Role and regulation of FOXO transcription factors in chronic myeloid leukaemia (CML)

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Effectiveness and safety of adalimumab in treating moderate to severe psoriasis patients with psoriatic arthritis in Taiwan

Background/Objective: The incidence of psoriasis vulgaris in Asians is estimated at 0.05–0.30%. Studies in North America and Europe demonstrated that adalimumab, a fully human monoclonal IgG1 antibody, is an efficacious treatment for psoriatic arthritis and chronic plaque psoriasis. The aim of this study was to evaluate the efficacy and safety of adalimumab in treating psoriatic arthritis (PsA) in patients who have moderate to severe psoriasis. Methods: This was a retrospective study comprising 12 patients with chronic plaque psoriasis and psoriatic arthritis who were treated with adalimumab between October 2008 and February 2013. All had failed treatment with conventional systemic agents. Patients were started on adalimumab 40 mg every other week. Results: At week 12, 3 of 12 patients (25%) achieved a 75% improvement in their Psoriasis Area and Severity Index (PASI 75). With regard to PsA, at week 12, the improved Psoriatic Arthritis Response Criteria (PsARC) response was experienced by 75% (9 of 12) of the patients. Mean improvement in Dermatology Life Quality Index (DLQI) was 42%. Five of 12 patients (42%) experienced adverse events, which were generally mild. Conclusion: Patients with refractory psoriatic arthritis appeared to be responsive to adalimumab. The achievement rate of PsARC in our study was comparable to the efficacy reported in previous literature. Detection of antinuclear antibodies was not associated with the responsiveness in this trial, nor did it influence the potential for adverse effects. Adalimumab as a monotherapy is generally effective and safe

Actinomycetoma caused by Nocardia otitidiscaviarum: Report of a case in Taiwan with long-term follow-up

Actinomycetoma is a chronic granulomatous infection, with Nocardia species being one of the infecting pathogens. Infections caused by N. otitidiscaviarum are relatively rare compared with those caused by other Nocardia species. Conventional methods for the diagnosis of nocardiosis based on phenotypic characterization of the strains (e.g., morphology, histopathology) are relatively time consuming and nonspecific. Molecular techniques have become the better choice for prompt and accurate identification of Nocardia isolates. We report a case of actinomycetoma due to N. otitidiscaviarum characterized by 16S ribosomal RNA (16S rRNA) gene sequence analysis and the long-term follow-up

Necrobiotic xanthogranuloma with paraproteinemia without periorbital involvement—a case report

Necrobiotic xanthogranuloma is an uncommon granulomatous disease involving the skin and extracutaneous tissues. It is characterized by indurated, yellow-red plaques and nodules, involving primarily the face and less frequently the trunk and extremities. The disease has a strong association with paraproteinemia and other hematologic or lym-phoproliferative disorders. Histologically, the dermal part shows xanthogranulomatous change with extensive necrobiosis and many Touton and foreign-body giant cells. Here, we describe a case of a 46-year-old man with a 1-year history of multiple cutaneous lesions over the trunk and thighs. Necrobiotic xanthogranuloma was diagnosed by histology and clinically associated with paraproteinemia. This case is also unusual in that there was no periorbital involvement, which is believed to be a typical feature of this disease

Cutaneous Adverse Events of Targeted Anticancer Therapy: A Review of Common Clinical Manifestations and Management

Targeted anticancer therapies, unlike the traditional cytotoxic chemotherapies which lead to systemic toxicities, frequently cause cutaneous adverse events that are symptomatic and manifest in cosmetically sensitive areas. The most common dermatologic toxicities related to epidermal growth factor receptor (EGFR) inhibitors are papulopustular eruption, xerosis, pruritus and paronychia. Vascular endothelial growth factor receptor (VEGFR) inhibitors usually cause hand-foot skin reaction. Reports of dermatologic side effects such as abnormalities of hair growth and mucosal changes also increased. These events may contribute to poor adherence, dose interruption and discontinuation of the regimens. In addition, psychosocial discomfort causing reduction in the quality of life does occur. However, the presence and severity of cutaneous adverse events has shown to have positive correlation with treatment response. The management of these side effects can be categorized into prophylaxis and reactive treatment. Systemic antibiotics and topical corticosteroid could possibly prevent or alleviate symptoms caused by EGFR inhibitors. The prevention of sun exposure is recommended to all patients on targeted therapy, and emollients and lubricants can be used to relieve and improve the hand-foot skin reaction

Serial QuantiFERON-TB Gold In-Tube testing for psoriatic patients receiving antitumor necrosis factor-alpha therapy

AbstractBackground/ObjectiveTumor necrosis factor-α (TNF-α) antagonists have become increasingly popular in the treatment of psoriasis. However, the increased risk of latent tuberculosis infection (LTBI) reactivation has also become an important issue in clinical practice. The aim of this study was to evaluate serial QuantiFERON-TB Gold In-Tube (QFT-GIT) testing for detecting LTBI among a cohort of psoriatic patients vaccinated with bacille Calmette-Guérin in a country with an intermediate burden of TB during long-term treatment with TNF-α antagonists.MethodsWe enrolled psoriatic patients treated with TNF-α antagonists who also accepted yearly serial QFT-GIT testing and regular chest X-ray examinations before and during the anti-TNF-α treatment from January 2010 to August 2014. Patients diagnosed with LTBI received chemoprophylaxis, and QFT-GIT testing was performed in these patients after completion of chemoprophylaxis.ResultsIn this retrospective study, 101 patients had completed baseline and at least 1 year of follow-up. Among these patients, 60 had continued TNF-α antagonists therapy and received examinations in the 2nd year, whereas 18 had continued the therapy until the 3rd year. The conversion rate among these patients was 14.29% (13/91). In this study, 23 patients were diagnosed with LTBI according to the positive results obtained in the QFT-GIT test, with 19 of them having completed chemoprophylactic therapy. Follow-up QFT-GIT testing revealed reversion in 11 patients (57.89%) and decreased interferon-γ (IFN-γ) levels (68.42%) in 13 patients. Patients over 45 years of age tended to have a persistent positive result.ConclusionThis study demonstrated that 14.29% of psoriatic patients undergoing long-term TNF-α antagonist therapy had a QFT-GIT conversion. Although a decreased IFN-γ level and QFT-GIT reversion were observed in most cases following prophylactic therapy, the value of QFT-GIT for evaluating the effect of LTBI prophylaxis remains controversial

A prospective clinical and histologic study of axillary osmidrosis treated with the microwave-based device

Background/Objective: Microwave-based devices target sweat glands through energy delivery at the dermal–subcutaneous interface. These devices have been approved by the Food and Drug Administration as a noninvasive treatment for axillary hyperhidrosis. Treatment for osmidrosis has only been reported in one preliminary study. This study aimed to investigate the efficacy, safety, and histological changes of the microwave-based devices in treating axillary osmidrosis. Methods: We conducted a prospective study in a tertiary referral center in Taiwan. Patients with axillary osmidrosis were recruited and received two consecutive treatment sessions with a 3-month interval. Skin biopsy was obtained to evaluate histological changes. The efficacy was determined by odor reduction using a patient reported 10-point odor scale. Responders were defined as participants with a reduction of at least 3 points of the Odor-10 score at their 90-day follow-up visit. Results: Seven patients were enrolled. Mean reduction of odor was 61.8%. Six patients met the primary endpoint of odor reduction. Skin biopsy specimens reveled 93% reduction of apocrine glands. Histopathological changes include dermal fibrosis, necrosis of sweat glands, and subcutaneous fat necrosis. Transient swelling, bruise, numbness, lumps, and hypotrichosis were possible side effects. No patient reported disabling side effects. Conclusion: Microwave-based devices are noninvasive and a potential alternative therapeutic modality for axillary osmidrosis treatment

Lymphomatoid papulosis: a clinical and histopathologic review and follow-up study of 34 cases in Taiwan

Background: Lymphomatoid papulosis (LyP) is a rare condition within the spectrum of CD30+ cutaneous lymphoproliferative disorders that is not well documented in Taiwan. This study aimed to analyze its clinical manifestations, diagnostic histopathology, clinical course, and treatment response among Taiwanese. Methods: A retrospective chart review was performed on patients diagnosed with LyP at a Taiwanese medical center from 1992 to 2008. Results: There were 34 patients with biopsy-proven LyP. The mean age at diagnosis was 36 years (range: 10–75 years), with male predominance (male:female ratio 3:2). Type-A LyP was identified in 32 patients and Type C in 2 patients. Seven cases showed CD4 predominance and six cases showed CD8 predominance. Of the 34 LyP patients, 2 had coexistent non-Hodgkin’s lymphoma, 1 (3%, 1/34) diagnosed before LyP onset and 1 (3%, 1/34) developed lymphoma 3 years after LyP. All of the patients were alive after a mean of 5.2 years (range: 3–12.7 years) of follow-up. Conclusions: Most of our cases are Type A LyP. No clinical features or pathologic features can predict increased risk for developing malignancy. Although only 6% (2/34) of LyP patients were found to have lymphoma in 3-year follow-up, longer follow up is needed. Regardless of treatment modalities, two-thirds of the patients have a recurrent and relapsing course. Observation is a reasonable approach for patients without cosmetic or symptomatic concerns

Pharmacogenomics on the Treatment Response in Patients with Psoriasis: An Updated Review

The efficacy and the safety of psoriasis medications have been proved in trials, but unideal responses and side effects are noted in clinical practice. Genetic predisposition is known to contribute to the pathogenesis of psoriasis. Hence, pharmacogenomics gives the hint of predictive treatment response individually. This review highlights the current pharmacogenetic and pharmacogenomic studies of medical therapy in psoriasis. HLA-Cw*06 status remains the most promising predictive treatment response in certain drugs. Numerous genetic variants (such as ABC transporter, DNMT3b, MTHFR, ANKLE1, IL-12B, IL-23R, MALT1, CDKAL1, IL17RA, IL1B, LY96, TLR2, etc.) are also found to be associated with treatment response for methotrexate, cyclosporin, acitretin, anti-TNF, anti-IL-12/23, anti-IL-17, anti-PDE4 agents, and topical therapy. Due to the high throughput sequencing technologies and the dramatic increase in sequencing cost, pharmacogenomic tests prior to treatment by whole exome sequencing or whole genome sequencing may be applied in clinical in the future. Further investigations are necessary to manifest potential genetic markers for psoriasis treatments