Improvement of psoriasis during glucagon-like peptide-1 analogue therapy in type 2 diabetes is associated with decreasing dermal γδ T-cell number: a prospective case-series study

BACKGROUND

A few case reports suggest that incretin-based therapies could improve psoriasis in patients with type 2 diabetes, the mechanism(s) of which remain unclear.

OBJECTIVES

To determine the effects after 16-20 weeks of treatment with a glucagon-like peptide (GLP)-1 analogue on clinical severity and histopathological aspects of psoriasis in patients with type 2 diabetes, and to examine the presence of γδ T cells and the expression of interleukin (IL)-17 in psoriasis before and after treatment.

METHODS

Seven patients with type 2 diabetes and psoriasis were followed. Psoriasis Area and Severity Index (PASI) was measured at baseline (T0) and after 7 ± 1 (T1) and 18 ± 2 (T2) weeks' treatment with exenatide/liraglutide. The histopathological pattern of psoriasis, and flow cytometry and immunological data (γδ T-cell percentage and IL-17 expression) were obtained from psoriatic and control sites.

RESULTS

The mean PASI decreased from 12·0 ± 5·9 to 9·2 ± 6·4 (P = 0·04). Histological analysis showed a reduction in epidermal thickness after treatment. The dermal γδ T-cell percentage was higher in psoriatic lesions than in control specimens (P = 0·03), as was IL-17 expression (P = 0·018). A reduction of γδ T cells from 6·7 ± 4·5% to 2·7 ± 3·8% (P = 0·05) was demonstrated in the six patients with improved/unchanged PASI. A correlation between PASI and γδ T-cell percentage evolution during therapy (T2-T0) was noted (r = 0·894, P = 0·007). IL-17 was reduced in the four patients with the highest PASI reductions.

CONCLUSIONS

The administration of a GLP-1 analogue improved clinical psoriasis severity in patients with type 2 diabetes. This favourable outcome was associated with a decrease of dermal γδ T-cell number and IL-17 expression. Further studies are needed to establish long-term efficacy in (diabetic) patients with psoriasis.

Nonlinear optical properties of proteins measured by hyper-rayleigh scattering in solution

Hyper-Rayleigh scattering has been used to determine the nonlinear optical properties of a chromophore-containing protein in solution. Because the technique of hyper-Rayleigh scattering allows the measurement of hyperpolarizabilities in an isotropic solution without the application of an electric field, this method is ideally suited for the study of proteins that carry a net charge. The observed orientational correlation between the nonlinear optical chromophores in incompletely solubilized protein molecules suggests that guidelines from protein structures can be used for the engineering of supramolecular structures with high optical nonlinearity.

Patients' experience of pain and discomfort during instrumentation in the diagnosis and non-surgical treatment of periodontitis

BACKGROUND

The present multicenter study aimed to survey the patients' experiences in relation to the diagnosis and non-surgical treatment of periodontitis according to current treatment routine.

METHODS

Patients (N = 268) treated for plaque-related periodontitis were enrolled in two groups: group 1 received primary probing of pocket depths (PD 1) and/or primary scaling and root planing (SRP 1); group 2 consisted of patients who were scheduled in the different centers for recall PD/scaling/subgingival instrumentation. Data collection included a full periodontal status, anesthesia employed, procedure time, and patient self-completed questionnaires to assess their previous and current experience of pain and discomfort during anesthesia and periodontal treatment.

RESULTS

Ninety percent of the patients received infiltration anesthesia during primary SRP, compared to only 2% during recall scaling/instrumentation and none during PD. Many patients (40% in SRP group 1 and 52% in the recall scaling/instrumentation group) were most bothered by the scaling procedure, while others (35% in the primary SRP patients) by the anesthetic injection. Painful experiences during previous primary PD and present SRP were highly correlated (r = 0.6).

CONCLUSIONS

From these results, it is evident that subgingival instrumentation causes pain and discomfort, an aspect that should be considered in periodontal therapy. Unfortunately, the use of local infiltration anesthesia to reduce pain is in itself a cause of discomfort. Attractive alternatives for anesthetic applications are much needed.

Patient evaluation of a novel non-injectable anesthetic gel: a multicenter crossover study comparing the gel to infiltration anesthesia during scaling and root planing

BACKGROUND

Periodontal scaling procedures commonly require some kind of anesthesia. From the patient's perspective, the choice of anesthetic method is a trade-off between the degree of anesthesia and accepting the side effects. The present study evaluates the preferences for a novel non-injection anesthetic product (a gel, containing lidocaine 25 mg/g plus prilocaine 25 mg/g and thermosetting agents) versus injection anesthesia (lidocaine 2% adrenaline) in conjunction with scaling and/or root planing (SRP).

METHODS

In a multicenter, crossover, randomized, open study patients were asked, after they had experienced both products, if they preferred anesthetic gel or injection anesthesia. In addition, the adequacy of anesthesia and occurrence of post-procedure problems were assessed. The patients were also asked about their willingness to return if they were offered anesthetic gel at their next visit and their maximum willingness to pay (WTP) for this option.

RESULTS

One-hundred seventy (170) patients at eight centers in Belgium were included in the study. There were 157 per protocol (PP) patients. A vast majority of the PP patients (70%) preferred the anesthetic gel to injection anesthesia (22%). The most common reason was less post-procedure numbness. Eighty percent (80%) of the patients expressed satisfactory anesthesia with the gel and 96% with injection anesthesia (P <0.001). Post-procedure problems were significantly less with the gel than with injection (P <0.001): numbness 15% versus 66%, unpleasant sensations such as soreness and pain 44% versus 63%, and problems connected with daily activities 19% versus 69%. The majority of patients (60%) who preferred gel were also willing to pay for it. A conservative estimate of the median WTP was $10.00. Furthermore, anesthetic gel would make almost every second patient (45%) more or much more willing to return for the next treatment.

CONCLUSIONS

The data suggest that a somewhat less profound anesthesia with gel is clearly preferred by the patients because of the low incidence of post-procedure problems as compared to conventional injection anesthesia. The median WTP is likely in excess of the acquisition cost of the product, which indicates a favorable cost-benefit ratio for the individual patient.

Incidence of atrial fibrillation early after cardiac surgery: can choice of the anesthetic regimen influence the incidence?

Occurrence of atrial fibrillation is a common complication after coronary surgery. This study aimed to identify the perioperative factors that are associated with its occurrence with specific attention to the possible influence of the choice of the anesthetic regimen after elective coronary surgery. A retrospective chart analysis was performed in 460 patients who underwent elective coronary artery surgery with cardiopulmonary bypass using the standard institutional anesthetic, surgical and postoperative protocols. The only difference in management was the choice of the primary anesthetic regimen. 110 patients had a total intravenous anesthesia with propofol, 90 patients had a total intravenous anesthesia with midazolam, 150 patients were anesthetized with sevoflurane and 110 patients with desflurane. The primary outcome variable was the incidence of atrial fibrillation within the first 24 postoperative hours. Atrial fibrillation occurred in 64 of the 460 patients included (13.9%). Multiple logistic regression analysis identified increased age (> 70 years), EuroSCORE > 4, prolonged CPB time (> 100 min) and need for prolonged inotropic support (> 6 hours) as the significant independent risk factors for the occurrence of postoperative atrial fibrillation. The incidence of postoperative atrial fibrillation differed among the different anesthetic groups with the lowest incidence in the sevoflurane group (propofol: 17/110; midazolam: 15/90; sevoflurane: 9/150; desflurane: 23/110) (p = 0.004). This finding should be further confirmed in a prospective sufficiently powered multicenter study.

Photorefractive polymers sensitized by two-photon absorption

We demonstrate the recording of holograms and their nondestructive readout in a photorefractive polymer, using two-photon absorption. Sensitivity is provided by the excitation of the electroactive chromophore with femtosecond pulses, followed by charge injection into the photoconducting poly(N -vinylcarbazole) matrix. The holograms can be fully erased with a pulsed laser source but are insensitive to cw laser beams with the same wavelength. Studies of the field and intensity dependence of the diffraction efficiency indicate that the holograms are formed through the photorefractive effect.

Tracking novelty filter at 780 nm based on a photorefractive polymer in a two-beam coupling geometry

We have constructed an all-optical tracking novelty filter based on the dynamic holographic properties of an efficient and fast infrared-sensitive photorefractive polymer. The photorefractive polymer was used in a two-beam coupling geometry. The polymer had a gain coefficient of 175 cm(-1) at a wavelength of 780 nm and an applied field of 72 V/microm. In contrast to what has been observed in photorefractive crystals, the gain coefficient and the filter contrast are largely independent of the writing beam's intensity ratio. We show images of a swinging pendulum observed through the novelty filter.

[Gender and cutaneous leishmaniasis in Colombia]

Leishmaniasis in Colombia has traditionally been seen as a health risk for adult males, as they become infected when they enter the vector's biotopes to tap natural resources. National health statistics seem to confirm this theory. However, during field studies, the Program for the Study and Control of Tropical Diseases (PECET) observed both equal proportions of men and women with active leishmaniasis and delayed hypersensitivity skin tests and equal proportions of males and females having had contact with the parasite from early childhood. Several factors that have not been analyzed in depth in Colombia thus far appear to distort the disease's epidemiological pattern in the country, and gender-linked differences in access to health care appear to exist. As a consequence, no relief is provided for this source of human suffering, and socioeconomic repercussions for households are significant. Preventive measures by the Colombian Ministry of Health (MOH) systematically underestimate the magnitude of intra- and peridomiciliary transmission, and female patients are excluded from active case detection. Further research should be devoted to this phenomenon. The MOH should be encouraged to improve leishmaniasis control programs, especially with regard to active case detection, training, and teaching, so that quicker diagnosis can be performed. Meanwhile, the MOH should retrain its health personnel.

Infrared photorefractive polymers and their applications for imaging

Photorefractive polymers with high diffraction efficiency in the visible and near-infrared regions of the electromagnetic spectrum have been developed. These polymers, which have a large dynamic range because of their high orientational birefringence, incorporate a dye designed to have a large dipole moment and a high linear polarizability anisotropy. Such polymers have enabled demonstrations of imaging through scattering media, using a holographic time-gating technique at a wavelength that is compatible with the transparency of biological tissues and with the emission of low-cost semiconductor laser diodes.

Control of a trackball by the chin for communication applications, with and without neck movements

The overall aim was to evaluate whether a trackball could be used for communication by people who cannot speak due to severe motor impairment. The precision of trackball control by isolated jaw movements or a combination of jaw and head movements was evaluated in 18 healthy physical-education students, free of overt symptoms of craniomandibular dysfunction. The participants were asked to operate a trackball using the chin to type a standard text of four short sentences. There were two experimental situations: nine participants performed the typewriting task with their heads fixed; the other nine performed this task with free head movements. Trackball operation moved to the cursor over an alphabetical keyboard displayed on a computer screen and character selection was made by depression of the left-hand click button using the chin. Participants were asked to perform the task as quickly and accurately as possible. Result showed that those with free head movement typed the test significantly faster than those restricted to using only their jaw muscles. The mean time per character selection was 2.4 s (SD 0.3) for the group with free head movement and 2.7 s (SD 0.3) for the group using only jaw muscles. Group scores were not significantly different with regard to accuracy. It is suggested that a chin-operated trackball could be used for communication applications both with and without neck movements.

Inefficacy of allopurinol as monotherapy for Colombian cutaneous leishmaniasis. A randomized, controlled trial

BACKGROUND

Hundreds of thousands of cases of cutaneous leishmaniasis occur each year worldwide. Available therapies are parenteral, moderately toxic, and costly.

OBJECTIVE

To determine the efficacy of and tolerance for oral allopurinol as monotherapy for cutaneous leishmaniasis.

DESIGN

Randomized, controlled trial.

SETTING

Outpatient clinics in 11 regions of Colombia in which cutaneous leishmaniasis is endemic.

PATIENTS

187 otherwise healthy adults with cutaneous leishmaniasis. Eighty-four percent of patients were infected with or were from regions with Leishmania panamensis; 16% were infected or were from regions with L. braziliensis.

INTERVENTION

Patients were randomly assigned to one of three treatment groups. The first group received allopurinol, three 100-mg tablets four times daily (20 mg/kg of body weight per day) for 28 days. The second group received three placebo tablets four times daily for 28 days. The third group received Glucantime, 20 mg of intramuscular antimony/kg per day for 20 days.

MEASUREMENT

Complete cure was defined as complete clinical reepithelialization of all lesions at 3 months and no relapse during 12 months of follow-up.

RESULTS

Of 182 patients whose data could be analyzed, 157 (86%) were evaluated. In the allopurinol group, 18 of 55 (33% [95% CI, 21% to 47%]) patients were cured; in the placebo group, 17 of 46 patients (37% [CI, 23% to 52%]) were cured (difference, 4% [CI, -14% to 22%]; P = 0.68); and in the Glucantime group, 52 of 56 patients (93% [CI, 83% to 98%]) were cured (P < 0.001 compared with the allopurinol and placebo groups combined). In most cases, therapy was considered to have failed because the lesion did not reepithelialize by 1.5 months after the end of therapy. Three cases of relapse (two in the allopurinol group and one in the placebo group) at the nasal mucosa (mucosal leishmaniasis) had occurred by the end of 12 months of follow-up.

CONCLUSIONS

Allopurinol monotherapy has no effect on Colombian cutaneous disease primarily caused by L. panamensis and therefore is unlikely to be effective against cutaneous leishmaniasis in other endemic regions.

[A simplified technique of skin transplantation (author's transl)]

A simplified technique of skin transplantation is proposed: local anaesthesia of donor site; use of a regular razor-blade for skin harvesting and use of donor site for preservation of residual skin grafts.