The Transpetrosal Approaches System in Posterior Fossa Meningiomas Surgery: Rationale and Results

Abstract

Purpose of Review

This is a retrospective review of 90 patients with a posterior fossa meningioma (PFM) treated between 1996 and 2017 in our two tertiary skull base centers. Patients underwent surgical resection via different approaches. We aimed to show how different surgical approaches may help to reach gross total resection (GTR) and low morbidity, especially on facial nerve function.

Recent Findings

PFM is a real surgical challenge with high morbidity and mortality due to the surrounding structures, their common large size at diagnosis, and their potentially invasive behavior. Total resection is the only way to cure people affected. We successfully treated 90 cases of PFM and evaluated different surgical approaches.

Summary

GTR is the aim of the surgery as the extent of resection influences the rate of recurrence, which in turn influences the prognosis. Seventy percent (p < 0.001) of surgical patients achieved a GRT with low morbidity and no mortality.

http://bit.ly/2Bc6yFm

A randomized, open, controlled trial of tretinoin 0.05% cream vs. low‐dose oral isotretinoin for the treatment of field cancerization

Abstract

Background

Sun exposure may lead to actinic keratoses (AKs), field cancerization, and skin cancer. Effective treatment of AKs and field cancerization is important. Oral and topical retinoids can be used for this purpose. To compare clinical, histological, and immunohistochemical effects of oral and topical retinoid for AKs and field cancerization on face and upper limbs of immunocompetent patients, as well as the impact on quality of life, safety, and tolerability.

Methods

This study compared 10 mg/day oral isotretinoin (ISO) to 0.05% tretinoin cream (TRE) every other night, associated with sunscreen (SPF 60). Patients of both genders, aged 50–75 years, underwent cryotherapy with liquid nitrogen for AKs at baseline and after 120 days when they were randomized into two groups, TRE (n = 31) and ISO (n = 30), for 6 months. Outcome measures were: number of AKs, histological (thickness of stratum corneum and epithelium) and immunohistochemical parameters (p53, Bcl‐2 and Bax), dermatology life quality index (DLQI), and adverse events.

Results

Both treatments reduced the number of AKs (around 28%), the thickness of stratum corneum, and expression of p53 and Bax. By contrast, the epithelium thickness and Bcl‐2 expression increased. There was no difference in the outcomes between TRE and ISO. Both treatments improved quality of life and were well tolerated with minimal side effects.

Conclusions

Retinoids are effective and safe for field cancerization. Classical treatments for field cancerization (imiquimod and ingenol mebutate) are used for a short period; retinoids may be a good choice to intercalate with them and can be used continuously.

http://bit.ly/2WzgrG4

Transgenic versus conventional corn: fate of fumonisins during industrial dry milling

Abstract

The aim of this study was to compare the fate of fumonisins in transgenic and non-transgenic corn during industrial dry milling. For this purpose, whole corn samples and their fractions (germ, pericarp, endosperm, corn meal, and grits) were collected from one of the major Brazilian milling plants, totaling 480 samples. There was no significant difference (p > 0.05) between mean fumonisin (FB₁ + FB₂) levels in transgenic (1130 μg/kg) and non-transgenic (920 μg/kg) whole corn. However, in non-transgenic germ, endosperm and corn meal fraction fumonisin levels were higher (2940 μg/kg, 250 μg/kg and 190 μg/kg, respectively) than in transgenic fractions (2180 μg/kg, 130 μg/kg and 85.0 μg/kg, respectively). Furthermore, the highest percentages of fumonisins were distributed in the germ, corresponding to about 87 and 76% of the total fumonisins present in the whole corn from non-transgenic and transgenic hybrids, respectively. Concerning the endosperm from non-transgenic and transgenic corn, approximately, 23% and 13% of the total fumonisins were retained after the dry milling. Further processing in corn meal (300 to 420 μm particle size) and grits (590 to 1190 μm) decreased the percentages of remaining fumonisins to 4% and 2% (transgenic) and 10% and 3% (non-transgenic corn), respectively. These results suggested that fumonisin concentration was higher in outer and inner non-transgenic fractions when compared to transgenic ones and that the fate of fumonisins during the industrial dry milling could be affected by the transgenic status. However, it was not possible to conclude that the difference was exclusively due to this variable.

http://bit.ly/2SgBT3s

First report of Fusarium foetens as a mycotoxin producer

Abstract

Fusarium foetens, a pathogen of Begonia plants, has been recently described as a new fungal species. This Fusarium species causes a destructive vascular wilt disease which leads to the death of the plant. Moreover, Fusarium species are known to produce a huge variety of secondary metabolites such as mycotoxins and phytotoxins. Here, we studied the toxicogenic profile of one F. foetens strain, isolated from maize, employing two methods based on the use of ultra-performance liquid chromatography coupled to mass spectrometry-ion trap-time of flight detection. The mycotoxins beauvericin and fusaric acid were detected in a pure culture of F. foetens. In addition, four fusaric acid analogs (10,11-dihidroxyfusaric acid, hydroxyfusaric acid, dehydrofusaric acid, and a hydroxylated unsaturated fusaric acid analog) were tentatively identified on the basis of their accurate mass and fragmentation patterns. Therefore, these preliminary data indicate that F. foetens isolated from maize is able to produce Fusarium mycotoxins including beauvericin and fusaric acid.

http://bit.ly/2GeP2U6

Severe case of pneumonia with pleural effusion in an immunocompromised woman due to Fusobacterium necrophorum

Infections caused by fusobacteria have a wide clinical spectrum, and in certain patients, they can lead to severe systemic illness. We report the case of an immunocompromised young woman who presented with severe pneumonia complicated by parapneumonic pleural effusion, despite wide-spectrum antibiotic treatment. Fusobacterium necrophorum was isolated in the samples obtained after thoracentesis was performed. Apart from the pulmonary involvement, we could not identify the infectious focus, since the patient did not have poor dentition or Lemierre's syndrome. After an extended antibiotic regimen and placement of a chest tube, the patient fully recovered and was able to be discharged.

http://bit.ly/2t0VQga

Complete resolution of erythrodermic psoriasis with first-line apremilast monotherapy

Erythrodermic psoriasis (EP) is the most serious type of psoriasis with high morbidity and mortality. First-line recommended therapies for EP, cyclosporine and infliximab have significant adverse effects. Cyclosporine increases the risk of hypertension, leucopenia, infections and renal failure. Infliximab increases the risk of reactivation of tuberculosis, hepatitis B and histoplasmosis, and increases risk for hepatitis, autoantibody formation, congestive heart failure, demyelinating disorders, pancytopenia, lymphoma and skin cancer. An effective drug with a much safer side effect profile will be of significant benefit in EP. The phosphodiesterase 4 inhibitor apremilast is U.S Food and Drug Administration (FDA) approved for plaque psoriasis and psoriatic arthritis. Adverse effects of apremilast reported are headache, nausea, diarrhoea, upper respiratory tract infection, potential for depression and weight loss. We report complete and long-standing resolution of EP with first-line apremilast monotherapy. Apremilast may be an effective option with comparatively minor side effects for EP.

http://bit.ly/2HHaaVm

Ectopic varices masquerading as lower gastrointestinal bleeding

A middle-aged woman previously in good health arrived to hospital with severe haemorrhagic shock. An abdominal and pelvic CT scan showed hepatomegaly, fluid in the sigmoid colon, perigastric and right sided pelvic varices without a clear source of bleeding. Urgent esophagogastroduodenoscopy excluded gastric varices and active upper gastrointestinal bleeding and the colonoscopy was inconclusive due to haemodynamic instability and massive bleeding which made it impossible to proceed with a full colonoscopy. An explorative laparotomy identified liver cirrhosis and bleeding from varices of the right fallopian tube which had formed a fistula with the caecum. A right hemicolectomy with a side to side anastomosis and a right sided salpingo-oophorectomy were carried out. The patient was thereafter transferred to the intensive care unit intubated, requiring massive fluid resuscitation and high doses of vasoactive agents. Nine days after hospital admission she was transferred to the surgical ward and followed up by a hepatologist.

http://bit.ly/2t1RfKR

Adipsic diabetes insipidus secondary to craniopharyngioma resection

Adipsic diabetes insipidus is an infrequent disease which may be associated with craniopharyngioma. It may be secondary to the tumour's extension, as well as to resection of the mass. We present the case of a 24-year-old woman with a history of delayed puberty and hypothyroidism, but no prior study reports. She consulted due to a headache with warning signs associated with altered visual acuity. Brain MRI was performed which showed signs of a non-adenomatous lesion with suprasellar and hypothalamic extension. Following transcranial surgery, she developed diabetes insipidus criteria, with absence of thirst documented during the hospitalisation. The histopathological findings confirmed the diagnosis of craniopharyngioma. The patient was treated with desmopressin and received recommendations regarding rehydration according to the quantification of losses, with electrolyte stabilisation.

http://bit.ly/2HLvo4t

Rare cause of lung atelectasis in a young woman

Pulmonary mucoepidermoid carcinoma is an extremely rare intrathoracic malignancy, comprising less than 1% of all lung tumours. These are very slow growing and are classified into low grade and high grade based on histological features. Surgical resection is the primary treatment with excellent outcomes, while chemotherapy or radiotherapy effectiveness is not known. Preoperative fluorine-18 fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) is useful for predicting tumour grade and postsurgical prognosis.

A clinical case of a 31-year-old woman who presented with dyspnoea on exertion, cough and wheezing is reported. Imaging studies revealed a mass involving the left lower lobe bronchus and atelectasis. 18F-FDG PET/CT showed uptake in the described mass with a maximum standardised uptake value of 9.7. Complete surgical resection was performed, and pathological examination revealed a high-grade mucoepidermoid carcinoma with tumour-free margins. Adjuvant chemotherapy was given and there is no evidence of tumour recurrence.

http://bit.ly/2HICtmd

Stickler syndrome: a possible presentation of Pierre Robin sequence

http://bit.ly/2t0VOF4

Long-lasting response to afatinib that persisted after treatment discontinuation in a case of EGFR-mutated lung adenocarcinoma

It is unknown whether tyrosine kinase inhibitors targeting epidermal growth factor receptor (EGFR) can be discontinued in patients in whom EGFR-mutated lung cancer has well stabilised. We present a case of a 73-year-old Japanese woman with no history of smoking. Right pulmonary lower lobectomy, lymph node dissection and segmental resection of the right middle lobe were performed. Additionally, she underwent adjuvant chemotherapy for stage IIIB adenocarcinoma harbouring an EGFR exon 19 deletion. Afatinib was administered for liver metastases after 15 months. A complete response of metastatic disease was achieved for 2 years. However, afatinib was unavoidably discontinued due to splenectomy for the treatment of idiopathic thrombocytopenic purpura. Although afatinib was not resumed, due to the abscess formation as surgery complication, a drug-free complete response was sustained for over 18 months. The present case suggests that exceptional and durable responses to afatinib can be achieved in individual cases.

http://bit.ly/2HK9YEY

Seizure in infancy: not the usual suspect

http://bit.ly/2sWcAVW

'Never say never: the first successful management of a type A aortic dissection in Liberia

The West African country of Liberia ranks as one of the lowest in the world in most measures of health. The diagnosis and management of complex surgical cases such as aortic dissection is extremely challenging, for reasons ranging from lack of diagnostic imaging capabilities to the high resources required for definitive surgical intervention. We present the first known successfully managed case of aortic dissection in the country's history and with it highlight the challenges faced and a number of lessons learned that are beneficial to anyone working in resource-limited environments.

http://bit.ly/2HEE7W2

What's new in atopic eczema? An analysis of systematic reviews published in 2016. Part 1: treatment and prevention

Summary

This review is part of a series of annual updates summarizing the evidence base for atopic eczema (AE). It provides a summary of key findings from 28 systematic reviews that were published or indexed during 2016 with a focus on treatment and prevention of AE. There is reasonable evidence of benefit for topical corticosteroids, calcineurin inhibitors, a glycyrrhetinic acid‐containing preparation (Atopiclair^®), oral ciclosporin, oral azathioprine, narrowband ultraviolet B radiation and education programmes. Overall, there is evidence that topical corticosteroids and calcineurin inhibitors have similar efficacy and that both can prevent AE flares when used twice weekly as maintenance therapy. However, topical calcineurin inhibitors are costlier and have more adverse reactions, thus topical corticosteroids should remain the standard of care for patients with AE. There is no evidence that multiple applications are better than once‐daily application of topical corticosteroid. There is inconsistent evidence to support omalizumab and specific allergen immunotherapy use in AE. There is some evidence that vitamin D supplementation and synbiotics reduce AE severity, although the margin of improvement may not be clinically meaningful. There is little evidence to support the use of wet wraps or of complementary/alternative medicine (including Chinese herbal medicine). There is some evidence to suggest that a diet high in fish in infancy may be preventative for AE, but other dietary interventions for the prevention of AE show little promise. This review provides a succinct guide for clinicians and patients wishing to remain up to date with the latest evidence for the treatment and prevention of AE.

http://bit.ly/2UBunO9

What's new in atopic eczema? An analysis of systematic reviews published in 2016. Part 2: Epidemiology, aetiology and risk factors

Summary

This review forms part of a series of annual updates that summarize the evidence base for atopic eczema (AE), providing a succinct guide for clinicians and patients. It presents the key findings from 14 systematic reviews published in 2016, focusing on AE epidemiology, aetiology and risk factors. For systematic reviews on the treatment and prevention of AE and for nomenclature and outcome assessments, see Parts 1 and 3 of this update, respectively. The annual self‐reported prevalence of AE is a range of 11.4–24.2%, compared with a general practioner‐diagnosed prevalence of 1.8–9.5%. The mean age of AE diagnosis is 1.6 years. Persistent AE is associated with more severe disease at the time of diagnosis, onset after the age of 2 years and female sex. There is a significant association between having AE and subsequent development of food allergy. Food allergy is also associated with more severe and persistent AE. No consistent association was found between the timing of allergenic food introduction and the risk of developing AE. Evidence from heterogeneous studies indicates that skin absorption is increased in patients with AE, and that there is increased colonization with Staphylococcus aureus in lesional and nonlesional skin and the nasal mucosa of patients with AE compared with controls. There is uncertain evidence indicating an association between AE and smoking exposure, antenatal infection and low maternal vitamin D levels during pregnancy. Weak evidence suggests an increased risk of basal cell carcinoma, but not of melanoma or squamous cell carcinoma, while the risk of glioma is reduced.

http://bit.ly/2RZXg9z

What's new in atopic eczema? An analysis of systematic reviews published in 2016. Part 1: treatment and prevention

Summary

This review is part of a series of annual updates summarizing the evidence base for atopic eczema (AE). It provides a summary of key findings from 28 systematic reviews that were published or indexed during 2016 with a focus on treatment and prevention of AE. There is reasonable evidence of benefit for topical corticosteroids, calcineurin inhibitors, a glycyrrhetinic acid‐containing preparation (Atopiclair^®), oral ciclosporin, oral azathioprine, narrowband ultraviolet B radiation and education programmes. Overall, there is evidence that topical corticosteroids and calcineurin inhibitors have similar efficacy and that both can prevent AE flares when used twice weekly as maintenance therapy. However, topical calcineurin inhibitors are costlier and have more adverse reactions, thus topical corticosteroids should remain the standard of care for patients with AE. There is no evidence that multiple applications are better than once‐daily application of topical corticosteroid. There is inconsistent evidence to support omalizumab and specific allergen immunotherapy use in AE. There is some evidence that vitamin D supplementation and synbiotics reduce AE severity, although the margin of improvement may not be clinically meaningful. There is little evidence to support the use of wet wraps or of complementary/alternative medicine (including Chinese herbal medicine). There is some evidence to suggest that a diet high in fish in infancy may be preventative for AE, but other dietary interventions for the prevention of AE show little promise. This review provides a succinct guide for clinicians and patients wishing to remain up to date with the latest evidence for the treatment and prevention of AE.

http://bit.ly/2UBunO9

What's new in atopic eczema? An analysis of systematic reviews published in 2016. Part 2: Epidemiology, aetiology and risk factors

Summary

This review forms part of a series of annual updates that summarize the evidence base for atopic eczema (AE), providing a succinct guide for clinicians and patients. It presents the key findings from 14 systematic reviews published in 2016, focusing on AE epidemiology, aetiology and risk factors. For systematic reviews on the treatment and prevention of AE and for nomenclature and outcome assessments, see Parts 1 and 3 of this update, respectively. The annual self‐reported prevalence of AE is a range of 11.4–24.2%, compared with a general practioner‐diagnosed prevalence of 1.8–9.5%. The mean age of AE diagnosis is 1.6 years. Persistent AE is associated with more severe disease at the time of diagnosis, onset after the age of 2 years and female sex. There is a significant association between having AE and subsequent development of food allergy. Food allergy is also associated with more severe and persistent AE. No consistent association was found between the timing of allergenic food introduction and the risk of developing AE. Evidence from heterogeneous studies indicates that skin absorption is increased in patients with AE, and that there is increased colonization with Staphylococcus aureus in lesional and nonlesional skin and the nasal mucosa of patients with AE compared with controls. There is uncertain evidence indicating an association between AE and smoking exposure, antenatal infection and low maternal vitamin D levels during pregnancy. Weak evidence suggests an increased risk of basal cell carcinoma, but not of melanoma or squamous cell carcinoma, while the risk of glioma is reduced.

http://bit.ly/2RZXg9z

Occurrence, speciation, and risks of trace metals in soils of greenhouse vegetable production from the vicinity of industrial areas in the Yangtze River Delta, China

Abstract

The effect of industrial activities on trace metals in farmland of rapidly industrializing regions in developing countries has increasingly been a concern to the public. Here, soils were collected from 13 greenhouse vegetable production (GVP) farms or bases near industrial areas in the Yangtze River Delta of China to investigate the occurrence, speciation, and risks of Cr, Cu, Zn, Cd, Ni, and Pb in GVP soil. The results revealed that the main metal elements causing GVP soil pollution were Cd, Zn, Ni, and Cu, of which contamination levels were generally unpolluted to moderately polluted. Zinc pollution was mainly attributed to heavy fertilization, while Cd, Ni, and Cu pollution may be greatly ascribed to industrial effluents and coal combustion. Metal speciation studies showed that most of Cr, Ni, Cu, and Zn was present in residual fraction while more than half of Cd and Pb was present in non-residual fractions. Additionally, pollution of Cd, Cu, Ni, and Zn in GVP soil increased their corresponding mobile fractions. Risk assessment using potential ecological risk index and risk assessment code showed that Cd was the major risk contributor. Specifically, Cd generally posed moderate or considerable ecological risk as well as displayed medium or high mobility risk in GVP soil. Thus, great attention should be paid to the contribution of both industrial discharges and intensive farming to soil pollution by trace metals, especially Cd, because of its high mobility risk.

http://bit.ly/2HJyh5Z

Techno-economic assessment of coconut biodiesel as a potential alternative fuel for compression ignition engines

Abstract

Over the past years, there were dramatic improvements in identifying and assessing various feedstocks for the production of biodiesel fuels. To promote a particular feedstock as a renewable source of energy, it is important to analyze their energy, economic, and engine performance characteristics. The current work attempts to evaluate the net energy and economic indices for both fossil diesel and coconut-blended diesel (B20) considering the diesel consumption by the Indian railways. Further, we present the experimental results of a multi-cylinder diesel engine operated with neat coconut biodiesel (B100) and fossil diesel at various load and speed conditions. The engine experiments reveal that the coconut biodiesel exhibits leaner combustion and shorter ignition delay than fossil diesel. Lower amount of carbon monoxide, hydrocarbon, and smoke emission is observed in the case of coconut biodiesel, with higher levels of nitric oxide (14%) and fuel consumption than diesel. The coefficient of variation in indicated mean effective pressure is within the range of better driveability zone for both the fuels at all test conditions. Overall the engine performance, emission and combustion results with neat coconut biodiesel are favorable with a penalty in NO emission at high load conditions. The techno-economical study highlights higher production cost per liter of B20 than the cost of fossil diesel. However, the net energy ratio (NER) for B20 is 1.021, favoring higher output than diesel and thus lowers the dependency on crude oil.

http://bit.ly/2sYbTLF

Biodegradation of anthracene and different PAHs by a yellow laccase from Leucoagaricus gongylophorus

Abstract

Laccases produced by Leucoagaricus gongylophorus act in lignocellulose degradation and detoxification processes. Therefore, the use of L. gongylophorus laccase (Lac1Lg) was proposed in this work for degradation of anthracene and others polycyclic aromatic hydrocarbons without the use of mediators. Degradation reactions were performed in buffer aqueous solution with 10 ppm of anthracene and other PAHs, Tween-20 in 0.25% v/v and a laccase preparation of 50 U. The optimum condition (pH 6.0 and 30 °C) was determined by response surface methodology with an excellent coefficient of determination (R²) of 0.97 and an adjusted coefficient of determination (R²_adj) of 0.93. In addition, the employment of the mediator ABTS decreased the anthracene biodegradation from 44 ± 1% to 30 ± 1%. This optimum pH of 6.0 suggests that the reaction occurs by a hydrogen atom transfer mechanism. Additionally, in 24 h Lac1Lg biodegraded 72 ± 1% anthracene, 40 ± 3% fluorene and 25 ± 3% phenanthrene. The yellow laccase from L. gongylophorus biodegraded anthracene and produced anthrone and anthraquinone, which are interesting compounds for industrial applications. Moreover, this enzyme also biodegraded the PAHs phenanthrene and fluorene justifying the study of Lac1Lg for bioremediation of these compounds in the environment.

http://bit.ly/2HJyczd

Quality and potency profile of eight recombinant isoallergens, largely mimicking total Bet v 1‐specific IgE binding of birch pollen

Abstract

Background

To date only limited information on structure, expression levels and IgE binding of Bet v 1 variants, which are simultaneously expressed in birch pollen, is available.

Objective

To analyze and compare structure and serum IgE/IgG binding of rBet v 1 variants to Bet v 1.0101.

Methods

Recombinant Bet v 1 variants were studied with sera of 20 subjects allergic to birch pollen. Folding, aggregation and solubility of the rBet v 1 variants was analyzed to attribute diverging IgE binding to either allergen structure or methodological features. IgE/IgG binding was studied with rBet v 1 in solution or adsorbed to solid phases. Allergen‐mediated crosslinking of FcεRI receptors was determined by mediator release of sensitized humanized rat basophil leukemia cells.

Results

All variants, except for rBet v 1.0113, were monomeric and had Bet v 1‐type conformation. Serum IgE binding to variants adsorbed to solid phase was reduced to 6.6% ‐ 36.5% compared with Bet v 1.0101. In contrast, inhibition of IgE binding to Bet v 1.0101 by rBet v 1 variants ranged from 62% ‐ 83%. Similarly, mediator release ranged from 30.7% ‐ 55.2% for all variants and was only clearly reduced for rBet v 1.0301 (10.4%). The IgE binding potency of rBet v 1 variants representing their native quantities in birch pollen was only slightly lower compared to extract. IgG binding to variants was between 50.9% ‐ 134.5% compared with rBet v 1.0101 (100%).

Conclusion and clinical relevance

Bet v 1 variants previously classified as hypoallergenic can exhibit similar functional IgE binding as Bet v 1.0101. Eight rBet v 1 variants largely reproduce total Bet v 1‐specific IgE binding of birch pollen extracts. Assay format dependent variation of IgE binding properties needs to be considered in the development of diagnostic or therapeutic products.

This article is protected by copyright. All rights reserved.

http://bit.ly/2G1Utqk

Anatomical Study of a Chimeric Fascio-Osteomyocutaneous Fibula Flap for Free Microvascular Tissue Transfer

J reconstr Microsurg
DOI: 10.1055/s-0039-1677769

Background Functional restoration in reconstructive surgery can require complex and adaptable approaches. In this anatomical study, the combined angiosome of the septofasciomyocutaneous vessels originating from the fibular artery was defined as basis for a chimeric flap of the lateral lower leg. Methods Methylene blue injection into the fibular artery was performed in 10 legs of fresh cadavers for visualization of the angiosome on the skin, fibula, and adjacent muscles as the lateral hemisoleus (HS) muscle. With regards to clinical specifications a maximum-size flap containing cutaneous, osseous, and muscular elements was raised. During dissection, the distribution pattern, number and size of stained septofasciomyocutaneous vessels at the lateral border of the proximal, middle, and distal thirds of the fibula length, as well as the flap dimensions were evaluated. Results In all specimens, vessels originating from the fibular artery and supplying the resected fibular bone, the fasciocutaneous flap and dorsally located muscles were found. The mean number of vessels to the skin was 4.2 per leg with a mean diameter of 1.1 ± 0.5 mm (range: 0.4–2.5 mm) and to the HS muscle 3.4 vessels with a mean diameter of 1.2 ± 0.7 mm (range: 0.3–3.0 mm). A total of 88.4% vessels occurred in the proximal and middle thirds of the legs. The resected fibula graft had a mean length of 23.8 ± 3.9 cm (range: 19.9–31.0 cm) and the skin paddle had a mean size of 23.8 ± 3.9 cm (range: 19.9–31.0 cm) × 7.0 cm. The flexor hallucis longus (FHL) muscle had a mean volume of 37.2 ± 15.8 cm3 (range: 18–58 cm3) and the lateral HS muscle 77.1 ± 23.3 cm3 (range: 48–105 cm3). Conclusion Our results and anatomical descriptions indicate that chimeric fibula flaps can meet the specific reconstructional requirements of complex and large sized defects representing a promising basis for further studies.
[...]

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http://bit.ly/2DMqUXn

Tenosynovial Giant Cell Tumours of the Hand: A Multicentre Case Control Study

Many factors have been proposed to contribute to the risk of recurrent TSGCT (Tenosynovial Giant Cell Tumours); however, we remain unable to predict those at risk which formed the rationale for this multicentre retrospective case control study of 28 patients with recurrence. We age and sex matched cases of recurrence 1:1 with controls over 10 years. Using Cox regression, we present hazard ratios (HR) for recurrence with 95% confidence intervals (CI). Out of 285 cases, 28 individuals developed recurrence after a median 2.4 years.

http://bit.ly/2RZAAq8

Socio‐demographic factors do not have a large influence on psoriasis patients’ adherence to topical treatment

Abstract

Topical drugs containing corticosteroids are the most frequently used treatments for mild‐to‐moderate psoriasis, but adherence rates to topical drugs are low and up to 80% of psoriasis patients are classified as non‐adherent, which present a barrier to treatment success.³ Barriers to treatment adherence can be divided into socio‐demographic, healthcare, disease, treatment, and patient‐related factors. In a prospective study by Zaghloul et al., adherence to unspecified topical and systemic antipsoriatic drugs was investigated by counting pills or weighing medication bottles; lower adherence was associated with being single, male, or unemployed.

This article is protected by copyright. All rights reserved.

http://bit.ly/2sX8ehr

Hypoxia Improves Hair Inductivity of Dermal Papilla Cells via Nuclear NADPH Oxidase 4‐Mediated Reactive Oxygen Species Generation

Summary

Background

Dermal papilla cells (DPCs) play a key role in hair regeneration and morphogenesis. Therefore, tremendous efforts have been made to promote DPCsʼ hair inductivity

Objectives

The aim of this study was to investigate the mitogenic and hair inductive effects of hypoxia on DPCs and examine the underlying mechanism of hypoxia‐induced stimulation of DPCs.

Results

Hypoxia significantly increased the proliferation and delayed the senescence of DPCs via Akt phosphorylation and downstream pathways. Hypoxia upregulated the growth factor secretion of DPCs through mitogen‐activated protein kinase pathway. Hypoxia‐preconditioned DPCs induced the telogen‐to‐anagen transition in C₃H mice, and also enhanced hair neogenesis in a hair reconstitution assay. Injected GFP‐labeled DPCs migrated to outer‐root sheath of hair follicle, and hypoxia‐preconditioning increased the survival and migration of DPCs in vivo. Conditioned medium obtained from hypoxia increased the hair length of mouse vibrissa follicles via upregulation of alkaline phosphatase, vascular endothelial growth factor, and glial cell line‐derived neurotrophic factor. We examined the mechanism of this hypoxia‐induced stimulation, and found that reactive oxygen species (ROS) play a key role. For example, inhibiting of ROS generation by N‐acetyl‐L‐cysteine or diphenyleneiodonium treatment attenuated DPCsʼ hypoxia‐induced stimulation, but treatment with ROS donors induced mitogenic effects and anagen transition. NADPH oxidase 4 (NOX4) is highly expressed in DPCsʼ nuclear region, and NOX4 knockout by CRISPR‐Cas9 attenuated the hypoxia‐induced stimulation of DPCs.

Conclusions

Our results suggest that DPC culture under hypoxia has great advantages over normoxia, and is a novel solution for producing DPCs for cell therapy.

This article is protected by copyright. All rights reserved.

http://bit.ly/2MHiOSB

Recommendation to include hydroxyethyl (meth)acrylate in the British Baseline Patch Test Series

Summary

Background

(Meth)acrylates are potent sensitisers and a common cause of allergic contact dermatitis (ACD). The frequency of (meth)acrylate ACD has increased with soaring demand for acrylic nails. A preliminary audit has suggested a significant rate of positive patch tests to (meth)acrylates using aimed testing in patients providing a clear history of exposure. (Meth)acrylates have to date not been routinely tested in the baseline patch test series in the U.K. and Europe.

Objectives

To determine whether inclusion of 2‐hydroxyethyl methacrylate (2‐HEMA) 2% in petrolatum (pet.) in the baseline series detects cases of treatable (meth)acrylate ACD.

Methods

During 2016‐2017, 15 U.K. dermatology centres included 2‐HEMA in the extended baseline patch test series. Patients with a history of (meth)acrylate exposure, or who tested positive to 2‐HEMA, were selectively tested with a short series of eight (meth)acrylate allergens.

Results

5,920 patients were consecutively patch tested with the baseline series, of whom 669 were also tested to the (meth)acrylate series. 102 of 5,920 (1·7%) tested positive to 2‐HEMA and 140 (2·4%) to at least one (meth)acrylate. Had 2‐HEMA been excluded from the baseline series, (meth)acrylate allergy would have been missed in 36 of 5,920 (0·6% of all patients). The top (meth)acrylates eliciting a positive reaction were 2‐HEMA (n=102; 1·7%), 2‐hydroxypropyl methacrylate (n=61; 1%) and 2‐hydroxyethyl acrylate (n=57; 1%).

Conclusions

We recommend that 2‐HEMA 2% pet. be added to the British baseline patch test series. We also suggest a standardised short (meth)acrylate series which is likely to detect most cases of (meth)acrylate allergy.

This article is protected by copyright. All rights reserved.

http://bit.ly/2MHj9ER

Decreased 5‐hydroxymethylcytosine immunoreactivity in primary Merkel cell carcinomas is a strong predictor for disease‐specific death

Abstract

Merkel cell carcinoma (MCC) is an infrequent malignant skin tumour with epithelial and neuroendocrine differentiation. Though it is a highly aggressive malignancy, the distinct molecular pathogenesis of MCC is not yet fully understood. Apart from DNA methylation, histone modification, and microRNA‐mediated and long non‐coding RNA‐mediated regulation, hydroxymethylation may also play an important role in cancer development. Loss of 5‐hydoxymethylcytosine (5‐hmc) has been reported in a variety of cancers, including skin malignancies such as melanoma.

This article is protected by copyright. All rights reserved.

http://bit.ly/2sX889z

A Reliability Study Using Network Oriented Research Assistant (NORA®) Examining the Use of Digital Photographs in the Assessment of Psoriasis

Abstract

Psoriasis is a chronic immune‐modulated condition affecting approximately 2‐3% of the general population. In addition to cutaneous lesions, psoriasis is associated with systemic and mental health co‐morbidities. Psoriasis is among the most extensively researched dermatologic conditions, with many novel treatment options in the drug development pipeline.

This article is protected by copyright. All rights reserved.

http://bit.ly/2MJbOov

Hypoxia Improves Hair Inductivity of Dermal Papilla Cells via Nuclear NADPH Oxidase 4‐Mediated Reactive Oxygen Species Generation

Summary

Background

Dermal papilla cells (DPCs) play a key role in hair regeneration and morphogenesis. Therefore, tremendous efforts have been made to promote DPCsʼ hair inductivity

Objectives

The aim of this study was to investigate the mitogenic and hair inductive effects of hypoxia on DPCs and examine the underlying mechanism of hypoxia‐induced stimulation of DPCs.

Results

Hypoxia significantly increased the proliferation and delayed the senescence of DPCs via Akt phosphorylation and downstream pathways. Hypoxia upregulated the growth factor secretion of DPCs through mitogen‐activated protein kinase pathway. Hypoxia‐preconditioned DPCs induced the telogen‐to‐anagen transition in C₃H mice, and also enhanced hair neogenesis in a hair reconstitution assay. Injected GFP‐labeled DPCs migrated to outer‐root sheath of hair follicle, and hypoxia‐preconditioning increased the survival and migration of DPCs in vivo. Conditioned medium obtained from hypoxia increased the hair length of mouse vibrissa follicles via upregulation of alkaline phosphatase, vascular endothelial growth factor, and glial cell line‐derived neurotrophic factor. We examined the mechanism of this hypoxia‐induced stimulation, and found that reactive oxygen species (ROS) play a key role. For example, inhibiting of ROS generation by N‐acetyl‐L‐cysteine or diphenyleneiodonium treatment attenuated DPCsʼ hypoxia‐induced stimulation, but treatment with ROS donors induced mitogenic effects and anagen transition. NADPH oxidase 4 (NOX4) is highly expressed in DPCsʼ nuclear region, and NOX4 knockout by CRISPR‐Cas9 attenuated the hypoxia‐induced stimulation of DPCs.

Conclusions

Our results suggest that DPC culture under hypoxia has great advantages over normoxia, and is a novel solution for producing DPCs for cell therapy.

This article is protected by copyright. All rights reserved.

http://bit.ly/2MHiOSB

Socio‐demographic factors do not have a large influence on psoriasis patients’ adherence to topical treatment

Abstract

Topical drugs containing corticosteroids are the most frequently used treatments for mild‐to‐moderate psoriasis, but adherence rates to topical drugs are low and up to 80% of psoriasis patients are classified as non‐adherent, which present a barrier to treatment success.³ Barriers to treatment adherence can be divided into socio‐demographic, healthcare, disease, treatment, and patient‐related factors. In a prospective study by Zaghloul et al., adherence to unspecified topical and systemic antipsoriatic drugs was investigated by counting pills or weighing medication bottles; lower adherence was associated with being single, male, or unemployed.

This article is protected by copyright. All rights reserved.

http://bit.ly/2sX8ehr

Recommendation to include hydroxyethyl (meth)acrylate in the British Baseline Patch Test Series

Summary

Background

(Meth)acrylates are potent sensitisers and a common cause of allergic contact dermatitis (ACD). The frequency of (meth)acrylate ACD has increased with soaring demand for acrylic nails. A preliminary audit has suggested a significant rate of positive patch tests to (meth)acrylates using aimed testing in patients providing a clear history of exposure. (Meth)acrylates have to date not been routinely tested in the baseline patch test series in the U.K. and Europe.

Objectives

To determine whether inclusion of 2‐hydroxyethyl methacrylate (2‐HEMA) 2% in petrolatum (pet.) in the baseline series detects cases of treatable (meth)acrylate ACD.

Methods

During 2016‐2017, 15 U.K. dermatology centres included 2‐HEMA in the extended baseline patch test series. Patients with a history of (meth)acrylate exposure, or who tested positive to 2‐HEMA, were selectively tested with a short series of eight (meth)acrylate allergens.

Results

5,920 patients were consecutively patch tested with the baseline series, of whom 669 were also tested to the (meth)acrylate series. 102 of 5,920 (1·7%) tested positive to 2‐HEMA and 140 (2·4%) to at least one (meth)acrylate. Had 2‐HEMA been excluded from the baseline series, (meth)acrylate allergy would have been missed in 36 of 5,920 (0·6% of all patients). The top (meth)acrylates eliciting a positive reaction were 2‐HEMA (n=102; 1·7%), 2‐hydroxypropyl methacrylate (n=61; 1%) and 2‐hydroxyethyl acrylate (n=57; 1%).

Conclusions

We recommend that 2‐HEMA 2% pet. be added to the British baseline patch test series. We also suggest a standardised short (meth)acrylate series which is likely to detect most cases of (meth)acrylate allergy.

This article is protected by copyright. All rights reserved.

http://bit.ly/2MHj9ER

Decreased 5‐hydroxymethylcytosine immunoreactivity in primary Merkel cell carcinomas is a strong predictor for disease‐specific death

Abstract

Merkel cell carcinoma (MCC) is an infrequent malignant skin tumour with epithelial and neuroendocrine differentiation. Though it is a highly aggressive malignancy, the distinct molecular pathogenesis of MCC is not yet fully understood. Apart from DNA methylation, histone modification, and microRNA‐mediated and long non‐coding RNA‐mediated regulation, hydroxymethylation may also play an important role in cancer development. Loss of 5‐hydoxymethylcytosine (5‐hmc) has been reported in a variety of cancers, including skin malignancies such as melanoma.

This article is protected by copyright. All rights reserved.

http://bit.ly/2sX889z

A Reliability Study Using Network Oriented Research Assistant (NORA®) Examining the Use of Digital Photographs in the Assessment of Psoriasis

Abstract

Psoriasis is a chronic immune‐modulated condition affecting approximately 2‐3% of the general population. In addition to cutaneous lesions, psoriasis is associated with systemic and mental health co‐morbidities. Psoriasis is among the most extensively researched dermatologic conditions, with many novel treatment options in the drug development pipeline.

This article is protected by copyright. All rights reserved.

http://bit.ly/2MJbOov

Extremity nevus count is an independent risk factor for basal cell carcinoma and melanoma, but not squamous cell carcinoma

The presence of nevi portends an increased risk for melanoma.

http://bit.ly/2UuXeU0

Risk factors for acne development in the first 2 years after initiating masculinizing testosterone therapy among transgender men

To the Editor: Female-to-male transgender patients (herein referred to as transgender men) receive masculinizing doses of testosterone to induce virilization and suppress menstruation. Studies have shown that elevated androgen levels among transgender men have been associated with an increased incidence of acne.1-5 Studies suggest that testosterone therapy increases the development of acne, though severe acne occurs only rarely.3 Our study assessed the timing of acne onset relative to initiation of testosterone therapy in transgender men and the biologic, behavioral, and sociodemographic predictors of acne in this population.

http://bit.ly/2MHgYkF

The effect of baclofen combined with a proton pump inhibitor in patients with refractory laryngopharyngeal reflux: a prospective, open‐label study in thirty‐two patients

Abstract

Thirty‐two patients with refractory LPR confirmed by 24‐h MII‐pH were given a 3‐month course of baclofen 10 mg three times a day combined with PPI 15 mg twice a day.

Changes in RSI and reflux‐related quality of life from baseline to after treatment were evaluated.

MII‐pH monitoring of refractory LPR patients showed that the number of non‐acid reflux was much higher than acid reflux in laryngopharyngeal reflux and full‐column reflux.

After 3 months of PPI + baclofen medication, most RSI items and quality of life score showed a significant improvement compared to the baseline score, and the percentage of responders at 3 months was 53.1%.

In our experience, when a PPI therapy is unresponsive to LPR patients, baclofen can be considered as a second treatment option.

This article is protected by copyright. All rights reserved.

http://bit.ly/2Sh6uOc

Trends in Utilization and Expenditure for Onychomycosis Treatments in the United States in 2013–2016

http://bit.ly/2HIMCQ0

Simultaneous adsorption and immobilization of As and Cd by birnessite-loaded biochar in water and soil

Abstract

A novel biochar was prepared by loading birnessite to improve its capability to simultaneously adsorb As(III), As(V), and Cd(II) in water and soil. Layer sheet–structured birnessite was successfully loaded onto the biochar surface with increased functional groups. SEM, XRD, and FTIR combining with XPS analysis were utilized to characterize birnessite-loaded biochar and its adsorption mechanisms for As and Cd(II). The saturated adsorption capabilities of the birnessite-loaded biochar (BRB) for As(III), As(V), and Cd(II) were as large as 3543, 2412, and 9068 mg/kg (calculated by Langmuir isotherm model), much higher than for the corresponding non-loaded biochar (no adsorption of As, 4335 mg/kg for Cd). Adsorption of Cd and As onto BRB was controlled by multi mechanisms; Cd(II) appeared to coordinate to vacant sites of birnessite, while As formed surface complex with functional groups. Furthermore, BRB showed higher abilities for co-adsorption of As(III) and Cd or As(V) and Cd, which may be due to the formation of Cd₃(AsO₄)₂ surface precipitate as well as synergistic reaction between anions and cations. After conditioning to soil, BRB showed potential for Cd and As remediation under both flooded and unflooded conditions. These results suggested that BRB can be used as an effective sorbent for simultaneous immobilization of heavy metals, especially As and Cd, in environmental and agricultural systems.

http://bit.ly/2RY6P9l

The Effect of Stimulus Polarity on the Relation Between Pitch Ranking and ECAP Spread of Excitation in Cochlear Implant Users

Abstract

Although modern cochlear implants (CIs) use cathodic-leading symmetrical biphasic pulses to stimulate the auditory nerve, a growing body of evidence suggests that anodic-leading pulses may be more effective. The positive polarity has been shown to produce larger electrically evoked compound action potential (ECAP) amplitudes, steeper slope of the amplitude growth function, and broader spread of excitation (SOE) patterns. Polarity has also been shown to influence pitch perception. It remains unclear how polarity affects the relation between physiological SOE and psychophysical pitch perception. Using a within-subject design, we examined the correlation between performance on a pitch-ranking task and spatial separation between SOE patterns for anodic and cathodic-leading symmetric biphasic pulses for 14 CI ears. Overall, there was no effect of polarity on either ECAP SOE patterns, pitch ranking performance, or the relation between the two. This result is likely due the use of symmetric biphasic pulses, which may have reduced the size of the effect previously observed for pseudomonophasic pulses. Further research is needed to determine if a pseudomonophasic stimulus might further improve the relation between physiology and pitch perception.

http://bit.ly/2TpFoBN

The Effect of Stimulus Polarity on the Relation Between Pitch Ranking and ECAP Spread of Excitation in Cochlear Implant Users

Abstract

Although modern cochlear implants (CIs) use cathodic-leading symmetrical biphasic pulses to stimulate the auditory nerve, a growing body of evidence suggests that anodic-leading pulses may be more effective. The positive polarity has been shown to produce larger electrically evoked compound action potential (ECAP) amplitudes, steeper slope of the amplitude growth function, and broader spread of excitation (SOE) patterns. Polarity has also been shown to influence pitch perception. It remains unclear how polarity affects the relation between physiological SOE and psychophysical pitch perception. Using a within-subject design, we examined the correlation between performance on a pitch-ranking task and spatial separation between SOE patterns for anodic and cathodic-leading symmetric biphasic pulses for 14 CI ears. Overall, there was no effect of polarity on either ECAP SOE patterns, pitch ranking performance, or the relation between the two. This result is likely due the use of symmetric biphasic pulses, which may have reduced the size of the effect previously observed for pseudomonophasic pulses. Further research is needed to determine if a pseudomonophasic stimulus might further improve the relation between physiology and pitch perception.

http://bit.ly/2TpFoBN

The antimicrobial protein S100A12 identified as a potential autoantigen in a subgroup of atopic dermatitis patients

Atopic dermatitis (AD) is a complex heterogeneous chronic inflammatory skin disease. Specific IgE antibodies against autoantigens have been observed in a subgroup of AD patients, however, little is known about...

http://bit.ly/2RZw2Qz

Survival and Long-Term Biochemical Cure in Medullary Thyroid Carcinoma in Denmark 1997–2014: A Nationwide Study

Thyroid, Ahead of Print.


http://bit.ly/2DLIeeV

Treatment of Desmoid Tumors in 2019

This article describes an approach to active surveillance and treatment of desmoid tumor (aggressive fibromatosis).

http://bit.ly/2G1MzwO

Improving the Nuclear-Localized Androgen Receptor Splice Variant 7 Test—In Reply

In Reply Nicolazzo and colleagues suggest that the use of confocal microscopy would improve the technical and clinical accuracy of the androgen receptor splice variant 7 (AR-V7) diagnostic test. It is hypothesized that limitations (unspecified) of the widefield optics limit the ability to determine the 3-dimensional cellular organization and the localization of protein. Although confocal microscopy is a suitable research tool for evaluating the subcellular localization of organelles and proteins, it is impractical for this application in the clinical setting and is redundant for accurately determining protein localization. As evidenced by our studies to date, the specificity of the test to determine a poor outcome if a patient is treated with androgen receptor signaling inhibitors is extremely high, a finding independently corroborated in a separate cohort and in the PROPHECY study presented at the 2018 annual meeting of the American Society of Clinical Oncology.

http://bit.ly/2Gdkxhe

The Best Medicine

Laughing with a patientis like opening the dishwasher

http://bit.ly/2FZKCkD

Adding Docetaxel to Androgen Deprivation Therapy in Patients With High-Risk Prostate Cancer

This randomized clinical trial compares the use of combined androgen-deprivation therapy plus docetaxel with androgen-deprivation therapy alone in patients with prostate cancer who develop increasing levels of prostate-specific antigen after primary local therapy.

http://bit.ly/2Gc1dkx

Derivation of Anthracycline and Anthraquinone Equivalence Ratios to Doxorubicin for Late-Onset Cardiotoxicity

This multicenter cohort study pools data from more than 28 000 children with cancer who had survived 5 or more years to evaluate the optimal dose equivalence ratio for late-onset cardiomyopathy between doxorubicin and other 3 other anthracyclines (daunorubicin, epirubicin, and idarubicin) and the anthraquinone mitoxantrone.

http://bit.ly/2G1MrgO

Improving the Nuclear-Localized Androgen Receptor Splice Variant 7 Test

To the Editor We read with great interest the article by Scher et al. The aim of the study was to evaluate the clinical use of the Epic Sciences nuclear-localized androgen receptor splice variant 7 (AR-V7) test in circulating tumor cells (CTCs) to determine the best therapeutic strategy for patients with metastatic castration-resistant prostate cancer. The issue is interesting and addresses an important challenge of precision medicine. However, we would like to make a few remarks, which are mainly technical in nature. Although the assay used for analysis of the CTCs is highly sophisticated, we believe that the use of the fluorescence microscopy is a limiting factor that might directly affect results. Notably, the authors considered only AR-V7–positive CTCs exhibiting a nuclear-specific localization (according to AR-V7 scoring criteria) and discarded those with a diffuse signal. We believe that fluorescence analysis using confocal technology would be useful. Confocal microscopy allows determination with absolute certainty of the cellular localization of a protein through an assessment of its 3-dimensional organization. The use of confocal microscopy would have clarified the predictive value of hormone therapy of CTCs with both nuclear and cytoplasmic AR-V7 localization. Furthermore, the establishment of a cut-off value of AR-V7–positive CTCs would be appreciated for predictive purposes in the clinical setting.

http://bit.ly/2Gc18NL

Adjuvant Androgen- Deprivation Therapy for Prostate Cancer

In this issue of JAMA Oncology, Oudard et al report on patients with the earliest form of potentially metastatic prostate cancer: those without castration (androgen dependent) with no detectable metastases who have developed rising prostate-specific antigen (PSA) levels. The hypothesis in 2003 was that early use of docetaxel could increase the rate of cure. Two hundred fifty patients were randomized to receive androgen-deprivation therapy (ADT) for 1 year or ADT for 1 year plus docetaxel for 6 cycles. There was no survival advantage with the addition of docetaxel or delay in the development of metastases, although there was a 15% reduction in PSA relapse. At a median follow-up of 10.5 years, survival was better than expected, there was no sign of separation of the survival curves between the treatment groups, and no significant between-arm difference in radiographic progression-free survival was noted (hazard ratio [HR], 0.99; 95% CI, 0.71-1.39; P = .95). The authors concluded that "Addition of docetaxel to androgen deprivation therapy seems unwarranted in patients with high-risk prostate cancer without metastases in the absence of better predictors of risk for metastatic disease." Is such a conclusion warranted?

http://bit.ly/2G1Mol8

Biospecimens, Research Consent, and Distinguishing Cell Line Research

This Special Contribution discusses newly revised regulations for human research affecting the use biospecimens and makes recommendations to enable ethically appropriate regulation of biospecimen research across the spectrum of cancer research.

http://bit.ly/2GevvTC

Variation in Care Delivery and Diagnostic Modality Among the Medicare Population

In this issue of JAMA Otolaryngology–Head & Neck Surgery, Hur et al suggest that during the past decade, the use of diagnostic nasal endoscopy in the Medicare population has increased substantially and this increase has not been paralleled by a similar increase in surgical ethmoidectomy. The overall increase in the number of endoscopies was also accompanied by marked variability in endoscopy utilization across different states, with some states showing a large increase and others showing smaller increases.

http://bit.ly/2BdJrdz

A Career in Global Surgery

This Viewpoint suggests that academic surgical departments are well positioned to lead global surgery efforts given their focus on teaching, innovation, and service.

http://bit.ly/2Bdfs5r

Toward a Broader, More Global Perspective for US Otolaryngology Residents

This essay discusses the benefits of the medical education system offering US otolaryngology residents the opportunity to gain a broader, more global perspective on the practice of otolaryngology.

http://bit.ly/2ToqTy5

Papillary Thyroid Microcarcinoma

A patient who was referred to our clinic for a second opinion on management of a small localized papillary thyroid cancer (PTC) asked, "Why should I have surgery to remove my thyroid if it's such a good cancer?" At the time of diagnosis, her health care practitioner told her she had a good cancer and recommended thyroidectomy. This question directly relates to the work by Davies et al in this issue of JAMA Otolaryngology–Head & Neck Surgery. However, it is important to first clarify some misconceptions about the experiences of patients with thyroid cancer.

http://bit.ly/2BaO5Ja

Patient Experience of Thyroid Cancer Active Surveillance in Japan

This study evaluates the concerns about cancer, treatment decisions, and overall experience of Japanese patients under active surveillance for thyroid cancer.

http://bit.ly/2TokPpr

Phosphaturic Mesenchymal Tumor of the Cerebellopontine Angle

This case report describes an otherwise healthy woman in her 30s who presented with left-ear hearing loss, tinnitus, distorted hearing, and occasional otalgia of a few months' duration.

http://bit.ly/2BdQCSV

Utilization of Nasal Endoscopy in the Medicare Population, 2000-2016

This study analyzes Medicare beneficiary and provider data from 2000 through 2016 to investigate trends in the number of nasal endoscopies performed among the Medicare population, reimbursement, and regional differences.

http://bit.ly/2TsOf5W

A Large Tonsillar Mass in a Healthy Teenager

A previously healthy 18-year-old woman presented with a growth in the right oropharynx of 4 months' duration as well as voice changes, recent weight loss, and decreased appetite. What is your diagnosis?

http://bit.ly/2Tnan1q

Role of PTP/PTK trans activated insulin-like signalling pathway in regulation of grasshopper ( Oedaleus asiaticus ) development

Abstract

Protein tyrosine phosphatase (PTPs) and protein tyrosine kinase (PTKs) genes are responsible for the regulation of insect insulin-like pathway (ILP), cells growth, metabolism initiation, gene transcription and observing immune response. Signal transduction in insect cell is also associated with PTPs and PTKs. The grasshopper (Oedaleus asiaticus) 'Bey-Bienko' were treated with dsRNA of protein tyrosine non-receptor type 4 (PTPN4) and protein tyrosine kinase 5 (PTK5) along with control (water). Applying dsPTK5 treatments in 5th instar of Oedaleus asiaticus, significant reduction was recorded in body dry mass, growth rate and overall performance except survival rate. Whereas with PTPN4, no such significant impact on all of these growth parameters was recorded. Expression of genes in ILP 5th instar of Oedaleus asiaticus by the application of dsPTPN4 and dsPTK5 revealed that PTK, INSR (insulin receptor), IRS (insulin receptor substrate), PI3K (phosphoinositide 3-kinase), PDK (3-phosphoinositide-dependent protein kinase), Akt (protein kinase B) and FOXO (forkhead transcription factor) significantly expressed with downregulation except PTPN4, which remained non-significant. On the other hand, the phosphorylation level of ILP four proteins in O. asiaticus with the treatment of dsPTPN4 and dsPTK5 significantly affected P-IRS and P-FOXO, while P-INSR and P-AKT remained stable at the probability level of 5%. This indicated that the stress response in the O. asiaticus insulin-like signalling pathway (ILP) reduced. Regarding association of protective enzymatic activities, ROS (relative oxygen species), CAT (catalase) and PO (phenol oxidase) increased significantly with exposure to dsPTK5 as compared to dsPTPN4 and control, while exposure of 5th instar of O. asiaticus to dsPTPN4 treatment slightly raised CAT and PO activities with but significant contribution. No such significant effect on MFO and POD was seen using dsPTPN4 and dsPTK5. This showed that in the ILP of O. asiaticus, PTK5 was detrimental to growth, body mass and overall performance, which ultimately benefited insect detoxification with high-energy cost.

http://bit.ly/2BdHSwd

A tale of 1 year: a case of bilateral conductive hearing loss due to bilateral ossicular chain disruption post head trauma

Abstract

The traumatic hearing loss is a common finding after head trauma that involves the temporal bone fracture or skull base injury, but the late presentation of the hearing loss bilaterally is a rare presentation. This case report describes the rare and late presentation of bilateral conductive hearing loss 1-year after the head trauma, limited to ossicular chain disruption and hearing loss. This case of post head trauma that was limited to ossicular chain distribution progressed to bilateral conductive hearing loss without temporal bone fracture. A 14-year-old male was presented conductive hearing loss of one year after head injury, CT scan revealed bilateral ossicles disruption. Afterwards, osicuoloplasty was performed which improved the hearing of the patient. In conclusion, bilateral hearing loss with no obvious skull fracture should be suspected and investigated so an early intervention could be established. The CT was considered the imaging modality of choice for ossicular chain distribution.

http://bit.ly/2BffZnh

Proceed or palliate: Surgicel® mimicking tumor recurrence and causing a small bowel obstruction

Abstract

Surgicel® is a commonly used hemostatic agent. We report a case of small bowel obstruction secondary to the prior placement of Surgicel® within the peritoneal cavity, and the radiological diagnosis conundrum and potential prognostic implications this finding has in a patient with a known history of malignancy.

http://bit.ly/2TjYp8G

Unclassified autoimmune pancreatitis mimicking pancreatic cancer

Abstract

A 24-year-old black male presented with a 1-week obstructive jaundice and intermittent abdominal pain, with no significant weight loss and an unsuspicious abdominal exam. Blood chemistry showed a cholestatic pattern but a complete immunological and tumoral panel (anti-smooth muscle antibody, anti-mitochondrial antibody, anti-nuclear antibody, anti-neutrophil cytoplasmic antibody, anti-Smith, anti-double-stranded-DNA antibody (anti-dsDNA), complement C3/C4, carcinoembryonic antigen, CA 19-9 and IgG4) were all within normal limits. Abdominal ultrasound revealed dilatation of the intra and extra-hepatic bile ducts. CT scan showed an abnormal dilatation of the distal bile duct but no focal enlargement of the head of the pancreas. Endoscopic ultrasound suggested an inflammatory process but the magnetic resonance cholangio-pancreatography favored a neoplastic obstruction of the distal common bile duct. Fine-needle aspiration cytology was insufficient for definitive diagnosis and the patient underwent major surgery. Follow-up with mild exocrine pancreatic insufficiency treated with enzyme replacement.

http://bit.ly/2BgqeYx

Combination of laparoscopy and endoscopy as an option for treatment patients with gastric neuroendocrine tumors

Abstract

Background

Neuroendocrine tumors (NETs) are relatively rare neoplasms with the increasing survival due to the development of early diagnostics. There is no universal position in treatment and follow up of small (~20 mm) gastric NETs.

Clinical cases

Two female patients 51 and 66 y.o. with multiple gastric NETs <2 cm were observed in our department. In both cases treatment was performed by combination of two minimally invasive technologies: laparoscopy and gastroscopy. According to the localization of tumors in one case intraluminal gastric resection controlled by laparoscopy was performed. In the second case laparoscopic gastric resection with gastroscopy assistance was done.

Discussion

There are two positions for surgical treatment of small NETs: to operate as the typical premalignant neoplasm or to make submucosa resections. We demonstrated combination of laparoscopy and gastroscopy as feasible approach with minimal risk of complications.

http://bit.ly/2Tnkfbl

Small bowel intussusception and concurrent sigmoid polyp with malignant transformation in Peutz–Jeghers syndrome

Abstract

Peutz–Jeghers syndrome (PJS) is an autosomal dominant condition characterized by the association of gastrointestinal polyposis, mucocutaneous pigmentation and cancer predisposition McGarrity, Amos, Baker (Peutz–Jeghers Syndrome, GeneReviews(R), National Center of Biotechnology Information.). Intussusception and malignant polyps are not rare complications of PJS, where the lifetime risk of intussusception is 48% and the possibility of developing any cancer by age 65 years is 37% Kopacova, Tacheci, Rejchrt, Bures (Peutz-Jeghers syndrome: diagnostic and therapeutic approach. World J Gastroenterol 2009;15:5397–408.). Very few cases of malignant polyps causing intussusception associated with synchronous malignant polyp in PJS have been reported to date Cai, Tian, Zhou, He, Hu, Deng (Jejunal intussusception and polyps with different types of malignant transformation in Peutz-Jeghers syndrome: report of a case. Oncol Lett 2013;5:239–41.). We describe a case of a patient with PJS presenting with symptomatic jejunal intussusception and an incidentally found malignant hamartoma in the sigmoid colon.

http://bit.ly/2Bgqcjn

Coexistence of intracranial solitary fibrous tumor/hemangiopericytoma and right middle cerebral artery aneurysm

Abstract

Intracranial solitary fibrous tumors are rare mesenchymal neoplasms originating in the meninges and constitute a heterogeneous group of rare spindle cell tumors that include benign and malignant neoplasms of which hemangiopericytoma is nowadays considered a cellular phenotypic variant. From literatures, the incidence of coexistence of brain tumors and intracranial aneurysms is ~0.7–5.4%. Meningioma is the most frequent tumor coexisted with intracranial aneurysms, followed by pituitary adenoma, neuroepithelial tumor, and metastatic tumor. We would like to report a case of 74-year-old man harboring a rare intracranial solitary fibrous tumor/hemangiopericytoma and an unruptured aneurysm of the right middle cerebral artery which probably the first report of these combinations in the English literature. Both lesions were treated surgically in one session with favorable outcome. Magnetic resonance angiography should be performed in patients with brain tumor preoperatively not only to visualize neoplastic vascularization but also to pick up incidental aneurysm.

http://bit.ly/2Tn7b5L

Jejunal diverticulitis

Abstract

Cases of small bowel diverticulitis, excluding Meckel's diverticulitis, are rare. Small bowel diverticular disease has been reported in approximately 0.3–1.3% cases of post mortem studies (Fisher JK, Fortin D. Partial small bowel obstruction secondary to ileal diverticulitis. Radiology 1977;122:321–322.) and in only 0.5–1.9% of contrast media study cases (Cattell RB, Mudge TJ. The surgical significance of duodenal diverticula. N Engl J Med 1952;246:317–324). Diverticula located within the small bowel may have presentations and complications similar to that of colonic diverticular disease. However, there is no consensus for the management for small bowel diverticulitis. Given that small bowel diverticulitis, like a colonic diverticulitis, can cause an acute abdomen, surgical intervention may be required. In this particular case, a patient presented with symptoms of lower abdominal pain, nausea and fever. Following an x-ray and CT scan, the patient underwent an open laparotomy and small bowel resection of a portion of jejunum that contained a symptomatic diverticulum.

http://bit.ly/2Bgq9nH

Myogenic fibrosis of the flexor tendons after amphetamine drug abuse

Abstract

Myogenic fibrosis of the flexor tendons in a 23-year-old patient was caused by intense drug abuse. He was presented in the clinic with spastic flexor tendon contracture of his right hand. The patient was treated by tendon elongation with a satisfactory result. The treatment of flexor tendon contracture in those cases is very difficult and needs to be done in a complex way.

http://bit.ly/2TjEGGd

Anterior mediastinal mass 4 years after type A aortic dissection

Abstract

A 47-year-old male who previously underwent emergency surgery for type A aortic dissection presented to the emergency department 4 years later with acute chest pain radiating to his back and a significant drop in hemoglobin. Clinical presentation was concerning for aortic graft failure, but imaging revealed a large (6.0 × 3.2 × 12.8 cm³) soft tissue mediastinal mass that was not present 4 years before. Pathologic analysis revealed a rare thymic cyst with a hemorrhagic component. This was a challenging case from diagnostic and operative perspectives, involving the expertise of both cardiac and thoracic surgical teams.

http://bit.ly/2BffM3t

A novel case of late left ventricular outflow tract obstruction post mitral valve surgery

Abstract

Left ventricular outflow tract (LVOT) obstruction (LVOTO) is a rare but recognized complication of mitral valve surgery. Concomitant factors can cause significant clinical deterioration which requires urgent intervention. We present the case of a female patient who underwent closed valvotomy at age 20 for mitral stenosis secondary to rheumatic heart disease. Seventeen years later, a re-stenosed valve prompted mitral valve replacement (MVR) with a Carbomedics mechanical prosthesis. 8 years later, she re-presented with increasing dyspnoea. On echocardiogram a frond-like structure was visible in the LVOT, the valve housing was protruding into the LVOT and she had marked septal hypertrophy. The LVOT gradient was 72 mmHg. This is a novel case of mechanical MVR associated LVOTO due to at least three discrete factors. This case demonstrates how multiple factors can amalgamate to result in significant clinical deterioration. Over an 8-year period, all three distinct factors contributed to the development of severe LVOTO.

http://bit.ly/2TjEAOR

Doctoring and Hearing Loss

In treating hearing loss, I've found there's a particular tendency–especially in men losing their hearing in late middle age–for patients...

http://bit.ly/2RsViK3

Tonsillectomy: Tonsilliths, Pandas, and other great band names

I can't tell you how many times people at parties find out that I'm an ENT and have me look...

http://bit.ly/2Wut05q

Microwave ablation for the treatment of arterial epistaxis: “how I do it”

Background

Arterial epistaxis is commonly seen in the rhinology clinic and can have a significant impact on quality of life. Previous studies have explored various therapies to address epistaxis.

Methods

Patients were treated in the outpatient clinic or operating room by microwave ablation (MWA) with a 2450‐MHz cooled‐shaft antenna to treat an epistaxis bleeding point.

Results

Of the 481 patients with arterial epistaxis, bleeding was controlled within 1 to 2 minutes and only 2 patients with recurrent bleeding required re‐ablation. The shape of the thermal lesion was elliptical and it was approximately 2 mm in length, 1 mm in width, and 0.5 to 1 mm in penetration depth. Of the 481 patients, 167 (34.7%) complained of minor nasal pain on the same day of ablation. No patients complained of nasal pain or obstruction during the follow‐up period. In addition, 139 (28.9%) patients showed a minor increase in rhinorrhea during the first postoperative week. Of the 481 patients, 469 (97.5%) were followed‐up at 6 months with no severe MWA‐related complications, such as septal perforation, synechiae formation, or orbit and brain complications.

Conclusion

MWA is a technically feasible alternative method for patients with arterial epistaxis.

http://bit.ly/2Us2h7K

In‐vitro evaluation of a ciprofloxacin‐ and ivacaftor‐coated sinus stent against Pseudomonas aeruginosa biofilms

Background

We recently developed a novel ciprofloxacin‐coated sinus stent capable of releasing antibiotics over a sustained period of time. Ivacaftor is a cystic fibrosis transmembrane conductance regulator (CFTR) potentiator that has synergistic bactericidal activity with ciprofloxacin and also enhances sinus mucociliary clearance. The objective of this study was to optimize and evaluate the efficacy of a ciprofloxacin‐ and ivacaftor‐releasing biodegradable sinus stent (CISS) in vitro.

Methods

A CISS was created by coating ciprofloxacin/ivacaftor‐embedded nanoparticles with an acrylate and ammonium methacrylate copolymer onto a biodegradable poly‐L‐lactic acid stent. In‐vitro evaluation of the CISS included: (1) assessment of drug stability in nanoparticles by zeta potential, and drug‐coating stability within the CISS using scanning electron microscopy (SEM); (2) determination of ciprofloxacin‐ and ivacaftor‐release kinetics; and (3) assessment of anti‒Pseudomonas aeruginosa biofilm formation by calculating relative optical density units (RODUs) compared with control stents at 590‐nm optical density.

Results

The presence of drugs and a uniform coating on the stent were confirmed by zeta potential and SEM. Sustained drug release was observed through 21 days without an initial burst release. Anti‐biofilm formation was observed after placing the CISS for 3 days onto a preformed 1‐day P aeruginosa biofilm. The CISS significantly reduced biofilm mass compared with bare stents and controls (RODUs at 590‐nm optical density; CISS, 0.31 ± 0.01; bare stent, 0.78 ± 0.12; control, 1.0 ± 0.00; p = 0.001; n = 3).

Conclusion

The CISS maintains a uniform coating and sustained delivery of drugs providing a marked reduction in P aeruginosa biofilm formation. Further studies evaluating the efficacy of CISS in a preclinical model are planned.

http://bit.ly/2DLQsDK

Does bilateral inferior turbinate reduction affect long‐term quality‐of‐life outcomes in patients undergoing endoscopic sinus surgery?

Background

The objective of this study was to evaluate the impact of bilateral inferior turbinate reduction (BITR) on patient‐reported quality of life (QOL) following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS).

Methods

This was a prospective cohort study. Patients with CRS, who were recruited from 10 different otolaryngologic practices between 2011 and 2014, completed the 22‐item Sino‐Nasal Outcome Test (SNOT‐22), Chronic Sinusitis Survey (CSS), and EuroQol 5 Dimension (EQ‐5D) survey at baseline, and at 12, 24, 36, and 48 months after ESS. A total of 113 patients who underwent ESS with BITR were compared to 788 patients who underwent ESS without BITR.

Results

Significant demographic and comorbid differences between BITR and non‐BITR cohorts included age (41 vs 49 years, p < 0.0001), presence of asthma (19% vs 36%, p < 0.0001), prior sinus surgery (22% vs 53%, p < 0.0001), and concurrent septoplasty (80% vs 53%, p < 0.0001), respectively. On univariate analysis, patients who underwent ESS with or without BITR were found to have statistically significant improvement in disease‐specific (SNOT‐22 and CSS) and general (EQ‐5D) QOL scores at years 1 through 4 (p < 0.05). On multivariate regression, however, the performance of BITR was not associated with any improvements in these outcome measures.

Conclusion

Patients undergoing ESS achieve similar long‐term improvement in both disease‐specific and general QOL regardless of the performance of concurrent BITR.

http://bit.ly/2UvFLuB

Eustachian Tubes: Pop It Like It’s Hawt

This topic is a bit related to the ear tubes topic, and I think it's worth covering because I get...

http://bit.ly/2G0VQ8I

Removal of antibiotics from aqueous solutions by nanoparticles: a systematic review and meta-analysis

Abstract

Antibiotics, as one of the emerging pollutants, are non-biodegradable compounds and long-term exposure to them may affect endocrine, hormonal, and genetic systems of human beings, representing a potential risk for both the environment and human health. The presence of antibiotics in surface waters and drinking water causes a global health concern. Many researches have stated that conventional methods used for wastewater treatment cannot fully remove antibiotic residues, and they may be detected in receiving waters. It is reported that nanoparticles could remove these compounds even at low concentration and under varied conditions of pH. The current study aimed to review the most relevant publications reporting the use of different nanoparticles to remove antibiotics from aqueous solutions. Moreover, meta-analysis was conducted on the results of some articles. Results of meta-analysis proved that different nanoparticles could remove antibiotics with an acceptable efficiency of 61%. Finally, this review revealed that nanoparticles are promising and efficient materials for degradation and removal of antibiotics from water and wastewater solutions. Furthermore, future perspectives of the new generation nanostructure adsorbents were discussed in this study.

http://bit.ly/2G0EzMG

Rebuttal to: Zhang et al. “Research development, current hotspots, and future directions of water research based on MODIS images: a critical review with a bibliometric analysis,” vol. 24, pp. 15226–15239

http://bit.ly/2GcNdXN

Parametric and non-parametric convergence analysis of electricity intensity in developed and developing countries

Abstract

This paper examines the pattern of convergence in electricity intensity in a sample of 79 countries. We apply the residual augmented least squares regression to the convergence of energy intensity. This method has been used in the convergence of per capita energy consumption but not convergence of energy intensity. Furthermore, in contrast to the previous studies which mainly used the conventional beta convergence approach to examine conditional convergence, we use a beta convergence method that is capable of identifying the actual number of countries that contribute to conditional convergence. The sigma and gamma convergences of electricity intensity are also examined. In addition to the full sample of countries, we also examine convergence in African countries, Asian and Oceanic countries, American countries and European countries, separately. Convergences in OECD and non-OECD countries are also examined, separately. In the full sample, the results show convergence exists in 54% of the countries in the total sample. There is convergence in 65% of the African countries, 61% of the American countries, 43% of the Asian and Oceanic countries and 33% of the European countries. In terms of the regional classification, it is also observed that convergence exists for 58% of the non-OECD countries and 31% of the OECD countries. There is evidence for sigma convergence in all the blocs with the exception of European and non-OECD countries. With the exception of African countries, there is evidence for gamma convergence in all the countries and the various blocs. The policy implications of the results are discussed.

http://bit.ly/2G1vOSq

Acknowledgment to reviewers—2018

http://bit.ly/2DNl6gp

Silver prices and solar energy production

Abstract

The goal of this paper is to identify, for the first time, the role of solar production in driving silver prices. The empirical analysis makes use of the ARDL model and the combined cointegration. The results, spanning the period 1990–2016, document that stronger solar installed capacities, as well as higher gross electricity production from solar sources, lead to higher silver prices. The findings could be of great importance to silver suppliers and to energy policymakers and regulators, as well as to solar panel manufacturers.

http://bit.ly/2t20sTb

Habitat selection of wintering cranes ( Gruidae ) in typical lake wetland in the lower reaches of the Yangtze River, China

Abstract

Shengjin Lake is a typical lake wetland in the lower reaches of the Yangtze River. It is one of the most important wetlands in the world. It is also an important habitat for wintering cranes in China. Environmental factors play an important role in habitat selection of cranes of wetland ecosystem. In this paper, we analyzed land-use types and the four kinds of winter cranes in the Shengjin Lake from the years 1986 to 2015. Also, we adopted grey relational analysis and power function model to analyze the relevance between crane population and land-use types, and the main habitat types of cranes were obtained. We used principal component analysis method to analyze the main influence factor for habitat selection of crane. The results indicated that the main habitat type of four species of overwintering crane was reed-flat; the main factors affecting the habitat selection of cranes were water level, planktonic biomass, and distance to settlement. Among them, the weight of water level factor was the highest, which showed that water level was the most important factor affecting the habitat selection of cranes, followed by planktonic biomass, and the third was the weight of distance to settlement. The average values of them were 0.37 m, 9.47 mg L⁻¹, and 1.25 km, respectively.

http://bit.ly/2MJyVio

Biodegradation of persistent environmental pollutants by Arthrobacter sp.

Abstract

Persistent environmental pollutants are a growing problem around the world. The effective control of the pollutants is of great significance for human health. Some microbes, especially Arthrobacter, can degrade pollutants into nontoxic substances in various ways. Here, we review the biological properties of Arthrobacter adapting to a variety of environmental stresses, including starvation, hypertonic and hypotonic condition, oxidative stress, heavy metal stress, and low-temperature stress. Furthermore, we categorized the Arthrobacter species that can degrade triazines, organophosphorus, alkaloids, benzene, and its derivatives. Metabolic pathways behind the various biodegradation processes are further discussed. This review will be a helpful reference for comprehensive utilization of Arthrobacter species to tackle environmental pollutants.

http://bit.ly/2sWuFmC

Perception of household in regards to water pollution: an empirical evidence from Pakistan

Abstract

Water pollution is one of the main threats to public health in Pakistan. The watchdogs for drinking water quality are toothless, hence Pakistan's ranking in maintaining water quality standards is 80th out of 122 nations. Despite such alarming situation coupled with violation of various drinking water quality parameters set by WHO, the risk perception of people remains an unfolded area of research. This paper examines the risk perception of household regarding water pollution in Pakistan and its potential effect on human health. In this way, we present a more analytical interpretation of the subject by collecting data from a survey questionnaire from one of the largest urban cities of Pakistan. Conclusions are drawn which stress that education, income, and knowledge of water pollution have higher impact on risk perception. From this position, and with the development of implications for policy, we demonstrate the need of a systematic quantification of various uncertainties that can provide more realistic support for remediation-related decisions to policy makers.

http://bit.ly/2MG0wRR

Effects of exposure to triphenyltin (TPT) contaminant on sperm activity in adulthood of Calomys laucha exposed through breastfeeding

Abstract

Triphenyltin (TPT) is an organotin compound (OT), primarily used in agriculture and in the composition of antifouling paints for ships worldwide. Studies have showed its effects as an endocrine disrupter in several organisms by preventing enzymatic expression and causing reproductive toxicity. This study aimed to evaluate the effects of exposure to TPT, via breastfeeding, on reproductive physiology in the Calomys laucha species. The experimental design was compound of five groups, two controls and three with different doses of TPT. Moreover, females were exposed by gavage to the TPT for 20 days, from the 1st day postpartum to the 21st postnatal day (PND). Then, the pups were euthanized and the kinetics, organelles, and biochemistry of the sperm were evaluated. The results presented a reduction in total motility in the groups exposed to TPT. Regarding cellular organelles analysis, a loss in membrane integrity was evidenced; the functionality of mitochondria showed diminution followed by increased acrosome reaction. In conclusion, the TPT causes alteration of the reproductive parameters, decreasing the activity and sperm quality in individuals exposed in the breastfeeding phase.

http://bit.ly/2t6FTFz

Delimitation of groundwater zones under contamination risk using a bagged ensemble of optimized DRASTIC frameworks

Abstract

Developing a reliable groundwater vulnerability and contamination risk map is very important for groundwater management and protection. This study aims to compare various modified DRASTIC vulnerability frameworks based on rate calibration using the Wilcoxon rank-sum test (WRST), frequency ratio (FR) and weight optimization using the correlation coefficient (CC), the analytic hierarchy process (AHP), and genetic algorithms (GA), as well as to introduce, for the first time, an aggregated approach based on a bagging ensemble to develop a combined modified DRASTIC model. This research was conducted in the Khoy plain, NW Iran. To develop a typical DRASTIC map, seven DRASTIC data layers were generated, weighted, and then overlaid in ArcGIS. The nitrate (NO₃) concentrations at 54 sites in the study area were used to validate the models by calculating the correlation coefficient (r) between the vulnerability/risk indices and NO₃ concentrations. The calculated r value for the typical DRASTIC was 0.12. A sensitivity analysis reveals that the impact of the vadose zone and conductivity parameters with mean variation indices of 22.2 and 7.5%, respectively, have the highest and lowest influence on aquifer vulnerability. The r values increased for all the optimized frameworks. The results show that the WRST and GA methods are the most effective methods for calibration and optimization of DRASTIC rates and weights, with the WRST-GA-DRASTIC model obtaining an r value of 0.64. A bagging ensemble model was employed to combine the advantages of each standalone model. The bagging ensemble model yields an r value of 0.67. The ensemble model has the potential to increase the r value further than both the standalone optimized frameworks and the typical DRASTIC approach. In terms of spatial distribution class area (%), the bagging ensemble-DRASTIC model demonstrates that the moderate and low contamination risk classes with 16.4 and 23.1% of the total area cover the lowest and highest parts of the plain.

http://bit.ly/2MMunrW

Buoyant wind-driven pollutant dispersion and recirculation behaviour in wedge-shaped roof urban street canyons

Abstract

The present study investigated the buoyant wind-driven pollutant plume dispersion and recirculation behaviour inside urban street canyons formed by buildings with wedge-shaped roofs. Numerical modelling was performed using a computational fluid dynamics (CFD) large eddy simulation (LES). Street canyon models with a strongly buoyant fire source located on the street and environmental winds perpendicular to the canyon were developed using the fire dynamics simulator (FDS). The complex interaction of buoyancy and wind, as well as their combined effects on the pollutant plume dispersion, was simulated inside the urban street canyon. The results showed that the flow pattern of pollutant plume dispersion inside the street canyon with increasing wind speed for different roof inclination angles could be divided into three regimes, including a recirculation regime, a quasi-recirculation regime and a non-recirculation regime. The pollutant levels in the street canyon, as indexed by carbon monoxide (CO) concentration, increased under the recirculation regime. For the quasi-recirculation regime, however, the leeward buildings primarily suffered from the higher pollutant levels. The critical wind speed needed to trigger recirculation was analysed for various roof inclination angles. A correlation was proposed to predict the critical wind speed of various wedge-shaped roof angles for recirculation regime and quasi-recirculation regimes.

http://bit.ly/2t6FN0F

Correlation between plan quality improvements and reduced acute dysphagia and xerostomia in the definitive treatment of oropharyngeal squamous cell carcinoma

Abstract

Background

To evaluate plan quality using volumetric‐modulated arc therapy (VMAT) and step‐and‐shoot intensity‐modulated radiation therapy (SS‐IMRT) techniques and for patients treated for oropharyngeal squamous cell carcinoma (OPSCC).

Methods

Treatment plans for patients treated definitively for stages I‐IVb, OPSCC between December 2009 and August 2015 were retrospectively reviewed. Dosimetric endpoints of involved organs‐at‐risk (OARs) were retrieved from clinical plans. Common Terminology Criteria for Adverse Events scores of acute toxicities were compared.

Results

Two‐hundred twenty‐two patients were identified with 134 and 88 receiving SS‐IMRT and VMAT with median follow‐up time of 23.0 and 7.9 months, respectively. The dosimetric endpoints of the OARs were significantly improved in VMAT cohort, which translated into significantly lower rates of grade 2 or higher acute dysphagia and xerostomia.

Conclusion

Improvements in stages I‐IVb, oropharyngeal cancer plan quality are associated with reduced grade ≥ 2 acute dysphagia and xerostomia.

http://bit.ly/2Wy7ZXq

Issue Information

http://bit.ly/2RsQAfg

Cover Image

The cover image, by Yifan Meng MD et al., is based on the Original Article Origin site‐based staging system of sinonasal inverted papilloma for application to endoscopic sinus surgery, DOI: 10.1002/hed.25435.

http://bit.ly/2Wy7Rao

Juvenile case of multiple morphea profunda resulting in joint contracture that was successfully treated with cyclosporin A: A case report and review of the published works

Abstract

Morphea profunda refers to inflammatory and sclerotic lesions that start primarily from the deep dermis, subcutaneous fat and fascia. Its pediatric case published work is limited. Here, we report the case of an 8‐year‐old girl with a 5‐year history of multiple subcutaneous nodules on her extremities and a right wrist joint contracture who had been previously diagnosed with juvenile idiopathic arthritis and treated with salazosulfapyridine, low‐dose prednisolone (PSL) and methotrexate. We performed biopsies of two subcutaneous nodules, which revealed the typical morphology of morphea profunda. She was administrated a tapered course of oral PSL then cyclosporin A (CyA) for 20 weeks which completely resolved her joint contracture and subcutaneous nodules. We reviewed 11 previously reported cases of morphea profunda and found that some include circumscribed/linear morphea that develop into subcutaneous tissues, indicating that "classical" morphea profunda arising within the deep tissues has rarely been reported. Our report is the first to demonstrate the efficacy of CyA for treatment of morphea profunda, and the possibility of CyA as a treatment option to reduce oral steroid doses in juvenile cases.

http://bit.ly/2RtJRlh

Severe genital frostbite due to improper use of an aerosol spray: A case of raising awareness of the risk of skin necrosis with aerosol propellants

http://bit.ly/2WxaHN1

Development of a liquid chromatography-tandem mass spectrometry method for quantification of the egg allergen ovalbumin in rat plasma

Publication date: Available online 31 January 2019

Source: Allergology International

Author(s): Ryohei Ogino, Tomoharu Yokooji, Asahi Omoto, Takanori Taogoshi, Eishin Morita, Hiroaki Matsuo

http://bit.ly/2RscBef

Age-related changes in serum periostin level in allergic and non-allergic children

Publication date: Available online 31 January 2019

Source: Allergology International

Author(s): Hiroko Fujitani, Saki Kasuga, Takuma Ishihara, Yusuke Higa, Shiori Fujikawa, Nobuo Ohta, Junya Ono, Kenji Izuhara, Haruo Shintaku

http://bit.ly/2Wx5btN

A very rare case of allergy to beluga caviar

Publication date: Available online 30 January 2019

Source: Allergology International

Author(s): Ciara Jade Bansal, Amolak Singh Bansal

http://bit.ly/2Rrwm5t

Prof. Heinz Stammberger, MD (Hon. FRCS (Ed.), Hon. FRCS (Engl.), Hon. FACS) December 1st 1946–December 9th 2018

http://bit.ly/2DJ2pdq

Default Mode Network Dynamics in Covert Consciousness

Publication date: Available online 30 January 2019

Source: Cortex

Author(s): Yelena G. Bodien, Zachary D. Threlkeld, Brian L. Edlow

http://bit.ly/2MIuyV0

Antecedents of satisfaction and engagement of low-carbon bicycle-sharing using in China

Abstract

Transport sector contributed numerous carbon emissions in China. It is important to promote low-carbon bicycle-sharing using in China. This paper aims to analyze the influencing factors of the satisfaction and engagement of bicycle-sharing in China. An extended model of customer satisfaction is established, which considers both customer satisfaction theory and customer engagement theory. We explore the different effect of convenience, health, safety, and facility on satisfaction of bicycle-sharing using. We also explore the role of satisfaction on three different dimensions of engagement: enthusiasm, participation, and social interaction. Multi-group structure equation model is employed to explore the different roles of gender on the determinants of satisfaction and engagement of bicycle-sharing using. The findings reveal that facilities had the larger effect on satisfaction of bicycle-sharing using than safety and health for male. Safety had the largest influence on satisfaction of bicycle-sharing using for female, followed by facility, convenience, and health.

http://bit.ly/2DM58mw

Assessment of swimming behavior of the Pacific oyster D-larvae ( Crassostrea gigas ) following exposure to model pollutants

Abstract

This study describes an image analysis method that has been used to analyze the swimming behavior of native oyster D-larvae (Crassostrea gigas) from the Arcachon Bay (SW, France). In a second time, this study evaluated the impact of copper and S-metolachlor pollutants on D-larvae swimming activity and the possible relationship between developmental malformations and abnormal swimming behavior. Analyses in wild and cultivated oyster D-larvae were investigated during two breeding-seasons (2014 and 2015) at different sampling sites and dates. In controlled conditions, the average speed of larvae was 144 μm s⁻¹ and the maximum speed was 297 μm s⁻¹ while the trajectory is mainly rectilinear. In the presence of environmental concentration of copper or S-metolachlor, no significant difference in maximum or average larval speed was observed compared to the control condition but the percentage of circular trajectory increased significantly while the rectilinear swimming larvae significantly declined. The current study demonstrates that rectilinear trajectories are positively correlated to normal larvae while larvae with shell anomalies are positively correlated to circular trajectories. This abnormal behavior could affect the survival and spread of larvae, and consequently, the recruitment and colonization of new habitats.

http://bit.ly/2UrCqgc

Using gauze to evenly spread starch for hyperhidrosis testing

Publication date: Available online 31 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Mohammed I. AlJasser

http://bit.ly/2MFPRql