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Τετάρτη 6 Φεβρουαρίου 2019
Medical Education Texts
Objective Skills Clinical Examination: Every Day in the Field of Practice
Assessing Competence in Medicine and Other Health Professions
Uptake kinetics and interaction of selenium species in tomato ( Solanum lycopersicum L.) seedlings
Abstract
Selenite and selenate are two main selenium (Se) forms absorbed by plants. The comparative effects of selenite and/or selenate on Se uptake and translocation in plants in spite of their coexistence in the environment are still unclear. Therefore, tomato (Solanum lycopersicum L.) seedlings were grown in a hydroponic solution with exogenous selenite, selenate, or selenite and selenate mixed, and Se concentrations in shoots, roots, and xylem sap were measured after harvest. Results showed that selenite (> 0.1 mg Se L−1) could cause phytotoxicity more easily than selenate (> 1 mg Se L−1) under hydroponic conditions. And the absorbability rate of tomato to selenate was higher than that to selenite when Se application level was 0.0175–0.2998 mg L−1, while the opposite result was observed in other Se concentrations. More Se accumulated in roots and Se(VI) in the xylem sap decreased when both Se forms supplied. This study demonstrated that the difference between selenite and selenate on Se uptake and translocation in tomatoes depended on exogenous Se concentration. And selenite could inhibit the absorption and translocation of selenate when supplied with both Se forms.
http://bit.ly/2TzpHYJ
Emission characteristics for co-combustion of leather wastes, sewage sludge, and coal in a laboratory-scale entrained flow tube furnace
Abstract
Four different mixed fuels consisted of leather waste, coal, and sewage sludge were combusted in a lab-scale entrained flow fluidized bed furnace. The influence of blending ratio on emission characteristics of SO2, NOx, HCl, particulate matter (PM), heavy metals, and polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/Fs) was studied. Results showed that the mixing of coal with sewage sludge had a complex effect on the emission characteristics. On the one hand, with more sewage sludge blending in the mixed fuel, the acid gas pollutant (SO2, NOx) decreased a lot, and the recovery of volatile heavy metals (Cd, Pb) increased at the same time. Furthermore, the leaching toxicity of Cr in the fly ash and bottom ash went down below the national standard with the adding of sewage sludge. On the other hand, the mixing of sewage sludge which consisted of more ash content resulted in the increase of the PM emission. Moreover, the high content of Cu and chlorine in the sewage sludge can promote the formation of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/Fs) when the fuel 3 and 4 were combusted. Most importantly, the concentration of toxic PCDD/Fs in the flue gas produced from fuel 3 and fuel 4 was successfully controlled down below 0.20 ng I-TEQ/Nm3 by the active carbon.
http://bit.ly/2BoDHgO
Synchronous multifocal necrotizing soft tissue infections: a case report and literature review
Abstract
Necrotizing soft tissue infections are a group of conditions with a common pathophysiological basis, affecting any or all layers of the soft tissue compartment. They are rare, life-threatening diseases that require a high index of suspicion for early detection as well as urgent surgical debridement. Rarely, they can occur in more than one non-contiguous site of the body ('multifocal' disease), and this is associated with a much higher mortality than monofocal disease. Here, we present the case of a 46-year-old male with bilateral upper limb necrotizing soft tissue infection following an unclear history of trauma. The patient developed septic shock necessitating transfer to the intensive care unit following emergency surgery. Microbiological tests yielded Streptococcus pyogenes, Staphylococcus aureus and opportunistic Candida spp. and Actinomyces infections. A total of seven surgical debridements were performed; fortunately, the patient survived. We discuss the presentation, diagnosis and management of this case including primary reconstruction of the soft tissue defects, and review the literature on necrotizing soft tissue infections as a clinical entity, incorporating clinical updates from the latest guidelines worldwide.
Level of Evidence: Level V, therapeutic study.
http://bit.ly/2BoRxjv
Evaluation of hydrocar efficiency for simultaneous removal of diclofenac and ibuprofen from aqueous system using surface response methodology
Abstract
Parmaceutically active compounds like diclofenac (DFS), ibuprofen (IBP), and other drugs that persist in the environment are listed as emerging contaminants. These escape from normal wastewater treatment plants and find their way to water streams; therefore, alternate treatment processes are needed. Herein, a sorbent material is reported that is prepared throug hydrotermal carbonization from dried fruit powder of Zizipus mauritiana L. (TC-ZM) and applied for simultaneous removal of DFS and IBP. Carbonized material (TC-ZM) was found as agglomerates of approximately 1 μm particle size with surface area of 1160 m2/g having oxygen functional groups (e.g., COO, O, C=O) on surface. Simultaneous removal of IBP and DFS onto TC-ZM was studied using response surface methodology with a set of 18 experiments using factors such as pH, amount of sorbent, contact time, and sorbate concentration. Maximum removal efficiency was obtained 88% and 97% for DFS and for IBP, respectively, with adsorption capacity of 2.03 mmol g−1 for DFS and 2.54 mmol g−1 for IBP. Kinetics modeling and "mean free energy" values predicted that sorption is mainly governed by pysical interactions followed by "pore filling" mechanism for uptake of DFS and IBP.
http://bit.ly/2SwrgJH
Feasibility Assessment of Using the Complete Patient‐Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO‐CTCAE) Item Library
AbstractThe patient‐reported outcomes version of the Common Terminology Criteria for Adverse Events (PRO‐CTCAE) complements capture of symptomatic adverse events (AEs) by clinicians. Previous trials have typically used a limited subset of relevant symptomatic AEs to reduce patient burden. We aimed to determine the feasibility of administering all 80 AEs included in the PRO‐CTCAE library by approaching consecutive patients enrolled in a large academic phase I program at three points in time. Here, we report a preplanned analysis after enrolling the first 20 patients. All items were answered on 51 of 56 potential visits (adherence 91%). Three (5%) additional PRO‐CTCAE assessments were partially completed, and two (4%) were missed because of conflicting appointments. No patient withdrew consent or chose not to complete the assessments once enrolled on study. Future trials of experimental drugs that incorporate the PRO‐CTCAE should consider using this unselected approach to identify adverse events more completely.
http://bit.ly/2RHkMmU
Efficacy of Split Schedule Versus Conventional Schedule Neoadjuvant Cisplatin‐Based Chemotherapy for Muscle‐Invasive Bladder Cancer
AbstractNeoadjuvant cisplatin‐based chemotherapy (NAC; 70 mg/m2) is standard of care for muscle‐invasive bladder carcinoma (MIBC). Many patients (pts) cannot receive cisplatin because of renal impairment, and administration of cisplatin 35 mg/m2 on day 1 + 8 or 1 + 2 (i.e., split schedule) is a commonly used alternative. In this retrospective analysis, we compared complete (pT0) and partial (<pT2) pathologic response rates between split schedule (SS) and conventional schedule (CS) pts, after 1:1 matching on chemotherapy regimen, number of cycles, tumor histology, and clinical stage. Eighty matched pts were identified. pT0 rates were 17.5% (95% confidence interval [CI], 7%–33%) and 32.5% (95% CI, 19%–49%) in SS and CS cisplatin pts, respectively (p = .21), corresponding to an odds ratio for pT0 of 0.45 (95% CI, 0.16–1.31) with SS cisplatin. Split schedule cisplatin was associated with numerically but not statistically significant lower pathologic response rates relative to full dose.
http://bit.ly/2WM9Zvv
Safety Studies in the Field of Liposuction: A Systematic Review
BACKGROUND There is an increasing demand for safety standards for cosmetic treatments. With regard to liposuction, interdisciplinary consensus is lacking, especially regarding treatment setting and physician specialty. OBJECTIVE A solid, independent interpretation of scientific data on safety requires a systematic approach, which is the aim of this study. METHODS A systematic literature search was conducted for safety studies about liposuction through April 2017. Fatalities and/or reported serious adverse events served as outcome measures for safety. RESULTS Twenty-four studies were included. Factors that contributed to increased serious complication and mortality risk were: use of the (super)wet technique; use of systemic anesthetics, especially general anesthesia and intravenous sedation; execution by a plastic surgeon; execution in an operating room; and combination with other procedures. CONCLUSION Liposuction using tumescent local anesthesia has been shown to be the safest method of fat removal, especially if no or only minimal systemic anesthesia is used. Performance of this technique in an office-based setting has been proven to be safe beyond doubt. When systemic anesthesia is used, an outpatient or ambulatory surgery facility seems also safe. Regardless of the physician specialty, knowledge and training on the execution of the tumescent procedure are vital to ensure optimal safety.http://bit.ly/2TD2mFG
Evolution of the Picosecond Laser: A Review of Literature
BACKGROUND Picosecond pulse duration lasers (PS) have altered the field of dermatology. PS were initially used in tattoo removal, to optimize efficacy and reduce side effects with nanosecond domain lasers. More recently, they have been demonstrated to be effective in the treatment of pigmentary disorders, acne scarring, and photoaging. OBJECTIVE In this article, we critically analyze the published data on the many uses of picosecond lasers in dermatology. MATERIALS AND METHODS A systematic review of PubMed was conducted using the following search terms: "picosecond," "picosecond laser," "picosecond laser dermatology," "picosecond laser pigment/pigmentation," and "picosecond laser tattoo removal." Articles ranged from 1988 until 2017. RESULTS Forty-one articles were identified, and 27 met inclusion criteria for review. Indications for the PS included a variety of dermatologic applications include tattoo removal, benign pigmented lesions/pigmentary disorders, acne scarring, and photoaging. Most studies demonstrated safe and effective treatment. CONCLUSION The development of the picosecond pulse duration is a breakthrough innovation in laser technology, changing the scope of laser treatment. Encouraging findings in tattoo pigment clearance spurred the use of PS in a wider array of dermatologic issues. The increasingly positive results and low incidence of adverse effects further substantiates PS efficacy for a variety of dermatologic uses.http://bit.ly/2ULOdpI
Acitretin-Altered Squamous Cell Carcinoma: A Pitfall in Diagnosis
No abstract availablehttp://bit.ly/2TF17WI
Noninvasive Atrophic Acne Scar Treatment in Asians With a 755-nm Picosecond Laser Using A Diffractive Optic Lens—A Retrospective Photographic Review
BACKGROUND The diffractive lens of the picosecond laser is relatively new, and there are few reports on its efficacy in treating atrophic acne scars, especially in Asian populations. OBJECTIVE Evaluating the efficacy of diffractive lens 755-nm picosecond laser for atrophic acne scar treatment in Asians. PATIENTS AND METHODS Forty-two patients who were treated for facial atrophic acne scars at a private dermatological clinic were enrolled in this retrospective analysis. Mean session count was 4.28. Before and after photographs were assessed by 2 blinded dermatologists, who rated the amount of overall skin quality improvement on a 5-point scale. RESULTS All patients experienced improvements in scar texture and overall skin quality after 2 to 6 sessions, with scores of +1.4, 1.45, 1.7, 1.33, 2.3, and 1.66 points after 2, 3, 4, 5, 6, and >6 treatments, respectively. There were no obvious adverse effects after treatment. The postinflammatory hyperpigmentation (PIH) risk was 4.7% (2 of 42, both spontaneously resolved). CONCLUSION The 755-nm diffractive lens picosecond laser showed good efficacy and low PIH rates when treating atrophic acne scars in darker skin–type patients. In addition to treatment results, additional improvements in overall skin quality and pigmentation make the picosecond laser an effective and desirable treatment option for Asians.http://bit.ly/2tayNj5
Treatment of Refractory Vitiligo With a Vellus Hair Punch Graft
No abstract availablehttp://bit.ly/2TAsyAV
Anatomy of the Superficial Venous Structures of the Neck: A Cadaveric Study to Guide Superficial Injections
BACKGROUND Minimally invasive aesthetic procedures of the neck are becoming more popular. However, anatomical studies on the venous structures of the neck in relation to these procedures are lacking. OBJECTIVE The aims of this study were to identify the locations and communication patterns of the anterior jugular vein and external jugular vein (AJV and EJV) and the communicating vein (CV) based on superficial anatomical landmarks and to determine dangerous areas for dermal filler injections into the neck. MATERIALS AND METHODS Thirty sides of the neck from Korean adult cadavers were dissected for this study. RESULTS Four anatomical variants were identified. In Type Ia, the CV ran along the anterior border of the sternocleidomastoid muscle (SCM) (33.4%); in Type Ib, a single vein was observed connecting the CV and the EJV at the level of laryngeal prominence (23.3%); in Type Ic, the CV proceeded separately from the medial side of the anterior border of the SCM (13.3%); and in Type II, the CV was absent while the EJV and AJV were observed (30%). CONCLUSION Given the 4 anatomical variants identified in this study, the authors recommend exerting caution when performing dermal filler injections approximately 10, 30, and 60 mm lateral to the midsagittal line to avoid iatrogenic side effects.http://bit.ly/2taYd0c
Sex Differences in Perioral Rhytides—Does Facial Hair Play a Role?
No abstract availablehttp://bit.ly/2ULNFQG
Use of Eye Shields for Mohs Micrographic Surgery of the Eyelids and Periorbital Area
BACKGROUND Internal eye shields are designed for use in periorbital procedures, but their use in Mohs micrographic surgery (MMS) of the eyelids has rarely been reported in the literature. OBJECTIVE The authors aim to discuss different types of internal eye shields as well as their indication, proper use, and potential complications. MATERIALS AND METHODS The authors performed a literature search on PubMed with the keywords "internal eye shield," "corneal shield," "scleral shield," and "periorbital Mohs micrographic surgery" with no restriction on publication time frame due to the scarcity of relevant literature. RESULTS Experts seem to agree that use of eye shield for MMS of the eyelids is a reasonable measure to undertake to prevent operative injuries. Although either plastic or stainless steel eye shield can be used, plastic eye shields are often preferred and recommended in procedures where electrosurgical devices need to be used. CONCLUSION Although the authors recommend the use of internal eye shields for MMS of the eyelids for preventing operative injuries, this recommendation (Grade C) is based on very limited evidence (Level 5). More research and higher-powered studies are needed for conclusive evidence and to establish clear guidelines for providers.http://bit.ly/2t9Ku9Z
Underappreciated Utility of the Purse-String Suture in Head and Neck Skin Cancer Defect Reconstruction
BACKGROUND The purse-string suture (PSS) is a simple, reversible method for reconstructing skin cancer defects. Its utility may be underappreciated in head and neck reconstructive surgery. OBJECTIVE To evaluate the utility of the PSS as an adjunct to the reconstructive ladder when reconstructing head and neck skin cancer defects. MATERIALS AND METHODS This prospective nonrandomized cohort included 109 consecutive adult patients with head and neck defects resulting from skin cancer resection. The PSS was placed in every patient after resection. Patients were evaluated before and after suture placement, and final reconstructive methods were recorded. RESULTS The PSS resulted in a mean defect area reduction of 77.1% (phttp://bit.ly/2tbRvHk
Outcomes for Invasive Melanomas Treated With Mohs Micrographic Surgery: A Retrospective Cohort Study
BACKGROUND Mohs micrographic surgery (MMS) has been used effectively to treat invasive melanoma. OBJECTIVE To further study the safety and efficacy of MMS in the treatment of invasive melanoma. METHODS AND MATERIALS A retrospective cohort study evaluated 123 melanomas excised using MMS with MART-1 immunostain. Local recurrence, metastasis, overall survival, and disease-free survival rates were calculated. These were compared with historical controls. RESULTS Among included patients, 78 were men (63%) and 45 were women (37%), with a mean age of 66.48 years. Mean follow-up time was 1,273 days (3.49 years). Local recurrence was identified in 2/123 (1.63%; 95% confidence interval, 0.20%–5.75%) lesions. Local recurrence was identified in 1/70 (1.43%; 95% confidence interval, 0.04%–7.70%) of head and neck cases. Tumor location was head and neck in 70 lesions (56.9%). Overall survival was 95.12% and disease-specific survival was 100%. CONCLUSION Mohs micrographic surgery is an effective treatment method for invasive melanoma, as evidenced by low recurrence rates and high rates of disease-free survival.http://bit.ly/2t7ks77
BRCA1-Associated Protein-1 Tumor Predisposition Syndrome in a Patient With Numerous Basal Cell Carcinomas
No abstract availablehttp://bit.ly/2ULNsNo
Randomized Controlled Trial of Preoperative Topical Decolonization to Reduce Surgical Site Infection for Staphylococcus aureus Nasal Swab–Negative Mohs Micrographic Surgery Patients
BACKGROUND Surgical site infection (SSI) is mainly due to endogenous bacteria. Topical decolonization is a preoperative intervention currently advised for proven nasal carriers of Staphylococcus aureus (S. aureus). OBJECTIVE The authors assessed whether topical decolonization could be of benefit for patients who are not nasal carriers of S. aureus. METHODS AND MATERIALS The authors performed a randomized controlled trial of S. aureus nasal swab–negative patients. Five days before Mohs surgery topical decolonization with nasal mupirocin and chlorhexidine, body wash was started. The control group had no intervention. RESULTS In the week after Mohs surgery, the infection rate in the intervention group was 2% (n = 661, 14) and that of the control group was 4% (n = 689, 29). CONCLUSION Topical decolonization reduces SSI in nasal swab–negative Mohs surgery patients.http://bit.ly/2tbsSKC
Factors Associated With Patient-Initiated Communication After Mohs Micrographic Surgery
BACKGROUND Despite extensive counseling, patients commonly call with postoperative concerns after Mohs micrographic surgery (MMS). OBJECTIVE We sought to determine the incidence, reasons, and patient and surgical characteristics that lead to patient-initiated communication after MMS. MATERIALS AND METHODS A retrospective chart review of 1,531 patients who underwent MMS during the observational period was conducted. Demographics and perioperative characteristics of patients who initiated communication were compared with a random sample of matched controls. RESULTS Of the 1,531 patients who underwent MMS, 263 patients (17.2%) initiated 412 communication encounters within 90 days of surgery. Top reasons for patient-initiated communication included wound concerns, bleeding, and postoperative pain. Female patients and those with a larger surgical defect size (cm2) were more likely to call postoperatively. Patients who underwent second intention healing, grafts, and interpolation flaps were more likely to initiate communication compared to patients repaired with a linear closure. CONCLUSION This study identifies the incidence, reasons, and patient and surgical factors predictive of patient-initiated communication after MMS, which may allow for targeted improvements in postoperative counseling, ameliorating patient anxiety, augmenting patient satisfaction, and improved efficiency for the health care team.http://bit.ly/2ti4R4V
Preoperative Ultrasound for Evaluation of Hidradenitis Suppurativa
No abstract availablehttp://bit.ly/2UG0P1y
Treatment of Corticosteroid-Induced Hypopigmentation Using Fractional Carbon Dioxide Laser
No abstract availablehttp://bit.ly/2ULMYXA
Patient-Centered Outcomes for Skin Cancer Management: Utilization of a Patient Delphi Process to Identify Important Treatment Themes
BACKGROUND Patient-reported outcomes are critical to research directed at maximizing patient benefit. The outcomes patients consider most relevant in the treatment of skin cancer have not been directly investigated. OBJECTIVE To develop a ranked list of outcomes deemed most important by patients with skin cancer through a proctored Delphi process. METHODS Twenty-one patients with a history of skin cancer volunteered to participate in the patient summit. The patient members participated in a guided discussion to generate a long list of potentially relevant outcomes. The list was then condensed and ranked through 2 rounds of a proctored Delphi process. RESULTS Patients were diverse in their skin cancer histories and complexities, ages, and states of residence. Twelve themes were rated as highly important by 70% or more of participants. Most of these themes related to patient education and the collaborative nature of the physician–patient relationship. Fear of recurrence and cosmetic outcome were also highly rated. Limitations include a preponderance of older patients and patients from the midwest and northeast. CONCLUSION Patients with skin cancer overwhelmingly prioritize a shared decision-making process, in which they are actively engaged and value detailed education regarding their disease. This should inform future research directed at skin cancer treatment and current physician–patient interactions.http://bit.ly/2ti4F5H
Concentrations of particulate matter, carbon dioxide, VOCs and risk assessment inside Korean taxis and ships
Abstract
The objective of this study was to investigate the concentration distribution of indoor air pollutants in taxis and ships (passengers) which are frequently used for public transportation and recreational activities in South Korea. In addition, it aimed to assess air quality factors to establish and evaluate the health risks of exposure to polluted indoor air. Particulate matter (PM10) concentrations were not affected by the number of passengers, time of day, and driving characteristics because there were only a few passengers (2 to 4 people) and the space was confined. In the ships, indoor air pollutants responded more sensitively to the operation characteristics depending on the time of sailing (i.e., anchoring and departure, movement of vehicles on the ship, movement of passengers, combustion in the shop, and ventilation) than to the number of people boarding and alighting. The carbon dioxide concentrations in different ship rooms did not vary according to season and degree of congestion; however, there were differences between different ships. These differences may result from the size, type, and operating characteristics of the ships. Volatile organic compounds (VOCs) and aldehydes in new taxis exceeded the standard levels during summer. VOC concentrations in ships were particularly high during summer when the outdoor temperature was high. Similar observations were made for other means of transportation. The risk assessment depended on the means of transportation and demonstrated that mortality risks due to PM10 and excess carcinogenic and non-carcinogenic risks from VOCs and aldehydes were within safety levels.
http://bit.ly/2Swzku4
Seawater intrusion vulnerability in the coastal aquifers of southern India—an appraisal of the GALDIT model, parameters’ sensitivity, and hydrochemical indicators
Abstract
An appraisal of seawater intrusion into the coastal aquifers is one of the major issues for groundwater resource management. The GALDIT model applies to the analysis of multiple parameters using systematic GIS techniques for mapping and assessment of seawater intrusion vulnerability. It demarcates the mapping of potential vulnerability that shows a higher vulnerability to seawater intrusion in various parts of the coast and the estimated vulnerability index value of 7.50 and 9.64. An area of 33.0 km2 spread in the low-lying coastal area comprising estuaries, salt marshes, and saltpans shows the high vulnerability condition with an estimated vulnerability value of 6.42–7.50. An area of 73.20 km2 spread over coastal and alluvial plains experiences moderate vulnerability (temporal salinity in the groundwater sources) with an estimated vulnerability index value of 5.46–6.42. Aquifers underlying coastal uplands (hard rock formations) and some parts of accretionary beaches (2.05 km2) are relatively protected fresh groundwater sources, wherein the estimated vulnerability index is 4.55–5.46. The vulnerability mapping of the GALDIT model using hydrochemical analysis of primary groundwater parameters such as TDS, Cl−, HCO3, and Cl−/HCO3 ratio is validated. Higher concentration of TDS (2637–4162 mg/l) and Cl− (1268–2347 mg/l) is taken for the areas falling under higher vulnerability to seawater intrusion, especially in the placer mining sites and coastal areas facing erosion. Similarly, the groundwater sources of the low-lying areas including estuaries, salt marshes, saltpans, and backwater were noted to have higher values of Cl−/HCO3 with a rationality of 9.87–12.18. Hydrological facies shows the highest concentration of NaCl in the groundwater sources within the proximity of eroded beaches, saltwater bodies, and sand mining areas. A hydrochemical facies evolution (HFE) diagram represents the hydrochemical facies of groundwater elements that shows an intrusion of seawater into the coastal aquifers underlying the very high vulnerable zones. Higher bicarbonate concentration (233–318 mg/l) is noticed in the upland areas and some parts of dunes and accreted beaches, sandy coasts, and uplands. Vulnerability analysis reveals that those areas near saltwater bodies and eroding coasts are prone to lateral and vertical diffusion of saltwater. The geodatabase developed through such modeling studies can help in planning and developing activities for sustainable groundwater resource management in coastal areas.
http://bit.ly/2DgLQnH
External and internal diameters of the facial artery relevant to intravascular filler injection
Background: Vision loss and skin necrosis caused by an accidental intra-arterial embolism or vascular compression are rare but devastating complications when injecting filler materials into the face. Accurate knowledge of the vascular anatomy of the anterior face is crucial for performing safe cosmetic procedures. Methods: Seventy-two facial arteries were harvested from 41 formalin-embalmed cadavers. After removing connective tissues attached to the arterial wall under stereomicroscope observation, the external and internal diameters and wall thicknesses of the facial artery and its branches were measured at various levels along where the arterial courses on the anterior face. Results: The diameter and thickness of the facial artery exhibited significant interregional differences. The external and internal diameters of the facial artery were 1.9±0.4 and 1.2±0.3 mm (mean±SD), respectively, at the inferior border of the mandible, 1.7±0.3 and 1.2±0.3 mm in the vicinity of the inferior labial artery, 1.5±0.3 and 1.0±0.3 mm at the mouth corner, 1.4±0.3 and 0.9±0.2 mm in the vicinity of the superior labial artery, and 1.1±0.2 and 0.7±0.2 mm in the vicinity of the lateral nasal artery. The external and internal diameters at the proximal parts of the inferior labial artery, superior labial artery, and lateral nasal artery were 1.0±0.3 and 0.6±0.2 mm, 0.9±0.3 and 0.6±0.2 mm, and 0.8±0.2 and 0.5±0.2 mm, respectively. Conclusions: Morphometric examinations of the facial artery under stereomicroscope observation as performed in the present study are expected to be more accurate than direct measurements made during cadaveric dissection or conventional histological evaluations. Financial disclosures: This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2015R1D1A1A01057983). Ethics: This study conformed to the World Medical Association Declaration of Helsinki (June 1964) and subsequent amendments. Conflict of interest statement: The authors have no conflicts of interest to report Correspondence to: Wu-Chul Song, MD, PhD, Department of Anatomy, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea, Telephone: +82 2 2030 7819, Fax: +82 2 2030 7845, E-mail: anatomy@konkuk.ac.kr ©2019American Society of Plastic Surgeons
http://bit.ly/2ShQXP5
http://bit.ly/2ShQXP5
Inframammary Fold Reconstruction in the Previously Reconstructed Breast: A Comprehensive Review
The inframammary fold (IMF) presents a reconstructive challenge once disrupted during total mastectomy or inadequately restored during breast reconstruction. Various methods of recreating the IMF have been proposed, but reports are generally based on small sample sizes and lack long-term analyses and patient-reported outcomes. We herein review the literature on IMF anatomy and reconstructive techniques, highlighting the need for more critical analysis of methodology to develop more predictable and durable outcomes. Financial Disclosure Statement: The authors have nothing to disclose All authors participated equally in all aspects of the manuscript including preparation, research, editing, and final approval. Corresponding Author: Michael J. Miller, MD, FACS, Professor of Plastic Surgery, Chair, Department of Plastic Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Ste 2100, Columbus, OH 43212, P: (614) 293-9885, F: (614)293-9024, Michael.Miller@osumc.edu ©2019American Society of Plastic Surgeons
http://bit.ly/2Dano7q
http://bit.ly/2Dano7q
Fenestration Improves Acellular Dermal Matrix Biointegration: An Investigation of Revascularization with Photoacoustic Microscopy.
Background: Acellular dermal matrices (ADMs) have revolutionized alloplastic breast reconstruction. Furthering our knowledge of ADM biointegration will allow for improved design of these biomaterials. The ideal ADM for breast reconstruction would provide durable soft tissue augmentation while undergoing rapid biointegration to promote physiologic elasticity and reduced infectious complications. The inclusion of fenestrations in the design of ADMs is thought to promote the process of biointegration; however, the mechanisms underlying this theory have not been evaluated. Methods: Biointegration of standard and fenestrated ADMs was assessed with serial photoacoustic microscopy (PAM) imaging, in a murine dorsal skin-fold window chamber model that is specifically designed to recapitulate the microenvironment of ADM–assisted alloplastic breast reconstruction. PAM allows for a serial, real-time noninvasive assessment of hemoglobin content and oxygen saturation in living tissues; generating high-resolution, three-dimensional maps of the nascent microvasculature within ADMs. Confirmatory histology and immunohistochemical assessments were performed at the terminal time point. Results: Fenestrated ADMs demonstrated increased fibroblast and macrophage lineage host cell infiltration, greater mean percent surface area vascular penetration (21% vs 11%, p=0.08), and greater mean oxygen saturation (13.5% vs 6.9%, p
http://bit.ly/2Sgk4ly
http://bit.ly/2Sgk4ly
Complication Profiles by Mastectomy Indication in Tissue Expander Breast Reconstruction
Background: Two-stage implant breast reconstruction is the most commonly performed breast reconstruction procedure. Limited data exists regarding reconstruction complication rates examined by mastectomy indication. Methods: Patients who underwent two-stage implant breast reconstruction at Yale New Haven Hospital from 2011-2017 were included in the study. Peri-operative complications were compared. T-tests, Chi-square analysis, and Fisher's exact tests were used to determine significant associations. A binary logistic regression was used to determine variables with a significant impact on the likelihood of mastectomy flap necrosis. Results: Between 2011 and 2017, complete perioperative records were available for 141 patients who underwent 226 mastectomies followed by two-stage tissue expander/permanent implant reconstruction. Of the 226 mastectomies, 134 were therapeutic and 92 were prophylactic. On regression analysis, there were no significant differences in demographics, comorbidities, or mastectomy and reconstructive details between the two breast groups except for there being more modified radical mastectomies in therapeutic breasts (p=.003). When comparing complications, there was a significantly higher risk of mastectomy flap necrosis in the therapeutic group (p=0.017). Therapeutic mastectomies had a 9.5 times higher risk of mastectomy flap necrosis than prophylactic mastectomies when adjusted for confounding variables. There were no significant differences in other reconstructive complications between the two groups. Conclusions: Patients undergoing therapeutic mastectomies have a significantly higher risk of mastectomy flap necrosis than prophylactic mastectomies. Although the underlying etiology still needs to be determined, differences in technique may be related to mastectomy flap necrosis. Financial Disclosure Statement: None of the authors have anything to disclose. No funding was received for this article. Corresponding Author: Michael Alperovich, MD, MSc, Assistant Professor of Plastic Surgery, Yale University School of Medicine, Section of Plastic and Reconstructive Surgery, 330 Cedar St. Boardman Bld 3rd fl. New Haven, CT 06510, Michael.Alperovich@yale.edu ©2019American Society of Plastic Surgeons
http://bit.ly/2Dan9Jy
http://bit.ly/2Dan9Jy
Mythbusting the DIEP Flap and An Introduction to the Abdominal Perforator Exchange (APEX) Breast Reconstruction Technique: A Single-Surgeon Retrospective Review
Background: Anatomic variations in perforator arrangement may impair the surgeon's ability to effectively avoid rectus muscle transection without impairing flap perfusion in the DIEP flap. Methods: A single surgeon's experience was reviewed with consecutive patients undergoing bilateral abdominal perforator flap breast reconstruction over 6 years, incorporating flap standardization, pedicle disassembly, and algorithmic vascular rerouting when necessary. Unilateral reconstructions were excluded to allow for uniform comparison of operative times and donor site outcomes. 364 flaps in 182 patients were analyzed. Operative details, and conversion rates from DIEP to APEX arms of the algorithm were collected. Patients with standardized DIEP flaps served as the controlling comparison group and outcomes were compared to those who underwent "APEX" (Abdominal Perforator Exchange) conversion. Results: APEX conversion rate from planned DIEP was 41.5%. Mean additional operative time to employ APEX pedicle disassembly was 34 minutes per flap. Early postsurgical complications were of low incidence and similar among the groups. 1 DIEP flap failed and there were no APEX failures. 1 abdominal bulge occurred in the DIEP group. There were no abdominal hernias in either group. Fat necrosis rates (2.4% APEX/3.4%DIEP) were significantly lower than that historically reported for both TRAM and DIEP flaps. Conclusions: This study revealed no added risk when employing pedicle disassembly to spare muscle/nerve structure during abdominal perforator flap harvest. Abdominal bulge/hernia was nearly completely eliminated. Fat necrosis rates were extremely low, suggesting benefit to pedicle disassembly and vascular routing exchange when required. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Financial Disclosure Statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. No funding was received for this article. Presented at: The 4th Annual London Breast Meeting, Royal College of Physicians Regents Park, London, UK September 8, 2017 and the American Society for Reconstructive Microsurgery Annual Scientific Meeting, Phoenix, AZ January 15, 2017. Corresponding Author: Frank J. DellaCroce, MD, FACS, Center For Restorative Breast Surgery, Dept. Plastic Surgery, 1717 St. Charles Avenue, New Orleans, LA 70130, Fax: (504) 899-2700, Phone: (504) 899-2800, Email: fjdellacroce@gmail.com / drd@breastcenter.com ©2019American Society of Plastic Surgeons
http://bit.ly/2Sku9yg
http://bit.ly/2Sku9yg
Fat Grafting into Younger Recipients Improves Volume Retention in an Animal Model
Background: Soft tissue deficits associated with various craniofacial anomalies can be addressed by fat grafting, although outcomes remain unpredictable. Furthermore, consensus does not exist for timing of these procedures. While some advocate approaching soft tissue reconstruction after the underlying skeletal foundation has been corrected, other studies have suggested earlier grafting may exploit a younger recipient niche that is more conducive for fat graft survival. As there is a dearth of research investigating effects of recipient age on fat graft volume retention, this study compared the effectiveness of fat grafting in younger versus older animals through a longitudinal, in vivo analysis. Methods: Human lipoaspirate from three healthy female donors was grafted subcutaneously over the calvarium of immunocompromised mice. Volume retention over 8 weeks was evaluated using micro-computed tomography in three experimental ages – 3-weeks old, 6-months old, and 1-year old. Histology was performed on explanted grafts to evaluate graft health and vascularity. Recipient site vascularity was also evaluated by confocal microscopy. Results: Greatest retention of fat graft volume was noted in the youngest group compared to both older groups (*p
http://bit.ly/2Dan0G0
http://bit.ly/2Dan0G0
“A Cost Minimization Analysis Evaluating the Use of Liposomal Bupivacaine in Reconstructive Plastic Surgery Procedures.”
Postsurgical pain management is critical to patient satisfaction and value. Several studies have evaluated liposomal bupivacaine (LB) in postoperative pain management protocols, however its economic feasibility remains undefined. This study analyzes the economic impact of LB using a national claims database to assess postoperative clinical and financial outcomes in plastic and reconstructive procedures. Methods: The Vizient Clinical Database/Resource Manager™ electronic database was reviewed for plastic surgery procedures (abdominoplasty, abdominal wall reconstruction, mastectomy with immediate tissue expander placement, mastectomy with direct-to-implant reconstruction, autologous breast reconstruction, and augmentation mammoplasty) at participating hospitals from July 1, 2016-July 1, 2017. The main outcome measures were the length of stay (LOS), 7-, 14-, and 30-day readmission rates, and direct and total costs observed. Results: During the study period, 958 total cases met inclusion criteria. LB was used in 239 (25%) cases. Compared to cases that did not utilize LB, LB cases had a decreased LOS (9.2 days vs. 5.8 days), decreased cost (total cost $39,531 vs. $28,021, direct cost $23,960 vs. $17,561), and lower 30-day readmission rates 4% vs. 0%. The 14- and 7-day readmission rates were similar between the two groups. Conclusion: The use of LB may contribute to a reduction in LOS, hospital costs, and 30-day readmission rates for abdominal and breast reconstructive procedures, which could contribute to a favorable economic profile from a system view. Focusing on the measurement and improvement of value in the context of whole, definable, patient processes will be important as we transition to value-based payments. Disclosures: Dr. Janis is has served a prior consultant for Pacira Pharmaceuticals, LifeCell, Bard, Daiichi Sankyo, and Allergan within the last 12 months, but has no active affiliations. He receives royalties from Thieme Publishing. Dr. Janis Keller and Ramshaw have received consulting fees and speaker fees from Pacira Pharmaceuticals, which produces and sells liposomal bupivacaine (Exparel). Drs Little and Brower have nothing to disclose. No funding was received for this article. Corresponding Author: Jeffrey E. Janis, MD, FACS, Professor of Plastic Surgery, Neurosurgery, Neurology, and Surgery, Department of Plastic Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Rd, Columbus, OH 43212, Phone: (614) 293-8566, Fax: (614) 293-9024, Email: jeffrey.janis@osumc.edu ©2019American Society of Plastic Surgeons
http://bit.ly/2Se3lzr
http://bit.ly/2Se3lzr
Structural Gender-Dimorphism and the Biomechanics of the Gluteal Subcutaneous Tissue – Implications for the Pathophysiology of Cellulite
Objective: To investigate gender differences in gluteal subcutaneous architecture and biomechanics to better understand the pathophysiology underlying the mattress-like appearance of cellulite. Materials and Methods: 10 males and 10 female body donors (mean age: 76 ± 16.47 years; range: 36–92 years; mean BMI: 25.27 ± 6.24 kg/m2; range: 16.69-40.76) were used to generate full-thickness longitudinal and transverse gluteal slices. In the superficial and deep fatty layers, fat lobule number, height, and width were investigated. The force needed to cause septal breakage between the dermis and superficial fascia was measured using biomechanical testing. Results: Increased age was significantly related to decreased dermal thickness, independent of gender (OR 0.997, 95% CI [0.996 – 0.998], p
http://bit.ly/2Sj31zp
http://bit.ly/2Sj31zp
Pre-operative assessment of 30-day mortality risk after major surgery: the role of the quick sequential organ failure assessment: A retrospective observational study
BACKGROUND The quick Sequential Organ Failure Assessment (qSOFA) is intended for the assessment of the prognosis and risk of sepsis. It may also help predict the mortality risk of nonseptic patients. OBJECTIVE This study investigated the relationship between pre-operative qSOFA scores and 30-day mortality after major surgery. It also evaluated the predictive value of qSOFA scores combined with the American Society of Anesthesiologists (ASA) physical status and Charlson comorbidity index (CCI). DESIGN A retrospective observational study. SETTING Single tertiary academic hospital. PATIENTS Medical records of patients who underwent major surgery (estimated blood loss >500 ml; surgery time >2 h) between January 2010 and December 2017 were examined. MAIN OUTCOME MEASURES The qSOFA score was measured within 24 h before surgery, and its association with 30-day mortality was analysed using multivariable logistic regression. A receiver-operating characteristic curve analysis was used to investigate the predictive power of the pre-operative qSOFA scores combined with the ASA physical status and with CCI. RESULTS A total of 6336 patients were included in the final analysis, and 91 (1.4%) died within 30 days. The multivariable logistic regression analysis including all covariates indicated that 30-day mortality was 2.43-times higher for the score 1 group than for the score 0 group (P = 0.002), and it was 3.54-times higher for the score at least 2 group than for the score 0 group (P
http://bit.ly/2ROfFl6
http://bit.ly/2ROfFl6
Flow-controlled ventilation during ear, nose and throat surgery: A prospective observational study
BACKGROUND Flow-controlled ventilation (FCV) is a new mechanical ventilation mode that maintains constant flow during inspiration and expiration with standard tidal volumes via cuffed narrow-bore endotracheal tubes. Originating in manually operated 'expiratory ventilation assistance', FCV extends this technique by automatic control of airway flow, monitoring of intratracheal pressure and control of peak inspiratory pressure and end-expiratory pressure. FCV has not yet been described in a clinical study. OBJECTIVE The aim of this study was to provide an initial assessment of FCV in mechanically ventilated patients undergoing ear, nose and throat surgery and evaluate its potential for future use. DESIGN An observational study. SETTING Two German academic medical centres from 24 November 2017 to 09 January 2018. PATIENTS Consecutive patients (≥ 18 years) scheduled for elective ear, nose and throat surgery. Exclusion criteria were planned laser surgery, intended fibreoptic awake intubation, emergency procedures, increased risk of aspiration, American Society of Anesthesiologists (ASA) physical status more than III and chronic obstructive pulmonary disease classified as GOLD stage more than II. INTERVENTION Peri-operative use of FCV provided by a new type of ventilator (Evone) via a narrow-bore endotracheal tube (Tritube). MAIN OUTCOME MEASURES Minute volume, respiratory rate, intratidal tracheal pressure amplitude (Δp) and end-tidal CO2 (PetCO2) were recorded every 5 min. All adverse events were noted. Data are presented as median [IQR]. RESULTS Sixteen patients provided 15 evaluable data sets. A minute volume of 5.0 [4.4 to 6.4] l min−1 and a respiratory rate of 9 [8 to 11] min−1 generated a PetCO2 of 4.9 [4.8 to 5.0] kPa. Δp was 10 [9 to 12] cmH2O. Five adverse events were recorded: a tube obstruction due to airway secretions and four tube dislocations (two attributed to coughing, two not study-related). CONCLUSION FCV achieves adequate PetCO2 levels with minute volume and Δp in the normal range. Tritube's high flow resistance may increase the likelihood of tube dislocations if the patient coughs. Although further evaluation is necessary, FCV provides a new option for short-term mechanical ventilation. The successful operation of FCV with narrow-bore tubes contributes to the armamentarium for airway management. TRIAL REGISTRATION DRKS00013312 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://bit.ly/OBJ4xP Correspondence to Dr. Johannes Schmidt, Department of Anaesthesiology and Critical Care, Medical Centre – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany Tel: +49 761 270 26390; e-mail: johannes.schmidt@uniklinik-freiburg.de Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://bit.ly/2ylyqmW). © 2019 European Society of Anaesthesiology
http://bit.ly/2SsAarR
http://bit.ly/2SsAarR
Collision of Subungual Neurofibroma and Onychomatricoma: S100 Positivity as a Clue
Abstract: We present a 41-year-old man with a hemionychodystrophy of the first toe, appearing as a longitudinal thickening of the nail plate, overcurved and with holes in its thickened free margin, thus leading to the clinical diagnosis of onychomatricoma. Complete excision showed typical nail plate of onychomatricoma and, underlying it, curvy disorganized neural-looking fascicles without atypia and with diffuse positivity for S100, interpreted as subungual neurofibroma (NF). Subungual NF is a very rare tumor, with only 12 previous cases reported. Its diagnosis is based on histopathology, as the tumor presents waves or whorls of disorganized neural-looking cells positive for S100. Regarding onychomatricoma, it is characterized by typical glove finger digitations (which were present in our case) and an underlying stroma composed by a cellular superficial layer (this layer expresses CD34 but not CD99) and a more sclerotic and deeper area. As we did not find information on S100 expression in the stroma of onychomatricoma, we have stained 4 typical cases, and all were negative with S100 and positive with CD34, as expected. In conclusion, as "subungual NF" is so rare and, in our case, seems to collide with a typical onychomatricoma, we recommend adding S100 staining to properly characterize tumors involving nail plate, to detect underlying neural tumors, as has happened in our case. Correspondence: Mar Llamas-Velasco, MD, Hospital Universitario de La Princesa, C/Diego de León, 62, Madrid CP28006, Spain (e-mail: mar.llamasvelasco@gmail.com). The authors declare no conflicts of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
http://bit.ly/2Bkm95C
http://bit.ly/2Bkm95C
Spontaneous Hair Repigmentation in an 80-Year-Old Man: A Case of Melanoma-Associated Hair Repigmentation and Review of the Literature
Abstract: Spontaneous hair repigmentation of physiologically white or gray hair is a rare occurrence that may be associated with melanoma in elderly individuals. We present the first case of this phenomenon in a man. A gray-haired, 80-year-old man presented to dermatology clinic with a 3-cm lock of black hair on his vertex scalp that developed over 1 year. Punch biopsies showed an increase in junctional dendritic melanocytes with rare pagetoid cells and extension along the follicular outer root sheath epithelium and interfollicular epidermis, associated with prominent dendritic melanocytic hyperplasia and pigment-containing melanocytes within the hair bulbs. Although the findings on the biopsies were not diagnostic of melanoma in situ, an irregular interfollicular distribution of melanocytes was concerning for an adjacent atypical process. A complete excision was performed and revealed melanoma in situ, lentigo maligna type. Rare reports describe spontaneous hair repigmentation as a harbinger of lentigo maligna in women. Repigmentation can occur in the setting of proliferation of malignant pigment-producing melanocytes or by paracrine stimulation of benign bulbar melanocytes through receptor tyrosine kinase KIT activation. Presence of prominent dendritic melanocytic hyperplasia and pigment-containing melanocytes within the hair bulbs in our patient's biopsies was suggestive of paracrine or physiologic stimulation of bulbar melanocytes. Given the importance of early melanoma detection and the low visibility of the scalp, this report raises awareness of an extraordinary presentation of lentigo maligna and exemplifies the importance of close clinicopathologic correlation to ensure optimal clinical management and patient outcome. Correspondence: Shabnam Momtahen, MD, Assistant Professor of Pathology and Laboratory Medicine, Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756 (e-mail: shabnam.momtahen@hitchcock.org). The authors declare no conflicts of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
http://bit.ly/2TvGImJ
http://bit.ly/2TvGImJ
A Unique and Rare Case of Extramammary Paget Disease With Concomitant Herpes Simplex
Abstract: We describe a rare and unique case of extramammary Paget disease in the genitals with concomitant histological features of herpes virus infection. This is a very rare and interesting association that has only been reported in 1 article in the literature so far. Correspondence: Valencia Long, MBBS, Department of Dermatology, National Skin Centre, 1 Mandalay Road Singapore 308205, Singapore (e-mail: valencialong@gmail.com). The authors declare no conflicts of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
http://bit.ly/2TASBYG
http://bit.ly/2TASBYG
Enhancement in combustion, performance, and emission characteristics of a diesel engine fueled with diesel, biodiesel, and its blends by using nanoadditive
Abstract
This article presents the results of investigations carried out to evaluate the improvement in combustion, performance, and emission characteristics of a diesel engine fueled with neat petro-diesel (PD), soybean biodiesel (SB), and 50% SB blended PD (PD50SB) by using carbon nanotube (CNT) as an additive. The acid–alkaline-based transesterification process with sodium hydroxide (NaOH) as a catalyst was applied to derive the methyl ester of SB. A mass fraction of 100 ppm CNT nanoparticle was blended with base fuels by using an ultrasonicator and the physiochemical properties were measured based on EN standards. The measured physiochemical properties are in good agreement with standard limits. The experimental evaluations were carried out under varying brake mean effective pressure (BMEP) conditions in a single-cylinder, four-stroke, and natural aspirated research diesel engine at a constant speed of 1500 rpm. The results reveal that the SB and its blend promote shorter ignition delay period (IDP) that is resulting in lower in-cylinder pressure (ICP) and net heat release rate (NHR) compared to PD. The SB and its blend increase the brake specific fuel consumption (BSFC), and reduce the brake specific energy consumption (BSEC) and exhaust gas temperature (EGT), due to lower heating value, and efficient combustion, respectively. As far as the emission characteristics are concerned, the SB and its blend promote lower magnitude of hydrocarbon (HC), carbon monoxide (CO), carbon dioxide (CO2), and smoke emissions compared to PD except for oxides of nitrogen (NOx) emission. The CNT nanoparticle inclusion with base fuels significantly improves the combustion, performance, and emissions level irrespective of engine load conditions.
http://bit.ly/2TB7JoS
Green sol–gel synthesis of novel nanoporous copper aluminosilicate for the eradication of pathogenic microbes in drinking water and wastewater treatment
Abstract
We used a green sol–gel synthesis method to fabricate a novel nanoporous copper aluminosilicate (CAS) material. Nanoporous CAS was characterized using X-ray powder diffraction (XRD), field emission transmission and scanning electron microscopies (FE-TEM/FE-SEM), Fourier transform infrared (FTIR) spectroscopy, and optical analyses. The CAS was also evaluated for use as a promising disinfectant for the inactivation of waterborne pathogens. The antimicrobial action and minimum inhibitory concentration (MIC) of this CAS disinfectant were determined against eight microorganisms (Escherichia coli, Salmonella enterica, Pseudomonas aeruginosa, Listeria monocytogenes, Staphylococcus aureus, Enterococcus faecalis, Candida albicans, and Aspergillus niger). An antimicrobial susceptibility testing of CAS was measured. Results of disc diffusion method pointed out that the diameters of the zone using well diffusion were wider than disc diffusion methods, and the findings also showed that the MIC of the CAS disinfectant against E. coli, S. enterica, and P. aeruginosa was 100 mg/L within 20 min of contact time. Meanwhile, the MIC of the CAS disinfectant was 100 mg/L within 40 min of contact time for the other strains. The efficacy of antimicrobial action (100%) reached within 20 to 40 min against all tested microbes. Herein, the antimicrobial susceptibility testing of CAS disinfectant showed no toxicity for human and bacterial cells. It can be concluded that nanoporous CAS is a promising, economically, and worthy weapon for water disinfection.
http://bit.ly/2SedJHj
Contamination status and potential release of trace metals in a mangrove forest sediment in Ho Chi Minh City, Vietnam
Abstract
Can Gio district is located in the coastal area of Ho Chi Minh City, southern Vietnam. Discharge of wastewater from Ho Chi Minh City and neighboring provinces to the rivers of Can Gio has led to concerns about the accumulation of trace metals (As, Cu, Cr, Ni, Pb, and Zn) in the coastal sediments. The main objective of this study was to assess the distribution of As, Cu, Cr, Ni, Pb, and Zn in surface and core sediments and to evaluate the contamination status in relation to local background values, as well as the potential release of these selected trace metals from sediments to the water environment. Sediment characteristization, including determination of fine fraction, pH, organic matter, and major elements (Al, Fe, Ca, K, Mg, and S), was carried out to investigate which parameters affect the trace metal enrichment. Fine fraction and Al contents were found to be the controlling proxies affecting the distribution of trace metals while other sediment characteristics did not show any clear influence on trace metals' distribution. Although As concentrations in the sediments were much higher compared to its reference value in other areas, the enrichment factor based on local background values suggests minor contamination of this element as well as for Cr, Cu, and Pb. Risk assessment suggested a medium to very high risk of Mn, Zn, and Ni under acidification. Of importance is also that trace metals in sediments were not easily mobilized by organic complexation based on their low extractabilities by ammonium-EDTA extraction.
http://bit.ly/2HXKzrz
Microbiological dynamics of red complex bacteria following full-mouth air polishing in periodontally healthy subjects—a randomized clinical pilot study
Abstract
Objectives
Suppression of periodontal pathogens in the oral cavity of periodontally healthy individuals may lower the risk for periodontal or periimplant diseases. Therefore, the present study aimed to analyze the effect of supragingival debridement (SD) with adjunctive full mouth glycine powder air polishing (FM-GPAP) on the prevalence of periodontal pathogens in periodontally healthy individuals.
Materials and Methods
Eighty-seven systemically and periodontally healthy intraoral carriers of red complex bacteria, i.e., Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola or other periodontal pathogens including Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Eikenella corrodens were enrolled into the study and randomly assigned to receive SD with adjunctive FM-GPAP (test, n = 42) or SD alone (control, n = 45). In the first observation period, microbiological samples were obtained prior to, and 2, 5, and 9 days following intervention. If one of these periodontal pathogens could still not be identified, additional microbial sampling was performed after 6 and 12 weeks.
Results
The prevalence of red complex bacteria was significantly reduced in the test compared to the control group following treatment (p = 0.004) and at day 9 (p = 0.031). Intragroup comparison showed a significant (test, p < 0.001; control, p ≤ 0.01) reduction in the mean prevalence in both groups from BL through day 9 with an additional significant intergroup difference (p = 0.048) at day 9. However, the initial strong reduction returned to baseline values after 6 and 12 weeks.
Conclusion
In periodontally healthy carriers of periodontal pathogens, FM-GPAP as an adjunct to SD transiently enhances the suppression of red complex bacteria.
Clinical relevance
Whether the enhanced suppression of red complex bacteria by adjunctive FM-GPAP prevents the development of periodontitis in periodontally healthy carriers requires further investigations.
http://bit.ly/2Sg7Pp6
Correlation of magnetic resonance imaging grades with cytokine levels of synovial fluid of patients with temporomandibular joint disorders: a cross-sectional study
Abstract
Objectives
Magnetic resonance imaging (MRI) is a standardized method for assisting joint diagnosis. To validate the reliability of different imaging-based grading systems, this study examined (1) the associations between grading systems for osseous change, joint effusion, and the Wilkes classification of temporomandibular joint (TMJ) disorders and (2) the correlation between cytokines in synovial fluid and imaging-based joint scores.
Materials and methods
Twenty-seven patients, who routinely received numeric rating scale (NRS) and MRI assessment before TMJ arthrocentesis, were enrolled. Each joint was evaluated through the grading criteria for severity of osseous change and joint effusion by blinded observers using MRI. ImageJ was employed for classifying joint effusion. Joint synovial fluid, collected through arthrocentesis, was examined for cytokine expression by using a Luminex multiplex assay. All data were analyzed using the Pearson correlation analysis.
Results
The Wilkes classification was strongly correlated with osseous change scores, but not with joint effusion scores. Joint effusion scores significantly correlated with NRS scores, but not with the Wilkes classification and osseous change scores. Compared with osseous change scores, joint effusion scores had a higher correlation with the levels of inflammatory cytokines (interleukin (IL)-8 and soluble IL-6 receptor (sIL-6R)) and with anti-inflammatory cytokines (soluble tumor necrosis factor receptors I and II (sTNF-RI/II)).
Conclusions
In patients with TMJ disorders, MRI grades are strongly correlated with NRS scores and levels of cytokines (IL-8, sIL-6R, and sTNF-RI/II) in the synovial fluid.
Clinical relevance
Joint effusion scoring can be a reliable and valid indicator for pathological assessment of TMJ disorders.
http://bit.ly/2SspiKz
Effect of induction hydroxy and hydrogen along with algal biodiesel blend in a CI engine: a comparison of performance and emission characteristics
Abstract
Gaseous fuel as a combustion enhancer with a pilot fuel offers significant benefits in improving engine efficiency. Hydrogen and hydroxy are the two most common gaseous fuels that have been widely investigated in the CI engine but which one performs best is still inconvenient. In this study, hydrogen and hydroxy were injected with BD40 (v/v) separately in a common diesel engine to compare the performance and emission characteristics of these fuels. Engine performance parameters include brake thermal efficiency (BTE) and brake-specific energy consumption (BSEC), and exhaust emissions include hydrocarbon (HC), CO, CO2, NOx, and smoke opacity. The induction of both hydroxy and hydrogen with BD40 has a positive effect on engine performance and emissions except NOx when compared to neat diesel fuel and BD40. The BTE of hydroxy-rich BD40 increased by 7.2% while BSEC reduced by 7.6% as compared to BD40 with hydrogen. The CO, HC, and smoke opacity of hydroxy-operated engine was found to be better than hydrogen-inducted engine. The NOx emission increased with the induction of both gaseous fuels and hydroxy-enriched BD40 produced 12.5% more emission than hydrogen-operated BD40 engine. Thus, more concisely, hydroxy-operated biodiesel engine performed better than hydrogen engine in terms of BTE, BSEC, CO, HC, and smoke opacity.
http://bit.ly/2I9roev
Histological and immunohistochemical evaluation of the effect of tartrazine on the cerebellum, submandibular glands, and kidneys of adult male albino rats
Abstract
Tartrazine is one of the most widely used food additives. The present investigation was carried out on 40 adult male albino rats. They were divided into four groups of ten animals for each. Group I was considered as a control group. Group II was treated with tartrazine daily in a dose 7.5 mg/kg body weight by oral gavage for 30 days. Group III was received 15 mg/kg body weight of tartrazine for the same period. Group IV was administered tartrazine in a dose 100 mg/kg body weight for the whole duration of the experiment. At the end of experiment, samples from the cerebellum, submandibular salivary glands, and kidneys were fixed in neutral buffered formalin 10% and prepared routinely for paraffin sectioning and staining for histopathological and immunohistochemical investigations of proliferating cell nuclear antigen "PCNA" and glial fibrillar acidic protein "GFAP". Tartrazine-treated groups revealed histopathological degenerative changes in the obtained organs. In group II, the cerebellum showed subcortical edema, congestion of the blood vessels, cytoplasmic vacuolations, and pyknosis of the nuclei in the gray matter neurons. Concerning the submandibular glands, they expressed cytoplasmic vacuolations and pyknosis of the nuclei of the acinar cells, congestion of the interacinar blood capillaries, and degenerative changes in the striated duct. The kidneys appeared with interstitial hemorrhage and dilatation of the glomerular capillaries. The PCT and DCT showed ill-defined cell boundaries. The collecting tubules in the renal medulla appeared with flattened epithelial cells. The severity of these changes increases by increasing the dose of tartrazine in group III and reach to the highest level in group IV. The immunoexpression of the GFAP in the cerebellum of the experimental groups was intense compared to the control group. The immunoreactivity of PCNA in the nuclei of the acinar and ductal cells of the submandibular gland and the cells of the renal cortex and medulla was strong in the tartrazine-treated groups compared to the control group. The current study concluded that the tartrazine had serious effect on the cerebellum, submandibular glands, and kidneys that adversely affect the functions of these organs.
http://bit.ly/2Bogj3n
Characterization of iron-metabolizing communities in soils contaminated by acid mine drainage from an abandoned coal mine in Southwest China
Abstract
Acid mine discharge (AMD) has been demonstrated to have significant impacts on microbial community composition in the surrounding soil environment. However, their effect on adjacent soil has not been extensively studied. In this study, microbial community composition of 20 AMD-contaminated soil samples collected from an abandoned coal mine along an AMD creek was characterized using high-throughput sequencing. All samples were characterized as extremely low in pH (< 3) and relatively enriched in HCl-extractable Fe species. The dominant phylotypes were belonging to genera Ochrobactrum, Acidiphilium, Staphylococcus, Brevibacterium, and Corynebacterium. Canonical correspondence analysis results revealed that the HCl-extractable Fe(III) had a strong impact on the soil microbial assemblage. Co-occurrence network analysis revealed that Aquicella, Acidobacteriaceae, Ochrobactrum, Enhydrobacter, Sphingomonas, and Legionellales were actively correlated with other taxa. As expected, most of the abundant taxa have been reported as acidophilic Fe-metabolizing bacteria. Hence, a co-occurring sub-network and a phylogenetic tree related to microbial taxa responsible for Fe metabolism were constructed and described. The biotic interaction showed that Dechloromonas exhibited densely connections with Fe(III)-reducing bacteria of Comamonas, Burkholderia, Shewanella, Stenotrophomonas, Acidithiobacillus, and Pseudomonas. These results demonstrated that Fe-metabolizing bacteria could have an important role in the Fe biogeochemical cycling.
http://bit.ly/2TAHrmG
Metal distribution in sediments of a drinking water reservoir: influence of reservoir morphometry and hydrodynamics
Abstract
Metal(loid)s in the reservoir sediment tend to be released into the water column when encountering disturbances and thus pose threats to the aquatic system. In this study, sediment and pore water samples collected from eight cross sections in the Biliu River Reservoir (Dalian, China) were analyzed to determine the spatial distributions of six metal(loid)s and their associations with reservoir morphometry and hydrodynamics. The results show that total metal concentrations of the sediments are higher at the sites with greater water depths and are influenced by the reservoir morphometry. Mn is of great concern with respect to its increasing total concentration from the upstream sites to the dam sites. According to the improved BCR sequential extraction procedure, the acid-soluble fraction of Mn increases along the thalweg to the dam, implying the soluble Mn2+ in the upstream hypolimnion, and sediment is possible to be transported longitudinally by water currents. For Fe, Mn, Pb, Cu, and Zn, the reducible fraction accounts for more than 15% of the total metal concentration, which suggests that Fe–Mn (hydr)oxides could be important in scavenging these metals. High Mn concentrations in pore waters close to the dam, with an average value of more than 40 mg/L, give rise to significant Mn diffusive flux up to 296.1 mg/m2/day.
http://bit.ly/2t7tGjA
Assessment of air pollution and health hazard associated with sawmill and municipal waste burning in Abeokuta Metropolis, Nigeria
Abstract
Indiscriminate disposal and open burning of sawmill and municipal solid wastes constitute hazards to the quality of the immediate environment and human health. This study assessed the levels of pollutants emitted by burning sawmill and municipal wastes, and their potential hazards. Nine selected sawmills and 6 municipal solid-waste dumps in Abeokuta metropolis were investigated. During waste burning, the concentrations of NO2, SO2, CO, H2S, NH3 and VOC were monitored in replicates at the dumpsites, 10 m, 20 m and the nearest houses using portable samplers (Aeroqual and Multi-RAE). Mean, ANOVA, correlation and regression statistical tools were used to analyse air quality data; air quality index (AQI) was employed to classify the hazard rating of the gaseous pollutants. Nearest neighbour analysis in ArcGIS 10.0 was used to investigate dumpsites location pattern within the city. The concentrations (mg/m3) of sampled parameters from source to nearest house (NH) at the dumpsites ranged as follows: < 0.002–0.175 (NO2), < 0.002–0.235 (SO2), 0.065–0.425 (H2S), 13.98–47.40 (CO), 6.74–170.41 (NH3) and 31.13–820.03 (VOC) in wet and dry seasons. The mean concentrations of NO2, SO2 and VOC were below permissible limits at most locations while CO values were higher at all dumpsite. Significant variations (p < 0.05) were observed in the concentrations of the monitored parameters except NO2 values (SMW) in dry season. AQI rated NO2 and SO2 concentrations as "good" at all sites while CO emission ranged from unhealthy to hazardous across the dumpsites. In conclusion, the present locations of SMW and MSW dumps in the city degrade environmental quality and are unsafe for human health.
http://bit.ly/2SCnNcy
Dechlorination and conversion mechanism of trichlorobenzene as a model compound of chlorine-containing wastes by different base-catalyzed combinations
Abstract
Chlorine-containing organic waste (COWs) is a big threat for the waste incineration because of the dioxin generation and equipment corrosion. Recently, dechlorination and detoxification of COWs is emergent in order to lower the environmental risk and treatment costs. In this study, base-catalyzed decomposition processes with different hydroxides, hydrogen donors, and catalysts were conducted for pre-treatment of COWs to reduce organic chlorine content, with the TCB as a model compound and industrial rectification residues for verification. Results showed that maximum chlorine retention efficiency (CRE) of four alkalis followed the order of KOH > NaOH–KOH > NaOH > Mg(OH)2, which were 98.3%, 93.4%, 97.2%, and 1.5%, respectively, and could be expressed as an apparent first-order reaction. The differences were resulted from the varying ionic potentials of the metal cations. Hydrogen donors (glycol, glycerol, paraffin oil, and PEG 200) acted as effective dechlorination regents follow the order of PEG > glycol > paraffin oil > glycerol. In addition, Fe, Ni, Cu, and activated carbon catalysts increased the CRE by 68.9% to 92.4%, 91.9%, 89.2%, and 73.3%, respectively. Residue analysis through X-ray diffraction and Fourier transform infrared spectroscopy revealed that KCl, sodium oxalate, and phenol were the main products and a plausible stepwise dechlorination pathway was proposed. The effectiveness of three optimized combinations including NaOH/PEG, KOH/PEG, and NaOH–KOH/PEG (with the Fe catalyst) was confirmed by using them for dechlorinating rectification residues, and they restrained 98.2%, 91.2%, and 94.6% of the chlorine, respectively. The organochlorine content decreased from 19.2 to 1.8% within 180 min, while inorganic chorine content increased from 1.5 to 18.9%, indicating the potential for COWs dechlorination.
http://bit.ly/2Dcp7cH
Bioaccumulation of dichlorodiphenyltrichloroethanes (DDTs) in carp in a water/sediment microcosm: important role of sediment particulate matter and bioturbation
Abstract
Sediments are reservoirs and sources of DDTs to the aquatic ecosystem. However, the role of sediment particulate matter and benthic organisms in transferring DDTs remains unclear. In this study, microcosms were built up with different groups to simulate a freshwater system with DDT-contaminated sediment and organisms. The impacts of different exposure routes (water and sediment) on the changes of DDT and its metabolites (DDD and DDE) in carp (Cyprinus carpio) were investigated. The bioturbation of Tubifex tubifex (Oligochaeta, Tubificidae) was investigated to understand the fate and transfer of DDTs in aquatic environment. For the sediment treatment, the concentrations of o,p'-DDT in carp were significantly higher than those of p,p'-DDT, and the metallothionein (MT) content decreased. The bioaccumulation of DDTs in carp via sediment particulate matter was significantly higher/faster than that via overlying water. T. tubifex and sediment particulate matter accelerate DDT bioaccumulation in carp. Selective enrichment of the (+)-o,p'-DDT and (+)-o,p'-DDD was found in carp. These results help to reduce uncertainty in ecological and health risk assessments and to better understand the risk of DDTs in the environment.
http://bit.ly/2SCnJtk
Can lithium disilicate ceramic crowns be fabricated on the basis of CBCT data?
Abstract
Objectives
Evaluating the fit of CAD/CAM lithium disilicate ceramic crowns fabricated on basis of direct and indirect digitalization of impressions by CBCT or of dental casts.
Material and methods
A metal model with a molar chamfer preparation was digitized (n = 12 per group) in four ways: IOS—direct digitalization using an Intra-Oral scanner (CS3600), cone-beam computed tomography scan (CBCT 1)—indirect digitalization of impression (CBCT-CS9300), CBCT 2—indirect digitalization of impression (CBCT-CS8100), and Extra-Oral scanner (EOS)—indirect digitalization of gypsum-cast (CeramillMap400). Accuracy of 3D datasets was evaluated in relation to a reference dataset by best-fit superimposition. Marginal fit of lithium disilicate crowns after grinding was evaluated by replica technique. Significant differences were detected for 3D accuracy by Mann–Whitney U and for fit of crowns by One-way ANOVA followed by Scheffe's post hoc (p = 0.05).
Results
3D analysis revealed mean positive and negative deviations for the groups IOS (− 0.011 ± 0.007 mm/0.010 ± 0.003 mm), CBCT 1 (− 0.046 ± 0.008 mm/0.093 ± 0.004 mm), CBCT 2 (− 0.049 ± 0.030 mm/0.072 ± 0.015 mm), and EOS (− 0.023 ± 0.007 mm/0.028 ± 0.007 mm). Marginal fit presented the results IOS (0.056 ± 0.022 mm), CBCT 1 (0.096 ± 0.034 mm), CBCT 2 (0.068 ± 0,026 mm), and EOS (0.051 ± 0.017 mm).
Conclusions
The marginal fit of EOS and IOS, IOS and CBCT 2, and CBCT 2 and CBCT 1 showed statistical differences. The marginal fit of CBCT 1 and CBCT 2 is within the range of clinical acceptance; however, it is significant inferior to EOS and IOS.
Clinical relevance
The use of a CBCT enables clinicians to digitize conventional impressions. Despite presenting results within clinical acceptable levels, the CBCT base method seems to be inferior to Intra-Oral scans or to scanning gypsum models regarding the resulting accuracy and fit.
http://bit.ly/2t67Hts
The Role of Sub-mental Ultrasonography in Diagnosing Obstructive Sleep Apnea and Its Correlation With Subjective Scales
Conditions: Obstructive Sleep Apnea; Diagnostic Imaging; Ultrasound
Intervention: Diagnostic Test: Sub-mental ultrasonography
Sponsor: Bartin State Hospital
Recruiting
http://bit.ly/2TAvJZ4
Intervention: Diagnostic Test: Sub-mental ultrasonography
Sponsor: Bartin State Hospital
Recruiting
http://bit.ly/2TAvJZ4
Team-based Ergonomics Educational Model for Workplace WELLNESS Improvement: A Pilot Study
Conditions: MSDs; Muscle Pain
Intervention: Behavioral: stretching exercises
Sponsor: Milton S. Hershey Medical Center
Not yet recruiting
http://bit.ly/2BkSYzy
Intervention: Behavioral: stretching exercises
Sponsor: Milton S. Hershey Medical Center
Not yet recruiting
http://bit.ly/2BkSYzy
Validation of Smartphone App for Head and Neck Cancer Control and Patient Support
Condition: Head Neck Cancer
Intervention: Other: Virtual Coach
Sponsors: Vibrent Health; Stanford University; Johns Hopkins University; Massachusetts General Hospital
Not yet recruiting
http://bit.ly/2Tzwm5r
Intervention: Other: Virtual Coach
Sponsors: Vibrent Health; Stanford University; Johns Hopkins University; Massachusetts General Hospital
Not yet recruiting
http://bit.ly/2Tzwm5r
A Study of pING-hHER3FL Vaccine in Cancer Patients WITH ADVANCED MALIGNANCIES
Condition: Advanced Cancer
Intervention: Biological: pING-hHER3FL
Sponsor: Herbert Lyerly
Not yet recruiting
http://bit.ly/2BkSRnC
Intervention: Biological: pING-hHER3FL
Sponsor: Herbert Lyerly
Not yet recruiting
http://bit.ly/2BkSRnC
Ischemic stroke in giant-cell arteritis: French retrospective study
Publication date: Available online 5 February 2019
Source: Journal of Autoimmunity
Author(s): Aaron Pariente, Alexis Guédon, Sonia Alamowitch, Sara Thietart, Fabrice Carrat, Stephen Delorme, Jean Capron, Carlotta Cacciatore, Michael Soussan, Azeddine Dellal, Olivier Fain, Arsene Mekinian
Abstract
Acute cerebrovascular ischemic events are a rare and severe complication of giant cell arteritis (GCA). We aimed to determine the prevalence of GCA-related stroke, the overall survival and the relapse-free survival in patients with GCA.
A multicentric retrospective analysis was performed on 129 patients with GCA diagnosed between September 2010 and October 2018 in two University Hospitals. Among 129 GCA patients, 18 (16%) presented an acute ischemic cerebrovascular event. Patients with stroke were older (83 [67–96] years versus 76 [58–96]; p = 0.014) and more frequently males (61% versus 30%; p = 0.014) than those without stroke. The frequency of anterior ischemic optic neuropathy was higher in patients with stroke (n = 6, 33%) than patients without stroke (n = 12, 11%)(p = 0.02). Overall survival was significantly decreased in GCA patients with stroke (4.4 months), comparatively to patients without stroke (221.7 months; log rank test = 0.006). The 3-years relapse-free survival was decreased in patients with stroke (8.42 versus78.0 months; log rank = 0.0001), as well as the time with sustained remission (78 versus 139 months; log rank test = 0.0004). This study shows the prevalence and risk factors of ischemic stroke in GCA.
http://bit.ly/2Tzw4LT
Working memory theory remains stuck: Reply to Hanley and Young
Publication date: Available online 6 February 2019
Source: Cortex
Author(s): Candice C. Morey
http://bit.ly/2t64Xwa
Insular networks and intercognition in the wild
Publication date: Available online 6 February 2019
Source: Cortex
Author(s): Agustín Ibáñez
http://bit.ly/2HUdHzR
Human motor cortical organization is influenced by handedness
Publication date: Available online 5 February 2019
Source: Cortex
Author(s): Chiara Nicolini, Diana Harasym, Claudia V. Turco, Aimee J. Nelson
Abstract
Although there is some evidence that handedness is associated with structural and functional differences in the motor cortex, findings remain inconclusive. Here, we evaluated whether handedness influences the location, size and overlap of the cortical representations of upper limb muscles across hemispheres in right-versus left-handed individuals. Using transcranial magnetic stimulation, the cortical representations of abductor pollicis brevis, flexor carpi radialis and biceps brachii muscles were mapped bilaterally with a 6 by 5 grid space. Results indicate that right-handers had more lateral and posterior representations in the non-dominant hemisphere as well as greater overall cortical territory compared to left-handers. Right- and left-handers did not differ in the extent of overlap between muscle representations. Our findings suggest that human motor cortical organization of upper limb muscles is indeed influenced by handedness, specifically with regard to the location of non-dominant cortical muscle representations and the size of cortical territory dedicated to upper limb muscle representations.
http://bit.ly/2taBi5c
Year-round film mulching system with monitored fertilization management improve grain yield and water and nitrogen use efficiencies of winter wheat in the dryland of the Loess Plateau, China
Abstract
Year-round film mulching in winter wheat field facilitates rainwater storage in summer fallow period and reduces water evaporation in growing reason, and then increases water use efficiency in the dryland of the Loess Plateau, China. Optimized fertilization further promotes fertilizer utilization efficiencies. In this study, plastic film mulching was extended from plant growth season to summer fallow, and fertilizers were applied by monitoring soil nutrient availability. Field trials were conducted in the dryland of the Loess Plateau over 4 years by using four types of cultivation to investigate the effects of year-round plastic film mulching with monitored fertilization on utilization efficiencies of rainwater and nitrogen (N), and winter wheat yield. The four types of cultivation were farmer practice (FP), ridge-furrow with plastic film mulching system plus conventional fertilization(RPCF), ridge-furrow with plastic film mulching system plus monitored fertilization (RPFM), and flat soil surface with plastic film mulching system plus monitored fertilization (FPFM). Our results indicate that the average yield of winter wheat in RPFM and FPFM treatments was 4491 kg ha−1. Compared with FP treatment, the combined effects of monitored fertilization and film mulching(RPFM and FPFM treatments) could increase grain yield in the range of 24.7 to 42.1%. The film mulching extended to the fallow season increased the water storage in 2 m depth of soil profile, and the amount of soil water storage in the summer fallow period increased by 27 to 30% in FPFM treatment than FP treatment. After 4-year consecutive planting of wheat, the accumulation of nitrate-N in 2 m soil reached 277 kg·ha−1 in the FP treatment, which is 87.7% higher than of the level at the beginning of the experiment. Seventy-five percent of nitrate-N was distributed in the soil layer of 0–120 cm. In addition, the residual nitrate-N showed downward leaching with rainfall during the experiment. The RPFM and FPFM treatments reduced the apparent loss and residual levels of soil N, whereas increased its apparent mineralization compared with FP treatment. The FPFM treatment exhibited a greater utilization of residual nitrate-N from previous years and showed a higher amount of the mineralized N from soil organic matter, therefore leading to a relatively high apparent utilization rate of N (56.7%). Considering both grain yield production and utilization efficiencies of water and N, FPFM with year-round mulching was the most effective cultivation measure for winter wheat in the Loess Plateau.
http://bit.ly/2UJi0j6
Development of a spatial web tool to identify hotspots of environmental burdens in Wallonia (Belgium)
Abstract
In response to the Walloon Environment and Health Program, the Scientific Institute of Public Services (ISSeP) developed an integrated approach of environmental exposure assessment in the Walloon region, Belgium. The study presents an index-based approach to estimate the multiple environmental burdens at regional level and detailed local resolution. Indicators are based on environmental measurements of pollutants in ambient air and soil, and on stressors for citizens related to noise and radon. These indicators were mapped as proportions to obtain an accurate comparison between spatial units. In order to indicate the need for intervention, environmental indicators are calculated as the proportion of areas where the level of detrimental environmental factors exceeds threshold values from WHO guidelines and Walloon legal threshold values. In parallel, a spatial web tool based on GIS was developed to enable a flexible and weighted combination of the normalized indicators by computing the resulting composite index online. This interactive web tool designed for policy makers and experts eases the spatial analysis of results in order to identify geographic areas where hotspot exposures are a potential risk to human health. The next steps of this work aim to integrate more environmental indicators (stressors and benefits) and some sociodemographic and health indicators in order to detect vulnerable populations. A holistic assessment is essential to inform environmental justice debates and to ensure a health conducive equal environment. Finally, this environmental health tool will support decision makers focus resources and programs to improve the environmental health of Walloons living in areas disproportionately burdened by multiple sources of pollution.
http://bit.ly/2GdUGqr
Health risk assessment of heavy metals in Cyprinus carpio (Cyprinidae) from the upper Mekong River
Abstract
The purposes of this research are to quantify the concentration of heavy metals (Zn, Cu, As, Pb, Cd, and Hg) in the water and fish tissues of common carp (Cyprinus carpio) in the upper Mekong River and to thereby elucidate the potential dietary health risks from fish consumption of local residents. Surface water and fish tissues (gill, muscle, liver, and intestine) from four representative sample areas (influence by a cascade of four dams) along the river were analyzed for heavy metal concentrations. Results revealed that the levels of heavy metals in fish were tissue-dependent. The highest Cu and As levels were found in the liver; the highest Zn and Pb levels occurred in the intestine, and the highest Hg level was found in the muscle. The total target hazard quotient (THQ) value for residents is > 1 for long-term fish consumption, and local residents are, therefore, exposed to a significant health risk. Results from the current study provide an overall understanding of the spatial and tissue distribution of heavy metals in water and fish body along the upper Mekong River under the influence of cascade dams and highlight the potential health risk of As for the local residents of long-term fish consumption.
http://bit.ly/2BoUhgL
Confirmatory Tests for the Diagnosis of Primary Aldosteronism: A Systematic Review and Meta‐analysis
Abstract
Objective
Saline infusion test (SIT), captopril challenge test (CCT), fludrocortisone suppression test (FST) and oral sodium loading test (SLT) are recommended by the Endocrine Society's clinical practice guidelines to diagnose primary aldosteronism, but which one is the best remains controversial. We aimed to summarize the available comparative data and evaluate the diagnostic accuracy of these four tests.
Design
We searched PubMed, Embase and the Cochrane Library for relevant studies published between January 1980 and January 2018.
Patients
Eligible studies reported on the accuracy of one or more of the four confirmatory tests in patients suspected of PA.
Measurements
Two reviewers independently conducted the data extraction of all selected studies, which consisted of study characteristics and data to estimate the summary receiver operating characteristic (SROC) curve and the corresponding summary area under the curve (SAUC), pooled sensitivity and specificity, diagnostic odds ratios (DOR) with 95% confidence interval (CI).
Results
We identified 26 articles including 3686 patients. 15 articles evaluated the diagnostic accuracy of CCT, 10 of SIT, 1 of FST, and none of SLT. For CCT, the SAUC was 0.9207, and the pooled sensitivity and specificity were 0.87 (95%CI 0.84‐0.89) and 0.84 (95%CI 0.81‐0.86), respectively. For SIT, the SAUC was 0.9232, and the pooled sensitivity and specificity were 0.85 (95%CI 0.82‐0.87) and 0.87 (95%CI 0.85‐0.89), respectively. For FST, the pooled sensitivity and specificity were 0.87 (95%CI 0.66‐0.97) and 0.95 (95%CI 0.82‐0.99), respectively. Overall, we found no significant differences in the diagnostic accuracy of CCT and SIT.
Conclusions
CCT and SIT exhibit high and comparable accuracy for diagnosing PA. CCT may be a more feasible alternative as it is safe and much easier to perform.
This article is protected by copyright. All rights reserved.
http://bit.ly/2t9U8cq
Growth Hormone Therapy and Short Stature‐Related Distress: A Randomized Placebo‐Controlled Trial
Summary
Context
Growth hormone (GH) treatment of short healthy children is based on the belief that short stature is associated with psychosocial problems and a diminished quality of life.
Objective
To determine the impact of GH therapy on psychosocial well‐being and the ability of psychological metrics to define short stature‐related distress.
Methods
Sixty prepubertal boys with idiopathic short stature (age: 10.0±1.4yrs, height‐SDS: ‐2.38±0.3) were enrolled in this four‐year intervention study [one‐year double‐blinded, randomized, placebo‐controlled (GH/placebo‐2:1) and three‐year open‐labeled GH‐therapy]. Explicit (conscious/voluntary) psychological metrics [Pediatric Quality‐of‐Life Inventory (PedsQL), Silhouette Apperception Test (SAT), Rosenberg Self‐Esteem Scale (RSES), Child Behavior Checklist (CBCL)] and implicit (unconscious/involuntary) psychological metrics [Single‐Category Implicit‐Association‐Test for height (SC‐IAT‐H), Height Perception Picture Test (HPPT)]. Psychosocial evaluations were performed at study entry, after one and four years.
Results
At study entry, PedsQL of boys with idiopathic short stature was lower than Israeli norms (P=.001). After one‐year blinded‐intervention only the GH‐treated boys improved their actual and anticipated adult height perception (SAT, P<.001 and P=.022) with reduced short stature‐related distress (SC‐IAT‐H, P<.001). At study end, RSES and SC‐IAT‐H improved significantly (P<.001), with no change in PedsQL and CBCL.
Conclusions
Our finding of improved psychosocial functioning only in the GH‐treated boys after one‐year blinded intervention suggests that it was the GH therapy, rather than being enrolled in a clinical trial, which contributed to the outcome. Long‐term open‐labeled GH‐treatment significantly improved height perception and self‐esteem. Future studies are needed to fully assess the relevance of complementing the routinely used explicit self‐report measures with the implicit measures.
This article is protected by copyright. All rights reserved.
http://bit.ly/2HUGFQa
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