Palaeogeography, Palaeoclimatology, Palaeoecology

Aberrations in the infrabasal circlet of the cladid crinoid genus Cupulocrinus (Echinodermata) and implications for the origin of flexible crinoids Publication date: 15 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 522 Author(s): M.E. Peter Abstract Flexible crinoids (subclass Flexibilia) likely originated from the cladid crinoid genus Cupulocrinus or one of its immediate ancestors in the Middle to Late Ordovician. A remarkably constant and clade-defining character of flexible crinoids is the possession of three plates in the infrabasal circlet of the calyx. This character was a significant morphological modification for the origin of the flexible clade, resulting from the reduction of the number of infrabasal plates from five plates in the ancestral cupulocrinid. Of 615 museum specimens of Cupulocrinus sp. for which the number of infrabasal plates could be determined, 21 specimens, or 3.4%, displayed a deviation from the normal five infrabasals. Of the aberrant specimens, fifteen have four infrabasal plates, and six have six infrabasal plates. An additional aberrant specimen has five infrabasals, with one significantly reduced in size. Although the number of infrabasals is typically thought to be constant within a species, this trait appears to have been variable in the immediate ancestor of flexible crinoids, in the time period just before the number of infrabasals became fixed at three for the Flexibilia. This paper documents the range of aberrations within the infrabasal circlet of Cupulocrinus and considers the implications for the origin of the flexible crinoids. Graphical abstract

Sedimentary pyrite framboid size-frequency distributions: A meta-analysis Publication date: 15 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 522 Author(s): David Rickard Abstract Framboids, microscopic sub-spheroidal aggregates of pyrite microcrystals, are found in sediments of all ages and framboid size-frequency distributions are widely used to determine the oxygenation states of paleo-waters. Sedimentary framboid populations display unimodal log-normal size distributions as a consequence of the multiplicative central limit theorem in probability theory. The application of additive statistics to framboid populations and their consequent characterization in terms of arithmetic means and standard deviations is wrong because it predicts a subset of framboids with negative diameters. A meta–analysis of 377 sets of measurements of the diameters of 48,063 pyrite framboids from 104 sediment and sedimentary rock locations shows that the geometric mean diameter of sedimentary framboids is 6.2 μm and the geometric standard deviation is 1.5. Ninety-five percent of all sedimentary framboids have geometric mean diameters between 2.9 and 13.9 μm. The geometric mean diameter of modern syngenetic framboids formed within euxinic water columns is 4.7 μm and that of diagenetic framboids formed within sediments is 6.7 μm. The estimated measurement error is ±10%. Framboid mean diameters can be used to help discriminate the oxygenation state of paleo-waters. A minimum number of 30 measurements is required and ideally ≥100 measurements are recommended. The conflicting evidence reported in the literature for the application of framboid size-frequency measurements results mainly from the intrinsic nature of statistical analyses: there is always a finite chance that a particular framboid size-frequency distribution is a result of either syngenetic or diagenetic processes. Including the systematic stereological error in framboid size measurements, the geometric mean size range for syngenetic framboids is 2.9–10.9 μm and that for diagenetic framboids 3.1–20.9 μm. This suggests a significant overlap in geometric mean diameters of framboids from euxinic and non-euxinic environments between ~3 and ~11 μm. Geometric mean framboid diameters within this size range are not robust proxies for paleo-water oxygenation conditions. The origin of the smaller sizes of syngenetic compared with diagenetic framboids appears to be related to the limited time available for framboid crystal growth within the water column. The statistical uncertainty in assigning particular framboid size-frequency distributions to defined oxygenation conditions results mainly from (a) some diagenetic framboids forming over a limited time, thereby also producing smaller framboids and (b) mixtures of syngenetic and diagenetic framboid populations through unavoidable time-averaging of samples. The absence of any significant differences in the sizes of modern and ancient framboids indicates that framboids do not continue to grow over extended time periods: once formed they remain the same over geologic time periods and only change through infilling, overgrowth and recrystallization. The result is that ancient framboids may sample the contemporary paleoenvironment in the sedimentary system in which they are found.

Combining machine learning algorithms and geometric morphometrics: A study of carnivore tooth marks Publication date: 15 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 522 Author(s): Lloyd A. Courtenay, José Yravedra, Rosa Huguet, Julia Aramendi, Miguel Ángel Maté-González, Diego González-Aguilera, Mari Carmen Arriaza Abstract Since the 1980s an intense scientific debate has revolved around the hunting capacities of early hominin populations and the behavioral patterns of carnivores sharing the same ecosystem, and thus competing for the same resources. This debate, commonly known as the hunter-scavenger debate, fostered the emergence of a new research line into the Bone Surface Modifications (BSMs) produced by both taphonomic agents. Throughout the following 20 years, multiple studies concerning the action of carnivores have been developed, with a particular focus on the oldest archaeological sites in East Africa. Recent technological advances applied to taphonomy have provided new insight into carnivore BSMs. A newly developed part of this work relies on Geometric Morphometrics (GMM) studies aimed at discerning carnivore agency through the morphologic characterization of tooth scores and pits. GMM studies have produced promising results, however methodological limitations are still present. This paper presents the first combined application of Machine Learning (ML) algorithms and GMM to the analysis of carnivore tooth marks, generating classification rates of 100% between carnivore species in some cases.

A robust vegetation-based elevation transfer method for reconstructing Arctic polygon mire palaeo-microtopography Publication date: 15 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 522 Author(s): Annette Teltewskoi, Dierk Michaelis, Lutz Schirrmeister, Hans Joosten, Ulf Schiefelbein, Michael Manthey Abstract The reconstruction of past environments by means of macrofossil and pollen analysis is commonly based on the modern ecological preferences of the taxa that may have produced these fossils. Here we present a modelling approach, in which we use modern vegetation–surface height relationships to quantify past surface heights in an Arctic ice-wedge polygon mire. Vegetation composition and ground surface height (GSH) were assessed in a polygon mire near Kytalyk (Northeastern Siberia). Cluster analysis revealed five plant communities, which are clearly separated with respect to ground surface height, frost surface height and coverages of open water and vegetation. Based on the composition of modern vegetation we constructed two sets of potential fossil types (plant macrofossils and pollen), an extensive one and a more restricted one to reflect different conditions of preservation and recognisability. We applied Canonical Correspondence Analysis to model the relationships between potential fossil types and measured GSH. Both models show a strong relationship between modelled and measured GSH values and a high accuracy in prediction. Finally, we used the models to predict GSH values for Holocene peat samples and found a fair correspondence with expert-based multi-proxy reconstruction of wetness conditions, even though only a minor part of the encountered fossils were represented in the GSH models, illustrating the robustness of the approach. Our approach can be used to reconstruct palaeoenvironmental conditions in a more objective way and can serve as a template for further palaeoecological studies. Graphical abstract

The evolution and control of detrital sediment provenance in the middle and northern Okinawa Trough since the last deglaciation: Evidence from Sr and Nd isotopes Publication date: 15 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 522 Author(s): Fuqing Jiang, Zhifang Xiong, Martin Frank, Xuebo Yin, Anchun Li Abstract The Okinawa Trough (OT) is a large sink of sediments supplied by the East Asian continent. Identifying the provenance of the OT sediments is key to reconstructing the temporal and spatial variations of the terrigenous supply to this area and is important for understanding the impact of paleoclimatic and paleoceanographic variability on the sediment supply to this marginal sea over the late Quaternary. In this contribution, we show that radiogenic strontium (Sr) and neodymium (Nd) isotopes allow to efficiently distinguish Yellow and Yangtze/Taiwan River detrital sediments, and can be used to reconstruct distinct changes in the provenance of the detrital fraction of marine sediments from the middle and northern OT since the last deglaciation. The Sr and Nd isotope signatures are compared to those of the potential sediment sources, namely the Yellow and Yangtze Rivers, the Taiwan orogen, and volcanic material from the OT and nearby islands, and the relative contributions of these sources are reconstructed. The Sr and Nd isotope compositions of the detrital fraction in the two sediment cores recovered from the middle and northern OT show that the sediments mainly originated from the Yangtze River between 18 and 10.5 ka, which was caused by low sea level and a widely developed channel system on the continental shelf. During the period between 10.5 and 7.0 ka, the rising sea level resulted in elevated Yangtze and Yellow Rivers sediment input into the OT. Simultaneously, large-scale volcanic activity also contributed significant amounts of material to the OT. During the last 7.0 ka, besides important contributions from the Yellow River, the intensification of the Kuroshio Current resulted in increased delivery of sediment from Taiwan to the OT.

The Permian-Triassic transition in ocean island setting: Environmental disturbances and new high-resolution carbon-isotope record from the Qiangtang Basin, NW China Publication date: 15 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 522 Author(s): Xiugen Fu, Jian Wang, Chunyan Song, Zhongwei Wang, Shengqiang Zeng, Dong Wang Abstract The Permian-Triassic boundary (PTB) events such as carbon-isotope excursion, volcanism, and environmental disturbances are not well understood in an ocean island setting. Here, we develop a new case study for the Permian-Triassic transition in the Qiangtang Basin, Tibet, by combining existing biostratigraphy, new carbon-isotope data, sedimentological data, UPb zircon age, mineralogical and geochemical data. These new data defined the Permian-Triassic transition age as about 252.3 ± 0.9 Ma, corresponding to the lowermost sea level. A long-term negative carbonate carbon isotope trend is present at the same stratigraphic level in different depositional environments, strongly suggesting its global nature. However, our new ocean island setting is characterized by an abrupt shift in carbon isotope values across the level, which is different from many chemostrtigraphic studies that show a gradual shift in carbon isotope values across the event horizon. The most likely explanation for the abrupt shift in δ13C values is a sedimentary hiatus at this level in the study section. Three-stage climatic models through the PTB in the ocean island setting are identified: Stage 1 is characterized by a warm and humid climate with moderate chemical weathering; while a hot and humid climate with intense chemical weathering dominates stage 2; the climate in stage 3 is a relatively hot and arid climatic condition with weak chemical weathering.

Phylogenetic community paleoecology of one of the earliest complex crinoid faunas (Brechin Lagerstätte, Ordovician) Publication date: 1 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 521 Author(s): Selina R. Cole, David F. Wright, William I. Ausich Abstract Integrating phylogenetic biology with paleoecology can provide a valuable context for understanding patterns of community structure and niche partitioning in ancient ecosystems. However, the lack of robust phylogenies for many fossil taxa precludes studies of this nature, particularly among marine invertebrates. Fossil Crinoidea (Echinodermata) comprise an ideal model system for phylogenetic community paleoecology for three reasons: (1) they preserve anatomical features that directly relate to feeding ecology, (2) assemblages of well-preserved specimens represent "ecological snapshots" in time, and (3) recent advances in resolving the crinoid tree of life have produced high-resolution phylogenies for Ordovician lineages. Here, we apply multivariate and phylogenetic comparative methods to investigate patterns of paleocommunity structure, niche partitioning, and ecomorphospace occupation in one of the earliest known complex crinoid paleocommunities, the Brechin Lagerstätte (Upper Ordovician, Katian). Results indicate niche differences among species were determined primarily by characters related to filtration fan morphology. Filtration fan density and body size distributions support phylogenetic niche conservatism, but traits related to the size of the feeding area are more labile and exhibit greater divergence than expected among closely related species. Finally, we compare changes in the shape and phylogenetic structure of niche distributions between the Brechin Lagerstätte and the Edwardsville crinoid fauna, a well-studied Mississippian (Viséan) paleocommunity, to examine patterns of community change across the Early to Middle Paleozoic Crinoid Macroevolutionary Faunas.

Paleoenvironmental changes during the late Albian oceanic anoxic event 1d: An example from the Capacho Formation, southwestern Venezuela Publication date: 1 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 521 Author(s): María-Emilia Rodríguez-Cuicas, Jean-Carlos Montero-Serrano, Grony Garbán Abstract The late Albian–early Cenomanian oceanic anoxic event 1d (OAE-1d; ~103 to 99.5 Ma) represents a global interval of enhanced organic carbon burial due to widespread oxygen deficiency in the water column and/or increased primary productivity. The biostratigraphy and geochemistry of organic-rich sediments in the La Grita Member (Capacho Formation) in southwestern Venezuela were studied to document the paleoenvironmental conditions that governed the deposition of this succession during OAE-1d. Carbon-isotope (δ13Ccarb and δ13CCorg) chemostratigraphy and biostratigraphic constraints show that the La Grita Member spans the late Aptian period (Rotalipora appenninica Zone), and that OAE-1d is well recorded in this succession. A prominent increase in total organic carbon (TOC) values (up to 10%) is clearly recorded through the onset of OAE-1d, coinciding with a prominent change in overall redox-sensitive proxies suggesting that the La Grita Member sediments accumulated under anoxic (and possibly euxinic) bottom-water conditions in a partially restricted basin. The detrital proxies suggest that the greenhouse climate prevailing during OAE-1d induced significant acceleration of the hydrologic cycle and an increase in continental chemical weathering rates. Overall, the carbon and oxygen isotope records, TOC contents, as well as the detrital proxies show cyclic variation during the late Albian stage. These variations support the hypothesis that orbital forcing likely also modulated the equatorial monsoonal activity during the OAE-1d.

Monsoon-influenced variations in plankton community structure and upper-water column stratification in the western Bay of Bengal during the past 80 ky Publication date: 1 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 521 Author(s): Yuki Ota, Junichiro Kuroda, Asuka Yamaguchi, Atsushi Suzuki, Daisuke Araoka, Toyoho Ishimura, NGHP Expedition 02 JAMSTEC Science Team, Hodaka Kawahata Abstract To enhance our understanding of the forcing factors of marine biological community structure in the Bay of Bengal, we studied proxies for biogenic carbonate and silicate production in the western Bay of Bengal and compared them with proxies for upper-ocean stratification and strength of the Indian summer monsoon (ISM). Specifically, we investigated the record in a sediment core from the western Bay of Bengal that extended to approximately 80 ky before the present (BP). The records of Globigerinoides ruber sensu stricto δ18O minus Neogloboquadrina dutertrei δ18O (Δδ18Or–d) were used to investigate changes in upper-ocean stratification. We reconstructed variations in mass accumulation rates (MARs) of CaCO3 and biogenic silica (BSi) to discuss plankton community structure. Greater difference between Globigerinoides ruber sensu stricto δ18O and Neogloboquadrina dutertrei δ18O during the marine isotope stage (MIS) 1 and 5a indicate intervals with less saline and more stratified conditions. In contrast, the relatively small difference between both planktic foraminiferal δ18O during MIS 2 and 4 indicates diminished stratification during these periods. Elevated carbonate production during MIS 2 and 4, demonstrated by the increase in CaCO3 MAR, could have been driven by lower freshwater influx to the western Bay of Bengal resulting from lower ISM precipitation, and thus the increased mixing and upwelling of deep nitrate into the photic zone. The relative increase in BSi MAR during periods of high ISM precipitation and decreased salinity of surface waters suggests a limited recovery in biological siliceous production under interglacial conditions, possibly due to enhanced fluvial SiO4 delivery to the ocean. Fluctuations of Δδ18Or–d during MIS 3 indicate that freshwater stratification was moderate and insufficient to restrict upwelling. This might have induced moderate biogenic silica and carbonate productions during this period.

Recovery of benthic communities following the Toarcian oceanic anoxic event in the Cleveland Basin, UK Publication date: 1 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 521 Author(s): Bryony A. Caswell, Stephanie J. Dawn Abstract During the Toarcian oceanic anoxic event (OAE) considerable environmental changes occurred that were associated with global warming, perturbations to the C-cycle and ocean deoxygenation which resulted in a mass extinction of marine fauna. Recovery of the biota after the event was protracted and has to date undergone limited study. However, understanding the patterns and processes of recovery are critical to anticipating ecosystem responses to the environmental changes predicted for the near future. Results showed that increases in benthic diversity, and the re-establishment of the Toarcian infauna was gradual and followed the changing redox conditions. Pioneering infauna, such as Dacryomya ovum that dominated the seafloor after the event in the Cleveland Basin, Yorkshire, UK, can modify the physico-chemical environment and thus facilitate ecological succession after disturbance. The length of D. ovum increased >8 mm throughout the bifrons Zone and these body-size changes were linked with total organic carbon (TOC) content suggesting a link to primary productivity, although only at intermediate levels of deoxygenation. Major changes in the phytoplankton, and so food supply, seem to have driven changes in bivalve body size, across trophic guilds, both during and after the event in Yorkshire, and on the mid to lower shelf in Spain and France, respectively. Primary productivity collapse seems then to have been a major driver of biotic change throughout the Toarcian event, as it was during the Permian–Triassic, Triassic/Jurassic and Cretaceous/Tertiary mass extinctions. Further investigation of both the palaeontological and geochemical changes that occurred within early successional Toarcian infaunal communities are required to more fully understand the pattern of recovery after the OAE.

Agriculture and Human Values

Gendered agrobiodiversity management and adaptation to climate change: differentiated strategies in two marginal rural areas of India Abstract Social and cultural contexts influence power dynamics and shape gender perceptions, roles, and decisions regarding the management of agrobiodiversity for dealing with and adapting to climate change. Based on a feminist political ecology framework and a mixed method approach, this research performs an empirical analysis of two case studies in the northern of India, one in the Himalayan Mountains and another in the Indian-Gangetic plains. It explores context-specific (i) influence of gender roles and responsibilities on on-farm agrobiodiversity management (ii) gendered expertise and knowledge related to agrobiodiversity and (iii) gendered preferences for practices and institutional arrangements for agrobiodiversity conservation linked to adaptation to climate change. In the Himalayan mountains women actively participate in crop and seed management decisions and tasks, and maintain informal institutions for seed and services exchanges in the case of crisis, which simultaneously favours high levels of agrobiodiversity and enhances women's social status. By contrast, in the Indio-Gangetic plains, where women from better-off households are socially secluded and women from poorer households work mainly as labourer to respond to high out-migration of men, they exercise less public control over agrobiodiversity, with their role being mainly invisible at the homestead and related to post-production tasks. We finally discuss as improved understanding of the links between gendered spaces, crops, tasks, social status, and agrobiodiversity management can facilitate the design of gender-sensitive policy interventions for conservation and adaptation to climate change.

Symposium introduction—ethics and sustainable agri-food governance: appraisal and new directions

Book review: Steve Ventura and Martin Bailkey (eds): Good food, strong communities: promoting social justice through local and regional food systems

Jennifer Meta Robinson and James Robert Farmer: Selling local: why local food movements matter

Collen Murphy, Paolo Gardoni and Robert McKim (eds): Climate change and its impacts: risks and inequalities

Stephanie Paladino and Shirley J. Fiske (Eds): The carbon fix: forest carbon, social justice, and environmental governance

Brandi Janssen: Making local food work: the challenges and opportunities of today's small farmers

Books received

The importance of food retailers: applying network analysis techniques to the study of local food systems Abstract As local food activities expand and grow, an important question to answer is how various participants contribute to a local food system's overall vitality and strength. This paper does so by focusing on the relationships between locally-oriented farm and retail actors and assessing what the configuration of these relationships tells us about the workings of the broader local food system. Such an analysis reveals two things. Empirically, it shows the important role food retailers play in the overall vibrancy of local food exchanges: food retailers form crucial links holding the broader system together and significantly expanding consumer access to local foods. Further, different retailer types have distinct impacts on network configurations, each serving particular roles in the development and maintenance of local food systems. Methodologically, this paper shows the value of applying social network analysis techniques to the study of local food systems: such an approach yields insights that may not be as readily assessable from other strategies. In this paper, I overview common network analysis techniques and apply them to a case study of local food activities in New England, suggesting how such an approach might be applied to local food systems in other places.

Challenging the urban–rural dichotomy in agri-food systems Abstract The idea of a profound urban–rural divide has shaped analysis of the 2016 U.S. presidential election results. Here, through examples from agri-food systems, we consider the limitations of the urban–rural divide framework in light of the assumptions and intentions that underpin it. We explore the ideas and imaginaries that shape urban and rural categories, consider how material realities are and are not translated into U.S. rural development, farm, and nutrition policies, and examine the blending of rural and urban identities through processes of rural deagrarianization and urban reagrarianization. We do not argue that an urban–rural divide does not exist, as studies and public opinion polls illustrate both measured and perceived differences in many aspects of the lived experiences that shape our individual and collective actions. Ultimately, we suggest that the urban–rural divide concept obscures the diversity and dynamism of experiences each category encompasses. Additionally, it ignores the connections and commonalities that demand integrative solutions to challenges in agri-food systems, and draw attention to the power relations that shape resource access and use within and across urban and rural spaces.

Dermatology

Update on management of polycystic ovarian syndrome for dermatologists Shalini Gainder, Bharti Sharma Indian Dermatology Online Journal 2019 10(2):97-105 Polycystic ovarian syndrome (PCOS) is the commonest endocrine disorder in women having wide range of clinical manifestation. These women may present with reproductive, dermatological, metabolic, psychological, or neoplastic implications from adolescence to menopause. The common dermatological manifestations include hirsutism, acne, alopecia, or acanthosis nigricans. Women presenting with these dermatological manifestations must be evaluated for PCOS. A multidisciplinary team approach involving a reproductive endocrinologist, dermatologist, psychologist/psychiatrist, dietician, and sometimes a bariatric surgeon should be undertaken for long-term management of these patients. Unless metabolic and underlying endocrinal disturbances arecorrected and simultaneous life-style modification is adopted, cosmetic treatment would give only temporary relief.

Recent laboratory advances in diagnostics and monitoring response to treatment in leprosy Utpal Sengupta Indian Dermatology Online Journal 2019 10(2):106-114 The present review briefly summarizes the highlights of the recent advances in Mycobacterium leprae-specific tests for early diagnosis of leprosy. In addition to establishing the diagnosis of clinical cases of leprosy, these tests have also been used to detect subclinical infections in endemic population. Several attempts have been made from 1980 onward for standardization of specific diagnostic assays for early detection of leprosy. Brief account about the development and use of these assays has been described in this review article.

Dietary protein deficit and deregulated autophagy: A new Clinico-diagnostic perspective in pathogenesis of early aging, skin, and hair disorders Suruchi Garg, Ankita Sangwan Indian Dermatology Online Journal 2019 10(2):115-124 Background: Diet has an important role to play in the well-being of human body. Aims: The study intends to establish the “hypothesis of conscious, selective, and self-destruction i.e., deregulated autophagy of skin and hair in low dietary protein scenario” by determining the facial profile, clinical presentation, and histopathological correlation of deficient protein intake and missing of meals in a tertiary care aesthetic skin institute. Methods: A total of 98 patients of skin- and hair-related complaints were enrolled in the study and a histopathological correlation was established by skin and scalp biopsies in high and low protein groups. Results: A significant number of subjects (68.4%) were taking less than half of the recommended daily allowance of proteins and faced problems like hair fall, acne, pigmentation, vitiligo, hirsutism, melasma, and premature aging. Subjects missing breakfast were found to have hypothyroidism, diffuse hairfall, autoimmune disorders like vitiligo, lichen planus, and alopecia areata. Histopathological images from submental area showed loose and fragmented collagen in high carbohydrate group in comparison to high protein group where thick, uniformly stained collagen bundles were found in dermis. Histopathology of scalp tissue showed chronic perifollicular inflammatory infiltrate and fibrosis in high carbohydrate group which was absent in histopathology specimen of high protein group. Patients taking early and nutrient-rich breakfast had higher mean protein intakes and less severe skin and hair problems suggesting a role of circadian rhythm as well. Conclusion: Dietary protein adequacy and early breakfast have significant role in preventing self-destruction or deregulated autophagy in trichology and cosmetic dermatology and may prevent various autoimmune, inflammatory, and metabolic diseases.

Oral antifungal therapy: Emerging culprits of cutaneous adverse drug reactions Raju G Chaudhary, Santoshdev P Rathod, Ashish Jagati, Dhara Zankat, Arwinder K Brar, Bansri Mahadevia Indian Dermatology Online Journal 2019 10(2):125-130 Introduction: Antifungals are one of the most widely used drugs in dermatology practice for dermatophytosis. Oral antifungal therapy against superficial dermatophytosis is generally associated with a low incidence of adverse events in an immunocompetent population. However, lately, cutaneous adverse drugs reactions (CADRs) have been reported with varying incidence rates in the patients on oral antifungal therapy with many uncommon morphological patterns. The present, observational study was conducted over a period of 4 months to report the cases which presented with antifungal therapy-associated CADRs. Materials and Methods: It was an observational, prospective study carried out at a tertiary care center in Western India over a period of 4 months. All patients diagnosed with superficial dermatophytic infections (clinically and fungal hyphae seen on 10% potassium hydroxide mount) started on oral antifungal therapy, presenting with cutaneous manifestation other than the primary dermatophytosis were included. The incidence of CADRs due to oral antifungal agents and the percentage of each clinical type of the CADR observed was calculated. Results: The incidence of CADRs due to antifungal drugs was 8.3 per 10,000 patients. In total, 35 cases were reported out of 4,208 cases of dermatophytosis. Terbinafine was the most common causative drug, accounting for nearly 83% of cases, followed by itraconazole for 14% cases, and griseofulvin for 2.8% of cases. Conclusion: The role of systemic antifungals must not be overlooked in any patient with a CADR and should be reported as a trend indicator.

Association of Vitamin D receptor gene polymorphisms and serum 25-Hydroxy Vitamin D levels in vitiligo – A case-control study Iffat Hassan, Yasmeen J bhat, Sabhiya Majid, Peerzada Sajad, Farhan Rasool, Rawoof A Malik, Inam Ul Haq Indian Dermatology Online Journal 2019 10(2):131-138 Background: Vitamin D has stimulatory and protective effects on melanocytes and acts through its nuclear vitamin D receptor (VDR) on target cells. Various single-nucleotide polymorphisms (SNPs) in VDR genes have been described. Aims: The aim was to study and compare the association of SNP of BsmI/Apa-I/TaqI/FokI/Cdx2 in VDR gene as well as the plasma vitamin D levels in vitiligo patients and healthy controls. Methods: This was a case-control study, in which 100 patients of vitiligo and an equal number of healthy individuals were studied. The VDR polymorphisms of Bsm I, Apa-I, TaqI, fok I, and cdx2 were investigated, after extraction of genomic DNA by rapid capillary polymerase chain reaction with melting curve analysis, and 25 hydroxy vitamin D levels were measured in cases and controls. Results: The frequency of genotypes (SNP FokI and cdx2) was higher in the patient group versus controls (P = 0.002). The genotype frequency (TaqI and Apa-I) was higher in the patients than the controls for the Tt genotype, but not significantly higher (48% vs. 39%, P= 0.1431). The difference between the groups in frequency of the genotype Aa(TaqI and Apa-I) was statistically significant (P = 0.0001 and P= 0.033). Statistically significant difference was also observed in Apa-I-evaluated alleles in cases when compared to controls (P = 0.0001). There was no significant difference in serum vitamin D levels between various genotypes among cases and controls. Out of 100 cases, 10 were found to have vitamin D levels of >30 ng/ml, 15 had levels between 20 and 30 ng/ml, 52 had ≤20 ng/ml, and 23 ≤ 10 ng/ml, respectively. Limitations: Since the skin biopsies were not taken from the lesions of vitiligo, the correlation of serum levels with tissue levels of VDR gene was not possible and the role of vitamin D supplementation was not evaluated. Conclusion: The single nucleotide gene polymorphisms of various VDR genes as found in the cases might lead to vitamin D deficiency, due to VDR dysfunction, which in turn could increase the susceptibility to develop vitiligo.

Awareness of cosmetic dermatology procedures among health workers in a Tertiary Care Hospital Deeptara P Thapa Indian Dermatology Online Journal 2019 10(2):139-143 Introduction: Cosmetic dermatology is a branch of dermatology which deals with the enhancement of beauty. There is a rise in cosmetic dermatological procedures throughout the world, but its awareness is limited not only in the general population but also among the health workers. Materials and Methods: We conducted a cross-sectional questionnaire-based study to know the knowledge and awareness of cosmetic dermatological procedures among health workers in a hospital setting. Results: There were a total of 155 respondents. The maximum number of respondents belonged to age group of 20–30 years (65.2%). Female respondents were 66% and males were 34%. Of the total respondents, 39% were medical students, 31% doctors, 23% nurses, 6% OPD assistants, and 1% ward maids. Hinduism was practiced by 91% of the respondents. About 84.5% of subjects were aware of cosmetic dermatological procedures. Regarding the source of information, 34.2% implicated textbooks. According to 53.5% participants, cosmetic dermatological procedures are done by a dermatologist. Around 59.4% responded that they were aware of many procedures such as botox injections, laser hair removal, hair transplant, and chemical peeling; 51% were aware of risks associated with procedures, such as allergy, burns, and pigmentation; 44.5% rated the facility as good; 31% believed that outcome of the procedures is different in Nepal as compared to a foreign countries. About 23.9% thought public disposition will change if they underwent the procedures. Around 11.6% thought this shall negatively affect them; however, 53.5% believed it would be socially acceptable. About 78.1% thought that these procedures are done only in cities with 62.6% believing it is commonly done by high-class economic status people. About 73.5% respondents believed that this was adopted by literate people; 7.1% were concerned about taboos against cosmetic dermatosurgical procedures; 84.5% agreed that there should be awareness program on these procedures. Conclusion: We found lack of awareness, knowledge, attitudes, and disposition about cosmetic dermatosurgical procedures among health workers. Further community-based population studies and awareness programmes should be carried out regarding this aspect.

An observational study to describe the clinical pattern of dermatological emergencies from emergency department and intensive care unit: Our experience from a tertiary care hospital in Northern India Debdeep Mitra, Ajay Chopra, Neerja Saraswat, Reetu Agarwal, Sushil Kumar Indian Dermatology Online Journal 2019 10(2):144-148 Background: A large number of skin diseases have the potential to culminate into potentially fatal “acute skin failure.” The concept of dermatological intensive care unit (ICU) has largely evolved as a result of increased number of emergencies encountered by dermatologists these days. Dermatological emergencies comprise 8–20% of cases presenting to the emergency department. A wide variety of these conditions require a collective effort by intensivists, surgeons, physicians, and nursing staff in association with the treating dermatologist to reduce the associated mortality and morbidity. Dermatology ICU along with state-of-the-art nursing care is required to manage these cases, which result in acute skin failure. Materials and Methods: A prospective study conducted in a tertiary care center with a round the clock emergency department and a state-of-the-art dermatology ICU over a period of 12 months. Patients requiring primary dermatological consultation in the emergency department and patients admitted in the dermatology intensive care unit were evaluated, and their clinical variables were statistically analyzed. Results: In total, 327 cases were seen in the emergency department, out of which 54 (16.5%) cases were admitted in dermatology ICU, 239 (73.1%) were treated as outpatient cases, and 34 (10.4%) were managed as inpatients in other wards of the hospital. The most common condition in out-patient cases was acute urticaria and angioedema in 71 (29.7%), while vesiculobullous disorders in 16 (29.6%) patients was the most common condition requiring admission in dermatology ICU. Conclusions: At present, only few studies are available in the literature on the spectrum of dermatological disorders reporting to emergency department, and further requiring intensive care under ICU setting. This prospective study highlights the varied patterns of dermatosis reporting to emergency outpatient department and those managed in the ICU.

Idiopathic localized involutional lipoatrophy: A retrospective study of 12 cases Reena K Sharma, Mudita Gupta, Lalita Negi Indian Dermatology Online Journal 2019 10(2):149-152 Background: Idiopathic localized involutional lipoatrophy (ILIL) is focal loss of subcutaneous tissue without any clinical or histopathological inflammation with spontaneous regression. Objective: To retrospectively study clinical features and evolution of lesions in patients diagnosed with idiopathic localized lipoatrophy presenting to the department of dermatology of two district hospitals of Himachal Pradesh. Materials and Methods: A retrospective study of clinical patterns and evolution of ILIL was done in patients presenting with this condition in two district hospitals in the past 4 years (October 2013–September 2017). All clinically suspected and histopathologically confirmed cases of idiopathic localized lipoatrophy were included in the study. All cases with history of antecedent injections, vaccination, or medications before the development of lesion and inflammatory lipoatrophy on histopathology were excluded. Results: We found a total of 12 patients with ILIL. About 66% were children (8/12), 3 (25%) young females, and 1 (8%) young adult male. The most common site involved was buttock in 9 (75%) cases followed by a single case each (8%) with lesion on arm, face, and lower back. Two children and one adult were having bilateral involvement (25%), whereas the remaining had unilateral lesions. Lipoatrophy in 8 (66%) patients decreased spontaneously (with placebo) within 4–12 weeks duration whereas 4 required treatment. None required surgical or cosmetic interventions. Limitations: Small sample size and nonavailability of immunohistochemistry reports in all patients. Conclusion: ILIL is a rare form of lipoatrophy with specific loss of adipose tissue without any inflammatory changes. We concluded that ILIL is an underreported entity, probably due to its spontaneous resolution.

Study on assessment of quality of life and depression in patients of vitiligo RahulKrishna S Kota, Rita V Vora, Jagdish R Varma, Suresh K Kota, Trusha M Patel, Jaishree Ganjiwale Indian Dermatology Online Journal 2019 10(2):153-157 Context: Vitiligo is an autoimmune pigmentary disorder characterized by localized or generalized depigmentation of the skin. It is associated with significant stigma and has impact on patient's quality of life (QoL) and psychological wellbeing. Aims: To see the variance in QoL and level of depression in vitiligo patients with extent of vitiligo. Materials and Methods: Vitiligo patients aged ≥18 years attending OPD were included in the study. Impairment in QoL was assessed by administering DLQI (Dermatology Life Quality Index) and VIS22 (Vitiligo Impact Scale22). Depression was assessed by administering QIDSSR16 (Quick Inventory of Depressive Symptomatology). The Vitiligo Area Scoring Index (VASI) was calculated based on clinical examination. Results: One hundred and fifty patients enrolled. Most common age group was 18–30 years. Mean DLQI, VIS22, QIDSSR16 scores were 7.02, 16.37, 5.87, respectively. QoL was affected to some extent in 85.3% and 86.7% according to the DLQI and VIS22, respectively. Depression was seen in 44%. Coclusion: Young patients showed higher impairment in QoL and also higher levels of depression. It would be useful to offer psychiatric consult and counseling in addition to specific treatment.Context: Vitiligo is an autoimmune pigmentary disorder characterized by localized or generalized depigmentation of the skin. It is associated with significant stigma and has impact on patient's quality of life (QoL) and psychological wellbeing. Aims: To see the variance in QoL and level of depression in vitiligo patients with extent of vitiligo. Materials and Methods: Vitiligo patients aged ≥18 years attending OPD were included in the study. Impairment in QoL was assessed by administering DLQI (Dermatology Life Quality Index) and VIS22 (Vitiligo Impact Scale22). Depression was assessed by administering QIDSSR16 (Quick Inventory of Depressive Symptomatology). The Vitiligo Area Scoring Index (VASI) was calculated based on clinical examination. Results: One hundred and fifty patients enrolled. Most common age group was 18–30 years. Mean DLQI, VIS22, QIDSSR16 scores were 7.02, 16.37, 5.87, respectively. QoL was affected to some extent in 85.3% and 86.7% according to the DLQI and VIS22, respectively. Depression was seen in 44%. Conclusion: Young patients showed higher impairment in QoL and also higher levels of depression. It would be useful to offer psychiatric consult and counseling in addition to specific treatment.

Barber Say Syndrome (A new case report) Mehrdad Rezaei, Susan Zamani, Hourvash Haghighinejad Indian Dermatology Online Journal 2019 10(2):158-161 Barber Say syndrome (BSS) is a rare ectodermal dysplasia with neonatal onset characterized by congenital generalized hypertrichosis, atrophic skin, ectropion and macrostomia. A literature review showed less than 20 previously reported cases of Barber Say syndrome. This presentation reports a one day old female with syndrome face, low hairline, coarse face, macrostomia, thin upper lip, bilateral ectropion and hypertelorism, hypertrichosis, senile skin appearance, hypoplastic nipples and one area of mild skin atrophy. These findings are consistent with BSS.

Community Health

Correction to: No-Notice Mystery Patient Drills to Assess Emergency Preparedness for Infectious Diseases at Community Health Centers in New York City, 2015–2016 The article No-Notice Mystery Patient Drills to Assess Emergency Preparedness for Infectious Diseases at Community Health Centers in New York City, 2015–2016, written by Mohsin Ali and Marsha D. Williams, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 02 January 2019 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 13 January 2019 to © The Author(s) 2019 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

Building Community Partnerships: The Role of Schools of Public Health

A Workplace-Based Intervention to Improve Awareness, Knowledge, and Utilization of Breast, Cervical, and Colorectal Cancer Screenings Among Latino Service and Manual Labor Employees in Utah Abstract In the United States, Latinos are more likely to be uninsured and diagnosed with later stage cancer than non-Hispanic whites. Promotoras (lay health educators) help improve cancer knowledge and facilitate access to cancer screenings. We tested a promotora led workplace-based intervention to improve knowledge of and adherence to breast, cervical, and colorectal cancer screening among Latino employees in service or manual labor jobs. Latinos 18 and older from Salt Lake County, Utah were enrolled from January 2015 to February 2016. N = 265 completed pre- and post-intervention surveys that measured knowledge of and adherence to breast, cervical, and colorectal cancer screenings. Demographic, economic, and cancer factors of participants who completed the intervention were compared to those who were incomplete. Changes in knowledge and adherence were calculated using McNemar's tests. Logistic regression compared outcomes by select demographic, economic and cancer factors. More participants were older, spoke Non-English languages, were single/widow(er)s, worked part-time, and had an immediate family member with cancer compared to those who did not complete the study (all p < 0.05). Knowledge of the age to begin cancer screenings increased significantly from baseline to follow-up for cervical (65.1–77.7%), breast (67.2–81.7%), and colorectal cancer (49.8–80.7%), all p ≤ 0.001. Knowledge of the frequency of cervical (34.0–46.5%) and colorectal (72.1–84.5%) screening increased from baseline to follow-up, both p < 0.001. Adherence to fecal immunochemical tests (FIT) for colorectal cancer increased from baseline to follow-up (13.8–56.9%, p < 0.001). Promotora led workplace-based interventions can strengthen community capacity for educating and supporting Latino employees in preventing breast, cervical, and colorectal cancer.

Sugary Drink Consumption Among NYC Children, Youth, and Adults: Disparities Persist Over Time, 2007–2015 Abstract Sugary drink consumption is associated with many adverse health outcomes, including weight gain, diabetes, and other chronic conditions. These beverages are widely marketed and ubiquitously available. This analysis explores sugary drink consumption across all age groups among New York City (NYC) residents using representative survey data. Three population-based representative surveys of NYC residents of different age groups were analyzed. Adult participants, youth participants, and caregivers of child participants self-reported the number of sugary drinks they consumed per day. Mean sugary drink intake per day was estimated overall and by demographic characteristics, for the 2015 cycle of each survey and the 2007–2015 cycles of the adult survey. T tests were used to determine whether means differed by demographics. Long-term trends in mean sugary drink consumption among adult participants were conducted to examine changes over time overall and by demographic characteristics. In 2015, the mean daily number of sugary drinks consumed was 0.53 (95% CI 0.45, 0.61) among children 0–5 years old, 1.05 (95% CI 0.90, 1.21) among children 6–12 years old, and 1.16 (95% CI 1.09, 1.29) among NYC high school students. Among all NYC adults, sugary drink intake decreased 36% from 1.03 (95% CI 0.99, 1.08) in 2007 to 0.66 (95% CI 0.62, 0.70) drinks per day in 2015, p < 0.01. However, at each age level, there were persistent disparities in sugary drink consumption by sex, race/ethnicity, educational attainment, and poverty level. Decreasing overall rates of sugary drink consumption are promising; however, disparities by socio-demographics are a concern. Reducing sugary drink consumption across all ages is recommended as is minimizing the introduction at an early age. Reduction of sugary drink consumption will require a collaborative, multi-sectoral approach.

A Mixed-Methods Assessment of a Peer-Enforced Tobacco- and Smoke-Free Policy at a Large Urban University Abstract The study aims to evaluate the enforcement, opinions, and effectiveness of the University of South Florida's tobacco free policy one year following implementation. By assessing readiness to change and using geographic information system (GIS) mapping this study sought to introduce a unique and effective way of evaluating college tobacco free policies. A cross-sectional survey was administered to students, faculty, and staff to assess knowledge of policy and resources, tobacco use observations, stage change regarding policy enforcement, self-efficacy to enforce, and policy impact on perceived campus tobacco use (n = 5242). Additionally, using ArcGIS Collector (in: ESRI, ArcGIS desktop: release 10, Environmental Systems Research Institute, Redlands, 2011) volunteers collected geospatial data on tobacco use continuing to occur on campus following policy implementation. Overall there was moderate knowledge of the current policy and low beliefs for policy enforcement. Majority of respondents were not approaching violators to remind them of the policy and did not plan to do so in the future. There were statistically significant differences between smokers and non-smokers as well as between students and faculty and staff. The mapping of observed violations revealed continued tobacco use on campus with 158 data points. From both the geospatial results as well as the survey findings, the current policy is ineffective in reducing tobacco use across campus. With rapidly increasing numbers of smoke and tobacco free universities, new and innovative evaluation tools are needed so institution leaders can efficiently evaluate their implementation.

A Systematic Review of Interventions to Minimize Transportation Barriers Among People with Chronic Diseases Abstract Transportation is an important social determinant of health. Transportation barriers disproportionately affect the most vulnerable groups of society who carry the highest burden of chronic diseases; therefore, it is critical to identify interventions that improve access to transportation. We synthesized evidence concerning the types and impact of interventions that address transportation to chronic care management. A systematic literature search of peer-reviewed studies that include an intervention with a transportation component was performed using three electronic databases—PubMed, EMBASE, and CINAHL—along with a hand-search. We screened 478 unique titles and abstracts. Two reviewers independently evaluated 41 full-text articles and 10 studies met eligibility criteria for inclusion. The transportation interventions included one or more of the following: providing bus passes (n = 5), taxi/transport vouchers or reimbursement (n = 3), arranging or connecting participants to transportation (n = 2), and a free shuttle service (n = 1). Transportation support was offered within multi-component interventions including counseling, care coordination, education, financial incentives, motivational interviewing, and navigation assistance. Community health/outreach workers (n = 3), nurses (n = 3), and research or clinic staff (n = 3) were the most common interventionists. Studies reported improvements in cancer screening rates, chronic disease management, hospital utilization, linkage and follow up to care, and maternal empathy. Overall, transportation is a well-documented barrier to engaging in chronic care among vulnerable populations. We found evidence suggesting transportation services offered in combination with other tailored services improves patient health outcomes; however, future research is warranted to examine the separate impact of transportation interventions that are tested within multi-component studies.

Awareness and Knowledge of Human Papilloma Virus and Cervical Cancer in Women with High Pap Uptake Abstract This cross-sectional study explored knowledge, awareness, and health practices surrounding cervical cancer prevention and screening. Patients (n = 129) were recruited from three community clinics of underserved populations in Dallas, Texas. Women between ages 18–65 were surveyed using a self-administered questionnaire to evaluate their knowledge, awareness, and attitudes related to pap tests, human papilloma virus (HPV), HPV vaccines, and cervical cancer. Most women reported having a pap test in the past 3–5 years (86.6%). Over half knew that there was an increased risk of cervical cancer with an HPV infection, abnormal pap test, or both (52%). However, less than half of women knew the purpose of a pap test (40%), the purpose of the HPV vaccine (48%), or the transmission mode of HPV (25%). Over half of participants first heard about a pap test from a doctor (60%), about one quarter from their mother (24%), and less than a quarter from others (16%). More than half of women were aware of HPV (55%), while less than half were aware of the HPV vaccine (48%). Overall, we found that while most women had a high uptake of pap tests, they had low knowledge of the purpose of a pap test, the HPV vaccine, and transmission mode of HPV. They also had low awareness of HPV and the HPV vaccine. Given that almost all cases of cervical cancer are due to HPV infection, future studies should aim to further explore the gap between knowledge and awareness of HPV and pap uptake.

Birth Certificate Validity and the Impact on Primary Cesarean Section Quality Measure in New York State Abstract In New York (NY), birth certificate data are routinely used for assessing quality of care and health outcomes such as primary cesarean section (PCS) rates. However rare events are often underreported. This study compared birth certificates to medical records, and examined the impact of underreporting on risk adjustment variables for PCS. We conducted an internal validation study using a random sample of 702 NY births in 2009. Sensitivity and positive predictive value (PPV) of rare events reported on birth certificates were determined using abstracted and matched medical records as the gold standard. To assess the impact, we calculated PCS odds ratios for variables in the risk-adjustment model before and after correcting for measurement error. The sensitivity and PPV of birth certificate data elements including those in the PCS risk model varied from 0 to 100. After correction for measurement error, PCS odds ratios increased for most variables. For example, the PCS odds ratio for those with no prior live births was 3.03 (95% CI 2.94, 3.13), but after correction of measurement error increased to 3.46 (95% CI 3.22, 3.67). A composite negative event variable including abruptio placenta, eclampsia, or infection was the only variable that decreased after correction and was no longer significant (uncorrected OR 3.06, 95% CI 2.86, 3.29; corrected OR 1.42, 95% CI 0.79, 2.59). Underreporting on birth certificates remains concerning and impacts the risk adjustment for quality measures. Without improved data validity, health plans' quality metrics do not fully account for patient case-mix.

Knowledge and Practice of Health Workers about Healthcare Waste Management in Public Health Facilities in Eastern Ethiopia Abstract Healthcare waste management (HWM) problems are growing with an ever-increasing number of hospitals, clinics, diagnostic laboratories, etc in Ethiopia. Health workers are one of the key personnel who are responsible for the proper management of healthcare wastes at any health facilities. However, this performance will depend the level of knowledge and practice regarding waste management. A facility based cross-sectional study design was applied on 400 health workers. All public health institutions inside Jigjiga town were included and the study participants were randomly selected from each health facility. Data were collected using pre-tested and self administered questionnaire. The collected data was analyzed using SPSS version 20. Multivariable logistic regression model was used to identify factors associated with knowledge and practice of health workers. Out of those involved in this study, 47.7% and 42.3% of respondents had good knowledge and good practice on healthcare waste management, respectively. Health workers in the age group of 35–44 years, nurses, midwifes, medical laboratory, were significantly associated with knowledge of health workers. On the other hand, only educational status was significantly associated with practice. In this study, both knowledge and practice of health workers about healthcare waste management was poor. To enhance both the knowledge and practice of health workers, on job training is recommended.

No-Notice Mystery Patient Drills to Assess Emergency Preparedness for Infectious Diseases at Community Health Centers in New York City, 2015–2016 Abstract Mystery patient drills using simulated patients have been used in hospitals to assess emergency preparedness for infectious diseases, but these drills have seldom been reported in primary care settings. We conducted three rounds of mystery patient drills designed to simulate either influenza-like illness (ILI) or measles at 41 community health centers in New York City from April 2015 through December 2016. Among 50 drills conducted, 49 successfully screened the patient–actor (defined as provision of a mask or referral to the medical team given concern of infection requiring potential isolation), with 35 (70%) drills completing screening without any challenges. In 47 drills, the patient was subsequently isolated (defined as placement in a closed room to limit transmission), with 29 (58%) drills completing isolation without any challenges. Patient–actors simulating ILI were more likely to be masked than those simulating measles (93% vs. 59%, p = 0.007). Median time to screening was 2 min (interquartile range [IQR] 2–6 min) and subsequently to isolation was 1 min (IQR 0–2 min). Approximately 95% of participants reported the drill was realistic and prepared them to deal with the hazards addressed. Qualitative analysis revealed recurring themes for strengths (e.g., established protocols, effective communication) and areas for improvement (e.g., hand hygiene, explaining isolation rationale). We conclude that mystery patient drills are an effective and feasible longitudinal collaboration between health departments and primary care clinics to assess and inform emergency preparedness for infectious diseases.

Chinesische Medizin

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Behandlung gynäkologischer Krankheiten mit TCM in der Tradition der Methoden des Zhang Zhongjing Zusammenfassung Dieser Artikel ist der Bericht über den Panel-Vortrag der Autorin auf dem SMS-Kongress 2017 in Tutzing, bei dem sie anhand von Fallbeispielen über den klinischen Einsatz und die Wirkung einiger Rezepturen aus den „Wichtigen Rezepturen aus dem Goldenen Schrein" (Jingui yaolüe) von Zhang Zhongjing (im 2. Jh. n.u.Z. verfasst) referiert hat. Ihr Hauptaugenmerk lag dabei auf der besonderen Relevanz dieser traditionellen Rezepturen in der modernen klinischen Praxis. Am Anfang steht der Einsatz des „Dekoktes zur Erwärmung der Menstruation" (Wenjing tang) bei einer Patientin mit primärer Dysmenorrhoe sowie der Wirkung der „Pille mit Cinnamomum und Poria" (Guizhi fuling wan) bei der Therapie eines Uterusmyoms und einer Ovarialzyste. Mit drei Fallberichten über den Einsatz des „Pulvers aus Angelica sinensis und Pfingstrosenwurzel" (Danggui shaoyao san) bei Dysmenorrhoe, oberflächlichen Wassereinlagerungen und unregelmäßigen Zyklen illustriert sie den breiten Anwendungsbereich dieser Rezeptur bei Krankheitsbildern, denen Disharmonie der oo.hepaticus et lienalis (Fk„Leber" und „Milz", gan pi), eine depletio xue (energetische Schwäche des Xue, xuexu), Qi-Blockaden und Blockaden durch humor („Feuchtigkeit", shi) zugrunde liegen. Es folgen Beschreibungen ihrer Therapie von Schwangerschaftserbrechen, das in einem Fall auf ein kontravektiv aus der s.impedimentalis (Breite Trossstraße, chong) nach oben steigendes Qi zurückzuführen ist und mit dem „Dekokt mit Cinnamomum" (Guizhi tang) therapiert wird und in einem zweiten Fall auf algor- („Kälte"-, han) und Blockaden von wässriger pituita (yin) in der „Mitte" beruht und mit der „Pille mit Ingwer, Ginseng und Pinellia" (Ganjiang renshen banxia wan) behandelt wird. Beim nächsten Fallbeispiel wird die Therapie einer Studentin mit seelischen Störungen im Verlauf des Menstruationszyklus durch eine Kombination aus Ohrakupressur mit dem „Dekokt mit Glycyrrhiza, Triticum und Jujuba" (Ganmai dazao tang) bei der Therapie dargestellt. Mit demselben Dekokt hat die Autorin auch eine Patientin mit Menopausensyndrom und Haarausfall aufgrund einer Defizienz der oo.hepaticus et renalis (Fk„Leber" und „Niere", gan shen) behandelt. Am Ende des Artikels empfiehlt die Autorin eine Reihe von Rezepturen für die Therapie von Infertilität aufgrund des Polyzystischen Ovarialsyndroms durch Stützen des o.renalis (Fk „Niere", shen), Kräftigen des o.lienalis(Fk „Milz", pi), Regulieren des o.hepaticus (Fk „Leber", gan), Beseitigen von humor („Feuchtigkeit", shi), Umwandeln von pituita („Schleim", tan) und Dynamisieren des Xue.

Morbus Basedow — Behandlung in der Chinesischen Medizin Zusammenfassung Josef Hummelsberger hat in den 1990-er Jahren insgesamt zwei Monate lang Prof. Shi Runjie an der Zhejiang-Akademie für TCM in Hangzhou begleitet und seine Vorlesungen gehört. Auf Grundlage von Mitschriften aus dieser Zeit und von eigenen Erfahrungen erläutert der Autor in diesem Artikel die Therapie von Morbus Basedow mit Chinesischer Medizin. Zu Beginn analysiert der Autor die vier Symptomkonfigurationen, die bei M. Basedow in Frage kommen: ardor („Glut", huo) im o. hepaticus (Fk „Leber", gan), calor („Hitze, re) durch depletio (energetische Schwäche, xu) des Yin und emporschlagendes Yang im o. hepaticus (Fk „Leber", gan), depletio (energetische Schwäche, xu) des Qi und Yin sowie pituita („Schleim", tan), Qi-Blockaden und Xue-Stasen und calor („Hitze", re) im o. hepaticus (Fk „Leber", gan). Für diese nennt er jeweils die Symptome, die Therapiestrategien sowie empfehlenswerte Rezepturen und Akupunkturpunkte. Das genaue Vorgehen wird anhand eines Fallbeispiels von Prof. Shi und zwei vom Autor selbst behandelten Fällen verdeutlicht.

Private Korrespondenz als medizinhistorische Quelle: Krankheit und Heilung in den Briefen des Kalligraphen Wang Xizhi — Teil 2 Zusammenfassung Die Briefe des Kalligraphen Wang Xizhi (303–361) können als der älteste Korpus persönlicher Krankheitsberichte in der chinesischen Geschichte beschrieben werden. Sie enthalten nicht nur zahlreiche Beschreibungen von Wangs eigenen Krankheiten und Heilversuchen, sondern auch Erkundigungen nach dem gesundheitlichen Ergehen seines Adressaten und gemeinsamer Bekannte. Die Briefe bilden dadurch eine wertvolle Quelle für das Studium der frühmittelalterlichen Briefkultur und Medizingeschichte. Dieser Artikel untersucht die medizinischen Ideen und Termini in Wang Xizhis Briefen, um einen Teil der facettenreichen, aber kaum dokumentierten Welt frühmittelalterlicher, chinesischer Heilungspraktiken zu beleuchten. Durch die Annäherung an den Körper des Kalligraphen, die uns Wangs Krankheitsberichte erlauben, wird es auch möglich, die körperlichen und mentalen Bedingungen des künstlerischen Prozesses in den Blick zu nehmen. Nach einem Überblick über Wangs Beschwerden im ersten Teil (in Chinesische Medizin 3/2018) werden im vorliegenden zweiten Teil seine Ätiologien und Erkrankungen im Licht der modernen medizinischen Literatur beleuchtet. Im dritten Teil (Chinesische Medizin 2/2019) beschreiben die Autoren die angewendeten Therapien.

Behandlung der reticulares (Netzleitbahnen, luomai ) bei psychischen Erkrankungen — Teil 2 Zusammenfassung Die reticulares (Netzleitbahnen, luomai) sind für die energetische Versorgung der Bindegewebe des Körpers zuständig. Die Bindegewebe stehen in enger Verbindung zum autonomen Nervensystem und damit zu allen Formen von emotionalem Stress. Sie spielen eine wesentliche Rolle in der psychosomatischen Verarbeitung und Speicherung von Traumata, aber auch allgemein von emotional ausgelösten (Körper-)Haltungen, die von großer Bedeutung für unser psychisches Befinden, für unser Selbstgefühl und für die Entwicklung von Ängsten und Depressionen sind. Die Akupunktur kann über die Behandlung der reticulares (Netzleitbahnen, luomai) deutlich Einfluss nehmen auf das psychische Befinden, Beschwerden lindern, psychotherapeutische Entwicklungen unterstützen und helfen, (psycho-)somatisch gespeicherte Haltungen und Selbstkonzepte zu verändern. Im ersten Teil dieses Artikels (in Chinesische Medizin 4/2018, S.197–204) wurde zunächst dargestellt, welches Verständnis der reticulares (Netzleitbahnen, luomai) uns aus den klassischen Texten der Chinesischen Medizin überliefert ist und wie dieses mit aktuellen Konzepten in Verbindung gebracht werden kann: Essayistisch wurde versucht, auf der Basis energetischer Konzepte darzulegen, weshalb allen Körpergeweben, nicht zuletzt Faszien und dem Bindegewebe, eine wichtige Rolle bei der Entstehung und Behandlung von psychischen und psychosomatischen Störungen zukommt. Dabei wurden Verbindungen zum neurowissenschaftlichen Verständnis der Gefühle und des Selbst am Beispiel der Darstellungen von Antonio Damasio aufgezeigt. Darauf aufbauend wird nun im zweiten Teils des Artikels ein psychosomatisch-emotionales Verständnis der reticulares (Netzleitbahnen, luomai) vorgestellt, und es werden die praktischen Möglichkeiten der Akupunkturbehandlung der reticulares (Netzleitbahnen, luomai) bei psychischen Störungen ausführlich dargestellt.

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