Skin in the game: a review of single-cell and spatial transcriptomics in dermatological research

Single-cell RNA sequencing (scRNA-seq) and spatial transcriptomics (ST) are two emerging research technologies that uniquely characterize gene expression microenvironments on a cellular or subcellular level. The skin, a clinically accessible tissue composed of diverse, essential cell populations, serves as an ideal target for these high-resolution investigative approaches. Using these tools, researchers are assembling a compendium of data and discoveries in healthy skin as well as a range of dermatologic pathophysiologies, including atopic dermatitis, psoriasis, and cutaneous malignancies. The ongoing advancement of single-cell approaches, coupled with anticipated decreases in cost with increased adoption, will reshape dermatologic research, profoundly influencing disease characterization, prognosis, and ultimately clinical practice.

Right-sided meralgia paresthetica from lateral femoral cutaneous nerve neuroma

Meralgia Paresthetica (MP) causes outer thigh discomfort, numbness, and tingling. Compression or injury to the Lateral Femoral Cutaneous Nerve (LFCN), which gives sensory innervation to outer aspect of the thigh. It frequently gets impinged beneath the inguinal ligament resulting in in sensory impairment in the distribution of LFCN. Compression of the LFCN is a frequent cause of MP, whereas LFCN neuromas is a rare cause. This case report describes a unique case of Meralgia Paresthetica produced by a LFCN neuroma and enhances our knowledge of Meralgia Paresthetica.

The non-steroidal anti-inflammatory drug salsalate provides safe and effective control of mucositis-unrelated pain during autologous and allogeneic hematopoietic stem cell transplantation

INTRODUCTION

Pain is a serious adverse event which frequently accompanies hematopoietic stem cell transplantation (HSCT). The safety and efficacy of NSAIDS during HSCT is currently unknown. Salsalate is a platelet-sparing NSAID with a favorable toxicity profile compared with other NSAIDS. We report the safety and efficacy of salsalate for different types of pain during SCT.

METHODS

We conducted a retrospective study of SCT recipients empirically treated with salsalate for > 48 h. Pain scores were assessed using the verbal rating scale for pain. A subset analysis of patients who received > 7 days of salsalate during periods of pancytopenia, mucositis, and other end-organ toxicities is included.

RESULTS

Sixty-four patients, 42 auto- and 22 allografts, were identified. Reason for use: vertebral-related pain (30%), musculoskeletal (30%), and cytokine inflammatory pain syndromes (24%). Median dose 1500 mg/day, number of treatment days = 5, started on day+5 post-HSCT. Pain resolved/improved to pain score < 4 in 76% and stable in 15%. Forty-four patients (28-auto and 16 allografts) received > 7-day salsalate. Median WBC and platelet nadir were < 0.1 and 10,000 cells/ml respectively.

EFFICACY

pain was improved or eradicated in 64% and stable in 32%.

TOXICITY

LFT elevation (n = 2), elevated serum creatinine (n = 2), and minor bleed (n = 5-nose, gums, and urine). Salsalate discontinuation (n = 6): ineffective (n = 1), the liver (n = 1), the kidney (n = 1), > 5 platelet transfusions (n = 1), and vomiting (n = 2). There was no treatment related mortality. Salsalate was well tolerated, safe, and beneficial for several different types of pain during HSCT.

PRMT5 Inhibition Modulates E2F1 Methylation and Gene-Regulatory Networks Leading to Therapeutic Efficacy in JAK2V617F-Mutant MPN

We investigated the role of PRMT5 in myeloproliferative neoplasm (MPN) pathogenesis and aimed to elucidate key PRMT5 targets contributing to MPN maintenance. PRMT5 is overexpressed in primary MPN cells, and PRMT5 inhibition potently reduced MPN cell proliferation ex vivo. PRMT5 inhibition was efficacious at reversing elevated hematocrit, leukocytosis, and splenomegaly in a model of JAK2V617F+ polycythemia vera and leukocyte and platelet counts, hepatosplenomegaly, and fibrosis in the MPLW515L model of myelofibrosis. Dual targeting of JAK and PRMT5 was superior to JAK or PRMT5 inhibitor monotherapy, further decreasing elevated counts and extramedullary hematopoiesis in vivo. PRMT5 inhibition reduced expression of E2F targets and altered the methylation status of E2F1 leading to attenuated DNA damage repair, cell-cycle arrest, and increased apoptosis. Our data link PRMT5 to E2F1 regulatory function and MPN cell survival and provide a strong mechanistic rationale for clinical trials of PRMT5 inhibitors in MPN. SIGNIFICANCE: Expression of PRMT5 and E2F targets is increased in JAK2V617F+ MPN. Pharmacologic inhibition of PRMT5 alters the methylation status of E2F1 and shows efficacy in JAK2V617F/MPLW515L MPN models and primary samples. PRMT5 represents a potential novel therapeutic target for MPN, which is now being clinically evaluated.This article is highlighted in the In This Issue feature, p. 1611.

Shift working reduces operative experience for trauma and orthopaedic higher surgical trainees: a UK multicentre study

INTRODUCTION

In recent years there has been a rise in the number of trauma and orthopaedics trainees working on full shift patterns. Historically, most trauma and orthopaedics trainees worked 24 hours non-resident on-call shifts. The effect of this change in shift patterns has not previously been measured. As two trusts (one trauma unit, one major trauma centre) in our region underwent a change to full shift working, we assessed the impact on the trainees' operating experience.

METHODS

Fifty-five logbooks were analysed across the two trusts over a two-year period, with comparisons made between pre- and post-shift working.

RESULTS

Overall operating fell by 13% for trainees working full shift patterns, which was statistically significant. There was a loss of elective operating of 15% at the trauma unit and 32% at the major trauma centre for trainees doing shift work. The effect on trauma operating opportunities was mixed. Index operating was largely preserved.

CONCLUSIONS

Shift working significantly impacts on surgical training opportunities. We explore approaches to minimising this effect.

Evaluation of the reliability and validity of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) in paediatric cutaneous lupus among paediatric dermatologists and rheumatologists

BACKGROUND

The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) is a reliable outcome measure for cutaneous lupus erythematosus (CLE) in adults used in clinical trials. However, it has not been validated in children, limiting clinical trials for paediatric CLE.

OBJECTIVES

This study aimed to validate the CLASI in paediatrics.

METHODS

Eleven paediatric patients with CLE, six dermatologists and six rheumatologists participated. The physicians were trained to use the CLASI and Physician's Global Assessment (PGA), and individually rated all patients using both tools. Each physician reassessed two randomly selected patients. Within each physician group, the intraclass correlation coefficient (ICC) was calculated to assess the reliability of each measure.

RESULTS

CLASI activity scores demonstrated excellent inter- and intrarater reliability (ICC > 0·90), while the PGA activity scores had good inter-rater reliability (ICC 0·73-0·77) among both specialties. PGA activity scores showed excellent (ICC 0·89) and good intrarater reliability (ICC 0·76) for dermatologists and rheumatologists, respectively. Limitations of this study include the small sample size of patients and potential recall bias during the physician rerating session.

CONCLUSIONS

CLASI activity measurement showed excellent inter- and intrarater reliability in paediatric CLE and superiority over the PGA. These results demonstrate that the CLASI is a reliable and valid outcome instrument for paediatric CLE.

Amphetamine and other pharmacological agents in human and animal studies of recovery from stroke

Neuromodulation with pharmacological agents, including drugs of abuse such as amphetamine, when paired with behavioral experience, has been shown to positively modify outcomes in animal models of stroke. A number of clinical studies have tested the efficacy of a variety of drugs to enhance recovery of language deficit post-stroke. The purpose of this paper is to: (1) present pertinent animal studies supporting the use of dextro-amphetamine sulfate (AMPH) to enhance recovery after experimental lesions with emphasis on the importance of learning dependent activity for lasting recovery; (2) briefly review neuropharmacological explorations in the treatment of aphasia; (3) present a pilot study in aphasia exploring a drug combination of AMPH and donepezil hydrochloride paired with behavioral treatment to facilitate recovery; and (4) conclude with comments regarding the role of adjunctive pharmacotherapy in the rehabilitation of aphasia, particularly AMPH.

Epidemiology of extra-pulmonary tuberculosis in the United States: high rates persist in the post-HIV era

BACKGROUND

The incidence of tuberculosis (TB) in the United States has declined following a logarithmic pattern, with few exceptions. One exception was during the acquired immunodeficiency syndrome (AIDS) epidemic, which was thought to have caused the deviation. However, since then, alternative explanations have been proposed, including the increased burden of chronic diseases, immigration, and the increase in the use of immune suppressant medications.

METHODS

Epidemiological data of the Center for Disease Control and Prevention (CDC) and the Bureau of the Census were analyzed regarding TB incidence, human immunodeficiency virus (HIV) infection, immigration status, and age for the period 1953-2011.

RESULTS

Data analysis identified a deviation from the logarithmic decline in TB cases that started in the mid-2000s. This divergence did not appear to be related to HIV status. The overall decline in TB cases since 1953 has been almost exclusively due to a reduction in pulmonary TB (PTB) and not to extra-pulmonary TB (EPTB).

CONCLUSIONS

The HIV/AIDS epidemic likely played a significant role in the 1979-1985 deviation, but not subsequently. Furthermore, EPTB as a proportion of total TB cases has remained high. Further studies to delineate the etiologies of these findings are needed.

Use of vasodilators in congestive heart failure

In order to select the proper vasodilator agent for the treatment of congestive heart failure, the underlying etiology and pathophysiology of heart failure must be understood since they are important determinants of the response to the particular vasodilator being used. Short-term studies are impressive. Most patients respond dramatically to vasodilators. Long-term studies are not available at this time. When they become available, the clinical usefulness of this group of drugs will be put in proper perspective.

Molecular epidemiology of epidermal growth factor receptor mutations in lung cancers in Indian population

BACKGROUND

Lung cancer is the leading cause of cancer related mortality world-wide and amongst males in India. The discovery of tyrosine kinase inhibitors holds a ray of hope for a subset of lung cancer patients, which have activating epidermal growth factor receptor (EGFR) mutations. Much of the preliminary data on frequency of EGFR mutations emanated from Western studies, which reported EGFR mutation rates of 10-15%. However, studies from Asian countries report a much higher frequency of EGFR mutations, not only in the male population, but also in females.

AIM

The object of this study was to share the author's experience of EGFR mutation testing in 402 lung cancer patients as no large-scale study addressing the issue has been published from India.

MATERIALS AND METHODS

Formalin fixed paraffin embedded tissues were analyzed for EGFR exon 19 deletions and exon 21 point mutation by length analysis of fluorescently labeled polymerase chain reaction products on Applied Biosystems Inc. 310 genetic analyzer.

RESULTS

Out of 402 samples, 35 samples could not be analyzed because of poor deoxyribonucleic acid material. Thus of the remaining 367 cases analyzed, EGFR mutations were found in 118 patients (32%). Mutations were equally distributed between males (50%) and females (50%). Majority of the mutations were seen in adenocarcinoma subtype (90%). Exon 19 mutations accounted for 76% while exon 21 mutations accounted for 24% of the mutations.

SUMMARY

EGFR mutation frequency is higher in Indian population vis-à-vis Caucasian population, but lower than that reported in the East Asian population. A significantly higher number of males also harbor EGFR mutations.

Antimicrobial prophylaxis in hematopoietic stem cell transplantation recipients: 10 years after

BACKGROUND

Antimicrobial prophylaxis is recommended for all patients undergoing hematopoietic stem cell transplantation. Evidence-based guidelines recently have been updated to incorporate the results from recent clinical studies.

METHODS

An antimicrobial prophylaxis survey was conducted during the 2013 ASBMT Tandem Meetings to discern the degree of concordance between transplant centers and society guidelines.

RESULTS

The results show significant differences in prescribing practices among transplant institutions and variance with evidence-based guidelines.

CONCLUSION

The clinical significance of this discordance is unknown.

Shrinking lung syndrome presenting as an initial pulmonary manifestation of SLE

Shrinking lung syndrome (SLS) is a rare pulmonary complication of an underlying autoimmune disorder and is reported in association with systemic lupus erythematosus (SLE). We describe the favorable outcome of SLS in an 18-year-old Hispanic male who presented with SLS as the initial pulmonary manifestation of SLE.

Rhabdomyosarcoma in middle ear of an adult: a rare presentation

Rhabdomyosarcoma of the middle ear is a rare tumor, even rarer in adults and has a very poor prognosis. We report here an unusual case of rhabdomyosarcoma in middle ear of an adult, mimicking chronic suppurative otitis media and facial nerve palsy.

Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome

BACKGROUND

Obstructive sleep apnoea (OSA) is often undiagnosed before elective surgery and may predispose patients to perioperative complications.

METHODS

A literature search of PubMed-Medline, Web of Science, Scopus, EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials up to November 2010 was conducted. Our search was restricted to cohort or case-control studies in adults diagnosed with OSA by screening questionnaire, oximetry, or polysomnography. Studies without controls, involving upper airway surgery, and with OSA diagnosed by ICD-9 codes alone were excluded. The primary postoperative outcomes were desaturation, acute respiratory failure (ARF), reintubation, myocardial infarction/ischaemia, arrhythmias, cardiac arrest, intensive care unit (ICU) transfer, and length of stay.

RESULTS

Thirteen studies were included in the final analysis (n=3942). OSA was associated with significantly higher odds of any postoperative cardiac events [45/1195 (3.76%) vs 24/1420 (1.69%); odds ratio (OR) 2.07; 95% confidence interval (CI) 1.23-3.50, P=0.007] and ARF [33/1680 (1.96%) vs 24/3421 (0.70%); OR 2.43, 95% CI 1.34-4.39, P=0.003]. Effects were not heterogeneous for these outcomes (I(2)=0-15%, P>0.3). OSA was also significantly associated with higher odds of desaturation [189/1764 (10.71%) vs 105/1881 (5.58%); OR 2.27, 95% CI 1.20-4.26, P=0.01] and ICU transfer [105/2062 (5.09%) vs 58/3681 (1.57%), respectively; OR 2.81, 95% CI 1.46-5.43, P=0.002]. Both outcomes showed a significant degree of heterogeneity of the effect among studies (I(2)=57-68%, P<0.02). Subgroup analyses had similar conclusions as main analyses.

CONCLUSIONS

The incidence of postoperative desaturation, respiratory failure, postoperative cardiac events, and ICU transfers was higher in patients with OSA.

Psychological aspects of prostate cancer: a clinical review

Prostate cancer is the most common non-skin cancer in men. It is fraught with both physical and psychological symptomatology. Depression, anxiety, stress, fatigue, pain and psychosocial factors all affect the patient with prostate cancer. Impotence, erectile dysfunction, sexual issues and incontinence in these patients complicate matters further. Anxiety may exist both before testing and while awaiting test results. Confusion over choosing from various interventions often adds to anxiety and depression in these patients. Various demographic factors and the developmental stage of the couple affect these psychological symptoms. The caregiver may undergo significant psychological turmoil while caring for a patient diagnosed with prostate cancer, which is addressed. The role of nurses in the management of prostate cancer is discussed. The present review looks at psychological issues in patients with prostate cancer from a clinical perspective, with the aim of highlighting these issues for the clinical urologist dealing with these patients. It also explores the consultation-liaison relationship between psychiatrists, psychologists and urologists as a team for the multimodal management of prostate cancer.