Abstract
No standard criteria exist for assessing response and progression in clinical trials involving patients with meningioma and there is no consensus on the optimal endpoints for trials currently underway. As a result, there is substantial variation in the design and response criteria of meningioma trials, making comparison between trials difficult. In addition, future trials should be designed with accepted standardized endpoints. The Response Assessment in Neuro-Oncology Meningioma Working Group is an international effort to develop standardized radiologic criteria for treatment response for meningioma clinical trials. In this proposal, we present the recommendations for response criteria and endpoints for clinical trials involving patients with meningiomas.Σάββατο 18 Αυγούστου 2018
Leptin is a physiological regulator of skeletal muscle angiogenesis and is locally produced by PDGFRα and PDGFRβ expressing perivascular cells
Abstract
Skeletal muscle capillarity is characteristically reduced in mature leptin receptor-deficient (Leprdb) mice, which has been attributed to the capillary loss that occurs secondary to metabolic dysfunction. Despite wide recognition of leptin as a pro-angiogenic molecule, the contribution of this adipokine has largely been overlooked in peripheral tissues. Moreover, prior documentation of leptin production within skeletal muscle indicates a potential paracrine role in maintaining local tissue homeostasis. Thus, we hypothesized that leptin is a physiological local paracrine regulator of skeletal muscle angiogenesis and that its production may be modulated by nutrient availability. Leprdb mice exhibited impaired angiogenesis during normal developmental maturation of skeletal myocytes, corresponding with an inability to increase vascular endothelial growth factor-A (VEGFA) mRNA and protein levels between 4 and 13 weeks. In cultured murine and human skeletal myocytes, recombinant leptin increased VEGFA mRNA levels. Leptin mRNA was detectable in skeletal muscle, increasing with prolonged high-fat feeding in mice, and with adiposity in human subjects. Platelet-derived growth factor receptor (PDGFR)α− and PDGFRβ− expressing perivascular cell populations were identified as leptin producing within skeletal muscle of mice and humans. Furthermore, in response to 2 weeks of high-fat feeding, PDGFRβ+ but not PDGFRα+ cells increased leptin production. We conclude that leptin is a physiological regulator of the capillary network in skeletal muscle and stimulates VEGFA production by skeletal myocytes. PDGFRβ expressing perivascular cells exhibit the capacity to act as local "nutrient-sensors" that couple nutrient status to leptin production in skeletal muscle.
Crude oil removal from aqueous solution using raw and carbonized Xanthoceras sorbifolia shells
Abstract
Fruit shell residue from Xanthoceras sorbifolia was investigated as a potential biosorbent to remove crude oil from aqueous solution. The shell powder and its carbonized material were compared while assessing various factors that influenced oil removal capacity. The structure and sorption mechanism were characterized using scanning electron microscopy and Fourier-transform infrared spectroscopy. The oil removal capacity of the raw material (75.1 mg g−1) was better than the carbonized material (49.5 mg g−1). The oil removal capacity increased with greater saponin content, indicating that hydrophobic and lipophilic surface characteristics of the saponins improved adsorption by the raw X. sorbifolia shell. An orthogonal experimental design was used to optimize the adsorption. Using 4 g L−1 of raw X. sorbifolia shell (particle size of < 0.15 mm), the highest crude oil removal efficiency was obtained using an initial oil concentration of 400 mg L−1, adsorption temperature of 30 °C, adsorption time of 10 min at a shaking speed of 150 rpm. The adsorption of crude oil onto X. sorbifolia shell was best described using a pseudo-second-order kinetic model. Raw X. sorbifolia shell material was more efficient than the carbonized material at crude oil removal from aqueous solution. This was attributable to the functional groups of saponins in raw X. sorbifolia shell. This study highlights that some agricultural and forest residues could be a promising source of low-cost biosorbents for oil contaminants from water—without requiring additional processing such as carbonization.
Arundo donax L. stem-derived biochar increases As and Sb toxicities from nonferrous metal mine tailings
Abstract
Toxic metal(loid)s released from tailing residues of mining operations have become a global issue with regard to environmental impacts. Biochar derived from the agriculture waste is considered as a cost-effective and stable material, which could be applied for remediation of sites contaminated with toxic metal(loid)s. In the present study, tailings were amended for 90 days with increasing concentrations of Arundo donax L. stem-derived biochar (ASBC; at 0, 1, 3, and 5%). The 7-day wheat seed germination toxicity test was then used to assess the bioavailability of toxicants in aqueous leachates of the biochar-amended tailing samples. Concentrations of As, Cd, Cu, Pb, and Sb in leachates and the Community Bureau of Reference chemical fractions were determined using ICP-OES. The results indicated that tailing leachates were phytotoxic, an effect that was partially decreased due to increasing concentrations of ASBC, with maximum effects (∼47% of tailing phytotoxicity) occurring at 3% ASBC. Results of further fractionation analyses indicated that increasing concentrations of ASBC amendment decreased the mobile fractions of Cd, Cu, and Pb in tailing samples, but increased the mobilities of As and Sb. A novel approach using the relative toxicity index (= sum of toxicities of individual potentially toxic elements) indicated that the toxicity of the tailings decreased when As was not present, since As decreased the biochar-reduced toxicity. Our results suggest that the ability of using biochar to decrease toxicity in tailings (by sequestration of cationic metals such as Cd, Cu, and Pb) is limited by its inability to immobilize oxyanionic metalloids such as As and Sb.
Éruption lichénoïde cutanéo-muqueuse sous anti-PD-1
Publication date: Available online 17 August 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): M. Amini-Adle, B. Balme, M. Locatelli-Sanchez, P.-J. Souquet, S. Dalle
Étude rétrospective d’une série de pemphigus paranéoplasiques
Publication date: Available online 17 August 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): M. Fournet, P. Roblot, P. Levillain, G. Guillet, L. Machet, L. Misery
Résumé
Contexte
Le pemphigus paranéoplasique (PPN) est une maladie très rare et de mauvais pronostic associant un pemphigus, particulier par certains critères cliniques, immunologiques et histologiques, à une néoplasie.
Méthodes
Nous avons rétrospectivement analysé les dossiers de patients présentant un PPN dans la région Poitou-Charentes entre 2000 et 2015.
Résultats
Sept patients présentaient neuf néoplasies diagnostiquées de 4 mois avant à 25 mois après l'apparition des lésions cutanées (6/7) ou muqueuses (6/7) de pemphigus. Les lésions étaient cliniquement polymorphes. L'examen histologique révélait une acantholyse épidermique (7/7), des nécroses kératinocytaires (4/7) et une dermite lichénoïde d'interface (5/7). On mettait en évidence des dépôts d'IgG et de C3 intercellulaires ou le long de la jonction dermo-épidermique en immunofluorescence directe (IFD) (7/7), des anticorps anti-substance intercellulaire en immunofluorescence indirecte (IFI) sur vessie de rat (4/6), un immunotransfert reconnaissant les cibles antigéniques du PPN (2/4). La durée du suivi allait de 1 à 132 mois, la survie à 1 an était de 85,7 %.
Discussion
Les présentations cliniques et histopathologiques observées chez nos patients sont polymorphes, avec un chevauchement entre les manifestations cliniques et histologiques de PPN et de pemphigus classique. Le pronostic est meilleur dans notre série que dans la littérature. Les néoplasies associées sont diverses. Il semble exister des associations fortuites de pemphigus à des néoplasies, de meilleur pronostic que les véritables PPN. Un nouveau consensus pour les critères diagnostiques du PPN est nécessaire, qui aiderait les praticiens à diagnostiquer le PPN de manière plus homogène pour réaliser des études pronostiques ou des essais thérapeutiques.
Summary
Context
Paraneoplastic pemphigus (PNP) is a rare condition associated with poor prognosis. It associates polymorphic mucocutaneous manifestations with neoplasia. Diagnosis is difficult because of the various clinical and histological features involved and the lack of specificity of immunological examinations.
Methods
We retrospectively analyzed the records of patients presenting with PNP in the Poitou-Charentes region between 2000 and 2015.
Results
Seven patients were included. They presented 9 neoplasias (1 lymphoma, 1 melanoma, and 7 carcinomas) diagnosed from 4 months before to 25 months after the occurrence of cutaneous (6/7) and/or mucosal (6/7) polymorphic lesions. Histological examination revealed epidermal acantholysis (7/7), keratinocytic necrosis (4/7), and interface lichenoid dermatitis (5/7). Intercellular deposits of IgG and C3 or along the dermo-epidermal junction were detected with direct immunofluorescence (IF) (7/7). Four of 6 patients tested had positive indirect IF on rat bladder epithelium. Follow-up ranged from 1–132 months with a one-year survival of 85.7%.
Discussion
The clinical and histopathological presentations observed in our patients were polymorphic, with overlap between the clinical and histological features of PNP and classical pemphigus. Prognosis and survival appear better in our series than in the literature. It is possible that in some cases, the association of pemphigus with neoplasia was fortuitous, which might account for the better prognosis. A new consensus on the diagnostic criteria for PNP is needed to help practitioners to consensually diagnose it for prognostic or therapeutic trials.
A Bayesian assessment of occupational health surveillance in workers exposed to silica in the energy and construction industry
Abstract
Medical records generated during occupational health surveillance processes have large amounts of unexploited information that can help to reduce silica-related health risks and many occupational diseases. The methodology applied in this study consists in analyzing through machine learning techniques a database with 70,000 medical examinations from workers in the energy and construction industry in Spain. First, a general unsupervised Bayesian model is built and node force analysis is used to identify the factors with the greatest impact on the worker's health surveillance process. Second, a predictive Bayesian model is created and mutual information is employed to assess the more relevant factors affecting the medical capability of workers exposed to silica dust. The lung auscultation and the breathing exploration are the two factors that influence the most the medical capability of silica-exposed employees. Probabilistic inference shows a remarkable gender effect, where women present more resilience towards occupational diseases than men showing a higher proportion of normal results in certain key factors, such as body mass index (♀49.73%, ♂25.17%) or spirometry (♀53.73%, ♂48.91%). Finally, environmental conditions demonstrate to have a major influence on spatial variability of occupational diseases. The design of health prevention programs based on geographical variations can be crucial to the attainment of an ongoing and sustained healthier workforce with a reduction in the number of chronic workplace illnesses.
Zoon's plasma cell balanitis: clinical and dermoscopic features in pediatric patients
International Journal of Dermatology, EarlyView.
Recommendations for the use of telemedicine in severely under‐resourced settings: results from a pilot study in Niamey, Niger
International Journal of Dermatology, EarlyView.
Gastrointestinal prophylaxis in patients with autoimmune blistering disease treated with corticosteroids: an expert survey
International Journal of Dermatology, EarlyView.
(Invited thematic article) Prevalence and pathogenesis of osteopenia and osteoporosis in epidermolysis bullosa: An Evidence Based Review
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
Appropriate use of dressings containing nanocrystalline silver to support antimicrobial stewardship in wounds
International Wound Journal, EarlyView.
An evidence‐based review of split‐thickness skin graft donor site dressings
International Wound Journal, EarlyView.
Efficacy and safety of daylight photodynamic therapy after tailored pretreatment with ablative fractional laser or microdermabrasion: a randomized, side‐by‐side, single‐blind trial in patients with actinic keratosis and large area field cancerization
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
Mosaic mutations in FGFR3 and FGFR2 are associated with naevoid acanthosis nigricans or RAVEN (round and velvety epidermal naevus)
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
Tumor spontaneous regression in an elderly patient with Squamous Cell Carcinoma of the cranial vertex pre‐treated with cetuximab monotherapy
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
Therapeutic efficacy of early photobiomodulation therapy on the zones of stasis in burns: An experimental rat model study
Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.
Adipose‐derived stem cells and the stromal vascular fraction in polyglycolic‐acid (PGA)‐collagen nerve conduits promote rat facial nerve regeneration
Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.
Patients’ prediction of their wound healing time
Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.
Validation of three‐dimensional wound measurements using a novel 3D‐WAM camera
Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.
Differences between Patient‐ and Proxy‐reported HRQoL Using the Wound‐Qol
Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.
A synthetic microRNA‐92a inhibitor (MRG‐110) accelerates angiogenesis and wound healing in diabetic and non‐diabetic wounds
Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.
Xeroderma pigmentosum group D: Report of a novel combination of ERCC2 variations and its phenotype
The Journal of Dermatology, EarlyView.
Development of Kasabach–Merritt phenomenon following vaccination: More than a coincidence?
The Journal of Dermatology, EarlyView.
Subungual exostosis with postoperative recurrence followed by spontaneous regression
The Journal of Dermatology, EarlyView.
Reciprocal relationship between herpes zoster and cardiovascular diseases: A nationwide population‐based case–control study in Korea
The Journal of Dermatology, EarlyView.
Παρασκευή 17 Αυγούστου 2018
Analysis of a photobioreactor scaling up for tertiary wastewater treatment: denitrification, phosphorus removal, and microalgae production
Abstract
The present work studies the removal of nutrients (nitrate and phosphate) from a synthetic wastewater simulating a secondary treatment effluent using the microalgae Chlorella vulgaris in autotrophic photobioreactors, together with an analysis of the critical points affecting the scaling-up process from laboratory to pilot scale. Laboratory experiments were done in open agitated 1-L photobioreactors under batch operation mode, while pilot-scale experiments were done using a 150-L closed tubular photobioreactor under continuous operation mode. In both scales, nitrate was the limiting substrate and the effect of its concentration on microalgae performance was studied. From laboratory experiments, an average microalgae productivity of 85 mgVSS L−1 day−1 and approximate maximum N-NO3− and P-PO43− removal rates of 8 mg N gVSS−1 day−1, and 2.6 mg P gVSS−1 day−1 were found. Regarding pilot scale, the average microalgae productivity slightly decreased (76 mgVSS L−1 day−1) while the approximate maximum N-NO3− and P-PO43− removal rates slightly were increased (11.7 mg N gVSS−1 day−1 and 3.04 mg P gVSS−1 day−1) with respect to the laboratory-scale results. The pilot-scale operation worked under lower levels of turbulence and higher dissolved oxygen concentration and light intensity than laboratory experiments; those parameters were difficult to control and they can be identified as the critical points in the differences found on both nutrient removal and microalgae production.
Integrating natural and engineered remediation strategies for water quality management within a low-impact development (LID) approach
Abstract
The objective of this paper is to demonstrate an interdisciplinary strategy combining both engineering- and biology-based approaches for stormwater and wastewater treatment. The work involves a novel and environmentally friendly surface material that can withstand urban load over its design service life, allows preliminary treatment through filtration, and diverts water to the subsurface to conduct secondary treatment below the surface through phytoremediation via the extensive rooting systems of trees. The present study highlights an interdisciplinary low-impact development (LID) approach developed for a polluted industrial wastewater site, for a cleaner and greener environment. The LID system involves (i) rhizofiltration and phytoremediation methods for removing heavy metals and organic pollutants using a hybrid poplar and aspen species; (ii) porous infrastructure produced using industrial waste, referred to as geopolymer pavers; and (iii) use of Silva cells as a tree-friendly and load support system. The design of the pavers over the Silva cells is innovative as it can deal with rainwater runoff and urban transportation loads simultaneously. The proposed system has the ability to extract heavy metals that are common in urban runoff or domestic and industrial effluents thus preserving the ecosystem naturally. The test site is only 15 m2, but designed for a water-retention capacity of 2 m3 (roughly 1:100 year design volume draining a 10 × 10 m parking lot), and remediation levels for Cu and Zn are expected to reach 180 mg/kg dry weight and 1200 mg/kg dry weight, respectively.
Short-term copper exposure as a selection pressure for antibiotic resistance and metal resistance in an agricultural soil
Abstract
Owing to the similar mechanisms of antibiotic and metal resistance, there is a growing concern that metal contamination may select for antibiotic resistance genes (ARGs) in the environment. Here, we constructed short-term laboratory microcosms to investigate the dynamics of a wide range of ARGs and two copper (Cu) resistance genes in an agricultural soil amended with a gradient of Cu concentrations (0~1000 mg kg−1). Mobile genetic elements (MGEs) were also quantified as a proxy for the horizontal gene transfer potential of ARGs. We detected 126 unique ARGs across all the soil samples using the high-capacity quantitative PCR array, and multidrug and β-lactam resistance were the most abundant ARG categories. The copper amendments significantly enhanced the absolute and relative abundances of ARGs and MGEs, which gradually increased along the gradient of increasing Cu concentrations. The two Cu resistance genes (copA and pcoR) were highly enriched in low-level Cu treatment (50 and 100 mg kg−1), and their abundances decreased with the increasing Cu concentrations. The level of metal and antibiotic resistance gradually declined over time in all Cu-amended treatments but was still considerably higher in contaminated soils than untreated soils after 56 days' incubation. Significant associations among ARGs and MGEs were revealed by the network analysis, suggesting the mobility potential of antibiotic resistance in Cu-amended soils. No significant positive correlations were found between ARGs and copper resistance genes, suggesting that these genes are not located in the same bacterial hosts. Taken together, our results provide empirical evidence that short-term copper stress can cause evolution of high-level antibiotic and metal resistance and significantly change the diversity, abundance, and horizontal transfer potential of soil ARGs.
Foliar application of Zn can reduce Cd concentrations in rice ( Oryza sativa L.) under field conditions
Abstract
Cadmium (Cd) pollution in rice and its transfer to food chain are cause of global concern. Application of zinc (Zn) can reduce Cd uptake by plants, as both these metals are generally antagonistic in soil–plant systems. In a field experiment on Cd-contaminated acid soil, we investigated the effectiveness of foliar application of Zn in minimizing Cd accumulation and its effect on the content of mineral nutrient elements in rice. The treatment was done at an early grain filling stag using 0.3 and 0.5% w/v ZnSO4·7H2O solution. The spray did not affect the grain yield of rice but decreased the Cd concentration in the root, straw, husk, and brown rice to some extent and increased the Zn concentration. Foliar application of 0.5% ZnSO4 resulted in maximum Zn concentration and minimum Cd concentration in brown rice. However, the concentrations of P, K, Ca, Mg, Cu, and Mn in brown rice were not affected. The correlation between Cd and Zn concentrations in brown rice, husk, and root was significantly negative, and that between Cd and Mn concentrations in brown rice was significantly positive. The inhibition of Cd uptake resulted in a decrease in its concentration in brown rice after the treatments. Thus, the foliar application of a suitable concentration of Zn at the early grain filling stage could effectively minimize the Cd concentration while enhancing the Zn concentration in brown rice on Cd-contaminated acid soil.
Evaluation of the odor impact of some environmental gaseous pollutants: calibration of the methodology and preliminary results
Abstract
During the last decades, it has been observed a growing interest on odor impact because of the frequenter social acceptability problems about energy plants handling and processing stored organic materials (e.g., biogas plants, landfills, farms, distilleries, etc.). In this context, the UNI EN 13725:2004 indicates the "dynamic olfactometry method" as validated, recognized, and adequate measurement procedure for estimating the odor concentration. This protocol is carried out by a panel of specifically trained and selected human receptors, but alternative analytical methodologies are currently under discussion. This work aims to describe the initial steps of a wider research toward the definition of a new analytical protocol for monitoring odor concentration. The alternative methodology is here presented through the implementation of a case study: stored organic materials exploited on an energy plant in Central Italy. The paper describes the preliminary activities related to the survey of the case study (i), the definition of alternative methods and devices for conducting emissions sampling (ii), and the adopted experimental approach (iii). Finally, preliminary results are also presented (iv). The resulting protocol, once validated, could be employed by local authorities to measure both the odor impacts and the effectiveness of specifically designed mitigation strategies.
Mixed Meal and Intravenous L-Arginine Tests Both Stimulate Incretin Release Across Glucose Tolerance in Man: Lack of Correlation with β Cell Function
Metabolic Syndrome and Related Disorders, Ahead of Print.
Magnetic ion exchange resin for effective removal of perfluorooctanoate from water: study of a response surface methodology and adsorption performances
Abstract
This research exhibited the use of magnetic ion exchange (MIEX) resin as an effective adsorbent for the removal of perfluorooctanoate (PFOA) in aqueous solution. The adsorption performance of PFOA was investigated by a batch experiment. All kinds of factors affecting the adsorption of PFOA, including adsorbent dosage, initial concentration, adsorption time, temperature, stirring intensity, coexistent anions, initial solution pH, natural organic matter, ion strength, and bed volume were studied. Moreover, the response surface methodology was put into use to know the key parameters affecting PFOA removal efficiency. The sorption equilibrium and kinetic data could conform well to the Langmuir and pseudo-second-order model, respectively. Thermodynamic parameters were obtained, and it was observed that the adsorption of PFOA onto MIEX resin was an endothermic and spontaneous process at the temperatures under investigation. It was summarized that both chemical absorption and physical adsorption were involved in the PFOA sorption onto the MIEX resin. Moreover, the MIEX resin could be effectively regenerated using a saturated sodium chloride solution. A series of batch experiments and characterizations demonstrated that the MIEX resin possessed a strong adsorption ability with the removal efficiency exceeding 90%, allowing a possible practical application in future water treatment.
Effects of organic-inorganic amendments on the cadmium fraction in soil and its accumulation in rice ( Oryza sativa L.)
Abstract
Cadmium (Cd) stress is a serious concern in agricultural soils worldwide, and increasing accumulation and subsequent transfer to humans via the food chain can have potentially harmful effects. In this study, field experiments were conducted to examine the uptake and translocation of Cd in rice, changes in the soil Cd speciation, and the subsequent effect on Cd accumulation in rice under combined organic (farmyard manure and crop straw) and inorganic (sepiolite, lime, and calcium-magnesium phosphate) soil amendments. The results showed that farmyard manure combined with sepiolite or lime and straw combined with lime or calcium-magnesium phosphate reduced the Cd translocation from the rice roots to the straw and the grains, significantly decreasing the Cd accumulation in brown rice. In addition, straw combined with sepiolite, lime, or calcium-magnesium phosphate reduced the Cd accumulation in brown rice but increased the Cd translocation from the roots to the straw by 37.8–279.3% compared with the control. Organic-inorganic amendments also decreased the soil exchangeable Cd and increased the organic-bound Cd by more than 40%. Fe-Mn oxide-bound Cd also increased but varied with growth. Cd accumulation in brown rice showed a significant positive relationship with soil exchangeable Cd at 90 days after transplantation, while at 30 days, the increase in Fe-Mn oxide- and organic-bound Cd was found to be the key factor in reducing the Cd accumulation in rice. These findings suggest that straw (under rice-rape rotation) and farmyard manure (under rice-wheat rotation) combined with sepiolite or lime are widely applicable as agronomic control techniques aimed at lowering Cd pollution.
ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up
Abstract
The European Society for Medical Oncology (ESMO) consensus conference on testicular cancer was held on 3–5 November 2016 in Paris, France. The conference included a multidisciplinary panel of 36 leading experts in the diagnosis and treatment of testicular cancer (34 panel members attended the conference; an additional two panel members [CB and K-PD] participated in all preparatory work and subsequent manuscript development). The aim of the conference was to develop detailed recommendations on topics relating to testicular cancer that are not covered in detail in the current ESMO Clinical Practice Guidelines (CPGs) and where the available level of evidence is insufficient. The main topics identified for discussion related to: (1) diagnostic work-up and patient assessment; (2) stage I disease; (3) stage II-III disease; (4) post-chemotherapy surgery, salvage chemotherapy, salvage and desperation surgery and special topics; and (5) survivorship and follow-up schemes. The experts addressed questions relating to one of the five topics within five working groups. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel. A consensus vote was obtained following whole-panel discussions, and the consensus recommendations were then further developed in post-meeting discussions in written form. This manuscript presents the results of the expert panel discussions, including the consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.Understanding patterns of pathologic response following neoadjuvant immunotherapy for solid tumors
The widespread use of immunotherapeutics in oncology [immune-oncology (IO)] today represents a fundamental shift in the clinical approach to elimination of cancer cells. In contrast to the directly cytotoxic and/or cytostatic effects of conventional chemotherapy, radiotherapy, and targeted therapies, drugs directed at immune checkpoints, including PD-1/PD-L1 and CTLA4, harness the patient's immune system to effect tumor cell killing [1]. IO approaches have shown particular promise in solid tumors with a high burden of immunogenic neoantigens, such as non-small-cell lung cancer (NSCLC) and melanoma, and currently represent standard of care treatment of at least a subset of patients with these tumor types [2]. Radiographic studies of tumors undergoing immunotherapy have identified some distinctive patterns of tumor response, such as pseudoprogression and development of new lesions despite shrinking of the baseline tumor, triggering proposals for revised approaches to radiographic response evaluation in IO-treated patients [3, 4]. These unique radiographic patterns are thought to represent tumor infiltration by immune cells, however, the actual reasons for dynamic changes in radiographic tumor appearance can only be inferred from imaging studies.
4th ESO–ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4)†
breast cancermetastaticadvancedguidelinesABCESO-ESMO
Morphea with oral mucosa involvement and unilateral nevoid telangiectasia: A case report and review of the literature
Morphea is a localized inflammatory skin disease that presents with sclerosis of the skin and underlying tissues due to excessive collagen deposition. Although the incidence of odontostomatologic abnormalities in patients with linear scleroderma of the face is higher, oral involvement remains quite rare. Unilateral nevoid telangiectasia is a rare vascular dermatosis characterized by unilateral telangiectasia distributed in a dermatomal pattern, especially on the upper trunk and extremities. We describe a case of a 10-year-old girl that presents with morphea on her left chin and upper lip extending to the inner oral mucosa as well as an unilateral nevoid telangiectasia on her left cheek.
Recurrent systemic follicular lymphoma presenting as facial nodules
Systemic follicular lymphomas (SFL) exhibit heterogeneous clinical presentations and cutaneous involvement is rare with less than 4% of patients developing skin involvement during their disease course. We report a case of recurrent SFL presenting with facial nodules. A 64-year-old man with a history of stage IV SFL had a complete response to bendamustine and rituximab in 2012. Approximately 5 years later, the patient presented with enlarging rubbery, violaceous, nontender nodules on his left submandibular, left zygomatic, and right temple areas that appeared one month before.
Psoriasis and the risk of foot and ankle tendinopathy or enthesopathy: A population-based study
Objectives: Cross-sectional imaging studies have demonstrated that patients with psoriasis often have asymptomatic bone and tendon changes of the foot and ankle consistent with tendinopathy or enthesopathy. While considered an extra-articular manifestation of psoriatic arthritis, it is unknown if psoriasis patients without psoriatic arthritis have an increased risk of symptomatic foot and ankle tendinopathy or enthesopathy compared with the general population.
Real-world apremilast experience in Australia
Introduction: This retrospective analysis undertaken in June 2017 was performed on 80 patients with chronic plaque psoriasis (CPP) who received apremilast in Australia and were enrolled in the Australasian Psoriasis Registry (APR). Apremilast received Therapeutic Goods Administration-approval in Australia in 2015. Other products approved for CPP include biologic agents targeting tumor necrosis factor alpha (TNF-α), interleukin (IL) 12/23 and IL-17, as well as conventional oral systemic therapies methotrexate, acitretin, and cyclosporine.
Pyoderma gangrenosum–like fixed cutaneous sporotrichosis
Introduction: Cutaneous sporotrichosis (CS) is a rare mycotic infection, caused by the Sporothrix schenckii complex. Lesions of CS are polymorphic by nature; however, most patients develop lymphocutaneous-type lesions following fungal inoculation, and only a minority disseminated disease or fixed cutaneous lesions. Fixed CS may display a wide range of clinical morphologies, including ulcerated, crusted, verrucous or psoriasiform plaques, with or without satellite lesions.
Non-destructive evaluation of watermelon seeds germination by using Delayed Luminescence
Publication date: Available online 17 August 2018
Source: Journal of Photochemistry and Photobiology B: Biology
Author(s): Grasso Rosaria, Gulino Marisa, Giuffrida Francesco, Agnello Michele, Musumeci Francesco, Scordino Agata
Abstract
The evaluation of optical properties of biological samples is gaining increasing interests both in scientific and commercial fields concerning agriculture and food processing. The optical techniques can indeed be able to provide information on quality assessment in a fast and non-destructive way. This feature makes them suitable for automatic management of control processes. In this paper, we propose to use the Delayed Luminescence, a ultra-weak and photo-induced emission of optical photons, as a tool for a rapid evaluation of germination performance, the principal index reflecting seed quality. Two lots of 'Mirella' F1 watermelon dried seeds, of 96 seeds each, were considered. The seeds were analyzed in the conditions as provided by seed/breeding company. Characteristics of Delayed Luminescence emission from each single seed were correlated to the different germination levels as assessed by International Seed Testing Procedures. Parametric differences in the two lots were determined, based on the relaxation kinetics of some spectral components. A control test, with the aim to construct a calibration model, was conceived and successfully tested. Time decays of Delayed Luminescence spectral components at central wavelengths 450 nm, 550 nm and 650 nm, corresponding to spectrum region where natural biomarkers as NADH, flavins and lipopigments, protoporphyrin and ROS respectively emit, have been evaluated. The results show that such time decays are strictly connected to the biological state of the system under analysis and allow also proposing Delayed Luminescence measurement as a quick, cheap and non-destructive test for seed viability analysis.
Extracellular matrix affects different aspects of cell behaviour potentially involved in response to aminolevulinic acid-based photoinactivation
Publication date: Available online 17 August 2018
Source: Journal of Photochemistry and Photobiology B: Biology
Author(s): Beata Čunderlíková, Barbora Filová, Karol Kajo, Miroslava Vallová, Zuzana Balázsiová, Michal Trnka, Anton Mateašík
Abstract
Two-dimensional cell cultures do not seem to be reliable models for anticancer drug discovery and validation. Numerous in vitro tumour models of different complexity have been evaluated with the aim to enhance anticancer drug development, but whether all these models could be considered as physiologically relevant is a question. Even type of the extracellular matrix may markedly influence experimental results and supposedly also clinical treatment outcome. By using three human oesophageal cell lines and three-dimensional cultures based on collagen type I, abundant component of stromal tissue, and Matrigel, a surrogate of basement membrane, we tested the impact of extracellular matrix on different aspects of cell behaviour. We applied live cell fluorescence confocal microscopy in combination with image analysis and supplemented it with immunohistochemical analysis of differentiation markers in fixed samples. We found that cell morphogenesis, differentiation, extracellular vesicle formation, protoporphyrin IX production from aminolevulinic acid and response to subsequent photodynamic intervention induced by red light may be affected by the type of extracellular matrix and these modifications occur in a cell-type dependent manner. Our results demonstrate that the choice of the correct extracellular matrix for in vitro tumour models is crucial for gathering clinically relevant information from in vitro experimental studies.
Adsorption characteristics of methylene blue by biochar prepared using sheep, rabbit and pig manure
Abstract
Sheep manure biochar (SMB500), rabbit faeces biochar (RFB500) and pig manure biochar (PMB500) prepared by controlled thermal decomposition at 500 °C were used to adsorb methylene blue (MB) in water. Elemental analysis, BET and SEM results showed that the specific surface area, total pore volume and average pore diameter of SMB500 were 7.59, 4.20 and 1.16 times greater than those of RFB500, which were also 12.02, 6.88 and 1.37 times greater than those of PMB500, respectively. SMB500 had stronger stability and aromaticity. When the initial concentration of MB was 50 mg L−1 and pH was 11, adsorption achieved equilibrium at approximately 210 min. The adsorption followed pseudo-second-order kinetics (R2 > 0.96), indicating that liquid film diffusion, surface adsorption and intraparticle diffusion all contributed to the adsorption rate. The results of isothermal adsorption showed that the adsorption performance of SMB500 was more consistent with a Freundlich model, whereas the performance of RFB500 and PMB500 was more consistent with a Langmuir model with a maximum adsorption capacity of 53.68 to 238.31 mg g−1. Thermodynamic and FTIR studies showed that the adsorption of MB on SMB500, RFB500 and PMB500 was spontaneous and endothermic, and hydrogen bonds and π-π bonds were closely related to the adsorption process. The results of regeneration show that the optimal number of cycles for SMB500, RFB500 and PMB500 are 8, 5 and 3, respectively.
Technique de prélèvement d’un lambeau perforant thoracodorsal : mise au point
Publication date: Available online 17 August 2018
Source: Annales de Chirurgie Plastique Esthétique
Author(s): R. Vaucher, S. Dast, A. Bout-Roumazeilles, C. Herlin, F. Bekara, R. Sinna
Résumé
Le lambeau perforant thoracodorsal (TDAP) est une méthode de reconstruction fiable dont les indications n'ont cessé d'augmenter ces dernières années. Plusieurs variantes chirurgicales existent et différentes techniques de prélèvement ont été décrites. Cependant, face à une dissection parfois complexe et chronophage du pédicule, l'utilisation fréquente de cette méthode de couverture nous a amené à adapter la technique de prélèvement de ce lambeau. L'objectif de cette étude descriptive est d'établir une mise au point quant à la méthode de dissection du pédicule du lambeau perforant thoracodorsal. La préservation du réseau nerveux et la préservation d'une collerette musculaire sur un diamètre de deux centimètres à l'entrée du pédicule dans le muscle en sont les points clefs.
Summary
The thoracodorsal artery perforator (TDAP) flap is a reliable method of reconstruction by which the indications were on a constant rise during the last few years. Several surgical variants exist and different harvesting techniques were described. However, with our experience using this flap for substance-loss coverage, we frequently faced a complex and relatively time-consuming pedicle dissection. This brought us to adapt our harvesting technique according to the anatomical situations of the neighboring structures. The purpose of this study is to revisit and adapt the method of the pedicle dissection for the TDAP flap. The conservation of both the nervous network and a section of a circumferential muscular collar with a diameter of two centimeters are the main keys of our study.
Adipose mesenchymal stromal cells: Definition, immunomodulatory properties, mechanical isolation and interest for plastic surgery
Publication date: Available online 17 August 2018
Source: Annales de Chirurgie Plastique Esthétique
Author(s): N. Bertheuil, B. Chaput, C. Ménard, A. Varin, J. Laloze, E. Watier, K. Tarte
Summary
Ever since their discovery in 2001, adipose mesenchymal stromal cells (ASC) have profoundly modified clinical indications and our practice of plastic surgery, thereby placing our discipline at the forefront of regenerative medicine. These cells act through paracrine signaling by synthesizing immunosuppressive and pro-angiogenic factors. They are of key importance with regard to the regenerative properties of autologously grafted adipose tissue (AT). Taken together, they make up the stromal vascular fraction (SVF) comprising all AT cells except for adipocytes. As our knowledge evolves, we are moving from fat grafting towards SVF grafting, of which the essential sought-after effect is tissue regeneration. The objective of the present review is to synthesize present-day information on ASCs and their immunomodulatory properties and, from a practical standpoint, to indicate present-day and future steps towards establishment of clinical routine, particularly through application of techniques favoring mechanical digestion of adipose tissue.
Résumé
Depuis leur découverte en 2001, les cellules stromales mésenchymateuses du tissu adipeux (ASC) ont profondément modifiées nos indications cliniques et notre pratique en chirurgie plastique, plaçant notre discipline au cœur de la médecine régénérative. Ces cellules agissent par action paracrine en synthétisant des facteurs immunosuppresseurs et pro-angiogéniques. Elles sont la clé des propriétés régénératives du tissu adipeux greffé de façon autologue. Ces cellules composent la fraction vasculaire stromale (FVS) comprenant l'ensemble des cellules du tissu excepté les adipocytes. Au fur et à mesure de nos connaissances, nous basculons du fat grafting vers la FVS grafting où l'effet recherché est essentiellement la régénération tissulaire. Ainsi, cette revue a pour objectif de réaliser une synthèse des connaissances actuelles en matière d'ASC, de leurs propriétés immunomodulatrices, et de leurs méthodes d'obtention en routine clinique, notamment les techniques de digestion mécanique du tissu adipeux.
Assessment of Subject and Physician Satisfaction after Long-Term Treatment of Glabellar Lines with AbobotulinumtoxinA (Dysport ® /Azzalure ® ): Primary Results of the APPEAL Noninterventional Study
Abstract
Background
Although the short- and long-term effectiveness of abobotulinumtoxinA (Dysport®/Azzalure®) for glabellar line (GL) treatment is well established, reporting of subject satisfaction over repeat treatment cycles is limited. The APPEAL study aimed to assess subject satisfaction with long-term GL treatment with abobotulinumtoxinA in a real-life setting.
Methods
APPEAL was a noninterventional, prospective, longitudinal study in subjects administered ≥ 3 abobotulinumtoxinA injection cycles for moderate-to-severe GL, according to routine clinical practice. Subjects completed a satisfaction questionnaire at 3 weeks (± 7 days) after each cycle. Primary endpoint included subjects' overall satisfaction with GL after three injection cycles. Secondary endpoints included satisfaction after Cycles 1 and 2 and factors associated with satisfaction after each cycle. Physician satisfaction was also assessed after Cycles 1 and 3.
Results
Of 150 subjects enrolled, 135 completed the overall subject satisfaction questionnaire after Cycle 3. At 3 weeks after Cycle 3, 99.3% of subjects were 'very satisfied' (74.1%) or 'satisfied' (25.2%) with GL. Levels of subject satisfaction and associated factors after Cycles 1 and 2 were as large and significant as after Cycle 3 (83–100%, depending on question). Physicians' satisfaction with GL appearance, facial expression, and overall satisfaction was almost complete after the first injection (≥ 97.4%) and unanimous after the third (100%).
Conclusions
In the APPEAL study, overall satisfaction was high after three abobotulinumtoxinA injection cycles for GL based on both subjects' (99.3%) and physicians' (100.0%) assessments. High levels of subject satisfaction reported after Cycle 1 were maintained with repeated injections. No new safety signals were observed.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Trial registration NCT02353897
Estrategias para disminuir el retraso en el diagnóstico del melanoma lentiginoso acral
Publication date: Available online 17 August 2018
Source: Actas Dermo-Sifiliográficas
Author(s): J. Bañuls
Electroquimioterapia con bleomicina intravenosa en el tratamiento del carcinoma de células de Merkel irresecable
Publication date: Available online 17 August 2018
Source: Actas Dermo-Sifiliográficas
Author(s): L. Padilla-España, T. Toledo-Pastrana, A. Fernández-Orland, L. Ferrándiz-Pulido
Pre-treatment with sumatriptan for cilostazol induced headache in healthy volunteers
Previous studies indicate that sumatriptan is not effective when second messenger levels are high as after cilostazol provocation. Therefore, we have conducted the present study, where sumatriptan is administr...
Comparative Endocrinology: Past, Present, and Future1
Abstract
Comparative endocrinology has traditionally focused on studies of the evolution of endocrine systems, regulation of hormone actions in animals, development of model systems, and the role of the environment in controlling hormone functions related to major life-history events. Comparative endocrinology also has made important contributions to basic research and clinical endocrinology. In recent years there has seen a shift to a focus on anthropogenic chemical factors and their alteration of major life history events through endocrine disruption. During the 21st century, environmental comparative endocrinologists must play an important role in the identification and assessment of endocrine disruption on vertebrate and invertebrate animals and their environment as well as in monitoring remediation. All comparative biologists are encouraged to communicate their understanding of threats to biological systems to non-scientists to facilitate their understanding of the human impacts of various kinds of pollution and habitat destruction on wildlife and ecosystems as well as their long-term consequences.Stenotrophomonas maltophilia mutant lacking flagella remains virulent in DBA/2N mice but is less efficient in stimulating TNF-α expression
Abstract
To understand the role of flagella of Stenotrophomonas maltophilia in lung infections, DBA/2N mice were challenged with aflagellate fliI− mutant and colonization, invasion and persistence, lung damage, and inflammatory response compared, on days 1 and 3 post-exposure (p.e.), with that of the isogenic wild-type. Following exposure to nebulized bacterial suspension, mice infected with wt and fliI− strains showed a comparable trend in body weight change, pulmonary persistence, lung damage, and mortality rate over the study period considered. Interestingly, although on day 1 p.e. both strains colonized near all the spleens, on day 3 p.e. wt strain persisted in 40% of spleens whereas fliI− mutant was completely cleared. No significant differences were found in MIP-2, IFN-γ, and IL-6 pulmonary levels between groups over time, except for TNF-α whose levels on day 1 p.e. were significantly higher in mice infected with flagellated wt strain. Overall, our results indicate that in S. maltophilia flagella and motility might not represent virulence traits involved in the pathogenesis of lung infection. However, the evidence for a specific flagellar-induced TNF-α response warrants further study.Isolation of a thermotolerant Rhodosporidium toruloides DMKU3-TK16 mutant and its fatty acid profile at high temperature
Abstract
Oleaginous yeast Rhodosporidium toruloides DMKU3-TK16 (TK16), which was isolated from Thailand, is considered a promising lipid producer for biodiesel production. For future industrial applications of this strain, thermotolerant traits are highly desired for their potential to reduce cooling costs in a commercial fermenter. Here, by using an adaptive breeding strategy, we isolated a thermotolerant R. toruloides mutant, L1–1. The isolated L1–1 strain exhibited better growth and higher lipid production at 37°C, and it was found to have significantly higher oleic acid (C18:1) content and yield compared to the wild-type TK16 when cultivated at 37°C. This is the first study to isolate a thermotolerant strain from the oleaginous yeast R. toruloides. The information gained herein will provide new clues for engineering lipid production and for studying the thermotolerance of R. toruloides.Bacillus and Virgibacillus strains isolated from three Mexican coasts antagonize Staphylococcus aureus and Vibrio parahaemolyticus
Abstract
This study identified marine microorganisms from Mexican coasts that had antimicrobial activity against Staphylococcus aureus and Vibrio parahaemolyticus, which are known worldwide to be food-poisoning agents. Representative specimens of algae, saline sediment, crustaceans and mollusks were collected. Of the 42 tested strains, 15 inhibited these pathogens. 16S rRNA gene sequencing identified Bacillus and Virgibacillus strains. The strains with the highest inhibitory activity against S. aureus were PCRS1–07 (B. aerius), BLCG-05 and GUO-01 (B. pumilus). Strains GUHC-04, BLCG-05, GUHC-03 (B. altitudinis), and BLBSe-05 (B. oryzicola) showed higher antimicrobial activity against V. parahaemolyticus. Biofilm production by all strains was moderate, but B. altitudinis produced a stronger biofilm. This is the first study to isolate B. aerius, B. oryzicola, B. safensis, B. boroniphilus, B. altitudinis and V. senegalensis from marine ecosystems in Mexico as well as the first study to report their inhibitory effects against both S. aureus and V. parahaemolyticus. Bioactivity of spent media from the antagonistic strains cultured as biofilm also demonstrated high antimicrobial activity. The active compounds of the antagonists are currently being studied and tested. Marine ecosystems have the highest bacterial diversity associated with invertebrates and seaweed; however, this bacterial diversity has not been well studied on Mexican coasts.Development and Validation of the Vitiligo Extent Score for a Target Area (VESTA) to Assess the Treatment Response of a Target Lesion
Pigment Cell &Melanoma Research, Volume 0, Issue ja, -Not available-.
3D microvascular analysis reveals irregularly branching blood vessels in the hyperpigmented skin of solar lentigo
Pigment Cell &Melanoma Research, Volume 0, Issue ja, -Not available-.
Homozygous intronic MITF mutation causes severe Waardenburg syndrome type 2A
Pigment Cell &Melanoma Research, Volume 0, Issue ja, -Not available-.
In Vitro Behavior and UV response of melanocytes derived from carriers of CDKN2A mutations and MC1R variants
Pigment Cell &Melanoma Research, Volume 0, Issue ja, -Not available-.
Analysis of the putative tumor suppressor gene cdkn2ab in pigment cells and melanoma of Xiphophorus and medaka
Pigment Cell &Melanoma Research, Volume 0, Issue ja, -Not available-.
S,S‐Chiral Linker Induced U‐Shape with a Syn‐facial Sensitizer and Photocleavable Ethene Group
Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.
Ultrasound‐assisted Synthesis of Ag‐ZnS/rGO and its Utilization in Photocatalytic Degradation of Tetracycline Under Visible Light Irradiation
Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.
Cytotoxic and Photocytotoxic Effects of Cercosporin on Human Tumour Cell Lines
Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.
Cutaneous Langerhans cell histiocytosis – an indication for dermatological pharmacotherapy with topical nitrogen mustard
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.
Optimal placement of Burow's triangles for aesthetically pleasing repair of multiple defects using local flaps after tumor excision
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.
Painful blisters and erosions after gardening
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.
Painful hemorrhagic bullae on the dorsal hands
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.
Estimated burden of serious human fungal diseases in Turkey
Mycoses, Volume 0, Issue ja, -Not available-.
Profile of Sunless Tanning Product Users: Results from a Nationwide Representative Survey
Photodermatology, Photoimmunology &Photomedicine, Volume 0, Issue ja, -Not available-.
Pathogens and autoimmune hepatitis
Clinical &Experimental Immunology, Volume 0, Issue ja, -Not available-.
PGK1 as an immune target in Kawasaki disease
Clinical &Experimental Immunology, Volume 0, Issue ja, -Not available-.
Locally advanced skin cancers of the frail and elderly – consider adaptive split course radiotherapy (ASCRT)
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
The Extent of PXE Skin Changes is Related to Cardiovascular Complications and Visual Loss: a Cross‐sectional Study
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
Recurrent fungal infections in a Chinese patient with CARD9 deficiency and a review of 48 cases
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
Associations between maternal socioeconomic position and psoriasis: A cohort study among the offspring of the Danish National Birth Cohort
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
Hormonal, Stem Cell and Notch Signaling as Possible Mechanisms of Disease in Hidradenitis Suppurativa: a Systems‐Level Transcriptomic Analysis
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
Atrophic scar formation in patients with acne involves long‐acting immune responses with plasma cells and alteration of sebaceous glands
British Journal of Dermatology, EarlyView.
Sensitive skin can be small fiber neuropathy: Results from a case‐control quantitative sensory testing study
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
Somatic GNAQ mutation in different structures of port‐wine macrocheilia
British Journal of Dermatology, EarlyView.
Cardiomyopathy in patients with epidermolysis bullosa simplex with mutations in KLHL24
British Journal of Dermatology, EarlyView.
Secukinumab shows high efficacy irrespective of HLA‐Cw6 status in patients with moderate‐to‐severe plaque‐type psoriasis: SUPREME study
British Journal of Dermatology, EarlyView.
Photosensitizing antihypertensive drug use and risk of cutaneous squamous cell carcinoma
British Journal of Dermatology, EarlyView.
Juvenile Xanthogranuloma: a herald to the diagnosis of Erdheim‐Chester Disease in an adult with acute leukemia
Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.
A severe chronic outdoor urban pollution alters some facial aging signs in Chinese women. A tale of two cities
International Journal of Cosmetic Science, Volume 0, Issue ja, -Not available-.
Zinc‐containing compounds for personal care applications
International Journal of Cosmetic Science, EarlyView.
Idiopathic histiocytoid Sweet syndrome: a case report with clinical and histopathological considerations
International Journal of Dermatology, EarlyView.
Chromoblastomycosis: clinical experience and review of literature
International Journal of Dermatology, EarlyView.
The role of interleukins in vitiligo: a systematic review
Journal of the European Academy of Dermatology and Venereology, EarlyView.
Rheumatoid Arthritis-Associated Orbital Vasculitis
A patient with a history of rheumatoid arthritis presented with bilateral orbital lesions while on abatacept. Biopsy of the lesions yielded pathologic assessment showing vasculitis with a mixed inflammatory infiltrate notable for numerous eosinophils. Despite initial improvement on cyclophosphamide therapy, she developed progression of the orbital lesions and lesions elsewhere on her body. All serologic studies were normal except for increased levels of rheumatoid factor and eosinophilia. The patient underwent a second biopsy, which was consistent with her initial pathology. The patient was started on high-dose mycophenolate mofetil treatment with a good response. After 1 year of treatment, the patient's lesions have nearly completely resolved. This patient illustrates the diagnostic and therapeutic challenges encountered when treating orbital vasculitis. Furthermore, this case shows the importance of not categorizing vasculitis with unclear etiology under the umbrella diagnosis of atypical granulomatosis with polyangiitis. This patient did not exhibit the serologic or pathologic characteristics of granulomatosis with polyangiitis, and she did not respond to treatment as would be expected for granulomatosis with polyangiitis. Maintaining an open approach to diagnosis and treatment was crucial in obtaining a favorable outcome for this patient. Accepted for publication June 22, 2018. Presented in part at the 2017 Spring Meeting of the American Society of Ophthalmic Plastic and Reconstructive Surgery on June 23, 2017 in Vancouver, Canada. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Michael T. Yen, M.D., 1977 Butler Boulevard, Houston, TX 77030. E-mail: myen@bcm.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Πέμπτη 16 Αυγούστου 2018
Against the iterative conception of set
Abstract
According to the iterative conception, each set is formed out of sets that are, in some sense, prior to it. Because priority plays an essential role in explanations of why contradiction-inducing sets, such as the universal set, do not exist, the success of these explanations depends on our ability to make sense of the relevant priority relation. I argue that attempts to do this have fallen short: understanding priority in a straightforwardly constructivist sense threatens the coherence of the empty set and raises serious epistemological concerns; but the leading realist interpretations–ontological and modal interpretations of priority—are deeply problematic as well. I conclude that the purported explanatory virtues of the iterative conception are, at present, unfounded.
Feasibility, Safety, and Periprocedural Complications Associated with Endovascular Treatment of Ruptured Intracranial Aneurysms according to the Depth of Anesthesia [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
The aim of the present study was to report the feasibility, safety, and periprocedural complications associated with EVT of ruptured intracranial aneurysms according to the depth of anesthesia. In most centers, endovascular treatment of intracranial aneurysm is performed under general anesthesia.
MATERIALS AND METHODS:Between March 2011 and December 2016, a total of 183 consecutive patients with 183 aneurysms were treated endovascularly at the authors' center. The data about the depth of anesthesia (local anesthesia, conscious sedation, deep sedation, and general anesthesia), procedural details, and clinical and radiologic outcomes were reviewed.
RESULTS:A total of 183 consecutive patients with 183 aneurysms (mean age, 60.2 ± 14.8 years; 54 men and 129 women) were successfully treated. Of these, 70 (38.3%) patients underwent endovascular treatment under local anesthesia, 33 (18.0%) patients underwent endovascular treatment under conscious sedation, 78 (42.6%) patients underwent endovascular treatment under deep sedation, and only 2 (1.1%) patients underwent endovascular treatment under general anesthesia. For patients who presented with Hunt and Hess grades 1, 2, 3, 4, and 5, 75%, 59.6%, 59.1%, 53.3%, and 35.3% were treated under local anesthesia or conscious sedation, respectively. The procedure-related complication rates amounted to 8.7% (16/183, with 11 thromboembolic complications and 5 intraprocedural ruptures) overall, and 7.7% (14/183) of complications were symptomatic events. In the patients with good clinical grade (Hunt and Hess 1 or 2), the procedure-related complication rate was 4.1% (4/97), and all complications were symptomatic events under local anesthesia or conscious sedation.
CONCLUSIONS:In the authors' experience, local anesthesia or conscious sedation seemed safe and feasible for the patients with good clinical grade SAH.
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