Update on diagnosis and treatment of actinic keratosis

Actinic keratosis (AK) is a relatively common skin condition occurring due to chronic sun-exposure, primarily affecting fair skin. Most dermatologists consider it an incipient malignancy due to its risk of full-blown malignant transformation to squamous cell carcinoma. However, the exact risk factors remain unknown, and thus its course cannot be predicted. Therefore, all cases of AK need early diagnosis and appropriate treatment to mitigate this risk. Over the years, several noninvasive diagnostic techniques such as dermoscopy, reflectance confocal microscopy, and newer treatment modalities (lesion-directed and field-directed) have been introduced with their own set of advantages and disadvantages. Notably, invasive skin biopsy with histopathology remains the gold-standard for diagnosis. Prevention is of paramount importance, highlighted by adequate sun-protection measures. This article reviews the diagnostic and treatment modalities of AK, with their latest updates, to optimize patient management

Effiziente Zwischenfrüchte zur Rekultivierung landwirtschaftlicher Flächen beim Bau einer 380 KV Höchstspannungs-Erdkabelleitung in der westfälischen Tieflandsbucht

In der westfälischen Tieflandsbucht wurden zwei parallele Kabelgräben mit je 5,5 m Sohlbreite errichtet, die 4 Gigawatt Stromleistung übertragen. Das Bauverfahren der Erdkabeltrasse verursacht eine enorme Störung des Bodens aller physikalischen, chemischen und biologischen Bodenkennwerte. Der Naturraum, indem die 3,5 km lange Erdkabelleitung verläuft, wird intensiv, landwirtschaftlich genutzt und zeichnet sich bodenkundlich durch eine ausgeprägte Heterogenität aus. Mithilfe eines speziellen Konzeptes sollen die Böden über der Kabeltrasse rekultiviert an die Landwirte übergeben werden. Zur Überprüfung der Rekultivierungsleistung unterschiedlicher Zwischenfruchtkulturen sowie deren Mischungen wurden Parzellen auf einem Teilstück der Kabeltrasse in einem Langzeitversuch angelegt. Erste Versuchsergebnisse zeigen eine Differenzierung der verschiedenen Kulturen/Mischungen in Hinblick auf das Rekultivierungspotential

Syncopated Dynamical Decoupling for Suppressing Crosstalk in Quantum Circuits

Theoretically understanding and experimentally characterizing and modifying the underlying Hamiltonian of a quantum system is of utmost importance in achieving high-fidelity quantum gates for quantum computing. In this work, we explore the use of dynamical decoupling (DD) in characterizing undesired two-qubit couplings as well as the underlying single-qubit decoherence, and in suppressing them. We develop a syncopated dynamical decoupling technique which protects against decoherence and selectively targets unwanted two-qubit interactions, overcoming both significant hurdles to achieving precise quantum control and realizing quantum computing on many hardware prototypes. On a transmon-qubit-based superconducting quantum device, we identify separate white and $1/f$ noise components underlying the single-qubit decoherence and a static ZZ coupling between pairs of qubits. We suppress these errors using syncopated dynamical decoupling in two-qubit benchmarking experiments and significantly boost performance in a realistic algorithmic quantum circuit

From caution to urgency: the evolution of HIV testing and counselling in Africa.

OBJECTIVE: To describe recent changes in policy on provider-initiated testing and counselling (PITC) for human immunodeficiency virus (HIV) infection in African countries and to investigate patients' experiences of and views about PITC. METHODS: A review of the published literature and of national HIV testing policies, strategic frameworks, plans and other relevant documents was carried out. FINDINGS: Of the African countries reviewed, 42 (79.2%) had adopted a PITC policy. Of the 42, all recommended PITC for the prevention of mother-to-child HIV transmission, 66.7% recommended it for tuberculosis clinics and patients, and 45.2% for sexually transmitted infection clinics. Moreover, 43.6% adopted PITC in 2005 or 2006. The literature search identified 11 studies on patients' experiences of and views about PITC in clinical settings in Africa. The clear majority regarded PITC as acceptable. However, women in antenatal clinics were not always aware that they had the right to decline an HIV test. CONCLUSION: Policy and practice on HIV testing and counselling in Africa has shifted from a cautious approach that emphasizes confidentiality to greater acceptance of the routine offer of HIV testing. The introduction of PITC in clinical settings has contributed to increased HIV testing in several of these settings. Most patients regard PITC as acceptable. However, other approaches are needed to reach people who do not consult health-care services

Benefits Analysis of Wind-Optimal Operations For Trans-Atlantic Flights

North Atlantic Tracks are trans-Atlantic routes across the busiest oceanic airspace in the world. This study analyzes and compares current flight-plan routes to wind-optimal routes for trans-Atlantic flights in terms of aircraft fuel burn, emissions and the associated climate impact. The historical flight track data recorded by EUROCONTROL's Central Flow Management Unit is merged with data from FAA's Enhanced Traffic Management System to provide an accurate flight movement database containing the highest available flight path resolution in both systems. The combined database is adopted for airspace simulation integrated with aircraft fuel burn and emissions models, contrail models, simplified climate response models, and a common climate metric to assess the climate impact of flight routes within the Organized Track System (OTS). The fuel burn and emissions for the tracks in the OTS are compared with the corresponding quantities for the wind-optimized routes to evaluate the potential environmental benefits of flying wind-optimal routes in North Atlantic Airspace. The potential fuel savings and reduction in emissions depend on existing inefficiencies in current flight plans, atmospheric conditions and location of the city-pairs. The potential benefits are scaled by comparing them with actual flight tests that have been conducted since 2010 between a few city-pairs in the transatlantic and trans-pacific region to improve fuel consumption and reduce the environmental impact of aviation

Emerging drugs for the treatment of vitiligo

Introduction: Vitiligo is a relatively common autoimmune depigmenting disorder of the skin. There has been a great advance in understanding the pathological basis, which has led to the development and utilization of various new molecules in treating vitiligo. This review aims at a comprehensively describing the treatments available and the emerging treatment aspects and the scope for future developments. Areas covered: This study comprehensively summarizes the current concepts in the pathogenesis of vitiligo with special focus on the cytokine and signaling pathways, which are the targets for newer drugs. JAK kinase signaling pathways and the cytokines involved are the focus of vitiligo treatment in current research, followed by antioxidant mechanisms and repigmenting mechanisms. Topical immunosuppressants may be an alternative to steroids in localized vitiligo. Newer repigmenting agents like basic fibroblast growth factors, afamelanotide have been included and a special emphasis is laid on the upcoming targeted immunotherapy. Expert opinion: The treatment of vitiligo needs to be multimodal with emphasis on targeting different limbs of the pathogenesis. Topical and oral JAK inhibitors are the most promising new class of drugs currently available for treating vitiligo and acts best in conjunction with NB-UVB

Interaction of Dendritic Cells with Skin Endothelium: A New Perspective on Immunosurveillance

The goal of this study was to determine the mechanisms by which dendritic cells (DCs) in blood could interact with endothelium, a prerequisite to extravasation into tissues. Our results indicate that DCs express both HECA-452–reactive and nonreactive isoforms of P-selectin glycoprotein ligand 1 (PSGL-1) and can tether and roll efficiently on E- and P-selectin under flow conditions in vitro. Freshly isolated blood DCs were further observed to roll continuously along noninflamed murine dermal endothelium in vivo. This interaction is strictly dependent on endothelial selectins, as shown by experiments with blocking antibodies and with E- and P-selectin–deficient mice. We hypothesize that DCs in blood are constitutively poised at the interface of blood and skin, ready to extravasate upon induction of inflammation, and we showed that cutaneous inflammation results in a rapid recruitment of DCs from the blood to tissues. We propose that this is an important and previously unappreciated element of immunosurveillance