Πέμπτη 1 Μαρτίου 2018
A new technique for evaluating heel xerosis grade and the effects of moisturizer on heel skin dryness
Abstract
Background
Dryness-related heel skin problems are common; however, there are very few studies about heel skin dryness. The objective of this study was to develop new assessment methods for evaluating heel skin dryness, to clarify the characteristics associated with heal skin dryness, and assess the effectiveness of moisturizer use according to dryness severity.
Materials and methods
We investigated the heel skin of 150 Korean women (aged 20-78 years). Heel skin images were taken using a DSLR camera and the distribution or severity of flakes, scaling, cracking, and fissures were visually assessed. Skin properties such as hydration, transepidermal water loss (TEWL), amount of dead skin cells, and efficacy of moisturizer were evaluated according to heel xerosis grade. Furthermore, as conventional evaluation methods for desquamation are not appropriate for heel skin, we developed new techniques using binarization of magnified images.
Results
Skin hydration tended to decrease and TEWL tended to increase as heel dryness grade increased. The amount of dead skin cells increased with increasing dryness grade using the new technique. Subjects in the severe dryness group achieved similar hydration levels as normal subjects at baseline after 3 hours of moisturizer application.
Conclusion
Our new methods of visually classifying heel dryness and quantifying dead skin cells using magnified images effectively evaluated heel skin properties. As heel skin is prone to dryness, daily repetitive application of moisturizer might be helpful for hydrating dry heel skin, and ultimately preventing complications.
Poor inter-rater reliability of hidradenitis suppurativa phenotypes
Publication date: Available online 2 March 2018
Source:Journal of the American Academy of Dermatology
Author(s): K.R. van Straalen, T. Verhagen, B. Horváth, C. Ardon, A.R.J.V. Vossen, R. Driessen, J. Boer, A. Rondags, E.P. Prens, H.H. van der Zee
T-cell–mediated immune response to pneumococcal conjugate vaccine (PCV-13) and tetanus toxoid vaccine in patients with moderate-to-severe psoriasis during tofacitinib treatment
Publication date: Available online 2 March 2018
Source:Journal of the American Academy of Dermatology
Author(s): Kevin L. Winthrop, Neil Korman, William Abramovits, Scott T. Rottinghaus, Huaming Tan, Annie Gardner, Geoffrey Mukwaya, Mandeep Kaur, Hernan Valdez
BackgroundPsoriasis is often treated with immunomodulatory therapies that can affect the immune response to common antigens. Tofacitinib is an oral Janus kinase inhibitor.ObjectiveTo characterize the effect of long-term exposure to tofacitinib 10 mg twice daily on T-cell function in psoriasis patients.MethodsPatients completing at least 3 months' continuous treatment with tofacitinib 10 mg twice daily were vaccinated with T-cell–dependent vaccines (monovalent tetanus toxoid and 13-valent pneumococcal conjugate [PCV-13]). Patients were assessed at baseline (before vaccination) and then again 4 weeks after vaccination. For PCV-13, we evaluated serotype-specific, opsonophagocytic antibody responses, and for tetanus toxoid, we evaluated humoral responses.ResultsAmong 60 patients who completed the study, the geometric mean fold rise from baseline for the 13 PCV serotypes at 4 weeks postvaccination varied from 8.3 (serotype 3) to 101.9 (serotype 6A). Similar results were observed for patients with and without lymphopenia at baseline. For tetanus toxoid, 51 (88%) patients had ≥2-fold and 35 (60%) patients had ≥4-fold rise in antibody concentration.LimitationsThere was no placebo control.ConclusionMost psoriasis patients who receive tofacitinib can mount satisfactory T-cell–dependent responses to PCV-13 and tetanus vaccines.
Book Review: Dermatology: Visual Recognition and Case Reviews by Christine J. Ko
Publication date: Available online 2 March 2018
Source:Journal of the American Academy of Dermatology
Author(s): Dirk M. Elston
Interleukin-17, Inflammation, and Cardiovascular Risk in Patients With Psoriasis
Publication date: Available online 2 March 2018
Source:Journal of the American Academy of Dermatology
Author(s): Benjamin Lockshin, Yevgeniy Balagula, Joseph F. Merola
In addition to being recognized as a chronic inflammatory disease that manifests in the skin, psoriasis is increasingly understood to be a systemic disease that causes immune dysregulation throughout the body. The systemic nature of psoriasis is evidenced by the higher burden of comorbidities and shorter life expectancies of patients with psoriasis, particularly those with early onset and severe disease. Notably, psoriasis is associated with an increased risk for cardiovascular disease, which is the most common cause of morbidity and mortality in patients with psoriasis. In this review, we examine the association between psoriasis and cardiovascular disease and specifically focus on the role of interleukin-17–mediated inflammation as a potential mechanistic link between psoriasis and cardiovascular disease. Moreover, we describe potential treatment approaches to reduce the burden of cardiovascular disease in patients with psoriasis, and discuss the clinical importance of the association of these 2 diseases with respect to patient management and education.
Collagen type III and elastin genes polymorphism and the risk of nonsyndromic striae
Summary
Background
Striae have been reported to be one of the most common skin lesions and a commonly encountered esthetic problem.
Objectives
The aim of this research was to examine elastin gene polymorphism (rs7787362, ELN) and collagen type III alpha 1 polymorphism (rs1800255, COL3A1) among polish woman population with SD in comparison with women without the lesions and to verify these polymorphisms as risk factors for SD.
Methods
Seventy female students (35 with striae (the mean age 23.9 years, SD 1.2 years) and 35 without these lesions (22.9 years, SD 1.7 years)) were included in the study. The subjects were asked to fill out a questionnaire including questions concerning risk factors for SD and had a cheek swabbed for cells for DNA isolation.
Results
Analysis of polymorphisms of elastin gene (rs7787362) and COL3A1 gene (rs1800255) showed that women with SD and without these lesions did not differ in these aspects. Polymorphism rs7787362 was also analyzed in relation to SD in different locations, and showed no differences.
Conclusion
In conclusion, we found that there are some clinical factors that reduced the risk of SD: history of intended weight loss, negative family history of SD, and lower BMI. Gene polymorphisms analysis in patients with SD may help to establish the etiology of these lesions and to target the therapy. Analysis of polymorphisms of elastin gene (rs7787362) did not show differences in allele distribution between women with and without SD. Polymorphisms of COL3A1 gene (rs1800255) also did not differ between the examined groups.
IL1A (-889) gene polymorphism is associated with the effect of diet as a risk factor in Acne Vulgaris
Summary
Background
Despite the several studies suggesting the genetic basis of acne vulgaris, the exact genetic architecture of this very common condition is not yet clear.
Aim of the work
This study aimed to investigate the association between IL-1A (−889) gene polymorphism and acne vulgaris in a sample of patients.
Subjects and Method
Blood samples from 100 patients with acne vulgaris and 100 healthy age, sex, and BMI matched controls were obtained. DNA samples were isolated from blood cells, and the PCR-RFLP method was used for genotyping.
Results
The genotype distributions of IL-1A (−889) polymorphism were as expected under Hardy-Weinberg equilibrium. T allele was predominant in the patients, while C allele predominated in the control subjects (P value < .001). The frequency of TT genotype in patients was significantly higher than in the control subjects (P value < .001). CT genotype was significantly more frequent in the control subjects compared to patients (P value < .001). Among the 47 patients who reported diet as a risk factor for triggering or exacerbating their lesions, 62.5% had TT genotype (P value = .038).
Conclusion
IL-1A (−889) gene polymorphism has a role in the pathogenesis of acne vulgaris. We suggest that the triggering or exacerbating effect of diet on acne may be related to IL-1A (−889) gene polymorphism.
Radiation Dosimetry of 3D Rotational Neuroangiography and 2D-DSA in Children [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
The benefit-risk assessment concerning radiation use in pediatric neuroangiography requires an extensive understanding of the doses delivered. This work evaluated the effective dose of 3D rotational angiography in a cohort of pediatric patients with complex neurovascular lesions and directly compared it with conventional 2D-biplane DSA.
MATERIALS AND METHODS:Thirty-three 3D rotational angiography acquisitions were acquired in 24 pediatric patients (mean age, 10.4 years). When clinically indicated, following 2D-biplane DSA, 3D rotational angiography was performed with 1 of 3 technical protocols (2 subtracted, 1 unsubtracted). The protocols consisted of 1 factory and 2 customized techniques, with images subsequently reconstructed into CT volumes for clinical management. Raw projections and quantitative dose metrics were evaluated, and the effective dose was calculated.
RESULTS:All 3D rotational angiography acquisitions were of diagnostic quality and assisted in patient management. The mean effective doses were 0.5, 0.12, and 0.06 mSv for the factory-subtracted, customized-subtracted, and customized-unsubtracted protocols, respectively. The mean effective dose for 2D-biplane DSA was 0.9 mSv. A direct intraprocedural comparison between 3D and 2D acquisitions indicated that customized 3D rotational angiography protocols delivered mean relative doses of 9% and 15% in unsubtracted and subtracted acquisitions, respectively, compared with biplane DSA, whereas the factory subtracted protocol delivered 68%.
CONCLUSIONS:In pediatric neuroangiography, the effective dose for 3D rotational angiography can be significantly lower than for 2D-biplane DSA and can be an essential adjunct in the evaluation of neurovascular lesions. Additionally, available 3D rotational angiography protocols have significant room to be tailored for effectiveness and dose optimization, depending on the clinical question.
Utility of Repeat Head CT in Patients with Blunt Traumatic Brain Injury Presenting with Small Isolated Falcine or Tentorial Subdural Hematomas [ADULT BRAIN]
BACKGROUND AND PURPOSE:
In blunt traumatic brain injury with isolated falcotentorial subdural hematoma not amenable to neurosurgical intervention, the routinely performed, nonvalidated practice of serial head CT scans frequently necessitates increased hospital resources and exposure to ionizing radiation. The study goal was to evaluate clinical and imaging features of isolated falcotentorial subdural hematoma at presentation and short-term follow-up.
MATERIALS AND METHODS:We performed a retrospective analysis of patients presenting to a level 1 trauma center from January 2013 to March 2015 undergoing initial and short-term follow-up CT with initial findings positive for isolated subdural hematoma along the falx and/or tentorium. Patients with penetrating trauma, other sites of intracranial hemorrhage, or depressed skull fractures were excluded. Patient sex, age, Glasgow Coma Scale score, and anticoagulation history were obtained through review of the electronic medical records.
RESULTS:Eighty patients met the inclusion criteria (53 males; 27 females; median age, 61 years). Of subdural hematomas, 57.1% were falcine, 33.8% were tentorial, and 9.1% were mixed. The mean initial Glasgow Coma Scale score was 14.2 (range, 6–15). Isolated falcotentorial subdural hematomas were small (mean, 2.8 mm; range, 1–8 mm) without mass effect and significant change on follow-up CT (mean, 2.7 mm; range, 0–8 mm; P = .06), with an average follow-up time of 10.3 hours (range, 3.9–192 hours). All repeat CTs demonstrated no change or decreased size of the initial subdural hematoma. No new intracranial hemorrhages were seen on follow-up CT.
CONCLUSIONS:Isolated falcotentorial subdural hematomas in blunt traumatic brain injury average 2.8 mm in thickness and do not increase in size on short-term follow-up CT. Present data suggest that repeat CT in patients with mild traumatic brain injury with isolated falcotentorial subdural hematoma may not be necessary.
Normal Values of Magnetic Relaxation Parameters of Spine Components with the Synthetic MRI Sequence [SPINE]
BACKGROUND AND PURPOSE:
SyMRI is a technique developed to perform quantitative MR imaging. Our aim was to analyze its potential use for measuring relaxation times of normal components of the spine and to compare them with values found in the literature using relaxometry and other techniques.
MATERIALS AND METHODS:Thirty-two spine MR imaging studies (10 cervical, 5 dorsal, 17 lumbosacral) were included. A modified multiple-dynamic multiple-echo sequence was added and processed to obtain quantitative T1 (millisecond), T2 (millisecond), and proton density (percentage units [pu]) maps for each patient. An ROI was placed on representative areas for CSF, spinal cord, intervertebral discs, and vertebral bodies, to measure their relaxation.
RESULTS:Relaxation time means are reported for CSF (T1 = 4273.4 ms; T2 = 1577.6 ms; proton density = 107.5 pu), spinal cord (T1 = 780.2 ms; T2 = 101.6 ms; proton density = 58.7 pu), normal disc (T1 = 1164.9 ms; T2 = 101.9 ms; proton density = 78.9 pu), intermediately hydrated disc (T1 = 723 ms; T2 = 66.8 ms; proton density = 60.8 pu), desiccated disc (T1 = 554.4 ms; T2 = 55.6 ms; proton density = 47.6 ms), and vertebral body (T1 = 515.3 ms; T2 = 100.8 ms; proton density = 91.1 pu). Comparisons among the mean T1, T2, and proton density values showed significant differences between different spinal levels (cervical, dorsal, lumbar, and sacral) for CSF (proton density), spinal cord (T2 and proton density), normal disc (T1, T2, and proton density), and vertebral bodies (T1 and proton density). Significant differences were found among mean T1, T2, and proton density values of normal, intermediately hydrated, and desiccated discs.
CONCLUSIONS:Measurements can be easily obtained on SyMRI and correlated with previously published values obtained using conventional relaxometry techniques.
Altered Regional Homogeneity in Chronic Insomnia Disorder with or without Cognitive Impairment [FUNCTIONAL]
BACKGROUND AND PURPOSE:
Many studies have shown that insomnia is an independent factor in cognitive impairment, but the involved neurobiological mechanisms remain unclear. We used regional homogeneity to explore the specific neurobiologic indicators of chronic insomnia disorder with mild cognitive impairment.
MATERIALS AND METHODS:Thirty-nine patients with insomnia were divided into a group with and without cognitive impairment; we also included a control group (n = 28). Abnormalities in brain functional activity were identified by comparing the regional homogeneity values for each brain region among the groups.
RESULTS:Subjective insomnia scores were negatively correlated with cognitive impairment after controlling for age, sex, and educational effects. Regions with significant differences in regional homogeneity values in the 3 groups were concentrated in the right medial prefrontal cortex, the right superior frontal gyrus, and the left superior occipital gyrus. Meanwhile, subjective insomnia scores were negatively correlated with the strength of the decreased regional homogeneity in the right medial prefrontal cortex. The increased regional homogeneity value in the right superior frontal gyrus was positively correlated with the Montreal Cognitive Assessment score in patients.
CONCLUSIONS:Our results indicate that decreased regional homogeneity values in the medial prefrontal cortex and increased regional homogeneity values in the cuneus may be important neurobiologic indicators of chronic insomnia disorder and accompanying cognitive impairment. Overall, our study described the regional homogeneity of the whole brain in chronic insomnia disorder with mild cognitive impairment and could be the basis for future studies.
The effect of template-based sequential (TBS) coding on an NHS plastic surgical practice
Clinical coding is often a mystery to us surgeons but in actuality, it has a huge bearing on the financial sustainability of our services. Given the rapid innovations in plastic surgical procedures, clinical coders often struggle to decipher the extent of surgery. Meeting midway is the way forward here.
A supermicrosurgery training model using the chicken mid and lower wing
Supermicrosurgery is considered the pinnacle of microsurgery with its challenging nature of dissection and anastomosis of very small diameter vessels in the 0.3 to 0.8 mm range.
The C-MAC® Video-assisted Nasoendoscopy vs Traditional Direct Flexible Nasoendoscopy: A Pilot Randomised controlled study
Abstract
The C-MAC® video monitor attachment is suitable for all otolaryngological scenarios, including post-operative follow up and difficult airway examination.
Currently, there are no studies looking at the effectiveness of C-MAC® portable monitor with portable flexible nasoendoscopy.
Our study demonstrates that the C-MAC® monitor with portable flexible nasoendoscopy is an excellent tool in terms of medical education, improving patient-doctor communication, efficiency of ward rounds and for medico-legal documentation, with distinct advantages over traditional direct flexible nasoendoscopy.
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Does otitis media in early childhood affect later behavioural development? Results from the Western Australian Pregnancy Cohort (Raine) Study
Abstract
Objectives
To examine the relationship between early life episodes of otitis media and later behavioural development with adjustment for confounders.
Design
Longitudinal cohort study.
Setting: The Western Australian Pregnancy Cohort (Raine) Study recruited 2900 pregnant women from King Edward Memorial Hospital (KEMH) in Perth, Western Australia, between 1989 and 1991.
Participants
Data from the children born were collected at both the Year 3 and Year 5 follow up. At Year 3, n = 611 were diagnosed with recurrent otitis media through parent-report and clinical examination. At Year 5, n = 299 were considered exposed to otitis media based upon tympanometry results.
Main Outcome Measures
Performance in the Child Behaviour Checklist (CBCL), a questionnaire completed by the primary caregiver at Year 10.
Results
Significant associations were found between recurrent otitis media at Year 3 and internalising behaviours (P = 0.011), and the somatic (P = 0.011), withdrawn (P = 0.014), attention (P = 0.003) and thought problems domains (P = 0.021), and the total CBCL score (P = 0.010). A significant association was also found between exposure to otitis media at Year 5 and externalising behaviours (P = 0.026).
Conclusions
A modest association was seen between recurrent otitis media at Year 3 and exposure to otitis media at Year 5 and a number of behaviour domains at Year 10.
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Decreasing cytokeratin 17 expression in head and neck cancer predicts nodal metastasis and poor prognosis: the first evidence
Abstract
Objectives
Cytokeratins (CKs) are mainly expressed in epithelial carcinomas and are valuable for making diagnoses and identifying metastatic status. Changes in the expression of individual CKs in certain carcinoma may be relevant to establishing a prognosis. However, the prognostic significance of CKs in head and neck squamous cell carcinoma (HNSCC) remains elusive. Herein, we investigated the diverse and unique expression patterns of Cytokeratin 13 (CK13) and Cytokeratin 17 (CK17) and assessed the role of CK17 as a predictor for HNSCC metastasis and prognosis.
Methods
CK13 and CK17 expressions were evaluated by using immunohistochemical tissue microarray (TMA) analysis with 106 patients of HNSCC. To clarify the characterization of CK17 expression with respect to its ability in predicting metastatic disease, an in-vitro study of cells migration/invasion assays was conducted. Furthermore, the correlation of CK17 expression to clinicopathologic variables and prognosis was analyzed by using a serial statistical method.
Results
CK13 was predominately expressed in noncancerous tissues and was lost in HNSCC. Decreasing expression of CK17 correlated with cancerous cell migration and invasion (P<0.0001) in an in-vitro study. CK17 expression was lower in the N1 and N2 nodal metastases category compared to the N0 stage. Moreover, Kaplan-Meier survival analyses showed that a lower CK17 expression was associated with a poorer survival connotation in HNSCC patients (P<0.05) with 10-year follow-up.
Conclusion
Our findings provide the first evidence that CK17 under-expression might be a potential predictor of nodal metastasis and adverse prognosis.
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Effects of sumatriptan nasal spray (Imigran) on human nasal mucosa
Abstract
Objectives
Sumatriptan (Imigran) is a potent and highly selective 5-HT1 receptor agonist often used in treating acute migraine. Intranasal sumatriptan is well absorbed and is generally effective in relieving headache. However, the effects of Imigran on human nasal mucosa have rarely been well explored. To verify the effect of Imigran, which act on human nasal mucosa directly in vitro.
Design and participants
We examined the effectiveness of Imigran on human nasal mucosa by testing: 1) effect on human nasal mucosa resting tension; 2) effect on contraction caused by 10-6 M methoxamine as a sympathetic mimetic; 3) effect of the drugs on electrically induced on human nasal mucosa contractions.
Results
The results indicated that addition of methoxamine to the incubation medium caused the nasal mucosa to contract in a dose-dependent manner. Addition of Imigran at doses of 10 −4 M elicited a significant relaxation response to 10–6 M methoxamine -induced contraction. Imigran couldn't inhibit electrical field stimulation-induced spike contraction. It also had a minimal effect on the basal tension of nasal mucosa as the concentration increased.
Conclusions
The study indicated that high concentrations of Imigran had a significant spasmolytic effect by antagonizing α-adreoceptors and nasal obstruction couldn't be released in the patient combined with acute migraine and stuffy nose by concomitant α-adrenergic agonist nasal spray plus Imigran nasal spray.
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MicroRNA-622 is a novel mediator of tumorigenicity in melanoma by targeting Kirsten rat sarcoma
Summary
The network of molecular players is similar when comparing neural crest-derived, actively migrating melanoblasts to melanoma cells. However, melanoblasts are sensitive to differentiation-initiating signals at their target site (epidermis), while melanoma cells maintain migratory and undifferentiated features.
We aimed at identifying downregulated genes in melanoma that are particularly upregulated in melanoblasts. Loss of such genes could contribute to stabilization of a dedifferentiated, malignant phenotype in melanoma.
We determined that microRNA-622 (miR-622) expression was strongly downregulated in melanoma cells and tissues compared to melanocytes and melanoblast-related cells. MiR-622 expression correlated with melanoma patient survival. MiR-622 re-expression inhibited clonogenicity, proliferation and migration in melanoma. Inhibition of miR-622 in melanocytes induced enhanced migration. Kirsten rat sarcoma (KRAS) was identified as a major functional target of miR-622 in melanoma. We conclude that miR-622 is a novel tumorsuppressor in melanoma and identify the miR-622-KRAS-axis as potential therapeutic target.
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Punctate palmoplantar keratoderma: an unusual mutation causing an unusual phenotype
Abstract
Palmoplantar keratodermas (PPKs, OMIM #144200) refers to a large phenotypically and genetically heterogeneous group of keratinization disorders characterized by marked hyperkeratosis on the surface of palms and soles. Punctate PPK (PPKP) features multiple hyperkeratotic papules that develop in early adolescence or later and are irregularly distributed on the palms and soles. The disease is clinically classified into three autosomal dominant subtypes: PPKP1 (OMIM #148600, 614936) characterized by multiple tiny punctate keratoses and caused by mutations in the AAGAB or COL14A1 genes; PPKP2 (OMIM #175860) which features tiny hyperkeratotic spinous papules and PPKP3 or acrokeratoelastoidosis (AKE, OMIM # 101850) which manifests with small hyperkeratotic papules located over the peripheral margins of the palms and soles and is typically associated with degeneration of elastic fibers on histology. The molecular etiology of PPKP2 and AKE remains unknown.
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Evaluation of treatment results in multifocal primary cutaneous anaplastic large cell lymphoma: Report of the Dutch Cutaneous Lymphoma Group
Abstract
Background
There is no consensus on the treatment of multifocal primary cutaneous anaplastic large cell lymphoma (C-ALCL). Radiotherapy (RT) and methotrexate (MTX) are the current treatment options, but their efficacy is unknown. Recently, targeted therapies showed promising results in C-ALCL, and may therefore be an attractive first choice of treatment.
Objectives
To assess the efficacy of conventional treatment strategies for patients with multifocal C-ALCL, and to define which patients may require novel targeted therapies.
Methods
In this multicenter study, treatment was evaluated in patients initially presenting (n=24) or relapsing with multifocal C-ALCL (n=17; 23 relapses). Distinction was made between cases with ≤ 5 (n=36) and >5 lesions (n=11).
Results
Treatments most commonly used were radiotherapy (n=21), systemic chemotherapy (n=9) and low-dose methotrexate (MTX; n=7) with complete response rates of 100%, 78% and 43%, respectively, and an overall response rate of 100%, 100%, and 57%, respectively. Four patients showed a complete spontaneous regression. Sixteen of 24 patients (67%) first presenting with multifocal C-ALCL relapsed, including all five patients initially treated with CHOP. Compared with patients presenting with 2-5 skin lesions, patients presenting with >5 lesions had a higher chance of developing extracutaneous relapse (56 vs 20%) and more often died of lymphoma (44% vs 7%).
Conclusion
Patients with ≤5 lesions should be treated with low-dose RT (2x4 Gy). Maintenance low-dose MTX (20 mg/week) is a suitable option in patients with >5 lesions. Targeted therapies may be considered in rare patients refractory to MTX or patients developing extracutaneous disease.
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Genome-wide association study identifies three novel susceptibility loci for systemic lupus erythematosus in Han Chinese
Abstract
Systemic lupus erythematosus (SLE) is a common prototypic autoimmune disease with substantial genetic predispositions. It is more prevalent in Asians than in Caucasians. Genome wide association studies (GWAS) have discovered more than 80 genetic loci for the risk of SLE1, which improve the understanding of SLE etiology and provide potential therapeutic targets. However, each GWAS finding only confers a relatively small effect, and they in total cannot fully explain SLE heritability, suggesting more genetic variants are yet to be discovered.
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Itch in dermatomyositis: the role of increased skin interleukin-31
Summary
Background
Interleukin-31 (IL-31) is implicated in pruritus associated with pruritic skin diseases like atopic dermatitis. Although pruritus is a prominent feature in dermatomyositis (DM), few studies have evaluated the pathogenesis of DM-associated itch.
Objectives
Our goals were to establish the prevalence of itch in DM, and to investigate the role of IL-31 in DM-related itch.
Methods
Pruritus and disease activity of DM were evaluated by a visual analog scale (VAS) and the Cutaneous Disease and Activity Severity Index (CDASI), respectively. Expression of IL-31 and IL-31 receptor alpha (IL-31RA) in lesional DM, non-lesional DM and healthy control (HC) skin was evaluated by qRT-PCR and immunofluorescence. Flow cytometry was performed on skin cells isolated from lesional DM skin to identify cellular sources of IL-31 in DM.
Results
Among 191 DM patients, 50.8% had moderate to severe itch, and itch was correlated with increased cutaneous severity (r= 0.34). In itchy DM patients, gene expression of IL-31 and IL-31RA in lesional skin was upregulated compared to non-lesional skin and HC skin. IL-31 mRNA expression positively correlated with VAS itch score (r= 0.67). On immunofluorescence, immunoreactivity for IL-31 and IL31RA was stronger in lesional skin. Flow cytometry showed lesional DM skin contained significantly more IL-31-producing cells and CD4+ cells were the most common cell type. Lenabasum, an emerging treatment for DM, significantly downregulated IL-31 from CpG-stimulated PBMCs.
Conclusion
Increased skin IL-31 may play a role in DM-associated itch, and ongoing trials will evaluate the effects of systemic treatment on IL-31 and itch in DM.
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A rare BRAF T599dup mutation conferring sensitivity to BRAF inhibitor in a patient with metastatic melanoma
Abstract
Treatment for patients with V600 mutation of the B-Raf protooncogene BRAF (BRAF-V600) and metastatic stage IV or unresectable stage III melanoma has greatly advanced with the introduction of selective BRAF inhibitors (BRAFi), such as vemurafenib and dabrafenib, combined with mitogen-activated protein kinase kinase inhibitors (MEKi), such as cobimetinib and trametinib, as first-line therapy [1,2]. Two mutations, V600E and V600K, are routinely searched in patients with stage IV and unresectable stage III cancer. The presence of the V600 mutation allows for prescribing BRAFi combined with MEKi according to the European Medicine Agency. Other non– BRAF-V600 mutations have been increasingly found by next-generation sequencing (NGS) and question the possible efficiency of BRAFi associated with MEKi with these mutations [3]. Here we report a case of metastatic melanoma in a patient with a non–BRAF-V600 mutation responding to combined BRAFi and MEKi treatment.
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Nasal Distortion in Short-Distance Photographs
This study presents a mathematical model to describe the distortive effects of self-photographs, prove the increased perceived nasal size, and calculate the magnitude of this effect from different camera distances.
Use of Viable Cryopreserved Placental Membrane as an Adjunct to Facial Keloid Resection
Summary: Keloids are the physical manifestation of an exaggerated inflammatory response resulting in excess collagen deposition. The resulting fibroproliferative mass can be distressing for patients due to appearance, pruritus, and/or pain. Despite extensive research into the pathophysiology of keloid formation and the development of numerous treatments, keloids remain a challenge to treat. Even when the initial treatment is successful, a risk of recurrence remains. Basic science research into viable cryopreserved placental membranes and viable cryopreserved umbilical tissue has demonstrated their anti-inflammatory and anti-fibrotic effects, which may decrease keloid recurrence after excision. In this article, we present the first-reported case of viable cryopreserved placental membrane, with living mesenchymal stem cells, to treat a painful preauricular keloid in conjunction with surgical resection.Long-wave plasma radiofrequency ablation for treatment of xanthelasma palpebrarum
Summary
Xanthelasma palpebrarum is the most common type of xanthoma affecting the eyelids. It is characterized by asymptomatic soft yellowish macules, papules, or plaques over the upper and lower eyelids. Many treatments are available for management of xanthelasma palpebrarum, the most commonly used include surgical excision, ablative CO2 or erbium lasers, nonablative Q-switched Nd:YAG laser, trichloroacetic acid peeling, and radiofrequency ablation. This study aims to evaluate the effectiveness of RF ablation in the treatment of xanthelasma palpebrarum, with D.A.S. Medical portable device (Technolux, Italia), a radiofrequency tool working with long-wave plasma energy and without anesthesia. Twenty patients, 15 female and 5 male, affected by xanthelasma palpebrarum, were enrolled for long-wave plasma radiofrequency ablation treatment. The treatment consisted of 3/4 sessions that were carried out at intervals of 30 days. Treatments were well tolerated by all patients with no adverse effects and optimal aesthetic results. The procedure is very fast and can be performed without anesthesia because of the low and tolerable pain stimulation. Long-wave plasma radiofrequency ablation is an effective option for treatment of xanthelasma palpebrarum and adds an additional tool to the increasing list of medical devices for aesthetic treatments.
Use of topical therapies for pediatric psoriasis: A systematic review
Abstract
Psoriasis is one of the most common chronic skin diseases, affecting 1%-3% of the general population. It can have a significant negative impact on a patient's quality of life, and in approximately 30% of patients first symptoms can be traced back to childhood. We have performed a comprehensive literature search using the MEDLINE database in order to ascertain the efficacy and adverse reactions of topical treatments in pediatric psoriasis. A total of 13 relevant articles were identified on the following topical agents: corticosteroids, calcineurin inhibitors, vitamin D analogs, and dithranol. Corticosteroids achieved clearance in 72.7% of patients. Calcitriol lead to a 57.2%-100% mean improvement in severity, and calcipotriol to 52%-64%. Combination of calcipotriol and corticosteroids achieved an improvement in mean severity ranging between 32.1% and 80%. Treatment with tacrolimus lead to an >50% improvement. Finally, short contact dithranol lead to a variable response in clearance between different studies, ranging between 3.7% and 81%. No serious adverse reactions were documented, the most common local reaction being irritation. Pediatric psoriasis is a common and challenging condition with no easy and definitive solution. Topical agents are safe, easy to use, readily available and cheap. However, they need to be applied repeatedly, may cause skin irritation, and can be messy. Based on the results presented above, we recommend utilizing all the available topical options before escalating to systemic treatments.
Phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA)-related overgrowth spectrum: A brief report
Abstract
A patient with extensive multisystem overgrowth caused by a somatic gain of function PIK3CA-mutation is described. This case is an example of the clinical diversity of the PIK3CA-Related Overgrowth Spectrum (PROS) as the patient had overlapping features of Congenital Lipomatous Overgrowth Vascular malformations Epidermal nevi and Skeletal abnormalities (CLOVES) syndrome and Megalencephaly-Capillary malformation Polymicrogyria (MCAP) syndrome and underlines the utility of this umbrella term.
First evidence of anticoagulant rodenticides in fish and suspended particulate matter: spatial and temporal distribution in German freshwater aquatic systems
Abstract
Anticoagulant rodenticides (ARs) have been used for decades for rodent control worldwide. Research on the exposure of the environment and accumulation of these active substances in biota has been focused on terrestrial food webs, but few data are available on the impact of ARs on aquatic systems and water organisms. To fill this gap, we analyzed liver samples of bream (Abramis brama) and co-located suspended particulate matter (SPM) from the German Environmental Specimen Bank (ESB). An appropriate method was developed for the determination of eight different ARs, including first- and second-generation ARs, in fish liver and SPM. Applying this method to bream liver samples from 17 and 18 sampling locations of the years 2011 and 2015, respectively, five ARs were found at levels above limits of quantifications (LOQs, 0.2 to 2 μg kg−1). For 2015, brodifacoum was detected in 88% of the samples with a maximum concentration of 12.5 μg kg−1. Moreover, difenacoum, bromadiolone, difethialone, and flocoumafen were detected in some samples above LOQ. In contrast, no first generation AR was detected in the ESB samples. In SPM, only bromadiolone could be detected in 56% of the samples at levels up to 9.24 μg kg−1. A temporal trend analysis of bream liver from two sampling locations over a period of up to 23 years revealed a significant trend for brodifacoum at one of the sampling locations.
Ecotoxicological assessment of oil-based paint using three-dimensional multi-species bio-testing model: pre- and post-bioremediation analysis
Abstract
The present study validates the oil-based paint bioremediation potential of Bacillus subtilis NAP1 for ecotoxicological assessment using a three-dimensional multi-species bio-testing model. The model included bioassays to determine phytotoxic effect, cytotoxic effect, and antimicrobial effect of oil-based paint. Additionally, the antioxidant activity of pre- and post-bioremediation samples was also detected to confirm its detoxification. Although, the pre-bioremediation samples of oil-based paint displayed significant toxicity against all the life forms. However, post-bioremediation, the cytotoxic effect against Artemia salina revealed substantial detoxification of oil-based paint with LD50 of 121 μl ml−1 (without glucose) and > 400 μl ml−1 (with glucose). Similarly, the reduction in toxicity against Raphanus raphanistrum seeds germination (%FG = 98 to 100%) was also evident of successful detoxification under experimental conditions. Moreover, the toxicity against test bacterial strains and fungal strains was completely removed after bioremediation. In addition, the post-bioremediation samples showed reduced antioxidant activities (% scavenging = 23.5 ± 0.35 and 28.9 ± 2.7) without and with glucose, respectively. Convincingly, the present multi-species bio-testing model in addition to antioxidant studies could be suggested as a validation tool for bioremediation experiments, especially for middle and low-income countries.
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Correction to: Effects-based spatial assessment of contaminated estuarine sediments from Bear Creek, Baltimore Harbor, MD, USA
Abstract
The authors of the article have informed the Journal that an author, Dr. Sacoby Wilson of the University of Maryland School of Public Health, was inadvertently omitted from the published version of their manuscript due to a miscommunication regarding authorship criteria.
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Publication date: Available online 25 July 2018 Source: Journal of Photochemistry and Photobiology B: Biology Author(s): Marco Ballestr...
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Editorial AJR Reviewers: Heartfelt Thanks From the Editors and Staff Thomas H. Berquist 1 Share + Affiliation: Citation: American Journal...
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https://www.youtube.com/watch?v=DFOhpBjLqN4&t=1s , Η ΘΕΡΑΠΕΙΑ ΓΙΑ ΟΛΕΣ ΤΙΣ ΑΣΘΕΝΕΙΕΣ 1 Περιεχόμενα Σύντομο βιογραφικό Πρόλογος μεταφραστ...
