Transcriptome analysis reveals the molecular response to cadmium toxicity in P. pseudoannulata

Abstract

Cadmium (Cd) can be transferred and accumulated in spiders, posing a survival risk to them. To analyze potential biological damage caused by Cd accumulation and relevant detoxification strategies employed by spiders in response to Cd exposure, we conducted transcriptome analysis of the 5th instar spider P. pseudoannulata, a common spider species playing a vital role in natural pest control in agricultural fields of southern China. We obtained 92,778 unigenes with an average length of 1104 bp and identified 302, 655, and 424 differentially expressed genes (DEGs) in the spiders fed with Cd-containing fruit flies for 2, 5, and 8 days, respectively. Results showed that the body mass of Cd-containing P. pseudoannulata were reduced when compared with controls, presumably due to delayed maturation of tissues and organs. Meanwhile, functional analysis of DEGs indicated that Cd may have a negative effect on neural signal transduction and molt cycle of the spider. For defense strategies, detoxification enzymes like glutathione S-transferase (GST), catalase (CAT), superoxide dismutase (SOD), and P450, and typical proteins like heat shock protein and metallothionein were all differentially expressed in response to Cd stress. Besides, innate immune responses like toll-like receptor signaling pathways were also upregulated. Multiple critical Cd-responsive genes involved in biological damage, detoxification, and immune response were identified, providing referable foundation for further research on Cd toxicity to P. pseudoannulata.

Synthesis of coal fly ash zeolite for the catalytic wet peroxide oxidation of Orange II

Abstract

Fly ash, a coal combustion residue produced by Termotasajero in Colombia, has been hydrothermally treated after an alkaline fusion to produce zeolite without addition of silicon or aluminum. The starting material was thoroughly mixed with NaOH, in a 1:1.2 mass ratio, to obtain a homogeneous mixture that was heated to 100 °C during different times (6, 8, and 10 h) and three zeolite samples were produced. The samples were characterized by XRD, SEM, XRF, Mössbauer spectroscopy, and N₂ physisorption. According to characterization results (high surface area and appropriate morphological properties including crystallinity) and synthesis time, zeolitic catalyst synthesized with 8 h of hydrothermal treatment was selected to perform further analysis. This sample consisted of a mixture of zeolite X and zeolite A of high surface area (301 m² g⁻¹) and a Fe content of 6% wt/wt. The zeolite was used as a catalyst for the Fenton oxidation of Orange II. Experiments were performed in a laboratory batch reactor at 70 °C and constant pH = 3, using different concentrations of H₂O₂. When the stoichiometric amount of H₂O₂ was used, good mineralization (X_TOC = 45%), complete discoloration, and oxidant consumption were obtained after 240 min of reaction. The sample retained activity after 16 h of usage. The presence of Fe in the reaction media was always detected and a homogeneous Fenton mechanism induced by surface-leached iron is suggested.

Phytochemical screening and antityrosinase activity of carvacrol, thymoquinone, and four essential oils of Lebanese plants

Journal of Cosmetic Dermatology, EarlyView.

Removal of vanadium and palladium ions by adsorption onto magnetic chitosan nanoparticles

Abstract

Chitosan (CS), synthesized from chitin chemically extracted from shrimp shells, was used for the synthesis of magnetic chitosan nanoparticles (Fe₃O₄-CSN), which makes the adsorbent easier to separate. Fe₃O₄-CSN was used for the removal of toxic metals such as vanadium (V(V)) and palladium (Pd(II)) ions from aqueous solutions. Influencing factors on the adsorption process such as pH, contact time, adsorbent dosage, and agitation speed were investigated. A competitive adsorption of V(V) and Pd(II) ions for the active sites was also studied. The monolayer maximum adsorption capacities (Q_m) of 186.6 and 192.3 mg/g were obtained for V(V) and Pd(II) ions, respectively. The pseudo-second-order equation gave the best fit for the kinetic data, implying that chemisorption was the determining step. Freundlich model yielded a much better fit than the other adsorption models assessed (Langmuir, Temkin and Dubinin-Radushkevich). Thus, the adsorption of V(V) and Pd(II) ions onto Fe₃O₄-CSN is a combination of physical and chemical adsorption, as based on the kinetics and equilibrium study. Generally, physical adsorption is the mechanism that governs the system, while chemical adsorption is the slowest adsorption step that takes place. Thermodynamic studies displayed that the adsorption process was exothermic and spontaneous. Removal efficiencies of 99.9% for V(V) and 92.3% for Pd(II) ions were achieved, implying that Fe₃O₄-CSN adsorbent had an excellent ability for the removal of the metal ions from real industrial wastewaters without remarkable matrix effect.

Graphical abstract

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Letter to the editor re: Cheng, YH., Chou, WC., Yang, YF. et al. Environ Sci Pollut Res (2017). https://ift.tt/2zUNieZ

Silver and gold nanoparticles biosynthesized by aqueous extract of burdock root, Arctium lappa as antimicrobial agent and catalyst for degradation of pollutants

Abstract

This study presents an efficient and facile method for biosynthesis of silver nanoparticles (AgNPs) and gold nanoparticles (AuNPs) using aqueous extract of burdock root (BR), A. lappa, and their applications. The nanoparticles were characterized by ultraviolet-visible spectrophotometry, X-ray diffraction, transmission electron microscopy, energy dispersive X-ray, thermogravimetry, and differential thermal analysis. AgNPs capped the BR extract (BR-AgNPs) possessed roughly spherical geometry with an average diameter of 21.3 nm while uneven geometry of AuNPs capped the BR extract (BR-AuNPs) showed multi shapes in average size of 24.7 nm. The BR-AgNPs strongly inhibited five tested microorganism strains. In particular, the nanoparticles showed excellent catalytic activity for the conversion of pollutants within wastewater. Pseudo-first-order rate constants for the degradation of 4-nitrophenol, methyl orange, and rhodamine B were respectively found 6.77 × 10⁻³, 3.70 × 10⁻³, and 6.07 × 10⁻³ s⁻¹ for BR-AgNPs and 6.87 × 10⁻³, 6.07 × 10⁻³, and 7.07 × 10⁻³ s⁻¹ for BR-AuNPs.

Graphical abstract

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A response surface methodology for optimization of 2,4-dichlorophenoxyacetic acid removal from synthetic and drainage water: a comparative study

Abstract

The potential of a granular activated carbon (GAC), a rice husk biochar (BRH), and multi-walled carbon nanotubes (MWCNTs) for removing 2,4-dichlorophenoxyacetic acid (2,4-D) from simulated wastewater and drainage water has been evaluated. In this regard, a response surface methodology (RSM) with a central composite design (CCD) (CCD-RSM design) was used to optimize the removal of 2,4-D from simulated wastewater under different operational parameters. The maximum adsorption capacities followed the order GAC > BRH > MWCNTs, whereas the equilibrium time increased in the order MWCNTs < GAC < BRH. In the case of GAC and BRH, the 2,4-D removal percentage increased significantly upon increasing the adsorbent dosage and temperature and decreased upon increasing the initial 2,4-D concentration and pH. The results showed that the contact time and temperature were not important as regards the adsorption efficiency of 2,4-D by MWCNTs, whereas rapid removal of 2,4-D from simulated wastewater was achieved within the first 5 min of contact with the MWCNTs. The results confirmed that the Freundlich isotherm model with the highest coefficient of determination (R²) and the lowest standard error of the estimate (SEE) satisfactorily fitted the 2,4-D experimental data. In addition, successful usage of the three adsorbents investigated was observed for removal of 2,4-D from drainage water from an agricultural drainage system. An economic analysis with a rate of return (ROR) method indicated that BRH could be used as an eco-friendly, low-cost, versatile, and high adsorption capacity alternative to GAC and MWCNTs for the removal of 2,4-D.

Coffee waste, vector control, and dengue

Genotoxicity of water samples from an area of the Pampean region (Argentina) impacted by agricultural and livestock activities

Abstract

The aim of this study was to assess the genotoxic potential of surface waters located in a rural area in the north east of Buenos Aires province (Argentina) using the Allium cepa test. Water samples were collected at four sites located in a drainage channel and two sites on the Burgos stream that receives water from the channel, taking into account the sowing and harvesting months and rainfall periods. Analytical determinations revealed high total concentrations of Cd, Cu, Pb, and Zn (maximum values: 0.030, 0.252, 0.176, and 0.960 mg L⁻¹, respectively), and concentrations of glyphosate and its metabolite aminomethylphosphonic acid (AMPA), with maximum values of 13.6 and 9.75 μg L⁻¹, respectively. Statistically positive correlations were observed between the total metal concentrations and precipitation. No cytotoxicity (mitotic index MI) was observed in A. cepa. However, several water samples showed significant increases in micronucleus (MN) frequencies with respect to the controls. No correlations were observed between MN and the abiotic variables or precipitation. These results showed a state of deterioration in the water quality at the rural area studied in Buenos Aires province, and heavy metal contamination may contribute to the genotoxic activity. A. cepa was shown to be a useful tool for the detection of genotoxicity in water samples from areas with agricultural and livestock activities.

Study on dynamic adsorption of p-nitrophenol by multi-walled carbon nanotubes dispersed cyclodextrin

Abstract

In this paper, the modified multi-walled carbon nanotubes were prepared by β-cyclodextrin denoted as β-CD-MWNTs. The structure and morphology of β-CD-MWNTs was characterized by TEM and the dynamic adsorption of p-nitrophenol on β-CD-MWNTs was studied by the Thomas model. Some affecting factors of dynamic adsorption and the adsorbent regeneration process such as the sewage concentration, the amount of absorbent in column, including the type of reagent, solid-liquid ratio, regeneration time, and regeneration times were investigated and optimized. The results indicated that the p-nitrophenol removal rate could reach 84% under stuffing 2 g β-CD-MWNTs. The curves of p-nitrophenol's dynamic adsorption conformed to the Thomas model. Moreover, the adsorption capacity of regenerated β-CD-MWNTs was similar to the fresh β-CD-MWNT column. The optimal conditions of regenerations of β-CD-MWNTs were shown as follows: the type of reagent is anhydrous ethanol, the solid-liquid ratio is 200:40 (mg/mL) and the regeneration time is 120 min.

Serum concentrations of HGF are correlated with response to anti-PD-1 antibody therapy in patients with metastatic melanoma

Anti-programmed cell death protein (PD)-1 antibody treatment is associated with a notable improvement in only 30%–40% of patients. Thus, a predictive and easily measured marker of the clinical benefit of anti-PD-1 antibody treatment is necessary; therefore, in this study, we focused on the serum concentration of hepatocyte growth factor (HGF).

Dermal CD207 negative migratory dendritic cells are fully competent to prime protective, skin homing CTL responses

Dendritic Cells (DC) are important inducers and regulators of T cell responses. They are able to activate- and modulate the differentiation of CD4+ and CD8+ T cells. In the skin there are at least five phenotypically distinct DC subpopulations that can be distinguished by differential expression of the cell surface markers CD207, CD103 and CD11b. Previous studies have suggested, that dermal CD11b−CD207+ conventional type 1 DC (cDC1) are indispensable for the priming of a skin homing cytotoxic T lymphocyte (CTL) response.

The use of topical rapamycin in the treatment of superficial lymphatic malformations

Rapamycin can be useful in the treatment of vascular malformations, but the value of its topical application to superficial lymphatic malformations has not been established .Topical rapamycin improves the clinical appearance of superficial lymphatic malformations and alleviates associated symptoms. 


Approaches to limit systemic antibiotic use in acne: Systemic alternatives, emerging topical therapies, dietary modification, and laser and light-based treatments

Acne is one of the most common diseases worldwide and affects approximately 50 million individuals in the United States. Oral antibiotics are the most common systemic agent prescribed for the treatment of acne. However, their use may be associated with a variety of adverse outcomes including bacterial resistance and disruption of the microbiome. As a result, multiple treatment guidelines call for limiting the use of oral antibiotics in the treatment of acne, although actual prescribing often does not follow these guidelines.

Surgical Pearl: Achieving Eversion Utilizing Topical Tissue Adhesive

Predictors of mucosal melanoma survival in a population-based setting

This population-based study underscores that extracutaneous melanomas are rare and aggressive neoplasms. Poorer survival in patients with mucosal melanoma was observed in relation to stage and anatomic site, but not tumor thickness (i.e., Breslow depth) or patient race/ethnicity. Due to the poor prognosis for all stages of mucosal melanoma, dermatologists should consider incorporating examination of the oropharynx and genitalia in the full body skin exam.

Dipeptidyl-peptidase IV inhibitor-associated bullous pemphigoid: A systematic review and meta-analysis

Relative efficacy of systemic treatments for atopic dermatitis

Systemic treatments are common for severe atopic dermatitis and biologic medications represent recent advances in the field. Dupilumab and cyclosporine are both effective at improving clinical severity of atopic dermatitis, as are newer biologic medications lebrikizumab and tralokinumab. Long term efficacy and safety results are needed for biologic medications.

Comparative Clinicopathological Analysis of Cutaneous Peripheral T-cell lymphoma, Not Otherwise Specified, According to Primary Tumor Site

Future considerations for clinical dermatology in the setting of 21st century American policy reform: corporatization and the rise of private equity in dermatology

Within the last two decades, for-profit financial groups have become increasingly involved in health care. Outlier dermatology practices with high volumes of well-reimbursed procedures are attractive to consolidation backed by private equity. With fewer choices for independent or group private practice, junior dermatologists are increasingly seeking employment without ownership in private equity-backed corporate groups, whose primary fiscal responsibility lies with investors. Medicare's response to corporatization and consolidation has already changed the practice of dermatopathology.

Co-occurrence of infantile hemangiomas and other birthmarks

Analysis of cutaneous Merkel Cell Carcinoma outcomes after different surgical interventions

Despite current recommendation of 1-2 cm excision margin for merkel cell carcinoma, we compared different surgical option for better outcome. We did not recommend local destruction and confirmed superior survival with excision margin of more than 2 cm in patients younger than 60 years having T1/T2 tumors or adjuvant radiotherapy.

Avidekel Cannabis extracts and cannabidiol are as efficient as Copaxone in suppressing EAE in SJL/J mice

Abstract

Multiple sclerosis (MS) is an autoimmune disease leading to the destruction of myelin with consequent axonal degeneration and severe physical debilitation. The disease can be treated with immunosuppressive drugs that alleviate the symptoms and retard disease aggravation. One such drug in clinical use is glatiramer acetate (Copaxone). The non-psychotropic immunosuppressive cannabinoid compound cannabidiol (CBD) has recently been shown to have beneficial effects on experimental autoimmune encephalomyelitis (EAE). The aim of our study was to compare the efficacy of CBD and standardized extracts from a CBD-rich, ∆⁹-THC^lowCannabis indica subspecies (Avidekel) with that of Copaxone. Our data show that CBD and purified Avidekel extracts are as efficient as Copaxone to alleviate the symptoms of proteolipid protein (PLP)-induced EAE in SJL/J mice. No synergistic effect was observed by combining CBD or Avidekel extracts with Copaxone. Our data support the use of Avidekel extracts in the treatment of MS symptoms.

Magnesium depletion suppresses the anti-grazer colony formation in Scenedesmus obliquus

Abstract

In aquatic ecosystems, many phytoplankton species have evolved various inducible defense mechanisms against the predation. The expression of these defenses is affected by environmental conditions such as nutrient availability. Here, we investigated the anti-grazer colony formation in Scenedesmus obliquus at different magnesium concentrations (0–7.3 mg L⁻¹ Mg²⁺) in the presence of zooplankton (Daphnia)-derived infochemicals. Results showed that at adequate Mg²⁺, S. obliquus formed high proportions of multi-celled (e.g., four- and eight-celled) colonies, resulting in significantly increased number of cells per colony in response to Daphnia filtrate. On the other hand, in Mg²⁺-deficient treatment, the proportion of multi-celled colonies decreased, together with reduced algal growth rate and photosynthetic efficiency. Finally, the treatment without Mg²⁺ strongly suppressed the formation of large colony (mainly eight-celled colonies), whereas the algal growth rate was comparable to that in Mg²⁺ sufficient treatment. Despite the inhibition of colony formation, the time reaching the maximum number of cells per colony was not affected by the Mg²⁺ concentration, which generally took three days in all groups. Our results indicate that Mg²⁺ deficient/absent environments significantly reduced anti-grazing colony formation but not the algal growth, suggesting strong dependability of this morphological defensive trait to magnesium fluctuation in S. obliquus.

An event study analysis of price adjustment of refined oil and air quality in China

Abstract

Since marketization of the refined oil price, the Chinese government has used refined oil price adjustments to control air pollution. Using an event study analysis, we examine whether these price adjustments have impacted air quality. We test the abnormal returns of 12 price adjustments between 2014 and 2015 in 51 major cities of China. The results show that the impact on air quality of refined oil price decreases is larger than the impact of oil price increases. Although results indicate air quality has deteriorated, the impact is insignificant for most of the cities. Consequently, we conclude that price suspension of refined oil has had a negligible impact on air quality. This policy is not a viable method to improve the air quality in the short run.

Chitosan oligosaccharides alleviate PM 2.5 -induced lung inflammation in rats

Abstract

Air pollution of particulate matter (PM), especially PM_2.5, has become a major public health problem in China. Exploration of therapeutic and preventive measures against PM_2.5 toxicity is of practical significance. The aim of this study was to examine the inhibitory effects of chitosan oligosaccharides (COS) on PM_2.5-induced lung inflammation in rats. Forty SPF (specific pathogen-free) male Wistar rats weighing 200–220 g were randomly divided into four groups: control group, COS group, PM_2.5 group, and PM_2.5+COS group. COS was pre-administered to rats by gavage at a single dose of 500 mg/kg 2 h before intratracheal instillation of PM_2.5 at a single dose of 1.2 mg/kg daily for 3 consecutive days. Normal saline (NS) was used as negative control. Twenty-four hours after the last instillation of PM_2.5, rats were sacrificed and subjected to bronchoalveolar lavage (BAL). The BAL fluids (BALF) were collected for measurement of levels of total proteins, lactate dehydrogenase (LDH), interleukin-1 (IL-1β), IL-8, and tumor necrosis factor-ɑ (TNF-ɑ) using colorimetric or ELISA kits. Levels of total proteins, LDH activities, and pro-inflammatory mediators including IL-1β, IL-8, and TNF-ɑ in BALF of rats in PM_2.5 group significantly increased in comparison with those of the control group. Pre-treatment of rats with COS markedly blocked PM_2.5-induced increase in LDH, IL-8, and TNF-ɑ levels in BALF. In conclusion, PM_2.5 exposure induces rat lung inflammation, which could be ameliorated by the pre-treatment of COS.

Low irradiance compared with conventional photodynamic therapy in the treatment of actinic keratoses

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

Durable response to mTOR inhibition in a patient with relapsing papillary tumor of the pineal region

Papillary tumor of the pineal region (PTPR) was first described as a distinct tumor entity by Jouvet et al in 2003¹ and was eventually included in the 2007 World Health Organization (WHO) classification of CNS tumors as a rare neuroepithelial tumor characterized by papillary architecture and epithelial cytology.² PTPR mostly occurs in younger adults and shows frequent local recurrence after surgery, which corresponds to WHO grade II or III.² So far, there is no established oncological treatment of these patients. We previously described that loss of chromosome 10 and phosphatase and tensin homolog (PTEN), and associated pathological activation of the Akt/mammalian target of rapamycin (mTOR) pathway, is a hallmark of PTPR.³ Here, we for the first time report a patient case with relapsing and rapidly progressing PTPR that showed loss of chromosome 10 and PTEN, phosphatidylinositol-3 kinase (PI3K)/Akt/mTOR hyperactivity, and a dramatic and durable response to mTOR inhibition with everolimus.

Joint know-how

Abstract

When two agents engage in a joint action, such as rowing together, they exercise joint know-how. But what is the relationship between the joint know-how of the two agents and the know-how each agent possesses individually? I construct an "active mutual enablement" (AME) account of this relationship, according to which joint know-how arises when each agent knows how to predict, monitor, and make failure-averting adjustments in response to the behaviour of the other agent, while actively enabling the other to make such adjustments. I defend the AME account from three objections, and I then use this account as the platform for an examination of the reducibility (or otherwise) of joint know-how to joint propositional knowledge. A summative account of joint propositional knowledge is incompatible with the reduction of joint know-how to joint propositional knowledge, whereas a distributive account is not (although serious difficulties for any such reduction remain). I close by highlighting some open questions the AME account brings into view concerning the evolutionary origin and scaling up of joint know-how.

Expression dynamics of the poly-γ-glutamic acid biosynthesis genes of Bacillus subtilis in response to glucose and glutamic acid-A pilot study

Abstract

Poly-γ-glutamic acid (PGA) is biosynthesized by various Bacillus species through PGA synthetase, encoded by PGA operon comprising of ywsC and ywtABC genes. Due to the minimal available knowledge, understanding the expression pattern of PGA operon genes is pivotal. In this study, the effect of glucose and glutamic acid on global gene expression profile of Bacillus subtilis Natto3 was investigated using high throughput microarray, with an emphasis on PGA operon and genes influencing PGA production. Two treatment groups (set1-in presence of glutamic acid and set2-in presence of glutamic acid+glucose) were analyzed against control, (in presence of glucose). In Microarray, both the groups, showed trend of up-regulation for ywsC and ywtA genes (log2 fold change of 0.55, p=0.0194, 0.92, p=0.0069 in set1 and 0.78, p=0.0023, 0.59, p=0.0172 in set2, respectively) and down-regulation of ywtB and ywtC genes (log2 fold change of -1.83, p=0.0001, -1.42, p=0.0017 in set1 and -1.52, p=0.0012, -0.55, p=0.1112 in set2, respectively), supporting indispensability of ywsC and ywtA genes in PGA production. Interestingly, ywtB and ywtC genes, belonging to the same operon were down-regulated in both the conditions (set1 and set2). To the best of our knowledge, this expression pattern of PGA operon genes is a unique observation.

Measuring costs and quality of life for venous leg ulcers

International Wound Journal, EarlyView.

Synthesis and quantitative characterization of coumarin-caged D-luciferin

Publication date: Available online 5 October 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Maki Kurata, Miyabi Hiyama, Takuma Narimatsu, Yuji Hazama, Takashi Ito, Yuhei Hayamizu, Xingping Qiu, Francoise M. Winnik, Hidehumi Akiyama

Abstract

Caged luciferin compounds of firefly luciferins have recently drawn much attention since firefly bioluminescence, in which D-luciferin acts as a substrate, is widely used in noninvasive gene-expression imaging, studies of in vivo cell trafficking, and the detection of enzyme activity. The objectives of this study are the development of new caged luciferins and the quantitative determination of the photophysical parameters of their photo-decomposition. We synthesized 7-(diethylaminocoumarin)-4-(yl)methyl caged D-luciferin (DEACM-caged D-luciferin) and quantitatively characterized its absorption spectrum, bioluminescence, and photoproducts using chiral HPLC chromatography, as a function of light-irradiation time. We observed that 4 min of UV irradiation generated maximum D-luciferin concentrations, which corresponds to 16.2% of the original DEACM-caged-D-luciferin concentration. Moreover, we evaluated not only the rate of photocleavage (0.20/min) from DEACM-caged D-luciferin to luciferin but also the rate of caged-luciferin degradation that did not produce luciferin (0.28/min) and the rate of luciferin decomposition (0.20/min) after exposure to irradiation with a 70 mW/cm² high-pressure mercury lamp (254–600 nm). The formation rate of L-luciferin via DEACM-caged–D-luciferin photocleavage was smaller by a factor of 1/10 compared with that of D-luciferin. These quantitative measurements and simultaneous evaluations of photocleavage, degradation, and decomposition are the most important and original methodology presented in this study.

Graphical abstract

Late growth of infantile hemangiomas in children >3 years of age: A retrospective study

Publication date: Available online 5 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Kathleen F. O'Brien, Sonal D. Shah, Elena Pope, Roderic J. Phillips, Francine Blei, Eulalia Baselga, Maria C. Garzon, Catherine McCuaig, Anita N. Haggstrom, Peter H. Hoeger, James R. Treat, Marissa J. Perman, Jane S. Bellet, Xavier Cubiró, Jeffrey Poole, Ilona J. Frieden

Background

The proliferative phase of infantile hemangiomas (IHs) is usually complete by 9 months of life. Late growth beyond age 3 years is rarely reported.

Objective

To describe the demographic and clinic characteristics of a cohort of patients with late growth of IH, defined as growth in a patient >3 years of age.

Methods

A multicenter, retrospective cohort study.

Results

In total, 59 patients, 85% of which were female, met the inclusion criteria. The mean first episode of late growth was 4.3 (range 3-8.5) years. Head and neck location (55/59; 93%) and presence of deep hemangioma (52/59; 88%) were common characteristics. Posterior fossa malformations, hemangiomas, arterial anomalies, cardiac defects, eye abnormalities (PHACE) syndrome was noted in 20 of 38 (53%) children with segmental facial IH. Systemic therapy (corticosteroid or β-blocker) was given during infancy in 58 of 59 (98%) and 24 of 59 (41%) received systemic therapy (β-blockers) for late IH growth.

Limitations

The retrospective nature and ascertainment by investigator recall are limitations of the study.

Conclusion

Late IH growth can occur in children after 3 years of age. Risk factors include head and neck location, segmental morphology, and involvement of deep dermal/subcutaneous tissues.

Use of disposable blade for harvesting epidermal skin graft

Publication date: Available online 4 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Rajsmita Bhattacharjee, Keshavamurthy Vinay, Davinder Parsad

The fitting attitudes analysis of value: an explanatory challenge

Abstract

This paper is concerned with the implication from value to fittingness. I shall argue that those committed to this implication face a serious explanatory challenge. This argument is not intended as a knock-down argument against FA but it will, I think, show that those who endorse the theory incur a particular explanatory burden: to explain how counterfactual (dis)favouring of actual (dis)value is possible. After making two important preliminary points (about one of the primary motivations behind the theory and what this implies, respectively) I briefly discuss an objection to FA made by Krister Bykvist a few years ago. The point of discussing this objection is to enable me to more easily present my own, and I believe stronger, version of that objection. The overall argument takes the form of, simply, a counterexample which can be constructed on the back of (an acceptance) of my two preliminary points. Throughout the paper I try to respond to various objections.

The most downloaded and most cited articles in radiology journals: a comparative bibliometric analysis

Abstract

Objectives

To evaluate and compare the characteristics of the most downloaded and most cited articles in radiology journals.

Methods

We selected 41 radiology journals that provided lists of both the most downloaded and most cited articles on their websites, and identified the 596 most downloaded articles and 596 most cited articles. We compared the following characteristics of the most downloaded and most cited articles: year of publication, journal title, department of the first author, country of origin, publication type, radiologic subspecialty, radiologic technique and accessibility.

Results

Compared to the most cited articles, the most downloaded articles were more frequently review articles (36.1% vs 17.1%, p < 0.05), case reports (5.9% vs 3.2%, p < 0.05), guidelines/consensus statements (5.4% vs 2.7%, p < 0.05), editorials/commentaries (3.7% vs 0.7%, p < 0.05) and pictorial essays (2.0% vs 0.2%, p < 0.05). Compared to the most cited articles, the most downloaded articles more frequently originated from the UK (8.7% vs 5.0%, p < 0.05) and were more frequently free-access articles (46.0% vs 39.4%, p < 0.05).

Conclusion

Educational and free-access articles are more frequent among the most downloaded articles.

Key Points

• There was only small overlap between the most downloaded and most cited articles.

• Educational articles were more frequent among the most downloaded articles.

• Free-access articles are more frequent among the most downloaded articles.

Ethylene vinyl alcohol copolymer for occlusion of specific portal branches during preoperative portal vein embolisation with n -butyl-cyanoacrylate

Abstract

Objectives

To evaluate the safety and efficacy of ethylene vinyl alcohol copolymer (EVOH) injection for selective occlusion of portal branches considered at risk for non-target embolisation during preoperative portal vein embolisation (PVE).

Methods

Twenty-nine patients (mean age, 57 ± 17 years) submitted to PVE with n-butyl-cyanoacrylate (NBCA) and additional EVOH for selected portal branches were retrospectively analysed. Indications for the use of EVOH and the selected portal branches were evaluated. Degree of hypertrophy of the future liver remnant (FLR) and kinetic growth were assessed by CT volumetry performed before and 3–6 weeks after PVE. Clinical outcome and histopathological analysis of portal veins occluded with EVOH were reviewed.

Results

EVOH was indicated intraoperatively for embolisation of selected portal branches that the operator reported at risk to provoke non-target embolisation with NBCA. Indications for the use of EVOH were embolisation of segment IV (n = 21), embolisation of segmental portal branches with early bifurcation (n = 7) and PVE in a 1-year-old girl with cystic hamartomas. All targeted portal branches were successfully embolised. There were no cases with non-target embolisation by EVOH. The degree of hypertrophy of the FLR was 14.3 ± 8.1% and the kinetic growth rate was 2.7 ± 1.8% per week.

Conclusion

EVOH is safe and effective for embolisation of selected portal vein branches considered at risk for non-target embolisation.

Key Points

• EVOH is another effective liquid embolic agent for preoperative PVE.

• EVOH is relatively simple to handle with a minimal risk of non-target embolisation.

• During PVE, some portal branches considered complicated to occlude with NBCA may be efficiently embolised with EVOH.

Can quantitative iodine parameters on DECT replace perfusion CT parameters in colorectal cancers?

Abstract

Objectives

To determine the correlation between iodine concentrations derived from dual-energy CT (DECT) and perfusion CT (PCT) parameters in patients with pathologically proven colorectal cancers (CRC) and to evaluate their reproducibility and respective radiation exposures.

Methods

Institutional review board approval and written informed consents were obtained for this study. Forty-one patients with CRCs who underwent same-day DECT and PCT were prospectively enrolled. Three radiologists independently analyzed the iodine concentration of the tumors and iodine ratios [ratio of lesion to aorta (IRa) or to infrarenal IVC (IRv)] from DECT as well as blood flow (BF), blood volume (BV), permeability (PMB), and mean transit time (MTT) from PCT. Pearson R and linear correlation, paired t-test, and intraclass correlation coefficients (ICCs) were used.

Results

Significant correlations were found between iodine parameters from DECT and PCT parameters: iodine concentration of tumors and BV (r = 0.32, p = 0.04), PMB (r = 0.34, p = 0.03), and MTT (r = -0.38, p = 0.02); iodine ratio (IRa) and MTT (r = -0.32, p = 0.04); iodine ratio (IRv) and BF (r = 0.32, p = 0.04) and PMB (r = 0.44, p = <0.01). DECT showed better intra- and interobserver agreements (ICC = 0.98, 0.90 in iodine concentration; 0.98, 0.91 in IRa; and 0.91, 0.93 in IRv, respectively) than PCT (ICC = 0.90, 0.78 in BF; 0.82, 0.76 in BV; 0.75, 0.75 in PMB; 0.64, 0.79 in MTT, respectively). As for radiation dosage, CTDIvol and DLP in DECT (10.48 ± 1.84 mGy and 519.7 ± 116.7 mGy·cm) were significantly lower than those of PCT (75.76 mGy and 911 mGy·cm) (p < 0.01).

Conclusion

Iodine parameters from DECT are significantly correlated with PCT parameters, but have higher intra- and interobserver agreements and lower radiation exposure.

Key Points

• Quantitative iodine concentrations from DECT are significantly correlated with perfusion CT parameters.

• Intra- and interobserver agreements of DECT are better than those of perfusion CT.

• Effective radiation doses of DECT are significantly lower than those of perfusion CT.

• DECT can be used as an alternative to perfusion CT with lower radiation doses.

Deep learning for staging liver fibrosis on CT: a pilot study

Abstract

Objectives

To investigate whether liver fibrosis can be staged by deep learning techniques based on CT images.

Methods

This clinical retrospective study, approved by our institutional review board, included 496 CT examinations of 286 patients who underwent dynamic contrast-enhanced CT for evaluations of the liver and for whom histopathological information regarding liver fibrosis stage was available. The 396 portal phase images with age and sex data of patients (F0/F1/F2/F3/F4 = 113/36/56/66/125) were used for training a deep convolutional neural network (DCNN); the data for the other 100 (F0/F1/F2/F3/F4 = 29/9/14/16/32) were utilised for testing the trained network, with the histopathological fibrosis stage used as reference. To improve robustness, additional images for training data were generated by rotating or parallel shifting the images, or adding Gaussian noise. Supervised training was used to minimise the difference between the liver fibrosis stage and the fibrosis score obtained from deep learning based on CT images (F_DLCT score) output by the model. Testing data were input into the trained DCNNs to evaluate their performance.

Results

The F_DLCT scores showed a significant correlation with liver fibrosis stage (Spearman's correlation coefficient = 0.48, p < 0.001). The areas under the receiver operating characteristic curves (with 95% confidence intervals) for diagnosing significant fibrosis (≥ F2), advanced fibrosis (≥ F3) and cirrhosis (F4) by using F_DLCT scores were 0.74 (0.64–0.85), 0.76 (0.66–0.85) and 0.73 (0.62–0.84), respectively.

Conclusions

Liver fibrosis can be staged by using a deep learning model based on CT images, with moderate performance.

Key Points

• Liver fibrosis can be staged by a deep learning model based on magnified CT images including the liver surface, with moderate performance.

• Scores from a trained deep learning model showed moderate correlation with histopathological liver fibrosis staging.

• Further improvement are necessary before utilisation in clinical settings.

Gadolinium deposition within the paediatric brain: no increased intrinsic T1-weighted signal intensity within the dentate nucleus following the administration of a minimum of four doses of the macrocyclic agent gadobutrol

Abstract

Objectives

To determine whether repeated administration of the macrocyclic gadolinium-based contrast agent (GBCA) gadobutrol in children is associated with T1-weighted hyperintensity within the dentate nucleus, an imaging surrogate for gadolinium deposition.

Methods

With institutional review board approval, we identified a cohort of eight patients aged 18 years or younger who underwent at least four gadobutrol-enhanced magnetic resonance imaging (MRI) examinations of the brain from 2013 to 2017. For comparison, we identified a cohort of 19 patients who underwent at least four gadopentetate dimeglumine-enhanced MRI examinations. For each examination, both dentate nuclei were contoured on unenhanced images; the mean dentate-to-pons signal intensity (DN-P SI) ratio was calculated. DN-P SI ratios from the first and last MRI exams were compared using Wilcoxon signed ranks tests and linear regression analyses.

Results

In the gadobutrol cohort, there was no significant change in the mean DN-P SI ratio from the first to the last scan (1.02 vs 1.02, p = 1.00). In the gadopentetate dimeglumine cohort, there was a significant increase in the mean DN-P SI ratio from the first to the last scan (1.05 vs 1.13, p = 0.003). After controlling for potentially confounding variables, the change in DN-P SI ratio from the first to the last scan was significantly lower for patients in the gadobutrol group than in the gadopentetate dimeglumine group (β = -0.08, p = 0.04).

Conclusions

Repeated administration of the macrocyclic GBCA gadobutrol in children was not associated with T1-weighted dentate hyperintensity, while the repeated administration of the linear GBCA gadopentetate dimeglumine was associated with T1-weighted dentate hyperintensity, presumably due to gadolinium deposition.

Key Points

• Gadolinium-based contrast agents are routinely used in magnetic resonance imaging.

• Repeated administration of the macrocyclic agent gadobutrol in children was not associated with T1-weighted dentate hyperintensity.

Percutaneous intentional intra-luminal-assisted recanalization (PILAR technique) of challenging chronic total occlusions using a high-frequency vibration device

Abstract

Objectives

Recanalization of peripheral chronic total occlusions (CTO) is technically challenging especially in cases of in-stent and/or pre-stent and heavily calcified lesions. A high-frequency vibrational device (HFVD) was first used as a secondary-intention device in CTO recanalizations when they were refractory to a guidewire. The aim of this study was to assess the safety and efficacy of the HFVD as a first-line treatment for challenging CTOs and thus to define the percutaneous intentional intraluminal-assisted recanalization (PILAR) technique.

Methods

Fifty-two patients were treated with the HFVD. Only challenging CTOs were included: 7 pre-stent, 7 in-stent, and 38 highly calcified CTOs. Technical success was defined as the ability to cross the CTO using the HFVD. Secondary outcome was defined as successful intraluminal crossing. Safety endpoints were procedure-related thromboembolism or perforation. Patients were followed up at 3 months and 1 year.

Results

The technical success rate for recanalization was 90%, of which 83% were intraluminal. The mean recanalized length was 91 ± 44 mm. One thromboembolic complication occurred, which was subsequently treated with thromboaspiration. Three-month and 1-year primary patency rates were 92% and 79%, respectively.

Conclusions

HFVD-based PILAR is a safe and effective technique for in-stent or pre-stent CTO recanalization of long and calcified lesions.

Key Points

• Intraluminal recanalization is the preferred procedure in heavily calcified or pre-/in-stent CTO.

• First-line use of assisted intraluminal recanalization for CTO defines the PILAR technique.

• HFVD-based PILAR is safe and provides a high success rate for challenging CTO recanalization.

Is it painful to be different? Sciatic nerve anatomical variants on MRI and their relationship to piriformis syndrome

Abstract

Objectives

To investigate the purported relationship between sciatic nerve variant anatomy and piriformis syndrome.

Methods

Over 49 months, 1039 consecutive noncontrast adult hip MRIs were completed for various clinical indications. Repeat and technically insufficient studies were excluded. Radiologists categorized sciatic nerve anatomy into Beaton and Anson anatomical types. Chart review using our institution's cohort search and navigation tool determined the prevalence of the explicit clinical diagnosis of piriformis syndrome (primary endpoint) and sciatica and buttock pain (secondary endpoints). A Z-test compared the prevalence of each diagnosis in the variant anatomy and normal groups.

Results

Seven hundred eighty-three studies were included, with sciatic nerve variants present in 150 hips (19.2%). None of the diagnoses had a statistically significant difference in prevalence between the variant and normal hip groups. Specifically, piriformis syndrome was present in 11.3% of variant hips compared with 9.0% of normal hips (p = 0.39).

Conclusions

There were no significant differences in the prevalence of piriformis syndrome, buttock pain, or sciatica between normal and variant sciatic nerve anatomy. This large-scale correlative radiologic study into the relationship between sciatic nerve variants and piriformis syndrome calls into question this purported relationship.

Key Points

• Large retrospective study relating variant sciatic nerve anatomy, present in 19.2% of hip MRIs, and piriformis syndrome

• While sciatic nerve variant anatomy has previously been implicated in piriformis syndrome in small studies, no relationship was identified between sciatic nerve variants and piriformis syndrome

Correction to: Volumetric dynamic oxygen-enhanced MRI (OE-MRI): comparison with CT Brody score and lung function in cystic fibrosis patients

The original version of this article, published on 13 April 2018, unfortunately contained a mistake.

Meniscal pathologies on MRI correlate with increased bone tracer uptake in SPECT/CT

Abstract

Objectives

To assess the relationship of subchondral bone tracer uptake (BTU) on SPECT/CT and meniscal pathologies on MRI in patients with painful knees.

Methods

Twenty-five patients who had MRI and SPECT/CT within 3 months without knee surgery or grade ≥3 cartilage lesions were prospectively included. Maximum values of each subchondral femorotibial area were quantified and a ratio was calculated in relation to a femoral shaft reference region, which represented the BTU background activity. Meniscal lesions were graded (intact/degeneration/tear) and meniscal extrusion (no/yes) was assessed using MRI by two musculoskeletal radiologists blinded to the SPECT/CT findings. One-tailed Spearman correlations served for statistics (p < 0.05).

Results

Knees with meniscal degeneration or tear showed a significantly higher BTU in the medial femorotibial compartment (p = 0.045) when compared to intact menisci. Meniscal degeneration was associated with an increased BTU in the lateral femorotibial compartment; however, this was not statistically significant (p = 0.143). Patients with an extruded meniscus showed significantly higher BTU compared to a non-extruded meniscus (p < 0.020).

Conclusions

Medial femorotibial BTU in SPECT/CT was associated with meniscal pathologies. Highest BTU was found in patients with meniscal tears. SPECT/CT appears to be a useful imaging modality to identify patients with overloading or early osteoarthritis.

Key Points

• Meniscal degeneration and tears correlate significantly with increased BTU using SPECT/CT.

• Medial meniscus extrusion is associated with an increased BTU in SPECT/CT.

• SPECT/CT allows detection of overloading and early osteoarthritis.

CT colonography: size reduction of submerged colorectal polyps due to electronic cleansing and CT-window settings

Abstract

Objectives

To assess whether electronic cleansing (EC) of tagged residue and different computed tomography (CT) windows influence the size of colorectal polyps in CT colonography (CTC).

Methods

A database of 894 colonoscopy-validated CTC datasets of a low-prevalence cohort was retrospectively reviewed to identify patients with polyps ≥6 mm that were entirely submerged in tagged residue. Ten radiologists independently measured the largest diameter of each polyp, two-dimensionally, before and after EC in colon, bone, and soft-tissue-windows, in randomised order. Differences in size and polyp count before and after EC were calculated for size categories ≥6 mm and ≥10 mm. Statistical testing involved 95% confidence interval, intraclass correlation and mixed-model ANOVA.

Results

Thirty-seven patients with 48 polyps were included. Mean polyp size before EC was 9.8 mm in colon, 9.9 mm in bone and 8.2 mm in soft-tissue windows. After EC, the mean polyp size decreased significantly to 9.4 mm in colon, 9.1 mm in bone and 7.1 mm in soft-tissue windows. Compared to unsubtracted colon windows, EC, performed in colon, bone and soft-tissue windows, led to a shift of 6 (12,5%), 10 (20.8%) and 25 (52.1%) polyps ≥6 mm into the next smaller size category, thus affecting patient risk stratification.

Conclusions

EC and narrow CT windows significantly reduce the size of polyps submerged in tagged residue. Polyp measurements should be performed in unsubtracted colon windows.

Key Points

• EC significantly reduces the size of polyps submerged in tagged residue.

• Abdominal CT-window settings significantly underestimate 2D sizes of submerged polyps.

• Size reduction in EC is significantly greater in narrow than wide windows.

• Underestimation of polyp size due to EC may lead to inadequate treatment.

• Polyp measurements should be performed in unsubtracted images using a colon window.

The role of core needle biopsy in the diagnosis of initially detected thyroid nodules: a systematic review and meta-analysis

Abstract

Objectives

To systematically review the published literature and evaluate the efficacy and safety of core needle biopsy (CNB) for initially detected thyroid nodules.

Methods

The Ovid-MEDLINE and Embase databases were searched for studies evaluating CNB for the diagnosis of initially detected thyroid nodules. A meta-analysis was performed to evaluate non-diagnostic results, inconclusive results and diagnostic accuracy for a diagnosis of malignancy with CNB. To overcome heterogeneity, multiple subgroup analyses were performed. The complication rate was also evaluated.

Results

Thirteen eligible studies, which included a total sample size of 9,166 patients with 13,585 nodules, were included. The pooled proportions were 3.5% (95% CI 2.4–5.1) for non-diagnostic results and 13.8% (95% CI 9.1–20.3) for inconclusive results. Considerable heterogeneity was observed among the studies in terms of the pooled proportions for CNB (I²=92.9%, 97%). With regard to the diagnostic performance for malignancy, the sensitivity was 80% (95% CI 75–85) and the specificity was 100% (95% CI 93–100). Only two major complications of CNB were observed.

Conclusions

CNB demonstrates a low non-diagnostic result rate and high diagnostic accuracy for initially detected thyroid nodules and a low major complication rate. These findings indicate that CNB may be a feasible diagnostic tool for patients with initially detected thyroid nodules.

Key Points

• CNB demonstrates high diagnostic accuracy for initially detected thyroid nodules.

• CNB demonstrates a low major complication rate.

• CNB may be a feasible diagnostic tool for patients with initially detected thyroid nodules.

Ultrasonography in diagnosing clinically occult groin hernia: systematic review and meta-analysis

Abstract

Objectives

To provide an updated systematic review on the performance of ultrasonography (US) in diagnosing clinically occult groin hernia.

Methods

A systematic search was performed in MEDLINE and Embase. Methodological quality of included studies was assessed. Accuracy data of US in detecting clinically occult groin hernia were extracted. Positive predictive value (PPV) was pooled with a random effects model. For studies investigating the performance of US in hernia type classification (inguinal vs femoral), correctly classified proportion was assessed.

Results

Sixteen studies were included. In the two studies without verification bias, sensitivities were 29.4% [95% confidence interval (CI), 15.1-47.5%] and 90.9% (95% CI, 70.8-98.9%); specificities were 90.0% (95% CI, 80.5-95.9%) and 90.6% (95% CI, 83.0-95.6%). Verification bias or a variation of it (i.e. study limited to only subjects with definitive proof of disease status) was present in all other studies. Sensitivity, specificity, and negative predictive value (NPV) were not pooled. PPV ranged from 58.8 to 100%. Pooled PPV, based on data from ten studies with low risk of bias and no applicability concerns with respect to patient selection, was 85.6% (95% CI, 76.5-92.7%). Proportion of correctly classified hernias, based on data from four studies, ranged between 94.4% and 99.1%.

Conclusions

Sensitivity, specificity and NPV of US in detecting clinically occult groin hernia cannot reliably be determined based on current evidence. Further studies are necessary. Accuracy may strongly depend on the examiner's skills. PPV is high. Inguinal and femoral hernias can reliably be differentiated by US.

Key Points

• Sensitivity, specificity and NPV of ultrasound in detecting clinically occult groin hernia cannot reliably be determined based on current evidence.

• Accuracy may strongly depend on the examiner's skills.

• PPV of US in detection of clinically occult groin hernia is high [pooled PPV of 85.6% (95% confidence interval, 76.5-92.7%)].

• US has very high performance in correctly differentiating between clinically occult inguinal and femoral hernia (correctness of 94.4- 99.1%).

Sagittal balance measures are more reproducible when measured in 3D vs in 2D using full-body EOS® images

Abstract

Purpose

An innovative low-dose X-ray biplanar imager (EOS®) allows measurement of the whole-body in standing-position which is necessary for the evaluation of spinal deformities.

Methods

A total of 60 asymptomatic subjects (ages 20–81 years) were evaluated using the 3D workflow called postural assessment and 2D measures. Subjects were measured twice each by two new observers following training, including: lordosis/kyphosis, pelvic parameters, sagittal-vertical axis, and spinal-sacral angle. Intra- and inter-observer reproducibility and similarity were compared between 2D and 3D measures.

Results

The intraclass correlation coefficient (ICC) was very high for the 3D measures (>0.9) and excellent for the 2D measures (>0.75). In all cases, the overall mean absolute difference between repeated 3D measures was less than 2°, or 2 mm. For all parameters, the inter- and intra-observer reproducibility in 3D measures were significantly superior to 2D measures (p < 0.03).

Conclusion

This study demonstrated that 3D measures have better reproducibility than 2D for sagittal balance.

Key Points

• Reproducibility of sagittal balance 2D/3D measurements was evaluated using EOS® full-body radiographs.

• Inter- and intra-observer reproducibility were significantly superior for 3D measures vs. 2D.

• 3D measures have better reproducibility than 2D for sagittal balance.

Computer-based self-training for CT colonography with and without CAD

Abstract

Objectives

To determine whether (1) computer-based self-training for CT colonography (CTC) improves interpretation performance of novice readers; (2) computer-aided detection (CAD) use during training affects learning.

Methods

Institutional review board approval and patients' informed consent were obtained for all cases included in this study. Twenty readers (17 radiology residents, 3 radiologists) with no experience in CTC interpretation were recruited in three centres. After an introductory course, readers performed a baseline assessment test (37 cases) using CAD as second reader. Then they were randomized (1:1) to perform either a computer-based self-training (150 cases verified at colonoscopy) with CAD as second reader or the same training without CAD. The same assessment test was repeated after completion of the training programs. Main outcome was per lesion sensitivity (≥ 6 mm). A generalized estimating equation model was applied to evaluate readers' performance and the impact of CAD use during training.

Results

After training, there was a significant improvement in average per lesion sensitivity in the unassisted phase, from 74% (356/480) to 83% (396/480) (p < 0.001), and in the CAD-assisted phase, from 83% (399/480) to 87% (417/480) (p = 0.021), but not in average per patient sensitivity, from 93% (390/420) to 94% (395/420) (p = 0.41), and specificity, from 81% (260/320) to 86% (276/320) (p = 0.15). No significant effect of CAD use during training was observed on per patient sensitivity and specificity, nor on per lesion sensitivity.

Conclusions

A computer-based self-training program for CTC improves readers' per lesion sensitivity. CAD as second reader does not have a significant impact on learning if used during training.

Key Points

• Computer-based self-training for CT colonography improves per lesion sensitivity of novice readers.

• Self-training program does not increase per patient specificity of novice readers.

• CAD used during training does not have significant impact on learning.

4D ASL-based MR angiography for visualization of distal arteries and leptomeningeal collateral vessels in moyamoya disease: a comparison of techniques

Abstract

Objectives

To evaluate the performance of four-dimensional pseudo-continuous arterial spin labeling (4D-pCASL)-based angiography using CENTRA-keyhole and view sharing (4D-PACK) in the visualization of flow dynamics in distal cerebral arteries and leptomeningeal anastomosis (LMA) collaterals in moyamoya disease in comparison with contrast inherent inflow-enhanced multiphase angiography (CINEMA), with reference to digital subtraction angiography (DSA).

Methods

Thirty-two cerebral hemispheres from 19 patients with moyamoya disease (mean age, 29.7 ± 19.6 years; five males, 14 females) underwent both 4D-MR angiography and DSA. Qualitative evaluations included the visualization of anterograde middle cerebral artery (MCA) flow and retrograde flow via LMA collaterals with reference to DSA. Quantitative evaluations included assessments of the contrast-to-noise ratio (CNR) on these vessels. The linear mixed-effect model was used to compare the 4D-PACK and CINEMA methods.

Results

The vessel visualization scores were significantly higher with 4D-PACK than with CINEMA in the visualization of anterograde flow for both Observer 1 (CINEMA, 3.53 ± 1.39; 4D-PACK, 4.53 ± 0.80; p < 0.0001) and Observer 2 (CINEMA, 3.50±1.39; 4D-PACK, 4.31 ± 0.86; p = 0.0009). The scores were higher with 4D-PACK than with CINEMA in the visualization of retrograde flow for both Observer 1 (CINEMA, 3.44 ± 1.05; 4D-PACK, 4.47 ± 0.88; p < 0.0001) and Observer 2 (CINEMA, 3.19 ± 1.20; 4D-PACK, 4.38 ± 0.91; p < 0.0001). The maximum CNR in the anterograde flow was higher in 4D-PACK (40.1 ± 16.1, p = 0.0001) than in CINEMA (27.0 ± 16.6). The maximum CNR in the retrograde flow was higher in 4D-PACK (36.1 ± 10.0, p < 0.0001) than in CINEMA (15.4 ± 8.0).

Conclusions

The 4D-PACK provided better visualization and higher CNRs in distal cerebral arteries and LMA collaterals compared with CINEMA in patients with this disease.

Key Points

• The 4D-PACK enables good visualization of distal cerebral arteries in moyamoya disease.

• The 4D-PACK enables direct visualization of leptomeningeal collateral vessels in moyamoya disease.

• Vessel visualization by 4D-PACK can be useful in assessing cerebral hemodynamics.

Parenchymal pattern in women with dense breasts. Variation with age and impact on screening outcomes: observations from a UK screening programme

Abstract

Objectives

To assess patterns of parenchymal tissue on mammography in women with dense breasts and to determine how this varies with age and affects recall to assessment and cancer diagnosis.

Method

Breast density data was obtained in women attending routine mammographic screening from April 2013 to March 2015 using automated breast density assessment software. Women with the densest breasts were selected for visual interpretation of parenchymal pattern (PP). One hundred non-assessed women, aged 50, 55, 60, 65 and 69-71 years (total = 500), provided controls. Cases included women recalled for assessment (mastectomy or implants excluded) (total = 280). Mammograms reviewed by ten readers and PP classified as: (1) very smooth; (2) mainly smooth; (3) mixed; (4) mainly nodular; (5) very nodular. The ratio of women in each category at each age and screening outcomes were compared by Pearson's chi-squared test.

Results

Reader agreement for scoring PP was good (intraclass correlation = 0.6302). Proportions of women in each PP category were similar at all ages for controls (p = 0.147) and cases (p = 0.657). The ratio of PP categories did not vary significantly with age in those who underwent biopsy (p = 0.484). Thirty-four cancers were diagnosed. There was a significant correlation between a diagnosis of cancer and nodular PP compared to not nodular PP (p = 0.043).

Conclusions

The ratio of smooth to nodular pattern in women with the densest breasts did not vary with age. The PP of the breast tissue did not affect likelihood of recall to assessment or biopsy. There was a significant relationship between a nodular parenchymal pattern and diagnosis of cancer.

Key Points

• This paper shows that there is good agreement between mammogram readers when classifying mammographic PP on a five-point scale from very smooth to very nodular.

• In non-assessed women with the densest breasts, there is no significant change in the proportions of smooth to nodular patterns with increasing age.

• The likelihood of recall for further assessment or biopsy at assessment is not related to PP in women with highest breast density.

• When recalled for further assessment, significantly more women are diagnosed with cancer in the group with nodular PP on mammography when compared with smooth and mixed patterns.

A radiopaque 3D printed, anthropomorphic phantom for simulation of CT-guided procedures

Abstract

Objectives

To develop an anthropomorphic phantom closely mimicking patient anatomy and to evaluate the phantom for the simulation of computed tomography (CT)-guided procedures.

Methods

Patient CT images were printed with aqueous potassium iodide solution (1 g/mL) on paper. The printed paper sheets were stacked in alternation with 1-mm thick polyethylene foam layers, cut to the patient shape and glued together to create an anthropomorphic abdomen phantom. Ten interventional radiologists performed periradicular infiltration on the phantom and rated the phantom procedure regarding different aspects of suitability for simulating CT-guided procedures.

Results

Radiopaque printing in combination with polyethylene foam layers achieved a phantom with detailed patient anatomy that allowed needle placement. CT-guided periradicular infiltration on the phantom was rated highly realistic for simulation of anatomy, needle navigation and overall course of the procedure. Haptics were rated as intermediately realistic. Participants strongly agreed that the phantom was suitable for training and learning purposes.

Conclusions

A radiopaque 3D printed, anthropomorphic phantom provides a realistic platform for the simulation of CT-guided procedures. Future work will focus on application for training and procedure optimisation.

Key Points

• Radiopaque 3D printing combined with polyethylene foam achieves patient phantoms for CT-guided procedures.

• Radiopaque 3D printed, anthropomorphic phantoms allow realistic simulation of CT-guided procedures.

• Realistic visual guidance is a key aspect in simulation of CT-guided procedures.

• Three-dimensional printed phantoms provide a platform for training and optimisation of CT-guided procedures.

"Desensitization to cross-reacting allergen in egg yolk and chicken meat"

Publication date: Available online 5 October 2018

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

Author(s): Manuel Jorge Rial Prado, Marcela Valverde Monge, Aida Gómez Cardeñosa, Rosialzhira Vera Berríos, Carlos Pastor Vargas, Javier Cuesta Herranz

Drug-induced Stevens–Johnson syndrome and toxic epidermal necrolysis: proportion and determinants of underreporting to pharmacovigilance

Publication date: Available online 5 October 2018

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

Author(s): Guillaume Chaby, Bénédicte Lebrun-Vignes, Cynthia Haddad, Francois Hemery, Saskia Ingen-Housz-Oro, Nicolas de Prost, Pierre Wolkenstein, Olivier Chosidow, Laurence Fardet

Role of skin tests in the diagnosis of immediate hypersensitivity reactions to taxanes. Results of a multicenter study

Publication date: Available online 5 October 2018

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

Author(s): Mauro Pagani, Sevim Bavbek, Adile Berna Dursun, Patrizia Bonadonna, Maria Caralli, Josefina Cernadas, Gabriele Cortellini, Maria Teresa Costantino, Asli Gelincik, Giuseppe Lucchini, Mariana Castells

Abstract

Background

Immediate hypersensitivity reactions (HSRs) to taxanes have been increasing in recent years, but the importance of skin tests in allergological work-up has not been established.

Objective

In our study we tried to evaluate the role of prick and intradermal tests in the diagnosis of HSRs to paclitaxel and docetaxel.

Methods

In this multicenter prospective study we enrolled patients with immediate HSRs reactions to the aforesaid agents. Skin tests were performed on these subjects and, if results were negative, intradermal tests with the culprit drug were conducted. Patients with grade 1 reactions subsequently underwent graded challenge; in cases of grade 2-3 reactions and/or positive tests the culprit drug was administered with a desensitization schedule. Skin tests were also performed in 30 control subjects exposed to the taxanes without HSRs.

Results

84 patients, 63 with HSRs to paclitaxel and 21 to docetaxel were recruited in the period July 2015 - July 2017 by 8 centers. 58 patients (69%) developed grade 2-3 reactions. Prick test resulted negatives in all the cases, while intradermal tests were positive in 14 patients, 10 with paclitaxel (15.9 %) and 4 with docetaxel (19%). The positivity of skin tests significantly correlated with grade 3 reactions and cutaneous involvement during HSRs. Graded challenge was performed in 16 patients without problems and 58 subjects underwent desensitization, which was well tolerated in all but two cases. In the control group skin testing resulted negatives in all the patients.

Conclusions

Skin tests for taxanes seem useful and can be performed in the allergological work-up of subjects with HSRs to these agents, especially in cases of severe reactions with cutaneous involvement.

Risk of postpartum depression among women with asthma

Publication date: Available online 5 October 2018

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

Author(s): Lucie Blais, Sherief Ibrahim Salah Ahmed, Marie-France Beauchesne, Amélie Forget, Fatima-Zohra Kettani, Kim Lavoie

Abstract

Background

Several epidemiological studies have suggested that the risk of depression is increased in patients with asthma, but the impact of asthma during pregnancy on postpartum depression remains unknown.

Objective

To assess the association between maternal asthma and postpartum depression in a population-based cohort study retrieved from administrative databases

Methods

A cohort of 35,520 pregnancies in women with asthma during pregnancy and 197,057 pregnancies in women without asthma who delivered between 1998 and 2009 was extracted from the Quebec Asthma and Pregnancy Database (QAPD). They were followed from the day of delivery up to 1 year postpartum. A generalized estimating equation model was used to estimate the adjusted odds ratios (OR) of postpartum depression with 95% confidence intervals (CI) in women with asthma during pregnancy versus women without asthma.

Results

Postpartum depression within 1 year after delivery occurred in 6.1% of women with asthma versus 2.9% of women without asthma. After adjusting for several potential confounders, including depression/postpartum depression up to 10 years before pregnancy, we found that women with asthma were 58% more likely to experience postpartum depression within 1 year after delivery than women without asthma during pregnancy (adjusted OR: 1.58; 95% CI: 1.50–1.67).

Conclusion

Our findings suggest that women with asthma are more likely to suffer from postpartum depression. A close monitoring of signs of depression for pregnant women with asthma is indicated, allowing prompt and efficient interventions if needed.

Does Changing Inhaler Device Impact Real-Life Asthma Outcomes? Clinical and Economic Evaluation

Publication date: Available online 5 October 2018

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

Author(s): Chin Kook Rhee, Job F.M. van Boven, Simon Wan Yau Ming, Hye Yun Park, Deog Kyeom Kim, Hae-Sim Park, Joanna Ling Zhi Jie, Kwang-Ha Yoo, David B. Price

Background

Inhaler usability and deposition differ between devices. Change of device may therefore have an impact on clinical and economic outcomes.

Objective

To characterize clinical and economic asthma outcomes surrounding the change from a dry powder inhaler (DPI) to a pressurized metered-dose inhaler (pMDI) for fixed-dose combination inhaled corticosteroid/long-acting β agonist (FDC ICS/LABA) treatment.

Methods

Three retrospective cohort substudies using 2010 to 2015 data from the Korean Health Insurance and Review Assessment Service database were performed. Patients with asthma who received an FDC ICS/LABA pMDI for the first time after initially being on FDC ICS/LABA DPI were included. The following outcomes were assessed: (1) persistence of change to pMDI over 6 months, (2) clinical outcomes during the year after the change compared with the baseline year; and (3) noninferiority comparison of costs and effectiveness between patients changing to a pMDI and matched patients who continued their DPI.

Results

Patients who change inhalers seem to represent a more severe subpopulation. Fifty-eight percent of patients (95% CI, 56-60) persisted with the change. After the change in therapy, an increased proportion of patients (58.3%) remained free from severe exacerbations compared with the year before (47.4%; P < .001). Patients who changed to pMDIs had significantly less severe exacerbations, acute respiratory events, and lower short-acting β agonist inhaler average daily dose, but higher average ICS daily dose (all P < .05), compared with matched patients remaining on a DPI. Total costs were similar between patients who changed to pMDI therapy compared with those remaining on a DPI.

Conclusion

Changing from a DPI to a pMDI for FDC ICS/LABA asthma treatment can be as effective and cost-effective as remaining on a DPI.

Extended analysis of parent and child confidence in recognizing anaphylaxis and using the epinephrine autoinjector during oral food challenges

Publication date: Available online 5 October 2018

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

Author(s): Lianne Soller, Timothy Teoh, Ingrid Baerg, Tiffany Wong, Kyla J. Hildebrand, Victoria E. Cook, Catherine M. Biggs, Nicole Lee, Lindsay Yaworski, Scott B. Cameron, Edmond S. Chan

The scratch collapse test: a systematic review

Publication date: Available online 4 October 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Urška Čebron, Catherine M Curtin

Abstract

The diagnosis of nerve compression relies on collecting diagnostic clues from the history, physical exam, imaging, and diagnostic testing. There are several provocative tests to aide in the diagnosis of nerve compression. The 'Scratch Collapse Test' (SCT) has emerged as a new provocative test to assist in the localization of peripheral nerve compression. This study aims to perform a systematic review of the literature to assess the data on the reliability of the SCT as a diagnostic test for entrapment neuropathy. Ten articles were reviewed. Five had sufficient numerical data for analysis, in these 5 the positive predictive values and specificity were high: between 0.71 and 0.99 and 0.6 and 0.99 respectively, while other values were very variable: individual Negative Predictive Values ranged from 0.15 to 0.92 and the sensitivity values ranged from 0.24 to 0.77. Another main finding was the versatility of the test, in that it can be used for various nerve entrapments, and localise the exact level of compression. The literature suggests that SCT has potential as a clinical diagnostic tool for of entrapment neuropathy. However wide variations in the early literature suggest SCT should not be used as a sole diagnostic tool but as an adjunct to a surgeon's diagnostic repertoire.

Histiocytome fibreux angiomatoïde de la gouttière du pouls radial

Publication date: Available online 4 October 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): L. Jelti, M. Alorini, C. Boivin, P. Courville, X. Balguerie, A. Bonmarchand, E. Angot

Résumé

Introduction

L'histiocytome fibreux angiomatoïde (HFA) est une tumeur rare des tissus mous, de malignité intermédiaire, à évolution lente, touchant principalement les enfants et les adultes jeunes, localisée préférentiellement aux extrémités. Sa rareté et sa présentation clinique non spécifique rendent son diagnostic difficile.

Observation

Un adolescent de 16 ans présentait depuis plusieurs années un nodule isolé, d'apparition spontanée, au sein de la gouttière du pouls radial droit. Une exérèse chirurgicale épargnant les structures anatomiques nobles était effectuée. L'examen histologique mettait en évidence une lésion tumorale d'architecture plurinodulaire, limitée par une pseudo-capsule fibreuse, constituée de cellules histiocytoïdes ou fusiformes disposées en faisceaux courts. Il s'y associait une réaction lympho-plasmocytaire d'architecture nodulaire en périphérie. Les cellules tumorales exprimaient la desmine, l'actine muscle lisse, le CD99 et l'antigène de membrane épithéliale EMA. Un transcrit de fusion EWSR1-ATF1 était mis en évidence.

Discussion

Les lésions d'HFA sont peu spécifiques et de diagnostic anatomopathologique. L'exérèse élargie recommandée a été, chez notre patient, limitée par la localisation complexe de la lésion, au contact de structures anatomiques majeures vasculo-nerveuses et fonctionnelles. L'examen histologique de la pièce d'exérèse chirurgicale, associé à la recherche du gène de fusion, a permis de porter le diagnostic. Après discussion en réunion de concertation pluridisciplinaire, une surveillance au long cours a été décidée.

Summary

Background

Angiomatoid fibrous histiocytoma (AFH) is a slowly progressing rare soft-tissue tumour of moderate malignant potential. It is most commonly seen in children and young adults. Clinically, the lesion is easily confused with a haematoma or soft-tissue haemangioma, and the radiological aspects are not specific.

Patients and methods

A 16-year-old male patient presented with a nodular lesion situated very close to the right radial artery, vein and nerve and which had been developing for several years. Surgical resection was carried out with sparing of vasculonervous and functional structures. Histological examination revealed a tumour of plurinodular architecture, surrounded by a fibrous pseudocapsule consisting of histiocytoid or fusiform cells in short bundles associated with a mononuclear inflammatory reaction of nodular architecture. The tumour cells expressed the following immunomarkers: desmin, smooth muscle actin, CD99, and epithelial membrane antigen. Fusion transcript EWSR1-ATF1 was found.

Discussion

In this case, as occurs in the literature, a diagnosis of AFH was not made on clinical examination or imaging. The enlarged excision normally recommended was greatly restricted in our patient due to the complex localization of the lesion, which was in contact with major anatomical structures. The diagnosis was based on histological examination of the surgical excision and identification of the fusion gene. Long-term follow-up is required to detect local recurrence or metastasis. Management is decided in multidisciplinary meetings.

Estimated Cost Efficacy of US Food and Drug Administration Approved Treatments for Acne

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

A “Seasonal Bromoderma” in a Farmer

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

Rituximab therapy in pemphigus: a long‐term follow‐up

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

New alcohol flushing in a patient with atopic dermatitis under therapy with dupilumab

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

Intralesional 2% zinc sulfate solution for plane warts: A case report

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

A case report demonstrating potential utility of topical imiquimod for cutaneous Rosai–Dorfman disease

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

Secondary failure of TNF‐α inhibitors in clinical practice

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

Polymethylmethacrylate‐induced nodules of the lips – clinical presentation and management by intralesional neodymium:YAG laser therapy

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

Efficacy and safety of cyclosporine in Stevens‐Johnson syndrome and toxic epidermal necrolysis

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

Imiquimod 5% cream in occlusion, for the treatment of lentigo maligna: a new scheme of short cycles and the need for clinical trials

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

First case of trastuzumab emtansine‐associated hemorrhagic telangiectasias treated with propranolol

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

Non‐Specific labelling of macrophages with Anti‐Cytokeratin 20 (SP33) in the evaluation of nodal micrometastasis from merkel cell carcinoma: A Pitfall for metastasis

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

Capsaicinoide und Cayennepfeffer-Extrakte

Clinical phenotypes of Hidradenitis Suppurativa

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

Author′s response to Drs. Marasca et al and Drs. De Vita and Melnik: Hidradenitis suppurativa, insulin resistance and mTOR

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

Evaluation of the treatment costs and duration of topical treatments for multiple actinic keratosis based on the area of the cancerization field and not on the number of lesions

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

Position statement: topical calcineurin inhibitors in atopic dermatitis

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

Rubronychia: A Rose by Any Other Name

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

Characteristics of Nonmelanoma Skin Cancers of the Cutaneous Perioral and Vermilion Lip Treated by Mohs Micrographic Surgery

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

Habits and Risk Perception Associated with Sun Exposure in Vitiligo Patients according to their participation in a patients’ organization

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

Isothiazolinone derivatives and allergic contact dermatitis: a review and update

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

Symmetrical acral keratoderma revisited: Proposal for a new term, ‘pigmented carpotarsal hyperkeratosis’

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

CAR‐T cell therapy in melanoma: a future success story?

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

Novel and recurrent mutations in keratin 1 cause epidermolytic ichthyosis and palmoplantar keratoderma

Clinical and Experimental Dermatology, EarlyView.

Juvenile pemphigus vulgaris manifesting as vegetating skin lesions

Clinical and Experimental Dermatology, EarlyView.

Dystrophic epidermolysis bullosa pruriginosa presenting with flagellate scarring lesions

Clinical and Experimental Dermatology, EarlyView.

Immunomodulatory properties of captopril, an ACE inhibitor, on LPS-induced lung inflammation and fibrosis as well as oxidative stress

Abstract

Background

The role of angiotensin converting enzyme inhibitors on the inflammation process has been demonstrated previously. In the present study, the effects of captopril on lung injury induced by lipopolysaccharide (LPS) were investigated.

Methods

Control, LPS, 12.5, 25 and 50 mg/kg captopril-treated before LPS administration and captopril 50 mg/kg before saline administration groups of rats were studied. Total and percentage of differential WBC, the levels of MDA, total thiol groups, the activities of SOD and CAT, the levels of IFN-γ, PGE2, TGF-β1 and IL-4 in the BALF were evaluated.

Results

MDA concentration in LPS groups treated with all captopril concentrations, total WBC in LPS + Cap50, percent of neutrophils in LPS + Cap25 and LPS + Cap50, levels of IFN-γ, PGE2, TGF-β1 in LPS + Cap50 and IFN-γ/IL-4 ratio in LPS + Cap25 and LPS + Cap50 were significantly decreased but total thiol groups and activity of SOD in LPS + Cap25 and LPS + Cap50, percent of lymphocyte, CAT activity and concentration of IL-4 only in LPS + Cap50 group were increased in comparison to the LPS group (p < 0.05 to p < 0.001).

Conclusion

Captopril dose dependently improved oxidant–antioxidant biomarkers, the imbalance between pro-inflammatory and anti-inflammatory cytokines and showed specific immunomodulatory effect on Th1/Th2 balance in the BALF of lung injury induced by LPS.