Serum biotin and zinc in male androgenetic alopecia

Summary

Background

Male androgenetic alopecia (MAGA) is caused by the conversion of the terminal to vellus hair. Zinc is one of the most studied trace elements in hair disorders and biotin is one of the most prescribed supplement for its treatment.

Objectives

The study aimed to evaluate serum zinc and biotin levels in MAGA patients to answer the question if there is a value to add zinc or biotin as a supplements in the MAGA treatment.

Patients and Methods

Sixty MAGA patients and 60 age, sex, and body mass index‐matched healthy volunteers were included. We measured serum biotin and zinc in all participants.

Results

Zinc (µg/dL) was lower significantly in patients compared to controls (P = 0.01), suboptimal biotin (ng/L) levels were in patients, and within normal values in controls (P = 0.01). A positive significant correlation was found between serum zinc and serum biotin (r = 0.489, P = 0.001). Serum zinc and biotin showed a nonsignificant correlation with age and disease duration. A non‐significant relation was obtained between the MAGA grades, and zinc (P = 0.485) and biotin levels (P = 0.367).

Conclusions

Serum zinc showed subnormal value and adding zinc supplement in MAGA treatment is recommended. Serum biotin showed a suboptimal level in MAGA patients that is not correlated with patients' age or disease severity. Biotin supplement in MAGA treatment may add value to hair quality and texture. We recommend future biotin evaluation in serum combined with its metabolites in MAGA patients' urine.

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Huge rhinophyma in a complicated patient successfully treated with C02 laser

Abstract

Rhinophyma is a bothersome and disfiguring condition of the nose that is often cause of cosmetic embarrassment and social reclusion.

Nowadays the therapeutic possibilities are highly variable and have to be personalized case by case. These possibilities include pharmacological therapy, laser surgery, mechanical dermabrasion and surgical excision. For patients with cardiovascular comorbidies and anticoagulant therapy, the therapeutic choice is limited. We present a case of a giant rhinophyma in a patient with several comorbidities that we successfully treated with CO2 laser.

This article is protected by copyright. All rights reserved.

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Small bowel obstruction with multiple perforations post chestnut ingestion

Phytobezoars are a rare cause of small bowel obstruction (SBO), which consists of vegetable matter such as seeds, skins, fibres of fruit and vegetables that have solidified. We present the case of a 61-year-old man with no previous surgery who presented with central abdominal pain, nausea and vomiting. An abdominal CT scan demonstrated SBO with a transition point in the left anterior abdomen. He proceeded to a laparoscopy, which revealed multiple perforations throughout the small bowel, from the proximal jejunum to the terminal ileum. Laparotomy was performed, and undigested chestnuts were milked out through the largest perforation and the perforations were oversewn. While obstruction due to phytobezoars is rare, this case demonstrates the importance of considering small bowel trauma and perforation due to phytobezoars and highlights the need for close inspection of the entire gastrointestinal tract for complications in the setting of phytobezoar-related bowel obstruction.

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Maculopathy from an accidental exposure to welding arc

Welding light can cause photic retinal injury. We report binocular maculopathy induced by a brief exposure to electric arc welding light in a patient who could not equipped with protective device because of narrow space. A 47-year-old man performed electric arc welding for approximately 10–15 min without wearing protective device because of narrow space and subsequently experienced eye discomfort and decreased visual acuity. At the initial visit, his best corrected visual acuity was 0.5. Fundus examination, optical coherence tomography (OCT) and multifocal electroretinogram (mfERG) were performed. OCT showed disruption in the ellipsoid zone, and mfERG amplitudes in the central 10° were markedly reduced in both eyes. The decrease in visual acuity had been noted for at least 18 months. Using the proper protective device is essential in welding, despite short time periods of work. For patients with welding-induced photokeratitis, doctors should also consider the possibility of photic retinal injury.

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Adalimumab-induced acute myeloid leukaemia in a patient with Crohns disease

We present a patient with Crohn's disease under treatment with adalimumab who developed acute myeloid leukaemia (AML) with core-binding factor beta gene rearrangement. This case report emphasises the importance of long-term close follow-up of patients receiving adalimumab because of the increased risk of developing AML and other malignancies.

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Food avoidance strategies in eosinophilic oesophagitis

Abstract

EoE is a chronic disease associated with significant morbidity that can result in permanent fibrosis and stricture formation. Given the complexity a multidisciplinary approach is recommended to manage these patients. In the majority of children with EoE not responsive to proton pump inhibitors (PPI), inflammation is driven by sensitivity to foods and treatment with an elimination diet can be effective.

Foods most commonly identified to trigger EoE in children are milk and wheat, but egg, soy, meats and grains can also be triggers. Foods can be eliminated using a step‐down or step‐up approach. If the goal is to achieve quick remission elemental diet or six food elimination diets are the most effective. A step‐up approach starting from a 1‐2 food elimination diet and increasing the number of foods based on a personalised dietary approach is recommended if the goal is to achieve remission using the least number of endoscopies and with increased acceptability to the patient.

Children with EoE on elimination diets require frequent monitoring of growth and nutrition, as well as screening for symptoms of EoE, allergy, and mindfulness regarding psychosocial impact of chronic disease on the family and child. Current research focused on tools to select patients who mostly will benefit from dietary treatment, identify relevant food allergens, obtain oesophageal tissue non‐invasively and induce tolerance will greatly improve the treatment of EoE.

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Donor characteristics, recipient outcomes, and histologic findings of kidney allografts with diffuse donor-derived glomerular fibrin thrombi

Background: Limited data is available regarding whether donor kidneys with diffuse glomerular fibrin thrombi (GFT) are safe to use. In this study, the clincopathologic characteristics of allografts with diffuse donor-derived GFT were examined. Methods: All deceased donor kidney transplant implantation biopsies from our institution between 07/2011 to 02/2018 with diffuse GFT were included. A control group for comparison consisted of all cases with implantation biopsies obtained during the study period without diffuse GFT. Clinical data were extracted from electronic medical records for all study patients, including donor information. Results: Twenty-four recipients received kidneys with diffuse GFT from 16 deceased donors. All donors died from severe head trauma. On average, 79% of glomeruli contained fibrin thrombi. Nineteen cases had subsequent biopsy; all revealed resolution of GFT. Compared to the control group, kidneys with diffuse GFT had longer cold ischemia time (34 versus 27 hours), were more frequently pumped using machine perfusion (100% versus 81%), and recipients experience a higher frequency of delayed graft function (58% versus 27%). Only two grafts with diffuse GFT failed within the first year. Overall graft survival was similar between the diffuse GFT group and control group. Conclusion: Deceased donor kidneys with diffuse GFT appear to be safe to use given that nearly 92% of recipients in this cohort who received such allografts experienced good clinical outcomes. Histologically, GFT demonstrated rapid resolution following transplantation. Interestingly, diffuse GFT only occurred in donors who suffered severe head trauma in this cohort, which may be a predisposing factor. Disclosure: The authors declare no conflicts of interest. Funding: None. Correspondence: Kuang-Yu Jen, MD, PhD, University of California Davis School of Medicine, Department of Pathology and Laboratory Medicine, 4400 V Street, Suite 1224, Sacramento, CA 95817, Phone: (916) 734-2579, Fax: (916) 734-2560, Email: kyjen@ucdavis.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2D7WJIp

Intraoperative Hemodynamic Parameters and Acute Kidney Injury After Living Donor Liver Transplantation

Background: Acute kidney injury (AKI) after living donor liver transplantation (LDLT) is associated with increased mortality. We sought to identify associations between intraoperative hemodynamic variables and postoperative AKI. Methods: We retrospectively reviewed 734 cases of LDLT. Intraoperative hemodynamic variables of systemic and pulmonary arterial pressure, central venous pressure (CVP), and pulmonary artery catheter-derived parameters including mixed venous oxygen saturation (SvO2), right ventricular end-diastolic volume (RVEDV), stroke volume, systemic vascular resistance, right ventricular ejection fraction, and stroke work index were collected. Propensity score matching analysis was performed between patients with (n= 265) and without (n=265) postoperative AKI. Hemodynamic variables were compared between patients with acute kidney injury (AKI), defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria, and those without AKI in the matched sample. Results: The incidence of AKI was 36.1% (265/734). Baseline CVP, baseline RVEDV and SvO2 at 5 min before reperfusion were significantly different between patients with and without AKI in the matched sample of 265 pairs. Multivariable logistic regression analysis revealed that baseline CVP, baseline RVEDV, and SvO2 at 5 min before reperfusion were independent predictors of AKI (CVP per 5 cmH2O increase: odds ratio [OR] 1.20, 95% confidence interval [CI] 1.09-1.32; SvO2: OR 1.45, 95% CI 1.27-1.71; RVEDV: OR 1.48, 95% CI 1.24-1.78). Conclusion: Elevated baseline CVP, elevated baseline RVEDV after anesthesia induction and decreased SvO2 during anhepatic phase were associated with postoperative AKI. Prospective trials are required to evaluate whether optimization of these variables may decrease the risk of AKI after LDLT. Source of funding: No external fund received. Conflict of interest: The authors declared no conflict of interests. Corresponding Author: Won Ho Kim, MD, PhD, Mailing Address: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. E-mail: wonhokim.ane@gmail.com; Phone: 82-2-2072-2462; FAX: 82-2-747-5639 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Biliary Complications Following Pediatric Living Donor Liver Transplantation: Risk Factors, Treatments and Prognosis

Background: We present retrospective analysis of our 15-year experience with pediatric living donor liver transplantation (LDLT), focusing on the risk factors, treatments and long-term prognosis for post-transplant biliary complications (BCs). Methods: Between May 2001 and December 2017, 290 LDLTs were performed. The median age was 1.4 years old. The median observation period was 8.4 years. Biliary strictures were classified as anastomotic stricture (AS) or non-anastomotic stricture (NAS). Results: Overall incidence of BCs was 18.6%, including AS in 46 cases, NAS in six, and other classifications in two. The mean period to diagnosis of the AS was 641 ± 810 post-operative days. The multivariate analysis showed that hepaticojejunostomy without external stent was an independent risk factor for AS (p=0.011). The first treatments for AS were percutaneous transhepatic biliary drainage (PTBD) in 25 cases, double-balloon enteroscopy (DBE) in 19, and surgical re-anastomosis in 2. The success and recurrence rates of PTBD treatments were 88.9% and 18.8%, respectively. The success and recurrence rates of endoscopic interventions under DBE were 76.8% and 69.9%, respectively. The 15-year graft survival rates in patients with and without AS were 95.7% and 89.1%, respectively (p=0.255), but 2 patients with cholangitis due to multiple NAS underwent re-transplantation. Conclusions: Post-transplant AS can be prevented by hepaticojejunostomy using external stent, and the long-term prognosis is good with early treatments using DBE or PTBD. However, the prognosis of multiple NAS is poor. Disclosures: We have no conflicts of interest to disclose as described by the Transplantation. Funding: We have no finding sources. This abstract of this manuscript was accepted for oral presentation at the 18th Congress of the European Society for Organ Transplantation held in Barcelona in September 2017. Correspondence information: Yukihiro Sanada M.D., Ph.D., Department of Transplant Surgery, Jichi Medical University Address: 3311-1 Yakushiji, Shimotsuke City, Tochigi 329-0498, JAPAN. Telephone and fax: +81-285-58-7069, E-mail: yuki371@jichi.ac.jp Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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CONTINUOUS MONITORING OF TRANSPLANT CENTER PERFORMANCE: DIFFERENT OPTIONS FOR DIFFERENT GOALS

Background– In France, the need for continuous monitoring of transplant center performance has recently become apparent. CUSUM monitoring of transplantation is already been used to monitor transplant outcomes in the UK and in the US. Because CUSUM monitoring can be applied by different methods, the objective was to assess and compare the performance of different CUSUM methods for detecting higher than expected (that is, excessive) graft failure rates. Methods– Data come from the French transplant registry. Lung and kidney transplants in 2011-2013 constituted the control cohort, and those in 2014-2016 the observed cohort. The performance of CUSUM monitoring, according to center type and predefined control limits, was measured by simulation. The outcome monitored was 3-month graft failure. Results– In a low-volume center with a low failure rate, 3 different types of control limits produced successful detection rates (SDRs) of excessive graft failures of 15, 62, and 73% and false alarm rates (FARs) of 5, 40, and 52%, with 3, 1, and 1 excess failures necessary before a signal occurred. In a high-volume center with a high failure rate, SDRs were 83, 93, and 100%, and FARs were 5, 16, and 69%, with 6, 13, and 17 excess failures necessary before a signal occurred. Conclusions– CUSUM performances vary greatly depending on the type of control limit used. A new control limit set to maximize specificity and sensitivity of detection is an appropriate alternative to those commonly used. Continued attention is necessary for centers with characteristics making it difficult to obtain adequate sensitivity or sufficiently prompt response. Disclosure: The authors declare no conflicts of interest. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Corresponding author contact information: Camille Legeai, Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Pôle Evaluation, 1 avenue du Stade de France, 93212 Saint-Denis La Plaine cedex, France. Phone: +33 1 55 93 69 02. Fax: +33 1 55 93 69 30. Email: camille.legeai@biomedecine.fr Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2D7WRYp

Conversion from calcineurin inhibitors to belatacept in HLA- sensitized kidney-transplant recipients with low-level donor specific antibodies.

Background. Belatacept could be the treatment of choice in renal-transplant recipients with renal dysfunction attributed to CNI nephrotoxicity. Few studies have described its use in patients with DSA. Methods. We retrospectively evaluated conversion from CNIs to belatacept in 29 HLA-immunized RTRs. Data regarding acute rejection, DSA and renal function were collected. These patients were compared to 42 non-immunized patients treated with belatacept. Results. Patients were converted from CNIs to belatacept a median of 444 days [IQR:85-1200] after transplantation and were followed-up after belatacept conversion, for a median of 308 days [IQR: 125-511]. At conversion, 16 patients had DSA. Nineteen DSA were observed in these 16 patients, of which 11/19 were less than 1000MFI, 7/19 were between 1000 and 3000 MFI , and one was more than 3000 MFI. At last follow-up, pre-existing DSA had decreased or stabilized. Seven patients still had DSA with a mean MFI of 1298 ± 930 at the last follow-up. No patient developed a de novo DSA in the DSA positive group. In the non-immunized group, one patient developed de novo DSA (A24- MFI 970; biopsy for cause did not show BPAR or microinflammation score). After belatacept conversion, one ABMR was diagnosed. The mean eGFR improved from 31.7 ± 14.2 mL/min/1.73 m2 to 40.7 ± 12.3 mL/min/1.73 m2 (p

http://bit.ly/2G9IOFH

Evaluation of Accepting Kidneys of Varying Quality for Transplantation or Expedited Placement with Decision Trees

Background: Underutilization of marginal-quality kidneys for transplantation produced ideas of expediting kidney placement for populations with decreased opportunities of receiving transplants. Such policies can be less efficacious for specific individuals and should be scrutinized until the decision-making for accepting marginal-quality organs, which has relied on experiential judgment, is better understood at the individual level. There exist rigorous tools promoting personalized decisions with useful and objective information. Methods: This article introduces a decision-tree methodology that analyzes a patient's dilemma: to accept a kidney offer now or reject it. The methodology calculates the survival benefit of accepting a kidney given a certain quality now and the survival benefit of rejecting it. Survival benefit calculation accounts for patients' and donors' characteristics and transplant centers' and organ procurement organizations' performances and incorporates patients' perceived transplant and dialysis utilities. Valuations of rejecting an offer are contingent on future opportunities and subject to uncertainty in the timing of successive kidney offers and their quality and donor characteristics. Results: The decision tree was applied to a realistic patient profile as a demonstration. The tool was tested on 1,000 deceased-donor kidney offers in 2016. Evaluating up to one year of future offers, the tool attains 61% accuracy with transplant utility 1.0 and dialysis utility 0.5. The accuracy reveals potential bias in kidney offer acceptance/rejection at transplant centers. Conclusions: The decision-tree tool presented could aid personalized transplant decision-making in the future by providing patients with calculated, individualized survival benefits between accepting and rejecting a kidney offer. *Corresponding Author: Vikram Kilambi, 20 Park Plaza Suite 920, Boston, MA 02116, E-mail: vkilambi@rand.org Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2D7WMnz

A custom made clamp facilitating stabilization of cuffs in murine heterotopic cervical heart transplantation

No abstract available

http://bit.ly/2G5SEZv

Developing CUSUM Charts for Monitoring Transplant Outcomes: Varied Goals and Many Possible Paths to Success

No abstract available

http://bit.ly/2G9MRC6

Utilization of deceased donor kidneys to initiate living donor chains: practical, ethical and logistical issues

No abstract available

http://bit.ly/2D9eUO7

Can mycophenolic acid-based immunosuppression benefit liver transplant patients with HCC?

No abstract available

http://bit.ly/2G96YAj

Tolerance Biomarkers in Liver Transplantation: Independent External Validation of the Predictive Strength of SENP6 and FEM1C Gene Expression

Background: Numerous studies have emphasized the genetic and phenotypic profiles of tolerant transplant patients. Moreover, different groups have defined several biomarkers, trying to distinguish patients who are going to be tolerant from those who are going to reject. However, most of these biomarkers have not been validated by other groups or even established for clinical practice. Methods: We reanalyzed and stratified the predictive capacity of 20 previously described biomarkers for liver transplantation tolerance in a cohort of 17 liver transplant patients subjected to an independent, nonrandomized, prospective study of immunosuppression drug withdrawal. Results: Only 4 of the 20 studied biomarkers (expression of SENP6, FEM1C, miR31 and miR95) showed a strong predictive capacity in the present study. miR31 and FEM1C presented an area under the ROC curve (AUC) of 96.7 %, followed by SENP1 with 93.3 %. Finally, miR95 had an AUC value below 86.7 %. Conclusions: Even though this independent analysis seems to confirm the predictive strength of SENP6 and FEM1Cin liver transplantation tolerance, there are also risks in establishing biomarkers for clinical phenotypes without an understanding of how they are biologically relevant. Future collaborations between groups should be promoted so that the most promising biomarkers can be validated and implemented in daily clinical practice. † Equal senior authors. Disclosure: The authors of this manuscript have no conflicts of interest to disclose. Funding: This work was supported by a grant from Instituto de Salud Carlos III (PI12/02042 and PI17/00489) for J.A.P. and Fundación Mutua Madrileña (FMM13) for A.B.M. as Principal Investigators. Corresponding Author: Alberto Baroja-Mazo; Murcia's Biohealth Research Institute-Virgen de la Arrixaca; LAIB Building - Lab 4.20; Ctra. Buenavista s/n 30120 Murcia (SPAIN); +34 868885031; alberto.baroja@um.es Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2D7WzAN

Tandem Orthotopic Living Donor Liver Transplantation Followed by Same Donor Haploidentical Hematopoietic Stem Cell Transplantation for DOCK8 Deficiency: Tandem Liver and Bone Marrow Transplant in DOCK8 Deficiency

Background: An 11-year old girl with DOCK8 deficiency was proposed for potentially curative hematopoietic stem cell transplantation (HSCT), the donor being her haploidentical mother. However, end-stage liver disease, caused by chronic Cryptosporidium infection required liver transplantation before HSCT. Methods: Consequently, a staged approach of a sequential liver transplant followed by a HSCT was planned, with her mother as the donor for both liver and HSCT. Results: The patient successfully underwent a left lobe orthotopic liver transplant, however, she developed a biliary leak delaying the HSCT. Notably, the recipient demonstrated 3 percent donor lymphocyte chimerism in her peripheral blood immediately prior to HSCT. Haploidentical related donor HSCT performed two months after liver transplantation was complicated by the development of acyclovir-resistant HSV viremia, primary graft failure, and sinusoidal obstruction syndrome (SOS). The patient died from SOS associated multiorgan failure with Candida sepsis on day +40 following HSCT. Conclusions: We discuss the many considerations inherent to planning for HSCT preceded by liver transplant in patients with primary immunodeficiencies, including the role of prolonged immunosuppression and the risk of infection prior to immune reconstitution. We also discuss the implications of potential recipient sensitization against donor stem cells precipitated by exposure of the recipient to the donor lymphocytes from the transplanted organ. Acknowledgments: This work was supported by the Intramural Research Program of the National Institute of Allergy and Infectious Diseases and National Cancer Institute, National Institutes of Health. This project has been funded in whole or in part with federal funds from the National Cancer Institute, National Institutes of Health, under Contract No. HHSN261200800001E. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. This trial is registered at Clinicaltrials.gov NCT01176006 Disclosure: The authors declare no conflicts of interest. Corresponding author: Nirali N. Shah , National Institutes of Health, Building 10/CRC, Room 1-5750, 10 Center Drive, Bethesda, MD 20892, USA. Phone 240-760-6199 , Email: shahnn@mail.nih.gov Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2G9INS9

Lost in Translation: Converting Empirical Evidence to Organ Acceptance Decision-Making: Lost in Translation

No abstract available

http://bit.ly/2G9xxoP

Racial/ethnic disparities in access and outcomes of simultaneous liver-kidney transplant among liver transplant candidates with renal dysfunction in the United States

Background: Since the Model for End-Stage Liver Disease (MELD) allocation system was implemented, the proportion of simultaneous liver-kidney transplantation (SLKT) has increased significantly. However, whether racial/ethnic disparities exist in access to SLKT and post-SLKT survival remains understudied. Methods: A retrospective cohort of patients age ≥18 with renal dysfunction on the liver transplant (LT) waiting list was obtained from Organ Procurement and Transplantation Network. Renal dysfunction was defined as estimated glomerular filtration rate

http://bit.ly/2D7Wtcp

Comment on Dai R. et al.: The effect of milk consumption on acne: a meta‐analysis of observational studies

Abstract

We have read with interest the article on milk implication in acne pathogenesis and we would like to congratulate the authors for creating the first meta‐analysis on this subject (1). Acne is a cutaneous disease with major implications for both adolescent and adult patients and each step towards the establishment of a complete, complex and individually adapted management plan (including dietary interventions) is of most importance.

This article is protected by copyright. All rights reserved.

http://bit.ly/2Sn7Vux

ATA supports dialogue on emergency preparedness around nuclear power stations

Here's what could happen in a nuclear disaster in Washtenaw County

The American Thyroid Association has called for pre-distribution of potassium iodide, also known as KI, to households within a 10-mile radius of nuclear power plants such as Fermi 2, and stockpiling it in public facilities such as schools, hospitals, clinics, post offices and police and fire stations in up to a 50-mile radius.
Michigan Live (www.MLive.com)

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The post ATA supports dialogue on emergency preparedness around nuclear power stations appeared first on American Thyroid Association.

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Issue Information

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Variable response to low‐dose naltrexone in patients with Darier disease: a case series

Abstract

Background

Darier disease is a rare autosomal‐dominant genodermatosis with a loss of function of a Ca²⁺‐ATPase pump (SERCA2‐pump). Clinically, the disease is characterized by red‐brown keratotic papules mainly in seborrheic areas and has only limited and unsatisfactory treatment options. Previously, low‐dose naltrexone was described as a successful treatment option in Hailey‐Hailey‐disease, a genodermatosis with a genetic mutation coding for a similar loss of function of a Ca²⁺‐ATPase pump (hSPCA1‐pump).

Objective

To assess the efficacy of low‐dose naltrexone as a treatment option in Darier disease.

Methods

Six patients with biopsy‐proven Darier disease (4 had severe, 1 had moderate and 1 mild clinical manifestations). The patients received off‐label therapy with naltrexone (5 mg per os [p.o.]) and magnesium (200 mg p.o.). Patients were followed up every 4 weeks for minimally 12 weeks. Upon clinical presentation, the disease severity and subjective pain and itch scores were assessed, and standardized photographs were obtained.

Results

The clinical response to naltrexone varied after 12 weeks. The 4 patients with severe Darier disease showed worsening after initial improvement during the first 4 weeks, whereas the 2 patients with a mild to moderate clinical manifestation clearly improved, showing almost full remission after 12 weeks with complete flattening of the keratotic papules.

Conclusion

Low‐dose naltrexone did not have an effect on severe Darier disease compared to Hailey‐Hailey disease, but it was beneficial in mild to moderate forms of the disease. Further studies are needed to confirm these observations of variable responses.

This article is protected by copyright. All rights reserved.

http://bit.ly/2WEYlSY

Stephen Ira Katz M.D., Ph.D., Director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), 1941–2018

http://bit.ly/2WETukX

Issue Information

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Asthma Status and Risks among Lesbian, Gay, and Bisexual Adults in the United States: A Scoping Review

Publication date: Available online 2 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Cindy B. Veldhuis, Jean-Marie Bruzzese, Tonda L. Hughes, Maureen George

http://bit.ly/2MLEvAT

MdRDH1, a HSP67B2-like rhodanese homologue plays a positive role in maintaining redox balance in Musca domestica

Publication date: March 2019

Source: Molecular Immunology, Volume 107

Author(s): Ting Tang, Hehe Sun, Yongbao Li, Peiru Chen, Fengsong Liu

Abstract

Rhodanese homology domains (RHODs) are the structural modules of ubiquitous tertiary that occur in three major evolutionary phyla. Despite the versatile and important physiological functions of RHODs containing proteins, little is known about their invertebrate counterparts. A novel HSP67B2-like single-domain rhodanese homologue, MdRDH1 from Musca domestica, whose expression can be induced by bacterial infection or oxidative stress. Silencing MdRDH1 through RNAi causes important accumulations of reactive oxygen species (ROS) and malondialdehyde (MDA), and increases mortality in the larvae treated with bacterial invasion. The E. coli with MdRDH1 and the mutant MdRDH1^C135A are transformed, with significant rhodanese activity of the recombinant protein of MdRDH1 in vitro found, without no detection of enzyme activity of the mutant MdRDH1^C135A, revealing that catalytic Cys135 in the active-site loop is essential in the sulfurtransferase activity of MdRDH1. When oxidative stress is insulted by phenazine methosulfate (PMS), the MdRDH1 transformed E. coli shows enhanced survival rates compared with those bacteria transformed with MdRDH1^C135A. Our research indicates that MdRDH1 confers oxidative stress tolerance, thus rendering evidence for the idea that rhodanese family genes play a critical role in antioxidant defenses. This paper yields novel insights into the potential antioxidative and immune functions of HSP67B2-like rhodanese homologues in invertebrate.

http://bit.ly/2WA7VXv

Cockroach allergens – coping with challenging complexity

Publication date: Available online 2 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Jörg Kleine-Tebbe, Robert G. Hamilton, Richard E. Goodman

http://bit.ly/2Tt4hN5

Mining Social Media Data to Assess the Risk of Skin and Soft Tissue Infections from Allergen Immunotherapy

Publication date: Available online 2 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Kimberly G. Blumenthal, Maxim Topaz, Li Zhou, Tyler Harkness, Roee Sa'adon, Ofrit Bar-Bachar, Aidan A. Long

Abstract

Background

Allergen immunotherapy (AIT) treatment for allergic rhinitis and asthma is used by 2.6 million Americans annually. Clinical and sterility testing studies identify no risk of contamination or infection from extracts prepared using recommended aseptic techniques, but regulatory concerns persist. Social media can be used to investigate rare adverse effects not captured by traditional studies.

Objective

To investigate large social media databases for suggestion of AIT skin and soft tissue infection (SSTI) risk and compare this risk to a comparator procedure with a sterile pharmaceutical.

Methods

We analyzed USA-restricted data from over 10 common text-based social media platforms including Facebook, Twitter, and Reddit between 2012-2016. We employed natural language processing (NLP) to identify posts related to AIT and, separately, Influenza vaccination (comparator procedure). NLP was followed by manual review to identify posts suggesting a possible SSTI associated with either AIT or Influenza vaccination. SSTI frequencies with 95% confidence intervals (CI) were compared.

Results

We identified 25,126 AIT posts, which were matched by social media platform to 25,126 Influenza vaccination-related posts. NLP identified 4,088 (16.3%) AIT posts that required manual review, with 6 posts (0.02%, 95%CI 0.005% to 0.043%) indicative of possible AIT-related SSTI. NLP identified 2,689 (10.7%) Influenza posts that required manual review, with 7 posts (0.03%, 95%CI 0.007% to 0.048%) indicative of possible Influenza vaccination-related SSTI.

Conclusion

Social media data suggest that SSTI from AIT and Influenza vaccination are equally rare events. Given that AIT's SSTI risk appears comparable to the risk using a sterile pharmaceutical based on social media data, current aseptic technique procedures seem safe.

http://bit.ly/2BjMKjh

Regulation of Ectodomain Shedding of ADAM33 In Vitro and In Vivo

Publication date: Available online 2 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Elizabeth R. Davies, Laura Denney, Marieke Wandel, Clare M. Lloyd, Donna E. Davies, Hans Michael Haitchi

http://bit.ly/2TubjRs

Pediatric Anesthesia: A Problem-Based Learning Approach

No abstract available

http://bit.ly/2WDeE2N

Severe asthma in children: therapeutic considerations

Purpose of review Children with poor asthma control despite maximal maintenance therapy have problematic severe asthma (PSA). A step-wise approach including objective adherence monitoring and a detailed multidisciplinary team assessment to identify modifiable factors contributing to poor control is needed prior to considering therapy escalation. Pathophysiological phenotyping in those with true severe therapy-resistant asthma (STRA) and the current array of add-on therapies will be discussed. Recent findings Adherence monitoring using electronic devices has shown that only 20–30% of children with PSA have STRA and need additional therapies. Omalizumab and mepolizumab are licensed for children with STRA aged 6 years and older. Although robust safety and efficacy data, with reduced exacerbations, are available for omalizumab, biomarkers predicting response to treatment are lacking. Paediatric safety data are available for mepolizumab, but efficacy data are unknown for those aged 6–11 years and minimal for those 12 years and older. A sub-group of children with STRA have neutrophilia, but the clinical significance and contribution to disease severity remains uncertain. Summary Most children with PSA have steroid sensitive disease which improves with adherence to maintenance inhaled corticosteroids. Add-on therapies are only needed for the minority with STRA. Paediatric efficacy data of novel biologics and biomarkers that identify the optimal add-on for each child are lacking. If we are to progress toward individualized therapy for STRA, pragmatic clinical trials of biologics in accurately phenotyped children are needed. Correspondence to Sejal Saglani, MD, Imperial College London, London, UK. E-mail: s.saglani@imperial.ac.uk Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Sepsis - What's new in 2019?

Purpose of review Sepsis-3 guidelines have implications in a deeper understanding of the biopathology of the disease. Further, the review focuses on timely topics and new literature on fluid resuscitation, the value of steroids in sepsis, and new therapeutic options such as angiotensin II, vitamin C, and thiamine as well as the emerging role of procalcitonin (PCT) in managing antibiotics. Recent findings Traditional therapies such as type of crystalloid fluid administration and steroid therapy for sepsis are currently under re-evaluation. Angiotensin II is investigated for reversing vasodilatory shock. The role of capillary endothelium leak and cellular metabolism can be affected by vitamin C and thiamine levels. Biomarker level trends, specifically PCT, can aid clinical suspicion of infection. Summary Sepsis-3 shifts the focus from a noninfectious inflammatory process and an emphasis on a dysregulated host response to infection. Hyperchloremic crystalloid resuscitation is associated with poor clinical outcomes. Steroid administration can reverse shock physiology; however, mortality benefits remain uncertain. Angiotensin II, vitamin C, and thiamine are novel treatment options that need further validation. PCT assays can help discern between infectious and noninfectious inflammation. Correspondence to Mark E. Nunnally, MD, Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Health, NYU Langone Medical Center, 550 1st Ave, New York, NY 10016, USA. Tel: +1 (212) 263 5072; e-mail: Mark.Nunnally@nyulangone.org Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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