Summary
Background
Over the last few years, several articles on dermoscopy of non‐neoplastic dermatoses have been published, yet there is poor consistency in the terminology among different studies.
...Objectives
We aimed to standardize the dermoscopic terminology and identify basic parameters to evaluate in non‐neoplastic dermatoses through an expert consensus.
Methods
The modified Delphi method was followed, with two phases: (i) identification of a list of possible items based on a systematic literature review and (ii) selection of parameters by a panel of experts through a three‐step iterative procedure (blinded e‐mail interaction in rounds 1 and 3 and a face‐to‐face meeting in round 2). Initial panellists were recruited via e‐mail from all over the world based on their expertise on dermoscopy of non‐neoplastic dermatoses.
Results
Twenty‐four international experts took part in all rounds of the consensus and 13 further international participants were also involved in round 2. Five standardized basic parameters were identified: (i) vessels (including morphology and distribution); (ii) scales (including colour and distribution); (iii) follicular findings; (iv) ‘other structures’ (including colour and morphology); and (v) ‘specific clues’. For each of them, possible variables were selected, with a total of 31 different subitems reaching agreement at the end of the consensus (all of the 29 proposed initially plus two more added in the course of the consensus procedure).
Conclusions
This expert consensus provides a set of standardized basic dermoscopic parameters to follow when evaluating inflammatory, infiltrative and infectious dermatoses. This tool, if adopted by clinicians and researchers in this field, is likely to enhance the reproducibility and comparability of existing and future research findings and uniformly expand the universal knowledge on dermoscopy in general dermatology.
What's already known about this topic?
Over the last few years, several papers have been published attempting to describe the dermoscopic features of non‐neoplastic dermatoses, yet there is poor consistency in the terminology among different studies.
What does this study add?
The present expert consensus provides a set of standardized basic dermoscopic parameters to follow when evaluating inflammatory, infiltrative and infectious dermatoses.
This consensus should enhance the reproducibility and comparability of existing and future research findings and uniformly expand the universal knowledge on dermoscopy in general dermatology.
Linked Editorial: Bahadoran. Br J Dermatol 2020; 182:260–261.
Plain language summary available online
To characterize the incidence of stress urinary incontinence (SUI) after radical prostatectomy (RP), its treatment, and impact on quality of life (QoL) and work status 1 year after RP.
Prostate ...cancer patients treated by RP (1998-2016) were selected from CaPSURE. SUI was defined as any pads per day (ppd) 1 year after RP. SUI procedures were tracked by CPT codes (sling and artificial sphincter). Patients reported work status (full-time, part-time, unpaid), UCLA PCa Index urinary function (UF) and bother (UB) and SF36 Index physical function (PF). Associations of incontinence with UF, UB and PF and work status changes were assessed (ANOVA). Lifetable estimates and Cox proportional hazards regression evaluated risk of undergoing SUI procedures.
664/2,989 (22%) men treated with RP reported SUI at 1 year. More men with SUI had ≥GG2, intermediate to high-risk disease and non-nerve sparing surgery (all p<0.01).
Cumulative incidence of SUI procedures was 1.4% at 10 years after RP. Age (HR 2.68 per 10 years, 95% CI 1.41-5.08) and number of ppd at 1 year (HR 3.20, 95% CI 2.27-4.50) were associated with undergoing SUI procedures.
UF declined at 1 year after RP, while UB and PF remained stable. UF, UB and PF were inversely associated with number of ppd (all p<0.01). Change in work status was not associated with incontinence or QoL scores.
Incontinence affected QoL without impacting work status, suggesting that men with SUI after RP may continue working and go under-treated despite impact on quality of life.
Inertial confinement fusion seeks to create burning plasma conditions in a spherical capsule implosion, which requires efficiently absorbing the driver energy in the capsule, transferring that energy ...into kinetic energy of the imploding DT fuel and then into internal energy of the fuel at stagnation. We report new implosions conducted on the National Ignition Facility (NIF) with several improvements on recent work Phys. Rev. Lett. 120, 245003 (2018)PRLTAO0031-900710.1103/PhysRevLett.120.245003; Phys. Rev. E 102, 023210 (2020)PRESCM2470-004510.1103/PhysRevE.102.023210: larger capsules, thicker fuel layers to mitigate fuel-ablator mix, and new symmetry control via cross-beam energy transfer; at modest velocities, these experiments achieve record values for the implosion energetics figures of merit as well as fusion yield for a NIF experiment.
To understand the relationship between common urologic medications phosphodiesterase-5 inhibitors (PDE5i) and anticholinergics (AC) and risk of dementia onset in men who underwent different primary ...treatments for prostate cancer.
Patients (>50years) with prostate cancer (1998-2022) without Alzheimer's disease or related dementias were selected from Cancer of the Prostatic Strategic Urologic Research Endeavor Registry. Minimum medication use was 3months. Fine-Gray regression was performed to determine the association between medication exposure and dementia onset ≥12months after primary treatment in men matched on age, race, comorbid conditions, smoking, and type of clinical site, with competing risk of death.
Among 5937 men (53% PDE5i; 14% AC), PDE5i users were younger (63 vs 70, P < .01) with less CAD, CVA, DM (all P < .01); AC users were older (68 vs 66, P < .01) with higher incidence of comorbidities (P < .01). Median months of use was 24.3 (IQR 12.1, 48.7) for PDE5i and 12.2 (IQR 6.1, 24.3) for AC users. Cumulative incidence of Alzheimer's disease or related dementias was 6.5% at 15years. PDE5i (P = .07) and AC (P = .06) were not associated with dementia regardless of primary treatment modality.
In this retrospective cohort study, PDE5i and AC use do not appear independently associated with risk of dementia. Notably, our cohort was generally healthy and younger which may limit our ability to detect significance. We recommend prospective investigation into association between PDE5i and dementia and advise continued judicious stewardship of AC in older patient populations.
Glucagon secretion is regulated by glucose but the mechanisms involved remain hotly debated. Both intrinsic (within the α‐cell itself) and paracrine (mediated by factors released β‐ and/or δ‐cells) ...have been postulated. Glucagon secretion is maximally suppressed by glucose concentrations that do not affect insulin and somatostatin secretion, a finding that highlights the significance of intrinsic regulation of glucagon secretion. Experiments on islets from mice lacking functional ATP‐sensitive potassium channels (KATP‐channels) indicate that these channels are critical to the α‐cell's capacity to sense changes in extracellular glucose. Here, we review recent data on the intrinsic and paracrine regulation of glucagon secretion in human pancreatic islets. We propose that glucose‐induced closure of the KATP‐channels, via membrane depolarization, culminates in reduced electrical activity and glucagon secretion by voltage‐dependent inactivation of the ion channels involved in action potential firing. We further demonstrate that glucagon secretion measured in islets isolated from donors with type‐2 diabetes is reduced at low glucose and that glucose stimulates rather than inhibits secretion in these islets. We finally discuss the relative significance of paracrine and intrinsic regulation in the fed and fasted states and propose a unifying model for the regulation of glucagon secretion that incorporates both modes of control.
Agriculture has been increasingly relying on groundwater irrigation for the last decades, leading to severe groundwater depletion and/or nitrate contamination. Understanding the links between nitrate ...concentration and groundwater resource is a prerequisite for assessing the sustainability of irrigated systems. The Berambadi catchment (ORE-BVET/Kabini Critical Zone Observatory) in Southern India is a typical example of intensive irrigated agriculture and then an ideal site to study the relative influences of land use, management practices and aquifer properties on NO3 spatial distribution in groundwater. The monitoring of >200 tube wells revealed nitrate concentrations from 1 to 360mg/L. Three configurations of groundwater level and elevation gradient were identified: i) NO3 hot spots associated to deep groundwater levels (30–60m) and low groundwater elevation gradient suggest small groundwater reserve with absence of lateral flow, then degradation of groundwater quality due to recycling through pumping and return flow; ii) high groundwater elevation gradient, moderate NO3 concentrations suggest that significant lateral flow prevented NO3 enrichment; iii) low NO3 concentrations, low groundwater elevation gradient and shallow groundwater indicate a large reserve. We propose that mapping groundwater level and gradient could be used to delineate zones vulnerable to agriculture intensification in catchments where groundwater from low-yielding aquifers is the only source of irrigation. Then, wells located in low groundwater elevation gradient zones are likely to be suitable for assessing the impacts of local agricultural systems, while wells located in zones with high elevation gradient would reflect the average groundwater quality of the catchment, and hence should be used for regional mapping of groundwater quality. Irrigation with NO3 concentrated groundwater induces a “hidden” input of nitrogen to the crop which can reach 200kgN/ha/yr in hotspot areas, enhancing groundwater contamination. Such fluxes, once taken into account in fertilizer management, would allow optimizing fertilizer consumption and mitigate high nitrate concentrations in groundwater.
•Tube well irrigation induces groundwater depletion in semi-arid areas.•An irrigated catchment in India shows high spatial variability of groundwater NO3.•Extreme NO3, up to 360mg/L, is related to areas of severe groundwater depletion.•Irrigation with NO3 rich groundwater induces a “hidden” input of N to the crop.•Considering it would help optimizing fertilizer and mitigating groundwater quality.
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Key biomolecular processes, which regulate primordial ovarian follicle dormancy and early folliculogenesis in mammalian ovaries, are not fully understood. The domestic cat is a useful model to study ...ovarian folliculogenesis and is the most relevant for developing in vitro growth methods to be implemented in wild felid conservation breeding programs. Previously, RNA-sequencing of primordial (PrF), primary (PF), and secondary follicle (SF) samples from domestic cat implicated ovarian steroidogenesis and steroid reception during follicle development. Here, we aimed to identify which sex steroid biosynthesis and metabolism enzymes, gonadotropin receptors, and sex steroid receptors are present and may be potential regulators. Differential gene expression, functional annotation, and enrichment analyses were employed and protein localization was studied too. Gene transcripts for PGR, PGRMC1, AR (steroid receptors), CYP11A1, CYP17A1, HSD17B1 and HSD17B17 (steroidogenic enzymes), and STS (steroid metabolizing enzyme) were significantly differentially expressed (Q values of ≤0.05). Differential gene expression increased in all transcripts during follicle transitions apart from AR which decreased by the secondary stage. Immunohistochemistry localized FSHR and LHCGR to oocytes at each stage. PGRMC1 immunostaining was strongest in granulosa cells, whereas AR was strongest in oocytes throughout each stage. Protein signals for steroidogenic enzymes were only detectable in SFs. Products of these significantly differentially expressed genes may regulate domestic cat preantral folliculogenesis. In vitro growth could be optimized as all early follicles express gonadotropin and steroid receptors meaning hormone interaction and response may be possible. Protein expression analyses of early SFs supported its potential for producing sex steroids. Summary sentence Primordial, primary, and secondary ovarian follicles of the domestic cat express gonadotropin and sex steroid receptors with secondary follicles presenting a steroidogenic potential too.
Aims/hypothesis The aim of this study was to characterise electrical activity, ion channels, exocytosis and somatostatin release in human delta cells/pancreatic islets. Methods Glucose-stimulated ...somatostatin release was measured from intact human islets. Membrane potential, currents and changes in membrane capacitance (reflecting exocytosis) were recorded from individual human delta cells identified by immunocytochemistry. Results Somatostatin secretion from human islets was stimulated by glucose and tolbutamide and inhibited by diazoxide. Human delta cells generated bursting or sporadic electrical activity, which was enhanced by tolbutamide but unaffected by glucose. Delta cells contained a tolbutamide-insensitive, Ba²⁺-sensitive inwardly rectifying K⁺ current and two types of voltage-gated K⁺ currents, sensitive to tetraethylammonium/stromatoxin (delayed rectifying, Kv2.1/2.2) and 4-aminopyridine (A current). Voltage-gated tetrodotoxin (TTX)-sensitive Na⁺ currents contributed to the action potential upstroke but TTX had no effect on somatostatin release. Delta cells are equipped with Ca²⁺ channels blocked by isradipine (L), ω-agatoxin (P/Q) and NNC 55-0396 (T). Blockade of any of these channels interferes with delta cell electrical activity and abolishes glucose-stimulated somatostatin release. Capacitance measurements revealed a slow component of depolarisation-evoked exocytosis sensitive to ω-agatoxin. Conclusions/interpretation Action potential firing in delta cells is modulated by ATP-sensitive K⁺-channel activity. The membrane potential is stabilised by Ba²⁺-sensitive inwardly rectifying K⁺ channels. Voltage-gated L- and T-type Ca²⁺ channels are required for electrical activity, whereas Na⁺ currents and P/Q-type Ca²⁺ channels contribute to (but are not necessary for) the upstroke of the action potential. Action potential repolarisation is mediated by A-type and Kv2.1/2.2 K⁺ channels. Exocytosis is tightly linked to Ca²⁺-influx via P/Q-type Ca²⁺ channels. Glucose stimulation of somatostatin secretion involves both KATP channel-dependent and -independent processes.
Purpose
Due to the lack of evidence, it was the aim of the study to investigate current possible cutbacks in orthopaedic healthcare due to the coronavirus disease 2019 pandemic (COVID-19).
Methods
An ...online survey was performed of orthopaedic surgeons in the German-speaking Arthroscopy Society (Gesellschaft für Arthroskopie und Gelenkchirurgie, AGA). The survey consisted of 20 questions concerning four topics: four questions addressed the origin and surgical experience of the participant, 12 questions dealt with potential cutbacks in orthopaedic healthcare and 4 questions addressed the influence of the pandemic on the particular surgeon.
Results
Of 4234 contacted orthopaedic surgeons, 1399 responded. Regarding arthroscopic procedures between 10 and 30% of the participants stated that these were still being performed—with actual percentages depending on the specific joint and procedure. Only 6.2% of the participants stated that elective total joint arthroplasty was still being performed at their centre. In addition, physical rehabilitation and surgeons’ postoperative follow-ups were severely affected.
Conclusion
Orthopaedic healthcare services in Austria, Germany, and Switzerland are suffering a drastic cutback due to COVID-19. A drastic reduction in arthroscopic procedures like rotator cuff repair and cruciate ligament reconstruction and an almost total shutdown of elective total joint arthroplasty were reported. Long-term consequences cannot be predicted yet. The described disruption in orthopaedic healthcare services has to be viewed as historic.
Level of evidence
V.
Purpose To develop a method to create anthropomorphic phantoms of individual patients with high precision of anatomic details and radiation attenuation properties. Materials and Methods Inkjet ...cartridges were filled with potassium iodide solutions (600 mg/mL) and prints were realized on plain paper (80 g/m
). Stacks of 100 prints resulted in three-dimensional phantoms of 1 cm thickness. In a first step, reproduction of patient anatomy was tested by printing computed tomographic (CT) images of a real patient abdomen scan. In a second step, gray scales, iodine deposition, and Hounsfield units were investigated by printing geometric phantoms with gray scales ranging from 0% (white) to 100% (black). On the basis of these results, a gray-scale-correction procedure was developed to achieve realistic Hounsfield units in the patient phantom. In a third step, reproduction of the real patient's Hounsfield units was verified by printing the initial patient CT scan again after application of the gray-scale-correction procedure. Data were analyzed by using Pearson correlation, linear regression, and nonlinear regression. Results The first abdomen phantom showed a detailed reproduction of the patient anatomy and demonstrated feasibility of the concept. However, individual-organ Hounsfield units deviated from the real patient CT scan. Analysis of the geometric phantoms revealed an exponential correlation between template gray scales and printer deposition. Application of a correction procedure to the template gray scales allowed for a linear correlation (r = 0.9946; 95% confidence interval: 0.9916, 0.9966). After the same correction procedure was applied to the abdomen phantom, linear correlation of phantom and patient Hounsfield units was confirmed (r = 0.9925; 95% confidence interval: 0.9635, 0.9985). Conclusion The method presented in this work can realize realistic and customizable phantoms for diagnostic and therapeutic radiology, including the reproduction of individual patients.
RSNA, 2016.
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