Home About us Contact
|
Home About us Contact | ||
|
|
||
April
Kinds of April Selected AbstractsAPRIL (TNFSF13) regulates collagen-induced arthritis, IL-17 production and Th2 responseEUROPEAN JOURNAL OF IMMUNOLOGY, Issue 12 2008Yanping Xiao Abstract A proliferation-inducing ligand (APRIL or TNFSF13) shares receptors with B-cell activation factor of the TNF family (BAFF) on B and T cells. Although much is known about the function of APRIL in B cells, its role in T cells remains unclear. Blocking both BAFF and APRIL suggested that BAFF and/or APRIL contributed to collagen-induced arthritis (CIA); however, the role of APRIL alone in CIA remained unresolved. We show here that, in vitro, our newly generated APRIL,/, mice exhibited increased T-cell proliferation, enhanced Th2 cytokine production under non-polarizing conditions, and augmented IL-13 and IL-17 production under Th2 polarizing conditions. Upon immunization with OVA and aluminum potassium sulfate, APRIL,/, mice responded with an increased antigen-specific IgG1 response. We also show that in APRIL,/, mice, the incidence of CIA was significantly reduced compared with WT mice in parallel with diminished levels of antigen-specific IgG2a autoantibody and IL-17 production. Our data indicate that APRIL plays an important role in the regulation of cytokine production and that APRIL-triggered signals contribute to arthritis. Blockade of APRIL thus may be a valuable adjunct in the treatment of rheumatoid arthritis. [source] To switch or not to switch , the opposing roles of TACI in terminal B cell differentiationEUROPEAN JOURNAL OF IMMUNOLOGY, Issue 1 2007Ulrich Salzer MD Abstract The TNF superfamily ligands BAFF and APRIL and their three receptors BAFFR, BCMA, and TACI comprise a network that is critically involved in the development and function of humoral immunity. Failure of this complex system is associated with autoimmune disease, B lymphocyte tumours, and antibody deficiency. While BAFF:BAFFR interactions control peripheral B cell survival and homeostasis, BCMA function seems limited to the survival of long-lived bone marrow plasma cells. The functional activity of the third receptor TACI is, however, ambiguous: while TACI,/, mice predominantly develop autoimmunity and lymphoproliferation, TACI deficiency in humans primarily manifests itself as an antibody deficiency syndrome. An article in this issue of the European Journal of Immunology demonstrates a negative regulation via TACI in human B cells by using TACI specific antibodies. B cell proliferation, class switch recombination, and Ig production induced by various stimuli were inhibited via TACI. Within the BAFF/APRIL network, the expression of the receptors and ligands is spatially, as well as temporally, highly regulated at various stages of B cell development and function. Defining the exact contribution of TACI stimulation by specific triggers in vitro enables us to better understand the complex, context-dependent responses initiated by TACI in vivo. See accompanying article http://dx.doi.org/10.1002/eji.200636623 [source] Atopic eczema or atopiform dermatitisEXPERIMENTAL DERMATOLOGY, Issue 4 2010Jan D. Bos Please cite this paper as: Atopic eczema or atopiform dermatitis. Experimental Dermatology 2010. Abstract:, Age period prevalence of atopic eczema (AE), a very common skin disease, has increased during the past decennia. This expansion seems to be ending in wealthy countries, while an increase is observed in developing nations, for which there is no firm explanation. Recent steps in understanding AE are the detection of skin barrier related filaggrin null mutations in approximately 25% of patients and the recognition of IL-31 as a molecule possibly involved in the itch (pruritus). Also interesting are the recognition of thymus and activation-regulated chemokine (TARC) and proliferating-inducing ligand (APRIL), as being associated with AE severity and activity. Immunocentric and corneocentric views on pathogenesis (the inside-outside paradigm) and the diagnostic entity atopiform dermatitis (AFD) are discussed here. We emphasize that diagnosing AE is not simple but challenging. We accentuate that a diagnosis of AE is only possible when there is allergen-specific IgE. Advice as to the need for elimination of allergens and adjustment of lifestyle are only proficient in patients having atopy and true AE, not in those having AFD. [source] Systemic activation of the immune system induces aberrant BAFF and APRIL expression in B cells in patients with systemic lupus erythematosusARTHRITIS & RHEUMATISM, Issue 7 2009Van Trung Chu Objective Elevated levels of BAFF and APRIL are characteristic of patients with systemic lupus erythematosus (SLE). The reasons for enhanced cytokine production are not well understood. This study was undertaken to identify the cells responsible for the overproduction of these cytokines. Methods BAFF expression was analyzed on peripheral blood mononuclear cells by multiparameter flow cytometry and in tissue samples by immunofluorescence staining. The levels of BAFF and APRIL mRNA were quantified in sorted B cells. In vitro cultures were used to analyze whether B cell survival and differentiation was supported by autocrine BAFF and/or APRIL. Results Aberrant activation of B cells in patients with SLE was associated with a significant up-regulation of BAFF expression in naive, memory, and plasma cells. Furthermore, strong expression of BAFF and APRIL was found in plasma cells from the lymph node, bone marrow, and kidney. The levels of BAFF and APRIL mRNA in CD19+ B cells correlated both with the titer of anti-double stranded DNA antibodies and with the SLE Disease Activity Index. In vitro experiments demonstrated that B cells released functional BAFF/APRIL upon activation. Conclusion Our data show that B cells contribute to the enhanced levels of circulating BAFF and APRIL. The aberrant up-regulation of these cytokines may initiate a vicious circle in which enhanced levels of BAFF and APRIL act in an autocrine manner to reinforce the systemic activation of the humoral immune system. [source] Rheumatoid arthritis fibroblast-like synoviocytes express BCMA and are stimulated by APRILARTHRITIS & RHEUMATISM, Issue 11 2007Katsuya Nagatani Objective Fibroblast-like synoviocytes (FLS) are among the principal effector cells in the pathogenesis of rheumatoid arthritis (RA). This study was undertaken to examine the variety of stimulating effects of APRIL and its specific effect on FLS in the affected RA synovium. Methods Synovium and serum samples were obtained from patients with RA, patients with osteoarthritis (OA), and healthy subjects. Soluble APRIL proteins were assayed by enzyme-linked immunosorbent assay. The relative gene expression of APRIL, BCMA, interleukin-6 (IL-6), tumor necrosis factor , (TNF,), IL-1,, and RANKL was assessed in RA and OA FLS by polymerase chain reaction. Effects of APRIL on the production of proinflammatory cytokines and RANKL in RA FLS were investigated by flow cytometry and with the use of a BCMA-Fc fusion protein. Results A significantly higher level of soluble APRIL was detected in RA serum compared with normal serum. Among the 3 receptors of APRIL tested, RA FLS expressed only BCMA, whereas OA FLS expressed none of the receptors. APRIL stimulated RA FLS, but not OA FLS, to produce IL-6, TNF,, IL-1,, and APRIL itself. In addition, APRIL increased RA FLS expression of RANKL and also enhanced progression of the cell cycle of RA FLS. Neutralization of APRIL by the BCMA-Fc fusion protein attenuated all of these stimulating effects of APRIL on RA FLS. Conclusion RA FLS are stimulated by APRIL and express the APRIL receptor BCMA. These results provide evidence that APRIL is one of the main regulators in the pathogenesis of RA. [source] Targeting MEK1/2 blocks osteoclast differentiation, function and cytokine secretion in multiple myelomaBRITISH JOURNAL OF HAEMATOLOGY, Issue 1 2007Iris Breitkreutz Summary Osteolytic bone disease in multiple myeloma (MM) is associated with upregulation of osteoclast (OCL) activity and constitutive inhibition of osteoblast function. The extracellular signal-regulated kinase 1/2 (ERK1/2) pathway mediates OCL differentiation and maturation. We hypothesized that inhibition of ERK1/2 could prevent OCL differentiation and downregulate OCL function. It was found that AZD6244, a mitogen-activated or extracellular signal-regulated protein kinase (MEK) inhibitor, blocked OCL differentiation and formation in a dose-dependent manner, evidenced by decreased ,V,3-integrin expression and tartrate-resistant acid phosphatase positive (TRAP+) cells. Functional dentine disc cultures showed inhibition of OCL-induced bone resorption by AZD6244. Major MM growth and survival factors produced by OCLs including B-cell activation factor (BAFF) and a proliferation-inducing ligand (APRIL), as well as macrophage inflammatory protein (MIP-1,), which mediates OCL differentiation and MM, were also significantly inhibited by AZD6244. In addition to ERK inhibition, NFATc1 (nuclear factor of activated T-cells, cytoplasmic, calcineurin-dependent 1) and c-fos were both downregulated, suggesting that AZD6244 targets a later stage of OCL differentiation. These results indicate that AZD6244 inhibits OCL differentiation, formation and bone resorption, thereby abrogating paracrine MM cell survival in the bone marrow microenvironment. The present study therefore provides a preclinical rationale for the evaluation of AZD6244 as a potential new therapy for patients with MM. [source] BAFF: a local and systemic target in autoimmune diseasesCLINICAL & EXPERIMENTAL IMMUNOLOGY, Issue 2 2009I. Moisini Summary BAFF (B lymphocyte activating factor of the tumour necrosis factor family) is a vital homeostatic cytokine for B cells that helps regulate both innate and adaptive immune responses. Increased serum levels of BAFF are found in a number of different autoimmune diseases, and BAFF is found in inflammatory sites in which there is lymphoid neogenesis. BAFF antagonism has been used in several autoimmune disease models, resulting in B cell depletion, decreased activation of T cells and dendritic cells (DC) and a reduction in the overall inflammatory burden. BAFF, through its interaction with BAFF-R, is required for survival of late transitional, marginal zone and mature naive B cells, all of which are depleted by BAFF blockade. Through their interactions with TACI (transmembrane activator and calcium modulator and cyclophilin ligand interactor) and BCMA (B cell maturation protein), BAFF and its homologue APRIL (a proliferation-inducing ligand), support the survival of at least some subsets of plasma cells; blockade of both cytokines results in a decrease in serum levels of immunoglobulin (Ig)G. In contrast, neither BAFF nor APRIL is required for the survival or reactivation of memory B cells or B1 cells. BAFF also helps DC maturation and interleukin (IL)-6 release and is required for proper formation of a follicular dendritic cell (FDC) network within germinal centres, although not for B cell affinity maturation. The clinical efficacy of BAFF blockade in animal models of autoimmunity may be caused both by the decline in the number of inflammatory cells and by the inhibition of DC maturation within target organs. Blockade of BAFF and its homologue APRIL are being explored for human use; several Phase I and II clinical trials of BAFF inhibitors for autoimmunity have been completed and Phase III trials are in progress. [source] Recently Received Books January , April 2009CONSERVATION BIOLOGY, Issue 4 2009Article first published online: 13 JUL 200 No abstract is available for this article. [source] Recently Received Books April,June 2008CONSERVATION BIOLOGY, Issue 5 2008Article first published online: 24 SEP 200 No abstract is available for this article. [source] Recently Received Books (April 2007,June 2007)CONSERVATION BIOLOGY, Issue 5 2007Article first published online: 19 SEP 200 No abstract is available for this article. [source] Recently Received Books (February 2006,April 2006)CONSERVATION BIOLOGY, Issue 4 2006Article first published online: 24 JUL 200 No abstract is available for this article. [source] P44 A case of contact dermatitis caused by a NSAID's soluble agentCONTACT DERMATITIS, Issue 3 2004Yoshimi Kato A fifty five year-old man had experienced itching sensation when he applied analgesic plasters for his lumbago. He tried to use several kinds of analgesic plasters, however he felt itching sensation whenever he used them. He applied a plaster containing ferbinac for his left elbow joint's pain on April 2003. On the next day, an itching erythema developed on the area where the plaster was applied. He was treated with a difluprednate ointment, and his dermatitis gradually improved. He visited our clinic for precise medical examination for finding out the causative agent of his dermatitis on May 13, 2003. We conducted 48 hours closed patch testing with the plaster he used and it's ingredients. He reacted positively to the plaster containing ferbinac and crotamiton 5%p that was used for dissolute the active drug. He also reacted positively to a cream containing ketoprofen, however he reacted negatively to ketoprofen 1%p. Crotamoton was also used in the ketoprofen cream. [source] Universal Owners: challenges and opportunitiesCORPORATE GOVERNANCE, Issue 3 2007James Hawley This special issue of Corporate Governance is devoted to the concept of "universal ownership" (UO) and grows out of a conference of universal owners, institutional investors, investment professionals and academics held in April 2006 at Saint Mary's College of California, under the sponsorship of the Center for the Study of Fiduciary Capitalism (A report of the conference is available at http://www.fidcap.org). Four of the seven articles in this issue are based on papers presented at the conference, while an additional three (by Lydenberg, Syse and Gjessing, and Lippman et al.) were written specifically for this issue. The conference purposefully developed a practitioners' perspective on universal ownership and these articles reflect this orientation, although each article in its own way breaks new ground which academics, policy researchers and practitioners can and should develop. [source] The probabilities of sex offender re-arrestCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 2 2003Roderic Broadhurst Associate Professor Background Estimates of the probabilities of re-arrest for sex offenders apprehended in Western Australia between April 1984 and December 1994 are reported. Population and method Of the 116,151 distinct male persons arrested for the first time from 1984,94, 2785 were identified with at least one sex offence. Subjects on average were followed up for 5.7 years and assessed by criminal record, Aboriginality, bail status, age, occupation and penal intervention. Three criteria, rearrest for any, repeat sex or a violent offence are used to summarize the ,careers' of sex offenders. Results Overall ultimate probabilities of rearrest for any offence were 0.61, for a repeat sex offence 0.33 and for a violent offence 0.51. Probabilities of re-arrest for non-Aboriginal offenders were lower for all definitions. Younger offenders, Aborigines and those with prior arrest for non-sex offences had higher probabilities for any or violent rearrest but older offenders tended to have higher probabilities of repeat sex offending. Community supervision and imprisonment significantly reduced the ,rate' or speed of re-arrest. Discussion Actuarial risk assessments for low-probability high-consequence events such as dangerous recidivism are useful for identifying groups with a high probability of rearrest, assisting management of these groups and evaluating penal interventions. Copyright © 2003 Whurr Publishers Ltd. [source] Brian Cox 5 September 1928 , 24 April 2008CRITICAL QUARTERLY, Issue 3 2008COLIN MacCABE No abstract is available for this article. [source] Film: State of Cinema Address: 49th San Francisco International Film Festival, 29 April 2006CRITICAL QUARTERLY, Issue 3 2006TILDA SWINTON Letter to a boy from his mother Boy, my darling, You asked me the other day, just as you were dropping off, what people's dreams were like before the cinema was invented. You who talk blabberish and chase rabbits in your sleep, hurrumphing like a dog . . . you who never watch television . . . I've been thinking of your question ever since. I have to talk to some people in America about cinema. I'm going there now on the plane and I can't think of anything but your question... [source] Comparison of bone marrow and peripheral blood ZAP-70 status examined by flow cytometric immunophenotyping in patients with chronic lymphocytic leukemiaCYTOMETRY, Issue 4 2006Rachel Sheridan Abstract Background: The mutational status of the immunoglobulin heavy chain variable gene in patients with chronic lymphocytic leukemia correlates with prognosis. Patients with mutated IgVH genes fare better than those with unmutated genes. Gene expression profiling studies identified the tyrosine kinase ZAP-70 to be expressed in unmutated CLL samples. Flow cytometric examination of ZAP-70 expression in tumor cells has been proposed to be a convenient surrogate marker for IgVH mutational status. However, a few studies have shown a small number of discordant results between ZAP-70 positivity, IgVH mutational status, and clinical outcome. There have been no reported studies comparing bone marrow samples with peripheral blood for ZAP-70 expression in CLL patients. Methods: We searched our flow cytometry files from October 2004 through April 2006 and identified CLL in 311 bone marrow and peripheral blood specimens from 256 patients. We defined ZAP-70 positivity as greater than 30% of the CD19+ B-cells above the isotype control value that coexpress ZAP-70. Statistical analyses were performed using the Fisher exact test and student t -test. Results: A significantly greater number of bone marrow specimens were positive for ZAP-70 when compared with the number of peripheral blood specimens. Of all the ZAP-70 negative specimens, CLL cells from bone marrow had a greater mean percentage of ZAP-70 positive cells when compared with the CLL cells from peripheral blood. Finally, six patients were identified who were ZAP-70 positive in the bone marrow but ZAP-70 negative in the peripheral blood. Conclusions: These results may be due to either an increase in the false positive rate in bone marrow specimens or to an intrinsic feature of CLL cells in the compartment that is biologically distinct from peripheral tumor cells. As prognosis and treatment decisions may be based on ZAP-70 results from either specimen type, it is prudent to further examine this observation. © 2006 International Society for Analytical Cytology [source] CPA assessment , the regional assessors' experienceCYTOPATHOLOGY, Issue 2007E. Welsh Many individuals within Laboratory Medicine will be unaware that CPA conducts assessments to two different sets of CPA Standards. There are the Standards for the Medical Laboratory and the Standards for EQA Schemes in Laboratory Medicine. The style and format of both sets of standards is very similar with each being presented in eight sections A , H. The EQA standards are almost identical to the laboratory standards with the exception of the E.F and G standards which are specific to EQA schemes. There are approximately 40 EQA Schemes registered with CPA compared with almost 2 500 laboratories. These EQA schemes vary from very large national/international schemes with numerous analytes to small interpretive schemes run by one individual with a personal interest in that specific subject. The large schemes usually come under the UKNEQAS consortia banner and due to their size and configuration do not present undue problems in the assessment process. Smaller interpretive EQA schemes present a challenge both for the scheme and CPA in gaining accreditation. These schemes are usually within the discipline of Histopathology and are regarded as educational rather than proficiency testing schemes. Very frequently, the scheme is organized by a single individual with a collection of microscope slides, storage facilities for the slides and a computer. This presents the Scheme Organizer with great difficulty in complying with the Quality Management System requirements of the CPA Standards. There are a number of models which can be applied in order to satisfy the requirement of the Quality Management System, but ultimately it must be recognized that in some circumstances it is not possible to accredit these small schemes. The NHSCSP Gynae Cytology EQA Scheme is probably the largest EQA scheme within the UK, in respect of the number of participants and the number of staff supporting the scheme. Scheme Management decided that all nine regions of England would apply for accreditation under one CPA Reference Number. This process meant that the scheme would be assessed as a Managed Pathology Network. This is unique in terms of EQA schemes and presented a number of problems not previously encountered in EQA scheme accreditation. This decision meant that all nine regions must comply with a single Quality Management System and other CPA standards whilst allowing flexibility within the system for each region to facilitate the assessment process specific to their user's requirements. The process worked in a satisfactory manner and the overall outcome was not dissimilar to that of other large EQA schemes. The assessment to the current EQA Standards only commenced in April 2006 whilst the Standards for Medical Laboratories commenced in 2003, and it is perhaps not surprising to find that the principal non-conformities are related to the Quality Management System. This parallels the findings encountered in laboratory accreditation. There is an ongoing educational process for Scheme Management and the Facilitators in each region in how to comply fully with the standards and a commitment to quality improvement which ultimately is beneficial to the participant's of the scheme and to patient safety. [source] CPA assessment , the regional assessors' experienceCYTOPATHOLOGY, Issue 2007G. Guthrie With the introduction in January 2006 of the new posts of Regional Assessors, the process and focus of CPA assessment changed to reflect the inclusion in the current standards of Quality Management systems and processes. Regional Assessors, trained in Quality Management Systems and their assessment against international standards, now form a vital part of the CPA assessment teams, looking specifically at this aspect of laboratory service provision. Their role in the new assessment process will be explained. The presentation will cover differences and similarities in the nature and number of non-compliances experienced since April 2006 when the new format of assessment was introduced. It will also look at a new format of timetable for assessment visits and explain the benefits of good two-way communication between all parties involved in the process - the laboratory, the assessors, particularly the Regional Assessor assigned to that site, and CPA Office staff. Understanding what is required by the standards, particularly in terms of evidential material, their interpretation and their classification of status , Critical, Non-Critical or Observation - is an aspect of assessment which is often not well understood. The presentation will seek to clarify these issues. The successful and timely clearance by laboratories of any non-compliances raised during the visits is vital to the achievement of accredited status and the presentation will give guidance as to how this is best achieved. The current standards, based on the international ISO 15189 standards, are considerably more challenging than the old ones. There is now a significant emphasis on Quality Management and its understanding, ethos and implementation within the laboratory, a key element which underpins all aspects of a laboratory's service. The achievement of accredited status assures our users of,the type of client and patient focused service expected of a modern laboratory. [source] The incidence of anxiety and depression among employees,the role of psychosocial work characteristicsDEPRESSION AND ANXIETY, Issue 11 2009Helene Andrea Ph.D. Abstract Background: Anxiety and depression are prevalent among employees and are associated with functional disability and work impairment. To date, little is known about the incidence and possible risk factors for developing anxiety and depression in the working population. Study aims were to (a) determine the incidence of subclinical anxiety and depression in a general working population and (b) identify the psychosocial work characteristics associated with the onset of subclinical anxiety and depression. Methods: This prospective study is based on 3,707 employees participating in the Maastricht Cohort Study on Fatigue at Work. Psychosocial work characteristics were measured in May 2000; anxiety and depression were measured with the Hospital Anxiety and Depression Scale in April 2002. Results: The cumulative 23-month incidence for subclinical anxiety and depression was 4.6 and 3.3%, respectively. High psychological job demands increased the risk for both subsequent anxiety and depression. Moreover, low social support was predictive for the onset of anxiety, whereas job insecurity increased the risk for the onset of depression. These prospective associations were independent of potential confounding variables and the other psychosocial work characteristics. Conclusions: Adverse psychosocial work characteristics are significant predictors for the onset of subclinical anxiety and depression in the general working population. These findings encourage intervention studies testing whether modifying the psychosocial work environment reduces both anxiety and depressive symptoms among employees. Depression and Anxiety 26:1040,1048, 2009. © 2009 Wiley-Liss, Inc. [source] Lactic Acid Chemical Peels as a New Therapeutic Modality in Melasma in Comparison to Jessner's Solution Chemical PeelsDERMATOLOGIC SURGERY, Issue 12 2006KHALIFA E. SHARQUIE MBCHB BACKGROUND Many chemicals have been used in the skin peeling for melasma such as Jessner's solution and glycolic acid. Lactic acid is an ,-hydroxy acid that has not been used before in chemical peeling of melasma. OBJECTIVE The purpose of the present work was to evaluate the efficacy and safety of lactic acid in chemical peeling of melasma in comparison to Jessner's solution chemical peels. METHODS This study was conducted at the Department of Dermatology and Venereology, Baghdad Hospital, in the period between April 2001 and August 2002. Thirty patients with melasma were included in this study. They were mostly of skin type IV according to Fitzpatrick's classification, 26 (86.67%) were women, and 4 (13.33%) were men, with an age range from 18 and 50 years (mean±SD, 33.53±6.96 years). Full clinical examination was done to all patients including Wood's light. The severity of melasma was assessed by MASI (Melasma Area Severity Index). Pure lactic acid full strength (92%, pH 3.5) was used as a new peeling agent on the left side of the face while Jessner's solution was applied to the right side of the face. The chemical peeling sessions were done every 3 weeks until the desired response was achieved. Follow-up was carried out for 6 months after the last session. RESULTS Six patients were defaulted from the study after the first session for unknown reasons. Twenty-four patients completed the study. Twenty (83.33%) were women and four were men (16.67%). Wood's light examination showed increased contrast in all patients of mostly epidermal melasma. The number of sessions ranged from 2 to 5. All patients showed marked improvement as calculated by MASI score before and after treatment, and the response was highly statistically significant. No side effect was recorded in all treated patients. CONCLUSION Lactic acid was found to be an effective and safe peeling agent in the treatment of melasma, and it was as effective as Jessner's solution. [source] Role of Intralesional Bleomycin in the Treatment of Complicated Hemangiomas: Prospective Clinical StudyDERMATOLOGIC SURGERY, Issue 5 2005Shapour Omidvari MD background. Hemangioma is the most common tumor of infancy. Although it has a basically benign nature and usually spontaneously regresses, a small percentage (5%) have complications that need treatment. Many different therapeutic modalities can be used in this tumor. objective. To investigate the effect of a new method of treatment (intralesional bleomycin injection) in complicated hemangiomas. materials and methods. In the Department of Radiation Oncology at Nemazee Hospital in Shiraz, Iran, from April 1992 to October 1998, 32 patients with complicated hemangioma were treated with four to six courses of direct injection of bleomycin into the lesion. results After a minimum follow-up of 6 years, there was 70 to 100% regression in 18 patients, 50 to 70% in 7 cases, and less than 50% reduction in 7 patients. conclusion. Intralesional injection of bleomycin is an easy, safe, and effective therapeutic modality in complicated cutaneous hemangiomas. [source] Pemphigus Foliaceus Masquerading as Postoperative Wound Infection: Report of a Case and Review of the Koebner and Related Phenomenon following Surgical ProceduresDERMATOLOGIC SURGERY, Issue 2 2005Adam M. Rotunda MD Background The Koebner phenomenon, also known as the isomorphic response, is the development of preexisting skin disease following trauma to uninvolved skin. Various cutaneous disorders have been described to arise at surgical wounds and scars. Moreover, dermatologic procedures, such as cold-steel and laser surgery, can evoke koebnerization. Objective To describe a case of pemphigus foliaceus arising in postoperative wounds and to present a review of dermatologic disorders triggered by surgical procedures. Methods We report a case of pemphigus foliaceus initially presenting at sites of Mohs' micrographic surgery, shave biopsy, and cryotherapy and, subsequently, at a nonsurgical site. We reviewed the English literature in MEDLINE from November 1955 to April 2004 for reports of Koebner and related phenomenon following surgical procedures. Results To our knowledge, this is the first reported case of pemphigus foliaceus erupting at surgical and cryotherapy wounds. The clinical appearance can mimic wound infection. In addition to inducing preexisting disease, cutaneous procedures can also trigger the onset of new disease, which can either be limited only to the surgical site or subsequently become generalized. Conclusion Postoperative Koebner or related responses should be included in the differential diagnosis of poorly healing surgical wounds. Skin biopsies for histopathology and immunologic studies may be necessary for definitive diagnosis and optimal management. ADAM M. ROTUNDA, MD, ANAND R. BHUPATHY, DO, ROBERT DYE, MD, AND TERESA T. SORIANO, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Guidelines for Sclerotherapy of Varicose Veins (ICD 10: I83.0, I83.1, I83.2, and I83.9)DERMATOLOGIC SURGERY, Issue 5 2004E. Rabe MD Background. Sclerotherapy is the targeted elimination of intracutaneous, subcutaneous, and/or transfascial varicose veins (perforating veins) as well as the sclerosation of subfascial varicose vessels in the case of venous malformation by the injection of a sclerosant. With duplex-guide sclerotherapy and foam sclerotherapy, modified methods came into use. Objective. The objective was to create a guideline, based on the available publications and on the European Consensus Document on foam sclerotherapy from April 2003. Methods. This guideline was drafted on behalf of the German Society of Phlebology (Deutsche Gesellschaft für Phlebologie) and adopted by the committee and scientific advisory board of the Deutsche Gesellschaft für Phlebologie on June 15, 2001, and amended on December 5, 2003. The guideline considers the present state of knowledge as reflected in the literature. Conclusions. This guideline represents the recent state of the art of sclerotherapy of varicose veins in Germany including foam sclerotherapy. [source] Making the case for objective performance metrics in newborn screening by tandem mass spectrometryDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 4 2006Piero Rinaldo Abstract The expansion of newborn screening programs to include multiplex testing by tandem mass spectrometry requires understanding and close monitoring of performance metrics. This is not done consistently because of lack of defined targets, and interlaboratory comparison is almost nonexistent. Between July 2004 and April 2006 (N = 176,185 cases), the overall performance metrics of the Minnesota program, limited to MS/MS testing, were as follows: detection rate 1:1,816, positive predictive value 37% (54% in 2006 till date), and false positive rate 0.09%. The repeat rate and the proportion of cases with abnormal findings actually been reported are new metrics proposed here as an objective mean to express the overall noise in a program, where noise is defined as the total number of abnormal results obtained using a given set of cut-off values. On the basis of our experience, we propose the following targets as evidence of adequate analytical and postanalytical performance: detection rate 1:3,000 or higher, positive predictive value >20%, and false positive rate <0.3%. © 2006 Wiley-Liss, Inc. MRDD Research Reviews 2006;12:255,261. [source] The clinical presentation of mitochondrial diseases in children with progressive intellectual and neurological deterioration: a national, prospective, population-based studyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 5 2010CHRISTOPHER M VERITY Aim, Our aim was to study the clinical presentation, mode of diagnosis, and epidemiology of mitochondrial disorders in children from the UK who have progressive intellectual and neurological deterioration (PIND). Method, Since April 1997, we have identified patients aged 16 years or younger with suspected PIND through the monthly notification card sent to all UK consultant paediatricians by the British Paediatric Surveillance Unit. Clinical details obtained from reporting paediatricians are classified by an Expert Group. Results, By July 2008, 2493 cases of PIND had been reported, among which there were 112 children (69 males, 43 females) with mitochondrial diseases presenting between birth and 14 years 7 months (median 12mo), divided into 13 subgroups. In some instances, clinical features were characteristic of mitochondrial disease, but many children presented non-specifically with combinations of developmental delay, hypotonia, failure to thrive, and seizures; 16 children had multisystem disease at presentation. Mortality was high: 40 children had died. Blood and/or cerebrospinal fluid lactate measurements were abnormal in 87 children, and 47 of 78 brain magnetic resonance images showed increased basal ganglia signal. Definite diagnoses were usually made by muscle enzyme or genetic studies. Interpretation, This is a unique population-based study of the mitochondrial disorders that cause childhood neurodegenerative disease. It provides detailed information about the clinical presentation and investigation of these complex cases. [source] Insulin therapy in type 2 diabetes: what is the evidence?DIABETES OBESITY & METABOLISM, Issue 5 2009Mariëlle J. P. Van Avendonk Aim:, To systematically review the literature regarding insulin use in patients with type 2 diabetes mellitus Methods:, A Medline and Embase search was performed to identify randomized controlled trials (RCT) published in English between 1 January 2000 and 1 April 2008, involving insulin therapy in adults with type 2 diabetes mellitus. The RCTs must comprise at least glycaemic control (glycosylated haemoglobin (HbA1c), postprandial plasma glucose and /or fasting blood glucose (FBG)) and hypoglycaemic events as outcome measurements. Results:, The Pubmed search resulted in 943 hits; the Embase search gave 692 hits. A total of 116 RCTs were selected by title or abstract. Eventually 78 trials met the inclusion criteria. The studies were very diverse and of different quality. They comprised all possible insulin regimens with and without combination with oral medication. Continuing metformin and/or sulphonylurea after start of therapy with basal long-acting insulin results in better glycaemic control with less insulin requirements, less weight gain and less hypoglycaemic events. Long-acting insulin analogues in combination with oral medication are associated with similar glycaemic control but fewer hypoglycaemic episodes compared with NPH insulin. Most of the trials demonstrated better glycaemic control with premix insulin therapy than with a long-acting insulin once daily, but premix insulin causes more hypoglycaemic episodes. Analogue premix provides similar HbA1c, but lower postprandial glucose levels compared with human premix, without increase in hypoglycaemic events or weight gain. Drawing conclusions from the limited number of studies concerning basal,bolus regimen seems not possible. Some studies showed that rapid-acting insulin analogues frequently result in a better HbA1c or postprandial glucose without increase of hypoglycaemia than regular human insulin. Conclusion:, A once-daily basal insulin regimen added to oral medication is an ideal starting point. All next steps, from one to two or even more injections per day should be taken very carefully and in thorough deliberation with the patient, who has to comply with such a regimen for many years. [source] Prediction of cardiovascular and total mortality in Chinese type 2 diabetic patients by the WHO definition for the metabolic syndromeDIABETES OBESITY & METABOLISM, Issue 1 2006G. T.-C. Aim:, The aim of this study is to investigate the prevalence of metabolic syndrome (MES) in type 2 diabetic patients and the predictive values of the World Health Organization (WHO) and National Cholesterol Education Programme (NCEP) definitions and the individual components of the MES on total and cardiovascular mortality. Methods:, A prospective analysis of a consecutive cohort of 5202 Chinese type 2 diabetic patients recruited between July 1994 and April 2001. Results:, The prevalence of the MES was 49.2,58.1% depending on the use of various criteria. There were 189 deaths (men: 100 and women: 89) in these 5205 patients during a median (interquartile range) follow-up period of 2.1 (0.3,3.6 years). Of these, 164 (87%) were classified as cardiovascular deaths. Using the NCEP criterion, patients with MES had a death rate similar to those without (3.51 vs. 3.85%). By contrast, based on the WHO criteria, patients with MES had a higher mortality rate than those without (4.3 vs. 2.4%, p = 0.002). Compared to patients with neither NCEP- nor WHO-defined MES, only the group with MES defined by the WHO, but not NCEP, criterion had significantly higher mortality rate (2.6 vs. 6.8%, p < 0.001). Using Cox regression analysis, only age, duration of diabetes and smoking were identified as independent factors for cardiovascular or total death. Among the various components of MES, hypertension, low BMI and albuminuria were the key predictors for these adverse events. Conclusions:, In Chinese type 2 diabetic patients, the WHO criterion has a better discriminative power over the NCEP criterion for predicting death. Among the various components of the MES defined either by WHO or NCEP, hypertension, albuminuria and low BMI were the main predictors of cardiovascular and total mortality. [source] A clinical analysis of diabetic patients with hand ulcer in a diabetic foot centreDIABETIC MEDICINE, Issue 7 2010C. Wang Diabet. Med. 27, 848,851 (2010) Abstract Aims, The aim of the study was to explore the prevalence and clinical characteristics of hand ulcer in hospitalized patients with diabetes. Methods, We analysed 17 subjects with hand ulcer among diabetic inpatients, who were admitted to the Diabetic Foot Care Center, Department of Endocrinology and Metabolism at the West China Hospital of Sichuan University from April 2003 to December 2008. Results, The prevalence of diabetic hand ulcer among hospitalized patients (0.37%) was significantly lower than that of diabetic foot ulcers (9.7%, P = 0.000). The mean age was 62.1 ± 9.4 years. The average known durations of diabetes and glycated haemoglobin (HbA1c) were 5.3 ± 4.9 years and 10.9 ± 2.4%, respectively. All patients lived in the subtropical zone. Fifteen patients (88.2%) were diagnosed with diabetic peripheral neuropathy. Ten patients had hand infection. After therapy, the ulcers healed in 13 patients (76.5%) and none of them experienced amputation. The average hospital stay for patients with local infection was characteristically longer than that for patients without infection (P = 0.012). The prognosis of the hand ulcer was poorer in the patients who had diabetes for > 3 years compared with those who had diabetes for < 3 years (P = 0.009). Conclusions, Diabetic hand ulcer is a relatively rare complication of diabetes in South-West China. Long duration of diabetes, poorly controlled blood glucose, minor trauma and delayed treatment are the risk factors. Diabetic peripheral neuropathy may play an important role in the pathogenesis of hand ulcer. Early control of blood glucose with insulin and early anti-microbial therapy with appropriate antibiotics are crucial. Debridement and drainage are necessary for hand abscesses. [source] Effectiveness of screening and monitoring tests for diabetic retinopathy , a systematic reviewDIABETIC MEDICINE, Issue 7 2000A. Hutchinson SUMMARY Aims To determine which screening and monitoring tests for diabetic retinopathy are most effective and under what circumstances. Methods A systematic review of the English language literature, published from 1983 to April 1999. Results Available studies are generally limited in their ability to answer the important questions on the effectiveness of tests for early detection of diabetic retinopathy. No randomized controlled trials were identified although primary studies exist for two screening tests: ophthalmoscopy, either direct or indirect, and retinal photography, using either mydriasis or non-mydriasis. Retinal photography under mydriasis appears to be the most effective test, with the majority reporting levels of sensitivity in excess of 80%. However effectiveness is compromised when photographs are ungradable. Ophthalmoscopy can also reach acceptable standards of sensitivity and specificity. Conclusion Based on an assessment of available cohort studies, the most effective strategy for testing is the use of mydriatic retinal photography with the additional use of ophthalmoscopy for cases where photographs are ungradable. This does not exclude the use of ophthalmoscopy alone for opportunistic case finding but there is evidence of considerable variation in effectiveness of this test. [source] | ||||||||||||||||||||||||||||||||||||||||||||||