Lower Skin Research Articles

Negative pressure wound therapy promotes wound healing of diabetic foot ulcers by up-regulating PRDX2 in wound margin tissue

To understand the changes in the peroxiredoxin-2 (PRDX2) expression level in the wound margin tissue (T-PRDX2) of patients with diabetic foot ulcer (DFU) before and after negative pressure wound therapy (NPWT). Additionally, the study aimed to explore the association between PRDX2 expression and the treatment outcome of DFUs to provide a new theoretical basis for revealing the mechanism of NPWT promoting the healing of DFUs. Fifty-six type 2 diabetes patients with foot ulcers undergoing NPWT (the DFU group) and 28 patients with chronic lower limb skin ulcers with normal glucose tolerance undergoing NPWT (the skin ulcer control [SUC] group) were included in the study. T-PRDX2 was detected using Western blotting, and the superoxide dismutase (SOD) activity and the malondialdehyde (MDA) and glutathione (GSH) levels were detected using a biochemical method. In addition, in vitro experiments were conducted to determine the effect of PRDX2 expression on normal human dermal fibroblast (NHDF) proliferation, migration, and apoptosis. Before NPWT, the DFU group exhibited a significantly lower T-PRDX2 expression level compared with the SUC group. After one week of NPWT, the T-PRDX2 expression level, SOD activity, and GSH content in the wound margin tissues of the DFU and SUC groups significantly increased compared with the before NPWT levels. Conversely, the inflammatory indicators (white blood cell, neutrophil percentage, C-reactive protein, and procalcitonin) and MDA content were significantly lower than the before NPWT levels. The expression changes of T-PRDX2 before and after NPWT in the DFU and SUC groups were positively correlated with the 4-week wound healing rate. In vitro experiments demonstrated that PRDX2 could alleviate the oxidative stress in NHDFs, thereby promoting their proliferation and migration, while reducing cell apoptosis. NPWT promotes DFU healing by increasing T-PRDX2, and changes in the T-PRDX2 might be associated with the therapeutic effect of NPWT.

Development of a Nanoemulgel for the Topical Application of Mupirocin.

Mupirocin (MUP) is an effective topical antibiotic with poor skin permeability; however, its skin permeability can be improved by a nanoemulsion formulation based on eucalyptus oil or eucalyptol. Despite this improvement, the nanoemulsion has limitations, such as low viscosity, low spreadability, and poor retention on the skin. To overcome these limitations, the aim of this study was to develop a nanoemulgel formulation that would enhance its rheological behaviour and physicochemical properties. The MUP nanoemulgel was prepared by incorporating a preprepared MUP nanoemulsion into Carbopol gel at a concentration of 0.75% in a 1:1 ratio. The nanoemulgel formulations were characterised and evaluated for their physicochemical and mechanical strength properties, rheological behaviour, and in vitro skin permeation and deposition, as well as antibacterial studies. Both nanoemulgels exhibited stability at temperatures of 4 and 25 °C for a period of 3 months. They had a smooth, homogenous, and consistent appearance and displayed non-Newtonian pseudoplastic behaviour, with differences in their viscosity and spreadability. However, both nanoemulgels exhibited lower skin permeability compared to the marketed control. The local accumulation efficiency of MUP from nanoemulgel after 8 h was significantly higher than that of the control, although there was no significant difference after 24 h. Micro-CT scan imaging allowed visualisation of these findings and interpretation of the deposited drug spots within the layers of treated skin. While there were no significant differences in the antibacterial activities between the nanoemulgels and the control, the nanoemulgels demonstrated superiority over the control due to their lower content of MUP. These findings support the potential use of the nanoemulgel for targeting skin lesions where high skin deposition and low permeability are required, such as in the case of topical antibacterial agents.

Effect of co-mingling non-littermates during lactation and feed familiarity at weaning on the performance, skin lesions and health of piglet

This study investigated how co-mingling of non-littermates before weaning and feed familiarity at weaning in a 2 × 2 factorial design can minimize the adverse effects related to conventional weaning. Before weaning, piglets were either conventionally reared or co-mingled by grouping piglets from 3 litters during 10 days before weaning. At weaning, piglets from 3 litters were distributed over 3 pens in the nursery. Conventionally reared piglets from 3 litters were mixed, whereas the co-mingled piglets were housed with those they were co-mingled with before weaning. At weaning, piglets were either or not provided with 0.538 kg creep feed per piglet in creep feeders, next to the weaner diet. Creep feed was the same provided the last 4 days before weaning. Hence, the treatment groups were conventional with (n = 9) or without creep feed (n = 9), and co-mingling with (n = 9) or without creep feed (n = 9). Co-mingling non-littermate piglets did not affect weaning weight, daily weight gain and creep feed intake during d-10-d0 before weaning. Co-mingling resulted in higher skin lesion scores of head and ears in piglets at d1 before weaning (P < 0.05), but in lower skin lesion scores at the snout, shoulders and flanks at d2 post-weaning compared to conventionally reared piglets (P < 0.05). Co-mingling did not affect salivary cortisol at d1 post-weaning . Hematocrit, hemoglobin, mean corpuscular volume and mean corpuscular hemoglobin were higher in the co-mingled piglets at d2 post-weaning (P < 0.05). Co-mingling resulted in higher glucose concentrations in blood (P < 0.05) and in a tendency for lower NEFA concentration in serum at d2 post-weaning (P < 0.10). Feed familiarity at weaning increased average daily feed intake and weight gain during the first 5 days post-weaning (P < 0.05). During d5–14 post-weaning average daily feed intake tended to be lower (P < 01.0) and daily gain was lower (P < 0.05) in creep feed fed piglets compared to no creep feed fed piglets. Nevertheless, feed familiarity did not affect overall piglet performance during the first 2 weeks after weaning. Feed familiarity did not affect blood hematology and biochemical blood parameters, except the level of basophils at d2 post-weaning. Neither housing nor feeding strategy affected piglet performance between d14–42 post-weaning and ear and tail damage at d42 post-weaning . In conclusion, pre-weaning co-mingling of piglets and feed familiarity at weaning each contributed to a better adaptation of the weaning process but did not affect long-term piglet performance.

Examining Potential Modifiers of Human Skin and Plasma Carotenoid Responses in a Randomized Trial of a Carotenoid-Containing Juice Intervention

BackgroundSkin carotenoid measurements are emerging as a valid and reliable indicator of fruit and vegetable intake and carotenoid intake. However, little is known about the extent to which skin carotenoid responsivity to dietary changes differs based on demographic and physiologic characteristics. ObjectivesThis study examined potential effect modifiers of skin carotenoid and plasma carotenoid responses to a carotenoid-rich juice intervention. MethodsWe leveraged data from 2 arms of a 3-site randomized controlled trial of a carotenoid-containing juice intervention (moderate dose = 6 ounces juice, 4 mg total carotenoids/d, high dose = 12 ounces juice, 8 mg total carotenoids/d) (n = 106) to examine effect modification by age, self-categorized race/ethnicity, biological sex, baseline body fat, body mass index, skin melanin, skin hemoglobin, skin hemoglobin saturation, skin coloration, sun exposure, and baseline intake of carotenoids from foods. Skin carotenoid concentrations were assessed using pressure-mediated reflection spectroscopy (Veggie Meter), and plasma carotenoid concentrations were measured using high-performance liquid chromatography. ResultsIn bivariate analyses, among the high-dose group (8 mg/d), those of older age had lower skin carotenoid responsiveness than their younger counterparts, and those with greater hemoglobin saturation and lighter skin had higher skin carotenoid score responsiveness. In the moderate-dose group (4 mg/d), participants from one site had greater plasma carotenoid responsiveness than those from other sites. In multivariate analyses, participants with higher baseline skin carotenoids had smaller skin carotenoid responses to both moderate and high doses. ConclusionsChanges in skin carotenoid scores in response to interventions to increase fruit and vegetable intake should be interpreted in the context of baseline skin carotenoid scores, but other variables (e.g., self-categorized race/ethnicity, biological sex, baseline body fat, body mass index, skin melanin, and sun exposure) do not significantly modify the effect of carotenoid intake on changes in skin carotenoid scores.This trial was registered at clinicaltrials.gov as NCT04056624.

Manufacturing and mechanical testing of curved sandwich beams with zero‐Poisson's ratio honeycomb cores

AbstractIn this research, free curling property of the over‐expanded honeycomb (OH) with zero Poisson's ratio was utilized to design and manufacture curved carbon fiber‐reinforced composite (CFRC) sandwich beams by hot compression molding technique and co‐curing process. Three‐point bending experiments were conducted to reveal the failure mechanism of these OH‐based curved sandwich beams with various curvatures. The results reveal that in this research no matter what the curvature is, the shearing fracture of the OH core controls the initial failure of the curved structure, which is followed by upper skin fracture, lower skin delamination and fracture. With the increase of curvature, the ultimate bearing capacity and flexural rigidity of the curved beams will increase. No debonding was observed in the experiments.Highlights Curved sandwich beams with zero‐Poisson's ratio honeycomb‐core was designed. Deformation process from arc, flattening to anti‐arc was revealed by testing. Strength of curved sandwich beams depends on shear strength of the honeycomb. Beams with smaller curvature have greater bearing capacity and stiffness.

Antibiotic prescribing to inpatients in Limpopo, South Africa: a multicentre point-prevalence survey

BackgroundElectronic continuous surveillance databases are ideal for monitoring antibiotic use (ABU) in hospitalised patients for antibiotic stewardship programmes (ASP). However, such databases are scarce in low-resource settings. Point prevalence surveys (PPS) are viable alternatives. This report describes ABU and identifies ASP implementation improvement areas in Limpopo Province, South Africa.MethodsThis cross-sectional descriptive study extracted patient-level ABU data from patients’ files using a modified global PPS tool. Data were collected between September and November 2021 at five regional hospitals in Limpopo Province, South Africa. All patients in the wards before 8 a.m. on study days with an antibiotic prescription were included. Antibiotic use was stratified by Anatomic Therapeutic Chemical and Access, Watch, Reserve classifications and presented as frequencies and proportions with 95% confidence intervals (CI). Associations between categorical variables were assessed using the chi-square test. Cramér’s V was used to assess the strength of these associations.ResultsOf 804 inpatients surveyed, 261 (32.5%) (95% CI 29.2–35.7) were prescribed 416 antibiotics, 137 were female (52.5%) and 198 adults (75.9%). One hundred and twenty-two (46.7%) patients received one antibiotic, 47.5% (124/261) received two, and 5.7% (15/261) received three or more antibiotics. The intensive care units had a higher ABU (68.6%, 35/51) compared to medical (31.3%, 120/384) and surgical (28.5%, 105/369) wards (p = 0.005, Cramér’s V = 0.2). Lower respiratory tract infection (27.4%, 104/379), skin and soft tissue infections (SST) (23.5%, 89/379), and obstetrics and gynaecology prophylaxis (14.0%, 53/379) were the common diagnoses for antibiotic prescriptions. The three most prescribed antibiotic classes were imidazoles (21.9%, 91/416), third-generation cephalosporins (20.7%, 86/416) and combination penicillin (18.5%, 79/416). Access antibiotics accounted for 70.2% (292/416) of prescriptions and Watch antibiotics for 29.6% (123/416) (p = 0.110, Cramér’s V = 0.1). Reasons for prescribing and treatment plans were documented in 64.9% (270/416) (95% CI 60.3–69.5) and 21.4% (89/416) (95% CI 17.3–25.3) of prescriptions, respectively.ConclusionsThe study serves as a baseline for ABU surveillance at the five regional hospitals in Limpopo Province. Lack of documentation indicates poor prescribing practices; ASP should address gaps by deploying evidence-based, multifaceted and stepwise interventions.

Lymphangiogenesis and Lymphatic Zippering in Skin Associated with the Progression of Lymphedema

Secondary lymphedema often develops after lymph node dissection or radiation therapy for cancer treatment, resulting in marked skin fibrosis and increased stiffness owing to insufficiency of the lymphatic system caused by abnormal structure and compromised function. However, little is known about the associated changes of the dermal lymphatic vessels. In this study, using the lower limb skin samples of patients with secondary lymphedema, classified as types 1-4 by lymphoscintigraphy, we first confirmed the presence of epidermal thickening and collagen accumulation in the dermis, closely associated with the progression of lymphedema. Three-dimensional characterization of lymphatic capillaries in skin revealed prominent lymphangiogenesis in types 1 and 2 lymphedema. In contrast, increased recruitment of smooth muscle cells accompanied by development of the basement membrane in lymphatic capillaries was observed in types 3 and 4 lymphedema. Remarkably, the junctions of dermal lymphatic capillaries were dramatically remodeled from a discontinuous button-like structure to a continuous zipper-like structure. This finding is consistent with previous findings in an infection-induced mouse model. Such junction tightening (zippering) could reduce fluid transport and cutaneous viral sequestration during the progression of lymphedema and might explain the aggravation of secondary lymphedema. These findings may be helpful in developing stage-dependent treatment of patients with lymphedema.

Spinal Dural Arteriovenous Fistula in a Pediatric Patient with History of Endovascular Therapy Failure: A Case Report

Spinal Dural Arteriovenous Fistula (SDAVF) cases in children are extremely rare and pose a high risk for intraoperative hemorrhage. The clinical manifestation and imaging results may be vague and deceptive, frequently mistaken for other conditions such as demyelinating or spinal degenerative illnesses. SDAVF's cause is not well understood. Here, we present the case of a 10-year-old male patient with SDAVF who did not improve after endovascular therapy. The patient complained of weakness in the lower extremities, skin thickness, tingling sensations, and painful bowel movements and urination. The patient underwent endovascular embolization due to spinal AVF from the 9th thoracic vertebrae until the sacral vertebrae one month earlier. But no significant clinical improvement was found. The vital signs of the patient were within normal limits. An MRI showed a flow-void lesion with tortuosity in the dorsal spinal area at the 9th and 10th thoracic vertebrae. Because an embolization procedure was performed on the patient, which resulted in no significant improvement, it was planned for the patient to undergo an MRI and MRA evaluation. An MRI and MRA later showed the formation of an extramedullary intradural cyst at levels T9 to T10 of the thoracic vertebrae. Decompression surgery (left hemilaminectomy) and tumor extirpation were thereafter carried out on the patient after the routine laboratory test was performed. After the procedure, the patient showed improvement and could carry out everyday activities independently at 10 months post-operatively. The failure of endovascular therapy can be attributed to several factors, such as the surgeon’s experience, tools, and embolization technique, and follow-up treatment by surgery.

Comparison Between the Efficacy of Spinal Cord Stimulation and of Endovascular Revascularization in the Treatment of Diabetic Foot Ulcers: A Retrospective Observational Study

ObjectiveWe aimed to compare the effects of spinal cord stimulation (SCS) with those of endovascular revascularization on the treatment of diabetic foot ulcers. Materials and MethodsA total of 104 patients with diabetic foot ulcers who met the inclusion criteria were retrospectively analyzed and classified to the SCS treatment group (n = 46) and endovascular revascularization treatment group (n = 46). The quality-of-life scores (Quality of Life Scale for Patients with Liver Cancer v2.0), visual pain analog scale score, lower limb skin temperature, lower limb arterial ultrasound results, and lower extremity electromyography results were analyzed to compare the efficacy of the two treatments for diabetic foot ulcers in the two groups before surgery and six months after surgery. ResultsA total of 92 patients (men: 73.9%, mean age: 66.51 ± 11.67 years) completed the six-month postoperative follow-up period. The patients in the SCS treatment group had a higher quality-of-life score (25.54% vs 13.77%, p < 0.05), a larger reduction in pain scores (69.18% vs 37.21%, p < 0.05), and a larger reduction in foot temperature (18.56% vs 7.24%, p < 0.05) than those of the endovascular revascularization treatment group at six months after surgery. The degree of vasodilation in the lower limbs on color Doppler arterial ultrasound and the nerve conduction velocity were higher in the SCS treatment group than in the endovascular revascularization treatment group at six months after surgery (p < 0.05). ConclusionSCS was more effective than endovascular revascularization in improving quality of life, relieving pain, improving lower limb skin temperature, increasing lower limb blood flow, and improving nerve conduction in patients with diabetic foot ulcers at six months after surgery.

Superficial versus deep injections of the upper midface-A prospective interventional split-face study.

Various injection algorithms have been proposed in the past which are in line with the three aesthetic principles: upper face first, lateral face first, and deep regions first. However, increasing evidence is provided that the upper midface can be targeted with superficial soft tissue filler injections alone too. To investigate in a prospective split-face study design whether superficial or deep upper midfacial injections provide superior aesthetic outcomes. A total of n = 20 study participants (100% females; age 43.95 (11.7) years; BMI 22.92 (2.6) kg/m2 ) were treated with superficial soft tissue filler injections on side of their face and deep injections on the contralateral side with a mean volume of 0.78 cc. Outcome was evaluated at 7 weeks follow-up for midfacial, and lower facial volume, for medial and lateral facial skin vector displacement, and for improvement of nasolabial, crow's feet, and upper cheek fullness severity scores. No adverse events related to safety or product tolerability were observed during the entire study period. All semiquantitative scores improved statistically significantly after the observational period (p < 0.001) but displayed no difference between the two applied injection techniques (p > 0.05). The results of this split-face study revealed that both the superficial and the deep cannula injection technique for midface volumization statistically significantly improve the midfacial volume, reduce nasolabial fold and crow's feet severity. No statistically significant difference was observed between the two injection techniques when compared via semiquantitative and objective outcome evaluation after 7 weeks follow-up.

Viral Conjunctivitis: Findings, Therapy, and Prophylaxis

Viral conjunctivitis is one of the most common acute eye diseases. The fall and winter months are known to be the main season for viral infections which is also reflected in the ophthalmological outpatient clinics. Viral conjunctivitis is often accompanied by symptoms of the upper and lower respiratory tract, fever, chills, arthralgia or skin lesions. The spectrum of pathogens comprises DNA viruses such as Adeno-, Herpes simplex and Molluscum contagiosum as well as RNA viruses. Symptoms caused by pandemic pathogens such as SARS-CoV-2 and mpox viruses can also cause ocular manifestation. Viral conjunctivitis is often self-limiting leaving no residual symptoms, however an ophthalmologist should be consulted if there are inflammatory symptoms of the anterior eye accompanied by visual disturbance. It is particularly important to recognize the affection of corneal or even intraocular structures early to initiate an adequate and effective therapy. Affection of the cornea, vitreus or retina can result in temporary or permanent impairment of the field of vision and visual acuity. The diagnosis is usually made without further tests on the basis of the typical clinical presentation. Rapid tests or PCR diagnostics are also available for confirmation. In most patients the treatment is symptomatically with artificial tears and antibiotic eye drops in cases accompanied by secondary bacterial infections, not prophylactically. If the cornea or other ocular structures are affected by certain viruses, local as well as systemic virostatic therapy is initiated. The most important prophylactic measure is meticulous and consistent hygiene.

Activity of cefotaxime versus ceftriaxone against pathogens isolated from various systemic infections: A prospective, multicenter, comparative, in vitro Indian study

Objectives: To determine the susceptibility of isolated pathogens with different samples collected from patients taking cefotaxime as compared with ceftriaxone. Materials and Methods In vitro susceptibility study was conducted at microbiology laboratories of east (Bhubaneshwar), west (Ahmedabad), north (Delhi), and south (Srikakulam) India. Samples of treatment naïve patients with various clinical infections were included if they were positive for bacterial culture. Minimum inhibitory concentration (MIC) and zone of inhibitions (ZoIs) for each isolate were determined using Ezy MIC strip test and disk diffusion methods, respectively. Findings of MIC and ZoI were interpreted as per the Clinical and Laboratory Standards Institute guidelines. Appropriate statistical tests were used. Statistical Analysis: Probable diagnosis, type of sample, and isolated organisms was presented as the proportion. Geometric mean was calculated for MIC and arithmetic mean was calculated for ZoI and they were presented as mean (95% confidence interval). Results: Four hundred clinical samples of urinary tract infection (42.75%), lower respiratory tract infection (20.75%), skin and soft tissue infection (16.75%), and sepsis (12.75%) were evaluated. Escherichia coli (47.75%) was the most common organism isolated followed by Klebsiella (26%), Salmonella (7.75%), and Proteus mirabilis (3.75%). The mean MIC values for E. coli, Klebsiella, Staphylococcus, Citrobacter koseri, and Serratia marcescens were found to be lower when treated with cefotaxime compared with ceftriaxone, although the difference was not statistically significant. However, cefotaxime produced significantly (p &lt; 0.05) more ZoI for E. coli, Klebsiella, and Salmonella as compared with ceftriaxone. Conclusion: Cefotaxime has shown better sensitivity profile in terms of MIC and ZoI to most of the isolated organisms as compared with ceftriaxone and thus can be preferred for empirical treatment of such patients.

Clinical and pathology characterization of small nerve fibers neuro(no)pathy in Cerebellar Ataxia with Neuropathy and Vestibular Areflexia Syndrome.

biallelic mutation/expansion of the gene RFC1 has been described in association with a spectrum of manifestation ranging from isolate sensory neuro(no)pathy to a complex presentation as Cerebellar Ataxia with Neuropathy and Vestibular Areflexia Syndrome (CANVAS). Our aim was to define the frequency and characteristics of small fiber neuropathy (SFN) in RFC1-disease at different stages. RFC1-cases were screened for SFN using the Neuropathic Pain Symptom Inventory (NPSI) and Composite Autonomic Symptom Score-31 (COMPASS-31) questionnaires. Clinical data were retrospectively collected. If available, lower limb skin biopsy samples were evaluated for somatic epidermal and autonomic subepidermal structures innervation and compared to healthy controls (HC). we enrolled 40 patients, median age at onset 54 years (IQR 49-61) and disease duration 10 years (IQR 6-16). Mild-to-moderate positive symptoms (median NPSI score 12.1/50, IQR 5.5-22.3) and relevant autonomic disturbances (median COMPASS-31 score 37.0/100, IQR 17.7-44.3) were frequently reported and showed scarce correlation with disease duration. A non-length-dependent impairment in nociception was evident on both clinical and paraclinical investigations. An extreme somatic denervation was observed in all patients at both proximal (fibers/mm RFC1-cases 0.0 vs HC 20.5, p < .0001) and distal sites (fibers/mm RFC1-cases 0.0 vs HC 13.1, p < .0001), instead only a slight decrease was observed in cholinergic and adrenergic innervation of autonomic structures. RFC1-disease is characterized by a severe and widespread somatic SFN. Skin denervation may potentially represent the earliest feature and drive towards the suspicion of this disorder.

Response of Anatomical Characteristics of Nile Flower Eichhornia crassipes to Environmental Changes and their Impact on Tigris Water Quality

The current study was conducted on the Tigris River in the distance between Qayyarah district of Nineveh province and Baiji district of Salahuddin province by five stations (Al-Gayyarah, Jisr Al-Shirgat, Asdeira, Al-Zuwia and Almsahag). Anatomical Characteristics of Nile flower Eichhornia crassipes were studied. Some qualitative properties of river water were studied. The results indicated that there were significant differences between the study stations in all anatomical characteristics of the plant, Significant differences were found in the different study stations in all the characteristics of the upper and lower skin of the leaves of the Nile flower plants, it is the dimensions of stomata and its index and the average dimensions of the cells of the upper and lower skin. For the stems of the Nile flower plants, anatomical characteristics showed significant differences with different study stations. Al- Mosahak station achieved the highest stomatal dimensions of 15 and 13 μm for length and width respectively. Al-Gayyarah station excelled in the highest averages of the stomata index and average length × width of normal cells with values of 14 and 32 × 15 μm respectively. The highest mean of the physical characteristics of the river water was 1407 mg / L of total dissolved solids at the Al-Zuwia station in December, 8.4 for pH at Al-Gayyarah and Jisr Al-Shirgat stations during January, and 1.4 mg / L for BOD5 in Al-Gayyarah station during March, 2.3 mg / L for total hardness at Asdira station in February, 1.02 mg / L of nitrate at Almsahag station in December, 1.231 mg / L for sulfate at Al-Gayyarah station in January, 2.38 mg / L for sodium at Al-Zauwia station in December, and 1.2 mg / L for potassium at Almsahag station in March.

The Indian Consensus Statement for the Management of Lower Extremity Peripheral Artery Disease

Peripheral arterial disease (PAD) is one of the underdiagnosed and undertreated vascular diseases despite its significant burden in India. In India, the etiological aspects, diagnostic approaches, treatment modalities, and other preventive measures probably vary in different regions. Therefore, this consensus was developed that provides a unified approach for physicians to effectively diagnose and manage PAD in India. In this consensus, we identify that the prevalence of PAD varies from 5% to 25% in Indian setting. Both atherosclerotic and non-atherosclerotic risk factors may underlie PAD. Asymptomatic PAD remains the most common presentation of the disease. The detailed clinical history, physical changes in the lower leg skin, and examination of peripheral pulses can provide clues to the diagnosis. Ankle-brachial index and Duplex ultrasound are advised as the initial choice of diagnostic measures. Besides control of risk factors such as hypertension, diabetes, dyslipidemia, and smoking, pharmacological treatment with anti-platelet and antithrombotic drugs is advised. By efficacy, ticagrelor is considered equivalent to clopidogrel and cilostazol is advised in intermittent claudication. In the revascularization of tibio-pedal lesions, endovascular therapy is effective and arterial bypass with vein graft may be needed in difficult and extensive revascularization scenarios. In these lesions, prosthetic grafts must be avoided. Diabetic foot ulcer management is challenging as foot care among diabetics is poor. In limb, salvation should always be a priority with avoidance of amputation if possible. Stem cell therapy has been successful in PAD which can be advised to “no-option” patients to prevent amputation. Physicians should undertake effective screening of PAD and be considered “PAD Clinics” in India.

Clinical features, radiological imaging, and treatment strategies of nonmetallic intraorbital foreign bodies: a retrospective analysis.

To provide comprehensive data on nonmetallic intraorbital foreign bodies (IOFBs) by summarizing and analyzing material types, clinical manifestations, imaging features, and treatment strategies. Totally 28 nonmetallic IOFB cases treated at Shengjing Hospital of China Medical University from 2012 to 2020 were retrospectively reviewed. The types of foreign bodies, clinical features, imaging manifestations, and treatment outcomes were analyzed. Among all cases, 67.8% (19/28) of the foreign bodies were organic. The top three entrances were the upper eyelid skin (7/28), lower fornix conjunctiva (6/28), and lower eyelid skin (4/28). In most cases (11/28, 39.3%), foreign bodies remained in the medial orbits. The major clinical manifestations included eyelid redness and swelling (20/28, 71.4%), conjunctival congestion and edema (17/28, 60.7%), and ophthalmoptosis (15/28, 53.6%). Infection was the main complication, which occurred in 57.1% (16/28) of all cases. Computerized tomography (CT) values differed for different foreign bodies and varied in the different periods after injury. The plant- and grease-derived foreign bodies and the surrounding pus cysts showed different signals on magnetic resonance imaging (MRI). The prognosis varied with different foreign body types, surgery timing, and intraoperative management. The majority of nonmetallic IOFBs are organic and often remain in the superior, medial, and inferior areas of the orbit. Clinical manifestations vary owing to their different textures. CT and MRI facilitate the identification of foreign body materials. Plant-derived foreign bodies should be completely removed, and surgical treatment is a complicated process.

Safety of Tazarotene 0.045% Lotion and Hyperpigmentation Improvements in Black Participants With Moderate-to-Severe Acne

Introduction: Post-inflammatory hyperpigmentation (PIH) that results from acne in patients with skin of color may be more distressing than the acne itself, and likely impacts patients with higher skin phototypes more greatly than those with lower skin phototypes. Topical retinoids, a mainstay of acne treatment, can also reduce hyperpigmentation. For example, significant PIH improvements with a cream formulation of the retinoid tazarotene (0.1%) were observed following 16 weeks of treatment in patients with acne. However, skin irritation and other skin reactions may limit use of some tazarotene gel and cream formulations. A hydrating, lower-dose tazarotene 0.045% lotion formulation utilizes polymeric emulsion technology to allow for more efficient delivery of tazarotene into dermal layers while reducing potential for skin irritation. This pooled, post hoc analysis evaluates safety of tazarotene 0.045% lotion and its effect on hyperpigmentation in Black individuals with acne.&#x0D; Methods: In two identical phase 3 randomized, double-blind, vehicle-controlled, studies (NCT03168321; NCT03168334), participants aged ≥9 years with moderate-to-severe acne (Evaluator's Global Severity Score of 3/4) were randomized (1:1) to once-daily tazarotene 0.045% or vehicle lotion for 12 weeks. Safety evaluations included adverse events (AEs) reports and investigator-assessed hyperpigmentation (4-point scale: 0 [none] to 3 [severe]). Post hoc analyses were based on participants’ self-identification of race, including ‘Black or African American’ (herein referred to as Black).&#x0D; Results: Of 1,614 participants randomized in the two phase 3 studies, 262 (16%) self-identified as Black. The safety population comprised 253 Black participants. The most common TEAEs with tazarotene 0.045% lotion were at the application site: pain (6.6%), exfoliation (5.0%), and dryness (3.3%). No Black participants reported application site irritation or dermatitis with tazarotene lotion. Hyperpigmentation rates in Black participants, which were high at baseline, decreased by week 12 with tazarotene treatment (40.5% to 31.4%) compared to vehicle (37.9% to 37.2%).&#x0D; Conclusions: Acne regimens that maximize efficacy while mitigating irritation is key to managing acne in patients with skin of color, given the higher pigmentary alteration risk in melanin-rich skin. Tazarotene 0.045% lotion was safe and well tolerated in Black participants, with no application-site irritation or dermatitis after 12 weeks of once-daily treatment. Tazarotene also led to improvements in hyperpigmentation, an inflammation-associated sequala of acne. As PIH can take longer than 12 weeks to resolve with treatment, additional improvements in hyperpigmentation may be expected with continued tazarotene 0.045% lotion use.&#x0D; Support: Ortho Dermatologics.

Interpreting Lower Trapezius Musculocutaneous Flap Skin Paddle Perfusion with Indocyanine Green Angiography.

Background: The lower trapezius myocutaneous flap (LTF) is a pedicled flap with clinically significant variability of distal skin flap perfusion. Objective: To compare the incidence of partial flap necrosis before and after the institution of routine intraoperative laser-assisted indocyanine green (ICG) angiography. Methods: This is a retrospective review of all LTF performed between November 2021 and July 2022. The outcomes measured in this study are the distance distal to the inferior border of the trapezius muscle with adequate perfusion, and incidence and degree of partial flap necrosis. Results: Sixteen patients met inclusion criteria with a median age of 64.5 years, and a median defect size of 147 cm2. Most patients (11/16) had undergone previous treatment for malignancy. Before utilizing ICG angiography, 40% (2/5) had partial flap necrosis, whereas after utilizing ICG angiography, 9% (1/11) of patients had partial flap necrosis. Seventy-three percent (8/11) of cases who underwent ICG angiography demonstrated a portion of the skin paddle with inadequate perfusion. The range of skin perfusion distal to the inferior border of the trapezius muscle was 0-7 cm (median, 4). Conclusions: The incidence of partial flap necrosis decreased after institution of routine ICG angiography.

Dynamic comfort criteria – A possible solution to the conflict between heat balance and adaptive thermal comfort models

Physiologists typically assume that optimal thermal comfort can only be achieved by minimizing thermoregulatory efforts. People are thus believed to be thermally comfortable with a mean skin temperature of 33–34 °C and minimized sweating rate at a low metabolic rate. Many heat balance comfort models are established based on these fixed comfort criteria. However, occupants’ thermal requirements are found to be more flexible and dynamic because of physiological and psychological adaptions. In this study, dynamic comfort criteria (DCC) are proposed to consider the adaption in the PMV model. Occupants tend to accept a lower skin temperature in a cold climate and a slightly higher sweating rate in a hot climate. We provide two methods to infer DCC based on ASHRAE thermal comfort database II. One is to develop a generalized DCC that can be applied globally. Another is to use Bayesian calibration to develop a customized DCC that further localizes the thermal requirements. With DCC, the deficiency of the PMV and the adaptive model can be largely eliminated. Unlike PMV, the model with DCC performs consistently in different operation modes. DCC is conceptually different from actual physiological responses, although they can sometimes be close to each other in values. The study paves the road for unifying comfort theories and equipping traditional comfort models with the ability to re-learn.

Evaluation of the effects of 10% and 30% gluconolactone chemical peel on sebum, pH, and TEWL.

Gluconolactone (GLA) exhibits antioxidant and moisturizing effects. It also presents soothing effects, protects elastin fibers from UV-induced degradation, and improves the function of the skin barrier. Evaluation of skin parameters such as pH, transepidermal water loss (TEWL), sebum levels before, during, and after a series of applications of 10% and 30% GLA chemical peel in a split-face model. The study involved 16 female subjects. Three split-face procedures were performed using two concentrations of GLA solution applied on two sides of the face. The skin parameters were measured before treatments and 7 days after the last procedure at four measurement sites on either side of the face, that is, on the forehead, around the eye, on the cheek, and on the nose wing. Measurement of sebum demonstrated some statistically significant changes between sebum levels in the cheeks after a series of treatments. The pH measurement showed that the pH value was reduced after each treatment at all measurement points. The level of TEWL after treatments was significantly lower around the eyes, on the left forehead, and on the right cheek. There were no significant differences between the use of different concentrations of the GLA solution. The results of the study show that GLA has a significant influence on lowering skin pH and TEWL. GLA also has seboregulatory properties.