[Core outcome measurements in hand eczema trials : The HECOS initiative]

BACKGROUND

To enhance the informative value and comparability of hand eczema trials, the consensus of a set of core outcomes is necessary.

OBJECTIVES

How is success of therapeutic and preventive interventions currently determined in hand eczema trials? Which standard should apply in the future?

MATERIALS AND METHODS

As a first step, a systematic literature review was conducted to describe the status in controlled and randomized-controlled hand eczema trials from 2000-2017 and to identify the applied outcomes. The Hand Eczema Core Outcome Set (HECOS) initiative follows the guidelines of the Cochrane Skin Group Core Outcomes Set Initiative (CS-COUSIN) so that its further process is going to ensure the validity of the proposed measurement instruments and the appropriate inclusion of patients', physicians', and researchers' perspectives.

RESULTS

Previous trials predominantly assessed erythema, scaling, fissures, vesicles, or pruritus as clinical signs and symptoms of hand eczema. These variables were often not reported separately but as part of a variety of scores. Only few hand eczema scores were applied in more than one trial-most commonly the Hand Eczema Severity Index (HECSI, in 10% of the trials). Overall skin condition, without mentioning specific signs or symptoms, was assessed in 51% of the trials.

CONCLUSIONS

Although certain clinical signs and symptoms were assessed by a majority of hand eczema trials, comparability of results was not ensured because various measurement instruments were applied. HECOS is going to agree on a set of relevant and valid core outcome measurement instruments.

[Type IV contact allergies in the food processing industry: an update]

BACKGROUND

The food sector is one of the high-risk areas for occupational irritative and allergic contact eczema.

OBJECTIVES

The present work provides an overview of the main allergens as well as sensitization frequencies and risk in various food industry occupations.

METHODS

The literature on type IV sensitization in the food sector is summarized.

RESULTS

The relative risk of developing a work-related eczema in food processing is increased by more than 3 times. The comparison group was calculated on the basis of the proportion of documented cases in the IVDK (Informationsverbund Dermatologischer Kliniken) network per 100,000 working persons in relation to the average of the years 2005 and 2010. For this purpose, the average risk of all patients was set as reference to 1. Bakers, pastry chefs, cooks and meat and fish processors are mainly affected. In addition to irritant contact eczema, allergic contact eczema and protein contact dermatitis often occur. Leading haptens (main allergens) are rubber ingredients, but also disinfectants and compositae.

CONCLUSION

Only a few contact allergens are responsible for the majority of job-relevant sensitizations in the food industry.

Effect of freeform surfaces on the volume and performance of unobscured three mirror imagers in comparison with off-axis rotationally symmetric polynomials

The invention of new design techniques for unobscured reflective systems using freeform surfaces has expanded the optical design space for these system types. We illustrate how the use of freeform surfaces can expand the design space of the Three Mirror Compact design type to allow both better performance at a given system volume and smaller volumes for a given performance target. By evolving designs using conventional off-axis asphere type surfaces to ever smaller volumes and then converting these off-axis asphere descriptions to centered Zernike descriptions, we show that the wavefront error improves by up to 69% in this case by allowing the surfaces to break rotational symmetry. In addition, we show that evolving designs from the same starting point as the off-axis asphere designs but instead using a centered Zernike description can produce a design with a 39% smaller volume in this case while maintaining the same diffraction-limited performance.

Design of an oblique camera based on a field-dependent parameter

In this paper, a new parameter, field focal length (FFL), is introduced to characterize the optical properties for each field of an optical system. A freeform three-mirror off-axis reflective system, working as an oblique camera, is found to have various FFLs across the field angle of 30°. With the help of FFL, the ground resolution (GR) of this camera is analyzed under two working modes. One of the two working modes has more uniform GR when the field with larger FFL value aims at the object far away from the camera. By using FFL to control the GR, an oblique camera system is designed that has a constant GR within 99.41% over the field of view.

Mechanically tunable focusing metamirror in the visible

A compact, flat lens with dynamically tunable focal length will be an essential component in advanced reconfigurable optical systems. One approach to realize a flat tunable lens is by utilizing metasurfaces, which are two-dimensional nanostructures capable of tailoring the wavefront of incident light. When a metasurface with a hyperboloidal phase profile, i.e., a metalens, is fabricated on a substrate that can be actuated, its focal length can be adjusted dynamically. Here, we design and realize the first reflection type, tunable metalens (i.e., metamirror) operating in the visible regime (670 nm). It is shown that the focal length can be continuously adjusted by up to 45% with a 0% to 20% lateral stretching of the substrate, while maintaining diffraction-limited focusing and high focusing efficiency. Our design as a flat optics element has potential in widespread applications, such as wearable mixed reality systems, biomedical instruments and integrated optics devices.

Therapierefraktäres atopisches Ekzem − erfolgreiche Therapie mit Dupilumab

Bis vor Kurzem standen zur Behandlung der atopischen Dermatitis, im Gegensatz zur Psoriasis vulgaris, keine Biologika zur Verfügung, sodass die therapeutischen Möglichkeiten, insbesondere bei schweren Verläufen und fehlendem Ansprechen auf die bisher einzige zugelassene Systemtherapie mit Ciclosporin A, sehr begrenzt waren. Mit Dupilumab ist seit Januar 2018 erstmals ein Biologikum zur Behandlung der atopischen Dermatitis zugelassen. Hierbei handelt es sich um einen vollständig humanen monoklonalen Antikörper gegen die Alpha-Untereinheit des Interleukin (IL)-4-Rezeptors, wodurch die IL-4/IL-13-Signalwege gehemmt werden. Hier beschreiben wir den Fall eines 46-jährigen asiatischen Patienten mit einer schweren therapierefraktären atopischen Dermatitis sowie einer nebenbefundlich bestehenden eosinophilen pustulösen Follikulitis und den Verlauf seiner Erkrankung unter Dupilumab.

On-the-fly surface manufacturability constraints for freeform optical design enabled by orthogonal polynomials

When leveraging orthogonal polynomials for describing freeform optics, designers typically focus on the computational efficiency of convergence and the optical performance of the resulting designs. However, to physically realize these designs, the freeform surfaces need to be fabricated and tested. An optimization constraint is described that allows on-the-fly calculation and constraint of manufacturability estimates for freeform surfaces, namely peak-to-valley sag departure and maximum gradient normal departure. This constraint's construction is demonstrated in general for orthogonal polynomials, and in particular for both Zernike polynomials and Forbes 2D-Q polynomials. Lastly, this optimization constraint's impact during design is shown via two design studies: a redesign of a published unobscured three-mirror telescope in the ball geometry for use in LWIR imaging and a freeform prism combiner for use in AR/VR applications. It is shown that using the optimization penalty with a fixed number of coefficients enables an improvement in manufacturability in exchange for a tradeoff in optical performance. It is further shown that, when the number of coefficients is increased in conjunction with the optimization penalty, manufacturability estimates can be improved without sacrificing optical performance.

Degeneracy in freeform surfaces described with orthogonal polynomials

Orthogonal polynomials offer useful mathematical properties for describing freeform optical surfaces. Their advantages are best leveraged by understanding the interactions between variables such as tip and tilt, base sphere and conic variables, and packaging variables that define the problem of design for manufacture. These interactions can cause degeneracy, which can complicate the interpretation of design specifications in manufacturing and, consequently, negatively impact the cost of fabrication and assembly. Optimization constraints to break degeneracy during design are also discussed.

A second KRT71 allele in curly coated dogs

Major characteristics of coat variation in dogs can be explained by variants in only a few genes. Until now, only one missense variant in the KRT71 gene, p.Arg151Trp, has been reported to cause curly hair in dogs. However, this variant does not explain the curly coat in all breeds as the mutant ¹⁵¹ Trp allele, for example, is absent in Curly Coated Retrievers. We sequenced the genome of a Curly Coated Retriever at 22× coverage and searched for variants in the KRT71 gene. Only one protein-changing variant was present in a homozygous state in the Curly Coated Retriever and absent or present in a heterozygous state in 221 control dogs from different dog breeds. This variant, NM_001197029.1:c.1266_1273delinsACA, was an indel variant in exon 7 that caused a frameshift and an altered and probably extended C-terminus of the KRT71 protein NP_001183958.1:p.(Ser422ArgfsTer?). Using Sanger sequencing, we found that the variant was fixed in a cohort of 125 Curly Coated Retrievers and segregating in five of 14 additionally tested breeds with a curly or wavy coat. KRT71 variants cause curly hair in humans, mice, rats, cats and dogs. Specific KRT71 variants were further shown to cause alopecia. Based on this knowledge from other species and the predicted molecular consequence of the newly identified canine KRT71 variant, it is a compelling candidate causing a second curly hair allele in dogs. It might cause a slightly different coat phenotype than the previously published p.Arg151Trp variant and could potentially be associated with follicular dysplasia in dogs.

Polarization-switchable holograms based on efficient, broadband multifunctional metasurfaces in the visible regime

Gradient metasurfaces provide a novel approach to the phase manipulation of incident electromagnetic waves. Thus, they have the potential to create compact, light-weight optical solutions. An attractive feature of metasurfaces is the ability to integrate multiple optical functionalities into a single surface design. Here we demonstrate a high-efficiency (up to ~60%), reflective meta-hologram for visible light by using an ultra-thin (~λ/4 thick) gap surface plasmon-based metasurface. By precisely sampling the predesigned image phase and amplitude to the unit cells of our device, polarization-controlled dual images are reconstructed with a high polarization extinction ratio and high fidelity. The proposed technique expands the range of possibilities for high-quality hologram generation by using ultra-thin nanophotonic devices and paves the way for variousholography-related applications across the visible band.

Response of the Skyrmion Lattice in MnSi to Cubic Magnetocrystalline Anisotropies

We report high-precision small-angle neutron scattering of the orientation of the Skyrmion lattice in a spherical sample of MnSi under systematic changes of the magnetic field direction. For all field directions the Skyrmion lattice may be accurately described as a triple-Q[over →] state, where the modulus |Q[over →]| is constant and the wave vectors enclose rigid angles of 120°. Along a great circle across ⟨100⟩, ⟨110⟩, and ⟨111⟩ the normal to the Skyrmion-lattice plane varies systematically by ±3° with respect to the field direction, while the in-plane alignment displays a reorientation by 15° for magnetic field along ⟨100⟩. Our observations are qualitatively and quantitatively in excellent agreement with an effective potential, which is determined by the symmetries of the tetrahedral point group T and includes contributions up to sixth order in spin-orbit coupling, providing a full account of the effect of cubic magnetocrystalline anisotropies on the Skyrmion lattice in MnSi.

Qualitätskriterien forensischer Ambulanzen des Strafvollzugs

Mit dem Gesetz zur Reform der Führungsaufsicht 2007 wurde forensische Nachsorge sowohl für ehemalige Patienten aus dem Maßregelvollzug als auch für Straffällige aus dem Justizvollzug verbindlich etabliert. Im Lauf der vergangenen zehn Jahre entstanden somit bundesweit forensische Ambulanzen des Strafvollzugs, welche den gesetzlichen Auftrag zu Behandlung und Betreuung entlassener Straffälliger länderspezifisch umsetzen. Hierbei handelt es sich teils um neu gegründete Ambulanzen, teils um bereits lange in der Behandlung von straffälligen Menschen tätige Einrichtungen, die ihr bisheriges Angebot um die Betreuung von Menschen unter Führungsaufsicht erweiterten. Diese heterogenen Ambulanzen haben sich seit einigen Jahren in einem jährlich stattfindenden fachlichen Austausch bundesweit vernetzt und Gemeinsamkeiten, Unterschiede und Besonderheiten in der Umsetzung des gesetzlichen Auftrags diskutiert. Angestoßen von der Diskussion um Mindeststandards in forensisch-psychiatrischen Nachsorgeambulanzen des Maßregelvollzugs 2014 entwickelte diese Bundesarbeitsgemeinschaft der forensischen Ambulanzen des Strafvollzug Qualitätskriterien, die trotz verschiedener Länder- und Trägerspezifika gemeinsame inhaltliche und formale Parameter erfolgreicher ambulanter Behandlung zur Deliktprävention fokussieren. Der Artikel stellt das Ergebnis dieses Diskussionsprozesses mit den verabschiedeten Qualitätskriterien in den Kategorien Struktur‑, Prozess- und Ergebnisqualität vor.

A frameshift variant in the EDA gene in Dachshunds with X-linked hypohidrotic ectodermal dysplasia

X-linked hypohidrotic ectodermal dysplasia (XLHED) is a genetic disease characterized by hypoplasia or absence of hair, teeth and sweat glands. The EDA gene, located on the X chromosome, encodes the type II transmembrane protein ectodysplasin A. Variants in the EDA gene can lead to XLHED in humans, mice, cattle and dogs. In the present study, we investigated a litter of Dachshund puppies, of which four male puppies showed clinical signs of XLHED. We performed a candidate gene analysis in one affected puppy and several non-affected relatives. This analysis revealed a single base-pair deletion in the coding sequence of the EDA gene in the affected puppy (NM_001014770.2:c.842delT). The deletion is predicted to cause a frameshift, NP_001014770.1:p.(Leu281HisfsTer22), leading to a premature stop codon which truncates more than one quarter of the EDA protein. Sanger sequencing results confirmed that this variant was inherited from the dam. Based on knowledge about the functional impact of EDA variants in dogs and other species, c.842delT is a convincing candidate causative variant for the observed XLHED in the male puppies.

A frameshift variant in the COL5A1 gene in a cat with Ehlers-Danlos syndrome

Ehlers-Danlos syndrome (EDS) is a group of heritable connective tissue disorders caused by defective collagen synthesis or incorrect assembly of the collagen triple helical structure. EDS is characterised by joint hypermobility, skin hyperextensibility, abnormal scarring, poor wound healing and tissue friability. Human EDS may be caused by variants in several different genes including COL5A1, which encodes the collagen type V alpha 1 chain. For the present study we investigated a 1.5-year-old, spayed female, domestic shorthair cat with EDS. The affected cat showed multiple recurrent skin tears, hyperextensibility of the skin and joint abnormalities. We obtained whole genome sequencing data from the affected cat and searched for variants in candidate genes known to cause EDS. We detected a heterozygous single base-pair deletion in exon 43 of the COL5A1 gene, namely c.3420delG. The deletion was predicted to result in a frameshift and premature stop codon: p.(Leu1141SerfsTer134). Sanger sequencing confirmed that the variant was present in the affected cat and absent from 103 unaffected cats from different breeds. The variant was also absent from a Burmese cat with EDS. Based on knowledge about the functional impact of COL5A1 variants in other species, COL5A1:c.3420delG represents a compelling candidate causative variant for the observed EDS in the affected cat.