Basic Therapeutic Approach for Patients with Plaque Psoriasis: Korean Expert Consensus Using the Modified Delphi Method.

BACKGROUND: Currently, there is no consensus on the treatment of psoriasis in Korean patients. OBJECTIVE: This study aimed to establish a consensus on the basic therapeutic principles for Korean patients with plaque psoriasis. METHODS: Using the modified Delphi method, a steering committee proposed 53 statements for the first Delphi round, which covered five subjects: (1) the goal of treatment and evaluation of disease severity, (2) topical therapy, (3) phototherapy, (4) conventional systemic therapy, and (5) biologic therapy. The panel of dermatologists scored the level of agreement for each statement on a ten-point scale with scores ranging from 1 (strongly disagree) to 10 (strongly agree). After discussing the results of the first round, the committee reformulated 41 statements. Finally, consensus was defined as more than 70% of the second round scores being ≥7. RESULTS: The panel participants strongly agreed that the ideal treatment goals for Korean patients with plaque psoriasis should include complete skin clearance and high dermatological quality of life. A strong consensus was also reached on the use of topical agents for psoriasis of any severity, the consideration of phototherapy before biologics therapy, the conventional systemic agents for moderate-to-severe psoriasis, and the recommendation of biologic for retractable psoriasis to conventional systemic therapy and phototherapy. CONCLUSION: This modified Delphi panel established an expert consensus on the therapeutic approach for Korean patients with plaque psoriasis. This consensus may improve the treatment outcomes for psoriasis in Korea.

Hot-melt extruded copper sulfate affects the growth performance, meat quality, and copper bioavailability of broiler chickens.

OBJECTIVE: This study was conducted to evaluate the effects of the supplementation of diets of broiler chickens with hot-melt extruded CuSO4 (HME-Cu) on their growth performance, nutrient digestibility, gut microbiota, small intestinal morphology, meat quality, and copper (Cu) bioavailability. METHODS: A total of 225 broilers (Ross 308), one-day old and initial weight 39.14 g, were weighed and distributed between 15 cages (15 birds per cage) in a completely randomized experimental design with 3 treatments (diets) and 5 replicates per treatment. Cages were allotted to three treatments including control (without supplemental Cu), IN-Cu (16 mg/kg of CuSO4), and HME-Cu (16 mg/kg of HME processed CuSO4). RESULTS: The HME-Cu treatment tended to increase the overall body weight gain (p<0.10). The apparent digestibility of Cu was increased by supplementation of HME-Cu at phase 2 (p<0.05). The Escherichia coli count in cecum tended to decrease with the supplementation with Cu (p<0.10). In addition, the HME-Cu treatment had a higher pH of breast meat than the control and IN-Cu treatments (p<0.05). Significant increases in the cooking loss, water-holding capacity, and lightness in the breast were observed in the HME-Cu treatment compared to the control (p<0.05). The Cu content of excreta increased with the Cu supplementation (p<0.05). The concentration of excreta Cu in broilers was decreased in the HME-Cu compared to the IN-Cu in phase 2 (p<0.05). The Cu concentration in the liver was increased with the HME-Cu supplementation, compared with the control diets (p<0.05). CONCLUSION: This study showed that HME-Cu supplementation at the requirement level (16 mg/kg diets) in broiler diets did not affect the growth performance and the physiological function of Cu in broilers. However, supplementation of Cu in HME form improved the meat quality and the bioavailability of Cu.

Prediction of calcium and phosphorus requirements for pigs in different bodyweight ranges using a meta-analysis.

Several studies have focused on Ca and P requirements for pigs. These requirements are estimated from their retention and bone formation. However, modern pig breeds have different responses to dietary Ca and P than traditional breeds, and their requirements are expected to change on an annual basis. Besides individual Ca and P needs, the Ca to P ratio (Ca/P) is an important factor in determining requirements. This study aimed to implement a linear and quadratic regression analysis to estimate Ca and P requirements based on average daily gain (ADG), apparent total tract digestibility (ATTD) of Ca (ATTD-Ca), ATTD of P (ATTD-P), and crude protein (CP) digestibility. Results show that Ca/P had linear and quadratic effects on ADG in the phytase-supplemented (PS) group in both the 6-11 kg and 11-25 kg categories. In the latter category, the CP digestibility was linearly increased in response to increasing Ca/P in the without-phytase (WP) group. In the 25-50 kg category, there was a linear response of ADG and linear and quadratic responses of CP digestibility to Ca/P in the PS group, while a linear and quadratic increase in CP digestibility and a quadratic effect on ATTD-Ca were observed in the WP group. In the 50-75 kg category, Ca/P had significant quadratic effects on ADG in the PS and WP groups, along with significant linear and quadratic effects on ATTD-Ca. In addition, Ca/P had significant quadratic effects on ATTD-P and led to a significant linear and quadratic increase in the CP digestibility in the WP group. In the 75-100 kg category, analysis showed a significant decrease in ATTD-Ca and ATTD-P in the PS and WP groups; in the latter, ATTD-P and ATTD-Ca were linearly decreased by increasing Ca/P. In conclusion, our equations predicted a higher Ca/P in the 6-25 kg bodyweight categories and a lower Ca/P in the 50-100 kg category than that recommended in the literature.

Tussilagonone Ameliorates Psoriatic Features in Keratinocytes and Imiquimod-Induced Psoriasis-Like Lesions in Mice via NRF2 Activation.

Psoriasis is a common inflammatory skin disorder that is characterized by keratinocyte hyperproliferation and abnormal differentiation, resulting in the thickening of the epidermis and stratum corneum. In this study, we investigated in vitro and in vivo pharmacological effects of tussilagonone (TGN), a sesquiterpenoid isolated from Tussilago farfara, on transcription factors relevant for the pathogenesis of psoriasis. TGN inhibited activation of NF-κB and STAT3, leading to the attenuated expression of psoriasis-related inflammatory genes and suppression of keratinocyte hyperproliferation. Mechanistically, we show that the inhibition of NF-κB and STAT3 by TGN is mediated through activation of the cytoprotective transcription factor NRF2. Evaluation of in vivo antipsoriatic effects of topical TGN in the imiquimod-induced psoriasis-like dermatitis mouse model demonstrated amelioration of imiquimod-induced phenotypical changes, lesion severity score, epidermal thickening, and reduction in dermal cellularity. The spleen index also diminished in TGN-treated mice, suggesting anti-inflammatory properties of TGN. Moreover, TGN significantly attenuated the imiquimod-induced mRNA levels of psoriasis-associated inflammatory cytokines and antimicrobial peptides and reduced epidermal hyperproliferation. Taken together, TGN, as a potent NRF2 activator, is a promising therapeutic candidate for the development of antipsoriatic agents derived from medicinal plants.

Effective treatment of facial redness caused by atopic dermatitis using intense pulsed light systems.

BACKGROUND: Patients with facial atopic dermatitis (AD) experience psychological and social distress. OBJECTIVE: To evaluate the safety and the efficacy of intense pulsed light (IPL) treatment in patients with facial AD. MATERIALS AND METHODS: Eleven patients (9 men, 2 women; aged 14-39) with mild to moderate refractory facial AD were included in this study. In three separate sessions at 2-week intervals, the whole face was exposed to an IPL device using a 590-nm cut-off filter. Objective clinical response was examined using the Eczema Severity Score (ESS), a polarization color imaging system, and two dermatologists' evaluations. Data on quality of life were evaluated using the Dermatology Life Quality Index (DLQI). RESULTS: The ESS in 11 patients with facial AD was significantly lower 4 weeks after the third treatment (p=.005). Scaling (p=.003); edema, induration, and papules (p=.011); erythema (p=.009), and lichenification (p=.008) improved significantly. The erythema scale, examined using the polarization color imaging system, also decreased significantly (p=.04). No patients showed any noticeable side effects. Mean DLQI score improved significantly after the completion of therapy (from baseline to 4 weeks after the last IPL treatment; p=.005). CONCLUSION: IPL treatment could be used as an adjunct modality for the treatment of refractory facial AD with minimal side effects.

Comparison of a 1,550 nm Erbium: glass fractional laser and a chemical reconstruction of skin scars (CROSS) method in the treatment of acne scars: a simultaneous split-face trial.

BACKGROUND AND OBJECTIVE: Acne scarring is a common complication of acne but no effective single treatment modality has been developed. To compare the efficacy of 1,550 nm Er:Glass fractional laser and chemical reconstruction of skin scar (CROSS) method in the treatment of acne scars. STUDY DESIGN/MATERIALS AND METHODS: A split-face trial was conducted in 20 patients (10 rolling, 10 icepick types) with acne scars. One side was treated with the 1,550 nm Er:Glass fractional laser three times with a 6-week interval. And the other side was treated with CROSS method two times every 12 weeks. RESULTS: Significant improvement was observed in both sides of the face. In rolling type, the objective and subjective improvement rates were significantly higher in the sides treated with laser than CROSS method. However, in icepick type, there were no statistically significant differences between the two treatment sides. In the laser sides, grades of pain were significantly higher than that of treated with CROSS method. However, downtimes and lasting days of erythema were significantly longer in the sides treated with CROSS method. CONCLUSION: A 1,550 nm Er:Glass fractional laser and CROSS method are both well-tolerated and effective treatment options in the acne scars. However, there was a relatively small difference between the two treatment modalities. Therefore, dermatologists should consider the acne scar type to select the treatment options. Lasers Surg. Med. 41:545-549, 2009. (c) 2009 Wiley-Liss, Inc.

Volumetric abnormalities in connectivity-based subregions of the thalamus in patients with chronic schizophrenia.

OBJECTIVE: The thalamus, which consists of multiple subnuclei, has been of particular interest in the study of schizophrenia. This study aimed to identify abnormalities in the connectivity-based subregions of the thalamus in patients with schizophrenia. METHODS: Thalamic volume was measured by a manual tracing on superimposed images of T1-weighted and diffusion tensor images in 30 patients with schizophrenia and 22 normal volunteers. Cortical regional volumes automatically measured by a surface-based approach and thalamic subregional volumes measured by a connectivity-based technique were compared between the two groups and their correlations between the connected regions were calculated in each group. RESULTS: Volume reduction was observed in the bilateral orbitofrontal cortices and the left cingulate gyrus on the cortical side, whereas in subregions connected to the right orbitofrontal cortex and bilateral parietal cortices on the thalamic side. Significant volumetric correlations were identified between the right dorsal prefrontal cortex and its related thalamic subregion and between the left parietal cortex and its related thalamic subregion only in the normal group. CONCLUSIONS: Our results suggest that patients with schizophrenia have a structural deficit in the corticothalamic systems, especially in the orbitofrontal-thalamic system. Our findings may present evidence of corticothalamic connection problems in schizophrenia.

The immune-enhancing effect of the herbal combination Bouum-Myunyuk-Dan.

The herbal formulation Bouum-Myunyuk-Dan (BMD) has long been used for various diseases. It has been shown to have antimicrobial and anti viral activity clinically. However, it is still unclear how BMD exerts these effects in experimental models. In this study, we investigated the effect of BMD on the production of cytokines in a human T cell line, MOLT-4 cells, and in mouse peritoneal macrophages. As a result, BMD significantly increased the viability and proliferation of splenocytes (p<0.05) and also significantly increased interleukin (IL)-2 and IL-4 production compared with media control (about 2.7-fold for IL-2 and 6.7-fold for IL-4, p<0.05) after 24 h. BMD increased the interferon (IFN)-gamma production by 3.7-fold but there were no significant differences compared with controls. Maximal effective concentrations of BMD were 1 mg/ml for IL-2 and IL-4 and 0.1 mg/ml for IFN-gamma. In addition, BMD (0.01 mg/ml) increased the production of tumor necrosis factor (TNF)-alpha and IL-12 in mouse peritoneal macrophages (by 2.7-fold for TNF-alpha and 42.5-fold for IL-12, p<0.05). In conclusion, these data indicate that BMD may have an immune-enhancing effect through the production of various cytokines.

Inhibition of HIV-1 integrase by galloyl glucoses from Terminalia chebula and flavonol glycoside gallates from Euphorbia pekinensis.

The bioassay-directed isolation of Terminalia chebula fruits afforded four human immunodeficiency virus type 1 (HIV-1) integrase inhibitors, gallic acid ( 1) and three galloyl glucoses ( 2 - 4). In addition, four flavonol glycoside gallates ( 5 - 8) from Euphorbia pekinensis containing the galloyl moiety also showed the inhibitory activity at a level comparable to those of 2 - 4. By comparison with the activities of the compounds not bearing this moiety, it is proposed that the galloyl moiety plays a major role for inhibition against the 3'-processing of HIV-1 integrase of these compounds.