Comparison of methods to estimate the affected body surface area and the dosage of topical treatments in psoriasis and atopic dermatitis: the advantage of a picture-based tool.

BACKGROUND: The accurate determination of the dosage of topical treatments is important given its repercussions on patient adherence and therapeutic efficacy. Up till now, the fingertip unit calculated by the rule of hands is considered the gold standard, although its use is associated with several drawbacks. OBJECTIVE: To compare different methods to estimate the affected body surface area (BSA) and dosage of topical treatments in atopic dermatitis and psoriasis and investigate its reliability, user-friendliness and timing. METHODS: In this study, we compared the reliability of three different methods: (i) the fingertip unit calculated by the 1% hand rule; (ii) a picture-based tool [termed Cutaneous Inflammatory Disease Extent Score (CIDES)]; and (iii) a digital drawing tool. Eleven observers scored 40 patients with psoriasis and eczema to assess the inter-rater and intrarater reliability. Timing was automatically recorded, and user-friendliness was investigated by a questionnaire. RESULTS: An excellent intraclass correlation (ICC) was found for both inter-rater agreement and intrarater agreement for the picture-based tool (ICC = 0.92 and ICC = 0.96, respectively). The ICCs for drawing the area of involvement on a silhouette were 0.89 and 0.93, respectively. Finally, the rule of hands was associated with an increased inter-rater variability although an excellent intrarater agreement was found (ICC = 0.79 and 0.95, respectively). Automated calculation of the amount of topical treatment improved reliability, and CIDES was associated with the least variation. CIDES was considered the preferred method by all observers and was fast to perform (median: 30 s). CONCLUSION: A picture-based method offered the most advantages (in terms of reliability, speed and user-friendliness) to estimate the affected BSA and calculate the dosage of topical treatments.

Unbiased random mutagenesis contributes to a better understanding of the virulent behaviour of Paenibacillus larvae.

AIMS: American foulbrood, caused by the Gram-positive bacteria Paenibacillus larvae, is one of the most severe bacterial diseases of the European honey bee. The bacterium has been known for long, but only the last decade the mechanisms used by the pathogen to cause disease in its host are starting to unravel. In this study, the knowledge of this virulent behaviour is expanded and several possible virulence factors are suggested. METHODS AND RESULTS: Identification of possible virulence factors has been done by random mutagenesis to ensure an unbiased approach. A library of mutants was tested for a significant difference in virulence using in vitro exposure assays. Affected loci were characterized and their potential to contribute in virulence of the pathogen was assessed. CONCLUSIONS: The identified mutated loci dacB, dnaK, metN, ywqD, lysC, serC and gbpA are known to encode for virulence factors in other bacteria and are suggested to play a similar role in P. larvae. SIGNIFICANCE AND IMPACT OF THE STUDY: The study identified new possible virulence factors for P. larvae genotype ERIC I in an unbiased way. This contributes to the knowledge and understanding of the possible mechanisms used by this pathogen to colonize and kill its host.

Eaton and Littler Ligament Reconstruction for the Painful first Carpometacarpal Joint : Patient satisfaction.

The ligamentous reconstruction according to Eaton and Littler (7) was designed to restore the stability of the carpometacarpal joint of the thumb. We evaluated the patients' satisfaction after an Eaton and Littler-procedure as well as possible risk factors in the development of thumb basal joint instability. A retrospective chart review and clinical assessment or telephone survey are executed in 33 patients, with a mean follow-up of 7 years. Only 45% of the patients were satisfied. Within the group of clinical assessed patients, there were significant differences in thumb function comparing operated with not operated side. Overall joint hypermobility can be a contributing factor for this thumb basal joint instability, but has no effect on the outcome after an Eaton-Littler procedure.

Evaluation of the metaphyseal ulnar shortening technique according to Sennwald.

The outcome of a metaphyseal ulnar shortening osteotomy, reported by Sennwald as an alternative option for ulnar abutment syndrome, was evaluated with -regard to the functional results, pain relief and incidence of complications. METHOD: We conducted a review of 12 patients ; measured parameters were DASH score, PRWE, VAS for pain, grip force and wrist motion. RESULTS: Only disability improved significantly with a DASH score of 42 (p = 0.03). The function and pain assessment scores did not improve in 3 patients. We found no correlation between change in functional scores and other measured variables. Six patients were reoperated for prominent screw heads or new-onset distal radioulnar joint osteoarthritis. CONCLUSION: All osteomies healed fast and uneventfully and disability improved in most patients but 25% did not improve and 50% were re-operated. Further investigation is needed to evaluate the value of the metaphyseal osteotomy as an alternative treatment for ulnar abutment syndrome.

Pick-up and drop transfer of diamond nanosheets.

Nanocrystalline diamond (NCD) is a promising material for electronic and mechanical micro- and nanodevices. Here we introduce a versatile pick-up and drop technique that makes it possible to investigate the electrical, optical and mechanical properties of as-grown NCD films. Using this technique, NCD nanosheets, as thin as 55 nm, can be picked-up from a growth substrate and positioned on another substrate. As a proof of concept, electronic devices and mechanical resonators are fabricated and their properties are characterized. In addition, the versatility of the method is further explored by transferring NCD nanosheets onto an optical fiber, which allows measuring its optical absorption. Finally, we show that NCD nanosheets can also be transferred onto two-dimensional crystals, such as MoS2, to fabricate heterostructures. Pick-up and drop transfer enables the fabrication of a variety of NCD-based devices without requiring lithography or wet processing.

Giant cell tumor of distal phalanx in an adolescent with Goltz-Gorlin syndrome.

We report on a unique case of a young female patient with the Goltz-Gorlin syndrome who developed a giant cell tumor of bone in the distal phalanx of the thumb. This case is noteworthy because of the combination of some unusual features. Firstly, it is only the fifth case report on the association of giant cell tumor of bone and the Goltz-Gorlin syndrome. Also the localization of the lesion in the bones of the hand and the presentation at adolescent age is rarely seen.

Prospective study to assess fluid accumulation and tenosynovial changes in the aromatase inhibitor-induced musculoskeletal syndrome: 2-year follow-up data.

BACKGROUND: Aromatase inhibitors (AIs) frequently lead to the AI-induced musculoskeletal syndrome (AIMSS). Looking into its pathophysiology, 6 months of AI therapy thickens the tendon sheath with intra-articular fluid (IAF) retention and loss of grip strength. We here report 24-month follow-up data. PATIENTS AND METHODS: A prospective cohort study of 33 postmenopausal breast cancer patients received adjuvant endocrine therapy; 27 received an AI and 6 received tamoxifen. At baseline, 6 and 24 months patients had a rheumatologic examination, including a grip strength test, and magnetic resonance imaging of both hands and wrists. The primary end point was tenosynovial changes; secondary end points were changes in morning stiffness, grip strength and IAF. RESULTS: Twenty-three AI and 5 tamoxifen patients completed all investigations. Between month 6 and 24, IAF further increased in AI users (P = 0.04) but not in tamoxifen users, and grip strength further decreased in both groups. The worsened tenosynovial changes were strongly correlated with a decrease in grip strength. At 24 months, morning stiffness continued to be present in over a third of AI users. CONCLUSION: AIMSS represents a substantial problem in breast cancer patients. It is associated with tenosynovial changes, IAF retention, joint stiffness and loss of grip strength that do not improve with prolonged use.

Hydrogen termination of CVD diamond films by high-temperature annealing at atmospheric pressure.

A high-temperature procedure to hydrogenate diamond films using molecular hydrogen at atmospheric pressure was explored. Undoped and doped chemical vapour deposited (CVD) polycrystalline diamond films were treated according to our annealing method using a H2 gas flow down to ~50 ml∕min (STP) at ~850 °C. The films were extensively evaluated by surface wettability, electron affinity, elemental composition, photoconductivity, and redox studies. In addition, electrografting experiments were performed. The surface characteristics as well as the optoelectronic and redox properties of the annealed films were found to be very similar to hydrogen plasma-treated films. Moreover, the presented method is compatible with atmospheric pressure and provides a low-cost solution to hydrogenate CVD diamond, which makes it interesting for industrial applications. The plausible mechanism for the hydrogen termination of CVD diamond films is based on the formation of surface carbon dangling bonds and carbon-carbon unsaturated bonds at the applied tempera-ture, which react with molecular hydrogen to produce a hydrogen-terminated surface.

Poland's syndrome with radial aplasia of the hand.

A case of symbrachydactyly with ipsilateral radial club hand is reported. Although this can fit in the vascular dysruption sequence, this is a rare combination.

Focal fibrocartilaginous dysplasia in the upper limb: case report and review of the literature.

Focal fibrocartilaginous dysplasia (FFCD) is an uncommon, benign bone lesion that causes angular deformities of the long bones in young children. Most deformities were seen around the knee. Diagnostic criteria are based on clinical and radiological signs: unilateral angular deformity in a long bone of a young child, associated with on X-ray a typical lucent bony defect with surrounding sclerosis at the concavity of the deformity with a cortical defect. The etiology is not understood. There were 16 cases described previously involving the upper extremity: 9 cases with FFCD of the ulna, 3 of the humerus, 2 of the radius and 2 of the phalanx. We report a case of cubitus varus deformity in a young girl of 2 years and 2 months where the deformity worsened very quickly. We believe that debridement of the fibrous tether at very young age will prevent further deformity and can correct spontaneously by remaining growth.

Optimization of drug delivery systems for intraperitoneal therapy to extend the residence time of the chemotherapeutic agent.

Intraperitoneal (IP) chemotherapy is an effective way of treating peritoneal carcinomatosis of colorectal origin after complete cytoreduction. Although IP therapy has been already performed for many years, no standardized treatment design has been developed in terms of schedule, residence time, drug, or carrier solution. Because of the fast clearance of the conventional intravenous (IV) drug delivery systems used for IP therapy, a lot of research is performed to optimize IP drug delivery and extend the residence time of the cytotoxic agent in the peritoneal cavity. This paper reviews the recent advances made in drug delivery systems for IP chemotherapy, discussing the use of microparticles, nanoparticles, liposomes, micelles, implants, and injectable depots for IP delivery.

Drying behaviour and visualization of surfactants after co-spray drying of surfactant-stabilized aqueous suspensions.

Surfactants are widely used in many industries as dispersants or flocculants for suspensions. As the addition of low concentrations of surfactant is sufficient to execute their effect, they barely alter the formulation composition. In this research it was examined whether surfactants, in particular polysorbate 80 (PS80), were suitable as suspension stabilizers for co-spray drying of drug-filler combinations. Therefore, their drying behaviour at different process and formulation settings was studied and mapped by means of fluorescently labelled PS80. Co-spray drying of 10% w/w aqueous suspensions stabilized with 0.1% w/w PS80 resulted in excessive loss of sticky powder in the conical lower part of the drying chamber and the powder conveyor ducts. Up to 16% of powder was lost in the first transporter (i.e. the first part of the conveyor ducts). The amount of powder deposited in the first transporter, and by extension the stickiness of the recovered powder, was correlated with the presence of PS80 on the surface of the spray dried particles. Redistribution of free surfactant molecules during droplet drying depended on the process and formulation parameters. Enrichment of PS80 at the particle surface was most pronounced after co-spray drying of liquid feedstocks with low suspended fraction at process conditions favouring rapid droplet drying.

Aromatase inhibitor-induced loss of grip strength is body mass index dependent: hypothesis-generating findings for its pathogenesis.

BACKGROUND: Our preliminary results showed that tenosynovial changes and decrease in grip strength are associated with the aromatase inhibitor-induced musculoskeletal syndrome (AIMSS). Here, we report the final results and assess the relationship between grip strength and body mass index (BMI). PATIENTS AND METHODS: We conducted a prospective study including postmenopausal early breast cancer patients receiving either an aromatase inhibitor (AI) or tamoxifen. Primary end point was change from baseline in tenosynovial abnormalities. Secondary end points were changes from baseline in morning stiffness, intra-articular fluid and grip strength and its association with BMI. RESULTS: After 6 months of therapy, 74% [95% confidence interval (CI) 51% to 89%] of AI-treated patients had worsened tenosynovial abnormalities, 56% (95% CI 34% to 75%) had increased intra-articular fluid, and 22% (95% CI 9% to 45%) had increased morning stiffness. Grip strength decreased 8% for the left hand (95% CI 2% to 21%) and 11% for the right (95% CI 4% to 17%). Regression analysis suggested that grip strength decreased more for subjects with high or with low BMI. CONCLUSIONS: AIMSS is characterized by tenosynovial changes, intra-articular fluid and morning stiffness. We hypothesize that the quadratic association between BMI and loss of grip strength reflects AI-induced changes on the endocrine control of the growth hormone insulin-like growth factor-I pathway.

Lateral elbow tendinopathy: surgery versus extracorporeal shock wave therapy.

Lateral elbow pain caused by tendinopathy - tendinosis - or tennis elbow is a highly prevalent problem. Unfortunately, no treatment method can guarantee clinical success. Inspired by the lithotripsy technique used for kidney stones, extracorporeal shock wave therapy (ESWT) has been introduced as an alternative to surgical treatment 25 years ago. In a randomized prospective study, we compared 15 patients with lateral elbow tendinopathy who were operated and 14 who underwent ESWT. Almost all patients had good or excellent outcomes according to the criteria by Verhaar. Subjective improvement was 57% for the ESWT group and 76% for the surgery group. No significant differences between both groups were found (p = 0.07). We therefore recommend considering non-invasive techniques such as ESWT treatment prior to surgery in tennis elbow.

Skin grafting prevents recurrence in Dupuytren's disease and extension correlates with fibrosis diathesis score.

Full thickness grafting can be considered after fasciectomy for Dupuytren contracture in severe cases with skin shortage or in radical dermofasciectomy. It is a common dogma that these skin grafts may prevent disease recurrence. We reviewed 47 patients after fasciectomy and full-thickness skin grafting for Dupuytren contracture at 3-16 years' follow-up. Recurrence beneath the skin graft and extension of the disease in the rest of the hand were recorded. Age at onset, gender and factors considered to influence the outcome due to fibrosis diathesis, such as bilateral disease, family history and ectopic lesions, were noted. The Tubiana classification was used to grade disease severity at surgery and at follow-up. None of the patients manifested recurrence underneath the skin graft, but the disease did show extension in 83% of cases. Disease extension was more likely in patients with higher fibrosis diathesis scores. We conclude that skin grafting may prevent disease recurrence underneath the grafts, but extension of the disease correlates with fibrosis diathesis. LEVEL OF EVIDENCE: IV, therapeutic cohort study.

Long-term follow-up of the three-ligament tenodesis for scapholunate ligament lesions: 9-year results.

We report on a retrospective cohort of 50 cases of three-ligament tenodesis for scapholunate instability. Fifteen cases (30% of our cohort) needed salvage surgery (11 proximal row carpectomies, 2 partial and 2 total wrist fusions) at an average of 33 months and are considered "failures". Of the 35 remaining cases ("success"), 16 (32% of our cohort) were reviewed at average 111 months and had good functional outcomes (QuickDASH 18/100, PRWE 11/100, pain 1/10, satisfaction 9/10). Return to work was 81% and grip strength was 80% of the opposite side. Radiological review found no significant correction in the short-term: scapholunate angle (SLA) from 72° to 69° (p = 0.544), scapholunate distance (SLD) from 3.4 mm to 3.4 mm (p = 0.833) and radiolunate angle (RLA) from 17° to 13° (p = 0.253). A significant deterioration in SLA from 72° to 80° (p = 0.014), not correlated to function, was seen at final follow-up. Radiographic progression to wrist degeneration was seen in 63% of successful cases. In failed cases, we noticed inferior radiographic parameters in the short-term: SLD of 4.6 mm in failed versus 3.4 mm in successful cases (p = 0.038) and RLA of 22° in failed versus 13° in successful cases (p = 0.046). Complication rate was 10% (2 scaphoid necroses, 1 septic arthritis and 2 complex regional pain syndromes). Despite radiological deterioration of SLA and development of degeneration in most cases, three-ligament tenodesis can give satisfactory wrist function in some patients, but we observed a significant number of failures and a high complication rate. LEVEL OF EVIDENCE: IV.

Dupuytren's disease: a predominant reason for elective finger amputation in adults.

Dupuytren's disease (DD) can lead to severe disabling finger contractures resistant to surgical treatment. In some cases, finger or ray amputation is considered, due to a severe functional deficit or vascular injury. To evaluate the weight of amputation surgery in DD, a retrospective study was conducted over a 5-year time interval, outlining all indications for elective finger amputation and its prevalence in the total of surgical interventions for DD. The outcome in DD was compared to post-traumatic amputations. Out of 31 elective finger and ray amputations, 12 (39%) were indicated for DD, all in the 4th or 5th ray, of which 92% were in recurrent disease. In the 646 surgical procedures for DD in the matching time interval, we conclude that almost 2% were elective amputations. The outcome of amputation in DD was similar to post-traumatic amputations. Based on these data, we feel that patients should be informed that sometimes, surgical treatment for Dupuytren's disease can lead to an eventual decision to amputate.

The Salmonella Enteritidis TolC outer membrane channel is essential for egg white survival.

Salmonella Enteritidis has developed the potential to contaminate eggs by surviving in the antimicrobial environment of the hen's egg white. This has led to a worldwide pandemic of foodborne salmonellosis infections in humans due to the consumption of contaminated eggs and egg-derived products. The molecular mechanisms of Salmonella Enteritidis egg white survival are not fully clear. Using in vivo expression technology and promoter-reporter fusions we showed that the promoter of the tolC gene, encoding the TolC outer membrane channel that is used by multidrug efflux pumps to export harmful molecules and to secrete bacterial products, is activated by egg white at the chicken body temperature. Using a Salmonella Enteritidis tolC deletion mutant we showed that TolC has an important role in egg white survival. Chromatographic separation techniques and subsequent testing of antimicrobial activities of separated egg white fractions led to the identification of ovotransferrin as the egg white antimicrobial factor which is capable of inhibiting growth of a tolC deletion strain but not the wild type strain. We provide evidence that TolC protects Salmonella Enteritidis against ovotransferrin-mediated growth inhibition in egg white.

Lipofibromatous hamartoma of the median nerve and macrodactyly.

A case of lipofibromatous hamartoma of the median nerve with macrodactyly of 2 digits is described. Nerve stripping resulted in a growth control.