Treatment of keloid scars with intralesional triamcinolone and 5-fluorouracil injections - a randomized controlled trial

Keloids have high recurrence rates. Current first-line therapy is triamcinolone (TAC) injection, but it has been suggested that approximately 50% of keloids are steroid resistant. We compared the efficacy of intralesional 5-fluorouracil (5-FU) and triamcinalone injections in a double-blind randomized controlled trial. Forty-three patients with 50 keloid scars were treated with either intralesional TAC or 5-FU-injections over 6 months. There was no statistically significant difference in the remission rate at 6 months between the 5-FU and TAC groups (46% vs 60%, respectively). Local adverse effects were higher in the TAC group compared to the 5-FU group. Occurrence of skin atrophy in TAC group was 44% and in the 5-FU group 8% (p <0.05). Also the occurrence of telangiectasia in the TAC group was 50% and in the 5-FU 21% (p <0.05). Vascularity of the keloids, assessed by spectral imaging and immunohistochemical staining for blood vessels, after treatment decreased in the TAC group, but not in the 5-FU group (p <0.05). Fibroblast proliferation evaluated by Ki-67 staining significantly decreased in the TAC group (p <0.05) but increased in the 5-FU group (p <0.05). TAC and 5-FU injections did not differ in their clinical effectivity in this randomized study, but 5-FU injections lead to increased proliferation rate and did not affect vascular density in histological assessment. Due to the greater number of adverse effects observed after TAC treatment, 5-FU injections may be preferable for cosmetically sensitive skin areas. (C) 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.Peer reviewe

What is required to combine human biomonitoring and health surveys?

© 2022 The Author(s). Published by Elsevier GmbH. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Obtaining holistic information about health and health determinants at the population level should also include data on environmental risk factors of health. So far, only a few countries have combined, at the national level, health and human biomonitoring (HBM) surveys to collect extensive information on health, lifestyles, biological health determinants and environmental exposures. This paper will provide guidelines on how to combine health and HBM surveys and what is the added value of doing so. Health and HBM surveys utilize similar infrastructure and data collection methods including questionnaires, collection and analysis of biological samples, and objective health measurements. There are many overlapping or comparable steps in these two survey types. At the European level, detailed protocols for conducting a health examination survey or HBM study exists separately but there is no protocol for a combined survey available by now. Our recommendations for combined health and HBM surveys focus on a cross-sectional survey on general population aged 6-79 years. To avoid unnecessary participant burden, for the selection of included measurements basic principle would be to ensure that results of the measurements have a public health relevance and clear interpretation. Combining health and HBM surveys into one survey would produce an extensive database for research to support policy decisions in many fields such as public health and chemical regulations. Combined surveys are cost-effective as only one infrastructure is needed to collect information and recruit participants.This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 733032.info:eu-repo/semantics/publishedVersio

Trends in mental health diagnosis and use of resources in Europe during the COVID-19 pandemic

Background: The European Population Health Information Research Infraestructure (PHIRI) conducted research through use cases of applicability for public health policies during the COVID-19 pandemic. The aim of this study is to present changes in diagnosis of depression or anxiety and the use of health services before and during the COVID-19 crisis. Methods: Aggregated datasets with the total number of diagnosis of depression or anxiety (ICD10: F30-F39 and F40-F48 codes) and the number of visits to primary care, hospital or emergency department were generated were generated. Diagnoses were obtained from electronic health records in Austria, Estonia, Finland, Croatia, Latvia, Romania and Aragon (Spain), using the PHIRI federated research infra structure. Incident trends were depicted by month and year of visit (2017 and 2020). Results: Overall, 1,514,311 diagnoses of depression or anxiety were reported in 2017 vs. 1,102,468 diagnoses in 2020. By countries, monthly mean diagnosis of depression or anxiety ranged 2.7/10000 population (standard deviation, SD:0.2) to 148.4(20.0) for 2017; after lockdown in 2020 incidence decreased in most countries. Visits to primary, specialized care and emergency related to anxiety and depression diagnoses dropped after lockdown but they increased in general in all countries during 2021. Conclusions: Despite differences in the European health systems, a slight impact on COVID-19 on mental health diagnoses could be detected. This study highlights the potential use of harmonized data for providing evidence for future pandemic preparedness. Key messages: The use of a federated research infrastructure has allowed assessing the impact of COVID-19 in mental health across European countries in a harmonized way. Slight changes in mental health diagnoses and use of resources could be detected in several European countries due to COVID-19 pandemic.S

Association of socioeconomic position and childhood obesity in Finland: a registry-based study

OBJECTIVE: To identify what dimensions of socioeconomic position (SEP) are most closely associated with childhood obesity in Finland, leveraging population-wide data among the whole child population aged 2–17 years in Finland. DESIGN: Registry-based study. SETTING: Data from several administrative registries linked on individual level covering the whole of Finland were used. Data on height and weight measurements in 2018 were obtained from the Register of Primary Health Care visits and data on sociodemographic and socioeconomic indicators (2014–2018) from Statistics Finland. PARTICIPANTS: Children aged 2–17 years with valid height and weight measurements performed at the child health clinic or school healthcare in 2018 (final n=194 423). MAIN OUTCOME MEASURES: Obesity was defined according to WHO Growth Reference curves. Sociodemographic and socioeconomic indicators were linked on individual level for adults (both parents) who lived in the same household (42 predictors). Boosted regression model was used to analyse the contribution of SEP to obesity. RESULTS: From socioeconomic indicators, annual household income (12.6%) and mother and father’s educational level (12.6% and 8.1%, respectively) had the highest relative influence on obesity risk. The relative influence of a child’s sex was 7.7%. CONCLUSIONS: The parents’ SEP was inversely associated with obesity among the offspring. A remarkable number of objective SEP indicators were analysed with parents’ education and household income finally being the indicators most strongly associated with obesity among children. In future research, more attention should be paid to reliable and objective ways of measuring educational status and income rather than on developing new SEP indicators. Administrative registries with information on both healthcare and socioeconomic indicators can in future provide better opportunities to assess the influence of SEP on various health risks

A National Public Sphere? Analyzing the Language, Location, and Form of Newspapers in Finland, 1771–1917

This article uses metadata from serial publications as a means of modelling the historical development of the public sphere. Given that a great deal of historical knowledge is generated through narratives relying on anecdotal evidence, any attempt to rely on newspapers for modeling the past challenges customary approaches in political and cultural history. The focus in this article is on Finland, but our approach is also scalable to other regions. During the period 1771–1917 newspapers developed as a mass medium in the Grand Duchy of Finland within two imperial configurations (Sweden until 1809 and Russia in 1809–1917), and in the two main languages – Swedish and Finnish. Finland is an ideal starting point for conducting comparative studies in that its bilingual profile already includes two linguistically separated public spheres that nonetheless were heavily connected. Our particular interest here is in newspaper metadata, which we use to trace the expansion of public discourse in Finland by statistical means. We coordinate information on publication places, language, number of issues, number of words, newspaper size, and publishers, which we compare with existing scholarship on newspaper history and censorship, and thereby offer a more robust statistical analysis of newspaper publishing in Finland than has previously been possible. We specifically examine the interplay between the Swedish- and Finnish-language newspapers and show that, whereas the public discussions were inherently bilingual, the technological and journalistic developments advanced at different pace in the two language forums. This analysis challenges the perception of a uniform public sphere in the country. In addition, we assess the development of the press in comparison with the production of books and periodicals, which points toward the specialization of newspapers as a medium in the period after 1860. This confirms some earlier findings about Finnish print production. We then show how this specialization came about through the establishment of forums for local debates that other less localized print media such as magazines and books could not provide.</p

Potential implications of differential preservation of testate amoeba shells for paleoenvironmental reconstruction in peatlands

Testate amoebae are now commonly used in paleoenvironmental studies but little is known of their taphonomy. There is some experimental evidence for differential preservation of some testate amoeba shell types over others, but it is unclear what, if any impact this has on palaeoenvironmental reconstruction. To investigate this issue we looked at palaeoecological evidence for the preservation of different shell types. We then investigated the possible impact of selective preservation on quantitative palaeoenvironmental inference. We first used existing palaeoecological data sets to assess the vertical patterns of relative abundance in four testate amoeba shell types: (1) shells made of secreted biosilica plates (idiosomes, e.g. Euglypha), (2) idiosomes with thick organic coating (Assulina), (3) proteinaceous shells (e.g. Hyalosphenia), (4) shells built from recycled organic or mineral particles (xenosomes) (e.g. Difflugia, Centropyxis). In three diagrams a clear pattern of decay was only observed for the idiosome type. In order to assess the implications of differential preservation of testate amoeba taxa for paleoenvironmental reconstruction we then carried out simulations using three existing transfer functions and a wide range of scenarios, downweighting different test categories to represent the impact of selective test decomposition. Simulation results showed that downweighting generally reduced overall model performance. However downweighting a shell type only produced a consistent directional bias in inferred water table depth where that shell type is both dominant and shows a clear preference along the ecological gradient. Applying a scenario derived from previous experimental work did not lead to significant difference in inferred water table. Our results show that differential shell preservation has little impact on paleohydrological reconstruction from Sphagnum-dominated peatlands. By contrast, for the minerotrophic peatlands data-set loss of idiosome tests leads to consistent underestimation of water table depth. However there are few studies from fens and it is possible that idiosome tests are not always dominant, and/or that differential decomposition is less marked than in Sphagnum peatlands. Further work is clearly needed to assess the potential of testate amoebae for paleoecological studies of minerotrophic peatlands

2019 WSES guidelines for the management of severe acute pancreatitis

Although most patients with acute pancreatitis have the mild form of the disease, about 20-30% develops a severe form, often associated with single or multiple organ dysfunction requiring intensive care. Identifying the severe form early is one of the major challenges in managing severe acute pancreatitis. Infection of the pancreatic and peripancreatic necrosis occurs in about 20-40% of patients with severe acute pancreatitis, and is associated with worsening organ dysfunctions. While most patients with sterile necrosis can be managed nonoperatively, patients with infected necrosis usually require an intervention that can be percutaneous, endoscopic, or open surgical. These guidelines present evidence-based international consensus statements on the management of severe acute pancreatitis from collaboration of a panel of experts meeting during the World Congress of Emergency Surgery in June 27-30, 2018 in Bertinoro, Italy. The main topics of these guidelines fall under the following topics: Diagnosis, Antibiotic treatment, Management in the Intensive Care Unit, Surgical and operative management, and Open abdomen. © 2019 The Author(s).Peer reviewe

Upper limits for undetected trace species in the stratosphere of Titan

In this paper we describe a first quantitative search for several molecules in Titan's stratosphere in Cassini CIRS infrared spectra. These are: ammonia (NH3), methanol (CH3OH), formaldehyde (H2CO), and acetonitrile (CH3CN), all of which are predicted by photochemical models but only the last of which observed, and not in the infrared. We find non-detections in all cases, but derive upper limits on the abundances from low-noise observations at 25{\deg}S and 75{\deg}N. Comparing these constraints to model predictions, we conclude that CIRS is highly unlikely to see NH3 or CH3OH emissions. However, CH3CN and H2CO are closer to CIRS detectability, and we suggest ways in which the sensitivity threshold may be lowered towards this goal.Comment: 11 pages plus 6 figure file