A case of ochronosis successfully treated with the picosecond laser

Summary

Exogenous ochronosis is a cutaneous condition characterized by blue‐black pigmentation resulting as a complication of long‐term application of skin‐lightening creams containing hydroquinone and other substances such as quinine, phenol and mercury derivatives. We report a case of a 55‐year‐old woman who developed exogenous ochronosis as a result of prolonged use of topical hydroquinone for 5 years, characterized by greyish hyperpigmented patches on the nose and cheeks. The diagnosis was confirmed histologically. Treatment with picosecond laser resulted in marked clinical improvement together with improvement in overall texture and quality of the skin.

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Cellular retinol‐binding protein‐1 expression increases with increasing clinical severity of alopecia areata

Summary

Background

Alopecia areata (AA) is multifactorial disease mostly autoimmune affecting anagen hair follicles. Many researchers hypothesize that adequate retinoic acid (RA) levels are important for proper hair follicle behavior. Previous animal studies revealed increase in RA synthesis proteins and decrease in RA degradation proteins in AA patients when compared with controls.

Objective

To evaluate cellular retinol‐binding protein‐1 expression in lesional skin of alopecia areata in comparison with controls, in an attempt to know its role in the pathogenesis of alopecia areata .

Methods

Immunohistochemical expression of cellular retinol‐binding protein‐1 CRBP1 was evaluated in skin biopsies taken from lesions of alopecia areata in 30 patients and 10 normal biopsy specimens taken from skin of healthy controls (HC) who were within the same age and sex.

Results

CRBP1 expression was significantly increased in lesional alopecia areata skin in comparison with normal skin of controls (P < 0.001*). Significant positive correlation was found between expression of CRBP‐1 and percentage of hair loss in the scalp (SALT score; r = 0.840, P = <0.001).

Conclusion

These results may enhance the idea of the possible role of CRBP1 in the pathogenesis of AA, and ensuring the importance of its level in AA treatment.

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Relationship between diet, atopy, family history, and premature hair graying

Abstract

Aim

Premature hair graying (PHG) is commonly observed in society, but there are a few studies evaluating risk factors associated with PHG. We aimed to evaluate the socio‐clinical risk factors associated with PHG in this study.

Methods

A total of 1192 volunteers between 18 and 20 years old were included in this cross‐sectional study. Volunteers were asked to fill in a questionnaire on socio‐clinical risk factors associated with PHG such as smoking, alcohol consumption, diet preference, atopy history, and family history of PHG and Perceived Stress Scale (PSS).

Results

Three hundred and seventy‐seven (31.6%) of the 1192 volunteers had PHG. Vegetarian diet preference, atopy history, and family history of PHG were significantly higher in subjects with PHG. Mean body mass index (BMI) and PSS scores were higher in subjects with PHG, but was not statistically significant. In the ordinal logistic regression analysis according to severity of PHG, male gender, BMI, alcohol consumption, and history of paternal PHG were significantly higher and onset age of PHG was significantly lower in PHG group.

Conclusion

Our study is the first study reporting a relationship between PHG and diet. It may be possible to prevent PHG or reduce its severity with some lifestyle changes such as diet preference, having normal weight, and decreasing alcohol consumption.

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Radiation therapy for patients with newly diagnosed metastatic head and neck squamous cell carcinoma

Abstract

Background

To assess the association between radiation therapy (RT) use and overall survival (OS) for patients with metastatic head and neck squamous cell carcinomas (HNSCC).

Methods

We analyzed the National Cancer Database to identify patients with newly diagnosed metastatic HNSCC from 2004 to 2013 who were treated with up‐front chemotherapy. Associations between the use of RT and OS were evaluated.

Results

We identified 3516 patients with metastatic HNSCC who were treated with chemotherapy; 2288 (65%) were also treated with RT. The addition of RT to chemotherapy was associated with prolonged survival (median: 13.6 vs 11.3 months, log‐rank P < .001). After adjusting for other prognostic factors in a multivariable Cox model, propensity score matching and landmark analyses limited to patients who survived at least 3, 6, and 12 months after diagnosis, the use of RT remained associated with prolonged survival.

Conclusion

The addition of RT to chemotherapy in the up‐front management of metastatic HNSCC was associated with prolonged OS in this study.

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Obituary

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A novel preservation solution containing a JNK inhibitory peptide efficiently improves islet yield for porcine islet isolation

Background For islet transplantation, pancreas preservation in UW solution is associated with disadvantages such as collagenase inhibition, resulting in poor islet yield and islets with poor viability. In this study, we evaluated a novel preservation solution, the extracellular-type c-Jun N-terminal kinase (JNK) inhibitor-containing (EJ) solution. Methods EJ solution has high sodium-low potassium composition with low viscosity compared to UW solution. Moreover, EJ solution contains a recently developed JNK inhibitor from our laboratory. Results We first compared the performance of EJ solution with that of UW solution. Islet yield before and after purification was significantly higher in the EJ group than in the UW group. Second, we compared the performance of EJ solution with that of EJ solution without the JNK inhibitor (EJ-J solution). After pancreas preservation in EJ solution, JNK activity was maintained at a relatively low level during islet isolation. Islet yield before and after purification was significantly higher in the EJ group than in the EJ-J group. After islet transplantation into streptozotocin-induced diabetic mice, blood glucose levels reached the normoglycemic range in 61.5% and 7.7% of diabetic mice in the EJ and EJ-J groups, respectively. Moreover, EJ solution exhibited reduced inhibition of collagenase digestion compared to UW solution. Conclusion Advantages of EJ solution over UW solution were inhibition of JNK activity and reduced collagenase inhibition. EJ solution may therefore be more suitable for islet isolation than UW solution. *Address correspondence to: Hirofumi Noguchi, MD, PhD, Department of Regenerative Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan. Tel: +81-98-895-1696; Fax: +81-98-895-1684. E-mail: noguchih@med.u-ryukyu.ac.jp Author Contributions H.N. designed the experiments and analyzed the data. H.N. carried out most of the experimental work with the help of. C.M-S., Y.N. N.E., E.H., Y.T., and K.K., S.K., N.K., I.S., and M.W. provided materials and discussion. H.N. wrote the manuscript. All authors discussed and commented on the manuscript. Competing Interests: The authors declare that they have no competing interests. Funding sources: This work was supported in part by JSPS KAKENHI Grant Numbers JP16H05404, JP16K10435, and JP18K08545, Japan Agency for Medical Research and Development, Okinawa Science and Technology Innovation System Construction Project, the Waksman Foundation of Japan, Inc., and The Naito Foundation. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Home-based Cognitive Prehabilitation in Older Surgical Patients: A Feasibility Study

Background: Cognitive training is beneficial in various clinical settings, although its perioperative feasibility and impact remain unknown. The objective of this pilot study was to determine the feasibility of home-based cognitive prehabilitation before major surgery in older adults. Materials and Methods: Sixty-one patients were enrolled, randomized, and allocated to either a home-based preoperative cognitive training regimen or no training before surgery. Outcomes included postoperative delirium incidence (primary outcome; assessed with the 3D-Confusion Assessment Method), perioperative cognitive function based on NIH Toolbox measures, hospital length of stay, and physical therapy session participation. Reasons for declining enrollment were reported, as were reasons for opting out of the training program. Results: Postoperative delirium incidence was 6 of 23 (26%) in the prehabilitation group compared with 5 of 29 (17%) in the control group (P=0.507). There were no significant differences between groups in NIH Toolbox cognitive function scoring, hospital length of stay, or physical therapy participation rates. Study feasibility data were also collected and reported. The most common reasons for declining enrollment were lack of computer access (n=19), time commitment (n=9), and feeling overwhelmed (n=9). In the training group, only 5 of 29 (17%) included patients were able to complete the prescribed 7 days of training, and 14 of 29 (48%) opted out of training once home. Most common reasons were feeling overwhelmed (n=4) and computer difficulties (n=3). Conclusions: Short-term, home-based cognitive training before surgery is unlikely to be feasible for many older patients. Barriers to training include feeling overwhelmed, technical issues with training, and preoperative time commitment. P.E.V. is supported by National Institutes of Health Grant K23GM126317. The study was also supported by the Department of Anesthesiology, University of Michigan Medical School (Ann Arbor, MI). The methodology of this trial was presented as a poster presentation at the Foundation for Anesthesia Education and Research 2017 Medical Student Anesthesia Research Fellowship Symposium (MSARF Fellow: A.R.D.). The authors have no funding or conflicts of interest to disclose. Address correspondence to: Phillip E. Vlisides, MD, Department of Anesthesiology, University of Michigan Medical School, 1H247 UH, SPC-5048, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5048 (e-mail: pvliside@med.umich.edu). Received September 12, 2018 Accepted November 16, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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