Observational study to estimate the proportion of surgical site infection following excision of ulcerated skin tumours (OASIS study).

BACKGROUND: Ulceration is a recognized risk factor for surgical site infection (SSI); however, the proportion of patients developing SSI after excision of an ulcerated skin cancer is unknown. AIM: To determine the proportion of participants with SSI after surgical excision of an ulcerated skin cancer. A secondary aim was to assess feasibility outcomes to inform the design of a randomized controlled trial to investigate the benefits and harms of perioperative antibiotics following excision of ulcerated tumours. METHODS: This was a multicentre, prospective, observational study of patients undergoing excision of an ulcerated skin cancer between March 2019 and March 2020. Prior to surgical excision, surface swabs of the ulcerated tumours of participants recruited from one centre were undertaken to determine organism growth. At 4 weeks after surgery, all participants were e-mailed or posted the Wound Healing Questionnaire (WHQ) to determine whether they had developed SSI. RESULTS: In total, 148 participants were recruited 105 (70.9%) males; mean ± SD age 77.1 ± 12.3 years. Primary outcome data were available for 116 (78.4%) participants, of whom 35 (30.2%) were identified as having an SSI using the WHQ with a cutoff score of 8, and 47 (40.5%) were identified with a cutoff score of 6. Using the modified WHQ in participants with wounds left to heal by secondary intention, 33 (28.4%) and 43 (37.1%) were identified to have SSI respectively. CONCLUSION: This prospective evaluation of SSI identified with the WHQ following excision of ulcerated skin cancers demonstrated a high proportion with SSI. The WHQ was acceptable to patients; however, further evaluation is required to ensure validity in assessing skin wounds.

Adjuvant bevacizumab for melanoma patients at high risk of recurrence: survival analysis of the AVAST-M trial.

Background: Bevacizumab is a recombinant humanised monoclonal antibody to vascular endothelial growth factor shown to improve survival in advanced solid cancers. We evaluated the role of adjuvant bevacizumab in melanoma patients at high risk of recurrence. Patients and methods: Patients with resected AJCC stage IIB, IIC and III cutaneous melanoma were randomised to receive either adjuvant bevacizumab (7.5 mg/kg i.v. 3 weekly for 1 year) or standard observation. The primary end point was detection of an 8% difference in 5-year overall survival (OS) rate; secondary end points included disease-free interval (DFI) and distant metastasis-free interval (DMFI). Tumour and blood were analysed for prognostic and predictive markers. Results: Patients (n=1343) recruited between 2007 and 2012 were predominantly stage III (73%), with median age 56 years (range 18-88 years). With 6.4-year median follow-up, 515 (38%) patients had died [254 (38%) bevacizumab; 261 (39%) observation]; 707 (53%) patients had disease recurrence [336 (50%) bevacizumab, 371 (55%) observation]. OS at 5 years was 64% for both groups [hazard ratio (HR) 0.98; 95% confidence interval (CI) 0.82-1.16, P = 0.78). At 5 years, 51% were disease free on bevacizumab versus 45% on observation (HR 0.85; 95% CI 0.74-0.99, P = 0.03), 58% were distant metastasis free on bevacizumab versus 54% on observation (HR 0.91; 95% CI 0.78-1.07, P = 0.25). Forty four percent of 682 melanomas assessed had a BRAFV600 mutation. In the observation arm, BRAF mutant patients had a trend towards poorer OS compared with BRAF wild-type patients (P = 0.06). BRAF mutation positivity trended towards better OS with bevacizumab (P = 0.21). Conclusions: Adjuvant bevacizumab after resection of high-risk melanoma improves DFI, but not OS. BRAF mutation status may predict for poorer OS untreated and potential benefit from bevacizumab. Clinical Trial Information: ISRCTN 81261306; EudraCT Number: 2006-005505-64.

A 10-year longitudinal follow-up study of a U.K. paediatric transplant population to assess for skin cancer.

BACKGROUND: Our earlier study, published in 2004,found no skin cancer in a cohort of paediatric organ transplant recipients (POTRs) 5-16 years post-transplantation. We re-evaluated the same cohort 10 years later. OBJECTIVES: To determine the prevalence of premalignant and malignant skin lesions and identify known risk factors associated with melanocytic naevi in a U.K. paediatric transplant population. METHODS: Ninety-eight POTRs from the original 2004 study were invited to participate in this longitudinal follow-up study. History of sun exposure, demographics and transplantation details were collected using face-to-face interviews, questionnaires and case note reviews. Skin examination was performed for regional count of malignant lesions, benign and atypical naevi. RESULTS: Of the 98 patients involved in the initial study, 45 POTRs (eight kidney, 37 liver), with a median follow-up of 19 years (range 15-26 years), agreed to participate. Neither skin cancer nor premalignant lesions were detected in these patients. When compared with the 2004 cohort, 41 patients in our current cohort had increased numbers of benign naevi (P < 0·001) with 11 patients having ≥ 50 benign naevi. Seventy-one per cent of benign naevi in our 2014 cohort occurred on sun-exposed sites (13% head/neck, 35% arms and 23% legs). Patients who regularly used sunscreen had more benign naevi on their arms (P = 0·008). CONCLUSIONS: Although skin cancer was not observed in our cohort, we identified a significant increase in the number of benign naevi, particularly in those reporting frequent sunburn and sunscreen use.

Generating new evidence, improving clinical practice and developing research capacity: the benefits of recruiting to the U.K. Dermatology Clinical Trials Network's STOP GAP and BLISTER trials.

Clinical trials may benefit clinical practice in three ways: firstly, clinicians may change their practice according to the new trial evidence; secondly, clinical processes can improve when working on a trial; and thirdly, research capacity is increased. We held a meeting to present and discuss the results of two large multicentre randomized controlled trials delivered through the U.K. Dermatology Clinical Trials Network. Investigators gave reflections on how the trials had changed their clinical practice. The STOP GAP trial showed that prednisolone and ciclosporin are equally effective as first-line systemic treatment for pyoderma gangrenosum. The final decision of which treatment to use should be based on the different adverse event profiles of the two drugs in relation to comorbidities, along with age, disease severity and patient preference. The BLISTER trial showed that starting people with pemphigoid on doxycycline produces acceptable short-term effectiveness and a superior safety profile to oral corticosteroids. Recruiting to these trials has led to the development of new specialist clinics with improved documentation. It has increased the profile of participating departments and embedded research in the department's activities. Helping to design and run these trials has also allowed trial staff to develop new skills in research design, which has been beneficial for career development. These and other benefits of recruiting to the trials are summarized here. We hope that these reflections will inspire wider involvement in clinical research.

Current Status and Future Prospects to Achieve Foot-and-Mouth Disease Eradication in South America.

South America has a favourable position with respect to foot-and-mouth disease (FMD) compared with other FMD-affected regions due to the elimination of endemic clinical presentation of the disease. South America has reached the final stage of control and aims to eradicate the disease in the region under the provisions of the Hemispheric Program for the Eradication of FMD 2011-2020 (PHEFA). This programme aims at bringing eradication to completion, thereby eliminating the pool of foot-and-mouth disease genotypes active in South America. This plan includes a regional political agreement that provides strategies and technical guidelines for the eradication of foot-and-mouth disease from South America. It incorporates knowledge and experience regarding the disease's history and its connection with the different production systems, animal movement and trade. The Pan American Foot and Mouth Disease Center has led the control and eradication programmes, providing the framework for designing national and subregional programmes that have led to significant progress in controlling the disease in South America. The current situation is the result of several factors, including the proper implementation of a national control programmes, good veterinary infrastructure in most countries and public-private participation in the process of eradicating the disease. Notwithstanding the favourable health status, there are significant challenges for the goal of eradication. At this stage, South American countries should enhance their surveillance strategies particularly through the use of target or risk-based surveys that contribute to increase the degree of sensitivity in the search for viral circulation in the context of absence of clinical occurrence of FMD.

Google Scholar e índice h en biomedicina: la popularización de la evaluación bibliométrica / Google Scholar and the h-index in biomedicine: The popularization of bibliometric assessment

El objetivo de este artículo es hacer una revisión de las características, prestaciones y limitaciones de los nuevos productos de evaluación científica derivados de Google Scholar, como son Google Scholar Metrics y Google Scholar Citations, y del índice h, el indicador bibliométrico adoptado como estándar por estos servicios. Asimismo se reseña la potencialidad de esta nueva base de datos como fuente para estudios en biomedicina y se realiza una comparación del índice h obtenido por las revistas e investigadores más relevantes en el ámbito de la medicina intensiva, a partir de los datos extraídos de Web of Science, Scopus y Google Scholar. Los resultados muestran que, pese a que los valores medios de índice h en Google Scholar son casi un 30% más elevados que los obtenidos en Web of Science y en torno a un 15% más altos que los recogidos por Scopus, no hay variaciones sustantivas en las clasificaciones generadas a partir de una u otra fuente de datos. Aunque existen algunos problemas técnicos, se concluye que Google Scholar es una herramienta válida para los investigadores en ciencias de la salud, tanto a efectos de recuperación de información como de cara a la extracción de indicadores bibliométricos (AU)

The aim of this study is to review the features, benefits and limitations of the new scientific evaluation products derived from Google Scholar, such as Google Scholar Metrics and Google Scholar Citations, as well as the h-index, which is the standard bibliometric indicator adopted by these services. The study also outlines the potential of this new database as a source for studies in Biomedicine, and compares the h-index obtained by the most relevant journals and researchers in the field of intensive care medicine, based on data extracted from the Web of Science, Scopus and Google Scholar. Results show that although the average h-index values in Google Scholar are almost 30% higher than those obtained in Web of Science, and about 15% higher than those collected by Scopus, there are no substantial changes in the rankings generated from one data source or the other. Despite some technical problems, it is concluded that Google Scholar is a valid tool for researchers in Health Sciences, both for purposes of information retrieval and for the computation of bibliometric indicators (AU)

[Google Scholar and the h-index in biomedicine: the popularization of bibliometric assessment]. / Google Scholar e índice h en biomedicina: la popularización de la evaluación bibliométrica.

The aim of this study is to review the features, benefits and limitations of the new scientific evaluation products derived from Google Scholar, such as Google Scholar Metrics and Google Scholar Citations, as well as the h-index, which is the standard bibliometric indicator adopted by these services. The study also outlines the potential of this new database as a source for studies in Biomedicine, and compares the h-index obtained by the most relevant journals and researchers in the field of intensive care medicine, based on data extracted from the Web of Science, Scopus and Google Scholar. Results show that although the average h-index values in Google Scholar are almost 30% higher than those obtained in Web of Science, and about 15% higher than those collected by Scopus, there are no substantial changes in the rankings generated from one data source or the other. Despite some technical problems, it is concluded that Google Scholar is a valid tool for researchers in Health Sciences, both for purposes of information retrieval and for the computation of bibliometric indicators.

Identifying areas of high risk of human exposure to coccidioidomycosis in Texas using serology data from dogs.

Coccidioidomycosis or Valley Fever (VF) is an emerging soil-borne fungal zoonosis affecting humans and animals. Most non-human cases of VF are found in dogs, which we hypothesize may serve as sentinels for estimating the human exposure risk. The objective of this study is to use the spatial and temporal distribution and clusters of dogs seropositive for VF to define the geographic area in Texas where VF is endemic, and thus presents a higher risk of exposure to humans. The included specimens were seropositive dogs tested at a major diagnostic laboratory between 1999 and 2009. Data were aggregated by zip code and smoothed by empirical Bayesian estimation to develop an isopleth map of VF seropositive rates using kriging. Clusters of seropositive dogs were identified using the spatial scan test. Both the isopleth map and the scan test identified an area with a high rate of VF-seropositive dogs in the western and southwestern parts of Texas (relative risk = 31). This location overlapped an area that was previously identified as a potential endemic region based on human surveys. Together, these data suggest that dogs may serve as sentinels for estimating the risk of human exposure to VF.

Identification and analysis of the first 2009 pandemic H1N1 influenza virus from U.S. feral swine.

The first case of pandemic H1N1 influenza (pH1N1) virus in feral swine in the United States was identified in Texas through the United States Department of Agriculture (USDA) Wildlife Services' surveillance program. Two samples were identified as pandemic influenza by reverse transcriptase quantitative PCR (RT-qPCR). Full-genome Sanger sequencing of all eight influenza segments was performed. In addition, Illumina deep sequencing of the original diagnostic samples and their respective virus isolation cultures were performed to assess the feasibility of using an unbiased whole-genome linear target amplification method and multiple sample sequencing in a single Illumina GAIIx lane. Identical sequences were obtained using both techniques. Phylogenetic analysis indicated that all gene segments belonged to the pH1N1 (2009) lineage. In conclusion, we have identified the first pH1N1 isolate in feral swine in the United States and have demonstrated the use of an easy unbiased linear amplification method for deep sequencing of multiple samples.

Experimental foot-and-mouth disease virus infection in white tailed deer.

White tailed deer (Odocoileus virginianus) were inoculated with foot-and-mouth disease virus (FMDV) O UKG 11/2001 and monitored for the development of clinical signs, histopathological changes and levels of virus replication. All FMDV-infected deer developed clinical signs starting at 2 days post inoculation and characterized by an increase in body temperature, increased salivation and lesions in the mouth and on the feet. Virus spread to various tissues was determined by quantifying the amount of FMDV RNA using quantitative reverse transcriptase polymerase chain reaction. Virus or viral antigen was also detected in tissues using traditional isolation techniques, enzyme linked immunosorbent assay and immunohistochemistry. Deer-to-cattle transmission of the virus was observed in this experimental setting; however, inoculated deer were not found to become carriers of FMDV.

Decline of dermatological publications in the UK: truth or myth?

BACKGROUND: For some time, there has been a suspicion that the number of articles published by UK-based authors in dermatology has declined. This probably reflects a reduction in the publication output of dermatology departments generally. METHODS: We identified articles with British authorship in the British Journal of Dermatology between 1970 and the present date, and compared the journal with the three most commonly cited dermatological journals: Archives of Dermatology, Journal of Investigative Dermatology and Journal of the American Academy of Dermatology. Later, we expanded this search to include a further 33 dermatological journals. RESULTS: Despite an increase in the total number of published papers by the British Journal of Dermatology, there was a decline in the number of British-authored papers, from 97 (57%) in 1970 to 80 (22%) in 2005. The trend was also seen in the Journal of the American Academy of Dermatology, with 16 papers (5%) in 1989 and 7 (2%) in 2005. In Journal of Investigative Dermatology, British papers increased from 10 papers in 1975 to 17 in 2005, with a percentage decrease from 7% to 4%. Overall, despite an increase in the total number of publications in dermatological journals from 2745 in 1985-5034 in 2005, British publications increased from 271 in 1989 to only 289 in 2005, which represents a percentage decrease from 10% to 6%. CONCLUSIONS: Despite a three-fold increase in dermatology consultants and registrars in UK, a three-fold increase in dermatological journals and a four-fold increase in dermatological papers published, the overall number of British papers has remained static over the years.

Degradation of foot-and-mouth disease virus during composting of infected pig carcasses.

The objective of this study was to investigate the inactivation and degradation of foot-and-mouth disease (FMD) virus during composting of infected pig carcasses as measured by virus isolation in tissue culture and by real-time reverse transcriptase polymerase chain reaction (RRT-PCR). Three FMD-infected pig carcasses were composted in a mixture of chicken manure and wood shavings in a biocontainment level 3 facility. Compost temperatures had reached 50 degrees C and 70 degrees C by days 10 and 19, respectively. Under these conditions, FMD virus was inactivated in specimens in compost by day 10 and the viral RNA was degraded in skin and internal organ tissues by day 21. In comparison, at ambient temperatures close to 20 degrees C, FMD virus survived to day 10 in the skin tissue specimen from the pig that had the highest initial level of viral RNA in its tissues and the viral RNA persisted to day 21. Similarly, beta-actin mRNA, tested as a PCR control, persisted to day 21 in specimens held at ambient temperatures, but it was degraded in the remnants of tissues recovered from compost on day 21. Results from this study provide evidence that composting could be used for safe disposal of pig carcasses infected with FMD virus.

Volatile and sensory profile of organic red wines produced by different selected autochthonous and commercial Saccharomyces cerevisiae strains.

Organic wines were produced at pilot scale to select the best autochthonous and commercial yeast strains to obtain wines with high organoleptic qualities. We tested the behaviour of five S. cerevisiae yeast strains and determined their volatile composition and organoleptic characteristics by sensory analysis. A total of 51 volatile compounds were quantified in the wines produced. The concentration of most of the volatile compounds was significantly influenced depending on which yeast strain was inoculated. The differences observed in the volatile composition of the wines appear to be quantitative rather than qualitative. In general, acetals were the most abundant group of volatile compounds in all the samples studied, followed by alcohols without ethanol. The highest contents of volatile compounds were found in two of the wines produced by autochthonous yeast strains. The results obtained in the sensory analysis suggest that autochthonous yeast produced wines of higher organoleptic quality because this sample gave the highest value for the general impression attribute.

Expression and purification of an anti-Foot-and-mouth disease virus single chain variable antibody fragment in tobacco plants.

Low-cost recombinant antibodies could provide a new strategy to control Foot-and-mouth disease virus (FMDV) outbreaks by passive immunization of susceptible animals. In this study, a single chain variable antibody fragment (scFv) recognizing FMDV coat protein VP1 was expressed in transgenic tobacco plants. To enhance the accumulation of scFv protein, the codon-usage of a murine hybridoma-derived scFv gene was adjusted to mimic highly expressed tobacco genes and fused to an elastin-like polypeptide (ELP) tag. This scFv-ELP fusion accumulated up to 0.8% of total soluble leaf protein in transgenic tobacco. To recover scFv-ELP protein from the leaf extract, a simple and scalable purification strategy was established. Purified scFv-ELP fusion was cleaved to separate the scFv portion. Finally, it was shown that the purified scFv proteins retained their capacity to bind the FMDV in the absence or presence of ELP fusion.

Treatment of disseminated superficial actinic porokeratosis with topical diclofenac gel: a case series.

Disseminated superficial actinic porokeratosis (DSAP) is the most common of the of five clinical variants of porokeratosis. These are disorders of keratinization and the distinctive pathological feature is the cornoid lamella at the margin. DSAP usually manifests in the third or fourth decades of life with a female preponderance and with multiple lesions over sun-exposed areas. A diverse range of treatments is employed though evidence of efficacy remains largely anecdotal. We report a series of eight patients with DSAP treated with 3% diclofenac gel (Solaraze gel).

Malnutrition and a rash: think zinc.

Endemic zinc deficiency is recognised to be a common and serious problem in developing countries. However, it may be seen in routine practice in the UK, and can be easily overlooked. Malnutrition from any cause in conjunction with an undiagnosed cutaneous problem should alert the clinician to the diagnosis. Investigations may be unreliable, and if in doubt, a therapeutic trial of zinc supplementation is indicated. We present three cases of malnourished patients, in whom zinc deficiency was diagnosed after the development of cutaneous features. The malnutrition resulted from alcoholism in two cases and anorexia nervosa in the third. The heterogeneity of underlying causes of zinc deficiency is discussed, along with its effects, treatment and zinc homeostasis.

Implementación de un protocolo para la identificación de vibrio parahaemolyticus a través de PCR / Implementation of a protocol for the identification of vibrio parahaemolyticus by PCR

Vibrio parahaemolyticus es una de las principales bacterias Gram-negativas causantes de toxiinfecciones alimentarias y gastroenteritis aguda en humanos. En peces causa septicemia hemorrágica y ulceraciones de la piel, conviertiéndose en una de las principales causas de pérdidas en las explotaciones piscícolas. El presente trabajo documenta el establecimeinto de un protocolo de identificación de Vibrio parahaemolyticus por la técnica de acción en cadena de la polimerasa (PCR). Se realizaron caracaterizaciones genómicas de 24 aislados de Vibrio sp. obtenidos del cepario del laboratorio de Bacteriología de Sanidad Animal CENIAP-INIA en Maracay, estado Aragua, Venezuela. En la identificación genética los aislados fueron caracterizaciones mediante la PCR, siguiendo la metodología descrita por Lee y col. (1) con modificaciones en la extracción del ADN, que se realizó con DNAzol. Los iniciadores utilizados para tal fin fueron: 5`-GCGAATTCGATAGGGTGTTAACC-3` y 5`-CGAATCCTTGAACATACGCAGC-3`. De los 24 aislados analizados por PCR se obtuvieron 7 amplificados, que se identificaron como V. parahaemolyticus