the upland soil and pH in the sediment.
“Over the Internet” sale of prescription‐level topical corticosteroids and dilemma of dermatologists
International Journal of Dermatology, EarlyView.
Activation of melanoblasts and melanocytes after treatment with monochromatic excimer light and narrowband‐ultraviolet B of skin of vitiligo patients
International Journal of Dermatology, EarlyView.
Correlation of clinical and pathologic evaluation of scarring alopecia
International Journal of Dermatology, EarlyView.
Issue Information
International Journal of Dermatology, Volume 57, Issue 10, Page i-iii,1147-1148, October 2018.
Pemphigus foliaceus induced by topical imiquimod treatment
International Journal of Dermatology, EarlyView.
Teaching and Learning Tips 12: Peer observation of teaching
International Journal of Dermatology, Volume 57, Issue 10, Page 1233-1236, October 2018.
Chronic granulomatous skin lesions leading to a diagnosis of TAP1 deficiency syndrome
Pediatric Dermatology, EarlyView.
A unique case of pressure‐induced alopecia following EEG monitoring
Pediatric Dermatology, EarlyView.
Management of a rare presentation of Kindler disease with digital constriction bands—Case report
Pediatric Dermatology, EarlyView.
Temporal trends in prenatal risk factors for the development of infantile hemangiomas
Pediatric Dermatology, EarlyView.
Subcutaneous fat necrosis of the newborn and associated hypercalcemia: A systematic review of the literature
Pediatric Dermatology, EarlyView.
Surgical treatment outcomes of infantile hemangioma in children: Does prior medical treatment matter
Pediatric Dermatology, EarlyView.
Cytomegalovirus ulcers following radiotherapy for a Marjolin ulcer in a renal transplant recipient
Australasian Journal of Dermatology, EarlyView.
Author Index 2018
Australasian Journal of Dermatology, Volume 59, Issue S2, Page 24-24, August 2018.
WCCS18 World Congress on Cancers of the Skin 2018 Sydney International Convention Centre 15‐18 August 2018
Australasian Journal of Dermatology, Volume 59, Issue S2, Page 3-23, August 2018.
Systemic treatments for alopecia areata: A systematic review
Australasian Journal of Dermatology, EarlyView.
Itching in a trichophytin contact dermatitis mouse model and the antipruritic effect of antifungal agents
Clinical and Experimental Dermatology, EarlyView.
Primary cicatricial alopecia in a single‐race Asian population: A 10‐year nationwide population‐based study in South Korea
The Journal of Dermatology, EarlyView.
Addition of oral mini pulse dexamethasone to NBUVB phototherapy and topical steroids helps arrest disease activity in patients with vitiligo
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
Local interventions for actinic keratosis in organ transplant recipients: A systematic review
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
Benefit‐risk of tofacitinib in patients with moderate to severe chronic plaque psoriasis: Pooled analysis across 6 clinical trials
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
A new clinical variant of acquired reactive perforating dermatosis‐like bullous pemphigoid
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
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