Retrospective study on the correlation between 18-fluorodeoxyglucose uptake in positron emission tomography-computer tomography and tumor volume, cytological activity as assessed with Ki-67 and GLUT-1 staining in 10 cases of Merkel cell carcinoma

Abstract

Merkel cell carcinoma (MCC) is a rare malignant neuro-endocrine tumor of the skin that shows aggressive behavior and has a high tendency for local recurrence and lymph node or distant metastasis.¹ Recently, some reports have stated that 18-fluorodeoxyglucose positron emission tomography-computer tomography (FDG PET-CT) is more useful than conventional CT.^{2, 3} However, the utility of FDG PET-CT for determining the proliferative or metabolic activity of MCC is unclear. In this study, we investigated the correlation between FDG uptake and proliferative of metabolic activity as revealed by PET-CT imaging with Ki-67 immunological staining or GLUT-1 immunological staining in 10 cases of MCC. In addition, we tested the correlation between FDG uptake and tumor volume.

This article is protected by copyright. All rights reserved.

Dissection of a circulating CD3+CD20+ T-cell subpopulation in patients with psoriasis

Summary

CD3⁺CD20⁺ T cells are a population of CD3⁺ T cells that express CD20 and identified in healthy donors and autoimmune diseases. However, the nature and role of these cells in patients with psoriasis remain unclear. Here, we aimed to investigate the level, phenotype, functional and clinical relevance of CD3⁺CD20⁺ T cells in the peripheral blood of patients with psoriasis. We found that a small subset of CD3⁺ T cells expressed CD20 molecule in the peripheral blood of patients with psoriasis, and their levels were similar to those in healthy donors. Circulating CD3⁺CD20⁺ T cells in patients with psoriasis were enriched in CD4⁺ cells and displayed an activated effector phenotype, for these cells contained less CD45RA⁺ naïve and CCR7⁺ cells with increased activity than those of CD3⁺ T cells lacking CD20. In addition, compared with healthy donors, circulating CD3⁺CD20⁺ T cells in patients with psoriasis produced more cytokines IL-17A, TNF-α and IL-21, but not IL-4 and IFN-γ. Furthermore, a significant positively correlation was found between the levels of IL-17A, TNF-α and IL-21-production CD3⁺CD20⁺ T cells with Psoriasis Area and Severity Index scores. Our findings suggest that CD3⁺CD20⁺ T cells may play a role in the pathogenesis of psoriasis. This article is protected by copyright. All rights reserved.

The CDK inhibitor Purvalanol A Induces Neutrophil Apoptosis and Increases the Turnover Rate of Mcl-1: Potential role of p38-MAPK in Regulation of Mcl-1 Turnover

Abstract

Human neutrophils are terminally-differentiated cells that do not replicate and yet express a number of enzymes, notably cell cycle-dependent kinases (CDKs) that are normally associated with control of DNA synthesis and cell cycle progression. In neutrophils, CDKs appear to function mostly to regulate apoptosis, although the mechanisms by which they regulate this process are largely unknown. Here we show that the CDK2 inhibitor, Purvalanol A induces a rapid decrease in Mcl-1 levels in human neutrophils and peripheral blood mononuclear cells (PBMCs), but only induces apoptosis in neutrophils which are dependent on expression on this protein for survival. This rapid decrease in cellular Mcl-1 protein levels was due to a Purvalanol A-induced decrease in stability, with the half-life of the protein decreasing from approximately 2h in control cells to just over 1h after addition of the CDK2 inhibitor: it also blocked the GM-CSF dependent stabilisation of Mcl-1. Purvanalol A blocked GM-CSF stimulated activation of Erk and STAT3, and stimulated an additive activation of Akt with GM-CSF. Purvalanol A alone stimulated a rapid and sustained activation of p38-MAPK and the pan p38-MAPK inhibitor, BIRB796 partly blocked the Purvalanol A-induced apoptosis and Mcl-1 loss. These novel effects Purvalanol A may result, at least in part, from blocking GM-CSF mediated Erk activation. In addition, we propose that Purvalanol A-induced activation of p38-MAPK is, at least in part, responsible for its rapid effects on Mcl-1 turnover and acceleration of neutrophil apoptosis. This article is protected by copyright. All rights reserved.

Measurement of Typhim Vi antibodies can be used to assess adaptive immunity in patients with immunodeficiency

ABSTRACT

Vaccine specific antibody responses are essential in the diagnosis of antibody deficiencies. Responses to Pneumovax II are used to assess the response to polysaccharide antigens but interpretation may be complicated. Typhim Vi®, a polysaccharide vaccine for Salmonella typhoid fever, maybe an additional option for assessing humoral responses in patients suspected of having an immunodeficiency. Here we report a UK multicentre study describing the analytical and clinical performance of a Typhi Vi IgG ELISA calibrated to an affinity purified Typhi Vi IgG preparation. Intra- and inter-assay imprecision were low and the assay was linear between 7.4-574 U/mL (Slope=0.99-1.00; R²>0.99). 71% of blood donors had undetectable Typhi Vi IgG antibody concentrations. Of those with antibody concentrations >7.4U/mL, the concentration range was 7.7-167 U/mL. In antibody deficient patients receiving antibody replacement therapy the median Typhi Vi IgG antibody concentrations were <25 U/mL. In vaccinated normal healthy volunteers, the median concentration post vaccination was 107 U/mL (range 31-542U/mL). 8/8 (100%) had post vaccination concentration increases of at least 3-fold and 6/8 (75%) of at least 10-fold. In an antibody deficient population (n=23), only 30% had post vaccination concentration increases of at least 3-fold and 10% of at least 10-fold. The antibody responses to Pneumovax II and Typhim Vi® correlated. We conclude that IgG responses to Typhim Vi® vaccination can be measured using the VaccZyme Salmonella typhi Vi IgG ELISA, and that measurement of these antibodies maybe a useful additional test to accompany Pneumovax II responses for the assessment of antibody deficiencies. This article is protected by copyright. All rights reserved.

Ok, thanks! A new mutualism between Chlamydomonas and Methylobacteria facilitates growth on amino acids and peptides

Abstract

Nitrogen is a key nutrient for land plants and phytoplankton in terrestrial and aquatic ecosystems. The model alga Chlamydomonas reinhardtii can grow efficiently on several inorganic nitrogen sources (e.g. ammonium, nitrate, nitrite) as well as many amino acids. In this study, we show that Chlamydomonas is unable to use proline, hydroxyproline, and peptides that contain these amino acids. However, we discovered that algal growth on these substrates is supported in association with Methylobacterium spp., and that a mutualistic carbon-nitrogen metabolic exchange between Chlamydomonas and Methylobacterium spp. is established. Specifically, the mineralization of these amino acids and peptides by Methylobacterium spp. produces ammonium that can be assimilated by Chlamydomonas, and CO₂ photosynthetically fixed by Chlamydomonas yields glycerol that can be assimilated by Methylobacterium. As Chlamydomonas is an algal ancestor to land plants and Methylobacterium is a plant growth-promoting bacterium (PGPB), this new model mutualism may facilitate insights into the ecology and evolution of plant-bacterial interactions and design principles of synthetic ecology.

The solute transport profile of two Aza-guanine transporters from the Honey bee pathogen Paenibacillus larvae

Abstract

Two nucleobase transporters encoded in the genome of the Honey bee bacterial pathogen Paenibacillus larvae belong to the azaguanine-like transporters and are referred to as PlAzg1 and PlAzg2. PlAzg1 & 2 display significant amino acid sequence similarity, share predicted secondary structures and functional sequence motifs with two Escherichia coli nucleobase cation symporter 2 (NCS2) members; adenine permease (EcAdeP) and guanine-hypoxanthine permease EcGhxP. However, similarity does not define function. Heterologous complementation and functional analysis using nucleobase transporter deficient Saccharomyces cerevisiae strains revealed that PlAzg1 transports, adenine, hypoxanthine, xanthine and uracil, while PlAzg2 transports adenine, guanine, hypoxanthine, xanthine, cytosine and uracil. Both PlAzg1 & 2 display high affinity for adenine with K_m of 2.95 ± 0.22 μM and 1.92 ± 0.22 μM, respectively. These broad nucleobase transport profiles are in stark contrast to the narrow transport range observed for EcAdeP (adenine) and EcGhxP (guanine and hypoxanthine). PlAzg1 & 2 are similar to eukaryotic Azg-like transporters in that they share a broad solute transport profile, particularly the fungal Aspergillus nidulans AzgA (that transports adenine, guanine and hypoxanthine) and plant AzgA transporters from Arabidopsis thaliana and Zea mays (that collectively move adenine, guanine, hypoxanthine, xanthine, cytosine and uracil).

Individual variation of natural D. melanogaster associated bacterial communities

Abstract

D. melanogaster has become an important model organism to study host-microbe interaction in the laboratory. However, the natural microbial communities that are associated with D. melanogaster have received less attention. Especially, information on inter-individual variation is still lacking because most studies so far have used pooled material from several flies. Here, we collected bacterial 16S rRNA gene community profiles from a set of 32 individuals from a single population. We simulated pools from the individual data (i) to assess how well the microbiome of a host population is represented by pools, and (ii) to compare variation of Drosophila microbiomes within and between populations. Taxon richness was increased in simulated pools, suggesting that pools paint a more comprehensive picture of the taxa associated with a host population. Furthermore, microbiome composition varied less between pools than between individuals, indicating that differences even out in pools. Variation in microbiome composition was larger between populations than between simulated pools from a single population, adding to the notion that there are population-specific effects on the Drosophila microbiome. Surprisingly, samples from individuals clustered into two groups, suggesting that there are yet unknown factors that affect the composition of natural fly-associated microbial communities and need further research.

Osmotolerance of Dekkera bruxellensis and the role of two Stl glycerol-proton symporters

Abstract

Dekkera bruxellensis is important for lambic beer fermentation, but is considered a spoilage yeast in wine fermentation. We compared two D. bruxellensis strains isolated from wine and found that they differ in some basic properties including osmotolerance. The genomes of both strains contain two highly similar copies of genes encoding putative glycerol-proton symporters from the STL family which are important for yeast osmotolerance. Cloning of the two DbSTL genes and their expression in suitable osmosensitive S. cerevisiae mutants revealed that both identified genes encode functional glycerol uptake systems, but only DbStl2 has the capacity to improve the osmotolerance of S. cerevisiae cells.

Frontal fibrosing alopecia after antiandrogen hormonal therapy in a male patient

Abstract

An 82-year-old man with a prostate adenocarcinoma, started eight years before a treatment with oral bicalutamide 50 mg daily and subcutaneous goserelin 10,8 mg each three months, an antiandrogen and a LHRH analogue, respectively. The rest of his past medical history was unremarkable. A few months after starting with the treatment, he began with recession of the frontotemporal hairline also with hypopigmentation and atrophy of the areas of alopecia and loss of axillary and pubic hair (Figure 1). He did not present any clinical signs or patterns of male androgenetic alopecia. He denied having any siblings or kindreds with a scarring alopecia and therefore a familial FFA was excluded. Laboratory test showed low levels of prostate specific antigen (0,024ɥg/L) and undetectable free serum testosterone levels (<0,1 nmol/L). A biopsy on the scalp revealed a lichenoid lymphocitic inflammatory infiltrate, important fibrosis with loss of elastic fibers and hair follicle destruction (Figure 2,3). The clinical and histopathological features were consistent with frontal fibrosing alopecia. He is still having this treatment in order to prevent the progression of the prostate adenocarcinoma.

This article is protected by copyright. All rights reserved.

A study of androgenic signs and disorders in Greek female patients with acne

Abstract

Acne represents an established cutaneous manifestation of hyperandrogenism (1). There are scarce studies of androgenic signs or disorders including polycystic ovary syndrome (PCOS), hirsutism, menstrual irregularities or androgenic alopecia, in patients with acne.

This article is protected by copyright. All rights reserved.

A systematic review of fluconazole resistance in clinical isolates of Cryptococcus species

Abstract

Fluconazole is the most commonly used antifungal agent for both the treatment of cryptococcal meningitis, and for prophylaxis against the disease. However, its prolonged use has the potential to exert selection pressure in favour of fluconazole-resistant strains. We evaluated the prevalence of fluconazole resistance of Cryptococcus spp. clinical isolates in 29 studies from 1988 to May 2017 included in EMBASE and MEDLINE databases. A total of 4,995 Cryptococcus isolates from 3,210 patients constituted this study; 248 (5.0%) of the isolates were from relapsed episodes of cryptococcosis were included in this analysis. Eleven (38%) of the studies used minimum inhibitory concentrations (MICs) breakpoints of ≥64 μg/mL to define fluconazole resistance, 6 (21%) used ≥32 μg/mL, 11 (38%) used ≥16 μg/mL, and 1 (3%) used ≤20 μg/mL. Overall, mean prevalence of fluconazole resistance was 12.1% (95% confidence interval (CI): 6.7% - 17.6%) for all isolates (n=4,995). Mean fluconazole resistance was 10.6% (95% CI: 5.5% - 15.6%) for the incident isolates (n=4,747), and 24.1% (95% CI: -3.1% - 51.2%) for the relapse isolates (n=248). Of the 4,995 isolates, 936 (18.7%) had MICs above the ecological cut-off value. Fluconazole resistance appears to be an issue in Cryptococcus isolates from patients with relapses. It is unclear whether relapses occur due to resistance or other factors. There is an urgent need to establish antifungal breakpoints for Cryptococcus spp.

This article is protected by copyright. All rights reserved.

Enlarging tumor of the lateral chest wall in a 14-year-old boy

Ulcerative telangiectasia on the face and back of a 6-year-old girl with elevated antinuclear antibodies

Biosimilars and patient care

Atypical fibroxanthoma with prominent CD8-positive lymphocytic infiltration and diffuse expression of epithelial membrane antigen

Assessment of the general quality of sunscreen products available in Palestine and method verification of the sun protection factor using Food and Drug Administration guidelines

Summary

Background

Sunlight exposure affects all skin types causing skin tanning, burns or even skin cancer. Sunscreens were invented to prevent these outcomes by scattering or absorbing the UV light.

Aims

This study aimed to verify the effectiveness of Mansur method in SPF measurement and to find out how much reliable the labeled sun protection factor (SPF) value for the products that are imported to Palestine knowing that they are considered as cosmetics and they don't undergo tests by the Ministry Of Health (MOH).

Materials

In this research, sun protection factor (SPF) was determined for 16 commercially available sunscreen products using Mansur equation which was also validated; moreover sunscreen classification, product phase determination and pH measurement were also done.

Results

Sun protection factor values were mostly 50, 43.75% of the analyzed samples were close to the labeled SPF, 31.25% were under the labeled value, and 25% SPF value above the labeled value. All samples exhibited a pH close to skin pH. 62% of them were found to be O/W. Cosmetic companies and importers should focus on pediatric sunscreens, since only 12.5% are pediatric sunscreens.

Conclusions

Ministry Of Health should ask prove about the quality of an SPF value of sunscreens for final registration of these products. More instructions should be available on the label regarding the proper use especially, if they are not water proof.

Chronology of regional lymph node metastases in cutaneous melanoma: a model based on mitotic rate

Abstract

Recently, the MSLT-II¹ and DeCOG² clinical trials have failed to demonstrate a benefit for the lymphadenectomy vs. observation in the setting of a patient with positive sentinel lymph node biopsy. Therefore, it is expected in the short term an increase in the patients with a more conservative management and obviously, more regional recurrences.

This article is protected by copyright. All rights reserved.

Sonochemical degradation of triclosan in water in a multifrequency reactor

Abstract

Degradation of triclosan (TCS) by multifrequency ultrasound (US) was studied at high and low frequencies. Frequency effect on initial degradation rates was analyzed, and an optimum frequency was found. Power density always has a positive effect on degradation rates over the whole equipment work range. A reaction mechanism similar to that proposed by Serpone resulted in a pseudo-linear model that fitted statistically better than the nonlinear model proposed by Okitsu. Pulsed US showed a positive effect on degradation rates; however, simultaneous analysis of the effect of power, frequency, pulse time, and silent time did not show a clear trend for degradation as a function of pulse US variables. According to these results and those for degradation in the presence of radical scavengers, it was concluded that US TCS degradation was taking place in the bubble/liquid interface. A toxicity test was conducted by Microtox®, showing a decrease in toxicity as TCS concentration decreased and increase in toxicity after total depletion of TCS. Eight possible degradation by-products were identified by GC-MS analysis, and a degradation pathway was proposed.

Topical Paromomycin for treating solitary mucosal leishmaniasis

Clinical features and management of schwannoma affecting the upper and lower lips

Abstract

Head and neck schwannomas comprise 25–40% of all schwannomas, with presentation on the lips as the rarest and most surgically complicated site for perioral tumors. A systematic literature review was conducted to include 21 cases of patients with schwannoma of the upper or lower lips. The majority of patients presented with a single, painless, well-encapsulated nodule on the upper or lower lips. The nodules were consistently slow-growing, with an average 29.3 months from symptom onset to clinical presentation. Most cases were complicated by profound cosmetic disfigurement as well as dysphagia, dysarthria, snoring, and/or sleep apnea. Overall, histological analysis was consistent with classic schwannoma, and all cases were treated via complete surgical excision, and for malignant tumors, additional therapy was utilized. All but four cases achieved full remission by final follow-up. Recurrence rate for benign lip schwannomas was 5.3%, which is remarkably different from the standard recurrence rate of 8–24% for benign peripheral schwannomas. Additionally, the proportion of malignant tumors was greater for lip schwannomas than other schwannomas. Lip schwannomas demonstrate different characteristics than schwannomas from other locations on the body, and these remarkable differences highlight significant implications for clinical practice. Complete excision is the primary mode of treatment with overall excellent postoperative prognosis and rare instances of recurrence. Given the rarity of this tumor, this review of available cases serves to comprehensively describe clinical presentation and surgical treatment approaches to upper and lower lip schwannomas.

Impact of climate change on dermatological conditions related to flooding: update from the International Society of Dermatology Climate Change Committee

Abstract

Climate change contributes to the increase in severity and frequency of flooding, which is the most frequent and deadly disaster worldwide. Flood-related damage can be very severe and include health effects. Among those health impacts, dermatological diseases are one of the most frequently encountered. Both infectious and noninfectious dermatological conditions are increasing after flooding. We searched PubMed using the search term climate change OR global warming OR rainfall OR flooding OR skin. Articles published in the English-language literature were included. We also searched the International Society of Dermatology website library on climate change for additional articles. There is an increased risk of trauma during the course of a natural disaster. The majority of post-tsunami wound infections were polymicrobial, but gram-negative bacteria were the leading causes. Infectious diseases with dermatological manifestations, such as impetigo, leptospirosis, measles, dengue fever, tinea corporis, malaria, and leishmaniasis, are important causes of morbidity among flood-afflicted individuals. Insect bites and stings, and parasite infestations such as scabies and cutaneous larva migrans are also frequently observed. Inflammatory conditions including irritant contact dermatitis are among the leading dermatological conditions. Dermatological conditions such as alopecia areata, vitiligo, psoriasis, and urticaria can be induced or exacerbated by psychological conditions post disaster. Prevention is essential in the management of skin diseases because of flooding. Avoiding exposure to contaminated environments, wearing protective devices, rapid provision of clean water and sanitation facilities, prompt vector controls, and education about disease risk and prevention are important.

Pathogenesis and treatment options for chemotherapy-induced alopecia: a systematic review

Abstract

Chemotherapy-induced alopecia (CIA) is one of the most troubling long-lasting side effects of cancer treatment. An estimated 65% of patients undergoing classic chemotherapy will experience hair loss, which is an extremely upsetting adverse event for many. CIA has been traditionally considered to be a diffuse, nonscarring alopecia; however, there are increasing reports of permanent hair loss post chemotherapy. Despite its large impact on patients, there are few proven treatments for CIA. Recent advancements in understanding the pathogenesis of hair loss are promising novel preventative and therapeutic strategies. Currently, scalp cooling during chemotherapy is the most effective preventive intervention with response rates ranging from 50 to 80%. To avoid patient morbidity, clinicians should be aware of the pathogenesis of CIA, characteristic patterns of hair loss associated with specific drug regimens, preventive measures that may be taken, and therapeutic options post chemotherapy. The following represents an updated systematic review of CIA, including characteristic clinical patterns, pathophysiology of the disease, therapeutic approaches, as well as a cost-effective analysis to assess the significance of this toxicity.

Incidence of diseases primarily affecting the skin by age group: population-based epidemiologic study in Olmsted County, Minnesota, and comparison with age-specific incidence rates worldwide

Abstract

Understanding the effects of age on the epidemiology of diseases primarily affecting the skin is important to the practice of dermatology, both for proper allocation of resources and for optimal patient-centered care. To fully appreciate the effect that age may have on the population-based calculations of incidence of diseases primarily affecting the skin in Olmsted County, Minnesota, and worldwide, we performed a review of all relevant Rochester Epidemiology Project–published data and compared them to similar reports in the worldwide English literature. Using the Rochester Epidemiology Project, population-based epidemiologic studies have been performed to estimate the incidence of specific skin diseases over the past 50 years. In older persons (>65 years), nonmelanoma skin cancer, lentigo maligna, herpes zoster, delusional infestation, venous stasis syndrome, venous ulcer, and burning mouth syndrome were more commonly diagnosed. In those younger than 65 years, atypical nevi, psoriatic arthritis, pityriasis rosea, herpes progenitalis, genital warts, alopecia areata, hidradenitis suppurativa, infantile hemangioma, Behçet's disease, and sarcoidosis (isolated cutaneous, with sarcoidosis-specific cutaneous lesions and with erythema nodosum) had a higher incidence. Many of the incidence rates by age group of diseases primarily affecting the skin derived from the Rochester Epidemiology Project were similar to those reported elsewhere.

Harlequin ichthyosis due to novel splice site mutation in the ABCA12 gene: postnatal to prenatal diagnosis

Abstract

Background

Harlequin ichthyosis (HI) is a severe genetic disorder caused by the mutation in the ABCA12 gene. Infants born with this condition have markedly thickened, hard stratum corneum skin all over the body.

Methods

A female child born with a thick white plate of skin with deep cracks all over the body was investigated for genes associated with congenital Ichthyosis by Next Generation sequencing. The variant relevant to the clinical indications was identified using Picard and GATK version 3.6. Variant's pathogenicity was predicted by "in silico" tools like Mutation Taster 2, Mutation Assessor and LRT. Bidirectional Sanger sequencing further validated the same variant detected in the proband and confirmed in the parental blood and CVS.

Results

A homozygous 5′ splice site variation that affects the position at 4 nucleotides downstream to the donor proximal splice site of intron 40 (c.5939+4A>G; ENST00000272895) of the ABCA12 gene was detected in the proband, and the parents were heterozygous for the same variant. This led to the confirmation of diagnosis of Harlequin ichthyosis in the proband. "In silico" prediction of the variant was found to be damaging by MutationTaster2. The CVS sample during subsequent pregnancy was confirmed to be heterozygous for the same variant.

Conclusions

The novel intronic mutation found in the proband confirmed the clinical diagnosis as a severe type of HI and has helped the family in providing precise genetic counseling for further prevention of the disease and carrier screening of other family members.

GAPO syndrome: a rare genodermatosis presenting with unique features

No difference in UVB-induced changes in antigen-presenting cells and in cytokines between subjects with and without loss-of-function mutations in FLG

Abstract

Ultraviolet B (UVB) irradiation-induced skin inflammation leads to epidermal depletion of Langerhans cells (LCs), which is followed by a rapid influx of monocytes.(1) Approximately 10% of Northern Europeans carry loss-of-function mutations in the filaggrin gene (FLG) which cause partial or complete lack of epidermal filaggrin and filaggrin metabolites.(2) Deficit of the filaggrin metabolite trans-urocanic acid has been shown to cause an increased keratinocyte photosensitivity to UVB irradiation in human skin models.(3)

This article is protected by copyright. All rights reserved.

A case of facial burn due to the misuse of garlic face mask for acne

A systematic review of pyoderma gangrenosum with pulmonmary involvement: clinical presentation, diagnosis, and management

Abstract

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis that often has extracutaneous manifestations, with lung involvement being the most common (1, 2). In this systematic review we have summarized the clinical presentation, predisposing factors, and treatment of PG patients with pulmonary involvement and compared them to classic neutrophilic disorders. Using the search terms "pulmonary, lung, respiratory, bronchi, or bronchopulmonary" AND "pyoderma gangrenosum" a systematic review was conducted using PubMed and Web of Science.

This article is protected by copyright. All rights reserved.

Basal cell carcinoma of the scrotum: an important but easily overlooked entity

Abstract

Basal cell carcinoma (BCC) is the most common skin cancer worldwide [1]. In Germany, 82/100.000 inhabitants are yearly diagnosed with BCC [2]. Since chronic exposure to UV-light is the major risk factor for the development of BCC, the tumor is rarely seen in non-sun-exposed anatomical sites such as the genital area [1]. So far, only a few case reports or small case series have been published about BCC in this location, the pathogenic mechanisms underlying the development of scrotal BCCs are unknown.

This article is protected by copyright. All rights reserved.

Progeria: case report and new drugs perspectives

Abstract

Hutchinson-Gilford progeria syndrome (HGPS) is one of the rarest human diseases, an autosomal dominant premature aging disorder ¹. Its incidence is 1-4 per 8 million newborns ². There are aging-associated symptoms, including lack of subcutaneous fat, hair loss, joint contractures, progressive cardiovascular disease resembling atherosclerosis, and death due to heart attacks and strokes in childhood.

This article is protected by copyright. All rights reserved.

A fifth subtype of Kaposi's sarcoma, classic Kaposi's sarcoma in men who have sex with men: a cohort study in Paris

Abstract

Background

Classic Kaposi's sarcoma (CKS) occurs predominantly among elderly men and is associated with KSHV (Kaposi's Sarcoma-Associated Herpesvirus). In low endemic countries, KSHV infects predominantly men having sex with men (MSM).

Objectives

To describe a cohort of classic Kaposi sarcoma in a low endemic area for KSHV, to highlight the features of CKS in MSM and identify prognostic factors.

Methods

Retrospective single-center study of CKS cases. We compared MSM to heterosexual patients. Then, we divided the patients into two subgroups, those requiring a systemic treatment and the others, and we performed univariate and multivariate analysis to determine aggressiveness of CKS.

Results

Between 2006 and 2015, seventy-four patients were included. Mean age at diagnosis was 68.9 years, sex ratio (M/F) was 6.4 and 28% were MSM; MSM patients were younger (p=0.02), less often originated from endemic areas (p<0.0001). KS was less severe (p=0.04), required more often a local treatment than a systemic one (p=0.03). On multivariate analysis, CD4 T cell count> 500/mm³ at baseline was associated with a reduced risk of severe evolution.

Conclusion

First CKS cohort in low endemic zone. We describe a fifth subtype of KS: KS in MSM. The CD4 T-cell count was found to correlate with prognosis.

This article is protected by copyright. All rights reserved.

Hypertrichosis of the pinnae in a patient using panitumumab

Abstract

Various subgroups of epidermal growth factor receptor inhibitors (EGFRIs) are increasingly being used in the treatment of several cancers. However, as a generalized class effect, they are frequently associated with a wide spectrum of dermatological adverse reactions affecting skin, hair and nail of varying severity.A 53-year-old male with metastatic rectal cancer receiving every two weeks infusions of panitumumab, a human monoclonal antibody targeting EGFR, presented with a generalized acneiform papulopustular eruption (Grade 3 according to the Common Terminology Criteria for Adverse Events version 4.03).

This article is protected by copyright. All rights reserved.

Reversed actinic damage in two children with xeroderma pigmentosum treated with topical imiquimod

Abstract

Xeroderma pigmentosum (XP) is a group of genetic diseases with high incidence of ultraviolet-related skin cancers that usually appear in childhood. Treatment options for skin cancer in XP include surgery, electrocoagulation, topical 5-fluorouracil or imiquimod 5% cream¹. Oral retinoids have been used for skin cancer prevention, alone or in combination with topical imiquimod, with good response².

This article is protected by copyright. All rights reserved.

Diagnostic approach to subcutaneous nodules in patients with neuroendocrine tumors treated with depot somatostatin analogs: a cross-sectional study

Abstract

Background

The presence of cutaneous nodules in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) receiving depot somatostatin analogs (SSAs) is a diagnostic challenge as differential diagnosis between injection site reactions and metastases is essential.

Objective

To characterize the clinical, radiological, cytological and histopathological features of subcutaneous nodules in patients with GEP-NETs treated with SSAs.

Materials and Methods

Retrospective, cross-sectional study of patients with GEP-NETs treated with SSAs in whom subcutaneous nodules were detected on routine abdominal CT scans. High resolution and color Doppler ultrasonography was performed. Those patients with inconclusive radiological studies went through fine-needle aspiration cytology (FNAC) and/or biopsy.

Results

Twelve patients (5 males, 7 females) were included (6 midgut carcinoid NETs, 6 pancreatic NETs). Three patients received intramuscular depot octreotide, 7 subcutaneous lanreotide, and 2 both treatments. CT scan findings were nonspecific. Sonography revealed a hyperechoic pattern in recent injections, and a hypoechoic pattern with a characteristic hyperechoic peripheral rim in long-term injections (more than 3 months after injection). On color Doppler sonography, nodules showed no signs of intralesional vascularity. Fine-needle aspiration cytology (FNAC) was performed in 5 patients, revealing a characteristic acellular proteinaceous material. Biopsy in 4 patients showed different reactional infiltrates around the acellular material.

Conclusions

High resolution and color Doppler ultrasonography may be very useful for the differential diagnosis of subcutaneous nodules in patients with GEP-NETs treated with SSAs. FNAC and a biopsy are useful tests for confirmation of the diagnosis in patients with inconclusive findings. We propose a management algorithm.

This article is protected by copyright. All rights reserved.

Atopic Dermatitis and Alcohol Use: A Meta-Analysis and Systematic Review

Abstract

While several maternal exposures have been associated with an increased risk of atopic dermatitis (AD) in offspring, the effect of alcohol use during pregnancy on the risk of AD in offspring is unclear. Furthermore, it is unclear whether adults with AD have an increased alcohol use, though other poor health behaviors have been associated with AD including smoking and physical inactivity as well as psychiatric disease. In this systematic review and meta-analysis, the association between alcohol use and AD were investigated in two ways: 1) whether alcohol use (drinkers versus abstainers) during pregnancy is associated with AD in offspring, and 2) whether AD is associated with increased alcohol use. The medical databases Pubmed, Embase and Web of Science were searched and data extraction was done by two independent reviewers. Eighteen studies were included in the qualitative analysis (comparing alcohol drinkers to abstainers) and 12 studies were included in the quantitative analysis. There was a positive association between alcohol use during pregnancy and development of AD in offspring (pooled odds ratio [OR] 1.16; 95% confidence interval [CI] 1.09-1.24). However, there was no consistent association between AD in adults and adolescents and alcohol use (pooled OR 1.06; 95% CI 0.92-1.23). There is a need for future well-designed prospective studies to firmly establish the association between alcohol use and AD.

This article is protected by copyright. All rights reserved.

Association of detoxification enzymes with butene-fipronil in larvae and adults of Drosophila melanogaster

Abstract

Insecticide resistance is a major challenge in successful insect pest control as the insects have the ability to develop resistance to various widely used insecticides. Butene-fipronil is a novel compound with high toxicity to insects and less toxicity to the non-target organisms. In the present study, the effect of butene-fipronil alone and in combination with three enzyme inhibitors, piperonyl butoxide (PBO), diethyl maleate (DEM), and triphenyl phosphate (TPP), was carried out on larvae and adults of Drosophilia melanogaster. Our results indicated that the co-toxicity indices of butene-fipronil + PBO, butene-fipronil + TPP, and butene-fipronil + DEM mixtures were 437.3, 335.0, and 210.3, respectively, in the second-instar larvae, while 186.6, 256.2, and 238.5, respectively, in the adults, indicating synergistic effects. Interestingly, butene-fipronil increased the expression of CYP28A5 in the larvae; CYP9F2, CYP304A1, CYP28A5, and CYP318A1 in the female adults; and CYP303A1 and CYP28A5 in the male adults. Furthermore, high-level expression of Est-7 was observed in the female adults compared to larvae and male adults. Our results suggest that there is no difference in butene-fipronil metabolism in larvae and male and female adults of D. melanogaster.

Optical clearing agent reduces scattering of light by the stratum corneum and modulates the physical properties of coenocytes via hydration

Abstract

Background

The interaction between light and the skin determine how the skin looks to the human eye. Light can be absorbed, scattered, and reflected by different components of the skin in a variety of different ways. Here, we focus on the scattering properties of the outmost layer, the stratum corneum (SC). However, we currently have limited methods with which to distinguish the scattering of light by SC from the changes due to other components of the skin.

Materials and methods

Dark-field images of tape-striped corneocytes were used in vitro to study the differences in light scattered by the SC and other skin components. Several optical clearing agents (OCAs) were tested for their ability to reduce light scattering. Physical properties of the SC (water content, keratin configuration, and volume) after OCA treatment were investigated using FT-IR, confocal Raman microscopy, and 3D laser microscopy.

Results

Urea derivatives, several reducing sugars, and sugar alcohols, which were used as OCA in optics and also used as humectants in cosmetic area, could reduce scattering. However, unlike dehydration in optics, penetration of water into the keratin was increased at low OCA concentrations. In such conditions, the volume of corneocytes was increased but their stiffness was reduced.

Conclusion

By analyzing the tape-striped SC, we were able to measure the changes in the optical and physical properties of corneocytes in response to OCAs. Hydration of the SC layer by OCAs reduces light scattering from the corneocytes and would be helpful in moisturizing the skin and helping the skin look healthy.

Handheld 3-dimensional wound measuring system

Abstract

Background

Measuring wound dimensions is important for monitoring and predicting the healing process. In our paper we propose and validate a handheld measuring system with dedicated software for measuring wound dimensions.

Methods

The measuring system comprises a commercial DSLR camera and a light pattern projection system. It is based on triangulation and structured illumination principles which enable handheld measuring. An edge of the wound is detected from the colour information of the measurement. Across the area of the wound, virtual healthy skin is approximated which enables the calculation of the wound volume and area, in addition to the wound circumference, which is calculated from the detected edge.

Results

In vitro verification using virtual standards showed that the accuracy of the analysis software is over 95% and 93% for measuring the area and volume respectively. A significant part of the error can be attributed to the inability of approximation to replicate entirely missing features. The accuracy of measuring the volume reduced to about 89% when a 3D measuring step was included in the analysis. When measuring in vivo wounds, the unrepeatability of the system was under 8% for measuring the area, which is a bit lower than comparable systems, and 5% for measuring the volume, which is about 4 times lower.

Conclusion

Based on these results and the ease of use, we conclude that the system is suitable to be used in daily clinical practice for measuring wound dimensions.

Effects of malathion and nitrate exposure on the zooplankton community in experimental mesocosms

Abstract

Surface waters are likely to be contaminated by both pesticides and fertilizers. Such contamination can result in changes in community composition if there is differential toxicity to individual taxa. We conducted a fully factorial mesocosm experiment that examined the single and interactive effects of environmentally realistic concentrations of nitrate and malathion on zooplankton communities and phytoplankton productivity. Malathion significantly decreased the abundance of total zooplankton, cyclopoid copepods, copepod nauplii, and Ceriodaphnia, and increased the abundance of rotifers. Nitrate addition generally had no effect on zooplankton; however, Ceriodaphnia abundance was higher in control mesocosms than in nitrate-treated mesocosms. There was only one significant interaction between malathion and nitrate treatments: For Ceriodaphnia, the no malathion, no nitrate mesocosms had much higher abundances than all other combinations of treatments. Without nitrate addition, chl a levels were uniformly low across all malathion treatments, whereas in the presence of nitrate, there were differences among the malathion treatments. In conclusion, our results demonstrate that malathion contamination of aquatic ecosystems can result in changes in the abundance and composition of zooplankton communities. In contrast, nitrate contamination appeared to have much less potential impact on zooplankton communities, either on its own or in interaction with malathion. Our results reinforce the notion that the effects of contaminants on aquatic ecosystems can be complex and further research examining the single and interactive effects of chemical stressors is needed to more fully understand their effects.

Ecologically friendly ways to clean up oil spills in harbor water areas: crude oil and diesel sorption behavior of natural sorbents

Abstract

This work aimed to evaluate the sorption capacity of natural sorbents (wool, moss, straw, peat) and their composites during the sorption of crude oil and of diesel overspread on the water surface. The work presents the research results of the maximum sorption capacity of the sorbents/their composites using crude oil/diesel; the sorption capacity of the sorbents/their composites when crude oil/diesel is spilled on the water surface; and the research results of the unrealized part of the crude oil/diesel in the sorbents. The results of the analysis showed that all the sorbents and their composites have their selectivity to crude oil less than 50%. Also the results showed that the distribution of diesel and water in the sorbents and their composites is very different compared with the distribution of crude oil during the sorption analyses. In total, the diesel in the liquid mass absorbed by the straw and the peat amounted to 17 and 20%, respectively. This shows that these sorbents are much more selective for water but not for diesel. A larger part of the diesel was in the liquid amount absorbed by the composites—up to 33%. Accordingly, the use of these composites in watery environments is much more effective than the use of individual sorbents. The composition of sorbents in the composite enhanced both the hydrophobic and the oleophilic properties; as a result, a more effective removal of the diesel and oil from the water surface was achieved.

Pollution characteristics of surface runoff under different restoration types in manganese tailing wasteland

Abstract

A great deal of manganese and associated heavy metals (such as Ni, Cu, Zn, Cd, Pb, etc.) was produced in manganese mining, smelting, and other processes and weathering and leaching of waste slag, which entered rainwater runoff by different means under the action of rainfall runoff. It caused heavy metal pollution in water environment to surrounding areas, and then environmental and human health risks were becoming increasingly serious. In the Xiangtan manganese mine, we studied the characteristics of nutritional pollutants and heavy metals by using the method of bounded runoff plots on the manganese tailing wasteland after carrying out some site treatments using three different approaches, such as (1) exposed tailings, the control treatment (ET), (2) external-soil amelioration and colonization of Cynodon dactylon (Linn.) Pers. turf (EC), and (3) external-soil amelioration and seedling seeding propagation of Cynodon dactylon (Linn.) Pers. (ES). The research showed that the maximum runoff occurred in 20,140,712 rainfall events, and the basic law of runoff was EC area > ET area > ES area in the same rainfall event. The concentration of total suspended solids (TSS) and chemical oxygen demand (COD) of three ecological restoration areas adopted the following rule: ET area > EC area > ES area. Nitrogen (N) existed mainly in the form of water soluble while phosphorus (P) was particulate. The highest concentrations of total nitrogen (TN) and total phosphorus (TP) were 11.57 ± 2.99 mg/L in the EC area and 1.42 ± 0.56 mg/L in the ET area, respectively. Cr, Ni, Pb, Zn, Mn, and Cu in surface runoff from three restoration types all exceeded the class V level of the environmental quality standard for surface water except Cu in EC and ES areas. Pollution levels of heavy metals in surface runoff from three restoration areas are shown as follows: ET area > EC area > ES area. There was a significant positive correlation between TSS and runoff, COD, and TP. And this correlation was significant between total dissolved nitrogen (TDN), TN, total dissolved phosphorus (TDP), and TP. The six heavy metals (Cu, Ni, Pb, Zn, Mn, and Cr) in surface runoff of different ecological restoration areas were strongly related to each other, and were significantly related to the TSS.

Analysis of multi drug resistant tuberculosis (MDR-TB) financial protection policy: MDR-TB health insurance schemes, in Chhattisgarh state, India

There are significant financial barriers to access treatment for multi drug resistant tuberculosis (MDR-TB) in India. To address these challenges, Chhattisgarh state in India has established a MDR-TB financial...

Toward a Militant Pedagogy in the Name of Love: On Psychiatrization of Indifference, Neurobehaviorism and the Diagnosis of ADHD—A Philosophical Intervention

Abstract

(Neuro)psychiatric diagnoses such as attention deficit hyperactivity disorder (ADHD) is a rapidly growing and globally increasing phenomenon, not least in different educational contexts such as in family and in school. Children and youths labelled as ADHD are challenging normative claims in terms of nurturing and education, whereas those labelled as ADHD are considered a (future) risk for society to handle. The dominant paradigm regarding ADHD is biomedical, where different levels of attention and activity-impulsivity are perceived as neurobiological dys/functions within the brain best managed by means of an individual diagnosis and instrumental pedagogy. The majority of those labelled as having ADHD encounter a dominant educational model in the form of what is referred to in this article as neurobehaviorism, which is based on onto-epistemological violence. As opposed to this act of violence against being—and against the psychiatrized subject—a less violent educational model is proposed, based on French philosopher Alain Badiou's ontological examination of being and his concept of love as a truth procedure. In terms of the latter, the focus is on the potential of the encounter as a 'Two scene of love'. Here, the encounter is a place where it is possible to create new truths and subjects, instead of taking the individual diagnosis as an axiom which only leads to individuals having fixed identities codified in a hierarchical order. This argument is drawn from the 'mathematical' formula 1 + 1 = ♥, which originates from an online forum for people who have come into contact with ADHD in one way or another.

Photodegradation of 2,4-dichlorophenol by supported Pd(X 2 ) catalyst (X = Cl, Br, N 3 ): a HOMO manipulating point of view

Abstract

Three different palladium(II) complexes with ligands containing nitrogenized aromatic rings were investigated theoretically as model to obtain the computational band gap energies. The results demonstrated promising possibility for designing palladium(II) complexes with photocatalytic properties at visible light irradiation. Deliberated products were synthesized via grafting on the silica-coated Fe₃O₄ magnetic nanoparticles (Fe₃O₄@SiO₂). Formation of complexes on the surface of Fe₃O₄@SiO₂, as insoluble and reusable photocatalysts, was proved by Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), thermogravimetric (TGA), X-ray photoelectron spectroscopy (XPS), vibrating sample magnetometer (VSM), transmission electron microscope (TEM), and scanning electron microscopy (SEM) analyses. The trend of the band gap energies of prepared structures was calculated via experimental and theoretical methods. The photocatalytic capability of these nanoparticles was investigated in degradation of 2,4-dichlorophenol by means of HPLC analysis. A tentative reaction mechanism for the formation of intermediates was proposed.

Graphical abstract

ᅟ

Air quality and acute myocardial infarction in adults during the 2016 Hangzhou G20 summit

Abstract

To fulfill its commitment to a successful Hangzhou G20 summit (4 to 5 September 2016), the Chinese government implemented a series of measures to improve the air quality in Hangzhou. We report findings on air quality and acute myocardial infarction (AMI) hospital admissions in adults during the Hangzhou G20 summit. Three study periods were defined. The first period was pre-G20 (28 July to 27 August: limited restrictions on industrial emissions). The second period was G20 (28 August to 6 September) when there were further restrictions on industrial emissions and increased transportation restrictions. The third period was post-G20 (7 September to 6 October) when restrictions were relaxed again. The mean number of AMI admissions per day was, respectively, 8.2 during G20, 13.3 during pre-G20, and 15.1 during post-G20. We used time-series Poisson regression models to estimate the relative risk (RR) for AMI associated with pollution levels. Our results suggest that the air quality improvement can reduce the number of hospital admissions for AMI.

Organic fertilizer application increases the soil respiration and net ecosystem carbon dioxide absorption of paddy fields under water-saving irrigation

Abstract

Quantifying carbon sequestration in paddy soil is necessary to understand the effect of agricultural practices on carbon cycles. The objective of this study was to assess the effect of organic fertilizer addition (MF) on the soil respiration and net ecosystem carbon dioxide (CO₂) absorption of paddy fields under water-saving irrigation (CI) in the Taihu Lake Region of China during the 2014 and 2015 rice-growing seasons. Compared with the traditional fertilizer and water management (FC), the joint regulation of CI and MF (CM) significantly increased the rice yields and irrigation water use efficiencies of paddy fields by 4.02~5.08 and 83.54~109.97% (p < 0.05). The effects of organic fertilizer addition on soil respiration and net ecosystem CO₂ absorption rates showed inter-annual differences. CM paddy fields showed a higher soil respiration and net CO₂ absorption rates during some periods of the rice growth stage in the first year and during most periods of the rice growth stage in the second year. These fields also had significantly higher total CO₂ emission through soil respiration (total R_soil) and total net CO₂ absorption compared with FC paddy fields (p < 0.05). The total R_soil and net ecosystem CO₂ absorption of CM paddy fields were 67.39~91.55 and 129.41~113.75 mol m⁻², which were 27.66~135.52 and 12.96~31.66% higher than those of FC paddy fields. The interaction between water and fertilizer management had significant effects on total net ecosystem CO₂ absorption. The frequent alternate wet–dry cycles of CI paddy fields increased the soil respiration and reduced the net CO₂ absorption. Organic fertilizer promoted the soil respiration of paddy soil but also increased its net CO₂ absorption and organic carbon content. Therefore, the joint regulation of water-saving irrigation and organic fertilizer is an effective measure for maintaining yield, increasing irrigation water use efficiency, mitigating CO₂ emission, and promoting paddy soil fertility.

Clinical value of 18FDG PET/CT in screening for distant metastases in head and neck squamous cell carcinoma

Abstract

Objectives

The detection of distant metastases is of major importance in management of head and neck squamous cell carcinoma patients.

Design

All patients underwent 18FDG PET/CT for the detection of distant metastases.

Setting

Retrospective single center study.

Participants

Head and neck squamous cell carcinoma patients with high risk factors for distant metastases.

Main outcome measures

Accuracy of 18FDG PET/CT for the detection of distant metastases using clinical development of distant metastases and a minimal follow-up of twelve months as reference standard. Comparison of overall survival between patients diagnosed with distant metastases during initial screening and patients diagnosed with distant metastases during follow-up.

Results

In 23 (12%) of the 190 patients 18FDG PET/CT detected distant metastases at screening. Sensitivity and negative predictive value were 46.2% (95% CI 32.6 – 59.7) and 82.6% (95% CI 76.8 – 88.5). No difference in median overall survival from the time of distant metastases detection was found between patients diagnosed with DM during work-up or during follow up.

Conclusions

In head and neck squamous cell carcinoma patients with high risk factors 18FDG PET/CT has a high negative predictive value for the detection of distant metastases and should be used in daily clinical practice, although the sensitivity is limited when long term follow-up is used as reference standard.

This article is protected by copyright. All rights reserved.

Correlation between septal body size and inferior turbinate hypertrophy on computed tomography scans in fifty patients: A radiological analysis

Abstract

The septal body contains expansile tissue that may behave in a similar manner to the inferior turbinate. It is situated in the nasal valve region and, like the inferior turbinate, can cause changes in the nasal cross-sectional area and resistance to airflow.

Septal body hypertrophy combined with inferior turbinate hypertrophy may result in changes to nasal cross-sectional area and resistance to airflow.

Septal body hypertrophy is likely to accompany inferior turbinate hypertrophy.

Septal body thickness demonstrated significant positive correlation with the widths of the anterior turbinate medial mucosa and middle turbinate lateral mucosa. Septal body length demonstrated significant correlation with the widths of the anterior turbinate lateral mucosa and posterior turbinate lateral mucosa.

Septal body hypertrophy is significantly associated with inferior turbinate hypertrophy and narrowed internal nasal valve area. These results indicate that clinicians should check for concomitant septal body hypertrophy in patients with inferior turbinate hypertrophy.

This article is protected by copyright. All rights reserved.

Applying the Ts of referred otalgia to a cohort of 226 patients

Abstract

Referred or secondary otalgia is the complaint of ear pain arising from pathology of non-otologic locations with which the ear shares common neural pathways. The pain can present in various degrees of intensity and characteristics while severity is not proportional to the seriousness of the underlying cause^1,2.

This article is protected by copyright. All rights reserved.

Superiorly Curved Scalp Incision for Implantation of Magnetic Transcutaneous Bone Conduction Devices: Multicentre Experience of 60 patients

Abstract

The authors describe the use of superiorly curved scalp Incision for Implantation of Magnetic Transcutaneous Bone Conduction Devices

They describe a new technical aspect to minimise numbness issues in a series of 60 patients from two tertiary referral centres.

An inferiorly-based flap design will help to preserve branches of the great auricular and lesser occipital nerves, which normally sacrificed with the original technique.

Superiorly curved scalp Incision will be suitable for subsequent retroauricular incision that is used in auricular reconstruction in microtia patients.

These easily reproducible technical modification comfortable be used safely for Implantation of Magnetic Transcutaneous Bone Conduction Devices, especially patients with auricular dysplasia where auricular reconstruction is planned

This article is protected by copyright. All rights reserved.

Intracranial suppurative complications of ear, nose and throat infections: a single-centre cohort study of 65 patients

Abstract

In the Picardie region of northern France, the prevalence of intracranial suppurative complications (particularly empyema) of ear, nose and throat infections seems to have increased over the last 10 to 15 years.

Three possible reasons for the increased incidence in this region are the inappropriate use of antibiotics, low socioeconomic status, and poor access to high-quality healthcare.

Intracranial complications affect both sexes and all ages.

If a patient suffering from sinusitis or (especially) otitis media complains of headache, the possible presence of an intracranial suppurative complication must be always be considered and should prompt immediate medical imaging (a cranial CT scan and MRI) for confirmation of the diagnosis.

Early diagnosis and multidisciplinary pharmacological and surgical management (focused on the intracranial complication) should enable complete recovery in more than three quarters of these cases

This article is protected by copyright. All rights reserved.

A Retrospective Case Series of 1773 patients

Abstract

A peritonsillar abscess (PTA) is a collection of pus between the pharyngeal musculature and palatine tonsil capsule. It is the most common deep space infection of the head and neck region and the most common indication for acute ORL hospital admission ¹. Causative microorganisms include Gram negative rods, Gram positive cocci and anaerobes ². Usual treatment is aspiration +/- incision and drainage of PTA, but there is practice variation based on geographical location ³.

This article is protected by copyright. All rights reserved.

Vascular Reconstruction in a Neonate after Iatrogenic Injury during Cardiac Catheterization

Summary: As technology and interventional techniques continue to evolve, both the volume and complexity of cardiac catheterizations will increase, leading to a rise in the number of complications. One of the most morbid complications of cardiac catheterization is vascular injury. We report the case of a 31-day-old, 3.0-kg infant with hypoplastic left heart syndrome who experienced a left common iliac artery disruption during cardiac catheterization resulting in a retroperitoneal hemorrhage. The extent of the vascular injury combined with the vessel caliber posed a technically challenging surgical scenario. Ultimately, the vascular supply to the left lower extremity was reconstructed by the plastic surgery team with a reverse autologous vein graft. To our knowledge, this multidisciplinary approach with the involvement of plastic surgery represents a unique case.

No Vertical Scar Breast Weight Transfer

Summary: Women desire beautiful breasts that are functional, pain free, and without foreign material. Vertical scars, insufficient elevation, inadequate upper pole fullness, nipple numbness, and loss of breast feeding are undesirable. Relieving pain attributed to enlarged breasts has required significant tissue removal. Software analysis of chest images, physical measurements, and desires are combined to generate a surgical blueprint. The breast is divided horizontally into two components preserving the neurovascular supply and major lactiferous ducts. The skin flap cephalad to the areola provides external coverage. The areola remains attached to a deepithelialized mound, which is rotated into a cone. Dermal straps originating from the base of the cone are looped through the pectoralis major muscle and the cone repeatedly. Weight transfer to the pectoralis major muscles eliminates pain in 54% and decreases pain in 38%. Incisions are concealed at the areola cutaneous junction and in the shadow of the breast. Upper pole fullness increased in 86% without implants or fat transfer. Nipple sensation was increased in 37% and unchanged in 44%. Overall results were excellent in 50% and good in 36%. Complications consisted of dog-ears, periareolar infection, and fat necrosis. No patient required a return to the operation room. Combing computer-aided design with plastic surgical principles creates beautiful, functional breasts without foreign material. Vertical scars are avoided, and weight transfer relieves pain.

Comprehensive circRNA expression profile and construction of circRNA-associated ceRNA network in fur skin

Abstract

Circular RNA (circRNA), a class of non-coding RNAs, is a new group of RNAs that are related to tumorigenesis. The role of circRNAs in various diseases has been already highlighted. However, the expression levels and functions of circRNAs related to the melanocytes in the skin are poorly understood. RNA sequence was performed to analyze the expression profiles of circRNAs in black fur skin and white fur skin during different differentiation stages and investigate the relevant metabolism mechanisms. Differentially expressed circRNAs were detected using empirical Bayes sequencing (EBSeq) and then verified through the quantitative real-time PCR method. The EQSeq analysis of circRNAs identified 11 downregulated and 32 upregulated circRNAs in the embryo of black fur skin and white fur skin, as well as 21 downregulated and 17 upregulated circRNA in the postnatal stage. A circRNA–microRNA (miRNA)– messenger RNA (mRNA) network was established to predict the circRNA targets. Gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were applied to enrich the mRNA data further. Results showed that the specific mRNAs mainly involved in the transcription- related GOs, especially GO:0042802, GO:0005080 and GO:0032403, demonstrate their specific actions in transcriptional regulation. In the circRNA–miRNA–mRNA network, the most enriched GO terms of the mRNAs were pigmentation, protein autophosphorylation, and protein complex. Therefore, the circRNA–miRNA–mRNA pathway may reveal novel mechanisms for pigmentation, and circRNAs may serve as candidates in pigmentation.

This article is protected by copyright. All rights reserved.

Practical Management of Toxicities Associated With Bosutinib in Patients With Philadelphia Chromosome–Positive Chronic Myeloid Leukemia

Abstract

Bosutinib (SKI-606) is an oral, dual Src/Abl tyrosine kinase inhibitor (TKI) approved for treatment of patients with Philadelphia chromosome–positive (Ph+) chronic myeloid leukemia (CML) that is resistant or intolerant to prior TKI therapy or for whom other TKIs are not appropriate choices. The objective of this review is to provide a longitudinal summary of toxicities that may arise during treatment with second-line or later bosutinib in patients with Ph+ chronic phase CML and to provide strategies for managing these toxicities. As bosutinib is not currently indicated for newly diagnosed CML, toxicities associated with first-line treatment are not reviewed. Recognition and optimal management of these toxicities can facilitate patient compliance and affect treatment outcomes.

Sox10 positive breast carcinoma metastatic to the skin

Abstract

Sox10 is a robust and sensitive immunostain for melanocytic neoplasia. The strong nuclear signal, the clean background, and the limited expression in normal cutaneous structures make it a highly useful marker in the histopathologic evaluation of skin tumors.

Antiaging efficacy of melatonin-based day and night creams: a randomized, split-face, assessor-blinded proof-of-concept trial

Profile of dupilumab and its potential in the treatment of inadequately controlled moderate-to-severe atopic dermatitis

3D imaging of cleared human skin biopsies using light-sheet microscopy: A new way to visualize in-depth skin structure

Abstract

Background

Human skin is composed of the superimposition of tissue layers of various thicknesses and components. Histological staining of skin sections is the benchmark approach to analyse the organization and integrity of human skin biopsies; however, this approach does not allow 3D tissue visualization. Alternatively, confocal or two-photon microscopy is an effective approach to perform fluorescent-based 3D imaging. However, owing to light scattering, these methods display limited light penetration in depth. The objectives of this study were therefore to combine optical clearing and light-sheet fluorescence microscopy (LSFM) to perform in-depth optical sectioning of 5 mm-thick human skin biopsies and generate 3D images of entire human skin biopsies.

Materials and Methods

A benzyl alcohol and benzyl benzoate solution was used to successfully optically clear entire formalin fixed human skin biopsies, making them transparent. In-depth optical sectioning was performed with LSFM on the basis of tissue-autofluorescence observations. 3D image analysis of optical sections generated with LSFM was performed by using the Amira^® software.

Results

This new approach allowed us to observe in situ the different layers and compartments of human skin, such as the stratum corneum, the dermis and epidermal appendages. With this approach, we easily performed 3D reconstruction to visualise an entire human skin biopsy. Finally, we demonstrated that this method is useful to visualise and quantify histological anomalies, such as epidermal hyperplasia.

Conclusion

The combination of optical clearing and LSFM has new applications in dermatology and dermatological research by allowing 3D visualization and analysis of whole human skin biopsies.

Comparison of two kinds of skin imaging analysis software: VISIA® from Canfield and IPP® from Media Cybernetics

Abstract

Background

Skin imaging analysis, acting as a supplement to noninvasive bioengineering devices, has been widely used in medical cosmetology and cosmetic product evaluation. The main aim of this study is to assess the differences and correlations in measuring skin spots, wrinkles, vascular features, porphyrin, and pore between two commercially available image analysis software.

Materials and Methods

Seventy healthy women were included in the study. Before taking pictures, the dermatologist evaluated subjects' skin conditions. Test sites included the forehead, cheek, and periorbital skin. A 2 × 2 cm cardboard was used to make a mark on the skin surface. Pictures were taken using VISIA^® under three kinds light conditions and analyzed using VISIA^® and IPP^® respectively.

Results

(1) Skin pore, red area, ultraviolet spot, brown spot, porphyrin, and wrinkle measured with VISIA^® were correlated with those measured with IPP^® (P < .01). (2) Spot, wrinkle, fine line, brown spot, and red area analyzed with VISIA^® were correlated with age on the forehead and periorbital skin (P < .05). L-value, Crow's feet, ultraviolet spot, brown spot, and red area analyzed with IPP^® were correlated with age on the periorbital skin (P < .05). (3) L-value, spot, wrinkle, fine line, porphyrin, red area, and pore analyzed with VISIA^® and IPP^® showed correlations with the subjective evaluation scores (P < .05).

Conclusions

VISIA^® and IPP^® showed acceptable correlation in measuring various skin conditions. VISIA^® showed a high sensibility when measured on the forehead skin. IPP^® is available as an alternative software program to evaluate skin features.

Changes in dermal structure and skin oxidative stress in overweight and obese Japanese males after weight loss: a longitudinal observation study

Abstract

Background/Purpose

Previous studies have reported decreased dermal echogenicity and increased skin oxidative stress in overweight males. However, it is unknown whether these skin parameters of overweight and obese people are similar to those of individuals exhibiting a normal body weight following weight loss. The purpose of this study was to (1) compare the changes in the dermal structure parameters and levels of skin oxidative stress before and after weight loss in overweight and obese people in Japan and (2) to clarify how these aspects changed when body weight would be reduced to normal body weight.

Methods

Male volunteers with a body mass index of ≥25 kg/m² were recruited. The dermal structure was visualized and dermal echogenicity and thickness were measured using ultrasound scanners. The mRNA expression level of heme oxygenase-1 in the hair follicles was quantitatively analyzed as a marker of skin oxidative stress.

Results

When overweight individuals in their 20s to 30s reduced their weight to normal, decreased dermal thickness in the abdominal region was observed in 50% of the subjects; however, no increase in dermal echogenicity was observed. A decrease in dermal thickness and an increase in dermal echogenicity in the thighs was observed in 83.3% of the subjects. No decrease in the level of dermal oxidative stress was observed.

Conclusion

The dermal structure in the thighs of overweight young individuals can be improved to the level of the structure in those of normal body weight individuals following weight loss.

Visible Light-Induced Radical Mediated DNA Damage

Abstract

Light-responsive compounds have been used to manipulate biological systems with spatial and temporal control of the event of interest. Illumination of alkylcobalamins with green light (500 – 570 nm) produces carbon-centered radicals, which have been demonstrated to effectively cause DNA damage. Molecules that cause DNA and RNA strand scission are useful for studying polynucleotide structure and the binding of small molecules and proteins to polynucleotides. Most molecules that cause DNA damage in a light-dependent manner require high energy, short wavelength ultraviolet light, which is readily absorbed by nucleotide bases causing damage to the polynucleotides. Therefore, using alkylcobalamins is advantageous for causing strand scission of polynucleotides, because they are activated by light wavelengths that are not absorbed by nucleotide bases. Green light illumination of methylcobalamin effectively causes DNA strand scission based on gel mobility assays. This cleavage is due to the generation of carbon-centered radicals based on the results of a radical trapping study. In addition, synthesis of an alkylcobalamin with a DNA binding moiety, spermine, improves DNA cleavage efficacy by an order of magnitude in comparison to methylcobalamin.

This article is protected by copyright. All rights reserved.

“I Fear for My Safety, but Want to Show Bravery for Others”: Violence and Discrimination Concerns Among Transgender and Gender-Nonconforming Individuals After the 2016 Presidential Election

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

Epidermotropic Presentation by Splenic B-cell Lymphoma: The Importance of Clinical-Pathologic Correlation

Abstract

There are exceedingly rare reports of patients with epidermotropic B-cell lymphomas. A subset presented with intermittent, variably pruritic papular eruptions and involvement of their spleens, peripheral blood, and bone marrow at the time of diagnosis. Furthermore, some experienced an indolent course despite dissemination of their lymphomas. We report a 66-year-old woman with a 12-year history of intermittent eruptions of nonpruritic salmon-colored papules on her torso and proximal extremities that occurred in winter and resolved with outdoor activity in spring. Skin biopsy revealed an epidermotropic B-cell lymphoma with a non-specific B-cell phenotype and heavy chain class switching with IgG expression. On workup, our patient exhibited mild splenomegaly and low-level involvement of her peripheral blood and bone marrow by a kappa-restricted B-cell population. A splenic B-cell lymphoma was diagnosed. Considering her longstanding history and absences of cytopenias, our patient has been followed without splenectomy or systemic therapy. Furthermore, the papules have responded dramatically to narrowband UVB. Our case and a review of similar rare reports aim to raise awareness among dermatopathologists and dermatologists of a clinically distinct and indolent subset of epidermotropic splenic lymphomas with characteristic clinical and histologic findings.

A quantitative comparison between SOX10 and MART-1 immunostaining to detect melanocytic hyperplasia in chronically sun-damaged skin

Abstract

Histologic differentiation of melanoma in situ (MIS) from solar keratosis on chronically sun-damaged skin is challenging. The first-line immunostain is usually MART-1/Melan-A, which can exaggerate the epidermal melanocytes, causing a diagnostic pitfall for MIS. By comparing MART-1 and SOX10 immunostaining, we scored the percentage of epidermal melanocytes per 2-mm diameter fields in pigmented actinic keratosis (n=16), lichenoid keratosis (n=7), junctional melanocytic nevus (n=6), keratosis with atypical melanocytic proliferation (AMP, n=17) and MIS (n=10). These cases represented an older population (68 years median age) and the head and neck (50%) was the most common anatomic site. MART-1 score was significantly higher than SOX10 (P value < 0.05) in solar keratoses, but showed no difference in detecting melanocytic proliferations, demonstrating their equal detection rate of melanocytes. The sensitivity of both MART-1 and SOX10 was 100% while their specificities were 17% and 96%, respectively. These results show SOX10 is more specific than MART-1 in distinguishing epidermal melanocytes on sun-damaged skin by avoiding over diagnosis of melanoma.

Cooking oil fume-derived PM 2.5 induces apoptosis in A549 cells and MAPK/NF-кB/STAT1 pathway activation

Abstract

Cooking oil fumes (COFs) are the major sources of indoor air pollution in Asia. It is well known that alveolar cells are key participants in the development of respiratory system; however, it still remains unknown whether alveolar cells are affected by COFs. Therefore, the present study investigated the effects of COFs on alveolar cells (A549 cells) and illuminated its apoptotic mechanism in response to COF-PM_2.5 exposure. When A549 cells were exposed to COF-PM_2.5, cell viability was substantially decreased, while the generation of ROS increased, and LDH levels and CCK-8 levels gradually changed within a dose-dependent manner. The nitrite concentration in the supernatants was augmented, while the SOD activity and GSH recycling were decreased upon COF-PM_2.5. Moreover, COF-PM_2.5 treatment increased mRNA levels of COX-2, inducible NO synthase, and TNF-α, and Elisa assay suggested that secretory proteins IL-6 and TNF-α were also increased. Furthermore, the Bax/Bcl-2 mRNA ratio was increased, and cleaved caspase-3 protein was activated in the A549 cells. Strikingly, COF-PM_2.5 induced the phosphorylation of STAT1 at Tyr701/Ser727 and activation of NF-кB and ERK1/2, p38, and JNK of the MAPK pathway. In short, our study suggested that COF-PM_2.5 resulted in inflammation, apoptosis, and cell damage in A549 cells, which might be modulated via the activation of MAPK/NF-кB/STAT1 pathway.

Protective effect of melatonin on cadmium-induced changes in some maturation and reproductive parameters of female Prussian carp ( Carassius gibelio B.)

Abstract

The aim of this study was to determine whether melatonin (Mel), which is a known antioxidant and free radical scavenger, could perform the role of a preventive agent against the toxic effects of cadmium (Cd²⁺) on mortality, fish growth, gonadosomatic index (GSI), luteinizing hormone (LH) secretion, the response to hormonal stimulation of spawning, and also tissue accumulation of Cd in Prussian carp females. These females received melatonin implants and were exposed to 0.4 or 4.0 mg/L of Cd (as CdCl₂·2.5H₂O) over either a 5- or 3-month period, followed by further 2 months of purification in clear water. Negative changes caused by exposure to cadmium in the water were as follows: higher fish mortality, lower body weight, increased accumulation of cadmium in the brain and ovary, lowered GSI, impaired spontaneous LH secretion during exposure, and impaired LH secretion during stimulation of spawning. All of these effects were observed in the group of fish exposed to 0.4 and/or 4.0 mg Cd/L but did not occur or were less pronounced in the groups exposed to cadmium in the presence of melatonin released from the implants. During depuration, in the group of fish which had been exposed to the highest Cd concentration, we observed a significant improvement in fish survival rate, body growth, inhibition of further cadmium accumulation in tissues, and gradual return of spontaneous LH secretion as well as normalization of the GSI value to the control group levels. In conclusion, these findings indicate that melatonin can be a preventive agent for some toxic effects on fish reproduction induced by environmental cadmium contamination.

Effects of dissolved organic matter leaching from macrophyte litter on black water events in shallow lakes

Abstract

In recent years, the black water phenomenon has become an environmental event in eutrophic shallow lakes in China, leading to deterioration of lake ecosystems and potable water crises. Decomposition of macrophyte debris has been verified as a key inducement for black water events. In this study, the effects of the decomposition of dissolved organic matter (Kottelat et al., WASP 187:343–351, 2008) derived from macrophyte leachate on the occurrence of black water events are investigated to clarify the detailed mechanisms involved. Results show that dissolved organic matter (DOM) is composed of a trace of chromophoric DOM and mostly non-chromophoric dissolved organic matter (CDOM). DOM decomposition is accompanied by varied concentration of CDOM components, generation of organic particles, and increased microbial concentrations. These processes increase water chroma only during initial 48 h, so the intensified water color cannot be maintained by DOM decomposition alone. During DOM decomposition, microorganisms first consume non-CDOM, increasing the relative CDOM concentration and turning the water color to black (or brown). Simultaneously, tryptophan and aromatic proteins, which are major ingredients of CDOM, enhance UV light absorption, further aggravating the macroscopic phenomenon of black color. Our results show that DOM leached from decayed macrophytes promotes or even triggers the occurrence of black water events and should be taken more seriously in the future.

Commentary on: “Comparison of the Effect of Dexamethasone and Tranexamic Acid, Separately or in Combination on Post-rhinoplasty and Edema and Ecchymosis”

Pressure pain thresholds over the cranio-cervical region in headache: a systematic review and meta-analysis

Sensitivity of tissues can be measured by algometry. Decreased pressure pain thresholds over the cranio-cervical area are supposed to reflect signs of sensitization of the trigemino-cervical nucleus caudalis. ...

Toxicity of aqueous mixture of phenol and chlorophenols upon photosensitized oxidation initiated by sunlight or vis-lamp

Abstract

It is well established that aquatic wildlife in marine and freshwater of the European Union is exposed to natural and synthetic endocrine disruptor compounds (EDCs) which are able to interfere with the hormonal system causing adverse effects on the intact physiology of organisms. The traditional wastewater treatment processes are inefficient on the removal of EDCs in low concentration. Moreover, not only the efficiency of treatment must be considered but also toxicological aspects. Taking into account all these aspects, the main goal of the study was to investigate the photochemical decomposition of hazardous phenolic compounds under simulated as well as natural sunlight from the toxicity point of view. The studies were focused on photodegradation of 2,4-dichlorophenol as well as mixture of phenol, 2-chlorophenol and 2,4-dichlorophenol. Photosensitized oxidation process was carried out in homogeneous and heterogeneous system. V. fischeri luminescence inhibition was used to determine the changes of toxicity in mixture during simulated and natural irradiation. The photodegradation was carried out in three kinds of water matrix; moreover, the influence of presence of inorganic matter on the treatment process was investigated. The experiments with natural sunlight proved applicability of photosensitive chitosan for visible-light water pollutant degradation. The results of toxicity investigation show that using photosensitive chitosan for visible-light, the toxicity of reaction mixture towards V. fischeri has significantly decreased. The EC₅₀ was found to increase over the irradiation time; this increase was not proportional to the transformation of the parent compounds.

Just War, Cyber War, and the Concept of Violence

Abstract

Recent debate on the relationship between cyber threats, on the one hand, and both strategy and ethics on the other focus on the extent to which 'cyber war' is possible, both as a conceptual question and an empirical one. Whether it can is an important question for just war theorists. From this perspective, it is necessary to evaluate cyber measures both as a means of responding to threats and as a possible just cause for using armed kinetic force. In this paper, I shift the focus away from 'war' as such in order to ask whether some cyber threats might justifiably be characterized as a form of 'violence.' Some theorists argue that the term violence ought to be defined so as to encompass things like 'structural' harm or harm by neglect and thereby question implicitly the focus of just war theorists on armed force. This paper draws on a theory of violence I developed elsewhere as a defence of just war theory's narrow understanding of violence. According to the 'Double-Intent' theory, a distinctive form of 'Violent Agency' is the factor uniting the category of violence while partly accounting for the peculiar moral connotations of the term. Here, I argue that the resulting definition of violence reshapes the category in a way that includes some forms of cyber-attack. This may help us to see where cyber might fit in relation to just war theory and the ethics of kinetic attack.

Rhizospheric effects on the microbial community of e-waste-contaminated soils using phospholipid fatty acid and isoprenoid glycerol dialkyl glycerol tetraether analyses

Abstract

We performed the study of rhizospheric effects on soil microbial community structure, including bacteria, fungi, actinomycete, and archaea, at an electronic waste (e-waste) recycling site by analyzing the phospholipid fatty acid (PLFA) and isoprenoid glycerol dialkyl glycerol tetraether (GDGT) contents. By comparing PLFA and isoprenoid GDGT profiles of rhizospheric and surrounding bulk soils of 11 crop species, we observed distinct microbial community structures. The total PLFA concentration was significantly higher in rhizospheric soils than in non-rhizospheric soils, whereas no obvious difference was found in the total isoprenoid GDGT concentrations. The microbial community structure was also different, with higher ratios of fungal-to-bacterial PLFAs (F/B) and lower relative abundance of Gram-positive bacteria in rhizospheric soils. The extent of rhizospheric effects varied among plant species, and Colocasia esculenta L. had the greatest positive effects on the total microbial biomass. Dissolved organic carbon and pH were the main environmental factors affecting the microbial community represented by PLFAs, while the archaeal community was influenced by copper and zinc in all soils. These results offer a comprehensive view of rhizospheric effects on microbes in heavy metal and persistent organic pollutant co-contaminated soil, and provide fundamental knowledge regarding microbial ecology in e-waste-contaminated soils.

Aktuelle medikamentöse Behandlung von Sarkomen

Zusammenfassung

Hintergrund

Der Part der Systemtherapie am Gesamtkonzept ist im Einzelfall im interdisziplinären Kontext zu eruieren. Beim lokal fortgeschrittenen Sarkom können verschiedene Therapieziele definiert werden, um einerseits bei Irresektabilität den Ansatz einer vollständigen Resektion zu erreichen, häufig in Kombination mit Strahlentherapie, oder um andererseits bei gegebener Operabilität die Fernmetastasierungsrate zu senken und die lokale Kontrolle zu verbessern. Dieser Ansatz trifft auch auf die postoperative Systemtherapie zu. Des Weiteren ist in der metastasierten Ausgangslage dieser Ansatz Standard.

Ziel, Material, Methoden

Die Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed mit den Suchwörtern „soft tissue sarcoma, GIST, locally advanced, metastatic, chemotherapy, targeted therapy, phase 2, phase 3".

Ergebnisse und Schlussfolgerungen

Für Patienten mit fortgeschrittenen Hochrisiko-Weichteilsarkomen im UICC-Stadium III (d. h. Größe >5 cm, tiefe Lokalisation, Grading > II nach FNCLCC [Fédération Nationale des Centres de Lutte Contre le Cancer]) können präoperative/neoadjuvante Therapieverfahren unter Einschluss von Anthrazyklinen und Ifosfamid (IFO) erwogen werden. Dies gilt also für alle High-grade-Sarkome, bei denen nicht zuverlässig ein ausreichender Sicherheitsabstand (>5–10 mm, Faszie) erreicht werden kann. Idealerweise sollte die Systemtherapie mit einer Radiatio kombiniert werden. Im neoadjuvanten Therapiekonzept ist eine höhere Dosisintensität erreichbar als postoperativ. Die komplette pathologische Response ist prognostisch bedeutsam. Die adjuvante Chemotherapie nach Resektion eines Sarkoms ist mit einer Verbesserung des erkrankungsfreien und des Gesamtüberlebens verbunden. Diese sollte nach detaillierter Aufklärung über die Risiken und unter Beachtung von Allgemeinzustand, Alter, Lokalisation, histologischem Subtyp, Organfunktion und Komorbidität auf Hochrisikopatienten begrenzt werden. In der palliativen Erstlinie bleibt eine Adriamycin(ADM)-basierte Therapie weiterhin Standard. Erstmals steht mit Olaratumab ein monoklonaler Antikörper in Kombination zur Verfügung („conditional approval"). Nachfolgende Linien werden entsprechend histologischem Subtyp, Allgemeinzustand und Organfunktion individuell adaptiert. Zugelassen ist bei refraktärer Erkrankung neben Pazopanib und Trabectedin nun auch Eribulin, begrenzt auf Liposarkome. Lokalisierte Hochrisiko-GIST (GIST gastrointestinale Stromatumoren) werden derzeit 3 Jahre mit Imatinib adjuvant behandelt. Die Dauer der Therapie ist Gegenstand von Untersuchungen. In der metastasierten Situation stehen drei Therapielinien zur Verfügung, mit denen ca. 20 % der Patienten ein Zehnjahresüberleben erreichen.

Moderne Radiotherapie beim Hodgkin-Lymphom

Zusammenfassung

Hintergrund

Die Behandlung der zumeist jungen Patienten mit einem Hodgkin-Lymphom (HL) führt in den meisten Fällen zu einer dauerhaften Heilung. Durch kontinuierliche Behandlung der Patienten in klinischen Studien konnte wie bei keiner anderen Erkrankung eine Therapieoptimierung erfolgen. Anfängliche Großfeldbestrahlung wurde nach und nach ebenso wie die Bestrahlungsdosis reduziert, und durch die Hinzunahme der Chemotherapie wurde die „combined modality" etabliert.

Methoden

Es erfolgte eine selektive Literaturrecherche in der Datenbank Pubmed zum Thema Hodgkin-Lymphom und Radiotherapie.

Ergebnisse

Aktuell prägen technische Fortschritte und neue Zielvolumenkonzepte die Planung und Durchführung der Bestrahlung wie nie zuvor. Aufgrund der exzellenten Prognose der Patienten spielen akute, aber v. a. Langzeitnebenwirkungen eine wesentliche Rolle. Lungenfibrose, Herzinfarkt und sekundäre Malignome sind mögliche Nebenwirkungen, deren Risiko durch sorgfältige Bestrahlungsplanung und Bestrahlungsdurchführung beeinflusst werden kann. Aus diesem Grund spielen Entwicklungen, wie die Bestrahlung in tiefer Inspiration (DIBH) und moderne Bestrahlungstechniken wie z. B. intensitätsmodulierte Radiotherapie (IMRT) und bildgeführte Radiotherapie (IGRT), eine ebenso herausragende Rolle im strahlentherapeutischen Alltag wie die neuen Zielvolumenkonzepte der International Lymphoma Radiation Oncology Group (ILROG).

Schlussfolgerung

Durch die Verwendung moderner Techniken in der Bestrahlungsplanung und Bestrahlungsdurchführung kann eine erhöhte Präzision erreicht werden. Ebenso zeigen aktuelle Auswertungen, dass mit hoher Wahrscheinlichkeit auch ein positiver Einfluss auf die akuten und Langzeitnebenwirkungen genommen werden kann.

Geochemical characteristics of n -alkanes and isoprenoids in coal seams from Zhuji coal mine, Huainan coalfield, China, and their relationship with coal-forming environment

Abstract

Ten coal seams in Upper Shihezi Formation, Lower Shihezi Formation, and Shanxi Formation from the Zhuji mine, Huainan coalfield, China, were analyzed for n-alkanes and isoprenoids (pristine and phytane) using gas chromatography-mass spectrometry (GC-MS), with an aim of reconstructing the coal-forming plants and depositional environments along with organic carbon isotope analyses. The total n-alkane concentrations ranged from 34.1 to 481 mg/kg. Values of organic carbon isotope (δ¹³C_org) ranged from − 24.6 to − 23.7‰. The calorific value (Q_b,d), maximum vitrinite reflectance (Ro_max), proximate, and ultimate analysis were also determined but showed no correlation with n-alkane concentrations. Carbon Preference Index (CPI) values ranged from 0.945 to 1.30, suggesting no obvious odd/even predominance of n-alkane. The predominance of C₁₁ and C₁₇n-alkanes implied that the coal may be deposited in the fresh and mildly brackish environment. According to the contrary changing trend of pristine/phytane (Pr/Ph) ratio and boron concentrations, Pr/Ph can be used as an indicator to reconstruct the marine transgression-regression in sedimentary environment of coal formation. The influence of marine transgression may lead to the enrichment of pyrite sulfur in the coal seam 4-2. C3 plants (− 32 to − 21‰) and marine algae (− 23 to − 16‰) were probably the main coal-forming plants in the studied coal seams. No correlation of the n-alkane concentration and redox condition of the depositional environment with organic carbon isotope composition were found.

Bony Regrowth After Deep Lateral Orbital Decompression

Purpose: To report on 2 cases of late bony regrowth with clinically apparent proptosis after deep lateral orbital decompression for thyroid orbitopathy. Methods: A retrospective review of 2 cases identified by the authors as having late bony regrowth. The authors review the clinical, historical, radiologic, and anatomical findings and discuss the significance thereof. Results: Bony regrowth with bowing toward the middle cranial fossa is observed at postoperative month 8 in the first case. Cortical bone and marrow was observed to regrow at 2 years postoperatively in the second case. Both patients underwent successful repeat deep lateral orbital decompression with resolution of proptosis and clinical symptoms. Conclusions: Late bony regrowth should be considered as a possible cause of recurrent proptosis after orbital decompression in thyroid eye disease. Accepted for publication January 2, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Sathyadeepak Ramesh, M.D., Division of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute, 300 Stein Plaza, Los Angeles, CA 90095. E-mail: sathyadeepak.ramesh@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Interlamellar Autogenous Tarsal Graft for the Correction of Lower Eyelid Trichiasis Associated With Eyelid Margin Thinning

Purpose: To evaluate the use of autogenous tarsal graft for surgical correction of lower eyelid trichiasis associated with eyelid thinning. Methods: A total of 23 eyelids of 19 consecutive patients with trichiasis were operated with a variant of the Van Millingen procedure. The surgery consisted of interposing a 3-mm high fragment of autogenous ipsilateral upper eyelid tarsus corresponding to the trichiasis segment between the pretarsal anterior lamella and the lower tarsal plate. Preoperative assessment included quantification of eyelid thickness on the midpoint of the segment with trichiasis, biomicroscopy of the eyelid margin and location of the trichiasis. All patients were examined at 1, 3, 6, and 12 months after surgery. Eyelid thickness was measured at 1 month and 12 months of follow up. Results: Preoperatively the mean thickness of the eyelid margin was 0.99 mm ± 0.06 standard error. One month postoperatively eyelid thickness increased to 2.08 ± 0.28 standard error, decreasing over time to reach 1. 48 mm ± 0.18 standard error 1 year after surgery, a value that did not differ from that of the control group. Small granulomas were diagnosed only in the early phases of the postoperative period. Trichiasis recurrence was seen in just 1 eyelid. Isolated abnormal lashes lateral or medial to the graft were present in 5 eyelids at the end of the study. Conclusions: Autogenous tarsal grafts placed parallel to the lower tarsus are a good option both to correct misdirected eyelashes and to restore normal lower eyelid thickness. Accepted for publication December 18, 2017. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Patricia M. S. Akaishi, M.D., Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Hospital das Clínicas-Campus, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14049 São Paulo, Brazil. E-mail: patriciamitiko@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

The Individualized Facelift Technique in Improving Facial Asymmetry for Asian Patients

Purpose: Among multiple influential factors affecting facial symmetry, the role of soft tissue is often overlooked. Skin and skeletal differences between Asian and Caucasian people also require the adaptation of current techniques for Asian patients. This article aimed to explore the ability of individual facelift techniques to improve facial symmetry and reset youthful eye in Asian people, while a new method, called the grid method, was tried to evaluate the improvement in facial symmetry. Methods: The authors conducted a review of 58 consecutive facelifts, which were all performed by a single surgeon between April 2009 and December 2016 following institutional review board approval. Among them, 21 patients underwent lower eyelid blepharoplasty. The original frontal photograph of each patient was evaluated by the grid method. Five independent plastic surgeons reviewed the facial asymmetry of the images before and after the operations using a visual analog scale to analyze the facial asymmetry of the patients. Results: In the preoperative group evaluated by the grid, the mean facial asymmetry score was 4.11, while in the postoperative group, the mean score was 1.07, which was significantly lower than the mean score before the operation (p

Idiopathic Canalicular Inflammatory Disease: New Disease Description of Clinical Patterns, Investigations, Management, and Outcomes

Purpose: The objective of this perspective is to present a separate disease description of "idiopathic canalicular inflammatory disease" and outline the diagnostic criteria and early experiences with its investigations and management. Methods: Retrospective case series of 44 canaliculi of 22 eyes of 11 patients presenting at a tertiary care Dacryology service over a period of 2 years with typical clinical patterns of inflammatory canaliculitis and its outcomes were studied. All the patients underwent microbiological work-up with culture and sensitivity, dacryoendoscopy imaging, serial Fourier domain ocular coherence tomography, and collagen vascular profiles. Stages in the evolution of the disease were studied. All patients were treated initially with topical steroids followed by punctal dilatation and placement of mini-monoka stents. Five patients in addition had a small biopsy from the inflamed portion of the vertical canaliculus. Stents were extubated at 6 weeks. Results: Forty-four canaliculi were diagnosed to have idiopathic canalicular inflammatory disease during the study period. There was a female preponderance (81.8%, 9/11) and the mean age at presentation was 57 years. All patients presented with unilateral epiphora without any discharge, pain, or swelling. Collagen vascular profiles and screening for autoimmune diseases were negative. Clinical picture ranged from stages 1 to 5, consisting of edema, progressive centripetal vascularization, pouting of vascularized mucosa, membrane formation, and progressive scarring. The presentation begins in 1 eye and usually involves the other eye at a mean of 6 months. Ocular coherence tomography and dacryoendoscopy were of adjunctive value in the diagnosis. Histopathological examination was suggestive of a chronic inflammation. All patients had relentless progression to end-stage disease, although delayed significantly by steroids and monoka intubation. Conclusion: Idiopathic canalicular inflammatory disease has a distinct and typical clinical behavior and the current study proposed diagnostic features and disease staging. The use of topical and systemic immunosuppressive agents needs to be explored to formulate effective protocols for its management. Accepted for publication December 8, 2017. Mohammad Javed Ali received support from the Alexander von Humboldt Foundation for his research and he also receives royalties from Springer for the textbook "Principles and Practice of Lacrimal Surgery' and Atlas "Atlas of Lacrimal Drainage Disorders". The authors have no conflicts of interest to disclose. Address correspondence and reprint requests to Mohammad Javed Ali, F.R.C.S., Govindram Seksaria Institute of Dacryology, L.V.Prasad Eye Institute, Road No. 2, Banjara Hills, Hyderabad-34, India. E-mail: drjaved007@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.