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Παρασκευή 8 Δεκεμβρίου 2017

Correctness of Self-Reported Task Durations: A Systematic Review

Abstract
Objectives
Duration of tasks in a job is an essential interest in occupational epidemiology. Such duration is frequently measured using self-reports, which may, however, be associated with both bias and random errors. The present systematic literature review examines the correctness of self-reported durations of tasks, i.e. the extent to which they differ from more valid reference data due to either systematic or random errors, and factors influencing this correctness, with particular emphasis on the assessment of exposures of relevance to musculoskeletal disorders.
Methods
The search for relevant studies included the databases ISI Web of Science, MEDLINE, EBSCO HOST, Proquest, and Psycnet.
Results
Thirty-two articles were identified; of which, 23 examined occupational tasks and 9 examined non-occupational tasks. Agreement between self-reports and a more correct reference was reported for, in total, 182 tasks. Average proportional errors were, for most tasks, between −50% (i.e. underestimations) and +100%, with a dominance of overestimations; 22% of all results considered overestimations of 100% or more. For 15% of the 182 reported tasks, the mean difference between the self-reported and the reference duration value was <5%, and 20% of the 182 mean differences were between 5 and 20%. In general, respondents were able to correctly distinguish tasks of a longer duration from shorter tasks, even though the actual durations were not correct. A number of factors associated with the task per se appeared to influence agreement between self-reports and reference data, including type of task, true task duration, task pattern across time (continuous versus discontinuous), and whether the addressed task is composed of subtasks. The musculoskeletal health status of the respondent did not have a clear effect on the ability to correctly report task durations. Studies differed in key design characteristics and detail of information reported, which hampers a formal aggregation of results.
Conclusions
The correctness of self-reported task durations is, at the best, moderate at the individual level, and this may present a significant problem when using self-reports in task-based assessment of individual job exposures. However, average self-reports at the group level appear reasonably correct and may thus be a viable method in studies addressing, for instance, the relative occurrence of tasks in a production system. Due to the disparity of studies, definite conclusions on the quantitative effect on agreement of different modifiers are not justified, and we encourage future studies specifically devoted to understanding and controlling sources of bias in self-reported task durations. We also encourage studies developing decision support for when to apply or avoid self-reports to measure task durations, depending on study purpose and occupational setting.

Harnessing the Power of Data in Facial Plastic and Reconstructive Surgery

The widespread use of electronic health records (EHRs) has created unprecedented opportunities to apply meaningful clinical data for quality improvement. Through machine learning, large data sets of patient clinical information gathered through routine clinical encounters can be analyzed for risk prediction and treatment algorithms. Although randomized clinical trials remain the criterion standard study type to show causality, the use of big data is showing promise as an alternative for discovery. This alternative is of particular significance in surgery, where randomized clinical trials are not feasible or likely.

Recreational Activity and Facial Trauma Among Older Adults

This database analysis uses the National Electronic Injury Surveillance System to collect data to evaluate the incidence of recreational activity–associated facial fractures among older adults and to further delineate injury characteristics including demographics, fracture location, and activities.

In Memoriam: Gary Burget, MD (1941-2017)

Facial plastic surgery recently lost a dear friend, teacher, and colleague on May 31, 2017, with the passing of Gary Burget, MD. Dr Burget was born in Toledo, Ohio, on April 20, 1941, the second child of Dean E. and Marie A. Burget. His parents were schoolteachers who had grown up on small working farms in southern Ohio near West Virginia near the Appalachian foothills. His parents obtained schoolteaching jobs in the Toledo, Ohio, public school system after graduating from Bowling Green State University at the height of the Great Depression. Dr Burget attended Thomas A. DeVilbiss High School and served as president of the student council his senior year. He attended Yale University and graduated with a BA in English and then followed his older brother, Dean, to Yale Medical School, which he completed in 1967. During his fourth year of medical school, he arranged a surgical clerkship in Edinburgh, Scotland, under the direction of Andrew Logan, MD, which increased his interest in surgery. Following medical school, he pursued an internship at Columbia University College of Physicians and Surgeons in New York City and spent much of his time at Harlem Hospital. He then went to Jackson Memorial Hospital at the University of Miami as a resident in general surgery, followed by a residency in plastic surgery under D. Ralph Millard, Jr, MD. He was influenced by his older brother, Dean, who preceded him into a career in plastic surgery. Following completion of his plastic surgery residency, he was invited to join Dr Millard as an associate partner in his private practice. While honored, Dr Burget decided to enter private practice with Walter Garst, MD. After several years, Dr Burget struck out on his own and opened a practice in Miami. Henry W. Menn, MD, an early Mohs surgeon, referred a large number of patients with difficult facial defects to Dr Burget. It was during these years that Dr Burget realized the importance of the aesthetic units of the face and the need to sometimes remove additional tissue to move scars into favorable positions.

Teaching Photographic Nasal Analysis

This study evaluates the common pitfalls exhibited by otolaryngology residents in performing photographic nasal analysis and a systematic approach model for teaching photographic nasal analysis.

Partial Cost Cartilage Harvest for Rhinoplasty

To the Editor The article by Nelson and Gaball, "Technique to Reduce Time, Pain, and Risk in Costal Cartilage Harvest," recently published in JAMA Facial Plastic Surgery, nicely describes a surgical technique to harvest only the anterior two-thirds of a donor rib when autologous costal cartilage is necessary for reconstructive rhinoplasty.

Simulation Course for Evaluation and Treatment of Facial Fractures

This study assesses the value of a novel facial trauma simulation course requiring residents to practice advanced decision making.

Teaching Rhinoplasty

Rhinoplasty is considered by many to be the most challenging operation that otolaryngologists do. Teaching rhinoplasty is even more challenging. In this issue of JAMA Facial Plastic Surgery, Robitschek and colleagues provide a combination of rhinoplasty analysis, science, and teaching our younger colleagues. Their study is a well-designed, prospective look at the effect of a simple teaching tool (a 10-minute slide presentation) and the thoroughness with which otolaryngology residents analyze the nose from patient photographs. The study concludes that 10 weeks after the teaching session, residents continue to perform better at rhinoplasty analysis, especially in terms of describing the position of the caudal septum.

Bony Batten Grafting to Correct Caudal Septal Deviation in Septoplasty

This cohort study evaluates the surgical outcomes of bony batten grafting for the management of caudal septal deviation in patients undergoing endonasal septoplasty.

The Columella Retraction Suture

This report presents the columella retraction suture as a way to control dead space after correction of the nasolabial and columella-tip complex.

Perception of Permanent Unilateral Facial Paralysis

This cohort study compares multiple domains of casual observer and expert perception with the actual experience of patients with permanent unilateral facial paralysis.

Review of Facial Plastic and Reconstructive Surgery

In 2001, Raza Pasha, MD, edited and published Otolaryngology–Head and Neck Surgery: A Clinical Reference Guide. This resource is currently in its fourth print edition and is ubiquitous in residency programs around the United States. The success of this book is due to its concise format and excellent overview of the specialty of Otolaryngology. Shaun Desai, MD, has borrowed some of this format for his text, Facial Plastic and Reconstructive Surgery: Clinical Reference Guide, and replicates this success with a narrower focus on the subspecialty of facial plastic and reconstructive surgery.

Costal Cartilage Warping Using Oblique Split vs Concentric Carving

This in vitro cadaveric study assesses whether the 30-degree oblique split method of preparing costal cartilage grafts produces less warping of the graft than the current standard of harvesting the central segment of a rib using the concentric carving method.

November-December Issue Highlights



Algorithm-Based Levator Aponeurectomy in Ptosis Surgery

This cohort study investigates the postoperative success of an algorithmic external levator aponeurosis resection technique in patients with aponeurotic ptosis and good levator function.

Training Current and Future Residents in Facial Plastic Surgery

In this issue of JAMA Facial Plastic Surgery, Christophel et al assess the value of a novel facial trauma simulation course given to 30 residents from 2 institutions. During this 1-day course, an impactor delivered a measurable force to create facial fractures in fresh frozen cadaver heads, which were then scanned with high-resolution computed tomography. Using each specimen's unique findings, a pair of trainees formulated and presented their theoretical treatment plan, which included airway management, fracture type, surgical approach, and type of fracture repair. Finally, the authors measured the improvement in the trainees' knowledge after the course with the Accreditation Council for Graduate Medical Education otolaryngology facial trauma residency milestone scale. This milestone is a national metric measure to monitor the resident's progress of learning; it uses a disease-based format for patient care and medical knowledge during training.

Complete Philtrum Reconstruction on the Partial-Thickness Cross-Lip Flap

This study describes the reconstruction of the philtrum in the cross-lip flap transfer using nasolabial muscle tension line group reconstruction.

Data Collection Integration to Optimize Clinical Outcomes Research

This Special Communication describes a method for prospective periodic evaluation of patients undergoing elective functional septorhinoplasty with data collection embedded into an electronic health record.

Electrochemical Therapy of Porcine Skin

This study examines the changes in optical, mechanical, and acoustic impedance properties in porcine skin after electrochemical therapy.

The Twisted Nose

A young man had functional nasal obstruction after facial trauma resulted in fractured nasal bones, had undergone a closed nasal fracture reduction but obstructive symptoms persisted, also expressed dissatisfaction with the appearance of his nose. What would you do next?

Lateral Crural Overlay Technique and Strength of Lower Lateral Cartilages

This cadaver study measures the difference in lateral crural strength and resilience after performing lateral crural overlay procedures using 2 different techniques.

Interleukin-21 receptor signaling is not critically required for imiquimod-induced psoriasiform dermatitis in mice

Abstract

Psoriasis is largely mediated by interleukin (IL)-23/ T helper (Th) 17 axis, and IL-21 is a pleiotropic cytokine expressed by Th17 cells. Despite previously reported possible pathogenic roles of IL-21 in human psoriasis, we found that IL-21 receptor (IL-21R) signaling was not crucial for imiquimod-induced psoriatic inflammation, using IL-21R−/− mice. The severity of imiquimod-induced psoriatic manifestation and pro-inflammatory Th17 cytokine levels, IL-17A-producing γδ T cells and CD4+ T cells, and in vitro IL-17A production by γδ T cells after IL-23 stimulation was comparable between wild-type and IL-21R−/− mice. Collectively, IL-21R signaling was not critically involved in IMQ-induced psoriatic inflammation despite an increased IL-21 expression in the IMQ-treated mouse skin. Our data may represent the significant differences between human psoriasis and murine psoriasis model, and further studies using other models will be required to elucidate the role of IL-21 in psoriasis pathogenesis.

This article is protected by copyright. All rights reserved.



Neuroblastoma PTPome analysis unveils association of DUSP5 and PTPN1 expression with poor prognosis

Ann Oncol 2017; 28 (Suppl 7): mdx511.023 (abstr. 57). http://ift.tt/2iGgg96.

A randomized phase II study evaluating different maintenance schedules of nab-Paclitaxel in the first-line treatment of metastatic breast cancer: final results of the IBCSG 42-12/BIG 2-12 SNAP trial

Abstract
Background
The phase II SNAP trial was designed to evaluate the efficacy of alternative chemotherapy schedules for prolonged administration in HER2-negative metastatic breast cancer (MBC), after a short induction at conventional doses.
Methods
Between April 2013 and August 2015, 258 women untreated with chemotherapy for MBC were randomly assigned to receive three different maintenance chemotherapy schedules after three cycles of identical induction chemotherapy: Arm A, nab-Paclitaxel 150 mg/m2 days 1,15 Q28; Arm B, nab-Paclitaxel 100 mg/m2 days 1,8,15 Q28; Arm C, nab-Paclitaxel 75 mg/m2 days 1,8,15,22 Q28. Induction was three cycles nab-Paclitaxel 150/125 mg/m2, days 1,8,15 Q28. The primary objective was to evaluate the efficacy of each maintenance schedule, in terms of progression-free survival (PFS), as compared to the historical reference of 7-month median PFS reported by previous studies with first-line docetaxel. One-sample, one-sided log-rank tests were utilized. Quality-of-life evaluation was performed, global indicator for physical well-being was defined as the primary endpoint; completion rates of quality-of-life forms were >90%.
Results
255 patients were evaluable for the primary endpoint. After 18.2 months median follow-up, 182 PFS events were observed. Median PFS was 7.9 months (90%CI 6.8-8.4) in Arm A, 9.0 months (90%CI 8.1-10.9) in Arm B and 8.5 months (90%CI 6.7-9.5) in Arm C. PFS in Arm B was significantly longer than the historical reference of first-line docetaxel (P=0.03). Grade≥2 sensory neuropathy was reported in 37.9%, 36.1% and 31.2% of patients in Arm A, Arm B and Arm C, respectively (Grade≥3 in 9.1%, 5.6% and 6.6% of patients, respectively). Noteworthy, the quality-of-life scores for sensory neuropathy did not worsen with prolonged nab-Paclitaxel administration in any of the maintenance arms.
Conclusion
The SNAP trial demonstrated that alternative nab-Paclitaxel maintenance schedules with reduced dosages after a short induction at conventional doses are feasible and active in the first-line treatment of MBC.
Registration
ClinicalTrials.gov NCT01746225

Analysis of Angiogenesis Biomarkers for Ramucirumab Efficacy in Patients with Metastatic Colorectal Cancer from RAISE, a Global, Randomized, Double-Blind, Phase III Study

Abstract
Background
The phase III RAISE trial (NCT01183780) demonstrated that the vascular endothelial growth factor (VEGF) receptor (VEGFR)-2 binding monoclonal antibody ramucirumab plus 5-fluororuracil, leucovorin, and irinotecan (FOLFIRI) significantly improved overall survival (OS) and progression-free survival (PFS) compared with placebo+FOLFIRI as second-line metastatic colorectal cancer (mCRC) treatment. To identify patients who benefit the most from VEGFR-2 blockade, the RAISE trial design included a prospective and comprehensive biomarker program that assessed the association of biomarkers with ramucirumab efficacy outcomes.
Patients and methods
Plasma and tumor tissue collection was mandatory. Overall, 1072 patients were randomized 1:1 to the addition of ramucirumab or placebo to FOLFIRI chemotherapy. Patients were then randomized 1:2, for the biomarker program, to marker exploratory (ME) and marker confirmatory (MC) groups. Analyses were performed using exploratory assays to assess the correlations of baseline marker levels (VEGF-C, VEGF-D, sVEGFR-1, sVEGFR-2, sVEGFR-3 [plasma], and VEGFR-2 [tumor tissue]) with clinical outcomes. Cox regression analyses were performed for each candidate biomarker with stratification factor adjustment.
Results
Biomarker results were available from >80% (n=894) of patients. Analysis of the ME subset determined a VEGF-D level of 115 pg/mL was appropriate for high/low subgroup analyses. Evaluation of the combined ME+MC populations found that the median OS in the ramucirumab+FOLFIRI arm compared with placebo+FOLFIRI showed an improvement of 2.4 months in the high VEGF-D subgroup (13.9 months [95% CI 12.5–15.6] versus 11.5 months [95% CI 10.1–12.4], respectively), and a decrease of 0.5 month in the low VEGF-D subgroup (12.6 months [95% CI 10.7–14.0] versus 13.1 months [95% CI 11.8–17.0], respectively). PFS results were consistent with OS. No trends were evident with the other antiangiogenic candidate biomarkers.
Conclusions
The RAISE biomarker program identified VEGF-D as a potential predictive biomarker for ramucirumab efficacy in second-line mCRC. Development of an assay appropriate for testing in clinical practice is currently ongoing.
Clinical trials registration
NCT01183780

Title: Rituximab: A Benchmark in the Development of Chemotherapy-free Treatment Strategies for Follicular Lymphomas

Abstract
Background
With the introduction of the anti-CD20 antibody rituximab, the outcomes of patients with follicular lymphoma (FL) has greatly improved over the last two decades. First-line prolonged rituximab monotherapy is effective, achieving long-term remission and prolonged failure-free survival in some patients. Maintenance strategies with rituximab have also improved on clinical endpoints. Additionally, rituximab has been shown to synergize with chemotherapeutic and novel targeted agents alike with measurable gains in duration of response. As such, rituximab has made its mark in the treatment of FL and remains a valid agent despite the availability of newer monoclonal antibodies. This review summarizes the evolving role of rituximab as the first available anti-CD20 monoclonal antibody, emphasizing its clear activity as a single agent and in combination with chemotherapy or molecular targeted agents, and setting the standard for the development of new anti-CD20 monoclonal antibodies. Conclusion: We provide data that supports the ongoing use of rituximab as a therapeutic partner for novel agents in future clinical trials exploring chemotherapy-free alternatives.

Validation of the diagnosis of mesothelioma and BAP1 protein expression in a cohort of asbestos textile workers from Northern Italy

Abstract
Background
Diagnosis of mesothelioma based on death certificate is subject to misclassification, which may bias the results of epidemiology studies. A high proportion of mesothelioma harbor mutations in the BRCA1-associated protein 1 (BAP1) gene.
Methods
We searched medical and pathology records and specimens for 127 workers from a textile- asbestos factory in Italy who died during 1963-2013 with a diagnosis of pleural or peritoneal neoplasm or mesothelioma on death certificate, to confirm the diagnosis with immunohistochemistry (IHC) markers. We calculated the odds ratio (OR) of confirmation by selected characteristics and asbestos exposure variables. When sufficient pathology material was available, we analyzed BAP1 protein expression.
Results
The diagnosis of mesothelioma was histologically confirmed for 35 cases (27.6%); 5 cases were classified as non-mesothelioma (3.9%), for 33 cases a mention of mesothelioma was found on record but no sufficient material was available for revision (26.0%); no records were available for 54 cases (death- certificate-only 42.5%). Diagnostic confirmation was not associated with sex, location of the neoplasm, age, or duration of employment; however, there was a significant association with time since first employment (p for linear trend 0.04). An association between duration of employment and time since first employment was observed for confirmed cases but not for death-certificate-only cases. BAP1 protein was lost in 18/35 cases (51.4%), without an association with sex, location, age, indices of asbestos exposure, or survival.
Conclusions
We were able to confirm by IHC a small proportion of mesothelioma diagnoses on certificates of deceased asbestos workers, and confirmation correlated with latency of asbestos exposure but not other characteristics. BAP1 protein loss is a frequent event in mesothelioma of asbestos-exposed workers, but does not correlate with exposure.

Progestin-associated shift of meningioma mutational landscape

Abstract
Background
Meningiomas are the most common primary tumor of the central nervous system. The relationship between meningioma and progestins is frequently mentioned but has not been elucidated.
Patients and methods
We identified 40 female patients operated for a meningioma after long-term progestin therapy and performed targeted next generation sequencing in order to decipher the mutational landscape of hormone-related meningiomas. A published cohort of 530 meningiomas in women was used as a reference population.
Results
Compared to the control population of meningiomas in women, progestin-associated meningiomas were more frequently multiple meningiomas (19/40(48%) vs. 25/530 (5%), p < 10−12) and located at the skull base (46/72 (64%) vs. 241/481 (50%), p = 0.03). We found a higher frequency of PIK3CA mutations (14/40 (35%) vs. 18/530 (3%), p < 10−8) and TRAF7 mutations (16/40 (40%) vs. 140/530 (26%), p < 0.001) and a lower frequency of NF2-related tumors compared to the control population of meningiomas (3/40 7.5% vs. 169/530 32%, p < 0.001).
Conclusion
This shift in mutational landscape indicates the vulnerability of certain meningeal cells and mutations to hormone-induced tumorigenesis. While the relationship between PIK3CA mutation frequency and hormone-related cancers such as breast and endometrial cancer is well-known, this hormonally induced mutational shift is a unique feature in molecular oncology.

The ESMO Precision Medicine Glossary



Skin Cancer Prevention Campaign in Childhood: Survey based on 3,676 children in Brazil

Abstract

Background and Objectives

Primary skin cancer prevention campaigns are essential and more effective among children, not only because of the importance of sun exposure effects during this period, but also because at this age is when individuals are developing behaviors. The Brazilian Society of Dermatology - Regional State of Sao Paulo developed and conducted, the program named "The Sun, Friend of Childhood", a school health education and disease prevention project for children and parents. Our objective was to evaluate the cognitive and behavioral effects of the children and parents before and after an education model-based intervention of sun protection.

Methods

We carried out a study on a school population of Social Service of Industry – Regional State of São Paulo, from the first to the fifth years of the regular course (6-10 years). Our educational project was planned to be based on two children's learning tools (comic magazine and a DVD cartoon). Questionnaires in relation to habits and knowledge in sun exposure where applied to the children (3,776) before and (2,748) after the intervention. A questionnaire was applied to 3,663 parents regarding personal details and habits of their children.

Results

According to the McNemar′s statistical test, all changes in the children in acquire new knowledge about good practices for sun exposure were statistically significant.

Conclusions

Educative sun exposure programs in childhood are a relevant tool to modify the history of life for next generations, to concern the skin cancer and good health practices.

This article is protected by copyright. All rights reserved.



Safety and Efficacy of Apremilast Through 104 Weeks in Patients With Moderate to Severe Psoriasis Who Continued on Apremilast or Switched From Etanercept Treatment: Findings From the LIBERATE Study

Abstract

Background

Apremilast, an oral phosphodiesterase 4 inhibitor, has demonstrated efficacy in patients with moderate to severe psoriasis.

Objective

To evaluate long-term efficacy and safety of apremilast in biologic-naive patients with moderate to severe plaque psoriasis and safety of switching from etanercept to apremilast in the phase 3b LIBERATE trial.

Methods

Two hundred fifty patients were randomized to placebo, apremilast 30 mg BID, or etanercept 50 mg QW through Week 16; thereafter, all patients continued or switched to apremilast through Week 104 (extension phase). Skin, scalp, and nail involvement at Weeks 16, 52, and 104 were assessed using the Psoriasis Area and Severity Index (PASI; 0–72), Scalp Physician Global Assessment (ScPGA; 0–5), and Nail Psoriasis Severity Index (NAPSI; 0–8); patient-reported outcomes (PROs) were assessed using the Dermatology Life Quality Index (DLQI; 0–32) and pruritus visual analog scale (VAS; 0–100 mm).

Results

The apremilast-extension phase (Weeks 16–104) included 226 patients in the placebo/apremilast (n=73), apremilast/apremilast (n=74), and etanercept/apremilast (n=79) groups, and at Week 104, 50.7%, 45.9%, and 51.9% of these patients, respectively, maintained ≥75% reduction from baseline in PASI score (based on last observation carried forward analysis). Across treatment groups, ScPGA 0 (clear) or 1 (minimal) was achieved by 50.0%–59.2% of patients; NAPSI mean change from baseline was −48.1% to −51.1%; DLQI score ≤5 was achieved by 66.0%–72.5% of patients; and pruritus VAS mean change from baseline was −24.4 to −32.3. AEs in ≥5% of patients (diarrhea, nausea, nasopharyngitis, upper respiratory tract infection, and headache) did not increase with prolonged apremilast exposure.

Conclusions

Apremilast demonstrated significant and sustained improvements in skin, scalp, nails, and PROs (pruritus and quality of life) over 104 weeks in patients with moderate to severe plaque psoriasis. Safety was consistent with the known safety profile of apremilast.

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Consensus on the management of patients with psoriatic arthritis in a dermatology setting

Abstract

Background

Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis (PsO). Early diagnosis and prompt therapeutic intervention are crucial for limiting PsA progression and prevention of disability. Dermatologists are in a privileged position to detect early PsA. The management of patients with PsA in the dermatology setting is widely variable.

Objective

To provide practical recommendations for the management of patients with PsA in the dermatology setting including early diagnosis and treatment.

Methods

A consensus document was written by an expert panel composed by dermatologists (n=12) and rheumatologists (n=6). Eleven highly relevant questions were selected and elaborated with answers/statements based on a narrative literature review. The resulting document was discussed in a face-to-face meeting adopting a nominal group technique to reach consensus (i.e. 100% agreement) by using the Delphi method.

Results

A consensus was achieved in defining the following: the clinical characteristics differentiating inflammatory and non-inflammatory signs and symptoms of joint disease; the most important differential diagnoses of PsA in clinical practice; the most useful screening questionnaires, serum laboratory tests and imaging techniques for the detection of early PsA; the criteria for dermatologist to refer patients with PsO to rheumatologist; the criteria for the diagnosis of PsA; the selection of the indices that the dermatologist could use for measuring the activity and severity of PsA in clinical practice; when systemic steroids and/or intra-articular steroid injections are indicated in the treatment of PsA. Finally, systemic treatments including synthetic and biological disease modifying anti rheumatic drugs to be considered for the treatment of PsA have been reported.

Conclusions

The implementations of these practical recommendations could be very helpful for the management of patients with PsA in the dermatology setting including early diagnosis and treatment.

This article is protected by copyright. All rights reserved.



Early stage mycosis fungoides screening investigations: a retrospective analysis of 440 cases

Abstract

Early stages of mycosis fungoides (MF stages IA and IB) carry similar long-term life expectancies as an age-, sex-, and race- matched control population (1-3). Despite this, the ten-year disease progression risk in stage IA and IB MF has been reported to be between 10% and 39% (4); hence, investigative screening is frequently performed at presentation. We conducted a retrospective chart review of screening investigations performed on 440 patients with stage T1/IA (52%) and T2/IB (48%) MF.

This article is protected by copyright. All rights reserved.



Reflectance Confocal Microscopy evaluation of Trichobacteriosis Axilaris

Abstract

We read with great interest the paper by Navarrete-Dechent et al recently published on the Journal of European Academy of Dermatology1, in which the authors detail the dermoscopic findings of trichobacteriosis and highlight the importance of dermoscopy in these cases. We present the case of a 44-year-old man, who emanated an unpleasant axilary odor during a routine check-up. Close examination of the axillary hair shafts showed soft, brown to yellow irregular masses adherent to the central segment of the hairs, suggesting the diagnosis of trichobacteriosis axilaris (TA).

This article is protected by copyright. All rights reserved.



Response to “Does Stromal Vascular Fraction Supplementation Improve Facial Lipotransfer?”

In response to the previous letter written by Dr. Swanson,1 we are very grateful for his interest in our paper and for spending the time to analyze and comment on it. We appreciate the opportunity to clarify our arguments and ideas that, we hope, can contribute to science and to plastic surgery practices.

Does Stromal Vascular Fraction Supplementation Improve Facial Lipotransfer?

Gontijo-de-Amorim et al1 claim that fat enriched with the stromal vascular fraction (SVF) improves volume retention after facial lipotransfer. The authors describe a comparison of 5 patients injected with enriched fat vs 5 patients injected without SVF supplementation using computed tomography (CT). The authors report that the enriched fat group lost only 9.6% of its volume vs 24% in the untreated group.1 The authors simply centrifuge the lipoaspirate rather than separating it enzymatically using collagenase to isolate adipose-derived stem cells.1 Whether the cell pellet left at the bottom of the tube after centrifugation truly represents the SVF is open to question.2

Rejuvenating the Face: An Analysis of 100 Absorbable Suture Suspension Patients

Abstract
Background
Absorbable suture suspension (Silhouette InstaLift, Sinclair Pharma, Irvine, CA) is a novel, minimally invasive system that utilizes a specially manufactured synthetic suture to help address the issues of facial aging, while minimizing the risks associated with historic thread lifting modalities.
Objectives
The purpose of the study was to assess the safety, efficacy, and patient satisfaction of the absorbable suture suspension system in regards to facial rejuvenation and midface volume enhancement.
Methods
The first 100 treated patients who underwent absorbable suture suspension, by the senior author, were critically evaluated. Subjects completed anonymous surveys evaluating their experience with the new modality.
Results
Survey results indicate that absorbable suture suspension is a tolerable (96%) and manageable (89%) treatment that improves age related changes (83%), which was found to be in concordance with our critical review.
Conclusions
Absorbable suture suspension generates high patient satisfaction by nonsurgically lifting mid and lower face and neck skin and has the potential to influence numerous facets of aesthetic medicine. The study provides a greater understanding concerning patient selection, suture trajectory, and possible adjuvant therapies.
Level of Evidence: 4


Immunotherapy and Overall Survival in Elderly Patients With Melanoma

This cohort study evaluates if age influences clinical outcome and immune adverse events in patients treated by immunotherapy for `metastatic melanoma.

Practicing Safe Dermatology—Screening Out Liability

The article "Characteristics of Medical Liability Claims Against Dermatologists From 1991 Through 2015" by Kornmehl and colleagues is a welcome addition in our quest to understand how to reduce dermatology practice risk. The study confirms much of what we already knew or suspected but also provides some new interesting insights. It is reassuring to see that most malpractice cases against dermatologists are "abandoned, withdrawn or dismissed." Similarly, it is comforting to know that there has been a net reduction of 29.2% in paid claims for dermatologists. Is this secondary to improved patient care? The changing landscape of tort reform? Or both?

Trends in Medical Liability Claims Against Dermatologists

This study analyzes 24 years of data through 2015 from a nationally representative liability claims registry to compare the medical liability claims against dermatologists vs nondermatologists.

Optical Coherence Tomography Features of Dermatophytoma

This case report illustrates the optical coherence tomography features of dermatophytoma.

Knowledge to Detect Scalp and Neck Melanoma

This study tests the association between a video intervention and hairdresser knowledge of melanoma and self-confidence in skin lesion detection.

Preference-Based QOL Measures for Economic Evaluations in Early Melanoma

This study uses randomized clinical trial data to compare utility scores from the AQoL-8D and the FACT-M and evaluate the sensitivity of both instruments in identifying the influence of fear of cancer recurrence on health-related quality of life in patients with early-stage melanoma.

Topical Tacalcitol for a Family With Follicular Keratosis of the Chin

This case report describes the use of topical tacalcitol to treat follicular keratosis of the chin in 2 brothers.

Allergen Concerns and Popular Skin Care Products—Reply

In Reply We thank Hamann and Thyssen, as well as Harview and Hsiao, for their interest in our work and thoughtful commentaries. We agree that the safety and affordability of cosmetics and personal care products explicitly marketed toward the pediatric population is important to public health. In a recent publication of all adverse events (AE) submitted to the US Food and Drug Administration surrounding cosmetics and personal care products from 2004 to 2016, baby products were associated with the highest percentage of self-reported serious AEs (eg, death, serious injury, or hospitalization).

Allergen Concerns and Popular Skin Care Products

To the Editor We read with great interest the Original Investigation by Xu et al titled "Consumer Preferences, Product Characteristics, and Potentially Allergenic Ingredients in Best-Selling Moisturizers" and published in a recent issue of JAMA Dermatology. In discussions with dermatology colleagues regarding this article, we noticed another disturbing marketing trend: the labeling of skin care products marketed for babies.

Laboratory Monitoring During Systemic Terbinafine Therapy for Pediatric Onychomycosis

This retrospective medical record review examines the prevalence of laboratory monitoring and laboratory abnormalities during systemic terbinafine therapy in pediatric onychomycosis.

Dermatologist Density and Volume and Costs of Dermatology Procedures

This cross-sectional study uses the 2013 Medicare Provider Utilization and Payment Database to characterize the effect of geographic variations in dermatologist density on the provision of dermatology procedures within Medicare.

Allergen Concerns and Popular Skin Care Products

To the Editor We read with great interest the article by Xu et al published in a recent issue of JAMA Dermatology highlighting the high prevalence of contact allergens in common moisturizers. Their data mirror similar results in our recent study investigating contact allergens in pediatric personal care products marketed as hypoallergenic, dermatologist recommended and/or tested, fragrance free, or paraben free. Similar to the study by Xu et al, which found that 88% of common moisturizers contained at least 1 common contact allergen, we found that 167 of 187 of our selection of pediatric products (89%) contained at least 1 allergen.

A NF-κB signature predicts low-grade glioma prognosis: a precision medicine approach based on patient-derived stem cells

Abstract
Background
While recent genome wide association studies have suggested novel low-grade glioma (LGG) stratification models based on a molecular classification, we explored the potential clinical utility of patient-derived cells. Specifically, we assayed glioma-associated stem cells (GASC) that are patient-derived stem cells representative of the glioma microenvironment.
Methods
By next generation sequencing, we analyzed the transcriptional profile of GASC derived from patients that underwent anaplastic transformation either within 48 months (GASC-BAD) or ≥7 years (GASC-GOOD) after surgery. Gene set enrichment and pathway enrichment analyses were applied. The prognostic role of an NF-κB signature derived from GASC-BAD was tested in 530 newly diagnosed diffuse LGG patients comprised within The Cancer Genome Atlas (TCGA) database. The prognostic value of the GASC upstream regulator p65 NF-κB was assessed, by univariate and multivariate Cox analyses, in a single center case study, including 146 grade II LGG.
Results
The key elements differentiating the transcriptome of GASC isolated from LGG with different prognosis were mostly related to hallmarks of cancer (e.g. inflammatory/immune process, and NF-κB activation). Consistently, the NF-κB signature extrapolated from the GASC study was prognostic in the TCGA dataset. Finally, the nuclear expression of the NF-kB-p65 protein, assessed using an inexpensive immunohistochemical method, was an independent predictor of both overall survival and malignant progression free survival in 146 grade II LGG.
Conclusion
This study demonstrates for the first time the independent prognostic role of NF-kB activation in LGG, and it outlines the role of patient-based stem cell models as a tool for precision medicine approaches.

ICON Intimidation and Predatory Behavior: From Hollywood, “to the Newsroom,” to the Halls of Congress

Violence and Gender , Vol. 0, No. 0.


Efficacy and Safety of Titanium Miniplates in Septorhinoplasty

This case series evaluates the efficacy and safety of titanium miniplates for cartilaginous graft fixation in patients undergoing septorhinoplasty.

Hybrid Cartilage-Modifying Otoplasty Technique and Outcomes

This observational study compares preoperative and postoperative measurements of the ears of patients who underwent hybrid cartilage-modifying otoplasty.

Blast SMS and Enrollment for Cleft Lip and Cleft Palate Surgery in Zimbabwe

This study tested the effectiveness of a "blast" short message service text message to facilitate enrollment with a visiting surgical team in Zimbabwe.

Characteristics, Diagnosis, and Management of Ehlers-Danlos Syndromes

This review summarizes characteristics, assessment, and management of Ehlers-Danlos syndromes, which can be associated with surgical complications and should be identified preoperatively to facilitate optimal treatment.

Opioid Use After Rhinoplasty

This case series examines patient use of an opioid-based drug after rhinoplasty to establish an optimal pain management regimen that also mitigates the misuse or diversion of physician-prescribed opioid medications.

Glutamate residues at positions 162nd and 164th influence the beta-lactamase activity of SHV-14 obtained from Klebsiella pneumoniae

Abstract
Extensive production of SHV-14 beta-lactamase makes Klebsiella pneumoniae resistant to beta-lactams. The presence of omega-loop has been reported to influence the beta-lactamase activity, which is also present in SHV-14. Its omega-loop has three glutamates in nearly alternating positions, 162, 164 and 167 but their concise role on the behaviour of SHV-14 is unknown. To uncover the influence of each glutamate on SHV-14, we replaced glutamates with alanine and estimated the effect of each mutation by assessing the change in beta-lactam sensitivities in the surrogate Escherichia coli cells and catalytic efficiencies for hydrolysis with the purified proteins. Upon expression, the clone of wild-type SHV-14 aggravated the resistance of host by 60–500 folds against penicillin and cephalosporin groups of antibiotics. However, the expression of mutated enzymes (especially E164A) substantially reduced the resistance level as compared to the wild-type, and the results were in synchrony with the estimated enzymatic efficiencies of wild-type and mutated proteins. Therefore, with further support from the in silico analysis, we hypothesize that mutation at the glutamate residues in the omega-loop of SHV-14 can considerably modulate the beta-lactam sensitivity and hydrolysis; thus, revealing the importance of such glutamates as the target for inhibitor design in future.

Microbial carbon dioxide fixation: new tricks for an old game

Abstract
The exploitation of petroleum as energy and material source opened unprecedented possibilities for the development of our human societies, but only now we realize that the use of fossil resources comes at devastatingly high environmental costs. Consequently, our efforts to tap other carbon sources are steadily increasing. Industrial microbiology has the potential to use carbon dioxide directly as carbon source, thereby converting a foe into a friend. This thematic issue of FEMS Microbiology Letters sheds some light on recent developments for the understanding of microbial pathways for carbon dioxide fixation and on strategies for their industrial exploitation.

Extracellular nucleic acids of the marine bacterium Rhodovulum sulfidophilum and recombinant RNA production technology using bacteria

Abstract
Extracellular nucleic acids of high molecular weight are detected ubiquitously in seawater. Recent studies have indicated that these nucleic acids are, at least in part, derived from active production by some bacteria. The marine bacterium Rhodovulum sulfidophilum is one of those bacteria. Rdv. sulfidophilum is a non-sulfur phototrophic marine bacterium, which is known to form flocs, structured communities of cells, and to produce extracellular nucleic acids in culture media. Recently, it has been revealed that this bacterium produces gene transfer agent-like particles and that this particle production may be related to the extracellular nucleic acid production mechanism. This review provides a summary of recent physiological and genetic studies of these phenomena and also introduces a new method for extracellular production of artificial and biologically functional RNAs using this bacterium. In addition, artificial RNA production using Escherichia coli, which is related to this topic will also be described.

Rapid screening method for detecting highly pathogenic Streptococcus intermedius strains carrying a mutation in the lacR gene.

Abstract
Streptococcus intermedius is a member of the normal human commensal flora and secretes a human-specific cytolysin intermedilysin (ILY) as a major virulence factor. Expression of ily is repressed by LacR and loss-of-function mutations of LacR are observed in many ILY high-producing strains isolated from deep-seated abscesses, suggesting that high ILY production is necessary for increased virulence. However, because ILY exhibits no β-hemolysis on animal blood agar plates, differentiating ILY high- and low-producing strains using conventional laboratory methods is not possible. Interestingly, S. intermedius also produces glycosidases, including MsgA and NanA, which exhibit N-acetyl-β-d-glucosaminidase and neuraminidase activities, respectively. Moreover, MsgA expression, but not NanA, is negatively regulated by LacR. Here we measured the activities of MsgA, NanA and ILY in strains isolated from clinical specimens and dental plaque to determine the correlation between these glycosidase activities and ILY hemolytic activity. Hemolytic activity showed a strong positive correlation with MsgA and a weak negative correlation with NanA activities. Therefore, we calculated the ratio of MsgA and NanA activity (M/N ratio). This value showed a stronger positive correlation (r = 0.81) with ILY hemolytic activity and many strains with high M/N ratios ( > 2) were ILY high-producers with loss-of-function mutations in LacR.

The impact of environmental factors on CO2 fixation by microalgae

Abstract
Microalgae are among the most productive biological systems for converting sunlight into chemical energy which is used to capture and transform inorganic carbon into biomass. The efficiency of CO2 capture depends on the cultivation system configuration (photobioreactors or open systems) and can vary according to the state of the algal physiology, the chemical composition of the nutrient medium and environmental factors, such as irradiance, temperature and pH. This mini-review is focused on some of the most important environmental factors determining photosynthetic activity, CO2 biofixation, cell growth rates and biomass productivities by microalgae. These include CO2 and O2 concentrations, light intensity, cultivation temperature, nutrients, etc. Finally, a review on operation of microalgae cultivation systems in outdoors is presented as an example of the impact of environmental conditions on biomass productivity and CO2 fixation.

Poly(3-hydroxybutyrate) hyperproduction by a global nitrogen regulator NtrB mutant strain of Paracoccus denitrificans PD1222

Abstract
Paracoccus denitrificans PD1222 accumulates short-length polyhydroxyalkanoates, poly(3-hydroxybutyrate), under nitrogen deficient conditions. Polyhydroxybutyrate metabolism requires the 3-ketoacyl-CoA thiolase PhaA, the acetoacetyl-CoA dehydrogenase/reductase PhaB, and the synthase PhaC for polymerization. Additionally, P. denitrificans PD1222 grows aerobically with nitrate as sole nitrogen source. Nitrate assimilation is controlled negatively by ammonium through the two-component NtrBC system. NtrB is a sensor kinase that autophosphorylates a histidine residue under low nitrogen concentrations and, in turn transfers a phosphoryl group to an aspartate residue of the response regulator NtrC protein, which acts as a transcriptional activator of the P. denitrificans PD1222 nasABGHC genes. The P. denitrificans PD1222 NtrB mutant was unable to use nitrate efficiently as nitrogen source when compared to the wild-type strain, and it also overproduced poly(3-hydroxybutyrate). Acetyl-CoA concentration in the P. denitrificans PD1222 NtrB mutant strain was higher than in the wild-type strain. The expression of the phaC gene was also increased in the NtrB mutant when compared to the wild-type strain. These results suggest that accumulation of poly(3-hydroxybutyrate) in the NtrB mutant strain of PD1222 responds to the high levels of acetyl-CoA that accumulate in the cytoplasm as consequence of its inability to efficiently use nitrate as nitrogen source.

Relationship between Escherichia coli growth rate and bacterial susceptibility to ciprofloxacin

Abstract
The effect of Escherichia coli growth rate on its susceptibility to ciprofloxacin was investigated using bacteria grown on different carbon sources and harboring mutations in genes encoding tricarboxylic acid cycle enzymes. A 1-h treatment of the wild type (wt) grown on glucose, succinate, malate, α-ketoglutarate or acetate with 0.3 μg ml–1 ciprofloxacin decreased the number of surviving cells (CFU ml–1), 560, 110, 74, 62 and 5 times, respectively. Among the mutants tested, sucB strain, which grew 1.75 times slower than wt, was 7.4-fold more tolerant to 0.3 μg ml–1 of ciprofloxacin than wt. Strong inverse correlations between log(CFU ml–1) after 1-h exposure to 0.3 and 3.0 μg ml–1 ciprofloxacin and the specific growth rate prior to antibiotic treatment (r = − 0.93 and − 0.96, respectively) were observed. Data from the current and previous studies on the inhibitory effect of ciprofloxacin on cultures exhibiting a wide range of growth rates (0.01–1.3 h–1) were collated. Statistical analysis revealed a significant inverse correlation between log(CFU ml–1) after exposure to 3.0 μg ml–1 of ciprofloxacin and the specific bacterial growth rate prior to antibiotic exposure (r = − 0.92). These data may be used in a design of antibiotic treatment protocols.

Biotransformation of trinitrotoluene by Citrobacter sp. YC4 and evaluation of its cyto-toxicological effects

Abstract
Trinitrotoluene (TNT) is an explosive chemical generally used for military, civil and industrial purposes. Therefore, TNT residue can be found in soil and ground water as an environmental pollutant. The environmental control of TNT pollution has become a critical issue because of its potential toxicity and carcinogenicity. The aim of this study is to evaluate the cyto-toxicological effects of TNT after bioremediation. Citrobacter sp. YC4 is able to utilize TNT as a sole nitrogen source. Citrobacter sp. YC4 cells grown in medium with TNT as the sole nitrogen source (TNT-N) were able to rapidly degrade TNT, in contrast to cells grown in Luria Bertani medium as determined by resting cell suspension. The concentration of TNT decreased from 100 ppm to 0 ppm within 10 hours in the solution containing TNT mixed with TNT-N-grown YC4. The cytotoxicity of TNT and its degradation products generated by TNT-N grown YC4 were assessed by WST-1-based cell cytotoxicity assays. Our results showed that the cytotoxic potential of solutions containing TNT decreased almost to the level of the control after a one-hour incubation with TNT-N grown YC4 cells. The rapid conversion of TNT into possibly less toxic products by Citrobacter sp. YC4 proposes a bioremediation prospection.

The promises of microalgae – still a long way to go

Abstract
Over the past decades, interest in microalgae has grown exponentially. Especially industrial applications, such as biodiesel production from microalgae were hyped in the early 2000s. But since the first attempts to commercialize microalgae derived products for energy applications, only a few developments made it to the market. What is hindering the full exploitation of this valuable resource for food, feed, and energy applications? This opinion paper reflects on the state of the art of industrial microalgae culturing and the knowledge gaps that still need to be filled jointly by academia and industry.

Assessing the diversity of the g23 gene of T4-like bacteriophages from Lake Baikal with high-throughput sequencing

Abstract
Based on second generation sequencing (MiSeq platform), we determined the genetic diversity of T4-like bacteriophages of the family Myoviridae by analysing fragments of the major capsid protein gene g23 in the plankton of Lake Baikal. The sampling depth in our study was significantly higher than in those obtained by the Sanger method before. We obtained 33701 sequences of the g23 gene fragments, 141 OTUs of which were identified. 86 OTUs (60.9%) had the closest relatives from lakes Bourget and Annecy, and 28 OTUs (19.8%) had the highest identity with the Baikal g23 clones, which had been previously identified in the northern and southern basins of the lake by the Sanger method. The remaining OTUs were similar to the clones from other ecosystems. We showed a high genetic diversity of T4-type bacteriophages and a genetic difference with the phage communities from other ecosystems.

Mating-type switching in CBS 732T derived sub-cultures unveils potential genetic and phenotypic novelties in haploid Zygosaccharomyces rouxii

Abstract
In haploid Saccharomyces cerevisiae, a complex recombination system regulates mating-type switching and requires one MAT expression locus, two donor cassettes (HML and HMR) and the HO endonuclease that catalyses gene conversion. Zygosaccharomyces rouxii is the most distant species from S. cerevisiae with a functional HO, but with a poorly understood mating-type switching. Here, we described that two sub-cultures of the type strain CBS 732T underwent the α to a genotype switching leading to mixed MATα and MATa populations. Remarkably, during this event the donor cassette was copied into the MAT locus, except for its own 3' end, resulting in a new MATa2 gene copy different from the silenced HMRa copy. Moreover, CBS 732T cells bypassed the cell-cycle control, which oversees HO transcription in S. cerevisiae, and expressed HO at the stationary phase. Despite HO dysregulation, mating-type switching seemed to occur rarely or belatedly during CBS 732T colony formation in most of the tested conditions. When morphology and mating behaviour were analysed, two sub-cultures displayed distinct outcross fertility responses. Overall, our data support that mating-type switching causes genotype instability and phenotypic novelties in CBS 732T and open the question whether this mechanism is shared by other Z. rouxii haploid homothallic strains.

Gram-scale production of recombinant microbial enzymes in shake flasks

Abstract
Heterologous production of recombinant proteins is a cornerstone of microbiological and biochemical research as well as various biotechnological processes. Yields and quality of produced proteins have a tremendous impact on structural and enzymology studies, development of new biopharmaceuticals and establishing new biocatalytic processes. Majority of current protocols for recombinant protein expression in Escherichia coli exploit batch cultures with complex media, often providing low yields of the target protein due to oxygen transfer limitation, rapid depletion of carbon sources, and pH changes during the cultivation. Recently introduced EnBase technology enables fed-batch-like cultivations in shake flasks with continuous glucose release from a soluble starch. In this study, we critically compare the yields of fourteen model enzymes in E. coli cultured in a novel semi-defined medium and in a complex medium. Significant improvements of the volumetric yields 2–31 times were observed for all tested enzymes expressed in enzymatic fed-batch-like cultures with no adverse impact on enzyme structure, stability, or activity. Exceptional yields, higher than one gram of protein per litre of culture, were obtained with six enzymes. We conclude that the novel semi-defined medium tested in this study provides a robust improvement of protein yields in shake flasks without investment into costly bioreactors.

Growth and carotenogenesis in Rhodosporidium diobovatum IMB Y-5023: Effects of culture medium and illumination intensity

Abstract
The oleaginous yeast Rhodosporidium diobovatum is a poorly described producer of carotenoids and may be of interest in biotechnology. This study investigated the effects of culture medium and illumination on effective carotenoid production by R. diobovatum IMB Y-5023. Yeast was cultured on carrot, bran extract, and modified YM medium at illuminations in the 0–5,000 lx range. Biomass, total carotenoids, and their profile were assessed after cultivation. In order to samples comparison, cluster analysis (CA) and principle component analysis (PCA) were used to visualize the relationships between the variables and samples.Results show that it is not illumination, but culture medium that is the main factor determining the quantity and proportions of carotenoids produced by R. diobovatum IMB Y-5023. The yeast grew and produced pigments throughout the tested range of illumination intensity. The modified YM medium was optimal for carotenogenesis. In cultures on that medium, the highest carotenoid yields of 24.98 mg g−1 DCW and 77 mg L−1 were recorded. It was found that this yeast is capable of assimilating oligosaccharides and can grow and produce carotenoids in low-glucose media containing DP3 and DP4. Moreover R. diobovatum IMB Y-5023 produced lycopene as the main pigment independently of the culture conditions.

Electroactive haloalkaliphiles exhibit exceptional tolerance to free ammonia

Abstract
Electrochemical activity in bacteria has been observed in numerous environments and conditions. However, enrichments in circumneutral freshwater media where acetate is the main electron donor seem to invariably lead to the dominance of Geobacter spp. Here we report on an electroactive bacterial consortium which was enriched on acetate as electron donor, but in a medium which reproduces hydrolysed urine (high pH, high salinity and high free ammonia). The consortium was found to be free of Geobacter species, whereas a previously undescribed community dominated by species closely related to Pseudomonas and Desulfuromonas was established. The salient features of this community were: (i) high electroactivity, with anodic current densities up to 47.4 ± 2.0 A m-2; (ii) haloalkaliphilicity, with top performance at a medium pH of 10 and 19.5 ± 0.5 mS cm−1; and (iii) a remarkably high tolerance to free ammonia toxicity at over 2,200 mgNH3-N L−1. This community is likely to find applications in microbial electrochemical technology for nutrient recovery from source-separated urine.

Descriptive Error in the Text

In the Original Investigation titled "Prevalence of Pubic Hair Grooming–Related Injuries and Identification of High-Risk Individuals in the United States," published online August 16, 2017, there was a descriptive error in the text. The term vagina was used rather than the more accurate labia majora in 4 instances. This article has been corrected online.

Magnetic ethylene diamine-functionalized graphene oxide as novel sorbent for removal of lead and cadmium ions from wastewater samples

Abstract

In this paper, magnetic ethylene diamine-functionalized graphene oxide (MDFGO) as a novel sorbent was synthesized and applied for removal of Pb(II) and Cd(II) from real wastewater samples. The morphology and molecular structure of MDFGO were studied by different analytical methods. The effective parameters in adsorption efficiency of Pb(II) and Cd(II) were studied and optimized using experimental design. Under the optimal condition, the effective parameters including pH, sorbent dosage, shaking rate, and adsorption time were 6.2, 33.0 mg, 500 rpm, and 11 min, respectively. Mechanism of adsorption kinetic was investigated using the Lagergren pseudo-first-order, pseudo-second-order, and intraparticle diffusion models. It was found that adsorption of lead and cadmium ions in the MDFGO sorbent followed from pseudo-first-order and pseudo-second-order models, respectively. Thermodynamic parameters (ΔG°, ΔH°, and ΔS°) for the lead and cadmium ions uptake onto the MDFGO sorbent were calculated and indicated that the adsorption processes were spontaneous and endothermic in nature for both cations. In order to investigate the isotherm model for adsorption of Pb(II) and Cd(II), the experimental data were studied using the Langmuir, Freundlich, and Harkins–Jura isotherm models. The results fitted well with Freundlich model for both metal ions. The new sorbent (MDFGO) was applied to remove Pb(II) and Cd(II) from battery wastewater and electroplating wastewater. The removal percentage of Pb(II) and Cd(II) were 99.6±0.5 and 99.4±0.6, respectively, and demonstrated that the new sorbent was very suitable for removal of lead and cadmium ion from the real wastewater samples.



Regional Epidemiology of Methicillin-Resistant Staphylococcus aureus among Adult Intensive Care Unit Patients following State-Mandated Active Surveillance

Abstract
Background
In 2007, Illinois became the first state in the United States to mandate active surveillance of methicillin-resistant Staphylococcus aureus (MRSA). The Illinois law applies to intensive care unit (ICU) patients; contact precautions are required for patients found to be MRSA-colonized. However, the effectiveness of a legislated "search and isolate" approach to reduce MRSA burden among critically ill patients is uncertain. We evaluated whether the prevalence of MRSA colonization declined in the 5 years after the start of mandatory active surveillance.
Methods
All hospitals with an ICU having ≥10 beds in Chicago, Illinois, USA were eligible to participate in single-day serial point prevalence surveys. We assessed MRSA colonization among adult ICU patients present at time of survey using nasal and inguinal swab cultures. The primary outcome was region-wide MRSA colonization prevalence over time.
Results
All 25 eligible hospitals (51 ICUs) participated in serial point prevalence surveys over 8 survey periods (2008 – 2013). A total of 3909 adult ICU patients participated in the point prevalence surveys, with 432 (11.1%) found to be colonized with MRSA (95% confidence interval [CI] 10.1% to 12.0%). The MRSA colonization prevalence among patients was unchanged during the study period; year-over-year relative risk for MRSA colonization was 0.97, 95% CI 0.89 to 1.05, P=0.48).
Conclusions
MRSA colonization prevalence among critically ill adult patients did not decline during the time period following legislatively mandated MRSA active surveillance. Our findings highlight the limits of legislated MRSA active surveillance as a strategy to reduce MRSA colonization burden among ICU patients.

Antibiotic resistance and the risk of recurrent bacteremia

Abstract
Background
Direct health effects of antibiotic resistance are difficult to assess. We quantified the risk of recurrent bacteremia associated with antibiotic resistance.
Methods
We extracted antimicrobial susceptibility testing data on blood isolates of Enterobacteriaceae, Pseudomonas spp., Enterococcus spp. and Staphylococcus aureus from the Dutch surveillance system for antimicrobial resistance between 2008 and 2017. First and first recurrent (4-30days) bacteremia episodes were categorized as susceptible, single non-susceptible or co-non-susceptible (I/R), to 3rd generation cephalosporins -/+ carbapenems (Enterobacteriaceae), ceftazidime -/+ carbapenems (Pseudomonas spp.), aminopenicillins -/+ vancomycin (Enterococcus spp.), or MSSA/MRSA (S. aureus). We calculated absolute and relative risks of recurrent bacteremia after single- and co-non-susceptible vs. susceptible first bacteremia, estimated the crude population attributable effect of antibiotic resistance for the Netherlands, and calculated absolute risks of developing non-susceptible recurrent bacteremia after a susceptible first episode.
Results
Risk ratios for recurrent bacteremia after a first episode caused by a single- and co-non-susceptible bacteria, respectively, vs. susceptible first episodes, were 1.7 (95% CI 1.5-2.0) and 5.2 (2.1-12.4) for Enterobacteriaceae, 1.3 (0.5-3.1) and 5.0 (2.9-8.5) for Pseudomonas spp., 1.4 (1.2-1.7) and 1.6 (0.6-4.2) for Enterococcus spp., and 1.6 (1.1-2.4) for MRSA vs. MSSA. The estimated population annual number of recurrent bacteremias associated with non-susceptibility was 40. Risks of recurrent bacteremia caused by a non-susceptible pathogen after a susceptible first episode were at most 0.4% (Pseudomonas spp.).
Conclusions
Although antibiotic non-susceptibility was consistently associated with higher risks of recurrent bacteremia, the estimated number of additional recurrent episodes in the Netherlands (40 per year) was rather limited.

Acute Retroviral Syndrome is Associated with High Viral Burden, CD4 Depletion, and Immune Activation in Systemic and Tissue Compartments

Abstract
Background
Many individuals with acute HIV infection (AHI) experience acute retroviral syndrome (ARS), which is associated with adverse long-term clinical outcomes. We characterized clinical, virologic, and immunologic features of ARS and described the impact of early antiretroviral therapy (ART) initiation.
Methods
Participants presenting for voluntary HIV testing were enrolled during AHI in Bangkok, Thailand. ARS was defined by ≥3 qualifying signs/symptoms. HIV burden, immunophenotypes, and biomarkers were stratified by ARS diagnosis at enrollment and after up to 96 weeks of ART.
Results
From 212,382 samples screened, 430 participants were enrolled during AHI, including 335 (78%) with ARS. Median age was 26 years and 416 (97%) were men. Sixty (14%) underwent sigmoid biopsy and 105 (24%) underwent lumbar puncture during AHI. Common symptoms included fever (93%), fatigue (79%), pharyngitis (67%) and headache (64%). Compared to those without ARS, participants with ARS were in later Fiebig stages with higher HIV RNA in blood, colon, and cerebrospinal fluid; higher total HIV DNA in blood; CD4 depletion in blood and colon; and elevated plasma TNFα, C-reactive protein, and D-dimer (all p-values <0.05). Subgroup analyses of Fiebig I/II participants (95 with ARS, 69 without) demonstrated similar findings. After 96 weeks of ART, TNFα and IL-6 were elevated in the ARS group (p-values <0.05) but other biomarkers equilibrated.
Conclusions
ARS was associated with high viral burden, CD4 depletion and immune activation across multiple body compartments during AHI and prior to ART. Persistent inflammation despite suppressive ART could contribute to increased morbidity in individuals who experience ARS.

Advances in Serodiagnostic Testing for Lyme Disease Are at Hand

Abstract
The cause of Lyme disease, Borrelia burgdorferi, was discovered in 1983. A 2-tiered testing protocol was established for serodiagnosis in 1994, involving an enzyme immunoassay (EIA) or indirect fluorescence antibody, followed (if reactive) by immunoglobulin M and immunoglobulin G Western immunoblots. These assays were prepared from whole-cell cultured B. burgdorferi, lacking key in vivo expressed antigens and expressing antigens that can bind non-Borrelia antibodies. Additional drawbacks, particular to the Western immunoblot component, include low sensitivity in early infection, technical complexity, and subjective interpretation when scored by visual examination. Nevertheless, 2-tiered testing with immunoblotting remains the benchmark for evaluation of new methods or approaches. Next-generation serologic assays, prepared with recombinant proteins or synthetic peptides, and alternative testing protocols, can now overcome or circumvent many of these past drawbacks. This article describes next-generation serodiagnostic testing for Lyme disease, focusing on methods that are currently available or near-at-hand.

Vivax malaria chemoprophylaxis: the role of Atovaquone-proguanil, compared to other options

Abstract
Background
Atovaquone-Proguanil is considered causal prophylaxis (inhibition of liver-stage schizonts) for Plasmodium falciparum, however, its causal prophylactic efficacy for P. vivax is not known. Travelers returning to non-endemic areas, provide a unique opportunity to study P. vivax prophylaxis.
Methods
A retrospective observational study. For 11 years Israeli rafters who had traveled to the Omo River in Ethiopia, a highly malaria endemic area, were followed for at least one year after their return. Malaria prophylaxis used during this period included: mefloquine, doxycycline, primaquine and atovaquone-proguanil. Prophylaxis failure was divided into early (within a month of exposure) and late malaria.
Results
252 travelers were included.in the study. 62 (24.6%) travelers developed malaria, 56 (91.9%) caused by P. vivax, with 54 (87.1%) cases considered as late malaria. Among travelers using atovaquone-proguanil there were no cases of early P.falciparum or P. vivax malaria. However, 50.0% of atovaquone-proguanil users developed late vivax malaria, as did 46.5% and 43.5% of mefloquine and doxycycline users; respectively; only 2 (1.4%) primaquine users developed late malaria (p<0.0001).
Conclusions
Short-course atovaquone-proguanil appears to provide causal (liver-schizont stage) prophylaxis for P. vivax, but is ineffective against late, hypnozoite-reactivation-related attacks. These findings suggest that primaquine should be considered as the chemoprophylactic agent of choice for areas with high co-circulation of P. falciparum and P. vivax.

Randomized Controlled Trial of Daily Text Messages To Support Adherence to PrEP In At-Risk for HIV Individuals: The TAPIR Study

Abstract
Background
Adherence is critical for efficacy of tenofovir disoproxil fumarate/emtricitabine as pre-exposure prophylaxis (PrEP).
Methods
Between 02/2013 and 02/2016, 398 men who have sex with men and transgender women were randomized 1:1 to receive individualized Texting for Adherence Building (iTAB) or standard care (SoC) for 48 weeks. The primary endpoint was dried blood spot (DBS) tenofovir (TFV-DP) concentrations at both week 12 and week 48 (or the last on-drug visit) of >719 fmol/punch consistent with ≥4 doses per week (i.e. adequate adherence). Secondary outcomes included DBS TFV-DP concentrations of >1246 fmol/punch consistent with 7 doses per week (i.e. near perfect adherence) and plasma FTC >350 ng/mL (consistent with dosing within the past 24 hours).
Results
Concentrations >719 fmol/punch of TFV-DP were found in 88.6% of participants at week 12 and 82.5% at week 48. For the primary endpoint the study arms did not differ (72.0% in iTAB and 69.2% in SoC, p>0.05). For the secondary composite endpoint of >1246 fmol/punch the iTAB arm was superior to SoC (33.5% vs 24.8%, p=0.06), reaching statistical significance when adjusting for age [Odds Ratio=1.56 (95% CI 1.00–2.42 p<0.05)]. At week 48, iTAB was superior to SoC for near-perfect adherence (51.0% vs. 37.4%, p=0.02). At week 12, iTAB was superior to SoC for dosing in past 24 hours by plasma FTC (47.5% versus 33.3%, p=0.007), but not at weeks 24, 36 and 48 (all P>0.05).
Conclusions
Automated text messaging is a low-burden tool that improves durability of near-perfect PrEP adherence.
Trial Registration
http://ift.tt/2kaPohP

Endoscopic ultrasound-guided biliary drainage using a newly designed metal stent with a thin delivery system: a preclinical study in phantom and porcine models

Abstract

Purpose

This study was designed to evaluate the feasibility and safety of a newly designed self-expandable metal stent for endoscopic ultrasound-guided biliary drainage (EUS-BD) when it was delivered via three different stent delivery systems: a 7.5Fr delivery catheter with a bullet-shaped tip (7.5Fr-bullet), a 7Fr catheter with a bullet-shaped tip (7Fr-bullet), or a 7Fr catheter with a tee-shaped tip (7Fr-tee).

Methods

This experimental study utilized a porcine model of biliary dilatation involving ten pigs. In the animal study, technical feasibility and clinical outcomes of the stent when placed with each of the delivery systems were examined. In addition, a phantom model was used to measure the resistance of these delivery systems to advancement.

Results

Phantom experiments showed that, compared with 7Fr-bullet, 7Fr-tee had less resistance force to the advancement of the stent delivery system. EUS-BD was technically successful in all ten pigs. Fistulous tract dilation was necessary in 100% (2/2), 75% (3/4), and 0% (0/4) of the pigs that underwent EUS-BD using 7.5Fr-bullet, 7Fr-bullet, and 7Fr-tee, respectively. There were no procedure-related complications.

Conclusion

Our newly designed metal stent may be feasible and safe for EUS-BD, particularly when delivered by 7Fr-tee, because it eliminates the need for fistulous tract dilation.



Chrysophyllum cainito (apple-star): a fruit with gastroprotective activity in experimental ulcer models

Abstract

The gastroprotective potential of the methanolic extracts from peels (MEPe), seeds (MESe) and pulp (MEPu) of Chrysophyllum cainito L. (Sapotaceae) fruits was evaluated in mice using ethanol/HCl- and indomethacin-induced ulcer, as well as the antiulcer effect of the juice and flour from this fruit. The lowest oral gastroprotective dose of MEPe, MESe and MEPu against ethanol/HCl was 3, 3 and 10 mg/kg, respectively. Moreover, all extracts increased mucin secretion at 176, 198 and 193%. Intraperitoneal administration of MEPe (0.3 mg/kg), MESe (0.3 mg/kg) and MEPu (1 mg/kg) also promoted gastroprotection against ethanol/HCl. In addition, MEPe (3 mg/kg, p.o), MESe (3 mg/kg, p.o) and MEPu (10 mg/kg, p.o) reduced indomethacin-induced gastric ulcer in mice by 78, 70 and 50%, respectively. Regarding the mode of action, the gastroprotective effect of MEPe was decreased by the pre-administration of N-ethylmaleimide (NEM, a sulfhydryl group chelator, 10 mg/kg, i.p), glibenclamide (a potassium channel blocker, 10 mg/kg, i.p), yohimbine (10 mg/kg, i.p, an alpha-adrenergic receptor antagonist, 10 mg/kg, i.p) and indomethacin (a cyclooxygenase inhibitor, 10 mg/kg, i.p). The gastroprotective effect of MESe was reduced by the pre-administration of NEM, glibenclamide, N-Nitro-l-arginine methyl ester (L-NAME, a nitric oxide synthase inhibitor, 70 mg/kg, i.p) and yohimbine, while MEPu had the gastroprotective effect decreased in animals pretreated with NEM and L-NAME. However, the extracts did not reduce gastric acid secretion. The supplementation with the flour from C. cainito fruit at 10% by 7 days, but not the juice intake, displayed gastroprotective potential, evidencing the fruit as a promising functional food. Together, the antiulcer effect of extracts of the C. cainito fruit in different experimental models was confirmed by the favoring of mucosal protective mechanisms among different, but complementary, modes of action. In parallel, the gastroprotective effects of the flour from C. cainito fruit were also described.



CFD modeling of hydro-biochemical behavior of MSW subjected to leachate recirculation

Abstract

The most commonly used method of operating landfills more sustainably is to promote rapid biodegradation and stabilization of municipal solid waste (MSW) by leachate recirculation. The present study is an application of computational fluid dynamics (CFD) to the 3D modeling of leachate recirculation in bioreactor landfills using vertical wells. The objective is to model and investigate the hydrodynamic and biochemical behavior of MSW subject to leachate recirculation. The results indicate that the maximum recirculated leachate volume can be reached when vertical wells are set at the upper middle part of a landfill (H W/H T = 0.4), and increasing the screen length can be more helpful in enlarging the influence radius than increasing the well length (an increase in H S/H W from 0.4 to 0.6 results in an increase in influence radius from 6.5 to 7.7 m). The time to reach steady state of leachate recirculation decreases with the increase in pressure head; however, the time for leachate to drain away increases with the increase in pressure head. It also showed that methanogenic biomass inoculum of 1.0 kg/m3 can accelerate the volatile fatty acid depletion and increase the peak depletion rate to 2.7 × 10−6 kg/m3/s. The degradation-induced void change parameter exerts an influence on the processes of MSW biodegradation because a smaller parameter value results in a greater increase in void space.



Enhanced activity and stability of La-doped CeO 2 monolithic catalysts for lean-oxygen methane combustion

Abstract

Effective utilization of coal bed methane is very significant for energy utilization and environment protection. Catalytic combustion of methane is a promising way to eliminate trace amounts of oxygen in the coal bed methane and the key to this technology is the development of high-efficiency catalysts. Herein, we report a series of Ce1-xLaxO2-δ (x = 0–0.8) monolithic catalysts for the catalytic combustion of methane, which are prepared by citric acid method. The structural characterization shows that the substitution of La enhance the oxygen vacancy concentration and reducibility of the supports and promote the migration of the surface oxygen, as a result improve the catalytic activity of CeO2. M-Ce0.8La0.2O2-δ (monolithic catalyst, Ce0.8La0.2O2-δ coated on cordierite honeycomb) exhibits outstanding activity for methane combustion, and the temperature for 10 and 90% methane conversion are 495 and 580 °C, respectively. Additionally, Ce0.8La0.2O2-δ monolithic catalyst presents excellent stability at high temperature. These Ce1-xLaxO2-δ monolithic materials with a small amount of La incorporation therefore show promises as highly efficient solid solution catalysts for lean-oxygen methane combustion.

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Against the perceptual model of utterance comprehension

Abstract

What accounts for the capacity of ordinary speakers to comprehend utterances of their language? The phenomenology of hearing speech in one's own language makes it tempting to many epistemologists to look to perception for an answer to this question. That is, just as a visual experience as of a red square is often taken to give the perceiver immediate justification for believing that there is a red square in front of her, perhaps an auditory experience as of the speaker asserting that p gives the competent hearer immediate justification for believing that the speaker has asserted that p. My aim here is to offer reasons for resisting this temptation. I argue that the perceptual model cannot adequately account for the hearer's justification in many cases. The arguments here also allow us to draw certain further morals about the role of phenomenology in the epistemology of perception.



Wound healing activity of Streptocaulon juventas root ethanolic extract

ABSTRACT

Streptocaulon juventas is a well-known plant that has antimicrobial activity, in vitro antiplasmodial activity, anti-proliferative activity, and antioxidant activity. In this study, we showed experimental evidence that proved that Streptocaulon juventas root ethanolic extract has wound healing activities. First, in a mouse excision wound model, Streptocaulon juventas root ethanolic extract at a dose of 100 mg/kg/day significantly reduced the wound closure time. After 7 days, the wound granulation tissue in mice treated with the extract exhibited a 2.3-fold decrease in inflammatory cells, a 1.7-fold increase in fibroblasts and enhanced angiogenesis. Molecular analysis also revealed that after wounds were treated with Streptocaulon juventas root ethanolic extract, TNF-α and NF-κB1 gene expression were down-regulated by 4.7 and 3.7 times, respectively. In contrast, TGF-β1 and VEGF gene expression were up-regulated by 1.9 and 6.5 times, respectively. Taken together, our experimental data strongly demonstrate that the ethanolic extract from Streptocaulon juventas root displays remarkable wound healing activity. This article is protected by copyright. All rights reserved.



Survival study of treatment adherence by patients given oral oxibutynin for hyperhidrosis

Abstract

Introduction

In recent years, increasing use has been made of oral anticholinergics such as oxybutynin for the management of hyperhidrosis. The primary aim of this study is to determine the variables associated with adherence to this treatment, and secondarily to obtain data on its effectiveness, safety and adverse effects.

Material and methods

Prospective study of patients with hyperhidrosis, at any location, receiving treatment with oral oxybutynin in the period 2007-2016. Epidemiological variables, treatment details, effectiveness and adverse effects were recorded. Effectiveness was determined according to the Hyperhidrosis Disease Severity Scale (HDSS) at baseline, at 3 and 12 months and in successive visits. A descriptive analysis was performed, and Cox's bivariate and multivariate regressions were calculated to determine the variables associated with treatment adherence.

Results

201 patients (140 women) with a mean age of 34 years were included. The mean initial HDSS score was 3.8 and the median follow-up period was 29 months. At 3 months, 84.57% of the patients had responded to treatment (excellent response: 72.94%), but adverse effects were reported by 68.2%. At 12 months, 54.23% had responded (excellent response: 79.82%), with adverse effects in 75.2%. The main variable associated with greater adherence was affected areas: palms of the hands and soles of the feet. The following variables were associated with poorer adherence: onset of hyperhidrosis in adolescence, failure to provide an incrementally increasing, individualised dose, initial HDSS score of 3, and partial initial response. The multivariate analysis confirmed the association between the onset of hyperhidrosis during adolescence, the failure to provide a progressively increasing dose, and palmar affectation.

Discussion

This study was conducted to identify the variables associated with adherence to treatment by hyperhidrosis patients treated with oral oxybutynin. This information would facilitate selection of patients for this treatment and enhance our understanding of the biological behaviour of such anticholinergics when used to treat hyperhidrosis.

This article is protected by copyright. All rights reserved.



Testing the role of fiscal policy in the environmental degradation: the case of Turkey

Abstract

This study introduces a new research topic that investigates the relationship between fiscal development and carbon emissions in Turkey through testing Environmental Kuznets Curve (EKC) hypothesis. Annual data covering the period, 1960–2013, has been used and in addition to gross domestic product and energy consumption, fiscal policy variables have been regressed on the level of carbon emissions in Turkey. Results reveal that fiscal policies and carbon emissions are in long-term equilibrium relationship in Turkey; carbon dioxide emission level converges towards long-term paths as contributed by fiscal policy. The effects of fiscal aggregates on the level of carbon dioxide emissions are negatively significant revealing that growth in fiscal aggregates leads to declines on the levels of carbon emissions. This proves that as far as environmental effects are concerned, fiscal policies regarding energy sector is successful in Turkey. Thus, the major finding of this study confirmed the validity of the fiscal policy-induced EKC hypothesis in the case of Turkey.



Essence, necessity, and definition

Abstract

What is it for something to be essential to an item? For some time, it was standard to think that the concept of necessity alone can provide an answer: for something to be essential to an item is for it to be strictly implied by the existence of that item. We now tend to think that this view fails because its analysans is insufficient for its analysandum. In response, some argue that we can supplement the analysis in terms of necessity with a further condition. In this paper I argue that this view is untenable in its current form. I then provide a glimmer of hope to those who think that essence is at least partially analyzable in terms of necessity.



Modulation of collagen population under honey assisted wound healing in diabetic rat model

Publication date: Available online 7 December 2017
Source:Wound Medicine
Author(s): Satarupa Sarkar, Amrita Chaudhary, Tanmoy Kumar Saha, Amit Kumar Das, Jyotirmoy Chatterjee
BackgroundDiabetic wound with impaired healing attributes owing to inappropriate synthesis and alignment of collagen fibrils with aberrant post translational modifications impose substantial economic burden. Honey: a recognized natural collagen pro-synthetic healing agent; stimulates rapid healing with its anti-inflammatory and anti-scarring approach. Present study investigates the effect of honey on collagen population in diabetic wound model.MethodologyFull thickness wound was created on rat and divided into three groups: normal saline treated group (N), diabetic honey treated group (H), diabetic povidone iodine treated group (PI). Biopsies were collected from wound edges for collagen characterization.Main findingsHistological attributes of collagen fibers in N and H group biopsy displayed proximity. Ultrastructure analysis using scanning electron microscope (SEM) revealed that the D-Spacing and collagen diameter under honey treatment were in close resemblance to normal skin collagen. FTIR spectra confirmed secondary structure of collagen with a greater peak height in PI group exhibiting excessive glycation than H group. Nano-indentation profiling showed decreased displacement in PI samples resulting from increased rigidity when compared to honey treated ones. Molecular expression of collagen I and III exhibited optimum ratio in H group similar to N group.ConclusionsBased on these findings, it might be opined that honey predominantly helps in regulating synthesis, glycation and deposition followed by mechanical quality of collagen alike normal skin and its application also accelerated diabetic healing process.



Dapsone for Recalcitrant Eosinophilic Annular Erythema: A Case Report and Literature Review

Abstract

Eosinophilic annular erythema (EAE) is a rare entity of unknown etiology that is possibly related to a hypersensitivity reaction and presents as annular erythematous plaques with tissue eosinophilia. It is classified as a figurate erythema with a controversial relationship to Wells syndrome (WS) in the literature, where it is generally considered a separate entity or subset based on clinical and histopathologic differences. EAE typically presents with recurrent, erythematous, arcuate, and annular plaques on the trunk and proximal extremities. The course of the disease is often chronic, recurrent, and relapsing. Responses to treatment are variable but are typically best with systemic steroids and antimalarials. We report a patient refractory to other therapies who had a striking response to dapsone.



Panorama



Protective effects of fucoxanthin and fucoxanthinol against tributyltin-induced oxidative stress in HepG2 cells

Abstract

Tributyltin (TBT) is a biocide extremely toxic to a wide range of organisms, which has been used for decades for industrial purposes. Fucoxanthin is a natural carotenoid that is isolated from seaweed, and fucoxanthinol is a major primary metabolite of fucoxanthin. Although fucoxanthin and fucoxanthinol have been reported to possess anti-oxidant activities in vitro, little is known as to whether they protect against TBT-induced oxidative stress in cultured cells. In the present study, the protective effect of fucoxanthin and fucoxanthinol against oxidative stress induced by TBT was investigated. The data showed that incubation of HepG2 cells with 0.2 μM TBT significantly increased cell apoptosis, whereas treatment with fucoxanthin or fucoxanthinol (3 μM) significantly recovered cell viability. In addition, fucoxanthinol treatment significantly decreased the intracellular reactive oxygen species (ROS) and malondialdehyde (MDA) in HepG2 cells incubated with TBT. Moreover, fucoxanthin and fucoxanthinol markedly increased the expression level of Bcl-2/Bax. These results demonstrated that both fucoxanthin and fucoxanthinol effectively prevented cytotoxicity in HepG2 cells treated with TBT, and the protective effect was likely associated with decreased intracellular ROS and MDA and increased Bcl-2/Bax levels.



Phytotoxic effects of silver nanoparticles in tobacco plants

Abstract

The small size of nanoparticles (NPs), with dimensions between 1 and 100 nm, results in unique chemical and physical characteristics, which is why they are implemented in various consumer products. Therefore, an important concern is the potential detrimental impact of NPs on the environment. As plants are a vital part of ecosystem, investigation of the phytotoxic effects of NPs is particularly interesting. This study investigated the potential phytotoxicity of silver nanoparticles (AgNPs) on tobacco (Nicotiana tabacum) plants and compared it with the effects of the same AgNO3 concentrations. Accumulation of silver in roots and leaves was equally efficient after both AgNP and AgNO3 treatment, with predominant Ag levels found in the roots. Exposure to AgNPs did not result in elevated values of oxidative stress parameters either in roots or in leaves, while AgNO3 induced oxidative stress in both plant tissues. In the presence of both AgNPs and AgNO3, root meristem cells became highly vacuolated, which indicates that vacuoles might be the primary storage target for accumulated Ag. Direct AgNP uptake by root cells was confirmed. Leaf ultrastructural studies revealed changes mainly in the size of chloroplasts of AgNP-treated and AgNO3-treated plants. All of these findings indicate that nano form of silver is less toxic to tobacco plants than silver ions.



Changes to tetracyclines and tetracycline resistance genes in arable soils after single and multiple applications of manure containing tetracyclines

Abstract

The influence of manure containing tetracyclines (TCs) on the prevalence of antibiotic resistance genes in soils remains poorly understood. Here, three different TCs (oxytetracycline (OTC), tetracycline (TC), and chlortetracycline (CTC)) were mixed respectively with unpolluted manure to fertilize arable soil. The soil received either a single application of 0 μg kg−1, 300 μg kg−1 (TC and CTC), or 700 μg kg−1 (OTC) or multiple applications every 14 days for 140 days. Four tetracycline resistance genes (TRGs), including tet(A), tet(L), tet(M), and tet(Q), were monitored. Although the abundances of the four TRGs in the single application treatment initially increased rapidly, they decreased over time and were significantly lower than those of the repeated treatments after day 112. All additions of TCs stopped on day 140, but we continued to assess the long-term accumulation of TRGs. Most of the TRGs were detected even after the TC-containing manures had not been applied for more than 15 months. The abundance of the TRGs after ceasing fertilization with the TC-containing manures was higher in the repeated application treatments than in the single application treatments. Therefore, more attention should be paid to repeated applications of antibiotic-containing manure to arable soils.



Pyoderma gangrenosum récidivant du post-partum et cardiomyopathie fatale

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Publication date: Available online 7 December 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): I. Naciri, M. Meziane, L. Benzekri, M. Ghaouti, K. Senouci, B. Hassam
IntroductionNous rapportons l'observation d'un pyoderma gangrenosum (PG) récidivant du post-partum, associé à une cardiomyopathie du post-partum (CMPP).ObservationUne femme de 23 ans signalait avoir eu un abcès du sein gauche lors de sa quatrième grossesse. Cette lésion avait évolué, après drainage chirurgical, vers une ulcération inflammatoire traitée par des soins locaux atraumatiques. Lors de sa cinquième grossesse, la patiente développait une ulcération large et douloureuse en regard d'une cicatrice de césarienne, malgré l'introduction d'une antibiothérapie à large spectre. Les prélèvements bactériologiques étaient négatifs. L'examen histologique était en faveur d'un PG. Une semaine après l'introduction d'une corticothérapie générale, elle présentait brutalement des signes d'insuffisance cardiaque. L'échocardiographie trans-thoracique permettait de retenir le diagnostic de CMPP, dont l'évolution était fatale.DiscussionCette observation soulève la question de la relation entre PG et grossesse, et décrit l'association d'un PG et d'une CMPP. La survenue du PG lors de la grossesse est rare ; elle pourrait être induite par l'élévation des taux de G-CSF constatée chez les femmes enceintes. L'association à une CMPP chez notre patiente pourrait être expliquée par le développement d'un climat anti-angiogénique en fin de grossesse, auquel s'ajouterait une agression myocardique inflammatoire neutrophilique en lien avec le PG.BackgroundWe report a case of recurrent post-partum pyoderma gangrenosum (PG) complicated by post-partum cardiomyopathy (PPCM).Patients and methodsA 23-year-old woman presented with a previous medical history of aseptic abscess of the left breast in her fourth pregnancy, which developed after surgical drainage of an inflammatory ulceration treated by atraumatic topical care. During her fifth pregnancy, the patient presented a large and painful ulceration in relation to the scar of the Caesarean section, despite the introduction of broad-spectrum antibiotic therapy. Bacteriological samples were negative. Histological examination militated in favor of PG. One week after initiation of corticosteroid therapy, the patient suddenly showed signs of heart failure. Based on trans-thoracic echocardiography PPCM was diagnosed, and the outcome was fatal.DiscussionThis observation raises the question of the relationship between PG and pregnancy and describes the association of PG and PPCM. PG occurs rarely during pregnancy and it may be induced by the rise in G-CSF levels found in pregnant women. The association with PPCM seen in our patient could have been due to the development of an anti-angiogenic climate at the end of pregnancy, together with inflammatory myocardial aggression linked to the PG.



An advanced simulator for orthopedic surgical training

Abstract

Purpose

The purpose of creating the virtual reality (VR) simulator is to facilitate and supplement the training opportunities provided to orthopedic residents. The use of VR simulators has increased rapidly in the field of medical surgery for training purposes. This paper discusses the creation of the virtual surgical environment (VSE) for training residents in an orthopedic surgical process called less invasive stabilization system (LISS) surgery which is used to address fractures of the femur.

Method

The overall methodology included first obtaining an understanding of the LISS plating process through interactions with expert orthopedic surgeons and developing the information centric models. The information centric models provided a structured basis to design and build the simulator. Subsequently, the haptic-based simulator was built. Finally, the learning assessments were conducted in a medical school.

Results

The results from the learning assessments confirm the effectiveness of the VSE for teaching medical residents and students. The scope of the assessment was to ensure (1) the correctness and (2) the usefulness of the VSE. Out of 37 residents/students who participated in the test, 32 showed improvements in their understanding of the LISS plating surgical process. A majority of participants were satisfied with the use of teaching Avatars and haptic technology. A paired t test was conducted to test the statistical significance of the assessment data which showed that the data were statistically significant.

Conclusion

This paper demonstrates the usefulness of adopting information centric modeling approach in the design and development of the simulator. The assessment results underscore the potential of using VR-based simulators in medical education especially in orthopedic surgery.



Issue Information



Levels, dietary intake, and health risk of potentially toxic metals in vegetables, fruits, and cereal crops in Pakistan

Abstract

Food safety is a major concern worldwide and human beings are frequently exposed to potentially toxic metals (PTMs) through consumption of vegetables, fruits, and cereal crops grown in contaminated areas. The present study investigates the concentrations of PTMs such as chromium (Cr), nickel (Ni), zinc (Zn), arsenic (As), cadmium (Cd), and lead (Pb) in the foodstuffs (fruits, vegetables, and cereals) collected from different markets of Khyber Pakhtunkhwa, Pakistan. Samples of fruits (banana, tangerine, apple, and guava), vegetables (tomato, onion, potato, pea, and lady finger), and cereals (rice, kidney beans, and chick peas) were acid-extracted and analyzed using ICP-MS. The concentrations of Cr, Zn, Pb, As, and Cd in fruits (54, 50, 50, 45, and 4% samples, respectively), vegetables (53, 43, 63, 80, and 46%), and cereals (37, 62, 25, 70, and 25%) exceeded their respective permissible limits set by FAO/WHO (2001). The results showed that the highest mean concentration was observed for Ni (14.95 mg/kg), Pb (0.57 mg/kg), and Cd (0.27 mg/kg) in vegetables followed by fruits and cereals. However, the highest mean concentration of As (0.44 mg/kg) was observed in cereal crops followed by vegetables and fruits. The individual health risk of PTMs via consumption of fruits, vegetables, and cereals were found within safe limits for adults and children. Nevertheless, the total HRI values (fruits + vegetables + cereals) for Ni, As, and Cd for both adults and children were observed > 1 and may posed potential risk for the community consuming these foodstuffs on a daily basis.

Graphical abstract

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Municipal solid waste compost as a novel sorbent for antimony(V): adsorption and release trials at acidic pH

Abstract

The ability of two municipal solid waste composts (MSW-Cs) to sorb antimony(V) in acidic conditions (pH 4.5) was investigated. Sorption isotherms and kinetics showed that both MSW-Cs could sorb antimony(V), even if in different amounts (~ 0.18 and 0.24 mmol g−1 of Sb(V) by MSW-C1 and MSW-C2, respectively). These differences were ascribed to the chemical composition of composts, as well as to the total acidity of their humic substances. The Sb(V) sorption by both MSW-Cs followed a pseudo-second-order kinetic model, while the sorption isotherms data fitted the Freundlich model better than the Langmuir one. The humic acids extracted from composts contributed to 4.26 and 8.24% of Sb(V) sorption by MSW-C1 and MSW-C2 respectively. SEM-EDX spectra of the MSW-C+Sb(V) systems showed a certain association of Ca(II) with Sb(V), while sequential extraction procedures indicated that more than 80% of the Sb(V) sorbed was strongly retained by MSW-Cs. On the other hand, treatment with oxalic acid at pH 4.5 favored the release of more than 98 and 65% of the Sb(V) sorbed by MSW-C1 and MSW-C2 respectively, supporting a possible role of calcium in Sb(V) retention. The results from this study suggest that MSW-Cs could be used as amendments for the in-situ immobilization of Sb(V) in acidic-polluted soils.



Responsibility for scientific misconduct in collaborative papers

Abstract

This paper concerns the responsibility of co-authors in cases of scientific misconduct. Arguments in research integrity guidelines and in the bioethics literature concerning authorship responsibilities are discussed. It is argued that it is unreasonable to claim that for every case where a research paper is found to be fraudulent, each author is morally responsible for all aspects of that paper, or that one particular author has such a responsibility. It is further argued that it is more constructive to specify what task responsibilities come with different roles in a project and describe what kinds of situations or events call for some kind of action, and what the appropriate actions might be.