Safety of Periocular Mohs Reconstruction: A Two-Center Retrospective Study.

BACKGROUND: Repair of periocular defects poses unique functional and aesthetic challenges. Data on the safety of periocular repairs by Mohs surgeons are limited. OBJECTIVE: Analyze the frequency and types of postreconstruction complications encountered with periocular repairs performed by Mohs surgeons, identify risk factors associated with complications, and enumerate interventions for complications encountered. MATERIALS AND METHODS: An institutional review board-approved retrospective study on periocular repairs performed by Mohs surgeons at 2 academic institutions between 07 2013 and 06 2016. Patients undergoing periocular Mohs surgery were identified via billing codes. Patient demographics and surgery details were recorded. Follow-up visit notes were reviewed for postoperative complications and interventions performed. RESULTS: Two hundred ten cases were included in the analysis. The most common locations for postreconstruction complications were the medial canthus (57%) and lower eyelid (37%). The complications identified included medial canthal webbing (4.3%), hypertrophic scarring (4.3%), ectropion (1.9%), infection (1.4%), pincushioning (1.4%), and epiphora (1.0%). The most common postoperative intervention was intralesional triamcinolone. Scar revision was performed in 2.4% of all cases. CONCLUSION: Periocular repairs performed by Mohs surgeons have a similar safety profile as repairs performed by oculoplastic surgeons.

Asymmetric forest transition driven by the interaction of socioeconomic development and environmental heterogeneity in Central America.

Forest transitions (FT) have been observed in many developed countries and more recently in the developing world. However, our knowledge of FT from tropical regions is mostly derived from case studies from within a particular country, making it difficult to generalize findings across larger regions. Here we overcome these difficulties by conducting a recent (2001-2010) satellite-based analysis of trends in forest cover across Central America, stratified by biomes, which we related to socioeconomic variables associated with human development. Results show a net decrease of woody vegetation resulting from 12,201 km(2) of deforestation of moist forests and 6,825 km(2) of regrowth of conifer and dry forests. The Human Development Index was the socioeconomic variable best associated with forest cover change. The least-developed countries, Nicaragua and Guatemala, experienced both rapid deforestation of moist forests and significant recovery of conifer and dry forests. In contrast, the most developed countries, Panama and Costa Rica, had net woody vegetation gain and a more stable forest cover configuration. These results imply a good agreement with FT predictions of forest change in relation to socioeconomic development, but strong asymmetry in rates and directions of change largely dependent upon the biome where change is occurring. The FT model should be refined by incorporating ecological and socioeconomic heterogeneity, particularly in multicountry and regional studies. These asymmetric patterns of forest change should be evaluated when developing strategies for conserving biodiversity and environmental services.

Granuloma Annulare in the Setting of Secukinumab.

Granuloma annulare (GA) is a common benign inflammatory skin condition classically presenting as skin-colored to erythematous dermal papules and annular plaques. Histologically, GA displays a dermal granulomatous infiltrate with palisaded histiocytes surrounding focally altered collagen. The exactly etiology of GA remains unknown, but it has been associated with trauma, various infections, diabetes mellitus, malignancy, thyroid disease, dyslipidemia, and several medications. In 2017, a case of GA developing in a patient treated with the interleukin 17A antagonist secukinumab was reported. Here we report a second case of GA in association with secukinumab use.

Advances in the stroke system of care.

OPINION STATEMENT: The stroke system of care is undergoing significant evolution. There are promising data to suggest that with new technologies and approaches, primary prevention and community education will become easier and more accessible, and will allow people to have greater participation in their own healthcare. The evidence-based primary and comprehensive stroke center concepts have been translated into robust, rapidly growing certification programs. The continued dissemination of improved EMS routing protocols allows for better allocation of patients to stroke centers, even as we confront the challenge of further improving prehospital recognition of stroke. National quality improvement initiatives help to ensure that patients directed to stroke centers receive evidence-based treatment, which has resulted in improved stroke care and better clinical outcomes. In remote areas, the use of technologies such as telemedicine to extend the reach of vascular neurologists has resulted in increased administration of time-sensitive thrombolytic therapy and better patient outcomes, although greater efficiency within the stroke system will likely be needed to realize the potential benefits of endovascular therapy. System-level paradigms for aggressive medical management promise to lessen the burden of recurrent stroke. Finally, further integration of rehabilitation programs into stroke centers and coordination with community-based rehabilitation services is needed to ensure the best possible outcome for stroke patients.

Land cover change in Colombia: surprising forest recovery trends between 2001 and 2010.

BACKGROUND: Monitoring land change at multiple spatial scales is essential for identifying hotspots of change, and for developing and implementing policies for conserving biodiversity and habitats. In the high diversity country of Colombia, these types of analyses are difficult because there is no consistent wall-to-wall, multi-temporal dataset for land-use and land-cover change. METHODOLOGY/PRINCIPAL FINDINGS: To address this problem, we mapped annual land-use and land-cover from 2001 to 2010 in Colombia using MODIS (250 m) products coupled with reference data from high spatial resolution imagery (QuickBird) in Google Earth. We used QuickBird imagery to visually interpret percent cover of eight land cover classes used for classifier training and accuracy assessment. Based on these maps we evaluated land cover change at four spatial scales country, biome, ecoregion, and municipality. Of the 1,117 municipalities, 820 had a net gain in woody vegetation (28,092 km(2)) while 264 had a net loss (11,129 km(2)), which resulted in a net gain of 16,963 km(2) in woody vegetation at the national scale. Woody regrowth mainly occurred in areas previously classified as mixed woody/plantation rather than agriculture/herbaceous. The majority of this gain occurred in the Moist Forest biome, within the montane forest ecoregions, while the greatest loss of woody vegetation occurred in the Llanos and Apure-Villavicencio ecoregions. CONCLUSIONS: The unexpected forest recovery trend, particularly in the Andes, provides an opportunity to expand current protected areas and to promote habitat connectivity. Furthermore, ecoregions with intense land conversion (e.g. Northern Andean Páramo) and ecoregions under-represented in the protected area network (e.g. Llanos, Apure-Villavicencio Dry forest, and Magdalena-Urabá Moist forest ecoregions) should be considered for new protected areas.