Acne vulgaris, probiotics and the gut-brain-skin axis - back to the future?

Over 70 years have passed since dermatologists John H. Stokes and Donald M. Pillsbury first proposed a gastrointestinal mechanism for the overlap between depression, anxiety and skin conditions such as acne. Stokes and Pillsbury hypothesized that emotional states might alter the normal intestinal microflora, increase intestinal permeability and contribute to systemic inflammation. Among the remedies advocated by Stokes and Pillsbury were Lactobacillus acidophilus cultures. Many aspects of this gut-brain-skin unifying theory have recently been validated. The ability of the gut microbiota and oral probiotics to influence systemic inflammation, oxidative stress, glycemic control, tissue lipid content and even mood itself, may have important implications in acne. The intestinal microflora may also provide a twist to the developing diet and acne research. Here we provide a historical perspective to the contemporary investigations and clinical implications of the gut-brain-skin connection in acne

Clinical implications of lipid peroxidation in acne vulgaris: old wine in new bottles

Acne vulgaris is a common dermatological disorder, one that is frequently associated with depression, anxiety and other psychological sequelae. In recent years there has been an increasing focus on the extent to which oxidative stress is involved in the pathophysiology of acne. Emerging studies have shown that patients with acne are under increased cutaneous and systemic oxidative stress. Indeed, there are indications that lipid peroxidation itself is a match that lights an inflammatory cascade in acne. The notion that lipid peroxidation is a 'starter gun' in acne is not a new one; here we review the nearly 50-year-old lipid peroxidation theory and provide a historical perspective to the contemporary investigations and clinical implications

Business Valuation of Natural Capital; learning by doing

Businesses are starting to take an interest in the natural capital agenda but much more work is needed to map their impacts and dependence on ecosystem services. Business greening organisations argue that such work has the potential to engage influential stakeholders in achieving sustainable outcomes (WBCSD, 2011; Cranston et al 2015). However, the economic valuation of ecosystem services/natural capital has also received criticism from sections of the academic community (e.g. Redford and Adams 2009; Gomez-Baggethun and Ruiz-Perez 2011) and the press (e.g. Monbiot 2014). Such criticism can be helpful in identifying potential pitfalls and areas that may require wider involvement and engagement of stakeholders, further thought and development of methods and policies

When groups help and when groups harm: origins, developments, and future directions of the 'social cure' perspective of group dynamics

A substantial literature supports the important role that social group memberships play in enhancing health. While the processes through which group memberships constitute a ‘Social Cure’ are becoming increasingly well-defined, the mechanisms through which these groups contribute to vulnerability and act as a ‘Social Curse’ are less understood. We present an overview of the Social Cure literature, and then go beyond this to show how the processes underpinning the health benefits of group membership can also negatively affect individuals through their absence. First, we provide an overview of early Social Cure research. We then describe later research concerning the potential health benefits of identifying with multiple groups, before moving on to consider the ‘darker side’ of the Social Cure by exploring how intra-group dynamics can foster Curse processes. Finally, we synthesise evidence from both the Cure and Curse literatures to highlight the complex interplay between these phenomena, and how they are influenced by both intra- and inter-group processes. We conclude by considering areas we deem vital for future investigation within the discipline

Cadmium Impairs p53 Activity in HepG2 Cells

Cadmium and cadmium compounds are contaminants of the environment, food, and drinking water and are important constituents of cigarette smoke. Cd exposure has also been associated with airborne particulate CdO and with Cd-containing quantum dots in medical therapy. Adverse cadmium effects reported in the literature have stimulated during recent years an ongoing discussion to better elucidate cadmium outcomes at cell and molecular level. The present work is designed to gain an insight into the mechanism of p53 impairment at gene and protein level to understand Cd-induced resistance to apoptosis. We used a hepatoma cell line (HepG2) derived from liver, known to be metal responsive. At genotoxic cadmium concentrations no cell cycle arrest was observed. The p53 at gene and protein level was not regulated. Fluorescence images showed that p53 was correctly translocated into the nucleus but that the , a downstream protein of p53 network involved in cell cycle regulation, was not activated at the highest cadmium concentrations used. The miRNAs analysis revealed an upregulation of mir-372, an miRNA able to affect expression and promote cell cycle progression and proliferation. The role of metallothioneins and possible conformational changes of p53 are discussed

Skin cancer excision is more efficient and cost effective in a specialist secondary care service

Aim: To compare the relative efficiencies of skin excisions in primary and secondary care. Methods: We compared the benign: malignant ratio for specimens referred by General Practice, General Surgery and the Skin Cancer Service to the regional pathology laboratory over one month. We used cost minimization analysis to compare the relative efficiencies of the services. Results: 620 excisions were received: 139 from General Practice, 118 from General Surgery and 363 from the Skin Cancer Service. The number (%) of malignant lesions was 13 (9.4%) from General Practice, 18 (15.2%) from General Surgery and 137 (37.7%) from the Skin Cancer Service. Excision was cheaper in General Practice at €84.58 as compared to €97.49 in the hospital day surgical unit. However, the cost per malignant lesion excised was €1779.80 in general practice versus €381.78 in the Skin Cancer Service. Conclusion: Our results indicate that moving skin cancer treatment to General Practice may result in an excess of benign excisions and therefore be both less efficient and less cost effective

Evaluation and exploration of a social prescribing initiative: study protocol

Attention is being given to healthcare initiatives with the potential to save money and improve lives. One example is Social Prescribing (SP), which supports patients whose ill-health is exacerbated by loneliness. While evidence has accumulated attesting to SP’s efficacy, one limitation has been the lack of a theoretical framework, which limits understanding of how tackling loneliness improves health. In our evaluation of an SP pathway, we adopt a 'Social Cure' approach, which posits that social relations affect health. Our study will evaluate the efficacy of the pathway and determine the extent to which group processes are responsible for health improvements

Islet neogenesis-associated protein signaling in neonatal pancreatic rat islets: Involvement of the cholinergic pathway

Islet neogenesis associated protein (INGAP) increases islet mass and insulin secretion in neonatal and adult rat islets. In the present study, we measured the short- and long-term effects of INGAP-PP (a pentadecapeptide having the 104-118 amino acid sequence of INGAP) upon islet protein expression and phosphorylation of components of the P13K, MAPK and cholinergic pathways, and on insulin secretion. Short-term exposure of neonatal islets to INGAP-PP (90 s, 5, 15, and 30 min) significantly increased Akt1-Ser473 and MAPK3/1-Thr202/ Tyr204 phosphorylation and INGAP-PP also acutely increased insulin secretion from islets perifused with 2 and 20 mM glucose. Islets cultured for 4 days in the presence of INGAP-PP showed an increased expression of Akt1, Frap1, and Mapk1 mRNAs as well as of the muscarinic M3 receptor subtype, and phospholipase C (PLC)-β2 proteins. These islets also showed increased Akt1 and MAPK3/1 protein phosphorylation. Brief exposure of INGAP-PP-treated islets to carbachol (Cch) significantly increased P70S6K-Thr389 and MAPK3/1 phosphorylation and these islets released more insulin when challenged with Cch that was prevented by the M3 receptor antagonist 4-DAMP, in a concentration-dependent manner. In conclusion, these data indicate that short- and long-term exposure to INGAP-PP significantly affects the expression and the phosphorylation of proteins involved in islet P13K and MAPK signaling pathways. The observations of INGAPP-PP-stimulated up-regulation of cholinergic M3 receptors and PLC- proteins, enhanced P70S6K and MAPK3/1 phosphorylation and Cch-induced insulin secretion suggest a participation of the cholinergic pathway in INGAP-PP-mediated effects.Facultad de Ciencias MédicasCentro de Endocrinología Experimental y Aplicad

Rural Readmissions in the Palliative Care Vacuum

Palliative care consultation is associated with reduced health care costs and improved quality of life while reducing length of stay. Small rural hospitals lack the depth of multidisciplinary resources to provide inpatient palliative care consult services. The purpose of this research was to assess the need for palliative care service in rural hospitals, while examining for a difference in hospital readmission rates in hospitals lacking palliative consult services. Data were obtained from the Pennsylvania Health Cost Containment Counsel including 3 hospitals with palliative programs and 3 without. Inclusion criteria were admissions for a patient carrying a diagnosis appropriate for palliative consultation between the last quarter of 2014 and 2015. There were 1394 index patients admitted to 3 rural hospitals lacking a palliative consult program. There was a higher rate of readmissions at the nonpalliative hospitals, 71.6% versus 55.1% (P \u3c .001). Data suggest there is a need for palliative telemedicine services to meet needs in rural hospitals. Palliative care consultation is associated with a more positive patient and family assessment of quality of life in the setting of complex life-limiting illness, while also improving the informed selection of health care choices that reduce the cost of care being provided.1-3 The Center for Advancing Palliative Care identifies palliative care as a multidisciplinary team including nursing, which is beneficial to patients and families facing serious illness.4 This includes, but is not limited to, illnesses such as cancer, cardiac disease, chronic obstructive pulmonary disease, and Alzheimer disease. Palliative consultation is associated with shorter intensive care unit (ICU) length of stay without altering mortality rates or disposition from the ICU.3 Palliative care services are becoming increasingly available in hospitals in urban centers or facilities with a bed capacity of greater than 200. Smaller, more rural hospitals, however, often lack the depth of multidisciplinary resources to provide an inpatient palliative care service.4 There is potential for palliative telemedicine services to reduce the burden to patient and families, as well as cost to the health care system. The extent of the rural disparity has not been fully explored and represents a significant gap in our knowledge. This research is designed to assess the need for palliative care consultation across a group of 6 hospitals utilizing readmission data in the population appropriate for palliative consultation. Population data were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes for all adult patients with diagnoses appropriate for palliative involvement. Data were obtained from Pennsylvania Health Cost Containment Counsel (PHC4). Three of the selected hospitals have an established palliative care program, and 3 hospitals do not. A correlational analysis of readmission rates was performed between these groups of hospitals in this patient population