Cutaneous B‐cell lymphomas: 2021 update on diagnosis, risk‐stratification, and management

Disease OverviewApproximately one‐fourth of primary cutaneous lymphomas are B‐cell derived and are generally classified into three distinct subgroups: primary cutaneous follicle center lymphoma (PCFCL), primary cutaneous marginal zone lymphoma (PCMZL), and primary cutaneous diffuse large B‐cell lymphoma, leg type (PCDLBCL, LT).DiagnosisDiagnosis and disease classification is based on histopathologic review and immunohistochemical staining of an appropriate skin biopsy. Pathologic review and an appropriate staging evaluation are necessary to distinguish primary cutaneous B‐cell lymphomas from systemic B‐cell lymphomas with secondary skin involvement.Risk‐StratificationDisease histopathology remains the most important prognostic determinant in primary cutaneous B‐cell lymphomas. Both PCFCL and PCMZL are indolent lymphomas that infrequently disseminate to extracutaneous sites and are associated with 5‐year survival rates that exceed 95%. In contrast, PCDLBCL, LT is an aggressive lymphoma with an inferior prognosis.Risk‐Adapted TherapyBoth PCFCL and PCMZL patients with solitary or relatively few skin lesions may be effectively managed with local radiation therapy. While single‐agent rituximab may be employed for patients with more widespread skin involvement, multi‐agent chemotherapy is rarely appropriate. In contrast, management of patients with PCDLBCL, LT is comparable to the management of patients with systemic DLBCL.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162801/2/ajh25970.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162801/1/ajh25970_am.pd

Do Maternal Vitamin D Levels Influence Vitamin D Levels in Preterm Neonates?

Objective To determine the prevalence of Vitamin D (VitD) deficiency/insufficiency in mothers of preterm neonates less than or equal to 32 weeks of gestation and determine if the current level of VitD supplementation used for preterm neonates is appropriate. Design Prospective study from 10th May 2015 to 1st November 2016. Setting Neonatal Intensive Care Unit at the Canberra Hospital. Patients Mothers and their preterm neonates born less than or equal to 32 weeks gestation. Interventions Maternal VitD levels were obtained within 3-4 days following delivery. Neonatal VitD levels were obtained in the first 3-4 days of life, at 3-4 weeks of age, and at 6-8 weeks of age. Demographic data and data on VitD intake from parenteral nutrition, enteral feeds, and vitamin supplementation agents were collected. Results 70 neonates were enrolled into the study. Median gestation was 29 (27-30) weeks and median birth weight 1197 (971.2-1512.5) grams. Median maternal VitD level was 54.5 (36-70.7) nmol/L, median neonatal Vit D level at birth was 57 (42-70) nmol/L. Median Vit D level at 3 weeks and 6 weeks were 63.5 nmol/L (53-80.2) nmol/L and 103 (71.5-144) nmol/L respectively. 22/55 (40%) mothers were VitD deficient/insufficient. 25/70 (36%) neonates were VitD deficient/insufficient at birth. Of those neonates who were VitD deficient/insufficient at birth 5/25(10%) were deficient/insufficient at 6 weeks. The median intake of VitD at 6 weeks was 826.5 (577.5-939.5) IU/day. Conclusions VitD deficiency/insufficiency in mothers of preterm neonates and in preterm neonates at birth is common. Routine screening of maternal VitD and their preterm neonates along with individualized supplementation regimens in mothers and preterm infants may optimize VitD status and reduce risk of ongoing VitD deficiency/insufficiency

RESTRICTED ROUTING PROTOCOL FOR CONTRIBUTION OF OPTIMIZATION METHOD

Simple secure connections between a random set of network nodes require that each node maintains the n-1 keys for each pair within the state of symmetric encryption and public keys n-1 in the case of unequal encoding where n represents the number of network nodes. In the operation phase of the network, each node finds the length of the primary road connected by using its overlapped neighbors by making simple path requests. A dynamic set of pre-distribution master plans constructed according to symmetric encryption concepts containing secret keys in pairs. In this document, we refer to the network layer because of the underlying layer as well as the encryption layer because the layer overlays. Our proposed option would essentially be to respond to the derived LP problem by loosening all logical constraints within the original problem. The effectiveness of our formula is within the logical LP solution with the complexity of the period that does not exceed the solution of the problem of LP sedative while ensuring the identification of the optimal solution. We note that the main advantage of our formula is that it has the ability to solve the problem of optimal routing for almost any graphic, whether directed or unguided, in addition to weight or not likely. Evaluate the performance, security and consumption characteristics of the network from the proposed format for pre-symmetric and non-uniform methods running on top of the on-demand routing protocols. In order to evaluate performance in our proposed format, we use it in three main pre-distribution methods: 2-UKP, SST, and PAKP, which operate over the dedicated distance vector routing protocol when necessary

Effective detection of rare variants in pooled DNA samples using Cross-pool tailcurve analysis

Sequencing targeted DNA regions in large samples is necessary to discover the full spectrum of rare variants. We report an effective Illumina sequencing strategy utilizing pooled samples with novel quality (Srfim) and filtering (SERVIC4E) algorithms. We sequenced 24 exons in two cohorts of 480 samples each, identifying 47 coding variants, including 30 present once per cohort. Validation by Sanger sequencing revealed an excellent combination of sensitivity and specificity for variant detection in pooled samples of both cohorts as compared to publicly available algorithms

Human surface anatomy terminology for dermatology: a Delphi consensus from the International Skin Imaging Collaboration

BackgroundThere is no internationally vetted set of anatomic terms to describe human surface anatomy.ObjectiveTo establish expert consensus on a standardized set of terms that describe clinically relevant human surface anatomy.MethodsWe conducted a Delphi consensus on surface anatomy terminology between July 2017 and July 2019. The initial survey included 385 anatomic terms, organized in seven levels of hierarchy. If agreement exceeded the 75% established threshold, the term was considered - accepted- and included in the final list. Terms added by the participants were passed on to the next round of consensus. Terms with <75% agreement were included in subsequent surveys along with alternative terms proposed by participants until agreement was reached on all terms.ResultsThe Delphi included 21 participants. We found consensus (- ¥75% agreement) on 361/385 (93.8%) terms and eliminated one term in the first round. Of 49 new terms suggested by participants, 45 were added via consensus. To adjust for a recently published International Classification of Diseases- Surface Topography list of terms, a third survey including 111 discrepant terms was sent to participants. Finally, a total of 513 terms reached agreement via the Delphi method.ConclusionsWe have established a set of 513 clinically relevant terms for denoting human surface anatomy, towards the use of standardized terminology in dermatologic documentation.Linked Commentary: R.J.G. Chalmers. J Eur Acad Dermatol Venereol 2020; 34: 2456- 2457. https://doi.org/10.1111/jdv.16978.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163915/1/jdv16855_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163915/2/jdv16855-sup-0001-FigS1-S3.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163915/3/jdv16855.pd

Practice Guidelines for Teledermatology

Previous American Telemedicine Association (ATA) Teledermatology Practice Guidelines were issued in 2007. This updated version reflects new knowledge in the field, new technologies, and the need to incorporate teledermatology practice in a variety of settings, including hospitals, urgent care centers, Federally Qualified Health Centers, school-based clinics, public health facilities, and patient homes.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140294/1/tmj.2016.0137.pd

Genetic associations of psoriasis in a Pakistani population

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99639/1/bjd12313.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/99639/2/bjd12313-sup-0001-TableS1-S2.pd

Large scale meta-analysis characterizes genetic architecture for common psoriasis associated variants

Psoriasis is a complex disease of skin with a prevalence of about 2%. We conducted the largest meta-analysis of genome-wide association studies (GWAS) for psoriasis to date, including data from eight different Caucasian cohorts, with a combined effective sample size amp;gt;39,000 individuals. We identified 16 additional psoriasis susceptibility loci achieving genome-wide significance, increasing the number of identified loci to 63 for European-origin individuals. Functional analysis highlighted the roles of interferon signalling and the NFkB cascade, and we showed that the psoriasis signals are enriched in regulatory elements from different T cells (CD8(+) T-cells and CD4(+) T-cells including T(H)0, T(H)1 and T(H)17). The identified loci explain similar to 28% of the genetic heritability and generate a discriminatory genetic risk score (AUC = 0.76 in our sample) that is significantly correlated with age at onset (p = 2 x 10(-89)). This study provides a comprehensive layout for the genetic architecture of common variants for psoriasis.Funding Agencies|National Institutes of Health [R01AR042742, R01AR050511, R01AR054966, R01AR063611, R01AR065183]; Foundation for the National Institutes of Health; Dermatology Foundation; National Psoriasis Foundation; Arthritis National Research Foundation; Ann Arbor Veterans Affairs Hospital; Dawn and Dudley Holmes Foundation; Babcock Memorial Trust; Medical Research Council [MR/L011808/1]; German Ministry of Education and Research (BMBF); Doris Duke Foundation [2013106]; National Institute of Health [K08AR060802, R01AR06907]; Taubman Medical Research Institute; Department of Health via the NIHR comprehensive Biomedical Research Center; Kings College London; KCH NHS Foundation Trust; Barbara and Neal Henschel Charitable Foundation; Heinz Nixdorf Foundation; Estonian Ministry of Education and Research [IUT20-46]; Centre of Translational Genomics of University of Tartu (SP1GVARENG); European Regional Development Fund (Centre of Translational Medicine, University of Tartu); German Federal Ministry of Education and Research (BMBF); National Human Genome Research Institute of the National Institutes of Health [R44HG006981]; International Psoriasis Council</p

New polymorphisms associated with response to anti-TNF drugs in patients with moderate-to-severe plaque psoriasis

Anti-tumor necrosis factor (anti-TNF) drugs are effective against psoriasis, although 20–30% of patients are nonresponders. Few pharmacogenomic studies have been performed to predict the response to anti-TNF drugs in psoriasis. We studied 173 polymorphisms to establish an association with the response to anti-TNF drugs in patients with moderate-to-severe plaque psoriasis (N=144). We evaluated the response using PASI75 at 3, 6 and 12 months. The results of the multivariate analysis showed an association between polymorphisms in PGLYR4, ZNF816A, CTNNA2, IL12B, MAP3K1 and HLA-C genes and the response at 3 months. Besides, the results for polymorphisms in IL12B and MAP3K1 were replicated at 6 months. We also obtained significant results for IL12B polymorphism at 1 year. Moreover, polymorphisms in FCGR2A, HTR2A and CDKAL1 were significant at 6 months. This is the first study to show an association with these polymorphisms. However, these biomarkers should be validated in large-scale studies before implementation in clinical practiceThis study was supported by Instituto de Salud Carlos III (FIS PI10/01740), Fundación Teófilo Hernando, and AbbVie. RPP has a grant from Universidad Autónoma de Madrid (FPI program 2013