Lesion Thickness Research Articles

A Hydatid Cyst Case Diagnosed in Recurrent Urinary Tract Infection Examination of a Pediatric Patient

A 10-year-old girl applied to the family health center with complaints of urinary burning and left-side pain. It was found that she received various treatments for the diagnosis of recurrent urinary tract infection based on medical history. Hepatomegaly and left costovertebral angle tenderness were detected in physical examination,. Abdominal ultrasonography (USG) and computed tomography (CT) revealed a 3 mm thick encapsulated cystic lesion measuring approximately 8.5 x 8 x 8 x 8 cm in the left lobe of the liver that also presses on the left kidney. In the follow-up of the patient, who was surgically treated and histopathologically diagnosed as a hydatid cyst, her complaints about recurrent urinary tract infection were observed to be resolved.

Fractional CO2 laser versus trichloroacetic acid 50% for xanthelasma palpebrarum therapy.

Although being a benign lesion, xanthelasma palpebrarum (XP) causes cosmetic concerns. There are numerous therapeutic methods for XP with adverse events for each method. Evaluate the safety, efficacy, and downtime of fractional CO2 laser (10600nm) versus 50% trichloroacetic acid (TCA) in XP therapy. Comparative interventional prospective study involved 20 adult patients with XP. Each patient received a split-face therapy where xanthelasma lesions treated with fractional CO2 laser on the one side and TCA 50% on the other side for maximum 5 sessions with 2-week intervals in between. Statistically significant improvement in lesion color, thickness, and size by both fractional CO2 and TCA 50%, with nonstatistically significant difference between both therapeutic modalities after treatment, although downtime, number of sessions, and patient's satisfaction were significantly better for fractional CO2 laser. Fractional CO2 laser (10600nm) is ideal for treatment of xanthelasma because it is safe and effective with short downtime, more patient satisfaction, less sessions, and less complications compared with chemical peeling using TCA (50%).

Rectal endometriosis: predictive MRI signs for segmental bowel resection.

To retrospectively determine the accuracy of MRI rectal and pararectal signs in predicting the necessity for segmental resection in the case of lesions located in the rectum. MR images of consecutive patients treated for rectal endometriosis over a 5-year period were reviewed in consensus by two blinded readers. A systematic analysis of 7 rectal (lesion length, transverse axis, thickness and circumference, and presence of a convex base, submucosal oedema and hyperintense cystic areas) and 4 pararectal (posterior vaginal fornix, parametrial, ureteral and sacro-recto-genital septum involvements) signs was performed for each lesion. MRI results were compared to the surgical procedure performed (shaving versus segmental resection). Among 61 patients studied, 32 received a segmental resection and 29, a shaving. Receiver operating characteristic curve analysis allowed determining cut-off values for length (≥ 32 mm), transverse axis (≥ 22 mm), thickness (≥ 14 mm) and circumference (≥ 3/8 radii). The 7 rectal signs, and only the sacro-recto-genital septum pararectal sign, were significantly associated with segmental resection in univariate analysis, nodular thickness ≥ 14 mm and circumference ≥ 3/8 radii being the most predictive signs (odds ratio 94.5 and 60.4, respectively). These 2 signs remained positively associated with segmental resection in multivariate analysis and, when combined, were predictive of segmental resection with an accuracy of 90.2%. Assessing MRI rectal and pararectal signs may accurately predict the need for segmental resection versus a more conservative approach such as shaving for rectal lesion management. • MRI analysis of rectal endometriosis, taking into account rectal and pararectal signs, may assist surgeons in the decision-making process, in counselling patients regarding the surgical procedure and in adequately allocating resources. • Among rectal signs, nodular thickness ≥ 14 mm and a circumference ≥ 38% were the most predictive signs of segmental resection. • Among pararectal signs, only the sacro-recto-genital septum involvement was significantly associated with segmental resection.

Does resurfacing of asymptomatic full-thickness localized articular defects of the trochlea influence the outcome following unicompartmental knee arthroplasty of the medial compartment?: A retrospective cohort study with minimum seven-year follow-up

BackgroundPatellofemoral joint (PFJ) degeneration has been found not to affect outcome following medial unicompartmental knee arthroplasty (UKA). However, PFJ disease occasionally presents as isolated trochlear cartilage lesions, with little available evidence regarding treatment options or necessity. We evaluated the effectiveness of concomitant trochlear resurfacing in patients undergoing medial UKA with asymptomatic trochlear lesions. MethodsWe included 60 patients undergoing medial UKA with an associated full thickness lesion of the trochlea. A fixed bearing UKA implant (PKR™, Stryker, Warsaw, IND) was used in all cases. In 30 patients, trochlear lesions were resurfaced with a HemiCAP® PF Classic (HemiCAP® PFC) implant (Arthrosurface, Franklin, MA). Outcome measures included VAS-, KOOS-, WOMAC-, SF-36 scores and radiological assessment. ResultsAverage length of follow-up was 97.4 months (range: 88–106 months). Both groups showed significant improvement for all clinical scores post-operatively compared to pre-operatively (p < 0.001 for all). The UKA group showed a better VAS score at all follow-up moments (p < 0.01 for all), but no differences were found between both groups at all time points for other outcome measures. None of the HemiCAP® PFC implants needed to be revised within the timeframe of the study. ConclusionsIn this retrospective cohort study, we found a 100% survivorship of the HemiCAP® PFC implant at an average eight-year follow-up. However, no clinical benefits were found in performing trochlear resurfacing in conjunction with medial UKA for asymptomatic end-stage trochlear cartilage lesions. Therefore, these lesions can be safely ignored when performing a medial UKA.

Evaluation of The Efficacy of Argon Laser in Treatment of Xanthelasma Palpebrarum using Ultrasound Biomicroscopy

Background: Xanthelasma palpebrarum [XP] is the most common of the xanthomas with asymptomatic, symmetrical, bilateral, soft, yellow, polygonal papules around the eyelids. The surgical laser offers an extremely elegant and powerful solution to this problem. Aim of the work:To evaluate the efficacy of Argon Laser in treatment of xanthelasma palpebrarum, based on ultrasound biomicroscopy [UBM]. Preoperatively, full history and clinical examination had been carried out. Patients and Methods: The study included 45 eyelids of 27 patients [13 males and 14 females] presenting with xanthelasma lesion. They underwent single session treatment of XP by Argon Laser, which had been performed on an outpatient basis. Postoperative UBM had been used to ensure eradication of the lesion. Follow up of the patient every 2 weeks in the first month then after 6 months]. Results: The UBM was successfully used preoperatively to determine the maximal lesion thickness that can be effectively safely eradicated in only single session. The therapy was well tolerated, and all lesions responded to the therapy in only single session. There were no functional or relevant aesthetic complications. The cosmetic outcome was considered to be excellent in 80% and good in 6.7%of the cases. The study included 45 eyelids, 36 [80.0%] of them had excellent, 3 [6.7%] had good, 2 [4.4%] had satisfactory and only 4[8.9%] patients had poor cosmetic outcome. There were no recorded recurrent cases [0.0%] in the present study. Conclusion: Argon laser photocoagulation [single session] represents an alternative treatment in selected cases. It is easy to be performed well tolerated by the patients. In addition, UBM was important to determine the maximal lesion thickness that can be eradicated safely in only one session.

Tunneling with conjunctival graft for volume increase peri-implant: case report

Introduction: The technique of tunneling connective graft has made it to recover defective vestibular volume, since it does not compromise aesthetics; it also gives the patient the function of the damaged area. Objective: The present study aims to report a case of tunneling with connective graft to increase peri-implant volume. Case Report: A 53-year-old female leucoderma sought a private clinic with complaint of pain, aesthetic dissatisfaction of element 11 and that had already had endodontic retreatment of the element in question and paraendodontic surgery, but without success. After performing the clinical examination and computed tomography, there was a paraendodontic lesion and little vestibular thickness and reabsorption of the cortical bone. In the planning, we opted for exodontic the element 11 and implant placement immediately. After healing, the need soft tissue grafting in the peri-implant region was observed to for vestibular volume increase. Final Considerations: it's corroborated that the technique of connective graft tunneling for soft vestibular soft tissue remodeling and new arrangement are excellent reconstructive technique, since it does not allow relaxing incisions, making it impossible to have scars.Descriptors: Connective tissue; Dental Implant; Grafts.ReferencesFaverani LP, Fereira GR, Gaetti-Jardim EC, Okamoto R, Shinohara EH, Assunção WG, Rangel Junior IR. Implantes osseointegrados: evolução e sucesso. Salusvita. 2011;30(1):47-58.Serrilho RP, Tolentino LS, Frare JG, Souza Pinto GN. Enxerto de tecido mole como opção para suprir defeitos peri-implantares. Relato de caso clínico. Rev Assoc Paul Cir Dent. 2015; 69(4):350-54.Thoma DS, Naenni N, Figuero E, Hammerle CHF, Schwarz F, Jung RE et al. Effects of soft tissue augmentation procedures on peri- implant health or disease: a systematic review and meta- analysis. Clin Oral Implants Res. 2018;29(Suppl 15):32-49. Giannobile WV, Jung RE, Schwarz F; Groups of the 2nd Osteology Foundation Consensus Meeting. Evidence-based knowledge on the aesthetics and maintenance of peri-implant soft tissues: Osteology Foundation Consensus Report Part 1-Effects of soft tissue augmentation procedures on the maintenance of peri-implant soft tissue health. Clin Oral Implants Res. 2018;29(Suppl 15):7-10. Zuhr O, Rebele SF, Cheung SL, Hürzeler MB; Research Group on Oral Soft Tissue Biology and Wound Healing. Surgery without papilla incision: tunneling flap procedures in plastic periodontal and implant surgery. Periodontol 2000. 2018;77(1):123-49.Xavier I, Alves R. Enxerto de tecido conjuntivo tunelizado – a propósito de um caso clínico. Rev port estomatol med dent cir maxilofac. 2015;56(4):256-61.Fiorin LG, Novaes VCN, Rinaldi H, Gusman DJR, Araujo NJ, Almeida JM et al. Enxerto de tecido conjuntivo subepitelial tunelizado em área periimplantar deficiente em mucosa queratinizada. Arch Health Invest 2017;6 (Spec Iss 2):154.

The effects of season on health, welfare, and carcass and meat quality of slaughter pigs.

This study assessed the effects of season on health, behaviour, physiological stress parameters, and carcass and meat quality in a total of 480 slaughter pigs. The following health indicators were recorded: pneumonia, pleurisy, milk spots, and pericarditis. Behaviour was monitored during unloading (slipping, falling, turning back, reluctance to move, panting, shivering) and lairaging (panting, shivering, huddling). Blood lactate and glucose concentrations were determined at exsanguination. Performance indices (live weight, daily weight gain), carcass (carcass weight, backfat and loin thickness, lean meat content, carcass lesion score), and meat quality (pH, temperature, drip, thawing and cooking losses, colour, marbling) traits were measured postmortem. Pigs slaughtered in winter had the highest live weight, carcass weight, loin thickness, and carcass lesion score, while the lowest live weight, carcass weight, and backfat thickness were recorded in pigs slaughtered in summer. The highest lactate and glucose concentrations were recorded in pigs slaughtered in summer. The highest prevalence of red, soft, and exudative meat was recorded in pigs slaughtered in winter. Pigs slaughtered in summer had the lowest pH, the highest thawing loss, L* value, b* value, and occurrence of pale, soft, and exudative meat. Pigs slaughtered in autumn had the lowest drip loss, cooking loss, L* value, b* value, and the greatest percentage of red, firm, and nonexudative meat. In conclusion, the summer and winter temperatures compromised health and welfare and reduced carcass and meat quality in slaughter pigs, indicating that protection against heat and cold stress is not yet effective.

Clinical, histopathological and immunohistochemical evaluation of daylight photodynamic therapy in the treatment of field cancerization: a study of 30 cases

Background Actinic keratosis (AK) are pre-malignant lesions, precursors of squamous cell carcinoma (SCC). Normal skin adjacent to AK, may present initial mutations with potential risk for new neoplasms, currently known today as field cancerization (FC). Objectives To evaluate the effectiveness of daylight photodynamic therapy (PDT) with methyl amino levulinate (MAL) based on clinical evaluation, histological examination and immunohistochemical expression of p53 and Ki67. Material and methods Thirty patients, over 35 years old, phototypes between I and III, presenting non-hypertrophic AK on the face or scalp. Two biopsies with 2 mm punch of the lesion and adjacent skin before and 60 days after daylight PDT were performed. Results: Improvement was seen in lesion thickness and Ki67. 19 (63.33%) lesions had atypia improvement with a p-value <.05, showing efficacy in treatment. After daylight PDT, 22 (73.33%) patients showed satisfactory esthetic improvement. Conclusion The study shows that PDT has cellular and molecular effects that support its indication in the control of carcinogenesis, as it decreases atypia and controls the expression of Ki67, reducing the proliferation of atypical cells. However, its indication following this study is still mainly aimed at clinical improvement of the skin, at this moment, probably due to the sample size.

Elevated IL-22 in psoriasis plays an anti-apoptotic role in keratinocytes through mediating Bcl-xL/Bax

IL-22 is known to mediate inflammation in psoriasis, while IL-22 binding protein (IL-22BP) binds IL-22 to suppress IL-22 signaling. However, the function of IL-22 in regulating apoptosis in psoriasis remains poorly understood. In this study, we found that IL-22/IL-22R1 in lesional skin and IL-22 in serum from psoriatic patients were highly upregulated compared with healthy controls, while IL-22BP was not changed. Correlations between IL-22/IL-22R1 levels and the thickness of psoriatic lesions suggested that IL-22 might positively regulate abnormal hyperplasia in psoriasis. Apoptotic keratinocytes were increased only in stratum corneum, but not in spinous and basal layers of psoriasis. Moreover, IL-22 promoted cell viability in human epidermal keratinocytes (HEKs). The apoptosis induced by TNF-α and IFN-γ was inhibited in HEKs treated with IL-22, since that IL-22 upregulated Bcl-xL and downregulated Bax production in HEKs in the presence of TNF-α and IFN-γ. In addition, IL-22BP could counteract the anti-apoptotic effect of IL-22. Our finding demonstrates that IL-22 might play an anti-apoptosis role on keratinocytes to balance cell proliferation and apoptosis in psoriatic epidermis.

Cimifugin ameliorates imiquimod-induced psoriasis by inhibiting oxidative stress and inflammation via NF-κB/MAPK pathway.

Cimifugin is an important component of chromones in the dry roots of Saposhikovia divaricata for treating inflammatory diseases. However, the possible effect of cimifugin in psoriasis needs further investigation. This current work was designed to evaluate the effects of cimifugin in psoriasis in vivo and in vitro, and unravel the underlying molecular mechanism. Here, we used imiquimod (IMQ) or tumor necrosis factor (TNF)-α to induce a psoriasis-like model in mice or keratinocytes. Obviously, the results showed that cimifugin reduced epidermal hyperplasia, psoriasis area severity index (PASI) scores, ear thickness and histological psoriasiform lesions in IMQ-induced mice. The decreased levels of reduced glutathione (GSH), superoxide dismutase (SOD) and catalase (CAT), and the accumulation of malondialdehyde (MDA) in skin tissues by IMQ were attenuated by cimifugin. Furthermore, it was observed that cimifugin effectively reversed IMQ-induced up-regulation of proinflammatory cytokines, including TNF-α, IL-6, IL-1β, IL-17A, and IL-22. Mechanically, we noticed that cimifugin inhibited IMQ-activated phosphorylation of NF-κB (IκB and p65) and MAPK (JNK, ERK, and p38) signaling pathways. Similar alterations for oxidative stress and inflammation parameters were also detected in TNF-α-treated HaCaT cells. In addition, cimifugin-induced down-regulation of ICAM-1 were observed in TNF-α-treated cells. Altogether, our findings suggest that cimifugin protects against oxidative stress and inflammation in psoriasis-like pathogenesis by inactivating NF-κB/MAPK signaling pathway, which may develop a novel and effective drug for the therapy of psoriasis.

The Effects of Fabric Containing Chamaecyparis obtusa Essential Oil on Atopic Dermatitis-Like Lesions: A Functional Clothing Possibility

Background: Essential oil derived from Chamaecyparis obtusa (EOCO) has been used as an alternative treatment for allergy-related diseases due to its immune-modulating characteristics. Clothing has the longest and most intense contact with human skin, and functional fabrics with intrinsic properties have been increasingly implemented in medical applications. Specially designed fabrics may support atopic dermatitis (AD) treatment. In this study, the effects of fabric containing EOCO on AD were investigated using an NC/Nga mouse model. Methods: The fabric was applied for 6 h per day for 14 days. The therapeutic effects were evaluated according to measurements of skin lesion severity (modified SCORAD score), transepidermal water loss (TEWL), serum IgE and inflammatory cytokine levels, lesion thickness measured after hematoxylin and eosin staining, and immunohistochemical and Western blot analysis for skin epidermal differentiation protein. Results: The EOCO group exhibited significantly reduced modified SCORAD score, TEWL, and serum IgE levels. Among the inflammatory cytokines analyzed, only the mean values of regulated on activation, normal T cell expressed and secreted were observed to be decreased compared with other control groups. The histological analysis of the skin also revealed that the EOCO group expressed reduced epidermal hyperplasia and recovered filaggrin, involucrin, and loricrin expression. Conclusions: It was confirmed that fabric containing EOCO has anti-atopic and anti-inflammatory properties. The study data show that fabric containing EOCO can be implemented as an alternative functional clothing for people suffering from AD.

Sonography: a sensitive and specific method for detecting trochlear cartilage pathologies.

MRI is now the modality of choice for evaluating articular cartilage. Nevertheless, it has some general drawbacks. Some patients cannot undergo MRI, and in others US scan could be the first examination and cartilage should be evaluated. Ultrasound could be a useful method for detecting trochlear cartilage low-grade lesions. In this study, our goal was to evaluate the efficacy of ultrasonography in detecting these lesions. All patients referred to our hospital, from July 2018 to July 2019, who were arthroscopic candidates due to sport-related pathologies, underwent ultrasound scan 1day prior to surgery. Ultrasound assessment was performed by an expert radiologist, with a 13-MHz probe, located transversely proximal to the patella in different degrees of knee flexion to assess trochlear lesion grade and thickness. Arthroscopic examination of all patients was performed by an experienced orthopedic knee surgeon (second author). Sensitivity and specificity of ultrasound were calculated. A total of 48 patients were involved in the study with a mean age of 33.2years (SD: 9.7), between 19 and 51years of age. Patients were 81% male (39 patients). The sensitivity of ultrasound in grading of trochlear cartilage lesion was 100%, meanwhile its specificity was 88.2% (30 cases had normal cartilage while this figure was 34 in arthroscopy). Sonography is a low-cost, accessible diagnostic tool with high sensitivity and specificity for early detection of trochlear cartilage pathologies. It can play an important role as an outpatient diagnostic workup in patients with anterior knee pain.

Measurement of Tumor Thickness in Cutaneous Squamous Cell Carcinomas: Do the Different Methods Provide Better Prognostic Data?

Cutaneous squamous cell carcinoma (cSCC) is the second most common cause of nonmelanoma skin cancers. Although it has a relatively low mortality rate, it may be locally destructive and potentially metastasize. Tumor thickness of the primary lesion is one important parameter associated with biologic behavior. Such measurement is currently performed in different ways depending on the anatomic location and subspecialty (eg, skin vs. head and neck vs. gynecologic pathology). Furthermore, the new The American Joint Committee on Cancer eighth edition has changed the previously recommended method of measurement of cSCC of head and neck from a modified Breslow thickness to measuring from the granular layer of adjacent, normal-appearing skin to the deepest invasive tumor cell. This study evaluated the clinical significance on patient outcome by measuring tumor thickness using 4 common, currently available methods (measurement from: A. uninvolved dermoepidermal junction; B. top of granular cell layer of the epidermis overlying the tumor, that is, similar to Breslow thickness; C. dermoepidermal junction with in situ cSCC; D. top of granular layer of uninvolved skin) in 85 specimens from nongenital areas of 78 patients with cSCC. Thirty-five percent of them were from the head and neck area. Measurements were performed in millimeters using the digital ruler of image analysis software (Olympus cellSens Standard) on whole-slide scanned images. Associations between recurrence-free survival (RFS) and each method were assessed. When thickness was considered as a continuous measure, there was no statistically significant association between any of the 4 measurement techniques and RFS. When using the currently recommended 6.0-mm cutoff, methods B and C were significantly associated with RFS. Similarly, when optimal cutoff values were selected, all 4 methods were significantly associated with RFS in univariable analysis. However, in a multivariable model that included the techniques and location of lesion, only method B, using the optimal cutoff value of 8.7 mm, was independently associated with RFS. In summary, in our series of cSCC, measurement of thickness using a Breslow method (method B) was significantly associated with RFS using the optimal cutoff and the currently recommended 6.0 mm in univariable analyses and the optimal cutoff in a multivariable assessment. Therefore, our data indicate that measurement of tumor thickness in a manner similar to Breslow thickness may be used to help predict recurrence in patients with cSCC.

Amyloidosis in the head and neck: CT findings with clinicopathological correlation

PurposeTo characterize the CT imaging features of head and neck amyloidosis and correlate with extent of disease and clinical outcomes. Materials and methodsThis retrospective study included 80 patients with head and neck amyloidosis who underwent soft tissue neck CT imaging between November 2003 and April 2018. The CT imaging features including lesion distribution, morphology (focal, diffuse/circumferential, or combined), presence and pattern of calcification, (punctate or diffuse), and thickness of airway lesion were evaluated and compared with the extent of amyloidosis (localized or systemic), and clinical course (stable, no recurrence, or progression requiring repeated surgical treatment). ResultsLocalized disease (83.8%, 67/80) was most common with AL type (97.6%, 41/42) representing nearly all cases of head and neck amyloidosis. The larynx was the most frequently affected organ (60.0%, 48/80), specifically the glottis (43.8%, 35/80). Calcification was seen in 65.0% of cases (52/80). Non-airway or tongue lesions were significantly associated with systemic (92.3%, 12/13) as opposed to localized amyloidosis (4.5%, 3/67; P < 0.001). Repeated surgical treatment was significantly associated with laryngeal amyloidosis (35.3%, 12/34; P = 0.002) and multi-centric disease (33.3%, 10/30; P = 0.048). Airway wall thickness in patients who required repeated surgical treatment was significantly greater than in patients with stable or no recurrent disease (P = 0.016). ConclusionKnowledge of the imaging features of head and neck amyloidosis can aid the diagnosis, disease monitoring, and prediction of patients requiring repeated surgical intervention.

Focal Scleral Nodule: A New Name for Solitary Idiopathic Choroiditis and Unifocal Helioid Choroiditis

To evaluate multimodal imaging findings of solitary idiopathic choroiditis (SIC; also known as unifocal helioid choroiditis) to clarify its origin, anatomic location, and natural course. Multicenter retrospective observational case series. Sixty-three patients with SIC in 1 eye. Demographic and clinical data were collected. Multimodal imaging included color fundus photography, OCT (including swept-source OCT), OCT angiography (OCTA), fundus autofluorescence, fluorescein and indocyanine green angiography, and B-scan ultrasonography. Standardized grading of imaging features. Mean age at presentation was 56 ± 15 years (range, 12-83 years). Mean follow-up duration in 39 patients was 39 ± 55 months (range, 1 month-25 years). The lesions measured a mean of 2.4× 2.1 mm in basal diameter, were located inferior (64%) or nasal to the optic disc, and appeared yellow (53%). No systemic associations were found. The lesions all appeared as an elevated subretinal mass, with OCT demonstrating all lesions to be confined to the sclera, not the choroid. On OCT, the deep lesion margin was visible in 12 eyes with a mean lesion thickness of 0.6 mm. Overlying choroidal thinning or absence was seen in 95% (mean choroidal thickness, 28 ± 35 μm). Mild subretinal fluid was observed overlying the lesions in 9 patients (14%). Retinal pigment epithelial disruption and overlying retinal thinning was observed in 56% and 57%, respectively. OCT angiography was performed in 13 eyes and demonstrated associated choroidal and lesional flow voids. Four lesions (6%) were identified at the macula, leading to visual loss in 1 patient. One lesion demonstrated growth and another lesion showed spontaneous resolution. In this largest series to date, multimodal imaging of SIC demonstrated a scleral location in all patients. The yellow and white clinical appearance may be related to scleral unmasking resulting from atrophy of overlying tissues. Additional associated features included documentation of deep margin on swept-source OCT, trace subretinal fluid in a few patients, and OCTA evidence of lesional flow voids. Because of the scleral location of this lesion in every patient, a new name, focal scleral nodule, is proposed.

Laparoscopic total biopsy for suspected gallbladder cancer: A case series.

Background and aimsImaging diagnosis of gallbladder cancer remains difficult to achieve preoperatively. We developed a novel approach based on laparoscopic whole‐layer cholecystectomy (LWLC) and laparoscopic gallbladder bed dissection (LGBD) for total biopsy, for ultimately determining the optimal treatment strategy for suspected gallbladder cancer detected on preoperative imaging. Here, we describe a case series of patients who underwent this procedure at our institution.MethodsWe retrospectively examined clinicopathological data of consecutive patients with suspected gallbladder carcinoma at Yamaguchi University Graduate School of Medicine from September 2016 to July 2018 on which a laparoscopic approach was used. Preoperative imaging findings suggestive of gallbladder cancer were defined as follows: elevated lesion >10 mm in diameter, increasing tumor size over time compared with the previous imaging, sessile lesion, irregular wall thickness lesion mimicking cancer, elevated lesion with dense enhancement, or positive results on fluorodeoxyglucose positron emission tomography. LWLC was performed for early‐stage or suspected malignant lesions without liver invasion, and LGBD was performed for lesions with an unclear border between the gallbladder and the liver. When postoperative pathological examination revealed the presence of gallbladder cancer invading into the subserosal layer, additional gallbladder bed resection and regional lymphadenectomy were considered. Patient characteristics, perioperative findings, pathological findings, and postoperative outcomes of patients who underwent LWLC or LGBD were reviewed retrospectively, and the short‐term outcomes of the laparoscopic approach were analyzed.ResultsFifteen consecutive patients were included in the study. The median age of the patients was 63 years (IQR 42‐76 years); 7 patients were males. We performed LWLC in 12 cases and LBGD in 3 cases. Median (IQR) operation time was 159 (140‐193) min and median blood loss was 10 (5–30) mL. No bile leakage caused by intraoperative perforation of the gallbladder was seen. Median hospital stay was 7 (5–9) days. Only one patient developed postoperative complications (abdominal abscess). Histologically, gallbladder cancer was diagnosed in five cases (pT1a, n = 2; pT2, n = 3), and two of the pT2 patients underwent additional open surgery.ConclusionsOur laparoscopic‐based approach for suspected gallbladder cancer might represent a safe strategy and could play an important role in defining the optimal treatment strategy.

Efficacy and Safety of Continuous Risankizumab Therapy vs Treatment Withdrawal in Patients With Moderate to Severe Plaque Psoriasis

Risankizumab selectively inhibits interleukin 23, a cytokine that contributes to psoriatic inflammation. To evaluate the efficacy and safety of risankizumab vs placebo and continuous treatment vs withdrawal in adults with moderate to severe plaque psoriasis. Multinational, phase 3, randomized, double-blind, placebo-controlled trial conducted from March 6, 2016, to July 26, 2018. A total of 507 eligible patients had stable moderate to severe chronic plaque psoriasis for 6 months or longer, body surface area involvement greater than or equal to 10%, Psoriasis Area and Severity Index (PASI) greater than or equal to 12, and a static Physician's Global Assessment (sPGA) score greater than or equal to 3. Intention-to-treat analysis was conducted. Patients were randomized (4:1, interactive response technology) to risankizumab, 150 mg, subcutaneously, or placebo at weeks 0 and 4 (part A1). All patients received risankizumab at week 16. At week 28, patients randomized to risankizumab who achieved an sPGA score of 0/1 were rerandomized 1:2 to risankizumab or placebo every 12 weeks (part B). Co-primary end points for the part A1 phase included proportions of patients achieving greater than or equal to 90% improvement in PASI (PASI 90) and sPGA score of 0/1 at week 16. The PASI measures severity of erythema, infiltration, and desquamation weighted by area of skin involvement over the head, trunk, upper extremities, and lower extremities; scores range from 0 (no disease) to 72 (maximal disease activity). The sPGA assesses average thickness, erythema, and scaling of all psoriatic lesions; scores range from 0 (clear) to 4 (severe), with 0/1 indicating clear or almost clear. Primary and secondary end points in part B included proportion of rerandomized patients achieving an sPGA score of 0/1 at week 52 (primary) and week 104 (secondary). Of 563 patients screened, 507 were randomized to risankizumab (n = 407) or placebo (n = 100). Most patients were men (356 [70.2%]); median age was 51 years (interquartile range, 38-60 years). At week 16, 298 patients (73.2%) in the treatment group vs 2 patients (2.0%) receiving placebo achieved a PASI 90 response, and 340 patients (83.5%) receiving risankizumab vs 7 patients (7.0%) receiving placebo achieved sPGA 0/1 scores (placebo-adjusted differences: PASI 90: 70.8%; 95% CI, 65.7%-76.0%; sPGA 0/1: 76.5%; 95% CI, 70.4%-82.5%; P < .001 for both). At week 28, 336 responders were rerandomized to risankizumab (n = 111) or treatment withdrawal (n = 225). At week 52, the sPGA 0/1 score was achieved by 97 patients (87.4%) receiving risankizumab vs 138 patients (61.3%) receiving placebo. At week 104, the sPGA 0/1 score was achieved by 90 patients (81.1%) receiving risankizumab vs 16 patients (7.1%) receiving placebo (placebo-adjusted differences: week 52: 25.9%; 95% CI, 17.3%-34.6%; week 104: 73.9%; 95% CI, 66.0%-81.9%; P < .001 for both). Rates of treatment-emergent adverse events were similar between risankizumab (186 [45.7%]) and placebo (49 [49.0%]) in part A1 and remained stable over time. Risankizumab showed superior efficacy compared with placebo through 16 weeks and treatment withdrawal through 2 years. Risankizumab was well tolerated, with no unexpected safety findings during the 2-year trial. ClinicalTrials.gov Identifier: NCT02672852.

HPV: The Power of Vaccination

INTRODUCTIONGenital human papillomavirus (HPV) is a sexually transmitted infection (STI) that can lead to oropharyngeal, anal, cervical, vaginal, and penile cancers. It is the initiating event for malignant transformation and cervical dysplasia classified by the thickness of squamous intraepithelial lesions. Histologic evidence shows disorganized architecture and koilocytic changes in the epithelium, with a predilection for the squamocolumnar junction or transformation zone. Compared to heterosexual population, LGBTQIA+ subgroups may be at higher risk to HPV infections. This study aims to determine how knowledgeable Oakland University (OU) students are about HPV infection and vaccination, their perception and attitude towards it, and willingness to receive the vaccine, with a focus on gender and sexual orientation.METHODSA cross‐sectional survey collecting data on various parameters with measurable indicators such as: general non‐identifying information, knowledge of HPV vaccination, attitude towards HPV vaccination, and intent for receiving HPV vaccine was conducted. An information section regarding HPV and its vaccine was provided to assess change in knowledge of and attitude towards vaccination. Comparisons were analyzed with ANOVA and Chi‐Square tests.RESULTSOn average, heterosexual respondents agreed less than LGBTQIA+ respondents that the current vaccine is capable of preventing cervical, penile, or anal cancer (P = 0.0091). Vaccinated respondents agreed more than unvaccinated respondents that all gynecologists and personal physicians should recommend the vaccine to patients whether or not they come from conservative families (P = 0.0002), and that they would recommend this vaccine for their college friends (P = &lt; 0.0001). Vaccinated respondents were significantly younger than unvaccinated respondents (P = 0.0005), but respondents who have heard of the HPV vaccine were significantly older than respondents who have not heard of the HPV vaccine (P = 0.0188). Adjusting for all factors, smokers have a significantly lower knowledge score than non‐smokers (P = 0.0290). A lower proportion of alcohol drinking respondents received the HPV vaccine as compared to non‐alcohol drinking respondents (P = 0.0358). On average, respondents who were unvaccinated were significantly more likely to undergo the HPV vaccine after taking the survey as compared to before taking the survey (P = 0.0016).CONCLUSIONDespite increasing social acceptance of the LGBTQIA+ community, few studies have addressed HPV infection and vaccination awareness among sexual minorities. Our findings show discrepancies in vaccine knowledge and vaccination status among different at‐risk groups. The findings also show increased likelihood of undergoing vaccination after reading an informational section within the survey, indicating the significant impact of and need to have widespread educational campaigns to influence behavioral perceptions and increase vaccine uptake.

Clinical Efficacy Of Intra-articular Mesenchymal Stem Cells For The Treatment Of Knee Osteoarthritis: A Double Blinded, Prospective, Randomized, Controlled Clinical Trial

Objectives:Currently, there are limited non-operative treatment options available for knee osteoarthritis (OA). Stem cell based therapies have emerged as promising non-operative treatments for knee OA. Various stem cell mediums have been investigated, but there are limited prospective, randomized controlled trials for any of these therapies. This study aimed to investigate the 6 month and 1 year efficacy of intra-articular injections of autologous stromal vascular fraction stem cell therapy (SVF) in a double blinded, prospective, randomized, placebo controlled trial.Methods:This was a multi-site prospective, randomized, double-blinded clinical trial. Adult patients with symptomatic knee OA were eligible for enrollment. Patients were randomized to high dose SVF injection (3.0×107 SVF cells), low dose SVF injection (1.5×107 SVF cells), or placebo injection (zero SVF cells) in a 1:1:1 fashion. SVF was obtained via liposuction, which was then processed and injected during the same clinic visit. Knee function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. MRIs were reviewed for changes in the cartilage thickness of chondral lesions. WOMAC scores and MRIs were obtained before injection, and at 6 and 12 months post-injection. The Wilcoxon Rank Sum non-parametric test was utilized to assess statistical significance and the Hodges-Lehmann Location Shift (HLLS) with confidence intervals was used to assess superiority.Results:A total of 39 participants were enrolled (high dose: 13, low dose: 13, placebo: 13). The median percent change in WOMAC scores from pre-injection to 6 months post-injection for the high dose group, low dose group, and placebo group were 83.9%, 51.5% and 25.0%, respectively. The high dose and low dose groups displayed a significantly greater percent change in WOMAC scores compared to the placebo group (high dose: p=0.04; low dose: p=0.02).The median percent change in WOMAC scores from baseline to 1 year post-injection for the high dose group, low dose group, and placebo group were 89.5%, 68.2%, and 0%, respectively. Similar to the 6 month evaluation, the high dose and low dose groups displayed a greater percent change in 1 year WOMAC scores compared to the placebo group (high dose: p = 0.006, low dose: p = 0.009). The 6-month follow-up MRIs demonstrated no change in cartilage thickness for all subjects. The mean change in cartilage thickness for the treatment group (high dose and low dose) and the placebo group was -0.2mm and 0.5 mm, respectively, with no statistical difference between groups (p= 0·89). During the 12 months post-injection there were no serious adverse events, or evidence of neoplastic growths.Conclusion:Intra-articular injection of both high dose and low dose SVF cells provides significant improvement in knee OA symptoms for at least 1 year post-injection. Knee function in all patients improved during the first 6 months post-injection; however, both high and low dose treatment groups experienced significantly greater improvement than the placebo group. The symptomatic treatment effect was found to be dose dependent. Furthermore, while WOMAC scores continued to improve for both treatment groups during the 6 months to 1 year period, the placebo group returned to baseline during the same time interval. The efficacy of SVF injections, in combination with its safety and ease of use, support its’ use as a treatment option for symptomatic knee osteoarthritis.

Evaluation of Topical Photo-Enhancer Assisted Intense Pulsed Light versus Methylene Blue Assisted Intense Pulsed Light for Treatment of Seborrheic Keratosis

Abstract Background seborrheic keratosis is one of the most common benign epidermal tumors that affects both sexes equally, and usually arises in individuals older than 50 years. It presents as sharply demarcated, slightly raised brownish patches or plaques, usually on sun-exposed surfaces of the skin. The clinical presentation can be quite variable and includes clinical variants, such as stucco keratosis and dermatosis papulosa nigra. Aim of the Work to evaluate the efficacy and safety of topical carbon gel photo-enhancer assisted intense pulsed light versus methylene blue assisted intense pulsed light photodynamic therapy for treatment of Seborrheic Keratosis. Patients and Methods this is a comparative prospective study that included thirty patients of skin types III to V Fitzpatrick class having multiple Seborrheic Keratosis lesions with no sex or age predilection. They were randomly recruited from Dermatology out-patient clinic of Ain –Shams University Hospitals, during period from June 2017 till March 2018. The study was approved by Research Ethical Committee of Ain Shams University and fulfilled all the ethical aspects required for human research. Results this denoted that the methylene blue-mediated photodynamic therapy (MB-PDT) (liposomal-loaded methylene blue gel 10%).and topical carbon gel photo-enhancer assisted intense pulsed light). could be effective in treating patients with Sks. Our findings denote the efficacy of them in curing multiple Sk lesions. The efficacy of methylene blue-mediated photodynamic therapy (MB-PDT) (liposomal-loaded methylene blue gel 10%). Conclusion that Intense Light Pulse using liposomal-loaded MB and Topical carbon suspension-assisted IPL treatment could be a good option for patients with indistinct pigmented or thick melanogenesic lesions. Adverse reactions to this treatment were minimal and the results acceptable, though appropriate lesions need to be chosen care- fully.