The Hand Eczema Trial (HET): design of a randomised clinical trial of the effect of classification and individual counselling versus no intervention among health-care workers with hand eczema

Background

The association between anxiety and depression, and eczema is well known in the literature, but factors underlying this association remain unclear. Low levels of omega-3 fatty acids and female gender have been found to be associated with both depression and eczema. Somatization and health anxiety are known to be associated with anxiety and depression, further, somatization symptoms and health anxiety have also been found in several dermatological conditions. Accordingly, omega-3 fatty acid supplement, female gender, somatization and health anxiety are possible contributing factors in the association between anxiety and depression, and eczema. The aim of the study is to examine the relevance of proposed contributing factors for the association between anxiety and depression, and eczema, including, omega-3 fatty acid supplement, female gender, health anxiety and somatization.

Methods

Anxiety and depression was measured in the general population (n = 15715) employing the Hospital Anxiety and Depression Scale (HADS). Information on eczema, female gender, omega-3 fatty acid supplement, health anxiety and somatization was obtained by self-report.

Results

Somatization and health anxiety accounted for more than half of the association between anxiety/depression, and eczema, while the other factors examined were of minor relevance for the association of interest.

Conclusions

We found no support for female gender and omega-3 fatty acid supplement as contributing factors in the association between anxiety/depression, and eczema. Somatization and health anxiety accounted for about half of the association between anxiety/depression, and eczema, somatization contributed most. The association between anxiety/depression, and eczema was insignificant after adjustment for somatization and health anxiety. Biological mechanisms underlying the mediating effect of somatization are yet to be revealed.     

Omalizumab for atopic dermatitis: case series and a systematic review of the literature

Omalizumab is a recombinant humanized monoclonal antibody targeting the high‐affinity Fc receptor of IgE, registered for the treatment of chronic spontaneous urticaria and severe allergic asthma. We present a case series of nine patients with atopic dermatitis (AD) treated off‐label with omalizumab and a systematic review of the existing literature. Patients were selected consecutively from a tertiary dermatological referral center during a 5‐year period. All patients were treated with omalizumab at a starting dose of 300 mg subcutaneously every 4 weeks. Systematic literature searches were performed in PubMed, Web of Science, EMBASE, and ClinicalTrials.gov to identify any study (case reports, case series, and controlled trials) evaluating the effect of treatment with omalizumab in AD. Based on physicians’ assessment, 50% of our patients had a good or excellent response to treatment with omalizumab; a further 12.5% had a moderate response, while 37.5% experienced no response or deterioration of symptoms during treatment. Treatment was generally well tolerated. Twenty‐six studies with a median of four patients each (range 1–21), comprising 174 patients, were included in the systematic review. Summed over all studies, a total of 129 patients (74.1%) experienced a beneficial effect of treatment ranging from little to complete response. Omalizumab appears to be a safe and well tolerated, however expensive, treatment with some clinical benefit in patients with severe recalcitrant AD. Recommendation for use in clinical practice awaits evidence from larger randomized controlled trials.     

Correlation of DNA ploidy and S-phase fraction with chemotherapeutic response and survival in a randomized study of disseminated malignant melanoma

DNA ploidy and S-phase fraction were measured by flow cytometry in the tumour tissue of 87 patients with disseminated malignant melanoma, who had been classified either as responders or with progressive disease in a study of the effects of 2 chemotherapeutic regimens. The patients had been randomized to receive treatment with dacarbazine (DTIC) and vindesine (Eldesine) with or without addition of cisplatin (Platinol). Tumour tissue was obtained from both the primary tumours and the last histologically verified metastases, but in some cases only the primary tumours or the last metastases could be evaluated. There was a significantly higher mean S-phase value in melanoma metastases from patients with complete or partial responses compared with patients with progressive disease. Neither the S-phase fraction of the primary tumour, nor the DNA ploidy of the primary tumour or of the last histologically verified metastases taken before inclusion into the study were associated with therapeutic response. In the multivariate analysis, both the anatomical location of the metastases and the S-phase fraction measured on the last metastases remained significant prognostic factors of response. In the univariate survival analysis, there was an association between high S-phase fractions of the metastases and longer survival. In the multivariate survival analysis, the S-phase fraction, the number of involved metastatic sites and the treatment response were independent predictive factors. We conclude that, in disseminated melanoma treated with chemotherapy, a high S-phase fraction measured in the last histologically verified metastases is associated with a higher response rate and a longer survival. Our results clearly support the role of S-phase measurement as a potential tool for selecting patients for treatment. © 1996 Wiley-Liss, Inc.     

Proliferating cell nuclear antigen (PCNA) in relation to ras,c-erbB-2, p53, clinico-pathological variables and prognosis in colorectal adenocarcinoma

Proliferating cell nuclear antigen (PCNA) expression was studied by immunohistochemistry on paraffin-embedded sections of 293 primary colorectal adenocarcinomas and 56 corresponding lymph node metastases. PCNA-positive expression was detected in <25% of tumour cells in 172 (59%) cases and in >25% in 121 (41%) cases. PCNA accumulation was related to over-expression of c-erbB-2 and p53 and tended to be increased in cases with ras over-expression. PCNA expression was identical in primary and corresponding metastases. No significant relationship was observed between PCNA expression and prognosis and other clinico-pathological variables, including grade of differentiation, growth pattern, Duke's stage, site, age or sex. We conclude that PCNA expression may be related to alterations of oncoproteins but that PCNA itself could not provide additional information for the development of metastasis and prognosis in colorectal adenocarcinoma. © 1996 Wiley-Liss, Inc.     

Current status of taxonomic groups of oral streptococci in endocarditis. Can virulence factors discriminate between endocarditis and non-endocarditis strains?

Objective: Infective endocarditis is frequently caused by oral streptococci, especially Streptococcus sanguis . In this group, many strains have recently been reclassified on the basis of new taxonomic schemes. The purpose of this study was to classify oral streptococci from patients with infective endocarditis and, further, to assess the importance of specific virulence factors for the development of streptococcal endocarditis.
Methods: Twenty-eight previously identified and 10 new streptococcal isolates from infective endocarditis were classified according to Kilian et al (1989) and compared to 30 streptococcal isolates from the oral cavities of periodontal patients without endocarditis. Subsequently, surface hydrophobicity was assessed by hydrophobic interaction chromatography, production of extracellular dextran was determined by precipitation, and non-specific proteolytic activity was evaluated by determination of hydrolysis of gelatin, and casein-precipitating activity.
Results: Eight streptococcal species were represented in the endocarditis isolates. Most strains were highly hydrophobic and none showed non-specific proteolytic activity. Dextran was produced with similar frequency in endocarditis and non-endocarditis isolates.
Conclusions: The present study showed that infective endocarditis may be caused by a variety of oral streptococcal species. The possible virulence factors investigated were found in the same proportions in endocarditis and non-endocarditis isolates, and thus did not seem to be crucial for development of endocarditis.     

Dupilumab for prurigo nodularis: Case series and review of the literature

Dupilumab is a recombinant complete human monoclonal antibody modulating the signaling of interleukin‐4 and interleukin‐13 pathways and has been approved for the treatment of moderate/severe atopic dermatitis. Here, we present three cases of prurigo nodularis treated off‐label with dupilumab, and a review of the existing literature. All patients in this study had longstanding severe disease and had tried multiple treatment modalities. They were treated with dupilumab at an initial dose of 600 mg subcutaneously, followed by 300 mg every 2 weeks. Systematic literature searches were performed to identify literature describing the evaluation of the effect of treatment with dupilumab in prurigo nodularis. The physician's assessment of the patients revealed a good or excellent response to the treatment with dupilumab. Patients were evaluated after treatment for 4 and 7 months. Treatment was generally well‐tolerated; one in three patients reported dry eyes. Four studies with a total of 11 patients (range: 1–4) were identified by the literature search. Complete response was noted in all 11 patients. Treatment with dupilumab appears to be safe and well‐tolerated with clinical benefit in recalcitrant prurigo nodularis. Larger randomized and controlled trials using validated outcome measures are needed before dupilumab could be applied in clinical settings.     

Progression of diabetic kidney disease and trajectory of kidney function decline in Chinese patients with Type 2 diabetes

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