Standardized Digital Photographs Research Articles

Evaluation of the efficacy of cysteamine cream compared to hydroquinone in the treatment of melasma: A randomised, double-blinded trial.

Melasma is a commonly acquired disorder of hyperpigmentation that often poses a therapeutic challenge for dermatologists. Recently, cysteamine cream has shown promising results compared to placebo. This study aims to determine the efficacy of cysteamine cream compared to hydroquinone cream in the treatment of melasma. A randomised, double-blinded, single-centre trial was conducted in Victoria, Australia. 20 recruited participants were given either cysteamine cream or hydroquinone cream for 16weeks. The primary outcome measure was a change in the modified Melasma Area and Severity Index (mMASI). Quality of life at baseline and week 16 as well as standard digital photography at each follow-up visit was assessed as secondary outcome measures. At week 16, 14 participants completed the study with 5 participants in the cysteamine group and 9 patients in the hydroquinone group. In the intention to treat analysis, there was a 1.52±0.69 (21.3%) reduction in mMASI for the cysteamine group and a 2.96±1.15 (32%) reduction in the hydroquinone group. The difference between groups was not statistically significant (P=0.3). Hydroquinone cream was generally better tolerated that cysteamine cream. Our study suggests that topical cysteamine may have comparable efficacy to topical hydroquinone. Cysteamine thus provides a possible alternative to patients and clinicians who wish to avoid or rotate off topical hydroquinone. While side effects were more common for participants using cysteamine compared with hydroquinone, these were mild and reversible. Larger studies comparing cysteamine and hydroquinone are required to support these findings.

Lip Augmentation Using Post-Auricular Fibroareolar Tissue as a New Autogenous Filler.

BACKGROUNDAugmentation of facial components is an acceptable approach in facial aesthetics. The best filler material and the optimal technique for facial soft tissue augmentation still remain to be determined. This study has assessed the lip augmentation using post-auricular fibroareolar tissue as a new autogenous filler.METHODSThis prospective study enrolled patients who were candidate for lip augmentation. Loose fibroareolar tissue was harvested from post-auricular region and was inserted in the prepared lip pocket. Standard digital photography was used for lip analysis in each patient before and 6 months after surgery (the height and projection of the upper lip and lower lip).RESULTSAt a mean follow-up period of 6 months, average upper and lower lip height increased from 5.27 to 8.72 mm (p<0.001), and the average upper and lower lip projection increased from 3.97 to 7.75 mm (p<0.001).CONCLUSIONOur technique was minimally invasive and a safe method, in which post-auricular loose fibroareolar tissue was applied for lip augmentation with minimum donor site morbidity and long-term results. On the follow-up, all patients were satisfied with the results and no patients required any revision operation. Moreover, the complication rate was negligible.

Evaluation of upper blepharoplasty outcome-objective measurements and patients` satisfaction

Background/Aim. Upper blepharoplasty is one of the most often performed aesthetic operations and is indicated for periorbital rejuvenation or correction of some functional problems. The aim of the study was to evaluate the outcome of this procedure and to assess patients? satisfaction and possibilities of objective measurement of operative results. Methods. A two-year prospective observational study was conducted among female patients who had upper blepharoplasty done by the same surgeon. Data were collected from medical documentation, questionnaire, and objective measurements conducted via standardized digital photographs taken before and two months after surgery. Tarsal platform show (TPS) and brow fat span (BFS) were measured at three points (P1, P2, P3) before and two months after the surgery. A questionnaire conducted before surgery and two months after it included general complaints considering upper eyelids (visual field narrowing, fallen eyelids, the sensation of heavy eyelids, raising head backward in order to enhance vision, headache), patients? assessment of eyelid asymmetry and an additional questionnaire after surgery included questions for the surgeon and patients concerning satisfaction with treatment outcome. Results. This study involved 50 female patients aged be-tween 33 and 67 years (49.98 ? 8.6 years). There was a statistically significant difference in all points for TPS and BFS measurements before and after the operation. No significant asymmetries were noticed between eyes neither before nor after surgery. There was a statistically significant difference in operation success among 3 age categories in TPS-P1 (?2 = 13.089, df = 2, p = 0.001) and TPS-P2 (?2 = 8.386, df = 2, p = 0.015) with best results achieved in older patients (&gt; 55 years). There was strong positive, statistically significant correlation between patient?s and surgeon?s satisfaction (r= 0.704, p = 0.002), as well as between patients? satisfaction and their age (r = 0.704, p = 0.002). Conclusion. Realistic expectations, adequate information about the surgery and possible complications, are essential to satisfied patients. Objective measurements correlate with patients? satisfaction and together with photographs can be a useful tool in communication with them.

1523-P: Chinese T2DM Females Are Prone to Diabetic Retinopathy: Based on a Cross-Sectional Study in Twelve Provinces

Aims: To investigate if the gender is a risk factor of the prevalence of diabetic retinopathy (DR) among type 2 diabetic patients, we designed and performed a cross-sectional study in twelve provinces in the mainland of China. Methods: Patients with type 2 diabetes, age of 18 years or older, were recruited from 76 cities/counties of 12 provinces in the mainland of China, during January 2015 to December 2018. All participants received a standard interview, eye examinations and digital fundus photography. The presence and severity of DR were diagnosed and graded by retinal specialists according to the DR domestic typing method. Results: A total of 12,766 eligible participants (5963 males and 6803 females) were included in this study. The overall prevalence of DR was 30.1%. Females exhibited a significantly higher prevalence of DR than males (31.1%% vs. 29.0%, P=0.011). A multivariate logistic regression analysis confirmed that the female sex was an independent predictor for higher prevalence of DR after adjusting for age, duration of diabetes, economic status and presence of hypertension (OR: 1.096, 95% CI: 1.013-1.186, P=0.023). Even after stratification by diabetic duration, age and economic status, the female sex was still independently associated with the presence of DR in patients whose T2DM history was more than 10 years (OR 1.150, 95% CI:1.012-1.306, P=0.032), whose ages were over 60 years (OR 1.141,95% CI:1.031-1.262, P=0.010) or who were in a relatively intermediate economic area (OR 1.123, 95% CI: 1.001-1.259, P=0.048). Conclusion: Chinese T2DM females had a higher prevalence of DR than T2DM males. In addition, the female sex remains as an independent predictor for DR in patients with diabetes for more than 10 years, ages over 60 years or a relatively intermediate economic status. Disclosure M. Li: None. P. Mu: None. Y. Tan: None. Y. Chen: None. Funding Research and Development Plans in Key Areas of Guangdong Province (2019B020227003); National Natural Science Foundation of China (81770826); National Key Research and Development Program of China (2017YFA0105803)

Gender-related differences in the facial aging of Caucasian French subjects and their relations with perceived ages and tiredness.

(a) To assess and compare the changes in five facial signs with age between genders of Caucasian subjects and (b) to evaluate their links with perceived ages and tiredness. Once zoomed from standardized digital photographs, five facial signs of 518 Caucasian French subjects of both genders and different ages (18-69years) were graded by 15 experts, using a referential Skin Aging Atlas. A large naïve panel of 1000 French subjects (500 men and 500 women) was asked to attribute a perceived age and a degree of tiredness to 200 subjects (among the 518). The severity of the facial signs increases with time at a linear-like rate. The changes in marionette lines significantly differ between genders, much more pronounced in women, and nasolabial fold was found more pronounced in men at older ages (>50years). Before 50's, Forehead wrinkles present a slightly higher severity in men whereas at 50's women present more severe ptosis. Crow's feet wrinkles did not show significant changes. Perceived ages were found significantly correlated with the severities of the facial signs and the perception of tiredness was associated with perceived ages in men, but not in women older than 40years. The gender-related perceptions from the naïve panel in both perceived ages and tiredness showed a low discrepancy. Interestingly, as for changes in facial signs, the upper-half face seems more affected for men and lower-half face for women; after 40years, the naïve panel seems more focusing on the same areas to predict a perceived age. As compared to the previous Chinese study, the present work reveals some slight ethnical-related differences, indicating that the facial signs of the lower face play a major role in the assessment of perceived age of both genders from different ethnicity.

Females with Type 2 Diabetes Mellitus Are Prone to Diabetic Retinopathy: A Twelve-Province Cross-Sectional Study in China.

Aims To investigate the distribution of diabetic retinopathy (DR) by sex in patients with type 2 diabetes mellitus (T2DM) in a twelve-province cross-sectional study in China. Methods Patients with T2DM, whose ages were ≥18 years, were recruited from 76 cities/counties in 12 provinces in mainland China between January 2015 and December 2018. All participants received a standardized interview, eye examinations, and digital fundus photography. The presence and severity of DR were diagnosed and classified by retina specialists according to the DR domestic typing method. Results A total of 12,766 participants (5963 males and 6803 females) were eligible for this study. The total prevalence of DR was 30.1%. Females exhibited a significantly higher prevalence of DR than males (31.1% vs. 29.0%, P = 0.011). A multivariate logistic regression analysis confirmed that female sex was an independent predictor for a higher prevalence of DR after adjusting for age, the duration of diabetes, economic status, and the presence of hypertension (OR: 1.096, 95% CI: 1.013-1.186, P = 0.023). Even after stratification by the diabetic duration, age, and economic status, female sex was still independently associated with the presence of DR in patients whose T2DM history was more than 10 years, whose ages were over 60 years, or who were in a relatively intermediate economic area. Conclusion Females had a higher prevalence of DR than males in T2DM patients with a diabetic history of more than 10 years, ages over 60 years, or a relatively intermediate economic status.

A comparison of animal color measurements using a commercially available digital color sensor and photograph analysis.

An animal’s pelage, feather, or skin color can serve a variety of functions, so it is important to have multiple standardized methods for measuring color. One of the most common and reliable methods for measuring animal coloration is the use of standardized digital photographs of animals. New technology in the form of a commercially available handheld digital color sensor could provide an alternative to photography-based animal color measurements. To determine whether a digital color sensor could be used to measure animal coloration, we tested the ability of a digital color sensor to measure coloration of mammalian, avian, and lepidopteran museums specimens. We compared results from the sensor to measurements taken using traditional photography methods. Our study yielded significant differences between photography-based and digital color sensor measurements of brightness (light to dark) and colors along the green to red spectrum. There was no difference between photographs and the digital color sensor measurements for colors along the blue to yellow spectrum. The average difference in recorded color (ΔE) by the 2 methods was above the threshold at which humans can perceive a difference. There were significant correlations between the sensor and photographs for all measurements indicating that the sensor is an effective animal coloration measuring tool. However, the sensor’s small aperture and narrow light spectrum range designed for human-vision limit its value for ecological research. We discuss the conditions in which a digital color sensor can be an effective tool for measuring animal coloration in both laboratory settings and in the field.

Paper wasps are darker at high elevation.

High mountains are harsh environments in which colder temperatures and higher levels of UV-B radiation are common. These abiotic conditions strongly affect animals' biology, often constraining their survival and reproduction. As a result, adaptations to live in such habitats are expected to evolve. Body color is thought to be adaptive to the environment that animals experience. Tegument melanization improves heat gain and provides photoprotection. Therefore, at high elevation, ectotherms are expected to be darker (well-melanized). We test this prediction in the paper wasp Agelaia pallipes (Hymenoptera: Vespidae), a species distributed across an elevational gradient in the Colombian Andes. We used Malaise traps and sampled a total of 146 wasps along nine elevations, ranging from 2,600-3,380m above sea level. Standard digital photography was used to measure the body luminance and colour patterning in different body parts of dry-preserved specimens. There was striking variation in body luminance (darker and lighter), color patterning (patched, smoothed, homogeneous) and surface texture (shiny and matte), but the kind and degree of variation depended on the body part examined. Wasps from higher elevations had darker thoraces, confirming our prediction. Besides, at high elevation, the frequency of wasps with a matte rather than a shiny face strongly increased. Overall, our findings support the thermal melanism hypothesis and suggest that intraspecific color variation might be an adaptation to the environment of paper wasps.

Age-related changes to characteristics of the human eyes in women from six different ethnicities.

To describe some morphological characteristics of the eyes of women of 6 different ethnicities and ages. Standard digital photographs of 3600 women of different ethnicities and ages were taken for evaluating the effects of some makeup products (eyeliners, mascaras, eyelids makeup, etc) through a before/after comparison. Photographs corresponding to pre-applications offered opportunity to quantify, through image analysis, some features of the human eyes (height, length, ellipticity, horizontality, etc) for recording their possible variations linked to ethnicities and/or age. Although some minor differences between ethnicities were found (inter-pupillary distance and inner canthal distance), most eyes criteria among the 11 recorded were comparable (height and length of the eyes, ellipticity, etc). The somewhat low variability of the latter more reflects individual morphologies, at comparable ages. Asian subjects significantly differ by a much more oblique orientation of their main axis versus the horizontal inter-pupillary line. In all ethnicities, the skin aging process was found significantly altering i) the height of the eyes and ii) their orientation. Whereas the decrease of height likely results from a sagging of the upper eyelid, the decrease of orientation in all ethnicities (more marked among Asian women) possibly results from a sagging of the outer corner of the eyes. Whether this sagging may be related to the progressive outcome of crow's feet wrinkles is a plausible hypothesis. The present work is an original and complementary approach to the skin aging process prone at modifying some characteristics of women eyes of different ethnicities.

How wry is a Wrybill?

The laterally asymmetrical bill of New Zealand’s endemic Wrybill Anarhynchus frontalis is unique among birds and has inspired much debate regarding its evolution and functional significance. Despite this, only one previous study has attempted to quantify the range of individual variation in bill shape, but used a single metric of curvature (bill tip angle). Using standardized digital photographs of 40 live Wrybills, we explored a range of metrics of bill length and curvature to describe the variation in bill shape in greater detail. Like the previous study, we found no sexual dimorphism in bill shape, despite males being slightly longer-billed than females, and recorded similar variation in bill tip angle (16–23°). However, we found that this single metric under-represented overall variation in bill shape, due to significant differences in where curvature began and was most pronounced along the length of the bill. Principal component analysis indicated that at least three independent metrics were required to describe the shape variation among individuals. Subtle differences in bill shape could plausibly affect an individual’s relative success among the range of Wrybill foraging strategies observed in breeding and non-breeding habitats. Elucidating the potential behavioral and fitness consequences of this variation will require detailed foraging and demographic studies with individuals of known bill morphology.

The influence of MC1R ondermal morphological features of photo-exposed skin in women revealed by reflectance confocal microscopy and optical coherence tomography.

The melanocortin 1 receptor (MC1R) gene is one of the major determinants of skin pigmentation. It is a highly polymorphic gene and some of its polymorphisms have been related to specific skin phenotypes, increased risk of skin cancers and skin photoageing. Currently, its contribution to changes in dermal features in photo-exposed skin is unknown. The main objective of this study is to evaluate the potential correlation between MC1R status and specific healthy photo-exposed skin characteristics. Skin facial features were estimated by evaluation with standard digital photography with automated featurescount, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) in 100 healthy women. Skin of the forearms was used as a control. The study found an association between RHC MC1R polymorphisms and dermal features in photo-exposed areas being represented by increased vessel density and pixel density in OCT (P=.025 and P=.001, respectively) and increased coarse collagen in RCM (P=.034), as compared to non-RHC subjects. To our knowledge this is previously unreported. Additionally, previously reported correlations between light hair colour and pigmented spots with MC1R RHC polymorphisms have been confirmed. Our results suggest the role of RHC MC1R variants in dermal variations of facial skin, as compared to non-RHC variants. To our knowledge this is previously unreported.

Study the effect of erbium:YAG laser plus topical 5‐flurouracil in stable vitiligo resistant to NB‐UVB phototherapy

NB-UVB phototherapy is still an effective treatment in vitiligo but requires more than 1year for its completion. Topical 5-flurouracil could improve the proliferation and migration of melanocytes. Laser-assisted dermabrasion results in stimulation of the inactive melanocytes present at the outer root sheath of the lower portion of the hair follicle, which migrates upward until they reach the surface of the skin. To evaluate the effect of Er:YAG laser skin ablation followed by topical 5-flurouracil on the outcome of NB-UVB phototherapy as a short term technique in resistant and stable vitiligo. The current study included 40 patients suffering from bilateral stable vitiligo resistant to NB-UVB. For each patient, one side of the body subjected to 4months NB-UVB sessions (control side). While the other side of the body subjected to one session of Er:YAG laser ablation combined with topical 5% 5-flurouracil application under occlusion followed by NB-UVB sessions for 4months after complete re-epithelization. Outcomes were evaluated objectively based on standard digital photographs, histopathological examination, patient satisfaction, and adverse effects. There was a statistically significant improvement in the repigmentation in laser side compared with control side. Histopathological examination revealed expression of prominent melanin pigmentation, with marked expression for Melan-A in laser side, whereas these findings were negative in control side. Er:YAG laser ablation, followed by 5FU application before NB-UVB phototherapy for vitiligo, is a safe and tolerable technique that improves the outcome of short-term NB-UVB therapy and is expected to increase patient compliance.

Treatment of Deformational Plagiocephaly With Physiotherapy.

Non-synostotic plagiocephaly consists in an asymmetry of the skull due to mechanical forces applied in utero or postnatally: main differential diagnosis is with true synostotic asymmetry, which is caused by the premature closure of a suture. The correction of positional forms is mostly conservative, with 3 main strategies: counterpositioning, physiotherapy and helmet therapy. There is no synthesized evidence on which is the most effective. The Authors evaluate the modification of antropometric measurments before and after a pediatric physical therapy program in a sample of patients with non-synostotic skull asymmetry, in order to evaluate the improvements in the skull shape. The hypothesis being tested was that physical therapy alone could improve the antropometric measurments. The authors enrolled in this study 24 patients diagnosed of non-synostotic asymmetry, clinically and with ultrasound, referred to the Maxillo-facial Unit of Policlinico Umberto I, Rome, within 2013 and 2016. A standardized pediatric physical therapy intervention program was designed: it consisted in a combination of excercises and manipulative procedures to reduce positional preference, musculoskeletal disorders and cranial deformity. Infants received 16 sessions of physical therapy, of 40 minutes each, once a week, for four months. The Authors evaluate the variation of four anthropometric measurments, performed before and after the physical therapy program: Argenta scale, Oblique Diameter Difference Index (ODDI), Cranial Proportional Index (CPI) or Cephalic Ratio (CR), Cranial Vault Asymmetry Index (CVAI). Craniometric evaluations were extrapolated by standardized 2D digital photographs of frontal, sagittal and transverse planes, by the same physician to minimize bias. The management of positional cranial deformities is still controversially discussed and especially the effects of physiotherapy and osteopathy have been only marginally researched. Statistical analysis revealed the effectiveness of the protocol: all anthropometric measurements improved with a high rate, major in youngest children (P < 0.5) and in more severe first presentations (P < 0.05 or P < 0.01). The results suggest manipulative approach may improve the outcome in the long term follow up of cranial asymmetries.

Morphometric characteristics of feminine eyebrows: variations with ethnicities and age.

To explore some morphological features of the eyebrows of women of different ethnicities and ages. Standard digital photographs of 3600 women of six ethnicities, aged 18-84years, previously used to describe the morphology of the human eyes, allowed us to focus on their eyebrows, as supplementary and opportunistic study. Photographs of both eyebrows were analysed partly by manual markings and automatically by dedicated algorithms. Six parameters of the eyebrows were recorded: length, waviness/curvature, oblique aspect, size (vertical height), total surface and hair coverage (density). Most criteria present ethnic specificities. These are: length (longer eyebrows of Indian, shorter among African women); waviness where the straighter eyebrows were found among Chinese and Japanese women. In general, the longer the eyebrows, the higher their waviness and vice versa. Thickness (or height) of the eyebrows presents a wide ethnic variability as well as hair coverage, where African women present the lower hair density, inversely to Indian women. The same holds true with regard to the total surface of eyebrows, of a large variability (by about four times). Some criteria appear more individually dependent than ethnic-specific, such as the oblique positioning, at the exception of Indian women with less oblique eyebrows. In all subjects, the criteria of both eyebrows (Left vs. Right) were found to be highly correlated (r>0.7, P<0.001). The present investigation brings new findings on a scarcely studied facial element, the morphologic features of which are, for most, ethnic-dependent. As applied consequences, the results of the present work pave the road to better adapt adorning procedures of the eyebrows vis-à-vis ethnic and age specificities.

Using Standard Digital Extra-Oral Photography in Patient With Cleft Lip and Palate

Using Standard Digital Extra-Oral Photography in Patient With Cleft Lip and Palate

Are Low-to-Moderate Average Alcohol Consumption and Isolated Episodes of Binge Drinking in Early Pregnancy Associated with Facial Features Related to Fetal Alcohol Syndrome in 5-Year-Old Children?

Fetal alcohol syndrome (FAS) typically is observed among individuals with high prenatal alcohol exposures (PAE), but exposure histories obtained in clinical diagnostic settings are often inaccurate. The present analysis used the Lifestyle During Pregnancy Study (LDPS) to assess the potential effects of low-to-moderate average weekly alcohol consumption and binge drinking in early pregnancy on facial features associated with FAS among children 5years of age. The analysis is a prospective follow-up study of 670 women and their children sampled from the LDPS cohort based on maternal alcohol consumption during pregnancy. The 4-Digit Code FAS Facial Photographic Analysis Software was used to measure the magnitude of expression of the 3 diagnostic facial features of FAS from standardized digital photographs. Logistic regression was used to estimate the odds of presenting with the FAS/partial fetal alcohol syndrome (PFAS) facial phenotypes relative to different patterns of prenatal alcohol exposure. Ten children presented with the FAS/PFAS facial phenotypes. None of the children sampled met the central nervous system (CNS) criteria for FAS or PFAS at age 5years. All remained at risk for PFAS since some types of CNS dysfunction associated with this diagnosis may only be assessed at older ages. The FAS/PFAS facial phenotypes were 8.5-fold more likely among children exposed to an average of 1 to 4 drinks/wk and 2.5-fold more likely among children with a single binge exposure in gestational weeks 3 to 4 compared to children with no such exposures. The magnitude of expression of the FAS facial phenotype was significantly correlated with all other diagnostic features of FAS: growth deficiency, microcephaly, and measures of CNS dysfunction. These findings suggest that low-to-moderate levels of PAE or isolated binge exposures may place some fetuses at risk for FAS/PFAS. Thus, conservative advice is still for women to abstain from alcohol consumption during pregnancy.

Tophus resolution in patients with chronic refractory gout who have persistent urate-lowering responses to pegloticase

BackgroundPegloticase is a recombinant mammalian uricase conjugated to polyethylene glycol approved in the United States for treatment of chronic refractory gout. It can profoundly decrease serum urate to < 1 mg/dl. In patients receiving pegloticase who did not generate high-titer antidrug antibodies (responders), the serum urate remained low for the duration of therapy, 6 months in the phase III clinical trials plus the open-label extension. The objective of this study was to assess the velocity of tophus resolution in subjects treated with pegloticase.MethodsData from two randomized controlled trials of pegloticase in chronic refractory gout were analyzed. Tophi were assessed by computer-assisted measurements of standardized digital photographs. Subjects were designated as responders and nonresponders based on maintenance of serum urate < 6 mg/dl at months 3 and 6 of treatment. The projected time of complete resolution of all tophi was determined by linear regression analysis.ResultsThe mean total tophus area at baseline was 585.8 mm2 for responders, 661.5 mm2 for nonresponders, and 674.4 mm2 for placebo-treated patients. Complete resolution at 6 months of at least one tophus was achieved by 69.6% of 23 responders, 27.9% of 43 nonresponders, and 14.3% of 21 patients who received placebo. Complete resolution of all photographed tophi was achieved by 34.8% of biochemical responders, 11.6% of nonresponders, and 0% of placebo-treated patients. The mean velocity of resolution of all tophi was 60.1 mm2/month in responders with a mean projected time of complete resolution of 9.9 months (4.6–32.6 months). There was a significant inverse correlation between serum urate AUC and tophus resolution velocity (r = − 0.40, P = 0.0002), although considerable heterogeneity in the velocity of resolution was noted. The only patient characteristic that correlated with the velocity of tophus resolution was the baseline tophus area.ConclusionsPegloticase treatment caused a rapid resolution of tophi in responders that correlated with the serum urate lowering associated with this therapy.

Authoritative parent feeding style is associated with better child dietary quality at dinner among low-income minority families

BackgroundParent feeding styles have been linked to child weight status across multiple studies. However, to our knowledge, the link between feeding styles and children's dietary quality, a more proximal outcome, has not been investigated.ObjectiveThe purpose of this study was to examine the relation between parent feeding styles and dietary quality of Head Start preschoolers’ dinner meals.DesignThe amount of food served and consumed by children was measured by using a standardized digital photography method during 3 in-home dinner observations of low-income minority families in Houston, Texas. Trained dietitians entered food served and consumed into the Nutrient Data System for Research 2009 for nutrient analysis. Overall dietary quality of the food served and consumed at dinner was evaluated by using the Healthy Eating Index 2010 (HEI-2010). Parent feeding style was assessed with the use of the Caregiver's Feeding Style Questionnaire (CFSQ). On the basis of a parent's level of demandingness and responsiveness to his or her child during feeding, the CFSQ categorizes parent feeding into 4 styles: authoritative (high demandingness and high responsiveness), authoritarian (high demandingness and low responsiveness), indulgent (low demandingness and high responsiveness), or uninvolved (low demandingness and low responsiveness).ResultsFor the overall sample, the mean ± SD HEI score for dinner served was 44.2 ± 8.4, and the mean ± SD HEI score for dinner consumed was 43.4 ± 7.0. In the fully adjusted model, ANCOVA indicated that the authoritative parent feeding style was associated with significantly higher child dietary quality compared with the authoritarian feeding style (mean ± SEE HEI consumed—authoritative 45.5 ± 0.9; authoritarian: 41.9 ± 0.7; P = 0.001).ConclusionsParent feeding style contributes to the overall dietary quality of children, and among low-income minority preschoolers an authoritative feeding style was associated with the highest dietary quality of the 4 feeding styles. Interventions to promote feeding practices that contribute to authoritative feeding are needed to improve the dietary quality of preschool children at dinner. This trial was registered at https://clinicaltrials.gov as NCT02696278.

Distribution of Ultraviolet Ornaments in Colias Butterflies (Lepidoptera: Pieridae).

Ultraviolet patterns in butterflies have been recognized and studied for many years. They are frequently involved in both intraspecific and interspecific interactions. Only a handful of studies, however, have investigated possible links between ultraviolet (UV) reflectance and ecological properties in some genera of the Lepidoptera as a whole. This study examines the impact of habitat and distribution on UV reflectance patterns on the wings of 106 species and subspecies of Colias butterflies. Based on standardized digital photographs, we performed a multivariate analysis of relations between UV reflectance, preferred habitat (alpine, arctic, dry grasslands, humid, forest, and ubiquitous), and distribution area (Afrotropical, Nearctic, Neotropical, European, Caucaso-Anatolian, boreal Eurasian, Central Asian mountains, northern China and Japan, and northern Oriental region). UV patterns occur more frequently in the male (60 taxa) than in female (25 taxa) Coliads. This difference in presence of UV patterns is used for differentiating between the males and females of a given species or subspecies. Further possible explanations of this phenomenon are also discussed. This study also shows that particular configurations of UV patterns are significantly associated with particular distribution areas. This relation is relatively strong but overall trends remain unclear. Based on the results of this study, it can be concluded that there exists a significant difference in the configuration of UV reflectance between the sexes, and that the configuration of UV reflectance significantly interacts with the geographical distribution of Colias species and subspecies.

Treatment of voluminous and complicated superficial slow-flow vascular malformations with sirolimus (PERFORMUS): protocol for a multicenter phase 2 trial with a randomized observational-phase design

BackgroundSlow-flow superficial vascular malformations (VMs) are rare congenital anomalies that can be responsible for pain and functional impairment. Currently, we have no guidelines for their management, which can involve physical bandages, sclerotherapy, surgery, anti-inflammatory or anti-coagulation drugs or no treatment. The natural history is progressive and worsening. Mammalian target of rapamycin (mTOR) is a serine/threonine kinase that acts as a master switch in cell proliferation, apoptosis, metabolism and angio/lymphangiogenesis. Sirolimus directly inhibits the mTOR pathway, thereby inhibiting cell proliferation and angio/lymphangiogenesis. Case reports and series have reported successful use of sirolimus in children with different types of vascular anomalies, with heterogeneous outcomes.ObjectiveThe objective of this trial is to evaluate the efficacy and safety of sirolimus in children with complicated superficial slow-flow VMs.Methods/designThis French multicenter randomized observational-phase, phase 2 trial aims to include 50 pediatric patients 6 to 18 years old who have slow-flow (lymphatic, venous or lymphatico-venous) voluminous complicated superficial VM. Patients will be followed up for 12 months. All patients will start with an observational period (no treatment). Then at a time randomly selected between month 4 and month 8, they will switch to the experimental period (switch time), when they will receive sirolimus until month 12. Each child will undergo MRI 3 times: at baseline, at the switch time, and at month 12. For both periods (observational and treatment), we will calculate the relative change in volume of the VM divided by the study period duration. This relative change weighted by the study period duration will constitute the primary endpoint. VM will be measured by MRI images, which will be centralized and interpreted by the same radiologist who will be blinded to the study period. Hence, each patient will be his/her own control. Secondary outcomes will include assessment of safety and efficacy by viewing standardized digital photographs and according to the physician, the patient or proxy; impact on quality of life; and evolution of biological makers (coagulation factors, vascular endothelial growth factor, tissue factor).DiscussionThe main benefit of the study will be to resolve uncertainty concerning the efficacy of sirolimus in reducing the volume of VMs and limiting related complications and the safety of the drug in children with slow-flow VMs. This trial design is interesting in these rare conditions because all included patients will have the opportunity to receive the drug and the physician can maintain it after the end of the protocol if is found efficient (which would not be the case in a classical cross-over study).Trial registrationClinicalTrials.gov Identifier: NCT02509468, first received: 28 July 2015.EU Clinical Trials Register EudraCT Number: 2015-001096-43.