Carlo Gelmetti
Indian Journal of Paediatric Dermatology 2018 19(1):1-8
A confusing nomenclature concerning the subject of vascular birthmark and angiomas lead (and leads!) to the consequence that parents with children affected by this kind of disorders become medical nomads, and therefore, the best treatment, when available, is frequently postponed. The concept of maternal imprint that began to crumble in the XVIII century is, unfortunately, still widespread. While a maternal responsibility as it has been conceived in the past has been definitively excluded, the pivotal classification proposed by John Mulliken that divides vascular anomalies in vascular tumors and vascular malformations is practically very useful. The rapid progress of genetic studies has explained to medical community a huge number of genotype-phenotype correlations, and it will individuate new forms in the next future. Understanding the biology of vascular birthmarks is a fundamental step forward to implement effective and specific drugs for specific forms. Discoveries by serendipity occur but are rare.
Πέμπτη 28 Δεκεμβρίου 2017
Prevalence of dermatoses among the tribal children studying in residential schools of South Chhattisgarh, India
Yasha Upendra, Sampreeti Sendur, Naveen Keswani, Abhishek Pallava
Indian Journal of Paediatric Dermatology 2018 19(1):15-20
Introduction: Dermatoses are common among schoolgoing children and lead to significant morbidity. Objective: The present study was conducted to find the prevalence of various dermatoses in children studying in residential schools of remote tribal areas. Materials and Methods: A cross-sectional study was conducted on 1943 children studying in eight residential government schools over a period of 2 months (August and September 2016). Diagnosis of various dermatoses was made on the basis of detailed clinical examination and necessary investigations. Data analysis done by SPSS version 21.0 and Chi-square test was used to analyze categorical variables. Results: The prevalence of dermatoses was 72.1%. Majority had single skin lesion. Among infections and infestations, scabies (13.6%), pediculosis capitis (9.2%), and pyoderma (7.5%) were most prevalent. Among the noninfective conditions, xerosis (32.63%), pityriasis alba (18.9%), acne (8.6%), and atopic dermatitis were most prevalent. The prevalence of pyoderma, tinea corporis, pityriasis versicolor, scabies, and xerosis was higher in boys while pediculosis capitis and pityriasis alba were more prevalent in girls. The prevalence of xerosis, pityriasis alba, and phrynoderma was higher in primary school students while tinea corporis, scabies, acne, and pediculosis capitis were more prevalent in high school students. Conclusions: The burden of dermatoses in residential school children is very high. Health education of children, teachers, and caregivers regarding signs and symptoms of dermatoses is warranted for early detection and timely intervention. There is urgent need to address dermatoses under school health program.
Indian Journal of Paediatric Dermatology 2018 19(1):15-20
Introduction: Dermatoses are common among schoolgoing children and lead to significant morbidity. Objective: The present study was conducted to find the prevalence of various dermatoses in children studying in residential schools of remote tribal areas. Materials and Methods: A cross-sectional study was conducted on 1943 children studying in eight residential government schools over a period of 2 months (August and September 2016). Diagnosis of various dermatoses was made on the basis of detailed clinical examination and necessary investigations. Data analysis done by SPSS version 21.0 and Chi-square test was used to analyze categorical variables. Results: The prevalence of dermatoses was 72.1%. Majority had single skin lesion. Among infections and infestations, scabies (13.6%), pediculosis capitis (9.2%), and pyoderma (7.5%) were most prevalent. Among the noninfective conditions, xerosis (32.63%), pityriasis alba (18.9%), acne (8.6%), and atopic dermatitis were most prevalent. The prevalence of pyoderma, tinea corporis, pityriasis versicolor, scabies, and xerosis was higher in boys while pediculosis capitis and pityriasis alba were more prevalent in girls. The prevalence of xerosis, pityriasis alba, and phrynoderma was higher in primary school students while tinea corporis, scabies, acne, and pediculosis capitis were more prevalent in high school students. Conclusions: The burden of dermatoses in residential school children is very high. Health education of children, teachers, and caregivers regarding signs and symptoms of dermatoses is warranted for early detection and timely intervention. There is urgent need to address dermatoses under school health program.
Hoyeraal–Hreidarsson syndrome: A rare dyskeratosis congenita phenotype
Mansoor C Abdulla
Indian Journal of Paediatric Dermatology 2018 19(1):83-84
Indian Journal of Paediatric Dermatology 2018 19(1):83-84
Effect of occurrence of vitiligo in children over quality of life of their families: A hospital-based study using family dermatology life quality index
Pratik Gahalaut, Sandhya Chauhan, Amit Shekhar, Madhur Kant Rastogi, Nitin Mishra
Indian Journal of Paediatric Dermatology 2018 19(1):21-25
Introduction: Vitiligo in an adult patient has a profound effect on the quality of life (QoL) of that particular patient. Although it is known that vitiligo in adult patient affects QoL in their family, very little information is available regarding QoL in a family having children suffering from vitiligo. Materials and Methods: This is a cross-sectional, hospital-based study to ascertain the effect children suffering from vitiligo have on the QoL of their respective families. Study participants were fifty healthy parent/immediate caregivers of fifty corresponding children suffering from vitiligo. The QoL in the family of these vitiliginous children was assessed with the help of Family Dermatology Life Quality Index (FDLQI). Results: There was significantly more impairment of FDLQI among respondents if vitiliginous child was female compared to male. The total FDLQI showed a significant negative correlation with duration of vitiligo in children. Analysis of individual items in FDLQI revealed emotional distress as the most impaired facet of FDLQI and housework as the least affected item. Conclusion: Presence of vitiligo in children affects the QoL of that particular child and his/her family. This impairment of FDLQI is more if the child suffering from vitiligo is female. Treatment of vitiligo in pediatric age group should include psychological counseling and support for the child as well as their parents/caregivers.
Indian Journal of Paediatric Dermatology 2018 19(1):21-25
Introduction: Vitiligo in an adult patient has a profound effect on the quality of life (QoL) of that particular patient. Although it is known that vitiligo in adult patient affects QoL in their family, very little information is available regarding QoL in a family having children suffering from vitiligo. Materials and Methods: This is a cross-sectional, hospital-based study to ascertain the effect children suffering from vitiligo have on the QoL of their respective families. Study participants were fifty healthy parent/immediate caregivers of fifty corresponding children suffering from vitiligo. The QoL in the family of these vitiliginous children was assessed with the help of Family Dermatology Life Quality Index (FDLQI). Results: There was significantly more impairment of FDLQI among respondents if vitiliginous child was female compared to male. The total FDLQI showed a significant negative correlation with duration of vitiligo in children. Analysis of individual items in FDLQI revealed emotional distress as the most impaired facet of FDLQI and housework as the least affected item. Conclusion: Presence of vitiligo in children affects the QoL of that particular child and his/her family. This impairment of FDLQI is more if the child suffering from vitiligo is female. Treatment of vitiligo in pediatric age group should include psychological counseling and support for the child as well as their parents/caregivers.
Recurrent pilomatricoma of the thigh: An unusual site of presentation
Vanlalhriatpuii Hmar, Nandakishore Thokchom, Sandhyarani Kshetrimayum
Indian Journal of Paediatric Dermatology 2018 19(1):65-67
Pilomatricoma is a benign tumor of the hair matrix. It is also known as calcifying epithelioma of Malherbe and is commonly located in head, neck, and upper extremities. A 10-year-old female patient presented with a solitary skin-colored firm nodule on her left mid-thigh which progressed to 1.5 cm diameter within 4 months. Surgical excision had been conducted 1 year ago at the same site. Clinical examination revealed a single, firm, well-circumscribed, non-tender, freely mobile nodule with irregular surface and hyperpigmented borders including surrounding skin. Histopathological examination showed dermis displaying benign adnexal tumor tissue with sheets of ghost cells, clusters of basaloid cells, and extensive areas of dystrophic calcification. Histopathological confirmation prior excision should be ideally performed. Although the tumor is most common in head and neck region, clinicians should be aware that tumors can arise rarely in the lower limbs as well.
Indian Journal of Paediatric Dermatology 2018 19(1):65-67
Pilomatricoma is a benign tumor of the hair matrix. It is also known as calcifying epithelioma of Malherbe and is commonly located in head, neck, and upper extremities. A 10-year-old female patient presented with a solitary skin-colored firm nodule on her left mid-thigh which progressed to 1.5 cm diameter within 4 months. Surgical excision had been conducted 1 year ago at the same site. Clinical examination revealed a single, firm, well-circumscribed, non-tender, freely mobile nodule with irregular surface and hyperpigmented borders including surrounding skin. Histopathological examination showed dermis displaying benign adnexal tumor tissue with sheets of ghost cells, clusters of basaloid cells, and extensive areas of dystrophic calcification. Histopathological confirmation prior excision should be ideally performed. Although the tumor is most common in head and neck region, clinicians should be aware that tumors can arise rarely in the lower limbs as well.
Childhood leprosy in the postelimination era: A vision achieved or a concern growing at large
Ashwini Babu, M Ramesh Bhat, Jyothi Jayaraman
Indian Journal of Paediatric Dermatology 2018 19(1):26-30
Background: The proportion of childhood leprosy has been gaining importance of late as a performance indicator of the National Leprosy Eradication Program. A sizable proportion of the newly detected cases comprises children. The prevalence rate has been used as a measure of existence of infection though leprosy has attained elimination levels in the country. Materials and Methods: A retrospective descriptive study was conducted. Case records of children newly diagnosed with leprosy aged <15 years between April 2005 and October 2015 were studied and included in the study. Findings such as patches, nerve thickness, spectrum of leprosy, grade of deformity, smear status, presence of reaction, histopathological diagnosis, and treatment history were noted. Results: The percentage of childhood leprosy among the newly diagnosed cases in our study was found to be 11.2%. A solitary skin lesion was the most frequent manifestation in 64.4% children. The second most common finding seen in these patients included the presence of thickened nerves in 46.6% children. Smear showed acid-fast bacilli in 8.8% cases. Conclusion: There is an urgent need for improving clinical acumen in diagnosing childhood leprosy. The importance of appropriate and complete treatment along with meticulous surveillance in endemic areas and looking for household contacts needs to be stressed on.
Indian Journal of Paediatric Dermatology 2018 19(1):26-30
Background: The proportion of childhood leprosy has been gaining importance of late as a performance indicator of the National Leprosy Eradication Program. A sizable proportion of the newly detected cases comprises children. The prevalence rate has been used as a measure of existence of infection though leprosy has attained elimination levels in the country. Materials and Methods: A retrospective descriptive study was conducted. Case records of children newly diagnosed with leprosy aged <15 years between April 2005 and October 2015 were studied and included in the study. Findings such as patches, nerve thickness, spectrum of leprosy, grade of deformity, smear status, presence of reaction, histopathological diagnosis, and treatment history were noted. Results: The percentage of childhood leprosy among the newly diagnosed cases in our study was found to be 11.2%. A solitary skin lesion was the most frequent manifestation in 64.4% children. The second most common finding seen in these patients included the presence of thickened nerves in 46.6% children. Smear showed acid-fast bacilli in 8.8% cases. Conclusion: There is an urgent need for improving clinical acumen in diagnosing childhood leprosy. The importance of appropriate and complete treatment along with meticulous surveillance in endemic areas and looking for household contacts needs to be stressed on.
Dermatopathia pigmentosa reticularis
Gauri Vats, Rohit Kataria, Durgesh Sonare, Vinod Jain
Indian Journal of Paediatric Dermatology 2018 19(1):77-79
Dermatopathia pigmentosa reticularis (DPR) is a rare disorder with characteristic triad of generalized reticulate hyperpigmentation, noncicatricial alopecia, and onychodystrophy. A 12-year-old Indian boy presented with classical features of the triad along with adermatoglyphia, hyperhidrosis, punctate hyperkeratosis of palm, and sole along with keratosis pilaris. Histopathology suggested a diagnosis of DPR with a differential of Naegeli–Franceschetti–Jadassohn syndrome and dyskeratosis congenita.
Indian Journal of Paediatric Dermatology 2018 19(1):77-79
Dermatopathia pigmentosa reticularis (DPR) is a rare disorder with characteristic triad of generalized reticulate hyperpigmentation, noncicatricial alopecia, and onychodystrophy. A 12-year-old Indian boy presented with classical features of the triad along with adermatoglyphia, hyperhidrosis, punctate hyperkeratosis of palm, and sole along with keratosis pilaris. Histopathology suggested a diagnosis of DPR with a differential of Naegeli–Franceschetti–Jadassohn syndrome and dyskeratosis congenita.
Unusual presentations and associations of hyper IgE Syndrome: Retrospective analysis of ten cases at tertiary care institute – With review of indian published reports
Nayan H Patel, Jigna K Padhiyar, Yogesh B Shah, Trusha P Gajjar, Mansi D Buch
Indian Journal of Paediatric Dermatology 2018 19(1):31-36
Background: Job syndrome also known as hyper IgE syndrome (HIES) is primary immunodeficiency syndrome. Autosomal dominant variant caused by mutation in signal transducer and activator of transcription-3 gene is characterized by recurrent staphylococcal skin infections, sinopulmonary infections, eczema, recurrent bone fractures, and coarse facial features. Autosomal recessive (AR) variant is because of mutation in DOCK8 gene which lacks the skeletal and dental involvement but manifest with severe viral infection and develop neurological complications. Aims: This study aims to evaluate variable presentations and associations of job syndrome. Methods: Analysis of ten cases, presented at our department between October 2015 and September 2016, with suspected HIES was done retrospectively. All cases were studied for their presentations and associations and were investigated accordingly for the same. Score for HIES was counted as per National Institutes of Health (NIH) scoring system. Indian published reports were found by internet search engine and were reviewed for unusual presentations. Results: NIH scoring was indeterminate in two patients and was highly likely for autosomal dominant-HIES in five patients. Three patients were diagnosed as AR-HIES. Two of our patients had multiple endocrinopathy, one had pyoderma gangrenosum and two patients had autoimmune disorders. Limitations: Genetic analysis was not done because of nonavailability of testing in our state and poor financial conditions of patients. It is a retrospective study. Conclusion: Our patients had unusual association in the form of multiple endocrinopathy, pyoderma gangrenosum, dermatomyositis, and all were diagnosed very much late in life. Hence, a vigilant eye for suspicion at a younger age might benefit patients.
Indian Journal of Paediatric Dermatology 2018 19(1):31-36
Background: Job syndrome also known as hyper IgE syndrome (HIES) is primary immunodeficiency syndrome. Autosomal dominant variant caused by mutation in signal transducer and activator of transcription-3 gene is characterized by recurrent staphylococcal skin infections, sinopulmonary infections, eczema, recurrent bone fractures, and coarse facial features. Autosomal recessive (AR) variant is because of mutation in DOCK8 gene which lacks the skeletal and dental involvement but manifest with severe viral infection and develop neurological complications. Aims: This study aims to evaluate variable presentations and associations of job syndrome. Methods: Analysis of ten cases, presented at our department between October 2015 and September 2016, with suspected HIES was done retrospectively. All cases were studied for their presentations and associations and were investigated accordingly for the same. Score for HIES was counted as per National Institutes of Health (NIH) scoring system. Indian published reports were found by internet search engine and were reviewed for unusual presentations. Results: NIH scoring was indeterminate in two patients and was highly likely for autosomal dominant-HIES in five patients. Three patients were diagnosed as AR-HIES. Two of our patients had multiple endocrinopathy, one had pyoderma gangrenosum and two patients had autoimmune disorders. Limitations: Genetic analysis was not done because of nonavailability of testing in our state and poor financial conditions of patients. It is a retrospective study. Conclusion: Our patients had unusual association in the form of multiple endocrinopathy, pyoderma gangrenosum, dermatomyositis, and all were diagnosed very much late in life. Hence, a vigilant eye for suspicion at a younger age might benefit patients.
Legius syndrome
Manoj Kumar Sharma, Ramesh Kumar, Savera Gupta, Suresh Kumar Jain
Indian Journal of Paediatric Dermatology 2018 19(1):86-88
Indian Journal of Paediatric Dermatology 2018 19(1):86-88
Cutaneous leishmaniasis in children: A case series
Mrinal Gupta
Indian Journal of Paediatric Dermatology 2018 19(1):37-39
Background: Cutaneous leishmaniasis (CL) is a protozoal disease usually caused by Leishmania major and Leishmania tropica and transmitted by the bite of a sandfly. It is usually characterized by a single, polymorphous lesion located in an uncovered area. Aims: This study aimed to evaluate the clinico-epidemiological characteristics of CL among children. Materials and Methods: It was a retro-prospective study carried out over a period of 18 months in our center, in which the clinico-epidemiological features of children presenting with CL were assessed. Results: A total of 10 children (male:female - 7:3) were included in the study with the age range of 1–15 years, with a mean age of 8.8 years. Face was the most commonly affected site (n = 8), followed by neck and hands (1 each), and nodulo-ulcerative was the most common clinical type seen in nine patients. Skin smears for Leishman–Donovan (LD) bodies were positive in five patients while the skin biopsy, which was done in four cases, showed the presence of LD bodies in only one patient. Conclusion: CL is a common presentation among children, especially in the endemic areas, and the clinical features are similar to the adult onset disease.
Indian Journal of Paediatric Dermatology 2018 19(1):37-39
Background: Cutaneous leishmaniasis (CL) is a protozoal disease usually caused by Leishmania major and Leishmania tropica and transmitted by the bite of a sandfly. It is usually characterized by a single, polymorphous lesion located in an uncovered area. Aims: This study aimed to evaluate the clinico-epidemiological characteristics of CL among children. Materials and Methods: It was a retro-prospective study carried out over a period of 18 months in our center, in which the clinico-epidemiological features of children presenting with CL were assessed. Results: A total of 10 children (male:female - 7:3) were included in the study with the age range of 1–15 years, with a mean age of 8.8 years. Face was the most commonly affected site (n = 8), followed by neck and hands (1 each), and nodulo-ulcerative was the most common clinical type seen in nine patients. Skin smears for Leishman–Donovan (LD) bodies were positive in five patients while the skin biopsy, which was done in four cases, showed the presence of LD bodies in only one patient. Conclusion: CL is a common presentation among children, especially in the endemic areas, and the clinical features are similar to the adult onset disease.
Ecthyma gangrenosum as the presenting clinical feature of autoimmune lymphoproliferative syndrome
Aniruddha Ghosh, Rashmita Das, Partha Pratim Halder, Sandipan Dhar
Indian Journal of Paediatric Dermatology 2018 19(1):62-64
Ecthyma gangrenosum (EG) is a severe invasive cutaneous infection caused classically by Pseudomonas aeruginosa typically affecting immunocompromised patients especially those with neutropenia. We report the case of a 2-year-old boy with autoimmune lymphoproliferative syndrome presenting with solitary EG on the forehead. Blood culture, as well as culture from the lesion both, showed growth of P. aeruginosa. Pseudomonal sepsis responded well to piperacillin-tazobactam and amikacin therapy. Prompt diagnosis of the lesion is crucial as failure to start timely appropriate therapy may lead to fatal outcome.
Indian Journal of Paediatric Dermatology 2018 19(1):62-64
Ecthyma gangrenosum (EG) is a severe invasive cutaneous infection caused classically by Pseudomonas aeruginosa typically affecting immunocompromised patients especially those with neutropenia. We report the case of a 2-year-old boy with autoimmune lymphoproliferative syndrome presenting with solitary EG on the forehead. Blood culture, as well as culture from the lesion both, showed growth of P. aeruginosa. Pseudomonal sepsis responded well to piperacillin-tazobactam and amikacin therapy. Prompt diagnosis of the lesion is crucial as failure to start timely appropriate therapy may lead to fatal outcome.
Study of physiological and pathological skin changes in neonates: An east indian perspective
Binodini Behera, Yatra Kavadya, Prasenjit Mohanty, Dipanweeta Routray, Subhra Ghosh, Lina Das
Indian Journal of Paediatric Dermatology 2018 19(1):40-47
Background: Numerous dermatological conditions are prevalent in neonatal period, i.e., first 28 days of life with varied presentations ranging from transient self-limiting lesions to serious dermatosis requiring clinical attention. Due to lack of complete knowledge, it is distressing for both parents and treating physician. Objectives: This study was done in eastern part of India to record various dermatosis, and their prevalence compared with other part of country and find association between skin conditions and parameters, namely, sex, parity, gestational age, mode of delivery, and birth weight. Materials and Methods: This descriptive cross-sectional study was done in tertiary care hospital entailed recording of 400 neonates having any kind of dermatosis and statistically evaluated using Chi-square test (SPSS) and significance (P < 0.05). Results: Mongolian spot followed by sebaceous gland hyperplasia and epstein pearls were the common dermatologic findings. Physiological desquamation, acrocyanosis, and sebaceous gland hyperplasia were more prevalent in males and was statistically significant while erythema toxicum neonatorum significantly high in females. Epstein pearls, physiological scaling was also significantly high in term babies. Physiological scaling in cesarean patients and acrocyanosis in vaginal delivery was also significantly associated. Some atypical cases such as phakomatosis pigmentovascularis, plantar keratoderma, collodion baby, and congenital whorled hypermelanosis were also present in our study group. Conclusion: Physiological skin lesions are very common in neonates and appreciation of these lesions are important.
Indian Journal of Paediatric Dermatology 2018 19(1):40-47
Background: Numerous dermatological conditions are prevalent in neonatal period, i.e., first 28 days of life with varied presentations ranging from transient self-limiting lesions to serious dermatosis requiring clinical attention. Due to lack of complete knowledge, it is distressing for both parents and treating physician. Objectives: This study was done in eastern part of India to record various dermatosis, and their prevalence compared with other part of country and find association between skin conditions and parameters, namely, sex, parity, gestational age, mode of delivery, and birth weight. Materials and Methods: This descriptive cross-sectional study was done in tertiary care hospital entailed recording of 400 neonates having any kind of dermatosis and statistically evaluated using Chi-square test (SPSS) and significance (P < 0.05). Results: Mongolian spot followed by sebaceous gland hyperplasia and epstein pearls were the common dermatologic findings. Physiological desquamation, acrocyanosis, and sebaceous gland hyperplasia were more prevalent in males and was statistically significant while erythema toxicum neonatorum significantly high in females. Epstein pearls, physiological scaling was also significantly high in term babies. Physiological scaling in cesarean patients and acrocyanosis in vaginal delivery was also significantly associated. Some atypical cases such as phakomatosis pigmentovascularis, plantar keratoderma, collodion baby, and congenital whorled hypermelanosis were also present in our study group. Conclusion: Physiological skin lesions are very common in neonates and appreciation of these lesions are important.
The use of suction blisters to measure sunscreen protection against UVR-induced DNA damage
Publication date: February 2018
Source:Journal of Photochemistry and Photobiology B: Biology, Volume 179
Author(s): Gwendal Josse, Thierry Douki, Jimmy Le Digabel, Eleonore Gravier, Emmanuel Questel
The formation of DNA photoproducts caused by solar UVR exposure needs to be investigated in-vivo and in particular in order to assess sunscreens' level of protection against solar genotoxicity. The study's purposes were: i) to evaluate if the roof of suction blisters is an appropriate sampling method for measuring photoproducts, and ii) to measure in-vivo sunscreen protection against cyclobutane pyrimidine dimers. Skin areas on the interior forearms of eight healthy volunteers were exposed in-vivo to 2 MED of simulated solar radiation (SSR) and to 15 MED on a sunscreen protected area. After irradiation, six suction blisters were induced and the blister roofs were collected. Analysis of SSR-induced CPDs was performed by two independent methods: a chromatography coupled to mass spectroscopy (HPLC-MS/MS) approach and a 3D–imaging of CPD immunostaining by multiphoton microscopy on floating epidermal sheets. HPLC-MS/MS analyses showed that SSR-unexposed skin presented no CPD dimers, whereas 2 MED SSR-exposed skin showed a significant number of TT-CPD. The sunscreen covered skin exposed to 15 MED appeared highly protected from DNA damage, as the amount of CPD-dimers remained below the detection limit. The multiphoton-immunostaining analysis consistently showed that no CPD staining was observed on the non-SSR-exposed skin. A significant increase of CPD staining intensity and number of CPD-positive cells were observed on the 2 MED SSR-exposed skin. Sunscreen protected skin presented a very low staining intensity and the number of CPD-positive cells remained very close to non-SSR-exposed skin. This study showed that suction blister samples are very appropriate for measuring CPD dimers in-vivo, and that sunscreens provide high protection against UVR-induced DNA damage.
Cryptococcosis and cryptococcal meningitis — new predictors and clinical outcomes at a united states academic medical center
Summary
Since the diagnosis of cryptococcosis is challenging in low prevalence settings, uncovering predictive factors can improve early diagnosis and timely treatment. The aim of the study was to relate clinical outcomes to predictive variables for the presence of cryptococcosis. A retrospective case-control study matching by collection date, age, and gender at a 1:2 ratio (55 cases and 112 controls) was performed in case patients diagnosed with Cryptococcus infection at the University of Colorado Hospital between 2000 and 2017 (n=167). A bivariate and a forward, stepwise multivariable logistic regression model was performed to identify predictors of cryptococcosis. In an adjusted multivariable model; cryptococcal infection was significantly associated with the presence of respiratory symptoms, hyponatremia, lung disease, or corticosteroids. Additionally; cryptococcal meningitis was associated with headaches, corticosteroids, or increased CSF protein. Conversely, a reduced risk of cryptococcosis was associated with hypertension or peripheral monocytosis. Cryptococcal meningitis lead to subsequent hearing impairment (16% vs. 4% (control), p=0.013), muscle weakness (40 vs. 20%, p=0.021), cognitive deficits (33% vs. 6%, p=0.0001) or any adverse outcome (84% vs. 29%, p=0.0001). We uncovered novel clinical predictors for the presence of cryptococcal infection or cryptococcal meningitis. This study in patients at a low prevalence US medical center underscores the importance of early diagnosis in this population.
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Significance of perithyroidal lymph nodes in benign thyroid diseases
Abstract
Purpose
The incidences of perithyroidal lymph nodes (PTLNs) in benign thyroid diseases were investigated.
Methods
A total of 108 patients were divided into 36 with benign thyroid nodules, 33 with Hashimoto's thyroiditis, 14 with Graves' disease, 10 with hypothyroidism of undetermined etiology, nine with silent thyroiditis, and six with subacute thyroiditis. We assessed the relationships among PTLNs and these groups, thyroid volume, thyroid parenchyma echogenicity, and anti-thyroid-stimulating hormone receptor, anti-thyroglobulin, and anti-thyroid peroxidase antibodies (TRAb, TgAb, and TPOAb).
Results
The PTLN-positive rates in Hashimoto's thyroiditis (69.7%), subacute thyroiditis (83.8%), silent thyroiditis (77.8%), and Graves' disease (35.7%) groups were significantly higher than those in benign thyroid nodules (5.6%) and hypothyroidism of unknown etiology (0%) groups. The PTLN-positive rates were significantly higher in cases with TgAb and/or TPOAb (P < 0.01) and in those with lower parenchyma echogenicity (P < 0.01).
Conclusion
PTLNs were seen in inflammatory thyroid diseases, but were rarely detected in other thyroid diseases. These findings indicate that PTLNs are an indicator for differentiating inflammation of the thyroid. Lower echogenicity of the thyroid, known to correspond to inflammation, showed a correlation with the positive rate of PTLNs. PTLNs in cases of Graves' disease may be due to coexisting thyroiditis related to TgAb and/or TPOAb.
Twofold minimum variance beamforming for enhanced ultrasound imaging
Abstract
Purpose
To calculate the optimal weights of a minimum variance (MV) beamformer, the covariance matrix of the received data should be estimated. In ultrasound imaging, it is done through spatial smoothing. However, this technique reduces the effective aperture and consequently limits the attainable resolution. To mitigate this effect, we propose a new configuration for applying an adaptive beamforming method.
Methods
The method is based on applying MV in a twofold configuration such that the outputs of the subarrays are combined through an adaptive MV-like beamformer, instead of simply summing them. In this way, a fully adaptive beamformer is obtained.
Results
Applying the method on a phantom containing point targets has shown that off-axis signals are attenuated more in comparison to MV. This results in a lowered mainlobe width and decreased sidelobe levels. Moreover, simulation results of a cyst phantom confirm the superiority of the method over the MV in terms of contrast.
Conclusion
The method yields significant improvement in the resolving capability and the contrast compared with the conventional MV. At the presence of the steering vector errors, these superiorities were achieved at a cost of slightly more errors in estimating the reflectivity coefficients.
Comparison of carotid artery ultrasonography findings between acute coronary syndrome and atherothrombotic cerebral infarction
Abstract
Background and purpose
Although risk factors for acute coronary syndrome (ACS) and atherothrombotic cerebral infarction (ACI) are common, it is unknown if the risk factors for these two conditions are similar. The purpose of our study was to elucidate differences in carotid artery atherosclerotic features between ACS and ACI.
Methods
We measured carotid artery ultrasound-based atherosclerotic parameters in 61 ACS and 33 ACI patients. In the ACS patients, 31 had single-vessel coronary artery disease (SVD) and 30 had multivessel coronary artery disease (MVD).
Results
The maximum intima–media thickness (IMT) of the common carotid artery was higher in ACS patients with MVD than in ACS patients with SVD (P < 0.05), and tended to be higher than that in ACI patients (P = 0.085). The values in ACS patients with SVD and ACI patients were similar. The maximum IMT of the carotid artery bulb in ACS patients with MVD was similar to that in both ACS patients with SVD and ACI patients. The plaque score was higher in ACS patients with MVD than in ACS patients with SVD (P < 0.01), but similar to that in ACI patients.
Conclusion
ACS and ACI show common atherosclerotic features as assessed by carotid artery ultrasonography.
Breast adenoid cystic carcinoma: report of a case with emphasis on routine sonographic findings and shear wave elastography
Abstract
Adenoid cystic carcinoma (ACC) of the breast is a rare malignant tumor. Its sonographic characteristics have been described in some reports, but there are few such reports available that describe the sonoelastographic findings of this tumor and provide additional information about the nature of the lesion. In this case report, we describe the routine sonographic findings and shear wave elastography findings of a breast adenoid cystic carcinoma in a 53-year-old woman.
Diagnosis of umbilical cord entanglement in a monochorionic diamniotic twin pregnancy with spontaneous septostomy of the dividing membranes using dual-gate Doppler imaging
Abstract
Umbilical cord entanglement is the leading cause of fetal mortality in monoamniotic twin pregnancies and a pseudo monoamniotic environment. Published methods for detecting this complication include color Doppler and pulsed Doppler sonography; however, no method provides an absolute diagnosis. In this case, we report the diagnosis of umbilical cord entanglement using dual-gate Doppler imaging. A 35-year-old woman was referred to our hospital at 28 weeks of gestation for prenatal management because of diagnosis of a monochorionic diamniotic twin pregnancy with spontaneous septostomy of the dividing membranes. Each fetus displayed normal fetal growth without obvious discordance and anatomical abnormalities. However, the dividing membrane was not detected, and an entangled cord was suspected. Dual-gate Doppler examination was carried out. Two regions of interest were considered at different areas of the umbilical arteries, and when each Doppler image showed two different heart rates at the same time, we considered this to be evidence of umbilical cord entanglement. Cesarean section was performed at 32 weeks of gestation and twins were delivered. The delivered umbilical cords had sixfold entanglement. In this case, dual-gate Doppler seems to have been more accurate than conventional single-gate Doppler for the diagnosis of cord entanglement because we confirmed two different heart rates at the same time with dual-gate Doppler.
Variations of placental migration in patients with early third trimester malposition
Abstract
Aim
This study aimed to investigate the impact of placental migration on the definitive prepartum diagnosis of patients with placenta previa (PP) and low-lying placenta (LLP) after late preterm.
Methods
This was a retrospective cohort study of singleton pregnancies with PP and LLP diagnosed at 30–33 weeks of gestation. We assessed the rate of changes in transvaginal ultrasonographic measurements of placental position during the period from 34 to 38 weeks of gestation.
Results
A total of 127 cases (82 of PP, 45 of LLP) were included. The PP group comprised 34 cases with complete PP and 48 with partial and marginal PP. The diagnosis of complete PP was changed to partial or marginal PP in two (5.9%) cases. Concerning cases with partial and marginal PP, 14 (29.2%) were eventually revised to LLP and four (8.3%) ultimately normalized. Among the patients with LLP, placental position was normalized in 23 (51.1%). Overall, a revision in diagnosis after late preterm was required in 48 cases (37.8%). Among the 93 patients who did not have complete PP, 46 (49.5%) needed revisions of their placental diagnosis.
Conclusions
Repeated evaluations of placental position by ultrasonography after late preterm could be of significant value in selecting the most appropriate mode of delivery.
Quantitative assessment of muscle stiffness with acoustic radiation force impulse elastography after botulinum toxin A injection in children with cerebral palsy
Abstract
Purpose
Our objective in this study was to assess the changes in medial gastrocnemius muscle (GCM) stiffness after botulinum toxin A (BTA) injection in children with cerebral palsy (CP) by using acoustic radiation force impulse (ARFI) elastography and to research the usability of this technique in clinical practice.
Materials and methods
Twenty-four spastic lower extremities of 12 children with CP were assessed. BTA injection treatment was applied to the medial GCM. Muscle stiffness was measured with the ARFI technique before the procedure and a month after the procedure. The patients were assessed with the modified Ashworth scale (MAS) in the physiotherapy department at about the same time. Shear wave velocity (SWV) values and MAS scores before and after the treatment were compared.
Results
Mean SWV values were measured as 3.20 ± 0.14 m/s before BTA and as 2.45 ± 0.21 m/s after BTA, and the difference between them was found to be statistically significant (p < 0.001). Mean MAS score (2.33 ± 0.70) after BTA decreased significantly when compared to the score before BTA (2.96 ± 0.62) (p = 0.001). SWV values positively correlated with MAS scores (ρ = 0.578, p = 0.003). The interobserver agreement expressed as interclass correlation coefficient (ICC) was 0.65 (95% CI 0.33–0.84, p < 0.001).
Conclusion
ARFI elastography for identifying structural changes that occur in the spastic muscle after BTA injection in children with CP can yield more valuable information with combined use of MAS.
Is color Doppler a reliable method for the diagnosis of malrotation?
Abstract
Purpose
The gold standard for the diagnosis of malrotation is barium contrast study of the upper gastrointestinal system (UGCS), while color Doppler ultrasonography (CDUS) is another method used in the diagnosis. We investigated the value of CDUS for the diagnosis of malrotation in this study.
Methods
UGCS images, CDUS images, plain abdominal images, demographic data, and symptoms of 82 patients who were investigated for presumed malrotation during a 7-year period were evaluated, retrospectively.
Results
All patients underwent CDUS, and 18% of these patients were diagnosed with malrotation as the superior mesenteric vein was seen to be on the left of the superior mesenteric artery. We found that 16% of the 75 patients who underwent UGCS were diagnosed with malrotation. The sensitivity and specificity of CDUS in the diagnosis of malrotation was found to be 93.8 and 100%, respectively. The respective values for UGCS were 91.7 and 98.4%.
Conclusion
Current data in the literature and our results underline that UGCS may yield false-positive and false-negative results. Although CDUS was found to be a reliable method for the diagnosis of malrotation in our study, the limitations of UGCS are also recognized for CDUS. Prospective studies are needed to determine the more valuable method.
Real-time ultrasound elastography of the Achilles tendon in patients with cerebral palsy: is there a correlation between strain ratio and biomechanical indicators?
Abstract
Purpose
Our aim was to comparatively investigate the strain ratio and thickness of the Achilles tendon in children with cerebral palsy (CP), and to elucidate whether there is a correlation between biomechanical features of the Achilles tendon and strain ratio.
Methods
A total of 155 participants (72 CP patients and 83 healthy controls) who underwent real-time elastography of both Achilles tendons were studied. A linear transducer (4.8–11.0 MHz) was used to obtain the images. Correlation analysis between age, length, and thickness of the Achilles tendon, and strain ratio (SR) was performed by means of Pearson correlation and Spearman's rho tests.
Results
Comparison of results obtained from CP patients and controls showed that the length of the Achilles tendon was shorter (p < 0.001) and SR was higher (p < 0.001) in CP patients. In CP patients, there was a positive correlation between SR and age and between SR and the thickness and length of the Achilles tendon (p < 0.001 for all). Furthermore, the length of the tendon and age were positively associated (p < 0.001). ROC analysis revealed that the cut-off value for SR was 1.89.
Conclusion
The results of the present study demonstrated that real-time elastography can constitute a simple, practical, and noninvasive method for evaluation of the elasticity of the Achilles tendon in children with CP.
Usefulness of end-diastolic ratio in carotid ultrasonography for the screening of dural arteriovenous fistula: a case series
Abstract
We report three cases in which carotid ultrasonography was useful for the diagnosis of dural arteriovenous fistula (dAVF). In all cases, dAVFs were fed by branches of the external carotid artery (ECA) and had retrograde leptomeningeal venous drainage. Carotid ultrasonography revealed high end-diastolic ratio (ED ratio) of the common carotid artery (CCA) (1.49–2.16) and low resistance index (RI) of the ECA (0.59–0.66). They were normalized after endovascular treatment (ED ratio of CCA 1.02–1.06, RI of ECA 0.75–0.87). In conclusion, high ED ratio of the CCA and low RI of the ECA might be a useful indicator for both screening and follow-up of dAVF.
Differential diagnosis between benign and malignant soft tissue tumors utilizing ultrasound parameters
Abstract
Purpose
Preoperative discrimination between benign and malignant soft tissue tumors is critical for the prevention of excess application of magnetic resonance imaging and biopsy as well as unplanned resection. Although ultrasound, including power Doppler imaging, is an easy, noninvasive, and cost-effective modality for screening soft tissue tumors, few studies have investigated reliable discrimination between benign and malignant soft tissue tumors.
Methods
To establish a modality for discrimination between benign and malignant soft tissue tumors using ultrasound, we extracted the significant risk factors for malignancy based on ultrasound information from 40 malignant and 56 benign pathologically diagnosed soft tissue tumors and established a scoring system based on these risk factors.
Results
The maximum size, tumor margin, and vascularity evaluated using ultrasound were extracted as significant risk factors. Using the odds ratio from a multivariate regression model, a scoring system was established. Receiver operating characteristic analyses revealed a high area under the curve value (0.85), confirming the accuracy of the scoring system.
Conclusion
Ultrasound is a useful modality for establishing the differential diagnosis between benign and malignant soft tissue tumors.
Presence of enthesopathy in patients with primary Sjogren’s syndrome: ultrasonographic study of a local cohort
Abstract
Background
Musculoskeletal findings in Sjögren's syndrome are arthralgia, arthritis, myalgia, myositis, fibromyalgia, and chronic fatigue. Enthesis zones are important in the formation of pain in the musculoskeletal system. Musculoskeletal ultrasound (US) may show subclinical enthesitis in the synovial joints and in the axial skeleton before joint swelling in inflammatory diseases characterized by arthritis.
Objective
In this study, we aimed to determine the presence of enthesopathy using the Madrid sonographic enthesitis index (MASEI) in patients with primary Sjögren's syndrome (PSS).
Patients and methods
Consecutive patients with PSS and age-matched healthy controls were included in this study. All the patients met the 2002 American College of Rheumatology/European League against Rheumatism classification criteria for PSS. The demographic characteristics of the patients were recorded. Six enthesis sites were evaluated using gray-scale and Doppler US with a linear transducer, and they were scored using the MASEI. They were assessed by the EULAR Sjögren's syndrome disease activity index (ESSDAI).
Results
We evaluated 40 patients with PSS (average age 48.67 ± 11.23 years) and 30 healthy controls (average age 45.40 ± 8.24 years). Patients with PSS had significantly higher MASEI scores than the healthy controls. Plantar fascia, Achilles tendon, and distal patellar tendons were significantly thicker in the PSS group than in the healthy controls. The MASEI total score had a positive correlation with age. There was no correlation between MASEI total score and BMI and ESSDAI.
Conclusion
In this study, it was shown that the MASEI scores assessed by US were significantly higher in patients with PSS than in healthy controls. Plantar fascia, Achilles tendon, and distal patellar tendon were significantly thicker in the PSS group than in the healthy controls. This result suggests that PSS may be one of the causes of musculoskeletal pain that can be seen in patients with PSS. Our study was the first study to use an enthesis index ultrasonographically in patients with PSS. In addition, it is the first study to investigate the relationship between the presence of enthesopathy and disease activity by means of US.
A case of successful transluminal drainage of walled-off necrosis under contrast-enhanced harmonic endoscopic ultrasonography guidance
Abstract
We report a case of successful transluminal drainage of walled-off necrosis (WON) under contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) guidance. Recently, EUS-guided transluminal drainage (EUS-TD) of WON has been increasingly used as a minimally invasive treatment option with reportedly high technical and clinical success rates; however, B-mode EUS occasionally fails to depict the target lesion and its margins, particularly in cases where the target shows a heterogeneous echogenicity. In our case, EUS-TD was attempted for infected WON, but visualization using B-mode EUS imaging was poor. Thus, CH-EUS was performed to enhance the contrast between the targeted WON and its surrounding tissues. Immediately after injecting a sonographic contrast agent, WON and its margins were clearly identified as an avascular area and were punctured under CH-EUS guidance. CH-EUS enables the assessment of the microvasculature and hemodynamics of the target lesion in real time. It may also provide valuable information and could be a useful modality for EUS-TD to clearly visualize target lesions and their margins and to decisively puncture them, even when they could not be identified using B-mode EUS.
Verification of recall criteria for masses detected on ultrasound breast cancer screening
Abstract
Purpose
Mammography is the only modality for breast cancer screening demonstrated to reduce the mortality rate. However, ultrasonographic screening is already being widely performed as opportunistic screening in Japan. The recall criteria for masses are very important as quality controls. The purpose of this study was to verify these criteria at multiple institutions.
Methods
Screening was performed by five institutions in various regions in Japan. The total number of cases screened at all five institutions was 10,519.
Results
The findings that could be concluded to be benign were a cystic pattern and three features of a solid pattern. The cystic pattern was noted in 6512 cases, typical fibroadenoma in 1483 cases, and typical complicated cyst in 70 cases. Only three of these 8065 cases were cancers, so the negative predictive value was 99.9%. The solid pattern with obvious malignant features, i.e., masses with an echogenic halo and/or interruption of the interface and masses with multiple echogenic foci, were noted in 33 cases. Twenty of the 33 cases were malignancy, resulting in a positive predictive value of 66.7%.
Conclusion
Although some parts of the criteria should be considered further for verification and revision, the current recall criteria are mostly valid.
IRF-2 haploinsufficiency causes enhanced imiquimod-induced psoriasis-like skin inflammation
Psoriasis is a T-cell-mediated immunologic skin disease with a complex pathogenesis where both genetic and environmental factors are involved [1–4]. Although the mechanism of psoriasis has not been fully understood, it has been reported that psoriasis can be induced or exacerbated by IFN-α treatment [5–10]. More direct evidence for the involvement of type I IFN in development of psoriasis comes from studies on interferon regulatory factor (IRF)-2 knockout mice. IRF-2 protein binds the same regulatory sequences as IRF-1, which suppresses transcription of IFN-inducible genes [11].
Effectiveness of Non-Steroidal Anti-Inflammatory Drugs among patients with Primary Hypertrophic Osteoarthropathy: a systematic review
Primary hypertrophic osteoarthropathy (PHO), also known as pachydermoperiostosis is a rare genetic disease which predominantly affects skin, bone and soft connective tissue. It is characterized by the triad of pachydermia, digital clubbing and periostosis of long bones. Arthralgia or arthritis is also present in most of the cases. Genetic studies have identified the impaired PGE2 metabolism as a culprit for hypertrophic osteoarthropathy in PHO cases. We conducted a systematic review to examine the effectiveness of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), a PGE2 synthesis blocker to reduce the symptoms among PHO patients.
Characterization of migraineurs presenting interictal widespread pressure hyperalgesia identified using a tender point count: a cross-sectional study
Migraineurs exhibit pain hypersensitivity throughout the body during and between migraine headaches. Migraine is classified as a central sensitivity syndrome, typified by fibromyalgia showing widespread pressu...
Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review
Sphenopalatine ganglion is the largest collection of neurons in the calvarium outside of the brain. Over the past century, it has been a target for interventional treatment of head and facial pain due to its e...
The burden of headache is associated to pain interference, depression and headache duration in chronic tension type headache: a 1-year longitudinal study
To investigate variables associated at one year (longitudinal design) with the physical or emotional component of burden in chronic tension type headache (CTTH).
The enigma of site of action of migraine preventives: no effect of metoprolol on trigeminal pain processing in patients and healthy controls
Beta-blockers are a first choice migraine preventive medication. So far it is unknown how they exert their therapeutic effect in migraine. To this end we examined the neural effect of metoprolol on trigeminal ...
Characteristics and diagnoses of acute headache in pregnant women – a retrospective cross-sectional study
Acute headache is one of the most frequent neurological symptoms in pregnant women. The early diagnosis of underlying secondary conditions has a major influence on patient outcome, especially in emergency sett...
Open Cancellous Bone Grafting for Recalcitrant Palatal Fistula: Repurposing the Papineau Technique
Summary: Cleft palate fistula is defined as a breakdown in the primary surgical repair of the palate resulting in oronasal communication, which can create symptomatic regurgitation for fluids/solids and affect speech, manifested by airflow escape during phonation. With the reported postoperative occurrence rate of 33–37% postfistula repair, it remains a challenging problem. The primary aim of this study was to describe our experience in the management of 7 consecutive cases of recalcitrant palatal fistula, all secondary to primary cleft palate repair. Pure cancellous bone graft was harvested in a standard fashion in sufficient quantity based on size of fistula from the iliac crest and was morselized and was kept mixed with the patient's blood. After flap turnover for nasal closure, the graft was packed over the raw surface on the oral aspect and was secured by placing an oxidized regenerated cellulose sheet fixed to the surrounding mucosa. As per the Papineau technique, no oral closure was performed. Six-month follow-up showed complete epithelization of the oral raw surface in 6 of the 7 patients. In the diverse spectra of cleft surgeries, management of recalcitrant cleft palate fistula remains a surgical challenge. Repurposing Papineau's concept of open cancellous bone grafting in cleft palate fistula is a novel attempt with a sound scientific basis. In our experience, this technique has proved to be very effective in managing recalcitrant palatal fistulae.Designing a Fibular Flow-Through Flap with a Proximal Peroneal Perforator-Free Flap for Maxillary Reconstruction
Summary: Reconstruction of a composite maxillary defect is frequently performed with a fibular osteocutaneous free flap to address both the bony and mucosal defect. If during the harvest of the fibula a distal skin perforator is not present due to vascular variations, reconstruction can potentially be done using the soleus muscle for filling of the palatal mucosal defect. An additional challenge arises when the accompanying skin paddle that has been harvested is not perfused, but the fibula remains viable. This case report describes salvage following loss of the skin paddle in an osteocutaneous fibular free flap by designing a fibular flow-through flap using a proximal peroneal perforator free flap. The use of this second free flap allows a skin paddle to be positioned on the distal fibular segment, provides a surgical backup, and limits the donor sites to the same extremity.Why the p Value Alone Is Not Enough: The Need for Confidence Intervals in Plastic Surgery Research
Background: The p value is one of the most used descriptors in statistical analysis; however, when reported in isolation, it does not convey the effect size of a treatment. The reporting of confidence intervals is an essential adjunct to determine the clinical value of treatment, as it permits an assessment of the effect size. The authors assessed the reporting of confidence intervals in clinical trials within the plastic surgery literature. Methods: The seven highest impact plastic surgery journals were screened using MEDLINE for clinical trials in the years 2006, 2009, 2012, and 2015. Studies were randomized based on a predetermined sample size, and various characteristics (e.g., Jadad quality score, reporting of statistical significance, journal impact factor, and participation of an individual with formal research training) were documented. Results: Two independent reviewers analyzed 135 articles. There was substantial interrater agreement (kappa = 0.78). Although 86.7 percent of studies reported a p value, only 25.2 percent reported confidence intervals. Of all journals assessed, Plastic and Reconstructive Surgery most frequently reported confidence intervals. The quality of the studies had a median Jadad score of 2 of 5. Bivariate analysis revealed that higher Jadad score and involvement of an individual with formal research training were associated with reporting of confidence intervals. Multivariate analysis revealed similar findings, whereas journal impact factor, year of publication, and statistical significance were not correlated with confidence interval reporting. Conclusions: Confidence intervals are underreported in the plastic surgery literature. To improve reporting quality of clinical trials, results should always include the confidence intervals to avoid misinterpretation of the effect size of a statistically significant result.The Expanded Use of Autoaugmentation Techniques in Oncoplastic Breast Surgery
Background: Autoaugmentation techniques have been applied to oncoplastic reductions to assist with filling larger, more remote defects, and to women with smaller breasts. The purpose of this report is to describe the use of autoaugmentation techniques in oncoplastic reduction and compare the results with those of traditional oncoplastic reduction. Methods: The authors queried a prospectively maintained database of all women who underwent partial mastectomy and oncoplastic reduction between 1994 and October of 2015. The autoaugmentation techniques were defined as (1) extended primary nipple autoaugmentation pedicle, and (2) primary nipple pedicle and secondary autoaugmentation pedicle. Comparisons were made to a control oncoplastic group. Results: There were a total of 333 patients, 222 patients (67.7 percent) without autoaugmentation and 111 patients (33 percent) with autoaugmentation (51 patients with an extended autoaugmentation pedicle, and 60 patients with a secondary autoaugmentation pedicle). Biopsy weight was smallest in the extended pedicle group (136 g) and largest in the regular oncoplastic group (235 g; p = 0.017). Superomedial was the most common extended pedicle, and lateral was the most common location. Inferolateral was the most common secondary pedicle for lateral and upper outer defects. There were no significant differences in the overall complication rate: 15.5 percent in the regular oncoplastic group, 19.6 percent in the extended pedicle group, and 20 percent in the secondary pedicle group. Conclusions: Autoaugmentation techniques have evolved to manage complex defects not amenable to standard oncoplastic reduction methods. They are often required for lateral defects, especially in smaller breasts. Autoaugmentation can be performed safely without an increased risk of complications, broadening the indications for breast conservation therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.Bovine Acellular Dermal Matrix in Immediate Breast Reconstruction: A Retrospective, Observational Study with SurgiMend
Background: Acellular dermal matrices can be combined with implant-based breast reconstruction to help optimize outcomes. SurgiMend PRS is a fetal bovine dermis–derived acellular dermal matrix composed of type I collagen and approximately 30 percent type III collagen, sharing many of the properties of human cadaveric acellular dermal matrix. Methods: This was a retrospective, single-center analysis of 111 adult patients (147 breasts) undergoing one-stage (83.7 percent) or two-stage (16.3 percent) immediate breast reconstruction after mastectomy. The aims were to characterize the safety profile of SurgiMend and investigate associations between risk factors and complications. Results: The mean age of the patients was 47.9 years and the mean body mass index was 24.7 kg/m2. After a median follow-up of 24.3 months, the overall rates of minor and major complications were 25.2 percent (n = 37 of 147) and 12.9 percent (n = 19 of 147), respectively. The most common major complications were seroma [n = 12 (8.2 percent)] and necrosis [n = 9 (6.1 percent)]. All occurred within 3 months after surgery. The rate of capsular contracture was 2.7 percent (n = 4). A total of 2.7 percent of implanted breasts (n = 4) required explantation. In a univariate analysis, smokers had a greater risk of major complications (p = 0.013), and postoperative radiation therapy and obesity were associated with an increased risk of capsular contracture (p = 0.006) and explantation (p = 0.006), respectively. In a multivariate analysis, several factors were associated with complications or explantation, including obesity (pMicrobial Evaluation in Capsular Contracture of Breast Implants
Background: Capsular contracture around breast implants is a severe and unpredictable complication experienced by up to 50 percent of patients after breast augmentation and reconstruction, and represents a major cause leading to reoperation. Several lines of evidence point to the involvement of subclinical infections and of bacterial biofilm formation. Methods: To reduce the incidence of capsular contracture following mammaplasty, the authors studied the correlation between contamination by exogenous and endogenous bacterial flora and the capacity to develop bacterial biofilm in mammary implants. The authors performed a microbiological study assessing microbial growth of swabs from breast skin, nipple-areola complex, and mammary gland biopsy specimens. Furthermore, the authors compared the results with the data resulting from cultural experiments from biopsy specimens of periprosthetic capsule, contracted or not, and from the surfaces of the relative prosthesis. Results: Between July of 2012 and July of 2013, a series of 65 female patients from the area of Naples, Italy, and its province, who underwent breast plastic surgery with the use of implants for aesthetic or reconstructive reasons, were included in the study. The authors noticed that there is a greater tendency for capsular contracture to form in oncologic patients who received radiotherapy, patients with precedent capsular contracture, and patients with cutaneous contamination by biofilm-producing microbes. Conclusions: Although all of the new technical procedures tend to reduce the amount of bacterial charge that comes into contact with the prosthesis at the time of its introduction, a minimal amount must always be taken for granted. This is the rationale for a preventative personalized antibiotic therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.Patient-Reported Outcomes following Breast Conservation Therapy and Barriers to Referral for Partial Breast Reconstruction
Background: The purpose of this study was to evaluate the self-reported aesthetic outcome of breast conservation therapy in a generalized sample of patients, and to describe potential barriers to referral for partial breast reconstruction. Methods: Consecutive breast conservation therapy patients completing radiotherapy over a 1-year period at a regional cancer center were identified. Eligible patients were contacted by means of mail/e-mail and invited to participate. Participants completed the BREAST-Q breast conservation therapy module along with a questionnaire examining feelings about breast reconstruction. Multiple regression analysis was performed using the satisfaction with breasts scale as the dependent variable. Results: Surveys were completed by 185 of 592 eligible participants (response rate, 31.3 percent; mean age, 61 years) an average of 38 months after lumpectomy. The mean score for the BREAST-Q satisfaction with breasts scale was 59 of 100. Younger age (p = 0.038), lumpectomy reexcision (p = 0.018), and lumpectomy at a nonacademic center (p = 0.026) were significantly associated with lower satisfaction. Bra size, months from lumpectomy, and tumor quadrant/size were not significantly associated with satisfaction (p > 0.05). The most common statements regarding reconstruction were "I don't feel the need for it" (60.0 percent), "I don't like the thought of having breast implants" (22.7 percent), and "I don't want any more surgeon/doctor visits" (22.2 percent). Before lumpectomy, only 1.6 percent had a consultation for reconstruction, and only 22.7 percent were aware of this option. If offered, 33.1 percent of patients would have attended this consultation. Conclusion: There is an unmet demand for partial breast reconstruction, with an opportunity to advocate and increase awareness on behalf of patients undergoing breast conservation therapy.22 Cases of Breast Implant–Associated ALCL: Awareness and Outcome Tracking from the Italian Ministry of Health
Background: To date, 359 cases of anaplastic large cell lymphoma (ALCL) in women with breast implants (breast implant–associated ALCL [BIA-ALCL]) worldwide have been reported among more than 10 million patients who have received implants, but health care authorities suspect this is a possible underestimation, and the limited number of cases makes it difficult to clarify its cause. The General Directorate of Medical Devices and Pharmaceutical Services of the Italian Ministry of Health has examined and studied the Italian BIA-ALCL cases. Methods: An official document has been diffused to all medical associations, aiming at encouraging all physicians to notify each BIA-ALCL case. A retrospective study has been performed on the notified BIA-ALCL cases collected in the database named Dispovigilance. Results: Research on Dispovigilance returns a list of 22 BIA-ALCL cases. The mean patient age was 49.6 years (range, 30 to 71 years). The average time to the onset of the symptoms was 6.8 years (range, 1 to 22 years). The average time to diagnosis was 7.8 years (range, 4 to 22 years). The estimated incidence of the Italian BIA-ALCL cases related to 2015 is 2.8 per 100,000 patients. Conclusions: The pathogenesis of BIA-ALCL remains unknown. The establishment of a national breast implant registry is needed to better understand some aspects of this disease. Future genetic studies on the population affected could clarify why only some patients with implants develop this disease.
Outcome Analysis of Free Flap Salvage in Outpatients Presenting with Microvascular Compromise
Background: Extensive flap salvage attempts are routinely performed in patients with late-onset flap vascular crisis despite low flap survival rates. A knowledge gap exists in management of compromised free flaps in patients who present with perfusion-related complications after hospital discharge. Methods: A retrospective review of 7443 free flaps used in 7128 cancer patients at a single institution from January of 2001 to March of 2015 was performed. Results: Of 7443 free flap reconstructions, 856 patients (12 percent) were taken back to the operating room. Also, 261 patients (4 percent) suffered from microvascular compromise, of whom 110 (1 percent) experienced total flap loss. The authors identified 17 patients (10 breast cancer patients and seven head and neck cancer patients) who had vascular flap compromise and underwent reoperation after hospital discharge (median, 10 days; range, 4 to 107 days) after free flap reconstruction. Of these 17 patients, nine breast cancer patients and two head and neck cancer patients underwent flap salvage attempts. Salvage procedures included thrombectomy, thrombolytic and heparin injections, and reanastomoses (11 patients); vein grafting (four patients); vein supercharging with cephalic turndown (two patients); and change of recipient vessels (two patients). Sixteen of the 17 patients (94 percent) experienced total flap loss, and one patient (6 percent) had partial flap loss requiring long-lasting wound treatment. Conclusions: Outpatient free flap salvage has a low success rate regardless of flap type, recipient site, or patient population. The authors' study suggests that immediate second-line reconstruction is more effective for late-onset flap vascular crisis than extensive flap salvage procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.Minimally Invasive Laparoscopically Dissected Deep Inferior Epigastric Artery Perforator Flap: An Anatomical Feasibility Study and a First Clinical Case
Summary: The deep inferior epigastric perforator (DIEP) flap is a workhorse of breast reconstruction. Risks of herniation derive from violation of the rectus abdominis muscle anterior rectus sheath and might be reduced by minimally invasive laparoscopic dissection ("MILD") of the deep inferior epigastric vessels. The authors performed a feasibility study on five anatomical subjects and performed a secondary right breast reconstruction on a 67-year-old woman. A 30-degree laparoscope was used with laparoscopy ports inset to preserve the flap. Blunt preperitoneal dissection followed by carbon dioxide insufflation allowed the deep inferior epigastric pedicle to be dissected and clip-sectioned. The anterior rectus sheath was opened around the perforating vessels, and the flap was anastomosed on the internal mammary vessels. The length of incision in the anterior rectus sheath was compared between laparoscopic and conventional approaches. The mean incision length in the anterior rectus sheath was 3 cm versus 12 cm in the classic approach. Average duration of laparoscopic flap harvest was 50 minutes, including a mean of 30 minutes for deep inferior epigastric dissection. Adhesions led to a 1-cm peritoneal laceration in our first anatomical subject. There were no preoperative or postoperative complications in the clinical case. The clinical procedure duration was 8 hours 15 minutes, with the anterior rectus sheath incision reduced from the conventional 12 cm to 5 cm. Flap ischemia lasted 50 minutes. The patient was discharged on postoperative day 5. This anatomical study and first successful laparoscope-assisted DIEP flap harvest prove that reduced trauma to the anterior rectus sheath is feasible and promising.MBN 2016 Aesthetic Breast Meeting BIA-ALCL Consensus Conference Report
Summary: Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon neoplasia occurring in women with either cosmetic or reconstructive breast implants. The actual knowledge about BIA-ALCL deriving from the literature presents several limits, and it remains difficult to make inferences about BIA-ALCL epidemiology, cause, and pathogenesis. This is the reason why the authors decided to organize an evidence-based consensus conference during the Maurizio Bruno Nava (MBN 2016) Aesthetic Breast Meeting held in Milan in December of 2016. Twenty key opinion leaders in the field of plastic surgery from all over the world have been invited to express and discuss their opinion about some key questions on BIA-ALCL, trying to reach a consensus about BIA-ALCL cause, pathogenesis, diagnosis, and treatment in light of the actual best evidence.Septum-Based Nasal Tip Plasty: A Comparative Study between Septal Extension Graft and Double-Layered Conchal Cartilage Extension Graft
Background: The septal extension graft is currently the most commonly used primary and secondary rhinoplasty technique in Asia because it provides maximal tip projection and rotational controllability. The authors compared the tip projection amount and rotational controllability of the tip support between the septal extension graft based on the L-strut septum and double-layer conchal cartilage graft based on the full septum at the nasal tip. Methods: Twenty-seven consecutive patients who underwent nasal tip plasty with the septal extension graft or double-layer conchal cartilage graft for purely aesthetic reasons between March of 2014 and July of 2016 were included. The nasal tip projection and columellar labial angle preoperatively (time 0), immediately postoperatively (time 1, an average of 2 weeks after the operation), and postoperatively (time 2, an average of 7 months after the operation) were analyzed with clinical photography. Results: Fourteen patients (group A) underwent septal extension graft surgery and 13 (group B) underwent double-layer conchal cartilage graft surgery. Changes of 61 and 74 percent in tip projection ratio were immediately achieved and were maintained after surgery for groups A and B, respectively (time 2 versus time 0 dividing time 1 versus time 0; p = 0.722 for groups A and B). Therefore, the relapse ratio of this technique was 39 and 26 percent for groups A and B, respectively. Conclusions: This comparative study between the septal extension graft and double-layer conchal cartilage graft showed that both nasal tip plasties are similar in terms of stability. Considering the fact that the double-layer conchal cartilage graft could preserve septal support, this technique could become an effective and safe alternative option for rhinoplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Frederic E. Mohs, M.D. and the history of zinc-chloride
Publication date: Available online 28 December 2017
Source:Clinics in Dermatology
Author(s): Charles DePaolo
The history of ZnCl2 therapy prior to and including Frederic E. Mohs' (1910–2002) early contributions to dermatologic oncology is presented. In 1932, Mohs devised a method of cutaneous surgery that employed zinc-chloride paste (ZCP) to devitalize basal (BCC) or squamous (SCC) cell carcinoma. Because ZnCl2 coagulates malignant tissue without destroying cellular architecture, he described the surgery and its preservative effect as the fixed-tissue method. This method involved the serial removal of devitalized malignant tissue and the freezing and histologic examination of each layer; the process was continued until a cancer-free plane was reached. In 1953, a modified version of the micrographic system, the fresh-tissue method, was introduced. For improved efficiency, Mohs retained the systematic mapping of a neoplasm but eliminated the chemical escharotic. While the fresh-tissue method has become the preferred treatment mode, ZCP therapy remains in use today. Although the history of Mohs micrographic surgery is well documented, its background has not received sufficient attention. This paper surveys the chemical synthesis of ZnCl2, the formulation of ZCP as a cutaneous escharotic, and the extent to which Mohs' method compares to those of nineteenth and of early-twentieth-century predecessors.
Pesticide dichorvos induces early solid Ehrlich tumoral development associated with a non-protective pro-inflammatory response
Abstract
Prolonged exposure to dichlorvos (DDVP), a common pesticide used for food crops, has been related to the development of infections and malignancies. Macrophages are used as bioindicators of immunotoxicity; thus, evaluation of their activity in solid Ehrlich tumor-bearing mice (TBM) may be useful to evaluate the influence of pesticides on human health. To investigate the effects of low DDVP doses, Swiss mice were divided into the following groups: the DDVP group, composed of mice fed diets containing 10 mg/kg of DDVP; the TBM group, consisting of mice subcutaneously inoculated with 107 tumor cells/100 μl and fed a basal diet; the DDVP-TBM group, consisting of mice previously fed DDVP-containing diets for 28 days and then subcutaneously inoculated with tumor cells; and the control (CTRL) group, composed of mice fed a basal diet. After 7 and 21 days of tumor inoculation, the mice were euthanized; and after necroscopic examination, the neoplastic mass, organs, and intraperitoneal fluid were collected. Adherent peritoneal cells were cultivated to determine the production of H2O2 and TNF. Altogether, our results indicate that even at low doses, the intake of DDVP caused weight loss and increased tumor mass, which were associated with H2O2 production and high levels of TNF, a pro-inflammatory cytokine. These data are important as the exposure to pesticides, even at low doses, could potentially hinder the immune response against tumors and, consequently, create favorable conditions for their development.
Phthalate esters in surface water of Songhua River watershed associated with land use types, Northeast China
Abstract
The ubiquitous presence of phthalate esters (PAEs) in the environment and their potential role as endocrine disruptors of marine organisms has attracted much attention. The presence of PAEs in different water sources collected from the Songhua River mainstream and its tributaries has been determined in this study. The total concentration of the seven PAEs (∑PAEs) detected was found to range from 1.153 to 7.867 μg L−1, with di(2-ethylhexyl) phthalate (DEHP) present as the predominate PAE congener. Dimethyl phthalate (DMP), diethyl phthalate (DEP), di-n-butyl phthalate (DBP), and DEHP were present in all of the water samples analyzed. The concentration of ∑PAEs in the Songhua River mainstream was shown to decrease initially, with a subsequent increase being detected due to inflow from branch tributaries contaminated with higher concentrations of PAEs. Analysis of land type usage, in this agriculture-dominated river watershed, also revealed an increase in ∑PAE concentration in waters flowing through forested area. The concentration of ∑PAEs in river waters also had a significant positive correlation with both agricultural and urban areas (p < 0.05); however, anthropogenic activities were not the only determining factor determining the ∑PAE concentration in this river watershed. Ecological risk assessment revealed that the levels of DMP and DEP in all waters were generally low, representing a relatively low ecological risk to marine organisms; however, DBP was present at medium or high risk levels, whilst DEHP also displayed high risk levels.
Formation of a lead-insoluble phase, pyromorphite, by hydroxyapatite during lead migration through the water-unsaturated soils of different lead mobilities
Abstract
This study combined the original unsaturated-column-percolation test with X-ray diffraction (XRD) analysis to understand how lead is transformed into lead-insoluble phase and immobilized by hydroxyapatite during lead migration in the water-unsaturated soil of different lead mobilities. The amounts of lead migrated from the soils without hydroxyapatite ranged from 4 to 46%, depending on the lead mobilities of soils. On the other hand, those of soils with hydroxyapatite were greatly suppressed by > 95% as compared with those without hydroxyapatite. The XRD analysis showed that the amounts of lead transformed into pyromorphite were compatible with those of lead migrated from the soil irrespective of the different lead mobilities. To the best of our knowledge, this study provides the first experimental evidence that lead migration can induce lead to transform into pyromorphite in the water-unsaturated soil. In addition, this study quantitatively demonstrates that the amount of lead migrated is almost equal to that of lead formed into pyromorphite. Thus, it was found that even if soluble lead remains after the application of immobilization material, it would be immobilized by the material during the lead migration as long as adequate material is applied to the soil.
Silicon alleviates cadmium toxicity in wheat seedlings ( Triticum aestivum L.) by reducing cadmium ion uptake and enhancing antioxidative capacity
Abstract
Cadmium (Cd) is a toxic element that poses a great threat to human health, while silicon (Si) is a beneficial element and has been shown to have a mitigation effect on plants under Cd toxicity. However, the mechanisms underlying the role of Si in alleviating Cd toxicity are still poorly understood in wheat. Therefore, growth status, photosynthesis parameters, root morphology, antioxidant system, and Cd2+ uptake and flux under Cd toxicity were studied through hydroponic experiment, aiming to explore the mitigation of Si on Cd toxicity in wheat seedlings. The results showed that Si supply improved plant biomass as well as photosynthetic but had little effects on root morphology of seedlings under Cd stress. Si addition decreased Cd contents both in shoots and roots. In situ measurements of Cd2+ flux showed that Si significantly inhibited the net Cd2+ influx in roots of wheat. Si also mitigated the oxidative stress in wheat leaves by decreasing malondialdialdehyde (MDA) and hydrogen peroxide (H2O2) contents as well as by increasing superoxide dismutase (SOD) and guaiacol peroxidase (POD) activity. Overall, the results revealed that Si could alleviate Cd toxicity in wheat seedlings by improving plant growth and antioxidant capacity and by decreasing Cd uptake and lipid peroxidation.
Activated carbons from avocado seed: optimisation and application for removal of several emerging organic compounds
Abstract
In this study, avocado seed was successfully used as raw material for producing activated carbons by conventional pyrolysis. In order to determine the best condition to produce the activated carbons, a 22 full-factorial design of experiment (DOE) with three central points was employed by varying the temperature and time of pyrolysis. The two evaluated factors (temperature and time of pyrolysis) strongly influenced the SBET, pore volumes, hydrophobicity–hydrophilicity ratio (HI) and functional groups values; both factors had a negative effect over SBET, pore volumes and functional groups which means that increasing the values of factors leads to decrease of these responses; on the other hand, with regards to HI, both factors caused a positive effect which means that increasing their values, the HI has an enhancement over its values. The produced activated carbon exhibited high specific surface areas in the range of 1122–1584 m2 g−1. Surface characterisation revealed that avocado seed activated carbons (ASACs) have hydrophilic surfaces and have predominantly acidic groups on their surfaces. The prepared ASACs were employed in the adsorption of 25 emerging organic compounds such as 10 pharmaceuticals and 15 phenolic compounds which presented high uptake values for all emerging pollutants. It was observed that the activated carbon prepared at higher temperature of pyrolysis (700 °C), which generated less total functional groups and presented higher HI, was the activated carbon with higher sorption capacity for uptaking emerging organic contaminants. Based on results of this work, it is possible to conclude that avocado seed can be employed as a raw material to produce high surface area and very efficient activated carbons in relation to treatment of polluted waters with emerging organic pollutants.
Photocatalytic reduction of carbon dioxide over Cu/TiO 2 photocatalysts
Abstract
The photocatalytic reduction of CO2 with H2O was investigated using Cu/TiO2 photocatalysts in aqueous solution. For this purpose, Cu/TiO2 photocatalysts (with 0.2, 0.9, 2, 4, and 6 wt.% of Cu) have been synthesized via sol-gel method. The photocatalysts were extensively characterized by means of inductively coupled plasma optical emission spectrometry (ICP-OES), N2 physisorption (BET), XRD, UV-vis DRS, FT-IR, Raman spectroscopy, TEM-EDX, and photoelectrochemical measurements. The as-prepared photocatalysts contain anatase as a major crystalline phase with a crystallite size around 13 nm. By increasing the amount of Cu, specific surface area and band gap energy decreased in addition to the formation of large agglomeration of CuO. Results revealed that the photocatalytic reduction of CO2 decreased in the presence of Cu/TiO2 in comparison to pure TiO2, which might be associated to the formation of CuO phase acting as a recombination center of generated electron-hole pair. Decreasing of photoactivity can also be connected with a very low position of conduction band of photocatalysts with high Cu content, which makes H2 production necessary for CO2 reduction more difficult.
Effectiveness of narrow grass hedges in reducing atrazine runoff under different slope gradient conditions
Abstract
Atrazine is frequently detected in surface runoff and poses a potential threat to the environment. Grass hedges may minimize runoff loss of atrazine from crop fields. Therefore, the effectiveness of two grass hedges (Melilotus albus and Pennisetum alopecuroides) in controlling atrazine runoff was investigated using simulated rainfall on lands at different slope gradients (15 and 20%) in northern China. Results showed that a storm (40 mm in 1 h), occurring 4 h after atrazine application, caused a loss of 3% of the applied amount. Atrazine loss under 20% slope was significantly greater than that under 15% slope in control plots. Atrazine exports associated with the water fraction accounted for the majority of total loss. Pennisetum hedges were more efficient in controlling atrazine loss with runoff compared to Melilotus hedges. No significant difference in the capacity of grass hedges to reduce atrazine exports was observed between 15 and 20% slopes. These findings suggest grass hedges are effective in minimizing atrazine runoff in northern China, and Pennisetum hedges should be preferentially used on sloping croplands in similar climatic regions.
Heavy metal enrichment in roadside soils in the eastern Tibetan Plateau
Abstract
The effects of human activities on heavy metal pollution in soil have been less investigated on the Tibetan Plateau. The present study was designed to assess the effects of highway traffic on Cu, Zn, Pb, and Cd enrichments in the 0–60-cm soil profile in the eastern Tibetan Plateau. Soils were sampled at four transects (with an altitude range of 2643–2911 m) across the G212 highway and five transects (3163–3563 m) across the G213 highway. Background concentrations of Cu, Zn, Pb, and Cd to the 60-cm soil depth (measured at each transect 400 m away from highways) varied greatly among transects and between highways. However, this spatial variation in the heavy metal concentrations was not related to the altitude of the investigated areas. On each the left and right sides of G212 or G213, Cu, Zn, and Pb concentrations to the 60-cm depth, at 5, 10, 20, and 50 m away from the highway, were all generally greater than the respective metal background concentrations. Cd concentrations to the 20 cm on G212 or 60-cm soil depth on G213 increased prominently within a distance of 20 m away from the highways, compared to background values in different depths. From the curb to 400 m away from highways, concentrations of Cu, Zn, Pb, and Cd were generally higher in the upper than in the lower soil layers. This may suggest that other factors such as atmospheric deposition were also contributable to the accumulation of heavy metals in soil. The contamination factor (Cf ) calculation showed that roadside soils to the 60-cm depth, within a distance of 50 m from the curbs of both G212 and G213, were moderately (1 ≤ Cf < 3) contaminated with Cu, Zn, and Pb. The contamination from Cd mainly occurred (1 ≤ Cf < 8) in the top 20 cm soil with a closer distance from the highways. Our results indicated that traffic effects in enriching heavy metals reached 60-cm depth in roadside soils on the eastern Tibetan Plateau. For assessment of heavy metal pollutions in soil in mountainous areas, it is necessary to in situ identify the background values.
Dynamics and sources of pharmaceutically active compounds in a coastal Mediterranean river during heavy rains
Abstract
Concentrations of pharmaceutically active compounds (PACs) in freshwater systems depend on numerous factors such as land use and hydrometeorological conditions. In the Mediterranean, heavy rain events are of particular importance as they highly influence the concentration of micropollutants found in freshwater and are a source of recurrent first foul flushes due to combined sewer overflows (CSOs). In this study, we seek to assess the dynamics of pharmaceuticals during storm events in coastal Mediterranean rivers at a fine scale and to determine their contribution to multicontamination phenomena owing to CSOs. Our results showed that, while dissolved PACs followed the same trend as other contaminants, i.e., they increased significantly during CSOs, PACs in the total fraction did not peak yet maintained their already high concentrations for slightly longer due to their release via CSOs. Pharmaceutical concentrations for both the dissolved and the total fraction were dramatically diluted during the peak river flow. A fine-scale follow-up of PACs dynamics in the total fraction, including the differentiation of sewer overflows from both the right and left river banks, as well as the analyses of a large amount of PACs molecules, allowed us to clearly identify their major sources. While domestic inputs were dominated by nicotine and caffeine, the use of gadolinium (an MRI contrast agent) as a marker, attributed the main source of medical drugs such as tramadol, ibuprofen, and diclofenac to the major public hospital of the region. Thus, identifying major sources of PACs and implementing adapted water treatments directly at those sources would be the most cost-efficient alternative to cope with pharmaceutical drugs in coastal Mediterranean aquatic environments. Moreover, PACs behavior differed depending on the molecules considered and the source of these molecules, but we could not establish a direct link between their behavior and their chemical or physical properties. Our study highlights the importance of monitoring at strategic locations and with a high frequency sampling in order to better understand fate, sources, and behavior of pharmaceuticals in aquatic environments.
Algorithm-Based Levator Aponeurectomy
To the Editor We read with great interest the article titled "Role of algorithm-based levator aponeurectomy in small-incision external ptosis surgery for involutional ptosis" by Repp et al. The authors clearly described a new surgical algorithm for treatment of involutional ptosis considering the biomechanical property of the superior levator complex. Aponeurotic ptosis is the most common type of acquired ptosis, resulting from involutional changes of the levator aponeurosis as a consequence of its gradual stretching or attenuation of its strength. We congratulate Repp et al for the new technique proposed to control the aponeurosis to standardize the amount of stress placed on it among different patients. The algorithm is very interesting because it allows calculation of the amount of aponeurosis resection needed, minimizing the variable depending on the operator, and thus standardizing the method of surgical correction.
Algorithm-Based Levator Aponeurectomy—Reply
In Reply We thank Innocenti et al for their comment on our article. Although we do agree that long-term follow-up is necessary to establish the longevity of each procedure, there is no consensus in the literature regarding the necessary minimum follow-up time for upper-eyelid ptosis repair procedures. Several prior published reports of ptosis repair techniques have had similar or less follow-up time compared with our study. In addition, Doxanas did not notice late recurrences of ptosis at 3 or more years after surgery. Frueh et al suggested that late recurrences may be related to the use of dissolvable sutures to repair or advance the aponeurosis. We use nondissolving sutures. In the study by Innocenti et al, it is unclear what type of sutures was used. In addition, it is unclear if their 7.5% recurrence rate represented late recurrences or if the failures occurred earlier and remained stable at 3 years. Using dissolvable sutures, Tucker and Verhulst noted stabilization of height in most eyelids at 6 weeks after surgery.
Scaffold-Assisted Artificial Hair Implantation in a Rat Model
This randomized prospective animal study tests the biocompatibility of porous high-density polyethylene and expanded polytetrafluoroethylene hair-bearing scaffolds in rats.
Lazy Pentagonal Wedge Resection of Eyelid Margin Lesions
This Surgical Pearl describes a modified curvilinear or "lazy" pentagonal wedge resection technique to achieve the tarsal alignment associated with the pentagonal wedge minimize scarring and dog-ear deformity.
Infant Health and Future Childhood Adversity
Abstract
Objective To investigate the extent to which disabling infant health conditions are associated with adverse childhood experiences at age 5. Methods We conducted a secondary analysis of data from the Fragile Families and Child Wellbeing Study, a national urban birth cohort. We estimated logistic regression models of associations between the presence of a disabling infant health condition and the child's ACE exposures at age 5, controlling for factors that preceded the child's birth, including the mother's sociodemographic characteristics, physical health, mental illness, and substance abuse and the parents' criminal justice system involvement and domestic violence or sexual abuse. ACEs included 4 categories of child maltreatment (physical, sexual, psychological abuse, neglect) and 5 categories of household dysfunction (father absence, substance use, mental illness, caregiver treated violently, incarceration). Results 3.3% of the children were characterized as having a disabling health condition that was likely present at birth. Logistic regression estimates indicate that having a disabling infant health condition was associated with 83% higher odds of the child experiencing 2 or more ACEs (AOR 1.83, CI 1.14–2.94) and 73% higher odds of the child experiencing 3 or more ACEs (AOR 1.73, CI 1.07–2.77) at age 5. Conclusions for Practice The finding of strong links between disabling infant health conditions and ACEs at age 5 suggests that child health and ACEs play intertwining and mutually reinforcing roles during the early lifecourse and highlights the critical importance of investing in systems that simultaneously promote optimal child development and address childhood adversity.
Spontaneous pulmonary adenosquamous carcinoma in a free-living black capuchin monkey (Sapajus nigritus)
Abstract
Pulmonary neoplasia is rare among wild New World primates. We report the gross, microscopical, and immunohistochemical features of a primary multicentric pulmonary adenosquamous carcinoma in a free-living black capuchin monkey (Sapajus nigritus). Herein, the spectrum of pulmonary neoplasms in non-human primates is widened and briefly reviewed.
Hepatocellular carcinoma in a free-living marmoset (Callithrix sp.) with concomitant biliary trematodiasis
Abstract
Hepatocellular carcinoma (HCC) is rare in New World primates. We report the gross, microscopical, and immunocytochemical features of a spontaneous HCC in a free-living marmoset (Callithrix sp.). Hepatitis B and C virus and aflatoxin immunohistochemistry were negative; however, concomitant intra- and extrahepatic biliary trematodiasis could have played a role.
Neck rejuvenation by direct anterior medial cervicoplasty: the modified zigzag-plasty according to Tschopp
Abstract
Background
Conventional cervicofacial rhytidectomy has become the standard treatment of skin excess of the ageing neck. However, some patients want to avoid an extensive surgical procedure, especially if the anterior neck is the predominant problem zone.
Objective
To report on the efficacy and safety of a zigzag-shaped skin excision combined with platysma plication.
Methods & Materials
We present a retrospective case review series of 6 female patients. Skin excess was marked preoperatively using the skin pinching technique, then transferred into a zigzag-shaped area and finally excised using the method according to Tschopp, which is described. Patients were followed up for at least one year.
Results
All patients (age: 55 to 82 yrs., median: 65 yrs.) were very satisfied with the results. On an overall patient satisfaction scale of 1 to 10 (1 being the best), the scars were graded on average 1,85 (median: 2) 1 year after surgery. No scar hypertrophy, functional impairment, nerve damage or other serious complications were observed.
Conclusion
In selected patients, the direct anterior zigzag-shaped excision poses an effective, safe and easy surgical option for both skin and fat excess and platysma banding. The technique is easily reproducible, with low morbidity and high patient satisfaction.
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Role of T-helper 17 cells and T regulatory cells in alopecia areata: Comparison of lesion and serum cytokine between controls and patients
Abstract
Background
Alopecia areata (AA) is an organ-specific autoimmune disease with T-cell-mediated attack of hair follicle autoantigens. As T-helper 17 (Th17) cells and T regulatory (Treg) cells are crucially involved in the pathogenesis, the role of Th17 and Treg cytokines has not been studied yet.
Objective
To determine whether AA is associated with alterations in lesional and serum Th17 and Treg cytokines, and studied whether they were associated with clinical type.
Methods
Scalp skin samples from 45 patients and 8 normal controls were obtained for PCR specific for IFN-γ, TNF-α, TGF-β, IL-1, IL-2, IL-4, IL-10, IL-12A, IL-13, IL-17, IL-22 and IL-23. Serum cytokines were measured from 55 patients and 15 normal controls using ELISA.
Results
Lesional IL-17 and IL-22 were significantly increased in patients group. Moreover, positive correlations were shown between lesional IL-17, IL-22 and disease severity. Serum IL-1, IL-17, TNF-α, and TGF-β were significantly increased, and positive correlation was shown between serum IL-17 and disease severity.
Conclusion
These results showed significantly high Th17 cytokines in both lesion and serum in AA patients, which may highlight a functional role of these cytokines in the pathogenesis of AA.
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Design, development and optimization of a transungual duple nail lacquer for onychomycosis therapy
Abstract
Onychomycosis is a degenerative fungal infection inflicting toes and finger nails which is caused by both dermatophytes and non-dermatophytes such as Trichophyton rubrum and Candida spp. respectively. The infection apparently causes nail mutilation making nails stiff, skinny, flawed, and dyschromic. Owing to the anatomical presentation of the disease, a topical application is warranted which asserts positive attributes like ease of preparation, improved adherence, negligible drug interactions, low systemic adverse effects and voluntary removal.
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Letter on ‘European dermatology forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 2: Scleromyxedema, scleredema and nephrogenic systemic fibrosis’
Abstract
We read with interest the guidelines recently published on sclerosing diseases of the skin (Part 2: Scleromyxedema, scleredema and nephrogenic systemic fibrosis)[1, 2]. However, we are concerned that the guideline recommendations proposed for prevention of nephrogenic systemic fibrosis (NSF) are potentially dangerous. Although we recognise the challenges in constructing comprehensive guidelines, we are concerned that this may be because the guidelines have not involved a multidisciplinary team.
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A novel scale for measurement of acquired dermal macular hyperpigmentation (ADHM) severity
Abstract
Acquired dermal macular hyperpigmentation (ADMH) is a hypernym which includes lichen planus pigmentosus (LPP), Riehl's melanosis (RM), pigmented contact dermatitis (PCD) and erythema dyschromicum perstans (EDP). There is considerable overlap between the clinical and histopathological features of these conditions. Despite affecting a large number of patients, there is no validated quantitative scale for LPP/EDP/RM/PCD/ADMH.
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A Pathway-Based Association Analysis Identified FMNL1-MAP3K14 as Susceptibility Genes for Leprosy
Abstract
The nuclear transcription factor-κB (NF-κB) plays a pivotal role in controlling both innate and adaptive immunity and regulates the expressions of many immunological mediators. Abundant evidences have showed that the importance of NF-κB pathway in the host immune responses against Mycobacterium leprae in the development of leprosy. However, no particular association study between leprosy and NF-κB pathway related gene polymorphisms was reported. Here, we performed a large scale and two-stage candidate association study to investigate the association between 94 NF-κB pathway related genes and leprosy. Our results showed that rs58744688 was significantly associated with leprosy (P=7.57×10-7, OR=1.12) by combining the previous genome wide association datasets and four independent validation sample series, consisting of a total of 4631 leprosy cases and 6413 healthy controls. This founding implicated that MAP3K14 and FMNL1 were susceptibility genes for leprosy, which suggested the involvement of macrophage targeting and NF-κB pathway in the development of leprosy.
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Characterization of the facial microbiome in twins discordant for rosacea
Abstract
Previously, we determined that genetic and environmental factors contributed equally towards rosacea in twins. To assess an environmental factor, we characterized the malar cheek bacterial microbiome from twins discordant for rosacea. We found no significant difference in facial microbiome alpha and beta diversity between related twins discordant for rosacea. However, the relative percentage abundance of Gordonia and Geobacillus, low abundant genera, was positively and negatively associated with rosacea severity, respectively. Our data demonstrate a significant correlation between facial microbiome and severity of rosacea in genetically matched twins and importantly that overall microbiome composition is largely unchanged.
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Making Sense of Self Talk
Abstract
People talk not only to others but also to themselves. The self talk we engage in may be overt or covert, and is associated with a variety of higher mental functions, including reasoning, problem solving, planning and plan execution, attention, and motivation. When talking to herself, a speaker takes devices from her mother tongue, originally designed for interpersonal communication, and employs them to communicate with herself. But what could it even mean to communicate with oneself? To answer that question, we need a theory of communication that explains how the same linguistic devices may be used to communicate with others and oneself. On the received view, which defines communication as information exchange, self talk appears to be an anomaly, for it is hard to see the point of exchanging information with oneself. However, if communication is analysed as a way of negotiating commitments between speaker and hearer, then communication may be useful even when speaker and hearer coincide. Thus a commitment-based approach allows us to make sense of self talk as well as social talk.
Improving the UNC Passive Aerosol Sampler Model Based on Comparison with Commonly Used Aerosol Sampling Methods
Abstract
Objectives
In an occupational environment, passive sampling could be an alternative to active sampling with pumps for sampling of dust. One passive sampler is the University of North Carolina passive aerosol sampler (UNC sampler). It is often analysed by microscopic imaging. Promising results have been shown for particles above 2.5 µm, but indicate large underestimations for PM2.5. The aim of this study was to evaluate, and possibly improve, the UNC sampler for stationary sampling in a working environment. Methods
Sampling was carried out at 8-h intervals during 24 h in four locations in an open pit mine with UNC samplers, respirable cyclones, PM10 and PM2.5 impactors, and an aerodynamic particle sizer (APS). The wind was minimal. For quantification, two modifications of the UNC sampler analysis model, UNC sampler with hybrid model and UNC sampler with area factor, were compared with the original one, UNC sampler with mesh factor derived from wind tunnel experiments. The effect of increased resolution for the microscopic imaging was examined. Results
Use of the area factor and a higher resolution eliminated the underestimation for PM10 and PM2.5. The model with area factor had the overall lowest deviation versus the impactor and the cyclone. The intraclass correlation (ICC) showed that the UNC sampler had a higher precision and better ability to distinguish between different exposure levels compared to the cyclone (ICC: 0.51 versus 0.24), but lower precision compared to the impactor (PM10: 0.79 versus 0.99; PM2.5: 0.30 versus 0.45). The particle size distributions as calculated from the different UNC sampler analysis models were visually compared with the distributions determined by APS. The distributions were obviously different when the UNC sampler with mesh factor was used but came to a reasonable agreement when the area factor was used. Conclusions
High resolution combined with a factor based on area only, results in no underestimation of small particles compared to impactors and cyclones and a better agreement with the APS's particle size distributions. The UNC sampler had lower precision than the impactors, but higher than the respirable cyclone. The UNC sampler with area factor could be used for PM2.5, PM10 and respirable fraction measurements in this working environment without wind.A 3-variable prognostic score (3-PS) for overall survival prediction in metastatic castration-resistant prostate cancer treated with 223 Radium-dichloride
Abstract
Objective
In mCRPC patients treated with 223Ra, a major issue is the validation of reliable prognostic and predictive biomarkers to maximize clinical benefit and minimize toxicities and costs. Bearing in mind how changes in tALP did not meet statistical requirements as surrogate marker for survival, aim of this single-center retrospective study was to characterize the prognostic and predictive role of baseline clinical variables associated with overall survival in patients receiving 223Ra treatment.
Methods
92 consecutive CRPC patients with symptomatic bone metastases receiving 223Ra treatment were included. Available baseline clinical data relevant to the survival analysis were retrospectively collected. The primary end-point of the study was overall survival, which was established from the first 223Ra administration until date of death from any cause.
Results
Median follow-up time from the first 223Ra administration was 6 months (range 1–31 months). The univariate analysis evaluating the prognostic value of all baseline clinical variables showed that patients' weight, BMI, ECOG PS, Hb and tALP values were independently associated with OS. On multivariable analysis only baseline Hb value and ECOG PS remained significantly correlated with OS. To determine reliable baseline predictive factors for survival in patients receiving 223Ra treatment, we produced a predictive score. We tried all possible variable combinations, and found that the best score was obtained by combining baseline ECOG PS with Hb < 12 g/dl and PSA ≥ 20 ng/ml. This resulted in a score ranging from 0 to 4, with AUC 78.4% (p < 0.001).
Conclusions
We propose a multidimensional clinical evaluation to select those mCRPC subjects suitable to receive the maximum benefit from 223Ra treatment.
Nickel and cobalt release from earrings and piercing jewellery – analytical results of a German survey in 2014
Summary
Background
Nickel and cobalt are important metal allergens, and more knowledge on the levels of exposure to these from everyday contacts is needed.
Objectives
To report the results of a repeat routine surveillance scheme in the Federal Republic of Germany on the release of nickel and cobalt.
Methods
Fifteen laboratories assessed earrings and piercing jewellery items from 12 of the states in 2014, complying with EN 1811:2011 + AC:2012 and using atomic absorption spectrometry, inductively coupled plasma mass spectrometry and inductively coupled plasma optical emission spectrometry for quantification. Kaplan–Meier analysis for left-censored data was employed to account for measurements below the limit of quantification.
Results
Nickel release exceeded 0.35 µg/cm2 per week in 26 of 160 piercing posts (16.2%), and 0.88 µg/cm2 per week in 2.0–5.9% of other parts, that is, the current respective 'pass' thresholds, with no change from the previous 2008 survey. The level of cobalt release was lower than that of nickel release, and also significantly lower than in the previous survey.
Conclusions
The finding of the highest level of nickel release from piercing posts, with their deliberately lower threshold of acceptability, is worrying, as is the largely unchanged overall level of nickel release. A regulation on cobalt release is currently lacking; risk assessment and management based on dose-elicitation data are needed.
Preeclampsia and Hypertension During Pregnancy in Areas with Relatively Low Levels of Traffic Air Pollution
Abstract
Objectives Air pollution exposure may contribute to the development of preeclampsia and hypertension during pregnancy. However, the evidence for such a relation is still limited. We investigated the associations between exposure for moderate to low levels of air pollution during pregnancy and preeclampsia and gestational hypertension in selected urban and county areas of Norway. Methods This study used a sub-group of 17,533 women in the Norwegian Mother and Child Cohort Study. Air pollution levels at residential addresses were estimated using land use regression models and back-extrapolated to the period of each pregnancy. Information on preeclampsia and gestational hypertension were obtained from the Medical Birth Registry of Norway and information on lifestyle factors was collected from questionnaires completed by the women during pregnancy. Results Moderate mean levels of NO2 (13.6 ± 6.9 µg/m3) at residential address during pregnancy were not associated with preeclampsia and pregnancy hypertension. We found no statistically significant associations per 10 µg/m3 change in NO2 exposure and preeclampsia (adjusted OR 0.89, 95% CI 0.74, 1.08) or hypertension during pregnancy (adjusted OR 0.91, 95% CI 0.78, 1.06). Conclusions for Practice In this large Norwegian pregnancy cohort, we found no statistically significant associations for moderate to low levels of pregnancy NO2 exposure and preeclampsia or hypertension during pregnancy.
Factors Associated with Vaccination Status of Children Aged 12–48 Months in India, 2012–2013
Abstract
Objectives India has more unvaccinated children than any other country despite provision of free vaccines through the government's Universal Immunization Program. In this study, we calculated the proportion of children aged 12–48 months who were fully vaccinated, under-vaccinated, or who had not received any vaccines. Childhood, household, and sociocultural factors associated with under-vaccination and non-vaccination were evaluated. Methods Using data from India's 4th District-level Health and Facility Survey, 2012–2013 (DLHS-4) and the 2012–2013 Annual Health Survey (AHS), we calculated the proportion of children who were non-vaccinated, under-vaccinated, or fully vaccinated with 1 dose of Bacillus Calmette–Guérin, 3 doses of oral polio vaccine, 3 doses of diphtheria–pertussis–tetanus, and 1 dose of measles-containing vaccine. The odds of full vaccination compared to non-vaccination and under-vaccination relative to various factors was assessed using a multivariable, multinomial logistic regression which accounted for survey design. Results Of 1,929,580 children aged 12–48 months, 59% were fully vaccinated, 34% were under-vaccinated, and 7% were non-vaccinated. Compared to children born in government institutions, children delivered in non-institutional settings with a skilled birth attendant present had higher odds of non-vaccination (OR 1.66) and those without a skilled attendant present had still greater odds of non-vaccination (OR 2.39) and under-vaccination (OR 1.11). Conclusions for Practice India's vaccination rates among children aged 12–48 months remains unacceptably low. The Indian government should encourage institutional delivery or birthing with a skilled attendant to ensure women receive adequate health education through antenatal care that includes the importance of childhood vaccination.
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A Case of Diprosopus Tetraophthalmos: Ocular Findings and Surgical Treatment of Exposure KeratopathyDiprosopus is a rare variation of conjoined twinning. In this report, ophthalmic findings in an infant with diprosopus tetraophthalmos are p...
