Inflammatory Nodules Research Articles

HIDRAdisk: validation of an innovative visual tool to assess the burden of hidradenitis suppurativa.

BackgroundHidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin disease characterized by painful inflamed nodules, recurrent abscesses and fistulas located in apocrine gland–bearing body sites. The negative impact of HS on patient's quality of life (QoL) has been reported to be greater than other dermatologic conditions as psoriasis and atopic eczema, and its improvement is an important goal in disease management. Nowadays, there are no specific validated QoL instruments available for HS and generic dermatologic questionnaires are used.ObjectiveThe objective of this study was to demonstrate the validity, reliability and responsiveness of HIDRAdisk, a new innovative tool designed for rapid assessment of HS burden and, at the same time, an intuitive graphic visualization of the measurement outcome.MethodsA multicentre, longitudinal, observational study was conducted to validate the HIDRAdisk compared with other validated questionnaires [Skindex‐16, Dermatology Life Quality Index (DLQI), Work Productivity and Activity Impairment–General Health (WPAI:GH)] and to evaluate its correlation with disease severity in Italian patients with any degree of HS severity, as measured by Hurley stage and HS Physician Global Assessment (HS‐PGA).ResultsA total of 140 patients (59% women; mean age 34.9 ± 11.0 years) were enrolled in 27 dermatologic centres. HIDRAdisk showed a strong correlation with Skindex‐16 and DLQI, and a good one with WPAI:GH (correlation coefficient: 0.7568, 0.6651 and 0.5947, respectively) and a statistically significant correlation with both Hurley stage and HS‐PGA. Very good internal consistency (Cronbach coefficient >0.80; intraclass correlation coefficient >0.6), with correlation between the 10 items, good test–retest reliability (Spearman correlation coefficient, 0.8331; P < 0.0001) and responsiveness to changes were demonstrated.ConclusionOur study shows that HIDRAdisk, a short and innovative visual HS QoL instrument, has been psychometrically validated in Italian language and it may help improve the management of HS once implemented in routine clinical practice.

Evolution and duration of nodules in severe nodular acne on the back: results from a four-week non-interventional, prospective study.

Severe nodular acne is characterized by inflammatory nodules and scarring. Their natural evolution and duration are insufficiently investigated. To investigate the evolution and duration of untreated acne nodules. Four-week, single-centre, non-interventional, prospective study in subjects with severe nodular acne on the back. Nodule evolution and duration was assessed using standardized photographs taken twice weekly. Data from 23 subjects were evaluable. Mean age was 25.1±4.9years, 87% were males, and mean acne duration was 9.7±6.7years. At baseline, the overall total nodule count was 132 (mean number: 5.7±3.0 nodules/subject). Among others, the following two main pathways were observed: nodules evolving directly into atrophic scars (31.8%) and nodules evolving towards papules into atrophic scars (37.9%). After 4weeks, 77.3% of baseline nodules had evolved into atrophic scars. After baseline visit, a total of 247 new nodules (3.1±2.2 nodules/week/subject) with a mean duration of 4.9±2.6days were observed. The mean duration of new nodules was significantly longer in subjects (n=16) with ≥6 new nodules compared to subjects (n=7) with <6 new nodules (5.2±1.4 vs. 3.6±0.8days; P=0.008)). There was no correlation between the number of new nodules and acne duration or with the number of baseline nodules. This study documents the natural nodule evolution and duration over 4weeks and showed in 23 patients the scarring potential of untreated severe nodular acne of the back.

Histology of the liver and small intestine broiler using phytobiotic in the ration infected Salmonella pullorum

Phytobiotic contains bioactive substances that function as antibacterial substances so that its use as Natural Growth Promotors substitute antibiotics continue to be suggested. This study aims to observe the histopathological changes of liver and small intestine in broilers infected with Salmonella pullorum with Turmeric Extract (TWE), Garlic Extract (GWE) and the combination of Turmeric and Garlic extract (1TWE: 3GWE) added to the feed. One-hundred-day old chick was kept intensive for 38 days and divided into five treatments and four replications, with five chicks in each replicate. The treatments were R0 (no phytobiotic and antibiotics as a negative control), R1; 0.015% tetracycline and infected Salmonella pullorum as a positive control, R2; 2.50% TWE) (Salmonella pullorum infected), R3; 2.00% GWE (Salmonella pullorum infected), R4; 2.50% GWE (Salmonella pullorum infected). The results showed a very significant effect (P <0.01) reduced the presence of inflammatory nodules, congestion and haemorrhages in liver and small intestine broilers due to Salmonella pullorum. The addition of TGWE phytobiotic to the feed can reduce damage in the liver and small intestine infected Salmonella pullorum compared with the use of tetracycline, TWE, and GWE.

Increased virulence of albino mutant of Fonsecaea monophora in Galleria mellonella.

Fonsecaea monophora has been the predominant pathogen of chromoblastomycosis in Southern China, but its pathogenic mechanism remains unclear. New models are needed to study this infection. In the current study, we examined the role of melanin on the pathogenicity of F. monophora in Galleria mellonella model using melanin and albino strain. Interestingly, the albino mutant strain displayed higher pathogenicity compared to the melanin stain and restoration of melanin of albino mutant could reverse the pathogenicity. Histopathology showed that inflammatory nodules were bigger than that infected with albino cells, which suggested that melanized cells could trigger a robust cellular immune response of G. mellonella than albino cells. The activated immune response in G. mellonella induced by melanized cells might explain the decreased virulence of melanized cells in larvae model. While further study was needed to gain full insights into the molecular immunological mechanism in G. mellonella activated by melanin.

Effect of Shodhana and Shamana Chikitsa in Mukhadushika (Acne Vulgaris) A Case Study

Acne vulgaris is a chronic disease that occurs in young adults when hair follicles are clogged with dead skin cells and oil from the skin. It is characterized by both inflammatory (papules, pustules and nodules) and non-inflammatory (Comedones, open and closed) lesions.In Ayurvedic classics, in the context of Kshudra Rogas, it is mentioned that Mukhadushika occurs in yuvavastha and its signs and symptoms are similar to that of Acne vulgaris. It is due to vitiation of Vata, Kapha and Rakta having the Shalmali thorn like thick or hard painful eruptions which are impregnated with Meda. We hereby report a case of acne vulgaris which was treated under an allopathic physician with oral and topical antibiotics and found no relief so she came to Panchakarma OPD at Ch. Brahm Prakash Ayurved Charak Sansthan. According to chronicity and severity of disease, Shodhana Chikitsa and Shamana chikitsa was given. Vamana and Virechana karma (Shodhana Chikitsa) along with the topical application of lodhradi lepa and internal administration of Brihat Manjisthadi Kwath (Shamana Chikitsa) was administered for a period of 1month. Substantial clinical improvement was observed. During treatment, all the signs and symptoms of the patient were reduced.&#x0D;

Efficacy of Bacteriophages in Propionibacterium acnes-Induced Inflammation in Mice.

BackgroundBacteriophages have been introduced as living drugs for infectious diseases; thus, they may provide an alternative to conventional acne therapeutics in patients with non-responsive acne.ObjectiveWe investigated the effect of bacteriophages using an acne mouse model with Propionibacterium acnes-induced inflammatory nodules by clinical examination, pathology, and immunohistochemical analysis.MethodsA human-isolated P. acnes suspension (109 colony forming units/µl) was injected into the backs of HR-1 mice. Group A was used as a control, Group B was injected on the back with P. acnes 4 weeks following the initial P. acnes suspension injection, and group C was injected on the back with P. acnes and bacteriophages 4 weeks following the initial P. acnes suspension injection. Clinical and histopathological evaluations were performed.ResultsInflammatory nodule size decreased with time in all groups. Group C showed the greatest decrease in size, followed by group B and group A. The histopathological findings showed a decrease in epidermal thickness and the number and size of microcomedone-like cysts in groups B and C compared to group A. Immunohistochemistry revealed similar expression of integrin α6, the epidermal proliferation marker, infiltration of CD4/CD8 T cells and neutrophils, and expression of myeloperoxidase, interleukin-1β, toll-like receptor-2, LL-37, and matrix metalloproteinase-2/3/9 in all three groups.ConclusionUsing an acne mouse model with P. acnes-induced inflammatory nodules, we demonstrate that bacteriophages may constitute an alternative to conventional acne therapies. However, additional studies are needed for human applications.

Can spectral computed tomography imaging improve the differentiation between malignant and benign pulmonary lesions manifesting as solitary pure ground glass, mixed ground glass, and solid nodules?

BackgroundThis study quantitatively assessed the efficacy of spectral computed tomography (CT) imaging parameters for differentiating the malignancy and benignity of solitary pulmonary nodules (SPNs) manifesting as ground glass nodules (GGNs) and solid nodules (SNs).MethodsThe study included 114 patients with SPNs (61 GGNs, and 53 SNs) who underwent CT plain and enhanced scans in the arterial (a) and venous (v) phases using the spectral imaging mode. The spectral CT imaging parameters included: iodine concentrations (IC) of lesions in the arterial (ICLa) and venous (ICLv) phases; normalized IC (NICa/NICv, normalized to the IC in the aorta); the slope of the spectral Hounsfield unit (HU) curve (λHUa/λHUv); and monochromatic CT number (CT40keVa/v, CT70keVa/v) enhancement on 40 and 70 keV images. The two‐sample Mann–Whitney U test was used to compare quantitative parameters between malignant and benign SPNs, SNs, and GGNs.ResultsPathology revealed 75 lung cancer cases, 3 metastatic nodules, 14 benign nodules, and 22 inflammatory nodules. Among the 53 SNs there were 37 malignant and 16 benign nodules. Among the 61 GGNs there were 41 malignant and 20 benign nodules. Overall, the CT40keVa, λHUa, CT40keVv, λHUv, and ICLv of benign SPNs were all greater than those of malignant SPNs (all P < 0.05). For GGNs, CT40keVa/v, CT70keVa/v, λHUa/λHUv, and ICLv of malignant GGNs were all lower than those of benign GGNs.ConclusionSpectral CT imaging is a more promising method for distinguishing malignant from benign nodules, especially in nodules manifesting as GGNs in contrast‐enhanced scanning.

The First 100 Cases of Epstein-Barr Virus-Positive Mucocutaneous Ulcers

In 2016, the World Health Organization provisionally classified Epstein-Barr virus (EBV)-positive mucocutaneous ulcer (EBVMCU) as a lymphoid neoplasm under the subcategory of mature B-cell neoplasms. Here we describe a 59-year-old Chinese woman with a long history of recurrent sinus and oropharyngeal infections and was diagnosed initially with EBVMCU and later, diffuse large B-cell lymphoma (DLBCL). She had sought medical attention after a particularly long bout of increased facial pressure and nasal obstruction. As a young adult she had undergone a tonsillectomy, adenoidectomy, and received innumerable treatments for bronchiectasis and recurrent sinopulmonary infections. A sinus computerized tomography (CT) scan showed mucosal thickening and swellings of the left frontal posterior sinus. A subsequent 18fludeoxyglucose (18FDG) positron emission tomography (PET)-CT scan showed a large hypermetabolic mass (standardized uptake value [SUV] 30.6) centered in the left half of the nasopharynx and sinus processes and extending across the mid-line. She underwent an endoscopic turbinate reduction with removal of a polypoid soft-tissue mass. Immunohistochemical studies indicated large atypical lymphoid cells that stained positively for CD20, CD30, EBER-1, MUM-1, OCT-2, and PAX-5 and variably for BCL-6, CD15, CD45, and CD79a. The Ki-67 proliferation index was 100% in the atypical cells. Tissue blocks were reviewed locally and at the National Institute of Health and were felt to be most consistent with EBVMCU. She received 4000 cGy involved-field external-beam radiation therapy over 20 fractions. At completion of treatment, no residual abnormalities were identified and no additional adjuvant therapy was pursued.Three years later she presented to medical attention with shortness of breath and a non-productive cough. A PET-CT scan showed whiteout of the left lung and intense 18FDG uptake in a left perihilar nodule (SUV of 18). Bronchoscopy revealed many reactive polypoid bronchial wall masses and a complete collapse of the lower left lobe due to an obstructing mass. The left lower lobe intraluminal mass biopsies however showed EBV-positive DLBCL of non-germinal center phenotype. She received six cycles of conventional R-CHOP therapy (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone) and 36 months later she remains cancer free but with persistent bronchial inflammatory nodules and recurrent infections.Using the key words “EBV mucocutaneous ulcers,” “EBV-associated lymphoproliferative disorders,” and “lymphoproliferative disorders,” we identified 100 cases of EBVMCU in the literature. EBVMCU is manifested as a well-circumscribed ulcer typically unifocal (90%) and of the oropharynx (58%), gastrointestinal (GI) tract (20%), and skin (20%). Immunohistochemical studies of the ulcers reveal monoclonal B-immunoblasts staining positively for CD20, CD30, EBER-1, MUM-1, OCT-2, and PAX-5 and staining variably for BCL-6, CD15, CD45, and CD79a. EBVMCU is most commonly associated with medication-induced (iatrogenic) immunosuppression (65%), advanced age-associated immunosenescence (27%), and primary (3%) and acquired (3%) immunodeficiencies. The median age for all EBVMCU cases is 68.5 (range, 16 -101) years. Of the 65 cases where medication-induced immunosuppression contributed to EBVMCU, 45 (69%) were in patients greater than 60 years-old. EBVMCU is a predominantly indolent disease reminiscent of post-transplant lymphoproliferative disorders in which conservative strategies are primarily employed with potential escalation to B-cell targeted therapy with or without cytotoxic chemotherapy, resection, and/or radiotherapy. Surveillance for EBVMCU should follow B-cell directed therapies and should be considered in the differential diagnosis in cases of suspected lymphoma relapse. Additionally, other LPDs, including lymphomas, should be monitored after resolution of EBVMCU. Due to overlap of the immunohistochemical profiles and risk factors associated with EBVMCU and other ulcerative LPDs of the oral and sinus cavities, nasopharynx, or GI tract, EBVMCU should be considered in the differential diagnosis to prevent under- or over-diagnosis and their associated potential repercussions. DisclosuresNo relevant conflicts of interest to declare.

Role of SOD3 in silica-related lung fibrosis and pulmonary vascular remodeling

BackgroundWork-place exposure to silica dust may lead to progressive lung inflammation culminating in the development of silicosis, an irreversible condition that can be complicated by onset of pulmonary hypertension (PH). The molecular mechanisms leading to the development of PH and lung fibrosis in response to silica are not well understood. Oxidant/antioxidant imbalance in the lung may promote fibroproliferation and vascular smooth muscle proliferation, ultimately leading to the development of PH. Herein, we analyze the development of PH and lung fibrosis in mice deficient in extracellular superoxide dismutase (SOD3), an enzyme with anti-oxidant activity.MethodsPH and silicosis were induced in wild-type and Sod3−/− mice through intratracheal injection of crystalline silica at dose 0.4 g/kg. Pulmonary hypertension and lung fibrosis were characterized by changes in right ventricular systolic pressure (RVSP) and collagen deposition 28 days following silica injections. Vascular remodeling was analyzed using immunohistochemistry and morphometric analysis. The expression of genes were analyzed using qRT-PCR and Western blot.ResultsC57BL6 mice exposed to silica showed attenuated expression of Sod3 in the lung suggesting a protective role for Sod3. Consistent with this, Sod3−/− mice developed more severe fibrotic inflammatory nodules with increased collagen deposition. Furthermore, the expression of genes involved in tissue remodeling (Timp1), fibrotic lesion formation (Fsp1) and inflammatory response (Mcp1) were significantly elevated in Sod3−/− mice compared to Sod3+/+ mice treated with silica. Infiltration of neutrophils and activated macrophages into affected lung was significantly higher in Sod3 deficient mice. In addition, silica produced more profound effects on elevation of RVSP in Sod3−/− compared to wild-type littermate. Increase in RVSP was concomitant with hypertrophy of pulmonary arteries located in silicotic nodules of both mouse strains, however, vascular remodeling in unaffected areas of lung was detected only in Sod3−/− mice.ConclusionsOur data suggest that Sod3 and extracellular oxidative stress may play an important role in the development of pneumoconiosis and pulmonary vascular remodeling following exposure to environmental and occupational silica.

SnapshotDx Quiz: December 2018

SnapshotDx Quiz: December 2018

Hidradenitis Suppurativa After Radical Surgery-Long-Term Follow-up for Recurrences and Associated Factors.

Hidradenitis suppurativa (HS) is a chronic debilitating skin disease in inverse body areas. Wide excision is recommended in Hurley Stages II to III, but the rate and symptoms of recurrences in long-term follow-up remain unclear. To analyze the allocation of recurrences regarding the operative field, the onset and quality of HS symptoms as well as factors associated with recurrences in long-term follow-up. Forty-eight patients with Hurley Stage III disease who had undergone 91 wide excisions from 2010 to 2015 were clinically examined regarding postoperative complications and allocation and quality of recurrences. To determine the risk of recurrence, possible surgery, and lifestyle-related associated factors were investigated. Postoperative recurrences of HS were seen in 54.2%. Most recurrences (inflamed nodules) were detected in a <1-cm margin around the operative field (18.7%). Surgery under tumescence local anesthesia showed symptoms in 40.6% compared with 28.6% under general anesthesia. Increased alcohol consumption (p = .027) but not body mass index (p = .11) or smoking behavior (p = .45) had significant effect on relapse of HS. Caution must be given especially in surgery with local anesthesia only. Half of patients with HS showed long-term follow-up signs of recurrence after wide excision, most frequently nearby the operation field.

Acne fulminans in a Vietnamese boy successfully treated with prednisolone and ibuprofen: A case report

Background: Acne fulminans (AF) is a rare disorder, the most severe form of the entire clinical spectrum of acne. It is characterized by the emergence of painful inflammatory nodules that turn into ulcers, concomitant with systemic manifestations. Here, we report for the first time a Vietnamese boy with Acne fulminans successfully treated with prednisolone and ibuprofen.&#x0D; Case presentation: The patient is a 14-year-old male teenager with moderate acne since the age of 13. After a day of swimming, his acne suddenly became inflamed and painful lesions were present on his face and back. He had high fever and polyarthritis, and tests showed leukocytosis, neutrophilia, and elevated C-reactive protein (CRP). Severe infection was diagnosed and treated by addition of antibacterial therapy for a long period, however, the condition did not improve. When called upon to evaluate the patient, we established the diagnosis of acne fulminans and initiated treatment with prednisone (1mg/kg/day) and ibuprofen (500 mg for two times daily). Following this treatment regimen, there was a rapid improvement.&#x0D; Conclusion: Herein, we have reported a Vietnamese boy with typical AF, but delayed diagnosis and treatment because of a rare condition. Our results support the role and benefit of prednisolone for AF treatment.

Prevalence of patients with self-reported hidradenitis suppurativa in a cohort of Danish blood donors: a cross-sectional study.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent inflamed nodules. No pathognomonic test is available for HS; hence the diagnosis is based on three clinical criteria. To estimate the cross-sectional prevalence and characterize patients with HS in the Danish Blood Donor Study cohort. A questionnaire previously developed containing HS screening questions, the Major Depression Inventory, the Short Form-12, as well as questions about height, weight and drinking habits was answered by 27765 blood donors. The prevalence of HS was 1·8% [95% confidence interval (CI) 1·6-2·0%] in the cohort of Danish blood donors. Donors with HS were on average 4·7years younger (P<0·001), had 1·3kg m-2 higher mean body mass index (BMI) (P<0·001) and were significantly more likely to smoke [odds ratio (OR) 1·44, 17·9% vs. 13·1%, P=0·002] compared with donors without HS. Furthermore, significantly more donors with HS were classified as having moderate depression (3·2% vs. 0·7%, P<0·001). Also, significantly more patients with HS were apprenticeship educated, received educational support and sickness or cash benefits. The prevalence of HS in the cohort of blood donors was estimated to 1·8% (95% CI 1·6-2·0%). Donors with HS reported characteristics similar to those reported for hospital-based patients with HS such as higher BMI, smoking rates and lower socioeconomic status than donors without HS.

« Poussées inflammatoires d’acné » sous isotrétinoïne révélant une hidradénite suppurée : 4 cas

Isotretinoin is the most potent treatment for acne but paradoxical flares can occur. HS lesions of the face may be mistaken for acne. We report on 4 patients in whom an "acne" flare on isotretinoin led to the correct diagnosis of HS. Four young male patients aged 15 to 28 years were referred to us because of an acne flare on isotretinoin. Three of them had clinical features considered unusual in acne: involvement of the nape of the neck (2), retroauricular cysts (2), a rope-like pre-sternal lesion (1), a large bag-like sinus on the face (1), large deep depressed U-type scars on the back (3). Questioning revealed that all three had previously experienced several attacks of inflammatory nodules in the axillae and/or inguinal folds; they had not mentioned these lesions since they seemed so minor. The fourth patient had lesions typical of HS comprising nodules, sinus, rope-like hypertrophic scars on the face mistaken for acne, epidermal cysts on the scrotum and pubic folliculitis. Treatment with systemic antibiotics resulted in regression of lesions in all 4 patients. An acne flare on isotretinoin requires investigations with a view to potential diagnosis of HS. Patients presenting "acne" and atypical features such as involvement of the neck, large U scars and cord-like structures should be questioned about the presence of nodules in the axillae and groin since patients with mild HS may not spontaneously acknowledge such typical symptoms.

Biofilm production and antibiotic susceptibility of Staphylococcus epidermidis strains from Hidradenitis Suppurativa lesions.

An aberrant interaction between commensal skin bacteria and the host skin immune system is considered important in the pathogenesis of hidradenitis suppurativa (HS). In this study, we investigated the antibiotic susceptibility and biofilm-forming capabilities of S. epidermidis strains isolated from HS patients. Skin biopsies were taken from active HS lesions such as inflammatory nodules and/or sinuses and non-involved skin from 26 patients and cultured under optimal microbiological conditions for 24 h. Planktonic growth, biofilm production, antibiotic susceptibility and biofilm eradication by clindamycin, doxycycline, rifampicin and tetracycline were tested including a laboratory control strain of S. epidermidis for reference. Staphylococcus epidermidis was cultured in 16 of 26 HS patients (62%). In total 27 different S. epidermidis isolates were identified; 16 (59%) from non-involved skin and 11 (41%) from HS lesions. All bacterial strains showed planktonic growth. Twenty-four of 27 (89%) isolates were strong biofilm producers in vitro. The biofilm-forming capability varied amongst the strains from non-involved skin and lesional skin. Twenty-four strains had an intermediate to resistant antibiotic susceptibility to clindamycin (89%). Rifampicin was the most effective antibiotic at inhibiting planktonic growth and at eradication of biofilm (P < 0.05). We observed a slight increase in S. epidermidis virulence, characterized by resistance to commonly used antibiotics, increased biofilm production and resistance to biofilm eradication. In particular, the reduced sensitivity to tetracycline and clindamycin, two standard antibiotics in the treatment of HS, is alarming. Rifampicin, also important in HS treatment, showed the greatest efficacy at eradicating the biofilm at low MIC concentrations.

Inflamed nodule on the upper cutaneous lip: Embedded tooth diagnosed at a dermatology practice

Inflamed nodule on the upper cutaneous lip: Embedded tooth diagnosed at a dermatology practice

Reliability of the hidradenitis suppurativa clinical response in the assessment of patients with hidradenitis suppurativa.

Hidradenitis suppurativa clinical response (HiSCR) is a validated clinical end point for measuring response to treatment in patients with hidradenitis suppurativa (HS). Previous studies have reported on the validity, responsiveness and meaningfulness of the HiSCR. To evaluate the HiSCR for inter- and intrarater reliability characteristics. A stand-alone, two-site, prospective, non-interventional observational study consisted of 22 patients, with self-reported severity between mild, moderate and severe HS. The Patient Global Impression of Change (PGI-C) scale was completed by patients at Timepoint 2. Descriptive statistics of Hurley Stage, total abscesses, total draining fistulas, total inflammatory nodules and total AN count (sum of inflammatory nodules and lesions) were reported at two timepoints. Inter-rater reliability and intrarater reliability for the HS lesion count tool were evaluated at two timepoints (baseline and Day 7) using the HS lesion count tool. Intraclass correlation (ICC) coefficients of lesion counts were calculated to evaluate inter- and intrarater reliability of lesion counts between pairs of dermatologists. The majority of patients demonstrated either no change or minimally worse PGI-C in HS scores. Descriptive statistics were similar between rater groups and timepoints assessed. Inter-rater ICC coefficients for abscess count at Timepoints 1 and 2 were 0.38 and 0.67. The ICC coefficients for draining fistula and AN count were ≥0.61 at both timepoints. In an exploratory model, ICC coefficients were ≥0.68 for all evaluated lesion counts. The test-retest reliability using ICC coefficients was ≥0.70 for total abscess, draining fistula, inflammatory nodule and AN count. The HS lesion count tool had an acceptable inter- and intrarater reliability, indicating that HiSCR has a strong degree of reproducibility and consistency in the evaluation of patients with HS.

Preclinical evaluation of the effects on the gastrointestinal tract of the antineoplastic drug vincristine repeatedly administered to rats.

Vincristine is a commonly used chemotherapeutic agent. It is associated with undesirable digestive side effects. However, the impact of vincristine on gastrointestinal structure and motility or its long-term effects have not been deeply studied in animal models. This could be useful in order to develop therapeutic or preventive strategies for cancer patients. The aim of this study was to analyze such effects. Rats received saline or vincristine (0.1mgkg-1 , ip) daily for 10days. Evaluations were performed during treatment and 2-6weeks after. Somatic mechano-sensitivity was assessed using von Frey hairs. Gastrointestinal motor function was studied by means of radiographic still images and colonic propulsion of fecal pellets using fluoroscopy videos. Histological assessment of the gut morphology and immunohistochemistry for HuC/D and nNOS were performed in whole-mount myenteric plexus preparations. Peripheral sensitivity was increased in animals treated with vincristine and did not subside 2weeks after treatment finalization. Vincristine treatment inhibited gastrointestinal motility although this was recovered to normal values with time. Damage in the digestive wall after vincristine treatment was greater in the ileum than in the colon. Villi shortening (in ileum) and large inflammatory nodules still remained 2weeks after treatment finalization. Finally, the proportion of nNOS-immunoreactive neurons was increased with vincristine and continued to be increased 2weeks after treatment finalization. Vincristine alters gastrointestinal motility, peripheral sensitivity and mucosal architecture. Vincristine-induced neuropathy (somatic and enteric), intestinal mucosa damage and inflammatory infiltrations are relatively long-lasting.

Autologous Bone Marrow Mesenchymal Stem Cells Improve the Quality and Stability of Vascularized Flap Surgery of Irradiated Skin in Pigs.

Cutaneous radiation syndrome has severe long‐term health consequences. Because it causes an unpredictable course of inflammatory waves, conventional surgical treatment is ineffective and often leads to a fibronecrotic process. Data about the long‐term stability of healed wounds, with neither inflammation nor resumption of fibrosis, are lacking. In this study, we investigated the effect of injections of local autologous bone marrow‐derived mesenchymal stromal cells (BM‐MSCs), combined with plastic surgery for skin necrosis, in a large‐animal model. Three months after irradiation overexposure to the rump, minipigs were divided into three groups: one group treated by simple excision of the necrotic tissue, the second by vascularized‐flap surgery, and the third by vascularized‐flap surgery and local autologous BM‐MSC injections. Three additional injections of the BM‐MSCs were performed weekly for 3 weeks. The quality of cutaneous wound healing was examined 1 year post‐treatment. The necrotic tissue excision induced a pathologic scar characterized by myofibroblasts, excessive collagen‐1 deposits, and inadequate vascular density. The vascularized‐flap surgery alone was accompanied by inadequate production of extracellular matrix (ECM) proteins (decorin, fibronectin); the low col1/col3 ratio, associated with persistent inflammatory nodules, and the loss of vascularization both attested to continued immaturity of the ECM. BM‐MSC therapy combined with vascularized‐flap surgery provided mature wound healing characterized by a col1/col3 ratio and decorin and fibronectin expression that were all similar to that of nonirradiated skin, with no inflammation, and vascular stability. In this preclinical model, vascularized flap surgery successfully and lastingly remodeled irradiated skin only when combined with BM‐MSC therapy. Stem Cells Translational Medicine 2018:569–582

Nodular Lymphangitis (Sporotrichoid Lymphocutaneous Infections). Clues to Differential Diagnosis.

Nodular lymphangitis, also known as sporotrichoid lymphocutaneous infections, is characterized by suppurative inflammatory nodules along the lymphatic vessels. This manifestation is classic of sporotrichosis, however, other infections such as nocardiosis, atypical mycobacteriosis, leishmaniasis, among others, can also express this clinical pattern. Sporotrichosis, which often occurs in gardeners, remains the most recognized cause of nodular lymphangitis. The histopathological studies, as well as the culture are diagnostic standards of lesions that do not respond to empirical treatment. In this article, we will review the main causes of nodular lymphangitis or lymphocutaneous sporotrichoid infections.