Combined treatment with fractional carbon dioxide laser, autologous platelet-rich plasma, and narrow band ultraviolet B for vitiligo in different body sites: A prospective, randomized comparative trial

Summary

Background

Multiple treatment options are introduced in treatment of vitiligo but the response is unsatisfactory.

Objective

In this prospective, randomized, comparative trial, we studied the effect of combined treatment with fractional carbon dioxide (CO₂) laser, platelet-rich plasma (PRP) injection, and narrowband ultraviolet B (NB-UVB) for stable nonsegmental vitiligo regarding repigmentation grade, patient's satisfaction, and side effects.

Methods

Eighty adult patients with localized nonsegmental vitiligo were enrolled in this study. The patients were randomly categorized to receive 4 lines of treatment; fractional CO₂ laser, PRP, combined fractional CO₂ laser and PRP, and combined fractional CO₂ laser and NB-UVB. The treatment period was 2 months. Patients were clinically evaluated 3 months after the last treatment. Outcome was evaluated by 5-point scale for repigmentation, 10-point visual analog scale for patient's satisfaction, and side effects.

Results

Laser and PRP group achieved the best results regarding repigmentation and patient's satisfaction. Sixty percent of the patients developed repigmentation >50% and 40% of patients developed repigmentation >75%. In laser and NB-UVB group, 5% developed repigmentation >75% and 25% developed repigmentation >50%. Only 10% of patients developed repigmentation >75% in laser group and only 20% of patients developed repigmentation >75% in PRP group.

Conclusions

Combination of fractional CO₂ laser with PRP injection is a promising treatment for vitiligo, followed by combination of fractional CO₂ laser with NB-UVB phototherapy. Both fractional CO₂ laser and PRP injection gave poor results if they received alone.

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Tubo-ovarian abscess infected by Salmonella typhi

We report a case of a tubo-ovarian abscess infected with Salmonella enterica serotype typhi. A 19-year-old Nepalese woman presented to a hospital in Kathmandu with lower abdominal pain, constipation, fever and a non-healing, suppurative surgical wound from an emergency caesarian section performed 2 months previously at 37 weeks of pregnancy. She also had an exploratory laparotomy for an appendix perforation with peritonitis at 25 weeks of gestation. Her wound infection did not respond to cloxacillin and she had an exploratory laparotomy, and a tubo-ovarian abscess was found from which S. typhi was isolated. She had a bilateral salpingo-oophorectomy and responded to 14 days of chloramphenicol. A tubo-ovarian abscess is a rare complication of enteric fever.

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Solitary biceps muscle metastasis from breast cancer

Although direct muscle invasion by carcinoma is well recognised, skeletal muscle metastases are rare. Breast cancer very rarely metastasises to skeletal muscles. We present a case of breast cancer that metastasised to the biceps muscle. The woman developed breast cancer in 1990 and then developed axillary subcutaneous metastasis in 2001. In 2015, she presented with pain in the left forearm extending to the hand. Initial imaging showed no abnormalities, but the positron emission tomography-CT scanning revealed a hot spot in the left biceps muscle. Additionally, the nerve conduction study showed feature of carpal tunnel syndrome. The hot spot was deemed inconclusive in the view of normal CT and MRI scans, and the patient was treated with carpal tunnel decompression. A few months later, the patient developed a lump in the left biceps muscle, which appeared to be a metastatic lesion from her primary breast cancer. The patient was treated with radiotherapy and responded satisfactorily.

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Topical ayurvedic ointment-induced chemical injury presenting as bilateral acute keratitis

A 40-years-old female patient was referred to the cornea clinic as a probable case of bilateral keratitis. The patient had a history of headache followed by acute onset of redness, pain and discharge from both eyes for 15 days. The patient was diagnosed as bilateral keratitis by the first contact physician and was started on topical antibiotics, cycloplegics and lubricating eye-drops. At presentation, both eyes had visual acuity of perception of light, conjunctival congestion, limbal blanching, diffuse corneal oedema and epithelial defect. A detailed history revealed application of Vicks VapoRub [topical ayurvedic analgesic which contains (per 100 g of product) menthol (2.82 g), camphor (5.25 g) and eucalyptol (1.49 mL) and excipients include thymol (0.1 g), turpentine oil (5.57 mL), nutmeg oil (0.54 mL), cedar wood oil and petrolatum)] on the forehead and eyelids for headache several times over 2–3 days before the onset. The patient further confirmed the accidental application of the ointment in the eyes. A provisional diagnosis of acute chemical injury with Vicks VapoRub was made and treatment with topical antibiotic, cycloplegic, steroid, lubricant and vitamin C was started. On follow-up, both eyes showed gradual resolution of corneal oedema and epithelial defect. Visual acuity improved in the left eye to 6/60 with no change in right eye due to corneal haze.

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Vermiform appendix within incisional hernia

The vermiform appendix (whether inflamed or not) within a hernia is very rare occurrence. We present the unprecedented case of a normal appendix found within a Pfannenstiel incisional hernia. A diagnostic laparoscopy was performed as appendicitis was suspected. However, the tip of a normal appendix was visualised within a previous Pfannenstiel incision. Laparoscopic appendicectomy was carried successfully and the patient was discharged. The patient later returned for a successful elective laparoscopic incisional hernia repair.

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Cutaneous lupus erythematosus. Quality of life and related factors in a cohort of 260 patients of A Coruña, Spain

Abstract

Dermatological disease has a significant impact on quality of life (QoL). However, information is scarce for cutaneous lupus erythematosus (CLE) in this regard. Thus, the manifestation of and co-morbidities associated with CLE were assessed in the current study to determine factors predictive of QoL impairment. A descriptive cross-sectional study was performed on predominantly Caucasian patients with CLE, recruited at our institution between April 2013 and August 2016 (α = 0.050; precision ± 6.5%).

This article is protected by copyright. All rights reserved.

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Comparison of pyoderma gangrenosum and hypertensive ischemic leg ulcer Martorell in a Swiss cohort

Abstract

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis presenting with painful and sterile skin ulcerations (1). Its aetiology remains largely unknown although an autoinflammatory background seems possible. Several comorbidities as well as triggering factors such as surgery, trauma or pharmacological therapies have been associated with the development of PG (2). Different topical and systemic treatments are recommended for PG, most commonly topical steroids or calcineurin inhibitors as well as systemic steroids, dapsone, infliximab and others, as well as by our group and others canakinumab and ustekinumab (3, 4).

This article is protected by copyright. All rights reserved.

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Clinical Thyroidology for the Public – Highlighted Article

From Clinical Thyroidology for the Public: While it is clear that overt hypothyroidism in the mother during pregnancy can affect the baby's brain development or cause other problems with the pregnancy, it is not clear if subclinical hypothyroidism would have similar adverse effects. Read More….

We welcome your feedback and suggestions. Let us know what you want to see in this publication.

Feedback & Suggestions

The post Clinical Thyroidology for the Public – Highlighted Article appeared first on American Thyroid Association.

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Clinical Thyroidology High-Impact Articles

FREE ACCESS through September 1, 2017
Read Now:

Parathyroid Lesions Can Be Distinguished from Thyroid Lesions on FNA but May Require Ancillary Studies and Molecular Analysis
Stephanie A. Fish

Older Age and Advanced Disease Are Risk Factors for Complications after Thyroid Cancer Surgery
Masha J. Livhits, Michael W. Yeh 

The Merits of Ultrasound Screening for Familial Nonmedullary Thyroid Cancer Are Strongly Dependent on the Number of Affected Family Members
Charles H. Emerson 

¹⁸F-FDOPA-PET Is More Sensitive than F-18-FDG-PET in Persistent or Recurrent Medullary Thyroid Cancer
Martin Biermann

The post Clinical Thyroidology High-Impact Articles appeared first on American Thyroid Association.

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Correlación entre medidas de evaluación perceptual GRB y cociente de contacto

Publication date: Available online 19 August 2017
Source:Acta Otorrinolaringológica Española
Author(s): Rodrigo Maximiliano Jerez
ObjetivoEl objetivo del presente trabajo es correlacionar los parámetros perceptuales de grade, roughness y breathiness de la escala GRBAS con el cociente de contacto (CQ) obtenido por medio de electroglotografía.Material y métodoSe analizaron 70 muestras de voces normales y patológicas por medio de análisis auditivo-perceptual y electroglotografía. El análisis perceptual fue llevado a cabo por dos jueces expertos en función de los parámetros grade, roughness y breathiness. Los valores de CQ fueron obtenidos por medio del sistema VoceVista Versión 3.3.7.ResultadosLos resultados demuestran correlación fuerte entre CQ y soplo (r = -0,869), mientras que, entre grado de disfonía y CQ (r = -0,567), y aspereza y CQ (r = 0,643) la correlación es media.ConclusionesEs posible establecer relaciones entre el comportamiento vibratorio de los pliegues vocales y el fenómeno resultante que percibimos auditivamente. El parámetro más relevante al respecto fue breathiness. La correlación entre grade, roughness y CQ fue más débil.ObjectiveThe aim of the present workis to correlate the perceptual parameters grade, roughness and breathiness of the GRB scale with the contact quotient (CQ) obtained by electroglotography.Material and method70 samples of normal and pathological voices were analyzed by means of auditory-perceptual analysis and electroglotography. The perceptual analysis was carried out by two expert judges depending on the parameters grade, roughness and breathiness. The CQ values were obtained through the VoceVista System Version 3.3.7.ResultsThe results show a strong correlation between CQ and breathiness (r = -0.869), whereas between grade of dysphonia and CQ (r = -0.567), and roughness and CQ (r = 0.643) the correlation is average.ConclusionsIt is possible to establish relationships between the vibrational behavior of the vocal folds and the resulting phenomenon that we perceive auditively. The most relevant parameter in this respect was breathiness. The correlation between grade, roughness and CQ was weaker.



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Regulatory T cell subsets in patients with medulloblastoma at diagnosis and during standard irradiation and chemotherapy (PBTC N-11)

Abstract

Background

We evaluated circulating levels of immunosuppressive regulatory T cells (T_regs) and other lymphocyte subsets in patients with newly diagnosed medulloblastoma (MBL) undergoing surgery compared to a control cohort of patients undergo craniectomy for correction of Chiari malformation (CM) and further determined the impact of standard irradiation and chemotherapy on this cell population.

Methods

Eligibility criteria for this biologic study included age 4–21 years, patients with CM undergoing craniectomy (as non-malignant surgical controls) and receiving dexamethasone for prevention of post-operative nausea, and those with newly diagnosed posterior fossa tumors (PFT) undergoing surgical resection and receiving dexamethasone as an anti-edema measure. Patients with confirmed MBL were also followed for longitudinal blood collection and analysis during radiotherapy and chemotherapy.

Results

A total of 54 subjects were enrolled on the study [22-CM, 18-MBL, and 14-PFT]. Absolute number and percentage T_regs (defined as CD4⁺CD25⁺FoxP3⁺CD127^low/−) at baseline were decreased in MBL and PFT compared to CM [p = 0.0016 and 0.001, respectively). Patients with MBL and PFT had significantly reduced overall CD4⁺ T cell count (p = 0.0014 and 0.0054, respectively) compared to those with CM. Radiation and chemotherapy treatment in patients with MBL reduced overall lymphocyte counts; however, within the CD4⁺ T cell compartment, T_regs increased during treatment but gradually declined post therapy.

Conclusions

Our results demonstrate that patients with MBL and PFT exhibit overall reduced CD4⁺ T cell counts at diagnosis but not an elevated proportion of T_regs. Standard treatment exacerbates lymphopenia in those with MBL while enriching for immunosuppressive T_regs over time.

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Conidiobolomycosis: An Unusual Fungal Disease—Our Experience

Abstract

Conidiobolomycosis is a rare mycotic disease caused by Conidiobolus coronatus. Very few cases have been reported in English literature. Often it is clinically misdiagnosed as soft tissue tumour. A prospective case study was done from 2006 to 2015 in a tertiary care hospital of West Bengal, India. The objectives of our study were to describe the epidemiological and clinical features and treatment of Conidiobolomycosis to prevent disfigurement. Patients clinically suspected to be suffering from Conidiobolomycosis were subjected to biopsy followed by histopathological and mycological examinations. Then they were treated with oral saturated solution of potassium iodide along with other drugs. Total six cases were histopathologically proved to be suffering from Conidiobolomycosis. Fungus was isolated and identified in one case. Complete resolution was seen in five patients. Conidiobolomycosis should be brought into mind as differential diagnosis of subcutaneous swelling in the rhinofacial region.

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A Successfully Treated Case of Gastrointestinal Stromal Tumor Causing Severe Anemia and Localized Peritonitis Showing Angina Pectoris Resulting in Watershed Cerebral Infarction

Ischemic stroke following acute myocardial infarction is a rare but a serious complication. Because the pathophysiology of stroke is dynamic, it is often hard to identify the cause of stroke. Here, we present the case of a 75-year-old man with ischemic stroke following angina pectoris caused by severe anemia and localized peritonitis due to gastrointestinal stromal tumor of small intestine. On admission, he showed consciousness disturbance, fever, and left hemiplegia. The electrocardiogram on admission showed ST-segment depression in V2 to V6 which was normalized 4 hours later. The ultrasound cardiogram showed the mild hypokinesis in the apical portion of left ventricle which was also normalized later. The magnetic resonance imaging and angiography showed ischemic stroke in watershed area between right anterior and middle cerebral arteries area and stenosis of distal portion of right middle cerebral artery. The computed tomography of abdomen showed a mass of small intestine. We decided to perform curative surgery after transfusion and successfully resected the mass of the small intestine, which was revealed to be a gastrointestinal stromal tumor (GIST). This is a successfully treated case of GIST in which the complicated pathophysiology of watershed cerebral infarction following angina pectoris might be clearly revealed.

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Effects of cavity reconstruction on morbidity and quality of life after canal wall down tympanoplasty

Publication date: Available online 19 August 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Sinan Uluyol, Omer Ugur, Ilker Burak Arslan, Ozlem Yagiz, Murat Gumussoy, Ibrahim Cukurova
IntroductionCanal wall down (CWD) tympanomastoidectomy is commonly used to treat advanced chronic otitis media or cholesteatoma. The advantages of CWD mastoidectomy are excellent exposure for disease eradication and postoperative control of residual disease; its disadvantages include the accumulation of debris requiring life-long otological maintenance and cleaning, continuous ear drainage, fungal cavity infections, and the occurrence of dizziness and vertigo by changing temperature or pressure.ObjectiveTo evaluate whether cavity-induced problems can be eliminated and patient comfort can be increased with mastoid cavity reconstruction.MethodsIn total, 11 patients who underwent mastoid cavity reconstruction between March 2013 and June 2013 comprised the study group, and 11 patients who had dry, epithelialized CWD cavities were recruited as the control group. The study examined three parameters: epithelial migration, air caloric testing, and the Glasgow Benefit Inventory (GBI). Epithelial migration, air caloric testing, and the GBI were studied in the study and control groups.ResultsThe epithelial migration rate was significantly faster in study group (1.63±0.5mm/week) than control group (0.94±0.37mm/week) (p=0.003, p<0.05). The mean slow component velocity of nystagmus of the study group (13.33±5.36°/s) was significantly lower when compared to control group (32.11±9.12°/s) (p=0.018). The overall GBI score was −7.21, and the general subscale, physical and social health scores were −9.71, −21.09, and +20.35, respectively in the control group. These were +33.93, +35.59, +33.31, and +29.61, respectively in the study group. All but the social health score improved significantly (0.007, 0.008, 0.018, and 0.181, respectively).ConclusionsCavity reconstruction improves epithelial migration, normalizes caloric responses and increases the quality of life. Thus, cavity rehabilitation eliminates open-cavity-induced problems by restoring the functional anatomy of the ear.



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Conidiobolomycosis: An Unusual Fungal Disease—Our Experience

Abstract

Conidiobolomycosis is a rare mycotic disease caused by Conidiobolus coronatus. Very few cases have been reported in English literature. Often it is clinically misdiagnosed as soft tissue tumour. A prospective case study was done from 2006 to 2015 in a tertiary care hospital of West Bengal, India. The objectives of our study were to describe the epidemiological and clinical features and treatment of Conidiobolomycosis to prevent disfigurement. Patients clinically suspected to be suffering from Conidiobolomycosis were subjected to biopsy followed by histopathological and mycological examinations. Then they were treated with oral saturated solution of potassium iodide along with other drugs. Total six cases were histopathologically proved to be suffering from Conidiobolomycosis. Fungus was isolated and identified in one case. Complete resolution was seen in five patients. Conidiobolomycosis should be brought into mind as differential diagnosis of subcutaneous swelling in the rhinofacial region.

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Corrigendum to “The Relationship between Population T4/TSH Set Point Data and T4/TSH Physiology”

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Hypermetabolic Thyroid Incidentaloma on Positron Emission Tomography: Review of Laboratory, Radiologic, and Pathologic Characteristics

Introduction. Incidental hypermetabolic thyroid lesions on Positron Emission Tomography have significant clinical value and may harbor malignancy. In this study we evaluated laboratory, radiologic, and pathologic characteristics of incidental hypermetabolic thyroid lesions. Materials and Methods. We evaluated 18 patients prospectively with various malignancies and hypermetabolic thyroid incidentaloma. The thyroid function tests, ultrasound assessment, and guided FNA biopsy were performed on all cases. Results. We included 9 male and 9 female patients with mean age of 51 years. Most common malignancy was colon cancer. Metabolic activity quantification using maximum standard uptake value demonstrated range between 1.4 and 65.4 with mean value of 9.4. We found highest metabolic activity in patients with lung adenocarcinoma, B-cell lymphoma, and colon adenocarcinoma. On ultrasound exam most thyroid lesions were of solid, hypoechoic, noncalcified nature with either normal or peripheral increased vascularity. FNA biopsy report was benign in 15 cases and malignant or highly suggestive for malignancy in 3 other cases. Two of the three malignant cases demonstrated metabolic activity higher than average SUV max. Conclusion. Most thyroid hypermetabolic incidentalomas are benign lesions, while higher values of SUV max are in favor of malignancy. This mandates further evaluation of incidentally found thyroid hypermetabolic lesions on routine PET/CT scans.

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Expansion of blood IgG4+ Bcells, Th2 and Tregulatory cells in IgG4-related disease

Publication date: Available online 19 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jorn J. Heeringa, A. Faiz Karim, Jan A.M. van Laar, Robert M. Verdijk, Dion Paridaens, P. Martin van Hagen, Menno C. van Zelm
BackgroundIgG4-related disease (IgG4-RD) is a systemic fibro-inflammatory condition affecting various organs and has a diverse clinical presentation. Fibrosis and accumulation of IgG4+ plasma cells in tissue are hallmarks of the disease and IgG4-RD is associated with elevated IgG4 serum levels. However, disease pathogenesis is still unclear and these cellular and molecular parameters are neither sensitive nor specific for diagnosis of IgG4-RD.ObjectiveWe here sought to develop a flowcytometric gating strategy to reliably identify blood IgG4+ B-cells to study their cellular and molecular characteristics and investigate their contribution in disease pathogenesis.MethodsSixteen patients with histologically confirmed IgG4-RD, 11 patients with sarcoidosis and 30 healthy individuals were included for 11-color flowcytometric analysis of peripheral blood for IgG4-expressing B cells and T-helper (Th) subsets. In addition, detailed analysis of activation markers and chemokine receptors was performed on IgG4-expressing B cells and IgG4 transcripts were analyzed for somatic hypermutations.ResultsCellular and molecular analyses revealed increased numbers of blood IgG4+ memory B-cells in patients with IgG4-RD. These cells showed reduced expression of CD27 and CXCR5 and increased signs of antibody maturation. Furthermore, IgG4-RD patients, but not patients with sarcoidosis, had increased numbers of circulating plasma blasts and CD21^low B-cells, as well as Th2 and regulatory T-cells, indicating of a common disease pathogenesis in IgG4-RD.ConclusionThese results provide new insights into the dysregulated IgG4 response in patients with IgG4-RD. A specific "peripheral lymphocyte signature" observed in patients with IgG4-RD, could support diagnosis and treatment monitoring.

Teaser

We here provide new insights into IgG4+ B-cells, and how their detection contributes to diagnosis and monitoring of treatment success in patients with IgG4-related disease.


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Granulomatosis with Polyangiitis with Myocarditis and Ventricular Tachycardia

Granulomatosis with polyangiitis (GPA), previously known as Wegener's granulomatosis, is a pulmonary-renal syndrome affecting small and medium sized blood vessels. The disease has a prevalence in studies ranging from 3 to 15.7 cases per 100,000, with a noted increasing incidence and prevalence in more recent studies. Pulmonary manifestations include hemorrhage, lung cavitary lesions, and pulmonary fibrosis. Within the kidney, GPA is known to cause rapidly progressive pauci-immune crescentic glomerulonephritis. Rare and severe cardiovascular manifestations include pericarditis, arrhythmias, myocarditis, and aortic valve disease. Our patient is a 43-year-old female with typical pulmonary and renal lesions from GPA and also acute myocarditis, multiple episodes of ventricular tachycardia, and a severe reactive thrombocytosis.

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Granulomatous rosacea: a case report

Granulomatous rosacea is a rare chronic inflammatory skin disease with an unknown origin. The role of Demodex follicularum in its pathogenesis is currently proved.

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Manifestation of atopic dermatitis-like skin in TNCB-induced NC/Nga mice is ameliorated by topical treatment of substance P, possibly through blockade of allergic inflammation

Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by intense pruritus and eczematous lesion. In this study, topically applied substance P (SP) significantly alleviated AD-like clinical symptoms in 2, 4, 6-trinitrochlorobenzene (TNCB)-induced dermatitis in NC/Nga mice. This effect was nullified by pre-treatment of the neurokinin-1 receptor (NK-1R) antagonist CP99994. SP treatment significantly reduced the infiltration of mast cells and CD3-positive T cells as well as inflammatory cytokines, such as tumor necrosis factor-α (TNF-α) and thymic stromal lymphopoietin (TSLP), in AD-like skin lesions and decreased the levels of IgE and thymus and activation-regulated chemokine in serum. This SP-induced alleviation of allergic inflammatory responses was also confirmed as reduced activation in the axillary lymph nodes (aLN) and spleen, suggesting the systemic effect of SP on immune responses in TNCB-induced NC/Nga mice. Furthermore, SP-mediated TSLP reduction was confirmed in human keratinocyte culture under pro-inflammatory TNF-α stimulation. Taken together, these results suggest that topically administered SP may have potential as a medication for atopic dermatitis.

This article is protected by copyright. All rights reserved.

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Over-expression of p53 explains isotretinoin′s teratogenicity

Abstract

The precise molecular basis of retinoid embryopathy is yet unknown. This hypothesis predicts that isotretinoin (13-cis retinoic acid), the prodrug of all-trans retinoic acid (ATRA), exaggerates neural crest cell (NCC) apoptosis via upregulation of the pro-apoptotic transcription factor p53, the guardian of the genome. Increased p53 signaling is associated with Treacher Collins-, CHARGE-, and fetal alcohol syndrome, which exhibit dysmorphic craniofacial features resembling retinoid embryopathy. In addition, developmental studies of NCC homeostasis in the zebrafish support the pivotal role of p53. Translational evidence implies that isotretinoin-stimulated over-activation of p53 during embryogenesis represents the molecular basis of isotretinoin′s teratogenicity.

This article is protected by copyright. All rights reserved.

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High Expression of B Lymphocyte Stimulator (BLyS) in Lesional Keratinocytes of Patients with Cutaneous Lupus Erythematosus

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Regression of Diffuse B-cell Lymphoma of the Leg with Intralesional Gentian Violet

Abstract

In this case report, a patient of Primary Cutaneous Diffuse B-cell lymphoma, leg type was treated with intralesional gentian violet as she was judged to be too medically fragile for conventional chemotherapy due to advanced age and multiple serious comorbidities. Gentian violet (Crystal violet/ hexamethyl pararosaniline) is a triphenylmethane dye. It has been shown to have an inhibitory effect on NADPH oxidase, an enzyme family which is found in abundance in reactive oxygen driven tumors such as melanoma and lymphoma. We hypothesize that intralesional gentian violet treatment caused signaling changes in the lymphoma which allowed for immune clearance of the lymphoma. Complete resolution of the patient's lesion was noted on a follow up visit.

This article is protected by copyright. All rights reserved.

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In vitro and in vivo models to investigate the pathomechanisms and novel treatments for pemphigoid diseases

Abstract

Pemphigoid diseases (PD) are a subgroup of rare acute or chronic autoimmune skin disorders characterized and caused by autoantibodies directed against distinct structural components of the dermal-epidermal junction. Binding of autoantibodies to their targets leads to the formation of blisters and erosions in patients. PDs comprise eight disorders for which the molecular target antigens have been identified. First, we review the available in vitro and ex vivo models for analysis of distinct aspects of the pathogenesis of PDs. This includes the binding of autoantibodies to skin sections, the analysis of blister formation capability and skin complement activation as well as investigation of neutrophil and keratinocyte activation. In addition to this, several animal models of PD have been developed during the last decades. These animal models have greatly contributed to our current understanding of the pathogenesis of PDs. We summarize spontaneously arising PD in animals and the induction of PD by transfer of (auto)-antibodies, transfer of (auto)-antigen specific lymphocytes and by immunization. In combined use, these models allow dissecting all aspects of PD pathogenesis, e.g. loss of tolerance, autoantibody production and inflammatory skin processes that lead to blister formation. Overall, we aim to foster translational biomedical research, to deepen our understanding of PD pathogenesis and to develop novel treatments for patients suffering from these life-threatening and difficult-to-treat autoimmune diseases.

This article is protected by copyright. All rights reserved.

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Cytotoxic anti-melanoma drugs suppress the activation of M2 macrophages

Abstract

Together with regulatory T cells (Tregs), tumor-associated macrophages (TAMs) play roles in maintaining the tumor microenvironment. Though cytotoxic anti-melanoma drugs such as dacarbazine (DTIC), nimustine hydrochloride (ACNU), and vincristine (VCR) have been used for the treatment of malignant melanoma as adjuvant therapy in Japan, the detailed mechanisms of their immunomodulatory effects are not fully understood. Since the majority of TAMs are alternatively activated M2 macrophages that favor tumor development, the aim of this study was to elucidate the immunomodulatory effects of these reagents on human monocyte-derived M2 macrophages. First, mRNA expressions and protein production of immune checkpoint molecules, PD-L1, and chemokines by CD163⁺ CD206⁺ M2 macrophages derived from peripheral blood mononuclear cells were investigated to determine the immunomodulatory effects of DTIC, ACNU, and VCR. DTIC and VCR significantly decreased PD-L1 mRNA expression, which was confirmed by flow cytometry. Moreover, the mRNA expression and production of CCL22 were significantly decreased by DTIC, which suggested that DTIC might suppress the recruitment of Tregs in the tumor site. Furthermore, the decreased expression of PD-L1 and production of CCL22 were validated in vivo, using the B16F10 mouse melanoma model, leading to abrogation of the suppressive function of T cell proliferation. The present report suggests one of the possible anti-melanoma mechanisms of DAV combination chemotherapy for melanoma patients.

This article is protected by copyright. All rights reserved.

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Eosinophils as putative therapeutic targets in bullous pemphigoid

Abstract

Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering skin disease and is characterized by the presence of autoantibodies directed against the hemidesmosomal proteins BP180 and BP230 that can be detected in the skin and serum of BP patients. Histologically, the dermal infiltration of eosinophils is obvious. The objective of this review is to present evidence that eosinophils play a key role in the pathogenesis of BP. Eosinophils, together with cytokines and chemokines regulating their production, recruitment and activation, are abundantly present in lesional skin, in blisters and in peripheral blood of patients with BP. Recently, using a cryosection model, eosinophils were demonstrated to induce dermal-epidermal separation in the presence of BP antibodies. Thus, eosinophils and their products, as well as mediators regulating their function, present promising targets for the treatment of BP.

This article is protected by copyright. All rights reserved.

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Towards the development of a RNAi-based topical treatment for psoriasis: Proof-of-concept in a 3D psoriasis skin model

Abstract

RNA interference has emerged as a powerful tool for therapeutic gene silencing, as it offers the possibility to silence virtually any known pathology-causing gene. However, in vivo delivery of RNAi molecules is hampered by their unfavorable physicochemical characteristics and susceptibility to degradation by endogenous enzymes. To overcome these limitations, we recently developed an elastic liposomal formulation, called DDC642, as topical delivery system of therapeutic RNAi molecules for skin disorders. In this study, we validated the therapeutic efficacy of DDC642-encapsulated RNAi molecules in the treatment of psoriasis using three different in vitro models: a standardized keratinocyte monolayer culture, psoriasis-induced keratinocytes and a psoriasis reconstructed skin model. Four genes (IL22RA1, KRT17, DEFB4 and TSLP), known to be upregulated in psoriatic lesions, and thereby key players in psoriasis pathogenesis were selected. Moreover, the possibility of using a combined siRNA therapy in the topical treatment of psoriasis was explored. Results indicate a successful gene silencing of each different target, both at mRNA and protein level. Additionally, siRNA-DDC642 treatment resulted in a reduced expression of specific psoriasis markers, indicating their potential in future therapeutic approach. The examined siRNA combination (i.e. simultaneous knockdown of KRT17, DEFB4 and TSLP) showed an enhanced reduction in TSLP expression, whereas the decrease in K17 protein expression was impaired in psoriatic keratinocytes. Although the here examined siRNA combination could still be further improved, our study proved already in vitro the clinical potential of targeting multiple genes at once, each playing a different role in a complex disease such as psoriasis.

This article is protected by copyright. All rights reserved.

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Prelingual Deafness: An Overview of Treatment Outcome

Abstract

Prelingually deaf child is one who is either born deaf or who lost his or her hearing early in childhood, before acquiring language. A child with subnormal hearing acuity suffers from consequences of hearing loss compounded by impaired speech development. The period from birth to 3 years of life is critical for the development of speech and language, therefore, there is need for early identification and assessment of hearing loss and early rehabilitation in children. 40 patients were evaluated clinically, radiologically and audiologically to assess the degree of patient's handicap. The modes of treatment included use of hearing aid in patients with moderate, moderately-severe, severe or profound HL and cochlear implantation in patients with profound HL. Each patient was followed for 18 months and results were calculated in terms of speech perception (CAP) and language (REELS) development of the patient. Out of the 40 patients, 60% (n = 24) were females and 40% (16) were males. 50% (n = 20) patients had PSNHL, 32.5% (n = 13) had SSNHL, 10% (n = 4) had MSSNHL and 7.5% (n = 3) had MSNHL. 30% (n = 12) of patients had significant radiological findings. Among the hearing aid users patients with PSNHL got no benefit at the end of 18 months whereas the patients with cochlear implantation had significant improvement. Also the patients managed at a younger age (<3 years) had a significantly better outcome then those managed later. Early identification of hearing loss, that is followed by immediate and appropriate intervention results in better language, speech, and social-emotional development when compared to children treated at a later age.

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Longitudinal Study of Type I Interlay Tympanoplasty

Abstract

The aim of the present study was to access success rate of tympanoplasty and complications with interlay technique of tympanoplasty. This Longitudinal Prospective study was carried out in the Department of Otorhinolaryngology and Head and Neck Surgery, Era's Lucknow Medical College, Lucknow. 50 patients aged between 10 and 50 years of chronic otitis media mucosal type disease with dry ears were selected. Otomicroscopic, tunning fork test, pure tone audiometry were done in all patients. All patients underwent interlay tympanoplasty. Patients were followed up regularly for a minimum period of 1.5 years. Successful graft uptake was noted in 48 (96%) cases. Interlay tympanoplasty results in excellent graft uptake and good post operative Air Bone Gap closure.

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Prelingual Deafness: An Overview of Treatment Outcome

Abstract

Prelingually deaf child is one who is either born deaf or who lost his or her hearing early in childhood, before acquiring language. A child with subnormal hearing acuity suffers from consequences of hearing loss compounded by impaired speech development. The period from birth to 3 years of life is critical for the development of speech and language, therefore, there is need for early identification and assessment of hearing loss and early rehabilitation in children. 40 patients were evaluated clinically, radiologically and audiologically to assess the degree of patient's handicap. The modes of treatment included use of hearing aid in patients with moderate, moderately-severe, severe or profound HL and cochlear implantation in patients with profound HL. Each patient was followed for 18 months and results were calculated in terms of speech perception (CAP) and language (REELS) development of the patient. Out of the 40 patients, 60% (n = 24) were females and 40% (16) were males. 50% (n = 20) patients had PSNHL, 32.5% (n = 13) had SSNHL, 10% (n = 4) had MSSNHL and 7.5% (n = 3) had MSNHL. 30% (n = 12) of patients had significant radiological findings. Among the hearing aid users patients with PSNHL got no benefit at the end of 18 months whereas the patients with cochlear implantation had significant improvement. Also the patients managed at a younger age (<3 years) had a significantly better outcome then those managed later. Early identification of hearing loss, that is followed by immediate and appropriate intervention results in better language, speech, and social-emotional development when compared to children treated at a later age.

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Longitudinal Study of Type I Interlay Tympanoplasty

Abstract

The aim of the present study was to access success rate of tympanoplasty and complications with interlay technique of tympanoplasty. This Longitudinal Prospective study was carried out in the Department of Otorhinolaryngology and Head and Neck Surgery, Era's Lucknow Medical College, Lucknow. 50 patients aged between 10 and 50 years of chronic otitis media mucosal type disease with dry ears were selected. Otomicroscopic, tunning fork test, pure tone audiometry were done in all patients. All patients underwent interlay tympanoplasty. Patients were followed up regularly for a minimum period of 1.5 years. Successful graft uptake was noted in 48 (96%) cases. Interlay tympanoplasty results in excellent graft uptake and good post operative Air Bone Gap closure.

http://ift.tt/2vU5QIO

Conchal contractility after inferior turbinate hypertrophy treatment: A prospective, randomized clinical trial

Publication date: Available online 19 August 2017
Source:American Journal of Otolaryngology
Author(s): Remzi Dogan, Erol Senturk, Orhan Ozturan, Yavuz Selim Yildirim, Selahattin Tugrul, Aysenur Meric Hafiz
ObjectiveThe aim of this study is to evaluate the effects of these two methods (Nasal corticosteroids (NCS) and radiofrequency (RF) application) on conchal contractility utilizing objective rhinologic measurement parameters.Methods82 patients were presented with the complaint of nasal obstruction and diagnosed with inferior turbinate hypertrophy and were included in the study. Patients in Group 1 received NCS for 12weeks. Patients in Group 2 were administered RF to their inferior turbinates. Acoustic rhinometry and rhinomanometry tests with and without decongestant were performed.ResultsIn the evaluation of the contractility difference of rhinometry parameters, there was not a significant difference among pre and postoperative acoustic rhinometric parameters in Group 1. Whereas in Group 2, postoperative contractility difference was significantly decreased compared to preoperative values.In the evaluation of the contractility difference of rhinomanometric parameters, no significant difference was found between pre and postoperative values in Group 1. However, postoperative contractility difference was significantly decreased compared to preoperative values in Group 2 in terms.ConclusionBecause the RF procedure produces fibrosis in the vascular tissues, inferior turbinates do not have a shrinking response to decongestant administration. Administration of NCS administration maintains the contractility function compared to RF application.



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