Impaired wound healing secondary to bevacizumab.

Bevacizumab is a monoclonal antibody that exerts its antitumor activity by inhibiting vascular endothelial growth factor. Consequently, it suppresses endothelial cell proliferation, vascular permeability, and angiogenesis. This inhibitory effect contributes to tumour size reduction but causes wound-healing delay, specifically during the proliferative phase, in patients receiving bevacizumab. Although surgical wound-healing complications (WHC) associated with bevacizumab have been extensively reported, there is limited literature on peripheral WHC. More importantly, the histopathology of bevacizumab-associated WHC has not been described. We present the histopathology findings of a non-healing ulcer in a patient receiving bevacizumab, providing insight into the possible aetiology of this drug's adverse reaction. Furthermore, our patient's positive response to hyperbaric oxygen suggests its possible use for treatment of bevacizumab-associated non-healing wounds.

In-Transit Metastasis of Cutaneous Squamous Cell Carcinoma With Lymphovascular Invasion in an Immunocompetent Patient.

In-transit metastases of melanoma and non-melanoma skin cancers are metastases located in the skin or subcutaneous tissue between the primary tumor and the nearest nodal basin. Although rare, in-transit cutaneous squamous cell carcinoma (SCC) is an emerging diagnosis in immunocompromised and immunocompetent patients that may have significant implications on treatment and prognosis. Lymphovascular invasion is an uncommon high-risk feature of SCC. Here, we present a case of a 73-year-old non-immunosuppressed man with no previous history of skin cancer, found to have in-transit metastasis with lymphovascular invasion during Mohs surgery for a primary SCC of his right ear. Patients with in-transit SCC should receive further staging imaging and a multimodal approach to treatment, including Mohs micrographic surgery, adjuvant radiation, and possibly sentinel lymph node biopsy and immunotherapy or chemotherapy.

Removal of Cd2+ and Pb2+ from Wastewater through Sequent Addition of KR-Slag, Ca(OH)2 Derived from Eggshells and CO2 Gas.

The effect of heavy metals in aqueous solutions has been addressed by several methods. Precipitation using lime, slaked or quick, is one of the commonly used techniques. In this work, KR-slag was used in addition to Ca(OH)2 that served as a seeding material. Furthermore, CO2 has been injected into the suspensions for pH stabilization, which further increases the removal efficiency. Accordingly, results have shown a great performance regarding both removal efficiency and reduced sludge production. More than 99% of Cd2+ and Pb2+ was removed with 1 g/L of KR-slag, 0.5 g/L of Ca(OH)2, and CO2 injection at a rate of 1 L/min. The effect of carbonation has been evaluated by examining the removal efficiency before and after carbonation. Following the injection of CO2, removal efficiency has increased from 58.7 to 99.8 and 71.2 to 99.3% for Cd2+ and Pb2+, respectively. Moreover, sludge volume from this treatment method was obtained as 103 mL/L, which is much less than the sludge volume obtained from the carbonation of only Ca(OH)2, that is, 361 mL/L. Leaching of residues was also conducted to evaluate the environmental performance of the removal process. After carbonation, there was a lower concentration of metals when leached out in a wide range of pH solutions. Contrarily, it was observed that a relatively higher concentration of metals was released in acidic solutions due to the substitution of metal ions (Cd2+ and Pb2+) with H+ ions. Residues were then characterized by X-ray diffraction and differential thermal analysis/thermogravimetric analysis for phase identification. Both characterizations detected the presence of CaCO3, which was an indication of the transformation of Ca(OH)2 to CaCO3.

Removal of Phosphorus from an Aqueous Solution by Nanocalcium Hydroxide Derived from Waste Bivalve Seashells: Mechanism and Kinetics.

Excessive supply of phosphorus, a vital macronutrient for all organisms, can cause unwanted environmental consequences such as eutrophication. An increase in agricultural and industrial activities has created a considerable imbalance in the phosphorus cycle with continuing adverse effects on sustainability and ecosystem health, thereby stipulating/postulating the significance of phosphorus removal. A unique and sustainable concept for the removal of phosphorus through the utilization of waste bivalve seashells was proposed in the present study. Flat-surfaced and hexagonally shaped nanocalcium hydroxide particles (∼96% purity) with size ranging from 100 to 400 nm have been synthesized, and phosphorus from its aqueous solution is treated via precipitation. An optimization study has been conducted using the Box-Behnken design of response surface methodology, which highlights that with a calcium/phosphorus mass ratio, pH, and temperature of 2.16, 10.20, and 25.48 °C, a phosphorus removal efficiency of 99.33% can be achieved in a residence time of 10 min. Also, under the same conditions, diluted human urine was analyzed and phosphorus removal efficiency of ∼95% was observed. Through experimental results, semiquantitative phase analysis, and transmission electron microscopy, it has been found that the reaction was diffusion-controlled, which was further confirmed through shrinking core diffusion modeling. The present study manifests the promising potential of waste seashell-derived nanocalcium hydroxide for phosphorus treatment and its precipitation in the form of value-added hydroxyapatite.

Childhood tonsillectomy alters the primary distribution of HPV-related oropharyngeal squamous cell carcinoma.

OBJECTIVES: We investigated how tonsillectomy during childhood may influence the distribution of human papillomavirus (HPV) positive cancer of the tonsils in adult life using p16 as a surrogate marker for HPV infection. STUDY DESIGN: Retrospective observational study. METHODS: A total of 280 patients diagnosed with oropharyngeal squamous cell carcinoma (OPSCC) and known p16 status were eligible for this study. Each participant was called to obtain the childhood tonsillectomy history. Respondents were subgrouped by p16 status and the primary tumor location. Patient demographic and clinical information was analyzed for association with Fisher's exact and Wilcoxon rank sum tests. Location of tumor was modeled using univariate (UVA) and multivariate (MVA) logistic regression with associated odds ratios (OR) and 95% confidence intervals. RESULTS: Of the 280 patients, 115 (41%) were respondents: 104 (90.4%) were p16 positive and 11 (9.6%) were p16 negative. For p16 positive patients, we observed a majority (93%) of intact tonsils in those with tonsil cancer, compared to 45% of intact tonsils in patients with p16 positive cancer elsewhere in the oropharynx (P < .001). MVA logistic regression showed that female gender (OR = 4.16, P = .0675), prior smoking history (OR = 2.6, P = .0367), and intact tonsils (OR = 15.2, P < .0001) were associated with tonsillar OPSCC. CONCLUSION: We found that patients with p16 positive OPSCC at a non-tonsil site were much more likely to have had prior tonsillectomy vs those with p16 positive OPSCC arising within the tonsil. Nevertheless, we do not advocate tonsillectomies as a public health policy to reduce HPV-related OPSCC. LEVEL OF EVIDENCE: 6.