Topical hydrocortisone,clobetasol propionate,and calcipotriol do not increase photocarcinogenesis induced by simulated solar irradiation in hairless mice

Please cite this paper as: Topical hydrocortisone, clobetasol propionate, and calcipotriol do not increase photocarcinogenesis induced by simulated solar irradiation in hairless mice. Experimental Dermatology 2010; 19 : 973–979. Abstract: Topical corticosteroids such as hydrocortisone‐17‐butyrate (HCB) and clobetasol‐17‐propionate (CP) and vitamin D₃ derivatives such as calcipotriol (CAL) are widely used to treat psoriasis. The immunosuppressive effects of corticosteroids make their topical use a concern for skin carcinogenicity. Few studies have assessed the effect of topical corticosteroids and topical vitamin D₃ derivatives on photocarcinogenesis induced by ultraviolet radiation. We investigated whether HCB, CP, or CAL can accelerate photocarcinogenesis using simulated solar radiation (SSR). HCB, CP, or CAL was applied topically to the backs of hairless, female, C3.Cg/TifBomTac‐immunocompetent mice in 16 groups of 25 mice each. The drugs were applied three times weekly followed by 0, 2, 4, or 6 standard erythema doses (SED) of SSR for 365 days or until death. No change was observed in the time required for tumor development in mice treated with HCB and 2 SED (HCB‐2SED) and HCB‐6SED. However, the time required for tumor development increased with HCB‐4SED treatment. Treatment with CP‐2SED did not change the time to onset of the first and second tumor, but all other CP treatments in combination with SSR increased the time. CAL‐2SED decreased the time to onset of the first tumor but not of the second and third tumor. CAL‐4SED and CAL‐6 SED did not change or increased the time to tumor development. Our data indicated that topical administration of HCB and CAL did not alter the photocarcinogenesis of SSR and that topical CP administration had a photoprotective effect. Thus, HCB, CP, and CAL do not increase photocarcinogenesis induced by SSR.     

Photodynamic therapy with topical methyl‐ and hexylaminolevulinate for prophylaxis and treatment of UV‐induced SCC in hairless mice

Please cite this paper as: Photodynamic therapy with topical methyl‐ and hexylaminolevulinate for prophylaxis and treatment of UV‐induced SCC in hairless mice. Experimental Dermatology 2010; 19 : e166–e172. Abstract Background: Hexyl aminolevulinate (HAL) is a long‐chained 5‐aminolevulinic acid‐ester that has been proposed as a novel photosensitizing agent to methyl aminolevulinate (MAL) in topical photodynamic therapy (PDT). The more lipophilic HAL, may improve treatment outcome for non‐melanoma skin cancer. Objective: To compare the prophylactic and therapeutic effects of HAL‐ and MAL‐PDT for ultraviolet‐induced squamous cell carcinomas (SCCs) in hairless mice. Methods: Mice (n = 249) were irradiated with solar UV‐radiation (UVR) until SCC occurred. Before any skin changes developed, two prophylactic PDT treatments were given, using creams of HAL (2%, 6%, 20%) or MAL (20%) followed by illumination (632 nm, Aktilite, Photocure). Two therapeutic PDT‐treatments were given by randomization to the first developed SCC of 1 mm. Primary end‐points were time to first SCC of 1 mm and complete SCC clearance. Secondary end‐points were time to SCC‐recurrence, PpIX fluorescence and skin reactions to PDT. Results: The median time to first SCC was significantly longer for mice treated with prophylactic HAL‐PDT (2%, 6% and 20% HAL, 264 days) and MAL‐PDT (20% MAL, 269 days) than mice exposed to UVR (186 days) and UVR + placebo‐PDT (199 days) (P < 0.0001). The therapeutic efficacy of HAL‐ and MAL‐PDT showed cure rates of 23–61.5% (P = 0.11). Similar PpIX fluorescence intensity and severity of clinical reactions were seen for HAL‐ and MAL‐groups, although mice developed more intense hyper‐pigmentation when treated with 20% MAL‐PDT compared with 2% HAL‐PDT. Conclusions: PDT with HAL (2%, 6% and 20%) and MAL (20%) is equally effective to prevent and treat UV‐induced SCC in hairless mice.     

Three‐Dimensional Stereophotogrammetry: A Novel Method in Volumetric Measurement of Infantile Hemangioma

Accurate and objective measurement of volume changes in infantile hemangiomas (IHs) is essential in routine clinical practice and clinical studies, particularly in the changing therapeutic landscape after the discovery of propranolol. Several bedside techniques for volume measurement have been described in the literature, but an objective method of measurement of this variable, dynamic vascular tumor is lacking. Three‐dimensional (3D) phototechnology with data analysis is an up‐and‐coming technique in the objective measurement of facial volume changes. In this pilot study, the usability and clinical relevance of two methods of 3D stereophotogrammetry in the volume measurement of IH were explored.     

X-rays and photocarcinogenesis in hairless mice

It is well known that excessive X-ray radiation can cause non-melanoma skin cancers. With the increased incidence of sun-related skin cancer there is a need to investigate the combination of sunlight and X-rays. Immunocompetent C3.Cg/TifBomTac mice (n = 298) were divided into 12 groups. Mice were irradiated with 12, 29 or 50 kV X-rays. The mice received a total dose of 45 Gy. They were irradiated with 3 SED simulated solar radiation (SSR) either before or after irradiation with X-rays. The groups irradiated with X-rays alone, 0, 3, 9 and 10 mice (0, 12, 29 and 50 kV, respectively) developed squamous cell carcinoma. In the groups irradiated with SSR after X-rays the development of tumours was significantly faster in the 50 kV group than in the corresponding control group (175 vs. 194 days, p < 0.001). In the groups irradiated with SSR prior to the X-ray radiation the development of tumours was significantly faster in the 29 and the 50 kV groups than in the corresponding control group (175 vs. 202 days, p < 0.001 and 158 vs. 202 days, p < 0.001, respectively). In conclusion, X-ray radiation alone is a weak carcinogen in hairless mice. There is an added carcinogenic effect if X-ray radiation is given on prior sun-exposed skin or if the skin is sun-exposed after X-rays. We still believe that X-ray radiation is a safe and effective therapy for various dermatological diseases but caution should be observed if a patient has severely sun-damaged skin or has a high-risk sun behaviour.     

Acidification of stratum corneum prevents the progression from atopic dermatitis to respiratory allergy

The presence of congenitally impaired skin barrier followed by atopic dermatitis (AD) is an initial step in the atopic march. The maintenance of acidic pH in the stratum corneum (SC) has been suggested as a therapeutic or preventive strategy for barrier impairment caused by skin inflammation. To determine whether an AD murine model, flaky tail mice, with inherited filaggrin deficiency could develop airway inflammation by repeated topical application followed by nasal inhalation of house dust mite (HDM) antigen (defined as a novel “atopic march animal model”), and whether maintenance of an acidic SC environment by continuous application of acidic cream could interrupt the following atopic march. During the course of HDM treatment, acidic cream (pH2.8) or neutral cream (pH7.4) was applied to flaky tail mice twice daily. Repeated applications and inhalations of HDM to flaky tail mice induced AD skin lesions followed by respiratory allergies. Maintenance of SC acidity inhibited the occurrence of respiratory allergic inflammation as well as AD‐like skin lesions. Collectively, a novel atopic march model could be developed by repeated epicutaneous and nasal applications of HDM to flaky tail mice, and that the acidification of SC could prevent the atopic march from AD to respiratory allergy.     

Risk of accidents and unintentional injuries in men and women with attention deficit hyperactivity disorder across the adult lifespan

Introduction

Attention deficit hyperactivity disorder (ADHD) is associated with risk-taking behavior, leading to accidents and unintentional injuries (summarized here as incidents). Main aim of this study is to determine if men and women with and without ADHD differ in the risk of mild (treated outpatient) and severe (treated inpatient) incidents across the adult lifespan (age groups: 18–29; 30–59, and ≥60 years). Secondary aim: investigate the role of comorbid mental disorders and drugs for the treatment of these comorbidities, and ADHD-medication.

Methods

Using anonymized German claims data (N = 4,575,027), adults with ADHD diagnosis during 2016–2019 (N = 17,041) were compared with a 1:4 age and sex-matched group without ADHD diagnosis. Regression analyses statistically tested group differences.

Results

Incidents occur in a U-shaped form across the adult lifespan. Individuals with ADHD show the same pattern but at a substantially increased risk of both mild and severe incidents throughout the lifespan. Women without ADHD are at lower risk in young adulthood than men but at higher risk in older adulthood. Women with ADHD show the same pattern for severe incidents, but for mild incidents they have the highest risk throughout the lifespan. Co-occurring anxiety disorder and the use of psycholeptics and ADHD-medication decreased the incident risk.

Conclusion

We extend available knowledge which has hitherto focused on young adult males and traffic accidents. ADHD is associated with increased incidents across the adult lifespan, with distinct patterns regarding age, sex, and incident severity. An accurate diagnosis of ADHD in adulthood provides the first step towards prevention of accidents and unintentional injuries.     

Ten‐Year Retrospective Follow‐Up Study of the TiOblast™ Dental Implant

Purpose: Long‐term results in the clinical outcome of different implant systems, including high patient numbers and a long follow‐up time, are rare. This retrospective study evaluated the cumulative survival rate of a self‐tapping, cylindrical implant system with a conical implant‐abutment connection after 10 years of prosthetic loading. Materials and Methods: A total of 516 TiOblast? implants (Astra Tech AB, Mölndal, Sweden) were placed in 108 patients. The patients were treated in the Department of Oral and Maxillofacial Surgery, Johannes Gutenberg University, Mainz, Germany, between September 1994 and May 2005. The main indications for implantation were the treatment of edentulous mandibles (74%) and partial edentulism (15%). Twenty‐three implants were placed postradiation, and a further 64 implants were irradiated after insertion. In 153 implants, a bony augmentation was conducted prior to implantation. Results: The in situ rate was 89.7% after an average implantation time of 108 months. Eighty‐three patients with 403 implants were available for investigation. Seventeen patients with 76 implants have died since 1994. Absence of osseointegration (n = 22), peri‐implantitis (n = 18), fracture of the implants (n = 9), failing of primary stability (n = 2), and implants next to tumors (n = 2) were the reasons of explantation in 26 patients. Under analysis with different implant success‐assessment criteria, the success rate showed results from 76 to 89%. Conclusion: With respect to the critical patient selection including a high number of patients with minor and major augmentations, the 10‐year clinical use of the studied implant system showed acceptable results.     

Experiences of the new role of advanced practice nurses in Swedish primary health care—A qualitative study

Lindblad E, Hallman E-B, Gillsjö C, Lindblad U, Fagerström L. International Journal of Nursing Practice 2010; 16 : 69–74
Experiences of the new role of advanced practice nurses in Swedish primary health care—A qualitative study
The aim of this study was to investigate and describe the experiences of the first advanced practice nurses (APNs), a new profession for Swedish health care, and of their supervising general practitioners (GPs), regarding the new role and scope of practice of APNs in primary health care. Individual interviews were conducted with the four first APNs and one focus group interview was conducted with five supervising physicians. The material was transcribed verbatim and analysed using latent content analysis. The respondents expressed confidence and trust in the new role of APNs. Some opposition to this new role from the GPs and other colleagues was observed, but was nonetheless overcome. The experiences of the APN role indicate that the new role is clearly demarcated from the role of physicians. The APNs were considered an extra resource for both the GPs and other nurses, which contributed to an increased availability of care for patients. The APN role requires an explicit definition and demarcation in relation to responsibility and roles among colleagues. Further development of the APN role presupposes the right to prescribe medication and order treatments, as well as an evaluation of patient, organizational and inter-professional perspectives on the matter.