Fibrosing Alopecia in a Pattern Distribution: Pathogenesis, Diagnosis and Treatment

Fibrosing alopecia in a pattern distribution is a recently recognized type of scarring alopecia, with hair loss in androgens- dependent area. Loss of follicular openings, perifollicular erythema, perifollicular hyperkeratosis and anisotriquia are the trichoscopic clues and follicular lichenoid inflammatory infiltrate the important finding in histopathology. It shares features of androgenetic alopecia and lichen planopilaris. Dermatologists should be familiarized with this entity in order to optimize the diagnosis and provide early treatment to prevent irreversible follicular damage.Alopecia fibrosante em padrão de distribuição androgenética é uma forma clínica de alopecia cicatricial recentemente reconhecida, manifestando-se por rarefacção de cabelo na área dependente de androgénios. Ausência de orifícios foliculares, eritema e hiperqueratose peri-pilar, e anisotriquia são as pistas em tricoscopia e o infiltrado inflamatório liquenóide folicular achado importante em histopatologia. Partilha características de alopecia androgenética e líquen plano pilar. Os dermatologistas devem estar familiarizados com esta entidade, a fim de otimizar o diagnóstico e tratar precocemente, evitando dano folicular irreversível

Antiplatelet agents and/or anticoagulants are not associated with worse outcome following nonvariceal upper gastrointestinal bleeding

BACKGROUND: Nonvariceal upper gastrointestinal bleeding emerges as a major complication of using antiplatelet agents and/or anticoagulants and represents a clinical challenge in patients undergoing these therapies. AIM: To characterize patients with nonvariceal upper gastrointestinal bleeding related to antithrombotics and their management, and to determine clinical predictors of adverse outcomes. METHODS: Retrospective cohort of adults who underwent upper gastrointestinal endoscopy after nonvariceal upper gastrointestinal bleeding from 2010 to 2012. The outcomes were compared between patients exposed and not exposed to antithrombotics. RESULTS: Five hundred and forty-eight patients with nonvariceal upper gastrointestinal bleeding (67% men; mean age 66.5 ± 16.4 years) were included, of which 43% received antithrombotics. Most patients had comorbidities. Peptic ulcer was the main diagnosis and endoscopic therapy was performed in 46% of cases. The 30-day mortality rate was 7.7% (n = 42), and 36% were bleeding-related. The recurrence rate was 9% and 14% of patients with initial endoscopic treatment needed endoscopic retreatment. There were no significant differences between the exposed and non-exposed groups in most outcomes. Co-morbidities, hemodynamic instability, high Rockall score, low hemoglobin (7.76 ± 2.72 g/dL) and higher international normalized ratio (1.63 ± 1.13) were associated significantly with mortality in a univariate analysis. CONCLUSIONS: Adverse outcomes were not associated with antithrombotic use. The management of nonvariceal upper gastrointestinal bleeding constitutes a challenge to clinical performance optimization and clinical cooperation.info:eu-repo/semantics/publishedVersio

Influence of Genetic Polymorphisms in Prostaglandin E2 Pathway (COX-2/HPGD/SLCO2A1/ABCC4) on the Risk for Colorectal Adenoma Development and Recurrence after Polypectomy

OBJECTIVES: Deregulation of prostaglandin E2 (PGE2) levels reported in colorectal carcinogenesis contributes to key steps of cancer development. Our aim was to evaluate the influence of the genetic variability in COX-2/HPGD/SLCO2A1/ABCC4 PGE2 pathway genes on the development and recurrence of colorectal adenomas. METHODS: A case-control study was conducted gathering 480 unscreened individuals and 195 patients with personal history of adenomas. A total of 43 tagSNPs were characterized using the Sequenom platform or real-time PCR. RESULTS: Ten tagSNPs were identified as susceptibility biomarkers for the development of adenomas. The top three most meaningful tagSNPs include the rs689466 in COX-2 (odds ratio (OR)=3.23; 95% confidence interval (CI): 1.52-6.86), rs6439448 in SLCO2A1 (OR=0.38; 95% CI: 0.22-0.65) and rs1751051 in ABCC4 genes (OR=2.75; 95% CI: 1.58-4.80). The best four-locus gene-gene interaction model included the rs1346271, rs1863642 and rs12500316 single nucleotide polymorphisms in HPGD and rs1678405 in ABCC4 genes and was associated with a 13-fold increased susceptibility (95% CI: 3.84-46.3, P<0.0001, cross-validation (CV) accuracy: 0.78 and CV consistency: 8/10). Interesting, in low-risk patients the ABCC4 rs9524821AA genotype was associated not only with a higher hazard ratio (HR=2.93; 95% CI: 1.07-8.03), but half of these patients had adenoma recurrence at 60 months, considerably higher than the 21% noticed in low-risk patients. CONCLUSIONS: Genetic polymorphisms in COX-2/PGE2 pathway appear to contribute to the development of colorectal adenomas and influence the interval time to adenomas recurrence. The definition of risk models through the inclusion of genetic biomarkers might improve the adherence and optimization of current screening and surveillance guidelines for colorectal cancer prevention.Financial support: This study was supported by a research grant from the Instituto Português de Oncologia do Porto— Centro de Investigação. Furthermore, C.P. was a recipient of a PhD grant (SFRH/BD/64805/2009) from FCT— Fundacão para a Ciência e Tecnologia, co-financed by European Social Funds (ESF) under Human Potential Operation Programme (POPH) from National Strategic Reference Framework (NSRF) and Liga Portuguesa Contra o Cancro—Núcleo Regional do Norte. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.info:eu-repo/semantics/publishedVersio

Extensive colectomy in colorectal cancer and hereditary nonpolyposis colorectal cancer – long-term results

Background: Colorectal cancer survival is better in hereditary nonpolyposis colorectal cancer patients than in sporadic colorectal cancer patients and even for hereditary nonpolyposis colorectal cancer with colorectal cancer is not consensual that extensive colectomy is preferable to partial colectomy. This study analyzes and compares the long-term results of these two groups of patients submitted to curative subtotal colectomy or total colectomy. Methods: Between 2002 and 2018, 68 patients with colorectal cancer without familial adenomatous polyposis were submitted to a total or subtotal colectomy in a single tertiary center. The patients were divided in two groups: hereditary nonpolyposis colorectal cancer patients (with Amsterdam criteria) and sporadic colorectal cancer patients (the others). The presence of Amsterdam criteria for hereditary nonpolyposis colorectal cancer and germline mutation for mismatch repair genes was confirmed by clinical records. Results and survival were analyzed following surgery. Results: We obtained a sporadic colorectal cancer group with 31 patients and a hereditary nonpolyposis colorectal cancer group with 37 patients. The two groups differ in age but not in gender, tumor stage or surgical morbidity. The overall survival and disease-free survival were good in both groups but even better for hereditary nonpolyposis colorectal cancer group with statistical significance when comparing the two groups. Conclusion: Total or subtotal colectomy for colorectal cancer provides a good survival. These surgical procedures should be considered the first option for colorectal cancer in young hereditary non polyposis colorectal cancer patients. In those cases, they provide good long-term results, avoiding the risk of metachronous colorectal cancer and the surveillance is restricted only to the remaining need for rectum.info:eu-repo/semantics/publishedVersio

Transhumant Sheep grazing enhances ecosystem multifunctionality in productive mountain grasslands: a case study in the Cantabrian Mountains

.Understanding the effects of traditional livestock grazing abandonment on the ability of mountain grasslands to sustain multiple ecosystem functions (ecosystem multifunctionality; EMF) is crucial for implementing policies that promote grasslands conservation and the delivery of multiple ecosystem services. In this study, we evaluated the effect of short- and long-term transhumant sheep abandonment on EMF through a grazing exclusion experiment in a grassland of the Cantabrian Mountains range (NW Spain), where transhumant sheep flocks graze in summer. We considered four key ecosystem functions, derived from vegetation and soil functional indicators measured in the field: (A) biodiversity function, evaluated from total plant species evenness, diversity and richness indicators; (B) forage production function, evaluated from cover and richness of perennial and annual herbaceous species indicators; (C) carbon sequestration function, evaluated from woody species cover and soil organic carbon indicators; and (D) soil fertility function, evaluated from NH4C-N, NO3-N, P and K content in the soil. The EMF index was calculated by integrating the four standardized ecosystem functions through an averaging approach. Based on linear mixed modeling we found that grazing exclusion induced significant shifts in the considered individual ecosystem functions and also on EMF. Long-term livestock exclusion significantly hindered biodiversity and forage production functions, but enhanced the carbon sequestration function. Conversely, the soil fertility function was negatively affected by both short- and long-term grazing exclusion. Altogether, grazing exclusion significantly decreased overall EMF, especially in long-term livestock exclusion areas, while the decline in EMF in short-term exclusions with respect to grazed areas was marginally significant. The results of this study support the sustainability of traditional transhumance livestock grazing for promoting the conservation of grasslands and their ecosystem function in mountain regions.S

Characterization of Fuji Apples from Different Harvest Dates and Storage Conditions from Measurements of Volatiles by Gas Chromatography and Electronic Nose

Volatile compounds in Fuji apples harvested at two different maturities were measured at harvest and after 5 and 7 months of cold storage (1 °C) in four different atmospheres. When the samples were characterized by both chromatographic measurements of volatiles and responses of an electronic nose, the analyses showed a clear separation between fruits from different storage conditions (a normal cold atmosphere and three controlled atmospheres). During poststorage, the apples were left to ripen for 1, 5, and 10 days at 20 °C before analytical measurements were done involving headspace-gas chromatography methods and electronic nose type quartz crystal microbalances. Electronic nose responses registered by seven different sensors were used to classify the apples using principal component analysis. It was possible to identify the samples from different storage periods, days of shelf life, and harvest dates, but it was not possible to differentiate the fruits corresponding to different cold storage atmospheres

A multicenter validation of an endoscopic classification with narrow band imaging for gastric precancerous and cancerous lesions

BACKGROUND AND STUDY AIM: The reliability and external validity of narrow band imaging (NBI) in the stomach have not been described consistently. The aim of the current study was to describe and estimate the accuracy and reliability of a simplified classification system for NBI in the diagnosis of gastric lesions. METHODS: Consecutive patients undergoing NBI endoscopy at two reference centers (n=85, 33% with dysplasia) were included in two studies. In total, 224 different areas were biopsied and recorded onto video. In the derivation study, previously described NBI features were analyzed in order to develop a simplified classification. In the validation study the accuracy and reliability of this classification were estimated among three groups of endoscopists with different levels of expertise in NBI. .RESULTS: The reliability/accuracy results from the derivation study allowed the creation of a simplified NBI classification. In the validation study, "regular vessels with circular mucosa" (pattern A) was associated with normal histology (accuracy 83%; 95% confidence interval [CI] 75?%-90%); "tubulo-villous mucosa" (pattern B) was associated with intestinal metaplasia (accuracy 84%; 95CI 77%-91%; positive likelihood ratio [LR+]=4.75); and "irregular vessels and mucosa" (pattern C) was associated with dysplasia (accuracy 95%; 95CI 90%-99%; LR+=44.33). The reproducibility of these patterns was high (k=0.62). "Light-blue crest" was moderately reliable (k=0.49) but specific (87%) for intestinal metaplasia. A variable vascular density (additional pattern+) was the best feature for Helicobacter pylori gastritis (accuracy 70%; 95CI 59%-80%) but showed only fair reliability (k=0.38). Non-experienced endoscopists presented lower agreement (k=0.6 vs. k=0.75) and accuracy (74% vs. 86%) than international experts/experienced endoscopists. CONCLUSION: A simplified NBI classification is accurate and reliable for the diagnosis of intestinal metaplasia and dysplasia. The classification should be further assessed and validated on a per-patient assessment of NBI, and by comparing NBI with other imaging technologies.This study was supported by a grant for medical investigation from the Portuguese Digestive Endoscopy Society (SPED 2009 Investigation Grant)

On the recent star formation history of the Milky Way disk

We have derived the star formation history of the Milky Way disk over the last 2 Gyr from the age distribution diagram of a large sample of open clusters comprising more than 580 objects. By interpreting the age distribution diagram using numerical results from an extensive library of N-body calculations carried out during the last ten years, we reconstruct the recent star formation history of the Milky Way disk. Our analysis suggests that superimposed on a relatively small level of constant star formation activity mainly in small-N star clusters, the star formation rate has experienced at least 5 episodes of enhanced star formation lasting about 0.2 Gyr with production of larger clusters. This cyclic behavior seems to show a period of 0.4+/-0.1 Gyr.Comment: Abridged abstract. Accepted by New Astronomy. Major changes. A number of figures have been added in order to improve the discussion on error