An increased expression of interleukin-23 has been observed in patients with pyoderma gangrenosum, leading to the use of ustekinumab as a therapeutic option. We report the successful use of ustekinumab in three patients with treatment-resistant pyoderma gangrenosum of varying clinical presentations.
In recent years, emphasis has been put on that medical student should demonstrate pre-practice/pre-registration core procedural skills to ensure patient safety. Nonetheless, the formal teaching and training of basic suturing skills to medical students have received relatively little attention and there is no standard for what should be tested and how. The aim of this study was to develop and validate, using scientific methods, a tool for assessment of medical students' suturing skills, measuring both micro- and macrosurgical qualities.
A tool was constructed and content, construct, concurrent validity, and inter-rater, inter-item, inter-test reliability were tested. Three groups were included: students with no training in suturing skills, students who have had training, plastic surgery.
The results show promising reliability and validity when assessing novice medical students' suturing skills.
Further studies are needed on implementation of the instrument. Moreover, how the instrument can be used to give formative feedback, evaluate if a required standard is met and for curriculum development needs further investigation.
Level of Evidence: Not ratable.
We report the successful treatment of multiple facial milia with manual extraction and tretinoin in a child with orofaciodigital syndrome type 1. Treatment with topical medications may be insufficient in individuals with orofaciodigital syndrome type 1, and pitted scarring is often a sequala. This case demonstrates that manual extraction is well tolerated and effective in the treatment of multiple milia. In addition, clinicians need to be aware of this rare genetic condition, which commonly presents de novo and can lead to significant morbidity if untreated.
In terms of both its physiological effects as well as its impact on flavor perception, ethanol is the defining component of alcoholic beverages. While ethanol's effect on alcoholic beverage systems has been studied across a variety of disciplines, a comprehensive review of the literature is lacking. The aim of this paper is to review the current literature on ethanol's effect on flavor perception.
This paper reviews the literature, exploring ethanol's effects on the areas of physiochemical properties, instrumental measurements of flavor release, and sensory evaluation across a variety of alcoholic beverages including beer, wine, and distilled beverages and how changes in ethanol concentration can affect flavor perception.
Physicochemical properties such as the molecular level structure of water/ethanol matrices are significantly altered as a function of ethanol concentration. Of particular importance to flavor perception is the effect of ethanol on the release of aroma compounds into the headspace of the beverage. Both static and dynamic headspace systems have been studied. In general, increasing the concentration of ethanol decreases the volatile headspace in static systems, while it tends to increase the volatile headspace in dynamic systems. Most importantly, sensory studies have demonstrated that ethanol concentration significantly changes the flavor profile of beverages to the point where sensory panelists are able to identify and articulate these differences.
The current literature demonstrates that ethanol can have a huge impact of flavor release and sensory perception of alcoholic beverages. Additionally monitoring ethanol's effects in systems as close to real life as possible (i.e., dynamic vs static evaluation) is important. Even with the extensive knowledge in the area, there are still many gaps in our understanding of ethanol's effects on the flavor of alcoholic beverages.
Ethanol has been shown to have a tremendous influence on flavor release and subsequent chemosensory perception in alcoholic beverages. Changes in ethanol concentration can affect consumers' perception of alcoholic beverages in terms of aroma, taste, and mouthfeel.
To assess the efficacy and safety of crisaborole ointment, a phosphodiesterase 4 inhibitor, for the treatment of mild or moderate atopic dermatitis (AD) in two phase III studies (AD-301 and AD-302).
Two identically designed multicentre, double-blind randomized controlled trials were conducted in the U.S.A. Participants were randomized 2 : 1 to receive crisaborole or vehicle treatment. In total 47 and 42 investigational centres were identified for AD-301 and AD-302, respectively.
Inclusion criteria were identified as age ≥ 2 years, clinical diagnosis of AD (as per the Hanifin and Rajka criteria), ≥ 5% body surface area involvement, and baseline Investigator's Static Global Assessment (ISGA) mild or moderate. Exclusion criteria included previous use of biologics or systemic corticosteroids (within the last 28 days) or a topical calcineurin inhibitor/corticosteroid (within the last 14 days), and active skin infection.
Participants were instructed to apply the study drug twice daily to all lesions identified at baseline, and all new lesions identified after day 1 (with weekly review of application instructions). Bland emollients were permitted to be used on skin not treated with the study drug.
The primary outcome was defined as ISGA clear or almost clear at day 29, with a 2-grade or more improvement from baseline.
Secondary outcomes included the proportion of patients with an ISGA score of clear or almost clear at day 29, and time to success in ISGA score. Additional outcomes included pruritus severity and signs of AD (erythema, exudation, excoriation, induration/papulation and lichenification), and were measured on a 4-point scale (none, mild, moderate, severe). Adverse events were also recorded.
More participants in the crisaborole-treated group achieved ISGA scores of clear or almost clear with ≥ 2-grade improvement than in the vehicle-treated group (AD-301, 32·8% vs. 25·4%, P = 0·38; AD-302, 31·4% vs. 18·0%, P < 0·001). Greater percentages of clear and almost clear scores were observed in the treatment groups (51·7% vs. 40·6%, P = 0·005; 48·5% vs. 29·7%; P < 0·001), as well as earlier success in ISGA score and improvement in pruritus (P ≤ 0·001). No serious treatment-related adverse events were identified.
Based on the study results, the authors suggest that crisaborole is a safe treatment that improves disease severity, pruritus and clinical signs associated with AD.
Hydrochlorothiazide, one of the most frequently used diuretic and antihypertensive drugs in the United States and Western Europe, is photosensitizing and has previously been linked to lip cancer.
This study investigated the acidogenic and microbiological perspectives in the anaerobic co-fermentation of waste-activated sludge (WAS) mixed with corn stalk (CS) and pig manure (PM). The volatile fatty acids (VFAs) increased dramatically to over 5000 mg COD/L accumulation just within 4–5 days with the feedstock carbon to nitrogen (C/N) ratio regulation of 20/1. The CS and PM addition enhanced the compressibility of fermentation residuals by increasing the particle distribution spread index (DSI). Moreover, the external carbon addition conduced to bacterial consortia diversity rising and uneven population distribution in the co-fermentation, which contributed to VFAs accumulation potentially. The organic loading rate (OLR) correlated with bacterial community closely at the early stage (days 1–5), while the oxidation-reduction potential (ORP) and pH played more important roles on bacterial consortia at the terminal stage (days 6–10). The C/N ratio adjustment by CS and PM and proper optimizations of OLR, pH, and ORP at various running stages facilitated VFA accumulation during the co-fermentation operation.
Nitrogen export from the nearshore vegetable field of Erhai Lake seriously threatens the water quality of Erhai Lake, which is the second largest highland freshwater lake in Yunnan Province, China. Among the nitrogen flows into Erhai Lake, shallow groundwater migration is a major pathway. The nitrogen variation and influencing factors in the shallow groundwater of the nearshore vegetable field of Erhai Lake are not well documented. A 2-year field experiment was conducted to determine the concentrations of nitrogen species in the shallow groundwater and their influencing factors in the nearshore vegetable field of Erhai Lake. The results showed that concentrations of TN, NO3−-N, and NO2−-N gradually increased with increasing elevation and distance from Erhai Lake, but the opposite was observed for NH4+-N in the shallow groundwater. The concentrations of nitrogen species in the rainy season were greater than those in the dry season. NO3−-N accounted for more than 79% of total nitrogen in shallow groundwater. Redundancy analysis showed that more than 70% of the temporal and spatial variations of nitrogen concentrations in the shallow groundwater were explained by shallow groundwater depth, and only approximately 10% of variation was explained by the factors of soil porosity, silt clay content of soil, and NH4+-N and NO3−-N concentrations of soil (p < 0.05). The shallow groundwater depth had more notable effects on nitrogen concentrations in the shallow groundwater than other factors. This result will strongly support the need for further research regarding the management practices for reducing nitrogen concentrations in shallow groundwater.
The widespread hydraulic connection is necessary for the formation of a salt lake. However, only limited studies have ever been carried out to investigate the influence of the hydraulic connection on the distribution of elements around certain salt lake. In this study, a total of 66 water samples (including river water, stream water, spring water, brine, intercrystalline brine, well water, and drilling brine) were collected around the Gas Hure salt lake (GSKLH) to investigate the relationship between hydraulic connection and uranium (U) distribution via hydrochemistry and isotope (234U/238U, δ11B) techniques. The results suggested that the GSKLH was recharged by water from the Kulamulekesay and Atetikan rivers, groundwater (borehole brine and some intercrystalline brine), and deep fluid (some intercrystalline brine), with each contributing 44.03%, 14.95%, and 41.02% of total recharge, respectively. The U-bearing rock was dominated mainly by silicates, carbonates, and evaporites in the high mountain area (region 1), overflow area (region 2), and plain area (region 3) of the GSKLH, respectively. In the GSKLH, the U distribution was strongly correlated with hydraulic connection and the U concentration was influenced by both groundwater flow system and flow velocity (represented by the γCl−/γCa2+ ratio). Thus, U was enriched under the conditions of regional groundwater flow system and slow velocity in the GSKLH.
A novel lignin-based flocculant (LBF) with superior flocculation performance was prepared from paper mill sludge in this work. The functional groups of LBF and alkaline lignin (AL) were determined by Fourier transform infrared spectroscopy (FTIR). The flocculation performance of LBF integrated with polyaluminum chloride (PAC) was tested in reactive dye wastewater treatment. Floc properties and color removals in multiple flocculation systems were discussed. Results indicated that the dye removal (93%) was greatly facilitated as the LBF was integrated with PAC (PAC + LBF). In addition, floc properties and color removals were significantly improved in the presence of Ca2+ and Mg2+. In contrary, flocculation performance was greatly restricted in the presence of SO42−. LBF was less pH sensitive and shear sensitive than polyacrylamide (PAM) due to the enhanced charge neutralization and bridging action. On the basis of that, LBF could be used as a promising flocculant in dye wastewater treatment.
Zinc oxide nanoparticles (ZnO NPs) are increasingly used in several personal care products, with high potential to be released directly into marine environment with consequent adverse impact on marine biota. This paper aimed to compare the ecotoxicological effect of ZnO NPs (< 100 nm) towards three marine organisms widely used in toxicity assessment: an algal species (Dunaliella tertiolecta), a bioluminescent bacterium (Vibrio fischeri), and a crustacean (Artemia salina). Bulk ZnO (ZnO bulk, 200 nm) and ionic zinc were also investigated for understanding the role of size and of ionic release in the ZnO toxic action. To this aim, different ecotoxicological tests were used: the inhibition of bioluminescence with V. fischeri at three exposure times (5, 15, and 30 min); the D. tertiolecta growth inhibition at 24, 48, and 72 h; the A. salina mortality at 24–96 h, and A. salina mortality and body growth each 3 days along chronic exposure (14 days). For all selected species, ZnO NPs toxicity was strictly dependent on the exposure time and different sensitivities were recorded: ZnO NPs were more toxic towards algae (EC50 2.2 mg Zn/L) but relatively less toxic towards bacteria (EC50 17 mg Zn/L) and crustaceans (EC50 96 h 58 mg Zn/L). During the 14-day chronic exposure of A. salina, ZnO NPs had a significant inhibition of vitality and body length (EC5014d 0.02 mg Zn/L), while the effect of ZnSO4 was not statistically different from the control. ZnO NP toxicity was related to zinc ions and to interactions of particle/aggregates with target organisms and therefore to NP behavior in the testing matrix and to the different testing time exposures.
Graphene oxide (GO) was prepared by using the natural graphite as raw materials via the modified Hummers' method and ultrasonic stripping method. GO was reduced online after its anchoring on the surface of polyurethane sponges by a dip-coating method, then in situ reduced graphene oxide-based polyurethane (IRGOPU) sponges were fabricated. The characterizations of IRGOPU sponges were investigated using Field emission scanning electron microscope (FESEM), Fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), and contact angle measurement. The IRGOPU sponges had an adsorption capacity for a broad range of oils up to 21.7 ~ 55 g/g. A simulation experiment of large-scale oil spill using a simple IRGOPU sponge hollow tube component was designed. The process of continuous oil removal from water surface was quick and effective, and the oil/water separation efficiency could be up to 99.6%. The results indicated that the IRGOPU sponge hollow tube may be an optimum candidate for the oil/water separation of large-scale oil spill.
Publication date: Available online 2 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): C.J. Stewart, D.A. Munnoch
BackgroundLymphoedema is a chronic, debilitating condition caused by a compromised lymphatic system. In recent years, the success of treating upper extremity lymphoedema with liposuction has been translated to patients with lower extremity lymphoedema (LEL), yet there remains a paucity of clinical evidence firmly supporting its use within this patient group.Methods69 patients with LEL (72 legs) were consecutively treated with liposuction by a single surgeon. Compression garments were applied in theatre and continued post-operatively.ResultsMean preoperative volume of oedema was 4372 mL (range 229 -15166 mL), and mean volume of aspirate was 4550 mL (range 575 – 12150 mL). There were no major surgical complications. An average reduction in volume of leg oedema of 85% was found at 3 months (n=72), 88% at 1year (n=60), 94% at 2 years (n=41) and 90% at 5 years (n=15).ConclusionsWe have demonstrated that liposuction combined with continuous compression therapy (CCT) is a safe and effective technique for treatment of primary and secondary LEL, with a significant reduction of the original excess limb volume. Male patients with primary lymphoedema have the poorest outcomes. Limbs with secondary lymphoedema respond best to this treatment.
Publication date: Available online 2 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): T.M. Noblet, P.C. Jackson, I.M. Smith
Publication date: Available online 2 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Stuart .J. Moulton, Csilla. Gullyas, Fiona. J. Hogg, Kevin. G. Power
BackgroundA limited number of studies have researched psychosocial predictors of body image dissatisfaction exclusively within the National Health Service (NHS) aesthetic surgery patient populations, despite aesthetic surgery being offered on an exceptional basis. The Adult Exceptional Aesthetic Referral Protocol (AEARP) defines criteria for aesthetic surgery under the NHS in Scotland. The protocol requires psychological assessment prior to surgery for the majority of aesthetic surgery procedures offered. It is therefore important to establish psychological predictors of body image dissatisfaction to aid with assessment and provision of psychological therapy for this patient group.Method334 consecutive potential aesthetic surgery patients referred for psychological assessment under the AEARP completed psychosocial self-report assessment measures as part of routine practice. Multiple regression analysis using the forced entry method was used to investigate psychosocial predictors of body image dissatisfaction.ResultsMultiple regression analysis indicated that younger age, greater symptoms of depression, lower levels of self-esteem and greater interpersonal sensitivity significantly predicted higher levels of self reported body image dissatisfaction. Symptoms of anxiety did not significantly predict body image dissatisfaction.ConclusionsThis study indicates that both self perception and perception of self in relation to others, especially fear of being judged by others, significantly relates to body image dissatisfaction in this patient group. Psychological assessment of patients' suitability for aesthetic surgery should consider factors such as the patient's interpersonal functioning. Psychological intervention targeted at symptoms of depression, difficulties with self-esteem and interpersonal functioning may be of significant benefit to patients either prior to undergoing surgery or as an alternative to aesthetic surgery.
The present study was aimed at investigating the relationship between the new Clermont's phylogenetic groups, virulence factors, and pathogenicity island markers (PAIs) among uropathogenic Escherichia coli (UPEC) in Iran. This cross-sectional study was carried out on 140 UPEC isolates collected from patients with urinary tract infections in Bushehr, Iran. All isolates were subjected to phylogenetic typing using a new quadruplex-PCR method. The presence of PAI markers and virulence factors in UPEC strains was evaluated by multiplex PCR. The most predominant virulence gene was fimH (85%), followed by iucC (61.4%), papC (38.6%), hlyA (22.1%), cnf-1 (18.6%), afa (10.7%), papG and neuC (each 9.3%), ibeA (3.6%), and sfa/foc (0.7%). The most common phylogenetic group was related to B2 (39.3%), and the least common to A (0.7%). The most prevalent PAI marker was PAI IV536 (77.14%), while markers for PAI III536 (13.57%), PAI IIJ96 (12.86%), and PAI II536 (12.14%) were the least frequent among the UPEC strains. Meanwhile, the PAI IJ96 marker was not detected. There was a significant association between the phylogenetic group B2 and all the studied virulence genes and PAI markers. To our knowledge, this is the first study to compare the relationship between new phylogenetic groups, virulence genes and PAI markers in UPEC strains in Iran. The phylogenetic group B2 was predominantly represented among the studied virulence genes and PAI markers, indicating the preference of particular strains to carry virulence genes.
Spatial and temporal variability of natural surfactant sea surface film structural parameters were evaluated from force-area isotherms, film pressure-temperature isochors, dynamic surface tension-time relations performed on samples collected in Baltic Sea shallow coastal waters. The film structure state was postulated as a 10-D dimensionless vector created from the normalized thermodynamic, adsorptive, and viscoelastic film parameters. The normalization procedure is based on the concept of self-corresponding states known in thermodynamics. The values taken by all the reduced parameters indicated a significant deviation from the reference ideal-2D gas behavior. The exhibited deviations of the surface parameters from the background values of the same thermodynamic state of each film were independent on the film-collecting procedure, sample solvent treatment, and temperature. The structural similarity was expressed quantitatively as a (Cartesian, street, and Czebyszew) distance between two vectors of the analyzed film and the standard one from the database, and appeared to be related to environmental conditions, surface-active organic matter production, and migration in the studied coastal sea region. The most distinctive parameters differing the films were y, M w and E isoth, as established from Czebyszew function application. The proposed formalism is of universal concern and could be applied to any natural water surfactant system (seawater, inland water, rain water, and snowmelt water).
