Leg Skin Research Articles

Application of gelatin from chicken leg skin as a stabilizer in ice cream

Gelatin is the result of the partial hydrolysis of collagen proteins. Food and non-food industries use gelatin a lot. Gelatin, especially in the food industry, is used as a foaming agent, a stabilizer, a gelling agent, an adhesive, a thickener, and an emulsifier. Chicken leg skin gelatin can be applied to food and non-food products and meet the halal requirement. Applications of gelatin to food products include one in the production of ice cream as a stabilizer. This study aimed to evaluate the application of gelatin from chicken leg skin to ice cream. This study used a randomized block design (RBD). In this study there were 3 treatments with 3 repeats: without any gelatin addition, with an addition of chicken leg skin gelatin, and with an addition of commercial gelatin. Analysis of data on the quality of ice cream was performed using ANOVA, followed by Duncan’s multiple comparison test. Data of the sensory properties of ice cream were tested non-parametrically (with the Kruskal-Wallis test). The results show that the quality of the ice cream added with gelatin from chicken leg skin was no different from the ice cream added with commercial gelatin. Chicken leg skin gelatin application to the ice cream manufacture produced good-quality ice cream whose sensory properties were acceptable to the panelists.

Primary erythromelalgia mainly manifested by hypertensive crisis: A case report and literature review.

BackgroundPrimary erythrocytic (PEM) is a rare autosomal dominant single gene disease. Most of the changes of gene loci can be found by whole exon gene sequencing, and the clinical symptoms and patient survival can be improved by specific site-to-site drug treatment. The other manifestations of this patient population are not remarkable. After the application of common drugs, the toxicity and side effects can be limiting. In addition to other common clinical manifestations, we found that the only unique manifestation of this patient was hypertensive crisis. Following multidisciplinary diagnosis and treatment (MDT), we decided to first control hypertension to alleviate the acute and critical patients. However, after controlling the hypertensive crisis, we unexpectedly found that the clinical symptoms of the patients had been significantly improved. Therefore, we concluded that the use of antihypertensive drugs can treat erythematous limb pain with the clinical manifestation of hypertensive crisis. Here, we describe a typical PEM disease, primary clinical features, diagnosis and treatment.MethodsMedical records of an 8-year-old boy with PEM were analyzed retrospectively, which included clinical characteristics, follow-up information, and SCN9A (Sodium Voltage-Gated Channel Alpha Subunit 9) gene analysis.ResultsThe 8-year-old boy had complained of abnormal paresthesia in his feet and ankles with burning sensation and pain for 2 years. The skin of both lower legs was red and underwent ichthyosis and lichenification. Genetic analysis confirmed the existence of a SCN9A gene mutation. The symptoms were gradually improved by treating with intravenous drip and oral administration of nitroglycerin to slow his heart rhythm.ConclusionPrimary erythrocytic is characterized by skin ulceration, redness, elevated temperature, and severe burning pain primarily in both lower extremities. PEM can be diagnosed by genetic analysis. As this case demonstrates, treating with nitroglycerin as the drug of choice to control the hypertensive crisis significantly improved the symptoms of PEM and hypertension in this patient.

Engaging the Person with a Lower Leg Skin Tear in the Wound Healing Journey: A Case Study

Engaging the Person with a Lower Leg Skin Tear in the Wound Healing Journey: A Case Study

Abstract 3304: Gene expression profiling of full-thickness skin after FLASH proton radiotherapy

Abstract Purpose: To investigate the transcriptomic changes induced by FLASH proton radiotherapy (F-PRT) that could be responsible for the protection of normal epithelial tissues by radiation-induced toxicities as have been previously shown by us and others. Methods: C57BL/6J mice received 30 Gy of F-PRT or S-PRT to the hind leg at respective dose rates of 69-124 Gy/sec or 0.39-0.65 Gy/sec. RNA sequencing was performed using full-thickness leg skin at 5 days after radiation revealing major pathways regulated by F-PRT and S-PRT. In an endeavor to identify the full repertoire of cells and gene expression profiles that are involved in the sparing effects of FLASH PRT, we expanded our studies to include single-cell RNA sequencing (sc-RNA seq) and examined additional time points such as Day 2 and Day 10 after radiation. Single-cell transcriptome libraries were generated on a 10X Genomics Chromium system. Datasets were acquired from cell samples derived and sequenced from pooled skin samples of three mice per group. Skin from the sequenced mice was also embedded for spatial analysis of gene expression. Results: RNA sequencing revealed that F-PRT uniquely upregulates almost four times more genes compared to S-PRT (F-PRT-uniquely upregulated 489 genes vs S-PRT-uniquely upregulated 129 genes). Also, F-PRT uniquely downregulated 178 genes, compared to the 125 genes uniquely downregulated by S-PRT. GO analysis demonstrates that the keratinization and apoptosis pathways are uniquely upregulated by S-PRT, whereas F-PRT uniquely upregulates genes involved in vascular development pathway. During submission of the abstract, analysis of sc-RNA seq samples was pending. Conclusion: Our comprehensive studies inform on the transcriptomic profiling of skin cell populations that are affected by F-PRT vs S-PRT; this insight will further spur discoveries on the biology of FLASH radiotherapy effects. Citation Format: Anastasia Velalopoulou, Ilias V. Karagounis, Giorgos Skoufos, Ioannis I. Verginadis, Michele Kim, Khayrullo Shoniyozov, Artemis G. Hatzigeorgiou, Eric Diffenderfer, Lei Dong, James Metz, Constantinos Koumenis, Keith A. Cengel, Amit Maity, Theresa M. Busch. Gene expression profiling of full-thickness skin after FLASH proton radiotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3304.

Case Series of Parinaud’s Oculoglandular Syndrome Caused by Fungal Infection

We report 5 cases of fungal-related Parinaud’s oculoglandular syndrome (POS), presenting to Hospital Sultanah Aminah from June 2017 to June 2019. This is a retrospective case series. Four patients presented with unilateral POS while another patient presented with unilateral granulomatous conjunctivitis which did not respond to a two-week course of oral doxycycline (4 patients) or a three-day course of oral azithromycin (1 patient). While all patients had contact with cats, only one had a history of being scratched by a cat. Three patient’s pet cats were receiving treatment for ‘Sporo’ skin infection by their veterinarians while another two patients had no history suggestive of their cats having active infection. The first patient who presented with POS following her cat scratching her leg, had a skin biopsy done and received a course of antifungal antibiotics from a dermatologist when it was discovered that the cat had a fungal skin infection. Both her leg skin lesion and POS completely resolved. Conjunctival biopsies were performed in other 4 patients at 2 weeks to 1 month after their first presentation in view of poor response to antibiotics. Two patients’ conjunctival fungal culture and sensitivity showed a growth of Sporothrix schenkii. Both symptoms and conjunctival lesions resolved completely after taking a course of oral Itraconazole for 6 weeks (1 patient), 3 months (3 patients) and 4 months (1 patient). POS is most commonly caused by Bartonella hensalae infection related to a cat’s scratch. Detailed history taking is important in diagnosing infection by other microorganisms such as fungi especially when the lesion does not respond to conventional antibiotic therapy. Besides clinical monitoring, conjunctival culture and sensitivity support the diagnosis.

Preoperative Peroneal Artery Perforator Mapping Using Indocyanine Green Angiography: A Prospective Clinical Trial.

Perforator imaging is a prerequisite in preoperative planning of the peroneal perforator flap and the fibula skin island. Although reports indicate that indocyanine green angiography assessment method might be advantageous over conventional ultrasound-based techniques (i.e., Doppler and color duplex), in practice, clear evidence is lacking. Thus, a comparative assessment of the utility of indocyanine green angiography and ultrasound-based techniques in the identification of suitable lower leg skin perforators was performed. A prospective clinical cohort study with a series of 12 consecutive patients was conducted to assess indocyanine green angiography, Doppler ultrasound, and color duplex ultrasound techniques for preoperative perforator detection in the lower leg before free fibula flap harvest. Anatomical dissection served as a reference. Parameters measured were perforator spatial distance to the reference (precision), operative time expenditure, and ease of device usage for assessment/outcomes. This study included 12 patients, with a total of 27 perforators. Exhibition of technique sensitivity and positive predictive values were as follows: indocyanine green angiography, 93 percent and 100 percent; Doppler ultrasound, 82 percent and 82 percent; and color duplex ultrasound, 89 percent and 86 percent, respectively. With regard to the indocyanine green angiography technique, the distance to the actual perforator location was significantly shorter, which aided detection and lesser time expenditure during operation. The indocyanine green angiography technique proved to have high precision, sensitivity, positive predictive value, and easy-to-use capabilities because of its exceptional spatial and temporal information, compared to the conventional, ultrasound-based techniques. Therefore, indocyanine green angiography is superior for preoperative perforator imaging of the lateral lower leg. Diagnostic, II.

Dietary Supplementation With Yucca Alleviates Heat Stress in Growing Broilers Exposed to High Ambient Temperature.

Yucca contains high a content of saponin that has a glucocorticord-like effect in animals, e.g., anti-inflammation and anti-microbiota. The objective of the present study was to test the hypothesis that dietary supplementation of yucca powder may alleviate heat stress and improve growth performance of growing broilers subjected to cycling high ambient temperature. A total of 240 male broiler chicks (yellow feathered chicken) aged 28 days, with body weight (BW) of 792 ± 43.7 g, were randomly allocated to one of four treatments (6 replicates per treatment): control (normal temperature, 24 ± 2°C, 24 h), fed diets supplemented with 100 mg/kg yucca under normal temperature (Y), high ambient temperature exposure (HT, 34 ± 2°C, 11 h), fed diets supplemented with 100 mg/kg yucca (HT+Y) under high ambient temperature. After 7 days of adaption, the experiment was conducted for 4 weeks (aged 28–56 days). HT significantly reduced feed intake, BW, and average daily gain (ADG) of broiler, but yucca improved the feed intake under HT condition. Yucca supplementation reduced (P < 0.05) the HT-induced increase in temperature of rectum and leg skin. Supplementation of yucca increased the hypothalamic mRNA expression of TRPV2, TRPV4, and TRPM8 (P < 0.05). Yucca reduced (P < 0.05) the plasma lipid oxidation product malondialdehyde (MDA), but did not affect the activities of antioxidant enzyme superoxide oxidase (SOD) and glutathione peroxidase (Gpx). Yucca did not affect the plasma neuro peptide Y (NPY), which was reduced by HT, yucca reduced circulation cholecystokinin (CCK) and hypothalamic mRNA expression of CCK. Supplementation of yucca increased the mRNA expression of both heat and cool sensing receptors. The results of the present study indicate that yucca could improve antioxidant status and attenuate the heat stress response by regulating hypothalamic temperature-sensing genes in growing chickens. Besides, yucca supplementation improved feed intake probably through modulating CCK in growing broilers under high ambient temperature.

Leiomyosarcoma of the scalp and lower leg skin. Clinical cases and literature review

Malignant soft tissue tumors localized in the skin, particularly leiomyosarcoma, are rare. Cutaneous leiomyosarcomas could have superficial and deep forms, while subcutaneous leiomyosarcomas are usually nodular. The tumor can spread to the underlying muscle fascia. The immunophenotype of leiomyosarcoma is determined by the following antibodies: ASMA, desmin, and N-caldeston; expression of PanCK is also possible. Researchers do not have any common opinion on the clinical course and biological behavior of cutaneous leiomyosarcomas. This is probably due to the tumor heterogeneity and the carcinogenesis specificity associated with molecular genetic changes. We detected these tumors at the histological examination which resulted in an analysis of the literature and our own material. We analyzed cutaneous tumors diagnosed in 2522 patients during 5 years (2016–2020). Squamous cell and basal cell histotypes were the most common ones. We did not diagnosed cutaneous leiomyosarcoma in our material during this period. This article presents two cases of cutaneous leiomyosarcoma localized in the scalp and calf skin. Morphological and immunohistochemical profiles of the tumors are described. The immunohistochemical analysis confirmed the morphological diagnosis and established the tumor immunophenotypes. The morphological diagnosis in one case was complicated due to the rarity of this pathology and the ambiguity of the interpretation of histological changes. Analysis of histological preparations and immunohistochemical study allowed verification of the tumor as leiomyosarcoma with its characteristic immunophenotype. All of the above demonstrate the need to perform morphological and immunohistochemical tests in specialized research cancer centers.

Single-cell transcriptomics defines keratinocyte differentiation in avian scutate scales

The growth of skin appendages, such as hair, feathers and scales, depends on terminal differentiation of epidermal keratinocytes. Here, we investigated keratinocyte differentiation in avian scutate scales. Cells were isolated from the skin on the legs of 1-day old chicks and subjected to single-cell transcriptomics. We identified two distinct populations of differentiated keratinocytes. The first population was characterized by mRNAs encoding cysteine-rich keratins and corneous beta-proteins (CBPs), also known as beta-keratins, of the scale type, indicating that these cells form hard scales. The second population of differentiated keratinocytes contained mRNAs encoding cysteine-poor keratins and keratinocyte-type CBPs, suggesting that these cells form the soft interscale epidermis. We raised an antibody against keratin 9-like cysteine-rich 2 (KRT9LC2), which is encoded by an mRNA enriched in the first keratinocyte population. Immunostaining confirmed expression of KRT9LC2 in the suprabasal epidermal layers of scutate scales but not in interscale epidermis. Keratinocyte differentiation in chicken leg skin resembled that in human skin with regard to the transcriptional upregulation of epidermal differentiation complex genes and genes involved in lipid metabolism and transport. In conclusion, this study defines gene expression programs that build scutate scales and interscale epidermis of birds and reveals evolutionarily conserved keratinocyte differentiation genes.

OP2: Pretibial Injuries are Unrecognized and Under Treated

INTRODUCTION: Pretibial injuries caused by low energy traumas are a distinct medical entity in the morbid elderly population. They present in the anterior leg skin as wounds; pretibial lacerations (PL) or closed hematomas; pretibial hematomas (PH). Comorbidities, compromised independence and dermatoporosis slow down and complicate wound healing. The incidence of pretibial injuries is high, 1 of 36 trauma admissions. MATERIALS AND METHODS: We reviewed the treatment, outcomes and risk factors of patients aged ≥65 years who were treated for a pretibial injury in Kymenlaakso Central Hospital, Finland, during 2015-2019. We focused on surgical treatment and wound healing. RESULTS: We recorded 176 patients (116 PL and 60 PH). The population was mostly female, 71.6%. Mean age was 79.9 years and the most common mechanism of injury was falling on flat ground, 25%. In none of the patient history files pretibial injury, either PL or PH, was mentioned. With PL we found prolonged wound healing, mean 75.2 days, range 0-356, long rehabilitative hospitalization periods, mean 21.1 days, and numerous follow-up visits, mean 18.9, range 0-200. Decisions on surgical treatment were rarely made, only 6 patients were treated with a STSG. With PH we found a delay in hematoma evacuation and a statistically significant correlation (p<0.0001) between dermatoporotic skin and PHs that caused broad skin necrosis. CONCLUSION: Despite being common pretibial injuries are clearly not recognized as a distinct medical entity. PLs require excessive healthcare resources. Early surgical intervention with STSG could facilitate wound healing. PHs among dermatoporotic patients need prompt surgical intervention to prevent skin necrosis and thus further complicated healing.

The No-Touch Saphenous Vein Harvesting Improves Graft Patency After Off-Pump Coronary Artery Bypass Surgery: A Propensity-Matched Analysis.

IntroductionThis single-center study of propensity-matched data was performed to assess the effect of the no-touch saphenous vein (NTSV) harvesting technique on early- and long-term outcomes of patients after off-pump coronary artery bypass grafting (OPCABG) in China.MethodsA retrospective analysis of 767 patients who underwent OPCABG in the Beijing Anzhen Hospital (June 2017 to October 2021) was performed, and their data entered the conventional saphenous vein (CSV) harvesting technique group or the NTSV group. In-hospital and follow-up outcomes were evaluated by adjusting baseline characteristics using propensity score matching (1:1). Clinical outcomes and postoperative angiographic results were compared.ResultsThe saphenous vein graft patency rates at postoperative three months and one year for the NTSV group vs. CSV group were 99.6% vs. 96.2% (P<0.001) and 97.3% vs. 93.1% (P<0.001), respectively. The two matched groups received a significantly different cumulative incidence function of saphenous vein graft occlusion for the longer follow-up period in Kaplan-Meier curves (χ2=4.330, log-rank P=0.037). No difference in early- and long-term mortality or major adverse cardiac and cerebrovascular events (MACCE) were observed between the groups. The rate of MACCE was not statistically significant different between the groups, but there was a tendency favoring the no-touch technique (9.8% CSV vs. 4.8% NTSV; P=0.067). More patients in the NTSV group developed postoperative leg wound exudation (5.4% vs. 1.2%; P=0.032) and skin numbness (22.2% vs. 8.9%; P=0.001) than in the CSV group.ConclusionThe NTSV is an excellent conduit to be used in OPCABG. There remains a need to reduce leg wound complications.

Large- and Small-Fiber Neuropathy in Patients with Tarlov Cysts.

PurposeTarlov cysts (TCs) are dilated nerve root sheaths originating from increased cerebrospinal pressure. Patients with TCs often complain of neuropathic pain and paresthesia. The aim of this study was to retrospectively review intraepidermal nerve fiber density (IENFD) and electrodiagnostic (EDX) data from TC patients.Patients and MethodsLower leg skin biopsy results and EDX data from the L2–S4 myotomes of patients with lumbar or sacral TCs ≥8 mm were retrieved from a database of a physical medicine clinic. Patients with compressive pathology, diabetes mellitus and chemotherapy were excluded.ResultsIENFD data from 17 patients and EDX data from 24 patients with TCs ≥8 mm were available. The mean age was 47 ± 10y, and 83% were women. In 82% of patients, the IENFD was below the 5th percentile by age and sex. EDX showed increased Hoffmann reflex latencies in 25%, increased anal reflex latencies in 95%, and a patchy distribution of neurogenic motor unit potentials in 100%. More than 50% of needle EMG abnormalities appeared in myotomes unrelated to the location of the TCs.ConclusionSmall- and/or large-fiber neuropathy was documented in a significant proportion of patients with TCs. The novel findings may add to the understanding of the mechanisms involved in symptomatic TCs. We propose that pathologically elevated cerebrospinal fluid pressure not only dilates some of the nerve root sheaths to form TCs but also potentially damages axons in nondilated nerve root sheaths and neurons in the dorsal root ganglia.

Remote Subthreshold Stimulation Enhances Skin Sensitivity in the Lower Extremity.

Foot sole skin interfaces with the ground and contributes to successful balance. In situations with reduced sensitivity in the glabrous foot skin, stochastic resonance (SR) improves skin sensitivity by adding tactile noise. Some situations, however, involve an interface comprised of hairy skin, which has higher thresholds for sensitivity. For example, in lower extremity amputation the residual limb is comprised of hairy leg skin. The main objective of this study was to determine if SR improves skin sensitivity in hairy skin, and whether a specific intensity of noise is most effective. Secondary objectives were to compare the effect between locations, ages and modalities. In 60 healthy participants a vibrotactile (test) input was delivered at the lower extremity concurrently with a second, noisy stimulus applied more proximally. The presence of a remote SR effect was tested in 15 young participants using electrotactile noise at the calf. Secondary objectives were tested in separate groups of 15 subjects and differed by substituting for one of the three variables: vibrotactile noise, heel site, and with older participants. A forced-choice protocol was used to determine detection ability of the subthreshold vibration test input with varying noise levels applied simultaneously (0, 20, 40, 60, 80, and 100% of perceptual threshold). An SR effect was identified when increased detection of the input was obtained at any level of noise versus no noise. It was found that all four test groups demonstrated evidence of SR: 33–47% of individuals showed better detection of the input with added noise. The SR effect did not appear consistently at any specific noise level for any of the groups, and none of the variables showed a superior ability to evoke SR. Interestingly, in approximately 33% of cases, threshold values fluctuated throughout testing. While this work has provided evidence that SR can enhance the perception of a vibrotactile input in hairy skin, these data suggest that the ability to repeatably show an SR effect relies on maintaining a consistent threshold.

Unilateral spinal anesthesia and the sciatic nerve block in foot surgery

Purpose of the study. To evaluate the effectiveness of unilateral spinal anesthesia as a method of pain relief during foot surgery. Analyze the effectiveness of unilateral spinal anesthesia versus sciatic nerve block. To develop an algorithm for performing unilateral spinal anesthesia during foot surgery.&#x0D; Materials and methods. We examined 64 patients who were treated in the department of purulent surgery of the 3rd city hospital in Zaporozhye with a diagnosis of diabetic foot syndrome in the period from 2017 to 2019.&#x0D; Research methods. Assessment of the level of pain intensity using the standard visual analogue scale and the concentration of glucose in the blood serum. Monitoring of the parameters of the cardiovascular system, the temperature of the skin of the lower leg during anesthesia, Doppler scanning of the peripheral circulation in the foot.&#x0D; Results. 4 hours after performing anesthesia, the intensity of pain during movement of the lower limb, according to the visual analogue scale in the group with unilateral spinal anesthesia was 2,3 times less than in the group with sciatic nerve block (p &lt; 0,05). After 10 hours – in the sciatic nerve block group there was a 9,4% increase in comparison with the unilateral spinal anesthesia group (p &lt; 0,05). Compared with the unilateral spinal anesthesia group, in the sciatic nerve block group 20 minutes after anesthesia, the heart rate decreased by 7,2% (p &lt; 0,05). After unilateral spinal anesthesia, the level of systolic blood pressure on 1 toe of the foot increased by 18,3% 20 minutes after anesthesia, and 20 minutes after sciatic nerve block – by 13,7% (p &lt; 0,05). In patients with the unilateral spinal anesthesia group, the temperature on the operated lower limb after anesthesia increased by 3,8%, in the sciatic nerve block group – by 2,8% (p &lt; 0,05).&#x0D; Conclusions. Regional anesthesia is the main method of choice for foot surgery compared to general anesthesia. sciatic nerve block does not in all cases lead to 100% surgical anesthesia and requires additional medical analgosedation. For foot surgery, unilateral spinal anesthesia is preferred.

Temperature and creatine kinase changes during a 10d taper period in sprinters

Objective. The aim of this prospective cohort study, performed during a 10 d training camp, was to analyze the effect of a series of successive speed-power training sessions on the concurrent circadian changes in resting leg skin temperature and blood creatine kinase (CK) levels and to determine the correlation between them. Approach. Seventeen elite sprinters, aged 22–31 years, were examined. Every morning and evening, capillary blood samples were drawn to assay CK levels. Lower limb skin temperature was measured simultaneously, and thermal images were taken using an infrared camera. Main results. From the first day of the training camp, the base temperature levels began to drop to obtain a significant reduction from the 6th day (male) and from the 8th day (female) to the end of the camp. Simultaneously, CK levels increased in the male group from 8th to the end of the camp, but it did not change significantly in females. Regarding the circadian rhythm, the CK levels always rose during the day and declined during the night. The temperature decreased during the day and increased during the night until the 6th day. After that, the temperature changed oppositely till the end of camp, i.e. it increased during the day and decreased during the night. This could suggest that the training microcycle should last about a week because after this time there may be a disturbance in the temperature circadian rhythm and a significant CK accumulation Significance. Multi-day speed-power training induced a progressive reduction in resting skin temperature and an elevation in CK levels. It also altered the circadian rhythm of the body skin temperature, which may indicate that after about 6 d of regular exercise, physiological deregulation may occur.

Circumferential volumetric modulated arc radiotherapy of the lower legs–a technique described in a case of disseminated superficial actinic porokeratosis

A case of a fit 65-year-old male with a long history of recalcitrant Disseminated Superficial Actinic Porokeratosis (DSAP) treated with Volumetric Modulated Arc Radiotherapy (VMAT) is presented. The whole circumference of both lower legs from knees to ankles were simultaneously treated to 43.2 Gray (Gy) in 24 fractions, one fraction short of the prescription dose of 45 Gy in 25 fractions. There was in-field clearance of DSAP at ten weeks. This is the first publication of circumferential VMAT treatment of the skin of the lower legs. More follow up is required to see the durability of control of DSAP, and more research is needed to test the generalisability of this technique.

Short-term Results of Percutaneous Ablation of Perforators for Incompetent Perforating Veins Present in Lower Leg Skin Lipodermatosclerosis and Refractory Ulcer

下腿うっ滞性皮膚炎や難治性潰瘍皮下に存在する不全穿通枝（incompetent perforating vein: IPV）を遮断する術式として考案されたのが2014年に保険収載された内視鏡下筋膜下穿通枝切離術（subfascial endoscopic perforator surgery: SEPS）である．われわれもSEPSを行ってきたが，SEPSでは対応できないIPVも経験し，この解決策の一つが経皮的穿通枝焼灼術（percutaneous ablation of perforators: PAPs）で，63例65肢のIPV 102本にPAPsを行った．使用機器に変遷があり，現在は1470 nmレーザー装置と外径の細いレーザーファイバーを用い，linear endovenous energy densityは平均68.1±14.9 J/cmであった．PAPsの利点としては，目的のIPV閉塞を術中に超音波検査で確認できることで，術中閉塞率は100%であった．さらに，解剖学的理由でSEPSでは処理できない部位のIPVも処理可能であった．

Rs7853346 Polymorphism in lncRNA-PTENP1 and rs1799864 Polymorphism in CCR2 are Associated with Radiotherapy-Induced Cognitive Impairment in Subjects with Glioma Via Regulating PTENP1/miR-19b/CCR2 Signaling Pathway.

LncRNA-PTENP1 was reported to promote multiple myeloma cancer stem cell proliferation, and the G allele of rs7853346 polymorphism in lncRNA-PTENP1 was demonstrated to enhance the effect of lncRNA-PTENP1. In this study, we aimed to study the potential effect of lncRNA-PTENP1 and CCR2 mRNA polymorphisms on cognitive impairment in glioma patients. In this study, 279 glioma patients were recruited and grouped according to their genotypes of rs7853346 in PTENP1 and rs1799864 in CCR1. Pathogenic parameters were collected from patients before radiotherapy (month 0) or at month 1 and month 3 after radiotherapy to study the effect of rs7853346 and rs1799864 on cognitive impairment. Sequence analysis, luciferase assay, real-time PCR, and Western blot were performed to study the regulatory relationships between lncRNA-PTENP1, miR-18b, and CCR2. The glioma patient groups exhibited no significant differences concerning basic characteristics. However, the CG&GG/GG genotype alleviated radiotherapy-induced cognitive impairment by exhibiting the highest MMSE among the four groups. On the contrary, parameters including the severity of depression, bladder control, global health status, itchy skin, and weakness of legs all showed no difference among different patient groups at month 0, month 1, and month 3. Also, a long-term positive effect of CG&GG/GG genotype on role functioning and social functioning was also observed after radiotherapy. Compared with patients carrying the CC genotype of rs7853346, the expression of lncRNA-PTENP1 was reduced while the miR-19b level was elevated in patients carrying the CG&GG genotypes of rs7853346. Moreover, the expression of CCR2 mRNA was the highest in the CC/GA&AA group and the lowest in the CG&GG/GG group. Subsequent sequence analysis and luciferase assay indicated that miR-19b could bind to lncRNA-PTENP1 and 3'UTR of CCR2 mRNA, and the knockdown of lncRNA-PTENP1 led to evident up-regulation of miR-19b and down-regulation of CCR2 mRNA/protein in a cellular model, thus verifying the presence of the lncRNA-PTENP1/miR-19b/CCR2 mRNA signaling pathway. In conclusion, by studying the changes in the key parameters of glioma patients who were subjected to radiotherapy, we concluded that the rs7853346 polymorphism in lncRNA-PTENP1 and the rs1799864 polymorphism in CCR2 could independently affect cognitive impairment, while a more significant combined effect on cognitive impairment was exerted in glioma patients via the signaling pathway of PTENP1/miR-19b/CCR2.

Physical Therapy in Women with Early Stage Lipedema: Potential Impact of Multimodal Manual Therapy, Compression, Exercise, and Education Interventions.

Background: Lipedema is a distinct adipose disorder from obesity necessitating awareness as well as different management approaches to address pain and optimize quality of life (QoL). The purpose of this proof-of-principle study is to evaluate the therapeutic potential of physical therapy interventions in women with lipedema. Methods and Results: Participants with Stage 1-2 lipedema and early Stage 0-1 lymphedema (n = 5, age = 38.4 ± 13.4 years, body mass index = 27.2 ± 4.3 kg/m2) underwent nine visits of physical therapy in 6 weeks for management of symptoms impacting functional mobility and QoL. Pre- and post-therapy, participants were scanned with 3 Tesla sodium and water magnetic resonance imaging (MRI), underwent biophysical measurements, and completed questionnaires measuring function and QoL (patient-specific functional scale, PSFS, and RAND-36). Pain was measured at each visit using the 0-10 visual analog scale (VAS). Treatment effect was calculated for all study variables. The primary symptomatology measures of pain and function revealed clinically significant post-treatment improvements and large treatment effects (Cohen's d for pain VAS = -2.5 and PSFS = 4.4). The primary sodium MRI measures, leg skin sodium, and subcutaneous adipose tissue (SAT) sodium, reduced following treatment and revealed large treatment effects (Cohen's d for skin sodium = -1.2 and SAT sodium = -0.9). Conclusions: This proof-of-principle study provides support that persons with lipedema can benefit from physical therapy to manage characteristic symptoms of leg pain and improve QoL. Objective MRI measurement of reduced tissue sodium in the skin and SAT regions indicates reduced inflammation in the treated limbs. Further research is warranted to optimize the conservative therapy approach in lipedema, a condition for which curative and disease-modifying treatments are unavailable.

Risk-based control of Campylobacter spp. in broiler farms and slaughtered flocks to mitigate risk of human campylobacteriosis – A One Health approach

Effects of risk-based control of Campylobacter spp. in Danish broiler farms and flocks were simulated, to assess potential reductions of human risk of campylobacteriosis, associated to the consumption of poultry meat produced in Denmark. Two national data streams were used and represented: Flock status by testing cloacal swabs (CS, 2018–2019) and carcass status by testing leg skin samples (LS, 2019). In the CS surveillance component all flocks slaughtered at the two major Danish slaughterhouses were tested with a polymerase chain reaction (PCR), while in LS one third randomly selected flocks were tested by culture (results in colony forming units per gram, cfu/g). Each farm was identified by its Central Husbandry Register (CHR) number. Two risk farm classification strategies (I-II) were based on CS data from 2018. Farms were classified as: always negative (Neg-CHRs), low risk (LowR-CHRs) and high risk (HighR-CHRs) farms. In strategy I, HighR-CHRs had more than five positive flocks, while in strategy II; they had more than 27.8% of the slaughtered flocks positive. Those two cut-offs were the annual 3rd quartiles across positive farms. Thereafter, a risk assessment model was used to estimate the annual relative risk (RR) of human campylobacteriosis in 2019, compared to that of 2013. Three hypothetical levels of cfu/g reductions (A, B and C) were simulated on the LS positive flocks (> 10 cfu/g) slaughtered by HighR-CHRs and were pairwise combined with the two classification strategies, yielding six risk-mitigation scenarios (A I-II; B I-II; C I-II). In scenarios A I-II, zero cfu/g were simulated, while in scenarios B and C, the original cfu/g were divided by three and by two. For each scenario, RRs were compared to the RR of the original cfu/g (scenario O).In 2018, if all flocks from HighR-CHRs had been negative, the annual CS flock prevalence would have reduced from 19.7% to 7.6% (strategy I) or 9.6% (strategy II). Whereas in 2019, it would have reduced from 17.1% to 7.8% or 11.6%. In both years, HighR-CHRs delivered a high percentage of the total annual positive flocks (61.4–54.4% under strategy I and 51.2–32.6% with strategy II). In 2019, if HighR-CHRs had delivered only LS negative flocks, the RR would have reduced from 0.94 (scenario “O”) to 0.51 (A-I). Other scenarios showed smaller RR reductions. Targeting high risk farms/flocks for intensive control could improve One Health-ness of national action plans against Campylobacter spp.