ABSTRACT
BACKGROUND: Atopic dermatitis is a systemic disorder characterized by abnormal barrier function across multiple organ sites. Causes of epidermal barrier breakdown are complex and driven by a combination of structural, genetic, environmental and immunological factors. In addition, alteration in microflora diversity can influence disease severity, duration, and response to treatment. Clinically, atopic dermatitis can progress from skin disease to food allergy, allergic rhinitis, and later asthma, a phenomenon commonly known as the atopic march. The mechanism by which atopic dermatitis progresses towards gastrointestinal or airway disease remains to be elucidated. OBJECTIVES: This review addresses how epithelial dysfunction linking microbiome alteration and immune dysregulation can predispose to the development of the atopic march. METHODS: A literature search was conducted using the PubMed database for relevant articles with the keywords 'atopic dermatitis', 'epithelial barrier', 'skin', 'gut', 'lung', 'microbiome' and 'immune dysregulation'. RESULTS: Initial disruption in the skin epidermal barrier permits allergen sensitization and colonization by pathogens. This induces a T helper 2 inflammatory response and a thymic stromal lymphopoietin-mediated pathway that further promotes barrier breakdown at distant sites, including the intestinal and respiratory tract. CONCLUSIONS: As there are no immediate cures for food allergy or asthma, early intervention aimed at protecting the skin barrier and effective control of local and systemic inflammation may improve long-term outcomes and reduce allergen sensitization in the airway and gut.
Subject(s)
Dermatitis, Atopic/immunology , Gastrointestinal Microbiome/immunology , Intestinal Mucosa/metabolism , Respiratory Mucosa/metabolism , Skin/metabolism , Asthma/immunology , Asthma/pathology , Dermatitis, Atopic/diagnosis , Dermatitis, Atopic/pathology , Dermatitis, Atopic/therapy , Disease Progression , Epithelium/immunology , Epithelium/metabolism , Food Hypersensitivity/immunology , Food Hypersensitivity/pathology , Humans , Intestinal Mucosa/immunology , Intestinal Mucosa/microbiology , Permeability , Respiratory Mucosa/immunology , Rhinitis, Allergic/immunology , Rhinitis, Allergic/pathology , Severity of Illness Index , Skin/immunology , Skin/pathology , Treatment OutcomeABSTRACT
Blunt pelvic trauma may lead to disruption of the pelvic ring, acetabular fracture, and significant soft tissue injury. The radiologist must be familiar with not only the imaging approach to these lesions but also the anatomy, biomechanics of injury, and fracture classification to communicate effectively with trauma surgeons and to participate as a member of the trauma team.
Subject(s)
Acetabulum/injuries , Pelvic Bones/injuries , Acetabulum/anatomy & histology , Acetabulum/physiology , Biomechanical Phenomena , Communication , Diagnostic Imaging , Fractures, Bone/classification , Fractures, Bone/diagnosis , Fractures, Bone/pathology , Fractures, Bone/physiopathology , General Surgery , Humans , Interprofessional Relations , Patient Care Team , Pelvic Bones/anatomy & histology , Pelvic Bones/physiology , Soft Tissue Injuries/diagnosis , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/pathology , Wounds, Nonpenetrating/physiopathologyABSTRACT
In 1978 the authors established a weekly psychiatric clinic for Indochinese refugees. During the first 20 months, 50 patients were evaluated and treated at the clinic; a Vietnamese psychiatric resident and several native Indochinese mental health counselors bridged the language and cultural barriers between patients and clinic personnel. Most of the patients seen at the beginning of the program were psychotic and severely impaired. However, patients seen later suffered from a wider variety of problems. A flexible approach to treatment was adopted that would be compatible with the cultural expectations of the refugees. This resulted in the use of different forms of therapy and special emphasis on the medical approach of the physician, a role familiar to Indochinese patients. Gradually the clinic gained acceptance by members of the local refugee community.
