Dermatological emergencies and determinants of hospitalization in Switzerland: A retrospective study.

BACKGROUND: Dermatologic conditions are estimated to account worldwide for approximately 8% of all visits at emergency departments (EDs). Although rarely life-threatening, several dermatologic emergencies may have a high morbidity. Little is known about ED consultations of patients with dermatological emergencies and their subsequent hospital disposal. OBJECTIVE: We explore determinants and clinical variables affecting patients' disposal and hospitalization of people attending the ED at a Swiss University Hospital, over a 56-month observational period, for a dermatological problem. METHODS: De-identified patients' information was extracted from the hospital electronic medical record system. Generalized estimating equations were used to explore determinants of patient's disposition. RESULTS: Out of 5096 consecutive patients with a dermatological main problem evaluated at the ED, 79% of patients were hospitalized after initial assessment. In multivariable analyses, factors which were significantly associated with an increased admission rate included length of ED stay, age ≥ 45 years, male sex, distinct vital signs, high body mass index, low oxygen saturation, admission time in the ED and number and type of dermatological diagnoses. Only 2.2% of the hospitalized patients were admitted to a dermatology ward, despite the fact that they had dermatological diagnoses critically determining the diagnostic related group (DRG) payment. The number of patients managed by dermatologists during in-patient treatment significantly decreased over the study period. CONCLUSIONS: Our study identifies a number of independent predictors affecting the risk of hospital admission for patients with dermatological conditions, which may be useful to improve patients' disposal in EDs. The results indicate that the dermatological specialty is becoming increasingly marginalized in the management of patients in the Swiss hospital setting. This trend may have significant implications for the delivery of adequate medical care, outcomes and cost-effectiveness. Dermatologists should be more engaged to better position their specialty and to effectively collaborate with nondermatologists to enhance patient care.

Macroalgae as biofactories of metal nanoparticles; biosynthesis and food applications.

Nanotechnology has opened a new frontier in recent years, capable of providing new ways of controlling and structuring products with greater market value and offering significant opportunities for the development of innovative applications in food processing, preservation, and packaging. Macroalgae (MAG) are the major photoautotrophic group of living beings known as a potential source of secondary metabolites, namely phenolic compounds, pigments, and polysaccharides. Biosynthesis based on the abilities of MAG as "nanobiofactories" targets the use of algal secondary metabolites as reducing agents to stabilize nanoparticles (NPs). Nowadays, most of the studies are focused on the use of metal (Ag, Au) and metal-oxide (CuO, ZnO) NPs derived from algae. The eco-friendly biosynthesis of metal NPs reduces the cost and production time and increases their biocompatibility, due to the presence of bioactive compounds in MAG, making them suitable for a wide variety of applications. These compounds have been attributed to the antimicrobial and antioxidant properties responsible for their application through innovative technologies such as nanoencapsulation, nanocomposites, or biosensors in the food industry. Nevertheless, toxicity is a key factor that should be considered, so the applicable regulation needs to guarantee the safe use of metal NPs. Consequently, the aim of this review will be to compile the available information on MAG-mediated metal NPs, their biosynthesis, and potential food applications.

Protection and controlled release of vitamin C by different micro/nanocarriers.

Ascorbic acid, known as vitamin C, is an important antioxidant and food ingredient, and highly sensitive to environmental conditions, which makes its incorporation into food, cosmetic and pharmaceutical products more difficult. The evaluation of its nano/microencapsulation enables the improvement of its stability and controlled release. There are various investigations regarding ascorbic acid encapsulation; however, a deep study related to the scale-up of encapsulation process, its application into food products and digestibility study are still needed. This review highlights the main physicochemical and health properties of vitamin C, recent advances of its encapsulation into micro/nanocarriers, and application in food products. Also, the controlled release and bioavailability of encapsulated forms within different carriers is underlined. The results of published studies clearly show that vitamin C can be successfully protected within micro/nanoencapsulation systems and it can be applied as an efficient ingredient in the formulation of various food products such as bakery goods.

Addition of milk to coffee beverages; the effect on functional, nutritional, and sensorial properties.

To date, there exists a debate on the effect of milk added to coffee infusions/beverages concerning the nutritional quality of coffee and the functional properties of its phenolic compounds. Yet, the full nutritional quality and functional properties of a coffee beverage without a significant negative impact on its sensorial profile are highly desired by the consumers. Negative/masking, positive, and neutral effects of milk on the antioxidant activity and bioavailability of coffee phenolics (particularly, chlorogenic acids) have been reported. Some potential factors including the type and amount of milk added, type of coffee beverage, the composition of both milk (protein and fat) and coffee (phenolic compounds), preparation method, assays used to measure antioxidant properties, and sampling size may account for the various reported findings. Interactions between phenolic compounds in coffee and milk proteins could account as the main responsible aspect for the reported masking/negative impact of milk on the antioxidant activity and bioaccessibility/bioavailability of coffee bioactives. However, considering the interactions between milk components and coffee phenolics, which result in the loss of their functionality, the role of milk fat globules and the milk fat globule membrane can also be crucial, but this has not been addressed in the literature so far.HighlightsIn most cases, milk is added to the coffee beverages in several various ways.Effect of milk on the nutritional/functional properties of coffee is controversial.Enough evidence suggests negative effects of milk addition on properties of coffee.Interactions of coffee phenolics and milk proteins could account as the main aspect.The role of milk fat globules and milk fat globule membrane may also be crucial.

Opportunities and challenges for the nanodelivery of green tea catechins in functional foods.

Green tea, the least processed tea product, is scientifically known for its rich antioxidant content originating from polyphenols, especially catechins. The most potent green tea catechin is epigallocatechin-3-gallate (EGCG), which is responsible for a wide range of health benefits including anticancer, antidiabetics, and anti-inflammatory properties. However, green tea catechins (GTCs) are very labile under both environmental and gastrointestinal conditions; their chemical stability and bioavailability primarily depend on the processing and formulation conditions. Nanocarriers can protect GTCs against such conditions, and consequently, can be applicable for designing nanodelivery systems suitable for GTCs. In this review, the latest findings about both opportunities and limitations for the nanodelivery of GTCs and their incorporation into various functional food products are discussed. The scientific findings so far confirm that nanodelivery of GTCs can be an efficient approach towards the enhancement of their health-promoting effects with a minimal dose, controlled and targeted release, lessening the dose-related toxicity, and the efficient incorporation into functional foods. However, further investigation is yet needed to fully explain the cellular mechanisms of action of GTCs on human health and to elucidate the effect of encapsulation on their bioefficacy using well-designed, systematic, long-term, and large-scale clinical interventions. There also exists a substantial concern regarding the safety of the manufactured nanoparticles, their absorption, and the associated release mechanisms.

Loss of Concurrent Regulation of the Expression of BIF-1, BAX, and Beclin-1 in Primary and Metastatic Melanoma.

Melanoma is one of the most aggressive and drug-resistant cancers. Despite novel promising therapeutic strategies, the prognosis of metastatic melanoma patients remains poor and it is often associated with high relapse rates. Endophilin B1, also known as BIF-1, is a multifunctional protein involved in several biological processes such as autophagy and apoptosis. BIF-1 promotes apoptosis through binding to BAX and its translocation to the mitochondrial outer membrane. On the other hand, BIF-1 can interact with Beclin-1 through UVRAG to promote autophagy. Several reports suggest an ambiguous role of BIF-1 in cancer development and progression. For example, it has been demonstrated that the expression of BIF-1 is reduced in both primary and metastatic melanoma and that the reduction of BIF-1 expression is associated with reduced overall survival of melanoma patients. Here we show that the expression of Beclin-1 and active form of BAX are also reduced in the melanoma patients. However, while we observed strong positive correlations between the expression of BIF-1 and Beclin-1 as well as between BIF-1 and BAX in benign nevi, these correlations were lost in the primary and metastatic melanoma cells. These data indicate disruption in the proximal molecular mechanisms which regulate expression of BIF-1, Beclin-1, and BAX in the primary and metastatic melanoma.

Melanoma of the nail apparatus: a systematic review and meta-analysis of current challenges and prognosis.

Nail apparatus melanoma (NAM) is a rare dermatologic malignancy. Its prognosis is poor because it is often diagnosed late. However, progression and survival of NAM patients have only been studied among small populations. Early biopsy could help to identify suspicious lesions at a less invasive stage. While surgery is generally seen as the treatment of choice, the extent of excision margins and the use of sentinel biopsy remain debated. This systematic review aims to summarize the treatment procedures and observed prognosis in the literature during the last two decades and present pooled survival and progression rates of NAM by using meta-analysis. A systematic review on studies assessing pathology, treatment and prognosis of NAM was carried out up to end of 2018. After evaluation of eligible studies, the main emerging topics were outlined and pooled survival outcomes estimated. A total of 30 articles out of 624 identified records were included for systematic review. Finally, meta-analysis of pooled mortality rates including 18 studies was 4.6 × 100 patient-years (95% CI: 2.7, 6.8) equivalent to 5-year cumulative survival of 77.0%. Additionally, the pooled progression rate based on 17 studies was 6.3 × 100 patient-years (95% CI: 4.1, 8.9) with estimated 5-year cumulative progression-free survival of 68.5%. While the optimal extent of surgical treatment remains debated, prompt biopsy could help to identify early lesions. This is the first study to present pooled survival and progression rates by meta-analysis.

Apoptosis and cell cycle regulatory effects of adenosine by modulation of GLI-1 and ERK1/2 pathways in CD44+ and CD24- breast cancer stem cells.

OBJECTIVES: Breast cancer stem cells (CSCs) are a small population of tumour cells with the ability of self-renewal and resistance to chemotherapy. Targeting CSCs is a promising strategy for treatment of cancer. A recent study demonstrated that adenosine receptor agonists inhibit glioblastoma CSCs proliferation. At present, the effect of adenosine on breast CSCs has not been reported. Therefore, this study was designed to evaluate the effect of adenosine and its signalling pathways in breast CSCs. MATERIALS AND METHODS: Anti-proliferative effect of adenosine on breast CSCs was evaluated by mammosphere formation and MTS assay. The effect of adenosine on cell cycle progression was examined using flow cytometry. Detection of apoptosis was conducted by Annexin V-FITC. The expression levels of cell cycle and apoptosis regulatory proteins as well as ERK1/2, and GLI-1 were measured by Western blot. RESULTS: Adenosine reduced CSCs population and mammosphere formation in breast CSCs. Adenosine induced G1 cell cycle arrest in breast CSCs in conjunction with a marked down-regulation of cyclin D1 and CDK4. Adenosine also induced apoptosis by regulation of Bax/Bcl-2 ratio, mitochondrial membrane potential depletion and activation of caspase-6. Moreover, adenosine inhibited ERK1/2 phosphorylation and GLI-1 protein expression. CONCLUSIONS: These findings indicated that adenosine induces cell cycle arrest and apoptosis through inhibition of GLI-1 and ERK1/2 pathways in breast CSCs.

Effects of thermal processing by nanofluids on vitamin C, total phenolics and total soluble solids of tomato juice.

In this research, our main idea was to apply thermal processing by nanofluids instead of conventional pasteurization processes, to shorten duration of thermal procedure and improve nutritional contents of fruit juices. Three different variables of temperature (70, 80 and 90 °C), nanofluid concentration (0, 2 and 4%) and time (30, 60 and 90 s) were selected for thermal processing of tomato juices by a shell and tube heat exchanger. The results demonstrated that 4% nanofluid concentration, at 30 °C for 30 s could result in 66% vitamin C retention of fresh juice while it was about 56% for the minimum nanofluid concentration and maximum temperature and time. Higher nanoparticle concentrations made tomato juices that require lowered thermal durations, because of better heat transfer to the product, and total phenolic compounds dwindle less severely; In fact, after 30 s thermal processing at 70 °C with 0 and 4% nanoparticles, total phenolic compounds were maintained by 71.9 and 73.6%, respectively. The range of total soluble solids for processed tomato juices was 5.4-5.6, meaning that nanofluid thermal processing could preserve the natural condition of tomato juices successfully. Based on the indices considered, a nanofluid thermal processing with 4% nanoparticle concentration at the temperature of 70 °C for 30 s will result in the best nutritional contents of final tomato juices.

Nanotechnology Approaches for Increasing Nutrient Bioavailability.

Health-promoting ingredients such as phenolic compounds, vitamins, and minerals are being increasingly introduced into foods and beverages to produce "functional foods" specifically designed to improve human health, well-being, and performance. However, it is often challenging to incorporate these nutraceuticals into foods because they have poor solubility characteristics, impart undesirable flavor profiles, are chemically unstable, or have low bioavailability. This problem can often be overcome by encapsulating the bioactive components in nanoparticle-based delivery systems. The bioavailability of encapsulated bioactive agents often increases when the size of the particles containing them decreases, due to their faster digestion, ability to penetrate the mucus layer, or direct uptake by cells. Nanoparticles can be formulated to survive passage through specific regions of the gastrointestinal tract and then release their payload at a specified point, thus maximizing their potential health benefits. Nutraceutical-loaded nanoparticles can be fabricated through lipid formulations, natural nanocarriers, specialized equipment, biopolymer nanoparticles, and miscellaneous techniques. Classification into these five groups is based on the main mechanism or ingredient used to fabricate the nanoparticles. This chapter focuses on the utilization of food-grade nanoparticles for improving the performance of nutraceuticals in functional foods and beverages.

New approach for virtual surgical planning and mandibular reconstruction using a fibula free flap.

Maxillofacial reconstruction poses a major challenge to surgeons because of the associated anatomical complexity, the sensitivity of the involved systems and the need to maintain a pleasing facial appearance. Here, we present a detailed description of a new method for extensive mandibular reconstruction using open-source virtual design software and a desktop 3D printer. A surgeon segmented preoperative computed tomography angiography scans with the Amira program to create a digital model of the mandible, skull and fibula. These datasets were imported into Blender, an open-source computer-aided design software package, where arrangement of the fibula segments into aligned sections was performed. Then, a desktop 3D printer was used to produce a reconstructed mandible. After fixation of a plate onto the reconstructed mandible, cutting guides were digitally designed using Blender. Following this, the surgeon performed mandible resection using the fixed cutting guides, which were 3D-printed using biocompatible plastic (Med 610/Stratasys Inc.) and fixed to the prebent reconstructed mandible at a predetermined position. After cutting the fibula with the help of the cutting guides and aligning the fibular segments into mandibular space, the surgeon fixed the segments to the reconstruction plate. Postoperatively, multislice computed tomography scans were taken for control purposes. Our method for mandibular reconstruction offers the following benefits: shorter operation planning time, increased accuracy during osteotomy through the use of a special fibula cutting guide and low costs. In brief, this method is an easy, precise and highly flexible technique for mandibular reconstruction with a fibula flap.

In vivo confocal microscopy efficacy assessment of daylight photodynamic therapy in actinic keratosis patients.

BACKGROUND: Reflectance confocal microscopy (RCM) is a noninvasive diagnostic technique with an acceptable sensitivity and specificity for actinic keratosis (AK). OBJECTIVES: We evaluated efficacy of daylight photodynamic therapy (DL-PDT) in patients with AK using a new RCM atypia scoring system. MATERIALS AND METHODS: All patients with AK lesions (Grade I-II) were included in our study (2012-15). Baseline clinical, dermoscopy and RCM evaluations were followed by DL-PDT. In the first follow-up, clinical examination, dermoscopy and RCM imaging of the treated area were carried out. Atypia scoring and cell size measurements were used to compare before and after RCM images. RESULTS: From 40 lesions (20 patients with mean age of 75·5 years), complete resolution and partial response of the actinic damage was detected in 80% and 17·5% of lesions, respectively. No cellular atypia was seen in the follow-up RCM images of 57·5% of lesions (n = 23), while in 40% of lesions (n = 16) minimal changes to the honeycomb pattern of the epidermis were seen in the follow-up RCM images (atypia score 1). Only one lesion showed minimal or no clinical response, and a persistent moderate amount of atypia in RCM. Furthermore, atypia score and mean cell size decreased significantly in the follow-up DL-PDT RCM images (P < 0·001, P = 0·001, respectively). CONCLUSIONS: RCM features of actinic damage at cellular level have been shown to correlate well with the results of a clinical assessment of AK lesions. This study confirms that in vivo RCM technology might be an additional technique to monitor the efficacy of DL-PDT for AK.

Latest developments in silica-based thermoluminescence spectrometry and dosimetry.

Using irradiated doped-silica preforms from which fibres for thermoluminescence dosimetry applications can be fabricated we have carried out a range of luminescence studies, the TL yield of the fibre systems offering many advantages over conventional passive dosimetry types. In this paper we investigate such media, showing emission spectra for irradiated preforms and the TL response of glass beads following irradiation to an 241Am-Be neutron source located in a tank of water, the glass fibres and beads offering the advantage of being able to be placed directly into liquid. The outcomes from these and other lines of research are intended to inform development of doped silica radiation dosimeters of versatile utility, extending from environmental evaluations through to clinical and industrial applications.

Excision of fascia in melanoma thicker than 2 mm: no evidence for improved clinical outcome.

BACKGROUND: Lack of evidence-based data causes significant variation among surgeons concerning the depth of wide excision for primary cutaneous melanomas. OBJECTIVES: To evaluate the clinical effect of excision of the deep fascia in melanomas thicker than 2 mm on patient outcome. METHODS: We performed a retrospective cohort review (1996-2012) of patients with melanomas thicker than 2 mm. Included patients underwent excision with a 1-cm margin. Data collected included the patients' sex, age, tumour location, tumour type, Breslow depth and presence of ulceration. Local recurrences, locoregional and distant metastases, and disease-free and overall survival were compared between the fascia-excised and the fascia-preserved groups. RESULTS: Out of 2182 patients with malignant melanomas, 213 melanomas thicker than 2 mm, with a median follow-up of 1547 days, were included. The mean age of the patients was 62·6 years and the mean Breslow depth was 4·2 mm. Analysis of data for death attributable to melanoma (P = 0·72), local recurrence (P = 0·71), and locoregional (P = 0·87) and distant metastases (P = 0·34) were not significantly different between the study groups. Furthermore, Kaplan-Meier and Cox regression analysis of both groups showed no evidence of significant difference regarding disease-free [P = 0·35; hazard ratio (HR) 1·25; 95% confidence interval (CI) 0·79-1·97] and overall survival (P = 0·63; HR 1·18; 95% CI 0·61-2·27). CONCLUSIONS: We believe that excision of the deep fascia does not improve the outcome of melanomas thicker than 2 mm.

Glass beads and Ge-doped optical fibres as thermoluminescence dosimeters for small field photon dosimetry.

An investigation has been made of glass beads and optical fibres as novel dosimeters for small-field photon radiation therapy dosimetry. Commercially available glass beads of largest dimension 1.5 mm and GeO2-doped SiO2 optical fibres of 5 mm length and 120 µm diameter were characterized as thermoluminescence dosimeters. Results were compared against Monte-Carlo simulations with BEAMnrc/DOSXYZnrc, EBT3 Gafchromic film, and a high-resolution 2D-array of liquid-filled ionization chambers. Measurements included relative output factors and dose profiles for square-field sizes of 1, 2, 3, 4, and 10 cm. A customized Solid-Water® phantom was employed, and the beads and fibres were placed at defined positions along the longitudinal axis to allow accurate beam profile measurement. Output factors and the beam profile parameters were compared against those calculated by BEAMnrc/DOSXYZnrc. The output factors and field width measurements were found to be in agreement with reference measurements to within better than 3.5% for all field sizes down to 2 cm2 for both dosimetric systems, with the beads showing a discrepancy of no more than 2.8% for all field sizes. The results confirm the potential of the beads and fibres as thermoluminescent dosimeters for use in small photon radiation field sizes.

Production of low fat french-fries with single and multi-layer hydrocolloid coatings.

In this study the influence of coating with different hydrocolloids on the oil absorption and quality attributes of French fries was investigated. Our results revealed that hydrocolloid coatings reduced the moisture loss during frying, and hence, reduced the oil uptake of French fries. Among the studied gums as a single layer coating, combination of carboxy methyl cellulose and pectin (0.5 and 1% w/w) lead to the lowest oil uptake of French fries. In samples coated with two and three-layer hydrocolloids, the oil absorption reduced further and the moisture content of final products was higher than the blank samples.