The mule on the Mount Wilson trail: George Ellery Hale, American scientific cosmology, and cosmologies of American science.

This article explores the relation between two different modes of cosmology: the social and the scientific. Over the twentieth century, scientific understandings of the dimensions and operations of the physical universe changed dramatically, significantly prompted by astronomical and astrophysical research undertaken at the Mount Wilson Observatory in Pasadena, California. Could those understandings be readily translated into social theory? Studies across a range of disciplines have intimated that the scientific cosmos might be less essential to the worlds of meaning and belonging that people and communities compose around themselves than more local and relational models of an ordered whole. The article applies that proposition to the Mount Wilson Observatory itself, arguing that the observatory's founder, George Ellery Hale, and his acolytes were deeply invested in practices of terrestrial place-making, the politics of belonging, and the cadences of civilizational time as applied to their city and its region. Moreover, they struggled to construct a philosophy integrating the cosmos they were seeking to fix at home with the contortions and careering trajectories of the universal whole.

Salazinic Acid and Norlobaridone from the Lichen Hypotrachyna cirrhata: Antioxidant Activity, α-Glucosidase Inhibitory and Molecular Docking Studies.

The present study was intended for the identification of secondary metabolites in acetone extract of the lichen Hypotrachyna cirrhata using UPLC-ESI-QToF-MS/MS and the detection of bioactive compounds. This study led to the identification of 22 metabolites based on their MS/MS spectra, accurate molecular masses, molecular formula from a comparison of the literature database (DNP), and fragmentation patterns. In addition, potent antioxidant and α-glucosidase inhibitory potentials of acetone extract of H. cirrhata motivated us to isolate 10 metabolites, which were characterized as salazinic acid (11), norlobaridone (12), atranorin (13), lecanoric acid (14), lichesterinic acid (15), protolichesterinic acid (16), methyl hematommate (17), iso-rhizonic acid (18), atranol (19), and methylatratate (20) based on their spectral data. All these isolates were assessed for their free radicals scavenging, radical-induced DNA damage, and intestinal α-glucosidase inhibitory activities. The results indicated that norlobaridone (12), lecanoric acid (14), methyl hematommate (17), and atranol (19) showed potent antioxidant activity, while depsidones (salazinic acid (11), norlobaridone (12)) and a monophenolic compound (iso-rhizonic acid, (18)) displayed significant intestinal α-glucosidase inhibitory activities (p < 0.001), which is comparable to standard acarbose. These results were further correlated with molecular docking studies, which indicated that the alkyl chain of norlobaridione (12) is hooked into the finger-like cavity of the allosteric pocket; moreover, it also established Van der Waals interactions with hydrophobic residues of the allosteric pocket. Thus, the potency of norlobaridone to inhibit α-glucosidase enzyme might be associated with its allosteric binding. Also, MM-GBSA (Molecular Mechanics-Generalized Born Surface Area) binding free energies of salazinic acid (11) and norlobaridone (12) were superior to acarbose and may have contributed to their high activity compared to acarbose.

Language as a Specimen.

Language was never studied by linguists (or philologists) alone. The greater part of the languages of the world was first known in the West through the reports of missionaries, explorers, and colonial administrators, and what they documented reflected their specific interests. Missionaries wrote catechisms, primers, dictionaries, and Bible translations (especially Lord's Prayers); for explorers and administrators, language was one aspect among many to cover in their accounts of faraway regions. Peoples were identified by their language; toponyms served for geographic description; names of plants and animals were gathered together with specimens and images of plants and animals. In this context, linguistic materials were equally described as "specimens." This article investigates the various ways in which language material was used and conceived of as a specimen, and the global trajectories of these "specimens." Especially the role of naturalist explorers deserves closer attention in this regard. What they did, throughout the late 18th and 19th century, was gathering language material as one kind of specimen among others, Forster in the Pacific, Humboldt, Martius, and d'Orbigny in South America, and Peters in Mozambique. Two large-scale expeditions from the mid-19th century stand out as examples: the U.S. Exploring Expedition (1838-1842), whose collections later filled the Smithsonian Institution, and the Austrian-Hungarian Novara expedition (1857-1859).

Indicuen, a new hopane from Parmotrema indicum Hale growing in Vietnam.

One new hopane-type triterpene, indicuen (1), along with eight known compounds (2-9) were isolated from the n-hexane extract of the lichen Parmotrema indicum Hale. The chemical structures of isolated compounds were identified by interpretation of their spectroscopic data (1D, 2D NMR and HRESIMS) combined with DFT-NMR chemical shift calculations and subsequent assignment of DP4+ probabilities and by comparison with the literature. Indicuen represents for a rare hopane bearing a 1-carboxyethyl substituent at C-21 in lichens. Compounds 1-3 and 5-8 were evaluated for α-glucosidase inhibition and cytotoxicity against K562 and HepG2 cancer cell lines. Compounds 1, 5 and 7 exhibited moderate α-glucosidase inhibition with IC50 values of 201.1, 156.3 and 187.4 µM, respectively. Compound 1 also showed weak cytotoxicity toward K562 cell line while others showed no activity.

A new diphenyl ether from Parmotrema indicum Hale growing in Vietnam.

Chemical investigation of the lichen Parmotrema indicum Hale led to the isolation of one new diphenyl ether, parmetherine D (1), along with eight known compounds (2-9). The structures were determined by analysis of MS and NMR data and by comparison with the literature. Compounds 1, 2, and 7 were evaluated for α-glucosidase inhibition. Only compound 1 exhibited significant inhibition.[Formula: see text].

Disparities in Breast Cancer Survivors in Rural West Texas.

OBJECTIVES: Breast cancer is the second highest female mortality rate in Texas for all races and ethnicities, except for Hispanics. Interestingly, Hale County is a rural underserved county in West Texas which experiences a lower rate of cancer, has higher age-adjusted mortality rates (26.2/100 000), on average, compared to all of Texas (23.1/100 000). The purpose of this study was to determine the relationship between sociodemographic variables and breast cancer outcomes in underserved Hale County which contributed to the highest mortality rate in Texas. METHODS: Hale County breast cancer data (1995-2014) were obtained from the Texas Cancer Registry. Statistical methods independent samples t-test, Kaplan-Meier curve, and Cox proportional hazard were used to describe the significant relationship between survival time, sociodemographic, and prognostic variables. RESULTS: Women with breast cancer in Hale County were more likely to be White non-Hispanics (n = 266, 65.5%) and had the highest longevity (2753.6 ± 2073.5 days). White Hispanics experienced the worst survival (2369.6 ± 2060.2 days) and were more likely to develop a serious grade of cancer. Significant relationships were found between the stage of cancer and insurance status with survival time for both White non-Hispanics and White Hispanics (P < .001). Patients in grades II and III were found to be significantly (P < .01) associated with breast cancer death, and grades II and III which had around five-fold and eleven-fold increased risk of death, respectively, compared with the referent group, grade I. CONCLUSION: Determining the impact of sociodemographic variables on breast cancer outcome is essential to addressing issues of geographic disparities and integrating such variables may guide relevant policy interventions to reduce breast cancer's incidence in rural underserved communities in West Texans.

Sex-Dependent End-of-Life Mental and Vascular Scenarios for Compensatory Mechanisms in Mice with Normal and AD-Neurodegenerative Aging.

Life expectancy decreases with aging, with cardiovascular, mental health, and neurodegenerative disorders strongly contributing to the total disability-adjusted life years. Interestingly, the morbidity/mortality paradox points to females having a worse healthy life expectancy. Since bidirectional interactions between cardiovascular and Alzheimer's diseases (AD) have been reported, the study of this emerging field is promising. In the present work, we further explored the cardiovascular-brain interactions in mice survivors of two cohorts of non-transgenic and 3xTg-AD mice, including both sexes, to investigate the frailty/survival through their life span. Survival, monitored from birth, showed exceptionally worse mortality rates in females than males, independently of the genotype. This mortality selection provided a "survivors" cohort that could unveil brain-cardiovascular interaction mechanisms relevant for normal and neurodegenerative aging processes restricted to long-lived animals. The results show sex-dependent distinct physical (worse in 3xTg-AD males), neuropsychiatric-like and cognitive phenotypes (worse in 3xTg-AD females), and hypothalamic-pituitary-adrenal (HPA) axis activation (higher in females), with higher cerebral blood flow and improved cardiovascular phenotype in 3xTg-AD female mice survivors. The present study provides an experimental scenario to study the suggested potential compensatory hemodynamic mechanisms in end-of-life dementia, which is sex-dependent and can be a target for pharmacological and non-pharmacological interventions.

Health expectancy indicators: what do they measure? / Indicadores de expectativa de vida saudável: o que medem?

Abstract Background Health expectancy indicators aim at capturing the quality dimension of total life expectancy.; however, the underlying approach, definition of health, and information source differ considerably among the indicators available. Objective (1) Review the main concepts and approaches used to estimate health expectancy focusing on two widely used European health indicators: Health-Adjusted Life Expectancy (HALE) and Healthy Life Years (HLY); (2) identify underlying differences between the results yielded by these two indicators. Method Statistical differences between the HALE and HLY indicators by sex at ages 50, 60, and 70 were tested using pairwise and global Student´s t-tests and z-scores based on standard deviation. Data for 29 European countries were collected from the European Health Expectancy Monitoring Unit (EHEMU) information system and the World Health Organization (WHO) Global Burden of Disease Study 2016 (GBD 2016). Results The HALE indicator estimates were smoother across European countries compared with those of the HLY indicator, present a narrower sex gap in morbidity, higher z-scores compared with the average distribution across Europe, and results less sensitive to cross-national variations. Conclusion The HALE estimates indicate that morbidity is more compressed for both sexes, whereas the HLY estimates suggest that morbidity is more compressed for males but more expanded for females. These contrasting results demonstrate that health expectancy indicators should be interpreted with caution.

Resumo Introdução Os indicadores de expectativa de vida saudável visam capturar uma dimensão de qualidade na expectativa de vida total. No entanto, os pressupostos, a definição de saúde e a fonte de informação diferem consideravelmente entre os indicadores. Objetivo (1) Revisar os principais conceitos e abordagens para estimar as expectativas de saúde com foco em dois indicadores de saúde usados no caso europeu (HALE e HLY); e (2) Identificar diferenças subjacentes nos resultados gerados por esses dois indicadores. Método As diferenças estatísticas entre HALE e HLY por sexo nas idades de 50, 60 e 70 são testadas através dos testes t de Student emparelhados e globais e escores z com base no desvio padrão. Os dados são de 29 países europeus do Sistema Europeu de Informação da Unidade de Monitoramento de Expectativas de Saúde (EHEMU) e do estudo OMS-GBD para o ano de 2016. Resultados As estimativas da HALE possuem menor variabilidade entre os países europeus do que a HLY, apresentam uma diferença de morbidade menor por sexo, apresentam escores-z mais altos em comparação com a distribuição média europeia e têm resultados menos sensíveis às variações entre países. Conclusão As estimativas da HALE indicam que a morbidade é mais comprimida para ambos os sexos, enquanto a HLY sugere que a morbidade para os homens é mais comprimida e para mulheres mais expandida. Esses resultados contrastantes implicam que se deve ter cuidado com os indicadores de expectativa de vida saudável e sua interpretação.

Henry Jacob Bigelow Inhaled Nitrous Oxide While an Undergraduate at Harvard College.

When teenaged Henry Jacob Bigelow was an undergraduate at Harvard College in 1833-1837, he prepared nitrous oxide gas for demonstrations to other students. Bigelow's son, William Sturgis Bigelow, related the claim, and there is an eyewitness account from Augustus Goddard Peabody, a fellow Harvard undergraduate with Bigelow. Peabody wrote to Henry David Thoreau about a nitrous frolic. College chemistry primed Bigelow to support the concept of inhaled surgical anesthesia when the idea came to Boston in 1845-1846. Bigelow's chemistry professor was John White Webster. According to Harvard alumnus Edward Everett Hale, in addition to demonstrating effects of nitrous oxide, Webster presciently treated two cases of carbon monoxide poisoning with copious volumes of synthetic oxygen gas. The career of Webster was inhibited by financial difficulties that were suspected to be contributory when he was convicted of the 1849 murder of physician George Parkman at the Harvard Medical School, then adjacent to Massachusetts General Hospital and its Ether Dome. Webster suffered the death penalty in 1850.

Initiation and Flow Conditions of Contemporary Flows in Martian Gullies.

Understanding the initial and flow conditions of contemporary flows in Martian gullies, generally believed to be triggered and fluidized by CO2 sublimation, is crucial for deciphering climate conditions needed to trigger and sustain them. We employ the RAMMS (RApid Mass Movement Simulation) debris flow and avalanche model to back calculate initial and flow conditions of recent flows in three gullies in Hale crater. We infer minimum release depths of 1.0-1.5 m and initial release volumes of 100-200 m3. Entrainment leads to final flow volumes that are ∼2.5-5.5 times larger than initially released, and entrainment is found necessary to match the observed flow deposits. Simulated mean cross-channel flow velocities decrease from 3-4 m/s to ∼1 m/s from release area to flow terminus, while flow depths generally decrease from 0.5-1 to 0.1-0.2 m. The mean cross-channel erosion depth and deposition thicknesses are ∼0.1-0.3 m. Back-calculated dry-Coulomb friction ranges from 0.1 to 0.25 and viscous-turbulent friction between 100 and 200 m/s2, which are values similar to those of granular debris flows on Earth. These results suggest that recent flows in gullies are fluidized to a similar degree as are granular debris flows on Earth. Using a novel model for mass flow fluidization by CO2 sublimation we are able to show that under Martian atmospheric conditions very small volumetric fractions of CO2 of ≪1% within mass flows may indeed yield sufficiently large gas fluxes to cause fluidization and enhance flow mobility.

Cystic renal oncocytoma mimicking renal cell carcinoma.

Cystic renal lesions are one of the commonly encountered urological conditions. They can be either benign or malignant. The Bosniak classification is employed to differentiate benign cysts from the malignant ones and to recommend treatment options. Bosniak type 4 cysts are mostly malignant. Rarely, benign tumors can be encountered in Bosniak type 4 cysts. We present a 59-year-old female who presented with a hilar Bosniak type 4 cyst in the right kidney. She underwent open exploration of the right renal tumor. The tumor was infiltrating into the renal vessels and could not be separated from the renal vein. In view of preoperative and intraoperative suspicion of malignancy, radical nephrectomy was done. Postoperative histopathological examination revealed the tumor to be an oncocytoma. The benign nature of the cyst could not be conclusively determined by preoperative investigations and intraoperative findings. Postoperative histological examination uncovered the rare cystic presentation of this benign tumor.

Operational and Financial Considerations of Using Drones for Medical Support of Mass Events in Poland.

OBJECTIVE: The implementation of drones in the medical security system requires a proper planning of the cooperation of different services, dividing the area into sectors, assessing potential risks, and other factors. This study refers to the cost analysis of using drones in the medical support of mass events. The aim of this research is to analyze the costs of unmanned aerial vehicle (UAV) implementation in the mass event medical support system. METHODS: The description includes purchase and maintenance costs of UAVs. The analysis also involves ways of raising funds for projects related to the UAV sector. Apart from the financial aspect, staff and drone operator training issues are the subjects of this analysis as well. RESULTS: This study is based on a specialist research involving drones and referring to reports on the current situation in Poland and in the world. CONCLUSIONS: The presented funds required for such projects and the way of raising these funds illustrate the range of the project and its requirements. (Disaster Med Public Health Preparedness. 2019;13:527-532).

On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review.

BACKGROUND: The amount a government should be willing to invest in adopting new medical treatments has long been under debate. With many countries using formal cost-effectiveness (C/E) thresholds when examining potential new treatments and ever-growing medical costs, accurately setting the level of a C/E threshold can be essential for an efficient healthcare system. OBJECTIVES: The aim of this systematic review is to describe the prominent approaches to setting a C/E threshold, compile available national-level C/E threshold data and willingness-to-pay (WTP) data, and to discern whether associations exist between these values, gross domestic product (GDP) and health-adjusted life expectancy (HALE). This review further examines current obstacles faced with the presently available data. METHODS: A systematic review was performed to collect articles which have studied national C/E thresholds and willingness-to-pay (WTP) per quality-adjusted life year (QALY) in the general population. Associations between GDP, HALE, WTP, and C/E thresholds were analyzed with correlations. RESULTS: Seventeen countries were identified from nine unique sources to have formal C/E thresholds within our inclusion criteria. Thirteen countries from nine sources were identified to have WTP per QALY data within our inclusion criteria. Two possible associations were identified: C/E thresholds with HALE (quadratic correlation of 0.63), and C/E thresholds with GDP per capita (polynomial correlation of 0.84). However, these results are based on few observations and therefore firm conclusions cannot be made. CONCLUSIONS: Most national C/E thresholds identified in our review fall within the WHO's recommended range of one-to-three times GDP per capita. However, the quality and quantity of data available regarding national average WTP per QALY, opportunity costs, and C/E thresholds is poor in comparison to the importance of adequate investment in healthcare. There exists an obvious risk that countries might either over- or underinvest in healthcare if they base their decision-making process on erroneous presumptions or non-evidence-based methodologies. The commonly referred to value of 100,000$ USD per QALY may potentially have some basis.

Cometary Dust.

This review presents our understanding of cometary dust at the end of 2017. For decades, insight about the dust ejected by nuclei of comets had stemmed from remote observations from Earth or Earth's orbit, and from flybys, including the samples of dust returned to Earth for laboratory studies by the Stardust return capsule. The long-duration Rosetta mission has recently provided a huge and unique amount of data, obtained using numerous instruments, including innovative dust instruments, over a wide range of distances from the Sun and from the nucleus. The diverse approaches available to study dust in comets, together with the related theoretical and experimental studies, provide evidence of the composition and physical properties of dust particles, e.g., the presence of a large fraction of carbon in macromolecules, and of aggregates on a wide range of scales. The results have opened vivid discussions on the variety of dust-release processes and on the diversity of dust properties in comets, as well as on the formation of cometary dust, and on its presence in the near-Earth interplanetary medium. These discussions stress the significance of future explorations as a way to decipher the formation and evolution of our Solar System.

[Rare Localization Of Angio-lymphoid Hyperplasia With Eosinophilia : A Case Study]. / Hyperplasie Angio-lymphoïde Avec Eosinophilie de localisation rare : à propos d'un cas.

INTRODUCTION: Angio-lymphoid hyperplasia with eosinophilia (ALHE) is a very rare dermatological vasoproliferative disease with unknown etiology. We report a case of rare localization and through a review of the literature, let us recall the radiological features of this condition. RESULTS: Young man of 16 years without a specific antecedent, presents pruritic nodules of the lower limbs. Ultrasound is a revealed nodules of the thighs, hypo-echo of varying size polylobed feeling in the subcutaneous fat in contact with the cutaneous coating. They are surrounded by hyperechogenic infiltration of the cellulo-fatty tissue. The most voluminous ones contain arteriovenous vascular branches without shunt, confirmed in color and pulsed Doppler mode. In computed tomography, it is the nodular isodense formations to the muscles, which presents an arterial vascularization derived from the more or less deep arteries of the limb for the most voluminous. The less voluminous are enhanced without clear identification of the vascular structures. The excision of the nodules and the historical study of the surgical specimen are revenues in favor of angiolymphoid hyperplasia with hypereosinophilia. The surgery was simple. Conclusion: Imaging plays an important role in the diagnosis, extension and preoperative assessment of angiolymphoid hyperplasia with hyper eosinophilia.

INTRODUCTION: L'hyperplasie angio-lymphoïde avec éosinophilie (HALE) est une maladie vasoproliferative essentiellement dermatologique très rare et d'étiologie inconnue. Nous rapportons un cas de localisation rare et à travers une revue de la littérature, rappelons les particularités radiologiques de cette affection. RÉSULTATS: Jeune homme de 16 ans sans antécédents particuliers, présente des nodules prurigineux des membres inférieurs. L'échographie doppler trouve des nodules des cuisses, hypo échogènes de taille variable polylobées siègent dans la graisse sous cutanée en contact avec le revêtement cutané. Elles sont entourées par l'infiltration hyperéchogène du tissu cellulo-graisseux. Les plus volumineux renferment des rameaux vasculaires artério-veineux sans shunte, confirmés en mode doppler couleur et pulsé. En tomodensitométrie, il s'agit des formations nodulaires isodenses aux muscles, présentant une vascularisation artérielle provenant des artères plus ou moins profondes du membre pour les plus volumineux. Les moins volumineuses se rehaussent sans identification nette des structures vasculaires. L'exérèse des nodules et l'étude histologique de la pièce opératoire sont revenues en faveur de l'hyperplasie angiolymphoïde avec hyperéosinophilie. Les suites opératoires étaient simples. CONCLUSION: L'imagerie joue un rôle important dans le diagnostic, extension et le bilan pré opératoire de l'hyperplasie angiolymphoïde avec hyper éosinophilie.

An analysis on health life expectancy of adult residents in Zhejiang Province / 预防医学

Objective To analyze the health life expectancy (HALE) of the residents aged 15 years and above in Zhejiang Province and to evaluate the health level among adults. Methods The study was based the mortality data collected from Zhejiang Chronic Disease Surveillance Information and Management System, and the mortality rates were from the Under-Reporting Survey and the sample data in Zhejiang from the 5th National Health Service Survey in 2013. A Sullivan' s method was used to calculate the HALE. Results The life expectancy and self-evaluated HALE were 63.62 years, 55.80 years, respectively, and the difference was 7.82 years (61.49 years VS 55.13 years in males and 66.10 years VS 56.57 years in females) . The self-evaluated HALE 55.89 years in urban and 55.54 years in rural residents aged 15 years and above. The proportion of self-evaluated HALE in the total life expectancy was 87.70%, and it decreased with age, and the proportion has dropped to 67.31% in ≥65 age group. Life expectancy without chronic morbidity was 46.68 years (46.35 years in males and 47.01 years in females; 44.03 years in urban and 47.15 years in rural areas) among residents aged 15 years and above, and the proportion of self-evaluated HALE without chronic morbidity in the total life expectancy without chronic morbidity was 73.37%. Conclusion In general the proportion of self-evaluated HALE in the total life expectancy was small , and males had a greater proportion than female, and adults in rural areas had a greater proportion than that in urban areas. We should consider NCDS management for the elderly residents and to improve the life quality among the elderly residents.

What really matters: living longer or living healthier Comment on "Shanghai rising: health improvements as measured by avoidable mortality since 2000".

The decline in Avoidable Mortality (AM) and increase in life expectancy in Shanghai is impressive. Gusmano and colleagues suggested that Shanghai's improved health system has contributed significantly to this decline in AM. However, when compared to other global cities, Shanghai's life expectancy at birth is improving as London and New York City, but has yet to surpass that of Hong Kong, Tokyo, and Paris. Over the past decade, the reduction in AM of Shanghai is just in line with the international experience in reducing avoidable premature deaths. We suggest that a more elaborate research design is needed to examine the impact of the improvement in Shanghai's health system on its population health status.

How much might a society spend on life-saving interventions at different ages while remaining cost-effective? A case study in a country with detailed data.

OBJECTIVE: We aimed to estimate the maximum intervention cost (EMIC) a society could invest in a life-saving intervention at different ages while remaining cost-effective according to a user-specified cost-effectiveness threshold. METHODS: New Zealand (NZ) was used as a case study, and a health system perspective was taken. Data from NZ life tables and morbidity data from a burden of disease study were used to estimate health-adjusted life-years (HALYs) gained by a life-saving intervention. Health system costs were estimated from a national database of all publicly funded health events (hospitalizations, outpatient events, pharmaceuticals, etc.). For illustrative purposes we followed the WHO-CHOICE approach and used a cost-effectiveness threshold of the gross domestic product (GDP) per capita (NZ$45,000 or US$30,000 per HALY). We then calculated EMICs for an "ideal" life-saving intervention that fully returned survivors to the same average morbidity, mortality, and cost trajectories as the rest of their cohort. FINDINGS: The EMIC of the "ideal" life-saving intervention varied markedly by age: NZ$1.3 million (US$880,000) for an intervention to save the life of a child, NZ$0.8 million (US$540,000) for a 50-year-old, and NZ$0.235 million (US$158,000) for an 80-year-old. These results were predictably very sensitive to the choice of discount rate and to the selected cost-effectiveness threshold. Using WHO data, we produced an online calculator to allow the performance of similar calculations for all other countries. CONCLUSIONS: We present an approach to estimating maximal cost-effective investment in life-saving health interventions, under various assumptions. Our online calculator allows this approach to be applied in other countries. Policymakers could use these estimates as a rapid screening tool to determine if more detailed cost-effectiveness analyses of potential life-saving interventions might be worthwhile or which proposed life-saving interventions are very unlikely to benefit from such additional research.

[Treatment of angiolymphoid hyperplasia with eosinophilia (ALHE) using topical tacrolimus: Two cases]. / Traitement de l'hyperplasie angiolymphoïde avec éosinophilie (HALE) par le tacrolimus topique : deux observations.

BACKGROUND: Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare disease, currently considered a benign vascular proliferation of unknown etiology, and whose treatment is still unclear and challenging. PATIENTS AND METHODS: Two women in their thirties consulted for itchy lesions of the right ear. Both presented with a reddish bleeding papulonodular infiltration of the auricle, with a nodule at the entrance to the external auditory canal in the first patient. Laboratory tests showed no abnormalities and in particular no hypereosinophilia or elevated serum immunoglobulin E. In both cases, histology of lesional skin showed vascular proliferation with thick-walled vessels lined by plump endothelial cells, protruding into the lumen, together with a mixed dermal inflammatory infiltrate consisting primarily of eosinophils and lymphocytes. A diagnosis of ALHE was made in both patients based on clinical and histological features. MRA revealed no underlying vascular malformation in both cases. Patients started treatment with 0.1% tacrolimus ointment twice daily. The pruritic sensation and bleeding had completely subsided within two weeks and the reddish infiltration and nodules had practically disappeared after two months of topical tacrolimus. Continuous application resulted in no recurrence at 6 months of follow-up. DISCUSSION: Treatment of ALHE is still poorly standardized due to doubts concerning the pathophysiology of this rare condition and the small number of available studies. Topical tacrolimus was originally developed for the treatment of moderate to severe atopic dermatitis because of its anti-inflammatory and immunomodulatory properties. Recent studies suggest that this drug may be effective in treating other forms of inflammatory dermatosis. Our two observations suggest that tacrolimus ointment also represents potentially valuable treatment in AHLE.