Τρίτη 16 Οκτωβρίου 2018
Assessment of community pharmacy professionals’ knowledge and counseling skills achievement towards headache management: a cross-sectional and simulated-client based mixed study
Headache is one of the most common disabling medical condition affecting over 40% of adults globally. Many patients with headache prefer to alleviate their symptom with a range of over-the-counter analgesics t...
Determinants of Fasting Hyperglucagonemia in Patients with Type 2 Diabetes and Nondiabetic Control Subjects
Metabolic Syndrome and Related Disorders, Ahead of Print.
Acute Physical Effort Increases Sympathovagal Balance Responses to Autonomic Stimulation in Metabolic Syndrome
Metabolic Syndrome and Related Disorders, Ahead of Print.
Continuous Negative Pressure Drain is Associated with Better Outcome: A Randomized Prospective Trial in Plastic Surgery Patients
Abstract
Background
A randomized prospective trial to compare the effects on minimizing complications using continuous negative pressure drain and intermittent suction mode in plastic surgeries.
Methods
There were 174 cases of stage II post-auricular flap expansion and ear reconstruction, 76 cases of skin expansion flap repair, 56 cases of breast augmentation surgery, 58 cases of abdominoplasty, and 76 cases with free skin grafts. Patients were randomized to intermittent suction mode group (control group) and continuous negative pressure external drain group (intervention group) stratified by surgery types. In the intervention group, different pressure levels were applied according to the surgery types. The drainage volume, the length of time of external drainage, incidence of seroma, flap necrosis, the first intending healing rate and drain-associated bleeding were recorded and compared.
Results
Generally, fewer complications and better healing were observed in the intervention group. In patients with stage II post-auricular flap expansion and ear reconstruction, lower incidence of flap necrosis and seroma, higher first intention healing rate, greater drain volume but shorter time of drainage were observed in the intervention group (p < 0.05 for all). Similar results were shown in patients with skin expansion flap repair, breast augmentation, abdominoplasty, and free skin grafts. In patients who underwent free skin grafts, a higher graft success rate and lower graft infection rate were also observed (p < 0.01 for both). No drain-associated bleeding was observed.
Conclusions
A continuous negative pressure drain was associated with better outcomes in patients underwent various plastic surgeries and is a powerful technique in the postoperative management of plastic surgery.
Level of Evidence II
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Synkinesis Between Orbicularis Oculi and Procerus Muscles: Video Presentation of an Unusual Type of Aberrant Innervation after Cosmetic Rhinoplasty
Abstract
Background
Synkinesis is a recognized complication following peripheral facial nerve paralysis. Different types of synkinesis have been described, with oral–ocular and ocular–oral synkinesis being the most common. Ocular–nasal synkinesis has been reported in two patients following cosmetic rhinoplasty. However, synkinesis between the orbicularis oculi and procerus muscles has not been reported by now.
Methods
This is an interventional case report.
Results
Two women, aged 42 and 37 years, presented with unilateral contraction of the medial eyebrow muscles (procerus) with spontaneous or voluntary blinking, 4 and 5 months after cosmetic rhinoplasty, respectively. Both were successfully treated with injection of botulinum toxin A.
Conclusions
Surgical trauma is inevitable during every procedure, including rhinoplasty, and may damage the fine structures including branches of the facial nerve innervating the muscles. Gentle tissue handling may minimize iatrogenic injury to the fine motor branches of the facial nerve and prevent subsequent aberrant innervation and synkinesis. Botulinum toxin A injection can effectively, yet temporarily, resolve the unintentional contractions and provide significant patient comfort.
Level of Evidence V
This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266.
Problems and Solutions for Platelet-Rich Plasma in Facial Rejuvenation: A Systematic Review
Abstract
Background
In recent years, platelet-rich plasma (PRP) has been widely applied in orthopedics, maxillofacial surgery, burns, and plastic surgery, especially in facial rejuvenation. Research is ongoing into new indications and mechanisms of PRP to promote its wider, safer, and more effective use in the clinic. This article reviews the possible mechanisms of PRP in facial rejuvenation and related research. It is expected that the application of PRP in this field will increase.
Methods
The use of PRP in facial rejuvenation was screened using inclusion and exclusion criteria. The relevant articles were searched through Pubmed digest database, SCI full-text database, ScienceDirect full-text database, and the CNKI full-text database. The different effects and limitations of PRP were extracted.
Results
A total of 108 articles were obtained, including 18 articles researching PRP in cells, 10 articles on animal research using PRP, 16 articles on the clinical study of PRP, 24 articles involving signs of skin aging, and four articles on the limitations of PRP. The remaining articles were related to the preparation of PRP, the introduction of PRP, and other aspects.
Conclusion
Based on in vitro and in vivo research, PRP may play a role in promoting tissue regeneration, oxidative stress and revascularization, which form the theoretical basis for the use of PRP in the clinical treatment of facial rejuvenation.
Level of Evidence III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Barrett’s esophagus is negatively associated with eosinophilic esophagitis in Japanese subjects
Abstract
Background
Although both eosinophilic esophagitis (EoE) and Barrett's esophagus (BE) are considered to be associated with T helper (Th) 2-mediated immune responses, the association between EoE and BE is unclear. We investigated the clinical relationship between EoE and BE.
Methods
We conducted a single-center retrospective observational study. The study included 95 patients with EoE and randomly selected age- and sex-matched controls who underwent esophagogastroduodenoscopy during a medical health check-up at Osaka City University in a ratio of 1:2 for comparison. We compared the clinical characteristics and the prevalence rate of BE, reflux esophagitis (RE), hiatal hernia, and atrophic gastritis between EoE patients and controls by univariate analysis. Furthermore, we performed multivariate logistic regression analysis to investigate the association of these factors with EoE.
Results
On univariate analysis, the prevalence rate of BE was significantly lower in patients with EoE than in controls (2.1% vs. 13.2%; p = 0.00528). In contrast, the prevalence rate of RE was higher in EoE patients than in controls, but it was not statistically significant (absence and Grades A, B, and C: 74.7%, 18.9%, 5.3%, and 1.1% vs. 83.7%, 12.6%, 3.7%, and 0%; p = 0.193, respectively). Multivariate analysis showed that BE was negatively associated with EoE (odds ratio: 0.132; 95% confidence interval: 0.0302–0.573; p = 0.00686).
Conclusions
BE is negatively associated with EoE in Japanese subjects. The mechanism behind the inverse relationship between EoE and BE should be examined.
The effects of melatonin supplementation in adjunct with non-surgical periodontal therapy on periodontal status, serum melatonin and inflammatory markers in type 2 diabetes mellitus patients with chronic periodontitis: a double-blind, placebo-controlled trial
Abstract
Background
Diabetes mellitus (DM) and periodontitis are two common chronic diseases with bidirectional relationship. Oxidative stress plays a key role in the pathogenesis of these two diseases. The aim of this study was to investigate the effects of melatonin supplementation in adjunct with non-surgical periodontal therapy on periodontal status, serum melatonin and inflammatory markers in type 2 DM patients with chronic periodontitis (CP).
Materials and methods
In this double-blind clinical trial study, 50 type 2 DM patients with CP were randomly allocated to the intervention and control groups. The intervention and control groups received either 6 mg melatonin or placebo (2 tablets) once a day. Serum levels of melatonin, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), hs-C-reactive protein (hs-CRP), clinical attachment loss (CAL), pocket depth (PD), bleeding on probing (BOP) and plaque index were evaluated in all subjects pre- and post-intervention.
Results
Melatonin supplementation significantly increased the mean serum levels of melatonin after intervention. The mean changes of melatonin were significantly higher in intervention group compared with control group. IL-6 and hs-CRP levels were significantly (p = 0.008 and p = 0.017, respectively) reduced in the intervention group. The mean changes of IL-6 were significantly lower in the intervention group compared with the control group (p = 0.04). In the intervention group, PD and CAL were significantly decreased after intervention (p < 0.001). There were significant differences in the mean change of PD and CAL between the intervention and control groups after intervention (p < 0.001).
Conclusions
Melatonin supplementation in adjunct with non-surgical periodontal therapy might improve inflammatory and periodontal status in T2DM with CP.
Association of hereditary angioedema type 1 with developmental anomalies due to a large and unusual de novo pericentromeric rearrangement of chromosome 11 spanning the entire C1 inhibitor gene (SERPING1)
Publication date: Available online 16 October 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Ebo Didier G, Blaumeiser Bettina, Kooy R. Frank, Beckers Sigri, Van Gasse Athina L, Saerens Michael, Spinhoven Maarten, Sabato Vito, Poirel Hélène A
Identification of the Fraction of Indolent Tumors and Associated Overdiagnosis in Breast Cancer Screening Trials
Abstract
It is generally accepted that some screen-detected breast cancers are overdiagnosed and would not progress to symptomatic cancer if left untreated. However, precise estimates of the fraction of non-progressive cancers remain elusive. In recognition of the weaknesses of overdiagnosis estimation methods based on excess incidence, there is a need for model-based approaches that accommodate non-progressive lesions. Here, we present an in-depth analysis of a generalized breast cancer natural history model that allows for a mixture of progressive and indolent lesions. We provide a formal proof of global structural identifiability of the model and use simulation to identify conditions that allow for parameter estimates that are sufficiently precise and practically actionable. We show that clinical follow-up after the last screen can play a critical role in ensuring adequately precise identification of the fraction of indolent cancers in a stop-screen trial design, and we demonstrate that model misspecification can lead to substantially biased mean sojourn time estimates. Finally, we illustrate our findings on the example of the Canadian National Breast Screening Study-2 and show that the fraction of indolent cancers is not precisely identifiable. Our findings provide the foundation for extended models that account for both in situ and invasive lesions.Myocardial Imaging with CMR Parametric Mapping: Clinical Applications
Abstract
Purpose of Review
Cardiovascular magnetic resonance (CMR) parametric mapping techniques enable the direct visualization and quantification of changes in myocardial T1, T2, T2* relaxation times and extracellular volume fraction. Recent updates on clinical applications of CMR parametric mapping techniques are reviewed in this article.
Recent Findings
CMR parametric mapping techniques are useful in the evaluation of multiple conditions, including iron overload, amyloid infiltration, glycosphingolipid accumulation, myocardial edema, and fibrosis. An advantage of parametric mapping over conventional tissue characterization sequences is that these techniques are quantitative, allowing for standardization of measurements and assessment of longitudinal changes over time. Parametric mapping techniques are useful in clinical practice, including aiding in establishing a diagnosis, monitoring disease progression, evaluating response to therapy, and informing prognosis.
Summary
This article provides a summary of the existing evidence for the clinical application of cardiac parametric mapping techniques.
Increasing Frequency and Share of Dermatologic Procedures Billed by Non-Physician Clinicians from 2012-2016
Publication date: Available online 15 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Andrew T. Rogers, Ge Bai, Manisha J. Loss, Gerard F. Anderson
Carcinoma en escroto de células escamosas gigantes productor de factor estimulante de colonias de granulocitos (G-CSF)
Publication date: Available online 15 October 2018
Source: Actas Dermo-Sifiliográficas
Author(s): M. Takako, K. Yasunobu, Y. Toshiyuki
The importance of ethics in dermatopathology: a fellow’s perspective
Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.
Allergic contact dermatitis to slime: The epidemic of isothiazolinone allergy encompasses school glue
Pediatric Dermatology, EarlyView.
Multifocal congenital pyogenic granuloma successfully treated with oral propranolol
Pediatric Dermatology, EarlyView.
Infantile hemangiomas with minimal or arrested growth: A retrospective case series
Pediatric Dermatology, EarlyView.
Prescribing isotretinoin for transgender youth: A pledge for more inclusive care
Pediatric Dermatology, EarlyView.
The readability, suitability, and content features of eczema action plans in the United States
Pediatric Dermatology, EarlyView.
Congenital tufted angioma: A multicenter retrospective study of 30 cases
Pediatric Dermatology, EarlyView.
Recalcitrant alopecia areata responsive to leflunomide and anthralin—Potentially undiscovered JAK/STAT inhibitors?
Pediatric Dermatology, EarlyView.
Does laser therapy improve the wound healing process after tooth extraction? ‐ A systematic review
Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.
Electrical stimulation disrupts biofilms in a human wound model and reveals the potential for monitoring treatment response with volatile biomarkers
Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.
Incidence and death rate of pemphigus vulgaris and pemphigus foliaceus in Korea: A nationwide, population‐based study (2006–2015)
The Journal of Dermatology, EarlyView.
Scabies herpeticum, an emerging clinical form of crusted scabies in AIDS patient: case report and literature review
International Journal of Dermatology, EarlyView.
Interactive thermal tissue reactions of 7‐MHz intense focused ultrasound and 1‐MHz and 6‐MHz radiofrequency on cadaveric skin
Skin Research and Technology, EarlyView.
Δευτέρα 15 Οκτωβρίου 2018
Decoupling between sulfate reduction and the anaerobic oxidation of methane in the shallow methane seep of the Black sea
ABSTRACT
Methane seepages are widespread in the Black Sea. However, microbiological research has been carried out only at the continental shelf seeps. The present work dealt with coastal gas seepages of the Kalamit Bay (Black Sea). High-throughput 16S rRNA gene sequencing and radiotracer analysis (14С and 35S) were used to determine the composition of the microbial community and the rates of microbial sulfate reduction and methane oxidation. The phylum Proteobacteria, represented mainly by sulfate reducers of the class Deltaproteobacteria, was the predominant in sequence dataset. Bacteroidetes and Planctomycetes were other numerous phyla. Among archaea, the phylum Woesearchaeota and Marine Benthic Group B were predominant in the upper horizons. Relative abundance of Euryarchaeota of the families Methanomicrobiaceae and Methanosarcinaceae (including ANME-3 archaea) increased in deeper sediment layers. Sulfate reduction rate (up to 2.9 mmol/L × day) was considerably higher than the rate of anaerobic methane oxidation (up to 43.4 μmol/L × day), which indicated insignificant contribution of anaerobic methane oxidation to the total sulfide production.Volatile phenols are produced by strains of Dekkera bruxellensis under Brazilian fuel ethanol industry-like conditions
ABSTRACT
Dekkera bruxellensis is a spoilage yeast in wine and fuel ethanol fermentations able to produce volatile phenols from hydroxycinnamic acids by the action of the enzymes cinnamate decarboxylase (CD) and vinyphenol reductase (VR) in wine. However, there is no information about this ability in the bioethanol industry. This work evaluated CD and VR activities and 4-ethylphenol production from p-coumaric acid by three strains of D. bruxellensis and PE-2, an industrial Saccharomyces cerevisiae strain. Single and multiple-cycle batch fermentations in molasses and sugarcane juice were carried out. Dekkera bruxellensis strains showed similar CD activity but differences in VR activity. No production of 4-ethylphenol by S. cerevisiae in any fermentation system or media was observed. The concentrations of 4-ethylphenol peaked during active growth of D. bruxellensis in single-cycle fermentation but they were lower than in multiple-cycle fermentation. Higher concentrations were observed in molasses with molar conversion (p-coumaric acid to 4-ethylphenol) ranging from 45% to 85%. As the first report on 4-ethylphenol production in sugarcane musts by D. bruxellensis in industry-like conditions, it opens up a new avenue to investigate its effect on the viability and fermentative capacity of S. cerevisiae as well as to understand the interaction between the yeasts in the bioethanol industry.Late Onset Complications Secondary to Polyacrylamide Hydrogel-Based Filler for Rehabilitation of HIV-Related Facial Lipoatropy
In 2015 we reported our experience of a 5-year follow-up study regarding the utilization of polyacrylamide hydrogel-based filler for rehabilitation of HIV-related facial lipoatropy.1 The outcomes of this study confirmed the safety and efficacy of this noninvasive treatment as already stated in an earlier report of 18-month follow-up period for that study population.2
The Launch of ASJ Open Forum Brings Changes to ASJ
I am pleased to announce that Aesthetic Surgery Journal Open Forum will launch in early 2019 and I am taking the opportunity to explain the effect this will have on the Aesthetic Surgery Journal (ASJ).
Congenital Oculonasal Synkinesis: Botulinum Toxin A in the Treatment of a Pure Facial Synkinesis
Oculonasal synkinesis (ONS) refers to involuntary contractions of the orbicularis oculi and the compressor narium minor muscles (CNMM). In this phenomenon, blinking triggers simultaneous depression of alar complex. The etiology of congenital type ONS is unknown and has not been investigated in depth. Anomalous connections between zygomatic and buccal branches of the facial nerve are attributed to the etiology.1,2
Filler Rhinoplasty: Evidence, Outcomes, and Complications
Rhinoplasty is one of the most popular facial aesthetic procedures but also one of the most technically challenging, with revision rates after surgical rhinoplasty ranging from 5% to 20%.1 The popularity of nonsurgical alternatives has been steadily increasing, especially that of injectable filler rhinoplasty using hyaluronic acid (HA), which offers reduced financial and anaesthetic impact, immediate aesthetic results, and rapid recovery.2 This is often demonstrated on video posts on social media platforms, which show immediate postprocedure results but often no further follow-up.3 Although fillers are predominantly used for aesthetic rhinoplasty, the technique has also been utilized to address functional issues including internal valve collapse.4
Tele-Interview in the Aesthetic Fellowship Selection Process
Aesthetic surgery fellowships traditionally select applicants for an in-person interview in the facility where the fellowship will occur. Most fellowship applicants are preselected by evaluation of the application package, which includes medical school and residency records, a personal statement, and letters of recommendation.
A treatise on topical corticosteroids in dermatology. Use, misuse and abuse
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):761-762
Histoid leprosy presenting with figurate lesions: A unique and rare presentation
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):736-739
N-acetylcysteine in dermatology
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):652-659
N-acetylcysteine is a mucolytic drug which is commonly used as an antidote for acetaminophen toxicity. It is a thiol compound, which acts as a donor of cysteine, leading to replenishment of glutathione and thus acts as an antioxidant. It also has anti-inflammatory effects, alters the levels of neurotransmitters, inhibits proliferation of fibroblasts and keratinocytes and causes vasodilatation. Due to these actions, n-acetylcysteine has found use in several dermatologic conditions in systemic and topical form. The drug has been used as an adjuvant in the management of conditions such as toxic epidermal necrolysis, drug hypersensitivity syndrome, trichotillomania, skin picking disorders and onychotillomania, ichthyoses, contact dermatitis, atopic dermatitis, melasma, pseudoporphyria, connective tissue diseases, wound healing and alopecia. It also has a role in protection from radiation-induced skin damage including photo-ageing, photocarcinogenesis and radiation dermatitis. Most indications in dermatology are supported by case reports, small case series and small trials. Higher quality of evidence is needed for its wider use. The drug is cheap and is generally safe with few adverse effects. Thus a greater role is possible for use of n-acetylcysteine in various skin conditions. This review explores the various uses of n-acetylcysteine in the field of dermatology, the evidence supporting the same, the possible mechanisms of action and the adverse effects of the drug.
Differential expression of capecitabine-induced hand foot syndrome on paretic limb
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):720-722
18F-fluorodeoxyglucose positron emission tomography-based evaluation of systemic and vascular inflammation and assessment of the effect of systemic treatment on inflammation in patients with moderate-to-severe psoriasis: A randomized placebo-controlled pilot study
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):660-666
Background: Psoriasis is a systemic inflammatory disorder associated with an increased risk of cardiovascular disease. Objective: To evaluate the utility of [[18]F]-fluorodeoxyglucose positron emission tomography/computed tomography in identifying vascular and systemic inflammation in psoriasis patients with moderate-to-severe disease and to analyze its usefulness in assessing the effect of systemic treatment. Methods: This was a randomized, double-blind pilot study conducted in a tertiary care center. Baseline standardized uptake value score was estimated by18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with moderate-to-severe psoriasis and compared with historical controls. Patients were then randomized using computer-generated randomization list into methotrexate or placebo (with or without pioglitazone) groups.18F-fluorodeoxyglucose positron emission tomography/computed tomography was repeated at 12 weeks and composite standardized uptake value score determined. The correlation between Psoriasis Activity and Severity Index and SUVmax was assessed. Results: A total of 16 patients were randomized to different treatment groups. Significant increase in mean SUVmax was observed in the ascending aorta in psoriasis patients as compared to historical controls (2.03 ± 0.53 vs 1.51 ± 0.36, P < 0.03). There was no difference in composite standardized uptake value score after 12 weeks of treatment in any of the treatment groups (P = 0.82), although an improvement in Psoriasis Activity and Severity Index score in the methotrexate arm was observed. No correlation was found between mean SUVmax and Psoriasis Activity and Severity Index scores in various aortic segments (r = 0.3–0.7). Limitations: Small sample size, short follow-up, historical controls, exclusion of patients with comorbid conditions and lack of surrogate markers of systemic inflammation. Conclusion: 18F-fluorodeoxyglucose positron emission tomography imaging showed higher vascular inflammation in ascending aorta of psoriasis patients as compared to historical controls. Systemic treatment with methotrexate and pioglitazone did not influence the vascular inflammation in the short term.
Four views of trichomycosis axillaris: Clinical, Wood's lamp, dermoscopy and microscopy
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):748-749
A study of prevalence of autoantibodies in patients with lichen planus from Mumbai, India
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):667-671
Background: Lichen planus is a common chronically relapsing autoimmune skin condition with poorly understood etiology. Apart from cellular immunity, presence of various antibodies has been hypothesized. Various studies have found the presence of serum anti-nuclear antibody, anti-mitochondrial antibody, anti-desmoglein 1 and 3 antibodies, anti-keratinocyte antibody and anti-thyroglobulin antibody in patients of cutaneous and oral lichen planus. Aim: To study the prevalence of autoantibodies and the clinical spectrum of disease in an Indian patient subpopulation with lichen planus. Methods: A cross-sectional epidemiological study comprising 100 lichen planus patients was conducted in the dermatology outpatient department of Seth G.S Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India. Serum concentrations of circulating anti-nuclear antibodies, anti-desmoglein 1 antibody, anti-desmoglein 3 antibody, anti-keratinocyte antibodies, anti-mitochondrial antibodies and anti-thyroglobulin antibodies were determined by indirect immunofluorescence. Pairs of groups were compared using "Student's t-test" for normally distributed continuous data. The "χ2-test" was used for the categorical variables as needed. Statistical significance was set at P < 0.05. Results: It was found that 65 (65%) patients showed the presence of at least one of the six autoantibodies that we studied, while 35 (35%) tested negative for all six of them. Positivity of anti-keratinocyte antibody in 26 (26%), anti-nuclear antibody in 22 (22%), anti-desmoglein 1 antibody in 19 (19%), anti-desmoglein 3 antibody in 16 (16%), anti-mitochondrial antibody in 9 (9%) and anti-thyroglobulin antibody in 6 (6%) patients was detected. It was observed that 55 (71.4%) patients of cutaneous lichen planus, 6 (46.1%) patients of mucosal lichen planus and 4 (40%) patients of cutaneous and mucosal lichen planus overlap showed presence of at least one autoantibody. Conclusion: This study provides the serological parameters of a population of lichen planus from western India. Presence of autoantibodies in lichen planus suggests the possible role of humoral immunity in lichen planus. Identifying antibodies linked to lichen planus may help in identifying suitable diagnostic tests and therapeutic targets. Well-controlled studies with larger sample size are the need of the hour to confirm the role of humoral immunity in lichen planus. Limitations: Studies with a larger number of patients as well as controls should be undertaken to further evaluate the role of autoantibodies in lichen planus.
Medical journalism and social media: A boon and a bane?
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):647-651
Proposed global drooping and wrinkles classification and scoring system for aging face with validation and experience on 54 Indian subjects
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):672-677
Background: Aging is an inevitable biological change, but understanding the process of aging of face is important to customize the treatment options for facial rejuvenation. Evidence-based estimation of global facial aging is necessary for the validation of various treatment modalities. Aims: Classification and implementation of a scoring system for aging face based upon volume loss and surface changes as evident by drooping of different areas of the face and appearance of fine and deep wrinkles, respectively, and to apply this drooping–wrinkles classification on 54 participants to evaluate and understand the validity of scoring. Methods: An observational study was conducted, and scores were calculated based on 13 parameters (7 areas of drooping and 6 areas of wrinkles on the face) at Aura Skin Institute, Chandigarh, India. Accordingly, age was divided in different age groups followed by clinical estimation of facial age and calculation of scores. Results: According to our classification and scoring system, 61% (33 out of 54) of the participants were correlated with their chronological age group. Out of the remaining 21 (39%) participants who were aging faster, 13 (24%) were in the age group of 25–35 years. Approximately one-fourth of the patients in the age groups 36–45 and 46–55 years were aging faster. Only 1 patient had scores showing younger age in comparison to chronological age. Overall, there was a good correlation between the calculated score and the chronological age of patients. Moreover, a gradual increase in scores was noticed with increasing age groups. Conclusions: This is a new clinical classification and scoring system for facial age which is much easier to apply in daily clinical practice for easy calculation of baseline scores and customizing their antiaging treatment options. Moreover, it will also make it easier to compare the efficacy of treatment in their future follow-ups. The limitation of this study is that it has been proposed for all skin types but validation has been done only for Indian participants.
Dermatoscopy of multiple piloleiomyomas with disseminated and segmental distribution
Mirjana Popadić, Dimitrije Brasanac, Mirjana Milinković, Danijela Milčić
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):726-729
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):726-729
A prospective study of the epidemiological and clinical patterns of recurrent dermatophytosis at a tertiary care hospital in India
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):678-684
Background: Recurrent and clinically unresponsive dermatophytosis is being increasingly encountered in our country. It runs a protracted course with exacerbations and remissions. However, there is little information regarding the extent of the problem and the characteristics of recurrent dermatophytosis in published literature. Aims: We sought to determine the prevalence, risk factors and clinical patterns of recurrent dermatophytosis in our institution. We also investigated the causative dermatophyte species and antifungal susceptibility patterns in these species. Methods: One hundred and fifty patients with recurrent dermatophytosis attending the outpatient department of the Postgraduate Institute of Medical Education and Research, Chandigarh, India were enrolled in the study conducted from January 2015 to December 2015. A detailed history was obtained in all patients, who were then subjected to a clinical examination and investigations including a wet preparation for direct microscopic examination, fungal culture and antifungal susceptibility tests. Results: Recurrent dermatophytosis was seen in 9.3% of all patients with dermatophytosis in our study. Trichophyton mentagrophytes was the most common species identified (36 patients, 40%) samples followed by T. rubrum (29 patients, 32.2%). In-vitro antifungal susceptibility testing showed that the range of minimum inhibitory concentrations (MIC) on was lowest for itraconazole (0.015–1), followed by terbinafine (0.015–16), fluconazole (0.03–32) and griseofulvin (0.5–128) in increasing order. Limitation: A limitation of this study was the absence of a suitable control group (eg. patients with first episode of typical tinea). Conclusion: Recurrence of dermatophytosis was not explainable on the basis of a high (MIC) alone. Misuse of topical corticosteroids, a high number of familial contacts, poor compliance to treatment over periods of years, and various host factors, seem to have all contributed to this outbreak of dermatophytosis in India.
Congenital alopecia of eyebrow
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):743-744
Acral angioosteoma cutis: A rare case
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):685-686
Acral angioosteoma cutis is a rare and benign cutaneous lesion clinically characterized by an exophytic growth resembling pyogenic granuloma on the acral skin; first described in 2006. Its pathogenesis is still unclear while well-formed capillaries, pale stroma, bland fibroblast-like cells, and multiple tiny spicules of woven bone constitute the histological hallmarks. Here, we present a case of acral angioosteoma cutis in a 34-year-old man to increase awareness regarding this rare condition.
Transepidermal elimination: Historical evolution, pathogenesis and nosology
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):753-757
Bilateral “turkey ear” as a cutaneous manifestation of lupus vulgaris
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):687-689
Lupus vulgaris is a common form of cutaneous tuberculosis in China, mostly involving the head and neck region. Turkey ear is a clinically descriptive term, used for a massively enlarged earlobe with bluish-red or violaceous indurated plaques and nodules, which can be a sign of lupus vulgaris. A 47-year-old female presented with edema and reddish ulcerated lesions on both ears which was diagnosed as lupus vulgaris by conventional laboratory investigations and the patient showed good response to antituberculous therapy. Occurrence of turkey ears in lupus pernio (sarcoidosis) should also be mentioned here as this presentation was originally described in this condition. Two case reports of turkey ear have been reported with cutaneous tuberculosis (not bilateral). However, occurrence of bilateral turkey ears in cutaneous tuberculosis has not been described so far in the literature.
Reversible twisted and rolled hairs due to manual twisting: Two case reports
Di-Qing Luo, Juan-Hua Liu, Rashmi Sarkar, Yu-Kun Zhao, Fang Wang, Hui-Hui Wu
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):763-763
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):763-763
Revisiting the role of the slit-skin smear in the diagnosis of Indian post-kala-azar dermal leishmaniasis
Aradhana Bhargava, V Ramesh, Sandeep Verma, Poonam Salotra, Manju Bala
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):690-695
Background: Post kala azar dermal leishmaniasis (PKDL) is a neglected dermatosis that develops as a sequel to kala azar after apparent complete treatment. Being a non life threatening condition, patients often delay treatment thereby maintaining a reservoir of infection. The diagnosis of PKDL rests on the demonstration of the parasite in tissue smears, immune diagnosis by detection of parasite antigen or antibody in blood, or detection and quantitation of parasite DNA in tissue specimens. Sophisticated molecular tests are not only expensive but also need skilled hands and expensive equipment. To be useful, diagnostic methods must be accurate, simple and affordable for the population for which they are intended. Aims: This study was designed to assess functionality and operational feasibility of slit-skin smear examination. Methods: Sensitivity and specificity was evaluated by performing slit-skin smear and histo-pathological examination in 46 PKDL patients and the results were compared with the parasite load in both the slit aspirate and tissue biopsy specimens by performing quantitative Real-time PCR (Q-PCR). Results: The slit-skin smear examination was more sensitive than tissue biopsy microscopy. The parasite loads significantly differed among various types of clinical lesions (P < 0.05). The threshold of parasite load for detection by SSS microscopy was 4 parasites/μl in slit aspirate and 60 parasites/μg tissue DNA in tissue biopsy while that for tissue microscopy was 63 parasites/μl and 502 parasites/μg tissue DNA respectively. As detection of Leishmania donovani bodies may be challenging in inexperienced hands, the microscopic structure of these has been detailed along with a comprehensive discussion of pre analytical, analytical and post analytical variables affecting its identification. To facilitate the diagnosis of PKDL, some scenarios have been suggested taking into consideration the clinical, epidemiological, immunological and microscopic aspects. Conclusion: Such evidence based medicine helps minimize intuition, systematize clinical experience and provides a diagnostic rationale as sufficient grounds for a clinical decision.
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):690-695
Background: Post kala azar dermal leishmaniasis (PKDL) is a neglected dermatosis that develops as a sequel to kala azar after apparent complete treatment. Being a non life threatening condition, patients often delay treatment thereby maintaining a reservoir of infection. The diagnosis of PKDL rests on the demonstration of the parasite in tissue smears, immune diagnosis by detection of parasite antigen or antibody in blood, or detection and quantitation of parasite DNA in tissue specimens. Sophisticated molecular tests are not only expensive but also need skilled hands and expensive equipment. To be useful, diagnostic methods must be accurate, simple and affordable for the population for which they are intended. Aims: This study was designed to assess functionality and operational feasibility of slit-skin smear examination. Methods: Sensitivity and specificity was evaluated by performing slit-skin smear and histo-pathological examination in 46 PKDL patients and the results were compared with the parasite load in both the slit aspirate and tissue biopsy specimens by performing quantitative Real-time PCR (Q-PCR). Results: The slit-skin smear examination was more sensitive than tissue biopsy microscopy. The parasite loads significantly differed among various types of clinical lesions (P < 0.05). The threshold of parasite load for detection by SSS microscopy was 4 parasites/μl in slit aspirate and 60 parasites/μg tissue DNA in tissue biopsy while that for tissue microscopy was 63 parasites/μl and 502 parasites/μg tissue DNA respectively. As detection of Leishmania donovani bodies may be challenging in inexperienced hands, the microscopic structure of these has been detailed along with a comprehensive discussion of pre analytical, analytical and post analytical variables affecting its identification. To facilitate the diagnosis of PKDL, some scenarios have been suggested taking into consideration the clinical, epidemiological, immunological and microscopic aspects. Conclusion: Such evidence based medicine helps minimize intuition, systematize clinical experience and provides a diagnostic rationale as sufficient grounds for a clinical decision.
Adverse cutaneous events after laser epilation in patients with photodermatosis
Laura Cubells Sánchez, Blanca Ferrer Guillén, José Luis Sánchez Carazo, Amparo Pérez Ferriols
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):718-720
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):718-720
Study of the relation between two common cyclooxygenase 2 gene polymorphisms with risk of developing and subtypes of vitiligo in Egyptian patients
Samar Abdallah M Salem, Dalia Gamal Aly, Khalda Sayed Amr, Mahmound Fawzy Abdel-Hamid
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):696-700
Background/Purpose: Genetic factors play an important role in the pathogenesis of vitiligo. Cyclooxygenase 2 (COX2) gene induced by ultraviolet radiation controls the synthesis of prostaglandins, which are are found to be beneficial in treating vitiligo. COX2 gene polymorphism has been previously evaluated in Chinese population. We aimed to study the relation between two common COX2 gene polymorphisms with vitiligo and its subtypes amongEgyptian patients. Patients and Methods: This study included 200 participants (100 vitiligo patients and 100 healthy controls). COX2-765G/C and -1195A/G gene polymorphism was studied by restriction fragment length polymorphism polymerase chain reaction analysis and the results were compared between the two groups and among different subtypes of vitiligo. Results: Frequency of COX2-1195 AA, AG, GG genotypes showed no significant association among patients with vitiligo (P = 0.626, 0.321, 0.08, respectively); those with generalized vitiligo (P = 0.739, 0.291, 0.101, respectively) and those with segmental vitiligo (P = 0.410, 1.00, 0.676, respectively) compared to the control group. Regarding COX2-765G/C genotypes, GG genotype was more frequent among patients with vitiligo [84 (84%)] compared to controls [63 (63%)] (P = 0.001). GC genotype was significantly less frequent [15 (15%)] among patients compared to controls [32 (32%)] (P = 0.005). Generalized and segmental types of vitiligo also showed no significant difference in the frequency of COX2-765G/C genotypes compared with controls. Limitations: Being a pilot study, a relatively small number of participants were included. Conclusion: COX2-1195A/G gene polymorphism is not associated with the risk of developing vitiligo or with vitiligo subtypes. COX2-765 GG genotype is associated with vitiligo, especially of the generalized type.
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):696-700
Background/Purpose: Genetic factors play an important role in the pathogenesis of vitiligo. Cyclooxygenase 2 (COX2) gene induced by ultraviolet radiation controls the synthesis of prostaglandins, which are are found to be beneficial in treating vitiligo. COX2 gene polymorphism has been previously evaluated in Chinese population. We aimed to study the relation between two common COX2 gene polymorphisms with vitiligo and its subtypes amongEgyptian patients. Patients and Methods: This study included 200 participants (100 vitiligo patients and 100 healthy controls). COX2-765G/C and -1195A/G gene polymorphism was studied by restriction fragment length polymorphism polymerase chain reaction analysis and the results were compared between the two groups and among different subtypes of vitiligo. Results: Frequency of COX2-1195 AA, AG, GG genotypes showed no significant association among patients with vitiligo (P = 0.626, 0.321, 0.08, respectively); those with generalized vitiligo (P = 0.739, 0.291, 0.101, respectively) and those with segmental vitiligo (P = 0.410, 1.00, 0.676, respectively) compared to the control group. Regarding COX2-765G/C genotypes, GG genotype was more frequent among patients with vitiligo [84 (84%)] compared to controls [63 (63%)] (P = 0.001). GC genotype was significantly less frequent [15 (15%)] among patients compared to controls [32 (32%)] (P = 0.005). Generalized and segmental types of vitiligo also showed no significant difference in the frequency of COX2-765G/C genotypes compared with controls. Limitations: Being a pilot study, a relatively small number of participants were included. Conclusion: COX2-1195A/G gene polymorphism is not associated with the risk of developing vitiligo or with vitiligo subtypes. COX2-765 GG genotype is associated with vitiligo, especially of the generalized type.
Docetaxel induced pellagroid dematitis
Preema Sinha, Aradhana Sood, Sukriti Baveja, Vikas Pathania
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):723-725
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(6):723-725
Endoscopic Management of Subperiosteal Orbital Abscesses
While the progression of acute rhinosinusitis to orbital infections has decreased in the modern antibiotic era, they still occur, particularly in the pediatric population. Infection may spread from the nasal cavity and sinuses via direct extension into the orbit through the thin lamina papyracea or through the valveless veins in the bony orbital wall.1 Congenital dehiscence and trauma also allow for direct extension of the infection to the orbit.1 Most of these orbital infections originate in the ethmoid sinuses and subperiosteal abscesses most commonly occur along the medial orbital wall.
Review of Human Hair Follicle Biology: Dynamics of Niches and Stem Cell Regulation for Possible Therapeutic Hair Stimulation for Plastic Surgeons
Abstract
Plastic surgeons are frequently asked to manage male- and female-pattern hair loss in their practice. This article discusses the epidemiology, pathophysiology, and current management of androgenetic alopecia and emphasizes more recent knowledge of stem cell niches in hair follicles that drive hair cycling, alopecia, and its treatment. The many treatment programs available for hair loss include newer strategies that involve the usage of growth factors, platelet-rich plasma, and fat to stimulate follicle growth. Future research may clarify novel biomolecular mechanisms that target specific cells that promote hair regeneration.
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
The Persistent Signal from Television Viewing in Childhood on Overweight and Obesity Throughout the Life Course
Abstract
Few studies address the association between television (TV) viewing in childhood and overweight/obesity across the life course. Among 30,921 mother-daughter dyads from the Nurses' Mothers' Cohort (2001) and the Nurses' Health Study II (1989 and 1991), the following information was collected: daughter's TV viewing and physical activity (PA) at ages 3─5 and 5─10, somatotype at ages 5 and 10, and body mass index at age 18 and in adulthood (ages 26─45). Using multivariable-adjusted logistic regression models, TV viewing for ≥4 hours/day versus no TV at ages 3─5 was associated with odds ratios of overweight/obesity of 1.61 (95% confidence interval (CI): 1.20, 2.17) at age 5, 1.46 (95% CI: 1.14, 1.86) at age 10, 1.31 (95% CI: 1.00, 1.70) at age 18 and 1.32 (95% CI: 1.10, 1.59) in adulthood. A composite variable of high TV/low PA versus low TV/high PA at ages 3─5 was associated with odds ratios of overweight/obesity ranging from 3.22 (95% CI: 2.23, 4.65) at age 5 to 1.82 (95% CI: 1.36, 2.45) in adulthood. Similar findings appeared when the exposures were assessed at ages 5─10. Long hours of TV viewing in childhood alone and in combination with low PA were consistently associated with overweight/obesity throughout life.Misclassification in Assessment of First Trimester In-Utero Exposure to Drugs used Proximally to Conception - The Example of Letrozole Utilization for Infertility Treatment
Abstract
Letrozole is an aromatase inhibitor with an unapproved use for ovulation induction with infertility. Because of the proximity of this use to conception, we selected letrozole to explore the effect of imperfect estimation in the pregnancy start on misclassification in measurement of first-trimester exposure. Using electronic health data from the United States Sentinel database (2001-2015), we identified live-birth pregnancies conceived through in-vitro fertilization or intrauterine insemination. The pregnancy start was calculated using 1) a validated algorithm to estimate the last menstrual period (LMP), 2) LMP+14 days (i.e. conception estimate), and 3) the fertility procedure date. We identified 47,628 live-births after intrauterine insemination (n=24,962) and in-vitro fertilization (n=22,666), 2,458 (5.3%) of which received letrozole. The algorithm-based conception estimate occurred within ±14 days of the fertility procedure for 78.3% of pregnancies. Defining pregnancy start as LMP (45.7/1000 pregnancies) or LMP+14 days (12.7/1000 pregnancies) overestimated letrozole exposure during pregnancy by 8.4-fold and 2.3-fold, respectively, compared to the fertility procedure (5.5/1000 pregnancies). While most pregnancy utilization studies use LMP as the conventional pregnancy start, this introduced substantial exposure misclassification in the example of letrozole. LMP+14 was less biased. Researchers should carefully consider the impact of pregnancy start date selection on potential for exposure misclassification.Chirurgische Therapie im Stadium I und II des nichtkleinzelligen Lungenkarzinoms
Zusammenfassung
Hintergrund
In den vergangenen Jahrzehnten hat sich die Prognose des Lungenkarzinoms trotz moderner Diagnostik und multimodaler Therapiestrategien kaum verbessert. Ein großer Anteil der Patienten mit einem nichtkleinzelligen Lungenkarzinom (NSCLC; 57 %) haben zum Zeitpunkt der Diagnose Fernmetastasen und nur etwa 40 % der Patienten sind in einem potenziell operablen Tumorstadium.
Material und Methoden
Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed sowie eigenen Erfahrungen zum Thema des Artikels.
Ergebnisse
Für Patienten in einem frühen Tumorstadium, Stadium I und II nach der Klassifikation der Tumorstadien in der 8. Ausgabe der Union for International Cancer Control (UICC), ist die chirurgische anatomische Tumorresektion in Kombination mit einer systematischen mediastinalen und hilären Lymphknotendissektion das Therapieverfahren der Wahl. Mit dem klassischen Resektionsverfahren der Lobektomie (Bilobektomie, Pneumonektomie) in Verbindung mit einer systematischen Lymphadenektomie lassen sich Fünfjahresüberlebensraten von über 80 % im Frühstadium IA bzw. 48 % im Stadium II erzielen. Neben der offenen chirurgischen Resektion konnten weltweit minimal-invasive, videoassistierte thorakoskopische Resektionsverfahren (VATS, „video-assisted thoracic surgery") im Stadium I und II erfolgreich etabliert werden. Im Stadium II kann eine adjuvante Chemotherapie das Überleben positiv beeinflussen.
Diskussion
Ob zielgerichtete Krebstherapien (sog. „targeted therapies") oder eine Immuntherapie im neoadjuvanten oder adjuvanten Therapiekonzept beim NSCLC im Frühstadium das Überleben der Patienten verbessern, wird momentan in Studien untersucht.
Staphylococcus aureus alpha toxin activates Notch in vascular cells
Abstract
Staphylococcus aureus infection is one of the leading causes of morbidity in hospitalized patients in the United States, an effect compounded by increasing antibiotic resistance. The secreted agent hemolysin alpha toxin (Hla) requires the receptor A Disintegrin And Metalloproteinase domain-containing protein 10 (ADAM10) to mediate its toxic effects. We hypothesized that these effects are in part regulated by Notch signaling, for which ADAM10 activation is essential. Notch proteins function in developmental and pathological angiogenesis via the modulation of key pathways in endothelial and perivascular cells. Thus, we hypothesized that Hla would activate Notch in vascular cells. Human umbilical vein endothelial cells were treated with recombinant Hla (rHla), Hla-H35L (genetically inactivated Hla), or Hank's solution (HBSS), and probed by different methods. Luciferase assays showed that Hla (0.01 µg/mL) increased Notch activation by 1.75 ± 0.5-fold as compared to HBSS controls (p < 0.05), whereas Hla-H35L had no effect. Immunocytochemistry and Western blotting confirmed these findings and revealed that ADAM10 and γ-secretase are required for Notch activation after inhibitor and siRNA assays. Retinal EC in mice engineered to express yellow fluorescent protein (YFP) upon Notch activation demonstrated significantly greater YFP intensity after Hla injection than controls. Aortic rings from Notch reporter mice embedded in matrix and incubated with rHla or Hla-H35L demonstrate increased Notch activation occurs at tip cells during sprouting. These mice also had higher skin YFP intensity and area of expression after subcutaneous inoculation of S. aureus expressing Hla than a strain lacking Hla in both EC and pericytes assessed by microscopy. Human liver displayed strikingly higher Notch expression in EC and pericytes during S. aureus infection by immunohistochemistry than tissues from uninfected patients. In sum, our results demonstrate that the S. aureus toxin Hla can potently activate Notch in vascular cells, an effect which may contribute to the pathobiology of infection with this microorganism.
Appropriateness of the institute certification system for esophageal surgeries by the Japan Esophageal Society: evaluation of survival outcomes using data from the National Database of Hospital-Based Cancer Registries in Japan
Abstract
Background
Since 2013, The Japan Esophageal Society has been certifying "Authorized Institute for Board Certified Esophageal Surgeon (AIBCES)" to contribute to improving national medical care by enhancing the professional knowledge and skills of esophageal surgeons. However, the appropriateness on this certification system has not yet been verified. Our aim was to assess the appropriateness of the institute certification system for esophageal surgeries used by the medical society.
Methods
Using data from the National Database of Hospital-based Cancer Registries, we analyzed the 5-year overall survival rates among 2135 patients with thoracic esophageal cancer who underwent an esophagectomy at 53 AIBCES or 141 non-AIBCES.
Results
There were 1343 (63%) patients who underwent surgery at an AIBCES and 792 (37%) who underwent surgery at a non-AIBCES. Registered patients were followed up for a median of 53 (range 1–88) months. Over the followed-up period examined, 670 (50%) patients treated at an AIBCES died and 455 (57%) treated at a non-AIBCES died. Comparison of the Kaplan–Meier survival curves indicated that patients with cStage II or cStage III disease treated at an AIBCES had significantly better 5-year survival rates than those treated at a non-AIBCES (55.4% vs. 44.9% and 38.0% vs. 30.3%, respectively). Univariate and multivariate analyses stratified based on stages and adjuvant therapies revealed that institute certification (AIBCES vs. non-AIBCES) is a significant independent factor for 5-year survival.
Conclusions
The institute certification system used by the Japan Esophageal Society may be appropriate, as indicated by improved 5-year survival outcomes. The institute certification system has the potential to contribute to a more appropriate medical delivery system in the future.
Enzymes in the Seafood Industry: Time for Health Studies with High-Quality Exposure Assessment
Enzymes are biocatalysts that increase the rate of most reactions within cells and are crucial for the function of humans and other living creatures. In addition, the use of enzymes in industry and everyday products largely of bacterial or fungal origin has increased in recent years. Food and beverages, detergent, perfume, pharmaceutical, textile, and chemical industries are increasingly using enzymes to improve fragrance, taste, and flavour (Budnik et al., 2017). A classic example is improver enzymes such as α-amylase, routinely added to accelerate, modify, and control dough making (Jones et al., 2016). Although the detrimental effects of these added active or inactive enzymes on the development of allergy and respiratory health are recognized (Baur, 2005; Jones et al., 2016), detailed exposure characterization and data to conduct dose–response relations for enzymes are lacking with the exception of a few agents such as α-amylase (Houba et al., 1996).
Sexuell übertragbare Infektionen in den Tropen
Zusammenfassung
Sexuell übertragbare Infektionen (STI) sind weltweit häufig; allein die Inzidenz für Chlamydien-Infektionen, Gonorrhö, Syphilis und Trichomoniasis wird auf 500 Mio. Fälle/Jahr geschätzt. Drei Viertel dieser Infektionen entfallen auf tropische Länder in Lateinamerika, Subsahara-Afrika sowie Süd- bzw. Südostasien. Unter „tropischen Geschlechtskrankheiten" werden die bakteriellen Infektionen Ulcus molle, Lymphogranuloma venereum und Granuloma inguinale zusammengefasst. Diese treten vornehmlich in den Ländern zwischen den Wendekreisen auf – Regionen, die zum einen durch ein feucht-heißes Klima, zum anderen vielfach durch Armut und Unterentwicklung gekennzeichnet sind. Die 3 Erkrankungen gehen primär mit Ulzera einher; ihr Vorliegen stellt daher ein erhöhtes Risiko für die Übertragung von HIV und anderen STI dar. Wie bei allen STI gilt auch für die Tropeninfektionen, dass Risikominimierung durch Verzicht auf riskante Sexualpraktiken und Kondombenutzung essenziell sind.
Supratotal Resection in Glioma: A Systematic Review
Abstract
Background
Emerging evidence suggests survival benefit from resection beyond all MRI abnormalities present on T1-enhanced and T2-FLAIR modalities in glioma (supratotal resection); however, the quality of evidence is unclear. We addressed this question via systematic review of the literature. Methods
EMBASE, MEDLINE, Scopus, and Web of Science databases were queried. Case studies, reviews or editorials, non-English, abstract-only, brain metastases, and descriptive works were excluded. All others were included. Results
309 unique references yielded 41 studies for full-text review, with 7 included in the final analysis. Studies were mostly of Oxford Center for Evidence-Based Medicine Level 4 quality. A total of 88 patients underwent supratotal resection in a combined cohort of 492 patients (214 males and 278 females, age 18 to 82 years). Fifty-one supratotal resections were conducted on high-grade gliomas, and 37 on low-grade gliomas. Karnofsky Performance Status, overall survival, progression-free survival, neurological deficits post-operatively, and anaplastic transformation were the main measured outcomes. No randomized controlled trials were identified. Preliminary low-quality support was found for supratotal resection in increasing overall survival and progression-free survival for both low-grade and high-grade glioma. Conclusions
The literature suggests insufficient evidence for carte blanche application of supratotal resection, particularly in lower grade gliomas where neurological deficits can result in long-term disability. While the preliminary studies discussed here, containing data from only a few centers, have reported increased progression-free and overall survival, these claims require validation in prospective research studies involving larger patient populations with clearly defined appropriate outcome metrics in order to reduce potential bias.Japanese familial anetoderma: A report of two cases and review of the published work
The Journal of Dermatology, EarlyView.
Extracellular proteoglycan decorin maintains human hair follicle stem cells
The Journal of Dermatology, EarlyView.
Cutaneous phaeohyphomycosis caused by Microsphaeropsis arundinis in a Japanese patient with cardiac sarcoidosis
The Journal of Dermatology, EarlyView.
Host MyD88 signaling protects against acute graft‐versus‐host disease after allogeneic bone marrow transplantation
Clinical &Experimental Immunology, EarlyView.
Pretarsal roll augmentation with dermal hyaluronic acid filler injection
Abstract
Pretarsal roll augmentation with dermal hyaluronic acid filler injection focuses on restoring pretarsal fullness. This study aimed to introduce a method of pretarsal roll augmentation with dermal hyaluronic acid filler injection and establish the level of difficulty, safety, and effectiveness of this method. Eighty female patients were enrolled in this study. Hyaluronic acid filler was used to perform pretarsal roll augmentation. Physician and patient satisfaction at 1 month and 4 months after surgery was investigated. The level of satisfaction was graded from points 1 to 5. The patient satisfaction and physician scores were 4.7 ± 1.1 (mean ± standard deviation) points at 1 month and 4.8 ± 0.9 points at 4 months and 4.6 ± 0.9 points at 1 month and 4.8 ± 1.0 points at 4 months, respectively. No major complications were observed. Our technique provided a natural and younger appearance with pretarsal fullness. This technique was easy to perform for the restoration of pretarsal fullness, and it improved periorbital contouring, rejuvenated the pretarsal roll, and provided excellent esthetic results.
Level of Evidence: Level V, therapeutic study.
Long‐term efficacy and safety of ixekizumab in Japanese patients with erythrodermic or generalized pustular psoriasis: Subgroup analyses of an open‐label, phase 3 study (UNCOVER‐J)
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
Association between psoriasis, psoriatic arthritis and gout: A nationwide population‐based study
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
Systemic corticosteroid use in psoriasis: a national survey of board‐certified dermatologists
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
Picosecond laser for atrophic surgical scars treatment: in vivo monitoring of results by means of reflectance confocal microscopy
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
Initial results of ixekizumab efficacy and safety in real‐world plaque psoriasis patients: A multicenter retrospective study
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
Socket Reconstruction With Bleomycin, Gentamicin, and Gelatin Sponges Following Eyelid-Sparing Orbital Exenteration for a Colobomatous Macrocyst in an Infant
Microphthalmia is defined by a globe axial length greater than or equal to 2 standard deviations below the age-adjusted mean and can occur as part of a broader syndrome. The presence of a colobomatous cyst with microphthalmia signifies failure of the embryonic neuroectodermal fissure to close appropriately during development of the globe, creating a protuberant globular appendage that inhibits normal growth and development of the eye itself. Cystic reaccumulation of fluid is common after aspiration or surgical removal. Here, the authors describe a case of a young boy with a colobomatous cyst who underwent eyelid-sparing orbital exenteration followed by reconstruction with absorbable gelatin sponge (Gelfoam, Pfizer, Inc.) and the chemotherapeutic agent bleomycin to promote scarring, achieving the equivalent of a biointegrated implant and facilitating satisfactory placement of an ocular prosthesis. A 2-year follow-up MRI revealed adequate volume in the posterior orbit. Accepted for publication August 23, 2018. All authors attest that they meet the current ICMJE criteria for Authorship. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Alon Kahana, M.D., Ph.D., Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, 1000 Wall St., Ann Arbor, MI. E-mail: akahana@med.umich.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Study on the Aging Dynamics of the Periorbital Region: From Observation to Knowledge of Physiopathology
Purpose: Several anatomical and physio-pathologic studies of eyelid region have allowed the creation of theories on facial tissues aging dynamics, which have not been clarified yet. We assessed the signs of aging in the region over the time by observing the characteristics in the same person at different times of his/her life. Methods: We compared the position of the main anatomical landmarks of the eyelid region of 80 patients by overlaying their photographs when they were 20, 40, and 60 years old. Then we made comparisons in the group of men (40 people) and in the group of women (40 people) and between men and women. Results: The medial portion of the eyebrow was higher in the photograph taken at 60 years of age than in the one taken at 20 years old in 56.2% of cases; it was higher in 47.5% of cases when comparing the images at 20 and 40. The lateral portion of the eyebrow was seen higher in women in the 20 to 40 group, and it was seen lower in men at 60 years in statistical significance. In more than half of the patients observed, there was not a real descent of the eyebrow and the presence of a more or less accentuated form of upper eyelid's ptosis in the photograph at 60 (globally 47.5%, 55.0% of women and 40.0% of men). This condition was observed in 27.5% of the photographs at 40. There were changes in the horizontal dimension of the palpebral fissure (shortening in 53.7%, preserved in 33.7%, and increased in 12.5% of cases at 60 years old). The position of lateral canthus appeared lower in 40.0% of patients photographed at 60, but it was stable in those photographed at 40. The herniation of the upper eyelid bags was observed in 31.2% of the patients photographed at 60 years old but only in 13.7% at 40. Dermatochalasis of the upper eyelid was present in 67.5% of the people at 60 years old and in 55.0% of those seen when they were 40. Comparing men and women groups 20 to 40, dermatochalasis is more present in men than women at 40 years old with statistical significance. The eyelid-cheek junction was seen to be lower in 75.0% of cases at 60 and in 48.7% of cases at 40, and it is more represented in men than in women. Conclusion: We have highlighted some interesting elements, partly agreeing with the data already recorded by other authors', and our data suggest an important role of the eyelid structures senescence and its impact on the surrounding structures. Accepted for publication August 25, 2018. All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationship, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this artilce. Address correspondence and reprint requests to Nicola Zingaretti, M.D, Department of Plastic Reconstructive Surgery, c/o Ospedale "S. Maria della Misericordia", piazzale santa maria della misericordia 15, 33100 Udine, Italy. E-mail: zingarettin@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
A Case of Diprosopus Tetraophthalmos: Ocular Findings and Surgical Treatment of Exposure Keratopathy
Diprosopus is a rare variation of conjoined twinning. In this report, ophthalmic findings in an infant with diprosopus tetraophthalmos are presented. A male infant who was born at 33 weeks of gestation to a nonconsanguineous 42-year-old mother and 47-year-old father was examined for orbital abnormalities. The infant had a large head, 2 faces, and 4 eyes, of which 2 were placed laterally and 2 were fused in the midline. In the laterally placed eyes, the pupils were unresponsive to light, and the optic discs were hypoplastic. In the fused eyes, the lower and upper eyelids were also fused, horizontally wide, vertically short, and immobile, resulting in a progressive exposure keratopathy. On the 33rd day of life, a modified total tarsorrhaphy was performed with the use of inhalational mask anesthesia. The patient died due to pneumonia and septicemia on the 45th day of life. Accepted for publication August 14, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Bulent Yazici, M.D., Izmir Yolu Senyurt Is Merk, no: 87/4, 16110 Bursa, Turkey. E-mail: byazici@uludag.edu.tr © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Pituitary Adenoma Apoplexy of the Orbit, Diagnosis, and Management With Presurgical Embolization
Orbital invasion of pituitary adenomas has been previously reported. In this report, the authors describe a 71-year-old female with a prolactinoma that presented with invasion of and apoplexy within the orbit. The patient underwent exenteration, followed by rapid tumor recurrence and growth. Given the hemorrhagic nature of the tumor, she subsequently underwent preoperative embolization and surgical resection. This case is notable in that it illustrates both apoplexy of a pituitary tumor within the orbit and the benefit of presurgical embolization. Accepted for publication August 15, 2018. The authors have no financial or conflicts of interest to disclose. Presented at Spring ASOPRS 2018, May 31 to June 2, 2018, Austin, TX. Address correspondence and reprint requests to Timothy J. McCulley, M.D., Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD. E-mail: Tmccull5@jhmi.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Orbitocerebral Mucormycosis in a Patient With Central Nervous System Lymphoma
A 61-year-old man with well-controlled diabetes mellitus type 2, cirrhosis from hepatitis C, alcohol abuse, and portal hypertension presented with painful vision loss and left orbital swelling. Imaging showed diffuse orbital, perineural, and pachymeningeal inflammation. He was initially diagnosed with neurosarcoidosis. However, cerebrospinal fluid analysis revealed central nervous system lymphoma, and lacrimal gland biopsy showed fungal organisms consistent with mucormycosis. The authors describe a case of Mucorales infection lacking sinonasal involvement and discuss the differential diagnosis and management of patients presenting with orbital and central nervous system inflammation from this uncommon fungal infection. Accepted for publication August 1, 2018. Supported in part by National Eye Institute Vision Core Grant P30EY010608 and the Hermann Eye Fund. No authors declare no conflicts of interest. Previously presented in part at the North American Neuro-Ophthalmology Society 43rd Annual Meeting on April 1–6, 2017 in Washington, DC. Address correspondence and reprint requests to Ore-ofe O. Adesina, M.D., Robert Cizik Eye Clinic, 6400 Fannin St, Suite 1800, Houston, TX 77030. E-mail: ore-ofeadesina@cizikeye.org © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
A Case of Hyaluronic Acid Induced Blindness With Ophthalmoplegia and Ptosis
Hyaluronic acid injection can lead to skin necrosis, visual loss, and other complications. The blindness with ophthalmoplegia and ptosis is a rare, but terrible and devastating complication. The disfigured appearance usually has significant impact on patient's social life. There is no standard treatment. A patient with hyaluronic acid induced blindness, ophthalmoplegia, and ptosis is reported. Six days after the onset, peribulbar/retrobulbar injections of high dosage hyaluronidase were performed. The orbital edema and ptosis immediately improved. The ophthalmoplegia and ptosis improved significantly within a month and resolved completely within 3 months, although the right vision remained blind. Peribulbar/retrobulbar injection of hyaluronidase is a potential rescue therapy for the hyaluronic acid induced ophthalmoplegia and ptosis. Accepted for publication August 9, 2018. Supported by the National Basic Research Program of China (973 Program, No. 2015CB554100), National Natural Science Foundation of China (No. 81271035/H1205), and Foundation for Returned Personals Studying Abroad of Sichuan Province in 2015. The authors have no financial or conflicts of interest to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.op-rs.com.). Hui Chen and Huan Wang are co-authors. Address correspondence and reprint requests to Hui Chen, M.D., Ophthalmology Department, Sichuan Provincial People's Hospital, No. 32, 1st Ring Road, 2nd West Section, Chengdu City, Sichuan 610072, People's Republic of China. E-mail: 540685790@qq.com; Zhenglin Yang, Ph.D., Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Provincial People's Hospital, No. 32, 1st Ring Road, 2nd West Section, Chengdu City, Sichuan 610072, People's Republic of China. E-mail: zliny@yahoo.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Septic Cavernous Sinus Thrombosis Associated With Orbital Cellulitis: A Report of 6 Cases and Review of Literature
Purpose: To describe risk factors, clinical parameters, treatment, and prognosis for patients with septic cavernous sinus thrombosis presenting with orbital cellulitis. Methods: Retrospective case series of 6 patients identified with septic cavernous sinus thrombosis and orbital cellulitis confirmed by magnetic resonance imaging at a tertiary care center from January 1980 to December 2016. Medical records were reviewed for demographics, risk factors, symptoms, etiology, radiographic diagnosis, complications, treatments, and outcomes. In addition, a literature review was performed from 2005 to 2018, and 119 cases of septic cavernous sinus thrombosis confirmed by imaging were included for aggregate comparison. This study adheres to the tenets of the Declaration of Helsinki, and institutional review board approval was obtained. Results: All 6 cases presented with headache, fever, ocular motility deficit, periorbital edema, and proptosis. The primary source of infection included sinusitis (n = 4) and bacteremia (n = 2). Identified microorganisms included methicillin resistant Staphylococcus aureus (n = 3) and Streptococcus anginosus (n = 1). All cases were treated with broad-spectrum intravenous antibiotics and anticoagulation, and one case underwent endoscopic sinus surgery. The mean time between initial presentation to diagnosis of cavernous sinus thrombosis was 2.8 days, and the average length of hospital admission was 21 days. The mortality rate was 0%, but 4 cases were discharged with neurological deficits including vision loss (n = 1) and ocular motility disturbance (n = 3). Literature review produced an additional 119 cases. Conclusions: Early diagnostic imaging with contrast-enhanced CT or MRI should be initiated in patients with risk factors and ocular symptoms concerning for cavernous sinus thrombosis. Treatment entails early administration of broad-spectrum intravenous antibiotics, anticoagulation, and surgical drainage when applicable. Accepted for publication July 31, 2018. The authors have no financial or conflicts of interest to disclose. Presented as a poster at the American Academy of Ophthalmology Annual Meeting on October 16, 2016 in Chicago, IL. Address correspondence and reprint requests to R. Patrick Yeatts, M.D., Wake Forest University Eye Center, Janeway Clincal Science Building, 6th flr, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: pyeatts@wakehealth.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Response to Critical appraisal of LIBERTY AD CHRONOS: reply from authors
British Journal of Dermatology, EarlyView.
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