Current treatment options in psoriasis

Physicians often do not appreciate the impact of the disease. A variety of topical and systemic treatments are available that--either alone or in rotation--may ameliorate psoriatic manifestations and attendant disability.     

MRSA-induced prosthetic valve endocarditis complicated by synthetic graft infection that did not respond to repeated vancomycin administration but improved after surgery]

We performed AVR and OMC in a 55-year-old male with ASR complicated by MS and ASO. Postoperatively, an ulcer formed on the left lower extremity, resulting in methicillin-resistant Staphylococcus aureus (MRSA) infection. Axillo-bilateral-femoral artery bypass was performed using synthetic grafts. However, infection developed in the anastomosis site, leading to MRSA sepsis. Since MRSA is highly susceptible to vancomycin (VCM), this drug was administered at a dose of 1.5 g/day. With negative conversion of MRSA, the infected wound healed, and the general status improved. However, after discontinuation of VCM administration, sepsis recurred. VCM administration was resumed with prolongation of the administration period and an increase in the dose. Drug administration was discontinued 3 times after 2-4 weeks each, but recurrence was observed each time. During this period, AR due to prosthetic valve endocarditis (PVE) developed. AVR and MVR were performed again, and the synthetic graft was left in place. However, after discontinuation of postoperative VCM administration, infection of the synthetic graft was also demonstrated. The graft was removed, and revascularization was performed by another route. The patient improved after these procedures. When MRSA-induced PVE or synthetic graft infection develops, the infectious foreign material should be completely removed at an early stage before progression of tissue destruction or ulcer formation even if antibiotics are effective.     

Current options in management of head and neck cancer patients

Head and neck cancer, particularly squamous cell carcinoma (SCC) of the upper aerodigestive tract, poses difficult diagnostic and therapeutic challenges to the clinician. A methodical approach, including complete visualization of mucosal surfaces, appropriate imaging, and tissue diagnosis whenever possible, gives patients the best opportunity for early intervention. A treatment program of surgery, radiation, or chemotherapy is best developed by a devoted head and neck oncologic team, involving surgeons, radiation and medical oncologists, and rehabilitative specialists with significant experience in the care of head and neck oncologic patients. Despite new advancements in the treatment of patients with advanced stage SCC of the head and neck, little progress has been made in overall survival. Several new avenues of investigation are currently being explored, one of which may ultimately provide the answer for this devastating disease.     

Risk factors for prosthetic joint infection: case-control study

Topology-representing neural networks are employed to generate pseudo-atomic structures of large-scale protein assemblies by combining high-resolution data with volumetric data at lower resolution. As an application example, actin monomers and structural subdomains are located in a three-dimensional (3D) image reconstruction from electron micrographs. To test the reliability of the method, the resolution of the atomic model of an actin polymer is lowered to a level typically encountered in electron microscopic reconstructions. The atomic model is restored with a precision nine times the nominal resolution of the corresponding low-resolution density. The presented self-organizing computing method may be used as an information-processing tool for the synthesis of structural data from a variety of biophysical sources.     

Lessons learned from the DIASTAT vascular access graft

In male Syrian hamsters, short days induce regression of the reproductive system, but eventually spontaneous recrudescence occurs ensuing from refractoriness to the inhibitory photoperiod. Although the photoperiod of 12 L:12 D (12 h light:12 h dark) may act like a short day by inducing the testicular cycle outlined above, it may fail to evoke the increase of circulating concentrations of prolactin that accompanies testicular recrudescence. This photoperiod may fail to induce photorefractoriness, as indicated by the prolonged low concentrations of prolactin in the blood. Herein, hamsters were exposed to either 8 L:16 D or 12 L:12 D from weaning and by 28 weeks exposure to either photoperiod, the hamsters had large testes following recrudescence from a photoperiod induced-regression). Transfer to 8 L:16 D from 12 L:12 D at 28 weeks resulted in a second testicular regression and recrudescence. In a second experiment, the testes of hamsters moved to 8 L:16 D from 12 L:12 D after 29 weeks exposure to the latter photoperiod similarly regressed and then regrew. Serum concentrations of prolactin decreased in these males after transfer to the shorter daylength but also decreased in hamsters kept under 12 L:12 D both groups were usually below those of hamsters moved to 14 L:10 D. These results show that exposure for 28 or 29 weeks to 12 L:12 D was insufficient to induce photorefractoriness, despite the recrudescence of the testes following involution.     

Current options for the topical treatment of acne vulgaris

The etiopathogenesis of acne vulgaris, a common disorder of youth and adolescence, includes four primary processes: hyperkeratinization (plugging) of the pilosebacous follicles, increased testosterone levels, bacterial colonization with Propionibacterium acnes, and inflammation. No single agent has yet been developed that addresses all of these factors. Combination regimens, therefore, which usually include an antibiotic and an agent to reduce follicular plugging, have become the mainstay of treatment. Despite a relative dearth of new treatments for almost a decade, recent research has produced a number of new significant oral and topical agents. Azelaic acid, a naturally occurring dicarboxylic acid analogue, has shown promise, and a group of retinoids that include adapalene, tazarotene, and reformulations of tretinoin represent new and forthcoming agents for topical treatment of acne vulgaris. Some studies indicate that several of these agents are associated with less skin irritation than previous formulations while they retain potent comedolytic activity. Adapalene also possesses significant anti-inflammatory activity.     

Intravascular ultrasound diagnosis of aortic graft infection

A clinical classification for Dupuytren's contracture of the hand is described. The classification system has been used to sort patients with Dupuytren's contracture into five broad surgical categories and takes into account predisposing factors, risk of recurrence and sympathetic tone in the individual patient. The system has many advantages in determining the approximate operation time and surgical experience required to treat patients. One hundred and four patients graded by this system have been analysed. There was a broad agreement between expected and actual operating times, with no significant difference between them.     

Mouse parvovirus infection potentiates allogeneic skin graft rejection and induces syngeneic graft rejection

BACKGROUND: The recently identified autonomous mouse parvovirus designated mouse parvovirus-1 (MPV-1) persists in adult BALB/c mice for at least 9 weeks, infects lymphoid tissues, interferes with the ability of cloned T cells to proliferate, and exhibits immunomodulatory properties. As a consequence of these findings, the present studies were undertaken to characterize further the inmunomodulatory effects of MPV-1 on T cell-mediated immune responses in vivo and in vitro. METHODS: To evaluate the effect of MPV-1 infection on CD8+ T cell-mediated responses, BALB/c-H2dm2 mice were infected after transplantation of allogeneic BALB/c skin. RESULTS: MPV-1 potentiated the rejection of allogeneic skin grafts. This potentiation was not a result of virus infecting the cellular or vascular component of the graft as determined by in situ hybridization, but was mediated by T cells. However, the proliferative capacity of alloantigen-reactive lymphocytes from graft-sensitized infected mice was diminished. MPV-1 also induced the rejection of syngeneic skin grafts, and T cells from these infected graft-sensitized mice lysed syngeneic P815 target cells. CONCLUSIONS: These results suggest that MPV-1 infection of skin-grafted mice may disrupt normal mechanisms of peripheral tolerance and provide a unique model to study virus-induced autoimmunity.     

Ex vivo gene therapy prevents chronic graft vascular disease in cardiac allografts

There continues to be considerable effort towards the construction of compound libraries targeted for the inhibition of protease enzymes. New tag-encoding methods for library deconvolution have been applied to this problem and there has been particular interest in novel solid-phase linkers for the introduction of key pharmacophore groups required for protease inhibition. Recent reports have tended to focus on nonpeptidic libraries, and, notably, structure-based design methods are now being applied to direct library design.