Hotspots and main drivers of fecal pollution in Neusiedler See, a large shallow lake in Central Europe

Abstract

To minimize the risk of negative consequences for public health from fecal pollution in lakes, the continuous surveillance of microbiological water quality parameters, alongside other environmental variables, is necessary at defined bathing sites. Such routine surveillance may prove insufficient to elucidate the main drivers of fecal pollution in a complex lake/watershed ecosystem, and it may be that more comprehensive monitoring activities are required. In this study, the aims were to identify the hotspots and main driving factors of fecal pollution in a large shallow Central European lake, the Neusiedler See, and to determine to what degree its current monitoring network can be considered representative spatially. A stochastic and geostatistical analysis of a huge data set of water quality data (~ 164,000 data points, representing a 22-year time-series) of standard fecal indicator bacteria (SFIB), water quality and meteorological variables sampled at 26 sampling sites was conducted. It revealed that the hotspots of fecal pollution are exclusively related to sites with elevated anthropogenic activity. Background pollution from wildlife or diffuse agricultural run-off at more remote sites was comparatively low. The analysis also showed that variability in the incidence of SFIB was driven mainly by meteorological phenomena, above all, temperature, number of sunny hours, and wind (direction and speed). Due to antagonistic effects and temporal undersampling, the influence of precipitation on SFIB variance could not be clearly determined. Geostatistical analysis did reveal that the current spatial sampling density is insufficient to cover SFIB variance over the whole lake, and that the sites are therefore in the most part representative of local phenomena. Suggestions for the future monitoring and managing of fecal pollution are offered. The applied statistical approach may also serve as a model for the study of other such areas, and in general indicate a method for dealing with similarly large and spatiotemporally heterogeneous datasets.

In defense of unfair compromises

Abstract

It seems natural to think that compromises ought to be fair. But it is false. In this paper, I argue that it is never a moral desideratum to reach fair compromises and that we are sometimes even morally obligated to try to establish unfair compromises. The most plausible conception of the fairness of compromises is David Gauthier's principle of minimax relative concession. According to that principle, a compromise is fair when all parties make equal concessions relative to how much they can gain from an agreement and relative to how much they would lose without an agreement. To find out whether reaching a fair compromise sometimes is a moral desideratum, I discuss several paradigmatic cases in friendships, economics and politics, and I try to show that even when the parties have moral reasons to refrain from trying to maximize utility in the negotiations, they do not have moral reasons to aim at a fair compromise. My second claim is that we are sometimes morally obligated to try to establish unfair compromises, in particular when we are dealing with parties that try to establish morally very bad political arrangements. In such cases, we should try to concede as little as possible to achieve an outcome that is morally acceptable. Fair compromises, in other words, are morally much more dubious than is usually appreciated.

Current treatment options for acanthosis nigricans

The microbiota of traumatic, open fracture wounds is associated with mechanism of injury

Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.

Use of Antibiotic Impregnated Resorbable Beads Reduces Pressure Ulcer Recurrence: A Retrospective Analysis

Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.

Risk factors for hypertrophic burn scar pain, pruritus, and paresthesia development

Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.

Tetrathiomolybdate, a copper chelator inhibited imiquimod-induced skin inflammation in mice

Humans have witnessed huge exploration and extensive utilization of heavy metal in the past few centuries. As a result, tremendous amount of heavy metal has entered the environment, in soil, water, and air, and inevitably into human bodies. In terms of millions of years of human evolution, elevation of the levels of heavy metal in the body is a quite recent event [1]. Increased body levels of heavy metal can cause many harmful effects [2]. Despite some heavy metals are essential for human body, toxic levels can cause inflammation and oxidative stress [3–6].

Algoritmo de tratamiento con omalizumab en urticaria crónica espontánea

Publication date: Available online 11 August 2018

Source: Actas Dermo-Sifiliográficas

Author(s): J. Spertino, E. Rozas Muñoz, L. Curto Barredo, I. Figueras Nart, A. Gimenez Arnau, E. Serra Baldrich, M. Bonfill-Ortí, V. Expósito-Serrano, A. Guilabert, G. Melé Ninot, M. Villar Buil, J. Garcias Ladaria, X. García Navarro, M. Vilavella, I. Bielsa Marsol, G. Aparicio Ortiz, C. Baliu Piqué, A. Álvarez Abella, N. Lamas Domenech, J.M. Mascaró

Resumen

Antecedentes y objetivo

Los ensayos pivotales de omalizumab en urticaria crónica espontánea (UCE) tienen un periodo de tratamiento de entre 12 y 24 semanas. Sin embargo, muchos pacientes en práctica clínica requieren periodos de tratamiento más prolongados. Por ello el objetivo es presentar un algoritmo de manejo del fármaco.

Materiales y métodos

El documento de consenso que detallamos nace de la puesta en común, aceptación, revisión y confrontación de la literatura reciente del grupo de trabajo de UCE «Xarxa d'Urticària Catalana i Balear» (XUrCB).

Resultados

Se inicia el tratamiento a dosis autorizada y se ajusta la dosis en intervalos trimestrales en función del Urticaria Activity Score de los últimos 7 días (UAS7) y/o el Urticarial Control Test (UCT).

Conclusiones

El algoritmo propuesto pretende servir de guía respecto a cómo ajustar dosis, cómo y cuándo parar el fármaco y el modo de reintroducirlo en casos de recaída.

Abstract

Background and objective

Pivotal trials with omalizumab for treatment of chronic spontaneous urticaria (CSU) are generally run over 12 to 24 weeks. However, in clinical practice, many patients need longer treatment. In this article, we present an algorithm for treatment with omalizumab.

Material and methods

The consensus document we present is the result of a series of meetings by the CSU working group of "Xarxa d'Urticària Catalana i Balear" (XUrCB) at which data from the recent literature were presented, discussed, compared, and agreed upon.

Results

Treatment with omalizumab should be initiated at the authorized dose, and is adjusted at 3-monthly intervals according to the Urticaria Activity Score Over 7 days, the Urticaria Control Test, or both.

Conclusions

The algorithm proposed is designed to provide guidance on how to adjust omalizumab doses, how and when to discontinue the drug, and how to reintroduce it in cases of relapse.

Uptake and accumulation of polycyclic aromatic hydrocarbons in the mangroves Avicennia marina and Rhizophora mucronata

Abstract

This study investigated the uptake and accumulation of polycyclic aromatic hydrocarbons (PAHs) in two mangrove species, Avicennia marina and Rhizophora mucronata. We tested the hypothesis that A. marina would absorb and accumulate more PAHs than R. mucronata. One-year old seedlings of both species were subjected to Bunker Fuel Oil 180 for 3 weeks, and the concentration of PAHs was analyzed by gas chromatography-mass spectrometry (GC/MS). The concentration of PAHs was significantly higher in A. marina than in R. mucronata. The major portion of the PAH pool was in roots (96% in A. marina, 98% in R. mucronata) compared to leaves. The dominant PAHs in roots of both species possessed two to three rings and included phenanthrene, anthracene, fluorene, and acenaphthene. In shoots, PAHs in A. marina included phenanthrene, chrysene, anthracene, acenaphthene, benzo[k+b]fluoranthene, pyrene, benzo[a] anthracene, and benzo[a] pyrene, while those in R. mucronata included phenanthrene, naphthalene, fluoranthene, fluorene, and acenaphthene. Phenanthrene was the dominant PAH in roots and shoots of both species. The greater susceptibility of A. marina appears to be due to its greater root length and specific root length, which permit more exposure to oil than R. mucronata. Other contributory factors include root anatomical characteristics such as larger air spaces, lower suberization of root epidermal cells, lower concentrations of polyphenols, tannins, lignin, and a less efficient antioxidative system. This study provides novel information on differences in the uptake and accumulation of PAHs in two contrasting mangrove species.

A new esophageal elongation technique for long-gap esophageal atresia: in vitro comparison of myotomy techniques

Abstract

Background

Complications such as stricture, leakage, recurrent tracheoesophageal fistula and mucosal pouch are commonly seen in myotomy techniques used for long-gap esophageal atresia (LGEA) treatments. Therefore, we think that there is a clear need for other techniques which would enable us to create more robust and longer esophagus in such cases. In this study, we reviewed multiple V-myotomy (VM) technique and the differences of the said technique with Livaditis circular myotomy (LM) and Kimura spiral myotomy (KM) techniques using literature as an aid.

Methods

21 esophagus samples from 21 male lambs aged 12 months were used in vitro for the study. All esophageal samples were matched to have a length of 120 mm. Samples were divided into 3 groups of 7 and VM, LM and KM techniques were used in each group, respectively. Post-op esophagus lengths, elongation amount with each incision and perforation pressures were measured.

Results

Post-op esophageal lengths were measured as 227, 210 and 200 mm for VM, LM and KM, respectively. Elongation amount per incision was measured as 5.1, 4 and 3.34 mm, again in previous order of VM, LM, and KM. Finally, perforation pressure following VM, LM, and KM was measured as 460, 400, and 410 mmHg.

Conclusion

VM was found to significantly increase total esophagus length and elongation per incision over LM and KM. In addition, VM was also shown to have a higher perforation pressure. Although in vivo live animal studies are required, we can say that VM can be used to create longer and robust esophagus.

A multicenter, randomized, single‐blind trial comparing the efficacy of viable cryopreserved placental membrane to human fibroblast‐derived dermal substitute for the treatment of chronic diabetic foot ulcers

Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.

Do you know when a wound has healed? Insights from a large‐scale multinational consumer survey

Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.

Prurigo pigmentosa au cours de la grossesse

Publication date: Available online 11 August 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): I. Devred, A. Sfecci, N. Cardot-Leccia, J.-P. Lacour, T. Passeron

Résumé

Introduction

Le prurigo pigmentosa est une dermatose inflammatoire rare marquée par son caractère prurigineux et son aspect réticulé typique du tronc, laissant un réseau pigmenté cicatriciel. Elle est très rarement rapportée en dehors de l'Asie et est encore méconnue en France.

Observation

Une femme de 21 ans, originaire du Maghreb, présentait une éruption très prurigineuse, faite de macules et de papules coalescentes formant un réseau réticulé inflammatoire sur le tronc. Cette éruption survenait lors du premier trimestre d'une grossesse marquée par des vomissements gravidiques majeurs ayant conduit à la perte de 13 kg, avec présence d'une cétonémie et d'une cétonurie. Devant l'aspect clinique caractéristique, l'absence de diagnostic différentiel et un aspect histologique compatible, le diagnostic de prurigo pigmentosa était retenu. L'évolution était marquée par des phases de diminution de l'inflammation et du prurit en alternance avec des poussées inflammatoires rythmées par des ré-ascensions de la cétonémie. Les symptômes étaient seulement résolus au deuxième trimestre de la grossesse, après disparition des vomissements, laissant un réseau hyperpigmenté brun séquellaire.

Discussion

Bien que rare, le prurigo pigmentosa a un aspect clinique très évocateur qui doit facilement en faire évoquer le diagnostic. D'étiologie encore indéterminée, il a été rapporté dans des cas de jeûne intense, d'anorexie, de diabète de type 1 mais aussi dans deux autres cas de grossesse avec vomissements intenses. Notre observation souligne l'importance de rechercher et de prendre en charge efficacement une cétonémie sous-jacente pour obtenir une rémission des poussées inflammatoires de prurigo pigmentosa.

Summary

Introduction

Prurigo pigmentosa is a rare inflammatory dermatosis characterized by pruritic and reticulate papules on the trunk leaving hyperpigmentation. This dermatosis has been rarely described outside Asia. The pathophysiology remains obscure.

Case report

We report the case of a 21-year-old North-African woman presenting with a highly pruritic eruption with numerous erythematous macules and papules coalescing in a reticular pattern on the trunk. The eruption occurred during the first trimester of pregnancy, which was marked by severe vomiting resulting in weight loss of 13 kg with ketonemia and ketonuria. Taking into account the characteristic pattern of the eruption, the absence of differential diagnosis, and the histological examination, we concluded on a diagnosis of prurigo pigmentosa. Progression of the disease exhibited phases of decreased inflammation and of pruritus alternating with episodes of inflammatory flares triggered by relapses of ketonemia. The symptoms finally resolved during the 2nd trimester of pregnancy after vomiting ceased. Secondary reticulated hyperpigmentation was observed.

Conclusion

Although rare, the highly evocative clinical presentation of the eruption should help clinicians in diagnosing prurigo pigmentosa. While pathophysiology remains undetermined, prurigo pigmentosa was reported in cases of intense fasting, anorexia, type-1 diabetes, and in two other cases of pregnancy with severe vomiting. Our case underlines the need to screen for and treat underlying ketonemia to achieve control of the inflammatory flares of prurigo pigmentosa.

On snubbing proximal intentions

Abstract

In the simplest case, a proximal intention is an intention one has now to do something now. Recently, some philosophers have argued that proximal intentions do much less work than they are sometimes regarded as doing. This article rebuts these arguments, explains why the concept of proximal intentions is important for some scientific work on intentional action, and sketches an empirical approach to identifying proximal intentions. Ordinary usage of "intend" and the place of intention in folk psychology and scientific psychology are discussed.

L’hydrochlorothiazide augmenterait le risque de mélanome

Publication date: Available online 10 August 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): J.-L. Schmutz

Exchange Rate and Risk of Noise-Induced Hearing Loss in Construction Workers

Akaike information criterionconstruction3-dB5-dBexchange ratehearing lossnoisenoise-inducedimpacttask-based

Synergetic effect of hydrochar on the transport of anatase titanium dioxide nanoparticles in the presence of phosphate in saturated quartz sand

Abstract

The rapid development of nanomaterials has led to the unavoidable leakage and release of nanoparticles (NPs) into soil and the underlying groundwater. It is possible for chars and phosphate introduced into soil to improve crop soil properties by improving contact with NPs. In this study, the influences of hydrochar and/or phosphate on the anatase nTiO₂ transport behaviors were investigated under different conditions. The breakthrough curves (BTCs) and retention profiles were obtained by the saturated sand column experiments. The additional analysis of zeta potentials, sedimentation kinetics, Raman mapping, and the two-site kinetic attachment model (TSKAM) was conducted to explore the possible underlying mechanisms. The simultaneous presence of phosphate and hydrochar acted in a synergetic fashion to enhance the transport of nTiO₂ in a sand medium compared to the facilitated effect of single phosphate or hydrochar. The higher levels of hydrochar induce the more nTiO₂ in the high IC solution passing through the saturated sand columns in the co-presence of phosphate. It was attributed to the competitive adsorption of hydrochar with nTiO₂ to the sand site and the phosphate adsorption on nTiO₂ occurred simultaneously through the sand columns. The fitting results of BTCs using TSKAM showed that the value of k₂ for nTiO₂ (the irreversible attachment coefficient at site 2) was smaller than that of k_1d/k₁ (the first-order reversible detachment and attachment coefficient at site 1, respectively), suggesting irreversible retention of anatase nTiO₂ at site 1. The value of k_1d/k₁ could be better used to explain the retention of nTiO₂ with combined phosphate and hydrochar. This study provides insight into the implications of phosphate and/or hydrochar for nTiO₂ transport in crop soil environments.

Graphical abstract

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The Gracilis Free Flap Is a Viable Option for Large Extremity Wounds

Background Traditionally, the gracilis free flap is used for coverage of small- to medium-sized wounds (100 cm2). Methods We retrospectively reviewed records of 34 patients who underwent extremity soft-tissue reconstruction using gracilis free flaps for wounds larger than 100 cm2 from 1998 to 2016. The primary outcome was overall flap success rate. Secondary outcomes were rates of major and minor complications. Mean defect size was 145 cm2 (range, 104–240 cm2). Seven flaps covered defects greater than 175 cm2. Indications were tumor extirpation (n = 18) and traumatic/posttraumatic wounds (n = 16). The most common time period for flap coverage was immediately (3 days or less) after the defect was created (n = 14). Most flaps were solely muscle (n = 28) and were used for lower extremity or foot coverage (n = 29). Results The overall success rate was 94%. Major and minor complications occurred in 5 and 13 cases, respectively. The most common major complication was unplanned reoperation (n = 5), and the most common minor complications were partial skin graft loss (n = 3), partial flap necrosis (n = 3), and planned recipient-site reoperation (n = 5). Conclusions Reconstruction of large extremity wounds using the gracilis free flap showed a 94% success rate with few major complications.

Ptosis Sensitivity Threshold for the Lay Observer

Purpose This study aims to understand the degree to which ptosis is recognizable to a layperson. Methods Fifteen color drawings of a gender-neutral human face were created. Six faces exhibited right-sided ptosis (decreased margin reflex distance 1 and lengthened tarsal platform show) of 0.5 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, and 3 mm, respectively. Six more faces exhibited left-sided ptosis of the same amounts. The 12 ptotic faces and 3 symmetrical faces were randomly placed on three 11-inch by 14-inch sheets of paper with 5 faces on each page. Lay observers were provided 6 seconds per face to indicate whether it appeared to be asymmetrical. Statistical tests examined the observers' ability to detect asymmetry better than chance. Sex differences in correctly recognizing asymmetry in ptosis at each 0.5 mm increment were analyzed. Results One hundred thirty-one lay observers were enrolled in the study. Fifty-seven were women and 74 were men. Lay people were able to correctly recognize ptosis better than chance when the asymmetry was 1.5 mm or greater. Moreover, females were more accurate in recognizing ptosis at 1.5 mm, 2.0 mm, and 2.5 mm of asymmetry. Conclusions Lay observers tend to recognize between 1.0 mm and 1.5 mm of ptosis on one side as being abnormal. This may have implications in the selection of candidates for ptosis surgery and the analysis of subsequent surgical outcomes.

The ReSurge Global Training Program: A Model for Surgical Training and Capacity Building in Global Reconstructive Surgery

Background A paradigm shift is underway in the world of humanitarian global surgery to address the large unmet need for reconstructive surgical services in low- and middle-income countries (LMICs). Here, we discuss the ReSurge Global Training Program (RGTP), a model for surgical training and capacity building in reconstructive surgery in the developing world. The program includes an online reconstructive surgery curriculum, visiting educator trips, expert reconstructive surgeon involvement, trainee competency tracking system, and identification of local outreach partners to provide safe reconstructive surgery to the neediest of patients in the developing world. Methods A retrospective review of the components of the RGTP from July 2014 through June 2017 was performed. Trainee milestones scores were analyzed to observe trends toward competency in specific plastic surgery skill sets. Results There were a total of 38 visiting educator trips during the study period. The trips took place in 10 LMICs. A total of 149 trainees were evaluated in the context of the visiting educator trips with 377 distinct submodule evaluations. Four trainees had more than 10 submodule evaluations over 2 or more visiting educator trips. There was notable improvement in milestones ratings over time among the trainees in this program. Conclusions The RGTP is a model of reconstructive surgical training and capacity building in LMICs. Trainees develop important skill sets in reconstructive surgery as a result of their involvement in the program. This comprehensive training approach addresses the disparity in access to care in the developing world by providing short- and long-term solutions to unmet reconstructive needs.