Recommendations for the topical treatment of psoriasis

Several topical treatments are available for patients with psoriasis. Although individualization of the treatment remains important, there is a need for treatment recommendations to identify the best treatment out of the available treatments and to help with improvement in treatment compliance. In this communication we give our views on the assessment of severity of psoriasis. We provide recommendations for selection of treatments, reconciling the clearance phase and the long‐term management. Finally, we provide recommendations for the treatment of particular localizations: the scalp and psoriasis at sensitive sites.     

健身宝对衰老模型小鼠血清SOD和MDA的影响

目的　研究健身宝补脾益肾、延缓衰老的作用机制。方法　将 60只小鼠随机分为 6组 ,除正常对照组外均每日注射对D -半乳糖造成衰老模型 ,同时给予不同剂量的健身宝和金匮肾气丸。 6周后检测小鼠血清中SOD活性、MDA含量。结果　衰老模型组与正常对照组比较 ,小鼠血清中SOD活性显著降低 ,MDA含量显著升高 (P <0 .0 1 ) ;而健身宝大、中剂量组与正常对照组相比较 ,小鼠血清中SOD活性显著升高 ,MDA含量显著降低 ,与衰老模型组相比较有显著性差异 (P <0 .0 5 )。结论　健身宝明显提升D -半乳糖拟衰小鼠血清中SOD活性 ,降低MDA含量 ,可从调节自由基代谢和提高抗氧化能力方面发挥延缓衰老的作用。     

Unsupervised fuzzy clustering analysis supports behavioral cutoff criteria in an animal model of posttraumatic stress disorder.

BACKGROUND: Unsupervised fuzzy clustering (UFC) analysis is a mathematical technique that groups together objects in the multidimensional feature space according to a specified similarity measurement, thereby yielding clusters of similar data points that can be represented by a set of prototypes or centroids. METHODS: Since clinical studies of mental disorders distinguish between affected and unaffected individuals, we designed an inclusion/exclusion criteria (cutoff behavioral criteria [CBC]) approach for animal behavioral studies. The effect of classifying the study population into clearly affected versus clearly unaffected individuals according to behaviors on two behavioral paradigms was statistically significant. RESULTS: Here the raw data from previous studies were subjected to UFC algorithms as a means of objectively testing the validity of the concept of the CBC for our experimental model. The first UFC algorithm yielded two clearly discrete clusters, found to consist almost exclusively of the exposed animals in the one and unexposed animals in the other. The second algorithm yielded three clusters corresponding to animals designated as clearly affected, partially affected, and clearly unaffected. The algorithm for physiological data in addition to behavioral data failed to elicit discrete clusters. CONCLUSIONS: The UFC analysis yielded data that support the conceptual contention of the CBC and lends additional validity to our previous behavioral studies.     

Impact of Increasing Margin Around the Lumpectomy Cavity to Define the Planning Target Volume for 3D Conformal External Beam Accelerated Partial Breast Irradiation

The purpose of this study was to evaluate the dose to normal tissues as a function of increasing margins around the lumpectomy cavity in accelerated partial breast irradiation (APBI) using 3D-conformal radiotherapy (3DCRT). Eight patients with Stage 0-I breast cancer underwent treatment planning for 3DCRT APBI. The clinical target volume (CTV) was defined as a 15-mm expansion around the cavity limited by the chest wall and skin. Three planning target volumes (PTV1, PTV2, PTV3) were generated for each patient using a 0, 5-, and 10-mm expansion around the CTV, for a total margin of 15, 20, and 25 mm. Three treatment plans were generated for every patient using the 3 PTVs, and dose-volume analysis was performed for each plan. For each 5-mm increase in margin, the mean PTV:total breast volume ratio increased 10% and the relative increase in the mean ipsilateral breast dose was 15%. The mean volume of ipsilateral breast tissue receiving 75%, 50%, and 25% of the prescribed dose increased 6% to 7% for every 5 mm increase in PTV margin. Compared to lesions located in the upper outer quadrant, plans for medially located tumors revealed higher mean ipsilateral breast doses and 20% to 22% more ipsilateral breast tissue encompassed by the 25% IDL. The use of 3DCRT for APBI delivers higher doses to normal breast tissue as the PTV increases around the lumpectomy cavity. Efforts should be made to minimize the overall PTV when this technique is used. Ongoing studies will be necessary to determine the clinical relevance of these findings.     

A corneal model for slit-scanning elevation topography

Computerised videokeratography is increasing in sophistication and accuracy. The Orbscan II Videokeratographer combines the advantages of Placido derived and slit-scanning derived topography, to acquire shape information on the posterior surface of the cornea. The purpose of this paper is to construct a model of slit-scanning elevation topography and highlight potential sources of variation in this methodology. Ray tracing calculations were performed on a defined, theoretical, spherical model to obtain a pachymetric measurement. These calculations were tested by comparing the pachymetry measurement derived from the model, over a refractive index shift from 1.376 to 1.400 with the pachymetry measurement obtained by Orbscan II, of a human eye, with an identical alteration in refractive index. The two methods of measurement differed by only 0.157 microm, suggesting that the model is a good representation of slit-scanning elevation topography, and that refractive index variations have only a minimal effect on Orbscan II pachymetry measurement.     

Does the Farnsworth D15 test predict the ability to name colours?

Background: The Farnsworth D15 test is designed to categorise colour vision deficiency as severe or moderate. The level of difficulty of the test was set so that those who passed it should be able to recognise surface colour codes, such as those used for electrical wiring. The test is widely used to provide advice to patients with abnormal colour vision and is often used for occupational selection when reliable recognition of surface colour codes is required. However, there has been only one previous study of the correlation between performance at the D15 test and the naming of surface colour codes and there has been no study of whether a person who passes the D15 can reliably name surface colours. Methods: One hundred and two people aged 11 to 65 years with abnormal colour vision were recruited from consecutively presenting optometric patients and were asked to name the colours of fabric, paint and cotton thread samples. There were 10 colours in each class of material and the samples were presented in a large (five to 10 degree angular subtense) and small size (2.5 deg and a single thread). The errors made were compared to those made by an age‐matched control group of equal size with normal colour vision. Results: The correlations between the Farnsworth D15 colour confusion index and colour naming errors were 0.62 for the large stimuli and 0.73 for the small stimuli. Its sensitivity and specificity identifymg those who made more errors than the worst performing colour normal person were 0.80 and 0.69 (large stimuli) and 0.75 and 0.71 (small stimuli). A Nagel anomaloscope range of less than 35 scale units provides essentially the same sensitivity and specificity. Conclusions: About 40 per cent of those with abnormal colour vision can name the main colours correctly under good visibility conditions. The D15 test is an imperfect predictor of those who can name surface colour codes correctly but it does provide useful information for general counselling. It is not suitable as a single test for occupational selection because it will pass 20 per cent who cannot name surface colours correctly and fail 30 per cent who can. In occupations in which recognition of surface colour codes is of critical importance, it may be best not to select people with abnormal colour vision because of the lack of a colour vision test that is a perfect predictor of the ability to recognise surface colours.     

柯萨奇病毒诱发实验性多发性肌炎的初步研究

分别用不同量的柯萨奇病毒Ｂ１、２、３感染和兔肌匀浆加完全弗氏佐剂免疫正常豚鼠；拟建立多发性肌炎模型。结果发现：０．１ｍｌ毒力为１０－５ＴＣＩＤ５０柯萨奇病毒Ｂ１感染豚鼠组，３周后出现多发性肌炎症状。肌酶谱异常与其它组有明显差异，病理检查证实为多发性肌炎改变。单纯兔肌匀浆免疫对照组未发病。提示柯萨奇病毒Ｂ１感染及感染的病毒量与多发性肌炎的发病相关     

The influence of support conditions in the loading fixture on failure mechanisms in the push-out test: a finite element study

The usefulness of the push-out test as an indicator of interface strength was evaluated using finite element models of intact and partially failed cylindrical push-out specimens loaded against a rigid annular support. The irregular stress distributions that were found in intact specimens depended more on interface conditions at the loading fixture than on a 35% increase in interface area. The maximum stress at the interface was a tensile stress. Critical energy release rates for interface failure were calculated for flawed specimens in which flaw size was either 10 or 100 microns, and for boundary conditions at the loading fixture that were either fixed or slipping in the radial direction. The critical energy release rates depended heavily on the support boundary conditions. Thus, the results of parametric push-out tests can be reasonably compared only for specimens that are very similar in geometry and that are loaded in very carefully controlled fixtures.     

Promoting inter-agency collaborátion in child services

Summary Effective collaboration between agencies is often difficult to achieve. Children and their families/carers, who have complex therapeutic needs, present particular difficulties in that agencies need to work together, if they are to produce a co-ordinated and integrated package of care. A Multi-Agency-Consultation-Team (MACT) was set up in an attempt to overcome some of these problems of interagency co-operation. This paper describes the protocol, types of children referred and the recommendations made by the team. Follow-up of these children at 4 months suggests that a MACT does have a role to play in developing high quality services.     

Lower level of serum potassium and higher level of C-reactive protein as an independent risk factor for giant aneurysms in Kawasaki disease

Giant aneurysms are the most serious issue of patients with Kawasaki disease (KD). To clarify risk factors for these giant aneurysms, we conducted a matched case-control study. Among the patients reported in nationwide surveys, 117 patients with giant aneurysms had an unequivocal new diagnosis and presented at the treatment center within 9 d of illness. We obtained clinical information on admission of about 69 patients (case) from the treatment centers. One control was selected for each case, an age- and sex-matched patient without coronary involvement, reported from the same treatment center at about the same time as the case, and we obtained the same clinical information about controls. Fourteen variables were analysed with a conditional logistic regression model: body temperature, hematocrit, hemoglobin, numbers of leukocyte and platelets, concentrations of serum albumin, globulin, total cholesterol, sodium, potassium and chloride, erythrocyte sedimentation rate, C-reactive protein and alanine aminotransferase activity. After adjustment for age, duration of illness before admission and use of intravenous gamma globulin therapy, C-reactive protein [odds ratio (OR) = 1.142, 95% confidence interval (CI) 1.054-1.237], alanine aminotransferase activity (OR = 1.008, 95% CI 1.002-1.014), serum sodium concentration (OR = 0.877, 95% CI 0.770-0.999) and serum potassium concentration (OR = 0.319, 95% CI 0.124-0.822) were significantly related to the risk for giant aneurysms. Further analyses with these four explanatory variables revealed that C-reactive protein (OR = 1.159, 95% CI 1.022-1.315) and serum potassium concentration (OR = 0.222, 95% CI 0.052-0.948) met the significant level. Thus, the values for serum C-reactive protein and potassium are independent risk factors for the development of the giant aneurysms of Kawasaki disease.