Postoperative Time and Anatomic Location Influence Skin Graft Reperfusion Assessed With Laser Speckle Contrast Imaging.

OBJECTIVES: Under optimal conditions, afferent and efferent human skin graft microcirculation can be restored 8-12 days postgrafting. Still, the evidence about the reperfusion dynamics beyond this period in a dermato-oncologic setting is scant. We aimed to characterise the reperfusion of human skin grafts over 4 weeks according to the necrosis extension (less than 20%, or 20%-50%) and anatomic location using laser speckle contrast imaging (LSCI). METHODS: Over 16 months, all eligible adults undergoing skin grafts following skin cancer removal on the scalp, face and lower limb were enroled. Perfusion was assessed with LSCI on the wound margin (control skin) on day 0 and on the graft surface on days 7, 14, 21 and 28. Graft necrosis extension was determined on day 28. RESULTS: Forty-seven grafts of 47 participants were analysed. Regardless of necrosis extension, graft perfusion equalled the control skin by day 7, surpassed it by day 21, and stabilised onwards. Grafts with less than 20% necrosis on the scalp and lower limb shared this reperfusion pattern and had a consistently better-perfused centre than the periphery for the first 21 days. On the face, the graft perfusion did not differ from the control skin from day 7 onwards, and there were no differences in reperfusion within the graft during the study. CONCLUSION: Skin graft reperfusion is a protracted process that evolves differently in the graft centre and periphery, influenced by postoperative time and anatomic location. A better knowledge of this process can potentially enhance the development of strategies to induce vessel ingrowth into tissue-engineered skin substitutes.

Análisis preliminar de alimentos para la población vegana/vegetariana. ¿son buenos aportadores de minerales de interés nutricional? / Preliminary analysis of foods for the vegan/vegetarian population. Are they good suppliers of minerals of nutritional interest?

Resumen Introducción: recientemente, se ha evidenciado gran desarrollo de variados productos destinados a la población vegetariana/vegana. Sin embargo, su valor nutricional no ha sido estudiado en profundidad. El objetivo del presente estudio fue evaluar aporte potencial (AP) y porcentaje de cobertura de requerimientos diarios (%RD) de hierro, calcio y zinc de alimentos dirigidos a poblaciones adolescente y adulta vegetariana/vegana. Materiales y método: se analizaron cinco medallones (4 comerciales, 1 casero) y once bebidas (9 comerciales, 4 de ellas c/jugo frutal y 2 caseras) elaborados con materias primas vegetales. Se estableció el AP de Fe, Ca y Zn en los productos considerando su contenido y dializabilidad porcentual (D%). Se calculó, para una porción de alimento, el porcentaje de cobertura del requerimiento diario de estos minerales. Resultados: el contenido de los minerales en los medallones fue: [Fe] 1,64-4,21 mg%; [Ca] 104-213 mg% y [Zn] 0,53-3,57 mg%; en las bebidas se observó: [Fe] 0,24-2,39 mg%; [Ca] 71-214 mg% y [Zn] 0,18-0,79 mg%. La D% en medallones fue: Fe 7,3-11,9; Ca 10,2-18,2 y Zn 17,0-21,4 y para las bebidas, Fe 5,2-32,8; Ca 6,4-35,7 y Zn 5,9-33,9. El %RD para adolescentes, considerando una porción de medallones fue: Fe mujeres 3,0-9,0%; hombres 5,0-16%; Ca 0,7-6,8% y Zn 1,5-3,9% y para adultos fue: Fe mujeres 3,0-10%; hombres 7,0-20%; Ca 0,6-5,8% y Zn 2,0-5,1%. Al considerar las bebidas, el %RD para adolescentes fue: Fe mujeres 2,0-28%; hombres 4,0-53%; Ca 0,4-22% y Zn 1,3-9,5%. Para adultos fue: Fe mujeres 2,0-31%; hombres 5,0-64%; Ca 0,3-19% y Zn 1,8-12%. Conclusiones: en los medallones se observó bajo %RD para los minerales estudiados. Las bebidas con agregado de jugos de naranja o manzana aportaron cantidades significativas de hierro. El %RD para zinc y calcio de los dieciséis alimentos fue bajo (ambos grupos estudiados). Consecuentemente, para cubrir los requerimientos de estos minerales habría que combinar adecuadamente los alimentos que se consumen.

Abstract Introduction: recently, there has been great development of various products aimed at the vegetarian/vegan population. However, its nutritional value has not been studied in depth. The objective of this study was to evaluate potential intake (PI) and percentage of coverage of daily requirements (% RD) of iron, calcium and zinc from foods aimed at adolescent and adult vegetarian/vegan populations Materials and method: five medallions (4 commercial, 1 homemade) and eleven beverages (9 commercial, 4 of them with fruit juice and 2 homemade) made with vegetable raw materials were analyzed. The PI of Fe, Ca and Zn was established in the products considering their content and percentage dialyzability (D%). It was calculated, for a portion of food, the percentage of coverage of the daily requirement of these minerals. Results: the mineral content in the medallions was: [Fe] 1.64-4.21 mg%; [Ca] 104-213 mg% and [Zn] 0.53-3.57 mg%; in beverages it was observed: [Fe] 0.24-2.39 mg%; [Ca] 71-214 mg% and [Zn] 0.18-0.79 mg%. The D% in medallions was: Fe 7,3-11,9; Ca 10.2-18.2 and Zn 17.0-21.4 and for beverages, Fe 5.2-32.8; Ca 6.4-35.7 and Zn 5.9-33.9. The %RD for adolescents, considering a portion of medallions was: Fe women 3.0-9.0%; men 5.0-16%; Ca 0.7-6.8% and Zn 1.5-3.9% and for adults it was: Fe women 3.0-10%; men 7.0-20%; Ca 0.6-5.8% and Zn 2.0-5.1%. When considering beverages, the %RD for adolescents was: Fe women 2.0-28%; men 4.0-53%; Ca 0.4-22% and Zn 1.3-9.5%. For adults it was: Fe women 2.0-31%; men 5.0-64%; Ca 0.3-19% and Zn 1.8-12%. Conclusions: in the medallions, low % RD was observed for the minerals studied. Drinks with added orange or apple juices provided significant amounts of iron. The %RD for zinc and calcium of the sixteen foods was low (both groups studied). Consequently, to meet the requirements of these minerals, it would be necessary to properly combine the foods consumed.

Genomic landscapes of ovarian clear cell carcinoma from latin countries reveal aberrations linked to survival and progression.

BACKGROUND: Ovarian clear cell carcinomas (OCCCs) are rare, aggressive and chemoresistant tumors. Geographical and ethnic differences in the incidence of OCCC have been reported with a higher incidence in Asiatic countries. There is a paucity of information regarding OCCC in Latin America (LA) and other countries. METHODS: Here, we characterized two cohorts of 33 patients with OCCC from LA (24 from Brazil and 9 from Costa Rica) and a cohort of 27 patients from Spain. Genomic analysis was performed for 26 OCCC using the OncoScan platform. Tumors were classified according to their genomic landscapes into subgroups. Clinical parameters were related to the frequency of genomic aberrations. RESULTS: The median overall survival (OS) was not significantly different between the cohorts. Genomic landscapes were characterized by different homologous recombination deficiency (HRD) levels. No difference in the distribution of genomic landscapes profiles was detected between patients from the different cohorts. OCCCs with MYC-amplified tumors harboring a concomitant loss of a region in chromosome 13q12-q13 that includes the BRCA2 gene had the longest OS. In contrast, patients carrying a high number (> 30) of total copy number (CN) aberrations with no concomitant alterations in MYC and BRCA2 genes presented the shortest OS. Furthermore, amplification of the ASH1L gene was also associated with a shorter OS. Initial-stage OCCCs with early progression were characterized by gains in the JNK1 and MKL1 genes. CONCLUSIONS: Our results provide new data from understudied OCCC populations and reveal new potential markers for OCCCs.

Tendência secular do crescimento físico em crianças de alto nível socioeconômico / Secular trend physical growth in children of high socioeconomic status

Introdução: A tendência secular de parâmetros antropométricos em crianças de alto nível socioeconômico tem sido pouco documentado e discutido em países em desenvolvimento. Objetivo: O objetivo do estudo foi analisar a tendência secular do crescimento físico de crianças em um período de oito anos. Métodos: Participaram 1136 crianças voluntárias (600 meninos), com idades entre sete e 10 anos, pertencentes a uma escola privada do município de Londrina, PR. A amostra foi dividida em três grupos para cada ano e sexo: 2002 (274 meninos e 237 meninas), 2005 (177 meninos e 145 meninas) e 2010 (149 meninos e 154 meninas). Avaliaram-se medidas antropométricas (massa corporal e estatura) e classificou-se o nível socioeconômico por questionário. Resultados: Verificou-se que o grupo masculino de 2010 apresentou idade, massa corporal e Índice de Massa Corporal (IMC) significativamente menores que o grupo 2005. Enquanto o grupo feminino de 2010 apresentou idade inferior quando comparado ao grupo 2002 (p<0,05). Todavia, considerando o ajuste pela idade cronológica, somente a estatura apresentou tendência secular positiva (p=0,005). Conclusão: Identificou-se que no período de oito anos de tendência secular não houve alterações nos indicadores de crescimento físico, com exceção da estatura para o sexo feminino que apresentou tendência secular positiva.

Introduction: The secular trend of anthropometric parameters in children of high socioeconomic status has been poorly documented and discussed in developing countries. Objective: The aim of the study was to analyze the secular trend of children's physical growth over an eight-year period. Methods: Participants were 1136 volunteer children (600 boys), aged between seven and 10 years, belonging to a private school in the city of Londrina, PR. The sample was divided into three groups for each year and sex: 2002 (274 boys and 237 girls), 2005 (177 boys and 145 girls) and 2010 (149 boys and 154 girls). Anthropometric measurements (body mass and height) were evaluated and the socioeconomic level of the patient was classified using a questionnaire. Results: It was found that the male group of 2010 had significantly lower age, body mass and Body Mass Index (BMI) than the 2005 group. While the female group of 2010 had a lower age when compared to the 2002 group (p<0.05). However, considering the adjustment for chronological age, only height showed a positive secular trend (p=0.005). Conclusion: It was identified that in the period of eight years of secular trend there were no changes in the indicators of physical growth, with the exception of height for females, which showed a positive secular trend.

Dermatological manifestations of hematologic neoplasms. Part II: nonspecific skin lesions/paraneoplastic diseases

Abstract Cutaneous manifestations occur in the course of hematologic malignancies and precede, accompany or occur late in relation to the diagnosis. They result from paraneoplastic phenomena, tumor infiltrations, immunosuppression resulting from the hematologic disease itself or its treatment. The dermatologist must be aware of these conditions that may be helpful both in the diagnosis of the underlying disease and in reducing patient morbidity. This review (part II) addresses the paraneoplastic dermatological changes associated with systemic hematologic malignancies.

DETERMINACIÓN DE LA ESTABILIDAD DE ÁCIDO ASCÓRBICO Y RETINOL EN PREPARACIONES REFORZADAS CON PRODUCTOS ALIMENTICIOS FORTIFICADOS / STABILITY ANALYSIS OF ASCORBIC ACID AND RETINOL IN REFORZED MEALS WITH FORTIFIED PRODUCTS

Introducción: La elaboración de comidas caseras implica pérdidas de vitaminas según el procedimiento de cocción. El uso de alimentos reforzados ayudaría a cubrir las recomendaciones nutricionales durante periodos críticos de la vida. El objetivo de este estudio piloto experimental es analizar la variación de las concentraciones de retinol y ácido ascórbico, en preparaciones reforzadas que incluyeron un cereal fortificado y analizar su valor como estrategia alimentaria. Material y métodos: El retinol y el ácido ascórbico se seleccionaron como indicadores de labilidad para tres recetas con diferentes procedimientos de cocción elaboradas de manera casera en condiciones reproducibles. El retinol se analizó mediante HPLC y el ácido ascórbico mediante electroforesis capilar en una muestra y HPLC en otras, debido a los límites de detección de cada método. Resultados: Según el método, el retinol aumentó su concentración en las muestras post-cocción debido a la pérdida de agua por evaporación (14% entre las reforzadas) o la redujo debido a las condiciones de temperatura, pH o presencia de oxígeno por cocciones a horno o fuego directo (5% y 22% respectivamente). Las muestras reforzadas cocidas presentaron un aumento del 18% - 20% frente a las no reforzadas. La cocción por conducción (sartén) u horno (corrientes de convección por aire) generó una pérdida parcial (13% y 24% respectivamente) de ácido ascórbico. La pérdida fue total en cocción a fuego directo y mayor relación superficie/volumen. Las muestras reforzadas cocidas presentaron un aumento de 90% cuando la vitamina se conservó. Las variaciones finales de concentración estuvieron relacionadas con las concentraciones iniciales y los métodos de cocción con diferentes formas de transferencia de calor y presiones parciales de O2. Conclusiones: Las vitaminas estudiadas son inestables en las comidas tras la cocción doméstica, aunque su pérdida es parcial; por lo tanto, reforzar las preparaciones con productos alimentarios reforzados sería una estrategia útil para cubrir los micronutrientes en situaciones críticas, en sistemas con baja densidad nutricional y diferentes consistencias

Introduction: Homemade meals elaboration implies vitamins losses in different cooking procedures. Using reinforced food would cover nutrient recommendations during critical periods of life. The aim of this experimental pilot study was to evaluate the variation of ascorbic acid and retinol concentrations in reinforced meals with fortified cereals and to analyze their value as a feeding strategy. Materials and Methods: These vitamins were selected as indicators of lability in three recipes with different cooking procedures prepared at home under reproducible conditions. Retinol was analysed through HPLC and Ascorbic Acid by capillary electrophoresis in one sample and HPLC in others because of detection limit of each methods. Results: According to cooking method, Retinol increased its concentration in post-cooking samples due to water evaporation (14% among enriched) or reduced it due to temperature, pH or presence of oxygen by oven or direct cooking (5% and 22% respectively). Between cooked samples, reinforced sample presented an 18% - 20% increase versus non-enriched one. Cooking by conduction (frying pan) or oven (air convection currents) generated a partial loss (13% and 24% respectively) of ascorbic acid. The loss was total in direct fire firing and higher surface/volume ratio. Cooked reinforced samples showed a 90% increase when the vitamin was preserved. Final concentration variations were related to initial concentrations and cooking methods involving different forms of heat transfer and partial pressures of O2.Conclusions: Vitamins studied were shown to be unstable in meals after domestic cooking, although their loss is partial. Therefore,reinforcing preparations with fortified food products would be a useful strategy to cover micronutrients in critical situations, in food preparations with low nutritional density and different consistencies

Molecular Determinants of Mouse Adaptation of Rat Hepacivirus.

The lack of robust immunocompetent animal models for hepatitis C virus (HCV) impedes vaccine development and studies of immune responses. Norway rat hepacivirus (NrHV) infection in rats shares HCV-defining characteristics, including hepatotropism, chronicity, immune responses, and aspects of liver pathology. To exploit genetic variants and research tools, we previously adapted NrHV to prolonged infection in laboratory mice. Through intrahepatic RNA inoculation of molecular clones of the identified variants, we here characterized four mutations in the envelope proteins responsible for mouse adaptation, including one disrupting a glycosylation site. These mutations led to high-titer viremia, similar to that observed in rats. In 4-week-old mice, infection was cleared after around 5 weeks compared to 2 to 3 weeks for nonadapted virus. In contrast, the mutations led to persistent but attenuated infection in rats, and they partially reverted, accompanied by an increase in viremia. Attenuated infection in rat but not mouse hepatoma cells demonstrated that the characterized mutations were indeed mouse adaptive rather than generally adaptive across species and that species determinants and not immune interactions were responsible for attenuation in rats. Unlike persistent NrHV infection in rats, acute resolving infection in mice was not associated with the development of neutralizing antibodies. Finally, infection of scavenger receptor B-I (SR-BI) knockout mice suggested that adaptation to mouse SR-BI was not a primary function of the identified mutations. Rather, the virus may have adapted to lower dependency on SR-BI, thereby potentially surpassing species-specific differences. In conclusion, we identified specific determinants of NrHV mouse adaptation, suggesting species-specific interactions during entry. IMPORTANCE A prophylactic vaccine is required to achieve the World Health Organization's objective for hepatitis C virus elimination as a serious public health threat. However, the lack of robust immunocompetent animal models supporting hepatitis C virus infection impedes vaccine development as well as studies of immune responses and viral evasion. Hepatitis C virus-related hepaciviruses were discovered in a number of animal species and provide useful surrogate infection models. Norway rat hepacivirus is of particular interest, as it enables studies in rats, an immunocompetent and widely used small laboratory animal model. Its adaptation to robust infection also in laboratory mice provides access to a broader set of mouse genetic lines and comprehensive research tools. The presented mouse-adapted infectious clones will be of utility for reverse genetic studies, and the Norway rat hepacivirus mouse model will facilitate studies of hepacivirus infection for in-depth characterization of virus-host interactions, immune responses, and liver pathology.

Dermatological manifestations of hematologic neoplasms. Part I: secondary specific skin lesions

Abstract Cutaneous manifestations occur during the course of hematologic malignancies and precede, follow, or are late events in relation to the diagnosis. They result from paraneoplastic phenomena, tumor infiltrations, and immunosuppression resulting from the hematologic neoplasia itself or its treatment. The dermatologist must be aware of these conditions, which can help both in the diagnosis of the underlying disease and in the reduction of patient morbidity. This review (part I) addresses skin lesions associated with direct infiltration by systemic hematologic malignancies.

Dermatological manifestations of hematologic neoplasms. Part II: nonspecific skin lesions/paraneoplastic diseases.

Cutaneous manifestations occur in the course of hematologic malignancies and precede, accompany or occur late in relation to the diagnosis. They result from paraneoplastic phenomena, tumor infiltrations, immunosuppression resulting from the hematologic disease itself or its treatment. The dermatologist must be aware of these conditions that may be helpful both in the diagnosis of the underlying disease and in reducing patient morbidity. This review (part II) addresses the paraneoplastic dermatological changes associated with systemic hematologic malignancies.

Basal cell carcinomas of the scalp after radiotherapy for tinea capitis: Clinicopathological study in a case series of 96 patients with analysis of 427 tumours.

BACKGROUND/OBJECTIVES: Low-dose X-ray radiotherapy to treat tinea capitis during childhood is a well-known risk factor for scalp basal cell carcinomas (BCCs). Post-radiotherapy BCCs are often multiple, and it has been suggested that they display more aggressive features. Our main objective was to study the clinicopathological aspects of post-radiotherapy BCCs to evaluate their biological behaviour and identify features that may differ from other BCCs. METHODS: We performed an observational, retrospective study assessing multiple clinical and pathological characteristics of patients with post-radiotherapy BCCs. RESULTS: We studied 96 patients with 427 post-radiotherapy scalp BCCs. Post-radiotherapy BCCs were often multiple (median of 4 lesions/patient, ranging from 1 to 54). Significant comorbidities included a high incidence of thyroid disease and meningiomas. Recurrences were observed in 23% of patients, but there may be confounding factors, such as referral bias, heterogenous treatment modalities and occurrence of new tumours due to field effect. We found a high incidence of infundibulocystic BCCs (in 14.6% of patients and corresponding to 5.4% of the total number of tumours), trichoblastomas (5.2%) and neurofibromas of the scalp (10%). CONCLUSIONS: This study is consistent with the occurrence of multiple lesions (sometimes numerous) and a relatively high tendency for recurrence in post-radiotherapy BCCs, as suggested by previous studies. We also found a high incidence of the infundibulocystic variant and a higher risk of follicular tumours and neurofibromas, which suggests that radiotherapy may influence the type of differentiation of BCCs and contribute to induce neoplasms of different cell lines.

Dermatological manifestations of hematologic neoplasms. Part I: secondary specific skin lesions.

Cutaneous manifestations occur during the course of hematologic malignancies and precede, follow, or are late events in relation to the diagnosis. They result from paraneoplastic phenomena, tumor infiltrations, and immunosuppression resulting from the hematologic neoplasia itself or its treatment. The dermatologist must be aware of these conditions, which can help both in the diagnosis of the underlying disease and in the reduction of patient morbidity. This review (part I) addresses skin lesions associated with direct infiltration by systemic hematologic malignancies.

fHER2, PR, ER, Ki-67 and Cytokeratin 5/6 Expression in Benign Feline Mammary Lesions.

Biomarkers are essential in the characterization of neoplastic lesions and aid not only in the classification of the nature of the lesions, but also in the understanding of their ontogeny, development and prognosis. In cats, while mammary carcinomas are increasingly being characterized, information on their benign lesions is still scarce. Indeed, a better characterization of benign lesions could have an important role in unravelling mammary oncogenesis, similar to that in human breast cancer. Thus, in this study, the expression of five markers was analyzed in 47 benign mammary lesions (hyperplasia, dysplasia and benign tumors) collected from 27 queens. Dysplastic and hyperplastic lesions were the most common (41/47, 81.7%). Most of the lesions were classified as ER positive (43/47, 91.5%), PR negative (30/47, 63.8%), fHER2 negative (29/47, 64.4%), CK 5/6 negative (36/47, 76.6%) and with a low Ki-67 index (37/47, 78.7%). Statistical analysis revealed a correlation between younger ages and ER positivity (p = 0.013) and between larger lesions and negative PR status (p = 0.038). These results reinforce the importance of evaluating the expression of the ER status, prevalent in benign lesions, as a putative precursor in cancer progression.

Tying the successor's hands or following the neighbor? Diffusion of access to information in Brazilian municipalities / ¿Atar las manos del sucesor o seguir al vecino? Difusión del acceso a la información en municipios brasileños / Atar as mãos do sucessor ou seguir o vizinho? Difusão do acesso à informação nos municípios brasileiros

Abstract Why do political actors promote public transparency? Studies show that adherence to transparency can be both politically strategic, i.e., to tie the hands of the successor, and a result of observing the adoption of the policy made by other municipalities, i.e., to minimize the cost of information. We test both the political and the informational motivations to explain the adoption of transparency laws with a subnational analysis of the diffusion of LAI in Brazilian municipalities (2011-2019). Results show that both the informational and the political strategy motivations affect the probability of adopting the LAI. Socioeconomic factors are also important explanatory factors. However, an analysis of heterogeneous effects shows that the learning mechanism is relevant for reducing the impact of socioeconomic factors. This means that learning from neighboring municipalities minimizes the cost of information and the reliance on structural factors to promote transparency at the local level.

Resumen ¿Por qué los actores políticos promueven la transparencia pública? Los estudios muestran que la adhesión a la transparencia puede ser tanto políticamente estratégica, es decir, para atar las manos del sucesor, como resultado de la observación de la adopción de la política hecha por otros municipios, esto es, para minimizar el costo de la información. Probamos las motivaciones políticas e informativas para explicar la adopción de leyes de transparencia con un análisis subnacional de la difusión de la LAI en los municipios brasileños (2011-2019). Los resultados muestran que tanto las motivaciones de aprendizaje como las de estrategia política afectan la probabilidad de adopción de la LAI. Los factores socioeconómicos también son factores explicativos importantes. Sin embargo, un análisis de los efectos heterogéneos muestra que el mecanismo de aprendizaje es relevante para reducir el impacto de los factores socioeconómicos. Esto significa que aprender de los vecinos minimiza el costo de la información y la dependencia de factores estructurales para promover la transparencia a nivel local.

Resumo Por que os atores políticos promovem a transparência pública? Estudos mostram que a adesão à transparência pode ser tanto politicamente estratégica, ou seja, para atar as mãos do sucessor, quanto resultado da observação da adoção da política feita por outros municípios, isto é, para minimizar o custo da informação. Testamos as motivações políticas e informacionais para explicar a adoção de leis de transparência com uma análise subnacional da difusão da LAI nos municípios brasileiros (2011-2019). Os resultados mostram que tanto o aprendizado quanto as motivações da estratégia política afetam a probabilidade de adoção da LAI. Fatores socioeconômicos também são importantes fatores explicativos. No entanto, uma análise dos efeitos heterogêneos mostra que o mecanismo de aprendizagem é relevante para reduzir o impacto dos fatores socioeconômicos. Isso significa que aprender com os vizinhos minimiza o custo da informação e a dependência de fatores estruturais para promover a transparência em nível local.

[Sarcoid Granulomas Over Scars: Beyond Sarcoidosis]. / Granulomas Sarcóides Sobre Cicatriz: Além da Sarcoidose.

Sarcoid granulomas can be found in a wide range of diseases and differentiating sarcoidosis from a sarcoid-like reaction may be a challenge. We present a woman with erythematoviolaceous papulonodular lesions located on the ears where piercings were placed. A skin biopsy showing an infiltrate of sarcoid and focal tuberculoid granulomas did not exclude sarcoidosis. There was a slight increase in the level of angiotensin-converting enzyme. Systemic involvement due to sarcoidosis was excluded. Epicutaneous tests performed revealed a strong positive reaction to palladium and nickel, supporting the diagnosis of granulomatous contact dermatitis. There are only a few reports of granulomatous contact dermatitis to palladium with piercings as the source of sensitization. The formation of sarcoid granulomas can represent either a sarcoid-like reaction or a form of cutaneous sarcoidosis, and patch tests are essential in order to establish the diagnosis.

Os granulomas sarcóides podem ser encontrados num vasto leque de doenças, pelo que diferenciar a sarcoidose de uma reação tipo sarcóide constituiu um desafio. Apresentamos o caso de uma jovem com lesões papulonodulares eritematovioláceas localizadas nos pavilhões auriculares sobre os locais de aplicação de piercings. A biópsia cutânea mostrou um infiltrado constituído por granulomas sarcóides ou focalmente tuberculóides, não excluindo a hipótese de sarcoidose. O estudo complementar, apesar de uma discreta elevação da enzima conversora da angiotensina, excluiu envolvimento ocular ou pulmonar por sarcoidose. Perante a localização das lesões foram realizados testes epicutâneos que revelaram uma reação fortemente positiva ao paládio e ao níquel, apoiando o diagnóstico de dermatite de contacto granulomatosa. Estão descritos escassos casos de dermatite de contacto granulomatosa ao paládio tendo o metal dos piercings como fonte de sensibilização. A formação de granulomas sarcóides pode representar quer uma reação tipo sarcóide, quer uma forma de sarcoidose cutânea, e os testes epicutâneos adquirem um papel fundamental no diagnóstico correto.

Efeitos imediatos da fotobiomodulação com laser de baixa intensidade e comprimentos de onda vermelho (660 nm) e infravermelho (808 nm) na fadiga eletromiográfica do músculo orbicular da boca: estudo clínico randomizado / Immediate effects of red (660 nm) and infrared (808 nm) photobiomodulation therapy on fatigue of the orbicularis oris muscle: a randomized clinical study

RESUMO Objetivo comparar os efeitos imediatos da fotobiomodulação com laser nos comprimentos de onda 660 nm e 808 nm na fadiga do músculo orbicular da boca. Métodos trata-se de um estudo experimental randomizado, com 60 mulheres, com idade entre 19 e 43 anos. As participantes foram divididas em quatro grupos. O grupo GV recebeu irradiação com laser de comprimento de onda de 660 nm em quatro pontos do orbicular da boca; o grupo GIV recebeu irradiação com laser de comprimento de onda de 808 nm nos mesmos pontos; o grupo controle não recebeu irradiação e o grupo placebo passou pelos mesmos procedimentos dos grupos GV e GIV, porém o equipamento não foi acionado. A irradiação foi realizada com laser de 100 mW de potência, 4 J de energia por ponto e 133,3 J/cm2 de fluência. Avaliação eletromiográfica foi realizada antes e após a irradiação, concomitantemente ao exercício de protrusão labial sustentada até a sensação de fadiga. O índice de fadiga eletromiográfica foi calculado a partir da frequência mediana. A amplitude do sinal foi avaliada, examinando o RMS, e os valores normalizados pelo pico. A diferença na amplitude entre lábios superiores e inferiores também foi analisada. Todas as variáveis foram comparadas antes e após a irradiação. Resultados não foram encontradas diferenças significativas nas medidas antes e após a irradiação. Conclusão a fotobiomodulação, com os parâmetros investigados neste estudo, não resultou em efeitos imediatos sobre a fadiga do músculo orbicular da boca.

ABSTRACT Purpose To compare the immediate effects of laser photobiomodulation at wavelengths of 660 nm and 808 nm on fatigue of the orbicularis oris. Methods This is a randomized study with 60 women aged between 19 and 43 years. The participants were divided into four groups. Group RG received photobiomodulation with a laser wavelength of 660 nm at four points of the orbicularis oris; group IRG received photobiomodulation with a laser wavelength of 808 nm at the same points; the control group did not receive light treatment; and the placebo group underwent the same procedures as RG and IRG but with the equipment switched off. The irradiation was performed with a laser of 100 mW of power, 4 J of energy per point and 133.3 J/cm2 of fluency. An electromyography evaluation was performed before and after the irradiation, concomitantly with the exercise of lip protrusion maintained until the sensation of fatigue. Fatigue was evaluated by a median frequency using the electromyographic fatigue index. The amplitude of the signal was evaluated, examining the root mean square, and the values were normalized by the peak. The difference in amplitude between the upper and lower lips was also analyzed. All variables were compared before and after irradiation. Results No significant difference was found between the measures taken before and after irradiation. Conclusion Photobiomodulation with the parameters investigated in this study had no immediate effect on orbicular oris fatigue.

Histopathology of chronic spontaneous urticaria with occasional bruising lesions is not significantly different from urticaria with typical wheals.

BACKGROUND: Chronic spontaneous urticaria (CSU) may occasionally exhibit long-lasting lesions with bruising, usually considered a hallmark of urticarial vasculitis (UV). Histopathology of these chronic urticarial lesions has not been extensively studied. METHODS: Skin biopsies from patients with anti-H1 resistant CSU were evaluated for several parameters (edema, location, intensity, and cell composition of the inflammatory infiltrate, and abnormalities in the blood vessels). RESULTS: We studied 45 patients (37 female/8 male, mean age 49.3 years) with CSU, 60% of whom with occasional bruising lesions and 3 patients with hypocomplementemic UV. Histopathology in CSU showed mainly perivascular and interstitial inflammatory infiltrate (91.1%), including eosinophils (80%), neutrophils (77.8%), and lymphocytes (71.1%), vasodilatation (88.9%), intravascular neutrophils (95.6%), dermal edema (51.1%), swelling of endothelial cells (51.1%), and minor and rare fibrinoid necrosis and karyorrhexis (6.7%). Significant karyorrhexis and frank fibrinoid necrosis were observed, respectively, in two and three cases of UV. In patients with occasional bruising, mast cells occurred in fewer cases whereas eosinophils were more frequent, but no statistically significant difference was found for other parameters. CONCLUSIONS: Histopathological findings were not significantly different between CSU with or without bruising lesions. Bruising may be associated with more severe forms of CSU with no histopathological signature, although UV cannot be completely excluded based on histopathology.

Incorporating patient centered benefits as endpoints in randomized trials of maintenance therapies in advanced ovarian cancer: A position paper from the GCIG symptom benefit committee.

BACKGROUND: Quality of life and patient reported outcome measures (PROMs) are important secondary endpoints and incorporated in most contemporary clinical trials. There have been deficiencies in their assessment and reporting in ovarian cancer clinical trials, particularly in trials of maintenance treatment where they are of particular importance. The Gynecologic Cancer InterGroup (GCIG) symptom benefit committee (SBC) recently convened a brainstorming meeting with representation from all collaborative groups to address questions of how to best incorporate PROMs into trials of maintenance therapies to support the primary endpoint which is usually progression free survival (PFS). These recommendations should harmonize the collection, analysis and reporting of PROM's across future GCIG trials. METHODS: Through literature review, trials analysis and input from international experts, the SBC identified four relevant topics to address with respect to promoting the role of PROMs to support the PFS endpoint in clinical trials of maintenance treatment for OC. RESULTS: The GCIG SBC unanimously accepted the importance of integrating PROM's in future maintenance trials and developed four guiding principles to be considered early in trial design. These include 1) adherence to SPIRIT-PRO guidelines, 2) harmonization of selection, collection and reporting of PROM's; 3) combining Health Related Quality of Life (HRQL) measures with clinical endpoints and 4) common approaches to dealing with incomplete HRQL data. CONCLUSIONS: Close attention to incorporating HRQL and PROM's is critical to interpret the results of ovarian cancer clinical trials of maintenance therapies. There should be a consistent approach to assessing and reporting patient centered benefits across all GCIG trials to enable cross trial comparisons which can be used to inform practice.

Coats plus syndrome (cerebroretinal microangiopathy with calcifications and cysts-1): A case report.

We present a 6-year-old girl with skin hyperpigmentation, leukoplakia, and onychodystrophy, the classic mucocutaneous triad usually associated with dyskeratosis congenita. The patient also had premature graying of the hair, bone marrow failure, hepatitis, exudative retinopathy, osteopenia with multiple long bone fractures, and intracranial calcifications and brain cysts. Coats plus syndrome is a rare disease with a clinical and genetic overlap with dyskeratosis congenita. This disease is reviewed, with a focus on the pathogenesis of the genetic anomalies and its background as a telomere biology disorder.