Use of Dermatoscopy in Lesions Suspicious for Melanoma: Two Case Reports

Abstract is missing (Short communication)

Basal cell carcinoma and rosacea: coincidence or relationship?

Introduction

The relationship between rosacea and basal cell carcinoma (BCC) is still not known. Almost all reports questioning the relation between BCC and rosacea are focused on rhinophyma.

Aim

To examine the possible connection of BCC and rosacea.

Material and methods

110 patients with BCC located on the face treated surgically in the Dermatosurgery Unit in 2020-2021 were included in the study. A trained dermatologist assessed the presence or absence of concomitant rosacea and assessed its severity according to the Investigator's Global Assessment (IGA).

Results

Fifty-one (46.4%) subjects with BCC and concomitant clinically diagnosed rosacea were found. In our group 35.5% of women had BCC located on the cheeks, while in men most cancers were located on the nose (55%, n = 11), however this difference has not reached statistical significance.

Conclusions

The incidence of rosacea in our population was undoubtedly higher, comparing to the normative population. Both rosacea and BCC share the same risk factors - UV exposure, the potential association should not be neglected.

Diagnosis of the Pneumatic Wheel Condition Based on Vibration Analysis of the Sprung Mass in the Vehicle Self-Diagnostics System

This paper presents a method for the multi-criteria classification of data in terms of identifying pneumatic wheel imbalance on the basis of vehicle body vibrations in normal operation conditions. The paper uses an expert system based on search graphs that apply source features of objects and distances from points in the space of classified objects (the metric used). Rules generated for data obtained from tests performed under stationary and road conditions using a chassis dynamometer were used to develop the expert system. The recorded linear acceleration signals of the vehicle body were analyzed in the frequency domain for which the power spectral density was determined. The power field values for selected harmonics of the spectrum consistent with the angular velocity of the wheel were adopted for further analysis. In the developed expert system, the Kamada-Kawai model was used to arrange the nodes of the decision tree graph. Based on the developed database containing learning and testing data for each vehicle speed and wheel balance condition, the probability of the wheel imbalance condition was determined. As a result of the analysis, it was determined that the highest probability of identifying wheel imbalance equal to almost 100% was obtained in the vehicle speed range of 50 km/h to 70 km/h. This is known as the pre-resonance range in relation to the eigenfrequency of the wheel vibrations. As the vehicle speed increases, the accuracy of the data classification for identifying wheel imbalance in relation to the learning data decreases to 50% for the speed of 90 km/h.

Risk Factors and Clinicopathological Features for Developing a Subsequent Primary Cutaneous Squamous and Basal Cell Carcinomas

Simple Summary

Patients with basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) often develop new keratinocyte carcinoma (KC), but information is limited on the frequency and timing of these subsequent tumors. This information is crucial to guide follow-up care. Given the significant clinical differences of the characteristic feature of individual skin cancer, estimation of the risk of a subsequent tumor should be estimating separately. The aim of our retrospective study was to assess risk factors for a subsequent skin cancer development. We demonstrated that patients with multiple tumors must be followed up carefully and for a long time. Moreover, we indicated the connection between the BCC subtype and increased risk for further KC development. BCC subtypes with an aggressive growth pattern predispose not only to increased risk for the recurrence but also are expected to be at an increased risk for a subsequent tumor. The non-invasive diagnosis, monitoring and follow up should be more comprehensive for those patients compared to low-risk BCC.

Abstract

Background: Patients with diagnosed keratinocyte carcinomas (KCs) have an increased risk of subsequent skin cancers development. Current studies indicate that patients with subsequent tumors should be followed up regularly. However, none of the studies indicate the connection between the specific subtypes and an increased risk for further KCs development. The study assesses the differences in the risk of developing a subsequent skin cancer after a previous diagnosis of KC, especially considering individual types of skin malignances, and identifies potential factors associated with an increased risk of new cutaneous tumor describing non-invasive diagnosis and monitoring. Methods: Pathology and medical records were examined to identify the characteristics of patients with multiple KCs diagnosed between 1999 and 2019. Results: The study group comprised 13,913 KCs occurring in 10,083 patients. Multiple KCs were observed in 2300 patients (22.8%). The analysis showed aggressive subtypes, multiple tumors, and male sex as significant prognostic factors. Conclusions: The most crucial risk factors for developing subsequent KC are being of a male gender, an aggressive tumor subtype, and previous history of multiple skin cancers. Basal cell carcinoma subtypes, such as infiltrative basosquamous, with aggressive growth patterns predispose not only to increased risk for the recurrence but are also expected to be at higher risk of subsequent KCs.

Serum Concentration and Skin Expression of S100A7 (Psoriasin) in Patients Suffering from Hidradenitis Suppurativa

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. An important role of innate immune dysregulation in the pathogenesis of HS has been highlighted. S100A7 (psoriasin) is an innate, antimicrobial protein that exerts proinflammatory and chemotactic action.

OBJECTIVES

The objective of the study was to investigate serum concentrations of S100A7 in individuals with HS as compared to healthy controls. Further, we evaluated the expression of S100A7 in lesional HS skin as compared to perilesional (clinically uninvolved) HS skin and normal skin.

METHODS

Serum concentrations of S100A7 were evaluated with a commercially available ELISA kit. The expression of S100A7 in the skin was assessed using qRT-PCR and immunofluorescence staining.

RESULTS

We found increased expression of S100A7 in lesional HS skin as compared to perilesional HS skin (p = 0.0017). The expression of S100A7 in lesional HS skin was positively associated with serum C-reactive protein concentration and the severity of disease according to Hurley staging. The serum concentration of S100A7 in individuals with HS was decreased as compared to healthy controls and patients with psoriasis.

CONCLUSIONS

Upregulated in lesional HS skin, S100A7 may enhance the inflammatory process and contribute to the HS pathogenesis.

Assessment of gait stability and preferred walking speed in virtual reality

PURPOSE

Analysis of human gait as well as diagnosis of human locomotion organ should always be conducted with velocity of gait equal to Preferred Walking Speed (PWS). The literature review shows that the PWS value is not the same in real and virtual environment. The aim of this study was to determine PWS values in both environments and to specify values of parameters used in equations enabling PWS calculations on the basis of lower limb length.

METHODS

Research-related tests involved 40 subjects walking on the treadmill and wearing HMD goggles. The spatial scenery made participants feel like during a walk in the park. The tests included measurements of displacements of the COP, allowing for the calculation of the Lyapunov exponent and Floquet Multiplier. Both coefficients were used to identify stability at various gait velocities.

RESULTS

The analysis revealed that the PWS in relation to gait on the treadmill with VR was lower than the PWS without VR. The final stage of research involved the determination of new values of coefficients of the formula enabling the identification of the velocity of comfort of gait in VR.

CONCLUSIONS

Obtained results proved that PWS in real and virtual environment are different. The lower values were obtained for measurements in VR. On the basis of these results, value of the "a" coefficient, used in PWS calculations on the basis of lower limb length, was re-determined. The new value makes it possible to assess PWS for gait conducted on treadmill in virtual environment, what can be very important in gait evaluation.

The assessment of the kinematics of the rescuer in continuous chest compression during a 10-min simulation of cardiopulmonary resuscitation

BACKGROUND

In pursuit of improvement in cardiopulmonary resuscitation (CPR), new technologies for the measurement and assessment of CPR quality are implemented. In our study, we assessed the kinematics of the rescuer during continuous chest compression (CCC-CPR). The proper performance of the procedure is a survival predictor for patients with cardiac arrest (CA). The purpose of the study was a prospective assessment of the kinematics of the rescuer's body with consideration given to the depth and rate of chest compression (CC) as the indicator of properly performed CC maneuver by professional and non-professional rescuers during a simulation of a 10-min CCC using a manikin.

METHODS

Forty participants were enrolled in the study. CCC-CPR was performed in accordance with the 2015 AHA guidelines on a manikin positioned on the floor. Kinematic data on the movement were obtained from the measuring system (X-sens MVN Biomech) transmitting information from 17 inertial sensors. Measurement data were imported to the author's program RKO-Kinemat written in the Matlab and C # environments. Two groups of results were distinguished: Group I-results of CC with the depth of ≥ 40 mm and Group 2-CC results with the depth of < 40 mm.

RESULTS

The multiple regression model demonstrated that the path length, left knee flexion angle, and left elbow flexion angle were the essential elements of the rescuer's kinematics that facilitated achieving and maintaining the normal depth of CC.

CONCLUSIONS

We believe that raising the rescuer's hips by moving the center of the rescuer's body over the point of sternal compression increases the value of the CC force vector, thereby increasing the depth of CC. In addition, we observed that, during an effective CC, the rescuer was unable to maintain arms straight and, in consequence, a slight elbow flexion was observed. It, however, did not influence the quality of the maneuver.

The Standard Deviation of Differential Index as an innovation diagnostic tool based on kinematic parameters for objective assessment of a upper limb motion pathology

PURPOSE

Indexing methods are very popular in terms of determining the degree of disability associated with motor dysfunctions. Currently, indexing methods dedicated to the upper limbs are not very popular, probably due to difficulties in their interpretation. This work presents the calculation algorithm of new SDDI index and the attempt is made to determine the level of physical dysfunction along with description of its kind, based on the interpretation of the calculation results of SDDI and PULMI indices.

METHODS

23 healthy people (10 women and 13 men), which constituted a reference group, and a group of 3 people with mobility impairments participated in the tests. In order to examine possibilities of the utilization of the SDDI index the participants had to repetitively perform two selected rehabilitation movements of upper extremities. During the tests the kinematic value was registered using inertial motion analysis system MVN BIOMECH.

RESULTS

The results of the test were collected in waveforms of 9 anatomical angles in 4 joints of upper extremities. Then, SDDI and PULMI indices were calculated for each person with mobility impairments. Next, the analysis was performed to check which abnormalities in upper extremity motion can influence the value of both indexes and interpretation of those indexes was shown.

CONCLUSION

Joint analysis of the both indices provides information on whether the patient has correctly performed the set sequence of movement and enables the determination of possible irregularities in the performance of movement given.

The Upper Limb Motion Deviation Index: A new comprehensive index of upper limb motion pathology

PURPOSE

The aim of the research was to formulate a new index enabling assessment of the overall pathology of the upper limb movement. It defines the difference between the pathological movement and a normal movement pattern.

METHODS

Methodology of determining the index is based on a mathematical algorithm for calculating the Gait Deviation Index which is based on advanced methods of image comparison. To calculate the ULMDI index, one must divide the analyzed movement into cycles appropriate to the nature of the movement (similarly in gait it is the gait cycle) and then determine kinematic quantities (courses of joint angles).

RESULTS

A group of 23 healthy people (10 women: k1-k10 and 13 men: m1-m13) as the reference group and a group of 3 persons with mobility impairments (p1-p3) took part in the research. Time values of the angles of the joints on both upper limbs were registered and then ULMDI indexes were calculated.

CONCLUSIONS

It has been shown that the developed ULMDI index allows to detect the deviations from the accepted norm in the performance of movements. The results showed that both the description of the motor dysfunction of examined person based on the diagnosis of the physician, a detailed analysis of kinematic waveforms received during the tests and the calculated values provide a coherent picture of the state of a human movement. The index analysis is less time-consuming for the doctor, and the comparison of the results at various stages of therapy gives an objective picture of the rehabilitation progress.

Influence of changing frequency and various sceneries on stabilometric parameters and on the effect of adaptation in an immersive 3D virtual environment

PURPOSE

The aim of the study was to examine the influence of different types of virtual sceneries and frequencies of movement of visual disturbances on stabilometric values as well as whether individual sceneries and changing frequency can minimize effect of adaptation of tested person to applied disturbances.

METHODS

There were 23 healthy participants. A person has been standing on a Zebris stabilometric platform. Virtual 3D environment was displayed by means of HMD Oculus Rift system. An open (a meadow) and closed (a room) sceneries were used. The sceneries moved along the sagittal axis and rotated around horizontal axis. The measurement lasted 30 seconds and in the middle of it frequency of translational movement was changed from 0.7 Hz to 1.4 Hz or from 1.4 Hz to 0.7 Hz.

RESULTS

The data were reported as medians of COP velocity and ellipse area. Visual disturbances caused the increase of these values in comparison with the tests conducted with open eyes. Results divided into periods (the first and the second 15 seconds) showed that in the first half of the test values were higher compared to the second half. The comparison of values obtained for open and closed scenery showed that higher values were recorded for open scenery.

CONCLUSIONS

The comparison of both types of sceneries on the basis of COP velocity and ellipse area showed that open scenery had a greater impact on the measured stabilometric values. It was found out as well that people got accustomed to the applied disturbances, but this effect was lower in the open scenery.

Increased interleukin (IL)-17 serum levels in patients with hidradenitis suppurativa: Implications for treatment with anti-IL-17 agents

BACKGROUND

Biologics seem to offer a promising nonsurgical approach in hidradenitis suppurativa (HS), especially in disease with highly pronounced inflammation. Recent studies revealed increased expression of a broad range of cytokines in lesional HS skin, including interleukin (IL)-17.

OBJECTIVE

This study was undertaken to determine IL-17 serum levels in this group of patients.

METHODS

Our study was conducted on a group of 86 patients between 16 and 72 years of age with HS. A total of 86 matched healthy volunteers constituted the control group. Enzyme-linked immunosorbent assay kits were used to quantify IL-17 serum concentration.

RESULTS

The mean IL-17 serum level of patients with HS was 3.68 ± 2.08 pg/mL, which was significantly elevated (P < .0001) compared with that found in healthy volunteers (2.5 ± 1.11 pg/mL). Moreover, there was a tendency toward higher serum concentrations of IL-17 in patients with more advanced disease (P = .005). Disease duration; patient sex, age, and body mass index; and smoking habits were not determining factors for IL-17 serum concentration.

LIMITATIONS

Hospital-based study population was a limitation, as was a lack of posttreatment assessment.

CONCLUSION

In light of our findings and literature on increased expression of IL-17 in HS lesions, evaluating the clinical effectiveness of using anti-IL-17 agents in the treatment of patients with HS is justified.

Surgical Procedures in Hidradenitis Suppurativa

Hidradenitis suppurativa is difficult to treat owing to its complex pathomechanism; beside the extensive inflammation with abscesses and inflammatory nodules, there is also an architectural loss with sinus tract formation and in severe cases with extensive scarring. Therefore, surgery is mandatory in moderate and severe HS.

SOX18 Expression in Non-melanoma Skin Cancer

BACKGROUND/AIM

SRY-related HMG box protein 18 (SOX18) is a transcription factor involved in a range of physiological processes, including differentiation of endothelial cells during new vessel formation. Numerous studies are being conducted to determine its role in carcinogenesis.

MATERIALS AND METHODS

Thirty-five cases of squamous cell carcinoma (SCC), 61 cases of basal cell carcinoma (BCC), 15 cases of actinic keratosis (AK) and 15 normal skin (NS) cases were examined in the study. Expression of SOX18 was investigated with immunohistochemistry and light optic microscopy. The obtained results were subjected to statistical analysis including available clinicopathological data.

RESULTS

Nuclear expression of SOX18 was shown in vascular endothelial cells, basal layer cells of NS epidermis, as well as in AK, BCC and SCC cancer cells. Expression of SOX18 in SCC, BCC and AK cells was significantly higher than in NS (p<0.01, p<0.001 and p<0.01, respectively). Additionally, higher expression of SOX18 in BCC than in SCC cells (p<0.001) was observed.

CONCLUSION

SOX18 may play a role in the development of BCC and SCC. Further studies with the use of additional markers tested at the mRNA and protein level are necessary for better explanation of SOX18 function in cancer transformation.

Expression of SATB1, MTI/II and Ki-67 in Mycosis Fungoides

BACKGROUND/AIM

A genome organizer protein, special AT-rich sequence binding protein 1, (SATB1), was recently shown to play an important role in the development and spread of various malignancies. Metallothioneins I and II (MTI/II) are multifunctional proteins involved, among others, in cell proliferation and apoptosis resistance in tumors. The role and relevance of these factors in mycosis fungoides (MF), the most common primary cutaneous T-cell lymphoma, is not fully understood. The aim of the present analysis was to evaluate the expression and potential correlation of SATB1, MTI/II and Ki-67 with clinicopathological data in MF.

MATERIALS AND METHODS

We performed immunohistochemical analysis for SATB1, MTI/II and Ki-67 on 90 cases of MF and 19 controls (chronic benign dermatoses). The expression of SATB1 and Ki-67 was analyzed in cancer cell nuclei, whereas nuclear and cytoplasmic expressions of MTI/II were scored separately (nMT, cMT; respectively).

RESULTS

We recorded a significantly higher expression of SATB1 and cMT in MF compared to the control group (p<0.002, p=0.04, respectively, Student's t-test). We also noted significant differences in the mean (±SD) expression of nMT and cMT in advanced MF compared to early MF, (1.4±1.3 vs. 0.9±0.9, 4.1±3.8 vs. 2.5±2.9, respectively; p=0.04 for both). Similarly, Ki-67 expression was significantly higher in advanced MF (p<0.01). The expression of SATB1, cMT and Ki-67 was significantly higher in more infiltrating skin lesions (p<0.001, p=0.08 and p<0.001, respectively). Regarding extracutaneous involvement, a higher expression of SATB1, nMT, cMT and Ki-67 was found in patients with clinical or histological involvement of lymph nodes (N1-3 vs. N0) (p<0.001, p=0.002, p<0.001 and p=0.1, respectively). A marked correlation was observed between SATB1 and Ki-67 (Spearman correlation test: r=0.53, p<0.001). No associations between SATB1, nMT and cMT expression and demographic data nor overall survival were found.

CONCLUSION

Our study provides data on the differences in the expression of SATB1 and cMT regarding differential diagnosis of MF and tumor-node-metastasis-blood staging. Additionally, our report documented significantly different expression levels of MTI/II and Ki-67 according to the advancement of the disease. In view of these data, the role of studied factors in the development of this type of cutaneous T-cell lymphoma is postulated. Our results indicate that both SATB1 and MTI/II may be of diagnostic value, but our study revealed no prognostic significance; however, given the small number of reports focusing on this topic, further studies are required.

The influence of frequency of visual disorders on stabilographic parameters

PURPOSE

Defining the influence of parameters of visual disorders on ability of balancing turns out to be an important process in effective diagnostics. Current diagnostic methods relating mainly to determination of the coefficient of BRUTM (Balance Rehabilitation Unit Trade Mark) depend on lots of tests carried out in a disturbed environment created by Virtual Reality Technology. The aim of this study is to determine the effect of the frequency of visual disturbances on stabilographic values in the virtual reality environment.

METHODS

The study was carried out involving one research group in Virtual Cave. There were induced visual disturbances with different frequencies and with the change of frequency during measuring the position of the center of pressure (COP) in the test. Before each test the reference test was performed. All tests were performed with disorders in two different sceneries: closed and open scenery. All measurements were carried out on an immobile Zebris platform which enables determination of feet pressure distribution. From the measured values of the position of the COP Short Time Fourier Transform (STFT) was calculated.

RESULTS

The results of calculation are shown in graphs. Their analysis showed that changing the parameters of disorder frequency in world created using Virtual Reality Technology affects stabilographic parameters. The intensity of these changes is also affected by applied research scenery.

CONCLUSIONS

Conditions have been set out to carry out similar studies in order to obtain reliable results. The study is the first step in a project to develop a system for diagnosis and rehabilitation of human movement using Virtual Reality Technology.

[The extensive phlegmon of the neck leading to severe complications - a case report]

Purulent infection of the neck is a serious condition, which can occur at any age and regardless of any factors. It often leads to the serious complications, including death. A case report. The authors present a case of a 56-year-old patient who reported to the emergency department because of the severe neck pain, fever and progressive weakness. Physical examination revealed an extensive inflammation involving skin and subcutaneous tissue surrounding suboccipital area and neck. Palpation of the thyroid gland showed tumor of the left lobe. Due to deteriorating condition, it was decided to admit the patient to the hospital, along with urgent surgery. It was necessary to perform a repeated removal of the necrotic tissues of the nuchal area. Diabetes mellitus type II was diagnosed during hospitalisation. Long and laborious extensive wound care enabled to perform a skin graft and full recovery. The patient was discharged in good general and local condition in the 11th week of the hospitalization.

Bacteriology of hidradenitis suppurativa - which antibiotics are the treatment of choice?

The bacterial superinfection in hidradenitis suppurativa (HS), although it does not initiate the disease itself, seems to be one of the major contributors to an inflammatory vicious circle. Antibiotic therapy is therefore commonly prescribed in HS. This study was undertaken to evaluate the prescription of systemic antibiotics in the light of bacteriological cultures and antibiograms. The study was conducted on a group of 69 patients with HS. The huge majority (n=62) of the patients were treated with antibiotics. The antibiotics were prescribed 132 times and taken for a mean period of 9.9 ± 8.9 weeks. The most commonly used antibiotic was doxycycline (16.7%). The majority of the patients had a polymicrobial flora with up to 5 species, predominantly staphylococci and bacteria of intestinal flora. The highest effectiveness against isolates was observed for carbapanems, penicillins with β-lactamase inhibitors and fluoroquinolones - 8.5%, 11.9%, and 11.9% of resistant strains, respectively. In daily practice penicillins with β-lactamase inhibitors or fluoroquinolones could serve as first-line therapy of HS.

Polymorphisms in nucleotide excision repair genes and basal cell carcinoma of the skin

BACKGROUND

Mutations in nucleotide excision repair (NER) genes are the cause of xeroderma pigmentosum, a genetic syndrome with proneness to basal cell carcinoma (BCC) of the skin. Single nucleotide polymorphisms (SNPs) may affect the effectiveness of DNA repair and hence influence individual susceptibility to a variety of neoplasms. The aim of this study was to find associations between SNPs in selected NER genes and sporadic BCC development.

MATERIALS AND METHODS

The study group consisted of 100 patients with histopathologically confirmed BCCs and the control group of 100 elderly individuals with no personal history of any cancer. DNA isolated from peripheral blood lymphocytes was genotyped for seven SNPs in five different NER genes. Statistical analyses for associations were performed.

RESULTS

A weak association between XPD exon 6 silent C/A polymorphism and BCC development risk was found when comparing single polymorphisms between the two groups. When considering sex and SNPs, men with the A-allele in XPC intron 11 C/A have been found to have a decreased risk of BCC.

CONCLUSIONS

There is no consistency in association studies between SNPs and BCC susceptibility. SNPs in NER genes seem to have an insignificant influence on the risk of developing BCC of the skin.