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Amanda M. Nelson Zhaoyuan Cong Samantha L. Gettle Amy L. Longenecker Michal Kidacki Joslyn S. Kirby David R. Adams Douglas B. Stairs Frederick W. Danby 《Experimental dermatology》2019,28(7):867-871
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease affecting the pilosebaceous units in the axilla, groin and buttocks. While the pathogenesis of HS is not clear, mechanical stress exacerbates HS. In this study, we aimed to determine whether intracellular adhesive junctions may be aberrant in HS patient skin. Strikingly, we observed loss of E‐cadherin and p120ctn protein expression, two key adherens junction proteins, in ~85% of HS severe skin lesions. Moreover, loss of protein expression was apparent in non‐lesional skin from HS patients and the degree of loss positively correlated with HS Hurley Stage of disease. E‐cadherin expression was unaltered in other inflammatory skin conditions including chronic wound epithelium, atopic dermatitis, and acne vulgaris compared with healthy skin suggesting that its loss may be uniquely relevant to HS pathogenesis. A complete loss of α‐catenin, β‐catenin and ZO‐1 was not observed; however, some cytoplasmic staining of the catenins was noted in HS epithelium. We also demonstrated diminished desmosome size in HS lesional skin. Overall, our data suggested that loss of adherens junction proteins and diminished desmosome size in HS skin contributes to the skin's inability to withstand mechanical stress and provides rationale as to why mechanical stress exacerbates HS symptoms. 相似文献
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Katherine T. Flynn-O’Brien Morgan K. Richards Davene R. Wright Frederick P. Rivara Wren Haaland Leah Thompson Keith Oldham Adam Goldin 《Journal of pediatric surgery》2019,54(4):621-627
Background
There is a movement to ensure that pediatric patients are treated in appropriately resourced hospitals through the ACS Children’s Surgery Verification (CSV) program. The objective of this study was to assess the potential difference in care provision, health outcomes and healthcare and societal costs after implementation of the CSV program.Methods
All 2011 inpatient admissions for selected complex pediatric patients warranting treatment at a hospital with Level I resources were evaluated across 6 states. Multivariate regressions were used to analyze differences in healthcare outcomes (postoperative complications including death, length of stay, readmissions and ED visits within 30 days) and costs by CSV level. Recycled predictions were used to estimate differences between the base case scenario, where children actually received care, and the optimized scenario, where all children were theoretically treated at Level I centers.Results
8,006 children (mean age 3.06 years, SD 4.49) met inclusion criteria, with 45% treated at Level I hospitals, 30% at Level II and 25% at Level III. No statistically significant differences were observed in healthcare outcomes. Readmissions within 30 days were higher at Level II compared to Level I centers (adjusted IRR 1.61; 95% CI 1.11, 2.34), with an estimated 24 avoidable readmissions per 1000 children if treatment were shifted from Level II to Level I centers. Overall, costs per child were not significantly different between the base case and the optimized scenario.Conclusion
Many complex surgical procedures are being performed at Level II/III centers. This study found no statistically significant increase in healthcare or societal costs if these were performed instead at Level I centers under the optimized scenario. Ongoing evaluation of efforts to match institutional resources with individual patient needs is needed to optimize children’s surgical care in the United States.Level of evidence
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Fawad Aslam Frederick Spencer Chivers Krupa B. Doshi April Chang‐Miller 《International journal of rheumatic diseases》2019,22(12):2213-2217
A 36‐year‐old man was treated for several years with multiple agents for ankylosing spondylitis based on positive human leukocyte antigen‐B27 and sacroiliitis. He was also diagnosed with osteoporosis and hypophosphatemia. Over these years, from being an avid runner, he became dependent on a walker for ambulation. The lack of treatment response and the low phosphorus were clues that eventually led to a diagnosis of tumor‐induced osteomalacia. This case discusses the importance of not solely relying on genetic markers and sacroiliitis for diagnosing ankylosing spondylitis as other conditions can cause similar presentations. 相似文献
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Frederick R. Taylor MD FAAN FAHS Wade Cooper DO Robert G. Kaniecki MD 《Headache》2020,60(8):1857-1867
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Matthias Christgen MD PhD Oleg Gluz MD Nadia Harbeck MD Ronald E. Kates PhD Mieke Raap MD Henriette Christgen Michael Clemens MD Wolfram Malter MD Benno Nuding MD Bahriye Aktas MD Sherko Kuemmel MD Toralf Reimer MD Andrea Stefek MD Petra Krabisch MD Marianne Just MD Doris Augustin MD Monika Graeser MD Frederick Baehner MD Rachel Wuerstlein MD Ulrike Nitz MD Hans Kreipe MD the West German Study Group PlanB Investigators 《Cancer》2020,126(22):4847-4858