Thermal Imaging of Root Caries In Vivo

Improved methods are needed to assess the structure and activity of lesions on root surfaces in order to improve clinical decision making. Conventional visual and tactile methods for assessing lesion activity are not reliable, and the clinician is often unable to evaluate if the lesion is progressing or has remineralized. An important marker of an arrested lesion is a highly mineralized surface zone that forms when mineral is deposited in the outer layer of the lesion. In vitro studies have shown that a mineralized surface zone influences the kinetics of water evaporation and the surface temperature while drying. Temperature changes can be monitored by measuring the thermal emission with thermal imaging. Studies have also shown that the depth and severity of demineralization and the thickness of the highly mineralized transparent surface zone on arrested lesions can be measured nondestructively with optical coherence tomography (OCT). Thermal imaging at 8-µm to 13-µm wavelengths was completed on 30 test subjects with a suspected active root caries lesion by monitoring thermal emission from the tooth surfaces during 30 s of air drying. Lesions were also evaluated using cross-polarization OCT (CP-OCT) during lesion dehydration to identify transparent surface zones indicative of arrested lesions and determine if shrinkage occurred during drying. The overall thermal emission recorded during drying was significantly different (P < 0.001) when comparing sound tooth surfaces, lesion areas identified as arrested, and lesion areas identified as active, demonstrating that thermal imaging is a promising approach for the clinical assessment of lesion activity on root surfaces. Ten of the lesions in this study had distinct areas with transparent surface zones that were visible in CP-OCT images. Shrinkage was detected with CP-OCT during drying for 12 lesions. This study confirms that these novel approaches for assessing lesion activity on root surfaces can be implemented in vivo.

Schmerzhafte artifizielle Ekchymosen an Hals und Gesicht

Es wird über den Fall einer 13-jährigen Patientin mit neu aufgetretenen, auf Druck schmerzhaften Hautveränderungen beidseits am Hals und im Gesicht berichtet. Auf Nachfrage traten die Effloreszenzen episodisch im Rahmen von Stresssituationen auf. Im Verlauf kam es zu einer Spontanheilung mit Narbenbildung und mehreren Rezidiven. Nach erfolgter Probebiopsie wurde ein Gardner-Diamond-Syndrom ausgeschlossen und der Verdacht auf selbstinduzierte Hautläsionen geäußert.

Evaluation of digital staining for ex vivo confocal laser scanning microscopy

BACKGROUND

Ex vivo confocal laser scanning microscopy (CLSM) is a novel diagnostic tool for the fast examination of native tissue. However, CLSM produces black/white/green images, depending on the refraction indices of the tissue structures, complemented by nuclear fluorescence staining, which the vast majority of Mohs surgeons and dermatopathologists are not trained to interpret. Digital staining is applicable to ex vivo CLSM investigations to simulate the images of conventional slides stained with haematoxylin and eosin (H&E).

OBJECTIVES

The aim of our study was to evaluate in detail the appearance of human skin structures using digitally stained ex vivo CLSM images and compare the results to that of conventional H&E slides of the same specimen.

METHODS

After providing informed consent, 26 patients donated their Burow's triangles (healthy skin) that resulted from plastic reconstruction after the R0 excision of skin tumours. After being investigated by ex vivo CLSM, including automated digital staining (VivaScope 2500M-4G, MAVIG GmbH), the specimens were fixed in formalin, embedded in paraffin and stained with H&E.

RESULTS

Almost all skin structures in the digitally stained ex vivo CLSM images morphologically resembled the structures in the histopathological images acquired from H&E slides. Due to the high refraction index of melanin, the hair shafts appeared bright pink, and the melanocytes and melanophages were poorly imaged, resulting in a strong pink appearance that vastly differed from the appearance of conventional H&E-stained histopathology.

CONCLUSIONS

Digital staining of ex vivo CLSM images is an easy and highly useful tool to facilitate the interpretation of black-field images generated by confocal laser scanning microscopy for dermatopathologists and Mohs surgeons who are familiar with H&E staining. Unlike the pigmented structures, the cutaneous and subcutaneous structures had excellent visualization with only minimal differences from their appearance on H&E slides.

Depression, anxiety and quality of life in subjects with atopic eczema in a population-based cross-sectional study in Germany

BACKGROUND

Atopic eczema (AE) may be associated with several mental health problems. In Germany, existing data from selected patient cohorts may lead to misestimation of the problem.

OBJECTIVES

We aimed to cross-sectionally determine associations of AE with depression, anxiety, quality of life (QoL) and social interactions in subjects from the population-based LIFE-Adult-Study.

METHODS

Subjects underwent standardized interviews (medical history) and answered standardized questionnaires [Centre of Epidemiologic studies-Depression scale (CES-D), Generalized Anxiety Disorder (GAD-7), Lubben Social Network Scale (LSNS), Short Form Health Survey (SF-8)]. We compared data from subjects with AE with those from subjects with selected other chronic/disabling diseases (cardiovascular, diabetes, cancer) and adjusted for selected sociodemographic parameters. Multivariate binary logistic regression was used for categorical variables, linear regression for continuous variables.

RESULTS

Out of 9104 adults included (57% female, median age 54 years), 372 (4.1%) had a history of AE. Compared with controls, subjects with AE showed higher scores for depressive symptoms (9.3% vs. 6.3%; P < 0.001) and anxiety (8.4% vs. 5.6%, P < 0.001). Odds ratio (OR) was 1.5 [CI 1.0; 2.3] (P = 0.031) for depression, which was comparable to OR in patients with a history of cancer (OR 1.6 [1-2.3], P = 0.001. OR for anxiety in AE was 1.5 [1.0; 2.2], P < 0.049, which was slightly higher than in diabetes mellitus (OR 1.2) and stroke (OR 1.4). Other than in diabetes and/or stroke, we did not find a significant association between AE and social isolation. QoL scores were lower in AE than in controls (mean 46.9 vs. 48.0, P < 0.001 for physical and 50.6 vs. 52.5, P < 0.001 for mental components).

CONCLUSIONS

Subjects with AE showed higher values for depression and anxiety as well as lower QoL scores compared to controls. With regard to depression, odds in AE and cancer were hardly different. Medical care of AE patients should therefore include mental health evaluation and treatment if indicated.

[Multiple well demarcated skin erosions and ulcers following exanthematous drug eruption after sultamicillin therapy]

This article presents the case of a patient with newly developed skin erosions and ulcerations following an exanthematous drug eruption due to sultamicillin therapy. The skin lesions were treated topically with clobetasol and prednicarbate and orally with methylprednisolone. A skin smear revealed massive growth of Escherichia coli bacteria. Blood cultures were negative. The cause for developing ecthyma gangrenosum in our patient were iatrogenic immunosuppression and transient bacteremia.

[Tinea barbae profunda due to Trichophyton mentagrophytes : Case report and review]

Tinea barbae is a rare dermatomycocis, by definition follicular bound in the beard area of adult men. Manifestation usually starts with erythema accompanied by desquamation. Deeper distribution along terminal hairs leads to folliculitis with formation of pustules and nodes as well as abscesses; fixed adherent yellowish crusts may appear. Frequently there is locoregional swelling of the lymph nodes and occasionally a deterioration of general condition with (sub)febrile temperatures. Often this leads to the initial suspected diagnosis of a bacterial folliculitis barbae or impetigo contagiosa. Tinea barbae is mostly induced by species of the genus Trichophyton (T.). The pathogens are diverse and are mostly zoophilic, sometimes anthropophilic and rarely geophilic dermatophytes. With the help of a specific anamnesis and diagnostic procedure, including mycological examinations, histology and molecular detection of dermatophytes via polymerase chain reaction (PCR), tinea barbae-in our patient induced by T. mentagrophytes-can be rapidly diagnosed. Early initiation and adequate treatment duration lead to restitutio ad integrum.

Protocol for the Definition of a Multi-Spectral Sensor for Specific Foliar Disease Detection: Case of "Flavescence Dorée"

Flavescence Dorée (FD) is a contagious and incurable grapevine disease that can be perceived on leaves. In order to contain its spread, the regulations obligate winegrowers to control each plant and to remove the suspected ones. Nevertheless, this monitoring is performed during the harvest and mobilizes many people during a strategic period for viticulture. To solve this problem, we aim to develop a Multi-Spectral (MS) imaging device ensuring an automated grapevine disease detection solution. If embedded on a UAV, the tool can provide disease outbreaks locations in a geographical information system allowing localized and direct treatment of infected vines. The high-resolution MS camera aims to allow the identification of potential FD occurrence, but the procedure can, more generally, be used to detect any type of foliar diseases on any type of vegetation.Our work consists on defining the spectral bands of the multispectral camera, responsible for identifying the desired symptoms of the disease. In fact, the FD diseased samples were selected after establishing a Polymerase Chain Reaction (PCR) confirmation test and then a feature selection technique was applied to identify the best subset of wavelengths capable of detecting FD samples. An example of a preliminary version of the MS sensor was also presented along with the geometric and radiometric required corrections. An image analysis based on texture and neural networks was also detailed for an enhanced disease classification.

[Smooth muscle hamartoma in volar skin]

We report the case of a 12-year-old girl with a smooth muscle hamartoma of the right index finger. Smooth muscle hamartoma (SMH) is a congenital, relatively common disorder typically with predominance of autochthonal arrector pili muscles. An SMH can also rarely originate from smooth muscles of vessels in palmoplantar skin with the absence of pilosebaceous units. Because of overlapping histological features, the possibility of Becker's nevus being identical or associated with SMH has often been suspected by some authors.

BASALIT trial: double-blind placebo-controlled allergen immunotherapy with rBet v 1-FV in birch-related soya allergy

BACKGROUND

Conflicting results exist on the effect of allergen immunotherapy (AIT) on pollen-related food allergy. We aimed to investigate the efficacy of one-year AIT with the folding variant (FV) of recombinant (r) Bet v 1 on birch-related soya allergy.

METHODS

Of 138 subjects with Bet v 1 sensitization, 82 were positive at double-blind placebo-controlled food challenge (DBPCFC) with soya. A total of 56 of 82 were randomized in the ratio of 2:1 (active: placebo). Per-protocol population (PPP) had received ≥150 μg of allergen or placebo preparation.

OUTCOME MEASURES

lowest observed adverse effect levels (LOAEL), postinterventional occurrence of objective signs (objS) at any dose level, sIgE/IgG4 against Bet v 1 and Gly m 4. Between-group changes were investigated (ancova, Mann-Whitney U-test, Fisher exact test).

RESULTS

Baseline characteristics including LOAELs were comparable in both groups with objS and subjS occurring in 82% and 95% of active (n = 38) vs 78% and 83% of placebo group (n = 18). After AIT, objS occurred in 24% and 47%, respectively. LOAEL group differences showed a beneficial tendency (P = 0.081) for LOAELobjective in PPP (30 active, 15 placebo). sIgG4 raised only in active group (Bet v 1: P = 0.054, Gly m 4: P = 0.037), and no relevant changes occurred for sIgE. Only 56% of the intended sample size was recruited.

CONCLUSION

For the first time, we present data on the effect of rBet v 1-FV on birch-related soya allergy. rBet v 1-FV AIT induced significant immunogenic effects. Clinical assessment showed a tendency in favour of the active group but did not reach statistical significance.

Standardization of double blind placebo controlled food challenge with soy within a multicentre trial

Background

Multicentre trials investigating food allergies by double blind placebo controlled food challenges (DBPCFC) need standardized procedures, challenge meals and evaluation criteria. We aimed at developing a standardized approach for identifying patients with birch related soy allergy by means of DBPCFC to soy, including determination of threshold levels, in a multicentre setting.

Methods

Microbiologically stable soy challenge meals were composed of protein isolate with consistent Gly m 4 levels. Patients sensitized to main birch allergen Bet v 1 and concomitant sensitization to its soy homologue Gly m 4 underwent DBPCFC. Outcome was defined according to presence and/or absence of ten objective signs and intensity of eight subjective symptoms as measured by visual analogue scale (VAS).

Results

138 adult subjects (63.8% female, mean age 38 years) underwent DBPCFC. Challenge meals and defined evaluation criteria showed good applicability in all centres involved. 45.7% presented with objective signs and 65.2% with subjective symptoms at soy challenge. Placebo challenge meals elicited non-cardiovascular objective signs in 11.6%. In 82 (59.4%) subjects DBPCFC was judged as positive. 70.7% of DPBCFC+ showed objective signs and 85.4% subjective symptoms at soy challenge. Subjective symptoms to soy challenge meal in DBPCFC+ subjects started at significantly lower dose levels than objective signs (p < 0.001). Median cumulative eliciting doses for first objective signs in DBPCFC+ subjects were 4.7 g [0.7–24.7] and 0.7 g [0.2–4.7] total soy protein for first subjective symptoms (p = 0.01).

Conclusions

We present the hitherto largest group of adults with Bet v 1 and Gly m 4 sensitization being investigated by DBPCFC. In this type of food allergy evaluation of DBPCFC outcome should not only include monitoring of objective signs but also scoring of subjective symptoms. Our data may contribute to standardize DBPCFC in pollen-related food allergy in multicentre settings.

Trial registration

EudraCT: 2009-011737-27.

Connective tissue response to fractionated thermo-ablative Erbium: YAG skin laser treatment

Indications for and prevalence of laser therapies with a fractionated laser beam have risen significantly. However, as of yet, little is known about the underlying molecular changes, especially with respect to dermal extracellular-matrix remodelling, wound healing and inflammation. This study aimed at the investigation of the connective tissue response of sun-damaged skin following fractionated laser treatment. Seven patients received a laser therapy on the lateral side of the neck of wrinkles grade III-IV (Glogau scale) using a fractionated thermo-ablative erbium yttrium aluminium garnet (Er:YAG) laser (2940 nm, BURANE XL; Quantel Derma, Erlangen, Germany). Skin biopsies were taken at baseline from untreated skin, 1 and 6 weeks after laser intervention to investigate hyaluronan (HA), collagen-I (Coll-I) and collagen-III (Coll-III) remodelling as well as alteration of matrix metalloproteinase 1 expression (MMP-1). To address this issue, HA synthesizing (HA synthetases, HAS) and degrading (hyaluronidases, HYAL) enzymes were measured at mRNA-level using a real-time PCR. Furthermore, immunohistochemical staining for HA was performed by using the HA binding protein (HAbP) and for Coll-I, Coll-III and MMP-1 by using monoclonal antibodies. The degree of inflammation was correlated descriptively. Our findings were that at the two examined read out points, HAS and HYAL showed a slight response alluding to HA synthesis under minimal signs of inflammatory reaction. Concordantly, although to a varying degree, an increase in the HA content of the skin after laser treatment could be detected by immunhistochemistry. During remodelling, Coll-I, Coll-III and MMP-1 showed a cyclic course with a peak after 1 week. Conclusively, our results indicate a light alteration of the HA metabolism towards synthesis and a transient collagen neogenesis caused by a single fractionated thermo-ablative laser skin intervention. Clinical improvement might be attributed to synergistic effects between collagen neogenesis and the water binding capacities of HA and its influence on skin contraction and remodelling.

Modulation contrast optimization for wavelength conversion of a 20 Gbit/s data signal in hybrid InP/SOI photonic crystal nanocavity

Photonic crystal cavity-based switching is studied both theoretically and experimentally in order to identify the best configuration to maximize "wavelength conversion" efficiency. In particular, it is shown that an enhanced contrast can be reached when the probe is blueshifted with respect to the resonance. The use of an InP/SOI hybrid photonic crystal nanocavity is reported for the first time for all-optical error-free "wavelength conversion" at 20  Gbit/s with a nonreturn to zero on-off keying signal.

New rhinophyma severity index and mid-term results following shave excision of rhinophyma

BACKGROUND

Rhinophyma is a progressive nasal deformity resulting from hyperplasia of the sebaceous glands and connective tissue, with a negative effect on quality of life. Partial-thickness shave excision has been used for the treatment of rhinophyma, but the mid- and long-term efficacy of the treatment is unknown.

OBJECTIVES

We analysed the clinical outcomes of shave excision in patients with rhinophyma in our centre between 2005 and 2009.

METHODS

The entire nose was shaved using a scalpel while under tumescent anaesthesia. The clinical assessment was scored using a novel Rhinophyma Severity Index.

RESULTS

Thirty-three patients with rhinophyma and shave excision were recruited for the study. A mid-term follow-up examination was possible in 23/33 (69.7%) patients. After a mean follow-up of 37.4 ± 13.2 months, 21 (91.3%) patients showed an improved Rhinophyma Severity Index (3.3 ± 1.1 to 1.7 ± 0.9, p < 0.0001). All patients reported a high level of satisfaction after surgery (excellent or good result). Eleven (47.8%) patients developed rhinophyma recurrence.

CONCLUSION

Shave excision under tumescent anaesthesia is an effective treatment for rhinophyma. The treatment is associated with high patient satisfaction and minimal side effects. A possible recurrence of rhinophyma must be addressed, however, while obtaining informed consent.

Inhibition of endotoxin-induced perinatal asthma protection by pollutants in an experimental mouse model

BACKGROUND

One of the most promising strategies to face the increasing asthma prevalence and to prevent disease development might be an early contact with microbial compounds. However, little is known about an interaction between an early-life contact to microbial compounds leading to asthma protection in the offspring and a co-exposure to allergy-promoting pollutants.

METHODS

Pregnant BALB/c mice were repeatedly exposed to aerosolized endotoxin (lipopolysaccharide, LPS). The offspring was further exposed to aerosolized LPS before allergen sensitization with ovalbumin (OVA). Some of the mice were co-exposed to mycotoxins or diesel exhaust particles (DEP) during pregnancy. The 6-week-old offspring was immunized with OVA and analyzed in a murine asthma model.

RESULTS

While the offspring of naïve mothers developed an asthma-like phenotype, the offspring of mice perinatally exposed to LPS was significantly protected. Co-exposure of mice to mycotoxins or DEP during pregnancy inhibited the LPS-induced protection leading to the development of eosinophilic airway inflammation, airway hyperactivity, and increased antigen-specific IgE levels in the offspring. Furthermore, the asthma-preventive effect of perinatal LPS exposure was IFN-gamma dependent. Additionally, the IFN-gamma promoter of CD4+ T cells in the LPS-exposed offspring revealed a significant protection against loss of histone 4 acetylation, which was abolished after prenatal co-exposure to pollutants. Prenatal treatment of mice with the antioxidant N-acetylcysteine reversed the pollutant-induced increased asthma risk in the offspring.

CONCLUSION

Our results show that exposure to pollutants during pregnancy may cause the development of allergic asthma in the offspring by inhibiting the endotoxin-induced perinatal asthma protection.

Sex steroid hormones are not altered in great saphenous veins after varicose vein treatment in male patients

OBJECTIVE

The objective of this study was to assess differences in blood samples (sex steroid hormone levels and blood counts) before and after surgical treatment of incompetent great saphenous veins (GSV) in males.

METHODS

Antecubital vein and GSV blood samples were taken from 11 men with varicose veins and GSV reflux before and after treatment. Six patients were treated with high ligation, stripping and phlebectomy. Five patients were treated with endoluminal radiofrequency ablation and phlebectomy. After a four-year follow-up period (FU) cubital vein and GSV blood samples were taken again.

RESULTS

In men with varicose veins, significantly higher (P < 0.05) serum testosterone (median 25.18 nmol/L, range 8.82-225.1) and oestradiol (median 179 pmol/L, range 79-941) levels were found in the saphenous vein samples before and after the FU (testosterone 18.8 nmol/L, range 7.96-83.1, oestradiol 171 pmol/L range 125-304) compared with the cubital vein samples before therapy (testosterone 15.72 nmol/L, range 8.36-23.29; oestradiol 84 pmol/L, range 41-147) and after the FU (testosterone 14.5 nmol/L, range 6.10-22.2, oestradiol 117 pmol/L, range 95-165). After the FU, one patient demonstrated recurrent varicose veins with groin neovascularization. Another presented with axial reflux of the anterior accessory saphenous vein. Further differences in blood counts and serum androstenedione levels between the upper and lower extremities were not detected.

CONCLUSION

The differences between testosterone and oestradiol levels in the leg veins compared with the cubital veins persist after treating men with refluxing saphenous veins. These results suggest that local hormone regulation may be different between leg and arm veins in men with varicose veins.

Identification of new potential allergens from Nile perch (Lates niloticus) and cod (Gadus morhua)

BACKGROUND

Globalization of the food industry has led to widespread exposure to new nondomestic fish species; therefore, identification of potential allergens is necessary in order to diagnose allergic reactions.

OBJECTIVE

Contact with a patient who was allergic to Nile perch (Lates niloticus) prompted us to investigate the immunoglobulin (Ig) E-reactive proteins that could be allergens of this species.

METHODS

2D gel electrophoresis was used to separate the muscle proteins of L niloticus and Gadus morhua. Immunoblotting was performed with sera from 12 patients with a history of immediate-type allergic reaction to fish and from atopic and nonatopic controls. IgE-reactive proteins were detected and identified using mass spectrometry.

RESULTS

The index patient had low levels of IgE binding to parvalbumins. However, 8 putative allergens other than parvalbumin from L niloticus and 5 from G morhua were identified. Further investigation revealed cross-sensitivity to enolase 3 from L niloticus in 7 of the 12 fish-allergic individuals (58%), whereas 11 of the 12 patients (92%) were sensitized to enolase 3 from G morhua. However, atopic control patients were also sensitized to enolase 3 from L niloticus and G morhua.

CONCLUSION

Identification of species-specific allergens and individual sensitization could help us to improve avoidance strategies.

[Neurological deficits and ipsilateral skin lesions of the face]

A 68-year-old woman presented with unilateral herpetiform skin lesions of the face. She also showed reduced eye lid and mimic function as well as hearing loss. In addition grouped vesicles were seen in the outer ear canal. We diagnosed Ramsay Hunt syndrome and administered intravenous acyclovir, prednisolone and pentoxifylline. Within a few weeks, there was complete remission including the neurological symptoms.

Randomized, double-blind, placebo-controlled study of safety and efficacy of miltefosine in antihistamine-resistant chronic spontaneous urticaria

BACKGROUND

Chronic spontaneous urticaria (CSU), a mast cell-driven condition, is debilitating, common, and hard to treat. Miltefosine, a lipid raft modulator, can inhibit mast cell responses in vivo.

OBJECTIVE

To study the safety and efficacy of systemic miltefosine treatment in CSU patients resistant to standard-dosed antihistamines.

METHODS

In this investigator-initiated multicentre, randomized, double-blind, placebo-controlled study, CSU patients were treated for 4 weeks with daily doses of up to 150-mg miltefosine (n = 47) or placebo (n = 26). Disease activity was assessed using the urticaria activity score. Safety and tolerability of miltefosine were also assessed.

RESULTS

After 4 weeks of treatment, Urticaria Activity Score (UAS7) levels were substantially more reduced in miltefosine-treated patients (-6.3 vs. -3.5 in placebo-treated patients; P = 0.05). Also, the number of weals, but not the intensity of pruritus, was significantly reduced in miltefosine-treated patients vs. placebo-treated patients (P = 0.02). In general, adverse events were frequent in both groups (miltefosine: 88%, placebo: 65% of patients) but mostly mild to moderate in severity. We did not observe any serious adverse events.

CONCLUSIONS

The results of this study indicate that miltefosine is an effective and safe treatment option for CSU patients who do not respond to standard-dosed antihistamines.

Cord blood Tregs with stable FOXP3 expression are influenced by prenatal environment and associated with atopic dermatitis at the age of one year

BACKGROUND

Regulatory T cells (Tregs) with stable FOXP3 expression are characterized by a specific demethylated region in the FOXP3 gene (Treg-specific demethylated region, TSDR). The aim of this study was to analyse the influence of prenatal factors on cord blood Treg numbers, as detected by changes in the TSDR demethylation, and the subsequent risk for allergic diseases.

METHODS

Analyses were performed within the LINA study in blood samples from pregnant women (34th gestational week) and in cord blood (n = 346 mother-child pairs). Treg numbers were detected via DNA demethylation in the FOXP3 TSDR. At age 1, total and specific IgE was measured in children's blood. In addition, maternal cytokine production (Th1/Th2/Th17) was analysed. Exposure and disease outcomes were assessed by questionnaires.

RESULTS

Boys had lower Treg numbers compared with girls (P < 0.001). Parental atopy history, particularly maternal hay fever and paternal asthma were related to lower Treg numbers in cord blood (adj. MR = 0.81, 95% CI = 0.68-0.97; adj. MR = 0.60, 95% CI = 0.45-0.81). Maternal cytokines (IL-13, IL-17E and IFN-γ) and maternal smoking/exposure to tobacco smoke during pregnancy were also associated with decreased cord blood Treg numbers (adj. MR = 0.89, 95% CI = 0.97-1.00). Children with lower Treg numbers at birth had a higher risk to develop atopic dermatitis (adj. OR = 1.55, 95% CI = 1.00-2.41) and sensitization to food allergens (adj. OR = 1.55, 95% CI = 1.06-2.25) during the first year of life.

CONCLUSIONS

These results indicate that both genetic and environmental factors presumably influence the development of foetal Tregs. Low cord blood Treg numbers may predict early atopic dermatitis.

Comparison of gene repertoires and patterns of evolutionary rates in eight aphid species that differ by reproductive mode

In theory, the loss of sexual reproduction is expected to result in the accumulation of deleterious mutations. In aphids, two main types of life cycle, cyclic and obligate parthenogenesis, represent respectively “sexual” and “asexual” reproductive modes. We used the complete pea aphid genome and previously published expressed sequence tags (ESTs) from two other aphid species. In addition, we obtained 100,000 new ESTs from five more species. The final set comprised four sexual and four asexual aphid species and served to test the influence of the reproductive mode on the evolutionary rates of genes. We reconstructed coding sequences from ESTs and annotated these genes, discovering a novel peptide gene family that appears to be among the most highly expressed transcripts from several aphid species. From 203 genes found to be 1:1 orthologs among the eight species considered, we established a species tree that partly conflicted with taxonomy (for Myzus ascalonicus). We then used this topology to evaluate the dynamics of evolutionary rates and mutation accumulation in the four sexual and four asexual taxa. No significant increase of the nonsynonymous to synonymous ratio or of nonsynonymous mutation numbers was found in any of the four branches for asexual taxa. We however found a significant increase of the synonymous rate in the branch leading to the asexual species Rhopalosiphum maidis, which could be due to a change in the mutation rate or to an increased number of generations implied by its change of life cycle.

The A2iA Intercheque System: Courtesy Amount and Legal Amount Recognition for French Checks

We developed a check reading system, termed INTERCHEQUE, which recognizes both the legal (LAR) and the courtesy amount (CAR) on bank checks. The version presented here is designed for the recognition of French, omni-bank, omni-scriptor, handwritten bank checks, and meets industrial requirements, such as high processing speed, robustness, and extremely low error rates.

We give an overview of our recognition system and discuss some of the pattern recognition techniques used. We also describe an installation which processes of the order of 70,000 checks per day. Results on a data base of about 170,000 checks show a recognition rate of about 75% for an error rate of the order of 1/10,000 checks.

[Dermal necrosis as cutaneous manifestation of heparin-induced thrombocytopenia II?]

Most of the rare cases of skin necrosis following heparin injections are associated with the immunologically mediated form of heparin-induced thrombocytopenia II (HIT II). We present a 62-year- old woman who developed a necrotic abdominal lesion seven days after starting daily subcutaneous injections of the low molecular heparin enoxaparin. We detected circulating antibodies against the platelet factor 4-complex but no concomitant thrombocytopenia. An isolated, antibody-mediated thrombosis of dermal vessels is the likely underlying cause of the skin necrosis in HIT II.

Surgical excision of basal cell carcinoma with complete margin control: outcome at 5-year follow-up

BACKGROUND

The incidence of skin cancer and especially basal cell carcinoma (BCC) has increased in the last few decades. The gold standard of care is usually a surgical excision, but it also has the risk of local recurrence depending on tumor characteristics.

OBJECTIVES

We analyzed the 5-year cure rates after surgical excision of BCC with complete margin control using paraffin-embedded sections.

METHODS

A retrospective analysis of 671 patients (45.3% male, 54.7% female) with 777 primary and 85 with recurrent BCC were collected during 2001-2003. All patients underwent surgery with complete margin control using paraffin-embedded sections. When the histological examination revealed a positive margin, another surgical step was performed in the area of residual tumor.

RESULTS

Five-year follow-up examinations were possible in 630/862 (73.1%) of patients with BCC. In the group with primary BCC (n = 562), 3 tumor recurrences (0.5%) were identified; in the group with recurrent BCC (n = 68), 2 tumor recurrences (2.9%) were seen, resulting in an overall 5-year recurrence rate of 0.8% for all patients with BCC. The mean tumor recurrence time after surgery was 36.6 months.

CONCLUSION

Local complete tumor resection confirmed by complete margin control using paraffin-embedded sections can achieve excellent cure rates for both primary and recurrent BCC.

No clinical benefit of preoperative fluorescence diagnosis of basal cell carcinoma localized in the H-zone of the face

BACKGROUND

Basal cell carcinoma (BCC) is the most common malignant skin carcinoma. Fluorescence diagnosis (FD) has been suggested as a promising method for noninvasive detection of subclinical tumour cell dissemination in BCC.

OBJECTIVES

In this prospective study, we evaluated the clinical performance of a preoperative definition of the lateral borders of BCC by FD in comparison with its definition by purely clinical diagnosis (CD). The fluorescence intensity on the skin was recorded using a digital light-emitting diode-based fluorescence imaging system.

METHODS

Twenty-six patients with BCC (22 with nodular subtype) of the H-zone were included. The tumour area was determined 3 h after application of methyl aminolaevulinate by inspection and photographic documentation (CD) and FD. Subsequently, BCCs were excised according to the complete area defined by CD and FD with a security margin of 3 mm; surgical specimens were sectioned horizontally and subjected to meticulous histological mapping. The tumour areas as determined by FD, CD and histology were superimposed to map the entire lateral tumour margin.

RESULTS

The tumour area could be visualized by FD in 24 of 26 patients. The mean tumour area as determined by FD was significantly smaller than the tumour area as determined by CD [80 mm(2) , 95% confidence interval (CI) 50-110 mm(2) vs. 101 mm(2) , 95% CI 76-125 mm(2) ; P < 0·012]. The superimposition of FD and histology showed in 10 of 26 patients a complete detection of the tumour margin by FD; thus sensitivity of FD was calculated as 38·5%. In only three of 26 patients FD revealed a tumour extent greater than determined by CD. Specificity of FD was calculated as 88·4%.

CONCLUSIONS

On aggregate, this study suggests that preoperative FD of nodular BCC localized in the H-zone offers no additional benefit to define subclinical tumour infiltration compared with CD alone.

[Desmoplastic fibroma on arm of 22-year-old woman]

Desmoplastic fibroblastoma ("collagenous fibroma") is a rare benign, slowly progressive fibrous soft tissue tumor that ranges 1-20 cm in size. The tumor occurs in all ages, predominantly in the upper part of the body. Children are rarely affected. The tumor often infiltrates the subcutis; less often it invades the fascia and skeletal muscle or causes bone erosions. Histologically, the tumor is composed of spindle-shaped cells embedded in a densely collagenous stroma, sometimes forming a pseudo-capsule. Magnetic resonance imaging and computed tomography as well as ultrasonography are used to define the extensions of the tumor. Because it is clinically extremely difficult to determine if soft tissue tumors are benign or malignant, all should be excised with a margin of safety and examined histologically. We report a 22-year old woman with desmoplastic fibroblastoma located on the upper arm. Clinical and histopathological findings and treatment options are discussed.

Reduced maternal regulatory T cell numbers and increased T helper type 2 cytokine production are associated with elevated levels of immunoglobulin E in cord blood

BACKGROUND

There is evidence that the basis of an atopic-skewed immune response is acquired early in life, perhaps at the fetal stage. Thus, we hypothesized that the development of the fetal immune system might be influenced by maternal regulatory T cells (Treg) and maternal T cell cytokine production during pregnancy. The aim of the present study was to assess the influence of maternal Treg and cytokine production during pregnancy on Treg and atopy at birth.

METHODS

Within the mother-child study LINA (Lifestyle and Environmental factors and their Influence on Newborns Allergy risk), we determined the frequency and function of Treg and the total IgE concentration in pregnant women in the 34th week of gestation and in corresponding cord bloods at birth (n=24). Furthermore, we assessed how maternal mitogen-induced T-helper type 1/T-helper type 2 and inflammatory cytokines influence the level of cord blood Treg and IgE.

RESULTS

Frequencies of CD4(+)CD25(high) T cells were higher (P=0.001), whereas percentages of FOXP3+ T cells were lower (P<0.001) in cord blood cells compared with maternal blood. Reduced maternal CD4(+)CD25(high) Treg frequencies correlated with increased total IgE concentrations at the 34th week of gestation (r=-0.32, P=0.028) and with increased IgE concentrations in cord blood (r=-0.50, P<0.001). Elevated maternal mitogen-induced Th2 cytokine production was related to increased total IgE levels in the serum of corresponding cord bloods (IL-4, r=0.53; IL-5, r=0.43; IL-13, r=0.52).

CONCLUSIONS

Because cord blood IgE has been shown to be predictive for allergic diseases in early childhood, our results indicate that reduced maternal Treg numbers and increased Th2 cytokine production during pregnancy might influence the allergy risk of the child.

[Linear ulcers with central keratinous plug]

Reactive perforating dermatosis (RPD) is a primary perforating dermatosis. Histologically, it presents with transepidermal discharge of basophile material and vertical arrangement of collagen fibers. RPD is treated using external keratolytic agents, topical and systemic glucocorticosteroids, retinoids and antihistamines. Good results have also been reported using photo(chemo)therapy. In the case study presented here, the patient responded very well to treatment with allopurinol.