Skin Alterations Research Articles

Case Report and Literature Review: A Severe Case of Pyoderma Gangrenosum Approached with Regenerative Medicine

Pyoderma gangrenosum (PG) is a challenging autoinflammatory neutrophilic dermatoses (ND) condition characterized by painful skin alterations leading to ulceration and tissue necrosis. Regenerative medicine (RG) offers promising strategies for addressing these challenges. Diverse therapies including mesenchymal stem cells (MSC), MSC-exosomes, tilapia skin grafts with fibroblast growth factors (FGF), and antioxidants like Vitamin C (VitC), have demonstrated effectiveness in promoting wound healing, reducing inflammation, and restoring tissue function. This paper offers comprehensive insights into the pathogenesis, epidemiology, and conventional treatment approaches for PG, while also providing a concise review of pertinent RM therapies. In this case report, a severe case of PG is managed with a combination of RM therapies, with remarkable results. A 73-year-old patient experienced persistent ulceration, pain, and edema despite conventional treatments. The administration of IV (Intravenous) MSCs, MSC-exosomes, tilapia skin graft, FGF, and VitC resulted in significant improvement in wound healing, pain reduction, and inflammation control. This case demonstrates the potential use of RM therapies in managing complex dermatological conditions like PG. The integration of regenerative approaches provides hope for patients with challenging conditions, potentially leading to enhanced outcomes and reduced recovery times. As PG remains a difficult-to-treat condition, RM holds promise as a valuable alternative therapy option for patients facing these severe dermatoses conditions.

Lipedema Research-Quo Vadis?

When studying the current literature, one might get the impression that lipedema is a "modern" disease, with increasing incidence and augmenting prevalence throughout Western countries during the last decade. However, a quick look into older textbooks shows that disproportionate accumulation of fat in female bodies has long been known without being recognized as an independent disease. Nevertheless, it was not until 1940 that Allen and Hines described a "syndrome characterized by fat legs and orthostatic edema" in a seminal publication. The mere awareness that people who have lipedema are not just overweight but suffer from a yet poorly defined pathological condition, may be considered a decisive leap forward in the understanding of lipedema. A number of comprehensive publications have since dealt with the clinical presentation of lipedema and have provided the first clues towards the potential pathological mechanisms underlying its initiation and progression. Nevertheless, despite all effort that has been undertaken to unravel lipedema pathology, many questions have remained unanswered. What can be deduced with certainty from all experimental and medical evidence available so far is that lipedema is neither a cosmetic problem nor is it a problem of lifestyle but should be accepted as a serious disease with yet undetermined genetic background, which makes women's lives unbearable from both a physical and psychological point of view. To date, results from clinical inspections have led to the categorization of various types and stages of lipedema, describing how the extremities are affected and evaluating its progression, as demonstrated by skin alterations, adipose tissue volume increase and physical and everyday-behavioral impediments. There is accumulating evidence showing that advanced stages of lipedema are usually accompanied by excessive weight or obesity. Thus, it is not unreasonable to assume that the progression of lipedema is largely driven by weight gain and the pathological alterations associated with it. Similarly, secondary lymphedema is frequently found in lipedema patients at advanced stages. Needless to say, both conditions considerably blur the clinical presentation of lipedema, making diagnosis difficult and scientific research challenging. The present literature review will focus on lipedema research, based on evidence fromex vivo and in vitro data, which has accumulated throughout the last few decades. We will also open the discussion as to whether the currently used categorization of lipedema stages is still sufficient and up-to-date for the accurate description of this enigmatic disease, whose name, strangely enough, does not match its pathologic correlate.

Development of a Vascularized Human Skin Equivalent with Hypodermis for Photoaging Studies.

Photoaging is an important extrinsic aging factor leading to altered skin morphology and reduced function. Prior work has revealed a connection between photoaging and loss of subcutaneous fat. Currently, primary models for studying this are in vivo (human samples or animal models) or in vitro models, including human skin equivalents (HSEs). In vivo models are limited by accessibility and cost, while HSEs typically do not include a subcutaneous adipose component. To address this, we developed an "adipose-vascular" HSE (AVHSE) culture method, which includes both hypodermal adipose and vascular cells. Furthermore, we tested AVHSE as a potential model for hypodermal adipose aging via exposure to 0.45 ± 0.15 mW/cm2 385 nm light (UVA). One week of 2 h daily UVA exposure had limited impact on epidermal and vascular components of the AVHSE, but significantly reduced adiposity by approximately 50%. Overall, we have developed a novel method for generating HSE that include vascular and adipose components and demonstrated potential as an aging model using photoaging as an example.

An Altered Skin and Gut Microbiota Are Involved in the Modulation of Itch in Atopic Dermatitis

Skin and gut microbiota play an important role in the pathogenesis of atopic dermatitis (AD). An alteration of the microbiota diversity modulates the development and course of AD, e.g., decreased microbiome diversity correlates with disease severity, particularly in lesional skin of AD. Itch is a hallmark of AD with unsatisfying treatment until now. Recent evidence suggests a possible role of microbiota in altering itch in AD through gut-skin-brain interactions. The microbial metabolites, proinflammatory cytokines, and impaired immune response lead to a modulation of histamine-independent itch, disruption of epidermal barrier, and central sensitization of itch mechanisms. The positive impact of probiotics in alleviating itch in AD supports this hypothesis, which may lead to novel strategies for managing itchy skin in AD patients. This review summarizes the emerging findings on the correlation between an altered microbiota and gut-skin-brain axis in AD, especially in modulating itchy skin.

ТРАНСПЛАНТАЦИЯ ДЕЦЕЛЛЮЛЯРИЗОВАННОЙ АМНИОТИЧЕСКОЙ МЕМБРАНЫ ЧЕЛОВЕКА ПРИ МЕСТНЫХ ЛУЧЕВЫХ ПОРАЖЕНИЯХ

Purpose: Evaluation of the effectiveness of the use of human decellularized amniotic membrane, both as an independent covering material and as a cell-free matrix for syngeneic regenerative cells of adipose tissue (stromal-vascular fraction – SVF, adipose tissue ‒ AT) in local radiation injuries (LRI) IIIb-IV severity in laboratory animals. Material and methods: 42 laboratory animals were studied. LRI modeling was carried out on an X-ray at a dose of 110 Gy. Animals were randomized randomly and divided into 6 groups depending on the type of treatment: 1st group (K) ‒ control group animals after irradiation did not receive specific treatment; the 2nd group (Gl) ‒ after irradiation, medical glue BF-6 was applied to the ulcer surface on the 21st day; 3rd group (Am) ‒ animals after irradiation on the ulcer surface was applied decellularized amniotic membrane, fixed with interrupted sutures on the 21st day; 4th group (Am-Gl) ‒ animals after irradiation on the ulcer surface was applied decellularized amniotic membrane, fixed with medical adhesive BF-6 for 21 days; 5th group (SVF-Gl) ‒ after irradiation, the SVF AT at a dose of 0.4×106 cells was applied to the ulcer surface after irradiation, followed by fixation with BF-6 medical glue for 21 days; the 6th group (Am-SVF) ‒ after irradiation, SVF AT was applied to the ulcer surface at a dose of 0.4×106 cells under the decellularized amniotic membrane, fixed with interrupted sutures on the 21st day. Results: On the 112th day, complete healing of the ulcer was observed in 100 % of animals in the Am-Gl group, in 70 % in the Am and Gl groups. There was no complete healing of the ulcer in the SVF-CGl and Am-SVF groups. The greatest reduction in the area of the total altered skin from 21 to 112 days of the experiment was noted in the groups Gl-SVF (34.7 %), K (31.6 %), Am-SVF (30.7 %). In the Am-Gl and Am groups, a reduction in the area of the total altered skin was recorded by 24.6 % and 14.7 %, respectively. In the GL group, the reduction in the area of the total altered skin was the smallest, by only 13.5 %. Conclusion: The use of a decellularized human amniotic membrane fixed with medical adhesive BF-6 can be considered as a promising method for the conservative treatment of LRI of the skin.

A Systematic Review and Quality Evaluation of Studies on Long-Term Sequelae of COVID-19.

COVID-19 made its debut as a pandemic in 2020; since then, more than 607 million cases and at least 6.5 million deaths have been reported worldwide. While the burden of disease has been described, the long-term effects or chronic sequelae are still being clarified. The aim of this study was to present an overview of the information available on the sequelae of COVID-19 in people who have suffered from the infection. A systematic review was carried out in which cohort studies, case series, and clinical case reports were included, and the PubMed, Scielo, SCOPUS, and Web of Science databases were extracted. Information was published from 2020 to 1 June 2022, and we included 26 manuscripts: 9 for pulmonary, 6 for cardiac, 2 for renal, 8 for neurological and psychiatric, and 6 for cutaneous sequelae. Studies showed that the most common sequelae were those linked to the lungs, followed by skin, cutaneous, and psychiatric alterations. Women reported a higher incidence of the sequelae, as well as those with comorbidities and more severe COVID-19 history. The COVID-19 pandemic has not only caused death and disease since its appearance, but it has also sickened millions of people around the globe who potentially suffer from serious illnesses that will continue to add to the list of health problems, and further burden healthcare systems around the world.

394 Potential disease-severity-related alterations in the uninvolved psoriatic skin

Data suggest that in psoriasis the entire epidermis of the individuals has inherited capacity to form lesions. The uninvolved (UN) skin potentially provides a tissue environment in which lesions can develop. Since cytokines, chemokines, proteases, and their inhibitors play important roles in regulating tissue-organization, we aimed to compare these proteins between healthy (H) and uninvolved (UN) skin of patients with mild (mean PASI: 9.06) and severe (mean PASI: 28.93) psoriasis using specific protein arrays.

199 Ex vivo infection of human skin with herpes simplex virus 1: Lesional AD skin and IL-4/IL-13-stimulated skin provide facilitated viral invasion

Herpes simplex virus 1 (HSV-1) is a prevalent human pathogen that can target skin to establish infection in the epithelium. Since the human skin provides effective barriers against pathogens under normal conditions, HSV-1 must find opportunistic pathways in order to penetrate the skin and initiate infection. As mechanical wounds of the human skin surface do not provide ad hoc entry portals for HSV-1, we explored the role of pathological skin conditions. Ex vivo infection studies revealed successful invasion in lesional AD skin implying that the virus can overcome both the stratum corneum and the tight junction barriers. To dissect the parameters that contribute to HSV-1 invasion, we treated human skin without pre-existing barrier defects with interleukin (IL)-4 and IL-13 to investigate whether Th2 cytokine-driven inflammation already induces modifications that allow viral penetration. Strikingly, we detected infected cells in the epidermis indicating that the IL-induced, AD-like skin phenotype can indeed facilitate HSV-1 invasion. Potential modifications allowing for facilitated viral access include impaired tight junctions, an altered stratum corneum, or a redistribution of the HSV-1 receptor nectin-1. Studies using human epidermal equivalents highlighted the importance of functional tight junctions in addition to the stratum corneum in restricting HSV-1 entry and provide a tool to mimic the pathological alterations in AD skin that allow HSV-1 invasion.

Blunted Microvascular Reactivity in Psoriasis Patients in the Absence of Cardiovascular Disease, as Assessed by Laser Speckle Contrast Imaging.

Psoriasis is associated with accelerated rates of cardiovascular disease (CVD). Laser Speckle Contrast Imaging (LSCI) is a novel, non-interventional technique for the dynamic assessment of microvascular endothelial dysfunction, which represents an early precursor of CVD. We investigated whether skin microvascular reactivity is impaired in psoriasis and whether an association exists with large artery stiffening. Skin microvascular reactivity was assessed with LSCI combined with post-occlusive reactive hyperaemia protocol in psoriasis patients and controls in the absence of established CVD. Arterial stiffness and central hemodynamics were assessed throughout a whole 24 h period with the Mobil-O-Graph device. Most LSCI indices of microvascular reactivity were impaired in psoriasis patients (n = 90) compared to controls (n = 45) [baseline flux; occlusion flux; peak-to-baseline magnitude; baseline cutaneous vascular conductance (CVC); percentage increase in CVC, p < 0.001 for all comparisons]. In multivariate analysis, psoriatic disease predicted the above markers independently of classical CVD risk factors. Augmentation index, peripheral pulse pressure, and central systolic/diastolic blood pressure correlated with LSCI microvascular responses in the study population (n = 135). Pulse wave velocity significantly correlated with nearly all LSCI parameters, while the association with baseline flux was independent of CVD risk factors and psoriatic disease in multivariate analysis (beta = 0.096, p = 0.039). This study provides evidence of altered skin microvascular responses in psoriasis by use of LSCI, and interaction with macrovascular dysfunction, before the establishment of overt CVD. A non-interventional approach of skin microcirculation with LSCI might be used as an early indicator of vascular health in psoriasis.

ATYPICAL PRESENTATION OF FAT EMBOLISM SYNDROME IN AN IMMUNOCOMPROMISED PATIENT

ATYPICAL PRESENTATION OF FAT EMBOLISM SYNDROME IN AN IMMUNOCOMPROMISED PATIENT

Patient-reported long-term outcome following allogeneic hematopoietic stem cell transplantation in pediatric chronic myeloid leukemia.

BackgroundPediatric CML is very rare. Before the introduction of tyrosine kinase inhibitors (TKIs), allogeneic hematopoietic stem cell transplantation (HSCT) from a donor -if available- was the standard cure attempt. Data on the long-term outcome and health-related quality of life (HRQOL) in former pediatric CML patients undergoing HSCT are lacking.Study questionWe investigated long-term survivors’ self-reporting to a questionnaire sent out to patients formerly enrolled in pediatric CML-HSCT trials.MethodsIndividuals with CML transplanted at age <18 years were identified from the German Childhood Cancer Registry database. Long-term survivors received a questionnaire based on the SF-36 and FACT-BMT asking them to self-report HRQOL issues. (Ethical vote #541_20 B, Medical Faculty, University of Erlangen-Nürnberg).Results111/171 (64.9%) individuals survived HSCT long-term and 86/111 (77.5%) fulfilled all inclusion criteria and received the questionnaire. 37/86 (43%) participants (24 female, 13 male, median age at HSCT 12 years [range 2-18], median age at the time of the survey 29 years [range 18-43]) responded after a median follow-up period of 19 years (range 4-27) after HSCT. 10/37 (27%) participants underwent no regular medical follow-up examinations. Self-reported symptoms like chronic graft-versus-host disease (cGvHD)-associated organ impairments and conditioning regimen consequences could causatively not sharply be separated in each case. Complains comprised hypothyroidism (N=11, 30%), infertility (N=9, 24%), lung problems, dry eyes (each N=7, 19%), skin alterations (N=6, 17%), hair problems (N=4, 11%), and sexual dysfunction (N=3, 9%). 10 (27%) participants experienced 13 CML relapses after a median interval from HSCT of 31 months (range 2-93). Only one patient underwent 2nd SCT after failure of relapse treatment with TKIs. Six secondary malignancies (dysplastic melanocytic nevus and ALL, basal cell carcinoma (N=2), rhabdomyosarcoma, and thyroid carcinoma developed in 5 (13%) participants. As assessed by the SF-36 questionnaire, impaired physical health was mainly associated with cGvHD. The mental component summary score showed that also participants without cGvHD scored significantly lower than the general population. When assessed by the FACT-BMT, participants with cGvHD scored significantly lower while participants without cGvHD scored even 5 points higher than the data from controls. 18 (49%) participants considered the sequelae of HSCT an obstacle to education. Out of the total cohort, N=20 (54%), N=7 (19%), N=5 (14%), and N=4 (11%) participants worked full time, part-time, were unemployed, or had not yet finalized their education, respectively. 20 (54%) participants lived as singles, 8 (22%) lived in a partnership, 6 (16%) were married, and 3 (8%) had been divorced. Four (11%) participants reported a total number of 7 children.ConclusionThis first assessment of HRQOL in former pediatric patients with CML surviving HSCT for more than two decades demonstrates self-reported satisfactory well-being only in the absence of cGvHD. Research-based on self-reported outcomes sheds light on former patients’ perspectives and provides an additional layer of valuable knowledge for pediatric and adult hematologists. Regular follow-up examinations are mandatory helping to avoid that late secondary neoplasias, CML-relapse, and disorders forming the broad range of possible long-term consequences of HSCT are not detected too late.

Analysis of Skin Cancer and Patient Healthcare Using Data Mining Techniques.

Skin cancer is the uncontrolled growth of irregular cancer cells in the human-skin's outer layer. Skin cells commonly grow in an uneven pattern on exposed skin surfaces. The majority of melanomas, aside from this variety, form in areas that are rarely exposed to sunlight. Harmful sunlight, which results in a mutation in the DNA and irreparable DNA damage, is the primary cause of skin cancer. This demonstrates a close connection between skin cancer and molecular biology and genetics. Males and females both experience the same incidence rate. Avoiding revelation to ultraviolet (UV) emissions can lower the risk rate. This needed to be known about in order to be prevented from happening. To identify skin cancer, an improved image analysis technique was put forth in this work. The skin alterations are routinely monitored by this proposed skin cancer categorization approach. Therefore, early detection of suspicious skin changes can aid in the early discovery of skin cancer, increasing the likelihood of a favourable outcome. Due to the blessing of diagnostic technology and recent advancements in cancer treatment, the survival rate of patients with skin cancer has grown. The strategy for detecting skin cancer using image processing technologies is presented in this paper. The system receives the image of the skin lesion as an input and analyses it using cutting-edge image processing methods to determine whether skin cancer is present. The Lesion Image Analysis Tools use texture, size, and shape assessment for image segmentation and feature phases to check for various cancer criteria including asymmetries, borders, pigment, and diameter. The image is classified as Normal skin and a lesion caused by skin cancer using the derived feature parameters.

Feature-based Differentiation of Malignant Melanomas, Lesions and Healthy Skin in Multiphoton Tomography Skin Images

Abstract Malignant melanoma is a very aggressive tumour with the ability to metastasize at an early stage. Therefore, early detection is of great importance. Multiphoton tomography is a new non-invasive examination method in the clinical diagnosis of skin alterations that can be used for such early diagnosis. In this paper, a method for automated evaluation of multiphoton images of the skin is presented. The following features at the cellular and subcellular level were extracted to differentiate between malignant melanomas, lesions, and healthy skin: cell symmetry, cell distance, cell density, cell and nucleus contrast, nucleus cell ratio, and homogeneity of cytoplasm. The extracted features formed the basis for the subsequent classification. Two feature sets were used. The first feature set included all the above-mentioned features, while the second feature set included the significantly different features between the three classes resulting from a multivariate analysis of variance. The classification was performed by a Support Vector Machine, the k-Nearest Neighbour algorithm, and Ensemble Learning. The best classification results were obtained with the Support Vector Machine using the first feature set with an accuracy of 52 % and 79.6 % for malignant melanoma and healthy skin, respectively. Despite the small number of subjects investigated our results indicate that the proposed automatic method can differentiate malignant melanoma, lesions, and healthy skin. For future clinical application, an extended study with more multiphoton images is needed.

34954 Cutaneous microbial markers of squamous cell carcinoma risk in solid organ transplant recipients

Solid organ transplant recipients (SOTRs) are 100-times more prone to aggressive cutaneous squamous cell carcinoma (SCC) compared with the general population. Despite this increased mortality, our ability to prognosticate risk of cancer in SOTRs is still poor. Accumulating evidence suggests a detrimental influence of microbial dysbiosis on transplant outcomes and immunosuppressant metabolism. Additionally, altered skin microbiome, specifically excessive colonization of the skin by Staphylococcus aureus, has been found in cutaneous SCCs of immunocompetent individuals. We hypothesized that cutaneous dysbiosis is a potential modifier to the risk of SCC in SOTRs and that the microbiome of SOTRs with a history of SCC (>4 instances) is distinct from the microbiome of SOTRs without a history of SCC. To investigate this theory, we generated microbial genomic data from the skin samples of 2 matched cohorts: SOTRs with and without history of SCC. Analyses included testing for differences in microbial diversity measures and differentially relatively abundant microbiome species between cohorts. In the cutaneous microbiomes of SOTRs with SCC history, we identified a significantly reduced abundance of Roseomonas mucosa, which is a S aureus–suppressive species. This suggests a protective effect of R mucosa against the development of SCC through suppression of a bacterial species hypothesized to initiate inflammation-related signaling involved in SCC-genesis. Overall, these findings not only point to a potential role of cutaneous microbiomes as predictive biomarkers for the development of SCC in SOTRs but also suggest that the microbiome can be used for potential preventive and interventional strategies.

Protective role of Portuguese natural mineral waters on skin aging: in vitro evaluation of anti-senescence and anti-oxidant properties.

Natural mineral waters (NMWs) emerge from the earth as springs and their beneficial therapeutic effecthas been empirically recognized in different countries. Portugal has diverse NMW resources that are sought for the relief of different afflictions including dermatological complications. However, there is a lack of scientific validation supporting this empiric knowledge. In this study, we aimed to screen the in vitro bioactivity of Portuguese NMWs with different chemical profiles, namely sulfurous/bicarbonate/sodic (SBS), bicarbonate/magnesium, sulfated/calcic, sulfurous/chlorinated/sodic, sulfurous/bicarbonate/fluoridated/sodic, and chlorinated/sodic, focusing on aging-related skin alterations. Mouse skin fibroblasts and macrophages were exposed to culture medium prepared in different NMWs. Cellular viability was evaluated by MTT assay and etoposide-induced senescence was analyzed through the beta-galactosidase staining kit. Wound healing was investigated by the scratch assay, and phototoxicity/photoprotection after UVA irradiation was evaluated using a neutral red solution. ROS production was quantified using the 2'7'-dichlorofluorescin diacetate dye, and the activity of superoxide dismutase (SOD) was analyzed by a commercial kit after lipopolysaccharide exposure. NMWs within the SBS profile demonstrated anti-senescence activity in skin fibroblasts, along with a variable effect on cellular viability. Among the tested NMWs, two decreased cellular senescence and preserved cell viability and were therefore selected for subsequent studies, together with a SBS NMW with therapeutic indications for dermatologic diseases. Overall, the selected NMW promoted wound healing in skin fibroblasts and activated SOD in macrophages, thus suggesting an anti-oxidant effect. None of the NMWs prevented phototoxicity after UV irradiation. Our results shed a light on the anti-aging potential of Portuguese NMW, supporting their putative application in cosmetic or medical products.

In Vitro and Ex Vivo Mechanistic Understanding and Clinical Evidence of a Novel Anti-Wrinkle Technology in Single-Arm, Monocentric, Open-Label Observational Studies

Skin aging is a biological process leading to visible skin alterations. The mechanism of action, clinical efficacy and tolerance of a novel anti-wrinkle technology were evaluated in two skin care products formulated for different skin types. Two single-arm monocentric, open-label observational clinical studies, which were 56 days long, evaluated a cream-gel (n = 30) and a cream (n = 33) on the face and neck. Morphometric analyses of five types of wrinkles were performed at 0, 7, 28 and 56 days. Structural changes in extracellular matrix (ECM) including collagen, elastin and hyaluronic acid (HA) were visualized and quantified by histochemical imaging after daily treatment of skin explants for 6 days. Protein and gene expression related to barrier and hydration were analyzed using ELISA and qRT-PCR, respectively, in a reconstituted human skin model treated daily for 48 h. A decrease in wrinkle dimensions was found in the majority of parameters after 28 days of treatment. Collagen, elastin, HA, procollagen type I, hyaluronan synthases, HAS2 and HAS3 were all stimulated. Based on significant and consistent changes in our investigations, we conclude that the underlying mechanism of action of the novel anti-wrinkle technology could be the remodeling of dermal ECM, and both the test formulations were efficacious and well tolerated.

Clinical presentation and etiology of Cushing's syndrome: Data from ERCUSYN.

This review presents the data on clinical presentation at diagnosis in 1564 patients included in the European Registry on Cushing's syndrome (ERCUSYN), of whom 1045 (67%) had pituitary-dependent Cushing's syndrome (CS) (PIT-CS), 385 (25%) had adrenal dependent CS (ADR-CS) and 89 (5%) had ectopic adrenocorticotropic hormone syndrome (ECT-CS). The most frequent symptoms in the overall series were weight gain (83%), hypertension (79%), skin alterations (76%) and myopathy (70%). Diabetes mellitus was present in 32% and depression in 35% of patients. Skin alterations, menstrual irregularities and reduced libido were more prevalent in PIT-CS patients compared to ADR-CS patients, whereas patients with ECT-CS more frequently had diabetes mellitus, myopathy, hirsutism and vertebral fractures compared to the other etiologies, consistent with a more severe clinical scenario. Reduced libido and bone fractures were more prevalent in men compared to women. Quality of life was poor at diagnosis, irrespective of the etiology of CS, and also associated with the presence of depression at baseline. A delay of 2 years between the onset of symptoms and diagnosis was also observed, with a high number of specialists consulted, who often missed the correct diagnosis. To develop strategies aimed at shortening the time elapsed to diagnosis, it is important to rapidly start treatment and reduce the burden of the disease on patient psychophysical health and longevity.

Prevalence and clinical relevance of udder thigh dermatitis in dairy cows

Udder thigh dermatitis (UTD) is especially common in heifers. Skin alterations and necrosis of muscle tissue characterise this condition and, although the disease is well understood, systematic analysis concerning prevalence, risk factors and consequences of UTD is lacking. The aim of this study, therefore were such systematic clinical examinations. Statistical analyses of data were performed to objectively evaluate the supposed higher risk of heifers developing UTD. The study included a total of 317 animals that were examined and classified as UTD positive or negative on the day of calving. The size of skin alterations and the severity of tissue damage were assessed on days 7, 14 and 21 p. p. The overall prevalence resulted in 18 % UTD with a higher risk in heifers (36.8 %) than in cows (4.3 %; P < 0.0001). A significant link was found between the size of tissue lesions and severity of UTD (day 7: P = 0.007; day 14: P = 0.002; day 21: P = 0.011). Peripartal udder oedemas were strongly associated with UTD (P < 0.05). The milk yield and the concentration of milk protein was found to have decreased. UTD appears to be a multi-factorial disease that is supposed to be painful due to the obvious avoidant behaviour in affected animals. In respect to the reduction in daily milk yield and an enhancement of pain related stress, neither the economic impact of UTD, nor the adverse effects on animal welfare should be underestimated. Heifers with udder oedema are advised to be examined for the presence of UTD in order to start an early treatment and diminish disease related negative impacts.

History, Current Practice, and the Future of Wound Care for Occupational and Physical Therapists.

History, Current Practice, and the Future of Wound Care for Occupational and Physical Therapists.

Vagus Nerve Hypothesis: Regulatory Mechanism and Treatment of Symptoms Induced by Fluctuations in Atmospheric Barometric Pressure

A treatment has been postulated for facilitating prevention or reduction of chronic predictable symptoms exacerbated by fluctuations in atmospheric barometric pressure and other weather phenomena (meteoropathy). An apparent vagus nerve (VN) mechanism was observed. Initial clinical results provide evidence to support the neurological basis of meteoropathy. Reported is the background, relevance, and science associated with an innovative application of auricular acupuncture. Patients reported reduced weather-induced symptoms. An analytical case-specific methodology was employed to detect and stimulate points of altered skin electrical resistance within the region innervated by the auricular branch of the VN. The METEO-Q Questionnaire (Mazza et al.) documented patients' susceptibility to weather and climatic changes pre and post treatment. Significant decreases in severity, frequency, and duration of symptoms associated with barometric pressure changes prior to treatment were documented. To the author's knowledge, no dependable, reproducible, or consistent intervention to facilitate a decrease in meteoropathic symptoms has been previously reported or studied.