To the Editor In their recent article, Brown et al(E7) conclude that "polyethylene glycol fusion has shown efficacy in the surgical repair of spinal nerve injuries, but this finding was not replicated in facial nerve injury repair." Problematically, Brown et al almost certainly did not induce polyethylene glycol (PEG)-mediated fusion repair of facial nerves in rats. We come to this conclusion for the following 3 reasons:
Πέμπτη 27 Σεπτεμβρίου 2018
Association of Skin and Cartilage Variables With Composite Graft Healing in a Rabbit Model
This animal model study investigates the ideal ratio of skin to cartilage and studies the importance of the perichondrial attachment for graft survival.
Superiorly Pediculated Superficial Musculoaponeurotic System Ligament Flap
This Surgical Pearl presents the technique for the superiorly pediculated SMAS ligament flap to hide nasal tip irregularities at the end of rhinoplasty.
Mediators of the Association Between Religious Service Attendance and Mortality
Abstract
Mounting evidence consistently shows associations between religious service attendance and reduced risk of mortality; yet research identifying mediators remains limited. Using prospective data from the Health and Retirement Study (2006-2014; n=5,200), we evaluated a range of potential mediators. After robust control for confounders (demographic, health, health behaviors, and social factors), among positive psychological factors, we observed mediation through increased life satisfaction (5.27% ; P=<.001) and possibly positive affect (1.52%; P=.06)—but not optimism, mastery, or purpose. Among dimensions of psychological distress, we observed mediation through reductions in hopelessness (1.92%; P=.01), trait anger (1.98%; P=.03), state anger (2.23%; P=.03), and possibly loneliness (1.21%; P=.06), but not cynical hostility or negative affect, and some evidence that increased anxiety (−3.61%; P=.008) and possibly depressive symptoms (−1.14%; P=.05) increased odds of mortality. Among social factors we observed mediation through contact with friends (10.73%; P=.005), but not living with a spouse, contact with children, or other family. Among health behaviors we observed mediation through exercise (5.38%; P=<.001), negative mediation through alcohol frequency (−2.55%; P=.03) and possibly body mass index (−2.34%; P=.08), but not smoking. These results highlight a range of mediators that may underlie the association between religious service attendance and reduced risk of mortality.Intraoperatives molekulares Bioimaging von Kopf-Hals-Karzinomen
Zusammenfassung
Hintergrund
Präoperativ werden umfassende onkologische Staging-Informationen gewonnen, um leitlinienorientierte Therapien für Patienten mit Kopf-Hals-Karzinomen zu definieren. Die präoperativen onkologischen Informationen können jedoch nicht verlustfrei in die intraoperative Situation transferiert werden. Trotz der steten Entwicklung der modernen Medizin sind für die intraoperative Detektion und Demarkierung malignen Gewebes lediglich klinische visuelle und taktile Informationen maßgebend.
Ziel der Arbeit
Ziel der Arbeit war die Entwicklung einer intraoperativen spezifischen Visualisierung invasiver Karzinomzellen in Echtzeit.
Material und Methoden
In Gewebe- und Zellkulturexperimenten wurden mittels Immun(fluoreszenz)histologie, Immunzytologie, Durchflusszytometrie (FACS), quantitativer Echtzeit-Polymerasekettenreaktion (qRT-PCR) und Western Blot die Expression und Regulation eines Biomarkers für invasive Karzinomzellen charakterisiert. Funktionelle Analysen erfolgten durch Invasions- und Migrations-Assays. Für In-vivo-Studien wurde ein „head and neck squamous cell carcinoma mouse-based patient-derived xenotransplant model" (HNSCC-PDX-Mausmodell) etabliert, um eine Visualisierung invasiver Karzinome mittels funktionalisierten RGD-Peptide kliniknah zu simulieren.
Ergebnisse
Das RGD bindende Integrin αvβ6 wurde als stabiler Biomarker invasiver Karzinomzellen identifiziert. Funktionalisierte RGD-Peptide zeigten eine selektive Bindung an Integrin αvβ6 zur Detektion αvβ6-positiver invasiver Karzinomzellen. Im HNSCC-PDX-Mausmodell konnte eine molekulare Bildgebung invasiven Karzinomgewebes (Bioimaging) etabliert werden.
Schlussfolgerung
Ein molekulares Bioimaging ermöglicht eine erweiterte Visualisierung der Lokalisation und Ausdehnung invasiven Karzinomgewebes in Echtzeit. Dieser intraoperative Informationsgewinn kann kurative chirurgische Therapieansätze unterstützen.
PMT1 deficiency extends the shortened replicative lifespan of TED1-deficient yeast in a Hac1p-dependent manner
Abstract
Protein O-mannosyltransferase-1 (Pmt1p) deficiency extends the replicative lifespan (RLS) of Saccharomyces cerevisiae, which is related to the activation of the unfolded protein response (UPR), an important pathway for alleviating endoplasmic reticulum (ER) stress. Trafficking of Emp24p/Erv25p-dependent cargo disrupted 1 (Ted1p) has been reported as a binding partner of yeast Pmt1p. We explored the potential relationship between Pmt1p and Ted1p in the cell lifespan and ER stress responses. The TED1-deleted strain (ted1Δ) had a shorter RLS with no increase in UPR activity. However, PMT1 deficiency prolonged the short lifespan of ted1Δ in a manner dependent on Hac1p, an upstream transcription factor of the UPR pathway. In addition, PMT1 deficiency enhanced the UPR activity and alleviated the ER stress resistance of the ted1Δ strain. Thus, the enhanced UPR activity was hypothesized to explain the longevity of the pmt1Δted1Δ strain, but this long-lived pmt1Δted1Δ strain showed decreased ER stress resistance compared with the short-lived ted1Δ strain. Taken together, our results suggest a possible relationship between PMT1 and TED1 regarding lifespan regulation and the ER stress response.Genome mining for the search and discovery of bioactive compounds: The Streptomyces paradigm
Abstract
The need for new antimicrobials is indisputable. The flight from natural products in drug discovery was unfortunate. However, the revolution that is genome mining, enabled by the explosion in sequencing technology, is a cause for hope. Nevertheless, renewed search and discovery is still a challenge. We explore novel metabolite diversity and the challenges in Streptomyces. Estimating novel bioactive metabolites remaining to be discovered is an important driver for future investment. Frequent re-discovery of known natural products was a major factor in big pharma exiting search and discovery and remains a reality. We explore whether this is exhaustive isolation and frequent lateral gene transfer. Analyzing all biosynthetic gene clusters across all genomes is challenging. Therefore, representative examples of the patterns of secondary metabolite diversity suggest re-discovery is linked to frequent expression in frequently isolated (and frequently mis-identified) strains. Lateral gene transfer of complete biosynthetic clusters is less frequent than might be perceived but frequent gene exchange implies a massive combinatorial biosynthesis experiment. Genome sequencing emphasizes rare expression of many secondary metabolite gene clusters and diversification at the finest levels of phylogenetic discrimination. And, we are only just beginning to unravel the impact of ecology. The hidden diversity suggests that cluster cloning and heterologous expression in microbial cell factories will explore this diversity more effectively.Phenotypes of Recurrent Wheezing in Preschool Children: Identification by Latent Class Analysis and Utility in Prediction of Future Exacerbation
Publication date: Available online 26 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Anne M. Fitzpatrick, Leonard B. Bacharier, Theresa W. Guilbert, Daniel J. Jackson, Stanley J. Szefler, Avraham Beigelman, Michael D. Cabana, Ronina Covar, Fernando Holguin, Robert F. Lemanske, Fernando D. Martinez, Wayne Morgan, Wanda Phipatanakul, Jacqueline A. Pongracic, Robert S. Zeiger, David T. Mauger, NIH/NHLBI AsthmaNet
Abstract
Background
Recurrent preschool wheezing is a heterogeneous disorder with significant morbidity, yet little is known about phenotypic determinants and their impact on clinical outcomes.
Objective
Latent class analysis (LCA) was used to identify latent classes of recurrent preschool wheeze and their association with future exacerbations and inhaled corticosteroid (ICS) treatment response.
Methods
Data from five clinical trials of 1,708 children age 12-71 months with recurrent wheezing were merged. LCA was performed on 10 demographic, exposure and sensitization variables to determine the optimal number of latent classes. The primary outcome was the annualized rate of wheezing exacerbations requiring systemic corticosteroids during the study intervention period; the secondary outcome was the time to first exacerbation. Exploratory analyses examined the effect of daily ICS treatment on exacerbation outcomes.
Results
Four latent classes of recurrent wheezing were identified; these were not distinguished by current symptoms or historical exacerbations but differed with regard to allergen sensitization and/or exposures. Annualized exacerbation rates (mean ± SEM/year) were 0.65 ± 0.06 for class 1 ("minimal sensitization"), 0.93 ± 0.10 for class 2 ("sensitization with indoor pet exposure"), 0.60 ± 0.07 for class 3 ("sensitization with tobacco smoke exposure"), and 0.81 ± 0.10 for class 4 ("multiple sensitization and eczema") (p < 0.001). In a research setting of high adherence, daily ICS treatment improved exacerbation rates in classes 2 and 4 but not the other groups.
Conclusion
Sensitization and exposure assessments are useful in the prediction of future exacerbation and may identify children most likely to respond favorably to daily ICS treatment.
Long-term Outcome of Peanut Oral Immunotherapy Facilitated Initially by Omalizumab
Publication date: Available online 26 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Christina S.K. Yee, Sultan Albuhairi, Elizabeth Noh, Kristel El-Khoury, Shervin Rezaei, Azza Abdel-Gadir, Dale T. Umetsu, Elizabeth Burke-Roberts, Jennifer LeBovidge, Lynda Schneider, Rima Rachid
Abstract
Background
We successfully used omalizumab to faciliate peanut oral immunotherapy (OIT) in children with reactivity to ≤50mg peanut protein and with high peanut-IgE (median 229 kU/L).
Objective
We report on long-term OIT outcomes in these patients, including dosing changes, adverse events, peanut immunoglobulin changes and quality of life (QoL).
Methods
Patients were followed for up to 72 months (67 months maintenance). Outcomes were collected on peanut dose amount, form and frequency, as well as adverse events, (QoL), and laboratory studies.
Results
Of 13 patients initially enrolled, 7 patients (54%) continued on peanut OIT through month 72; 6 (46%) discontinued therapy because of adverse reactions. Maintenance peanut protein dose varied between 500-3,500mg. Most patients consumed different peanut-containing products. All patients experienced at least one adverse event, and one patient developed eosinophilic eosphagitis. Peanut- IgE, Arah1-IgE and Arah2-IgE, peanut-SPT, Peanut-IgE:IgE ratio, and Arah2-IgE:Arah2-IgG4 ratio decreased on OIT. Peanut-IgG4, Arah1-IgG4, Arah2-IgG4 initially increased on OIT then decreased, though not falling to baseline levels. In patients who stopped OIT, there was a trend for reversal of these biomarker changes. Higher peanut-IgE and Arah2-IgE at study month 12 was associated with discontinuation. Patient and parent QoL improved from baseline, even in patients who discontinued OIT.
Conclusion
While adjunctive omalizumab allowed for faster and successful desensitization in patients with high peanut-IgE, almost half of patients discontinued OIT within 72 months because of reactions. Patients who stopped therapy had higher month 12 peanut-IgE and Arah2-IgE. It is possible that these patients might benefit from longer omalizumab administration.
Early exposure to cow’s milk protein is associated with a reduced risk of cow’s milk allergic outcomes.
Publication date: Available online 26 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Rachel L. Peters, Jennifer J. Koplin, Shyamali C. Dharmage, Mimi L.K. Tang, Vicki L. McWilliam, Lyle C. Gurrin, Melanie Neeland, Adrian J. Lowe, Anne-Louise Ponsonby, Katrina J. Allen
Abstract
Background
Overall early exposure to allergenic foods in the infant's diet is a new strategy for preventing food allergy to that allergen, but the optimal timing of exposure for different allergens is not known.
Objectives
We aimed to examine the relationship between exposure to cow's milk protein in the first 3 months of life and risk of cow's milk allergy at age 12 months.
Methods
HealthNuts is a longitudinal population-based food allergy study which recruited 5276 12-month old infants. Skin prick testing to cow's milk was conducted on the second half of the cohort (n=2715) and sensitisation defined as a wheal ≥ 2mm. Cow's milk allergy was defined as a parent reported reaction to cow's milk consistent with IgE-mediated allergy together with evidence of sensitisation. Early exposure to cow's milk protein was captured through parental questionnaire administered at one year of age and defined as consumption of cow's milk-based infant formula during the first 3 months of life.
Results
Forty-two percent of infants were exposed to cow's milk in the first 3 months of life (n= 1977/4712) and 87% of these infants were also breastfed. Early exposure to cow's milk protein was associated with a reduced risk of cow's milk sensitisation (aOR 0.44, 95% CI 0.23-0.83), parent-reported reactions to cow's milk (aOR 0.44, 95% CI 0.29-0.67) and cow's milk allergy (aOR 0.31, 95% CI 0.10-0.91) at age 12-months. Age at exposure to cow's milk protein was not associated with the risk of other food allergies.
Conclusion
Exposure to cow's milk protein in the first 3 months of life was associated with a reduced risk of cow's milk allergy. These findings are from an observational study and clinical trials are warranted to further assess this association before any recommendations to infant feeding guidelines can be made.
Multiple Acral Syringomas
Publication date: Available online 27 September 2018
Source: Actas Dermo-Sifiliográficas (English Edition)
Author(s): C. Gómez-de Castro, B. Vivanco Allende, B. García-García
Reconstructing Probabilistic Realism: Re-enacting Syntactical Structures
Abstract
Probabilistic realism and syntactical positivism were two among outdated theories that Feigl criticised on account of their semantical poverty. In this paper, I argue that a refined version of probabilistic realism, which relies on what Feigl specified as the pragmatic description of the symbolic behaviour of scientists' estimations and foresight, is defendable. This version of statistical realism does not need to make the plausibility of realist thesis dependent on the conventional acceptance of a constructed semantic metalanguage. I shall rely on the Prediction Error Minimisation theory (PEM) to support my probabilistic version of realism with a scientifically-informed and naturalistically plausible statistical account of the theories-world relationship which has a pragmatic ring to it.
Laser-assisted photodynamic therapy for actinic keratosis: A systematic review and meta-analysis
Publication date: Available online 27 September 2018
Source: Journal of the American Academy of Dermatology
Author(s): Theresa Steeb, Justin Gabriel Schlager, Christoph Kohl, Thomas Ruzicka, Markus V. Heppt, Carola Berking
Abstract
Background
Photodynamic therapy (PDT) is an effective intervention for actinic keratosis (AK) and field-cancerization. Ablative fractional laser may facilitate the delivery of photosensitizers and thereby improve the effects of PDT.
Objective
To summarize the current evidence on the efficacy and safety of laser-assisted PDT.
Methods
We performed a systematic literature research in Medline, Embase, and CENTRAL and hand-searched pertinent trial registers for eligible randomized controlled trials (RCTs). Results from individual studies were pooled using a random-effects model. The risk of bias was estimated with the Cochrane Risk of Bias Tool and the quality of evidence of the outcomes with the GRADE approach.
Results
Out of 817 records initially identified, 7 RCTs were included in the qualitative analysis and 4 in the meta-analysis. Laser-assisted PDT showed significantly higher clearance rates compared to PDT monotherapy (risk ratio 1.33, 95% CI 1.24 to 1.42, I2=25%, p<0.01). There was no difference in pain intensity between laser-assisted PDT and other interventions (mean difference 0.31, 95% CI to 0.12 to 0.74, I2=0%, p=0.16). The included studies showed a high risk of bias.
Limitations
The clinical heterogeneity of included studies.
Conclusion
Laser-assisted PDT is more efficient but not more painful than PDT or laser treatment only.
Results of a nationwide epidemiologic survey of autosomal recessive congenital ichthyosis and ichthyosis syndromes in Japan
Publication date: Available online 26 September 2018
Source: Journal of the American Academy of Dermatology
Author(s): Michiko Kurosawa, Ritei Uehara, Atsushi Takagi, Yumi Aoyama, Keiji Iwatsuki, Masayuki Amagai, Masaki Nagai, Yosikazu Nakamura, Yutaka Inaba, Kazuhito Yokoyama, Shigaku Ikeda
Background
Autosomal recessive congenital ichthyosis (ARCI) and ichthyosis syndrome (IS) are rare genetic skin disorders.
Objective
To estimate the number of patients with ARCI and IS in Japan and clarify the clinicoepidemiologic features of these diseases.
Methods
We performed a nationwide survey of patients treated for ARCI or IS during January 2005-December 2009. We developed diagnostic criteria and conducted a primary survey in a stratified random sample of Japanese hospitals to quantify the number of outpatients and inpatients with ARCI or IS. We performed a secondary survey of clinicoepidemiologic features in positive cases.
Results
The estimated number of patients receiving treatment for ARCI and IS during 2005-2009 was 220 (95% confidence interval [CI] 180-260). The estimated disease distribution was as follows: 95 (95% CI 80-110) patients with nonbullous congenital ichthyosiform erythroderma, 30 (95% CI 20-40) with lamellar ichthyosis, 15 (95% CI 10-20) with harlequin ichthyosis, and 85 (95% CI 50-120) with IS.
Limitations
Patients with a mild case of the disease might not have visited a dermatology department, potentially causing underestimation of affected patients.
Conclusion
We report the estimated number of patients with ARCI and IS in Japan and sex differences in the age distribution.
The Infraorbital Artery: Clinical Relevance in Esthetic Medicine and Identification of Danger Zones of the midface
Publication date: Available online 27 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): K. Hufschmidt, N. Bronsard, R. Foissac, P. Baqué, T. Balaguer, B. Chignon-Sicard, J. Santini, O. Camuzard
Summary
Background
Over the past decade, cosmetic injections of dermal fillers or fat have become a popular procedure in facial rejuvenation in an overconsuming society. However, complications such as arterial embolism and occlusion can occur even with experienced injectors, especially in high-risks zones namely the glabella, the nasal dorsum or the nasolabial fold. The aim of this study was to define the vascular danger zones of the infraorbital area in order to provide guidelines helping avoid them.
Materials and Methods
The infraorbital artery, its main branches and their anastomoses with neighbouring vessels were studied in 18 fresh cadavers. Mimetic injections of inked hyaluronic acid were performed in the infraorbital area in the interest of analysing its distribution and to determine potential vascular risks towards the infraorbital artery and its branches.
Results
The infraorbital artery and its branches were located in common injection regions and anastomosed to the supratrochlear artery, the dorsal nasal artery and the angular artery through the nasal branch of the infraorbital artery. Two danger zones could be depicted: injections can be risky when performed too superficially in the midcheek area, and likewise risky when performed in a periosteal layer in infraorbital hollow or tear-trough correction, because of an obvious possibility of retrograde embolism.
Conclusion
The infraorbital artery can be involved in anatomic mechanism of arterial occlusion, further blindness and stroke, among the related neighbouring arteries. Based on the findings of this study, injections to the periosteum layer in tear-trough correction and above the periosteum on the zygomatic arch is not advised.
Efficacy of Feracrylum as Topical Hemostatic Agent in Therapeutically Anticoagulated Patients Undergoing Dental Extraction: A Comparative Study
Abstract
Aims and Objective
To compare the efficacy of feracrylum with tranexamic acid (TXA), following dental extraction in patients who are therapeutically anticoagulated with warfarin.
Study Design
Sixty patients on warfarin were randomly divided into three groups. Groups 1 and 2 patients were given feracrylum (1%), and TXA (5%) solution pressure pack and a control group (Group 3) was given normal saline (NS) pressure pack after extraction. Postoperative bleeding was assessed and graded numerically and periodically (0, 1, 2, 5 and 7 days). The values were statistically analyzed.
Results
Sixty patients (M:F::37:23) with a mean age of 56 years who were therapeutically anticoagulated for different medical conditions were included. The mean warfarin dosage was 3.5 mg, and the mean INR was 2.83. Out of 27 patients who showed bleeding on day of extraction, eight, ten and nine patients belonged to groups I, II and III, respectively, and the difference was nonsignificant. Out of 15 patients who showed bleeding on post-extraction day 1, one, five and nine patients belonged to groups I, II and III, respectively. The difference was statistically significant on day 1 and nonsignificant in the next follow-ups.
Conclusion
Local hemostatic agents like TXA and feracrylum arrest bleeding without having any systemic action and without the necessity of altering the anticoagulant regimen. Feracrylum has an added advantage of a single application, formation of a mechanical barrier and an additional antimicrobial effect. These agents should be incorporated in the protocol for managing patients on oral anticoagulants.
Problemas de la CIE-10 para la codificación de diagnósticos dermatológicos. Estudio DIADERM
Publication date: Available online 27 September 2018
Source: Actas Dermo-Sifiliográficas
Author(s): G. González-López, I. García-Doval, A. Molina-Leyva, M.A. Descalzo-Gallego, R. Taberner, Y. Gilaberte, A. Buendía-Eisman, P. Fernández-Peñas
Resumen
Introducción y objetivos
La codificación de la enfermedad dermatológica en la 10.ª edición de la Clasificación Internacional de Enfermedades (CIE-10) presenta algunas carencias, motivo por el cual en 1999 se desarrolló una adaptación para Dermatología. En el estudio DIADERM se recogieron 10.999 diagnósticos de consulta ambulatoria realizados por dermatólogos a través de una muestra representativa nacional en España. El objetivo del presente trabajo es analizar los diagnósticos de DIADERM en los que no fue posible asignar un código diagnóstico con la CIE-10 adaptada, encontrar las causas y comprobar si la nueva CIE-11, en fase de borrador, permite codificar el diagnóstico.
Material y métodos
Se incluyeron todos los diagnósticos dermatológicos de DIADERM en los que no se pudo asignar un código diagnóstico con la CIE-10 adaptada. Se cuantificaron y se recogieron los diagnósticos incluidos para los que la CIE-10 adaptada y el borrador de la CIE-11 carecen de códigos específicos.
Resultados
A partir de un total de 10.999 diagnósticos del estudio DIADERM, se incluyeron 41 diagnósticos dermatológicos que no tenían código asignado, de los que, tras ser revaluados, 19 pudieron ser codificados, pero en 22 y en 17 diagnósticos, la CIE-10 adaptada y la CIE-11 provisional carecían de código específico, respectivamente.
Conclusiones
La CIE-10 adaptada a Dermatología contiene códigos diagnósticos que permiten clasificar adecuadamente a la inmensa mayoría de los diagnósticos dermatológicos vistos en consulta habitual. No obstante, presenta pequeñas carencias a la hora de clasificar ciertas enfermedades dermatológicas, sobre todo las de descubrimiento o desarrollo más reciente; algunos de estos problemas han sido resueltos en la nueva CIE-11. Con base en los resultados, se proponen algunas modificaciones para la CIE-11.
Abstract
Background and objectives
The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) has some shortcomings when it comes to coding certain dermatological disorders. To overcome these shortcomings, a compatible version of the ICD-10 specifically adapted to dermatology was produced in Spain in 1999. The recent DIADERM study recorded 10 999 dermatological diagnoses using a representative sample of dermatologists working at outpatient clinics in Spain. The aims of the current study were to identify diagnoses from the DIADERM study that could not be coded using the adapted ICD-10, determine why, and check if they could be coded using the draft ICD-11.
Material and methods
We included all dermatological diagnoses from the DIADERM study that could not be assigned a code from the adapted ICD-10. We then quantified and recorded all the diagnoses that could not be coded using either the adapted ICD-10 or the draft ICD-11.
Results
Of the 10 999 diagnoses analyzed, 41 had not been assigned a code. Of these, 19 were assigned an adapted ICD-10 code on reassessment. However, the adapted ICD-10 and the draft ICD-11 lacked specific codes for 22 and 17 diagnoses, respectively.
Conclusions
The adapted ICD-10 can be used to correctly code the vast majority of dermatological diagnoses seen in routine clinical practice. Nevertheless, the system does have some minor shortcomings when it comes to coding certain diseases, particularly newly discovered and emerging diseases. Some of these problems, however, were resolved with the new ICD-11. Based on our findings, we propose some modifications to the ICD-11.
Graphical abstract
La agenda oculta
Publication date: Available online 26 September 2018
Source: Actas Dermo-Sifiliográficas
Author(s): E. Martínez-García, A. Buendía-Eisman
Reconstrucción palpebral inferior mediante «colgajo triangular de Mutaf»
Publication date: Available online 26 September 2018
Source: Actas Dermo-Sifiliográficas
Author(s): P. Fernández Canga, E. Varas Meis, J. Castiñeiras González, M. Espasandín Arias, M.Á. Rodríguez Prieto
El colgajo del lector en cirugía dermatológica
Publication date: Available online 26 September 2018
Source: Piel
Author(s): Nuria Blázquez-Sánchez, Juan Bosco Repiso-Jiménez, Cristina García-Harana, Magdalena de Troya-Martín
Spectroscopic Properties of Lumiflavin: A Quantum Chemical Study
Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.
Inhibitory Effect of Lupeol on MMPs Expression using Aged Fibroblast through Repeated UVA Irradiation
Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.
Chronic wounds in Australia: A systematic review of key epidemiological and clinical parameters
International Wound Journal, EarlyView.
Epidemiology of Aspergillus species causing keratitis in Mexico
Mycoses, Volume 0, Issue ja, -Not available-.
Nagashima‐type palmoplantar keratoderma and malignant melanoma in Japanese patients
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
Beware what lies beneath: a case of a gigantic cutaneous squamous cell carcinoma
Clinical and Experimental Dermatology, EarlyView.
Herpes vegetans in a human immunodeficiency virus‐negative kidney transplant patient
Clinical and Experimental Dermatology, EarlyView.
Risk factors associated with frontal fibrosing alopecia: a multicentre case–control study
Clinical and Experimental Dermatology, EarlyView.
Diabetic scleroedema successfully treated by topical hyaluronidase injection: efficacy of magnetic resonance imaging
Clinical and Experimental Dermatology, EarlyView.
Successful treatment of PAPA syndrome with minocycline, dapsone, deflazacort and methotrexate: a cost‐effective therapy with a 2‐year follow‐up
Clinical and Experimental Dermatology, EarlyView.
WhatsApp platforms in tropical public health resource‐poor settings
International Journal of Dermatology, EarlyView.
Τετάρτη 26 Σεπτεμβρίου 2018
In Search of an Ideal Closure Method: A Randomized, Controlled Trial of Octyl-2-Cyanoacrylate and Adhesive Mesh versus Subcuticular Suture in Reduction Mammaplasty
Background: An ideal wound closure system is one that is effective, consistent, and efficient. Recent studies have demonstrated the efficacy of octyl-2-cyanoacrylate and mesh (Dermabond Prineo) in the closure of surgical wounds. This study compared the use of Prineo to use of subcuticular suture closure in reduction mammaplasty. Methods: A prospective, randomized, controlled, single-blind study of patients undergoing bilateral reduction mammaplasty was performed. Each breast per patient was randomized to layered closure with Prineo or subcuticular sutures. Incisions were assessed at 2 weeks, 6 weeks, 6 months, and 1 year. Subjects completed the Patient and Observer Scar Assessment Scale for each breast, and two blinded plastic surgeons evaluated scar quality using the Vancouver Scar Scale at each time point. Results: Twenty-one patients participated in the study. On average, Prineo closure took 58.38 seconds (2.50 seconds/cm) and subcuticular closure took 444.76 seconds (18.94 seconds/cm). Prineo closure was approximately 6.8 times faster (pTreatment of Infected Wounds in the Age of Antimicrobial Resistance: Contemporary Alternative Therapeutic Options
Summary: As antibiotic resistance increases and antimicrobial options diminish, there is a pressing need to identify and develop new and/or alternative (non–antimicrobial-based) wound therapies. The authors describe the implications of antibiotic resistance on their current wound treatment paradigms and review the most promising non–antibiotic-based antimicrobial agents currently in research and development, with a focus on preclinical and human studies of therapeutic bacteriophages, antimicrobial peptides, cold plasma treatment, photodynamic therapy, honey, silver, and bioelectric dressings.The Influence of Physician Payments on the Method of Breast Reconstruction: A National Claims Analysis
Background: Flap-based breast reconstruction demands greater operative labor and offers superior patient-reported outcomes compared with implants. However, use of implants continues to outpace flaps, with some suggesting inadequate remuneration as one barrier. This study aims to characterize market variation in the ratio of implants to flaps and assess correlation with physician payments. Methods: Using the Blue Health Intelligence database from 2009 to 2013, patients were identified who underwent tissue expander (i.e., implant) or free-flap breast reconstruction. The implant-to-flap ratio and physician payments were assessed using quadratic modeling. Matched bootstrapped samples from the early and late periods generated probability distributions, approximating the odds of surgeons switching reconstructive method. Results: A total of 21,259 episodes of breast reconstruction occurred in 122 U.S. markets. The distribution of implant-to-flap ratio varied by market, ranging from the fifth percentile at 1.63 to the ninety-fifth percentile at 43.7 (median, 6.19). Modeling the implant-to-flap ratio versus implant payment showed a more elastic quadratic equation compared with the function for flap-to-implant ratio versus flap payment. Probability modeling demonstrated that switching the reconstructive method from implants to flaps with a 0.75 probability required a $1610 payment increase, whereas switching from flaps to implants at the same certainty occurred at a loss of $960. Conclusions: There was a correlation between the ratio of flaps to implants and physician reimbursement by market. Switching from implants to flaps required large surgeon payment increases. Despite a relative value unit schedule over twice as high for flaps, current flap reimbursements do not appear commensurate with physician effort.
Accuracy of Three Software Applications for Breast Volume Calculations from Three-Dimensional Surface Images
Background: Knowing breast volumes before certain surgeries helps the surgeon to obtain breast symmetry. Calculating breast volumes from three-dimensional surface images is possible with specialized software applications. However, limited data exist concerning the accuracy of such volume calculations. The purpose of this study was to investigate the accuracy of breast volume calculations performed with the 3D BreAST, 3dMD Vultus, and VECTRA software applications. Methods: Twenty-six subjects who underwent 44 mastectomies were enrolled. Preoperative three-dimensional surface images were acquired with a VECTRA-XT stereophotogrammetry device. Breast volumes were calculated from these images with the three software applications. The mastectomy specimens were weighed to derive their actual volume and compared with the software calculations. Results: For all three methods, a positive correlation between the breast volume and absolute calculation error was found (pPreoperative Multimodal Analgesia Decreases Postanesthesia Care Unit Narcotic Use and Pain Scores in Outpatient Breast Surgery
Background: The opioid epidemic demands changes in perioperative pain management. Of the 33,000 deaths attributable to opioid overdose in 2015, half received prescription opioids. Multimodal analgesia is a practice-altering evolution that reduces reliance on opioid medications. Ambulatory breast surgery is an ideal opportunity to implement these strategies. Methods: A retrospective review of 560 patients undergoing outpatient breast procedures was conducted. Patients received (1) no preoperative analgesia (n = 333); (2) intraoperative intravenous acetaminophen (n = 78); (3) preoperative oral acetaminophen and gabapentin (n = 95); or (4) preoperative oral acetaminophen, gabapentin and celecoxib (n = 54). Outcomes included postanesthesia care unit narcotic use, pain scores, postanesthesia care unit length of stay, rescue antiemetic use, and 30-day complications. Results: Both oral multimodal analgesia regimens significantly reduced postanesthesia care unit narcotic use (oral acetaminophen and gabapentin, 14.3 ± 1.7; oral gabapentin, acetaminophen, and celecoxib, 11.9 ± 2.2; versus no drug, 19.2 ± 1.1 mg oral morphine equivalents; p = 0.0006), initial pain scores (oral acetaminophen and gabapentin, 3.9 ± 0.4; oral gabapentin, acetaminophen, and celecoxib, 3.4 ± 0.7; versus no drug, 5.3 ± 0.3 on a 1 to 10 scale, p = 0.0002) and maximum pain scores (oral acetaminophen and gabapentin, 4.3 ± 0.4; oral gabapentin, acetaminophen, and celecoxib, 3.6 ± 0.7; versus no drug, 5.9 ± 0.3 on a 1 to 10 scale; pUse of Composite Arterial and Venous Grafts in Microsurgical Breast Reconstruction: Technical Challenges and Lessons Learned
Summary: The success of microvascular reconstruction depends on many factors. Although many factors cannot be dictated by a surgeon, the success of anastomosis can be maximized by honing skill with performing anastomoses. However, size discrepancy of vessels remains a common challenge, given the lack of an ideal technique. In this study, the authors introduce their experience in using composite deep inferior epigastric arterial and venous grafts to overcome the vessel size and pedicle length discrepancy in lateral thigh and superficial inferior epigastric artery (SIEA) flaps. Of the 1095 flaps performed, the authors identified a total of 12 flaps (one lateral thigh flap and 11 SIEA flaps) on nine patients for breast reconstruction. The authors used deep inferior epigastric vessels to act as interposition grafts between the internal mammary artery and flap pedicle. For the SIEA flaps, the authors anastomosed the SIEA system to the deep inferior epigastric arterial system, checked the viability of the flap, and then transferred the flap to the internal mammary artery and flap pedicle. For the SIEA flaps, the authors anastomosed the SIEA system to the deep inferior epigastric arterial system, checked the viability of the flap, and then transferred the flap to the internal mammary artery system in three patients. In the last five patients, the authors anastomosed the deep inferior epigastric vessels to the internal mammary artery system first, and then transferred the SIEA flap. For the lateral thigh flap, the authors anastomosed grafts to the internal mammary artery system first as well. There were no flap losses or fat necrosis. Although the authors' outcomes are limited to only breast reconstruction, they believe this method could be expanded to different types of reconstruction, especially reconstruction of the head and neck.
Current Approaches to Prepectoral Breast Reconstruction
Summary: Prepectoral prosthetic breast reconstruction has become an acceptable option for women following mastectomy. Benefits include no animation deformity, absence of pectoralis major muscle spasm, and less pain and discomfort. Important aspects of prepectoral reconstruction include working with breast surgeons that are adept at performing an optimal mastectomy. Tissue perfusion and reasonable thickness of the mastectomy are critical components of success. Tissue necrosis, infection, and delayed healing can lead to reconstructive failure. Given the risks and benefits of this procedure, questions regarding indications, patient selection, and specific details related to technique remain because there is no consensus. Whether it is safe to perform prepectoral reconstruction in obese or previously irradiated patients is controversial. The use of acellular dermal matrix is common but not universal. The amount of acellular dermal matrix used is variable, with success being demonstrated with the partial and total wrap techniques. Device selection can vary but is critical in the prepectoral setting. Postoperative care and the management of adverse events are important to understand and can impact surgical and aesthetic outcomes. This article provides current approaches, recommendations, and an algorithm for prepectoral breast reconstruction with an emphasis on patient selection, immediate versus delayed prepectoral reconstruction, specific technical details, and postoperative management.
The Public Face of Rhinoplasty: Impact on Perceived Attractiveness and Personality
Background: The authors assess the impact of rhinoplasty on public perception of a patient's appearance and personality. Methods: A survey was created using standardized before-and-after photographs of 10 Caucasian women who had undergone primary rhinoplasty. Photographs of two additional women who had not undergone facial surgery were randomly included as controls, for a total of 12 survey items. Preoperative and postoperative photographs were placed side by side. The survey was administered by means of crowd-sourcing. Respondents were asked to evaluate which photograph better represented 11 traits of appearance or personality, according to a seven-point Likert scale. A score of 1 meant the preoperative photograph was much better, 7 meant the postoperative photograph was much better, and 4 meant no difference. T tests and analyses of variance were used to evaluate rating changes for each trait and differences between demographic groups. Results: There were 264 responses received. Averaged scores across the 10 survey patients produced a value for each appearance or personality trait. In 10 of 11 categories (i.e., symmetry, youthfulness, facial harmony, likeability, trustworthiness, confidence, femininity, attractiveness, approachability, and intelligence), the postoperative photograph was significantly favorable compared with the preoperative photograph (pThe Orbital Oval Balance Principle: A Morphometric Clinical Analysis
Background: The aim of this study was to test the validity of the "orbital oval balance principle," a system of analysis and guideline that is used among aestheticians, artists, and makeup artists to create and design aesthetically pleasing eyebrows for optimal upper facial appearance. According to this principle, a face is optimally attractive when the eye is centered in an "oval" defined by the lid-cheek junction and the eyebrow. Methods: One hundred participants were asked to rank digital morphed images of four female models with four different periorbital proportions: higher or lower lid-cheek junction versus higher or lower eyebrow position. In addition, the participants were asked to quantify seven emotions on these morphed images. Results: A higher lid-cheek junction was rated as significantly more attractive with a lower eyebrow position, and a lower lid-cheek junction was regarded far more attractive in combination with a higher eyebrow position. Moreover, a higher lid-cheek junction was rated as more attractive than a lower lid-cheek junction, and elevation of the lid-cheek junction improved the perception of emotions such as tiredness and sadness. Conclusions: This study lends support to the orbital oval balance principle that can provide important insight into facial attractiveness to surgeons undertaking procedures intended to improve and rejuvenate facial appearance. Moreover, this study has also shown not only that a high(er) lid-cheek junction is regarded as more youthful and attractive, but that it also may reduce the appearance of tiredness and sadness.Abdominoplasty with Circumferential Liposuction: A Review of 1000 Consecutive Cases
Background: The authors present the technique called "abdominoplasty with concurrent circumferential liposuction," where the whole trunk is addressed as a single aesthetic unit. Methods: Between January of 2008 and June of 2016, abdominoplasty with circumferential liposuction was performed in 1000 patients (984 women and 16 men) by the senior author. Patients had a mean body mass index of 27.5 kg/m2 (range, 18.1 to 34.5 5 kg/m2). Liposuction was performed circumferentially and the abdominal flap was detached up to the costal margins. Simultaneous fat grafting was also performed if required. Outcomes and complications were documented. Results: Traditional abdominoplasty incisions were used in 359 patients, whereas extended incisions were used in 641 patients. The mean duration of follow-up was 27 months (range, 12 days to 61 months), and the mean duration of surgery was 154 minutes (range, 109 to 260 minutes). The mean amount of simultaneously aspired supernatant lipoaspirate was 1940 cc (range, 1700 to 4580 cc). Simultaneous gluteal fat grafting was performed in 34 percent. None of the patients had any skin necrosis. The most common complication was seroma (19 percent). Conclusions: In abdominoplasty, the entire central body should be considered as a single unit. Circumferential widespread liposuction with standard undermining of the abdominal flap up to the costal margins is safe and yields superior aesthetic outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.Isolation, characterization, genomic sequencing, and GFP-marked insertional mutagenesis of a high-performance nitrogen-fixing bacterium, Kosakonia radicincitans GXGL-4A and visualization of bacterial colonization on cucumber roots
Abstract
A gram-negative bacterium GXGL-4A was originally isolated from maize roots. It displayed nitrogen-fixing (NF) ability under nitrogen-free culture condition, and had a significant promotion effect on cucumber growth in the pot inoculation test. The preliminary physiological and biochemical traits of GXGL-4A were characterized. Furthermore, a phylogenetic tree was constructed based on 16S ribosomal DNA (rDNA) sequences of genetically related species. To determine the taxonomic status of GXGL-4A and further utilize its nitrogen-fixing potential, genome sequence was obtained using PacBio RS II technology. The analyses of average nucleotide identity based on BLAST+ (ANIb) and correlation indexes of tetra-nucleotide signatures (Tetra) showed that the NF isolate GXGL-4A is closely related to the Kosakonia radicincitans type strain DSM 16656. Therefore, the isolate GXGL-4A was eventually classified into the species of Kosakonia radicincitans and designated K. radicincitans GXGL-4A. A high consistency in composition and gene arrangement of nitrogen-fixing gene cluster I (nif cluster I) was found between K. radicincitans GXGL-4A and other Kosakonia NF strains. The mutants tagged with green fluorescence protein (GFP) were obtained by transposon Tn5 mutagenesis, and then, the colonization of gfp-marked K. radicincitans GXGL-4A cells on cucumber seedling root were observed under fluorescence microscopy. The preferential sites of the labeled GXGL-4A cell population were the lateral root junctions, the differentiation zone, and the elongation zone. All these results should benefit for the deep exploration of nitrogen fixation mechanism of K. radicincitans GXGL-4A and will definitely facilitate the genetic modification process of this NF bacterium in sustainable agriculture.
3,6-Di(pyridin-2-yl)-1,2,4,5-tetrazine (pytz)-capped silver nanoparticles (TzAgNPs) inhibit biofilm formation of Pseudomonas aeruginosa : a potential approach toward breaking the wall of biofilm through reactive oxygen species (ROS) generation
Abstract
Microbial biofilms are factions of surface-colonized cells encompassed in a matrix of extracellular polymeric substances. Profound application of antibiotics in order to treat infections due to microbial biofilm has led to the emergence of several drug-resistant microbial strains. In this context, a novel type of 3,6-di(pyridin-2-yl)-1,2,4,5-tetrazine (pytz)-capped silver nanoparticles (TzAgNPs) was synthesized, and efforts were given to test its antimicrobial and antibiofilm activities against Pseudomonas aeruginosa, a widely used biofilm-forming pathogenic organism. The synthesized TzAgNPs showed considerable antimicrobial activity wherein the MIC value of TzAgNPs was found at 40 μg/mL against Pseudomonas aeruginosa. Antibiofilm activity of TzAgNPs was also tested against Pseudomonas aeruginosa by carrying out an array of experiments like microscopic observation, crystal violet assay, and protein count using the sub-MIC doses of TzAgNPs. Since TzAgNPs showed efficient antibiofilm activity, thus, in the present study, efforts were put together to investigate the underlying cause of biofilm attenuation of Pseudomonas aeruginosa by using TzAgNPs. To this end, we discerned that the sub-MIC doses of TzAgNPs increased ROS level considerably in the bacterial cell. The result showed that the ROS level and microbial biofilm formation are inversely proportional. Thus, the attenuation in microbial biofilm could be attributed to the accumulation of ROS level. Furthermore, it was also duly noted that microorganisms upon treatment with TzAgNPs exhibited considerable diminution in virulence factors (protease and pyocyanin) in contrast to the control where the organisms were not treated with TzAgNPs. Thus, the results indicated that TzAgNPs exhibit considerable reduction in the development of biofilms and spreading of virulence factors. Taken together, all the results indicated that TzAgNPs could be deemed to be a promising agent for the prevention of microbial biofilm development that might assist to fight against infections linked to biofilm.
Further characteristics of Arcanobacterium pinnipediorum DSM 28752 T and Arcanobacterium wilhelmae DSM 102162 T , two novel species of genus Arcanobacterium
Abstract
The newly described type strains Arcanobacterium pinnipediorum DSM 28752T and Arcanobacterium wilhelmae DSM 102162T, initially isolated from an anal swab of a harbor seal (Sammra et al. Int J Syst Evol Microbiol 65:4539–4543, 2015) and the genital tract of a rhinoceros (Sammra et al. Int J Syst Evol Microbiol 67:2093–2097, 2017), could be further characterized by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and Fourier transform infrared (FT-IR) spectroscopy and by sequencing the genomic targets 16S-23S rDNA intergenic spacer region (ISR) and the genes rpoB, gap, and tuf. The two strains investigated in the present study were isolated together with several other bacterial species indicating that the pathogenic importance of both species remained unclear. However, the detection of specific spectra by MALDI-TOF MS and by FT-IR spectroscopy and the presented genotypic approaches might help to identify A. pinnipediorum and A. wilhelmae in the future and might elucidate the role these two species play in infections of animals.
Rapid and simultaneous detection of Salmonella spp., Escherichia coli O157, and Listeria monocytogenes by magnetic capture hybridization and multiplex real-time PCR
Abstract
The application of rapid, specific, and sensitive methods for pathogen detection and quantification is very advantageous in diagnosis of human pathogens in several applications, including food analysis. The aim of this study was the evaluation of a method for the multiplexed detection and quantification of three significant foodborne pathogenic species (Escherichia coli O157, Salmonella spp., and Listeria monocytogenes). The assay combines specific DNA extraction by multiplex magnetic capture hybridization (mMCH) with multiplex real-time PCR. The amplification assay showed linearity in the range 106–10 genomic units (GU)/PCR for each co-amplified species. The sensitivity corresponded to 1 GU/PCR for E. coli O157 and L. monocytogenes, and 10 GU/PCR for Salmonella spp. The immobilization process and the hybrid capture of the MCH showed good efficiency and reproducibility for all targets, allowing the combination in equal amounts of the different nanoparticle types in mMCH. MCH and mMCH efficiencies were similar. The detection limit of the method was 10 CFU in samples with individual pathogens and 102 CFU in samples with combination of the three pathogens in unequal amounts (amount's differences of 2 or 3 log). In conclusion, this multiplex molecular platform can be applied to determine the presence of target species in food samples after culture enrichment. In this way, this method could be a time-saving and sensitive tool to be used in routine diagnosis.
KH-type splicing regulatory protein is regulated by nuclear factor-κB signaling to mediate innate immunity in Caco-2 cells infected by Salmonella enteritidis
Abstract
Salmonella enteritidis infection occurs in enterogenous diseases, such as gastroenteritis and parenteral focal infection, which often involve inflammation of intestinal epithelial cells. The nuclear factor kappa B (NF-κB) pathway participates in the innate immune response to many gram-negative pathogenic bacteria and initiates inflammation in epithelial cells. KH-type splicing regulatory protein (KSRP) is a multi-domain RNA-binding protein that recruits the exosome-containing mRNA degradation complex to mRNAs coding for inflammatory response factors. However, it remains unclear whether KSRP is regulated by NF-κB signaling pathway in response to S. enteritidis infection and affects the development of inflammation. Accordingly, in this study, we investigated the role of KSRP in mediating the response to S. enteritidis in Caco-2 cells. The data revealed that S. enteritidis infection decreased KSRP expression, which was suppressed by blocking the NF-κB pathway. Additionally, S. enteritidis infection significantly increased the expression of inducible nitric oxide synthase and cyclooxygenase-2. Overexpression of KSRP reduced the expression levels of inflammatory factors in Caco-2 cells. KSRP was regulated by the NF-κB signaling pathway and participated in mediating the innate immune response to S. enteritidis infection in Caco-2 cells, and KSRP acted as a negative regulator of inflammatory gene expression.
Production and cleavage of a fusion protein of porcine trypsinogen and enhanced green fluorescent protein (EGFP) in Pichia pastoris
Abstract
Pharmaceutical grade trypsin is in ever-increasing demand for medical and industrial applications. Improving the efficiency of existing biotechnological manufacturing processes is therefore paramount. When produced biotechnologically, trypsinogen—the inactive precursor of trypsin—is advantageous, since active trypsin would impair cell viability. To study factors affecting cell physiology and the production of trypsinogen in fed-batch cultures, we built a fusion protein of porcine trypsinogen and enhanced green fluorescent protein (EGFP) in Pichia pastoris. The experiments were performed with two different pH values (5.0 and 5.9) and two constant specific growth rates (0.02 and 0.04 1/h), maintained using exponential addition of methanol. All the productivity data presented rely on an active determination of trypsin obtained by proteolysis of the trypsinogen produced. The pH of the medium did not affect cell growth, but significantly influenced specific production of trypsinogen: A 1.7-fold higher concentration of trypsinogen was achieved at pH 5.9 (64 mg/L at 0.02 1/h) compared to pH 5.0. EGFP was primarily used to facilitate detection of intracellular protein over the biosynthetic time course. Using flow cytometry with fluorescence detection, cell disruption was avoided, and protein extraction and purification prior to analysis were unnecessary. However, Western blot and SDS-PAGE showed that cleavage of EGFP-trypsinogen fusion protein occurred, probably caused by Pichia-endogenous proteases. The fluorescence analysis did therefore not accurately represent the actual trypsinogen concentration. However, we gained new experimentally-relevant insights, which can be used to avoid misinterpretation of tracking and quantifying as well as online-monitoring of proteins with the frequently used fluorescent tags.
Local retrospective analysis of galactomannan cut-off values in bronchoalveolar lavage fluids for diagnosis of invasive aspergillosis
Abstract
Galactomannan antigen (GM) testing has been used for decades to screen immunocompromised patients for invasive aspergillosis (IA). Recent publications suggested that using a higher cut-off value than 0.5 in bronchoalveolar lavage fluid (BALF) could be more discriminant for hematology patients. We retrospectively analyzed the values of GM in BALF over 7 years (from 2010 to 2016). Performance indicators of the GM in BALF, according to three different cut-off values (0.5, 0.8, 1.5), were calculated using Stata 14.1. IA classification for hematology patients was based on European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria, as defined in 2008. A number of 716 GM were performed on BALF from 2010 to 2016 (597 patients) and 66 were positive (> 0.5). Among these 597 patients, 27 IA were diagnosed, 13 with a positive GM in BALF, 9 with a negative GM in BALF, and 5 unclassified IA (ICU patients). The analysis of performance indicators, based on our local data, did not demonstrate any significant difference using a higher cut-off value of GM in BALF. This result may be explained by the local recruitment of patients and by pre-analytic variations during BALF realization.
Analysis of Streptomyces ghanaensis ATCC14672 gene SSFG_07725 for putative γ-butyrolactone synthase
Abstract
Low molecular weight signaling compounds (LMWC) are important players in regulating various aspects of Streptomyces biology. Their exact roles in certain strain will ultimately depend on overall configuration of regulatory network and thus cannot be predicted on basis of in silico studies. Here, we explored S. ghanaensis gene SSFG_07725 (afsAgh) presumably involved in initial steps of formation of γ-butyrolactone LMWC. Disruption of afsAgh impaired aerial mycelium formation and increased the transcription of pleiotropic regulatory gene adpAgh, whereas level of moenomycin production remained virtually unaffected. We provide evidence that morphogenetic deficiency of afsAgh-minus mutant was caused by inability to produce diffusible LMWC. Possible links between γ-butyrolactone signaling and various aspects of S. ghanaensis biology are discussed.
Yeast species diversity in apple juice for cider production evidenced by culture-based method
Abstract
Identification of yeasts isolated from apple juices of two cider houses (one located in a plain area and one in an alpine area) was carried out by culture-based method. Wallerstein Laboratory Nutrient Agar was used as medium for isolation and preliminary yeasts identification. A total of 20 species of yeasts belonging to ten different genera were identified using both BLAST algorithm for pairwise sequence comparison and phylogenetic approaches. A wide variety of non-Saccharomyces species was found. Interestingly, Candida railenensis, Candida cylindracea, Hanseniaspora meyeri, Hanseniaspora pseudoguilliermondii, and Metschnikowia sinensis were recovered for the first time in the yeast community of an apple environment. Phylogenetic analysis revealed a better resolution in identifying Metschnikowia and Moesziomyces isolates than comparative analysis using the GenBank or YeastIP gene databases. This study provides important data on yeast microbiota of apple juice and evidenced differences between two geographical cider production areas in terms of species composition.
Are zoonotic Staphylococcus pseudintermedius strains a growing threat for humans?
Abstract
Staphylococcus pseudintermedius is a species often isolated from animals, as a common element of their microbiota or an agent of infection, and from people associated with an animal habitat, including owners of home pets—dogs and cats. As with many other species, adaptation of these bacteria to the human body can occur, and they become important human pathogens. 59 S. pseudintermedius strains were investigated in this study to determine the factors contributing to human body colonization: inhibition growth of human skin residents isolated from human skin (Staphylococcus epidermidis, Corynebacterium spp., Cutibacterium acnes (formerly Propionibacterium acnes)), biofilm formation, and the presence of ten genes encoding infection-promoting features (including ebpS, spsE, lukS, lukF, pvl, lip, hlgA, hlgB). The ability of human skin to be colonized and the presence of genes that promote the development of skin infections showed the significant potential of the studied strains in their adaptation to the host. However, while a comparison of the characteristics of animal strains and those isolated from human infections does not allow us to claim that we are the witnesses of the speciation of a new human pathogen, it does indicate their gradual adaptation to the human organism.
Relation to enterocins of variable Aeromonas species isolated from trouts of Slovakian aquatic sources and detected by MALDI-TOF mass spectrometry
Abstract
Aeromonads represent bacteria thought to be primarily mostly autochthonous to aquatic environments. This study was focused on the relation with antibiotics and enterocins of identified Aeromonas species isolated from the intestine of trouts living in Slovakian aquatic sources. Intestinal samples from 50 trouts (3 Salmo trutta and 47 Salmo gairdnerii) were collected in April of years 2007, 2010, and 2015 from trouts of different water sources in Slovakia (pond Bukovec near Košice, river Čierny Váh). Due to the MALDI-TOF mass spectrometry evaluation, 25 strains were proposed to the genus Aeromonas involving nine different species (Aeromonas bestiarum—nine strains, Aer. salmonicida—four strains, Aer. encheleia, Aer. eucrenophila, Aer. molluscorum, Aer. media, Aer. sobria, Aer. popoffii, Aer. veronii). Phenotypic evaluation of individual strains confirmed their species identification. Twenty-five strains of different Aeromonas species were sensitive to azithromycin, amikacin, mecillinam, mezlocillin, piperacillin, gentamicin, chloramphenicol, and tetracycline. On the other side, they were resistant to carbenicillin and ticarcillin. The growth of Aer. bestiarum R41/1 was inhibited by treatment with Ent M and Ent 2019 (inhibition activity 100 AU/mL). Aer. bestiarum R47/3 was inhibited by eight enterocins (100 AU/mL). It is the first study testing enterocins to inhibit the growth of Aeromonas species from trouts.
MALDI-TOF MS Supplementary database for species identification employing the yeast diversity encountered on southern Brazil grapes
Abstract
The study of grape microflora is of interest when autochthonous yeasts, which are related to typical wine characteristics, are intended to be used in winemaking. The election of matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF MS) as the first method for yeast identification was based on its accuracy and rapidity compared to alternative laboratory protocols for identification. The aims of this study are to consolidate the MALDI-TOF MS Supplementary database for environmental yeasts already constructed, to expand it through the addition of standard spectra of not included yeast species, and to discuss the grape microflora encountered in Southern Brazil. A total of 358 strains, isolated from grape berries, were submitted to protein profiling employing Biotyper and Supplementary database. Molecular biology techniques were used as alternatives to identify 6.4% of strains not promptly designated by protein profiling. These strains corresponded to the species Candida californica, Zygoascus meyerae, Candida akabanensis, Candida azyma, and Hanseniaspora vineae. The MALDI-TOF MS spectra of the identified species were added to Supplementary database. The presented results strengthen the need for further expansion of the mass spectra database to broaden its microbiological application.
Bacterial DNA detected on pathologically changed heart valves using 16S rRNA gene amplification
Abstract
Nowadays, dental diseases are one of the most common illnesses in the world. Some of them can lead to translocation of oral bacteria to the bloodstream causing intermittent bacteraemia. Therefore, a potential association between oral infection and cardiovascular diseases has been discussed in recent years as a result of adhesion of oral microbes to the heart valves. The aim of this study was to detect oral bacteria on pathologically changed heart valves not caused by infective endocarditis. In the study, patients with pathologically changed heart valves were involved. Samples of heart valves removed during heart valve replacement surgery were cut into two parts. One aliquot was cultivated aerobically and anaerobically. Bacterial DNA was extracted using Ultra-Deep Microbiome Prep (Molzym GmbH, Bremen, Germany) followed by a 16S rRNA gene PCR amplification using Mastermix 16S Complete kit (Molzym GmbH, Bremen, Germany). Positive PCR products were sequenced and the sequences were analyzed using BLAST database (http://www.ncbi.nlm.nih/BLAST). During the study period, 41 samples were processed. Bacterial DNA of the following bacteria was detected in 21 samples: Cutibacterium acnes (formerly Propionibacterium acnes) (n = 11; 52.38% of patients with positive bacterial DNA detection), Staphylococcus sp. (n = 9; 42.86%), Streptococcus sp. (n = 1; 4.76%), Streptococcus sanguinis (n = 4; 19.05%), Streptococcus oralis (n = 1; 4.76%), Carnobacterium sp. (n = 1; 4.76%), Bacillus sp. (n = 2; 9.52%), and Bergeyella sp. (n = 1; 4.76%). In nine samples, multiple bacteria were found. Our results showed significant appearance of bacteria on pathologically changed heart valves in patients with no symptoms of infective endocarditis.
Metabolic reconstruction and experimental verification of glucose utilization in Desulfurococcus amylolyticus DSM 16532
Abstract
Desulfurococcus amylolyticus DSM 16532 is an anaerobic and hyperthermophilic crenarchaeon known to grow on a variety of different carbon sources, including monosaccharides and polysaccharides. Furthermore, D. amylolyticus is one of the few archaea that are known to be able to grow on cellulose. Here, we present the metabolic reconstruction of D. amylolyticus' central carbon metabolism. Based on the published genome, the metabolic reconstruction was completed by integrating complementary information available from the KEGG, BRENDA, UniProt, NCBI, and PFAM databases, as well as from available literature. The genomic analysis of D. amylolyticus revealed genes for both the classical and the archaeal version of the Embden-Meyerhof pathway. The metabolic reconstruction highlighted gaps in carbon dioxide-fixation pathways. No complete carbon dioxide-fixation pathway such as the reductive citrate cycle or the dicarboxylate-4-hydroxybutyrate cycle could be identified. However, the metabolic reconstruction indicated that D. amylolyticus harbors all genes necessary for glucose metabolization. Closed batch experimental verification of glucose utilization by D. amylolyticus was performed in chemically defined medium. The findings from in silico analyses and from growth experiments are discussed with respect to physiological features of hyperthermophilic organisms.
The heterologous expression potential of an acid-tolerant Talaromyces pinophilus β-glucosidase in Saccharomyces cerevisiae
Abstract
A filamentous fungus displaying high cellulase activity was isolated from a compost heap with triticale (a wheat-rye hybrid) as the main constituent. It was preliminarily identified as a Talaromyces pinophilus species. A 2577 base pair β-glucosidase gene was cloned from complementary DNA and heterologously expressed in Saccharomyces cerevisiae. The recombinant β-glucosidase production profile was assessed and compared to that of the Saccharomycopsis fibuligera β-glucosidase which served as a benchmark. The enzyme was also characterised in terms of pH and temperature tolerance as well as response to inhibitors. Maximal extracellular β-glucosidase activity of 0.56 nkat/mg total protein was measured using p-nitrophenyl-β-D-glucopyranoside as substrate. The recombinant protein displayed a pH optimum of 4.0, and good thermostability as 70% of maximal enzyme activity was retained after 1 h at 60 °C. Activity of the recombinant β-glucosidase was adversely affected by the presence of glucose and ethanol at higher concentrations while xylose had no effect. The expression of the T. pinophilus β-glucosidase did not reach the same titres as for the benchmark; however, in the context of constructing a yeast strain for bioethanol production in a consolidated bioprocess, the enzyme may still show good potential.
Management of the Platysma in Neck Lift
Traditional techniques to treat platysma bands relied on corset tightening of the anterior platysma muscle borders or rigid suspension of the lateral platysma borders to sternocleidomastoid or periauricular fascia. Although results seemed good, recurrence was common and the ultimate outcome was poor. Despite modifications, they have largely failed, and for surgeons seeking to rejuvenate the face, treating platysma bands remains a most frustrating and perplexing problem in neck surgery. However, if problems are understood and carefully defined, and logical plans are used to treat them, significant improvement in common neck problems related to the platysma muscles can be obtained.
Short Scar Neck Lift
For a subset of patients poor neck contour exists as a largely isolated problem and can be treated with a short scar neck lift procedure whereby no skin is removed. The procedure is performed through a submental incision without any removal of skin and relies on modification of deep-layer structures to improve neck contour. "Excess" skin is allowed to redistribute itself over the increased neck surface area created when deep-layer maneuvers are performed, neck contour is improved, and the cervicomental angle deepened. For properly selected patients, the procedure can produce a marked improvement in facial appearance.
Extended Deep Plane Facelift
This article describes our extended, deep plane facelift technique. This procedure releases 4 key retaining ligaments in the face and neck, the zygomatic cutaneous, masseteric cutaneous, mandibular cutaneous, and cervical retaining ligaments. Once released, the composite deep plane flap is repositioned to volumize the midface and gonial angle. Important anatomic considerations during deep plane dissection are discussed. In the neck, focus is on extending the deep plane dissection of the platysma, releasing the cervical retaining ligaments, creating a platysmal hammock to support the submandibular gland, defining the inferior mandibular contour, and minimizing the need to open the neck.
Neck Lift
Success or failure in treating the neck lies in the diagnosis of underlying problems and the application of a logical surgical plan. Although it is a commonly advocated practice, it is not enough to perform submental liposuction and tighten the skin in most patients, as such an approach ignores a number of anatomic problems present in many patients seeking neck improvement. Removing subcutaneous fat and tightening skin over these problems does not correct them, and the presence or absence of each must be looked for to create and apply an appropriate surgical plan.
Lower Facial Rejuvenation
Traditionally, when facial rejuvenation was discussed, the face would receive the majority of the attention. Over the last decade, it has increasingly recognized that, in most cases without excellent concomitant neck rejuvenation, the overall result of a face–neck-lift will be average rather than superb. In fact, some authors would argue that the highest yield in satisfaction is provided by an excellent result in the neck component of the facial rejuvenation. The motifs in neck rejuvenation have also changed over the years, similarly to the face, but lagging by several decades.
Large pseudoencapsulated subcutaneous angiomyxoma: Surgical management
Superficial angiomyxoma is a rare benign skin tumor of mesenchymal origin composed of a myxoid matrix, thin-walled blood vessels, and sparse small spindle cells. This tumor is reported to have a high local recurrence rate when excised, possibly because muscle and soft tissue infiltration can occur. Thus, the term superficial can be misleading. In one published series, the local recurrence rate was 36%1 and in another 38%.2 However, all reported series are pathologic studies in which details of surgical excisions are scant.
Lichen planopilaris with Koebner phenomenon
Lichen planopilaris (LLP) is a rare, progressive disease of the scalp and is an important cause of scarring alopecia.1 LPP is classified clinically into 3 types: classic LPP, frontal fibrosing alopecia, and Graham-Little-Piccardi-Lassueur syndrome.2,3 In classic LPP, patients commonly present with single or multiple patches of alopecia in the vertex of the scalp.4 The exact pathogenesis of LPP remains unclear.5,6 Here we describe a case involving one of the youngest reported adult subjects in which the trigger for LPP is unique and was not previously reported.
Recalcitrant annular pustular psoriasis associated with psoriatic arthritis successfully treated with secukinumab
Pustular psoriasis is a well-known form of psoriasis, the main variants of which are acute generalized pustular psoriasis (GPP), including GPP of pregnancy, annular pustular psoriasis (APP), acrodermatitis continua of Hallopeau (ACH), and palmoplantar pustulosis (PPP). APP is a rare entity that presents as recurring annular or figurate erythematous plaques with peripheral pustules and scales that expand centrifugally.
Treatment of psoriasis vulgaris using low-dose naltrexone
Psoriasis is a common, immune-mediated skin disease affecting 3.1% of the US population.1 Psoriasis negatively impacts health-related quality of life and is associated with multiple physical and mental health comorbidities2 in addition to symptoms such as pain, itching, and bleeding. Psoriasis also imparts substantial burden on the national economy, including high health care resource use and direct and indirect costs and contributes to work impairment, presenteeism, and employment status changes because of symptoms.
55-year-old man with ulcers in inguinal fold and intergluteal cleft found to have systemic Langerhans cell histiocytosis
This article describes the case of a patient with cutaneous ulcers who was found to have systemic Langerhans cell histiocytosis (LCH). This article includes the clinical, histology, and electron microscopy images, in addition to a description of the presentation, workup, and management of this rare disease in this patients, with a review of the literature.
Group C streptococcal cellulitis, looking deeper than the skin
Group C streptococci (GCS), predominantly Streptococcus dysgalactiae subspecies equisimilis in humans, are gram-positive, ß-hemolytic bacteria that form part of the normal oral flora and may be seen in cases of pharyngitis and cellulitis. In a review of 88 patients with GCS bacteremia, infections commonly originated from the upper respiratory tract (20.5%), gastrointestinal tract (18.2%), or the skin (17.1%).1 GCS has also been reported in septic arthritis, endocarditis, meningitis, pneumonia, necrotizing fasciitis, and toxic shock–like syndrome.
Dermoscopy of eccrine angiomatous hamartoma: The spitzoid pattern
A 5-year old girl presented with an erythematous, asymptomatic nodule of the left knee, which appeared 1 year before (Fig 1).
Rare presentation of erythema elevatum diutinum
Erythema elevatum diutinum (EED) is a rare, chronic, and progressive skin condition, classified within the neutrophilic vasculitides. It presents as erythematous and violaceus papules and plaques. The distribution tends to be bilateral and symmetrical, overlying joints and localized on extensor surfaces. EED generally affects middle-age patients. Although its cause is yet unknown, it can be associated with other underlying autoimmune, infectious, or malignant diseases. Dapsone is used as a first-line therapeutic agent.
Persistent injection site nodules from exenatide: Successful treatment with intralesional triamcinolone
Exenatide extended release is a once-weekly injectable medication used for the treatment of type II diabetes mellitus. The long-acting formulation consists of the original twice-daily formulation encapsulated in 0.06-mm-diameter microspheres.1 The subcutaneously injected exenatide microspheres then diffuse the medication slowly over time, reaching therapeutic range by 2 weeks and steady state by 6 to 7 weeks.1 Pharmacologically, it acts as an incretin analogue that activates glucagonlike peptide 1 receptors causing a glucose-dependent insulin secretion.
Madelung lipomatosis presenting as a manifestation of myoclonic epilepsy with ragged red fibers (MERRF) syndrome
This is a unique case of a patient with a history of myoclonic epilepsy with ragged red fibers (MERRF) syndrome presenting with Madelung or multiple symmetric lipomatosis. We discuss the etiology of MERRF syndrome and its link with Madelung lipomatosis via a common mitochondrial mutation that can be present in both diseases. The appearance of Madelung lipomatosis should prompt physicians to search for other neural, muscular, and pulmonary findings that may lead to a diagnosis of MERRF syndrome.
Certolizumab in a patient with severe psoriasis and concomitant hepatitis C virus infection
The treatment of psoriasis has benefited in recent years from the introduction of biological drugs that target specific components of the immune system. Some of these drugs block the excess production of tumor necrosis factor (TNF)-α in the skin or joints, thus, helping stop the inflammatory cycle of psoriatic disease. However, it has been suggested that anti–TNF-α agents could be associated with exacerbations of concomitant viral infections, an effect that could have potentially serious consequences in patients with hepatitis C virus (HCV) infection.
Reply: Commentary on letter to the editor from Drago et al
To the Editor: We appreciate the opportunity to respond to the letter by Drago et al, regarding our recently published report, "Ibrutinib-associated pityriasis rosea-like rash."1
Removal notice
Removal notice to "Severe recalcitrant cutaneous eruption with dual immune checkpoint blockade"
Granulomatous dermatitis as a postherpetic isotopic response in immunocompromised patients: A report of 5 cases
Granulomatous dermatitis (GD) describes disorders in which mixed inflammatory infiltrates composed primarily of histiocytes invade the skin. The pathogenesis of GD is unknown; however, GD has been noted to occur in areas previously affected by trauma, sun damage, or infection.1 When GD presents at the same site of a healed, unrelated skin disease, it falls within the category of a Wolf's isotopic response.2 The regional restriction of a Wolf's isotopic response is proposed to occur due to an area of localized immunocompromise known as an immunocompromised district.
Superficial granulomatous pyoderma of the leg improved after conservative management with Unna boot and intralesional steroid injections
Superficial granulomatous pyoderma (SGP) is a rare condition that some regard as a variant of pyoderma gangrenosum (PG) given their clinical similarities; however, SGP is distinct in its cutaneous presentation, histology, lack of underlying disease, and prognosis. Treatment options have ranged from oral antibiotics to oral and intralesional steroids, immunomodulatory agents, and intravenous immunoglobulin (IVIG), among others. We describe a case of long-standing SGP that responded to conservative management with Unna boot and intralesional steroid injections.
Successful treatment of type I pityriasis rubra pilaris with ixekizumab
Pityriasis rubra pilaris (PRP) is a rare condition that has been classified into 6 subtypes dependent on morphologic features, prognosis, age of onset, and HIV status.1,2 Classic adult subtype I accounts for approximately 55% of cases. It is clinically characterized by diffuse follicular plugging and perifollicular erythema coalescing to form orange-red scaly plaques with follicular plugging extending caudally to form generalized erythema with characteristic small islands of normal-appearing skin.
Palisaded neutrophilic and granulomatous dermatitis associated with ledipasvir/sofosbuvir
Palisaded neutrophilic and granulomatous dermatitis (PNGD) is a cutaneous reaction pattern seen in association with systemic diseases and rarely with infections or medications.1 Typical clinical presentation includes tender, erythematous-to-violaceous papules, plaques, or nodules affecting extensor and acral surfaces, most commonly the elbows and hands.1,2 Histopathologic examination of the lesions can vary, and the disease is thought to occur along a continuum, with early lesions histologically resembling leukocytoclastic vasculitis with dense neutrophilic infiltration and more established lesions consisting of palisaded histiocytes and small granulomas with trapping of collagen and neutrophilic debris.
Acquired epidermodysplasia verruciformis in setting of tumor necrosis factor-α inhibitor therapy
Epidermodysplasia verruciformis (EV) is a rare dermatologic condition in which patients have recalcitrant lesions associated with specific human papillomavirus (HPV) types. More than 20 types of HPV are associated with EV (termed EV-HPV types) and most commonly include HPV 5 and 8.1-3 First described as a genodermatosis, it has more recently been reported as an acquired form in patients with an underlying source of immunosuppression, namely, HIV.2 It has not been reported in patients on tumor necrosis factor (TNF)-α inhibitors.
Medium-vessel vasculitis presenting as multiple leg ulcers after treatment with abatacept
Abatacept (Orencia) is a recombinant fusion protein of cytotoxic T-lymphocyte–associated antigen-4 and human immunoglobulin that inhibits T-cell activation and proliferation by binding to CD80 and CD86 on antigen-presenting cells and prevents binding to CD28 on T cells.1 The drug is approved by the US Food and Drug Administration to treat adult rheumatoid arthritis, juvenile idiopathic arthritis, and, more recently, psoriatic arthritis.
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A Case of Diprosopus Tetraophthalmos: Ocular Findings and Surgical Treatment of Exposure KeratopathyDiprosopus is a rare variation of conjoined twinning. In this report, ophthalmic findings in an infant with diprosopus tetraophthalmos are p...
