Experiences of Dermatologic Surgeons With the Sunshine Act: A National Survey

No abstract available

https://ift.tt/2GjNhGS

Incidence, Risk Factors, Progression, and Treatment of Endovenous Heat-Induced Thrombosis Class 2 or Greater After Endovenous Radiofrequency Ablation

BACKGROUND Endovenous heat-induced thrombosis (EHIT) is a thrombus that extends from an ablated saphenous vein into the common femoral vein after endovenous radiofrequency ablation (RFA). OBJECTIVE To investigate the incidence, progression, treatment, and risk factors associated with EHIT-2 or greater after RFA. MATERIALS AND METHODS This retrospective study included patients diagnosed with symptomatic superficial venous incompetence that were treated by RFA of the great saphenous vein or anterior accessory saphenous vein during the July 2012 to December 2016 study period. Duplex ultrasound scanning was performed at 1 week, 1 month, 3 months, and every year after RFA to detect EHIT. RESULTS A total of 317 legs from 274 patients were included. The incidence of EHIT-2 or greater was 7.0%, including 5.4% EHIT-2, 1.3% EHIT-3, and 0.3% EHIT-4. No symptomatic pulmonary embolism was found. The independent risk factors for EHIT-2 or greater were vein diameter (p = .027) and concomitant sclerotherapy (p = .037). CONCLUSION The risk factors found to be independently associated with EHIT-2 or greater were large vein size and concomitant sclerotherapy. Screening for EHIT should be performed in patients with one or both of these risk factors within 1 week after RFA and in patients with postoperative symptoms suggestive of venous thromboembolism. Address correspondence and reprint requests to: Nuttawut Sermsathanasawadi, MD, PhD, Division of Vascular Surgery, Department of Surgery Faculty of Medicine Siriraj Hospital, Mahidol University 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand, or e-mail: nuttawut@gmail.com Supported by a grant from the Siriraj Research Development Fund (managed by Routine to Research: R2R), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Discrepancy Between Online Images of Mohs Surgery and Reality: An Opportunity for Improvement

No abstract available

https://ift.tt/2GhX0xu

The “Sketch, Etch, and Sketch” Approach to Improve Accuracy and Durability of Surgical Skin Markings: Surgical Pearl

No abstract available

https://ift.tt/2rEM0Qk

A Survey of Mohs Tissue Tracking Practices

BACKGROUND There are little data regarding error within the multistep process of Mohs micrographic surgery (MMS). OBJECTIVE A survey of Mohs surgeons was performed to evaluate variation in tissue handling and processing within the MMS process. METHODS AND MATERIALS A 9-question electronic survey was distributed to members of the American College of Mohs Micrographic Surgery. A total of 97 responses were analyzed. RESULTS Most surgeons personally transport the tissue (71.1%), most frequently in a specimen container (54.6%). Method of tissue identification during transportation varied significantly. Most surgeons personally hand-draw the map (77.1%). A diagram was most commonly used to convey tissue orientation to the histotechnician (65.4%). Only 31.3% of histotechnicians used labeling of blocks to identify tissue within the cryostat. Most respondents (72.2%) are the only surgeon processing tissue in the laboratory at one time; however, 28.9% reported performing 10 or more cases per day. CONCLUSION Most respondents are responsible for tissue transport and mapping, which likely reduces potential error. However, the method of transport and labeling, as well as identification by the histotechnician, was more variable. Ultimately, having a consistent process and clear communication with personnel will help reduce potential error during Mohs surgery. Address correspondence and reprint requests to: Jessica B. Dietert, MD, 505 W Louis Henna Blvd, Suite 200, Austin, TX 78728, or e-mail: nikkidietert@gmail.com The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2GrLAqK

Clinical Evaluations of a Novel Thread Lifting Regimen Using Barbed Polyglyconate Suture for Facial Rejuvenation: Analysis Using a 3-Dimensional Imaging System

BACKGROUND Thread lifting with absorbable sutures has recently gained prominence for rejuvenating ptotic and sagging soft tissues in aging face. A barbed, delayed absorbable polyglyconate monofilament shows significantly high tensile loads with superior flexibility and elasticity. OBJECTIVE To evaluate the safety and efficacy of novel thread lifting regimen with barbed polyglyconate suture for counteracting the descent and laxity of the aging face. METHODS A retrospective chart review was conducted for 25 Korean patients with mild to moderate facial skin laxity receiving thread lifting procedures using barbed polyglyconate suture. Dermatologists' objective assessments using a 5-point Global Aesthetic Improvement Scale (GAIS), 3D imaging system, and subjective satisfaction were recorded at baseline and 4 months after treatments. RESULTS In most patients (84%), GAIS scores were more than score 3 ("improved"), with 40% of score 4 ("much improved") and 24% of score 5 ("excellent") at the follow-up point. Subjective assessments paralleled these patterns. Three-dimensional analysis quantitatively showed volume migration of low face upward, clinically interpreted as facial lifting. No serious adverse effect was observed. CONCLUSION This novel thread lifting procedure using barbed polyglyconate suture is a safe and effective method for tightening and lifting for aging face with mild to moderate face sagging. Address correspondence and reprint requests to: Jae Yoon Jung, MD, Oaro Dermatology Clinic, 507, Nohaero, Nowongu, Seoul 01695, Republic of Korea, or e-mail: jaeyoon007@hanmail.net The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2rE79KG

Benefit of Mohs Micrographic Surgery Over Wide Local Excision for Melanoma of the Head and Neck: A Rational Approach to Treatment

BACKGROUND There are limited published data comparing wide local excision (WLE) with Mohs micrographic surgery (MMS) for the treatment of melanoma. OBJECTIVE To describe a novel treatment algorithm for the surgical management of head and neck melanoma and compare rates of local recurrence for tumors treated with either MMS using immunohistochemistry or WLE. MATERIALS AND METHODS A 10-year retrospective chart review including all in situ and invasive melanomas of the head and neck treated at one institution from January 2004 to June 2013. RESULTS Among 388 patients with melanoma, MMS was associated with decreased rates of local recurrence (p = .0012). However, patient and tumor characteristics varied significantly, and WLE subgroup was largely composed of higher stage and risk tumors. Subgroup analysis found that patients with in situ or thin invasive tumors (

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Repair of a Large Glabellar/Nasal Defect

No abstract available

https://ift.tt/2rB13uF

Cosmetics, Vol. 5, Pages 71: Preparation and Characterization of Callus Extract from Pyrus pyrifolia and Investigation of Its Effects on Skin Regeneration

Cosmetics, Vol. 5, Pages 71: Preparation and Characterization of Callus Extract from Pyrus pyrifolia and Investigation of Its Effects on Skin Regeneration

Cosmetics doi: 10.3390/cosmetics5040071

Authors: Dae Eung Park Deepak Adhikari Rudra Pangeni Vijay Kumar Panthi Hyun Jung Kim Jin Woo Park

In the present study, an aqueous extract was prepared using calli from the in vitro-derived leaves of Pyrus pyrifolia cultured in Murashige and Skoog medium containing picloram for a plant growth regulator. The major biological components in the callus extract were identified as uridine (1), adenosine (2), and guanosine (3). In terms of the antioxidant activity, at 300 µg/mL, the extract exhibited free radical scavenging activity of 76.9% ± 2.88% in the 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay, comparable to that of 44 µg/mL ascorbic acid (82.5% ± 3.63%). In addition, the IC50 values for inhibition of advanced glycation end product formation from collagen and elastin were 602 ± 2.72 and 3037 ± 102.5 µg/mL, respectively. The extract significantly promoted keratinocyte and fibroblast cell proliferation in a dose-dependent manner. Moreover, fibroblasts treated with 1.36 µg/mL extract exhibited a 1.60-fold increase in procollagen type I C-peptide level compared to controls. The in vitro wound recovery rates of keratinocytes and fibroblasts were also 75% and 38% greater, respectively, than those of serum-free controls at 9 and 36 h after extract treatment (1.36 µg/mL). Additionally, the extract flux across the human epidermis increased by 1598% after its incorporation into elastic nanoliposomes (NLs). Therefore, elastic NLs loaded with Pyrus pyrifolia callus extract have potential use as skin rejuvenators and antiaging ingredients in cosmetic formulations.

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Central serous retinopathy as presentation of an adrenal adenoma

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Bidirectional ventricular tachycardia due to hypokalaemia

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MRI of radial cutaneous nerve abscess in recurrent neural leprosy

https://ift.tt/2LgHSPP

Pericardial effusion as a complication of chronic graft versus host disease

A 24-year-old man with previous matched unrelated donor allogenic bone marrow transplant for aplastic anaemia and chronic graft versus host disease on steroid taper presented with progressively worsening anasarca. CT revealed large pericardial effusion, while echocardiogram was concerning for early tamponade physiology. He underwent emergent pericardiocentesis with pericardial drain placement. Extensive rheumatological and infectious work-up was unrevealing with patient's presentation attributed to pericardial graft versus host disease. This highlights the need of physicians to be aware of pericardial serositis as a complication of graft versus host disease due to its life-threatening complications, which require immediate intervention.

https://ift.tt/2Cg19xX

Potassium chloride mixture may maintain hypokalaemia and hypertension

Hypokalaemia can be treated with potassium chloride mixture. Some mixtures contain liquorice extract (glycyrrhizin) as a supplement to improve taste. Glycyrrhizin can cause pseudohyperaldosteronism and thereby result in hypertension and hypokalaemia. We here present a case where treatment with potassium chloride mixture causes hypertension and hypokalaemia in a 50-year-old woman. After unravelling differential diagnosis, the potassium chloride mixture was stopped. After the discontinuation, the patient's blood pressure was well managed and the potassium levels normalised.

https://ift.tt/2Cg3J6Z

Catatonia due to alprazolam withdrawal

A 50-year-old man with multiple psychiatric comorbidities including major depressive disorder and general anxiety disorder presented to the emergency room (ER) with altered mental status, immobility and mutism. The patient was unresponsive to commands and unable to provide any history. In the ER he was given a provisional diagnosis of cerebrovascular accident (CVA). Vital signs on admission were stable. On physical examination, he exhibited grimacing, muscle rigidity and areflexia. Workup for CVA and infectious aetiology was unremarkable and the patient's urine toxicology screen was negative. History from the patient's family revealed that 4 days prior to presentation, the patient had discontinued his prescribed dose of alprazolam 1 mg four times per day. The patient was diagnosed with catatonia due to benzodiazepine withdrawal and had gradual return to baseline with administration of lorazepam 1 mg intravenous three times per day.

https://ift.tt/2CfGdHr

Late onset of dropped head syndrome following mantle radiation therapy for Hodgkin lymphoma

Dropped head syndrome (DHS) is a rare condition, characterised by weakness of the cervical paraspinal muscles with sagging of the head. It is usually seen in association with neurological disorders and rarely can follow radiotherapy. We report a case of a 54-year-old man survivor of Hodgkin lymphoma (HL), who developed DHS 28 years after radiotherapy. He was referred to our department due to progressive weakness and atrophy of cervical paraspinal and shoulder girdle musculature. Physical and neurophysiological examination, electromyography and MRI confirmed the diagnosis of DHS. In the following years, there was no progression of symptoms.

https://ift.tt/2LgZkna

Metastatic adenocarcinoma of mandible: in search of the primary

We present here a case of a 64-year-old female patient who reported with a complaint of pain in the chin region of 3-month duration. The radiographs revealed an irregular radiolucent lesion in the anterior part of the mandible. An incisional biopsy was carried out and the microscopy showed features of adenocarcinoma. Suspecting a metastatic lesion, the patient was then sent for whole body examination which showed a mass in the lungs. A whole body scan also showed metastasis to other organs such as kidney, gallbladder and vertebrae. This case is unusual in that the patient complained only of a vague jaw pain with no other systemic symptoms even in the presence of widespread disease.

https://ift.tt/2CeZjNJ

Haemostatic radiation therapy for a bleeding intraductal papillary neoplasm of the biliary tree

Haemostatic radiation was effectively used as a novel rescue therapy in a 60-year-old man who presented with recurrent melaena refractory to all conventional medical and surgical measures. He needed multiple transfusions and was diagnosed to be bleeding from an intraductal papillary biliary neoplasm which was not amenable to surgical resection in view of the background liver disease. He received conventional radiation therapy (RT) of a dose of 3 Gy per fraction for 3 consecutive days after which he stabilised. After cessation of the RT, he did not require transfusion for the next 2 months. His quality of life improved and it gave us time to evaluate for other definitive measures.

https://ift.tt/2CdtZPs

Renal sarcoidosis: a rare case

Sarcoidosis is a multisystemic granulomatous disease with rare renal involvement. We describe a case of a 45-year-old female patient admitted to the hospital with severe acute kidney injury and uveitis. After clinical investigation, sarcoidosis with renal, hepatic and ocular involvement was diagnosed. Renal biopsy revealed acute granulomatous interstitial nephritis and treatment with systemic corticosteroids was started with marked improvement in renal function.

https://ift.tt/2CeU7cC

Single right coronary artery with congenital absence of left coronary system

Single coronary artery (SCA) is a very rare coronary anomaly. The accurate diagnosis of the entity requires multimodality imaging of the coronary anatomy. SCA is often incidentally diagnosed when patients are investigated for symptoms of suspected coronary artery disease with invasive or non-invasive coronary angiography. There are no established diagnostic electrocardiographic or echocardiographic criteria to identify the presence of SCA, which makes the diagnosis a far-reaching fruit. We present a young male patient presenting with a non-ST elevation myocardial infarction. He was found to have SCA on invasive coronary angiography, which was subsequently confirmed by CT coronary angiography.

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Primary mural infective endocarditis with associated central line infection

https://ift.tt/2CeqM28

Thyroid storm: a case of haemodynamic failure promptly reversed by aggressive medical therapy with antithyroid agents and steroid pulse

Hyperthyroidism is a common metabolic disorder, although its presentation as an endocrine emergency called thyroid storm is rare. Here we review a case of a thyroid storm as the initial presentation of thyrotoxicosis, with multiple organ failure and haemodynamic collapse due to low-output cardiac dysfunction. Quick intervention with aggressive antithyroid therapy, including steroid pulse, and supportive intensive care measures led to an outstanding improvement and full recovery. The present case clearly shows the beneficial impact of initial clinical suspicion resulting in an early diagnosis and intensive therapy. Moreover, it supports the additional role of steroids to aggressive antithyroid strategy in order to control associated deleterious systemic inflammatory reactions.

https://ift.tt/2LgZfQo

Dexmedetomidine-assisted drug interviews: an observation in psychiatric setting

Drug-assisted interviews are an effective tool in the management of various psychiatric illnesses where psychopharmacological, as well as routine psychological interventions, do not prove beneficial. These have most commonly been done by using barbiturates and benzodiazepines that have given favourable results for a long time. However, they carry the risk of respiratory depression and difficulty in maintaining the plane of sedation where the patient is amenable to interviewing. In our experience of drug-assisted interviews with two patients we used intravenous dexmedetomidine, which is being used in anaesthesia practice for conscious sedation or sedation in the intensive care unit. We found dexmedetomidine to be superior to thiopentone in achieving a level of conscious sedation where the patients were amenable for an interview, with no significant adverse events and faster post-anaesthetic recovery.

https://ift.tt/2LiDEqP

Anaphylaxis after treatment with recombinant factor VIII: investigation and therapeutic challenge

We report a 10-year-old patient with haemophilia A developing anaphylaxis to recombinant factor VIII (octocog alfa). Allergic reactions, and especially anaphylactic events, are rare in patients with haemophilia A. The nature of these reactions is not fully understood. Here, we demonstrate a type I hypersensitivity reaction using sodium dodecyl sulfate-polyacrylamide gel electrophoresis immunoblotting assay. This test revealed itself as an essential diagnostic tool, as it allowed us to choose an alternative treatment (moroctocog alfa). Its safety was later confirmed by an uneventful challenge test.

https://ift.tt/2CeRLKM

Exogenous steroid-induced hypoadrenalism in a person living with HIV caused by a drug-drug interaction between cobicistat and intrabursal triamcinolone

We report a diagnosis of exogenous steroid-induced hypoadrenalism in a person living with HIV caused by a drug–drug interaction (DDI) between intrabursal triamcinolone and the pharmacokinetic booster cobicistat. A 53-year-old woman living with HIV, managed with dolutegravir and cobicistat-boosted darunavir, presented to the orthopaedic clinic with worsening hip pain. She was diagnosed with greater trochanteric pain syndrome (GTPS) of the hip and was treated with intrabursal injection of bupivacaine and triamcinolone. Seven days following this injection, she presented with Cushingoid features, an undetectable cortisol and was diagnosed with exogenous steroid-induced hypoadrenalism. Cobicistat is a cytochrome P450 3A inhibitor and in this case inhibited clearance of intrabursal triamcinolone, leading to exogenous glucocorticoid excess and adrenal suppression. This is the first report to describe this predictable DDI with cobicistat following intrabursal glucocorticoid injection. This case highlights the complexities in managing non-HIV-related chronic morbidities in people living with HIV.

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Perivascular tumour balls in primary vitreoretinal lymphoma

https://ift.tt/2Lpfzih

Giant juvenile papillomatosis of the breast in a Nigerian girl

Juvenile papillomatosis is a benign epithelial proliferative tumour of young women. It was recognised as a distinct clinicopathological entity with defining criteria by Rosen et al since 1980. However, giant juvenile papillomatosis is rare. We report a case of a 14-year-old girl who presented to our institution's breast clinic with a huge right breast mass measuring 20 cm x 15 cm. She had no personal history of previous breast disease and there was no family history of breast cancer. Our initial preoperative diagnosis was of a phylloides tumour. The patient had a total excision of her breast mass which revealed florid juvenile papillomatosis at histology. This presentation highlights the clinical presentation and imaging features of juvenile papillomatosis. The classical histopathological characteristics, unusual microscopic findings and management of a huge-sized tumour in an adolescent Nigerian patient are also presented.

https://ift.tt/2LgZefi

Unusual case of cellulitis due to primary cutaneous histoplasmosis

A 63-year-old white man with a history of rheumatoid arthritis on adalimumab was admitted to the hospital for left arm swelling and erythema. On physical examination, the patient was afebrile and non-toxic appearing and there was tense oedema of the left forearm. Initial laboratory work was unremarkable except for elevated inflammatory markers. MRI of the arm showed non-specific findings of inflammation. The patient was started on empiric antibiotics but did not improve. Given the patient's immunosuppression, early consideration was given to fungal or mycobacterial causes. Initial serum fungal studies were negative and the patient was taken for diagnostic local incision and biopsy of the left volar forearm. Grocott's methenamine silver and periodic acid–Schiff staining revealed fungal organisms resembling Histoplasma and intraoperative fungal cultures grew Histoplasma capsulatum confirming the diagnosis. The patient was treated with a 6-month course of itraconazole with improvement in his condition and eventual complete resolution.

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Case of a missed airway stent migration

This case report describes a rare complication to stent management of airway compression. An 84- year-old man was admitted to the outpatient clinic with haemoptysis, cough and dyspnoea. A CT scan showed an intraluminal, non-occluding tumour close to the right side of the main carina. A stent was inserted in the right main bronchus. The patient was, 7 months later, admitted to the emergency room with severe cough and dyspnoea. The stent was produced during a coughing spell. Retrospective investigation of available imaging revealed that the stent had been dislodged to a nearly 'perfect' position in the left main bronchus several months earlier which, however, had not been noticed and thus not reported by the radiologist describing the CT. The possibility of a right-left confusion should always be kept in mind, especially if a patient presents with renewed symptoms that should have been managed successfully.

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Benign paroxysmal positional vertigo and osteoporosis

https://ift.tt/2SPLpqC

The Na+/H+ Exchanger Nhe1 Modulates Network Excitability via GABA Release

Abstract

Brain functions are extremely sensitive to pH changes because of the pH-dependence of proteins involved in neuronal excitability and synaptic transmission. Here, we show that the Na⁺/H⁺ exchanger Nhe1, which uses the Na⁺ gradient to extrude H⁺, is expressed at both inhibitory and excitatory presynapses. We disrupted Nhe1 specifically in mice either in Emx1-positive glutamatergic neurons or in parvalbumin-positive cells, mainly GABAergic interneurons. While Nhe1 disruption in excitatory neurons had no effect on overall network excitability, mice with disruption of Nhe1 in parvalbumin-positive neurons displayed epileptic activity. From our electrophysiological analyses in the CA1 of the hippocampus, we conclude that the disruption in parvalbumin-positive neurons impairs the release of GABA-loaded vesicles, but increases the size of GABA quanta. The latter is most likely an indirect pH-dependent effect, as Nhe1 was not expressed in purified synaptic vesicles itself. Conclusively, our data provide first evidence that Nhe1 affects network excitability via modulation of inhibitory interneurons.

https://ift.tt/2CfTP5h

Cytoarchitectonic segregation of human posterior intraparietal and adjacent parieto-occipital sulcus and its relation to visuomotor and cognitive functions

Abstract

Human posterior intraparietal sulcus (pIPS) and adjacent posterior wall of parieto-occipital sulcus (POS) are functionally diverse, serving higher motor, visual and cognitive functions. Its microstructural basis, though, is still largely unknown. A similar or even more pronounced architectonical complexity, as described in monkeys, could be assumed. We cytoarchitectonically mapped the pIPS/POS in 10 human postmortem brains using an observer-independent, quantitative parcellation. 3D-probability maps were generated within MNI reference space and used for functional decoding and meta-analytic coactivation modeling based on the BrainMap database to decode the general structural–functional organization of the areas. Seven cytoarchitectonically distinct areas were identified: five within human pIPS, three on its lateral (hIP4-6) and two on its medial wall (hIP7-8); and two (hPO1, hOc6) in POS. Mediocaudal areas (hIP7, hPO1) were predominantly involved in visual processing, whereas laterorostral areas (hIP4-6, 8) were associated with higher cognitive functions, e.g. counting. This shift was mirrored by systematic changes in connectivity, from temporo-occipital to premotor and prefrontal cortex, and in cytoarchitecture, from prominent Layer IIIc pyramidal cells to homogeneous neuronal distribution. This architectonical mosaic within human pIPS/POS represents a structural basis of its functional and connectional heterogeneity. The new 3D-maps of the areas enable dedicated assessments of structure–function relationships.

https://ift.tt/2CeWv34

Brain Functional Organization Associated With Language Lateralization

Abstract

Although it is well-established that human language functions are mostly lateralized to the left hemisphere of the brain, little is known about the functional mechanisms underlying such hemispheric dominance. The present study investigated intrinsic organization of the whole brain at rest, by means of functional connectivity and graph theoretical analysis, with the aim to characterize brain functional organization underlying typical and atypical language dominance. We included healthy left-handers, both those with typical left-lateralized language and those with atypical right-lateralized language. Results show that 1) differences between typical and atypical language lateralization are associated with functional connectivity within the language system, particularly with weakened connectivity between left inferior frontal gyrus and several other language-related areas; and 2) for participants with atypical language dominance, the degree of lateralization is linked with multiple functional connectivities and graph theoretical metrics of whole brain organization, including local efficiency and small-worldness. This is the first study, to our knowledge, that linked the degree of language lateralization to global topology of brain networks. These results reveal that typical and atypical language dominance mainly differ in functional connectivity within the language system, and that atypical language dominance is associated with whole-brain organization.

https://ift.tt/2LhxOpt

A Breakdown of Imagined Visuomotor Transformations and Its Neural Correlates in Young Elderly Subjects

Abstract

Several studies have shown age-related changes in motor imagery (MI) in older adults and the associated compensatory brain activation patterns; most of these studies have used explicit MI tasks or implicit MI tasks focused on mental rotation of body parts. Here, we address the effect of ageing on MI for the more complex visuomotor transformations entailed by mentally simulated hand-tool interactions triggered by a grip selection task (GST) for tools used in daily life. We studied 22 young and 22 elderly subjects performing the GST, in which they were asked to report whether they would grip a portrayed tool with an overhand or an underhand grip. We found a behavioral decline in the elderly group, accompanied by reduced activations of the left posterior parietal lobule, in a subregion associated specifically with reaching behavior by previous investigations. No differences were observed in the temporal cortices associated with object semantics. These results suggested a specific age-related vulnerability of the neural substrates, particularly for the imaginary reaching component of the task, rather than for the semantically driven grasping component. The combination of behavioral deficits and reduced activation of specific brain regions speaks in favor of a specific age-associated deficit for the complex imaginary movements required by the GST.

https://ift.tt/2LhxMxR

Roles of Ventromedial Prefrontal Cortex and Anterior Cingulate in Subjective Valuation of Prospective Effort

Abstract

The perceived effort level of an action shapes everyday decisions. Despite the importance of these perceptions for decision-making, the behavioral and neural representations of the subjective cost of effort are not well understood. While a number of studies have implicated anterior cingulate cortex (ACC) in decisions about effort/reward trade-offs, none have experimentally isolated effort valuation from reward and choice difficulty, a function that is commonly ascribed to this region. We used functional magnetic resonance imaging to monitor brain activity while human participants engaged in uncertain choices for prospective physical effort. Our task was designed to examine effort-based decision-making in the absence of reward and separated from choice difficulty—allowing us to investigate the brain's role in effort valuation, independent of these other factors. Participants exhibited subjectivity in their decision-making, displaying increased sensitivity to changes in subjective effort as objective effort levels increased. Analysis of blood-oxygenation-level dependent activity revealed that the ventromedial prefrontal cortex (vmPFC) encoded the subjective valuation of prospective effort, and ACC activity was best described by choice difficulty. These results provide insight into the processes responsible for decision-making regarding effort, partly dissociating the roles of vmPFC and ACC in prospective valuation of effort and choice difficulty.

https://ift.tt/2Cd4Hkq

The Cerebral Cortex is Bisectionally Segregated into Two Fundamentally Different Functional Units of Gyri and Sulci

Abstract

The human cerebral cortex is highly folded into diverse gyri and sulci. Accumulating evidences suggest that gyri and sulci exhibit anatomical, morphological, and connectional differences. Inspired by these evidences, we performed a series of experiments to explore the frequency-specific differences between gyral and sulcal neural activities from resting-state and task-based functional magnetic resonance imaging (fMRI) data. Specifically, we designed a convolutional neural network (CNN) based classifier, which can differentiate gyral and sulcal fMRI signals with reasonable accuracies. Further investigations of learned CNN models imply that sulcal fMRI signals are more diverse and more high frequency than gyral signals, suggesting that gyri and sulci truly play different functional roles. These differences are significantly associated with axonal fiber wiring and cortical thickness patterns, suggesting that these differences might be deeply rooted in their structural and cellular underpinnings. Further wavelet entropy analyses demonstrated the validity of CNN-based findings. In general, our collective observations support a new concept that the cerebral cortex is bisectionally segregated into 2 functionally different units of gyri and sulci.

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Herpes zoster‐associated paresis of the left arm

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Herpes zoster‐associated paresis of the left arm

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The Relationship of Exhaled Nitric Oxide with Ethnicity and Gender in Rural Georgia YouthAuthors

Nitric oxide is produced by the human bronchial epithelium1 and is associated with airway eosinophilic inflammation seen in asthmatics and other airway diseases.2 Airway inflammation is a characteristic of asthma, along with airway hyper-responsiveness and airway obstruction. Inhaled corticosteroids (ICS) to treat the inflammation are a mainstay of asthma treatment. Measurement of exhaled nitric oxide (eNO) as a biomarker of eosinophilic inflammation is noninvasive, safe, reproducible, and easy to perform; however, the clinical value of measurements has been limited by imprecise reference ranges.

https://ift.tt/2zY8f8I

Associations of urban greenness with asthma and respiratory symptoms in Mexican American children

Asthma is one of the most common childhood chronic conditions with approximately 19 million adults and seven million children affected in the United States alone. 1 The etiology of asthma and other allergic conditions is not fully understood, but environmental and lifestyle factors have been implicated in the inception of these conditions. In the United States, the prevalence of asthma and asthma related symptoms is disproportionately high in urban poor neighborhoods.2-4 Although this might be due partly to sociodemographic factors, studies have suggested that urbanization and its detrimental impact on the natural environment and lifestyle might increase the risk of respiratory conditions.

https://ift.tt/2PGtMYF

miR-487b mitigates allergic rhinitis through inhibition of the IL-33/ST2 signaling pathway

OBJECTIVE: To investigate the potential effect of miR-487b/IL-33-ST2 axis on the pathology of allergic rhinitis (AR) and the relevant mechanism.

PATIENTS AND METHODS: The expression level of interleukin-33 (IL-33), a homolog of sulfotransferase (ST2), and miR-487b were detected in patients with or without allergic rhinitis. Luciferase assay was performed to evaluate the interaction between miR-487b and IL-33, and the effects of miR-487b/IL-33-ST2 axis on allergic rhinitis mice were determined by established allergic rhinitis model in mice by ovalbumin (OVA). The levels of OVA-specific immunoglobulin E (Ig-E), proinflammatory cytokines (IL-4, IL-5, and IL-13), and pathological alterations were detected.

RESULTS: The level of IL-33 and its specific ligand ST2 were found increased in allergic rhinitis patients while miR-487b expression level was markedly repressed. To confirm whether miR-487b has a regulation effect on IL-33, we checked it in three publicly available algorithms, TargetScan, miRDB, and microRNA. We found that IL-33 is a direct target of miR-487b, and Luciferase assays confirmed our hypothesis, the subsequent experiments showed that up-regulation of miR-487b could inhibit expression of IL-33 and ST2, resulting in the decrease of the immunoglobulin E (Ig-E), proinflammatory cytokines and mitigation of pathological alterations.

CONCLUSIONS: Our research discovered the suppressor function of miR-487b in allergic rhinitis and revealed that miR-487b/IL-33-ST2 axis may be a potential therapeutic target for the treatment of allergic rhinitis.

L'articolo miR-487b mitigates allergic rhinitis through inhibition of the IL-33/ST2 signaling pathway sembra essere il primo su European Review.

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Positive influence of simvastatin used as adjuvant agent for cavity lining

Abstract

Objectives

To assess the biological, antimicrobial, and mechanical effects of the treatment of deep dentin with simvastatin (SV) before application of a glass-ionomer cement (GIC).

Materials and methods

Dentin discs were adapted to artificial pulp chambers and SV (2.5 or 1.0 mg/mL) was applied to the occlusal surface, either previously conditioned or not with EDTA (±EDTA). The extracts (culture medium + SV that diffused through dentin) was obtained and then applied to cultured odontoblast-like MDPC-23 cells. Cell viability, alkaline phosphatase (ALP) activity, and mineralization nodule (MN) deposition were evaluated. Untreated discs were used as control. The antibacterial activity of SV (2.5 or 1.0 mg/mL) against Streptococcus mutans and Lactobacillus acidophilus, as well as the bond strength of GIC to dentin in the presence of SV 2.5 mg/mL (±EDTA) were also assessed. The data were analyzed by ANOVA/Tukey tests (α = 5%).

Results

EDTA + SV 2.5 mg/mL significantly enhanced the ALP activity and MN deposition in comparison with the control, without changing in the cell viability (p < 0.05). The association EDTA + SV 2.5 mg/mL + GIC determined the highest ALP and MN values (p < 0.05). SV presented intense antimicrobial activity, and the EDTA dentin conditioning followed by SV application increased bond strength values compared with SV treatment alone (p < 0.05).

Conclusion

SV presents antimicrobial activity and diffuses across conditioned dentin to biostimulate odontoblast-like pulp cells.

Clinical significance

The use of SV as adjuvant agent for indirect pulp capping may biostimulate pulp cells thus preserving vitality and function of the pulp-dentin complex.

https://ift.tt/2S0AYAI

New validated diagnostic criteria for pyoderma gangrenosum

https://ift.tt/2PGmF2p

In response to: “New validated diagnostic criteria for pyoderma gangrenosum”

https://ift.tt/2zWjb6I

Making the Case for Sesame: A Major U.S. Food Allergen

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 241-242, December 2018.


https://ift.tt/2Lgm7iV

Pediatric Spontaneous Pneumothorax: Our Experience and a Review of the Literature

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 208-214, December 2018.


https://ift.tt/2CdaYfM

Angiopoietin-1, Angiopoietin-2, and Periostin Levels in Children with Recurrent Wheeze

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 230-235, December 2018.


https://ift.tt/2Lijugt

Comparison of 3 Indices for Assessing the Severity of Bronchial Asthma Exacerbations in Children

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 215-220, December 2018.


https://ift.tt/2CfC6Lj

Looking Towards the Future

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 207-207, December 2018.


https://ift.tt/2LklhS8

Relationship Between Health Literacy in Parents and Asthma Control in Their Children: A Prospective Study in a Diverse Suburban Population

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 221-225, December 2018.


https://ift.tt/2Cf1mkQ

Role of the Airway Microbiome in Respiratory Infections and Asthma in Children

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 236-240, December 2018.


https://ift.tt/2Liha9p

Direct Observed Therapy of Inhaled Corticosteroids for Asthma at School or Daycare

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 226-229, December 2018.


https://ift.tt/2Cd0MnA

Highlights from the U.S. Asthma Summit 2018

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 243-244, December 2018.


https://ift.tt/2LjaxDU

Hyaluronic acid is superior to autologous fat for treatment of temporal hollowing after lateral orbital wall decompression: A prospective interventional trail

To compare injections with hyaluronic acid and autologous fat for treatment of unsightly temporal hollowing after lateral orbital wall decompression in thyroid eye disease.

https://ift.tt/2S05HxD

Combination free foot flaps for digit reconstruction: A retrospective analysis of 37 cases

Combination foot flaps for digit reconstruction was previously introduced by our group as an alternative method for toe-to-hand transfer. The aim of this study was to analyze our experience with the combination foot flaps and to present the surgical refinements that were introduced. A prospective study was conducted including all combination foot flaps performed at our hospital since September 2009. Surgical refinements that were introduced during this study included island flap for repair of toe nail donor site and the use of Z-plasty.

https://ift.tt/2QwzG3z

Intraoral anastomosis of a vascularized iliac-crest flap in maxillofacial reconstruction

Intraoral anastomosis of free flaps was introduced to avoid extraoral scars. In addition, advances in vascularized iliac-crest flap have greatly facilitated jaw reconstruction. The primary aim of this study was to evaluate feasibility and outcomes of intraoral anastomosis of vascularized iliac-crest flaps used for jaw reconstruction.Methods: From December 2015 to June 2018, 10 (3 men and 7 women) patients aged 12-55 (median, 28) years were treated at the Peking University School and Stomatology Hospital, China.

https://ift.tt/2QwzBNj

Nuss procedure for patients with pectus excavatum with a history of intrathoracic surgery

The aim of this study was to demonstrate the feasibility and safety of the Nuss procedure for patients with pectus excavatum with a history of intrathoracic surgery.

https://ift.tt/2S2kuYG

Keystone island flaps for reconstruction following lower leg skin cancer resection: a comparison with split-thickness skin grafts

The lower leg is a common site for skin cancer in older patients. For all but the smallest defects, split thickness skin grafts (SSG) remain the mainstay of reconstruction in this patient group but are complicated by poor graft take, donor site morbidity and poor aesthetics.1 Local flaps are an attractive option, given their like-for-like characteristics but limited soft tissue availability makes traditional local flaps challenging.

https://ift.tt/2QB6zwl

Perforator navigation using color Doppler ultrasound and three-dimensional reconstruction for preoperative planning of optimal lateral circumflex femoral artery system perforator flaps in head and neck reconstruction

The authors introduce an algorithm for preoperative planning of optimal lateral circumflex femoral artery system perforator flap (LCFAPF) supplied by the best quality and the easiest dissection of the perforators and the source vessels for simplified and customized strategies in head and neck reconstruction with perforator navigation using color Doppler ultrasound and three-dimensional reconstruction (3D-CDUS PN).

https://ift.tt/2RWX1YN

Use of Integra Flowable Wound Matrix for nasal dorsum reconstruction or augmentation: a series of 6 cases

The nasal dorsum is one of the major components of the nose's architecture and its esthetics. Resection or reduction procedures are much more common that projection procedures. However, by definition, adding volume is more complicated than removing it as new materiel must be added to obtain this projection. There are many published studies on this topic.1–5

https://ift.tt/2QxvFw1

Wound management in acute medicine

Wounds are common and often have a complex aetiology that may lead to serious consequences if mis-managed. Effective treatment relies on a good clinical assessment, understanding of the underlying aetiology and physiology and appropriate intervention.1 Early appropriate wound management is likely to prevent further wound-related problems, shorten hospital stay and reduce re-admission rates.2 This is particularly relevant in acute medicine where wounds are often referred late (especially when the wounds are not the primary medical presentation) and a lack of expertise in wound care exists.

https://ift.tt/2QB6wk9

The Influence of Marital Status on Contemporary Patterns of Post-Mastectomy Breast Reconstruction

Marital status is known to influence quality of life, survival, and treatment decision-making after breast cancer diagnosis. We aimed to determine whether relationship status impacts contemporary patterns of immediate breast reconstruction.

https://ift.tt/2S3MjQC

Re: The Use of Ultrasound guidance for foreign body removal

Patients with implanted subcutaneous foreign bodies (FB) are a common presentation to Plastic Surgery services. This implantation may be accidental, or as part of self-embedding behaviour. Removal of FB poses multiple risks including the usual risks of an operation, which may include a general anaesthetic and a tourniquet. In addition, there are risks posed by removal of FB in particular. They are often sharp, posing a needlestick risk to the surgeon. They are usually small, making identification potentially difficult, lengthy and occasionally unsuccessful.

https://ift.tt/2S0VqBn

Measuring Visual Attention to Faces with Cleft Deformity

Limited data is available regarding observers' visual attention to faces with congenital difference. We implemented eye tracking technology in order to examine this issue as it pertains specifically to faces with cleft deformity.

https://ift.tt/2S1Vzoi

The Polish version of the Boston Carpal Tunnel Questionnaire: Associations between patient-rated outcome measures and nerve conduction studies

The aim of this study was to investigate the associations between nerve conduction studies and three commonly used patient-reported outcome measures (Disabilities of the Arm, Shoulder and Hand [DASH], Michigan Hand Outcomes Questionnaire [MHQ], and the Polish version of the Boston Carpal Tunnel Questionnaire [BCTQ])

https://ift.tt/2S3xugD

Anatomic Location of a Sensory Nerve to the Lateral Thigh Flap: A Novel Option for Sensate Autologous Tissue Reconstruction

The principle of providing sensate reconstruction is not novel and has enhanced reconstruction of many regions of the body from a protective and functional standpoint.

https://ift.tt/2QwzkKh

Application of Suction Retractor for Lymphaticovenular Anastomoisis

As super-micro surgical techniques have improved, lymphaticovenular anastomosis (LVA) has become the major treatment for lymph edema. Furthermore, indocyanine green fluorescent lymphography (ILG) can detect lymph vessels accurately1 and LVA can be performed through a small incision. However, lymph vessels which are suitable for LVA exist under the superficial fascia2 therefore an assistant has to open the surgical site or retractors are required. Another factor that makes LVA complicated is lymph fluid.

https://ift.tt/2QyQsz0

Augmented Reality Microsurgical Planning with a Smartphone (ARM-PS): A dissection route map in your pocket

Perioperative microsurgical planning increases the likelihood of successful results. Augmented reality is the addition of artificial information allowing the user to perform tasks more efficiently. The aim of our study is to report the use of augmented reality for microsurgical planning with a smartphone (ARM-PS) as a dissection route map.

https://ift.tt/2S7jfYw

Lower Eyelid Tension Balance Reconstruction: A New Procedure for the Repair of Congenital Epiblepharon with Epicanthus

Congenital epiblepharon with epicanthus is a common eyelid malposition in Asian children that generally involves the lower eyelid. The induced cilial entropion may cause constant ocular irritation that requires surgical repair. The purpose of this study is to report the outcomes and surgical details of a novel procedure, lower eyelid tension balance reconstruction, for the correction of congenital epiblepharon with epicanthus.

https://ift.tt/2QB6s3T

Comparable investigation of polyaniline behavior towards gaseous ammonia and toluene adsorption

Abstract

With raising awareness of gaseous air pollutants and their harmful impact, adsorption is considered one of the most prominent techniques for gaseous emissions control. The usage of polyaniline as a gas adsorbent is an innovative idea. This work aims to compare the efficacy of synthesized polyaniline nanotubes (PANT) as a novel adsorbent towards inorganic gases (ammonia NH₃) and volatile organic compounds (toluene vapor). PANT was prepared via a sol-gel preparation technique. The molecular structure of prepared PANT was characterized by Fourier-transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD). The morphological structure was confirmed using transmission electron microscopy (TEM) and scanning electron microscope (SEM). The PANT adsorbent surface area was determined using Brunner Emmett Teller (BET). Dynamic behavior of simulated feed gas mixture of NH₃ and toluene in air were examined using a fixed bed adsorption arrangement. The same adsorption conditions (inlet concentration, gas mixture feed flow rate, and a fixed amount of adsorbent) were applied for both NH₃ and toluene adsorption test. The NH₃ and toluene removal efficiencies were 100% and 96% respectively. Consequently, PANT is an auspicious adsorbent that can be utilized to control the indoor and outdoor gaseous air emissions.

Graphical Abstracts

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https://ift.tt/2CetKDu

Clear cell acanthoma (CCA)-like lesions of the nipple/areola: A clinicopathological study of 12 cases supporting a nonneoplastic eczematous disease

Clear cell acanthoma (CCA) of the nipple/areola has been reported. The CCA-like histology more likely represents a feature of eczematous dermatitis of the nipple/areola.

https://ift.tt/2A19BiX

High prevalence of clinical spondyloarthritis features in patients with hidradenitis suppurativa

To the Editor: Hidradenitis suppurativa (HS) is associated with several comorbidities, including possibly spondyloarthritis.1 Spondyloarthritis is a group of interrelated chronic autoinflammatory rheumatic conditions.2 A spondyloarthritis diagnosis is based mainly on the presence of spondyloarthritis features, which includes spinal (axial) features sacroiliitis and spondylitis, peripheral features, such as peripheral arthritis, enthesitis, and dactylitis; and the extra-articular manifestations uveitis, psoriasis, and inflammatory bowel disease.

https://ift.tt/2QxrbWd

In vitro characterization of hepatic toxicity of Alternaria toxins

Abstract

Alternaria mycotoxins are secondary fungal metabolites which can contaminate food and feed. They are produced by Alternaria species with alternariol (AOH), alternariol monomethyl ether (AME), tenuazonic acid (TeA), and tentoxin (TEN) as the main representatives for Alternaria mycotoxins in food. Once passing the intestinal barrier, Alternaria toxins can reach the liver to exert yet uncharacterized molecular effects. Therefore, hepatic in vitro systems were used to examine selected Alternaria mycotoxins for their induction of metabolism-dependent cytotoxicity, phosphorylation of the histone H2AX as a surrogate marker for DNA double-strand breaks, and relevant marker genes for hepatotoxicity. Analysis of cell viability as well as the induction of H2AX phosphorylation in the hepatocarcinoma cell line HepG2 revealed a detoxification of 100 μmol/l AME and AOH by pre-treatment with S9 liver homogenate as shown by a decrease in cytotoxicity and H2AX histone phosphorylation to levels observed in control cells. Concentrations up to 100 μmol/l TeA and TEN did not induce H2AX phosphorylation whether metabolized or not. In the metabolically competent human hepatoma cell line HepaRG, no cytotoxicity of Alternaria toxins occurred even at high concentrations up to 100 μmol/l, which indicates a low cytotoxic potential. Induction of gene expression associated with liver toxicity was analyzed by quantitative real-time PCR using a specific hepatotoxicity PCR array in HepaRG cells: here, an evidence was found that 50 μmol/l of AOH, AME, TeA, and TEN might be associated with hepatotoxic effects, necrosis, and the development of diseases like cholestasis and phospholipidosis.

https://ift.tt/2QWDfzu

The impact of public transportation on carbon emissions: a panel quantile analysis based on Chinese provincial data

Abstract

Although the Chinese government emphasizes the significance of public transportation development and encourages green travel, no empirical study has examined whether the expansion of public transportation facilitates the mitigation of carbon emissions. To this end, we employ a panel quantile regression to test the endogenous relationship between public transportation scale and carbon emissions. The results suggest that the effect of public transportation scale on carbon emissions is heterogeneous across China's provinces based on the level of carbon emissions. Even so, the results still support a stable inverted U-shaped relationship between public transportation scale and carbon emissions for provinces with different levels of carbon emissions. That is, when public transportation scale exceeds a threshold value, the relationship between public transportation and carbon emissions will turn from positive to negative. Our findings provide evidence advocating for public transportation development and green travel. It is of great significance for China to respond to climate changes.

https://ift.tt/2BglIbI

Acquired partial lipoatrophy as graft-versus-host disease and treatment with metreleptin: two case reports

Acquired partial lipoatrophy has been reported after bone marrow transplantation during childhood; however, no adult cases have previously been reported. We herein report two adult cases of acquired partial li...

https://ift.tt/2rzSWOR

Sensitivity of physiological and biochemical endpoints in early ontogenetic stages of crops under diclofenac and paracetamol treatments

Abstract

Early stages of ontogenesis determining subsequent growth, development, and productivity of crops can be affected by wastewater and sludge contaminated with pharmaceuticals. Diclofenac (DCF) and paracetamol (PCT; both 0.0001 to 10 mg/L) did not affect seed germination and primary root length of onion, lettuce, pea, and tomato. Conversely, 20-day-old pea and maize plants exhibited decrease in biomass production, leaf area (by approx. 40% in pea and 70% in maize under 10 mg/L DCF), or content of photosynthetic pigments (by 10% and 60% under 10 mg/L PCT). Quantum yields of photosystem II were reduced only in maize (F_V/F_M and Φ_II by more than 40% under 10 mg/L of both pharmaceuticals). Contents of H₂O₂ and superoxide increased in roots of both species (more than four times under 10 mg/L PCT in pea). Activities of antioxidant enzymes were elevated in pea under DCF treatments, but decreased in maize under both pharmaceuticals. Oxidative injury of root cells expressed as lowered oxidoreductase activity (MTT assay, by 40% in pea and 80% in maize) and increase in malondialdehyde content (by 60% and 100%) together with the membrane integrity disruption (higher Evans Blue accumulation, by 100% in pea and 300% in maize) confirmed higher sensitivity of maize as a C4 monocot plant to both pharmaceuticals.

https://ift.tt/2LlEBPi

Effectiveness of 2% Articaine as an anesthetic agent in children: randomized controlled trial

Abstract

Aim

The aim of this study was to compare the effectiveness of 2% articaine and 2% lignocaine in achieving adequate anesthesia in children between the age group of 6–13 years using inferior alveolar nerve block.

Methods

A triple blinded randomized controlled trial was conducted in 180 participants (90 patients- 2% articaine, 90 patients-2% lignocaine). Effectiveness of the anesthetic agent was determined at 3 points determined by subjective evaluation of pain using pain scales (FPS-R). Paired sample t-test and chi square test were performed for statistical significance.

Result

Anesthetic success for 2% articaine were 64.4%, 42.2% and 81.8% respectively. The anesthetic success of 2% lignocaine was 66.7%, 48.9% and 85.7% at point one, point two and point three respectively (p > 0.05).

Conclusion

This study concludes that 2% articaine in 1:2,00,000 did not demonstrate superior clinical effectiveness in comparison to 2% lignocaine.

Clinical significance

Lignocaine has always been considered the gold standard. With its unique chemical structure and increased potency, Articaine has been gaining popularity. Its efficacy in 2% concentration had not been compared to 2% lignocaine. 2% articaine did not show clinical superiority but its comparable effectiveness with lignocaine can encourage further research in using articaine in reduced concentrations to improve effectiveness.

https://ift.tt/2zYR9aw

Composite scaffold obtained by electro-hydrodynamic technique for infection prevention and treatment in bone repair.

Related Articles

Composite scaffold obtained by electro-hydrodynamic technique for infection prevention and treatment in bone repair.

Int J Pharm. 2018 Dec 10;:

Authors: Aragón J, Feoli S, Irusta S, Mendoza G

Abstract
Bone infection is a devastating condition resulting from implant or orthopaedic surgery. Therapeutic strategies are extremely complicated and may result in serious side effects or disabilities. The development of enhanced 3D scaffolds, able to promote efficient bone regeneration, combined with targeted antibiotic release to prevent bacterial colonization, is a promising tool for the successful repair of bone defects. Herein, polymeric electrospun scaffolds composed of polycaprolactone (PCL) nanofibres decorated with poly(lactic-co-glycolic acid) (PLGA) particles loaded with rifampicin were fabricated to achieve local and sustained drug release for more efficient prevention and treatment of infection. The release profile showed an initial burst of rifampicin in the first six hours, enabling complete elimination of bacteria. Sustained and long-term release was observed until the end of the experiments (28 days), facilitating a prolonged effect on the inhibition of bacterial growth, which is in agreement with the common knowledge concerning the acidic degradation of the microparticles. In addition, bactericidal effects against gram negative (Escherichia coli) and gram positive (Staphylococcus aureus) bacteria were demonstrated at concentrations of released rifampicin up to 58 ppm after 24 h, with greater efficacy against S. aureus (13 ppm vs 58 ppm for E. coli). Cell morphology and cytocompatibility studies highlighted the suitability of the fabricated scaffolds to support cell growth, as well as their promising clinical application for bone regeneration combined with prevention or treatment of bacterial infection.

PMID: 30543890 [PubMed - as supplied by publisher]

https://ift.tt/2S3001V

Distinctive Neuroanatomical Substrates for Depression in Bipolar Disorder versus Major Depressive Disorder

Abstract

No neuroanatomical substrates for distinguishing between depression of bipolar disorder (dBD) and major depressive disorder (dMDD) are currently known. The aim of the current multicenter study was to identify neuroanatomical patterns distinct to depressed patients with the two disorders. Further analysis was conducted on an independent sample to enable generalization of results. We directly compared MR images of these subjects using voxel-based morphometry (VBM) and a support vector machine (SVM) algorithm using 1531 participants. The VBM analysis showed significantly reduced gray matter volumes in the bilateral dorsolateral prefrontal (DLPFC) and anterior cingulate cortices (ACC) in patients with dBD compared with those with dMDD. Patients with the two disorders shared small gray matter volumes for the right ACC and left inferior frontal gyrus when compared with healthy subjects. Voxel signals in these regions during SVM analysis contributed to an accurate classification of the two diagnoses. The VBM and SVM results in the second cohort also supported these results. The current findings provide new evidence that gray matter volumes in the DLPFC and ACC are core regions in displaying shared and distinct neuroanatomical substrates and can shed light on elucidation of neural mechanism for depression within the bipolar/major depressive disorder continuum.

https://ift.tt/2BiRvJe

The Essentials-Only Emergency Tracheotomy Pan: Keeping It Simple With Open Emergent Airways.

Related Articles

The Essentials-Only Emergency Tracheotomy Pan: Keeping It Simple With Open Emergent Airways.

JAMA Otolaryngol Head Neck Surg. 2018 Dec 13;:

Authors: Van Mai JP, Whited C, Dailey S

PMID: 30543370 [PubMed - as supplied by publisher]

https://ift.tt/2zYm9Ya

Severe Facial-Disfiguring Xeroderma Pigmentosum With Rapidly Progressing Malignant Tumors.

Related Articles

Severe Facial-Disfiguring Xeroderma Pigmentosum With Rapidly Progressing Malignant Tumors.

JAMA Otolaryngol Head Neck Surg. 2018 Dec 13;:

Authors: Zan T, Huang X, Li Q

PMID: 30543363 [PubMed - as supplied by publisher]

https://ift.tt/2PG0KIF

Is It Time to Rethink the Approach to Internal Nasal Valve Stenosis?

Related Articles

Is It Time to Rethink the Approach to Internal Nasal Valve Stenosis?

JAMA Otolaryngol Head Neck Surg. 2018 Dec 13;:

Authors: Moss WJ

PMID: 30543362 [PubMed - as supplied by publisher]

https://ift.tt/2A0iE3I

Association Between Conventional Bicycle Helmet Use and Facial Injuries After Bicycle Crashes.

Related Articles

Association Between Conventional Bicycle Helmet Use and Facial Injuries After Bicycle Crashes.

JAMA Otolaryngol Head Neck Surg. 2018 Dec 13;:

Authors: Benjamin T, Hills NK, Knott PD, Murr AH, Seth R

Abstract
Importance: Bicycling is an increasingly common activity in the United States that is often associated with fall injuries to the head and face. Although helmets lessen head injury, their role in reducing facial injuries is less clear; therefore, it is important to understand the protective capacity for the face in current helmet design.
Objective: To estimate the conventional bicycle helmet's association with the rate of facial injury after bicycle crashes.
Design, Setting, and Participants: This retrospective cohort study accessed records from January 1, 2010, to December 31, 2014, from the National Trauma Databank, which collects data from emergency departments in US hospitals. Each record pertained to 1 emergency department admission for a bicycle crash. The National Trauma Databank registry data are collected and recorded by incident, which is equivalent to an injury-related hospital admission. All injuries involving patients aged 18 to 65 years for whom data on helmet use and injury were available were included. Statistical analysis was conducted from July 19 to October 17, 2016.
Exposures: Helmeted and nonhelmeted bicycle crashes.
Main Outcomes and Measures: Head and facial injuries among helmeted and nonhelmeted bicycle crashes.
Results: A total of 85 187 facial injuries met inclusion criteria (patient age 18-65 years, availability of helmet use status, and type of injury). Demographic information on bicycle riders was frequently unavailable. Among all injuries, fractures to the head (11.6% [9854]) and face (11.3% [9589]) occurred at similar rates. Helmets reduced head fractures by 52% (from 14.0% [7623] to 7.3% [2231]) and head soft-tissue injuries by 30% (from 15.0% [8151] to 10.9% [3358]), but had lower rates in protecting against facial injuries. While reducing facial injuries overall, the amount of protection with helmet use varied with facial location of the injury. Reduction in facial fractures was 35% (95% CI, 31%-39%) for upper face, 28% (95% CI, 23%-32%) for mid face, and 21% (95% CI, 15%-26%) for the lower face. Helmets were less protective against facial soft-tissue injuries, with a reduction of 33% (95% CI, 30%-36%) in the upper face, 21% (95% CI, 16%-26%) in the mid face, and 2% (95% CI, 0-6%) in the lower face.
Conclusions and Relevance: Although bicycle helmets provide some protection against facial injuries after bicycle crashes, the level of protection depends on the proximity of the injury to the helmeted head. The lower face is particularly vulnerable to injury despite helmet use.

PMID: 30543361 [PubMed - as supplied by publisher]

https://ift.tt/2PAgYms

Tumor Size Affects Efficacy of Adjuvant Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma and Microvascular Invasion

AbstractBackground.Patients with hepatocellular carcinoma (HCC) and microvascular invasion (mVI) have shown dismal postoperative prognosis; however, whether adjuvant transarterial chemoembolization (TACE) can improve their outcomes remains unclear.Materials and Methods.We retrospectively identified 549 eligible patients to form the crude cohort and adopted propensity score matching method to assemble another cohort of 444 patients with similar baseline characteristics. We assessed the effects of adjuvant TACE by stratified analyses and multivariate Cox analyses in two cohorts.Results.There was significant interaction between tumor size and adjuvant TACE with respect to overall survival (OS; p = .006 for interaction). In the matched cohort, patients who received adjuvant TACE showed higher rates of 5‐year OS (72.4% vs. 50.9%, p = .005) and 5‐year recurrence‐free survival (50.5% vs. 36.4%, p = .003) in the tumor ≤5 cm subgroup, but not in the tumor >5 cm subgroup (32.3% vs. 24.9%, p = .350 and 18.8% vs. 19.7%, p = .180). The independent protective role of adjuvant TACE on OS was observed in patients with tumor ≤5 cm (adjusted odds ratio [OR] = 0.59, 95% confidence interval [CI] 0.36–0.97) but not in patients with tumor >5 cm (adjusted OR = 1.17, 95% CI 0.84–1.62). The effects of adjuvant TACE did not change materially while the analysis was performed in the crude cohort.Conclusion.For patients with HCC and mVI, adjuvant TACE was associated with improved outcomes, but not for those with tumor >5 cm, according to the current protocol.Implications for Practice.The outcomes of patients with hepatocellular carcinoma and microvascular invasion who received adjuvant transarterial chemoembolization were inconsistent in this study. According to the current protocol, adjuvant transarterial chemoembolization was associated with improved prognosis in patients with microvascular invasion, except for those with tumor >5 cm. Multivariate Cox models confirmed adjuvant transarterial chemoembolization was an independent protective factor in the tumor ≤5 cm subgroup but not in the tumor >5 cm subgroup.

https://ift.tt/2SReK4h

Patient‐Reported Toxicities During Chemotherapy Regimens in Current Clinical Practice for Early Breast Cancer

AbstractBackground.This study explores the incidence of patient‐reported major toxicity—symptoms rated "moderate," "severe," or "very severe"—for chemotherapy regimens commonly used in early breast cancer.Patients and Methods.Female patients aged 21 years or older completed a validated Patient‐Reported Symptom Monitoring instrument and rated 17 symptoms throughout adjuvant or neoadjuvant chemotherapy. Fisher's exact tests compared differences in percentages in symptom ratings, and general linear regression was used to model the incidence of patient‐reported major toxicity.Results.In 152 patients, the mean age was 54 years (range, 24–77), and 112 (74%) were white; 51% received an anthracycline‐based regimen. The proportion of patients rating fatigue, constipation, myalgia, diarrhea, nausea, peripheral neuropathy, and swelling of arms or legs as a major toxicity at any time during chemotherapy varied significantly among four chemotherapy regimens (p < .05). The mean (SD) number of symptoms rated major toxicities was 6.3 (3.6) for anthracycline‐based and 4.4 (3.5) for non‐anthracycline‐based regimens (p = .001; possible range, 0–17 symptoms). Baseline higher body mass index (p = .03), patient‐reported Karnofsky performance status ≤80 (p = .0003), and anthracycline‐based regimens (p = .0003) were associated with greater total number of symptoms rated major toxicities (alternative model: chemotherapy duration, p < .0001). Twenty‐six percent of dose reductions (26 of 40), 75% of hospitalizations (15 of 20), and 94% of treatment discontinuations (15 of 16) were in anthracycline‐based regimens.Conclusion.Capturing multiple toxicity outcomes throughout chemotherapy enables oncologists and patients to understand the range of side effects as they discuss treatment efficacies. Continuous symptom monitoring may aid in the timely development of interventions that minimize toxicity and improve outcomes.Implications for Practice.This study investigated patient‐reported toxicities for 17 symptoms recorded prospectively during adjuvant and neoadjuvant chemotherapy regimens for early breast cancer. An analysis of four commonly used chemotherapy regimens identified significant differences among regimens in both individual symptoms and total number of symptoms rated moderate, severe, or very severe. Longer chemotherapy regimens, such as anthracycline‐based regimens followed by paclitaxel, had higher proportions of symptoms rated major toxicities. The inclusion of patient perspectives on multiple toxicity outcomes at the same time at multiple time points during chemotherapy has the potential for improving patient‐provider communication regarding symptom management, patient satisfaction, and long‐term clinical outcomes.

https://ift.tt/2QUBN0u

Phase II Randomized Trial of Sequential or Concurrent FOLFOXIRI‐Bevacizumab Versus FOLFOX‐Bevacizumab for Metastatic Colorectal Cancer (STEAM)

AbstractBackground.First‐line treatment for metastatic colorectal cancer (mCRC) typically entails a biologic such as bevacizumab (BEV) with 5‐fluorouracil/leucovorin/oxaliplatin (FOLFOX) or 5‐fluorouracil/leucovorin/irinotecan (FOLFIRI). STEAM (NCT01765582) assessed the efficacy of BEV plus FOLFOX/FOLFIRI (FOLFOXIRI), administered concurrently (cFOLFOXIRI‐BEV) or sequentially (sFOLFOXIRI‐BEV, FOLFOX‐BEV alternating with FOLFIRI‐BEV), versus FOLFOX‐BEV for mCRC.Patients and Methods.Patients with previously untreated mCRC (n = 280) were randomized 1:1:1 to cFOLFOXIRI‐BEV, sFOLFOXIRI‐BEV, or FOLFOX‐BEV and treated with 4–6‐month induction followed by maintenance. Coprimary objectives were overall response rate (ORR; first‐line cFOLFOXIRI‐BEV vs. FOLFOX‐BEV) and progression‐free survival (PFS; pooled first‐line cFOLFOXIRI‐BEV and sFOLFOXIRI‐BEV vs. FOLFOX‐BEV). Secondary/exploratory objectives included overall survival (OS), liver resection rates, biomarker analyses, and safety.Results.ORR was 72.0%, 72.8%, and 62.1% and median PFS was 11.9, 11.4, and 9.5 months with cFOLFOXIRI‐BEV, sFOLFOXIRI‐BEV, and FOLFOX‐BEV, respectively. OS was similar between arms. ORR between cFOLFOXIRI‐BEV and FOLFOX‐BEV did not significantly differ (p = .132); thus, the primary ORR endpoint was not met. cFOLFOXIRI‐BEV and sFOLFOXIRI‐BEV numerically improved ORR and PFS, regardless of RAS status. Median PFS was higher with pooled concurrent and sequential FOLFOXIRI‐BEV versus FOLFOX‐BEV (11.7 vs. 9.5 months; hazard ratio, 0.7; 90% confidence interval, 0.5–0.9; p < .01). Liver resection rates were 17.2% (cFOLFOXIRI‐BEV), 9.8% (sFOLFOXIRI‐BEV), and 8.4% (FOLFOX‐BEV). Grade ≥ 3 treatment‐emergent adverse events (TEAEs) were observed in 91.2% (cFOLFOXIRI‐BEV), 86.7% (sFOLFOXIRI‐BEV), and 85.6% (FOLFOX‐BEV) of patients, with no increase in serious chemotherapy‐associated TEAEs.Conclusion.cFOLFOXIRI‐BEV and sFOLFOXIRI‐BEV were well tolerated with numerically improved ORR, PFS, and liver resection rates versus FOLFOX‐BEV, supporting triplet chemotherapy plus BEV as a first‐line treatment option for mCRC.Implications for Practice.The combination of first‐line FOLFIRI with FOLFOX and bevacizumab (concurrent FOLFOXIRI‐BEV) improves clinical outcomes in patients with metastatic colorectal cancer (mCRC) relative to FOLFIRI‐BEV or FOLFOX‐BEV, but it is thought to be associated with increased toxicity. Alternating treatment of FOLFOX and FOLFIRI (sequential FOLFOXIRI‐BEV) could improve tolerability. In the phase II STEAM trial, which is the largest study of FOLFOXIRI‐BEV in patients in the U.S., it was found that both concurrent and sequential FOLFOXIRI‐BEV are active and well tolerated in patients with previously untreated mCRC, supporting the use of these regimens as potential first‐line treatment options for this population.

https://ift.tt/2QR4iwd

Patient‐Reported Outcomes with PD‐1/PD‐L1 Inhibitors for Advanced Cancer: A Meta‐Analysis

AbstractBackground.The aim of this meta‐analysis was to compare patient‐reported outcomes (PROs) between programmed death receptor‐1/programmed death‐ligand 1 (PD‐1/PD‐L1) inhibitors and standard‐of‐care therapy in patients with advanced cancer.Methods.We searched randomized controlled trials (RCTs) comparing single‐agent PD‐1/PD‐L1 inhibitors (nivolumab, pembrolizumab, atezolizumab, avelumab, or durvalumab) with standard‐of‐care therapy in patients with advanced cancer reporting PROs with generic measures: the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 items (QLQ‐C30) and the EuroQol Five Dimensions Questionnaire. The summary outcomes were changes in PROs from baseline to follow‐up within and between treatment groups and time to deterioration (TTD) in PROs based on clinically meaningful change.Results.A total of 6,334 patients from 13 RCTs were included: six nivolumab, five pembrolizumab, and two atezolizumab trials. For the QLQ‐C30 global health status/quality of life, the pooled difference in mean change between treatment groups was 5.1 (95% confidence interval [CI], 3.3–6.9; p < .001) favoring PD‐1/PD‐L1 inhibitors. The pooled mean change from baseline in PD‐1/PD‐L1 inhibitors and controls was 0.1 (95% CI, −2.2, 2.5) and − 6.1 (95% CI, −8.4, −3.8), respectively. The TTD was significantly longer with PD‐1/PD‐L1 inhibitors, with a hazard ratio of 0.72 (95% CI, 0.55–0.93; p = .011). Similarly, significantly better outcomes were noted with PD‐1/PD‐L1 inhibitors on most of the other PRO measures.Conclusion.PD1/PD‐L1 inhibitors maintained health‐related quality of life to a greater degree and had less worsening in symptoms than standard‐of‐care therapy even though patients on these immune modulators were on treatment longer. The better PRO profile further supports the clinical benefit of this treatment strategy for advanced cancer.Implications for Practice.We conducted a systematic review and meta‐analysis to compare patient‐reported outcomes (PROs) of programmed death receptor‐1/programmed death‐ligand 1 (PD‐1/PD‐L1) inhibitors and standard‐of‐care therapy in patients with advanced cancer. PD‐1/PD‐L1 inhibitors were associated with consistently smaller PRO score deterioration from baseline to follow‐up for different health‐related quality‐of‐life and symptoms scales. In addition, the time to deterioration in multiple PRO domains was significantly longer with PD‐1/PD‐L1 inhibitors. Taken together, these findings indicate that the patients treated with PD‐1/PD‐L1 inhibitors maintained health‐related quality of life to a greater degree and had less symptom burden compared with those treated with standard‐of‐care therapy.

https://ift.tt/2SRf1El

Safety and Activity of Sorafenib in Addition to Vinflunine in Post‐Platinum Metastatic Urothelial Carcinoma (Vinsor): Phase I Trial

AbstractLessons Learned. First trial to report safety and activity of the microtubule inhibitor vinflunine plus the tyrosine kinase inhibitor sorafenib in post‐platinum metastatic urothelial cancer (mUC) patients.A recommended phase II dose was identified for the treatment combination of vinflunine plus sorafenib, with main adverse events including fatigue, febrile neutropenia, neutropenia, hypertension, and hyponatremia.An overall response rate of 41% to second‐line vinflunine plus sorafenib treatment in patients with platinum‐resistant mUC was confirmed.Background.Platinum‐progressive metastatic urothelial carcinoma (mUC) is a clinical challenge. The tyrosine kinase inhibitor sorafenib has demonstrated varied activity in mUC. This trial was designed to examine safety and activity of vinflunine plus sorafenib in mUC.Methods.In addition to standard dose of vinflunine (320 or 280 mg/m2), patients received sorafenib (400, 600, or 800 mg/day), in a 3 + 3 dose‐escalation phase I design.Results.Twenty‐two patients (median age 62.5 years) were included. Five patients received vinflunine 320 mg/m2 and 17 received 280 mg/m2. The maximum tolerated dose (MTD) of sorafenib with vinflunine 280 mg/m2 was 600 mg, and with vinflunine 320 mg/m2 it was not determined, owing to toxicity. Adverse events (AEs) grades 3 + 4 consisted of neutropenia (6 patients), febrile neutropenia (5), and hyponatremia (5). The overall response rate (ORR) in the efficacy‐evaluable patients was 41% (7 of 17), all partial responses evaluated by RECIST version 1.1. Median overall survival (OS) was 7.0 months (1.8–41.7).Conclusion.The defined recommended phase II dose (RPTD) was vinflunine 280 mg/m2 plus sorafenib 400 mg. Sorafenib was too toxic in combination with vinflunine 320 mg/m2. The ORR of 41% to this second‐line combination treatment of mUC is noteworthy and supports further trials.

https://ift.tt/2QUjw3r

Direct‐Acting Antivirals in Hepatitis C Virus‐Associated Diffuse Large B‐cell Lymphomas

AbstractBackground.International guidelines suggest hepatitis C virus (HCV) eradication by direct‐acting antivirals (DAAs) after first‐line immunochemotherapy (I‐CT) in patients with HCV‐positive diffuse large B‐cell lymphoma (DLBCL), although limited experiences substantiate this recommendation. Moreover, only a few data concerning concurrent administration of DAAs with I‐CT have been reported.Subjects, Materials, and Methods.We analyzed hematological and virological outcome and survival of 47 consecutive patients with HCV‐positive DLBCL treated at 23 Italian and French centers with DAAs either concurrently (concurrent cohort [ConC]: n = 9) or subsequently (sequential cohort [SeqC]: n = 38) to first‐line I‐CT (mainly rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone [R‐CHOP]‐like).Results.Median age was 61 years, 89% of patients had stage III/IV, and 25% presented evidence of cirrhosis. Genotype was 1 in 56% and 2 in 34% of cases. Overall, 46 of 47 patients obtained complete response to I‐CT. All patients received appropriate DAAs according to genotype, mainly sofosbuvir‐based regimens (n = 45). Overall, 45 patients (96%) achieved sustained virological response, 8 of 9 in ConC and 37 of 38 in SeqC. DAAs were well tolerated, with only 11 patients experiencing grade 1–2 adverse events. Twenty‐three patients experienced hepatic toxicity (grade 3–4 in seven) following I‐CT in SeqC, compared to only one patient in ConC. At a median follow‐up of 2.8 years, two patients died (2‐year overall survival, 97.4%) and three progressed (2‐year progression‐free survival, 93.1%).Conclusion.Excellent outcome of this cohort of HCV‐positive DLBCL suggests benefit of HCV eradication by DAAs either after or during I‐CT. Moreover, concurrent DAAs and R‐CHOP administration appeared feasible, effective, and ideally preferable to deferred administration of DAAs for the prevention of hepatic toxicity.Implications for Practice.Hepatitis C virus (HCV)‐associated diffuse large B‐cell lymphomas (DLBCLs) represent a great therapeutic challenge, especially in terms of hepatic toxicity during immune‐chemotherapy (I‐CT) and long‐term hepatic complications. The advent of highly effective and toxicity‐free direct‐acting antivirals (DAAs) created an exciting opportunity to easily eradicate HCV shortly after or in concomitance with first‐line immunochemotherapy (usually R‐CHOP). This retrospective international study reports the real‐life use of the combination of these two therapeutic modalities either in the concurrent or sequential approach (DAAs after I‐CT) in 47 patients. The favorable reported results on long‐term outcome seem to support the eradication of HCV with DAAs in all patients with HCV‐positive DLBCL. Moreover, the results from the concurrent approach were effective and safe and displayed an advantage in preventing hepatic toxicity during I‐CT.

https://ift.tt/2SOV3d1

Stereotaktische Strahlentherapie übertrifft Sorafenib beim fortgeschrittenen hepatozellulären Karzinom im Hinblick auf das Überleben

https://ift.tt/2UIZOXA

Environmental performance of ordinary and new generation concrete structures—a comparative analysis

Abstract

The development of concrete technology results in a new generation of cement-based concrete such as high-performance concrete, self-compacting concrete and high-performance, self-compacting concrete. These concretes are characterised by better parameters not only in terms of strength and durability but also rheology of the mixtures. Obtaining such properties requires the adoption of a different composition and proportion of ingredients than ordinary concrete. The greater share of cement in these concretes causes an increase in the energy consumption and emissions (per unit of concrete volume) at the production stage. However, use of new generation concrete allows for a reduction of overall dimensions of a structural element, due to the increased strength parameters. Such a solution may finally result in lower consumption of resources and energy, as well as a decrease of gas emissions. The article presents the results of a comparative environmental analysis of ordinary and new generation concrete structures.

https://ift.tt/2SNP1tc

Individualized Follow-Up Strategy for Patients with an Indeterminate Response to Initial Therapy for Papillary Thyroid Carcinoma

Thyroid, Ahead of Print.


https://ift.tt/2QQV179

Role of “revascularization surgery” in the management of mandibular osteoradionecrotic lesions: a report of twenty‐one years of experience

Abstract

Experiment based on the conviction of a biological dimension of reconstructive surgery where the contribution of a vascularized transplant within irradiated tissue constitutes a physiological response to hypoxia, hypocellularity and hypovascularization characteristic of osteoradionecrotic injury.

Between 1992 and 2013, 119 osteoradionecrotic lesions were treated requiring 125 free flaps.

Revascularization surgery efficiency rate during the study period of 94%.

Complex surgery: 49% complications including 38% vascular complications (total or partial flap necrosis) and 37% intolerance to osteosynthesis material.

Proposal of a therapeutic algorithm retaining the indication of a revascularization surgery in case of cutaneous osteoradionecrotic damage and/or bone exposure greater than 2 centimeters and/or osteolysis of interest to the lower alveolar canal.

This article is protected by copyright. All rights reserved.

https://ift.tt/2rynSis

Oral Cancer With Wide Excision and Free Flap Reconstruction

Condition:   Head and Neck Cancer
Intervention:   Procedure: swallow fuction and swallow training
Sponsor:   National Taiwan University Hospital
Recruiting

https://ift.tt/2GfOr65

Safety of CDNF by Brain Infusion in Patients With Parkinson's Disease. Extension to HP-CD-CL-2002 Clinical Study

Conditions:   Parkinson Disease;   Movement Disorders;   Neuro-Degenerative Disease;   Nervous System Diseases;   Brain Diseases
Interventions:   Drug: Cerebral Dopamine Neurotrophic Factor;   Device: Renishaw Drug Delivery System
Sponsors:   Herantis Pharma Plc.;   Renishaw plc.
Recruiting

https://ift.tt/2GfOkYd

A Phase I Safety, Pharmacodynamic and Pharmacokinetic Study of GZ17-6.02 in Advanced Solid Tumors or Lymphoma

Conditions:   Advanced Cancer;   Gastric Cancer;   Breast Cancer;   Pancreatic Cancer;   Prostate Cancer Metastatic;   Colo-rectal Cancer;   Solid Tumor;   Solid Carcinoma;   Solid Carcinoma of Stomach;   Cancer of Stomach;   Lymphoma;   Sarcoma;   Cutaneous T Cell Lymphoma;   Head and Neck Squamous Cell Carcinoma
Intervention:   Drug: GZ17-6.02
Sponsors:   Genzada Pharmaceuticals USA, Inc.;   Translational Drug Development
Not yet recruiting

https://ift.tt/2rD6MQG

The Role of Bathing Additives in the Treatment of Pediatric Atopic Dermatitis

Conditions:   Atopic Dermatitis;   Eczema
Interventions:   Procedure: Water;   Procedure: Bleach;   Procedure: Acetic acid
Sponsors:   Mayo Clinic;   HealthPartners Institute
Not yet recruiting

https://ift.tt/2Lo2aqJ

Nivolumab, Ipilimumab and Chemoradiation in Treating Patients With Resectable Gastric Cancer

Conditions:   Clinical Stage 0 Gastric Cancer AJCC v8;   Clinical Stage 0 Gastroesophageal Junction Adenocarcinoma AJCC v8;   Clinical Stage I Gastric Cancer AJCC v8;   Clinical Stage I Gastroesophageal Junction Adenocarcinoma AJCC v8;   Clinical Stage IIB Gastric Cancer AJCC v8;   Clinical Stage IIB Gastroesophageal Junction Adenocarcinoma AJCC v8;   Clinical Stage III Gastroesophageal Junction Adenocarcinoma AJCC v8;   Clinical Stage IVA Gastric Cancer AJCC v8;   Clinical Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8;   Gastric Adenocarcinoma;   Localized Gastric Carcinoma;   Localized Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage 0 Gastric Cancer AJCC v8;   Pathologic Stage 0 Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage I Gastric Cancer AJCC v8;   Pathologic Stage IA Gastric Cancer AJCC v8;   Pathologic Stage IA Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IB Gastric Cancer AJCC v8;   Pathologic Stage IB Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IC Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage II Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IIA Gastric Cancer AJCC v8;   Pathologic Stage IIA Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IIB Gastric Cancer AJCC v8;   Pathologic Stage IIB Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IIIA Gastric Cancer AJCC v8;   Pathologic Stage IIIB Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8
Interventions:   Drug: Fluorouracil;   Radiation: Intensity-Modulated Radiation Therapy;   Biological: Ipilimumab;   Biological: Nivolumab;   Drug: Oxaliplatin;   Procedure: Therapeutic Conventional Surgery
Sponsors:   M.D. Anderson Cancer Center;   National Cancer Institute (NCI)
Not yet recruiting

https://ift.tt/2CdH1fI

hand-foot syndrome due to paclitaxel: A rare case report p. 284 Pritam S Kataria, Pradip P Kendre, Apurva A Patel, Nahush Tahiliani, Vijay Bhargav, Honey Parekh DOI:10.4103/ijp.IJP_547_17 Hand-foot syndrome (HFS) is a relatively frequent adverse reaction to certain anticancer drugs. HFS is a type of dermatitis which has been most commonly described with 5-fluorouracil and capecitabine. However, HFS with paclitaxel is rare and has been reported sparingly in the literature. A 52-year-old male patient with recurrent carcinoma of the buccal mucosa was started on palliative chemotherapy regimen, injection paclitaxel (175 mg/m2) in combination with injection carboplatin. On post-chemotherapy day 13, the patient started developing pain, dysesthesia followed by bullae formation, and desquamation over palms and soles. Clinically, the patient had Grade 3 HFS characterized by symmetrical, tender skin lesions over the dorsal aspect of palms, and soles with desquamation necessitating interrupti

https://plus.google.com/u/0/+AlexandrosGSfakianakis/posts/b1LJWb9JV61

Safety of CDNF by Brain Infusion in Patients With Parkinson's Disease. Extension to HP-CD-CL-2002 Clinical Study

Conditions:   Parkinson Disease;   Movement Disorders;   Neuro-Degenerative Disease;   Nervous System Diseases;   Brain Diseases
Interventions:   Drug: Cerebral Dopamine Neurotrophic Factor;   Device: Renishaw Drug Delivery System
Sponsors:   Herantis Pharma Plc.;   Renishaw plc.
Recruiting

https://ift.tt/2GfOkYd

A Phase I Safety, Pharmacodynamic and Pharmacokinetic Study of GZ17-6.02 in Advanced Solid Tumors or Lymphoma

Conditions:   Advanced Cancer;   Gastric Cancer;   Breast Cancer;   Pancreatic Cancer;   Prostate Cancer Metastatic;   Colo-rectal Cancer;   Solid Tumor;   Solid Carcinoma;   Solid Carcinoma of Stomach;   Cancer of Stomach;   Lymphoma;   Sarcoma;   Cutaneous T Cell Lymphoma;   Head and Neck Squamous Cell Carcinoma
Intervention:   Drug: GZ17-6.02
Sponsors:   Genzada Pharmaceuticals USA, Inc.;   Translational Drug Development
Not yet recruiting

https://ift.tt/2rD6MQG

Oral Cancer With Wide Excision and Free Flap Reconstruction

Condition:   Head and Neck Cancer
Intervention:   Procedure: swallow fuction and swallow training
Sponsor:   National Taiwan University Hospital
Recruiting

https://ift.tt/2GfOr65

The Role of Bathing Additives in the Treatment of Pediatric Atopic Dermatitis

Conditions:   Atopic Dermatitis;   Eczema
Interventions:   Procedure: Water;   Procedure: Bleach;   Procedure: Acetic acid
Sponsors:   Mayo Clinic;   HealthPartners Institute
Not yet recruiting

https://ift.tt/2Lo2aqJ

Nivolumab, Ipilimumab and Chemoradiation in Treating Patients With Resectable Gastric Cancer

Conditions:   Clinical Stage 0 Gastric Cancer AJCC v8;   Clinical Stage 0 Gastroesophageal Junction Adenocarcinoma AJCC v8;   Clinical Stage I Gastric Cancer AJCC v8;   Clinical Stage I Gastroesophageal Junction Adenocarcinoma AJCC v8;   Clinical Stage IIB Gastric Cancer AJCC v8;   Clinical Stage IIB Gastroesophageal Junction Adenocarcinoma AJCC v8;   Clinical Stage III Gastroesophageal Junction Adenocarcinoma AJCC v8;   Clinical Stage IVA Gastric Cancer AJCC v8;   Clinical Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8;   Gastric Adenocarcinoma;   Localized Gastric Carcinoma;   Localized Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage 0 Gastric Cancer AJCC v8;   Pathologic Stage 0 Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage I Gastric Cancer AJCC v8;   Pathologic Stage IA Gastric Cancer AJCC v8;   Pathologic Stage IA Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IB Gastric Cancer AJCC v8;   Pathologic Stage IB Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IC Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage II Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IIA Gastric Cancer AJCC v8;   Pathologic Stage IIA Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IIB Gastric Cancer AJCC v8;   Pathologic Stage IIB Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IIIA Gastric Cancer AJCC v8;   Pathologic Stage IIIB Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8
Interventions:   Drug: Fluorouracil;   Radiation: Intensity-Modulated Radiation Therapy;   Biological: Ipilimumab;   Biological: Nivolumab;   Drug: Oxaliplatin;   Procedure: Therapeutic Conventional Surgery
Sponsors:   M.D. Anderson Cancer Center;   National Cancer Institute (NCI)
Not yet recruiting

https://ift.tt/2CdH1fI

Lichen planus pigmentosus and frontal fibrosing alopecia: The link explored Highly accessed article p. 73 Ashraf Raihan, Muthu Sendhil Kumaran DOI:10.4103/Pigmentinternational.Pigmentinternational_19_18 There has been a recent rush of data regarding the combined presentation of lichen planus pigmentosus and frontal fibrosing alopecia in premenoposal women of dark skin. This review article addresses the relationship between the two.

Sunscreens

Sunscreens: Time to think beyond UV rays

p. 78

Chitralekha Keisham, Nelson Elangbam, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_15_18   It has been known to us that solar radiation contributes to photoaging. Until recently, it was thought to be due to ultraviolet rays alone. However, a growing number of evidence confirms that visible and infrared (IR) rays also contribute to extrinsic aging. Visible and IR rays account for 50% and 45% of the solar radiation reaching the earth. Ultraviolet A induces retrograde mitochondrial signal, thus leading to induction of matrix metalloproteinase. Ultraviolet B and IRC cause heat-related generation of free radicals and destruction of collagen and elastin. Exposure to visible light induces cytokines, free-radical formation, and pigmentary changes in human skin. The end result of solar radiation is generation of free radicals and ultimately oxidative damage, photoaging, and photocarcinogenesis. The present broad spectrum sunscreen does not provide complete protection of the human skin from oxidative insult. So, a combination of a sun protection factor active component along with an antioxidant is the ideal way of photoprotection. Till date, a number of antioxidants have been tried in human and animals which have shown to be an effective photoprotective agent, though few studies have failed to prove the same. Even with conflicting reports, effect of antioxidants on human skin needs to be explored more. A good study design with a large sample size in humans must be conducted as visible light and IR rays contribute significantly to photodamage.

Idiopathic guttate hypomelanosis: An overview p. 83 Indrashis Podder, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_17_18 Idiopathic guttate hypomelanosis is a commonly acquired, benign leukoderma characterized by multiple, discrete round or oval, porcelain-white macules on sun-exposed areas, especially the extensor aspect of forearms and shins, sparing the face, neck, and trunk. It usually affects the geriatric population (>50 years); chronic exposure to ultraviolet rays and senile degeneration being the important pathogenic factors. The diagnosis remains essentially clinical, whereas newer confirmatory investigations are emerging. Despite the benign course of progression, many patients seek medical attention owing to cosmetic concerns. Several treatment modalities have been tried over time including topical, physical, and surgical measures, although there is lack of a standard treatment regime. In this article, we have reviewed the different aspects of this

Melasma p. 91 Rupali Dharni, Bhushan Madke, Adarsh L Singh, DOI:10.4103/Pigmentinternational.Pigmentinternational_33_17 Introduction: Melasma is a commonly acquired pigmentary disorder that manifests as symmetric hyperpigmented macules and patches on the face. Aim: To correlate Wood’s lamp and dermatoscopic findings in patients having melasma. Materials and Methods: A total of 80 patients who were clinically diagnosed with melasma were examined under a Wood’s lamp and dermatoscope, and all the findings were recorded and analyzed. Result: The degree of agreement between the Wood’s lamp findings and dermatoscopic findings was found to be substantial as analyzed by kappa statistics with K = 0.813 and P = 0.0001 (significant). Conclusion: Dermatoscopy is advocated globally as a screening and diagnostic procedure for melasma and other pigmentary disorders, especially for earlier therapeutic intervention targeting different stages and mechanisms involved in pathogenesis.

PUVASOL and NBUVB in patients with vitiligo p. 96 Vaaruni Ravishankar, Santoshdev P Rathod, Siddhartha Saikia, Raju G Chaudhary, Rekha B Solanki DOI:10.4103/Pigmentinternational.Pigmentinternational_39_17 Introduction: Vitiligo is an acquired, hypomelanotic disease, characterized by circumscribed depigmented macules. Phototherapy, which is the use of ultraviolet irradiation with or without exogenous photosensitizer is a well established treatment option. Psoralens with sunlight as the source of ultraviolet A-rays is known as PUVASOL. Narrow band Ultraviolet B phototherapy (NBUVB; 311–313 nm) has been introduced over the past decade. Aims: To study the clinical effectiveness and assess the safety of NBUVB and PUVASOL therapy in Vitiligo patients. Methods: The patients were randomly allocated in to two groups containing 25 patients each. Group A patients received NBUVB with an initial dose of 250 mJ/cm2, incremented by 20% with each subsequent visit till optimum dose was achiev

A highly resistant structure between the cuticle and the cortex of human hair. II. ‐ CARB, a penetration barrier

Abstract

Objective

We previously reported that a chemically resistant structure is present at the interface between the cuticle and the cortex of human hair. The goal of this study was to identify the position of that structure and to clarify its barrier ability.

Methods

Untreated, partially and completely decuticled hair fibers were characterized. The correlation between the number of cuticle layers and the penetration depth of a dye into the cortex was microscopically investigated. In addition, similar measurements were performed using hair with a denatured cell membrane complex.

Results

The penetration depth of the dye into the cortex showed no statistically significant correlation with the number of cuticle layers in the case of partially decuticled hair fibers (the number of cuticle layers ranged from 1 to 4). Penetration of the dye proceeded drastically just when the last cuticle layer was lost, but denaturation of the cell membrane complex did not affect the depth of penetration. That suggested that the penetration barrier at the interface between the cuticle and the cortex is not the cell membrane complex, but rather is the resistant structure previously reported. It was observed that a thin layer structure is located beneath the endocuticle of the innermost cuticle cell layer, only in the range where the cuticle borders the cortex. It is thought that this is the structure in question.

Conclusion

These results demonstrate that a highly resistant structure located at the interface between the cuticle and the cortex of human hair acts as a penetration barrier. We propose that structure be named CARB, cuticle anchored resistant base.

This article is protected by copyright. All rights reserved.

https://ift.tt/2LgCIDm

Actinic keratosis in vitiligo after oral PUVAsol therapy with review p. 103 Saumya Sankhwar, Sunil K Gupta DOI:10.4103/Pigmentinternational.Pigmentinternational_2_18 Abstract Vitiligo is an acquired disorder characterised by depigmentation. The etiopathogenesis is still unclear and many theories have been proposed for the same. It is believed that due to lack of protective melanin, a vitiliginous patch is more prone to photodamage by UV radiation and development of skin cancers especially following PUVASOL therapy. But, few cutaneous malignancies have been reported and even fewer cases of actinic keratoses have been reported over a vitiliginous skin. Here, we report a case of elderly female who developed actinic keratoses over longstanding sun exposed vitiliginous skin post PUVA therapy.

Xeroderma pigmentosum complicated by keratoacanthoma in a Kashmiri girl p. 107 Yasmeen J Bhat, Peerzada Sajad, Najmu Saqib, Iffat Hassan, Roohi Wani DOI:10.4103/Pigmentinternational.Pigmentinternational_5_18 Xeroderma pigmentosum is a rare autosomal recessive genetic disorder characterized by defective DNA repair leading to clinical and cellular hypersensitivity to ultraviolet radiation. It manifests clinically as intense cutaneous photosensitivity, acute burning under minimal sun exposure, erythema, xerosis, poikiloderma, actinic keratosis, lentigines, and development of malignant lesions like basal cell carcinoma, squamous cell carcinoma, and melanoma in sun-exposed areas. We hereby report a case of xeroderma pigmentosum complicated by keratoacanthoma in a 9-year-old ethnic Kashmiri girl who had history of photosensitivity, dry skin, and pigmentary changes from the age of 2 years.

Erythema dyschromicum perstans in pregnancy p. 110 Shagufta Rather, Atiya Yaseen, Sameena Batool, Iffat Hassan DOI:10.4103/Pigmentinternational.Pigmentinternational_8_18 Erythema dyschromicum perstans is a slowly progressive acquired dermatoses characterized by macular hyperpigmentation. There is no racial, genetic, or sex predilection. It occurs in adults, with some isolated cases and small series occurring in prepubertal children. The pigmentary disorder has never been reported in patients during pregnancy. We report a singular case of the disorder in a pregnant woman.

Steroid-induced perilymphatic hypopigmentation: Response to tacrolimus p. 114 Sneha Ghunawat, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_11_18 Intralesional steroids are commonly used in dermatological practice. This route of administration has the advantage of minimal side effects. However, other adverse reactions namely local atrophy, ulceration, infections, etc. have been noted. One peculiar side effect following this route of administration “steroid-induced perilymphatic hypopigmentation and atrophy” has been described below. Although this condition repigments spontaneously, the use of tacrolimus to fasten the response has been highlighted in the case report.

Pigment International (Pigment Int) 2018 | July-December | Volume 5 | Issue 2

EDITORIAL
	Lichen planus pigmentosus and frontal fibrosing alopecia: The link explored	p. 73
	Ashraf Raihan, Muthu Sendhil Kumaran DOI:10.4103/Pigmentinternational.Pigmentinternational_19_18   There has been a recent rush of data regarding the combined presentation of lichen planus pigmentosus and frontal fibrosing alopecia in premenoposal women of dark skin. This review article addresses the relationship between the two.
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REVIEW ARTICLES
	Sunscreens: Time to think beyond UV rays	p. 78
	Chitralekha Keisham, Nelson Elangbam, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_15_18   It has been known to us that solar radiation contributes to photoaging. Until recently, it was thought to be due to ultraviolet rays alone. However, a growing number of evidence confirms that visible and infrared (IR) rays also contribute to extrinsic aging. Visible and IR rays account for 50% and 45% of the solar radiation reaching the earth. Ultraviolet A induces retrograde mitochondrial signal, thus leading to induction of matrix metalloproteinase. Ultraviolet B and IRC cause heat-related generation of free radicals and destruction of collagen and elastin. Exposure to visible light induces cytokines, free-radical formation, and pigmentary changes in human skin. The end result of solar radiation is generation of free radicals and ultimately oxidative damage, photoaging, and photocarcinogenesis. The present broad spectrum sunscreen does not provide complete protection of the human skin from oxidative insult. So, a combination of a sun protection factor active component along with an antioxidant is the ideal way of photoprotection. Till date, a number of antioxidants have been tried in human and animals which have shown to be an effective photoprotective agent, though few studies have failed to prove the same. Even with conflicting reports, effect of antioxidants on human skin needs to be explored more. A good study design with a large sample size in humans must be conducted as visible light and IR rays contribute significantly to photodamage.
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	Idiopathic guttate hypomelanosis: An overview	p. 83
	Indrashis Podder, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_17_18   Idiopathic guttate hypomelanosis is a commonly acquired, benign leukoderma characterized by multiple, discrete round or oval, porcelain-white macules on sun-exposed areas, especially the extensor aspect of forearms and shins, sparing the face, neck, and trunk. It usually affects the geriatric population (>50 years); chronic exposure to ultraviolet rays and senile degeneration being the important pathogenic factors. The diagnosis remains essentially clinical, whereas newer confirmatory investigations are emerging. Despite the benign course of progression, many patients seek medical attention owing to cosmetic concerns. Several treatment modalities have been tried over time including topical, physical, and surgical measures, although there is lack of a standard treatment regime. In this article, we have reviewed the different aspects of this condition including treatment, along with the recent updates to create awareness about this dermatological entity.
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ORIGINAL ARTICLES
	Correlation of clinicodermatoscopic and Wood's lamp findings in patients having melasma	p. 91
	Rupali Dharni, Bhushan Madke, Adarsh L Singh,  DOI:10.4103/Pigmentinternational.Pigmentinternational_33_17   Introduction: Melasma is a commonly acquired pigmentary disorder that manifests as symmetric hyperpigmented macules and patches on the face. Aim: To correlate Wood's lamp and dermatoscopic findings in patients having melasma. Materials and Methods: A total of 80 patients who were clinically diagnosed with melasma were examined under a Wood's lamp and dermatoscope, and all the findings were recorded and analyzed. Result: The degree of agreement between the Wood's lamp findings and dermatoscopic findings was found to be substantial as analyzed by kappa statistics with K = 0.813 and P = 0.0001 (significant). Conclusion: Dermatoscopy is advocated globally as a screening and diagnostic procedure for melasma and other pigmentary disorders, especially for earlier therapeutic intervention targeting different stages and mechanisms involved in pathogenesis.
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	A study of comparison of PUVASOL and NBUVB in patients with vitiligo	p. 96
	Vaaruni Ravishankar, Santoshdev P Rathod, Siddhartha Saikia, Raju G Chaudhary, Rekha B Solanki DOI:10.4103/Pigmentinternational.Pigmentinternational_39_17   Introduction: Vitiligo is an acquired, hypomelanotic disease, characterized by circumscribed depigmented macules. Phototherapy, which is the use of ultraviolet irradiation with or without exogenous photosensitizer is a well established treatment option. Psoralens with sunlight as the source of ultraviolet A-rays is known as PUVASOL. Narrow band Ultraviolet B phototherapy (NBUVB; 311–313 nm) has been introduced over the past decade. Aims: To study the clinical effectiveness and assess the safety of NBUVB and PUVASOL therapy in Vitiligo patients. Methods: The patients were randomly allocated in to two groups containing 25 patients each. Group A patients received NBUVB with an initial dose of 250 mJ/cm2, incremented by 20% with each subsequent visit till optimum dose was achieved, twice a week on non-consecutive days. Group B patients received PUVASOL-oral Trimethylpsoralen or topical 0.2% w/w Trioxsalen followed by exposure to sunlight, twice a week on non-consecutive days. The extent of repigmentation was documented at regular intervals upto 6 months. Results: Amongst patients receiving NBUVB and PUVASOL, 56% and 48% had ≥50% repigmentation respectively. Disease was unstable in 48% and 36% of patients prior to commencement of therapy which reduced to 12% and 16% after therapy, respectively. 16% and 36% of the patients experienced side effects and 76% and 48% showed excellent colour match of the repigmented patches respectively. Conclusion: While both PUVASOL and NBUVB are both good therapeutic options; NBUVB therapy is found to be more effective and more cosmetically acceptable, with better colour matching of lesions and minimal adverse effects.
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CASE REPORTS
	Actinic keratosis in vitiligo after oral PUVAsol therapy with review	p. 103
	Saumya Sankhwar, Sunil K Gupta DOI:10.4103/Pigmentinternational.Pigmentinternational_2_18   Abstract Vitiligo is an acquired disorder characterised by depigmentation. The etiopathogenesis is still unclear and many theories have been proposed for the same. It is believed that due to lack of protective melanin, a vitiliginous patch is more prone to photodamage by UV radiation and development of skin cancers especially following PUVASOL therapy. But, few cutaneous malignancies have been reported and even fewer cases of actinic keratoses have been reported over a vitiliginous skin. Here, we report a case of elderly female who developed actinic keratoses over longstanding sun exposed vitiliginous skin post PUVA therapy.
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	Xeroderma pigmentosum complicated by keratoacanthoma in a Kashmiri girl	p. 107
	Yasmeen J Bhat, Peerzada Sajad, Najmu Saqib, Iffat Hassan, Roohi Wani DOI:10.4103/Pigmentinternational.Pigmentinternational_5_18   Xeroderma pigmentosum is a rare autosomal recessive genetic disorder characterized by defective DNA repair leading to clinical and cellular hypersensitivity to ultraviolet radiation. It manifests clinically as intense cutaneous photosensitivity, acute burning under minimal sun exposure, erythema, xerosis, poikiloderma, actinic keratosis, lentigines, and development of malignant lesions like basal cell carcinoma, squamous cell carcinoma, and melanoma in sun-exposed areas. We hereby report a case of xeroderma pigmentosum complicated by keratoacanthoma in a 9-year-old ethnic Kashmiri girl who had history of photosensitivity, dry skin, and pigmentary changes from the age of 2 years.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	Erythema dyschromicum perstans in pregnancy	p. 110
	Shagufta Rather, Atiya Yaseen, Sameena Batool, Iffat Hassan DOI:10.4103/Pigmentinternational.Pigmentinternational_8_18   Erythema dyschromicum perstans is a slowly progressive acquired dermatoses characterized by macular hyperpigmentation. There is no racial, genetic, or sex predilection. It occurs in adults, with some isolated cases and small series occurring in prepubertal children. The pigmentary disorder has never been reported in patients during pregnancy. We report a singular case of the disorder in a pregnant woman.
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	Steroid-induced perilymphatic hypopigmentation: Response to tacrolimus	p. 114
	Sneha Ghunawat, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_11_18   Intralesional steroids are commonly used in dermatological practice. This route of administration has the advantage of minimal side effects. However, other adverse reactions namely local atrophy, ulceration, infections, etc. have been noted. One peculiar side effect following this route of administration "steroid-induced perilymphatic hypopigmentation and atrophy" has been described below. Although this condition repigments spontaneously, the use of tacrolimus to fasten the response has been highlighted in the case report.
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LETTER TO EDITOR
	Dermoscopy − Master by analysis and patience, not haste and nonchalance	p. 117
	Sidharth Sonthalia, Abhijeet K Jha, Manal Bosseila, Enzo Errichetti DOI:10.4103/Pigmentinternational.Pigmentinternational_38_17
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THE CLINICAL PICTURE
	Bilateral nevus of Ota	p. 120
	M. M. Aarif Syed, Bibush Amatya, Shazia Alam DOI:10.4103/Pigmentinternational.Pigmentinternational_1_18
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THROUGH THE DERMOSCOPE
	Dermoscopy of pigmented basal cell carcinoma	p. 123
	Kinjal D Rambhia, Vrutika H Shah, Rajesh P Singh DOI:10.4103/Pigmentinternational.Pigmentinternational_13_18
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CURRENT BEST EVIDENCE
	Current Best Evidence in Pigmentary Dermatology	p. 125
	Divya Kamat, Vinay Keshavamurthy DOI:10.4103/Pigmentinternational.Pigmentinternational_22_18
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CROSSWORD
	PIGMENTCROSS 4	p. 130
	Ashish Amrani, Anupam Das DOI:10.4103/Pigmentinternational.Pigmentinternational_24_18
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