Current Issue : July - September Volume : 2012 Issue Number : 3 Articles : 8 Articles
Background: Diagnosing pigmented skin lesions in general practice is challenging. SIAscopy has been shown to\r\nincrease diagnostic accuracy for melanoma in referred populations. We aimed to develop and validate a scoring\r\nsystem for SIAscopic diagnosis of pigmented lesions in primary care.\r\nMethods: This study was conducted in two consecutive settings in the UK and Australia, and occurred in three\r\nstages: 1) Development of the primary care scoring algorithm (PCSA) on a sub-set of lesions from the UK sample;\r\n2) Validation of the PCSA on a different sub-set of lesions from the same UK sample; 3) Validation of the PCSA on\r\na new set of lesions from an Australian primary care population. Patients presenting with a pigmented lesion were\r\nrecruited from 6 general practices in the UK and 2 primary care skin cancer clinics in Australia. The following data\r\nwere obtained for each lesion: clinical history; SIAscan; digital photograph; and digital dermoscopy. SIAscans were\r\ninterpreted by an expert and validated against histopathology where possible, or expert clinical review of all\r\navailable data for each lesion.\r\nResults: A total of 858 patients with 1,211 lesions were recruited. Most lesions were benign naevi (64.8%) or\r\nseborrhoeic keratoses (22.1%); 1.2% were melanoma. The original SIAscopic diagnostic algorithm did not perform\r\nwell because of the higher prevalence of seborrhoeic keratoses and haemangiomas seen in primary care. A primary\r\ncare scoring algorithm (PCSA) was developed to account for this. In the UK sample the PCSA had the following\r\ncharacteristics for the diagnosis of ââ?¬Ë?suspiciousââ?¬â?¢: sensitivity 0.50 (0.18-0.81); specificity 0.84 (0.78-0.88); PPV 0.09 (0.03-\r\n0.22); NPV 0.98 (0.95-0.99). In the Australian sample the PCSA had the following characteristics for the diagnosis of\r\nââ?¬Ë?suspiciousââ?¬â?¢: sensitivity 0.44 (0.32-0.58); specificity 0.95 (0.93-0.97); PPV 0.52 (0.38-0.66); NPV 0.95 (0.92-0.96). In an\r\nanalysis of lesions for which histological diagnosis was available (n = 111), the PCSA had a significantly greater\r\nArea Under the Curve than the 7-point checklist for the diagnosis of melanoma (0.83; 95% CI 0.71-0.95 versus 0.61;\r\n95% CI 0.44-0.78; p = 0.02 for difference).\r\nConclusions: The PCSA could have a useful role in improving primary care management of pigmented skin\r\nlesions. Further work is needed to develop and validate the PCSA in other primary care populations and to\r\nevaluate the cost-effectiveness of GP management of pigmented lesions using SIAscopy....
The establishment of the diagnosis of cutaneous malignant melanoma (CMM) always calls for histopathological confirmation.\r\nFurther to the recognition of the CMM aspects, immunohistochemistry is helpful, in particular, in determining the size of the\r\nreplicative compartment and the activity in each of the cell cycle phases (G1, S, G2, M). The involvement of cancer stem cells and\r\ntransient amplifier cells in CMM genesis is beyond doubt. The proliferation activity is indicative of the neoplastic progression and\r\nis often related to the clinical growth rate of the neoplasm. It allows to distinguish high-risk CMM commonly showing a high\r\ngrowth rate, from those CMMs of lower malignancy associated with a more limited growth rate. The recruitment and progression\r\nof CMM cells in the cell cycle of proliferation depend on mitogen-activated protein kinase (MAPK) pathway and result from a loss\r\nof control normally involving a series of key regulatory cyclins. In addition, the apoptotic pathways potentially counteracting any\r\nexcess in proliferative activity are out of the dependency of specific regulatory molecular mechanisms. Key molecular components\r\ninvolved in the deregulation of the growth fraction, the cell cycle phases of proliferation, and apoptosis are presently described in\r\nCMM....
Background: Classic Kaposiâ��s sarcoma (CKS) is a rare disease likely associated with human herpes virus 8 (HHV-8)\r\ninfection, and occurs predominantly in Jewish, Mediterranean and middle eastern men .There is a dearth of data in\r\nMoroccan patients with CKS regarding epidemiology, clinical characteristics and outcomes. This report examines a\r\ncohort of patients with CKS evaluated at the national institute of oncology over 11-year period.\r\nMethods: A retrospective analysis of patients referred to the national institute of oncology with classical Kaposi\r\nsarcoma, between January 1998 and February 2008, was performed. Reviewed information included demographics,\r\nclinical and pathological staging, death or last follow-up.\r\nResults: During the study period, 56 patients with a diagnosis of CKS have been referred to our hospital. There\r\nwere 11(19,7%) females and 45 (80,3%) males (male-to-female ratio: 4:1). Mean age at diagnosis was 61,7 �± 15\r\n(range: 15- 86 years). Nodules and/or plaques were the most frequent type of lesion. The most common location\r\nwas the lower limbs, particularly the distal lower extremity (90%). In addition to skin involvement, visceral spread\r\nwas evident in 9 cases. The most common visceral involvement sites were lymph nodes (44%), lung (22%), and\r\ngastrointestinal tract (22%). Associated lymphoedema was seen in 24 (42%) of the patients. There were 18 stage I\r\npatients (32,14%), 8: stage II (14,28%), 21 stage III(37,5%) and 9 stage IV (16,07%). A second primary malignancy was\r\ndiagnosed in 6 cases (10,7%), none of the reticuloendothelial system.\r\nWith a median follow-up of 45 months, 38 (67,8) patients are alive, of whom 25 (65,78%) patients with stable\r\ndisease, five with progressive disease currently under systemic chemotherapy and 8(21,05%) are alive and free of\r\ndisease, over a mean interval of 5 years.\r\nConclusion: This is the largest reported series in our context. In Morocco, CKS exhibits some special characteristics\r\nincluding a disseminated skin disease at diagnosis especially in men, a more common visceral or lymph node\r\ninvolvement and a less frequent association with second malignancies....
Modulation of cell : cell junctions is a key event in cutaneous wound repair. In this study we report that activation of the epidermal\r\ngrowth factor (EGF) receptor disrupts cell : cell adhesion, but with different kinetics and fates for the desmosomal cadherin\r\ndesmoglein and for E-cadherin. Downregulation of desmoglein preceded that of E-cadherin in vivo and in an EGF-stimulated\r\nin vitro wound reepithelialization model. Dual immunofluorescence staining revealed that neither E-cadherin nor desmoglein-\r\n2 internalized with the EGF receptor, or with one another. In response to EGF, desmoglein-2 entered a recycling compartment\r\nbased on predominant colocalization with the recycling marker Rab11. In contrast, E-cadherin downregulation was accompanied\r\nby cleavage of the extracellular domain. A broad-spectrum matrix metalloproteinase inhibitor protected E-cadherin but not the\r\ndesmosomal cadherin, desmoglein-2, from EGF-stimulated disruption. These findings demonstrate that although activation of\r\nthe EGF receptor regulates adherens junction and desmosomal components, this stimulus downregulates associated cadherins\r\nthrough different mechanisms....
Infantile haemangioma therapy has long been a wait-and-see policy. Since recent development of laser and light therapy, pulsed\r\ndye laser has been successfully used for treating superficial haemangiomas. Few studies have been published about treatment with\r\nintense pulsed light (IPL) to assess the risk/benefit of IPL in the treatment of infantile haemangiomas during their early proliferative\r\nphase. In the present retrospective cohort study, we retrieved data about a series of 14 Caucasian children (median age: 4.8 months)\r\nwith infantile haemangiomas treated with Photoderm Vasculight flash lamp. All patients experienced a rapid regression of the\r\nhaemangiomas after 3 treatments on average. Few adverse events were noted, including ulceration and crusts. No residual scarring\r\nand cosmetic damages were noticed. Fast growing haemangiomas should be treated with light therapy as soon as possible. This\r\ntechnology is safe, efficient, inducing regression, and preventing any further functional and aesthetic complications. The benefitrisk\r\nratio favours the treatment of most types of haemangiomas which are out of the scope of betablocker administration....
Background: Massive duplication of effort occurs when researchers all over the world undertake extensive searches\r\nfor randomized controlled trials when preparing systematic reviews, when developing evidence-based guidelines\r\nand when applying for research funding for eczema treatments. Such duplication wastes valuable resources.\r\nSearching for randomized controlled trials of eczema is a laborious task involving scrutiny of thousands of\r\nindividual references from diverse electronic databases in order to obtain a few papers of interest. Clinicians and\r\npatients who wish to find out more about a particular treatment are at risk of missing the relevant evidence if they\r\nare not trained in electronic bibliographic searching. Systematic reviews cannot be relied upon to comprehensively\r\ninform current optimal eczema treatments due to incomplete coverage and because many may be out of date.\r\nAn international, publically available and comprehensive resource which brings together all randomized controlled\r\ntrials on eczema treatment using a highly sensitive search has the potential to release more filtered knowledge\r\nabout patient care to those who need it most and to significantly shorten the duration and costs of many clinical\r\neczema research and guideline projects.\r\nDescription: The Global Resource of EczemA Trials brings together information on all randomized controlled trials\r\nof eczema treatments published from the beginning of 2000 up to the end of 2010 and will be updated every\r\nmonth.\r\nWe searched the Cochrane Central Register of Controlled Trials in The Cochrane Library and the Cochrane Skin\r\nGroup Specialised Register, MEDLINE, EMBASE, LILACS, AMED and CINHAL databases. We included 268 RCTs (24th\r\nMarch 2011) covering over 70 different treatment interventions.\r\nThe structure of the Global Resource of Eczema Trials allows the user as much, or as little, specificity when\r\nretrieving information on trials as they wish, in an easy to use format. For each trial, the database gives the citation\r\nfor the published report and also provides enough information to enable a user to decide whether the trial is\r\nworth further scrutiny.\r\nConclusions: The Global Resource of Eczema Trials has been created to facilitate knowledge mobilization into\r\nhealthcare and to reduce wastage of research time through unnecessary duplication. The collective time saved by\r\nresearch groups around the world can now be used to make strides in optimising the treatment of eczema, in order to\r\nfurther benefit people with eczema. The database can be accessed free of charge at http://www.greatdatabase.org.uk...
Background: With the availability of large-scale genome-wide association study (GWAS) data, choosing an optimal\r\nset of SNPs for disease susceptibility prediction is a challenging task. This study aimed to use single nucleotide\r\npolymorphisms (SNPs) to predict psoriasis from searching GWAS data.\r\nMethods: Totally we had 2,798 samples and 451,724 SNPs. Process for searching a set of SNPs to predict\r\nsusceptibility for psoriasis consisted of two steps. The first one was to search top 1,000 SNPs with high accuracy for\r\nprediction of psoriasis from GWAS dataset. The second one was to search for an optimal SNP subset for predicting\r\npsoriasis. The sequential information bottleneck (sIB) method was compared with classical linear discriminant\r\nanalysis(LDA) for classification performance.\r\nResults: The best test harmonic mean of sensitivity and specificity for predicting psoriasis by sIB was 0.674(95% CI:\r\n0.650-0.698), while only 0.520(95% CI: 0.472-0.524) was reported for predicting disease by LDA. Our results indicate\r\nthat the new classifier sIB performs better than LDA in the study.\r\nConclusions: The fact that a small set of SNPs can predict disease status with average accuracy of 68% makes it\r\npossible to use SNP data for psoriasis prediction....
As melanoma survival rates continue to increase, optimal surveillance strategies for recurrences are needed, as are effective\r\nimaging modalities. Therefore, we performed a meta-analysis to evaluate the current state of imaging modalities for surveillance\r\nof melanoma in the published medical literature to determine the sensitivity, specificity, and positive predictive values of\r\nultrasonography, computed tomography (CT), positron emission tomography (PET), and CT-PET combined. Ultrasonography\r\nwas found to be the most sensitive and specific for detecting lymph node metastases, and PET-CT was the most sensitive and\r\nspecific for detecting distant metastases. In addition to identifying appropriate surveillance methods, future studies should focus\r\non the most effective and cost-effective intervals for performing these tests. In addition, the results from the meta-analysis related\r\nto sensitivity and specificity of the tests should be made available to doctors in community practice....
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