Lesion Thickness Research Articles

Relationship between longitudinal changes in amyloid deposition and incident dementia in non‐demented individuals age 80+

AbstractBackgroundIncident dementia increases with age and is associated with amyloid deposition. There is little knowledge about the progression of amyloid deposition in non‐demented individuals age 80+. The purpose of this study was to determine the relationship between changes in amyloid deposition over time and incident dementia in non‐demented individuals followed for a period of 11 years.MethodsWe examined a group of elderly participants (baseline age: 85.86 + 2.84) who had clinical evaluations from 2009 to 2020 and up to 5 measurements of Pittsburgh compound‐B (PiB)‐PET. 94 participants had two PiB‐PET scans, 76 three, 18 four, and 10 five. Mean age was 95 at 2020, at which time 49% of the participants with two or more scans developed dementia and 61% were deceased.ResultsThere was a gradual increase in amyloid deposition in all participants whether they were considered amyloid positive or negative at baseline. Time to dementia in baseline amyloid negative participants was 7.09 + 2.90 years (range 2.92 – 11.22), and in amyloid positive participants 5.6 + 2.10 (range 2.27 – 9.67). Baseline amyloid deposition was a significant predictor of increase deposition over time. In a Cox model controlled for age, sex, education level, APOE‐4 allele, mortality, and baseline MMSE, change in amyloid deposition from 2009 to 2010‐11 was not significantly associated with incident dementia (HR 2.19 (0.41‐11.73). Baseline continuous measures of amyloid deposition, cortical thickness and white matter lesions (WMLs) were strong predictors of dementia. Approximately 70% of the participants who converted to dementia had either significant amyloid deposition (SUVR ≥1.67), cortical thickness, or WMLs positivity at baseline.ConclusionsThere was a substantial and steady amyloid deposition in this age group. There were very few (10%) participants who developed dementia without being amyloid positive. Individuals classified as amyloid negative at baseline became incident amyloid positive (SUVR > 1.67) prior to the dementia diagnosis, and most individuals who were amyloid positive at baseline developed dementia, especially when neurodegeneration was present.

Impact of lesion size on reproducibility of quantitative measurement and radiomic features in vessel wall MRI.

To investigate reproducibility of quantitative measurement and radiomic features in vessel wall MRI (VW-MRI), evaluate the impact of lesion size, and identify reproducible radiomic features. This retrospective, single-center study included 251 patients (mean age, 53 ± 12 years; 128 women) with atherosclerosis, dissection, aneurysm, moyamoya disease, and vasculitis of the intracranial arteries who underwent three-dimensional turbo spin echo T1-weighted image. Lesion thickness, volume, and signal intensity were measured, and 157 radiomic features were extracted. Intra-observer reproducibility of quantitative measurement and radiomic features was evaluated by calculating the concordance correlation coefficient (CCC) and proportion of radiomic features above the predefined CCC. The reproducibility of quantitative measurement and radiomic features according to lesion size (binary comparison and stratification into 5 and 18 groups) was evaluated. There was an overall serial increase in CCC for thickness measurement when stratified by lesion thickness and volume. There was an overall serial increase in the median CCC for radiomic features and proportion of radiomic features with CCC > 0.85 when stratified by lesion thickness and volume. Reproducibility of radiomic features was higher in the lesions with thickness ≥ 2.5 mm (median CCC, 0.97 vs. 0.89, p < .001; proportion with CCC > 0.85, 88.5% vs. 59.6%, p < .001) and volume ≥ 50 mm3 (median CCC, 0.97 vs. 0.88, p < .001; proportion with CCC > 0.85, 90.4% vs. 59.0%, p < .001). Intensity-based statistical features remained most reproducible in the thinnest and smallest lesions. Intra-observer reproducibility of thickness measurement and radiomic features was affected by lesion size in VW-MRI although intensity-based statistical features remained most reproducible. • There was an overall serial increase in CCC for thickness measurement when stratified by lesion size. • There was an overall serial increase in the median CCC for radiomic features and proportion of radiomic features with CCC > 0.85 when stratified by lesion size. • Intensity-based statistical features remained most reproducible in the thinnest and smallest lesions.

Predictors of treatment responses of superficial infantile hemangiomas to topical timolol.

Topical timolol is not effective in the treatment of some superficial infantile hemangiomas (IHs). This is a prospective study aiming to investigate the predictors of treatment response of superficial IHs to topical timolol. Patients with superficial IHs were prescribed timolol 0.5% cream four times daily and followed up every 2-3months until 1 year of age. IH thickness was objectively measured by ultrasound, and the proportional change was calculated as a regression rate. In total, 193 patients (211 lesions) were enrolled. Topical timolol was initiated at an average age of 3.1 (0-6) months for 7.4 (2-11) months. The average regression rate of all lesions was 41.8% (-137.5%-100%). Lesion thickness (p=0.000) and patient age at initial treatment (p=0.001) were major variables that predicted the treatment response. On average, an increase in lesion thickness of 1 mm decreased the regression rate by 22.1%, and lesions thicker than 1.9 mm were unlikely to respond (average regression rate=-0.27%). Available results did not show a significant effect of sex (p=0.659), lesion size (p=0.311), or location (p > 0.05) on regression. Treatment for superficial IHs should be individualized according to lesion thickness and patient age.

Polycystic ovarian syndrome with endometrial hyperplasia and uterine fibroids treated with homoeopathy: A case report

Introduction: Any circumstance that alters the balance of oestrogen and progesterone leads to excessive, prolonged estrogenic stimulation, or preventing the counteracting effects of progesterone causing various pathological conditions in the reproductive system, as a result. Women with polycystic ovarian syndrome (PCOS) have mostly anovulatory cycles and low serum progesterone levels. Endometrial hyperplasia is most often due to excess oestrogen without progesterone. The clinical significance of chronic oestrogen secretion is an increased risk of endometrial hyperplasia. A striking feature of uterine fibroids (UFs) is their dependency on the ovarian oestrogen and progesterone. Existing treatments are mostly directed at the symptoms but not at the syndrome itself. Case Summary: A patient suffering from PCOS, with Endometrial Hyperplasia and multiple UFs, was successfully treated with the homoeopathic medicine Pulsatilla nigricans. Repeat ultrasonography showed normal endometrial thickness, no hyperechoic or hypoechoic lesions in uterus and no ovarian PCOS morphology after treatment. Thus, the usefulness of homeopathic medicines for the treatment of multi-morbid pathologies related to reproductive system of women is demonstrated.

POS-133 CASE REPORT OF DISSEMINATED KLEBSIELLA INFECTION IN T2DM LEADING TO CKD

K. pneumoniae can present as two forms of community-acquired pneumonia, acute and chronic. Although acute pneumonia may turn into necrotizing pneumonia, which results in a prolonged clinical course, it often has a rapidly progressive clinical course. In contrast, chronic Klebsiella pneumonia runs a protracted indolent course that mimics other chronic pulmonary infections and malignancies. The Klebsiella pneumoniae bacteria usually affects the right upper lung lobe and results in the creation of a cavity, as well as pus-producing tissue death.K. pneumoniae is an aggressive microorganism, accounting for 0.5 to 5% of pneumonia cases. It can lead to cavitation (30-50% of cases) and necrotising pneumonia (NP) within a short period of time (days). Case : 40 year old male with a history of diabetes mellitus (DM) was admitted 20 days back patient was admitted and treated for DKA and LRTI discharged after treatment. Patient readmitted 20 days later with complaints of right sided loin pain, high grade fever of 8 days, cough with expectoration for one month, pyuria for 5 days and anuria for one day. Patient readmitted On admission – P-96/min, BP-140/90 mmhg, RR-26/min, Spo2-96% with O2. On evaluation patient was found to have raised creat (8mg/dl) initiated on hemodialysis. Patient ultrasound showed of left sided bulky kidney with acute pyelonephritis. CXR showed cavitatory lesion in middle lobe of right side lung. 5days Later patient complaint of increased left loin pain repeat USG showed left sided psoas abscess so CT showed no any evidence of communication of pyelonephritis with abscess. Pigtail drain was placed for psoas abscess, culture which was positive for klebsiella. Sputum culture was positive for klebsiella, A diagnosis of dissiminated klebsiella infection was made. In spite of all necessary investigations and treatment patient was dialysis dependent, patient deteriorated over time and could not be saved. Investigations :Tabled 1ParametersValuesHemoglobin9.8 gm/dlTotal leukocyte counts25,500/cummPlatelets2.4 lac/cummUrea104 mg/dlCreatenine4.2 mg/dlSerum Na136 mmol/lSerum K4.5 mmol/lBilirubin1.5 mg/dlSGOT/SGPT45/32Calcium7.6 mg/dlPhosphorus5.8 mg/dlUric acid6.2 mg/dlHbA1c10.5%Urine examinationAlb ++ Sug + Epi cells 1-2/min Pus cells - plenty RBC - 1-2/hpf24 hr urinary protein1.5 gm/day Open table in a new tab Sputum culture & Pus culture – klebsiella Sputum for MTB - negative Fundus – moderate NPDR CXR – Cavitatory lesion in right lung middle zone USG – RK – 12.5*5.9cm, LK – 13.6*6.2cm mod dilation of pelvicalyceal system bilateral bulky kidneys with left acute pyelonephritis. CT abd – left psoas bulky with evidence of 8*2.5 cm well defined hypodense collection within. CT chest – Thick walled cavitatory lesions with surrounding consolidation noted in medial segment of right middle lobe, postero-basal segment of right lower lobe, superior segment of left lower lobe We conclude that patients with immunocompromised state like Diabetes mellitus are more prone to disseminated infections which can lead to high morbidity and mortality. Good glycemic control, early diagnosis and effective management with could be key role in managing a diabetic patient.

Evaluation of Transdermal Transport and Concurrent Cutaneous Hydrolysis of Timolol Prodrug for the Treatment of Infantile Hemangiomas.

Infantile hemangiomas (IH) leave sequelae after involution. Topical application of timolol maleate (TM) is the mainstream treatment for superficial lesions but is limited by its low penetrable properties. We aimed to develop a superior skin permeation drug while maintaining the therapeutic properties of timolol. We predict that this drug will promote the involution of thick and deep IH lesions and avoid sequelae. We chemically modified drug structure to prepare butyryl timolol maleate (BT) prodrug and conducted in vitro and in vivo toxicity evaluations of BT with rat dorsal skin and normal skin cells. Skin permeation and absorption comparisons of TM and BT were conducted using rat and porcine skin models. Conversion efficiency of BT to timolol was also tested on human skin ex vivo. BT did not cause skin irritation on rat dorsal skin and exhibited low cytotoxicity overall. BT exhibited superior skin permeation ability compared with that of TM, whilst maintaining a low systemic absorbance. Further, BT was converted to timolol in human skin in a time-dependent manner. Noticeably, timolol accumulation in the skin from BT was higher than that from TM. Finally, BT demonstrated similar biocompatibility with TM in the IH tumor. BT enhances local delivery of timolol and its skin permeation. Using BT, we could eliminate thicker IH lesions that are prone to leave sequelae, and potentially help young children avoid dermal sequelae, disfigurement, and concomitant therapy.

Tumor stage-specific trends of sentinel lymph node biopsy for vulvar melanoma (406)

<b>Objectives:</b> Vulvar melanoma is a rare and understudied malignancy. Due to its poor prognosis, management has included vulvectomy and complete bilateral inguinofemoral lymphadenectomy. The Standard of care for cutaneous melanomas is to perform sentinel lymph node (SLN) biopsy during excision of intermediate thickness lesions. Lymph node dissection in the inguinofemoral region can result in significant morbidity; thus, the utilization of SLN biopsy for vulvar melanoma is under active investigation. The Standard of care regarding SLN biopsy for vulvar melanoma is not yet determined due to limited prospective data. The objective of this study was to examine the trends and outcomes related to SLN biopsy for vulvar melanoma in the United States according to the local tumor stage. <b>Methods:</b> This population-based retrospective cohort study utilized the National Cancer Institute's Surveillance, Epidemiology, and End Result program from 2004 to 2018. The study population included women with non-metastatic T1-4 stage vulvar melanoma who underwent vulvectomy and had data regarding the method of nodal evaluation. The exposure assignment was based on nodal evaluation: lymphadenectomy, SLN biopsy, or no surgical nodal evaluation. The main outcome was <i>(i)</i> temporal trends of lymphadenectomy or SLN biopsy based on T stage, assessed with a three-year time increment and the Cochrane-Armitage trend test, and <i>(ii)</i> overall survival related to SLN biopsy assessed with inverse probability of treatment weighting propensity score. <b>Results:</b> A total of 729 women with T1-4 vulvar melanoma were examined for analysis. For T1 disease (<i>n</i>=215), the utilization of SLN biopsy significantly increased from 16.7% to 38.9% (<i>p</i>=0.002) over time. For T2 disease (<i>n</i>=156) and T3 disease (<i>n</i>=120), the frequency of SLN biopsy was unchanged during the study period (T2 disease, 22.6% to 26.6%, <i>p</i>=0.279; and T3 disease, 27.3% to 37.0%, <i>p</i>=0.812). For T4 disease (<i>n</i>=238), there was a statistically significant increase in the number of women receiving SLN biopsy from 21.2% to 32.9% (<i>p</i>=0.042) during the study period. Across the four disease groups, the SLN biopsy and LND groups had comparable overall survival in the weighted models (all <i>p</i>>0.05). <b>Conclusions:</b> This large sample size, population-based study found an upward trend in performance of SLN biopsy in both T1 and T4 vulvar melanoma in the past decade in the United States. In T2 and T3 vulvar melanoma, SLN biopsy did not increase. While SLN biopsy is standard in T2-3 cutaneous melanoma, it appears to be less utilized in these tumor stages of vulvar melanoma. Given the significant morbidity associated with inguinal lymph node dissection, further research is warranted on whether these trends have truly resulted in decreased perioperative morbidity.

Anti-inflammatory and anti-pruritic effects of Chi-Huang Solution in a murine model of allergic contact dermatitis

Ethnopharmacological relevanceIn treating atopic dermatitis, multi-mode management is adopted, including trying to avoid the allergens, controlling and preventing secondary infections, and using drugs to control itching. At present, most of the commonly used anti-pruritic drugs in the clinic are single-target and lead to serious side effects. Many studies have shown that a variety of traditional Chinese medicines have significant anti-inflammatory and anti-pruritic effects, and have the characteristics of multiple components, multiple targets, and multiple effects. Aim of the studyThe study aimed to explore the anti-inflammatory and anti-pruritic effects of the Chi-Huang Solution in a murine model of Allergic contact dermatitis (ACD). This study considers the effectiveness of the Chi-Huang Solution for external use on skin to provide an experimental basis for the clinical development and application of Chinese medicine and related preparations for Canine atopic dermatitis (CAD). Materials and methodsForty-two male SPF C57BL/6 mice were randomly divided into control group (n = 6), ACD model group (n = 6), HAC control group (n = 6), and 4 Chi-Huang Solution groups (n = 6 in each group). With SADBE induce the murine model of ACD chronic pruritus, and initially evaluate whether the model is successful by counting scratching behavior, measuring the skin fold thickness and skin lesion score within 1 h. After treating the ACD model mice with deionized water, HAC, 1CH, 2CH, 3CH, and 4CH for 7 days, behavioral changes were used to evaluate the anti-pruritic effect. The skin fold thickness, skin lesion score, and spleen index were used to evaluate the anti-inflammatory effect of the Chi-Huang Solution. H.E. staining was used for the epidermal thickness measurement and pathological evaluation. RT-qPCR was used to analyze the mRNA expression of related inflammatory factors such as IL-1β, TNF-α, IL-33, IL-4, IL-17A, CXCL10, and its receptor CXCR3 in the skin of the lesion site, as well as to detect the mRNA expression of pruritus-related genes such as TRPV1, TRPA1, and GRP in DRG. ResultsAfter the treatment of low-dose (0.1 g/mL) and medium-dose (0.2 g/mL) Chi-Huang Solution, the scratching times both decreased significantly (P < 0.05), meanwhile the medium-dose Chi-Huang Solution had an obvious effect on reducing scratches/scab score (P < 0.05). Moreover, no matter what dose it takes, all Chi-Huang Solution can alleviate the epidermal thickening (P < 0.05) and the infiltration of mast cells in the ACD murine model of ACD. It is worth mentioning that the count of mast cells in the dermis was significantly down-regulated after the treatment of medium-dose Chi-Huang Solution (P < 0.005). Furthermore, Chi-Huang Solution can significantly down-regulate the mRNA expression of related inflammatory factors in the skin, and reduce the mRNA expression of pruritus-related genes, such as TRPA1, TRPV1, and GRP in the spinal cord. ConclusionsThe results indicated that Chi-Huang Solution for external use exhibits significant anti-inflammatory and anti-pruritic effects on SADBE-induced ACD chronic pruritus murine models. Chi-Huang Solution might emerge as an effective drug for the treatment of CAD and high-dose Chi-Huang Solution (0.4 g/ml) has better comprehensive effects.

625 Association of race with thickness in cutaneous melanoma

Prior studies examining racial disparities in cutaneous melanoma have found that Black patients (BPs) present at a later stage than non-Hispanic White patients (NHWPs). However, previous studies have not assessed whether there are differences in the thickness of primary melanoma lesions between BPs and NHWPs, nor have they examined in detail socioeconomic status (SES) and primary body location (PBL) as potential explanations for the stage differences noted. This study sought to determine whether there are differences in the thickness distribution between melanoma of BPs and NHWPs matched for histologic subtype, controlling for SES and PBL.

The value of high-definition intelligent endoscopy combined with stroboscopy in the diagnosis and treatment of vocal cord leukoplakia

Objective: To evaluate the clinical value of high-definition intelligent endoscopy (iSCAN) combined with stroboscopy in identifying vocal cord leukoplakia. Methods: Seventy-nine patients with vocal cord leukoplakia who underwent CO2 laser laryngeal microsurgery and diagnosed by histopathology were recruited between October 2020 to August 2021. The morphological features, microvascular morphology and mucosal waves were observed by stroboscope; SPSS 20.0 software was used for statistical analysis. Results: There were 79 patients with a total of 119 lesions (56 on left and 63 on right).Pathological examination showed that 51 sides of the vocal cords were malignant lesions (severe dysplasia, carcinoma in situ and invasive carcinoma), and 68 sides were benign lesions.Under stroboscopy, 69 sides of mucosal wave were normal or slightly decreased, and 50 sides were severely decreased or disappeared.The decrease degree of mucosal wave was positively correlated with malignant lesions (ρ=0.687, P<0.001).Under iSCAN endoscopy, there was a positive correlation between the morphological changes of microvessels at the lesion site (vertical) and the malignant lesion (ρ=0.687, P<0.001).Univariate analysis showed that lesion size, thickness, uneven color, granular elevation, peripheral erythema and asymmetry were positively correlated with malignant lesions (ρ=0.530, 0.401, 0.538, 0.315, 0.497, 0.281, P<0.05).Logistic regression analysis showed that the risk of pathological malignancy with large lesions was 5.437 times higher than those of small lesions, the vertical vascular changes under iSCAN were 8.711 times higher than that of normal vascular morphology, and the severe reduction or disappearance of mucosal waves was 9.12 times higher than that of normal or mild reduction of mucosal waves. Conclusion: ISCAN can be combined with staphyloscopy to comprehensively observe and evaluate the changes of vocal cord morphology, submucosal microvessels and mucosal wave of vocal cord in patients with vocal cord leukoplosis, thus improving the ability to distinguish benign and malignant lesions.

Clinical and biological subtypes of late-life depression

BackgroundLate-life depression (LDD) results from multiple psychosocial and neurobiological changes occurring in later life. The current study investigated how patterns of clinical symptoms and brain structural features are classified into LDD subtypes. MethodSelf-report scale of depression, behavioral rating of affective symptoms, and brain structural imaging of white matter change and cortical thickness were assessed in 541 older adults with no cognitive impairment or mild cognitive impairment. Latent profile analysis was used to identify distinct subtypes of depression. ResultsThe latent profile analysis identified four classes with mild to severe depressive symptoms and two classes with minimal symptoms. While the classes primarily differed in the overall severity, the combinatory patterns of clinical symptoms and neuropathological signature distinguished the classes with similar severity. The classes were distinguished in terms of whether or not neurodegenerative risk accompanied the corresponding depressive symptoms. The presence of the negative self-scheme and cortical thinning pattern notably characterized the subtypes of LDD. LimitationsThe underlying etiologies of the biological subtypes are still speculative, and the current study lacks clinical history that differentiates late- and early-onset depression. ConclusionsOur finding provides insight in identifying heterogeneities of depressive disorder in later life and suggests that self-report and behavioral symptom profile in combination with white matter lesion and cortical thickness effectively characterizes distinct subtypes of LDD.

MERLIN_001: A prospective registry study of a primary melanoma gene-signature to predict sentinel node (SN) status and determine its prognostic value for more accurate staging of patients with SN-negative melanoma.

TPS9606 Background: For patients with cutaneous melanoma, sentinel lymph node biopsy (SLNB) provides important staging and prognostic information that guides surveillance and adjuvant systemic therapy decisions. At most centers, SLNB is indicated for patients with cutaneous melanoma with at least a 5% risk of having nodal metastases, typically melanomas ≥ 0.8 mm in thickness or thinner lesions with high-risk features such as elevated mitotic rate and/or ulceration. SLNB, generally involving a separate incision, does carry a small but measurable risk of complications including seroma, infection and rarely lymphedema, and most patients have negative sentinel lymph nodes. Currently, there is an unmet clinical need to identify patients who may safely forgo SLNB due to a low (&lt;5%) risk of nodal metastasis, who otherwise meet established criteria for SLNB. Previously, a model consisting of gene expression profile (GEP) of the primary tumor combined with clinicopathological features (CP) has been developed to identify melanoma patients with a low risk of having a positive SLNB. The model has also been validated in multiple retrospective studies. The aim of the MERLIN_001 registry study is to prospectively validate the CP-GEP model in an independent multicenter cohort of primary cutaneous melanoma patients who undergo SLNB for standard indications. Methods: In the next two years, a total of 10 centers across the US will enroll 2,340 patients with clinically node-negative cutaneous melanoma undergoing SLNB using current guideline indications and will follow these patients for 5 years (ClinicalTrials.gov identifier: NCT04759781). Enrollment of patients started in September 2021 and 242 patients have been enrolled as of February 1, 2022. FFPE material from the initial melanoma biopsy will be used to assess the GEP of the primary melanoma. The CP-GEP probability scores will be expressed as a binary classification (Low Risk or High Risk for nodal metastasis) and will be compared to SLN pathology. Performance metrics for CP-GEP will be evaluated and will include: Negative Predictive Value, Positive Predictive Value, Sensitivity and Specificity, and the corresponding 95% confidence intervals. Risk for nodal metastasis will be calculated for Low Risk and High Risk CP-GEP patients. Finally, the performance of CP-GEP to stratify patients according to risk of recurrence (local, regional, distant, death) will also be studied, since data will be collected for up to 5 yrs. Clinical trial information: NCT04759781.

POST-COVID-19 PULMONARY ASPERGILLOSIS AND MUCORMYCOSIS CO-INFECTION IN A PATIENT WITH DIABETES: A COMBINED CHALLENGING COMPLICATION

TYPE: Abstract TOPIC: Chest Infections PURPOSE: The recent emergence of COVID-19 disease had been associated with rare, invasive and life threatening fungal infections such as pulmonary aspergillosis and mucormycosis caused by Aspergillus fumigatus and Rhizopus arrhizus respectively with higher case fatality rate(>50%) especially among immunocompromised patients, diabetes mellitus, usage of steroids & other immunomodulators and covid infection itself. Here,we describe a case of Pulmonary aspergillosis and mucormycosis occuring in a 62 years old male diabetic patient who had history of COVID-19 infection 42 days back. After confirmation of diagnosis and aggressive therapeutic measures, he was discharged after 6 weeks of indoor treatment. The treatment depends on early and precise diagnosis followed by long term use of combination of antifungal agents and surgical intervention when necessary. Thus careful assessment and early diagnosis could lead to early therapeutic interventions and ultimately better outcomes. METHODS: Diagnosis on the basis of imaging CT Thorax findings- 52*48 mm thick walled cavity lesion with surrounding area of consolidation- reverse halo sign in right lower lobe and bronchoscopy guided TBLB & HPE findings were positive for aspergillus and mucormycosis. RESULTS: Both bronchoscopic and TBLB are effective tools to diagnose aspergillus and mucomycosis infection.In the treatment part, if feasible, attempts to reverse the underlying predisposing factors should be made. CONCLUSIONS: This case report highlights the need for healthcare professionals to be aware that combined pulmonary aspergillosis and mucormycosis can present as secondary complications of COVID-19 coinfection in diabetics. CLINICAL IMPLICATIONS: The combined risk factors of diabetes mellitus, COVID-19 and recent corticosteroid treatment contributed to both infections in our patient. DISCLOSURE: Nothing to declare. KEYWORD: COVID-19 , Pulmonary , Aspergillosis , Mucormycosis , Diabetes mellitus

Serum neurofilament as a predictor of 10-year grey matter atrophy and clinical disability in multiple sclerosis: a longitudinal study

BackgroundThe predictive value of serum neurofilament light chain (sNfL) on long-term prognosis in multiple sclerosis (MS) is still unclear.ObjectiveInvestigate the relation between sNfL levels over a 2-year period in patients...

Analyzing the correlation among the five indications of the regenerative effectiveness of expanded skin: A retrospective study of 277 expansion cases

BackgroundSkin expansion is a useful method for harvesting extra tissue. However, the outcome is hardly predictable. MethodsA total of 158 patients with 277 expanded skin cases were reviewed and evaluated via photographs. The review and evaluation were conducted to determine the skin’s regenerative condition. The overall texture of the expanded skin, which was deemed good, fair, or poor, was evaluated. The occurrence of five indications of the limitation of skin regeneration (thinning, color change, stretch marks, varicose vessels, and skin lesions) during expansion was recorded. The correlation between the five indications and the overall texture was statistically analyzed. ResultsAmong the 277 retrospectively reviewed expansion cases, the occurrence rate of skin deterioration showed significant differences between the expansion sites (P<0.01). Skin deterioration was most commonly seen on the neck and at the back. The occurrence of each indication varied among locations. The odds ratios of color change, stretch marks, varicose vessels, thinning, and skin lesions between good and poor skin conditions were 44.97, 5.09, 22.26, 89.79, and 4.61, respectively (all P<0.001). ConclusionSkin color, stretch marks, varicose vessels, thickness, and skin lesions are closely correlated with the skin regenerative capacity. An integrated evaluation can help predict the regenerative capacity of expanded skin.

The relative contribution of the decreasing trend in tumourthickness to the 2010s increase in net survival fromcutaneous malignant melanoma in Italy: a population-based investigation.

BackgroundThe long‐term increase in survival from cutaneous malignant melanoma (CMM) is generally attributed to the decreasing trend in tumour thickness, the single most important prognostic factor.ObjectivesTo determine the relative contribution of decreased tumour thickness to the favourable trend in survival from CMM in Italy.MethodsEleven local cancer registries covering a population of 8 056 608 (13.4% of the Italian population in 2010) provided records for people with primary CMM registered between 2003 and 2017. Age‐standardized 5‐year net survival was calculated. Multivariate analysis of 5‐year net survival was undertaken by calculating the relative excess risk (RER) of death. The relative contribution of the decrease in tumour thickness to the RER of death was evaluated using a forward stepwise flexible parametric survival model including the available prognostic factors. Results Over the study period, tumour thickness was inversely associated with 5‐year net survival and multivariate RER in both sexes. The median thickness was 0.90 mm in 2003–2007, 0.85 mm in 2008–2012 and 0.75 mm in 2013–2017 among male patients, and 0.78 mm, 0.77 mm and 0.68 mm among female patients, respectively. The 5‐year net survival was 86.8%, 89.2% and 93.2% in male patients, and 91.4%, 92.0% and 93.4% in female patients, respectively. In 2013–2017, male patients exhibited the same survival as female patients despite having thicker lesions. For them, the increasing survival trend was more pronounced with increasing thickness, and the inclusion of thickness in the forward stepwise model made the RER in 2013–2017 vs. 2003–2007 increase from 0.64 [95% confidence interval (CI) 0.51–0.80] to 0.70 (95% CI 0.57–0.86). This indicates that the thickness trend accounted for less than 20% of the survival increase. For female patients, the results were not significant but, with multiple imputation of missing thickness values, the RER rose from 0.74 (95% CI 0.58–0.93) to 0.82 (95% CI 0.66–1.02) in 2013–2017.ConclusionsFor male patients in particular, decrease in tumour thickness accounted for a small part of the improvement in survival observed in 2013–2017. The introduction of targeted therapies and immune checkpoint inhibitors in 2013 is most likely to account for the remaining improvement.

Nicotinamide mononucleotide ameliorates DNFB-induced atopic dermatitis-like symptoms in mice by blocking activation of ROS-mediated JAK2/STAT5 signaling pathway

Background and purposeAtopic dermatitis (AD) is a chronic inflammatory skin disease, characterized by pruritus and impaired skin barrier function. The pathology of AD involves in immune dysfunction and epidermal barrier disruption. Reactive oxygen species (ROS) are found to be associated with AD, and play a role in the immunological abnormalities and dysfunctional skin barrier. Nicotinamide mononucleotide (NMN) plays an important role in oxidative stress related diseases, but its role in AD is unclear. MethodsKM mice were treated with DNFB to induce AD-like lesion and typical applied with NMN for two weeks. The dermatitis score, the degree of itching and TEWL were evaluated during modeling. Epidermal thickness of skin lesions and histopathological changes were detected. Further, inflammatory factors, epidermal differentiation-related genes, oxidative stress indicators and JAK2/STAT5 signaling pathway were evaluated. NHEK cells were stimulated by TNF-α/IFN-γ after pre-treatment with NMN, then ROS levels, inflammatory factors and JAK2/STAT5 signaling pathway were detected. ResultsNMN exhibited potent anti-atopic activities, shown by alleviated AD-like symptoms, inhibited the increased expression of inflammatory cytokines and restored proteins and mRNA level of skin barrier genes. In addition, NMN inhibited TNF-α/IFN-γ-stimulated elevation of inflammatory chemokines, which was associated with blocking the activation of ROS-mediated JAK2/STAT5 pathway. ConclusionNMN may have a positive effect on relieving symptoms of AD.

Knee chondral delaminations and blisters

<h2>ABSTRACT</h2> Cartilage injuries are well known to be troublesome and difficult to treat. Such injuries are partial and full thickness lesions most often easily detectable on MRI scanning. However, less well-known are lesions that start between the calcified bone (in the calcified zone) and the bone plate and they are called chondral delaminations. Such lesions often take time to detect. If not found and treated they may develop into full thickness lesions. In a short review, the diagnosis and treatment alternatives are discussed.

Self-made transparent optoacoustic detector for measurement of skin lesion thickness in vivo

In skin cancer diagnosis and treatment, one of the key factors is tumor depth, which is connected to the severity and the required excision depth. Optoacoustical (OA) imaging is a relatively popular technique that provides information based on the optical absorption of the sample. Although often demonstrated with ex vivo measurements or in vivo imaging on parts of small animals, in vivo measurements on humans are more challenging. This is presumably because it is too time consuming and the required excitation pulse energies and their number exceed the allowed maximum permissible exposure (MPE). Here, we demonstrate thickness measurements with a transparent optoacoustical detector of different suspicious skin lesions in vivo on patients. We develop the signal processing technique to automatically convert the raw signal into thickness via deconvolution with the impulse response function. The transparency of the detector allows optical excitation with the pulsed laser to be performed perpendicularly on the lesion, in contrast to the conventional illumination from the side. For validation, the measured results were compared to the histological thickness determined after excision. We show that this simple transparent detector allows to determine the thickness of a lesion and thus, aid the dermatologist to estimate the excision depth in the future.

Isolation of circulating tumor cells to diagnose melanoma and evaluate the efficacy of surgical resection using melanoma-specific microsystem.

Melanoma is one of the most aggressive skin cancers due to its potential to metastasize widely in the body. The risk of metastasis is increased with later detection and increased thickness of the primary lesion, thus early identification and surgical removal is critical for higher survival rates for patients. However, even with appropriate treatment, some patients will develop recurrence which may be difficult to identify until advanced or causing symptoms. Recent advances in liquid biopsy have proposed less-invasive alternatives for cancer diagnosis and monitoring using minimal/zero invasion at sample collection, and circulating tumor cells(CTCs) have been considered a promising blood-based surrogate marker of primary tumors. However, previous CTC technologies relying on epithelial-cell adhesion molecules have limited to epithelial cells, thus hampering use of CTCs for non-epithelial cancers such as melanoma. Here, we used the Melanoma-specific OncoBean platform(MelanoBean) conjugated with melanoma specific antibodies(MCAM and MCSP). The device was used in comprehensive studies for diagnosing melanoma and evaluating surgery efficacy based on change in the number and characteristics of CTCs and CTC-clusters pre- and post-surgical treatment. Our study demonstrated that melanoma patients(n=45) at all stages(I-IV) have a noticeable number of MCTCs as well as MCTC-clusters compared to healthy donors(n=9)(P=0.0011), and surgical treatment leads to a significant decrease in the number of CTCs(P<0.0001). The CTCs recovered from the device underwent molecular profiling for melanoma-associated genes expression using multiplexed qRT-PCR, demonstrating the ability to monitor molecular signature through treatment. The presented MelanoBean and the comprehensive approach will empower prognostic value of CTCs in melanoma in much larger cohort studies.