Association between BMI and vitiligo distribution: an observational cohort study

Vitiligo is an inflammatory skin condition affecting 0·5–2% of people. Previous studies have found that vitiligo does not appear to have an association with an increased body mass index (BMI) nor is BMI a risk factor for vitiligo. However, to the best of our knowledge, the relationship between a patient being over or underweight and the presentation of vitiligo has not been explored. Here, we aim to explore the relationship between BMI classifications and vitiligo distribution. A total of 1685 consecutive patients with vitiligo were recruited as part of an ongoing survey study. Patients self-identified their sex, age, race and regions of vitiligo distribution. Patients reported their height and weight, which was then used to generate BMI values, which were then grouped into classifications. The BMI classifications were underweight for patients with a BMI >18·5, normal for patients with a BMI equal to 18·5 or larger but <30 and overweight for patients with a BMI equal to or over 30. Analysis was performed with R (version 1·4). The cohort (n = 1685) had a median age of 42 years, was predominantly female (72%) and was predominantly white (64%). The patients were divided into three weight classes: 1270 normal weight, 344 overweight and 71 underweight. Vitiligo presentation was more likely for overweight individuals in the chest (P = 0·007), stomach (P < 0·001), underarms (P = 0·005), arms (P = 0·007), elbows (P = 0·031), wrists (P = 0·040), hands (P = 0·003), fingers (P = 0·004), buttocks (P = 0·002), ankles (P = 0·033), feet (P < 0·001) and toes (P = 0·022). Vitiligo presentation does not seem to have a relationship with one’s BMI classification in the distribution of the eyelids, lips, mouth, back, hips, genitals, legs and knees. Our preliminary analysis supports that there is a relationship between a patient’s body mass classification and the distribution of vitiligo. Vitiligo presentation seems to be more likely for overweight individuals in the chest, stomach, underarms, arms, elbows, wrists, hands, fingers, buttocks, ankles, feet and toes. Vitiligo presentation does not seem to have a relationship with one’s BMI classification in the distribution of the eyelids, lips, mouth, back, hips, genitals, legs and knees. The effect of weight-induced friction and metabolic syndrome on vitiligo disease progression needs to be explored further. Further studies are needed to explore the varying presentation of vitiligo in individuals of all BMI subtypes and whether weight can help reduce the spread of the disease.

Immune biomarkers are more accurate in prediction of survival in ulcerated than in non-ulcerated primary melanomas

INTRODUCTION

Ulcerated melanomas may have a unique biology and microenvironment. We test whether markers of immune infiltration correlate with clinical outcome in ulcerated compared to non-ulcerated primary melanoma tumors.

METHODS

Sixty-two stage II-III cutaneous melanomas, 32 ulcerated and 30 non-ulcerated, were analyzed for tumor-infiltrating lymphocytes (TILs). Immunohistochemistry (IHC) was performed for CD2, a marker previously shown to correlate with overall survival (OS) and recurrence-free survival (RFS) in this patient population. IHC using antibody, VE1, to BRAF V600E was also performed on a subset of 41 tumors to assess the relationship of BRAF mutation to immune markers.

RESULTS

We found, using Cox regression models, that the presence of TILs was associated with improved OS (p = 0.034) and RFS (p = 0.002) in ulcerated melanoma tumors, but not in non-ulcerated melanoma (p = 0.632, 0.416). CD2 expression also was correlated with improved OS (p = 0.021) and RFS (p = 0.001) in ulcerated melanoma, but no relationship was seen in non-ulcerated melanoma (p = 0.427, 0.682). In this small population, BRAF status did not correlate with TILs or CD2+ count.

CONCLUSION

Our data show that immune markers including TILs and CD2 count correlate more closely with survival in ulcerated melanomas than that in non-ulcerated melanomas. We propose that immune biomarkers may be particularly relevant to ulcerated, as compared to non-ulcerated, melanomas and that this merits study in larger populations.

Treatment of severely recalcitrant chronic spontaneous urticaria: a discussion of relevant issues

Chronic spontaneous urticaria (CSU) is a common disorder with a prevalence of 1% that is characterized by recurrent wheals, angioedema, or both. CSU is self-limited but in many patients symptoms recur for several years and can be refractory to standard therapies. In this review, we present an illustrative case of a female patient with CSU who, despite taking 15 antihistamines a day in addition to a number of second-line therapies, continued to be refractory to treatment. However, once we initiated subcutaneous treatment with omalizumab 300 mg every 4 weeks, she experienced rapid relief of her CSU symptoms. Through this case, we present a review of the relevant issues, including the efficacy of laboratory tests to identify the cause of a patient's CSU, the association between CSU and thyroid disease and its relevance to treatment options, the recommendation to increase antihistamine dose up to fourfold and possible adverse events associated with this treatment option. We also include a discussion of the use of second-line therapies as well as omalizumab in refractory CSU patients.

Investigation of Textured Back Reflectors for Microcrystalline Silicon Based Solar Cells

Microcrystalline silicon (μc-Si:H) solar cells require an effective light trapping in the near infrared (NIR) to enhance the long wavelength spectral response. For this purpose we investigated back reflectors based on texture-etched ZnO/Ag stacks prepared on glass substrates by magnetron sputtering. With decreasing sputter pressure the resulting surface texture of the glass/Ag/ZnO substrates after etching exhibits a larger feature size and root mean square roughness. The increase in feature size corresponds to an increase of diffuse reflectivity. Applied in microcrystalline solar cells prepared by VHF plasma enhanced chemical vapour deposition (PECVD), the reflectors showing the largest feature size (prepared at the lowest possible sputter pressure) yielded the highest long wavelength spectral response. The μc-Si n-i-p cells prepared on the latter back reflector exhibited efficiencies of 6.9 % (short circuit current density jsc= 18.8 mA/cm2) and 7.5 % (jsc=25 mA/cm2) for an i-layer thickness of 1 μm and 3.5 μm, respectively.

Custom shade guide system for composite resins

Shade guides that are included in most composite kits are not made of the actual resin material. Therefore the true shade, translucency, or opacity of the composite resin is not readily apparent with stock shade guides. Due to this fact, it has become evident that the best solution to the shade guide problem is to construct a custom shade guide from the actual resin. Until recently, fabrication of custom shade guides has been a time-consuming, inefficient task. Now, a simple and efficient method of forming accurate shade guides for composites is available. With its unique handle/template design, T-TABs enable a dentist to create a precise, labeled shade guide within minutes. There are many advantages to both dentist and patient when T-TABs are employed in the construction of custom shade guides.

Regulatory factors specific for adult and embryonic globin genes may govern their expression in erythroleukemia cells

In order to test if trans-acting regulatory factors specific for globin genes of the adult and embryonic stages of development exist in erythroid cells, transcriptionally active embryonic and adult globin genes on the same chromosome were transferred by cell fusion from the human leukemia cell K562 into phenotypically adult mouse erythroleukemia cells. Restriction-fragment-length polymorphisms of the K562 zeta (embryonic) globin genes were used to establish that all three copies of human chromosome 16 present in the K562 cell showed the same pattern of human globin gene expression after transfer to the mouse erythroleukemia cell. Adult (alpha) but not embryonic (zeta) human globin mRNA was detected in all nine of the independently derived mouse erythroleukemia hybrid cells, each of which contained human chromosome 16. Restriction endonuclease studies of the K562 alpha- and zeta-globin genes after transfer into the mouse erythroleukemia cell showed no evidence of rearrangements or deletions that could explain this loss of zeta-globin gene expression. These data suggest that regulation of globin gene expression in these erythroleukemia cells involves trans-acting regulatory factors specific for the adult and embryonic stages of development.

Pulmonary artery occlusion due to histoplasmosis

Histoplasma mediastinitis with complete or partial pulmonary artery obstruction due to compression and/or intraluminal granuloma was diagnosed in five patients and surgically verified in two. The patients, ages 12-27 years, had cough, dyspnea (four cases), and hemoptysis (two cases). Radionuclide imaging showed unilateral absence of pulmonary perfusion and minimal diminution of ventilation. Differentiation of this inflammatory process from other causes of ventilation-perfusion mismatch, for example, congenital hypoplasia and certain acquired causes of arterial obstruction, especially thromboembolism, may be possible by correlating radiographs, laminograms, and clinical history. Angiography can delineate the extent of perfusion impairment and may suggest its cause.

Improved routine chest radiography with a trough filter

Use of the aluminum trough filter for phototimed posteroanterior chest radiographs at 120 kVp provides excellent detail within the parenchyma of the lung as well as greatly enhanced visualization of mediastinal structures on a single exposure. An improvement in overall diagnostic value was noted by a panel of radiologists in 87% of 50 cases compared with conventional 120 kVp technique. Dosimetric measurements of the entrance exposure indicate a 12.5% reduction over the mediastinum and a 62% reduction over the lateral lung field compared with routine nonfilter examinations. The filter is inexpensive and readily adapted to any x-ray unit and is, therefore, an attractive alternative to costly high kVp sources. Furthermore, the attenuation coefficient for calcium in bone and parenchyma remains relatively high with preservation of calcium contrast. Repeat exposures have been minimized and the need for additional projections virtually eliminated.

Use of bacteriophage transposon Mu d1 to determine the orientation for three proC-linked phosphate-starvation-inducible (psi) genes in Escherichia coli K-12

We have previously used the bacteriophage transposon Mu d1 (which encodes the lacZY structural genes but without their promoter) to construct strains that have lacZY fused to phosphate-regulated promoters in Escherichia coli K-12. Among 18 identified phosphate-starvation-inducible (psi) genes, three (the phoA and two new genes: psiF and psiG) are closely linked to the proC region. The gene order (clockwise) is phoA psiF proC psiG phoB phoR. Using these mutants containing Mu d1 insertions, we devised and tested a new method to determine their orientation. In this procedure, mutants with deletions that are selectable by their ability to grow at 42 degrees C are tested for the presence of Mu d1 and of neighboring genes. Some difficulties arose during analysis of suspected deletion-containing strains derived from Mu d1 lysogens (which also contained a Tn5 element) that were caused by Mu d1 and transposon transpositions and other possible genome rearrangements. Nevertheless, we have shown that the phoA and psiF genes are transcribed clockwise and the psiG gene is transcribed counterclockwise towards proC. Because phoA, but not psiF, gene expression requires the phoB+ (positive regulator) gene product, the phoA and psiF genes do not constitute an operon. On the other hand, the psiG:lacZ fusion-bearing strain may have a fusion to the promoter-distal end of the phoB gene. This implies that phoB expression is phosphate regulated. We believe that this method may be useful in general to elucidate the direction of gene transcription.

Asymmetric prostatic hyperplasia simulating bladder tumor

A rare case of hyperplasia of a single lateral lobe of the prostate presenting as a solitary intravesical filling defect is presented.

Fibrous mediastinitis: a late manifestation of mediastinal histoplasmosis

Fibrosing mediastinitis is an uncommon manifestation of histoplasmosis that occurs primarily in younger patients. Findings include tracheobronchial narrowing, compromise of the main pulmonary artery and veins, and circumferential narrowing of the esophagus. The initial chest radiograph is often diagnostic, although additional studies including tomography and angiography help clarify the extent and severity of the disease process.

Displacement of pontine arteries by fungating pontine astrocytomas

Pontine astrocytomas may fungate, encircling the basilar artery and pontomesencephalic vein and intruding between these structures and the clivus. The tumor thus may prevent anterior displacement of these vascular structures against the clivus or produce paradoxical posterior displacement. However, the pontine arteries are usually swept forward by the tumor nodules to lie anterior to the basilar artery. These arteries are also stretched as they encircle the enlarged pons, losing their normal undulations. An increased posterior extent of the vessels may be seen, presumed due to hypertrophy or displacement or both. These findings seem highly specific for the diagnosis of fungating pontine astrocytoma.