Colliding, Colonizing, or Combining?: Four Cases Illustrating the Unique Challenges of Melanoma arising in conjunction with Basal Cell Carcinoma

Biphasic lesions comprised of melanocytic and epithelial components are rare entities believed to arise either as a collision of two histologically distinct lesions in the same anatomic location or as a singular progenitor tumor differentiating along two differing lineages. Regardless of mechanism of origin, these tumors present unique challenges in pathologic interpretation and in determining appropriate measurements, which assigns subsequent prognosis to the patient.

We present 4 tumors of melanoma co-existing with basal cell carcinoma and discuss relevant literature regarding these biphasic entities. Patients consisted of 3 males and 1 female, ranging in age from 62–93, with lesions located on the shoulder, frontal scalp, forearm, and nose. Three of four lesions demonstrated melanoma cells limited to basal cell carcinoma tumor lobules, without evidence of direct dermal invasion by melanoma cells, raising question of whether or not these tumors should be classified as in situ or invasive melanoma.

These cases highlight the complexity that such lesions pose to dermatopathologists, in terms of their uncertain origin and variable microscopic appearance. In the absence of data regarding outcomes for these tumors (given their rarity), it is important to utilize a case-by-case approach with careful clinical correlation and appropriate use of ancillary techniques.

How to take better photomicrographs: a step-wise approach

Digital photomicrographs are often used to illustrate cutaneous diseases; however, there exists no formal protocol on how to best capture these images. We present a nine-step photomicrographing protocol for dermatopathologists, using standard overhead cameras or smartphones alongside image editing packages. A notable difference in image quality is observed when using our detailed photomicrographing protocol compared to routinely procured photomicrographs.

Correction to: Behaviour and risk assessment of fluopyram and its metabolite in cucumber ( Cucumis sativus ) fruit and in soil

Abstract

Unfortunately, the original publication of this paper contains a mistake. The correct name of the 3rd Author is Sunny H. Patel. The original article has been corrected.

Fluorinated waste and firefighting activities: biodegradation of hydrocarbons from petrochemical refinery soil co-contaminated with halogenated foams

Abstract

Perfluorinated compounds, including fluorotelomers, are important constituents of firefighting foams to extinguish fuel fires in the petrochemical industry, airports, and at fire-training sites. In this study, we monitored the biodegradation process in a co-contamination scenario with monoaromatic hydrocarbons commonly found in fuels (benzene, toluene) and fluorotelomers. The CO₂ production rates were evaluated by a factorial design taking into account the effect of seasonality at in situ natural attenuation processes. Headspace analysis by gas chromatography with a thermal conductivity detector (GC-TCD) was applied to detect CO₂ production, whereas monoaromatics were analyzed by gas chromatography coupled to mass spectrometry (GC–MS). According to our results, seasonality had a detectable effect during summer, yielding different CO₂ production rates. Higher temperatures increased CO₂ production rate, while higher concentrations of fluorotelomer inhibited the biodegradation process. On average, benzene and toluene were depleted 17.5 days earlier in control assays without fluorotelomers. Toluene removal efficiency was also notably higher than benzene. The noticeable decrease in degradation rates of monoaromatics was caused by perfluorinated compounds that are possibly linked to metabolic inhibition mechanisms. Fluorotelomer diminished catabolism in all of our batch cultures. In addition to this, an alternative production of by-products could be detected. Thus, we propose that transient components of the benzene and toluene degradation may be differentially formed, causing the benzene, toluene, and perfluorinated co-contaminations to go through switched metabolic stages under the presence of fluoride in a contamination scenario.

Enhancing denitrification with waste sludge carbon source: the substrate metabolism process and mechanisms

Abstract

Using waste sludge internal carbon source for nitrogen removal in wastewater has drawn much attention, due to its economic advantages and sludge reduction. In this study, the performance of enhanced denitrification with waste sludge thermal hydrolysate and fermentation liquid as carbon sources at different SCOD/N (soluble chemical oxygen demand/NO₃^--N) was investigated. The optimum SCOD/N was 8 for sludge thermal hydrolysate and 7 for fermentation liquid, with NO₃^--N removal efficiency of 92.3 and 98.9%, respectively, and no NO₂^--N accumulation. To further understand the fate of sludge carbon source during denitrification, the changes of SCOD, proteins, carbohydrates, and volatile fatty acids (VFAs) were analyzed, and three-dimensional fluorescence excitation-emission matrix (EEM) spectroscopy with fluorescence regional integration (FRI) analysis was introduced. The utilization of SCOD was consistent with NO₃^--N reduction, and the utilization efficiency of different organic matter was as follows: VFAs > proteins > carbohydrates. The soluble organic-like materials (region IV) were the most readily utilized organic matter according to three-dimensional fluorescence EEM spectroscopy. Regarding denitrification mechanisms, the denitrification rate (V_DN), denitrification potential (P_DN), heterotroph anoxic yield (Y_H), and the most readily biodegradable COD (S_S) were also investigated.

Polycyclic aromatic hydrocarbons in a bakery indoor air: trends, dynamics, and dispersion

Abstract

Indoor air pollution assessment in work environments remains challenging due to a combination of logistic reasons and availability of costly instrumentation for data acquisition and post-processing. Existing literature focuses on energy production environments, hospitals, and less so on food production spaces. Studies on indoor air quality in bakeries are scarce or even absent. Motivated by this, the present study investigates indoor air quality in a bakery located in Bari province in South Italy, using a combination of approaches including analytical chemistry analyses and computational fluid dynamics to reconstruct the air ventilation in response to air temperature gradients within the working environment. PM_2.5 indoor samplings were collected every 6 h from 7 to 19 April 2013 in the proximity of two bakery ovens powered by gas and wood, respectively. For each sampling day, 4 PM_2.5 samples were collected: from 3:00 to 9:00 h (first), from 9:00 to 13:30 h (second), from 14:00 to 21:00 h (third), and from 21:00 to 3:00 h (fourth). In total, 40 samples were collected. On each sample, several polycyclic aromatic hydrocarbons (PAHs) were determined such as benzo[a]anthracene (228), benzo[b]fluoranthene (252), benzo[k]fluoranthene (252), benzo[a]pyrene (252), benzo[g,h,i]perylene (276), indeno[1,2,3-cd]pyrene (276), and dibenzo[a,h]anthracene (278), the main compounds of 16 priority US Environmental Protection Agency (US-EPA) PAHs in particulate phase. The PAH mean concentrations showed higher values during the first (from 3:00 to 9:00 h) and fourth (from 21:00 to 3:00 h) sampling intervals than the other two with benzo[a]pyrene mean values exceeding the Italian law limit of 1 ng/m³. Taking into account benzo[a]pyrene mean concentration for the first interval and the first plus the second one, which are the hours with the largest working activity, we have estimated that the baker and co-workers are exposed to a cancer risk of 4.3 × 10⁻⁷ and 5.8 × 10⁻⁷, respectively (these values are lower than US-EPA recommended guideline of 10⁻⁶). Our study was complemented by numerical analyses using state-of-the-art computational fluid dynamics to reconstruct at high resolution air movement from the various working places, i.e., the bakery and the selling area which were connected via a door. The numerical simulations were possible given that surface temperature using infrared thermography as well as air temperature was continuously recorded throughout the sampling acquisition. The use of this approach allowed us to estimate the transport and diffusion of benzo[a]pyrene from one area to the other thus complementing the point sampling information. Computational fluid dynamic simulation results confirm the presence of benzo[a]pyrene in the laboratory as obtained from the measurements and suggests its presence in the sales' area of the bakery with concentrations similar those found in the laboratory.

Undifferentiated headache: broadening the approach to headache in children and adolescents, with supporting evidence from a nationwide school-based cross-sectional survey in Turkey

Headache is a leading disabler in adults worldwide. In children and adolescents, the same may be true but the evidence is much poorer. It is notable that published epidemiological studies of these age groups h...

Exposure of human melanocytes to UVB twice and subsequent incubation leads to cellular senescence and senescence-associated pigmentation through the prolonged p53 expression

Skin aging is induced both intrinsically and extrinsically, with intrinsic aging reflecting the genetic background and dependent upon the passage of time, whereas extrinsic aging is caused by environmental factors, such as ultraviolet radiation (UVR), smoking, alcohol abuse, and poor nutrition [1,2]. Among these environmental factors, UVR contributes to up to 80% of the acceleration of skin aging by inducing DNA damage (photoaging) or by activation of diverse oncogenes [3]. To prevent DNA damage by UVR, skin cells harbor well-coordinated systems, including those associated with cell cycle checkpoints, DNA repair, apoptosis, and premature senescence.

Efficacy and safety of topical SR-T100 gel in treating actinic keratosis in Taiwan: A Phase III randomized double-blind vehicle-controlled parallel trial

Actinic keratosis (AK) is the precursor lesion of cutaneous squamous cell carcinoma (SCC) and displays squamous cell dysplasia confined to the epidermis [1]. AK is exceedingly common in the skin of elderly Caucasians who have chronic exposure to sunlight [2–4]. The actual risk regarding progression from AK to invasive SCC for specific individual lesions is not known, but is estimated to be approximately 0.25–20% per year [5]. Remarkably, up to 60% of invasive SCC was derived from AK [6]. Therefore, the current treatment consensus recommends eradication of all AK when detected clinically [5,7,8].

IL-33 down-regulates CLDN1 expression through the ERK/STAT3 pathway in keratinocytes

A skin barrier defect is a well-known distinctive feature of atopic dermatitis (AD). Stratum corneum (SC) and tight junction (TJ) molecules play important roles in the barrier function of keratinocytes [1]. TJs are major barrier structures of the skin, tightly connecting neighboring cells and restricting the paracellular passage of substances [2]. TJs are composed of numerous proteins such as occludin (OCLN), junctional adhesion molecule A, zonula occludens (ZO)-1 and, −2, cingulin, symplekin, and claudin (CLDN) [2].

Commentary on the paper: “efficacy of a novel strategy for poststernotomy deep sternal infection after thoracic aorta replacement using a prosthetic graft”

Deep sternal wound infections and especially sternal osteomyelitis and mediastinitis in post cardiac surgery still remains a plastic surgical challenge because the reconstructive procedure is extremely intertwined with human physiology. This is in part due to the typically existing multiple co-morbidities in patients afflicted with this complication in addition to the thoracic defect. Since in most cases the thoracic vessels on either one or both sides have been harvested for cardiac revascularization there is the problem of a diminished local peristernal microcirculation 1 .

Risk of thromboembolic events in patients treated with thalidomide for cutaneous lupus erythematosus: a multicenter-retrospective study

Air pollution from industrial waste gas emissions is associated with cancer incidences in Shanghai, China

Abstract

Outdoor air pollution may be associated with cancer risk at different sites. This study sought to investigate outdoor air pollution from waste gas emission effects on multiple cancer incidences in a retrospective population-based study in Shanghai, China. Trends in cancer incidence for males and females and trends in waste gas emissions for the total waste gas, industrial waste gas, other waste gas, SO₂, and soot were investigated between 1983 and 2010 in Shanghai, China. Regression models after adjusting for confounding variables were constructed to estimate associations between waste gas emissions and multiple cancer incidences in the whole group and stratified by sex, Engel coefficient, life expectancy, and number of doctors per 10,000 populations to further explore whether changes of waste gas emissions were associated with multiple cancer incidences. More than 550,000 new cancer patients were enrolled and reviewed. Upward trends in multiple cancer incidences for males and females and in waste gas emissions were observed from 1983 to 2010 in Shanghai, China. Waste gas emissions came mainly from industrial waste gas. Waste gas emissions was significantly positively associated with cancer incidence of salivary gland, small intestine, colorectal, anus, gallbladder, thoracic organs, connective and soft tissue, prostate, kidney, bladder, thyroid, non-Hodgkin's lymphoma, lymphatic leukemia, myeloid leukemia, and other unspecified sites (all p < 0.05). Negative association between waste gas emissions and the esophagus cancer incidence was observed (p < 0.05). The results of the whole group were basically consistent with the results of the stratified analysis. The results from this retrospective population-based study suggest ambient air pollution from waste gas emissions was associated with multiple cancer incidences.

Fate of perfluorooctanoic acid (PFOA) in sewage sludge during microwave-assisted persulfate oxidation treatment

Abstract

The fate of perfluorooctanoic acid (PFOA) has been investigated for an emerging sludge treatment technique using microwave heating-assisted persulfate (PS) oxidation. The effect of heating temperature (20, 50, and 70 °C) and PS dose (PS1: 0.01; PS2: 0.1; PS3: 0.2 g/g wet sludge) was studied in sludge spiked with PFOA at an environmentally relevant concentration (200 ng/g wet weight). Control degradation experiments using spiked sludge without PS addition and background sludge (no PFOA spike) with PS addition were also conducted at each temperature. Sludge samples were analyzed for eight perfluorocarboxylic acids (PFCAs) (C4 – C11) using LC-MS/MS. At 20 °C (PS2 dose), minimal (~ 5%) removal of the spiked PFOA was observed after 72 h, suggesting the need for elevated treatment temperature. For the same PS dose (0.1 g /g sludge), treatment at 50 and 70 °C showed a decrease in PFOA concentration with increasing temperature, with ~ 28 and ~ 42% removal following 4 h of treatment. No significant increase in degradation was observed for the highest dose (PS3) after 2 h, possibly indicating self-scavenging of PS at high dosage. Due to the low initial spiking concentration of PFOA and low extraction recovery, all shorter-chain PFCAs (< C8), the degradation products of PFOA, were below quantification limits in all sludge samples.

Pyrolysis of wastewater sludge and composted organic fines from municipal solid waste: laboratory reactor characterisation and product distribution

Abstract

Sludge from municipal wastewater treatment plants and organic fines from mechanical sorting of municipal solid waste (MSW) are two common widespread waste streams that are becoming increasingly difficult to utilise. Changing perceptions of risk in food production has limited the appeal of sludge use on agricultural land, and outlets via landfilling are diminishing rapidly. These factors have led to interest in thermal conversion technologies whose aim is to recover energy and nutrients from waste while reducing health and environmental risks associated with material re-use. Pyrolysis yields three output products: solid char, liquid oils and gas. Their relative distribution depends on process parameters which can be somewhat optimised depending on the end use of product. The potential of pyrolysis for the conversion of wastewater sludge (SS) and organic fines of MSW (OF) to a combustion gas and a carbon-rich char has been investigated. Pyrolysis of SS and OF was done using a laboratory fixed-bed reactor. Herein, the physical characterisation of the reactor is described, and results on pyrolysis yields are presented. Feedstock and chars have been characterised using standard laboratory methods, and the composition of pyrolysis gases was analysed using micro gas chromatography. Product distribution (char/liquid/gas) from the pyrolysis of sewage sludge and composted MSW fines at 700°C for 10 min were 45/26/29 and 53/14/33%, respectively. The combustible fractions of pyrolysis gases range from 36 to 54% for SS feedstock and 62 to 72% from OF. The corresponding lower heating value range of sampled gases were 11.8–19.1 and 18.2–21.0 MJ m⁻³, respectively.

Ascorbic acid protects male rat brain from oral potassium dichromate-induced oxdative DNA damage and apoptotic changes: the expression patterns of caspase-3, P 53, Bax, and Bcl-2 genes

Abstract

Our study designed to study the potential of potassium dichromate (K₂Cr₂O₇) oral exposure to induce damage in male rat brain and to compare the possible protective role of vitamin C (VC) either pre and/or concurrent supply against (K₂Cr₂O₇) induced changes. Thirty male rats were divided into five groups. First control group received distilled water (C), second received 120 mg/kg b.wt (VC), third received 25 mg/kg b.wt K₂Cr₂O₇ (Cr), fourth group received VC together with K₂Cr₂O₇ by the same former doses (VC + Cr), and the fifth group received the same oral doses of VC 2 weeks prior to and along with K₂Cr₂O₇ for 6 weeks (VC + Cr pro/co treated). The obtained results revealed that K₂Cr₂O₇ induced a significant decrease in cholinergic activity, glutathione reductase GR activity, reduced glutathione content GSH and ATP levels. Furthermore, K₂Cr₂O₇ induced a significant increase in oxidative DNA damage indicated by 8-hydroxy 2′-deoxyguanosine (8OH2′dG) and formation of apoptotic DNA ladders, significant increase in malondialdehyde (MDA), protein carbonyl, and lactate dehydrogenase enzyme. Increased mRNA expression of pro-apoptotic genes, including caspase-3, p53, and Bax, unlike Bcl-2 expression, was decreased. K₂Cr₂O₇ increased caspase-3 and decreased Bcl-2 immuno-labeling. VC supply noticeably ameliorates K₂Cr₂O₇-induced changes which were more significantly in VC pro and concurrent supplement rather than VC concurrent supply only. Finally, it is concluded that K₂Cr₂O₇ oral administration induced oxidative apoptotic changes in rat brain and confirms the usefulness of VC pre and concurrent supply for the amelioration of K₂Cr₂O₇-induced events more significantly than VC concurrent supply only.

Surgical team proficiency in minimally invasive esophagectomy is related to case volume and improves patient outcomes

Abstract

Background

Minimally invasive esophagectomy (MIE) is being increasingly performed; however, it is still associated with high morbidity and mortality. The correlation between surgical team proficiency and patient load lacks clarity. This study evaluates surgical outcomes during the first 3-year period after establishment of a new surgical team.

Methods

A new surgical team was established in September 2013 by two expert surgeons having experience of performing more than 100 MIEs. We assessed 237 consecutive patients who underwent MIE for esophageal cancer and evaluated the impact of surgical team proficiency on postoperative outcomes, as well as the team learning curve.

Results

In the cumulative sum analysis, a point of downward inflection for operative time and blood loss was observed in case 175. After 175 cases, both operative time and blood loss significantly decreased (P < 0.001 and P < 0.001, respectively), and postoperative incidence of pneumonia significantly decreased from 18.9 to 6.5% (P = 0.024). Median postoperative hospital stay also decreased from 20 to 18 days (P = 0.022). Additionally, serum CRP levels on postoperative day 1 showed a significant, but weak inverse association with the number of cases (P = 0.024).

Conclusions

After 175 cases, both operative time and blood loss significantly decreased. In addition, the incidence of pneumonia decreased significantly. Additionally, surgical team proficiency may decrease serum CRP levels immediately after MIE. Surgical team proficiency based on team experience had beneficial effects on patients undergoing MIE.

ERAP1/ERAP2 and RUNX3 polymorphisms are not associated with AS susceptibility in Chinese Han

SUMMARY

Previous studies show that ERAP1/ERAP2 and RUNX3 gene polymorphisms are associated with AS (ankylosing spondylitis) in European Caucasians. However, contradictory results were reported in different Asian populations. Purpose of this study was to determine whether 11 candidate SNPs in ERAP1/ERAP2 and 6 in RUNX3 genes confer susceptibility to AS with or without AAU (AS⁺AAU⁺ or AS⁺AAU^-) in Chinese Han. Therefore, a case-control association study was performed in 882 AS⁺AAU^-, 884 AS⁺AAU⁺ and 1727 healthy controls. Genotyping was performed using iPLEXGold genotyping assay. A meta-analysis was performed to assess the association of polymorphisms of ERAP1 with AS susceptibility in Asian populations. No association was found between SNPs of ERAP1/ERAP2/RUNX3 and susceptibility of AS with or without AAU. A case-control study between patients with HLA-B27 positive and healthy controls also failed to demonstrate an association of the tested SNPs with AS with or without AAU. Moreover, a meta-analysis showed that there was no association of rs30187, rs27037, rs27980, rs27434 and rs27582 in ERAP1 with AS in Chinese Han. Taken together, 17 SNPs in ERAP1/ERAP2 and RUNX3 genes did not confer disease susceptibility to AS in Chinese Han. This article is protected by copyright. All rights reserved.

Simultaneous operative use of both hands during laryngeal rigid endoscopic surgery

Abstract

MLS, FL, and exolaryngoscopy represent the traditional endoscopic technique to treat laryngeal disorders.

The authors describe a novel holder laryngeal system that allows performing rigid endoscopic laryngeal surgery simultaneously using both hands in operative way.

This surgical procedure is easy, less expensive and allows obtaining very good images of the surgical filed and operating under endoscopic control.

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Transpalpebral approach for frontal sinus diseases: a camouflaged technique

Abstract

Endoscopic or transfacial external frontal sinus approaches do not provide good monitoring of the frontal sinus lateral extent. Moreover, endoscopic or transfacial external approaches remain associated with numerous complications or therapeutic failure, e.g. frontal sinus drainage pathway synechia, healing problems or residual hypoesthesia.

We propose a rapid, easy-to-perform, 5-step procedure called the transpalpebral approach which is indicated in case of sequestered disease within the lateral extent of the frontal sinus. We use this technique in the following indications (osteomas, mucoceles, inverted papillomas, fungus balls, foreign bodies).

Our transpalpebral approach avoids leaving a visible scar and entails no danger to the skull base, the frontal sinus drainage pathway or the supratrochlear and supraorbital pedicles. It provides wide access to the lateral extent of the frontal sinus and also reduces the number of transfacial external approaches required.

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Diphencyclopropenone (DPCP) for alopecia areata: a UK survey

Abstract

Alopecia areata (AA) is a T-cell mediated autoimmune hair loss condition with an estimated lifetime risk of 1.7%. It is characterized clinically by sudden-onset non-inflammatory hair loss that may occur at any site. The disease course is unpredictable with many patients experiencing spontaneous re-growth along with episodes of further loss. Unfortunately, around a fifth of patients presenting with patchy alopecia will progress to complete scalp (alopecia totalis (AT)) or scalp & body (alopecia universalis (AU)) hair loss from which spontaneous regrowth is rare (<10%). The adverse psychological consequences of AA include high rates of anxiety and depression.

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Safety and efficacy of biologic therapies in psoriatic patientswith alcoholic cirrhosis: a French retrospective study of 23 cases

Abstract

There are few studies specifically addressing the safety and efficacy of biologic treatments, especially anti TNF-alpha agents, in psoriatic patients with cirrhosis as such patients are usually excluded from prospective interventional studies. However, one should be aware that biologics are often prescribed in this particular population for several reasons. This is probably due to the fact that physicians are usually reluctant to prescribe conventional systemic treatment such as methotrexate or acitretine in psoriatic patients with liver abnormalities because of their liver toxicity. In addition, there is a general agreement that biologics have very few pharmacologic interaction with liver function and are not contraindicated in case of liver insufficiency.

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Scientific Writing Between Tabloid Storytelling, Arcane Formulaic Hermetism, and Narrative Knowledge

Abstract

The present discussion contribution argues that O. Müller not only suppresses Goethe's declared intentions with regard to the latter's Theory of Colors and ignores his place in what in any case is a different scientific culture than his (Müller's) own or Newton's, namely a premodern culture of "narrative knowledge" in the sense specified by Lyotard. Moreover, Müller entangles himself in the paradox of wanting on the one hand to back up Goethe on the level of fact when the latter opposes the militant selfrighteousness of the Newtonian school, but doing so on the other hand by constructing an epic-heroic narrative of Newtonian militance, not to say eristic belligerence contradictory to Goethe's own "tolerant enlightenment" in Lakatos' sense. Thus, we are confronted with one of those cases where, as Paul de Man puts it, a multidimensional critical reading on the semiological as well as rhetorical levels shows "that the text does not practice what it preaches" (1979, 5).

A long-term follow-up study of the Hand Eczema Trial (HET): a randomized clinical trial of a secondary preventive programme introduced to Danish healthcare workers

Summary

Background

Preventive skin care programmes have shown beneficial effects on the prevalence and severity of hand eczema, but most trials only report short-term outcomes. One such trial was the randomized Hand Eczema Trial (HET, 2009) investigating the effects of a secondary prevention programme in healthcare workers. Positive results have been reported at 5-month follow-up.

Objectives

To examine the long-term (42–47 months) effects of the HET.

Methods

The present study was a follow-up questionnaire study on the effect of the intervention. Outcomes were the presence and severity of hand eczema, health-related quality of life (HR-QoL), skin protective behaviour, and knowledge of skin protection. A supplementary outcome was general improvement/worsening of hand eczema.

Results

Comparison of the outcomes at follow-up showed no marked differences between the two groups. General improvement was reported by 70% in the intervention group and by 54% in the control group (p = 0.25). A small, statistically significant improvement was found regarding HR-QoL in the intervention group only (p = 0.015).

Conclusions

The impact of an intervention that is effective after 5 months is attenuated over time, with no long-term effect on the outcomes examined. We suggest that skin care education should be repeated at regular intervals.

A case of shiitake mushroom dermatitis

The optimization of microalgal culturing in liquid digestate after struvite precipitation using gray relational analysis

Abstract

Liquid digestate (LD) is highly turbid and contains ammonium (NH₄⁺–N), which negatively influences microalgal growth. Therefore, a method of reducing LD turbidity and NH₄⁺–N content is proposed, using struvite precipitation. To obtain struvite precipitation supernatant with an ideal UV transmittance, NH₄⁺–N concentration, and N/P ratio for microalgal growth, the effects of pH and the molar ratio of NH₄⁺/Mg²⁺/PO₄³⁻ were studied. Results show that the optimal NH₄⁺/Mg²⁺/PO₄³⁻ molar ratio was 1:1.5:1.5, with a pH value of 8.5, following NaOH addition. Gray relational analysis (GRA) was applied to obtain a relative gray scale for the evaluation of multiple outputs. Results show that Chlorella regularis FACHB-1068 was the optimal microalgae species to support growth in the struvite precipitation supernatant. Using struvite precipitation and treatment with cultured C. regularis FACHB-1068 for 7 days, the removal efficiencies of NH₄⁺–N, PO₄³⁻−P, and COD in LD were 96.52, 99.33, and 35.30%, respectively.

Insights into the redox components of dissolved organic matters during stabilization process

Abstract

The changes of dissolved organic matter (DOM) components during stabilization process play significant effects on its redox properties but are little reported. Composting is a stabilization process of DOM, during which both the components and electron transfer capacities (ETCs) of DOM change. The redox components within compost-derived DOM during the stabilization process are investigated in this study. The results show that compost-derived DOM contained protein-like, fulvic-like, and humic-like components. The protein-like component decreases during composting, whereas the fulvic- and humic-like components increase during the process. The electron-donating capacity (EDC), electron-accepting capacity (EAC), and ETC of compost-derived DOM all increase during composting but their correlations with the components presented significant difference. The humic-like components were the main functional component responsible for both EDC and ETC, whereas the protein- and fluvic-like components show negative effects with the EAC, EDC, and ETC, suggesting that the components within DOM have specific redox properties during the stabilization process. These findings are very meaningful for better understanding the geochemical behaviors of DOM in the environment.

Sediment evidence of industrial leakage-induced asynchronous changes in polycyclic aromatic hydrocarbons and trace metals from a sub-trophic lake, southwest China

Abstract

It has been well established that regional patterns of atmosphere-borne polycyclic aromatic hydrocarbons (PAHs) and trace metals were predominantly associated with the trajectory of socio-economic development; however, they could be potentially modulated by anthropogenic fingerprint of local sources such as industrial spill. Here, we established historical pollution data of both PAHs and trace metals from a well-dated sediment core from Yangzong Lake of Southwest China, which experienced a severe tailing leakage accident derived from a zinc concentrate smelting plant in 2007, aiming to evaluate the heterogeneity in their temporal trajectories and their sources of contamination in the context of regional deposition patterns. Sedimentary records show that the concentrations and fluxes of both PAHs and trace metals remained a consistently low level before the 1950s. An increasing trend and the synchronous changes of both PAHs and trace metals during ~ 1950–2002 were well consistent with the temporal pattern of socio-economic development in western China, with coal combustion and smelting industries as the main sources of contamination in this region. However, arsenic (As) and PAHs exhibited a concurrent spike for the period of ~ 2007–2013, contrasting strongly to the regional pattern of these contaminants. The modern concentrations of As revealed a 5- to 14-fold increase over the pre-1950 level, with the contemporary concentrations of PAHs rising by ~ 10–14 times. The sediment records reveal that local fingerprints of smelting activities in the catchment of Yangzong Lake have overridden the temporary pattern of regional atmosphere-borne As and PAHs over the last decade. This highlights the important role of local pollution sources in modulating or even overriding the regional pattern of anthropogenic contamination in highly impacted systems.

Optimizing the vermicomposting of organic wastes amended with inorganic materials for production of nutrient-rich organic fertilizers: a review

Abstract

Vermicomposting is a bio-oxidative process that involves the action of mainly epigeic earthworm species and different micro-organisms to accelerate the biodegradation and stabilization of organic materials. There has been a growing realization that the process of vermicomposting can be used to greatly improve the fertilizer value of different organic materials, thus, creating an opportunity for their enhanced use as organic fertilizers in agriculture. The link between earthworms and micro-organisms creates a window of opportunity to optimize the vermi-degradation process for effective waste biodegradation, stabilization, and nutrient mineralization. In this review, we look at up-to-date research work that has been done on vermicomposting with the intention of highlighting research gaps on how further research can optimize vermi-degradation. Though several researchers have studied the vermicomposting process, critical parameters that drive this earthworm–microbe-driven process which are C/N and C/P ratios; substrate biodegradation fraction, earthworm species, and stocking density have yet to be adequately optimized. This review highlights that optimizing the vermicomposting process of composts amended with nutrient-rich inorganic materials such as fly ash and rock phosphate and inoculated with microbial inoculants can enable the development of commercially acceptable organic fertilizers, thus, improving their utilization in agriculture.

The contribution of feedback loops between miRNAs, cytokines and growth factors to the pathogenesis of psoriasis

Abstract

The present review describes in detail the existent data regarding feedback loops between miRNAs and cytokines or growth factors in the psoriatic inflammation. We have chosen to describe the roles of miR- 31, miR-21, miR-146a, miR-155, miR-197 and miR-99a in this process. This choice derives from the fact that among around 250 miRNAs being altered in the psoriatic lesion, the comprehensive functional role was described only in those detailed above. In addition, considering the molecular targets and the pathways, which may possibly be regulated by those miRNAs, it seems that they may be chosen as preferred targets for the therapy of psoriasis.

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Decrease in the annual emissions of CH 4 and N 2 O following the initial land management change from rice to vegetable production

Abstract

In recent years, rice paddies have been increasingly converted to vegetable production resulting from economic benefits and changes in demand of diets, potentially altering soil greenhouse gas (GHG) balance. Here, we implemented a parallel field experiment to simultaneously quantify the differences in emissions of CH₄ and N₂O among rice paddy (RP) and conventional vegetable field (CV) and greenhouse vegetable field (GV), both of which have been recently converted from rice paddy in subtropical China over a full year. The results revealed that CH₄ emission was reduced dramatically by nearly 100% following the initial land management change from rice to vegetable production, with annual emissions of 720.9, 0.9, and 0.2 kg CH₄-C ha⁻¹ for RP, CV, and GV, respectively. This conversion however substantially increased N₂O emissions, resulting in the transition from a minor sink of N₂O in RP (−0.1 kg N ha⁻¹ yr⁻¹) to considerable N₂O sources in CV (31.8 kg N ha⁻¹ yr⁻¹) and GV (52.2 kg N ha⁻¹ yr⁻¹). Furthermore, annual N₂O emission from GV significantly exceeded that from CV due to lower soil pH and higher soil temperature facilitating N₂O production in GV relative to CV. Land management change significantly decreased the annual total emissions of CH₄ and N₂O from CV and GV by 19–51% as compared to RP, attributing to the reduced CH₄ emissions outweighing the increased N₂O emissions in CV and GV. These results indicate that expansion of vegetable production at the expense of rice paddies for higher economic benefits also helps mitigate the total emissions of CH₄ and N₂O.

Latitudinal distribution of OCPs in the open ocean atmosphere between the Argentinian coast and Antarctic Peninsula

Abstract

Long-range atmospheric transport is one of the most important ways in which persistent organic pollutants can be transported from their source to remote and pristine regions. Here, we report the results of the first Argentinian measurements of organochlorine pesticides in the Antarctic region. During a 9665-km track onboard OV ARA Puerto Deseado, within the framework of Argentinian Antarctic Expeditions, air samples were taken using high-volume samplers and analyzed using GC-μECD. HCB, HCHs, and endosulfans were the major organic pollutants found, and a north-south gradient in their concentrations was evident by comparing data from the Argentinian offshore zone to the South Scotia Sea.

Early life exposure of zebrafish ( Danio rerio ) to synthetic pyrethroids and their metabolites: a comparison of phenotypic and behavioral indicators and gene expression involved in the HPT axis and innate immune system

Abstract

Ecotoxicological studies have revealed the association between synthetic pyrethroid (SP) exposure and aquatic toxicity in fish; however, research on the toxic effects of SP metabolites is still limited. In this study, the toxicity of two SPs (permethrin (PM) and β-cypermethrin (β-CP)) and their three metabolites (3-phenoxybenzoic alcohol (PBCOH), 3-phenoxybenzaldehyde (PBCHO), and 3-phenoxybenzoic acid (PBCOOH)) towards zebrafish embryos and larvae was evaluated. Both SPs and their metabolites exhibited significant developmental toxicities, caused abnormal vascular development, and changed locomotor activities in larvae. The alteration of gene expression involved in the thyroid system and the innate immune system indicated that SPs and their three metabolites have the potency to induce thyroid disruption and trigger an immune response. The results from the present study suggest that SP metabolites could induce multiple toxic responses similar to parent compounds, and their toxicity should be considered for improving the understanding of environmental risks of SPs.

Facial dermatitis caused by undeclared methylisothiazolinone in a gel mask: is the preservation of raw materials in cosmetics a cause of concern?

In vivo optical coherence tomography imaging in a case of mucous membrane pemphigoid and a negative Nikolsky's sign

Abstract

There is currently a growing interest in new diagnostic tools of the oral cavity and mucosa which are non-invasive, repeatable and reliable. A diagnosis of a suspected, autoimmune pathology was made regarding a 57-year-old patient with desquamative gingivitis. However, a negative Nikolsky's sign did not seem to indicate a diagnosis of mucous membrane pemphigoid neither was there any indication as to the optimum location for an incisional biopsy. As an imaging method, the use of optical coherence tomography (OCT) has enabled the obtaining of tomographic (cross-sectional) scans of tissue. Such images are acquired prior to and after verifying Nikolsky's sign, thereby enabling the clinician to identify the presence (or not) of subepithelial bullae. Thereafter, an assessment of changes in the subepithelium (the split) can be performed, even in the absence of a suitable clinical picture, such as, for example, a negative Nikolsky's sign. Histological analysis and the use of indirect immunofluorescence have facilitated a diagnosis of mucous membrane pemphigoid, an autoimmune pathology, which can be confirmed with the appearance of subepithelial bullae. OCT was found to be a valid, non-invasive, auxiliary diagnostic device, capable of revealing in vivo and real-time bullae, which were hitherto clinically undetectable.

Phacomatosis pigmentovascularis type 2b (phacomatosis cesioflammea) with double superior vena cava, abdominal varicosities, and natal tooth: Novel associations

Abstract

Phacomatosis pigmentovascularis is characterized by coexistent extensive cutaneous vascular (capillary) and pigmentary anomalies. We describe a 2-month-old infant presenting with classic features of phacomatosis pigmentovascularis 2b (phacomatosis cesioflammea). He was also found to have hitherto unreported associations in the form of extensive venous anomalies presenting as striking abdominal wall varicosities and persistent left superior vena cava and natal tooth.

Retronychia a little-known cause of paronychia: A report of two cases in adolescent patients

Abstract

Retronychia is a clinical condition resulting from embedding of the nail plate into the proximal nail fold. We report two adolescent girls, 14 and 16 years of age, with a history of chronic proximal paronychia of the great toe, one of them developing osteomyelitis. After failure of treatment with several systemic antibiotics, nail avulsion was performed, leading us to the diagnosis of retronychia and with rapid and complete resolution of symptoms in both cases. Delay in diagnosis of retronychia can lead to local complications and prolonged discomfort.

Nipple adenoma in a 2-year-old boy

Abstract

Nipple adenoma is an uncommon proliferative process of the breast and predominantly occurs in women aged 40-50. Its incidence is extremely low in men, and it has not been reported in a boy. Although nipple adenoma is rare and benign, being familiar with it is important because it clinically resembles Paget disease and histologically adenocarcinoma. We report a case of nipple adenoma in a boy.

Efficacy and safety of topical application of 15% and 10% potassium hydroxide for the treatment of Molluscum contagiosum

Abstract

Background/Objectives

Molluscum contagiosum is the most common skin infection in children. One topical treatment used for Molluscum contagiosum is potassium hydroxide. The objective of this study was to compare the efficacy of potassium hydroxide topical treatment at different concentrations with that of placebo in terms of complete clearing of Molluscum contagiosum lesions and to assess the safety and tolerance of potassium hydroxide topical treatment.

Methods

This was a double-blind randomized clinical trial of three treatments (potassium hydroxide 10%, potassium hydroxide 15%, placebo) applied once daily up to complete clearing of lesions (maximum duration 60 days) in 53 children aged 2-6 years in primary health care pediatric offices in Catalonia, Spain.

Results

In the intention-to-treat analysis, potassium hydroxide 10% (58.8%, P = .03) and potassium hydroxide 15% (64.3%, P = .02) had efficacy superior to that of placebo (18.8%). The number of Molluscum contagiosum lesions was significantly reduced with potassium hydroxide 10% and 15%. The main efficacy outcome was achieved in 58.8% of children in the potassium hydroxide 10% group (P = .03 vs placebo) and in 64.3% of children in the potassium hydroxide 15% group (P = .02 vs placebo). Potassium hydroxide 10% and 15% were not significantly different in efficacy from each other. Potassium hydroxide 10% and placebo were better tolerated than potassium hydroxide 15%. No adverse events were reported during the study period.

Conclusions

Potassium hydroxide 10% and 15% demonstrated high rates of efficacy in clearing Molluscum contagiosum lesions, with potassium hydroxide 10% being better tolerated.

Effects of pregnancy on skin properties: A biomechanical approach

Abstract

Background

A woman's skin is dramatically affected by pregnancy. Its biomechanical properties are critical for resisting highly stressed areas. The aim of this work was to evaluate the impact of pregnancy on the mechanical properties of skin, as well as to evaluate the imprint that pregnancy leaves on the skin after delivery.

Materials and Methods

Suction tests using a cutometer were performed on 15 non-pregnant women and 26 pregnant women at 8 months of pregnancy and 4 months after delivery. Areas of abdomen and thighs were studied.

Results

Significant differences between the non-pregnant and 8-month pregnant groups were observed. Our data demonstrate that skin becomes less elastic and less deformable on the abdomen during pregnancy. On the thighs, a loss of elasticity and firmness was also observed. At 4 months after delivery, the skin did not return to its initial state.

Conclusion

This study showed that the mechanical properties of skin changed drastically during pregnancy compared to the non-pregnant condition and that these properties remain altered 4 months after delivery. In addition to alterations in abdominal skin during pregnancy, we also observed mechanical changes on the thighs, which are less subject to stretching.

The report of two cases with multiple sulfatase deficiency resulting from a rare similar gene mutation

Clinical characteristics and management of patients with rosacea in a tertiary dermatology center in Singapore from 2009 to 2013

Abstract

Introduction

Rosacea is a common chronic facial skin disease. A multiethnic society such as Singapore provides an opportunity to evaluate the demographic characteristics and their impact on clinical outcome in rosacea.

Aims

The aim of this study was to evaluate characteristics and outcome of rosacea in a multiracial population in Singapore.

Methods

Records of all rosacea patients between January 2009 and December 2013 were retrospectively retrieved from the electronic medical records (EMR). Descriptive analysis was performed to understand the characteristics of patients with rosacea. Multivariate logistic regression was used to evaluate the associations between the various variables and types of rosacea as well as the clinical outcome.

Results

A total of 1340 patients were identified. The mean age at presentation was 42.8 years with a female predominance (65%). Most of the patients had erythematotelangiectatic rosacea (ETR) (56.3%) followed by papulopustular rosacea (PPR) (37%). With multinomial logistic regression, controlling for age, gender, and known triggers, Indians and Caucasians were more likely to have PPR compared to ETR (OR: 3.4, P = 0.01 and OR: 2.1, P = 0.01 respectively). Patients who had phymatous rosacea are also more likely to be older males (OR: 3.82 95% CI 1.64–8.92, P = 0.002).

Conclusion

The epidemiology and outcome of rosacea among local patients were studied. Rosacea is more common among certain racial groups such as Chinese, Caucasian, and other races. The clinical subtypes also seem to be related to races of certain skin colors and might be related to varied natural intrinsic responses to the sun among different racial groups.

Clinical profile of dermatological emergencies and intensive care unit admissions in a tertiary care center – an Indian perspective

Abstract

Background

Although dermatology is largely considered as an outpatient specialty, dermatological conditions comprise 5–8% of cases presenting to the emergency department. The need for a dermatological intensive care unit is widely acknowledged due to the increasing incidence of acute skin failure. Very few studies have been done to characterize the common conditions seen in the emergency department and intensive care units. We undertook this study to analyze the spectrum of dermatological conditions presenting to the emergency department and the clinical profile of patients admitted to the intensive care unit.

Methods

A prospective study was conducted for 9 months. Patients requiring primary dermatological consultation in the emergency department and patients admitted in the dermatology intensive care unit were examined, and their clinical variables were statistically analyzed.

Results

A total of 248 cases were seen in the emergency department, out of which 72 (29.1%) cases were admitted and 176 (70.9%) were treated in the emergency department on an outpatient basis. The most common condition seen in non-admitted patients was acute urticaria (28.9%). The most common cause for admission in patients presenting to the emergency department was erythroderma (23.6%). Sixty-two patients were admitted to the intensive care unit, the most common diagnosis being erythroderma (40.3%).

Conclusions

This prospective study aimed to provide an insight into the types of cases evaluated in the emergency department by dermatologists in a large tertiary care hospital in coastal Karnataka in South India.

Onycholemmal carcinoma: a case report with its molecular profiling

Onycholemmal carcinoma (OC), also called microcystic nail bed carcinoma by some authors¹, is a slow-growing malignant epithelial tumor originating from the nail bed epithelium. Since the first description by Alessi and collegues in 2004², only twelve other cases have been described in the English literature, so far^1,3-7.

Yield improvement of epothilones in Burkholderia strain DSM7029 via transporter engineering

Abstract

Transporter engineering has been shown to be a positive approach for enhancing natural product titers in microbial cell factories by expelling target compounds out of feasible hosts. In this work, two multidrug efflux pumps, Orf14 and Orf3, were modulated in the epothilone production strain Burkholderia DSM7029::Tn5-km-epo (named G32) via Red/ET engineering to increase heterologous polyketide epothilone yields. Compared with the prior G32 strain, the total production of several epothilones in the G32::orf14-orf3 mutant was meaningfully doubled according to high-performance liquid chromatography-mass spectrometer (HPLC-MS) analysis. Typically for epothilone B, in simple and clear liquid medium CYMG, the overall productivity in the engineered high-yield producer G32::orf14-orf3 was improved for almost three-fold, from 2.7 to about 8.1 μg/l. Additionally, the ratio of extracellular to intracellular accumulation of epothilone B was raised from 9.3:1 to 13.7:1 in response to expression of two putative transport genes orf14 and orf3. Hence, we strongly recommend that the Orf14 and Orf3 transporters export epothilone, thus promotes the forward reaction of biosynthesis on epothilone manufacture inside the cells. Our results afford a practical stage for yield improvement of other heterologous natural products in broad chassis cells.

Validation of Reference Genes for RT-qPCR Analysis in the Deep-sea Bacterium Shewanella psychrophila WP2

Abstract

Reference genes are critical to obtain reliable results of RT-qPCR, which is widely used for relative quantification of gene expression. In this study, we evaluated the validity of seven candidate reference genes for normalization in RT-qPCR analysis in the deep-sea bacterium Shewanella psychrophila WP2 under different environmental conditions. Among the set of genes investigated, gyrA, 16S rRNA and rho were identified as the most suitable reference genes for WP2 at different temperatures, hydrostatic pressures and salinities, respectively. Notably, the rho gene is conserved in Shewanella genus and other deep-sea bacteria, thus could be used as a versatile reference gene for RT-qPCR analysis of these microorganisms under extreme environmental conditions.

Optimization of physicochemical parameters of tannase post-purification and its versatile bioactivity

Abstract

The present study investigates the optimization of tannase production from A. nidulans for various physicochemical parameters and harvests tannase for its chemical characterization. The maximum tannase activity was observed on the third day of incubation at 35°C and the stability was observed at pH 5.5 to 6.0 by holding its 100% activity. The tannase was partially purified from A. nidulans [FT10] by ammonium sulfate precipitation at different concentrations and it was found that at 80% of ammonium sulfate concentration, the precipitate exhibited the maximum activity for tannase of 96 U/ml. LCMS showed its M/Z value as 162.3 which was reconfirmed by SDS-PAGE. The UV spectrum and FTIR confirmed the presence of two oxy- and three hydroxyl groups in the benzene ring structure. The antibacterial activity of tannase was enhanced with antibiotics such as streptomycin and ceftazidime whereas the biofilm formation was significantly inhibited by the purified tannase. The scavenging activity was greatly increased with purified component and when the concentration of the purified tannase, TN09 was increased. To the best of our knowledge, this is one of the few reports where microbial species was used as the source for producing tannase enzyme and its role in various bioactivities such as antibacterial, anti-biofilm and antioxidant activity was evaluated.

Exploratory analysis of the association of depth of response and survival in patients with metastatic non-small-cell lung cancer treated with a targeted therapy or immunotherapy

Ann Oncol 2017; 28: 2707–2714 (doi: 10.1093/annonc/mdx414)

Fate of estrogens in a pilot-scale step-feed anoxic/oxic wastewater treatment system controlling by nitrogen and phosphorus removal

Abstract

The control measures for estrogens in the aquatic environment are topics of growing concern. It is a meaningful issue to finding optimal process parameters for efficient removal of estrogens with the purpose of efficient total nitrogen (TN) or total phosphorus (TP) removal in sewage treatment plants. The present paper is concerned with the relationships between the estrogen removal and TN or TP removal in a pilot-scale three-stage anoxic/oxic (A/O) system treating real municipal wastewater. The total removal efficiency for estrone (E1) and 17β-estradiol (E2) and their sulfate and glucuronide conjugates were on average 87% in the pilot-scale system. The concentrations of the sulfate and glucuronide conjugates of estrogens (E1 and E2) in the system were much lower than the estrogens, which might be caused by the rapid degradation of conjugates in the pilot-scale system. The average removal efficiencies of E1 and E2 and their sulfate and glucuronide conjugates were significantly lower under high TP removal conditions than those under high TN removal conditions that suggested that the ammonia oxidation promotes estrogen degradation. When the system achieved efficient TN removal, the concentrations of both E1 and E2 were generally lower in the aerobic zones than those in the anoxic zones. Instead, when the system achieved efficient TP removal conditions, the estrogen concentrations were higher in the aerobic zones than in the anoxic zones. However, it was thought that the variation of the concentrations of the estrogen conjugates had weak influence on concentrations of the free estrogens. The increase of the free estrogens in the aerobic zones could be attributed to the release of the estrogens adsorbed on the sludge. The variation of estrogens in a three-stage A/O system can be properly estimated and measured by a binary linear regression model with the variables of TP and TON (NO₂⁻-N and NO₃⁻-N), which is probably the important information for the improvement and optimization of wastewater treatment processes to obtain higher removal efficiency for estrogens.

Is HPV vaccination of pregnant women really safe?

Altered density, composition and microanatomical distribution of infiltrating immune cells in cutaneous squamous cell carcinoma of organ transplant recipients

Summary

Background

The inflammatory tumor microenvironment is crucial for effective tumor control and long-term immunosuppression has been identified as a major risk factor for skin carcinogenesis. In solid organ transplant recipients (OTR) undergoing long-term pharmacologic immunosuppression an increased incidence of cutaneous squamous cell carcinoma (SCC) and more aggressive tumor growth compared to immunocompetent patients (IC) has been reported.

Objectives

To determine the density and phenotype of immune cells infiltrating SCC and surrounding skin in OTR, and to characterize the microanatomical distribution patterns in comparison to IC.

Methods

We analyzed immune cell infiltrates within SCC and at defined regions of interest (ROI) of tumor- surrounding skin in formalin-fixed paraffin-embedded (FFPE) tissue of 20 renal transplant patients and 18 carefully matched IC by high-resolution semi-automated microscopy on complete tissue sections stained for CD4, CD8, CD20 and CD68.

Results

The overall immune cell density of SCC arising in OTR was significantly reduced compared to IC. Particularly CD4+ infiltrates at the directly invasive margin and tumor vicinity, intratumoral CD8+ T cell densities and the overall density of CD20+ tumor-infiltrating B cells (TIL-B) were significantly reduced in tissue of OTR.

Conclusions

Immune cells infiltrates within SCC and at defined ROI of tumor-surrounding skin in OTR differ markedly in their composition and microanatomical distribution compared to tumors arising in IC. Our findings substantially broaden the understanding of how long-term systemic immunosuppression modulates the local inflammatory microenvironment in the skin and at the site of invasive SCC.

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SSET Project: Cost-effectiveness Analysis of Surgical Specialty Emergency Trays in the Emergency Department

Background: We hypothesize that reusable, on-site specialty instrument trays available to plastic surgery residents in the emergency department (ED) for bedside procedures are more cost-effective than disposable on-site and remote re-usable operating room (OR) instruments at our institution. Methods: We completed a cost-effectiveness analysis comparing the use of disposable on-site kits and remote OR trays to a hypothetical, custom, reusable tray for ED procedures completed by PRS residents. Material costs of existing OR trays were used to estimate the purchasing and use-cost of a custom on-site tray for the same procedures. Cost of per procedure 'consult time' was estimated using procedure and resident salary. Results: Sixteen bedside procedures were completed over a 4.5 month period. A mean of 2.14 disposable kits were used per-procedure. Mean consultation time was 1.66 hours. Procedures that used OR trays took 3 times as long as procedures that used on-site kits (4 vs. 1.1 hours). Necessary, additional instruments were unavailable for 75% of procedures. Mean cost of using disposable kits and OR trays was $115.03/procedure versus an estimated $26.67/procedure cost of using a custom tray, yielding $88.36/procedure cost-savings. Purchase of a single custom tray ($1,421.55) would be redeemed after 2.3 weeks at 1 procedure/day. Purchasing 4 trays has projected annual cost-savings of $26,565.20. Conclusion: The purchase of specialized procedure trays will yield valuable time and cost-savings while providing quality patient care. Improving time efficiency will help achieve the Accreditation Council of Graduate Medical Education (ACGME) goals of maintaining resident well-being and developing quality improvement competency.

Incidence and Prevalence of Rosacea: A Systematic Review and Meta-Analysis

Abstract

Background

The exact prevalence and incidence of rosacea remain unknown, although it is a common condition associated with severe non-cutaneous diseases. We performed a systematic review of published literature to examine the global incidence and prevalence of rosacea.

Methods

A systematic review of population-based studies reporting the incidence and/or prevalence of rosacea was performed using three electronic medical databases, PubMed, EMBASE, and Web of Science. Data were extracted, and a proportion meta-analysis was performed to obtain pooled proportions.

Results

A total of 32 studies were included examining a total of 41 populations with 26,519,836 individuals. 22 populations were from Europe, three from Africa, four from Asia, nine from North America, and three from South America. The pooled proportion of rosacea was 5.46% (95% CI 4.91-6.04) in the general population and 2.39% (95% CI 1.56-3.39) among dermatology outpatients. Self-reported rosacea gave higher prevalence estimates than rosacea diagnosed by clinical examination, suggesting a low specificity of questionnaires based on symptoms. Rosacea affected both women (5.41%, (CI 95% 3.85-7.23)) and men (3.90% (CI 95% 3.04-4.87)), and mostly those aged 45-60 years.

Conclusion

We estimated the global prevalence of rosacea based on published data and found that 5.46% of the adult population is affected. However, the prevalence of rosacea depended on the diagnostic method with higher estimates in questionnaire studies and lower estimates in health registries.

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Effectiveness of Systemic Treatments for Pyoderma Gangrenosum:A Systematic Review of Observational Studies & Clinical Trials

Summary

Background

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis with substantial morbidity. Currently, there is no consensus on gold-standard treatments.

Objectives

Our primary objective was to review the effectiveness of systemic therapy for PG.

Methods

We searched Cochrane Central, Cochrane DSR, EMBASE, MEDLINE, PubMed, and Web of Science for 24 systemic therapies for PG. Primary outcomes were complete healing and clinical improvement; secondary outcomes were time-to-healing and adverse effects.

Results

We found 3,326 citations, of which 375 articles underwent full-text review, and 41 studies met inclusion criteria. There were 704 participants amongst 26 retrospective cohort studies, 3 prospective cohort studies, 7 case series, 1 case-control study, 2 open-label trials, and 2 randomized controlled trials (RCT). Systemic corticosteroids were the most studied (n=32 studies), followed by cyclosporine (n=21), biologics (n=16), and oral dapsone (n=11). One RCT (STOP-GAP, n=121) showed that prednisolone and cyclosporine were similar, with 15-20% complete healing at 6-weeks and 47% at 6-months. Another RCT (n=30) found that infliximab was superior to placebo at 2-weeks (46% vs. 6% response), with 21% complete healing rate at 6-weeks. Two uncontrolled trials showed 60% and 37.5% healing in four months with canakinumab and infliximab, respectively; other data suggest that patients with concurrent IBD may benefit from biologics. The remaining studies were of poor quality and small sample sizes, though supported the use of corticosteroids, cyclosporine, and biologics.

Conclusions

Systemic corticosteroids, cyclosporine, infliximab, and canakinumab had the most evidence in treating PG. However, current literature is limited to small and lower-quality studies with substantial heterogeneity.

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Use of emollients and topical glucocorticoids among adolescents with eczema – datafrom the population-based birth cohort BAMSE

Summary

Background

Knowledge regarding how adolescents treat their eczema is sparse.

Objectives

To explore the use of emollients and topical glucocorticoids in adolescents with eczema in relation to sex and disease severity, and to study dispensing patterns of topical glucocorticoids.

Methods

Questionnaire-based data on symptoms of eczema, eczema severity and treatment with emollients and topical glucocorticoids were obtained from 3,108 adolescents in the Swedish population-based birth cohort BAMSE. Severity of reported eczema was evaluated with the BAMSE Eczema Severity Score (BESS) in a questionnaire and with the Patient-Oriented Eczema Measure in clinically examined subjects with current eczema (n = 247). Information on dispensed topical glucocorticoids was obtained from the Swedish Prescribed Drug Register.

Results

In all, 10% reported eczema in the preceding year: 73% mild, 17% moderate and 10% severe according to BESS. Almost all used emollients, whereas use of topical glucocorticoids was reported by 55%, with no significant difference between sexes. The likelihood of treatment with emollients and topical glucocorticoids increased when the adolescents had symptoms of current eczema (OR_Adj 5.95, 95% CI 1.90-18.8), but not if they had more severe eczema compared to mild eczema (OR_Adj 1.57, 95% CI 0.58-4.25). Among those with reported eczema, 24% had a topical glucocorticoid dispensed in the preceding year and among those with moderate to severe current eczema 25% had dispensed a potent topical glucocorticoid.

Conclusions

This population-based study indicates that adolescents with eczema are undertreated or completely untreated, even those with severe eczema.

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Novel in vivo observations of scrotal Nannizzia gypsea infection

Abstract

Tinea cruris is a common dermatophytosis, which usually firstly involved the intertriginous fold near the scrotum. Although dermatophytes may colonize the scrotum, they typically do not infect scrotal skin. However, tinea of scrotum is seldom reported as a specific type of Microsporum gypseum infection, presenting as white-paint-dot appearance, scutular-like or pseudomembranous-like lesions in immunocompromised or immunocompetent patients^1-6. According to the newest taxonomy, M. gypseum is now called Nannizia gypsea⁷. Herein we report novel in vivo observations of five cases of scrotal tinea caused by N. gypsea (formerly Microsporum gypseum) in immunocompetent patients.

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Association between childhood atopic dermatitis, cutaneous, extracutaneous and systemic infections

Abstract

Atopic dermatitis (AD) is associated with higher risk of skin infections. US population-based studies found that childhood AD is associated with increased risk of caregiver-reported extra-cutaneous infections. We sought to confirm whether AD in childhood is associated with increased rates of healthcare diagnosed cutaneous and extra-cutaneous infections.

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Unique clinical and serological features of bullous pemphigoid associated with dipeptidyl peptidase-4 inhibitors

Abstract

Recently, several cases of bullous pemphigoid (BP) associated with the use of a dipeptidyl peptidase-4 (DPP-4) inhibitor, a type of antihyperglycemic drug, have been reported (DPP4i-BP).^1,2 Béné reported a strong association between DPP-4 inhibitor use and the risk of BP.³ The juxtamembranous extracellular non-collagenous 16a (NC16a) domain of type XVII collagen (COL17, also termed BP180) is a major target epitope of autoantibodies in BP.⁴ A recent study found that BP cases whose autoantibodies bound to BP180 at regions other than NC16a exhibited a non-inflammatory phenotype with fewer erythemas. Intriguingly, half of these cases had taken DPP-4 inhibitors at the time of development of BP.⁵ In this study, we explored whether DPP4i-BP exhibited any unique clinical and serological features as suggested by the previous study.

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Tanning Addiction: Conceptualisation, Assessment, and Correlates

Abstract

Background

Research into problematic tanning (or 'tanning addiction') has markedly increased over the past few years. Although several excessive tanning instruments exist, most of these are psychometrically poor, not theoretically anchored, and have mainly been used on small samples.

Objective

Against this background, a new tanning addiction scale was developed based on a specific theoretical approach utilising core addiction criteria.

Methods

A scale comprising seven items (i.e. salience/craving, mood modification, tolerance, withdrawal, conflict, relapse/loss of control, and problems) was administered online to a cross-sectional convenience sample of 23,537 adults (M_age=35.8 years, SD=13.3), together with an assessment of demographic factors, the five-factor model of personality, and symptoms of obsessive-compulsive disorder, anxiety and depression.

Results

A confirmatory factor analysis showed that a one-factor model showed an optimal fit with the data collected (RMSEA=.050 [90% CI=.047–.053], CFI=.99, TLI=.99). High factor loadings (.781–.905, all p<.001) and coefficient omega indicator of reliability (ω=.941 [95% CI=.939–.944]) were also found using the new scale. In a multiple linear regression analysis, tanning addiction was positively associated with being female, not being in a relationship, extroversion, neuroticism, anxiety and obsessive-compulsiveness. It was also found that educational level, intellect/openness and depression were inversely associated with tanning addiction.

Conclusions

The new scale, Bergen Tanning Addiction Scale (BTAS), showed good psychometric properties, and is the first scale to fully conceptualise tanning addiciton within a contemporary addiction framework. Given this, the BTAS may potentially assist future clinical practice in providing appropriate patient care, prevention and disease management.

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Incidence of Sexual Dysfunction Among Patients with Hidradenitis Suppurativa: a population based retrospective analysis

Abstract

Given the devastating psychological impact of hidradenitis suppurativa (HS), and since the disease process commonly affects intimate body regions, patients with the disease may be at risk for sexual dysfunction (SD). While SD has been established among HS patients through qualitative studies using instruments not validated for this context,the burden of SD has not been described in a population of HS patients.

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Computerized tomographic evaluation of supraorbital notches and foramen in patients with frontal migraine headaches and correlation with clinical symptoms

Publication date: Available online 14 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Navid Pourtaheri, Bahman Guyuron
PurposeTo correlate the location and size of supraorbital notches (SON) and foramen (SOF) with migraine headache symptoms in a migraine patient population.MethodsA retrospective review was performed on consecutive patients who were candidates for frontal migraine surgery with available pre-operative computed tomography (CT) images of the face/perinasal sinuses. The supraorbital anatomy from CT images was analyzed and correlated with presenting migraine headache symptoms. To assess for anatomic variations associated with migraine headaches, normative anatomic data was obtained through performing a meta-analysis.Results56 patients were included; 95% female, aged 17-80 (mean 47) years. Bilateral SON were present in 58.9% patients, combination of SON/SOF in 25%, and bilateral SOF in 16.1%. SOF mean diameter (1.22 mm) was 45% smaller than SON (2.20 mm, p<0.0001). The mean lateral distance from midline for SOF (2.74 cm) was ~0.5 cm farther than SON (2.25 cm, p<0.0001). Migraine patients with SOF had 178.6% longer mean migraine headache duration (p=0.0020), 9.8% higher intensity (p=0.0052), and 91.4% greater migraine headache index (p=0.0498) compared to those without SOF. Compared to normative patient data, migraine patients are more likely to have SON/SOF (100% vs. 83%, p=0.0047) and have mean SON and SOF diameters that are 34.3-41.5% smaller (p<0.0001).DiscussionNerve compression at SON and especially SOF contributes significantly to migraine headache symptoms and these structures (if present) should be released during frontal migraine surgery. Given the variable presence and location of SON/SOF, analysis of available face/perinasal sinus CT images helps pre-operative planning for foraminotomy and bands release.

A prospective randomised comparison of fixation methods in Tamai's zone I amputation

Publication date: Available online 22 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Hyung-Sup Shim, Byung Yeun Kwon, Bommie F. Seo, Ho Kwon, Sung-No Jung
BackgroundThe treatment of choice for fingertip amputation is replantation to restore function and aesthetics. The purpose of this study was to compare the success rates and salvage periods between patients with Tamai's zone I amputation injuries treated with bony fixation and suture fixation.MethodsFifty-five patients with Tamai's zone I amputations with bony involvement were included in this study. The patients were allocated randomly to two groups treated by bony fixation with Kirschner (K-)wire and suture fixation, respectively. In the bony fixation group (n = 21), the distal phalangeal bone was fixed with K-wire; in the suture fixation group (n = 34), the amputated portion was fixed with sutures alone. The success rate was defined as the percentage of fully viable replanted cases, and the salvage period was defined as extending from the first postoperative day to the cessation of salvation.ResultsThe success rates for the bony and suture fixation groups were 90.0% and 91.1%, respectively, with no significant difference. The average salvage period was longer in the bony fixation group than in the suture fixation group (8.7 ± 1.25 vs. 6.4 ± 0.98 days; P = 0.01). No case of non-union of the distal phalangeal bone, limitation of motion, or disfigurement was observed in either group.ConclusionThe average salvage period was significantly longer for the bony fixation group, but the success rate did not differ between groups. We suggest that bony fixation is not mandatory in the treatment of Tamai's zone I amputation.

Invited commentary on “Dutch breast reconstruction guideline”

Publication date: March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 3
Author(s): Jeremy N. Rodrigues

The use of SERI™ Surgical Scaffolds in direct-to-implant reconstruction after skin-sparing mastectomy: A retrospective study on surgical outcomes and a systematic review of current literature

Publication date: Available online 15 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Arjen A.W.M. van Turnhout, Charlotte J.J. Franke, Eline J.C. Vriens-Nieuwenhuis, Wouter B. van der Sluis
IntroductionLittle is reported on surgical outcomes of SERI Surgical Scaffold, a bioresorbable silk-derived surgical scaffold, developed to provide soft-tissue support and repair, in implant/expander breast reconstruction.MethodsA retrospective chart study was conducted of all patients who underwent direct-to-implant reconstruction with a SERI surgical scaffold after skin-sparing mastectomy, recording surgical characteristics, perioperative complications and reoperations. A systematic literature review was conducted focusing on preclinical and clinical studies reporting on use of SERI in breast surgery.ResultsA total of 16 patients (22 breasts) were identified (mean age at surgery was 47 ± 6.8 years, mean BMI 23.1 ± 3.1 kg/m², mean ablation weight 530 ± 221 g, median clinical follow-up time 27 months (range 25–37)). There were no intraoperative complications. Postoperative bleeding, that required reoperation occurred in one (5%) breast, postoperative seroma in 10 (45%) and surgical site infection in 2 (9%). Scaffold-related complications occurred in 3 (14%) breasts, comprising lack of scaffold integration in all, resulting in skin ulceration in 2 and the scaffold lying free in the breast pocket surrounded with seroma in one. Nine articles were selected and reviewed from the 170 identified.DiscussionThe role of silk-derived scaffolds in breast reconstruction is yet to be determined. Though first reports have shown promising results, our and others results suggest that scaffold-related complications, such as lack of scaffold integration, may occur more frequently than previously described. Further research is necessary to determine possible (dis)advantages of the scaffold in specific patient groups.

The U.K. approach to putting patient safety first when receiving non-surgical cosmetic therapies: The cosmetic practice standards authority

Publication date: March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 3
Author(s): Alexander Armstrong, Lilli Cooper, Katie Young, Alex Woollard, Emma Craythorne, Tamara Griffiths, Simon Withey, Nigel Mercer

Wound irrigation and the lack of evidence-based-practice

Publication date: Available online 23 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Sarvnaz Sepehripour, Baljit S. Dheansa

Breast reconstruction and risk of arm lymphedema development: A meta-analysis

Publication date: Available online 21 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Charalampos Siotos, Mohamad E. Sebai, Eric L. Wan, Ricardo J. Bello, Mehran Habibi, Damon S. Cooney, Michele A. Manahan, Carisa M. Cooney, Stella M. Seal, Gedge D. Rosson
BackgroundLymphedema remains a significant complication following breast cancer surgery when there is axillary lymph node intervention. Previous systematic reviews have identified risk factors for breast cancer-related lymphedema, including increased BMI, number of lymph nodes dissected and radiotherapy. However, they have not examined the effect of breast reconstruction on lymphedema occurrence. In this systematic review and meta-analysis, we sought to evaluate the association between breast reconstruction (BR) and lymphedema.MethodsWe searched PubMed (1966–2016), Embase (1966–2016), Scopus (2004–2016) and Google Scholar (2004–2016) for studies involving breast reconstruction and upper-extremity lymphedema or breast cancer-related lymphedema. Our primary outcome was lymphedema occurrence. We performed a meta-analysis using random effects due to heterogeneity of the studies.ResultsOur search strategy identified 934 articles. After screening, 19 studies were included in our meta-analysis evaluating outcomes based on number of patients (7501) or number of breasts surgically treated (2063). Breast reconstruction was significantly associated with lower odds of lymphedema (p < 0.001) compared to mastectomy only or breast-conserving surgery. Lymphedema rates were not statistically significantly different between patients undergoing implant-based or autologous BR.ConclusionsBreast reconstruction is associated with lower rates of lymphedema compared to mastectomy only or breast conserving surgery patients. Although the study does not prove causation, we hypothesize that this association is likely due to multiple factors, including a self-selecting population and mechanisms through which BR may contribute to primary or secondary prevention of lymphedema. Further prospective studies are needed to clarify this beneficial relationship between breast reconstruction and reduced lymphedema risk.

Anatomical relationship of the right internal jugular vein and the spinal accessory nerve: A word of caution

Publication date: Available online 15 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): A.J. Robinson, K. Ekanyanke

Biodurability of poly implant prothèse (PIP) breast implants: a prospective analysis of 1028 prostheses in 514 patients.

Publication date: Available online 14 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Richard M. Thomson, Samuel E. Healy, Mohammed Haj Basheer, Keith Morris, I.S. Whitaker

Foot reconstruction using a free proximal peroneal artery perforator flap: anatomical study and clinical application

Publication date: Available online 22 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Hyun Ho Han, Yeon Ji Lee, Suk-Ho Moon
BackgroundWhen a small, thin and durable flap is required for coverage of the foot, the proximal peroneal artery perforator (PPAP) free flap may be novel option. However, few clinical results and anatomical studies on the PPAP flap have been published.MethodsA total of 24 PPAP flaps used in 22 patients from January 2013 to December 2016 were analyzed. All flaps were elevated in the subfascial plane based on a single perforator from the peroneal artery between the soleus and peroneus muscles.ResultsThe average harvested flap size was 18.9 cm² (range, 9-40 cm²), pedicle length was 4.3 cm (range, 3.1-5.5 cm), and pedicle artery diameter was 1.1 mm (range, 0.8-1.5 mm). Twenty-three of 24 PPAP flaps survived. Average time to harvest the flap was 35 minutes (range, 20-55 minutes). Perforator location (ratio by fibula length) was confirmed at the 0.32 site (standard deviation, ±0.04) from the fibular head. Percentages of septocutaneous and musculocutaneous types were 42% (10/24) and 58% (14/24), respectively, for perforator vessel course; average intramuscular course was 1.3 cm (range, 0.7-2.4 cm). Vessel graft was conducted in 4 cases, with an average length of 2.2 cm (range, 1.5-3.0 cm).ConclusionsThe PPAP flap is one of the thinnest flaps available and is relatively easy to elevate. Moreover, it can be elevated in the same operative field as the foot, and primary closure is available for the donor site. Thus, the PPAP flap may be a good surgical option for soft tissue coverage of the foot.

A critical review of melanoma self-screening tools on YouTube – a missed opportunity?

Publication date: Available online 21 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Benjamin Smeeton, Justin C.R. Wormald, Agata M. Plonczak, Daniel Butler, Stephen Hamilton

The ‘WiFi’ otoplasty : Combined concentric posterior microchondrectomies and sutures for correction of prominent ears

Publication date: Available online 19 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Benoit I.M.M. Hendrickx, Moustapha Hamdi, Assaf Zeltzer, Andrew Greensmith
BackgroundProminent ears are by far the most common congenital ear deformity. Many techniques have been described using one or a combination of 3 basic methods: cartilage cutting, cartilage weakening and pure cartilage shaping techniques. The ideal otoplasty technique should yield a natural correction of the deformity, with low recurrence rates and with little risk of complications.MethodsA new cartilage shaping technique using closing wedge concentric microchondrectomies through an entirely posterior approach is presented. Between 2006 and 2017, 200 bilateral otoplasties using this 'WiFi' pattern technique were performed. This technique combined with Mustarde sutures is based on the excision of concentric partial thickness cartilage wedges designed in the pattern of the WiFi symbol.ResultsThere were no major complications such as anterior skin necrosis and no returns to theatre for infections or haematomas. 3 patients (1.5%) had complete recurrence of the deformity and 10 patients (5%) had to undergo a minor revision for recurrence at the upper pole. 5 patients have had exposure of the end of the permanent upper pole scapho-temporal suture more than 3 months after surgery requiring simple outpatient suture trimming/removal without any recurrence of results. Palpable or bridging sutures were present upon clinical examination in 10 patients (5%) but did not require revision surgery.ConclusionsHere, we describe a fast, safe and reliable technique for otoplasty with no need for extensive dissection, which is applicable to the full range of deformity.

The impact of a career night information session on medical students' perceptions of the scope of practice of plastic surgeons

Publication date: Available online 15 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Helene Retrouvey, Kevin J. Zuo, Emily S. Ho, Christopher R. Forrest

A fast and improved method of rapid prototyping for ear prosthesis using portable 3d laser scanner

Publication date: Available online 14 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Nafij Bin Jamayet, Johari Yap Abdullah, Ahmed Mushfiqur Rahman, Adam Husein, Mohammad Khursheed Alam
Conventionally, facial prostheses are developed using wax or clay sculpted patterns. However, recent technological advancements in rapid prototyping systems have shown noteworthy advantages in fabricating facial prostheses that contrast traditional methods. Selective laser sintering technology is an example of this type of technological innovation. This technology can be used as an alternative method in the fabrication of wax patterns for a partial auricular prosthesis. The utilization of this advanced approach greatly reduces manual laboratory steps by directly creating the wax auricular pattern.

RE: MRI anatomical preoperative evaluation of distally based peroneus brevis muscle flap in reconstructive surgery of the lower limb

Publication date: Available online 14 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Rebecca A. Rollett, Rachel M. Clancy, Daniel J. Wilks, Jonathan D. Wiper

Efficacy of a novel strategy for poststernotomy deep sternal infection after thoracic aorta replacement using a prosthetic graft

Publication date: Available online 14 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Motone Kuriyama, Yukitaka Yoshida, Hitoshi Ninomiya, Shin Yamamoto, Shiro Sasaguri, Shinsuke Akita, Nobuyuki Mitsukawa
BackgroundPoststernotomy deep sternal wound infections are persistent and occasionally fatal, especially in cases involving prosthetic grafts, because of its complicated structure and virtual impossibility of removal. We aimed to verify the influence of cooperation with plastic surgeons and our novel strategy for treating deep sternal wound infection after aortic replacement on cardiovascular surgery outcomes.Patients and MethodsNine hundred and eighty-three consecutive patients were divided into two groups: an early (2012-2013) and a late group (2014-2015). The late group had received cooperatively improved perioperative wound management: our novel strategy of deep sternal infection, based on radical debridement and immediate reconstruction decided by reference to severities of patient's general condition and widespread infection by early intervention of plastic surgeons. The groups were analysed retrospectively. Binary variables were analysed statistically with a Fisher's exact test and continuous variables with a Mann-Whitney U test. Inter-group differences were assessed with a chi-square test.ResultsTwenty of 390 cases in the early group and 13 of 593 cases in the late group were associated with deep sternal infection. Morbidity rates of deep sternal wound infection and associated mortality rates one-year after reconstruction surgery were significantly less (p<0.05 for both) in the late group.ConclusionsIntervention by plastic surgeons improved perioperative wound management outcomes. Our treatment strategy for deep sternal wound infection also reduced associated mortality rates. Facilities should consider the early inclusion of plastic surgeons in the treatment of patients undergoing aortic replacement to facilitate better outcomes.

Altered epigenetic pathways and cell cycle dysregulation in healthy appearing skin of patients with koebnerized squamous cell carcinomas following skin surgery

Abstract

Background

Koebnerized non-melanoma skin cancer following skin trauma represents a rare and obscure event.

Objectives

To study molecularpathological parameters in koebnerized squamous cell carcinomas (K-SCCs) occurring after complete tumour removal.

Methods

We assessed two patients with multiple sclerosis who were on treatment with dimethylfumarate (DMF) preceded by long-term azathioprine therapy. Both patients rapidly developed several K-SCCs following histopathologically proven complete excision of cutaneous SCCs. We performed immunohistochemistry for p53, p16, Ki-67, TET-2, IDH-2, 5-hmc, and 5-mc. PCR was carried out for the detection of human papilloma viruses. Mutation analysis was performed for BRAF, K-RAS, and EGFR.

Results

All lesions investigated were negative for HPV DNA. Mutations were not detected. Healthy appearing skin of both patients showed relatively high Ki-67, p16, and p53 expression which was comparable to the expression observed in primary SCCs as well as K-SCCs. Protein expression of Ki-67, p16, and mutant p53 was barely detected in the specimens of the healthy controls. A decreased protein expression of TET-2 enzyme was seen in all tumours and healthy appearing skin when compared to the skin of healthy controls.

Conclusions

We observed two patients with K-SCCs developing under DMF treatment. In healthy appearing skin of patients with K-SCCs, wound healing processes, including induction of proliferation and growth factor release, might promote the growth of pre-neoplastic keratinocytes and cancer formation on the basis of pre-existing altered epigenetic pathways and cell cycle dysregulation. Although fumarates can reduce TET-2 expression, the role of DMF intake in the development of K-SCCs remains unclear.

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The measurement of drug-induced interferon-γ releasing cells and lymphocyte proliferation in severe cutaneous adverse reactions

Abstract

Background

The lymphocyte transformation test (LTT) is a standard laboratory method to identify culprit drugs in patients with a history of drug-induced non-immediate hypersensitivity and is mainly performed during the recovery phase. The measurement of drug-specific interferon-γ (IFN-γ)-releasing cells has been introduced to confirm culprit drugs, even during the acute phase of drug allergy.

Objectives

This study aimed to evaluate the capability of the enzyme-linked immunospot assay (ELISpot) to detect drug-specific IFN-γ-releasing cells during the acute phase and the capability of LTT to identify culprit drugs during the recovery phase in patients presenting with severe cutaneous adverse reactions (SCARs).

Methods

Peripheral blood mononuclear cells (PBMCs) from 23 SCAR patients were collected during the acute and recovery phases and assayed for drug-specific IFN-γ-releasing cells and lymphocyte proliferation, respectively.

Results

Drug-specific IFN-γ releasing cells were detectable in 73.9% of SCAR subjects (55.6% and 85.7% in patients who were and were not taking systemic steroids, respectively), whereas LTT results were positive in 52.2% of SCAR subjects. The frequencies of drug-specific IFN-γ-releasing cells were significantly higher in patients with positive LTT than in those with negative LTT (260.1 ± 110.0 and 46.6 ± 20.7 cells/10⁶ PBMCs, P = 0.01). A significant correlation between the results of the IFN-γ ELISpot assay and LTT was demonstrated (r = 0.65, P value < 0.01).

Conclusion

The IFN-γ ELISpot assay could be a useful tool to identify culprit drugs in SCAR patients when culprit drug identification is urgently needed during the acute phase of drug allergy.

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CYLD mutations differentially affect splicing and mRNA decay in Brooke-Spiegler syndrome

Abstract

Brooke-Spiegler syndrome (BSS; OMIM 605041), also known as familial cylindromatosis (OMIM 132700), is an autosomal dominant tumour predisposition disorder characterised by the occurrence of cylindromas, trichoepitheliomas, and spiradenomas.BSS is caused by heterogenous mutations in the CYLD gene. To date, different CYLD mutations have been reported, most of them resulting in a premature termination codon (PTC).² Among these, thirteen splice site mutations have been described. However, it remains largely elusive how such mutations affect splicing.

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Papulopustular rosacea and rosacea-like demodicosis: two phenotypes of the same disease?

Abstract

Background

Papulopustular rosacea and rosacea-like demodicosis have numerous similarities but they are generally considered as two distinct entities, mainly because the causal role of the Demodex mite in the development of rosacea is not yet widely accepted. Several clinical characteristics are traditionally considered to differentiate the two conditions; for example, papulopustular rosacea is typically characterised by central facial papulopustules and persistent erythema, whereas small superficial papulopustules and follicular scales rather suggest rosacea-like demodicosis. However, none of these characteristics is exclusive to either entity.

Objective

To explore differences in Demodex densities according to clinical characteristics traditionally associated with these two conditions.

Methods

Retrospective, observational, case-control study of 242 patients with central face papulopustules. Demodex densities were measured on two consecutive standardised skin surface biopsies.

Results

In the whole cohort, Demodex densities were greater in patients with persistent erythema than in those without. In 132 patients without recent treatment or other facial dermatoses, 120 (91%) had persistent erythema, 119 (90%) small superficial papulopustules, and 124 (94%) follicular scales; 116 (88%) simultaneously had clinical characteristics traditionally associated with both papulopustular rosacea and rosacea-like demodicosis. Higher Demodex densities were linked to the presence of follicular scales, but not to papulopustules size, nor to the presence/absence of persistent erythema.

Conclusion

Our observations highlight the difficulty differentiating between these entities and suggest that rosacea-like demodicosis and papulopustular rosacea should no longer be considered as two separate entities, but rather as two phenotypes of the same disease.

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Influence of cigarette smoking on pemphigus:a systematic review and pooled analysis of the literature

Abstract

Epidemiological evidence suggests that smoking cigarettes may be beneficial in pemphigus, but no systematic evaluation exists to corroborate this assumption. Therefore, a systematic literature review with pooled data analysis of the smoking status in pemphigus patients was conducted. Electronic searches using PubMed from inception to November 2017 identified 13 reports meeting predetermined inclusion and exclusion criteria. Most were case-control studies partly reporting that pemphigus vulgaris and foliaceus occurred less frequently in current and former smokers. Studies also indicated that duration of smoking and number of cigarettes smoked was lower in pemphigus patients than controls and that remission may be achieved sooner in those who smoke. However, although a generally low prevalence of smoking was demonstrated in pemphigus patients, which was lower than in controls by pooled analysis, some investigations found no difference regarding the smoking status compared with non-pemphigus subjects. One study demonstrated more severe mucosal involvement in non-smoking pemphigus patients, whereas another observed no difference in the rate of cutaneous or mucosal lesions between smokers and non-smokers with pemphigus. This review indicates that smoking may be a possible protective factor in pemphigus, although some compromised study methodologies yet hinder any firm conclusion. Further investigations with a refined quality design are required to resolve the so far partly conflicting results in this area.

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Alternative test models for skin aging research

Abstract

Increasing ethical concerns regarding animal experimentation have led to the development of various alternative methods based on the 3Rs (Refinement, Reduction, and Replacement), first described by Russell and Burch in 1959. Cosmetic and skin aging research are particularly susceptible to concerns related to animal testing. In addition to animal welfare reasons, there are scientific and economic reasons to reduce and avoid animal experiments. Importantly, animal experiments may not reflect findings in humans mainly because of the differences of architectures and immune responses between animal skin and human skin. Here we review the shift from animal testing to the development and application of alternative non-animal based methods and the necessity and benefits of this shift. Some specific alternatives to animal models are discussed, including biochemical approaches, two-dimensional and three-dimensional cell cultures, and volunteer studies, as well as future directions, including genome-based research and the development of in silico computer simulations of skin models. Among the in vitro methods, three-dimensional reconstructed skin models are highly popular and useful alternatives to animal models however still have many limitations. With careful selection and skillful handling, these alternative methods will become indispensable for modern dermatology and skin aging research.

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Blood vessel occlusion with erythrocyte aggregates causes burn injury progression: microvasculature dilation as a possible therapy

Abstract

Other than radiation, caustic strong alkali insults, and massive over-reactive inflammation (pyoderma gangrenosum), injury progression after trauma is usually secondary to ischemia from decreased blood vessel perfusion. Impeded blood flow contributes to injury progression in a variety of disorders including venous stasis ulcers, arterial ulcers, diabetic ulcers, flap and graft necrosis, sickle cell disease, cryoglobulinemia and other vasculopathies, vasculitis, post-myocardial infarction, and post stroke. The cause of impeded blood flow in these disorders/diseases is well known.

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Adjuvant Therapy for Revision Rhinoplasty of Contracted Nose Using Polydeoxyribonucleotide and Invasive Bipolar Radiofrequency

Summary: Most cases of severely contracted nose require revision rhinoplasty and septoplasty, wherein preoperative and/or intraoperative expansion of nasal soft tissue is necessary for tension-free revision surgery. The present study aimed to evaluate the efficacy and safety of pre- and postoperative adjuvant therapy using polydeoxyribonucleotide (PDRN) and invasive, pulsed-type, bipolar, alternating current radiofrequency (RF) for revision surgery of a contracted nose. In total, 30 patients were treated with 16 sessions (8 preoperative sessions and 8 postoperative sessions) of intralesional injection of PDRN and invasive RF treatment using microneedle electrodes at 1-week intervals. One week after the final combined pretreatment using PDRN and invasive bipolar RF, the skin of contracted noses was sufficiently softened, and nasal skin mobility was notably improved in all the patients. During revision rhinoplasty and septoplasty, the contracted nasal skin in each patient was adequately released for proper covering of the nasal tip without tension. Postoperatively, 8 sessions of adjuvant therapy elicited marked clinical improvements in persistent nasal tip dimpling and contracture, septal deviation, and warping from the incomplete recovery of nasal contracture after revision surgery. In conclusion, our pre- and postoperative adjuvant therapies using PDRN and invasive bipolar RF remarkably improved the therapeutic outcomes of revision rhinoplasty and septoplasty for contracted skin of the nose without major side effects.