Dilated Vein of the Filum Terminale on MRI: A Marker for Deep Lumbar and Sacral Dural and Epidural Arteriovenous Fistulas [SPINE]

BACKGROUND AND PURPOSE:

Conventional MR imaging can provide important clues regarding the location of a spinal vascular malformation. We hypothesized that a dilated vein of the filum terminale, identified as a curvilinear flow void on T2WI, could be an imaging marker for a lower lumbar (L3–L5) or sacral fistula.

MATERIALS AND METHODS:

We retrospectively identified all spinal dural and spinal epidural arteriovenous fistulas from 2 large tertiary referral centers from 2005 to 2018. All patients had a lumbar spinal MR imaging and a conventional spinal angiography. Images were reviewed by 2 neuroradiologists who categorized the level of the arterial feeder to the fistula and the presence or absence of a dilated vein of the filum terminale on T2WI and T1 postcontrast images. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of the presence of a dilated filum terminale vein for a deep lumbar or sacral fistula.

RESULTS:

One hundred sixty-two patients were included. An enlarged filum terminale vein was identified in 39 patients. Sensitivity, specificity, positive predictive value, and negative predictive value of the presence of a dilated filum terminale vein for a deep lumbar or sacral fistula were 86%, 98.3%, 94.9%, and 95.1%, respectively.

CONCLUSIONS:

The presence of a dilated vein of the filum terminale can accurately localize a spinal dural arteriovenous fistula/spinal epidural arteriovenous fistula to the lower lumbar or sacral spine in patients being evaluated for such lesions. This finding can be used to facilitate both noninvasive and conventional spinal angiography.

The ASNR-ACR-RSNA Common Data Elements Project: What Will It Do for the House of Neuroradiology? [PRACTICE PERSPECTIVES]

SUMMARY:

The American Society of Neuroradiology has teamed up with the American College of Radiology and the Radiological Society of North America to create a catalog of neuroradiology common data elements that addresses specific clinical use cases. Fundamentally, a common data element is a question, concept, measurement, or feature with a set of controlled responses. This could be a measurement, subjective assessment, or ordinal value. Common data elements can be both machine- and human-generated. Rather than redesigning neuroradiology reporting, the goal is to establish the minimum number of "essential" concepts that should be in a report to address a clinical question. As medicine shifts toward value-based service compensation methodologies, there will be an even greater need to benchmark quality care and allow peer-to-peer comparisons in all specialties. Many government programs are now focusing on these measures, the most recent being the Merit-Based Incentive Payment System and the Medicare Access Children's Health Insurance Program Reauthorization Act of 2015. Standardized or structured reporting is advocated as one method of assessing radiology report quality, and common data elements are a means for expressing these concepts. Incorporating common data elements into clinical practice fosters a number of very useful downstream processes including establishing benchmarks for quality-assurance programs, ensuring more accurate billing, improving communication to providers and patients, participating in public health initiatives, creating comparative effectiveness research, and providing classifiers for machine learning. Generalized adoption of the recommended common data elements in clinical practice will provide the means to collect and compare imaging report data from multiple institutions locally, regionally, and even nationally, to establish quality benchmarks.

Spinal Imaging Findings of Open Spinal Dysraphisms on Fetal and Postnatal MRI [SPINE]

BACKGROUND AND PURPOSE:

Fetal MRI has become a valuable tool in the evaluation of open spinal dysraphisms making studies comparing prenatal and postnatal MRI findings increasingly important. Our aim was to determine the accuracy of predicting the level of the spinal dysraphic defect of open spinal dysraphisms on fetal MR imaging and to report additional findings observed when comparing fetal and postnatal MR imaging of the spine in this population.

MATERIALS AND METHODS:

A single-center retrospective analysis was performed of fetal MRIs with open spinal dysraphisms from 2004 through 2016 with available diagnostic postnatal spine MR imaging. Images were reviewed by 2 board-certified fellowship-trained pediatric neuroradiologists. Corresponding clinical/operative reports were reviewed.

RESULTS:

One hundred nineteen fetal MRIs of open spinal dysraphisms were included. The level of the osseous defect between fetal and postnatal MR imaging was concordant in 42.9% (51/119) of cases and was 1 level different in 39% (47/119) of cases. On postnatal MR imaging, type II split cord malformation was seen in 8.4% (10/119) of cases, with only 50% (5/10) of these cases identified prospectively on fetal MR imaging. Syrinx was noted in 3% (4/119) of prenatal studies, all cervical, all confirmed on postnatal MR imaging.

CONCLUSIONS:

Fetal MR imaging is accurate in detecting the level of the spinal dysraphic defect, which has an impact on prenatal counseling, neurologic outcomes, and eligibility for fetal surgery. In addition, fetal MR imaging is limited in its ability to detect split cord malformations in patients with open spinal dysraphisms. Although rare, fetal MR imaging has a high specificity for detection of cervical spinal cord syrinx.

Facial Venous Malformations Are Associated with Cerebral Developmental Venous Anomalies [HEAD & NECK]

BACKGROUND AND PURPOSE:

A number of studies have demonstrated the existence of segmental vascular disorders affecting soft tissues of the head and neck along with the intracranial vasculature. The purpose of this study was to determine whether there is an association between cerebral developmental venous anomalies and venous malformations of the face, head, and neck.

MATERIALS AND METHODS:

A consecutive series of patients with head and neck venous malformations who underwent MR imaging of the brain with postcontrast T1- or T2*-weighted imaging were included. Developmental venous anomaly prevalence in this patient population was compared with an age- and sex-matched control group without venous malformations at a ratio of 1:2. All images were interpreted by 2 neuroradiologists. Data were collected on venous malformation location, developmental venous anomaly location, developmental venous anomaly drainage pattern, and metameric location of venous malformations and developmental venous anomalies. Categoric variables were compared using ² tests.

RESULTS:

Forty-two patients with venous malformations were included. The mean age was 38.1 ± 11.1 years, and 78.6% of patients were female. The prevalence of developmental venous anomalies in this patient population was 28.6%. The control population of 84 patients had a mean age of 40.0 ± 5.9 years, and 78.6% of patients were female. The prevalence of developmental venous anomalies in this patient population was 9.5% (P = .01). In 83.3% of cases, developmental venous anomalies were ipsilateral to the venous malformation, and in 75% of cases, they involved the same metamere.

CONCLUSIONS:

Our case-control study demonstrated a significant association between brain developmental venous anomalies and superficial venous malformations. These findings suggest that there may be a similar pathophysiologic origin for these 2 entities.

Imaging of Clival Hypoplasia in CHARGE Syndrome and Hypothesis for Development: A Case-Control Study [PEDIATRICS]

BACKGROUND AND PURPOSE:

We present the largest case series to date on basiocciput abnormalities in CHARGE syndrome (Coloboma of the eye, Heart defects, Atresia of the choanae, Retardation of growth and/or development, Genital and/or urinary abnormalities, and Ear abnormalities and/or deafness). We aimed to show that basiocciput abnormalities are common and may aid in diagnosis. We furthermore explored whether clivus size correlates with the type of chromodomain-helicase-DNA binding protein 7 gene (CHD7) mutation, which causes CHARGE syndrome, and with clinical criteria according to Blake et al and Verloes.

MATERIALS AND METHODS:

We retrospectively analyzed the clivus of 23 patients with CHARGE syndrome with CHD7 mutations on MR imaging or CT. We recorded the size of the clivus, the Welcher angle, basilar invagination, and Chiari I malformations. We compared the clival size and Welcher angle of patients with CHARGE syndrome with those of 72 age-matched controls. Additionally, we tested for correlations between clivus size and mutation type or clinical criteria.

RESULTS:

Eighty-seven percent of the patients with CHARGE syndrome had an abnormal clivus; 61% had a clivus >2.5 SD smaller than that of age-matched controls. An abnormally large Welcher angle was observed in 35%. Basiocciput hypoplasia was found in 70%, and basilar invagination, in 29%. None of the patients had a Chiari I malformation. At the group level, patients with CHARGE syndrome had a smaller clivus and larger Welcher angle than controls. No significant correlation between clivus size and mutation type or clinical criteria was found.

CONCLUSIONS:

Most patients with CHARGE syndrome have an abnormal clivus. This suggests that clivus abnormalities may be used as an additional diagnostic tool. Our results provide evidence that CHD7, which is expressed in the presomitic mesoderm during somitogenesis, plays an important role in the formation of the clivus.

Cerebrovascular Reactivity during Prolonged Breath-Hold in Experienced Freedivers [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Experienced freedivers can endure prolonged breath-holds despite severe hypoxemia and are therefore ideal subjects to study apnea-induced cerebrovascular reactivity. This multiparametric study investigated CBF, the spatial coefficient of variation as a correlate of arterial transit time and brain metabolism, dynamics during prolonged apnea.

MATERIALS AND METHODS:

Fifteen male freedivers (age range, 20–64 years; cumulative previous prolonged breath-holds >2 minutes and 30 seconds: 4–79,200) underwent repetitive 3T pseudocontinuous arterial spin-labeling and ³¹P-/¹H-MR spectroscopy before, during, and after a 5-minute breath-hold (split into early and late phases) and gave temporally matching venous blood gas samples. Correlation of temporal and regional cerebrovascular reactivity to blood gases and cumulative previous breath-holds of >2 minutes and 30 seconds in a lifetime was assessed.

RESULTS:

The spatial coefficient of variation of CBF (by arterial spin-labeling) decreased during the early breath-hold phase (–30.0%, P = .002), whereas CBF remained almost stable during this phase and increased in the late phase (+51.8%, P = .001). CBF differed between the anterior and the posterior circulation during all phases (eg, during late breath-hold: MCA, 57.3 ± 14.2 versus posterior cerebral artery, 42.7 ± 10.8 mL/100 g/min; P = .001). There was an association between breath-hold experience and lower CBF (1000 previous breath-holds reduced WM CBF by 0.6 mL/100 g/min; 95% CI, 0.15–1.1 mL/100 g/min; P = .01). While breath-hold caused peripheral lactate rise (+18.5%) and hypoxemia (oxygen saturation, –24.0%), cerebral lactate and adenosine diphosphate remained within physiologic ranges despite early signs of oxidative stress [–6.4% phosphocreatine / (adenosine triphosphate + adenosine diphosphate); P = .02].

CONCLUSIONS:

This study revealed that the cerebral energy metabolism of trained freedivers withstands severe hypoxic hypercarbia in prolonged breath-hold due to a complex cerebrovascular hemodynamic response.

Engorgement of Deep Medullary Veins in Neurosarcoidosis: A Common-Yet-Underrecognized Cerebrovascular Finding on SWI [ADULT BRAIN]

SUMMARY:

We describe the prevalence and potential significance of deep medullary vein engorgement on SWI in patients with neurosarcoidosis, a finding that has not been described previously. Engorgement was evaluated for possible associations with meningeal or perivascular disease, intracranial hemorrhage, and venous thrombosis, as well as with modified Rankin Scale scores at the time of MR imaging and at follow-up. Deep medullary vein engorgement was seen in 7 of 21 patients and was more common in men. Patients with venous engorgement had a significantly increased incidence of microhemorrhages, perivascular disease, and hydrocephalus. There was no association with the degree of leptomeningeal disease, venous dural sinus thrombosis, or modified Rankin Scale scores. In conclusion, deep medullary vein engorgement was common in our patients with neurosarcoidosis. Although its pathophysiology remains uncertain, it could be related to venous or perivenous abnormalities and may represent a useful secondary finding of cerebrovascular disease.

Correct species identification (reclassification in CNCTC) of strains of Staphylococcus intermedius -group can improve an insight into their evolutionary history

Abstract

A group of 59 putative strains of Staphylococcus intermedius/Staphylococcus pseudintermedius deposited in the Czech National Collection of Type Cultures (CNCTC, National Institute for Public Health, Prague, Czech Republic) and the National Reference Laboratory for Staphylococci (NRL for Staphylococci, National Institute for Public Health, Prague, Czech Republic) was reclassified using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). There the biggest human collection of S. pseudintermedius in Europe was analysed; 44 samples (75%) were of human origin. Twenty-two percent (n = 13) of the strains were isolated from animals, and two staphylococci were of unknown origin. This study revealed the prevalence of Staphylococcus pseudintermedius (94%, n = 53) vs. Staphylococcus intermedius (6%, n = 6) in the collection of human and veterinary staphylococci after reclassification. Results of PCR-RFLP analysis were verified by comparison with a repetitive element sequence-based polymerase chain reaction (Rep-PCR) analysis on 26 (44%) randomly selected strains. Due to a low-resolution ability of PCR-RFLP to separate Staphylococcus intermedius from Staphylococcus delphini, four isolates of Staphylococcus intermedius were biochemically verified further to exclude the presence of Staphylococcus delphini in the collection. Our results indicate that S. intermedius and S. pseudintermedius have occurred independently over an age-long period of their co-evolution.

Clinical, Dermoscopic and Histologic Features of Recurrent Cutaneous Eosinophilic Vasculitis Cases

Publication date: Available online 20 September 2018

Source: Actas Dermo-Sifiliográficas (English Edition)

Author(s): E.G. Quijano-Gomero, M.J.M. Rodríguez-Zúñiga, M.E. Sanz-Montero, D. Durand-Buse

Abstract

Primary recurrent cutaneous eosinophilic vasculitis is a rare condition characterized by pruritic, erythematous, purpuric plaques associated to edema. We compared and analyze the clinical, dermoscopic and histological features of the disease in 4 patients from our hospital and 13 patients published in the literature. Seventeen patients were included, with a median age of 56 yo, a median duration of disease of 6 months. Lesions were most frequently generalized (47%) or localized in lower limbs (41%). The most frequent features were purpuric color (71%), local edema (65%), necrotizing vasculitis (94%) and eosinophil infiltration (100%) in histology. Most of the patients (82.4%) were given oral steroids with a median dose of 30 mg. Primary recurrent cutaneous eosinophilic vasculitis might be an infra-diagnosed condition. The analysis of the patients allowed us to propose diagnostic criteria for the definition of this disease. We suggest a therapeutic strategy with high-potency steroids and dapsone, which might be considered as first-line treatment.

Resumen

La vasculitis eosinofílica recurrente cutánea primaria es una enfermedad rara, caracterizada por placas purpúricas, eritematosas y pruriginosas asociadas a edema. Comparamos y analizamos las características clínicas, dermatoscópicas e histológicas de la enfermedad en 4 pacientes de nuestro hospital y en 13 casos de pacientes publicados previamente. Se incluyeron 17 pacientes, con una mediana de edad de 56 años, y una mediana de duración de la enfermedad de 6 meses. En la mayoría de los casos las lesiones fueron generalizadas (47%) o localizadas en los miembros inferiores (41%). Las características histológicas más frecuentes fueron: color purpúrico (71%), edema local (65%), vasculitis necrosante (94%) e infiltración eosinofílica (100%). La mayoría de los pacientes (82,4%) recibió esteroides orales (mediana de la dosis de 30 mg). La vasculitis eosinofílica recurrente cutánea primaria podría ser una entidad clínica infradiagnosticada. El análisis de los pacientes nos permitió proponer algunos criterios diagnósticos para su definición. Recomendamos una estrategia terapéutica con esteroides de alta potencia y dapsona, pudiéndose considerar como el tratamiento de primera línea.

The Effectiveness of a Twice-weekly Narrowband Ultraviolet B Phototherapy Schedule in Early-stage Mycosis Fungoides in a Cohort of 18 Argentinian Patients

Publication date: Available online 19 September 2018

Source: Actas Dermo-Sifiliográficas (English Edition)

Author(s): D.A. De Luca, E.A. Zambrano, R.L. Galimberti, P.A. Enz

Erratum zu: Rohstoffpotenzial von MVA-Rostaschen für Metallrückgewinnung und Karbonatisierung

Erratum zu:

Österr Wasser- und Abfallw 2018

https://ift.tt/2OGYG3g

Statt Abb. 9 wurde irrtümlicherweise Abb. 7 wiederholt abgedruckt. In Abb. 9 ist die Verteilung der potenziell kritischen (PKE) und der kritischen Elemente (KE) auf die Outputströme der Fe/NE-Scheidung 6,3–10 mm und

Detectable levels of eHSP72 in plasma are associated with physical activity and antioxidant enzyme activity levels in hypertensive subjects

Abstract

Previous studies reported that extracellular HSP72 (eHSP72) correlates with poor prognosis, markers of vascular dysfunction, and the severity of cardiovascular diseases, associated with a systemic oxidative and inflammatory profile. On the other hand, eHSP72 may represent immune-regulatory signaling that is related to exercise benefits, but the association between physical activity levels and eHSP72 levels is not established. Thus, since regular physical activity may avoid oxidative stress and inflammation, we investigate whether detectable levels of eHSP72 in plasma are associated with physical activity and antioxidant enzyme activity levels in hypertensive subjects. Physical activity levels of hypertensive subjects (n = 140) were measured by tri-axial movement sensor pedometer for 24 h during 5 consecutive days. One day after, blood was collected into heparinized tubes for oxidative stress analyses (catalase—CAT and superoxide dismutase—SOD activities and malondialdehyde levels) or in disodium EDTA tubes for eHSP72 assays. Thus, hypertensive subjects were classified as physically inactive (< 10,000 footsteps/day) or active (> than 10,000 footsteps/day) and according detectable or not detectable eHSP72 levels in plasma, performing the inactive/eHSP72⁻, active/eHSP72⁻, inactive/eHSP72⁺, and active/eHSP72⁺ groups. We found that detectable levels of eHSP72 in plasma were associated with physical activity levels and low oxidative stress profile (Higher CAT and SOD activities and low malondialdehyde levels). eHSP72 levels can be used as a biomarker of the amount of physical activity necessary to improve antioxidant defense and thus cardiovascular health in hypertensive subjects.

Should physicians be empathetic? Rethinking clinical empathy

Abstract

The role and importance of empathy in clinical practice has been widely discussed. This paper focuses on the ideal of clinical empathy, as involving both cognitive understanding and affective resonance. I argue that this account is subject to a number of objections. Affective resonance may serve more as a liability than as a benefit in clinical settings, and utilizing this capacity is not clearly supported by the relevant empirical literature. Instead, I argue that the ideal account of empathy in medicine remains cognitive, though there is a central role for expressing empathic concern toward patients.

Aufklärung bei kosmetischen Eingriffen

Zusammenfassung

Die Aufklärung ist vor einem geplanten kosmetischen Eingriff die rechtliche Stütze für eine wirksame Einwilligung des Patienten und damit vom Operateur auf keinen Fall zu vernachlässigen. Sie darf unter keinen Umständen auf nichtärztliches Personal delegiert werden und muss, insbesondere auch dann, wenn Aufklärungsformulare zum Einsatz kommen, stets rechtzeitig im Rahmen eines Aufklärungsgesprächs erfolgen. Bei kosmetischen Eingriffen ist im Vergleich zu medizinisch indizierten Eingriffen besonders schonungslos aufzuklären. Bei Fehlern in der Aufklärung kann der Operateur zivilrechtlich wegen Arzthaftung in Anspruch genommen werden und riskiert im schlimmsten Fall ein staatsanwaltliches Ermittlungsverfahren wegen Körperverletzung. Oftmals dringt der Patient auch mit Hornorarrückforderungen durch.

Wound dressings for leg ulcers in Germany: distribution, regional variations and health care providers

Publication date: Available online 19 September 2018

Source: Wound Medicine

Author(s): Kristina Hagenström, Kerstin Protz, Gerd Glaeske, Matthias Augustin

ABSTRACT

Background

Although there are standards in guideline-compliant treatment of chronic wounds, little is known about the use of wound dressings in Germany.

Objective

The objective of the longitudinal study was to analyze the use of wound dressings, to explore regional differences and to characterize prescriptions by different physician specialties in patients with leg ulcers in Germany.

Methods

Wound dressing rates for incident leg ulcers were analyzed from a German statutory health insurance between 2010 and 2012.

Results

From 2010 to 2012, out of 7,248,644 insured persons 0.52 % [95 %-CI 0.51–0.52 %] were identified as having an incident ulcer. 76.0 % were treated with hydroactive wound dressings. By contrast, in 23.7 % only non-hydroactive dressings were used, and more often prescribed in venous (24.0 %) than in mixed leg ulcers (20.8 %). Most frequently used products were foam dressings (49.7 %), followed by gauze compresses (29.5 %). Wound specialized physicians had the highest overall proportion of prescriptions (60.2 %) and a slightly higher proportion of non-hydroactive wound dressings. Large regional variations were observed.

Conclusion

In Germany, a high level of use of hydroactive wound dressings in leg ulcers and marked regional variations were found.

Affluent-Born White Mother’s Descending Neighborhood Income and Infant Mortality: A Population-Based Study

Abstract

Objectives To determine whether affluent-born White mother's descending neighborhood income is associated with infant mortality rates (< 365 day, IMR). Methods Stratified and multilevel logistic regression analyses were completed on the Illinois transgenerational dataset of singleton births (1989–1991) to non-Latina White mothers (1956–1976) with an early-life residence in affluent neighborhoods (defined as the fourth quartile of income distribution). The breadth of descending neighborhood income was defined by mother's neighborhood income at the time of delivery. Results Infants of White mothers (n = 4890) who did not suffer descending neighborhood income by the time of delivery had a first-year mortality rate of 5.1/1,000. Infants of White mothers who experienced minor (n = 5112), modest (n = 2158), or extreme (n = 339) descending neighborhood income had IMR of 6.5/1,000, 14.4/1,000, and 11.8/1,000, respectively; RR [95% CI] = 1.3 [0.8, 2.1], 2.8 [1.7, 4.8], and 2.3 [0.8, 6.6], respectively. The incidence of young maternal age, inadequate prenatal care utilization, and cigarette smoking rose as descending neighborhood income increased, p < 0.01. In multilevel logistic regression models, the adjusted (controlling for selected individual-level co-variates) OR [95% CI] of infant mortality for White women with an early-life residence in affluent neighborhoods who subsequently experienced minor or modest to extreme (versus absent) descending neighborhood income equaled 1.0 [0.6, 1.8] and 2.1 [1.1, 3.8] respectively. Conclusions White mother's modest to extreme descending neighborhood income from early-life residence in affluent neighborhoods is associated with a twofold greater risk of infant mortality independent of selected biologic, medical, and behavioral characteristics.

Disparities in Risk Factors and Birth Outcomes Among American Indians in North Dakota

Abstract

Objectives High infant mortality rates among American Indians in North Dakota contribute to a 20-year gap in average age at death compared to whites. Geographic- and race-specific health disparities data to drive policy making and interventions are not well disseminated. The current study examines prenatal risk factors and birth outcomes between American Indian and whites in North Dakota. Methods A retrospective descriptive analysis of North Dakota live births from 2007 to 2012 was conducted. Period prevalence and prevalence ratios were calculated. Results The infant mortality rate from 2010 to 2012 for infants born to American Indian women was 3.5 times higher than whites. Racial disparities existed in education, teen births, tobacco use during pregnancy, and breastfeeding initiation. Disparities widened for inadequate prenatal care, illegal drug use during pregnancy, and infant mortality from 2007–2009 to 2010–2012 and narrowed for sexually transmitted infections and alcohol use during pregnancy. Conclusions for Practice American Indians are disproportionately affected by poor pregnancy and birth outcomes in North Dakota. Future geographic-specific American Indian research is warranted to aid current and future public health interventions.

Newborn Screening Collection and Delivery Processes in Michigan Birthing Hospitals: Strategies to Improve Timeliness

Abstract

Objectives This study aimed to determine which steps in the newborn screening collection and delivery processes contribute to delays and identify strategies to improve timeliness. Methods Data was analyzed from infants (N = 94,770) who underwent newborn screening at 83 hospitals in Michigan between April 2014 and March 2015. Linear mixed effects models estimated effects of hospital and newborn characteristics on times between steps in the process, whereas simulation explored how to improve timeliness through adjustments to schedules for the state laboratory and for specimen pickup from hospitals. Results Time from collection to receipt of arrival to the state laboratory varied greatly with collection timing (P < 0.001), with specimens collected on Friday or Saturday delayed an average of 9–12 h compared to other specimens. Simulation estimates shifting specimen pickup from 6 p.m. Sunday–Friday to 9 p.m. Sunday–Friday could lead to an additional 12.6% of specimens received by the Michigan laboratory within 60 h of birth. Conclusions for Practice The time between when a specimen is collected and received by the laboratory can be a significant bottleneck in the newborn screening process. Modifying hospital pickup schedules appears to be a simple way to improve timeliness.

Evaluation of a Multilevel Intervention to Reduce Preterm Birth Among Black Women in Newark, New Jersey: A Controlled Interrupted Time Series Analysis

Abstract

Objective To evaluate the effectiveness of a multilevel intervention, Healthy Babies are Worth the Wait (HBWW), in reducing preterm birth (PTB) and very preterm birth (VPTB) among black women in Newark, NJ. Methods HBWW is a program linking the local March of Dimes office, providers, community-based organizations, and public health institutions to increase uptake of evidence based preterm birth interventions. We used birth certificate data before (2009–2011) and after (2012–2015) the introduction of HBWW in Newark. We estimated differences in PTB and VPTB between these periods among black women in Newark and compared them to rate differences among black women in the rest of NJ (difference-in-differences). We used interrupted time series analysis (ITSA) to examine declines in PTB and VPTB following the introduction of HBWW controlling for secular trends. All models adjusted for maternal age, education and parity. Results PTB declined in Newark 1.1 case per 100 (95% confidence interval (CI) − 2.3, 0) and in the rest of NJ 0.5 case per 100 (− 1.4, 0.4) (difference-in-differences = 0.6 fewer cases per 100 in Newark, 95% CI − 1.6, 0.3). VPTB declined in both Newark (− 0.6 cases per 100, 95% CI − 1.0, 0) and the rest of NJ (− 0.2 cases per 100, 95% CI − 0, 0.3) (difference-in-differences = 0.4 fewer cases per 100 in Newark, 95% CI − 0.9, 0). However, using ITSA the downward VPTB trend in Newark was not different from the rest of NJ or pre-intervention trends. Conclusions for Practice Our study supports the importance of critically evaluating and advancing complex interventions to reduce PTB among black women.

Structural and organisational conditions for being a machine

Abstract

Although the analogy between macroscopic machines and biological molecular devices plays an important role in the conceptual framework of both neo-mechanistic accounts and nanotechnology, it has recently been claimed that certain complex molecular devices (consisting of biological or synthetic macromolecular aggregates) cannot be considered machines since they are subject to physicochemical forces that are different from those of macroscopic machines. However, the structural and physicochemical conditions that allow both macroscopic machines and microscopic devices to work and perform new functions, through a combination of elemental functional parts, have not yet been examined. In order to fill this void, this paper has a threefold aim: first, to clarify the structural and organisational conditions of macroscopic machines and microscopic devices; second, to determine whether the machine-like analogy fits nanoscale devices; and third, to assess whether the machine-like analogy is appropriate for describing the behaviour of some biological macromolecules. Finally, the paper gives an account of 'machine' which, while acknowledging the physicochemical and organisational differences between man-made machines and biological microscopic devices, nevertheless identifies a common conceptual core that allows us to consider the latter 'machines'.

Clinical feasibility of early scanning after administration of 68 Ga-DOTATOC

Abstract

Objective

Positron emission tomography (PET)/computed tomography (CT) using ⁶⁸Ga-labeled 1,4,7,10-tetraazacyclododecane-N,N′,N″,N‴-tetraacetic acid-d-Phe¹-Tyr³-octreotide (DOTATOC) is usually performed about 1-h post-injection; however, because of rapid blood clearance, the waiting time for scanning could possibly be shortened without affecting diagnostic performance. The purpose of this study was to investigate the feasibility of early scanning at 30 min post-injection.

Methods

Thirty-eight patients who underwent DOTATOC-PET/CT were analyzed. After administration of ⁶⁸Ga-DOTATOC, data acquisition was performed twice, at 30-min and 60-min post-injection. The number of known or suspected pathological lesions, and quantitative values of those lesions and physiological uptake were compared. SUV_max, SUV_peak, metabolic tumor volume (MTV), and total lesion uptake (TLU) were calculated as quantitative values of the pathological lesions.

Results

A total of 125 known or suspected pathological lesions were found at both timepoints, with no differences between the two datasets. The SUV_max, SUV_peak, MTV, and TLU were highly reproducible, with Spearman's ρ of 0.983, 0.986, 0.918, and 0.981, respectively. The average percent differences (%DIFF_ave) defined as the differences of the values divided by the value at 1-h post-injection were 11.1% for SUV_max, 8.5% for SUV_peak, 15.1% for MTV, and 20.6% for TLU. Physiological uptake in the two datasets was closely comparable in the pituitary gland (Spearman's ρ = 0.954, %DIFF_ave = 11.0%), liver (0.989, 3.9%), spleen (0.970, 6.3%), adrenal glands (0.879, 13.0%), and pancreatic uncus (0.946, 12.7%).

Conclusion

The diagnostic performance of visual interpretation should be comparable between DOTATOC-PET/CT images obtained at 30-min and 60-min post-injection. Some differences between quantitative values may exist; however, they appear to be minimal.

Assessment and treatment of trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder

Publication date: Available online 19 September 2018

Source: Clinics in Dermatology

Author(s): Grant Jones, Nancy Keuthen, Erica Greenberg

Abstract

Recommendations are provided for the assessment and treatment of trichotillomania (hair pulling disorder, or HPD) and excoriation disorder (skin picking disorder, or SPD), two body-focused repetitive behavior (BFRB) disorders, based on their severity, comorbidities, and behavioral style. Habit reversal training (HRT) and stimulus control are first-line behavioral treatments that can be used in cases of all severity levels and may be particularly helpful when pulling or picking is performed with lowered awareness/intention. Acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT) are behavioral treatments that can be employed to augment HRT/stimulus control, especially when negative emotions trigger the pulling or picking. There are currently no FDA-approved pharmacologic treatments for HPD or SPD, though certain medications/supplements have shown varying degrees of efficacy in trials. N-acetylcysteine (NAC) should be considered for all severity levels and styles given its moderate gain/low side effect profile. Other pharmacologic interventions, including selective serotonin reuptake inhibitors (SSRIs), should be considered in cases with significant comorbidities or previous behavioral/NAC treatment failure.

Business administration training for dermatology residents: Preparing for the business of medicine

Publication date: Available online 19 September 2018

Source: Clinics in Dermatology

Author(s): Jordan V Wang, Christian A Albornoz, Ezra Hazan, Matthew Keller, Nazanin Saedi

Abstract

Previous studies have evidenced the lack of practice management and business training components in the residency curriculum, and satisfaction with this training, when provided, was low. Whether considered good or bad, medicine has been moving increasingly towards becoming more business-centric. Dermatology represents a unique field, since most residents choose to pursue private practice, where competent business skills are helpful to running a successful clinic. Our study examines the current state of business administration training for dermatology residents in ACGME-approved programs as of 2017–2018. Our results show that residents both value and desire business administration training. However, the current training provided is considered to be insufficient and inadequate. Promoting and encouraging the teaching of business administration skills, while still balancing core competencies, may help to prepare residents in navigating the future of our field.

Psychosomatic and Psychiatric Disorders and Psychologic Factors in Pruritus

Publication date: Available online 19 September 2018

Source: Clinics in Dermatology

Author(s): Astrid Stumpf, Gudrun Schneider, Sonja Ständer

Abstract

Chronic pruritus (CP) is a bothersome symptom of many different diseases and is often associated with psychosomatic and psychiatric comorbidity. This review gives an overview of psychologic factors that influence the perception and modulation of pruritus based on the well-known biopsychosocial model. Not only psychic comorbidities, such as anxiety and depression, play an important role in the etiology and perception of pruritus, but also internal factors, including personality, mentalization, suggestibility, and external factors, as well as stress. Expectations concerning the intensity of pruritus can also play a role in itch perception that can be modulated by cognitions and behavior of the patient. Obsessive rituals of scratching and skin manipulation with instruments present challenges in the treatment of CP. Initial studies on the efficacy of psychotherapeutic approaches to different problems, such as scratching, comorbidity or stress-associated itch, show that these might be very useful additions to the multidisciplinary treatment of pruritus.

The dynamic-lymphaticovenular anastomosis method for breast cancer treatment-related lymphedema: creation of functional lymphaticovenular anastomoses with use of preoperative dynamic ultrasonography

Lymphaticovenular anastomosis (LVA) is generally effective for breast cancer treatment-related upper extremity lymphedema (UEL). Clinical improvement is, however, limited by the degree of sclerosis of the lymphatic vessels. We have developed a method by which we use dynamic ultrasonography to depict vessels through which lymph can be propelled into the LVA under the power of the patient's natural hand movements.

Adipose-derived regenerative cells and fat grafting for treating breast cancer-related lymphedema: Lymphoscintigraphic evaluation with one year follow-up

Background: Breast cancer-related lymphedema (BCRL) is a feared late complication. Present treatment options are lacking. Recent studies have suggested that mesenchymal stromal cells can alleviate lymphedema. Herein, we report the results from the first human pilot study with adipose-derived regenerative cells (ADRC) for treating BCRL with one year follow-up. Material and methods: We included ten BCRL patients. ADRCs were injected directly into the axillary region together with a scar releasing fat graft procedure.

Outcomes of shoulder abduction after nerve surgery in patients over 50 following traumatic brachial plexus injury

There is controversy regarding the effectiveness of brachial plexus reconstruction in older patients as it is felt that outcomes are poor. The aim of this study is to determine the outcomes of shoulder abduction obtained after nerve reconstruction in patients over the age of 50 and factors related to success.

Use of a perforator/subcutaneous pedicled propeller flap for reconstruction of lower eyelid defects

Full thickness skin grafts (FTSGs) and flaps from the upper eyelid or cheek can be used for reconstruction of lower eyelid defects, including the anterior lamella. However, the upper eyelid has a limited and insufficient amount of skin, while cheek flaps have a restricted arch of rotation. Here we report the procedure and outcomes of a perforator/subcutaneous pedicled propeller flap for reconstruction of lower eyelid defects including the anterior lamella.A retrospective study of 12 patients who underwent treatment for eyelid anterior lamella defects with perforator/subcutaneous pedicled propeller flaps was conducted between March 2015 and June 2017.

Predictors of complications following breast reduction surgery: A national surgical quality improvement program study of 16812 cases.

Breast reduction is one of the most common procedures performed by plastic surgeons. Despite good outcomes and high patient satisfaction, there is little national data examining the predictors leading to complications in this patient population. We accessed a national outcomes database to examine these factors.

A reduction in inflammatory macrophages may contribute to skin cancer chemoprevention by nicotinamide

Excess vascular endothelial growth factor-A disrupts pericyte recruitment during blood vessel formation

Abstract

Pericyte investment into new blood vessels is essential for vascular development such that mis-regulation within this phase of vessel formation can contribute to numerous pathologies including arteriovenous and cerebrovascular malformations. It is critical therefore to illuminate how angiogenic signaling pathways intersect to regulate pericyte migration and investment. Here, we disrupted vascular endothelial growth factor-A (VEGF-A) signaling in ex vivo and in vitro models of sprouting angiogenesis, and found pericyte coverage to be compromised during VEGF-A perturbations. Pericytes had little to no expression of VEGF receptors, suggesting VEGF-A signaling defects affect endothelial cells directly but pericytes indirectly. Live imaging of ex vivo angiogenesis in mouse embryonic skin revealed limited pericyte migration during exposure to exogenous VEGF-A. During VEGF-A gain-of-function conditions, pericytes and endothelial cells displayed abnormal transcriptional changes within the platelet-derived growth factor-B (PDGF-B) and Notch pathways. To further test potential crosstalk between these pathways in pericytes, we stimulated embryonic pericytes with Notch ligands Delta-like 4 (Dll4) and Jagged-1 (Jag1) and found induction of Notch pathway activity but no changes in PDGF Receptor-β (Pdgfrβ) expression. In contrast, PDGFRβ protein levels decreased with mis-regulated VEGF-A activity, observed in the effects on full-length PDGFRβ and a truncated PDGFRβ isoform generated by proteolytic cleavage or potentially by mRNA splicing. Overall, these observations support a model in which, during the initial stages of vascular development, pericyte distribution and coverage are indirectly affected by endothelial cell VEGF-A signaling and the downstream regulation of PDGF-B-PDGFRβ dynamics, without substantial involvement of pericyte Notch signaling during these early stages.

12th European Headache Federation Congress jointly with 32nd National Congress of the Italian Society for the Study of Headaches

pH and a mixed carbon-substrate spectrum influence FocA- and FocB-dependent, formate-driven H2 production in Escherichia coli

Abstract

Escherichia coli encodes two formate channels, FocA and FocB, which either export formate or import it for further disproportionation by the formate hydrogenlyase (FHL) complex to H₂ and CO₂. We show that FocA/B appear to change their substrate-translocation direction depending on pH and electron donor. When cells were grown on glucose and glycerol at pH 7.5 formate accumulated in focB or focA-focB mutants when glucose or formate was used as electron donor because H₂ production increased ∼2 and ∼1.5 fold, respectively. Moreover, addition of external formate to the growth medium increased H₂ production in a focA-focB mutant. This indicates that in the wild type, formate is preferentially exported at pH 7.5 and that another FocA/B-independent uptake system exists. At pH 6.5 and 5.5 the formate channel mutants showed reduced H₂ production, suggesting that formate is usually imported by them to produce H₂ at acidic pH. Addition of formate to the growth medium increased H₂ production at these pHs. Notably, glycerol failed to act as an effective electron donor for formate production. Taken together, our results suggest that regulation of formate translocation direction by FocA/FocB channels is important for maintaining internal pH and proton motive force by modulating H₂ production.

The Smallest Intestine (TSI) – a low volume in vitro model of the small intestine with increased throughput

Abstract

There is a growing interest in understanding the fate and behaviour of probiotic microorganisms and bioactive compounds during passage of the human gastrointestinal tract (GIT). Here we report the development of a small volume in vitro model called The smallest Intestine (TSI) with increased throughput focusing on simulating passage through the stomach and small intestine (SI). The basic TSI module consists of 5 reactors, with a working volume of 12 ml each. During the simulated passage through the SI, bile is absorbed and pH is adjusted to physiologically relevant values for duodenum, jejunum and ileum. A consortium of seven representative bacterial members of the ileum microbiota is included in the ileal stage of the model. The behaviour of 3 putative probiotic Lactobacillus strains during in vitro simulated upper GIT passage was tested in the model and results were compared to previous studies describing probiotic survival. It was found, that probiotic persistence is strongly related to whether food was ingested, but also to presence of the ileal microbiota, which significantly impacted probiotic survival. In conclusion TSI allows testing a substantial number of samples, at low cost and short time, and is thus suitable as an in vitro screening platform.

Highly Cited Papers in Microbiology: Identification and Conceptual Analysis

Abstract

Microbiology is an area with a high research production, classified in different branches. Thus, it is difficult to identify research trends without many backgrounds. The present paper aims to apply bibliometric methods to identify the highly cited papers that contribute to the Microbiology development. Furthermore, a science mapping analysis allows discovering the main thematic areas covered by those detected papers. From the 572,153 papers (articles and reviews) indexed in the Web of Science Microbiology category (1900–2017), a total of 645 highly cited papers were detected. Concerning the main scientific producers in Microbiology, Applied and Environmental Microbiology as a journal, R. Knight from the University of Colorado (USA) as an author, and the USA as a country are the most productive actors. Nevertheless, taking into account the gross domestic product (GDP) per capita, China and Spain are remarkable countries. Furthermore, according to the relative priority index (RPI), Denmark, Belgium, Spain, and The Netherlands are the countries that make a higher scientific effort in this field. About the co-word analysis, several important themes were detected, such as Next Generation Sequencing, Gene, Escherichia Coli or Gene Expression. Concerning these results, this work supposes a framework on which to base future research.

Antibiotic allergy labels in children are associated with adverse clinical outcomes

Publication date: Available online 19 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Michaela Lucas, Annabelle Arnold, Aine Sommerfield, Michelle Trevenen, Laure Braconnier, Alina Schilling, Fuad Abass, Lliana Slevin, Brittany Knezevic, Christopher Blyth, PhD. Kevin Murray, Britta von Ungern-Sternberg, Kristina Rueter

Abstract

Background

Self-reported antibiotic allergies are common among hospitalised adults and children. There is a paucity of studies investigating the impact of an antibiotic allergy label in childhood.

Objective

To investigate the impact of antibiotic allergy labelling on clinical outcomes in children.

Method

Retrospective study conducted in a major paediatric tertiary hospital, to capture 1672 inpatient admissions in April 2014 and April 2015. Data, collected by chart review, included documented antibiotic allergy labels, antibiotic prescriptions, admitting specialty, hospital length of stay, and hospital readmissions.

Results

Of the 1672 paediatric patients surveyed, 58.1% were male and 44.8% were prescribed antibiotics. Antibiotic allergy labels were recorded in 5.3% of patients; the majority were beta-lactam labels (85%), mostly to unspecified penicillins. There was an increasing incidence of antibiotic allergy label with age, which was statistically significant (P<0.001); no gender effect was seen. Patients with antibiotic allergy labels received more macrolide (p=0.045), quinolones (P=0.01), lincosamide antibiotics (P<0.001) as well as metronidazole (p=0.009) than patients without an antibiotic allergy label. After adjusting for patient age, sex, principal diagnosis and admitting specialty, children with any antibiotic or beta-lactam allergy label had longer hospital lengths of stay (OR 1.62, 95% CI 1.05-2.50, P=0.03; with mean length of stay of 3.8 days for those without a label and 5.2 days for those with a beta-lactam allergy label).

Conclusions

This is the first study demonstrating the negative impact of antibiotic allergy labels on clinical outcomes in children, as evidenced by significant alternate antibiotic use and longer hospital lengths of stay.

Initiating yellow jacket venom immunotherapy with a 100-μg dose: A challenge?

Publication date: Available online 19 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Byrthe J.P.R. Vos, Anthony E.J. Dubois, Michèle M. Rauber, Wolfgang Pfützner, Michaela Miehe, Barbara Bohle, Christian Möbs, Joanne N.G. Oude Elberink

Predictors of inhaled corticosteroid taper failure in adults with asthma

Publication date: Available online 19 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Juan Carlos Cardet, Christopher D. Codispoti, Tonya S. King, Leonard Bacharier, Tara Carr, Mario Castro, Vernon Chinchilli, Ryan Dunn, Fernando Holquin, Linda Engle, Kyle Nelson, Victor E. Ortega, Michael Peters, Sima Ramratnam, Jerry A. Krishnan, Michael E. Wechsler, Elliot Israel, NHLBI Asthmanet

Comparison of Common Monogenic Defects in a Large Predominantly Antibody Deficiency Cohort

Publication date: Available online 19 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Reza Yazdani, Hassan Abolhassani, Fatemeh Kiaee, Sima Habibi, Gholamreza Azizi, Marzieh Tavakol, Zahra Chavoshzadeh, Seyed Alireza Mahdaviani, Tooba Momen, Mohammad Gharagozlou, Masoud Movahedi, Amir Ali Hamidieh, Nasrin Behniafard, Mohammamd Nabavi, Mohammad Hassan Bemanian, Saba Arshi, Rasol Molatefi, Roya Sherkat, Afshin Shirkani, Reza Amin

Abstract

Background

Predominantly antibody deficiencies (PADs) are the most common primary immunodeficiencies, characterized by hypogammaglobulinemia and inability to generate effective antibody responses.

Objective

We intended to report most common monogenic PADs and to investigate how PAD patients who were primarily diagnosed as agammaglobulinemia, hyper IgM syndrome (HIgM) and common variable immunodeficiency (CVID) have different clinical and immunological findings.

Methods

Stepwise next generation sequencing and Sanger sequencing were performed for confirmation of the mutations in the patients clinically diagnosed as agammaglobulinemia, HIgM and CVID.

Results

Among 550 registered patients, the predominant genetic defects associated with agammaglobulinemia (48 BTK and 6 μ heavy chain deficiencies), HIgM (21 CD40L and 7 AID deficiencies) and CVID (17 LRBA deficiency and 12 atypical ICF syndromes) were identified. Clinical disease severity was significantly higher in patients with μ heavy chain and CD40L compared to patients with BTK (P = 0.003) and AICDA (P = 0.009) mutations. Paralysis following live polio vaccination was considerably higher in patients with μ heavy chain deficiency compared with BTK deficiency (P <0.001). We found a genotype–phenotype correlation among patients with BTK mutations regarding clinical manifestation of meningitis and chronic diarrhea. Surprisingly, we noticed that first presentations in the majority of ICF patients were respiratory complications (P = 0.008), while first presentations in LRBA patients were non-respiratory complications (P = 0.008).

Conclusion

This study highlights similarities and differences in clinical and genetic spectrum of the most common PAD-associated gene defects. This comprehensive comparison will facilitate clinical decision making, and improve prognosis and targeted treatment.

Facial Reanimation Procedures Performed With Total Parotidectomy and Facial Nerve Sacrifice

This cross-sectional database analysis assesses the incidence and types of facial nerve reanimation performed concurrently with total parotidectomy and facial nerve sacrifice among patients identified in the American College of Surgeons–National Surgical Quality Improvement Project database.

Nuances of the Tongue-in-Groove Technique for Controlling Tip Projection and Rotation

This Surgical Pearl presents the tongue-in-groove technique in rhinoplasty surgery for controlling tip projection and rotation.

The Incisionless Otoplasty Technique

This Surgical Pearl describes a technique for performing an incisionless otoplasty to reduce ear prominence.

September Issue Highlights

A Decade of Thread-Lifting—What Have We Learned Over the Last 10 Years?

This Viewpoint evaluates the use of the thread-lifting technique for face-lifts in the 10 years since its introduction.

Local Anesthesia Shortages—Adapting to a New Way of Life

To the Editor Over the past several months, there have been increasing numbers of medication shortages throughout North America, exacerbated (but not solely caused) by Hurricane Maria's effect on the pharmaceutical manufacturing industry on the island of Puerto Rico. Medication shortages are affecting health care facilities in new ways on a weekly basis without imminent solutions. In particular, within the field of facial plastic and reconstructive surgery, we have noted a shortage in formulations of lidocaine and bupivacaine. We have received various sizes of bottles of these anesthetics in varying concentrations with varying concentrations of epinephrine, further complicating our "typical" anesthesia protocol. Our clinic's typical anesthesia was a 1:1 mixture of lidocaine, 1%, with a dilutional ratio of 1:100 000 and bupivacaine, 0.5%, with a dilutional ratio of 1:200 000.

Autologous Fat Transfer in Facial Reconstructive Surgery

This systematic review and meta-analysis investigates the safety and efficacy of autologous fat transfer in facial reconstruction.

Preoperative Photographing and Morphing for Predictable Profiles in Rhinoplasty

This Surgical Pearl discusses preoperative photographing and morphing for predictable profiles in rhinoplasty.

Association of Dorsal Reduction and Tip Rotation With Social Perception

This survey study examines social perceptions of age, approachability, perceived success, overall health, intelligence, and attractiveness of people who have undergone cosmetic rhinoplasty for dorsal hump reduction, tip rotation, or both in combination.

Lateral Wall Insufficiency Severity and Patient-Reported Nasal Obstruction Measures

This cohort study examines differences in lateral wall insufficiency severity in patients seen in consultation for functional, cosmetic, and combined rhinoplasty.

Volumizing Hyaluronic Acid Filler for Infraorbital Hollows

This observational study reports safety and patient satisfaction outcomes of Juvéderm Voluma XC hyaluronic acid filler for correction of infraorbital hollows.

Perceived Facial Distortions in Selfies Are Explained by Viewing Habits—Reply

In Reply Drs Cooper and Banks raise an important, well-studied point: the human visual system can correctly convert from a 2-dimensional image (or a 2-dimensional projection on the retina) into 3 dimensions when the objects subtend the same angle and distance at initial capture and when subsequently viewed. In real life, this is almost instantaneous. The moment we see an individual in front of us, we perceive them and there is essentially no chance of there being a mismatch and the correct viewing angle/distance is a moot point. Interestingly, this phenomenon is mostly studied in controlled environments (eg, using a bite bar) and for specific tasks (eg, estimating angles between planes). As far as we know, it has never been studied for the specific task of evaluating the appearance of one's nose. As the authors of the Letter to the Editor have rightfully noted, if the viewing distance is too close then there is a mismatch between the "correct" and actual viewing distances. As our Discussion stated, "photographs taken at shorter distances will increase the perceived ratio of nasal breadth to bizygomatic breadth." The focus here is on this perceived distortion.

A 3-Dimensional–Printed Short-Segment Template Prototype for Mandibular Fracture Repair

This feasibility study explores the potential application of a 3-dimensional–printed short-segment mandibular template in the management of complex mandibular fractures.

Diagnostic and Therapeutic Management of Nasal Airway Obstruction

This review summarizes advances in diagnosis and treatment of patients with nasal airway obstruction as reported in studies published within the past 5 years.

Outcomes From Lateral Eyelid Coupling for Facial Paralysis Using Modified Tarsoconjunctival Flap

This cohort study assesses whether lateral eyelid coupling in patients with facial paralysis improves quality of life as measured by the Facial Clinimetric Evaluation scale and Moe Ectropion Grading Scale.

A Scarless Repair Technique for the Lower Lip in Patients With Facial Palsy

This Surgical Pearl describes the vermilion-mucosal advancement flap, a technique that provides the benefits of surgery without the stigma of a surgical facial scar.

Temporal Hollowing Augmentation by Targeted Fat-Grafting Technique in Chinese Adults

This cohort study evaluates the safety and efficacy of the targeted fat-grafting technique for temporal hollowing augmentation of the face in Chinese adults.

Slow-Growing Giant Disfiguring Mass on the Left Side of the Face

A woman presented for evaluation of a disfiguring facial mass on the left side of her face; the mass had started as a 1-cm subcutaneous nodule on her left upper eyelid at birth and gradually grew to more than 94 cm in length. What is your diagnosis?

Treatment of Frontal Secondary Headache Attributed to Nerve Entrapment

This cohort study compares treatment outcomes of oral medication, botulinum toxin type A injections, and endoscopic decompression surgery in patients with frontal secondary headache attributed to supratrochlear nerve and supraorbital nerve entrapment.

Zygomaticomaxillary Complex–Orbit Fracture Alignment—Buccal vs Orbital Approach Techniques

This study proposes the use of a sublabial incision without a lower eyelid incision to address zygomaticomaxillary complex fractures involving the orbital rim.

Seasonal aggravation of acne in summers and the effect of temperature and humidity in a study in a tropical setting

Journal of Cosmetic Dermatology, EarlyView.

Angioedema is an unfavorable factor for the response to omalizumab in chronic spontaneous urticaria: a retrospective study

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

Recurrent merkel cell carcinoma of the gluteal region: a case report

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

Atopic‐like dermatitis after Secukinumab injection: a case report

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

A preliminary study of fractional CO2 laser added to topical tacrolimus combined with 308 nm excimer lamp for refractory vitiligo

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

New therapeutic vision of Nutrition in dermatology: Integrative Nutrition

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

ANGIOTENSIN‐CONVERTING‐ENZYME INHIBITORS AND ANGIOTENSIN II RECEPTOR BLOCKERS INDUCED PEMPHIGUS: A CASE SERIES AND LITERATURE REVIEW

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

Implications of irradiance exposure and non-photochemical quenching for multi-wavelength (bbe FluoroProbe) fluorometry

Publication date: Available online 20 September 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Joel W. Harrison, Laura Beecraft, Ralph E.H. Smith

Abstract

Multi-wavelength fluorometers, such as the bbe FluoroProbe (FP), measure excitation spectra of chlorophyll a (Chl-a) fluorescence to infer the abundance and composition of phytoplankton communities as well as the concentration of chromophoric dissolved organic matter (CDOM). Experiments were conducted on laboratory cultures and on natural communities of freshwater phytoplankton to determine how the response of phytoplankton to high irradiance might affect fluorometric estimates of community composition and concentrations of Chl-a and CDOM. Cultures of a representative cyanobacterium, bacillariophyte, synurophyte, cryptophyte, and chlorophyte revealed changes in Chl-a excitation spectra as irradiance was increased to saturating levels and non-photochemical quenching (NPQ) increased. The degree of change and resulting classification error varied among taxa, being strong for the synurophyte and cryptophyte but minimal for the cyanobacterium. Acute-exposure experiments on phytoplankton communities of varying taxonomic composition from five lakes yielded variable results on apparent community composition. There was a consistent decrease in CDOM estimates, whereas Chl-a estimates were generally increased. Subsequent exposure to low PAR relaxed NPQ and tended to reverse the effects of high irradiance on composition, total Chl-a, and CDOM estimates. Relaxation experiments on near-surface communities in a sixth, large lake, Georgian Bay, showed that total Chl-a estimates increased by 44% on average when dark treatments were used to relax NPQ, though, in contrast to the findings from the small lakes, there was little effect on CDOM estimates. We observed a statistically-significant, negative linear relationship between the photon flux density of in situ irradiance and the accuracy of taxonomic assignment by FP in Georgian Bay. Not discounting the correlations between light intensity and the accuracy of the FP that were observed in this study, we conclude that the applicability of the reference spectra to the system under investigation is a more important consideration than variability in natural irradiance conditions.

Effect of laser irradiation on aphthae pain management: A four different wavelengths comparison

Publication date: Available online 20 September 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Rocca Jean-Paul, Zhao Meng, Fornaini Carlo, Tan Lixin, Zhao Zengyi, Merigo Elisabetta

Abstract

Recurrent Aphthous Stomatitis (RAS) is an oral condition characterized by painful ulcerations of the mucosa, healing spontaneously in 10–14 days but sometimes, due to their number, size and frequency of recurrence, lesions may be the cause of a severe disconfort with an impact on the quality of life of the patients due to the increased difficulty to eat, swallow and speak.

For RAS, different protocols and treatments have been proposed as standard topical treatment to provide symptomatic relief, immunomodulating drugs as thalidomide, colchicine and steroids have been also proposed with the outcome to relief the pain, accelerating the healing process and increase the duration of ulcer-free period but without definitive results and without side effects.

In this study we analysed the effect of laser treatment of aphthous lesions with four devices available on the market, two with wavelength in the infra-red region (2940 nm 808 nm) and two with a wavelength in the visible region (450 nm and 635 nm).

Diode lasers 808 nm and 450 nm defined almost the same results with an improvement starting already after the application and gradually improving until 7 days after treatment without any statistically significant difference between them. Diode 635 nm was the device gaining the earliest effect reducing the pain already during the treatment and maintaining it at low level immediately after the laser application and after 3 and 7 days with levels of pain comparable with them obtained with 808 nm and 450 nm lasers. Er:YAG laser with the used parameters obtained a pain relief only during the treatment.

The originality of this study was to compare different laser wavelengths, some of them never used for this purpose, and to compare also the two different ways to use lasers, the photobiomodulation (LLLT) and the high-power irradiation.

Mechanism of the photo-induced activation of CoC bond in methylcobalamin-dependent methionine synthase

Publication date: Available online 20 September 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Arghya Pratim Ghosh, Abdullah Al Mamun, Piotr Lodowski, Maria Jaworska, Pawel M. Kozlowski

Abstract

Methylcobalamin (MeCbl)-dependent enzyme methionine synthase (MetH), plays a critical role in the catalysis of methyl group transfer from methyltetrahydrofolate (CH₃-H₄folate) to homocysteine. It often performs a side reaction to generate cob(II)alamin through photolysis of the organometallic CoC bond. A hybrid QM/MM method has been applied to explore the photochemistry of MeCbl-bound MetH. The photolytic properties of MeCbl inside MetH are mediated by its manifold of low-lying excited states. The corresponding potential energy surfaces (PESs) of the electronically excited S₁ state has been constructed as a function of axial bond lengths to elucidate the mechanism of photo-induced activation of CoC bond inside the enzyme. The analysis of the S₁ PES has revealed that the two different electronic states of the S₁ PES, namely metal-to-ligand charge transfer (MLCT) and the ligand field (LF), are relevant to the photodissociation of the CoC bond. There are two possible pathways identified, Path A and Path B, that connect the MLCT to LF state that represent possible photodissociation mechanisms. In the case of MetH, one possible photodissociation pathway (Path B) was identified based on the energetics of the MLCT and LF states. The energetically accessible Path B involves the initial detachment of the Co-N_Im bond followed by a subsequent displacement of the CoC bond prior to the formation of cob(II)alamin / CH₃ radical pair (RP). The photochemical data of base-on MeCbl in solution was compared with the computed result of MeCbl-bound MetH to understand the effect of the enzymatic environment on the photolytic properties of MeCbl.

Graphical Abstract

Biogenesis of copper oxide nanoparticles (CuONPs) using Sida acuta and their incorporation over cotton fabrics to prevent the pathogenicity of Gram negative and Gram positive bacteria

Publication date: Available online 19 September 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Selvam Sathiyavimal, Seerangaraj Vasantharaj, Devaraj Bharathi, Saravanan Mythili, Elayaperumal Manikandan, Smita S. Kumar, Arivalagan Pugazhendhi

Abstract

Textile industry is a major sector providing global financial and employment support to different countries of the world. The major problems of the textile industry are dirt and microbial contaminants affecting the quality of cotton fabrics. Recently, nanoparticles such as silver, chitosan, silicon dioxide, titanium dioxide and zinc oxide have gained attraction in textile industries to avoid the contamination of fabrics through microbes. The necessity to develop an ecofriendly, efficient and cost effective method for the synthesis of nanoparticles is under the radar. Plant extracts serve as potential reducing and coating agents due to the presence of bioactive molecules such as phenols, lipids, carbohydrates, enzymes, protein molecules etc., which endow effective antimicrobial activity to the nanoparticles. In the present study, biological synthesis of Copper oxide nanoparticles (CuONPs) was performed using S. acuta leaf extract. CuONPs were synthesized and characterized using UV–vis, FTIR, SEM and TEM analyses. The antimicrobial property of CuONPs was tested against Gram negative (Escherichia coli and Proteus vulgaris) and Gram positive (Staphylococcus aureus) pathogens, which showed zones of inhibition at different concentrations. As the final part of the study, CuONPs were coated over cotton fabrics showing longer stability, which prevented the growth of infectious pathogens. Apart from the antimicrobial activity, CuONPs synthesized using S. acuta possessed effective photocatalytic activity against commercial dyes.

Graphical Abstract

Whole-Body Vibration and Trunk Posture During Operation of Agricultural Machinery

Abstract

Exposure to whole-body vibration (WBV) is common among agricultural workers and is associated with musculoskeletal health outcomes such as low back pain. Little is known, however, about the characteristics of exposure experienced during actual production practices. We measured WBV levels during agricultural machinery use among a sample of farmers (n = 55) performing routine agricultural activities and explored machinery attributes that may explain WBV summary measures. We also measured trunk posture to provide additional information about physical exposures during machinery operation. Measurements were made on-farm and during actual work conditions of a sample of agricultural machines (n = 112), including tractors, combines, heavy utility vehicles, and all-terrain vehicles (ATVs). Results indicated the presence of high levels of vibration (median frequency-weighted root-mean-square acceleration of approximately 0.8 m s⁻²) with time signatures that include high-amplitude mechanical shocks (median crest factor of nearly 23). Compared to other machinery types, combines exhibited the lowest WBV levels and among the most favorable trunk postures. Substantial variability was observed in both the WBV and trunk posture summary measures, suggesting for future studies that alternative sampling strategies are needed to fully capture temporal patterns of machinery use.

Evaluation of Dermal Exposure to the Herbicide Alachlor Among Vegetable Farmers in Thailand

Abstract

Vegetable farmers applying the herbicide alachlor may be highly exposed through dermal contact when spraying. Dermal patches were attached to 10 locations on the farmers' skin when they mixed and applied alachlor in vegetable farming areas in Thailand. Measurements were made on farmers using either a backpack sprayer with a 2 stroke gasoline motor and fan or a battery operated pump. Forty-seven vegetable farmers in Bungphra subdistrict of Thailand participated in this study. Both motorized and battery pump backpack sprayers wearing long-sleeve shirts had significantly lower alachlor concentrations on the dermal patches under their long-sleeve shirts compared to those who wore only short-sleeve shirts, regardless of the sprayer type. Moreover, sprayers wearing long pants had significantly lower alachlor concentrations on dermal patches placed under the pants on the lower legs than those wearing short pants, regardless of the sprayer type. The highest estimated alachlor exposures were found on the upper legs (median = 9.29 µg/h) for those using a 2 stroke engine/fan backpack sprayer and on the lower legs (2.87 µg/h) for those using the battery operated pump backpack sprayer. The estimated total body alachlor exposures of applicators using the 2 stroke engine/fan backpack sprayer (219.48 µg/h) were significantly higher than those using the battery operated pump backpack sprayer (15.50 µg/h). Using long-sleeve shirts as personal protection reduced alachlor exposures for the arms 97–99% and wearing long pants reduced alachlor exposure to the legs for 81–99%. Thus, training about the protection provided by clothing choices would be one step in improving the health and safety of Thai farmers.

Au-delà des kératoses actiniques, le champ de cancérisation cutané

Publication date: Available online 20 September 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): P. Reygagne, G. Rostain

Résumé

Les kératoses actiniques (KA) forment des papules érythémateuses, squameuses et kératosiques apparaissant sur la peau chroniquement exposée au soleil sous l'effet des rayons ultraviolets. Elles correspondent à une prolifération de kératinocytes atypiques limitée à l'épiderme et sont susceptibles de progression vers le carcinome épidermoïde in situ et le carcinome épidermoïde cutané (CEC). S'il est faible, le risque métastatique associé au CEC ne doit pas pour autant être négligé. Le concept de champ de cancérisation a été introduit en 1953 à la suite d'études de lésions néoplasiques de la muqueuse buccale. Il est défini comme une zone prétumorale d'aspect normal, comportant des anomalies infracliniques multifocales qui peuvent faire le lit de nouvelles lésions néoplasiques. De tels champs sont fréquents dans les zones cutanées photo-exposées et en périphérie des KA et des CEC. Dans cette situation, le traitement ne devrait pas se limiter aux lésions visibles ou palpables de KA et, en cas de suspicion de champ de cancérisation, un traitement visant à la destruction physique ou à l'élimination des kératinocytes atypiques de la totalité de la zone devrait être envisagé. Une telle approche pourrait en théorie améliorer le pronostic à long terme en diminuant l'émergence de nouvelles lésions, voire diminuer le coût économique global lié à la prise en charge des KA et optimiser l'aspect cosmétique du champ de cancérisation ; cela mérite, cependant, d'être confirmé.

Summary

Lesions occurring in actinic keratoses (AK) form erythematous, squamous, crusty and keratotic papules that appear on skin chronically exposed to the sun due to ultraviolet radiation. They are formed by the proliferation of atypical keratinocytes limited to the epidermis and may progress to squamous cell carcinoma in situ and to cutaneous squamous cell carcinoma (CEC). Although low, the metastatic risk associated with the CEC is not negligible. The concept of field cancerization was introduced in 1953 following studies of neoplastic lesions of the oral mucosa. A cancer field is a normal-looking pre-tumoral zone with subclinical, multifocal anomalies, which may constitute a base for new neoplastic lesions. Such fields are frequently seen in areas of photo-exposed skin and around the edges of AK and CEC. In this event, treatment should not be limited to visible or palpable AK lesions, and if a cancer field is suspected, treatment involving the physical destruction or elimination of atypical keratinocytes from the entire area should be considered. Such an approach may improve the long-term prognosis, reduce treatment costs and ensure optimal cosmetic outcome.

Antioxidant Properties of Ferulic Acid and Its Possible Application

Ferulic acid has low toxicity and possesses many physiological functions (anti-inflammatory, antioxidant, antimicrobial activity, anticancer, and antidiabetic effect). It has been widely used in the pharmaceutical, food, and cosmetics industry. Ferulic acid is a free radical scavenger, but also an inhibitor of enzymes that catalyze free radical generation and an enhancer of scavenger enzyme activity. Ferulic acid has a protective role for the main skin structures: keratinocytes, fibroblasts, collagen, elastin. It inhibits melanogenesis, enhances angiogenesis, and accelerates wound healing. It is widely applied in skin care formulations as a photoprotective agent, delayer of skin photoaging processes, and brightening component. Nonetheless, its use is limited by its tendency to be rapidly oxidized.
Skin Pharmacol Physiol 2018;31:332–336

Validated Patient-Reported Outcome Measurements for Psoriasis may not Reflect Patients’ Current Preferences

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Oluwatobi Ogbechie-Godec, Sarah Azarchi, Jasmine Lee, David E. Cohen, Andrea Neimann, Arielle R. Nagler

Lack of an FDA indication should not limit access to appropriate treatment

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Joerg Albrecht, Adewole S. Adamson, John Barbieri, Daniel D. Bennett, Elizabeth A. Kiracofe, A. Shadi Kourosh, Kieron S. Leslie, Joseph F. Merola, Josephine Nguyen, Elaine Siegfried, Nicole Strickland, Suzanne Olbricht, Maryam M. Asgari, AADA Task Force on Drug Pricing and Transparency

A population-based registry study on relative survival from melanoma in Germany stratified by tumor thickness for each histological subtype

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Alicia Brunssen, Lina Jansen, Nora Eisemann, Annika Waldmann, Janick Weberpals, Klaus Kraywinkel, Andrea Eberle, Bernd Holleczek, Sylke Ruth Zeissig, Hermann Brenner, Alexander Katalinic, GEKID Cancer Survival Working Group

Abstract

Background

Differences in melanoma relative survival (RS) between histologies were discussed to be mainly caused by tumor thickness.

Objective

To investigate RS from melanoma, stratified by tumor thickness for each histological subtype, and identify survival trends.

Methods

Using cancer registry data on melanoma cases (ICD-10: C43.0-C43.9) diagnosed in Germany in 1997-2013, 5- and 10-year age-standardized RS stratified by histology and stratified or standardized by T-stage was estimated using standard and modelled period analyses. We restricted 10-year RS analyses to patients younger than 75 years.

Results

We analyzed 82,901 cases. Overall, 5- and 10-year RS was 91.7% and 90.8%, respectively. Prognosis worsened with increasing T-stage for all histologies but T-stage distribution varied substantially. Survival differences by histology were strongly alleviated after adjustment for T-stage, but remained significant. Overall, 5-year RS increased significantly by 3.8 percentage points between 2002-2005 and 2010-2013. This increase was no longer seen after adjustment for T-stage.

Limitations

Exclusion of cases due to missing information on T-stages, changes in the definition of T-stages, and lack of information on screening and treatment limit our analyses.

Conclusion

Differences in RS between histologies were strongly mediated by tumor thickness. Over time, melanoma RS increased due to changes in T-stage distribution.

Clinical and dermoscopic features of cutaneous BAP1 inactivated melanocytic tumors: results of a multicenter case-control study by the International Dermoscopy Society (IDS)

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Oriol Yélamos, Cristián Navarrete-Dechent, Michael A. Marchetti, Tova Rogers, Zoe Apalla, Philippe Bahadoran, Nuria Blázquez-Sánchez, Klaus Busam, Cristina Carrera, Stephen W. Dusza, Arnaud de la Fouchardière, Gerardo Ferrara, Pedram Gerami, Harald Kittler, Aimilios Lallas, Josep Malvehy, José F. Millán-Cayetano, Kelly C. Nelson, Victor Li Quan, Susana Puig

Abstract

Background

Multiple BAP-1 inactivated melanocytic tumors (BIMTs) have been associated with a familial cancer-syndrome involving germline mutations in BAP1.

Objectives

We sought to describe the clinical and dermoscopic features of BIMTs.

Methods

Retrospective, multicenter, case-control study. Participating centers clinical data, dermoscopic images, and histopathological data of biopsy-proven BIMTs. We compared the dermoscopic features between BIMTs and controls.

Results

The dataset consisted of 48 BIMTs from 31 patients (22 females, median age=37 years), and 80 controls. Eleven patients had a BAP1 germline mutation. Clinically, most BIMTs presented as pink, dome-shaped papules (n=24). Dermoscopically, we identified 5 patterns: structureless pink-to-tan with irregular eccentric dots/globules (n=14, 29.8%); structureless pink-to-tan with a peripheral vessels (n=10, 21.3%); structureless pink-to-tan (n=7, 14.9%); network with raised, structureless, pink-to-tan areas (n=7, 14.9%); and globular pattern (n=4, 8.5%). The structureless with eccentric dots/globules pattern and network with raised structureless areas pattern were only identified in BIMT and were more common in patients with BAP1 germline mutations (p<0.0001 and p=0.001, respectively)

Limitations

Small sample size, retrospective design, absence of germline genetic testing in all patients, inclusion bias towards more atypical-looking BIMTs.

Conclusion

Dome-shaped papules with pink-to-tan structureless areas and peripheral irregular dots/globules or network should raise suspicion for BIMT.

A Provider Global Assessment Quality Measure for Clinical Practice for Inflammatory Skin Disorders

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): International Dermatology Outcome Measures and the American Academy of Dermatology, Alice Gottlieb, Nicole Salame, April W. Armstrong, Joseph F. Merola, Sylvia Parra, Junko Takeshita, Suephy C. Chen, John Latella, Marta Van Beek

Abstract

In our evolving healthcare system, dermatologists are increasingly being asked to prove the value of care they provide to patients with severe skin diseases. Current quality measures for inflammatory dermatoses have limited validity and feasibility. Through collaboration and a modified Delphi process, the International Dermatology Outcome Measures (IDEOM) group and American Academy of Dermatology (AAD) sought to reach consensus on a valid and feasible provider-assessed global disease severity metric to be incorporated into a quality measure for inflammatory dermatoses. To inform the modified Delphi process, a review of the literature was performed, and data was collected on current provider-assessed global disease severity metrics. Following literature review, 36 members of IDEOM and the AAD participated in the modified Delphi process to reach consensus on features of the metric. Psoriasis, atopic dermatitis, and acne achieved overwhelming consensus for inflammatory dermatoses that could be measured in a global disease severity metric. Consensus was also reached on the utilization of a 5-point ordinal scale with descriptors provided through referenced electronic platforms. Expert development of quality measures incorporating this metric and its inclusion in data collection platforms are critical to enabling dermatologists to prove the value of care provided to patients with severe inflammatory dermatoses.

Clinical outcomes in high-risk squamous cell carcinoma patients treated with Mohs micrographic surgery alone

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Gerardo Marrazzo, John A. Zitelli, David Brodland

Abstract

Background

There is little evidence to predict patient outcomes following the treatment of high risk cutaneous SCC (hrSCC) using Mohs micrographic surgery (MMS).

Objective

To report the rates of poor outcomes in patients with hrSCC treated by MMS alone, and determine if any specific clinical factors may be more predictive of these outcomes.

Methods

We conducted a retrospective chart review of all hrSCC patients treated in our clinic from October 2011 to December 2015.

Results

We identified 647 hrSCC tumors that met inclusion criteria. During the follow-up period, there were 19 local recurrences(LR) (2.9%), 31 nodal metastases(NM) (4.8%), 7 distant metastases(DM) (1.1%), and 7 disease-specific deaths(DSD) (1.1%). Two factors, poor differentiation and invasion beyond the subcutaneous fat, were positively associated with local recurrence, nodal metastasis, and disease-specific death through multivariate analysis.

Conclusions

Invasion beyond subcutaneous fat and poor histologic differentiation may carry a greater risk of poor outcomes than other factors in hrSCC. Mohs surgery alone provides excellent marginal control with low rates of local recurrence, nodal metastasis and disease-specific death.

Rethinking the classification of alopecia areata

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): C.G. Wambier, B.A. King

Comment on Okhovat et al “The first 30 years of the American Academy of Dermatology skin cancer screening program: 1985-2014”

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Dayoung Ko, Shari R. Lipner

Platelet rich plasma as an adjunctive treatment in Lichen Plano pilaris

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Abhijeet Kumar Jha

Reflectance confocal microscopy as novel tool for pre-surgical identification of basal cell carcinoma biopsy site

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Cristián Navarrete-Dechent, Shoko Mori, Miguel Cordova, Kishwer S. Nehal

Dermoscopy of Pityrosporum Folliculitis

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Deepak Jakhar, Ishmeet Kaur, Richa Chaudhary

Global Epidemiology and Clinical Spectrum of Rosacea, Highlighting Skin of Color: Review and Clinical Practice Experience

Publication date: Available online 19 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Andrew F. Alexis, Valerie D. Callender, Hilary E. Baldwin, Seemal R. Desai, Marta I. Rendon, Susan C. Taylor

Abstract

Among individuals with skin of color, rosacea has been reported less frequently than in those with white skin, but it is not a rare disease. In fact, rosacea may be underreported and underdiagnosed in populations with skin of color because of the difficulty of discerning erythema and telangiectasia in dark skin, as well as underestimation of the susceptibility of more highly pigmented skin to dermatologic conditions like rosacea whose triggers include sun exposure. Many people with skin of color who have rosacea may experience delayed diagnosis leading to inappropriate or inadequate treatment, greater morbidity, and uncontrolled, progressive disease with disfiguring manifestations, including phymatous rosacea. This paper reviews the epidemiology of rosacea in skin of color and highlights variations in the clinical presentation of rosacea across the diverse spectrum of patient populations affected. It presents strategies to aid in the timely diagnosis and effective treatment of rosacea in patients with skin of color, with an aim of promoting increased awareness of rosacea in these patients and reducing disparities in the management of their disease.

Radiotherapy‐induced Pemphigus Foliaceous: a rare adverse effect of breast cancer therapy

International Journal of Dermatology, EarlyView.

Pseudodidymosis: nevus psiloliparus with aplasia cutis congenita, an initial manifestation of Haberland syndrome

International Journal of Dermatology, EarlyView.

Clinical use of dimethyl fumarate in moderate‐to‐severe plaque‐type psoriasis: a European expert consensus

Journal of the European Academy of Dermatology and Venereology, EarlyView.

Increased immunoreactivity of TRPM8 in cutaneous squamous cell carcinoma

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.

Are Descriptions Really Descriptive? An Experimental Study on Misdescription and Reference

Abstract

This paper presents an experimental study on definite descriptions. According to the classical views, a definite description, i.e., a phrase of the form "the F", has – roughly speaking - purely descriptive semantics, that is, it designates the object which uniquely (opt. uniquely in a context) satisfies the description. However, as several philosophers including Keith Donnellan have argued, there are uses of definite descriptions on which these expressions do not seem to designate objects which satisfy the descriptions. Namely, a description may refer in some circumstances to an object which does not have the property from the description. This argument is called "the Argument from misdescription" and it is raised against the classical views on the semantics of definite descriptions. In our paper, we present an experimental study on misdescription and explored reactions of ordinary users of language to various statements involving misdescriptions. The results of our research indicate that the intuition of ordinary speakers is consistent with the prediction expressed in the Argument from misdescription. We argue that the most common pragmatic explanation of misdescription, appealing to Gricean distinction between saying and meaning, is unconvincing. We vote for an alternative semantic account of definite descriptions, on which a description "the F" designates an object being F, which is at the same time the most salient individual according to a contextually established ranking of salience.

The epidemiology of non‐Candida yeasts isolated from blood: the Asia Surveillance Study

Mycoses, Volume 0, Issue ja, -Not available-.

Editorial Board

SnapshotDx Quiz: October 2018

Editorial note: Welcome to the Journal of Investigative Dermatology (JID) SnapshotDx Quiz. In this monthly online-only quiz, the first question ("What is your diagnosis?") relates to the clinical images above, while additional questions concern the findings reported in the JID article by Lauffer et al (https://ift.tt/2xBBOLj).

Subscription Information

Topical Antiseptics and the Skin Microbiota

The impact of antiseptics on the skin microbiota is poorly understood. SanMiguel et al. (2018) use a sequencing-based approach to compare treatment effects and find that they are dependent on interpersonal and body site–specific community differences. While treatment results in an immediate depletion of the skin microbiota, not all bacterial families are affected equally.

Automated Classification of Skin Lesions: From Pixels to Practice

The letters "Interpretation of the Outputs of Deep Learning Model trained with Skin Cancer Dataset" and "Automated Dermatological Diagnosis: Hype or Reality?" highlight the opportunities, hurdles, and possible pitfalls with the development of tools that allow for automated skin lesion classification. The potential clinical impact of these advances relies on their scalability, accuracy, and generalizability across a range of diagnostic scenarios.

Cells to Surgery Quiz: October 2018

Editorial note: Welcome to the Journal of Investigative Dermatology (JID) Cells to Surgery Quiz. In this monthly online-only quiz, the first question ("What is your diagnosis?") relates to the clinical image above, while additional questions concern the findings reported in a JID article by Miller et al (https://ift.tt/2QJo8X8).

Research Techniques Are Not Simple

"Education is not the filling of a pail, but the lighting of a fire."—W.B. Yeats

The Value and Process of Authoring a “Research Techniques Made Simple” Article

The "Research Techniques Made Simple" (RTMS) series has covered nearly 75 research topics in the past 6 years to help readers build a foundation from which to understand the vast array of basic science and clinical research tools used in the field of dermatology. The early RTMS articles published in late 2012 through 2014 covered fundamental techniques including flow cytometry (Jahan-Tigh et al., 2012), PCR (Garibyan and Avashia, 2013), how a transgenic mouse is made (Scharfenberger et al., 2014), and basics of systematic reviews and meta-analyses (Abuabara et al., 2012).

Building on a Solid Foundation

The JID Connector was established to do just that—connect. It was in that spirit that "Research Techniques Made Simple" (RTMS) was born. The initial concept, conceived by Barbara Gilchrest of Harvard University and implemented by Kathy Schwarzenberger of the University of Tennessee Health Science Center, was to increase the accessibility of articles that appeared in the Journal of Investigative Dermatology (JID). It was recognized, however, that to reach trainees, interested clinicians, and non-cognoscenti, the science had to be more accessible and understandable.

Research Techniques Made Simple: Animal Models of Wound Healing

Animal models have been developed to study the complex cellular and biochemical processes of wound repair and to evaluate the efficacy and safety of potential therapeutic agents. Several factors can influence wound healing. These include aging, infection, medications, nutrition, obesity, diabetes, venous insufficiency, and peripheral arterial disease. Lack of optimal preclinical models that are capable of properly recapitulating human wounds remains a significant translational challenge. Animal models should strive for reproducibility, quantitative interpretation, clinical relevance, and successful translation into clinical use.

Editors’ Picks

Vitiligo results from CD8+ T cell targeting of melanocytes, leading to patchy depigmentation. Upon cessation of therapy, depigmentation recurs at the same locations, implicating resident autoimmune memory T (TRM) cells. Indeed, Richmond and colleagues found that vitiligo patients have antigen-specific autoreactive TRM cells in lesional skin. As interleukin (IL)-15 is critical for generation of TRM cells, these investigators examined the effects of blocking IL-15 signaling via an antibody to the IL-15 CD122 subunit, which is expressed on autoreactive TRM cells in vitiligo.

Table of Contents

Clinical Snippets

Simpson and colleagues examined the clinical and physiological features and serum biomarkers in adult atopic dermatitis (AD) patients with and without Staphylococcus aureus colonization. AD patients colonized by S. aureus exhibited a distinct clinical phenotype and endotype, marked by more severe disease, greater epidermal function impairment, more pronounced defects in permeability and skin hydration, increased immune activation, type 2 immunity, and more extensive tissue damage than non-AD patients colonized by S. aureus.

IL-22 downregulates Cx43 expression and decreases gap junctional intercellular communication by activating the JNK pathway in psoriasis

The roles of interleukin-22 (IL-22) in the pathomechanisms of psoriasis have been well demonstrated. Gap junctional intercellular communication (GJIC) is widely known for its involvement in multiple biological and pathological processes such as growth-related events, cell differentiation, and inflammation. Here, we show that IL-22 significantly decreased GJIC and downregulated Cx43 expression in HaCaT cells. Cx43 overexpression markedly inhibited the proliferation of and increased GJIC in HaCaT cells, while the silencing of Cx43 exerted the opposite effects.

Vaccinating against Acne: Benefits and Potential Pitfalls

Acne vulgaris is treated with antibiotics and retinoids, but side effects are numerous. Novel safe and efficient therapies are still needed. Wang et al. demonstrate that the secreted virulence factor Christie-Atkins-Munch-Peterson factor 2 from Propionibacterium acnes, a bacterium involved in acne pathogenesis, promotes inflammatory responses. This proinflammatory property could be inhibited by antibodies to Christie-Atkins-Munch-Peterson factor 2, suggesting Christie-Atkins-Munch-Peterson factor 2 as a candidate target in acne vaccination.

Revisiting the clinical and biologic relevance of partial PTEN loss in melanoma

The extent of PTEN loss that confers clinical and biological impact in melanoma is unclear. We evaluated the clinical and biologic relevance of PTEN dosage in melanoma, and tested the postulate that partial PTEN loss is due to epigenetic mechanisms. PTEN expression was assessed by immunohistochemistry in a stage III melanoma cohort (n=190) with prospective follow up. 21/190 (11%) of tumors had strong PTEN expression, 51/190 (27%) had intermediate PTEN, 44/190 (23%) had weak PTEN, and 74/190 (39%) had absent PTEN.

Exosomes in HNSCC plasma as surrogate markers of tumour progression and immune competence

Clinical &Experimental Immunology, EarlyView.

High MDR‐1 expression by MAIT cells confers resistance to cytotoxic but not immunosuppressive MDR‐1 substrates

Clinical &Experimental Immunology, EarlyView.

Issue Information

International Wound Journal, Volume 15, Issue 5, Page 677-680, October 2018.

Erratum

International Wound Journal, Volume 15, Issue 5, Page 854-854, October 2018.

How millennials could impact the evolution of wound care

International Wound Journal, Volume 15, Issue 5, Page 681-682, October 2018.

Corrigendum

International Wound Journal, Volume 15, Issue 5, Page 855-855, October 2018.

Society news

International Wound Journal, Volume 15, Issue 5, Page 683-683, October 2018.

News and views

International Wound Journal, Volume 15, Issue 5, Page 684-685, October 2018.

Calendar

International Wound Journal, Volume 15, Issue 5, Page 853-853, October 2018.

Ultraviolet B induced immunosuppression is not associated with RANKL upregulation in human skin

Photodermatology, Photoimmunology &Photomedicine, Volume 0, Issue ja, -Not available-.

Intestinal microbiota profiling and predicted metabolic dysregulation in psoriasis patients

Experimental Dermatology, Volume 0, Issue ja, -Not available-.

HIF‐1α‐mediated BMP6 down‐regulation leads to hyperproliferation and abnormal differentiation of keratinocytes in vitro

Experimental Dermatology, Volume 0, Issue ja, -Not available-.

Down‐regulated SHARPIN may accelerate the development of atopic dermatitis through activating interleukin‐33/ST2 signaling

Experimental Dermatology, Volume 0, Issue ja, -Not available-.

Size‐dependent Tumor Response to Photodynamic Therapy and Irinotecan Monotherapies Revealed by Longitudinal Ultrasound Monitoring in an Orthotopic Pancreatic Cancer Model

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

Trachelas tranquillus envenomation with presumed bacterial superinfection in a child

Pediatric Dermatology, EarlyView.

Eugenol allergy mimicking burning mouth syndrome

Contact Dermatitis, EarlyView.

Successful treatment of refractory juvenile generalized pustular psoriasis with secukinumab monotherapy: A case report and review of published work

The Journal of Dermatology, EarlyView.

Epidemiology of pyoderma gangrenosum in Japanese patients by questionnaire survey

The Journal of Dermatology, EarlyView.

Distant recurrence of Merkel cell carcinoma after spontaneous regression

The Journal of Dermatology, EarlyView.

Primary cutaneous diffuse large B‐cell lymphoma, leg type, localized in the right periorbital region

The Journal of Dermatology, EarlyView.

Case of psoriatic erythroderma induced by the discontinuation of the chronic use of topical steroid after dialysis initiation and successfully treated with secukinumab

The Journal of Dermatology, EarlyView.

Anti‐PL‐12 antibody‐positive antisynthetase syndrome with recurrent digital ulcers

The Journal of Dermatology, EarlyView.

Bone scintigraphy analysis of 44 cases of pustulotic arthro‐osteitis associated with palmoplantar pustulosis

The Journal of Dermatology, EarlyView.

Acneiform eruptions: An unusual dermatological side effect of ribavirin

Dermatologic Therapy, EarlyView.

When side effect becomes the effect: Efficacy of capecitabine in refractory psoriasis

Dermatologic Therapy, EarlyView.

Successful treatment of erythrodermic pityriasis rubra pilaris with acitretin

Dermatologic Therapy, EarlyView.

Cost‐effectiveness analysis of imaging strategy for an intensive follow‐up of patients with American Joint Committee on Cancer stage IIB, IIC and III malignant melanoma

British Journal of Dermatology, EarlyView.

Risk of first‐time and recurrent depression in patients with psoriasis – a population‐based cohort study

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

Subtype‐Specific Inherited Predisposition to Pemphigus in Chinese Population

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

Psoriasin (S100A7) and koebserisin (S100A15) as potential markers of atherosclerosis in patients with psoriasis

Clinical and Experimental Dermatology, EarlyView.

Multiple rapidly growing necrotic eruptions on the face

Clinical and Experimental Dermatology, EarlyView.

Uncommon low-grade brain tumors

Abstract

The 2016 WHO classification of primary central nervous system (CNS) tumors include numerous uncommon (representing ≤1% of tumors) low-grade (grade I-II) brain neoplasms with varying clinical behaviors and outcomes. Generally, gross tumor or maximal safe resection is the primary treatment. Adjuvant treatments, though their exact role is unknown, may be considered individually based on pathological subtypes and a proper assessment of risks and benefits. Targetable mutations such as BRAF, TRAIL, and PDGFR etc. have a promising role in the future management.

Search strategy and selection criteria

An initial search of PubMed used broad search terms 'brain tumors', 'low-grade', 'radiotherapy, 'chemotherapy', 'surgery' and 'treatment' from January 1990 to March 2018. A subsequent focused search was undertaken using the names of individual histological subtypes of low-grade brain tumors as in the 2016 WHO classification. Only papers published in English were reviewed. The final reference list was generated on the basis of originality and relevance to the broad scope of this review.

Linear IgA bullous dermatosis presenting as chronic prurigo: unveiling of the diagnosis by serrated pattern analysis

International Journal of Dermatology, EarlyView.

Onycholysis and subungual purpura of nails

International Journal of Dermatology, EarlyView.

What lengths for a lash?

International Journal of Dermatology, EarlyView.

Reflectance confocal microscopy of tinea capitis: comparing images with results of dermoscopy and mycological exams

International Journal of Dermatology, EarlyView.

Multiple “halo nevi” occurring during pembrolizumab treatment for metastatic melanoma

International Journal of Dermatology, EarlyView.

Predicting risk for seroma development after axillary or inguinal sentinel lymph node biopsy in melanoma patients

International Journal of Dermatology, EarlyView.

Plasma cell vulvitis: further confirmation of the diagnostic utility of dermoscopy

International Journal of Dermatology, EarlyView.

Asymptomatic indurated plaque on the tongue in an immunocompetent man

International Journal of Dermatology, EarlyView.

Aversion caused by skin diseases – a crowdsourcing study

International Journal of Dermatology, EarlyView.

Expression and significance of phosphodiesterase 4B gene in peripheral blood of patients with oral lichen planus

International Journal of Dermatology, EarlyView.

Cutaneous effects associated with fluconazole in patients treated for coccidioidomycosis

International Journal of Dermatology, EarlyView.

Cutaneous collagenous vasculopathy induced by the vascular endothelial growth factor receptor inhibitor axitinib

International Journal of Dermatology, EarlyView.

Mutation in the SR6 region of desmoplakin is associated with pustular psoriasiform rash and left ventricular dysfunction

International Journal of Dermatology, EarlyView.

Lymphoepithelioma‐like carcinoma of the skin: a possible culprit when biopsy indicates a benign inflammatory reaction

International Journal of Dermatology, EarlyView.

A novel cognitive stress management technique for acne vulgaris: a short report of a pilot experimental study

International Journal of Dermatology, EarlyView.

Evaluation of lead release potential of new premise plumbing materials

Abstract

Premise plumbing materials such as pipes, valves, fittings, and faucets are made of various materials, including plastic, stainless steel, copper, and brass/bronze. Although lead pipe has been banned for its use in drinking water supply by most countries in the 1980s, lead is still commonly used as an additive in many plumbing materials for its flexibility and malleability. Certified leaching tests for plumbing materials are usually conducted using relatively mild solutions over short periods which may not reveal the true risk of lead exposure when these materials are used. The objective of this study is to investigate the extents of lead release from commonly used premise plumbing materials into drinking water. The maximum lead leaching potential for pluming material was operationally determined using high strength acidic EDTA solutions (pH 4, EDTA = 100 mg/L) for a stagnation time of 3 days for a total period of up to 1 month. Lead leaching from each plumbing material was also evaluated using reconstituted tap water. Brass- and bronze-based plumbing materials were found to release dangerous levels of lead. Surface lead weight percentage obtained using SEM-EDX and lead weight percentages of the material body obtained using strong acid digestion were found to positively correlate with lead release. A re-examination of the appropriateness of current certified leaching tests and a more stringent regulation on the use of lead as an additive for plumbing materials should be considered.