Atopic Dermatitis Disease Education.

There has been an influx of new educational resources for atopic dermatitis (AD) patients in recent years. The two primary organizations in the United States offering educational materials, online resources, and other forms of support include the National Eczema Association (NEA) and the American Academy of Dermatology (AAD). Educational workshops and interventions have emerged as tools that can deliver comprehensive information on AD, such as symptoms, treatments, and disease management. In regard to these workshops, studies have proven longer interventions to be more effective. Studies have also found multidisciplinary teams, including psychologists, dietitians, and AD specialists, to be more effective in AD treatment and education. Additionally, video-based education was found to be the most effective delivery medium compared to various written modes of education. Given the psychosocial impacts of AD, support groups have been found to improve life quality and decrease disease severity, with age-specific groups offering the greatest benefits. Technology such as social media and smartphones has also improved education. Social media has allowed the rapid exchange of information to wider audiences, but due to its unregulated nature, false information has also been disseminated. Despite this, web-based interventions have still been found to be satisfying, convenient, and effective in increasing treatment awareness. The advent of smartphone applications has provided patients with access to information on AD symptoms and treatment on demand. While the effectiveness of these promising applications hasn't been confirmed by studies, patient provider interactions via smartphone (teledermatology) have been found to be as effective as in-person appointments. This chapter will discuss these different types of emerging resources available to AD patients including educational materials, interventions, support groups, organizational support, and technological resources and their effectiveness.

Use of a topical Janus kinase inhibitor in immune checkpoint inhibitor-induced eczematous reaction: a case report.

In this report, we describe the case of a 28-year-old female with bilateral breast cancer in the setting of a BRCA1 mutation, who presented to dermatology with an eczematous reaction, ultimately diagnosed as a cutaneous immune-related adverse event (cirAE) secondary to an immune checkpoint inhibitor (ICI), pembrolizumab. Our case report highlights a novel therapeutic option for an eczematous cirAE: the topical JAK 1/2 inhibitor, ruxolitinib. CirAEs can occur in up to 55% of patients on ICIs, a class of medications seeing rapidly increasing use in cancer therapy, and prior research has demonstrated that ICI-induced dermatitis may involve different pathways than traditionally observed in their spontaneous counterparts. Specifically, marked Th1 skewing is noted in ICI-induced dermatitis, as opposed to a predominant Th2 response which typically characterizes spontaneous atopic dermatitis. To our knowledge, this is the first case report in the literature discussing use of a topical JAK inhibitor, ruxolitinib, in the treatment of topical steroid-refractory cirAEs. Furthermore, as topical JAK inhibitors are thought to not carry the risks of systemic JAK inhibitors, including malignancy, ruxolitinib cream is a promising therapeutic option for this challenging patient population.

The 10,000-year biocultural history of fallow deer and its implications for conservation policy.

Over the last 10,000 y, humans have manipulated fallow deer populations with varying outcomes. Persian fallow deer (Dama mesopotamica) are now endangered. European fallow deer (Dama dama) are globally widespread and are simultaneously considered wild, domestic, endangered, invasive and are even the national animal of Barbuda and Antigua. Despite their close association with people, there is no consensus regarding their natural ranges or the timing and circumstances of their human-mediated translocations and extirpations. Our mitochondrial analyses of modern and archaeological specimens revealed two distinct clades of European fallow deer present in Anatolia and the Balkans. Zooarchaeological evidence suggests these regions were their sole glacial refugia. By combining biomolecular analyses with archaeological and textual evidence, we chart the declining distribution of Persian fallow deer and demonstrate that humans repeatedly translocated European fallow deer, sourced from the most geographically distant populations. Deer taken to Neolithic Chios and Rhodes derived not from nearby Anatolia, but from the Balkans. Though fallow deer were translocated throughout the Mediterranean as part of their association with the Greco-Roman goddesses Artemis and Diana, deer taken to Roman Mallorca were not locally available Dama dama, but Dama mesopotamica. Romans also initially introduced fallow deer to Northern Europe but the species became extinct and was reintroduced in the medieval period, this time from Anatolia. European colonial powers then transported deer populations across the globe. The biocultural histories of fallow deer challenge preconceptions about the divisions between wild and domestic species and provide information that should underpin modern management strategies.

Clinical Experience of a Long-acting Pegylated Erythropoietin-Stimulating Agent in Pediatric Chronic Kidney Disease.

OBJECTIVE: Management of anemia of chronic kidney disease (CKD) often includes subcutaneous or intravenous administration of erythropoietin-stimulating agents (ESAs). Mircera, a pegylated continuous erythropoietin receptor agonist, has a longer duration of action and requires less frequent administration than other ESAs. Pediatric experience with Mircera is limited. We retrospectively reviewed our long-term experience of Mircera in a national pediatric nephrology center. METHODS: Patients were identified via an electronic patient record database. Data collected included demographics (sex, age, etiology of CKD, CKD stage, dialysis modality), dosing information, and laboratory data-hemoglobin (Hb), parathormone (PTH), ferritin, hematinics prior to commencing Mircera and all subsequent values associated with dose adjustments. RESULTS: Seventy-seven patients aged 2 to 18 years, with CKD stages 2 to 5T had received at least 1 dose of Mircera, with 75 patients having sufficient data and a total of 1473 doses. No patients discontinued Mircera owing to adverse effects. One patient experienced a potential severe adverse drug reaction. Mircera was effective in improving or maintaining Hb ≥10.0 g/dL in most (58/75, 77.3%) patients. The median dose to achieve Hb ≥10.0 g/dL was 2.1 µg/kg/4 wk. Most doses (1039, 71.5%) were administered 4-weekly. The doses (161, 11.1%) that were administered 6-weekly remained efficacious. Thirty-two patients started Mircera with Hb <10.0 g/dL; 26 (81%) achieved Hb ≥10.0 g/dL within a median time of 4 months. Mircera was less effective if given every 8 weeks, or in the presence of hyperparathyroidism or hyperferritinemia. CONCLUSION: Mircera appears safe and effective in pediatric patients with CKD.

Wet feet: developing sulfur isotope provenance methods to identify wetland inhabitants.

The stable isotopes of sulfur provide a distinctive signature for marine proximity and interaction. Exploring coastal proximity has been the principal application of sulfur isotopes in archaeology and palaeoecology, but this deals only with high (greater than 14‰) isotope values, meaning little interpretation has been gained from lower values. Progress has been hindered by issues with biosphere mapping. Air pollution can impact modern landscapes, significantly lowering sulfur isotope baselines, leading to the assumption that modern vegetation-based sulfur maps are not reliable. This research explores the potential of previously undiagnostic low, and often, negative sulfur isotope values for identifying wetland dwellers. Impervious clays that support wetlands are distinctive ecosystems and this study tests the hypothesis that they will produce low isotope values owing to both the underlying substrate and to redox conditions. Primary mapping of targeted areas using modern plants highlights zones with natural negative sulfur values and demonstrates that this constitutes a distinctive wetland signature. Analysis of modern and archaeological fauna demonstrates that these distinctive isotope compositions are transferred into the food chain. These findings propel the interpretative potential of sulfur isotopes forward and add to the growing knowledge to provide means for identifying archaeological humans and animals raised in wetlands.

Bortezomib-Induced Reticular Eruption in Patient with Multiple Myeloma.

Bortezomib is the first proteasome inhibitor to treat a variety of malignancies and is currently part of the standard of care regimen for the initial treatment of patients with newly diagnosed multiple myeloma. While bortezomib is generally well tolerated, it has been associated with various side effects, which have limited its use in some patients. Here, we describe a unique case with histological confirmation of a reticular eruption that appeared at the site of a subcutaneous administration of bortezomib in a 62-year-old male who was newly diagnosed with IgG kappa multiple myeloma. A skin biopsy was performed, which revealed superficial perivascular dermatitis predominantly composed of lymphocytes with rare eosinophils. The patient was successfully treated with betamethasone dipropionate 0.05% cream. When consulted, dermatologists should advise the oncology team of multiple myeloma patients treated with bortezomib to maintain a high threshold before discontinuing the drug when a patient experiences an atypical, reticular rash following subcutaneous administration. Additionally, potent topical corticosteroids, such as betamethasone dipropionate 0.05% cream, should be considered in managing the cutaneous reticular eruptions related to bortezomib administration, in order to maintain an optimal treatment regimen for patients with multiple myeloma.

Mobility and kinship in the world's first village societies.

Around 10,000 y ago in southwest Asia, the cessation of a mobile lifestyle and the emergence of the first village communities during the Neolithic marked a fundamental change in human history. The first communities were small (tens to hundreds of individuals) but remained semisedentary. So-called megasites appeared soon after, occupied by thousands of more sedentary inhabitants. Accompanying this shift, the material culture and ancient ecological data indicate profound changes in economic and social behavior. A shift from residential to logistical mobility and increasing population size are clear and can be explained by either changes in fertility and/or aggregation of local groups. However, as sedentism increased, small early communities likely risked inbreeding without maintaining or establishing exogamous relationships typical of hunter-gatherers. Megasites, where large populations would have made endogamy sustainable, could have avoided this risk. To examine the role of kinship practices in the rise of megasites, we measured strontium and oxygen isotopes in tooth enamel from 99 individuals buried at Pinarbasi, Boncuklu, and Çatalhöyük (Turkey) over 7,000 y. These sites are geographically proximate and, critically, span both early sedentary behaviors (Pinarbasi and Boncuklu) and the rise of a local megasite (Çatalhöyük). Our data are consistent with the presence of only local individuals at Pinarbasi and Boncuklu, whereas at Çatalhöyük, several nonlocals are present. The Çatalhöyük data stand in contrast to other megasites where bioarchaeological evidence has pointed to strict endogamy. These different kinship behaviors suggest that megasites may have arisen by employing unique, community-specific kinship practices.

Isotope analysis of human dental calculus δ13 CO3 2- : Investigating a potential new proxy for sugar consumption.

RATIONALE: Dental calculus (mineralised dental plaque) is composed primarily of hydroxyapatite. We hypothesise that the carbonate component of dental calculus will reflect the isotopic composition of ingested simple carbohydrates. Therefore, dental calculus carbonates may be an indicator for sugar consumption, and an alternative to bone carbonate in isotopic palaeodiet studies. METHODS: We utilised Fourier transform infrared attenuated total reflectance analysis to characterise the composition and crystallisation of bone and dental calculus before isotope analysis of carbonate. Using a Sercon 20-22 mass spectrometer coupled with a Sercon GSL sample preparation system and an IsoPrime 100 dual inlet mass spectrometer plus Multiprep device to measure carbon, we tested the potential of dental calculus carbonate to identify C4 resources in diet through analysis of δ13 C values in paired bone, calculus and teeth mineral samples. RESULTS: The modern population shows higher δ13 C values in all three tissue carbonates compared to both archaeological populations. Clear differences in dental calculus δ13 C values are observed between the modern and archaeological individuals suggesting potential for utilising dental calculus in isotope palaeodiet studies. The offset between dental calculus and either bone or enamel carbonate δ13 C values is large and consistent in direction, with no consistent offset between the δ13 C values for the three tissues per individual. CONCLUSIONS: Our results support dental calculus carbonate as a new biomaterial to identify C4 sugar through isotope analysis. Greater carbon fractionation in the mouth is likely due to the complex formation of dental calculus as a mineralized biofilm, which results in consistently high δ13 C values compared to bone and enamel.

UK experience of ofatumumab in recurrence of focal segmental glomerulosclerosis post-kidney transplant.

BACKGROUND: Steroid-resistant nephrotic syndrome (SRNS), commonly caused by focal segmental glomerulosclerosis (FSGS), is associated with progression to stage 5 chronic kidney disease, requirement for kidney replacement therapy and a risk of disease recurrence post-kidney transplantation. Ofatumumab (OFA) is a fully humanised monoclonal antibody to CD20, with similar mechanisms of action to rituximab (RTX). METHODS: We report a case series of seven UK patients (five paediatric, two adult), all of whom developed FSGS recurrence after kidney transplantation and received OFA as part of their therapeutic intervention. All also received concomitant plasmapheresis. The 2-year outcome of these seven patients is reported, describing clinical course, kidney function and proteinuria. RESULTS: Four patients (all paediatric) achieved complete urinary remission with minimal proteinuria 12 months post-treatment. Three of those four also had normal graft function. Two patients showed partial remission-brief improvement to non-nephrotic proteinuria (197 mg/mmol) in one patient, maintained improvement in kidney function (estimated glomerular filtration rate 76 ml/min/1.73 m2) in the other. One patient did not demonstrate any response. CONCLUSIONS: OFA may represent a useful addition to therapeutic options in the management of FSGS recurrence post-transplantation, including where RTX has shown no benefit. Concomitant plasmapheresis in all patients prevents any definitive conclusion that OFA was the beneficial intervention.

Diversity aboard a Tudor warship: investigating the origins of the Mary Rose crew using multi-isotope analysis.

The great Tudor warship, the Mary Rose, which sank tragically in the Solent in 1545 AD, presents a rare archaeological opportunity to research individuals for whom the precise timing and nature of death are known. A long-standing question surrounds the composition of the Tudor navy and whether the crew were largely British or had more diverse origins. This study takes a multi-isotope approach, combining strontium (87Sr/86Sr), oxygen (δ18O), sulfur (δ34S), carbon (δ13C) and nitrogen (δ15N) isotope analysis of dental samples to reconstruct the childhood diet and origins of eight of the Mary Rose crew. Forensic ancestry estimation was also employed on a subsample. Provenancing isotope data tentatively suggests as many as three of the crew may have originated from warmer, more southerly climates than Britain. Five have isotope values indicative of childhoods spent in western Britain, one of which had cranial morphology suggestive of African ancestry. The general trend of relatively high δ15N and low δ13C values suggests a broadly comparable diet to contemporaneous British and European communities. This multi-isotope approach and the nature of the archaeological context has allowed the reconstruction of the biographies of eight Tudor individuals to a higher resolution than is usually possible.

Thromboprophylaxis in congenital nephrotic syndrome: 15-year experience from a national cohort.

INTRODUCTION: Congenital nephrotic syndrome (CNS) is an ultra-rare disease associated with a pro-thrombotic state and venous thromboembolisms (VTE). There is very limited evidence evaluating thromboprophylaxis in patients with CNS. This study aimed to determine the doses and duration of treatment required to achieve adequate thromboprophylaxis in patients with CNS. METHODS: From 2005 to 2018 children in Scotland with a confirmed genetic or histological diagnosis of CNS were included if commenced on thromboprophylaxis. The primary study endpoint was stable drug monitoring. Secondary outcomes included VTE or significant haemorrhage. RESULTS: Eight patients were included; all initially were commenced on low-molecular weight heparin (enoxaparin). Four patients maintained therapeutic anti-Factor Xa levels (time 3-26 weeks, dose 3.2-5.07 mg/kg/day), and one patient developed a thrombosis (Anti-Factor Xa: 0.27 IU/ml). Four patients were subsequently treated with warfarin. Two patients maintained therapeutic INRs (time 6-11 weeks, dose 0.22-0.25 mg/kg/day), and one patient had two bleeding events (Bleed 1: INR 6, Bleed 2: INR 5.5). CONCLUSIONS: Achieving thromboprophylaxis in CNS is challenging. Similar numbers of patients achieved stable anticoagulation on warfarin and enoxaparin. Enoxaparin dosing was nearly double the recommended starting doses for secondary thromboprophylaxis. Bleeding events were all associated with supra-therapeutic anticoagulation.

An ideal solution? Optimising pretreatment methods for artificially mummified ancient Egyptian tissues.

RATIONALE: Although the analysis of skeletal remains dominates the study of ancient dietary stable isotopes, mummified bodies also allow short-term diet to be studied through the analysis of soft tissues. The application of resins, waxes and oils during mummification can affect the results obtained. This study assesses a range of methods for removing such substances from mummified tissue. METHODS: An experimental mummification model following ancient Egyptian methods was created using a modern pig leg. Sub-samples of skin, muscle and bone were removed and coated with a range of substances used in Egyptian mummification. Four methods were used to clean these samples before the measurement of the carbon and nitrogen stable isotope ratios of their gelatinised collagen content using a ThermoFinnigan Flash Elemental analyser coupled to a DeltaPlus XL isotope ratio mass spectrometer via a ConFlo III interface. RESULTS: The results showed that embalming materials can significantly affect dietary stable isotope ratios, and that these substances are most effectively removed using a mixture of polar and non-polar solvents. Results indicate that bone samples demineralised with HCl and skin samples produce more accurate results than bone samples demineralised with EDTA or muscle samples. CONCLUSIONS: The choice of tissue and the preparation methods used can have a significant effect on the accuracy of stable isotope data obtained from mummified tissue, particularly when embalming materials are also present. A mixture of solvents appears to be a more effective cleaning agent than a single solvent. Demineralisation with HCl is preferable for well-preserved bone, as used in this study, but whether this is the case for more fragile, less well-preserved bone requires further study. Skin samples produce more consistent data than muscle, but visually distinguishing between these tissues is not simple on ancient mummies.

Feasting and Mobility in Iron Age Ireland: Multi-isotope analysis reveals the vast catchment of Navan Fort, Ulster.

Navan Fort is an iconic prehistoric Irish ceremonial centre and the legendary capital of Ulster. The fort has produced an exceptional pig-dominated faunal assemblage that also contained a barbary macaque skull. Dating from the 4th to 1st century BC, it is likely to be a ceremonial feasting centre that may have drawn people and their animals from across Ulster and beyond. This study uses a multi-isotope (87Sr/86Sr, δ34S, δ13C, δ15N) approach to identify non-local animals and reconstruct site catchment. New biosphere mapping means that isotope data can be more confidently interpreted and the combination of strontium and sulphur analysis has the potential to estimate origins. In the absence of human remains, fauna provide the best proxy for human movement. Results for the 35 analysed animals are wide-ranging, especially in terms of strontium (0.707-0.715), which has the largest range for an Irish site. Sulphur values are more restricted (13.1‰-17.1‰) but are high in the context of British and Irish data. Results provide clear evidence for animals (and thus people) coming from across Ulster and beyond, demonstrating the site's wide catchment. Navan Fort was clearly a major ceremonial centre with far-reaching influence and hosted feasts that drew people and animals from afar.

Immune state is associated with natural dietary variation in wild mice Mus musculus domesticus.

The ability, propensity and need to mount an immune response vary both among individuals and within a single individual over time.A wide array of parameters has been found to influence immune state in carefully controlled experiments, but we understand much less about which of these parameters are important in determining immune state in wild populations.Diet can influence immune responses, for example when nutrient availability is limited. We therefore predict that natural dietary variation will play a role in modulating immune state, but this has never been tested.We measured carbon and nitrogen stable isotope ratios in an island population of house mice Mus musculus domesticus as an indication of dietary variation, and the expression of a range of immune-related genes to represent immune state.After accounting for potential confounding influences such as age, sex and helminth load, we found a significant association between carbon isotope ratio and levels of immune activity in the mesenteric lymph nodes, particularly in relation to the inflammatory response.This association demonstrates the important interplay between diet and an animal's response to immune challenges, and therefore potentially its susceptibility to disease. A plain language summary is available for this article.

The relationship between the phosphate and structural carbonate fractionation of fallow deer bioapatite in tooth enamel.

RATIONALE: The species-specific relationship between phosphate (δ18 OP values) and structural carbonate (δ18 OC values) oxygen isotope ratios has been established for several modern and fossil animal species but until now it has not been investigated in European fallow deer (Dama dama dama). This study describes the relationship between phosphate and structural carbonate bioapatite in tooth enamel of extant fallow deer, which will help us further understand the species' unique environmental and cultural history. METHODS: The oxygen isotope composition of phosphate (δ18 OP value) and structural carbonate (δ18 OC value) of hydroxylapatite was determined in 51 modern fallow deer tooth enamel samples from across Europe and West Asia. The δ18 OC values were measured on a GV IsoPrime dual-inlet mass spectrometer and the δ18 OP values on a temperature-controlled elemental analyser (TC/EA) coupled to a DeltaPlus XL isotope ratio mass spectrometer via a ConFlo III interface. RESULTS: This study establishes a direct and linear relationship between the δ18 OC and δ18 OP values from fallow deer tooth enamel (δ18 OC = +9.244(±0.216) + 0.958 * δ18 OP (±0.013)). Despite the successful regression, the variation in δ18 O values from samples collected in the same geographical area is greater than expected, although the results cluster in broad climatic groupings when Koppen-Geiger classifications are taken into account for the individuals' locations. CONCLUSIONS: This is the first comprehensive study of the relationship between ionic forms of oxygen (phosphate oxygen and structural carbonate) in fallow deer dental enamel. The new equation will allow direct comparison with other herbivore data. Variable δ18 O values within populations of fallow deer broadly reflect the ecological zones they are found in which may explain this pattern of results in other euryphagic species.

An early Cambrian greenhouse climate.

The oceans of the early Cambrian (~541 to 509 million years ago) were the setting for a marked diversification of animal life. However, sea temperatures-a key component of the early Cambrian marine environment-remain unconstrained, in part because of a substantial time gap in the stable oxygen isotope (δ18O) record before the evolution of euconodonts. We show that previously overlooked sources of fossil biogenic phosphate have the potential to fill this gap. Pristine phosphatic microfossils from the Comley Limestones, UK, yield a robust δ18O signature, suggesting sea surface temperatures of 20° to 25°C at high southern paleolatitudes (~65°S to 70°S) between ~514 and 509 million years ago. These sea temperatures are consistent with the distribution of coeval evaporite and calcrete deposits, peak continental weathering rates, and also our climate model simulations for this interval. Our results support an early Cambrian greenhouse climate comparable to those of the late Mesozoic and early Cenozoic, offering a framework for exploring the interplay between biotic and environmental controls on Cambrian animal diversification.