Practical algorithm to inform clinical decision-making in the topical treatment of atopic dermatitis

Atopic dermatitis is a chronic relapsing, inflammatory skin disorder associated with skin barrier dysfunction, the prevalence of which has increased dramatically in developing countries. In this article, we propose a treatment algorithm for patients with mild-tomoderate and severe atopic dermatitis flares in daily clinical practice. An international panel of 15 dermatology and allergy experts from eight countries was formed to develop a practical algorithm for the treatment of patients with atopic dermatitis, with a particular focus on topical therapies. In cases of mild-to-moderate atopic dermatitis involving sensitive skin areas, the topical calcineurin inhibitor pimecrolimus should be applied twice daily at the first signs of atopic dermatitis. For other body locations, patients should apply a topical calcineurin inhibitor, either pimecrolimus or tacrolimus, twice daily at the first signs of atopic dermatitis, such as pruritus, or twice weekly in previously affected skin areas. Emollients should be used regularly. Patients experiencing acute atopic dermatitis flares in sensitive skin areas should apply a topical corticosteroid twice daily or alternate once-daily topical corticosteroid/topical calcineurin inhibitor until symptoms improve. Following improvement, topical corticosteroid therapy should be discontinued and patients switched to a topical calcineurin inhibitor. Maintenance therapy should include the use of pimecrolimus once daily for sensitive areas and tacrolimus for other body locations. This treatment algorithm can help guide clinical decision-making in the treatment of atopic dermatitis

КОРРЕКЦИЯ НУТРИТИВНОГО СТАТУСА В КОМПЛЕКСНОЙ ТЕРАПИИ ДЕТЕЙ, СТРАДАЮЩИХ ДИСТРОФИЧЕСКОЙ ФОРМОЙ ВРОЖДЕННОГО БУЛЛЕЗНОГО ЭПИДЕРМОЛИЗА

Children  suffering  from  dystrophic  forms  of  innate  epidermolysis  bullosa  (IEB),  have  malnutrition  of  multifactorial  genesis.  And, despite the experience of working with this complex group of patients, many practical issues of optimal nutrition organization at IEB remain  unsolved.  The review presents  modern  approaches  to the assessment  of nutritional status  with children,  including those developed for the assessment of eating disorders with children having IEB; the formulas for calculating the nutrient requirement are presented. The analysis of the scientific data on the pathogenesis and characteristics of disturbances in nutritional status with children having IEB is done. It is noted that the complexity of nutritional support of this severe category of patients is due to a mismatch between the increased need for nutrients and limited assimilation of food, which requires a special diet with increased energy and protein value without increasing the amount of food intake. Reasonability of the organization of feeding children having IEB with specialized products for enteral nutrition and nutritional support is analyzed.Дети, страдающие дистрофической  формой врожденного  буллезного эпидермолиза  (ВБЭ), имеют недостаточность питания многофакторного  генеза. И, несмотря на накопленный опыт по ведению этой сложной  категории больных, многие практические вопросы организации оптимального питания при ВБЭ остаются нерешенными. В обзоре представлены современные подходы к оценке нутритивного статуса у детей, в том числе разработанные для оценки нарушения питания у детей с ВБЭ; приводятся формулы для расчета потребности в нутриентах. Проведен анализ научных данных по патогенезу и особенностям нарушения нутритивного статуса у детей с ВБЭ. Отмечено, что сложность организации нутритивной поддержки этой тяжелой  категории больных обусловлена  несоответствием между повышенной потребностью в питательных веществах и ограниченными возможностями усвоения пищи, что требует особой диеты с повышенной энергетической и белковой ценностью без увеличения объема пищи. Рассмотрена целесообразность организации  кормления детей c ВБЭ с использованием  специализированных  продуктов  для энтерального  питания и нутритивной поддержки

An overview of the approaches for automotive safety integrity levels allocation

YesISO 26262, titled Road Vehicles–Functional Safety, is the new automotive functional safety standard for passenger vehicle industry. In order to accomplish the goal of designing and developing dependable automotive systems, ISO 26262 uses the concept of Automotive Safety Integrity Levels (ASILs), the adaptation of Safety Integrity Levels. ASILs are allocated to the components and subsystems that can cause system failure and malfunctions that lead to hazards. ASILs allocation is a hard problem consists of finding the optimal allocation of safety levels to the system architecture which must guarantee that the highest safety requirements are met while development cost of the automotive system is kept minimum. There were many successful attempts to solve this problem using different techniques. However, it is worth pointing out that there is an absence of a review that provides an in-depth study of all the existing methods and highlights their merits and demerits. This paper presents an overview of different approaches that were used to solve ASILs allocation problem. The review provides an overview of safety requirements including the related standards followed by a study of the resolution methods of the existing approaches. The study of each approach provides a detailed explanation of the used methodology and a discussion of its strength and weaknesses including the main open challenges

Severe plastic deformation for producing superfunctional ultrafine-grained and heterostructured materials: An interdisciplinary review

Ultrafine-grained and heterostructured materials are currently of high interest due to their superior mechanical and functional properties. Severe plastic deformation (SPD) is one of the most effective methods to produce such materials with unique microstructure-property relationships. In this review paper, after summarizing the recent progress in developing various SPD methods for processing bulk, surface and powder of materials, the main structural and microstructural features of SPD-processed materials are explained including lattice defects, grain boundaries and phase transformations. The properties and potential applications of SPD-processed materials are then reviewed in detail including tensile properties, creep, superplasticity, hydrogen embrittlement resistance, electrical conductivity, magnetic properties, optical properties, solar energy harvesting, photocatalysis, electrocatalysis, hydrolysis, hydrogen storage, hydrogen production, CO2 conversion, corrosion resistance and biocompatibility. It is shown that achieving such properties is not limited to pure metals and conventional metallic alloys, and a wide range of materials are currently processed by SPD, including high-entropy alloys, glasses, semiconductors, ceramics and polymers. It is particularly emphasized that SPD has moved from a simple metal processing tool to a powerful means for the discovery and synthesis of new superfunctional metallic and nonmetallic materials. The article ends by declaring that the borders of SPD have been extended from materials science and it has become an interdisciplinary tool to address scientific questions such as the mechanisms of geological and astronomical phenomena and the origin of life

SYSTEM THERAPY OF PSORIASIS IN CHILDREN (PART I)

We include a review of modern methods of systemic therapy of psoriasis in children, indications for which are moderate and severe forms of psoriasis with PASI > 10, skin pathological process that is uncontrollable with topical drugs, skin lesions with functional localization (lesions of genitals, palms and soles, facial skin), erythrodermic psoriasis, pustular psoriasis, psoriatic arthritis. We provide information on the techniques of narrow-band phototherapy (UVB 311 nm) that are used in the treatment of psoriasis in children. We provide data on efficacy, safety, necessary monitoring of clinical and laboratory indicators, peculiarities of vaccination during treatment of children with acitretin, methotrexate, cyclosporine

Systemic Psoriasis Treatment at an Early Age (Part II): Issues of Biological Therapy

The authors present an overview of the present day knowledge of methods of biological therapy used for treatment of severe psoriasis at an early age. Data is presented on efficiency, safety, required monitoring of clinical and laboratory performance, specifics of vaccination during the treatment of children with genetically engineered biological drugs. Data is presented on the authors’ own clinical observations of 10 adolescents who were administered the preparation of ustekinumab. The objective of the observational study was assessment of efficiency and safety of application of ustekinumab for treatment of severe psoriasis with children over 12 years of age. Materials and Methods. The observation covered 10 children, their average age being 15±2.8 years old, the PASI index 39.3±9.5, who were administered ustekinumab at a dose of 45 mg under a standard administration regimen. Results. The therapeutic effect was assessed based on the PASI index, which was found to decrease by 75% with 6 adolescents, and by 90% with 4 adolescents as soon as by week 14 of the therapy. As is shown by the follow-up observation, the skin pathological process was completely resolved with 80% of adolescents after 3 injections of ustekinumab, and with 100% after 4 injections. Conclusion. The preparation of ustekinumab is efficient and safe for treatment of psoriasis at an early age. As based on the PASI index as the main criterion of assessment of treatment efficiency, ustekinumab (Stelara) is the medicine of choice for treatment of severe forms of the disease from the age of 12 years old

Topical treatment of atopic dermatitis in children: current challenges and answers

Atopic dermatitis (AD) is the most prevalent skin disease in the early childhood and is a considerable problem both for patients and members of their families and for the society on the whole. In most cases, AD requires a long-term therapy such as the use of anti-inflammatory drugs. Selective inhibitors of the synthesis and release of proinflammatory cytokines - topical calcineurin inhibitors (Tcis) - are now used to solve this problem, with pimecrolimus being one of them. Pimecrolimus has been thoroughly examined for the past decade in different clinical studies involving a total of over 4,000 infants (below 2 years of age). These studies demonstrated the efficacy and safety of pimecrolimus for AD in children provided it is used in a long-term therapy on an intermittent basis. Unlike topical corticosteroids, the long-term use of pimecrolimus is not associated with any risk of development of systemic immunosuppression, skin atrophy, skin barrier dysfunction or systemic absorption so it is safe even if applied to the most sensitive skin areas. In view of this, the authors make a conclusion that pimecrolimus used in the form of a cream is a safe and efficient drug for the treatment of infants aged over three months suffering from atopic dermatitis

CORRECTION OF NUTRITIONAL STATUS IN COMPLEX THERAPY FOR CHILDREN SUFFERING FROM DYSTROPHIC FORMS OF INNATE EPIDERMOLYSIS BULLOSA

Children  suffering  from  dystrophic  forms  of  innate  epidermolysis  bullosa  (IEB),  have  malnutrition  of  multifactorial  genesis.  And, despite the experience of working with this complex group of patients, many practical issues of optimal nutrition organization at IEB remain  unsolved.  The review presents  modern  approaches  to the assessment  of nutritional status  with children,  including those developed for the assessment of eating disorders with children having IEB; the formulas for calculating the nutrient requirement are presented. The analysis of the scientific data on the pathogenesis and characteristics of disturbances in nutritional status with children having IEB is done. It is noted that the complexity of nutritional support of this severe category of patients is due to a mismatch between the increased need for nutrients and limited assimilation of food, which requires a special diet with increased energy and protein value without increasing the amount of food intake. Reasonability of the organization of feeding children having IEB with specialized products for enteral nutrition and nutritional support is analyzed