Pilot study for permanent resolution of axillary hyperhidrosis: elimination of sweat glands with intradermal microneedle radiofrequency

Abstract

Background

Hyperhidrosis is a disorder of the autonomic nervous system that creates severe social and work problems through the production of excess uncontrolled perspiration. This disease affects about 1 to 3% of the world's population. Essential or primary hyperhidrosis being most frequently seen. Treatment with a variety of surgical and non-surgical systems has been reported. Recently, intradermal microneedle radiofrequency has attracted favorable attention.

Methods

Seventy-four armpits in 37 patients (9 males, 28 females, average age 28 years [range 15–68 years]) diagnosed as having axillary hyperhidrosis who were performed intradermal microneedling fractional radiofrequency (MRF) in three deeps 2 mm, 3 mm, and 3.5 mm. The study was performed from July 2014 until July 2016. All patients completed control and follow-up sessions for 6 months.

Results

A permanent decrease in sweating of over 50% was achieved in 30 patients (80%); intermediate results in 2 (7%) and little or no results in 5 patients (13% of patients).

Conclusions

results suggest that MFR is a novel, safe, effective, permanent, and minimally invasive method to treat AHH with tolerable side effects.

Level of Evidence: Level IV, therapeutic study.

http://bit.ly/2sul6LL

Actigraphy‐measured nocturnal wrist movements and assessment of sleep quality in patients with bullous pemphigoid: a pilot case–control study

Summary

Background

Bullous pemphigoid (BP) is a distressing autoimmune bullous disease strongly associated with severe pruritus; however, data concerning pruritus in BP are still scarce. No clinical research evaluating the effect of BP on sleep quality has been conducted.

Aim

To evaluate the intensity of pruritus measured by nocturnal wrist movements (NWMs) and the sleep quality in patients with BP using actigraphy in comparison with nonpruritic healthy controls (HCs) with subsequent correlations with an itch visual analogue scale (VAS) as a subjective measure, disease severity [Bullous Pemphigoid Disease Area Index (BPDAI), urticaria/erythema, erosions/blisters] and serum total IgE level.

Methods

In total, 31 patients with newly diagnosed BP (mean ± SD age 75.4 ± 12.3 years) and 40 nonpruritic HCs (age 73.5 ± 11.7 years) were recruited. All participants wore a sleep monitor (ActiSleep+) on the dominant wrist.

Results

For patients with BP, median VAS score was 5.5 and median BPDAI was 43 (urticaria/erythema BPDAI was 16, erosions/blisters BPDAI was 29). Scratching, defined as bouts of NWMs, was significantly (P < 0.001) more intensive in patients with BP than in controls. Characteristic of BP was that scratching bouts corresponded with the slowest wrist movements. There were no correlations with VAS, BPDAI or total IgE level. Compared with HCs, patients with BP presented significant (P < 0.001) sleep disturbances, as determined by sleep efficiency, waking after sleep onset and average duration of awakening, and these were strongly correlated with urticaria/erythema BPDAI.

Conclusion

Nocturnal wrist movements measured by actigraphy are more intensive in patients with BP than in nonpruritic HCs, and characteristically slow movements. Actigraphy method showed very low sleep quality in patients with BP, thus severity of BP has a negative impact on sleep.

http://bit.ly/2Ru9ZBn

Association of interleukin‐6 gene promoter polymorphism with acne vulgaris and its severity

Summary

Background

Acne vulgaris (AV) is an inflammatory disorder with a possible genetic background. Different cytokines and mediators are involved in its pathogenesis.

Aim

Our aim was to investigate the interleukin (IL)‐6 572 polymorphism in patients with AV and its relation to patient sex and acne severity.

Methods

In total, 30 patients with acne and 20 healthy controls (HCs) were enrolled. The Global Acne Grading System was used to assess acne severity. The IL‐6 572 gene promoter polymorphism was assessed using the PCR–restriction fragment length polymorphism method.

Results

There was a significantly higher association of IL‐6 572 variants genotypes in patients with acne (93%) compared with the HC group (45%) (P < 0.001), with a higher incidence of the IL‐6 572 CC polymorphism in patients with acne. A significant difference (P < 0.001) between C and G alleles in patients vs. HCs was detected. There were no significant associations between the IL‐6 572 variant genotypes and either patient sex or AV severity.

Conclusion

IL‐6 gene promoter polymorphism might have a role in AV susceptibility but it is not related to AV severity.

http://bit.ly/2CoI7Ek

Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS): How Far Have We Come?

Abstract

Drug reaction with eosinophilia and systemic symptoms (DReSS), also known as drug-induced hypersensitivity syndrome (DiHS), is an uncommon severe adverse reaction to medications. It is important to recognize it as it is potentially fatal and can cause significant morbidity. From the first reports of drug reactions related to certain anticonvulsants characterized by fever, liver enzyme elevation, and skin changes, our continuously growing understanding of this entity has allowed us to describe its physiopathology and clinical features even further. The relationship of genetic factors, viral activation, and specific drug exposure is now known to play a role in this disease. There is still not a widely accepted marker for DReSS/DiHS, but the spectrum of clinical and laboratory features has now been better outlined. The mainstay of treatment is the use of systemic corticosteroids, but other options such as intravenous immunoglobulin, cyclosporine, mycophenolate mofetil, rituximab, and cyclophosphamide have been described. We present a comprehensive review of the literature on DReSS/DiHS, focusing on its history, etiopathogenesis, diagnosis, therapeutic approach, and outcome.

http://bit.ly/2DgwDVb

Osimertinib in Elderly Patients with Epidermal Growth Factor Receptor T790M‐Positive Non‐Small‐Cell Lung Cancer Who Progressed During Prior Treatment: A Phase II Trial

AbstractLessons Learned. Non‐small‐cell lung cancer (NSCLC) represents 85% of lung cancer in elderly patients.In the present study performed in the 36 elderly subjects with epidermal growth factor receptor (EGFR) T790M mutation‐positive NSCLC, osimertinib 80 mg demonstrated statistically significant improvement in the objective response rate, which was comparable to those in the nonelderly population.Osimertinib appears to be an effective and safe treatment option in elderly patients with advanced NSCLC with EGFR mutation; further research in larger scale is warranted.Background.Previous findings suggest the possibility of relatively safe use of osimertinib for patients with T790M‐positive non‐small‐cell lung cancer (NSCLC), with few serious adverse events for the elderly in comparison with conventional endothelial growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), and with an antitumor effect.Methods.This phase II study was performed to prospectively investigate the efficacy and safety of osimertinib for elderly patients aged ≥75 years with ineffective prior EGFR TKI treatment or with recurrence in T790M EGFR TKI resistance mutation‐positive NSCLC.Results.A total of 36 patients were included in the analyses. Among the 36 subjects, 63.9% were female, with mean age of 79.9 years. The objective response rate (ORR) was 58.3% (95% confidence interval [CI], 42.2%–72.9%), demonstrating statistically significant efficacy of osimertinib (p = .0017). The median duration of response (DOR) was 27.9 weeks (95% CI, 21.1–82.0). Complete response (CR) and partial response (PR) were 2.8% and 55.6%, respectively. Disease control rate (DCR) was 97.2%. A waterfall plot revealed that 33 (91.6%) subjects exhibited tumor shrinkage during treatment, including 12 of 14 subjects who had stable disease (SD). All adverse events were not reason for discontinuation of the study drug.Conclusion.Osimertinib may be an effective and safe treatment option in elderly patients with advanced NSCLC with EGFR mutation.

http://bit.ly/2DdCyKC

Exploring Biomarkers of Phosphoinositide 3‐Kinase Pathway Activation in the Treatment of Hormone Receptor Positive, Human Epidermal Growth Receptor 2 Negative Advanced Breast Cancer

AbstractResistance to endocrine therapy (ET) is common in patients with hormone receptor positive (HR+) advanced breast cancer (ABC). Consequently, new targeted treatment options are needed in the post‐ET setting, with validated biomarkers to inform treatment decisions. Hyperactivation of the phosphoinositide 3‐kinase (PI3K) signaling pathway is common in ABC and is implicated in resistance to ET. The most frequent mechanism of PI3K pathway activation is activating mutations or amplification of PIK3CA, which encodes the α‐isoform of the catalytic subunit of PI3K. Combining buparlisib, a pan‐PI3K‐targeted agent, with ET demonstrated modest clinical benefits in patients with aromatase inhibitor‐resistant, HR+, human epidermal growth receptor 2 negative (HER2−) ABC in two phase III trials. Importantly, greater efficacy gains were observed in individuals with PIK3CA‐mutated disease versus PIK3CA‐wild‐type tumors. Although the challenging safety profile did not support widespread use of this treatment combination, isoform‐selective PI3K inhibitors may improve tolerability. In early clinical trials, promising disease control benefits were demonstrated with the PI3K isoform‐selective inhibitors alpelisib and taselisib in patients with PIK3CA‐mutated HR+, HER2− ABC. Ongoing biomarker‐guided phase II/III studies may provide further opportunities to identify patients most likely to benefit from treatment with PI3K inhibitors and provide insight into optimizing the therapeutic index of PI3K inhibitors. Challenges facing the implementation of routine PIK3CA mutation testing must be addressed promptly so robust and reproducible genotyping can be obtained with liquid and tumor biopsies in a timely and cost‐effective manner.Implications for Practice.The development of phosphoinositide 3‐kinase (PI3K) inhibitors, especially those that selectively target isoforms, may be an effective strategy for overcoming endocrine therapy resistance in hormone receptor positive, human epidermal growth receptor 2 negative advanced breast cancer. Early‐phase studies have confirmed that patients with PIK3CA mutations respond best to PI3Kα‐isoform inhibition. Ongoing phase III trials will provide further data regarding the efficacy and safety of PI3K inhibitors in patients with different biomarker profiles.

http://bit.ly/2TOSacW

S‐1 plus Raltitrexed for Refractory Metastatic Colorectal Cancer: A Phase II Trial

AbstractLessons Learned.The upregulation of dihydropyrimidine dehydrogenase (DPD) and thymidylate synthase (TS) are important mechanisms of resistance to 5‐fluorouracil (5‐FU) in metastatic colorectal cancer (mCRC) after long exposure to 5‐FU.S‐1 (containing a DPD inhibitor) combined with raltitrexed (a TS inhibitor) showed a moderate effect, which needs further study as a third‐ or later‐line therapy in mCRC.Background.5‐fluorouracil (5‐FU) is a fundamental drug in the treatment of metastatic colorectal cancer (mCRC). Patients with mCRC are often exposed to 5‐FU and/or its analogues for a long time because of its central role in treatment regimens. The upregulation of dihydropyrimidine dehydrogenase (DPD) and/or thymidylate synthase (TS) are important mechanisms of resistance of 5‐FU. To evaluate the efficacy and safety of S‐1 (containing a DPD inhibitor) and raltitrexed (a TS inhibitor) for refractory mCRC, a one‐center, single‐arm, prospective phase II trial was conducted.Methods.Patients who had mCRC that had progressed after treatment with fluoropyrimidine, irinotecan, and oxaliplatin and who had at least one measurable lesion were eligible for this trial. Patients received oral S‐1 (80–120 mg for 14 days every 3 weeks) plus an intravenous infusion of raltitrexed (3 mg/m2 on day 1 every 3 weeks). The primary endpoint was objective response rate (ORR). Secondary endpoints included progression‐free survival (PFS), overall survival (OS), and toxicity.Results.In total, 46 patients were enrolled. Three patients did not complete the first assessment because of adverse events and unwillingness, leaving tumor response evaluation available in 43 patients. Of 43 evaluable patients, the ORR was 13.9% and disease control rate was 58.1%. In the intention‐to‐treat population (n = 46), the ORR was 13.0% and disease control rate was 54.3%. Median PFS and median OS were 107 days (95% confidence interval [CI], 96.3–117.7) and 373 days (95% CI, 226.2–519.8), respectively. Most of the adverse effects were mild to moderate.Conclusion.S‐1 combined with raltitrexed for refractory mCRC showed moderate effect, and it is worthy of further study as third‐ or later‐line therapy in mCRC.

http://bit.ly/2CprZ5l

Long‐Term Safety Experience with Telotristat Ethyl Across Five Clinical Studies in Patients with Carcinoid Syndrome

AbstractBackground.Patients with neuroendocrine tumors (NETs) and carcinoid syndrome experience considerable morbidity and mortality; carcinoid syndrome may be associated with shorter survival. Carcinoid syndrome is linked to tumoral secretion of serotonin and other bioactive substances. The subsequent debilitating diarrhea and urgency to defecate pose significant health risks. In previous studies, telotristat ethyl, a tryptophan hydroxylase inhibitor, was effective and well tolerated in treating carcinoid syndrome diarrhea. We present pooled safety data from five clinical trials with telotristat ethyl in patients with carcinoid syndrome.Subjects, Materials, and Methods.Adverse events reported during telotristat ethyl treatment were pooled from two phase II and three phase III clinical trials in 239 patients with carcinoid syndrome. Long‐term safety of telotristat ethyl and causes of hospitalization and death were reviewed; overall survival was estimated.Results.Mean (median; range) duration of exposure and follow‐up was 1.3 years (1.1 years; 1 week to 5.7 years), with 309 total patient‐years of exposure. Leading causes of hospitalization were gastrointestinal disorders or were related to the underlying tumor and related treatment. Survival estimates at 1, 2, and 3 years were 93%, 88%, and 77%. Nearly all deaths were due to progression or complication of the underlying disease; none were attributable to telotristat ethyl. There was one death in year 4.Conclusion.Based on long‐term safety data, telotristat ethyl is well tolerated and has a favorable long‐term safety profile in patients with carcinoid syndrome.Implications for Practice.Carcinoid syndrome can cause persistent diarrhea, even in patients treated with somatostatin analogs. Across five clinical trials in patients with carcinoid syndrome, telotristat ethyl has been well tolerated and efficacious, providing clinicians with a new approach to help control carcinoid syndrome diarrhea, in addition to somatostatin analog therapy. By reducing the stool frequency in patients with carcinoid syndrome whose diarrhea is refractory to anticholinergics, such as loperamide and atropine/diphenoxylate, and somatostatin analog dose escalation, improvement in quality of life becomes an achievable goal.

http://bit.ly/2DdChay

January is Thyroid Awareness Month

PDF file for Printing and Saving

The post January is Thyroid Awareness Month appeared first on American Thyroid Association.

http://bit.ly/2FuRzdj

A case of erythrodermic psoriasis successfully treated with ixekizumab

Abstract

Erythrodermic psoriasis (EP) is the most severe form of psoriasis, resulting in significant morbidity and mortality. International guidelines on EP treatment are lacking, with most of the biologic drugs being used basing on case reports or small case series. Ixekizumab, a fully human anti‐interleukin (IL)‐17A monoclonal antibody, is approved for moderate to severe plaque psoriasis while its use in EP is off label. However, two studies conducted on 8 Japanese EP patients have showed ixekizumab as an efficacious and well tolerated therapy up to 24 and 52 weeks, respectively. To date, no case reports on Caucasian patients have been described. We report the case of a 66‐year‐old Caucasian female with EP successfully treated with ixekizumab, reaching PASI 100 after only 6 weeks of therapy and still maintaining this response at week 24. Our case report suggest ixekizumab as a highly efficacious treatment in EP, presenting also a very rapid action which leads to complete resolution of the disease after 6 weeks. Further studies are warrant to confirm our data, with controlled trials specifically dedicated to EP being strictly needed in order to verify the role and efficacy of the new biologics in EP.

This article is protected by copyright. All rights reserved.

http://bit.ly/2AZQO8n

Elucidating the dechlorination mechanism of hexachloroethane by Pd-doped zerovalent iron microparticles in dissolved lactic acid polymers using chromatography and indirect monitoring of iron corrosion

Abstract

The degradation mechanism of the pollutant hexachloroethane (HCA) by a suspension of Pd-doped zerovalent iron microparticles (Pd-mZVI) in dissolved lactic acid polymers and oligomers (referred to as PLA) was investigated using gas chromatography and the indirect monitoring of iron corrosion by continuous measurements of pH, oxidation-reduction potential (ORP), and conductivity. The first experiments took place in the absence of HCA, to understand the evolution of the Pd-mZVI/PLA/H₂O system. This showed that the evolution of pH, ORP, and conductivity is related to changes in solution chemistry due to iron corrosion and that the system is initially cathodically controlled by H⁺ mass transport to Pd surfaces because of the presence of an extensive PLA layer. We then investigated the effects of Pd-mZVI particles, temperature, initial HCA concentration, and PLA content on the Pd-mZVI/PLA/HCA/H₂O system, to obtain a better understanding of the degradation mechanism. In all cases, HCA dechlorination first requires the production of atomic hydrogen H^*—involving the accumulation of tetrachloroethylene (PCE) as an intermediate—before its subsequent reduction to non-chlorinated C₂ and C₄ compounds. The ratio between Pd-mZVI dosage, initial HCA concentration, and PLA content affects the rate of H^* generation as well as the rate-determining step of the process. A pseudo-first-order equation can be applied when Pd-mZVI dosage is much higher than the theoretical stoichiometry (600 mg for [HCA]₀ = 5–20 mg L⁻¹). Our results indicate that the HCA degradation mechanism includes mass transfer, sorption, surface reaction with H^*, and desorption of the product.

http://bit.ly/2VY2JMF

Chloroplast proteomic analysis of Triticum aestivum L. seedlings responses to low levels of UV-B stress reveals novel molecular mechanism associated with UV-B tolerance

Abstract

In this study, we have investigated UV-B-induced alterations including chloroplast ultrastructure, chlorophyll fluorescence parameters, physiological metabolism, and chloroplast proteome profile. Comparison of seedling phenotypic characterization and physiological status revealed that the low level of 1.08 KJ m⁻² of UV-B irradiation had no obvious effects on seedling phenotype and growth and maintained better chloroplast ultrastructure and higher photosynthetic efficiency. Nevertheless, the high dose of 12.6 KJ m⁻² of UV-B stress caused significant inhibitory effects on the growth and development of wheat seedlings. Proteomic analysis of chloroplasts with or without 1.08 KJ m⁻² of UV-B irradiation identified 50 differentially expressed protein spots, of which 35 were further analyzed by MALDI-TOF/TOF mass spectrometry. These proteins were found to be involved in multiple cellular metabolic processes including ATP synthesis, light reaction, Calvin cycle, detoxifying and antioxidant reactions, protein metabolism, malate and tetrapyrrole biosynthesis, and signal transduction pathway. We also identified 3 novel UV-B-responsive proteins, spots 8801, 8802, and 9201, and predicted three new proteins might be UV-B protective proteins. Our results imply chloroplasts play a central protective role in UV-B resistance of wheat seedlings and also provide novel evidences that UV-B stress directly affects on the structure and function of chloroplasts and explore molecular mechanisms associated with plant UV-B tolerance from chloroplast perspective.

http://bit.ly/2QQxgIl

“A morphometric study of age and sex dependent changes in eyebrow height and shape”

Rejuvenation procedures of the periorbital region and the forehead with the eyebrow as a key structure are often performed in plastic surgery. There is no common consent on the changes of aging in this region and the consecutive treatment options. This study was designed to support the body of literature with a broader data basis about the natural changes of eyebrow position and its shape.

http://bit.ly/2He7RJ1

Origin and behavior of radionuclides in sediment core: a case study of the sediments collected from man-made reservoirs located in the past mining region in Central Slovakia

Abstract

The analyzed sediments were taken from the man-made reservoirs (Velka Richnava, Rozgrund and Vindsachta) located in an area intensively mined for polymetallic ores since the end of the eleventh century (Banska Stiavnica region, Central Europe). The aims of this study were to determine the radioactivity of natural (²²⁶Ra, ²²⁸Th, ²¹⁰Pb) and artificial (¹³⁷Cs and ²⁴¹Am) radionuclides, compare the radionuclides' distribution, and indicate the correlation of radioisotopes and their origin related to sediment properties. Two analytical techniques were used. ²²⁸Th, ²²⁶Ra, ²⁴¹Am, and ¹³⁷Cs were measured by means of gamma spectrometry and ²¹⁰Pb was determined by its daughter radionuclide ²¹⁰Po using alpha spectrometry. The results showed that the highest mean level of ²²⁶Ra (42.6 Bq·kg⁻¹), ²²⁸Th (49.7 Bq·kg⁻¹) and ²¹⁰Pb (75.2 Bq·kg⁻¹) was in the sediments collected from Rozgrund. The radioactivity of ¹³⁷Cs and ²⁴¹Am were present at a higher level in the layer related to Chernobyl (1986) accident and nuclear weapon test (1950/1960). The distribution of natural radionuclides was quite similar in all reservoirs. Chemometric analysis confirmed the radionuclides' origin and correlation between the analyzed parameters.

http://bit.ly/2sqKySi

The patterns and treatment of postoperative hemorrhage and hematoma in total endoscopic thyroidectomy via breast approach: experience of 1932 cases

Abstract

Purpose

Postoperative hemorrhage and hematoma formation is a potentially lethal complication in thyroid surgery, although the patterns and treatment of hemorrhage after total endoscopic thyroidectomy (TET) via breast approach has not been reported previously. We aim to share our experience about postoperative bleeding.

Methods

A retrospective analysis of 1932 patients who underwent TET from April 2008 to May 2018 in our institution was carried out. The patterns of postoperative hemorrhage and hematoma formation that need surgical treatment were summarized and focused on the relation to the source of bleeding and the time interval between first surgery and hemorrhage. Related risk factors were analyzed by univariate or multivariate analysis processes.

Results

The overall rate of hemorrhage and hematoma occurrence was only 0.724% (14 in 1932 patients). Of them, 12 occurred in the first 24 h after surgery, and the other two occurred after withdrawal of the drainage tube. The principle independent risk factors for postoperative hemorrhage and hematoma were age (older than 35 years old) and lateral compartment dissection (LCD) revealed by multivariate regression. During re-exploration, obvious bleeding points were detected in 13 patients. Among them, 12 bled from the vessels in the main trocar cavity and another 1 bled from a broken vein located between the two heads of the sternocleidomastoid (SCM) muscle with LCD.

Conclusions

Hemorrhage after TET usually occurs within 24 h, and the main video trocar cavity was the area most likely to bleed. Age and LCD may increase the bleeding risk. Appropriate dissection level is the main solution to prevent postoperative hemorrhage.

http://bit.ly/2FDZSTq

The patterns and treatment of postoperative hemorrhage and hematoma in total endoscopic thyroidectomy via breast approach: experience of 1932 cases

Abstract

Purpose

Postoperative hemorrhage and hematoma formation is a potentially lethal complication in thyroid surgery, although the patterns and treatment of hemorrhage after total endoscopic thyroidectomy (TET) via breast approach has not been reported previously. We aim to share our experience about postoperative bleeding.

Methods

A retrospective analysis of 1932 patients who underwent TET from April 2008 to May 2018 in our institution was carried out. The patterns of postoperative hemorrhage and hematoma formation that need surgical treatment were summarized and focused on the relation to the source of bleeding and the time interval between first surgery and hemorrhage. Related risk factors were analyzed by univariate or multivariate analysis processes.

Results

The overall rate of hemorrhage and hematoma occurrence was only 0.724% (14 in 1932 patients). Of them, 12 occurred in the first 24 h after surgery, and the other two occurred after withdrawal of the drainage tube. The principle independent risk factors for postoperative hemorrhage and hematoma were age (older than 35 years old) and lateral compartment dissection (LCD) revealed by multivariate regression. During re-exploration, obvious bleeding points were detected in 13 patients. Among them, 12 bled from the vessels in the main trocar cavity and another 1 bled from a broken vein located between the two heads of the sternocleidomastoid (SCM) muscle with LCD.

Conclusions

Hemorrhage after TET usually occurs within 24 h, and the main video trocar cavity was the area most likely to bleed. Age and LCD may increase the bleeding risk. Appropriate dissection level is the main solution to prevent postoperative hemorrhage.

http://bit.ly/2FDZSTq

Τhe minimum fascia–tumor distance (MFTD) criterion is more feasible for benign tumors than for malignant tumors for the localization of parotid tumors. For benign parotid tumors, US is enough to guide operations.

The Diagnostic Performance of Ultrasonography and Computed Tomography in Differentiating Superficial from Deep Lobe Parotid Tumors

Ping‐Chia Cheng  Chih‐Ming Chang  Chun‐Chieh Huang  Wu‐Chia Lo  Tsung‐Wei Huang  Po‐Wen Cheng Li‐Jen Liao

First published: 12 January 2019 https://doi.org/10.1111/coa.13289

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/coa.13289

ePDFPDFTOOLS SHARE

Abstract

Objectives

To validate and compare ultrasound (US) versus computed tomography (CT) criteria in the localization of superficial/deep lobe tumors of the parotid gland.

Design and Setting

This was a retrospective study of diagnostic tests performed from January 2008 to June 2017.

Participants

We included adult patients who were referred for a neck ultrasonography examination due to parotid tumors, and who subsequently underwent parotid surgery.

Main outcome measures

We assessed the location of parotid tumors, comparing the minimum fascia–tumor distance (MFTD) criterion on an US with eight CT criteria. We analyzed receiver operating characteristic (ROC) curves of the MFTD for malignant, benign, and all parotid tumors, and compared the accuracy, sensitivity, and specificity of the optimal MFTD with those of CT anatomical criteria.

Results

A total of 166 parotid tumors were included. The mean (SD) MFTD in superficial lobe tumors was significantly shorter than that of deep lobe tumors (1.2 [0.7] vs 2.8 [1.9] mm, effect size: 1.84; 95% CI, 1.27 to 2.41). The areas under the ROC curve were 0.63 for malignant tumors and 0.88 for benign tumors. The optimal MFTD cut point was 2.4 mm for the 154 benign parotid tumors and the accuracy, sensitivity, and specificity were 90%, 80% and 91%, respectively. For the 136 benign parotid tumors that underwent CT examination, three criteria had an accuracy of over 90% (FNline, tMasseter and Conn's arc), but the sensitivities were all below 50%.

Conclusions

MFTD is more feasible for benign tumors than for malignant tumors for the localization of parotid tumors. For benign parotid tumors, US is enough to guide operations.

Mitteilungen DGKFO

http://bit.ly/2Mg4TCP

Mitteilungen DGKFO

http://bit.ly/2Mg4TCP

Anterior Corpus Callosotomy Using Laser Interstitial Thermal Therapy for Refractory Epilepsy

Corpus callosotomy is a viable treatment for patients with refractory generalized or multifocal epilepsy, particularly those who have drop attacks. Laser interstitial thermal therapy (LITT) is a minimally invasive surgical option for various intracranial lesions. In this report, we present a 2-trajectory thermal ablation using the NeuroBlate® system (Monteris Medical, MN, USA) for an anterior two-thirds callosotomy in a patient with refractory epilepsy and frequent drop attacks. Adequate ablation of the corpus callosum was confirmed by MRI during the procedure. At the 1-month follow-up, the frequency had decreased from multiple seizures per day to only 3 over the course of 1 month. In addition, he had not suffered any drop attacks or tonic-clonic movements since the procedure. Five months after surgery, seizures had decreased to 1 per month with no drop attacks or loss of consciousness, consistent with an Engel class II outcome. In conclusion, LITT ablation of the corpus callosum is a safe, feasible, and minimally invasive treatment option for patients with refractory epilepsy, and it may be an attractive alternative for patients unwilling or unable to undergo open surgery.
Stereotact Funct Neurosurg

http://bit.ly/2VYAopi

The Pioneering and Unknown Stereotactic Approach of Roeder and Orthner from Göttingen. Part II: Long-Term Outcome and Postmortem Analysis of Bilateral Pallidotomy in the Pre-Levodopa Era

Before the advent of levodopa, pallidotomy was initially the most effective treatment for Parkinson disease, but it was soon superseded by thalamotomy. It is widely unknown that, similar to Leksell, 2 neurologists from Göttingen, Orthner and Roeder, perpetuated pallidotomy against the mainstream of their time. Postmortem studies demonstrated that true posterior and ventral pallidoansotomy sparing the overwhelming mass of the pallidum was accomplished. This was due to a unique and individually tailored stereotactic technique even allowing bilateral staged pallidotomies. In 1962, the long-term effects (3-year follow-up on average) of the first 18 out of 36 patients with staged bilateral pallidotomies were reported in great detail. Meticulous descriptions of each case indicate long-term improvements in parkinsonian rigidity and associated pain, as well as posture, gait, and akinesia (e.g., improved repetitive movements and arm swinging). Alleviation of tremor was found to require larger lesions than needed for suppression of rigidity. No improvement in speech, drooling, or seborrhea was observed. By 1962, the team had operated 13 patients with postencephalitic oculogyric crises with remarkable results (mean follow-up: 5 years). They also described alleviation of nonparkinsonian hyperkinetic disorders (e.g., hemiballism and chorea) with pallidotomy. The reported rates for surgical mortality and other complications had been remarkably low, even if compared to those reported after the revival of pallidotomy by Laitinen in the post-levodopa era. This applies also to bilateral pallidotomy performed with a positive risk-benefit ratio that has remained unparalleled to date. The intricate history of pallidotomy for movement disorders is incomplete without an appreciation of the achievements of the Göttingen group.
Stereotact Funct Neurosurg

http://bit.ly/2QUSpRQ

Gamma Knife Radiosurgery for Trigeminal Neuralgia Caused by a Cavernous Malformation: Case Report and Literature Review

Objective: Trigeminal neuralgia (TN) related to a brainstem cavernous malformation (CM) is a rare entity. We present the first radiosurgical management of a patient with TN secondary to a CM. Clinical Presentation: An 80-year-old female presented with a 33-year history of progressively severe TN refractory to medications. Imaging confirmed a solitary CM located at the pontine dorsal root entry zone of cranial nerve 5. Treatment: Stereotactic radiosurgery of the trigeminal nerve was performed using the Leksell gamma knife. A single 4-mm isocenter of radiation was focused on the trigeminal nerve and a maximum dose of 80 Gy (40 Gy at the 50% isodose line) was delivered to the nerve. Results: At 1 year, the patient noted that the severe pain attacks had been reduced by 75%, although a background lingering discomfort persisted. Pain suppression medications had been significantly reduced to lamotrigine 100 mg twice daily. Her preoperative distribution of sensory dysfunction mildly increased. Conclusion: For medically refractory TN related to a CM, radiosurgery of the afferent nerve may ameliorate pain without a major decrease in sensation. The more than 30-year history of pain in our patient may have reduced the chance of more significant pain relief.
Stereotact Funct Neurosurg

http://bit.ly/2VXwsFt

Association Between Psoriasis and Dementia: A Population-Based Case–Control Study

Abstract

Background

Dementia is a syndrome that involves the deterioration of several higher mental functions in advanced age, and psoriasis is an autoimmune disease characterized by skin plaque. Epidemiological studies have indicated an association between dementia and psoriasis; however, to date, no studies in Asia have reported this association.

Objective

This study used a population-based medical dataset to explore the association between previously diagnosed psoriasis and dementia in Taiwan.

Methods

Using the Taiwan Longitudinal Health Insurance Database 2000, we identified 7118 individuals with a diagnosis of dementia; a further 21,354 sex- and aged-matched individuals were randomly extracted as controls. Patients with bullous pemphigoid, which is characterized by inflammatory phenomena similar to that evident in psoriasis, were chosen as a control group. Conditional logistic regression was performed to evaluate the association between dementia and prior psoriasis or bullous pemphigoid among the sampled patients.

Results

Of the 28,472 individuals, 2.2, 3.0, and 1.5% of the total, case, and control groups, respectively, had been diagnosed with psoriasis. After adjustments were made for patients' monthly income, region, urbanization level, diabetes, hyperlipidemia, hypertension, and coronary heart disease, the odds ratio (OR) of diagnosed psoriasis for the case group was 1.46 (95% confidence interval [CI] 1.23–1.73; p < 0.001) compared with the control group. The ORs of a previous psoriasis diagnosis with arthritis and without arthritis in the case group were, respectively, 1.95 and 1.44 times (95% CI 1.03–3.89 and 1.21–1.72, respectively) those of the control group after adjustments for socioeconomic variables, diabetes, hyperlipidemia, hypertension, and coronary heart disease. However, no significant differences in prior bullous pemphigoid were observed between the dementia and control groups (0.5% and 0.4%, respectively).

Conclusions

More patients with dementia had prior psoriasis than did patients in the control group. Additional research is required to confirm our results and clarify the relationship.

http://bit.ly/2RsYxpq

Issue Information

http://bit.ly/2Co6Jx6

Sliding motion compensated low-rank plus sparse (SMC-LS) reconstruction for high spatiotemporal free-breathing liver 4D DCE-MRI

Publication date: Available online 15 January 2019

Source: Magnetic Resonance Imaging

Author(s): Wenyuan Qiu, Dongxiao Li, Xinyu Jin, Fan Liu, Thanh D. Nguyen, Martin R. Prince, Yi Wang, Pascal Spincemaille

Abstract

Liver dynamic contrast-enhanced MRI (DCE-MRI) requires high spatiotemporal resolution and large field of view to clearly visualize all relevant enhancement phases and detect early-stage liver lesions. The low-rank plus sparse (L + S) reconstruction outperforms standard sparsity-only-based reconstruction through separation of low-rank background component (L) and sparse dynamic components (S). However, the L + S decomposition is sensitive to respiratory motion so that image quality is compromised when breathing occurs during long time data acquisition. To enable high quality reconstruction for free-breathing liver 4D DCE-MRI, this paper presents a novel method called SMC-LS, which incorporates Sliding Motion Compensation into the standard L + S reconstruction. The global superior-inferior displacement of the internal abdominal organs is inferred directly from the undersampled raw data and then used to correct the breathing induced sliding motion which is the dominant component of respiratory motion. With sliding motion compensation, the reconstructed temporal frames are roughly registered before applying the standard L + S decomposition. The proposed method has been validated using free-breathing liver 4D MRI phantom data, free-breathing liver 4D DCE-MRI phantom data, and in vivo free breathing liver 4D MRI dataset. Results demonstrated that SMC-LS reconstruction can effectively reduce motion blurring artefacts and preserve both spatial structures and temporal variations at a sub-second temporal frame rate for free-breathing whole-liver 4D DCE-MRI.

http://bit.ly/2SZSw0q

Influence of the Topographic Vascular Distribution of the Face on Dermal Filler Accidents

Objective: Dermal fillers are an important tool in the field of aesthetic dermatology. Fillers are relatively noninvasive and easy to use but are not free of secondary complications. The main complications are vascular and are due to either the compression of an artery or the direct introduction of the product into the arterial lumen. The aim of this study is to provide an overview of the vascular territories of the face to avoid many possible complications when using facial fillings. Anatomical localization of the main arterial supply to the face has been described to assess the risk of vascular injury. Methods: The authors dissected 17 hemifaces of embalmed adult cadavers that had previously been injected, through the common carotid artery, with latex containing a red dye. Results: A topographic distribution was generated by facial regions following a clinical approach from where the facial fillings were placed and related to the pathways of the arteries. Following these criteria, we established 8 topographic regions (I–VIII) that indicate the main vascular problems of each of these regions. Detailed anatomical localizations of the main arteries in these topographic regions of the face and their relationships are described. Conclusions: The highest index of vascular lesions and especially visual alterations occurred for fillings of the upper third of the face. To prevent and avoid this type of lesion, it is advisable to avoid, as much as possible, treatments with filling materials in the upper third of the face, mainly including the glabellar and nasal region (III) and supraorbital region (VIII).
Dermatology

http://bit.ly/2HiAgxJ

Long-Wave Medical Infrared Thermography: A Clinical Biomarker of Inflammation in Hidradenitis Suppurativa/Acne Inversa

Background: A more reliable classification of skin inflammation and severity of active disease results from ultrasound sonography and the new hidradenitis suppurativa/acne inversa (HS) classification system IHS4. However, an objective assessment of skin inflammation in a continuous mode is still the ultimate goal. Long-wave medical infrared thermography (MIT) may offer a blood flow and temperature differential assessment in inflammatory conditions. Objective: To evaluate the application of MIT in HS. Methods: Standardized photography of the areas involved or previous candidates for HS involvement was performed and MIT pictures were taken simultaneously and superimposed on the photographs of 18 patients (11 female, 7 male, median age 38.75 years [95% confidence interval 28.5–51 years], Hurley score I 5.6%, Hurley score II 38.9%, and Hurley score III 55.5%). A modification of the Otsu method facilitated the automatic lesion segmentation from the background, depicting the inflammation area. Moreover, MIT was administered in real-time mode during radical HS surgery. Results: A 1°C temperature difference from a corresponding symmetric body region was indicative of inflammation. MIT figures detected a gradual increase of skin temperature from 33.0°C in healthy skin on average to 35.0–36.6°C at the center of inflamma tory lesions in the axilla and to 35.4–36.9°C at the center of inflammation in the groin area. Real-time MIT assessment enabled the definition of the margins and depth of the surgical intervention during the procedure. Conclusion: MIT is a promising tool for the detection of inflammation severity in HS lesions and can be used as a clinical biomarker in evaluation studies of medical and surgical HS treatment.
Dermatology

http://bit.ly/2ROUbsk

Removal of indigo carmine dye by electrocoagulation using magnesium anodes with polarity change

Abstract

The aim of this study was to evaluate the performance of high purity magnesium and the magnesium-aluminum-zinc alloy AZ31 as sacrificial anodes in an electrocoagulation process with polarity change for the treatment of synthetic indigo carmine solution. It was studied the effect of the main parameters such as temperature, anodic material, current density, initial dye concentration, and agitation speed on the diminishing of indigo carmine concentration and non-purgeable organic carbon. Also, image analysis was used in conjunction with zeta potential measurements to understand the mechanism of flocs formation. The best results were 80% and 96% removal for non-purgeable organic carbon and dye content respectively at room temperature, by using turbulent regime, initial dye concentration of 100 mg L⁻¹ and 50 A m⁻² as current density with AZ31 alloy as electrodes. Particularly, high purity magnesium reached 75% in non-purgeable organic carbon removal and 86% in dye removal at the conditions described above. Finally, an additional improvement of 43% in the diminishing of the organic carbon content was observed when polarity change was used, a phenomenon that was attributed to the distribution of the oxidation reaction between electrodes, avoiding the saturation of the surface with oxide and hydroxide layers. Major areas and major fractal dimension were obtained by using a polarity change.

http://bit.ly/2sDv3ql

Dickkopf-1 Expression in Androgenetic Alopecia and Alopecia Areata in Male Patients

Background: Androgenetic alopecia (AGA) results from shortening of the anagen phase of the hair cycle and, subsequently, miniaturization of hair follicles. Alopecia areata (AA) is a disease of autoimmunity where T cells attack anagen hair follicles and shows multifactorial etiology. Dickkopf-1 (DKK-1) is a gene that is responsible for transformation of anagen to catagen, which suggests that it is involved in development of both diseases. Objectives: To evaluate the tissue levels of dickkopf-1 in male patients with AGA and AA in comparison with controls, in an attempt to know its role in the pathogenesis of both disorders. Methods: DKK-1 immunohistochemical expression was evaluated in lesional scalp biopsies taken from 20 male patients with AGA evaluated clinically by the modified Norwood–Hamilton score, 20 male patients with AA evaluated clinically by SALT score, and 20 healthy controls within the same age and sex of the studied patients. Results: A highly significant difference in DKK-1 expression between patients with AGA and healthy controls was found (P2

http://bit.ly/2stVFK0

High-Risk Human Papillomavirus E6/E7 mRNA Is Rarely Detected in Nonanogenital Cutaneous Squamous Cell Carcinoma: An RNA In Situ Hybridization–Based Tissue Microarray Study

Abstract: High-risk human papillomavirus (HR-HPV) is known to play an oncogenic role in squamous cell carcinoma (SCC) at certain anatomical sites, namely the uterine cervix, oropharynx, and anogenital skin. However, the association between HR-HPV and nonanogenital cutaneous SCC (CSCC) remains controversial. In this study, we addressed this controversy by performing HR-HPV E6/E7 mRNA in situ hybridization (ISH) on 243 CSCC samples. A cocktail of E6/E7 mRNA ISH probes, recognizing 18 HR-HPV genotypes, was applied to a tissue microarray of paraffin-embedded sections of 154 invasive and 89 in situ CSCC specimens. The anatomical sites of CSCC included the head and neck (n = 100), extremities (n = 100), trunk (n = 25), and anogenitalia (n = 18). We also investigated the correlation between the p16 expression and HR-HPV status by immunohistochemistry. The results of HR-HPV E6/E7 mRNA ISH showed that 5.8% (14/243) of all CSCC samples were positive for HR-HPV, including 66.7% (12/18) of the anogenital and only 0.9% (2/225) of the nonanogenital CSCC samples (P

http://bit.ly/2Mc0FfD

Histological Features of Flagellate Erythema

Abstract: Flagellate erythema is a distinctive eruption characterized by "whip-like" linear or curvilinear streaks and plaques, occurring mainly on the trunk. It has classically been described in 2 disparate clinical settings: chemotherapy with bleomycin and ingestion of mushrooms (most commonly Shiitake mushrooms). Most of the literature comprises single case reports, often with minimal histological description of rather nonspecific features. We describe in detail the histological features of 3 cases of flagellate erythema (2 related to bleomycin therapy and one related to ingestion of mushrooms) and review the findings described in the literature to define the spectrum of histological changes encountered in this eruption. Our 3 cases showed mild epidermal changes, with spongiosis and variable interface inflammation. All 3 showed a relatively prominent dermal lymphohistiocytic infiltrate, with features suggestive of a lymphocytic vasculopathy extending to at least the mid-reticular dermis. Eosinophils were a prominent component of the inflammatory infiltrate in 2 cases. Our review of the literature identified a total of 45 publications, representing reports of 46 patients, containing histological information. As well as bleomycin- and mushroom-related cases, similar eruptions have been reported in the context of connective tissue disease and other drugs. Although cases related to connective tissue disease show features of the underlying condition, cases secondary to drugs or mushrooms predominantly show features compatible with common patterns of exanthematous/morbilliform drug reaction. In particular, subtle spongiosis and/or interface dermatitis combined with a dermal lymphocytic infiltrate that includes increased numbers of eosinophils is a common finding. Features of a lymphocytic vasculopathy may be seen in a subset of these cases. Correspondence: Nathan T. Harvey, Dermatopathology Group, Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Hospital Avenue, Nedlands, Western Australia 6009, Australia (e-mail: nathan.harvey@health.wa.gov.au). The authors declare no conflicts of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2sDnXlH

Rare Presentation of a Rare Cutaneous Neoplasm: Nonacral Sclerosing Perineuroma

Abstract: Sclerosing perineuromas are rare, benign peripheral nerve sheath tumors classically reported on the fingers and palms of young men. We present the case of a 12-year-old boy with a slow-growing nodule on his right knee. Excision was performed, and pathology was consistent with a sclerosing perineuroma. This case highlights an atypical presentation of a rare lesion and provides useful knowledge of the clinical scenarios in which sclerosing perineuromas should be included in a differential diagnosis. Correspondence: Kevin M. Donnelly, MD, Department of Internal Medicine, Division of Dermatology, The Ohio State University College of Medicine, 540 Officenter Pl #240, Columbus, OH 43230 (e-mail: Kdonnelly19@gmail.com). The authors declare no conflicts of interest. All authors approve of this manuscript and its submission. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2RuefAX

The Life and Work of Felix Pinkus—A Reminder on the Occasion of His 150th Birthday

No abstract available

http://bit.ly/2MczpgQ

A Large Crusted Nodule on the Upper Ear: Challenge

No abstract available

http://bit.ly/2stMTM3

Reflectance Confocal Microscopy Features of Plaque Psoriasis Overlap With Horizontal Histopathological Sections: A Case Series

Abstract: Reflectance confocal microscopy (RCM) displays horizontal, en face tissue sections of the epidermis and upper dermis, and interpretation of its features is classically based on the comparison with vertical conventional histopathological sections that, as known, do not reflect the same plane of observation. In 10 patients affected by psoriasis, we correlated RCM images with horizontal histopathological sections from skin biopsies, observing in all cases marked overlaps between the 2 techniques. Although vertical section examination remains the gold standard for the diagnosis of psoriasis, this novel comparative approach may contribute to a more precise definition of RCM findings and could represent the drive for further research as well as an innovative tool for educational purposes. Correspondence: Giuseppe Micali, MD, Dermatology Clinic, University of Catania, Via S. Sofia 78, Catania 95123, Italy (e-mail: cldermct@gmail.com). The authors declare no conflicts of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2Mczhhm

Hailey–Hailey–Like Pattern of Acantholysis on the Scalp Should Raise the Possibility of Incipient Pemphigus Vulgaris

Abstract: Hailey–Hailey disease (familial benign chronic pemphigus) is a genodermatosis with a typical clinical presentation of macerated plaques involving intertriginous areas of the body and affects multiple family members. Epidermal acanthosis, incipient, and completed acantholysis of many of the spinous keratinocytes of the epidermis and foci of dyskeratosis are well-recognized histologic findings. We have observed solitary lesions on the "scalp" of patients having a Hailey–Hailey–like pattern, and not the suprabasilar clefting of pemphigus represents the first manifestation of pemphigus vulgaris, which was confirmed with direct immunofluorescence in all our patients. Correspondence: Silvija P. Gottesman, MD, 1991 Marcus Avenue, Suite 300, Lake Success, NY 11042 (e-mail: silvija.gottesman@gmail.com). The authors declare no conflicts of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2st2Tht

Lack of Deletion of 1p36 in 8 Cases of Primary Adenoid Cystic Carcinoma of the Skin

No abstract available

http://bit.ly/2Mkx041

A Perianal Mass Associated With Eosinophilic Granulomatosis With Polyangiitis: Challenge

No abstract available

http://bit.ly/2su0u6f

Dyschromatosis symmetrica hereditaria and reticulate acropigmentation of Kitamura: an update

Publication date: Available online 15 January 2019

Source: Journal of Dermatological Science

Author(s): Michihiro Kono, Masashi Akiyama

ABSTRACT

Dyschromatosis symmetrica hereditaria (DSH) and reticulate acropigmentation of Kitamura (RAK) are rare, inherited pigmentary diseases. DSH shows a mixture of pigmented and depigmented macules on the extremities. RAK shows reticulated, slightly depressed pigmented macules on the extremities. The causative gene of DSH was clarified as ADAR1 by positional cloning including linkage analysis and haplotype analysis in 2003. Ten years later, the causative gene of RAK was identified as ADAM10 by whole-exome sequencing, in 2013. ADAR1 is an RNA-editing enzyme which catalyzes the deamination of adenosine to inosine (A-to-I) in double-stranded RNA substrates during post-transcription processing. Inosine acts as guanine during translation, resulting in codon alterations or alternative splice sites that lead to functional changes in proteins when they occur in coding regions. In 2012, it was clarified that ADAR1 mutations cause Aicardi-Goutières syndrome 6, which is a severe genetic inflammatory disease that affects the brain and the skin. A zinc metalloprotease, a disintegrin and metalloprotease domain-containing protein 10 (ADAM10), is involved in the ectodomain shedding of various membrane proteins and shows various functions in vivo. ADAM10 is known to be involved in the ectodomain shedding of Notch proteins as substrates in the skin. We speculate that the pathogenesis of RAK and Dowling-Degos disease (DDD, a pigmentary disease similar to RAK) is associated with the Notch signaling pathway. In addition, ADAM10 mutations proved to be associated with late-onset Alzheimer disease. This review comprehensively discusses the updated pathophysiology of those genetic pigmentary disorders.

http://bit.ly/2HenL6h

Hypoxia accelerates the progression of angiosarcoma through the regulation of angiosarcoma cells and tumor microenvironment

Publication date: Available online 15 January 2019

Source: Journal of Dermatological Science

Author(s): Saki Maeda-Otsuka, Ikko Kajihara, Yukino Tasaki, Saori Yamada-Kanazawa, Ryoko Saskamoto, Soichiro Sawamura, Mamiko Masuzawa, Mikio Masuzawa, Yasuyuki Amoh, Daichi Hoshina, Riichiro Abe, Yoshihiro Komohara, Hironobu Ihn

Abstract

Background

Angiosarcoma is a rare malignant tumor with a poor prognosis. It is known that hypoxic condition activates tumor progression in several cancers. Additionally, hypoxic tumor microenvironment accelerates immune escape. However, the presence and significance of hypoxia in angiosarcoma has not been adequately investigated.

Objective

To study the role of hypoxia in the progression of angiosarcoma.

Methods

The protein level of hypoxia inducible factor-1α (HIF-1α) in angiosarcoma was examined using immunohistochemistry and immunoblotting. To study the effect of hypoxia on tumor progression, cell proliferation, migration, invasion, and tube formation assays were performed in angiosarcoma cells. The influence of tumor cell supernatant in hypoxia from angiosarcoma cells on immune escape and angiogenesis was analysed to investigate the modulatory effect of hypoxia on tumor microenvironment of angiosarcoma. The molecular mechanism related to these results was investigated using immunoblotting and real time RT-PCR.

Results

HIF-1α protein was over-expressed in angiosarcoma tissues and cell lines under hypoxic conditions, and there was heterogeneity of oxygen supply in angiosarcoma. Hypoxia enhanced the proliferation, migration, and invasion abilities and inhibited tube formation in angiosarcoma cells. Tumor cell supernatant in hypoxia from angiosarcoma cells activated the monocyte invasion ability, facilitated its differentiation into M2-like macrophages, and suppressed cell-adhesion. These in vitro results were compatible to the pathological findings of angiosarcoma patients.

Conclusion

Hypoxia plays a major role in progression of angiosarcoma cells by enhancing cell proliferation, migration, and invasion and by modulating the tumor microenvironment.

http://bit.ly/2RM9pON

Identification of photoproducts of florasulam in water using UPLC-QTOF-MS

Abstract

Here, we aimed to investigate florasulam photodegradation in aquatic environments under UV-visible irradiation. LC-MS/MS was used to explore the photolysis kinetics of florasulam degradation with respect to different light source types, florasulam concentrations, water sources, and pH. We also tested whether the addition of the nitrate ions, Fe³⁺, or I⁻ to the reaction solution influences florasulam photolysis kinetics. NO₃⁻ accelerates florasulam degradation at low concentrations (0.01–1 mg L⁻¹), but decreases the process at higher concentrations. At low concentrations (≤ 0.1 mg L⁻¹), Fe³⁺ enhanced florasulam photodegradation obviously. However, the addition of 0.01–10 mg L⁻¹ I⁻ decreased the degradation rate linearly. The florasulam photolysis rates in alkaline and neutral solutions were higher than that in acidic solutions. The florasulam degradation rate under mercury light irradiation was greater than that under xenon light. The rate of florasulam degradation in distilled water was greater than in tap water, lake water, and rice paddy water. As the concentration of florasulam increased, the photodegradation rate decreased. Six kinds of transformation products (TPs) were isolated and identified using UPLC/Q-TOF-MS. Based on these TPs and their evolutionary processes, we inferred the florasulam degradation mechanisms, identifying four possible florasulam degradation pathways. Cleavage of the florasulam sulfonamide bond yielded TPs2. TPs2 was intermolecularly rearranged to form a SO₂ extrusion compound, TPs3. Cleavage of the [C-F] bonds led to the formation of TPsl, TPs4, and TPs5, while hydroxylation led to the formation of TPs6. We then predicted the stability of each of the florasulam TPs in water. TPs2 and TPs3 rapidly degraded after reaching maximum concentration due to poor light stability. TPs4 and TPs6 were more photostable than florasulam (the parent compound) and may be important contributors to water pollution.

http://bit.ly/2DcCgDN

A case of multiple osseous choristomas arising on the medial side of the lateral pterygoid muscle

Abstract

Osseous choristoma is a rare entity in the oral and maxillofacial region. The most common site is the tongue, followed by the buccal mucosa. Osseous choristoma of the muscle is unusual and few cases have been described in the literature. No reports have described osseous choristoma arising on the medial side of the lateral pterygoid muscle. Herein, we report the first such case. A 61-year-old woman was referred to our facility for treatment of temporomandibular joint disorder. Computed tomography (CT) revealed two osseous lesions on the medial side of the lateral pterygoid muscle. Preoperatively, a three-dimensional (3D) life-sized model of the skull was fabricated from the CT imaging data. The 3D skull model was used to clarify the 3D positional relationships of the osseous lesions relative to the surrounding anatomical structures. Surgery to remove the osseous lesions was performed under general anesthesia. Unfortunately, only the larger of the two masses was able to be resected because of the risk of nerve and vascular injury. Histological examination revealed that the resected lesion comprised mature lamellar bone with regular osteocytes and no atypia. The diagnosis was multiple osseous choristomas based on the histological and clinical findings.

http://bit.ly/2RxE1E6