Successful therapy of ocular rosacea with topical ivermectin

Approximately 75% of cutaneous rosacea patients also suffer from an ocular involvement with blepharitis and meibomian gland dysfunction often presented as chalazia. Clinical symptoms are foreign body sensation, light sensitivity, burning and tearing.

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FOSB immunoreactivity in endothelia of epithelioid hemangioma (angiolymphoid hyperplasia with eosinophilia)

Background

Accurate distinction of epithelioid hemangioma (EH) from its malignant mimics is paramount but it remains challenging due to its wide morphological spectrum and lack of objective molecular markers. FOSB oncogenic activation was recently identified as a key event in endothelial proliferation. We sought to investigate the FOSB staining pattern in EH with angiolymphoid hyperplasia with eosinophilia morphology (EH-AHLE) and to evaluate its value in differential diagnosis of epithelioid vascular tumors.

Methods

From the authors' files, 15 representative cases of EH-ALHE were selected and evaluated for their FOSB immunostaining pattern. Other vascular proliferations which can be morphological mimics were also tested: epithelioid hemangioendothelioma (EHE) (5 cases) and epithelioid angiosarcoma (EAS) (5 cases).

Results

All 15 cases of EH-ALHE showed strong and homogeneous FOSB nuclear positivity in endothelial cells with ample cytoplasm and intracytoplasmic vacuoles. All cases of EHE and EAS lacked FOSB immunoreactivity or showed only incidental weak FOSB immunoreactivity in less than 5 nuclei per lesion.

Conclusions

FOSB immunohistochemistry is sensitive in the diagnosis of EH-ALHE, and allows differentiation from its histological mimics. An immunohistochemical panel including not only pan-cytokeratin AE1/AE3 and endothelial markers, but also FOSB, helps in the diagnosis of epithelioid vascular tumors.

Botulinum Toxin Type A: Assessing The Effects on The Brain Stem

Abstract

Background

In this study, our aim is to investigate the possible effects of Botulinum toxin type A administrations in the early and late periods on the brain stem.

Methods

Eighteen white New Zealand rabbits were used in this study with the subjects being divided into three groups. Group I received 0.05 mL sterile saline to the left anterior auricular muscles. Group II and III were injected with Botulinum toxin type A (Botox, Allergan) to the left anterior auricular muscles. Group II was sacrificed 5 days after application and Group III was sacrificed 12 weeks after application; brain stem tissues were then taken. The samples were examined with Caspase 3, 8, and 9 immunohistochemical stainings.

Results

In the control group with Caspase-3 immune staining, moderate-to-strong immune reactivity was seen in a small number of neurons. In the Caspase-8 and 9 immune stainings, the immune reactive neurons were seen in greater numbers when compared with the Caspase-3 immune reactive neurons. In the early and late period, groups with Caspase-8 and 9 immune stainings, the immune reactive neurons were seen in greater numbers and in the wider area when compared with the Caspase-3 immune reactive neurons. No significant differences were recognized in the Caspase immune stainings between the early and late period groups. The results were statistically supported.

Conclusion

It was concluded that Botulinum toxin type A application did not trigger apoptosis in stem cell tissues.

No Level Assigned

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Nanofat Increases Dermis Thickness and Neovascularization in Photoaged Nude Mouse Skin

Abstract

Object

To investigate the effects of nanofat injection into photoaged nude mouse skin on dermis thickness, neovascularization, and cell proliferation.

Methods

Adipose-derived stem cells (ADSCs) and nanofat were prepared from human liposuction aspirates. The photoaged skin model was created using ultraviolet B (UVB) radiation onto BALB/c nude mice. A total of 24 mice were used in this study; 6 mice without treatment (natural aging) served as controls, while 18 mice were irradiated under the UVB lamp and treated with PBS (200 μl per injection area), ADSCs (1 × 10⁶/200 μl ADSCs per injection area), or nanofat (200 μl per injection area) on the dorsal skin. Four weeks after injection, skin specimens were collected. The skin texture of each group was evaluated by general observation. Histological analyses were performed to analyze skin structure, dermis thickness, collagen fiber arrangement, capillary density, and cell proliferation.

Results

Four weeks after injection, no obvious differences were observed between the PBS group, ADSCs group, and nanofat group by skin gross observation. From the histological analyses, the ADSCs group and the nanofat group showed obviously thicker dermis than the PBS group (P < 0.05). More capillaries were observed in skin using anti-CD31 staining in the ADSCs and Nanofat groups than was observed in the PBS group (P < 0.05). No significant differences in the average dermis proliferation index were observed between groups by anti-Ki-67 staining. However, an increased epidermal proliferation index was observed in the ADSCs and Nanofat groups, compared to that in the PBS group (P < 0.05).

Conclusions

Nanofat increased dermis thickness and neovascularization in photoaged skin.

No Level Assigned

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Clinical Application of Platelet-Rich Fibrin in Plastic and Reconstructive Surgery: A Systematic Review

Abstract

Background

Platelet-rich fibrin (PRF) has been applied in the clinical field for more than a decade, but largely in oral surgery and implant dentistry. Its utilization in plastic and reconstructive surgery is limited and lacking a comprehensive review. Hence, this article focuses on the various clinical applications of PRF pertaining to the plastic and reconstructive field through a systematic review.

Methods

In this review, articles describing the clinical application of PRF in plastic and reconstructive surgery were screened using predetermined inclusion and exclusion criteria. The articles were summarized and divided into groups based on the utilization of PRF. The effects and complications of PRF were analyzed and concluded.

Results

Among the 634 articles searched, 7 articles describing 151 cases are eligible. PRF was applied on 116 (76.8%) wounds to facilitate tissue healing, and the complete wound closure rate was 91.4% (106/116). Otherwise, PRF was applied in 10 (6.6%) cases of zygomaticomaxillary fracture to reconstruct orbital floor defects and in 25 (16.6%) cases of facial autologous fat grafts to increase the fat retention rate successfully. There is no report of PRF-related complications.

Conclusions

PRF could facilitate wound healing, including the healing of soft tissues and bony tissues, and facilitate fat survival rate. Further studies are needed to test the mechanism of PRF and expand its scope of application in plastic and reconstructive surgery.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Commentary on: Dorsal Preservation: The Push Down Technique Reassessed

Some time ago, in 2010, I was visiting my esteemed colleague and friend, the great Mexican functional rhinologist and cosmetic rhinoplasty surgeon, Dr Fausto Lopez Infante (1935-2013). I asked him how often he performed dorsal preservation procedures in rhinoplasty such as the push down or let down operations. He paused for not more than a blink and earnestly stated, "For the first 10 years of practice I did the Push Down; the next 10 years I chiseled off the dorsum. What do you think I did for this last 10 years?" As I remember that instant in time, I said, "You returned to the push down or let down." "Exactly," he replied, "because I loved the smooth dorsum and avoiding the postoperative disrupted K-area with the attendant dorsal irregularities. And of course, I did not like the infracture needed to close the open roof that at times narrowed the nasal valve angle and area producing postoperative breathing disturbances."

Dorsal Preservation: The Push Down Technique Reassessed

Abstract

Management of the nasal dorsum remains a challenge in rhinoplasty surgery. Currently, the majority of reduction rhinoplasties results in destruction of the keystone area (K-area), which requires reconstruction with either spreader grafts or spreader flaps, both for aesthetic and functional reasons. This article will present the senior author's current operative technique for dorsal preservation in reduction rhinoplasty based on 320 clinical cases performed over a 5-year period. The author's operative technique is as follows: (1) endonasal approach; (2) removal of a septal strip in the subdorsal area whose shape and height were determined preoperatively; (3) complete lateral, transverse, and radix osteotomies; and (4) dorsal reduction utilizing either a push down operation (PDO) or a let down operation (LDO). The PDO consists of downward impaction of the fully mobilized nasal pyramid and is utilized in patients with smaller humps (<4 mm). The LDO consists of a maxillary wedge resection and is performed in patients who need more than 4 mm of lowering. A total of 320 patients had a dorsal preservation operation (DPO). Postoperatively, there were no dorsal irregularities nor inverted-V deformities. Among our 44 personal revision cases, 27 patients (8.74%) had had a previous DPO, 16 of whom required tip revisions with no further dorsal surgery. Of the remaining 11 patients, the main problems were either hump recurrence and/or lateral deviation of the dorsum or widening of the middle third, which required simple surgical revision. Based on the authors' experience, adoption of a PDO/LDO is justified in selected primary patients. The key question before any primary rhinoplasty procedure should be "Can I keep the nasal dorsum intact?" Precise analysis and surgical execution are required to preserve the dorsal osseocartilaginous vault and K-area. Dorsal preservation results in more natural postoperative dorsum lines and a "not operated" aspect without the need for midvault reconstruction. Moreover, this technique is quick and easy to perform by any rhinoplasty surgeon. Rhinoplasty surgeons should consider incorporating dorsal preservation techniques in their surgical armamentarium rather than relying solely on the Joseph reduction method or an open structure rhinoplasty.

Level of Evidence: 4

The Preservation Rhinoplasty: A New Rhinoplasty Revolution

Rhinoplasty surgery tends to evolve in generational epochs often associated with landmark publications and the simultaneous popularization of revolutionary surgical techniques. In 1978, Sheen published his monumental text Aesthetic Rhinoplasty which confirmed his status as the greatest rhinoplasty surgeon since Joseph.¹ Three critical concepts were summarized. First, rhinoplasty became a truly aesthetic operation which included preoperative analysis, operative planning, and surgical execution. Second, the reduction-only concept of Joseph was replaced with a balanced approach combining reduction and grafting in primary rhinoplasty. Third, the previously dismal results for secondary rhinoplasty were dramatically improved. Suddenly, the mark of a great rhinoplasty surgeon was no longer how quickly one could do a "nose job," but rather the achievement of an attractive natural nose with normal function.

Comments on “Double-Blind Comparison of Ultrasonic and Conventional Osteotomy in Terms of Early Postoperative Edema and Ecchymosis”

I read the manuscript by Ilhan et al¹ with great interest. The authors performed a randomized study comparing two types of osteotomy in rhinoplasty: ultrasonic and conventional osteotomy. They found that ultrasonic osteotomy results in less edema and ecchymosis. Their patients were blind to the study and not informed about which osteotomy technique was applied to them. The same surgeon performed both types of surgery and was not blinded. The postoperative evaluation of the surgical results was performed by blinded examiners. Although the authors called their study a "double-blinded" comparison, I do not agree with them.

Response to “Does Stromal Vascular Fraction Supplementation Improve Facial Lipotransfer?”

In response to the previous letter written by Dr. Swanson,¹ we are very grateful for his interest in our paper and for spending the time to analyze and comment on it. We appreciate the opportunity to clarify our arguments and ideas that, we hope, can contribute to science and to plastic surgery practices.

Response to “Comments on ‘Double-Blind Comparison of Ultrasonic and Conventional Osteotomy in Terms of Early Postoperative Edema and Ecchymosis’”

We thank Dr Cağici for his kind thoughts and for commenting¹ on our article.² Dr Cağici is correct that one cannot consider a study as "double-blinded" if both patients and surgeons are not blinded. Unfortunately, Dr Cağici misunderstood in thinking that our surgeon was not blinded. Patients who underwent surgery during odd-numbered months received conventional osteotomy, and patients who underwent surgery during even-numbered months received ultrasonic osteotomy. However, the surgeon was blinded as to which patients were included in the study, which was our randomization method for the surgeon. The patients were also blinded, as they were not informed preoperatively which osteotomy procedure they would undergo.

Response to “The Micromort Concept and its Applicability to Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) Risk Assessment”

Thank you for your insightful comments¹ on our article entitled "What's Your Micromort? A Patient-Oriented Analysis of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) Risk Assessment."² Activities such as drinking wine present risk in a J-shaped curve, in part because wine consumption may occur along a spectrum from none to excess. Whereas moderate wine consumption, even alongside heavy alcohol consumption, demonstrates multiple health benefits.³ Although the activities demonstrated by Wilson occur along a spectrum as well, many may present as all or none events, such as riding a bicycle 10 miles, riding 300 miles in a car, or traveling 1000 miles in a jet.⁴ Despite his data being older, these events would not present in a J-shaped curve as riding less in a car will not impose health benefits, but will instead only decrease risk. Likewise, having breast implants is an all or nothing event. Therefore, one cannot have "less" of a breast augmentation in hopes of pursuing health benefits. For this reason, we believe using the micromort terminology is well founded and is a valuable tool for patient education on BIA-ALCL.

Response to “Comments on ‘Nonsurgical Medical Penile Girth Augmentation: Experience-Based Recommendations’”

We thank Dr Solomon¹ for his interest in our article.² We agree that penile augmentation using injectable materials, including hyaluronic acid (HA), does have some disadvantages. HA fillers do slowly reabsorb over time and so are not a permanent solution. However, our in-progress research suggests that the nonpermanency of the procedure is potentially part of the appeal for at least some patients. These men consider a nonpermanent procedure on such an important part of their body, which they closely associate with their sense of masculinity, to be less daunting.

The Micromort Concept and its Applicability to Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) Risk Assessment

I read with interest the article by Sieber and Adams about the micromort concept and its applicability to anaplastic large cell lymphoma (ALCL) risk assessment.¹ While I concur with the conclusions of the article, I wish to point out some issues with the source data in Table 1 for risks associated with common activities. I recently attempted to locate the original reference for the micromort concept and this proved challenging. The only reference from Ronald Howard listed in PubMed is from 1989.² A 1979 article by Richard Wilson in Technology Review³ is the first appearance of the table of lifestyle risks that I could locate. The author's methodology in drafting the table appears to have simply taken averages such as the number of deaths from alcoholic cirrhosis and national average drinking, and deriving risk of a single drink from that. More sophisticated analysis shows a J-shaped curve for alcohol, especially wine, with lower risk at moderate consumption.⁴ The risk we run is missing more nuanced aspects of risk for ALCL by not factoring in the positive aspects of breast implant use. For example, there is some evidence that breast cancer survival is improved with reconstruction⁵; breast implants may have their own J-shaped curve. So while micromort analysis offers a reassuring perspective on the ALCL situation, we need to be cautious about citing outdated and poorly documented data on comparative risk.

Comments on “Nonsurgical Medical Penile Girth Augmentation: Experience-Based Recommendations”

I am writing to express my concern regarding this article.¹ The authors support the use of hyaluronic acid as an injectable material for penis enlargement. As a plastic surgeon who has been performing procedures for penis enlargement for more than 20 years, I have concerns about this endorsement. Hyaluronic acid dissipates in all cases over time. Its absorption is irregular creating nodules in every case (Figure 1). About half of the patients that I treat have unsatisfactory results from injection of a variety of materials, including hyaluronic acid, polymethylmethacrylate, fat (Figure 2), liquid silicone (Figure 3), and silicone devices (Figure 4). Each of these has unique challenges for surgical removal and each of these patients is very unhappy when they present to me. While there are options for increasing the length and girth of the penis, they are surgically demanding (Figure 5). Unlike hyaluronic acid, or any of the other fillers mentioned, the results are permanent. This is not to say that complications of surgery cannot occur. Complications do occur and as surgeons, we should be prepared to manage them to restore our patients to full function. I think it is incumbent for our members to be aware that the US Food and Drug Administration has not approved any filler for penile injection therapy. These are dermal fillers and there is no significant dermal layer in the penis. Due to the anatomy of the penis, these materials are placed in the superficial fascial layer of the penis. Placement of these materials disrupts the blood supply to the skin of the penis. When removing these materials, the blood supply to the overlying skin is compromised, which can cause skin loss as a subsequent challenge for reconstruction. I would discourage our members from adopting this method of penis enlargement.

ASJ’s Position on Publishing Papers That Discuss Off-Label Product Usage

As the Editor-in-Chief of Aesthetic Surgery Journal (ASJ), I would like to thank Dr Solomon for his Letter to the Editor entitled "Comments on 'Nonsurgical Medical Penile Girth Augmentation: Experience-Based Recommendations.'"¹ One of Dr Solomon's remarks calls for a response.

Does Stromal Vascular Fraction Supplementation Improve Facial Lipotransfer?

Gontijo-de-Amorim et al¹ claim that fat enriched with the stromal vascular fraction (SVF) improves volume retention after facial lipotransfer. The authors describe a comparison of 5 patients injected with enriched fat vs 5 patients injected without SVF supplementation using computed tomography (CT). The authors report that the enriched fat group lost only 9.6% of its volume vs 24% in the untreated group.¹ The authors simply centrifuge the lipoaspirate rather than separating it enzymatically using collagenase to isolate adipose-derived stem cells.¹ Whether the cell pellet left at the bottom of the tube after centrifugation truly represents the SVF is open to question.²

Aesthetic Refinements in C-V Flap: Raising a Perfect Cylinder

Nipple reconstruction is the keystone procedure to complete an aesthetically satisfying postmastectomy breast reconstruction. Positioning the nipple at the edge of the breast cone and achieving symmetry with the contralateral side (native or reconstructed nipple) are critical in completing a pleasing result. Furthermore, patient expectations are always higher; aesthetics becomes of paramount concern after having gone through the feelings connected with the disease.

Commentary on: Incidence and Predictors of Venous Thromboembolism in Abdominoplasty

Among healthcare providers, we all agree that collecting data is essential to document our current approach to patient care and learn how to optimize and improve this. However, if data are merely collected and never analyzed, it serves no real purpose. We congratulate the authors of this excellent paper¹ for "looking into the box" and uncovering some interesting observations through analysis of the Internet Based Quality Assurance Program (IBQAP) database that lends insight into the enigma of venous thromboembolism (VTE) occurring in patients undergoing abdominoplasty.

Facial Plastic Surgery Clinics of North America: Functional Rhinoplasty

MarcusBenjamin C., ed. Facial Plastic Surgery Clinics of North America: Functional Rhinoplasty. New York, NY: Elsevier, 2017. ISBN-13: 978-0323528382. $98.99.

Commentary on: Adipose-Derived Stem Cells in Aesthetic Surgery: A Mixed Methods Evaluation of the Current Clinical Trial, Intellectual Property, and Regulatory Landscape

Adipose-derived stem cells (ADSC) continue to incite controversy in the medical profession, are highly sought after by the public, incite excitement in commercial companies, and are seen as a lucrative income generator in clinics. This interesting analysis of ADSC registered trials as well as registered intellectual properties further illustrates these points.¹

Incidence and Predictors of Venous Thromboembolism in Abdominoplasty

Abstract

Background

The prevention of venous thromboembolism (VTE) is a high priority in aesthetic surgery. Abdominoplasty is the aesthetic procedure most commonly associated with VTE, yet the mechanisms for the development of VTE associated with this procedure are unclear.

Objectives

The purpose of this study was to analyze the incidence and predictors of VTE in patients undergoing abdominoplasty procedures in outpatient surgery centers using data from the Internet Based Quality Assurance Program (IBQAP).

Methods

IBQAP data from 2001 to 2011 were queried retrospectively to identify abdominoplasty cases and VTE cases. Patient- and procedure-specific variables were analyzed to identify potential predictors of VTE in abdominoplasty.

Results

Among all outpatient aesthetic surgery cases entered from 2001 to 2011, 414 resulted in VTE, representing a VTE incidence of 0.02%. Of these, 240 (58%) occurred in abdominoplasty cases. Predictors of VTE were age greater than 40 years and BMI greater than 25 kg/m². Patient sex, duration of anesthesia and surgery, type of anesthesia, type of additional procedure, and number of procedures did not appear to influence the risk of VTE. Importantly, 95.5% of the VTEs identified for this study occurred in patients whose Caprini risk assessment model score was between 2 and 8, which would not be an indication for chemoprophylaxis according to current recommendations.

Conclusions

Many factors must be considered when determining the true incidence of VTE in abdominoplasty. Research is needed to discover the reason abdominoplasty carries a greater risk compared with other aesthetic surgery procedures so that appropriate steps can be taken to prevent its occurrence and improve the safety of the procedure.

Level of Evidence: 2

Scarless Breast Reconstruction: Indications and Techniques for Optimizing Aesthetic Outcomes in Autologous Breast Reconstruction

Summary: Breast reconstruction that leaves no visible scars on the breast is possible for a subset of patients. This article reviews a cohort of 10 patients who underwent 14 autologous breast reconstructions. To achieve a reconstruction without visible breast scars, the mastectomy and autologous reconstruction are carried out through a periareolar incision. At the completion of the reconstruction, a small skin paddle is externalized through the mastectomy incision and in a subsequent stage entirely incorporated into a nipple areola reconstruction. Following completion of the breast and nipple areola reconstruction, a tattoo is performed that extends beyond the perimeter of the reconstructed areola and conceals all scars on the breast mound. The ideal candidate for this technique has a small or medium size breast, which is non- or minimally ptotic, and a donor site that can yield a flap larger than the volume of the native breast. In properly selected patients, this technique consistently yields high-quality results, which match or even surpass the aesthetics of the original breast.

Reexploring the Anatomy of the Distal Humerus for its Role in Providing Vascularized Bone

Background: The lateral arm flap is used for composite defects in need of vascularized soft tissue, skin, and bone. From its original description, the distal humeral metaphysis can be included with the flap, supplied by the periosteal extensions of the posterior branch of the radial collateral artery. We sought to reexplore the anatomy of the lateral arm to determine its utility as a donor site for vascularized bone. Methods: Twelve fresh, silicone-injected cadaver dissections were performed. Arteriovenous anatomy, pedicle length and diameter, and anatomic variability as well as photo documentation was recorded. Results: The distal extent of the deltoid, lateral intermuscular septum and lateral humeral epicondyle were identified before the dissection. A septocutaneous perforator was consistently located 10 cm proximal to the lateral humeral epicondyle, which could be used for a skin paddle to monitor. Harvest of a 1.5 cm × 2 cm corticocancellous bone graft was performed. Average pedicle length was 9.1 ± 1.1 cm, and average pedicle diameter was 1.74 ± 0.52 mm. The inferior lateral cutaneous nerve of the arm and the posterior cutaneous nerve of the forearm were consistently identified and preserved. Conclusion: The predictable anatomy of the lateral distal humerus make it an ideal donor site for small segments of vascularized bone.

Novel compound heterozygous mutations in KREMEN1 confirm it as a disease gene for ectodermal dysplasia

Abstract

Ectodermal dysplasia (ED) is a heterogeneous group of disorders caused by mutations in at least thirteen genes. Recently, a study reported Palestinian patients with ED from consanguineous families with a homozygous mutation in KREMEN1 (Kringle-containing transmembrane protein 1) and proposed it to be a causative gene for the autosomal recessive ED 13, hair/tooth type (ECTD13; OMIM #617392). A Thai family, parents and two children affected with ED, was recruited. The study was exempted from review by the Institutional Review Board, Faculty of Medicine, Chulalongkorn University (IRB584/60). Written informed consents of each participant were obtained according to the Declaration of Helsinki. Mutation analyses were performed as described previously.

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Pulmonary function in subjects with psoriasis: A cross-sectional population study

Abstract

Psoriasis is a prevalent chronic inflammatory disease associated with comorbidities, e.g. cardiometabolic diseases, inflammatory bowel disease, and depression that may share an inflammatory origin. Smoking increases the risk of psoriasis and the disease has also been linked to chronic obstructive pulmonary disease (COPD) and asthma, with evidence of shared inflammatory cytokine-mediated mechanisms. Moreover, subjects with psoriasis display increased risk of infections, especially respiratory infections including pneumonia. However, only a small single-center study of pulmonary function in subjects with psoriasis is available.

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Recurrent erysipelas of the face with hyperimmune reaction to group C streptococcus

Abstract

We present the case of a 73-year-old-woman, admitted in 2014 for n erysipelas of the face (figure 1a) beginning 3 days before, with red oedematous papules of the left temple, hyperthermia and chills the day after. Clinical examination did not find lymphadenopathy or skin lesion especially at her left ear. Blood samples showed a raised C reactive protein (CRP) to 120 mg/L without leukocytosis. Antinuclear antibodies were negative. Viral serologies (HIV, hepatitis C and B, EBV, parvovirus B19, VZV, mumps), viral PCR assay (EBV, parvovirus B19, CMV, VZV) and bacterial blood cultures were all negative Histopathological findings revealed a reactive infiltrate without vasculitis and necrosis.

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Differential blood cellular profile in patients with moderate to severe psoriasis treated with classical systemic therapies: A step forward in personalised medicine

Abstract

patients with moderate to severe psoriasis are difficult to treat with topical therapy only and they usually require additional systemic therapy. Despite this, a significant percentage of patients on these therapies shows an inadequate response to these drugs. Treatment decisions are often difficult as they usually rely on subjective terms. Therefore, finding indicators that predict efectiveness or failure to classical systemic therapy is an urgent need. The objective of this study was to analyse whether the phenotype of peripheral blood mononuclear cells (PBMC) would be different in responder or non-responder patients to classical systemic therapy, and thus could be used as a efectiveness predictor of this therapy effectiveness. These predictor markers could help physicians to choose the best individualised treatment for psoriasis patients.

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Cutaneous squamous cell carcinomas are associated with basal proliferating actinic keratoses

Abstract

Background

In addition to the extent of atypical keratinocytes throughout the epidermis, actinic keratoses (AKs) are histologically characterized by downward directed basal layer expansion. It is not known if this growth pattern correlates with the risk of developing invasive squamous cell carcinoma (iSCC).

Objective

To characterize the prevalence of downward directed basal layer expansion of AKs adjacent to iSCC.

Methods

The epidermis overlying and adjacent to iSCCs was assessed histologically. We determined the histological grade (AKI-III), basal growth pattern (PROI-III) and accompanying parameters such as adnexal involvement.

Results

Of 307 lesions, 52.4% of AKs were histologically classified as AKI, 38.1% as AKII, and 6.8% as AKIII (chi-squared; P<0.0001). 2.6% of adjacent epidermis did not show any atypical keratinocytes. The epidermis adjacent to iSCCs was classified as having a PROI basal growth pattern in 25.7%, PROII in 31.9%, and PROIII in 39.4% cases. 2.9% of AKs showed no basal growth (chi-squared; P<0.0001).118 (48.8%) AKs showed extension into adnexal structures. These AKs were graded as PROI in 18.6%, PROII in 30.5%, and PROIII in 50.8%. The epidermis above iSCCs could only be assessed for upwards directed growth and showed no significant differences in the three AK grades (P=0.4211).

Conclusions

Basal proliferative AKs as well as atypical keratinocytes restricted to the lower third of the epidermis are most commonly seen adjacent to iSCC with less evidence for full thickness epidermal dysplasia. Our study supports the important role of dysplastic keratinocytes in the epidermal basal layer and their potential association with iSCC.

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Population-based prevalence of Eosinophilic (Shulman's) Fasciitis: a capture-recapture study

Abstract

Our knowledge of Eosinophilic fasciitis (EF), also known as Shulman's syndrome, is limited, and its prevalence has not been estimated so far. We conducted a regional survey which aimed at estimating the prevalence of EF in Alsace, a Region in the North-East of France. We retrospectively collected EF cases from the first of January 1983 to the 30^th of March 2015 among Alsace residents aged >18 years, then performed a capture-recapture analysis with the prevalent cases in 2015.

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On the Mechanism of Photodehydrogenation of Aryl(hetaryl)pyrazolines in the Presence of Perchloroalkanes

Abstract

New (1,5-diaryl-3-pyrazolinyl)coumarins have been synthesized. In opposite to (1,5-diaryl-3-pyrazolinyl)-4-hydroxycoumarins these compounds are not able to keto-enol tautomeric transformations with changes of the solvent. (1,5-Diaryl-3-pyrazolinyl)coumarins provide dehydrogenation reaction under irradiation in the presence of perchloroalkanes and manifest themselves as effective photogenerators of acidity. Several aspects of photodehydrogenation mechanism have been studied. Oxygen is shown not be involved in the reaction. Polar solvents increase rate of the reaction. The measured rate constants of the photodehydrogenation reactions vary in a significant range according to the structure of pyrazoline. The data correlate with ionization potentials of pyrazolines available from DFT quantum chemical calculations. These results are discussed in terms of proposed scheme of mechanism of pyrazolines photodehydrogenation assuming formation of ion-radical and ion intermediates.

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