Eine seltene kutane Manifestation eines systemischen B-Zell-Lymphoms unter dem klinischen Bild einer seltenen Infektionserkrankung

Dargestellt wird der seltene Fall eines diffus großzelligen B-Zell-Lymphoms unter dem klinischen Verdacht einer kutanen Anthrax-Infektion. Bei Aufnahme präsentierte der 82-jährige Patient an der Stirn rechtsseitig oberhalb der Augenbraue eine ca. 3,5 cm messende ulzerierte Plaque mit zentral festhaftender schwarzer Nekrose und erhabenem livid-erythematösen Randwall. Wir sahen im Verlauf des stationären Aufenthaltes eine fulminante AZ-Verschlechterung des Patienten mit rezidivierenden Fieberschüben bis 40,0 °C und plötzlich disseminierter Aussaat neuer kutaner Herde ähnlich der Morphe der primären Läsion. In der CT zeigten sich multiple pulmonale und hepatische Rundherde sowie einzelne in den Nieren sowie in der rechten Nebenniere. In der Biopsie eines Leberrundherdes und in einer Hautbiopsie wurde die Diagnose eines diffus großzelligen B-Zell-Lymphoms vom ABC-Subtyp gesichert. Bei rezidivierenden Fieberschüben über 39 °C unter eskalierter Antibiose sowie persistierender nicht invasiver Beatmung wurde der Patient im Verlauf auf eine Intensivstation verlegt und verstarb nach 6-wöchiger Krankheitsdauer. Die Autoren schlussfolgern, dass bei sich extrem fulminant darstellenden Krankheitsverläufen, die klinisch einer dermatologischen Infektionserkrankung entsprechen können, jedoch unkontrollierbar unter antimikrobieller Therapie verlaufen, immer an die kutane Manifestation eines systemischen Lymphoms gedacht werden sollte. Hier können auch die primär der Infektionserkrankung zugeordnete B-Symptomatik und die elevierten Akute-Phase-Proteine auftreten. Lymphom-Manifestationen erscheinen an der Haut häufig unspezifisch mit ekzematöser, lichenoider oder pruriginös-nodulärer Morphe. Der Verlauf machte die Einordnung der Dignität der Erkrankung in unserem Fall dann möglich.

Analysis of pigmented skin lesions and malignant melanoma by Laser Doppler flowmetry - Report of different cases and further analysis by a neuronal network

BACKGROUND

Dermatoscopy is successfully used for the early diagnosis of suspicious skin lesions, however, correct diagnosis depends on training. There is evidence that wavelet analysis by Laser Doppler flowmetry (LDF) can identify malignant melanomas by their hypervascularization and changes in the capillary morphology.

OBJECTIVE

To show the capability of LDF in the distinction of melanomas and benign pigmented skin lesions based on data collected over 16 years.

METHODS

Evaluation of pigmented skin lesions was based on clinical information. The LDF measurements were taken. The suspect lesion was excised afterwards for histological work-up. Four case reports are presented. Data collected over 16 years was processed into a neuronal network to estimate the dignity of the lesion.

RESULTS

A total of 517 suspicious lesions were analyzed by LDF. In the histological work-up, 114 lesions turned out to be melanomas, whereas 403 benign naevi were secured. Specificity to detect melanomas was good based on the clinical information. The LDF increases the sensitivity of melanoma detection, which is also illustrated in four case reports.

CONCLUSION

In addition to clinical parameters, such as color and border, information from the LDF can help in the diagnosis of malignant melanomas. The LDF provides information on the vascularization of the skin lesion.

Sorting Beef Subprimals by Ribeye Size at the Packer Level to Maximize Utility and Product Uniformity in Foodservice and Retail Sectors

ObjectivesTo determine the impact of sorting beef carcasses at the packer level by ribeye area, instead of sorting subprimals by weight, to provide more consistent products for the end user via foodservice and retail channelsMaterials and MethodsInstrument grading technology was used to select 100 USDA Choice, yield grade 2 or 3 sides, and 100 USDA Select, yield grade 2 or 3 sides. Carcass sides were sorted into one of five ribeye area (REA) categories, as outlined in Tabsle 6.USDA Choice carcass sides were fabricated to remove beef rib, ribeye, lip-on (IMPS 112A) and beef loin, strip loin, boneless (IMPS 180) from each USDA Choice. Beef loin, tenderloin, full, side muscle on, partially defatted (IMPS 189B) subprimals were procured from each USDA Select side. Subprimals were weighed, trimmed to specification, and passed through a 3-D visual analysis portioning machine and to obtain scan data for a variety of portioning outcomes generated by simulation software.ResultsBased on input from our foodservice collaborators, 1.25 inches (3.18 cm) was identified, for ribeye and strip loin steaks, as the targeted optimal thickness to meet consumer expectations. After evaluation of multiple portioning outcomes, it was determined that a 14.00-ounce (396.89 g) portion, for each REA category, most consistently delivered the preferred steak thickness identified previously. REA categories 1 and 2 most frequently produced desirable thickness and portion weight outcomes in ribeye and strip loin steaks. Statistical analysis of number of portions per subprimal stratified by portion weight and portion thickness revealed differences (P < 0.05) across all REA area categories in both ribeyes and strip loins. As portion weight and thickness increased, steak portion number tended to decrease. In tenderloins, an optimal steak thickness of 1.75 to 2.00 in (4.45 to 5.08 cm) was identified as optimal. Most frequently, 8, 9, and 10-ounce (226.80, 255.15, and 283.50 g) portions met the targets for optimal portion weight and thickness parameters. For tenderloins, number of portions by portion weight showed significant differences (P < 0.05) in all ribeye area categories with the exception of 7-ounces (198.45 g) and showed no differences when stratified by portion thickness. In this investigation, USDA Choice carcasses (r = 0.76) and USDA Select carcasses (r = 0.56) expressed moderate correlation between REA area and hot carcass weight.ConclusionResults of the present study suggest strip loin, ribeye, and tenderloin subprimals from carcasses possessing a ribeye area ranging from 74.8 cm2 to 87.1 cm2 offered the greatest level of utility when portioned for use in foodservice and retail sectors. Further research is warranted to continue examining the merit of sorting carcasses by ribeye area at the packer level, but results of this study suggest that there is potential for improved consistency and utility of subprimals in the foodservice and retail sectors.Table 6.Ribeye area (REA) categories and associated acceptable REA ranges.

Protein-coding variants contribute to the risk of atopic dermatitis and skin-specific gene expression

BACKGROUND

Fifteen percent of atopic dermatitis (AD) liability-scale heritability could be attributed to 31 susceptibility loci identified by using genome-wide association studies, with only 3 of them (IL13, IL-6 receptor [IL6R], and filaggrin [FLG]) resolved to protein-coding variants.

OBJECTIVE

We examined whether a significant portion of unexplained AD heritability is further explained by low-frequency and rare variants in the gene-coding sequence.

METHODS

We evaluated common, low-frequency, and rare protein-coding variants using exome chip and replication genotype data of 15,574 patients and 377,839 control subjects combined with whole-transcriptome data on lesional, nonlesional, and healthy skin samples of 27 patients and 38 control subjects.

RESULTS

An additional 12.56% (SE, 0.74%) of AD heritability is explained by rare protein-coding variation. We identified docking protein 2 (DOK2) and CD200 receptor 1 (CD200R1) as novel genome-wide significant susceptibility genes. Rare coding variants associated with AD are further enriched in 5 genes (IL-4 receptor [IL4R], IL13, Janus kinase 1 [JAK1], JAK2, and tyrosine kinase 2 [TYK2]) of the IL13 pathway, all of which are targets for novel systemic AD therapeutics. Multiomics-based network and RNA sequencing analysis revealed DOK2 as a central hub interacting with, among others, CD200R1, IL6R, and signal transducer and activator of transcription 3 (STAT3). Multitissue gene expression profile analysis for 53 tissue types from the Genotype-Tissue Expression project showed that disease-associated protein-coding variants exert their greatest effect in skin tissues.

CONCLUSION

Our discoveries highlight a major role of rare coding variants in AD acting independently of common variants. Further extensive functional studies are required to detect all potential causal variants and to specify the contribution of the novel susceptibility genes DOK2 and CD200R1 to overall disease susceptibility.

Propofol use in children with allergies to egg, peanut, soybean or other legumes

Propofol is the most commonly administered intravenous agent for anaesthesia in children. However, there are concerns that the emulsified preparation may not be safe in children with an allergy to egg, peanut, soybean or other legumes. We conducted a retrospective study of children with immunologically confirmed egg, peanut, soybean or legume allergy and who underwent general anaesthesia at Princess Margaret Hospital for Children between 2005 and 2015. We extracted details regarding allergy diagnosis, each anaesthetic administered and any adverse events or signs of an allergic reaction in the peri-operative period. A convenience sample of patients without any known food allergies was identified from our prospective anaesthesia research database and acted as a control group. We identified 304 food-allergic children and 649 procedures where propofol was administered. Of these, 201 (66%) had an egg allergy, 226 (74%) had a peanut allergy, 28 (9%) had a soybean allergy and 12 (4%) had a legume allergy. These were compared with 892 allergy-free patients who were exposed to propofol. In 10 (3%) allergy patients and 124 (14%) allergy-free patients, criteria for a possible allergic reaction were met. In nine of the food-allergic children and in all the controls valid non-allergic explanations for the clinical symptoms were found. One likely mild allergic reaction was experienced by a child with a previous history of intralipid allergy. We conclude that genuine serious allergic reaction to propofol is rare and is not reliably predicted by a history of food allergy.

Die kontralaterale doppelte Transpositionslappenplastik

Das Prinzip der einfachen Transpositionslappenplastik (TLP) (Synonym: Schwenklappenplastik) besteht darin, dass in der unmittelbaren Umgebung eines Hautdefektes ein gestielter Lappen mit axialer oder randomisierter Gefäßversorgung generiert und durch eine geringfügige Drehbewegung an seiner Basis über eine dazwischenliegende Zone von normaler Haut in den Defekt eingeschwenkt wird. Häufig erwähnte Varianten der einfachen Transpositionslappenplastik sind die Rhomboidplastiken nach Limberg und Dufourmentel sowie die unilateralen „bi-lobed“ und „tri-lobed“ Schwenklappen 1, 2, 3, 4, 5, 6. Die kontralaterale doppelte TLP findet hingegen in der Literatur nur sehr selten Erwähnung 4.

Vasculitis allergica – ein nicht-IgE-vermitteltes Hypersensitivitätssyndrom

Die Diagnose „Vasculitis allergica“ suggeriert eine klassisch allergische IgE-vermittelte Genese. Dies ist jedoch nicht der Fall, vielmehr handelt es sich um einen hochkomplex ablaufenden Mechanismus, der häufig das eigentlich auslösende Antigen vor der Detektion bewahrt.

Die aktuelle Nomenklatur für dieses dermatologische Erkrankungsbild lautet kutane IgM oder IgG Immunkomplex-Vaskulitis, es handelt sich um eine leukozytoklastische Vaskulitis der postkapillären Venolen 3. Diese neue Einordnung legt die mit dem ursprünglichen Namen einhergehende Assoziation mit einer typisch IgE-vermittelten allergischen Erkrankung ab.

Vaskulitiden werden immunologisch betrachtet den Immunkomplex-Erkrankungen, der sogenannten Typ III Reaktion nach Coombs und Gell, zugeordnet 14, 15, 16. Sie werden als entsprechend dem dahinter liegenden immunologischen Prozess als „non-IgE-mediated allergic hypersensitivity Syndrom“ eingestuft 14, 15, 16. Viele Vaskulitiden machen sich klinisch zuerst an der Haut u. a. durch akut auftretende, rasch progrediente Ulzerationen bemerkbar, häufig assoziiert mit starker Schmerzhaftigkeit. Sie sind damit in der Ursachenabklärung eines Ulcus cruris bedeutsam, rangieren hier aber unter den seltenen Diagnosen.

Der lange bestehende Begriff einer „leukozytoklastischen Vaskulitis“ für diese Erkrankung steht entsprechend nicht länger für ein einzelnes Erkrankungsbild, sondern vielmehr für ein histologisches Muster einer Gruppe von Vaskulitiden, den sogenannten Immunkomplexvaskulitiden. 3 Hierbei handelt es sich von Gefäßkaliber überwiegend um „small vessel“ Vaskulitiden, diese können als „single organ vasculitis“ (SOV) mit alleiniger Manifestation an der Haut oder auch als kutanes Teilsymptom einer anderen „multi organ vasculitis“ (MOV) zum Beispiel im Rahmen eines systemischen Lupus erythematodes auftreten 1. Die kutane IgM oder IgG Immunkomplex-Vaskulitis zeigt den für Vaskulitiden klassisch plötzlich auftretenden, rasch progredienten Verlauf und ist klinisch durch eine typische Primäreffloreszenz, die palpable Purpura, mit hoher Inflammation charakterisiert. 2 Im Therapiekonzept steht an erster Stelle das auslösende Agens zu identifizieren und zu eliminieren 2, 42, 44. In der Regel zeigt dieser Typ von Vaskulitis eine überwiegend residuenfreie Abheilung mit niedrigem Rezidivrisiko unter der Voraussetzung, dass das auslösende Agens identifiziert und beseitigt ist 2, 41, 42, 44.

Positive Effect of Steroids in Posterior Reversible Encephalopathy Syndrome

We present a case of posterior reversible encephalopathy syndrome with severe clinical manifestation. Apart from initial aphasia, hemiparesis, and a generalized seizure, the patient had a prolonged loss of consciousness. Although blood pressure was normalized, the clinical status deteriorated continuously. After adding steroids to the therapy, the patient recovered rapidly, suggesting that this could have been a useful therapeutic approach. Even the vasogenic edema in the cerebral magnetic resonance imaging disappeared shortly within 6 days.

Dislocation rates of postoperative airway exchange catheters - a prospective case series of 200 patients

Background

The dislocation rate of oral versus nasal airway exchange catheters (AEC) in the postoperative care unit (PACU) are unknown. Our aim was to establish dislocation rates and to assess the usefulness of waveform capnography to detect dislocation.

Methods

In this non-randomized, prospective observational trial at the University Hospital Bern, Switzerland, we included 200 patients admitted to PACU after extubation via AEC, having provided written informed consent. The study was approved by the local ethical committee. AEC position was assessed by nasal fiberoptic endoscopy at beginning of PACU stay and before removal of the AEC. Capnography was continuously recorded via the AEC. Additional measurements included retching and coughing of the patient, and re-intubation, if necessary.

Results

Data from 182 patients could be evaluated regarding dislocation. Overall dislocation rate was not different between oral and nasal catheters (7.2% vs. 2.7%, p = 0.16). Retching was more often noted in oral catheters (26% vs. 8%, p < 0.01). Waveform capnography was unreliable in predicting dislocation (negative predictive value 17%). Re-intubation was successful in all five of the nine re-intubations where an AEC was still in situ. In four patients, the AEC was already removed when re-intubation became necessary, and re-intubation failed once, with a front of neck access as a rescue maneuver.

Conclusions

We found no difference in dislocation rate between nasal and oral position of an airway exchange catheter. However, nasal catheters seemed to be tolerated better. In the future, catheters like the staged extubation catheter may further increase tolerance.

Trial registration

The study was registered in a clinical study registry (ISRCTN 96726807) on 10/06/2010.

Round window and promontory movements during bone conduction with different middle ear conditions in Thiel embalmed specimens

BACKGROUND

Thiel conservation is mainly based on a watery solution of salts. We have shown that bone conduction (BC) evokes motion in normal middle ears of Thiel embalmed specimens that is comparable to the motion for other cadaveric models.

AIMS/OBJECTIVES

We evaluated whether promontory and round window (RW) motion identifies differences in BC transmission for different middle ear conditions.

METHODS

We investigated the conditions of mobile ossicle chain, cement-fixed stapes and stapedectomy in seven ears. A retroauricular bone anchored hearing system provided BC stimulation. The motions of the promontory and the RW were measured using single point laser Doppler vibrometer (LDV, HLV1000, Polytec).

RESULTS

The averaged differences between the conditions were small for RW motion and for promontory motion. However, for RW motion we found differences of more than one standard deviation at some frequencies. These differences in RW motion were more apparent when we limited the analysis to three selected specimens.

CONCLUSIONS AND SIGNIFICANCE

Extracochlear measurement of the RW motion with LDV allowed differentiation between BC for different middle ear conditions. These changes could be detected best in a small frequency range in selected specimens. Promontory motion could not be used to differentiate between different conditions of the middle ear.

ABBREVIATIONS

LDV: laser Doppler vibrometry; Prom: cochlear promontory; RW: round window; ST: stapes; TM: tympanic membrane; VProm: velocity of the promontory; VRW: velocity of the round window.

Impact of radiation, systemic therapy and treatment sequencing on survival of patients with melanoma brain metastases

BACKGROUND

Combining stereotactic radiosurgery (SRS) and active systemic therapies (STs) achieved favourable survival outcomes in patients with melanoma brain metastases (MBMs) in retrospective analyses. However, several aspects of this treatment strategy remain poorly understood. We report on the overall survival (OS) of patients with MBM treated with a combination of radiotherapy (RT) and ST as well as the impact of the v-Raf murine sarcoma viral oncogene homolog B (BRAF)-V600 mutation (BRAFmut) status, types of RT and ST and their sequence.

PATIENTS AND METHODS

Data of 208 patients treated with SRS or whole brain radiation therapy (WBRT) and either immunotherapy (IT) or targeted therapy (TT) within a 6-week interval to RT were analysed retrospectively. OS was calculated from RT to death or last follow-up. Univariate and multivariate Cox proportional hazard analyses were performed to determine prognostic features associated with OS.

RESULTS

The median follow-up was 7.3 months. 139 patients received IT, 67 received TT and 2 received IT and TT within 6 weeks to RT (WBRT 45%; SRS 55%). One-year Kaplan-Meier OS rates were 69%, 65%, 33% and 18% (P < .001) for SRS with IT, SRS with TT, WBRT with IT and WBRT with TT, respectively. Patients with a BRAFmut receiving IT combined with RT experienced higher OS rates (88%, 65%, 50% and 18%). TT following RT or started before and continued thereafter was associated with improved median OS compared with TT solely before RT (12.2 [95% confidence interval {CI} 9.3-15.1]; 9.8 [95% CI 6.9-12.6] versus 5.1 [95% CI 2.7-7.5]; P = .03).

CONCLUSION

SRS and IT achieved the highest OS rates. A BRAFmut appears to be a favourable prognostic factor for OS. For the combination of RT and TT, the sequence appears to be crucial. Combinations of WBRT and ST achieved unprecedentedly high OS rates and warrant further studies.

A novel retroauricular fixed port for hemodialysis: surgical procedure and preliminary results of the clinical investigation

BACKGROUND

Inspired by bone conduction implants, which have a low infection rate, a bone-anchored port (BAP) system for hemodialysis was designed.

OBJECTIVES

To demonstrate the surgical procedure for the BAP and to present preliminary results of the clinical investigation.

MATERIALS AND METHODS

Patients with end-stage renal disease and contraindications for an arteriovenous forearm fistula were recruited for BAP implantation. A workflow specifically developed for implantation was followed. Postoperative evolution, the dialysis procedure, the functionality of the implant, and signs of infection were monitored.

RESULTS

So far, five patients have been implanted with the BAP system. Hemodialysis with the BAP was unproblematic in all five patients, on average starting from the 9th day after implantation (range 2 to 15 days). Up to now, 1789 cumulative patient days (average 355 days, range 154 to 448 days) have been recorded. One patient died 14 months after implantation, from a cardiac arrest unrelated to the system. Dialysis was painless, and no catheter-related infections have occurred.

CONCLUSION

BAP implantation can be safely performed but requires an interdisciplinary team. No infections related to the device have occurred.

SIGNIFICANCE

The presented system is a promising addition to the choices of vascular accesses for hemodialysis patients.

Long-term outcome of open surgery in CVI patients concerning postoperative complications, perioperative hemodynamics and clinical efficacy, Part II1

BACKGROUND

Chronic venous disease (CVD) is extremely common worldwide with prevalence increasing with age. It is associated with a reduced quality of life, particularly in relation to pain, physical function and mobility. Symptomatic chronic venous insufficiency (CVI) with venous ulcer at its' endpoint, indicates interventional surgery to cure venous reflux therewith promoting wound healing and preventing recurrence. In this retrospective, single-centre, consecutive case-control study in a single patient population of a university clinic in northern Germany a holistic evaluation of varicose vein surgeries has been undertaken. Part I covered postoperative complications in relation to co-morbidities, co-medication and clinical presentation. Part II of this article presents now the hemodynamic results in relation to the perioperative evolution of CVI specific symptoms.

METHODS

Records of n = 429 (467 extremities) patients from 2009-2013 treated with open surgery were analysed with regards to perioperative hemodynamics. Evolution of CVI symptomology was accessed postoperatively with the help of a questionnaire and patient records in the case of complication development. Venous hemodynamics was analysed in the whole patient population and with regards to complication subgroups: no events (NE), neglectable adverse events (NAE) and non-neglectable adverse events (NNAE).

RESULTS

Postoperatively, patients' CVI-symptoms like pain (p < 0.001), swelling (p < 0.001) and itching (p = 0.003) significantly improved. The venous refill time and venous pump capacity improved significantly after open vein surgery (p < 0.05). Regardless of the development of postoperative complications there was a significant improvement of venous function at 6 weeks- and one-year postoperative in follow-up (p < 0.05). Symptom regression was strongly correlated with hemodynamic improvement.

CONCLUSION

A significant improvement of patients' symptoms was achieved by means of open-surgery, regardless of postoperative complication development. This was in accordance with the improvement of venous hemodynamics. A strong correlation between symptom regression and improvement in venous hemodynamics could be proven.

Tunable DNA Hybridization Enables Spatially and Temporally Controlled Surface-Anchoring of Biomolecular Cargo

The controlled immobilization of biomolecules onto surfaces is relevant in biosensing and cell biological research. Spatial control is achieved by surface-tethering molecules in micro- or nanoscale patterns. Yet, there is an increasing demand for temporal control over how long biomolecular cargo stays immobilized until released into the medium. Here, we present a DNA hybridization-based approach to reversibly anchor biomolecular cargo onto micropatterned surfaces. Cargo is linked to a DNA oligonucleotide that hybridizes to a sequence-complementary, surface-tethered strand. The cargo is released from the substrate by the addition of an oligonucleotide that disrupts the duplex interaction via toehold-mediated strand displacement. The unbound tether strand can be reloaded. The generic strategy is implemented with small-molecule or protein cargo, varying DNA sequences, and multiple surface patterning routes. The approach may be used as a tool in biological research to switch membrane proteins from a locally fixed to a free state, or in biosensing to shed biomolecular receptors to regenerate the sensor surface.

Long-term outcome of open surgery in CVI patients concerning postoperative complications, perioperative hemodynamics and clinical efficacy, Part I

BACKGROUND

Chronic venous disease (CVD) is extremely common worldwide. The prevalence is increasing with age and is associated with a reduced quality of life, particularly in relation to pain, physical function and mobility. Symptomatic chronic venous insufficiency (CVI) with venous ulcer at its' endpoint, indicates interventional surgery to cure venous reflux therewith promoting wound healing and preventing recurrence. To our knowledge up to now no coherent study has been undertaken in patients with CVI who underwent an open venous surgery concerning complications, venous hemodynamics and perioperative symptomology in one study population. This was undertaken in our retrospective, single-centre, consecutive case-control study in a single patient population of a university clinic in northern Germany. Part I covers postoperative complications in relation with co-morbidities, co-medication and clinical presentation. Part II will focus on pre- and postoperative hemodynamics and evolution of symptoms.

METHODS

Records of n = 429 (467 extremities) patients from 2009-2013 treated with open surgery were analysed. Number and type of complication were evaluated with regards to demographic parameters, co-existing medical conditions and procedure related aspects. Complications were grouped as no events (NE), neglectable adverse events (NAE), non-neglectable adverse events (NNAE) and severe (life-threatening) adverse events (SAE).

RESULTS

In 467 extremities of 429 patients with CVI 130 (27,84%) postoperative complications were observed after open surgery, thereof 64 (13,7%) NAE, 66 (14,14%) NNAE and 0 SAE. 29 (6,76%) patients developed a postoperative surgical site infection, thereof 4 (0,9%) with consecutive septicaemia. Except one case with nerval lesion and paraesthesia and hypoesthesia not resolving after 12 months all complications resolved within surveillance time span of 12 months. Patients developing NAE had a higher BMI (p = 0.003), were more likely to have diabetes mellitus (p < 0.001), and co-morbidities leading to the intake of anti-platelet or anticoagulation drugs (p < 0.001). Metabolic syndrome (p < 0.001) and anti-platelet or anticoagulation (p < 0.001) could be defined as independent risk factors for the development of complications. Patients receiving open surgery of small saphenous veins had 8 times higher risk of calf muscle venous thrombosis (p = 0.001).

CONCLUSION

Patients with a metabolic syndrome or receiving anti-platelet therapy or anticoagulation medication should undergo open venous surgery under hospital conditions with routine postinterventional surveillance visits. Patients undergoing an open surgery of SSV are definite candidates for postoperative subcutaneous heparin thromboprophylaxis. In general stripping below knee increases the risk of postoperative sensory deficit. This resolves in almost all patients within one year.

Author Correction: Genome-wide association and HLA fine-mapping studies identify risk loci and genetic pathways underlying allergic rhinitis

In the version of this article initially published, in Fig. 3, the y-axis numbering did not match the log scale indicated in the axis label. The error has been corrected in the HTML and PDF version of the article.

Psychosocial distress and desire for support among inpatients with skin cancer

BACKGROUND

Regular assessment of psychosocial distress is an important component of adequate psycho-oncological and social support in cancer patients. To date, relevant studies on skin cancer patients have primarily included individuals with melanoma.

OBJECTIVES

(1) Does the need for psychosocial support vary with the type of skin cancer? (2) Do mentally distressed patients desire support? (3) From the various individuals in the treatment team, whom do patients choose as potential contact person?

PATIENTS UND METHODS

Inpatients with skin cancer were asked to self-assess their psychosocial situation using the Hornheide questionnaire. In addition, they were asked about their desire for psychosocial support and the preferred potential contact person.

RESULTS

The need for support among the 116 patients surveyed varied significantly depending on the diagnosis (p = 0.007). However, the direct comparison between patients with melanoma (n = 38; 32.8 %) and squamous cell carcinoma (n = 9; 7.8 %) (p = 0.724) or other types of skin cancer (n = 20; 17.2 %) (p = 0.366) revealed no such difference. The prevalence of psychosocial distress (n = 49; 42.2 %) and the desire for support (n = 20; 17.4 %) showed considerable differences. Patients primarily chose a physician (n = 14/35) or a psychologist (n = 13/35) as potential "go-to" person for their mental distress.

CONCLUSIONS

Apart from psychosocial distress, the desire for support should be assessed, and patients should be provided access to additional psychosocial care options. With respect to the need for psychosocial support, it does not seem to be justified to preferentially - or even exclusively - consider melanoma patients in clinical practice and research.

Genome-wide association and HLA fine-mapping studies identify risk loci and genetic pathways underlying allergic rhinitis

Allergic rhinitis is the most common clinical presentation of allergy, affecting 400 million people worldwide, with increasing incidence in westernized countries^1,2. To elucidate the genetic architecture and understand the underlying disease mechanisms, we carried out a meta-analysis of allergic rhinitis in 59,762 cases and 152,358 controls of European ancestry and identified a total of 41 risk loci for allergic rhinitis, including 20 loci not previously associated with allergic rhinitis, which were confirmed in a replication phase of 60,720 cases and 618,527 controls. Functional annotation implicated genes involved in various immune pathways, and fine mapping of the HLA region suggested amino acid variants important for antigen binding. We further performed genome-wide association study (GWAS) analyses of allergic sensitization against inhalant allergens and nonallergic rhinitis, which suggested shared genetic mechanisms across rhinitis-related traits. Future studies of the identified loci and genes might identify novel targets for treatment and prevention of allergic rhinitis.