Three unusual histopathological presentations of angiolymphoid hyperplasia with eosinophilia

Abstract

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a poorly understood benign vasculoproliferative disorder. Histopathologicaly, the lesions are composed of a dermal or subcutaneous proliferation of blood vessels of varying sizes with plump and bland endothelial cells, which often show vacuolization and protrusion of the cytoplasm into the lumen. The vascular proliferation is admixed with a diffuse inflammatory infiltrate composed of lymphocytes, eosinophils, and mast cells. Lymphoid follicles with germinal centers can sometimes be seen. Additionally, fibrosis is a common accompanying feature. Some clinical and histopathological variants of ALHE have already been described in the literature. In this report, we present three rare associations of ALHE that have not been previously described. Case 1 was a 73-year-old woman with a lesion on her right medial thigh. Examination showed ALHE admixed with a chronic lymphocytic leukemic (CLL) infiltrate. Case 2 was a 55-year-old woman with a lesion on her right anterior ankle, which was a syringocystademoma papilliferum coexisting with an ALHE. Case 3 was a 54-year-old man with a lesion on the left medial thigh, which showed overlapping features of IgG4-related disease associated with areas of ALHE. Given these multiple and diverse associations, it seems likely that ALHE may be a reactive rather than neoplastic process.

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Cutaneous Extranodal NK/T Cell Lymphoma Mimicking Cellulitis in a HIV Positive Patient without Lymphopenia

Abstract

We present the case of a 28-year-old male with a history of HIV with a 1-month history of a steadily enlarging, firm painful lesion on the right posterior shoulder. The patient was initially treated for cellulitis given his clinical picture. Histopathologic examination revealed an angiocentric and dermal proliferation of markedly atypical lymphoid cells with numerous mitoses and apoptotic bodies along with broad zones of necrosis. Biopsy revealed the presentation to be consistent with NK/T-cell lymphoma. The cutaneous lesions from NK/T-cell lymphoma can often be initially mistaken for cellulitis, therefore this malignancy should be included on the differential in a patient HIV/AIDS.

http://ift.tt/2iLcObs

Associations between Both Lignan and Yogurt Consumption and Cardiovascular Risk Parameters in an Elderly Population: Observations from a Cross-Sectional Approach in the PREDIMED Study

Publication date: Available online 29 December 2016
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Anna Creus-Cuadros, Anna Tresserra-Rimbau, Paola Quifer-Rada, Miguel Angel Martínez-González, Dolores Corella, Jordi Salas-Salvadó, Montse Fitó, Ramon Estruch, Enrique Gómez-Gracia, José Lapetra, Fernando Arós, Miquel Fiol, Emili Ros, Lluís Serra-Majem, Xavier Pintó, Juan José Moreno, Miguel Ruiz-Canela, Jose Vicente Sorli, Josep Basora, Helmut Schröder, Rosa Maria Lamuela-Raventós
BackgroundThe study of dietary patterns is gaining interest. Although the health benefits of yogurt and lignans have been investigated separately, to our knowledge there are no studies on their associative effects.ObjectiveThe aim of this study was to evaluate a possible association between yogurt and lignans using biomarkers of cardiovascular disease risk in an elderly population.DesignWe conducted a cross-sectional analysis of the association between baseline dietary information and cardiovascular risk parameters using food frequency questionnaires.ParticipantsWe enrolled 7,169 Spanish participants of the PREDIMED (Prevención con Dieta Mediterránea) study (elderly men and women at high cardiovascular risk) from June 2003 to June 2009.Main outcome measuresCardiovascular risk parameters, including cholesterol, triglycerides, glucose, body mass index, weight, waist circumference, and blood pressure were measured.Statistical analysisGeneral linear models were used to assess the relationship between categorical variables (yogurt, total dairy intake, lignans, and yogurt plus lignans) and cardiovascular risk parameters.ResultsThe consumption of either yogurt or lignans seems to have beneficial effects on human health, but the consumption of both showed greater improvement in some cardiovascular health parameters. Indeed, participants with a higher consumption of both yogurt and lignans showed lower total cholesterol (estimated β-coefficients=−6.18; P=0.001) and low-density lipoprotein cholesterol levels (β=−4.92; P=0.005). In contrast, participants with lower yogurt and lignan consumption had a higher body mass index (β=0.28; P=0.007) and weight (β=1.20; P=0.008).ConclusionsHigh lignan and yogurt consumption is associated with a better cardiovascular risk parameters profile in an elderly Mediterranean population. Further research is warranted to determine the mechanisms and consequences of this potential effect.



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The immune infiltrate in prostate, bladder and testicular tumors: an old friend for new challenges

Publication date: Available online 30 December 2016
Source:Cancer Treatment Reviews
Author(s): Cinzia Solinas, Nieves Martinez Chanzá, Ahmad Awada, Mario Scartozzi
In genito-urinary tumors immunotherapy has been administered for a long time: Calmette-Guèrin Bacillus as adjuvant treatment in high risk patients with non-muscle invasive urothelial bladder cancer and interleukin-2 and interferon-α in metastatic kidney cancer. The vaccine Sipuleucel-T has been recently approved by United States Food and Drug Administration for the treatment of castration resistant prostate cancer patients with asymptomatic or minimally symptomatic disease, given the 22% reduction of mortality risk in this group. Recently immunotherapeutic agents targeting inhibitory immune checkpoint molecules lead to improved outcomes and lasting anti-tumor effects in a variety of hematological and solid malignancies, including urogenital tumors. The benefit from these treatments has been observed in a proportion of subjects, raising a need in optimizing patients' selection. The composition and activity of a pre-existing immune infiltrate may aid in identifying ideal candidates to immunotherapy, with possible implications for the clinical management of neoplastic diseases from earlier to later stages.



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Impact of targeted therapies in metastatic renal cell carcinoma on patient-reported outcomes: methodology of clinical trials and clinical benefit

Publication date: Available online 30 December 2016
Source:Cancer Treatment Reviews
Author(s): M. Dos Santos, P.E. Brachet, C. Chevreau, F. Joly
BackgroundMolecular targeted therapies have improved progression-free survival (PFS) without translating systematically into overall survival (OS) for patients with metastatic renal cell carcinoma (mRCC). In this population, patient-reported outcomes (PROs) have become a significant outcome. We evaluated the methodological quality of the assessment of PROs in randomised controlled trials (RCTs) and the clinical benefit of the different treatments including survival and quality of life (QoL).MethodsA systematic review identified RCTs published between January 2005 and July 2014. They were evaluated according to 11 items derived from the 2013 CONSORT PROs reporting guidelines. Survival outcomes and PROs main results were analysed and the magnitude of clinical benefit was assessed with the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS).Results12 RCTs were included with a total of 22 publications. The mean CONSORT score for all items was 4.5 on an 11-point scale. No publication reported the power of the PROs analysis and only one reported a PRO hypothesis. 50% of studies did not interpret PROs in relation to clinical outcomes and only 18% discussed specific limitations of PROs and their implications for generalizability. By adding the QoL criterion to PFS, 4 trials (36.4%) obtained a high level of proven clinical benefit according to the ESMO-MCBS.ConclusionThe methodology for assessing PROs in mRCC is not optimal. Efforts should focus on defining PROs endpoint and increasing the quality of reporting of QoL.New-generation therapies in mRCC should demonstrate a gain not only in survival but also in QoL to be included in the therapeutic arsenal.



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Exploring the possible mechanisms of blunted cardiac reactivity to acute psychological stress

Publication date: Available online 30 December 2016
Source:International Journal of Psychophysiology
Author(s): Ryan C. Brindle, Anna C. Whittaker, Adam Bibbey, Douglas Carroll, Annie T. Ginty
Blunted cardiovascular reactivity to acute psychological stress has been linked to a range of adverse health and behavioral outcomes. However, the origins of blunted reactivity remain unclear. The current study aimed to explore the following possibilities: different appraisals of task stressfulness and/or difficulty, diminished task effort, or reduced physiological capacity to respond. Individuals characterized, via pre-screening, as blunted (n=17) or exaggerated (n=16) heart rate (HR) reactors to acute psychological stress (socially evaluative mental arithmetic) were exposed to a psychological stress, cold pressor and exercise tasks during a follow-up testing session while HR and blood pressure (BP) were measured. At follow-up, groups again mounted significantly different HR reactions to psychological stress, despite reporting similar levels of subjective stress and difficulty, and achieving similar tasks scores (measure of task effort) at both testing sessions. In response to the cold pressor and exercise blunted and exaggerated reactors displayed similar HR and BP responses. Results indicated that blunted reactors do not differ from exaggerated reactors on appraisals of task stressfulness or difficulty, or objective task effort, and do possess the physiological capacity to respond to other laboratory challenges. Other sources of blunted stress reactivity remain to be explored.



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Local recurrence of cutaneous mixed tumor (chondroid syringoma) as malignant mixed tumor of the thumb 20 years after initial diagnosis

ABSTRACT

Benign cutaneous mixed tumor (chondroid syringoma) is the cutaneous counterpart of the benign mixed tumor (pleomorphic adenoma) of salivary glands, consisting of both epithelial and mesenchymal elements. The incidence of cutaneous mixed tumor is rare, composing < 0.01% of all primary skin tumors. Herein, we report a case of malignant mixed tumor which recurred in the right thumb 20 years after the reported initial diagnosis of a benign mixed tumor at this site. Histologically, the lesion consisted of highly atypical and infiltrative cells in cords and ductal structures, with an adjacent focus of residual benign mixed tumor present. Perineural invasion of multiple dermal and subcutaneous nerves was also seen. . Immunohistochemical staining was strongly and diffusely positive for CK5/6 and p63, with patchy positive S100 and CK7 staining. Wide excision was performed, with no evidence of recurrence or over metastasis five years later.

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Extra-acral cutaneous sclerosing perineurioma with CD34 fingerprint pattern.

Abstract

Sclerosing perineuroma is a variant of extraneural perineurioma that, as a rule, occurs in acral sites. However, it has also been occasionally reported in non-acral regions. Recently, CD34 expression in a pattern reminiscent of the human fingerprint has been observed in a subset of perineuriomas, but this immunohistochemical finding has not been documented in non-acral sclerosing perineuriomas. We report a case of sclerosing perineurioma presenting CD34 expression in a fingerprint-like pattern on the skin of the neck (a previously unreported site for this neoplasm) of a 56-year-old man. Additionally, alpha smooth-muscle actin showed a similar pattern of expression, suggesting that the cell population implicated in the remarkable immunolabeling is most likely fibroblastic/myofibroblastic. Other immunohistochemical findings included EMA and claudin1 - positive lesional cells, and the absence of S100, GLUT1, MUC4, and desmin.

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A Rare Case of Cutaneous Oncocytic Hidradenoma

Abstract

Oncocytes are epithelial cells characterized by their abundant eosinophilic and finely granular cytoplasm. Their histologic appearance is due to excessive amounts of cytoplasmic mitochondria. Oncocytes generally occur in the setting of benign neoplasms. Oncocytomas, or tumors composed primarily of oncocytes, are typically found in the kidneys. Other common sites include the salivary, thyroid, and parathyroid glands. Oncocytic metaplasia has only been rarely reported in various cutaneous neoplasms. We report a case of an elderly male presenting with a 5 millimeter erythematous papule on his left scalp, who underwent a shave biopsy showing a nodular, dermal-based adnexal tumor with prominent ductal differentiation, composed of multiple small, well-formed lumina surrounded by enlarged, bland-appearing epithelioid cells. CK7, EMA, and mCEA immunohistochemical stains were positive, consistent with adnexal differentiation. PTAH and LFB stains highlighted the cytoplasmic granules, consistent with mitochondria. The overall findings were consistent with oncocytic nodular hidradenoma. Oncocytic hidradenoma is a very rare entity, with only 1 previously reported case in the literature.

http://ift.tt/2ijNM43

MRI-guided functional anatomy approach to prostate brachytherapy

Publication date: Available online 29 December 2016
Source:Brachytherapy
Author(s): Payal D. Soni, Alejandro Berlin, Aradhana M. Venkatesan, Patrick W. McLaughlin
PurposeTo provide an MRI based functional anatomy guide to prostate brachytherapy.Methods and MaterialsWe performed a narrative review of periprostatic functional anatomy and the significance of this anatomy in prostate brachytherapy treatment planning.ResultsMRI has improved delineation of gross tumor and critical periprostatic structures that have been implicated in toxicity. Furthermore, MRI has revealed the significant anatomic variants and the dynamic nature of these structures that can have significant implications for treatment planning and dosimetry.ConclusionsThe MRI-based functional anatomy approach to prostate brachytherapy takes into account extent of disease, its relation to the patient's individual anatomy, and functional baseline to optimize the therapeutic ratio of prostate cancer treatment.



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Lipid Desaturation Is a Metabolic Marker and Therapeutic Target of Ovarian Cancer Stem Cells

Publication date: Available online 29 December 2016
Source:Cell Stem Cell
Author(s): Junjie Li, Salvatore Condello, Jessica Thomes-Pepin, Xiaoxiao Ma, Yu Xia, Thomas D. Hurley, Daniela Matei, Ji-Xin Cheng
Lack of sensitive single-cell analysis tools has limited the characterization of metabolic activity in cancer stem cells. By hyperspectral-stimulated Raman scattering imaging of single living cells and mass spectrometry analysis of extracted lipids, we report here significantly increased levels of unsaturated lipids in ovarian cancer stem cells (CSCs) as compared to non-CSCs. Higher lipid unsaturation levels were also detected in CSC-enriched spheroids compared to monolayer cultures of ovarian cancer cell lines or primary cells. Inhibition of lipid desaturases effectively eliminated CSCs, suppressed sphere formation in vitro, and blocked tumor initiation capacity in vivo. Mechanistically, we demonstrate that nuclear factor κB (NF-κB) directly regulates the expression levels of lipid desaturases, and inhibition of desaturases blocks NF-κB signaling. Collectively, our findings reveal that increased lipid unsaturation is a metabolic marker for ovarian CSCs and a target for CSC-specific therapy.

Graphical abstract

Teaser

Cheng and colleagues using Raman spectroscopic imaging find that ovarian cancer stem cells contain unusually high levels of unsaturated lipids and show evidence that this metabolic difference could be used as a marker for these cells and as a new target for CSC-specific therapy.


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Induction of Expansion and Folding in Human Cerebral Organoids

Publication date: Available online 29 December 2016
Source:Cell Stem Cell
Author(s): Yun Li, Julien Muffat, Attya Omer, Irene Bosch, Madeline A. Lancaster, Mriganka Sur, Lee Gehrke, Juergen A. Knoblich, Rudolf Jaenisch
An expansion of the cerebral neocortex is thought to be the foundation for the unique intellectual abilities of humans. It has been suggested that an increase in the proliferative potential of neural progenitors (NPs) underlies the expansion of the cortex and its convoluted appearance. Here we show that increasing NP proliferation induces expansion and folding in an in vitro model of human corticogenesis. Deletion of PTEN stimulates proliferation and generates significantly larger and substantially folded cerebral organoids. This genetic modification allows sustained cell cycle re-entry, expansion of the progenitor population, and delayed neuronal differentiation, all key features of the developing human cortex. In contrast, Pten deletion in mouse organoids does not lead to folding. Finally, we utilized the expanded cerebral organoids to show that infection with Zika virus impairs cortical growth and folding. Our study provides new insights into the mechanisms regulating the structure and organization of the human cortex.

Graphical abstract

Teaser

The growth and structural formation of the human cortex can be modeled in vitro using cerebral organoids. In this article, Li, Muffat, and colleagues show that enhancing the PTEN-AKT signaling pathway leads to the generation of human cerebral organoids that are expanded in size and display surface folding.


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A Quiescent Bcl11b High Stem Cell Population Is Required for Maintenance of the Mammary Gland

Publication date: Available online 29 December 2016
Source:Cell Stem Cell
Author(s): Shang Cai, Tomer Kalisky, Debashis Sahoo, Piero Dalerba, Weiguo Feng, Yuan Lin, Dalong Qian, Angela Kong, Jeffrey Yu, Flora Wang, Elizabeth Y. Chen, Ferenc A. Scheeren, Angera H. Kuo, Shaheen S. Sikandar, Shigeo Hisamori, Linda J. van Weele, Diane Heiser, Sopheak Sim, Jessica Lam, Stephen Quake, Michael F. Clarke
Stem cells in many tissues sustain themselves by entering a quiescent state to avoid genomic insults and to prevent exhaustion caused by excessive proliferation. In the mammary gland, the identity and characteristics of quiescent epithelial stem cells are not clear. Here, we identify a quiescent mammary epithelial cell population expressing high levels of Bcl11b and located at the interface between luminal and basal cells. Bcl11b^high cells are enriched for cells that can regenerate mammary glands in secondary transplants. Loss of Bcl11b leads to a Cdkn2a-dependent exhaustion of ductal epithelium and loss of epithelial cell regenerative capacity. Gain- and loss-of-function studies show that Bcl11b induces cells to enter the G0 phase of the cell cycle and become quiescent. Taken together, these results suggest that Bcl11b acts as a central intrinsic regulator of mammary epithelial stem cell quiescence and exhaustion and is necessary for long-term maintenance of the mammary gland.

Graphical abstract

Teaser

Bcl11b interacts with cell-cycle regulators to induce a quiescent state. Cai et al. describe a quiescent mammary stem cell population labeled by Bcl11b and located at the luminal-basal interface that supports mammary gland regeneration. Bcl11b sustains this population by inducing cell-cycle regulators that promote the dormant state.


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Cooling devices in laser therapy

Anupam Das, Aarti Sarda, Abhishek De

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):215-219

Cooling devices and methods are now integrated into most laser systems, with a view to protecting the epidermis, reducing pain and erythema and improving the efficacy of laser. On the basis of method employed, it can be divided into contact cooling and non-contact cooling. With respect to timing of irradiation of laser, the nomenclatures include pre-cooling, parallel cooling and post-cooling. The choice of the cooling device is dictated by the laser device, the physician's personal choice with respect to user-friendliness, comfort of the patient, the price and maintenance costs of the device. We hereby briefly review the various techniques of cooling, employed in laser practice.

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O to Z local skin flap: The role for managing depressed facial scar after resolution of odontogenic source of infection

Amin Rahpeyma, Saeedeh Khajehahmadi

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):278-279



http://ift.tt/2hSI6x2

Diode laser ear piercing: A novel technique

Bibilash Babu Suseela, Preethitha Babu, Ravi Kumar Chittoria, Devi Prasad Mohapatra

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):263-265

Earlobe piercing is a common office room procedure done by a plastic surgeon. Various methods of ear piercing have been described. In this article, we describe a novel method of laser ear piercing using the diode laser. An 18-year-old female patient underwent an ear piercing using a diode laser with a power of 2.0 W in continuous mode after topical local anaesthetic and pre-cooling. The diode laser was fast, safe, easy to use and highly effective way of ear piercing. The advantages we noticed while using the diode laser over conventional methods were more precision, minimal trauma with less chances of hypertrophy and keloids, no bleeding with coagulation effect of laser, less time taken compared to conventional method and less chance of infection due to thermal heat effect of laser.

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Use of dermatoscope to monitor the repigmentation of various vitiligo surgical procedures

Balakrishnan Nirmal

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):286-287



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Overview of local flaps of the face for reconstruction of cutaneous malignancies: Single institutional experience of seventy cases

Jagdeep K Rao, Kaustubh Sharad Shende

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):220-225

Context: The most common malignant tumours of the face are basal cell carcinoma, squamous cell carcinoma and melanoma. While the results of skin graft are less than satisfactory for large areas to cover, distant flaps are bulky with a poor colour match. Local fasciocutaneous flaps provide reasonable option for reconstruction of facial defects with good colour and texture match and good success rate. Aims: This study aimed to analyse the various modalities of reconstruction after resection of facial malignancies and their advantages and disadvantages. Settings and Design: This was a retrospective study. Materials and Methods: Of 70 patients, 34 were managed with V-Y advancement flap, 24 with nasolabial flap, 8 with median forehead flap and 4 with standard forehead flap cover. The duration of follow-up ranged from 6 months to 2 years. Statistical Analysis Used: Nil. Results: Of 34 V-Y advancement flaps, 2 showed suture dehiscence at the apex of triangle which was allowed to heal secondarily with regular dressings. All the 24 nasolabial flaps were healthy without any complication. All patients had satisfactory functional and cosmetic outcomes. Conclusions: In our experience, local flaps give the best results and are the first choice for reconstruction of the face. Most defects can be best closed by nasolabial, V-Y advancement and forehead flap. Outstanding functional and cosmetic results can be achieved. Proper execution requires considerable technical skill and experience.

http://ift.tt/2hSCm68

Outcome of flap surgeries in dermatosurgical unit at a tertiary care centre in India with a review of literature

Gorur Kalappa Divya, Kanathur Shilpa, Sacchidanand Sarvajnamurthy, Eswari Loganathan, Biju Vasudevan, GB Chitrika, C Madhura, DV Lakshmi

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):226-231

Introduction: Flap surgeries are an excellent choice for closing large defects following trauma, excision of carcinomas or removal of large lesions. This article is a prospective interventional study of various flap surgeries performed at a tertiary care centre with their outcome in dermatosurgical unit. Materials and Methods: A total of 35 flap surgeries performed from January 2012 to December 2014 formed part of the study. Data were recorded for each case including age, sex, indications and type of flap surgery and any occurrence of complications. Results: Out of the 35 patients, basal cell carcinoma was the most common indication for surgery in 22 patients, followed by Bowen's disease in five, dermatofibroma in three and porocarcinoma in two. Other indications were squamous cell carcinoma, tuberous xanthoma, myxoid cyst and nevus sebaceous. Rhomboid flap and rotaion flap were done in 12 patients each, V-Y plasty in three patients, advancement flap, crescentic advancement flap and O-Z plasty were done in two patients each, O-Z plasty was done in two patients, A-T plasty and H plasty were done in one patient each. Common complications observed were flap necrosis seen in three patients and one patient developed hematoma on the second post-operative day, hypertrophic scar in one case and recurrence of BCC. Conclusion: Malignant and pre-malignant lesions were common indications in our study. Excellent outcome of flap surgeries promises to be a birdie stroke in the armamentarium of dermatosurgeons.

http://ift.tt/2hB04rE

Onychomatricoma: A case report with 5-year follow-up

Cleide Eiko Ishida, Bruna Melhoranse Gouveia, Tullia Cuzzi, Marcia Ramos-e-Silva

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):270-273

The authors present a case of onychomatricoma, a rare benign tumour of the nail matrix, first described by Baran and Kint in 1992. The lesion appeared on the proximal nail fold, covering half the nail of the second left finger. The nail was thickened and yellowish with longitudinal melanonychia. It was surgically removed with very satisfactory aesthetic results even after 5 years. A review on the subject is also presented.

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Reduction of blister formation time in suction blister epidermal grafting in vitiligo patients using a household hair dryer

Shweta Arora, Bikash Ranjan Kar

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):232-235

Background: Suction blister epidermal grafting (SBEG) is a simple and effective way of surgical repigmentation in vitiligo. The major problem faced is the time taken for the formation of blisters. Temperature at the suction site is one of the factors affecting the blister formation time. Aims and Objectives: To reduce the blister formation time in SBEG by increasing the surface temperature to 44°C. Materials and Methods: This is a left-right comparison study. Total seven patients with lip vitiligo involving both the angles of lips were enrolled. Suction syringes were applied on both the thighs of all the patients. On the right thigh, blisters were raised as per the procedure standardised by Gupta et al. On the left thigh, similar procedure was used, but a hair dryer was used additionally to increase the surface temperature of the skin to 44°C. The time taken for the formation of well-formed, dome-shaped, unilocular blister was noted. Results: The mean time taken for the formation of blister on the right thigh was 121.1 ± 6.2 min and on the left thigh was 69.6 ± 5.4 min. All the seven patients were started on PUVASOL after SBEG. There was complete repigmentation of the grafted sites in all the patients after 2 months. Conclusion: Hair dryer is easily available, affordable and simple to use and the time saved during the procedure is quite significant.

http://ift.tt/2hB838e

Angiolymphoid hyperplasia with oeosinophilia showing promising result with intralesional radio-frequency ablation therapy: A new cost-effective and hassle-free modality of treatment

Chintaginjala Aruna, Senthil Kumar Alagappan, Ramamurthy Damaraju Venkata Satya Bhaskara, Sruthi Kondaveeti

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):281-283



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Comparative study to evaluate the efficacy of radiofrequency ablation versus trichloroacetic acid in the treatment of xanthelasma palpebrarum

Praveen Kumar Shanmugam Reddy, Sumathy Tharayil Kunneth, Shyam Prasad Arakali Lakshminarayana, Suparna Madivalara Yallappa, Ranganathan Chandrashekara, Shivaswamy Kanakapura Nanjundaswamy

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):236-240

Background: Xanthelasma palpebrarum (XP) is a metabolic disorder involving the eyelids. Radiofrequency(RF) surgery and trichloroacetic acid (TCA) applications have been listed among the procedures for XP, but comparative studies are not available. Aim: To compare the efficacy of radiofrequency surgery versus trichloroacetic acid application in the treatment of XP. Settings and Design: 20 consecutive cases of XP attending dermatology, medicine and endocrinology out-patient departments of M.S.Ramaiah teaching hospital were enrolled for the study. It was an open-label clinical trial conducted in our hospital for a duration of 1 year. Materials and Methods: 20 consecutive patients conforming to inclusion criteria were selected for the study. For each patient, lesions were treated with radiofrequency ablation on one side and TCA application on the other side. Results: RF ablation was done for 12 patients over right eye lesions and 8 patients over the left eye lesions. TCA applications were done for 8 patients over right eye lesions and 12 patients over left eye lesions. 70% of lesions treated with RF ablation had a score of improvement of 4 and 70% of lesions treated with TCA application had a score of improvement of 4, at 4 weeks of follow-up. At four weeks of follow-up 40% in RF group and 15% in TCA group had scarring and 45% in RF group and 30% in TCA group had pigmentation. Conclusion: RF ablation as compared to TCA application, required fewer sessions for achieving more than 75% clearance of lesions. However, TCA applications were associated with fewer complications comparatively.

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Crossing surgical borders: Where are we, where are we going and can we find the way?

Niti Khunger

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):213-214



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Papular acne scars of the nose and chin: An under-recognised variant of acne scarring

Faisal R Ali, Michael Kirk, Vishal Madan

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):241-243

Background: Scarring following acne vulgaris is common and can be of profound psychosocial consequence. Aims and Objectives: We have clinically noted a variant of acne scarring, overlooked by previous categorisation schemes, which we have denominated as papular acne scars of the nose and chin. We sought to characterise these novel entities further. Materials and Methods: Initially, we identified 14 patients with papular acne scars of the nose and chin in a cosmetic dermatology clinic, of whom two were female and rest were male. We then prospectively evaluated 100 consecutive patients attending our tertiary referral acne isotretinoin clinic and 49 patients attending a general dermatology clinic. Results: Amongst 149 patients, from a general dermatology and tertiary acne clinic, soft papular scars were noted in four patients, distributed on the nose and chin. Three of the four patients were male, three patients had additional acne scars and the median age was 23.5. Conclusions: We have identified 18 patients with papular acne scars of the nose and chin and propose that this new category should be added to acne scarring classification schemes. Future work should be directed at corroborating the epidemiology of such lesions and describing effective treatment modalities.

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Familial disseminated cutaneous glomuvenous malformation: Treatment with polidocanol sclerotherapy

Aditi Jha, Niti Khunger, K Malarvizhi, V Ramesh, Avninder Singh

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):266-269

Glomuvenous malformations (GVMs) present as asymptomatic multiple pink-to-blue nodules or plaques. Disseminated lesions are rare, representing 10% of all the cases. Familial cases are caused by mutations in the glomulin gene. A young male presented with multiple bluish-to-dusky red-coloured nodules 10-15 in numbers over the trunk, limbs and buttocks since 12 years of age. They ranged in size from 1 to 3 cm, partially to non-compressible and tender on palpation. There was no history of any systemic complaint. His sister and mother had similar lesions but in a limited distribution. Biopsy showed multiple ectatic dilated vascular channels lined by multiple layers of glomus cells consistent with the diagnosis of GVM. The biopsy of the lesions from the mother and sister also showed similar features. Mutation analysis for glomulin gene could not be done because of the unavailability of the facility at our setting. He underwent sclerotherapy with 3% polidocanol every 2 weeks, and there was significant improvement in the lesions after six sessions of sclerotherapy. The patient is under follow-up and there is no recurrence of the lesions over treated sites after 6 months.

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Outcome of dermal grafting in the management of atrophic facial scars

Kanathur Shilpa, S Sacchidanand, Budamakuntla Leelavathy, Padmanabha Shilpashree, Gorur Divya, Rammurthy Ranjitha, DV Lakshmi

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):244-248

Background: Scars over the face are cosmetically and psychologically disturbing. Various techniques have been described and are being practiced in the management of these scars. Aims and Objectives: This study was undertaken to study the safety, effectiveness of using dermal grafts as fillers in the management of facial scars due to acne, chickenpox, trauma or any others. Materials and Methods: Fifteen patients with atrophic facial scars of varied aetiology and willing for surgery were considered for dermal graft technique. After pre-operative workup, subcision was done 2 weeks before planned surgery. Depending on the type of scar, grafts were inserted using pocket or road railing techniques. Scar improvement was assessed based on patient satisfaction. Results: Linear scars showed excellent improvement. Acne, varicella and traumatic scars also showed good improvement. However, two patients did not appreciate improvement due to marked surface irregularities as the scars were elevated. They were further subjected to LASER and chemical peel resurfacing. Conclusion: Dermal grafting can be used in the management of any round to oval facial scar which is soft, prominent and at least 4-5 mm across; linear scars at least 2-3 mm across and 3-4 cm in length. However, scars with prominent surface irregularities need further resurfacing techniques along with dermal grafting. Limitations: Limitations of the study include small sample size, and only subjective assessment of the scar has been taken into consideration to assess the outcome.

http://ift.tt/2hSBGxO

It is the cooperation, stupid!

Somesh Gupta

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):274-277

The rise of aesthetics in medicine has resulted from society's acknowledgement of the importance of physical beauty. This has led to an emerging conflict between allied specialties. The author introduces the concept of "Aesthetic Socialism" according to which everyone should have an opportunity to enhance or restore the beauty where it is missing or when it is lost due to disease, trauma or ageing. However, there are multiple aspects of aesthetics, which can not be addressed by a single specialty, therefore author recommends interdisciplinary cooperation rather than conflict to achieve aesthetic socialism.

http://ift.tt/2hB3yu4

Near infrared pulsed light for permanent hair reduction in Fitzpatrick skin types IV and V

Pratik Thacker, Pramod Kumar

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):249-253

Background: Excessive hair on the face is a significant cause for distress amongst women. Permanent hair reduction methods including lasers and pulsed light devices are increasingly being used. Aims: The aim of this study is to evaluate the efficacy and safety of near infrared pulsed light source for permanent hair reduction in women seeking treatment for excessive hair growth on the upper lip and chin. Settings and Design: This was a prospective observational study done at a tertiary care hospital in South India. Materials and Methods: Women above 18 years of age were observed for six sittings of the treatment for excessive hair over the upper lip and chin using a near infrared intense pulsed light device. Efficacy was evaluated by measuring percentage hair reduction using digital photography. Further, efficacy amongst women with polycystic ovarian syndrome (PCOS) was compared with those without PCOS. Side effects were noted. Statistical Analysis Used: Student's unpaired t-test using the software SPSS version 16. Results: Percentage hair reduction at the end of 6 sittings in 24 women for the upper lip and chin was 52.87% and 73.81%, respectively. Out of the 24 women, 12 had PCOS and the difference in hair reduction in these women was statistically insignificant when compared to that observed in those without PCOS. Only two patients experienced side effects in the form of mild pain and discomfort. Conclusions: Intense pulsed light is a safe and efficacious tool for permanent hair reduction over the upper lip and chin, efficacy being similar in patients with or without PCOS.

http://ift.tt/2hSI20g

Utility of laser in lobuloplasty

Sandhya Pandey, Ravi Kumar Chittoria, Elan Kumar, Devi Prasad Mohapatra, MT Friji, Dinesh Kumar Sivakumar

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):279-281



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Nail photography: Tips and tricks

Feroze Kaliyadan, KT Ashique

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):254-257

Photographic documentation of the nails is important in the objective evaluation of response to treatment and in disseminating scientific information related to nail diseases. The key to a good image of the nail is proper framing and achieving a sharp focused image with good contrast with the background, at the same time avoiding strong reflections from the nail surface. While the general principles of clinical photography apply to nail imaging also, this article attempts to highlight some tips which can be specifically used to improve the quality of nail images.

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A linear fleshy corrugated plaque on the right vulva: A diagnostic surprise

Aditya Kumar Bubna, Poojitha Pedarla

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):283-285



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Autologous smashed dermal graft with epidermal re-closure: Modified technique for acne scars

Umashankar Nagaraju, Mahesh K Chikkaiah, Belliappa P Raju, Priyanka Agarwal

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):258-262

Conventional technique of dermal grafting for acne scars where the source of filler material used is the patient's own dermis requires longer surgical time, recovery period and can result in unsightly scars at the donor area. Hence, it is not suitable for treating a larger number of scars. Furthermore, these dermal grafts are firm and cannot be contoured to fit all types of acne scars. Occurrence of epidermal cyst and secondary infection is another complication if epidermis is not completely removed. Enzymatic techniques need trypsinisation which is expensive and requires laboratory facilities.

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Repeatability of CT-based anthropomorphic measurements of frailty in patients with pulmonary fibrosis undergoing lung transplantation

Publication date: Available online 29 December 2016
Source:Current Problems in Diagnostic Radiology
Author(s): Taylor McClellan, Brian C. Allen, Matthew Kappus, Lubna Bhatti, Randa A. Dafalla, Laurie D. Snyder, Mustafa R. Bashir
PurposeTo determine inter- and intra-reader repeatability and correlations between measurements of CT based anthropomorphic measurements in patients with pulmonary fibrosis undergoing lung transplantation.MethodsThis was an IRB approved, HIPAA compliant retrospective study of 23 randomly selected subjects (19 male and 4 female; median age: 69 years, range: 66–77 years) with idiopathic pulmonary fibrosis undergoing pulmonary transplantation, who had also undergone preoperative thoraco-abdominal CT. Five readers of varying imaging experience independently performed the following cross-sectional area measurements at the inferior endplate of the L3 vertebral body: right and left psoas muscles, right and left paraspinal muscles, total abdominal musculature, visceral and subcutaneous fat. The following measurements were obtained at the inferior endplate of T6: right and left paraspinal muscles with and without including the trapezius muscles and subcutaneous fat. Three readers repeated all measurements to assess intra-reader repeatability.ResultsIntra-reader repeatability was nearly perfect (ICC=0.99, p<0.001). Inter-reader agreement was excellent across all five readers (ICC=0.71–0.99, p<0.001). Coefficients of variance between measures ranged from 3.2–6.8% for abdominal measurements, but were higher for thoracic measurements, up to 23.9%. Correlation between total paraspinal and total psoas muscle area was strong (r²=0.67, p<0.001). Thoracic and abdominal musculature had a weaker correlation (r²=0.35 to 0.38, p<0.001).ConclusionMeasures of thoracic and abdominal muscle and fat area are highly repeatable in patients with pulmonary fibrosis undergoing lung transplantation. Measures of muscle area are strongly correlated between abdominal locations but inversely correlated between abdominal and thoracic locations.



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IFC (Ed. Board)

Publication date: January 2017
Source:Brain Research Bulletin, Volume 128





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Corrigendum to “Colocalization of neurotransmitter transporters on the plasma membrane of the same nerve terminal may reflect cotransmission” [Brain Res. Bull. 127 (2016) 100–110]

Publication date: January 2017
Source:Brain Research Bulletin, Volume 128
Author(s): Cristina Romei, Tiziana Bonifacino, Marco Milanese, Cesare Usai, Luca Raiteri




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Adenosine A2A receptor deletion affects social behaviors and anxiety in mice: Involvement of anterior cingulate cortex and amygdala

Publication date: 15 March 2017
Source:Behavioural Brain Research, Volume 321
Author(s): Laura López-Cruz, Maria Carbó-Gas, Marta Pardo, Pilar Bayarri, Olga Valverde, Catherine Ledent, John D. Salamone, Mercè Correa
Blockade of adenosine A2A receptors can potentiate motivation to work for natural reinforcers such as food. Conspecific interaction is a potent natural reinforcer in social animals that can be manifested as preference for social exploration versus other sources of novel stimulation. Deficiencies in this type of motivated behavior (social withdrawal) have been seen in several pathologies such as autism and depression. However, the role of A2A receptors in motivation for social interaction has not been widely explored. Social interaction paradigms evaluate the natural preference of animals for exploring other conspecifics, and the ability to differentiate between familiar versus novel ones. Anxiety is one of the factors that can induce avoidance of social interaction. In the present study, adenosine A2A knockout (A2AKO) and wild-type (WT) mice were assessed for social and anxiety-related behaviors. c-Fos immunoreactivity was evaluated as a measure of neuronal activation in brain areas involved in different aspects of motivation and emotional processes. Although A2AKO mice showed an anxious profile, they displayed higher levels of sociability and were less sensitive to social novelty. WT mice displayed a typical pattern of social recognition 24h later, but not A2AKO mice, which explored equally both conspecifics. There were no differences between strains in aggressiveness, perseverance or social odor preferences. c-Fos immunoreactivity in A2AKO mice was higher in anterior cingulate and amygdala compared to WT mice. Thus, A2A receptors appear to be potential targets for the improvement of pathologies related to social function.



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Pre-treatment with nimodipine and 7.5% hypertonic saline protects aged rats against postoperative cognitive dysfunction via inhibiting hippocampal neuronal apoptosis

Publication date: 15 March 2017
Source:Behavioural Brain Research, Volume 321
Author(s): Zhang Qi, Yuan Tianbao, Li Yanan, Xin Xi, He Jinhua, Wang Qiujun
ObjectiveThis study aimed to investigate the effects of pre-treatment with nimodipine and 7.5% hypertonic saline (HS) on postoperative cognitive dysfunction (POCD) in aged rats.MethodsHealthy Sprague-Dawley aged rats were randomly assigned into 4 groups: POCD group, nimodipine group, HS group, and nimodipine+HS group. Rats in POCD group received normal saline injection and then splenectomy 30min later under 1.8% isoflurane inhalation for 2h. In remaining groups, rats received injection of 1mg/kg nimodipine (i.p) and/or 4ml/kg 7.5% HS (i.v) and then splenectomy. Morris water maze test was performed before and after surgery. The hippocampus was harvested for the detection of neuronal apoptosis rate (AR), cytoplasmic calcium ([Ca²⁺]i), Bcl-2 and Bax mRNA expression and hippocampal neuronal ultrastructure.ResultsWhen compared with POCD group, the latency to escape, neuronal AR, [Ca²⁺]i, Bax mRNA expression and Bax/Bcl-2 ratio reduced dramatically, but the times of crossing the platform and Bcl-2 mRNA expression increased significantly (P<0.05) in nimodipine group, NS group and nimodipine+HS group. In addition, the latency to escape, neuronal AR, [Ca²⁺]i, Bax mRNA expression and Bax/Bcl-2 ratio reduced markedly, but the times of crossing the platform and Bcl-2 mRNA expression increased significantly in nimodipine+HS group as compared to nimodipine group and NS group (P<0.05). Hippocampal neuronal ultrastructure damage was observed in all 4 groups, but it was the mildest in nimodipine+HS group.ConclusionPre-treatment with both nimodipine and 7.5% HS exerts better protective effects, which is related to the inhibition of hippocampal neuronal apoptosis.



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Proatherogenic effects of 4-hydroxynonenal

Publication date: Available online 29 December 2016
Source:Free Radical Biology and Medicine
Author(s): Anne Nègre-Salvayre, Sandra Garoby-Salom, Audrey Swiader, Myriam Rouahi, Mélanie Pucelle, Robert Salvayre
4-hydroxy-2-nonenal (HNE) is a α,β-unsaturated hydroxyalkenal generated by peroxidation of n-6 polyunsaturated fatty acid. This reactive carbonyl compound exhibits a huge number of biological properties that result mainly from the formation of HNE-adducts on free amino groups and thiol groups in proteins. In the vascular system, HNE adduct accumulation progressively leads to cellular dysfunction and tissue damages that are involved in the progression of atherosclerosis and related diseases. HNE contributes to the atherogenicity of oxidized LDL, by forming HNE-apoB adducts that deviate the LDL metabolism to the scavenger receptor pathway of macrophagic cells, and lead to the formation of foam cells. HNE activates transcription factors (Nrf2, NF-kappaB) that (dys)regulate various cellular responses ranging from hormetic and survival signaling at very low concentrations, to inflammatory and apoptotic effects at higher concentrations. Among a variety of cellular targets, HNE can modify signaling proteins involved in atherosclerotic plaque remodeling, particularly growth factor receptors (PDGFR, EGFR), cell cycle proteins, mitochondrial and endoplasmic reticulum components or extracellular matrix proteins, which progressively alters smooth muscle cell proliferation, angiogenesis and induces apoptosis. HNE adducts accumulate in the lipidic necrotic core of advanced atherosclerotic lesions, and may locally contribute to macrophage and smooth muscle cell apoptosis, which may induce plaque destabilization and rupture, thereby increasing the risk of athero-thrombotic events.

Graphical abstract

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NON-INVASIVE EVALUATION OF ATOPIC DERMATITIS BASED ON REDOX STATUS USING IN VIVO DYNAMIC NUCLEAR POLARIZATION MAGNETIC RESONANCE IMAGING

Publication date: Available online 29 December 2016
Source:Free Radical Biology and Medicine
Author(s): Hinako Eto, Gaku Tsuji, Takahito Chiba, Masutaka Furue, Fuminori Hyodo
Atopic dermatitis (AD) is a chronic inflammatory condition with complex etiology, including genetic, environmental and immunologic factors. Redox imbalance caused by excessive oxidative stress has been shown to mediate disease activity of AD. Currently, an imaging technique that can monitor the redox status of the skin in vivo has not yet been developed. Consequently, we have established such a technique that can detect and visualize the redox status of the skin using in vivo dynamic nuclear polarization magnetic resonance imaging (DNP-MRI). To evaluate this technique, we utilized an AD mouse model that was generated by repeated topical application of mite antigen in NC/Nga mice. We imaged alterations in redox balance of the resulting AD skin lesions of the mice. Using in vivo DNP-MRI and non-toxic nitroxyl radicals to visualize free radicals in vivo, we revealed that AD skin lesions demonstrated more rapid decay rates of image intensity enhancement than normal skin, indicating that our technique can monitor excessive oxidative stress occurring in AD skin lesions. Therefore, this technique has the potential to provide a novel approach for evaluating disease activity of inflammatory skin diseases, including AD, from the view point of altered redox status.

Graphical abstract

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Electrochemical Reverse Engineering: A Systems-Level Tool to Probe the Redox-Based Molecular Communication of Biology

Publication date: Available online 29 December 2016
Source:Free Radical Biology and Medicine
Author(s): Jinyang Li, Yi Liu, Eunkyoung Kim, John C. March, William E. Bentley, Gregory F. Payne
The intestine is the site of digestion and forms a critical interface between the host and the outside world. This interface is composed of host epithelium and a complex microbiota which is "connected" through an extensive web of chemical and biological interactions that determine the balance between health and disease for the host. This biology and the associated chemical dialogues occur within a context of a steep oxygen gradient that provides the driving force for a variety of reduction and oxidation (redox) reactions. While some redox couples (e.g., catecholics) can spontaneously exchange electrons, many others are kinetically "insulated" (e.g., biothiols) allowing the biology to set and control their redox states far from equilibrium. It is well known that within cells, such non-equilibrated redox couples are poised to transfer electrons to perform reactions essential to immune defense (e.g., transfer from NADH to O2 for reactive oxygen species, ROS, generation) and protection from such oxidative stresses (e.g., glutathione-based reduction of ROS). More recently, it has been recognized that some of these redox-active species (e.g., H2O2) cross membranes and diffuse into the extracellular environment including lumen to transmit redox information that is received by atomically-specific receptors (e.g., cysteine-based sulfur switches) that regulate biological functions. Thus, redox has emerged as an important modality in the chemical signaling that occurs in the intestine and there have been emerging efforts to develop the experimental tools needed to probe this modality. We suggest that electrochemistry provides a unique tool to experimentally probe redox interactions at a systems level. Importantly, electrochemistry offers the potential to enlist the extensive theories established in signal processing in an effort to "reverse engineer" the molecular communication occurring in this complex biological system. Here, we review our efforts to develop this electrochemical tool for in vitro redox-probing.

Graphical abstract

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ACTL6A Is Co-Amplified with p63 in Squamous Cell Carcinoma to Drive YAP Activation, Regenerative Proliferation, and Poor Prognosis

Publication date: Available online 29 December 2016
Source:Cancer Cell
Author(s): Srinivas Vinod Saladi, Kenneth Ross, Mihriban Karaayvaz, Purushothama R. Tata, Hongmei Mou, Jayaraj Rajagopal, Sridhar Ramaswamy, Leif W. Ellisen
Loss-of-function mutations in SWI/SNF chromatin-remodeling subunit genes are observed in many cancers, but an oncogenic role for SWI/SNF is not well established. Here, we reveal that ACTL6A, encoding an SWI/SNF subunit linked to stem cell and progenitor cell function, is frequently co-amplified and highly expressed together with the p53 family member p63 in head and neck squamous cell carcinoma (HNSCC). ACTL6A and p63 physically interact, cooperatively controlling a transcriptional program that promotes proliferation and suppresses differentiation, in part through activation of the Hippo-YAP pathway via regulators including WWC1. Ectopic ACTL6A/p63 expression promotes tumorigenesis, while ACTL6A expression and YAP activation are highly correlated in primary HNSCC and predict poor patient survival. Thus, ACTL6A and p63 collaborate as oncogenic drivers in HNSCC.

Graphical abstract

Teaser

Saladi et al. show that ACTL6A, which encodes an SWI/SNF subunit, is frequently amplified and highly expressed together with TP63 in head and neck squamous cell carcinoma (HNSCC). ACTL6A and p63 coordinately regulate key genes, including WWC1, to dictate oncogenic YAP activity and patient outcomes in HNSCC.


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Isolated left brachiocephalic artery with the right aortic arch: A rare differential of large patent ductus arteriosus

Gajendra Dubey, Saurabh Kumar Gupta, Shyam Sundar Kothari

Annals of Pediatric Cardiology 2017 10(1):78-81

We report a case of isolation of the left brachiocephalic artery with the right aortic arch in a 9-year-old male child masquerading as large patent ductus arteriosus with left-to-right shunt. We have emphasized the subtle clinical findings which served as clues to the diagnosis.

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Spectrum of cyanotic congenital heart disease diagnosed by echocardiographic evaluation in patients attending a tertiary cardiac care center of South Rajasthan

Amit Kumar, Kapil Bhargava

Annals of Pediatric Cardiology 2017 10(1):97-98



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Transcatheter pulmonary valve perforation using chronic total occlusion wire in pulmonary atresia with intact ventricular septum

Shweta Bakhru, Shilpa Marathe, Manish Saxena, Sudeep Verma, Rajan Saileela, Tapan K Dash, Nageswara Rao Koneti

Annals of Pediatric Cardiology 2017 10(1):5-10

Background: Perforation of pulmonary valve using radiofrequency ablation in pulmonary atresia with intact ventricular septum (PA IVS) is a treatment of choice. However, significant cost of the equipment limits its utility, especially in the developing economies. Objective: To assess the feasibility, safety, and efficacy of perforation of pulmonary valve using chronic total occlusion (CTO) wires in patients with PA IVS as an alternative to radiofrequency ablation. Methods: This is a single.center, nonrandomized, retrospective study conducted during June 2008 to September 2015. Twenty-four patients with PA IVS were selected for the procedure during the study period. The median age and weight of the study population were 8. days and 2.65 kg, respectively. Four patients were excluded after right ventricular angiogram as they showed right ventricular-dependent coronary circulation. The pulmonary valve perforation was attempted using various types of CTO wires based on the tip load with variable penetrating characteristics. Results: The procedure was successful in 16 of twenty patients using CTO wires: Shinobi in nine, Miracle in four, CROSS-IT in two, and Conquest Pro in one. Two patients had perforation of right ventricular outflow tract (RVOT). Pericardiocentesis was required in one patient to relieve cardiac tamponade. Later, the same patient underwent successful hybrid pulmonary valvotomy. The other patient underwent ductus arteriosus. (DA) stenting. Balloon atrial septostomy was needed in three cases with systemic venous congestion. Desaturation was persistent in five cases necessitating DA or RVOT stenting to augment pulmonary blood flow. There were two early and two late deaths. The mean follow-up was 22.66. ± 16 months. Three patients underwent one and half ventricle repair and one Blalock-Taussig shunt during follow-up. Conclusion: Perforation of the pulmonary valve can be done successfully using CTO wires in selected cases of pulmonary atresia with intact ventricular septum.

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Impact of Abernathy malformation on pulmonary circulatory hemodynamics in a univentricular heart

Vinoth Doraiswamy, Kothandam Sivakumar

Annals of Pediatric Cardiology 2017 10(1):90-91



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Mechanism of valve failure and efficacy of reintervention through catheterization in patients with bioprosthetic valves in the pulmonary position

Ryan Callahan, Lisa Bergersen, Christopher W Baird, Diego Porras, Jesse J Esch, James E Lock, Audrey C Marshall

Annals of Pediatric Cardiology 2017 10(1):11-17

Background: Surgical and transcatheter bioprosthetic valves (BPVs) in the pulmonary position in patients with congenital heart disease may ultimately fail and undergo transcatheter reintervention. Angiographic assessment of the mechanism of BPV failure has not been previously described. Aims: The aim of this study was to determine the mode of BPV failure (stenosis/regurgitation) requiring transcatheter reintervention and to describe the angiographic characteristics of the failed BPVs and report the types and efficacy of reinterventions. Materials and Methods: This is a retrospective single-center review of consecutive patients who previously underwent pulmonary BPV placement. (surgical or transcatheter) and subsequently underwent percutaneous reintervention from 2005 to 2014. Results: Fifty-five patients with surgical. (41) and transcutaneous pulmonary valve. (TPV) (14) implantation of BPVs underwent 66 catheter reinterventions. The surgically implanted valves underwent fifty reinterventions for indications including 16 for stenosis, seven for regurgitation, and 27 for both, predominantly associated with leaflet immobility, calcification, and thickening. Among TPVs, pulmonary stenosis. (PS) was the exclusive failure mode, mainly due to loss of stent integrity. (10) and endocarditis. (4). Following reintervention, there was a reduction of right ventricular outflow tract gradient from 43 ± 16 mmHg to 16 ± 10. mmHg (P < 0.001) and RVp/AO ratio from 0.8 ± 0.2 to 0.5 ± 0.2 (P < 0.001). Reintervention with TPV placement was performed in 45. (82%) patients. (34 surgical, 11 transcatheter) with no significant postintervention regurgitation or paravalvular leak. Conclusion: Failing surgically implanted BPVs demonstrate leaflet calcification, thickness, and immobility leading to PS and/or regurgitation while the mechanism of TPV failure in the short- to mid-term is stenosis, mainly from loss of stent integrity. This can be effectively treated with a catheter.based approach, predominantly with the valve-in-valve technique.

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A novel technique for percutaneous closure of an atrial septal defect in a patient with interrupted inferior vena cava using a “modified” short sheath from an internal jugular vein approach

Tharakanatha R Yarrabolu, Andrew Robinson, Athar M Qureshi

Annals of Pediatric Cardiology 2017 10(1):102-103



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Cardiac magnetic resonance feature tracking in Kawasaki disease convalescence

Konstantinos Bratis, Pauline Hachmann, Nicholas Child, Thomas Krasemann, Tarique Hussain, Sophie Mavrogeni, Rene Botnar, Reza Razavi, Gerald Greil

Annals of Pediatric Cardiology 2017 10(1):18-25

Objective: The objective of this study was to determine whether left ventricular (LV) myocardial deformation indices can detect subclinical abnormalities in Kawasaki disease convalescence. We hypothesized that subclinical myocardial abnormalities due to inflammation represent an early manifestation of the disease that persists in convalescence. Background: Myocardial inflammation has been described as a global finding in the acute phase of Kawasaki disease. Despite normal systolic function by routine functional measurements, reduced longitudinal strain and strain rate have been detected by echocardiography in the acute phase. Methods and Results: Peak systolic LV myocardial longitudinal, radial, and circumferential strain and strain rate were examined in 29 Kawasaki disease convalescent patients (15 males; mean [standard deviation] age: 11 [6.6] years; median interval from disease onset: 5.8 [5.4] years) and 10 healthy volunteers (5 males; mean age: 14 [3.8] years) with the use of cardiac magnetic resonance (CMR) feature tracking. Routine indices of LV systolic function were normal in both groups. Comparisons were made between normal controls and (i) the entire Kawasaki disease group, (ii) Kawasaki disease subgroup divided by coronary artery involvement. Average longitudinal and circumferential strain at all levels was lower in patients compared to normal controls. In subgroup analysis, both Kawasaki disease patients with and without a history of coronary involvement had similar longitudinal and circumferential strain at all levels and lower when compared to controls. There were lower circumferential and longitudinal values in Kawasaki disease patients with persisting coronary artery lesions when compared to those with regressed ones. Conclusion: In this CMR study in Kawasaki disease convalescent patients with preserved routine functional indices, we detected lower circumferential and longitudinal strain values compared to normal controls, irrespective of the coronary artery status.

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Pseudoaneurysm of the left atrium following infective endocarditis

Devi A Manuel, Bino John Sahayo, Viji Samuel Thomson, Jacob Jose

Annals of Pediatric Cardiology 2017 10(1):84-86

Transthoracic echocardiogram of a 3-year-old child showed a hypoechoic cavity in the posterior wall of the left atrium communicating with the left ventricle through an orifice in the mitral annulus, suggestive of pseudoaneurysm (Ps), probably the result of infective endocarditis. Three-dimensional echocardiography was helpful to confirm the diagnosis and assess the anatomical relationship of the Ps.

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Elective nasal continuous positive airway pressure to support respiration after prolonged ventilation in infants after congenital cardiac surgery

Hemang Gandhi, Amit Mishra, Rajesh Thosani, Himanshu Acharya, Ritesh Shah, Jigar Surti, Alpesh Sarvaia

Annals of Pediatric Cardiology 2017 10(1):26-30

Background: We sought to compare the effectiveness of oxygen (O2) treatment administered by an O2 mask and nasal continuous positive airway pressure (NCPAP) in infants after congenital cardiac surgery. Methods: In this retrospective observational study, 54 infants undergoing corrective cardiac surgery were enrolled. According to the anesthesiologist's preference, the patients ventilated for more than 48 h were either put on NCPAP or O2 mask immediately after extubation. From pre-extubation to 24 h after treatment, arterial blood gas and hemodynamic data were measured. Results: After 24 h of NCPAP institution, the patients showed a significant improvement in oxygenation compared to O2 mask group. Respiratory rate (per minute) decreased from 31.67 ± 4.55 to 24.31 ± 3.69 (P < 0.0001), PO2 (mmHg) increased from 112.12 ± 22.83 to 185.74 ± 14.81 (P < 0.0001), and PCO2 (mmHg) decreased from 42.88 ± 5.01 to 37.00 ± 7.22 (P < 0.0076) in patients on NCPAP. In this group, mean pediatric cardiac surgical Intensive Care Unit (PCSICU) stay was 4.72 ± 1.60 days, with only 2 (11.11%) patients requiring re-intubation. Conclusion: NCPAP can be used safely and effectively in infants undergoing congenital cardiac surgery to improve oxygenation/ventilation. It also reduces the work of breathing, PCSICU stay, and may reduce the likelihood of re-intubation.

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Transcatheter closure of aortopulmonary window with Amplatzer duct occluder II

Hemant Kumar Nayak, Nurul Islam, Bhanu Kumar Bansal

Annals of Pediatric Cardiology 2017 10(1):93-94



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A pediatric echocardiographic Z-score nomogram for a developing country: Indian pediatric echocardiography study – The Z-score

Rajendra Kumar Gokhroo, Avinash Anantharaj, Devendra Bisht, Kamal Kishor, Nishad Plakkal, Rajeswari Aghoram, Nivedita Mondal, Shashi K Pandey, Ramsagar Roy

Annals of Pediatric Cardiology 2017 10(1):31-38

Background: Almost all presently available pediatric echocardiography Z-score nomograms are based on Western data. They may not be a suitable reference standard for assessing the sizes of cardiac structures of children from developing countries. Objective: This study's objective was to collect normative data of 21 commonly measured cardiovascular structures using M-mode and two-dimensional echocardiography in Indian children aged between 4 and 15 years and to derive Z-score nomograms for each. Subjects and Methods: The study was conducted at two centers in India . Ajmer, Rajasthan, and Mohali, Punjab. We studied a community-based sample involving healthy school going children. After excluding children with cardiovascular abnormalities on the screening echocardiogram, 746 children were included in the final analysis. Echocardiographic assessment was performed using a Philips iE33 system. Results and Analysis: For each parameter measured, seven models were evaluated to assess the relationship of that parameter with the body surface area and the one with the best fit was used to plot the Z-score chart for that parameter. Z score charts were thus derived. Conclusions: The Z-score nomograms derived by this study may be better alternatives to the Western nomograms for use in India and other developing countries for preprocedural decision making in the pediatric population. However, they will require validation in large-scale studies before they can become clinically applicable.

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Massive pericardial effusion, yet no signs of tamponade!

Sunitha Vaidyanathan, Amol Gupta, Kothandam Sivakumar

Annals of Pediatric Cardiology 2017 10(1):100-101



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Rheumatic heart disease screening: Current concepts and challenges

Scott Dougherty, Maziar Khorsandi, Philip Herbst

Annals of Pediatric Cardiology 2017 10(1):39-49

Rheumatic heart disease (RHD) is a disease of poverty, is almost entirely preventable, and is the most common cardiovascular disease worldwide in those under 25 years. RHD is caused by acute rheumatic fever (ARF) which typically results in cumulative valvular lesions that may present clinically after a number of years of subclinical disease. Therapeutic interventions, therefore, typically focus on preventing subsequent ARF episodes (with penicillin prophylaxis). However, not all patients with ARF develop symptoms and not all symptomatic cases present to a physician or are correctly diagnosed. Therefore, if we hope to control ARF and RHD at the population level, we need a more reliable discriminator of subclinical disease. Recent studies have examined the utility of echocardiographic screening, which is far superior to auscultation at detecting RHD. However, there are many concerns surrounding this approach. Despite the introduction of the World Heart Federation diagnostic criteria in 2012, we still do not really know what constitutes the most subtle changes of RHD by echocardiography. This poses serious problems regarding whom to treat and what to do with the rest, both important decisions with widespread implications for already stretched health-care systems. In addition, issues ranging from improving the uptake of penicillin prophylaxis in ARF/RHD-positive patients, improving portable echocardiographic equipment, understanding the natural history of subclinical RHD and how it might respond to penicillin, and developing simplified diagnostic criteria that can be applied by nonexperts, all need to be effectively tackled before routine widespread screening for RHD can be endorsed.

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Should we close small ventricular septal defects?

Sangeetha Viswanathan, R Krishna Kumar

Annals of Pediatric Cardiology 2017 10(1):1-4



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Pediatric cardiovascular care in Uganda: Current status, challenges, and opportunities for the future

Twalib Olega Aliku, Sulaiman Lubega, Judith Namuyonga, Tom Mwambu, Michael Oketcho, John O Omagino, Craig Sable, Peter Lwabi

Annals of Pediatric Cardiology 2017 10(1):50-57

In many developing countries, concerted action against common childhood infectious diseases has resulted in remarkable reduction in infant and under-five mortality. As a result, pediatric cardiovascular diseases are emerging as a major contributor to childhood morbidity and mortality. Pediatric cardiac surgery and cardiac catheterization interventions are available in only a few of Sub-Saharan African countries. In Uganda, open heart surgeries (OHSs) and interventional procedures for pediatric cardiovascular disease are only possible at the Uganda Heart Institute (UHI), having been started with the help of expatriate teams from the years 2007 and 2012, respectively. Thereafter, independent OHS and cardiac catheterization have been possible by the local team at the UHI since the year 2009 and 2013, respectively. The number of OHSs independently performed by the UHI team has progressively increased from 10 in 2010 to 35 in 2015, with mortality rates ranging from 0% to 4.1% over the years. The UHI pediatric catheterization team has independently performed an increasing number of procedures each year from 3 in 2013 to 55 in 2015. We herein describe the evolution and current status of pediatric cardiovascular care in Uganda, highlighting the unique aspects of its establishment, existing constraints, and future plans.

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Interventional therapy for partial anomalous pulmonary venous connection with dual drainage

Saurabh Kumar Gupta, Anita Saxena, Rajnish Juneja

Annals of Pediatric Cardiology 2017 10(1):82-83

A 6-year-old boy presented with dual drainage of left upper pulmonary vein, with connection to innominate vein inaddition to its normal connection to the left atrium. Despite relief of aortic stenosis at the age of 3 years, significant left to right shunt persisted. The dual drainage allowed successful percutaneous closure of the levoatriocardinal vein without obstruction to the pulmonary venous flow to the left atrium.

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Modified closed chamber sutureless technique for anomalous pulmonary venous connection

Sabarinath Menon, Thomas Mathew, Jayakumar Karunakaran, Baiju Sashidhar Dharan

Annals of Pediatric Cardiology 2017 10(1):58-60

Visibility continues to be a major problem during repair of obstructed total anomalous pulmonary venous connection (TAPVC) resulting in frequent use of deep hypothermia and low flow bypass. Sutureless technique for primary repair of anomalous pulmonary venous connection is fast becoming popular. In this described modification of sutureless technique through the lateral approach, the left atrium is marsupialized around the common pulmonary venous chamber, except on the right lateral aspect, providing a bloodless field with minimal retraction of heart facilitating the surgery at mild hypothermia. This technique can be particularly useful in small confluence obstructed TAPVC and in mixed TAPVC.

http://ift.tt/2hQBnU8

A rare case of cardiac tumor in a child

Mallar Mukharjee, Jigna N Bathia, Apurba Ghosh, Anil Kumar Singhi

Annals of Pediatric Cardiology 2017 10(1):87-89

Pediatric cardiac tumors are rare and usually benign. An infectious etiology like tuberculosis invading myocardium and presenting as infiltrative mass is extremely rare. We present a case of a 15 month old girl with clinical feature of cardiac failure who had infiltrative multiple myocardial masses in echocardiogram. Advanced cardiac imaging by Cardiac Magnetic resonance imaging (MRI ) helped in tissue delineation. Therapeutic trial of anti-tubercular drugs in view clinical suspicion of Tuberculosis resulted in complete remission of symptom and disappearance of the cardiac mass.

http://ift.tt/2hz3prj

Surgical repair of tricuspid valve leaflet tear following percutaneous closure of perimembranous ventricular septal defect using Amplatzer duct occluder I: Report of two cases

Saatchi Mahesh Kuwelker, Devi Prasad Shetty, Bharat Dalvi

Annals of Pediatric Cardiology 2017 10(1):61-64

Tricuspid valve (TV) injury following transcatheter closure of perimembranous ventricular septal defect (PMVSD) with Amplatzer ductal occluder I (ADO I), requiring surgical repair, is rare. We report two cases of TV tear involving the anterior and septal leaflets following PMVSD closure using ADO I. In both the patients, the subvalvular apparatus remained unaffected. The patients presented with severe tricuspid regurgitation (TR) 6 weeks and 3 months following the device closure. They underwent surgical repair with patch augmentation of the TV leaflets. Postoperatively, both are asymptomatic with a mild residual TR.

http://ift.tt/2hzcbp5

Isolated facial nerve palsy after arterial switch operation: A rarity

Manoj Kumar Sahu, Intekhab Alam, Sarvesh Pal Singh, Ramesh Menon, Sachin Talwar

Annals of Pediatric Cardiology 2017 10(1):92-93



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Circulation Editors and Editorial Board.

Author:

Page: 1-2

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Beyond the Headlines: Insights on Potassium Supplementation for the Treatment of Hypertension From the Canadian Hypertension Education Program Guidelines (CHEP).

Author: Whelton, Seamus P. MD, MPH; Blumenthal, Roger S. MD

Page: 3-4

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Putting the Acute Coronary Syndrome in Context After 80 Years of Age.

Author: Alexander, Karen P. MD

Page: 5-6

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Association of Traditional Cardiovascular Risk Factors With Venous Thromboembolism: An Individual Participant Data Meta-Analysis of Prospective Studies.

Author: Mahmoodi, Bakhtawar K. MD, PhD, MPH; Cushman, Mary MD, MSc; Anne Naess, Inger MD, PhD; Allison, Matthew A. MD, MPH; Jan Bos, Willem MD, PhD; Braekkan, Sigrid K. PhD; Cannegieter, Suzanne C. MD, PhD; Gansevoort, Ron T. MD, PhD; Gona, Philimon N. PhD, MPH; Hammerstrom, Jens MD, PhD; Hansen, John-Bjarne MD, PhD; Heckbert, Susan MD, PhD; Holst, Anders G. MD, PhD; Lakoski, Susan G. MD, MS; Lutsey, Pamela L. PhD; Manson, JoAnn E. MD, DrPH; Martin, Lisa W. MD; Matsushita, Kunihiro MD, PhD; Meijer, Karina MD, PhD; Overvad, Kim MD, PhD; Prescott, Eva MD, DMSc; Puurunen, Marja MD, PhD; Rossouw, Jacques E. MD; Sang, Yingying MSc; Severinsen, Marianne T. MD, PhD; ten Berg, Jur MD, PhD; Folsom, Aaron R. MD, MPH; Zakai, Neil A. MD, MSc

Page: 7-16

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Smoking: A Dual Pathogen for Arterial and Venous Thrombosis.

Author: Anand, Sonia S. MD, PhD

Page: 17-20

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Genetic Polymorphisms and Clopidogrel Efficacy for Acute Ischemic Stroke or Transient Ischemic Attack: A Systematic Review and Meta-Analysis.

Author: Pan, Yuesong MD; Chen, Weiqi MD; Xu, Yun MD, PhD; Yi, Xingyang MD; Han, Yan MD, PhD; Yang, Qingwu MD, PhD; Li, Xin MD, PhD; Huang, Li'an MD, PhD; Johnston, S. Claiborne MD, PhD; Zhao, Xingquan MD, PhD; Liu, Liping MD, PhD; Zhang, Qi MD; Wang, Guangyao MD; Wang, Yongjun MD; Wang, Yilong MD, PhD

Page: 21-33

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Clinical Impact of Pharmacogenomics of Clopidogrel in Stroke.

Author: Simon, Tabassome MD, PhD; Danchin, Nicolas MD, PhD

Page: 34-37

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Reassessment of Cardiac Function and Implantable Cardioverter-Defibrillator Use Among Medicare Patients With Low Ejection Fraction After Myocardial Infarction.

Author: Pokorney, Sean D. MD, MBA; Miller, Amy L. MD, PhD; Chen, Anita Y. MS; Thomas, Laine PhD; Fonarow, Gregg C. MD; de Lemos, James A. MD; Al-Khatib, Sana M. MD, MHS; Velazquez, Eric J. MD; Peterson, Eric D. MD, MPH; Wang, Tracy Y. MD, MHS, MSc

Page: 38-47

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Total Anomalous Pulmonary Venous Connection: The Current Management Strategies in a Pediatric Cohort of 768 Patients.

Author: Shi, Guocheng MD; Zhu, Zhongqun MD, PhD; Chen, Jimei MD, PhD; Ou, Yanqiu MD, PhD; Hong, Haifa MD, PhD; Nie, Zhiqiang MS; Zhang, Haibo MD, PhD; Liu, Xiaoqing MD; Zheng, Jinghao MD, PhD; Sun, Qi MD, PhD; Liu, Jinfen MD; Chen, Huiwen MD, PhD; Zhuang, Jian MD, PHD

Page: 48-58

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Insulin-Like Growth Factor 1 Receptor-Dependent Pathway Drives Epicardial Adipose Tissue Formation After Myocardial Injury.

Author: Zangi, Lior PhD; Oliveira, Marcela S. PhD; Ye, Lillian Y. BS; Ma, Qing MD; Sultana, Nishat PhD; Hadas, Yoav PhD; Chepurko, Elena PhD; Spater, Daniela PhD; Zhou, Bin PhD; Chew, Wei Leong PhD; Ebina, Wataru PhD; Abrial, Maryline PhD; Wang, Qing-Dong MD, PhD; Pu, William T. MD; Chien, Kenneth R. MD, PhD

Page: 59-72

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Inhibiting Insulin-Mediated [beta]2-Adrenergic Receptor Activation Prevents Diabetes-Associated Cardiac Dysfunction.

Author: Wang, Qingtong MD, PhD; Liu, Yongming MD, PhD; Fu, Qin MD, PhD; Xu, Bing BS; Zhang, Yuan PhD; Kim, Sungjin PhD; Tan, Ruensern MS; Barbagallo, Federica PhD; West, Toni MS; Anderson, Ethan PhD; Wei, Wei PhD; Abel, E. Dale MB. BS, DPhil; Xiang, Yang K. PhD

Page: 73-88

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Cardiovascular Effects of Performance-Enhancing Drugs.

Author: La Gerche, Andre MBBS, PhD; Brosnan, Maria J. MBBS, PhD

Page: 89-99

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Highlights of the American Heart Association Scientific Sessions 2016.

Author: Sellke, Frank W. MD; Peterson, Eric D. MD, MPH

Page: 100-101

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Highlights From the Circulation Family of Journals.

Author:

Page: 102-107

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Handheld Technologies May Lead to Better Detection of Atrial Fibrillation.

Author: Hampton, Tracy PhD

Page: 108-109

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Head-to-Head Comparison of the AliveCor Heart Monitor and Microlife WatchBP Office AFIB for Atrial Fibrillation Screening in a Primary Care Setting.

Author: Chan, Pak-Hei MBBS; Wong, Chun-Ka MBBS; Pun, Louise BA; Wong, Yu-Fai MBBS; Wong, Michelle Man-Ying MBBS; Chu, Daniel Wai-Sing MBBS; Siu, Chung-Wah MD

Page: 110-112

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Letter by Maesen et al Regarding Article, "Ablation of Atrial Fibrillation: Patient Selection, Periprocedural Anticoagulation, Techniques, and Preventive Measures After Ablation".

Author: Maesen, Bart MD, PhD; Pison, Laurent MD, PhD; Meir, Mark La MD, PhD

Page: e1-e2

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Response by Link et al to Letter Regarding Article, "Ablation of Atrial Fibrillation: Patient Selection, Periprocedural Anticoagulation, Techniques, and Preventive Measures After Ablation".

Author: Link, Mark S. MD; Haissaguerre, Michel MD; Natale, Andrea MD

Page: e3-e4

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Graphene makes probing the brain easier

Publication date: Available online 29 December 2016
Source:Nano Today





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Integrated graphene systems by laser irradiation for advanced devices

Publication date: Available online 29 December 2016
Source:Nano Today
Author(s): Yang Zhao, Qing Han, Zhihua Cheng, Lan Jiang, Liangti Qu
With the development of portable electronics, integrated graphene microstructures and devices have attracted increasing attention due to their environment-benign, lightweight feature with small occupied area. Laser irradiation technique with advantages of rapid processing speed, large scan area and nanometer spatial resolution has been widely studied and applied in the fabrication of various nano/microstructures of graphene materials for integrated electronic applications. This review summarizes the significant advance on laser-directed design and fabrication of integrated graphene devices, along with state-of-the-art applications in microcircuits, supercapacitors, sensors, actuators, memory chips and optoelectronic devices. The perspectives and challenges in designing and improving future graphene integrated devices are also discussed.

Graphical abstract

http://ift.tt/2humKVA

Simple solution to nanomaterial production

Publication date: Available online 29 December 2016
Source:Nano Today





http://ift.tt/2hus7UB

Metal-phenolic networks as a versatile platform to engineer nanomaterials and biointerfaces

Publication date: Available online 29 December 2016
Source:Nano Today
Author(s): Hirotaka Ejima, Joseph J. Richardson, Frank Caruso
Surface modification is crucial for conferring novel functionalities to objects and interfaces. However, simple yet versatile strategies for the surface modification of multiple classes of nanomaterials, including biointerfaces, are rare, as the chemical interactions between the surface modifiers and the substrates need to be tailored on a case-by-case basis. Recently, metal-phenolic networks (MPNs) have emerged as a versatile surface modifier based on the universal adherent properties of phenolic molecules, namely the constituent gallol and catechol groups. Additionally, the dynamic interactions between metal ions and phenolic molecules confer additional functionalities to the MPNs, such as stimuli-responsiveness. Given the interest in MPNs for nanomaterial and biointerface engineering, this review aims to provide an overview of the assembly process, physicochemical properties and applications of MPN coatings.

Graphical abstract

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High levels of mercury in wetland resources from three river basins in Ghana: a concern for public health

Abstract

Crustaceans, mollusks, and fish are wetland resources that constitute an important source of protein and foreign exchange for the Ghanaian population, and many species of these are sold in the open market and restaurants, yet studies on their heavy metal contents are generally scarce. This paper evaluates the levels of mercury in five species of crustaceans, two species of mollusks, and ten species of fish inhabiting three river basins with different catchment activities in Ghana. These include the Ankobra Basin, characterized with mining and agriculture, Densu Basin, associated with urban waste discharges and agriculture, and Lower Volta River Basin, associated with agricultural activities. Mercury concentration was highest in Ankobra (2.5 ± 2.59 μg g⁻¹) followed by Densu (1.75 ± 1.35 μg g⁻¹) and Volta (0.74 ± 1.46 μg g⁻¹). The mercury load of the organisms range from <0.1 to 4 μg g⁻¹ with the highest load in Cynoglossus senegalensis at Ankobra. Except for Panaeus notialis from Densu and Ankobra, and three other species from Ankobra (Tympanotonus fuscatus, Cardisoma armatum, Callinectes amnicola) in which mercury was not detected, mercury loads of all the organisms were above the permissible limit of 0.5 mg kg⁻¹ established by Commission Regulation-EC (2006) for fishery products and muscle meat of fish. Weekly quantities of crustaceans and mollusks considered safe for consumption by adults ranged from 88 and 1000 g while that of the fishes were between 70 and 700 g (on a dry weight basis) depending on the species. It was clear that some caution needs to be exercised in the consumption of Ghana's fresh and brackish water fisheries.

http://ift.tt/2hxF3N5

Emission and distribution of PCDD/Fs, chlorobenzenes, chlorophenols, and PAHs from stack gas of a fluidized bed and a stoker waste incinerator in China

Abstract

The concentrations, homologue, and congener profiles, as well as the gas/particle distribution of polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs), chlorobenzenes (CBzs), chlorophenols (CPhs), and polyaromatic hydrocarbons (PAHs) from stack gas of two different municipal solid waste incinerators in China, were characterized. The incinerators were a stoker furnace incinerator equipped with the advanced air pollution control device (APCD) and a common circulating fluidized bed (CFB) furnace. The concentration of PCDD/Fs in the stack gas of the stoker incinerator ranged 0.011–0.109 ng international toxic equivalent factor (I-TEQ)/Nm³ and was below the current limit for PCDD/F emissions from the municipal solid waste incinerators (MSWIs) in China (0.1 ng I-TEQ/Nm³) in most of the cases. Moreover, the concentration of PCDD/Fs in the stack gas of the stoker incinerator was significantly lower than that of the CFB incinerator (0.734 to 24.6 ng I-TEQ/Nm³). In both incinerators, the majority of the total PCDD/F emissions (above 90%) ended up in the gas phase. 2,3,4,7,8-PeCDF, which occupied 24.3–43.6 and 32.5–75.6% of I-TEQ contribution in MSWIs A and B, respectively, was the most abundant congener. However, different types of incinerators and APCDs induced different congener and homologue distributions. The total concentration of CBzs from the stoker incinerator (0.05–3.2 μg/Nm³) was also much lower than that formed from the CFB incinerator (10.9–75.2 μg/Nm³). The phase distribution of CBzs followed the same pattern as with the PCDD/Fs. Moreover, the emission level of CBz was 100–1000 times higher than that of the PCDD/Fs, which determines the applicability of CBzs as indicators of PCDD/F emissions. High correlations between the emission concentrations of PCDD/Fs, TeCBz, and PCBz in specific ranges were revealed. Furthermore, high concentrations of CPhs (0.6–141.0 μg/Nm³) and PAHs (148.6–4986.5 μg/Nm³) were detected in the stack gases of MSWI B. In some cases, the concentrations were as high as the concentrations in the fumes exiting the boiler of one foreign stoker without flue gas purification indicating the abundance of CPh and PAH emissions in the stack gas of waste incinerators.

http://ift.tt/2ivAyRv

Physiological response of Polygonum perfoliatum L. following exposure to elevated manganese concentrations

Abstract

Polygonum perfoliatum L. is a Mn-tolerant plant as considered having the potential to revegetate in manganese mine wasteland. The glasshouse experiments were carried out to evaluate its tolerance and physiological response in different Mn concentrations (5, 500, 1000, 2000, 5000, and 10,000 μmol L⁻¹). Absorption bands of P. perfoliatum differed greatly in lipids, proteins, and carbohydrates. With elevated levels of Mn (5–2000 μmol L⁻¹), absorbance changed little, which demonstrated that lower Mn concentrations had negligible influence on transport functions. As Mn concentrations in excess of 2000 μmol L⁻¹, absorbance increased slightly but eventually decreased. Furthermore, a hydroponic culture was carried out in order to study its changes of ultrastructure with the increasing Mn concentrations (5, 1000, and 10,000 μmol L⁻¹). Lower Mn levels with 5 and 1000 μmol L⁻¹ had no breakage function to the ultrastructure of P. perfoliatum. However, as Mn concentration was up to 10,000 μmol L⁻¹, visible damages began to appear, the quantity of mitochondria in root cells increased, and the granum lamellae of leaf cell chloroplasts presented a disordered state. In comparison with the controls, black agglomerations were found in the cells of P. perfoliatum under the controlling concentration of Mn with 1000 and 10,000 μmol L⁻¹ for 30 days, which became obvious at higher Mn concentrations. As Mn concentration was 10,000 μmol L⁻¹, a kind of new acicular substance was developed in leaf cells and intercellular spaces, possibly indicating a resistance mechanism in P. perfoliatum. These results confirm that P. perfoliatum shows potential for the revegetation of abandoned manganese tailings.

http://ift.tt/2hxvzkT

Considerations for the development of in vitro dissolution tests to reduce or replace preclinical oral absorption studies

Publication date: 1 March 2017
Source:European Journal of Pharmaceutical Sciences, Volume 99
Author(s): Elise Grignard, Robert Taylor, Mark McAllister, Karl Box, Nikoletta Fotaki
The pharmaceutical development of new chemical entities can be hampered by their solubility and/or dissolution limitations. Currently, these properties are characterised mostly during in vivo pre-clinical studies. The development of appropriate in vitro methods to study the solubility and dissolution properties in preclinical species would lead to a significant reduction or replacement of the animal experiments at this stage of development. During clinical development, media simulating the human gastrointestinal tract fluids are commonly used and a similar approach mimicking laboratory animals' gastrointestinal tract fluids would impact on the preclinical stage of development. This review summarises the current knowledge regarding the gastrointestinal physiology of the most common laboratory animals, and animal simulated gastric and intestinal media are proposed.

Graphical abstract

http://ift.tt/2hu033V

Prediction and mechanism elucidation of analyte retention on phospholipid stationary phases (IAM-HPLC) by in silico calculated physico-chemical descriptors

Publication date: 1 March 2017
Source:European Journal of Pharmaceutical Sciences, Volume 99
Author(s): Giacomo Russo, Lucia Grumetto, Francesco Barbato, Giulio Vistoli, Alessandro Pedretti
The present study proposes a method for an in silico calculation of phospholipophilicity. Phospholipophilicity is intended as the measure of analyte affinity for phospholipids; it is currently assessed by HPLC measures of analyte retention on phosphatidylcholine-like stationary phases (IAM – Immobilized Artificial Membrane) resulting in log kW^IAM values. Due to the amphipathic and electrically charged nature of phospholipids, retention on these stationary phases results from complex mechanisms, being affected not only by lipophilicity (as measured by n-octanol/aqueous phase partition coefficients, log P) but also by the occurrence of polar and/or electrostatic intermolecular interaction forces. Differently from log P, to date no method has been proposed for in silico calculation of log kW^IAM.The study is aimed both at shedding new light into the retention mechanism on IAM stationary phases and at offering a high-throughput method to achieve such values. A wide set of physico-chemical and topological properties were taken into account, yielding a robust final model including four in silico calculated parameters (lipophilicity, hydrophilic/lipophilic balance, molecular size, and molecule flexibility). The here presented model was based on the analysis of 205 experimentally determined values, taken from the literature and measured by a single research group to minimize the interlaboratory variability; such model is able to predict phospholipophilicity values on both the two IAM stationary phases to date marketed, i.e. IAM.PC.MG and IAM.PC.DD2, with a fairly good degree (r²=0.85) of accuracy.The present work allowed the development of a free on-line service aimed at calculating log kW^IAM values of any molecule included in the PubChem database, which is freely available at http://ift.tt/2hu7KXF.

Graphical abstract

http://ift.tt/2hu4nQF

Development of novel self-assembled ES-PLGA hybrid nanoparticles for improving oral absorption of doxorubicin hydrochloride by P-gp inhibition: In vitro and in vivo evaluation

Publication date: 1 March 2017
Source:European Journal of Pharmaceutical Sciences, Volume 99
Author(s): Jia Wang, Lin Li, Lei Wu, Bingjun Sun, Yuqian Du, Jin Sun, Yongjun Wang, Qiang Fu, Peng Zhang, Zhonggui He
To increase the encapsulation efficiency and oral absorption of doxorubicin hydrochloride (DOX), a novel drug delivery system of enoxaparin sodium-PLGA hybrid nanoparticles (EPNs) was successfully designed. By introducing the negative polymer of enoxaparin sodium (ES) to form an electrostatic complex with the cationic drug, DOX, the encapsulation efficiency (93.78%) of DOX was significantly improved. The X-ray diffraction (XRD) results revealed that the DOX-ES complex was in an amorphous form. An in vitro release (pH6.8 PBS) study showed the excellent sustained-release characteristics of DOX-loaded EPNs (DOX-EPNs). In addition, in situ intestinal perfusion and intestinal biodistribution experiments demonstrated the improved membrane permeability and intestinal wall bioadhesion of DOX-EPNs, and caveolin- and clathrin-mediated endocytosis pathways were the main mechanisms responsible. The cytotoxicity of DOX was significantly increased by EPNs in Caco-2 cells, compared with DOX-Sol. Confocal laser scanning microscope (CLSM) images confirmed that the amount of DOX-EPNs internalized by Caco-2 cells was higher than that of DOX-Sol showing that P-glycoprotein-mediated drug efflux was reduced by the introduction of EPNs. The qualitative detection of transcytosis demonstrated the ability of the nanoparticles (NPs) to cross Caco-2 cell monolayers. An in vivo toxicity experiment demonstrated that DOX-EPNs reduced cardiac and renal toxic effects and were biocompatible. An in vivo pharmacokinetics study showed that the AUC(0-t) and t1/2 of DOX-EPNs were increased to 3.63–fold and 2.47–fold in comparison with DOX solution (DOX-Sol), respectively. All these results indicated that the novel EPNs were an excellent platform to improve the encapsulation efficiency of an aqueous solution of this antitumor drug and its oral bioavailability.

Graphical abstract

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2016: An Unbelievable Year.

Author: Kennedy, Maureen Shawn MA, RN, FAAN

Page: 7

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Establishing a Voice at Home and Abroad.

Author: Tour, Svetlana RN

Page: 10

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Progress in Policymaking.

Author: T., Linda

Page: 10

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Importance of Forensic Nurses.

Author: Perez-Solis, Isabel RN

Page: 10

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Stop the Eye Rolling: Supporting Nursing Students in Learning.

Author: Taylor, Rosemary PhD, RN, CNL

Page: 11

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Top Health Stories of 2016: ACA, Opioids, Zika-Representation and Misrepresentation in a Post-Fact Era.

Author: Molyneux, Jacob Senior Editor

Page: 12-13

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The Top Health Care Policy News Stories of 2016.

Author: Sofer, Dalia

Page: 14

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The Top Nursing Stories of 2016.

Author: Halpern, Lucy Wang

Page: 15

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NewsCAP: New guidelines clarify cervical screening in specific groups.

Author:

Page: 15

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NewsCAP: Colonoscopy after age 70 has only modest benefits.

Author:

Page: 15

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The Top Clinical News Stories of 2016.

Author: Zolot, Joan PA

Page: 16

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NewsCAP: Dietary supplement trends remain stable overall but vary by subgroup.

Author:

Page: 16

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Stories to Watch in 2017.

Author: Potera, Carol

Page: 17

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2016 Win-Loss Scoreboard.

Author:

Page: 18

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Physical Activity in Schools Declines, Obesity Rates Climb: What Can Be Done?.

Author: Potera, Carol

Page: 19-20

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AJN On the Cover.

Author: Szulecki, Diane Associate Editor

Page: 21

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AJN On the Web.

Author:

Page: 21

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Teaching Patients How to Avoid Extortion Scams.

Author: Aschenbrenner, Diane S. MS, RN

Page: 22

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FDA Offers Continuing Education Courses.

Author: Aschenbrenner, Diane S. MS, RN

Page: 22

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Medication Errors Prompt Brand Name Change.

Author: Aschenbrenner, Diane S. MS, RN

Page: 22-23

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Auditory changes in acromegaly

Abstract

Objective

The aim of this study is to determine the changes involving auditory system in cases with acromegaly.

Materials and methods

Otological examinations of 41 cases with acromegaly (uncontrolled n = 22, controlled n = 19) were compared with those of age and gender-matched 24 healthy subjects. Whereas the cases with acromegaly underwent examination with pure tone audiometry (PTA), speech audiometry for speech discrimination (SD), tympanometry, stapedius reflex evaluation and otoacoustic emission tests, the control group did only have otological examination and PTA. Additionally, previously performed paranasal sinus-computed tomography of all cases with acromegaly and control subjects were obtained to measure the length of internal acoustic canal (IAC).

Results

PTA values were higher (p < 0.001 for right ears and p = 0.001 for left ears), and SD scores were (p = 0.002 for right ears and p = 0.002 for left ears) lower in acromegalic patients. IAC width in acromegaly group was narrower compared to that in control group (p = 0.03 for right ears and p = 0.02 for left ears). When only cases with acromegaly were taken into consideration, PTA values in left ears had positive correlation with growth hormone and insulin-like growth factor-1 levels (r = 0.4, p = 0.02 and r = 0.3, p = 0.03). Of all cases with acromegaly 13 (32%) had hearing loss in at least one ear, 7 (54%) had sensorineural type and 6 (46%) had conductive type hearing loss.

Conclusion

Acromegaly may cause certain changes in the auditory system in cases with acromegaly. The changes in the auditory system may be multifactorial causing both conductive and sensorioneural defects.

http://ift.tt/2ilQPLI

Quality of life and swallowing with standard chemoradiotherapy versus accelerated radiotherapy and panitumumab in locoregionally advanced carcinoma of the head and neck: A phase III randomised trial from the Canadian Cancer Trials Group (HN.6)

Publication date: February 2017
Source:European Journal of Cancer, Volume 72
Author(s): Jolie Ringash, John N. Waldron, Lillian L. Siu, Rosemary Martino, Eric Winquist, Jim R. Wright, Abdenour Nabid, John H. Hay, Alex Hammond, Khalil Sultanem, Sebastien Hotte, Carson Leong, Ali Abdel Halim El-Gayed, Farah Naz, Kevin Ramchandar, Timothy E. Owen, Alexander Montenegro, Brian O'Sullivan, Bingshu E. Chen, Wendy R. Parulekar
AimTo compare quality of life (QOL) between standard (SFX) chemoradiotherapy (arm A) and altered fractionation radiotherapy (AFX) with panitumumab (PMab; arm B).MethodsPatients with T any N + M0 or T3-4N0M0 squamous cell head-neck carcinoma were randomised to SFX (70 Gy/35/7 wks) plus cisplatin (100 mg/m² IV × 3) versus AFX (70 Gy/35/6 wks) plus PMab (9 mg/kg IV × 3). QOL was collected at baseline, end of radiation therapy (RT) and 2, 4, 6, 12, 24 and 36 months post-RT using the Functional Assessment of Cancer Therapy Head and Neck (FACT-H&N), MD Anderson Dysphagia Index (MDADI) and SWAL-QOL. We hypothesised a 6-point more favourable change in FACT-H&N score from baseline to 1 year in arm B over arm A.ResultsAmong 320 patients, median follow-up was 46 (range: 0.1–64.3) months, median age 56, 84% male, Eastern Cooperative Oncology Group PS 0 (71%), 1 (29%). Primary site was oropharynx in 81% (p16+ 68%, p16− 16%, missing 16%). Baseline scores did not differ by arm (A/B): FACT-H&N 116.5/115, MDADI Global 83/77, SWAL-QOL General 67/68. At 1 year, no difference was seen between arms in FACT-H&N change from baseline: A −1.70, B −4.81, p = 0.194. Subscale change scores by arm were (A/B): last week RT, FACT-Physical (−11.6, −10, p = 0.049), MDADI Physical (−40.4, −33.9, p = 0.045), and SWAL-QOL Eating Duration (−61.2, −51.2, p = 0.02), Eating Desire (−53.3, −43.9, p = 0.031) and Mental Health (−42, −32.6, p = 0.009); 4 months, HN subscale (−7.7, −10, p = 0.014). No clinically important differences by arm were seen post-treatment.ConclusionsPMab with AFX did not durably improve QOL or swallowing as compared with SFX with cisplatin.Trial registrationClinicalTrials.gov: NCT00820248.



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