Minimal Residual Activity Research Articles

"Low Dose MR" Dixon Technique for Imaging FDG PET-MR Lymphoma.

Introduction Hybrid PET-MR is a relatively new imaging modality with its major strength being the MR component offering superior soft tissue contrast. While PET/MRI offers the inherent advantage of reduced radiation dose, it has been shown to result in a markedly prolonged examination time becoming a challenge in children and sick patients. "Low dose MRI" is a term used in the nuclear medicine community to describe fast acquired PET-MR scan protocols that rely heavily on PET images for diagnosis. In this study, we sought to determine if the Dixon sequences obtained for attenuation correction could be used as a diagnostic sequence for interpreting PET-MRI lymphoma cases, potentially reducing scan time. Materials and Methods We retrospectively identified 40 patients who underwent 88 FDG PET-MR body imaging studies for staging or restaging lymphoma. A radiologist and nuclear medicine physician initially reviewed top of the head to mid thigh PET images, attenuation correction coronal Dixon MRI sequences, and PET-MR fusion with Dixon sequence. The same physicians reviewed the PET images, multi-sequence MR including the attenuation correction Dixon, and multi-sequence PET-MR fusion images The lesions were further characterized based on their imaging characteristics, size, SUVmax, and malignant potency. A consensus read followed. Results All patients were adults with an average study age of 43.8 years. Our study consisted of 40 females and 48 males out of which 7 were for staging and 81 were for re-staging. All patients had systemic lymphoma. Thirty-seven of the studies had active lymph nodes on Dixon PET-MR that agreed with multi-sequence PET-MR which identified 33 positive cases (89.1%) having an average SUV 10.2 ± 7.74 SD. Four Dixon PET-MR cases did not detect lesions, with an average SUV 2.3 ± 0.55 SD, which was read as minimal residual activity. Multi-sequence MR identified 11 patients with enlarged lymph nodes without FDG uptake, which were not seen on Dixon MR. All 5 studies with bones lesions were detected by Dixon PET-MR as well as 2 soft tissue organ lesions. Multi-sequence MR identified 1 patient with non-active, healed bone lesion. Fifty-five of these studies were true negatives. Compared to multi-sequence PET-MR, Dixon PET-MR demonstrated 89.2% sensitivity, 100% specificity with no false positive studies. Conclusion The present study investigated the diagnostic potential of a fast protocol for integrated PET/MRI used for dedicated tumor staging of patients with lymphoma. In this retrospective study, Dixon PET-MR was shown to be sensitive and specific compared to multi-sequence PET-MR in the detection of lymphoma. The low number of these cases not detected had minimally active lymph nodes that resolved on subsequent imaging and probably were not clinically important.

Bone Marrow Activation After Chemotherapy Presenting as Diffuse Skeletal Uptake on 18F-Fluorocholine PET/CT.

Diffuse 18F-FDG skeletal uptake due to chemotherapy-induced bone marrow activation is well documented, whereas it has never been reported with 18F-fluorocholine. We described a patient with pelvic recurrence of prostate cancer at 18F-fluorocholine PET/CT. A second PET/CT after docetaxel showed minimal residual activity in pelvis, but it revealed diffuse, intense 18F-fluorocholine skeletal uptake. Considering biochemical and metabolic response and absence of morphologically suspected bone lesions, skeletal hyperactivity was interpreted as chemotherapy-related bone marrow rebound rather than diffuse metastatic involvement, as confirmed by its resolution after treatment ended. The occurrence of such 18F-fluorocholine pattern should be considered to avoid imaging misinterpretation.

Paenibacillus barengoltzii A1_50L2 as a Source of Plant Cell Wall Degrading Enzymes and Its Use on Lignocellulosic Biomass Hydrolysis

Lignocellulosic residues daily generated as a by-product of economic activities worldwide, stand out as potential feedstock to biorefineries. Industrial processes based on their use still face a challenge in the development of low-cost enzymatic mixtures resistant to inhibitors produced during pre-treatment step and efficient in the complete deconstruction of different lignocellulosic wastes. In the present work, Paenibacillus barengoltzii A1_50L2 isolated from bovine rumen was studied as a source of plant cell wall degrading enzymes. In addition, the natural produced enzymatic cocktail was characterized and applied to the hydrolysis of lignocellulosic substrates. P. barengoltzii grew in liquid media containing cellulose, sugarcane bagasse and wheat bran, as carbon source producing endo-1,4-β-xylanases, pectinases, mannanases, endo-1,4-β-glucanases, exo-1,4-β-glucanases and β-glucosidases, with highest values of endo-1,4-β-xylanase activity. Six isoforms of endo-1,4-β-xylanase (45 to 116 kDa), three of endo-1,4-β-glucanase (40 to 66 kDa) and a single band of mannanase (62 kDa) were secreted by the bacterium during growth on wheat bran, all enzymes presented maximal activity in pH ranging from 4 up to 8 and temperature from 45 up to 60 °C. Endo-1,4-β-xylanases, endo-1,4-β-glucanases, exo-1,4-β-glucanases, pectinases, mannanases and β-glucosidases produced by P. barengoltzii are tolerant to lignin-derived compounds showing a minimal residual activity of 61%. Ferulic, gallic, tannic and cinnamic acids enhanced activities of endo-1,4-β-glucanases/endo-1,4-β-xylanases, mannanase and pectinase, respectively. P. barengoltzii enzymatic cocktail (PbEC) hydrolyzes sugarcane bagasse, banana stem and corncob with hydrolysis values comparable to those obtained for the commercial blend Viscozyme®. The addition of PbEC to Viscozyme® increases the hydrolysis rate of sugarcane bagasse, banana stem and corncob in three to four times.

Review of an established UK home phototherapy service 1998–2011: improving access to a cost-effective treatment for chronic skin disease

ObjectivesTo review the Tayside home phototherapy service, including numbers of patients treated, diagnoses and outcomes, side-effects and safety, cost-effectiveness and absolute costs. To consider why home or outpatient phototherapy is not available to all patients who might benefit and how this could be addressed. Study designObservational and cost analysis. MethodsAnalysis of the Tayside home phototherapy database 1998 and 2011, home phototherapy patient questionnaires, outcome data, costs and a comparison with outpatient phototherapy. Review of literature and current national guidelines for phototherapy, traditional systemic and biologic therapies for psoriasis. Results298 courses of home narrowband UVB (NB-UVB) phototherapy were undertaken by 212 patients between 1998 and 2011, five courses in 1998 increasing to 36 in 2011. The main diagnoses treated were psoriasis (72%), atopic dermatitis (8%), and desensitization of photodermatosis (7%). For psoriasis, 74.5% achieved clearance or minimal residual activity in a median of 30 exposures (range 10–60). The estimated costs to the hospital ranged from £229 to £314 per course (£307 to £422 per effective course for psoriasis), compared with £114 for out-patient therapy (£149 per effective course for psoriasis). The total cost to society (hospital and patient costs) is around £410 per course, compared to an estimated £550 for outpatient therapy for this group of patients. Treatment was well tolerated, erythema rates were similar to outpatient therapy, there were no complaints and the vast majority would choose home over outpatient phototherapy if required in the future. ConclusionsHospital supervised home phototherapy appears as safe and effective as outpatient therapy and provides equality of access for patients who cannot attend for outpatient therapy. These patients may otherwise be inadequately treated or given more costly and higher risk systemic therapies, particularly for psoriasis. Commissioners and clinicians involved in dermatology services should provide accessible phototherapy for all patients who might benefit, utilizing home phototherapy where outpatient access is not possible.

Functional Analysis Of TTP-Associated ADAMTS13 Mutants Under Shear Flow

Upon agonist stimulation endothelial cells secrete ultralarge von Willebrand Factor (VWF) multimers. These multimers form prothrombotic VWF strings on the cell's surface which are size-regulated by ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13). Under physiological conditions, this metalloprotease cleaves VWF between Tyr1605 and Met1606 in its A2 domain only when this domain is unfolded by shear stress and the respective binding sites of both, VWF and ADAMTS13, adjoin each other (Gao W, et al., Blood. 2008 Sep 1;112(5):1713-9). This sophisticated substrate recognition involves distinct steps during which the TSP5-CUB domains of ADAMTS13 initially bind to VWF shear force independent, then, upon shear induced elongation of VWF, additional exosite binding sites become exposed which subsequently can be bound by the complementary spacer domain of ADAMTS13 (Crawley JT, et al., Blood. 2011 Sep 22;118(12):3212-21).Mutations in ADAMTS13 cause Upshaw-Schulman Syndrome, the inherited form of Thrombotic Thrombocytopenic Purpura (TTP), a microangiopathy characterized by platelet clumping, hemolytic anemia, and subsequent organ failure (Coppo P & Veyradier A, Cardiovasc Hematol Disord Drug Targets. 2009 Mar;9(1):36-50).State-of-the-art ADAMTS13 tests of patients' plasma use static approaches based on either proteolysis of VWF minimal fragments or full length VWF under denaturing conditions. In some cases the results of these static assays could be without pathological finding, e.g. when a mutation in the shear dependent spacer region of ADAMTS13 would prevent binding to VWF strings only under flow conditions without affecting its proteolytic activity towards denatured VWF substrates in static assays.We developed an assay based on gain of function GPIba mutants immobilized on latex particles that facilitates the visualization of VWF strings on the surface of stimulated endothelial cells without the need for whole blood or isolated platelets. We then used this assay to observe the proteolytic activity of wildtype (wt) ADAMTS13. Under shear flow imitating the physiological conditions of the venous blood stream, VWF string formation was induced by histamine stimulation and visualized by binding of the GPIba coated particles. wtADAMTS13 was then floated over the cells at the same shear rate (500 s-1) thereby offering the VWF strings as substrate. VWF string proteolysis was observed live and the time was determined that was needed for complete degradation. wtADAMTS13 degraded the up to 1mm long VWF strings within seconds. 5-10 minutes after ADAMTS13 addition only a few string fragments with a maximal length of 10 µm remained intact. To determine the accuracy of our assay, we then determined the catalytic activity of two ADAMTS13 mutants with mutations in the C-terminal TPS1 domains. Since these domains are responsible for shear flow independent substrate binding we expected the same results as in the static assays. Mutant ADAMTS13-R1060W possesses a single point-mutation in its TSP1-7 domain which leads to a secretion defect and a catalytic activity that is reduced by 65% in a static assay. We indeed also determined a decrease in proteolytic activity by 65% and VWF multimeric fragments with a size of 10-30 µm remained intact. The truncated mutant ADAMTS13-R910*, lacking the TSP1-7, TSP1-8 and the CUP domains was incapable of producing VWF-fragments smaller than 80 µm within one hour and therefore only showed a minimal residual activity in accordance to the previously published catalytic activity of 2%.After these prove-of-principle experiments our assay could now be adapted to be used with blood samples of TTP patients who exhibit reduced proteolytic band patterns in VWF multimer analysis but possess normal ADAMTS13 activity in static assays.Summarizing we developed an assay that allows functional characterization of TTP-associated ADAMTS13 mutants with shear flow dependent dis-functionalities. The assay may serve as a valuable tool for research but could also broaden the range of TTP diagnostics. Disclosures:No relevant conflicts of interest to declare.

Extrapleural Pneumonectomy for Primary Pleural Mullerian Tumor in a Young Woman

We present a case of a low-grade mullerian tumor of right pleural origin in a 23-year-old woman treated with an aggressive multimodal treatment paradigm. This tumor is heretofore undescribed in the medical literature. She received induction therapy of carboplatin and paclitaxel with minimal response, then had a maximally cytoreductive right extrapleural pneumonectomy. She subsequently underwent intensity-modulated radiotherapy to the right hemithorax. We propose a treatment paradigm for this previously undescribed primary pleural mullerian tumor.

Mineralocorticoid Receptor Mutations and a Severe Recessive Pseudohypoaldosteronism Type 1

Pseudohypoaldosteronism type 1 (PHA1) is a rare genetic disease of mineralocorticoid resistance characterized by salt wasting and failure to thrive in infancy. Here we describe the first case of a newborn with severe recessive PHA1 caused by two heterozygous mutations in NR3C2, gene coding for the mineralocorticoid receptor (MR). Independent segregation of the mutations occurred in the family, with p.Ser166X being transmitted from the affected father and p.Trp806X from the asymptomatic mother Whereas the truncated MR(166X) protein was degraded, MR(806X) was expressed both at the mRNA and protein level. Functional studies demonstrated that despite its inability to bind aldosterone, MR(806X) had partial ligand-independent transcriptional activity. Partial nuclear localization of MR(806X) in the absence of hormone was identified as a prerequisite to initiate transcription. This exceptional case broadens the spectrum of clinical phenotypes of PHA1 and demonstrates that minimal residual activity of MR is compatible with life. It also suggests that rare hypomorphic NR3C2 alleles may be more common than expected from the prevalence of detected PHA1 cases. This might prove relevant for patient's care in neonatal salt losing disorders and may affect renal salt handling and blood pressure in the general population.

A Randomized Comparison of Methods of Selecting Narrowband UV-B Starting Dose to Treat Chronic Psoriasis

To compare narrowband UV-B (TL-01 lamp) phototherapy for psoriasis with individual patient starting doses based on minimal erythemal dose (MED) determination vs a standard fixed starting dose and to compare the efficacy of 70% of MED vs 50% of MED starting dose regimens. Single-center, randomized, double-blind, clinical trial. Department of Dermatology, Ninewells Hospital and Medical School, Dundee, Scotland. A total of 210 adult patients (207 of skin phototypes I to III) referred for narrowband UV-B to treat chronic psoriasis. The study was designed to have 90% power to detect a difference of 3 or more treatments to clearance and/or minimal residual activity (MRA) between groups. Narrowband UV-B phototherapy was given according to 3 standard regimens, differing only by starting dose selection method. The randomly allocated starting doses were (1) a fixed starting dose, (2) 70% of individual MED, and (3) 50% of individual MED. All patients were MED tested to ensure blinding and for safety reasons. The number of treatments to clearance and/or MRA of psoriasis was the primary efficacy outcome measure, with changes in Psoriasis Area and Severity Index and Psoriasis Disability Index scores as secondary measures. Adverse effects were recorded. There were no significant differences in the number of treatments to clearance and/or MRA across all 3 groups or in the percentages achieving clearance in each group. More uncomfortable erythemas occurred in the 50% of MED starting dose group (39%) than in the 70% of MED starting dose group (24%) or the fixed starting dose group (24%) (P=.07). The methods of determining the starting dose in this predominantly skin phototype I and II population, treated 3 times weekly, with a 20% followed by 10% incremental reduction in dose, did not significantly influence the effectiveness of treatment. Had there been a clinically important difference in efficacy, we would have expected to identify this. Thus, basing starting dose on individual MED assessments may not influence the treatment's efficacy in a skin phototype I to III population, although it remains important for patient safety. It remains possible that in populations containing individuals with a broader range of erythemal sensitivity, basing the starting dose on MED testing could have an important impact on treatment effectiveness. isrctn.org Identifier: ISRCTN84614024.

Comparative study on cloudy apple juice qualities from apple slices treated by high pressure carbon dioxide and mild heat

Abstract Qualities of cloudy apple juices from apple slices treated by high pressure carbon dioxide (HPCD) and mild heat (MH) were evaluated. Temperatures were from 25 to 65 °C, time 20 min, and pressure 20 MPa. Polyphenol oxidase (PPO) was completely inactivated by HPCD and its minimal residual activity ( RA ) by MH at 65 °C was 38.6%. RA of pectin methylesterase (PME) with HPCD was significantly lower than MH and its minimum was 18%. L value of cloudy apple juice from HPCD-treated apple slices was significantly greater than that from MH-treated apple slices, however, b value, browning degree (BD) and turbidity were lower. And no differences in a value, total soluble solids, pH and conductivity were observed. After 7-day storage at 4 °C, HPCD caused no BD alteration but a significant turbidity loss. MH increased BD at 55 and 65 °C, and led to turbidity loss from 35 to 65 °C. The turbidity was not well related to RA of PME. Industrial relevance Cloudy apple juice is one of the popular fruit juices, and it requires strict processing treatment conditions to protect its quality, especially to prevent enzymatic browning and cloud loss. HPCD is one promising novel non-thermal technique and is likely to replace or partially substitute thermal processes. This study analyzed the effect of HPCD as a pretreatment means on qualities of cloudy apple juice, including inactivating enzymes which are crucial to quality control. Available data provided in this study will benefit the fruit juice industry.

The treatment of severe atopic dermatitis in childhood with narrowband ultraviolet B phototherapy

There is a lack of data regarding the use of narrowband ultraviolet B (NB-UVB) phototherapy in children with atopic dermatitis (AD). Many centres use this mode of treatment for children with AD; however, there have only been two previous studies observing the effect of NB-UVB in children with AD. We undertook a retrospective review of children with severe eczema who had undergone NB-UVB consecutively in our department between 1999 and 2005. All children with AD who had undergone NB-UVB consecutively in our department between 1999 and 2005 were identified from the phototherapy database. Their clinical notes were reviewed for information on age, sex, skin type, minimal erythema dose (MED), adjuvant therapy, previous therapy, adverse effects, number of exposures, cumulative dose, response to treatment and length of remission. In total, 50 children (83%) completed more than 10 exposures of NB-UVB. Complete clearance or minimal residual activity was achieved in 20 children (40%). A good improvement was achieved in a further 10 children (23%), and a moderate improvement in 13 (26%). Children with MEDs > 390 mJ/cm2 were more likely to clear, and this was found to be statistically significant (P = 0.02). Overall, the treatment was well tolerated and the median length of remission was 3 months. NB-UVB is an effective treatment for children with severe AD. Children with MEDs > 390 mJ/cm2 are more likely to clear. Further studies are needed to evaluate the efficacy of NB-UVB and long-term safety in treating children with severe AD.

History of psoriasis response to sunlight does not predict outcome of UVB phototherapy.

We prospectively asked 146 consecutive patients starting narrow-band UVB (NB-UVB) for psoriasis about the effects of sunlight on their psoriasis. Eighty-eight (60%) patients reported improvement with sunlight, six (4%) reported worsening, and 52 (36%) had not noted any change in their psoriasis with sunlight exposure. Overall, 101 (69%) were recorded to reach clearance or minimal residual activity (MRA), 24 (16.5%) to achieve moderate improvement, and 21 (14.5%) had other recorded outcomes (mainly 'did not attend'), with UVB phototherapy. Forty-two (72%) of the 58 who did not report improvement with sunlight went on to clearance/MRA with UVB compared to 59/88 (67%) of those who did report improvement (95% confidence interval for difference in percentage improving, -10% to 20%, P = 0.49). Patients' replies to questions about how their psoriasis responds to sunlight do not appear to predict response to UVB phototherapy in our patient population.

Network of hydrogenase maturation in Escherichia coli: role of accessory proteins HypA and HybF.

We have studied the roles of the auxiliary protein HypA and of its homolog HybF in hydrogenase maturation. A mutation in hypA leads to the nearly complete blockade of maturation solely of hydrogenase 3 whereas a lesion in hybF drastically but not totally reduces maturation and activity of isoenzymes 1 and 2. The residual level of matured enzymes in the hybF mutant was shown to be due to the function of HypA; HybF, conversely, was responsible for a minimal residual activity of hydrogenase 3 in the mutant hypA strain. Accordingly, a hypA DeltahybF double mutant was completely blocked in the maturation process. However, the inclusion of high nickel concentrations in the medium could restore limited activity of all three hydrogenases. The results of this study and of previous work (M. Blokesch, A. Magalon, and A. Böck, J. Bacteriol. 189:2817-2822, 2001) show that the maturation of the three functional hydrogenases from Escherichia coli is intimately connected via the activity of proteins HypA and HypC and of their homologs HybF and HybG, respectively. The results also support the suggestion of Olson et al. (J. W. Olson, N. S. Mehta, and R. J. Maier, Mol. Microbiol. 39:176-182, 2001) that HypA cooperates with HypB in the insertion of nickel into the precursor of the large hydrogenase subunit. Whereas HypA is predominantly involved in the maturation of hydrogenase 3, HybF takes over its function in the maturation of isoenzymes 1 and 2.

Gene disruption of tissue transglutaminase.

Transglutaminase 2 (TGase 2), or tissue transglutaminase, catalyzes either epsilon-(gamma-glutamyl)lysine or N(1), N(8)-(gamma-glutamyl)spermidine isopeptide bonds. TGase 2 expression has been associated with apoptosis, and it has been proposed that its activation should lead to the irreversible assembly of a cross-linked protein scaffold in dead cells. Thus, TGase 2-catalyzed protein polymerization contributes to the ultrastructural changes typical of dying apoptotic cells; it stabilizes the integrity of the apoptotic cells, preventing the release of harmful intracellular components into the extracellular space and, consequently, inflammation and scar formation. In order to perform a targeted disruption of the enzyme, we prepared a construct deleting part of exons 5 and 6, containing the active site, and intron 5. Complete absence of TGase 2 was demonstrated by reverse transcription-PCR and Western blot analysis. TGase activity measured on liver and thymus extracts showed, however, a minimal residual activity in TGase 2(-/-) mice. PCR analysis of mRNA extracted from the same tissues demonstrated that at least TGase 1 (normally present in the skin) is also expressed in these tissues and contributes to this residual activity. TGase 2(-/-) mice showed no major developmental abnormalities, and histological examination of the major organs appeared normal. Induction of apoptosis ex vivo in TGase 2(-/-) thymocytes (by CD95, dexamethasone, etoposide, and H(2)O(2)) and in vitro on TGase 2(-/-) mouse embryonal fibroblasts (by retinoids, UV, and H(2)O(2)) showed no significant differences. A reduction in cross-linked apoptotic bodies with a modestly increased release of lactate dehydrogenase has been detected in some cases. Together our results show that TGase 2 is not a crucial component of the main pathway of the apoptotic program. It is possible that the residual enzymatic activity, due to TGase 1 or redundancy of other still-unidentified TGases, can compensate for the lack of TGase 2.

Co-localization of hydrolytic enzymes with widely disparate pH optima: implications for the regulation of lysosomal pH.

Lysosomes are traditionally defined by their acidic interior, their content of degradative 'acid hydrolases', and the presence of distinctive membrane proteins. Terminal degradation of the N-linked oligosaccharides of glycoproteins takes place in lysosomes, and involves several hydrolases, many of which are known to have acidic pH optima. However, a sialic acid-specific 9-O-acetyl-esterase and a glycosyl-N-asparaginase, which degrade the outer- and inner-most linkages of N-linked oligosaccharides, respectively, both have pH optima in the neutral to alkaline range. By immunoelectron microscopy, these enzymes co-localize in lysosomes with several conventional acid hydrolases and with lysosomal membrane glycoproteins. Factors modifying the pH/activity profiles of these enzymes could not be found in lysosomal extracts. Thus, the function of the enzymes with neutral pH optima must depend either upon their minimal residual activity at acidic pH, or upon the possibility that lysosomes are not always strongly acidic. Indeed, when lysosomes are marked in living cells by uptake of fluorescently labeled mannose 6-phosphorylated proteins, the labeled organelles do not all rapidly accumulate Acridine Orange, a vital stain that is specific for acidic compartments. One plausible explanation is that lysosomal pH fluctuates, allowing hydrolytic enzymes with a wide range of pH optima to efficiently degrade macromolecules.

Sequential early and delayed myocardial 99mTc pyrophosphate scans: evaluation of diffuse myocardial uptake.

Of 114 pyrophosphate (PPi) myocardial studies, eleven were selected to assess the significance of diffuse uptake observed in the images obtained early (2-3 h) following injection and compared with delayed scintigrams at 6-24 h. From the results of the late studies the patients were divided into two groups; those with no or minimal residual activity in the delayed study (five cases) and those with approximately the same intensity of delayed scans as in the early study (six cases). No significant abnormalities in cardiac enzymes or the EKG (obtained within 24 h) were noted in the patients of the first group. Cardiac enzymes, EKG abnormalities, indicating myocardial damage, or decreased radionuclide LVEF dysfunction were found in the patients of second group. We concluded that a late image is required in a case of diffuse PPi myocardial uptake in the early image, and myocardial damage may be present if there is persistently diffuse uptake of PPi in the late image.

Aspects of the relationship between psychiatric status, sleep, nocturnal motility and nutrition

To review the Tayside home phototherapy service, including numbers of patients treated, diagnoses and outcomes, side-effects and safety, cost-effectiveness and absolute costs. To consider why home or outpatient phototherapy is not available to all patients who might benefit and how this could be addressed.Observational and cost analysis.Analysis of the Tayside home phototherapy database 1998 and 2011, home phototherapy patient questionnaires, outcome data, costs and a comparison with outpatient phototherapy. Review of literature and current national guidelines for phototherapy, traditional systemic and biologic therapies for psoriasis.298 courses of home narrowband UVB (NB-UVB) phototherapy were undertaken by 212 patients between 1998 and 2011, five courses in 1998 increasing to 36 in 2011. The main diagnoses treated were psoriasis (72%), atopic dermatitis (8%), and desensitization of photodermatosis (7%). For psoriasis, 74.5% achieved clearance or minimal residual activity in a median of 30 exposures (range 10–60). The estimated costs to the hospital ranged from £229 to £314 per course (£307 to £422 per effective course for psoriasis), compared with £114 for out-patient therapy (£149 per effective course for psoriasis). The total cost to society (hospital and patient costs) is around £410 per course, compared to an estimated £550 for outpatient therapy for this group of patients. Treatment was well tolerated, erythema rates were similar to outpatient therapy, there were no complaints and the vast majority would choose home over outpatient phototherapy if required in the future.Hospital supervised home phototherapy appears as safe and effective as outpatient therapy and provides equality of access for patients who cannot attend for outpatient therapy. These patients may otherwise be inadequately treated or given more costly and higher risk systemic therapies, particularly for psoriasis. Commissioners and clinicians involved in dermatology services should provide accessible phototherapy for all patients who might benefit, utilizing home phototherapy where outpatient access is not possible.