Beyond the physico-chemical barrier: Glycerol and xylitol markedly yet differentially alter gene expression profiles and modify signalling pathways in human epidermal keratinocytes

Abstract

Polyols (e.g. glycerol, xylitol) are implicated as moisturizers of the skin and other epithelial tissues. However, we lack information about their exact cellular mechanisms and their effects on the gene expression profiles. Therefore, in this study, we aimed at investigating the effects of glycerol and xylitol on human epidermal keratinocytes. The polyols (identical osmolarities; xylitol: 0.0045%-0.45%; glycerol: 0.0027%-0.27%) did not alter cellular viability or intracellular calcium concentration. However, they exerted differential effects on the expression of certain genes and signalling pathways. Indeed, both polyols up-regulated the expression of filaggrin, loricrin, involucrin and occludin; yet, xylitol exerted somewhat more profound effects. Moreover, while both polyols stimulated the MAPK pathway, only xylitol induced the activation-dependent translocation of protein kinase Cδ, a key promoter of epidermal differentiation. Finally, in various keratinocyte inflammation models, both polyols (albeit with different efficacies) exerted anti-inflammatory effects. Taken together, these data strongly suggest that glycerol and xylitol differentially modulate expressions of multiple genes and activities of signalling pathways in epidermal keratinocytes. Thus, our findings invite clinical trials to explore the applicability and the impact of a combined glycerol-xylitol therapy in the management of various skin conditions.

Issue Information

A case of CD8+ and CD56+ cytotoxic variant of poikilodermatous mycosis fungoides: Dermoscopic features of reticular pigmentation and vascular structures

A novel IKBKG mutation in a patient with incontinentia pigmenti and features of hepatic ciliopathy

Abstract

We describe a new mutation in exon 4 of IKBKG, encoding nuclear factor-kappa B in a patient with incontinentia pigmenti. The patient had a severe cholestatic liver disease with features of a ciliopathy and underwent liver transplantation. We cannot establish a link between incontinentia pigmenti, a very rare disease, and hepatic ciliopathy, but we suggest that hepatic evaluation should be considered in patients with incontinentia pigmenti.

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The Editor's Choice

Congenital Aqueductal Stenosis: Findings at Fetal MRI That Accurately Predict a Postnatal Diagnosis [PEDIATRICS]

BACKGROUND AND PURPOSE:

Congenital aqueductal stenosis is a common cause of prenatal ventriculomegaly. An accurate diagnosis provides prognostic information and may guide obstetric management. The purpose of this study was to identify specific anatomic findings on prenatal MR imaging that can be used as predictors of congenital aqueductal stenosis.

MATERIALS AND METHODS:

Prenatal and postnatal MRIs of fetuses referred to our institution for ventriculomegaly between June 2008 and August 2015 were reviewed. Imaging findings in postnatally confirmed congenital aqueductal stenosis (disease group) were compared with those of ventriculomegaly cases from other causes (control group). Univariate analysis was performed using the Fisher exact test and the Wilcoxon rank test, and multivariate analysis, via the random forest method.

RESULTS:

Forty-three cases of ventriculomegaly had a confirmed postnatal diagnosis of congenital aqueductal stenosis. Thirty-two ventriculomegaly cases negative for congenital aqueductal stenosis were included in the control group. Dominant findings associated with an accurate prenatal diagnosis of congenital aqueductal stenosis on multivariate analysis included the following: enlarged inferior third ventricular recesses, enlargement of the lateral ventricles and third ventricle, and an abnormal corpus callosum. Findings that significantly increase the probability of congenital aqueductal stenosis (high positive predictive value) included the following: enlarged third ventricular recesses, aqueduct funneling, hemorrhage in the cerebral aqueduct, ventricular diverticulum, rhombencephalosynapsis, and dystroglycanopathy-related cerebellar dysplasia.

CONCLUSIONS:

Our study identified specific characteristics on fetal MR imaging that can be used as predictors of the diagnosis of congenital aqueductal stenosis. Most of these findings are secondary to the obstructive nature of the resulting hydrocephalus. Common associated malformations such as rhombencephalosynapsis and dystroglycanopathies should also increase the suspicion of congenital aqueductal stenosis when present with ventriculomegaly.

Prenatal Brain MR Imaging: Reference Linear Biometric Centiles between 20 and 24 Gestational Weeks [PEDIATRICS]

BACKGROUND AND PURPOSE:

Evaluation of biometry is a fundamental step in prenatal brain MR imaging. While different studies have reported reference centiles for MR imaging biometric data of fetuses in the late second and third trimesters of gestation, no one has reported them in fetuses in the early second trimester. We report centiles of normal MR imaging linear biometric data of a large cohort of fetal brains within 24 weeks of gestation.

MATERIALS AND METHODS:

From the data bases of 2 referral centers of fetal medicine, accounting for 3850 examinations, we retrospectively collected 169 prenatal brain MR imaging examinations of singleton pregnancies, between 20 and 24 weeks of gestational age, with normal brain anatomy at MR imaging and normal postnatal neurologic development. To trace the reference centiles, we used the CG-LMS method.

RESULTS:

Reference biometric centiles for the developing structures of the cerebrum, cerebellum, brain stem, and theca were obtained. The overall interassessor agreement was adequate for all measurements.

CONCLUSIONS:

Reference biometric centiles of the brain structures in fetuses between 20 and 24 weeks of gestational age may be a reliable tool in assessing fetal brain development.

Fast and Robust Unsupervised Identification of MS Lesion Change Using the Statistical Detection of Changes Algorithm [ADULT BRAIN]

SUMMARY:

We developed a robust automated algorithm called statistical detection of changes for detecting morphologic changes of multiple sclerosis lesions between 2 T2-weighted FLAIR brain images. Results from 30 patients showed that statistical detection of changes achieved significantly higher sensitivity and specificity (0.964, 95% CI, 0.823–0.994; 0.691, 95% CI, 0.612–0.761) than with the lesion-prediction algorithm (0.614, 95% CI, 0.410–0.784; 0.281, 95% CI, 0.228–0.314), while resulting in a 49% reduction in human review time (P = .007).

Long-Term Outcomes of Patients with Stent Tips Embedded into Internal Carotid Artery Branches during Aneurysm Coiling [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

During stent-assisted coiling of ICA aneurysms, stent tips are sometimes unintentionally embedded into ICA branches. Stent tips can be visualized because they have radiopaque markers. Concerns regarding stent tip misplacement include risks of artery perforation and occlusion. The aim of this study was to evaluate the long-term outcomes of ICA branches with embedded stent tips.

MATERIALS AND METHODS:

ICA branches with embedded stent tips were identified among 35 patients with unruptured ICA aneurysms treated with stent-assisted coiling between November 2003 and November 2014. Patient clinical and angiographic outcomes associated with the embedded stent tip were analyzed.

RESULTS:

Most of the 35 studied aneurysms were paraclinoid ICA aneurysms (n = 30). The most commonly involved ICA branch was the posterior communicating artery (26 patients, 74.3%), followed by the anterior choroidal artery (8 patients, 22.9%) and ophthalmic artery (1 patient, 2.9%). During the follow-up period (38.6 ± 17.9 months), no new neurologic deficits developed. Neither hemorrhagic nor thromboembolic events occurred. Angiography was performed during the final follow-up evaluation at a mean of 32.7 ± 18.0 months, and all ICA branches with embedded stent tips showed patent blood flow without severe luminal narrowing.

CONCLUSIONS:

In our experience, placement of a stent tip into ICA branches during stent-assisted coiling was not associated with any major adverse events.

MRI Features Can Predict 1p/19q Status in Intracranial Gliomas [ADULT BRAIN]

BACKGROUND AND PURPOSE:

The 2016 revision of the World Health Organization Classification of Tumors of the Central Nervous System mandates codeletion of chromosomes 1p and 19q for the diagnosis of oligodendroglioma. We studied whether conventional MR imaging features could predict 1p/19q status.

MATERIALS AND METHODS:

Patients with previous 1p/19q testing were identified through pathology department records, typically performed on the basis of an oligodendroglial component on routine histology; 69 patients met the inclusion criteria. Preoperative imaging of patients with grade II or III gliomas was retrospectively assessed by 2 neuroradiologists, blinded to the 1p/19q status. Thirteen MR imaging features were first assessed in a small initial cohort (n = 10), after which the criteria were narrowed for the remaining patients as a validation cohort.

RESULTS:

There was 85% agreement between radiologists for the overall prediction of 1p/19q status in the validation cohort, with an accuracy of 84%. The presence of >50% T2-FLAIR mismatch and calcification was found to be the most useful for predicting 1p/19q status. The >50% T2-FLAIR mismatch variable was demonstrated in 14 tumors and had 100% specificity for identifying a noncodeleted tumor (P = .001), with 97% interobserver correlation. Calcification was visualized in 7 tumors, 6 of which were 1p/19q codeleted (specificity, 97%; P = .006), with 100% interobserver correlation.

CONCLUSIONS:

The presence of >50% T2-FLAIR mismatch is highly predictive of a noncodeleted tumor, while calcifications suggest a 1p/19q codeleted tumor. If formal 1p/19q testing is not possible, a combined MR imaging–histologic assessment may improve the diagnostic accuracy over histology alone.

Quantitative Phase-Contrast MR Angiography to Measure Hemodynamic Changes in Idiopathic Intracranial Hypertension [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Idiopathic intracranial hypertension is a syndrome of raised intracranial pressure of unknown etiology. Few MR imaging–based studies have investigated arterial and venous blood flow in these patients. Results are inconclusive, and to our knowledge, no comparison of the hemodynamic parameters before and after CSF pressure reduction has been published. The aim of this study was to assess the short-term effects of normalizing CSF pressure on intracranial flow to better understand the pathophysiology of idiopathic intracranial hypertension.

MATERIALS AND METHODS:

In this study, we performed quantitative MR imaging–derived flow measurements of brain-supplying arteries and draining veins/dural sinuses to visualize hemodynamic changes in patients with idiopathic intracranial hypertension before and after therapy by lumbar puncture in comparison with a healthy control group.

RESULTS:

We found differences in patients before and after lumbar puncture in the calculated resistance and pulsatility indices in the superior sagittal sinus. Venous pulsatility showed a negative correlation with CSF pressure in untreated patients. Additionally, there was a trend toward lower flow in the superior sagittal sinus in patients compared with healthy controls. Flow in the internal jugular veins was significantly reduced by lumbar puncture, and the resistance and pulsatility indices differed in patients and controls. The arterial flow was not influenced by pressure normalization.

CONCLUSIONS:

The results of the present study indicate that venous but not arterial blood flow differs in patients compared with controls and that calculating resistance and pulsatility indices may contribute to assessing short-term hemodynamic changes in patients with diagnosed idiopathic intracranial hypertension before and after CSF diversion.

Whole-Tumor Histogram and Texture Analyses of DTI for Evaluation of IDH1-Mutation and 1p/19q-Codeletion Status in World Health Organization Grade II Gliomas [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Prediction of the isocitrate dehydrogenase 1 (IDH1)-mutation and 1p/19q-codeletion status of World Health Organization grade ll gliomas preoperatively may assist in predicting prognosis and planning treatment strategies. Our aim was to characterize the histogram and texture analyses of apparent diffusion coefficient and fractional anisotropy maps to determine IDH1-mutation and 1p/19q-codeletion status in World Health Organization grade II gliomas.

MATERIALS AND METHODS:

Ninety-three patients with World Health Organization grade II gliomas with known IDH1-mutation and 1p/19q-codeletion status (18 IDH1 wild-type, 45 IDH1 mutant and no 1p/19q codeletion, 30 IDH1-mutant and 1p/19q codeleted tumors) underwent DTI. ROIs were drawn on every section of the T2-weighted images and transferred to the ADC and the fractional anisotropy maps to derive volume-based data of the entire tumor. Histogram and texture analyses were correlated with the IDH1-mutation and 1p/19q-codeletion status. The predictive powers of imaging features for IDH1 wild-type tumors and 1p/19q-codeletion status in IDH1-mutant subgroups were evaluated using the least absolute shrinkage and selection operator.

RESULTS:

Various histogram and texture parameters differed significantly according to IDH1-mutation and 1p/19q-codeletion status. The skewness and energy of ADC, 10th and 25th percentiles, and correlation of fractional anisotropy were independent predictors of an IDH1 wild-type in the least absolute shrinkage and selection operator. The area under the receiver operating curve for the prediction model was 0.853. The skewness and cluster shade of ADC, energy, and correlation of fractional anisotropy were independent predictors of a 1p/19q codeletion in IDH1-mutant tumors in the least absolute shrinkage and selection operator. The area under the receiver operating curve was 0.807.

CONCLUSIONS:

Whole-tumor histogram and texture features of the ADC and fractional anisotropy maps are useful for predicting the IDH1-mutation and 1p/19q-codeletion status in World Health Organization grade II gliomas.

Targeting the Clot in Acute Stroke [LETTERS]

Oculoplastics Abstracts

No abstract available

Subepidermal Calcinosis in the Ocular Adnexa: A Systematic Review

Purpose: To review the clinical and histopathologic findings associated with subepidermal calcinosis of the eyelids. Methods: A systematic review of the literature on subepidermal calcinosis of the eyelids was performed. Cases included were idiopathic in nature and met the histologic criteria for subepidermal calcinosis with calcium deposits in the dermis of the skin. Results: Twenty-one publications presenting 53 cases of subepidermal calcinosis involving the eyelids were published between 1970 and 2016. Males were affected more than females (67% vs. 33%), and 89% of patients were 21 years of age or younger. A total of 63% were non-Caucasian. Most cases involved a single lesion (82%), and lesions were most frequently located on the upper eyelid (63%). In 81% of cases, the lesion was less than 5 mm in diameter. When reported, the treatment of choice was complete surgical excision. Conclusions: Subepidermal calcinosis should be considered in the differential diagnosis of idiopathic lesions on the eyelid, particularly in young males with no history of systemic disease or laboratory abnormalities. These nodules usually present as painless, small, firm, mobile solitary cutaneous lesions with a predilection for the upper eyelid. Diagnosis is confirmed by histopathology, and treatment is with surgical excision.

Orbital Inclusion Cyst Formation 3 Years After Penetrating Orbital Trauma

No abstract available

Ophthalmic Manifestations of Facial Dog Bites in Children

Purpose: To characterize ophthalmic manifestations and periocular injuries of pediatric facial dog bites. Methods: A retrospective review of all children younger than 18 years who sought medical attention after a dog bite to the face between January 1, 2003 and May 22, 2014 was performed at a large tertiary pediatric hospital. Data on type and location of injury, surgical intervention, and complications were collected. Results: A total of 1,989 children aged 0.19 to 17 years were identified with dog bites. Dog bites to the face occurred in most patients (n = 1, 414 [71%]). Of those children with facial dog bite injuries, 230 (16%) suffered ophthalmic manifestations. The average age was 4.3 years. Eyelid injuries occurred in 227 (99%) of children, 47 (20%) sustained canalicular system injuries, 3 (1.3%) suffered corneal abrasions, and 2 patients sustained facial nerve injury resulting in lagophthalmos. No patients suffered vision loss. Complications occurred in 32 patients (14%), with the most common being epiphora in 9 patients (28%), upper eyelid ptosis in 8 (25%), and prominent scar formation in 4 patients (13%). Thirteen children (5.7%) needed one or more secondary procedure to correct complications. Conclusions: The authors report the clinical features and management on the largest series of ophthalmic and periocular injuries associated with pediatric facial dog bites. These injuries occur in about 1 in 6 dog bites to the face and primarily involve the ocular adnexa. Despite early and appropriate surgical management, complications and the need for revision surgery are relatively common.

Koebner Phenomenon Triggered by External Dacryocystorhinostomy Scar in a Patient With Psoriasis: A Case Report and Literature Review

Koebner phenomenon is the development of isomorphic pathologic lesions on a wound of a patient with preexisting cutaneous disease, most commonly psoriasis. An elderly male with palmoplantar psoriasis developed periocular psoriasis in the form of blepharitis and conjunctivitis following an external dacryocystorhinostomy as a manifestation of Koebner phenomenon. Immediate diagnosis and treatment with topical steroids led to complete recovery. Thus, the authors report the first case of Koebner phenomenon in ophthalmic literature, with a review of previously published postsurgical cases of Koebnerization in psoriasis patients. All surgeons should be aware of its existence and warn susceptible patients regarding its occurrence.

Programmed Death-1 Pathway in Orbital Invasion of Cutaneous Carcinomas

Purpose: The programmed death-1 pathway negatively regulates the immune system. Previous reports have indicated worse tumor-related outcomes with increased expression of the ligand for this pathway. This study was undertaken to assess the role of the PD pathway in cutaneous malignancies that invade the orbit. Methods: Immunohistochemical staining for the programmed death-1 receptor and ligand was performed on exenteration specimens of invasive cutaneous orbital malignancies (n = 12) and nodular basal cell carcinoma (n = 10). The numbers of positively-staining cells/40× field were counted across 5 consecutive fields, and statistical analyses were performed to compare the differences between the 2 groups. Results: Programmed death-1 receptor positivity was seen in means of 30.9 cells/40× field and 62.4 cells/40× field for nodular basal cell carcinomas and invasive malignancies, respectively (p = 0.0046). A mean of 4.54 cells/40× field stained positively for the programmed death-1 ligand in nodular basal cell carcinoma, whereas a mean of 46.4 cells/40× field stained positively for programmed cell death ligand-1 in orbital invasive cutaneous carcinomas (p = 0.0015). Both of these differences were statistically significant. Conclusions: Both the programmed death-1 receptor and its ligand are enriched in invasive cutaneous malignancies. This finding indicates that negative regulation of the immune system likely prohibits tumor surveillance, and facilitates increasing aggressiveness and invasion of cutaneous malignancies.

Re: “Postoperative Changes in Strabismus, Ductions, Exophthalmometry, and Eyelid Retraction After Orbital Decompression for Thyroid Orbitopathy”

No abstract available

Operating Room Fires in Oculoplastic Surgery

Purpose: This study was performed to characterize the frequency, causes, and possible risk factors of operating room (OR) fires experienced by members of the American Society of Ophthalmic Plastic and Reconstructive Surgery. Methods: An online questionnaire was distributed to American Society of Ophthalmic Plastic and Reconstructive Surgery members, collecting data on surgical fires experienced by respondents throughout their careers. In addition, the questionnaire investigated viewpoints on OR fire safety, current practice patterns with oxygen delivery and surgical device usage, and management of patients referred after previous surgical fire exposure. Results: There were 258 participants in the survey. Eighty-three surgeons (32.2%) experienced at least 1 surgical fire in their careers. Most OR fires occurred during monitored sedation cases with oxygen delivered by nasal cannula underneath drapes completely covering the head and use of a monopolar or battery-operated device. Patient hair and skin were the most common fuel sources, and most of the injuries were limited to singing of facial hair. Regarding current practice patterns, monopolar, bipolar, and battery-powered disposable devices were the most frequently used electrosurgery and electrocautery tools. Patients seen after an OR fire with another surgeon generally experienced more severe burns requiring hospitalization and subsequent procedures. Conclusions: Many oculoplastic surgeons have experienced OR fires during their careers. Certain surgical and anesthetic techniques, particularly the delivery of supplemental oxygen underneath surgical drapes and the use of monopolar electrosurgery and battery-powered electrocautery, may be associated with increased fire risk. While most of the reported OR fires did not result in significant patient injury, caution must be taken to prevent these potentially devastating events.

Orbital Inflammation as a Presenting Sign for CREST Syndrome

A 61-year-old male was referred with a week's history of a painful and swollen left eye. Examination revealed normal visual acuities, left proptosis and global restriction of ocular ductions, and subretinal fluid at the macula. CT imaging confirmed thickening of the posterior scleral coat, with an associated choroidal effusion. Serology revealed positive antinuclear antibodies with a centromere staining pattern; subsequent rheumatology review revealed extensive telangiectasia with digital ulceration in both hands, and a diagnosis of limited cutaneous systemic sclerosis was made. Orbital inflammatory disease is often the initial presentation of systemic diseases such as sarcoidosis, granulomatosis with polyangiitis, and IgG4 disease. Limited cutaneous systemic sclerosis is rarely encountered in the context of orbital inflammation, but is a further systemic association, reminding the clinician of the diagnostic importance of peripheral symptoms and serological markers in patients presenting with orbital inflammation and scleritis.

Optimal Epinephrine Concentration and Time Delay to Minimize Perfusion in Eyelid Surgery: Measured by Laser-Based Methods and a Novel Form of Extended-Wavelength Diffuse Reflectance Spectroscopy

Objective: This study investigates the hypoperfusion effects of epinephrine in local anesthesia in eyelid surgery. A novel form of extended-wavelength diffuse reflectance spectroscopy was evaluated. Methods: Blood perfusion in porcine eyelid flaps was measured using laser Doppler velocimetry and laser speckle contrast imaging, whereas the tissue response was measured using diffuse reflectance spectroscopy with a broad spectrum (450–1550 nm). Epinephrine was either injected cumulatively, 0.1 (1:10,000,000), 1.0 (1:1,000,000), 10 (1:100 000), and 100 μg/ml (1:10 000), to determine the dose–response relation, or given as a single dose (10 μg/ml). Control experiments were performed with saline or lidocaine. Results: Increasing concentrations of epinephrine resulted in a gradual decrease in tissue perfusion, measured by laser Doppler velocimetry and laser speckle contrast imaging, approaching a minimum after the injection of 10 μg/ml. Similar tissue response was observed with diffuse reflectance spectroscopy. The time from the injection of epinephrine (10 μg/ml) to the stabilization of hypoperfusion was 75 seconds. After administration of 10 μg/ml epinephrine, about 20% of the blood perfusion remained, supporting the use of epinephrine in eyelid flaps with a narrow pedicle. Conclusions: 10 μg/ml epinephrine appears to be adequate for vasoconstriction before oculoplastic surgery. Incisions need only be delayed for about 1 minute. Extended-wavelength diffuse reflectance spectroscopy appears to be a promising technique for monitoring the tissue response following changes in blood perfusion in plastic surgery reconstructions. However, more rigorous validation of the technique is required before it can be implemented in clinical practice.

Clinical Description, Molecular Analysis of TWIST2 Gene, and Surgical Treatment in a Patient With Barber-Say Syndrome

Barber-Say syndrome is a rare autosomal dominant disease characterized by dysmorphic features, mainly of the eyelids and skin. It is caused by heterozygous mutations in gene TWIST2, localized in chromosome 2q37.3. The authors present the case of a pediatric patient with a clinical diagnosis of Barber-Say syndrome with ocular symptoms related to exposure keratitis. Molecular analysis of her DNA revealed a mutation on TWIST2 gene confirming the diagnosis of Barber-Say syndrome. Surgical treatment of the patient's eyelids resolved her signs and symptoms.

Can We Improve the Tolerance of an Ocular Prosthesis by Enhancing Its Surface Finish?

Purpose: Patients who wear an ocular prosthesis frequently suffer with dry eye symptoms and socket discharge, often on a daily basis. The aim of the study was to determine whether a smoother, optical quality polish of the prosthesis' surface could improve symptoms and wear tolerance. The study was designed as single-center, single-masked, prospective randomized controlled trial. Eighty-eight consecutive patients undergoing annual ocular prosthesis maintenance review were approached from the prosthesis clinic. Forty-one out of 49 eligible patients were recruited. Methods: Participants were randomized to either a standard or a higher "optical quality" polish of their prosthesis. At entry to the trial, at 1 month, and 12 months they completed a questionnaire covering cleaning, lubricant use, inflammation, discomfort, and discharge. Lower scores indicated better tolerance of the prosthesis. At each visit, the prosthesis was stained and photographed against a standard background to assess deposit build up. Primary outcome measures were 1) a subjective questionnaire score and 2) an objective assessment of surface deposit build-up on prosthetic eyes by standardized photographic grading. Results: Forty-one patients participated in the study. The median age of their prosthesis was 36 months (range 9 months–40 years). There was no statistically significant difference in questionnaire scores or deposit build up between the 2 groups at baseline. By 12-months, the higher optical quality polish showed a statistically significant reduction in symptoms and frequency of discharge (2.19 vs. 3.85; p = 0.05—lower scores better). Scoring of the prosthesis' deposit build-up showed a significant difference at 1 month, but this was not sustained at 12 months. Conclusions: Creating an optical quality finish to an ocular prosthesis reduces deposit build up on artificial eyes. The authors found this modification improved patient tolerance at 12 months.

Re: “A Single- Versus Double-Layered Closure Technique in Anophthalmic Surgery”

No abstract available

Nanoskin® Subcutaneous Implant in Guinea Pigs

Purpose: To evaluate the suitability of Nanoskin®, a biomaterial derived from bacterial cellulose, as an alternate material for repairing the posterior lamellae of the eyelids. Methods: Forty guinea pigs received a fragment of Nanoskin® subcutaneously in the dorsal region. The animals received Nanoskin® (group 1) or Nanoskin® coated with a gelatin layer (group 2). The animals were observed daily for over 7, 30, 90, or 180 days with the subcutaneous implants in place. The animals were euthanized at a designated time and the Nanoskin® was removed for histologic, morphometric, and transmission electron microscopy evaluation. Results: The results were similar for both groups. The subcutaneously implanted Nanoskin® resulted in good tissue integration, induced mild inflammation, and was surrounded by a delicate pseudocapsule. Conclusion: The good tissue integration of Nanoskin® in study indicates that it may be a potential material for application as a substitute of posterior eyelid lamellar tissue. Further clinical studies are required to confirm the preliminary outcomes of this experimental study.

Assessing the Effectiveness of Arnica montana and Rhododendron tomentosum (Ledum palustre) in the Reduction of Ecchymosis and Edema After Oculofacial Surgery: Preliminary Results Erratum.

No abstract available

Lateral Rectus Muscle Expands More Than Medial Rectus Following Maximal Deep Balanced Orbital Decompression

Purpose: It has been reported that extraocular muscles can enlarge following orbital decompression in thyroid eye disease. In this article, the authors studied the changes in extraocular muscles size following maximal deep lateral and medial balanced decompression in a large sample of thyroid eye disease patients. Methods: Imaging data were reviewed preoperatively and postoperatively. Radiologic proptosis was assessed. Maximal axial muscle width of the medial and lateral recti was measured. Results: Data from 48 consecutive patients (75 orbits) were included. There was a significant increase in the width of both the lateral and medial recti after decompression (p 1 mm. Mean (SD) proptosis reduction was 8.2 mm (3.4 mm). Conclusion: These results suggest that the extraocular muscles enlarge in the most deep lateral wall decompressions. For decompression as performed in this article, expansion tends to be more commonly found and of a greater magnitude in the lateral rectus compared with medial.

Acquired Intermittent Pediatric Horner Syndrome due to Neuroblastoma

A 3-month-old male developed intermittent left upper eyelid ptosis at the age of 1 month that was gradually increasing in frequency and duration. Examination revealed anisocoria and left upper and lower eyelid ptosis, consistent with a left Horner syndrome. Imaging showed a mass in the left superior posterior mediastinum, which was resected, and pathology was consistent with neuroblastoma. Eight months thereafter, the patient underwent left upper eyelid ptosis repair. Cases of infantile acquired Horner syndrome due to neuroblastoma are rare. To the authors' knowledge, there has only been one case described that presented with intermittent symptoms. The authors report the second case of intermittent acquired Horner syndrome due to neuroblastoma. This case demonstrates the importance of recognizing that Horner syndrome may present with subtle and intermittent symptoms. In a pediatric patient, one should maintain suspicion for neuroblastoma.

Spheno-Orbital Meningiomas: An Analysis Based on World Health Organization Classification and Ki-67 Proliferative Index

Purpose: To evaluate the clinical behavior of spheno-orbital meningiomas with regard to World Health Organization (WHO) tumor grade and Ki-67, a cellular marker of proliferation. Methods: A retrospective review over a 16-year period of the demographic, clinical, radiographic, and surgical data of all patients with spheno-orbital meningioma who underwent surgical resection. Tumor specimens were examined histologically using the current WHO 2016 classification and immunohistochemically using Ki-67/MIB-1 monoclonal antibody. Results: Thirty-eight patients met all inclusion criteria: 78.9% of tumors were WHO grade I with a mean Ki-67 of 3.76, and 93% of patients were clinically stable at last follow up; 10.5% of lesions were WHO grade II (atypical) with a mean Ki-67 of 14.93, and 10.5% of lesions were WHO grade III (anaplastic) with a mean Ki-67 of 58.3. All grade II and III meningiomas exhibited an aggressive clinical course. There were statistically significant correlations between disease clinical progression and WHO tumor grade (p

Lenalidomide-Associated Thyroid-Related Eyelid Retraction

Several antineoplastic treatments have been responsible for thyroid dysfunction and thyroid eye disease. Min, Vaidya, and Becker (2011) reported a case of euthyroid Graves orbitopathy after treatment with ipilimumab with the patient displaying proptosis and myositis in the setting of normal thyroid function tests and elevated thyroid antibodies. The authors report a case of a 76-year-old woman who developed right upper lid retraction and proptosis after 2.5 years of treatment with lenalidomide for multiple myeloma. Thyroid function tests were normal: thyroid-stimulating hormone 0.808 mIU/mL, total T3 102 ng/dL, free T4 1.48 ng/dL. Thyroid antibodies were elevated: thyrotropin receptor antibody 2.26 IU/L, thyroglobulin antibody 1043.1 IU/mL, and thyroid peroxidase antibody 38 IU/mL. A nuclear medicine thyroid scan was normal. Given the possible thyroid effects from lenalidomide, patients who receive this medication should be periodically evaluated for thyroid dysfunction and thyroid eye disease.

The Phenylephrine Test Revisited

Purpose: To characterize the phenylephrine test in ptotic patients to help clinicians perform the test more efficiently. Methods: Adults with involutional ptosis (n = 24, 30 eyes) were assessed with digital photographs for response to topical 2.5% phenylephrine drop instillation. Patient characteristics (age, gender, iris color, dermatochalasis, brow ptosis, and baseline marginal reflex distance-1 [MRD-1] height) were recorded. From the photographs, change in (MRD-1), presence of conjunctival blanching, pupillary dilation, and Hering effect were recorded at specified time intervals, 1 minute to 1 hour after drop placement. Correlations between patient characteristics and measured outcomes were evaluated using analysis of variance, Pearson coefficient, or chi-square tests. Results: The authors found that 73% of eyes had eyelid elevation with phenylephrine. Of these, 50% reached maximal eyelid elevation by 5 minutes, and 86% by 10 minutes after drop placement, but 14% did not reach maximal MRD-1 until 30 minutes. There is a negative correlation between the maximum MRD-1 and the baseline MRD-1 eyelid height (r = −0.5330, p

An Overview of Epidermal Lamellar Bodies: Novel roles in biological adaptations and secondary barriers

The epidermal lamellar bodies (LBs) are specialized organelles that contain pro-barrier lipids imparting a fully lamellar internal structure, but also other cargoes such as enzymes (lipid metabolizing and proteolytic), enzyme inhibitors, and antimicrobial peptides. Thus, the LB secretory system, by virtue of delivering these cargoes to the stratum corneum (SC) interstices, is essential for forming the various skin barriers located in the SC. Ultrastructural studies have suggested that the morphologic features of LBs reflect the functional status of the SC.

Mechanical forces in skin disorders

Mechanical forces are known to regulate homeostasis of the skin and play a role in the pathogenesis of skin diseases. The epidermis consists of keratinocytes that are tightly adhered to each other by cell junctions. Defects in keratins or desmosomal/hemidesmosomal proteins lead to the attenuation of mechanical strength and formation of intraepidermal blisters in the case of epidermolysis bullosa simplex. The dermis is rich in extracellular matrix, especially collagen, and provides the majority of tensile force in the skin.

Effects of a novel neonicotinoid insecticide cycloxaprid on earthworm, Eisenia fetida

Abstract

Cycloxaprid (CYC) is a novel neonicotinoid insecticide with high activity against resistant pests but is safe for mammals. The toxic effects of CYC on earthworms (Eisenia fetida) were studied in this paper. The 14-day exposure results showed that CYC is potentially toxic to earthworms, with a 14d-LC₅₀ of 10.21 mg/kg _{dry soil}, and that it induced tissue damage to the epidermis, gut, and neurochord at sublethal doses. During a 21-day exposure, CYC induced oxidative stress in earthworms, and both enzyme activities of catalase (CAT) and superoxide dismutase (SOD) were impacted. In addition, expression of the genes Cat and Sod were down- and upregulated, respectively. The activity of the enzyme acetylcholinesterase (AChE) was increased at day 7 but decreased at day 21 after CYC exposure, while expression of the signal transduction-related genes was significantly regulated. Our study shows for the first time that negative impacts could be induced by CYC on earthworms under both acute and chronic exposure through oxidative stress and gene regulation. The present study provides a database for assessing the environmental risk to non-target organisms resulting from the use of CYC.

Mapping for the management of diffuse pollution risks related to agricultural plant protection practices: case of the Etang de l’Or catchment area in France

Abstract

Faced with health, environmental, and socio-economic issues related to the heavy use of pesticides, diffuse phytosanitary pollution becomes a major concern shared by all the field actors. These actors, namely the farmers and territorial managers, have expressed the need to implement decision support tools for the territorial management of diffuse pollution resulting from the plant protection practices and their impacts. To meet these steadily increasing requests, a cartographic analysis approach was implemented based on GIS which allows the spatialization of the diffuse pollution impacts related to plant protection practices on the Etang de l'Or catchment area in the South of France. Risk mapping represents a support-decision tool that enables the different field actors to identify and locate vulnerable areas, so as to determine action plans and agri-environmental measures depending on the context of the natural environment. This work shows that mapping is helpful for managing risks related to the use of pesticides in agriculture by employing indicators of pressure (TFI) and risk on the applicator's health (IRSA) and on the environment (IRTE). These indicators were designed to assess the impact of plant protection practices at various spatial scales (field, farm, etc.). The cartographic analysis of risks related to plant protection practices shows that diffuse pollution is unequally located in the North (known for its abundant garrigues and vineyards) and in the South of the Etang de l'Or catchment area (the Mauguio-Lunel agricultural plain known for its diversified cropping systems). This spatial inequity is essentially related to land use and agricultural production system. Indeed, the agricultural lands cover about 60% of the total catchment area. Consequently, this cartographic analysis helps the territorial actors with the implementation of strategies for managing risks of diffuse pollution related to pesticides use in agriculture, based on environmental and socio-economic issues and the characteristics of the natural environment.

Biochar application increases sorption of nitrification inhibitor 3,4-dimethylpyrazole phosphate in soil

Abstract

Biochar (BC) application to soils is of growing interest as a strategy to improve soil fertility and mitigate climate change. However, BC-induced alterations in the soil N cycle are currently under debate. BC has recently been shown to accelerate the emissions of N₂O via the biotic ammonium oxidation pathway, which results in lower nitrogen use efficiency and environmentally harmful losses of NO₃ and/ or N₂O. To avoid these potential losses, the use of nitrification inhibitor (NI) could provide a useful mitigation strategy for BC-amended agricultural fields. Here, we tested the sorption behavior of a model NI, the synthetic 3,4-dimethylpyrazole phosphate (DMPP) on 15-month-aged soil-BC mixtures. We saw that BC additions increased DMPP sorption to varying extents depending on BC feedstock type and pyrolysis temperature. The highest sorption was found for BC pyrolyzed at a lower temperature. BC effects on soil physico-chemical characteristics (i.e., hydrophobicity) seem to be important factors.

Bleaching of biofilm-forming algae induced by UV-C treatment: a preliminary study on chlorophyll degradation and its optimization for an application on cultural heritage

Abstract

Green microalgae colonizing stone surfaces represent a major problem for the conservation of heritage monuments, since they lead to biodegradation and aesthetic issues. Previous studies in La Glacière show cave (France) have demonstrated that UV-C may have a strong effect on microalgae, thus leading to chlorophyll bleaching, which was increased when biofilms were maintained under VIS-light condition unlike to those maintained in the dark. To understand the physiological mechanisms underlying this response and in order to optimize in situ treatment, 30 kJ m⁻² UV-C exposure times were applied to Chlorophyta Chlorella sp. and chlorophyll degradation kinetics were then monitored. UV-C irradiation was enough to inhibit photosynthesis and to directly kill all algal cells. Results also showed that chlorophyll a was degraded faster than chlorophyll b and that 14 h were necessary for complete degradation of all the present chlorophyll. In addition, our results highlighted the importance of visible light exposition after UV-C treatment which leading to chlorophyll bleaching. Irradiated algae cultivated in the dark were still green 5 days after treatment while cultivated samples in the light lost their green color after 14 h. An efficient UV-C treatment applicable to show caves and other heritage monuments was proposed.

Levels of urinary metabolites of four PAHs and cotinine determined in 1016 volunteers living in Central Italy

Abstract

Polycyclic aromatic hydrocarbons (PAH) are products of the incomplete combustion of organic materials, and exposure of the general population to PAH is ubiquitous. They are also present in tobacco smoke. Some PAH are classified as carcinogens. Urine samples from 747 non-smoking and 269 smoking subjects living in the same area of Central Italy were analyzed in order to determine reference values for PAHs exposure of a general population. The concentration of cotinine, urinary metabolite of nicotine was also measured in these samples in order to classify the subjects as smokers or not. The median concentration and 50th percentile in females was higher than in males for all metabolites; 1- and 2-hydroxynaphtalene (1-OHNAP and 2-OHNAP) and 1-hydroxypyrene (1-OHPy), are significantly higher in smokers; on the other side 3-hydroxybenzo[a]pyrene (3-OHBaPy) and 6-hydroxynitropyrene (6-OHNPy) do not correlate with the cotinine concentration.

NO 3 − /NH 4 + ratios affect nutritional homeostasis and production of Tanzania guinea grass under Cu toxicity

Abstract

Nitrogen (N) can alleviate metal toxicity. However, as of yet, there have been no studies showing the efficacy of NO₃⁻/NH₄⁺ in mitigating Cu toxicity. The objective of this study was to evaluate the Cu toxicity on the nutritional and productive attributes of Panicum maximum cv. Tanzania as well as the role of NO₃⁻ and NH₄⁺ ratios in nutritional homeostasis. The experiment was conducted using 3 × 4 factorial treatments arranged in a randomized complete block design with three replicates. The treatments were three NO₃⁻/NH₄⁺ ratios (100/0, 70/30, and 50/50) and four Cu rates (0.3, 250, 500, and 1000 μmol L⁻¹) in nutrient solution. Copper concentrations in the diagnostic leaves (DL) were highest in plants grown under 70/30 NO₃⁻/NH₄⁺ ratios and a Cu rate of 1000 μmol L⁻¹. In this combination, it was observed that DL had higher concentrations of NH₄⁺, greater glutamine synthetase activity, lower chlorophyll concentration (SPAD value), and lower shoot dry mass, suggesting high disorders of nutritional homeostasis. Plants receiving N in the form of NO₃⁻ and 1000 Cu μmol L⁻¹ showed that DL had lower concentrations of Cu, higher concentration of chlorophyll, higher NO₃⁻ concentration, higher nitrate reductase activity, and higher NO₃⁻ accumulation in the roots, suggesting a reduction in disorders of nutritional homeostasis. The disorders on mineral uptake, N assimilation, and biomass production caused by Cu toxicity are shown to be affected by NO₃⁻/NH₄⁺ ratios, and N supply via NO₃⁻ allowed for better homeostasis of the forage grass.

Detoxification, oxidative stress, and cytogenotoxicity of crack cocaine in the brown mussel Perna perna

Abstract

The presence of cocaine and its metabolites and by-products has been identified in different aquatic matrices, making crack cocaine the target of recent studies. The aim of this study was to evaluate the sublethal effects of crack on the brown mussel Perna perna. Mussels were exposed to three concentrations of crack cocaine (0.5, 5.0, and 50.0 μg L⁻¹) for 168 h. Gills, digestive glands, and hemolymph were extracted and analyzed after three different exposure times using a suite of biomarkers (EROD, DBF, GST, GPX, LPO, DNA damage, ChE, and lysosomal membrane stability [LMS]). After 48 and 96 h of exposure, EROD, DBF, GST, GPX activities and DNA strand breaks in the gills increased significantly after 48 and 96 h of exposure. Alterations in LMS were also observed in the mussels exposed to all crack concentrations after 96 and 168 h. Our results demonstrated that crack cocaine is metabolized by CYP-like and GST activities in the gills. GPX was not able to prevent primary genetic damage, and cytotoxic effects in the hemocytes were also observed in a dose- and time-dependent response. Our study shows that the introduction of illicit drugs into coastal ecosystems must be considered a threat to marine organisms.

Effects of export concentration on CO 2 emissions in developed countries: an empirical analysis

Abstract

This paper provides the evidence on the short- and the long-run effects of the export product concentration on the level of CO₂ emissions in 19 developed (high-income) economies, spanning the period 1962–2010. To this end, the paper makes use of the nonlinear panel unit root and cointegration tests with multiple endogenous structural breaks. It also considers the mean group estimations, the autoregressive distributed lag model, and the panel quantile regression estimations. The findings illustrate that the environmental Kuznets curve (EKC) hypothesis is valid in the panel dataset of 19 developed economies. In addition, it documents that a higher level of the product concentration of exports leads to lower CO₂ emissions. The results from the panel quantile regressions also indicate that the effect of the export product concentration upon the per capita CO₂ emissions is relatively high at the higher quantiles.

Study on embodied CO 2 transfer between the Jing-Jin-Ji region and other regions in China: a quantification using an interregional input-output model

Abstract

Jing-Jin-Ji region (i.e., Beijing, Tianjin, and Hebei) is China's key development region, but it is also the leading and most serious air pollution region in China. High fossil fuel consumption is the major source of both carbon dioxide (CO₂) emissions and air pollutants. Therefore, it is important to reveal the source of CO₂ emissions to control the air pollution in the Jing-Jin-Ji region. In this study, an interregional input-output model was applied to quantitatively estimate the embodied CO₂ transfer between Jing-Jin-Ji region and other region in China using China's interregional input-output data in 2010. The results indicated that there was a significant difference in the production-based CO₂ emissions in China, and furthermore, the Jing-Jin-Ji region and its surrounding regions were the main regions of the production-based CO₂ emissions in China. Hebei Province exported a large amount of embodied CO₂ to meet the investment, consumption, and export demands of Beijing and Tianjin. The Jing-Jin-Ji regions exported a great deal of embodied CO₂ to the coastal provinces of southeast China and imported it from neighboring provinces.

Transcriptomic analysis of FUCA1 knockdown in keratinocytes reveals new insights in the pathogenesis of fucosidosis skin lesions

Abstract

Fucosidosis is a rare lysosomal storage disease which has been classified into two subtypes, depending on the severity of clinical signs and symptoms. Fucosidosis patients' skin abnormalities include angiokeratoma corporis diffusum, widespread telangiectasia, thick skin, hyperhidrosis and hypohidrosis, acrocyanosis and distal transverse nail bands. It has been described that >50% of fucosidosis patients have angiokeratoma. At molecular level, fucosidosis is caused by lysosomal alpha-L-fucosidase (FUCA1) gene mutations. Obtaining samples for functional studies has been challenging due to the inherent difficulty in finding affected individuals. The effect of FUCA1 dysfunction on gene expression is unknown.

The aim of the present study was to analyse, in keratinocytes, the transcriptomic effect of FUCA1 knock-down for a better understanding of skin lesions' pathogenesis affecting fucosidosis patients. FUCA1 knock-down (siRNA) was performed in human HaCaT immortalised keratinocytes. Affymetrix arrays and qPCR were used for analysing gene expression. Bioinformatics was used for functional clustering of modified genes.

387 genes showed differential expression between FUCA1 silenced and non-silenced cells (222 up-regulated and 165 down-regulated). Upregulated genes belonged to two major groups: keratinocyte differentiation/epidermal development (n=17) and immune response (n= 61). Several transcription factors were upregulated in FUCA1-siRNA transfected cells. This effect might partly have been produced by abnormal transcription factor expression, i.e. FOXN1. We thus propose that fucosidosis-related skin lesions (e.g. angiokeratoma) and those of other diseases (e.g. psoriasis) might be caused by dysfunctions in common aetiological overlapping molecular cascades.

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3D skin models for 3R research: the potential of 3D reconstructed skin models to study skin barrier function

Abstract

The skin barrier is an important shield regulating the outside-in as well as inside-out penetration of water, nutrients, ions and environmental stimuli. We can distinguish four different barrier compartments, the physical, chemical, immunological and microbial skin barrier. Well-functioning of those is needed to protect our body from the environment. To better understand the function and the contribution of barrier dysfunction in skin diseases, 3D skin or epidermal models are a valuable tool for in vitro studies. In this review we summarize the development and application of different skin models in skin barrier research. During the last years enormous effort was made on optimizing these models to better mimic the in vivo composition of the skin, by fine-tuning cell culture media, culture conditions and including additional cells and tissue components. Thereby in vitro barrier formation and function has been improved significantly. Moreover, in this review we point towards changes and chances for in vitro 3D skin models to be used for skin barrier research in the nearby future.

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Agricultural solid waste for sorption of metal ions: part I—characterization and use of lettuce roots and sugarcane bagasse for Cu(II), Fe(II), Zn(II), and Mn(II) sorption from aqueous medium

Abstract

Sugarcane bagasse and hydroponic lettuce roots were used as biosorbents for Cu(II), Fe(II), Zn(II), and Mn(II) removal from monoelemental solutions in aqueous medium, at pH 5.5, using batch procedures. These biomasses were studied in natura (lettuce roots, NLR, and sugarcane bagasse, NSB) and modified with HNO₃ (lettuce roots, MLR, and sugarcane bagasse, MSB). Langmuir, Freundlich, and Dubinin-Radushkevich non-linear isotherm models were used to evaluate the data from the metal ion adsorption assessment. The maximum adsorption capacities (q_max ) in monoelemental solution, calculated using the Langmuir isothermal model for Cu(II), Fe(II), Zn(II), and Mn(II), were respectively 24.61, 2.64, 23.04, and 5.92 mg/g for NLR; 2.29, 16.89, 1.97, and 2.88 mg/g for MLR; 0.81, 0.06, 0.83, and 0.46 mg/g for NSB; and 1.35, 2.89, 20.76, and 1.56 mg/g for MSB. The Freundlich n parameter indicated that the adsorption process was favorable for Cu(II) uptake by NLR; Fe(II) retention by MLR and MSB; and Zn(II) sorption by NSB, MLR, and NSB and favorable for all biomasses in the accumulation of Mn(II). The Dubinin-Radushkevich isotherm was applied to estimate the energy (E) and type of adsorption process involved, which was found to be a physical one between analytes and adsorbents. Organic groups such as O–H, C–O–C, CH, and C=O were found in the characterization of the biomass by FTIR. In the determination of the biomass surface charges by using blue methylene and red amaranth dyes, there was a predominance of negative charges.

EDTA-functionalized clinoptilolite nanoparticles as an effective adsorbent for Pb(II) removal

Abstract

An efficient Pb(II) adsorbent was prepared by the modification of clinoptilolite nanoparticles (CpN) with ethylenediaminetetraacetic acid (EDTA). Samples were characterized by XRD, FT-IR, SEM, BET, TG-DTG, CHNS analyzer, and energy dispersive analysis X-ray spectroscopy (EDX). The experiments were designed by response surface methodology (RSM) based on central composite design (CCD) that suggested a quadratic model to predict the conditions and the interactions between the variables including adsorbent dosage, removal time, C_Pb, and its solution pH. Adequacy of the suggested quadratic model was judged by ANOVA. The maximum Pb(II) removal of 0.27 mmol_Pb(II)/g_ads was achieved in optimal run including adsorbent dosage 2 g L⁻¹, removal time 271 min, C_Pb 22.51 mmol L⁻¹, and Pb(II) solution pH 5.88. In binary metal cation systems including 1000 mg L⁻¹ with respect to both Pb(II) and interfering cations, good selectivity of CpN-EDTA adsorbent was observed towards Pb(II) among the tested cations except Fe(III). Adsorption isotherm of lead removal by the adsorbent was well modeled by Langmuir equation, indicating a monolayer sorption of Pb(II) onto the adsorbent. The pseudo-second-order rate equation, indicating chemical reaction rate limiting step for the process, well modeled the kinetic of the process. An exothermic and spontaneous process was confirmed by the negative ∆H and ∆G.

Variations of the nirS -, nirK -, and nosZ -denitrifying bacterial communities in a northern Chinese soil as affected by different long-term irrigation regimes

Abstract

Denitrification causes nitrogen loss from agricultural soils and emission of nitrous oxide (N₂O). Water addition leads to an increase in soil moisture which greatly influenced soil denitrification. However, it is unclear how irrigation management affected the denitrifying bacterial communities in agricultural systems. In the present study, we investigated the abundance, diversity, and composition of the nirS-, nirK-, and nosZ-denitrifying bacterial communities in the soil under different long-term irrigation regimes by using real-time PCR (qPCR) and Illumina MiSeq sequencing approaches. Results showed that the abundance of nosZ gene was 3.94–6.01 and 35.09–60.21 times more than that of nirS and nirK genes, and the abundance of nirS gene was 5.84–15.30 times higher than that of nirK gene, respectively, in different irrigation treatments. However, the Alpha diversity indices of the nirK-denitrifying bacterial community were higher than those of the nirS- and nosZ-denitrifying bacterial communities. Proteobacteria was the predominant phylum for all the denitrifying bacterial communities, and significant differences were observed in relative abundance of Alphaproteobacteria and Betaproteobacteria in predominant class between different irrigation treatments for the nirS- and nosZ-denitrifying bacterial communities, respectively. Irrigation significantly affected the abundance, Shannon and Invsimpson indices, and structure of the nirS- and nosZ-denitrifying bacterial communities, whereas it only minor influenced the structure of the nirK-denitrifying bacterial community. Furthermore, the shifts in abundance, diversity, and structure of the nirS- and nosZ-denitrifying bacterial communities correlated significantly with the soil property variations; however, no soil property was significantly correlated with the abundance and Alpha diversity index of the nirK-denitrifying bacterial community. Our results demonstrate that different long-term irrigation regimes greatly altered the abundance, diversity, and structure of the nirS- and nosZ- rather than the nirK-denitrifying bacterial communities.

JAMA Facial Plastic Surgery Peer Reviewers in 2017

JAMA Facial Plastic Surgery—The Year in Review, 2017

JAMA Facial Plastic Surgery is nearly 20 years old—youthful compared with many of the JAMA Network journals! The biggest news for the journal this year was the impressive jump in our impact factor to 2.7, which positions the journal in the top echelon among journals that publish similar content. As we have attracted higher-quality scientific submissions, our acceptance rate for research manuscripts has now dipped to 24% (last year the rate was 33%) (Table). We will be carefully monitoring this trend because we wish to be inclusive and inviting to our research community while striving to be selective in showcasing the very best work of our colleagues.

Spanish Linguistic Validation of the VELO Instrument

This Research Letter describes the methodology of developing a Spanish translation of the VPI Effects on Life Outcomes (VELO) instrument through the linguistic validation.

In vitro activity of azole derivatives and griseofulvin against planktonic and biofilm growth of clinical isolates of dermatophytes

Abstract

Background

As shown by recent researches, most of the clinically relevant fungi, including dermatophytes, form biofilms in vitro and in vivo, which may present antimicrobial tolerance favoring recurrent infections.

Objectives

The aim of this study was to determine the minimum inhibitory concentrations (MICs) of itraconazole (ITC), voriconazole (VCZ) and griseofulvin (GRI) against Trichophyton rubrum, Trichophyton tonsurans, Trichophyton mentagrophytes, Microsporum canis and Microsporum gypseum, in planktonic and biofilm growth.

Methods

For the planktonic form, susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI), document M38-A2, while biofilm susceptibility was evaluated using the XTT colorimetric essay.

Results

The planktonic growth of all strains was inhibited by MIC values ranging from 0.00195-0.1225 μg/mL for VRC, 0.00195-0.25 μg/mL for ITC and <0.0039-4 μg/mL for GRI, while an increase of 50-fold the MIC was required to significantly reduce the metabolic activity (P<0.05) of dermatophyte biofilms.

Conclusions

In brief, the ability of dermatophytes to form biofilms may be a contributing factor for the recalcitrance of dermatophytoses or the dissemination of the disease

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Formulation, stability study, and pre-clinical evaluation of a vaginal cream containing curcumin in a rat model of vulvovaginal candidiasis

Abstract

Background

Owing to the growing resistance among isolates of Candida species to usual antifungal agents and the well-known therapeutic potential of curcumin, the purpose of this study was to develop and validate a vaginal formulation containing this substance and to evaluating its effectiveness in the treatment of experimental vulvovaginal candidiasis

Methods

Curcumin was incorporated in a vaginal cream in three concentrations (0.01, 0.1 and 1.0%). The different concentrations of the cream and its controls were intravaginally administered in an immunosuppressed rat model to evaluate the efficacy in the treatment of experimental vulvovaginal candidiasis. Samples of the cream were also subjected to centrifugation and physical stability tests and an analytical method for quantification of curcumin was validated based on HPLC

Results

The formulation was stable and the HPLC method could be considered suitable for the quantitative determination of curcumin in the cream. After six days of pre-clinical study, the number of infected animals was 1/6 in all groups treated with curcumin vaginal cream and the fungal burden showed a progressive reduction. Reduction of the inflammatory infiltrate was observed in the group treated with 1.0% cream

Conclusion

Vaginal cream containing curcumin could be considered a promising effective antifungal medicine in the treatment of vulvovaginal candidiasis.

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Effects of platelet-rich plasma on tissue-engineered vascularized flaps in an in vivo chamber

Publication date: Available online 7 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Yoshio Tanaka, Yusuke Hamamoto, Aizezi Niyazi, Tomohisa Nagasao, Masaki Ueno, Yasuhiko Tabata
AimsWe investigated the reproducibility of creating a vascularized tissue flap in an in vivo tissue engineering chamber by incubating a vascular pedicle imbedded in a collagen sponge with activated platelet-rich plasma (aPRP) and basic fibroblast growth factor (bFGF).MethodsCollagen sponge soaked with saline (control group), bFGF (Group 1), aPRP (Group 2), and aPRP/controlled release bFGF (Group 3) was implanted with a saphenous arteriovenous pedicle into a tissue-engineering chamber, located subcutaneously in the groin of rabbits. After 4 weeks of implantation, the contents in the chamber were harvested for volumetric and histological analyses.ResultsThe total volume of generated tissue in Group 3 was the largest among the Groups (control group vs. Group 3, p< 0.01). The volume of the pedicle vascular bundle/adipose tissue component was larger in Groups 1 and 3 than in the control group (p<0.05 and p<0.01, respectively). The inflammatory tissue volume was larger in Groups 2 and 3 (control group vs. Group 3, p<0.05). In a smaller long-term study, inflammatory tissue at 4 weeks was gradually replaced by adipose tissue within 8 weeks.ConclusionPRP-induced inflammatory reactions were considered to be necessary to stimulate cell migration into the chamber, leading to more tissue regeneration with abundant cell components. We conclude that PRP contributes to the reproducibility of preparing vascularized flaps in an in vivo chamber.

Issue Information

Corrigendum

Eco-friendly preparation of zinc oxide nanoparticles using Tabernaemontana divaricata and its photocatalytic and antimicrobial activity

Publication date: April 2018
Source:Journal of Photochemistry and Photobiology B: Biology, Volume 181
Author(s): A. Raja, S. Ashokkumar, R. Pavithra Marthandam, J. Jayachandiran, Chandra Prasad Khatiwada, K. Kaviyarasu, R. Ganapathi Raman, M. Swaminathan
The present work reports the green synthesis of Zinc Oxide Nanoparticles (ZnO NPs) using aqueous Tabernaemontana divaricata green leaf extract. ZnO NPs have been characterized by X-ray diffraction (XRD), Ultra Violet–Visible (UV–Vis) studies, Scanning Electron Microscopy (SEM), Transmission Electron Microscopy (TEM) and Fourier Transform–Infra Red (FT–IR) analysis. XRD pattern analysis confirms the presence of pure hexagonal wurtzite crystalline structure of ZnO. The TEM images reveal the formation of spherical shape ZnO NPs with the sizes ranging from 20 to 50 nm. The FT–IR analysis suggests that the obtained ZnO NPs have been stabilized through the interactions of steroids, terpenoids, flavonoids, phenyl propanoids, phenolic acids and enzymes present in the leaf extract. Mechanism for the formation of ZnO NPs using Tabernaemontana divaricata as bioactive compound is proposed. As prepared ZnO NPs reveals antibacterial activity against three bacterial strains, Salmonella paratyphi, Escherichia coli and Staphylococcus aureus. The ZnO NPs shows higher antibacterial activity against S. aureus and E. coli and lesser antibacterial activity against S. paratyphi compared to the standard pharmaceutical formulation.Photocatalytic activity of synthesized ZnO NPs was analyzed for methylene blue (MB) dye degradation with sunlight. Almost complete degradation of dye occurred in 90 min. This nano-ZnO, prepared by eco-friendly method will be much useful for dye removal and bacterial decontamination.

Photobiological effect of Laser or LED light in a thermophilic microbial consortium

Publication date: Available online 8 March 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Pedro Jorge Louro Crugeira, Gustavo M. Pires-Santos, Susana C.P.S. de Oliveira, Fernando José Pires Sampaio, Neandder Andrade Correia, Sandra R.C. de A. Fagnani, Fabio Alexandre Chinalia, Paulo Fernando Almeida, Antônio L.B. Pinheiro
Cellulose has a highly diversified architecture and its enzymatic complexes are studied for achieving an efficient conversion and a high level of efficiency in the deconstruction of cellulolytic biomass into sugars. The aim of this investigation was to evaluate the effect of Laser or LED light in the cellulolytic activity (CMCase) and on the proliferation of the thermophilic microbial consortium used on the degradation process of a lignocellulosic biomass of green coconut shell. The irradiation protocol consisted of six Laser irradiations (λ660 ηm, 40 mW, 270 s, 13 J/cm²) or LED (λ632 ± 2 ηm, 145 mW, 44 s, 13 J/cm²) with 12- h time intervals in nutrient deprivation conditions. After irradiation, the consortium was inoculated into a lignocellulosic biomass (coconut fibers). Non- irradiated consortium was also inoculated and acted as control. Cell proliferation and endoglucanase activity were quantified during the experimental time. Experiments were carried out in triplicate. The results showed an increase of 250 % of thermo-cellulolytic microorganisms for the LED group and 200% for the Laser group when compared to the control. The enzymatic index (red Congo method), showed a statistically significant difference in the process of degradation of the lignocellulosic biomass between the Laser and LED groups compared to the control group [p < 0.0029; p < 0.029, respectively] 48-hs after the inoculation of the microorganisms. At the end of 72-h, this significant difference was maintained for both irradiated groups (p < 0.0212). Based upon the protocol used on the present study, it is possible to concluded that LED light enhanced cell proliferation of the thermophilic microbial consortium while the Laser light increase the enzymatic index of the lignocellulosic biomass of green coconut shell.

Graphical abstract

Cricopharyngeal myotomy with flexible endoscope for Zenker’s diverticulum using hook knife and endoclips (with video describing an objective measurement of the cutting length)

Abstract

Cricopharyngeal myotomy with flexible endoscope is a well-known and safe treatment for Zenker's diverticulum. We describe hereafter how we perform this flexible endotherapy. From January 2011 to January 2017, we treated 28 patients with this endotherapy. Our technique is described step-by-step in the paper: the main principle is to perform an endoscopic cut of the diverticular septum and cricopharyngeal muscle's fibers (see the video). We describe an objective measurement of the cutting length and depth of the myotomy. Technical success was achieved in all the patients. As to clinical success, 76.2% of patients showed a significant improvement and relevant disappearance of preoperative dysphagia. The present follow-up ranges from 6 months to 5 years. This flexible endoscopic technique can overcome some limitations of rigid endoscopic technique (i.e., upper teeth protrusion, inadequate jaw opening, or limited neck mobility). The main indication was based on clinical presentation and referred to the diverticular dimensions between 2 and 5 cm. Tips for the technique are described in the paper. This variant of cricopharyngeal myotomy with flexible endoscopy is feasible and effective for the treatment of Zenker's diverticulum in selected patients.

Prevalence of hidradenitis suppurativa in Brazil: a population survey

Flat Incision Technique for Reconstructive Brow Surgery: A Wound Healing Model and Clinical Evaluation

Background: Skin incision is considered to be placed at 90° in reference to the skin to get perfect wound edge adaptation. The incision on hair-bearing tissues, as the scalp, is considered to be bevelled at 45° to promote hair growth through the scar. There is no consensus about the preferred incision angle on the brow. The aim of this article was to demonstrate the feasibility of the "flat incision technique" for brow repositioning, where brow deformation results after forehead reconstruction. A wound-healing model for the bevelled incision is presented. Methods: Brow incisions are bevelled with an angle of 20°. The lower incision is placed inside the brow so that the upper 2 rows of hair are included; the dermis is completely transected and dissection is continued into the subdermal plane. The procedure is presented in a patient who underwent resection of the forehead due to melanoma. Results: The bevelled incision increases the surface area of dermal layer by a factor of 2 compared with the standard vertical skin incision at 90°. Loss of the dermal tissue integrity and continuity due to trauma hinders the recovery of cell migration and function, resulting in a more prominent scar formation. It appears reasonable that with the increased surface area of the dermal layers in the wound edges, the scar quality improves. The case study demonstrates the feasibility of the procedure. Conclusion: The bevelled 20° incision for brow repositioning and reshaping showed to be a viable and predictable procedure.

Combining Breast Reduction Techniques to Treat Gigantomastia in Ghana

Summary: In this presentation of 2 consecutive cases of symptomatic juvenile breast hypertrophy in Ghana, we review the patient presentation, workup, and discuss outcomes following a combined technique of inferior pedicle stump with free nipple graft reduction mammoplasty. Surgical goals for treatment of gigantomastia were 2-fold: to resect adequate tissue to obtain symptomatic relief with improved quality of life, while avoiding a flat, boxy-appearing breast shape.

Enhanced adsorption of Cd(II) from aqueous solution by a magnesium oxide–rice husk biochar composite

Abstract

In this study, a magnesium oxide–rice husk biochar composite (MgO–BCR) was successfully prepared by a MgO impregnation method, and its adsorption performance was investigated in Cd(II) aqueous solution. A pseudo-second-order kinetic model described the Cd(II) adsorption behaviour on BCR and MgO–BCR well, while a Langmuir adsorption isotherm was more suitable for Cd(II) adsorption on the adsorbent. The fitting results of the monolayer model indicated that the number of ions captured by per site varied between 0.97 and 1.09. The calculated thermodynamic parameters indicated that Cd(II) adsorption onto MgO–BCR was spontaneous and endothermic. Characterisation of the adsorbent revealed that in situ precipitation, surface complexation, and electrostatic attraction contributed to the Cd(II) adsorption. The adsorption capacities of rice husk biochar (BCR) and MgO–BCR for Cd(II) reached 6.36 and 18.1 mg/g, respectively. The results demonstrated that MgO–BCR composite could be used as an effective and eco-friendly adsorbent to enhance the removal of Cd(II) from aqueous solution.

In This Issue

Schlafen-8 is essential for lymphatic endothelial cell activation in experimental autoimmune encephalomyelitis

Abstract

Schlafen-8 (Slfn8) is a member of the Schlafen family of proteins, which harbor helicase domains and are induced by LPS and interferons. It has been reported that the Schlafen family are involved in various cellular functions, including proliferation, differentiation and regulation of virus replication. Slfn8 has been implicated in T-cell differentiation in the thymus. However, the roles of Slfn8 in the immune system remains unclear. In this study, we generated Slfn8 knockout mice (Slfn8^−/−) and investigated the immunological role of Slfn8 using the T-cell-mediated autoimmune model experimental autoimmune encephalomyelitis (EAE). We found that the clinical score was reduced in Slfn8^−/− mice. IL-6 and IL-17A cytokine production, which are associated with EAE onset and progression, were decreased in the lymph nodes of Slfn8^−/− mice. Immune cell populations in Slfn8^−/− mice, including macrophages, neutrophils, T cells and B cells, did not reveal significant differences compared with wild-type mice. In vitro activation of Slfn8^−/− T cells in response to TCR stimulation also did not reveal significant differences. To confirm the involvement of non-hematopoietic cells, we isolated CD45⁻ CD31⁺ endothelial cells and CD45⁻CD31⁻ gp38⁺ fibroblastic reticular cells by FACS sorting. We showed that the levels of IL-6 and Slfn8 mRNA in CD45⁻ CD31⁺ endothelial cells were increased after EAE induction. In contrast, the level of IL-6 mRNA after EAE induction was markedly decreased in CD31⁺ endothelial cells from Slfn8^−/− mice. These results indicate that Slfn8 may play a role in EAE by regulating inflammation in endothelial cells.

Mechanisms controlling nucleic acid-sensing Toll-like receptors

Abstract

Nucleic acid (NA)-sensing Toll-like receptors (TLRs) respond to DNA/RNA derived from pathogens and dead cells. Structural studies have revealed a variety of molecular mechanisms by which TLRs sense NAs. Double-stranded RNA and single-stranded DNA directly bind to TLR3 and TLR9, respectively, whereas TLR7 and TLR8 bind to nucleosides and oligoribonucleotides derived from RNAs. Activation of ligand-bound TLRs is influenced by the functional status of TLRs. Proteolytic cleavage of NA-sensing TLRs enables ligand-dependent TLR dimerization. Trafficking of ligand-activated TLRs in endosomal and lysosomal compartments is requisite for production of type I interferons. Activation of NA-sensing TLRs is required for the control of viruses such as herpes simplex virus and endogenous retroviruses. On the other hand, excessive activation of NA-sensing TLRs drives disease progression in a variety of inflammatory diseases including systemic lupus erythematosus, heart failure, arthritis and non-alcoholic steatohepatitis. NA-sensing TLRs are targets for therapeutic intervention in these diseases. We here focus on our recent progresses in our understanding of NA-sensing TLRs.

Single blood transfusion induces the production of donor-specific alloantibodies and regulatory T cells mainly in the spleen

Abstract

Donor-specific blood transfusion is known to induce alloresponses and lead to immunosuppression. We examined their underlying mechanisms by employing fully allogeneic rat combinations. Transfused recipients efficiently produced alloantibodies of the IgM and IgG subclasses directed against donor class I MHC. The recipients exhibited active expansion of CD4⁺ T cells and CD4⁺FOXP3⁺ regulatory T cells (T_reg cells), followed by CD45R⁺ B cells and IgM⁺ or IgG subclass⁺ antibody-forming cells mainly in the spleen. From 1.5 days, the resident MHCII⁺CD103⁺ dendritic cells (DCs) in the splenic T-cell area, periarterial lymphocyte sheath, formed clusters with recipient BrdU⁺ or 5-ethynyl-2′-deoxyuridine⁺ cells, from which the proliferative response of CD4⁺ T cells originated peaking at 3–4 days. Transfusion-induced antibodies had donor passenger cell-depleting activity in vitro and in vivo and could suppress acute GvH disease caused by donor T cells. Furthermore, T_reg cells significantly suppressed mixed leukocyte reactions in a donor-specific manner. In conclusion, single blood transfusion efficiently induced a helper T-cell-dependent anti-donor class I MHC antibody-forming cell response with immunoglobulin class switching, and a donor-specific T_reg cell response mainly in the spleen, probably by way of the indirect allorecognition via resident DCs. These antibodies and T_reg cells may be involved, at least partly, in the donor-specific transfusion-induced suppression of allograft rejection.

Oxidative burst and Dectin-1-triggered phagocytosis affected by norepinephrine and endocannabinoids: implications for fungal clearance under stress

Abstract

A prolonged stress burden is known to hamper the efficiency of both the innate and the adaptive immune systems and to attenuate the stress responses by the catecholaminergic and endocannabinoid (EC) systems. Key mechanisms of innate immunity are the eradication of pathogens through phagocytosis and the respiratory burst. We tested the concentration-dependent, spontaneous and stimulated (via TNFα and N-formylmethionine-leucyl-phenylalanine) release of reactive oxygen species (ROS) by human polymorphonuclear leukocytes (PMNs) in vitro in response to norepinephrine (NE) and AM1241, a pharmacological ligand for the EC receptor CB₂. We evaluated phagocytosis of Dectin-1 ligating zymosan particles and tested the cytokine response against Candida antigen in an in vitro cytokine release assay. Increasing concentrations of NE did not affect phagocytosis, yet stimulated ROS release was attenuated gradually reaching maximum suppression at 500 nM. Adrenergic receptor (AR) mechanisms using non-AR-selective (labetalol) as well as specific α-(prazosin) and β-(propranolol) receptor antagonists were tested. Results show that only labetalol and propranolol were able to recuperate cytotoxicity in the presence of NE, evidencing a β-receptor-mediated effect. The CB₂ agonist, AM1241, inhibited phagocytosis at 10 µM and spontaneous peroxide release by PMNs. Use of the inverse CB₂ receptor agonist SR144528 led to partial recuperation of ROS production, confirming the functional role of CB₂. Additionally, AM1241 delayed early activation of monocytes and induced suppression of IL-2 and IL-6 levels in response to Candida via lower activity of mammalian target of rapamycin (mTOR). These findings provide new insights into key mechanisms of innate immunity under stressful conditions where ligands to the sympatho-adrenergic and EC system are released.

Targeting cell cycle dependencies represent a novel therapeutic approach for selected sarcoma subgroups

The associations between psychological stress and psoriasis: a systematic review

Abstract

Psoriasis is estimated to affect around 2–3% of the general population. More than one-third of Australians report having a significant level of distress in their daily lives. Psychological stress has long been shown to play an important role in the natural history of psoriasis, but the details of this relationship remain to be clearly defined. We performed a systematic review of the literature with the aim of determining whether there is a temporal association between psychological stress as the predictor and onset and/or exacerbation of psoriasis as the outcome measure. Our secondary aim was to establish whether there is a relationship between the degree of psychological stress and clinical severity of psoriasis. Our systematic review demonstrates a probable temporal association between different measures of psychological stress and onset, recurrence, and severity of psoriasis. In the light of this, we suggest clinicians include "stress" as a trigger factor in their psoriasis assessment and consider psychological interventions as adjuncts, particularly in those who identify as "stress-responders".

Self-Control and Overcontrol: Conceptual, Ethical, and Ideological Issues in Positive Psychology

Abstract

In what they call their "manual of the sanities"—a positive psychology handbook describing contemporary research on strengths of character—Christopher Peterson and Martin Seligman argue that "there is no true disadvantage of having too much self-control." This claim is widely endorsed in the research literature. I argue that it is false. My argument proceeds in three parts. First, I identify conceptual confusion in the definition of self-control, specifically as it pertains to the claim that you cannot be too self-controlled. Second, I consider disadvantages to having too much self-control, several of which point to the value of acting spontaneously from time to time, in a pointedly uncontrolled way. Third, I raise worries about the social and political values embedded in the science of self-control. Self-control as it is understood in the positive psychology literature benefits some people more than others, depending, for example, on their race and their socio-economic status. I conclude by briefly outlining an empirical framework for understanding self-control in traditional virtue theoretic terms as something that admits of deficiencies and excesses.

Melanocyte abnormalities and senescence in the pathogenesis of idiopathic guttate hypomelanosis

Abstract

Background

Idiopathic guttate hypomelanosis (IGH) is a pigmentary disorder of unknown pathogenesis characterized by small discrete white macules. In the skin, epidermal melanin unit between melanocytes and keratinocytes is responsible for melanin synthesis and equal distribution of melanin pigment.

Objective

Therefore, this study was designed to check the role of melanocytes in the pathogenesis of IGH.

Methods

For this study, six IGH patients and six controls were enrolled. Melanin content was checked in the skin sections and in the cultured melanocytes. Senescence was checked in the lesional skin of IGH patients by comparing the mRNA and protein expression of senescence markers p16, hp1, and p21.

Results

Cultured melanocytes from the IGH patients showed morphological changes in comparison to the control melanocytes. Melanocytes from IGH patients were bigger in size with very small and retracted dendrites as compared to the control melanocytes. Melanin accumulation was more in the IGH patients as compared to the controls. Our results showed that expression of p16, p21, and hp1 was significantly higher in lesional skin of IGH patient as compared to healthy controls.

Conclusion

This study revealed large-sized melanocytes with small and retracted dendrites in IGH patients. Accumulation of more melanin in the IGH melanocytes might be due to problem in the transfer of melanin from melanocytes to keratinocytes. Accumulation of melanin can lead to the senescence in the melanocytes of IGH patients.

Diagnosing diabetes mellitus in patients with porphyria cutanea tarda

Abstract

The prevalence of diabetes mellitus is increased in patients with porphyria cutanea tarda. Different tests are available for diagnosing and screening for type II diabetes mellitus, however choosing the most suitable test is challenging. The pitfalls in the different tests along with the interfering comorbidities and treatments concerning patients with porphyria cutanea tarda complicate diagnosing these patients with diabetes mellitus. HbA1c, fasting glucose, or oral glucose tolerance are the current available tests, with HbA1c as first choice. Measuring HbA1c requires no fasting, however HbA1c can be false low if the patient is treated with phlebotomy or has liver cirrhosis or chronic hepatitis. Instead fasting glucose and oral glucose tolerance tests can be used if the patient is not acutely ill. If either of the tests give a result in the diagnostic range, the test should be repeated if the patient has no clinical symptoms of diabetes. Diagnosing diabetes mellitus is important for the purpose of early intervention, and this review provides the knowledge needed to diagnose this special patient group properly.

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RE: “A MULTINOMIAL REGRESSION APPROACH TO MODEL OUTCOME HETEROGENEITY”

Mycobacterium gordonae-associated skin infection in an immunocompetent patient

Psoriasis and subclinical atherosclerosis in a Chinese population

Malignant atrophic papulosis with motor aphasia and intestinal perforation: A case report and review of published works

Abstract

Malignant atrophic papulosis (MAP) is a rare type of obliterating vasculopathy that can present as pure cutaneous lesions or a systemic entity affecting multiple organs. Systemic disease, such as gastrointestinal or central nervous system involvement, may predispose the patients to poorer or even fatal outcomes. We present a 30-year-old female patient with systemic manifestation of MAP 10 days after delivery of a full-term pregnancy who subsequently developed motor aphasia and intestinal perforation. The patient was administrated empirical treatment with an antiplatelet, anticoagulant, methylprednisolone sodium succinate and alprostadil. Antibiotics were administrated due to intestinal perforation and secondary sepsis. Despite all treatment, the patient died a week later. We summarized all the previous reports of MAP based on thorough review of previous published work. Overall, this is the first patient with MAP combined with motor aphasia and intestinal perforation and may provide insights for future studies on the treatment of this disease.

Surgical Site Identification with Personal Digital Device: A Prospective Pilot Study

Publication date: Available online 7 March 2018
Source:Journal of the American Academy of Dermatology
Author(s): Leon Chen, Adam M. Parsons, Alexander B. Aria, Ana M. Ciurea, Anisha B. Patel, Christopher Chan, John R. Griffin, Tri H. Nguyen, Michael R. Migden
BackgroundVarious means to facilitate accurate biopsy site identification have been proposed.ObjectiveTo determine the accuracy of biopsy site identification using photos taken with a patient's digital device by a dermatologist versus professional medical photography.MethodsPhotographs of circled biopsy sites were taken with personal digital devices by the principal investigator (PI). Another set of photographs were taken by a professional photographer. Secondary photographs were taken of the biopsy site location pointed to by the staff and PI based on the personal digital device image and professional medical photography, respectively. Based on secondary photographs, two independent dermatologists determined if the skin biopsy locations pointed out by the staff were consistent with the ones pointed out by PI.ResultsPer Dermatologist A, the staff correctly identified all 53/53 biopsy sites. Per Dermatologist B, the staff were correct on 51/53 observations. Dermatologist C, the final arbiter, concurred with Dermatologist A in the two cases that Dermatologist B was not certain of the biopsy site location.LimitationsThe mean interval from initial biopsy to re-identification of the site was 36.2 days.ConclusionUtilizing patients' personal digital devices is a cost-effective, HIPAA compliant, and readily available means to identify skin biopsy sites.

Teaser

Many novel means of biopsy site identification have been proposed., This is a pilot study comparing the accuracy of biopsy site identification with personal digital device photography to professional medical photography., Personal digital device photography is a cost-effective, HIPPA complaint, and readily available means to accurately identify biopsy sites.

Pathologist Characteristics Associated with Accuracy and Reproducibility of Melanocytic Skin Lesion Interpretation

Publication date: Available online 7 March 2018
Source:Journal of the American Academy of Dermatology
Author(s): David E. Elder, Mike Piepkorn, Raymond L. Barnhill, Gary M. Longton, Heidi D. Nelson, Stevan R. Knezevich, Margaret S. Pepe, Patricia A. Carney, Linda J. Titus, Tracy Onega, Anna N.A. Tosteson, Martin A. Weinstock, Joann G. Elmore
BackgroundDiagnostic interpretations of melanocytic skin lesions vary widely among pathologists, yet the underlying reasons remain unclear.ObjectiveIdentify pathologist characteristics associated with rates of accuracy and reproducibility.MethodsPathologists independently interpreted the same set of biopsies of melanocytic lesions on two occasions. Diagnoses were categorized into one of five classes according to the MPATH-Dx^© system. Reproducibility was determined by pathologists' concordance of diagnoses across two occasions. Accuracy was defined by concordance with a consensus reference standard. Associations of pathologist characteristics with reproducibility and accuracy were assessed individually and in multivariable logistic regression models.ResultsRates of diagnostic reproducibility and accuracy were highest among pathologists with board certification and/or fellowship training in dermatopathology, and those with ≥5 years of experience. In addition, accuracy was high among pathologists with higher caseload composition and volume of melanocytic lesions.LimitationsData gathered in a test set situation using a classification tool not currently in clinical use.ConclusionDiagnoses are more accurate among pathologists with specialty training and those with more experience interpreting melanocytic lesions. These findings support the practice of referring difficult cases to more experienced pathologists to improve diagnostic accuracy, although the impact on patient outcomes of these referrals requires additional research.

Hygiene practices: Are they protective factors for eczema symptoms?

Abstract

Introduction

Exact etiology and proper treatment of eczema are still unknown. The hygiene hypothesis and epidermal barrier dysfunction hypothesis attempted to give some plausible explanations for these issues but they still remain unclear. The identification of factors, including hygiene practices, related to eczema symptoms (ES) could shed some light on these matters. Therefore, this study aimed to determine risk factors related to ES and the ES prevalence in two disparate areas in terms of urbanization in Aceh, Indonesia.

Methods

A cross-sectional study with convenience sampling was conducted among schoolchildren living in urban and rural Aceh. Data on ES, socio-demographic characteristics, environmental factors, partial ablution and other hygiene related factors were collected by parental questionnaires. In addition, children's anthropometric measurements were also collected.

Results

The prevalence of current ES in the study population was 21%. When stratifying by residency, the prevalence of ES in urban and rural area was 20.93% versus 21.05%. Partial ablution was independently associated with a reduced risk of ES (OR = 0.36; 95% CI 0.13–0.96). Important risk factors for ES were paternal history of allergic disease (OR = 4.09%; 95% CI 1.51–11.11) and belonging to the older group of schoolchildren (10–13 years old) (OR = 2.57; 95% CI 1.03–6.40).

Conclusions

There were no significant differences in the prevalence of ES between urban and rural settings, and partial ablution had a protective effect on ES. These findings support the epidermal barrier dysfunction hypothesis as a possible pathway of eczema.

Hygiene practices that involves frequent washing without detergents, such as partial ablution, seem to be protective for eczema symptoms. This finding is in line with the epidermal barrier dysfunction hypothesis.

Surgical Site Identification with Personal Digital Device: A Prospective Pilot Study

Many novel means of biopsy site identification have been proposed., This is a pilot study comparing the accuracy of biopsy site identification with personal digital device photography to professional medical photography., Personal digital device photography is a cost-effective, HIPPA complaint, and readily available means to accurately identify biopsy sites.

Pathologist Characteristics Associated with Accuracy and Reproducibility of Melanocytic Skin Lesion Interpretation

Diagnostic interpretations of melanocytic skin lesions vary widely among pathologists, yet the underlying reasons remain unclear.