Advanced oxidation of antihypertensives losartan and valsartan by photo-electro-Fenton at near-neutral pH using natural organic acids and a dimensional stable anode-gas diffusion electrode (DSA-GDE) system under light emission diode (LED) lighting

Abstract

In this work photo-electro-Fenton (PEF) processes using a dimensionally stable anode-gas diffusion electrode (DSA-GDE) system under light emission diodes (LED)-type radiation were used in the degradation of the angiotensin-II-receptor antagonists (ARA II), valsartan (VAL), and losartan (LOS), which are used in the treatment of hypertension diseases, and are considered among the emerging contaminants (ECs). Organic acids as citric, tartaric, and oxalic acids were used as complexing agents of iron ions in order to maintain the performance of the Fenton reaction at near-neutral pH value. The results show that at 3.42 mA/cm² after 90 min of electro-Fenton (EF) treatment, degradation of 70% of VAL and 100% of LOS were observed. Total degradation of VAL and LOS was reached with a PEF process at the same time with mineralization of 30%. When citric and tartaric acids were used instead of oxalic acid, similar results were obtained, i.e., total degradation of both compounds, LOS and VAL, after 90 min of treatment. The degradation performance can be attributed to the increase of the initial dissolved iron in the system, facilitating the Fe³⁺/Fe²⁺ turnover in the catalytic photo-Fenton reaction and consequently, hydroxyl radical (^•OH) production. In addition, the increased photo-activity of the complexes can be associated with their high capability to complex Fe³⁺ and to promote ligand-to-metal charge transfer, which is of key importance to feed Fe²⁺ to the Fenton process. The results show that the system evaluated was more efficient to eliminate sartan family compounds using LED lighting in comparison with traditional UV-A lamps used in this kind of work. Moreover, three transformation products of VAL degradation and two transformation products of LOS degradation were identified by high-resolution mass spectrometry (HRMS) using hybrid quadrupole-time-of-flight (QTOF) MS and, at the end of the PEF system, the several organic compounds accumulated and no mineralized were effectively treated in a subsequent aerobic biological system.

Tamarind seed coat extract restores fluoride-induced hematological and biochemical alterations in rats

Abstract

Fluoride (F⁻) is becoming an ineluctable environmental pollutant causing deleterious effects in humans. In the present study, we examined whether tamarind seed coat extract (TSCE) is beneficial against the F⁻-induced systemic toxicity and hematological changes. Wistar rats were randomly grouped as follows: group I served as control; group II intoxicated with sodium fluoride (NaF, 300 ppm) in drinking water; group III was administered through oral intubation with TSCE (100 mg/kg bw); group IV was treated with NaF (300 ppm) in association with TSCE (100 mg/kg bw) for 30 days. The results indicated that F⁻ exposure induced oxidative stress as evidenced by elevated levels of reactive oxygen species and lipid peroxidation in the brain, liver, and kidney. F⁻ administration modulates hematological indices—WBC, RBC, and mean corpuscular volume. Moreover, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, acetylcholinesterase, and monoamine oxidase significantly increased on F⁻ exposure. Conversely, δ-aminolevulinic acid dehydratase and glutathione/reduced glutathione ratio were decreased. Activity of antioxidants—superoxide dismutase, catalase, glutathione peroxidase, and vitamin C—was also significantly decreased due to F⁻ administration. Treatment with TSCE effectively mitigated the alterations through its antioxidant potential. The data suggested that the TSCE had beneficial effects in alleviating the F⁻-induced toxicity and hence can serve as a promising neutraceutical agent.

EXTRACAPSULAR DISSECTION AND LIMITED PAROTIDECTOMY

Parotid surgery has evolved over the last century. Many of the long-held principles have been questioned and consequently modified. The basic tenets of parotid surgery for benign disease have been identifying and preserving the facial nerve and complete excision of the tumor with an adequate cuff of normal tissue. This can be safely accomplished by extracapsular dissection or limited/partial parotidectomy. Extracapsular dissection implies no attempt at finding the facial nerve, while limited or partial parotidectomy includes finding one (or more) branch of the facial nerve and then dissecting that branch in a retrograde fashion.

Neck dissection for salivary gland malignancies

Salivary gland carcinomas are diverse, and their biological behavior and surgical management are also variable and somewhat controversial. Cervical lymph node status is an important prognostic variable for salivary gland malignancies. Neck dissection should be undertaken if there is clinical or radiographic evidence of associated nodal metastasis in the neck. However, indications for elective neck dissections in a clinically N0 neck remains a controversial topic. This article describes indications for elective neck dissection in salivary gland malignancies, provides a detailed review of the neck dissection technique, and discusses postoperative management of these patients.

Sublingual Gland

It is infrequent for surgery to be necessary for the sublingual salivary gland. As such the anatomy of the floor of mouth is not well taught or understood to medical graduates and head and neck surgeons. Three diseases or conditions require surgical management: the ranula, neoplasm and sialolithiasis. In the benign conditions, the lingual nerve and submandibular duct must be identified and preserved to avoid patient morbidity. Malignant salivary gland neoplasms are rare, and hence an inaccurate diagnosis frequently delayed commencement of correct treatment.

A Phase 2, Randomized Dose-Finding Study of Tapinarof (GSK2894512 Cream) for the Treatment of Atopic Dermatitis

Safe and efficacious topical treatments are needed for atopic dermatitis (AD).

Apremilast for moderate hidradenitis suppurativa: results of a randomized controlled trial

Effective anti-inflammatory treatments for hidradenitis suppurativa (HS) are limited.

A Comparison of Skin Cancer Screening and Treatment Costs at a Massachusetts Cancer Center, 2008 versus 2013

Temporal analyses of skin cancer costs are needed to examine how expenditure differences between diagnoses are changing.

Chronic Non-Melanoma Skin Cancers and Health Related Impairment: A Case-Control Study

Kinetics, mechanism, and global warming potentials of HFO-1234yf initiated by O 3 molecules and NO 3 radicals: insights from quantum study

Abstract

In the present investigation, the oxidation of HFO-1234yf (2,3,3,3-tetrafluoropropene) with O₃ molecule and NO₃ radical is studied by quantum chemical methods. The possible reaction pathways of the titled molecule with O₃ molecule and NO₃ radical are analyzed using M06-2X meta-hybrid density functional with the 6-311++G(d,p) basis set. We have further employed a series of single-point energy calculations by using a potentially high-level couple cluster method with single and double excitations, including perturbative corrections ((CCSD(T)) at the same basis set. The addition reaction of HFO-1234yf with O₃ molecule is initiated by the formation of primary ozonide complex, which leads to the formation of various carbonyl compounds and Criegee intermediates. The calculated energy barriers and thermochemical parameters inferred that decomposition of C˙H₂OO˙ and CF₃CFO is slightly more preferred over the formation of CF₃C˙FOO˙ and CH₂O. Further, the NO₃ radical addition at α- and β-sits of CF₃CF〓CH₂ molecule is analyzed in details. The individual and overall rate constants for each reaction pathways are calculated by using canonical transition state theory over the temperature range of 250–450 K. We have observed that the computed rate constants are in good agreement with the available experimental data. Atmospheric lifetimes and global warming potentials of the HFO-1234yf are also reported in this manuscript.

Underuse of the Sentinel Lymph Node Biopsy for High-Risk SCC of the Skin—Reply

In Reply We read with interest the response by Glazer et al regarding our study on the underuse of sentinel lymph node biopsy (SLNB) for high-risk cutaneous squamous cell carcinoma (cSCC) and noted several important inquiries and comments.

Onychomadesis Following a Fish Pedicure

This case reports describe the occurrence of onychomadesis in a patient following a fish pedicure.

An Annular Eruption in a Young Child

A young child had a 6-month history of an asymptomatic expanding erythematous eruption on the lower legs, abdomen, and buttocks; clinical examination was significant for faint, nonscaling annular serpiginous, erythematous plaques. What is your diagnosis?

Prescription to OTC Switch of Metronidazole and Azelaic Acid for Rosacea

This Viewpoint considers the advantages and disadvantages of topical treatments for rosacea, specifically metronidazole and azelaic acid, undergoing review to switch from prescription to over-the-counter availability.

The Future of JAMA Dermatology

I am deeply humbled to be selected to serve as Editor in Chief of JAMA Dermatology. The fundamental role of an editor in chief is to review, select, and publish the articles that best help clinicians practice more safely and effectively. The opportunity to illuminate the aspects of our field that deserve spotlight is a task both daunting and delightful. I am committed to do a deep dive into dermatology to identify what is most significant, what is most fascinating, what is most problematic, and to find opportunities to improve and elevate the practice of dermatologists. My ultimate goal is to ensure that dermatologists deliver the best patient care possible, and I consider it an incredible honor to be able to contribute to the specialty through this work.

Dupilumab Treatment of Very Severe Refractory Atopic Hand Eczema

This case report describes the use of dupilumab to treat a patient with very severe refractory atopic hand eczema.

Underuse of the Sentinel Lymph Node Biopsy for High-Risk SCC of the Skin

To the Editor We read with interest the article by Ahadiat et al regarding the potential underuse of sentinel lymph node biopsy (SLNB) in patients with high-risk cutaneous squamous cell carcinoma (cSCC). Although SLNB may be underused in these patients, we have some inquiries regarding the research methods and generalizability of the data.

Human Papillomavirus Vaccine to Treat Cutaneous Basaloid Squamous Cell Carcinomas

This case report describes a woman with multiple, inoperable cutaneous basaloid squamous cell carcinomas who was treated with 9-valent human papillomavirus vaccine.

Association of Inadequately Controlled Disease With Patient-Reported Disease Burden in Atopic Dermatitis

This cross-sectional study examines the association of atopic dermatitis severity and disease control with the patient-reported disease burden in clinical practice.

Assessment of arsenic removal efficiency by an iron oxide-coated sand filter process

Abstract

Arsenic is among the most dangerous contaminants which can limit groundwater use for drinking water consumption. Among the most diffused As-removal technologies around the world, adsorptive media systems are usually favored for relatively low cost and simplicity of operation. This study examines the performance of a laboratory-scale iron oxide-coated sand (IOCS) column filter, to remove arsenic (arsenate (As[V]) and arsenite (As[III])) from groundwater. This technology could be adopted in small communities, as it showed consistent removal rates of 99% with an easy-to-operate process. Some considerations about the possible introduction of such technology in developing countries are provided, highlighting the general impacts to human health related to high arsenic concentrations in groundwater. This, among other adsorption processes, could be recommended as a sustainable mean of ensuring good drinking water quality in developing regions, reducing human health impacts.

Partitioning of absorbed light energy within photosystem II in barley can be affected by chloroplast movement

Publication date: Available online 2 July 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): J. Semer, M. Štroch, V. Špunda, M. Navrátil
Plants have developed many ways to protect reaction centres of photosystems against overexcitation. One of the mechanisms involves reduction of the leaf absorption cross-section by light-induced chloroplast avoidance reaction. Decrease in the probability of photon absorption by the pigments bound within photosystem II (PSII) complexes leads to the increase in quantum yield of PSII photochemistry (ΦPSII). On the other hand, the decrease of PSII excitation probability causes reduction of chlorophyll a fluorescence intensity which is manifested as the apparent increase of determined quantum yield of regulated light induced non-photochemical quenching (ΦNPQ). Absorption of different light intensity by phototropins led to the different chloroplast distribution within barley leaves, estimated by measurement of the leaf transmittance. Due to a weak blue light used for transmittance measurements, leaves exposed to actinic light with wavelengths longer than 520 nm undergo chloroplast accumulation reaction, in contrast with leaves exposed to light with shorter wavelengths, that showed a different extent of chloroplast avoidance reaction. Based on the ΦNPQ action spectra measured simultaneously with the transmittance, the influence of different chloroplast distribution on ΦNPQ was assessed. The analysis of results showed that decrease in the leaf absorption cross-section due to increasing part of chloroplasts reaching profile position significantly affected the partitioning of excitation energy within PSII and such rearrangement also distorted measured ΦNPQ and cannot be neglected in its interpretation. When the majority of chloroplasts reached profile position the photoprotective effect appeared to be the most prominent for strong blue light that has the highest absorption in the upper leaf layers in comparison with green or red ones.

Tuning the chain length of new pyrene derivatives for site-selective photocleavage of avidin

Publication date: Available online 2 July 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Sudarat Yenjai, Challa V. Kumar, Mayuso Kuno, Teerayuth Liwporncharoenvong, Siritron Samosorn, Apinya Buranaprapuk
Rational design of photoreagents with systematic modifications of their structures can provide valuable information for a better understanding of the protein photocleavage mechanism by these reagents. Variation of the length of the linker connecting the photoactive moiety with the protein anchoring-group allowed us to investigate the control of the protein photocleavage site. A series of new photochemical reagents (PMA-1A, PMA-2A and PMA-3A) with increasing chain lengths is examined in the current study. Using avidin as a model system, we examined the interaction of these probes by UV–Vis, fluorescence spectroscopic methods, photocleavage and computational docking studies. Hypochromism of the absorption spectrum was observed for the binding of these new photochemical reagents with estimated binding constants (Kb) of 6.2 × 10⁵, 6.7 × 10⁵ and 4.6 × 10⁵ M⁻¹, respectively. No significant changes of Stern-Volmer quenching constant (Ksv) with Co(NH3)6Cl3 has been noted and the data indicated that the probes bind near the surface of the protein with sufficient exposure to the solvent. Photoexcitation of the probe-avidin complex, in the presence of Co(NH3)6Cl3, resulted in protein fragmentation, and the cleavage yield decreased with the increase in the linker length, and paralleled with the observed Ksv values. Amino acid sequencing of the photofragments indicated that avidin is cleaved between Thr77 and Val78, as a major cleavage site for all the three photoreagents. This site is proximate to the biotin binding site on avidin, and molecular docking studies indicated that the H-bonding interactions between the polar end-group of the photoreagents and hydrophilic amino acids of avidin were important in positioning the reagent on the protein. The major cleavage site, at residues 77–78, was within 5 Å of the pyrenyl moiety of the probe, and hence, molecular tuning of the linker provided a simple approach to position the photoreagent along the potential photocleavage site.

Graphical abstract

The percentage of patients achieving complete remission of urticaria increases with repeated courses of treatment

Publication date: Available online 2 July 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Andrea Matucci, Francesca Nencini, Oliviero Rossi, Sara Pratesi, Paola Parronchi, Enrico Maggi, Alessandra Vultaggio

Environmental Endocrinology: Insights Into the Diversity of Regulatory Mechanisms in Life Cycles

Abstract

All organisms must time their life cycles appropriately and organize life history stages into temporal sequences that enhance fitness in a changing environment. The endocrine system plays a major regulatory role in transducing information from the environment into morphological, physiological and behavioral responses appropriate for the time of year. The perception, transduction, response pathways via neural and endocrine mechanisms are beginning to be explored and underscore the critical regulatory roles they play. Whereas many conserved mechanisms (evolutionary constraints hypothesis) are emerging, there is a growing realization that there may be alternate pathways unique to populations and individuals (evolutionary flexibility hypothesis). Field investigations (field endocrinology) over the past 45 years have revealed patterns of hormonal responses to environmental changes, physical and social, that could not have been anticipated from laboratory investigations alone. These patterns include differences at population and individual levels that have enabled new insights into acclimation and adaptation to environmental transitions. The number of species studied under natural conditions has grown exponentially in recent years to include all vertebrate classes and some invertebrates as well. These data are now driving evolutionary perspectives and with the advent of comparative genomics a new and exciting era of evolutionary/ecological endocrinology is developing. This paper gives a brief overview of where the field stands now and where it is likely to go in the future especially in relation to the networks of regulatory pathways and how they can be modulated to enable acclimation of individuals as well as populations. One illustrative example, mechanisms underlying modulation of the adrenocortical responses to environmental stress, is the focus of this communication. These "coping" mechanisms will be key for acclimation and adaptation to global change.

Application of Box–Behnken design and desirability function in the optimization of Cd(II) removal from aqueous solution using poly(o-phenylenediamine)/hydrous zirconium oxide composite: equilibrium modeling, kinetic and thermodynamic studies

Abstract

In this research work, poly(o-phenylenediamine) was incorporated into the hydrous zirconium oxide matrix to form poly(o-phenylenediamine)/hydrous zirconium oxide composite which is used for the removal of Cd(II) from aqueous solution. The characterization of the material was done based on FTIR, XRD, SEM, and TGA-DTA. The effects of contact time, pH, adsorbent dose, and initial concentration of Cd(II) on the removal of Cd(II) were studied by performing 29 sets of sorption runs using Box–Behnken design combined with response surface methodology (RSM). Various isotherm models were tested to describe the adsorption equilibrium. The adsorption equilibrium data fitted well with Freundlich isotherm model. The maximum adsorption capacity of 66.66 mg g⁻¹ was obtained from Langmuir isotherm. The pseudo-second-order kinetic model described the adsorption kinetics more accurately. Diffusion-based kinetics such as intraparticle diffusion and Bangham's model suggested that both film and intraparticle pore diffusion were involved in the adsorption process. The Elovich model pointed towards the chemisorption. The investigation of desorption and regeneration suggested that the material can be used as an effective sorbent for removal of Cd(II) from aqueous system.

Microbial fuel cell and membrane bioreactor coupling system: recent trends

Abstract

Membrane bioreactor (MBR) and microbial fuel cell (MFC) are new technologies based on microbial process. MBR takes separation process as the core to achieve the high efficient separation and enrichment the beneficiation of microbes during the biological treatment. MFC is a novel technology based on electrochemical process to realize the mutual conversion between biomass energy and electric energy, in order to solve the problems of serious membrane fouling and low efficiency of denitrification in membrane bioreactor, the low power generation efficiency, and unavailability of bioelectric energy of MFC. In recent years, MFC-MBR coupling system emerged. It can effectively mitigate the membrane fouling and reduce the excess sludge production. Simultaneously, the electricity can be used effectively. The new coupling system has good prospects for development. In this paper, we summarized the research progresses of the two kinds of coupling systems in recent years and analyzed the coupling structure and forms. Based on the above, the future development fields of the MFC-MBR coupling system were prospected.

Fate of PAHs in the vicinity of aluminum smelter

Abstract

Investigation has been carried out in the vicinity of an aluminum smelter located in the industrialized town of Konin. Concentrations of 14 polycyclic aromatic hydrocarbons (PAHs) were determined in grass, spruce needles, and soil collected in the period of the smelter operation and several years after its closing. Significant changes in the quantity of PAHs and their profiles observed in the two measuring periods, stressing the importance of aluminum production with regard to PAH emission. It was confirmed by very high values of the carcinogenic potential (CP) found for PAHs accumulated in grass and soil when compared to the values found in urban and remote sites. PAH ratio rates used as a tool for identifying emission sources showed a pyrogenic origin of PAHs in both periods; the ratios in the period of the smelter running activity were similar to those found in other studies carried out near aluminum smelters. Grass turned out to be a good biomonitor of PAHs similarly to commonly used leaves of various tree species. The use of four age classes of spruce needles, some of which were subjected to emission from the smelter, showed that such approach could serve as an analysis tool for describing retrospective pollution.

Evaluation of psychiatric hospital wastewater toxicity: what is its impact on aquatic organisms?

Abstract

The primary source of pharmaceuticals to the aquatic environment is the discharge of wastewater effluents. Pharmaceuticals are a large and diverse group of compounds. Among them, psychotropic substances are particularly interesting to study due to their specific known mode of action. The present study was performed to investigate the effects of wastewater effluents from a psychiatric hospital wastewater treatment plant (WWTP) on several aquatic organisms. All the analyzed pharmaceuticals (10 compounds) were detected in WWTP effluents as well as in the receiving river. Although the environmental concentrations were generally at trace levels (ng L⁻¹ to μg L⁻¹), induce toxic effects were observed. This study showed the effects of the WWTP effluents on the oogenesis and/or embryogenesis of amphipod crustacean Gammarus fossarum, Japanese fish medaka Oryzias latipes, mollusk Radix peregra, and planarian Schmidtea polychroa. A decrease of the number of oocytes and produced embryos was observed for G. fossarum and S. polychroa. Similarly, the hatching rate of R. peregra was affected by effluents. In the receiving river, the macroinvertebrate community was affected by the wastewater effluents discharge.

Vertebroplasty in Elderly Patients: A Clinical Effectiveness Analysis

Abstract

Purpose of Review

Minimally invasive vertebral augmentation procedures (VAP) have been first introduced to provide pain relief in patients with osteoporotic vertebral fractures (VF). However, in the last decade scientific literature revealed to be quite controversial about their efficacy. The aim of this review was to analyze clinical evidences from current literature, supported by our own experience.

Recent Findings

Compared to conservative therapies, VAP represent an effective treatment for recent VF and, in elderly patients, reduce mortality and morbidity. Advances in technology have widened the fields of application towards other spine pathologies typical of elderly, such as primary and metastatic tumors.

Summary

In patients with severe pain for recent or un-healed vertebral fracture, VAP are clinically more effective than conservative treatment. Accurate pain assessment and pre-procedural Magnetic Resonance Imaging are highly recommended to obtain optimal patient selection and best treatment results.

Peer Review to Peer Learning in Radiology: Where Have We Been, What Have We Learned and Where Are We Headed?

Abstract

Purpose of review

To review and contrast varying methods of peer assessment driven practice quality improvement programs in radiology with an emphasis on peer review and peer learning.

Recent findings

Review of the literature revealed that the current consensus is that a shift away from the original peer review system toward a peer learning process has the most beneficial effects for organizations seeking to maximally improve performance. This requires altering perceptions towards the peer review process itself, and significant time, effort, and resources.

Summary

The transition to a peer learning process is a necessity to advance the field of radiology into an era of delivering near faultless quality health care.

PET/CT and Bone Scintigraphy: Metabolic Results in Musculoskeletal Lesions

Abstract

Purpose

This review aimed to provide an overview on findings from metabolic imaging modalities such as bone scintigraphy and positron emission tomography–computed tomography (PET/CT) in musculoskeletal lesions. It is conceivable that methods assessing metabolism of bone tumors, combined with the morphological assessment, could enhance the possibility for a personalized therapy with particular emphasis to malignant neoplasms.

Recent Findings

The assessment of bone tumors by conventional scintigaphic and morphological imaging has been recently integrated with the morpho-metabolic appraisal obtained by PET/CT systems. Increasing availability of this diagnostic modality has been shown to stratify properly the patients and the findings correlate well with outcome. Moreover, new tracers are being implemented in the study of musculoskeletal lesions by PET/CT while the new volumetric parameters used to identify the lesions hold great promise.

Summary

Results from PET/CT are associated with tumor grading and histopathology in bone malignant lesions and they could be of value for implementing treatment strategy. Additionally, the metabolic assessment has been demonstrated useful for predicting surgical response and patients' outcome.

A Systematic Review of Full-Shift, Noise Exposure Levels Among Construction Workers: Are We Improving?

Abstract

Context

Construction industry workers are at high risk of occupational noise exposure. Although regulations and guidelines for this industry specify the use of noise controls, workers continue to be exposed to hazardous noise levels.

Objectives

The objectives of this study were (i) to collate and describe full-shift noise exposure experienced by construction workers; (ii) to review trends in full-shift exposure over time and between countries; and (iii) to identify any occupational categories within the construction industries that have higher levels of exposure.

Results

Of the 1171 studies found using key terms, 25 contained noise exposure measurements that met our inclusion criteria. Sample populations were predominantly from large construction sites and primarily comprised occupations known to engage in noisy workplace activities. Studies spanned over 36 years with all having average full-shift noise exposure over 85 A-weighted decibels (dBA). No time trend in full-shift noise exposure levels for construction workers was observed. Construction workers in the subgroup occupations of mason, sheet metal workers, carpenters, concrete workers, and operating engineers consistently had mean L_Aeq,8h over the 85 dBA limit.

Conclusion

Studies spanning 36 years in 10 countries consistently show construction workers have been exposed to hazardous noise levels. There has been no significant change over time of the average full-shift exposure levels of construction workers, including in all occupational subgroups except iron-workers. Some variability in full-shift measures is due to sampling methods and population characteristics and to a lesser extent, methods used to derive exposure levels.

Correction to: Genetic aberrations of the K-ras proto-oncogene in bladder cancer in relation to pesticide exposure

The original publication of this paper contains a mistake. Line 6 in the abstract, line should read "One hundred patients were diagnosed with bladder cancer and two hundred controls attended the outpatient clinic;"

Biofilm architecture on different substrates of an Oculatella subterranea (Cyanobacteria) strain isolated from Pompeii archaeological site (Italy)

Abstract

The Cyanobacterium Oculatella subterranea Zammit, Billi, Albertano inhabits hypogea and stone caves and is a pioneer of different stone substrata. In this study, a strain isolated from the House of Marco Castricio (Archaeological Park of Pompeii, Italy) was identified by a polyphasic approach and used for an in vitro colonization test to verify the influence of the substrate on the biofilm architecture. Fine structure of O. subterranea microbial mats was revealed as well as filaments orientation toward light source. This aim has been achieved through confocal laser scanner microscope microscopy and computer image analysis. Moreover, bioreceptivity of five different substrates, commonly retrieved in archaeological sites of Campania, was assessed for O. subterranea. Our results show that the three-dimensional structure of O. subterranea microbial mats is poorly affected by physical and geochemical features of substrates: in fact, the porous architecture of its biofilm was preserved, independently of the materials. On the other hand, the area/perimeter ratio relative to the O. subterranea growth on tuff, brick, and porphyry showed significant differences, indicating dissimilar levels of bioreceptivity of the three substrates.

Effects of inorganic ions on the photolysis of propranolol in FA solution

Abstract

Photolysis of the widely used beta-blocker propranolol (PRO) was investigated in the presence of fulvic acid (FA) and inorganic ions under simulated solar irradiation. PRO undergoes direct photolysis proceeding mainly via degradation of the triplet excited state, ³PRO*. FA and inorganic ions inhibited photolysis of PRO in the order of FA > Fe³⁺ > Cl⁻ > Ca²⁺ > Mg²⁺ > NO₃⁻ > K⁺. An antagonistic effect between FA and inorganic ions toward the suppression of PRO photolysis was exhibited. The binding behaviors of PRO, FA, and inorganic ions were examined through fluorescence quenching experiments, which showed that inorganic ions affected the binding between FA and PRO through competing for the binding sites of FA or PRO. The correlation analysis demonstrated a positive correlation between the binding constant (K_OC) of FA-PRO and the inhibition rate of FA on PRO photolysis. The observed rate constants of photolysis (k_obs) have opposite correlations with the concentration of singlet oxygen (¹O₂). These findings strongly suggest that inorganic ions decrease the inhibition effect of FA on PRO photolysis via restraining the complexation of FA-PRO and production of ¹O₂.

Réplica a «Factores de riesgo cardiovascular y grosor de la íntima media carotídea en una población colombiana con psoriasis»

Publication date: Available online 2 July 2018
Source:Actas Dermo-Sifiliográficas
Author(s): Á. González-Cantero, J. González-Cantero, A.I. Sánchez-Moya, C. Pérez-Hortet, C. Schoendorff-Ortega

Nevus epidérmicos y síndromes relacionados. Parte 2: Nevus derivados de estructuras anexiales

Publication date: Available online 2 July 2018
Source:Actas Dermo-Sifiliográficas
Author(s): J. Garcias-Ladaria, M. Cuadrado Rosón, M. Pascual-López
Los nevus epidérmicos son hamartomas originados en la epidermis y/o en las estructuras anexiales de la piel que se han clasificado clásicamente partiendo de la morfología. En los últimos años se han descrito variantes nuevas y se han producido avances en el campo de la genética que han permitido caracterizar mejor estas lesiones y comprender su relación con algunas de las manifestaciones extracutáneas a las que se han asociado. En esta segunda parte revisaremos los nevus derivados de estructuras anexiales de la piel y los síndromes que se asocian.Epidermal nevi are hamartomatous lesions derived from the epidermis and/or adnexal structures of the skin; they have traditionally been classified according to their morphology. New variants have been described in recent years and advances in genetics have contributed to better characterization of these lesions and an improved understanding of their relationship with certain extracutaneous manifestations. In the second part of this review article, we will look at nevi derived from the adnexal structures of the skin and associated syndromes.

Graphical abstract

Tratamiento biológico como primera línea en pacientes con psoriasis: una población no estudiada

Publication date: Available online 2 July 2018
Source:Actas Dermo-Sifiliográficas
Author(s): O. Baniandrés Rodríguez

Inhibidores selectivos de la IL-23: los recién llegados al tratamiento de la psoriasis

Publication date: Available online 2 July 2018
Source:Actas Dermo-Sifiliográficas
Author(s): T. Torres

Abdominal wall herniation after herpes zoster

Pragya A Nair, Kira Pariath

Indian Dermatology Online Journal 2018 9(4):278-279

Periorbital hyperpigmentation: What lies beneath?

Rashmi Sarkar, Anupam Das

Indian Dermatology Online Journal 2018 9(4):229-230

Clinical training and research opportunities for dermatology residents in India

Seetharam A Kolalapudi, Ameet R Valia, Deepika Pandhi

Indian Dermatology Online Journal 2018 9(4):231-233

Turban tumor: A classical presentation of brooke–Spiegler syndrome

Indian Dermatology Online Journal 2018 9(4):284-285

Immunohistochemistry in dermatopathology and its relevance in clinical practice

Debajyoti Chatterjee, Rajsmita Bhattacharjee

Indian Dermatology Online Journal 2018 9(4):234-244

Immunohistochemistry (IHC) is an important diagnostic tool in histopathology. Dermatopathology is a rapidly developing subspecialty of histopathology. Although IHC is not widely used in routine dermatopathology practice, its application is gradually increasing. IHC is used to differentiate two conditions with similar morphology, to confirm a diagnosis as well as to assess prognosis. It is more commonly used for neoplastic conditions like melanocytic, hematolymphoid, and spindle cell tumors, although uses can be very wide. Although IHC can aid in diagnosis, sometimes interpretation can be difficult as there may be overlapping findings. Thus, IHC should not be interpreted in isolation and should be done in the context of clinical and histological findings. In this review, we have discussed the uses of various immunohistochemical markers in dermatopathology in the light of current literature and their clinical relevance.

Basal cell carcinoma with sebaceous differentiation

Sushrut Save, Swagata Tambe, Chitra Nayak

Indian Dermatology Online Journal 2018 9(4):273-275

A study of clinicopathological correlation of periorbital hyperpigmentation

Chitra S Nayak, Atul S Giri, Uddhao S Zambare

Indian Dermatology Online Journal 2018 9(4):245-249

Context: "Dark circles" are esthetic concerns that can affect individuals of any age, gender, or race. They can be familial, physiological, or associated with various medical illnesses. Aim: To study the clinicopathological correlation of periorbital hyperpigmentation. Patients and Methods: Fifty patients affected with periorbital melanosis (POM) were enrolled for the study after obtaining informed consent. Details regarding history, demographic data, and physical examination of POM were recorded, and a 2-mm punch skin biopsy was taken from the affected skin under local anesthesia and stained with hematoxylin and eosin (H and E), Fontana Masson (Melanin), Perls Prussian blue (Hemosiderin). Results: Twenty-three (46%) patients with POM had history of chronic illness before developing POM; 18% patients were atopic, 16% had jaundice, 18% had associated pigmentary demarcation lines (PDL) of type F and G, 8% had acanthosis nigricans, 22% patients had anemia, 16% patients gave positive family history of POM, and menstrual irregularity was seen in 16%. Histopathology revealed dermal melanin deposition with melanophages along with predominantly increased epidermal melanin and melanin in vellus follicular epithelium. Prussian blue for hemosiderin was negative in all cases. Conclusions: The study has elicited the multifactorial origin of POM; females are affected more than males. Dermal melanin deposition is a constant feature. Hemosiderin is not found in POM. Increased pigmentation of the vellus follicular epithelium is a feature of POM.

Comment on “Mean platelet volume: A reliable marker of inflammation in recurrent aphthous stomatitis and Behçet's disease?”

Esin Avsar

Indian Dermatology Online Journal 2018 9(4):281-281

Evaluation of serum Vitamin D levels in patients with systemic sclerosis and healthy controls: Results of a pilot study

Sarita Gupta, Vikram K Mahajan, Rajinder S Yadav, Karaninder S Mehta, Satya Bhushan, Pushpinder S Chauhan, Ritu Rawat, Vikas Sharma

Indian Dermatology Online Journal 2018 9(4):250-255

Background: The anti-inflammatory, immunomodulatory, and anti-proliferative effects of vitamin D in pathogenesis of autoimmune diseases have been highlighted in recent years but implications of vitamin D deficiency in systemic sclerosis (SSc) remain understudied. Objectives: To evaluate serum vitamin D levels in SSc patients and matched controls. Materials and Methods: Serum vitamin D levels were estimated in 38 (M:F 5:33) patients aged 23–70 years of untreated SSc and age and gender matched healthy controls. Clinical and investigative evaluation for skin sclerosis by modified Rodnan skin score (mRSS), presence of digital ulcers, Raynaud's phenomenon, type of auto-antibodies, systemic involvement, and serum vitamin D levels were performed. Serum vitamin D levels were defined as normal (30–100 ng/ml), insufficient (10–30 ng/ml), and deficient (<10 ng/ml). Results: Serum vitamin D levels (median ± IQR) were 19.5 ± 77.8 ng/ml in 38 patients and 100 ± 31.3 ng/ml in controls each. Vitamin D deficiency in 13 (34.2%) and insufficiency in 10 (26.3%) patients were identified. Only 2 (5.3%) controls had vitamin D insufficiency and the difference was statistically significant (P = 0.001). An inverse relationship was observed between mRSS and serum vitamin D levels. Conclusions: Patients with SSc have significantly lower serum vitamin D levels than healthy controls. Serum vitamin D levels do not correlate well with age, gender, disease duration or its variants, type of auto antibodies, presence of digital ulceration, or systemic involvement but has inverse correlation with skin sclerosis. Better-designed studies will perhaps resolve issues of potential benefits of vitamin D supplementation in modification of disease activity or severity in SSc.

Dermoscopy of eccrine hidrocystomas

Ananta Khurana, Purnima Malhotra, RK Gautam

Indian Dermatology Online Journal 2018 9(4):288-289

Polymorphous cutaneous sarcoidosis associated with peripheral vascular disease and its dermatoscopic findings

Balakrishnan Nirmal, Renu George, Ramesh Babu Telugu

Indian Dermatology Online Journal 2018 9(4):256-258

Sarcoidosis is a multisystem disorder with cutaneous involvement with myriad of morphological presentations, often leading to diagnostic dilemma. We report a case of 31-year-old male with peripheral arterial disease who presented with three morphological forms of sarcoidosis simultaneously, namely, papular, psoriasiform, and pigmented purpuric dermatosis-like lesions. Dermatoscopy of cutaneous lesions showed yellow-orange globules, red dots, linear vessels, and white crystalline structures depending on the clinical forms. Histopathology of all three morphological types of skin lesions demonstrated sarcoidal naked granulomas.Sarcoid specific lesions of more than one morphological type presenting in a same patient is rare. Association of peripheral vascular disease with sarcoidosis is also seen rarely.

Efficacy and safety of 1% Clotrimazole cream occlusion with the mechanical reduction as an adjuvant therapy for the treatment of onychomycosis

Saranjit Wimoolchart, Sumanas Bunyaratavej, Charussi Leeyaphan, Chuda Rujitharanawong, Chanai Muanprasert, Lalita Matthapan

Indian Dermatology Online Journal 2018 9(4):271-272

Multiple eruptive eccrine poromas associated with chemotherapy and autologous bone marrow transplantation

Manuel A Valdebran, Chris Hong, Jisun Cha

Indian Dermatology Online Journal 2018 9(4):259-261

Eccrine poroma is a benign adnexal tumor that originates from the uppermost portion of the intraepidermal eccrine duct. It usually presents as a solitary tumor. Histopathology shows a monomorphic proliferation of cuboidal cells, which radially extend from the basal layer to the dermis. Here, we present a rare multilesional eruption of eccrine poroma after chemotherapy and bone marrow stem cell transplantation for acute promyelocytic leukemia along with a description of clinical, pathological, and dermoscopic findings.

Risk of atrial fibrillation in pemphigus vulgaris

Nastaran Namazi, Shahram Ariaeenejad, Mitra E Azad, Mehdi Pishgahi

Indian Dermatology Online Journal 2018 9(4):275-277

Palisaded encapsulated neuroma: An unusual presentation

Jaskaran Batra, V Ramesh, Anupama Molpariya, Khushpreet K Maan

Indian Dermatology Online Journal 2018 9(4):262-264

Palisaded encapsulated neuroma (PEN) is a distinctive benign neural tumor, which usually presents as a solitary skin-colored papule or a nodule. It is a benign lesion and may clinically mimic a cutaneous neurofibroma, melanocytic nevi, or cutaneous schwannoma. Here we report a rare case of multifocal cutaneous PENs and its differentiation from cutaneous schwannomas, which is possible by histopathology.

In response to “Safety and efficacy of different systemic treatment modalities for acutepain of herpes zoster: A pilot study”

Pragya A Nair, Kira Pariath

Indian Dermatology Online Journal 2018 9(4):280-280

Clear cell dermatofibroma on the chest wall: A case report and its diagnostic traps

Tangul Bulut, Betul Celik

Indian Dermatology Online Journal 2018 9(4):265-267

Dermatofibromas are common lesions of the skin. Although they occur at any part of the body, they are most commonly observed on the lower legs of middle-aged women. The lesion comprises fibroblast-like cells, histiocytes, collagenous tissue, and blood vessels. Many histological variants have been defined based on the ratio of cell components and their location. These variants of dermatofibroma may cause problems during differential diagnosis between benign and malignant mesenchymal lesions of the skin and may lead pathologists to overdiagnose this lesion. Here, we report a case of clear cell dermatofibroma, which is a rare variant of dermatofibroma, together with its diagnostic traps.

SkinIndia Quiz 46: Asymptomatic unilateral inguinal swelling with peripheral eosinophilia

Sidharth Tandon, Jasmeet Singh, Surabhi Sinha, Preeti Sharma

Indian Dermatology Online Journal 2018 9(4):282-283

Unilateral discoid lupus erythematosus over the face: An unusual presentation

Savita Yadav, Suman Patra, Ashok Singh

Indian Dermatology Online Journal 2018 9(4):268-269

Dermoscopy of topical steroid Damaged/Dependent face

Deepak Jakhar, Ishmeet Kaur

Indian Dermatology Online Journal 2018 9(4):286-287

In vitro inhalation/ingestion bioaccessibility, health risks, and source appointment of airborne particle-bound elements trapped in room air conditioner filters

Abstract

The airborne particle-bound elements (Ca, Fe, Al, Mg, K, Na, Zn, Mn, P, Pb, Cu, Sr, Ti, Ba, Cr, Ni, As, Sb, Cd, Co, and V) trapped in room air conditioners' filters (filter dusts) during recirculating indoor air from different types of rooms were analyzed, and the objectives of this study were to assess the potential sources of those elements and their potential health risks via inhalation/ingestion exposure. Main crustal elements such as Ca, Fe, Al, Mg, and K with an average value of 60.6, 17.9, 11.3, 7.58, and 6.90 mg g⁻¹, respectively, are the preponderant elements, and the mean values of main toxic elements were 2230, 344, 508, 85.7, 71.5, 36.0, 8.02, and 16.9 mg kg⁻¹ for Zn, Cu, Pb, Cr, Ni, As, Cd, and Sb, respectively. The enrichment factors indicated the significant enrichment of Cd, Pb, Cr, Cu, Sb, and Zn in the filter dusts. Four potential sources with the contributions of 33.5, 29.1, 22.6, and 14.8%, respectively, were identified by absolute principal component scores-multiple linear regression analysis (APCS-MLR). Enrichment factor and APCS-MLR model reveal the outdoor input of toxic elements. In vitro inhalation and ingestion bioaccessibility of toxic elements showed elemental and in vitro procedure dependence. There are potential carcinogenic risks via ingestion exposure and no non-carcinogenic risks to both children and adults based on bioaccessible contents of toxic elements. This study reveals the potential health risks posed by the particle-bound elements.

Optimization of preparation of monolithic carbon foam from rice husk char for benzene leakage emergency

Abstract

In the aim of BTEX leakage emergency, monolithic carbon foam (MCF) was designed and prepared via a simple method. Rice husk char (RHC) was chosen as raw material, polyurethane sponge (PUS) was used as sacrificed template to form inner channel, and corn starch and ZnO were employed as binder and reinforcing filler, respectively. The optimized preparation parameter was determined by adopting of Taguchi experimental design method. Both MCF-RHC and MCF-CAC were made from RHC and commercial activated carbon (CAC) under the same condition, and three reported monolithic carbon adsorbents were selected for comparative study with MCFs. The surface and structural properties were characterized by XRD, SEM, and N₂ adsorption/desorption isotherm analyses. XRD analysis results reveal that MCF-RHC was the composites of carbon, SiO₂, and ZnO, and MCF-RHC and MCF-CAC have good potential in organic adsorption. Hierarchical structure of MCF was constructed by inner macro-channel from burning up of PUS and micro- and meso-pores from resultant carbon composite, and these inner macro-channels play a more important role in benzene rapid adsorption. Specific surface area of MCF-RHC was 465.5 m² g⁻¹, which included micro- and meso-pores, which mainly come from RHC during the carbonization process. Adsorption kinetics study demonstrated that the benzene equilibrium uptake of MCF-RHC and MCF-CAC was similar, and both of data well fitted the pseudo-second-order kinetic model. However, MCF-RHC has the ability to absorb benzene more quickly, which meets the demand of absorbent utilizing in benzene leakage emergency.

Evaluation and Diagnosis of Salivary Gland Neoplasms

Salivary gland tumors are an uncommon heterogeneous group of neoplasms that vary in their anatomic site, histology and biologic behavior. Pleomorphic adenoma is the most common benign tumor and mucoepidermoid and adenoid cystic carcinoma are the most common malignant tumors. Evaluation and diagnosis of these tumors includes not only a complete history and head and neck exam, but also biopsy and imaging of the tumors. Controversy remains regarding the necessity and type of biopsy to be performed and the usefulness of imaging.

Financial instability and CO 2 emissions: the case of Saudi Arabia

Abstract

This study aims to investigate the nexus between financial instability and CO₂ emissions within the multivariate framework in Saudi Arabia's economy over 1971–2016. Autoregressive Distributed Lag (ARDL) model is used to estimate long-run dynamics followed by Vector Error Correction Model (VECM) to detect the direction of causality. The result of the study reveals that financial instability has an insignificant impact on CO₂ emissions. However, electricity consumption has an adverse impact on environmental quality by producing a huge amount of CO₂ emissions in the atmosphere. The coefficients of oil and non-oil GDPs also suggest that both oil and non-oil GDPs contribute to producing a massive amount of CO₂ emissions. Bi-directional causality is observed among all the core variables of the study. Moreover, the reliability and validity are confirmed by applying several diagnostic tests. This study provides novel findings which not only help to advance the existing literature but can be a particular interest to the country's policymakers regarding financial sector and its role in environmental degradation.

Regulation on the toxicity of microcystin-LR target to protein phosphatase 1 by biotransformation pathway: effectiveness and mechanism

Abstract

Biotransformation was an important pathway to regulate the toxicity of microcystins (MCs) targeted to protein phosphatases (PPs). To explore the regulation effectiveness and mechanism, several typical biothiol transformation products originated from MCLR were prepared by nucleophilic addition reaction. The reduced inhibition effect of MCLR transformation products on PP1 was evaluated and compared with their original toxin. Though molecular simulation showed the introduced biothiols enhanced the total combination areas and energies for target complexes, the steric hindrance of introduced biothiols inhibited the combination between the key action sites (Mdha⁷ and Adda⁵ residues) and PP1. Furthermore, the introduced biothiols also weakened the hydrogen bonds for some key interaction sites and altered the ion bonds between PP1 and the two Mn²⁺ ions in the catalytic center. The discrepant regulation effect for biothiols on the toxicity of MCLR was closely related to above indexes and influenced by molecular sides.

Odorous emission reduction from a waste landfill with an optimal protection system based on fuzzy logic

Abstract

Effective landfill management and operation require an accurate evaluation of the occurrence and extent of odour emission events, which are among the main causes of resident complaints and concerns, in particular in densely urbanised areas. This paper proposes a fuzzy optimal protection system (FOPS) based on fuzzy logic to manage odour production from a municipal solid waste (MSW) landfill. The case study is a MSW landfill in an old quarry site located 6 km north-west of Naples city centre (Italy). The aim is to reduce the odour nuisance in the area surrounding the landfill where there are several sensitive receptors. FOPS is based on logical relationships between local atmospheric dynamics, number and intensity of odour pollution events detected by certain fixed receptors and odour emission rate via an optimal fuzzy approach. Such system allows to start, in real time, established mitigation actions required to further reduce the odorous emissions from the landfill itself (e.g. spraying of perfumed substances and activation of extraction wells), especially when weather conditions might not be favourable and cause by causing a higher odour perception. The fuzzy system was coupled with the air pollutant transport software CALPUFF to simulate the odour dispersion in the considered area taking into account both different odour emission rates and local weather conditions. FOPS results show that this approach can be very useful as, by measuring the odour concentrations, a significant reduction of the odour exceedances over the thresholds fixed, to minimise the olfactory harassment, was observed in the whole area studied.

CO 2 emission thresholds for inclusive human development in sub-Saharan Africa

Abstract

We provide policy-relevant critical masses beyond which, increasing CO₂ emissions negatively affects inclusive human development. This study examines how increasing CO₂ emissions affects inclusive human development in 44 sub-Saharan African countries for the period 2000–2012. The empirical evidence is based on fixed effects and Tobit regressions. In order to increase the policy relevance of this study, the dataset is decomposed into fundamental characteristics of inclusive development and environmental degradation based on income levels (low income versus (vs.) middle income); legal origins (English common law vs. French civil law); religious domination (Christianity vs. Islam); openness to sea (landlocked vs. coastal); resource-wealth (oil-rich vs. oil-poor) and political stability (stable vs. unstable). All computed thresholds are within policy range. Hence, above these thresholds, CO₂ emissions negatively affect inclusive human development.

Biomonitoring of atmospheric particulate pollution via chemical composition and magnetic properties of roadside tree leaves

Abstract

Particulate matter (PM) is a main atmospheric pollution which threats human health and well-being. In this research, we chemically and magnetically analysed roadside tree leaves, collected from three tree species in two main roads (from two different cities) and a reference area, for 28 elements and the saturation isothermal remanent magnetisation. Comparison of unwashed and washed leaves revealed that deposited particles on the leaf surface contain various elements including Al, Ca, Fe, Mg, Mn, Na, Si, Ti, Ba, Co, Cr, Cu, Ni, Rb, V, Zn and Zr. Moreover, there was no significant difference between washed/unwashed leaves in Cl, K, P, S, As, Cd, Cs, Pb, Sn and Sr concentrations, which indicates tree leaves may not be a suitable biomonitor for these elements. Our results showed that site and tree species are important factors which affect atmospheric elements deposition. Among the three considered tree species, Chamaecyparis lawsoniana showed the highest potential for atmospheric particle accumulation. The PCA results revealed that Al, Fe, Ti, Co, Cr, Cu, Ni, Rb, Si, V, Zn and Zr indicated emissions from road traffic activities and soil dust; Ca, Mg and Na from sea salts and Mn and Sb from industrial activity. The biplot results showed that the site effect was much stronger than the species effect for all elements and saturation isothermal remanent magnetisation (SIRM) values. Moreover, elements from traffic, industrial activity and soil dust are significantly correlated with leaf SIRM indicating that leaf SIRM can be a suitable bioindicator of exposure to traffic-derived particles and soil dust, and not from sea salts. It is concluded that chemical composition and SIRM of urban tree leaves can serve as a good indicator of atmospheric PM pollution in Iran and anywhere else where the studied trees grow.

Fermented camel milk by Lactococcus lactis subsp. cremoris attenuates erythrocytes oxidative stress-induced hematological and immunological damage in CCl 4 -intoxicated mice

Abstract

Fermented camel by Lactococcus lactis subsp. cremoris has been recently discovered to protect against the toxic effect of carbon tetrachloride (CCl₄), but its beneficial effects in the presence of oxidative stress in the erythrocytes have not been established. In the present study, 28 mice were randomly divided into four groups: control group; CCl₄ group: intoxicated by a single intraperitoneal injection (ip) of CCl₄; group FCM-LLC + CCl₄: pretreated with FCM-LLC daily during 14 days, and received a single dose of CCl₄. FCM-LLC group received FCM-LLC alone. The occurrence of oxidative stress in erythrocytes was evidenced by an increase in lipid peroxidation, protein carbonyl, and changes in antioxidant enzyme activities and non-enzymatic antioxidant. The oxidative injury induced by CCl₄ in the erythrocytes was confirmed by modifications in hematological parameters and decreases in protein, albumin, and globulin content in the serum of intoxicated mice. Therefore, CCl₄ caused a significant decrease in immunotoxic indices, including immunoglobulin G (IgG), immunoglobulin M (Ig M), and immunoglobulin A (IgA) levels, and an increase of inflammatory markers such as C-reactive protein (CRP) level. Meanwhile, FCM-LLC effectively restored the parameters cited above to near-normal values. It can be suggested that fermented camel milk could regulate deviant physiological effects induced by CCl₄ which is due to its powerful antioxidant and immunomodulatory and anti-inflammatory capacity.

Late gadolinium enhancement of colorectal liver metastases post-chemotherapy is associated with tumour fibrosis and overall survival post-hepatectomy

Abstract

Purpose

To determine whether late gadolinium MRI enhancement of colorectal liver metastases (CRCLM) post-chemotherapy is associated with tumour fibrosis and survival post-hepatectomy.

Materials and methods

The institutional review board approved this retrospective cohort study and waived the requirement for informed consent. A cohort of 121 surgical patients who received preoperative MRI after chemotherapy between 2006-2012 was included in this study. Target tumour enhancement (TTE), defined as the mean contrast-to-noise ratio of up to two target lesions on late-phase gadobutrol-enhanced MRI, was determined by two independent raters. The average TTE was correlated with tumour fibrosis on post-hepatectomy specimens using Spearman correlation and with survival post-hepatectomy using Kaplan-Meier and Cox regression. Inter-rater reliability was determined using relative intra-class correlation coefficients.

Results

In the surgical cohort (mean age: 63.0 years; male: 58%), TTE was associated with tumour fibrosis (r = 0.43, p < 0.001). Strong TTE was associated with improved survival compared to weak TTE (3-year survival: 88.4% vs. 58.8%, p = 0.003) with a hazard ratio of 0.32 (95% CI: 0.14-0.75, p = 0.008), after taking into account known prognostic variables. Inter-rater reliability was very good with a relative intraclass correlation of 0.84 (95% CI: 0.77-0.89).

Conclusion

Late gadolinium MRI enhancement of CRCLM post-chemotherapy is associated with tumour fibrosis and survival.

Key Points

• MRI enhancement of colorectal liver metastases is associated with survival post-hepatectomy

• MRI enhancement of chemotherapy-treated colorectal liver metastases correlates with tumour fibrosis

• Measuring late MRI enhancement using target tumour enhancement is reliable

Forensic age assessment by 3.0T MRI of the knee: proposal of a new MRI classification of ossification stages

Abstract

Purpose

To explore the possibility of determining majority via a morphology-based examination of the epiphyseal-diaphyseal fusion by 3.0 T magnetic resonance imaging (MRI), a prospective cross-sectional study developing and applying a new stage classification was conducted.

Materials and methods

344 male and 350 female volunteers of German nationality between the ages of 12-24 years were scanned between May 2013 and June 2015. A 3.0 T MRI scanner was used, acquiring a T1-weighted (T1-w) turbo spin-echo sequence (TSE) and a T2-weighted (T2-w) TSE sequence with fat suppression by spectral pre-saturation with inversion recovery (SPIR). The gathered information was sifted and a five-stage classification was formulated as a hypothesis. The images were then assessed using this classification. The relevant statistics were defined, the intra- and interobserver agreements were determined, and the differences between the sexes were analysed.

Results

The application of the new classification made it possible to correctly assess majority in both sexes by the examination of the epiphyses of the knee joint. The intra- and interobserver agreement levels were very good (κ > 0.80). The Mann-Whitney-U Test implied significant sex-related differences for most stages.

Conclusion

Applying the presented MRI classification, it is possible to determine the completion of the 18th year of life in either sex by 3.0 T MRI of the knee joint.

Key points

• Based on prospective referential data a new MRI classification was formulated.

• The setting allows assessment of the age of an individual's skeletal development.

• The classification scheme allows the reliable determination of majority in both sexes.

• The staging shows a high reproducibility for instructed and trained professional personnel.

• The proposed classification is likely to be adaptable to other long bone epiphyses.

MRI-based detection of renal artery abnormalities related to renal denervation by catheter-based radiofrequency ablation in drug resistant hypertensive patients

Abstract

Objectives

Endovascular renal denervation (RDN) using catheter-based radiofrequency (RF) ablation has emerged as a potential treatment option for drug-resistant hypertension. Its efficacy is currently under debate. We aimed to evaluate the capability of contrast-enhanced magnetic resonance imaging (MRI) to assess the effects of RDN on the renal arterial wall in patients presenting with drug-resistant hypertension.

Methods

Patients were included prospectively following institutional review board approval and written informed consent. Renal arteries were imaged using a two-dimensional T1-weighted TSE sequence pre- and post-administration of a gadolinium-based contrast agent, before (D0), 2 days (D2) and 6 months (M6) after RDN. Mean enhancement of the wall (mENH) and mean wall thickness (mWT) were compared across time using an ANOVA with repeated measures and post-hoc paired t-test.

Results

Follow-up was completed for 23 patients (median age, 57 years; 16 men). The mENH at D2 (96.3 ± 36.0 %) was significantly higher than at D0 (61.1 ± 26.3%, p < 0.001) and M6 (66.1±22.7%, p < 0.001). Similarly, mWT was significantly higher at D2 (3.1 ± 0.4 m) than at D0 (2.7 ± 0.4mm, p < 0.001) and M6 (2.9 ± 0. 5 mm, p = 0.002).

Conclusions

MRI demonstrated abnormalities of the arterial wall 2 days after RDN that had resolved at 6 months.

Key Points

• Contrast-enhanced MRI provides anatomic evidence of renal artery RF ablation

• Temperature increase related to RF ablation induces transient arterial wall inflammation

• Morphological effects observed 2 days post RF ablation are not visible after 6 months

Imaging complex ventral hernias, their surgical repair, and their complications

Abstract

Complex ventral hernia (CVH) describes large, anterior, ventral hernias. The incidence of CVH is rising rapidly due to increasing laparotomy rates in ever older, obese and co-morbid patients. Surgeons with a specific interest in CVH repair are now frequently referring these patients for imaging, normally computed tomography scanning. This review describes what information is required from preoperative imaging and the surgical options and techniques used for CVH repair, so that radiologists understand the postoperative appearances specific to CVH and are aware of the common complications following surgery.

Key Points

• Complex ventral hernia (CVH) describes large abdominal wall hernias (e.g. width ≥10cm).

• CVH patients are being referred increasingly for preoperative and postoperative imaging.

• Imaging is pivotal to characterise preoperative morphology and quantify loss of domain.

• Postoperative imaging appearances are contingent on the surgical methods used for CVH repair.

• Postoperative complications are depicted easily by imaging.

Magnetic resonance with diffusion-weighted imaging improves assessment of focal liver lesions in patients with potentially resectable pancreatic cancer on CT

Abstract

Purpose

To investigate added value of MRI to preoperative staging MDCT for evaluation of focal liver lesions (FLLs) in potentially resectable pancreatic ductal adenocarcinomas (PDACs).

Materials and methods

In patients with potentially resectable PDACs after staging MDCT (n=167), characteristics of FLLs were scored as benign, indeterminate or metastases on an MDCT set and combined MDCT and MRI set by two readers, independently. Size of hepatic lesions was measured and detection rate of hepatic metastasis unsuspected by MDCT and diagnostic yield of MRI for FLLs were assessed.

Results

Reader-averaged figure-of-merit (FOM) of the combined set was significantly higher than that of MDCT alone (0.94 vs. 0.86, p=.028). In the negative-on-CT group, the diagnostic yield of MRI was 1.5–2.3% (2/133 and 3/133 for readers 1 and 2, respectively). In the indeterminate-on-CT group, MRI yield was 10.5–13.6% (2/19 and 3/22) and in patients with suspicious-metastasis-on-CT, 8.3–26.7% (1/12 and 4/15). All lesions with false-positive and false-negative CT findings were ≤1 cm.

Conclusion

In potentially resectable PDACs, addition of MRI with DWI can provide significantly better diagnostic performance in characterization of focal liver lesions, especially for small-sized (≤ 1 cm) MDCT-indeterminate or suspicious metastasis lesions, aiding in determination of appropriate operation candidates.

Key Points

• Addition of MRI provides better diagnostic performance in characterization of liver lesions.

• Combined interpretation of MRI and MDCT provided less frequent indeterminate liver lesions.

• Diagnostic yield of MRI was high in CT-indeterminate or suspicious metastatic lesions.

• Operation candidates can be determined with greater confidence in potentially resectable PDACs.

Progressive supranuclear palsy and idiopathic Parkinson’s disease are associated with local reduction of in vivo brain viscoelasticity

Abstract

Objectives

To apply three-dimensional multifrequency MR-elastography (3DMRE) for the measurement of local cerebral viscoelasticity changes in patients with Parkinson's disease (PD) and progressive supranuclear palsy (PSP).

Methods

T1-weighted anatomical imaging and 3DMRE were performed in 17 PD and 20 PSP patients as well as 12 controls. Two independent viscoelasticity parameters, |G*| and φ, were reconstructed combining seven harmonic vibration frequencies (30–60 Hz). Spatially averaged values were compared by one-way ANOVA, groups were compared using unpaired t test and Mann-Whitney test, respectively. Correlation between clinical data and parameters of brain elasticity and volume were calculated by Pearson's correlation coefficient.

Results

In patients, |G*| was significantly reduced in the frontal and mesencephalic regions (p < 0.05). Beyond that, reduced mesencephalic |G*| discriminated PSP from PD (p < 0.05). Neurodegeneration causes significant brain atrophy (p < 0.01) and is pronounced in PSP patients (p < 0.05 vs. PD). Reduced brain viscoelasticity is correlated with brain atrophy in PSP (r=0.64, p=0.002) and PD (r=0.65, p=0.005) patients but not in controls.

Conclusions

MRE-measured viscoelasticity reflects local structural changes of brain tissue in PSP and in PD and provides a useful parameter to differentiate neurodegenerative movement disorders based on imaging examinations.

Key points

• 3D multifrequency MR-elastography reveals diffuse regional changes in brain viscoelasticity in neurodegenerative disorders.

• Reduced mesencephalic viscoelasticity separates PD and PSP.

• Reduced brain viscoelasticity and brain atrophy as independent hallmarks of neurodegeneration hypothesized.

Contrast media injection protocol optimization for dual-energy coronary CT angiography: results from a circulation phantom

Abstract

Objectives

To investigate the minimum iodine delivery rate (IDR) required to achieve diagnostic coronary attenuation (300 HU) with dual-energy coronary CTA.

Methods

Acquisitions were performed on a circulation phantom with a third- generation dual-source CT scanner. Contrast media was injected for a fixed time whilst IDRs varied from 1.0 to 0.3 gI/s in 0.1-gI/s intervals. Noise-optimized virtual monoenergetic imaging (VMI+) reconstructions from 40 to 90 keV in 5 keV increments were generated. Contrast-to-noise ratio (CNR) and coronary HU were measured for each injection.

Results

VMI+ from 40–70 keV reached diagnostic attenuation with at least one IDR. The minimum IDR achieving a diagnostic attenuation ranged from 0.4 gI/s at 40 keV (312.8 HU) to 1.0 gI/s at 70 keV (334.1 HU). Attenuation values reached with IDR of 1.0 gI/s were significantly higher at each keV level (p<0.001). CNR showed a near perfect correlation with the IDR (ρ≥0.962; p<0.001), the IDR of 1.0 gI/s provided the highest CNR at each keV level, achieving the highest overall value at 40 keV (54.0±3.1).

Conclusions

IDRs from 0.4–1.0 gI/s associated with VMI+ from 40–70 keV provide diagnostic coronary attenuation with dual-energy coronary CTA.

Key Points

• Iodine delivery rate (IDR) is a major determinant of contrast enhancement.

• Low-keV noise-optimized monoenergetic images (VMI+) maximize iodine attenuation.

• Low-keV VMI+ allows for lower IDRs while maintaining adequate coronary attenuation.

• Lowest IDR to reach 300 HU was 0.4 gI/s, 40 keV VMI+.

Experimental feasibility of spectral photon-counting computed tomography with two contrast agents for the detection of endoleaks following endovascular aortic repair

Abstract

Objectives

After endovascular aortic repair (EVAR), discrimination of endoleaks and intra-aneurysmatic calcifications within the aneurysm often requires multiphase computed tomography (CT). Spectral photon-counting CT (SPCCT) in combination with a two-contrast agent injection protocol may provide reliable detection of endoleaks with a single CT acquisition.

Methods

To evaluate the feasibility of SPCCT, the stent-lined compartment of an abdominal aortic aneurysm phantom was filled with a mixture of iodine and gadolinium mimicking enhanced blood. To represent endoleaks of different flow rates, the adjacent compartments contained either one of the contrast agents or calcium chloride to mimic intra-aneurysmatic calcifications. After data acquisition with a SPCCT prototype scanner with multi-energy bins, material decomposition was performed to generate iodine, gadolinium and calcium maps.

Results

In a conventional CT slice, Hounsfield units (HU) of the compartments were similar ranging from 147 to 168 HU. Material-specific maps differentiate the distributions within the compartments filled with iodine, gadolinium or calcium.

Conclusion

SPCCT may replace multiphase CT to detect endoleaks without sacrificing diagnostic accuracy. It is a unique feature of our method to capture endoleak dynamics and allow reliable distinction from intra-aneurysmatic calcifications in a single scan, thereby enabling a significant reduction of radiation exposure.

Key Points

• SPCCT might enable advanced endoleak detection.

• Material maps derived from SPCCT can differentiate iodine, gadolinium and calcium.

• SPCCT may potentially reduce radiation burden for EVAR patients under post-interventional surveillance.

Prediction of rupture risk in anterior communicating artery aneurysms with a feed-forward artificial neural network

Abstract

Objectives

Anterior communicating artery (ACOM) aneurysms are the most common intracranial aneurysms, and predicting their rupture risk is challenging. We aimed to predict this risk using a two-layer feed-forward artificial neural network (ANN).

Materials and method

594 ACOM aneurysms, 54 unruptured and 540 ruptured, were reviewed. A two-layer feed-forward ANN was designed for ACOM aneurysm rupture-risk analysis. To improve ANN efficiency, an adaptive synthetic (ADASYN) sampling approach was applied to generate more synthetic data for unruptured aneurysms. Seventeen parameters (13 morphological parameters of ACOM aneurysm measured from these patients' CT angiography (CTA) images, two demographic factors, and hypertension and smoking histories) were adopted as ANN input.

Results

Age, vessel size, aneurysm height, perpendicular height, aneurysm neck size, aspect ratio, size ratio, aneurysm angle, vessel angle, aneurysm projection, A1 segment configuration, aneurysm lobulations and hypertension were significantly different between the ruptured and unruptured groups. Areas under the ROC curve for training, validating, testing and overall data sets were 0.953, 0.937, 0.928 and 0.950, respectively. Overall prediction accuracy for raw 594 samples was 94.8 %.

Conclusion

This ANN presents good performance and offers a valuable tool for prediction of rupture risk in ACOM aneurysms, which may facilitate management of unruptured ACOM aneurysms.

Key Points

• A feed-forward ANN was designed for the prediction of rupture risk in ACOM aneurysms.

• Two demographic parameters, 13 morphological aneurysm parameters, and hypertension/smoking history were acquired.

• An ADASYN sampling approach was used to improve ANN quality.

• Overall prediction accuracy of 94.8 % for the raw samples was achieved.

Vessel architecture in human knee cartilage in children: an in vivo susceptibility-weighted imaging study at 7 T

Abstract

Objectives

To evaluate the clinical feasibility of ultrahigh field 7-T SWI to visualize vessels and assess their density in the immature epiphyseal cartilage of human knee joints.

Methods

7-T SWI of 12 knees (six healthy volunteers, six patients with osteochondral abnormalities; mean age 10.7 years; 3 female, 9 male) were analysed by two readers, classifying intracartilaginous vessel densities (IVD) in three grades (no vessels, low IVD and high IVD) in defined femoral, tibial and patellar zones. Differences between patients and volunteers, IVDs in different anatomic locations, differences between cartilage overlying osteochondral abnormalities and corresponding normal zones, and differences in age groups were analysed.

Results

Interrater reliability showed moderate agreement between the two readers (κ = 0.58, p < 0.001). The comparison of IVDs between patients and volunteers revealed no significant difference (p = 0.706). The difference between zones in the cartilage overlying osteochondral abnormalities to corresponding normal zones showed no significant difference (p = 0.564). IVDs were related to anatomic location, with decreased IVDs in loading areas (p = 0.003). IVD was age dependent, with more vessels present in the younger participants (p = 0.001).

Conclusions

The use of SWI in conjunction with ultrahigh field MRI makes the in vivo visualization of vessels in the growing cartilage of humans feasible, providing insights into the role of the vessel network in acquired disturbances.

Key Points

• SWI facilitates in vivo visualization of vessels in the growing human cartilage.

• Interrater reliability of the intracartilaginous vessel grading was moderate.

• Intracartilaginous vessel densities are dependent on anatomical location and age.

Are growth patterns on MRI in small (< 4 cm) solid renal masses useful for predicting benign histology?

Abstract

Purpose

To evaluate previously described growth patterns in < 4 cm solid renal masses.

Materials and Methods

With IRB approval, 63 renal cell carcinomas (RCC; clear cell n = 22, papillary n = 28, chromophobe n = 13) and 36 benign masses [minimal-fat (mf) angiomyolipoma (AML) n = 13, oncocytoma n = 23) from a single institution were independently evaluated by two blinded radiologists (R1/R2) using T2-weighted MRI for (1) the angular interface sign (AIS), (2) bubble-over sign (BOS), (3) percentage (%) exophytic growth and (4) long-to-short axis ratio. Comparisons were performed using ANOVA, chi-square and multi-variate regression.

Results

AIS was present in 11.1% (7/63) -9.5% (6/63) R1/R2 RCC compared to 13.9% (5/36) -19.4% (7/36) R1/R2 benign masses (p = 0.68 and 0.16). BOS was present in 11.1% (7/63) -3.2% (2/63) R1/R2 RCC compared to 16.7% (6/36) -8.3% (3/36) R1/R2 benign masses (p = 0.432 and 0.261). Agreement was moderate (K = 0.50 and 0.55). mf-AML [66 ± 32% (range 0-100%)] and oncocytoma [53 ± 26% (0-90%)] had larger % exophytic growth compared to RCC [32 ± 23% (0-80%)] (p < 0.001). No RCC had 90-100% exophytic growth, present in 38.5% (5/13) mf-AMLs and 17.4% (4/23) oncocytomas. The long-to-short axis did not differ between groups (p = 0.053).

Conclusions

Benign masses show greater % exophytic growth whereas other growth patterns are not useful. Future studies evaluating % exophytic growth using multi-variate MR analysis in renal masses are required.

Key Points

• Greater exophytic growth is associated with benignity among solid renal masses.

• Only minimal fat AMLs and oncocytomas had 90-100% exophytic growth.

• The angular interface sign was not useful to differentiate benign masses from RCC.

• The bubble-over sign was not useful to differentiate benign masses from RCC.

• Subjective analysis of growth patterns had fair-to-moderate agreement.

Sequential high intensity focused ultrasound (HIFU) ablation in the treatment of benign multinodular goitre: an observational retrospective study

Abstract

Objectives

Assessing the efficacy and safety of sequential high-intensity focused ultrasound (HIFU) ablation in a multinodular goitre (MNG) by comparing them with single HIFU ablation.

Methods

One hundred and four (84.6%) patients underwent single ablation of a single nodule (group I), while 19 (15.4%) underwent sequential ablation of two relatively-dominant nodules in a MNG (group II). Extent of shrinkage per nodule [by volume reduction ratio (VRR)], pain scores (by 0-10 visual analogue scale) during and after ablation, and rate of vocal cord palsy (VCP), skin burn and nausea/vomiting were compared between the two groups.

Results

All 19 (100%) sequential ablations completed successfully. The 3- and 6-month VRR of each nodule were comparable between the two groups (p > 0.05) and in group II, the 3- and 6-month VRR between the first and second nodules were comparable (p = 0.710 and p = 0.548, respectively). Pain score was significantly higher in group II in the morning after ablation (2.29 vs 1.15, p = 0.047) and nausea/vomiting occurred significantly more frequently in group II (15.8% vs 0.0%, p = 0.012). However, VCP and skin burn were comparable (p > 0.05).

Conclusions

Sequential ablation had comparable efficacy and safety as single ablation. However, patients undergoing sequential ablation are at higher likelihood of pain in the following morning and nausea/vomiting after ablation.

Key Points

• Sequential HIFU ablation is well-tolerated in patients with two dominant thyroid nodules

• More pain is experienced in the morning following sequential HIFU ablation

• More nausea/vomiting is experienced following sequential HIFU ablation

Diffusion tensor magnetic resonance imaging of breast cancer: associations between diffusion metrics and histological prognostic factors

Abstract

Objectives

To investigate whether quantitative diffusion metrics derived from diffusion tensor imaging (DTI) are associated with histological prognostic factors in breast cancer patients.

Methods

This retrospective study was approved by the institutional review board, and informed consent was waived. Between 2016 and 2017, 251 consecutive women (mean age, 53.8 years) with breast cancer (230 invasive, 21 in situ) who underwent preoperative magnetic resonance (MR) imaging with DTI were identified. Diffusion gradients were applied in 20 directions (b values, 0 and 1,000 s/mm²). DTI metrics – mean diffusivity (MD) and fractional anisotropy (FA) – were measured for breast lesions and contralateral normal breast by two radiologists and were correlated with histological findings using the Mann-Whitney U-test and linear regression analysis.

Results

MD and FA were significantly lower for breast cancers than for normal fibroglandular tissues (1.03 ± 0.25×10⁻³ mm²/s vs. 1.60 ± 0.19×10⁻³ mm²/s, p < 0.001 and 0.29 ± 0.09 vs. 0.33 ± 0.06, p < 0.001, respectively). Significant differences were observed in MD between invasive cancer and ductal carcinoma in situ lesions (p < 0.001). Multivariate linear analysis showed that larger size (>2 cm) (p = 0.007), high histological grade (grade 3) (p = 0.045) and axillary node metastasis (p = 0.009) were significantly associated with lower MD in invasive breast cancer patients. Larger size (p < 0.001) and high histological grade (p = 0.025) were significantly associated with lower FA.

Conclusions

DTI-derived diffusion metrics, such as MD and FA, are associated with histological prognostic factors in breast cancer patients.

Key points

• MD was significantly lower for breast cancers than for normal breast tissues.

• FA was significantly lower for breast cancers than for normal breast tissues.

• Reduced DTI metrics were associated with poor prognostic factors of breast cancer.

• DTI may provide valuable information concerning biological aggressiveness in breast cancer.

Correction to: A predictive model for distinguishing radiation necrosis from tumour progression after gamma knife radiosurgery based on radiomic features from MR images

Abstract

The original version of this article, published on 24 November 2017, unfortunately contained a mistake.

Mammographic density changes following discontinuation of tamoxifen in premenopausal women with oestrogen receptor-positive breast cancer

Abstract

Objectives

To evaluate the changes in mammographic density after tamoxifen discontinuation in premenopausal women with oestrogen receptor-positive breast cancers and the underlying factors

Methods

A total of 213 consecutive premenopausal women with breast cancer who received tamoxifen treatment after curative surgery and underwent three mammograms (baseline, after tamoxifen treatment, after tamoxifen discontinuation) were included. Changes in mammographic density after tamoxifen discontinuation were assessed qualitatively (decrease, no change, or increase) by two readers and measured quantitatively by semi-automated software. The association between % density change and clinicopathological factors was evaluated using univariate and multivariate regression analyses.

Results

After tamoxifen discontinuation, a mammographic density increase was observed in 31.9% (68/213, reader 1) to 22.1% (47/213, reader 2) by qualitative assessment, with a mean density increase of 1.8% by quantitative assessment compared to density before tamoxifen discontinuation. In multivariate analysis, younger age (≤ 39 years) and greater % density decline after tamoxifen treatment (≥ 17.0%) were independent factors associated with density change after tamoxifen discontinuation (p < .001 and p = .003, respectively).

Conclusions

Tamoxifen discontinuation was associated with mammographic density change with a mean density increase of 1.8%, which was associated with younger age and greater density change after tamoxifen treatment.

Key Points

• Increased mammographic density after tamoxifen discontinuation can occur in premenopausal women.

• Mean density increase after tamoxifen discontinuation was 1.8%.

• Density increase is associated with age and density decrease after tamoxifen.

Comparison of image quality and radiation dose between split-filter dual-energy images and single-energy images in single-source abdominal CT

Abstract

Objectives

To compare image quality and radiation dose of abdominal split-filter dual-energy CT (SF-DECT) combined with monoenergetic imaging to single-energy CT (SECT) with automatic tube voltage selection (ATVS).

Methods

Two-hundred single-source abdominal CT scans were performed as SECT with ATVS (n = 100) and SF-DECT (n = 100). SF-DECT scans were reconstructed and subdivided into composed images (SF-CI) and monoenergetic images at 55 keV (SF-MI). Objective and subjective image quality were compared among single-energy images (SEI), SF-CI and SF-MI. CNR and FOM were separately calculated for the liver (e.g. CNR_liv) and the portal vein (CNR_pv). Radiation dose was compared using size-specific dose estimate (SSDE). Results of the three groups were compared using non-parametric tests.

Results

Image noise of SF-CI was 18% lower compared to SEI and 48% lower compared to SF-MI (p < 0.001). Composed images yielded higher CNR_liv over single-energy images (23.4 vs. 20.9; p < 0.001), whereas CNR_pv was significantly lower (3.5 vs. 5.2; p < 0.001). Monoenergetic images overcame this inferiority in CNR_pv and achieved similar results compared to single-energy images (5.1 vs. 5.2; p > 0.628). Subjective sharpness was equal between single-energy and monoenergetic images and diagnostic confidence was equal between single-energy and composed images. FOM_liv was highest for SF-CI. FOM_pv was equal for SEI and SF-MI (p = 0.78). SSDE was significant lower for SF-DECT compared to SECT (p < 0.022).

Conclusions

The combined use of split-filter dual-energy CT images provides comparable objective and subjective image quality at lower radiation dose compared to single-energy CT with ATVS.

Key points

• Split-filter dual-energy results in 18% lower noise compared to single-energy with ATVS.

• Split-filter dual-energy results in 11% lower SSDE compared to single-energy with ATVS.

• Spectral shaping of split-filter dual-energy leads to an increased dose-efficiency.

MRI-based decision tree model for diagnosis of biliary atresia

Abstract

Objectives

To evaluate MRI findings and to generate a decision tree model for diagnosis of biliary atresia (BA) in infants with jaundice.

Methods

We retrospectively reviewed features of MRI and ultrasonography (US) performed in infants with jaundice between January 2009 and June 2016 under approval of the institutional review board, including the maximum diameter of periportal signal change on MRI (MR triangular cord thickness, MR-TCT) or US (US-TCT), visibility of common bile duct (CBD) and abnormality of gallbladder (GB). Hepatic subcapsular flow was reviewed on Doppler US. We performed conditional inference tree analysis using MRI findings to generate a decision tree model.

Results

A total of 208 infants were included, 112 in the BA group and 96 in the non-BA group. Mean age at the time of MRI was 58.7 ± 36.6 days. Visibility of CBD, abnormality of GB and MR-TCT were good discriminators for the diagnosis of BA and the MRI-based decision tree using these findings with MR-TCT cut-off 5.1 mm showed 97.3 % sensitivity, 94.8 % specificity and 96.2 % accuracy.

Conclusions

MRI-based decision tree model reliably differentiates BA in infants with jaundice. MRI can be an objective imaging modality for the diagnosis of BA.

Key Points

• MRI-based decision tree model reliably differentiates biliary atresia in neonatal cholestasis.

• Common bile duct, gallbladder and periportal signal changes are the discriminators.

• MRI has comparable performance to ultrasonography for diagnosis of biliary atresia.

Have we forgotten imaging prior to and after kidney transplantation?

Key Points

• The number of publications on imaging and kidney transplantation is low.

• These publications are poorly cited, as compared with other fields of imaging.

• Conversely, there is a clinical need for evidence-based recommendations.

• Innovative advances for the use of imaging and kidney transplantation are essential.

• An increased focus and adequate research funding are highly anticipated by clinicians.

The role of breast tomosynthesis in a predominantly dense breast population at a tertiary breast centre: breast density assessment and diagnostic performance in comparison with MRI

Abstract

Objectives

To compare breast density measured on digital breast tomosynthesis (DBT) (BI-RADS-based breast composition and fully-automatic estimation) and magnetic resonance imaging (MRI) (BI-RADS amount of fibroglandular tissue), and to evaluate the diagnostic performance in terms of sensitivity and specificity of DBT and MRI in a predominantly dense breast population.

Methods

Between 2015 and 2016, 152 women with 103 breast malignancies, who underwent 3-T breast MRI and DBT within 2 months' time, were enrolled in this study. Breast composition/fibroglandular tissue and findings on DBT (two readers) and MRI were reported using BI-RADS 5th edition. Digital mammography images were analysed for breast percent density (PD) using the Libra software tool.

Results

A majority of women had dense breasts as categorised by breast composition c (heterogeneously dense) (68%) and d (extremely dense) (15%). The mean PD was 44% (range, 18-89%) and the correlation between breast composition and PD was r = 0.6. The diagnostic performance of MRI was significantly higher compared to DBT for one reader as described by the area under the receiver operating characteristic (ROC) curve (p = 0.004) and of borderline significance for the other reader (p = 0.052).

Conclusions

MRI had higher diagnostic performance than DBT in a dense breast population in the tertiary setting.

Key Points

• MRI had higher diagnostic performance than DBT in a dense breast population

• Diagnostic performance of DBT was comparable to MRI in women with fatty breasts

• MRI was superior to DBT in preoperative breast cancer size assessment

Overall and Sex-specific Associations between Fetal Adversity and Child Development at One Year: Evidence from Brazil

Abstract

A growing body of epigenetic research suggests that in-utero adaptations to environmental changes display important sex-specific variation. We test this heterogeneous adaptation hypothesis using data from 900 children born at the University Hospital in São Paulo, Brazil, between October 2013 and April 2014. Adjusted and unadjusted linear models were used to quantify the associations between prematurity, small for gestational age and children's physical and mental development at 12 months of age. Prematurity was negatively associated with neuropsychological development in fully adjusted models (z-score difference -0.42, 95% confidence intervals: -0.71, -0.14), but associations did not vary significantly by sex. For small for gestational age, associations with height-for-age, weight-for-age and neuropsychological development were also negative, but systematically larger for male than for female infants (p-values all <0.05). These results suggest that male fetuses may be more vulnerable to intra-uterine adversity than females; further research will be needed to better understand the mechanisms underlying these sex-specific associations.

Ixekizumab provides superior efficacy compared to ustekinumab over 52-weeks of treatment: results from IXORA-S, a phase 3 study

The IL-17 antagonist ixekizumab is effective in the clearance of plaque psoriasis. The superior efficacy of ixekizumab over ustekinumab observed at earlier time points is maintained through Week 52 and is associated with greater quality of life improvements. Over 52 weeks, the overall safety of ixekizumab and ustekinumab was comparable.

The Use of a Tympanoplasty Blade for Tumor Extirpation of the Auricle

Natural History of Disease Activity and Damage in Patients with Cutaneous Lupus Erythematosus

There are few longitudinal studies characterizing disease activity and damage of CLE patients. This study utilizes the CLASI to delineate the disease course of CLE patients on standard-of-care treatments. Having high baseline disease activity, minority race, or CLE disease duration <1 year predict CLE activity improvement.

Choosing the Right Biologic for Psoriatic Patients May Be in the Cards

Preliminary Analysis of Pulsed Radiofrequency Therapy Combined with Carpal Tunnel Release for Reducing the Pain in Postoperative Period: Early Outcomes

Carpal tunnel release (CTR) surgery is the main treatment used for moderate and severe CTS. However, despite this treatment, symptoms of pain may continue into the early postoperative period in some cases1.

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

It is with great interest that we have read the recent publication of Legemate CM et al. on the technique and long-term outcome of the pedicled internal pudendal artery perforator (PIPAP) flap for ischial pressure sore reconstruction.1 First described by Hashimoto et al., this flap is an interesting option due to its rich vascular network, easy dissection, feasible primary closure of the donor site, and the fact that the pudendal artery perforators are close to the location of the ischial defect.

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

Abdominal-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.

Optimization of the method of the content‐containing interaction evaluation for cosmetic products by gas chromatography–mass spectrometry

International Journal of Cosmetic Science, EarlyView.

Radiomics signature: a biomarker for the preoperative discrimination of lung invasive adenocarcinoma manifesting as a ground-glass nodule

Abstract

Objectives

To identify the radiomics signature allowing preoperative discrimination of lung invasive adenocarcinomas from non-invasive lesions manifesting as ground-glass nodules.

Methods

This retrospective primary cohort study included 160 pathologically confirmed lung adenocarcinomas. Radiomics features were extracted from preoperative non-contrast CT images to build a radiomics signature. The predictive performance and calibration of the radiomics signature were evaluated using intra-cross (n=76), external non-contrast-enhanced CT (n=75) and contrast-enhanced CT (n=84) validation cohorts. The performance of radiomics signature and CT morphological and quantitative indices were compared.

Results

355 three-dimensional radiomics features were extracted, and two features were identified as the best discriminators to build a radiomics signature. The radiomics signature showed a good ability to discriminate between invasive adenocarcinomas and non-invasive lesions with an accuracy of 86.3%, 90.8%, 84.0% and 88.1%, respectively, in the primary and validation cohorts. It remained an independent predictor after adjusting for traditional preoperative factors (odds ratio 1.87, p < 0.001) and demonstrated good calibration in all cohorts. It was a better independent predictor than CT morphology or mean CT value.

Conclusions

The radiomics signature showed good predictive performance in discriminating between invasive adenocarcinomas and non-invasive lesions. Being a non-invasive biomarker, it could assist in determining therapeutic strategies for lung adenocarcinoma.

Key Points

• The radiomics signature was a non-invasive biomarker of lung invasive adenocarcinoma.

• The radiomics signature outweighed CT morphological and quantitative indices.

• A three-centre study showed that radiomics signature had good predictive performance.

Dynamic contrast-enhanced CT for the assessment of tumour response in malignant pleural mesothelioma: a pilot study

Abstract

Objectives

The aim of this pilot study was to investigate the utility of haemodynamic parameters derived from dynamic contrast-enhanced computed tomography (DCE-CT) scans in the assessment of tumour response to treatment in malignant pleural mesothelioma (MPM) patients.

Methods

The patient cohort included nine patients undergoing chemotherapy and five patients on observation. Each patient underwent two DCE-CT scans separated by approximately 2 months. The DCE-CT parameters of tissue blood flow (BF) and tissue blood volume (BV) were obtained within the dynamically imaged tumour. Mean relative changes in tumour DCE-CT parameters between scans were compared between the on-treatment and on-observation cohorts. DCE-CT parameter changes were correlated with relative change in tumour bulk evaluated according to the modified RECIST protocol.

Results

Differing trends in relative change in BF and BV between scans were found between the two patient groups (p = 0.19 and p = 0.06 for BF and BV, respectively). No significant rank correlations were found when comparing relative changes in DCE-CT parameters with relative change in tumour bulk.

Conclusions

Differing trends in the relative change of BF and BV between patients on treatment and on observation indicate the potential of DCE-CT for the assessment of pharmacodynamic endpoints with respect to treatment in MPM. A future study with a larger patient cohort and unified treatment regimens should be undertaken to confirm the results of this pilot study.

Key Points

• CT-derived haemodynamic parameters show differing trends between malignant pleural mesothelioma patients on treatment and patients off treatment

• Changes in haemodynamic parameters do not correlate with changes in tumour bulk as measured according to the modified RECIST protocol

• Differing trends across the two patient groups indicate the potential sensitivity of DCE-CT to assess pharmacodynamic endpoints in the treatment of MPM

Bioadsorption of trivalent and hexavalent chromium from aqueous solutions by sericin-alginate particles produced from Bombyx mori cocoons

Abstract

In this study, particles produced from sericin-alginate blend were used as non-conventional bioadsorbent for removing Cr(III) and Cr(VI) from aqueous solutions. Besides chromium mitigation, the use of sericin-alginate particles as bioadsorbent aims to offer an environmental solution of added value for sericin, which is a by-product from silk industry. Sericin-alginate particles in natura and loaded with Cr(III) and Cr(VI) were characterized using N₂ physical adsorption analysis, optical microcopy, mercury porosimetry, helium pycnometry, scanning electron microscope coupled with energy dispersive X-ray spectrometer, Fourier transform infrared spectrometer, and X-ray diffraction. Kinetic studies on the removal of Cr(III) (at pH = 3.5) and Cr(VI) (at pH = 2) indicate the ion exchange mechanism with Ca(II) and the predominance of external mass transfer resistance. Cr(VI) uptake occurs through an adsorption-coupled reduction process, and bioadsorption equilibrium is reached after ~ 1000 min. Cr(III) bioadsorption occurs faster (~ 210 min). The Cr(VI) bioadsorption is endothermic, as bioadsorption capacity increases with temperature: 0.0783 mmol/g (20 °C), 0.1960 mmol/g (30 °C), 0.4570 mmol/g (40 °C), and 0.7577 mmol/g (55 °C). The three-parameter isotherm model of Tóth best represents the equilibrium data of total chromium. From Langmuir isotherm model, the maximum bioadsorption capacity is higher for total chromium, 0.25 mmol/g (30 °C), than for trivalent chromium, 0.023 mmol/g (30 °C). The comparison of bioadsorption capacities with different biomaterials confirms sericin-alginate particles as potential bioadsorbent of chromium.

Magnetic flocculants synthesized by Fe 3 O 4 coated with cationic polyacrylamide for high turbid water flocculation

Abstract

A novel magnetic flocculant (CPAMF) was synthesized by using Fe₃O₄ coated with cationic polyacrylamide (CPAM) for flocculation of high turbid water. The surface morphology and chemical structures of CPAMF were confirmed by Fourier transform infrared spectroscopy (FTIR) and thermo-gravimetric analysis (TGA). X-ray diffraction (XRD) was employed to verify the crystal structure of CPAMF. The magnetic property of CPAMF was compared with Fe₃O₄ in this study. The flocculation performance by using flocculants CPAMF was evaluated in high turbid water treatment. The maximum transmittance 92.4% of kaolin suspension was achieved at corresponding optimal flocculation conditions. The result indicated that CPAMF was efficient in high turbid water flocculation. Analysis of FTIR, XRD of flocs, and zeta potential (ZP) of supernatant were accomplished for flocculation mechanism investigation. Because of low recovery factor in reflocculation under the effect of shear force on flocs, the bridging effect was found to be dominant in both acidic and alkaline conditions. Sedimentation experiments under the role of permanent magnet indicated that nano-Fe₃O₄ could effectively improve the settling property of CPAM.

Graphical abstract

ᅟ