Laparoscopic total fundoplication is superior to medical treatment for reducing the cancer risk in Barrett's esophagus: a long-term analysis

The present study aims to compare the effectiveness of surgical and medical therapy in reducing the risk of cancer in Barrett's esophagus in a long-term evaluation. A prospective cohort was designed that compared Barrett's esophagus patients submitted to medical treatment with omeprazole or laparoscopic Nissen fundoplication. The groups were compared using propensity score matching paired by Barrett's esophagus length. A total of 398 patients met inclusion criteria. There were 207 patients in the omeprazole group (Group A) and 191 in the total fundoplication group (Group B). After applying the propensity score matching paired by Barrett's esophagus length, the groups were 180 (Group A) and 190 (Group B). Median follow-up was 80 months. Group B was significantly superior for controlling GERD symptoms. Group B was more efficient than Group A in promoting Barrett's esophagus regression or blocking its progression. Group B was more efficient than Group A in preventing the development of dysplasia and cancer. Logistic regression was performed for the outcomes of adenocarcinoma and dysplasia. Age and body mass index were used as covariates in the logistic regression models. Even after regression analysis, Group B was still superior to Group A to prevent esophageal adenocarcinoma or dysplasia transformation (odds ratio [OR]: 0.51; 95% confidence interval [CI]: 0.27-0.97, for adenocarcinoma or any dysplasia; and OR: 0.26; 95% CI: 0.08-0.81, for adenocarcinoma or high-grade dysplasia). Surgical treatment is superior to medical management, allowing for better symptom control, less need for reflux medication use, higher regression rate of the columnar epithelium and intestinal metaplasia, and lower risk for progression to dysplasia and cancer.

Toxicities of acetogenin-based bioacaricides against two-spotted spider mite and selectivity to its phytoseiid predators

Tetranychus urticae is the main pest of strawberry crops and can cause up to 80% of productivity losses under high infestations. Aiming to search T. urticae management alternatives compatible with eco-friendly or organic-based food production systems, this study evaluated the lethal and sublethal toxicities of formulated derivatives from Annonaceae (rich in acetogenins) against this pest species. In addition, it also evaluated the selectivity of the most promising formulation to the predatory mites Neoseiulus californicus and Phytoseiulus macropilis, which are largely applied in biological control in Brazil. Among the derivatives tested, the emulsion from the ethanolic seed extract of Annona mucosa-ESEAm (major component: acetogenin bis-tetrahydrofuran rolliniastatin-1) caused pronounced mortality of T. urticae after 120 h of exposure (LC₅₀ = 465.5 mg L^-1), in a comparable or superior manner to an abamectin-based synthetic acaricide used as positive control (LC₅₀ = 1243.4 mg L^-1). Moreover, ESEAm exposure resulted in a significant decrease in the number of eggs laid by females and caused the most pronounced ovicidal action for T. urticae, with only 5% embryonic viability. However, ESEAm also showed high toxicity to the predatory mites tested, causing 100% mortality for both species after 120 h exposure, similar to abamectin. The interaction between these bioacaricides and biological control agents should be tested under field conditions to further assess the potential ecological selectivity of these derivatives.

Prevalence and determinants of sunbed use in thirty European countries: data from the Euromelanoma skin cancer prevention campaign

BACKGROUND

Although considered as a first-group carcinogen, indoor tanning is a common practice in Europe. Euromelanoma is a pan-European skin cancer prevention campaign.

OBJECTIVES

To compare several European countries in terms of the prevalence and determinants of sunbed use.

METHODS

Participants in the Euromelanoma campaigns filled in questionnaires containing demographics and risk factors, including type/duration of sunbed use. Multivariate analyses adjusted for age, gender, education, skin type and year of survey were employed to assess factors independently associated with sunbed use in each country.

RESULTS

In total, 227 888 individuals (67.4% females, median age 44, 63.4% highly educated, 71.9% skin types III-VI) from 30 countries participated. Overall, the prevalence of sunbed ever use was 10.6% (≤19-year-olds: 5.9%; 20 to 35-year-olds: 17.0%; >35-year-olds: 8.3%). Females displayed a higher prevalence than males in all countries. Balkan countries displayed the highest female/male ratios (≥4). Sunbed use was significantly more prevalent among skin type III-VI (14/30 countries) and highly educated participants (11/30 countries). Significant correlations were found between sunbed use prevalence and countries' latitude (P < 0.001) and sunshine (P = 0.002); Italy and Spain represented exceptions towards excessive exposure. Very different prevalence rates were found for Spain (19.3%) and Portugal (2.0%). Scandinavian countries ranked highest in sunbed use among ≤19-year-olds, Baltic countries among 20 to 35-year-olds.

CONCLUSIONS

Sunbed use prevalence was higher in northern, sun-deprived countries, with the exception of Italy and Spain. The main determinants of sunbed use were age (young adults) and gender (females), whereas education and skin type had a less relevant effect. Geographic particularities were found in four regions: Iberian (prevalence ten times higher in Spain than Portugal), Balkan (prevalence disproportionately higher among women), Baltic (highest prevalence among young adults) and Scandinavian (highest prevalence among adolescents). These data have public health relevance for future interventions aimed at reducing sunbed use in Europe.

Association of sunbed use with skin cancer risk factors in Europe: an investigation within the Euromelanoma skin cancer prevention campaign

INTRODUCTION

Sunbed use has been significantly associated with increased risk of melanoma and non-melanoma skin cancer (NMSC), but its relationship with melanoma's risk factors such as high nevus count, atypical nevi and lentigines is poorly studied. Euromelanoma is a skin cancer prevention campaign conducted all over Europe. It offers a once-a-year screening during which participants' data, including sunbed use and phenotype, are collected via questionnaires.

OBJECTIVES

To investigate the association of sunbed use with nevus count, atypical nevi, lentigines and suspicion of skin cancer.

METHODS

To ensure reliability of the data, we defined inclusion and exclusion criteria for countries' eligibility for the risk analysis. Multivariate logistic regression models (including age, gender, education, skin type, family history of melanoma, personal history of skin cancer, any sun exposure and any sunscreen use) were used to calculate summary odds ratios (SORs) of each clinical endpoint for ever sunbed use.

RESULTS

Overall, 227 888 individuals from 30 countries completed the Euromelanoma questionnaire. After the data quality check, 16 countries were eligible for the multivariate analysis, for a total of 145 980 participants (64.8% females; median age 43 years; 62.3% highly educated; 28.5% skin type I-II; 11.0% ever sunbed use). Ever sunbed use was independently associated with nevus count >50 [SOR = 1.05 (1.01-1.10)], atypical nevi [SOR = 1.04 (1.00-1.09)], lentigines [SOR = 1.16 (1.04-1.29)] and suspicion of melanoma [SOR = 1.13 (1.00-1.27)]. Conversely, no significant association was found between ever sunbed use and suspicion of NMSC [SOR = 1.00 (0.91-1.10)].

CONCLUSIONS

Indoor tanning is significantly associated with well-recognized risk factors for melanoma (including high nevus count, presence of atypical nevi and lentigines) as well as suspicion of melanoma within the Euromelanoma screenees. In order to reduce the prevalence of melanoma risk factors, avoidance/discontinuation of sunbed use should always be encouraged, especially but not exclusively for individuals with high-risk phenotypes.

Skin cancer healthcare impact: A nation-wide assessment of an administrative database

BACKGROUND

Skin cancer is an important health concern, with an increasing incidence worldwide.

OBJECTIVE

To assess the clinical and economic burden of melanoma (MM) and non-melanoma skin cancer (NMSC) at public hospitals in mainland Portugal.

METHODS

We used an administrative database containing a registration of all hospitalizations and ambulatory episodes occurred in Portuguese public hospitals between 2011 and 2015. We assessed all episodes with associated diagnoses of MM or NMSC regarding neoplasm location, metastases occurrence, length of stay, in-hospital mortality and hospital costs.

RESULTS

We assessed 15,913 MM and 72,602 NMSC episodes. 14.3% of MM episodes presented with metastases, compared to 1.9% of NMSC episodes. Patients' median age was lower for MM (66 years) than NMSC (76 years). The trunk was the most common location for MM (32.5%), followed by the lower limbs (26.5%). NMSC presented with higher length of stay than MM (median 5 versus 4 days; p < 0.001), but with lower in-hospital mortality (7.3% versus 11.9%; p < 0.001). MM episodes had higher average hospital costs than NMSC episodes (1197.7 versus 1113.5 €; p < 0.001). Overall, NMSC episodes amounted a total of 80.8 million € in hospital costs versus 19.1 million € for MM episodes.

CONCLUSION

Skin neoplasms have substantial impact on healthcare services. NMSC is an important contributor to this burden. NMSC underreporting should be tackled and it should not be downplayed in skin cancer preventative strategies.

"Retronychia--clinical and pathophysiological aspects"

Retronychia represents proximal ingrowth of the nail that occurs when the nail embeds backwards into the proximal nail fold. It is suspected when there is a persistent paronychia, particularly in the setting of trauma. Important clinical criteria for diagnosis are inflammation of the proximal nail fold, granulation tissue emerging from under the nail fold, thickening of the proximal portion of the nail plate and interruption of nail growth. The condition is rarely diagnosed and often misinterpreted, and is therefore unnecessarily treated with systemic antibiotics and antifungals. Avulsion of the nail confirms the diagnosis and it is the curative treatment. Conservative treatment with an adhesive technique is a valid option in early cases. We report 20 cases of retronychia diagnosed in our department between 2010 and 2013.

Development of disseminated superficial porokeratosis in a patient with complicated acute pancreatitis

Porokeratosis is a group of hereditary or acquired diseases with abnormal epidermal keratinization. A 71-year-old man was admitted to the Surgery Department after an attack of acute pancreatitis complicated with pancreatic necrosis, which required surgical resection. Three weeks after the admission, the patient was observed by our Dermatology department with sudden onset of a generalized eruption of asymptomatic flat papules with a hyperkeratotic rim, sparing the face, palms, soles, and mucous membranes. A skin biopsy was performed at the border of a leg lesion, which disclosed the presence of cornoid lamella, confirming the clinical diagnosis of disseminated superficial porokeratosis (DSP). The skin eruption spontaneously subsided about one month after pancreatic resection. The late onset of DSP in our patient may represent a type of immunosuppression-induced porokeratosis. Possibly, the pathologic clone of keratinocytes for porokeratosis was present, but remained latent until there was a decrease in the immunological status. It is possible that this relative and transient state of immunosuppression was the result of the concurrent necrotizing pancreatitis. This case represents an unusually good outcome of DSP. To the authors best knowledge, this is the first case of DSP related to severe acute pancreatitis.

Rowell syndrome - case report and review of the literature

Rowell syndrome is a rare distinctive entity first described in 1963 by Rowell and coworkers. It consists in erythema multiforme-like lesions associated with lupus erythematosus. Zeitouni et al. recently redefined the major and minor diagnostic criteria. Major criteria are lupus erythematosus, erythema multiforme-like lesions and speckled pattern of antinuclear antibody. Minor criteria are chilblains, positive anti-La (SS-B) or anti-Ro (SS-A) antibody and reactive rheumatoid factor. We report a case of a 63-year-old woman, with no previous history of lupus erythematosus, who developed erythema multiforme-like lesions and laboratory findings consistent with Rowell syndrome.

Delta-aminolevulinate dehydrase (ALAD) polymorphism in mixed Brazilians from the State of Bahia

Electrophoretic polymorphism of delta-aminolevulinate dehydrase (ALAD) was studied on 519 individuals from Bahia, Brazil. Subjective assessment of Black ancestries carried out in a five point visual scale (White, Light Mulatto, Medium Mulatto, Dark Mulatto and Black) allowed to show that the ALAD*2 allele frequency decreases from 8% in Whites to 0% in Blacks. These findings agree with previous reports of ALAD in Africans, American Indians and Spanish. The powerful peculiarity of the ALAD system in assessing racial admixture is stressed.