EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris - Part 2: specific clinical and comorbid situations.

This evidence- and consensus-based guideline on the treatment of psoriasis vulgaris was developed following the EuroGuiDerm Guideline and Consensus Statement Development Manual. The second part of the guideline provides guidance for specific clinical and comorbid situations such as treating psoriasis vulgaris patient with concomitant psoriatic arthritis, concomitant inflammatory bowel disease, a history of malignancies or a history of depression or suicidal ideation. It further holds recommendations for concomitant diabetes, viral hepatitis, disease affecting the heart or the kidneys as well as concomitant neurological disease. Advice on how to screen for tuberculosis and recommendations on how to manage patients with a positive tuberculosis test result are given. It further covers treatment for pregnant women or patients with a wish for a child in the near future. Information on vaccination, immunogenicity and systemic treatment during the COVID-19 pandemic is also provided.

Northern preference for terrestrial electromagnetic energy input from space weather.

Terrestrial space weather involves the transfer of energy and momentum from the solar wind into geospace. Despite recently discovered seasonal asymmetries between auroral forms and the intensity of emissions between northern and southern hemispheres, seasonally averaged energy input into the ionosphere is still generally considered to be symmetric. Here we show, using Swarm satellite data, a preference for electromagnetic energy input at 450 km altitude into the northern hemisphere, on both the dayside and the nightside, when averaged over season. We propose that this is explained by the offset of the magnetic dipole away from Earth's center. This introduces a larger separation between the magnetic pole and rotation axis in the south, creating different relative solar illumination of northern and southern auroral zones, resulting in changes to the strength of reflection of incident Alfvén waves from the ionosphere. Our study reveals an important asymmetry in seasonally averaged electromagnetic energy input to the atmosphere. Based on observed lower Poynting flux on the nightside this asymmetry may also exist for auroral emissions. Similar offsets may drive asymmetric energy input, and potentially aurora, on other planets.

EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris - Part 1: treatment and monitoring recommendations.

This evidence- and consensus-based guideline on the treatment of psoriasis vulgaris was developed following the EuroGuiDerm Guideline and Consensus Statement Development Manual. The first part of the guideline includes general information on the scope and purpose, health questions covered, target users and strength/limitations of the guideline. Suggestions for disease severity grading and treatment goals are provided. It presents the general treatment recommendations as well as detailed management and monitoring recommendations for the individual drugs. The treatment options discussed in this guideline are as follows: acitretin, ciclosporin, fumarates, methotrexate, adalimumab, apremilast, brodalumab, certolizumab pegol, etanercept, guselkumab, infliximab, ixekizumab, risankizumab, secukinumab, tildrakizumab and ustekinumab.

Stratum corneum integrity as a predictor for peristomal skin problems in ostomates.

BACKGROUND: Peristomal skin problems are common, most often the result is disruption of the skin barrier and this may account for more than one in three visits to ostomy nurses. Therefore a specific assessment of individual risk factors relating to the skin barrier function would be of great interest. METHODS: Skin barrier integrity in ostomy patients with peristomal skin problems (PSP) was compared with that of ostomy patients with normal skin (controls) using transepidermal water loss (TEWL). Mechanical barrier disruption was determined by a tape stripping test and chemical barrier disruption [sodium lauryl sulphate (SLS) 0.25%]. RESULTS: Patients and controls had a highly significant increase in TEWL value in the peristomal area compared with nonperistomal contralateral abdominal skin (P < 0.0001 for both groups). The skin barrier of normal-looking contralateral skin of ostomates was found to be borderline impaired in patients with PSP compared with those without. A linear association was seen between the number of tape strips removed and TEWL for both cases and controls. Tape stripping suggested that patients with PSP had less resilient skin (P = 0.002). A significant difference in TEWL value between cases and controls was also seen for the SLS patch test on the dorsal skin (P = 0.02). CONCLUSION: Successive tape stripping, a situation analogous to the normal use of a pouching system, caused a higher degree of barrier damage more rapidly in patients with PSP, indicating an impaired mechanical quality of the barrier. The SLS exposure test suggested a generally increased susceptibility to irritant dermatitis as assessed by TEWL. Our findings suggest tape stripping and SLS testing may have a role as predictive tests to identify patients at risk of PSP.

Stratum corneum damage and ex vivo porcine skin water absorption - a pilot study.

A simple ex vivo screening technique would be of interest for mass screening of substances for potential barrier disruptive qualities. Ex vivo water absorption as a marker of skin barrier integrity was studied on pig ear skin. Skin water absorption was quantified by weighing and weight changes were found to reflect prehydration barrier damage. It is suggested that this simple model may be elaborated to provide a rapid, economical screening tool for potential skin irritants.

Common polymorphisms in CYP2C9, subclinical atherosclerosis and risk of ischemic vascular disease in 52,000 individuals.

Cytochrome P450 2C9 (CYP2C9) enzymes metabolize warfarin and arachidonic acid. We hypothesized that the CYP2C9(*)2 (rs.1799853) and CYP2C9(*)3 (rs.1057910) polymorphisms with decreased enzyme activity affect risk of subclinical atherosclerosis (reduced ankle brachial index and increased C-reactive protein), ischemic vascular diseases (ischemic heart disease, myocardial infarction, ischemic cerebrovascular disease and ischemic stroke) and death after an ischemic heart disease diagnosis. We genotyped the Copenhagen City Heart Study, a prospective study including 10 398 participants with 30-32 years of follow-up; the Copenhagen General Population Study, a cross-sectional study including 21 629 participants; and the Copenhagen Ischemic Heart Disease Study, a case-control study including 5082 cases and 14 904 controls. CYP2C9 carriers versus noncarriers did not associate with subclinical atherosclerosis. Furthermore, the odds/hazard ratios for ischemic vascular disease did not differ from 1.0 for CYP2C9 carriers versus noncarriers. Finally, we found no altered risk of early death after a diagnosis of ischemic heart disease. For all end points, we could exclude even minor changes in risk of disease with 90% power. In conclusion, in three independent studies totaling more than 52 000 individuals, we found no association between CYP2C9(*)2 and CYP2C9(*)3 polymorphisms and risk of subclinical atherosclerosis, ischemic vascular disease or death after ischemic heart disease.

Survival of Salmonella spp. and Escherichia coli O157:H7 on fresh and frozen strawberries.

For maximum shelf life, fresh strawberries are harvested directly without washing into retail containers. Frozen berries are usually hulled in the field and washed prior to freezing, sometimes with the addition of sucrose. To determine survival of potential bacterial contaminants, cut or intact surfaces of fresh strawberries were spot inoculated with five- or six-strain cocktails of Salmonella or Escherichia coli O157:H7 (log 7.0 CFU/sample). Inoculated strawberries were dried for 1 h at 24 degrees C and were stored in closed containers at 5 or 24 degrees C. Sliced strawberries with or without added 20% sucrose were inoculated with one of two strains of E. coli O157:H7 and frozen at -20 degrees C. An initial population reduction of approximately 0.5-log cycles was observed on intact but not cut berries after the 1-h drying period. During storage at 24 degrees C for up to 48 h, populations of Salmonella and E. coli O157:H7 did not decline further. When strawberries were stored at 5 degrees C for up to 7 days, populations of both pathogens remained constant on cut surfaces but decreased by 1 - to 2-log cycles on intact surfaces. After 30 days of frozen storage, the population of E. coli O157:H7 had declined by 0.7- to 2.2-log cycles (with and without sucrose, respectively). Results of this study indicate that E. coli O157:H7 and Salmonella are capable of survival but not growth on the surface of fresh strawberries throughout the expected shelf life of the fruit and can survive in frozen strawberries for periods of greater than 1 month.

The feasibility of high dose iodine 131 treatment as an alternative to surgery in patients with a very large goiter: effect on thyroid function and size and pulmonary function.

Some patients with very large goiters (>150 mL) are not candidates for surgery. We evaluated the feasibility of high dose 131I in such patients. Twenty-three patients (2 men and 21 women; median age, 67 yr; range, 42-86 yr) with very large goiter (8 toxic) were treated with calculated high dose 131I [median, 2281 megabecquerels (61.6 mCi); range, 988-4620 megabecquerels (26.7-124.9 mCi)]. During the 12-month observation period, goiter reduction and tracheal anatomy were monitored by magnetic resonance imaging, and the respiratory capacity was monitored by pulmonary function tests. Five patients (22%) developed hypothyroidism. Thyroid volumes were at baseline, after 1 week, and after 1 yr [mean +/- SEM, 311 +/- 28, 314 +/- 26 (P = NS), and 215 +/- 26 (P < 0.01) mL]. The relative changes 1 week after therapy ranged from -14.1% to 15.3%. After 1 yr the mean size was reduced by 33.9% (range, 13.5-61.4%). Only the initial goiter size showed a significant negative correlation to the percent reduction. The smallest cross-sectional area of the trachea decreased 9.2% within 1 week after treatment, but eventually emerged with a 17.9% larger area [mean +/- SEM, 84.3 +/- 4.8, 75.5 +/- 5.1 (P < 0.01), and 98.2 +/- 6.0 (P < 0.01) mm2]. The inspiratory parameter, FIF50%, improved after an initial insignificant decline [baseline therapy, after 1 week, after 3 months, and after 1 yr (mean +/- SEM), 2.37 +/- 0.24, 2.20 +/- 0.21 (P = NS), 2.51 +/- 0.23 (P = NS), and 2.76 +/- 0.25 (P = 0.01) L/s]. FIF50% correlated significantly with the smallest cross-sectional tracheal area (baseline, 1 week, and 1 yr: r = 0.74; P < 0.001, r = 0.63; P < 0.005, and r = 0.46; P < 0.05). Changes in tracheal anatomy did not correlate with changes in either lung dynamics or goiter size. In conclusion, very large goiters can be reduced by a third, on the average, with high dose 131I therapy without any initial clinically significant tracheal compression. Tracheal cross-sectional area as well as pulmonary inspiratory capacity improve. No serious adverse effects are seen.

Ultrasonographically guided fine-needle aspiration biopsy of intrathoracic tumors.

PURPOSE: Evaluation of diagnostic accuracy and complication frequency at ultrasonographically guided fine-needle aspiration biopsy of intrathoracic tumors. MATERIAL AND METHODS: A total of 134 ultrasonographically guided percutaneous fine-needle aspiration biopsies were performed on 128 patients with intrathoracic tumors abutting on the pleura. A cytologic diagnosis was obtained in 119 patients (93%). RESULTS: In 83 patients, cytologic malignancy was found; in 34, benignity; and in 2, cellular atypia. A total of 117 diagnoses were correct and 2 diagnoses were false-positive. A malignancy subtyping based on the cytologic aspirates was made in 80 patients. In 40 (93%) of 43 histologically proven subtypes, the subtyping was correct. The complication frequency in terms of pneumothorax was 3.7%. CONCLUSION: Ultrasonographically guided percutaneous fine-needle aspiration biopsy is a safe and reliable method of establishing the cytologic diagnosis of intrathoracic tumors.

Ultrasound-guided renal biopsy with biopsy gun technique--efficacy and complications.

One hundred and thirty-one ultrasound-guided renal biopsies performed in 127 patients with automated spring-loaded biopsy technique were evaluated. Adequate tissue for histologic diagnosis was obtained in 92% of the procedures (94% of the patients). The mean glomerular yield was 16.8 glomeruli. Complications were seen in 21% of the patients, 18% having minor and 3% having major complications. Patients with severe hypertension had significantly more complications than the rest of the patients. The rate of complications in patients who had 3 or 4 biopsy passes was not increased compared to patients who had one or 2 biopsy passes. Thus, this study indicates that the risk of complications and the safety of the procedure is not influenced by increasing the number of biopsy passes in order to obtain representative specimens.

[Injection site for quick-acting insulin. Significance for glycemic control in basal bolus insulin regimen]. / Injektionssted for hurtigtvirkende insulin. Betydning for glykoemisk kontrol ved basal-bolus insulinregimet.

The impact on glycaemic control of soluble insulin injected either intramuscularly into the thigh (IMT), subcutaneously into the abdominal wall (SCA) or subcutaneously into the thigh (SCT) was evaluated in 49 Type 1 diabetic outpatients following a randomised three-month intervention study. Insulin doses were adjusted based on patients' self-monitored blood glucose values and reported hypoglycaemic episodes. More patients in the SCA and IMT groups than in the SCT group had serum fructosamine values within normal limits following intervention. Blood glucose at 03.00 was lower in the SCT group than in the SCA and IMT groups, due to a higher number of low nocturnal blood glucose values (less than 4 mmol/l) in the SCT group. In conclusion, s.c. injection of soluble insulin into the abdominal wall or intramuscularly into the thigh is preferable compared to s.c. injection into the thigh in the basal bolus insulin delivery regimen. Soluble insulin injection s.c. into the thigh during daytime is a risk factor for nocturnal hypoglycaemia.

Impact of injection sites for soluble insulin on glycaemic control in type 1 (insulin-dependent) diabetic patients treated with a multiple insulin injection regimen.

The absorption rate of rapid acting (soluble) insulin is slow from the subcutaneous tissue of the thigh compared to intramuscular injection into the thigh and s.c. injection into the abdominal wall. The aim of the study was to evaluate the impact of soluble insulin injected either intramuscularly into the thigh (IMT), s.c. into the abdominal wall (SCA) or s.c. into the thigh (SCT) on glycaemic control in Type 1 (insulin-dependent) diabetic outpatients treated with the basal bolus insulin delivery regimen. Fifty-five, C-peptide negative Type 1 diabetic outpatients were included in a randomised 3-month intervention study. The insulin doses were adjusted frequently by blinded observers based on the patients' self-monitored blood glucose values and reported hypoglycaemic episodes. The serum fructosamine value was within normal limits in three patients in the IMT group, in six patients in the SCA group and in none of the patients in the SCT group following the intervention period (p < 0.01). However, the difference in mean serum fructosamine values did not reach statistical significance (IMT: 1.24 mmol/l (95% confidence interval; 1.17 to 1.31), SCA: 1.25 mmol/l (1.18 to 1.32), SCT: 1.34 mmol/l (1.26 to 1.41), (p = 0.09). Blood glucose excursions were larger in the SCT group than in the SCA and IMT group from post-lunch to pre-dinner measurements and from pre- to post-dinner measurements. A higher number of measured low nocturnal blood glucose values (less than 4 mmol/l) was observed in the SCT group (34 of 85) than in the IMT (14 of 64) and SCA (21 of 81) group (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Mouse strain differences in susceptibility to cerebral ischemia are related to cerebral vascular anatomy.

The consequences of cerebral ischemia were studied in three different strains (BDF, CFW, and BALB/C) of mice. The different strains exhibited significant differences in susceptibility to 24-h focal ischemia. Following middle cerebral artery occlusion (MCAO), infarct volumes (mm3) were 5 +/- 3 in BDF, 15 +/- 5 in CFW, and 23 +/- 3 in BALB/C mice (p < 0.05). MCAO plus ipsilateral common carotid artery occlusion (CCAO) resulted in infarct volumes of 15 +/- 9 in BDF, 38 +/- 10 in CFW, and 72 +/- 12 in BALB/C mice (p < 0.05). In addition, MCAO plus CCAO produced death by 24 h in 42% of CFW and 67% of BALB/C mice, but not in any BDF mice (p < 0.05). CCAO alone produced multifocal hemispheric infarctions in 36% of BALB/C mice but not in the other two strains. Brains of all mouse strains subjected to sham surgery were free of any ischemic injury. Arterial blood pressures, blood gases, and blood cell profiles were relatively similar for the three mouse strains. However, carbon black studies of the cerebrovascular anatomy revealed an incomplete circle of Willis (i.e., a significant decrease in the frequency of patent posterior communicating arteries) for BALB/C compared with BDF mice (p < 0.05), with CFW mice being intermediary. Based on these anatomical data, BALB/C mice also were evaluated following transient global brain ischemia produced by bilateral CCAO. BALB/C mice exhibited a > 85% reduction in cortical microvascular perfusion and EEG power within 1 min of bilateral CCAO. Also, hippocampal neuronal CA1 damage and mortality over 7 days were related to the duration of global brain ischemia (p < 0.05). These data demonstrate a significant difference between mouse strains in their sensitivity to cerebral ischemia that appears to be related, at least in part, to the functional vascular anatomy at the level of the posterior communicating arteries. In particular, we point out the potential usefulness of BALB/C mice as a sensitive and reproducible model of focal and global ischemia.

Incidence of otitis media in CBA/J and CBA/CaJ mice.

The inbred CBA/J mouse has become a standard experimental animal for auditory study because of its lifelong good hearing. In a newly established mouse breeding colony that housed CBA/J and CBA/CaJ mice to reared as auditory subjects, otitis media frequently afflicted CBA/J mice, reaching an incidence of 90% in animals greater than 400 days of age. Otitis media was not found in CBA/CaJ mice. Three attempts to establish a colony that was free of otitis were unsuccessful. Although the primary pathogen was not clearly established, Pasteurella pneumotropica was isolated from infected bullae. Partial control of otitis media followed the introduction of tetracycline prophylaxis. The CBA/CaJ mice may be suitable replacements for CBA/J mice in studies that require inbred mice with good hearing, since their auditory thresholds did not differ significantly from those of otitis-free CBA/J mice.

Response of adult New Zealand white rabbits to enrichment objects and paired housing.

Enhancing the psychological well-being of laboratory animals has received much attention recently. Although many studies have been undertaken to determine the effects of cage enrichment techniques on dogs and nonhuman primates, other than scant empirical observations, little has been done to measure these events objectively in lagomorphs. We studied adult female New Zealand White (NZW) rabbits to learn if, when given the opportunity, individual rabbits would use different enrichment objects placed in their cages, and to determine if rabbits preferred to be in proximity to one another, or apart. Three different objects were evaluated with eight rabbits individually housed in conventional cages. Each object introduced into individual rabbit cages stimulated substantial interaction, especially chewing behavior. Eight other rabbits were pair-housed in a modified caging system with a special access port between two separate cages. When given a choice, rabbits preferred to be in the same cage with other rabbits. In both studies, individual behaviors were monitored, as well as either the type of interaction and percentage of observations spent with each object or, in the housing study, percentage of observations involved with different types of activity, and relative location of the paired rabbits.

Does the intestinal microflora synthesize pyrroloquinoline quinone?

Pyrroloquinoline quinone (PQQ) functions as a cofactor for prokaryotic oxidoreductases, such as methanol dehydrogenase and glucose dehydrogenase. When chemically-defined diets without PQQ are fed to animals, lathyritic changes are observed. In previous studies, it was assumed that PQQ was produced by the intestinal microflora; consequently, antibiotics were routinely added to diets. In the present study this assumption is tested further in mice by: (i) examining the effects of dietary antibiotics on fecal PQQ excretion, (ii) isolating the intestinal flora to identify bacteria known to synthesize PQQ and (iii) determining in vitro if the intestinal microflora synthesizes PQQ from radio-chemically labeled precursors. The results of these experiments indicate that little if any PQQ is synthesized by the intestinal microflora. Rather, when PQQ is present in the intestine, the diet is a more obvious source.