Skin Markers Research Articles

The flip side of frequent sanitising and hand washing.

The stratum corneum is the outermost layer of the epidermis. It acts as an interface with the external environment and functions as a barrier that prevents microorganisms and allergens from penetrating the skin, while preventing bodily fluids, electrolytes and proteins from being lost in a process aimed at maintaining homeostasis. With the novel coronavirus disease 2019 (COVID-19) outbreak, there has been an increase in hygiene practice, particularly hand washing and the use of hand sanitisers. These practices have undoubtedly assisted a great deal in combatting the rate of transmission and contributed immensely to saving lives. However, repeated hand washing and the use of sanitisers have both been linked with marked skin dryness and contact dermatitis. This especially holds true when the above-mentioned practices are carried out in the absence of intermittent hand moisturiser usage.

Assessment of thoracic spinal curvatures in static postures using spatially tracked 3D ultrasound volumes: a proof-of-concept study

The assessment of spinal posture is a difficult endeavour given the lack of identifiable bony landmarks for placement of skin markers. Moreover, potentially significant soft tissue artefacts along the spine further affect the accuracy of marker-based approaches. The objective of this proof-of-concept study was to develop an experimental framework to assess spinal postures by using three-dimensional (3D) ultrasound (US) imaging. A phantom spine model immersed in water was scanned using 3D US in a neutral and two curved postures mimicking a forward flexion in the sagittal plane while the US probe was localised by three electromagnetic tracking sensors attached to the probe head. The obtained anatomical ‘coarse’ registrations were further refined using an automatic registration algorithm and validated by an experienced sonographer. Spinal landmarks were selected in the US images and validated against magnetic resonance imaging data of the same phantom through image registration. Their position was then related to the location of the tracking sensors identified in the acquired US volumes, enabling the localisation of landmarks in the global coordinate system of the tracking device. Results of this study show that localised 3D US enables US-based anatomical reconstructions comparable to clinical standards and the identification of spinal landmarks in different postures of the spine. The accuracy in sensor identification was 0.49 mm on average while the intra- and inter-observer reliability in sensor identification was strongly correlated with a maximum deviation of 0.8 mm. Mapping of landmarks had a small relative distance error of 0.21 mm (SD = ± 0.16) on average. This study implies that localised 3D US holds the potential for the assessment of full spinal posture by accurately and non-invasively localising vertebrae in space.

Chronic Recurrent Multifocal Osteomyelitis (CRMO) and Juvenile Spondyloarthritis (JSpA): To What Extent Are They Related?

Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disease occurring mainly in the pediatric age group (before 16 years) and generally presents as a separate entity. Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome combines osteoarticular and cutaneous involvement, similar to CRMO, and falls into the spectrum of spondyloarthritis (SpA). The fact that a patient can progress from one disease to another raises the question of whether CRMO, like SAPHO, could fall within the spectrum of SpA, ranging from a predominantly osteoarticular form to an enthesitic form with more or less marked skin involvement. In this review, we set out to discuss this hypothesis by highlighting the differences and similarities between CRMO and juvenile SpA in clinical, radiological and pathophysiological aspects. A common hypothesis could potentially consider intestinal dysbiosis as the origin of these different inflammatory diseases. Interindividual factors such as gender, environment, genetics and/or epigenetic background could act as combined disease modifiers. This is why we suggest that pathophysiology, rather than clinical phenotype, be used to reclassify these diseases.

Marking Techniques for Targeted Axillary Dissection Among Patients With Node-Positive Breast Cancer Treated With Neoadjuvant Chemotherapy

Invasive breast cancer with axillary lymph node (LN) invasion is a continuing problem worldwide. The morbidity associated with axillary LN dissection along with the high rate of nodal downstaging after neoadjuvant chemotherapy (NACT) made the standard treatment shift towards less invasive surgery. Sentinel lymph node biopsy (SLNB) after NACT is associated with high false-negative rates (13%-14%). To overcome this problem, it was concluded that the positive nodes should first be indicated with image-detectable markers and then removed together with SLNB: targeted axillary dissection (TAD). This review aims to describe and evaluate the different marking techniques for TAD in patients with node-positive breast cancer treated with NACT, namely: clip placement and guidewire localization; clip placement and 125I-labelled radioactive seed localization; clip placement and skin mark; clip placement and intraoperative ultrasound; tattooing with a sterile black carbon suspension; magnetic seeds; radar and infrared light technology localization. Targeted axillary dissection techniques have shown false-negative rates below 9% and identification rates above 95%. The most studied technique is guidewire localization, as it is also the oldest one. However, according to data gathered from this review, some newer techniques have shown to be very promising due to their statistical results and management factors.

Dermoscopic Features of Lichenoid Pseudovesicular Papular Eruption of the Nose (LiPEN): A Rare Entity.

Dermoscopic Features of Lichenoid Pseudovesicular Papular Eruption of the Nose (LiPEN): A Rare Entity.

Clinical Practice Guidelines for the Therapeutic Use of Repetitive Transcranial Magnetic Stimulation in Neuropsychiatric Disorders.

Clinical Practice Guidelines for the Therapeutic Use of Repetitive Transcranial Magnetic Stimulation in Neuropsychiatric Disorders.

Clinical Practice Guidelines for the Use of Transcranial Direct Current Stimulation in Psychiatry.

Clinical Practice Guidelines for the Use of Transcranial Direct Current Stimulation in Psychiatry.

Descriptive study of sweat dermatitis: A rare dermatoses not so rare in tropics

BackgroundSweat dermatitis is an irritant inflammatory dermatosis commonly encountered in tropics during summers. Profuse sweating triggered by high heat index, friction, clothing, outdoor activities, military training, overcrowding, prolonged working in ill-ventilated places, etc., are responsible or this dermatitis. Aim was to study the clinical, dermoscopic, vapometric, histopathological, and immunohistochemistry (IHC) findings in sweat dermatitis. MethodsTwenty-five patients of sweat dermatitis attending out-patient department (OPD) of tertiary care hospital, were recruited over a period of three months (June to August 2022). A detailed history was followed by dermatological examination, dermoscopy, vapometry, histopathology, and IHC studies. ResultsTwenty-five patients were included in the study. There was male preponderance with male: female ratio of 2.1:1. The mean age of patients was 30.36 years. Dermatological examination in all patients revealed brownish “parchment”-like, shiny “crinkled cellophane paper”-like patches over the entire upper back and shoulder region with areas of exfoliation. Dermoscopy revealed increased skin markings, deep brown pigmentary changes with superimposed whitish scales with islands of eroded skin, and prominent eccrine duct openings. Vapometric analysis revealed increased transepidermal water loss (TEWL) in the affected area in 88% of patients. Histopathological examination showed features of spongiotic dermatitis. IHC with CK7 (cytoplasmic) highlighted the normal eccrine coils. ConclusionSweat dermatitis is common seasonal dermatoses in tropics, but it remains undiagnosed due to lack of awareness. This study aims to sensitize medical doctors and dermatologists about sweat dermatitis and prevention strategies that can be helpful in mitigating it. The study also discusses the role of investigative modalities, such as dermoscopy, vapometry, histopathology, and IHC, in sweat dermatitis.

Склероатрофический лихен: этиология, клиника, лечение

Scleroatrophic lichen (lichen sclerosus) is a benign progressive disease characterized by marked skin inflammation, epithelial thinning, and itching. The etiology of scleroatrophic lichen is unknown. Autoimmune, hormonal, inflammatory, and genetic factors are indicated in the pathogenesis of the disease. Dominant clinical manifestations include marked itching, tissue thinning, dyspareunia, and dysuria. Chronic inflammation gradually leads to irreversible changes in tissue architectonics. Topical glucocorticosteroids for 4–6 weeks are the first-line treatment for scleroatrophic lichen. To improve tissue trophism, the combined use of topical agents with hyaluronic acid and lanolin is effective. Key words: scleroatrophic lichen, lichen, vulvodynia, topical glucocorticosteroids, dyspareunia, hyaluronic acid, lanolin, superlymph

The Effect of The Topical Application of Eurycoma Longifolia Jack (TA) Root Extract Hydrogel on Vascular Endothelial Growth Factor (VEGF) Expression During Wound Healing in vivo Excisional Wound Model

INTRODUCTION: Medicinal plants are known for their positive impacts on wound healing by stimulating angiogenesis in the skin. Eurycoma longifolia Jack locally known as Tongkat Ali (TA), is a medicinal plant characterised by anti-inflammatory and antioxidant effects. MATERIALS AND METHODS: Excisional wound (15mm × 15mm) in diameter and (2mm) depth was created at the back of 20 male Sprague Dawley rats by incising the marked skin with sterilized surgical scalpel blade then excised the skin by surgical scissors and toothed forceps. The wounded rats were divided into 4 groups, each group contained 5 rats (n=5). Experimental groups were formed as follows: untreated (-ve) control, Hydrocyn® aqua gel (+ve) control, vehicle hydrogel, and TA hydrogel. All the treatments were applied twice daily for 5 days starting on the first day (wounding day). On Day 5 post-wounding, the granulation tissue was harvested from all groups and evaluated by immunohistochemistry assay for Vascular endothelial growth factor (VEGF) expression. RESULTS: VEGF expression in granulation tissue of rat’s skin treated with TA hydrogel and vehicle hydrogel increased significantly compared to that in the untreated (-ve) control group with p-values of 0.040 and 0.029, respectively. Although there was no significant difference in VEGF expression in granulation tissue of rat’s skin treated with the TA group, Hydrocyn® aqua gel (+ve) control, and vehicle hydrogel groups, our study group showed higher expression of VEGF. CONCLUSION: Our study showed that the topical application of TA hydrogel increased the VEGF expression in granulation tissue of rat’s skin, which is an essential growth factor for wound healing. Thus, there is great potential for TA hydrogel to be an effective wound-healing agent for managing cutaneous wounds.

Protocolo “RichBlend” para preenchimento facial e bioestimulação de colágeno

ABSTRACT The “RichBlend” protocol was designed for facial filling and collagen biostimulation, by means of a mixture of calcium hydroxyapatite (CaHA), hyaluronic acid (AH) and autologous platelet concentrates. This work reports the case of a 53-year-old patient with cutaneous photoaging, loss of facial volume, multiple rhythms in the frontal and periorbital regions, also marked skin flaccidity, especially the eyelid. The treatment was done with botulinum toxin (65 U) and the “RichBlend” protocol. Venipuncture was performed and the blood was centrifuged to obtain i-PRF (injectable platelet-rich fibrin) and plasma gel. After venipuncture and blood centrifugation, i-PRF and plasma gel were obtained. CaHA (Radiesse®) was diluted: a) in saline solution + i-PRF (hyperdilution) for biostimulationof the lower third of the face; and b) in AH (Juvederm Ultraplus XC®) + plasma gel, for hydrolifting on the forehead and dark circles, malar and temples. Plasma gel was applied to the nasogenian grooves and then the entire face was properly massaged. The “RichBlend” protocol rejuvenated the patient, as it promoted filling, volumizing, collagen formation (biostimulation), reduction of flaccidity, in addition to skin whitening. Since HA and CaHA are high-cost products, their mixture with autologous platelet concentrates, in liquid or gel form, allows the use of a greater amount of filled and biostimulator material on the face, at a more affordable cost.

High-resolution melt analysis for the detection of skin/sweat via DNA methylation.

The determination of tissue type is important when reconstructing a crime scene as skin cells may indicate innocent contact, whereas other types of cells, such as blood and semen, may indicate foul play. Up to now, there has been no specific DNA methylation-based marker to distinguish skin cell DNA from other body fluids. The goal of this study is to develop a DNA methylation-based assay to detect and identify skin cells collected at forensic crime scenes for use in DNA typing. For this reason, we have utilized a DNA methylation chip array-based genome-wide association study to identify skin-specific DNA methylation markers. DNA obtained from skin along with other body fluids, such as semen, saliva, blood, and vaginal epithelia, were tested using five genes that were identified as sites for potential new epigenetic skin markers. Samples were collected, bisulfite converted, and subjected to real-time polymerase chain reaction (PCR) with high-resolution melt analysis. In our studies, when using WDR11, PON2, and NHSL1 assays with bisulfite-modified PCR, skin/sweat amplicons melted at lower temperatures compared to blood, saliva, semen, and vaginal epithelia. One-way analysis of variance demonstrates that these three skin/sweat markers are significantly different when compared with other body fluids (p<0.05). These results demonstrate that high-resolution melt analysis is a promising technology to detect and identify skin/sweat DNA from other body fluids.

From sneaker to bourgeois male: Long-term observations on recognized tompot blenny Parablennius gattorugine individuals reveal new information on their biology.

The behaviour of the tompot blenny Parablennius gattorugine was studied by underwater observation and photography on the south-west coast of the UK over an 11 year period, with >50 individuals identified at two locations by their distinctive skin markings. Observations showed males engaging in rapid swimming behaviour when approached by a female, and younger males using alternative 'sneaker' tactics before becoming 'bourgeois' territory-holders. The noninvasive recognition technique also facilitated detailed observations on territory retention (up to 7 years) and agonistic behaviours among both males and females.

Fatal aspergillosis and evidence of unrelated hearing loss in a harbor porpoise (Phocoena phocoena) from the German Baltic Sea

Detailed post-mortem investigations including the auditory pathway are needed to advance our understanding of how underwater noise and other stressors affect hearing in cetaceans. A 12-year-old female porpoise (Phocoena phocoena) stranded alive in June 2021 at the German Baltic Sea coast and died some hours later. The most significant pathological findings were lesions caused by a severe aspergillosis that spread from the lung and pulmonary lymph node to the cerebellum. Based on molecular sequencing, the fungus was identified as Aspergillus fumigatus. Severe pyogranulomatous and necrotizing inflammation was diagnosed in the lung and the associated lymph node. In the left part of the cerebellum, focal, severe purulent and necrotizing meningoencephalitis with intralesional fungal structures was confirmed histologically. In addition, multifocal, severe, chronic, granulomatous, and eosinophilic gastritis with intralesional parasite structures was found in the stomach. Parallel stripes (linear skin markings) were detected along the caudal part of both body sides, which have not been previously described for harbor porpoises. Inner ear analysis revealed evidence of focal loss of outer hair cells in several regions from 120 to 580 µm from the apex of the right cochlea using immunofluorescence. The evidence of low-frequency hearing impairment was compatible with noise-induced hearing loss. This is the first case of concurrent presumptive noise-induced hearing loss and unrelated aspergillosis in a free-ranging harbor porpoise.

Verification of patient-setup accuracy using a surface imaging system with steep measurement angle.

We evaluate an SGRT device (Voxelan HEV-600M/RMS) installed with Radixact, with the view angle of the Voxelan's camera at 74 degrees. The accuracy of Voxelan with this steep angle was evaluated with phantom experiments and inter-fractional setup errors of patients. In the phantom experiments, the difference between the measured values of Voxelan from the truth was evaluated for translations and rotations. The inter-fractional setup error between the setup using skin markers with laser localizer (laser setup: LS) and the setup using Voxelan (surface setup: SS) was compared for head and neck (N=19), chest (N=7) and pelvis (N=9) cases. The inter-fractional setup error was calculated by subtracting from bone matching by megavoltage computed tomography (MVCT) as ground truth. From the phantom experiments, the average difference between the measured values of Voxelan from the truth was within 1mm and 1 degree. In all cases, inter-fractional setup error based on MVCT was not significantly different between LS and SS by Welch's t-test (P>0.05). The vector offset of the LS for head and neck, chest, and pelvis were 6.5, 9.6, and 9.6mm, respectively, and that of the SS were 5.8, 8.6, and 12.6mm, respectively. Slight improvement was observed for the head and neck, and chest cases, however, pelvis cases were not improved because the umbilical region could not be clearly visualized as a reference. The results show that SS in Voxelan with an installation angle of 74 degrees is equal to or better than LS.

Concomitant Use of Biopsy Clips and Wire Localization in Invasive Breast Cancer is Associated With Successful Clip Retrieval

IntroductionSurgical management of the axilla in patients with clinically node-positive breast cancer has shifted to less invasive surgical approaches, such as sentinel lymph node dissection (SLND) and targeted axillary dissection (TAD). Successful retrieval of the biopsy clip marking the lymph node of interest is crucial for assessment of pathologic response and locoregional disease control. MethodsWe performed a retrospective review of patients ≥18 years old with invasive breast cancer and biopsy-proven axillary LN involvement, who underwent LN clip placement from January 2012 to July 2017 at Johns Hopkins Hospital. ResultsOf the 128 eligible patients, the median age at diagnosis was 51.5 years (range, 23-92 years) with predominately stage T2-3 disease (54.7% T2, 42.2% T3), of ductal histology (76.6%), and located in the upper outer quadrant (42.2%). Among the 63.3% (81) of patients who received neoadjuvant systemic therapy, 43.2% (35) had a partial response and 30.9% (25) had a complete response. Axillary procedures performed consisted of 36.7% (47) SLND/TAD, 53.9% (69) ALND, and 9.4% (12) SLND/TAD with conversion to ALND. The clipped LN was successfully retrieved in 63.8% (30) of SLND/TADs, 39.1% (27) of ALNDs, and 58.3% (7) of SLND/TADs followed by ALND. Pre-operative node localization by wire and/or skin markings was performed for 16.4% (21) of patients. Among these, 90.5% (19) of clipped LNs were successfully retrieved, compared to 42.1% (45) retrieved in axillary procedures without preoperative node localization. ConclusionUse of preoperative targeted node localization improved rate of clipped LN retrieval across all three types of axillary procedures.

Optimizing the Patient Positioning Workflow of Patients with Pelvis, Limb, and Chest/Spine Tumors at an Ion-Beam Gantry based on Optical Surface Guidance

PurposeSurface-guided radiation therapy (SGRT) has been investigated intensively to ensure correct patient positioning during a radiation therapy course. Although the implementation is well defined for photon-beam facilities, only a few analyses have been published for ion-beam therapy centers. To investigate the accuracy, reliability, and efficiency of SGRT used in ion-beam treatments against the conventional skin marks, a retrospective study of a unique SGRT installation in an ion gantry treatment room was conducted, where the environment is quite different to conventional radiation therapy. Methods and MaterialsThere were 32 patients, divided into 3 cohorts—pelvis, limb, and chest/spine tumors—and treated with ion-beams. Two patient positioning workflows based on 300 fractions were compared: workflow with skin marks and workflow with SGRT. Position verification was followed by planar kilo voltage imaging. After image matching, 6 degrees of freedom corrections were recorded to assess interfraction positioning errors. In addition, the time required for patient positioning, image matching, and the number of repeated kilo voltage imaging also were gathered. ResultsSGRT decreased the translational magnitude shifts significantly (P < .05) by 0.5 ± 1.4 mm for pelvis and 1.9 ± 0.5 mm for limb, whereas for chest/spine, it increased by 0.7 ± 0.3 mm. Rotational corrections were predominantly lowered with SGRT for all cohorts with significant differences in pitch for pelvis (P = .002) and chest/spine (P = .009). The patient positioning time decreased by 18%, 9%, and 15% for pelvis, limb, and chest/spine, respectively, compared with skin marks. By using SGRT, 53% of all studied patients had faster positioning time, and 87.5% had faster matching time. Repositioning and consequent reimaging decreased from about 7% to 2% with a statistically significant difference of .042. ConclusionsThe quality of patient positioning before ion-beam treatments has been optimized by using SGRT without additional imaging dose. SGRT clearly reduced inefficiencies in the patient positioning workflow.

Comparison of skin and shoe marker placement on metatarsophalangeal joint kinematics and kinetics during running

This study investigated the effects of marker placement (skin- vs shoe-mounted) on metatarsophalangeal joint (MTP) kinematics and kinetics during running. Fifteen trained men ran on a 15-m track at 10 and 13 km/h with three (low, standard and high stiffness) shoe longitudinal bending stiffnesses (LBS). Reflective markers were fixed on the shoe upper, and on the skin using holes cut in the shoe. Three-dimensional marker positions and ground reaction forces were recorded at 200 and 2000 Hz, respectively. Kinematic and kinetic parameters were analyzed using one-dimensional metrics (statistical parametric mapping). MTP joint was less dorsiflexed at midstance ([57% to 100%] of braking phase and [0% to 48%] of pushing phase), and the MTP joint plantarflexion moment was higher ([22% to 55%] of pushing phase) with the shoe markerset in comparison with the skin markerset. The effect of LBS on MTP angle was found to be significant for a larger percentage of each stride using the shoe markerset compared to the skin markerset. However, the effect of LBS on plantarflexion moment was significant with the shoe markerset only. The effect of running speed on MTP angle was significant for a larger percentage of each stride with the skin markerset. This study demonstrates that the placement of markers influences the measurement of MTP kinematics and kinetics and that these effects are mediated by other variables such as LBS or running speed. It is concluded that the shoe markerset does not fully reflect the movement of the MTP joint.

Cathepsin B/NLRP3/GSDMD axis-mediated macrophage pyroptosis induces inflammation and fibrosis in systemic sclerosis

BackgroundPyroptosis is a newly discovered type of programmed cell death associated with inflammatory and fibrotic diseases. Macrophages play an important role in inducing early immune inflammation in systemic sclerosis (SSc). ObjectiveTo investigate the effect of macrophages pyroptosis on fibrosis of SSc. MethodsPyroptosis/inflammatory markers in serum and skin of SSc patients were detected. Bleomycin (BLM) was subcutaneously injected to establish SSc mouse model. The levels of pyroptosis markers, dermal thickness and collagen deposition in skin were assessed before and after the administration of pyroptosis inhibitors, including MCC950, Disulfiram and necrosulfonamide (NSA). Human-derived monocyte-macrophage cell line (THP-1) or mouse bone marrow-derived macrophages (BMDMs) were primed with lipopolysaccharide (LPS) and stimulated by silicon dioxide (SiO2) to induce cell pyroptosis. Fibroblasts from patients with SSc were co-cultured with pyroptotic THP-1 cells, and the collagen production was assessed. ResultsPyroptotic/inflammatory proteins, including NLRP3, cleaved-Caspase (CASP)1, GSDMD-N terminal and IL-18 were increased in the serum, and ASC aggregation and GSDMD were elevated in macrophages in the skin of SSc patients. SSc mice showed increased pyroptosis markers, dermal thickness and collagen deposition in skins, which were alleviated by MCC950, Disulfiram and NSA. Pyroptosis of THP-1 cells and BMDMs was induced by LPS/SiO2, and it was reduced by the inhibitors of Cathepsin B, NLRP3, CASP1 and GSDMD. Co-culture with pyroptotic THP-1 cells increased the fibrotic proteins in fibroblasts, which were alleviated by pyroptosis inhibitors. ConclusionsSSc patients and BLM-induced mouse model presented increased pyroptosis. LPS/SiO2-induced macrophage pyroptosis promoted fibrosis of SSc through Cathepsin B/NLRP3/GSDMD pathway.

Community-associated Methicillin-Resistant Staphylococcus aureus (ca-MRSA) as a Pandemic Pathogen: Risk Factors and Implications for Healthcare

Abstract Background A diversity of risk factors for ca-MRSA manifestations has been described so far. Up to date toxic contact dermatitis induced by plants has not been identified as one. Patients and Methods After intense skin contact with poison ivy in the US a 24-year-old Afro-American showed pronounced bullous contact dermatitis on the back of the neck and subsequently massive ca-MRSA furunculitis with proof of Panton-Valentine-leucocidin (PVL). After travelling to Germany, his German girlfriend developed a subacute ca-MRSA, PVL-positive superinfection of a mosquito bite at her lower leg. Both infections required surgical intervention. Results While the male patient displayed contact dermatitis by poison ivy, the female patient demonstrated two risk factors for ca-MRSA: contact with a ca-MRSA positive person and a predisposing skin lesion. Both cases underpin the role of ca-MRSA transmission and the potential severeness of wound infections in young and immunocompetent persons, just to be resolved by invasive intervention. Conclusions Marked and recalcitrant skin or soft tissue infections in otherwise healthy young patients require instant microbiological analysis and surgical intervention flanked by adequate antibiotic therapy. Contact dermatitis induced by plant toxins should be taken into consideration as possible risk factor for the acquisition of ca-MRSA.