A critical assessment of Pereboom’s Frankfurt-style example

Abstract

In this paper, I assess Derk Pereboom's argument for the thesis that moral responsibility does not require the ability to do otherwise. I argue that the Frankfurt-style example Pereboom develops presupposes a prior act or omission which the agent was able to avoid. This undermines his argument. I propose a way for Pereboom to revise his example and thereby undercut this objection. Along the way, I also argue that Pereboom should supplement his account of what counts as a robust alternative—an alternative of the sort that should matter to those who argue for an ability-to-do-otherwise condition on moral responsibility.

Quantum monism: an assessment

Abstract

Monism is roughly the view that there is only one fundamental entity. One of the most powerful argument in its favor comes from quantum mechanics. Extant discussions of quantum monism are framed independently of any interpretation of the quantum theory. In contrast, this paper argues that matters of interpretation play a crucial role when assessing the viability of monism in the quantum realm. I consider four different interpretations: modal interpretations, Bohmian mechanics, many worlds interpretations, and wavefunction realism. In particular, I extensively argue for the following claim: several interpretations of QM do not support monism at a more serious scrutiny, or do so only with further problematic assumptions, or even support different versions of it.

Substitution in a sense

Abstract

The Reference Principle (RP) states that co-referring expressions are everywhere intersubstitutable salva congruitate. On first glance, (RP) looks like a truism, but a truism with some bite: (RP) transforms difficult philosophical questions about co-reference into easy grammatical questions about substitutability. This has led a number of philosophers to think that we can use (RP) to make short work of certain longstanding metaphysical debates. For example, it has been suggested that all we need to do to show that the predicate '( ) is a horse' does not refer to a property is point out that '( ) is a horse' and 'the property of being a horse' are not everywhere intersubstitutable salva congruitate. However, when we understand 'substitution' in the simplest and most straightforward way, (RP) is no truism; in fact, natural languages are full of counterexamples to the principle. In this paper, I introduce a new notion of substitution, and then develop and argue for a version of (RP) that is immune to these counterexamples. Along the way I touch on the following topics: the relation between argument forms and their natural language instances; the reification of sense; the difference between terms and predicates; and the relation between reference and disquotation. I end by arguing that my new version of (RP) cannot be used to settle metaphysical debates quite as easily as some philosophers would like.

Direct perception and the predictive mind

Abstract

Predictive approaches to the mind claim that perception, cognition, and action can be understood in terms of a single framework: a hierarchy of Bayesian models employing the computational strategy of predictive coding. Proponents of this view disagree, however, over the extent to which perception is direct on the predictive approach. I argue that we can resolve these disagreements by identifying three distinct notions of perceptual directness: psychological, metaphysical, and epistemological. I propose that perception is plausibly construed as psychologically indirect on the predictive approach, in the sense of being constructivist or inferential. It would be wrong to conclude from this, however, that perception is therefore indirect in a metaphysical or epistemological sense on the predictive approach. In the metaphysical case, claims about the inferential properties of constructivist perceptual mechanisms are consistent with both direct and indirect solutions to the metaphysical problem of perception (e.g. naïve realism, representationalism, sense datum theory). In the epistemological case, claims about the inferential properties of constructivist perceptual mechanisms are consistent with both direct and indirect approaches to the justification of perceptual belief. In this paper, I demonstrate how proponents of the predictive approach have conflated these distinct notions of perceptual directness and indirectness, and I propose alternative strategies for developing the philosophical consequences of the approach.

The semantic plights of the ante-rem structuralist

Abstract

A version of the permutation argument in the philosophy of mathematics leads to the thesis that mathematical terms, contrary to appearances, are not genuine singular terms referring to individual objects; they are purely schematic or variables. By postulating 'ante-rem structures', the ante-rem structuralist aims to defuse the permutation argument and retain the referentiality of mathematical terms. This paper presents two semantic problems for the ante-rem view: (1) ante-rem structures are themselves subject to the permutation argument; (2) the ante-rem structuralist fails to explain reference in a way that makes her account different to, and privileged over, that of her eliminativist rivals. Both problems undercut the motivation behind ante-rem structuralism.

Material objects and essential bundle theory

Abstract

In this paper we present a new metaphysical theory of material objects. On our theory, objects are bundles of property instances, where those properties give the nature or essence of that object. We call the theory essential bundle theory. Property possession is not analysed as bundle-membership, as in traditional bundle theories, since accidental properties are not included in the object's bundle. We have a different story to tell about accidental property possession. This move reaps many benefits. Essential bundle theory delivers a simple theory of the essential properties of material objects; an explanation of how object coincidence can arise; an actual-world ground for modal differences between coincident objects; a simple story about intrinsic properties; and a plausible account of certain ubiquitous cases of causal overdetermination.

Philosophers should prefer simpler theories

Abstract

Recent years have seen considerable attention paid to the methodology of philosophy. The puzzle is simple—if philosophy is not an empirical discipline, how can one philosophical theory be rationally preferred over another? One answer to this question is that we should apply the theoretical virtues. Foremost among these theoretical virtues is simplicity—so perhaps we should prefer simpler philosophical theories to more complex ones. Huemer (Philos Q 59:216–236, 2009) objects that the reasons to prefer simpler theories in science do not apply in philosophy. I will argue that Huemer is mistaken—the arguments he marshals for preferring simpler theories in science can also be applied in philosophy. Like Huemer, I will focus on the philosophy of mind and the nominalism/Platonism debate. But I want to engage with the broader issue of whether simplicity is relevant to philosophy.

Scalar consequentialism the right way

Abstract

Rightness and wrongness come in degrees that vary on a continuous scale. Examples in which agents have many options that morally differ from each other demonstrate this. I suggest ways to develop scalar consequentialism, which treats the rightness and wrongness of actions as matters of degree, and explains them in terms of the value of the actions' consequences. Scalar consequentialism has a variety of linguistic resources for understanding unsuffixed "right." It also has advantages over some deontological theories in accounting for rightness.

‘The Most Beautiful Blue’: Painting, Science, and the Perception of Coloured Shadows

Abstract

This article examines first of all how painters' ability to perceive transient coloured shadows was both facilitated, and impoverished, by scientific theories of their causes. It then investigates how developing techniques of viewing the scene through a frame or half-closed eyes allowed artists to apprehend these elusive phenomena in something approaching their full richness.

Paula Gerber and Katie O’Byrne (eds): Surrogacy, law and human rights

Rivka Weinberg: The risk of a lifetime: how, when, and why procreation may be permissible

Dermatologic Reactions to Novel Immune Checkpoint Inhibitors

Abstract

Purpose of Review

Dermatologic toxicities secondary to immune checkpoint inhibitors are prevalent and can be difficult to manage in the setting of underlying malignancy. This review summarizes the mucocutaneous adverse events associated with these agents and provides management options for varying degrees of presentation.

Recent Findings

Pruritus and rash are the most common dermatologic findings, but other manifestations such as vitiligo, lichenoid reactions, bullous pemphigoid, alopecia, and mucosal lesions have been observed. More recently, novel cases of rarer side effects, such as immunotherapy-induced scleroderma, fasciitis, and dermatomyositis, have been reported. Management often involves topical corticosteroids while more severe reactions require systemic treatment or discontinuation of immunotherapy.

Summary

Immune checkpoint inhibitors comprise a newer class of agents used in the treatment of various cancers. There is an increasing number and variety of cutaneous toxicities being reported as more of these immunotherapies are being used. Early diagnosis and treatment are crucial in effective management of these skin toxicities.

Evaluation of the Implementation of the Healthy Start Program: Findings from the 2016 National Healthy Start Program Survey

Abstract

Objectives The Healthy Start Program has taken a community-based approach to improving maternal and child health outcomes among underserved populations for 25 years. Although the program has been evaluated in the past, it has not undergone a national evaluation since it was transformed in 2014. The purpose of this study is to present data from an early component of the latest national evaluation—the 2016 National Healthy Start Program Survey, which includes information describing grantees, the risk profile of participants served, and the scope of services offered to meet participant needs. Methods Ninety-five grantees completed the survey, and responses are reported at the aggregate level. Study analyses are descriptive. Results Grantees reported serving a population with a high-risk profile characterized by chronic medical conditions or risk behaviors. Most grantees conduct comprehensive needs/risk assessments for participants upon program entry, yet service delivery strategies were mixed, with some differences found by geographic region. Grantees provide a core set of services to participants, including case management and health promotion/education, and tend to refer participants to community providers for services that are deemed appropriate during individual risk assessments. While most grantees have protocols in place related to these priority services, participants may not have been universally offered all services across sites. Conclusions for Practice Although grantees often highlight their facilitation of service/care coordination with existing resources, findings suggest potential areas on which to focus strategic efforts to ensure that the Healthy Start Program is successfully bridging gaps in access and utilization of services for underserved communities.

A paediatric case of cutaneous larva migrans acquired in the UK

Clinical and Experimental Dermatology, EarlyView.

Dear Dr. Dermatoethicist: Erection Ethics

Surgical Pearl: Reverse Beveling to Improve Wound Edge Apposition

The Cost of an Itch: A Nationally Representative Retrospective Cohort Study of Pruritus-Associated Healthcare Expenditure in the United States

Association between atopic dermatitis, depression and suicidal ideation: A systematic review and meta-analysis

This meta-analysis found that atopic dermatitis was associated with increased odds of clinical depression, depressive symptoms, anti-depressant use, suicidality and parental depression. Presence of depression and suicidality should be incorporated into clinical decision-making of atopic dermatitis patients.

Treatment of primary non-metastatic melanoma at high-volume academic facilities is associated with improved long-term patient survival

Volume-outcome relationships in cancer care have motivated calls for regionalization of care. We demonstrate that high-volume academic facilities achieve improved outcomes for melanoma patients. Increased utilization of those aspects of these centers that increase patient survival, whether by regionalization of care or dissemination of these practices, may improve patient outcomes.

High-Throughput Sequencing of the T-cell receptor beta chain gene distinguishes two subgroups of cutaneous T-cell lymphoma

IgE-selective immunoadsorption reduces peripheral and skin-bound IgE and modulates cutaneous IL-13 expression in severe atopic dermatitis

'Oldest Intact Shipwreck Known To Mankind' Found In Depths Of Black Sea

The vessel dates back 2,400 years to the days of ancient Greece. "This will change our understanding of shipbuilding and seafaring in the ancient world," says archaeologist Jon Adams.

(Image credit: Black Sea MAP/EEF Expeditions)

What's Going On With That Bizarre Rectangular Iceberg?

It's getting a lot of attention because of its unexpected angles and straight lines. A sea ice specialist explains why it formed this way.

(Image credit: NASA ICE)

Face and Neck Lifting After Weight Loss

After massive weight loss, deflation of the tissues and loss of skin elasticity in the face and neck can result in the appearance of accelerated facial aging. Surgical facial rejuvenation can be successfully performed with several modifications. Proper preoperative counseling and expectation management regarding staged or ancillary procedures is recommended. Wide undermining of the face and neck, and extended postauricular incisions are required to allow for mobilization of excess skin and access to the mobile superficial musculoaponeurotic system (SMAS). Fat transfer into the deep malar compartment for midface volumizing is helpful. Treatment of the SMAS and platysma are universally necessary.

Breast Reshaping After Massive Weight Loss

The technique of dermal suspension, parenchymal reshaping mastopexy is a useful procedure for patients with massive weight loss with a typical presentation. The operation is tailored to the individual deformity, powerfully reshapes the breast, and can be safely combined with other commonly performed procedures. It is long-lasting and associated with minor complications that are easily treated in an office setting.

A Practical Approach to the Diagnosis and Treatment of Adult Erythroderma

Publication date: Available online 22 October 2018

Source: Actas Dermo-Sifiliográficas (English Edition)

Author(s): A. Cuellar-Barboza, J. Ocampo-Candiani, M.E. Herz-Ruelas

Abstract

Erythroderma is an inflammatory skin syndrome that involves desquamation and erythema of more than 90% of the body surface area. It represents a final clinical endpoint for many adult dermatological conditions. The most frequent cause of erythroderma is psoriasis followed by eczematous conditions, drug-induced reactions, pityriasis rubra pilaris and cutaneous T-cell lymphomas. Diagnostic approach must include a thorough history and clinical examination. If the etiology of erythroderma is uncertain multiple skin biopsies may enhance diagnostic accuracy. The initial management of erythroderma must include a nutrition expert evaluation, fluid imbalance assessment, maintaining skin barrier function, sedative antihistamines and exclusion of secondary bacterial infection. We present a practical review of the etiology, diagnosis, and treatment of this entity.

Resumen

La eritrodermia es un síndrome inflamatorio de la piel caracterizado por descamación y eritema en más del 90% de la superficie corporal. Representa la etapa final de muchas enfermedades dermatológicas en el adulto. La causa más frecuente es la psoriasis, le siguen las enfermedades eccematosas, las reacciones medicamentosas, la pitiriasis rubra pilaris y los linfomas cutáneos de células T. El abordaje diagnóstico debe incluir una historia y examen físicos exhaustivos. Si se desconoce la etiología de la eritrodermia es posible que múltiples biopsias a lo largo del curso de la enfermedad aumenten las posibilidades de un diagnóstico correcto. El abordaje inicial de la eritrodermia debe incluir la evaluación de un experto en nutrición, la valoración del balance hidroelectrolítico, medidas para mantener la función de barrera de la piel, antihistamínicos con efecto sedante y la exclusión de infecciones bacterianas secundarias. Presentamos una revisión práctica de la etiología, diagnóstico y tratamiento de esta entidad.

Combined, two‐layered reconstruction technique for full‐thickness nasal defects

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.

Outcomes of Frontalis Sling Versus Levator Resection in Patients With Monocular Elevation Deficiency Associated Ptosis

Purpose: To compare outcomes of frontalis sling (FS) silicone and levator resection (LR) in ptosis associated with monocular elevation deficiency. Methods: Retrospective interventional comparative case series of FS and LR in monocular elevation deficiency associated ptosis. Favorable outcome was defined as difference in margin reflex distance 1 of ≤1 mm between the 2 eyes in unilateral cases and margin reflex distance 1 of 4 mm in bilateral cases at last follow-up visit. Results: One hundred four eyes of 95 patients were included. Median age at surgery was 14 years, and the mean follow-up period was 19.75 ± 34.55 months. Ptosis was severe in 91 (87.5%) patients. Associated Marcus Gunn jaw-winking (MGJW) phenomenon was seen in 43 (42%) patients. Frontalis sling was performed in 76 (73%) and LR in 28 (27%). Mean pre- and postoperative margin reflex distance 1 were −1.27 ± 2.17 mm and 2.18 ± 1.49 mm (p

Aspergillus fumigatus conidia stimulate lung epithelial cells (TC-1 JHU-1) to produce IL-12, IFNγ, IL-13 and IL-17 cytokines: Modulatory effect of propolis extract

Publication date: Available online 22 October 2018

Source: Journal de Mycologie Médicale

Author(s): A.R. Khosravi, S. Alheidary, D. Nikaein, N. Asghari

Abstract

Aspergillus fumigatus conidia are the most prevalent indoors fungal allergens. The interaction between Aspergillus antigens and lung epithelial cells (LECs) result in innate immune functions. The association between Aspergillus conidia and allergic reactions, like allergic bronchopulmonary aspergillosis (ABPA) and asthma have been repeatedly reported. Since conventional therapies for allergy and asthma are limited, finding new promising treatments are inevitable. This study was designed to evaluate the effect of A. fumigatus conidia on IL-12, IFNγ, IL-13 and IL-17 release from mouse LECs and to investigate the effect of propolis on cytokines modulation. Cells were divided to two groups, one was exposed to 3 × 10⁴ conidia of Aspergillus fumigatus and another group was treated by propolis (25 μg/mL) as well as exposed to A. fumigatus conidia. Cytokines IL-13, IL-12, IFNγ and IL-17 were measured at times 0, 6 and 12 hours after exposure using ELISA assay. The results indicated that A. fumigatus could increase the release of the cytokines with IL-13 and IL-17 being the most affected ones whilst treatment with propolis decreased the effects of A. fumigatus on IL-13 and IL-17 production. The results showed that propolis has down regulatory effects on Th2 cytokine, IL-13, and IL-17 production, whereas it caused a significant induction of IL-12, as an important Th1 cytokines by LECs. With respect to the obtained results, propolis extract might be contributed to decrease Th2 responses in allergic asthma phenomenon. However more investigations must be done in future to fully understand its efficacy.

A link between Autophagy and Apoptosis: Chat with First Author Brent E. Fitzwalter

By Christina Towers, PhD.

Autophagy is a cellular recycling process and most often a pro-survival mechanism that regulates cellular homeostasis. On the contrary, apoptosis is an extensively conserved and elaborate programmed cell death process, and it is well established that the two processes are often opposing forces within the cell. Despite the agreed upon notion that autophagy can protect cells from apoptosis, the mechanistic link has yet to be elucidated. This is especially important given the 60 (and growing) number of clinical trials that are currently underway inhibiting autophagy in cancer in combination with other chemotherapies and targeted therapeutics.

The field is hopeful that autophagy inhibition will enhance drug induced cell death. A recent publication by Fitzwalter et al. in the journal Developmental Cell identifies FOXO3a mediated regulation of PUMA as a critical link between autophagy and apoptosis¹. Most importantly, they also show that cell death induced by clinically relevant targeted therapeutics can be greatly improved upon when combined with autophagy inhibitors; and this mechanism is dependent on FOXO3a mediated regulation of PUMA.

Find out more about the publication and its relevance to the field in this chat with the first author graduate student:

Your browser does not support the audio element.

Brent E. Fitzwalter is a PhD candidate in the laboratory of Andrew Thorburn at the Department of Pharmacology, University of Colorado School of Medicine, Aurora, CO, USA

Learn more about Autophagy

Christina Towers, PhD
University of Colorado (AMC)
Dr. Towers studies the roles of autophagy, apoptosis and cell death in cancer.

References

1. Autophagy Inhibition Mediates Apoptosis Sensitization in Cancer Therapy by Relieving FOXO3a Turnover. Fitzwalter BE, Towers CG, Sullivan KD, Andrysik Z, Hoh M, Ludwig M, O'Prey J, Ryan KM, Espinosa JM, Morgan MJ, Thorburn A.Dev Cell. 2018 Mar 12;44(5):555-565.e3. doi: 10.1016/j.devcel.2018.02.014.

Tags: 

Autophagy

autophagosome

Lysosome

Apoptosis

FOXO3A

PUMA

Category: 

Antibodies

Antibody catalog

Antibody database

Antibody suppliers

Autophagy

Autophagosome

Apoptosis

Cancer

Cancer Research

Neurodegeneration

Lésions auto-provoquées dans un contexte d’hidradénite suppurée : un cas de pathomimicrie

Publication date: Available online 22 October 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): A. Marzouki-Zerouali, A. Schoeffler, A.-L. Liegeon, P. Le Vaou, F. Truchetet

Résumé

Introduction

Les troubles factices constituent un domaine complexe de la pathologie. Si le diagnostic est souvent évoqué, il est difficile à poser et la thérapeutique est délicate. La pathomimie cutanée est une expression somatique cutanée d'un désordre psychiatrique souvent grave, provoquée dans un état de conscience claire par le malade lui-même sur son revêtement cutanéomuqueux mais dont la motivation est inconsciente, sans recherche de bénéfices secondaires ; elle se distingue donc de la simulation. Les pathomimicries représentent une entité particulière proche de la pathomimie : il s'agit de l'induction de poussées d'une maladie connue déclenchées par l'exposition volontaire à l'agent responsable. Nous rapportons un cas de pathomimicrie dans un contexte d'hidradénite suppurée.

Observation

Une adolescente ayant pour antécédents principaux une obésité de grade 2 et un épisode d'abcès pubien était vue en consultation pour des lésions axillaires. Elle arrivait dans un état d'incurie, méfiante, agressive et refusait de se déshabiller. Après mise en confiance, l'examen clinique montrait de larges ulcérations à distance des plis sur les zones axillaires, à contours géographiques et à fond propre et bourgeonnant, associées à des lésions typiques d'hidradénite suppurée de grade 2 (Hurley), avec des pertuis purulents et des cicatrices en corde des plis inguinaux. Une hospitalisation était proposée et l'évolution était favorable sous antibiothérapie par doxycycline et soins locaux par pansements alginates et hydrocellulaires. L'avis psychiatrique concluait à une faille narcissique ancienne à type de dysmorphophobie probablement réactionnelle à un harcèlement scolaire récurrent depuis l'enfance. Sous couvert d'une relation de confiance difficilement établie, la patiente reconnaissait la manipulation de ses lésions. Devant les données anamnestiques, cliniques, la négativité du bilan paraclinique, le diagnostic de pathomimicrie était retenu.

Discussion

Plusieurs cas de pathomimicrie de dermatoses (auto-entretien d'un ulcère de cause connue, contact avec un allergène identifié dans l'eczéma ou reprise d'un médicament incriminé dans une toxidermie) ou de maladies systémiques (injections d'insuline chez un patient diabétique) ont été rapportés. Ce cas est le premier décrit, à notre connaissance, de pathomimicrie dans le cadre d'une hidradénite suppurée. Sur le plan thérapeutique, le suivi doit être multidisciplinaire. Il faut éviter l'affrontement avec le patient et ne pas forcer son aveu, ce qui risquerait d'induire une décompensation psychiatrique grave. Une attitude rassurante permet le recours au psychiatre une fois la confiance durablement établie. Le dermatologue a donc une place primordiale dans la prise en charge de ces patients.

Summary

Background

Factitious disorders constitute a complex pathology for the dermatologist. Although a diagnosis is often indicated, it is difficult to confirm and treatment is complicated. Dermatitis artefacta is the somatic expression of an often serious psychiatric disorder consciously created by patients on their own cutaneous-mucosal surfaces but the motivation is unconscious and no secondary benefits are sought (in contrast to simulation). Pathomimicry represent a specific entity: the provocation of outbreaks of a known disease, triggered by voluntary exposure to a causative agent. Herein we report on a case of pathomimicry in a context of hidradenitis suppurativa.

Patients and methods

A teenage girl whose main previous medical history consisted of grade-2 obesity and an episode of pubic abscess was seen at our clinic for axillary lesions. She presented in a state of negligence, was suspicious and aggressive, and refused to undress. After gaining her trust, clinical examination revealed prominent ulcerations (each with a granulated base) at a distance from the folds in the axillary areas, as well as typical hidradenitis lesions of Hurley Grade 2 with purulent openings and rope-like scars from the inguinal folds. Hospitalization was recommended and a positive outcome was achieved under antibiotic therapy with doxycycline, topical alginate and hydrocellular dressings. A psychiatric evaluation concluded that the patient was presenting dysmorphophobic narcissistic weakness, probably in reaction to recurrent harassment at school since childhood. Once she developed trust with us, which was difficult to establish, the patient admitted to having caused the lesions herself. Given the history and clinical data, as well as the negative laboratory tests, a diagnosis of pathomimicry was made.

Discussion

Several cases of dermatological pathomimicry (sustainment by the patient of an ulcer with a known cause, contact with an allergen found in eczema, or renewed use of a medication implicated in toxiderma) or systemic disease (insulin injection in a diabetic patient) have been reported. To the best of our knowledge, this is the first description of pathomimicry associated with hidradenitis suppurativa. Regarding therapy, aftercare should be multidisciplinary. Confessions should not be forced and confrontations, which risk serious psychiatric collapse, should be avoided. A reassuring attitude enables psychiatry to be applied once trust has been sustainably established, hence the crucial role of the dermatologist.

Exserohilum Infections in Australian Queensland Children

Mycoses, Volume 0, Issue ja, -Not available-.

Hyaluronic acid gel based on CPM® technology with and without lidocaine: Is there a difference?

Journal of Cosmetic Dermatology, EarlyView.

Effects of isotretinoin on the hair cycle

Journal of Cosmetic Dermatology, EarlyView.

Autologous pure platelet‐rich plasma injections for facial skin rejuvenation: Biometric instrumental evaluations and patient‐reported outcomes to support antiaging effects

Journal of Cosmetic Dermatology, EarlyView.

Predictive value of primary tumor parameters using 18 F-FDG PET/CT for occult lymph node metastasis in breast cancer with clinically negative axillary lymph node

Abstract

Objective

This study aimed to demonstrate the clinical significance of total lesion glycolysis (TLG) of primary breast cancer using ¹⁸F-FDG PET/CT to predict axillary lymph node (ALN) metastasis in invasive ductal breast cancer (IDC) with a clinically negative axillary lymph node (cN-ALN).

Methods

135 patients, newly diagnosed with IDC with _CN-ALN between July 2016 and October 2017, were retrospectively enrolled. We estimated primary tumor PET/CT parameters including the maximum standard uptake value (SUV_max), metabolic tumor volume (MTV), and TLG, as well as clinicopathologic findings. All patients received breast surgery followed by pathologic axillary lymph node examination.

Results

Of the 135 patients, 31 (23.0%) were diagnosed with pathologically proven metastatic ALN. In univariate analysis, SUV_max, MTV, and TLG of the primary breast tumor were correlated with metastatic ALN along with tumor size, lymphovascular invasion, CD34, and D2-40. On multivariate analysis, TLG (> 5.74, p = 0.009) had independent significance for predicting ALN metastasis in IDC with cN-ALN.

Conclusion

We demonstrated that TLG of primary tumors can be useful in predicting pathologic ALN metastasis in IDC patients with cN-ALN.

Andrologie bei onkologischen Erkrankungen

Zusammenfassung

In der dermatoonkologischen Behandlung findet sich eine Vielzahl gonadotoxischer Interventionen. Insbesondere alkylierende und hormonell aktive Substanzen sowie gonadale Bestrahlungen sind bekannt für eine fertilitätseinschränkende Wirkung beim Mann. Die zertifizierten Hautkrebszentren in Deutschland haben deshalb seit 2017 die Auflage zur Umsetzung von Beratungen zum Fertilitätserhalt. Gestützt wird dies durch die S2k-Leitlinie zur Fertilitätserhaltung bei onkologischen Therapien. Da die verschiedenen Interventionen von den dermatoonkologischen Leitlinien stadienabhängig empfohlen werden, befürworten die Autoren mindestens die Frage „Ist Kinderwunsch ein Thema für Sie?", wenn Patienten ein entsprechendes Stadium erreichen. Die Fertilitätsprotektion des Mannes über eine Kryokonservierung von Ejakulat oder Hodenmaterial ist dann eine einfache und sichere Möglichkeit. Das Verfahren ist standardisiert und häufig verfügbar. Zudem bietet sich über das neue Projekt Androprotect jetzt die Möglichkeit zur Kryokonservierung von Hodenmaterial präpubertärer männlicher Kinder und Säuglinge. Treten unter Therapie Zeichen eines Hypogonadismus auf, kann in Abwägung der Testosteronwirkungen eine Behandlung erwogen werden, wichtig ist, hier die anabolen und immunmodulierenden Effekte zu beachten.

High-intensity focused ultrasound ablation: a non-surgical approach to treat advanced and complicated liver alveococcosis

Abstract

Liver alveococcosis is a life-threatening parasitic disease with progressive growth and wide metastasis to neighboring tissues, lungs, and brain. The radical treatment option is surgery along with a few chemical therapies. However, the frequency of progression and recurrence, as well as postoperative complications and mortality, remains very high. The high-intensity focused ultrasound (HIFU) treatment system, a therapeutic application using ultrasound to deliver heat or agitation into the body, was initially designed to treat cancer. Advanced and complicated forms of liver alveococcosis usually require surgical treatment to provide partial ectomy of necrotized liver tissue along with alveococcal caverns and sanitation of the peritoneal cavity. In this article, we presented a case of successful HIFU ablation with transhepatic puncture and drainage in treatment of complicated and advanced liver alveococcosis to avoid wide surgical treatment.

Andrologie bei onkologischen Erkrankungen

Zusammenfassung

In der dermatoonkologischen Behandlung findet sich eine Vielzahl gonadotoxischer Interventionen. Insbesondere alkylierende und hormonell aktive Substanzen sowie gonadale Bestrahlungen sind bekannt für eine fertilitätseinschränkende Wirkung beim Mann. Die zertifizierten Hautkrebszentren in Deutschland haben deshalb seit 2017 die Auflage zur Umsetzung von Beratungen zum Fertilitätserhalt. Gestützt wird dies durch die S2k-Leitlinie zur Fertilitätserhaltung bei onkologischen Therapien. Da die verschiedenen Interventionen von den dermatoonkologischen Leitlinien stadienabhängig empfohlen werden, befürworten die Autoren mindestens die Frage „Ist Kinderwunsch ein Thema für Sie?", wenn Patienten ein entsprechendes Stadium erreichen. Die Fertilitätsprotektion des Mannes über eine Kryokonservierung von Ejakulat oder Hodenmaterial ist dann eine einfache und sichere Möglichkeit. Das Verfahren ist standardisiert und häufig verfügbar. Zudem bietet sich über das neue Projekt Androprotect jetzt die Möglichkeit zur Kryokonservierung von Hodenmaterial präpubertärer männlicher Kinder und Säuglinge. Treten unter Therapie Zeichen eines Hypogonadismus auf, kann in Abwägung der Testosteronwirkungen eine Behandlung erwogen werden, wichtig ist, hier die anabolen und immunmodulierenden Effekte zu beachten.

La efectividad del tratamiento con omalizumab en la vida real es menor en pacientes con urticaria crónica de más de 18 meses de evolución y tratamiento inmunosupresor previo

Publication date: Available online 22 October 2018

Source: Actas Dermo-Sifiliográficas

Author(s): X. Cubiró, J. Spertino, E. Rozas-Muñoz, E. Serra-Baldrich, L. Puig

Resumen

Antecedentes

Aunque la eficacia del omalizumab en el tratamiento de la urticaria crónica espontánea está demostrada en ensayos clínicos de fase iii, la información disponible sobre la efectividad en la vida real utilizando la puntuación de actividad urticarial semanal (UAS7) es escasa. El objetivo del estudio fue evaluar la respuesta clínica (UAS7 ≤ 6) y la respuesta completa (UAS7 = 0) en las semanas 12 y 24 en una cohorte de la vida real e identificar posibles predictores de respuesta al omalizumab.

Métodos

Se llevó a cabo una revisión retrospectiva de los registros clínicos de pacientes consecutivos con urticaria crónica espontánea de moderada a grave (UAS ≥ 16) tratados con omalizumab en el Servicio de Dermatología de un hospital universitario en Barcelona, España, desde febrero de 2014 a septiembre de 2017. Se evaluaron los valores de UAS7 y la evolución siguiendo un protocolo predefinido. El análisis estadístico de los datos se realizó utilizando el paquete estadístico SPSS 18 (SPSS 18 Inc., Chicago, IL, EE. UU.).

Resultados

Se incluyeron en el estudio 48 pacientes, que completaron 24 semanas de seguimiento. Las tasas de respuesta clínica (UAS7 < 6) y completa (UAS7 = 0) fueron del 70,8% y del 47,9% a la semana 12 y del 64,6% y del 52,1% a la semana 24.

Los pacientes con urticaria de larga duración (≥ 18 meses) tuvieron menor probabilidad de lograr una respuesta clínica en la semana 12 (odds ratio: 0,25; intervalo de confianza del 95%: 0,06-0,96). El tratamiento inmunosupresor previo tendía a asociarse con una menor probabilidad de respuesta completa en la semana 12 (odds ratio: 0,27; intervalo de confianza del 95%: 0,07-1,02). El tratamiento con antihistamínicos H1 se asoció con una menor probabilidad de respuesta a la semana 24 (odds ratio: 0,1; intervalo de confianza del 95%: 0,01-0,88).

Conclusiones

La eficiencia y la seguridad del omalizumab en la vida real son similares a la eficacia y la seguridad en los ensayos clínicos. La duración de la enfermedad, la terapia inmunosupresora previa y el requerimiento de tratamiento concomitante con antihistamínicos H1 pueden ayudar a predecir la respuesta al tratamiento con omalizumab.

Abstract

Background

The efficacy of omalizumab in the treatment of chronic spontaneous urticaria has been demonstrated in phase iii clinical trials, but limited information is available regarding real-life effectiveness using the weekly Urticarial Activity Score (UAS7). The aim of the study was to assess clinical response (UAS7 ≤ 6) and complete response (UAS7 = 0) rates at weeks 12 and 24 in a real-life cohort and to identify possible predictors of response to omalizumab.

Methods

Clinical records of consecutive patients with moderate-to-severe chronic spontaneous urticaria (UAS ≥ 16) treated with omalizumab at a university-affiliated reference dermatology department in Barcelona, Spain, from February 2014 to September 2017 were retrospectively reviewed. UAS7 values and patients' evolution were assessed according to a predefined protocol. Statistical analysis of data was done using SPSS 18 statistical package (SPSS 18 Inc., Chicago, IL, USA) software.

Results

Forty-eight patients were included in the study. All of them completed at least 24-weeks of treatment and follow-up. At week 12, clinical response rates (UAS7 < 6) were 70.8% and complete response rates (UAS7 = 0) were 47.9%. At week 24, clinical response rates were 64.6% and complete response rates were 52.1%.

Patients

with long-term urticaria (≥ 18 months' duration) were less likely to achieve a clinical response at week 12 (odds ratio: 0.25; 95% confidence interval 0.06-0.96). Previous immunosuppressive treatment tended to be associated with a lower probability of complete response at week 12 (odds ratio: 0.27 95% confidence interval: 0.07-1.02). H1-antihistamine treatment was associated with lower probability of response at week 24 (odds ratio: 0.1 95% 95% confidence interval: 0.01-0.88)

Conclusions

The effectiveness and safety of omalizumab in real life are similar to efficacy and safety in clinical trials. Duration of disease, previous immunosuppressive therapy and requirement for concomitant H1-antihistamine treatment may be helpful in predicting response to omalizumab treatment.

Nevus lipomatoso superficial gigante

Publication date: Available online 22 October 2018

Source: Actas Dermo-Sifiliográficas

Author(s): V.A. González-Delgado, P. Cordero-Romero, J.M. Martín

Sarcoma de Kaposi subcutáneo primario, una rara variante clínica

Publication date: Available online 22 October 2018

Source: Actas Dermo-Sifiliográficas

Author(s): M. Franco-Muñoz, M. García-Arpa, B. Lozano-Masdemont, I. Lara-Simón

Interconsulta hospitalaria en dermatología en una unidad de transplante renal

Publication date: Available online 22 October 2018

Source: Actas Dermo-Sifiliográficas

Author(s): A.R. Pereira, A.M. Porro, C.A. Seque, V.P. Pasin, J. Tomimori

Resumen

Introducción

El número de pacientes receptores de trasplante renal (RTR) está en aumento, y estos con frecuencia, además presentarán complicaciones dermatológicas derivadas del trasplante. Si bien el rol del dermatólogo a nivel de la consulta ambulatoria está establecido, no encontramos ningún estudio acerca de interconsultas dermatológicas en pacientes RTR hospitalizados.

Objetivos

La finalidad de este estudio fue determinar las características epidemiológicas de las enfermedades dermatológicas que afectan a los pacientes RTR hospitalizados, así como valorar el impacto que tienen las interconsultas dermatológicas durante el ingreso hospitalario de estos pacientes.

Métodos

Durante un periodo de 36 meses consecutivos, se incluyeron de forma retrospectiva las consultas realizadas al servicio de dermatología en pacientes RTR ingresados en un hospital de referencia en trasplantes renales de Brasil.

Resultados

Se incluyeron 176 interconsultas. Las dermatosis infecciosas fueron las más prevalentes (52,3%), seguidas de las enfermedades inflamatorias (14,2%), neoplasias (12,5%) y reacciones medicamentosas (8,5%). La concordancia diagnóstica entre el diagnóstico de derivación y el diagnóstico final fue del 38,1%. La mayoría de las interconsultas se debieron a condiciones dermatológicas comunes que no guardaban relación con el motivo de ingreso. Se evidenciaron algunas diferencias con estudios previos en pacientes ingresados en hopitales generales; por ejemplo, en los pacientes RTR hubo una mayor proporción de dermatosis infecciosas y neoplasias y una menor proporción de enfermedades inflamatorias. Así mismo un mayor porcentaje de biopsias cutáneas fueron realizadas, una mayor proporción de interconsultas requirieron más de una visita y hubo la necesidad de pautar tratamiento sistémico en un mayor número de pacientes.

Conclusión

Los pacientes RTR ingresados presentaron características epidemiológicas diferentes, así como un mayor nivel de complejidad clínica en comparación con con estudios realizados en hospitales generales. Concluimos que la colaboración del servicio de dermatología durante el ingreso será beneficiosa en el manejo multidisciplinario de estos pacientes, ya que ayudará en el estudio de las enfermedades sistémicas, así como a tratar comorbilidades cutáneas.

Abstract

Background

Renal transplant recipients (RTR), which are an increasing population, frequently suffer from post-transplant dermatological complications. Despite the well-established role of dermatologists in the outpatient care of these patients, no previous studies were found concerning dermatology consultations for hospitalized RTR.

Objectives

To investigate the epidemiology of dermatological conditions presented by RTR during hospitalization and assess the impact of dermatology consultations performed in the hospital setting.

Methods

Dermatology consultations requested for RTR admitted at a kidney transplantation referral hospital in Brazil over 36 consecutive months were retrospectively included.

Results

176 consultations were included. Infectious dermatoses prevailed (52.3%), followed by inflammatory diseases (14.2%), neoplasms (12.5%) and drug reactions (8.5%). Diagnostic agreement between requesting and consulting teams was 38.1%. Most consultations were motivated by common dermatological conditions, unrelated to admission diagnosis. There were some differences in comparison to previous studies including general inpatients, such as: larger proportion of infectious dermatoses and neoplasms, smaller proportion of inflammatory diseases, higher percentage of patients submitted to skin biopsy, smaller proportion of consultations managed with a single visit and higher probability of a systemic treatment being recommended in this population.

Conclusion

Hospitalized RTR present distinct dermatological epidemiology and higher level of complexity, when compared to studies including general inpatients. Dermatology interventions during hospitalization may be beneficial in the multidisciplinary care of these patients, either contributing to the investigation of systemic conditions or providing relief for cutaneous comorbidities.

Developmental and family history‐based analysis of congenital fused labia phenotype in the captive common marmoset (Callithrix jacchus)

Journal of Medical Primatology, EarlyView.

In Response to “Descriptive Survival Study of Nail Melanoma Patients Treated With Functional Surgery vs Distal Amputation”

Publication date: Available online 23 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Brooke Vasicek, Taylor Erickson, Eden Lake

High-Throughput Sequencing of the T-cell receptor beta chain gene distinguishes two subgroups of cutaneous T-cell lymphoma

Publication date: Available online 23 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Jie Wang, Bryan Rea, Paul Haun, Ryan Emerson, Ilan Kirsch, Adam Bagg

Dear Dr. Dermatoethicist: Erection Ethics

Publication date: Available online 23 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Paige Norwick, Gillian K. Weston, Jane M. Grant-Kels

Surgical Pearl: Reverse Beveling to Improve Wound Edge Apposition

Publication date: Available online 23 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Kourosh Beroukhim, Lindsay R. Sklar, Daniel B. Eisen

Association between atopic dermatitis, depression and suicidal ideation: A systematic review and meta-analysis

Publication date: Available online 23 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Kevin R. Patel, Supriya Immaneni, Vivek Singam, Supriya Rastogi, Jonathan I. Silverberg

Abstract

Background

Atopic dermatitis (AD) is associated with psychological distress. However, previous studies found conflicting results about whether AD is associated with increased depression or suicidality.

Objectives

To determine the complex relationship between AD and depression.

Methods

A systematic review was performed of all published observational studies in MEDLINE, Pubmed, EMBASE, GREAT, LILACS, Cochrane Library, Scopus and PsychInfo that analyzed depression in AD. Two reviewers performed study title/abstract review and data abstraction. Pooled meta-analysis was performed using random-effects weighting.

Results

Overall, 106 studies met inclusion criteria; 36 had sufficient data for meta-analysis. The prevalence of any depression was higher in persons with vs. without AD (20.1% vs. 14.8%). Similar results were found in sensitivity analyses of studies assessing clinical depression, depressive symptoms, and adults, with healthy controls, low and high study quality. AD was associated with significantly higher depression scales, parental depression, anti-depressant use, and suicidality. No publication bias was detected

Limitations

Individual level data were not available.

Conclusions

AD patients have higher odds of depression and suicidality.

The Cost of an Itch: A Nationally Representative Retrospective Cohort Study of Pruritus-Associated Healthcare Expenditure in the United States

Publication date: Available online 23 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Raghav Tripathi, Konrad D. Knusel, Harib H. Ezaldein, Jeremy S. Bordeaux, Jeffrey F. Scott

Reply

Publication date: Available online 22 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Suelen Montagner

The Prognostic Value of Inositol Polyphosphate 5-Phosphatase in Cutaneous Squamous Cell Carcinoma

Publication date: Available online 22 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Helen JL. Cumksy, Collin M. Costello, Nan Zhang, Richard Butterfield, Matthew Buras, Jessica Schmidt, Kevin Drenner, Steven A. Nelson, Shari A. Ochoa, Christian Baum, Mark R. Pittelkow, David J. DiCaudo, Aleksandar Sekulic, Aaron R. Mangold

Abstract

Background

Inositol Phosphate 5-Phosphatase (INPP5A) has been shown to play a role in development and progression of cutaneous squamous cell carcinoma (cSCC). The goal of the current study is to explore the prognostic value of INPP5A expression in cSCC.

Methods

A total of 189 cases of actinic keratoses and SCCs from 174 patients were identified, clinical and outcome data abstracted, histopathology re-rereviewed, and immunohistochemical (IHC) staining and interpretation was performed for INPP5A.

Results

The majority of tumors (89.4%) had an INPP5A score of 2 or 3. No patients had complete loss of INPP5A. Tumors with INPP5A score of 1 were more likely to be intermediate to high risk (BWH stage T2a and above 85.0% vs 23.7%, p < 0.0001), have a larger diameter (2.4 cm vs. 1.3 cm, p = 0.0004), moderate to poor differentiation (86.7% vs. 17.6%, p < 0.0001), and perineural invasion (37.5% vs. 5.3%, p < 0.0001). INPP5A score of 1 has worse 3-year survival of 42.3% (HR = 2.81, p = 0.0006) and local metastatic rates of 48.0% (HR=4.71, p < 0.0001).

Conclusions

Low INPP5A scores are predictive of aggressive tumors and may be a useful adjunct to guide clinical management of cSCC.

Clinicopathologic, immunophenotypic, and molecular analysis of subcutaneous panniculitis‐like T‐cell lymphoma: A retrospective study in a tertiary care center

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.

Occupational allergic contact dermatitis caused by phenol formaldehyde resin in an interior coating for beverage cans

Contact Dermatitis, EarlyView.

Response to Weili Zhao

F. Munzel, Kant’s Conception of Pedagogy: Toward Education for Freedom

Review of G. Felicitas Munzel’s Kant’s Conception of Pedagogy: Toward Education for Freedom

The Superficial Temporal Artery: Anatomical Map for Facial Reconstruction and Aesthetic Procedures

Abstract

Background

The superficial temporal artery (STA) is a terminal branch of the external carotid artery, which supplies multiple regions of the scalp and face. Reconstructive and aesthetic procedures are important clinical aspects of STA supply.

Objectives

The aim of this study was to develop an anatomical map of the STA related to anatomical landmarks.

Methods

Head computed tomographic angiographies of 215 patients were included in this study, with 419 STAs in the final analysis. The STA's main branches and variants were identified. Diameters of the STA and its frontal and occipital branches were measured and the distance was delineated between the STA tree and anatomical landmarks.

Results

Frontal and parietal branches were recorded in 98.1% and 90.7% of patients, respectively. The mean diameters, measured 1 and 7 cm from the STA bifurcation for the frontal branch, were 0.97 ± 0.32 mm and 0.81 ± 0.26 mm, respectively, and for parietal branch, they were 0.96 ± 0.28 mm and 0.76 ± 0.23 mm, respectively. The STA bifurcation point was located above the zygomatic arch (ZA) in 75.6%, below in 14.7%, and on the ZA in 9.7% of patients. The mean distance from the ZA center to the STA bifurcation was 16.8 ± 16.0 mm.

Conclusion

The STA artery and its main branches have a conservative course, and serious anatomical variations are relatively rare. The STA and its main branches may be localized using simple anatomical landmarks. An anatomical map showing artery-free zones in the lateral forehead region was presented, which may be supportive for plastic, reconstructive, and aesthetic surgeons.

Delayed granulomatous reaction and cutaneous fistula induced by retained electrodes from a cardiac pacemaker in a child

Pediatric Dermatology, EarlyView.

Healing Chronic Wounds: Current Challenges and Potential Solutions

Abstract

Purpose of Review

The purpose of this review is to raise awareness, examine the challenges faced by wound care researchers, and explore opportunities for potential improvements.

Recent Findings

Chronic wounds are associated with significant morbidity and mortality, and they represent a major medical and financial burden. Despite this, no new therapy has received FDA efficacy approval for the treatment of chronic wounds since 1997. Previous preclinical studies using animal models did not translate to human wounds due to inherent limitations of experimental models, variability in assessment methods, and overall experimental design. Clinical trials continued to be challenged by the balance of the inclusion and exclusion criteria, the high cost and time expenditure of the trials, and the constraint of a single FDA-acceptable outcome of complete wound closure.

Summary

Wound research faces multiple challenges in both preclinical and clinical research that slowed progress and development of efficacious therapies. Solutions to such challenges will provide new opportunities for improved study design in the future.

Passion for Immune checkpoint blockade in triple negative breast cancer? Comment on the IMpassion130 study

Network meta‐analyses of systemic treatments for psoriasis: a critical appraisal

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.

Combined THC and CBD to treat pain in epidermolysis bullosa: a report of three cases

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.

Tetracycline, nicotinamide, and lesionally administered clobetasol as a therapeutic option to prednisone in patients with bullous pemphigoid: a comparative, retrospective analysis of 106 patients with long‐term follow‐up

International Journal of Dermatology, EarlyView.

Clinical and molecular evaluation of therapy with the use of cyclosporine A in patients with psoriasis vulgaris

International Journal of Dermatology, EarlyView.