Plaque‐like dermatofibroma: A distinct and rare benign neoplasm?

Unusual large dermatofibromata are reported in a 40-year-old man and a 48-year-old man, who both presented with plaques on a lower limb. The largest plaque in each case was well-defined, reddish brown, indurated and measured 50 mm x 30 mm and 70 mm x 40 mm, respectively. Several satellite lesions were present around the large plaques. Dermoscopic examination showed diffuse homogenous pigmentation in the absence of other diagnostic criteria for dermatofibroma. Light microscopy of biopsies from each patient displayed similar features. There was a dermal proliferation of fibrohistiocytic cells that entrapped intervening thickened collagen fibres. The overlying epidermis was acanthotic, and in some instances this showed basal hyperpigmentation. There was no evidence of malignancy. Immunohistochemical staining was positive for Factor XIIIa and negative for CD34. Based on the histological findings, a diagnosis of dermatofibroma was made for each of these cases. Fewer than 20 adult cases of large dermatofibroma of this scale, designated giant dermatofibroma, have been reported to date; and only two have shown a plaque-like appearance, the remainder being pedunculated. The authors propose plaque-like dermatofibroma as a variety of large dermatofibroma distinct to pedunculated giant dermatofibroma.     

A randomized controlled trial assessing the effectiveness of professional oral care by dental hygienists

Abstract: Objectives:  This study was designed to compare professional oral care (POC) by a dental hygienist with tooth brushing and mouth rinsing by patients themselves according to the instructions of a nurse (control). Methods:  Forty patients were randomly assigned to either the POC group (n = 20) or control group (n = 20). The presence of plaque and bacteria was assessed clinically. Results:  One patient in the POC group and three patients in the control group dropped out because of exacerbation of underlying disease or death. Plaque control record scores were significantly lower in the POC group than in the control group on the fifth hospital day and the day of discharge. There was no significant difference between the groups in the detection rate of Candida species; and nosocomial pathogens on either day. Conclusions:  Professional oral care by a dental hygienist is more effective than tooth brushing and mouth rinsing by patients themselves according to the instructions of a nurse.     

Combining etanercept and acitretin in the therapy of chronic plaque psoriasis: a 24-week, randomized, controlled, investigator-blinded pilot trial

Background Combination treatments may increase efficacy while reducing dosages and side‐effects of individual agents. No randomized controlled trials have been published combining biologics with conventional agents for psoriasis. Objectives To investigate the efficacy and safety of the association of acitretin and etanercept in the treatment of moderate to severe chronic plaque psoriasis. Methods A 24‐week, randomized, controlled, investigator‐blinded pilot trial was conducted. Sixty adult patients with moderate to severe chronic plaque psoriasis were randomized into three groups to receive etanercept 25 mg twice weekly subcutaneously, oral acitretin 0·4 mg kg^?1 daily or etanercept 25 mg once weekly plus acitretin 0·4 mg kg^?1 daily. The primary end point was a 75% or greater improvement in Psoriasis Area and Severity Index (PASI) from baseline (PASI 75) at week 24. Results At week 24, PASI 75 response was achieved by 10 of 22 patients in the etanercept group (45%), six of 20 in the acitretin group (30%) and eight of 18 (44%) in the group treated with etanercept plus acitretin (P = 0·001 for both etanercept groups compared with acitretin alone). A 50% or greater improvement from baseline in PASI was achieved by 15 of 22 (68%), 10 of 20 (50%) and 12 of 18 (67%) patients, respectively (P = 0·001). The safety profiles of the three groups were similar. Conclusions A combined therapeutic regimen with etanercept 25 mg once weekly and acitretin 0·4 mg kg^?1 daily is as effective as etanercept 25 mg twice weekly, and more effective than acitretin alone. Although larger studies are needed to confirm these results, the etanercept/acitretin association could offer several advantages in the therapy of moderate to severe chronic plaque psoriasis.     

易损斑块磁共振成像：共识与挑战

研究显示,黑血管壁成像技术能够较为准确地识别和定量分析动脉粥样硬化易损斑块的特征,尤其在颈动脉血管床。采用磁共振技术早期识别易损斑块的重要特征将有助于预防心血管事件的发生。因此,有必要对该技术进行临床推广应用。然而,目前广泛推广磁共振斑块成像技术亦存在一定的挑战性,如应用该技术在冠状动脉等其他血管床仍具有一定的局限性,以及如何权衡效益/费用比等等。本文重点描述应用磁共振斑块成像技术的共识性观点和所面临的挑战。     

MRI检测易损斑块的优势与不足

MRI具有高分辨率、无创和可重复检查等优点,可有效区分动脉粥样硬化斑块的组成成分及形态学特征,对易损斑块的筛查及易损性评估的应用价值已成为临床研究热点。本文就MRI检查易损斑块的优势与不足,以及未来MRI在易损斑块的研究方向进行综述。     

易损斑块的影像学检查方法

目前动脉粥样硬化斑块的影像学检查方法主要包括无创性（如多普勒超声、CT和MRI）和有创性（如DSA、血管内超声、血管内MRI）检查,每种检查方法各有优缺点,无创影像学评估易损斑块的比较研究有利于优化影像学检查技术。多种方法的联合应用,可以大大提高诊断准确率。     

Molecular mechanisms and therapeutic strategies of vulnerable atherosclerotic plaques

Vulnerable atherosclerotic plaque rupture leading to thrombosis is the major cause of acute coronary syndrome (ACS). Studies on the pathophysiologic mechanism of both ACS and plaque stabilizing treatment are driving the development of animal models of vulnerable plaque. In our laboratory, we established animal models of plaque rupture and thrombosis in rabbits and mice that are similar to human plaque rupture. Potential mechanisms involved in plaque vulnerability were studied from the inflammation-immunity, proliferation-apoptosis, oxidative stress and biomechanics aspects. Imaging markers and biomarkers were used to detect vulnerable plaques, including high frequency duplex ultrasound, intravascular ultrasound (IVUS), intravascular ultrasound elastography, magnetic resonance imaging (MRI) and inflammatory markers. Effective gene and drug strategies to treat vulnerable plaques were explored.     

多层螺旋CT评估冠状动脉分叉角度对动脉粥样硬化斑块形成的影响

目的探讨冠状动脉前降支（LAD）-对角支（DX）分叉角度与冠状动脉斑块形成和分布的相关性。方法选取我院行64层螺旋CT冠状动脉造影检查者72例,所选患者均无高血脂、高血压和糖尿病病史。原始图像经后处理工作站重建出冠状动脉的二维和三维图像。测量冠脉LAD-DX分叉角度、分叉管壁交点至斑块中心垂直线的直线距离,研究冠脉斑块距分叉处的距离和LAD-DX分叉角度的相关性。结果 33例前降支（LAD）存在斑块的患者中,LAD-DX分叉角度与斑块距分叉处的距离之间存在负相关。12例对角支（DX）有斑块者中,LAD-DX分叉角度与斑块距分叉处的距离之间无相关性。结论冠状动脉分叉角度作为一种潜在血流动力学因素对冠状动脉粥样斑块的形成和分布具有重要影响。     

18F-FDG PET与MRI联合检测颈动脉易损斑块的应用前景

颈动脉粥样硬化斑块的破裂是导致脑卒中发生的主要原因.利用18F-FDG PET联合MRI的方法可以同时提供斑块代谢、形态及成分方面的信息,大大提高诊断的灵敏度和特异性.     

Atherosclerosis imaging using 3D black blood TSE SPACE vs 2D TSE

AIM: To compare 3D Black Blood turbo spin echo (TSE) sampling perfection with application-optimized contrast using different flip angle evolution (SPACE) vs 2D TSE in evaluating atherosclerotic plaques in multiple vascular territories.METHODS: The carotid, aortic, and femoral arterial walls of 16 patients at risk for cardiovascular or atherosclerotic disease were studied using both 3D black blood magnetic resonance imaging SPACE and conventional 2D multi-contrast TSE sequences using a consolidated imaging approach in the same imaging session. Qualitative and quantitative analyses were performed on the images. Agreement of morphometric measurements between the two imaging sequences was assessed using a two-sample t-test, calculation of the intra-class correlation coefficient and by the method of linear regression and Bland-Altman analyses.RESULTS: No statistically significant qualitative differences were found between the 3D SPACE and 2D TSE techniques for images of the carotids and aorta. For images of the femoral arteries, however, there were statistically significant differences in all four qualitative scores between the two techniques. Using the current approach, 3D SPACE is suboptimal for femoral imaging. However, this may be due to coils not being optimized for femoral imaging. Quantitatively, in our study, higher mean total vessel area measurements for the 3D SPACE technique across all three vascular beds were observed. No significant differences in lumen area for both the right and left carotids were observed between the two techniques. Overall, a significant-correlation existed between measures obtained between the two approaches.CONCLUSION: Qualitative and quantitative measurements between 3D SPACE and 2D TSE techniques are comparable. 3D-SPACE may be a feasible approach in the evaluation of cardiovascular patients.