Efficacy of trichloroacetic acid (95%) in the management of xanthelasma palpebrarum

Background. Xanthelasma palpebrarum (XP) is a commonly occurring benign eyelid disorder. Aim. To determine the efficacy of topical trichloroacetic acid (TCA) 95% in the management of XP. Methods. This was a retrospective review of patients treated with TCA between June 2000 and July 2007. We recorded the outcomes of patients who attended the clinic at least 3 months after their treatment. We also contacted all patients with a minimum interval of 12 months between treatment and a telephone interview to assess for recurrence/persistence of the lesion(s). Results. In total, 102 patients were enrolled in the study. Of these, 44 were reviewed in the clinic. There were nine persistent lesions and four recurrences recorded at a mean follow-up of 14.3 months. Telephone interviews were conducted with 51 patients (146 lesions). Of these 51 patients, 43 had been given bilateral TCA treatment. The mean number of TCA treatments was 1.68. Mean time from the past TCA treatment to the telephone interview was 31.8 months. Of the 51 patients, 17 patients reported no recurrence, 22 patients had experienced a recurrence, 9 patients had persistence of the lesion and 3 patients undergone surgical excision of the lesion since the last TCA treatment. Overall, the success rate for TCA was 61% at a mean follow-up of 31.8 months. Conclusions. XP has a strong history of recurrence. TCA treatment may be effective in XP and is a short, simple and cheap procedure that can be repeated. Although the requirement for retreatment is high, patient satisfaction with the procedure is also high.     

Credentialing of surgical skills centers

Major imperatives regarding quality of patient care and patient safety are impacting surgical care and surgical education. Also, significant emphasis continues to be placed on education and training to achieve proficiency, expertise, and mastery in surgery. Simulation-based surgical education and training can be of immense help in acquiring and maintaining surgical skills in safe environments without exposing patients to risk. Opportunities for repetition of tasks can be provided to achieve pre-established standards, and knowledge and skills can be verified using valid and reliable assessment methods. Also, expertise and mastery can be attained through repeated practice, specific feedback, and establishment of progressively higher learning goals. Simulation-based education and training can help surgeons maintain their skills in infrequently performed procedures and regain proficiency in procedures they have not performed for a period of time. In addition, warm-ups and surgical rehearsals in simulated environments should enhance performance in real settings.Major efforts are being pursued to advance the field of simulation-based surgical education. New education and training models involving validation of knowledge and skills are being designed for practicing surgeons. A competency-based national surgery resident curriculum was recently launched and is undergoing further enhancements to address evolving education and training needs. Innovative simulation-based surgical education and training should be offered at state-of-the-art simulation centers, and credentialing and accreditation of these centers are key to achieving their full potential.     

B cell antigen receptor signal strength and peripheral B cell development are regulated by a 9-O-acetyl sialic acid esterase

We show that the enzymatic acetylation and deacetylation of a cell surface carbohydrate controls B cell development, signaling, and immunological tolerance. Mice with a mutation in sialate:O-acetyl esterase, an enzyme that specifically removes acetyl moieties from the 9-OH position of α2–6-linked sialic acid, exhibit enhanced B cell receptor (BCR) activation, defects in peripheral B cell development, and spontaneously develop antichromatin autoantibodies and glomerular immune complex deposits. The 9-O-acetylation state of sialic acid regulates the function of CD22, a Siglec that functions in vivo as an inhibitor of BCR signaling. These results describe a novel catalytic regulator of B cell signaling and underscore the crucial role of inhibitory signaling in the maintenance of immunological tolerance in the B lineage.     

Retinoic acid nuclear receptors and tumor promotion: decreased expression of retinoic acid nuclear receptors by the tumor promoter 12-O-tetradecanoylphorbol-13-acetate

During studies to determine the mechanism of tumor promotionby 12-O-tetradecanoylphorbol-13-acetate (TPA), we found thatTPA downregulates mouse epidermal retinoic acid nuclear receptors(RAR), a superfamily of nuclear steroid/thyrold receptors implicatedin mediating effects of retinoic acid (RA). Application of TPAto mouse skin decreased the binding of [³H]RA to RAR from mouseepidermal nuclear extracts. In this experiment, 20 nmol of TPAwas applied to mouse skin and 3.5 h later binding of [³H]RAto RAR was analyzed by chromatography on a size-exclusion column.TPA treatment resulted in an     

Tuberculosis in renal transplant recipients: Rifampicin sparing treatment protocol

The reactivation of mycobacterium infection inrenal transplant recipients in developingcountries is a common therapeutic dilemma,especially in those patients receivingcyclosporin immunosuppression. The inclusion ofrifampicin in the antituberculosis protocolincreases the risk of precipitating acuteallograft rejection due to its interaction withcyclosporin and also increases the financialburden. We successfully treated 16 patients whodeveloped mycobacterial infection post renaltransplant with a rifampicin sparingantituberculosis drug regimen. Pyrexia ofunknown origin was the most common manifestationobserved and a therapeutic trial withantituberculosis drugs is justified. De novodiabetes mellitus appears to be an added riskfactor and increases the susceptibility tomycobacterial infection.