Plexiform Xanthomatous Tumor, Variety of Xanthoma or Subtype of Fibrohistiocytic Tumors?

Plexiform xanthomatous tumor was proposed as an independent neoplasm within fibrohistiocytic tumor group a few years ago. The arguments were based on their different clinical features as well as their own morphological and immunohistochemical findings. Nevertheless, it has not been widely studied yet, and there are few reports about this entity. Regarding a case, we reviewed the diagnostic characteristics of this underdiagnosed tumor.

Nonalcoholic fatty liver disease puts patients with psoriasis at greater cardiovascular risk.

BACKGROUND/OBJECTIVE: Psoriasis and nonalcoholic fatty liver disease (NAFLD) are inflammatory diseases associated with increased cardiovascular risk, but no studies have evaluated cardiovascular risk in patients with both. The objective was to assess cardiovascular risk in patients with psoriasis and NAFLD. MATERIAL AND METHODS: Cross-sectional, single-centre study in patients with moderate to severe psoriasis. Participants underwent liver ultrasound to determine the presence of NAFLD. Cardiovascular risk was evaluated using the calibrated Framingham function and Systematic Coronary Risk Evaluation (SCORE) charts. Statistical analyses included a descriptive analysis, chi-square tests for comparing independent samples and stepwise multiple logistic regression to identify associations with the two risk scores. RESULTS: Psoriatic patients with NAFLD had significantly higher odds of moderate to very high 10-year cardiovascular risk compared to those without NAFLD, according to SCORE (71.5% versus 29.2%; odds ratio [OR] 6.0, 95% confidence interval [CI] 3.3-11.1; P < 0.001). Using both the SCORE and Framingham assessment methods, moderate to very high cardiovascular risk was independently associated with metabolic syndrome (Framingham: adjusted odds ratio [ORa] 5.5, 95% CI 2.3-12.9, P < 0.001; SCORE: ORa 4.7, 95% CI 1.9-11.7, P = 0.001) and systemic treatment (Framingham: ORa 3.4, 95% CI 1.4-8.5, P = 0.009; SCORE: ORa 3.2, 95% CI 1.2-8.2, P = 0.021). Using SCORE, cardiovascular risk was also associated with NAFLD (ORa of 2.8, 95% CI 1.2-6.6, P = 0.014). CONCLUSION: Psoriasis plus NAFLD confers higher cardiovascular risk at 10 years than psoriasis alone. In comorbid patients, more intense diagnostic efforts and follow-up are justified.

Primary cutaneous ganglioneuroma: anatomico-clinical study of 4 cases with focus on Merkel cells.

Cutaneous ganglioneuromas (CGNs) are exceptional. We aim to describe the anatomico-clinical profile of primary CGN and report 4 cases. Patients were 2 men and 2 women aged 53 to 76 years, who had flesh-colored nodules on the back, associated with adjacent keratotic changes, that is, epidermal nevus (1 case) or seborrheic keratosis (3 cases). Histopathology showed ganglion cells within a proliferation of Schwann cells. The epidermis was acanthotic, associated with sebaceous induction in 2 cases, with follicular hyperplasia as in fibroepithelial tumors (1 case) or with tricholemmoma (2 cases). Cytokeratin-20 immunostaining showed Merkel cells in the epidermis. A higher density of Merkel cells was observed in BerEP4+ follicular structures. Along with 16 published cases, our study indicates that a nodule associated with seborrheic keratosis on the back may represent a CGN, a complex mesenchymal and epidermal/follicular lesion of neuroectodermal lineage, associating neuronal proliferation and Merkel cell hyperplasia with follicular induction.

Retronychia a little-known cause of paronychia: A report of two cases in adolescent patients.

Retronychia is a clinical condition resulting from embedding of the nail plate into the proximal nail fold. We report two adolescent girls, 14 and 16 years of age, with a history of chronic proximal paronychia of the great toe, one of them developing osteomyelitis. After failure of treatment with several systemic antibiotics, nail avulsion was performed, leading us to the diagnosis of retronychia and with rapid and complete resolution of symptoms in both cases. Delay in diagnosis of retronychia can lead to local complications and prolonged discomfort.

Non-alcoholic fatty liver disease is associated with bacterial translocation and a higher inflammation response in psoriatic patients.

Psoriasis and non-alcoholic fatty liver disease (NAFLD) are both inflammatory diseases. The study objective was to estimate the risk of NAFLD, non-alcoholic steatohepatitis, and liver fibrosis (by liver stiffness and liver biopsy) in patients with psoriasis and to determine the epidemiological, clinical, immunological (TNF-α, IL-2, IL-6, IL-12, IL-17, IL-23, and TGF-ß) characteristics, and bacterial translocation. Of the 215 psoriatic patients included, 91 presented NAFLD (prevalence: 42.3%). Compared to patients with psoriasis alone, those with NAFLD were significantly more likely to have metabolic syndrome, diabetes, dyslipidemia, body mass index ≥ 30 kg/m2, homeostatic model assessment of insulin resistance ≥ 2.15, and greater psoriasis area severity index. NAFLD patients also had significantly higher levels of TNF-α (p = 0.002) and TGF-ß (p = 0.007) and a higher prevalence of bacterial translocation (29.7% vs. 13.7%; p = 0.004). Liver stiffness measurement was over 7.8 kPa in 17.2% (15/87) of NAFLD patients; 13 of these underwent liver biopsy, and 5.7% (5/87) had liver fibrosis, while 1.1% (1/87) had advanced fibrosis or non-alcoholic steatohepatitis. In conclusion the prevalence of NAFLD in patients with psoriasis is high and associated with a higher prevalence of metabolic syndrome features, bacterial translocation and a higher pro-inflammatory state. It is worth mentioning that liver fibrosis and non-alcoholic steatohepatitis are not frequent in this population of patients.

Accelerated nucleophilic substitution reactions of dansyl chloride with aniline under ambient conditions via dual-tip reactive paper spray.

Paper spray ionization (PSI) mass spectrometry (MS) is an emerging tool for ambient reaction monitoring via microdroplet reaction acceleration. PSI-MS was used to accelerate and monitor the time course of the reaction of dansyl chloride with aniline, in acetonitrile, to produce dansyl aniline. Three distinct PSI arrangements were explored in this study representing alternative approaches for sample loading and interaction; conventional single tip as well as two novel setups, a dual-tip and a co-axial arrangement were designed so as to limit any on-paper interaction between reagents. The effect on product abundance was investigated using these different paper configurations as it relates to the time course and distance of microdroplet travel. It was observed that product yield increases at a given distance and then decreases thereafter for all PSI configurations. The fluorescent property of the product (dansyl aniline) was used to visually inspect the reaction progress on the paper substrate during the spraying process. Amongst the variety of sample loading methods the novel dual-tip arrangement showed an increased product yield and microdroplet density, whilst avoiding any on-paper interaction between the reagents.

Analysis of non-conjugated steroids in water using paper spray mass spectrometry.

A novel strategy for the direct analysis of non-conjugated steroids in water using paper spray mass spectrometry (PS-MS) has been developed. PS-MS was used in the identification and quantification of non-conjugated (free) steroids in fish tank water samples. Data shown herein indicates that individual amounts of free steroids can be detected in aqua as low as; 0.17 ng/µL, 0.039 ng/µL, 0.43 ng/µL, 0.0076 ng/µL for aldosterone, corticosterone, cortisol, and ß-estrone, respectively, and with an average relative standard deviation of ca. < 10% in the positive ion mode using PS-MS/MS. Direct detection of free steroids in a raw water mixture, from aquaculture, without prior sample preparation is demonstrated. The presence of free steroids released in fish water samples was confirmed via tandem mass spectrometry using collision-induced dissociation. This approach shows promise for rapid and direct water quality monitoring to provide a holistic assessment of non-conjugated steroids in aqua.

Topics and PRISMA Checklist Compliance for Meta-analyses in Dermatology: Journal Case Study.

Meta-analyses are usually the final step of systematic reviews and provide robust scientific evidence (1,2). The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Statement is a useful tool to improve the reporting of meta-analyses (3). There are few data available on the current topics and characteristics of meta-analyses in dermatology or on the clarity and comprehensiveness of the information they report (4-8). This case study aims to describe the meta-analyses published in the British Journal of Dermatology (BJD) and assess whether the data they contain are reported fully according to the PRISMA Statement. We conducted a descriptive study of all meta-analyses indexed in PubMed between January 1, 2010, and December 31, 2014. To identify the manuscripts, we used PubMed to search all articles published in the BJD classified by MEDLINE as "meta-analysis." We excluded all trials that did not involve human patients and all secondary analyses of previously published data. Study topics were not mutually exclusive. Two review authors collected the data, resolving any disagreements through discussion. We extracted the following data from each included study: country of origin, number of authors, research topic, funding (yes/no), type of funding, type of population, number and type of databases searched, initial and final number of studies, study type, and number of patients included. In addition, we applied the PRISMA 27-item checklist to all manuscripts. Twenty-seven meta-analyses were published during the study period. Germany was the main country where the studies were conducted (25.9%). The most common topic was psoriasis (n=11; 40.7%). The mean number of authors was 4.8. Thirteen (48.1%) documents received funding. Only five (18.5%) studies included the pediatric population. The mean number of databases consulted was four. All meta-analyses used the PubMed database; 18 (66.7%) used Cochrane and 17 (63.0%) used Embase. The mean number of included studies in the analyses was 31.1. The main study design was case-control (48.1%), followed by cohort (40.7%) and randomized controlled trials (33.3%) (Table 1). Most documents completed the 27 items on the PRISMA checklist correctly. In total, 51.9% of the reports were identified as both systematic reviews and meta-analyses and 48.1% as meta-analyses only. A structured summary was provided in 40.7% of cases. All the publications described the rationale in the introduction, and most (85.2%) correctly explained the objectives (including at least four of five sub-items). Regarding methods, only 18.5% of the studies specified a protocol or registration number. Eligibility criteria and information sources were explained in all the documents. Most of the documents fulfilled the criteria listed under search (96.3%), data collection process (88.9%), data items(85.5%), and summary measures (88.9%). In Methods and Results, the publications included the following items in the respectively indicated proportions: study selection (100.0% and 95.3%), risk of bias in individual studies (70.4% and 63.0%), synthesis of results (92.6 and 100.0%), risk of bias across studies (66.7 and 70.4%), and additional analyses (70.4 and 81.5%). All studies described the study characteristics, and 96.3% presented the results of individual studies. The summary of evidence, limitations, and conclusions were provided in all the publications. Similarly, all the documents detailed sources of funding (Table 2). To sum up, we observed that most of the studies in the BJD correctly recorded the items included in the PRISMA checklist. The meta-analyses mainly concerned psoriasis, which is consistent with a previous study on randomized trials in BJD finding that psoriasis was the main topic (5). A limitation of our study was that the meta-analyses included were published in a single journal, so the results are not generalizable to all dermatology journals. However, this is a novel study of PRISMA checklist compliance in dermatology meta-analyses, and we consider it important to validate and build on these results through larger studies including more journals specializing in dermatology.

Onychocryptosis: a long-term retrospective and comparative follow-up study of surgical and phenol chemical matricectomy in 520 procedures.

BACKGROUND: Onychocryptosis or ingrown toenail is a common condition for which there are several treatment options. Surgical matricectomy (SM) is the classical procedure, whereas chemical matricectomy with phenol (CMP) is the most widely used nowadays. OBJECTIVES: This study was designed to evaluate the success rate, postoperative comfort, postoperative complications, and patient satisfaction provided by each of these procedures. METHODS: A retrospective study of all patients who underwent surgery for ingrown toenail over a 5-year period was performed. Data used for the descriptive study and success rates were obtained from medical records. Postoperative data were collected by telephone interviews. RESULTS: Ingrown toenail surgery was carried out in 520 patients. SM was associated with a lower recurrence rate (8.2%) than CMP (17.8%), more pain (5.7/10 vs. 3.6/10), a higher risk for infection (15.3% vs. 2.9%), and lower cosmetic satisfaction (7.3/10 vs. 8.0/10). Overall satisfaction was similar in both procedures (8.5/10 and 8.4/10, respectively). CONCLUSIONS: Although SM is associated with a lower recurrence rate, CMP appears to facilitate better postoperative outcomes.

Bicitopenia secundaria a infección por parvovirus B19 en un octogenario. Presentación de un caso / Bicytopenia due to parvovirus b19 infection in octogenarian: a case report

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