Adsorption kinetics and mechanisms of copper ions on activated carbons derived from pinewood sawdust by fast H 3 PO 4 activation

Abstract

Two kinds of pinewood sawdust activated carbon adsorbents were prepared by fast activation with H₃PO₄ in a spouted bed, and the application in adsorption of copper ions was investigated. With only 3 min of activation time, the BET surface area of activated carbons reached 1537.5 m²/g for impregnation mass ratio of H₃PO₄ to sawdust at 1:1 and activation temperature of 500 °C (IR1-500), whereas it was 1750.7 m²/g for the impregnation ratio at 4:1 and activation temperature of 800 °C (IR4-800). The pseudo second-order reaction kinetics well describes the experimental adsorption of copper ion in this study, indicating chemisorption dominated in the process. By the C_1s spectrum, activated carbons from IR1-500 contained more carboxyl groups (-COOH) and carbonyl groups (C=O), which played an important role in copper ions adsorption. In addition, it was found that the P-containing groups (metaphosphates) also involved in the adsorption of copper ion.

Bed-Sharing in the First 8 Weeks of Life: An Australian Study

Abstract

Background As the evidence continues to emerge about the relationship between sudden unexpected death in infancy (SUDI) and the way an infant sleeps, providing consistent and evidence-informed recommendations on how best to sleep infants is an ongoing challenge. A recent case series study in the state of Victoria, Australia, identified 45.8% of sleep-related infant deaths occurred whilst bed-sharing. This study prompted the need for further exploration of infant sleeping practices, including bed-sharing, in this population. Methods A cross-sectional survey of 2745 mothers attending the Maternal and Child Health (MCH) Service across Victoria, Australia was conducted. Data included the prevalence and circumstances of bed-sharing, family demographics, and SUDI risk and protective factors. Associations between bed-sharing and SUDI risk and protective factors were examined using univariate and multivariate analyses. Results Bed-sharing prevalence was found to be 44.7%, with 21.5% reporting that this was intended. Multivariate analyses showed bed-sharing was less likely amongst those with an annual household income above $AUS104, 000 (OR 0.72; 95% CI 0.54–0.96) and more likely amongst mothers who breastfed (OR 1.71; 95% CI 1.23–2.37). Conclusions Bed-sharing prevalence in this population compares closely with the Victorian case series study and a previous cross-sectional study in the state of Queensland, Australia, in 2002. Noted gaps in how families are implementing current recommendations about reducing the risk of SUDI were identified for sleep position, sleep location and the sleep environment. Further consideration needs to be given to addressing these gaps and applying these findings of current bed-sharing practices to the development of infant safe sleeping policy and programs.

The Montreal Augmentation Mammoplasty Operation (MAMO) Simulator: An Alternative Method to Train and Assess Competence in Breast Augmentation Procedures

Abstract

Background

Surgical residents' exposure to aesthetic procedures remains limited in residency training. The development of the Montreal Augmentation Mammoplasty Operation (MAMO) simulator aims to provide an adjunctive training method and assessment tool to complement the evolving competency-based surgical curriculum.

Objectives

To perform face, content and construct validations of the MAMO simulator for subpectoral breast augmentation procedures and assess the reliability of the assessment scales used.

Methods

Plastic surgery staff and residents were recruited to perform a subpectoral breast augmentation on the simulator. Video recordings of their performance were blindly evaluated using the Objective Structured Assessment of Technical Skills (OSATS) system consisting of the Global Rating Scale (GRS), Mammoplasty Objective Assessment Tool (MOAT) and a surgery-specific Checklist score.

Results

Fourteen plastic surgery residents and seven expert plastic surgeons were enrolled. Experts' performance was significantly higher than residents' according to each of GRS, MOAT and Checklist scores. Mean values of residents and experts were 23.4 (2.5) vs. 36.9 (3.1) (p<0.0001) for GRS score, 30.4 (2.2) vs. 40 (3.2) (p<0.0001) for MOAT scores and 9.7 (1.5) vs. 12 (1) (p<0.001) for Checklist scores, respectively. Face and content validations showed excellent results among parameters evaluated, with an overall mean score of 4.8 (0.3) on 5. Cronbach's alpha was 0.96 and 0.83 for GRS and MOAT scores, respectively. Intraclass Correlation Coefficients for interrater reliability were excellent at 0.93, 0.92, and 0.89 for the GRS, MOAT, and Checklist scores, respectively.

Conclusions

This study proves the construct simulator to be valid and the assessment scales to be reliable.

Perceptions of hyperbaric oxygen therapy among podiatrists practicing in high-risk foot clinics

Foot ulceration is a devastating and costly consequence of diabetes. Hyperbaric oxygen therapy is recognised as an adjunctive therapy to treat diabetes-related foot ulceration, yet uptake is low. Semi-structured interviews were conducted with 16 podiatrists who manage patients with foot ulcers related to diabetes to explore their perceptions of, and the barriers/facilitators to, referral for hyperbaric oxygen.

Podiatrists cited logistical issues such as location of facilities as well as poor communication pathways, lack of delegation and lack of follow up when patients presented for hyperbaric treatment. In general, podiatrists had an understanding of the premise of hyperbaric oxygen therapy and evidence to support its use but could only provide very limited citations of key papers and guidelines to support their position. Podiatrists stated that they felt a patient was lost from their care when referred for hyperbaric oxygen and that aftercare might not be adequate.

Improved referral and delegation pathways for patients presenting for hyperbaric oxygen, as well as the provision of easily accessible evidence to support this therapy, could help to increase podiatrists' confidence in deciding whether or not to recommend their patients for hyperbaric oxygen therapy.

The relative contribution of symptomatic and asymptomatic Plasmodium vivax and Plasmodium falciparum infections to the infectious reservoir in a low-endemic setting in Ethiopia

Abstract

Background

The majority of P. vivax and P. falciparum infections in low-endemic settings are asymptomatic. The relative contribution to the infectious reservoir of these infections, often of low-parasite-density, compared to clinical malaria cases, is currently unknown but important for malaria elimination strategies.

Methods

We assessed infectivity of passively-recruited symptomatic malaria patients (n=41) and community-recruited asymptomatic individuals with microscopy- (n=41) and PCR-detected infections (n=82) using membrane feeding assays with Anopheles arabiensis mosquitoes in Adama, Ethiopia. Malaria incidence and prevalence data was used to estimate the contributions of these populations to the infectious reservoir.

Results

Overall, 34.9% (29/83) of P. vivax and 15.1% (8/53) P. falciparum infected individuals infected ≥1 mosquitoes. Mosquito infection rates were strongly correlated with asexual parasite density for P. vivax (ρ = 0.63; P < .001) but not for P. falciparum (ρ = 0.06; P = .770). P. vivax symptomatic infections were more infectious to mosquitoes (infecting 46.5% of mosquitoes, 307/660) compared to asymptomatic microscopy-detected (infecting 12.0% of mosquitoes, 80/667; P = .005) and PCR-detected infections (infecting 0.8% of mosquitoes, 6/744; P < .001). Adjusting for population prevalence, symptomatic, asymptomatic microscopy- and PCR-detected infections were responsible for 8.0%, 76.2% and 15.8% of the infectious reservoir for P. vivax, respectively. For P. falciparum, mosquito infections were sparser and also predominantly from asymptomatic infections.

Conclusions

In this low-endemic setting aiming for malaria elimination, asymptomatic infections are highly prevalent and responsible for the majority of onward mosquito infections. The early identification and treatment of asymptomatic infections might thus accelerate elimination efforts.

An Oral Disease Severity Score (ODSS) validated for use in oral pemphigus vulgaris

Summary

Objectives

The primary aim of this study was to validate the Oral Disease Severity Score (ODSS) for the assessment of oral involvement in pemphigus vulgaris (PV). A secondary aim was to compare the inter – intra- observer variability and ease of use with the Physician's Global Assessment (PGA) and the oral scoring methods used in Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and the Pemphigus Disease Area Index (PDAI).

Methods

15 patients with mild to moderately severe oral PV were scored for disease severity by 10 oral medicine clinicians using the ODSS, PGA and the oral sections of ABSIS and PDAI. Two clinicians re-scored all patients after a minimum two-hour interval.

Results

Inter-observer reliability was assessed using an intra-class correlation coefficient (ICC). For the ODSS total score the ICC was 0.83, PDAI (oral total activity) 0.79 ABSIS (oral total) 0.71 and PGA was 0.7. Intra-observer agreement between initial scoring and re-scoring of the same subject by two clinicians demonstrated an ICC for each of 0.97 and 0.96 for ODSS total score; 0.99 and 0.82 for the PDAI oral activity; 0.86 and 0.45 for the ABSIS total and 0.99 and 0.64 for the PGA. Convergent validity was good with a correlation coefficient of greater than 0.5 (p<0.0001). The mean time (SD) (seconds) taken to complete each scoring method was: ODSS 76±37; PDAI 117±16; ABSIS 75±19.

Conclusion

This study has validated the ODSS for the assessment of oral PV. It has shown superior inter- and intra-observer reliability to PDAI, ABSIS and PGA and is quick to perform.

This article is protected by copyright. All rights reserved.

An observational study of the efficacy of azithromycin in erythema annulare centrifugum

Summary

Erythema annulare centrifugum (EAC) is a form of figurate erythema consequent to a cutaneous hypersensitivity reaction to an underlying agent. In the present study, we aimed to assess the role of oral azithromycin in cases of idiopathic EAC. We performed an open trial of azithromycin in 10 patients with idiopathic EAC. Histopathological examination of biopsies was performed to exclude any alternative diagnosis and to assess the depth of the infiltrate. Patients were administered oral azithromycin 250 mg once daily until clinical resolution of the disease, and followed up regularly to monitor for possible relapse. Histopathological examination of the 10 biopsies revealed superficial pattern in 3, deep pattern in 2 and mixed pattern in the remaining 5. Of the 10 patients, 8 responded to azithromycin 250 mg, with no relapse during follow-up. Oral azithromycin might be a promising therapy in cases of idiopathic EAC. Cases with a superficial pattern respond earlier than cases with a deep pattern.

Brain Injuries and Facial Fractures: A Prospective Study of Incidence of Head Injury Associated with Maxillofacial Trauma

Abstract

Background

Presence of head injuries in patients with maxillofacial trauma is a lifethreatening condition. Prompt determination of head injury in these patients is crucial for improving patient survival and recovery. Hence, the need to know about the incidence of head injuries associated with maxillofacial trauma becomes an important aspect.

Materials and Methods

A total of 100 patients were included in the study. Patient with head injuries associated with maxillofacial fractures was accounted to determine the incidence and pattern of head injuries accompanying maxillofacial trauma. They were evaluated for epidemiological demographic and clinical characteristics.

Results

The present study had 91% predominance of male patients with age ranging from 1 to 75 years. 91% cases were as a result of RTA. The most frequent maxillofacial injury represented was the fractured mandible. The incidence of head injuries associated with maxillofacial trauma was 67 %. Among all the patterns of head injuries, concussion was the most common head injury associated with maxillofacial trauma.

Conclusion

In our study, the risk of head injury increased significantly as the Glasgow Coma Scale score decreased and with increase in the number of facial fractures. There was association between head injury and maxillofacial trauma.

Nonlinear deformation of tractography in ultrasound-guided low-grade gliomas resection

Abstract

Purpose

In brain tumor surgeries, maximum removal of cancerous tissue without compromising normal brain functions can improve the patient's survival rate and therapeutic benefits. To achieve this, diffusion MRI and intra-operative ultrasound (iUS) can be highly instrumental. While diffusion MRI allows the visualization of white matter tracts and helps define the resection plan to best preserve the eloquent areas, iUS can effectively track the brain shift after craniotomy that often renders the pre-surgical plan invalid, ensuring the accuracy and safety of the intervention. Unfortunately, brain shift correction using iUS and automatic registration has never been shown for brain tractography so far despite its rising significance in brain tumor resection.

Methods

We employed a correlation-ratio-based nonlinear registration algorithm to account for brain shift through MRI–iUS registration and used the recovered deformations to warp both the brain anatomy and tractography seen in pre-surgical plans. The overall technique was demonstrated retrospectively on four patients who underwent iUS-guided low-grade brain gliomas resection.

Results

Through qualitative and quantitative evaluations, the preoperative MRI and iUS scans were well realigned after nonlinear registration, and the deformed brain tumor volumes and white matter tracts showed large displacements away from the pre-surgical plans.

Conclusions

We are the first to demonstrate the technique to track nonlinear deformation of brain tractography using real clinical MRI and iUS data, and the results confirm the need for updating white matter tracts due to tissue shift during surgery.

Mathematical descriptions

Abstract

In this paper, the authors briefly summarize how object theory uses definite descriptions to identify the denotations of the individual terms of theoretical mathematics and then further develop their object-theoretic philosophy of mathematics by showing how it has the resources to address some objections recently raised against the theory. Certain 'canonical' descriptions of object theory, which are guaranteed to denote, correctly identify mathematical objects for each mathematical theory T, independently of how well someone understands the descriptive condition. And to have a false belief about some particular mathematical object is not to have a true belief about some different mathematical object.

Evaluation of carboxytherapy and platelet-rich plasma in treatment of periorbital hyperpigmentation: A comparative clinical trial

Summary

Background

Management of periorbital hyperpigmentation (POH) is still a therapeutic challenge. Although different therapeutic modalities are available, the outcomes of most of them are unsatisfactory.

Objectives

To investigate and compare the efficacy and safety of two new modalities in the treatment of POH; the platelet rich plasma (PRP) and the carboxytherapy.

Subjects and Methods

The study included 30 patients with POH. Every patient was subjected to seven intradermal injections of PRP on the left periorbital area with 2 week intervals between sessions and carboxytherapy on the right area with 1 week interval apart. Assessments were done by investigators' assessment, visual analogue scale by both patients and doctors, and patients' satisfaction. Side effects were reported.

Results

All patients completed the sessions in the carboxy-treated side. In the PRP-treated side, 10 patients refused to complete all sessions because of intolerable side effects. Significant improvement in POH was achieved in both sides (P ≤ .0001). The improvement was comparable with no statistically significant difference between both modalities. Side effects in the carboxy treated side were mild and well tolerated by all patients while they were relatively severe, and persisted for days after sessions in the PRP-treated side.

Conclusions

Both PRP and carboxytherapy are relatively effective and their efficacy is comparable in treatment of POH. Carboxtherapy is simple and slightly more effective modality and well tolerated than PRP. We believe that both modalities are promising but not the ideal solutions of the POH problem which is caused by multifactorial etiology.

Application of lipidomics to reveal differences in facial skin surface lipids between males and females

Summary

Purpose

To analyze and compare differences in facial skin surface lipids (SSL) between 18- to 25-year-old males and females.

Methods

Ultra-performance liquid chromatography quadrupole time of flight mass spectrometry (UPLC-Q-TOF-MS) technology was used to measure the facial SSL composition of 18- to 25-year-old males and females. Measurement results were combined with the orthogonal projections to latent structures discriminant analysis (OPLS-DA) model for analysis and comparisons, and differences in lipids with significance were selected.

Results

There were significant differences in facial SSL composition between 18- to 25-year-old males and females. Under selected conditions, 37 types of lipids with significant differences were obtained (P ≤ .05). All of them had higher content in females, and primarily included ceramides (Cers), glucosylceramide (GlcCer), phosphatidylserine (PS), phosphatidylcholine (PC), and others.

Conclusions

There are significant differences in facial SSL between 18- to 25-year-old males and females.

The effect of temperature on airborne filamentous fungi in the indoor and outdoor space of a hospital

Abstract

Fungi are one of the bioaerosols in indoor air of hospitals. They have adverse effects on staff and patients. The aim of this study was to investigate the effects of three incubation temperature on the density and composition of airborne fungi in an indoor and outdoor space of hospital. Sabouraud dextrose agar was used for culture the fungi. For improvement of aseptic properties, chloramphenicol was added to this medium. The density of airborne fungi was less than 282 CFU/m³. The highest density was detected in emergency room and the lowest of them was in neonatal intensive care unit (NICU) and operation room (OR). Results showed that fungi levels at 25 °C were higher than 37 and 15 °C (p = 0.006). In addition, ten different genera of fungi were identified in all departments. The predominant fungi were Fusarium spp., Penicillium spp., Paecilomyces spp., and Aspergillus niger. Moreover, the density and trend of distribution of Fusaruim spp. in the indoor space was directivity to outdoor space by ventilation system. The present study has provided that incubation temperature had effect on airborne fungi remarkably. We are suggested that more studies would be conducted on incubation temperature and other ambient factors on airborne fungi.

Ultrastructural alterations in sperm formation of the beetle, Blaps polycresta (Coleoptera: Tenebrionidae) as a biomonitor of heavy metal soil pollution

Abstract

Little is known about ultrastructural alterations induced by heavy metals pollution in insects. Therefore, the main objective of the present study is to elucidate ultrastructural changes in sperm formation of the tenebrionid beetle, Blaps polycresta as a biomonitor of heavy metal soil pollution. Metal percentages in testicular tissues of adult insects collected from reference and polluted sites were estimated using energy-dispersive X-ray microanalysis (EDX). Only cadmium, among eight detected metals, showed significantly higher percentages in the polluted testes compared with the reference ones. Ultrastructure investigation revealed severe alterations both in spermatogenic and spermiogenic stages of the polluted insects. Some cells were totally eroded. No spermatozoa were observed in all the examined cysts. Most degenerations were confined to the flagella of spermatids having enlarged vacuolated cytoplasm and malformed mitochondrial derivatives. Groups of multiple axial filaments were appeared in the form of bi-and tetra-flagellate spermatids. Electron dense vesicles were observed in almost all stages of the polluted testes. It is a novel trend in which ultrastructural alterations in sperm formation of insects could be used as a promising biomonitoring and risk assessment tool for heavy metal soil pollution.

Resistance and Susceptibility to Mycobacterium Tuberculosis Infection and Disease in Tuberculosis Households in Kampala, Uganda

Abstract

Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), remains a major public health problem. Household contact studies identify children and adults along the spectrum from Mtb exposure to disease. In the Kawempe Community Health Study, conducted in Kampala, Uganda, 872 culture-confirmed pulmonary TB cases and their 2,585 contacts were enrolled between 2002–2012 and followed for up to 2 years each. Risk factors identified by time-to-event analysis for secondary TB differed among children, women and men. Younger age (P = 0.0061), HIV (P = 0.0002), thinness (P = 0.01), absent Bacille Calmette-Guérin vaccine (P = 0.002) and epidemiologic risk score (P < 0.0001) were risks for children. For women, risks were HIV (P < 0.0001), thinness (WHO criteria; P < 0.0001) and epidemiologic risk score (P = 0.003). For men, HIV (P = 0.0007) and low body mass index (P = 0.008) resulted in faster progression to TB. Tuberculin skin testing (TST) identified contacts with Mtb infection and those with persistently negative TST (PTST−). Risks for faster time to Mtb infection were identified, and included age (P = 0.0007), baseline TST induration (P < 0.0001), and epidemiologic risk score (P < 0.0001) only in children. PTST− comprised 10% of contacts but had no unique epidemiologic characteristics in adults. The burden of Mtb infection and disease is high in TB households, and risk factors for progression from exposure to infection and disease differ among children, women and men.

Performance of the Net Reclassification Improvement for Non-nested Models and a Novel Percentile-based Alternative

Abstract

The Net Reclassification Improvement (NRI) is a widely used metric used to assess the relative ability of two risk models to distinguish between low- and high-risk individuals. However, the validity and usefulness of the NRI have been questioned. Criticism of the NRI focuses on its use comparing nested risk models, whereas in practice it is often used to compare non-nested risk models derived from distinct data sources. In this study, we evaluated the performance of the NRI in a non-nested context by using it to compare competing cardiovascular risk prediction models. We explored the NRI's sensitivity to variations in risk categories and to the calibration of the compared models. We found that the NRI was very sensitive to changes in the definition of risk categories, especially when at least one model was mis-calibrated. To address these shortcomings, we describe a novel alternative to the usual NRI that uses percentiles of risk instead of cut-offs based on absolute risk. This percentile-based NRI demonstrates the relative ability of two models to rank patient risk. It displays more stable behavior, and we recommend its use when there are no established risk categories or when models are mis-calibrated.

Type 2 Diabetes and Risk of Incident Cancers in China: A Prospective Study among 0.5 Million Chinese Adults

Abstract

Using data from the China Kadoorie Biobank study, we conducted a prospective investigation on the association between type 2 diabetes mellitus (T2DM) and cancer risk in Chinese adults. A total of 508,892 participants (mean (standard deviation) age = 51.5 (10.7) years) without prior cancer diagnosis at baseline (2004–2008) were included. We documented 17,463 incident cancer cases during follow-up until December 31, 2013. Participants with T2DM had increased risks of total and certain site-specific cancers, and the hazard ratio (HR) was 1.13 (95% confidence interval (CI): 1.07, 1.19) for total cancer, 1.51 (1.29, 1.76) for liver cancer, 1.86 (1.43, 2.41) for pancreatic cancer, and 1.21 (1.01, 1.47) for female breast cancer. The associations were largely consistent when doctor-diagnosed and screen-detected T2DM were analyzed separately, except for colorectal cancer (HR = 0.91 (95% CI: 0.73, 1.13) for doctor-diagnosed T2DM, and HR = 1.44 (95% CI: 1.18, 1.77) for screen-detected T2DM). In participants without prior diagnosis of T2DM, higher random blood glucose levels were positively associated with risk of total cancer, liver cancer, and female breast cancer (all P for trend ≤0.02). In conclusion, T2DM is associated with an increased risk of new-onset cancer in China, particularly cancers of the liver, pancreas, and female breast.

Lichen planopilaris: A retrospective study of 32 cases in an Australian tertiary referral hair clinic

Abstract

Background/Objectives

Lichen planopilaris is a primary lymphocytic cicatricial alopecia. Management of patients with lichen planopilaris is difficult due to a paucity of high-quality data on its epidemiology and pathogenesis and the efficacy of therapies. The purpose of this study was to report the characteristics and treatment outcomes of patients with lichen planopilaris in a tertiary referral centre.

Methods

A retrospective review of medical records in patients with lichen planopilaris seen in the Hair Clinic at the Skin & Cancer Foundation Inc., Melbourne, from 2012 to 2016.

Results

Altogether 32 patients with lichen planopilaris (29 women) were included. The onset age ranged from 17 to 77 years with a mean age of 55.2 ± 13.5 years. Scalp pruritus (84%) and perifollicular erythema (72%) were the most common presenting symptoms and signs, respectively. Lichen planopilaris involved the frontal scalp in 66% of patients, the parietal in 56%, and vertex scalp in 50%. There were wide variations in treatment response.

Conclusion

Lichen planopilaris is characterised by a marked female predominance and clinically with pruritus, perifollicular erythema and perifollicular scale. The current range of treatments used produced mixed and often unsatisfactory results. Multicentre, prospective, randomised controlled trials are warranted to provide clearer data on efficacious treatment options.

Contents Vol. 30, 2017

Skin Pharmacol Physiol 2017;30:II-V

Acknowledgement to the Reviewers

Skin Pharmacol Physiol 2017;30:329-330

Food Patterns and Framingham Risk Score in Iranian Adults: Tehran Lipid and Glucose Study: 2005–2011

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

The good, the bad, and the ugly of environmental quality benchmarks: EQSPAE-2016 dedicated to Dr. Peter Michael Chapman (1951–2017)

Correction to: Molecular identification of Leishmania spp. isolates causes cutaneous leishmaniasis (CL) in Sanliurfa Province, Turkey, where CL is highly endemic

Abstract

In published article (Molecular Identification of Leishmania spp. Isolates Causes Cutaneous Leishmaniasis (CL) in Sanliurfa Province, Turkey, Where CL is Highly Endemic) Table 1 titled "The pH values of yogurts collected from villages in Turkey" doesn't belong to this article.

Effects of maharishi yoga asanas on mood states, happiness, and experiences during meditation

Sonja Gobec, Frederick Travis

International Journal of Yoga 2018 11(1):66-71

Context/Background: Many studies showed positive effects of Yoga Asanas. There is no study on Maharishi Yoga Asanas yet. This research replicated and expanded observed improvements on the profile of mood states (POMS) as a result of 2-week Maharishi Yoga Asanas course. Thirteen college students taking part in a 4-week course on Maharishi Yoga Asanas were matched with 13 students taking other courses at the university. Aims and Objective: The main objective of the study was to assess the effects of Maharishi Yoga Asanas on mood states, degree of happiness, and experiences in Transcendental Meditation (TM) practice. Methods: All students were given two psychological tests and additional question before and after their 4-week course: POMS, Meditation Depth Questionnaire, and question about the degree of happiness. Results: Repeated measure MANOVA showed the 4-week Maharishi Yoga Asanas course resulted in significant increase in happiness during the day and significant improvements in (1) sense of personal self, (2) transpersonal qualities, and (3) transpersonal self during their TM practice. Conclusion: This research shows that Maharishi Yoga Asanas affect more than body and mind. Rather they influence much deeper levels of one's subjectivity including one's transpersonal self.

Yoga into cancer care: A review of the evidence-based research

Ram P Agarwal, Adi Maroko-Afek

International Journal of Yoga 2018 11(1):3-29

To cope with cancer and its treatment-related side effects and toxicities, people are increasingly using complementary and alternative medicine (CAM). Consequently, integrative oncology, which combines conventional therapies and evidence-based CAM practices, is an emerging discipline in cancer care. The use of yoga as a CAM is proving to be beneficial and increasingly gaining popularity. An electronic database search (PubMed), through December 15, 2016, revealed 138 relevant clinical trials (single-armed, nonrandomized, and randomized controlled trials) on the use of yoga in cancer patients. A total of 10,660 cancer patients from 20 countries were recruited in these studies. Regardless of some methodological deficiencies, most of the studies reported that yoga improved the physical and psychological symptoms, quality of life, and markers of immunity of the patients, providing a strong support for yoga's integration into conventional cancer care. This review article presents the published clinical research on the prevalence of yoga's use in cancer patients so that oncologists, researchers, and the patients are aware of the evidence supporting the use of this relatively safe modality in cancer care.

Response to comment on “sleep quality and body composition variations in obese male adults after 14 weeks of yoga intervention: A randomized controlled trial” by Rshikesan et al., 2017

PB Rshikesan, Subramanya Pailoor, Deepeshwar Singh

International Journal of Yoga 2018 11(1):85-85

Exploration of lower frequency EEG dynamics and cortical alpha asymmetry in long-term rajyoga meditators

Kanishka Sharma, Sushil Chandra, Ashok Kumar Dubey

International Journal of Yoga 2018 11(1):30-36

Background: Rajyoga meditation is taught by Prajapita Brahmakumaris World Spiritual University (Brahmakumaris) and has been followed by more than one million followers across the globe. However, rare studies were conducted on physiological aspects of rajyoga meditation using electroencephalography (EEG). Band power and cortical asymmetry were not studied with Rajyoga meditators. Aims: This study aims to investigate the effect of regular meditation practice on EEG brain dynamics in low-frequency bands of long-term Rajyoga meditators. Settings and Design: Subjects were matched for age in both groups. Lower frequency EEG bands were analyzed in resting and during meditation. Materials and Methods: Twenty-one male long-term meditators (LTMs) and same number of controls were selected to participate in study as par inclusion criteria. Semi high-density EEG was recorded before and during meditation in LTM group and resting in control group. The main outcome of the study was spectral power of alpha and theta bands and cortical (hemispherical) asymmetry calculated using band power. Statistical Analysis: One-way ANOVA was performed to find the significant difference between EEG spectral properties of groups. Pearson's Chi-square test was used to find difference among demographics data. Results: Results reveal high-band power in alpha and theta spectra in meditators. Cortical asymmetry calculated through EEG power was also found to be high in frontal as well as parietal channels. However, no correlation was seen between the experience of meditation (years, hours) practice and EEG indices. Conclusion: Overall findings indicate contribution of smaller frequencies (alpha and theta) while maintaining meditative experience. This suggests a positive impact of meditation on frontal and parietal areas of brain, involved in the processes of regulation of selective and sustained attention as well as provide evidence about their involvement in emotion and cognitive processing.

Effectiveness of mindfulness-based cognitive therapy in patients with bipolar affective disorder: A case series

Suvarna Shirish Joshi, Mahendra Prakash Sharma, Shivarama Varambally

International Journal of Yoga 2018 11(1):77-82

The present investigation was undertaken to examine the effects of mindfulness-based cognitive therapy (MBCT) on interepisodic symptoms, emotional regulation, and quality of life in patients with bipolar affective disorder (BPAD) in remission. The sample for the study comprised a total of five patients with the diagnosis of BPAD in partial or complete remission. Each patient was screened to fit the inclusion and exclusion criteria and later assessed on the Beck Depressive Inventory I, Beck Anxiety Inventory, Difficulties in Emotion Regulation Scale, Acceptance and Action Questionnaire-II, and The World Health Organization Quality of Life Assessment-BREF. Following preassessments, patients underwent 8–10 weeks of MBCT. A single case design with pre- and post-intervention assessment was adopted to evaluate the changes. Improvement was observed in all five cases on the outcome variables. The details of the results are discussed in the context of the available literature. Implications, limitations, and ideas for future investigations are also discussed.

Yoga offers cardiovascular protection in early postmenopausal women

Sinha M Praveena, Gandhi Asha, Mondal Sunita, Jain Anju, Biswas Ratna

International Journal of Yoga 2018 11(1):37-43

Context: Postmenopause, an estrogen deficient state comes with increased incidence of cardiovascular diseases (CVDs). Yoga has been described as having a beneficial effect on heart rate variability (HRV), a marker for cardiac autonomic activity which can assess cardiovascular risk, in various populations. Aim: the aim of the study was to study the effect of 3-month long Yoga practice on HRV in early postmenopausal women. Settings and Design: A prospective longitudinal study of 67 women within 5 years of menopause between 45 and 60 years of age attending menopause clinic of Department of Gynaecology, Sucheta Kriplani Hospital fulfilling inclusion and exclusion criteria and consenting were enrolled for the study. Subjects and Methods: HRV of 37 cases (Yoga group) and 30 controls (non-Yoga group) was recorded pre and 3-month postintervention. Statistical Analysis Used: GraphPad Prism Version 5 software was used. Values are a mean and standard error of mean. Statistical significance was set up at P < 0.05. Results: In HRV, frequency domain analysis showed a significant fall in low frequency (LF) in normalized units (nu) and LF: high frequency (HF) ratio and significant rise in HF in nu in the Yoga group (depicting parasympathetic dominance) against a significant rise in LF (nu) and LF: HF ratio and significant fall in HF (nu) in non-Yoga group (indicating sympathetic dominance). Time domain analysis showed a significant decrease in Standard Deviation of NN intervals in Non-Yoga group against nonsignificant changes in Yoga group indicating deterioration in parasympathetic activity in non-Yoga group. Conclusions: Three-month long Yoga practice improved HRV in early postmenopausal women significantly and has the potential to attenuate the CVD risk in postmenopausal women.

Cancer: Prevention and rehabilitation through yoga

HR Nagendra

International Journal of Yoga 2018 11(1):1-2

Yoga-based postoperative cardiac rehabilitation program for improving quality of life and stress levels: Fifth-year follow-up through a randomized controlled trial

Eraballi Amaravathi, Nagendra Hongasandra Ramarao, Nagarathna Raghuram, Balaram Pradhan

International Journal of Yoga 2018 11(1):44-52

Objectives: This study was aimed to assess the efficacy of yoga-based lifestyle program (YLSP) in improving quality of life (QOL) and stress levels in patients after 5 years of coronary artery bypass graft (CABG). Methodology: Three hundred patients posted for elective CABG in Narayana Hrudayalaya Super Speciality Hospital, Bengaluru, were randomized into two groups: YLSP and conventional lifestyle program (CLSP), and follow-up was done for 5 years. Intervention: In YLSP group, all practices of integrative approach of yoga therapy such as yama, niyama, asana, pranayama, and meditation were used as an add-on to conventional cardiac rehabilitation. The control group (CLSP) continued conventional cardiac rehabilitation only. Outcome Measures: World Health Organization (WHO)-QOL BREF Questionnaire, Perceived Stress Scale, Positive and Negative Affect Scale (PANAS), and Hospital Anxiety and Depression Scale (HADS) were assessed before surgery and at the end of the 5th year after CABG. As data were not normally distributed, Mann–Whitney U-test was used for between-group comparisons and Wilcoxon's signed-rank test was used for within-group comparisons. Results: At the end of 5 years, mental health (P = 0.05), perceived stress (P = 0.01), and negative affect (NA) (P = 0.05) have shown significant improvements. WHO-QOL BREF score has shown improvements in physical health (P = 0.046), environmental health (P = 0.04), perceived stress (P = 0.001), and NA (P = 0.02) in YLSP than CLSP. Positive affect has significantly improved in CLSP than YLSP. Other domains of WHO-QOL-BREF, PANAS, and HADS did not reveal any significant between-group differences. Conclusion: Addition of long-term YLSP to conventional cardiac rehabilitation brings better improvements in QOL and reduction in stress levels at the end of 5 years after CABG.

A comparative study on the effects of vintage nonpharmacological techniques in reducing myopia (Bates eye exercise therapy vs. Trataka Yoga Kriya)

Komal Krishna Tiwari, Rahul Shaik, B Aparna, Rajesh Brundavanam

International Journal of Yoga 2018 11(1):72-76

Background: Human eye captures light rays as they come and fall on the retina and convert them into an image. However, in myopia, light rays fall in front of retina, causing blurring of image. Correction of this is generally done using correcting devices such as corrective glasses and contact lenses. Existence of some alternative therapies is also noticed in literature. Aim: To compare the effects of Bates eye exercises and Trataka Yoga Kriya on myopia. Materials and Methodology: Ethical clearance was obtained from the institution, and informed consent was taken from participants. In this randomized comparative study, 24 participants (48 eyes) were taken based on inclusion and exclusion criteria and were randomly divided into two groups: Group A and Group B, where Bates eye exercise therapy and Trataka Yoga Kriya were given, respectively, for 8 weeks. Participants were assessed for their refractive errors and visual acuity pre- and post-intervention. Results: Data were analyzed by SPSS version 20. Results obtained revealed that both Bates exercises and Trataka Yoga Kriya were not significantly effective in reducing refractive errors and in improving visual acuity (P value of refractive error in right eye: 0.4250; left eye: 0.4596; P value of visual acuity in right eye: 0.5691; left eye: 0.8952). Conclusion: This study concludes that nonpharmacological approaches such as eye exercises and Trataka Yoga Kriya are not significant on myopia.

Effect of modified slow breathing exercise on perceived stress and basal cardiovascular parameters

G Sunil Naik, GS Gaur, GK Pal

International Journal of Yoga 2018 11(1):53-58

Context: Different types of breathing exercises have varied effects on cardiovascular parameters and the stress levels in an individual. Aim: The aim of this study was to assess the effect of a modified form of isolated alternate nostril, slow breathing exercise on perceived stress, and cardiovascular parameters in young, male volunteers. Settings and Design: This was a randomized control study carried out at Advanced Centre for Yoga Therapy Education and Research, Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry in 2014. Subjects and Methods: Hundred healthy male volunteers were randomized into control group, n = 50 and slow breathing group (study), n = 50. Slow breathing exercise training was given to study group for 30 min a day, 5 times/week for 12 weeks, under the supervision of certified yoga trainers. Perceived Stress Scale (PSS) using Cohen's questionnaire, anthropometric parameters such as body mass index (BMI), waist-hip ratio (WHR), and cardiovascular parameters such as heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded at baseline and after 12 weeks. The control group did not receive any intervention. Slow breathing exercise training was provided for the study group. During the study period, one volunteer opted out of the study group due to personal reasons. Results: HR, SBP, DBP, and PSS decreased significantly (P < 0.05) in the study group following 12 weeks slow breathing exercise training, while no significant change (P > 0.05) was observed in BMI and WHR. There was no significant change in the control group. Conclusion: Twelve weeks of modified slow breathing exercise reduced perceived stress and improved the cardiovascular parameters. The above results indicate that our modified slow breathing exercise is effective in reducing stress and improving the cardiovascular parameters.

The Conclusions Are Unsupported by the Data, Are Based on Invalid Analyses, Are Incorrect, and Should be Corrected: Letter Regarding “Sleep Quality and Body Composition Variations in Obese Male Adults after 14 weeks of Yoga Intervention: A Randomized Controlled Trial”

David B Allison

International Journal of Yoga 2018 11(1):83-84

Effects of multimodal mandala yoga on social and emotional skills for youth with autism spectrum disorder: An exploratory study

Lyn Gorbett Litchke, Ting Liu, Stephanie Castro

International Journal of Yoga 2018 11(1):59-65

Context: Youth with autism spectrum disorder (ASD) demonstrates impairment in the ability to socially and emotionally relate to others that can limit participation in groups, interaction with peers, and building successful life relationships. Aims: The aim of this exploratory study was to examine the effects of a novel multimodal Mandala yoga program on social and emotional skills for youth with ASD. Subjects and Methods: Five males with ASD attended 1 h yoga sessions, twice a week for 4 weeks. Multimodal Mandala yoga comprised 26 circular partner/group poses, color and tracing sheets, rhythmic chanting, yoga cards, and games. Treatment and Research Institute for ASD Social Skills Assessment (TSSA) scores were collected before and after the eight yoga sessions. The Modified Facial Mood Scale (MFMS) was used to observe mood changes before and after each yoga class. Paired sample t-tests were conducted on TSSA and MFMS scores to compare social and emotional differences post the 4-week camp. Narrative field notes were documented after each of the eight yoga sessions. Results: A significant improvement from pre- to post-test was found in overall TSSA (t(4) = −5.744, P = 0.005) and on respondent to initiation (t(4) = −3.726, P = 0.020), initiating interaction (t(4) = −8.5, P = 0.039), and affective understanding and perspective taking subscales (t(4) = −5.171 P = 0.007). Youth's MFMS scores increased from 80% to 100% at the end of eight yoga sessions demonstrating a pleasant or positive mood. Thematic analysis of the narrative notes identified three key factors associated with the yoga experience: (a) enhanced mood and emotional expression, (b) increased empathy toward others, and (c) improved teamwork skills. Conclusion: This multimodal Mandala yoga training has implication for developing positive social and emotional skills for youth with ASD.

The principles and practice of yoga in health care

Hemant Bhargav

International Journal of Yoga 2018 11(1):86-87

Comparative habitat use by takin in the Wanglang and Xiaohegou Nature Reserves

Abstract

We investigated the habitat use characteristics of takin in Wanglang and Xiaohegou Nature Reserves to detect whether takin has the different habitat use patterns in different environments. We found that takin has similarities and differences in habitat use in these two nature reserves. Takin at Wanglang usually used the habitats with greater bamboo coverage and bamboo density, whereas takin at Xiaohegou usually used the habitats with a lower canopy. The results of a logistic regression analysis showed that bamboo density, herb-cover proportion, and tree size contributed significantly to the difference between takin plots at Wanglang and Xiaohegou, with an overall correct prediction rate of 92.3%, indicating that these are the main factors discriminating habitat use characteristics of takin in these two nature reserves. Considering takin has different habitat use characteristics in different areas, different protection measures should be taken to protect different takin populations. Based on the habitat use characteristics of takin at Wanglang and Xiaohegou, we summarized adaptation of takin to environments as general adaptation, regional adaptation, and special adaptation.

Spatial variations and sources of trace elements in recent snow from glaciers at the Tibetan Plateau

Abstract

Trace elements (TEs) could pose a potential threat to the environment and human health and hence they have been paid attention increasingly at present. This study presents the acid-leached concentrations of TEs (e.g., Al, As, Ba, Co, Cr, Cs, Cu, Fe, Li, Mn, Mo, Pb, Rb, Sb, Sr, Ti, Tl, U, V) and dust content sampled from Qiumianleike (QMLK), Meikuang (MK), Yuzhufeng (YZF), Xiaodongkemadi (XDKMD), Gurenhekou (GRHK) glaciers on the Tibetan Plateau (TP) from April to May in 2013. A nonparametric Jonckheere-Terpstra Method was used to test the trend of spatial distribution of TEs. The statistical analysis indicates that TEs were the highest in the QMLK glacier, lowest in the YZF glacier, and comparable in the other three glaciers. Comparison with other glaciers of the plateau, the statistical analysis on As, Cu, Mo, Pb, and Sb shows that their concentrations had, in general, a decreasing distribution characteristic from the north to the south of TP, which indicates that the northern TP is loading more atmospheric-polluted impurity than central and southern TP. Enrichment factor (EF) analysis indicates that Rb, V, U, Cr, Ba, Cs, Li, As, Co, Mn, Tl, Sr, and Cu originated mainly from crustal dust, while anthropogenic inputs such as nonferrous metals melting, coal combustion, and traffic emission made an important contribution to the Mo, Pb, and Sb. Evidences from air mass back trajectories show that TEs in the five studied glaciers might not only come from surrounding areas of glaciers but also might be long-range transported by atmosphere from the Central Asia and South Asia and deposited on these glaciers.

Health status of Pelophylax ridibundus (Amphibia: Ranidae) in a rice paddy ecosystem in Southern Bulgaria and its importance in assessing environmental state: haematological parameters

Abstract

Pollution effects on haematological parameters in Pelophylax ridibundus individuals were investigated; animals were collected from two sites in Southern Bulgaria: the Tsalapitsa rice fields (RF) and the Vacha river (reference site, RS). Blood analysis showed significant differences between the haematological parameters of RBC, WBC, Hb, packed cell volume (PCV) and frogs' leucogram from RF and those from RS. These findings provide information on long-term background pollution of the habitat (RF) under investigation. In our view, the erythropenia, leucopenia, hypоchromia, lower values of PCV, St-neutrophilia, Sg-neutropenia, basopenia, eosinophilia, monocytosis and lymphopenia that were found in Pelophylax ridibundus individuals inhabiting the Tsalapitsa rice fields were probably caused by the pesticides and fertilizers that enter the paddy cages during the rice production process. The present study proves the practical usefulness of haematological parameters of Pelophylax ridibundus individuals in bioindication analyses for environmental assessment of agroecosystems.

Wet nitrogen deposition across the urban-intensive agricultural–rural transect of a small urban area in southwest China

Abstract

Understanding of the spatial and temporal variation of the flux of atmospheric nitrogen (N) deposition is essential for assessment of its impact on ecosystems. However, little attention has been paid to the variability of N deposition across urban-intensive agricultural–rural transects. A continuous 2-year observational study (from January 2015 to December 2016) was conducted to determine wet N deposition across the urban-intensive agricultural–rural transect of a small urban area in southwest China. Significantly spatial and temporal variations were found in the research area. Along the urban-intensive agricultural–rural transect, the TN and NH₄⁺-N deposition first increased and then decreased, and the NO₃⁻-N and dissolved organic N (DON) deposition decreased continuously. Wet N deposition was mainly affected by the districts of agro-facilities, roads and build up lands. Wet NH₄⁺-N deposition had non-seasonal emission sources including industrial emissions and urban excretory wastes in urban districts and seasonal emission sources such as fertilizer and manure volatilization in the other districts. However, wet NO₃⁻-N deposition had seasonal emission sources such as industrial emissions and fireworks in urban district and non-seasonal emission sources such as transportation in the other districts. Deposition of DON was likely to have had similar sources to NO₃⁻-N deposition in rural district, and high-temperature-dependent sources in urban and intensive agricultural districts. Considering the annual wet TN deposition in the intensive agricultural district was about 11.1% of the annual N fertilizer input, N fertilizer rates of crops should be reduced in this region to avoid the excessive application, and the risk of N emissions to the environment.

Insights into the effect and interaction mechanism of bisphenol S on lipids hydrolysis in sludge through multi-spectra, thermodynamics, and molecule docking analysis

Abstract

As an alternative to bisphenol A, bisphenol S (BPS) is widely used in industrial production and daily life, which is then discharged into sewage treatment plants and accumulates in sludge. In this research, impact and interaction mechanism of BPS on lipids hydrolysis in sludge is studied from the respect of soluble organic matter and volatile organic fatty acids (VFAs). Multi-spectra, thermodynamics, molecule docking, and enzyme activity assay are applied to elucidate the effect mechanism of BPS on lipids hydrolysis. Results show that lipids hydrolysis is restrained due to the denaturation of lipase with BPS exposure. The interaction mechanism is involved in hydrophobic bond and hydrogen bond interaction in the activity region of lipase. This interaction not only results in an unfolding skeleton structure of lipase and a less hydrophobic microenvironment of tyrosine and tryptophan residues but also leads to fluorophore static quenching with the formation of lipase-BPS complex. The experimental results and the combined research methods not only contribute to the development of novel technique for sludge treatment containing micropollutant but also profit to clarify the interaction mechanism between other micropollutant and enzymes.

Proteolytic extracts of three Bromeliaceae species as eco-compatible tools for leather industry

Abstract

Most tanneries use high proportions of Na₂S and CaO during the dehairing step, resulting in effluents of high alkalinity and large amounts of suspended solid, besides the risk of liberating the toxic H₂S. Solid waste rich in protein is another environmental problem of tanneries. Enzymes are an interesting technological tool for industry due to their biodegradability, nontoxic nature, and nonpolluting effluent generation. In the leather industry, proteases have been chosen as a promising eco-friendly alternative to Na₂S/CaO dehairing. Extracts with high proteolytic activity have been obtained from fruits of Bromeliaceae species: Bromelia balansae Mez (Bb), Bromelia hieronymi Mez (Bh), and Pseudananas macrodontes (Morr.) Harms (Pm). In this work, Bb, Bh, and Pm have been studied for application in the leather industry, focusing in their dehairing properties. Enzymatic activities were measured against collagen, keratin, elastin, and epidermis while a dehairing assay was performed by employing cowhide. All extracts showed similar activity on collagen and epidermis, while Bh and Pm were the most active against keratin at the same caseinolytic unit (CU) values; Bh was the only extract active against elastin. Bb (1 CU/ml), Bh (1.5 CU/ml), and Pm (0.5 CU/ml) were able to depilate cowhide. Desirable characteristics of dehairing were observed for all extracts since hair pores did not show residual hair, grain surface was clean and intact, and collagen fiber bundles of dermis were not damaged. In conclusion, results here presented show that proteolytic extracts of Bromeliaceae species are promising eco-compatible tools for leather industry.

Sesquiterpenoids with antialgal activity against the common red tide microalgae from marine macroalga Porphyra yezoensis

Abstract

Previous studies showed that methanol extracts from Porphyra yezoensis significantly inhibited Karenia mikimitoi and Skeletonema costatum. Five sesquiterpenoids (1–5) were successfully isolated from this marine macroalga through a combination of silica gel column chromatography and repeated preparative thin-layer chromatography in this paper. Their structure was identified as gossonorol (1), 7,10-epoxy-ar-bisabol-11-ol (2), cyclonerodiol (3), cadinol, (4) and 4-cadinen-1-ol (5) on the basis of spectroscopic data. These sesquiterpenoids were isolated from Porphyra yezoensis for the first time, and cyclonerodiol (3) and cadinol (4) isolated from marine macroalgae for the first time. Further, a quantitative relationship between the inhibition of algal growth and the concentration of each antialgal sesquiterpenoid (gossonorol, 7,10-epoxy-ar-bisabol-11-ol and cyclonerodiol) was determined and important parameters, e.g., EC_50-96h for future practical HAB control are to be obtained. Results showed that three sesquiterpenoids (1–3) had selective antialgal activity against the growth of red tide microalgae (Amphidinium carterae, Heterosigma akashiwo, Karenia mikimitoi, Phaeocystis globosa, Prorocentrum donghaiense, and Skeletonema costatum). More than two test red tide microalgae were significantly inhibited by these three sesquiterpenoids (1–3). Their antialgal activity against red tide microalgae has not been previously reported. Furthermore, EC_50-96h of gossonorol (1) and 7,10-epoxy-ar-bisabol-11-ol (2) for specific test red microalgae were not only significantly less than 10 μg/mL, but also were smaller than/or very close to those of potassium dichromate. Gossonorol (1) and 7,10-epoxy-ar-bisabol-11-ol (2) possessed good application potential than potassium dichromate as a characteristic antialgal agent against the specific harmful red tide microalgae (Heterosigma akashiwo, Phaeocystis globosa, and Prorocentrum donghaiense) (or Heterosigma akashiwo and Karenia mikimitoi).

The Many Connections Between Autophagy and Kidney Disease

By Yoskaly Lazo-Fernandez, PhD

The first description of what is called today an autophagosome was given in a paper published in 1957. Its author employed electron microscopy to observe the neonatal features of mouse kidneys¹. Autophagosomes where then described as large round bodies found in the cytoplasm, primarily of proximal tubule epithelial cells, and consisting of an amorphous material containing concentrically lamellar structures and mitochondria. It was not by chance that these structures were found in kidney tubules, because autophagy plays an essential role in kidney function both in health and disease^2,3. This blog will briefly introduce the main pathophysiological areas of connection between autophagy and the kidneys. Future blogs will expand on these topics.

Autophagy is a protective mechanism that results in the degradation of dangerous protein aggregates, infectious agents, and defective organelles, which prevents inflammation, oxidative stress and apoptosis. Consequently, defects in autophagy in the kidneys, as well as in other organs, lead to cellular injury. Specific kidney conditions that have been associated with autophagy defects include acute kidney injury⁴, chronic kidney disease⁵, renal fibrosis⁶, glomerular disease⁷, renal autoimmune and inflammatory responses⁸, polycystic kidney disease⁹, diabetic nephropathy¹⁰ and metabolic acidosis¹¹.

In general, conditions that affect nutrient or oxygen levels in kidney cells will induce a strong protective autophagy response. For example, hypoxia is a dangerous condition particularly common in the kidneys and strongly correlated with both acute kidney injury and with end stage chronic kidney diseases. Ischemic insults induce apoptosis or necrosis in kidney epithelial cells, as well as kidney vasoconstriction, inflammation and fibrosis. Low oxygen levels cause dissociation of the key autophagy inhibitor mTORC1 from its target ULK1¹², independently from energy-signaling, thus allowing ULK1 to activate autophagy as a protective mechanism.

Immunohistochemistry: HIF-1 alpha Antibody (H1alpha67) [NB100-105] - Staining of HIF1 alpha in human kidney. Renal tubular epithelium showed moderate membranous, cytoplasmic and nuclear staining, and glomeruli showed faint to moderate nuclear staining.

The The other most common connection between autophagy and kidney diseases is the deregulation of nutrient-sensing signals, usually observed during aging and in diabetes- or obesity-mediated kidney changes. In these cases, prolonged high intracellular levels of glucose cause stimulation of mTORC1's activity leading to chronic inhibition of autophagy. Kidney injury then follows from the accumulation of the damage caused by reactive oxygen species (ROS) and protein aggregates, particularly of advanced glycation end products¹³.

Autophagy induction through the inhibition of mTORC1 signaling, both pharmacologically and by calorie restriction, has thus been reported as beneficial in numerous models of kidney disease^14–16. Other disease- and cell-specific autophagy related targets are being actively studied in the search of new therapies, offering new hope for the more than 15% of adults in the United States that suffer from kidney diseases.

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Yoskaly Lazo Fernandez, PhD
Emory University, Department of Medicine/Renal Division
Dr. Lazo-Fernandez is interested in understanding the dietary factors that contribute to the development of hypertension and other chronic diseases.

References

1. CLARK. Cellular differentiation in the kidneys of newborn mice studies with the electron microscope. The Journal of biophysical and biochemical cytology. 1957;3(3):349-362.
2. Lenoir, Tharaux, Huber. Autophagy in kidney disease and aging: lessons from rodent models. Kidney international. 2016;90(5):950-964. doi:10.1016/j.kint.2016.04.014.
3. Fougeray, Pallet. Mechanisms and biological functions of autophagy in diseased and ageing kidneys. Nature Reviews Nephrology. 2015;11(1):34-45. doi:10.1038/nrneph.2014.201.
4. Livingston, Dong. Autophagy in Acute Kidney Injury. Seminars in Nephrology. 2014;34(1):17-26. doi:10.1016/j.semnephrol.2013.11.004.
5. Liu, Shi, Zhuang. Autophagy in Chronic Kidney Diseases. Kidney Diseases. 2016;0(0):37-45. doi:10.1159/000444841.
6. Ding, Choi. Regulation of Autophagy by TGF-β: Emerging Role in Kidney Fibrosis. Seminars in Nephrology. 2014;34(1):62-71. doi:10.1016/j.semnephrol.2013.11.009.
7. Hartleben, Wanner, Huber. Autophagy in Glomerular Health and Disease. Seminars in Nephrology. 2014;34(1):42-52. doi:10.1016/j.semnephrol.2013.11.007.
8. Leventhal, He, Ross. Autophagy and Immune Response in Kidneys. Seminars in Nephrology. 2014;34(1):53-61. doi:10.1016/j.semnephrol.2013.11.008.
9. Ravichandran, Edelstein. Polycystic Kidney Disease: A Case of Suppressed Autophagy? Seminars in Nephrology. 2014;34(1):27-33. doi:10.1016/j.semnephrol.2013.11.005.
10. Kume, Yamahara, Yasuda, Maegawa, Koya. Autophagy: Emerging Therapeutic Target for Diabetic Nephropathy. Seminars in Nephrology. 2014;34(1):9-16. doi:10.1016/j.semnephrol.2013.11.003.
11. Namba, Takabatake, Kimura, Takahashi, Yamamoto, Matsuda, Kitamura, Niimura, Matsusaka, Iwatani, Matsui, Kaimori, Kioka, Isaka, Rakugi. Autophagic Clearance of Mitochondria in the Kidney Copes with Metabolic Acidosis. Journal of the American Society of Nephrology. 2014;25(10):2254-2266. doi:10.1681/asn.2013090986.
12. Alers, Löffler, Wesselborg, Stork. Role of AMPK-mTOR-Ulk1/2 in the Regulation of Autophagy: Cross Talk, Shortcuts, and Feedbacks. Molecular and Cellular Biology. 2012;32(1):2-11. doi:10.1128/mcb.06159-11.
13. Liu, Shen, Chen, Wu, Wang, Deng, Chen, Pan, Fu, Tao, Liang, Liu. Autophagy-Lysosome Pathway in Renal Tubular Epithelial Cells Is Disrupted by Advanced Glycation End Products in Diabetic Nephropathy. Journal of Biological Chemistry. 2015;290(33):20499-20510. doi:10.1074/jbc.m115.666354.
    
14. Satriano, Sharma. Autophagy and metabolic changes in obesity-related chronic kidney disease. Nephrology Dialysis Transplantation. 2013;28(suppl_4):iv29-iv36. doi:10.1093/ndt/gft229.
    
15. Inoki, Huber. Mammalian target of rapamycin signaling in the podocyte. Current Opinion in Nephrology and Hypertension. 2012;21(3):251. doi:10.1097/mnh.0b013e3283520f38.
    
16. Kitada, Takeda, Nagai, Ito, Kanasaki, Koya. Dietary Restriction Ameliorates Diabetic Nephropathy through Anti-Inflammatory Effects and Regulation of the Autophagy via Restoration of Sirt1 in Diabetic Wistar Fatty (fa/fa) Rats: A Model of Type 2 Diabetes. Experimental Diabetes Research. 2011;2011:908185. doi:10.1155/2011/908185.

 

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Septolobular Panniculitis in Disseminated Lyme Borreliosis

Abstract

Lyme disease classically evolves through clinical manifestations according to the stage of illness. Because many of the systemic symptoms are nonspecific, and because serology may yield false negative results, cutaneous findings merit even greater importance to diagnosis. The prototypical skin lesion, erythema migrans (EM), occurs early and is the only independently diagnostic clinical feature according to the guidelines of the Infectious Disease Society of America. EM itself has protean guises, being, at times, vesicular, indurated, necrotic, purpuric, solid, or targetoid, but it is not the sole Borrelia-associated skin lesion. Acrodermatitis chronica atrophicans and borrelial lymphocytoma cutis are other well-known skin manifestations. A rare cutaneous manifestation that is increasingly reported in Lyme patients is panniculitis, which develops after dissemination of the spirochete. We present such a case in a patient who was initially treated for cellulitis as well as neck and radicular leg pain, thereby expanding the cutaneous spectrum of Lyme disease.

Objective evaluation of nipple position after 336 breast reductions

.

Blastic plasmacytoid dendritic cell neoplasm with centrocyte-like morphology clinically simulating a melanocytic nevus

Abstract

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic malignancy originating from immature or resting plasmacytoid dendritic cells.(1) Since the most recently revised nomenclature by consensus in 2008 by the World Health Organization (WHO), 21 cases of BPDCN have been reported in the literature.

Dead-Survivors, the Living Dead, and Concepts of Death

Abstract

The author introduces and critically analyzes two recent, curious findings and their accompanying explanations regarding how the folk intuits the capabilities of the dead and those in a persistent vegetative state (PVS). The dead are intuited to survive death, whereas PVS patients are intuited as more dead than the dead. Current explanations of these curious findings rely on how the folk is said to conceive of death and the dead: either as the annihilation of the person (via the secular conception of death), or that person's continuation as a disembodied being (via folk dualism). The author argues that these two conceptions are incompatible and inconsistent with each other and the evidence. Contrariwise, the author argues that the folk intuition about dead-survivors and the living dead are more easily explained by appealing to cross-culturally established concepts: the folk biological concept of death the existential (metaphorical) concept of death, and the concept of social death.

Targeting the fibroblast growth factor receptor 2 in gastric cancer: promise or pitfall?

Ann Oncol 2017; 28: 1207–1216 (doi: 10.1093/annonc/mdx081)

A phase II study of temsirolimus added to low-dose weekly carboplatin and paclitaxel for patients with recurrent and/or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC)

Ann Oncol 2017; 28: 2533–2538 (doi: 10.1093/annonc/mdx346)

Incidence and management of diarrhea in patients with HER2-positive breast cancer treated with pertuzumab

Ann Oncol 2017; 28: 761–768 (doi: 10.1093/annonc/mdw695)

Phototherapie der entzündlichen Akne

Zusammenfassung

Verfahren der Phototherapie könnten sich als neue Ansätze der Aknebehandlung etablieren, die das Risiko bakterieller Resistenzen nicht steigern und bei günstigem Sicherheitsprofil potenziell wirksam sind. Nach aktuellen Studiendaten bewirkt die photodynamische Therapie eine Verringerung entzündlicher Läsionen und eine deutliche Verbesserung der Akne. Allerdings besteht keine Einigkeit über die optimale Durchführung im Rahmen der Aknebehandlung. Neben der topisch angewendeten photodynamischen Therapie wurden die Intense-pulsed-light-Methode (hochenergetische Lichtblitze), gepulste Farbstofflaser, Kaliumtitanylphosphatlaser, Infrarotdiodenlaser und polychromatische Lichtquellen (Rotlicht, Rot-blau-Licht) als alternative Verfahren eingeführt. Da gut konzipierte Studien zur Wirksamkeitsprüfung im Vergleich zu traditionellen Pharmakotherapien fehlen und die Methoden nicht standardisiert sind, sollten Verfahren wie Laser‑, Intense-pulsed-light- und photodynamische Therapie gegenwärtig nicht als Erstlinienbehandlung der entzündlichen Akne betrachtet werden.

Nachtdienst in der Hautklinik

308 nm-Excimerlaser

Zusammenfassung

Die 308 nm-Excimerlasertherapie von Hypopigmentierungen und Vitiligo ist der herkömmlichen UV-Therapie hinsichtlich Ergebnissen und Sicherheit meist überlegen. Sie ist insbesondere vorteilhaft, wenn Herde gezielt behandelt werden können, ohne die übrige Haut zu belasten. Es sind weniger Sitzungen mit geringerer kumulativer Dosierung nötig. Verschiedene Kombinationstherapien können das Resultat verbessern, Auswahlkriterien wie früher Behandlungsbeginn und häufigere Sitzungen mit geringeren Abständen erleichtern die Entscheidung, welche Patienten wie behandelt werden sollen und wie am meisten erreicht wird.

Signal attenuation maps for needle enhancement and localization in 2D ultrasound

Abstract

Purpose

We propose a novel framework for enhancement and localization of steeply inserted hand-held needles under in-plane 2D ultrasound guidance.

Methods

Depth-dependent attenuation and non-axial specular reflection hinder visibility of steeply inserted needles. Here, we model signal transmission maps representative of the attenuation probability within the image domain. The maps are employed in a contextual regularization framework to recover needle shaft and tip information. The needle tip is automatically localized by line-fitting along the local-phase-directed trajectory, followed by statistical optimization.

Results

The proposed method was tested on 300 ex vivo ultrasound scans collected during insertion of an epidural needle into freshly excised porcine and bovine tissue. A tip localization accuracy of \(0.55\pm 0.06\,\hbox {mm}\) was achieved.

Conclusion

The proposed method could be useful in challenging procedures where needle shaft and tip are inconspicuous. Improved needle localization results compared to previously proposed methods suggest that the proposed method is promising for further clinical evaluation.

Neighborhood Disadvantage and Neighborhood Affluence: Associations with Breastfeeding Practices in Urban Areas

Abstract

Objective To estimate the associations between neighborhood disadvantage and neighborhood affluence with breastfeeding practices at the time of hospital discharge, by race-ethnicity. Methods We geocoded and linked birth certificate data for 111,596 live births in New Jersey in 2006 to census tracts. We constructed indices of neighborhood disadvantage and neighborhood affluence and examined their associations with exclusive (EBF) and any breastfeeding in multilevel models, controlling for individual-level confounders. Results The associations of neighborhood disadvantage and affluence with breastfeeding practices differed by race-ethnicity. The odds of EBF decreased as neighborhood disadvantage increased for all but White women [Asian: Adjusted odds ratio (AOR) 0.82 (95% confidence interval (CI) 0.69–0.97); Black: AOR 0.77 (95% CI 0.70–0.86); Hispanic: AOR 0.78 (95% CI 0.70–0.86); White: AOR 0.99 (95% CI 0.91–1.08)]. The odds of EBF increased as neighborhood affluence increased for Hispanic [AOR 1.19 (95% CI 1.08–1.31)] and White [AOR 1.12 (95% CI 1.06–1.18)] women only. The odds of any breastfeeding decreased with increasing neighborhood disadvantage only for Hispanic women [AOR 0.85 (95% CI 0.79–0.92)], and increased for White women [AOR 1.16 (95% CI 1.07–1.26)]. The odds of any breastfeeding increased as neighborhood affluence increased for all except Hispanic women [Asian: AOR 1.31 (95% CI 1.13–1.51); Black: AOR 1.19 (95% CI 1.07–1.32); Hispanic: AOR 1.08 (95% CI 0.99–1.18); White: AOR 1.30 (95% CI 1.24–1.38)]. Conclusions Race-ethnic differences in associations between neighborhood disadvantage and affluence and breastfeeding practices at the time of hospital discharge indicate the need for specialized support to improve access to services.

Determination of point of zero charge of natural organic materials

Abstract

This study evaluates different methods to determine points of zero charge (PZCs) on five organic materials, namely maple sawdust, wood ash, peat moss, compost, and brown algae, used for the passive treatment of contaminated neutral drainage effluents. The PZC provides important information about metal sorption mechanisms. Three methods were used: (1) the salt addition method, measuring the PZC; (2) the zeta potential method, measuring the isoelectric point (IEP); (3) the ion adsorption method, measuring the point of zero net charge (PZNC). Natural kaolinite and synthetic goethite were also tested with both the salt addition and the ion adsorption methods in order to validate experimental protocols. Results obtained from the salt addition method in 0.05 M NaNO₃ were the following: 4.72 ± 0.06 (maple sawdust), 9.50 ± 0.07 (wood ash), 3.42 ± 0.03 (peat moss), 7.68 ± 0.01 (green compost), and 6.06 ± 0.11 (brown algae). Both the ion adsorption and the zeta potential methods failed to give points of zero charge for these substrates. The PZC of kaolinite (3.01 ± 0.03) was similar to the PZNC (2.9–3.4) and fell within the range of values reported in the literature (2.7–4.1). As for the goethite, the PZC (10.9 ± 0.05) was slightly higher than the PZNC (9.0–9.4). The salt addition method has been found appropriate and convenient to determine the PZC of natural organic substrates.

A novel succinate dehydrogenase subunit B germline variant associated with head and neck paraganglioma in a Dutch kindred: a family based study

Abstract

Objective

In the Netherlands, the majority of hereditary head and neck paragangliomas (HNPGL) are caused by germline variants in the succinate dehydrogenase genes (SDHD, SDHB, SDHAF2). Here, we evaluate a four-generation family linked to a novel SDHB gene variant with the manifestation of a HNPGL.

Design

a family based study.

Setting

The VU University Medical Center (VUmc) Amsterdam, a tertiary clinic for Otolaryngology and Head and Neck Surgery.

Participants and main outcome measures

The index patients presented with an embryonic rhabdomyosarcoma and a non-Hodgkin lymphoma. Array-based comparative genomic hybridization (aCGH) analysis and multiplex ligation-dependent probe amplification (MLPA) revealed a novel deletion of exon 1-3 in the SDHB gene, suspected to predispose to paraganglioma (PGL)/pheochromocytoma (PHEO) syndrome type 4. Subsequently, genetic counseling and DNA testing was offered to all family members at risk. Individuals that tested positive for this novel SDHB gene variant were counseled and additional clinical evaluation was offered for the identification of HNPGL and/or PHEO.

Results

The DNA of 18 family members was tested, resulting in the identification of 10 carriers of the exon 1-3 deletion in the SDHB gene. One carrier was diagnosed with a carotid body PGL and serum catecholamine excess, which was surgically excised. Negative SDHB immunostaining of the carotid body tumour confirmed that it was caused by the SDHB variant. The remaining 9 carriers showed no evidence of PGL/PHEO.

Conclusion

Deletion of exon 1-3 in the SDHB gene is a novel germline variant associated with the formation of hereditary HNPGL.

This article is protected by copyright. All rights reserved.

Clinical evaluation of a new laser-ablated titanium implant for bone-anchored hearing in 34 patients: 1 year experience

Abstract

In specific patient groups, i.e. children or patients with compromised bone quality, the incidence of implant loss of for bone conduction hearing implants is much higher; further implant optimization is, therefore, needed.

The new laser-ablated titanium implant for bone-anchored hearing implantation has an enlarged contact area for osseointegration compared to the standard implant, aiming to improve implant loss rates.

This retrospective multicenter study is the first to assess the performance of this implant in healthy adults 1 year after surgery.

With excellent survival rates, good soft tissue tolerability, and few complications, the implant is safe to use in healthy adults.

This article is protected by copyright. All rights reserved.

Erythema elevatum diutinum with pustule formation: An unusual finding

Parietal scalp is another affected area in female pattern hair loss: an analysis of hair density and hair diameter

Smartphone apps for skin cancer diagnosis: Implications for patients and practitioners

Abstract

A research team at Stanford recently reported that their deep convolutional neural network had learned to classify skin cancer with a level of competence equivalent to that of board-certified dermatologists. It is possible that in time, and using larger datasets, such software may surpass the average doctor in diagnostic ability, and that highly accurate technology may be available to both clinicians and patients via smartphones. This technology is poised to change the landscape of skin cancer diagnosis for both physicians and patients, but whether such changes are beneficial will depend on how they are regulated and implemented.

Giant tumour on the foot

Comparison of skin cancers in liver and renal transplant recipients: Results of a prospective study in an Australian tertiary referral centre

Abstract

Background/Objectives

Organ transplant recipients (OTR) have an increased risk of skin cancers compared with the general population.

Methods

A prospective study of renal (RTR) and liver transplant recipients (LTR) was conducted in a single New South Wales tertiary referral centre over 60 months. Initial and subsequent visit data were recorded in our transplant database. Only patients with a minimum of 11 months follow up were included.

Results

Altogether 142 RTR and 88 LTR were included in the analysis. Compared with RTR, the median age of liver transplant recipients was higher (64 vs 57 years), more men were patients (73 vs 60%) and there were higher rates of high-risk skin types (54 vs 33%) and heavy sun exposure (43 vs 30%). RTR developed 304 non-melanoma skin cancers (NMSC) with a squamous cell carcinoma:basal cell carcinoma ratio of 1.7:1. LTR developed 205 NMSC with a squamous cell carcinoma:basal cell carcinoma ratio of 1.6:1. The odds ratio of developing NMSC in LTR:RTR was 1.8:1 (95% CI: 1.02–3.11, P = 0.044) on univariate analysis but there was no difference on multivariate analysis. A previous history of NMSC, age, time from transplant from first visit, skin phenotype and previous sun exposure were significant risk factors for developing NMSC.

Conclusions

Liver transplant recipients are not at a lower risk of NMSC than RTR. Our study supports routine and regular post-transplant skin surveillance of all LTR, like other OTR.

Histiocitosis intralinfática, a propósito de 2 casos

Publication date: January–February 2018
Source:Actas Dermo-Sifiliográficas, Volume 109, Issue 1
Author(s): M.E. Gómez-Sánchez, J.M. Azaña-Defez, M.L. Martínez-Martínez, M.T. López-Villaescusa
La histiocitosis intralinfática es un proceso benigno caracterizado por placas eritematosas mal delimitadas, a veces reticuladas, otras con nódulos o vesículas en su interior. Su etiopatogenia parece estar relacionada con procesos inflamatorios crónicos en el área afectada, cirugía previa o con enfermedades sistémicas, sobre todo con la artritis reumatoide. Presentamos 2 nuevos casos, ambos asociados a cirugía articular del área afecta y enfermedad osteoarticular (osteocondromatosis sinovial primaria y artritis reumatoide). Esta entidad tiene un comportamiento crónico y no existe un tratamiento específico. En los 2 casos presentados se plantearon distintas opciones terapéuticas, mostrando uno de ellos una respuesta espectacular al tratamiento con pentoxifilina oral junto con tacrolimus tópico.Intralymphatic histiocytosis is a benign condition characterized by poorly defined erythematous plaques (sometimes forming a reticular pattern) as well as the presence of nodules and vesicles. Its etiology and pathogenesis appear to be related to chronic inflammation in the affected area, prior surgery, or systemic disease, particularly rheumatoid arthritis. We report on 2 new cases, both associated with joint surgery in the affected area and osteoarticular disease (primary synovial osteochondromatosis and rheumatoid arthritis). This is a chronic disease and there is no specific treatment. Different treatment options were chosen in the 2 cases described. A spectacular response to treatment with oral pentoxifylline and topical tacrolimus was observed in 1 of the patients.

Tumoración en cuero cabelludo de gran tamaño de larga evolución con adenopatías ipsilaterales

Publication date: January–February 2018
Source:Actas Dermo-Sifiliográficas, Volume 109, Issue 1
Author(s): A. Hermosa-Gelbard, C. Moreno García del Real, S. Vañó-Galván

Un tumor rosado, hiperplasia angiolinfoide con eosinofilia

Publication date: January–February 2018
Source:Actas Dermo-Sifiliográficas, Volume 109, Issue 1
Author(s): I. Pérez-López, A. Martínez-López, P. Aguayo-Carreras, M.J. Naranjo-Díaz

Glyphosate, a chelating agent—relevant for ecological risk assessment?

Abstract

Glyphosate-based herbicides (GBHs), consisting of glyphosate and formulants, are the most frequently applied herbicides worldwide. The declared active ingredient glyphosate does not only inhibit the EPSPS but is also a chelating agent that binds macro- and micronutrients, essential for many plant processes and pathogen resistance. GBH treatment may thus impede uptake and availability of macro- and micronutrients in plants. The present study investigated whether this characteristic of glyphosate could contribute to adverse effects of GBH application in the environment and to human health. According to the results, it has not been fully elucidated whether the chelating activity of glyphosate contributes to the toxic effects on plants and potentially on plant–microorganism interactions, e.g., nitrogen fixation of leguminous plants. It is also still open whether the chelating property of glyphosate is involved in the toxic effects on organisms other than plants, described in many papers. By changing the availability of essential as well as toxic metals that are bound to soil particles, the herbicide might also impact soil life, although the occurrence of natural chelators with considerably higher chelating potentials makes an additional impact of glyphosate for most metals less likely. Further research should elucidate the role of glyphosate (and GBH) as a chelator, in particular, as this is a non-specific property potentially affecting many organisms and processes. In the process of reevaluation of glyphosate its chelating activity has hardly been discussed.

Correlation Between Incisional Biopsy Histological Subtype and a Mohs Surgery Specimen for Nonmelanoma Skin Cancer

Publication date: January–February 2018
Source:Actas Dermo-Sifiliográficas (English Edition), Volume 109, Issue 1
Author(s): E.C. Cortés-Peralta, J. Ocampo-Candiani, O.T. Vázquez-Martínez, I.M. Gutiérrez-Villarreal, I. Miranda-Maldonado, V. Garza-Rodríguez
BackgroundHistological diagnosis of a clinically suspected nonmelanoma skin cancer (NMSC) is recommended before treatment. For NMSC, concordance between the histological subtype of the preoperative biopsy and the excision specimen of basal cell carcinoma (BCC) has been reported to range from 10% to 81%. No large study on the concordance between NMSC histology seen in a preoperative biopsy with the following tumour specimen from Mohs micrographic surgery (MMS) has been performed in a Latin American population.ObjectiveThe aim of this study was to analyse and compare the histological subtype of the incisional biopsies reviewed by the dermatopathologist with the histological subtype of the tumour specimen obtained during MMS interpreted by the dermatopathologist and the Mohs surgeon.MethodsA retrospective analysis of 320 NMSC was performed. The interobserver correlation was based on kappa values.ResultsThe mean weighted kappa value between the preoperative NMSC biopsy and intraoperative histological subtype of the tumour specimen from MMS analysed by the Mohs surgeon and the dermatopathologist was 0.22 and 0.24, respectively. The correlation in the histologic subtype of the intraoperative tumour specimen from MMS that was interpreted by the dermatopathologist and Mohs surgeon was 0.58.ConclusionsDermatologists need to be aware of the limited value of incisional biopsies to accurately diagnose the histological subtype of a NMSC. The concordance rate in the histological diagnosis of the tumour specimens that were obtained from MMS between the Mohs surgeon and the dermatopathologist is moderate. However, the correlation is low compared with incisional biopsy subtypes.

Reply To: The Possible Combined Action of Different Trigger Agents in Rosacea

Publication date: January–February 2018
Source:Actas Dermo-Sifiliográficas (English Edition), Volume 109, Issue 1
Author(s): Á. Hernández-Martín

Male breast cancer mimicking melanoma

Publication date: January–February 2018
Source:Actas Dermo-Sifiliográficas (English Edition), Volume 109, Issue 1
Author(s): T. Kueder Pajares, A.J. García Malinis, P. Manchado López

Prevalence of Actinic Keratosis in Different Regions of Spain: The EPIQA Study

Publication date: January–February 2018
Source:Actas Dermo-Sifiliográficas (English Edition), Volume 109, Issue 1
Author(s): C. Ferrándiz-Pulido, M. Lera-Imbuluzqueta, C. Ferrándiz, M.J. Plazas-Fernandez

The Possible Combined Action of Different Trigger Agents in Rosacea

Publication date: January–February 2018
Source:Actas Dermo-Sifiliográficas (English Edition), Volume 109, Issue 1
Author(s): G. Ciccarese, A. Parodi, A. Rebora, F. Drago

PET and MRI in gliomas: progress and perspectives

Stakeholders’ Perspectives on Postmastectomy Breast Reconstruction: Recognizing Ways to Improve Shared Decision Making

Background: Postmastectomy breast reconstruction (PMBR) is an elective, preference-sensitive decision made during a stressful, time-pressured period after a cancer diagnosis. Shared decision making (SDM) can improve decision quality about preference-sensitive choices. Stakeholders' perspectives on ways to support PMBR decision-making were explored. Methods: Forty semi-structured interviews with stakeholders (20 postmastectomy patients, 10 PMBR surgeons, 10 PMBR nurses) were conducted. Clinicians were recruited from diverse practices across the United States. Patients were recruited using purposive sampling with varying PMBR experiences, including no reconstruction. The interview guide was based on an implementation research framework. Themes were identified using grounded theory approach, based on frequency and emotive force conveyed. Results: Engagement in SDM was variable. Some patients wanted more information about PMBR from clinicians, particularly about risks. Some clinicians acknowledged highlighting benefits and downplaying risks. Many patients felt pressured to make a choice by their clinicians. Clinicians who successfully engaged patients through decisions often used outside resources to supplement conversations. Conclusions: Patient–clinician trust was critical to high-quality decisions, and many patients expressed decision regret when they were not engaged in PMBR discussions. Patients often perceived a race- or age-related bias in clinician information sharing. Interventions to support SDM may enhance decision quality and reduce decision regret about PMBR, ultimately improving patient-centered care for women with breast cancer.

Creation of Nepal’s First Skin Bank: Challenges and Outcomes

Background: In Nepal, burn trauma causes more than 55,000 injuries each year. Burn-related mortality is high in Nepal, in part due to lack of allograft, leading to high infection rates. To address this challenge, our collaboration between Kirtipur Hospital, America Nepal Medical Foundation, Stanford University, and ReSurge International established Nepal's first skin bank. Methods: We identified 3 major tasks to create a sustainable skin banking program: 1) identify and acquire the equipment and personnel needed to collect, process, store, and graft cadaveric skin for burn injuries; 2) develop safe donation protocols and documentation tools that remain feasible for low-resource settings; and 3) develop a long-term awareness program to educate the Nepali people on skin donation, a previously foreign concept. Results: Kirtipur Hospital acquired the necessary equipment and materials for the skin bank through a combination of local and international fundraising efforts. Existing U.S. skin banking protocols were adapted for the Nepali setting and piloted on potential patients, donors, and physicians. For the first time in the hospital's history, patients with > 40% total body surface area burns were successfully treated with extensive allografts. Conclusions: It is feasible to create a skin bank in a country with no tradition of allograft skin use. Long-term sustainability now depends on spreading awareness and education in the Kathmandu Valley to overcome religious and cultural barriers that have hindered donor recruitment. Our low-cost and high-impact skin bank provides a model to expand this system to other hospitals both within Nepal and beyond.

Effects of Autologous Fat and ASCs on Swine Hypertrophic Burn Scars: A Multimodal Quantitative Analysis

Background: Hypertrophic scar formation is unpredictable and poorly understood, afflicting both the pediatric and adult populations. Treatment methods with conservative and invasive approaches have low rates of compliance and high rates of morbidity. The purpose of this study was to test a reproducible scar model and investigate a new technique of scar modification through the use of adipose- derived progenitor stromal cells (ASCs). Methods: Twenty thermal deep-partial thickness contact burns were created on the dorsum of three 8-week-old domestic swine and allowed to mature for 10 weeks. Scars were then injected with 2 cc saline, expanded autologous ASCs, or 2 cc fresh lipoaspirate and sampled at 2 week intervals up to 10 weeks postinjection. Volumetric analysis with a 3-D scanner, mechanical elasticity testing through negative pressure transduction, and standardized photography evaluation with Image J was performed. RNA sequencing was performed on scar tissue samples, cultured cells, and fresh lipoaspirate to determine relevant gene transcription regulation. Immunohistochemistry was used to verify expression level changes within the scars. Results: Volumetric analysis demonstrates a reduction in average scar thickness at 6 weeks when injected with ASCs (−1.6 cc3) and autologous fat (−1.95 cc3) relative to controls (−0.121 cc3; P

Photodynamic Therapy Interventions in Facial Photodamage: A Systematic Review

Publication date: Available online 30 December 2017
Source:Actas Dermo-Sifiliográficas
Author(s): G. Sanclemente, V. Ruiz-Cañas, J.M. Miranda, A.P. Ferrín, P.A. Ramirez, G.N. Hernandez
IntroductionPhotodynamic therapy (PDT) involves the combination of a light source and a photosensitizing agent to induce tissue damage via the generation of singlet oxygen. Although topical PDT has been approved for other indications, its use in facial photodamage is uncertain.AimsTo assess the efficacy and safety of PDT in facial skin photoaging.MethodsAll randomized clinical trials (RCTs) evaluating the efficacy and safety of any form of topical PDT for the treatment of facial photodamage (dermatoheliosis) or photoaging in patients older than 18 years, were included. Photodynamic-therapy using any topical photosensitizing agent at any dose, and with any light-source, were considered. Comparators were chemical exfoliation, intense pulsed light (IPL), light emitting diodes (LED), dermabrasion or microdermabrasion, ablative or non-ablative lasers, injectables, surgery, placebo and/or no treatment.A systematic search in PubMed, Embase, Lilacs, Google Scholar and RCT's registry databases, was performed.ResultsSearch was conducted up to May 4th 2016. Four authors independently selected and assessed methodological quality of each RCT. According to inclusion criteria, twelve studies were included (6 aminolevulinate (ALA) trials and 6 methyl aminolevulinate (MAL) trials), but the majority of them had methodological constraints particularly in randomization description and patients/outcome assessors blindness.Discussion and conclusionsOverall results indicated that PDT either with ALA or with MAL was effective and safe for facial photodamage treatment, but high quality of evidence was found mainly for MAL studies.

Graphical abstract

Mice over-expressing placenta growth factor in the skin exhibit increased vascularization and vessel permeability independently of VEGF-A

Placenta growth factor (PlGF), a member of the vascular endothelial growth factor (VEGF) family, shows strong pro-angiogenic properties in adult pathological angiogenesis [1]. In the skin, where keratinocytes represent the major source of VEGF-A and PlGF, these two factors are contemporaneously induced [2,3]. VEGF-A is also expressed in macrophages, and at minimal levels in dermal fibroblasts and endothelial cells; PlGF is also expressed in endothelial cells, at higher levels than VEGF-A. PlGF binds to tyrosine kinase receptor VEGFR-1 (Flt-1), while VEGF-A also binds to VEGFR-2 (Flk-1), which mediates the strongest angiogenic response.

Virus and Antibody Dynamics in Travelers With Acute Zika Virus Infection

Abstract

Background

To improve our understanding of the natural history of Zika virus (ZIKV) infection in humans, we described the dynamics of ZIKV RNA shedding in different body fluids and antibody responses in patients with acute infection.

Methods

Twenty-nine adults with travel-associated infection and 1 case of sexual transmission were enrolled and followed up with weekly ZIKV RNA testing in blood, urine, saliva, and semen samples and antibody testing.

Results

ZIKV RNA was detected in plasma, urine, and saliva of 57%, 93.1%, and 69.2% of participants, with estimated median times to clearance of 11.5 days (interquartile range [IQR] 6–24 days), 24 days (IQR, 17–34), and 14 days (IQR, 8–31), respectively. In 2 pregnant women, ZIKV RNA persisted in blood until delivery of apparently healthy infants. ZIKV RNA was detected in semen of 5 of 10 tested men; median time to clearance was 25 days (IQR 14–29), and the longest time of shedding in semen was 370 days. In flavivirus-naive patients, the median times to detection of ZIKV nonstructural protein 1 (NS1)–specific immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies were estimated as 8 days (IQR, 5–15 days) and 17 days (IQR, 12–26 days), respectively. ZIKV NS1 IgM antibodies were undetectable in patients with previous dengue.

Conclusions

Prolonged viremia and ZIKV RNA shedding in urine, saliva, and semen occur frequently in patients with acute ZIKV infection. At the time of diagnosis, about half of patients are ZIKV IgM negative. ZIKV NS1 IgM antibodies remain undetectable in patients with previous dengue. Estimates of the times to viral clearance and seroconversion are useful to optimize diagnostic algorithms.

Evidence for Mother-to-Child Transmission of Zika Virus Through Breast Milk

Abstract

Zikavirus (ZIKV) is an emerging viral pathogen that continues to spread throughout different regions of the world. Herein we report a case that provides further evidence that ZIKV transmission can occur through breastfeeding by providing a detailed clinical, genomic, and virological case-based description.

Impact of Dengue Vaccination on Serological Diagnosis: Insights From Phase III Dengue Vaccine Efficacy Trials

Abstract

Background

We previously reported that vaccination with the tetravalent dengue vaccine (CYD-TDV; Dengvaxia) may bias the diagnosis of dengue based on immunoglobulin M (IgM) and immunoglobulin G (IgG) assessments.

Methods

We undertook a post hoc pooled analysis of febrile episodes that occurred during the active surveillance phase (the 25 months after the first study injection) of 2 pivotal phase III, placebo-controlled CYD-TDV efficacy studies that involved ≥31000 children aged 2–16 years across 10 countries in Asia and Latin America. Virologically confirmed dengue (VCD) episode was defined with a positive test for dengue nonstructural protein 1 antigen or dengue polymerase chain reaction. Probable dengue episode was serologically defined as (1) IgM-positive acute- or convalescent-phase sample, or (2) IgG-positive acute-phase sample and ≥4-fold IgG increase between acute- and convalescent-phase samples.

Results

There were 1284 VCD episodes (575 and 709 in the CYD-TDV and placebo groups, respectively) and 17673 other febrile episodes (11668 and 6005, respectively). Compared with VCD, the sensitivity and specificity of probable dengue definition were 93.1% and 77.2%, respectively. Overall positive and negative predictive values were 22.9% and 99.5%, respectively, reflecting the much lower probability of correctly confirming probable dengue in a population including a vaccinated cohort. Vaccination-induced bias toward false-positive diagnosis was more pronounced among individuals seronegative at baseline.

Conclusions

Caution will be required when interpreting IgM and IgG data obtained during routine surveillance in those vaccinated with CYD-TDV. There is an urgent need for new practical, dengue-specific diagnostic algorithms now that CYD-TDV is approved in a number of dengue-endemic countries.

Arbovirus Diagnostics: From Bad to Worse due to Expanding Dengue Virus Vaccination and Zika Virus Epidemics

dengueZikadiagnosticsserologyarbovirus

Improved survival and cure rates with concurrent treatment for MDR-TB/HIV co-infection in South Africa

Abstract

Background

The global epidemic of multidrug-resistant tuberculosis (MDR-TB) threatens gains in TB and HIV outcomes over the past two decades. Mortality in MDR-TB/HIV co-infection has historically been high, but most studies predated the availability of antiretroviral therapy (ART). We prospectively compared survival and treatment outcomes in MDR-TB/HIV co-infected patients on ART to those in patients with MDR-TB alone.

Methods

This prospective, observational study enrolled culture-confirmed MDR-TB patients, with and without HIV co-infection, in South Africa between 2011–2013. Participants received standardized MDR-TB and HIV regimens and were followed monthly for treatment response, adverse events, and adherence. The primary outcome was survival.

Results

Among 206 participants, 150 were HIV-infected, 131 (64%) were female, and the median age was 33 years (IQR 26-41). Of the 191 participants with a final MDR-TB outcome, 130 (73%) were cured or successfully completed treatment, which did not differ by HIV status (p=0.50). After two years, the median CD4 count was 386 cells/mm³ (IQR 219-510), an increase of 140 cells/mm³ from baseline (p=0.005), and 64% had an undetectable HIV viral load. HIV-infected and HIV-uninfected participants had high rates of survival (86% and 94%, respectively; p=0.34). The strongest risk factor for mortality was having a CD4 count ≤100 cells/mm³ (aHR 15.6, 95%CI 4.4-55.6).

Conclusions

Survival and treatment outcomes among MDR-TB/HIV individuals receiving concurrent ART were improved, approaching those of HIV-uninfected MDR-TB patients. The greatest risk of death was among HIV-infected individuals with CD4 counts ≤100 cells/mm³. These findings provide critical evidence to support concurrent treatment of MDR-TB and HIV.

Dolutegravir plus lamivudine maintain HIV-1 suppression through week 48 in a pilot randomized trial

Abstract

In this randomized pilot clinical trial, dolutegravir plus lamivudine was non-inferior to continuation of standard three-drug maintenance therapy in virologically-suppressed HIV-1 infected individuals. There was no emergence of drug resistance in the participant with virologic failure on dolutegravir plus lamivudine.