Risk of a Second Skin Cancer in a Cohort of Patients With Nonmelanoma Skin Cancer -Basal Cell Carcinoma or Squamous Cell Carcinoma-Treated With Mohs Micrographic Surgery: A National Prospective Cohort Study. / Riesgo de aparición de segundas neoplasias cutáneas en una cohorte de pacientes diagnosticados de carcinoma queratinocítico (carcinoma basocelular y carcinoma epidermoide) tratados con cirugía de Mohs. Estudio de cohortes prospectivo nacional.

OBJECTIVE: Patients with nonmelanoma skin cancer (NMSC)-ie, basal cell carcinoma (BCC) or squamous cell carcinoma (SCC)-have an increased risk of developing a second skin cancer. The aim of this study was to describe the frequency, incidence per 1000 person-years, and predictors of a second skin cancer in a cohort of patients with NMSC treated with Mohs micrographic surgery (MMS). MATERIAL AND METHODS: Prospective study of a national cohort of patients with NMSC who underwent MMS at 22 Spanish hospitals between July 2013 and February 2020; case data were recorded in the REGESMOHS registry. The study variables included demographic characteristics, frequency and incidence per 1000 person-years of second skin cancers diagnosed during the study period, and risk factors identified using mixed-effects logistic regression. RESULTS: We analyzed data for 4768 patients who underwent MMS; 4397 (92%) had BCC and 371 (8%) had SCC. Mean follow-up was 2.4 years. Overall, 1201 patients (25%) developed a second skin cancer during follow-up; 1013 of the tumors were BCCs (21%), 154 were SCCs (3%), and 20 were melanomas (0.4%). The incidence was 107 per 1000 person-years (95% CI, 101-113) for any cancer, 90 per 1000 person-years (95% CI, 85-96) for BCC, 14 (95% CI, 12-16) per 1000 person-years for SCC, and 2 (95% CI, 1-3) per 1000 person-years for melanoma. More men than women developed a subsequent skin cancer (738 [61%] vs 463 [39%]). The main risk factors were a history of multiple tumors before diagnosis (relative risk [RR], 4.6; 95% CI, 2.9-7.1), immunosuppression (RR, 2.1; 95% CI, 1.4-3.1), and male sex (RR, 1.6; 95% CI, 1.4-1.9). CONCLUSION: Patients have an increased risk of developing a second tumor after MMS treatment of NMSC. Risk factors are a history of multiple tumors at diagnosis, immunosuppression, and male sex.

Safe and successful treatment of refractory polyarteritis nodosa with tocilizumab in a patient with past hepatitis B virus infection: a case-based review.

Polyarteritis nodosa is a primary systemic necrotizing vasculitis whose evolution follows, in many cases, a chronic remitting-recurrent course with refractoriness to conventional immunosuppressants. We report here the clinical case of a 75-year-old patient with serologies suggestive of past hepatitis B virus infection who presented a flare of polyarteritis nodosa with great secondary functional impairment. She had not responded to several previous immunosuppressants and required high doses of glucocorticoids to control the flare. After the initiation of biological therapy with tocilizumab, the patient experienced a rapid and marked clinical and analytical improvement, going into clinical remission and being able to remarkably lower the corticosteroid dose and stop the rest of the immunosuppressants. There was no evidence of hepatitis B virus reactivation or changes in the titers of any of the parameters related to the aforementioned infection. This clinical case represents the first case reported in the literature about the successful and safe treatment of polyarteritis nodosa with tocilizumab in a patient with serologies suggestive of past hepatitis B virus infection.

Mantle redox state drives outgassing chemistry and atmospheric composition of rocky planets.

Volcanic degassing of planetary interiors has important implications for their corresponding atmospheres. The oxidation state of rocky interiors affects the volatile partitioning during mantle melting and subsequent volatile speciation near the surface. Here we show that the mantle redox state is central to the chemical composition of atmospheres while factors such as planetary mass, thermal state, and age mainly affect the degassing rate. We further demonstrate that mantle oxygen fugacity has an effect on atmospheric thickness and that volcanic degassing is most efficient for planets between 2 and 4 Earth masses. We show that outgassing of reduced systems is dominated by strongly reduced gases such as [Formula: see text], with only smaller fractions of moderately reduced/oxidised gases ([Formula: see text], [Formula: see text]). Overall, a reducing scenario leads to a lower atmospheric pressure at the surface and to a larger atmospheric thickness compared to an oxidised system. Atmosphere predictions based on interior redox scenarios can be compared to observations of atmospheres of rocky exoplanets, potentially broadening our knowledge on the diversity of exoplanetary redox states.

Influence of type of dairy matrix micro- and macrostructure on in vitro lipid digestion.

Recent research indicates that the food matrix can influence digestion kinetics and uptake of nutrients, thus affecting human health. The aim of this study was to obtain knowledge on how variations in microstructure and texture of foods represented by four dairy products; (i) cheddar cheese, (ii) a homogenized cheddar cheese, (iii) a micellar casein and cream drink or (iv) a micellar casein and cream gel, all of identical nutrient ratios of protein : fat and calcium : fat, affect the in vitro digestibility kinetics of lipids. Rheology of the four dairy structures was measured at 10 °C and 37 °C before digestion, and during the gastric phase of in vitro digestion. During digestion cheddar cheese was most resistant to enzymatic and mechanical disintegration, followed by homogenized cheese, while both the drink and gel had low resistance and dissolved in the gastric juice. Particle size, fat droplet size and microstructure were assessed by light scattering and confocal microscopy during digestion. Significantly larger fat droplets were observed during digestion of the cheddar cheese sample. The release of free fatty acids during the initial intestinal digestion showed cheddar cheese to provide a significantly lower release than homogenized cheese, whereas the drink and gel both had significantly higher free fatty acid release. The results suggest that the cheese matrix resistance to degradation and its large fat droplets were responsible for a slower fat digestion.

European dermatology forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 2: Scleromyxedema, scleredema and nephrogenic systemic fibrosis.

The term 'sclerosing diseases of the skin' comprises specific dermatological entities which have fibrotic changes of the skin in common. These diseases mostly manifest in different clinical subtypes according to cutaneous and extracutaneous involvement and can sometimes be difficult to distinguish from each other. The present guideline focuses on characteristic clinical and histopathological features, diagnostic scores and the serum autoantibodies most useful for differential diagnosis. In addition, current strategies in the first- and advanced-line therapy of sclerosing skin diseases are addressed in detail. Part 2 of this guideline provides clinicians with an overview of the diagnosis and treatment of scleromyxedema, scleredema (of Buschke) and nephrogenic systemic sclerosis (nephrogenic fibrosing dermopathy).

European Dermatology Forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 1: localized scleroderma, systemic sclerosis and overlap syndromes.

The term 'sclerosing diseases of the skin' comprises specific dermatological entities, which have fibrotic changes of the skin in common. These diseases mostly manifest in different clinical subtypes according to cutaneous and extracutaneous involvement and can sometimes be difficult to distinguish from each other. The present guideline focuses on characteristic clinical and histopathological features, diagnostic scores and the serum autoantibodies most useful for differential diagnosis. In addition, current strategies in the first- and advanced-line therapy of sclerosing skin diseases are addressed in detail. Part 1 of this guideline provides clinicians with an overview of the diagnosis and treatment of localized scleroderma (morphea), and systemic sclerosis including overlap syndromes of systemic sclerosis with diseases of the rheumatological spectrum.

Dietas pós-eclosão suplementadas com fontes de gordura e acrescidas de taurina e glicina sobre a morfometria intestinal e o desempenho de frangos de corte de um a 21 dias / Post-hatch diets supplemented with sources of fat and added taurine and glycine on the intestinal morphology and performance of broilers at 1 to 21 days

O objetivo deste estudo foi avaliar o efeito do fornecimento de dietas pós-eclosão suplementadas com diferentes fontes de gordura insaturada e adicionadas ou não de taurina e glicina sobre o desempenho produtivo, a biometria e a morfometria do intestino delgado de pintos de corte de um a 21 dias de idade. Foram utilizados 480 pintos de corte machos de um dia de idade da linhagem Cobb. O delineamento foi inteiramente ao acaso, em esquema fatorial 2 x 4, com e sem suplementação de taurina e glicina e quatro dietas (controle, óleo de peixe, de soja e de girassol), totalizando oito tratamentos com seis repetições de 10 aves cada. As rações experimentais foram fornecidas de zero a quatro dias de idade. O desempenho zootécnico foi avaliado ao alojamento e aos quatro, sete e 21 dias de idade. Nestas mesmas datas, foram sacrificadas duas aves por unidade experimental para biometria do intestino e histomorfometria da mucosa do intestino. A adição de diferentes fontes de gordura e a suplementação de glicina e taurina às dietas de transição não influenciaram o desempenho produtivo de um a 21 dias. A suplementação das dietas com glicina e taurina alterou a morfologia da mucosa intestinal, principalmente do duodeno, resultando em maior comprimento do vilo e relação vilo:cripta. Entretanto, parte dos efeitos positivos depende do tipo de óleo adicionado, mostrando que dietas pós-eclosão acrescidas de fontes de lipídios podem ser benéficas no desenvolvimento da capacidade funcional do intestino de frangos de corte.(AU)

The aim of this study was to assess post-hatch diets supplemented with different sources of unsaturated fat and added or not with taurine and glycine on the productive performance, biometry and morphology of small intestine of chicks from 1 to 21 days of age. Four hundred and eighty (480) one day old male broiler Cobb chicks were used. The experimental design was completely randomized in a factorial 2 x 4, with and without supplemental taurine and glycine and 4 diets (control, fish, soy and sunflower oil), totaling six treatments with six repetitions of 10 birds each. The experimental diets were supplied from 0 to 4 days old. The performance was evaluated in housing and 4, 7 and 21 days of age. On these same dates, 2 birds per experimental unit were sacrificed for gut biometrics and histomorphometry of intestinal mucosa. The addition of different sources of fat, glycine and taurine supplementation on transition diets did not influence productive performance from 1 to 21 days. Supplementation of diets with glycine and taurine altered the morphology of the intestinal mucosa, mainly of the duodenum, resulting in greater length of villi and villi: crypt ratio. However, the positive effects depend on the type of oil added, showing that post-hatch diets increased with lipid sources may be beneficial in the development of the functional capacity of the intestine of broilers.(AU)

Single stage incubators and Hypercapnia during incubation affect the vascularization of the chorioallantoic membrane in broiler embryos.

Incubation management can have direct effects on neonate health and consequently affect post-hatching development. The effects of incubation in multiple and single stage incubators with different concentrations of CO2 were evaluated in terms of the vessel density in the chorioallantoic membrane, hatching, heart morphology, and body development of the neonate up to the tenth day. A total of 2,520 fertile eggs were used and distributed in a completely randomized design with 4 levels of CO2 in 4 single-stage incubators (4,000; 6,000; 8,000; and 10,000 ppm) and a control treatment based on multiple-stage incubation, totaling 5 treatments. The levels of CO2 were used during the first 10 d of the incubation period, and after this period, all eggs were submitted to the same level of CO2 (4,000 ppm). Eggs that were incubated in multiple-stage incubators presented a lower percentage of vessels in the chorioallantoic membrane, lower yolk absorption by the embryo, wall depth of the right ventricle, and greater humidity losses in the eggs when compared to eggs in the single-stage incubators. The eggs submitted to hypercapnia, between 5,000 and 6,000 ppm of CO2, had a higher percentage of vessels in the chorioallantoic membrane; the embryos originating from these eggs had higher weight, with higher relative weight of the liver. However, the same levels reduced the yolk absorption. Single-stage incubation with moderate levels of hypercapnia is an efficient tool to be adopted by the hatcheries when attempting to improve chick quality.

Behavioural response to combined insecticide and temperature stress in natural populations of Drosophila melanogaster.

Insecticide resistance evolves extremely rapidly, providing an illuminating model for the study of adaptation. With climate change reshaping species distribution, pest and disease vector control needs rethinking to include the effects of environmental variation and insect stress physiology. Here, we assessed how both long-term adaptation of populations to temperature and immediate temperature variation affect the genetic architecture of DDT insecticide response in Drosophila melanogaster. Mortality assays and behavioural assays based on continuous activity monitoring were used to assess the interaction between DDT and temperature on three field-derived populations from climate extremes (Raleigh for warm temperate, Tasmania for cold oceanic and Queensland for hot tropical). The Raleigh population showed the highest mortality to DDT, whereas the Queensland population, epicentre for derived alleles of the resistance gene Cyp6g1, showed the lowest. Interaction between insecticide and temperature strongly affected mortality, particularly for the Tasmanian population. Activity profiles analysed using self-organizing maps show that the insecticide promoted an early response, whereas elevated temperature promoted a later response. These distinctive early or later activity phases revealed similar responses to temperature and DDT dose alone but with more or less genetic variance depending on the population. This change in genetic variance among populations suggests that selection particularly depleted genetic variance for DDT response in the Queensland population. Finally, despite similar (co)variation between traits in benign conditions, the genetic responses across population differed under stressful conditions. This showed how stress-responsive genetic variation only reveals itself in specific conditions and thereby escapes potential trade-offs in benign environments.

Proteinuria in canine patients with lymphoma.

OBJECTIVES: To determine if proteinuria is more common in dogs with lymphoma when compared with healthy dogs and to assess the severity and frequency of proteinuria in dogs with lymphoma. METHODS: Determination of urine protein:creatinine ratio in 32 dogs with lymphoma compared with 30 healthy dogs. RESULTS: Canine patients with lymphoma are more likely to be proteinuric compared with healthy dogs. Proteinuria is common in dogs with lymphoma, although in most cases it is not severe. The presence of proteinuria is not linked with the stage or substage of lymphoma. CLINICAL SIGNIFICANCE: Mild proteinuria is a common finding in dogs with lymphoma. The clinical impact of the proteinuria is probably low.

Effect of rebleeding on the course and incidence of vasospasm after subarachnoid hemorrhage.

OBJECTIVE: Rebleeding of an aneurysm is a leading cause of morbidity and mortality after subarachnoid hemorrhage (SAH). Whereas numerous studies have demonstrated the risk factors associated with rebleeding, few data on complications of rebleeding, including its effect on the development of delayed cerebral ischemia (DCI), are available. METHODS: A nested case-control study was performed on patients with rebleeding and control subjects matched for modified Fisher scale, Hunt-Hess grade, age, and sex previously entered into a prospective database. Rebleeding was defined as new hemorrhage apparent on repeat CT with or without new symptoms. Incidence and time course of DCI and hospital complications were compared. A secondary analysis of DCI and hospital complications was also performed on subjects surviving to postbleed day 7. RESULTS: We identified 120 patients with rebleeding and 359 control subjects from 1996 to 2011. The rebleeding rate was 8.6%. In both the primary and secondary analyses, there was no difference in the incidence of DCI or its time course (29% vs. 27%, p = 0.6; 7 ± 5 vs. 7 ± 6 days, p = 0.9 for primary analysis; 39% vs. 31%, p = 0.1, 7 ± 5 vs. 7 ± 6 days, p = 0.6 for the secondary analysis). In a multivariate logistic regression model, rebleeding was associated with the complications of hyponatremia, respiratory failure, and hydrocephalus. Patients with rebleeding had higher rates of mortality, brain death, and poor outcomes. CONCLUSIONS: Rebleeding after SAH is associated with multiple medical and neurologic complications, resulting in higher morbidity and mortality, but is not associated with change of incidence or timing of DCI.

Canine paediatric oncology: retrospective assessment of 9522 tumours in dogs up to 12 months (1993-2008).

Little information is available on the occurrence of neoplasms in dogs up to the age of 12 months. This is a retrospective review of histopathological diagnoses of neoplasia in dogs up to the age of 12 months based on biopsy specimens submitted to a commercial veterinary diagnostic laboratory in the United Kingdom between 1993 and 2008. In 20 280 histological submissions, 9522 neoplasms were identified. Canine cutaneous histiocytoma (n = 8465; 89%) was the most common histological type. Neoplasms other than histiocytoma (n = 1057; 11%) were grouped as benign epithelial (n = 375; 4%), haematopoietic (n = 229; 2%), benign mesenchymal (n = 145; 2%), miscellaneous (n = 118; 1%), non-hematopoietic malignant mesenchymal (n = 118; 1%) or malignant epithelial tumours (n = 72; <1%). Excluding canine cutaneous histiocytoma, 52% of tumours (n = 547) were benign, and 66% were from the skin or soft tissues. These data provide valuable epidemiological information on neoplasms occurring in juvenile dogs in the United Kingdom.

Feline paediatric oncology: retrospective assessment of 233 tumours from cats up to one year (1993 to 2008).

OBJECTIVES: To determine which types of tumour occur in cats up to the age of 12 months based on biopsies submitted to Idexx Laboratories, Wetherby, UK. METHODS: Retrospective review of histopathological diagnoses of tumours in cats up to the age of 12 months from biopsies received between September 1993 and March 2008. RESULTS: A total of 4196 submissions from cats 12 months old or younger were identified; 233 biopsies (6%) were neoplastic and fulfilled the search criteria. Tumours were categorised as haematopoietic (n=73, 31%), malignant epithelial (n=44; 19%), malignant mesenchymal (n=38; 16%), benign epithelial (n=37; 16%), benign mesenchymal (n=30, 13%) and miscellaneous (n=11; 5%). The most frequent tumours were lymphoma (n=51; 22%), soft-tissue sarcoma (n=34; 15%), mast cell tumour (n=22; 9%) and squamous cell carcinoma (n=16; 7%). The most common tumour site was the skin and soft tissues (41% of tumours). In all, 164 neoplasms (70%) were malignant or had malignant potential. CLINICAL SIGNIFICANCE: These data provide unique epidemiological information on a poorly characterised subgroup of feline cancer patients in the UK.

Believing in order to understand: Hahnemann's hierarchisation of values.

During the last 200 years, the social, scientific, and religious framework in which homeopathy is taught and practiced has changed tremendously. Various different forms of homeopathy have been advocated. To avoid being misled by the prevailing pluralism as a standard of reference for assessing new concepts, Hahnemann's original ideas and attitude toward medicine, philosophy, and ethics are discussed. Hahnemann's hierarchisation of values appears to consist primarily in striving for a world view in which he could conceive of himself as a spiritual and moral being, secondly in a yearning for scientific advancement, and thirdly in his need to earn a living. Homeopaths are challenged to match this hierarchisation and be aware that homeopathy comprises dimensions other than just science and economics.

Obstetric Anaesthesia : the Source of the Crisis

The Saving Mothers Reports have consistently shown that; out of all the provinces of South Africa; the Free State has one of the highest rates of maternal deaths arising from anaesthesia.The province's Department of Health requested the University of the Free State's Department of Anaesthesiology to investigate the problem. We examined possible factors; including training and experience of doctors administering anaesthesia; availability of suitable anaesthetic drugs and equipment; and use of regional anaesthesia. All the level 1 and 2 hospitals in which caesarean sections (CSs) were being performed were investigated. The foremost problems identified were lack of training andexperience in administering obstetric anaesthesia; and lack of senior anaesthetic assistance

Fever after subarachnoid hemorrhage: risk factors and impact on outcome.

OBJECTIVE: To identify risk factors for refractory fever after subarachnoid hemorrhage (SAH), and to determine the impact of temperature elevation on outcome. METHODS: We studied a consecutive cohort of 353 patients with SAH with a maximum daily temperature (T(max)) recorded on at least 7 days between SAH days 0 and 10. Fever (>38.3 degrees C) was routinely treated with acetaminophen and conventional water-circulating cooling blankets. We calculated daily T(max) above 37.0 degrees C, and defined extreme T(max) as daily excess above 38.3 degrees C. Global outcome at 90 days was evaluated with the modified Rankin Scale (mRS), instrumental activities of daily living (IADLs) with the Lawton scale, and cognitive functioning with the Telephone Interview of Cognitive Status. Mixed-effects models were used to identify predictors of T(max), and logistic regression models to evaluate the impact of T(max) on outcome. RESULTS: Average daily T(max) was 1.15 degrees C (range 0.04 to 2.74 degrees C). The strongest predictors of fever were poor Hunt-Hess grade and intraventricular hemorrhage (IVH) (both p < 0.001). After controlling for baseline outcome predictors, daily T(max) was associated with an increased risk of death or severe disability (mRS > or = 4, adjusted OR 3.0 per degrees C, 95% CI 1.6 to 5.8), loss of independence in IADLs (OR 2.6, 95% CI 1.2 to 5.6), and cognitive impairment (OR 2.5, 95% CI 1.2 to 5.1, all p < or = 0.02). These associations were even stronger when extreme T(max) was analyzed. CONCLUSION: Treatment-refractory fever during the first 10 days after subarachnoid hemorrhage (SAH) is predicted by poor clinical grade and intraventricular hemorrhage, and is associated with increased mortality and more functional disability and cognitive impairment among survivors. Clinical trials are needed to evaluate the impact of prophylactic fever control on outcome after SAH.

Cerebrovascular reactivity and vasospasm after subarachnoid hemorrhage: a pilot study.

The authors performed serial transcranial Doppler (TCD) and carbon dioxide reactivity (CO2R) testing in 20 aneurysmal subarachnoid hemorrhage patients to determine whether impaired cerebrovascular reactivity was associated with symptomatic vasospasm. Symptomatic vasospasm occurred in 9 of 14 patients with abnormal CO2R and in none of 6 patients with preserved reactivity (p = 0.011). Abnormal CO2R preceded the onset of vasospasm in 7 of 9 patients. Abnormal standard TCD testing was not associated with vasospasm.

Hahnemann's legacy in a new light--a systematic approach to the Organon of Medicine.

The sixth edition of Samuel Hahnemann's Organon of Medicine is an obligatory work of reference for homeopathy. Nevertheless, its philosophy can be questioned with constructivistic and historistic objections. Three levels of content may be distinguished: (1) practical directions and maxims, (2) theoretical explanations and hypotheses, (3) conceptual foundations and premises. Ideally, these levels should be considered, studied, and taught separately and gradually. My new German edition of the Organon, published in 2003, tries to meet these demands. It contains: (A) a complete version of Hahnemann's original text, in the original order of paragraphs, but in modern German with section headings, summary boxes, etc added, (B) another full version of its content, organized in three levels, as indicated above, (C) a glossary of about 400 problematic terms.