Photodynamic Therapy of Necrobiosis Lipoidica - A Multicenter Study of 18 Patients

Background: Necrobiosis lipoidica (NL) is a granulomatous skin disease of unknown origin, and no reliably effective treatment option exists to handle this often disfiguring disease. Recently, a patient with long-lasting NL was reported to be cured by topical photodynamic therapy (PDT). Objective: To evaluate the overall potential of PDT in the treatment of NL on the lower legs. Methods: Retrospective study of 18 patients (aged 16 - 62 years) from 3 European university departments of dermatology treated with PDT for NL. Methyl aminolevulinate or 5-aminolevulinic acid were used as topically applied photosensitizers. Illumination followed with red light-emitting diode light. Results: Complete response was seen in 1/18 patients after 9 PDT cycles, and partial response in 6/18 patients (2 - 14 PDT cycles) giving an overall response rate of 39% (7/18). Conclusion: Although almost 40% of the cases showed some degree of response, PDT cannot currently be recommended as first-line therapy of NL. Subpopulations of therapy-resistant NL patients may, however, benefit from PDT. Copyright (C) 2008 S. Karger AG, Base

The Outcome of Patients with Melanoma Is Not Associated with the Time Point of Lymphatic Mapping with Respect to Excisional Biopsy of the Primary Tumor

Background: Sentinel lymph node biopsy (SLNB) has become the standard care for melanoma and is an important diagnostic procedure. It has been doubted whether lymphoscintigraphy detects the correct sentinel lymph node (SLN) when excision of the tumor and SLNB are not performed at the same time. This would imply that this sequential approach may have an increased risk of undetected micrometastases resulting in a worse outcome. Objective: The purpose of the present study was to compare the outcome of melanoma patients having received excision of the tumor and SLNB either at the same time or consecutively. Methods: A total of 854 patients with cutaneous melanoma were enrolled in this retrospective study between September 1996 and November 2007. Disease-free (DFS) and overall survivals (OS) were estimated using the Kaplan-Meier product limit method and were analyzed by the log rank test. Results: No statistically significant difference was found regarding DFS, progression rates and OS in patients with primary tumor excision and SLNB at the same time compared with patients with excisional biopsy of primary tumor and SLNB at different times. Conclusion: These data suggest that excisional biopsy of the primary tumor does not prevent the correct SLN mapping in melanoma patients. Copyright (C) 2010 S. Karger AG, Base

Modern impacts on an ancient landscape, the piedmont plain in southwest Turkmenistan

The piedmont plain in southwestern Turkmenistan has experienced a millennia-long settlement history despite prevailing arid climates. One of the prerequisites for the various agricultural efforts was irrigation. Most of the water used for irrigation measures came from the adjacent Kopet Dag mountain chain. This situation changed with the introduction of the Karakum canal in the middle of the 20th century. The present study evaluates the rich irrigation history of the piedmont plain by investigating two small catchments that drain the eastern ranges of the Kopet Dag. Within their catchments, geomorphological and hydrological analyses were conducted. We present several Optically Stimulated Luminescence and 14-C dating results that add to the understanding of the landscape history from the Pleistocene until modern ages. Moreover, modern climatological and hydrological data were analyzed that show a remarkable drop in runoff from the Kopet Dag since the 1960s

High-Definition Optical Coherence Tomography for the in vivo Detection of Demodex Mites

Background: Demodex mites are involved in different skin diseases and are commonly detected by skin scrape tests or superficial biopsies. A new high-definition optical coherence tomography (HD-OCT) with high lateral and axial resolution in a horizontal (en-face) and vertical (slice) imaging mode might offer the possibility of noninvasive and fast in vivo examination of demodex mites. Methods: Twenty patients with demodex-related skin diseases and 20 age- and gender-matched healthy controls were examined by HD-OCT. Mites per follicle and follicles per field of view were counted and compared to skin scrape tests. Results: HD-OCT images depicted mites in the en-face mode as bright round dots in groups of 3-5 mites per hair follicle. In the patients with demodex-related disease, a mean number of 3.4 mites per follicle were detected with a mean number of 2.9 infested follicles per area of view compared to a mean of 0.6 mites in 0.4 infested follicles in the controls. The skin scrape tests were negative in 21% of the patients. Conclusion: The innovative HD-OCT enables fast and noninvasive in vivo recognition of demodex mites and might become a useful tool in the diagnosis and treatment monitoring of demodex-related skin diseases. Copyright (C) 2012 S. Karger AG, Base

Quantitative analysis of cell types during growth and morphogenesis in Hydra

Tissue maceration was used to determine the absolute number and the distribution of cell types in Hydra. It was shown that the total number of cells per animal as well as the distribution of cells vary depending on temperature, feeding conditions, and state of growth. During head and foot regeneration and during budding the first detectable change in the cell distribution is an increase in the number of nerve cells at the site of morphogenesis. These results and the finding that nerve cells are most concentrated in the head region, diminishing in density down the body column, are discussed in relation to tissue polarity

Geo-statistical methods to analyse changes in pre-Hispanic settlement patterns in the Río Ica catchment, Peru

Within arid regions allochthonous rivers as a main source of fresh water play a significant role in the spatial organisation of human occupation.This study aims at a comprehensive view on changes in the prehistoric occupation patterns within the Río Ica catchment on the southern coast of Peru. Results of different research projects are integrated. The heterogeneous character of the catchment allows us to define three sub-sections which differ greatly in terms of vegetation, relief and water regime.Based on quantitative geo-statistical methods we analyse spatio-temporal changes in human occupation from the Early Horizon (c. 1000–200 BC) through to the Inca Late Horizon (AD 1450–1532) in the context of environmental conditions, as well as socio-economic processes. Examining known archaeological sites we are able to assess the significance of environmental location factors for pre-Hispanic settlements. In addition, areas of high human interaction are identified on the basis of a classification of archaeological sites according to their function (craft/industry, cult, cooperation and trade). We thereby transfer the concept of central place theory to the spatial distribution of archaeological remains, introducing a novel approach to identifying central functions in a spatially explicit way.Our results crystallise the changing character of occupation in the study area over more than two millennia. They contribute to the ongoing debate on the decline of the Nasca culture, endorsing a complex combination of natural and socio-economic reasons. Furthermore, the results support the concept of a more widespread exchange and cooperation during ‘Horizon’ periods in the study area and likewise indicate that the disappearance of a supra-regional administrative polity during ‘Intermediate’ periods might have led to higher human activity in smaller scale societies, as reflected in a more diverse spatial organisation in terms of geomorphometric units and central areas

The role of zinc acquisition and zinc tolerance in group A streptococcal infection

Zinc plays an important role in host innate immune function. However, the innate immune system also utilizes zinc starvation ('nutritional immunity') to combat infections. Here, we investigate the role of zinc import and export in protection of(Group A; GAS), a Gram-positive bacterial pathogen responsible for a wide spectrum of human diseases, against challenge from host innate immune defence. In order to determine the role of GAS zinc import and export during infection, we utilized the zinc import (Δ) and export (Δ) deletion mutants in competition with wild-type in bothandvirulence models. We demonstrate that nutritional immunity is deployed extracellularly while zinc toxicity is utilized upon phagocytosis of GAS by neutrophils. We also show that lysosomes and azurophilic granules in neutrophils contain zinc stores for use against intracellular pathogens

Efficacy and cost-effectiveness of a web-based and mobile stress-management intervention for employees: design of a randomized controlled trial

Background: Work-related stress is associated with a variety of mental and emotional problems and can lead to substantial economic costs due to lost productivity, absenteeism or the inability to work. There is a considerable amount of evidence on the effectiveness of traditional face-to-face stress-management interventions for employees; however, they are often costly, time-consuming, and characterized by a high access threshold. Web-based interventions may overcome some of these problems yet the evidence in this field is scarce. This paper describes the protocol for a study that will examine the efficacy and cost-effectiveness of a web-based guided stress-management training which is based on problem solving and emotion regulation and aimed at reducing stress in adult employees. Methods. The study will target stressed employees aged 18 and older. A randomized controlled trial (RCT) design will be applied. Based on a power calculation of d=.35 (1-β of 80%, α =.05), 264 participants will be recruited and randomly assigned to either the intervention group or a six-month waitlist control group. Inclusion criteria include an elevated stress level (Cohen's Perceived Stress Scale-10 ≥ 22) and current employment. Exclusion criteria include risk of suicide or previously diagnosed psychosis or dissociative symptoms. The primary outcome will be perceived stress, and secondary outcomes include depression and anxiety. Data will be collected at baseline and seven weeks and six months after randomization. An extended follow up at 12 months is planned for the intervention group. Moreover, a cost-effectiveness analysis will be conducted from a societal perspective and will include both direct and indirect health care costs. Data will be analyzed on an intention-to-treat basis and per protocol. Discussion. The substantial negative consequences of work-related stress emphasize the necessity for effective stress-management trainings. If the proposed internet intervention proves to be (cost-) effective, a preventative, economical stress-management tool will be conceivable. The strengths and limitations of the present study are discussed. Trial registration. German Register of Clinical Studies (DRKS): DRKS00004749. © 2013 Heber et al.; licensee BioMed Central Ltd

Opportunities to inform German residents about the possibility of skin cancer screening and to inform stakeholders to take appropriate actions: A qualitative approach

AbstractBackgroundThe national skin cancer screening (SCS) was introduced in Germany in 2008. However, public awareness and participation rates remain low. There are no campaigns or target group‐specific invitation strategies for SCS yet. Thus, our aim was to derive potential suggestions on how to best inform German residents about the possibility of SCS.MethodsSemi‐structured, individual interviews with male and female German residents aged ≥35 years were conducted in Erlangen (Germany) to explore opportunities on raising awareness of SCS. Interviews were audiotaped, transcribed verbatim, and analyzed using qualitative content analysis.ResultsOverall, 39 persons were interviewed. About 79.5% (31/39) had already undergone at least one SCS. Numerous opportunities to raise awareness of the possibility of SCS were suggested which were categorized into three main topics: the role of public promotion, health‐related caregivers, and health insurance. Similar themes were identified for inviting entitled persons to undergo SCS after 2 years. Furthermore, age‐dependent communication approaches were proposed, that is, younger persons should be approached electronically, while the older generation should be targeted with traditional media like mail.ConclusionsThe results of this project will inform stakeholders to take appropriate actions. The findings may contribute to increase participation rates in SCS and thus lead to earlier detection of skin cancer.</jats:sec