Real-Time Precision Needle Tracking for Gynecological Interstitial Brachytherapy: A Phantom Feasibility Study

PURPOSE/OBJECTIVE(S)

To determine if an advanced needle navigation and real-time precision tracking system developed for prostate biopsies can be used for the purpose of real-time guidance of interstitial needles in modern image-guided gynecologic brachytherapy.

MATERIALS/METHODS

An agarose gel pelvic phantom was previously designed using 3D Slicer and Autodesk Fusion360 to model an average uterus from a 50-patient dataset, a vaginal canal from KleenSpec (TM, Welch Allyn) speculum dimensions, and a rectum to accommodate a BK 8848 endocavity biplane ultrasound [US] probe. After manufacturing the phantom with a 7.2cm x 3.7cm x 4.4cm (LxWxH) uterus and an attached 2.7cm x 1.4cmx 1.7cm (LxWxH) focal HR-CTV target, the model was imaged using MRI. The uterus and HR-CTV were contoured on MRI to aid in registration with US and provide a target for needle placement. The tracking system with endorectal probe was then used to image the phantom. Ultrasound images from a 180-degree sweep were acquired and a 3D Ultrasound-based volume was generated. Using the commercially available system, the MRI was imported and an MRI-Ultrasound fusion performed based on the uterus contours and then refined using contour-based deformable registration. Three desired locations for needle placement were defined to test the ability of the system to guide needles at these locations: one in the most lateral aspect of the HRCTV, one at the HRCTV-uterus interface, and one inside the uterus. The needle tracking sleeve that was indexed to the probe was used in conjunction with the software interface to guide the 17-gauge titanium needle placement in real time. The distance between actual needle and the intended needle location was measured for each successful needle placement. When possible, needles were removed and reinserted at the same desired location to test the reproducibility of insertion under US guidance.

RESULTS

Two of the three intended needles were successfully placed using real-time US guidance. The most lateral needle in the HRCTV was not inserted due to limitations of the phantom design, specifically inaccessibility to the agarose phantom through the phantom wall supports. The inserted needles were visible and tracked to the desired location within 0.6 mm (needle located at HRCTV-uterus interface), and 2.2 mm (needles inserted centrally in the uterus). For the target within the uterus, needles were reinserted at the same target of interest with a ∆ 0.15mm in greatest range between attempts.

CONCLUSION

We have demonstrated a proof of concept in which existing technology for prostate biopsies can be utilized for the application of interstitial gynecologic brachytherapy with a high degree of fidelity. Ongoing modifications to our validation phantom and the tracking system are needed to allow for variations in uterine anatomy, more rigorous evaluation of reproducibility, and multi-catheter placement.

Melatonin and the Human Hair Follicle

BACKGROUND

Melatonin, a pleiotropic hormone, affects the physiological processes including that of the hair follicle. We seek to identify the scientific evidence to support the potential benefits of melatonin in human hair growth.

OBJECTIVE

To summarize the evidence on the association between melatonin and hair health, denoted by hair growth.

METHODS

A literature review using 3 databases (PubMed, Google Scholar, and Cochrane) identified studies investigating the relationship between melatonin and hair loss (2022). The following search terms were used: (hair OR hair loss OR alopecia OR hair growth OR effluvium OR scalp) and (melatonin). Two independent reviewers screened studies for inclusion criteria, and data collection included demographics, melatonin intervention, study type, and effects on hair.

RESULTS

A total of 11 human studies were identified with evidence of melatonin use in subjects with diagnosed alopecia (2,267 patients; 1,140M). Eight of the studies reviewed observed positive outcomes after topical melatonin use in subjects with androgenetic alopecia (AGA). Most studies report improved scalp hair growth (n=8), density (n=4), and hair shaft thickness (n=2) among melatonin users compared with controls. Effective topical melatonin dosage appears to be 0.0033% or 0.1% solution applied once-daily for 90 to 180 days vs 1.5 mg twice-daily oral melatonin supplementation for 180 days.

CONCLUSION

There is evidence to support melatonin use to facilitate scalp hair growth, particularly in men with AGA. Further studies should include more patients and investigate the mechanism of action. J Drugs Dermatol. 2023;22(3): doi:10.36849/JDD.6921.

Inflammatory Vulvar Dermatoses (Part I)

Vulvar disease is common, and urologists are often the first providers to see patients with a vulvar skin condition. Primary vulvar dermatoses can be localized to the anogenital area or a manifestation of more diffuse cutaneous disease. Additionally, secondary dermatoses can develop from exogenous agents and inflammatory vaginitis. Vulvar conditions are challenging to diagnose due to location and different types of skin and mucosal epithelium involved. Herein, we provide an overview of noninfectious inflammatory vulvar dermatoses (part I) and benign and malignant vulvar neoplasms (part II), grouped by morphologic findings. We include diagnostic evaluation, workup, and management of these conditions.

Vulvar Neoplasms (Part II)

Vulvar disease is common, and urologists are often the first providers to see patients with a vulvar skin condition. Primary vulvar dermatoses can be localized to the anogenital area or a manifestation of more diffuse cutaneous disease. Additionally, secondary dermatoses can develop from exogenous agents and inflammatory vaginitis. Vulvar conditions are challenging to diagnose due to location and different types of skin and mucosal epithelium involved. Herein, we provide an overview of non-infectious inflammatory vulvar dermatoses (Part I) and benign and malignant vulvar neoplasms (Part II), grouped by morphologic findings. We include diagnostic evaluation, workup, and management of these conditions.

A clinician's guide to cutaneous T-cell lymphoma presenting as recalcitrant eczematous dermatitis in adults

Cutaneous T-cell lymphoma (CTCL) encompasses a group of low-grade, non-Hodgkin lymphoma, including mycosis fungoides and Sézary syndrome. Diagnosis of CTCL can be challenging given the prolonged, gradual onset and shared characteristics with many benign inflammatory skin diseases. In this case series, we describe four unique cases of patients with chronic, recalcitrant eczematous dermatitis who presented for a patch-test consultation and were ultimately diagnosed with CTCL. In particular, we highlight clinical pearls to aid in distinguishing CTCL from inflammatory dermatoses and describe the diagnostic strategy to help dermatologists arrive at the diagnosis of CTCL at earlier stages of the disease.

Idiopathic pure sudomotor failure: A review and two cases

Idiopathic pure sudomotor failure (IPSF) is a rare disease characterized by acquired impairment in total body sweating despite exposure to heat or exercise. Its etiology is unknown but thought to involve defective cholinergic receptors on eccrine sweat glands. This article reviews the epidemiology, pathophysiology, presentation, and management of IPSF. Additionally, we report two cases of IPSF treated with multimodal therapy, including stacked antihistamine regimens and omalizumab, resulting in symptom improvement. This is the first report of treatment of IPSF with omalizumab, although its benefit is uncertain and requires further study.

Catamenial Hyperpigmentation: A Review

BACKGROUND: Changes in skin pigmentation patterns related to the fluctuation of estrogen receptors and progesterone receptors during menstruation, also known as catamenial hyperpigmentation, have been reported in several studies. OBJECTIVE: We sought to summarize the literature on catamenial skin hyperpigmentation and menses-induced exacerbations of skin pigmentation disorders. METHODS: We searched PubMed/MEDLINE and the Cochrane Skin database with the search terms menses and pigment, estrogen and pigment, progesterone and pigment, and hyperpigmentation and menses, then assessed the relevant literature on skin diseases related to nonpathological menstruation. RESULTS: The most commonly reported primary catamenial hyperpigmentation disorders are postinflammatory hyperpigmentation (PIH) after laser therapy and ultraviolet sensitivity (UV). The most reported chronic skin pigmentation exacerbated by menses is melasma. The literature detailing catamenial hyperpigmentation is limited to cross-sectional studies, experimental studies, surveys, review articles, case reports, and small trials, leading to a lower level of evidence. CONCLUSION: Our review of the literature revealed that the most common catamenial hyperpigmentation is melasma. We also found a reported higher risk of PIH after laser therapies and UV sensitivity. Estrogen and progesterone are two of the major factors responsible for catamenial hyperpigmentation of the skin. Generally, the changes happen in the luteal phase of the menstrual cycle when the serum levels of sex hormones are at their peak. Although the exact balance of influence is controversial, most recent studies indicate that estrogen has a more prominent role than progesterone in inducing hyperpigmentation.

Clinical recognition and management of alopecia in women of color,

Certain types of alopecia, such as traction alopecia, discoid lupus erythematosus, and central centrifugal cicatricial alopecia, occur more commonly in African-American individuals than in those of other ethnicities. Both intrinsic hair qualities and hair care practices play a role. Lower baseline tensile strength, hair density, and growth rates, as well as the use of high-tension hairstyles and chemical relaxers may contribute to alopecia in this group. Alopecia can also occur as a result of discoid lupus erythematosus, which involves chronic lymphocytic infiltration and eventual scarring of the hair follicle. Lichen planopilaris is a less common cause of scarring alopecia that can appear clinically similar to other forms of cicatricial alopecia. Lastly, although not classically associated with hair loss, recent evidence indicates that seborrheic dermatitis may play a role in shedding and alopecia. Recognizing and differentiating these alopecic subtypes clinically and histopathologically is important for prompt diagnosis and treatment. This article is based on a chapter in Ethnic Skin and Hair, and intended as a supplemental article to “Current and Emerging Treatment Strategies for Hair Loss in Women of Color.”

Investigating the role of allergic contact dermatitis in residual ocular surface disease on dupilumab (ROSDD),

Background

The mechanisms underlying eye-related complications with dupilumab are poorly understood.

Objective

This study aimed to determine the incidence and characteristics of ocular complications with dupilumab and the prevalence of comorbid allergic contact dermatitis in the same subpopulation.

Methods

This is a retrospective chart review of 48 patients with atopic dermatitis who received dupilumab. For patients with eye involvement at first follow-up, we discuss the presence of eyelid dermatitis, blepharitis, or conjunctivitis and analyze available patch test findings in patients with ocular complications while treated with dupilumab.

Results

A total of 14 patients (29.2%) showed eye involvement while on dupilumab, all of whom experienced eye involvement prior to dupilumab. The results of the patch test were most commonly positive for emulsifier/surfactants (42.5%) and fragrances (30.4%). Nine patients experienced improvement with allergen avoidance subsequent to patch testing, and four of nine patients’ conditions cleared almost entirely. This is a non-randomized study in a small cohort of patients. Only 18 patients had their disease confirmed by an ophthalmologist.

Conclusion

All patients with eye involvement while on dupilumab had a history of eye involvement prior to dupilumab, suggest that dupilumab may encourage rather than cause ocular surface inflammation. Significant improvement after patch testing in nearly half of patients suggests that allergic contact dermatitis contributes to some cases of dupilumab-associated eye complications.

Work-life balance among female dermatologists

Background

Female dermatologists often face the challenges of balancing a rewarding medical career with duties of home life and childrearing. Excessive responsibility at home or work can introduce barriers to balance and prove detrimental to the health and wellness of the physician.

Objective

We aim to perform a needs assessment through a series of survey questions with regard to home and work responsibilities and impacts on mental health.

Methods

Survey participants were selected from the Women's Dermatologic Society through an e-mail invitation with a link to an anonymous survey tool and a paper questionnaire at the Women's Dermatologic Society Forum in February 2019 in Dallas, Texas. The survey included 20 questions with regard to household responsibilities, child care, clinical responsibilities, specialty education, and impacts on personal time, sleep, and overall sense of well-being. There were a total of 127 respondents.

Results

Eighty-five percent of physicians in our cohort are currently married. A large percent of respondents utilized hired household help in the form of nannies to perform chores. Spousal contribution was emphasized in this cohort and often highlighted as an important factor in maintaining home life duties.

Conclusion

The professional women in our cohort may be balancing work and life at the expense of personal physical and mental health with little time to exercise and fewer hours of sleep per night.

Treatment of moist desquamation for patients undergoing radiotherapy

Moist desquamation occurs in approximately 36% of patients who receive radiation therapy and is associated with severe opioid-resistant pain and discomfort. Moist desquamation is typically at its worst within 1 to 3 weeks after treatment conclusion and resolves over a period of 6 weeks. Herein, we present a therapeutic pearl for the treatment of moist desquamation based on methods from the burn literature, with the goal of helping patients who undergo radiation therapy for breast cancer and other indications.

Advances in solid alanine radiolysis understanding

To better understand the composite character of irradiated alanine ESR spectra, a comparative study of few simple amino acids is performed in order to identify the different radio-induced radicals and their proportions. A dedicated spin-trapping method coupled with High Performance Liquid Chromatography (HPLC) is developed and carried out on irradiated alanine, glycine and valine; labeled or not. This study leads us to obtain different isolated trapped radical spectra where hyperfine coupling constants could be evaluated. For alanine, only two species are identified with relative proportions around 97 and 3% in contradiction with recent published articles. The main species has a particularity on its hyperfine coupling constants when labeled carbons are used. Very high hyperfine coupling constants are observed with the carboxylic acid function carbon for the three studied amino acid.

EPR study of gamma induced radicals in amino acid powders

To better understand the composite character of amino acids EPR spectra, the radiolysis and reactions which occurred after irradiation of amino acids, a comparative EPR study of a few simple amino acids has been made in order to identify qualitatively and quantitatively the different radiation-induced radicals in amino acid powders. A spin-trapping methodology has been developed and carried out on irradiated glycine, alanine and valine.

Spectroscopic study of bituminous oxidative stress

Bitumen, as each organic substance, is a product which alters over time. Indeed, roads deteriorate under the effect of several phenomena. A number of studies have been undertaken to increase the quality of road's coating, mostly by adding polymer to bitumen. This work was based on the study, by electron paramagnetic resonance (EPR), FTIR and Synchronous UV fluorescence, of different base and modified bitumens after different treatments used to simulate the ageing (gamma irradiation, thermal treatment). Our purpose was to compare and correlate the results obtained by different techniques to improve the knowledge of bitumen's reactivity and evolution submitted to ageing phenomena.

Electron paramagnetic resonance of radicals induced in drugs and excipients by radiation or mechanical treatments

Radiation as well as mechanical treatments induced in drugs and excipients radicals, which can be studied by electron paramagnetic resonance. A special attention is pointed about the use of electron paramagnetic resonance (EPR) to bring the proof whether or not a drug has been irradiated or not. We also discuss of other methods (thermoluminescence (TL), gas phase chromatography (GPC)) which can be used to bring the same proof in case of irradiated drugs, excipients and cosmetic products.

Photodegradation of cassava and corn starches

The baking expansion properties of sour cassava starch (Polvilho azedo) are attributable to photochemical starch degradation induced by heterolactic fermentation after sun-drying. This study investigated the effects of UV irradiation on the different structural levels of cassava starch as compared to those of corn starch and dextrins. Photosensitive compounds excited at 360 and 290 nm in cassava starch were photodegraded when starch was exposed to sunlight or 360 nm irradiation. UV irradiation depolymerized cassava and corn starches, inducing modifications due, at least in part, to a mechanism involving free radicals. Lactic acid was also photodegraded. Photodegradation induced by UV absorption could have been due to fluorescent chromophores found in starches and nonfluorescent chromophores present in glucosidic units.

Detection of irradiated spices by different physical techniques

We used thermoluminescence, electron spin resonance, and viscosimetric measurements to establish whether or not a spice had been irradiated. Thermoluminescence, using the 1788 EN official protocol with an alternative method for the extraction of mineral impurities, led to proof of irradiation or proof of no treatment. Electron spin resonance led to different spectrum shapes depending on the chemical composition of the spices; ESR could only be used as proof of irradiation up to several weeks after irradiation, and only for some spices. Viscosimetric measurements carried out on spice suspensions led to a presumption of treatment (or of no treatment) and possibly to proof of irradiation.Key words: irradiation, thermoluminescence, electron spin resonance, viscosimetry, spice.

Detection of irradiated spices by different physical techniques

We used thermoluminescence, electron spin resonance, and viscosimetric measurements to establish whether or not a spice had been irradiated. Thermoluminescence, using the 1788 EN official protocol with an alternative method for the extraction of mineral impurities, led to proof of irradiation or proof of no treatment. Electron spin resonance led to different spectrum shapes depending on the chemical composition of the spices; ESR could only be used as proof of irradiation up to several weeks after irradiation, and only for some spices. Viscosimetric measurements carried out on spice suspensions led to a presumption of treatment (or of no treatment) and possibly to proof of irradiation.

Identification of irradiation treatment of aromatic herbs, spices and fruits by electron paramagnetic resonance and thermoluminescence

Electron paramagnetic resonance and thermoluminescence signals induced by gamma irradiation in some herbs, spices and fruits were systematically studied in order to detect the treatment. Using European protocols the validity and effectiveness of these two techniques are compared in regard to time of storage after irradiation.

A point about electron paramagnetic resonance detection of irradiated foodstuffs

This paper makes a point about the identification of irradiated foodstuffs by means of electron paramagnetic resonance (EPR) or electron spin resonance (ESR). EPR is the most accurate method for such routine applications since radicals are stabilised for a long time in all (or part of) foods that are in solid and dry states; consequently, EPR can be applied to meat and fish bones, fruit and relative products (from vegetal origin). More details are given for mollusc shells, such as oysters and mussels.