No abstract available
Πέμπτη 25 Οκτωβρίου 2018
The Timing of Chemoprophylaxis in Autologous Microsurgical Breast Reconstruction
Background: Patients undergoing autologous breast reconstruction are at high risk of perioperative venous thromboembolic events. The efficacy of chemoprophylaxis in decreasing venous thromboembolic events is well established, but the timing of chemoprophylaxis remains controversial. The authors compare the incidence of bleeding following preoperative versus postoperative initiation of chemoprophylaxis in microvascular breast reconstruction. Methods: A retrospective chart review was performed from August of 2010 to July of 2016. Initiation of chemoprophylaxis changed from postoperative to preoperative in 2013, dividing subjects into two groups. Patient demographics, comorbidities, and complications were reviewed. Results: A total of 196 patients (311 flaps) were included in the study. A total of 105 patients (166 flaps) received preoperative enoxaparin (40 mg) and 91 patients (145 flaps) received postoperative chemoprophylaxis. A total of five patients required hematoma evacuation (2.6 percent). Of these, one hematoma (1 percent) occurred in the preoperative chemoprophylaxis group. Seven patients received blood transfusions: three in the preoperative group and four in the postoperative group (2.9 percent versus 4.4 percent; p = 0.419). There was a total of one flap failure, and there were no documented venous thromboembolic events in any of the groups. Conclusions: This study demonstrates that preoperative chemoprophylaxis can be used safely in patients undergoing microvascular breast reconstruction. The higher rate of bleeding in the postoperative group may be related to the onset of action of enoxaparin of 4 to 6 hours, which allows for intraoperative hemostasis in the preoperative group and possibly potentiating postoperative oozing when administered postoperatively. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.Hybrid Prepectoral Breast Reconstruction: A Surgical Approach that Combines the Benefits of Autologous and Implant-Based Reconstruction
Background: The advantages of hybrid breast reconstruction (i.e., the combination of free tissue transfer with simultaneous implant placement) are well known. In an attempt to further minimize morbidity and simplify the procedure, the authors have modified their approach in that a prepectoral approach is now routinely chosen. Methods: A retrospective analysis of patients who underwent immediate microsurgical breast reconstruction with simultaneous prepectoral implant placement was performed. Clinical outcomes and postoperative complications were examined. Results: A total of 23 patients with a mean age of 46.6 years (range, 26 to 72 years) and mean body mass index of 25.8 kg/m2 (range, 21.4 to 32.1 kg/m2) underwent reconstruction with 46 free flaps with simultaneous prepectoral silicone gel implant placement. The most common implant volume was 210 cc (range, 150 to 255 cc). Postoperative complications included hematoma [n = 1 (4.3 percent)], mastectomy skin flap necrosis [n = 5 (21.7 percent)], fat necrosis [n = 3 (13 percent)], and delayed wound healing at the flap donor site [n = 4 (17.4 percent)]. No case of implant malposition, implant infection, flap loss, or "red breast" syndrome was encountered during a mean follow-up of 8.4 months (range, 2 to 17 months). Conclusions: Prepectoral hybrid breast reconstruction is a safe procedure that combines the benefits of autologous and implant-based reconstruction. Although the transfer of well-vascularized soft tissue allows reconstruction of natural breast ptosis, the addition of an implant provides the desired projection, but without being associated with complications such as rippling or animation deformity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.Low-Level Laser Treatment Is Ineffective for Capsular Contracture: Results of the LaTCon Randomized Controlled Trial
Background: Breast reconstruction with implants can be complicated by symptomatic capsular contracture, especially after radiotherapy. A phase I, nonrandomized clinical trial demonstrated improvement in capsular contracture and avoidance of revision surgery with low-level laser therapy. This phase II, double-blind, randomized controlled trial assessed the efficacy of low-level laser for treating capsular contracture in women with breast reconstruction following mastectomy for breast cancer. Methods: Participants had completed their definitive implant-based reconstruction a minimum of 6 months previously and were randomized to weekly treatments over 6 weeks with either an active or inactive low-level laser handpiece (Riancorp LTU-904). Pain, tightness, arm movement, and appearance were assessed by patient questionnaires. Breast symmetry, shape, naturalness, softness, and grade of contracture were assessed by clinician reports. Participants were assessed at 1 and 6 months after completion of the treatments. Results: A total of 42 patients (intervention arm, n = 20; placebo, n = 22) were assessed in the trial. Thirty-two had postmastectomy radiotherapy. There was no significant difference in the change in any patient-reported outcomes or clinician-reported outcomes of breast symmetry, shape, or naturalness for the two groups. There was a significantly greater improvement in clinician-reported breast softness (pSubcutaneous Mastectomy Improves Satisfaction with Body and Psychosocial Function in Trans Men: Findings of a Cross-Sectional Study Using the BODY-Q Chest Module
Background: The effectiveness of gender-confirming surgery is best evaluated on the basis of patient-reported outcomes. This is the first explorative study using the BODY-Q chest module, administered in trans men before and after mastectomy. Methods: Between October of 2016 and May of 2017, trans men were recruited to participate in a cross-sectional study. Data collection included standardized anamnesis and examination, screening questions on depression/anxiety, and seven BODY-Q scales, including new scales measuring satisfaction of the chest and nipples. Mean scores for preoperative and postoperative participants were compared, and regression analyses were conducted to identify factors associated with BODY-Q scores. Results: In total, 101 persons participated (89 percent; 50 preoperatively and 51 postoperatively). Postoperative participants reported significantly higher (better) scores on the chest (67), nipple (58), body (58) (t tests, all p
Perioperative Ketorolac Use and Postoperative Hematoma Formation in Reduction Mammaplasty: A Single-Surgeon Experience of 500 Consecutive Cases
Background: In light of the escalating opioid crisis, surgeons are increasingly focused on minimizing opioid use. Ketorolac has well-documented opioid-sparing effects in the postoperative period; however, its use is limited because of concerns of postoperative bleeding and hematoma formation. This study explores the relationship between hematoma formation and administration of perioperative ketorolac in adolescent female patients and young adult women undergoing reduction mammaplasty. It also aims to determine the effect of perioperative ketorolac administration on the requirement for opioid analgesia. Methods: The authors reviewed the medical records of 500 consecutive female patients who underwent reduction mammaplasty for bilateral macromastia from 2007 to 2017. The authors collected data pertaining to perioperative analgesia use and postoperative hematoma formation. Results: Five-hundred patients were included in analyses. The average age of the patients was 18.1 ± 2.2 years. Three hundred eighty-nine patients (77.8 percent) received intravenous ketorolac during the perioperative period. Seven patients (1.4 percent) developed a postoperative hematoma. Hematoma was not associated with intraoperative, postoperative, and perioperative ketorolac use (p > 0.43, all). Intraoperative ketorolac use was associated with lower total intraoperative dosing of fentanyl and morphine, and postoperative ketorolac use was associated with lower total postoperative doses of oxycodone and morphine (pBreast Implant Mycobacterial Infections: An Epidemiologic Review and Outcome Analysis
Background: Epidemiologic evidence of periprosthetic mycobacterial infections is limited. The recent boom in cosmetic surgery tourism has been associated with a rise of surgical-site infections in returning patients. This review aims to explore available data, examine trends of documented periprosthetic mycobacterial infections, and analyze outcomes of management techniques. Methods: A search in the Biosis, Embase, LILACS, MEDLINE, and Web of Science databases from inception until December of 2017 for "Breast Implants" and "Mycobacterial Infections" and equivalents was performed. Data were pooled after two screening rounds following full-text retrieval and cross-referencing. Results: Forty-one reports describing 171 female patients who had breast prosthesis–related mycobacterial infections were identified. Bibliometric case-based analysis revealed a rise of periprosthetic mycobacterial infections in developing countries since the start of the millennium. The mean patient's age was 37.9 years and the majority of patients had undergone bilateral breast augmentation. Most patients presented with breast pain or tenderness, after an average incubation period of 9 months. Mycobacterium fortuitum was isolated from 90 cases (52.6 percent). Immediate explantation with or without delayed reimplantation was the most commonly used surgical strategy, complemented by combination antimicrobial therapy for an average of 4.6 months. The mean follow-up time was 39.7 months, during which recurrence was observed in 21 of 171 patients (12.3 percent). Conclusions: The emergence of periprosthetic mycobacterial infections in relation to cosmetic medical tourism alerts clinicians to the importance of educating the public about the associated risks. In addition, this study identifies risk factors associated with recurrence of periprosthetic mycobacterial infections.Anatomy of the Superficial Fascia System of the Breast: A Comprehensive Theory of Breast Fascial Anatomy
Background: It has been two centuries since Petrus Camper identified superficial fascia and over 175 years since Sir Astley Cooper wrote his book on the anatomy of the breast. In the 1990s, Ted Lockwood taught us the importance of the superficial fascia layers in body contouring procedures he pioneered. These descriptions, however, fail to explain the three-dimensional fascial system in the breast. The authors set out to discover and describe a theory of superficial fascia structures responsible for breast shape. Methods: The nature of the superficial fascia system that surrounds the breast and its attachments to the chest were studied in 12 cadaver breast dissections and in clinical cases of both cosmetic and reconstructive breast procedures. Results: The authors found a three-dimensional, closed system of fascia and fat surrounding the corpus mammae, which attaches to the skin by means of specialized vertical cutaneous ligaments, or Cooper ligaments, and which attaches to the chest wall by means of a three-dimensional zone of adherence at the breast's periphery. Conclusions: The breast is shaped by a three-dimensional, fibrofatty fascial system. Two layers of this system surround the corpus mammae and fuse together around it, and anchor it to the chest wall in a structure we have called the circummammary ligament.Ergonomics in the Operating Room: The Cervicospinal Health of Today’s Surgeons
Summary: In its many forms, operating can lead surgeons to adopt postures that have damaging long-term effects on physical health through imparting musculoskeletal fatigue. One area that is particularly susceptible is the cervical spine, as surgeons are forced into positions that require sustained cervical hyperflexion. The repercussions of resultant injuries can be steep, as they have the potential to adversely affect one's operative capacity. The purpose of this article is to assess the spinal health of today's surgeons by evaluating available research in various surgical subspecialties. By focusing on the ergonomic principles that govern the surgical arena and identifying unifying themes between plastic surgery and other surgical subspecialties, it is the goal of this article to enhance the understanding of cervical spine health as it pertains to the plastic and reconstructive surgeon.The Relationship between Age and Facial Asymmetry
Background: Facial symmetry is a fundamental goal of plastic surgery, yet some asymmetry is inherent in any face. Three-dimensional photogrammetry allows for rapid, reproducible, and quantitative facial measurements. With this tool, the authors investigated the relationship between age and facial symmetry. Methods: The authors imaged normal subjects using three-dimensional photogrammetry. Facial symmetry was calculated by identifying the plane of maximum symmetry and the root-mean-square deviation. Regression analysis was used to assess the relationship between age and symmetry. Subgroup analyses were performed among facial thirds. Results: The authors imaged 191 volunteers with an average age of 26.7 ± 22.2 years (range, 0.3 to 88 years). Root-mean-square deviation of facial symmetry clustered between 0.4 and 1.3 mm (mean, 0.8 ± 0.2 mm). The authors found a significant positive correlation between increasing age and asymmetry (pThe Feasibility Determination of Risky Severe Complications of Arterial Vasculature Regarding the Filler Injection Sites at the Tear Trough
Background: The tear trough is a significant sign of periorbital aging and has usually been corrected with filler injection. However, the arterial supply surrounding the tear trough could be inadvertently injured during injection; therefore, this study aimed to evaluate the nearest arterial locations related to the tear trough and investigate the possibility of severe complications following filler injection. Methods: Thirty hemifaces of 15 Thai embalmed cadavers were used in this study. Results: The artery located closest to both the inferior margin (TT1) and mid-pupil level (TT2) of the tear trough was found to be the palpebral branch of the infraorbital artery. Furthermore, at 0.5 mm along the tear trough from the medial canthus (TT3), the angular artery was identified, which was found to be a branch of the ophthalmic artery. The artery at TT1 and TT2 was located beneath both the zygomaticus major and the orbicularis oculi muscles. The distances from TT1 to the artery were measured as follows: laterally, 2.79 ± 1.08 mm along the x axis; and inferiorly, 2.88 ± 1.57 mm along the y axis. For the TT2, the artery was located inferomedially from the landmark of 4.65 ± 1.83 mm along the x axis and 7.13 ± 3.99 mm along the y axis. However, the distance along the x axis at TT3 was located medially as 4.00 ± 2.37 mm. Conclusion: The high risk of injury to the artery at the tear trough should be considered because of the numerous arteries to this area.High-Throughput Screening of Full-Face Clinically Relevant Arterial Variations Using Three-Dimensional Postmortem Computed Tomography
Background: Vascular complications resulting from intravascular filler injection and embolism are major safety concerns for facial filler injection. It is essential to systematically screen full-face arterial variations and help design evidence-based safe filler injection protocols. Methods: The carotid arteries of 22 cadaveric heads were infused with adequate lead oxide contrast. The facial and superficial temporal arteries of another 12 cadaveric heads were injected with the contrast in a sequential order. A computed tomographic scan was acquired after each contrast injection, and each three-dimensional computed tomographic scan was reconstructed using validated algorithms. Results: Three-dimensional computed tomography clearly demonstrated the course, relative depth, and anastomosis of all major arteries in 63 qualified hemifaces. The ophthalmic angiosome consistently deploys two distinctive layers of branch arteries to the forehead. The superficial temporal and superior palpebral arteries run along the preauricular and superior palpebral creases, respectively. The study found that 74.6 percent of the hemifaces had nasolabial trunks coursing along the nasolabial crease, and that 50.8 percent of the hemifaces had infraorbital trunks that ran through the infraorbital region. Fifty percent of the angular arteries were the direct anastomotic channels between the facial and ophthalmic angiosomes, and 29.2 percent of the angular arteries were members of the ophthalmic angiosomes. Conclusions: Full-face arterial variations were mapped using postmortem three-dimensional computed tomography. Facial creases were in general correlated with underlying deep arteries. Facial and angular artery variations were identified at high resolution, and reclassified into clinically relevant types to guide medical practice.Alar Cinching with Subcutaneous Flaps: A Procedure to Achieve Narrowing of the Nasal Base while Controlling the Alar Axis and Sidewall Curvature
Background: Insufficient narrowing of alar width, alar distortion, and noticeable scarring are commonly encountered after alar base reduction. The authors aimed to demonstrate an alar cinching with subcutaneous flaps procedure to reduce the alar width while controlling the alar axis and sidewall curvature. Methods: A retrospective chart review of 560 patients who underwent alar base reduction between 2000 and 2015 was performed. The clinical outcomes of alar cinching with subcutaneous flaps were compared to those of vestibular floor excision with cinching suture. Mean change in alar width was compared to assess narrowing efficacy between the two groups. In addition, mean changes in interalar distance for the upper, middle, and lower parts of the alae were compared to evaluate the alteration of alar axes. Results: Seventy-three patients who underwent alar base narrowing alone (alar cinching with subcutaneous flaps, n = 42; vestibular floor excision with cinching suture, n = 31) were identified. Alar cinching with subcutaneous flaps was significantly more effective than vestibular floor excision with cinching suture in reducing alar width. In patients with vertical alar axes, alar cinching with subcutaneous flaps achieved more uniform narrowing of the entire alae, resulting in prevention of alar distortion. The incidence of complications after alar cinching with subcutaneous flaps was 5.7 percent. Conclusions: Alar cinching with subcutaneous flaps achieved sufficient narrowing of the nasal base in the long-term follow-up in patients with any type of alar axis and enabled the reduction of sidewall curvature while eliminating the need for wedge resection. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.Investigation and analysis of 1030 primary hair transplantation cases: a retrospective study
Abstract
Background
Hair transplantation has progressed since the introduction of the concept of follicular unit transplantation, a method that recognizes the follicular unit as the basic element of tissue to be transferred. It was aimed to estimate the area of donor scalp with the greatest probability contains the number of follicular units desired to transplant and to analyze the complications in all patients who underwent hair transplantation procedure.
Methods
A retrospective study was conducted in our clinic from January 2014 to January 2018.
Results
One thousand thirty hair restoration procedures were performed. Each patient was evaluated for age and gender in addition to the follicular unit density and postoperative complication rates. The mean age was 37.2 years. It was noted that the most common type of hair grouping was the 2-hair follicular unit grafts. The FU density ranged between 70 and 90 and the hair density ranged between 130 and 220 hair/cm2. Postoperative frontal edema was the most common postoperative complication.
Conclusions
Data collected from this series can help to estimate the area of donor scalp with the greates probability of containing the number of follicular units desired to transplant.
Level of Evidence: Level IV, therapeutic study.
An update of the pathogenesis of frontal fibrosing alopecia: What does the current evidence tell us?
Australasian Journal of Dermatology, EarlyView.
Use of calcium hydroxylapatite in the upper third of the face: Retrospective analysis of techniques, dilutions and adverse events
Journal of Cosmetic Dermatology, EarlyView.
Hemodynamic Impairment Measured by Positron-Emission Tomography Is Regionally Associated with Decreased Cortical Thickness in Moyamoya Phenomenon [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Impaired cerebrovascular reactivity has been associated with decreased cortical thickness in patients with arterial occlusive diseases. This study tests the hypothesis that severe hemodynamic impairment, indicated by increased oxygen extraction fraction ratios on positron-emission tomography with 15O tracers, is associated with decreased cortical thickness in patients with Moyamoya phenomenon.
MATERIALS AND METHODS:Patients with unilateral or bilateral idiopathic Moyamoya phenomenon were recruited. Oxygen extraction fraction ratio maps were generated from cerebral images of O[15O] counts divided by H2[15O] counts with normalization by corresponding cerebellar counts. The normal range of the oxygen extraction fraction ratio was estimated from historically available healthy control subjects. Cortical thickness was estimated from T1-weighted MR imaging and FreeSurfer. Regional samples of oxygen extraction fraction ratios and cortical thicknesses were drawn using FreeSurfer parcellations, retaining only parcellations from the vascular territory of the middle cerebral artery.
RESULTS:Complete MR imaging and PET datasets were available in 35 subjects, including 23 women; the mean age at scanning was 44 years. Patients with Moyamoya phenomenon had a significantly increased regional oxygen extraction fraction ratio compared with 15 healthy control subjects (P < .001). Regional oxygen extraction fraction ratio and age were significant predictors of cortical thickness (P < .001 for each) in a generalized linear mixed-effects model. Using hemisphere averages and patient averages, we found that only age was a significant predictor of cortical thickness (P < .001).
CONCLUSIONS:Chronic hemodynamic impairment, as indicated by a higher regional oxygen extraction fraction ratio, was significantly predictive of reduced cortical thickness in mixed-effects analysis of FreeSurfer regions. This phenomenon may be related to reversible metabolic down-regulation.
Imaging and Surgical Findings in Patients with Hemi-Laryngopharyngeal Spasm and the Potential Role of MRI in the Diagnostic Work-Up [HEAD & NECK]
BACKGROUND AND PURPOSE:
Hemi-laryngopharyngeal spasm is a recently discovered condition characterized by episodic coughing and unilateral throat contractions that may lead to severe stridor. These symptoms are caused by a vascular compression of the ipsilateral vagus nerve, typically the PICA. Microvascular decompression of the vagus nerve has been demonstrated to be a potential cure for this neurovascular compression syndrome. The main aim of this study was to clarify the role of MR imaging in the diagnostic work-up of this rare condition.
MATERIALS AND METHODS:We describe the imaging and surgical findings of 3 patients from our prospective case series of patients with hemi-laryngopharyngeal spasm from 2015 to 2017. Second, the imaging data of 100 patients (control cohort) with symptoms unrelated to hemi-laryngopharyngeal spasm were reviewed to investigate the rate and degree of neurovascular conflict of the vagus nerve.
RESULTS:All patients with hemi-laryngopharyngeal spasm reported to date have had vascular compression of the vagus nerve due to the PICA. In the control cohort, there was a good interrater agreement in scoring the "contact" and "compression" of the vagus nerve ( = 0.73. P = < .001). The frequency of contact or compression of the vagus nerve was approximately 50%. The PICA was the most frequent vessel involved in 74%.
CONCLUSIONS:The presence of unilateral neurovascular contact or compression of the vagus nerve does not confirm the diagnosis of hemi-laryngopharyngeal spasm. The MR imaging finding of ipsilateral vascular compression of the vagus nerve is a necessary but not sufficient finding for the diagnosis of hemi-laryngopharyngeal spasm.
Perspectives on Neuroradiology Medical Expert Testimony: Fact and Fiction [PRACTICE PERSPECTIVES]
SUMMARY:
There are numerous misconceptions about serving as a medical malpractice expert witness. By maintaining an objective perspective based in the unbiased interpretation of the images provided (for both sides of the conflict), one can best serve society as a whole. Most cases for which a neuroradiology expert is recruited are the following: 1) not with the radiologist as a defendant, 2) resolved without court testimony, and 3) short-lived if frivolous. One can learn much about medicine, our nonradiology colleagues, and the litigation process by participating as an expert witness.
Percutaneous Radiofrequency Ablation of Spinal Osteoid Osteomas Using a Targeted Navigational Bipolar Electrode System [PATIENT SAFETY]
SUMMARY:
Safe and effective percutaneous CT-guided radiofrequency ablation of spinal osteoid osteomas can be performed using a targeted navigational bipolar electrode system. Articulating bipolar electrodes with built-in thermocouples along an electrode shaft and variable generator wattage settings allow optimal nidus access, particularly in challenging locations; provide precise real-time monitoring of ablation zone volume and geometry; and minimize the risk of undesired thermal injury.
Does the Presence or Absence of DESH Predict Outcomes in Adult Hydrocephalus? [ADULT BRAIN]
BACKGROUND AND PURPOSE:
The DESH (disproportionately enlarged subarachnoid-space hydrocephalus) pattern of "tight high-convexity and medial subarachnoid spaces, and enlarged Sylvian fissures with ventriculomegaly" is used to determine which patients undergo an operation for adult hydrocephalus at many centers. Our aim was to review adult hydrocephalus cases when DESH has not been a criterion for an operation to determine the prevalence of DESH among the cohort and compare the surgical outcomes in the presence or absence of DESH.
MATERIALS AND METHODS:A retrospective cohort study was conducted at a single institution (Johns Hopkins Hospital) to include patients surgically treated for adult hydrocephalus between 2003 and 2014 drawn from a data base of patients who had undergone standardized hydrocephalus protocol MR imaging. Preoperative imaging was reviewed by 2 blinded neuroradiologists to characterize the presence of DESH. Preoperative and postoperative clinical symptomatology was recorded. Frequencies were compared using the Fisher exact test, and nonparametric means were compared using the Mann-Whitney U Test.
RESULTS:One hundred thirty-three subjects were identified and included (96 DESH absent, 37 DESH present). Shunting led to significant improvement in gait and urinary and cognitive symptoms for the overall cohort and for patients with and without DESH (P < .05). The Fisher exact test did not demonstrate any significant differences in either gait or urinary or cognitive symptom improvement between patients with or without DESH (P > .05).
CONCLUSIONS:The current study demonstrated symptom improvement in patients with adult hydrocephalus following shunting, with no significant differences between subjects with and without DESH. Thus, shunt insertion for patients with adult hydrocephalus should not rely solely on the presence of preoperative DESH findings.
The Top 20 Most Prolific Authors in the American Journal of Neuroradiology: What Is Their Impact? [RESEARCH PERSPECTIVES]
BACKGROUND AND PURPOSE:
Many articles that are relevant to patient care but published in radiology journals may escape notice by clinicians. We sought to determine how often the 20 most prolific American Journal of Neuroradiology (AJNR) authors from 2013 to 2017 published in clinical journals and the extent to which their articles were disseminated into the clinical literature.
MATERIALS AND METHODS:We counted all authors' first- or senior-authored articles in the AJNR from 2013 to 2017 to identify the 20 most prolific authors in AJNR. We searched for these 20 authors' total articles from 2013 to 2017 to determine which were published in radiology or clinical journals and the number of citations received from radiology and clinical journals. Authors were sorted into quartiles according to these metrics, and other descriptive statistics were performed.
RESULTS:The top 20 AJNR authors contributed to 1463 articles during 5 years, including 711 (48.6%) in radiology and 752 (51.4%) in clinical journals. These articles were cited 15,857 times, including 4659 (29.3%) by articles in radiology journals. The more prolific authors published in clinical journals more often (Spearman = 0.65, P = .002) and were cited more ( = 0.42, P = .07). Articles published in clinical journals were cited more often (mean, 12.3 clinical, 9.3 radiology general versus 8.7 in AJNR), and whether published in radiology or clinical journals, they were cited more frequently by clinical journals.
CONCLUSIONS:Regardless of where it is published, radiology research is disseminating into the clinical realm. Radiology articles published in clinical journals are cited more often than those published in radiology journals.
Peeking into the Black Box of Coregistration in Clinical fMRI: Which Registration Methods Are Used and How Well Do They Perform? [FUNCTIONAL]
BACKGROUND AND PURPOSE:
Interpretation of fMRI depends on accurate functional-to-structural alignment. This study explores registration methods used by FDA-approved software for clinical fMRI and aims to answer the following question: What is the degree of misalignment when registration is not performed, and how well do current registration methods perform?
MATERIALS AND METHODS:This retrospective study of presurgical fMRI for brain tumors compares nonregistered images and 5 registration cost functions: Hellinger, mutual information, normalized mutual information, correlation ratio, and local Pearson correlation. To adjudicate the accuracy of coregistration, we edge-enhanced echo-planar maps and rated them for alignment with structural anatomy. Lesion-to-activation distances were measured to evaluate the effects of different cost functions.
RESULTS:Transformation parameters were congruent among Hellinger, mutual information, normalized mutual information, and the correlation ratio but divergent from the local Pearson correlation. Edge-enhanced images validated the local Pearson correlation as the most accurate. Hellinger worsened misalignment in 59% of cases, primarily exaggerating the inferior translation; no cases were worsened by the local Pearson correlation. Three hundred twenty lesion-to-activation distances from 25 patients were analyzed among nonregistered images, Hellinger, and the local Pearson correlation. ANOVA analysis revealed significant differences in the coronal (P < .001) and sagittal (P = .04) planes. If registration is not performed, 8% of cases may have a >3-mm discrepancy and up to a 5.6-mm lesion-to-activation distance difference. If a poor registration method is used, 23% of cases may have a >3-mm discrepancy and up to a 6.9-mm difference.
CONCLUSIONS:The local Pearson correlation is a special-purpose cost function specifically designed for T2*–T1 coregistration and should be more widely incorporated into software tools as a better method for coregistration in clinical fMRI.
Primary diffuse large B cell lymphoma of the vulva—Two new cases of a rare entity and review of the literature
With fewer than two dozen detailed cases reported in the literature, primary diffuse large B-cell lymphoma (DLBCL) of the vulva is a rare entity.
Successful treatment of drug reaction with eosinophilia and systemic symptoms syndrome relapse with oral pulsed dexamethasone
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe hypersensitivity reaction that can be life threatening. Long-term treatment with corticosteroids is required in the management of DRESS syndrome, and relapse or worsening of symptoms after a short course of steroids after initial improvement is common. Oral steroid pulse therapy has been used to treat various dermatologic conditions with the goal of reducing toxicity associated with sustained steroid use. The use of oral pulse therapy in the treatment of DRESS syndrome has not been reported.
Purpura fulminans–like lesions in antiphospholipid syndrome with endothelial C3 deposition
Antiphospholipid syndrome (APS) is an autoimmune disease characterized by the presence of antiphospholipid antibodies (aPL) associated with thrombosis or pregnancy morbidity. These antibodies include lupus anticoagulant (LA), anticardiolipin antibody (ACL), and anti–β2-glycoprotein antibody (anti-β2GPI). APS can be either primary or secondary to autoimmune diseases, mainly to systemic lupus erythematosus, but it can also be associated with other autoimmune, malignant, or drug-induced diseases.1
A novel mutation in the HPGD gene results in the unusual phenotype of palmoplantar keratoderma with digital clubbing and hyperhidrosis
Palmoplantar keratoderma (PPK) is a disorder of keratinization. Here we present an unusual case of PPK in association with hyperhidrosis and digital clubbing. This patient had a novel homozygous mutation in the HPGD gene, a mutation not previously reported in the pathogenesis of this phenotype.
Generalized bullous fixed-drug eruption secondary to the influenza vaccine
Fixed drug eruption (FDE) is a type IV hypersensitivity reaction characterized by recurrence of lesions at identical sites with each exposure to the offending medication. After morbilliform exanthems, FDE is the most common cutaneous drug reaction.1 Generalized bullous fixed drug eruption (GBFDE) is a variant of FDE that can present rarely with significant, life-threatening body surface involvement akin to Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).2 There are few reported cases of GBFDE occurring after the influenza vaccine, and all occurred after decades of receiving the vaccine.
Extragenital condyloma acuminatum in the left axillary vault
Condyloma acuminatum is a benign epithelial proliferation attributed to the epidermotropic human papillomavirus (HPV) and generally associated with sexual transmission. More than 100 types of HPV have been discovered, but strains 6 and 11 are found to cause approximately 90% of condyloma acuminatum. Lesions occur most frequently on the mucous membranes of the anogenital region, but also may occur in the conjunctiva and oral mucosa. Extragenital condyloma acuminatum not associated with sexual activity is rare, having previously only been described in the groin and inframammary fold.
Transformation from pityriasis rubra pilaris to erythema gyratum repens–like eruption without associated malignancy: A report of 2 cases
Erythema gyratum repens (EGR), considered one of the most specific cutaneous paraneoplastic phenomena, is characterized by a serpiginous morphology and a migrating scaly border. EGR is associated with malignancy, most commonly bronchial, esophageal, and breast, in more than 80% of cases.1,2 Here we report 2 cases of patients with pityriasis rubra pilaris (PRP), whose eruption transformed to an EGR-like eruption without any evidence of malignancy.
A new single red nodule on the abdomen of a woman with history of endometrial carcinoma: Noninvasive evaluation and histologic correlation
An 82-year-old woman was referred to our dermatology department from the oncology department with a new, well-demarcated, red papule on her abdomen (Fig 1). The patient had a history of endometrial carcinoma treated 3 years prior with extensive surgery and radiotherapy. She had been in complete remission for the past 2 years.
Extragenital lichen sclerosus et atrophicus within a skin graft scar
Lichen sclerosus et atrophicus (LSA) is rare chronic relapsing skin condition typically arising in postmenopausal women and prepubescent children in the genital area. Only 6% of cases occur in extragenital skin without concomitant anogenital involvement.1 LSA can exhibit the Koebner phenomenon. Although various types of inciting events have been documented for the development of extragenital lichen sclerosus et atrophicus, we present the first case, to our knowledge, to occur within a skin graft donor site.
Cutaneous squamous cell carcinoma with subtle perineural invasion detected with cytokeratin and epithelial membrane antigen immunohistochemistry
Perineural invasion (PNI), the infiltration of tumor within the perineural space, is an independent risk factor for adverse outcomes in cutaneous squamous cell carcinoma (cSCC) including recurrence, metastasis, and death.1,2 During microscopically controlled excision, histopathologic features seen on intraoperative tissue sections can present challenges in assessing the presence of PNI. Benign findings such as normal perineurium may mimic PNI in routine sections. Conversely, subtle PNI may be mistaken for benign findings.
Cutaneous erysipeloid metastasis of cholangiocarcinoma and evaluation by in vivo reflectance confocal microscopy
Cutaneous metastases are relatively uncommon, occurring in only 0.7% to 9% of all internal malignancies.1 Cholangiocarcinoma is a rare bile duct neoplasm that accounts for less than 2% of maligancies.2 Although it is well known that cholangiocarcinoma metastasizes to the lungs, liver, peritoneum, and retroperitoneal lymph nodes,2 a retrospective review of the literature from 1978 to 2014 indicates only 30 cases of cutaneous cholangiocarcinoma, with 17 cases presenting without concurrent metastasis in other sites.
Successful dabrafenib transition after vemurafenib-induced toxic epidermal necrolysis in a patient with metastatic melanoma
Vemurafenib improves survival in advanced metastatic melanoma, but has rarely been associated with severe skin reactions including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).1,2 Dabrafenib is a BRAF inhibitor that shares a sulfonamide moiety with vemurafenib, and only one prior report documents a switch to dabrafenib after the development of SJS/TEN with vemurafenib.2,3 We report a case of vemurafenib-induced TEN followed by successful transition to full-dose therapy with dabrafenib in a patient with metastatic melanoma.
Tumoral melanosis associated with combined BRAF/MEK inhibition (dabrafenib/trametinib) in metastatic melanoma
Tumoral melanosis describes a pigmented lesion clinically suspicious for melanoma but characterized histopathologically by aggregates of melanin-laden macrophages without malignant cells.1,2 Limited cases of tumoral melanosis exist in the literature; often it is identified on the skin as a macule or papule or may present in the lymph nodes of a patient with a history of melanoma or a longstanding atypical lesion, and further investigation can yield undiagnosed local or metastatic disease.2,3 Recently, there are examples of tumoral melanosis arising during treatment for melanoma, mostly with anti-PD-1 or anti-CTLA-4 therapy.
Eruptive lentiginosis in resolving psoriatic plaques
Eruptive lentiginosis confined to areas of resolving psoriatic plaques (ELRP) is a rare occurrence. Several previous reports described this phenomenon after the use of different treatment modalities to resolve psoriatic plaques, including topical, ultraviolet light, and biologic therapies. We present a case of ELRP after treatment with ustekinumab. We completed a review of the literature synthesizing all available reports describing lentiginous macules at the site of resolving psoriatic plaques to describe the patient population, treatments, and clinical characteristics associated with this entity.
Squamous cell carcinoma arising from a chromomycosis lesion caused by Rhinocladiella aquaspersa with postsurgical recurrence of chromomycosis
Chromomycosis is a chronic granulomatous infection of the skin and the subcutaneous tissue that often follows traumatic injury and inoculation of the agent, which belongs to the group of dematiaceous fungi.
Proximal nail fold swelling, pain, and granulation tissue
A 28-year-old man presented with a 4-month history of left great toe pain, swelling, erythema, and drainage. The patient was previously treated with a topical antifungal, oral antibiotics, and hot water soaks without improvement of symptoms. The patient's toe upon presentation is depicted in Fig 1 and after gentle washing in Fig 2. The patient's nail plate is depicted in Fig 3.
The use of a suture retention device with punctureless technique for rapid tissue expansion in facial and lower extremity wounds
Surgical defects of the face and lower extremity provide unique reconstructive challenges because of the highly visible site and limited local tissue supply.1 Aesthetic reconstructive options are scarce when a patient declines a flap or graft. As previously published, the use of a novel suture retention device (SRD) (SUTUREGARD; SUTUREGARD Medical, Portland, OR) may provide stress-relaxation of wounds and tissue expansion in a timely manner using percutaneous simple interrupted sutures.2 Using subcuticular sutures along with the SRD may circumvent factors that lead to the formation of suture marks, which include high wound tension and epidermal puncture wounds.
Vulvovaginal pyoderma gangrenosum in association with rituximab
Pyoderma gangrenosum (PG) is an uncommon inflammatory and ulcerative skin disease with 4 major clinical forms: ulcerative, vesicular-bullous, pustular, and superficial granulomatous/vegetative. Lesions are painful and most frequently occur on the lower extremities, although they can occur anywhere, including mucus membranes and peristomal sites. The pathophysiology of PG is speculative, but proposed mechanisms include loss of innate immune regulation or altered neutrophil chemotaxis.1 Biopsies most characteristically find neutrophilia, and the concept of neutrophil dysregulation has also been supported by the clinical response that may be seen with the use of antineutrophilic agents including colchicine and dapsone.
Dupilumab in the management of topical corticosteroid withdrawal in atopic dermatitis: A retrospective case series
Topical corticosteroid (TCS) withdrawal, or steroid addiction, is a poorly understood, distinct adverse effect of inappropriate TCS use. It occurs most commonly in adult women applying mid- or high-potency TCS to the face or genital region and is associated with increased frequency and duration of treatment.1-3 TCS withdrawal should be suspected when confluent erythema appears within days to weeks of discontinuing therapy, stinging and burning are prominent symptoms, and history is consistent with the at-risk population described above.
Treatment of an ulcerated hemangioma with dehydrated human amnion/chorion membrane allograft
We report the case of a 10-month-old girl with a large segmental "beard-distributed" infantile hemangioma (IH) with recalcitrant ulceration, successfully treated with dehydrated Human Amnion/Chorion Membrane allograft (dHACM, EpiFix; MiMedx Group, Marietta, GA). The patient initially presented at 10 days of life with respiratory distress and was noted to have a segmental IH of the lower face and neck. Endoscopy confirmed involvement of the upper airway. Findings from a PHACE (posterior fossa malformations, hemangiomas, arterial anomalies, cardiac defects, eye abnormalities, sternal cleft, and supraumbilical raphe) workup were normal.
Local bivalve allergens
Abstract
Background
Apart from the nutritional benefits, bivalves are also considered to be among a group of allergenic foods. Symptoms of allergy to bivalves are largely similar to those of allergic reactions reported for other shellfish. The identification of allergenic proteins in a particular species is an important step for the development of more accurate allergy tests and for the definition of more effective management of patients. Currently, studies regarding the allergens in bivalve species are lacking.
Materials and methods
This minireview is an overview of local scientific articles on identification of bivalve allergens by allergenomics methods including sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), two-dimensional gel electrophoresis (2-DE), immunoblotting and mass-spectrometry analysis.
Results
Tropomyosin has been the only well recognized allergen in a wide range of bivalve species. In addition to tropomyosin, our local study resulted in discovery of three novel bivalve major allergens; arginine kinase (40 kDa), actin (42 kDa) and troponin C (18 kDa).
Conclusion
This minireview will provide a better understanding of each allergen derived from local bivalves which subsequently will help in the understanding of the specific immunoglobulin E(IgE)-mediated immune response.
A century of “intrinsic asthma”
Abstract
Background
One hundred years ago Rackemann published the first description of Intrinsic Asthma. This was the beginning of a process of phenotyping the disease.
Materials and methods
The literature regarding asthma phenotypes of the last 100 years has been checked. Lately, there have been many new publications dealing with this specific asthma phenotype.
Conclusion
Today, the term asthma is looked at as an umbrella covering different phenotypes of the disease. According to a recent publication, Intrinsic Asthma is most often cited now as eosinophilic adult-onset asthma. New treatment strategies for this phenotypes have evolved in recent years.
Long-acting muscarinic antagonists for the treatment of asthma in children—a new kid in town
Abstract
Background
Asthma is the most prevalent chronic airway disease observed in children and adolescents, yet the variety of treatment options available for this age group is limited. With many factors influencing therapeutic efficacy including patient knowledge, adherence, and therapy choice as well as delivery device, it is important to have more options to tailor to individual patient needs.
Methods
This article is an overview of recent scientific articles using a systematic literature search in PubMed and specialist databases.
Results
Tiotropium is the first long-acting muscarinic antagonist to be licensed for treatment of asthma and has been demonstrated to be an effective add-on therapy across all age groups. Its therapeutic success in clinical trials resulted in Food and Drug Administration and the European Medicines Agency approval for asthma treatment in people over the age of 6 years in the US and EU.
Conclusion
Further studies into the use of tiotropium, especially in younger children, could be of interest for future treatment decisions.
Allergen immunotherapy for oral allergy syndrome: what is the evidence for efficacy?
Abstract
Background
The vast majority of IgE-mediated food allergies in adults are based on sensitization to pollen and subsequent cross-reactions to structurally related allergens in fruit, vegetables, and spices. The effect of allergen immunotherapy (AIT) against pollen on pollen-related food allergy has not been conclusively elucidated.
Methods
A review of studies on AIT in pollen-related food allergy was conducted.
Results
The fact that the published studies show considerable differences in terms of design (e.g., number of subjects, treatment duration, mode of administration, allergen content, oral provocation testing) hampers their evaluation and comparison. Only some of the studies demonstrated an improvement in pollen-related food allergy as a result of AIT with pollen allergens.
Conclusion
Reliable recommendations on the use of AIT with pollen allergens in pollen-related food allergy are not possible as yet. AIT with birch pollen allergens appears to have a positive effect on concomitant food allergy in some patients with birch pollen allergy.
David Rubinsztein - common name
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Thursday, October 25, 2018 - 16:00
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Tuesday, November 20, 2018 - 08:00
Secretomic analysis of Beauveria bassiana related to cattle tick, Rhipicephalus microplus , infection
Abstract
Beauveria bassiana is widely studied as an alternative to chemical acaricides in controlling the cattle tick Rhipicephalus microplus. Although its biocontrol efficiency has been proved in laboratory and field scales, there is a need to a better understanding of host interaction process at molecular level related to biocontrol activity. In this work, applying a proteomic technique multidimensional protein identification technology (MudPIT), the differential secretome of B. bassiana induced by the host R. microplus cuticle was evaluated. The use of the host cuticle in a culture medium, mimicking an infection condition, is an established experimental model that triggers the secretion of inducible enzymes. From a total of 236 proteins, 50 proteins were identified exclusively in infection condition, assigned to different aspects of infection like host adhesion, cuticle penetration and fungal defense, and stress. Other 32 proteins were considered up- or down-regulated. In order to get a meaningful global view of the secretome, several bioinformatic analyses were performed. Regarding molecular function classification, the highest number of proteins in the differential secretome was assigned in to hydrolase activity, enzyme class of all cuticle-degrading enzymes like lipases and proteases. These activities were also further validated through enzymatic assays. The results presented here reveal dozens of specific proteins and different processes potentially implicated in cattle tick infection improving the understanding of molecular basis of biocontrol of B. bassiana against R. microplus.
Erosive pustular dermatosis of the scalp: a neutrophilic folliculitis within the spectrum of neutrophilic dermatoses. A clinicopathologic study of thirty cases
Histopathology of primary lesion of erosive pustular dermatosis of the scalp has not been characterized. Biopsy of intact follicular pustules shows spongiotic vesiculo-pustules affecting the follicular infundibula. Erosive pustular dermatosis of the scalp is a neutrophilic superficial folliculitis, with some clinicopathologic similarities with other pathergic neutrophilic dermatoses, such as pyoderma gangrenosum.
Characterization of glucose‐stimulated insulin release protocols in african green monkeys (Chlorocebus aethiops)
Journal of Medical Primatology, EarlyView.
Dysplastic Nevi: Monitoring and Management
Is it safe to observe moderately dysplastic nevi with positive histologic margins, or is the risk for cutaneous melanoma too high?
Medscape Dermatology
Melanoma Early Detection: Big Data, Bigger Picture
Innovative technologies, including novel communication and imaging tools, are affecting dermatology in profound ways. A burning question for the field is whether we will retrospectively react to innovations or proactively leverage them to benefit precision medicine. Early detection of melanoma is a dermatologic area particularly poised to benefit from such innovation. This session of the Montagna Symposium on Biology of Skin focused on provocative, potentially disruptive advances, including crowdsourcing of patient advocacy efforts, rigorous experimental design of public education campaigns, research with mobile phone applications, advanced skin imaging technologies, and the emergence of artificial intelligence as a diagnostic supplement.
Methamphetamine Roils Rural Towns Again Across The U.S.
Meth is back "with a vengeance," police say. Now made mostly by superlabs in Mexico, it is stronger, cheaper and more prevalent, cutting across demographic barriers and sparking serious crime.
(Image credit: GUILLERMO ARIAS/AFP/Getty Images)
Effect of Decantation Time on Viability and Apoptosis in Adipocytes After Liposuction
Abstract
Background
The effect of decantation time on viability and apoptosis in adipocytes has not been described. The objective of the study was to describe viability and apoptosis in adipocytes up to 2 h after harvesting.
Methods
Twenty patients who underwent esthetic liposuction from the abdomen were included. The lipoaspirate was obtained from the infra-umbilical area with the tumescent technique. Liposuction was performed with a 60-ml syringe and a 3-ml cannula. Lipoaspirates were centrifuged at 50 g for 5 min at 0, 60 and 120 min after harvesting. One gram of fat was digested with 0.1% type 1 collagenase and incubated at 37 degrees for 30 min. Adipocytes were counted on 10 random microscopic fields. Apoptosis was determined by TUNEL assay. A fluorescence microscope was used to visualize the staining nuclei and cells.
Results
Regarding viability, immediately after harvesting, 57.6 ± 18.9% of the cells were viable, whereas 60 min after liposuction the viability decreased to 51.62 ± 8.8% and 120 min after liposuction the percentage of viable cells was 46.8 ± 16.9%. The percentage of apoptotic cells at time 0 was 38.2 ± 8.0%, whereas it was 51.24 ± 8.1% at 60 min and 62.9 ± 16.1% at 120 min after collection.
Conclusions
Apoptosis and mortality of adipocytes after liposuction increase directly proportional to the time of decantation. Lipoinjection should be performed as soon as possible after harvesting.
No Level Assigned
This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Sensation-Sparing Correction of Inverted Nipples Using the ‘Drawbridge’ Flap Approach
Abstract
Introduction
An inverted nipple can cause significant functional and psychologic disturbance to women. The holy grail of any surgical technique to correct this is to restore adequate nipple projection and at the same time, try to preserve lactation and nipple sensation. We describe our experience using an inferior dermal nipple-areolar interposition flap to correct the inverted nipple alongside with selective release of the lactiferous ducts of the nipple.
Materials and Methods
We have employed this technique successfully in 97 cases of inverted nipples in 60 patients with follow-up periods of up to 2 years. Twenty-three of them had unilateral inversion, and 37 of them had bilateral nipple inversion.
Results
The appearance of the nipple was good to excellent. Seventy to 80% of the initial postoperative nipple projection at the end of 1 year was maintained. Postoperative complications included stitch abscess in one patient (n = 1) and an epidermal cyst in another (n = 1). Nipple sensation was preserved in 100% of cases. There was no recurrence of inversion in any of the nipples.
Discussion
By identifying the root cause of inverted nipples in each individual case, and selectively targeting them, we minimize surgical morbidity with a simple technique that avoids any form of traction or compression of the nipple and minimizes the risk of altered nipple sensation.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266.
Demystifying Kashmiri Rasa Ideology: Rāmacandra–Guṇacandra’s Theory of Aesthetics in Their Nāṭyadarpaṇa
Abstract
This paper presents a study of Rāmacandra–Guṇacandra's theory of aesthetics in light of the Kashmiri rasa ideology and demonstrates that the Jain authors offer a new and original conceptualization of aesthetic experience, in which the spectator remains cognitively active in the course of watching the drama. In their model, the relationship between rasa and pleasure is mediated by a cognitive error, and the feeling of pleasure does not coincide with the savoring of rasa but emerges after the savoring of rasa ceases. This paper argues that Rāmacandra and Guṇacandra demystify the Kashmiri theory of aesthetics by identifying affinities between the lived world and the fictive world of drama and by rendering the regular means of knowledge, such as inference and memory, as instrumental for the experience of rasa. It further suggests that this new conceptualization, in which pleasure is contingent upon the dissolution of illusion, may have facilitated the development of playwrighting among Jain monks from the twelfth century on.
Rethinking the role of theory in exploratory experimentation
Abstract
To explain their role in discovery and contrast them with theory-driven research, philosophers of science have characterized exploratory experiments in terms of what they lack: namely, that they lack direction from what have been called "local theories" of the target system or object under investigation. I argue that this is incorrect: it's not whether or not there is direction from a local theory that matters, but instead how such a theory is used to direct an experiment that matters. Appealing to contemporary exploratory experiments that involve the use of experimental techniques—specifically, examples where scientists explore the interaction of neural activity and human behavior by magnetically stimulating brains—I argue that local theories of a target system can inform auxiliary hypotheses in exploratory experiments, which direct these experiments. These examples illustrate how local theories can direct the exploration of target systems where researchers do not aim to evaluate these theories.
Prion protein is essential for diabetic retinopathy-associated neovascularization
Abstract
Diabetic retinopathy (DR), a major complication of diabetes caused by vascular damage and pathological proliferation of retinal vessels, often progresses to vision loss. Vascular endothelial growth factor (VEGF) signaling plays a pivotal role in the development of DR, but the exact underlying molecular mechanisms remain ill-defined. Cellular prion protein (PrPc) is a surface protein expressed by vascular endothelial cells, and the increased expression of PrPc is associated with physiological and pathological vascularization. Nevertheless, a role for PrPc in the development of DR has not been appreciated. Here, we addressed this question. We found that the development of streptozocin (STZ)-induced DR, but not the STZ-induced hyperglycemia/diabetes itself, was significantly attenuated in PrPc-KO mice, compared to control wildtype (WT) mice, evident by measurement of retinal vascular leakage, retinal neovascularization, a retinopathy score and visual acuity assessment. Moreover, the attenuation of DR severity seemingly resulted from attenuation of retinal neovascularization via VEGF/ras/rac signaling. Together, our study suggests a previously unappreciated role for PrPc in the development of DR.
Endothelial loss of Fzd5 stimulates PKC/Ets1-mediated transcription of Angpt2 and Flt1
Abstract
Aims
Formation of a functional vascular system is essential and its formation is a highly regulated process initiated during embryogenesis, which continues to play important roles throughout life in both health and disease. In previous studies, Fzd5 was shown to be critically involved in this process and here we investigated the molecular mechanism by which endothelial loss of this receptor attenuates angiogenesis.
Methods and results
Using short interference RNA-mediated loss-of-function assays, the function and mechanism of signaling via Fzd5 was studied in human endothelial cells (ECs). Our findings indicate that Fzd5 signaling promotes neovessel formation in vitro in a collagen matrix-based 3D co-culture of primary vascular cells. Silencing of Fzd5 reduced EC proliferation, as a result of G0/G1 cell cycle arrest, and decreased cell migration. Furthermore, Fzd5 knockdown resulted in enhanced expression of the factors Angpt2 and Flt1, which are mainly known for their destabilizing effects on the vasculature. In Fzd5-silenced ECs, Angpt2 and Flt1 upregulation was induced by enhanced PKC signaling, without the involvement of canonical Wnt signaling, non-canonical Wnt/Ca2+-mediated activation of NFAT, and non-canonical Wnt/PCP-mediated activation of JNK. We demonstrated that PKC-induced transcription of Angpt2 and Flt1 involved the transcription factor Ets1.
Conclusions
The current study demonstrates a pro-angiogenic role of Fzd5, which was shown to be involved in endothelial tubule formation, cell cycle progression and migration, and partly does so by repression of PKC/Ets1-mediated transcription of Flt1 and Angpt2.
Issue Information
Wound Repair and Regeneration, Volume 26, Issue 2, Page 111-115, March/April 2018.
Thiuram allergic contact dermatitis on the hands after skin contact with a rubber cellphone case
Contact Dermatitis, EarlyView.
Experience and Acceptance of Cosmetic Procedures Among South Korean Women in Their 20s
Abstract
Purpose
This study aimed to investigate the relationship between acceptance of cosmetic surgery (ACS) and cosmetic procedure experience in women in their 20s.
Methods
We collected 330 randomly sampled women in their 20s in November 2017. The collected data were analyzed by descriptive statistics, t test, crosstabs, Chi-square test, ANOVA, Pearson's correlation, and binary logistic regression.
Results
Almost all (97.9%) of the subjects had heard about the side effects of cosmetic surgery, and "Internet" was the most common source of information (57.3%). The number of subjects who had already undergone more than 1 cosmetic procedure was 124 women (37.6%), and the first age of cosmetic procedure was 21.81 (± 2.83) years old. ACS had a negative correlation with appearance satisfaction (r = − 0.18, p = 0.001). There was positive correlation between appearance satisfaction and self-esteem (r = 0.62, p < 0.001) and negative correlation between appearance satisfaction and body mass index (BMI) (r = − 0.28, p < 0.001). The higher the age of 1 year, the greater the probability of experience of cosmetic procedure (1.17 times) (OR 1.17, p = 0.002), and the higher the ACS score, the greater the probability of cosmetic procedure being 1.06 times (OR 1.06, p < 0.001). The higher the BMI score, the lower the probability of experiencing cosmetic procedure by 0.84 times (OR 0.84, p < 0.001).
Conclusion
Age, ACS and BMI were the factors influencing the cosmetic procedure experience, and the cosmetic procedure experience led to more cosmetic procedures.
Level of Evidence V
Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Expression of Lactobacillus plantarum KW30 gcc genes correlates with the production of glycocin F in late log phase
Abstract
Antibacterial compounds known as bacteriocins are microbial inventions designed to reduce competition for limited resources by inhibiting the growth of closely related bacteria. Glycocin F (GccF) is an unusually di-glycosylated bacteriocin produced in a lactic acid bacterium (LAB), Lactobacillus plantarum KW30 that has been shown to be resistant to extreme conditions. It is bacteriostatic rather than bactericidal, and all its post-translational modifications (a pair of nested disulfide bonds, and O-linked and S-linked N-acetylglucosamines) are required for full activity. Here we examine a cluster of genes predicted to be responsible for GccF expression and maturation. The expression of eight genes, previously reported to make up the gcc operon, were profiled for their expression during cell culture. We found that all but one of the genes of the gcc cluster followed a pattern of expression that correlated with the stage of growth observed for the producer organism along with the increase in GccF secretion. We also found that most of the gcc genes are transcribed as a single unit. These data provide evidence that the gcc cluster genes gccABCDE constitute a true operon for regulated GccF production, and explain the observed increase in GccF concentration that accompanies an increase in cell numbers.Luminol Chemiluminescence Reports Photodynamic Therapy‐Generated Neutrophil Activity In Vivo and Serves as a Biomarker of Therapeutic Efficacy
Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.
Audiological and clinical outcomes of a transcutaneous bone conduction hearing implant: 6‐month results from a multicenter study
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
5 Major Crops In The Crosshairs Of Climate Change
The plants that nourish us won't disappear entirely. But they may have to move to higher, cooler latitudes. Some places may find it harder to grow anything at all, because there's not enough water.
(Image credit: Mary Mathis and Heather Kim/NPR)
Optimal Timing of Reconstruction When Using Tissue Grafts After Mohs Micrographic Surgery
Does a delay in reconstruction after Mohs micrographic surgery (MMS) result in a higher complication rate than same-day repair? The results of the study from David et al in this issue of JAMA Facial Plastic Surgery suggest that delaying reconstruction may not be harmful, and in the case of skin grafts and composite grafts, waiting to repair may actually be beneficial.
Volumizing Hyaluronic Acid Filler for Treatment of Infraorbital Hollows
To the Editor I commend Dr Hall and colleagues for their intrepid and innovative contribution to the cosmetic literature. Although anecdotal experience indicates that aesthetic clinicians have been using injectable fillers of various cohesivities and hydrophilicities throughout the face, the prevailing wisdom and literature from core physicians have dictated that physicians avoid products with a high viscous modulus (G′) when treating the tear trough. It is thus refreshing that Hall et al have used their comfort with and knowledge of the tear trough to demonstrate that a long-lasting filler can be both safe and cosmetically pleasing when placed in the infraorbital hollows. Given that hyaluronic acid is commonly placed on periosteum to rejuvenate the tear trough, it would logically follow that Juvéderm Voluma, a product with low hydrophilicity and long duration, designed to be placed supraperiosteally, might yield excellent and sustained outcomes. However, a variety of reasons, ranging from simple risk aversion to insufficient comfort with orbital anatomy to uncertainty about the behavior of a highly cross-linked product in a notoriously delicate and unforgiving space, have dictated that most aesthetic physicians use products of lower cohesivity and G′. In addition, although Hall et al should be commended for their use of the FACE-Q, it is worth noting the potential limitations of this metric. Although overall patient Satisfaction With Eyes and Decision to Treat were 71.1% and 65.6%, respectively, these numbers might be interpreted as artificially low because of the nature of the questions asked. For example, a patient could have an excellent response to tear trough filler resulting in high satisfaction with attractiveness and youthfulness of the eyes but still report being "very dissatisfied" with the shape, openness, and bright-eyed appearance of the eyes; these elements might not be expected to be modulated by infraorbital filler. Overall, this is an interesting and important study demonstrating excellent cosmetic and patient-reported outcomes with the potential to change injection practices.
Comparison of Outcomes of Early vs Delayed Graft Reconstruction of Mohs Surgery Defects
This study reviews the outcomes of Mohs micrographic surgery using full-thickness skin grafts and composite grafts with respect to patient- and surgery-specific variables, particularly early vs delayed defect reconstruction.
Altered metabolic pathways regulate synovial inflammation in Rheumatoid Arthritis
Clinical &Experimental Immunology, Volume 0, Issue ja, -Not available-.
AID and TET2 cooperation modulates FANCA expression by active demethylation in diffuse large B cell lymphoma
Clinical &Experimental Immunology, Volume 0, Issue ja, -Not available-.
Discoid lupus erythematosus: Reflectance confocal microscopy features correlate with horizontal histopathological sections
Skin Research and Technology, EarlyView.
Dynamic thermal imaging on actinic keratosis patients: A preliminary study
Skin Research and Technology, EarlyView.
Minimal erythema dose, minimal persistent pigment dose which model for whitening products evaluation is better?
Skin Research and Technology, EarlyView.
Ultrasound‐guided fine‐needle aspiration biopsy in skin lesions
Skin Research and Technology, EarlyView.
Age‐related changes in lip morphological and physiological characteristics in Korean women
Skin Research and Technology, EarlyView.
The Severe Asthma Network in Italy (SANI): findings and perspectives
Publication date: Available online 25 October 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Enrico Heffler, Francesco Blasi, Manuela Latorre, Francesco Menzella, Pierluigi Paggiaro, Girolamo Pelaia, Gianenrico Senna, Giorgio Walter Canonica, SANI Network
ABSTRACT
Background
Severe Asthma Network in Italy (SANI) is a registry of patients recruited by accredited centers on severe asthma.
Objective
to analyze epidemiological, clinical, inflammatory, functional and treatment characteristics of severe asthmatics from the SANI registry
Methods
All consecutive patients with severe asthma were included into the registry, without exclusion criteria in order to have real-life data on demographics, asthma control, treatments (including biologics), inflammatory biomarkers and comorbidities.
Results
437 patients (mean age: 54.1 years, 57.2% females, 70.7% atopics, 94.5% in GINA severity step 5) were enrolled into the study. Mean annual exacerbation rate was 3.75. Mean blood eosinophil level was 536.7 cells/mcl and average serum total IgE was 470.3 kU/l. About 64% of patients were on regular oral corticosteroid treatment, 57% with omalizumab and 11.2% with mepolizumab. Most common comorbidities were rhinitis, nasal polyposis and bronchiectasis. Patients with nasal polyposis had higher age of disease onset, higher blood eosinophil count and lower frequency of atopy and atopic eczema. Bronchiectasis was associated with more frequent severe exacerbations, higher blood eosinophils and total IgE. Stratifying patients, those with late-onset asthma were less frequently atopic (with less frequent allergic rhinitis and food allergy), and more frequently with nasal polyposis and higher serum total IgE levels.
Conclusions
This study revealed a high frequency of relevant comorbidities and that a substantial proportion of patients have a late-onset asthma; all these features define specific different disease phenotypes. Severe asthma complexity and comorbidities require multidisciplinary approaches, led by specifically trained Pulmonologists and Allergists.
The HEDIS Medication Management for People with Asthma (MMA) Measure Is Not Associated with Improved Asthma Outcomes
Publication date: Available online 25 October 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Shilpa H. Desai, William W. Crawford, Javed Sheikh, Zoe Q. Li, Wansu Chen, Aili Gong, Ralph Vogel, Michael Schatz
Angioedema frequently occur in cholinergic urticaria
Publication date: Available online 25 October 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Emilia Juliane Mellerowicz, Aida Asady, Marcus Maurer, Sabine Altrichter
Clinical Characteristics of Patients with Chronic Rhinosinusitis without Nasal Polyps in an Academic Setting
Publication date: Available online 25 October 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Mariel R. Benjamin, Whitney W. Stevens, Newton Li, Sumit Bose, Leslie C. Grammer, Robert C. Kern, Bruce K. Tan, David B. Conley, Stephanie S. Smith, Kevin C. Welch, Robert P. Schleimer, Anju T. Peters
A simple score for future risk prediction in patients with controlled asthma who undergo a guidelines-based step-down strategy.
Publication date: Available online 25 October 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Luis Pérez de Llano, Juan Luis García-Rivero, Isabel Urrutia, Eva Martínez-Moragón, Jacinto Ramos, Pilar Cebollero, Francisco Carballada, Marina Blanco, María del Carmen Vennera, María Merino, Yolanda Torralba García, NR, Vicente Plaza
Abstract
Background
The minimum controlling dose of treatment must be established in asthma patients, but the outcome of step-down is unpredictable.
Objective
To identify factors associated with risk of control loss when stepping-down asthma treatment and to develop a score to predict this risk.
Methods
Prospective, multicenter study including adults with well-controlled asthma. Treatment was stepped-up or stepped-down over a 12-month period to maintain asthma control. We determined associations between clinical and functional variables and step-down failure. Finally, we derived a score to predict loss of control in one cohort and validated it in an independent cohort.
Results
The derivation cohort consisted of 228 patients, 218 completed at least one step-down episode and a total of 495 step-down episodes were evaluated. A medical-record documented post-bronchodilator spirometry result of < 70% FEV1/FVC (OR = 2.08; 95% CI: 1.26–3.43), current FEV1 < 80% (OR = 1.80; 95% CI: 1.03–3.14), ≥1 severe exacerbation in the previous 12 months (OR = 2.43; 95% CI: 1.48–4.01) and ACT score < 25 (OR = 2.30; 95% CI: 1.35–3.92) were independently associated with failure. The score showed an AUC of 0.690 (95% CI: 0.633-0.747; p < 0.05) in the derivation cohort and 0.76 (95% CI: 0.643-0.882; p <0.001) in a validation cohort of 114 patients. A score < 4.5 implies a low risk of failure (< 20%) whereas a score >8 implies a high risk (>40%).
Conclusion
This score can facilitate the prediction of step-down failure before medication taper in well-controlled asthma patients.
Azathioprine hypersensitivity syndrome in a cohort of ANCA-associated vasculitis patients
Publication date: Available online 24 October 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Arno C. Hessels, Jan Stephan F. Sanders, Annick A.J.M. van de Ven, Bart-Jan Kroesen, Annechien J.A. Lambeck, Abraham Rutgers, Coen A. Stegeman
Abstract
Background
Azathioprine hypersensitivity syndrome is a rare complication of azathioprine therapy. Its symptoms resemble infection or relapse of inflammatory disease, hindering correct diagnosis. Current literature is limited to sporadic case reports and reviews.
Objective
To estimate the incidence of azathioprine hypersensitivity syndrome and describe its characteristics in the context of an observational cohort of ANCA-associated vasculitis patients. Also, to facilitate early recognition and awareness among clinicians.
Methods
Within a cohort of 290 ANCA-associated vasculitis patients receiving azathioprine maintenance therapy, frequency of azathioprine hypersensitivity was described and characteristics were compared between hypersensitive and non-hypersensitive patients. Clinical picture, laboratory abnormalities and concurrent medication of patients with azathioprine hypersensitivity were described.
Results
Of 290 patients, 25 (9%) experienced azathioprine hypersensitivity after a median of 14 (IQR 12-18) days. Frequent symptoms were fever (100%), malaise (60%), arthralgia (36%) and rash (32%). All patients used prednisolone (median 10mg/d, IQR 9.4-16.3mg/d) at the time of the hypersensitivity reaction. Most patients had a rise in CRP, leukocyte counts and neutrophil counts, but no eosinophilia. Thiopurine S-methyltransferase (TPMT) activity was significantly lower in hypersensitive patients (median 74.4 [IQR 58.0-80.1]nmol/gHb/l) compared to controls (median 81.4 [71.9-90.5] nmol/gHb/l), P=0.01. Hypersensitive patients had a higher risk of relapse (HR 2.2, 95% CI 1.2-4.2; P=0.01).
Conclusion
Azathioprine hypersensitivity syndrome is strikingly common in ANCA-associated vasculitis, might be associated with reduced TPMT activity, is accompanied by an increase in neutrophil counts and may occur even during concomitant prednisolone therapy. Proper recognition may prevent unnecessary hospital procedures and damage to the patient.
First psychodermatology clinic in a Portuguese department of Dermatology
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
Methotrexate and melanoma‐specific mortality
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
Inherited epidermolysis bullosa: description of clinical and subclinical morphological features with optical coherence tomography
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
Increased tumour cell PD‐L1‐expression, macrophage and dendritic cell infiltration characterise the tumour microenvironment of ulcerated primary melanomas
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
JAK1/3‐inhibition preserves epidermal morphology in full thickness 3D skin models of atopic dermatitis and psoriasis
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
Validation of “ItchApp©” in Poland and in the USA Multicenter validation study of an electronical Diary for the Assessment of pruritus
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
Post‐orf epidermolysis bullosa acquisita
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
Pcal_0970: an extremely thermostable l -asparaginase from Pyrobaculum calidifontis with no detectable glutaminase activity
Abstract
The genome sequence of Pyrobaculum calidifontis contains two open reading frames, Pcal_0144 and Pcal_0970, exhibiting homology with l-asparaginases. In search of a thermostable l-asparaginase with no glutaminase activity, we have cloned and expressed the gene encoding Pcal_0970 in Escherichia coli. Recombinant Pcal_0970 was produced in insoluble and inactive form which was solubilized and refolded into enzymatically active form. The refolded Pcal_0970 showed the highest activity at or above 100 °C. Optimum pH for the enzyme activity was 6.5. Addition of divalent metal cations or EDTA had no significant effect on the activity. The enzyme was capable of hydrolyzing d-asparagine with a 20% activity as compared to 100% with l-asparagine. Pcal_0970 did not show any detectable activity when l-glutamine or d-glutamine was used as substrate. Pcal_0970 exhibited a Km value of 4.5 ± 0.4 mmol/L and Vmax of 355 ± 13 μmol min−1 mg−1 towards l-asparagine. The activation energy, from the linear Arrhenius plot, was determined as 39.9 ± 0.6 kJ mol−1. To the best of our knowledge, Pcal_0970 is the most thermostable l-asparaginase with a half-life of more than 150 min at 100 °C and this is the first report on characterization of an l-asparaginase from phylum Crenarchaeota.
Intraoperative Indocyanine Green Angiography for Fat Necrosis Reduction in the Deep Inferior Epigastric Perforator (DIEP) Flap
Abstract
Background
Fat necrosis is a frequent complication (up to 62.5%) of microsurgical breast reconstruction using the deep inferior epigastric perforator (DIEP) flap. This could have important clinical and psychological repercussions, deteriorating the results and increasing reconstruction costs. Objectives
The aim of this study was to demonstrate the intraoperative use of indocyanine green angiography (ICGA) to reduce fat necrosis in DIEP flap. Methods
Sixty-one patients who underwent unilateral DIEP flap procedures for breast reconstruction after oncological mastectomy were included (24 cases with intraoperative use of ICGA during surgery, 37 cases in the control group). The follow-up period was 1 year after surgery. The association between the use of ICGA and the incidence of fat necrosis in the first postoperative year, differences in fat necrosis grade (I-V), differences in fat necrosis requiring reoperation, quality of life, and patient satisfaction were analyzed. Results
The incidence of fat necrosis was reduced from 59.5% (control group) to 29% (ICG-group) (P = 0.021) (relative risk = 0.49 [95% CI, 0.25-0.97]). The major difference was in grade II (27% vs 2.7%, P = 0.038). The number of second surgeries for fat necrosis treatment was also reduced (45.9% vs 20.8%, P = 0.046). The ICG group had higher scores on the BREAST-Q. Conclusions
Intraoperative ICGA is a useful technique for reconstructive microsurgery that might improve patient satisfaction and reduce the incidence of fat necrosis by half as well as reduce its grade, especially in small fat necrosis cases; consequently, ICGA could reduce the number of secondary surgeries for treatment of fat necrosis. Level of Evidence: 4
Increased Angiogenic and Adipogenic Differentiation Potentials in Adipose-Derived Stromal Cells from Thigh Subcutaneous Adipose Depots Compared with Cells from the Abdomen
Abstract
Background
Adipose-derived stromal cells (ADSCs) may play a pivotal role by differentiating into multilineage cells or by secreting growth factors or cytokines in cell-assisted lipotransfer, which participates in adipose tissue regeneration. The angiogenic potential of various ADSCs from different anatomical regions remains uncertain. Objectives
The authors sought to offer appropriate choices of sources of adipose-derived stromal cells for cell-assisted lipotransfer and tissue engineering. Methods
ADSCs were harvested from subcutaneous adipose depots in the abdomen and thighs. The expression of adipocyte-specific markers was evaluated, and Oil Red O staining was performed to assess the capacity for adipogenic differentiation. Angiogenic differentiation potential was evaluated by detecting the expression of vascular endothelial growth factor, vascular endothelial growth factor 2, and CD31. A tube formation assay was also performed to analyze the angiogenic differentiation capacity. Results
ADSCs from the thigh showed more significant angiogenic and adipogenic potential. More lipogenesis was identified in ADSCs from the thigh, and this was accompanied by the enhancement of adipocyte markers. Angiogenesis was more vigorous in the thigh-derived stromal cells, and ADSCs from the thigh depot showed more junctions and longer tubule formation on Matrigel in vitro. Conclusions
Thigh-derived ADSCs exhibited greater capacity for adipogenic and angiogenic differentiation and would be a better option for cell-assisted lipotransfer and tissue engineering.Evaluation of pelvic floor muscle by transperineal elastography in patients with deep infiltrating endometriosis: preliminary observation
Abstract
Purpose
To assess the elasticity of the pelvic floor muscle (PFM) affected by deep infiltrating endometriosis (DIE) with transperineal elastography.
Methods
This prospective observational study included 88 patients who were diagnosed with DIE, ovarian endometrioid cyst, or ovarian teratoma. All the patients were assigned to one of the three groups and underwent transperineal elastography. The scoring system and strain ratio (SR) values were recorded and analyzed. Assessments were conducted at maximal Valsalva and under quiescent condition, respectively.
Results
The mean elastography score was statistically significantly higher for the levator ani of group I than groups II and III under quiescent condition. In addition, SR of the levator ani in group I was higher than that in groups II and III. However, at maximal Valsalva, the mean elastography score of group I was lower than that of groups II and III. In addition, SR of group I was lower than that of groups II and III.
Conclusion
The elasticity of the PFM in DIE patients could be qualitatively evaluated by transperineal elastography. The coordination of the PFM was injured and decreased elasticity appeared in DIE patients.
Effect of inactivation of luxS gene on the properties of Serratia proteamaculans 94 strain
Abstract
The luxS gene is responsible for the synthesis of AI-2 (autoinducer-2), a signaling molecule that participates in quorum sensing regulation in a large number of bacteria. In this work, we investigated which phenotypes are regulated by luxS gene in Serratia proteamaculans 94, psychrotrophic strain isolated from spoiled refrigerated meat. AI-2 was identified in S. proteamaculans 94, and the luxS gene involved in its synthesis was cloned and sequenced. A mutant with the inactivated luxS gene was constructed. Inactivation of the luxS gene was shown to lead to the absence of AI-2 synthesis, chitinolytic activity, swimming motility, suppression of the growth of fungal plant pathogens Rhizoctonia solani and Helminthosporium sativum by volatile compounds emitted by S. proteamaculans 94 strain, and to a decrease of extracellular proteolytic activity. The knockout of the luxS gene did not affect synthesis of N-acyl-homoserine lactones, lipolytic, and hemolytic activities of S. proteamaculans 94.
Statistical based experimental optimization for co-production of endo-glucanase and xylanase from Bacillus sonorensis BD92 with their application in biomass saccharification
Abstract
Endo-glucanase (cellulase) and xylanase have high industrial demand due to their vast application in industrial processes. This study reports statistical based experimental optimization for co-production of endo-glucanase and xylanase from Bacillus sonorensis BD92. Response surface methodology (RSM) involving central composite design (CCD) with full factorial experiments (23) was applied to elucidate the components that significantly affect co-production of endo-glucanase and xylanase. The optimum co-production conditions for endo-glucanase and xylanase were as follows: carboxymethyl cellulose (CMC) 20 g/L, yeast extract 15 g/L, and time 72 h. The maximum endo-glucanase and xylanase production obtained was 1.46 and 5.69 U/mL, respectively, while the minimum endo-glucanase and xylanase production obtained was 0.66 and 0.25 U/mL, respectively. This statistical model was efficient because only 20 experimental runs were necessary to assess the highest production conditions, and the model accuracy was very satisfactory as coefficient of determination (R2) was 0.95 and 0.89 for endo-glucanase and xylanase, respectively. Further, potential application of these enzymes for saccharification of lignocellulosic biomass (wheat bran, wheat straw, rice straw, and cotton stalk) was also investigated. The results revealed that the biomass was susceptible to enzymatic saccharification and the amount of reducing sugars (glucose and xylose) increased with increase in incubation time. In conclusion, Bacillus sonorensis BD92 reveals a promise as a source of potential endo-glucanase and xylanase producer that could be useful for degrading plant biomass into value-added products of economic importance using precise statistically optimized conditions.
Consensus Recommendation Indications and methods for microbiological wound diagnostics
Publication date: Available online 24 October 2018
Source: Wound Medicine
Author(s): Axel Kramer, Ojan Assadian, Jürgen Bohnert, Georg Daeschlein, Joachim Dissemond, Veronika Gerber, Peter Hinz, Adam Junka, Simon Kim, Roald Papke, Christian Willy
Abstract
Aim
To describe the indication and technique of microbiological wound investigation in treating infected or colonised wounds with or without multi-drug resistant microorganisms (MDROs). The clinical symptoms and criteria of locally or systemically infected wounds are summarized and described.
Method
An interdisciplinary consensus of microbiological wound diagnosis was elaborated between representatives of different medical specialities. Moreover, some perspectives on future wound diagnostics were presented
Results
The panel agreed on ten clinical signs, situations and symptoms, which give the indication for further microbiological wound investigation: formation of pus, clinical signs or suspicion of an infection, suspicion or presence of a surgical site infection, localised progredient infection with or without systemic involvement (e.g. joint empyema, phlegmone), gangrene formation and necrotising fasciitis, ulcerative neoplasia, burn wounds with > 15% thermally injured surface area, exacerbation of dermatological disorders, localised wound infection without sign of systemic involvement after 3 days treatment with antiseptics without obvious clinical improvement, and chronic skin lesion with indication to screen for MDROs.
The panel agreed that no indication for microbiological investigation is given in acute wounds without signs of infection and uncomplicated superficial wounds.
Today, the gold standard for microbiological investigation is processing tissue biopsies in the laboratory. However, in many instances it may be easier and more rapid to perform a wound swab. If swabs are obtained, the Essener circle or the Levine technique shall be applied. Wound swabs, however, are the method of choice in screening for wound colonisation with MDROs. Additionally, information is summarised pertaining to transport and processing of microbiological wound specimens Also, potential applicability of future wound diagnostic methods based on genomic, metabolomic and proteomic approach are discussed.
Conclusion
Beside a full understanding of all clinical symptoms and clinical experience of wound experts the correct microbiological wound investigation will be the basis for a succesfull management of infected wounds.
Conflict of interest and citation impact among dermatology guideline authors
Publication date: Available online 24 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Kamber Loren Hart, Roy Howard Perlis, Clifford Scott Perlis
Sekundäre Kieferspaltosteoplastik
Zusammenfassung
Die sekundäre Spaltosteoplastik wird im Alter zwischen 6 und 12 Jahren im Rahmen der Therapie von Patienten mit Lippen‑, Kiefer- und Gaumenspalte zur Rekonstruktion des knöchernen Defekts im Alveolarkammbereich durchgeführt. Als Augmentationsmaterial wird i. d. R. Knochen vom Beckenkamm gewonnen, um nach Rekonstruktion des Nasenbodens, Einlagerung und plastischem Verschluss den angrenzenden Spaltzähnen einen physiologischen Zahndurchbruch unter orthodontischer Therapie zu ermöglichen. Zudem dient die Osteoplastik der Stabilisierung der Oberkiefersegmente und hat weitere zahlreiche Vorteile.
Prevalence of human pathogens of the clade Nakaseomyces in a culture collection—the first report on Candida bracarensis in Poland
Abstract
Human pathogens belonging to the Nakaseomyces clade include Candida glabrata sensu stricto, Candida nivariensis and Candida bracarensis. Their highly similar phenotypic characteristics often lead to misidentification by conventional laboratory methods. Therefore, limited information on the true epidemiology of the Candida glabrata species complex is available. Due to life-threatening infections caused by these species, it is crucial to supplement this knowledge. The aim of the study was to estimate the prevalence of C. bracarensis and C. nivariensis in a culture collection of C. glabrata complex isolates. The study covered 353 isolates identified by biochemical methods as C. glabrata, collected from paediatric and adult patients hospitalised at four medical centres in Southern Poland. The multiplex PCR was used to identify the strains. Further species confirmation was performed via sequencing and matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS) analysis. One isolate was recognised as C. bracarensis (0.28%). To our knowledge, it is the first isolate in Poland. C. glabrata sensu stricto species has been confirmed for all the remaining isolates. No C. nivariensis was found. Our study has shown that the prevalence of C. nivariensis and C. bracarensis strains is infrequent. However, it should be emphasised that the incidence of these strains may differ locally and depend on environmental factors and the population.
Laryngeal stroboscopy ‐ normative values for amplitude, open quotient, asymmetry and phase difference in young adults
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
Single‐Sided Deafness and cochlear implantation in congenital and acquired hearing loss in children
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
New tools for preoperative diagnosis of allergic fungal sinusitis? A prospective study about 71 patients
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
Postoperative radiotherapy of intermediate‐risk head and neck cancer in 134 patients: Does subset matter?
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
Analysis of inner ear malformations associated with a facial nerve anomaly in 653 children fitted with a cochlear implant
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
Wound Healing with Botanicals: a Review and Future Perspectives
Abstract
Purpose of Review
Botanicals have long played a crucial role in the management of chronic and infected wounds, yet the mechanistic basis of these therapies remains largely poorly understood by modern science.
Recent Findings
Studies have begun to unveil the mechanistic bases of botanical therapies for wound healing, but more work is necessary. Most notably, investigation into the growing conditions, post-harvest treatment, and pharmacological preparation of these botanicals has demonstrated their importance in terms of the chemical makeup and pharmacological activity of the final product used in pre-clinical and clinical studies.
Summary
This work evaluates the potential safety, efficacy, and mechanistic basis of some key botanical ingredients used in traditional medicine for wound care: aloe, marigold, and St. John's Wort. Furthermore, perspectives on the future role that botanical natural products may play in anti-infective and wound care, innovations are explored.
Pediatric Inpatient Dermatology: New Insights on Severe Eruptions and Cutaneous Adverse Reactions
Abstract
Purpose of Review
This manuscript reviews important advances in our understanding of severe eruptions and cutaneous adverse reactions in children.
Recent Findings
The latest research provides significant insights regarding severe cutaneous eruptions including coxsackievirus eruptions, mycoplasma-induced rash and mucositis, urticaria multiforme, erythema multiforme, and severe cutaneous adverse reactions. Recent literature expands our understanding of the incidence and cost, pathophysiology, and management considerations for pediatric patients with Stevens-Johnson syndrome and toxic epidermal necrolysis.
Summary
Pediatric inpatient cutaneous eruptions, from infectious and inflammatory to adverse reactions are very burdensome diseases. It is important to recognize salient features to initiate appropriate workup and management, particularly for patients with severe cutaneous adverse reactions for which early recognition of complications of disease and consultation with colleagues may minimize sequelae.
Cryotherapy vs trichloroacetic acid 90% in treatment of common warts
Journal of Cosmetic Dermatology, EarlyView.
Hypomelanotic melanoma simulating pigmented Bowen's disease and its challenging dermoscopic features
The Journal of Dermatology, EarlyView.
Eruptive keratoacanthoma with spontaneous regression arising from a cervical squamous cell carcinoma patient treated with nivolumab
The Journal of Dermatology, EarlyView.
Thrombocytopenia in a psoriatic patient sequentially treated with adalimumab, secukinumab and ustekinumab
The Journal of Dermatology, EarlyView.
Treatment of Grade I and II types of xanthelasma palpebrarum with intralesional heparin sodium
Dermatologic Therapy, EarlyView.
Neoadjuvant intralesional methotrexate in squamous cell carcinoma of the lip
Australasian Journal of Dermatology, EarlyView.
Dharmakīrti and His Commentators on the Process of Perceptual Activities
Abstract
In the tradition of Dharmakīrti (ca. 600–660), perception is, by definition, free from conceptual construction. Insofar as perception is thus, it lacks the nature of determining its object. Without identifying its object, how does perception lead one to a successful action? Perception in isolation would not be pramāṇa unless it is supplemented by perceptual judgement. This paper looks at how Dharamkīrti and his commentators offer solutions to the contradiction between perception's foundational role and its seeming dependence on conceptual construction. The key point in their proposed solutions is the argument that perception is understood in accordance with two distinct perspectives of the moment (kṣaṇa) and the continuum (santāna). Perception from the perspective of the moment has the activities of 'grasping' (grahaṇa) and 'ascertaining' (niścaya). The 'grasping' induces perceptual awareness to be possessed of the image (ākāra) of an object-moment; the 'ascertaining' identifies its object in the form of "this is something." Perception from the perspective of the continuum, on the other hand, consists of a series of the first moment of sense perception and its subsequent moments of mental perception. It is a continuous process allowing one to attain or avoid a thing that s/he sees. The fulfilment of a purpose is achieved not through a perception-moment but through a perception-continuum. It is worthy stressing, however, that in a very strict sense, the perception-moment alone is ultimately real. Perception from the perspective of the moment is purely epistemological while perception from the perspective of the continuum is pragmatic.
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