Harmonization of Respiratory Data From Nine US Population-Based Cohorts: The NHLBI Pooled Cohorts Study

Abstract

Chronic lower respiratory diseases (CLRD) are the fourth leading cause-of-death in the US. To support investigations into CLRD risk determinants and new approaches to primary prevention, we aimed to harmonize and pool respiratory data from US general population-based cohorts. Data were obtained from prospective cohorts that performed pre-bronchodilator spirometry, which was harmonized following 2005 ATS/ERS standards. In cohorts conducting follow-up for non-cardiovascular events, CLRD events were defined as hospitalizations/deaths adjudicated as CLRD-related or assigned relevant administrative codes. Coding and variable names were applied uniformly. The pooled sample included 65,251 adults in nine cohorts followed-up for CLRD-related mortality over 653,380 person-years from 1983-2016. Average baseline age was 52 years; 56% were female; 49% were never-smokers; and racial/ethnic composition was 44% White, 22% Black, 28% Hispanic/Latino, and 5% American-Indians. Over 96% had complete data on smoking, clinical CLRD diagnoses, and dyspnea. After excluding invalid spirometry exams (13%), there were 105,696 valid exams (median 2 per participant). Of 29,351 participants followed-up for CLRD hospitalizations, median follow-up was 14 years; only 5% were lost-to-follow-up at 10 years. Hence, the NHLBI Pooled Cohorts Study provides a harmonization standard applied to a large, US population-based sample that may be used to advance epidemiologic research on CLRD.

¿Qué tipo de guantes debemos utilizar en la cirugía dermatológica? Recomendaciones sobre los guantes a emplear

Publication date: Available online 29 June 2018
Source:Actas Dermo-Sifiliográficas
Author(s): X. Bosch-Amate, D. Morgado-Carrasco, J. Riera-Monroig, J. Ferrando

Removal of bisphenol A by Fe-impregnated activated carbons

Abstract

A commercial wood-based activated carbon and the oxidized counterpart were impregnated with iron. The two Fe-impregnated carbons were prepared and characterized for their iron content, textural characteristics, surface chemistry, and their performance for bisphenol A adsorption. Batch adsorption experiments were conducted to study the effect of pH, ionic strength, kinetics, and thermodynamic equilibrium. Equilibrium adsorption data were described by both Langmuir and Freundlich isotherms. The iron impregnated activated carbon and the oxidized impregnated activated carbon presented maximum adsorption capacities of 785.65 and 469.78 mg/g, respectively, while adsorption followed second-order rate kinetics for both impregnated carbons. According to the thermodynamic parameters (ΔΗο, ΔSo, ΔGo), the adsorption is a spontaneous, exothermic, and physical process. Fenton-driven experiments conducted at different molar ratios of [H₂O₂]/[BPA] showed efficient degradation of BPA in spent Fe-impregnated carbons up to 82–95%, with traces of hydroxylated products.

S olubilization of insoluble zinc compounds by zinc solubilizing bacteria (ZSB) and optimization of their growth conditions

Abstract

In this research, the optimum growth conditions for two zinc solubilizing bacteria (ZSB) have been studied for their potential application as bioinoculants to overcome Zn unavailability in soils. For this purpose, a laboratory-scale experiment was carried out to evaluate the zinc solubilizing ability of 80 plant growth promoting bacteria (PGPB) strains isolated from the rhizosphere of barley and tomato plants. To select effective ZSB, isolates were evaluated on Tris-mineral medium supplemented separately with zinc oxide, zinc carbonate, and zinc phosphate at a concentration of 0.1%. Two strains (Agrobacterium tumefaciens and Rhizobium sp.) were selected, based on a clear halo zone around their colonies in the solid medium supplemented with zinc oxide after 10 days of incubation at 29 °C. Results of solubilization at different pH values showed that these strains had solubilization activity in the range of pH 8–10 while no solubilization was observed at pH 6 and 7. The maximum Zn solubilization values were noted at pH 9: 51.4 mg L⁻¹ (Agrobacterium tumefaciens) and 72.1 mg L⁻¹ (Rhizobium sp). According to findings, bacterial growth was affected by different NaCl concentrations under in vitro condition. The salt concentration required for 50% inhibition of absorbance was 2.11 and 2.27% NaCl for Agrobacterium tumefaciens and Rhizobium sp., respectively. The maximum bacterial growth was observed at about 0.8% NaCl concentration.

Evaluating the effect of biochar addition on the anaerobic digestion of swine manure: application of Py-GC/MS

Abstract

The anaerobic digestion process of swine manure was studied when char was used as supplement for improving performance. The use of pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS) was proposed for assessing the organic matter degradation. The assessment on biogas production was carried out using samples of swine manure (SM) supplemented with char in one case and pre-treated by microwave irradiation in the other. This experimental set-up allows for the comparison of the biological degradation observed under these two different configurations and therefore aids in understanding the effect of char particles on the process. Results showed similar performance for both systems, with an average improvement of 39% being obtained in methane production when compared to the single digestion of SM. The analysis of digestate samples by Fourier transform infrared (FTIR) spectroscopy and Py-GC/MS showed improved degradation of proteins, with the Py-GC/MS technique also capable of identifying an increase in microbial-derived material when char was added, therefore highlighting the relevant role of carbon conductive particles on biological systems. Py-GC/MS along with the use of FTIR spectroscopy has proven to be useful tools when evaluating anaerobic digestion.

A new concept for risk analysis relating to the degradation of water reservoirs

Abstract

This paper presents a proposal for a procedure by which to analyse the risk of reservoirs being degraded. The body of water assessed for its susceptibility to degradation in line with the proposed procedure is Myczkowce Reservoir, SE Poland. This reservoir has a maximum capacity of ten million m³ and helps provide hydropower, by serving as a surge tank located above the main Solina Reservoir. On the basis of an assessment of its morphometric and hydrological parameters, Myczkowce Reservoir was assigned to the low-resilience category where risk of degradation was concerned. The primary factors responsible for that are limited capacity in relation to shoreline length, a lack of thermal stratification, and a high value for the Schindler index. These and other environmental parameters provided for Myczkowce's assignment to the category of susceptible to the impact of matter supplied by its catchment, with this reflecting the instantaneous nature of the basin, high values for the Ohle coefficient, average catchment slope, and the lack of a septic system. The designated risk level supported Myczkowce's assignment to a category characterised by an "unacceptable" risk of degradation. The proposed method taking two parameters (resilience and susceptibility) into account represents the first universal method for assessing reservoirs without reference to risks such as drought, flooding, or lack of water supply for human consumption. The risk depends only on the reservoir and catchment parameters.

Frontalis–Orbicularis Muscle Advancement for Correction of Upper Eyelid Ptosis: A Systematic Literature Review

Purpose: To review the level of standardization of frontalis–orbicularis muscle advancement to correct severe blepharoptosis and the degree of scientific evidence supporting the procedure as a useful modality of blepharoptosis repair. Methods: The authors searched the Medline, Lilacs, and Scopus databases for all articles in English, Spanish, and French that used as keywords the terms "frontalis muscle flap," "orbicularis muscle flap," and "ptosis." Data retrieved included authorship specialty, geographic region where the surgeries were performed, characteristics of the samples reported, type and dimensions of the flaps used, time of follow-up, rate of undercorrection, and complications. Results: Thirty-eight articles were retrieved and analyzed. Most studies originated from Asian countries, especially China, Taiwan, and Korea. Many variations of the procedure were encountered, including location of incisions and frontalis flap design. There were 23 case series with more than 10 patients. None compared the procedure to conventional frontalis suspension surgery. The samples were not homogeneous, including patients with different type of ptosis, variable degrees of levator function, and using distinct methods of evaluating eyelid position. Undercorrection rates ranged from 1.8% to 38% with a median value of 12.2%. The rate of complications (eyelid crease abnormalities, entropion, hematoma, and supraorbital nerve injury) was low. Conclusions: The direct frontalis–orbicularis muscle advancement has been judged positively in all reports analyzed. However, the level of standardization of the surgery is low, and the reported series are not homogeneous. Further studies are needed to better evaluate this operation. Accepted for publication April 4, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Patricia Mitiko S. Akaishi, M. D., Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil. E-mail: patriciamitiko@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Stop eating plastic, molecular signaling of bisphenol A in breast cancer

Abstract

Breast cancer is the second most common fatal cancer in women. Developing a breast cancer is a multi-factorial and hormonal-dependent process, which may be triggered by many risk factors. An endocrine disrupting substance known as bisphenol A (BPA), that is used greatly in the manufacture of plastic products, was suggested as a possible risk factor for developing breast cancer. BPA has a strong binding affinity to non-classical membrane estrogen receptors like estrogen-related and G protein-coupled (GPER) receptors. Based on animal and in vitro studies, results showed a link between BPA exposure and increased incidence of breast cancer. BPA has the ability to alter multiple molecular pathways in cells namely, G protein-coupled receptor (GPER) pathway, estrogen-related receptor gamma (ERRγ) pathway, HOXB9 (homeobox-containing gene) pathway, bone morphogenetic protein 2 (BMP2) and (BMP4), immunoregulatory cytokine disturbance in the mammary gland, EGFR-STAT3 pathway, FOXA1 in ER-breast cancer cells, enhancer of zeste homolog 2 (EZH2), and epigenetic changes. Thus, the aforementioned alterations cause undesired gene stimulation or repression that increase risk of developing breast cancer. So, restricting exposure to BPA should be considered to aid in lowering the risk of developing breast cancer.

Removal of aromatic and hydrophobic fractions of natural organic matter (NOM) using surfactant modified magnetic nanoadsorbents (MNPs)

Abstract

The present study investigated the potential of surfactant modified magnetic nanoadsorbents (MNPs) for the removal of aromatic and hydrophobic fractions of natural organic matter (NOM), leading to the formation of trihalomethanes (THMs) in chlorinated drinking water. Co-precipitation method was used for the synthesis of MNPs. However, MNPs have a tendency to form an agglomeration. Therefore, polyethylene glycol (PEG) was used as a surface modifier to reduce the agglomeration. The PEG-coated MNPs were characterized by field emission scanning electron microscopy (FESEM), transmission electron microscopy (TEM), energy-dispersive X-ray analysis (EDX), BET surface area, X-ray diffraction (XRD), Fourier transform spectrometer (FTIR), and zeta (ζ) potential. FESEM observation indicates that PEG-coated MNPs were spherical in shape and 25 nm in size. Zeta potential values (− 58.35 to − 74.9 mV) indicated excellent stability of PEG-MNPs. FTIR spectra indicated the presence of a −CH₂ group, responsible for the chemical interaction between aromatic and humic content. Batch experiments were conducted by studying the effect of pH, contact time, and adsorbent dosage on NOM removal. Excellent removal of DOC (94.49%) and UV₂₅₄ (89.32%) was observed at the optimum dose of adsorbent (0.75 g/L) and at pH 7.0. Adsorption kinetics followed pseudo-second-order reaction (R², 0.973) and occurs by multilayer chemisorption which is due to the chemical interaction between aromatic and humic compounds of NOM with MNPs. Thus, MNPs showed great potential as a novel adsorbent for the removal of aromatic and hydrophobic compounds of NOM and can significantly be used to curtail the problem of THMs in drinking water supplies.

Effect of controlled-release fertilizer on N 2 O emissions and tea yield from a tea field in subtropical central China

Abstract

Tea (Camellia sinensis L.), a perennial leaf-harvested crop, favors warm/humid climate and acidic/well-drained soils, and demands high nitrogen (N) fertilizer inputs which lead to significant emissions of N₂O. Potential mitigation options should be adopted to improve N use efficiency (NUE) and reduce environmental pollution in tea field system. A 3-year field experiment was carried out in a tea field in southern China from January 2014 to December 2016 to investigate the effect of controlled-release fertilizer (CRF) application on N₂O emissions in tea field system. Three practices, namely conventional treatment (CON, 105 kg N-oilcake ha⁻¹ year⁻¹ + 345 kg N-urea ha⁻¹ year⁻¹), treatment with a half amount of the N fertilizer (CRF50%, 105 kg N-oilcake ha⁻¹ year⁻¹ + 120 kg N CRF ha⁻¹ year⁻¹) and full amount of N fertilizer (CRF100%, 105 kg N-oilcake ha⁻¹ year⁻¹ + 345 kg N CRF ha⁻¹ year⁻¹) were used. Compared with the CON, our results showed that CRF50% reduced the N₂O emissions by 26.2% (p > 0.05) and increased the tea yield by 31.3% (p > 0.05), while CRF100% significantly increased the N₂O emissions by 96.7% (p < 0.05) and decreased the tea yield by 6.77% (p > 0.05). Overall, yield-scaled N₂O emissions of tea were reduced by 44.5% (p > 0.05) under CRF50% and significantly increased by 100% (p < 0.05) under CRF100%, compared with CON. Based on the gross margin analysis, CRF50% obtained the highest net economic profit. Our findings suggest that reducing N input of CRF (CRF50%) is necessary and feasible for adoption in the current tea plantation system.

Prognostic significance of high serum p53 antibody titers in patients with esophageal squamous cell carcinoma

Abstract

Background

The p53 protein overexpression that usually results from genetic alterations reportedly induces serum antibodies against p53. However, little information is available about the prognostic significance of perioperative serum p53 antibody (s-p53-Abs) titers in patients with esophageal squamous cell carcinoma.

Methods

In this study, we retrospectively evaluated the clinical significance of perioperative s-p53-Abs in 135 patients with esophageal squamous cell carcinoma. Of these, 58 patients received neoadjuvant chemotherapy comprising 5-FU and CDDP. While the cutoff level at 1.3 U/ml indicated seropositive patients, level of 13.4 U/ml was used to identify high-titer patients. We monitored serum titers seropositive patients after surgery and evaluated the prognostic significance by the univariate and multivariate analyses.

Results

In this study, 29 patients (21.5%) were positive for s-p53-Abs before treatment. The frequency of both seropositive patients and high-titer patients (> 13.4 U/ml) was not significantly associated with tumor progression. While seropositive patients did not demonstrate significant poor overall survival, high-titer patients demonstrated significant poor overall survival based on the multivariate analysis (P < 0.001). Moreover, the s-p53-Abs titer did not correlate with the response to neoadjuvant chemotherapy. Among seropositive patients, the negative conversion of s-p53-Abs more likely led to be long-term survival.

Conclusions

This study determined that the high-titer of s-p53-Abs was an independent risk factor to reduce the overall survival of patients with esophageal cancer patients. The negative conversion of s-p53-Abs could be a good indicator of favorable prognosis.

Studies on the UV filtering and radical scavenging capacity of the bitter masking flavanone Eriodictyol

Publication date: Available online 28 June 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Vijisha K. Rajan, T.K. Shameera Ahamed, K. Muraleedharan
A computational analysis of UV filtering and radical scavenging capacity of a flavanone, Eriodictyol has been performed under DFT-B3LYP/6–31+ G (d, p). Eriodictyol is nontoxic and nonirritant bitter masker commonly used in the wine industry. It has been reported that the flavanones were widely acceptable for photoprotection due to its potential UV filtering and radical scavenging capacity. This study provides theoretical evidence that the eriodictyol has an absorbance in the UV-A and UV-B region of the electromagnetic spectrum and therefore can be used as a potential UV filter in sunscreen lotions and other cosmetic products. The major transitions in the UV–Visible spectrum of Eriodictyol are between HOMO and HOMO-1 with LUMO level and are well explained by NBO-NLMO tool in G09 software. In addition to this, Eriodictyol is a potent antioxidant than that of the most commonly studied Quercetin. The most active site in the compound is 3′ position and is confirmed by NPA, NBO and pKa value analysis. The lowest energy conformer of Eriodictyol contains a Hydrogen bond between carbonyl oxygen (O2) and H30. This is confirmed by the highest value of interaction energy between lone pairs of O2 and σ* of O3– H30. Both the two lone pairs of O2 interacts with the σ* of O3-H30. This decreases the bond order of 5 OH and at the same time it restricts the hydrogen transfer from this position to form a radical. Similarly, the lone pair of O5 (3′ position) interacts with H33 resulting in the low bond order value and consequently less favorable for radical formation. These results indicate that the BDE values follow the order 3′ < 4′ < 7 < 5. Thus the title compound can be used for photo protection due to its potential UV filtering and radical scavenging capacity.

Graphical abstract

Wetlands for wastewater treatment and subsequent recycling of treated effluent: a review

Abstract

Due to water scarcity challenges around the world, it is essential to think about non-conventional water resources to address the increased demand in clean freshwater. Environmental and public health problems may result from insufficient provision of sanitation and wastewater disposal facilities. Because of this, wastewater treatment and recycling methods will be vital to provide sufficient freshwater in the coming decades, since water resources are limited and more than 70% of water are consumed for irrigation purposes. Therefore, the application of treated wastewater for agricultural irrigation has much potential, especially when incorporating the reuse of nutrients like nitrogen and phosphorous, which are essential for plant production. Among the current treatment technologies applied in urban wastewater reuse for irrigation, wetlands were concluded to be the one of the most suitable ones in terms of pollutant removal and have advantages due to both low maintenance costs and required energy. Wetland behavior and efficiency concerning wastewater treatment is mainly linked to macrophyte composition, substrate, hydrology, surface loading rate, influent feeding mode, microorganism availability, and temperature. Constructed wetlands are very effective in removing organics and suspended solids, whereas the removal of nitrogen is relatively low, but could be improved by using a combination of various types of constructed wetlands meeting the irrigation reuse standards. The removal of phosphorus is usually low, unless special media with high sorption capacity are used. Pathogen removal from wetland effluent to meet irrigation reuse standards is a challenge unless supplementary lagoons or hybrid wetland systems are used.

Analysis of the adsorption and retention models for Cd, Cr, Cu, Ni, Pb, and Zn through neural networks: selection of variables and competitive model

Abstract

In this study, the neural networks are used to predict and explain the behavior of different edaphological variables in the adsorption and retention of heavy metals, both isolated and competing. A comparison with the results obtained using multiple regression, stepwise analysis, and regression trees is performed. In the neural network technique, CEC amorphous and crystallized oxides and kaolinite in the clay fraction are the most selected variables for making the optimal models, while mica and, to a lesser extent, plagioclase, are the next variables selected. Additionally, a competitive model has been considered, using simultaneously different metals. In the competitive model, the model predicts a more intense competence between Pb and Ni for the adsorption process and between Cr and Ni for the retention process.

Reply to the Editor: The pedicled internal pudendal artery perforator (PIPAP) flap for ischial pressure sore reconstruction: Technique and long-term outcome of a cohort study

Publication date: Available online 28 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): K.W. Karl Waked, A.Z. Assaf A. Zeltzer

Patients with Abdominal-based Free Flap Breast Reconstruction a Decade after Surgery - A Comprehensive Long-term Follow-up Study

Publication date: Available online 28 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Tianyi Liu, Christoffer Freijs, Holger J Klein, Anna Feinbaum, Andreas Svee, Andres Rodrigues Lorenzo, Anders Liss, Rafael Acosta, Maria Mani
BackgroundAbdominal-based free flap breast reconstruction has increasingly become the gold standard, however long-term evidence of aesthetic outcome and quality of life is lacking. Our study aims to gain an overview of patients with abdominal-based free flap breast reconstructions in a long-term perspective.MethodsSeventy-five patients who received abdominal-based free flap breast reconstructions between 2000-2007 in Uppsala, Sweden were invited back for photographs, 3D imaging and questionnaires. A retrospective chart review was conducted. Patient satisfaction with appearance and quality of life were assessed using the Breast-Q questionnaire. A layman panel and a professional panel rated the aesthetic appearance of the reconstructed breast from photographs and 3D images.ResultsFifty-five patients participated with a mean age of 52±8 years at the time of reconstruction and a mean follow-up time of 11.4±1.8 years completed the study. The majority of the patients had received unilateral (83%), delayed reconstructions (73%) with prior radiation (55%). There were 53 patients with DIEP flaps, one with free TRAM flap and one with SIEA flap. Overall patient satisfaction and quality of life were comparable to normative values of women without breast cancer (p<0.001). There was a high level of agreement for the aesthetic results of the reconstructions between patient, professionals and layman panels (0.89 ICC, 95% CI: 0.83 - 0.93).ConclusionAbdominal-based free flap reconstructions were effective in achieving a lasting positive aesthetic result and a high quality of life in patients a decade after surgery.

Examining the Role of Neighborhood-Level Foreclosure in Smoking and Alcohol Use Among Older Adults in the Multi-Ethnic Study of Atherosclerosis

Abstract

The US Great Recession resulted in an alarming number of home foreclosures that weakened the social and physical environment of thousands of neighborhoods. Few studies have evaluated whether these neighborhood changes were related to changes in individual behaviors. We examined the relationship between changes in neighborhood-level home foreclosure within a quarter-mile (0.4-km) buffer of the residence and changes in cigarette smoking and alcohol use among 3,807 adults enrolled in the Multi-Ethnic Study of Atherosclerosis during 2005–2012, using econometric individual-level fixed-effects models. Increases in neighborhood-level foreclosure were associated with small decreases in the number of cigarettes smoked per day (mean difference = −0.08, 95% confidence interval: −0.11, −0.04) and small increases in the number of alcoholic beverages consumed per week (mean difference = 0.11, 95% confidence interval: 0.05, 0.17). Neighborhood-level foreclosure may not uniformly influence high-risk behaviors. The impact of home foreclosure on adult drinking should be further explored, given its potentially negative implications for health.

Leukocyte Telomere Length and All-Cause Mortality: A Between-Within Twin Study With Time Dependent Effects Using Generalized Survival Models

Abstract

Although previous studies examining leukocyte telomere length (LTL) and all-cause mortality controlled for several confounders, the observed association could be biased due to unmeasured confounders, including familial factors. We aimed to examine the association of LTL with all-cause mortality in a Swedish twin sample adjusting for familial factors and allowing for time dependent effects. Three hundred and sixty-six participants were recruited from the Swedish Twin Registry. LTL was assessed using the Southern blot method. All-cause mortality data were obtained through linkage to the Swedish Population Registry updated through to November 2017. To control for familial factors within twin pairs, we applied a between-within shared frailty model based on generalized survival models. Overall, 115 (31.4%) participants were men and 251 (68.6%) were women. The average age of the study participants when blood was drawn was 79.1 years, and follow-up duration spanned from ten days to 25.7 years (mean = 10.2 years). During the follow-up period, 341 (93.2%) participants died. Shorter LTL was associated with higher mortality rates when controlling for familial factors in the between-within shared frailty model. We found significant time dependent effects of LTL on all-cause mortality, where the mortality rate ratios were attenuated with increasing age.

As Long as the Breath Lasts. In Utero Exposure to Ramadan and the Occurrence of Wheezing in Adulthood

Abstract

While prenatal exposure to Ramadan has been shown to be negatively associated with general physical and mental health, studies on specific organs remain scarce. This study explores whether Ramadan during pregnancy has impacts on the occurrence of wheezing, a main symptom for obstructive airways diseases. Using data from the Indonesian Family Life Survey collected between 1993 and 2008 (waves 1 to 4), we compare wheezing occurrence among adult Muslims who had been in utero during Ramadan with adult Muslims who had not been in utero during Ramadan. Wheezing prevalence is higher among adult Muslims who had been in utero during Ramadan, independent of the pregnancy phase in which the exposure to Ramadan occurred. Moreover, this association tends to increase with age, being strongest in the age groups 45+. This is in line with fetal programming theory suggesting that impacts of in utero exposures often only show after the reproductive age. Particularly strong associations were detected for smokers. The respiratory system of prenatally exposed Muslims thus seems to perform worse in mitigating later ex utero harmful influences such as smoking. This study suggests that exposure to Ramadan during pregnancy may have lasting consequences for adult lung functionality.

Associations of dietary protein intake with fat free mass and grip strength: cross-sectional study in 146,816 UK Biobank participants

Abstract

Adequate dietary protein intake is important for the maintenance of fat-free mass (FFM) and muscle strength: optimal requirements remain unknown. The aim of the current study was to explore the associations of protein intake with FFM and grip strength. We used baseline data from the UK Biobank (146,816 participants aged 40-69 years with data collected 2007-2010 across the UK) to examine the associations of protein intake with FFM and grip strength. Protein intake was positively associated with FFM (men 5.1% [95% CI: 5.0; 5.2] and women 7.7% [95% CI: 7.7; 7.8]) and grip strength (men 0.076 kg/kg [95% CI: 0.074; 0.078] and women 0.074 kg/kg [95% CI: 0.073; 0.076]) per 0.5 grams per kg body mass per day (g/kg/day) increment in protein intake. FFM and grip strength were higher with higher intakes across the full range of intakes, i.e. highest in those reporting consuming > 2.0 g/grams per kg/day independently of socio-demographics, other dietary measures, physical activity and comorbidities. FFM and grip strength were lower with age, but this association did not differ by protein intake categories (P > 0.05). Current recommendation for all adults (40-69 years) for protein intake (0.8 grams per kg body mass per day) may need to be increased to optimise FFM and grip strength.

Adsorptive removal of endocrine-disrupting compounds and a pharmaceutical using activated charcoal from aqueous solution: kinetics, equilibrium, and mechanism studies

Abstract

Bisphenol A (BPA), diethyl phthalate (DEP), and carbamazepine (CBZ) have been widely used in chemical and pharmaceutical fields, and their residues are detected in various environments. Therefore, to find a suitable method for removing the compounds from an aqueous solution, an adsorption method by granular activated charcoal (AC) was studied. To investigate the adsorption properties of AC, its kinetics, equilibrium, pH effects, and regeneration of AC were examined. Moreover, its surface properties (i.e., surface area, pore volume, functional groups, and surface charge) were characterized by N₂ adsorption and desorption isotherm, Fourier transform infrared (FTIR), and zeta potential analyses. Experimental results show that AC has high removal efficiencies for the target compounds at the low initial concentration as well as high estimated adsorption capacities (q_m) for DEP, BPA, and CBZ, whose values were 293.4 ± 18.8, 254.9 ± 16.2, and 153.3 ± 1.61 mg/g, respectively. In comparison with other adsorbents based on previously reported results, AC was shown to have generally higher removability for the three compounds than others. Moreover, it was observed that AC's ability to adsorb DEP and BPA was dependent on pH because of hydrolysis and ionization, respectively. Meanwhile, there is no pH effect for CBZ adsorption by AC. After 3 cycles of adsorption/desorption, AC still maintained 92, 100, and 82% of initial adsorption capacities for DEP, BPA, and CBZ, respectively. Therefore, the AC is an effective adsorbent for the removal of endocrine-disrupting chemicals and pharmaceuticals from aqueous solution.

Organophosphorus poisoning in animals and enzymatic antidotes

Abstract

Organophosphorus compounds (OPs) are neurotoxic molecules developed as pesticides and chemical warfare nerve agents (CWNAs). Most of them are covalent inhibitors of acetylcholinesterase (AChE), a key enzyme in nervous systems, and are therefore responsible for numerous poisonings around the world. Many animal models have been studied over the years in order to decipher the toxicity of OPs and to provide insights for therapeutic and decontamination purposes. Environmental impact on wild animal species has been analyzed to understand the consequences of OP uses in agriculture. In complement, various laboratory models, from invertebrates to aquatic organisms, rodents and primates, have been chosen to study chronic and acute toxicity as well as neurobehavioral impact, immune response, developmental disruption, and other pathological signs. Several decontamination approaches were developed to counteract the poisoning effects of OPs. Among these, enzyme-based strategies are particularly attractive as they allow efficient external decontamination without toxicity or environmental impact and may be of interest for treatment. Approaches using bioscavengers for prophylaxis, treatment, and external decontamination are emphasized and their potential is discussed in the light of toxicological observations from various animal models. The relevance of animal models, regarding their cholinergic system and the abundance of naturally protecting enzymes, is also discussed for better extrapolation of results to human.

Equilibrium adsorption study of the adsorptive removal of Cd 2+ and Cr 6+ using activated carbon

Abstract

The performance of activated carbon (AC) with respect to characterization, adsorption kinetics, thermodynamics, and isotherms was addressed in this study. The effects of initial concentration, pH, contact time, ion strength, and temperature on removal efficiency were also studied. The adsorption isotherms of Cd²⁺ and Cr⁶⁺ on activated carbon can fit the Langmuir model well, and correlation coefficients were above 0.99, all higher than the Freundlich and Temkin models. The maximum adsorption quantities of Cd²⁺ and Cr⁶⁺ were 19.380 and 19.305 mg g⁻¹ at 25 °C, respectively. The adsorption capacities of Cd²⁺ and Cr⁶⁺ are clearly pH dependent. The kinetics of the removal of Cd²⁺ and Cr⁶⁺ was in agreement with a pseudo-second-order model, and the adsorption efficiency of Cd²⁺ is higher than that of Cr⁶⁺. The thermodynamic results showed that increased temperature is favorable to adsorption. The speciation on activated carbon was mainly residual Cd²⁺ and Cr⁶⁺, and the potential ecological risk of Cd²⁺ is higher than that of Cr⁶⁺. The adsorptions of Cd²⁺ and Cr⁶⁺ on activated carbon were dominated by chelation and ion exchange, respectively.

The effects of recombinant human epidermal growth factor containing ointment on wound healing and post inflammatory hyperpigmentation prevention after fractional ablative skin resurfacing: A split‐face randomized controlled study

Journal of Cosmetic Dermatology, EarlyView.

Screening of microalgae for treating Garcinia cambogia wash water with potential lipid production

Abstract

The microalgae-based water treatment is gaining importance in recent years as it serves multiple purposes of which includes water treatment and biofuel production. Garcinia cambogia, a Malabar tamarind is a tropical fruit and the active ingredient hydroxycitric acid is popularly used as a weight-loss supplement. After extraction of the hydroxycitric acid, the wash water of G. cambogia is considered as an effluent. The potential microalgal species that can grow and treat G. cambogia wash water were isolated and identified as Dicloster acuatus BVR1 and Kalenjenia gelanitosa BVR2. Both the microalgal species adapted to G. cambogia wash water and entered exponential phase after sixth day with maximum specific growth rate of 0.310 day⁻¹ for D. acuatus and 0.296 day⁻¹ for K. gelanitosa during tenth day. The biomass productivity of D. acuatus was 0.03 g L⁻¹ day⁻¹ which is 58% higher than K. gelanitosa with 0.019 g L⁻¹ day⁻¹. The microalgal strains besides water treatment were subsequently subjected for lipid extraction and lipid productivity determination. The lipid productivity of D. acuatus was 2.68 mg L⁻¹ day⁻¹ which is lesser compared to 3.38 mg L⁻¹ day⁻¹ for K. gelatinosa. Both the microalgal isolates were promising for G. cambogia wash water treatment and lipid production. Hence, an environment friendly approach of water treatment with simultaneous lipid production for biofuel conversion is conducted.

Simultaneous removal of NO and SO 2 from flue gas using vaporized H 2 O 2 catalyzed by nanoscale zero-valent iron

Abstract

To remove NO and SO₂ from flue gas simultaneously, a heterogeneous catalytic oxidation system was developed with the nanoscale zero-valent iron (nZVI), vaporized H₂O₂, and sodium humate (HA-Na) acting as the catalyst, oxidant, and absorbent, respectively. The experimental results indicated that the desulfurization was mainly influenced by the absorption, and the denitrification was significantly affected by the catalytic oxidation parameters. Under the optimal conditions, the simultaneous removal efficiencies of SO₂ and NO were 100 and 88.4%, respectively. The presence of ^·OH during the removal process was proved by the scavenger tests, and the production of ^·OH with and without nZVI was indirectly evaluated by the electron paramagnetic resonance (EPR) and methylene blue experiments. Moreover, the fresh and aged nZVI were characterized by a series of techniques and the results suggested that the redox pair Fe²⁺/Fe³⁺ released by nZVI could react with H₂O₂ to provide the sustainable ^·OH, which was important for the oxidation from NO and SO₂ to NO₃⁻ and SO₄²⁻. The removal mechanism was proposed preliminarily based on the correlative experiments, characterizations, and references.

Pachyonychia congenita: Affecting three generations!

Rohit Singla, Pihu Sethi, TG Savitha, Amrinder Jit Kanwar

Indian Journal of Paediatric Dermatology 2018 19(3):261-262

Pachyonychia congenita is an autosomal dominantly inherited disease that primarily presents as nail dystrophy and dyskeratosis of skin and mucous membranes. A 32-year-old female presented with thickening of the nails and thickening of both heels. Her father showed pincer nails with periungual thickening of skin and fissures with focal plantar keratoderma. Her two sons had similar nail changes.

Monogenic autoinflammatory syndromes in children: Through the dermatologist's lens

Vishal Gupta, M Ramam

Indian Journal of Paediatric Dermatology 2018 19(3):194-201

Autoinflammatory syndromes are a group of rare disorders of innate immunity characterized by repeated episodes of inflammation without an obvious cause. Many of these disorders have a childhood onset, and present as recurrent fevers, skin lesions, joint pains and other systemic features. Newer autoinflammatory syndromes with previously undescribed clinical phenotypes are being increasingly recognized. Several of these have distinctive cutaneous manifestations, and dermatologists have an important role to play in the diagnosis of these conditions. Recently, molecular basis for many of these diseases has been identified, thus paving the way for novel targeted therapies. Interleukin-1 blockers have been found to be more effective than the conventional immunosuppressants in their treatment. In this article, we focus on the cutaneous features of well-recognized as well as some of the recently described monogenic autoinflammatory syndromes in children.

Severe acute malnutrition with hyperpigmentation: An uncommon association

Ibrahim Aliyu, Zainab F Ibrahim

Indian Journal of Paediatric Dermatology 2018 19(3):285-286

Pediatric cutaneous tuberculosis: Indian scenario

Bhushan Kumar, Sheetanshu Kumar

Indian Journal of Paediatric Dermatology 2018 19(3):202-211

Burden of tuberculosis still persists in developing countries despite major advances in its treatment strategies. Cutaneous tuberculosis which is a form of extra-pulmonary tuberculosis is seen in a small but significant subset of patients visiting dermatology outpatient services. Cutaneous tuberculosis is characterized by a spectrum of multiple distinct clinical and histopathology presentations. A significant proportion of patients with cutaneous tuberculosis are seen in paediatric age group. Clinical features in children remain mostly the same as that in adults with cutaneous tuberculosis. However, systemic and lymph node involvement and incidence of disseminated disease is observed more commonly in paediatric age group . Awareness among clinicians of the clinical manifestations of cutaneous tuberculosis is of paramount importance for early diagnosis and management of cases with paediatric cutaneous tuberculosis. This would significantly prevent morbidity and complications of the disease . This review aims to discuss the epidemiology, clinical and histopathological features, diagnosis, differential diagnosis and treatment options in children with tuberculosis, especially in the Indian context.

Focal actinic porokeratosis: A new variant?

Pihu Sethi, Neeti Kumari, Bhuvan Adhlakha, Amrinder Jit Kanwar

Indian Journal of Paediatric Dermatology 2018 19(3):272-273

Porokeratosis is an autosomal dominantly transmitted disorder of keratinization predominantly affecting trunk and extremities. Many clinical variants have been described having a common histopathological feature of coronoid lamella-porokeratosis of Mibelli, superficial disseminate, disseminated superficial actinic porokeratosis, linear porokeratosis and punctuate palmoplantar porokeratosis. We present a case of 16-year-old female who had focal lesions of porokeratosis aggravated by sun exposure, over alae of nose confirmed by histopathology. The previous reports show quite a number of cases of isolated lesions of the disease on nose and perinasal area. This article highlights the actinic nature of focal facial porokeratosis.

Childhood vitiligo: A clinicoepidemiological study

Mrinal Gupta

Indian Journal of Paediatric Dermatology 2018 19(3):212-214

Background: Vitiligo is a chronic disorder of pigmentation which has serious psychosocial implications. Early onset or childhood vitiligo, although clinically similar to adult-onset vitiligo, has been found to have a distinct epidemiological, clinical, therapeutic, and prognostic profile. Aims and Objectives: This study was carried out to study the clinicoepidemiological characteristics of vitiligo in patients aged <18 years. Materials and Methods: It was a prospective, observational study carried out over a period of 1 year in which fifty children having vitiligo were examined. After taking an informed consent from the attendants/parents of the patients, a complete history including age, sex, duration of the disease, family history, history of Koebner's phenomenon, and history of associated diseases was noted. Results: The study group comprised of 29 females and 21 males (male:female 1:1.38), aged between 6 months and 17 years with a mean age of 8.45 ± 2.34 years and the mean age of onset was 5.6 years. The most common clinical subtypes observed in childhood vitiligo were vitiligo vulgaris in 42% (n = 21) followed by focal in 24% (n = 12), segmental in 12% (n = 6), and acrofacial in 10% patients (n = 5). A family history of vitiligo was seen in 16% patients (n = 8). Leukotrichia was observed in four patients, Koebner phenomenon in 5, and halo nevus in one patient. Conclusions: Childhood vitiligo is a common entity with vitiligo vulgaris being the most common subtype and lower limbs being the most common site of involvement. Children with positive family history had an earlier age of onset, and thyroid abnormalities were more common in nonsegmental variant.

Skin lesions simulating child abuse

Sahana M Srinivas, Celia Moss

Indian Journal of Paediatric Dermatology 2018 19(3):187-193

Child abuse is a broad term which describes various forms of maltreatment and neglect in children and is recognized increasingly. Physical abuse presents to dermatologists as well as pediatricians because the skin is so readily accessible for harm. Doctors unfamiliar with the wide range of skin disorders that simulate child abuse may mistakenly diagnose child abuse or "fabricated or induced illness by carers" (Munchausen by proxy), with traumatic consequences for the family. Mimics of child abuse include various cultural practices, birthmarks, bleeding disorders, bacterial infections, bullous diseases, and hereditary conditions. Dermatitis artefacta and self-harm must also be considered. Observation of the skin lesions and their evolution during hospitalization may provide the correct answer, but knowledge of the morphology and presentation of various skin disorders is crucial to avoid incorrect diagnosis of child abuse. This article describes some of the less well-known mimics of child abuse. It is essential that dermatologists support pediatricians in managing conditions that appear unusual and possibly artifactual.

Cutaneous markers of spinal dysraphism: A cross sectional study

Farhana Tahseen Taj

Indian Journal of Paediatric Dermatology 2018 19(3):215-219

Background: Spinal dysraphism is a rare condition where there are many cutaneous markers which will help a dermatologist to arrive at early diagnosis and prevent complications. Aims and Objectives: The aim and objectives of this are to study the various cutaneous marker of spinal dysraphism in neonatal period and its importance of recognizing early to plan for further management. Materials and Methods: Neonates were examined for cutaneous signs of spinal dysraphism in the first 4 weeks of life. Both occult and open spinal dysraphism clinical features were recorded. Detail history was recorded with respect to age of the mother, parity, consanguinity, and folic acid supplementation. Diagnosis was made clinically. Biopsy is not done as it may introduce infection into spinal canal. Results: A total of 1000 neonates were examined, out of which cutaneous signs of spinal dysraphism were seen in 135 (13.5%) newborns. Sacral dimple was most common seen in 128 (12.8%) neonates, meningomyelocele in 5 (0.5%), dermoid cyst in 1 (0.1%) and acrochordons in 1 (0.1%) neonate. Conclusion: Dermatologist should be aware of the cutaneous marker of spinal dysraphism. Although dermatologist has a less role in the management of spinal dysraphism, their early diagnosis will help in the further management and prevent orthopedic, vertebral, and urological complications.

Systematized inflammatory linear verrucous epidermal nevus moderately responsive to systemic acitretin and topical calcipotriol

Sanjay Singh, Mamta Rai, Neetu Bhari, Savita Yadav

Indian Journal of Paediatric Dermatology 2018 19(3):266-268

Inflammatory linear verrucous epidermal nevus (ILVEN) is a rare form of epidermal nevus which usually presents in childhood, mostly on the lower half of the body in a blaschkoid distribution. A wide variety of topical, systemic, and surgical modalities have been tried for its treatment, but it is known to be refractory to treatment. We hereby are reporting a rare case of extensive systematized ILVEN which showed moderate response to treatment with acitretin and topical calcipotriol.

A retrospective study of the pattern of sexually transmitted diseases in teenagers attending sexually transmitted disease clinic during a 7-year period at a tertiary care centre

Jigna P Barot, Avanita D Solanki, Neela M Patel, Khushboo R Modi, Miral B Bodar

Indian Journal of Paediatric Dermatology 2018 19(3):220-223

Background: Adolescent period corresponds to the age group of 10-15 years. While teenage period, which corresponds to 13-19 year of age group, is the stage of psychosocial development. More and more young people are becoming sexually active in their mid-teens making them vulnerable to contracting the STDs. Adolescents especially in urban areas have favorable attitudes toward premarital and extramarital sex. Material and Methods: This is a retrospective study conducted at tertiary care center. Data regarding STD in teenagers (13-19 year) and their sexual behavior from January 2009 to December 2015 was collected from STI clinic. Result: Total number of adolescent attended STI clinic was 381,out of which 200 were male and 181 were female. Most common STD in female was VVC and in male was nodular scabies. out of 381 patients 155 male and 93 female had confessed about indulging in sexual activity.10 patients were tested positive for HIV and 11 patients were tested positive for syphilis. Conclusion: There is increasing incidence & prevalence of STDs in adolescents due to risky sexual behavior. It is essential to include sex education in teaching methods.

Darier's sign

Tarang Goyal, Sakshi Kohli

Indian Journal of Paediatric Dermatology 2018 19(3):277-279

Efficacy and safety of propranolol on the proliferative phase of infantile hemangioma: A hospital-based prospective study

Jignaben Krunal Padhiyar, Nayan H Patel, Trusha P Gajjar, Mansi D Buch, Yogesh B Shah, Rekha Solanki

Indian Journal of Paediatric Dermatology 2018 19(3):224-229

Background: Propranolol may be more effective and safer than previously established therapies, and it may be used as a first-line therapy for infantile hemangioma (IH). Propranolol is thought to inhibit the growth of blood vessels by decreasing vascular endothelial growth factor. Aims and Objectives: The aim of this study is to study the efficacy and safety of propranolol in IH and for standardization of dose in tablet form. Materials and Methods: A total of 23 patients with 30 IH s were recruited in the study prospectively, after ruling out any contraindications for oral propranolol and obtaining consent from parents. Patients with <7 kg weight were given oral propranolol 5 mg twice daily and >7 kg weight were given 5 mg thrice daily. Patients were evaluated according to visual analog scale and ultrasonographically on day 0, day 30, day 60, and day 90. Results: Out of a total of 30, 25 (83.33%) were superficial, 3 (10%) were deep, and 2 (6.66%) were mixed hemangioma. All patients with superficial hemangiomas showed a change in the color of the lesion and arrest of growth within the 1st month of therapy and a gradual decrease in size was noticed in 23 (92%, n = 25) patients during the study period except in 2 (8%). Complete clearance was noticed in 68% of patients of superficial hemangioma at the end of the study period. Out of 25 patients, a total of 5 (20%) patients had ulceration at the time of presentation which started to heal within 15 days of therapy. Five (16.66%, n = 30) patients with deep and mixed variety showed arrest of growth but no decrease in size. No side effects were seen except temporary coldness of extremity in 1 (3.33%) patient. Conclusion: Propranolol is safe and effective for treatment of proliferative phase of superficial hemangiomas with very less side effects compared to oral steroids and other recommended therapies, and unavailability of syrup can be overcome by giving tablet in fixed dosage.

LEOPARD syndrome with late onset lentigines: A rarity

Sunder Nagakeerthana, Sankar Madhavi, Kaliaperumal Karthikeyan

Indian Journal of Paediatric Dermatology 2018 19(3):287-290

The efficacy of a combination of oral low-dose prednisolone with propranolol for the treatment of infantile hemangioma

Pradyumna Pan

Indian Journal of Paediatric Dermatology 2018 19(3):230-235

Background: Infantile hemangiomas (IHs) are very common vascular tumors. Corticosteroid and propranolol are drugs for the treatment of hemangioma. High dose given for longer duration causes higher side effects. Aim and Objective: The aim and objective of this study was to determine the outcome of a combination of low-dose oral prednisolone with oral propranolol for the treatment of IH. Methods: The study comprised 42 consecutive patients with IH managed with low-dose oral prednisolone and oral propranolol between 2013 and 2016. Patients fulfilling the inclusion criteria were registered through the outpatient department. Diagnosis was confirmed clinically and on Color Doppler. All the patients were given oral prednisolone at a dose of 1 mg/kg/day and propranolol at a dose of 1.5 mg/kg/day. Treatment was given for 4 months and then titrated down for 2 months before the cessation of treatment. Results: Distribution was more on head, face, and neck. The median age at the start of treatment was 4.7 months. Out of the total 42 patients, forty patients responded to therapy (95.2%). Results were found to be excellent in 57.14% of infants and good in 30.95%. Treatment failure was seen in 4.7%. Side effects were not serious and resolved when treatment was discontinued. Rebound growth occurred in two infants (4.7%). No patients suffered drug morbidity. Conclusion: The frequency of acceptable outcome of a combination of low-dose oral prednisolone with oral propranolol for the treatment of IH shows high efficacy, low severe complication rate, and rapid clinical improvement.

Solitary mastocytoma arising from a tight infant identification bracelet

Wei-Liang Koh, Yong-Kwang Tay, Chee-Seng Sim

Indian Journal of Paediatric Dermatology 2018 19(3):258-260

Mastocytosis is characterized by a proliferation of mast cells in the skin and extracutaneous organs. Cutaneous mastocytoma is the second most common presentation of mastocytosis in children and has been reported to arise post-trauma. We report herein the second case of solitary mastocytoma resulting from application of an excessively tight infant identification bracelet and the first in the English literature.

Cutaneous manifestations of juvenile onset lupus erythematosus: A clinical study

Vinitha Panicker, Anil Mathew, Gopikrishnan Anjaneyan, Soumya Jagadeesan, S. Lekshmi, Jacob Thomas

Indian Journal of Paediatric Dermatology 2018 19(3):236-240

Introduction: Juvenile-onset systemic lupus erythematosus (SLE) is one of the most common systemic autoimmune connective tissue disorders in children. Studies focusing on the mucocutaneous manifestations of childhood lupus are scanty in literature. Objectives: This study was an attempt to describe the cutaneous changes seen in Pediatric Lupus and to correlate with the histopathological and immunofluoresecence findings. Methods: This was a retrospective study. All children under the age of 18 years who were diagnosed to have SLE according to the ACR criteria and presented to the dermatology outpatient department during a period of 1 year were included in the study. Details including clinical features, investigation findings including immunological tests and skin biopsy findings were noted. The analysis was performed using descriptive statistical tools such as percentage and frequency. Results: A total of 14 cases, average age at presentation was 10.14 years. Among the cutaneous manifestations, the most common presenting feature was urticarial vasculitis. Malar rash was seen in 57% of cases. Other cutaneous features seen were diffuse alopecia, oral ulcers. Antinuclear antibody was positive in all cases. Conclusion: Pediatric lupus tends to have a more aggressive course than adult lupus. Early diagnosis and treatment is necessary to prevent progression and development of complications.

A child with multiple café au lait macules: Rare presentation of plexiform neurofibromatosis with facial dysmorphism, alopecia, proptosis, stridor, and limb length discrepancy

Aniruddha Ghosh, Payel Kundu, Sandipan Dhar, Arunaloke Bhattacharya

Indian Journal of Paediatric Dermatology 2018 19(3):263-265

Multiple café au lait macules are one of the cornerstones in diagnosing neurofibromatosis Type 1 (NF 1). NF 1 is often a multisystem neurocutaneous disorder, plexiform NF being one of the most important variants of this phacomatosis. Here, a rare case of a 2.5-year-old male child without positive family history has been described who presented with multiple large café au lait spots, alopecia, dysmorphic facies, proptosis, protrusion and deviation of tongue, biphasic stridor, bilateral neck swelling, and abnormal gait due to foreshortened left leg. Magnetic resonance imaging revealed abnormal soft-tissue infiltration of cavernous sinus through sphenoid bone, retro-orbital, retropharyngeal, parapharyngeal spaces, floor of mouth, and encasement of unilateral neck vessels and compression over trachea. Indirect laryngoscopy revealed unilateral vocal cord palsy most likely due to recurrent laryngeal nerve involvement. Biopsy confirmed the diagnosis of NF. Pediatricians and dermatologists should be aware of syndromic causes and their varied presentations while encountering a child with multiple large café au lait spots.

A novel case of chronic mucocutaneous candidiasis: Overlap between autoimmune polyendocrinopathy, candidiasis, ectodermal dystrophy syndrome and hyper IgE syndrome

Bauyelal Mahto, Payel Kundu, Aniruddha Ghosh, Sandipan Dhar

Indian Journal of Paediatric Dermatology 2018 19(3):241-244

Chronic mucocutaneous candidiasis (CMC) is a clinical entity where extensive fungal infection of skin, hair, nail, and mucosa with Candida sp. is seen. It has got association with several immunological and endocrinal dysfunctions. We report a case of a 14-year-old boy who presented with peculiar facies, gross failure to thrive, fungal granulomatous lesions with scaring alopecia, oropharyngeal candidiasis, ectodermal dystrophy, grade 3 clubbing of all four limbs, interstitial keratitis with leukoma due to recurrent corneal ulcerations, and persistent deciduous teeth. A diagnosis of CMC was made and evaluation of immunological pathways revealed a high titer of immunoglobulin E. CMC with overlapping features of autoimmune polyendocrinopathy candidiasis ectodermal dystrophy syndrome and hyper IgE syndrome is extremely rare in literature. Timely diagnosis of an underlying etiology and proper treatment of a case of CMC may provide a better quality of life of the patient.

Extensive childhood alopecia areata responding to combination of oral cyclosporine and corticosteroid therapy – clinical experience in four patients

Nibedita Patro, Maitreyee Panda, Sibasish Patro, Madhuchhanda Mohapatra

Indian Journal of Paediatric Dermatology 2018 19(3):269-271

Alopecia areata (AA) is a disease of unpredictable treatment outcome. Due to a great psychosocial impact associated with the disease, multitudes of therapy have been tried. We recommend safe consideration of oral cyclosporine in cases of extensive nonresponsive childhood AA.

Homozygous familial hypercholesterolemia: A rare case report

Shashikant Malkud, Sirisha Varala, Geeta Kiran Arakkal, Purnachandra Badabagni

Indian Journal of Paediatric Dermatology 2018 19(3):245-247

A 9-year-old male child presented with asymptomatic skin-colored-to-yellowish nodules over both the buttocks, feet, and over the right Achilles' tendon for 4 years. There was a history of similar complaints in elder sibling and also a history of premature sudden cardiac death in father. Biopsy from the lesions was suggestive of xanthoma. Fasting lipid profile was consistent with the pattern of Type IIa hyperlipoproteinemia. The child was further worked up for systemic involvement which was normal. He was started on rosuvastatin and fenofibrate and is under regular follow-up. The timely diagnosis of familial hypercholesterolemia, especially the homozygous variant, is important for early intervention and prevention of complications.

Prognostic Value of the Metabolic and Volumetric Parameters of 11C-Methionine Positron-Emission Tomography for Gliomas: A Systematic Review and Meta-Analysis [ADULT BRAIN]

BACKGROUND:

Several studies have demonstrated that ¹¹C-methionine positron-emission tomography provides information on prognosis.

PURPOSE:

We performed a systematic review and meta-analysis of the prognostic value of the metabolic and volumetric parameters of ¹¹C-methionine-PET for gliomas.

DATA SOURCES:

A systematic search was performed using the following combination of keywords: "methionine," "PET," "glioma," and "prognosis."

STUDY SELECTION:

The inclusion criteria were the use of ¹¹C-methionine-PET as an imaging tool, studies limited to gliomas, studies including metabolic parameters (tumor-to-normal ratio) and/or volumetric parameters (metabolic tumor volume), and studies reporting survival data. The electronic search first identified 181 records, and 14 studies were selected.

DATA ANALYSIS:

Event-free survival and overall survival were the outcome measures of interest. The effect of the tumor-to-normal ratio and metabolic tumor volume on survival was determined by the effect size of the hazard ratio. Hazard ratios were extracted directly from each study when provided or determined by analyzing the Kaplan-Meier curves.

DATA SYNTHESIS:

The combined hazard ratios of the tumor-to-normal ratio for event-free survival was 1.74 with no significance and that of the tumor-to-normal ratio for overall survival was 2.02 with significance. The combined hazard ratio of the metabolic tumor volume for event-free survival was 2.72 with significance and that of the metabolic tumor volume for overall survival was 3.50 with significance.

LIMITATIONS:

The studies selected were all retrospective, and there were only 4 studies involving the metabolic tumor volume.

CONCLUSIONS:

The present meta-analysis of ¹¹C-methionine-PET suggests that the tumor-to-normal ratio for overall survival and the metabolic tumor volume for event-free survival and overall survival are significant prognostic factors for patients with gliomas.

Assessing Corticospinal Tract Asymmetry in Unilateral Polymicrogyria [PEDIATRICS]

BACKGROUND AND PURPOSE:

Asymmetry of the corticospinal tract in congenital lesions is a good prognostic marker for preserved motor function after hemispherectomy. This study aimed to assess this marker and provide a clinically feasible approach in selected cases of unilateral polymicrogyria.

MATERIALS AND METHODS:

Corticospinal tract asymmetry of 9 patients with unilateral polymicrogyria substantially affecting the central region was retrospectively assessed on axial T1WI and DTI. Volumes of the brain stem and thalamus and DTI parameters of the internal capsule were measured. Two neuroradiologists independently rated the right-left asymmetry at 4 levels along the corticospinal tract. DTI tractography was used to determine the motor cortex within polymicrogyria, with task-based functional MR imaging available in 3/9 cases.

RESULTS:

Visual assessment of the brain stem asymmetry showed excellent correlation with quantitative measures on both T1WI and color-coded DTI maps (P = .007 and P = .023). Interrater reliability regarding structural and DTI-based corticospinal tract asymmetry was best at the midbrain (Cohen = 0.77, P = .018). Three patients underwent functional hemispherectomy with postsurgical stable motor function, all showing marked corticospinal tract asymmetry preoperatively. Following the DTI-based corticospinal tract trajectories allowed identifying the presumed primary motor region within the dysplastic cortex in 9/9 patients, confirmed by functional MR imaging in 3/3 cases.

CONCLUSIONS:

Visual assessment of corticospinal tract asymmetry in unilateral polymicrogyria involving the motor cortex is most reliable with T1WI and color-coded DTI maps at the level of the midbrain. Pronounced asymmetry predicts preserved motor function after hemispherectomy. DTI-based tractography can be used as a guidance tool to the motor cortex within polymicrogyria.

Comparative Study of MRI Biomarkers in the Substantia Nigra to Discriminate Idiopathic Parkinson Disease [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Several new MR imaging techniques have shown promising results in patients with Parkinson disease; however, the comparative diagnostic values of these measures at the individual level remain unclear. Our aim was to compare the diagnostic value of MR imaging biomarkers of substantia nigra damage for distinguishing patients with Parkinson disease from healthy volunteers.

MATERIALS AND METHODS:

Thirty-six patients and 20 healthy volunteers were prospectively included. The MR imaging protocol at 3T included 3D T2-weighted and T1-weighted neuromelanin-sensitive images, diffusion tensor images, and R2* mapping. T2* high-resolution images were also acquired at 7T to evaluate the dorsal nigral hyperintensity sign. Quantitative analysis was performed using ROIs in the substantia nigra drawn manually around the area of high signal intensity on neuromelanin-sensitive images and T2-weighted images. Visual analysis of the substantia nigra neuromelanin-sensitive signal intensity and the dorsolateral nigral hyperintensity on T2* images was performed.

RESULTS:

There was a significant decrease in the neuromelanin-sensitive volume and signal intensity in patients with Parkinson disease. There was also a significant decrease in fractional anisotropy and an increase in mean, axial, and radial diffusivity in the neuromelanin-sensitive substantia nigra at 3T and a decrease in substantia nigra volume on T2* images. The combination of substantia nigra volume, signal intensity, and fractional anisotropy in the neuromelanin-sensitive substantia nigra allowed excellent diagnostic accuracy (0.93). Visual assessment of both substantia nigra dorsolateral hyperintensity and neuromelanin-sensitive images had good diagnostic accuracy (0.91 and 0.86, respectively).

CONCLUSIONS:

The combination of neuromelanin signal and volume changes with fractional anisotropy measurements in the substantia nigra showed excellent diagnostic accuracy. Moreover, the high diagnostic accuracy of visual assessment of substantia nigra changes using dorsolateral hyperintensity analysis or neuromelanin-sensitive signal changes indicates that these techniques are promising for clinical practice.

Análisis de supervivencia, eficacia y seguridad en psoriasis moderada–grave tratada con ustekinumab. Estudio observacional de 69 pacientes en la práctica clínica habitual

Publication date: Available online 28 June 2018
Source:Actas Dermo-Sifiliográficas
Author(s): I. Salgüero Fernández, M. Hospital Gil, M. Sigüenza Sanz, G. Roustan Gullón

Terapia fotodinámica en el tratamiento de la leishmaniasis cutánea

Publication date: Available online 28 June 2018
Source:Actas Dermo-Sifiliográficas
Author(s): L. Sainz-Gaspar, E. Rosón, J. Llovo, H. Vázquez-Veiga

“Dealing with the changeable and blurry edges of living things: a modified version of property-cluster kinds”

Abstract

Despite many attempts to achieve an adequate definition of living systems by means of a set of necessary and sufficient conditions, the opinion that such an enterprise is inexorably destined to fail is increasingly gaining support. However, we believe options do not just come down to either having faith in a future success or endorsing skepticism. In this paper, we aim to redirect the discussion of the problem by shifting the focus of attention from strict definitions (in terms of necessary and sufficient conditions) towards a philosophical framework that allows conceiving of living systems as a natural kind, but whereby natural kinds are not to be defined by fixed necessary and sufficient conditions. We argue for a property-cluster kind approach according to which living systems constitute a natural kind with vague boundaries, capable of changing, and whose members do not need to instantiate every property. We draw from Boyd's homeostatic property-cluster theory and introduce two modifications, one regarding homeostatic mechanisms and another related to the scientific role of kinds. Thus, our view overcomes some difficulties of Boyd's theory and we are able to account for the natural kindhood of living things. We also emphasize the most appealing features of our approach for specific research fields and address three objections to this sort of approach.

Reply: Transversus Abdominis Plane Blocks with Single-Dose Liposomal Bupivacaine in Conjunction with a Nonnarcotic Pain Regimen Help Reduce Length of Stay following Abdominally Based Microsurgical Breast Reconstruction

No abstract available

Nipple-Sparing Mastectomy Incisions for Cancer Extirpation Prospective Cohort Trial: Perfusion, Complications, and Patient Outcomes

Background: Nipple-sparing mastectomy offers several advantages for women seeking postmastectomy breast reconstruction, but compromised skin and nipple perfusion may lead to skin and nipple necrosis. It is unclear whether the incisional approach contributes to these complications; therefore, the purpose of this study was to compare the impact of incision type on outcomes in patients undergoing nipple-sparing mastectomy. Methods: This is a prospective cohort study of patients undergoing nipple-sparing mastectomy with prosthetic breast reconstruction through an inframammary fold versus a lateral radial incision. Skin and nipple perfusion as represented by fluorescence intensity, mammometric parameters, patient-reported outcomes, and clinical outcomes were analyzed and compared for the two cohorts, and multivariable logistic regression models were performed to evaluate the effects of covariates on outcomes. Results: Seventy-nine patients were studied: 55 in the inframammary fold cohort and 24 in the lateral radial cohort. The inframammary fold group had significantly less fluorescence intensity to the inferior (21.9 percent versus 36.9 percent; p = 0.001) and lateral portions of breast skin (23.1 percent versus 40.7 percent; p = 0.003) after reconstruction. Decreased fluorescence intensity was associated with smoking, decreased mean arterial pressure, and greater specimen weight. Postreconstruction breast volumes were increased over preoperative volumes in the inframammary fold group (38.3 percent) versus the lateral radial (31.2 percent) group; however, patients with a lateral radial incision had a greater increase in satisfaction with their breasts and psychosocial well-being. Conclusions: There are significant differences in patient-reported outcomes and final breast volumes based on the incisional approach to nipple-sparing mastectomy. These data can be used to guide providers and counsel patients considering nipple-sparing mastectomy with prosthetic reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Outcomes for the Journal: Introduction of Four Subdomains

No abstract available

The Lumbar Artery Perforator Flap in Autologous Breast Reconstruction: Initial Experience with 100 Cases

Background: The lumbar artery perforator flap is an alternative flap in breast reconstruction for those patients who are not eligible for a deep inferior epigastric artery perforator (DIEAP) flap. Shaping of this flap is easier compared with other flaps because of the quality of the lumbar fat and the gluteal extension. Methods: Between October of 2010 and June of 2017, a total of 100 lumbar artery perforator free flap breast reconstructions were performed in 72 patients. Patient demographics, indications, flap specifics, and complications were reviewed retrospectively. Results: Twenty-eight bilateral and 44 unilateral breast reconstructions with a lumbar artery perforator flap were performed. Mean patient age was 48 years, and the average body mass index was 23.11 kg/m2. The authors report 43 preventive mastectomies for elevated cancer risk with subsequent immediate reconstruction, 34 secondary reconstructions, and 14 tertiary reconstructions. Mean operative time was 7 hours 4 minutes, including the mastectomy in primary cases. Mean flap weight was 499 g (range, 77 to 1216 g) and mean follow-up time was 30 months. The revision rate was 22 percent and nine flaps were lost. Conclusions: The lumbar artery perforator flap is a valuable alternative to the DIEAP flap in breast reconstructive surgery. It is an excellent flap for BRCA-positive patients who are typically young and have limited excess tissue at the conventional donor sites. Despite higher revision rates compared with the DIEAP flap, the lumbar flap is superior in mimicking the shape and feel of native breast tissue. Scarring at the donor site remains a sore point but can be easily treated and used to an advantage to contour the flanks. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Personal Safety of the Plastic Surgeon: Keeping Yourself Healthy While You Work

Learning Objectives: After reading this study, the participant should be able to: 1. Recognize the primary physical and mental risks faced by the practicing plastic surgeon. 2. State the primary risk factors for cervical spine disease and back pain. 3. State the critical steps for protection from ionizing and nonionizing radiation. 4. List the characteristics of a surgeon exhibiting signs of burnout. 5. Develop a plan for mitigating personal risk of musculoskeletal, exposure, and other injuries. Summary: Health care workers are exposed to significant occupational hazards, and have a risk of injury similar to that of construction, mining, and manufacturing employees. Plastic surgeons must have a clear understanding of the types of risks they face and the techniques for mitigating them. Exposure to some risks is attributable to unavoidable occupational conditions, but others can be avoided completely. The sources of injury risk from musculoskeletal, exposure, and other causes are discussed in this article, and evidence-based recommendations to ameliorate these risks are presented.

Location of the Internal Mammary Vessels for Microvascular Autologous Breast Reconstruction: The “1–2–3 Rule”

Background: Postmastectomy breast reconstruction provides psychosocial benefits in self-esteem, sexuality, and quality of life. Autologous procedures yield the highest overall patient satisfaction compared with implant-based breast reconstruction as the gold standard. The internal mammary vessels are the preferred recipient vessels for free flap breast reconstruction. The purpose of this study is to provide surgeons with a reliable method for locating the vessels intraoperatively. Methods: The internal mammary vessels were dissected bilaterally on 30 cadaveric specimens. Distances from the lateral sternal borders and the costochondral junctions to the internal mammary vessels at the second, third, and fourth costal levels were recorded. Descriptive bifurcation patterns were recorded. Initial dissection practicums were performed using the proposed safer dissection zone according to quantitative data. Results: Sixty internal mammary arteries and 120 internal mammary veins were studied at three costal levels, resulting in 180 sets of measurements. Distances from the lateral sternal border to the medial internal mammary vein were 6.12, 9.04, and 10.45 mm at costal levels 2, 3, and 4, respectively. Mean distances between costochondral junctions and internal mammary arteries were 12.80, 24.78, and 33.28 mm at costal levels 2, 3, and 4, respectively. Most internal mammary vein bifurcated at the third costal level, and the left side bifurcated higher than the right. Dissection practicums revealed that the proposed dissection zone was consistently reliable in locating the vessels. Conclusions: This study provides mean measurements from common bony landmarks to the internal mammary vessels, equipping surgeons with a reliable zone of dissection for recipient vessel exposure. This may decrease morbidity and improve outcomes in autologous breast reconstructions.

Validated Outcomes in the Grafting of Autologous Fat to the Breast: The VOGUE Study. Development of a Core Outcome Set for Research and Audit Correction

No abstract available

Comparison between Negative-Pressure Fixation and Film Dressing in Wound Management after Tissue Expansion: A Randomized Controlled Trial

Summary: Wound compression and fixation are important to reduce scarring. Numerous postoperative treatments have been developed to reduce scar formation; however, a simple and effective device that improves the appearance and histochemical properties of incisional scars is needed. Therefore, the authors have devised a novel method, negative-pressure fixation, that applies negative pressure inside polyurethane foam covered with film. In the present study, negative-pressure fixation was applied to incisional wounds resulting from the insertion of a tissue expander in patients undergoing two-stage breast reconstruction. The authors aimed to evaluate the effects of negative-pressure fixation on scar appearance and histochemical properties in comparison to those for film dressing without negative pressure. A prospective, open-label, randomized, single-center study was performed. A half-side test was conducted on the incisional scar resulting from tissue expander insertion during breast reconstruction after mastectomy in 13 female patients. The dressings on both sides of the scar were replaced once per week until the tissue expander was adequately inflated. The outcomes were assessed 6 months later. Scars were photographed before the second operation and were evaluated using a visual analogue scale. All scars were removed and resutured during the final operation, allowing a histochemical analysis. The mean visual analogue scale score for the negative-pressure fixation side was significantly lower compared with that for the film dressing side (p = 0.0025). In addition, the scar on the negative-pressure fixation side was significantly narrower (p = 0.0015). Thus, negative-pressure fixation is a simple and effective device for improving the appearance and histochemical properties of incisional scars.

Reply: The Inside-Out Septal Mucoperichondrial Flap Reconstruction of Nasal Lining Simplified

No abstract available

Discussion: Comparison between Negative-Pressure Fixation and Film Dressing in Wound Management after Tissue Expansion A Randomized Controlled Trial

No abstract available

What Does the Public Think? Examining Plastic Surgery Perceptions through the Twitterverse

Background: Twitter is a recognized social media platform for communication of health information. Rime reported that emotion is the main motive for social sharing. This study is a content analysis of Twitter that was performed to identify the public's perceptions and attitudes toward plastic surgery and the emotional triggers that drive social sharing of plastic surgery information. Methods: Tweets containing "#PlasticSurgery" or "Plastic Surgery" were archived randomly from August 1, 2014, to December 30, 2016 (n = 4548). Tweets were categorized according to tweet author, specialty, topic, content, multimedia included, emotion, tone, accuracy of information, source, and retweet rate. Statistical analysis was performed to detect significant patterns. Results: Tweets on cosmetic surgery (74 percent) were shared mostly on Twitter, predominantly posted by the public [n = 1611 (48 percent)]. More than 13 percent of posts contained "celebrity news" and 42.8 percent contained professional information and resources. The most frequent emotions shared and retweeted were "relaxed/content" (51.5 percent) and "excited/interested" (18.4 percent). Most tweets posted by the public contained inaccurate information [n = 1486 (80 percent)]. Only 154 (11.2 percent) of board-certified plastic surgeons' tweets were rated as "most accurate." Conclusions: The majority of tweets posted on Twitter contained inaccurate information that can lead to misperception among the public. Understanding emotional triggers for social sharing provides insight into what is most appealing. To enhance public uptake and sharing of tweets, plastic surgeons can use these findings to promote the specialty using relaxed/content emotions or excitement in their social media posts.

Use of Roof-Shaped Costochondral Cartilage for Correction of Saddle Nose Deformity

Background: Cartilage grafts are routinely used in secondary and posttraumatic rhinoplasty. However, in most cases, there are weak areas in the nasal bones and upper lateral cartilages. The purpose of this study was to seek a solution for the keystone area and dorsum of the nose in revision and posttraumatic rhinoplasty cases, and reconstruction of saddle nose deformity including upper lateral cartilage with a roof-shaped graft. Methods: A retrospective review of reconstructive rhinoplasties performed for saddle nose deformities was conducted. A part of the costochondral graft was carved and thinned (roof graft) for reconstruction of the keystone area and upper lateral cartilages, and another portion was used for making a neoseptal (reconstructed septum) graft and strut graft. The roof graft was capped onto the neoseptal graft with sutures, and this cartilage framework was adapted with fitting the cranial edge of the neoseptal cartilage between the nasal bones. Finally, the strut graft was fixed to the cartilage framework. Results: A significant improvement in nasal shape and overall appearance was achieved in all cases, and 71.42 percent of patients recovered from nasal obstruction. No gross absorption, graft exposure, or recurrence of deformities was observed. Conclusions: Surgical correction of a saddle-shaped nose should be an acceptable and uncomplicated technique, and the cosmetic result should be totally acceptable. There are many management options for a saddle-shaped nose. Use of roof grafts (shrunk gull-wing grafts) with neoseptal and strut grafts enables simulation of the internal nasal valve and results in a natural nasal position. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Spotlight in Plastic Surgery

No abstract available

Discussion: Use of Roof-Shaped Costochondral Cartilage for Correction of Saddle Nose Deformity

No abstract available

Direct-to-Implant versus Two-Stage Tissue Expander/Implant Reconstruction: 2-Year Risks and Patient-Reported Outcomes from a Prospective, Multicenter Study

No abstract available

Role of Fractionated Fat in Blending the Lid-Cheek Junction

Background: Fat grafting has been used extensively in plastic surgery in the past two decades. Here, the authors report the retrospective comparison of patients who underwent fractionated fat injection to blend the lid-cheek junction with those who had regular fat injection. Methods: After obtaining institutional review board approval, a retrospective review of patients who underwent lower blepharoplasty with fractionated fat injection for blending the lid-cheek junction from January of 2014 through October of 2015 was performed. The results were compared to those of lower blepharoplasty patients who did not have fractionated fat injected before January of 2014. Twelve prospectively selected patients underwent histopathologic and gene expression comparisons. Results: A comparison of complications between the two groups revealed no significant differences. Furthermore, there was no significant difference between the two groups for sequelae of fractionated fat injection and regular fat injection. The gene expression analysis of the fractionated and regular fat did not show any difference between undifferentiated and differentiated cells. In addition, Oil Red O staining of the fractionated and regular fat after differentiation showed that cells from both fat groups differentiated equally well. Conclusions: Fractionated fat injection appears to be a safe addition in blending the lid-cheek junction in the five-step lower blepharoplasty. There is no fat nodule formation with injection of fractionated fat injection compared with injection of regular fat performed superficially in the tear trough area. Contrary to what has previously been shown, the presence of viable cells in fractionated fat was noted. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Reply: Transabdominal Breast Augmentation A Review of 114 Cases Performed over 14 Years

No abstract available

IDEAL IMPLANT Structured Breast Implants: Core Study Results at 6 Years

Background: The structured breast implant uses different technology than saline or silicone gel implants, making it a third type of implant. The U.S. Food and Drug Administration and Health Canada granted approval in November of 2014. This implant is filled with saline but has an internal structure consisting of a series of nested shells that support the upper pole when upright and control fluid movement. It combines certain key features and benefits of saline and silicone gel implants. As with saline, the filler is only saline, which women like for peace of mind in case of rupture/deflation. As with silicone gel, it has a natural feel, but without the risk of silent rupture and U.S. Food and Drug Administration–recommended magnetic resonance imaging scans—women can simply look in the mirror and know their implants are intact. Methods: This U.S. trial enrolled 502 women: 399 primary augmentations and 103 replacements of existing augmentation implants. Investigators were 45 American Board of Plastic Surgery–certified plastic surgeons at 35 sites. Of the 502 women enrolled, 438 (87.3 percent) completed 6-year follow-up visits, a higher percentage than other Core breast implant trials. Results: At 6 years, patient satisfaction was 89.7 percent for primary and 91.6 percent for replacement augmentations; surgeon satisfaction was 92.6 percent for primary and 94.0 percent for replacement augmentation. Kaplan-Meier adverse event rates were as follows: Baker grade III and IV capsular contracture, 5.7 percent for primary and 11.5 percent for replacement augmentation; and rupture/deflation, 1.8 percent for primary and 4.7 percent for replacement augmentation. Conclusion: Six-year results from 438 women show that the structured breast implant has high patient and surgeon satisfaction, a low rate of capsular contracture, and a low rate of rupture/deflation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

ASPS/PSF Sponsored Symposia and Workshops

No abstract available

Do Adolescents with Gynecomastia Require Routine Evaluation by Endocrinology?

Background: Primary evidence for the role of endocrinologic investigations in patients with adolescent gynecomastia is lacking in the current literature. The objective of this study was to assess the yield of endocrinologic investigations in the evaluation of adolescent gynecomastia to inform current practice for this common condition. Methods: A 26-year retrospective review was conducted. Data collection included patients with gynecomastia presenting to endocrinology at a quaternary children's hospital with a catchment area of 1 million. Clinical metrics, endocrinologic results, treatments, and costs were reviewed. Results: One hundred ninety-seven patients met inclusion criteria. Ninety-eight (50 percent) were overweight or obese and 29 (15 percent) had a positive family history. The median age at onset was 11.5 years; 25 cases (13 percent) were prepubertal. A total of 15 patients (7.6 percent) were diagnosed with secondary gynecomastia (10 related to exogenous substance use). Endocrine investigations were performed in 173 patients (87 percent), with positive findings in three cases (1.7 percent). One hundred one patients were observed, with a median age at resolution of 14.6 years; 86 patients underwent surgery at a median age of 16.5 years. The case-cost of endocrine evaluation was $389. Conclusions: Endocrinologic workup identified secondary gynecomastia in 7.6 percent of patients, of which only 1.7 percent were evident on blood work. This workup is associated with an avoidable case-cost burden to the health care system and largely unnecessary testing for the child. Because a majority of secondary gynecomastia cases (67 percent) were drug-induced, we do not suggest routine endocrinology workup, as it adds little value. The authors' data suggest that referral for surgery is warranted if gynecomastia persists beyond 16 years of age. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.

Molecular Photoacoustic Contrast Agents (MPACs): Design Principles & Applications

Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.

Polychlorinated biphenyls (PCBs) as sentinels for the elucidation of Arctic environmental change processes: a comprehensive review combined with ArcRisk project results

Abstract

Polychlorinated biphenyls (PCBs) can be used as chemical sentinels for the assessment of anthropogenic influences on Arctic environmental change. We present an overview of studies on PCBs in the Arctic and combine these with the findings from ArcRisk—a major European Union-funded project aimed at examining the effects of climate change on the transport of contaminants to and their behaviour of in the Arctic—to provide a case study on the behaviour and impact of PCBs over time in the Arctic. PCBs in the Arctic have shown declining trends in the environment over the last few decades. Atmospheric long-range transport from secondary and primary sources is the major input of PCBs to the Arctic region. Modelling of the atmospheric PCB composition and behaviour showed some increases in environmental concentrations in a warmer Arctic, but the general decline in PCB levels is still the most prominent feature. 'Within-Arctic' processing of PCBs will be affected by climate change-related processes such as changing wet deposition. These in turn will influence biological exposure and uptake of PCBs. The pan-Arctic rivers draining large Arctic/sub-Arctic catchments provide a significant source of PCBs to the Arctic Ocean, although changes in hydrology/sediment transport combined with a changing marine environment remain areas of uncertainty with regard to PCB fate. Indirect effects of climate change on human exposure, such as a changing diet will influence and possibly reduce PCB exposure for indigenous peoples. Body burdens of PCBs have declined since the 1980s and are predicted to decline further.

The influence of solid-liquid coefficient in the fate of pharmaceuticals and personal care products in aerobic wastewater treatment

Abstract

Wastewater treatment plants (WWTPs) are considered to be a source of environmental contamination by micropollutants, especially from pharmaceuticals and personal care products (PCPs). The pathway of those compounds during sewage treatment has been investigated, but data from real-scale WWTPs is still missing (for example, the values of the solid-liquid coefficient (K_d) during treatment). This paper uses the K_d values for some pharmaceuticals and PCPs (fenofibrate, gemfibrozil, propranolol, metoprolol, salicylic acid, acetylsalicylic acid, ibuprofen, diclofenac, naproxen, fenoprofen, caffeine, triclosan, methylparaben, ethylparaben, propylparaben, butylparaben, and benzylparaben) to describe the micropollutants' behavior in the treatment process. In order to attain this data, an aerobic wastewater treatment plant located in Brazil was studied. Six samplings were carried out and a mass balance was performed, associating the concentrations of the micropollutants in the liquid phase with the solid phase (sludge and suspended solids). Of all the compounds analyzed, caffeine was the most biodegradable pollutant, as almost 98% of its mass was biodegraded. In contrast, triclosan had the highest load in sludge (median of 163.0 mg day⁻¹) and adsorbed in SS (median of 0.593 mg day⁻¹) at the output. Summing up, each micropollutant had a specific way to be removed during wastewater treatment.

The effect of pre‐phototest sun exposure on minimal erythema dose (MED) and minimal melanogenic dose (MMD) among skin phototypes III, IV and V

Photodermatology, Photoimmunology &Photomedicine, Volume 0, Issue ja, -Not available-.

Influence of darkness on pigments of Tetraselmis indica (Chlorodendrophyceae, Chlorophyta)

Publication date: Available online 28 June 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Sangeeta Mahableshwar Naik, Arga Chandrashekar Anil
In the photic zone, phytoplankton experience diurnal variation in darkness. However, prolonged exposure to aphotic conditions influences their physiological state. Pigment composition is a useful biomarker to decipher cells physiological state and adaptive response to changing environmental conditions. Chlorophyll, a natural pigment is biosynthesised even in darkness and studies have shown such an ability is determined by the genetic characteristics of the organism. The purpose of this study was to examine the influence of darkness on pigments and chlorophyll autofluorescence of Tetraselmis indica. Dark exposure (up to 6 months) had no significant impact on chlorophyll a and b concentration, whereas carotenoids were enhanced. Upon re-illumination pigments gradually recovered to pre-dark phase concentrations. These adaptive survival strategies by altering pigment concentration in response to prolonged darkness is interesting. The absence of loroxanthin and loroxanthin esters in T. indica is reported in a first Tetraselmis species so far. The evaluation of autofluorescence and cellular chlorophyll concentration pointed out that they are not interdependent in this species. Hence, careful consideration of these two factors is needed when either of them is used as a proxy for other. The results obtained encourage a thorough study of pigment analysis, especially when subjected to darkness, to elucidate potential role in the evolution, chemotaxonomy, and survivability of species.

Intraoperative Measurement of the Lateral Cartilage in the Asian Nose

This case series report describes use of lower lateral cartilage measurements in evaluating the nasal tip shape in Asian patients.

Perceived Facial Distortions in Selfies Are Explained by Viewing Habits

To the Editor In their recent article, Ward et al analyze the effect of camera distance on the relative sizes of facial dimensions in photographs. They argue that these dimensions are distorted in "selfies"—photographs that people take of themselves with a smartphone camera at arm's length. Given the increasing popularity of selfies, they express concern that such photographs affect decisions about cosmetic medical procedures. We agree with the authors' calculations of facial dimensions in photographs. We wish, however, to clarify the cause of perceived nasal widening in selfies. The perceived nasal widening is not, as the authors suggest, due to physical distortion in the photographs.

Perceived Facial Distortions in Selfies Are Explained by Viewing Habits—Reply

In Reply Drs Cooper and Banks raise an important, well-studied point: the human visual system can correctly convert from a 2-dimensional image (or a 2-dimensional projection on the retina) into 3 dimensions when the objects subtend the same angle and distance at initial capture and when subsequently viewed. In real life, this is almost instantaneous. The moment we see an individual in front of us, we perceive them and there is essentially no chance of there being a mismatch and the correct viewing angle/distance is a moot point. Interestingly, this phenomenon is mostly studied in controlled environments (eg, using a bite bar) and for specific tasks (eg, estimating angles between planes). As far as we know, it has never been studied for the specific task of evaluating the appearance of one's nose. As the authors of the Letter to the Editor have rightfully noted, if the viewing distance is too close then there is a mismatch between the "correct" and actual viewing distances. As our Discussion stated, "photographs taken at shorter distances will increase the perceived ratio of nasal breadth to bizygomatic breadth." The focus here is on this perceived distortion.

Detection of VBNC Vibrio cholerae by RT-Real Time PCR based on differential gene expression analysis

Abstract

The recognition of the viable but non-culturable (VBNC) state of pathogenic bacteria has brought with it many questions to answer related to the need to detect and quantify viable bacteria in the environment in an accurate way. To assess viability of Vibrio cholerae, we developed a RT-Real Time PCR technique based on differential expression analysis from mRNA deep sequencing data. We compared two induction conditions to achieve the VBNC state: a bacterial suspension induced by artificial seawater at 4 °C, and the addition of c-di-GMP. The evaluation of the up-regulated genes in the induced bacterial samples was compared with a fresh culture in the mid-exponential phase. The data analysis was performed with the NOISeq R-package and revealed 17 up-regulated genes for induction condition I and 22 up-regulated genes for induction condition II. Only one region was found to be up-regulated for both induction conditions. The VCA0656 gene related to the aminoimidazole riboside kinase protein was detected as the most up-regulated region and used as a genetic marker to precisely detect the VBNC state in combination with the RT-Real Time PCR technique. This approach describes a novel method to differentiate the VBNC state of V. cholerae in water samples.

Gene circuit engineering to improve the performance of a whole-cell lead biosensor

Abstract

To improve the performance of a whole-cell biosensor for lead detection, we designed six gene circuits by re-configuring the regulatory elements and incorporating positive feedback loops to the circuits. The lead resistance operon pbr encodes six genes with pbrRT on one side of the promoter and pbrABCD on the other side. PbrR, the divergent promoter it regulates, and GFP were used to design the lead biosensors. One has pbrR and gfp on opposite sides of the promoter mimicking the native operon. We re-configured it by placing pbrR and gfp on the same side or under two separate promoters. The one with pbrR and gfp on the same side demonstrated lead sensitivity 10 times higher than the others. Positive feedback loop was introduced to these circuits. The strength of the output signal from the designs with positive feedback loop was 1.5–2 times stronger than those without positive feedback. This study demonstrates the importance of configuration and positive feedback as effective strategies to improve the performance of lead biosensors and they can be extended to the design of other whole-cell biosensors.

Molecular Diversity of Fungal Inhibitor Cystine Knot Peptides Evolved by Domain Repeat and Fusion

Abstract

Peptides with an inhibitor cystine knot (ICK) motif are extensively present in animals and plants where they exert a diversity of biological functions. However, few studies have been undertaken on this class of peptides in fungi. In this work, we identify a total of 386 fungal ICK peptides and proteins containing this motif by computational data mining of fungal genome databases, which exhibit 14 different exon-intron structures. According to their domain architectures, these proteins are classified into three distinct structural types, including single domains, tandem repeat domains and fusion domains, in which six families belonging to single and tandem repeat domains show remarkable sequence similarity to those from animals and plants, suggesting their orthologous relationship. Extremely high molecular diversity in fungal ICKs might be attributable to different genetic mechanisms, such as gene/domain duplication and fusion. This work not only enlarges the number of ICK peptides in multicellular organisms, but also uncovers their complex evolutionary history in a specific lineage.

Strange-but-true: a (quick) new argument for contextualism about ‘know’

Abstract

A powerful objection to subject-sensitive invariantism (SSI) concerns various 'strange-but-true' (or "embarrassing") conditionals. One popular response to this objection is to argue that strange-but-true conditionals pose a problem for non-sceptical epistemological theories in general. In the present paper, it is argued that strange-but-true conditionals are not a problem for contextualism about 'know'. This observation undercuts the proposed defence of SSI, and supplies a surprising new argument for contextualism.

A weak symmetry condition for probabilistic measures of confirmation

Abstract

This paper presents a symmetry condition for probabilistic measures of confirmation which is weaker than commutativity symmetry, disconfirmation commutativity symmetry but also antisymmetry. It is based on the idea that for any value a probabilistic measure of confirmation can assign there is a corresponding case where degrees of confirmation are symmetric. It is shown that a number of prominent confirmation measures such as Carnap's difference function, Rescher's measure of confirmation, Gaifman's confirmation rate and Mortimer's inverted difference function do not satisfy this condition and instead exhibit a previously unnoticed and rather puzzling behavior in certain cases of disconfirmation. This behavior also carries over to probabilistic measures of information change, causal strength, explanatory power and coherence.