Review on applications of artificial intelligence methods for dam and reservoir-hydro-environment models

Abstract

Efficacious operation for dam and reservoir system could guarantee not only a defenselessness policy against natural hazard but also identify rule to meet the water demand. Successful operation of dam and reservoir systems to ensure optimal use of water resources could be unattainable without accurate and reliable simulation models. According to the highly stochastic nature of hydrologic parameters, developing accurate predictive model that efficiently mimic such a complex pattern is an increasing domain of research. During the last two decades, artificial intelligence (AI) techniques have been significantly utilized for attaining a robust modeling to handle different stochastic hydrological parameters. AI techniques have also shown considerable progress in finding optimal rules for reservoir operation. This review research explores the history of developing AI in reservoir inflow forecasting and prediction of evaporation from a reservoir as the major components of the reservoir simulation. In addition, critical assessment of the advantages and disadvantages of integrated AI simulation methods with optimization methods has been reported. Future research on the potential of utilizing new innovative methods based AI techniques for reservoir simulation and optimization models have also been discussed. Finally, proposal for the new mathematical procedure to accomplish the realistic evaluation of the whole optimization model performance (reliability, resilience, and vulnerability indices) has been recommended.

The role of the water footprint in the context of green marketing

Abstract

The environmental degradation, because of various factors, such as climate change, human activities, increase of population globally, etc. have brought on pressures on the fresh water supplies that vary on time and space. Consequently, economic, environmental, and social tools have emerged known as footprints, in an effort to examine and measure the needs and consequences of humanity on the Earth's life support systems and take measures towards sustainable development. Furthermore, the constantly worsening environmental conditions have resulted in the cultivation of a green culture among society stakeholders that brought on terms such as green marketing and green products. This paper deals with the water footprint (WF) concept and an effort is performed, to explore through a literature review, in which ways it can contribute to the sustainable development of water use, in the context of green marketing (GM) strategies. The approach of the analysis is based on the discrimination to the following aspects: international scale, national and subnational scale, farmers, business, and consumers, in order to track the affection of each part in water issues. The main findings of the literature review showed that the aforementioned factors are playing a key role in protecting water recourses, by the way they formulate their water use and they are interrelated and interdependent. WFs can be useful in the context of GM, by providing helpful information about direct and indirect water consumption, to every contributor factor in supply chains, to consumers, governments, and water managers.

Official control of plant protection products in Poland: detection of illegal products

Abstract

Market presence of illegal and counterfeit pesticides is now a global problem. According to data published in 2012 by the European Crop Protection Association (ECPA), illegal products represent over 10% of the global market of plant protection products. Financial benefits are the main reason for the prevalence of this practice. Counterfeit and illegal pesticides may contain substances that may pose a threat to the environment, crops, animals, and humans, inconsistent with the label and registration dossier. In Poland, action against illegal and counterfeit plant protection products is undertaken by the Main Inspectorate of Plant Health and Seed Inspection (PIORiN), the police, the prosecution, and the pesticide producers. Results of chemical analyses carried out by the Institute of Plant Protection - National Research Institute Sośnicowice Branch, Pesticide Quality Testing Laboratory (PQTL IPP-NRI Sosnicowice Branch) indicate that a majority of illegal pesticides in Poland are detected in the group of herbicides. Products from parallel trade tend to have the most irregularities. This article describes the official quality control system of plant protection products in Poland and presents the analytical methods for testing pesticides suspected of adulteration and recent test results.

Does biologic treatment of psoriasis lower the risk of cardiovascular events and mortality? A critical question that we are only just beginning to answer

Modernizing Regulation of Cosmetic Products: Reintroduction of the Personal Care Products Safety Act

Can We Perform CT of the Appendix with Less Than 1 mSv? A De-escalating Dose-simulation Study

Abstract

Objectives

To systematically explore the lowest reasonably achievable radiation dose for appendiceal CT using an iterative reconstruction (IR) in young adults.

Methods

We prospectively included 30 patients who underwent 2.0-mSv CT for suspected appendicitis. From the helical projection data, 1.5-, 1.0- and 0.5-mSv CTs were generated using a low-dose simulation tool and the knowledge-based IR. We performed step-wise non-inferiority tests sequentially comparing 2.0-mSv CT with each of 1.5-, 1.0- and 0.5-mSv CT, with a predetermined non-inferiority margin of 0.06. The primary end point was the pooled area under the receiver-operating-characteristic curve (AUC) for three abdominal and three non-abdominal radiologists.

Results

For the abdominal radiologists, the non-inferiorities of 1.5-, 1.0- and 0.5-mSv CT to 2.0-mSv CT were sequentially accepted [pooled AUC difference: 2.0 vs. 0.5 mSv, 0.017 (95% CI: -0.016, 0.050)]. For the non-abdominal radiologists, the non-inferiorities of 1.5- and 1.0-mSv CT were accepted; however, the non-inferiority of 0.5-mSv CT could not be proved [pooled AUC difference: 2.0 vs. 1.0 mSv, -0.017 (-0.070, 0.035) and 2.0 vs. 0.5 mSv, 0.045 (-0.071, 0.161)].

Conclusion

The 1.0-mSv appendiceal CT was non-inferior to 2.0-mSv CT in terms of diagnostic performance for both abdominal and non-abdominal radiologists; 0.5-mSv appendiceal CT was non-inferior only for abdominal radiologists.

Key points

• For both abdominal and non-abdominal radiologists, 1.0-mSv appendiceal CT could be feasible.

• The 0.5-mSv CT was non-inferior to 2.0-mSv CT only for expert abdominal radiologists.

• Reader experience is an important factor affecting diagnostic impairment by low-dose CT.

Cervical ultrasonography has no additional value over negative 18 F-FDG PET/CT scans for diagnosing cervical lymph node metastases in patients with oesophageal cancer

Abstract

Objectives

To investigate the additional value of cervical ultrasonography over ¹⁸F-FDG PET/CT for diagnosing cervical lymph node metastases in patients with newly diagnosed oesophageal cancer.

Methods

Between January 2013 and January 2016, 163 patients with newly diagnosed oesophageal cancer underwent both cervical ultrasonography and ¹⁸F-FDG PET/CT at a tertiary referral centre in the Netherlands. Retrospective clinical data analysis was performed to assess the diagnostic value of cervical ultrasonography and ¹⁸F-FDG PET/CT for the detection of cervical lymph node metastases. Fine needle aspiration or clinical follow-up was used as reference standard.

Results

The overall incidence of patients with cervical lymph node metastases was 14%. The sensitivity of ¹⁸F-FDG PET/CT to detect cervical lymph node metastases was 82% (95% CI 59–94%) and specificity was 91% (95% CI 85–95%). The sensitivity and specificity of cervical ultrasonography were 73% (95% CI 50–88%) and 84% (95% CI 77–90%), respectively. In patients with a negative ¹⁸F-FDG PET/CT, 12 of 133 (9%) patients had suspicious nodes on cervical ultrasonography. In all these 12 patients the nodes were confirmed benign.

Conclusions

Cervical ultrasonography has no additional diagnostic value to a negative integrated ¹⁸F-FDG PET/CT for the detection of cervical lymph node metastases in patients with newly diagnosed oesophageal cancer.

Key Points

• Cervical ultrasonography has no value over PET/CT in evaluating cervical node metastases.

• PET/CT provides greater diagnostic confidence compared to cervical ultrasonography.

• Cervical ultrasonography during standard diagnostic work-up may be considered unnecessary.

• Cervical lesions on PET/CT require cytopathological confirmation by FNA.

Round-the-clock performance of coronary CT angiography for suspected acute coronary syndrome: Results from the BEACON trial

Abstract

Objective

To assess the image quality of coronary CT angiography (CCTA) for suspected acute coronary syndrome (ACS) outside office hours.

Methods

Patients with symptoms suggestive of an ACS underwent CCTA at the emergency department 24 hours, 7 days a week. A total of 118 patients, of whom 89 (75 %) presented during office hours (weekdays between 07:00 and 17:00) and 29 (25 %) outside office hours (weekdays between 17:00 and 07:00, weekends and holidays) underwent CCTA. Image quality was evaluated per coronary segment by two experienced readers and graded on an ordinal scale ranging from 1 to 3.

Results

There were no significant differences in acquisition parameters, beta-blocker administration or heart rate between patients presenting during office hours and outside office hours. The median quality score per patient was 30.5 [interquartile range 26.0–33.5] for patients presenting during office hours in comparison to 27.5 [19.75–32.0] for patients presenting outside office hours (p=0.043). The number of non-evaluable segments was lower for patients presenting during office hours (0 [0–1.0] vs. 1.0 [0–4.0], p=0.009).

Conclusion

Image quality of CCTA outside office hours in the diagnosis of suspected ACS is diminished.

Key Points

• Quality scores were higher for coronary-CTA during office hours.

• There were no differences in acquisition parameters.

• There was a non-significant trend towards higher heart rates outside office hours.

• Coronary-CTA on the ED requires state-of-the-art scanner technology and sufficiently trained staff.

• Coronary-CTA on the ED needs preparation time and optimisation of the procedure.

The impact of injector-based contrast agent administration in time-resolved MRA

Abstract

Objectives

Time-resolved contrast-enhanced MR angiography (4D-MRA), which allows the simultaneous visualization of the vasculature and blood-flow dynamics, is widely used in clinical routine. In this study, the impact of two different contrast agent injection methods on 4D-MRA was examined in a controlled, standardized setting in an animal model.

Methods

Six anesthetized Goettingen minipigs underwent two identical 4D-MRA examinations at 1.5 T in a single session. The contrast agent (0.1 mmol/kg body weight gadobutrol, followed by 20 ml saline) was injected using either manual injection or an automated injection system. A quantitative comparison of vascular signal enhancement and quantitative renal perfusion analyses were performed.

Results

Analysis of signal enhancement revealed higher peak enhancements and shorter time to peak intervals for the automated injection. Significantly different bolus shapes were found: automated injection resulted in a compact first-pass bolus shape clearly separated from the recirculation while manual injection resulted in a disrupted first-pass bolus with two peaks. In the quantitative perfusion analyses, statistically significant differences in plasma flow values were found between the injection methods.

Conclusions

The results of both qualitative and quantitative 4D-MRA depend on the contrast agent injection method, with automated injection providing more defined bolus shapes and more standardized examination protocols.

Key points

• Automated and manual contrast agent injection result in different bolus shapes in 4D-MRA.

• Manual injection results in an undefined and interrupted bolus with two peaks.

• Automated injection provides more defined bolus shapes.

• Automated injection can lead to more standardized examination protocols.

Evaluation of an adaptive detector collimation for prospectively ECG-triggered coronary CT angiography with third-generation dual-source CT

Abstract

Objectives

To investigate the impact of an adaptive detector collimation on the dose parameters and accurateness of scan length adaption at prospectively ECG-triggered sequential cardiac CT with a wide-detector third-generation dual-source CT.

Methods

Ideal scan lengths for human hearts were retrospectively derived from 103 triple-rule-out examinations. These measures were entered into the new scanner operated in prospectively ECG-triggered sequential cardiac scan mode with three different detector settings: (1) adaptive collimation, (2) fixed 64 × 0.6-mm collimation, and (3) fixed 96 × 0.6-mm collimation. Differences in effective scan length and deviation from the ideal scan length and dose parameters (CTDIvol, DLP) were documented.

Results

The ideal cardiac scan length could be matched by the adaptive collimation in every case while the mean scanned length was longer by 15.4% with the 64 × 0.6 mm and by 27.2% with the fixed 96 × 0.6-mm collimation. While the DLP was almost identical between the adaptive and the 64 × 0.6-mm collimation (83 vs. 89 mGycm at 120 kV), it was 62.7% higher with the 96 × 0.6-mm collimation (135 mGycm), p < 0.001.

Conclusion

The adaptive detector collimation for prospectively ECG-triggered sequential acquisition allows for adjusting the scan length as accurate as this can only be achieved with a spiral acquisition. This technique allows keeping patient exposure low where patient dose would significantly increase with the traditional step-and-shoot mode.

Key points

• Adaptive detector collimation allows keeping patient exposure low in cardiac CT.

• With novel detectors the desired scan length can be accurately matched.

• Differences in detector settings may cause 62.7% of excessive dose.

Prognostic importance of peritoneal lesion-to-primary tumour standardized uptake value ratio in advanced serous epithelial ovarian cancer

Abstract

Objectives

Using preoperative PET/CT, we evaluated the prognostic value of preoperative [¹⁸F]FDG uptake ratio between various metastatic lesions and primary tumour in patients with advanced serous epithelial ovarian cancer (EOC).

Methods

We retrospectively reviewed patients with International Federation of Gynecology and Obstetrics (FIGO) stage III, IV serous EOC who underwent preoperative [¹⁸F]FDG PET/CT scans. Clinico-pathological variables and PET/CT parameters such as maximum standardized uptake value of the ovarian cancer (SUV_ovary), pelvic or para-aortic LN (SUV_LN), peritoneal (SUV_perit) and distant extra-peritoneal (SUV_dist) metastatic lesions, and the metastatic lesion-to-ovarian cancer standardized uptake value ratio were assessed.

Results

Clinico-pathological data were retrospectively reviewed for 97 eligible patients. The median progression-free survival (PFS) was 18 months (range, 6–90 months) and 59 (60.8 %) patients experienced recurrence. In multivariate regression analysis, older age (p = 0.035, hazard ratio (HR) 1.032, 95 % CI 1.002–1.062), and high SUV_perit/SUV_ovary (p = 0.046, HR 1.755, 95 % CI 1.011–3.047) were independent risk factors of recurrence. Patient group categorized by SUV_perit/SUV_ovary showed significant difference in PFS (Log-Rank test, p = 0.001).

Conclusions

In patients with advanced serous EOC, preoperative SUV_perit/SUV_ovary measured by [¹⁸F]FDG PET/CT provides significant incremental performance for prediction of recurrence.

Key points

• PET/CT data from advanced serous epithelial ovarian cancer patients were analysed.

• Prognostic value of SUV ratio between metastatic and primary tumour was investigated.

• SUV _perit /SUV _ovary provides incremental performance for prediction of recurrence.

Accuracy of computed tomography for selecting the revascularization method based on SYNTAX score II

Abstract

Objectives

The application of SYNTAX score II based on coronary CT angiography (CCTA) for selecting further treatment options has not been studied. This study aimed to investigate the diagnostic performance of CCTA combined with SYNTAX score II for selecting the revascularization method compared with invasive coronary angiography (ICA) based on 2014 European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) guidelines.

Methods

From January–May 2011, 160 patients who underwent both CCTA and ICA within 30 interval days were included. The diagnostic performance of CCTA, CCTA plus CT-SYNTAX score I and CT-SYNTAX score II was analysed using ICA counterparts as references.

Results

Overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CCTA plus CT-SYNTAX I for selecting coronary artery bypass grafting (CABG) candidates using ICA plus ICA-SYNTAX I as reference, were 70.6 %, 95.8 %, 66.7 %, 96.5 % and 93.1 %, respectively. The diagnostic performance of CCTA plus CT-SYNTAX II showed improvement with values of 83.3 %, 97.3 %, 71.4 %, 98.6 % and 96.3 %, respectively, using ICA plus ICA-SYNTAX II as reference.

Conclusions

CCTA combined with CT-SYNTAX score II is an accurate method for selecting CABG surgery candidates compared with ICA-SYNTAX score II.

Key points

• SYNTAX plus CCTA can be highly specific for selecting the revascularization method.

• SYNTAX II was complemented by including clinical considerations to SYNTAX I.

• CCTA plus CT-SYNTAX II is an accurate method for selecting CABG candidates.

18 F-fluorodeoxyglucose specimen-positron emission mammography delineates tumour extension in breast-conserving surgery: Preliminary results

Abstract

Objectives

We aimed to determine whether high-resolution specimen-positron emission mammography (PEM) using fluorodeoxyglucose (¹⁸F-FDG) can reveal extension of breast cancer in breast-conserving surgery (BCS), and assess the safety of radiation exposure to medical staff.

Methods

Sixteen patients underwent positron emission tomography, and then BCS with intraoperative frozen section analysis on the same day. Resected specimens with remaining ¹⁸F-FDG accumulation were scanned by high-resolution PEM. At least 1 day after surgery, tumour extension was evaluated by three independent experienced readers and by binarized images from the specimen-PEM data. Intraoperative exposure of medical staff to ¹⁸F-FDG was measured.

Results

Specimen-PEM evaluations of binarized images and the three investigators detected all (100 %, 12/12) invasive lesions and 94.4 % (17/18) of in situ lesions using both methods. The positive predictive value of the accumulated lesions was 74.4 % (29/39) for the binarized images and 82.9 % (29/35) for the three investigators. Analysis of intraoperative frozen sections detected 100 % (2/2) of the margin-positive cases, also detected by both specimen-PEM evaluation methods with no false-positive margin cases. The mean exposure of the medical staff to ¹⁸F was 18 μSv.

Conclusions

Specimen-PEM detected invasive and in situ lesions with high accuracy and allowable radiation exposure.

Key points

• Specimen-PEM detected invasive and in situ lesions with high accuracy.

• Specimen-PEM predicted complete resection with the same accuracy as frozen section analysis.

• Breast-conserving surgery after fluorodeoxyglucose injection was performed with low medical staff exposure.

Validation of goose liver fat measurement by QCT and CSE-MRI with biochemical extraction and pathology as reference

Abstract

Objectives

This study aimed to validate the accuracy and reliability of quantitative computed tomography (QCT) and chemical shift encoded magnetic resonance imaging (CSE-MRI) to assess hepatic steatosis.

Methods

Twenty-two geese with a wide range of hepatic steatosis were collected. After QCT and CSE-MRI examinations, the liver of each goose was removed and samples were taken from the left lobe, upper and lower half of the right lobe for biochemical measurement and histology. Fat percentages by QCT and proton density fat fraction by MRI (MRI-PDFF) were measured within the sample regions of biochemical measurement and histology. The accuracy of QCT and MR measurements were assessed through Spearman correlation coefficients (r) and Passing and Bablok regression equations using biochemical measurement as the "gold standard".

Results

Both QCT and MRI correlated highly with chemical extraction [r = 0.922 (p < 0.001) and r = 0.949 (p < 0.001) respectively]. Chemically extracted triglyceride was accurately predicted by both QCT liver fat percentages (Y = 0.6 + 0.866 × X) and by MRI-PDFF (Y = -1.8 + 0.773 × X).

Conclusions

QCT and CSE-MRI measurements of goose liver fat were accurate and reliable compared with biochemical measurement.

Key Points

• QCT and CSE-MRI can measure liver fat content accurately and reliably

• Histological grading of hepatic steatosis has larger sampling variability

• QCT and CSE-MRI have potential in the clinical setting

Transoesophageal echocardiography prior to catheter ablation could be avoided in atrial fibrillation patients with a low risk of stroke and without filling defects in the late-phase MDCT scan: A retrospective analysis of 783 patients

Abstract

Objectives

To test whether multidetector computed tomography (MDCT) could completely replace transoesophageal echocardiography (TEE) to detect left atrial appendage (LAA) thrombi in atrial fibrillation (AF) patients using a large sample size.

Methods

783 patients with AF who underwent MDCT and TEE before catheter ablation were retrospectively included. Demographic data were obtained. Two radiologists blinded to clinical data made the imaging diagnosis.

Results

Most of the patients (96.2 %) had a CHA₂DS₂-VASc score (congestive heart failure, hypertension, age ≥ 75 years old (doubled), diabetes, stroke/transient ischaemic attack/thromboembolism (doubled), vascular disease, age 65–74 years, female sex) ≤ 3. Eight thrombi were identified by TEE, all of which were detected by MDCT; no thrombus was observed with TEE without the observation of filling defects by late-phase MDCT scanning in any of the patients. Using TEE as reference standard, the sensitivity, specificity, positive predictive value and negative predictive value of MDCT for thrombus detection were 100 %, 95.74 % (95 % CI 94.33 %–97.15 %), 19.51 % (95 % CI 16.73 %–22.29 %) and 100 %, respectively.

Conclusions

For AF patients with low risk of stroke, when MDCT images showed no filling defect in the late phase, TEE prior to catheter ablation can be avoided.

Key Points

• MDCT can help detect the presence of LAA thrombus.

• TEE can be avoided when late-phase MDCT shows no filling defect.

• TEE is required in patients whose MDCT images indicate thrombus.

The efficacy of real-time colour Doppler flow imaging on endoscopic ultrasonography for differential diagnosis between neoplastic and non-neoplastic gallbladder polyps

Abstract

Objectives

We evaluated the usefulness of real-time colour Doppler flow (CDF) endoscopic ultrasonography (EUS) for differentiating neoplastic gallbladder (GB) polyps from non-neoplastic polyps.

Methods

Between August 2014 and December 2016, a total of 233 patients with GB polyps who underwent real-time CDF-EUS were consecutively enrolled in this prospective study. CDF imaging was subjectively categorized for each patient as: strong CDF pattern, weak CDF pattern and no CDF pattern.

Results

Of the 233 patients, 115 underwent surgical resection. Of these, there were 90 cases of non-neoplastic GB polyps and 23 cases of neoplastic GB polyps. In a multivariate analysis, a strong CDF pattern was the most significant predictive factor for neoplastic polyps; sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 52.2 %, 79.4 %, 38.7 %, 86.9 % and 73.9 %, respectively. Solitary polyp and polyp size were associated with an increased risk of neoplasm.

Conclusions

The presence of a strong CDF pattern as well as solitary and larger polyps on EUS may be predictive of neoplastic GB polyps. As real-time CDF-EUS poses no danger to the patient and requires no additional equipment, it is likely to become a supplemental tool for the differential diagnosis of GB polyps.

Key points

• Differential diagnosis between neoplastic polyps and non-neoplastic polyps of GB is limited.

• The use of real-time CDF-EUS was convenient, with high agreement between operators.

• The real-time CDF-EUS is helpful in differential diagnosis of GB polyps.

Hemispherical photoacoustic imaging of myocardial infarction: in vivo detection and monitoring

Abstract

Objectives

This study aimed to demonstrate the capacity for noninvasive localisation and characterisation of myocardial infarction (MI) in vivo using a hemispherical photoacoustic imaging (PAI) system. MI remains a leading cause of morbidity and mortality worldwide. To enable optimal treatment of patients, timely and accurate diagnosis and longitudinal monitoring is critical.

Methods

Ischaemia was induced in Balb/c mice by ligation of the left anterior descending artery. The hemispherical PAI system, equipped with 128 ultrasonic transducers spirally distributed on the surface, along with parallel data acquisition, was applied for imaging of the mouse heart.

Results

Our study showed that hemispherical PAI can delineate thoracic vessels and the morphology of the entire heart. Longitudinal PAI images revealed gradual expansion of the infarcted area along with necrosis and fibrosis, which were quantitatively validated by triphenyltetrazolium chloride staining. After MI modelling, the photoacoustic (PA) signal intensity decreased by 399.1 ± 56.3 (p < 0.001), a ~2.5-fold reduction compared to that of healthy cardiac tissue. The calculated size of the enlarged heart, 10.4 ± 6.0 mm² (p < 0.001), represents an increase of ~18% versus that of a healthy heart.

Conclusions

PAI enables MI diagnosis and injury localisation with its capabilities for both deep organ imaging and lesion region differentiation.

Key Points

• Photoacoustic imaging (PAI), combining optical absorption and ultrasonic resolution, can delineate cardiac anatomy.

• PAI can diagnose myocardial infarction lesions with 10 mm imaging depth in vivo.

• Quantified results are in excellent agreement with enzyme and histological examinations.

• PAI can serve as a complementary modality to SPECT and ultrasound imaging.

• This study will encourage further PAI development for clinical use.

Advanced CT acquisition protocol with a third-generation dual-source CT scanner and iterative reconstruction technique for comprehensive prosthetic heart valve assessment

Abstract

Objectives

Multidetector CT (MDCT) is a valuable tool for functional prosthetic heart valve (PHV) assessment. However, radiation exposure remains a concern. We assessed a novel CT-acquisition protocol for comprehensive PHV evaluation at limited dose.

Methods

Patients with a PHV were scanned using a third-generation dual-source CT scanner (DSCT) and iterative reconstruction technique (IR). Three acquisitions were obtained: a non-enhanced scan; a contrast-enhanced, ECG-triggered, arterial CT angiography (CTA) scan with reconstructions at each 5 % of the R-R interval; and a delayed high-pitch CTA of the entire chest. Image quality was scored on a five-point scale. Radiation dose was obtained from the reported CT dose index (CTDI) and dose length product (DLP).

Results

We analysed 43 CT examinations. Mean image quality score was 4.1±1.4, 4.7±0.5 and 4.2±0.6 for the non-contrast-enhanced, arterial and delayed acquisitions, respectively, with a total mean image quality of 4.3±0.7. Mean image quality for leaflet motion was 3.9±1.4. Mean DLP was 28.2±17.1, 457.3±168.6 and 68.5±47.2 mGy.cm for the non-contrast-enhanced (n=40), arterial (n=43) and delayed acquisition (n=43), respectively. The mean total DLP was 569±208 mGy.cm and mean total radiation dose was 8.3±3.0 mSv (n=43).

Conclusion

Comprehensive assessment of PHVs is possible using DSCT and IR at moderate radiation dose.

Key points

• Prosthetic heart valve dysfunction is a potentially life-threatening condition.

• Dual-source CT can adequately assess valve leaflet motion and anatomy.

• We assessed a comprehensive protocol with three acquisitions for PHV evaluation.

• This protocol is associated with good image quality and limited dose.

Preoperative multiparametric MRI of the prostate for the prediction of lymph node metastases in prostate cancer patients treated with extended pelvic lymph node dissection

Abstract

Objectives

To assess the role of preoperative multiparametric MRI (mpMRI) of the prostate in the prediction of nodal metastases in patients treated with radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND).

Methods

We retrospectively analyzed 101 patients who underwent both preoperative mpMRI of the prostate and RP with ePLND at our institution. For each patient, complete preoperative clinical data and tumour characteristics at mpMRI were recorded. Final histopathologic stage was considered the standard of reference. Univariate and multivariate logistic regression analyses were performed.

Results

Nodal metastases were found in 23/101 (22.8%) patients. At univariate analyses, all clinical and radiological parameters were significantly associated to nodal invasion (all p<0.03); tumour volume at MRI (mrV), tumour ADC and tumour T-stage at MRI (mrT) were the most accurate predictors (AUC = 0.93, 0.86 and 0.84, respectively). A multivariate model including PSA levels, primary Gleason grade, mrT and mrV showed high predictive accuracy (AUC = 0.956). Observed prevalence of nodal metastases was very low among tumours with mrT2 stage and mrV<1cc (1.8%).

Conclusion

Preoperative mpMRI of the prostate can predict nodal metastases in prostate cancer patients, potentially allowing a better selection of candidates to ePLND.

Key points

• Multiparametric-MRI of the prostate can predict nodal metastases in prostate cancer

• Tumour volume and stage at MRI are the most accurate predictors

• Prevalence of nodal metastases is low for T2-stage and <1cc tumours

• Preoperative mpMRI may allow a better selection of candidates to lymphadenectomy

Diagnostic accuracy of low and high tube voltage coronary CT angiography using an X-ray tube potential-tailored contrast medium injection protocol

Abstract

Objectives

To compare the diagnostic accuracy between low-kilovolt peak (kVp) (≤ 100) and high-kVp (> 100) third-generation dual-source coronary CT angiography (CCTA) using a kVp-tailored contrast media injection protocol.

Methods

One hundred twenty patients (mean age = 62.6 years, BMI = 29.0 kg/m²) who underwent catheter angiography and CCTA with automated kVp selection were separated into two cohorts (each n = 60, mean kVp = 84 and 117). Contrast media dose was tailored to the kVp level: 70 = 40 ml, 80 = 50 ml, 90 = 60 ml, 100 = 70 ml, 110 = 80 ml, and 120 = 90 ml. Contrast-to-noise ratio (CNR) was measured. Two observers evaluated image quality and the presence of significant coronary stenosis (> 50% luminal narrowing).

Results

Diagnostic accuracy (sensitivity/specificity) with ≤ 100 vs. > 100 kVp CCTA was comparable: per patient = 93.9/92.6% vs. 90.9/92.6%, per vessel = 91.5/97.8% vs. 94.0/96.8%, and per segment = 90.0/96.7% vs. 90.7/95.2% (all P > 0.64). CNR was similar (P > 0.18) in the low-kVp vs. high-kVp group (12.0 vs. 11.1), as ws subjective image quality (P = 0.38). Contrast media requirements were reduced by 38.1% in the low- vs. high-kVp cohort (53.6 vs. 86.6 ml, P < 0.001) and radiation dose by 59.6% (4.3 vs. 10.6 mSv, P < 0.001).

Conclusions

Automated tube voltage selection with a tailored contrast media injection protocol allows CCTA to be performed at ≤ 100 kVp with substantial dose reductions and equivalent diagnostic accuracy for coronary stenosis detection compared to acquisitions at > 100 kVp.

Key points

• Low-kVp coronary CT angiography (CCTA) enables reduced contrast and radiation dose.

• Diagnostic accuracy is comparable between ≤ 100 and > 100 kVp CCTA.

• Image quality is similar for low- and high-kVp CCTA.

• Low-kVp image acquisition is facilitated by automated tube voltage selection.

• Tailoring contrast injection protocols to the automatically selected kVp-level is feasible.

Optimisation of sonourethrography: the clamp method

Abstract

Purpose

To describe the clamp method for performing retrograde sonourethrography (RSUG) and contrast-enhanced voiding sonourethrography (CE-VSUG) via the transperineal approach in male adults.

Materials and methods

Prospective study of 113 males (14-86 years) with urethral strictures confirmed by urethrography who received sonourethrography via the clamp method between 2011 and 2015. The characteristic parameters of the quantitative variables were calculated and a comparative analysis of the qualitative variables was conducted using the McNemar test.

Results

RSUG was performed successfully in all the cases (n = 113) and detected 49 cases with anterior urethral strictures; the strictures in the proximal bulbar cone in five of them (10.2%) were not visualised on retrograde urethrography (RUG) (p < 0.05). CE-VSUG was performed successfully in 97 cases and observed posterior urethral strictures in 82; the bladder neck strictures in 6 of them (7.3%) were not observed on voiding cystourethrography (VCUG) (p < 0.05). Retrograde bladder filling was achieved in approximately 6 min.

Conclusion

The clamp method enables RSUG and CE-VSUG to be performed simply, effectively and painlessly by a single operator. It also allows the evaluation of cases with urethromeatal alterations (stricture, hypospadias and meatotomy).

Key Points

• The clamp method enables RSUG to be performed simply and painlessly.

• The clamp method requires only one operator and allows assessing urethromeatal alterations.

• RSUG shows greater capacity for detecting anterior urethral strictures than RUG.

• The clamp method achieves retrograde bladder filling in approximately 6 min.

• CE-VSUG shows greater capacity for detecting strictures than VCUG.

Chemical shift magnetic resonance imaging for distinguishing minimal-fat renal angiomyolipoma from renal cell carcinoma: a meta-analysis

Abstract

Objectives

To determine the performance of chemical shift signal intensity index (CS-SII) values for distinguishing minimal-fat renal angiomyolipoma (mfAML) from renal cell carcinoma (RCC) and to assess RCC subtype characterisation.

Methods

We identified eligible studies on CS magnetic resonance imaging (CS-MRI) of focal renal lesions via PubMed, Embase, and the Cochrane Library. CS-SII values were extracted by lesion type and evaluated using linear mixed model-based meta-regression. RCC subtypes were analysed. Two-sided p value <0.05 indicated statistical significance. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool.

Results

Eleven articles involving 850 patients were included. Minimal-fat AML had significantly higher CS-SII value than RCC (p < 0.05); there were no significant differences between mfAML and clear cell RCC (cc-RCC) (p = 0.112). Clear cell RCC had a significantly higher CS-SII value than papillary RCC (p-RCC) (p < 0.001) and chromophobe RCC (ch-RCC) (p = 0.045). The methodological quality was relatively high, and Begg's test data points indicated no obvious publication bias.

Conclusions

The CS-SII value for differentiating mfAML from cc-RCC remains unproven, but is a promising method for differentiating cc-RCC from p-RCC and ch-RCC.

Key Points

• RCC CS-SII values are significantly lower than those of mfAML overall.

• CS-SII values cannot aid differentiation between mfAML and cc-RCC.

• CS-SII values might help characterise RCC subtypes.

Breast lesions classified as probably benign (BI-RADS 3) on magnetic resonance imaging: a systematic review and meta-analysis

Abstract

Purpose

To investigate prevalence, malignancy rates, imaging features, and follow-up intervals for probably benign (BI-RADS 3) lesions on breast magnetic resonance imaging (MRI).

Methods

A systematic database-review of articles published through 22/06/2016 was performed. Eligible studies reported BI-RADS 3 lesions on breast MRI. Two independent reviewers performed a literature review and data extraction. Data collection included study characteristics, number/type of BI-RADS 3 lesions, final diagnosis (histopathology and/or follow-up). Sources of bias (QUADAS-2) were assessed. Meta-analysis included data-pooling, heterogeneity testing, and meta-regression.

Results

Fifteen studies were included. Prevalence was reported in 11 studies (range: 1.2-24.3%). Malignancy rates ranged between 0.5-10.1% (pooled 61/2814, 1.6%, 95%-CI:0.9-2.3% (random-effects-model), I²=53%, P=0.007). In a subgroup of 11 studies (2183 lesions), highest malignancy rates were observed in non-mass lesions (pooled 25/714, 2.3%, 95%-CI:0.8-3.9%, I²=52%, P=0.021) followed by mass lesions (pooled 15/771, 1.5%, 95%-CI:0.7-2.4%, I²=0%, P=0.929), and foci (pooled 10/698, 1%, 95%-CI:0.3-1.7%, I²=0%, P=0.800). There was non-significant negative association between prevalence and malignancy rates (P=0.077). Malignant lesions were diagnosed at all follow-up time points.

Conclusion

While prevalence of MRI BI-RADS 3 lesions was strongly heterogeneous, pooled malignancy rates met BI-RADS benchmarks (<2%). Malignancy rates varied, exceeding 2% in non-mass lesions. Twenty-four-month surveillance is required to detect all malignant lesions.

Key points

• Probably benign (BI-RADS 3) lesions showed a pooled malignancy-rate of 1.6% (95%-CI:0.9-2.3%).

• Malignancy rates differ and are highest in non-mass lesions (2.3%, 95%-CI:0.8-3.9%).

• The prevalence of BI-RADS 3 lesions on breast MRI ranged from 1.2-24.3%.

• Malignant lesions were diagnosed at follow-up time points up to 24 months.

The Fascist Seduction of Narrative: Walter Benjamin’s Historical Materialism Beyond Counter-Narrative

Abstract

This essay introduces Walter Benjamin's historical materialism to illuminate how history teachers may invoke a critique of the past and present through democratizing the production of knowledge in the classroom. Historical materialism gives students access to the means of knowledge production and entrusts them with the task of generating a critique of politics though encounters with historical objects. The rise of the alt-right, alternative facts, and fake news sites necessitates social studies methods that intervene into the fascist seductions of narrative in history. A Benjaminian pedagogy emphasizes reading practices that acknowledge the political layers of history inscribed within the objects. This generates space for forms of pessimism and dialectic critiques of barbarism that students may experience with history beyond the teacher's capacity for understanding. In the name of democracy over fascism, the article adds a political critique to students' historical and critical thinking skills.

Effect of Fluid Intake on Hydration Status and Skin Barrier Characteristics in Geriatric Patients: An Explorative Study

Background/Aim: Inadequate fluid intake is assumed to be a trigger of water-loss dehydration, which is a major health risk in aged and geriatric populations. Thus, there is a need to search for easy to use diagnostic tests to identify dehydration. Our overall aim was to investigate whether skin barrier parameters could be used for predicting fluid intake and/or hydration status in geriatric patients. Methods: An explorative observational comparative study was conducted in a geriatric hospital including patients aged 65 years and older. We measured 3-day fluid intake, skin barrier parameters, Overall Dry Skin Score, serum osmolality, cognitive and functional health, and medications. Results: Forty patients were included (mean age 78.45 years and 65% women) with a mean fluid intake of 1,747 mL/day. 20% of the patients were dehydrated and 22.5% had an impending dehydration according to serum osmolality. Multivariate analysis suggested that skin surface pH and epidermal hydration at the face were associated with fluid intake. Serum osmolality was associated with epidermal hydration at the leg and skin surface pH at the face. Fluid intake was not correlated with serum osmolality. Diuretics were associated with high serum osmolality. Conclusions: Approximately half of the patients were diagnosed as being dehydrated according to osmolality, which is the current reference standard. However, there was no association with fluid intake, questioning the clinical relevance of this measure. Results indicate that single skin barrier parameters are poor markers for fluid intake or osmolality. Epidermal hydration might play a role but most probably in combination with other tests.
Skin Pharmacol Physiol 2018;31:155–162

Contribution to the understanding of biologic concentrations of arsenic in children living in an urban area from Rio de Janeiro, Brazil

Abstract

There are few studies about children's environmental exposure to arsenic (As) in Brazil, most of them being in mining regions. The objective of this study was to contribute to the understanding of biologic concentrations of arsenic in children living in an urban area, in Brazil. A study of arsenic concentrations in capillary blood (n = 270), nail (n = 261), and urine (n = 99) samples, in male and female children, 8 to 10 years old, from two public schools in Rio de Janeiro, was conducted. Socio-economic and health data were obtained through questionnaires. The nail and capillary blood analysis were performed by inductively coupled plasma mass spectrometry (ICP-MS), while urine samples were analyzed using hydride generation atomic absorption spectrometry (HG-AAS). The median, geometric mean, and 95th percentiles of total arsenic concentrations were, respectively, 2.53, 2.40, and 3.58 μg/L in capillary blood; 0.09, 0.10, and 0.24 μg/g in nails; and 12.50, 10.97, and 39.45 μg/L in urine. The geometric mean of urinary arsenic level was above the values reported by international surveys for non-exposed populations. The arsenic concentrations in nails were compatible with the values found in national studies. These outcomes can contribute to the increase of knowledge on biologic concentrations of arsenic in children living in urban areas, in Brazil.

Characterization of toluene metabolism by methanotroph and its effect on methane oxidation

Abstract

Methanotrophs not only oxidize CH₄, but also can oxidize a relatively broad range of other substrates, including trichloroethylene, alkanes, alkenes, and aromatic compounds. In this study, Methylosinus sporium was used as a model organism to characterize toluene metabolism by methanotrophs. Reverse transcription quantitative PCR analysis showed that toluene enhanced the mmoX expression of M. sporium. When the toluene concentration was below 2000 mg m⁻³, the kinetics of toluene metabolism by M. sporium conformed to the Michaelis-Menten equation (V_max = 0.238 g g_{dry weight}⁻¹ h⁻¹, K_m  = 545.2 mg m⁻³). The use of a solid-phase extraction technique followed by a gas chromatography-mass spectrometry analysis and molecular docking calculation showed that toluene was likely to primarily bind the di-iron center structural region of soluble methane monooxygenase (sMMO) hydroxylase and then be oxidized to o-cresol. Although M. sporium oxidized toluene, it did not incorporate toluene into its biomass. The coexistence of toluene and CH₄ could influence CH₄ oxidation, the growth of methanotrophs, and the distribution of CH₄-derived carbon, which were related to the ratio of the toluene concentration to biomass. These results would be helpful to understand the metabolism of CH₄ and non-methane volatile organic compounds in the environment.

Variation laws and release characteristics of phosphorus on surface sediment of Dongting Lake

Abstract

The variation trend and growth rate of P were analyzed by the concentration of the phosphorus fraction on surface sediment of Dongting Lake from 2012 to 2016, to reveal the cumulative effect of P in the actual environment. Meanwhile, the adsorption kinetics and adsorption isotherm were employed to examine the P-release possibility of sediment, which predicts the yearly released sediment phosphorus in Dongting Lake. The actual growth rate of TP (Total Phosphorus) is 53 mg·(kg·year)⁻¹ in East Dongting Lake, 39 mg·(kg·year)⁻¹ in South Dongting Lake, and 29 mg·(kg·year)⁻¹ in West Dongting Lake, while the sum of the phosphorus fraction growth rates has little difference from the rate of TP in sediments of the three areas of Dongting Lake. Furthermore, the Elovich model and the Langmuir crossover-type equations are established to present the adsorption characteristic of sediment in Dongting Lake; the result shows that the sediments play a source role for phosphorus in East and South Dongting Lake from zero equilibrium phosphorus concentration (EPC₀) in the present situation, but an adsorption effect on TP is shown in West Dongting Lake. When the conditions of environment change are ignored, the maximum P-sorption level in sediments of East Dongting Lake will reach in 2040 according to the actual growth rate of sediments, while that in West Dongting Lake and South Dongting Lake will be in 2046 and 2061, respectively.

Ipseity at the Intersection of Phenomenology, Psychiatry and Philosophy of Mind: Are we Talking about the Same Thing?

Abstract

In recent years, phenomenologically informed philosophers, psychologists and psychiatrists have attempted to import philosophical notions associated with the self into the empirical study of pathological (self-)experience. In particular, so-called ipseity disturbances have been put forward as generative of symptoms of schizophrenia, and several attempts have been made to operationalize and measure kinds and degrees of ipseity disturbances in schizophrenia. However, we find that this work faces challenges caused by the fact that (a) the notion of ipseity is used ambiguously, both in the philosophical and in the empirical discussion, and (b) the methods employed to operationalize ipseity often portray a rather different understanding of the notion from that found in the (phenomenological) literature that is cited as providing the philosophical foundation for the studies in question. In particular, according to the definitions found in the philosophical literature, while being phenomenologically available, the self is not represented in ipseity. However, when it comes to the empirical study of ipseity and its disturbances, the object of investigation is often a kind of explicit self-representation. As a result, it is unclear whether different researchers are really talking about the same thing. Future progress in this area will require more careful conceptual distinctions; the present article aims to contribute to this task.

The Microbiome and Population Health: Considerations to Enhance Study Design and Data Analysis in Observational and Interventional Epidemiology

Abstract

Measurement and characterization of the human microbiome in large population-based human studies has recently become a reality secondary to technological advances in high throughput DNA sequencing. These advances bring new challenges and knowledge gaps for study planning, data analysis and interpretation that are novel to large-scale epidemiological studies. In this issue of The Journal, Sinha et al. have provided data to inform statistical power and sample size requirements for microbiome studies in population-based settings. This work serves as a helpful starting point for study planning while also serving as a springboard for discussion regarding additional considerations for improving microbiome research. This commentary emphasizes the importance of selecting microbiome metrics appropriate for the biological hypothesis under investigation as well as the need for new analytical tools that can better capitalize on the unique, yet rich, information contained in microbiome data sets.

Commentary on the “Evidence- and Consensus-Based (S3) Guidelines for the Treatment of Actinic Keratosis” Published by the International League of Dermatological Societies in Cooperation with the European Dermatology Forum

In 2015, the International League of Dermatological Societies and the European Dermatology Forum published a guideline for the treatment of actinic keratosis, which is classified as an evidence- and consensus-based S3 guideline. From the point of view of the GD Task Force "Licht.Hautkrebs.Prävention," an interdisciplinary expert panel of the Society for Dermopharmacy for the prevention and treatment of skin cancer, this guideline reveals strengths and weaknesses but, in summary, does not meet the claim for an evidence- and consensus-based S3 guideline.
Skin Pharmacol Physiol 2018;31:144–146

Correction to: On Harman’s theory of knowledge

Abstract

In the original publication of the article, the corresponding author used pseudonym as 'M. Lisagor'. The correct name is given in this correction.

Cutis laxa associated monoclonal gammopathy: 14 new cases and review of the literature

Publication date: Available online 3 April 2018
Source:Journal of the American Academy of Dermatology
Author(s): Marie Jachiet, Stéphanie Harel, Anne Saussine, Maxime Battistella, Michel Rybojad, Bouchra Asli, Djaouida Bengoufa, Thibault Mahevas, Didier Bessis, Lionel Galicier, Jean-Luc Schmutz, Smail Hadj-Rabia, David Boutboul, Céleste Lebbé, Martine Bagot, Marion Malphettes, Dan Lipsker, Jean-Paul Fermand, Jean-David Bouaziz, Bertrand Arnulf

Adding A New Analytical Procedure With Clinical Interpretation in the Tool Box of Survival Analysis

The Way Things Look: a Defence of Content

Abstract

How does perceptual experience disclose the world to our view? In the first introductory section, I set up a contrast between the representational and the purely relational conception of perceptual experience. In the second section, I discuss an argument given by Charles Travis (Mind 113: 57–94, 2004) against perceptual content. The third section is devoted to the phenomenon of perceptual constancy: in 3.1 I describe the phenomenon. In 3.2 I argue that the description given suggests a phenomenological distinction that can be deployed for a defence of content. In 3.3 I compare and contrast my view of perceptual content with that of Susanna Schellenberg (The Journal of Philosophy 105(02): 55–84, 2008). Finally (3.4), I support my conception of content by means of an argument that links content to the way in which the mind-independent nature of material objects is manifest in perceptual experience.

Optimizing the use of topical retinoids in Asian acne patients

The Journal of Dermatology, EarlyView.

Age Differences in Perceptions of and Motivations for Voluntary Medical Male Circumcision Among Adolescents in South Africa, Tanzania, and Zimbabwe

Abstract

Background

The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have set a Fast-Track goal to achieve 90% coverage of voluntary medical male circumcision (VMMC) among boys and men aged 10–29 years in priority settings by 2021. We aimed to identify age-specific facilitators of VMMC uptake among adolescents.

Methods

Younger (aged 10–14 years; n = 967) and older (aged 15–19 years; n = 559) male adolescents completed structured interviews about perceptions of and motivations for VMMC before receiving VMMC counseling at 14 service provision sites across South Africa, Tanzania, and Zimbabwe. Adjusted prevalence ratios (aPRs) were estimated using multivariable modified Poisson regression models with generalized estimating equations and robust standard errors.

Results

The majority of adolescents reported a strong desire for VMMC. Compared with older adolescents, younger adolescents were less likely to cite protection against human immunodeficiency virus (HIV) or other sexually transmitted infections (aPR, 0.77; 95% confidence interval [CI], .66–.91) and hygienic reasons (aPR, 0.55; 95% CI, .39–.77) as their motivation to undergo VMMC but were more likely to report being motivated by advice from others (aPR, 1.88; 95% CI, 1.54–2.29). Although most adolescents believed that undergoing VMMC was a normative behavior, younger adolescents were less likely to perceive higher descriptive norms (aPR, 0.79; .71–.89), injunctive norms (aPR, 0.86; 95% CI, .73–1.00), or anticipated stigma for being uncircumcised (aPR, 0.79; 95% CI, .68–.90). Younger adolescents were also less likely than older adolescents to correctly cite that VMMC offers men and boys partial HIV protection (aPR, 0.73; 95% CI, .65–.82). Irrespective of age, adolescents' main concern about undergoing VMMC was pain (aPR, 0.95; 95% CI, .87–1.04). Among younger adolescents, fear of pain was negatively associated with desire for VMMC (aPR, 0.89; 95% CI, .83–.96).

Conclusions

Age-specific strategies are important to consider to generate sustainable demand for VMMC. Programmatic efforts should consider building on the social norms surrounding VMMC and aim to alleviate fears about pain.

Perceived Quality of In-Service Communication and Counseling Among Adolescents Undergoing Voluntary Medical Male Circumcision

Abstract

Background

Experience with providers shapes the quality of adolescent health services, including voluntary medical male circumcision (VMMC). This study examined the perceived quality of in-service communication and counseling during adolescent VMMC services.

Methods

A postprocedure quantitative survey measuring overall satisfaction, comfort, perceived quality of in-service communication and counseling, and perceived quality of facility-level factors was administered across 14 VMMC sites in South Africa, Tanzania, and Zimbabwe. Participants were adolescent male clients aged 10–14 years (n = 836) and 15–19 years (n = 457) and completed the survey 7 to 10 days following VMMC. Adjusted prevalence ratios (aPRs) were estimated by multivariable modified Poisson regression with generalized estimating equations and robust variance estimation to account for site-level clustering.

Results

Of 10- to 14-year-olds and 15- to 19-year-olds, 97.7% and 98.7%, respectively, reported they were either satisfied or very satisfied with their VMMC counseling experience. Most were also very likely or somewhat likely (93.6% of 10- to 14-year olds and 94.7% of 15- to 19-year olds) to recommend VMMC to their peers. On a 9-point scale, the median perceived quality of in-service (counselor) communication was 9 (interquartile range [IQR], 8–9) among 15- to 19-year-olds and 8 (IQR, 7–9) among 10- to 14-year-olds. The 10- to 14-year-olds were more likely than 15- to 19-year-olds to perceive a lower quality of in-service (counselor) communication (score <7; 21.5% vs. 8.2%; aPR, 1.61 [95% confidence interval, 1.33–1.95]). Most adolescents were more comfortable with a male rather than female counselor and provider. Adolescents of all ages wanted more discussion about pain, wound care, and healing time.

Conclusions

Adolescents perceive the quality of in-service communication as high and recommend VMMC to their peers; however, many adolescents desire more discussion about key topics outlined in World Health Organization guidance.

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Scaling Up Voluntary Medical Male Circumcision for Human Immunodeficiency Virus Prevention for Adolescents and Young Adult Men: A Modeling Analysis of Implementation and Impact in Selected Countries

Abstract

Background

The new World Health Organization and Joint United Nations Programme on HIV/AIDS strategic framework for voluntary medical male circumcision (VMMC) aims to increase VMMC coverage among males aged 10–29 years in priority settings to 90% by 2021. We use mathematical modeling to assess the likelihood that selected countries will achieve this objective, given their historical VMMC progress and current implementation options.

Methods

We use the Decision Makers' Program Planning Toolkit, version 2, to examine 4 ambitious but feasible scenarios for scaling up VMMC coverage from 2017 through 2021, inclusive in Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Uganda, and Zimbabwe.

Results

Tanzania is the only country that would reach the goal of 90% VMMC coverage in 10- to 29-year-olds by the end of 2021 in the scenarios assessed, and this was true in 3 of the scenarios studied. Mozambique, South Africa, and Lesotho would come close to reaching the objective only in the most ambitious scenario examined.

Conclusions

Major changes in VMMC implementation in most countries will be required to increase the proportion of circumcised 10- to 29-year-olds to 90% by the end of 2021. Scaling up VMMC coverage in males aged 10–29 years will require significantly increasing the number of circumcisions provided to 10- to 14-year-olds and 15- to 29-year-olds.

Impact of Counseling Received by Adolescents Undergoing Voluntary Medical Male Circumcision on Knowledge and Sexual Intentions

Abstract

Background

Little is known regarding the impact of counseling delivered during voluntary medical male circumcision (VMMC) services on adolescents' human immunodeficiency virus (HIV) knowledge, VMMC knowledge, or post-VMMC preventive sexual intentions. This study assessed the effect of counseling on knowledge and intentions.

Methods

Surveys were conducted with 1293 adolescent clients in 3 countries (South Africa, n = 299; Tanzania, n = 498; Zimbabwe, n = 496). Adolescents were assessed on HIV and VMMC knowledge-based items before receiving VMMC preprocedure counseling and at a follow-up survey approximately 10 days postprocedure. Sexually active adolescents were asked about their sexual intentions in the follow-up survey. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated by modified Poisson regression models with generalized estimating equations and robust variance estimators.

Results

Regarding post-VMMC HIV prevention knowledge, older adolescents were significantly more likely than younger adolescents to know that a male should use condoms (age 10–14 years, 41.1%; 15–19 years, 84.2%; aPR, 1.38 [95% CI, 1.19–1.60]), have fewer sex partners (age 10–14 years, 8.1%; age 15–19 years, 24.5%; aPR, 2.10 [95% CI, 1.30–3.39]), and be faithful to one partner (age 10–14 years, 5.7%; age 15–19 years, 23.2%; aPR, 2.79 [95% CI, 1.97–3.97]) to further protect himself from HIV. Older adolescents demonstrated greater improvement in knowledge in most categories, differences that were significant for questions regarding number of sex partners (aPR, 2.01 [95% CI, 1.18–3.44]) and faithfulness to one partner post-VMMC (aPR, 3.28 [95% CI, 2.22–4.86]). However, prevention knowledge levels overall and HIV risk reduction sexual intentions among sexually active adolescents were notably low, especially given that adolescents had been counseled only 7–10 days prior.

Conclusions

Adolescent VMMC counseling needs to be improved to increase knowledge and postprocedure preventive sexual intentions.

Adolescent Male Circumcision for HIV Prevention in High Priority Countries: Opportunities for Improvement

Abstract

Global experts recognize the need to transform conventional models of healthcare to create adolescent responsive health systems. As countries near 80% coverage of voluntary medical male circumcision (VMMC) for those aged 15–49 years, prioritization of younger men becomes critical to VMMC sustainability. This special supplement reporting 9 studies focusing on adolescent VMMC programming and services comes at a critical time. Eight articles report how well adolescents are reached with the World Health Organization's minimum package for comprehensive human immunodeficiency virus (HIV) prevention in South Africa, Zimbabwe, and Tanzania, analyzing motivation, counseling, wound healing, parental involvement, female peer support, quality of in-service communication, and providers' perceptions, and one presents models for achieving high VMMC coverage by 2021. One important finding is that adolescent boys, especially the youngest, experience gaps in their comprehension of key elements in the World Health Organization's minimum package. Although parents, counselors, and providers are involved and supportive, they are inadequately prepared to counsel youth, partly owing to discomfort with adolescent sexuality. At the country level, deliberately prioritizing young adolescents (aged 10–14 years) is likely to achieve national coverage targets more quickly and cost-effectively than continuing to focus on older, harder-to-reach men. The studies in this supplement point to areas where VMMC programs are achieving successes and they reveal areas for improvement. Given that prioritizing adolescents will be the best means of achieving sustainable VMMC for HIV prevention for the foreseeable future, applying the lessons learned here will increase the effectiveness of VMMC programs.

Females’ Peer Influence and Support for Adolescent Males Receiving Voluntary Medical Male Circumcision Services

Abstract

Background

While female involvement in voluntary medical male circumcision (VMMC) has been studied among adults, little is known about the influence of adolescent females on their male counterparts. This study explored adolescent females' involvement in VMMC decision making and the postoperative wound healing process in South Africa, Tanzania, and Zimbabwe.

Methods

Across 3 countries, 12 focus group discussions were conducted with a total of 90 adolescent females (aged 16–19 years). Individual in-depth interviews were conducted 6–10 weeks post-VMMC with 92 adolescent males (aged 10–19 years). Transcribed and translated qualitative data were coded into categories and subcategories by 2 independent coders.

Results

Adolescent female participants reported being supportive of male peers' decisions to seek VMMC, with the caveat that some thought VMMC gives males a chance to be promiscuous. Regardless, females from all countries expressed preference for circumcised over uncircumcised sexual partners. Adolescent females believed VMMC to be beneficial for the sexual health of both partners, viewed males with a circumcised penis as more attractive than uncircumcised males, used their romantic relationships with males or the potential for sex as leveraging points to convince males to become circumcised, and demonstrated supportive attitudes in the wound-healing period. Interviews with males confirmed that encouragement from females was a motivating factor in seeking VMMC.

Conclusions

Adolescent female participants played a role in convincing young males to seek VMMC and remained supportive of the decision postprocedure. Programs aiming to increase uptake of VMMC and other health-related initiatives for adolescent males should consider the perspective and influence of adolescent females.

Counseling Received by Adolescents Undergoing Voluntary Medical Male Circumcision: Moving Toward Age-Equitable Comprehensive Human Immunodeficiency Virus Prevention Measures

Abstract

Background

The minimum package of voluntary medical male circumcision (VMMC) services, as defined by the World Health Organization, includes human immunodeficiency virus (HIV) testing, HIV prevention counseling, screening/treatment for sexually transmitted infections, condom promotion, and the VMMC procedure. The current study aimed to assess whether adolescents received these key elements.

Methods

Quantitative surveys were conducted among male adolescents aged 10–19 years (n = 1293) seeking VMMC in South Africa, Tanzania, and Zimbabwe. We used a summative index score of 8 self-reported binary items to measure receipt of important elements of the World Health Organization–recommended HIV minimum package and the US President's Emergency Plan for AIDS Relief VMMC recommendations. Counseling sessions were observed for a subset of adolescents (n = 44). To evaluate factors associated with counseling content, we used Poisson regression models with generalized estimating equations and robust variance estimation.

Results

Although counseling included VMMC benefits, little attention was paid to risks, including how to identify complications, what to do if they arise, and why avoiding sex and masturbation could prevent complications. Overall, older adolescents (aged 15–19 years) reported receiving more items in the recommended minimum package than younger adolescents (aged 10–14 years; adjusted β, 0.17; 95% confidence interval [CI], .12–.21; P < .001). Older adolescents were also more likely to report receiving HIV test education and promotion (42.7% vs 29.5%; adjusted prevalence ratio [aPR], 1.53; 95% CI, 1.16–2.02) and a condom demonstration with condoms to take home (16.8% vs 4.4%; aPR, 2.44; 95% CI, 1.30–4.58). No significant age differences appeared in reports of explanations of VMMC risks and benefits or uptake of HIV testing. These self-reported findings were confirmed during counseling observations.

Conclusions

Moving toward age-equitable HIV prevention services during adolescent VMMC likely requires standardizing counseling content, as there are significant age differences in HIV prevention content received by adolescents.

Parental Communication, Engagement, and Support During the Adolescent Voluntary Medical Male Circumcision Experience

Abstract

Background

Voluntary medical male circumcision (VMMC) is one of few opportunities in sub-Saharan Africa to engage male adolescents in the healthcare system. Limited data are available on the level of parental communication, engagement, and support adolescents receive during the VMMC experience.

Methods

We conducted 24 focus group discussions with parents/guardians of adolescents (N = 192) who agreed to be circumcised or were recently circumcised in South Africa, Tanzania, and Zimbabwe. In addition, male adolescents (N = 1293) in South Africa (n = 299), Tanzania (n = 498), and Zimbabwe (n = 496) were interviewed about their VMMC experience within 7–10 days postprocedure. We estimated adjusted prevalence ratios (aPRs) using multivariable Poisson regression with generalized estimating equations and robust standard errors.

Results

Parents/guardians noted challenges and gaps in communicating with their sons about VMMC, especially when they did not accompany them to the clinic. Adolescents aged 10–14 years were significantly more likely than 15- to 19-year-olds to report that their parent accompanied them to a preprocedure counseling session (56.5% vs 12.5%; P < .001). Among adolescents, younger age (aPR, 0.86; 95% confidence interval [CI], .76–.99) and rural setting (aPR, 0.34; 95% CI, .13–.89) were less likely to be associated with parental–adolescent communication barriers, while lower socioeconomic status (aPR, 1.37; 95% CI, 1.00–1.87), being agnostic (or of a nondominant religion; aPR, 2.87; 95% CI, 2.21–3.72), and living in South Africa (aPR, 2.63; 95% CI, 1.29–4.73) were associated with greater perceived barriers to parental–adolescent communication about VMMC. Parents/guardians found it more difficult to be involved in wound care for older adolescents than for adolescents <15 years of age.

Conclusions

Parents play a vital role in the VMMC experience, especially for younger male adolescents. Strategies are needed to inform parents completely throughout the VMMC adolescent experience, whether or not they accompany their sons to clinics.

Adolescent Wound-Care Self-Efficacy and Practices After Voluntary Medical Male Circumcision—A Multicountry Assessment

Abstract

Background

Adolescent boys (aged 10–19 years) constitute the majority of voluntary medical male circumcision (VMMC) clients in sub-Saharan Africa. They are at higher risk of postoperative infections compared to adults. We explored adolescents' wound-care knowledge, self-efficacy, and practices after VMMC to inform strategies for reducing the risks of infectious complications postoperatively.

Methods

Quantitative and qualitative data were collected in South Africa, Tanzania, and Zimbabwe between June 2015 to September 2016. A postprocedure survey was conducted approximately 7–10 days after VMMC among male adolescents (n = 1293) who had completed a preprocedure survey; the postprocedure survey assessed knowledge of proper wound care and wound-care self-efficacy. We also conducted in-depth interviews (n = 92) with male adolescents 6–10 weeks after the VMMC procedure to further explore comprehension of providers' wound-care instructions as well as wound-care practices, and we held 24 focus group discussions with randomly selected parents/guardians of the adolescents.

Results

Adolescent VMMC clients face multiple challenges with postcircumcision wound care owing to factors such as forgetting, misinterpreting, and disregarding provider instructions. Although younger adolescents stated that parental intervention helped them overcome potential hindrances to wound care, parents and guardians lacked crucial information on wound care because most had not attended counseling sessions. Some older adolescents reported ignoring symptoms of infection and not returning to the clinic for review when an adverse event had occurred.

Conclusions

Increased involvement of parents/guardians in wound-care counseling for younger adolescents and in wound-care supervision, alongside the development of age-appropriate materials on wound care, are needed to minimize postoperative complications after VMMC.

Providers’ Perceptions and Training Needs for Counseling Adolescents Undergoing Voluntary Medical Male Circumcision

Abstract

Background

The majority of individuals who seek voluntary medical male circumcision (VMMC) services in sub-Saharan Africa are adolescents (ages 10–19 years). However, adolescents who obtain VMMC services report receiving little information on human immunodeficiency virus (HIV) prevention and care. In this study, we assessed the perceptions of VMMC facility managers and providers about current training content and their perspectives on age-appropriate adolescent counseling.

Methods

Semistructured in-depth interviews were conducted with 33 VMMC providers in Tanzania (n = 12), South Africa (n = 9), and Zimbabwe (n = 12) and with 4 key informant facility managers in each country (total 12). Two coders independently coded the data thematically using a 2-step process and Atlas.ti qualitative coding software.

Results

Providers and facility managers discussed limitations with current VMMC training, noting the need for adolescent-specific guidelines and counseling skills. Providers expressed hesitation in communicating complete sexual health information—including HIV testing, HIV prevention, proper condom usage, the importance of knowing a partner's HIV status, and abstinence from sex or masturbation during wound healing—with younger males (aged <15 years) and/or those assumed to be sexually inexperienced. Many providers revealed that they did not assess adolescent clients' sexual experience and deemed sexual topics to be irrelevant or inappropriate. Providers preferred counseling younger adolescents with their parents or guardians present, typically focusing primarily on wound care and procedural information.

Conclusions

Lack of training for working with adolescents influences the type of information communicated. Preconceptions hinder counseling that supports comprehensive HIV preventive behaviors and complete wound care information, particularly for younger adolescents.

Title Page

Recognition of early melanoma: a monocentric dermoscopy follow‐up study comparing de novo melanoma with nevus‐associated melanoma

International Journal of Dermatology, EarlyView.

Long-term trends in Swiss rivers sampled continuously over 39 years reflect changes in geochemical processes and pollution

Abstract

Long-term changes of 14 water constituents measured in continuously and water discharge proportionally collected samples of four Swiss rivers over a period of 39 years are analyzed using several statistical techniques. Possible drivers and causes for the identified trends and shifts are explained by consideration of catchment characteristics and anthropogenic activities. Water temperatures increased by 0.8–1.3 °C, whereas water discharges remained largely unchanged. Concentrations of alkalinity, total hardness, Ca, and Mg regulated by dominant carbonate lithologies in catchments increased by up to 10%. We attribute this change to an increase in the partial pressure of CO₂ in the subsurface, provoked by increasing temperatures. Re-oligotrophication processes in lakes also influence the behavior of alkalinity and silicic acid. In contrast to concentrations, most loads did not change significantly, due to their large variances. Therefore, no changes in overall weathering rates of carbonate rocks can be detected. The outgassing of CO₂ in rivers from the place of carbonate dissolution to measurement stations amounts up to 6% (mean) of CO₂ sequestered (mean 1.1 mol m⁻² a⁻¹) by the weathering of rock minerals. Changes in alkalinity/Ca/Mg ratios indicate an increase in calcite precipitation over time. Total nitrogen concentrations and loads peaked at the end of the 1980s and then decreased up to 50%, while NO₃ concentrations showed almost no changes. This dynamic matches the changes in the agricultural N balance. Concentrations and loads of Na and Cl increased up to 60% due to an increase in the various uses of rock salt.

In This Issue

The levels of polycyclic aromatic hydrocarbons (PAHs) in human milk and exposure risk to breastfed infants in petrochemical industrialized Lanzhou Valley, Northwest China

Abstract

We investigated in this paper the presence of PAHs in human milk from lactating women residing in Lanzhou, a petrochemical industrialized valley city in Northwest China. The PAH concentration levels in human milk samples from 98 healthy women were determined by gas chromatography/mass spectrometry (GC/MS). The associations between the lifestyle factors and the PAHs levels of human milk were analyzed. Moreover, we applied principal component analysis (PCA) method to gain a better insight into the similarities or dissimilarities of the human milk PAH loads and different pathways of source exposure. In addition, the exposure risks of breastfed infants due to PAH ingestion via breast milk were assessed and the relative breast-feeding risk to the total intake dose of infants was addressed. The results showed that the average fat-normalized human milk ∑₁₅PAHs concentrations for the lactating women residing in four districts of Lanzhou, namely, Xigu, Anning, Qilihe, and Chengguan were 320.40, 270.36, 374.04, and 259.84 ng/g of fat, respectively. The ∑₁₅PAHs of human milk from the lactating women of Qilihe District exhibited the highest concentration level, while the concentration level for women from Xigu District is the second highest for the observed human milk ∑₁₅PAHs. And the corresponding BaPeq concentrations for women in Xigu, Anning, Qilihe, and Chengguan districts were 58.29, 47.95, 65.13, and 45.60 ng/g of fat, respectively. A significant correlation was only found between human milk and living district environment (p < 0.05). Although the Spearman correlation analysis showed that there were no significant correlation existing between other lifestyle and human milk PAHs, we confirmed that consuming barbecue food could elevate PAHs levels in human milk: the barbecue intake frequency caused 10% fluctuation of ∑₁₅PAHs concentration between high frequency and low frequency group in our study. Furthermore, the exposure to second-hand smoke can also increase the ∑₁₅PAHs levels in human milk by 4 to 11% here. Ingestion doses of PAHs by infants (19.37–77.75 ng kg⁻¹ day⁻¹) were much higher than the inhalation doses (2.83–16.48 ng kg⁻¹ day⁻¹), which indicated that the ingestion is the main exposure risk pathway for infants. Since there are limited guidelines and standards for PAHs ingestion dose in human milk by infant, we compared the ingestion dose of BaP with the upper bound estimates of BaP dietary exposure of 108 ng kg⁻¹ day⁻¹ for toddlers of ages between 1.5 and 2.5 years of age in the UK reported by Committee on Toxicity of Chemicals in Food (COT) and the data we obtained were lower than this upper bound. However, the estimated margin of exposure (MOE) values of BaP-MOE, PAH2-MOE, PAH4-MOE, and PAH8-MOE were smaller than 10,000 which indicated that there are potential hazard for breastfed infants consuming these human milk samples.

Does the application of silicon and Moringa seed extract reduce heavy metals toxicity in potato tubers treated with phosphate fertilizers?

Abstract

Two field trials were carried out in two successive agricultural seasons to study the possibility of using silicon (Si) and Moringa seed extract (MSE) for reducing heavy metal contamination resulting from phosphate fertilizers addition to potato tubers. A randomized complete block design experiment was performed using three replicates. Various sources of phosphate fertilizers as ordinary super phosphate and rock phosphate were added at rate of 100 kg P ha⁻¹ prior sowing. Silicon was added as potassium silicate (20% SiO₂) at rate of 6 L ha⁻¹, and MSE was also added at rate of 150 L ha⁻¹ in three equal doses with the 2nd, 4th, and 6th irrigations during the last 10 min of drip irrigation. Results indicated that the addition of phosphate fertilizers increased fresh tuber yield, dry weight yield, NPK uptake, catalase, peroxidase, superoxide dismutase, and glutathione reductase of potato either alone or combined with silicon and MSE. The accumulation rate of Cu, Cd, and Ni in potato was higher with the single addition of rock phosphate fertilizer compared with single addition of super phosphate fertilizer. The highest reduction (P < 0.05) in heavy metal accumulation in potato leaves and tubers as well as soil was found with MSE treatment plus super phosphate fertilizer. It is recommended to add MSE at a rate of 150 L ha⁻¹ along with fertilizing the potato crop with ordinary super phosphate fertilizer.

Identification and quantitation of semi-crystalline microplastics using image analysis and differential scanning calorimetry

Abstract

There are several techniques used to analyze microplastics. These are often based on a combination of visual and spectroscopic techniques. Here we introduce an alternative workflow for identification and mass quantitation through a combination of optical microscopy with image analysis (IA) and differential scanning calorimetry (DSC). We studied four synthetic polymers with environmental concern: low and high density polyethylene (LDPE and HDPE, respectively), polypropylene (PP), and polyethylene terephthalate (PET). Selected experiments were conducted to investigate (i) particle characterization and counting procedures based on image analysis with open-source software, (ii) chemical identification of microplastics based on DSC signal processing, (iii) dependence of particle size on DSC signal, and (iv) quantitation of microplastics mass based on DSC signal. We describe the potential and limitations of these techniques to increase reliability for microplastic analysis. Particle size demonstrated to have particular incidence in the qualitative and quantitative performance of DSC signals. Both, identification (based on characteristic onset temperature) and mass quantitation (based on heat flow) showed to be affected by particle size. As a result, a proper sample treatment which includes sieving of suspended particles is particularly required for this analytical approach.

Mode of action of nanoparticles against insects

Abstract

The employment of nanoparticles obtained through various synthesis routes as novel pesticides recently attracted high research attention. An impressive number of studies have been conducted to test their toxic potential against a wide number of arthropod pests and vectors, with major emphasis on mosquitoes and ticks. However, precise information on the mechanisms of action of nanoparticles against insects and mites are limited, with the noteworthy exception of silica, alumina, silver, and graphene oxide nanoparticles on insects, while no information is available for mites. Here, I summarize current knowledge about the mechanisms of action of nanoparticles against insects. Both silver and graphene oxide nanoparticles have a significant impact on insect antioxidant and detoxifying enzymes, leading to oxidative stress and cell death. Ag nanoparticles also reduced acetylcholinesterase activity, while polystyrene nanoparticles inhibited CYP450 isoenzymes. Au nanoparticles can act as trypsin inhibitors and disrupt development and reproduction. Metal nanoparticles can bind to S and P in proteins and nucleic acids, respectively, leading to a decrease in membrane permeability, therefore to organelle and enzyme denaturation, followed by cell death. Besides, Ag nanoparticles up- and downregulate key insect genes, reducing protein synthesis and gonadotrophin release, leading to developmental damages and reproductive failure. The toxicity of SiO₂ and Al₂O₃ nanoparticles is due to their binding to the insect cuticle, followed by physico-sorption of waxes and lipids, leading to insect dehydration. In the final section, insect nanotoxicology research trends are critically discussed, outlining major challenges to predict the ecotoxicological consequences arising from the real-world use of nanoparticles as pesticides.

Cutis laxa associated monoclonal gammopathy: 14 new cases and review of the literature

UVΑ pre-irradiation to P25 titanium dioxide nanoparticles enhanced its toxicity towards freshwater algae Scenedesmus obliquus

Abstract

There has recently been an increase in the usage of TiO₂ nanoparticles (NPs). P25 TiO₂ NPs, a mixture of anatase and rutile phase in 3:1 ratio, are generally used for photocatalytic applications because both phases exhibit a synergistic effect on the photocatalytic activity of the TiO₂ NPs. In the present study, increased toxicity of UVA-pre-irradiated P25 TiO₂ NPs on freshwater algae Scenedesmus obliquus was assessed under visible light and dark exposure conditions at actual low concentrations (0.3, 3 and 35 μM of Ti). Photocatalytic property of P25 TiO₂ NPs caused disaggregation of UVA-pre-irradiated NPs, thus significantly decreasing the mean hydrodynamic diameter (MHD) (188.74 ± 0.54 nm) than that of non-irradiated NPs (232.26 ± 0.44). This decrease in diameter of UVA-pre-irradiated NPs may increase its biological activity towards algal samples. All concentrations of pre-irradiated NPs, under both light and dark conditions, showed a significantly lesser cell viability (p < 0.001) when compared with non-irradiated NPs. Increased production of ROS, antioxidant enzymes and lipid peroxidation supported the viability data. Higher exopolysaccharide production and more nuclear damage were observed for pre-irradiated NPs. NP uptake was also more for the pre-irradiated NPs on treated samples when compared with non-irradiated NPs on treated samples, which, in turn, established the higher toxic potential of UVA-pre-irradiated TiO₂ NPs. This study improves our understanding of the toxic effects of UVA-pre-irradiated TiO₂ NPs on freshwater algae, thereby emphasising the need for ecological risk assessments of metal oxide nanoparticles in a natural experimental medium.

Immunocompetence analysis of the aquatic snail Lymnaea stagnalis exposed to urban wastewaters

Abstract

Wastewater treatment plant effluents from urban area are a well-known source of chronic multiple micropollution to the downstream living organisms. In this study, ecologically relevant laboratory-bred freshwater gastropods, Lymnaea stagnalis, were exposed for 29 days to raw effluents of a wastewater treatment plant in Lyon area (France). A time-course analysis of individual markers of immunocompetence (hemocyte density and viability, hemocyte NADPH activity, phenol oxidase activity, and capacity of phagocytosis) has shown slight trends of inflammatory-like responses induced by the 100% effluents. So far, no short-term hazard for L. stagnalis can be revealed. However, over the long term, such environmental stress-stimulating immune responses could provoke deleterious life history trade-offs because the immune system is known to be highly energy-consuming.

Experimental assessment and validation of quantification methods for cellulose content in municipal wastewater and sludge

Abstract

Cellulose, mostly in the form of toilet paper, forms a major component of the particulates in raw municipal wastewater, which could lead to significant consequences due to the potential accumulation of cellulosic fibers and slow biodegradability. Despite the sparse reports on cellulose content and degradation in wastewater and sludge, an accurate and validated method for its quantification in such matrices does not exist. In this paper, four different methods were compared including dilute acid hydrolysis, concentrated acid hydrolysis, enzymatic hydrolysis, and the Schweitzer reagent method. The Schweitzer reagent method, applied to municipal wastewater and sludge, was found to be a very robust and reliable quantification method in light of its reproducibility, accuracy, and ideal (100%) recovery. The determination of cellulose content is critical to understand its fate in wastewater treatment plants as well as improve sludge management and enhance resource recovery.

Morphological and functional responses of a metal-tolerant sunflower mutant line to a copper-contaminated soil series

Abstract

The potential use of a metal-tolerant sunflower mutant line for biomonitoring Cu phytoavailability, Cu-induced soil phytotoxicity, and Cu phytoextraction was assessed on a Cu-contaminated soil series (13–1020 mg Cu kg⁻¹) obtained by fading a sandy topsoil from a wood preservation site with a similar uncontaminated soil. Morphological and functional plant responses as well as shoot, leaf, and root ionomes were measured after a 1-month pot experiment. Hypocotyl length, shoot and root dry weight (DW) yields, and leaf area gradually decreased as soil Cu exposure rose. Their dose-response curves (DRC) plotted against indicators of Cu exposure were generally well fitted by sigmoidal curves. The half-maximal effective concentration (EC₅₀) of morphological parameters ranged between 203 and 333 mg Cu kg⁻¹ soil, corresponding to 290–430 μg Cu L⁻¹ in the soil pore water, and 20 ± 5 mg Cu kg⁻¹ DW in the shoots. The EC₁₀ for shoot Cu concentration (13–15 mg Cu kg⁻¹ DW) coincided to 166 mg Cu kg⁻¹ soil. Total chlorophyll content and total antioxidant capacity (TAC) were early biomarkers (EC₁₀: 23 and 51 mg Cu kg⁻¹ soil). Their DRC displayed a biphasic response. Photosynthetic pigment contents, e.g., carotenoids, correlated with TAC. Ionome was changed in Cu-stressed roots, shoots, and leaves. Shoot Cu removal peaked roughly at 280 μg Cu L⁻¹ in the soil pore water.

Issue Information

Dermatologic Therapy, Volume 31, Issue 2, March/April 2018.

Controls on the spatial distribution of iodine in groundwater in the Hebei Plain, China

Abstract

In the Hebei Plain of North China, 70% of the inhabitants depend on groundwater for drinking water. Little is known regarding high-iodine concentrations in groundwater because there have been few systematic studies on high levels of iodine in groundwater in this region. To help identify the mechanisms that control the spatial distribution of iodine in groundwater, 61 samples of shallow groundwater and 161 samples of deep groundwater were collected along a sample section from Taihang Mountain to the Bo Sea. There were four pockets of high-iodine concentrations along the sample section. As the groundwater depth increased, the ratio of undetected iodine decreased, and the ratio of high-iodine concentrations increased. The high-iodine concentrations in the groundwater reflect the geological and sedimentary settings, and were mainly controlled by pH and Eh. Iodine concentrations were particularly high when the pH was between 7.3 and 8.5, and there was an inflection point at 150 μg/L in the curve of the relationship between iodine concentrations and Eh.

A comprehensive air quality investigation at an aquatic centre: Indoor/outdoor comparisons

Abstract

Air quality and comfort parameters in a naturally ventilated aquatic centre were studied in relation to the outdoor pollution levels. Simultaneous measurements of PM 2.5, as well as of volatile organic compounds, were carried out for the indoor and outdoor environment of the aquatic centre. The chemical analysis of ionic species and trace elements associated with particulate matter was also performed. In addition, automated analyzer for NO₂ and O₃ was used in order to record the indoor and outdoor levels of these pollutants. Analysis of diurnal variation of the pollutants' concentration was applied to the collected data, allowing the identification of potential variation on the sources affecting the indoor air quality. PM 2.5 concentration was almost two times higher indoors than outdoors with average values of 13.96 and 6.78 μg/m³, respectively. Concerning the ion fraction of PM 2.5, SO₄²⁻ and Ca²⁺ were the ions with higher concentration indoors with values of 1.06 and 0.93 μg/m³, respectively, while the percentage of Cl⁻ to the PM 2.5 fraction of the indoor atmosphere (9%) was too high than outdoor ones (1%). These results showed that indoor air of swimming pool concerning PM 2.5 and ionic species is mainly affected by the chlorination process along with the comfort conditions (high relative humidity) created during the operation of the facility. The common volatile organic compound concentrations at indoor air are generally in higher levels, compared to the outdoor air with p,m-xylene and toluene to be the substances with the higher concentration for indoor and outdoor area, respectively (7.80 and 1.57 μg/m³); nevertheless, values were rather low compared with the findings of other studies. Also, they clearly demonstrate a diurnal variation as a result of poor ventilation during night. As it was expected, chloroform showed the highest concentration compared to the other volatile organic compounds with values ranging from 3.35 to 135.89 μg/m³, with an average of 54.50 μg/m³. Concerning the NO₂ concentration, indoor levels showed an increased pattern when the swimming pool was fully occupied, a fact that reveals a possible correlation. As an overall conclusion, the natural ventilation and the disinfection process seem to play a key role to the air quality of the indoor air of the aquatic centre.

Characteristics of menstrual versus non-menstrual migraine during pregnancy: a longitudinal population-based study

Migraine is a common headache disorder that affects mostly women. In half of these, migraine is menstrually associated, and ranges from completely asymptomatic to frequent pain throughout pregnancy.

Current and Emerging Therapeutic Targets for Metastatic Renal Cell Carcinoma

Abstract

Purpose of review

The treatment of advanced renal cell carcinoma has evolved dramatically over recent years. In this review, we will summarize current and emerging therapies based on molecular targets and provide insight into treatment strategy for metastatic renal cell carcinoma.

Recent findings

We have witnessed a paradigm shift in the therapeutic landscape as treatment was formerly reliant on cytokine-based agents which have now been replaced with therapies targeting angiogenesis, mammalian target of rapamycin pathways, and immune responses. These dramatic changes are primarily due to our improved understanding of the underlying mutations and molecular mechanisms leading to tumorigenesis and progression.

Summary

We now have targeted agents in the form of small-molecule tyrosine kinase inhibitors, monoclonal antibodies, and mTOR inhibitors. Moreover, immunotherapy-targeting checkpoints of T-lymphocyte activity has provided increased overall survival and a new class of agents with potential to radically change the treatment options. With these agents and their combination, durable responses are increasingly seen even though treatment resistance remains a huge challenge. New treatment strategies are rapidly developing and the therapeutic landscape is expected for further evolution.

Pubogenital tinea after intimate shaving with isolation of Trichophyton benhamiae

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.

Zika virus in Germany: case report and possible routes of transmission

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.

Erythematous non‐ulcerated nodule of the scapular region

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.

Uncommon ulcers in a patient with diabetes

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.

A long history of widespread asymptomatic giant plaques

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.

Disseminated Mycobacterium marinum skin infection due to chronic lymphedema in an immunocompetent patient

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.

Targeted Agents in Cervical Cancer: Beyond Bevacizumab

Abstract

Cervical cancer constitutes a leading cause of morbidity and cancer deaths in women throughout the world. Approximately two thirds of the patients are diagnosed with locally advanced cervical cancer, showing disappointing survival rates despite correct multidisciplinary management. Metastatic disease implies a poor prognosis itself since diagnosis. Platinum-based chemotherapy has been the backbone treatment of metastatic cervical cancer for years with no major outstanding improvements on survival. The addition of new molecules, such as antiangiogenic agents, dramatically changed the treatment of this disease. Bevacizumab, an antiangiogenic agent that targets vascular endothelial growth factor 2 (VEGF-2), added to standard chemotherapy in cervical cancer showed significant improvement on survival; therefore, the combination of carboplatin, paclitaxel, and bevacizumab is currently the standard frontline treatment in cervical cancer. Other antiangiogenic agents have been tested in this disease with no further development nor approvals. New compounds are currently being under development with promising results in this disease as well as a number of new strategies that could potentially fulfill the unmet need of establishing effective therapeutic approaches in cervical cancer.

Platform trials arrive on time for glioblastoma

The German National Center for Tumor Diseases (NCT) has developed a noncomparative screening trial called Neuro Master Match (N2M2) for first-line unmethylated glioblastoma (GBM) patients.¹ In the current issue of Neuro-Oncology, the NCT presents pilot data to evaluate feasibility and timeliness of performing complex multilayer molecular diagnostics in a clinical setting to support N2M2. These data are timely in our field, as many platform trials are either ongoing² or planned³ where biomarker data are important for patient allocation. We will first provide a bit more depth on N2M2 and then compare and contrast this trial with 2 other platform trials: the INdividualized Screening trial of Innovative GBM Therapy (INSIGhT)² and the GBM Adaptive Global Innovative Learning Environment (GBM AGILE).³

Tian as Cosmos in Z hu Xi’s Neo-Confucianism

Abstract

Tian 天 is central to the metaphysics, cosmology, and ethics of the 800-year-long Chinese philosophical tradition we call "Neo-Confucianism," but there is considerable confusion over what tian means—confusion which is exacerbated by its standard translation into English as "Heaven." This essay analyzes the meaning of tian in the works of the most influential Neo-Confucian, Zhu Xi 朱熹 (1130–1200), presents a coherent interpretation that unifies the disparate aspects of the term's meaning, and argues that "cosmos" does an excellent job of capturing this meaning and therefore should be adopted as our translation of tian.

Thirty‐two Japanese cases of infantile hemangiomas treated with oral propranolol

The Journal of Dermatology, EarlyView.

Successful treatment of cutaneous phaeohyphomycosis caused by Exophiala lecanii‐corni with voriconazole

The Journal of Dermatology, EarlyView.

Case of photosensitivity after the administration of olmesartan medoxomil

The Journal of Dermatology, EarlyView.

Angiolymphoid hyperplasia with eosinophilia: A case of spontaneous partial regression post‐biopsy

The Journal of Dermatology, EarlyView.

Cutaneous hydrophilic polymer embolism accompanied by acute renal failure

The Journal of Dermatology, EarlyView.

Ischemic oculomotor nerve palsy due to hyaluronic acid filler injection

Journal of Cosmetic Dermatology, EarlyView.

Safety and complications of absorbable threads made of poly‐L‐lactic acid and poly lactide/glycolide: Experience with 148 consecutive patients

Journal of Cosmetic Dermatology, EarlyView.

Turmeric tonic as a treatment in scalp psoriasis: A randomized placebo‐control clinical trial

Journal of Cosmetic Dermatology, EarlyView.

A novel heterozygous missense mutation of DSP in a Chinese Han pedigree with palmoplantar keratoderma

Journal of Cosmetic Dermatology, EarlyView.

Correlations between skin hydration parameters and corneocyte‐derived parameters to characterize skin conditions

Journal of Cosmetic Dermatology, EarlyView.

Clinical and dermoscopic response predictors in psoriatic patients undergoing narrowband ultraviolet B phototherapy: results from a prospective study

International Journal of Dermatology, EarlyView.

A retrospective study of the characteristics of patients with early‐onset compared to adult‐onset hidradenitis suppurativa

International Journal of Dermatology, EarlyView.

Acquired ichthyosis associated with gastric adenocarcinoma

International Journal of Dermatology, EarlyView.

Peristomal psoriasis: an extraintestinal manifestation of inflammatory bowel disease?

International Journal of Dermatology, EarlyView.

Cutaneous protothecosis in a patient on ustekinumab for psoriasis

International Journal of Dermatology, EarlyView.

No association between circulating concentrations of vitamin D and risk of lung cancer: An analysis in 20 prospective studies in the Lung Cancer Cohort Consortium (LC3)

Abstract

Background

There is observational evidence suggesting that high vitamin D concentrations may protect against lung cancer. To investigate this hypothesis in detail, we measured circulating vitamin D concentrations in pre-diagnostic blood from 20 cohorts participating in the Lung Cancer Cohort Consortium (LC3).

Patients and methods

The study included 5,313 lung cancer cases and 5,313 controls selected from. Blood samples for the cases were collected, on average, 5 years prior to lung cancer diagnosis. Controls were individually matched to the cases by cohort, sex, age, race/ethnicity, date of blood collection, and smoking status in 5 categories. Liquid chromatography coupled with tandem mass spectrometry was used to separately analyze 25-hydroxyvitamin D₂ (25(OH)D₂) and 25-hydroxyvitamin D₃ (25(OH)D₃) and their concentrations were combined to give an overall measure of 25(OH)D. We used conditional logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI) for 25(OH)D as both a continuous and categorical variable.

Results

Overall, no apparent association between 25(OH)D and risk of lung cancer was observed (multivariable adjusted OR for a doubling in concentration: 0.98, 95% confidence interval: 0.91, 1.06). Similarly, we found no clear evidence of interaction by cohort, sex, age, smoking status, or histology.

Conclusion

This study did not support an association between vitamin D concentrations and lung cancer risk.

Connolly, Tim, Doing Philosophy Comparatively

H uang Zongxi as a Republican: A Theory of Governance for Confucian Democracy

Abstract

Confucianism has been historically intertwined with authoritarianism in general and monarchy in specific. Various contemporary attempts to reconcile Confucianism with democracy have yielded controversial results mostly due to the theoretical tension between the authoritarian character of the former and the liberal one of the latter. This article seeks to develop an alternative route to Confucian democracy by drawing from Huang Zongxi's 黃宗羲 Waiting for the Dawn: A Plan for the Prince (Mingyi Daifang Lu 明夷待訪錄). In this well-known work, Huang argues for a form of limited government that is built upon laws, political protection of academic freedom, good institutional designs, and separation of governmental powers. While these features seem to qualify Huang only as a defective liberal, this article argues that they are in much coherence with the insights of republicanism concerning good governance. This article will argue that the republican themes embodied in Waiting for the Dawn can justify and support a particular form of Confucian republican democracy.

RE: “Deployment And Preterm Birth Among US Army Soldiers”

2017 Articles of the Year, Reviewers of the Year, and Figure of the Year

Adverse reactions to tattoos in the general population of Denmark

Safety and Efficacy of a Halobetasol/Tazarotene Fixed Combination in the Treatment of Moderate-to-Severe Plaque Psoriasis: Results of two Phase 3 randomized controlled trials

Topical corticosteroids are the mainstay of psoriasis treatment; long-term safety concerns limit use. Combination with tazarotene may optimize efficacy, minimizing safety/tolerability concerns, In patients with moderate-to-severe plaque psoriasis treated with HP/TAZ lotion, improvement is noted within 2 weeks with few adverse effects observed after 8 weeks., HP/TAZ lotion may provide a realistic topical option for psoriasis management