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1.
J Eur Acad Dermatol Venereol ; 35(5): 1087-1093, 2021 May.
Article in English | MEDLINE | ID: mdl-33300200

ABSTRACT

BACKGROUND: Dynamic optical coherence tomography (D-OCT) allows in vivo visualization of blood vessels in the skin and in malignant tumours. Vessel patterns in malignant melanoma may be associated with tumour stage. OBJECTIVE: The aim of this study was to describe blood vessel patterns in melanomas and to correlate them with stage. METHODS: One hundred fifty-nine malignant melanomas were assessed in a multicentre study. Every tumour was imaged using D-OCT prior to surgery and histologic evaluation. The tumour data such as thickness and ulceration as well as the staging at primary diagnosis and a follow-up of at least 40 months resulted in a stage classification. The vessel patterns were assessed according to predefined categories, compared with healthy adjacent skin, and correlated to stage. RESULTS: Melanomas contained more blood vessels in different patterns compared with healthy adjacent skin. In particular, irregular vascular shapes such as blobs, coils, curves and serpiginous vessels were more common in melanomas. In addition, these patterns were significantly more often found in high-risk and metastatic melanomas than in low-risk lesions. CONCLUSION: In melanomas, the density of the blood vessels is increased, and irregular vascular patterns are more frequent. At higher stages, especially in metastatic melanomas, these atypical vessels are significantly more common.


Subject(s)
Melanoma , Skin Neoplasms , Humans , Melanoma/diagnostic imaging , Skin , Skin Neoplasms/diagnostic imaging , Tomography, Optical Coherence
3.
J Hosp Infect ; 100(3): e138-e141, 2018 Nov.
Article in English | MEDLINE | ID: mdl-30081145

ABSTRACT

Adolfo Lutz Institute in Sao Paolo State performs mycobacterial identification for many healthcare units, and in 2008 identified a possible outbreak involving patients submitted to bronchoscopy at the same hospital. This study aimed to analyse the clonality of isolates. Mycobacterium abscessus subsp. massiliense isolated from 28 patients, water from one bronchoscope and water from four automated endoscope reprocessing machines presented high similarity by pulsed-field gel electrophoresis. This strain was not found in the water supply, and it was hypothesized that an infected patient contaminated the bronchoscope, with further false-positive cultures from subsequent patients.


Subject(s)
Bronchoscopes/microbiology , Bronchoscopy/adverse effects , Disease Outbreaks , Mycobacterium Infections, Nontuberculous/epidemiology , Mycobacterium abscessus/isolation & purification , Brazil/epidemiology , Electrophoresis, Gel, Pulsed-Field , Genotype , Hospitals , Humans , Molecular Epidemiology , Molecular Typing , Mycobacterium abscessus/classification , Mycobacterium abscessus/genetics , Water Microbiology
4.
J Eur Acad Dermatol Venereol ; 32(10): 1687-1694, 2018 Oct.
Article in English | MEDLINE | ID: mdl-29704275

ABSTRACT

BACKGROUND: Lentigo maligna may be challenging to clear surgically. OBJECTIVE: To evaluate feasibility of using superficial skin cuts as RCM imaging anchors for attaining negative surgical margins in lentigo maligna. METHODS: Included patients presented with lentigo maligna near cosmetically sensitive facial structures. We evaluated, with hand-held-RCM, microscopic clearance of melanoma beyond its dermoscopically detected edges. Evaluated margins were annotated using shallow skin cuts. If a margin was positive at 'first-step' RCM evaluation, we sequentially advanced the margin radially outward at that segment by 2-mm intervals until an RCM-negative margin was identified. Prior to final surgical excision, we placed sutures at the outmost skin cuts to allow comparison of RCM and histopathological margin assessments. Primary outcome measure was histopathological verification that RCM-negative margins were clear of melanoma. RESULTS: The study included 126 first-step margin evaluations in 23 patients, median age 70 years (range: 43-91). Seventeen patients (74%) had primary in-situ melanoma and six (26%) invasive melanoma, mean thickness 0.3 mm (range 0.2-0.4 mm). Six cases (26%) showed complete negative RCM margins on 'first-step', 11 (48%) were negative at 'second-step', and four (17%) at 'third-step'. In two additional cases (9%), margins clearance could not be determined via RCM due to widespread dendritic cells proliferation. The RCM-negative margins in all 21 cases proved clear of melanoma on histopathology. Of the 15 cases that returned at 1-year follow-up, none showed any residual melanoma on dermoscopic and RCM examinations. Interobserver reproducibility showed fair agreement between bedside RCM reader and blinded remote-site reader, with Spearman's rho of 0.48 and Cohen's kappa of 0.43; using bedside reader as reference, the remote reader's sensitivity was 92% and specificity 57% in positive margin detection. CONCLUSIONS: Margin mapping of lentigo maligna with hand-held-RCM, using superficial skin cuts, appears feasible. This approach needs validation by larger studies.


Subject(s)
Dermatologic Surgical Procedures/methods , Hutchinson's Melanotic Freckle/diagnostic imaging , Hutchinson's Melanotic Freckle/surgery , Skin Neoplasms/diagnostic imaging , Skin Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Feasibility Studies , Female , Humans , Hutchinson's Melanotic Freckle/pathology , Male , Margins of Excision , Microscopy, Confocal/instrumentation , Middle Aged , Neoplasm, Residual , Observer Variation , Reproducibility of Results , Sensitivity and Specificity , Skin Neoplasms/pathology
5.
Skin Res Technol ; 24(2): 285-293, 2018 May.
Article in English | MEDLINE | ID: mdl-29363175

ABSTRACT

BACKGROUND: Seborrheic keratoses (SebK) with atypical dermoscopy presentation are increasingly reported. These lesions do not exhibit typical dermoscopy features of SebK and sometimes mimic melanoma, thus complicating the differential diagnosis. Reflectance confocal microscopy (RCM) is a non-invasive tool, which allows an in vivo imaging of the skin. The study objectives were to evaluate the agreement between RCM classification and histological diagnoses, and the reliability of well-known RCM criteria for SebK in the identification of SebK with atypical dermoscopy presentation. MATERIALS AND METHODS: We retrospectively analysed at RCM excised lesions presenting in dermoscopy ≥1 score at revisited 7-point checklist. The study population consisted of cases showing no melanocytic RCM findings. Lesions were investigated for distinct non-melanocytic RCM features, blinded from histopathology diagnoses. Histopathology matching was then performed before statistical analysis. RESULTS: The study consisted of 117 cases, classified at RCM as SebK (71 cases), dermatofibroma (18 cases), basal cell carcinoma (13 cases), squamous cell carcinoma (2 cases), and "non-specific" (13 cases). Overall K strength of agreement at histopathology matching proved 0.76. Of the 71 cases classified at RCM with SebK, agreement was achieved in 97%. CONCLUSION: Reflectance confocal microscopy classification proved high agreement with histopathology for SebK with atypical dermoscopy presentations, allowing an early differential diagnosis. RCM features in this group of lesions were similar to those described for typical cases of SebK, and may assist clinician therapy decision making, whilst avoiding unnecessary excisions.


Subject(s)
Keratosis, Seborrheic/diagnostic imaging , Melanoma/diagnostic imaging , Skin Neoplasms/diagnostic imaging , Carcinoma, Basal Cell/diagnostic imaging , Carcinoma, Squamous Cell/diagnostic imaging , Dermoscopy , Diagnosis, Differential , Histiocytoma, Benign Fibrous/diagnostic imaging , Humans , Microscopy, Confocal , Retrospective Studies
6.
J Eur Acad Dermatol Venereol ; 32(1): 152-155, 2018 Jan.
Article in English | MEDLINE | ID: mdl-28776772

ABSTRACT

BACKGROUND: Dynamic optical coherence tomography (D-OCT) has recently been introduced in dermatology. In contrast to 'Standard' OCT imaging, which exclusively relies on the morphological analysis of the tissue, D-OCT allows the in vivo visualization of blood flow. Preliminary D-OCT data showed differences in the vascularization of nevus to melanoma transition, suggesting that this technology may help to differentiate between benign and malignant lesions. OBJECTIVE: Several factors may influence the quality of D-OCT imaging. Therefore, standard operating procedures as well as a common terminology are required for better validation and comparison of the images. METHODS: Here, we present practical guidelines for optimal image acquisition and a proposed terminology on vascular patterns observed by D-OCT. RESULTS: Dynamic OCT allows the morphologic distinction of different vascular shapes (e.g. dots, blobs, curves, lines), their distribution and organization within skin lesions. CONCLUSION: D-OCT adds functional information on skin microvasculature and the vascular networks within lesions.


Subject(s)
Blood Vessels/diagnostic imaging , Practice Guidelines as Topic , Skin/blood supply , Skin/diagnostic imaging , Terminology as Topic , Tomography, Optical Coherence/methods , Humans
7.
Skin Res Technol ; 24(1): 145-151, 2018 Feb.
Article in English | MEDLINE | ID: mdl-29057513

ABSTRACT

BACKGROUND/PURPOSE: Mohs Micrographic Surgery (MMS) is the preferred therapeutic treatment for high-risk basal cell carcinoma (BCC). Optical Coherence Tomography (OCT) is a non-invasive imaging technique that enables the diagnosis of BCC. We thought to determine the margins of BCCs with OCT, prior to MMS, to reduce the number of surgical steps. METHODS: Different permanent markers were tested on the skin regarding line width, resistance against disinfection and brightness in the OCT image. The visible tumor margins of BCCs were defined by dermoscopy, adding a safety margin of 2 mm and labeled using the selected pen, causing a signal shadow in OCT. Scans of the center and of entire margin were performed. If parts of the BCC were visible outside the margin, another 2 mm were added and the scan was repeated until the tissue outside the labeling looked tumor free. RESULTS: Eight out of ten BCCs were totally excised in a single stage when margin delineation was done by OCT. Macroscopic margins were enlarged after OCT scanning in four patients, saving further stages of MMS. CONCLUSION: OCT may help to better define the microscopic dimensions of BCCs and therefore reduce the number of stages of MMS.


Subject(s)
Carcinoma, Basal Cell/diagnostic imaging , Mohs Surgery/methods , Skin Neoplasms/diagnostic imaging , Tomography, Optical Coherence/methods , Aged , Aged, 80 and over , Carcinoma, Basal Cell/pathology , Carcinoma, Basal Cell/surgery , Dermoscopy/methods , Humans , Margins of Excision , Middle Aged , Pilot Projects , Preoperative Care/methods , Skin Neoplasms/pathology , Skin Neoplasms/surgery
8.
J Eur Acad Dermatol Venereol ; 32(6): 947-955, 2018 Jun.
Article in English | MEDLINE | ID: mdl-29115737

ABSTRACT

BACKGROUND: Pigment network is an important dermoscopic feature for melanocytic lesions, but alterations in grid line thickness are also observed in melanomas. OBJECTIVE: To investigate features of thick, thin and mixed pigment networks at dermoscopy and their respective features at reflectance confocal microscopy (RCM) for differential diagnosis, correlated with histology. METHODS: All melanocytic lesions with histological diagnosis, evaluated between January 2010 and May 2014, were enrolled and classified according to dermoscopy evaluation of the pigment networks: thin, thick and mixed. RESULTS: Thin network in melanoma was characterized by a honeycombed pattern (P < 0.001), dendritic cells (P < 0.001), atypical ringed pattern (P = 0.035) and structureless area (P = 0.012), whereas round cells (P < 0.001), dendritic cells (P < 0.001) and atypical meshwork pattern (<0.001) characterized thick network in melanoma. Mixed network type in melanoma shared honeycombed (P = 0.049) and typical ringed patterns (P = 0.045) in the thin area and round cells (P < 0.001) and atypical meshwork pattern (P < 0.001) in the thick area. Thin network in nevi was characterized by cobblestone (P < 0.001) and typical ringed patterns (P = 0.035), whereas thick network in nevi showed a typical meshwork pattern (P < 0.001). Mixed nevi shared the same features and patterns, but more frequently with inflammatory infiltrate (P = 0.047). CONCLUSION: Differential diagnosis between melanocytic lesions (nevi or melanoma) in thin, thick and mixed pigment networks observed at dermoscopy can be assisted by RCM to improve diagnostic accuracy.


Subject(s)
Dermoscopy/methods , Melanoma/diagnosis , Microscopy, Confocal/methods , Pigments, Biological/metabolism , Skin Neoplasms/diagnosis , Diagnosis, Differential , Humans , Melanoma/metabolism , Melanoma/pathology , Nevus/diagnosis , Retrospective Studies , Skin Neoplasms/metabolism , Skin Neoplasms/pathology
9.
PLoS One ; 12(11): e0187748, 2017.
Article in English | MEDLINE | ID: mdl-29121636

ABSTRACT

BACKGROUND: Reflectance confocal microscopy (RCM) is an imaging device that permits non-invasive visualization of cellular morphology and has been shown to improve diagnostic accuracy of dermoscopically equivocal cutaneous lesions. The application of double reader concordance evaluation of dermoscopy-RCM image sets in retrospective settings and its potential application to telemedicine evaluation has not been tested in a large study population. OBJECTIVE: To improve diagnostic sensitivity of RCM image diagnosis using a double reader concordance evaluation approach; to reduce mismanagement of equivocal cutaneous lesions in retrospective consultation and telemedicine settings. METHODS: 1000 combined dermoscopy-RCM image sets were evaluated in blind by 10 readers with advanced training and internship in dermoscopy and RCM evaluation. We compared sensitivity and specificity of single reader evaluation versus double reader concordance evaluation as well as the effect of diagnostic confidence on lesion management in a retrospective setting. RESULTS: Single reader evaluation resulted in an overall sensitivity of 95.2% and specificity of 76.3%, with misdiagnosis of 8 melanomas, 4 basal cell carcinomas and 2 squamous cell carcinomas. Combined double reader evaluation resulted in an overall sensitivity of 98.3% and specificity of 65.5%, with misdiagnosis of 1 in-situ melanoma and 2 basal cell carcinomas. CONCLUSION: Evaluation of dermoscopy-RCM image sets of cutaneous lesions by single reader evaluation in retrospective settings is limited by sensitivity levels that may result in potential mismanagement of malignant lesions. Double reader blind concordance evaluation may improve the sensitivity of diagnosis and management safety. The use of a second check can be implemented in telemedicine settings where expert consultation and second opinions may be required.


Subject(s)
Dermoscopy , Image Interpretation, Computer-Assisted , Microscopy, Confocal , Skin Neoplasms/diagnosis , Telemedicine , Humans , Retrospective Studies , Sensitivity and Specificity , Skin Neoplasms/diagnostic imaging
10.
Dermatol Ther ; 30(5)2017 Sep.
Article in English | MEDLINE | ID: mdl-28677237

ABSTRACT

Atopic dermatitis (AD) is a result of complex genetic, epigenetic, environmental, and immunological interactions with an overlapping epidermal barrier defect. The study evaluates the efficacy and tolerability of topical Vitamin B12-barrier cream (MB12) compared with standard glycerol-petrolatum-based emollient cream (GPC) used three times a day for mild AD. The study was conducted as a on one hemi-body randomized, controlled, single-blind, intra-patient left-to-right comparative trial by patients with clinical diagnosis of mild AD measured with total SCORAD index over 4 months. MB12 was compared on one hemi-body treated (GPC). The comparisons of score values were performed primarily by using non-parametric procedures: Mann-Whitney-U test (for independent samples) and Wilcoxon test (for dependent samples). All 22 patients were randomized (left or right side treated with MB12 or GPC). At week 12 a reduction from baseline in SCORAD index was assessed in both body sites with 77.6% SCORAD index reduction in the MB12 treated body sites versus 33.5% in the GPC treated body sites. These results suggest that MB12 could represent a new option in the treatment of mild AD.


Subject(s)
Dermatitis, Atopic/drug therapy , Dermatologic Agents/administration & dosage , Emollients/administration & dosage , Vitamin B 12/administration & dosage , Administration, Cutaneous , Dermatitis, Atopic/pathology , Dermatologic Agents/adverse effects , Emollients/adverse effects , Female , Glycerol/administration & dosage , Glycerol/adverse effects , Humans , Male , Petrolatum/administration & dosage , Petrolatum/adverse effects , Severity of Illness Index , Single-Blind Method , Statistics, Nonparametric , Time Factors , Treatment Outcome , Vitamin B 12/adverse effects
11.
J Eur Acad Dermatol Venereol ; 31(9): 1541-1546, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28556980

ABSTRACT

BACKGROUND: Acne vulgaris is a disease of the pilosebaceous unit, characterized by hyper-keratinization process, comedos formation and inflammatory reactions. OBJECTIVE: The definition of the morphology and the vascularization of acne lesions by means of dynamic optical coherence tomography (D-OCT), to non-invasively define the alterations occurring during the acne development and patient therapeutic management. METHODS: A set of standardized clinical pictures and D-OCT images were acquired from 114 acne lesions of 31 volunteers, presenting mild to moderate acne and evaluated by experts. Fifteen patients treated with oral antibiotics were followed during time at 0, 20, 40, and 60 days. RESULTS: Optical coherence tomography enabled to identify vascular and morphological aspects characterizing different types of acne lesions. Oral antibiotic treatment improved the morphologic features and decreased the digitally reconstructed vascular signal during time. CONCLUSION: The characterization of acne lesions and the identification of vascular pattern in acne lesions through D-OCT, corresponding to blood vessel dilation and inflammatory associated hyper-vascularization, may have important clinical consequences in the assessment of acne severity, therapeutic decisions and treatment efficacy monitoring.


Subject(s)
Acne Vulgaris/diagnostic imaging , Tomography, Optical Coherence/methods , Acne Vulgaris/drug therapy , Acne Vulgaris/pathology , Acne Vulgaris/therapy , Administration, Oral , Adolescent , Adult , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Child , Female , Humans , Male , Young Adult
12.
J Biotechnol ; 257: 87-98, 2017 Sep 10.
Article in English | MEDLINE | ID: mdl-28363874

ABSTRACT

Effects of butyrate on CHO producer cells are contradictory, promoting productivity and at the same time repressing proliferation. Though in previous omics studies the background of butyrate impact on producer cells has been investigated, the knowledge about the mechanism is still very limited. As previous proteomic results on this field are mainly based on 2DE-gels, we conducted a label-free MS quantification, based on fast high resolution ESI-MS and a straight forward software solution, to gain insight in shifted cellular processes of CHO cells 25h after butyrate treatment. 118 proteins or subunits with significantly altered abundances were identified suggesting changes in carbohydrate, protein metabolic and cell cycle processes. Effects of butyrate on the nucleosome assembly as a known direct epigenetic influence on HDAC activity turned out to be unexpectedly fast and persistent, as confirmed by Western blots of histone-H4 acetylation. Contradictory to increased cell specific productivity, most elements of protein metabolism exhibited decreased levels after butyrate treatment. In comparison to published results some overlap of our label free MS data could be observed but also apparently diverging findings, showing the need for complementary omics techniques for a holistic view on cellular processes such as response to butyrate.


Subject(s)
Butyric Acid/pharmacology , CHO Cells/drug effects , CHO Cells/metabolism , Animals , Apoptosis/drug effects , Butyrates/pharmacology , Carbohydrate Metabolism/drug effects , Cell Cycle/drug effects , Cell Division/drug effects , Cell Survival , Cricetulus , Histone Code/drug effects , Histones/metabolism , Mass Spectrometry/methods , Metabolic Networks and Pathways/drug effects , Nucleosomes/drug effects , Proteins/metabolism , Proteomics/methods
13.
Photodiagnosis Photodyn Ther ; 16: 44-49, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27519350

ABSTRACT

BACKGROUND: Early diagnosis of non-melanoma skin cancer (NMSC) is potentially possible using optical coherence tomography (OCT) which provides non-invasive, real-time images of skin with micrometre resolution and an imaging depth of up to 2mm. OCT technology for skin imaging has undergone significant developments, improving image quality substantially. The diagnostic accuracy of any method is influenced by continuous technological development making it necessary to regularly re-evaluate methods. OBJECTIVE: The objective of this study is to estimate the diagnostic accuracy of OCT in basal cell carcinomas (BCC) and actinic keratosis (AK) as well as differentiating these lesions from normal skin. METHODS: A study set consisting of 142 OCT images meeting selection criterea for image quality and diagnosis of AK, BCC and normal skin was presented uniformly to two groups of blinded observers: 5 dermatologists experienced in OCT-image interpretation and 5 dermatologists with no experience in OCT. During the presentation of the study set the observers filled out a standardized questionnaire regarding the OCT diagnosis. Images were captured using a commercially available OCT machine (Vivosight ®, Michelson Diagnostics, UK). RESULTS: Skilled OCT observers were able to diagnose BCC lesions with a sensitivity of 86% to 95% and a specificity of 81% to 98%. Skilled observers with at least one year of OCT-experience showed an overall higher diagnostic accuracy compared to inexperienced observers. CONCLUSIONS: The study shows an improved diagnostic accuracy of OCT in differentiating AK and BCC from healthy skin using state-of-the-art technology compared to earlier OCT technology, especially concerning BCC diagnosis.


Subject(s)
Carcinoma, Basal Cell/diagnostic imaging , Keratosis, Actinic/diagnostic imaging , Skin Neoplasms/diagnostic imaging , Tomography, Optical Coherence/methods , Aged , Carcinoma, Basal Cell/pathology , Female , Humans , Keratosis, Actinic/pathology , Male , Observer Variation , Reproducibility of Results , Sensitivity and Specificity , Single-Blind Method , Skin Neoplasms/pathology , Triclosan
15.
J Eur Acad Dermatol Venereol ; 30(3): 413-9, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26446299

ABSTRACT

BACKGROUND: The sub-optimal diagnostic accuracy for melanoma leads to excise a high number of benign lesions, with consequent costs. Reflectance confocal microscopy (RCM) improves diagnostic specificity, thus possibly inducing a reduction in unnecessary excisions and related costs. OBJECTIVE: To estimate the influence of RCM on number of benign lesions needed to excise (NNE) a melanoma, in term of clinical outcomes and costs per patient. PATIENTS AND METHODS: Skin neoplasms excised by the dermatology public service in the Province of Modena were retrieved form centralized pathology database. Differences in NNE between the territorial service (using dermoscopy only) and the University Hospital (adding also RCM to the patients' workflow) were calculated and cost analysis was performed through a micro-costing approach. RESULTS: A large reduction in benign lesions excised at University Hospital was evident, leading to NNE of 6.25 for University Hospital, compared to 19.41 for Territorial Dermatology. Since 4320 unnecessary excisions can be saved every million inhabitants, an overall yearly saving of over 280,000 Eur can be expected from the use of RCM. CONCLUSIONS: The systematic use of RCM was dramatically affecting the number of benign lesions excised, and this can be translated in a significant cost-benefit advantage.


Subject(s)
Dermatology/economics , Melanoma/pathology , Microscopy, Confocal/economics , Skin Neoplasms/pathology , Cost-Benefit Analysis , Dermoscopy/economics , Humans , Retrospective Studies
17.
Br J Dermatol ; 173(1): 128-33, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25413382

ABSTRACT

BACKGROUND: The clinical recognition of lentigo maligna (LM) and LM melanoma can be very challenging due to the overlapping features it shares with other pigmented macules of the skin. Noninvasive diagnostic techniques can assist in the differential diagnosis. OBJECTIVES: To identify reflectance confocal microscopy (RCM) indicators for LM through the identification of in vivo microscopic substrates of the main dermoscopic features seen in flat pigmented lesions of the face. METHODS: Retrospective analysis of 60 pigmented lesions (LM, invasive melanoma, solar lentigo/flat seborrhoeic keratosis, lichen planus-like keratosis, pigmented actinic keratosis) was carried out. The main dermoscopic patterns and RCM features were described. A new method for correlating RCM with dermoscopic patterns was developed. RESULTS: Pseudonetwork (37 of 60 lesions) and annular granular structures (37 of 60 lesions) were the most frequent dermoscopic patterns, followed by pigmented blotches (27 of 60 lesions). Upon RCM examination, pseudonetwork and blotches differed in melanomas and other nonmelanocytic lesions. These differences included the intraepidermal proliferation of atypical cells (predominantly dendritic-shaped with adnexal tropism) and the presence of a meshwork pattern at the junction. Also, annular granular structures exhibited dendritic cells almost exclusively in melanoma, with no difference between melanomas and nonmelanocytic lesions for the junctional and upper dermal pattern (characterized by dermal inflammation). Fingerprinting was mostly present in nonmelanocytic lesions or corresponded to an overlap with solar lentigo in melanomas. CONCLUSIONS: RCM is useful for identifying the histological substrate of dermoscopic features in pigmented lesions of the face. It can provide a better definition of the lesion areas, enabling an improved diagnostic approach.


Subject(s)
Facial Neoplasms/pathology , Hutchinson's Melanotic Freckle/pathology , Pigmentation Disorders/pathology , Skin Neoplasms/pathology , Dermatitis, Seborrheic/pathology , Dermoscopy/methods , Diagnosis, Differential , Facial Dermatoses/pathology , Humans , Keratosis, Actinic/pathology , Lichen Planus/pathology , Melanoma/pathology , Microscopy, Confocal/methods , Retrospective Studies
18.
J Eur Acad Dermatol Venereol ; 29(6): 1135-40, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25303304

ABSTRACT

BACKGROUND: Early detection of melanoma is the main objective to ensure a high survival rate. In some cases melanoma diagnosis still remain difficult and this leads to unnecessary excisions. OBJECTIVE: The aim of this study was to detect the most relevant Reflectance confocal microscopy (RCM) features for the detection of dermoscopic difficult melanomas. METHOD: A total of 322 lesions were selected from database and were evaluated on dermoscopy according to the 7-point checklist score, in blind from histological diagnosis. We classified the lesions into three categories: (i) 'featureless' lesions with score ranging between 0 and 2; (ii) 'positive-borderline' moles with score between 3 and 4 and (iii) 'positive-clear cut' lesions with score from 5 to 10. We evaluated confocal features of the 'featureless' lesions and of the 'positive-borderline' lesions. Evaluated confocal features were as follows: presence of pagetoid cells, cell shape (roundish or dendritic) and number (< 5 or >5 cells per mm(2) ), overall architecture (ringed, meshwork, clods and non-specific pattern); architectural disorder, presence of cytological atypia (>5 cells per mm(2) ) and cells arranged in nests. RESULTS: Among 322 lesions 70 were melanomas and 252 were nevi. According to the classification based on the 7-point checklist score, 130 'featureless lesions' (score 0-2) including six melanomas, and 102 'positive-borderline' moles (score 3-4) including 17 melanomas, were identified. Round pagetoid cells >5 cells per mm(2) and/or architectural disorder on RCM were found in all of six melanomas with featureless dermoscopy. Round pagetoid infiltration and five or more atypical cells at the DEJ were found in 16 positive 'borderline melanomas'. CONCLUSIONS: RCM represents a rapid non-invasive technique that can aid early diagnosis of dermoscopic difficult melanomas. Use of RCM on lesions with clinical and/or dermoscopic suspect of malignancy may reduce the number of unnecessary excision increasing the rate of accurate diagnoses.


Subject(s)
Dermoscopy , Melanoma/pathology , Microscopy, Confocal , Nevus/pathology , Skin Neoplasms/pathology , Checklist , Diagnosis, Differential , Humans
19.
Philos Trans A Math Phys Eng Sci ; 370(1965): 1871-95, 2012 Apr 28.
Article in English | MEDLINE | ID: mdl-22431761

ABSTRACT

Modelling the longitudinal compressive failure of carbon-fibre-reinforced composites has been attempted for decades. Despite many developments, no single model has surfaced to provide simultaneously a definitive explanation for the micromechanics of failure as well as validated predictions for a generic stress state. This paper explores the reasons for this, by presenting experimental data (including scanning electron microscopic observations of loaded kink bands during propagation, and brittle shear fracture at 45° to the fibres) and reviewing previously proposed micromechanical analytical and numerical models. The paper focuses mainly on virgin unidirectional (UD) composites, but studies for woven and recycled composites are also presented, highlighting similarities and differences between these cases. It is found that, while kink-band formation (also referred to in the literature as microbuckling) is predominant in UD composites under longitudinal compression, another failure mode related to the failure of the fibres can be observed experimentally. It is also shown that the micromechanics of the failure process observed in UD composites is similar to that in other fibre architectures, hence encouraging the adaptation and application of models developed for the former to the latter.

20.
Vaccine ; 28(38): 6247-55, 2010 Aug 31.
Article in English | MEDLINE | ID: mdl-20643092

ABSTRACT

We report efficacy and immunogenicity of the HPV-16/18 AS04-adjuvanted vaccine up to 7.3 years post-vaccination. The study was conducted in a population (N=433) of women enrolled in Brazilian centres from an initial placebo-controlled study. Women were aged 15-25 years at first vaccination. During the most recent year of follow-up, approximately 7 years after initial vaccination, no cases of infection or cytohistological lesions associated with HPV-16/18 were observed in the vaccinees. Vaccine efficacy (95% confidence interval) up to 7.3 years was 94.5% (82.9, 98.9) for incident infection, 100% (55.7, 100) for 12-month persistent infection and 100% (-129.8, 100) for cervical intraepithelial neoplasia grade 2+. Antibody titres for total IgG and neutralising antibodies remained several folds above natural infection levels and >or=96% of women were seropositive. Vaccine safety was similar to placebo. This is the longest follow-up study for a licensed cervical cancer vaccine.


Subject(s)
Cancer Vaccines/immunology , Papillomavirus Infections/prevention & control , Papillomavirus Vaccines/immunology , Uterine Cervical Neoplasms/prevention & control , Adjuvants, Immunologic/administration & dosage , Adolescent , Adult , Antibodies, Neutralizing/blood , Antibodies, Viral/blood , Brazil , Cancer Vaccines/administration & dosage , Female , Follow-Up Studies , Human papillomavirus 16/immunology , Human papillomavirus 18/immunology , Humans , Immunoglobulin G/blood , Lipid A/analogs & derivatives , Papillomavirus Vaccines/administration & dosage , Uterine Cervical Neoplasms/virology , Young Adult
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