Vitamin D deficiency in solid‐organ transplant recipients from a Spanish Mediterranean population

Summary

Background

Solid‐organ transplant recipients (SOTRs) are at risk of developing vitamin D deficiency, mainly caused by reduced sunlight exposure with subsequent low vitamin D synthesis in the skin.

Aim

To analyse whether SOTRs from a Spanish Mediterranean region were vitamin D‐deficient.

Methods

This was a cross‐sectional, descriptive and observational study in a transplantation‐specialized Dermatological Unit from a Mediterranean area to determine the calcidiol levels of a cohort of 78 consecutively attending patients not receiving vitamin D supplements. Serum 25(OH)D₃ levels were determined and clinical characteristics were collected. Logistic regression analysis was used to analyse variables associated with dichotomized 25(OH)D₃ levels (≤ or > 10 ng/mL).

Results

The cohort comprised 30 lung, 29 kidney and 19 liver transplant recipients. Mean calcidiol was 18 ± 9 ng/mL. Deficiency of 25(OH)D₃ was present in 19% of patients, while 68% had insufficient levels and 13% had sufficient levels. Following multivariate logistic regression analysis, the season of blood sampling remained the only predictor of deficient 25(OH)D₃ levels.

Conclusion

Despite living in a mid‐latitude country with sunny weather, our SOTR population was at high risk of developing hypovitaminosis D, especially in autumn/winter. Avoiding sun exposure is important to prevent skin cancer, but careful monitoring of vitamin D status is recommended, with supplementation if hypovitaminosis D is detected.

http://bit.ly/2HEBdRa

Transdermal absorption of active substances from cosmetic vehicles

Summary

Background

Cosmetic products mean any substance or mixture intended to be placed in contact with the external parts of the human body (eg, epidermis, lips) and should not pass to the lower parts and penetrate to the skin. As a part of evaluation of cosmetic safety, the transdermal absorption of substances should be investigated.

Materials and Methods

In vitro absorption was investigated with Franz diffusion cells on untreated porcine skin and specimens of the same treated with 15%wt. SLS. The integrity of the skin was discerned by gauging transdermal electrical conductivity (TEC), the concentration of caffeine absorbed by the samples of skin membrane by liquid chromatography, which took place by applying an emulsion and/or a gel containing active hydration agents (urea, sodium hyaluronate, and sericin).

Results

The greatest extent of caffeine penetration was seen for pretreatment with just SLS; similar results were in skin treated with the base gel with 10%wt. urea. In the skin treated with the base emulsion only, the amount of caffeine absorbed was twofold less; this increased after adding the active hydration substances. The values measured for TEC corresponded with the amount of caffeine absorbed.

Conclusion

The gel proved to be the more potent vehicle for the active ingredient, as it demonstrated greater transdermal caffeine penetration than the emulsions, correlating with the degree of damage to the skin as detected by TEC.

http://bit.ly/2sTBm9a

Check out the ten Top-viewed articles in 2018 – Clinical Thyroidology for the Public

1. THYROID HORMONE THERAPY Taking levothyroxine with breakfast may be fine for many patients
Volume 6 Issue 11
Heather Hofflich, DO
90,612 views

2. THYROID NODULES Risk of thyroid cancer based on thyroid ultrasound findings
Volume 7 Issue 1
Jamshid Farahiti, MD
86,024 views

3. HYPOTHYROIDISM Desiccated thyroid extract vs Levothyroxine in the treatment of hypothyroidism
Volume 6 Issue 8
Angela M. Leung, MD, MSc
53,659 views

4. THYROID CANCER High risk of thyroid cancer in patients with multinodular goiter
Volume 6 Issue 11
Jamshid Farahiti, MD
46,359 views

5. HYPOTHYROIDISM When is the best time to take thyroid hormone?
Volume 4 Issue 5
Whitney Woodmansee, MD
46,413 views

6. THYROID AND PREGNANCY First Trimester TSH levels between 2.5 and 5.0 are associated with increased pregnancy loss
Volume 3 Issue 8
Whitney Woodmansee, MD
34,091 views

7. THYROID HORMONE TESTS Determination of optimal TSH ranges for reflex Free T4 testing
Volume 11 Issue 2
Whitney W. Woodmansee MD
22,787 views

8. HYPERTHYROIDISM Thyroid tests on newborns within the first five days will detect neonatal hyperthyroidism
Volume 7 Issue 7
Heather Hofflich, DO
21,568 views

9. THYROID AND PREGNANCY Low TSH levels early on in pregnancy may be normal
Volume 9 Issue 10
Alan P. Farwell, MD, FACE
21,047 views

10. THYROID AND PREGNANCY Increasing levothyroxine doses early in pregnancy is associated with a lower risk for pregnancy loss in hypothyroid women
Volume 9 Issue 10
Shirin Haddady, MD
20,502 views

 

The post Check out the ten Top-viewed articles in 2018 – Clinical Thyroidology for the Public appeared first on American Thyroid Association.

http://bit.ly/2RsRY1w

Superficial CD34-Positive Fibroblastic Tumor: A Case Report and Review of the Literature

No abstract available

http://bit.ly/2RsgCiu

Intraoral Cutaneous Hamartomas—Clinicopathologic and Immunohistochemical Characteristics of 3 Cases

Abstract: Intraoral cutaneous hamartomas (ICHs) are uncommon mucosal lesions characterized microscopically by a combination of cutaneous structures, including various stages of follicular and sebaceous elements. Due to their rarity, the clinicopathologic and immunohistochemical attributes of ICHs have not been thoroughly delineated. Three cases of ICH were identified from our records, and formalin-fixed paraffin-embedded sections were immunohistochemically stained with antibodies against androgen receptor, estrogen receptor, and progesterone receptor, p63, factor XIIIα, and CD34. All 3 ICHs involved the buccal mucosa with an M:F ratio = 2:1 and mean age = 42.3 years (age range: 27–61 years). ICHs presented as thickened, painless, white and yellow plaques or nodules of long duration, measuring 0.6–1.5 cm. No history of skin graft in the area of the lesions was reported. Histopathologically, the lesions showed aggregates of rudimentary folliculosebaceous structures. Although well-defined piloerector muscles were present in all cases of ICH, bona fide hair follicles and isolated hair shafts were identified only in 1 case. The overlying oral epithelium exhibited epidermis-like morphological features, while inflammation was generally absent. Immunohistochemically, strong and diffuse nuclear staining for androgen receptor and factor XIIIα was observed in the sebaceous glands, and estrogen receptor and p63 reactivity were confined exclusively to the peripheral basal cells, while progesterone receptor staining was negative in ICHs. CD34 diffusely decorated the lesional stroma. In conclusion, ICH is a rare lesion composed of cutaneous elements in an abnormal location. A predilection for the buccal mucosa is reported in the current study. Correspondence: Prokopios P. Argyris, DDS, MS, PhD, Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, 515 Delaware Street SE 16-206B, Minneapolis, MN 55455 (e-mail: argyr005@umn.edu). The authors declare no conflicts of interest. Presented at the poster session of the Joint International Academy of Oral Pathology (IAOP) and American Academy of Oral and Maxillofacial Pathology (AAOMP) Meeting; June 23–28, 2018; Vancouver, Canada. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2WvMHd9

A Reactive Peripheral Gamma-Delta T-cell Lymphoid Proliferation After a Tick Bite

Abstract: Peripheral gamma-delta T-cell proliferations are encountered in reaction to certain infections and in primary malignancies. Identifying sources of benign reactions is key in avoiding unnecessary workup and surveillance of these aggressive malignancies. Borrelia infections have been implicated in a number of lymphoproliferative disorders, but rarely, if ever, in this setting. While gamma-delta T-cells are known to play a prominent role in the immune response to Borrelia infection, B-cell differentiation is encountered in the majority of Borrelia-associated proliferations. We present here a unique case of benign-appearing peripheral gamma-delta T-cell lymphoid proliferation in the setting of a tick-bite with subsequent erythema migrans-like skin findings. Correspondence: Seth M. Martin, BA, University of Virginia School of Medicine, 345 Crispell Drive, Charlottesville, VA 22908 (e-mail: smm4uy@virginia.edu). The authors declare no conflicts of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2Ru8Ftc

Relationship between surrogate estimates and direct measurement of insulin resistance in women with polycystic ovary syndrome

Abstract

Purpose

To evaluate the relationship between surrogate estimates of insulin resistance and a direct measurement of insulin-mediated glucose uptake women with and without PCOS.

Methods

Retrospective cohort study of 75 PCOS and 118 controls. Fasting plasma glucose and insulin concentrations, insulin resistance as determined by the insulin suppression test, calculation of multiple surrogate estimates of insulin resistance, total and free testosterone concentrations, and correlations between the direct measure and surrogate estimates of insulin resistance were evaluated.

Result(s)

Surrogate markers of insulin resistance were correlated to a variable, but statistically significant degree with the direct measure of insulin resistance in control population and the women with PCOS. There was no correlation between the surrogate estimates of insulin resistance and total or free plasma testosterone concentrations.

Conclusion(s)

The surrogate estimates of insulin resistance evaluated were significantly related to a direct measure of insulin resistance, and this was true of both the control population and women with PCOS. The magnitude of the relationship between the surrogate estimates and the direct measurement was comparable and not significantly altered by androgen levels. Fasting plasma insulin concentration seems to be at least as accurate as any other surrogate estimate, and is by far the simplest.

http://bit.ly/2SbesZj

Expression and clinicopathological role of miR146a in thyroid follicular carcinoma

Abstract

Purpose

Dysregulation of microRNA expression has been involved in the development and progression of follicular thyroid carcinoma (FTC). The aim of this work was to study the expression of miRNA146a in FTC and the association with clinicopathological features of the disease.

Methods

Thirty-eight patients affected by FTC were included in the study. Twenty patients carrying follicular thyroid adenoma (FA) were also enroled as the benign counterpart of FTC. Total RNA including miRNA146a was extracted from formalin-fixed paraffin-embedded (FFPE) pairs of affected/unaffected tissue and its expression was assessed by real-time PCR. Two selected target genes, TRAF6 (tumour necrosis factor receptor-associated factor 6) and IRAK1 (Il-1 receptor-associated kinase 1/2), were also analysed.

Results

miR146a expression in FTC tissue was overall not downregulated in malignant versus unaffected tissue, but its expression was inversely correlated with clinicopathological features of FTCs at diagnosis. A decreased expression of miR146a became apparent in FTC thyroid tissue of widely compared to minimally invasive tumours. However, miR146a expression differences between contralateral unaffected tissue (extra-FTC) and FTC were not observed regardless of clinicopathological features. IRAK1, a known target for miR146a, was upregulated in FTC and the increase was mainly appreciable in Hurtle FTC variant. Unexpectedly, miR146a did not correlate with TRAF6 showing an inverse trend compared to IRAK1 although both genes regulate the activity of nuclear factor- kB (NF-kB).

Conclusion

The results of this study indicate that downregulation of miR146a, inversely correlated with clinicopathological features of FTCs at diagnosis and suggest a possible involvement of miR146a in FTC development. IRAK1 over-expression in FTC may be related to tumour development/progression. In vitro experiments are needed to support this hypothesis.

http://bit.ly/2DJNmAg

Expression and clinicopathological role of miR146a in thyroid follicular carcinoma

Abstract

Purpose

Dysregulation of microRNA expression has been involved in the development and progression of follicular thyroid carcinoma (FTC). The aim of this work was to study the expression of miRNA146a in FTC and the association with clinicopathological features of the disease.

Methods

Thirty-eight patients affected by FTC were included in the study. Twenty patients carrying follicular thyroid adenoma (FA) were also enroled as the benign counterpart of FTC. Total RNA including miRNA146a was extracted from formalin-fixed paraffin-embedded (FFPE) pairs of affected/unaffected tissue and its expression was assessed by real-time PCR. Two selected target genes, TRAF6 (tumour necrosis factor receptor-associated factor 6) and IRAK1 (Il-1 receptor-associated kinase 1/2), were also analysed.

Results

miR146a expression in FTC tissue was overall not downregulated in malignant versus unaffected tissue, but its expression was inversely correlated with clinicopathological features of FTCs at diagnosis. A decreased expression of miR146a became apparent in FTC thyroid tissue of widely compared to minimally invasive tumours. However, miR146a expression differences between contralateral unaffected tissue (extra-FTC) and FTC were not observed regardless of clinicopathological features. IRAK1, a known target for miR146a, was upregulated in FTC and the increase was mainly appreciable in Hurtle FTC variant. Unexpectedly, miR146a did not correlate with TRAF6 showing an inverse trend compared to IRAK1 although both genes regulate the activity of nuclear factor- kB (NF-kB).

Conclusion

The results of this study indicate that downregulation of miR146a, inversely correlated with clinicopathological features of FTCs at diagnosis and suggest a possible involvement of miR146a in FTC development. IRAK1 over-expression in FTC may be related to tumour development/progression. In vitro experiments are needed to support this hypothesis.

http://bit.ly/2DJNmAg

One-year treatment with gonadotropin-releasing hormone analogues does not affect body mass index, insulin sensitivity or lipid profile in girls with central precocious puberty

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


http://bit.ly/2GcCKvp

Frequency, clinical characteristics, biochemical findings and outcomes of DKA at the onset of type-1 DM in young children and adolescents living in a developing country – an experience from a pediatric emergency department

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


http://bit.ly/2FZjJNA

Carney complex due to a novel pathogenic variant in the PRKAR1A gene – a case report

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


http://bit.ly/2GcCY5J

Outcome of loco-regional radiotherapy in metastatic castration-resistant prostate cancer patients treated with abiraterone acetate

Abstract

Purpose

To evaluate the potential benefit of curative radiotherapy (RT) to the primary tumor in metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone.

Materials and methods

The clinical parameters of 106 mCRPC patients treated with abiraterone were retrospectively evaluated. Patients were either oligometastatic (≤5 metastases) at diagnosis or became oligometastatic after the systemic treatment was analyzed. Local RT to the primary tumor and pelvic lymphatics was delivered in 44 patients (41%), and 62 patients (59%) did not have RT to the primary tumor. After propensity match analysis, a total of 92 patients were analyzed.

Resultsn

Median follow-up time was 14.2 months (range: 2.3–54.9 months). Median overall survival (OS) was higher in patients treated with local RT to the primary tumor than in those treated without local RT with borderline significance (24.1 vs. 21.4 months; p = 0.08). Local RT to the prostate and pelvic lymphatics significantly diminished the local recurrence rate (16 patients, 31% vs. 2 patients, 5%; p = 0.003). In multivariate analysis, the prostate specific antigen (PSA) response ≥50% of the baseline obtained 3 weeks after abiraterone therapy was the only significant prognostic factor for better OS and progression-free survival (PFS). Patients treated with primary RT to the prostate had significantly less progression under abiraterone and a longer abiraterone period than those treated without local prostate RT.

Conclusions

Local prostate RT significantly improved OS and local control in mCRPC patients treated with abiraterone. The patients treated with primary RT had significantly less progression under abiraterone and a longer abiraterone period than those treated without local prostate RT.

http://bit.ly/2HCT1w0

Bismuth supplements as the first‐line regimen for Helicobacter pylori eradication therapy: Systemic review and meta‐analysis

Abstract

Background and Aims

An increase in the use of antibiotics leads to increased antibiotic resistance of Helicobacter pylori (H pylori). Consequently, it has been considered that the first‐line standard regimen should be changed. The main purpose of this study was to evaluate the efficacy of nonantibiotic (bismuth) supplements as a first‐line regimen for H pylori eradication.

Methods

We searched PubMed, EMBASE, CINAHL, and the Cochrane Library databases for randomized controlled trials (RCTs) reported in English and undertaken up until August 2018. A meta‐analysis of all randomized controlled trials comparing bismuth supplements with non‐bismuth‐containing regimens in H pylori eradication was performed. RCTs of classic bismuth‐containing quadruple therapy as a first‐line regimen were excluded.

Results

We identified twenty‐five randomized trials (3990 patients), and the total H pylori eradication rate, according to per protocol analyzed, was 85.8%. The odds ratio was 1.83 (95% confidence interval (CI). 1.57‐2.13). Among these RCTs, there were 7 RCTs for bismuth add‐on therapy, and the odds ratio was 2.81 (95% CI. 2.03‐3.89). When the studies were performed in a high clarithromycin resistance area (≥15%) or included patients with clarithromycin resistance, bismuth‐containing regimens were superior to non‐bismuth regimens. Moreover, the incidence of total side effects was insignificant.

Conclusions

Bismuth supplements as a first‐line regimen could be effective, with bismuth add‐on regimens being the most effective. Particularly, bismuth supplements showed the potential efficacy for clarithromycin‐resistant strains and would be the most viable alternative in clinical practice.

http://bit.ly/2TlKkrt

Removal of benzene by non-thermal plasma catalysis over manganese oxides through a facile synthesis method

Abstract

Three manganese oxide catalysts (MnO_x) were synthesized via a simple method, and then they were introduced into the non-thermal plasma (NTP) system for benzene removal. The XRD and EXAFS results showed the MnO_x were mainly in the Mn₃O₄ phase, and from the analysis of N₂ adsorption/desorption isotherms, we knew the MnO_x calcined at 250 °C (Mn250) had the largest surface area of 274.5 m² g⁻¹. Besides, Mn250 also exerted higher benzene adsorption capacity (0.430 mmol g⁻¹) according to C₆H₆-TPD. O₂-TPD indicated that Mn250 showed better oxygen mobility than Mn300. Moreover, by analyzing XPS results, it revealed that Mn250 exhibited rich abundant of surface adsorbed oxygen species (O_ads) and moderate ratio of Mn⁴⁺/Mn³⁺, and the reducibility temperature was also the lowest among all the MnO_x catalysts drawn by H₂-TPR profiles. As a result, Mn250 combined with NTP could remove 96.9% of benzene at a low input power of 3 W (benzene concentration 200 ppm, and GHSV 60,000 mL g_cat.⁻¹ h⁻¹), performing the best catalytic activity among the three catalysts and plasma only. Furthermore, the "NTP + Mn250" system also produced the highest CO₂ concentration and lowest CO concentration in downstream, and the residual O₃ after catalytic reaction was also the lowest, that is to say, the synergistic effect between NTP and Mn250 was more effective than other catalysts in benzene removal.

Graphical abstract

ᅟ

http://bit.ly/2Gapd7A

Letter to the editor “Estimation of sodium adsorption ratio indicator using data mining methods: a case study in Urmia Lake basin, Iran” by Mohammad Taghi Sattari, Arya Farkhondeh, and John Patrick Abraham

http://bit.ly/2FXfvWO

Relative hyperestrogenism in Klinefelter Syndrome: results from a meta-analysis

Abstract

Objective

Klinefelter Syndrome (KS) is classically described as characterized by hyperestrogenism, although solid evidence is lacking. This study aims to test the hypothesis that men with KS have higher serum estradiol than normal controls.

Design

Meta-analysis of all studies extracted by MEDLINE from 1942 to 31 January 2018. All studies reporting serum estradiol measurement were considered, among them only case-control studies were included in the meta-analysis.

Methods

Meta-analysis was conducted according to the PRISMA statement using RevMan.

Results

Out of 4120 articles, 23 case-control studies, 14 case series, and 19 case reports reported data on serum estradiol. A total of 707 KS and 1019 controls were included in the meta-analysis. Serum estradiol was slightly, but significantly higher in KS than controls (mean difference 4.25 pg/mL; CI: 0.41, 8.10 pg/mL; p = 0.030). This difference was lost considering only studies using estradiol assays with good accuracy (5.48 pg/mL, CI: −2.11, 13.07 pg/mL; p = 0.160). Serum testosterone and estradiol/testosterone ratio were significantly lower and higher in KS than controls, respectively. Data from KS case series and case reports confirmed that serum estradiol is within the normal ranges.

Conclusions

Serum estradiol is not increased in KS although slightly higher than controls. However, the meta-analysis that included only studies using a serum estradiol assay with good accuracy showed no difference in serum estradiol between KS and controls. The traditional belief that KS is associated with elevated serum estradiol should be reconsidered. This meta-analysis shows that men with KS have relative hyperestrogenism (increased estradiol/testosterone ratio) compared to controls.

http://bit.ly/2ToA2Xu

Histologically proven AMA positive primary biliary cholangitis but normal serum alkaline phosphatase: Is alkaline phosphatase truly a surrogate marker?

Publication date: Available online 30 January 2019

Source: Journal of Autoimmunity

Author(s): Chunyan Sun, Xiao Xiao, Li Yan, Li Sheng, Qixia Wang, Pan Jiang, Min Lian, Yanmei Li, Yiran Wei, Jun Zhang, Yong Chen, Bo Li, You Li, Binyuan Huang, Yikang Li, Yanshen Peng, Xiaoyu Chen, Jingyuan Fang, Dekai Qiu, Jing Hua

Abstract

Background and aims

The most highly directed and specific autoantibody in human immunopathology is the serologic hallmark of primary biliary cholangitis (PBC), antimitochondrial antibodies (AMAs). However the clinical significance of finding a positive AMA, with normal alkaline phosphatase (ALP) remains enigmatic.

Methods

We took advantage of 169 consecutive outpatients who were identified as having a positive AMA, but normal ALP levels between January 2012 and January 2018. A liver biopsy was performed on 67/169 of these AMA positive normal ALP patients.

Results

In all 169 patients we reconfirmed the AMA and also performed anti-gp210 and anti-sp100, liver stiffness (LSM) assessed by vibration-controlled transient elastography (VCTE), an abdominal computed tomography (CT) scan, and either a magnetic resonance imaging (MRI) or ultrasound. The liver biopsies were reviewed by two unbiased observers. 87.6% of the 169 patients were females with a mean age of 46; the median AMA titer 1:320; an elevated serum IgM was found in 53.3%. Importantly, in patients with a liver biopsy, 55（82.1%）out of 67 had varying degrees of cholangitis activity, diagnostic of PBC.

Conclusion

In patients who were AMA-positive but had normal ALP levels, more than 80% were associated with histological classic PBC. These data emphasize the importance of a positive AMA, even with a normal ALP and also question the role of ALP as a sole surrogate marker of cholangitis.

http://bit.ly/2B7Cbja

Relative hyperestrogenism in Klinefelter Syndrome: results from a meta-analysis

Abstract

Objective

Klinefelter Syndrome (KS) is classically described as characterized by hyperestrogenism, although solid evidence is lacking. This study aims to test the hypothesis that men with KS have higher serum estradiol than normal controls.

Design

Meta-analysis of all studies extracted by MEDLINE from 1942 to 31 January 2018. All studies reporting serum estradiol measurement were considered, among them only case-control studies were included in the meta-analysis.

Methods

Meta-analysis was conducted according to the PRISMA statement using RevMan.

Results

Out of 4120 articles, 23 case-control studies, 14 case series, and 19 case reports reported data on serum estradiol. A total of 707 KS and 1019 controls were included in the meta-analysis. Serum estradiol was slightly, but significantly higher in KS than controls (mean difference 4.25 pg/mL; CI: 0.41, 8.10 pg/mL; p = 0.030). This difference was lost considering only studies using estradiol assays with good accuracy (5.48 pg/mL, CI: −2.11, 13.07 pg/mL; p = 0.160). Serum testosterone and estradiol/testosterone ratio were significantly lower and higher in KS than controls, respectively. Data from KS case series and case reports confirmed that serum estradiol is within the normal ranges.

Conclusions

Serum estradiol is not increased in KS although slightly higher than controls. However, the meta-analysis that included only studies using a serum estradiol assay with good accuracy showed no difference in serum estradiol between KS and controls. The traditional belief that KS is associated with elevated serum estradiol should be reconsidered. This meta-analysis shows that men with KS have relative hyperestrogenism (increased estradiol/testosterone ratio) compared to controls.

http://bit.ly/2ToA2Xu

The Efficacy of Omalizumab in Cutaneous Mastocytosis: A Case Series

Abstract

Background

Mastocytosis describes a heterogeneous group of disorders arising from a clonal proliferation of mast cells. Given the lack of curative treatments for the cutaneous form, there is a significant need for superior therapies. Omalizumab is a recombinant DNA‐derived humanized IgG monoclonal antibody that selectively binds to human immunoglobulin E (IgE). It represents a potential treatment for the treatment of cutaneous mastocytosis, which currently has no standard treatment.

Methods

Two patients were treated with subcutaneous omalizumab 300 mg every four weeks.

Discussion

Patient one experienced 50% reduction in cutaneous infiltration and moderate improvement in pruritus. Patient two underwent 90% complete clearance of cutaneous lesions and reported full resolution of pruritus. The median duration of treatment was 24 weeks and time to response was eight weeks. No significant changes in tryptase levels were observed. Both patients experienced injection site reactions.

Conclusion

We provide evidence from two cases supporting the efficacy of IgE‐mediated therapy in the treatment of cutaneous mastocytosis. Even at a higher‐than‐standard dose (300mg versus 150mg), the drug was well‐tolerated. As we await the results of pivotal clinical trials, omalizumab appears to be a promising treatment option in patients with cutaneous mastocytosis unresponsive to traditional therapies.

This article is protected by copyright. All rights reserved.

http://bit.ly/2sUDTjB

Effectiveness and safety of switching to biosimilar infliximab and etanercept in patients with psoriasis

Abstract

Real‐life data on the effectiveness and safety of biosimilar and biologic drugs licensed for treatment of psoriasis is lacking. We retrospectively analysed patient records from 69 patients with moderate to severe psoriasis treated at the department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark in the period March 1st 2015 to October 1st 2017 who were administratively switched from the anti‐TNF biologics infliximab (Remicade) and etanercept (Enbrel) to the biosimilars Remsima and Benepali, respectively.

Approximately 25% of patients treated with infliximab and approximately 40% of patients treated with etanercept reported a worse effect after being switched from the original drug to its biosimilar. Quality of life was worse in approximately 30% after switching in both patient groups, respectively. The number of patients reporting adverse events increased in both groups.

This article is protected by copyright. All rights reserved.

http://bit.ly/2MDCrLe

Cover figure

Publication date: February 2019

Source: Cortex, Volume 111

Author(s):

http://bit.ly/2SaAlId

Prism adaptation: From rehabilitation to neural bases

Publication date: February 2019

Source: Cortex, Volume 111

Author(s): Yves Rossetti, Shigeru Kitazawa, Tanja Nijboer

http://bit.ly/2HGZC8J

Acknowledgements 2018

Publication date: February 2019

Source: Cortex, Volume 111

Author(s):

http://bit.ly/2SaAcVb

Editorial Board

Publication date: February 2019

Source: Cortex, Volume 111

Author(s):

http://bit.ly/2HEcfBn

Circadian circuits in humans: White matter microstructure predicts daytime sleepiness

Publication date: Available online 30 January 2019

Source: Cortex

Author(s): Kristin Koller, Robert D. Rafal, Paul G. Mullins

Abstract

The suprachiasmatic nucleus of the hypothalamus is the chief circadian pacemaker in the brain, and is entrained to day-night cycles by visual afferents from melanopsin containing retinal ganglion cells via the inferior accessory optic tract. Tracer studies have demonstrated efferents from the suprachiasmatic nucleus projecting to the paraventricular nucleus of the hypothalamus, which in turn project to first-order sympathetic neurons in the intermedio-lateral grey of the spinal chord. Sympathetic projections to the pineal gland trigger the secretion of the sleep inducing hormone melatonin. The current study reports the first demonstration of potential sympathopetal hypothalamic projections involved in circadian regulation in humans with in vivo virtual white matter dissections using probabilistic diffusion tensor imaging (DTI) tractography. Additionally, our data shows a correlation between individual differences in white matter microstructure (measured with fractional anisotropy) and increased daytime sleepiness (measured with the Epworth Sleepiness Scale (ESS, Johns, 1991)). Sympathopetal connections with the hypothalamus were virtually dissected using designated masks in the optic chiasm, which served as an anatomical landmark for retinal fibres projecting to the suprachiasmatic nucleus, and a waypoint mask on the lateral medulla, where hypothalamic projections to the sympathetic nervous system traverse in humans. Sympathopetal projections were demonstrated in each hemisphere in twenty-six subjects. The tract passed through the suprachiasmatic nucleus of the hypothalamus and its trajectory corresponds to the dorsal longitudinal fasciculus traversing the periaqueductal region and the lateral medulla. White matter microstructure (FA) in the left hemisphere correlated with high scores on the ESS, suggesting an association between circadian pathway white matter microstructure, and increased daytime sleepiness and decreased arousal.

http://bit.ly/2SaA4VH

Mice carrying a humanized Foxp2 knock-in allele show region-specific shifts of striatal Foxp2 expression levels

Publication date: Available online 30 January 2019

Source: Cortex

Author(s): C. Schreiweis, T. Irinopoulou, B. Vieth, L. Laddada, F. Oury, E. Burguière, W. Enard, M. Groszer

Abstract

Genetic and clinical studies of speech and language disorders are providing starting points to unravel underlying neurobiological mechanisms. The gene encoding the transcription factor FOXP2 has been the first example of a gene involved in the development and evolution of this human-specific trait. A number of autosomal-dominant FOXP2 mutations are associated with developmental speech and language deficits indicating that gene dosage plays an important role in the disorder. Comparative genomics studies suggest that two human-specific amino acid substitutions in FOXP2 might have been positively selected during human evolution. A knock-in mouse model carrying these two amino acid changes in the endogenous mouse Foxp2 gene (Foxp2^hum/hum) shows profound changes in striatum-dependent behaviour and neurophysiology, supporting a functional role for these changes. However, how this affects Foxp2 expression patterns in different striatal regions and compartments has not been assessed. Here, we characterized Foxp2 protein expression patterns in adult striatal tissue in Foxp2^hum/hum mice. Consistent with prior reports in wildtype mice, we find that striatal neurons in Foxp2^hum/hum mice and wildtype littermates express Foxp2 in a range from low to high levels. However, we observe a shift towards more cells with higher Foxp2 expression levels in Foxp2^hum/hum mice, significantly depending on the striatal region and the compartment. As potential behavioural readout of these shifts in Foxp2 levels across striatal neurons, we employed a morphine sensitization assay. While we did not detect differences in morphine-induced hyperlocomotion during acute treatment, there was an attenuated hyperlocomotion plateau during sensitization in Foxp2^hum/hum mice. Taken together, these results suggest that the humanized Foxp2 allele in a mouse background is associated with a shift in striatal Foxp2 protein expression pattern.

http://bit.ly/2HGZBBH

Lexical retrieval treatment in primary progressive aphasia:An investigation of treatment duration in a heterogeneous case series

Publication date: Available online 30 January 2019

Source: Cortex

Author(s): Karen Croot, Theresa Raiser, Cathleen Taylor-Rubin, Leanne Ruggero, Nibal Ackl, Elisabeth Wlasich, Adrian Danek, Angela Scharfenberg, David Foxe, John R. Hodges, Olivier Piguet, Nicole A. Kochan, Lyndsey Nickels

Abstract

Word-finding difficulty is typically an early and frustrating symptom of primary progressive aphasia (PPA), prompting investigations of lexical retrieval treatment in PPA. This study aimed to investigate immediate treatment gains following two versus four weeks of treatment, item generalisation, and maintenance of gains with ongoing treatment in a single case series of eight individuals with heterogeneous PPA presentations (three non-fluent/agrammatic, two logopenic, two semantic, and one mixed PPA). Three individuals made initial gains in picture naming and maintained them over 6 months or more with ongoing treatment. By contrast, three individuals made marginal initial gains but were unable to continue treatment, and two individuals did not make the typically-reported initial gains with two or four weeks of treatment. There was little evidence of generalisation to untreated items. Our results add to the evidence that daily home practice of Repetition and Reading in the Presence of a Picture over extended periods can increase and maintain retrieval of personally-relevant words in picture naming for some individuals with semantic or nonfluent/agrammatic variant PPA. Further research is needed into the factors associated with long-term treatment adherence and gains, and the factors associated with nonadherence to treatment.

http://bit.ly/2ShzwgK

Musical memory and hippocampus revisited: Evidence from a musical layperson with highly selective hippocampal damage

Publication date: Available online 29 January 2019

Source: Cortex

Author(s): Nazli Esfahani-Bayerl, Carsten Finke, Ute Kopp, Daa-Un Moon, Christoph J. Ploner

Abstract

The role of the human hippocampus for musical memory is still unclear. While imaging studies in healthy humans have repeatedly shown hippocampal activation in musical memory tasks, studies in musicians with chronic bilateral medial temporal lobe damage and in non-musicians suffering from neuro-degenerative diseases suggest that musical memory may at least partly be independent of hippocampal integrity. Here, we report on a musical layperson who acutely developed an amnesic syndrome in the context of autoimmune encephalitis. Structural and resting state functional MRI revealed exceptionally selective bilateral lesions of the hippocampi and altered functional connectivity with retrosplenial cortex and precuneus. Neuropsychological testing showed a severe global amnesic syndrome. Perception and processing of scales, melodic contours, intervals, rhythms and meter were unaffected. Most notably, the patient performed completely normally on tests of recognition memory for unfamiliar melodies and excerpts of complex musical material, while recognition memory for visual and verbal information was severely impaired. Likewise, emotional evaluation of musical excerpts did not differ from controls. We infer that integrity of musical processing and recognition memory in patients with hippocampal dysfunction does not result from training-induced or post-lesional brain plasticity, but rather reflects integrity of brain networks outside the hippocampi and presumably also outside retrosplenial cortex and precuneus. Our findings suggest major differences in the neural substrates of musical and non-musical recognition memory.

http://bit.ly/2HFyIhF

Is Human Papilloma Virus Infection Linked to Periodontitis? A Narrative Review

Abstract

Purpose of Review

Research suggests that periodontal tissue might serve as a reservoir for oral human papillomavirus (HPV) infection, while another hypothesis is that chronic inflammation of the tissue might perpetuate an infection with oral HPV infection. In this narrative review, we summarize the evidence related to a potential association between oral HPV infection and periodontitis.

Recent Findings

Twelve articles were identified, and their key findings summarized. Studies vary in sample size, study population, study design, and methods for assessment of oral HPV and periodontitis. Although results are conflicting and still inconclusive, various studies have found an association between oral HPV infection and periodontitis, which is supported by biological plausibility.

Summary

Future longitudinal studies should further evaluate this association, using clinical definitions of oral HPV infection and periodontitis, and focusing on high-risk populations for oral HPV infection. Studying this association is important since periodontitis might help identify at-risk individuals for oral HPV infection and potentially HPV-related oropharyngeal cancers.

http://bit.ly/2ThmoW5

Co‐existence of Juvenile dermatomyositis and psoriasis vulgaris with fungal infection: A case report and literature review

Summary

Introduction

The incidence rate of psoriasis vulgaris (PSV) coexisting with Juvenile dermatomyositis (JDM) is low. Through our thorough literature search, we found that PSV arising on JDM with superficial fungal infection of facial skin is rarely reported. So, we hereby, report a case of combination of the above three diseases. Meanwhile, we also reviewed the previous literatures aiming at the related basis, clinical manifestation, diagnosis, and treatment of the diseases. Interestingly, of all cases, this case is the only one in which the symptom of muscle weakness preceded the appearance of rash.

Case Presentation

A 21‐year‐old man diagnosed with JDM 6 years ago came to our inpatient department due to the appearance of new rash. Skin examination showed some sharply demarcated scaly plaques over the head, neck, torso, and bilateral upper limbs with pruritus and scaling. Histological examination and typical clinical manifestation confirmed the diagnosis of PSV for his new rash. Family history was negative for JDM and PSV. The clear erythema located on his face revealed the existence of superficial fungal infection with the help of fungal fluorescence microscopy. He had marked improvement of his symptoms with the treatment given at our department. In the past 3 months, the patient has been on regular follow‐up at our outpatient department, and his condition is stable at present.

Discussion

This paper presents a case of PSV arising on JDM coexisting with superficial fungal infection on the face hoping that this will help clinicians in the better diagnosis of the diseases during literature search.

http://bit.ly/2CPZn5A

Identification and validation of amino acid‐based mild exfoliating agents through a de novo screening method

Summary

Background

Due to internal or external factors, the desquamation (turnover) rate of the stratum corneum slows down, resulting in skin problems. Therefore, adjusting the exfoliation rate through cosmetics is an important issue.

Objective

This report aimed to develop exfoliating agents with lesser adverse effects and higher efficiency through an ex vivo screening method and in vivo turnover rate analysis of human skin.

Methods

Various molecules were evaluated by the ex vivo porcine skin exfoliation method and screened for their potential as effective agents. To confirm the effect and mechanism of each agent found, the exfoliation efficiency was evaluated. Each agent was also applied to the actual human skin to determine its efficacy and side effects.

Results

Despite the pH 6, carnitine and serine, which have similar or better efficiency compared to PHA, were selected. Based on the results, it was confirmed that calcium. And it is nonirritating to the human skin and increases the turnover rate (~130%).

Conclusion

Amino acid‐based exfoliating agents, such as carnitine and serine, were identified and verified to enhance the rate of exfoliation of the stratum corneum. It is expected that the improvement of dullness, mild acne, fine wrinkles, and pores through skin exfoliation in the field of cosmetics can be achieved safely through these agents.

http://bit.ly/2RY26V7

Efficacy and possible mechanisms of botulinum toxin treatment of oily skin

Summary

Background

Oily skin is one of the most common dermatological complaints. Oily skin may be accompanied by enlarged pores, acne, and seborrheic dermatitis. Moreover, oily skin has negative effects on self‐perception. Most therapeutic approaches used to treat oily skin have had varying degrees of efficacy and include topical treatments, such as photodynamic therapy and lasers. However, certain of these therapies for oily skin may lead to severe side effects. With the expanding use and high safety profile of botulinum toxin type A (BoNT‐A), its use in the treatment of oily skin has caused significant concerns; moreover, relevant reports have gradually accumulated to address the efficacy of BoNT‐A and explore its mechanisms of action.

Aims

The objective of this article was to review the efficacy and possible treatment mechanisms of BoNT‐A on oily skin.

Methods

A retrospective review of the published data was conducted.

Results

Most studies have suggested that the intradermal injection of BoNT‐A decreased sebum production and pore size. Furthermore, this treatment attained high patient satisfaction without significant side effects. BoNT‐A effectively decreased sebum production and excretion, which was in keeping with previous studies, possibly via its blockade of cholinergic signaling and its neuromodulatory effects.

Conclusions

Intradermal BoNT‐A injection may represent a promising new treatment for oily skin and other relevant dermatological problems, such as enlarged pores, acne, and seborrheic dermatitis. Further study is still needed to determine the specific mechanisms of BoNT‐A and the optimal injection techniques and doses for oily skin and other relevant cosmetic concerns.

http://bit.ly/2CQNyw6

Construction of precious metal-loaded BiOI semiconductor materials with improved photocatalytic activity for microcystin-LR degradation

Abstract

The composite photocatalyst of precious metal loaded on BiOI (M/BiOI, M = Pt, Au, Ag) was prepared by photochemical deposition and used for the photocatalytic degradation of microcystins (MC-LR). The material was characterized by X-ray powder diffraction (XRD), field emission scanning electron microscopy (FESEM), ultraviolet visible (UV-vis) diffuse reflectance spectroscopy, X-ray photoelectron spectroscopy (XPS), and photoluminescence spectra (PL). The effect of photodegradation of MC-LR and the possible mechanism were investigated. It turned out that, among precious metals of Pt, Au, and Ag, Ag had the most significant improvement for photocatalytic activity of BiOI and Au was the least. The Ag/BiOI catalyst was illuminated 2 h under the simulated visible-light condition with the optimal load ratio of Ag catalyst (1.0 wt%) and the 2-h illumination under simulated visible-light condition, the degradation rate of MC-LR was 61.26% ± 0.12%. In addition, through the experiment of trapping agent and the analysis of electron spin resonance (ESR), we could conclude that the main active species is O₂⁻ in the process of the degradation of MC-LR by three precious metal-loaded BiOI semiconductor materials.

http://bit.ly/2RqN84z

Pond-bottom decomposition of leaf litters canopied by free-floating vegetation

Abstract

In wetland ecosystems, vegetation can float freely on water surface, forming dense canopy which may play important ecological roles. This is especially true in many urban wetlands in which fluidity is low and nutrient level is high. So far, effects of free-floating vegetation on abiotic and biotic factors of wetlands have been known, while little on wetland ecosystem functions such as litter decomposition. To examine whether the canopy of free-floating vegetation on water surface will influence litter decomposition in wetlands or not, we conducted a 50-day in situ decomposition experiment in a subtropical urban pond wetland, in which litter bags of nine combinations of three mesh sizes and three litter species were put on the bottoms of total 22 ponds which were half with and half without free-floating vegetation canopy on the water surface. The ponds with and without the canopy had different water physicochemical properties. Overall, the canopy, the species identity, and the mesh size significantly decelerated mass loss and carbon loss of leaf litters while slightly on nitrogen loss. Effects of the canopy on leaf litter decomposition also showed species- and mesh size-dependent. Our results suggest that free-floating vegetation on water surface can alter water environmental factors and consequently change ecosystem functioning in wetlands.

http://bit.ly/2Wr4ORq

Partitioning characteristic of chlorine ion in gas and solid phases in process of desulfurization wastewater evaporation: model development and calculation

Abstract

Since the promulgation of "Water Pollution Control Action Plan " in China, zero liquid discharge of desulfurization wastewater has become a new trend of power plant water pollution control. Aiming at the application of desulfurization wastewater evaporation technology using high-temperature flue gas, simulation and experimental research on quantifying and predicting gas-solid partitioning of chlorine ion under different operation conditions are carried out in this paper. The gas-liquid equilibrium theory is applied to the complex mixed salt system; based on state equation, the semi-empirical model of gas-solid phase partitioning coefficient of chlorine ion is calculated, with high degree of fitting range from 180 to 380 °C. The essential effects of pH, Cl⁻ concentration, and total dissolved solids (TDS) on the gas-solid phase partitioning coefficient of chlorine ion are investigated. The study provides key data for the application of evaporation technology using high-temperature flue gas, obtaining the quantification and prediction of chlorine ion volatilization during desulfurization wastewater evaporation.

http://bit.ly/2RoDxvd

H 3 PO 4 -activated carbons produced from açai stones and Brazil nut shells: removal of basic blue 26 dye from aqueous solutions by adsorption

Abstract

The adsorption characteristics of C.I. basic blue 26 (BB26) from aqueous solutions onto H₃PO₄-activated carbons (ACs) produced from açai stones (Euterpe oleracea Martius) and Brazil nut shells (Bertholletia excelsa H. B. K) were investigated in a batch system. The ACs were characterized by XRD, FT-IR, N₂ adsorption at 77 K, mercury porosimetry, and acidity/basicity analysis. The pseudo-first-order, pseudo-second-order kinetic models and intraparticle diffusion model were used for the kinetic interpretations. The adsorption processes follow the pseudo-second-order kinetic model. The Boyd plots revealed that the adsorption processes were mainly controlled by film diffusion. Equilibrium data were analyzed by the Langmuir and Freundlich models, at different temperatures. The equilibrium data were best represented by the Langmuir isotherm. The adsorption processes were found to be favorable, exothermic, and spontaneous. The açai stones and Brazil nut shells-based ACs were shown to be effective adsorbents for removal of BB26 from aqueous solutions.

http://bit.ly/2WtVAnt

Indeterminate Dendritic Cell Sarcoma in a Patient With Myelodysplastic Syndrome

No abstract available

http://bit.ly/2GeinOF

Reticulated Purpura in the Abdomen of a Severely Ill Patient: Answer

No abstract available

http://bit.ly/2FYbRw4

A New Histologic Pattern in 6 Biopsies From Early Frontal Fibrosing Alopecia

Abstract: Frontal fibrosing alopecia (FFA) is an irreversible scarring alopecia with unknown etiology and no cure. The goal is to establish the diagnosis in the early stage, before developing a hairless band of atrophy involving the frontal, temporal scalp and sideburns. Pathology is rarely needed once the disease is clinically apparent. The classic histologic features include follicular dropout with the absence or atrophy of the sebaceous glands and lichenoid lymphohistiocytic infiltrate with concentric layered fibrosis at the upper follicular level. We describe a common pattern that was repeatedly seen in 6 horizontally sectioned scalp biopsies from patients with early presentation of FFA suspected on trichoscopy by the focal presence of peripilar casts around terminal hairs. All biopsies revealed overall preserved follicular architecture with average number of 11 vellus follicles, atrophy of the sebaceous glands, and perifollicular lymphohistiocytic infiltrate involving the outer root sheath of the vellus follicles (n = 5). There was no perifollicular fibrosis of the vellus follicles and no lichenoid inflammation and perifollicular fibrosis of the terminal follicles. This new pattern of "inflammatory vellus involvement" most likely corresponds to an early onset of the disease. The absence of the classic features in such biopsies from early FFA can lead to misdiagnosis.

http://bit.ly/2GbIshk

Persistent Asymptomatic Papules on the Chest: Challenge

No abstract available

http://bit.ly/2FWb7Yd

Dickkopf-1 Expression in Androgenetic Alopecia and Alopecia Areata in Male Patients

Background: Androgenetic alopecia (AGA) results from shortening of the anagen phase of the hair cycle and, subsequently, miniaturization of hair follicles. Alopecia areata (AA) is a disease of autoimmunity where T cells attack anagen hair follicles and shows multifactorial etiology. Dickkopf-1 (DKK-1) is a gene that is responsible for transformation of anagen to catagen, which suggests that it is involved in development of both diseases. Objectives: To evaluate the tissue levels of dickkopf-1 in male patients with AGA and AA in comparison with controls, in an attempt to know its role in the pathogenesis of both disorders. Methods: DKK-1 immunohistochemical expression was evaluated in lesional scalp biopsies taken from 20 male patients with AGA evaluated clinically by the modified Norwood–Hamilton score, 20 male patients with AA evaluated clinically by SALT score, and 20 healthy controls within the same age and sex of the studied patients. Results: A highly significant difference in DKK-1 expression between patients with AGA and healthy controls was found (P2

http://bit.ly/2GbTpPW

Persistent Asymptomatic Papules on the Chest: Answer

No abstract available

http://bit.ly/2FTRVKA

Reflectance Confocal Microscopy Can Help the Dermatopathologist in the Diagnosis of Challenging Skin Lesions

Abstract: Despite the successful assignment of Current Procedural Terminology codes, there are barriers to incorporating in vivo reflectance confocal microscopy (RCM) into daily practice. Importantly, the dermatopathologist can play a key role in interpreting RCM images and can use these images to correlate with histopathology. Herein, we describe, using a case series, how RCM can be incorporated into the dermatopothalogist's practice. We also summarize the criteria for RCM diagnosis of common neoplasms.

http://bit.ly/2GaFJEz

Reticulated Purpura in the Abdomen of a Severely Ill Patient: Challenge

No abstract available

http://bit.ly/2FXHd64

Acquired Dermal Melanocytosis Associated With Diffuse Systemic Sclerosis in a White Patient

Abstract: We report a case of a 65-year-old man who developed an asymptomatic bluish spot that affected the flank and left lumbar region with the onset 10 years prior. He had a history of diffuse systemic sclerosis with anti-Scl-70–positive antibodies. The appearance of the skin lesion coincided with the onset of his disease. The skin biopsy was consistent with the diagnosis of acquired dermal melanocytosis. The relationship between the appearance of acquired pigmented macules and spots and systemic sclerosis has been known for years, although it is an infrequent finding.

http://bit.ly/2DJrW6r

Cutaneous Elastic Tissue Anomalies

Abstract: After a review of the physiology in the formation and degradation of cutaneous elastic tissue, we describe the clinicopathologic disorders characterized by increased and decreased cutaneous elastic tissue. Cutaneous disorders characterized by increased and/or abnormal elastic tissue in the dermis include elastoma, also named nevus elasticus, dermatosis lenticularis disseminata, pseudoxanthoma elasticum, late-onset focal dermal elastosis, linear focal elastosis, elastoderma, elastofibroma dorsi, and elastosis perforans serpiginosa. In some of these conditions, the specific histopathologic diagnosis may be rendered with hematoxylin-eosin stain, whereas in other ones special elastic tissue stains are necessary to demonstrate the anomalies. Cutaneous disorders characterized by decreased dermal elastic tissue include nevus anelasticus, papular elastorrhexis, perifollicular elastolysis, anetoderma cutis laxa, postinflammatory elastolysis and cutis laxa, white fibrous papulosis of the neck, pseudoxanthoma elasticum–like papillary dermal elastolysis, and mid dermal elastolysis. In most of these conditions, the histopathologic anomalies are only seen with elastic tissue stains, and cutaneous biopsies of these processes stained with hematoxylin-eosin show appearance of normal skin. The diagnosis of some of these disorders characterized by increased or decreased elastic dermal tissue should be followed by general exploration of the patient to rule out associated severe systemic anomalies, and in some cases, a genetic counseling should be offered to the family.

http://bit.ly/2GbIl5o

Facial Phaeohyphomycosis in an Immunocompetent Individual: A Rare Presentation of a Rare Fungus

Abstract: Phaeohyphomycosis is a rare mycotic infection caused by heterogenous groups of dematiaceous fungi involving the skin and subcutaneous tissue. Here, we report a case of cutaneous phaeohyphomycosis presenting as cauliflower-like verrucous lesion over the face in an immunocompetent individual. Histopathology showed suppurative granulomatous inflammation replete with pigmented broad fungal hyphae which is stained with periodic acid–Schiff stain, Grocott's methanamine silver stain, Schmorl's stain, and Masson-Fontana stain. Culture showed black-colored colonies identified as Exophiala spinifera.

http://bit.ly/2Usfzky

Onychomatricoma in a Patient with Extensive Vitiligo: Answer

No abstract available

http://bit.ly/2FZSxhK

Squamoid Eccrine Ductal Carcinoma: An Aggressive Mimicker of Squamous Cell Carcinoma

Abstract: Squamoid eccrine ductal carcinoma (SEDC) is an uncommon cutaneous adnexal malignancy that has the potential for an aggressive clinical course. The authors present a case of SEDC that resulted in widespread metastases and death. The clinical, histological, and immunohistochemical features of SEDC and several entities on the differential diagnosis are reviewed.

http://bit.ly/2GbI5TY

Eccrine Poroma of the Vulva

No abstract available

http://bit.ly/2FUvNjv

Cutaneous Angiomyolipoma of the Ear: A Case Report and Literature Review

Abstract: Cutaneous angiomyolipoma is a rare mesenchymal tumor, distinct from its renal counterpart. Only few cases have been reported in English language literature to date. Here, we report a case in a 36-year-old man who presented with a painless swelling on his right ear. Microscopy revealed a well-circumscribed tumor, composed of an admixture of mature adipocytes, blood vessels, and bundles of smooth muscles. The tumor cells were positive for desmin and calponin but negative for HMB45, melan-A, SOX10, tyrosinase, and CD10. We present the case to emphasize the uniqueness of cutaneous angiomyolipoma from its renal counterpart. We also review the relevant literature on this topic.

http://bit.ly/2GbToeQ

Multiple Targetoid Plaques: Challenge

No abstract available

http://bit.ly/2FZSen6

Atypical Histiocytic Lesion Preceding a Peripheral T-Cell Lymphoma Involving the Skin Exhibiting the Same Molecular Alterations

Abstract: Peripheral T-cell lymphoma (PTCL), not otherwise specified (NOS) is a diagnosis of exclusion, showing extreme cytological and phenotypic heterogeneity. Skin involvement of PTCL may be primary or secondary. Diagnosis of histiocytosis may be difficult, requiring clinical–pathological correlation. We describe a laryngeal atypical histiocytic lesion (AHL) and a nasal PTCL, NOS with cutaneous involvement in the same patient presenting with peculiar histopathologic and immunophenotypic features. The laryngeal neoplasm showed morphological and immunophenotypic evidence of histiocytic differentiation and does not fit any other category of the WHO classification nor the revised classification of histiocytosis. The nasal and cutaneous lesions presented features close to natural killer/T-cell lymphoma and gamma–delta T-cell lymphoma but did not meet accurately the WHO criteria. A somatic activating Q61K mutation was found on exon 3 of the NRAS gene in both AHL and PTCL, NOS. The mutation on NRAS gene in both AHL and PTCL, NOS may suggest a common origin from a precursor cell.

http://bit.ly/2DHcUOH

Onychomatricoma in a Patient With Extensive Vitiligo: Challenge

No abstract available

http://bit.ly/2GbHO3o

Multiple Targetoid Plaques: Answer

No abstract available

http://bit.ly/2FZRYEE

Osteoma Cutis Arising in Common Blue Nevus (Blue Osteonevus): A Clinicopathologic, Immunohistochemical, and Dermoscopic Study

Abstract: Osteonevus of Nanta is a rare histopathologic variant of melanocytic nevus that results from ossification of the dermis between dermal nests of melanocytes. Most cases described in the literature have been associated with long-standing intradermal nevi and were often located in the upper part of the body. We report a lesion on the shoulder of an elderly man showing the association of a common blue nevus and osteoma cutis, an exceptional feature which has been previously reported in 2 instances. We also describe for the first time the dermoscopic appearance of this "blue osteonevus."

http://bit.ly/2Utjkq8