Τετάρτη 24 Οκτωβρίου 2018
Association between phenotypic characteristics and melanoma in a large prospective cohort study
To delineate causal pathways for melanoma, it is essential to derive unbiased estimates of risk. Extant knowledge derives largely from case-control studies with potential for bias. In a population-based prospective study (QSkin, n=38,854), we assessed melanoma risks associated with pigmentation characteristics and other phenotypes, and explored additive interactions.We fitted Cox proportional hazards models adjusting for other factors to estimate independent effects of each characteristic on melanoma risk.
Antagonization of IL-17A attenuates skin inflammation and vascular dysfunction in mouse models of psoriasis
Besides skin inflammation, patients with severe psoriasis suffer from an increased risk of cardiovascular mortality. Interleukin-17A (IL-17A) plays a central role in the development of psoriasis and might connect skin and vascular disease. The aim of this study was to clarify whether anti-IL-17A therapy could also ameliorate the vascular dysfunction associated with severe psoriasis.We analyzed three murine models with varying severity of psoriasis-like skin disease concerning their vascular function and inflammation: K14-IL-17Aind/+ mice with keratinocyte-specific IL-17A overexpression and an early onset severe psoriasis-like phenotype, homozygous CD11c-IL-17Aind/ind and heterozygous CD11c-IL-17Aind/+ mice overexpressing IL-17A in CD11c+ cells leading to a delayed onset of moderate psoriasis-like skin disease, and the acute model of imiquimod-induced psoriasis-like skin inflammation.
An atypical occurrence of Aspergillosis in leukemic patient: Brief description of a clinical case
Publication date: Available online 23 October 2018
Source: Journal de Mycologie Médicale
Author(s): L. Pastrone, M.-T. Corsetti, L. Depaoli, S. Sampò, M. Colonna, A. Rocchetti
Abstract
Herein we describe a 43 year-old Caucasian female patient with acute myeloid leukemia that developed an unconventional form of invasive Aspergillosis. For therapeutic reasons, a Groshong-type central venous catheter was positioned. Monitoring the patient's clinical conditions, positive values for C-reactive protein and galactomannan were correlated with a probably Aspergillosis. Surprisingly no pulmonary evidences were observed. Due to worsening conditions, she was re-hospitalized and a blood culture was performed, whom positivity resulted as the first clinical evidence of Aspergillus fumigatus. Further evidence about species identification was obtained by sequencing the fungal ITS region. We support the clinical value of blood culture as a decisive factor to improve the diagnosis of catheter-related Aspergillosis.
Droplet-based microfluidics as a future tool for strain improvement in lactic acid bacteria
Abstract
Strain development is frequently used to improve the performance and functionality of industrially important microbes. As traditional mutagenesis screen is especially utilized by the food industry to improve strains used in food fermentation, high-throughput and cost-effective screening tools are important in mutant selection. The emerging droplet-based microfluidics technology miniaturizes the volume for cell cultivation and phenotype interrogation down to the pico-liter scales, which facilitates screening of microbes for improved phenotypical properties tremendously. In this mini-review, we present recent application of the droplet-based microfluidics in microbial strain improvement with a focus on its potential use in the screening of lactic acid bacteria.Recommandations diagnostiques et thérapeutiques pour les maladies sexuellement transmissibles : herpès génital
Publication date: Available online 23 October 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): B. Milpied, M. Janier, J. Timsit, N. Spenatto, E. Caumes, O. Chosidow, L. Sentilhes, M.-V. Senat, Groupe infectiologie dermatologique et infections sexuellement transmissibles (GrIDIST) de la Société française de dermatologie et du Collège national des gynécologues obstétriciens français (CNGOF)
Résumé
Traitement de la primo-infection ou du premier épisode clinique d'herpès génital en cours de grossesse
Le traitement de la primo-infection ou du premier épisode clinique d'herpès génital est basé sur l'aciclovir oral, 200 mg × 5/j pendant 5 à 10 jours en fonction de l'état clinique. Concernant le valaciclovir, la posologie recommandée est de 1 g × 2 jours avec une durée de traitement identique à celle proposée pour l'aciclovir.
Traitement de la récurrence herpétique en cours de grossesse
Il n'y a pas d'étude permettant d'évaluer l'efficacité d'un traitement antiviral sur la symptomatologie en cas de récurrence d'herpès génital pendant la grossesse. Le traitement antiviral par aciclovir ou valaciclovir peut cependant être proposé devant une symptomatologie le justifiant (durée et intensité des symptômes). Le valaciclovir pourra être préféré (efficacité d'utilisation même si les données d'innocuité sont plus nombreuses pour l'aciclovir). Le valaciclovir peut être utilisé à la dose de 1cp à 500 mg per os deux fois par jour pendant 5 jours.
Traitement antiviral prophylactique en cas de grossesse
Chez les femmes ayant eu une infection initiale ou une récurrence pendant la grossesse, bien qu'il n'existe pas de bénéfice démontré du traitement prophylactique pour réduire le risque d'herpès néonatal, il est recommandé de proposer une prophylaxie antivirale à partir de 36 SA (semaines d'aménorrhée) afin de réduire le risque de césarienne pour lésion herpétique. Les antiviraux recommandés sont l'aciclovir à la posologie de 400 mg trois fois par jour per os ou le valaciclovir à la posologie de 500 mg deux fois par jour per os jusqu'à l'accouchement.
Summary
Treatment of the initial infection or first clinical episode of genital herpes
An initial infection or first clinical episode of genital herpes is treated with oral aciclovir 200 mg × 5/d for 5 to 10 days depending on clinical status. The recommended dosage for valaciclovir is 1 g × 2/d and treatment duration is identical to that for aciclovir.
Treatment of herpes recurring during pregnancy
There are no studies of the efficacy of antiviral therapy on the symptoms of genital recurring during pregnancy. However, initial anti-viral treatment using aciclovir or valaciclovir may be given where warranted by symptoms (i.e. duration and severity of symptoms). Valaciclovir may be used instead (equivalent efficacy but better safety data for aciclovir). Valaciclovir may be given at a dosage of 1 × 500 mg b.i.d. p.o. for 5 days.
Prophylactic anti-viral treatment during pregnancy
In female patients presenting an initial infection or infection recurring during pregnancy, although there is no demonstrated benefit for prophylactic treatment in reducing the risk of neonatal herpes, anti-viral prophylaxis is recommended after 36 WA (weeks' amenorrhoea) to limit the need for Caesarean section due to herpetic lesions. The recommended antivirals are aciclovir at a dosage of 400 mg t.i.d p.o. or valaciclovir at a dosage of 500 mg b.i.d. p.o. until delivery.
Ulcérations buccales aphtoïdes inaugurales d’une maladie inflammatoire chronique de l’intestin induite par le sécukinumab
Publication date: Available online 23 October 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): X. Grimaux, S. Leducq, P. Goupille, A. Aubourg, E. Miquelestorena-Standley, M. Samimi
Résumé
Introduction
Le sécukinumab, anticorps monoclonal humanisé ciblant l'interleukine 17A, a été associé à la survenue de maladies inflammatoires digestives. Nous rapportons le cas d'une patiente ayant développé des ulcérations buccales inaugurales d'une maladie inflammatoire chronique intestinale (MICI) induite par le sécukinumab. Cette patiente avait eu six ans auparavant des ulcérations buccales similaires au cours d'un traitement par tocilizumab (ciblant l'IL6R), suggérant un lien immunologique entre les deux épisodes.
Observation
Une femme de 36 ans avait une spondylarthrite ankylosante réfractaire. En 2010, elle avait présenté des ulcérations buccales au cours d'un traitement par tocilizumab. En 2011, le tocilizumab avait été arrêté et l'aphtose résolutive. En 2016, l'introduction du sécukinumab s'accompagnait d'une récidive d'ulcérations buccales aphtoïdes puis d'une iléo-pancolite. Une corticothérapie, puis un traitement par ustékinumab, permettaient une évolution partiellement favorable.
Discussion
Cette patiente a développé une maladie inflammatoire chronique intestinale au cours d'un traitement par sécukinumab, précédée par des ulcérations buccales aphtoïdes. Elle avait développé, six ans auparavant, des ulcérations buccales similaires au cours d'un traitement ciblant l'IL6R. L'IL6 est une cytokine pléiotrope qui peut activer la voie Th17. Ainsi, le tocilizumab a pu induire un effet « anti-IL17-like » expliquant la survenue de lésions buccales aphtoïdes possiblement en lien avec une maladie inflammatoire digestive a minima.
Conclusion
La survenue d'ulcérations buccales au cours d'un traitement par sécukinumab peut être inaugurale d'une maladie inflammatoire chronique intestinale. La notion d'aphtose préalable, notamment au cours de traitements biologiques antérieurs, devrait faire discuter le rapport bénéfices/risques de la prescription d'un anti-IL17.
Summary
Background
Secukinumab, a humanized monoclonal antibody targeting interleukin 17A, has been associated with the development of inflammatory bowel diseases. We report a case of a female patient developing recurrent oral ulcers prior to inflammatory bowel disease induced by secukinumab. The patient had developed similar oral ulcers 6 years earlier while on tocilizumab (targeting IL6R), suggesting an immunological link between the two episodes.
Patients and methods
A 36-year-old female patient had refractory spondylarthrosis. In 2010, she had presented oral aphthous ulcers during treatment with tocilizumab. In 2011, tocilizumab was stopped and the ulcers resolved. In 2016, secukinumab was introduced and led to recurrence of oral aphthous ulcers followed by ileitis-pancolitis. Corticosteroids and ustekinumab resulted in partial remission.
Discussion
The patient developed inflammatory bowel disease during treatment with secukinumab, preceded by recurrent oral aphthous ulcers. She had presented similar oral ulcers 6 years earlier while on a treatment targeting IL6R. IL6 is a pleiotropic cytokine that may activate the Th17 pathway. Thus, tocilizumab could have induced an "anti-IL17-like" effect, accounting for the occurrence of oral aphthous ulcers, possibly related to mild inflammatory bowel disease.
Conclusion
The occurrence of oral ulcers during treatment with secukinumab may herald inflammatory bowel disease. In patients with a previous history of recurrent aphthous stomatitis, especially where induced by previous biologics, consideration must be given to the risk-benefit ratio of prescribing an anti-IL17 antibody.
Knocking On Doors To Get Opioid Overdose Survivors Into Treatment
Within days of an OD from opioids or other drugs, users in Huntington, W.Va., are visited by a quick-response team at home, the hospital or in jail. Reversing an OD is just recovery's first step.
(Image credit: Sarah McCammon/NPR)
Dose tailoring of adjuvant chemotherapy for breast cancer based on hematologic toxicities: Further results from the prospective PANTHER study with focus on obese patients
Abstract
Background
Adjuvant chemotherapy (ACT) for breast cancer improves relapse free (BCRFS) and overall survival. Differences in terms of efficacy and toxicity could partly be explained by the significant interpatient variability in pharmacokinetics which cannot be captured by dosing according to body surface area. Consequently, tailored dosing was prospectively evaluated in the PANTHER trial. Patients and methods
PANTHER is a multicenter, open-label, randomized phase III trial which compared tailored, dose dense epirubicin/cyclophosphamide (EC) and docetaxel (D) (tDD) with standard interval 5-fluorouracil/E/C and D. The primary endpoint was BCRFS and the primary efficacy analysis has been previously published. In this secondary analysis, we aimed to retrospectively explore the concept of dose tailoring. Our two hypotheses were that BCRFS would not vary depending on the cumulative administered epirubicin dose; and that dose tailoring would lead to appropriate dosing and improved outcomes for obese patients, who are known to have worse prognosis and increased toxicity after dose dense ACT. Results
Patients treated with tDD had similar BCRFS regardless of the cumulative epirubicin dose (p = 0.495), while obese patients in this group (BMI ≥30) had improved BCRFS compared to non-obese ones (BMI <30) (HR = 0.51, 95% CI 0.30 – 0.89, p = 0.02). Moreover, tDD was associated with improved BCRFS compared to standard treatment only in obese patients (HR = 0.49, 95% CI 0.26 – 0.90, p = 0.022) but not in non-obese ones (HR = 0.79, 95% CI 0.60 – 1.04, p = 0.089). The differences were not formally statistically significant (p for interaction 0.175). There were no differences in terms of toxicity across the epirubicin dose levels or the BMI groups. Conclusions
Dose tailoring is a feasible strategy which can potentially improve outcomes in obese patients without increasing toxicity and should be pursued in further clinical studies. ClinicalTrials.gov identifier
NCT00798070An Adaptive Population Enrichment Phase 3 Trial of TRC105 and Pazopanib Versus Pazopanib Alone in Patients with Advanced Angiosarcoma (TAPPAS Trial)
Abstract
Background
Major challenges in clinical trials of ultra orphan oncology diseases include limited patient availability and paucity of reliable prior data for estimating the treatment effect and, therefore, determining optimal sample size. Angiosarcoma (AS), a particularly aggressive form of soft tissue sarcoma with an incidence of about 2,000 cases per year in the United States and Europe is poorly addressed by current systemic therapies. Pazopanib, an inhibitor of vascular endothelial growth factor receptor (VEGFR) is approved for the treatment of AS, with modest benefit. TRC105 (carotuximab) is a monoclonal antibody to endoglin, an essential angiogenic target highly expressed on proliferating endothelium and both tumor vessels and tumor cells in AS, that has the potential to complement VEGFR tyrosine kinase inhibitors (TKIs). In a phase 1/2 study of soft tissue sarcoma, TRC105 combined safely with pazopanib and the combination demonstrated durable complete responses and encouraging PFS. In addition, there was a suggestion of superior benefit in patients with cutaneous lesions versus those with the non-cutaneous. Design
This paper describes the design of a recently initiated Phase 3 trial of TRC105 and Pazopanib versus Pazopanib alone in patients with Advanced AngioSarcoma (TAPPAS trial). Given the ultra-orphan status of the disease and the paucity of reliable prior data on progression free survival or overall survival (endpoints required for regulatory approval as a pivotal trial), an adaptive design incorporating population enrichment and sample size re-estimation was implemented. The design incorporated regulatory input from the FDA and EMA, and proceeded following special protocol assessment designation by the FDA. Conclusions
It is shown that the benefit of the adaptive design as compared to a conventional single-look design arises from the learning and subsequent improvements in power that occur after an unblinded analysis of interim data.Registered on Clinicaltrials.gov: NCT02979899Activity of the Hsp90 inhibitor Luminespib Among Non-Small Cell Lung Cancers Harboring EGFR Exon 20 Insertions
Abstract
Background
There are currently no approved targeted therapies for NSCLC patients with EGFR exon 20 insertions (ins20), a subgroup of EGFR mutations which are generally refractory to 1st/2nd generation EGFR inhibitors. We report the final results of a phase II trial evaluating the activity of the Hsp90 inhibitor luminespib (AUY922) in NSCLC patients with EGFR ins20. Patients and Methods
29 patients with stage IV NSCLC with EGFR ins20 identified on local testing and at least one prior therapy were enrolled on the trial between 8/2013 and 10/2016. The primary endpoint was objective response rate (ORR), with a pre-determined target rate of effectiveness (defined as the rate of partial response (PR) plus stable disease (SD) lasting ≥ 3 months) of 20%. Secondary endpoints were PFS, OS, safety and response by EGFR ins20 subtype. Results
Among the 29 patients (18 female, median age 60 years,) the ORR was 17%, median progression-free survival (mPFS) was 2.9 mos (95% CI, 1.4-5.6,) and mOS was 13 mos (95% CI, 4.9-19.5.) The results exceeded the pre-determined target rate of effectiveness with 11/29 (38%) patients having a PR or SD ≥ 3 months. The most common luminespib-related toxicities were diarrhea (83%,) visual changes (76%) and fatigue (45%). All study treatment was stopped on 2/28/17 due to dissolution of study drug availability; 3 patients were on treatment at study termination. Conclusion
The study met its primary endpoint, suggesting that luminespib may be an active therapy for advanced NSCLC patients with EGFR ins20. Luminespib is generally well-tolerated, though reversible low-grade ocular toxicity is common. Further study of luminespib and other hsp90 inhibitors in this population is warranted.Study on the correlation between age and changes in mosquito bite response
The Journal of Dermatology, EarlyView.
Effects of topical 0.8% piroxicam and 50+ sunscreen filters on actinic keratosis in hypertensive patients treated with or without photosensitizing diuretic drugs: an observational cohort study.
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Effects of topical 0.8% piroxicam and 50+ sunscreen filters on actinic keratosis in hypertensive patients treated with or without photosensitizing diuretic drugs: an observational cohort study.
Clin Cosmet Investig Dermatol. 2018;11:485-490
Authors: Mazzilli S, Garofalo V, Ventura A, Diluvio L, Milani M, Bianchi L, Campione E
Abstract
Background: Photosensitizing diuretics use (especially thiazide compounds) is associated with a significantly higher risk of squamous cell carcinoma (SCC). Actinic keratosis (AK) is a precursor of SCC.
Study aim: To evaluate in a prospective cohort study the efficacy of topical piroxicam 0.8% and sunscreen 50+ (ACTX) in the treatment of AK in hypertensive subjects with or without TD treatment.
Subjects and methods: A total of 119 hypertensive subjects with multiple AK (39 under chronic TD treatment; and 80 treated with other non-TD, non-photosensitizing antihypertensive drugs) were enrolled after their informed consent in a 6-month observational cohort study. All the subjects were treated with ACTX twice daily. The primary endpoint was the evolution of AK lesions at baseline, after 3 and 6 months. The secondary endpoint was the clearance of AK target lesions and field of cancerization by dermoscopic evaluation using a score evaluating erythema, scaling, pigmentation, and follicular plugs (ESPFP score; ranging from 0 to 20). An investigator, unaware of the type of antihypertensive treatments (TD or non-TD), performed all the clinical and dermoscopy evaluations.
Results: At baseline, AK mean (SD) lesion number in TD group was 14.1(4) and 14.6(4) in the non-TD group. ESPFP mean (SD) score at baseline was 5.8(1.2) in both groups. A significant reduction of AK lesions in comparison with baseline was observed in both groups. A statistically significant greater reduction was observed in TD in comparison with the non-TD group (-54% vs -32%). ESPFP score was reduced in a higher proportion in the TD group in comparison with the non-TD group (-60% vs -37%, respectively). ACTX treatment was very well tolerated.
Conclusion: In hypertensive subjects with multiple AK, the topical use of ACTX is associated with a significant reduction of lesions count with an improvement in the field cancerization. The clinical efficacy is more pronounced in subjects under thiazide diuretics treatment.
PMID: 30349346 [PubMed]
Genetic polymorphism analysis of patients with primary hyperhidrosis.
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Genetic polymorphism analysis of patients with primary hyperhidrosis.
Clin Cosmet Investig Dermatol. 2018;11:477-483
Authors: Simes BC, Moore JP, Brown TC, Rushforth TJ, Bookout AL, Richardson CL
Abstract
Background: Hyperhidrosis affects 220 million people worldwide. The hallmark of this condition is excessive sweating, which negatively impacts the social, emotional, and occupational lives of these individuals. A familial predisposition has been established; however, the specific genes involved have yet to be identified.
Objective: The aim of this study was to determine possible genetic variations contributing to primary hyperhidrosis, specifically single-nucleotide polymorphisms (SNPs).
Patients and methods: Twenty-one case and 21 control DNA samples were extracted and genotyped for 20 SNPs associated with the Butyrylcholinesterase (BCHE) and Cholinergic Receptor Nicotinic Alpha-7 subunit (CHRNA7) genes.
Results: For rs1126680, the -116A variant allele (P-value=0.15) was found only in hyperhidrosis patients who also had the K-variant allele (P-value=0.65) in rs1803274. Further analysis testing the null hypothesis of independence between the combined genotypes and case/control status yielded a P-value of 0.30.
Conclusion: Our results are consistent with previous research that shows the K-variant requires the -116A variant to be present in order to observe a decrease in BChE activity levels. These results are not statistically significant (P-value >0.05), but the exclusive association between the -116A and K-variants on the BCHE gene in hyperhidrosis patients warrants further investigation using a larger sample size.
PMID: 30349345 [PubMed]
Evaluating the role of small particle hyaluronic acid fillers using micro-droplet technique in the face, neck and hands: a retrospective chart review.
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Evaluating the role of small particle hyaluronic acid fillers using micro-droplet technique in the face, neck and hands: a retrospective chart review.
Clin Cosmet Investig Dermatol. 2018;11:467-475
Authors: Nikolis A, Enright KM
Abstract
Background: Loss of the viscoelastic properties of the skin is a primary sign of aging and contributes to the appearance of wrinkles. Hyaluronic acid (HA) fillers are one of the most commonly used treatments for age-related soft-tissue reduction and volume loss. Evidence is also emerging that HA fillers rejuvenate the skin.
Methods: A retrospective chart review was completed on 20 subjects treated with small particle HA (SP-HA), to investigate its effects on skin properties. Subjects having received three treatments in the face, neck, and/or hands were considered in the analyses. Skin hydration, trans-epidermal water loss (TEWL), and pH were assessed at baseline (injection #1), Week 4 (injection #2), Week 8 (injection #3), and Week 12 (follow-up).
Results: Treatment with SP-HA significantly improved hydration levels in the face, neck, and hands. Significant results were seen in the face following the first three treatments, with subjects moving up to the next hydration level (ie, hydration went from dry to moisturized) and by the second treatment in the neck and hands. TEWL scores on the face and neck remained within healthy values throughout all visits. At baseline, TEWL scores on the hands were within critical condition and after three injections they recuperated to healthy values, while pH values remained within the normal range throughout treatment.
Conclusion: A treatment regimen consisting of three SP-HA injections was safe and well tolerated. SP-HA use demonstrated a hydrating effect while positively impacting the skin's ability to retain moisture.
PMID: 30349344 [PubMed]
Can emollients of similar composition be assumed to be therapeutically equivalent: a comparison of skin occlusivity and emulsion microstructure.
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Can emollients of similar composition be assumed to be therapeutically equivalent: a comparison of skin occlusivity and emulsion microstructure.
Clin Cosmet Investig Dermatol. 2018;11:461-465
Authors: Antonijević MD, Novac O, O'Hagan BM
Abstract
Introduction: Emollient therapy is the mainstay for treating skin conditions such as atopic dermatitis and psoriasis. New emollients have been introduced recently and are assumed to be therapeutically interchangeable with the innovator products because, superficially, they appear to have similar compositions. This study compares a) the ex vivo human skin occlusion performance and b) the visual and microscopic properties of Isomol gel (IMG) and Doublebase gel (DBG).
Materials and Methods: Occlusion was measured gravimetrically by reduction in cumulative 48-hour evaporative weight loss from ex vivo human skin samples following single applications of the two test emollients and Vaseline®. Skin samples from a single donor were mounted in Franz diffusion cells and then the emollients were spread over the skin surface with an applied dose of approximately 2 mg/cm2. The assemblies (four replicates per treatment) were then accurately weighed at baseline (T0) and again after 5-, 24-, and 48-hour postapplication. The quality of the two emollient gel formulations was compared by visual examination of their film-forming characteristics and by microstructural examination using environmental scanning electron microscopy (ESEM).
Results: Occlusivity of the DBG emollient gel formulation was comparable with Vaseline and substantially better than IMG, with the DBG-treated skin samples losing less than half as much weight as the IMG-treated skin samples over 48 hours and at a much slower rate during the first 5 hours. The film-forming characteristics and microstructure of the gels were also very different. Whereas DBG maintained a smooth, uniform film over 24 hours, the IMG formulation phase-separated. ESEM results showed that the DBG emulsion has a stable structural matrix with uniform oil droplets, whereas for IMG the emulsion system is inhomogeneous with the oil phase coalescing into larger irregular shaped rafts.
Conclusions: We have demonstrated substantial performance differences between two prescribed emollient gels.
PMID: 30349343 [PubMed]
Calcipotriol/betamethasone dipropionate aerosol foam for the treatment of psoriasis vulgaris: case series and review of the literature.
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Calcipotriol/betamethasone dipropionate aerosol foam for the treatment of psoriasis vulgaris: case series and review of the literature.
Clin Cosmet Investig Dermatol. 2018;11:451-459
Authors: Pinter A, Thormann H, Angeletti F, Jalili A
Abstract
An aerosol foam formulation of a once-daily, fixed-dose combination of a synthetic vitamin D3 analog/synthetic corticosteroid (calcipotriol [Cal] 50 µg/g and betamethasone dipropionate [BD] 0.5 mg/g) has recently been introduced for the topical treatment of plaque psoriasis in adults. Data from several sources - randomized controlled trials, case reports (as highlighted in this review), and real-world evidence (RWE) - underscore the considerable and rapid clinical response, effectiveness, and favorable safety and tolerability of Cal/BD aerosol foam in mild-to-moderate psoriatic patients previously treated with class 3 or 4 topical corticosteroids, in patients unsatisfied with ongoing phototherapy in combination with topical therapy and in patients with moderate-to-severe psoriasis. In addition, our case series, considered together with other RWE, highlights that Cal/BD aerosol foam is more effective and with greater levels of patient preference and acceptability than comparator preparations. Thus, Cal/BD aerosol foam offers several treatment advantages, including relief of itch, and is an appropriate first-line topical therapy for consideration in patients with psoriasis of any severity.
PMID: 30349342 [PubMed]
Effects of oral supplementation with FOS and GOS prebiotics in women with adult acne: the "S.O. Sweet" study: a proof-of-concept pilot trial.
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Effects of oral supplementation with FOS and GOS prebiotics in women with adult acne: the "S.O. Sweet" study: a proof-of-concept pilot trial.
Clin Cosmet Investig Dermatol. 2018;11:445-449
Authors: Dall'Oglio F, Milani M, Micali G
Abstract
Background: We evaluated the effects of 3-month prebiotic oral supplementation with fructo-oligosaccharides (FOS) and galacto-oligosaccharides (GOS) on glucose and lipid metabolic parameters in women with adult acne (female adult acne).
Methods: Twelve women, mean age 35 years, with mild to moderate acne were enrolled. Exclusion criteria were severe acne, body mass index (BMI) >25, history of diabetes mellitus, polycystic ovary syndrome, regular intake of prebiotics or probiotics, and history of inflammatory intestinal diseases. At baseline visit (T0), at month 1 (T1), and at month 3 (T2) fasting glucose, blood insulin, glycated hemoglobin (HbA1c), C-peptide, triglycerides, total cholesterol levels, and BMI were measured. Subjects were treated with a food supplement containing FOS (100 mg) and GOS (500 mg), one sachet daily, for 3 months. Subjects were instructed to follow their regular diet, and no dietary restrictions were suggested.
Results: At baseline, the BMI, mean ± SD, was 23±0.7. No modification of BMI was observed during the study. At baseline, fasting blood glucose levels were 92±7 mg/dL. A significant (P=0.02) reduction was observed at month 1 (86±5 mg/dL) and at month 3 (85±7 mg/dL) (-10%). Total cholesterol levels were reduced significantly (P=0.018) from 184±19 to 161±10 mg/dL (-13%) at the end of the study. Triglycerides at baseline were 51 mg/dL and were reduced to 46 mg/dL (P=0.05). Insulin and C-peptide plasma levels showed a nonsignificant reduction trend from baseline to the end of the study. In subjects with baseline insulin level >6 µUI/mL (n=6) the FOS/GOS supplementation induced a significant (P=0.03) reduction from 7.8 to 4.3 µUI/mL at day 90 (-45%). C-peptide was reduced from 2.1 to 1.6 ng/mL (month 3). HbA1c at baseline was 35 mg/dL and 32 mg/dL at the end of the study (NS).
Conclusion: In adult female acne, supplementation with prebiotic FOS and GOS was associated with positive effects on glycemic and lipid metabolic parameters.
PMID: 30349341 [PubMed]
Palmar crease xanthomas in familial hypercholesterolemia
International Journal of Dermatology, EarlyView.
Treatment of primary non-metastatic melanoma at high-volume academic facilities is associated with improved long-term patient survival
Publication date: Available online 23 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Shayan Cheraghlou, George O. Agogo, Michael Girardi
Abstract
Background
Previous studies of cancer care have demonstrated improved long-term patient outcomes for those treated at high-volume centers. The influence of treatment center characteristics on outcomes for primary non-metastatic melanoma is not currently established.
Objective
We aimed to investigate the association of cancer treatment center case volume and academic affiliation on long-term patient survival for cases of primary non-metastatic melanoma.
Methods
US adult melanoma cases diagnosed from 2004-2014 in the NCDB were identified. Hospitals were grouped by yearly case volume quartile: bottom quartile, middle quartiles, and top quartile.
Results
Facility case volume was significantly associated with long-term patient survival (p<0.0001). Five-year survival was 76.8%, 81.9%, and 86.4% respectively for patients treated at institutions in the bottom, middle, and top quartiles of case volume respectively. On multivariate analysis, treatment at both middle-quartile (HR 0.834;95% CI 0.778-0.895) and top-quartile (HR 0.691;95% CI 0.644-0.741) volume centers was associated with improved survival relative to bottom-quartile volume hospitals. Academic affiliation was associated with improved outcomes for top-quartile but not middle-quartile volume facilities.
Limitations
Disease-specific survival was not available.
Conclusions
Treatment at a high-volume facility is associated with improved long-term patient survival for melanoma. High-volume academic centers have improved patient outcomes compared to other high-volume centers.
Brote de psoriasis en placas y edema periférico en un paciente tratado con atezolizumab
Publication date: Available online 23 October 2018
Source: Actas Dermo-Sifiliográficas
Author(s): J. Santos-Juanes, P. Munguía Calzada, C. Álvarez Fernández
Are childhood flexural comedones hamartomas? A single institution experience
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.
Level of knowledge among pharmacists regarding anaphylaxis and the use of epinephrine autoinjectors
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.
Asymptomatic perianal papules in a 75‐year‐old man
Clinical and Experimental Dermatology, EarlyView.
Delayed angioedema of the unilateral tongue associated with angiotensin II receptor blocker in a patient with polypharmacy
Australasian Journal of Dermatology, EarlyView.
Volume outlier benchmark proposal for Australian Mohs surgery
Australasian Journal of Dermatology, EarlyView.
Τρίτη 23 Οκτωβρίου 2018
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.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.
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.
'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
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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 |
Christina Towers, PhD
University of Colorado (AMC)
Dr. Towers studies the roles of autophagy, apoptosis and cell death in cancer.
References
- 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.
Category:
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.
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)
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A Case of Diprosopus Tetraophthalmos: Ocular Findings and Surgical Treatment of Exposure KeratopathyDiprosopus is a rare variation of conjoined twinning. In this report, ophthalmic findings in an infant with diprosopus tetraophthalmos are p...
