Dupilumab-associated head and neck dermatitis shows a pronounced type 22 immune signature mediated by oligoclonally expanded T cells

Dupilumab, an IL4R-blocking antibody, has shown clinical efficacy for atopic dermatitis (AD) treatment. In addition to conjunctivitis/blepharitis, the de novo appearance of head/neck dermatitis is now recognized as a distinct side effect, occurring in up to 10% of patients. Histopathological features distinct from AD suggest a drug effect, but exact underlying mechanisms remain unknown. We profiled punch biopsies from dupilumab-associated head and neck dermatitis (DAHND) by using single-cell RNA sequencing and compared data with untreated AD and healthy control skin. We show that dupilumab treatment was accompanied by normalization of IL-4/IL-13 downstream activity markers such as CCL13, CCL17, CCL18 and CCL26. By contrast, we found strong increases in type 22-associated markers (IL22, AHR) especially in oligoclonally expanded T cells, accompanied by enhanced keratinocyte activation and IL-22 receptor upregulation. Taken together, we demonstrate that dupilumab effectively dampens conventional type 2 inflammation in DAHND lesions, with concomitant hyperactivation of IL22-associated responses.

Late effects in patients with Fanconi anemia following allogeneic hematopoietic stem cell transplantation from alternative donors

Hematopoietic stem cell transplantation (HSCT) is curative for hematological manifestations of Fanconi anemia (FA). We performed a retrospective analysis of 22 patients with FA and aplastic anemia, myelodysplastic syndrome or acute myelogenous leukemia who underwent a HSCT at Memorial Sloan Kettering Cancer Center and survived at least 1 year post HSCT. Patients underwent either a TBI- (N=18) or busulfan- (N=4) based cytoreduction followed by T-cell-depleted transplants from alternative donors. Twenty patients were alive at time of the study with a 5- and 10-year overall survival of 100 and 84% and no evidence of chronic GvHD. Among the 18 patients receiving a TBI-based regimen, 11 (61%) had persistent hemochromatosis, 4 (22%) developed hypothyroidism, 7 (39%) had insulin resistance and 5 (27%) developed hypertriglyceridemia after transplant. Eleven of 16 evaluable patients (68%), receiving TBI, developed gonadal dysfunction. Two patients who received a TBI-based regimen died of squamous cell carcinoma. One patient developed hemochromatosis, hypothyroidism and gonadal dysfunction after busulfan-based cytoreduction. TBI appears to be a risk factor for malignant and endocrine late effects in the FA host. Multidisciplinary follow-up of patients with FA (including cancer screening) is essential for early detection and management of late complications, and improving long-term outcomes.

The consequences of diminishing industry support on the independent education landscape: an evidence-based analysis of the perceived and realistic impact on professional development and patient care among oncologists

In recent years, commercial funding for continuing medical education (CME) has dropped significantly. Yet, little has been written about how this might affect CME in oncology, a field in which new drugs and advances emerge at a rapid pace. This study examines the role oncologists and oncology fellows say that CME plays in their ongoing professional development and their attitudes about the potential and realistic impact upon both the dissemination of medical information and the impact on patient care if commercial support were removed from CME. The study is based upon a national survey of 368 oncology clinicians (283 oncologists and 85 oncology fellows). Respondents indicated that CME is an important part of their ongoing professional development. The majority of oncologists (90%) and oncology fellows (78%) "agreed" or "strongly agreed" that commercial support may be more necessary for oncology than for other specialties due to the rate at which cancer therapies are introduced. Respondents felt loss of commercial support would impact cost, format, and availability of oncology CME programs. Half of oncologists thought eliminating commercial support for CME would have a negative impact on application of new therapies in oncology. Yet, both oncologists and oncology fellows were reluctant to claim the removal of commercial support would negatively affect the practice of evidence-based medicine, patient outcomes, or patient safety. A possible explanation of this apparent contradiction is found in the social sciences literature.

Observation of electromagnetically induced transparency and slow light in the dark state--bright state basis

The quantum coherence phenomenon of electromagnetically induced transparency (EIT) is observed in a three-level system composed of an excited state and two coherent superpositions of the two ground-state levels. This peculiar ground state basis is composed of the so-called bright and dark states of the same atomic system in a standard coherent population trapping configuration. The characteristics of EIT, namely, width of the transmission window and reduced group velocity of light, in this unusual basis, are theoretically and experimentally investigated and are shown to be essentially identical to those of standard EIT in the same system.

Energy localization in the phi4 oscillator chain

We study energy localization in a finite one-dimensional phi(4) oscillator chain with initial energy in a single oscillator of the chain. We numerically calculate the effective number of degrees of freedom sharing the energy on the lattice as a function of time. We find that for energies smaller than a critical value, energy equipartition among the oscillators is reached in a relatively short time. On the other hand, above the critical energy, a decreasing number of particles sharing the energy is observed. We give an estimate of the effective number of degrees of freedom as a function of the energy. Our results suggest that localization is due to the appearance, above threshold, of a breather-like structure. Analytic arguments are given, based on the averaging theory and the analysis of a discrete nonlinear Schrödinger equation approximating the dynamics, to support and explain the numerical results.

Insomnia, fatigue, anxiety, depression, and quality of life of cancer patients undergoing chemotherapy

The purposes of this study were to examine: (a) the relationships between the symptoms of insomnia and fatigue and the psychological factors of anxiety and depression, and; (b) the relationships between these psychological and symptom variables and quality of life in cancer patients who were receiving chemotherapy. The Theory of Unpleasant Symptoms was the framework for the study. A descriptive correlational design was used in a secondary analysis of data obtained from a sample of 263 cancer patients who were undergoing chemotherapy. Insomnia, fatigue, depression, and anxiety were positively correlated with one another (r = .26 to r = .69, p < .001) and negatively correlated with quality of life (r = -.28 to r = -.63, p < .001). Women had more anxiety and fatigue and poorer quality of life than did men. Older age was associated with better quality of life and less insomnia, fatigue, anxiety, and depression. Multiple regression analysis revealed that the symptoms and psychological variables explained 47% of the variance in quality of life, with the largest proportion of the variance explained by depression. Fatigue and insomnia explained only 4% of the variance in quality of life in excess of that contributed by the psychological factors. Although overall depression levels were low in this sample, these findings suggest that insomnia and fatigue are related to depression and that depression is more closely associated with quality of life than are insomnia and fatigue.

Levels of dissociation in detoxified substance abusers and their relationship to chronicity of alcohol and drug use

This study compared the frequency and types of dissociative experiences reported by detoxified alcoholics and drug abusers, and examined the relationship between dissociation and recent and lifetime use of alcohol, cannabis, cocaine, and heroin. One hundred thirty-eight self-referred male veterans detoxified from alcohol (N=62) and drugs (N=76) on inpatient units at a Veterans Affairs hospital completed questionnaires including the Dissociative Experiences Scale. Three types of dissociative experiences were examined: amnesia, depersonalization/derealization, and absorption. Ninety-one of the patients were also given the Addiction Severity Index interview to determine their histories of recent (past 30 days) and lifetime drug and alcohol use. High levels of dissociation were found in both groups, with alcoholics reporting higher levels of all three types of dissociative experiences than drug addicts. Chronicity (lifetime years) of both alcohol and cocaine use was significantly correlated with dissociation scores. The amnestic effect of chronic cocaine use persisted even after controlling for the effects of chronic alcohol use. In contrast, no dissociative effects of recent (past month) use of alcohol or drugs were found. These findings suggest that dissociation may be a chronic residual effect of long-term substance abuse, including both alcohol and cocaine. Implications are discussed for the treatment of chronic substance abusers.

Initial reliability and validity of a new retrospective measure of child abuse and neglect

OBJECTIVE

This report presents initial findings on the reliability and validity of a new retrospective measure of child abuse and neglect, the Childhood Trauma Questionnaire.

METHOD

Two hundred eighty-six drug- or alcohol-dependent patients were given the Childhood Trauma Questionnaire as part of a larger test battery, and 40 of these patients were given the questionnaire again after an interval of 2 to 6 months. Sixty-eight of the patients were also given a structured interview for child abuse and neglect, the Childhood Trauma Interview, that was developed by the authors.

RESULTS

Principal-components analysis of responses on the Childhood Trauma Questionnaire yielded four rotated orthogonal factors: physical and emotional abuse, emotional neglect, sexual abuse, and physical neglect. Cronbach's alpha for the factors ranged from 0.79 to 0.94, indicating high internal consistency. The Childhood Trauma Questionnaire also demonstrated good test-retest reliability over a 2- to 6-month interval (intraclass correlation = 0.88), as well as convergence with the Childhood Trauma Interview, indicating that patients' reports of child abuse and neglect based on the Childhood Trauma Questionnaire were highly stable, both over time and across type of instruments.

CONCLUSIONS

These findings provide strong initial support for the reliability and validity of the Childhood Trauma Questionnaire.

Increased calcium affinity of a fucosylated chondroitin sulfate from sea cucumber

Calcium binding and charge distribution on a fucosylated chondroitin sulfate and a standard chondroitin 6-sulfate have been studied using a metallochromic indicator and conductimetric titrations. The fucosylated chondroitin sulfate has a approximately 5-fold greater affinity for calcium ions than the standard chondroitin 6-sulfate. Possibly, this increased affinity for calcium ions is due to the branches on the fucosylated chondroitin sulfate, since the calcium affinity of an unbranched, sulfated fucan is similar to that of the standard chondroitin 6-sulfate. More charged groups per disaccharide unit (and a shorter distance between these groups) also distinguish the fucosylated chondroitin sulfate from standard chondroitin 6-sulfate. Comparison between native and chemically modified (desulfated or carboxyl-reduced) polysaccharides suggests that the sulfate esters are responsible for the increased charge density of the fucosylated chondroitin sulfate and that the presence of the fucose branches does not alter the length of the repetitive units which compose the central core of chondroitin from sea cucumber. These results are consistent with the chemical studies of these two polysaccharides.

Charge effect in the interaction of doxorubicin and derivatives with polydeoxynucleotides

The equilibrium interaction of doxorubicin and its N-acetyl derivative with a series of purine-pyrimidine alternating polydeoxynucleotides has been studied through spectrofluorometry to assess the relevance of the electrostatic contribution to DNA intercalation. The results have shown that: (a) the suppression of the positive charge on the aminosugar has: (I) a profound negative effect on the free energy of intercalation, as expected, and (II) a negligible influence on the base specificity, which supports the notion of an essentially electrostatic effect of N-acetylation on intercalation; (b) a reasonably good accord with the demands of a polyelectrolytic model, due to Friedman and Manning, is found.

Motional properties of spin labels in proteins: Effects of hydration

Conventional and saturation transfer (electron spin resonance) techniques are used to study the motional properties of several spin labels introduced in three proteins: lysozyme, sperm whale myoglobin and human hemoglobin. The mobilities of a maleimide spin label which binds covalently to the proteins, as well as of two small probes TEMPO and PD-TEMPOL were monitored in the temperature range from –−10 to −150 °C for samples in the dry and solution states. The three proteins show a similar temperature dependence as indicated by the parameters 2Azz and ΔH. A small linear increase in 2Azz with decrease in temperature is observed for the dry samples. For the proteins in solution, on the other hand, the 2Azztemperature dependence shows a change of behaviour around −60 °C that is related to the freezing of the water molecules in the hydration shell. The changes observed for the parameter ΔH are such that at temperatures below −60 °C ΔH is greater for the solution sample, while at temperatures above −60 °C ΔH is greater for the dry sample. Saturation transfer measurements show that the motion of the spin label is very restricted in all systems (τc > 10−5s) in the temperature range studied, so that the residual librational motion of the label is sensitive to the hydration, being responsible for the observed changes of the esr parameters with temperature.

On the interaction of small molecules with hemoglobin: orientational effects of hydration layers in protein crystal

The spin label TEMPO does not show a binding to hemoglobin molecule in solution. In the crystal however the spin label is bound and a considerable anisotropy in the ESR spectra is observed similar to that with covalent spin labeling. Since TEMPO is a small spherical molecule the anisotropy should be a consequence of the ordering in the crystal packing observed for the hydration layers. Besides the anisotropic sites (one per asymmetric unit) an isotropic signal is apparent. The population of these sites is sensitive to the temperature and above around 30 degrees C a transition is observed of the label from the anisotropic site to the isotropic one. This is consistent with a change in the hydration structure above this temperature so that the spin label is sensitive to the reorganization of water or crystallization. Results of simulations based on the relaxation theory in liquids are compared for different hemoglobin physical states: crystal, powder and solution. It is shown that the ESR parameters obtained in the crystal are very different from those used for spectral stimulation at low temperature.

Central venous catheterization for parenteral nutrition

To define the risks associated with central venous catheterization for total parenteral nutrition (TPN) 3291 patient days of this therapy, delivered by an established nutrition support team, were evaluated. One hundred and seventy-five catheters placed in 104 patients were reviewed over an 18 month period. Positive cultures were reported on 11 cannulae for a 6.4% incidence of colonization; five catheters (2.8%) were considered septic. Pleural or mediastinal complications of subclavian or internal jugular venipuncture occurred in eight patients (4.8%). Misdirection of the catheter tip occurred in 11.5% of insertions. Five patients (4.8%) had clinically apparent thrombosis in the superior vena cava, innominate and/or subclavian veins during hospitalization; four others had evidence of thrombosis at autopsy examination, giving an incidence of 8.7% in the entire series. No death directly resulted from the use of this therapy. Compliance with a rigid protocol by an experienced team can allow safe and effective use of central venous catheters and parenteral nutrition therapy.

Nonvolumetric methods of detecting impaired intracranial compliance or reactivity: pulse width and wave form analysis

The authors have attempted to find a clinically reliable method of measuring intracranial pressure (ICP) compliance or reactivity that does not require volumetric manipulation. An analysis was undertaken of ICP, pulse widths and of the presence or absence of B waves, both experimentally in dogs and clinically in postoperative human patients. In both dogs and humans, ICP pulse width generally increased with increasing ICP and with increasing intracranial mass, and definitely increased with systolic arterial blood pressure. Nonetheless, ICP pulse width commonly failed to increase with increasing cerebral reactivity, and low ICP pulse width measurements were at times recorded in distinctly pathological situations. From the clinical study it was found that B waves were encountered more commonly in patients with increased ICP or increased ICP pulse width. However, the correlation between B waves alone or in combination with increased ICP or ICP pulse width and quantitative measurements of ICP reactivity was not significant. Mean reactivity and the range of reactivity measurements were almost identical in patient groups with and without B waves. For the time being the "ICP reserve test" remains the most accurate, the safest, and the most clinically useful method of quantitating ICP reserve.