Journal of Cosmetic Dermatology, EarlyView.
Τρίτη 23 Οκτωβρίου 2018
Hyaluronic acid gel based on CPM® technology with and without lidocaine: Is there a difference?
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 (SUVmax), 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, SUVmax, 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-.
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.
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-.
Clinical and molecular evaluation of therapy with the use of cyclosporine A in patients with psoriasis vulgaris
International Journal of Dermatology, EarlyView.
Δευτέρα 22 Οκτωβρίου 2018
Ambient Fine Aerosol Concentrations in Multiple Metrics in Taconite Mining Operations
Abstract
Studies in environmental epidemiology and of occupational cohorts have implicated the effects of fine particulates with increased risk of cardiovascular diseases. Motivated by this evidence, we conducted an ambient air monitoring campaign to characterize fine aerosol concentrations around various taconite ore processes in six taconite mines in northeastern Minnesota. The ore processes were first categorized into 16 broad work areas/buildings. We then took air samples at 91 fixed locations using an array of direct-reading instruments to obtain measurements of mass (PM2.5 or particles with aerodynamic diameter <2.5 µm, and respirable particulate matter or RPM), alveolar-deposited surface area (ADSA), and particle number (PN) concentrations. At each location, a respirable gravimetric pump (which was used for calibration purposes) and the instruments measured the ambient dust level for 4 h producing ~240 1-min averaging real-time measurements. To analyze these data, we fit a Bayesian hierarchical model with an autoregressive order 1 correlation structure to estimate pooled concentrations for the 16 work areas/buildings while accounting for temporal correlation. PM2.5 and RPM average ambient concentrations were highly correlated to each other (Pearson's correlation = 0.98), followed by ADSA and PN correlation (R = 0.77). Office and control room areas were found to have the lowest concentrations in all four metrics when compared to other groups. Distinguishing between concentration levels among the remaining groups was more difficult due to the high uncertainty associated with the geometric mean estimates. The geometric standard deviation within location (GSDWL) generally ranged from 1 to 3 for all exposure metrics, except for a few locations that may have had changes in the work activities that generated the observed peaks and variability during the sampling duration. The geometric standard deviation between locations estimates were generally higher than GSDWL, which may indicate larger variability in the processes/activities between locations within each broad work area/building. Future work may look into whether it is feasible to use area measurements for epidemiological investigation and use personal measurements (if available) to validate such approach.Recruitment of Activated Neutrophils Correlates with Disease Severity in Adult Crohn's Disease
Clinical &Experimental Immunology, Volume 0, Issue ja, -Not available-.
Microplastics Are Turning Up Everywhere, Even In Human Excrement
A very small study shows that microplastics are in human waste in many parts of the world. While it's not entirely clear what that means for our health, it might be a sign that we need to pull back.
(Image credit: Desiree Martin/AFP/Getty Images)
Vertical Medial Thigh Contouring
Excess thigh laxity is a problem for many patients following significant weight loss. Thigh laxity has both vertical and horizontal components that require correction to optimize the aesthetic appearance of the thigh. The vertical vector is best corrected first with a lower body lift or extended abdominoplasty. The remaining loose skin in the medial thigh can then be removed using a horizontal vector resulting in a vertical incision. Residual vertical skin excess is also removed parallel to the groin crease. This article describes the author's surgical approach and management of medial thigh deformity in the significant weight loss patient.
Common Complications and Management After Massive Weight Loss Patient Safety in Plastic Surgery
This article discusses strategies to prevent and manage the most common complications seen in body contouring surgery. General approaches to avoidance and treatment of these complications are addressed, including wound dehiscence, delayed wound healing, seroma, hematoma, infections of the surgical or remote sites, lymphedema, suture extrusion, and fat necrosis. Procedure-specific complications and pearls to avoiding complications in these cases are presented. Difficult problems, such as management of the disappointed patient, also are discussed.
Safety in Body Contouring to Avoid Complications
Body contouring after weight loss is becoming more prevalent. An appropriate systematic approach that starts from the first consultation needs to focus on residual comorbidities and weight of the patient. A thorough discussion about potential outcomes manages expectations. Preoperative optimization with smoking, herbal cessation, and nutritional assessment is mandatory. Planned staged approach minimizes lengthy procedures associated with increased postoperative morbidity. In the operating room, appropriate ambient temperature, positioning of the patient, and continuous discussion between surgeon and anesthesiologist prevent further complications. Careful transition to postoperative care with early ambulation and use of compressive garments add to an approach to minimize postoperative complications.
Arm Contouring in the Massive-Weight-Loss Patient
Brachioplasty is an increasingly popular procedure performed for improved arm contour in the massive-weight-loss population. There are challenging deformities presented in this population, such as redundant skin, posterior arm lipodystrophy, and loosening of fascial layers of the upper arm and chest wall that must be addressed to achieve successful contour of the arms. Common complications can be minimized with meticulous technique and knowledge of surgical anatomy. Additionally, brachioplasty can be combined with liposuction of the posterior arm as a safe and effective method for arm contouring without a higher risk of complications.
Buttock Lifting
There are some precise rules to succeed with a buttock lift. The article begins with a reminder about the ideal buttock shape. It explains the different quality of skin that is essential to be aware of at the back part of the body. Afterward it gives the tightening rule and the author's application in buttock lift. The markings and the cutting principles are described in detail. At the end, the article describes the problems of volume at the buttocks and about the author's new flap that is useful to avoid violin deformation. The article finishes with some examples of surgeries.
Bra-Line Back Lift
Upper back deformity caused by aging or fluctuations in weight are cosmetically and functionally unappealing to patients. Natural upper torso adherence zones create tether points that lead to horizontal and vertical laxity. Bra-line back lift is a versatile technique that can be used in any individual showing signs of redundant skin and adiposity. A 3-layered space-obliterating suture closure method prevents seroma and eliminates need for drain. Predictable outcomes correcting laxity from neck to lower back can be achieved. Gentle learning curve yields consistent and predictable results. Patient acceptance of the procedure, its results, and satisfactory morbidity rates have been universal.
The Prognostic Value of Inositol Polyphosphate 5-Phosphatase in Cutaneous Squamous Cell Carcinoma
Inositol polyphosphate-5-phosphatase (INPP5A) has been shown to play a role in cancer development and progression. We found that low INPP5A expression is associated with aggressive tumors and poor outcomes. INPP5A is a novel tumor marker that may help in the management of cutaneous squamous cell carcinoma.
Genetic Abnormalities in Large to Giant Congenital Nevi: Beyond NRAS mutations
Large and giant congenital melanocytic nevi (CMN) are rare melanocytic lesions mostly caused by post-zygotic NRAS alteration. Molecular characterization is usually focused on NRAS and BRAF genes in a unique biopsy of the CMN. However, large/giant CMN may exhibit phenotypic differences among distinct areas, and patients differ in features such as presence of multiple CMN or Spilus-like lesions. Herein, we have characterized a series of 21 large/giant CMN including Spilus-type nevus patients (9/21 cases, 42.8%).
EU Panel Backs Drug for Rare Hereditary Angioedema
Lanadelumab would be the first monoclonal antibody for preventing recurrent attacks of HAE in patients ages 12 years and older.
International Approvals
Growth Hormone Deficiency and Nonalcoholic Fatty Liver Disease with Insights from Humans and Animals: Pediatric Implications
Metabolic Syndrome and Related Disorders, Ahead of Print.
Plasma Growth Arrest-Specific 6 Protein and Genetic Variations in the GAS6 Gene in Patients with Metabolic Syndrome
Metabolic Syndrome and Related Disorders, Ahead of Print.
Multimodal image registration for liver radioembolization planning and patient assessment
Abstract
Purpose
Multimodal imaging plays a key role in patient assessment and treatment planning in liver radioembolization. It will reach its full potential for convenient use in combination with deformable image registration methods. A registration framework is proposed for multimodal liver image registration of multi-phase CT, contrast-enhanced late-phase T1, T2, and DWI MRI sequences.
Methods
A chain of four pair-wise image registrations based on a variational registration framework using normalized gradient fields as distance measure and curvature regularization is introduced. A total of 103 cases of 35 patients was evaluated based on anatomical landmarks and deformation characteristics.
Results
Good anatomical correspondence and physical plausibility of the deformation fields were attained. The global mean landmark errors vary from 3.20 to 5.36 mm, strongly influenced by low resolved images in z-direction. Moderate volume changes are indicated by mean minimum and maximum Jacobian determinants of 0.44 up to 1.88. No deformation foldings were detected. The mean average divergence of the deformation fields range from 0.08 to 0.16 and the mean harmonic energies vary from 0.08 to 0.58.
Conclusion
The proposed registration solutions enable the combined use of information from multimodal imaging and provide an excellent basis for patient assessment and primary planning for liver radioembolization.
Benefits of a membership in a psoriasis patient organisation: a quasi-experimental longitudinal study
Abstract
Background and Objectives
Patient organisations play an important role in supporting patients with chronic diseases and allow information transfer beyond professional care structures. Until now, only few studies have investigated the benefits of a dermatological patient organisation. In this study, potential benefits of joining the German Psoriasis Association (Deutscher Psoriasis Bund e. V., DPB) were surveyed.
Methods
The quasi-experimental longitudinal design included four groups of individuals suffering from psoriasis: those (1) with DPB membership of 5 years, (2) with voluntary new membership, (3) with randomly awarded membership, and (4) without membership. Participants were interviewed two times in 12 months, about quality of life, depression, participation in patient education classes, health status, and treatment benefits.
Results
295 individuals participated (mean age 54 years; 50.3% females). At the outset of the study, participants with voluntary new membership rated their health status worse and showed higher depression scores than those with awarded membership. The proportion of participants who joined patient education classes only increased in the group of long-term members. Health status worsened in the group of non-members, and it improved in the group of those with awarded and voluntary new membership. Treatment benefit only increased in the voluntary new members group.
Conclusions
DPB membership seems to be associated with some relief from psoriasis-related strains, particularly in the group of those who joined voluntarily. This could be due to the fact that individuals who become members out of their own volition are more likely to seek information and, therefore, benefit from their active engagement.
Integrating Clinical and Epidemiological Data on Allergic Diseases Across Birth Cohorts: a MeDALL Harmonization Study
Abstract
International collaborations among birth cohorts to better understand asthma and allergies have increased in the last years. However, differences in definitions and methods preclude direct pooling of original individual participant data. We harmonized data from 14 birth cohorts, with three to 20 follow-ups, from nine European countries, as part of the Mechanisms of the Development of Asthma and Allergies (MeDALL) project. The harmonization process followed six steps: organization of the harmonization panel; identification of variables relevant to MeDALL objectives (candidate variables); proposal of a definition for each candidate variable (reference definition); assessment of the compatibility of each cohort variable to its reference definition (inferential equivalence) and classifications of this inferential equivalence as complete, partial, or impossible; workshop to agree on the reference definitions and classifications of inferential equivalence; and data preparation and delivery through a knowledge management portal. We agreed on 137 reference definitions. The inferential equivalence of 3,551 cohort variables to their corresponding reference definition was classified as complete, partial and impossible for 70%, 15% and 15% of the variables, respectively. A harmonized database was delivered. In birth cohorts of asthma and allergies, the harmonization of data for pooled analyses is feasible and may achieve high inferential comparability. The MeDALL harmonization approach can be used in other collaborative projects.The Development and Validation of a Clinical Prediction Rule to Predict Transmission of Methicillin-Resistant Staphylococcus aureus in Nursing Homes
Abstract
The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization among nursing home residents is high. Healthcare workers (HCWs) often serve as a vector in the transmission of MRSA. The ability to identify residents who are likely to transmit MRSA to HCWs' hands and clothing during clinical care is important so that infection control measures, such as Contact Precautions, can be employed. We developed a clinical prediction rule with demographics and clinical characteristics as predictors of MRSA transmission to HCWs' gowns collected from residents of community nursing homes in Maryland and Michigan between 2012-2014. We externally validated this model in a cohort of Veterans Affairs nursing home residents from 7 states between 2012-2016. The prediction model, which included sex, race, resident dependency on HCWs for care, the presence of any device, diabetes, and chronic skin breakdown, showed good performance (c-statistic=0.70, sensitivity=76%, specificity=49%) in the development set. The decision curve analysis indicates this model has greater clinical utility than using a nares surveillance culture for MRSA colonization, which is current clinical practice for placing hospital inpatients on Contact Precautions. The prediction rule demonstrated less utility in the validation cohort, suggesting a separate rule should be developed for residents of Veterans Affairs nursing homes.Application of the HTA Core Model for complex evaluation of the effectiveness and quality of Radium-223 treatment in patients with metastatic castration resistant prostate cancer
Health technology assessment (HTA) is currently one of the major challenges in assessing medical innovations and healthcare systems. In Europe, the European Network for Health Technology Assessment (EUnetHTA) ...
Antipsychotic Drugs Don't Ease ICU Delirium Or Dementia
Though widely prescribed in hospital intensive care units to treat hallucinations and other signs of delirium, Haldol and similar drugs are no better than a placebo for such patients, a study finds.
(Image credit: Nehru Sulejmanovski/Getty Images)
Specialisation and the Incommensurability Among Scientific Specialties
Abstract
In his mature writings, Kuhn describes the process of specialisation as driven by a form of incommensurability, defined as a conceptual/linguistic barrier which promotes and guarantees the insularity of specialties. In this paper, we reject the idea that the incommensurability among scientific specialties is a linguistic barrier. We argue that the problem with Kuhn's characterisation of the incommensurability among specialties is that he presupposes a rather abstract theory of semantic incommensurability, which he then tries to apply to his description of the process of specialisation. By contrast, this paper follows a different strategy: after criticising Kuhn's view, it takes a further look at how new scientific specialties emerge. As a result, a different way of understanding incommensurability among specialties will be proposed.
Leptomeningeal tumor response to combined MAPK/ERK inhibition in V600E mutated gliomas despite undetectable CSF drug levels
dabrafenibtrametinibBRAFleptomeningeal disseminationglioma
Techniques for generating attenuation map using cardiac SPECT emission data only: a systematic review
Abstract
To reliably interpret and perform quantitative analysis, attenuation correction for cardiac single-photon emission computed tomography (SPECT) is fundamental. Thus, knowledge of the patient-specific attenuation map for accurate correction is required in SPECT quantitative imaging. The aim of this systematic review is to present general principles of attenuation correction and provide a structured summary of the approaches that have been proposed for generating the attenuation map for cardiac SPECT. We identified relevant articles published in English pertaining to the attenuation map (AM) determination using SPECT emission data only by searching PubMed, EMBASE, Scopus, and Web of Science databases. Moreover, other articles were hand searched. The protocol of this systematic review was registered in PROSPERO and the code given is CRD42017060512. Transmissionless techniques of determining attenuation map including calculated methods, statistical modeling for simultaneous estimation of attenuation and emission, consistency conditions criteria, using scattered data and other methods were reviewed. Methods for performing attenuation map for cardiac SPECT are developing and the progresses made are promising. However, much work is needed to assess the efficacy of the correction schemes in the clinical routine.
Beyond Annulus Size: Imaging for TAVR Planning
Abstract
Purpose of Review
The aim of this article is to review the role of imaging in pre-procedural assessment prior to transcatheter aortic valve replacement (TAVR)—with a focus on relevant anatomic findings apart from the size of the aortic annulus.
Recent Findings
Pre-procedure imaging prior to TAVR heavily emphasizes assessment of the aortic annulus for appropriate valve sizing, with computed tomography angiography (CTA) emerging as the test of choice due to its ability to assess not only the aortic annulus but also the thoracoabdominal aorta and peripheral vasculature. Some patients with underlying kidney disease may be at increased risk of renal dysfunction following contrast-enhanced CTA; however, alternate imaging techniques can be performed to mitigate this risk such as magnetic resonance imaging.
Summary
Familiarity with underlying anatomic variability and pathology relevant to TAVR implantation in addition to annulus size, as well as imaging approaches in patients with renal dysfunction, will allow radiologists to better contribute to multidisciplinary discussion for potential TAVR candidates.
Against predicativism about names
Abstract
According to predicativism about names, names which occur in argument positions have the same type of semantic contents as predicates. In this paper, I shall argue that these bare singular names do not have the same type of semantic contents as predicates. I will present three objections to predicativism—the modal, the epistemic, and the translation objections—and show that they succeed even against the more sophisticated versions of predicativism defended by Fara and Bach.
Simulation study on X-ray phase contrast imaging with dual-phase gratings
Abstract
Purpose
Two phase gratings in an X-ray grating interferometers can solve several technical challenges for clinical use of X-ray phase contrast. In this work, we adapt and evaluate this setup design to clinical X-ray sources and detectors in a simulation study.
Methods
For a given set of gratings, we optimize the remaining parameter space of a dual-phase grating setup using a numerical wave front simulation. The simulation results are validated with experimentally obtained visibility measurements on a setup with a microfocus tube and a clinical X-ray detector. We then confirm by simulation that the Lau condition for the \(G_0\) grating also holds for two phase gratings. Furthermore, we use a \(G_0\) grating with a fixed period to search for periods of matching phase grating configurations.
Results
Simulated and experimental visibilities agree very well. We show that the Lau condition for a dual-phase grating setup requires the interference patterns of the first phase grating to constructively overlay at the second phase grating. Furthermore, a total of three setup variants for given \(G_{0}\) periods were designed with the simulation, resulting in visibilities between 4.5 and 9.1%.
Conclusion
Dual-phase gratings can be used and optimized for a medical X-ray source and detector. The obtained visibilities are somewhat lower than for other Talbot–Lau interferometers and are a tradeoff between setup length and spatial resolution (or additional phase stepping, respectively). However, these disadvantage appears minor compared to the overall better photon statistics, and the fact that dual-phase grating setups can be expected to scale to higher X-ray energies.
Biophysical properties of striae rubra and striae alba in human skin: Comparison with normal skin
Skin Research and Technology, EarlyView.
The role of in vivo reflectance confocal microscopy in assessing the stability of vitiligo vulgaris prior to cellular grafting
Skin Research and Technology, EarlyView.
Water adsorption with relative humidity changes for keratin and collagen as studied by infrared (IR) micro‐spectroscopy
Skin Research and Technology, EarlyView.
Want To Keep Your Brain Sharp? Take Care Of Your Eyes And Ears
Two large studies show that age-related memory loss can be slowed significantly when older people promptly address hearing and vision loss.
(Image credit: Leyla B/Getty Images)
Research Letter: Cross reactivity of latex agglutination assay complicates the identification of Burkholderia pseudomallei from soil.
Abstract
The monoclonal antibody—based latex agglutination tests targeting a high molecular weight exopolysaccharide antigen of Burkholderia pseudomallei are commercially available. The tests are primarily used in routine diagnosis of melioidosis in major hospitals in Thailand and some endemic countries. Being a rapid test, this technique was employed as a presumptive test to identify colonies of B. pseudomallei among many others grown from soil specimens collected from southern Thailand. Cross-reactivity of these tests with other soil bacteria was a concern since it complicated the identification of B. pseudomallei. Here, we describe the cross-reactivity of two commercial latex agglutination tests for melioidosis with B. territorii, B. pseudomultivorans, B. multivorans and B. cenocepacia isolates from soil.Metabolomics approach used for understanding temperature-related pectinase activity in Bacillus licheniformis DY2
Abstract
Pectinases are enzymes that catalyze pectin degradation. There is a global demand for pectinases because of their wide utility and catalytic efficiency. Optimization of the fermentation process to increase the pectolytic enzyme activity is generally practiced to lower process costs, but whether temperature influences the metabolome, enhancing pectinase activity, is not known. Here, we developed a metabolomics approach to explore it. The activity of P-DY2 pectinase produced by Bacillus licheniformis DY2 was higher in cells grown at 30°C than those grown at 37 °C. Differential metabolome analysis revealed fluctuating tricarboxylic acid (TCA) cycle at 30 °C. Consistently, the transcripts of TCA cycle genes and activities of pyruvate dehydrogenase and α-Ketoglutaric dehydrogenase were lower at 30 °C than 37 °C. Furthermore, inhibition of pyruvate dehydrogenase and succinate dehydrogenase enhanced the activity of P-DY2, supporting the conclusion that the inactivated pyruvate metabolism and TCA cycle were required for pectinase activity, and that P-DY2 was TCA cycle-independent. Collectively, these findings indicated that fermentation temperature affected P-DY2 activity by metabolic modulation, with an inactivated TCA cycle as a characteristic feature of high P-DY2 activity. More importantly, the present study highlights an approach of promoting pectinase activity through metabolic modulation by using metabolic pathway inhibitors.Genome analysis of lactic acid bacterial strains selected as potential starters for traditional Slovakian bryndza cheese
Abstract
Genomes of 21 strains of lactic acid bacteria isolated from Slovakian traditional cheeses were sequenced on an Illumina MiSeq platform. Subsequently, they were analysed regarding taxonomic classification, presence of genes encoding defence systems, antibiotic resistance and production of biogenic amines. Thirteen strains were found to carry genes encoding at least one bacteriocin, 18 carried genes encoding at least one restriction-modification system, all strains carried 1–6 prophages and 9 strains had CRISPR-Cas systems. CRISPR-Cas type II-A was the most common, containing 0–24 spacers. Only 10% spacers were found to be homological to known bacteriophage or plasmid sequences in databases. Two Enterococcus faecium strains and a Lactococcus lactis strain carried antibiotic resistance genes. Genes encoding for ornithine decarboxylase were detected in 4 strains and genes encoding for agmatine deiminase were detected in 4 strains. Lb. paraplantarum 251 L appeared to be the most interesting strain, as it contained genes encoding for two bacteriocins, a restriction-modification system, two CRISPR-Cas systems, four prophages and no genes connected with antibiotic resistance or production of biogenic amines.Epidemiology and Immunopathogenesis of Psoriasis and Its Comorbidities
Abstract
Purpose of Review
While psoriasis has traditionally been considered primarily a skin and joint disorder, there is a new appreciation that psoriasis affects multiple organs. In fact, psoriasis is associated with several comorbidities that also affect the vasculature, guts, lung, kidney, and other tissues. This review aims to summarize the epidemiology and immunopathogenesis of psoriasis and its comorbidities.
Recent Findings
We reviewed the current literature characterizing the epidemiology and immune pathways of psoriasis and its comorbidities and report common inflammatory and immune pathways implicated in the pathogenesis of psoriasis and its comorbidities.
Summary
A variety of diseases are associated with psoriasis, including psoriatic arthritis, metabolic syndrome, atherosclerosis and cardiovascular disease, nonalcoholic fatty liver disease, inflammatory bowel disease, uveitis, and chronic obstructive pulmonary disease. These comorbidities share similar inflammatory and immune pathways with those that are classically implicated in psoriasis: especially the adipokines, TH17, and TNF-α.
Advances in Immune Pathways and Pathogenesis of Atopic Dermatitis
Abstract
Purpose of Review
Atopic dermatitis (AD) is a common chronic skin inflammatory disorder characterized by recurrent eczema accompanied by an intractable itch that leads to an impaired quality of life. This review aims to summarize the advances in immune pathways and pathogenesis of AD.
Recent Findings
We review and summarize the current literature characterizing immune pathways and pathogenesis of AD. The complex interplay among skin barrier deficiency, immunological derangement, microbiome dysbiosis especially Staphylococcus aureus predominance, and pruritus contribute to the development, progression, and chronicity of the disease.
Summary
AD is a complex and multifactorial disease. The skin barrier, dysbiosis of the skin microbiome, immune dysregulation, and severe itch all play a part in the pathogenesis of AD. Based on this progress, better targeted therapies are now emerging.
Sensitive and rapid detection of TERT promoter and IDH mutations in diffuse gliomas
Abstract
Background
Mutations in the promoter of telomerase reverse transcriptase (TERTp) and isocitrate dehydrogenase 1 (IDH1) offer objective markers to assist in classifying diffuse gliomas into genetic subgroups. However, traditional mutation detection techniques lack sensitivity, or have long turnaround times, or high costs. We developed GliomaDx, an allele-specific, locked nucleic acid (LNA)-based qPCR assay to overcome these limitations and sensitively detect TERTp and IDH mutations. Methods
We evaluated the performance of GliomaDx on cell line DNA and frozen tissue diffuse glioma samples with variable tumor percentage to mimic use in clinical settings and validated low percentage variants using sensitive techniques including droplet digital PCR (ddPCR) and next generation sequencing. We also developed GliomaDx Nest, which incorporates a high-fidelity multiplex pre-amplification step prior to allele-specific PCR for low-input samples such as FFPE. Results
GliomaDx detects the TERTp and IDH1 alterations at an analytical sensitivity of 0.1% mutant allele fraction (MAF), corresponding to 0.2% tumor cellularity. GliomaDx identified TERTp/IDH1 alterations in a cohort of frozen tissue samples with variable tumor percentage of all major diffuse glioma histologic types. GliomaDx Nest is able to detect these hotspot mutations with similar sensitivity from pre-amplified samples and was successfully tested on a cohort of clinical FFPE samples. Testing of a cohort of previously identified TERTp WT-IDHWT gliomas (by Sanger sequencing) revealed that 26.3% harbored low-percentage mutations. Analysis by ddPCR and whole exome sequencing of these tumors confirmed the low mutant fraction of these alterations and overall mutation-based tumor purity. Conclusions
Our results show that GliomaDx can rapidly detect TERTp/IDH mutations with high sensitivity, identifying cases that might be missed due to the lack of sensitivity of other techniques. This approach may facilitate more objective classification of diffuse glioma samples in clinical settings such as intraoperative diagnosis or in testing cases with low tumor purity.The role of 13 N -ammonia in the differential diagnosis of gliomas and brain inflammatory lesions
Abstract
Objective
To investigate the utility of 13N-ammonia PET/CT imaging in the differential diagnosis of gliomas and brain inflammations.
Methods
13N-ammonia PET/CT imaging data of 77 patients with gliomas and 34 patients with brain inflammations were retrospectively analyzed. No patients received any treatment before 13N-ammonia imaging. All the patients were diagnosed by stereotactic biopsy or clinical follow-up. Visual and semi-quantitative analysis was performed to analyze the results of 13N-ammonia imaging. Finally, the uptake ratios of each lesion were calculated and its differences among different groups were tested with one-way ANOVA.
Results
29.4% inflammations, 51.6% low-grade gliomas and 91.3% high-grade gliomas were positive by visual analysis in 13N-ammonia imaging. The sensitivity, specificity and accuracy for the diagnosis of gliomas were 75.3%, 55.8% and 67.8%, respectively. As for semi-quantitative analysis, the T/G ratios of inflammatory lesions, low-grade gliomas and high-grade gliomas were 0.88 ± 0.24, 1.04 ± 0.43 and 1.43 ± 0.49, respectively. One-way ANOVA revealed that the T/G ratios of high-grade gliomas were significantly higher than those of low-grade gliomas and inflammations (P < 0.05), but there was no statistical difference between low-grade gliomas and inflammations (P = 0.118). Among the inflammatory lesions, T/G ratios were not statistically different between infectious and demyelinating lesions (P > 0.05). ROC curve analysis showed that the optimal cut-off value of T/G ratio in distinguishing gliomas from inflammations was 1.21 with the AUC 0.78. The sensitivity, specificity, accuracy, PPV and NPV were 52.9%, 94.4%, 65.3%, 95.7% and 45.9%, respectively. ROC curve analysis showed that the optimal cut-off value of T/G ratio in distinguishing high-grade gliomas from low-grade gliomas was 1.06 with the AUC 0.78. The sensitivity, specificity, accuracy, PPV and NPV were 81.5%, 67.7%, 76.5%, 81.5% and 67.7%, respectively. ROC curve analysis showed that the optimal cut-off value of T/G ratio in distinguishing high-grade gliomas from low-grade gliomas and inflammations was 1.19 with the AUC 0.84. The sensitivity, specificity, accuracy, PPV and NPV were 70.4%, 85.1%, 78.5%, 79.2% and 78.1%, respectively.
Conclusions
13N-ammonia imaging is effective in distinguishing high-grade gliomas from low-grade gliomas and inflammations, but its role in the differential diagnosis of low-grade gliomas and brain inflammatory lesions is limited, and the accuracy needs to be improved.
PD‐L1 methylation regulates PD‐L1 expression and is associated with melanoma survival
Pigment Cell &Melanoma Research, Volume 0, Issue ja, -Not available-.
Therapeutic approaches to pyogenic granuloma: an updated review
International Journal of Dermatology, EarlyView.
Pyoderma gangrenosum associated with dulaglutide therapy
International Journal of Dermatology, EarlyView.
Diffuse palmoplantar keratotic papules and melanosis
International Journal of Dermatology, EarlyView.
Mid borderline leprosy in type Bα Blaschko linear pattern: a rare phenomenon
International Journal of Dermatology, EarlyView.
Crisaborole Ointment Improves Quality of Life of Patients with Mild to Moderate Atopic Dermatitis and Their Families
Abstract
Introduction
The impact of crisaborole ointment, a nonsteroidal phosphodiesterase 4 inhibitor for the treatment of mild to moderate atopic dermatitis (AD), on quality of life (QoL) was assessed in two identically designed phase 3 studies (AD-301: NCT02118766; AD-302: NCT02118792, both at http://www.clinicaltrials.gov).
Methods
In both studies, patients aged ≥ 2 years with mild to moderate AD per the Investigator's Static Global Assessment were randomly assigned 2:1 to receive crisaborole or vehicle twice daily for 28 days. QoL was assessed using the Children's Dermatology Life Quality Index (CDLQI) (2–15 years), the Dermatology Life Quality Index (DLQI) (≥ 16 years), and the Dermatitis Family Impact Questionnaire (DFI) (parents/caregivers/family of patients aged 2–17 years). Established QoL score severity bands provided clinical context.
Results
Greater mean improvement in QoL was observed in crisaborole-treated patients than in vehicle-treated patients at day 29 [mean change from baseline (∆BL), CDLQI: − 4.6 vs. − 3.0; P < 0.001; DLQI: − 5.2 vs. − 3.5; P = 0.015]. At baseline, more than half the patients had a "moderate effect" or higher of AD on QoL. At day 29, there was a trend toward more crisaborole- than vehicle-treated patients having "small effect" to "no effect", The QoL of parents/caregivers/family improved more for crisaborole-treated than for vehicle-treated patients (∆BL, DFI: − 3.7 vs. − 2.7; P = 0.003).
Conclusion
Crisaborole treatment results in clinically meaningful improvement in QoL for patients and their parents/caregivers/families.
Trial Registration
AD-301: http://www.clinicaltrials.gov, NCT02118766; AD-302: http://www.clinicaltrials.gov, NCT02118792.
Funding
Anacor Pharmaceuticals, Inc., a wholly owned subsidiary of Pfizer Inc., New York, NY.
Κυριακή 21 Οκτωβρίου 2018
Painful Complications After Cosmetic Surgery: Management of Peripheral Nerve Injury
Abstract
Background
Aesthetic procedures are among the most common surgeries performed by plastic surgeons. The prevalence of persistent pain remains unknown and underappreciated in the plastic surgery literature. Objectives
The purpose of this article was to increase awareness of this problem while describing the diagnostic and management strategies for patients with postoperative pain after aesthetic plastic surgery. Methods
A literature review of was performed using the PubMed database to identify painful complications of: brachioplasty, blepharoplasty, rhytidectomy, abdominoplasty, breast augmentation, mastopexy, and breast reduction. A treatment algorithm was described to guide plastic surgeons presented with patients reporting pain after aesthetic surgery. Results
Title and abstract review followed by application of inclusion and exclusion criteria finally resulted in a total of 20 clinical studies that were included in this review. These included: lateral femoral cutaneous nerve, iliohypogastric nerve, and intercostal nerves after Abdominoplasty; median antebrachial cutaneous nerve after brachioplasty; supraorbital, supratrochlear and infratrochlear nerves after blepharoplasty; greater auricular nerve, auriculotemporal nerve, and zygomaticofacial nerve after rhytidectomy; intercostobrachial nerve after breast surgery. Conclusions
Neuromas can be the source of pain following aesthetic surgery. The same clinical and diagnostic approach used for upper and lower extremity neuroma pain can be used in patients with persistent pain after aesthetic surgery.Google Ranking of Plastic Surgeons Values Social Media Presence Over Academic Pedigree and Experience
Abstract
Background
Patients increasingly rely on online resources to make healthcare decisions. Google dominates the search engine market, with first page results receiving the majority of web traffic, therefore serving as an important indicator of consumer reach. Objectives
Our objective was to analyze the respective importance of physician academic pedigree, experience and social media presence on plastic surgeon Google first page search result placement. Methods
A Google.com search was conducted in the top 25 United States metropolitan areas to identify the top 20 websites of board-certified plastic surgeons. Social media presence was quantified by tracking the number of followers on Facebook, Twitter, and Instagram for every surgeon, as well as medical school and year of graduation. The primary outcome was website ranking in the first page of Google search results. To identify the independent predictors of presence on the front page, we performed a multivariate logistic regression. Results
Total number of social medial followers was associated with Google front page placement (p<0.001), while medical school ranking and years in practice were not (p = 0.17 and 0.39, respectively). 19.6% of plastic surgeon practices in our study cohort still had no social media accounts whatsoever. Conclusions
For the past few decades, plastic surgery practices relied on referrals, word of mouth, the surgeon's reputation and academic pedigree to attract new patients. It is now clear that this practice building model is being rapidly supplanted by a new paradigm based on social media presence to reach potential patients.Ageism and Health in Patients Undergoing Cosmetic Procedures
Abstract
Background
Ageism is a common form of prejudice that negatively affects the health of older adults. Anti-aging procedures are increasingly popular among patients seeking aesthetic surgery and minimally-invasive treatments. Objectives
This study aimed to identify the prevalence of age-based discrimination, and its relationship to health, among patients seeking cosmetic procedures. Methods
Patients from a university-based single-surgeon aesthetic plastic surgery clinic completed the Everyday Discrimination Scale, which assesses the frequency with which individuals have experienced "microaggressions" and the main reason(s) for discrimination (including age). Participants also completed: measures of perceived age discrimination across interpersonal, romantic, work, and health care contexts and anticipation of age-based discrimination in the future via a single-item measure of self-rated health (rated 1-5) and the Rosenberg Self-Esteem Scale. Results
Fifty patients consented to participate in the study (94% women, 78% white, mean age 49.4 ± 13.5 years). Over 30% of participants reported age as the main reason for everyday discrimination. Participants who reported experiencing age-based discrimination, compared to those who did not, had worse self-rated health, lower self-esteem, and greater anticipated age-based discrimination. Participants most frequently endorsed experiencing age-based discrimination in an interpersonal context (36.0%), followed by work settings (20.0%). Conclusions
A significant portion of patients seeking cosmetic procedures may experience age-based discrimination, which could negatively affect their health and well-being. Patients might benefit from expectation management about how their procedure may or may not address their concerns about age-based discrimination. More research is needed to determine whether cosmetic procedures help to mitigate discrimination in aging patients.Crisaborole Ointment Improves Quality of Life of Patients with Mild to Moderate Atopic Dermatitis and Their Families
Abstract
Introduction
The impact of crisaborole ointment, a nonsteroidal phosphodiesterase 4 inhibitor for the treatment of mild to moderate atopic dermatitis (AD), on quality of life (QoL) was assessed in two identically designed phase 3 studies (AD-301: NCT02118766; AD-302: NCT02118792, both at http://www.clinicaltrials.gov).
Methods
In both studies, patients aged ≥ 2 years with mild to moderate AD per the Investigator's Static Global Assessment were randomly assigned 2:1 to receive crisaborole or vehicle twice daily for 28 days. QoL was assessed using the Children's Dermatology Life Quality Index (CDLQI) (2–15 years), the Dermatology Life Quality Index (DLQI) (≥ 16 years), and the Dermatitis Family Impact Questionnaire (DFI) (parents/caregivers/family of patients aged 2–17 years). Established QoL score severity bands provided clinical context.
Results
Greater mean improvement in QoL was observed in crisaborole-treated patients than in vehicle-treated patients at day 29 [mean change from baseline (∆BL), CDLQI: − 4.6 vs. − 3.0; P < 0.001; DLQI: − 5.2 vs. − 3.5; P = 0.015]. At baseline, more than half the patients had a "moderate effect" or higher of AD on QoL. At day 29, there was a trend toward more crisaborole- than vehicle-treated patients having "small effect" to "no effect", The QoL of parents/caregivers/family improved more for crisaborole-treated than for vehicle-treated patients (∆BL, DFI: − 3.7 vs. − 2.7; P = 0.003).
Conclusion
Crisaborole treatment results in clinically meaningful improvement in QoL for patients and their parents/caregivers/families.
Trial Registration
AD-301: http://www.clinicaltrials.gov, NCT02118766; AD-302: http://www.clinicaltrials.gov, NCT02118792.
Funding
Anacor Pharmaceuticals, Inc., a wholly owned subsidiary of Pfizer Inc., New York, NY.
MALDI-TOF MS identification of Malassezia species isolated from patients with pityriasis versicolor at the seafarers’ medical service in Dakar, Senegal
Publication date: Available online 16 October 2018
Source: Journal de Mycologie Médicale
Author(s): K. Diongue, O. Kébé, M.D. Faye, D. Samb, M.A. Diallo, M. Ndiaye, M.C. Seck, A.S. Badiane, S. Ranque, D. Ndiaye
Abstract
Pityriasis versicolor (PV) is a superficial mycosis caused by yeast of the genus Malassezia. The most common isolated Malassezia species in PV lesions differ among M. furfur, M. globosa and M. sympodialis. We purpose to determine the distribution of Malassezia species in PV patients at the seafarers' medical service in Dakar, Senegal and to examine whether any association between identified Malassezia species and patients' profile. From May 2017 to August 2017, first a questionnaire was filled to get informative data before collection of skin scrapings taken from most scaly site using sterile scalpel blade and application of scotch® for direct examination (DE). At the laboratory, DE, culture and identification by MALDI-TOF MS were done. One hundred patients with PV – all men – were included with a mean age of 34 years. Among seafarers, 81% were sailors. Clinical prevalence of PV was highest in aged adults patients with ages of 31 to 60 years (56%). Seafarers with high level of education were less representative with only 2%. The mean duration of the PV was 26.83 months. 20% of subjects suffered lesions in more than one location. The chest was the most affected anatomical site. Furthermore, possible predisposing factors associated with PV were also detected. DE was positive in 95% but culture growth only in 46%. MALDI-TOF MS analysis of the positive cultures could be performed in 84.8% (39/46). Only M. furfur was identified in 100% (39/39). In definitive, M. furfur is the only causative agent of PV in Dakar.
Tacrolimus, not triamcinolone acetonide, interacts synergistically with itraconazole, terbinafine, bifonazole, and amorolfine against clinical dermatophyte isolates
Publication date: Available online 15 October 2018
Source: Journal de Mycologie Médicale
Author(s): J. Zhang, J. Tan, L. Yang, Y. He
Abstract
Objectives
To compare the in vitro interactions between tacrolimus (TAC)/triamcinolone acetonide (TRI) with itraconazole (ITC), terbinafine (TRB), bifonazole (BIZ), and amorolfine (AMF) in 28 clinical dermatophyte isolates, including 13 Trichophyton rubrum, 6 Trichophyton mentagrophytes, 5 Microsporum canis, and 4 Epidermophyton floccosum strains.
Materials and methods
The interactions between TAC or TRI with antifungal agents were tested according to the microdilution checkerboard technique adapted from the CLSI M38-A2 microdilution method.
Results
TAC and TRI did not exhibit significant antifungal activity against the tested strains at the highest concentration (MICs > 8 μg/mL). However, a strong synergistic interaction was observed for combinations of TAC with ITC (53%), TRB (53%), or BIZ (63%) against Trichophyton strains. Comparatively, TRI/ITC (11%) and TRI/BIZ (16%) combinations showed weaker synergistic activity against the same Trichophyton strains. TAC also showed synergistic interaction with ITC against 20% M. canis strains, with TRB against 60% M. canis strains, and with BIZ against 25% E. floccosum strains. No synergism was observed when M. canis and E. floccosum strains were exposed to TRI in combination with these drugs. Antagonism was not observed for any combinations.
Conclusions
Compared with TRI, TAC showed better synergy when combined with antifungal agents, especially topical TRB and BIZ, against dermatophyte isolates.
Molecular epidemiology of environmental Cryptococcus species isolates based on amplified fragment length polymorphism
Publication date: Available online 12 October 2018
Source: Journal de Mycologie Médicale
Author(s): K. Pakshir, H. Fakhim, A. Vaezi, J.F. Meis, M. Mahmoodi, K. Zomorodian, J. Javidnia, S. Ansari, F. Hagen, H. Badali
Abstract
Objective
Cryptococcosis is a major opportunistic fungal infection caused by members of the genus Cryptococcus, mainly those belonging to the Cryptococcus neoformans/Cryptococcus gattii species complexes. Here, we report a comprehensive molecular epidemiological study of the environmental distribution of Cryptococcus isolates in Shiraz, Iran with review of litreature.
Method
A total of 406 samples were obtained from Eucalyptus trees and 139 samples from pigeon droppings. Cryptococcus species identification and genotyping were performed by amplified fragment length polymorphism (AFLP) fingerprinting sequencing and sequencing of the ITS rDNA region.
Results
Majority of the isolates belonged to the Naganishia taxon (n = 69) including N. albida (formerly C. albidus, n = 62), N. globosa (formerly C. saitoi, n = 4), N. adeliensis (formerly C. adeliensis, n = 2), N. diffluens (formerly C. diffluens, n = 1), and the identified C. neoformans isolates (n = 25) belonged to genotype AFLP1/VNI (n = 22) and AFLP1B/VNII (n = 3).
Conclusion
More research efforts should be employed to isolate C. gattii species complex from environmental niches in Iran and provide additional evidence related to novel molecular types.
Molecular characterization of Aspergilli isolated from outdoor air
Publication date: Available online 3 October 2018
Source: Journal de Mycologie Médicale
Author(s): S. Aghaei-Gharehbolagh, M. Shams-Ghahfarokhi, S. Amanloo, M. Razzaghi-Abyaneh
Abstract
Ubiquitous airborne conidia of the genus Aspergillus are responsible for a diverse group of human disorders from allergy to life treating invasive aspergillosis and mycotoxicoses. The aim of this study was to determine the population structure of Aspergillus isolated from outdoor air in Tehran by comparing the nucleotide sequences of ITS region and the PCR-RFLP molecular method. Internal transcribed spacer domains of 47 Aspergillus spp. were amplified and sequenced and PCR products were digested individually with restriction enzymes TaqI and EcoRI. For all species the PCR reaction produced a fragment of approximately 600 bp in length. All of the nucleotide sequences were highly similar with the corresponding reference sequences registered at the gene bank. The all isolates displayed same banding pattern on the basis EcoR1 cleavage. While Taq1 enzyme profiling provided 5 different banding pattern. The results show that the A. niger section has the highest frequency with 27 isolates (57.4%). Of these, 23 isolates (48.9%) belonged to the A. niger complex and 4 isolates (8.5%) to the A. aculeatus complex. The A. flavus complex was also placed in the next ranking with 9 isolates (19.1%). These results strongly support the need for using molecular markers as an auxiliary tool in differentiating Aspergillus species.
Repeated mutKRAS ctDNA measurements represent a novel and promising tool for early response prediction and therapy monitoring in advanced pancreatic cancer
Abstract
Background
The presence of mutated KRAS (mutKRAS ctDNA) in plasma samples has been consistently shown to be a negative prognostic indicator in pancreatic cancer (PC). Only small pilot studies have evaluated the value of serial mutKRAS ctDNA-measurements in PC. Patients and methods
The aim of the present study was to explore the potential of repeated mutKRAS ctDNA measurements for response prediction and therapy monitoring in advanced PC patients. We used the BEAMing technology to determine levels of mutKRAS ctDNA, CA 19-9, CEA and CYFRA 21-1 in 284 plasma samples of 54 patients with advanced PC receiving gemcitabine-based chemotherapy. Absolute levels and kinetics of mutKRAS ctDNA, CA 19-9, CEA and CYFRA 21-1 were correlated to radiological response, progression-free and overall survival. Results
mutKRAS ctDNA was present in a majority of advanced PC patients (n = 36/54, 67%) and indicated tissue KRAS mutation status with a high sensitivity (75%) and specificity (100%). The presence of mutKRAS ctDNA, as well as higher levels of CA 19-9, CEA and CYFRA 21-1 before initiation of the first-line chemotherapy, was significantly correlated to an adverse overall survival. During therapy, changes in mutKRAS ctDNA levels were more rapid and pronounced than changes in protein-based tumor markers. A decrease in mutKRAS ctDNA levels during therapy was an early indicator of response to therapy, while there was no significant correlation between kinetics of CA 19-9, CEA or CYFRA 21-1 and response to chemotherapy during the first four weeks of treatment. Repeated mutKRAS ctDNA measurements during follow-up appeared to be superior to protein-based tumor markers in detecting progressive disease (sensitivity: 83%, specificity: 100%). Conclusion
mutKRAS ctDNA kinetics appear to be a powerful and highly specific tool in early response prediction and therapy monitoring of advanced PC patients receiving chemotherapy.Low-dose sulfasalazine in a case of Pyodermatitis-pyostomatitis Vegetans
Publication date: Available online 21 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Suo Li, Zhiliang Li, Suying Feng
Lack of evidence for feminization of males exposed to spironolactone in utero: a systematic review
Publication date: Available online 21 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Walter Liszewski, Christina Boull
Morphea and systemic sclerosis are associated with an increased risk of melanoma and non-melanoma skin cancer
Publication date: Available online 21 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Emily Boozalis, Ami A. Shah, Fredrick Wigley, Sewon Kang, Shawn G. Kwatra
Efficacy and safety of Etanercept for postoperative Pyoderma Gangrenosum after infliximab serum sickness
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
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