Publication date: May 2018
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 4, Supplement
Author(s): C. Chouk, N. Litaiem, M. Jones, S. Harbaoui, S. Rammeh, N. Ezzine, F. Zeglaoui
IntroductionLa maladie de Kaposi (MK) est une pathologie néoplasique multifocale, induite par une infection par HHV8. Quatre formes épidémiologiques ont été individualisées dont la forme méditerranéenne ou classique est la plus fréquente et la plus indolente.ButÉtudier caractéristiques épidémio-cliniques, thérapeutiques et évolutives des formes sévères de MK classique.MéthodesIl s'agit d'une étude rétrospective réalisée dans notre étude sur une période de 10 ans (2008–2017) incluant tous les patients présentant une MK avec une atteinte cutanée et/ou viscérale sévère. Une confirmation histologique couplée à une positivité du marquage cellulaire HHV8 était exigée dans tous les cas. Le diagnostic de la forme classique était retenu après exclusion des causes iatrogènes et d'une infection VIH.RésultatsOnze patients (7 hommes et 4 femmes) ont été inclus dans notre étude. L'âge moyen était de 71 ans (extrêmes de 35 et 87 ans). Des comorbidités (hypertension artérielle dans 5 cas, diabète dans 3 cas, coronaropathie dans 3 cas) étaient notées chez 9 patients. La durée d'évolution moyenne était de 2 ans avant la 1re consultation. Cinq patients présentaient une atteinte étendue des quatre membres et du visage. Deux patients avaient une atteinte des muqueuses buccale et génitale. Un patient présentait une tumeur solitaire géante de la cheville et de l'avant-pied infiltrant radiologiquement les tendons tibiaux antérieurs et les muscles extenseurs des orteils. Une forme invalidante était diagnostiquée 5 patients : un patient était amputé au niveau de la cuisse suite à une surinfection de tumeurs nécrosées avec toutefois une récidive des lésions sur moignon d'amputation. Deux patients avaient une impotente gêne fonctionnelle avec des lésions des têtes métatarsiennes avec limitation des mouvements articulaires. Un traitement par radiothérapie fractionnée était indiqué chez 4 patients. Une monochimiothérapie (bléomycine) était indiquée chez 4 patients. Un traitement chirurgical était réalisé chez un patient. La réponse aux traitements était partielle pour tous les patients. Aucun décès spécifique de la maladie n'a été noté au cours de la période de suivi.ConclusionLa MK classique est caractérisée généralement par un âge avancé d'installation, une évolution très lente et une prédilection pour les membres inférieurs avec un lymphœdème souvent associé. Notre série souligne néanmoins ces formes sévères, longtemps considérés rares, pouvant occasionner une importante gêne fonctionnelle, et se compliquer de nécrose et de surinfection. Le traitement repose sur la monochimiothérapie.
Παρασκευή 27 Απριλίου 2018
Formes sévères de la maladie de Kaposi classique
MF à grandes squames : le « grand imitateur »
Publication date: May 2018
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 4, Supplement
Author(s): D. Declaye, C. Peeters, L. de Montjoye, L. Marot, M. Baeck, D. Tennstedt
IntroductionLe mycosis fongoïde (MF) est le type le plus fréquent de lymphome T cutané. Il peut prendre de multiples présentations cliniques. Zackheim et McCalmont [1] ont proposé de lui attribuer l'appellation antérieurement dédiée à la syphilis de « grand imitateur ».Observations– Un homme de 57 ans, sans antécédent notoire, se plaint, depuis 5 ans, d'un prurit diffus associé, sur le plan clinique, à un aspect ichtyosiforme (à grandes squames) de sa peau. Sur le tronc et les membres, il est apparu de manière progressive des lésions papuleuses, réticulées, érythémato-violacées, squameuses et asymptomatiques prenant un aspect très particulier « en damier » ;– Une femme de 45 ans, originaire du Togo, habitant en Belgique depuis 20 ans, consulte en raison d'un développement de plaques diffuses poïkilodermiques d'aggravation progressive depuis 10 ans. Le prurit est important. Les lésions se situent sur les zones non insolées, les membres et le tronc. Le centre des plaques est atrophique, entouré par une collerette pigmentée périphérique avec ici aussi un aspect très particulier « en nid d'abeille ».Chez les deux patients, l'examen anatomopathologique permet de mettre en évidence la présence de lymphocytes particuliers situés le long de la lame basale, avec formation de micro-abcès de Pautrier. Focalement, on objective de la spongiose avec formation de vésicules sous-cornées, contenant des lymphocytes et des cellules histiocytaires. Le derme superficiel est le siège d'un infiltrat inflammatoire dense, essentiellement interstitiel, constitué de cellules lymphohistiocytaires associées à quelques polynucléaires éosinophiles.L'immunohistochimie confirme la suspicion anatomoclinique, avec mise en évidence de nombreux lymphocytes T CD4 essentiellement au niveau épidermique. Un réarrangement monoclonal T est retrouvé à l'analyse en biologie moléculaire. L'examen anatomopathologique et la clinique confirment le diagnostic de mycosis fongoïde CD4+.DiscussionLe MF fait partie des lymphomes T épidermotropes de bon pronostic. Il représente 50 % des lymphomes cutanés et son incidence augmente, il atteint plus fréquemment les adultes, avec prédominance masculine (sexe ratio de 2/1). Une association avec le rétrovirus HTLV−1 est suspectée mais non confirmée à ce jour. Le MF peut prendre des formes cliniques multiples parfois surprenantes, dont l'examen anatomopathologique permet alors d'en affirmer le diagnostic : pityriasis alba, plaques hypo pigmentées vitiligoïdes, acanthosis nigricans, érythème annulaire centrifuge, cellulite disséquante du cuir chevelu, lésions dysidrosiformes, éruption vésiculeuse, bulleuse, dermatite périorale, dermatite purpurique et pigmentée, érythème polymorphe, ichtyose acquise, kératodermie et pustulose palmoplantaire, kératose lichénoïde chronique, lymphome pilotrope, chalazodermie granulomateuse, porokératose de Mibelli, pyoderma gangrenosum, pseudo cutis laxa, plaques psoriasiformes, REM… Le traitement du MF reste délicat, équilibre difficile entre engager trop tôt un traitement agressif et rester trop longtemps timoré. L'attitude thérapeutique peut être expectative, et ne comporter que des traitements symptomatiques permettant de contrôler le prurit, la douleur, les surinfections, et l'accompagnement psychologique. Selon le stade, le traitement peut être local : dermocorticoïdes, agents alkylants, PUVA ou UVBthérapie, radiothérapie locale (TSEB low-dose 10–12Gy ou radiothérapie locale classique 2×4Gy) ou systémique : rétinoïdes, méthotrexate faible dose, mono ou polychimiothérapie. La présentation clinique du mycosis fongoïde est parfois déroutante, et nécessite une indispensable confrontation anatomoclinique. Nous rapportons le cas de deux patients, le premier présentant une forme clinique exceptionnelle et l'autre, une clinique classique, caractéristique mais peu connue (et donc digne de figurer dans nos « textbooks »).
Profil épidémio-clinique, histologique et thérapeutique du syndrome de Sweet : à propos de 25 cas
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 4, Supplement
Author(s): S. Harbaoui, N. Litaiem, M. Jones, C. Chouk, N. Ktari, S. Rammeh, N. Ezzine, F. Zeglaoui
IntroductionLe syndrome de Sweet (SS) a été décrit à l'origine par le Dr Robert Douglas Sweet en 1964. Il appartient au groupe des dermatoses neutrophiliques et peut être considéré comme la plus typique des entités de ce groupe.But À travers une série hospitalière, nous nous proposons d'étudier les particularités épidémio-cliniques, histologiques et thérapeutiques observées au cours du SS.MéthodesIl s'agit d'une étude rétrospective, monocentrique, descriptive, colligeant 25 malades atteints du SS et hospitalisés dans notre service entre janvier 1999 et décembre 2015.RésultatsVingt-cinq patients ont été inclus dans cette étude. L'âge moyen était de 50,5 ans (32–73 ans). Le sex-ratio F/H=5,25. Un stade prodromique était observé chez 19 patients. Il s'agissait d'une fièvre (16 cas), d'arthralgie (12 cas), d'un syndrome pseudo-grippal (12 cas) et d'une conjonctivite (1 cas). Le délai entre le stade prodromique et l'apparition de l'éruption cutanée était de 6,53 jours en moyenne. Une prise médicamenteuse précédant l'éruption a été rapportée chez une patiente suite une prise de la lincomycine 3 jours avant le début des signes du SS. L'enquête de pharmacovigilance permettait de retenir l'imputabilité vraisemblable de ce traitement dans la survenue du SS. Le début de l'éruption cutanée était brutal dans la totalité des cas. Des plaques érythémato-papuleuses infiltrées étaient observées chez tous les malades, prenant par endroit une disposition annulaire (3 cas, 12 %), ou mamelonnée (1 cas, 4 %). D'autres lésions moins typiques étaient observées à savoir des plaques infiltrées bulleuses dans 5 cas (20 %) ; des pustules de grande taille surmontant les plaques érythémateuses dans 4 cas (16 %) et des nodules sous-cutanés des membres inférieurs, dans un seul cas (4 %). Le siège préférentiel était les membres inférieurs atteints chez 24 cas (96 %) et le visage était atteint dans 13 cas (52 %). À l'histologie, un infiltrat inflammatoire riche en polynucléaires neutrophiles (PNN) était retrouvé dans tous les cas. Concernant le traitement, les anti-inflammatoires non stéroïdiens (AINS) constituaient le traitement le plus utilisé en première ligne (18 malades, 72 %), suivis par les corticoïdes systémiques (3 malades, 12 %), les dermocorticoïdes (2 malades, 8 %) et la colchicine (1 malade, 4 %). À noter que pour un cas (4 %), les lésions avaient disparu avant l'instauration d'un traitement.ConclusionLe SS fait partie du spectre des maladies neutrophiliques. L'association du SS à une étiologie néoplasique, dont il peut être un signe avant-coureur, justifie la réalisation d'un bilan étiologique clinique et paraclinique initial éventuellement répété au cours de l'évolution.
Psoriasis pustuleux compliqué de pustulose exanthématique généralisée : un dilemme diagnostic !
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 4, Supplement
Author(s): A. Arousse, R. Gammoudi, C. Ben salem, L. Boussofara, N. Ghariani, S. Mokni, A. Aounallah, C. Belajouza, M. Denguezli, R. Nouira
IntroductionLe psoriasis pustuleux généralisé (PPG) est une variante rare et sévère de psoriasis. La Pustulose exanthématique aiguë généralisée (PEAG) est une dermatose multifactorielle le plus souvent médicamenteuse. Le PPG et la PEAG partagent des similitudes cliniques et immunopathologiques rendant leur distinction peu aisée.ObservationIl s'agissait d'une patiente âgée de 32 ans, suivie initialement pour une dermatose compatible cliniquement et histologiquement avec un PPG évoluant par poussées récurrentes depuis 4 ans et pour lequel elle avait bénéficié de plusieurs traitements systémiques (acitrétine, ciclosporine et méthotrexate). Elle a été récemment admise devant une poussée pustuleuse généralisée dans un contexte fébrile survenant 2jours après l'introduction d'Oxacilline pour une otite aiguë. L'examen retrouvait un érythème diffus parsemé d'un semis de pustules stériles en tête d'épingle prédominant au niveau des plis avec des bulles hypopion-like sans signe de Nikolsky ni atteinte muqueuse. La biologie montrait un syndrome inflammatoire. L'histologie cutanée avait montré l'image d'une pustule sous-cornée associée à une spongiose à neutrophiles, des kératinocytes apoptotiques et un derme œdémateux siège d'un infiltrat inflammatoire comprenant des éosinophiles. Le diagnostic de PEAG a été retenu avec un score EuroSCAR de 10. L'arrêt de l'oxacilline était suivi d'une résolution de l'atteinte dermatologique dans un délai de 10jours. Un patch-test à l'oxacilline effectué 10 semaines après l'épisode était positif. La description récente de mutations du gène ILR36Ra dans le PPG et dans quelques cas sévères de PEAG nous ont conduits à rechercher l'anomalie génétique chez notre patiente sans la trouver.DiscussionLa survenue d'événements de type PEAG au cours du psoriasis est bien connue. La distinction ce pendant entre PEAG et PPG chez notre patiente n'a pas été aisée et a reposé sur un faisceau d'arguments cliniques, histologiques et chronologiques : l'induction médicamenteuse de l'éruption, la distribution flexurale prédominante, la résolution rapide après arrêt du médicament imputé, la présence d'éosinophiles et de kératinocytes nécrotiques à l'histologie et la positivité du patch-test. Nous rapportons le premier cas de PEAG à l'oxacilline chez une patiente suivie pour un PPG.ConclusionNotre cas illustre la difficulté diagnostique devant les pustuloses sévères de type PPG et PEAG en raison du parallélisme entre ces entités. Bien que la mutation ILR36Ra n'ait pas été retrouvée chez notre patiente, nous pensons que d'autres voies de signalisation pourraient être impliquées dans le déterminisme de ces maladies.
Mycétomes en Tunisie : étude rétrospective de 41 ans (1976–2017)
Publication date: May 2018
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 4, Supplement
Author(s): N. Ferjani, N. Litaiem, M. Jones, S. Harbaoui, O. Midassi, S. Rammeh, N. Ezzine, F. Zeglaoui
IntroductionLes mycétomes se définissent comme un processus pathologique au cours duquel des agents fongiques ou actinomycosiques d'origine exogène produisent des grains. Les grains noirs orientent vers une étiologie fongique, les grains rouges vers une étiologie actinomycosique. Les grains blancs ou jaunes ne sont pas discriminants. Les zones d'endémie principales des mycétomes sont les régions tropicales et subtropicales semi-désertiques. Les mycétomes sont très rares en Tunisie.ButÉtudier les aspects épidémiologiques, cliniques, diagnostiques, thérapeutiques et pronostiques des mycétomes en Tunisie.MéthodesNous avons réalisé une étude rétrospective colligeant tous les patients qui présentaient des tuméfactions fistulisées avec émission des grains consultant au service de dermatologie de l'hôpital Charles-Nicolle de Tunis sur une période de 41 ans (janvier 1976–décembre 2017).RésultatsLe diagnostic de mycétome était retenu chez 15 patients (âge moyen 33 ans) sur des critères cliniques, histologiques et biologiques. La durée d'évolution était de 12 ans en moyenne. L'agent pathogène n'était identifié que dans 10 cas (4 actinomycosiques et 6 fongiques). Les grains étaient noirs (4 cas), blancs (7 cas) et jaunes (2 cas). Les espèces actinomycosiques étaient Actinomadura madurae (2 cas) et Sreptomyces somaliensis (2 cas) et les espèces fongiques étaient Madurella mycetomatis (4 cas) et Pseudalleschia boydii (2 cas). Les lésions siégeaient exclusivement au niveau des pieds chez 14 malades dont 11 avaient une origine rurale et 4 rapportaient la notion de microtraumatismes antérieurs. La localisation extrapodale était notée chez un patient qui était le seul à présenter une atteinte bifocale (visage et périnée). Une atteinte osseuse était retrouvée chez 10 patients à type d'ostéite (7 cas) ou de déminéralisation (2 cas). Une antibiothérapie était instaurée chez 12 patients (cotrimoxazole/ampicilline dans 4 cas ; cotrimoxazole/amoxicilline dans 1 cas et cotrimoxazole/dapsone dans 1 cas). Les eumycétomes par du kétoconazole per os (200mg/j) (5 cas) et itraconazole 400mg/j (1 cas). Le recours à la chirurgie était l'apanage de 6 cas parmi les 10 patients présentant une atteinte osseuse. L'évolution était favorable dans 9 cas. Trois patients étaient perdus de vue.ConclusionsEn Tunisie, les mycétomes sont sporadiques et souvent méconnus, ce qui explique en partie le retard diagnostique et thérapeutique et le recours fréquent à la chirurgie qui peut être mutilante. Le pronostic fonctionnel et esthétique est souvent mis en jeu avec un retentissement psychique et socio-économique important.
L’Atteinte extra céphalique lors du Syndrome du Parry Romberg : à propos d’une nouvelle observation
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 4, Supplement
Author(s): Ouiam El anzi, Ilhame Naciri, Mariame Meziane, Laila Benzekri, Nadia Ismaili, Karima Senouci, Baderddine Hassam
ObservationUne fille âgée de 12 ans, sans antécédent notable ni notion de consanguinité, consultait pour une déformation du menton évoluant progressivement depuis 2 ans. L'examen clinique révélait une hémiatrophie droite du menton et de la région mandibulaire sans induration cutanée en regard, et sans retentissement dentaire. Elle avait également une alopécie cicatricielle temporale homolatérale, une macule achromique de 4mm en pré-auriculaire droit, et de multiples plaques hyperpigmentées souples et pliables, siégeant sur le cou, l'abdomen, les flancs, et les plis. Le reste de l'examen somatique ne révélait pas d'anomalies, en dehors d'une discrète attitude scoliotique du rachis lombaire. Les autoanticorps antinucléaires étaient positifs à 1/80. La sérologie de la borréliose était négative. La biopsie cutanée de la macule achromique était en faveur de vitiligo. Le scanner du massif facial objectivait une discrète atrophie des parties molles jugales droites, sans atteinte osseuse. La téléradiographie du rachis était en faveur d'une scoliose dorsolombaire par inégalité des 2 membres inférieurs, avec un raccourcissement de 14mm du membre inférieur gauche sans lésions osseuses apparentes. L'électroencéphalogramme, l'échographie des troncs supra-aortiques, et l'IRM cérébrale étaient sans particularités. Un traitement systémique par association de corticoïdes à dose de 0,5mg/kg/jr et de Méthotrexate à dose de 12,5mg/semaine était instaurée. L'évolution était satisfaisante, devant l'arrêt de la progression de l'atrophie, avec un recul de 18 mois. Une lipostructure du visage pour restauration morphologique est prévu après l'arrêt de la croissance.CommentairesLe syndrome de Parry-Romberg (SPR), également connu sous le nom d'hémiatrophie faciale progressive, est une affection rare, sporadique, fréquemment observée chez les femmes. Il apparaît vers la première ou deuxième décennie, pour évoluer progressivement pendant des années (2–10 ans) avant de se stabiliser. Cliniquement, il est caractérisé par une atrophie hémifaciale progressive, par atteinte de la peau, du tissu adipeux, des muscles et parfois du tissu osseux adjacent, impliquant généralement des dermatomes d'une ou plusieurs branches du cinquième nerf crânien (V) avec une fréquence plus élevée de l'atteinte du côté gauche. Cependant, d'autres localisations ont été également documentées, notamment le cou, les épaules, la poitrine, et les membres inférieurs homolatéraux. Notre patiente avait une atteinte de l'hémiface droit (territoire du V3), avec une extension de l'atrophie vers le membre inférieur controlatéral, ce qui a rarement était décrit auparavant dans la littérature. Le traitement de SPR peut être difficile. L'objectif principal est d'arrêter la progression de l'atrophie. Une fois la maladie est stabilisée, d'autres thérapeutiques esthétiques peuvent être utilisées, pour réparer les lésions tissulaires et diminuer l'asymétrie faciale.
Neoadjuvant rectal score as individual-level surrogate for disease-free survival in rectal cancer in the CAO/ARO/AIO-04 randomized phase 3 trial
Updated results from MONALEESA-2, a phase III trial of first-line ribociclib plus letrozole versus placebo plus letrozole in hormone receptor-positive, HER2-negative advanced breast cancer
Litter breakdown as a tool for assessment of the efficiency of afforestation and ash-aided phytostabilization on metal-contaminated soils functioning in Northern France
Abstract
The main objective of the study was to assess the efficiency of phytoremediation methods implemented for 14 years on highly metal-contaminated soils. The different experimental strategies were plots planted with a tree mix or with a single tree species coupled or not with the use of fly-ashes as an amendment to limit metals mobility in soil. The breakdown of poplar litter on the four plots was monitored during 10 months. In parallel, colonization of litter bags by functional groups of mesofauna (Collembola and Acari) was followed. Two mesh-sized litter bags were used to allow distinguishing microbial and mesofaunal actions on the litter breakdown. We observed the breakdown of litter in four studied plots. Litter breakdown occurred faster in 3-mm litter bags than 250 μm ones during summer demonstrating the importance of mesofauna. Mixed plantation allowed faster litter breakdown than mono-specific plantation. A higher abundance of mesofauna and/or better abiotic conditions (moisture, shading…) could explain this result. Regarding litter breakdown and mesofauna, no significant difference was observed between the amended plots and those subjected to soil phytomanagement. However, communities of the studied area are disturbed since a low abundance of detritivores was observed. This could explain also the slower litter breakdown than expected in our study. To conclude, among the phytomanagement methods tested, mixed plantations could provide a benefit for the restoration of degraded soils. By contrast, the use of fly-ashes does not seem to have any effect on the functionality of ecosystem neither on the litter breakdown process nor on the abundance of mesofauna.
Gender differences in the fluorescence of human skin in young healthy adults
Skin Research and Technology, EarlyView.
Structure-based working model of SecDF, a proton-driven bacterial protein translocation factor
Ask not what your technician can do for you—ask what you can do for your technician
Πέμπτη 26 Απριλίου 2018
Hyponatremia in patients with esophageal cancer treated with chemotherapy including cisplatin
Abstract
Background
Little is known about hyponatremia in patients with esophageal cancer treated with cisplatin-based chemotherapy. The aim of this study was to analyze the risk factors for hyponatremia and its effect on outcomes in patients with esophageal cancer treated with chemotherapy including cisplatin.
Methods
We retrospectively analyzed the records of 137 patients with esophageal cancer who received chemotherapy including cisplatin for the first time between January 2011 and December 2014.
Results
Hyponatremia (Na < 135 mEq/L) was seen in 77 patients (59%), of whom 29 had Grade 3 (120 ≤ Na < 130 mEq/L) or Grade 4 (Na < 120 mEq/L) hyponatremia. We divided patients into the hyponatremia group (patients with Na < 130 mEq/L) and the control group (patients with Na ≥ 130 mEq/L), and compared the results between the two groups. Three patients (2%) were diagnosed with the syndrome of inappropriate secretion of antidiuretic hormone. The serum sodium level before starting chemotherapy was significantly lower and white blood cell count was significantly higher in the hyponatremia group. Appetite loss was seen significantly more often in the hyponatremia group as the chemotherapy-related adverse effect. There was no significant difference in overall survival between the two groups.
Conclusions
Hyponatremia is a common adverse effect induced by cisplatin. Caution should be exercised with patients with a low sodium level before starting chemotherapy. Hyponatremia can be associated with other chemotherapy-related adverse effects, and it should therefore be treated correctly.
Biochemical responses of the Protaetia brevitarsis Lewis larvae to subchronic copper exposure
Abstract
Copper (Cu) is one of the most commonly detected heavy metals in livestock manure pollution. Protaetia brevitarsis Lewis larvae are widely used in the decomposition of livestock manure. During decomposition, heavy metals in livestock manure can accumulate in P. brevitarsis larvae and affect normal growth and reproduction. Therefore, this research focused on characterizing the toxic effects of Cu to P. brevitarsis Lewis larvae. Larvae were exposed to Cu concentrations of 0, 100, 200, 400, and 800 mg kg−1 in edible fungi residue for 7, 14, 21, and 28 days. Results showed that the soluble protein content was markedly increased in 200 and 400 mg kg−1 treatment groups on day 28. Compared to the control group, superoxide dismutase (SOD) and glutathione S-transferase (GST) activities were significantly stimulated on day 7 and then decreased as exposure length was increased (e.g., after 14, 21, and 28 days). Catalase (CAT) activity was also significantly increased after 7 days of exposure. Malondialdehyde (MDA) levels were markedly increased in the 100, 200, and 400 mg kg−1 treatment groups on day 7. However, as time and Cu concentration were increased, MDA levels gradually decreased. These results indicate that Cu has biochemical effects on P. brevitarsis Lewis larvae, and both time and dose affect this biochemical response.
Quantification of Carbon Nanotubes by Raman Analysis
Development of Fe/Nb-based solar photocatalysts for water treatment: impact of different synthesis routes on materials properties
Abstract
Semiconductors based on Fe/Nb oxides can present both solar sensitivity and high catalytic activity. However, there is still a lack regarding the comparison between different routes to produce Fe/Nb-based solar photocatalysts and the evaluation of the impact of the synthesis operating conditions on the material properties. In this work, Fe/Nb2O5 ratio, type of precipitating agent, presence/absence of washing stage, and temperature of calcination were verified to be the most relevant parameters in the synthesis by the co-precipitation method. These factors led to remarkable differences in the properties and performance of the photocatalysts produced by each distinct synthesis route. Composition, iron species present in the materials, crystallinity characteristics, and pH of the catalysts were affected, leading to different photocatalytic activities under UV-Vis light. Due to their characteristics, the synthesized materials are potential photocatalysts for application in solar processes.
Graphical abstract
A case series: Association of anaphylaxis with a significant decrease in platelet levels and possible secondary risk of thrombosis
Immunity, Inflammation and Disease, EarlyView.
Cluster analysis of microclimate data to optimize the number of sensors for the assessment of indoor environment within museums
Abstract
For the first time, the cluster analysis (k-means) has been applied on long time series of temperature and relative humidity measurements to identify the thermo-hygrometric features in a museum. Based on ASHRAE (2011) classification, 84% of time all rooms in the Napoleonic Museum in Rome (case study) were found in the class of control B. This result was obtained by analyzing all recorded data in 10 rooms of the museum as well as using the cluster aggregation. The use of objective-oriented methodology allows to achieve an acceptable knowledge of the microclimate in case of multi-room buildings, reducing computations with large amounts of collected data and time-consuming in redundant elaborations. The cluster analysis enables to reduce the number of the sensors in microclimate monitoring programs within museums, provided that the representativeness of the instrument location is known, and professional conservators have assessed that the artifacts are well preserved.
Multicentric Experience in Distal-to-Proximal Revascularization of Tandem Occlusion Stroke Related to Internal Carotid Artery Dissection [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
Internal carotid dissection is a frequent cause of ischemic stroke in young adults. It may cause tandem occlusions in which cervical carotid obstruction is associated with intracranial proximal vessel occlusion. To date, no consensus has emerged concerning endovascular treatment strategy. Our aim was to evaluate our endovascular "distal-to-proximal" strategy in the treatment of this stroke subtype in the first large multicentric cohort.
MATERIALS AND METHODS:Prospectively managed stroke data bases from 2 separate centers were retrospectively studied between 2009 and 2014 for records of tandem occlusions related to internal carotid dissection. Atheromatous tandem occlusions were excluded. The first step in the revascularization procedure was intracranial thrombectomy. Then, cervical carotid stent placement was performed depending on the functionality of the circle of Willis and the persistence of residual cervical ICA occlusion, severe stenosis, or thrombus apposition. Efficiency, complications, and radiologic and clinical outcomes were recorded.
RESULTS:Thirty-four patients presenting with tandem occlusion stroke secondary to internal carotid dissection were treated during the study period. The mean age was 52.5 years, the mean initial NIHSS score was 17.29 ± 6.23, and the mean delay between onset and groin puncture was 3.58 ± 1.1 hours. Recanalization TICI 2b/3 was obtained in 21 cases (62%). Fifteen patients underwent cervical carotid stent placement. There was no recurrence of ipsilateral stroke in the nonstented subgroup. Twenty-one patients (67.65%) had a favorable clinical outcome after 3 months.
CONCLUSIONS:Endovascular treatment of internal carotid dissection–related tandem occlusion stroke using the distal-to-proximal recanalization strategy appears to be feasible, with low complication rates and considerable rates of successful recanalization.
Diffusion-Weighted Zonal Oblique Multislice-EPI Enhances the Detection of Small Lesions with Diffusion Restriction in the Brain Stem and Hippocampus: A Clinical Report of Selected Cases [ADULT BRAIN]
SUMMARY:
Diffusion restriction is the morphologic hallmark of acute ischemic infarcts and excitotoxic brain injury in various cerebral pathologies. Diffusion restriction is visible as hyperintensity on DWI and as hypointensity on ADC maps. Due to the vicinity of multiple anatomic structures in the brain stem and hippocampus, very small lesions with diffusion restriction may result in severe clinical symptomatology, but these small lesions easily go undetected on standard cerebral DWI due to insufficient spatial resolution, T2* blurring, and image artifacts caused by susceptibility-related image distortions. Diffusion-weighted zonal oblique multislice–EPI with reduced FOV acquisition permits a considerable increase in spatial resolution and enhances the visualization of very small pathologic lesions in the brain stem and hippocampus. Improved performance in the depiction of different pathologic lesions with diffusion restriction in the brain stem and hippocampus using this sequence compared with standard DWI in selected cases is presented.
Segmentation of the Globus Pallidus Internus Using Probabilistic Diffusion Tractography for Deep Brain Stimulation Targeting in Parkinson Disease [FUNCTIONAL]
BACKGROUND AND PURPOSE:
Although globus pallidus internus deep brain stimulation is a widely accepted treatment for Parkinson disease, there is persistent variability in outcomes that is not yet fully understood. In this pilot study, we aimed to investigate the potential role of globus pallidus internus segmentation using probabilistic tractography as a supplement to traditional targeting methods.
MATERIALS AND METHODS:Eleven patients undergoing globus pallidus internus deep brain stimulation were included in this retrospective analysis. Using multidirection diffusion-weighted MR imaging, we performed probabilistic tractography at all individual globus pallidus internus voxels. Each globus pallidus internus voxel was then assigned to the 1 ROI with the greatest number of propagated paths. On the basis of deep brain stimulation programming settings, the volume of tissue activated was generated for each patient using a finite element method solution. For each patient, the volume of tissue activated within each of the 10 segmented globus pallidus internus regions was calculated and examined for association with a change in the Unified Parkinson Disease Rating Scale, Part III score before and after treatment.
RESULTS:Increasing volume of tissue activated was most strongly correlated with a change in the Unified Parkinson Disease Rating Scale, Part III score for the primary motor region (Spearman r = 0.74, P = .010), followed by the supplementary motor area/premotor cortex (Spearman r = 0.47, P = .15).
CONCLUSIONS:In this pilot study, we assessed a novel method of segmentation of the globus pallidus internus based on probabilistic tractography as a supplement to traditional targeting methods. Our results suggest that our method may be an independent predictor of deep brain stimulation outcome, and evaluation of a larger cohort or prospective study is warranted to validate these findings.
Dark Rims: Novel Sequence Enhances Diagnostic Specificity in Multiple Sclerosis [ADULT BRAIN]
BACKGROUND AND PURPOSE:
The 2010 McDonald criteria are designed to sensitively detect MS; however, the low specificity of these criteria can occasionally lead to the misdiagnosis of MS. The purpose of this study was to determine whether a novel double inversion recovery MR imaging technique has the potential to increase the specificity of diagnostic criteria distinguishing MS from non-MS white matter lesions.
MATERIALS AND METHODS:This was a cross-sectional observational study. MR imaging data were acquired between 2011 and 2016. A novel double inversion recovery sequence that suppresses CSF and GM signal was used (GM-double inversion recovery). We compared WM lesions in a group of patients with multiple sclerosis and in a second group of positive controls with white matter lesions who did not have a diagnosis of MS. The presence of a rim on the GM-double inversion recovery MR imaging sequence was combined with the 2001 and 2010 McDonald disseminated-in-space criteria. Multiple MR imaging markers, including lesion location, size, and the presence of a rim, were compared between groups as well as a quantitative measure of lesion T1 hypointensity.
RESULTS:MR images from 107 patients with relapsing-remitting MS (median age, 32 years) and 36 positive control (median age, 39 years) subjects were analyzed. No significant differences were found in age and sex. In patients with MS, 1120/3211 lesions (35%) had a rim on GM-double inversion recovery; the positive control group had only 9/893 rim lesions (1%). Rims were associated with a decrease in the lesion T1 ratio. Using the 2010 MR imaging criteria plus the presence of rims on GM-double inversion recovery, we achieved 78% and 97% specificity in subjects with ≥1 and ≥2 rim lesions, respectively.
CONCLUSIONS:The addition of a novel GM-double inversion recovery technique enhanced specificity for diagnosing MS compared with established MR imaging criteria.
Antituberculosis drug isoniazid degraded by electro-Fenton and photoelectro-Fenton processes using a boron-doped diamond anode and a carbon-PTFE air-diffusion cathode
Abstract
Solutions with 0.65 mM of the antituberculosis drug isoniazid (INH) in 0.050 M Na2SO4 at pH 3.0 were treated by electro-Fenton (EF) and UVA photoelectro-Fenton (PEF) processes using a cell with a BDD anode and a carbon-PTFE air-diffusion cathode. The influence of current density on degradation, mineralization rate, and current efficiency has been thoroughly evaluated in EF. The effect of the metallic catalyst (Fe2+ or Fe3+) and the formation of products like short-chain linear aliphatic carboxylic acids were assessed in PEF. Two consecutive pseudo-first-order kinetic regions were found using Fe2+ as catalyst. In the first region, at short time, the drug was rapidly oxidized by ●OH, whereas in the second region, at longer time, a resulting Fe(III)-INH complex was much more slowly removed by oxidants. INH disappeared completely at 300 min by EF, attaining 88 and 94% mineralization at 66.6 and 100 mA cm−2, respectively. Isonicotinamide and its hydroxylated derivative were identified as aromatic products of INH by GC-MS and oxalic, oxamic, and formic acids were quantified by ion-exclusion HPLC. The PEF treatment of a real wastewater polluted with the drug led to slower INH and TOC abatements because of the parallel destruction of its natural organic matter content.
Modeling the oxygen transport process under preferential flow effect in landfill
Abstract
Evaluation of oxygen distribution during aeration in landfill is significantly important to determine the design parameters of an injection well. A coupling model describing gas preferential transport in a landfill was developed, which linked the effect of advection–diffusion and oxidation reaction and mass exchange between the fracture and the matrix system. The quantitative simulation of the variation in gas distribution during vertical well aeration in short term was presented, combined with the typical cases in field site. The parameter sensitivity in the coupling model to gas transport was addressed. Simulation result of the oxygen and methane concentrations by using the dual advective–diffusive (DAD) model, which considered the immobile zone effect, was closer to the monitoring data than that by using single advective–diffusive model. The variation of the AR under aeration was presented with the key parameters to provide the theory evidence for gas well design in landfill. This study provided reference for the design of the gas injection well distribution in aerobic landfill.
Glycyrrhiza flavonoids and its major component, licochalcone A, inhibit melanogenesis through MAPK/ERK pathway by activating ERK phosphorylation
Melanin is synthesized mainly by melanocytes that are located in the basal layer of the epidermis and its formation is associated with tyrosinase and dopachrome tautomerase activities [1]. And tyrosinase plays an important role in melanogenesis which can catalyze the hydroxylation of tyrosine to 3, 4-L-dihydroxyphenylalanine (DOPA) and further oxidation of DOPA to dopaquinone [2]. Microphthalmia-associated transcription factor (MITF) is a basic helix-loop-helix leucine zipper transcription factor, which can control the expression of various genes for normal melanin synthesis in melanocytes [3].
Leveraging organismal biology to forecast the effects of climate change
Mitochondrial adaptations to variable environments and their role in animals’ stress tolerance
Selenium and silicon reduce cadmium uptake and mitigate cadmium toxicity in Pfaffia glomerata (Spreng.) Pedersen plants by activation antioxidant enzyme system
Abstract
Cadmium (Cd) is toxic to plants and animals, making it necessary to develop strategies that seek to reduce its introduction into food chains. Thus, the aim of this study was to investigate whether silicon (Si) and selenium (Se) reduce Cd concentrations in Pfaffia glomerata medicinal plant and attenuate the oxidative stress promoted by this metal. These plants were cultivated in hydroponics under the following treatments: control (nutrient solution), 2.5 μM Se, 2.5 mM Si, 50 μM Cd, 50 μM Cd + 2.5 μM Se, 50 μM Cd + 2.5 mM Si. After 14 days of exposure to treatments, leaves and roots were collected for the determination of dry weight of shoot and roots, Cd concentrations, chlorophyll and carotenoids content, and biochemical parameters (lipid peroxidation and guaiacol peroxidase and superoxide dismutase activities). The data were submitted to analysis of variance and means were compared with Scott-Knott test at 5% error probability. Roots of P. glomerata plants showed a significant reduction on dry weight accumulation when exposed to Cd. However, both Se and Si promoted a significant reduction of deleterious effects of Cd. The Cd concentrations in the tissues were reduced in the presence of Se or Si. Plants treated with Cd together with Se or Si presented higher pigment content than those with only Cd, thus showing a reduction in the negative effects caused by this element. In the treatments in which Se and Si were added in the growth medium together with Cd, an activation of superoxide dismutase and guaiacol peroxidase enzymes was observed in the roots and shoot, which may have contributed to lower lipid peroxidation. Thus, Se and Si reduce Cd concentrations and have potential to ameliorate Cd toxicity in P. glomerata plants, which can be used to increase productivity and quality of medicinal plants.
Changes in the nutritional composition of maize flour due to Tribolium castaneum infestation and application of carbon dioxide to manage this pest
Abstract
Maize flour was infested with fresh emerged Tribolium castaneum adults, and its nutritional composition was evaluated after 0, 45, and 90 days of the infestation. Furthermore, 99% carbon dioxide was applied to different developmental stages of T. castaneum for its management. There were six treatments and five replicates; for each replicate, maize flour (150 g) was taken in a 250-ml plastic jar container, insects were released in the flour, and jars were placed into the incubator at a temperature of 28 ± 1 °C, 60 ± 5% RH. Similarly, the application of 99% CO2 was done with four exposure times of 12, 24, 48, and 72 h, at 35 °C 65 ± 5% RH. Present results showed major fluctuations in the nutritive composition of maize flour. Increase in the moisture, fat, fiber, protein, and ash contents was directly proportional to the increase in infestation level and time, contrary to the depletion of carbohydrates and total weight loss. The results of CO2 treatment indicated that pupa was the most resilient stage as compared with larvae and adult stage. The observed susceptibility order was as follows: adult > larvae > pupae. The maximum mortality of adult, larval, and pupal stages was recorded after 24, 48, and 72 h of CO2 application, respectively. These findings might be helpful to develop an ecofriendly technique to manage this crucial pest.
Effective sorption of atrazine by biochar colloids and residues derived from different pyrolysis temperatures
Abstract
Biochar has attracted much attention, which owns many environmental and agronomic benefits, including carbon sequestration, improvement of soil quality, and immobilization of environmental contaminants. Biochar has been also investigated as an effective sorbent in recent publications. Generally, biochar particles can be divided into colloids and residues according to particle sizes, while understanding of adsorption capacities towards organic pollutants in each section is largely unknown, representing a critical knowledge gap in evaluations on the effectiveness of biochar for water treatment application. Scanning electron microscopy (SEM) images, X-ray diffraction (XRD), Raman spectra, Fourier-transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), and Brunauer-Emmett-Teller (BET) method are used to examine the structures and surface properties of biochar colloids and residues derived from corn straws prepared at different pyrolysis temperatures. Also, their roles in atrazine (a typical organic pollutant) removal are investigated by batch adsorption experiments and fitted by different kinetic and thermodynamic models, respectively. The adsorption capacities of biochar colloids are much more than those of residues, resulting from the colloids containing abundant oxygen functional groups and mineral substances, and the adsorption capacities of biochar colloids and residues increase with the increase of pyrolysis temperatures. The highest adsorption performance of 139.33 mg g−1 can be obtained in biochar colloids prepared at 700 °C, suggesting the important functions of biochar colloids in the application of atrazine removal by biochar.
Towards saving freshwater: halophytes as unconventional feedstuffs in livestock feed: a review
Abstract
Water represents 71% of all earth area and about 97% of this water is salty water. So, only 3% of the overall world water quantity is freshwater. Human can benefit only from 1% of this water and the remaining 2% freeze at both poles of earth. Therefore, it is important to preserve the freshwater through increasing the plants consuming salty water. The future prosperity of feed resources in arid and semi-arid countries depends on economic use of alternative resources that have been marginalized for long periods of time, such as halophytic plants, which are one such potential future resource. Halophyte plants can grow in high salinity water and soil and to some extent during drought. The growth of these plants depends on the contact of the salted water with plant roots as in semi-desert saline water, mangrove swamps, marshes, and seashores. Halophyte plants need high levels of sodium chloride in the soil water for growth, and the soil water must also contain high levels of salts, as sodium hydroxide or magnesium sulfate. There are many uses for halophyte plants, including feed for animals, vegetables, drugs, sand dune stabilizers, wind shelter, soil cover, wetland cultivation, laundry detergents, and paper production. This paper will focus on the use of halophytes as a feed additive for animals. In spite of the good nutritional value of halophytes, some anti-nutritional factors as nitrates, nitrite complexes, tannins, glycosides, phenolic compounds, saponins, oxalates, and alkaloids may be present in some of them. The presence of such anti-nutritional agents makes halophytes unpalatable to animals, which tends to reduce feed intake and nutrient use. Therefore, the negative effects of these plants on animal performance are the only objection against using halophytes in animal feed diets. This review article highlights the beneficial impact of considering halophytes in animal feeding on saving freshwater and illustrates its nutritive value for livestock from different aspects.
PR‐957 mediates neuroprotection by inhibiting Th17 differentiation and modulating cytokine production in a mouse model of ischaemic stroke
Clinical &Experimental Immunology, EarlyView.
Placental inflammation in pre‐eclampsia by Nod‐like receptor protein (NLRP)3 inflammasome activation in trophoblasts
Clinical &Experimental Immunology, EarlyView.
Preoperative Photographing and Morphing for Predictable Profiles in Rhinoplasty
A Closer Look at the Analgesic Regimen After Rhinoplasty—Reply
A Closer Look at the Analgesic Regimen After Rhinoplasty
A 3-Dimensional–Printed Short-Segment Template Prototype for Mandibular Fracture Repair
Aseptic Freeze-Dried versus Sterile Wet-Packaged Human Cadaveric Acellular Dermal Matrix in Immediate Tissue Expander Breast Reconstruction: A Propensity Score Analysis
Background: Although multiple acellular dermal matrix sources exist, it is unclear how its processing impacts complication rates. The authors compared complications between two preparations of human cadaveric acellular dermal matrix (freeze dried and ready-to-use) in immediate tissue expander breast reconstruction to analyze the effect of processing on complications. Methods: The authors retrospectively reviewed all alloplastic breast reconstructions with freeze-dried or ready-to-use human acellular dermal matrices between 2006 and 2016. The primary outcome measure was surgical-site occurrence defined as seroma, skin dehiscence, surgical-site infection, or reconstruction failure. The two groups were compared before and after propensity score matching. Results: The authors included 988 reconstructions (freeze-dried, 53.8 percent; ready-to-use, 46.2 percent). Analysis of 384 propensity score–matched pairs demonstrated a slightly higher rate of surgical-site occurrence (21.4 percent versus 16.7 percent; p = 0.10) and surgical-site infection (9.6 percent versus 7.8 percent; p = 0.13) in the freeze-dried group than in the ready-to-use group, but the difference was not significant. However, failure was significantly higher for the freeze-dried versus ready-to-use group (7.8 percent versus 4.4 percent; p = 0.050). Conclusions: This is the largest study comparing the outcomes of alloplastic breast reconstruction using human acellular dermal matrix materials prepared by different methods. The authors demonstrated higher early complications with aseptic, freeze-dried matrix than with sterile ready-to-use matrix; reconstructive failure was the only outcome to achieve statistical significance. The authors conclude that acellular dermal matrix preparation has an independent impact on patient outcomes in their comparison of one company's product. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.Preoperative and Postoperative Assessment of Rectus Abdominis Muscle Size and Function following DIEP Flap Surgery
Background: Prospective evaluation of rectus abdominis muscle function after deep inferior epigastric artery perforator (DIEP) flap breast reconstruction is limited. Elimination of muscle harvest with this procedure is theoretically associated with preservation of rectus abdominis function and minimization of abdominal wall morbidity. In this study, the authors evaluate the change in rectus abdominis muscle size and function after DIEP flap surgery. Methods: Patients undergoing unilateral DIEP flap surgery were recruited prospectively. Using computed tomography, the change in preoperative to postoperative rectus abdominis muscle size was compared between the operative side rectus abdominis muscle and the contralateral, nonoperative control rectus abdominis. Postoperative muscle integrity and contractility were evaluated using ultrasound by comparing the change in rectus abdominis muscle dimensions between contractile and relaxed states. The BREAST-Q was used to score patients' subjective satisfaction. Clinical and radiographic hernia rates were also calculated. Results: Analysis of 26 paired rectus abdominis muscles revealed no significant change in muscle size from preoperative to postoperative values. Furthermore, dimensional change from contractile to relaxed states postoperatively was similar for paired operative and nonoperative rectus abdominis muscles. BREAST-Q scores indicated a high degree of satisfaction in abdominal well-being, breast satisfaction, and surgical experience domains. There were no clinical or radiographic abdominal wall hernias noted. Conclusions: The DIEP flap is an effective surgical procedure with minimal abdominal wall morbidity that is associated with no measurable loss in rectus abdominis size and contractile function postoperatively. Patients are highly satisfied with their abdominal function postoperatively using this technique. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.Evolution in Monitoring of Free Flap Autologous Breast Reconstruction after Nipple-Sparing Mastectomy: Is There a Best Way?
Background: Free flap monitoring in autologous reconstruction after nipple-sparing mastectomy remains controversial. The authors therefore examined outcomes in nipple-sparing mastectomy with buried free flap reconstruction versus free flap reconstruction incorporating a monitoring skin paddle. Methods: Autologous free flap reconstructions with nipple-sparing mastectomy performed from 2006 to 2015 were identified. Demographics and operative results were analyzed and compared between buried flaps and those with a skin paddle for monitoring. Results: Two hundred twenty-one free flaps for nipple-sparing mastectomy reconstruction were identified: 50 buried flaps and 171 flaps incorporating a skin paddle. The most common flaps used were deep inferior epigastric perforator (64 percent), profunda artery perforator (12.1 percent), and muscle-sparing transverse rectus abdominis myocutaneous flaps (10.4 percent). Patients undergoing autologous reconstructions with a skin paddle had a significantly greater body mass index (p = 0.006). Mastectomy weight (p = 0.017) and flap weight (pThe Cost of Contralateral Prophylactic Mastectomy in Women with Unilateral Breast Cancer
Background: Contralateral prophylactic mastectomy may be unnecessary from an oncologic perspective; therefore, the debate persists about the value of contralateral prophylactic mastectomy in women with early-stage unilateral breast cancer. Given finite health care resources, this study aims to evaluate the cost of contralateral prophylactic mastectomy and breast reconstruction. Methods: Women with unilateral breast cancer undergoing either unilateral mastectomy or unilateral mastectomy with contralateral prophylactic mastectomy and immediate breast reconstruction were selected from the Truven MarketScan databases between 2009 and 2013. Demographic and treatment data were recorded, and over an 18-month follow-up period, the treatment cost was tallied. A log-transformed linear model was used to compare cost between the groups. Results: A total of 2343 women were identified who met our inclusion criteria, with 1295 undergoing unilateral mastectomy and 1048 undergoing contralateral prophylactic mastectomy. Complication rates within 18 months were similar for women undergoing unilateral mastectomy and contralateral prophylactic mastectomy (39 percent versus 42 percent; p = 0.17). Management with unilateral mastectomy with reconstruction required an adjusted cumulative mean cost of $33,557. Contralateral prophylactic mastectomy with reconstruction was an additional $11,872 in expenditure (pPhotoacoustic Tomography Shows the Branching Pattern of Anterolateral Thigh Perforators In Vivo
Summary: The distal branching pattern of perforators is associated with thin anterolateral thigh flap failure. The purpose of this study was to investigate the feasibility of using photoacoustic tomography as a diagnostic imaging modality to identify anterolateral thigh perforators and their branching patterns in the subcutaneous layer. Ten thighs in five healthy men were studied. The anterolateral aspect of the midthigh was examined using photoacoustic tomography. The correlation between photoacoustic tomography and ultrasound findings was evaluated. To determine the detectability of photoacoustic tomography by depth, the depth of vessels in the stem portion was compared to the depth of the deep fascia measured by ultrasound. Branching patterns of vessels in the adipose and suprafascial layers were evaluated by three-dimensional observation. A total of 18 perforators were visualized by photoacoustic tomography. Photoacoustic tomography and ultrasound had comparable diagnostic potential for the detection of perforators. Photoacoustic tomography visualized microvessels in the subcutaneous layer, especially those in oblique or horizontal orientations. The estimated mean depth of visualized vessels was 9 mm; the maximum depth was 13 mm. There was a strong correlation between the depth of visualized vessels in the stem portion and the depth of the deep fascia. Three-dimensional observation of photoacoustic tomographic images showed the branching morphology of perforators. This study showed the applicability of photoacoustic tomography to identification of the branching patterns of anterolateral thigh perforators in vivo, although limited visualization of subfascial vessels is a technical issue. The authors believe that photoacoustic tomography has the potential to be a new imaging modality for thin anterolateral thigh flap surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.Validated Outcomes in the Grafting of Autologous Fat to the Breast: The VOGUE Study. Development of a Core Outcome Set for Research and Audit
Background: Autologous fat grafting is an important part of the reconstructive surgeon's toolbox when treating women affected by breast cancer and subsequent tumor extirpation. The debate over safety and efficacy of autologous fat grafting continues within the literature. However, work performed by the authors' group has shown significant heterogeneity in outcome reporting. Core outcome sets have been shown to reduce heterogeneity in outcome reporting. The authors' goal was to develop a core outcome set for autologous fat grafting in breast reconstruction. Methods: The authors published their protocol a priori. A Delphi consensus exercise among key stakeholders was conducted using a list of outcomes generated from their previous work. These outcomes were divided into six domains: oncologic, clinical, aesthetic and functional, patient-reported, process, and radiologic. Results: In the first round, 55 of 78 participants (71 percent) completed the Delphi consensus exercise. Consensus was reached on nine of the 13 outcomes. The clarity of the results and lack of additional suggested outcomes deemed further rounds to be unnecessary. Conclusions: The VOGUE Study has led to the development of a much-needed core outcome set in the active research front and clinical area of autologous fat grafting. The authors hope that clinicians will use this core outcome set to audit their practice, and that researchers will implement these outcomes in their study design and reporting of autologous fat grafting outcomes. The authors encourage journals and surgical societies to endorse and encourage use of this core outcome set to help refine the scientific quality of the debate, the discourse, and the literature. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.Facebook Facts: Breast Reconstruction Patient-Reported Outcomes Using Social Media
Background: Social media are used for information sharing among patients with similar health conditions, and analysis of social media activity could inform clinical decision-making. The aim of this study was to use Facebook to evaluate a cohort of individuals' perceptions of and satisfaction with breast reconstruction. Methods: In this observational study, the authors collected and analyzed posts pertaining to autologous and implant-based breast reconstruction from active Facebook groups. Patient satisfaction data were categorized, and a thematic analysis of posts was conducted. Qualitative posts were grouped based on common themes and quantitatively compared using frequency and chi-square analysis. Results: The authors evaluated 500 posts from two Facebook groups. Two hundred sixty-four posts referenced deep inferior epigastric perforator (DIEP) flap reconstruction and 117 were related to implant-based reconstruction. Among individuals referencing DIEP flap reconstruction, 52 percent were satisfied, compared with 20 percent of individuals who referenced satisfaction with implant-based reconstruction (pEvaluating Platelet-Rich Therapy for Facial Aesthetics and Alopecia: A Critical Review of the Literature
Background: Despite the growing popularity of platelet-rich plasma, existing evidence supporting its efficacy remains controversial due to the lack of large-scale studies and standardized protocols for preparation and application. This article reviews its use in facial rejuvenation, fat grafting, acne scarring, and androgenic alopecia. Emphasis is placed on comparing methods of platelet-rich plasma preparation and application across studies. Methods: A systematic review was performed for articles published between 2006 and 2015. All clinical studies and case reports that addressed platelet-rich plasma alone and/or in combination with fat grafting for facial rejuvenation, acne scarring, or androgenic alopecia were included. Results: Of the 22 articles included in the analysis, seven studies used platelet-rich plasma alone for facial rejuvenation, seven in combination with fat grafting, two for treatment of acne scarring, and six for treatment of androgenic alopecia. Individual study procedures, means of evaluation, and significant results are summarized. Although the majority of studies in this review report positive results, significant variation exists in preparation protocols and in the number and frequency of clinical treatments. Conclusions: The majority of studies report positive results for all indications evaluated in this review, but the procedure is limited by the lack of a standardized method for preparation and application of platelet-rich plasma. The extent to which significant variability in platelet-rich plasma preparation and/or application methods may affect clinical outcomes is not completely clear. In the interim, we present a consolidation of platelet-rich plasma treatment techniques and outcomes currently in use to help guide physicians in their clinical practice.Cheek Volumization and the Nasolabial Fold
Background: The impression that cheek filling results in longitudinal shortening ("lift") of the skin and elevation of the nasolabial crease or nasolabial fold has become common within the facial injection community but remains unsubstantiated. Methods: In this study, 77 patients were evaluated before and after injection of the cheeks with a hyaluronic acid filler using a three-dimensional camera system. Results: A constant pattern of skin expansion away from the center of the injection and perpendicular to the surface of the skin was observed. A subgroup of 37 patients without differences in their preinjection and postinjection facial expression were analyzed by direct comparison and failed to demonstrate lateral traction (or "pull") on the intervening skin from the cheek injection site to the nasolabial crease. Furthermore, there was no photographic difference in the nasolabial fold or nasolabial crease. The only patients who demonstrated photographic improvement of the medial face were those who had filler placed directly in the transition between the lateral nasolabial fold and cheek (nasojugal crease). Conclusions: Filling the cheek with 3 cc of volume does not create traction forces or move the skin between the site of injection and the nasolabial crease. It is likely that expanding the nasojugal crease is the direct visual cue that leads to perceived improvement in the nasolabial fold.Accessory Nerves of the Forehead: A Newly Discovered Frontotemporal Neurovascular Bundle and Its Implications in the Treatment of Migraine Headache, Migraine Surgery, and Cosmetic Temple Filler Injection
Background: Surgical decompression of peripheral cranial and spinal nerves at several anatomically studied trigger sites has demonstrated significant efficacy in bringing permanent relief to migraine sufferers. In their experience performing frontal nerve decompression on migraine patients, the authors noticed a previously undescribed accessory nerve and vessel in the frontotemporal area, and report its implication in migraine surgery and cosmetic filler injection. Methods: A retrospective review of 113 patients who underwent frontal migraine decompression surgery at the University of Texas Southwestern Medical Center from July of 2011 to May of 2016 was performed. For the included 76 patients, measurements of this nerve had been taken intraoperatively using high-definition endoscopic assistance, and topographic measurements were correlated with endoscopic location of the nerve. Results: This frontotemporal nerve was present in 55 percent, and the bilateral incidence was 57 percent of those. An accompanying vessel was also present in 81 percent of nerve complexes. Both nerve and vessel varied in size. A large vessel was present in 8 percent of all patients, and a medium vessel was present in 20 percent. Consistently, the nerve exited a foramen in the frontal bone on average 3.4 ± 0.47 cm superior to the lateral canthus. Conclusions: The identification and proper avulsion neurectomy of this newly described sensory frontotemporal nerve may lead to better surgical response rate during migraine surgery. In addition, this nerve should be considered during nerve block and botulinum toxin injections in migraine treatment. The existence of the accompanying vessel could have significant implications in the safety of filler and fat injections to this area.Expansion Vibration Lipofilling: A New Technique in Large-Volume Fat Transplantation
Background: Despite rapid growth, gluteal fat transplantation is an operation in search of science and a teachable technique. Long operating times, tedious syringe transfers, inability to shape the recipient site, and the risk of fat embolism all headline as impediments to clinical adoption of the procedure. Expansion vibration lipofilling is a syringe-free surgical strategy that is a logical extension of Separation, Aspiration, and Fat Equalization (SAFELipo). In expansion vibration lipofilling, there is simultaneous disruption of recipient-site connective tissue, internal expansion using exploded-tip cannulas, and backfilling of these spaces with roller pump–propelled fat. Methods: Two thousand four hundred nineteen consecutive cases of expansion vibration lipofilling fat transplantation to the buttocks were reviewed. Average follow-up was 12 months. The technique of expansion vibration lipofilling is dependent on the use of larger caliber cannulas attached to a roller pump and to an oscillatory power-assisted liposuction device, which is less labor-intensive, potentially allowing for better knowledge of cannula-tip location at all times during the procedure. Results: Operating times averaged 1 hour 40 minutes. The average volume of fat inserted was 1003 cc. Complications included donor-site seroma, infection, and one pulmonary embolism treated with anticoagulation. There were no cases of fat embolism or death. Conclusions: Expansion vibration lipofilling is a new method for large-volume fat transplantation. Avoidance of fatal fat emboli demands a surgeon's complete knowledge of cannula tip location at all times during the procedure. Syringe-free, larger caliber, and less flexible cannulas, combined with techniques requiring less operator upper extremity effort resulting in less fatigue, may contribute to avoidance of this dreadful complication. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.Mechanical versus Hand-Sewn Venous Anastomoses in Free Flap Reconstruction: A Systematic Review and Meta-Analysis
Background: Venous complications are the primary reason for flap loss in massive defect reconstructions; therefore, the quality and reliability of microvascular anastomoses are significant. The aim of this systematic review was to evaluate venous anastomotic time, the venous complication rate, and the flap failure rate with the mechanical anastomotic coupling device versus the hand-sewn technique in venous anastomoses of microvascular free flap operations. Methods: Chinese and English databases were searched for eligible articles published between their inception and July of 2017. The pooled relative risk was calculated for dichotomous variables, and the weighted mean difference was calculated for continuous data. Whether to use the fixed effects or random effects model depended on the heterogeneity evaluation among the studies. Results: Twelve studies were selected, including 3788 flaps (mechanical anastomotic coupling device, n = 1667; hand-sewn, n = 2121). Using the mechanical anastomotic coupling device significantly decreased venous anastomotic time (weighted mean difference, −13.50; 95 percent CI, −17.09 to −9.91; pFreie Vorträge • 26. Jahrestagung ADH 2018
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue S2, Page 1-2, April 2018.
Poster • 26. Jahrestagung ADH 2018
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue S2, Page 3-10, April 2018.
A case of photodistributed multicentric reticulohistiocytosis: correlation with multiphoton microscopy imaging
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.
Short‐term efficacy of adalimumab in a patient with pyrin‐associated autoinflammation with neutrophilic dermatosis
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.
Influence of uvrA, recJ and recN gene mutations on nucleoid reorganization in UV-treated Escherichia coli cells
E-Health-Angebote in der Onkologie
Zusammenfassung
Hintergrund
Die krankheits- und behandlungsbedingten Belastungen von Krebserkrankungen gehen in der Regel mit deutlichen Beeinträchtigungen der Lebensqualität der Betroffenen einher. Durch die starke Verbreitung des Internets in deutschen Haushalten stellen onkologische E‑Health-Angebote eine schnelle und einfach zugängliche mögliche Quelle der Unterstützung für Patienten und Angehörige dar. Angebote für Behandler umfassen z. B. Informationsportale, die Behandler auf die Bedürfnisse von Krebspatienten vorbereiten. Die Zukunft von onkologischen E‑Health Angeboten scheint in der Entwicklung von Angeboten für das Smartphone zu liegen.
Ziel
Die Autoren beschreiben E‑Health-Angebote in der Onkologie, v. a. hinsichtlich Form und Inhalt, Inanspruchnahme und Wirksamkeit.
Diskussion/Schlussfolgerung
In der Literatur ist eine große Anzahl von Studien zu finden, die Prozess und Outcome von E‑Health-Interventionen evaluieren. Jedoch wird weiterhin ein Bedarf für gut designte höherwertige RCTs (randomisierte kontrollierte Studien) konstatiert, unter anderem um genauere Aussagen zur Wirksamkeit der Angebote treffen zu können. Häufig berichtete Probleme der E‑Health-Angebote sind hohe Dropout-Raten und ein Nachhohlbedarf bei der bisher weitgehend fehlenden Implementierung der in Studien erprobten Ansätze in die Versorgungspraxis. Das Einbeziehen von potenziellen Zielgruppen in den Entwicklungsprozess der Angebote könnte hilfreich sein, um das Auftreten von hohen Dropout-Raten und Usability-Problemen zu vermindern und sicherzustellen, dass die Angebote dem Bedarf der Patienten entsprechen.
Data Literacy in der Medizin
Zusammenfassung
Hintergrund
Die digitale Transformation des Gesundheitssystems verändert den Beruf des Arztes. Data Literacy wird hierbei als eine der führenden Zukunftskompetenzen erachtet, findet jedoch derzeit weder in den implementierten Curricula des Medizinstudiums noch in den aktuell laufenden Reformprozessen (Masterplan Medizinstudium 2020 und Nationaler Kompetenzbasierter Lernzielkatalog) Beachtung.
Ziel
Der Beitrag möchte zum einen die Aspekte beleuchten, die im Begriff der Data Literacy im medizinischen Kontext gebündelt werden. Zum andern wird ein Lehrkonzept vorgestellt, das Data Literacy im Zeichen der digitalen Transformation erstmals im Medizinstudium abbildet.
Material und Methoden
Das Blended-Learning-Curriculum „Medizin im digitalen Zeitalter" adressiert in 5 Modulen den diversen Transformationsprozess der Medizin von digitaler Kommunikation über Smart Devices und medizinische Apps, Telemedizin, virtuelle/augmentierte und robotische Chirurgie bis hin zu individualisierter Medizin und Big Data. Diese Arbeit stellt Konzept und Erfahrungen der erstmaligen Implementierung des 5. Moduls dar, welches transdisziplinär und integrativ den Aspekt Data Literacy erläutert.
Ergebnisse
Die Evaluation des Kurskonzepts erfolgte sowohl qualitativ als auch quantitativ und demonstriert einen Kompetenzgewinn in den Bereichen Wissen und Fertigkeiten sowie eine differenziertere Haltung nach Kursabschluss.
Schlussfolgerungen
Die curriculare Integration von Data Literacy ist eine transdisziplinäre und longitudinale Aufgabe. Bei der Entwicklung dieser Curricula sollten die hohe Geschwindigkeit des Veränderungsprozesses der digitalen Transformation beachtet und die curriculare Anpassung im Sinne eines Agility by Design bereits bei der Konzeption adressiert werden.
The Influence of Reactive Oxygen Species and Glucocorticoids on Dry Skin in a Mouse Model of Arthritis
Skin Pharmacol Physiol 2018;31:188–197
Exploring an in situ LED-illuminated isothermal micro-calorimetric method to investigating the thermodynamic behavior of Chlorella vulgaris during CO 2 bio-fixation
Abstract
Much endeavor has been dispensed recently to evaluate the potential of CO2 mitigation by microalgae. We introduce an alternative, novel, LED-illumination isothermal microcalorimetric method to assess the thermodynamic behaviors of microalgae for better understanding of their carbon sequestration capacity. Microalgae thermodynamic behaviors were recorded as power-time curves, and their indices such as total heat evolution (QT ), maximum power output (Pmax) and heat generated by per algae cell (JN/Q ) were obtained. The values for highest (74.80 g L−1) and control sample (0.00 g L−1) of QT , Pmax and JN/Q were 20.85 and 2.32 J; 252.17 and 57.67 μW; 7.91 × −06 and 8.80 × −07 J cell−1, respectively. According to the values of QT , a general order to promote the CO2 sequestration was found at 74.8 g L−1 > 29.92 g L−1 > 14.96 g L−1 > 7.48 g L−1 > 0 g L−1 of C sources, which directly corresponded to carbon availability in the growth medium. Chlorella vulgaris GIEC-179 showed the highest peak Pmax at 74.8 g L−1 concentration which was directly transformed to their biomass during bio-fixation of CO2 process. This study is applicable for better understanding of CO2 fixation performance of algae.
Errance médicale des patients atteints d’hidradénite suppurée : un problème majeur et persistant. Étude « R-ENS Verneuil »
Publication date: Available online 26 April 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J. Loget, C. Saint-Martin, P. Guillem, L. Kanagaratnam, P.-A. Becherel, A. Nassif, A.-C. Fougerousse, M. Siham, C. Girard, H. Barthelemy, G. Chaby, G. Gabison, J.-L. Perrot, V. Pallure, N. Beneton, T. Boye, C. Jacobzone, E. Begon, P. Bernard, Z. Reguiai
ObjectifL'objectif principal de cette étude était d'analyser les facteurs associés à l'existence d'un délai diagnostique significatif chez les patients atteints d'hidradénite suppurée (HS) en France.Malades et méthodesCette étude nationale prospective multicentrique réalisée d'octobre 2015 à mars 2016 incluait tous les patients consultant pour une HS. Les données concernant les patients étaient recueillies à l'aide d'un questionnaire standardisé. Des analyses univariée et multivariée ont été effectuées afin de recueillir les facteurs associés à un délai diagnostique significatif, défini comme un délai d'au moins 5,5 ans entre les premiers signes de la maladie et son diagnostic formel.RésultatsLes 16 centres ont inclus 312 patients (62 % de femmes) d'âge moyen 35 ans. L'âge moyen de début de l'HS était de 22 ans. Respectivement 170 (54 %), 114 (37 %) et 45 (15 %) patients avaient consulté au moins 3, 5 et 10 médecins avant le diagnostic formel, qui était posé par un dermatologue dans 64 % des cas. Les premiers signes d'HS étaient apparus en moyenne 6,2 ans avant la première consultation de dermatologie et 8,4 ans avant le diagnostic. Un tabagisme actif (Odd Ratio (OR) ajusté 1,85; p=0,027) et un début des signes à un âge plus précoce (OR ajusté 0,92; p<0,001) étaient associés à un délai diagnostique significatif.ConclusionCes résultats soulignent l'errance médicale des patients atteints d'HS, mais ne montrent pas d'association entre les caractéristiques sociodémographiques ou économiques des patients et l'existence d'un délai diagnostique significatif.ObjectiveTo provide physicians with an understanding of the factors behind significant delays in the diagnosis of hidradenitis suppurativa (HS) in France.Patients and methodsThis prospective multicentre national study conducted from October 2015 to March 2016 included all patients consulting for HS. Patient data were collected by means of a standardized questionnaire. Univariate and multivariate analyses were conducted to collect factors associated with a significant time to diagnosis of at least 5.5years, defined as the period between the onset of initial clinical signs and the time of formal diagnosis.ResultsThe 16 participating centres enrolled 312 patients (62% women), of average age 35years. The average age at onset of HS was 22years. Before formal diagnosis by a dermatologist (64% of cases), 170 (54%), 114 (37%) and 45 (15%) patients had previously consulted at least 3, 5 and 10 general physicians, respectively. The average time between the initial clinical signs of HS, the first dermatology visit and the definitive diagnosis was 6.2 and 8.4 years, respectively. Active smoking (OR adjusted 1.85; P=0.027) and disease onset at a younger age (adjusted OR 0.92; P<0.001) were both associated with significant delays in diagnosis.ConclusionThese results emphasized misdiagnosis among HS patients but did not evidence any association between either sociodemographic or economic characteristics and the existence of significant times to diagnosis.
Measurement of Current Substance Use in a Cohort of HIV-infected Persons in Continuity HIV Care, 2007-2015
Medical History, Medication Use, and Risk of Nasopharyngeal Carcinoma
Characterizing the correlation between dephosphorization and solution pH in a calcined water treatment plant sludge
Abstract
This study focused on characterizing the correlation between the dephosphorization process of calcined water treatment plant sludge (C-WTPS) and the solution initial pH in batch experiments. The specific aim was to illustrate the effect of different initial pH on the adsorption and desorption of phosphorous in C-WTPS. In addition, the effects of solution initial pH on the release of ammonia nitrogen and total organic carbon (TOC) from C-WTPS and the change of pH after adsorption were also investigated. The results demonstrated that the initial pH significantly influenced the adsorption of phosphorus on C-WTPS. When initial pH was increased from 3 to 10, the phosphorous absorption capacity reduced by 76.5%. Especially, when the initial pH reached to 11, the phosphorus adsorption capacity became a negative value, indicating that C-WTPS released phosphorus into the solution. The addition of C-WTPS to the solution had little impact on the initial pH of the solution. The absorbed phosphorous on C-WTPS was relatively stable in the pH range of 3 to 10. Nevertheless, when the solution pH was higher than 11, it can be easily released into the solution. Furthermore, by comparison with WTPS, C-WTPS released less ammonia nitrogen and TOC into the solution and adsorbed more phosphorus from the solution in the experimental pH range. Therefore, C-WTPS is more suitable to serve as a cost-effective sorbent for phosphorus removal.
A case of acrodermatitis continua of Hallopeau (ACH) successfully treated with sulfasalazine
Dermatologic Therapy, EarlyView.
-
A Case of Diprosopus Tetraophthalmos: Ocular Findings and Surgical Treatment of Exposure KeratopathyDiprosopus is a rare variation of conjoined twinning. In this report, ophthalmic findings in an infant with diprosopus tetraophthalmos are p...
