Chilblains in immune-mediated inflammatory diseases: a review

Chilblains were first described over a hundred years ago as cutaneous inflammatory lesions, typically on the digits, occurring on cold exposure. Chilblains can be primary, or secondary to a number of conditions such as infections, including COVID-19, and immune-mediated inflammatory disorders (IMIDs) with SLE being the commonest. Chilblain lupus erythematosus (CHLE) was first described in 1888 as cold-induced erythematous lesions before the terms 'chilblains' or 'perniosis' were coined. Diagnostic criteria exist for both chilblains and CHLE. Histopathologically, CHLE lesions show interface dermatitis with perivascular lymphocytic infiltrate. Immunofluorescence demonstrates linear deposits of immunoglobulins and complement in the dermo-epidermal junction. This narrative review focuses on chilblains secondary to immune-mediated inflammatory disorders, primarily the epidemiology, pathogenesis and treatment of CHLE.

Viral manipulation of functionally distinct interneurons in mice, non-human primates and humans

Recent success in identifying gene-regulatory elements in the context of recombinant adeno-associated virus vectors has enabled cell-type-restricted gene expression. However, within the cerebral cortex these tools are largely limited to broad classes of neurons. To overcome this limitation, we developed a strategy that led to the identification of multiple new enhancers to target functionally distinct neuronal subtypes. By investigating the regulatory landscape of the disease gene Scn1a, we discovered enhancers selective for parvalbumin (PV) and vasoactive intestinal peptide-expressing interneurons. Demonstrating the functional utility of these elements, we show that the PV-specific enhancer allowed for the selective targeting and manipulation of these neurons across vertebrate species, including humans. Finally, we demonstrate that our selection method is generalizable and characterizes additional PV-specific enhancers with exquisite specificity within distinct brain regions. Altogether, these viral tools can be used for cell-type-specific circuit manipulation and hold considerable promise for use in therapeutic interventions.

Women's empowerment: Finding strength in self-compassion

Empowerment is often a desired outcome for health programs; however, it is rarely evaluated. One way to increase empowerment may be through self-compassion. The authors of the current study aimed to determine whether self-compassion and empowerment were positively related. Two hundred and five women (ages 18 to 48 years) were recruited from a pool of undergraduate students at a university in the southeastern United States in the summer/fall of 2012. Participants completed the study using Qualtrics, an online survey system. Participants wrote about a fight in a romantic relationship and were randomly assigned to write about the fight either self-compassionately or generally. Empowerment and perceptions of the fight were assessed as dependent measures. Hierarchical regression analyses investigated the relation of self-compassion, manipulated self-compassion, and their interaction with empowerment. A significant positive relationship was found between self-compassion and empowerment. However, manipulated self-compassion was not significantly related to empowerment. These findings suggested that self-compassion and empowerment were strongly related, but using a short-term self-compassion intervention may not be strong enough to influence empowerment. Empowerment-based practitioners may find empowerment increases more easily in women who are self-compassionate. If self-compassion is incorporated into empowerment settings, a long-term intervention may be necessary.

Who Owns the Data? Open Data for Healthcare

Research on large shared medical datasets and data-driven research are gaining fast momentum and provide major opportunities for improving health systems as well as individual care. Such open data can shed light on the causes of disease and effects of treatment, including adverse reactions side-effects of treatments, while also facilitating analyses tailored to an individual's characteristics, known as personalized or "stratified medicine." Developments, such as crowdsourcing, participatory surveillance, and individuals pledging to become "data donors" and the "quantified self" movement (where citizens share data through mobile device-connected technologies), have great potential to contribute to our knowledge of disease, improving diagnostics, and delivery of -healthcare and treatment. There is not only a great potential but also major concerns over privacy, confidentiality, and control of data about individuals once it is shared. Issues, such as user trust, data privacy, transparency over the control of data ownership, and the implications of data analytics for personal privacy with potentially intrusive inferences, are becoming increasingly scrutinized at national and international levels. This can be seen in the recent backlash over the proposed implementation of care.data, which enables individuals' NHS data to be linked, retained, and shared for other uses, such as research and, more controversially, with businesses for commercial exploitation. By way of contrast, through increasing popularity of social media, GPS-enabled mobile apps and tracking/wearable devices, the IT industry and MedTech giants are pursuing new projects without clear public and policy discussion about ownership and responsibility for user-generated data. In the absence of transparent regulation, this paper addresses the opportunities of Big Data in healthcare together with issues of responsibility and accountability. It also aims to pave the way for public policy to support a balanced agenda that safeguards personal information while enabling the use of data to improve public health.

'No news today': talk of witnessing with families of missing people

The paper contributes new ways of thinking about and responding to interview talk in the context of recent scholarship on interviewing, orality and witnessing. We proceed by paying attention to specific examples of interview talk on the experience of absence via the collecting of narratives from families of missing people. We highlight how ambiguous emotions are bound up with broader ways of recognizing such talk, largely exercised here as reflections on what is involved in witnessing those who are missing in communications with police. Tensions that may be produced by official ways of regarding and responding to family character witness of the missing are discussed in the context of two case studies. In response to these tensions, we offer suggestions for finding different spaces through which to value such 'witness talk' by families, particularly via ideas from grief scholarship. The paper concludes by briefly reflecting on how interviewing encounters might produce versions of praxis in which the content of talk is not just, and simply, 'apprehended' as academic evidence.

Sophie's story: writing missing journeys

'Sophie's story' is a creative rendition of an interview narrative gathered in a research project on missing people. The paper explains why Sophie's story was written and details the wider intention to provide new narrative resources for police officer training, families of missing people and returned missing people. We contextualize this cultural intervention with an argument about the transformative potential of writing trauma stories. It is suggested that trauma stories produce difficult and unknown affects, but ones that may provide new ways of talking about unspeakable events. Sophie's story is thus presented as a hopeful cultural geography in process, and one that seeks to help rewrite existing social scripts about missing people.

Lentigo maligna : prognosis and treatment options

Lentigo maligna is a premalignant melanocytic neoplasm occurring on the sun-exposed skin of the middle-aged and elderly. It is believed to represent the in situ phase of lentigo maligna melanoma and, as such, cure is usually the aim of treatment. However, factors such as site and size of lesion and patient co-morbidities may influence the treatment modality undertaken. Surgical excision is the treatment of choice to obtain clinical and histologic clearance, but many other modalities have been used with variable success. Mohs micrographic surgery is associated with the lowest recurrence rate at 4-5%, but conventional surgery, cryotherapy and radiotherapy also yield good results, with recurrence rates in the order of 7-10%. Other treatments have been tried but currently there are not enough data to support their routine use. In order to make the best decision regarding appropriate management of lentigo maligna, the dermatologist or surgeon must be aware of all the options available and the evidence supporting their use.

Fumaric acid esters in severe psoriasis, including experience of use in combination with other systemic modalities

BACKGROUND

Fumaric acid esters (FAE) are used as a systemic treatment for severe psoriasis in Germany but there has been only very little published experience from the U.K. The potential for use in combination with other systemic drugs has not been explored.

OBJECTIVES

To present data relating to the efficacy of FAE in severe psoriasis and to examine the potential dose-sparing effect and safety issues when FAE are combined with other systemic agents.

METHODS

We retrospectively analysed the records of patients who had received FAE for severe psoriasis either alone (in two cases) or along with other systemic medications (in 10 cases). We reviewed the efficacy of FAE and assessed whether dose reductions were achieved for other systemic drugs. Patients were monitored carefully for possible adverse effects.

RESULTS

Of 12 patients treated with FAE one discontinued the drug very early, due to flushing, while on a very low dose. The other 11 patients all demonstrated an improvement in psoriasis after starting FAE. Nine patients received FAE in combination with other systemic therapies including ciclosporin, acitretin, hydroxyurea and methotrexate. Seven achieved useful overall reductions in the dose of the other drugs. In two patients severe psoriasis was controlled using FAE alone. The side-effect profile of FAE was similar to that previously reported. There was no evidence of drug interactions.

CONCLUSIONS

FAE appear effective and less toxic than other systemic treatments for psoriasis. FAE were used successfully in combination with other systemic agents and generally enabled the doses of the more hazardous drugs to be reduced. Extremely careful monitoring is required when using FAE in such combined regimens as experience is currently very limited.