EuroGuiderm guideline on lichen sclerosus-introduction into lichen sclerosus.

INTRODUCTION: Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness. It may lead to sexual and urinary dysfunction in females and males; however, it may be asymptomatic. First signs of LS are redness and oedema, typically followed by whitening of the genital skin; sometimes fissuring, scarring, shrinkage and fusion of structures may follow in its course. LS is associated with an increased risk of genital cancer. LS has a huge impact on the quality of life of affected patients, and it is important to raise more awareness of this not uncommon disease in order to diagnose and treat it early. OBJECTIVES: The guideline intends to provide guidance on the diagnostic of LS, highlight important aspects in the care of LS patients (part 1), generate recommendations and treatment algorithms (part 2) on topical, interventional and surgical therapy, based on the latest evidence, provide guidance in the management of LS patients during pregnancy, provide guidance for the follow-up of patients with LS and inform about new developments and potential research aspects. MATERIALS AND METHODS: The guideline was developed in accordance with the EuroGuiDerm Methods Manual v1.3 https://www.edf.one/de/home/Guidelines/EDF-EuroGuiDerm.html. The wording of the recommendations was standardized (as suggested by the GRADE Working Group). The guideline development group is comprised of 34 experts from 16 countries, including 5 patient representatives. RESULTS: Ultrapotent or potent topical corticosteroids in females and males, adults and children remain gold standard of care for genital LS; co-treatment with emollients is recommended. If standard treatment fails in males, a surgical intervention is recommended, complete circumcision may cure LS in males. UV light treatment is recommended for extragenital LS; however, there is limited scientific evidence. Topical calcineurin inhibitors are second line treatment. Laser treatment, using various wave lengths, is under investigation, and it can currently not be recommended for the treatment of LS. Treatment with biologics is only reported in single cases. CONCLUSIONS: LS has to be diagnosed and treated as early as possible in order to minimize sequelae like scarring and cancer development. Topical potent and ultrapotent corticosteroids are the gold standard of care; genital LS is often a lifelong disease and needs to be treated long-term.

EuroGuiderm guideline on lichen sclerosus-Treatment of lichen sclerosus.

INTRODUCTION: Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness; it may lead to sexual and urinary dysfunction in females and males; however, it may be asymptomatic. First signs of LS are usually a whitening of the genital skin, sometimes preceded by redness and oedema; fissuring, scarring, shrinkage and fusion of structures may follow in its course. LS is associated with an increased risk of genital cancer. LS has a huge impact on the quality of life of affected patients, and it is important to raise more awareness of this not uncommon disease in order to diagnose and treat it early. OBJECTIVES: The guideline intends to provide guidance on the diagnostic of LS (part 1), highlight important aspects in the care of LS patients, generate recommendations and treatment algorithms (part 2) on topical, interventional and surgical therapy, based on the latest evidence, provide guidance in the management of LS patients during pregnancy, provide guidance for the follow-up of patients with LS and inform about new developments and potential research aspects. MATERIALS AND METHODS: The guideline was developed in accordance with the EuroGuiDerm Methods Manual v1.3 https://www.edf.one/de/home/Guidelines/EDF-EuroGuiDerm.html. The wording of the recommendations was standardized (as suggested by the GRADE Working Group). The guideline development group is comprised of 34 experts from 16 countries, including 5 patient representatives. RESULTS: Ultrapotent or potent topical corticosteroids in females and males, adults and children remain gold standard of care for genital LS; co-treatment with emollients is recommended. If standard treatment fails in males, a surgical intervention is recommended, complete circumcision may cure LS in males. UV light treatment is recommended for extragenital LS; however, there is limited scientific evidence. Topical calcineurin inhibitors are second line treatment. Laser treatment, using various wave lengths, is under investigation, and it can currently not be recommended for the treatment of LS. Treatment with biologics is only reported in single cases. CONCLUSIONS: LS has to be diagnosed and treated as early as possible in order to minimize sequelae like scarring and cancer development. Topical potent and ultrapotent corticosteroids are the gold standard of care; genital LS is often a lifelong disease and needs to be treated long-term.

Periodic Mesoporous Organosilica Nanomaterials with Unconventional Structures and Properties.

Periodic mesoporous organosilicas (PMOs) are high surface area organic-inorganic hybrid nanomaterials that have found broad applications in various fields of research such as in (bio)chemistry or material science. By choosing suitable organic groups in the framework of these materials, their surface properties such as polarity, optical/electrical characteristics and adsorption capacity can be tuned. This critical review provides an overview of the current state of the art in the developments and applications of some PMO nanomaterials in diverse fields of research. This is placed in the context of four leading areas of PMO nanomaterials, including chiral PMOs, plugged PMO nanomaterials, Janus PMOs and PMO-based nanomotors. The review briefly discusses the recent and key findings on these PMO nanomaterials as well as their potential applications for future developments.

Electronic spectroscopy of homo- and heterometallic binuclear coinage metal phosphine complexes in isolation.

Binuclear coinage metal phosphine complexes are examined under ion trap isolation in order to elucidate their noncovalent binding, structural properties and intrinsic electronic spectra. Our survey shows an intriguing order of electronic transitions obtained by in situ synthesis and mass-spectrometrically supported UV photodissociation spectroscopy on a series of six isolated homo- and heterobinuclear complexes of type [MM'(dcpm)2]2+ (M, M' = CuI, AgI, AuI; dcpm = bis(dicyclohexyl-phosphino)methane). This approach provides the unique opportunity to study all possible coinage metal interactions within a fixed ligand framework. A successive blue-shift (33 700-38 500 cm-1; 297-260 nm) of the lowest-energy bright electronic transition energy in gas phase was observed in the order of Cu2 < CuAu < CuAg < Au2 < AgAu < Ag2. This order was reproduced by quantum chemical calculations using a scalar-relativistic GW-Bethe-Salpeter-equation (GW-BSE) approach. Theory ascribes the electronic bands of all complexes to metal-centered 1MC(dσ*-pσ) transitions revealing a strengthening of metal-metal' (M-M') binding upon excitation, in agreement to mass spetrometric results. A test of the correlation of transition energies with M-M' distance by quantum chemical calculations of single point energies as a function of intermetallic distance indicates qualitative agreement with experimental results. However, the experimentally observed high sensitivity of spectroscopic shifts towards metal composition cannot be accounted for solely by M-M' distance variation. The differences in electronic transitions are qualitatively rationalized by the varying (n + 1)s (n = 3, 4, 5) orbital contributions (increase from Cu2via CuAu/CuAg to Au2/AgAu/Ag2) within the nd(n + 1)s/p-hybridization for the ground electronic state of the different complexes, whereas the excited state (of (n + 1)p orbital character) shows significantly less variation in energy. In particular, the observed spectroscopic and mass spectrometric sequence for the Ag/Au complexes is traced back to the interplay of Pauli repulsion and variation in metal-ligand bond strength within the orbital hybridization model.

Impact of off-label use regulations on patient care in dermatology - a prospective study of cost-coverage applications filed by tertiary dermatology clinics throughout Germany.

BACKGROUND: In dermatology, a medical speciality with a relatively high number of rare diseases, physicians often have to resort to off-label treatment options. To avoid claims, physicians in Germany can file a cost-coverage request (off-label application, OL-A). OBJECTIVES: Our aim was to investigate the extent to which the current regulations affect patient care. MATERIAL AND METHODS: Prospective cohort study among tertiary dermatology clinics throughout Germany, consecutively including OL-As (05/2019-09/2020) and assessing the follow-up correspondence. We modelled regressions to assess factors associated with cost-coverage decisions and the time needed by health insurers to process the OL-As. RESULTS: Thirteen clinics provided data on 121 OL-As, two of which applied for on-label treatments. Of the remaining 119 OL-As, 70 (58.8%) were immediately approved and 44 (37.0%) rejected. Including cases with one or more appeals, 87 of 119 OL-As (73.1%) were finally approved and 26 (21.9%) rejected. There was an association of the final approval rate with (1) the class of medication/treatment, with approval rates being significantly lower for JAK inhibitors than for biologics (OR 0.16, 95%-CI: 0.03-0.82); (2) German state, with approval rates being lower in eastern than in western states (OR 0.30, 95%-CI 0.12-0.76); and (3) cost of the intervention (no linear trend). However, none of these predictors was significant in our multiple logistic regression models. The median health insurer's processing time (first response) was 29 days (IQR 22-38). Our analyses showed no evidence of an association with the predictors we assessed. In cases approved, the median time from the decision to file an OL-A to the actual initiation of the treatment was 65.5 days (IQR 51-92). CONCLUSIONS: Our study points to substantial delays and inequalities in the provision of timely health care for dermatological patients with rare diseases, often involving treatments for which there is no adequate approved therapy.

Quantum Walks: Schur Functions Meet Symmetry Protected Topological Phases.

This paper uncovers and exploits a link between a central object in harmonic analysis, the so-called Schur functions, and the very hot topic of symmetry protected topological phases of quantum matter. This connection is found in the setting of quantum walks, i.e. quantum analogs of classical random walks. We prove that topological indices classifying symmetry protected topological phases of quantum walks are encoded by matrix Schur functions built out of the walk. This main result of the paper reduces the calculation of these topological indices to a linear algebra problem: calculating symmetry indices of finite-dimensional unitaries obtained by evaluating such matrix Schur functions at the symmetry protected points ± 1 . The Schur representation fully covers the complete set of symmetry indices for 1D quantum walks with a group of symmetries realizing any of the symmetry types of the tenfold way. The main advantage of the Schur approach is its validity in the absence of translation invariance, which allows us to go beyond standard Fourier methods, leading to the complete classification of non-translation invariant phases for typical examples.

Task-Specific Janus Materials in Heterogeneous Catalysis.

Janus materials are anisotropic nano- and microarchitectures with two different faces consisting of distinguishable or opposite physicochemical properties. In parallel with the discovery of new methods for the fabrication of these materials, decisive progress has been made in their application, for example, in biological science, catalysis, pharmaceuticals, and, more recently, in battery technology. This Minireview systematically covers recent and significant achievements in the application of task-specific Janus nanomaterials as heterogeneous catalysts in various types of chemical reactions, including reduction, oxidative desulfurization and dye degradation, asymmetric catalysis, biomass transformation, cascade reactions, oxidation, transition-metal-catalyzed cross-coupling reactions, electro- and photocatalytic reactions, as well as gas-phase reactions. Finally, an outlook on possible future applications is given.

A Cyclometalated NHC Iridium Complex Bearing a Cationic (η5 -Cyclopentadienyl)(η6 -phenyl)iron Backbone*.

Nucleophilic substitution of [(η5 -cyclopentadienyl)(η6 -chlorobenzene)iron(II)] hexafluorophosphate with sodium imidazolate resulted in the formation of [(η5 -cyclopentadienyl)(η6 -phenyl)iron(II)]imidazole hexafluorophosphate. The corresponding dicationic imidazolium salt, which was obtained by treating this imidazole precursor with methyl iodide, underwent cyclometallation with bis[dichlorido(η5 -1,2,3,4,5-pentamethylcyclopentadienyl]iridium(III) in the presence of triethyl amine. The resulting bimetallic iridium(III) complex is the first example of an NHC complex bearing a cationic and cyclometallated [(η5 -cyclopentadienyl)(η6 -phenyl)iron(II)]+ substituent. As its iron(II) precursors, the bimetallic iridium(III) complex was fully characterized by means of spectroscopy, elemental analysis and single crystal X-ray diffraction. In addition, it was investigated in a catalytic study, wherein it showed high activity in transfer hydrogenation compared to its neutral analogue having a simple phenyl instead of a cationic [(η5 -cyclopentadienyl)(η6 -phenyl)iron(II)]+ unit at the NHC ligand.

Fast and Selective Aqueous-Phase Oxidation of Styrene to Acetophenone Using a Mesoporous Janus-Type Palladium Catalyst.

A heterogeneous Janus-type palladium interphase catalyst was obtained by selective surface modification of a hollow mesoporous silica material. The catalyst comprises hydrophobic octyl groups on one side of the silica nanosheets and single-site bis-imidazoline dichlorido palladium(II) complexes on the other. The structure of this composite material has been analyzed by means of elemental analysis, atomic absorption spectroscopy, BET surface analysis, TGA, SEM and solid-state CP-MAS 13C and 29Si NMR spectroscopy. The catalyst showed extraordinary activity for the aqueous-phase oxidation of styrene to acetophenone using 30% hydrogen peroxide as the oxidant. An 88% yield of acetophenone could be achieved after 60 min.

Triazolyl Conjugated (Oligo)Phenothiazines Building Blocks for Hybrid Materials-Synthesis and Electronic Properties.

The Cu-catalyzed alkyne-azide 1,3-dipolar cycloaddition variant provides a highly efficient entry to conjugated triazolyl-substituted (oligo)phenothiazine organosilicon derivatives with luminescence and reversible redox characteristics. Furthermore, by in-situ co-condensation synthesis several representative mesoporous MCM-41 type silica hybrid materials with embedded (oligo)phenothiazines are prepared and characterized with respect to their structural and electronic properties. The hybrid materials also can be oxidized to covalently bound embedded radical cations, which are identified by their UV/Vis absorption signature and EPR signals.

[Current dermatology guidelines in Germany and Europe : A selection of clinically relevant recommendations]. / Aktuelle dermatologische Leitlinien in Deutschland und Europa : Eine praxisorientierte Übersicht ausgewählter Empfehlungen.

Clinical practice guidelines are systematically developed decision aids for specific medical conditions. In Germany, national dermatology guidelines are developed chiefly under the aegis of the German Dermatological Society in collaboration with the Professional Association of German Dermatologists. European and international dermatological guidelines also exist and are developed by a range of organisations, such as the European Centre for Guidelines Development, which was founded by the European Dermatology Forum in 2018. In the years 2019 and 2020, new or updated German national guidelines were published on topics such as pathological scars (hypertrophic scars and keloids), cutaneous lupus erythematosus, pyoderma grangrenosum, anal pruritus, anal eczema, anal canal and anal rim carcinomas, as well as the prevention of HPV-associated neoplasms through vaccination, syphilis and the systemic treatment of neurodermitis. A new European guideline on lichen planus closes a gap in the spectrum of guidelines available in Germany. Key recommendations and relevant changes in the guidelines are presented in this article.

2019 IUSTI-Europe guideline for the management of anogenital warts.

This guideline is an update of the 2011 European Guideline for the Management of Anogenital Warts. It is intended to support best practice in the care of patients with anogenital warts by including evidence-based recommendations on diagnosis, treatment, follow-up and advice to patients. It is intended for use by healthcare professionals in sexual healthcare or dermato-venereology clinics in Europe but may be adapted for use in other settings where the management of anogenital warts is undertaken. As a European guideline, recommendations should be adapted according to national circumstances and healthcare systems. Despite the availability of vaccine to prevent HPV types 6 and 11, the cause of >95% anogenital warts, they remain an important and frequent health problem. The previous systematic review of randomized controlled trials for anogenital warts was updated. The changes in the present guideline include the following: Updated background information on the prevalence, natural history and transmission of human papillomavirus (HPV) infection and anogenital warts. Key recommendations for diagnosis and treatment have been graded according to the strength of the recommendation and the quality of supporting evidence. 5-fluorouracil, local interferon and photodynamic therapy have been evaluated and included as potential second-line treatment options. Evidence of the impact of HPV vaccination on the incidence of anogenital warts has been updated.

Robust and Resource-Efficient Microwave Near-Field Entangling

Microwave trapped-ion quantum logic gates avoid spontaneous emission as a fundamental source of decoherence. However, microwave two-qubit gates are still slower than laser-induced gates and hence more sensitive to fluctuations and noise of the motional mode frequency. We propose and implement amplitude-shaped gate drives to obtain resilience to such frequency changes without increasing the pulse energy per gate operation. We demonstrate the resilience by noise injection during a two-qubit entangling gate with ^{9}Be^{+} ion qubits. In the absence of injected noise, amplitude modulation gives an operation infidelity in the 10^{-3} range.

Photoinitiated Charge Transfer in a Triangular Silver(I) Hydride Complex and Its Oxophilicity.

The photoexcitation of a triangular silver(I) hydride complex, [Ag3 (µ3 -H)(µ2 -dcpm)3 ](PF6 )2 ([P](PF6 )2 , dcpm=bis(dicyclohexylphosphino)methane), designed with "UV-silent" bis-phosphine ligands, provokes hydride-to-Ag3 single and double electron transfer. The nature of the electronic transitions has been authenticated by absorption and photodissociation spectroscopy in parallel with high-level quantum-chemical computations utilizing the GW method and Bethe-Salpeter equation (GW-BSE). Specific photofragments of mass-selected [P]2+ ions testify to charge transfer and competing pathways resulting from the unique [Ag3 (µ3 -H)]2+ scaffold. This structural motif of [P](PF6 )2 has been unequivocally verified by 1 H NMR spectroscopy in concert with DFT and X-ray diffraction structural analysis, which revealed short equilateral Ag-Ag distances (dAgAg =3.08 Å) within the range of argentophilic interactions. The reduced radical cation [P]. + exhibits strong oxophilicity, forming [P+O2 ].+ ,which is a model intermediate for silver oxidation catalysis.

2H-enrichment of cellulose and n-alkanes in heterotrophic plants.

Hydrogen (H) isotopes of plant organic compounds are rarely employed in ecological studies. If so, these values are interpreted as being indicative of the plant source and/or leaf water. Recent observations suggest, however, that variations in hydrogen isotope fractionation that occur during the biosynthesis of plant compounds (2H-εbio) imprint valuable metabolic information into the hydrogen isotope composition (δ2H values) of plant organic compounds. Here we show a consistent 2H-enrichment of compounds in heterotrophically growing plants across a series of autotrophic/heterotrophic plant pairs. We suggest that this is due to a higher recycling of compounds in the Calvin and tricarboxylic acid cycles in heterotrophic plants that is associated with a more complete exchange of C-bound H with the surrounding 2H-enriched foliar water. Interestingly, we found that 2H-enrichment in heterotrophic plants was larger for carbohydrates than for lipids, with an average 2H-enrichment of 76 ± 9‰ in α-cellulose and 23 ± 23‰ in n-alkanes. We propose that this systematically larger 2H-enrichment for carbohydrates than for lipids is either due to different level of 2H-fractionation associated with heterotrophically produced NADPH, or to the potential uptake of lipids by heterotrophic plants. With the work we present here, we contribute to a better mechanistic understanding of what the biochemical principles are that couple the carbohydrate dynamics of plants to their δ2H values and hope to foster as such the application of H isotopes in plant sciences.

Prioritizing topics in guideline development: results of a two-phase online survey of dermatologist members of the EADV.

BACKGROUND: Most clinical guidelines in dermatology are encyclopaedic, covering a disease and its aetiology, diagnosis, treatment and prevention in their entirety. The usability and uptake of guideline recommendations might be improved by guidelines that are more concise and address specific questions ranked by users according to their perceived importance. OBJECTIVE: To survey the largest association of dermatologists in Europe, identify which questions in their everyday practice they felt would benefit from short, evidence-based guidance and rank these systematically. METHODS: A two-phase online survey using a structured ranking approach and the members directory of the European Academy of Dermatology and Venereology (EADV). RESULTS: The first survey yielded 265 suggestions, indicating a response rate of 3.7%. We grouped all responses according to themes and subsequently combined these into a list of 35 broader topics. These were presented to all members of the EADV in the second survey (response rate: 9.7%), which yielded a list of the top 10 topics participants felt were most in need of guidance. The first three were 'Systemic drug treatment in dermatology during pregnancy and for women wishing to have children in the near future', 'alopecia areata' and 'interpretation of laboratory results in connective tissue diseases'. CONCLUSION: Our two-phase survey of EADV members and a structured ranking process were practical to implement and yielded a list of the top 10 topics in dermatology and venereology for guideline development. Guideline dissemination needs to be improved, and practical, more concise guidelines may facilitate efforts to do so.

The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria.

This evidence- and consensus-based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on 1 December 2016. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-founded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life and affect performance at work and school. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.

Studies on the Biocompatibility of Poly(diethyl vinyl-phosphonate) with a New Fluorescent Marker.

Utilization of group transfer polymerization for the synthesis of poly(diethyl vinylphosphonate) (PDEVP) allows its controlled end-group functionalization. Thus, a new fluorescent chromophore/PDEVP conjugate is prepared and subjected to biocompatibility tests on two different human cell lines. In contrast to the previous studies, the tagged polymer is not absorbed by cells from the solution and has nearly no impact on cell mortality rate.

Sonoelastography of the Common Flexor Tendon of the Elbow with Histologic Agreement: A Cadaveric Study.

Purpose To determine the correlation of the results of conventional B-mode ultrasonography (US) and compression sonoelastography with histologic results in common flexor tendons of the elbow in human cadavers. Materials and Methods Twenty-five common flexor tendons were evaluated in 16 fresh, unembalmed cadavers of 11 women with a median age of 85 years (range, 71-101 years) and five men with a median age of 78 years (range, 70-88 years). Informed consent was provided according to the last will of the donors. B-mode US results were classified as grade 1, normal tendon with homogeneous fibrillar pattern; grade 2, tendon thickening or hypoechoic areas and/or calcifications in less than 30% of the tendon; or grade 3, hypoechoic areas and/or calcifications greater than 30% of the tendon. Sonoelastographic results were grade 1, blue (hardest) to green (hard); grade 2, yellow (soft); and grade 3, red (softest). The intraclass correlation coefficient was calculated to determine agreement with histologic findings for each B-mode US, sonoelastographic, and combined B-mode US and sonoelastographic examination. Histologic results were grade 1, normal, with parallel fibrillar pattern; grade 2, mild tendinopathy, with cellular infiltration, angiogenesis, or fatty vacuoles; or grade 3, severe tendinopathy, with loss of parallel collagen structure and necrosis. Results Histologic alterations were detected in 44% (11 of 25) of biopsy specimens. Intraclass correlation with histologic results was 0.57 for B-mode US, 0.68 for sonoelastography, and 0.84 for the combination of the two approaches. Conclusion The addition of sonoelastography to B-mode US provided statistically significant improvement in correlation with histologic results compared with the use of B-mode US alone (P < .02). © RSNA, 2016 Online supplemental material is available for this article.

[2.2]Paracyclophanes with N-Heterocycles as Ligands for Mono- and Dinuclear Ruthenium(II) Complexes.

[2.2]Paracyclophane, with its unique structure, allows the design of unusual 3D structures by functionalization of this rigid and stable hydrocarbon scaffold. Therefore different mono- and homodisubstituted [2.2]paracyclophanes with pyridyl, pyrimidyl and oxazolinyl substituents were developed in order to evaluate their ability as bridging ligands for two ruthenium centres. With the successfully synthesized [2.2]paracyclophane-based N-donor functions, the cycloruthenation reaction using [RuCl2 (p-cymene)]2 as precursor was explored. Compared to 2-phenylpyridine, the [2.2]paracyclophane derivative is clearly inferior in the cycloruthenation reaction, resulting in poor yields for the neutral complexes. By addition of KPF6 , the cationic complexes can be obtained in good yields and are formed diastereoselectively in case of a pyridyl substituent, resulting in only one diastereomer for dinuclear ruthenium complexes of bispyridyl-substituted [2.2]paracyclophanes as bridging ligands.