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Clinical and Experimental Dermatology Jan 2021Nail involvement is estimated to affect 80-90% of patients with psoriasis at some point in their lives and is often associated with severe disease. Patients with nail... (Review)
Review
Nail involvement is estimated to affect 80-90% of patients with psoriasis at some point in their lives and is often associated with severe disease. Patients with nail involvement experience pain, functional impairment and social stigma, with significant restriction of daily activities and quality of life. Nail psoriasis is also considered a risk factor for the development of psoriatic arthritis (PsA). Management of nail psoriasis is deemed challenging and as a result, it is often left untreated by physicians. Assessing the severity of nail disease can also be difficult in clinical practice. While the Nail Psoriasis Severity Index is used widely in trials, it is time-consuming and rarely used in the clinic, highlighting the need to develop a simplified disease severity score for nail psoriasis. All patients should be advised to keep their nails short, wear gloves for wet and dirty work, and regularly apply emollient to the nail folds and nail surface. Patients with mild nail psoriasis, without signs of severe cutaneous psoriasis or PsA, may benefit from topical treatment, while systemic treatment is indicated in patients with severe nail involvement. Evidence suggests that all anti-tumour necrosis factor (TNF)-α, anti-interleukin (IL)-17, and anti-IL-12/23 antibodies available for plaque psoriasis and PsA are highly effective treatments for nail psoriasis. This article aims to provide an up-to-date review of the therapeutic options currently available for the management of nail psoriasis in patients with or without skin psoriasis. Therapeutic options for the management of nail psoriasis in children will also be discussed.
Topics: Administration, Topical; Child; Dermatologic Agents; Humans; Immunosuppressive Agents; Methotrexate; Nail Diseases; Nails; Psoriasis
PubMed: 32741010
DOI: 10.1111/ced.14314 -
Pharmacological Research Feb 2023Age-related gastrointestinal decline contributes to whole-organism frailty and mortality. Genistein is known to have beneficial effects on age-related diseases, but its...
Age-related gastrointestinal decline contributes to whole-organism frailty and mortality. Genistein is known to have beneficial effects on age-related diseases, but its precise role in homeostasis of the aging gut remains to be elucidated. Here, wild-type aging mice and Zmpste24 progeroid mice were used to investigate the role of genistein in lifespan and homeostasis of the aging gut in mammals. A series of longitudinal, clinically relevant measurements were performed to evaluate the effect of genistein on healthspan. It was found that dietary genistein promoted a healthier and longer life and was associated with a decrease in the levels of systemic inflammatory cytokines in aging mice. Furthermore, dietary genistein ameliorated gut dysfunctions, such as intestinal inflammation, leaky gut, and impaired epithelial regeneration. A distinct genistein-mediated alteration in gut microbiota was observed by increasing Lachnospira abundance and short-chain fatty acid (SCFA) production. Further fecal microbiota transplantation and dirty cage sharing experiments indicated that the gut microbiota from genistein-fed mice rejuvenated the aging gut and extended the lifespan of progeroid mice. It was demonstrated that genistein-associated SCFAs alleviated tumor necrosis factor alpha-induced intestinal organoid damage. Moreover, genistein-associated propionate promoted regulatory T cell-derived interleukin 10 production, which alleviated macrophage-derived inflammation. This study provided the first data, to the authors' knowledge, indicating that dietary genistein modulates homeostasis in the aging gut and extends the healthspan and lifespan of aging mammals. Moreover, the existence of a link between genistein and the gut microbiota provides a rationale for dietary interventions against age-associated frailty.
Topics: Mice; Animals; Longevity; Genistein; Frailty; Fatty Acids, Volatile; Aging; Inflammation; Gastrointestinal Microbiome; Homeostasis; Mice, Inbred C57BL; Mammals
PubMed: 36693599
DOI: 10.1016/j.phrs.2023.106676 -
Cancer Medicine Feb 2023Dirty necrosis (DN) in renal cell carcinoma (RCC) is morphologically characterized by abundant neutrophil infiltration and has significant potential as an unfavorable...
AIM
Dirty necrosis (DN) in renal cell carcinoma (RCC) is morphologically characterized by abundant neutrophil infiltration and has significant potential as an unfavorable prognostic indicator. This study aimed to analyze the pathological and biological features of DN.
MATERIALS AND METHODS
A total of 81 RCC tumors, including 33 cases of DN and 48 cases of tumor necrosis without DN features (ghost necrosis [GN]), were enrolled in this study. We compared the number of neutrophils; the activation of cell death pathways, including ferroptosis, NETosis, and apoptosis; the rate of epithelial-mesenchymal transition (EMT); and proliferation status using immunohistochemistry. We further assessed the effect of the necrosis type on systemic inflammation.
RESULTS
DN tumors had a significantly higher number of neutrophils in both areas around the necrotic foci and far from the necrotic foci. Ferroptosis status did not differ between DN and GN; however, DN tumors had significantly larger areas exhibiting cell detritus with neutrophil extracellular traps (NETs) detected by citrullinated histone H3 (citH3) than GN tumors. DN tumors also had more apoptotic cells within areas around the necrotic foci. There was no significant difference between the EMT and proliferation status between DN and GN groups. Systemic inflammation markers including C-reactive protein (CRP), CRP-to-albumin ratio (CRP/Alb), platelet-to-lymphocyte ratio (PLR), and hemoglobin were significantly higher in patients with DN. In addition, some of these inflammation markers (CRP/Alb and PLR) significantly decreased after surgery.
CONCLUSIONS
DN in RCC is characterized by NETs production and systemic inflammation.
Topics: Humans; Carcinoma, Renal Cell; Inflammation; Neutrophils; C-Reactive Protein; Kidney Neoplasms; Necrosis
PubMed: 36127822
DOI: 10.1002/cam4.5249 -
Cancer Science May 2023Dirty necrosis (DN) is a form of tumor necrosis (TN) with prominent neutrophil infiltration and cell detritus in the necrotic foci. This study aimed to characterize the...
Dirty necrosis (DN) is a form of tumor necrosis (TN) with prominent neutrophil infiltration and cell detritus in the necrotic foci. This study aimed to characterize the clinicopathological features of DN in metastatic lung cancers of the colon and rectum (MLCRs). A total of 227 patients who underwent pulmonary metastasectomy and complete resection for MLCR were included in this study. TN was evaluated using digitally scanned resection specimens. These slides were immunostained for biomarkers of NETosis (citrullinated histone H3 [citH3] and myeloperoxidase [MPO]), and the area positive for citH3 and MPO was further quantified. TN was observed in 216 cases (95.2%), and 54 (25.0%) of these cases had DN. The presence of TN was not associated with a worse prognosis; however, patients with DN had a significantly shorter overall survival than those without DN (p < 0.01). Furthermore, the presence of DN was a poor prognostic factor in both the univariate and multivariate analyses. Immunohistochemical analysis revealed that the percentage of citH3-positive and MPO-positive areas in the DN-positive cases was significantly higher than that in the DN-negative cases (p < 0.01 and p < 0.01, respectively). In surgically resected MLCR, DN is the characteristic TN subtype associated with poor prognosis and neutrophil extracellular traps (NETs).
Topics: Humans; Prognosis; Rectum; Histones; Lung Neoplasms; Colon; Necrosis; Neutrophils
PubMed: 36369892
DOI: 10.1111/cas.15647 -
Skinmed 2021A boy weighing 4500 g was born at 41 weeks' gestation by Cesarean section due to fetal distress. The pregnancy was complicated by gestational diabetes. He had an Apgar...
A boy weighing 4500 g was born at 41 weeks' gestation by Cesarean section due to fetal distress. The pregnancy was complicated by gestational diabetes. He had an Apgar score of 5 and 6 after 5 and 10 minutes, respectively. At birth, the newborn manifested respiratory distress, which needed assisted ventilation for 48 hours. He developed a convulsive attack, diagnosed as a grade 2 hypoxic-ischemic encephalopathy, which was controlled by phenobarbital. Four days later, dermatologic examination revealed subcutaneous and firm nodules, ranging from 1 to 4 cm in diameter, on the cheeks, neck, arms, legs, and back (Figure 1). Some nodules became fluctuant as abscesses. Fine-needle aspiration cytology performed on a nodule revealed a dirty background with necrotic fat-containing characteristic, radially- oriented, refractile, needle-shaped crystals (Figure 2), which was diagnosed as subcutaneous fat necrosis. The diagnosis of subcutaneous fat necrosis of the newborn was made. Laboratory studies revealed hypocalcemia at 1.65 mmol/L, hypomagnesemia at 0.48 mmol/L, and hypokalemia at 3 mmol/L. The infant received calcium, magnesium, vitamin D, and potassium supplementation. On day 18, the serum calcium increased to 3.3 mmol/L. It was associated with hypertriglyceridemia at 2.6 mmol/L. Bilateral nephrocalcinosis was detected on renal ultrasound. So, hyperhydration, diuretics, and withdrawal of vitamin D were indicated. The patient was given betamethasone 0.125 mg/kg/day for 3 weeks. After a two months course, there had been complete healing of the fat necrosis (Figure 3), normalization of the calcium and triglyceride levels, and a normal growth pattern.
Topics: Cesarean Section; Fat Necrosis; Female; Humans; Infant; Infant, Newborn; Male; Necrosis; Pregnancy; Subcutaneous Fat; Ultrasonography
PubMed: 34861924
DOI: No ID Found -
Journal of Ultrasound Mar 2023Necrotizing fasciitis is one of the most common soft tissue infections, with a high risk of major amputation and a mortality ranging from 6 to 33% which has not changed...
Necrotizing fasciitis is one of the most common soft tissue infections, with a high risk of major amputation and a mortality ranging from 6 to 33% which has not changed in the past 20 years. Early surgical resection of necrotic tissue plays a key role in determining the prognosis. Nawijn et al. identified an optimal 6 hours window from presentation to surgery. Symptoms of necrotizing fasciitis mimic those of common skin infections, such as erysipelas and cellulitis, making rapid surgical management difficult. In this context, the aid of point-of-care-ultrasound is a valuable tool for early diagnosis, detecting the presence of subcutaneous thickening, gas and perifascial liquid. Other characteristic ultrasound findings include the "cobblestone" appearance of the subcutaneous soft tissues and reverberation artifacts due to hyperechoic outbreaks, defined as "snow globes" due to the presence of heterogeneous swirling material, and "dirty shadowing" due to the foggy shadow created by the gas.
Topics: Humans; Fasciitis, Necrotizing; Prognosis; Necrosis; Point-of-Care Testing; Soft Tissue Infections
PubMed: 36609958
DOI: 10.1007/s40477-022-00717-9 -
Journal of Cancer Research and Clinical... Apr 2021Tumor necrosis (TN) is one of the unfavorable prognostic factors in renal cell carcinoma (RCC). We identified two patterns of TN according to their morphology: dirty...
PURPOSE
Tumor necrosis (TN) is one of the unfavorable prognostic factors in renal cell carcinoma (RCC). We identified two patterns of TN according to their morphology: dirty necrosis and ghost necrosis. We aimed to elucidate the morphological features and unfavorable prognostic impact of dirty necrosis in RCC.
METHODS
A total of 261 tumors collected after nephrectomy, which were pathologically identified as RCC, were analyzed in this study. We classified TN as dirty necrosis or ghost necrosis and compared their clinicopathological features. We also assessed their morphological features using digitally analyzed slides. The correlation between tumor size and necrosis area or the number of necrotic foci was calculated.
RESULTS
There were 77 tumors (30%) with TN, and the presence of TN was significantly associated with unfavorable clinicopathological factors. Thirty tumors (39%) had dirty necrosis, and 47 tumors (61%) had ghost necrosis. There were significantly higher numbers of unfavorable factors associated with dirty necrosis than with ghost necrosis. In dirty necrosis, both the TN area and the number of necrotic foci were correlated with tumor size (p < 0.001 and p = 0.003, respectively). However, in ghost necrosis, no correlation was found between tumor size and the number of necrotic foci (p = 0.58). Tumors (without stage IV) with dirty necrosis had a significantly shorter disease-free survival time than those with ghost necrosis and those without TN (p = 0.024 and p < 0.001, respectively).
CONCLUSION
Dirty necrosis has potential as an unfavorable prognostic indicator of surgically resected RCC.
Topics: Aged; Carcinoma, Renal Cell; Female; Follow-Up Studies; Humans; Kidney Neoplasms; Male; Necrosis; Nephrectomy; Prognosis; Retrospective Studies; Survival Rate
PubMed: 33475860
DOI: 10.1007/s00432-020-03505-2 -
Operative Orthopadie Und Traumatologie Oct 2018Debridement of soft tissue and bone in an open fracture situation to minimize infection risk and achieve primary skin closure, or to provide conditions for early soft... (Review)
Review
OBJECTIVE
Debridement of soft tissue and bone in an open fracture situation to minimize infection risk and achieve primary skin closure, or to provide conditions for early soft tissue coverage.
INDICATIONS
Indications are Gustilo-Anderson grade I-III A-C open fractures.
CONTRAINDICATIONS
Contraindications are injuries requiring amputation, burns, and life-threatening injuries which make appropriate treatment temporarily impossible.
SURGICAL TECHNIQUE
Removal of gross contamination and macroscopic contaminants; debridement of the wound; complete resection of contaminated and dirty tissue; sparse step-by-step resection of contaminated or non-vital wound and bone margins until vital, bleeding tissue begins; low-pressure irrigation with isotonic irrigation fluid; diagnostic biopsies for microbiological testing; reduction of dead space by interpositioning of muscle or cement spacers loaded with local antibiotics; primary wound closure if tension-free closure possible; otherwise, if resources and knowhow permit and satisfactory clean debridement was achieved, local flap; if flap impossible, debridement not satisfactory, secondary tissue necrosis likely, potential remaining contamination or contamination with fecal matter, then vacuum-assisted closure therapy.
POSTOPERATIVE MANAGEMENT
Wound inspection on the second postoperative day, generous indication for second-look surgery after 36-48 h, wound inspection on the second postoperative day, wound inspection every other day, primary antibiotic prophylaxis with a first- or second-generation cephalosporin (e. g., cefuroxime), and adaptation of antibiotic therapy according to susceptibility screening.
RESULTS
Infection rates of 2-4.7% are reported for immediate primary wound closure in Gustilo-Anderson grade I, II, and III A open fractures. For Gustilo-Anderson grade III B, good wound healing, bony consolidation, and no need for secondary surgery was reported in 86.7% when primary wound closure was achieved.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Debridement; Fractures, Open; Humans; Soft Tissue Injuries; Surgical Flaps; Surgical Wound Infection; Therapeutic Irrigation; Treatment Outcome; Wound Healing
PubMed: 30182178
DOI: 10.1007/s00064-018-0562-8 -
American Journal of Clinical Pathology Jan 2022To systematically evaluate gynecologic malignancies (adnexal or uterine) causing gastrointestinal (GI) signs (eg, mass on colonoscopy) or symptoms (eg, bloody stools)...
OBJECTIVES
To systematically evaluate gynecologic malignancies (adnexal or uterine) causing gastrointestinal (GI) signs (eg, mass on colonoscopy) or symptoms (eg, bloody stools) clinically mimicking a GI primary malignancy.
METHODS
The archives of 2 institutions were retrospectively reviewed for gynecologic malignancies clinically manifesting as colonic lesions. For each case, available radiologic, endoscopic, and histologic findings were recorded.
RESULTS
We identified 16 cases: 13 biopsies and 3 resections. The masses were localized in the rectosigmoid (14 cases [88%]), right (1 case [6%]), and transverse (1 case [6%]) colon. Gastrointestinal-type complaints included abdominal pain, weight loss, hematochezia, and obstruction; 1 case was asymptomatic and found during screening colonoscopy. Nine patients (56%) had no known prior gynecologic malignancy, and in only 2 of these patients was there some clinical suspicion of a noncolonic primary malignancy. Most cases (13 [81%]) were serous carcinoma, usually high-grade adnexal or primary peritoneal. Six cases (38%) directly extended into the colon, and 7 (44%) metastasized; route of spread was unclear in the others. Only 1 case (6%) showed mucosal involvement, and none showed desmoplasia or dirty necrosis. Four of the 13 serous carcinomas (31%) showed psammoma bodies.
CONCLUSIONS
Advanced gynecologic malignancies, most commonly serous carcinoma, can rarely manifest as GI lesions. Clues to noncolonic origin on biopsy include lack of colonic mucosal involvement/dysplasia, desmoplasia, or dirty necrosis.
Topics: Colonic Neoplasms; Colonoscopy; Cystadenocarcinoma, Serous; Female; Genital Neoplasms, Female; Humans; Retrospective Studies
PubMed: 34302332
DOI: 10.1093/ajcp/aqab097 -
Medical Journal, Armed Forces India Sep 2022Colorectal cancer (CRC) is one of the commonest cancers worldwide, with incidence rates in India being around 4%. It is a heterogeneous disease with multiple established...
BACKGROUND
Colorectal cancer (CRC) is one of the commonest cancers worldwide, with incidence rates in India being around 4%. It is a heterogeneous disease with multiple established prognostic factors. Ten to fifteen percent originate from microsatellite instability (MSI) pathway, characterized by defect in mismatch repair (MMR) gene. Identification of MMR defective protein is relevant for diagnosis, prognosis, and prediction. Certain clinical and histological features are known to be associated with defective MMR genes. The objectives of this study are to find the prevalence of MSI in CRC to identify features associated with MSI and assess the value of histopathology in predicting MSI.
METHODS
We evaluated various clinical and histological parameters for identifying prognostically favorable colon cancers in a tertiary hospital. One hundred fifty colon cancers were evaluated, and MSI status was correlated with clinicopathologic variables.
RESULTS
The prevalence of MSI in CRC was found to be 11.3%. The factors associated with MSI were tumor differentiation, stage, tumor site, tumor size, tumor-infiltrating lymphocytes, Crohn's-like lymphoid reaction, and dirty necrosis. We have defined a "P" score for prediction of MSI using the clinicohistological parameters, which could be used to select patients who are to be tested for MSI.
CONCLUSION
Assessment of clinical and histopathological features will help in patient stratification and selection of patients for MSI testing. The evaluation is economical, reproducible, and easy to apply.
PubMed: 36147411
DOI: 10.1016/j.mjafi.2021.03.024