Free-to-use DIR solutions in radiotherapy: Benchmark against commercial platforms through a contour-propagation study.

PURPOSE: A contour propagation study has been conducted to benchmark three algorithms for Deformable Image Registration (DIR) freely available online against well-established commercial solutions. METHODS: ElastiX, BRAINS and Plastimach, available as modules in the open source platform 3DSlicer, were tested as the recent AAPM Task group 132 guidelines proposes. The overlap of the DIR-mapped ROIs in four computational anthropomorphic phantoms was measured. To avoid bias every algorithm was left to run without any human interaction nor particular registration strategy. The accuracy of the algorithms was measured using the Dice Similarity Coefficient (DSC) and Mean Distance to Conformity (MDC) metrics. The registration quality was compared to the recommended geometrical accuracy suggested by AAPM TG132 and to the results of a large population-based study performed with commercial DIR solutions. RESULTS: The considered free-to-use DIR solutions generally meet acceptable accuracy and good overlap (DSC > 0.85). Mild failures (DSC < 0.75) were detected only for the smallest structures. In case of extremely severe deformations acceptable accuracy was not met (MDC > 3 mm). The morphing capability of the tested algorithms equals those of commercial systems when the user interaction is avoided. Underperformances were detected only in cases where a specific registration strategy is mandatory to obtain a satisfying match. CONCLUSIONS: All of the considered algorithms show performances not inferior to previously published data and have the potential to be good candidates for use in the clinical routine. The results and conclusions only apply to the considered phantoms and should not be considered to be generally applicable and extendable to patient cases.

[Physical activity in severe asthma: Results of the FASE-CPHG Study]. / Activité physique et asthme sévère : résultats de l'étude FASE-CPHG.

INTRODUCTION: Data on physical activity in severe asthma are scarce. From May 2016 to June 2017, 1502 adult patients with severe asthma visiting a pulmonologist practicing in one of the 104 non-academic hospitals participating in the study were included in this prospective, cross-sectional, multicenter study, provided they gave consent. Physical activity was classified according to 4 levels: 1 (no activity), 2 (occasional), 3 (regular), or 4 (frequent). Clinical and therapeutic parameters were described according to these levels. RESULTS: Respectively, 440, 528, 323, and 99 patients had physical activity of level 1, 2, 3, and 4. The percentage of patients with controlled asthma increased with physical activity. Treatment adherence did not differ with physical activity. Percentages of obese patients, patients with FEV1 <60%, and patients with anxiety, depressive syndrome, gastro-esophageal reflux disease, arterial hypertension, diabetes, obstructive sleep apnoea-hypopnoea syndrome, and osteoporosis decreased with physical activity. Respiratory rehabilitation was offered to only 5% of patients. CONCLUSIONS: In this large study, physical activity is associated with disease control in severe asthma and with less comorbidity. Its practice should be encouraged and respiratory rehabilitation offered more often.

Short communication: Associations between blood fatty acids, ß-hydroxybutyrate, and α-tocopherol in the periparturient period in dairy cows: An observational study.

The objective of the present study was to examine the relationships between blood concentrations of fatty acids, ß-hydroxybutyrate (BHB), and α-tocopherol during the periparturient period in dairy cows. Blood samples were collected from 131 cows belonging to 4 different commercial dairy farms in southeastern Europe (Greece and Italy). We determined blood concentrations of fatty acids, BHB, and α-tocopherol at dry-off, at calving, and 30d postpartum. Results indicated that fatty acid concentrations were low at dry-off, reached maximum value at calving, and then declined at 30d postpartum. In fact, fatty acid concentrations at 30d postpartum were 50% lower than at calving. In contrast, BHB concentrations were low at dry-off, increased by 27% at calving, and continued to increase by another 20% at 30d postpartum. Overall, we found a weak correlation between fatty acids and BHB throughout the periparturient period. Concentrations of α-tocopherol were lowest at calving, and we detected no differences in α-tocopherol concentrations at dry-off or 30d postpartum. Negative correlations between fatty acids and α-tocopherol were highly significant at 30d postpartum and approached the level of significance at dry-off. However, both correlations became nonsignificant following the adjustment of α-tocopherol with cholesterol, indicating that the correlations were a reflection of changes in lipid transport. We found significant negative correlations (strong at dry-off and weak at 30d postpartum) between BHB and α-tocopherol after adjustment with cholesterol. The physiological basis for the negative correlations between BHB and α-tocopherol, especially that at dry-off, is not known and should not be taken to imply a cause-effect relationship. However, it opens the door to investigating the effects of vitamin E on liver function in dairy cows.

Computed tomography-based virtual colonoscopy in the assessment of bowel endometriosis: The surgeon's point of view.

OBJECTIVE: To discuss the role of computed tomography-based virtual colonoscopy (CTC) in preoperative assessment of bowel endometriosis. METHODS: Retrospective study using data prospectively recorded, including 127 patients with colorectal endometriosis, having undergone CTC for bowel endometriosis. The study was conducted in a tertiary referral center during 38 consecutive months. Preoperative assessment included CTC, magnetic resonance imaging (MRI), endorectal ultrasound (ERUS) and clinical examination. Information concerning identification of deep infiltrating endometriosis (DIE) of the bowel, the length and height of colorectal involvement, stenosis of digestive lumen and associated digestive localizations were compared with intraoperative findings. RESULTS: Sensitivity and specificity of CTC for DIE of the rectum, the sigmoid colon, associated digestive localizations, and stenosis of the digestive lumen were respectively 97% and 84%, 93% and 88%, 84% and 97%, 96% and 96%. Intraoperative estimation of the length of digestive tract involved by DIE was closer to that provided by CTC than those provided by MRI and ERUS. When CTC revealed stenosis of digestive lumen, higher rates of colorectal resection (63% vs. 9.6%, < 0.001) and disc excision (25.9% vs. 11%, 0.03) were recorded. DISCUSSION: For those surgeons using various procedures for management of bowel endometriosis, accurate information on the length and height of bowel involvement, as well as the existence of bowel stenosis enables informed decision regarding the feasibility of conservative techniques versus bowel resection. Preoperative identification of associated localizations above the sigmoid colon is another major advantage related to CTC. CONCLUSIONS: CTC provides accurate data on the length and height of colorectal involvement by DIE, stenosis of digestive lumen and associated lesions of digestive tract, which impact on the choice of surgical procedure.

[Ustekinumab-induced eosinophilic pneumonia during the course of ustekinumab therapy for plaque psoriasis]. / Pneumopathie à éosinophiles chez un patient atteint de psoriasis en plaques traité par ustékinumab.

BACKGROUND: Ustekinumab (Stelara(®)) is efficacious in severe cutaneous psoriasis. Numerous adverse effects have been reported but treatment withdrawal is rarely required. The present case concerns eosinophilic pneumonia treated with ustekinumab. PATIENT AND METHODS: A 71-year-old male patient presented severe plaque psoriasis with an indication for biotherapy. Pre-treatment investigations showed a highly positive interferon gamma test without any anomalies in the CT chest scan. The patient was treated with anti-tuberculosis agents and ustekinumab was then introduced. Seven months later, the patient presented a cough resistant to antibiotics. A CT scan showed frosted-glass-like shadows and mediastinal lymphadenopathy. The bronchoalveolar lavage fluid contained 800elements/mm(3), of which 34% eosinophils. There were 1480G/L eosinophils in peripheral blood. There was nothing evocative of infectious or tumoral causes, and a diagnosis of eosinophilic pneumonia was made. Ustekinumab was stopped and 10weeks later, the patient's condition worsened; after further examination, systemic corticosteroids were given, beginning with prednisone 1mg/kg. Seven months later, the patient was symptom-free, without eosinophilia, and his chest scan was normal. The corticosteroids were stopped. DISCUSSION: Eosinophilic pneumonia includes various disorders characterized by eosinophilic infiltration of lung tissue, with or without the presence of eosinophils in peripheral blood. Eosinophilic pneumonia can be caused by many different drugs. Diagnosis is difficult because clinical and radiological abnormalities may develop at different times after treatment initiation and they are non-specific. A favourable outcome may occur spontaneously on treatment withdrawal or a short course of corticosteroid therapy may be needed. A case of eosinophilic pneumonia under ustekinumab has already been reported, supporting the causal involvement of this drug in our patient. Eosinophils in peripheral blood have also been reported with anti-TNF-alpha. In conclusion, where a patient on biologic treatment for psoriasis presents persistent cough, once infectious disease has been ruled out, eosinophilic pneumonia should be considered.

[Management of the sedated patient]. / Prise en charge du patient sédaté.

A sedation strategy aimed at minimizing alteration of consciousness once comfort, analgesia and adaptation to the ventilator have been ensured is feasible in critically-ill patients requiring mechanical ventilation, even if, in patients with severe ARDS or ICH, the high dosages of sedatives and analgesics transiently required to provide perfect adaptation to the ventilator often preclude preservation of consciousness. The main components of a sedation algorithm include a clear objective of sedation-analgesia, regular assessments of patient status using validated clinical tools and a precise yet simple dosage adaptation schedule. Development and implementation of a sedation algorithm requires a multidisciplinary approach and an important input from both physicians and nurses. However, several methodologically-correct interventional studies have shown that using an algorithm to administrate sedatives and analgesics results in a significant reduction of MV duration, reaching 50% in some studies. This might translate into a real benefit for the patient point of view provided that preserving patient's comfort remains a constant concern for the caregivers. There is no reliable evidence to date to use propofol rather than midazolam as a sedative agent. Indeed, the way the sedative drug is used, as part of a sedation algorithm, is very likely more important than the selection of the drug itself. Analgesia-based sedation, promoting the use of morphinics alone before the adjunction of hypnotics, represents a new alternative to the traditional combined administration of hypnotics and morphinics. However data on the impact of analgesia-based sedation on patients' outcomes remain sparse to date.

Phenotypic plasticity in Passiflora suberosa L.(Passifloraceae): induction and reversion of two morphs by variation in light intensity.

Leaf morphology may vary considerably even within a branch of Passiflora suberosa plants. Leaves are of a typical green type in shaded areas, but in open fields turn into violet, and apparently have greater thickness and trichome density. The proximate causes and the adaptive meaning, if any, for the existence of the violet morph are still unknown. By cultivating P. suberosa clones under two light regimes (total and partial exposure to sunlight), we consecutively induced (first year) and then reversed (second year) the appearance of the violet morph. We evaluated the corresponding changes in morpho-anatomic and chemical leaf characteristics. Plants that were grown under partial sunlight had a greater size and did not alter their green color, but those grown under total sunlight changed into violet, were smaller in size and their leaves were tougher, thicker, and had a greater number of trichomes. The violet morph had increased anthocyanins and phenolic derivatives. It also showed cellular hypertrophy, a greater number of cell layers in the mesophyll, and a lignified pericycle. Since these morphs are interchangeable by changing light conditions, we inferred that they are not determined by genotypic diversity, but are mainly a result of a physiological response to light stress, and thus part of P. suberosa phenotypic plasticity.

Phenotypic plasticity in Passiflora suberosa L.(Passifloraceae): induction and reversion of two morphs by variation in light intensity / Plasticidade fenotípica em Passiflora suberosa L. (Passifloraceae): indução e reversão de duas formas pela variação na intensidade luminosa

Leaf morphology may vary considerably even within a branch of Passiflora suberosa plants. Leaves are of a typical green type in shaded areas, but in open fields turn into violet, and apparently have greater thickness and trichome density. The proximate causes and the adaptive meaning, if any, for the existence of the violet morph are still unknown. By cultivating P. suberosa clones under two light regimes (total and partial exposure to sunlight), we consecutively induced (first year) and then reversed (second year) the appearance of the violet morph. We evaluated the corresponding changes in morpho-anatomic and chemical leaf characteristics. Plants that were grown under partial sunlight had a greater size and did not alter their green color, but those grown under total sunlight changed into violet, were smaller in size and their leaves were tougher, thicker, and had a greater number of trichomes. The violet morph had increased anthocyanins and phenolic derivatives. It also showed cellular hypertrophy, a greater number of cell layers in the mesophyll, and a lignified pericycle. Since these morphs are interchangeable by changing light conditions, we inferred that they are not determined by genotypic diversity, but are mainly a result of a physiological response to light stress, and thus part of P. suberosa phenotypic plasticity.

A morfologia das folhas de Passiflora suberosa pode variar consideravelmente mesmo dentro dos ramos de um dado espécime. P. suberosa ocorre tipicamente em áreas sombreadas e as folhas são verdes. Porém, em áreas abertas, onde há maior incidência de luz solar, as folhas são de coloração roxa, aparentemente mais duras e com grande densidade de tricomas. As possíveis causas e o significado adaptativo da manifestação destas características ainda são desconhecidas. Com base no cultivo de clones de P. suberosa sob dois regimes de luz solar (incidência total e parcial), nós consecutivamente induzimos (primeiro ano) e então revertemos (segundo ano) o aparecimento da forma roxa. As mudanças nas características morfológicas e químicas das formas verde e roxa foram avaliadas. As plantas que foram cultivadas sob incidência parcial de luz solar apresentaram maior tamanho dos ramos e não alteraram a cor verde das folhas. As plantas que foram cultivadas sob incidência total dos raios solares apresentaram coloração roxa, maior dureza, espessura e pilosidade. A forma roxa apresentou alto teor de antocianinas e derivados fenólicos. As plantas exibiram hipertrofia celular, maior número de camadas celulares no mesofilo e lignificação do periciclo. Considerando que as formas são intercambiáveis perante a mudança na intensidade luminosa, nós inferimos que elas não resultam da diversidade genotípica, mas sim de uma resposta fisiológica ao estresse luminoso e, dessa forma, parte da plasticidade fenotípica de P. suberosa.

Phosphate feeding strategy during production phase improves poly(3-hydroxybutyrate-co-3-hydroxyvalerate) storage by Ralstonia eutropha.

The effect of a phosphate feeding strategy and the optimal rate of biomass production ( r(x)) during the production phase of P(3HB-co-3HV) in a 6-l fermentor were determined in cultures of Ralstonia eutropha with the goal of enhancing polymer productivity. Rates of biomass production ( r(x)) between 0.00 and 0.20 gx r l(-1) h(-1) were monitored during the production phase. When a low rate of cell growth was maintained ( r(x) of 0.02 gx r l(-1) h(-1)), polymer production improved, resulting in a final cell mass, P(3HB-co-3HV) mass, and P(3HB-co-3HV) content of 98.2 g, 62.0 g and 63.1 wt%, respectively, after 27.3 h. The maximum polymer productivity obtained during the production phase was 1.36 g l(-1 )h(-1).

Search for alpha4 and alpha7 nicotinic acetylcholine receptor markers in a pedigree of benign familial infantile convulsions (BFIC).

In this study we investigate the possible involvement of the recently reported locus for benign familial infantile convulsions (BFIC) in human chromosome 19 and that of the neuronal acetylcholine receptor alpha4 (CHRNA4) and alpha7 (CHRNA7) subunits in a family with at least twelve clinically diagnosed cases of BFIC. Six polymorphic microsatellite markers covering the BFIC locus on chromosomal region 19q, one marker for CHRNA4 (chromosome 20) and two for CHRNA7 (chromosome 15) were used for the screening. The two-point lod score analysis showed no evidence of BFIC phenotype on chromosome 19. Similarly, when markers for chromosome 20 (CHRNA4 intron1, Amplimer: CHRNA4. PCR.1) and chromosome 15 (D15S165 and D15S1010) were used, score analysis showed no indication of linkage. The most likely interpretation of these results is that BFIC is a genetically heterogeneous form of epilepsy.

Severe acute asthma with bowel infarction and pneumatosis intestinalis in a young adult.

A young patient presented with a small bowel infarction with pneumatosis intestinalis in the early course of life-threatening severe acute asthma. Low cardiac output with severe congestive right heart failure combined with the use of high doses of epinephrine to reverse the near-fatal bronchospasm probably contributed to this previously unreported complication. The presence of gas collections in the submucosal space was possibly the consequence of diffuse small bowel mucosal disruption. Early recognition of this unusual complication is of major importance to ensure appropriate therapeutic management.

"Colonization pressure" and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit.

OBJECTIVE: To determine the roles of "colonization pressure," work load or patient severity in patient acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in intensive care units (ICUs). DESIGN: Prospectively collected data from October 1996 through December 1998. SETTING: A 12-bed medical ICU in a university-affiliated general hospital. PATIENTS: Patients with risk factors for MRSA admitted to the ICU were screened within 72 hours of admission and weekly thereafter. MRSA was considered imported if detected during the first 72 hours of admission and nosocomial if detected only thereafter. Three screening strategies were used on admission during three consecutive periods. INTERVENTIONS: The unit of time chosen for measurements was the week. Weekly colonization pressure (WCP) was defined as the number of MRSA-carrier patient-days/total number of patient-days. Patient severity (number of deaths, Simplified Acute Physiologic Score [SAPS] II), work load (number of admis sions, Omega score), and colonization pressure (number of MRSA carriers at the time of admission, WCP) were compared with the number of MRSA-nosocomial cases during the following week. RESULTS: Of the 1,016 patients admitted over 116 weeks, 691 (68%) were screened. MRSA was imported in 91 (8.9%) admitted patients (13.1% of screened patients) and nosocomial in 46 (4.5%). The number of MRSA-nosocomial cases was correlated to the SAPS II (P=.007), the Omega 3 score (P=.007), the number of MRSA-imported cases (P=.01), WCP (P<.0001), and the screening period (P<.0001). In multivariate analysis, WCP was the only independent predictive factor for MRSA acquisition (P=.0002). Above 30% of WCP, the risk of acquisition of MRSA was approximately fivefold times higher (relative risk, 4.9; 95% confidence interval, 1.2-19.9; P<.0001). CONCLUSION: Acquisition of MRSA in ICU patients is strongly and independently influenced by colonization pressure.

Using and understanding sedation scoring systems: a systematic review.

OBJECTIVE: To systematically review instruments for measuring the level and effectiveness of sedation in adult and pediatric ICU patients. STUDY IDENTIFICATION: We searched MEDLINE, EMBASE, the Cochrane Library and reference lists of the relevant articles. We selected studies if the sedation instrument reported items related to consciousness and one or more additional items related to the effectiveness or side effects of sedation. DATA ABSTRACTION: We extracted data on the description of the instrument and on their measurement properties (internal consistency, reliability, validity and responsiveness). RESULTS: We identified 25 studies describing relevant sedation instruments. In addition to the level of consciousness, agitation and synchrony with the ventilator were the most frequently assessed aspects of sedation. Among the 25 instruments, one developed in pediatric ICU patients (the Comfort Scale), and 3 developed in adult ICU patients (the Ramsay scale, the Sedation-Agitation-Scale and the Motor Activity Assessment Scale), were tested for both reliability and validity. None of these instruments were tested for their ability to detect change in sedation status over time (responsiveness). CONCLUSION: Many instruments have been used to measure sedation effectiveness in ICU patients. However, few of them exhibit satisfactory clinimetric properties. To help clinicians assess sedation at the bedside, to aid readers critically appraise the growing number of sedation studies in the ICU literature, and to inform the design of future investigations, additional information about the measurement properties of sedation effectiveness instruments is needed.

Gamma irradiation can reduce muscle damage in mdx dystrophic mice.

We report the effects of a single gamma irradiation delivered to the soleus muscle of one limb of normal and mdx mice at the age of 16-20 days. At 45, 75 and 90 days of age transverse cryostat sections from the mid-belly of the muscles were used for microscopic examination. In normal mice the growth of fibres was appreciably reduced by irradiation without fibre loss. In the irradiated soleus of mdx mice the number of the regenerated centrally nucleated fibres was very small and the total number of fibres was remarkably reduced. The number of the peripherally nucleated fibres, presumably surviving since the birth of the animal, was almost consistently larger than in the contralateral non-irradiated limb. The cross-sectional area of the irradiated fibres was smaller. It is well known that proliferation and fusion of satellite cells are required both for regeneration after fibre damage and for the normal postnatal growth of muscle fibres: irradiation appears to reduce regeneration and growth. It is suggested that irradiation reduces damage by reducing fusion associated with growth. Our hypothesis indirectly indicates a significant link between dystrophin deficiency and fibre necrosis and accounts well for many features of mouse dystrophy under natural and experimental conditions.

Astra blue and basic fuchsin double staining of plant materials.

Methods for double staining plant materials using astra blue and basic fuchsin are described here. These methods can be applied to free hand and microtome sections embedded in paraffin, paraplast or historesin. Also, they can be used to study isolated epidermal peels and pollen preparations. Temporary, semipermanent and permanent preparations were studied. Astra blue stained polysaccharides of the cell wall such as cellulose and pectins. Basic fuchsin showed an affinity for lignified, suberized or cutinized walls. The easy preparation of the reagents, excellent color contrast of the histological preparations, and brief staining times of some methods makes them useful for both routine research and didactic purposes. Also, excellent color or black and white photomicrography can be obtained after the double staining described here.

[The TNM classification. Critical review]. / La classification TNM. Revue critique.

The TNM classification was adopted as a means of evaluating bronchopulmonary cancer and has been used since-1996. It is an international classification and has been recognised since 1986 [5]. After a brief review of the former TNM classification the different features of the newly defined classification are specified concerning particularly the definition of T3 and T4 tumours, some malignant T4 pleural effusions and disease of the lymph nodes (N2, N3) as well as a final classification with 5 stages. Some controversy has appeared over the daily use of this classification and are discussed in the recent literature. They are related to: the re-grouping in Stage 1 of patients with different survivals (T1N0M0 and T2N0M0), the resectability of certain T4 tumours involving the carina, the adverse prognosis of invasion of the visceral pleural and above all the definition of N2 mediastinal node disease which groups together patients with a very heterogeneous prognosis. In 1993, a supplemental was published by the International Union Against Cancer (UICC) entitled "Commentary on the Uniform use of TNM". The commentaries referred to the bronchopulmonary cancers that have been re-grouped and included point by point discussion of the TNM classification. Very recently, Moutain has published some revisions of the TNM classification which will be discussed here.

Solid state NMR spectroscopy study of molecular motion in cyclomaltoheptaose (beta-cyclodextrin) crosslinked with epichlorohydrin.

Dry and hydrated insoluble cyclomaltoheptaose (beta-cyclodextrin, beta-CD) polymers have been investigated by solid state 13C NMR spectroscopy techniques such as cross polarization/magic angle spinning with dipolar decoupling (CP/MAS), magic angle spinning both with (DD-MAS) and without (MAS) dipolar decoupling and CP/MAS dipolar dephasing (dd-CP/MAS) to allow the assignment of the main 13C signals. In the solid state, the presence of water in the samples resulted in a better resolution reflecting increased mobility. Two distinct components (crosslinked beta-CD and polymerized epichlorohydrin) have been found. The molecular mobility of these two components has been analyzed in terms of relaxation parameters such as 13C spin lattice relaxation (T1) and 1H spin lattice relaxation in the rotating frame (T1 rho). The T1 values of the polymers show that the beta-CD trapped inside the polymers does not seem to undergo changes in its mobility whatever the amount of epichlorohydrin. The addition of water to beta-CD significantly increases the T1 values reflecting strong interaction between beta-CD and the solvent. The T1P values obtained reflect the homogeneous nature of the materials.

Laser microsurgery for superficial T1-T2 basal cell carcinoma of the eyelid margins.

BACKGROUND: Basal cell carcinoma (BCC), the most common malignancy of the eyelid margins, poses therapeutic problems. Surgery, radiation therapy, and cryotherapy are the currently accepted methods for the treatment of this affliction. To verify the technical and clinical effectiveness of the surgical laser method, a specific approach was developed by performing laser-combined procedures under microscopic control. METHODS: A series of 26 patients underwent carbon dioxide (CO2) laser microsurgical excision of 27 primary superficial BCCs of the eyelid margins. Eighteen tumors were T1 and 9 were T2. The lesions were located at the lid margins in 18 and at the canthus in 9 cases. The eyelash line was involved in all cases, whereas intermarginal space was involved in 17 cases, without extension to the conjunctival border. Six lesions were in the lacrimal region. Median linear extent of the lesion was 5 mm (range, 4-10 mm). Treatment was performed with the patient under local anesthesia in a Day Hospital regimen. The authors used the microscope-mounted CO2 laser as a scalpel to excise the tumor mass, thus obtaining the specimen for histologic evaluation. The authors treated the deep and lateral resection margins with laser vaporization and left the wound bed to heal by secondary intention. RESULTS: No significant complications were observed. As full-thickness eyelid resections were avoided, the authors noted conservation of lid function and cosmetic aspect in all patients. With a median follow-up of 73 months (range, 18-118), only one patient had tumor recurrence after 22 months. This tumor, located at the outer canthus, had a second microsurgical laser excision, and the patient is disease free 51 months after the last treatment. CONCLUSIONS: Laser microsurgery appears to be a safe and effective treatment method for primary superficial T1 and T2 BCC of the eyelid margins without conjunctival extension.