A clinicopathologic study of 92 cases of granulosa cell tumor of the ovary with special reference to the factors influencing prognosis

Ninety-two cases of granulosa cell tumor of the ovary have been studied. The clinical and pathologic data from this group were similar to that obtained in previous series. Because of the long natural history of many granulosa cell tumors, crude death rates over a relatively short period give little indication of the true malignant potential of these neoplasms and hence corrected survival rates were calculated; these show that, if no patient died from any other disease, approximately half of the women with this neoplasm would die, as a result of the tumor, within 20 years. Factors indicating a relatively poor survival rate were: age over 40 at the time of diagnosis, a presentation with abdominal symptoms, a palpable mass, a solid large tumor, bilateral tumors, extraovarian spread, and numerous mitotic figures in the tumor. It is suggested that all granulosa cell tumors should be considered as malignant and that the factors pointing to a poor prognosis are those indicating that a particular tumor has been diagnosed at a late stage in its natural history, either because it has been present for a long time or because it is highly malignant. There are no definite criteria for defining the prognosis in a case in which the tumor has been removed at any early stage in its natural life history.

Oculocutaneous manifestations in xeroderma pigmentosa

Xeroderma pigmentosum (XP) is a rare genetic disease characterised by defective DNA repair leading to clinical and cellular hypersensitivity to ultraviolet radiation. The oculocutaneous features of 10 patients with XP were studied retrospectively. General features included parental consanguinity (40%), familiarity (60%), onset of symptoms in first 2 years (50%), malignant skin neoplasms (60%), and carcinoma of the tongue (20%). Among the ocular features, 50% of patients presented with photophobia. Lid freckles or atrophic skin lesions were seen in all patients. Lower lid tumours were seen in 30%, chronic conjunctival congestion in 40%, corneal opacification in 40%, squamous cell carcinoma of limbus in 20%, bilateral pterygium in 40%, and visual impairment in 50%. The clinical features (ocular and cutaneous) of the cases are discussed.

Prevention of chemotherapy toxicity by agents that neutralize or degrade cell-free chromatin

Background

Toxicity associated with chemotherapy is a major therapeutic challenge and is caused by chemotherapy-induced DNA damage and inflammation. We have recently reported that cell-free chromatin (cfCh) fragments released from dying cells can readily enter into healthy cells of the body to integrate into their genomes and induce DNA double-strand breaks, apoptosis and inflammation in them. We hypothesized that much of the toxicity of chemotherapy might be due to release of large quantities of cfCh from dying cells that could trigger an exaggerated DNA damage, apoptotic and inflammatory response in healthy cells over and above that caused by the drugs themselves.

Methods

We tested this hypothesis by administering cfCh neutralizing/degrading agents namely, anti-histone antibody complexed nanoparticles, DNase I and a novel DNA degrading agent-Resveratrol-Cu concurrently with five different chemotherapeutic agents to examine if chemotherapy-induced toxicity could be minimized.

Results

We observed (i) significant reduction in chemotherapy-induced surge of cfCh in blood; (ii) significant reduction in chemotherapy-induced surge of inflammatory cytokines CRP, IL-6, IFNγ and TNFα in blood; (iii) abolition of chemotherapy-induced tissue DNA damage (γH2AX), apoptosis (active caspase-3) and inflammation (NFκB and IL-6) in multiple organs and peripheral blood mononuclear cells; (iv) prevention of prolonged neutropenia following a single injection of adriamycin and (v) significant reduction in death following a lethal dose of adriamycin.

Conclusion

Our results suggest that toxicity of chemotherapy is caused to a large extent by cfCh released from dying cells and can be prevented by concurrent treatment with cfCh neutralizing/degrading agents.

Bioremediation of heavy metals from wastewater: a current perspective on microalgae-based future

Heavy metals-containing drinking water and wastewater are posing a severe threat to the environment, and living beings on land, air and water. Different conventional, advanced nanomaterials-based and biological method has been employed for the treatment of heavy metals. Among the biological methods, microalgae are an important group of micro-organisms that have numerous environmental applications and can remediate heavy metals from wastewater. Also, it has numerous advantages over conventional remediation processes. Microalgae cells can uptake the heavy metal via different physiological and biological methods and are utilized as a nutrient source to regulate its metabolic process for the production of biomass. Furthermore, the enhancement in heavy metal removal efficiency can be improved using different strategies such as immobilization of algal cells, development of algal consortia and designing of microalgae-based nanocomposite materials. Also, it can significantly contribute towards environmental sustainability and future. Thus, the review provides a critical overview of heavy metals and their existence along with their negative effects on humans. This review provides insight on recent advanced nanomaterial approaches for the removal of heavy metals, overviews of microalgae-based heavy metal uptake mechanisms and their potential for the amputation of different heavy metals. Furthermore, the special focus is on recent strategies that enhance heavy metal removal efficiency and contribute towards sustainability for the development of a microalgae-based future.

Pitfalls and Limitations of Radionuclide Planar and Hybrid Bone Imaging

The radionuclide (99m)Tc-MDP bone scan is one of the most commonly performed nuclear medicine studies and helps in the diagnosis of different pathologies relating to the musculoskeletal system. With its increasing utility in clinical practice, it becomes more important to be aware of various limitations of this imaging modality to avoid false interpretation. It is necessary to be able to recognize various technical, radiopharmaceutical, and patient-related artifacts that can occur while carrying out a bone scan. Furthermore, several normal variations of tracer uptake may mimic pathology and should be interpreted cautiously. There is an important limitation of a bone scan in metastatic disease evaluation as the inherent mechanism of tracer uptake is not specific for tumor but primarily relies on an osteoblastic response. Thus, it is crucial to keep in mind uptake in benign lesions, which can resemble malignant pathologies. The utility of a planar bone scan in benign orthopedic diseases, especially at sites with complex anatomy, is limited owing to lack of precise anatomical information. SPECT/CT has been significantly helpful in these cases. With wider use of PET/CT and reintroduction of the (18)F-fluoride bone scan, increasing knowledge of potential pitfalls on an (18)F-fluoride bone scan and (18)F-FDG-PET/CT will help in improving the accuracy of clinical reports.

Congenital bilateral intermaxillary bony fusion

Congenital fusion of maxillary and mandibular alveolar margins is extremely rare. Bony fusion between the jaws is still more uncommon. Only eight patients with bony fusion have been described in the literature to date, of whom only three had bilateral bony fusion. We present here a patient with very extensive bilateral bony fusion of the jaws, who underwent surgery with excellent immediate postoperative results. Details of the surgical management of this rare and difficult problem in a neonate with poor general condition are described.

Vitiligo: repigmentation with dermabrasion and thin split-thickness skin graft

BACKGROUND

Vitiligo is a common benign condition of great concern. Though a large number of medical and surgical treatment methods are available, none of them is fully dependable in all the areas.

OBJECTIVE

Split-thickness skin grafting (STSG) has been used for the treatment of vitiligo for over three decades, but it did not gain popularity. This presentation evaluates the degree of repigmentation achieved with this technique, its complications, and drawbacks.

METHODS

A case series of 21 patients with 32 localized, stable, and refractory vitiligo patches treated institutionally by dermabrasion and thin STSG has been presented. The patients have been followed up for 1-6 years. Three patients lost to follow-up before 1 year have not been included.

RESULTS

The graft take was 100% in 27 patches and 90-95% in the remaining five. One hundred percent repigmentation was achieved in 22 patches and 90-95% in 10. Time taken for satisfactory color match was 4-9 months (average, 6.3 months). The complications encountered were all minor and did not affect the results.

CONCLUSION

This is a simple, outpatient procedure performed under local anesthesia resulting in an excellent color match on a long-term follow-up. This technique can be used over any part of the body, including the hair-bearing areas, without compromising the end results.

Tissue regeneration during tissue expansion and choosing an expander

This paper reviews the various aspects of tissue regeneration during the process of tissue expansion. “Creep” and mechanical and biological “stretch” are responsible for expansion. During expansion, the epidermis thickens, the dermis thins out, vascularity improves, significant angiogenesis occurs, hair telogen phase becomes shorter and the peripheral nerves, vessels and muscle fibres lengthen. Expansion is associated with molecular changes in the tissue. Almost all these biological changes are reversible after the removal of the expander.This study is also aimed at reviewing the difficulty in deciding the volume and dimension of the expander for a defect. Basic mathematical formulae and the computer programmes for calculating the dimension of tissue expanders, although available in the literature, are not popular. A user-friendly computer programme based on the easily available Microsoft Excel spread sheet has been introduced. When we feed the area of defect and base dimension of the donor area or tissue expander, this programme calculates the volume and height of the expander. The shape of the expander is decided clinically based on the availability of the donor area and the designing of the future tissue movement. Today, tissue expansion is better understood biologically and mechanically. Clinical judgement remains indispensable in choosing the size and shape of the tissue expander.

Primary reconstruction of major human bite wounds of the face

Primary reconstruction of 36 major human bite wounds of the face without clinical infection has been carried out successfully as late as the fourth day after the initial injury. Primary healing was achieved in all patients. The postoperative period was free from major infection in all patients except one, including the latecomers. Extensive bacteriologic studies reveal that the infection in human bite wounds occurs secondarily as invasion to devitalized tissue. We therefore consider that debridement of wound edges to eliminate the crushed devitalized tissue is the key to success.

Efficacy and Safety of Actinium-225 Prostate-Specific Membrane Antigen Radioligand Therapy in Metastatic Prostate Cancer: A Systematic Review and Metanalysis

BACKGROUND

Actinium-225 (Ac-225) labelled PSMA RLT has been tested recently in metastatic castration-resistant prostate cancer (mCRPC), with encouraging results. Ac-225, being an alpha emitter, is expected to have higher efficacy and fewer side effects compared to the beta-emitters such as Lutetium-177. We have performed a meta-analysis to assess the therapeutic responses, survival effects, and significant side effects of Ac-225 PSMA RLT in patients with mCRPC.

METHODOLOGY

Systematic literature search was carried out from five electronic databases PubMed/MEDLINE, SCOPUS, EMBASE, Web of Science, and Cochrane Library until March 2021. Eight studies were found to be eligible for this metanalysis.

RESULTS

Eight studies with 226 patients were analyzed in this metanalysis. 81% (95% CI 73-89) patients had a decline in PSA levels. 60% of the patients showed more than 50% PSA decline. Two studies assessed survival effects of radioligand naïve patients compared to patients who had received Lu-PSMA therapy previously and the pooled HR for radioligand naïve patients is 0.22. The most common toxicity reported was xerostomia in 167 patients out of 226 patients (73.9%, 95% CI 67.6-79.5%); however, most of them were confined to grade I and II levels. Other reported side effects include hematologic toxicity and nephrotoxicity.

CONCLUSION

Ac-PSMA RLT is a safe and potentially effective treatment option for patients with mCRPC.

The diagnostic thresholds for synovial fluid analysis in late periprosthetic infection of the hip depend on the duration of symptoms

Aims

We hypothesised that the synovial white blood cell (WBC) count in patients with a late periprosthetic joint infection (PJI) of the hip would depend on the duration of a patient’s symptoms, and that the optimal diagnostic threshold would also depend on this period of time.

Patients and Methods

The synovial WBC count and percentage of polymorphonuclear cells (%PMN), and the serum CRP and ESR levels obtained > six weeks after primary THA were compared between 50 infected and 88 non-infected THAs, and in patients with symptoms for more than or less than two weeks. Diagnostic thresholds for the synovial WBC count were calculated using area under the curve calculation.

Results

The synovial WBC count was significantly higher in patients with symptoms for ≤ two weeks compared with those with symptoms for > two weeks (p = 0.03). The optimal threshold for diagnosing PJI for the synovial WBC count was 5750 cells/µL (sensitivity 94; specificity 100; PPV 100%; NPV 89%; AUC 99%) and 1556 cells/µL (sensitivity 91; specificity 94; PPV 87% and NPV 97%; AUC 95%), respectively. The thresholds for the cut-offs based on duration of symptoms improved the diagnostic performance of this test.

Conclusion

This study shows that the diagnostic thresholds for synovial fluid analysis in late periprosthetic infection following THA may depend on duration of symptoms. Cite this article: Bone Joint J 2016;98-B:1355–9.

Flexible laryngeal mask airway for cleft palate surgery in children: a randomized clinical trial on efficacy and safety

OBJECTIVE

To evaluate the efficacy of a flexible laryngeal mask airway in children undergoing palatoplasty.

DESIGN

Prospective, randomized, single-center study.

SETTING

Jawaharlal Institute of Postgraduate Medical Education and Research.

PATIENTS

Sixty-six children (American Society of Anesthesiologists physical status 1 and 2) scheduled to undergo palatoplasty were assigned randomly to an endotracheal intubation group (RAE group, n = 33) and a flexible laryngeal mask airway group (FLMA group, n = 33).

MAIN OUTCOME MEASURES

Peak airway pressure, inspired and expired tidal volume, end-tidal carbon dioxide, lung compliance, and airway resistance were continuously measured after placement of the assigned airway. The percentage leak around the airway was quantified as the leak fraction. Parametric data between groups were analyzed using an unpaired Student's t test and within groups using a one-way analysis of variance. Nonparametric variables were analyzed using the Fisher exact test.

RESULTS

In two children, the flexible laryngeal mask airway was displaced from its original position; whereas, one endotrachial tube advanced endobronchially. The leak fraction was significantly higher in the RAE group when compared with that in FLMA group (13.34% +/- 13.74% versus 5.96% +/- 3.78%, p < .05) until the throat pack was applied. Peak airway pressure and resistance were significantly higher in the RAE group compared with the FLMA group at all time intervals, p < .05. During emergence, frequency of coughing, desaturation, and laryngospasm were increased in the RAE group.

CONCLUSION

A flexible laryngeal airway mask is suitable for maintaining the airway and helps in smooth emergence in children undergoing palatoplasty.

Incidence and Significance of Incidental Focal Thyroid Uptake on (18)F-FDG PET Study in a Large Patient Cohort: Retrospective Single-Centre Experience in the United Kingdom

OBJECTIVE

To assess the prevalence and pathological nature of incidental focal thyroid uptake on (18)F-FDG (2-[(18)F]-fluoro-2-deoxy-D-glucose) PET (positron emission tomography) and examine the role of the maximum standardised uptake value (SUVmax) to differentiate benign from malignant thyroid pathology.

MATERIAL AND METHODS

(18)F-FDG PET reports were retrospectively reviewed. Incidental focal tracer uptake in the thyroid was noted in 147 patients (0.5%). Patients with known primary thyroid malignancy were excluded. The final diagnosis was made following ultrasonography of the neck, fine-needle aspiration cytology (FNAC) or histopathology of the surgically resected specimen where surgery was indicated. A Mann-Whitney U test was used to compare the SUVmax of benign and malignant thyroid pathology. Receiver operating characteristic (ROC) analysis was performed to identify an SUVmax cutoff in differentiating benign from malignant pathology.

RESULTS

A final diagnosis was achieved in 47/147 (32%) of the patients. The diagnoses included benign lesions in 36 patients and malignancy in 9 patients. In 2 patients, FNAC demonstrated indeterminate follicular lesions; however, surgical excision was not performed. There was a highly significant difference in the mean SUVmax of malignant focal thyroid uptake (15.7 ± 5.9) compared to that of benign lesions (7.1 ± 6.8) with a p value of 0.000123. An SUVmax of 9.1 achieved a sensitivity of 81.6%, specificity of 100% and area under the curve of 0.915 in the ROC analysis differentiating benign from malignant disease.

CONCLUSION

The malignancy potential of incidental focal thyroid uptake remains high and warrants prompt and appropriate follow-up by the clinician. The SUVmax may aid in further characterisation of the lesion and its management.

Xeroderma pigmentosum: resurfacing versus dermabrasion

Three patients of Xeroderma Pigmentosum (XP) have been managed for recurrent tumours. Improvement in pigment pattern was observed at both the donor as well as the recipient sites. An attempt has been made to prevent further occurrence of tumours over the exposed parts of the body by resurfacing and also by dermabrasion. A comparative study of the two procedures is being carried out and the preliminary results are discussed. Deep dermabrasion appears to be preferable as a prophylactic procedure.

Comparison of Acute Followed by Maintenance ECT vs Clozapine on Psychopathology and Regional Cerebral Blood Flow in Treatment-Resistant Schizophrenia: A Randomized Controlled Trial

BACKGROUND AND HYPOTHESIS

In treatment-resistant schizophrenia (TRS), Clozapine is only approved treatment with undesirable side-effects, warranting better alternatives. Our hypothesis is acute followed by maintenance Electroconvulsive Therapy (M-ECT) will be comparable in efficacy and safety to Clozapine in TRS.

STUDY DESIGN

In this open-label trial, 60 TRS patients were randomized equally to M-ECT (following an acute-course) or Clozapine. Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Schizophrenia Scale (CGI-SCH), Montreal Cognitive Assessment (MoCA), and Global assessment of functioning (GAF) were measured and compared within and between the groups at baseline, 6 weeks, 12 weeks, and 24 weeks. SPECT-CT brain was done at baseline and 24 weeks to compare the changes in regional cerebral perfusion between the groups and correlate with the changes in the outcome-measures.

STUDY RESULTS

The PANSS-T scores changes from baseline over the observation-points were significant in both M-ECT and clozapine groups (P < .001), with comparatively better reduction with M-ECT (P < .001). Similar trends were observed in PANSS subscales, CGI-SCH and GAF in both groups, with significantly better improvement with M-ECT over the study-period. After 24 weeks, there was significantly better perfusion with M-ECT in bilateral prefrontal and temporal cortices (P < .05). With M-ECT, a positive correlation was found between changes in PANSS-P scores and left-lateral Temporal cortical perfusion (r = .465, P = .017).

CONCLUSIONS

Acute followed by M-ECT was more effective than clozapine over 6 months in reducing the positive and negative symptoms, general psychopathology, illness-severity, and improving the global functionality in TRS [clinicaltrials.gov: NCT03807882].

Osteopetrosis: radiological & radionuclide imaging

Osteopetrosis is a rare inherited bone disease where bones harden and become abnormally dense. While the diagnosis is clinical, it also greatly relies on appearance of the skeleton radiographically. X-ray, radionuclide bone scintigraphy and magnetic resonance imaging have been reported to identify characteristics of osteopetrosis. We present an interesting case of a 59-year-old man with a history of bilateral hip fractures. He underwent ^99mTc-methylene diphosphonate whole body scan supplemented with single-photon emission computed tomography/computed tomography of spine, which showed increased uptake in the humeri, tibiae and femora, which were in keeping with osteopetrosis.

The effect of insulin-like growth factor 1 on craniofacial bone healing

Human insulin-like growth factor 1, a known regulator of bone formation, was investigated for its possible effect on membranous bone formation in a rat model. Full-thickness bone defects (10 x 10 x 1 mm) were created in the rat calvarium, and insulin-like growth factor 1 was administered by an osmotic minipump directly into the defect enclosed by the periosteum and dura mater. The dose of insulin-like growth factor 1 was 100 micrograms every 2 weeks. The defects were studied radiographically, macroscopically, and microscopically at 3, 6, 9, and 12 weeks. The group treated with insulin-like growth factor 1 showed qualitative and quantitative differences when compared with the control group. The amount of new bone formation in the group treated with insulin-like growth factor 1 was significantly larger than that of the control group. In the insulin-like growth factor 1 group, the location of new bone formation occurred in the center and at the margin of the bone defect. In the control group, bone was formed only around the margin of the bone defect. This study suggests that insulin-like growth factor 1 improved membranous bone healing in vivo and that insulin-like growth factor 1 makes mesenchymal precursor cells of bone differentiate directly into bone-forming cells.

Vitiligo: surgical repigmentation of leukotrichia

BACKGROUND

Patients with vitiligo frequently have premature gray hair. Until recently the literature was silent about its management. While surgically treating vitiligo, we incidentally observed repigmentation of gray hair.

OBJECTIVE

Based on our observations we undertook this study to see the effect of surgical treatment of vitiligo on repigmentation of leukotrichia, as well as to evaluate the percentage of repigmentation, if any, in the different hair-bearing areas, and the time taken for it.

METHODS

A case series of eight patients with nine patches of localized, stable, and refractory vitiligo with leukotrichia of 3-12 years duration is presented. The patients were followed up for 2-6 years. One patient was lost from follow-up after 2 months. The vitiligo was treated by dermabrasion and thin split-thickness skin grafting under local anesthesia, as outpatients.

RESULTS

Repigmentation of the hair occurred in all the areas but it was seen earlier (3 months) and was more complete in the eyebrows (70-95%). In the scalp and the beard areas it started later (6-9 months) and was around 50-60% only. The degree of pigmentation increased until about 3 years after surgery. No complications in the form of graft loss or alopecia were observed.

CONCLUSIONS

Partial to near-total repigmentation of leukotrichia can be achieved surgically. Contrary to the present theory, we hypothesize that melanocytes also migrate from the repigmented epidermis to the hair follicle, resulting in repigmentation of the hair.

Clinical significance of patterns of incidental thyroid uptake at (18)F-FDG PET/CT

Incidental uptake of 2-[(18)F]-fluoro-2-deoxy-d-glucose ((18)F-FDG) in the thyroid gland is not uncommonly encountered in day-to-day practice of oncological (18)F-FDG positron-emission tomography/computed tomography (PET/CT). These are often felt to be "nuisance lesions" by referring clinicians and radiologists alike. However, recognition of the importance of different patterns of FDG uptake in the thyroid gland and knowledge of the possible underlying aetiologies are crucial in ensuring that patients are managed appropriately in the clinical context of their primary diagnosis, as the underlying pathological condition may be clinically important in a significant minority of such cases. This review describes the various patterns of (18)F-FDG uptake within the thyroid and discusses the clinical significance and possible impact on patient management. Incidental low-grade homogeneous diffuse increased thyroid (18)F-FDG uptake is usually seen in the patients with chronic thyroiditis, Grave's disease, and hypothyroidism. Thyroid function tests and antibody profiling are advised in these patients. Incidental focal (18)F-FDG thyroid uptake should raise the possibility of underlying malignancy. Ultrasound with or without fine-needle aspiration cytology is usually recommended for the evaluation of these lesions. Heterogeneous uptake with prominent focal uptake in the thyroid should be further evaluated to exclude malignancy.

Single photon emission computed tomography/computed tomography of the skull in malignant otitis externa

Malignant otitis externa is a severe, rare infective condition of the external auditory canal and skull base. The diagnosis is generally made from a range of clinical, laboratory, and imaging findings. Technetium 99m methylene diphosphonate bone scintigraphy is known to detect osteomyelitis earlier than computed tomography. The authors present a patient with bilateral malignant otitis externa where the extent of skull base involvement was determined on 3-phase bone scintigraphy with single photon emission computed tomography/computed tomography.

Firecracker injuries during Diwali festival: The epidemiology and impact of legislation in Delhi

SETTING AND DESIGN

A hospital-based retrospective study of firecracker-related injuries was carried out at a government sponsored hospital in Delhi.

MATERIALS AND METHODS

1373 patients attended the emergency burn care out-patients clinic during 2002-2010 pre-Diwali, Diwali and post-Diwali days. Every year, a disaster management protocol is revoked during these 3 days under the direct supervision of the Ministry of Health and Family Welfare, Government of India.

RESULTS

There was an increase in the number of patients of firecracker-related injuries in Delhi national capital region from the year 2002 to 2010, based on the hospital statistics. During the study period, the hospital received approximately one patient with firecracker-related injury per 100,000 population of the city. 73.02% of the victims were 5-30 years old. Majority (90.87%) of them sustained <5% total body surface area burn.

CONCLUSIONS

In spite of legislations and court orders, the number of patients is on the rise. The implementation agencies have to analyse the situation to find a way to control this preventable manmade accident. Websites, emails, SMS, social sites, etc. should be used for public education, apart from conventional methods of public awareness.

Serine protease allergen favours Th2 responses via PAR-2 and STAT3 activation in murine model

BACKGROUND

Protease activity of Per a 10 favours Th2 responses by differential regulation of IL-12p70 and IL-23 cytokine subunits. This study aimed to elucidate the underlying mechanism of differential regulation of IL-12p70 and IL-23.

METHODS

PAR-2 activation was blocked in murine model by administering SAM11 before each sensitization. CD11c⁺ p-STAT3⁺ cells were measured in lungs by flow cytometry. BMDCs were pretreated with SAM11 or isotype control or stattic and stimulated with Per a 10. p-STAT3 levels were measured using Western blot. Transcript levels of IL-12p35, IL-12/23p40 and IL-23p19 were measured using RT-PCR. Cytokine levels were analysed using ELISA.

RESULTS

Protease activity of Per a 10 increased p-STAT3 levels in mouse lungs, which was reduced upon PAR-2 blockage. Percentage of p-STAT3⁺ CD11c⁺ cells was higher in Per a 10-administered mice and was reduced upon PAR-2 blockage. IL-12p35 and IL-12p70 levels were higher, and IL-23p19 and IL-23 levels were lower in both SAM11-treated mice and BMDCs indicating a role of PAR-2-mediated signalling. IL-4, TSLP, IL-17A, EPO activity, total cell count and specific IgE and IgG1 levels were lower in SAM11-administered mice. Inhibiting STAT3 activation via stattic also leads to lower levels of IL-23p19 and IL-23 and higher levels of IL-12p35.

CONCLUSIONS

Per a 10 leads to PAR-2 activation on BMDCs resulting in downstream activation of STAT3 to regulate the balance between IL-12/IL-23 subunits causing a cytokine milieu rich in IL-23 to favour Th2 polarization.

An inexpensive self fabricated pressure clip for the ear lobe

Pressure therapy is an integral part of keloid treatment. There are certain areas of the body which are prone to keloid formation but are not amenable to pressure therapy. The ear lobe is one such area. A simple, self fabricated and inexpensive pressure clip has been used for applying postoperative pressure to the ear lobe. This is fabricated with cold-cure poly methyl methacrylate and orthodontic wire. This has been used in 41 ear lobe keloids in 26 patients along with postexcisional triamcinolone acetonide therapy, 5 ear lobe reconstructions and 2 cases of ear lobe clefts over a period of 8 years. Although these clips are not very aesthetic, still the acceptability is very high as the patients were well motivated. A total of 27 ear lobes in 18 patients of ear lobe keloids have undergone ear boring after 6-18 months of pressure therapy. The only complication noticed is in the form of pressure ulcer due to continuous pressure in two patients at the beginning of our experience with these clips. These healed well after temporarily stopping the use of the clip.