Dear Sir,
Πέμπτη 23 Αυγούστου 2018
Self-Knowledge in a Predictive Processing Framework
Abstract
In this paper I propose an account of self-knowledge based on a framework of predictive processing. Predictive processing understands the brain as a prediction-action machine that tries to minimize error in its predictions about the world. For this view to evolve into a complete account of human cognition we ought to provide an idea how it can account for self-knowledge – knowledge of one's own mental states. I provide an attempt for such an account starting from remarks on introspection made by Hohwy (2013). I develop Hohwy's picture into a general model for knowledge of one's mental states, discussing how predictions about oneself can be used to capture self-knowledge. I further explore empirical predictions, and thereby argue that the model provides a good explanation for failure of self-knowledge in cases involving motor aftereffects, such as the broken escalator phenomenon. I conclude that the proposed account is incomplete, but provides a valuable first step to connect research on predictive processing with the epistemology of self-knowledge.
Psychisches Wohlbefinden bei Patienten mit Leberzellkarzinom
Zusammenfassung
Hintergrund
Krebserkrankungen sowie die daraus resultierenden Folgen und Behandlungen stellen für Betroffene meist eine starke Belastung dar. Bei einem hepatozellulären Karzinom (HCC) handelt es sich um eine Krebserkrankung mit sehr schlechter Prognose. Mögliche Risikofaktoren, ein HCC zu entwickeln, nehmen in der Bevölkerung seit Jahren zu. Dennoch ist nur wenig über die psychische Belastung der Betroffenen bekannt.
Ziel der Arbeit
Ziel dieser Untersuchung war es, die psychische Belastung und Unterstützungswünsche von HCC-Patienten darzustellen.
Patienten und Methoden
In einer prospektiven Studie wurden Leberzellkarzinompatienten untersucht. Sie wurden zu Beginn und während eines Krankenhausaufenthalts, kurz vor der Entlassung aus demselben sowie 1/2 und 1 Jahr später befragt. Die psychische Belastung wurde mittels „hospital anxiety and depression scale" (HADS) erhoben. Zusätzlich wurden die Patienten gefragt, durch wen sie sich zusätzliche Betreuung wünschen. Bei der Auswertung wurde Häufigkeitsvergleiche mittels χ2-Test und Korrelationen mittels Pearson-Korrelationskoeffizient berechnet.
Ergebnisse
Insgesamt nahmen 97 Patienten an der Studie teil. Bei mehr als der Hälfte (56 %) lag der HADS-Gesamtwert zu Beginn der stationären Aufnahmen über 13, was einer überdurchschnittlichen psychischen Belastung entspricht. Über 90 % der befragten Patienten wünschten sich zu diesem Zeitpunkt psychosoziale Betreuung, zumeist durch Ärzte, Pflegekräfte und/oder Psychologen. Vor der Entlassung erhofften sich alle befragten Personen Unterstützung von Ärzten sowie Pflegekräften. Nach 1/2 Jahr wünschten sich die Betroffenen v. a. Unterstützung von Ärzten und Selbsthilfegruppen.
Diskussion
HCC-Patienten sind psychisch erheblich belastet, mit erhöhtem Betreuungsbedarf.
Routine Functional and Aesthetic Outcome Measurements in Secondary Cleft Lip Rhinoplasty and Patient Satisfaction
This cohort study describes the implementation and advantages of an automated and prospective secondary cleft lip rhinoplasty outcome system and its association with patient satisfaction.
The Modified Bullhorn Approach for the Lip-lift
This Surgical Pearl describes the lip-lift procedure and details of the modified bullhorn approach.
Adjuvant sunitinib in patients with high-risk renal cell carcinoma: safety, therapy management, and patient-reported outcomes in the S-TRAC trial
Abstract
Background
Adjuvant sunitinib has significantly improved disease-free survival versus placebo in patients with renal cell carcinoma at high risk of recurrence post-nephrectomy (hazard ratio 0.76; 95% confidence interval, 0.59–0.98; two-sided P=0.03). We report safety, therapy management, and patient-reported outcomes for patients receiving sunitinib and placebo in the S-TRAC trial. Patients and methods
Patients were stratified by the University of California, Los Angeles Integrated Staging System and Eastern Cooperative Oncology Group performance status score, and randomized (1:1) to receive sunitinib (50 mg/day) or placebo. Single dose reductions to 37.5 mg, dose delays, and dose interruptions were used to manage adverse events (AEs). Patients' health-related quality of life, including key symptoms typically associated with sunitinib, were evaluated with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Results
Patients maintained treatment for 9.5 (mean, SD 4.4) and 10.3 (mean, SD 3.7) months in the sunitinib and placebo arms, respectively. In the sunitinib arm, key AEs occurred ∼1 month (median) after start of treatment and resolved within ∼3.5 weeks (median). Many (40.6%) AEs leading to permanent discontinuation were grade 1/2, and most (87.2%) resolved or were resolving by 28 days after last treatment. Patients taking sunitinib showed a significantly lower EORTC QLQ-C30 overall health status score versus placebo, although this reduction was not clinically meaningful. Patients reported symptoms typically related to sunitinib treatment with diarrhea and loss of appetite showing clinically meaningful increases. Conclusions
In S-TRAC, AEs were predictable, manageable, and reversible via dose interruptions, dose reductions, and/or standard supportive medical therapy. Patients on sunitinib did report increased symptoms and reduced HRQoL, but these changes were generally not clinically meaningful, apart from appetite loss and diarrhoea, and were expected in the context of known sunitinib effects. Clinical Trial Registration
ClinicalTrials.gov, NCT00375674.Colorectal Premalignancy is Associated with Consensus Molecular Subtypes 1 and 2
Abstract
Background
Gene expression-based profiling of colorectal cancer (CRC) can be used to identify four molecularly homogeneous Consensus Molecular Subtypes (CMS) groups with unique biologic features. However, its applicability to colorectal premalignant lesions remains unknown. Patients and methods
We assembled the largest transcriptomic premalignancy data set by integrating different public and proprietary cohorts of adenomatous and serrated polyps from sporadic (N = 311) and hereditary (N = 78) patient populations and performed a comprehensive analysis of carcinogenesis pathways using the CMS Random Forest (RF) classifier. Results
Overall, transcriptomic subtyping of sporadic and hereditary polyps revealed CMS2 and CMS1 subgroups as the predominant molecular subtypes in premalignancy. Pathway enrichment analysis showed that adenomatous polyps from sporadic or hereditary cases (including Lynch syndrome) displayed a CMS2-like phenotype with WNT and MYC activation, whereas hyperplastic and serrated polyps with CMS1-like phenotype harbored prominent immune activation. Rare adenomas with CMS4-like phenotype showed significant enrichment for stromal signatures along with TGFβ activation. There was a strong association of CMS1-like polyps with serrated pathology, right-sided anatomic location and BRAF mutations. Conclusions
Based on our observations made in premalignancy, we propose a model of pathway activation associated with CMS classification in colorectal carcinogenesis. Specifically, while adenomatous polyps are largely CMS2, most hyperplastic and serrated polyps are CMS1 and may transition into other CMS groups during evolution into carcinomas. Our findings shed light on the transcriptional landscape of premalignant colonic polyps and may help guide the development of future biomarkers or preventative treatments for CRC.Induction chemotherapy (IC) followed by radiotherapy (RT) vs. cetuximab plus IC and RT in advanced laryngeal/hypopharyngeal cancer resectable only by total laryngectomy – final results of the larynx organ preservation trial DeLOS-II
Abstract
Background
The German multicenter randomized phase-II larynx-organ preservation (LOP) trial DeLOS-II was performed to prove the hypothesis that cetuximab (E) added to induction chemotherapy (IC) and radiotherapy improves laryngectomy-free survival (LFS; survival with preserved larynx) in locally advanced laryngeal/hypopharyngeal cancer (LHSCC). Patients and methods
Treatment-naïve patients with stage III/IV LHSCC amenable to total laryngectomy (TL) were randomized to three cycles IC with TPF (docetaxel [T] and cisplatin [P] 75 mg/m2/day 1, 5-FU [F] 750 mg/m2/day days 1-5) followed by radiotherapy (69.6 Gy) without (A) or with (B) standard dose cetuximab for 16 weeks throughout IC and radiotherapy (TPFE). Response to first IC-cycle (IC-1) with ≥30% endoscopically estimated tumor surface shrinkage (ETSS) was used to define early responders; early salvage TL was recommended to non-responders. The primary objective was 24-months LFS above 35% in arm B. Results
Of 180 patients randomized (7/2007-9/2012), 173 fulfilled eligibility criteria (A/B: larynx 44/42, hypopharynx 41/46). Because of 4 therapy-related deaths among the first 64 randomized patients, 5-FU was omitted from IC in the subsequent 112 patients reducing further fatal toxicities. Thus, IC was TPF in 61 patients and TP in 112 patients, respectively. The primary objective (24-months LFS above 35%) was equally met by arms A (40/85, 47.1%) as well as B (41/88, 46.6%). 123 early responders completed IC+RT; their overall response rates (TPF/TP) were 94.7%/87.2% in A vs. 80%/86.0% in B. The 24-months overall survival (OS) rates were 68.2% and 69.3%. Conclusions
Despite being accompanied by an elevated frequency in adverse events, the IC with TPF/TP plus cetuximab was feasible but showed no superiority to IC with TPF/TP regarding LFS and OS at 24 months. Both early response and 24-months LFS compare very well to previous LOP trials and recommend effective treatment selection and stratification by ETSS. Clinical trial information
NCT00508664“Optimism Bias” in Contemporary National Clinical Trial Network Phase III Trials: Are We Improving?
Abstract
Background
Previous studies have found that overestimating treatment effects (i.e., "optimism bias") leads to underpowered clinical trials. The prevalence of "optimism bias" in contemporary National Clinical Trials Network (NCTN) cancer clinical trials is unknown. Methods
We conducted a systematic review of NCTN phase III randomized trials published from January 2007 to January 2017. We compared the hypothesized vs. observed treatment effects in each trial, and examined whether trial-related factors were correlated with the study results. We also reviewed the methods of each protocol to assess whether a rationale for the hypothesized effect size was provided. Results
We identified 161 clinical trials, of which 130 were eligible for analysis. Original protocols could not be located for 8 trials (5.0%). Twenty-eight trials (21.5%) observed a statistically significant difference in the primary endpoint favoring the experimental treatment. The median ratio of observed-to-expected HRs among trials that observed a statistically significant effect on the primary endpoint was 1.07 (range: 0.33-1.28) vs 1.32 (range: 0.86-2.02) for trials that did not, compared with 1.34 and 1.86, respectively, for National Cancer Institute (NCI) trials published between 1955 to 2006. An effect size at least as large as the one projected in the protocol trials was observed in 9.8% of trials, compared to 17% of NCI trials published from 1955 to 2006. Most trials (64.6%) provided no rationale to support the magnitude of the proposed treatment effect in the protocol. Conclusions
Despite a reduction in "optimism bias" compared to previous eras, most contemporary NCTN phase III trials failed to establish statistically significant benefits of new cancer therapies. Better rationalization of proposed effect sizes in research protocols is needed.FDG-PET response and outcome from anti-PD-1 therapy in metastatic melanoma
Abstract
Background
Immune checkpoint inhibitor therapy has resulted in impressive and durable clinical activity for many cancers including melanoma, however there remain few reliable predictors for long-term response. This study investigated whether FDG-PET imaging may better predict long-term outcomes compared to standard CT response criteria. Patients and methods
Retrospective analysis of metastatic melanoma patients treated with anti-PD-1 based immunotherapy with baseline and 1-year 18F-FDG PET and CT imaging at Melanoma Institute Australia. 1-year response was determined using RECIST for CT and EORTC criteria for PET, coded as complete response (CR or CMR), partial response (PR or PMR), stable disease (SD or SMD) or progressive disease (PD or PMD). Progression-free survival (PFS) was determined from the 1-year landmark. Results
104 patients were evaluated with median follow-up 30.1 months and 98% remain alive. Most received anti-PD-1 as monotherapy (67%) or combined with ipilimumab (31%). At 1-year, 28% had CR, 66% had PR and 6% had SD on CT, while 75% had CMR, 16% PMR and 9% SMD/PMD on PET. CMR was observed in 68% of patients with PR on CT. RECIST PFS post 1-year landmark was similar in patients with CR vs PR/SD, but improved in patients with CMR vs non-CMR (median not reached [NR] vs 12.8 mths; HR 0.06 [95% CI 0.02-0.23]; p<0.01). In patients with PR on CT, PFS was improved in patients with PR+CMR vs PR+non-CMR (median NR vs 12.8 months; HR 0.07 [95% CI 0.02-0.27]; p<0.01). In the 78 CMR patients, 78% had discontinued treatment and 96% had ongoing response. Conclusions
Whilst only a small proportion of patients have a CR at 1-year, most patients with a PR have CMR on PET. Almost all patients with CMR at 1-year have ongoing response to therapy thereafter. PET may have utility in predicting long-term benefit and help guide discontinuation of therapy.The state of the art in peer review
Abstract
Scholarly communication is in a perpetual state of disruption. Within this, peer review of research articles remains an essential part of the formal publication process, distinguishing it from virtually all other modes of communication. In the last several years, there has been an explosive wave of innovation in peer review research, platforms, discussions, tools, and services. This is largely coupled with the ongoing and parallel evolution of scholarly communication as it adapts to rapidly changing environments, within what is widely considered as the 'open research' or 'open science' movement. Here, we summarise the current ebb and flow around changes to peer review and consider its role in a modern digital research and communications infrastructure and suggest why uptake of new models of peer review appears to have been so low compared to what is often viewed as the 'traditional' method of peer review. Finally, we offer some insight into the potential futures of scholarly peer review and consider what impacts this might have on the broader scholarly research ecosystem. In particular, we focus on the key traits of certification and reputation, moderation and quality control, and engagement incentives, and discuss how these interact with socio-technical aspects of peer review and academic culture.Adsorption of myo -inositol hexakisphosphate in water using recycled water treatment residual
Abstract
Dissolved organic phosphorus (DOP) in rainwater runoff or other contaminated waters can cause or aggravate eutrophication of water bodies. Water treatment residual (WTR) containing spent coagulant has been shown to provide excellent adsorption capacity for inorganic phosphorus such as orthophosphate, but little information has been available on adsorption of DOPs by WTR. In this study, the adsorption characteristics of myo-inositol-1,2,3,4,5,6-hexakisphosphate (IHP), a prototype DOP in soil and stormwater, by WTR were investigated through batch adsorption equilibrium and kinetic experiments. The influences of pH and various size fractions of WTR on the adsorption capacity were tested and analyzed, and the adsorption mechanism was elucidated based on Fourier-transform infrared spectroscopy (FTIR) analysis. The experimental results showed that WTR can effectively adsorb IHP from simulated rainwater, and the IHP uptake was favored under neutral and acidic conditions. Moreover, the 1.0–2.0-mm fraction of the WTR particles was most suitable for practical application because of the well-balanced adsorption rate and capacity. The classical Langmuir isotherm model well described the equilibrium adsorption data and the pseudo-second-order kinetic model adequately interpreted the rate data. Thermodynamic analysis revealed that the adsorption is a spontaneous, endothermic, and entropy-driven reaction. The FTIR analysis indicated that adsorption of IHP on WTR is associated with the formation of ≡Al–PO3− groups and the release of –OH from WTR. A comparison of the adsorption capacities of orthophosphate and IHP on WTR suggested that binding one IHP may take two times more sites than for orthophosphate, indicating that two of the six phosphate groups in IHP were bound to WTR. This work shows that recycled WTR may be used as a low-cost adsorbent for effective removal of organic phosphate in gray water and wastewater.
Insight into the impact of Fe 3 O 4 nanoparticles on anammox process of subsurface-flow constructed wetlands under long-term exposure
Abstract
The increasing use of Fe3O4 nanoparticles (NPs) had posed an emerging challenge to wastewater treatment processes, and their potential impact on anaerobic ammonium oxidation (anammox) process of unplanted subsurface-flow constructed wetlands (USFCWs) was investigated firstly under the long-term exposure of different Fe3O4 NP concentrations. It was found that Fe3O4 NP exposure could improve total nitrogen (TN) removal. The abundance of Candidatus Anammoxoglobus increased significantly at 10 mg/L Fe3O4 NPs, while decreased under 1 mg/L Fe3O4 NP exposure. Desulfosporosinus and Exiguobacterium increased to some extent at 1 mg/L Fe3O4 NPs, suggesting that Fe-anammox played an important role in TN removal. The ROS production increased with the increase of Fe3O4 NP concentration, and the integrity of cell membrane was good under Fe3O4 NP exposure. The functional genes that related to inorganic ion transport and metabolism and lipid transport and metabolism were upregulated, and cell motility decreased after long-term exposure of 1 mg/L Fe3O4 NPs.
Graphical abstract
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A systemic approach to identify signaling pathways activated during short-term exposure to traffic-related urban air pollution from human blood
Abstract
The molecular mechanisms that promote pathologic alterations in human physiology mediated by short-term exposure to traffic pollutants remains not well understood. This work was to develop mechanistic networks to determine which specific pathways are activated by real-world exposures of traffic-related air pollution (TRAP) during rest and moderate physical activity (PA). A controlled crossover study to compare whole blood gene expression pre and post short-term exposure to high and low of TRAP was performed together with systems biology analysis. Twenty-eight healthy volunteers aged between 21 and 53 years were recruited. These subjects were exposed during 2 h to different pollution levels (high and low TRAP levels), while either cycling or resting. Global transcriptome profile of each condition was performed from human whole blood samples. Microarrays analysis was performed to obtain differential expressed genes (DEG) to be used as initial input for GeneMANIA software to obtain protein-protein (PPI) networks. Two networks were found reflecting high or low TRAP levels, which shared only 5.6 and 15.5% of its nodes, suggesting specific cell signaling pathways being activated in each environmental condition. However, gene ontology analysis of each PPI network suggests that each level of TRAP regulate common members of NF-κB signaling pathway. Our work provides the first approach describing mechanistic networks to understand TRAP effects on a system level.
Comparable safety of two aspirin desensitization protocols for aspirin exacerbated respiratory disease (AERD)
Publication date: Available online 23 August 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Teresa Pelletier, Gigia Roizen, Zhen Ren, Golda Hudes, David Rosenstreich, Elina Jerschow
Direct sunlight enabled photo-biochemical synthesis of silver nanoparticles and their Bactericidal Efficacy: Photon energy as key for size and distribution control
Publication date: Available online 22 August 2018
Source: Journal of Photochemistry and Photobiology B: Biology
Author(s): A.K. Bhardwaj, A. Shukla, S. Maurya, S.C. Singh, K.N. Uttam, S. Sundaram, M.P. Singh, R. Gopal
Abstract
It is highly desirable to discover novel green synthesis methods for cheap and scalable synthesis of nanoparticles (NPs) to reduce the negative impact on the environment. But these approaches generally impose great challenge in controlling size, shape, and homogeneity of product NPs. Here in the present study, we report a novel approach enabling direct sunlight and oyster mushroom (Pleurotus citrinopileatus) extract for the photo-biochemical synthesis of Ag NPs. Sunlight of different wavelength was used to control the size and distribution of photo-biochemically produced NPs. Interestingly, it is observed that a smaller wavelength of sunlight produces smaller sized of NPs with a narrow size distribution. For examples; blue sunlight produces colloidal silver NPs with an average diameter of ~ 3.28 nm and 0.72 nm size distribution, while full sunlight produces comparatively larger sized (7.08 nm) NPs with wider (2.92 nm) size distribution. Since present approach uses only direct sunlight, freely available renewable energy source, a cheap biological extract as reducing and capping agent and cheap sliver precursor, therefore it is an environment-friendly approach and can be used for the synthesis of NPs at industrial scale. Moreover, the size-dependent bactericidal effect has also been studied against pathogenic, Escherichia coli, bacteria. The minimum inhibitory concentration (MIC) 25 ppm and MBC 30 ppm have been observed for silver NPs of 3.28 nm average diameter.
Graphical abstract
Examen mycologique en dermatologie
Publication date: Available online 22 August 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): M. Feuilhade de Chauvin
Résumé
Les dermatomycoses sont des infections dermatologiques très fréquentes en pratique de ville puisqu'elles peuvent atteindre un tiers de la population. Cependant, leur symptomatologie est souvent commune avec d'autres affections ou infections cutanées, et peut être très atypique. Il n'est donc pas possible de poser un diagnostic de certitude par un simple examen clinique. C'est pourquoi le diagnostic mycologique est indispensable pour confirmer ou infirmer une dermatomycose, et ne se discute pas lorsqu'un antifongique systémique doit être proposé comme dans le traitement d'une teigne du cuir chevelu et de la barbe, ou d'une onychomycose. Il devient indispensable lorsqu'un traitement prescrit sur l'aspect clinique des lésions est en échec ou si les lésions cutanées récidivent. La confirmation d'une mycose permet de prescrire un traitement antifongique et la négativité de l'examen justifie d'envisager une autre cause aux lésions observées. Néanmoins, quelle que soit la technique du diagnostic mycologique, la qualité de sa réponse dépend avant tout de la qualité du prélèvement sur le site infecté, mais aussi de l'expertise du biologiste. L'examen mycologique classique demeure le plus informatif, le moins cher, et le seul examen capable d'isoler le champignon responsable quelle que soit la mycose : dermatophytose ; scytalidiose ; infection unguéale à moisissure ; candidose ; infections à Malassezia sp. C'est le seul examen capable d'identifier les variations épidémiologiques. Toutes les autres techniques récemment proposées reposent sur la simple mise en évidence d'éléments fongiques sans identification de l'espèce fongique ou sont dépendantes d'une banque de données de champignons généralement très incomplète.
Abstract
Dermatomycoses are dermatological infections very commonly encountered in private dermatological practice since they affect up to one third of the population. However, the symptoms are very often shared by other skin infections and disorders and may be highly atypical. It is thus impossible to make a diagnosis with any certainty on clinical grounds alone. For this reason, mycological diagnosis is essential to either confirm or rule out dermatomycosis, and is unavoidable when antifungal therapy is required for the treatment of ringworm of the scalp or beard, or for onychomycosis. It is also vital where therapy guided by the clinical appearance of lesions has failed or in the event of recurring skin lesions. Confirmation of mycosis enables antifungals to be initiated and a negative test warrants investigation for other underlying causes for the lesions seen. However, regardless of the mycological diagnostic technique employed, the quality of the results depends chiefly on the quality of sampling of the infected site, but also on the expertise of the microbiologist. Standard mycological testing remains the most informative, the least expensive and the sole examination capable of isolating the causative fungus irrespective of the type of mycosis, such as dermatophytosis, scytalidiosis, mould-induced ungual infection, candidiasis, or infections due to Malassezia sp. This is the only examination able to identify epidemiological variations. All other more recent techniques are either based upon simple demonstration of the fungal elements involved, without identification of the fungal species in question, or else they are reliant upon a fungal database that is generally highly incomplete.
Maladies bulleuses auto-immunes à expression gingivale : proposition d’une technique de biopsie gingivale non iatrogène
Publication date: Available online 22 August 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): S.-M. Dridi, F. Bellakhdar, N. Ortonne, K. Bayet, S. Ingen-Housz-Oro, F. Gaultier
Résumé
Introduction
L'expression gingivale des maladies bulleuses auto-immunes (MBAI) est parfois inaugurale, exclusive ou prédominante (pemphigoïde des muqueuses, pemphigus vulgaire). L'histologie et l'immunofluorescence directe sont essentielles au diagnostic. Le choix du site et la technique chirurgicale déterminent la qualité histologique des prélèvements tissulaires. Or, la gencive est souvent considérée comme un tissu fragile, facilement altérable lors de la biopsie. Nous proposons un protocole original de biopsie intéressant les papilles gingivales, simple à réaliser, non iatrogène et accessible à tous les praticiens qui prennent habituellement en charge les patients atteints de MBAI à expression gingivale isolée (dermatologue, stomatologue, odontologiste spécialiste, oto-rhino-laryngologiste).
Patients et méthodes
Nous avons mené une étude rétrospective de 2012 à 2017 recensant tous les patients atteints de MBAI à expression gingivale ayant eu, à visée diagnostique, une biopsie de gencive papillaire. Notre objectif principal était d'évaluer la performance pour le diagnostic et la tolérance de cette technique opératoire.
Résultats
Sur la période d'étude, 34 biopsies de gencive papillaire ont été réalisées chez 19 patients, 15 pour l'examen anatomopathologique et 19 pour l'immunofluorescence directe. Sur les 34 biopsies, seule une n'a pas pu être analysée correctement en raison de l'absence de l'épithélium et a imposé la réalisation d'un second prélèvement. Aucune complication post-opératoire n'a été enregistrée à court ou à long terme.
Conclusion
La biopsie des papilles gingivales est parfaitement adaptée aux examens anatomopathologiques et immunohistochimiques nécessaires au diagnostic des maladies bulleuses auto-immunes (MBAI) à expression gingivale isolée. Cette technique chirurgicale non douloureuse présente une haute efficience et une très bonne tolérance. Toutefois, des études supplémentaires sont nécessaires pour confirmer nos résultats préliminaires dont l'absence de iatrogénèse.
Summary
Background
Gingival expression of autoimmune bullous diseases (AIBD) may be inaugural, exclusive or dominant (mucous membrane pemphigoid, pemphigus vulgaris). Histology and direct immunofluorescence are essential to diagnosis. The location of the biopsy and the surgical technique determine the histological quality of the tissue sample. However, gingival tissue is often considered fragile and easily impaired during biopsy. We suggest an original biopsy protocol for the gingival papillae that is simple to perform, non-iatrogenic, and readily accessible to all practitioners who usually treat AIBD patients presenting isolated gingival expression (dermatologists, stomatologists, odontology specialists, ENT specialists).
Patients and methods
We conducted a retrospective study from 2012 to 2017 identifying all patients presenting AIBD with gingival expression for whom we performed papillary gingival biopsy for diagnostic ends. Our main objective was to determine the diagnostic efficacy and safety of this surgical technique.
Results
Over the study period, 34 papillary gingival biopsies were taken from 19 patients : 15 for histopathological examination and 19 for direct immunofluorescence. Of the 34 biopsies, only one could not be properly analyzed due to lack of epithelium and a second tissue sample was therefore necessary. No short- or long-term complications occurred during post-operative follow-up.
Conclusion
Gingival papilla biopsy is perfectly suited to the histopathological and immunohistochemical examinations needed for diagnosis of AIBD with isolated gingival expression. This surgical technique shows great efficacy and very good safety. However, additional studies are necessary to confirm our preliminary results, in particular the absence of iatrogenic effects.
Editorial board
Publication date: August–September 2018
Source: Annales de Dermatologie et de Vénéréologie, Volume 145, Issues 8–9
Author(s):
Calendrier
Publication date: August–September 2018
Source: Annales de Dermatologie et de Vénéréologie, Volume 145, Issues 8–9
Author(s):
Deux cas d’adénite cervicale à mycobactéries non tuberculeuses chez l’enfant
Publication date: August–September 2018
Source: Annales de Dermatologie et de Vénéréologie, Volume 145, Issues 8–9
Author(s): N. Sigg, S. Bailleul, J.-M. Turmel, G. Legrand, S. Kettani, L. Martin
Résumé
Introduction
L'adénite cervicale est la manifestation la plus commune des infections à mycobactéries non tuberculeuses (MNT) chez l'enfant immunocompétent. Elle est pourtant mal connue des dermatologues. Son incidence actuellement en augmentation soulève plusieurs problèmes quant à sa physiopathologie, son diagnostic et sa prise en charge.
Observations
Nous rapportons deux cas d'adénite à MNT, chez une fille de 2 ans vaccinée pour le BCG et chez un garçon de 22 mois non vacciné, dont la présentation trompeuse a entraîné un retard au diagnostic. L'évolution s'est faite vers la fistulisation et le diagnostic a été finalement posé sur des cultures de prélèvements ganglionnaires. Les délais diagnostiques étaient respectivement de 2 et 4 mois. Les enfants ont été traités par 3 semaines d'érythromycine, puis 3 semaines de clarithromycine pour la fille ; par clarithromycine d'emblée pendant 7 semaines suivies d'une excision chirurgicale complète pour le garçon.
Discussion
L'adénite à MNT concerne préférentiellement des filles de moins de 4 ans et survient plus fréquemment en hiver et au printemps. Il faut éliminer les diagnostics différentiels, notamment la tuberculose, par une radiographie pulmonaire. Le diagnostic est orienté par la clinique, une intradermo-réaction à la tuberculine (IDR) positive et la résistance aux antibiotiques classiques. Il n'est certifié que par la culture systématique ou une PCR sur prélèvement ganglionnaire avec recherche spécifique de mycobactéries atypiques. L'augmentation de l'incidence des adénites à MNT, dont les plus fréquentes appartiennent au complexe Mycobacterium avium (MAC), coïncide avec la diminution de la protection infantile par le vaccin BCG. Le traitement de référence est la prise en charge chirurgicale. Néanmoins, des traitements alternatifs (excision incomplète, antibiothérapie, abstention, etc.) sont à discuter en cas d'échec de la chirurgie ou de risque trop élevé de lésion d'une branche du nerf facial.
Conclusion
L'adénite à MNT chez l'enfant immunocompétent est une infection de plus en plus fréquente depuis l'arrêt de la vaccination par le BCG en 2007. Une meilleure connaissance de l'affection, notamment par les dermatologues, permettrait une excision chirurgicale complète à un stade précoce, avec un taux plus faible de séquelles esthétiques.
Summary
Background
Cervical lymphadenitis is the most common manifestation of infection with nontuberculous mycobacteria (NTM) in immunocompetent children. Nevertheless, it is poorly known by dermatologists. Its incidence, which is currently increasing since the cessation of BCG vaccination in 2007, raises several issues regarding its pathophysiology, diagnosis and management.
Patients and methods
We report two cases of NTM adenitis: one in a 2-year-old girl vaccinated with BCG and one in an unvaccinated 22-month-old boy, in whom a misleading presentation led to delayed diagnosis. The condition progressed to fistula formation and the diagnosis was finally made on systematic cultures of lymph node samples. The time to diagnosis was 2 and 4 months, respectively. The girl was treated with erythromycin for 3 weeks and with clarithromycin for 3 weeks; the boy received clarithromycin for 7 weeks and underwent complete surgical excision.
Discussion
NTM adenitis preferentially affects girls under 4 years and occurs more frequently in winter and spring. First, the other differential diagnoses, including tuberculosis, must be ruled out by chest radiography. The diagnosis is oriented by the clinical picture, a positive TST and resistance to conventional antibiotics. However, it is only certified by systematic culture or PCR of lymph node biopsies, with screening for atypical mycobacteria being specified. The decrease in child protection by BCG vaccination coincides with the current increase in NTM infections, of which the most frequent is Mycobacterium avium complex (MAC) for cervical adenitis. The reference treatment is surgery. However, alternative treatments (incomplete excision, antibiotics, watchful waiting, etc.) should be considered where surgery fails or there is excessive risk of injury to a branch of the facial nerve.
Conclusion
Atypical mycobacterial adenitis in immunocompetent children has become an increasingly common infection since the abandonment of BCG vaccination. Improved knowledge of this disease would result in complete surgical excision at an early stage with a lower rate of aesthetic sequelae.
Mastectomie avec reconstruction mammaire immédiate : indications et techniques, algorithme de décision d’une reconstruction immédiate
Publication date: Available online 23 August 2018
Source: Annales de Chirurgie Plastique Esthétique
Author(s): F. Rimareix, B. Sarfati, N. Leymarie, H. Alkhashnam, J.F. Honart, K. Tran De Frémicourt, A. Conversano, S. Struk, J.-B. Schaff, Y. Bennis, C. Mazouni, S. Delaloge, S. Rivera, F. Kolb
Résumé
Les indications de reconstruction mammaire immédiate s'étendent aux carcinomes infiltrants, du fait de nouvelles techniques de couverture des implants par matrice et du fait du développement des lambeaux perforants. Ces techniques autorisent les traitements adjuvants. Il faut, cependant, que la décision de reconstruction immédiate soit encadrée par l'avis de la RCP oncologique et il faut aussi évaluer les bénéfices et risques au regard de la morphologie de la patiente et de ses comorbidités. Le type de mastectomie choisi : classique ou avec conservation de peau et/ou avec conservation de la plaque aréolo-mamelonnaire (PAM) dépend de la forme et du volume du sein, de la localisation de la tumeur dans le sein et par rapport à la PAM. Nous définissons un algorithme pour permettre en cas de mastectomie thérapeutique avec ou sans radiothérapie adjuvante, une reconstruction immédiate par prothèse ou lambeau libre ou pédiculé.
Summary
Immediate breast reconstruction indications extend to infiltrating carcinomas, due to new matrix implant coverage techniques and the development of perforator flaps. These techniques allow adjuvant treatments. However, the decision of immediate reconstruction must be discussed with the oncological multidisciplinary team and the benefits/risks must also be evaluated in relation to the morphology of the patients and their co-morbidities. The chosen type of mastectomy: conventional or skin sparing and/or nipple sparing depends on the shape and volume of the breast, the localization of the tumor in the breast and the distance from the nipple areola complex (NAC). We describe an algorithm to allow, in the case of therapeutic mastectomy with or without adjuvant radiotherapy, an immediate reconstruction with implants or free or pedicled flaps.
La reconstruction mammaire par TRAM
Publication date: Available online 23 August 2018
Source: Annales de Chirurgie Plastique Esthétique
Author(s): B. Couturaud
Résumé
Le lambeau de grand droit de l'abdomen ou Transverse rectus abdominis musculocutaneous flap (TRAM) a été décrit pour la première fois par Hartrampf en 1982. Il consiste à prélever un lambeau musculo cutané dont la palette cutanée de plastie abdominale est centrée sur des perforantes issues des vaisseaux épigastriques supérieurs, avec pour support vasculaire le muscle grand droit de l'abdomen. Nous décrivons la technique chirurgicale pas à pas par des photos commentées sur les différents temps.
Summary
The Transverse Rectus Abominis Musculocutaneous flap or TRAM was first described by Hartrampf in 1982. It consists in raising a abdominal musculocutaneous flap whose perforators vessels come from the superior epigastric vessels. We describe the surgical technique step by step with photos commented on different times.
Algorithmes décisionnels en reconstruction mammaire immédiate
Publication date: Available online 22 August 2018
Source: Annales de Chirurgie Plastique Esthétique
Author(s): B. Sarfati, F. Rimareix, J.F. Honart, H. Alkhashnam, K.T. De Frémicourt, A. Conversano, S. Struk, J.-B. Schaff, Y. Bennis, C. Mazouni, F. Kolb, N. Leymarie
Résumé
La reconstruction mammaire immédiate a montré de nombreux avantages en termes de résultats esthétiques et d'amélioration de la qualité de vie des patientes comparativement à la reconstruction mammaire secondaire. Les antécédents de radiothérapie ou la nécessité de traitement adjuvants (radiothérapie, chimiothérapie…) ne sont plus des contre-indications à la reconstruction mammaire immédiate. Il est, cependant, nécessaire de respecter certaines règles pour diminuer le risque de complications : le choix de la technique de reconstruction, la gestion de l'enveloppe cutanée en fonction de la forme du sein que l'on souhaite reconstruire, les délais entre le 1er et le 2e temps de reconstruction en fonction d'une éventuelle chimiothérapie ou radiothérapie adjuvante.
Summary
Immediate breast reconstruction showed many advantages in terms of aesthetic and functional results and improvement of quality of life when compared to delayed breast reconstruction. Previous radiotherapy or the use of adjuvant treatments such as radiation therapy, or chemotherapy are no longer a contraindication for immediate breast reconstruction. However, it is important to respect certain rules in order to decrease the risk of complications: the choice of reconstruction technique, the management of the skin envelope according to the breast shape you want to create, the time delay between the first and the second stage of reconstruction depending on a possible adjuvant treatment.
Correction to: “Dealing with the changeable and blurry edges of living things: a modified version of property-cluster kinds”
The article "Dealing with the changeable and blurry edges of living things: a modified version of property-cluster kinds", written by María J. Ferreira Ruiz and Jon Umerez, was originally published electronically on the publisher's internet portal (currently SpringerLink) on June 29, 2018 without open access.
European position paper on drug‐induced sleep endoscopy (DISE): 2017 update
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
Understanding the Hawthorne effect in wound research—A scoping review
International Wound Journal, EarlyView.
Potential gains in life expectancy by eliminating deaths from cardiovascular diseases and diabetes mellitus in the working life ages among Slovak population
In recent years, high mortality from cardiovascular diseases (chronic ischemic heart disease, acute coronary syndrome, cerebrovascular diseases, atherosclerosis, hypertensive diseases) and diabetes mellitus ha...
Factors for healthcare utilization and effect of mutual health insurance on healthcare utilization in rural communities of South Achefer Woreda, North West, Ethiopia
To identify factors for healthcare utilization and to describe effect of Mutual Health Insurance on health service utilization in rural community in South Achefer, North West Ethiopia.
Regret-sensitive treatment decisions
The threshold approach to medical decision-making, in which treatment decisions are made based on whether the probability of sickness exceeds a predetermined threshold, was introduced by (Pauker and Kassirer, ...
Gelatin as a convenient surrogate protein to model the in vitro effects of advanced glycation end‐product formation
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
The treatment of ingrown nail: Chemical matricectomy with NAOH versus wedge resection
Dermatologic Therapy, EarlyView.
Effect of massage therapy by VOSKIN 125+ painkiller® on inflammatory skin lesions
Dermatologic Therapy, EarlyView.
Complementary and integrative therapies for psoriasis: Looking forward
Dermatologic Therapy, EarlyView.
Familial facial lichen planopilaris and satisfactory response to isotretinoin
Dermatologic Therapy, EarlyView.
Secukinumab reduces plasma oxidative stress in psoriasis: A case‐based experience
Dermatologic Therapy, EarlyView.
A case of microcystic lymphatic malformation successfully treated with topical sirolimus
Dermatologic Therapy, EarlyView.
Treatment of recalcitrant generalized morphea with mycophenolate mofetil and intravenous immunoglobulin
Dermatologic Therapy, EarlyView.
A case of pityriasis lichenoides: Rapid resolution with azithromycin monotherapy in 3 weeks
Dermatologic Therapy, EarlyView.
Potential gains in life expectancy by eliminating deaths from cardiovascular diseases and diabetes mellitus in the working life ages among Slovak population
In recent years, high mortality from cardiovascular diseases (chronic ischemic heart disease, acute coronary syndrome, cerebrovascular diseases, atherosclerosis, hypertensive diseases) and diabetes mellitus ha...
Factors for healthcare utilization and effect of mutual health insurance on healthcare utilization in rural communities of South Achefer Woreda, North West, Ethiopia
To identify factors for healthcare utilization and to describe effect of Mutual Health Insurance on health service utilization in rural community in South Achefer, North West Ethiopia.
Systemic and stratum corneum biomarkers of severity in infant AD include markers of innate and Th‐related immunity and angiogenesis
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
Patient education and support group for patients with cutaneous lymphoma and their caregivers
Clinical and Experimental Dermatology, EarlyView.
Τετάρτη 22 Αυγούστου 2018
Reproductive Control Among Women with Violent Partners in Paraguay
Violence and Gender, Ahead of Print.
Do the Ages of Mass Shooters Matter? Analyzing the Differences Between Young and Older Offenders
Violence and Gender, Ahead of Print.
Health insurance and the ongoing debate of quality and quantity
Health disparities are differences in health among different groups of people. Generally related to socioeconomic factors, they culminate in differential outcomes among people suffering from similar conditions. Health disparities span all of health care—from management of chronic conditions (hypertension) to more acute conditions (cancer). An often-cited result is a widening gap in life expectancy between groups. Beyond survival, health disparities have a profound impact on general well-being. Multiple factors contribute to health disparities, including income inequality, which has increased dramatically and has been associated with a widening gap in life expectancy.1 Wealthier individuals have greater flexibility when considering options. The relationship between health care outcomes and income is likely more complicated than available monetary resources. Education has consistently correlated with health outcomes. New technology created a demand for skilled labor demanding higher wages while simultaneously decreasing demand for less skilled labor. Better jobs afforded by advanced education provide access to higher quality insurance. Education (in conjunction with financial potential) may increase access to and adaptation of healthful behaviors—smoking cessation, weight loss, etc—and improves compliance with complex therapies. Rising income inequalities promote geographic segregation of high- and low-income populations, resulting in differential diffusion of positive and negative influences. Health care access and type of insurance are other determinants of disparities. The article by Brown et al in this issue reports that the type of insurance correlates with treatment and outcome in glioblastoma patients.2
Revival of the VEGF ligand family?
The failure of anti-angiogenic drugs to increase the survival of glioblastoma (GBM) patients was certainly one of the most disappointing results of the last 10 years in neuro-oncology. A meta-analysis of available clinical trials with various compounds and encompassing more than 4300 patients confirmed the lack of survival benefit either as first- or second-line treatment.1 Despite this, the use of bevacizumab, a monoclonal antibody against vascular endothelial growth factor A (VEGF-A) and the most promising anti-angiogenic agent on the market, remains a matter of debate. Bevacizumab is approved for recurrent GBM in several countries, including the US, Australia, and Japan,2 and although not approved by the European Medical Agency, it continues to be used in some European countries as a salvage therapy. There is lingering hope that a subpopulation of patients benefiting from the drug may be identified and/or that a combination treatment may be effective.
High PAH degradation and activity of degrading bacteria during alfalfa growth where a contrasted active community developed in comparison to unplanted soil
Abstract
PAH biodegradation in plant rhizosphere has been investigated in many studies, but the timescale of degradation and degrading bacteria activity was rarely considered. We explored the impact of plants on the temporal variability of PAH degradation, microbial abundance, activity, and bacterial community structure in a rhizotron experiment. A historically contaminated soil was spiked with PAHs, planted or not with alfalfa, over 22 days with sampling once a week. In both conditions, most of the spiked PAHs were dissipated during the first week, conducting to polar polycyclic aromatic compound production and to decreased richness and diversity of bacterial communities. We showed a rapid impact of the rhizosphere on PAH degradation via the increased activity of PAH-degrading bacteria. After 12 days, PAH degradation was significantly higher in the planted (100% degradation) than in unplanted (70%) soil. Gram-negative (Proteobacteria) PAH-dioxygenase genes and transcripts were higher in planted than unplanted soil and were correlated to the spiked PAH degradation. Conversely, Gram-positive (Actinobacteria) PAH-dioxygenase gene transcription was constant over time in both conditions. At 12 days, plant growth favored the activity of many Gammaproteobacteria (Pseudomonadaceae, Stenotrophomonas, and Acinetobacter) while in unplanted soil Alphaproteobacteria (Sphingomonadaceae, Sphingobium, and Magnetospirillum) and Actinobacteria (Iamia, Geodermatophilaceae, and Solirubrobacterales) were more active.
Considerable radioactivity levels in the granitic rocks of the central areas of the Eastern Desert, Egypt
Abstract
The distribution of the natural radioisotopes 238U, 226Ra, 232Th, and 40K in addition to their radiological parameters in granitic rock samples from five different localities (Gebel El-Missikat, Gebel El-Gidamy, Gebel Ria El-Garra, Gebel El-Aradiya, and Gebel Kab Amira) in the central area of the Eastern Desert, Egypt, was measured using high purity germanium (HPGe) detector-based γ-spectrometry. The average activity concentrations of 238U, 226Ra, 232Th, and 40K in all five studied areas are higher than the corresponding global average values. The highest average activity concentrations of 238U and 226Ra were observed in Gebel El-Missikat, whereas the highest average value of 232Th activity concentration was found at Gebel El-Gidamy, and the highest concentration of 40K was obtained at Gebel El-Aradiya. The radiological hazard parameters radium equivalent (Raeq), external hazard index (Hex), internal hazard index (Hin), absorbed dose rate (ADR), annual effective dose rate (AEDR) outdoors, annual gonadal dose equivalent (AGDE), and excess lifetime cancer risks (ELCR) were calculated to assess the radiation hazards associated with the rock samples. The average values of these parameters are higher than the recommended reference levels. The obtained data provide a valuable future database for estimating the impact of radioactive contamination in the studied area and in the places where the rocks are used.
Removal of tetracycline from aqueous solution by biochar derived from rice straw
Abstract
Antibiotic pollution has drawn considerable attention and the removal of antibiotic from water is crucial. In the present study, biochars were produced from rice straw under different pyrolytic temperatures of 300 °C, 500 °C, and 700 °C (RSBC300, RSBC500, and RSBC700, respectively). The biochars were used to remove tetracycline (TC) from aqueous solution and the influence of different experimental conditions on TC removal was investigated. The results showed that the order of adsorption was as follows: RSBC700 > RSBC500 > RSBC300. A pseudo-second-order model and Langmuir isotherm model described the adsorption process of TC on biochars. Maximum adsorption capacity could reach 50.72 mg g−1 at 35 °C based on Langmuir fitting. Initial pH of the solution had little influence on TC removal. The inhibitory effect of Ca2+ on TC removal was greater than that of Na+. High system temperature was beneficial for TC removal. Minerals in RSBC500 affected TC removal and minerals in RSBC300 and RSBC700 had little influence on TC removal. TC removal rate decreased from 58.86 to 27.84% when the minerals were removed from RSBC500. The main mechanism involved in high-temperature biochar and TC adsorption included EDA π-π interactions and electrostatic interactions. Therefore, high-temperature biochar derived from rice straw has the potential to act as an adsorbent to remove tetracycline from aqueous solution.
Association of Risk of Obstructive Sleep Apnea With Thyroid Eye Disease: Compressive Optic Neuropathy
Purpose: To evaluate the association of risk of obstructive sleep apnea (OSA) and thyroid eye disease-compressive optic neuropathy (TED-CON). Methods: The authors performed a retrospective observational study. All TED patients evaluated by the principal investigator over the past 5 years were screened with the snoring tired observed pressure (STOP)-Bang questionnaire to assess their risk for OSA. Patients were grouped into 2 age-matched cohorts based on the presence (TED-CON) or absence of CON. The groups were then compared using chi-square analysis for binary variables and Student t test for continuous variables. Results: Three hundred twenty-six patients were identified to have TED. Of those, 109 were enrolled in the study. The prevalence of high risk of OSA was significantly higher in the TED-CON (59.2%) when compared with the noncompressive TED group (32.8%; p = 0.006). Conclusions: Obstructive sleep apnea and TED have each been independently associated with elevated serologic and tissue inflammatory mediators. The systemic inflammation associated with OSA has been implicated in the pathogenesis of disease states aggravated by untreated OSA. Effective treatment of OSA decreases the levels of circulating inflammatory mediators. Currently, smoking is the only known modifiable risk factor in TED. There is evidence to implicate the pathologic elevation of inflammatory cytokines in the mechanism of smoking on TED. This preliminary investigation reveals a significantly greater prevalence of OSA risk factors among patients with TED-CON, suggesting that this may be another modifiable risk factor associated with TED. Based on screening with the STOP-Bang questionnaire, there is a higher percentage of patients at high risk of OSA with TED with CON than with TED without CON. Accepted for publication July 8, 2018. The authors have no financial or conflicts of interest to disclose. Presented at American Society of Oculoplastic and Reconstructive Surgery on October 14, 2016 in Chicago, IL. Address correspondence and reprint requests to Larissa A. Habib, M.D., 243 Charles St, Boston, MA 02114. E-mail: habiblarissa@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Efficacy of Care for Blind Painful Eyes
Purpose: Pain relief for a blind painful eye often follows an escalating paradigm of interventions. This study compares the efficacy of common interventions. Methods: A retrospective chart review of blind painful eye cases was conducted at a single tertiary institution from April 2012 to December 2016. Demographics, etiology, treatment, and pain level were assessed. Results: Among 99 blind painful eyes, 96 eyes initially received medical therapy (topical steroids, cycloplegics, and/or hypotensives), with pain relief in 39% of eyes. Minimally invasive interventions (laser cyclophotocoagulation, retrobulbar injection, or corneal electrocautery) were performed 41 times in 36 eyes, 34 of which had failed medical therapy, and led to pain relief in 75% of eyes. Evisceration or enucleation was performed in 28 eyes, and long-term pain relief was achieved in 100% of eyes. Surgery allowed discontinuation of oral analgesics in 100% of cases versus 20% for minimally invasive therapy (p = 0.005) and 14% for medical therapy (p = 0.0001). Compared with medical therapy, minimally invasive therapy was 2.5 times more likely to achieve lasting pain relief (p = 0.003) and surgical therapy 35.6 times more likely to achieve lasting pain relief (p = 0.011). High initial pain score was associated with nonsurgical treatment failure. Conclusions: Medical therapy provides pain relief in a moderate number of patients with a blind painful eye. When medical therapy fails, minimally invasive therapy and surgical interventions are successively more effective in relieving ocular pain. High initial pain score is a risk factor for nonsurgical therapy failure and may merit an earlier discussion of surgical intervention. Accepted for publication July 3, 2018. Supported in part by NIH-NEI EY002162–Core Grant for Vision Research and by an unrestricted grant from Research to Prevent Blindness. The authors have no conflicts of interest to disclose. Poster presentation at ASOPRS 48th Annual Fall Scientific Symposium in New Orleans, LA on November 9, 2017. Address correspondence and reprint requests to M. Reza Vagefi, M.D., 10 Koret Way, K201, San Francisco, CA 94143. E-mail: reza.vagefi@ucsf.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Clinical and Magnetic Resonance Imaging Characteristics of Postfenestration Optic Nerve Sheath Pseudomeningoceles
Purpose: The clinical significance of postoperative pseudomeningocele formation following optic nerve sheath fenestration (ONSF) has not been fully characterized. A literature review identifies 9 previously published cases the authors believe demonstrate pseudomeningocele formation and approximately 19 other similar findings that were either transient or less defined blebs. This study was undertaken to more clearly define the clinical, radiographic, and histopathologic features associated with this entity. Methods: Sixteen-year, single-center, retrospective chart review of all ONSF cases performed by 2 surgeons. Clinical data, intracranial pressure, radiographic imaging, and histopathology of clinically detected pseudomeningoceles after ONSF were reviewed. Results: Eighty-six eyes in 57 patients underwent ONSF (28 unilateral, 12 bilateral sequential, 17 bilateral simultaneous). Forty-nine of 57 patients had elevated intracranial pressure preoperatively (41 idiopathic intracranial hypertension, 4 venous thrombosis, 2 meningitis, 1 arteriovenous malformation, and 1 sarcoid). In 32 patients undergoing postoperative imaging, 4 eyes (4.7%) in 4 patients developed well-defined pseudomeningoceles, of which 3 were symptomatic and 2 required surgical revision. Each pseudomeningocele developed in the setting of elevated preoperative intracranial pressure (350, 360, 430, 500 mm H20). Magnetic resonance imaging and/or computed tomography revealed sharply demarcated fluid-filled sacs adjacent to the optic nerve. The contents of these sacs were hypointense on T1-weighted imaging, hyperintense on T2-weighting, variably enhanced with contrast, and hypointense on fluid attenuated inversion recovery, and were thus consistent with cerebrospinal fluid. Histopathologic analysis of one of these outpouchings demonstrated an acellular, fibrocollagenized lining consistent with pseudomeningocele. Three eyes in 3 additional patients had less well-defined findings on imaging interpreted as bleb-like or cyst-like change. Conclusions: Pseudomeningoceles following ONSF may be asymptomatic or may cause symptomatic orbital mass effect and rarely visual loss, amendable to surgical excision. Post-ONSF pseudomeningoceles are identified on computed tomography or magnetic resonance imaging to occur at the locations of fenestration sites and contain cerebrospinal fluid communicating with the subdural space that may act as a "filtration" bleb in some cases. Imaging findings may represent a spectrum spanning intraorbital cerebrospinal fluid leakage, partial walling off of bleb, or fully developed cysts. Resection of optic nerve pseudomeningoceles is considered in symptomatic cysts or eyes with papilledema that fails to improve. Accepted for publication June 22, 2018. Supported, in part, by an unrestricted Grant from Research to Prevent Blindness, Inc., New York, NY; Fund for the New Jersey Blind, Newark, NJ; Lions Eye Research Foundation of New Jersey, Newark, New Jersey; The Eye Institute of New Jersey, Newark, New Jersey; and the Gene C. Coppa Memorial Fund. The authors have no conflicts of interest to disclose. Presented at a podium at the American Society of Ophthalmic Plastic and Reconstructive Surgery 47th Annual Fall Scientific Symposium on October 14, 2016 in Chicago, IL, and a poster presentation at the North American Neuro-Ophthalmology Society 43rd Annual Meeting on April 4, 2017 in Washington, DC. Address correspondence and reprint requests to Roger E. Turbin, M.D., F.A.C.S., Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, 90 Bergen Street, DOC Room 6177, Newark, NJ 07103. E-mail: turbinre@njms.rutgers.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Ophthalmic Eosinophilic Granulomatosis With Polyangiitis (Churg–Strauss Syndrome): A Systematic Review of the Literature
Purpose: To review and summarize the clinical features, presentations, diagnostic modalities, and management of ophthalmic manifestations of eosinophilic granulomatosis with polyangiitis (EGPA, formerly Churg–Strauss Syndrome). Methods: A systematic PubMed search of all English articles on EGPA with ophthalmic involvement was performed. Emphasis was placed on English-language articles, but any article with an abstract translated into English was also included. Only those cases that satisfied the American Rheumatology criteria (1990) for diagnosis were included. Data examined included epidemiology, pathogenesis, presentations, diagnostic modalities, and management. Results: There was a wide range in ophthalmic manifestations of EGPA. In order of most frequent presentation to least frequent, these include central retinal artery or vein occlusion, ischemic optic neuropathy, conjunctival nodules, orbital myositis, proptosis, dacryoadenitis, retinal vasculitis/infarcts/edema, cranial nerve palsy, and amaurosis. The 46 qualifying cases were divided into the categories of ischemic vasculitis versus idiopathic orbital inflammation due to prognostic significance. Ischemic vasculitis cases tended to be older patients (p = 0.03), unilateral (p = 0.006), require immunosuppressive therapy beyond steroids (p = 0.015), and were less likely to show improvement on therapy (p = 0.0003). Conclusions: Prompt diagnosis of EGPA by the ophthalmologist can decrease patient morbidity and mortality. This requires knowledge of likely ophthalmic EGPA presentations, as well as recommended workups and treatment. Accepted for publication June 27, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Anne Barmettler, M.D., Department of Ophthalmology and Visual Sciences, Montefiore Medical Center Bronx, NY 10467. E-mail: annebarmettler@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Embryologic and Fetal Development of the Human Orbit
Purpose: To review the recent data about orbital development and sort out the controversies from the very early stages during embryonic life till final maturation of the orbit late in fetal life, and to appreciate the morphogenesis of all the definitive structures in the orbit in a methodical and timely fashion. Methods: The authors extensively review major studies detailing every aspect of human embryologic and fetal orbital morphogenesis including the development of extraocular muscles, orbital fat, vessels, nerves, and the supportive connective tissue framework as well as bone. These interdisciplinary studies span almost a century and a half, and include some significant controversial opposing points of view which the authors hopefully sort out. The authors also highlight a few of the most noteworthy molecular biologic studies regarding the multiple and interacting signaling pathways involved in regulating normal orbital morphogenesis. Results: Orbital morphogenesis involves a successive series of subtle yet tightly regulated morphogenetic events that could only be explained through the chronological narrative used by the authors. The processes that trigger and contribute to the formation of the orbits are complex and seem to be intricately regulated by multifaceted interactions and bidirectional cross-talk between a multitude of cellular building raw materials including the developing optic vesicles, neuroectoderm, cranial neural crest cells and mesoderm. Conclusions: Development of the orbit is a collective enterprise necessitating interactions between, as well as contributions from different cell populations both within and beyond the realm of the orbit. A basic understanding of the processes underlying orbital ontogenesis is a crucial first step toward establishing a genetic basis or an embryologic link with orbital disease. Accepted for publication May 23, 2018. The authors have no financial or conflicts of interest to disclose. Diane Rothrock served as a guest editor for this submission. Address correspondence and reprint requests to Hatem A. Tawfik, M.D., Villa 49 Safari, Golf City, Alobur, Cairo, Egypt. E-mail: hatem35@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Un-segregated waste disposal: an alarming threat of antimicrobials in surface and ground water sources in Delhi
Abstract
Exposure of active pharmaceutical compounds (APCs) to the environment during human use is of potential importance in the emergence of drug resistance, changing soil microbiota and their residual effect on living organisms. Thus, this study aimed to assess the extent of exposure of APCs in the hydrologic cycle in and around New Delhi. This study analyzed the presence of 28 drugs from different classes in the surface water (river Yamuna) and aquifers collected from 48 places in Delhi (within the radius of 40 km). The collected water samples were quantified for APCs content using LC-MS/MS. This study revealed that aquifers are extensively affected in most areas based on the accumulation of APCs in water resources to the levels > 0.01 μg/L. Interestingly, a geographical plot of total APCs studied indicated clustering in aquifers with such high levels closer to an unscientific landfill. This 30-year-old un-segregated landfill is found to drain leachate into surface water that had high APCs. This study further revealed that apart from therapeutic usage, the main source of ecological exposure could be due to the disposal of unused and expired pharmaceutical compounds into landfills. For the first time, this study revealed the existence of antimicrobial agents and other APCs in the aquifers of Delhi with levels > 0.1 μg/L, which is a matter of serious concern in terms of multi-drug resistance and other environmental perils. This study warrants the enforcement of regulations for the disposal of unused/expired APCs in high-density population areas.
Combined Reflectance Confocal Microscopy–Optical Coherence Tomography for Basal Cell Carcinoma
This pilot study of 85 lesions from 55 patients assesses the accuracy of a handheld imaging device that combines reflective confocal microscopy (RCM) and optical coherence tomography (OCT) to detect, diagnose, and estimate the depth of basal cell carcinoma in adults.
Palatal Swelling in a Patient With Refractory Leukemia
A man in his 20s with acute myeloid leukemia presented with rapidly growing, severely painful oral lesions on the left hard palate. What is your diagnosis?
Association Between Autoantibody Phenotype and Cutaneous Adverse Reactions to Hydroxychloroquine
This cohort study examines myositis-specific autoantibodies observed during hydroxychloroquine therapy in patients with dermatomyositis to determine whether certain subsets of patients are more likely to experience a skin eruption.
Dupilumab for the Treatment of Recalcitrant Bullous Pemphigoid
This case report describes the use of dupilumab to treat recalcitrant bullous pemphigoid.
Pathogenetic Characteristics of Mesenchymal Stem Cells in Hidradenitis Suppurativa
This case-control study investigates the mesenchymal stem cell profile in patients with hidradenitis suppurativa and in healthy controls, with punch biopsy samples from axillary skin analyzed for immunophenotypic profiles.
How Should AI Screen for Skin Cancer and Deliver Diagnostic Predictions to Patients?
This Viewpoint describes the current state of deep learning algorithms used in artificial intelligence and discusses their potential use in dermatology screening and diagnosis, including mobile apps for patient use.
Multiethnic comparison of facial skin aging
Overt signs of skin aging can differ in type, onset and magnitude across individuals of different races. To understand the molecular basis for these differences, we conducted a study with women of four races/ethnicities spanning in age from 20 to mid-70s; we named this study the MultiDecades and Ethnic (MDE) Study. U.S. women volunteers were African-American, Hispanic and Chinese with ∼25 women in the age groups of 20-24, 40-44, and 60-64 years, and European-descended Caucasian women across each decade from 20-24 to 70-74 years.
The use of EpiPen for urticaria pigmentosa: Beneficial or burdensome?
Objective: To evaluate the frequency of EpiPen prescription in children diagnosed with urticaria pigmentosa (UP) and the utility of prophylactic EpiPen prescription for potential anaphylactic reactions in children with UP.
Influenza in New Zealand Before 1918: A Preliminary Report
Abstract
This paper aims to test the hypothesis of possible fatal immunological reactions to the A/H1N1 virus of the 1918 "Spanish" influenza pandemic caused by previous exposure to the A/H3N8 virus of the 1890–2 "Russian" influenza pandemic. Reconstruction of mortality peaks from influenza and excess pneumonia deaths in New Zealand before 1918 from newspapers and official death records enables comparison with peaks of influenza mortality by age in 1918 from individual death records. Influenza outbreaks in 1885, 1890–2, 1894 and 1898 appear to match mortality peaks for males in the 1918 pandemic. Peaks of female deaths in 1918 correspond to the previous influenza outbreaks of 1887 and 1890–2. The peak mortality for both sexes was in the age-groups 28–32 years. While lending strong support to the hypothesis of fatal immunological reaction derived from early exposure to a different influenza virus, this study also raises more puzzles: given that the A/H1N1 virus of 1918 was exceptionally virulent, why did so few children aged 5–15 die from it? Influenza normally kills only the very young and the very old. And why did twice as many European males than females die in the young-adult age-groups, while Māori males and females died at almost identical rates?Association Between Twenty-Year Trajectories of Non-Occupational Physical Activity From Midlife to Old Age and Biomarkers of Cardiovascular Disease: A 20-Year Longitudinal Study of British Men
Abstract
The trajectories of physical activity (PA) from midlife into old age and their associations with established and novel cardiovascular disease (CVD) risk factors in later life remain unclear. This study examined associations between 20-year non-occupational PA trajectories and a range of CVD biomarkers at 60–79 years. 3,331 men (mean baseline age = 50.2 ± 5.8 years) recruited in 1978–80 were followed up after 12, 16 and 20 years, reporting habitual non-occupational PA at each wave. At the 20-year follow up, surviving men attended a physical examination and provided a fasting blood sample. Group-based trajectory modelling was used to identify trajectories. Adjusted regression analyses examined the association between trajectory group membership and several cardiometabolic, cardiac and inflammatory markers at follow up. Three distinct 20-year trajectories were identified: low decreasing (21.3%), light stable (51.8%) and moderate increasing (27.0%). Compared to the low decreasing group, membership of the light stable and moderate increasing trajectory groups was associated with a more favorable cardiometabolic profile, lower levels of inflammation and endothelial dysfunction. Although following a moderate increasing PA trajectory was most favorable, more modest but sustained doses of PA into old age may be sufficient to lower CVD risk.Age-specific Excess Mortality Patterns During the 1918-1920 Influenza Pandemic in Madrid, Spain
Abstract
Although much progress has been made to uncover age-specific mortality patterns of the 1918 influenza pandemic in populations around the world, more studies in different populations are needed to make sense of the heterogeneous mortality impact of this deadly pandemic. Here we assess the absolute and relative magnitude of 3 pandemic waves in city of Madrid between 1918-1920 based on age-specific all-cause and respiratory excess death rates. We estimate excess death rates using a Serfling model with a parametric bootstrapping approach to calibrate baseline mortality levels with quantified uncertainty. We then estimate excess all-cause and pneumonia and influenza mortality rates for different pandemic waves and age groups. Age-specific analyses reveal the youngest and oldest experienced the highest excess mortality rates, and young adults faced the highest standardized mortality risk. Waves differed in strength; the peak standardized mortality risk occurred during the herald wave in spring 1918, but the highest excess rates occurred during the fall and winter of 1918-1919. We find little evidence to support a 'w'-shaped age-specific excess mortality curve. Our results indicate acquired immunity may have tempered a protracted fall wave, but recrudescent waves following the initial two outbreaks heightened the total pandemic mortality impact.Evaluation of a dry filter for dust removal under laboratory conditions in comparison to practical use at a laying hen barn
Abstract
The high amount of particulate matter from poultry houses in the exhaust air, especially at different types of laying hen barns, is the main challenge farmers are faced with concerning emissions. As a possibility for the mitigation of particulate matter in the outgoing air, a dry filter based on the principle of centrifugal force was investigated under laboratory and field conditions. Aerosol spectrometers were used for continuous measurements in raw and clean gas. Field experiments took place under summer and winter conditions, so that filter efficiency under different climate conditions could be compared and measurement values at the barn were continuously collected over 24-h periods. Data collected under laboratory conditions showed a high efficiency of the dry filter, whereas results of the field experiments differed in each size fraction of the particulate matter. These differences may be explained by the fact that under laboratory conditions, better circumstances for correct measuring were created, e.g., laminar flow of the air.
Profiling of heavy metal and pesticide residues in medicinal plants
Abstract
Application of medicinal plant to cure ailments has been practiced by several civilizations. Nowadays, contamination of heavy metals and pesticide residues in medicinal plant is a serious concern, due to toxic effects on human health. The present study was designed with an aim to quantify the heavy metals and pesticide residues in the 20 medicinal herbs, frequently sold in the local market as raw material without any quality assurance. The concentrations of the elements are as follows: copper (2.42–19.14 μgg−1), cadmium (0.01–2.10 μgg−1), chromium (17.63–58.63 μgg−1), iron (7.61–322.6 μgg−1), and lead (13.00–54.47 μgg−1), whereas total metal concentration ranged between 44.73 and 385.15 μgg−1. Among the organic pesticides, HCH (1.63–6.44 μgg−1) and DDT (0.63–7.14 μgg−1) isomers were found to be present in medicinal plant material. Result showed that lead and chromium concentrations in the herbs were above the permissible limits set by WHO. These herbs should be regularly checked for quality assurance before using raw or as a herbal formulation to avoid chronic exposure of metal and pesticides to human being.
Photocatalytic degradation of azo dye using core@shell nano-TiO 2 particles to reduce toxicity
Abstract
Clean and safe water is fundamental for human and environmental health. Traditional remediation of textile dye-polluted water with chemical, physical, and biological processes has many disadvantages. Due to this, nano-engineered materials are drawing more attention to this area. However, the widespread use of nano-particles for this purpose may lead to photocatalytic degradation of xenobiotics, while increasing the risk of nano-particle-induced ecotoxicity. Therefore, we comparatively evaluated the toxicity of novel synthesized core@shell TiO2 and SiO2 nano-particles to embryonic stages of Danio rerio and Xenopus laevis. The ability of photocatalytic destruction of the synthesized nano-particles was tested using toxic azo dye, disperse red 65, and the effects of reducing the toxicity were evaluated. The reflux process was used to synthesize catalysts in the study. The samples were characterized by scanning electron microscopy, X-ray fluorescence spectroscopy, X-ray diffractometry, BET surface area, and UV–vis-diffuse reflectance spectra. It was determined that the synthesized nano-particles had no significant toxic effect on D. rerio and X. laevis embryos. On the other hand, photocatalytic degradation of the dye significantly reduced lethal effects on embryonic stages of the organisms. Therefore, we suggest that specific nano-particles may be useful for water remediation to prevent human health and environmental impact. However, further risk assessment should be conducted for the ecotoxicological risks of nano-particles spilled in aquatic environments and the relationship of photocatalytic interaction with nano-particles and xenobiotics.
Optimizing Glioma Detection using an EGFR‐Targeted Fluorescent Affibody
Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.
The effectiveness of hyperbaric oxygen therapy for healing chronic venous leg ulcers: A randomised, double blind, placebo‐controlled trial
Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.
Paradoxical uveitis and pyoderma gangrenosum in a patient with psoriatic arthritis under infliximab treatment
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.
Presence of molluscum contagiosum virus within an epidermal cyst
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.
Rapid development of atypical fibroxanthoma during vismodegib treatment
Clinical and Experimental Dermatology, EarlyView.
Facial Microfiber Tissue with plant extracts: A new cosmetic concept shows whitening efficacy in Asian volunteers
Journal of Cosmetic Dermatology, EarlyView.
JCD Commentary August 2018
Journal of Cosmetic Dermatology, Volume 17, Issue 4, Page 577-577, August 2018.
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