Endoplasmic reticulum stress in skin aging induced by UVB.

Aging is a normal and complex biological process. Skin is located in the most superficial layer of the body, and its degree of aging directly reflects the aging level of the body. Endoplasmic reticulum stress refers to the aggregation of unfolded or misfolded proteins in the endoplasmic reticulum and the disruption of the calcium ion balance when cells are stimulated by external stimuli. Mild endoplasmic reticulum stress can cause a series of protective mechanisms, including the unfolded protein response, while sustained high intensity stimulation leads to endoplasmic reticulum stress and eventually apoptosis. Photoaging caused by ultraviolet radiation is an important stimulus in skin aging. Many studies have focused on oxidative stress, but increasing evidence shows that endoplasmic reticulum stress plays an important role in photoaging. This paper reviews the development and mechanism of endoplasmic reticulum stress (ERS) in skin photoaging, and provides research directions for targeting the ERS pathway to slow aging.

Randomised, controlled trial of erenumab for the prevention of episodic migraine in patients from Asia, the Middle East, and Latin America: The EMPOwER study.

OBJECTIVE: EMPOwER, a double-blind, randomised, phase 3 study, evaluated the efficacy and safety of erenumab in adults with episodic migraine from Asia, the Middle East, and Latin America. METHODS: Randomised patients (N = 900) received monthly subcutaneous injections of placebo, erenumab 70 mg, or 140 mg (3:3:2) for 3 months. Primary endpoint was change from baseline in monthly migraine days at Month 3. Other endpoints included achievement of ≥50%, ≥75%, and 100% reduction in monthly migraine days, change in monthly acute migraine-specific medication treatment days, patient-reported outcomes, and safety assessment. RESULTS: At baseline, mean (standard deviation) age was 37.5 (9.9) years, 81.9% were women, and monthly migraine days was 8.2 (2.8). At Month 3, change from baseline in monthly migraine days (primary endpoint) was -3.1, -4.2, and -4.8 days for placebo, erenumab 70 mg, and erenumab 140 mg, respectively, with a statistically significant difference for erenumab versus placebo (P = 0.002 [70 mg], P < 0.001 [140 mg]). Both erenumab doses were also significantly superior to placebo on all secondary endpoints, including the proportion of patients achieving ≥50% reduction from baseline in monthly migraine days, change from baseline in monthly acute migraine-specific medication treatment days and change from baseline in the Headache Impact Test-6™ scores. The safety profile of erenumab was comparable with placebo; no new safety signals were observed. CONCLUSIONS: This study of erenumab in patients with episodic migraine from Asia, the Middle East, and Latin America met all primary and secondary endpoints. A consistent numerical benefit was observed with erenumab 140 mg versus erenumab 70 mg across all efficacy endpoints. These findings extend evidence of erenumab's efficacy and safety to patients under-represented in previous trials.ClinicalTrials.gov identifier: NCT03333109.

Geographical Differences in Trigger Factors of Tension-Type Headaches and Migraines.

In this review, we discussed the types and frequencies of trigger factors of primary headache [migraine and tension-type headache (TTH)] among adult patients. We assessed the influence of geographical location, ethnicity and gender on the various trigger factors of a migraine and a TTH. We also evaluated the trigger factors among the multi-ethnic Southeast Asian adult patients. In a recent study, odor triggered more migrainous headaches compared to the other primary headaches. Odor was observed to be specific of migraines. Moreover, stress is one of the most common trigger factors for patients with migraines and TTHs worldwide. Migrainous patients have an increased sensitivity in comparison to non-migrainous patients. Furthermore, these patients have much difficulty in adapting to the high level of sensitivity, and the sensitized brain is therefore more vulnerable to trigger factors. In addition, the presence of one trigger factor may increase the exposure of other trigger factors. This phenomenon is more marked in the patients with migraines who have stress and menstruation as triggers, predisposing them to be more sensitive to other triggers. In conclusion, the geographical location factor has an influence on the trigger factors of headaches. Ethnicity may have an effect due to the cultural differences. Change in weather and sunlight are important commonly identified trigger factors for headaches. Moreover, gender differences in some trigger factors are present among the patients with headaches, especially sunlight and sleep deprivation. More research studies can be conducted to have a better understanding on trigger factors in the future. This will enable proper identification of trigger factors, leading to a decrease in the number of headache episodes and an improvement in quality of life for patients.

Fucoidan from Undaria pinnatifida Ameliorates Epidermal Barrier Disruption via Keratinocyte Differentiation and CaSR Level Regulation.

The epidermal barrier acts as a line of defense against external agents as well as helps to maintain body homeostasis. The calcium concentration gradient across the epidermal barrier is closely related to the proliferation and differentiation of keratinocytes (KCs), and the regulation of these two processes is the key to the repair of epidermal barrier disruption. In the present study, we found that fucoidan from Undaria pinnatifida (UPF) could promote the repair of epidermal barrier disruption in mice. The mechanistic study demonstrated that UPF could promote HaCaT cell differentiation under low calcium condition by up-regulating the expression of calcium-sensing receptor (CaSR), which could then lead to the activation of the Catenin/PLCγ1 pathway. Further, UPF could increase the expression of CaSR through activate the ERK and p38 pathway. These findings reveal the molecular mechanism of UPF in the repair of the epidermal barrier and provide a basis for the development of UPF into an agent for the repair of epidermal barrier repair.

Ocular perfusion pressure and ophthalmic artery flow in patients with normal tension glaucoma.

BACKGROUND: Vascular insufficiency has been reported to be a cause of normal tension glaucoma (NTG). The aim of this study was to compare ocular perfusion pressure (OPP) and ophthalmic artery flow (OAF) between patients with NTG and those without glaucoma. METHODS: We considered one eye each from 31 NTG and 15 non-glaucoma control patients. Blood pressure and intraocular pressure (IOP) were measured in the sitting position, for calculation of OPP. Humphrey visual field (HVF) assessment was then carried out on NTG patients. All patients then underwent Transcranial Doppler ultrasound measurements of OAF parameters, including mean flow velocity (MFV), end diastolic velocity (EDV), peak systolic velocity (PSV) and resistive index (RI). We looked at differences in OPP and OAF parameters between the two groups, and their correlations in NTG patients. T-tests, χ (2), ANOVA and Pearson Correlation tests were performed, with p < 0.05 considered statistically significant. RESULTS: There were no statistically significant differences in OPP between the NTG and control groups (60.5+/-8.7 mmHg and 62.9+/-10.2 mmHg respectively, p = 0.393), and also no statistically significant differences in MFV, EDV, PSV and RI (all p > 0.05). In the NTG group, there were positive correlations between OPP and both MFV (r = 0.416, p = 0.020) and EDV (r = 0.369, p = 0.041). There were no statistically significant correlations between HVF mean deviation and OPP or OAF parameters (all p > 0.05). CONCLUSION: There is no difference in OPP and OAF parameters between patients with NTG and non-glaucoma controls, suggesting that vascular insufficiency or dysregulation by themselves may not account for the pathogenesis of NTG.

Association between serum 25-hydroxyvitamin D levels and carotid atherosclerosis in chronic kidney disease patients.

BACKGROUND: Epidemiological studies have shown an inverse relationship between vitamin D levels and cardiovascular diseases. However, this does not infer a causal relationship between the two. Chronic kidney disease (CKD) patients have a high prevalence of vitamin D deficiency and carotid atherosclerosis. Therefore, in this study we have aimed to determine the association between serum 25-hydroxyvitamin D levels and carotid atherosclerosis in the CKD population. METHODS: 100 CKD stage 3-4 patients were included in the study. Direct chemiluminesent immunoassay was used to determine the level of serum 25-hydroxyvitamin D. All subjects underwent a carotid ultrasound to measure common carotid artery intima-media thickness (CCA-IMT) and to assess the presence of carotid plaques or significant stenosis (≥50 %). Vitamin D deficiency was defined as serum 25-hydroxyvitamin D < 25 nmol/L. Abnormal CCA-IMT was defined as CCA-IMT ≥ 0.8 mm. Plaque was defined as a focal structure that encroaches into the arterial lumen of ≥ 0.5 mm or 50 % of the surrounding IMT value. Significant stenosis was defined as peak-systolic velocities ≥ 125 cm/s and end-diastolic velocities ≥ 40 cm/s. RESULTS: The vitamin D deficiency and non-deficiency groups did not differ significantly in terms of abnormal CCA-IMT (P = 0.443), carotid plaque (P = 0.349), and carotid stenosis (P = 0.554). No significant correlation between serum 25-hydroxyvitamin D levels and CCA-IMT (P = 0.693) was found. On a backward multiple linear regression model, serum 25-hydroxyvitamin D levels was not associated with CCA-IMT, abnormal CCA-IMT, or plaque presence. CONCLUSIONS: No important association between serum 25-hydroxyvitamin levels and carotid atherosclerosis was found in CKD patients.

Microballoons: Osmotically-inflated elastomer shells for ultrafast release of encapsulants and mechanical energy.

HYPOTHESIS: Microcapsules with osmotically-inflated elastic shells exhibit an ultrafast release of encapsulants while mechanically stimulating the microenvironments, akin to popping balloons. EXPERIMENTS: To prepare elastic shells with uniform thickness and size, monodisperse water-in-oil-in-water (W/O/W) double-emulsion drops are produced in a capillary microfluidic device. The polydimethylsiloxane (PDMS)-containing oil phase is thermally cured to create the elastic shell. The elastic shells are inflated by pumping water into the lumen in hypotonic conditions. The inflated microcapsules produced undergo mechanical compression, and their release properties are studied. FINDINGS: By controlling the osmotic pressure difference, Microballoons are inflated into a diameter of 200 µm - 316 µm and shell thickness of 7.8 µm - 0.7 µm, respectively. The inflated shell pops due to mechanical failure when subjected to mechanical stress above a certain threshold, resembling a balloon. During popping, the stretched shell rapidly retracts to the original uninflated state, resulting in an ultrafast release of encapsulants from the lumen within a millisecond. This process converts elastic potential energy stored in the shell into mechanical energy with substantial power. The microballoons mechanically stimulate the local environment, leading to the direct and rapid release of encapsulants. This has the potential to improve absorption efficiency.

Unveiling the mechanism of high sugar diet induced advanced glycosylation end products damage skin structure via extracellular matrix-receptor interaction pathway.

BACKGROUND: AGEs accumulate in the skin as a result of a high-sugar diet and play an important role in the skin aging process. OBJECTIVES: The aim of this study was to characterize the mechanism underlying the effect of a high-sugar diet on skin aging damage at a holistic level. METHODS: We established a high-sugar diet mouse model to compare and analyze differences in physiological indexes. The effect of a high-sugar diet on skin aging damage was analyzed by means of a transcriptome study and staining of pathological sections. Furthermore, the differences in the protein expression of AGEs and ECM components between the HSD and control groups were further verified by immunohistochemistry. RESULTS: The skin in the HSD group mice tended toward a red, yellow, dark, and deep color. In addition, the epidermis was irregular with anomalous phenomena, the epidermis was thinned, and the dermis lost its normal structure and showed vacuolated changes. Transcriptomics results revealed significant downregulation of the ECM-receptor interaction pathway, significant upregulation of the expression of AGEs and significant downregulation of the expression levels of COLI, FN1, LM5, and TNC, among others ECM proteins and ECM receptors. CONCLUSIONS: High-sugar diets cause skin aging damage by inducing the accumulation of AGEs, disrupting the expression of ECM proteins and their receptors, and downregulating the ECM-receptor interaction pathway, which affects cellular behavioral functions such as cell proliferation, migration, and adhesion, as well as normal skin tissue structure.

Active Ingredients of Schisandra chinensis Fruit Oil and their Effect on Propionibacterium acnes-Induced Inflammation in HaCaT Cells.

BACKGROUND: Propionibacterium acnes causes upregulation of inflammatory factors, such as cycloxygenase-2, prostaglandin E2, interleukin-1ß, and tumor necrosis factor-alpha, increased levels of reactive oxygen species (ROS) and inward flow of calcium ions. This causes increased levels of the antimicrobial peptide LL-37 and inflammation of the skin, leading to redness, swelling, itching and other symptoms. Schisandra chinensis fruit oil (SCO) is rich in lignan active ingredients with various antioxidant and anti-inflammatory properties. METHODS: In this study, SCO is obtained by supercritical CO2 fluid extraction. SCO's anti-inflammatory actions were investigated using P. acnes-induced inflammation HaCaT cells model. A method based on reversed-phase high-pressure liquid chromatography with a diode array detector was developed and validated for the simultaneous detection of five lignan components. Levels of inflammatory factors and LL-37 were measured by ELISA kit and western blot respectively. Ca2+ and ROS levels detected by flow cytometry. RESULTS: The experimental results show that the contents of schisanol A, schisanol B, schisanin A, schisanin B, and schisanin C were 33.89 ± 0.24, 14.89 ± 0.45, 8.92 ± 0.02, 29.14 ± 0.67, and 4.74 ± 0.09 mg/g, respectively. Studies have demonstrated that SCO can alleviate skin inflammation by inhibiting the COX-2/PGE2 and NF-κB signalling pathway. In addition, SCO can inhibit ROS production, significantly block inward Ca2+ flow, alleviate cell damage, and modulate the content of the antimicrobial peptide LL-37. CONCLUSIONS: In summary, our study elucidated the anti-inflammatory activity of SCO in a cell model and provided a scientific basis for its application as a raw material in skin care.

Primary headache in the elderly in South-East Asia.

Headache aetiology and presentation are considerably different in elderly individuals. However, literature on headache characteristics among Asians is limited. The objective of this study was to evaluate the headache characteristics among elderly in an outpatient clinic setting in Malaysia, a South-East Asian country with diverse ethnicity. In this prospective cross-sectional study, patients presenting with headache to Neurology and Primary Care Clinics of University Malaya Medical Centre between February 2010 and July 2010 were included. Data for consecutive eligible adult patients were entered in a prospective headache registry. International Headache Criteria II (ICHD-II) were used to classify various headache subtypes. Patients with headache due to intracranial space occupying lesions were excluded. Patient were divided into two age groups-elderly (55 years and above) and younger (less than 55 years of age). Of the 175 screened patients, 165 were included in the study-70 in elderly age group and 95 in younger group. Tension-type headache was the commonest subtype (45.7 %) among the elderly while Migraine without aura (54.7 %) was more common in young adults. More elderly patients suffered from chronic daily headache as compared to younger patients (47.1 vs. 28.4 %; p = 0.015). Headache subtypes and frequency differ considerably among elderly South East Asian patients.

Osmosis-Mediated Microfluidic Production of Submillimeter-Sized Capsules with an Ultrathin Shell for Cosmetic Applications.

There is a demand for submillimeter-sized capsules with an ultrathin shell with high visibility and no tactile sensation after release for cosmetic applications. However, neither bulk emulsification nor droplet microfluidics can directly produce such capsules in a controlled manner. Herein, we report the microfluidic production of submillimeter-sized capsules with a spacious lumen and ultrathin biodegradable shell through osmotic inflation of water-in-oil-in-water (W/O/W) double-emulsion drops. Monodisperse double-emulsion drops are produced with a capillary microfluidic device to have an organic solution of poly(lactic-co-glycolic acid) (PLGA) in the middle oil layer. Hypotonic conditions inflate the drops, leading to core volume expansion and oil-layer thickness reduction. Afterward, the oil layer is consolidated to the PLGA shell through solvent evaporation. The degree of inflation is controllable with the osmotic pressure. With a strong hypotonic condition, the capsule radius increases up to 330 µm and the shell thickness decreases to 1 µm so that the ratio of the thickness to radius is as small as 0.006. The large capsules with an ultrathin shell readily release their encapsulant under an external force by shell rupture. In the mechanical test of single capsules, the threshold strain for shell rupture is reduced from 75 to 12%, and the threshold stress is decreased by two orders for highly inflated capsules in comparison with noninflated ones. During the shell rupture, the tactile sensation of capsules gradually disappears as the capsules lose volume and the residual shells are ultrathin.

Efficacy and safety testing of dissolving microarray patches in Chinese subjects.

OBJECTIVES: There is a lack of clinical research in the Chinese market concerning dissolving microarray (DMA) patches in cosmetic applications. In this study, the clinical efficacy and safety tests of DMA patch technology were performed on Chinese consumers. METHODS: A 4-week clinical efficacy and safety evaluation was conducted on 30 Chinese female subjects with crow's feet and eye bags. DMA patches loaded with hyaluronic acid (HA-DMA) were applied under the eyes and corners of the eyes of the subjects three times a week over four consecutive weeks. Skin firmness and dermal layer strength were measured using ultrasound, and changes in skin wrinkles were detected using VISIA-CR and Primos Lite. Eye bag ratings were evaluated by professional dermatologists based on the 0-6 grades of eye bags in the "Skin Aging Atlas Volume 2: Asian Type." RESULTS: HA-DMA patches produced good clinical improvements on both crow's feet and eye bags in the study participants. HA-DMA effectively increased skin firmness while reducing the number, area, and volume of crow's feet, along with reducing eye bag ratings. The reductions in all metrics were statistically significant with positive effects evident in as little as 1 week of treatment. There were no adverse effects related to the treatments observed during the test period. CONCLUSIONS: In a clinical efficacy trial of 30 Chinese female subjects, HA-DMA showed excellent therapeutic benefits without adverse effects while reducing crow's feet and eye bags. HA-DMA is expected to be a safe, effective, and novel cosmetic for improving the appearance of aging skin.

Acne and its post-inflammatory hyperpigmentation treatment by applying anti-acne dissolving microneedle patches.

OBJECTIVE: Acne is a significant problem in young people. At present, most acne treatment products are topically applied cosmetics, whose efficacy is limited by the stratum corneum. The dissolving microneedle technique can effectively deliver drug molecules into the body. In this study, dissolving microneedles containing anti-acne ingredients were tested for human efficacy and safety. METHODS: We conducted a 28-day clinical efficacy and safety trial on 30 individuals with visible facial acne. During the trial, anti-acne microneedle (AA-DMN) patches were applied to designated skin areas once daily for 28 consecutive days. Skin pigmentation was measured using a Courage + Khazaka skin melanin and hemoglobin test probe Mexameter MX18. Acne volume was measured using a Canfieldsci skin rapid optical imaging system PRIMOS. In addition, skin irritation was evaluated via self-report and dermatologist's examination. RESULTS: The AA-DMN patches showed good efficacy including improvement of skin pigmentation and reduced acne volume. Acne volume was reduced by 12.34% after 3 days of patch use and further reduced by 10.01% after 7 continuous days of use. After 28 days of treatment, skin melanin decreased by 5.88% and heme decreased by 7.83%. No adverse reactions were observed in any of the participants. CONCLUSIONS: Anti-acne microneedle patches showed an excellent effect in reducing acne and post-inflammatory hyperpigmentation (PIH), without adverse skin reactions. The novel AA-DMN patch is a safe and effective anti-acne treatment.

Impact of polyphenols extracted from Tricholoma matsutake on UVB-induced photoaging in mouse skin.

BACKGROUND: Despite Tricholoma matsutake has been used as natural health products with multiple medicinal properties, detailed information about its polyphenolic composition as sources of anti-photoaging agents remains to be determined. OBJECTIVE: To investigate the impact of polyphenols extracted from Tricholoma matsutake (TME) on Ultraviolet B (UVB)-induced skin photoaging. MATERIALS AND METHODS: Various factors of oxidative stress and inflammation as well as histological and immunohistochemical analysis in the mouse dorsal skin were determined after UVB radiation. RESULTS: Topical administration with TME suppressed the UVB-induced skin thickness, wrinkles and erythema, and increased skin collagen content. Furthermore, TME decreased reactive oxygen species (ROS) level, upregulated glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), catalase (CAT), and glucose-6-phosphate dehydrogenase (G6PDH) activities and inhibited the expression of IL-1, IL-6, IL-8, and TNF-α in mice irradiated with UVB. TME could reduce UVB-induced p38 mitogen-activated protein kinase (p38 MAPK) phosphorylation and effectively inhibited the activity of the transcriptional factor nuclear factor-kappa B (NF-κB), thereby reducing the cyclooxygenase-2 (COX-2) expression, which is an important mediator of inflammatory cascade leading to the inflammatory response. CONCLUSION: Our data demonstrated that TME had various beneficial effects on UVB-induced skin photoaging due to its antioxidant and anti-inflammatory activities, and it might be exploited as a promising natural product in skin care, anti-photoaging and the therapeutic intervention of skin disorders related to both oxidative stress and inflammation.

Improvement of Skin Barrier Dysfunction by Phenolic-containing Extracts of Lycium barbarum via Nrf2/HO-1 Regulation.

Lycium barbarum have received an increasing popularity due to its powerful biological activity and medicinal use. However, the effect of Lycium barbarum on skin remains largely uncharacterized. The general purpose of this paper was to characterize the phenolic compounds in Lycium barbarum extract (LBE) using LC-HRMS/QTOF method and to investigate whether topical administration of LBE can repair skin barrier dysfunction in mice. Our data demonstrated that LBE could not only decrease ROS level and matrix metalloproteinase expression, but also strengthen intrinsic antioxidant defense system including SOD, GSH-Px and CAT, thereby resulting in increased skin collagen content and an improvement of UV-induced skin erythema, thickness and wrinkles. Improved skin barrier functions were highly correlated with increased expression of filaggrin, involucrin and loricrin as well as antioxidant proteins such as Nrf2 and HO-1 in UV-irradiated mice, suggesting that LBE may be promising natural products at a lower cost for the topical application in the treatment of skin diseases with defective barrier function.

Investigating Psychological Differences Between Nurses and Other Health Care Workers From the Asia-Pacific Region During the Early Phase of COVID-19: Machine Learning Approach.

BACKGROUND: As the COVID-19 pandemic evolves, challenges in frontline work continue to impose a significant psychological impact on nurses. However, there is a lack of data on how nurses fared compared to other health care workers in the Asia-Pacific region. OBJECTIVE: This study aims to investigate (1) the psychological outcome characteristics of nurses in different Asia-Pacific countries and (2) psychological differences between nurses, doctors, and nonmedical health care workers. METHODS: Exploratory data analysis and visualization were conducted on the data collected through surveys. A machine learning modeling approach was adopted to further discern the key psychological characteristics differentiating nurses from other health care workers. Decision tree-based machine learning models (Light Gradient Boosting Machine, GradientBoost, and RandomForest) were built to predict whether a set of psychological distress characteristics (ie, depression, anxiety, stress, intrusion, avoidance, and hyperarousal) belong to a nurse. Shapley Additive Explanation (SHAP) values were extracted to identify the prominent characteristics of each of these models. The common prominent characteristic among these models is akin to the most distinctive psychological characteristic that differentiates nurses from other health care workers. RESULTS: Nurses had relatively higher percentages of having normal or unchanged psychological distress symptoms relative to other health care workers (n=233-260 [86.0%-95.9%] vs n=187-199 [74.8%-91.7%]). Among those without psychological symptoms, nurses constituted a higher proportion than doctors and nonmedical health care workers (n=194 [40.2%], n=142 [29.5%], and n=146 [30.3%], respectively). Nurses in Vietnam showed the highest level of depression, stress, intrusion, avoidance, and hyperarousal symptoms compared to those in Singapore, Malaysia, and Indonesia. Nurses in Singapore had the highest level of anxiety. In addition, nurses had the lowest level of stress, which is the most distinctive psychological outcome characteristic derived from machine learning models, compared to other health care workers. Data for India were excluded from the analysis due to the differing psychological response pattern observed in nurses in India. A large number of female nurses emigrating from South India could not have psychologically coped well without the support from family members while living alone in other states. CONCLUSIONS: Nurses were least psychologically affected compared to doctors and other health care workers. Different contexts, cultures, and points in the pandemic curve may have contributed to differing patterns of psychological outcomes amongst nurses in various Asia-Pacific countries. It is important that all health care workers practice self-care and render peer support to bolster psychological resilience for effective coping. In addition, this study also demonstrated the potential use of decision tree-based machine learning models and SHAP value plots in identifying contributing factors of sophisticated problems in the health care industry.

Elaeagnus L gum polysaccharides alleviate the impairment of barrier function in the dry skin model mice.

BACKGROUND: Dry skin is a common skin condition caused by reduction of water-holding capacity, which is regulated by skin barrier function. Dry skin can also be a symptom that indicates a more serious diagnosis. There are a number of moisturizers on the market, which play an important role in dermatologic and cosmetic therapies. However, the demand for these products with good and therapeutic efficiency is still growing. AIMS: It remains necessary to investigate the effects of Elaeagnus L gum polysaccharides (EAP), which are prepared from gum of Elaeagnus angustifolia L. on the epidermal permeability barrier function and their possible underlying mechanisms. PATIENTS/METHODS: EAP were purified, analyzed, and tested on human keratinocyte cell line (HaCaT) and then on the skin in vivo to evaluate their antiinflammatory activities and their impacts on impaired skin barrier function. RESULTS: Histological analyses revealed that topical administration with EAP effectively attenuated dryness-like skin condition, including less percutaneous water loss rate, less infiltrate inflammation cells, and less epidermal thickening. Moreover, EAP inhibited the production of various inflammatory mediators and increased AQP-3, FLG, and LOR expression. CONCLUSION: Our results indicated that EAP enhances epidermal permeability barrier function, and they can be used as a promising adjuvant agent in skin care cosmetics and in treating some skin disorders characterized by cutaneous inflammation and abnormal barrier function.

Anthropometric, biochemical and clinical assessment of malnutrition in Malaysian patients with advanced cirrhosis.

BACKGROUND: There is limited data on the nutritional status of Asian patients with various aetiologies of cirrhosis. This study aimed to determine the prevalence of malnutrition and to compare nutritional differences between various aetiologies. METHODOLOGY: A cross-sectional study of adult patients with decompensated cirrhosis was conducted. Nutritional status was assessed using standard anthropometry, serum visceral proteins and subjective global assessment (SGA). RESULTS: Thirty six patients (mean age 59.8 +/- 12.8 years; 66.7% males; 41.6% viral hepatitis; Child-Pugh C 55.6%) with decompensated cirrhosis were recruited. Malnutrition was prevalent in 18 (50%) patients and the mean caloric intake was low at 15.2 kcal/kg/day. SGA grade C, as compared to SGA grade B, demonstrated significantly lower anthropometric values in males (BMI 18.1 +/- 1.6 vs 26.3 +/- 3.5 kg/m2, p < 0.0001; MAMC 19.4 +/- 1.5 vs 24.5 +/- 3.6 cm, p = 0.002) and females (BMI 19.4 +/- 2.7 vs 28.9 +/- 4.3, p = 0.001; MAMC 18.0 +/- 0.9 vs 28.1 +/- 3.6, p < 0.0001), but not with visceral proteins. The SGA demonstrated a trend towards more malnutrition in Child-Pugh C compared to Child-Pugh B liver cirrhosis (40% grade C vs 25% grade C, p = 0.48). Alcoholic cirrhosis had a higher proportion of SGA grade C (41.7%) compared to viral (26.7%) and cryptogenic (28.6%) cirrhosis, but this was not statistically significant. CONCLUSION: Significant malnutrition in Malaysian patients with advanced cirrhosis is common. Alcoholic cirrhosis may have more malnutrition compared to other aetiologies of cirrhosis.

Acute Ischaemic Stroke Successfully Treated with Thrombolytic Therapy and Endovascular Thrombectomy with Non-Contrast Computed Tomography and Computed Tomography Angiogram Protocol.

Early endovascular thrombectomy leads to improved outcomes for patients with proximal occlusions when started within 6 h from onset of symptoms. We present a case illustrating the flow of events for a patient who underwent endovascular thrombectomy in our centre after conventional imaging - a brain non-contrast computed tomography (NCCT) and CT angiogram (CTA) - achieving a door-to-groin time of 195 min. The patient is a 65-year-old who presented with signs and symptoms of a left middle cerebral artery (MCA) territory infarct. His National Institute of Health Stroke Scale (NIHSS) score was 15 on presentation and his brain NCCT showed an Alberta Stroke Programme Early CT Score (ASPECTS) of 8. His CTA showed a left MCA distal M1 occlusion with focal calcification and stenosis of the proximal left internal carotid artery. He was subsequently thrombosed and underwent thrombectomy successfully, with a door-to-groin-puncture time of 195 min. A TICI 2b reperfusion was achieved. His NIHSS score improved to 9 over the next 2 days. For cases with straightforward NCCT and CTA with no contraindications, endovascular thrombectomy should be pursued without delay. A review of the current available literature for the usage of NCCT and CTA as well as the importance of ASPECTS scoring in patient selection for endovascular thrombectomy was included.