Lichen sclerosus in men is associated with elevated body mass index, diabetes mellitus, coronary artery disease and smoking

Purpose

To elucidate disease associations and possible etiology of lichen sclerosus (LS), we identified comorbidities present in men with LS. LS is a chronic inflammatory disease of unknown etiology affecting genitals and urethra of men commonly resulting in strictures.

Methods

Men with LS of the urethra, penis, prepuce and scrotum were identified. A control population was generated from men seen in the Department of Urology matched by age and race in a 5:1 ratio. A case–control study was performed and comorbidities identified by ICD9, CPT codes and medication use via systematic electronic medical record review. Subgroup analysis of men with urethral strictures was performed based on their LS status.

Results

Men with LS had a significantly higher mean body mass index [31.0 (range 18.9–52.6)] compared to controls [28.1 (16.8–64.1), p = 0.001], significantly increased rate of coronary artery disease (CAD) (15.3 vs. 8.9 %, p = 0.05) as well as a twofold higher rate of diabetes mellitus (15.5 vs. 8.3 %, p = 0.02). Of men with LS and stricture disease, 11/19 (58 %) were current or former smokers, compared to 28 % of men with strictures without LS (p = 0.006). No association of LS with other morbidities like hyperlipidemia, hypertension, cerebrovascular disease, peripheral vascular disease or dermatologic disorders was found.

Conclusions

Men suffering from LS have an increased BMI and a higher prevalence of concomitant CAD, diabetes mellitus and tobacco use. Development and chronicity of LS may not be a purely dermatologic condition, but be associated or confounded by systemic or vascular compromise from disorders of CAD, DM and smoking.     

Design,Development, and Evaluation of a Novel Retraction Device for Gallbladder Extraction During Laparoscopic Cholecystectomy

Background

A source of frustration during laparoscopic cholecystectomy involves extraction of the gallbladder through port sites smaller than the gallbladder itself. We describe the development and testing of a novel device for the safe, minimal enlargement of laparoscopic port sites to extract large, stone-filled gallbladders from the abdomen.

Methods

The study device consists of a handle with a retraction tongue to shield the specimen and a guide for a scalpel to incise the fascia within the incision. Patients enrolled underwent laparoscopic cholecystectomy. Gallbladder extraction was attempted. If standard measures failed, the device was implemented. Extraction time and device utility scores were recorded for each patient. Patients returned 3–4 weeks postoperatively for assessment of pain level, cosmetic effect, and presence of infectious complications.

Results

Twenty (51 %) of 39 patients required the device. Average extraction time for the first eight patients was 120 s. After interim analysis, an improved device was used in 12 patients and average extraction time was 24 s. There were no adverse events. Postoperative pain ratings and incision cosmesis were comparable between patients with and without use of the device.

Conclusion

The study device enables safe and rapid extraction of impacted gallbladders through the abdominal wall.     

Humidity sensation requires both mechanosensory and thermosensory pathways in Caenorhabditis elegans

All terrestrial animals must find a proper level of moisture to ensure their health and survival. The cellular-molecular basis for sensing humidity is unknown in most animals, however. We used the model nematode Caenorhabditis elegans to uncover a mechanism for sensing humidity. We found that whereas C. elegans showed no obvious preference for humidity levels under standard culture conditions, worms displayed a strong preference after pairing starvation with different humidity levels, orienting to gradients as shallow as 0.03% relative humidity per millimeter. Cell-specific ablation and rescue experiments demonstrate that orientation to humidity in C. elegans requires the obligatory combination of distinct mechanosensitive and thermosensitive pathways. The mechanosensitive pathway requires a conserved DEG/ENaC/ASIC mechanoreceptor complex in the FLP neuron pair. Because humidity levels influence the hydration of the worm’s cuticle, our results suggest that FLP may convey humidity information by reporting the degree that subcuticular dendritic sensory branches of FLP neurons are stretched by hydration. The thermosensitive pathway requires cGMP-gated channels in the AFD neuron pair. Because humidity levels affect evaporative cooling, AFD may convey humidity information by reporting thermal flux. Thus, humidity sensation arises as a metamodality in C. elegans that requires the integration of parallel mechanosensory and thermosensory pathways. This hygrosensation strategy, first proposed by Thunberg more than 100 y ago, may be conserved because the underlying pathways have cellular and molecular equivalents across a wide range of species, including insects and humans.Moisture is essential for life. As such, many animals have adapted different behavioral mechanisms to migrate toward their preferred moisture level (hygrotaxis) (1–6). For instance, Drosophila avoid high humidity that impedes flight, whereas green frogs orient toward high humidity to maintain hydration (5, 6). Animals also sense moisture levels to determine important information about their environment; for example, moths detect humidity levels around flowers to deduce which ones might be damaged and contain less nectar (7). These behaviors are often critical to keep an animal within its niche and regulate essential processes such as growth and reproduction. Thus, it is surprising that the molecular basis for how different humidity levels are detected and encoded by the nervous system (hygrosensation) remains unknown in most animals.The search for humidity receptors has achieved the most progress in insects. For instance, distinct sets of hygrosensitive neurons have been found in dome-shaped organs on the antenna of the giant cockroach (8). One set activates with moist air, and the other set responds to dry air. Similar moist and dry receptive neurons have been detected in the branched arista subsegment of the antennae in adult Drosophila (9). Removal of the arista or deletion of any one of three TRP channels expressed in the arista prevents hygrotaxis (5, 9). These TRP channels represent tantalizing candidates for moisture receptors because different TRP channels were required for activity of moist or dry neuronal responses (9). Whether these TRP channels contribute to hygrosensation in other animals remains to be seen, however.Humidity also can be detected by animals that lack branched organs or hair that changes shape with hydration. In 1905, Thunberg (10) proposed that humidity may be perceived in humans as the synthesis of mechanical distension associated with changes in skin hydration, along with temperature signals from the rate of evaporative cooling. This old idea might apply to other animals as well; for instance, the hygrosensitive organs in cockroach and Drosophila also house thermosensitive neurons (8, 11). Whether paired thermosensitive neurons are required for hygrosensation in insects or, for that matter, whether any animal (including humans) senses humidity via this mechanism, remains unknown.To gain information about the neuromolecular basis for hygrosensation, we studied how the free-living nematode Caenorhabditis elegans responds to humidity gradients. This model has been used to successfully elucidate neuronal mechanisms and molecules critical for diverse sensory pathways (12–14). We expected C. elegans to be sensitive to humidity because its small volume (∼3.8 × 10⁶ μm³) and hydrostatic skeleton make it vulnerable to desiccation and overhydration, which are often lethal to this tiny (∼1 mm) worm (15). Although C. elegans does not feature an arista-like appendage, its completely described nervous system of 302 neurons conveniently limits the search for candidate hygroreceptive neurons. Here we report that C. elegans appears to use a strategy for hygrosensation first predicted by Thunberg (10) that combines dual mechanosensory and thermosensory pathways.     

Dairy Food Intake,Peripheral Bone Structure,and Muscle Mass in Elderly Ambulatory Women

Previous studies suggest that dairy intake may be associated with reduced bone and muscle loss with aging, but there are limited data in the very old. We evaluated the association between intake of dairy foods and peripheral bone structure and muscle mass in 564 elderly women aged 80 to 92 (mean 84.7) years, who were participants of the Calcium Intake Fracture Outcome Study/CAIFOS Aged Extension Study (CAIFOS/CARES) cohort and attended the 10‐year follow‐up. Assessments included dairy consumption (milk, yogurt, and cheese) by a validated food frequency questionnaire, 15% tibia bone mass, area and volumetric bone mineral density (vBMD) by peripheral quantitative computed tomography (pQCT), and appendicular bone and skeletal muscle mass by dual‐energy X‐ray absorptiometry (DXA). Women were categorized according to tertiles of dairy intake: first tertile (≤1.5 servings/d), second tertile (1.5 to 2.2 servings/d) and third tertile (≥2.2 servings/d). Controlling for confounding factors, pQCT assessment at the 15% tibia showed that compared with those in the first tertile of dairy intake, women in the third tertile had 5.7% greater total bone mass (p = 0.005), principally because of an increase in cortical and subcortical bone mass (5.9%, p = 0.050), resulting in a 6.2% increase in total vBMD (p = 0.013). Trabecular but not cortical and subcortical vBMD was also higher (7.8%, p = 0.044). DXA assessment showed that women in the third tertile of dairy intake had greater appendicular bone mass (7.1%, p = 0.007) and skeletal muscle mass (3.3%, p = 0.014) compared with tertile 1. The associations with bone measures were dependent on dairy protein and calcium intakes, whereas the association with appendicular muscle mass was not totally dependent on dairy protein intake. Our results suggest a positive association of dairy intake with appendicular bone mineralization and muscle mass in elderly women. Because many fractures in this age group are of the appendicular skeleton often associated with falls, dairy intake may be a modifiable lifestyle factor contributing to healthy aging. © 2014 American Society for Bone and Mineral Research.