The use of photodynamic therapy in dermatology: results of a consensus conference

Photodynamic therapy (PDT) has significant promise in improving outcomes of patients with a variety of cutaneous conditions. A group of experts met to review the principles, indications, and clinical benefits of PDT with 5-aminolevulinic acid (ALA). They also reviewed PDT with methyl aminolevulinate. The experts established consensus statements for pretreatment, posttreatment, ALA contact time, light sources, and numbers of sessions associated with ALA PDT for actinic keratosis and superficial basal cell carcinoma, photorejuvenation and cosmetic enhancement, acne, sebaceous skin, rosacea, and rhinophyma. They based consensus recommendations on their clinical experience and the medical literature. They also suggested future applications of ALA PDT. Experts concluded that ALA PDT is a safe and effective modality for the treatment of conditions commonly encountered in dermatology. Since downtime is minimal, the technique is suitable for patients of all ages and lifestyles. Appropriate light sources are available in many dermatology offices. The expanding clinical and financial benefits of PDT justify the purchase of an appropriate light source.     

Methamphetamine use among young adults: health and social consequences

The current research analyzed the relationship between methamphetamine use and health and social outcomes. Interviews were conducted with a sample of 106 respondents. Virtually all of the respondents experienced negative consequences of methamphetamine use. The most serious, but least prevalent, methamphetamine-related health problem was seizures and convulsions. The most prevalent health effect was weight lose. A substantial number of respondents experienced severe psychological symptoms: depression, hallucinations, and paranoia. Of the 106 respondents, 34.9% had committed violence while under the influence of methamphetamine. The data suggest that methamphetamine-based violence was more likely to occur within private domestic contexts, both family and acquaintance relationships. It is apparent from the findings that methamphetamine use heightens the risk for negative health, psychological, and social outcomes. Having said this, it is crucial to acknowledge that there was no evidence of a single, uniform career path that all chronic methamphetamine users follow. Furthermore, a significant number of sample members experienced limited or no serious social, psychological, or physical dysfunction as a result of their methamphetamine use.     

Age-related femoral bone loss in men: evidence for hyperparathyroidism and insulin-like growth factor-1 deficiency

BACKGROUND: We sought to determine the extent to which the age-related decline of femoral neck (FN) bone mineral density (BMD) might be explained by the age-related change of body composition and biological parameters and the mechanisms by which these factors might influence FN BMD in men. METHODS: The relationships between FN BMD and anthropometric, hormonal, and biochemical parameters and bone turnover markers were studied in 82 men aged 25-86 years. RESULTS: Age was associated with a decline of FN BMD and osteocalcin (OC), bone alkaline phosphatase (bALP), and urinary C-telopeptide (p <.05). The significant relationship between FN BMD and OC (p <.01) did not remain after adjustment for age. With use of multiple linear regression and adjusting for all significant variables associated with FN BMD in univariate analysis (p <.01) (age, weight, lean and fat mass, height, and levels of dehydroepiandrosterone sulfate, insulin-like growth factor [IGF-1], testosterone, and parathyroid hormone [PTH]), age accounted for 29.5% of FN BMD variance. When age was excluded from the model, PTH accounted for 19.5% and IGF-1 for 10% of the FN BMD variance. Bone turnover markers were significantly intercorrelated, and levels of IGF-1 were positively associated with those of bALP and OC (p <.05). CONCLUSIONS: These results show that age is a strong predictor of FN BMD in men, resulting in a decline of bone remodeling, especially of bone formation. The results also show that, after taking into account anthropometric and other biological factors possibly involved in bone aging, the major part of the effect of age on bone is explained by the age-related increase of PTH and decrease of IGF-1 in men, suggesting that all measures taken to limit these age-related changes may be effective in the prevention of the age-related decline of FN BMD in men.     

Effects of bilateral and unilateral ophthalmectomy on plasma melatonin in Rana tadpoles and froglets under various experimental conditions

The effect of ophthalmectomy (enucleation) on plasma melatonin in Rana tadpoles and froglets was studied under various experimental conditions to determine if ocular melatonin is released into the circulation from the eyes and to study the factors which might affect this process. Where operations occurred in early or mid-photophase on a 12 light:12 dark (12L:12D) cycle (light onset at 08:00 h), sampling in mid-light and mid-dark revealed that scotophase plasma melatonin was reduced at all developmental stages, with the more significant effects occurring before metamorphic climax. Experiments sampling prometamorphic tadpoles six times in a 24h period on 18L:6D, 12L:12D, or 6L:18D five days after enucleation also showed a significant lowering of plasma melatonin in the dark, so that the scotophase peak was virtually eliminated on all the LD cycles. These findings indicated that the reduction in plasma melatonin after bilateral eye removal was independent of the LD cycle and the metamorphic stage, and that it abolished the diel melatonin rhythm at the expense of the scotophase peak. Experiments carried out for 5 weeks suggested that compensatory secretion of melatonin by other organs after eye removal might partially restore the plasma melatonin level over time. Unilateral ophthalmectomy tended to reduce, but not eliminate, the night peak of plasma melatonin, and did not result in a compensatory increase in ocular melatonin in the remaining eye. Ophthalmectomized tadpoles exhibited darkening of the skin after the operation, which was not associated with a significant change in pituitary alpha-melanotropin. The findings overall indicate that the eyes in Rana tadpoles and froglets contribute up to somewhat over one-half of the circulating melatonin, particularly during the scotophase, and provide experimental evidence for ocular secretion into the blood for the first time in the Amphibia.     

Transverse and Sigmoid Sinus Dural Arteriovenous Fistula Mimicking Idiopathic Intracranial Hypertension and Carotid Cavernous Fistula

Intracranial dural arteriovenous fistulas (dAVFs) can produce a variety of symptoms depending on fistula location, size, and venous drainage. Although cavernous sinus fistulas (CCFs) classically present with symptoms of orbital venous congestion due to retrograde venous drainage into the superior ophthalmic vein (i.e. an arterialised “red eye”) (Miller NR. Neurosurg Focus 2007;23:1--15), dAVFs not localised to the cavernous sinus rarely present with a “red eye” and instead produce increased intracranial pressure, which can mimic idiopathic intracranial hypertension (IIH). The authors present a unique case of an intracranial dAVF with clinical features suggestive of both CCF and IIH. Clinicians should be aware of this possibility to avoid delayed diagnosis of the intracranial dAVF.     

Cost Per Responder Associated with Biologic Therapies for Crohn’s Disease, Psoriasis, and Rheumatoid Arthritis

Introduction

Biologic therapies have demonstrated efficacy and safety in several chronic systemic disorders. The authors indirectly compared response rates and costs per responder associated with biologic treatments for moderate-to-severe Crohn??s disease (CD), psoriasis (Ps), and/or rheumatoid arthritis (RA).

Methods

A systematic literature search was performed to identify phase 3 randomized controlled trials of biologics for CD (adalimumab, infliximab), Ps (adalimumab, etanercept, infliximab, ustekinumab 45 mg, ustekinumab 90 mg), or methotrexate-refractory RA (abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, tocilizumab). Food and Drug Administration-approved dosing schedules were evaluated. Published response rates were extracted, with response defined in CD, Ps, and RA as: ??70-point reduction in CD Activity Index at 12 months; ??75% improvement in Psoriasis Area and Severity Index at 3 months; and ??50% improvement in American College of Rheumatology component scores at 6 months. Within each indication, mixed-treatment comparison meta-analyses were conducted to derive pooled estimates and 95% CIs of response rate difference versus placebo for each biologic, adjusting for cross-trial variation in control-arm response rates. Cost per responder was estimated for each biologic as projected per patient drug costs (2011 US$) divided by response rate difference.

Results

Altogether, 23 publications were selected. In CD, 12-month cost per responder was estimated at $116,291 (95% CI $71,637?C208,348) for adalimumab and $125,169 (95% CI $60,532?C267,101) for infliximab. Among biologics approved in Ps, 3-month cost per responder was lowest for adalimumab ($9,756; 95% CI $8,668?C11,131), infliximab ($12,828; 95% CI $11,772?C13,922), and ustekinumab 45 mg ($13,821; 95% CI $12,599?C15,167). In RA, biologics with the lowest 6-month cost per responder were adalimumab ($27,853; 95% CI $19,284?C40,270), etanercept ($29,140; 95% CI $14,170?C61,030), and tocilizumab ($31,363; 95% CI $14,713?C64,232).

Conclusion

Meta-analyses of clinical trials found considerable variation in cost-effectiveness of biologic therapies for CD, Ps, and RA. These results may help determine biologic utilization in these chronic diseases.