Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Outcome measures for the evaluation of treatment response in hidradenitis suppurativa for clinical practice

Importance Although several clinician- and patient-reported outcome measures have been developed for trials in hidradenitis suppurativa (HS), there is currently no consensus on which measures are best suited for use in clinical practice. Identifying validated and feasible measures applicable to the practice setting has the potential to optimize treatment strategies and generate generalizable evidence that may inform treatment guidelines. Objective To establish consensus on a core set of clinician- and patient-reported outcome measures recommended for use in clinical practice and to establish the appropriate interval within which these measures should be applied. Evidence Review Clinician- and patient-reported HS measures and studies describing their psychometric properties were identified through literature reviews. Identified measures comprised an item reduction survey and subsequent electronic Delphi (e-Delphi) consensus rounds. In each consensus round, a summary of outcome measure components and scoring methods was provided to participants. Experts were provided with feasibility characteristics of clinician measures to aid selection. Consensus was achieved if at least 67% of respondents agreed with use of a measure in clinical practice. Findings Among HS experts, response rates for item reduction, e-Delphi round 1, and e-Delphi round 2 surveys were 76.4% (42 of 55), 90.5% (38 of 42), and 92.9% (39 of 42), respectively; among patient research partners (PRPs), response rates were 70.8% (17 of 24), 100% (17 of 17), and 82.4% (14 of 17), respectively. The majority of experts across rounds were practicing dermatologists with 18 to 19 years of clinical experience. In the final e-Delphi round, most PRPs were female (12 [85.7%] vs 2 males [11.8%]) and aged 30 to 49 years. In the final e-Delphi round, HS experts and PRPs agreed with the use of the HS Investigator Global Assessment (28 [71.8%]) and HS Quality of Life score (13 [92.9%]), respectively. The most expert-preferred assessment interval in which to apply these measures was 3 months (27 [69.2%]). Conclusions and Relevance An international group of HS experts and PRPs achieved consensus on a core set of HS measures suitable for use in clinical practice. Consistent use of these measures may lead to more accurate assessments of HS disease activity and life outcomes, facilitating shared treatment decision-making in the practice setting

Adhesión y movilidad de los querantinocitos humanos: integrina 'beta'1 y tetraspaninas

Tesis doctoral inedita leida en la Universidad Autonoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 5-10-200

Molecular Classifiers in Skin Cancers: Challenges and Promises

Skin cancers are common and heterogenous malignancies affecting up to two in three Australians before age 70. Despite recent developments in diagnosis and therapeutic strategies, the mortality rate and costs associated with managing patients with skin cancers remain high. The lack of well-defined clinical and histopathological features makes their diagnosis and classification difficult in some cases and the prognostication difficult in most skin cancers. Recent advancements in large-scale “omics” studies, including genomics, transcriptomics, proteomics, metabolomics and imaging-omics, have provided invaluable information about the molecular and visual landscape of skin cancers. On many occasions, it has refined tumor classification and has improved prognostication and therapeutic stratification, leading to improved patient outcomes. Therefore, this paper reviews the recent advancements in omics approaches and appraises their limitations and potential for better classification and stratification of skin cancers

Acneiform eruption in a patient with metastatic melanoma after ceasing combination dabrafenib/trametinib therapy

BRAF inhibitors (BRAFi) and MEK inhibitors (MEKi) increase survival in BRAF mutant metastatic melanoma patients; however, they induce a well-known spectrum of cutaneous side effects during treatment. Whereas the BRAFi dabrafenib induces cutaneous squamous cell carcinomas and verrucal keratosis, the MEKi trametinib frequently induces acneiform eruptions that are reversible after drug discontinuation. Furthermore, when dabrafenib and trametinib are used in combination, there are fewer cutaneous toxicities. We report a patient with BRAF mutant metastatic melanoma treated with the BRAFi/MEKi combination therapy who developed an acneiform eruption after treatment discontinuation rather than during active therapy. Moreover, the eruption resolved when the combination treatment was reintroduced and recurred after increasing the dose of trametinib. The eruption may be explained by the longer half-life of trametinib (4.5 days) compared with dabrafenib (5.2 h). This is the first case reported with this particular side effect induced after stopping the treatment and could become more frequent as the BRAFi/MEKi combination of drugs is more frequently prescribed.3 page(s

Potential response of single successive constant-current-driven electrolytic hydrogen bubbles spatially separated from the electrode

The presence of bubbles in gas-evolving electrolytic processes can heavily alter the mass transport of gaseous products and can induce severe overpotential penalties at the electrode through the action of bubble coverage (hyperpolarization) and electrolyte constriction (Ohmic shielding). However, bubble formation can also alleviate the overpotential by lowering the concentration of dissolved gas in the vicinity of the electrode. In this study, we investigate the latter by considering the growth of successive hydrogen bubbles driven by a constant current in alkaline-water electrolysis and their impact on the half-cell potential in the absence of hyperpolarization. The bubbles nucleate on a hydrophobic cavity surrounded by a ring microelectrode which remains free of bubble coverage. The dynamics of bubble growth does not adhere to one particular scaling law in time, but undergoes a smooth transition from pressure-driven towards supply-limited growth. The contributions of the different bubble-induced phenomena leading to the rich behaviour of the periodic fluctuations of the overpotential are identified throughout the different stages of the bubble lifetime, and the influence of bubble size and applied current on the concentration and Ohmic overpotential components is quantified. We find that the efficiency of gas absorption, and hence the concentration-lowering effect, increases with increasing bubble size and also with increasing current. However, the concentration-lowering effect is always eventually countered and overcome by the effect of Ohmic shielding as the bubble size outgrows and eclipses the electrode ring beneath

Decoupling Gas Evolution from Water-Splitting Electrodes

Bubbles are known to hinder electrochemical processes in water-splitting electrodes. In this study, we present a novel method to promote gas evolution away from the electrode surface. We consider a ring microelectrode encircling a hydrophobic microcavity from which a succession of bubbles grows. The ring microelectrode, tested under alkaline water electrolysis conditions, does not suffer from bubble coverage. Consequently, the chronopotentiometric fluctuations of the cell are weaker than those associated with conventional microelectrodes. Herein, we provide fundamental understanding of the mass transfer processes governing the transient behaviour of the cell potential. With the help of numerical transport models, we demonstrate that bubbles forming at the cavity reduce the concentration overpotential by lowering the surrounding concentration of dissolved gas, but may also aggravate the ohmic overpotential by blocking ion-conduction pathways. The theoretical and experimental insight gained have relevant implications in the design of efficient gas-evolving electrodes.</div

Decoupling Gas Evolution from Water-Splitting Electrodes

Bubbles are known to hinder electrochemical processes in water-splitting electrodes. In this study, we present a novel method to promote gas evolution away from the electrode surface. We consider a ring microelectrode encircling a hydrophobic microcavity from which a succession of bubbles grows. The ring microelectrode, tested under alkaline water electrolysis conditions, does not suffer from bubble coverage. Consequently, the chronopotentiometric fluctuations of the cell are weaker than those associated with conventional microelectrodes. Herein, we provide fundamental understanding of the mass transfer processes governing the transient behavior of the cell potential. With the help of numerical transport models, we demonstrate that bubbles forming at the cavity reduce the concentration overpotential by lowering the surrounding concentration of dissolved gas, but may also aggravate the ohmic overpotential by blocking ion-conduction pathways. The theoretical and experimental insight gained have relevant implications in the design of efficient gas-evolving electrodes

Factors influencing the development of cutaneous squamous cell carcinoma in patients on BRAF inhibitor therapy

Background BRAF inhibitors (BRAFi) cause paradoxical activation of the MAPK pathway in keratinocytes resulting in cutaneous squamous cell carcinoma (cuSCC). Objective We sought to examine the clinical factors involved in BRAFi-induced cuSCC development. Methods We studied 134 patients with BRAF-mutant metastatic melanoma treated with a BRAFi at Westmead Hospital, Sydney, Australia. Details of cuSCC development and associations with melanoma clinicopathologic features and treatment outcome were examined. Results In all, 32 (24%) patients developed 110 cuSCC after commencing treatment. In all, 61 (55%) cuSCC developed within the first 3 months. Age was the only independent risk factor for cuSCC development. After 3 months of therapy 4% of patients younger than 40 years developed cuSCC compared with 33% who were older than 60 years, and the hazard ratio of developing a cuSCC increased by 1.7 (95% confidence interval 1.3-2.3) per decade (P <.001). BRAFi cuSCC occurred more often in sun-protected areas (42%) compared with sporadic cuSCC (21%) (P <.001). cuSCC was not associated with progression-free survival. Limitations The study was from a single center and patients were also at risk of sporadic cuSCC. Conclusion Most BRAFi-induced cuSCC develop within 3 months of BRAFi therapy. The only independent risk factor is increasing age. cuSCC may present in anatomical locations with low ultraviolet exposure such that thorough dermatologic assessment is required