bluuebunny/crossref_metadata_2025 huggingface dataset:
Tensions in Teaching Character: How the ‘Entrepreneurial Character’ is Reproduced, ‘Refused’, and Negotiated in an English Academy School
Authors: Morrin Kirsty
Published: April 2018

This article examines ‘character education’ in a school setting. It does so by drawing on ethnographic data collected at Milltown Community Academy, a secondary school in northern England. In this piece I focus on how character education at Milltown materialises and is enacted within the sites and everyday practices of schooling. By analysing the practices of teachers at the school, I show how, on one hand, the character initiative is embedded and complied with, but, on the other hand, teachers’ practice is also littered with instances of ‘refusal’ and non-compliance. Through recent reforms, Milltown Academy now houses an ‘entrepreneurship specialism’. At the school, ‘entrepreneurship’ is embedded in the school’s core ethos and curriculum and as part of this, the ‘entrepreneurial character’ is sold as necessary and progressive and is regularly deployed in narratives of attachment to and detachment from success and failure, respectively. Therefore, I make a claim that not only is a character agenda at place in the school but an ‘entrepreneurial character’ initiative. The analysis in this article is foregrounded in the idea that the Academy’s attempts to instil an ‘entrepreneurial character’ are part of a problematic policy complex that reproduces class-based inequalities, I argue, however, that those tasked with ‘teaching entrepreneurial character’ are indeed part of the process of the socio-cultural reproduction of inequality and dominance, but importantly, they also engage in plural and contradictory practices when it comes to putting the agenda into action.
Regional Anesthesia for Arteriovenous Fistula Surgery May Reduce Hospital Length of Stay and Reoperation Rates
Authors: Cole Naida M. , Vlassakov Kamen , Brovman Ethan Y. , Heydarpour Mahyar , Urman Richard D.
Published: April 2018

Background and Objectives:

Regional anesthesia has been proposed as the preferred mode of anesthesia for arteriovenous fistula surgery due to its associated vasodilatory effects and fistula patency rates. We analyzed patient outcomes after arteriovenous fistula surgery for their association with the type of anesthesia received.

Methods:

The National Surgical Quality Improvement Project database was accessed to identify a cohort of 3199 patients undergoing arteriovenous fistula surgery from 2007 to 2015. Multiple regression models were used to examine the association of anesthesia with 12 postoperative outcomes. Additional multivariate logistic regression was performed to assess significant independent variables predictive of anesthesia choice.

Results:

Patients who received regional anesthesia had the shortest postoperative length of stay (0.67 [standard deviation: 2.0] days) compared to monitored anesthesia care/intravenous (IV) sedation (0.77 [1.8] days) and general anesthesia (1.44 [2.8] days). Administration of regional anesthesia was associated with a shorter length of stay compared to general anesthesia (odds ratio [OR]: 0.55, P = .001). Patients who received monitored anesthesia care/IV sedation had a lower risk of reoperation compared to general anesthesia (OR: 0.65, P = .012) but not compared to regional anesthesia (OR: 0.89, P = .759). Anesthesia type had no significant effects on other measured postoperative complications. Predictors of the type of anesthesia were age and surgical procedure as defined by Current Procedural Terminology code ( P < .001).

Conclusions:

Use of regional anesthesia is associated with a shorter postoperative length of stay after arteriovenous fistula surgery and lower risk of reoperation compared to general anesthesia or monitored anesthesia care/IV sedation. Regional anesthesia may be an excellent choice for arteriovenous fistula surgery to reduce postoperative length of stay and risk of reoperation.
Procalcitonin as a postoperative marker in the follow-up of patients affected by medullary thyroid carcinoma
Authors: Trimboli Pierpaolo , Lauretta Rosa , Barnabei Agnese , Valabrega Stefano , Romanelli Francesco , Giovanella Luca , Appetecchia Marialuisa
Published: April 2018

Aim:

Due to the limits of calcitonin, other markers are warranted to better manage medullary thyroid carcinoma patients, and procalcitonin has been reported as promising. Here we aimed to evaluate procalcitonin as a marker of medullary thyroid carcinoma in the post-treatment follow-up.

Methods:

Medullary thyroid carcinoma patients previously treated by thyroidectomy were enrolled. After complete imaging work-up (i.e. ultrasonography, computed tomography, magnetic resonance and 18FDG-PET-CT) we identified patients with structural recurrent/persistent medullary thyroid carcinoma (active medullary thyroid carcinoma) and subjects with no evidence of disease. Then, both calcitonin and procalcitonin were measured and their performance analyzed.

Results:

The final series included 55 medullary thyroid carcinoma patients treated and followed-up for about five years. Of these, 43 were assessed as no evidence of disease, and 12 as active medullary thyroid carcinoma. The median value of procalcitonin was significantly higher ( P < 0.0001) in active medullary thyroid carcinoma patients (3.10 ng/mL) than in those with no evidence of disease (0.10 ng/mL). Also, calcitonin levels of active medullary thyroid carcinoma (96.7 pg/mL) were significantly ( P < 0.0001) higher than that of no evidence of disease (2.0 pg/mL). At the receiver operating characteristic curve analysis, the optimal cut-off of procalcitonin was ≥0.32 ng/mL with 92% sensitivity and 98% specificity, while the most accurate threshold of calcitonin was ≥12.0 pg/mL with 100% sensitivity and 91% specificity. There was no active medullary thyroid carcinoma with simultaneously negative results of procalcitonin and calcitonin.

Conclusions:

Procalcitonin is reliable in discriminating medullary thyroid carcinoma patients with active disease from those with no evidence of disease. We suggest using procalcitonin as complementary to calcitonin to follow-up medullary thyroid carcinoma patients.
The use of arts interventions for mental health and wellbeing in health settings
Authors: Jensen A , Bonde LO
Published: April 2018

Aims:

This literature review aims to illustrate the variety and multitude of studies showing that participation in arts activities and clinical arts interventions can be beneficial for citizens with mental and physical health problems. The article is focused on mental health benefits because this is an emerging field in the Nordic countries where evidence is demanded from national health agencies that face an increasing number of citizens with poor mental health and a need for non-medical interventions and programmes.

Methods:

A total of 20 articles of interest were drawn from a wider literature review. Studies were identified through the search engines: Cochrane Library, Primo, Ebscohost, ProQuest, Web of Science, CINAHL, PsycINFO, PubMed and Design and Applied Arts Index. Search words included the following: arts engagement + health/hospital/recovery, arts + hospital/evidence/wellbeing, evidence-based health practice, participatory arts for wellbeing, health + poetry/literature/dance/singing/music/community arts, arts health cost-effectiveness and creative art or creative activity + health/hospital/recovery/mental health. The inclusion criteria for studies were (1) peer review and (2) empirical data.

Results:

The studies document that participation in activities in a spectrum from clinical arts interventions to non-clinical participatory arts programmes is beneficial and an effective way of using engagement in the arts to promote holistic approaches with health benefits. Engagement in specially designed arts activities or arts therapies can reduce physical symptoms and improve mental health issues.

Conclusion:

Based on the growing evidence of the arts as a tool for enhancing mental health wellbeing, and in line with the global challenges in health, we suggest that participatory arts activities and clinical arts interventions are made more widely available in health and social settings. It is well-documented that such activities can be used as non-medical interventions to promote public health and wellbeing.
Flavonoid-rich extract of Polygonum capitatum attenuates high-fat diet–induced atherosclerosis development and inflammatory and oxidative stress in hyperlipidemia rats
Authors: Wang Zhiqian , Jiang Xuejun
Published: April 2018

This research was carried out to investigate the effects of flavonoids ingredient from Polygonum capitatum (FPC) on blood lipid levels, vascular inflammation, and oxidative stress in high-fat diet (HFD) rats, as well as their mechanism of action. Rats fed with HFD for 6 weeks obviously displayed hyperlipidemia ( P < 0.01). Treatment with FPC at 90 and 180 mg/kg body weight significantly increased serum apolipoprotein A (ApoA) and high-density lipoprotein-cholesterol (HDL-C) levels and decreased serum apolipoprotein B (ApoB), triglyceride (TG), total cholesterol (TC), and low-density lipoprotein-cholesterol (LDL-C) levels of hyperlipidemia rats. FPC also improved the serum superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) activities and decreased serum malondialdehyde (MDA), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) levels. Meanwhile, the result of reverse transcription polymerase chain reaction (RT-PCR) manifested that FPC upregulated the messenger RNA (mRNA) expression of low-density lipoprotein receptor (LDLR) and peroxisome proliferator–activated receptor α (PPARα) and downregulated the mRNA expression of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), acetyl CoA carboxylase (ACC), and sterol regulatory element-binding protein 1c (SREBP-1C) in the hepatic. These results demonstrated that FPC exerted anti-atherosclerosis effect in hyperlipidemia rats by regulating blood lipid metabolism, improving antioxidant ability, and modulating a proinflammatory profile and the expression levels of genes referred to lipogenesis and lipid oxidation, which might be attributed to flavonoid ingredients such as luteolin-7-O-glucoside, rutin, and quercitrin.
Researching men who pay for sex: Using online methods for recruiting and interviewing
Authors: Hammond Natalie
Published: April 2018

The use of online tools for recruitment and data collection are increasingly offering researchers access to hard to reach groups, and providing data about sensitive topics that were previously inaccessible to the research community. In this article, drawing on the experience of researching men who pay for sex with female sex workers in the United Kingdom, I explore the complexities of conducting online research, arguing that online research is indeed a valuable research tool, but that it should not be seen as the ‘easy’ option. This article outlines my rationale for using online methods and how traditional interview and recruitment practices and ethical issues were altered by this approach. A discussion of transformations in space and time follows. Finally, I reflect on how engaging with certain methods can reveal insights into the practices of those we research.
The Influence of Diagnosis, Age, and Gender on Surgical Outcomes in Patients With Adult Spinal Deformity
Authors: Ayhan Selim , Yuksel Selcen , Nabiyev Vugar , Adhikari Prashant , Villa-Casademunt Alba , Pellise Ferran , Perez-Grueso Francisco Sanchez , Alanay Ahmet , Obeid Ibrahim , Kleinstueck Frank , Acaroglu Emre ,   European Spine Study Group
Published: April 2018

Study Design:

Retrospective review of prospectively collected data from a multicentric database.

Objectives:

To determine the clinical impact of diagnosis, age, and gender on treatment outcomes in surgically treated adult spinal deformity (ASD) patients.

Methods:

A total of 199 surgical patients with a minimum follow-up of 1 year were included and analyzed for baseline characteristics. Patients were separated into 2 groups based on improvement in health-related quality of life (HRQOL) parameters by minimum clinically important difference. Statistics were used to analyze the effect of diagnosis, age, and gender on outcome measurements followed by a multivariate binary logistic regression model for these results with statistical significance.

Results:

Age was found to affect SF-36 PCS (Short From-36 Physical Component Summary) score significantly, with an odds ratio of 1.017 (unit by unit) of improving SF-36 PCS score on multivariate analysis ( P < .05). The breaking point in age for this effect was 37.5 years (AUC = 58.0, P = .05). A diagnosis of idiopathic deformity would increase the probability of improvement in Oswestry Disability Index (ODI) by a factor of 0.219 and in SF-36 PCS by 0.581 times ( P < .05). Gender was found not to have a significant effect on any of the HRQOL scores.

Conclusions:

Age, along with a diagnosis of degenerative deformity, may have positive effects on the likelihood of improvement in SF-36 PCS (for age) and ODI (for diagnosis) in surgically treated patients with ASD and the breaking point of this effect may be earlier than generally anticipated. Gender does not seem to affect results. These may be important in patient counseling for the anticipated outcomes of surgery.
Time of Day and Hearing Aid Adoption
Authors: Singh Gurjit , Launer Stefan
Published: April 2018

To date, there is little understanding of how contextual factors may influence the decisions individuals make regarding the adoption of options for hearing rehabilitation. This explorative retrospective study investigated whether hearing aid adoption and return rates are associated with the time of the day at which an appointment takes place. The study sample consisted of 24,842 patients experiencing their first audiology appointment. It was observed that hearing aid adoption was significantly associated with appointment times whereby lower hearing aid adoption rates were observed at noon and 4 p.m. It was also observed that hearing aid return rates were significantly associated with appointment times whereby lower return rates were observed at noon and 4 p.m. In light of the methodology employed in the study, it is not possible to unequivocally determine why time of day is associated with hearing aid adoption and return rates. Several possible explanations for the patterns of associations are discussed. In light of previous research observing that hunger lowers risk tolerance and glucose consumption increases risk tolerance, the results are consistent with an interpretation based on risk-aversion resulting from hunger. To establish causality between hunger and decision-making in audiology, additional research employing experimental methodologies are necessary.
Accuracy of Inpatient Recall of Interaction With a Pharmacist: A Validation Study From 2 Acute Care Teaching Hospitals
Authors: Sidhu Vaninder K , Bresee Lauren , Kemp Kyle , Koshman Sheri , Pereira Taciana , Neilson Sheena
Published: April 2018

Background:

Research has shown that inpatients may not accurately report interacting with a pharmacist.

Objective:

To determine accuracy of patients’ recollection of meeting with a pharmacist at 2 acute care teaching hospitals in Edmonton, Alberta, Canada.

Methods:

Retrospective review of 391 surveyed patients discharged from April 2013 to March 2014. Responses to meeting a pharmacist (yes/no) were compared with 2 reference standards: pharmacist documentation in patient charts and pharmacist clinical workload data. Sensitivity, specificity, positive predictive, and negative predictive values were calculated.

Results:

One hundred ninety-five (49.9%) respondents reported meeting with a pharmacist. Of these, 71 (36.4%) had corresponding pharmacist chart documentation. Of the 196 respondents who reported not speaking with a pharmacist, 73 (37.2%) had documentation present. Compared with patient charts, sensitivity and specificity were 49.3% and 49.8%, respectively. Positive and negative predictive values were 36.4% and 62.8%, respectively. Similar results were seen in comparison with the workload data.

Conclusions:

Patients often inaccurately reported meeting with a pharmacist in the acute care setting. The results are useful for pharmacist training, patient education, and for refinement of the current survey question.
The Asymmetrical Effects of Economic Development on Consumption-based and Production-based Carbon Dioxide Emissions, 1990 to 2014
Authors: Huang Xiaorui , Jorgenson Andrew K.
Published: April 2018

The authors examine the potentially asymmetrical relationship between economic development and consumption-based and production-based CO2 emissions. They decompose economic development into economic expansions and contractions, measured separately as increases and decreases in gross domestic product per capita, and examine their unique effects on emissions. Analyzing cross-national data from 1990 to 2014, the authors find no statistical evidence of asymmetry for the overall sample. However, for a sample restricted to nations with populations larger than 10 million, the authors observe a contraction-leaning asymmetry whereby the effects of economic contraction on both emissions outcomes are larger in magnitude than the effects of economic expansion. This difference in magnitude is more pronounced for consumption-based emissions than for production-based emissions. The authors provide tentative explanations for the variations in results across the different samples and emissions measures and underscore the need for more nuanced research and deeper theorization on potential asymmetry in the relationship between economic development and anthropogenic emissions.
Demyelination and Neurological Sequelae in Etanercept and Infliximab Therapies: A Review of the Literature
Authors: Madkan Vandana K. , Koo John Y.M.
Published: April 2018

Etanercept (Enbrel) and infliximab (Remicade) are two relatively new drugs, referred to as biologics, which target the cytokine tumor necrosis factor-α (TNF-α). Both are used in the treatment of psoriasis and psoriatic arthritis. Recently, there have been rare reports of demyelinating and neurological sequelae in patients while on these therapies. The authors sought to systematically review the reported cases of new-onset neurological symptoms and exacerbation of established multiple sclerosis (MS) found in the literature to determine the causality, if any, of demyelinating events by these therapies. Although these two medications may uncover latent multiple sclerosis in patients who are prone to the disease, no cause-and-effect relationship can currently be established.
Methotrexate Update: Mechanism of Action in Psoriasis Therapy
Authors: Law Jennie H. , Koo Bonnie , Koo John Y.M.
Published: April 2018

Background

Long before the advent of the biologic agents, methotrexate was the gold standard for the treatment of moderate to severe psoriasis. Although methotrexate's therapeutic efficacy in the treatment of psoriasis is well-established, the mechanism of action is still poorly understood.

Objective

This paper reviews the published research on methotrexate's mechanism of action in psoriasis.

Methods

Studies published with English abstracts between January 1970 and December 2006 identified in MEDLINE with the keywords methotrexate, psoriasis and mechanism were reviewed.

Results

Methotrexate appears to exert clinical efficacy in psoriasis by interfering with CLA+ T-cell infiltration into lesional skin via multiple mechanisms.

Conclusion

It is likely that methotrexate interferes with the inflammatory pathways critical to psoriasis pathogenesis by multiple mechanisms. Current evidence suggests that methotrexate works by decreasing the number of circulating CLA+ T cells; decreasing inflammatory infiltrate into the dermis and epidermis by downregulating adhesion molecules in endothelial cells; and downregulating the expression of adhesion molecules on T cells.
Genetics of Psoriasis and Psoriatic Arthritis
Authors: Kamili Qurat ul Ain , Menter Alan
Published: April 2018

Psoriasis and psoriatic arthritis are the result of a complex interaction of genetic, immunological and environmental factors. The role of genetics is evident by various population-based studies, family-based studies and candidate gene studies both within and outside the major histocompatibility (MHC) region. The PSORS1 gene in the MHC class-l region on chromosome 6 is considered to be the most important gene locus associated with psoriasis. The discovery of the PSORS2 gene 14 years ago paved the way for extensive research in this regard, which led to the identification of various genetic susceptibility factors for psoriasis and psoriatic arthritis. The complex interrelation of immunological changes in psoriasis and other immune-mediated disorders have been studied at a genetic level as well. Novel disease-specific biological pathways have been identified which, in the future, will likely serve as diagnostic or prognostic markers, as well as potential targets of therapy.
Ustekinumab and Marked Clinical Responses in Patients with Moderate to Severe Psoriasis
Authors: Reich Kristian , Shakery Kaweh , Mrowietz Ulrich , Szapary Philippe O. , Wang Yuhua , Hsu Ming-Chun , Langley Richard G.
Published: April 2018

Background

Ustekinumab has demonstrated significant efficacy and favorable safety in patients with moderate to severe psoriasis.

Objective

Characterization of patients achieving marked clinical responses (Psoriasis Area and Severity Index [PASI] 90 or Physician's Global Assessment [PGA] of cleared) in two double-blind, placebo-controlled, phase III studies.

Methods

PHOENIX 1 (n=766) and PHOENIX 2 (n=1,230) patients were randomized to receive placebo or ustekinumab 45 or 90 mg at weeks 0 and 4, then every 12 weeks. At week 12, placebo patients crossed over to ustekinumab. Marked responses, defined as PASI 90 or PGA of cleared, are reported.

Results

A significantly higher proportion of ustekinumab-treated patients in PHOENIX 1 (39.9%) and PHOENIX 2 (47.0%) achieved marked responses at week 12, compared with placebo-treated patients (p<0.001 each). At week 28, approximately 50% of ustekinumab-treated patients achieved marked responses.

Conclusion

Significant proportions of ustekinumab-treated patients with moderate to severe psoriasis achieved marked clinical responses through week 28. Ustekinumab had a favorable risk-benefit profile through up to 18 months of follow-up.
Identification of the Effect of Amphiregulin on Keratinocytes and T Cells in Psoriasis
Authors: Lu Jun , Squillace Karen , Pittelkow Mark R.
Published: April 2018

Background

In addition to its fundamental functions in mediating the survival, proliferation, and migration of keratinocytes, increasing evidence suggests that the amphiregulin-epidermal growth factor receptor pathway has a major impact on cutaneous inflammation. Transgenic expression of amphiregulin in the epidermis of mice induces skin pathology with striking phenotypic similarity to that of psoriasis. Prominent T-cell and dendritic cell infiltrates are observed in the lesional skin from these mice.

Objective

In this study, we aimed to identify more fully the effect of amphiregulin on keratinocytes and T cells during cutaneous inflammation through examining relevant cytokines in the lesional skin as well as in human keratinocyte culture.

Methods

Using a multicytokine enzyme-linked immunosorbent assay, we found that amphiregulin directly induces the production of monocyte chemoattractant protein-1, interleukin-α, and interleukin-8 from keratinocytes in vitro. In addition, we examined the cutaneous expression of T-cell cytokines in amphiregulin transgenic mice compared with wild-type mice using quantitative polymerase chain reaction, which demonstrated upregulation of interferon-γ, vascular endothelial growth factor, and interleukin-4 in amphiregulin transgenic mice.

Results and Conclusion

Our study suggested that amphiregulin in the epidermis not only induces keratinocyte proliferation but also induces T-cell activation through a complex circuit of proinflammatory cytokines. Elucidating the role of amphiregulin on the generation, interactions, and balance among T-cell subsets will advance the understanding of psoriasis pathogenesis.
Pediatric Psoriasis: An Emphasis on Treatment
Authors: Volf Eva M. , Au Shiu-Chung
Published: April 2018

Childhood psoriasis is a common chronic disease that may have devastating physical and psychosocial consequences. Most children are treated with topical agents, including corticosteroids, coal tars, anthralin, calcipotriene, and tazarotene. For moderate to severe cases, systemic treatments such as phototherapy, methotrexate, cyclosporine, and acitretin are used. In the last 10 years, biologics with an emphasis on tumor necrosis factor-α inhibitors have been shown to be effective without the toxicities associated with older systemic treatments. Future studies are needed that focus on the efficacy and safety of these treatments in children.
A Practical Approach to the Use of Acitretin for the Treatment of Psoriasis
Authors: Bhutani Tina , Busse Kristine
Published: April 2018

This clinical review outlines a practical approach to the use of acitretin in the treatment of psoriasis. Acitretin is approved by the Food and Drug Administration for the treatment of adult patients with chronic moderate to severe plaque psoriasis. It is an oral retinoid and is the only systemic agent that is not clinically immunosuppressive; it works primarily by enhancing differentiation and maturation of cells. Side effects associated with this medication are usually mild and manageable; serious adverse events are rare. Therefore, it can be used for long-term maintenance therapy or in combination with other topical or systemic agents and phototherapy.
Cardiovascular Risk in Psoriatic Arthritis: Search for New Biological Markers
Authors: Korotaeva Tatiana V. , Loginova Elena Yu , Novikova Diana S. , Klimova Nadezhda V. , Novikov Aleksandr A. , Denisov Lev N. , Firsov Nikolay N. , Erdes Shandor
Published: April 2018

Objective

We investigated the relationships between the risk for coronary heart disease (CHD), psoriatic arthritis activity, and red blood cell aggregation (RBCA).

Methods

Our study comprised 130 patients with psoriatic arthritis (mean age, 41.7 ± 9.8) whose mean duration of psoriatic arthritis was 7 (IQ-range, 2.5–13) years and disease activity score (DAS) was 3.86 (IQ-range 2.72–5.14). We measured psoriatic arthritis DAS, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), time to formation of linear aggregates formation (T1 [s]), strength of the largest aggregates (la2.5[%]), hydrodynamic strength of aggregates (β [s−1]), velocity of aggregates formation (Kt [r.u.]), relative risk of CHD (RR CHD), and 10-year absolute risk (AR) of total and hard CHD in all patients. Statistical analysis was performed with Spearman correlation (R).

Results

Significant correlations were found between RBCA (T1/la2.5 /Kt) and DAS (R = −0.32/0.32/0.33), CRP (R = −0.34/0.41/0.47), and ESR (R = −0.34/0.35/0.42). RBCA (T1/Kt) significantly correlated with RR CHD (R = −0.32/0.35), total CHD (R = −0.32/0.31), and hard CHD risks (R = −0.31/0.30); no correlation was found between risk for CHD and psoriatic arthritis activity.

Conclusion

RBCA may be useful for assessment of psoriatic arthritis activity and CHD risk.
Treatment of Erythrodermic Psoriasis: Practical Application of the National Psoriasis Foundation Consensus Statement
Authors: Patel Rita V. , Frankel Amylynne , Levitt Jacob
Published: April 2018

The management of erythrodermic psoriasis often presents a dermatologic challenge because of the lack of adequate high-quality medical literature concerning treatment options, side effect profiles associated with available therapies, and the development of concomitant comorbidities during treatment that further limit therapeutic options. After reviewing the literature published on erythrodermic psoriasis, taking into account the quality of the evidence-based medicine, in April 2010 the medical board at the National Psoriasis Foundation released a consensus algorithm for treating the patient with erythrodermic psoriasis. We present a case of a 53-year-old man with a 20-year history of plaque psoriasis who developed an erythrodermic exacerbation involving 100% body surface area. The patient was eventually administered cyclosporine 5 mg/kg/day divided into two equal doses, and the results of this treatment were excellent. He was eventually changed to a maintenance regimen involving cyclosporine 3.5 mg/kg/day divided into two equal doses along with methotrexate 15 mg weekly given for a 1-month period followed by a 1-month drug holiday. The patient has been successfully maintained on this intermittent regimen for the past 3 years with no evidence of toxicity.
Pustular Psoriasis: A Practical Review of the Literature
Authors: Roosevelt Laura , Emer Jason
Published: April 2018

Psoriasis is a chronic inflammatory skin condition linked to a dysregulation of the immune system that results clinically in well-circumscribed erythematous plaques with a silvery scale. In certain instances, the disease may manifest as a localized or generalized pustular variant that runs a more severe course and requires more diligent treatments. Precipitating factors influencing both the local and generalized forms include various drugs or withdrawal of certain drugs, irritation from topical therapy, infection, pregnancy, and sunburn. Many treatments for the pustular variant of psoriasis have been described in the literature, but no consensus statements have been published regarding the correct hierarchy of therapies to follow. Localized forms may be treated with topical or light therapies but may require systemic medications. Generalized forms most inevitably require aggressive systemic therapies offering a quick therapeutic response because of their increased morbidity and mortality. In all cases, the factors that are precipitating the disease must be eliminated. We present a review of the literature on the available treatments for pustular psoriasis.
Does Simultaneous Methotrexate Treatment Improve Dead Sea Climatotherapy Outcomes in Plaque Psoriasis?
Authors: Czarnowicki Tali , Ingber Arieh , Ruzicka Thomas , Novack Lena , Harari Marco
Published: April 2018

Background

Dead Sea climatotherapy is a proven and useful option for the treatment of plaque psoriasis. However, combination with methotrexate treatment has not been studied.

Objective

We sought to evaluate the added benefit of Dead Sea climatotherapy in patients with psoriasis vulgaris receiving methotrexate treatment and compare their results with those of patients not receiving this therapy.

Methods

In this retrospective comparative study, 40 patients with psoriatic vulgaris were recruited at the Deutsches Medizinisches Zentrum Medical Center in Ein Bokek, Israel, between 2003 and 2005. Twenty (50%) patients were also treated with methotrexate (group 1), and 20 (50%) patients were not (group 2). A five-item scale, equivalent to Psoriasis Area and Severity Index (PASI) scores, was used to evaluate clinical response. Logistic regression using an exact method was performed on demographic and clinical parameters.

Results

Ten (50%) patients in group 1 and 13 (65%) patients in group 2 were totally plaque free on leaving the Dead Sea. Five (25%) patients in group 1 and four (20%) patients in group 2 were almost cleared (<5% involvement, 95%–99% PASI improvement), and five patients (25%) in group 1 and three patients (15%) in group 2 were markedly improved (>50% clearance, 50%–94% PASI improvement) at the end of Dead Sea climatotherapy (adjusted OR 1.43; 95% CI 0.2–16.6).

Conclusion

Dead Sea climatotherapy did not show better results in patients treated simultaneously with methotrexate. No side effects were observed from this combination therapy. However, the study design and the small sample size do not allow conclusions about methotrexate withdrawal before natural phototherapy.
The Role of a Gluten-Free Diet in Psoriasis
Authors: Rush Margaret , Bagel Jerry
Published: April 2018

Recent evidence suggests that a group of psoriasis patients have silent gluten intolerance and may experience improvement of their psoriasis by going on a gluten-free diet. Although there is still controversy as to the prevalence of this subset of psoriasis patients, screening patients with moderate to severe psoriasis for antigliadin antibodies may be helpful in identifying this group. Evidence illustrates that patients with positive antigliadin antibodies who undertake a gluten-free diet experience significant improvement of their psoriasis compared with prediet measurements. To make definitive clinical recommendations, a large randomized, controlled trial is needed. Even though the evidence is limited, it may be beneficial to screen psoriasis patients for silent gluten intolerance to identify those who could benefit from a gluten-free diet.
The Role of Stress in Children with Psoriasis
Authors: Manolache Liana , Petrescu-Seceleanu Dana , Benea Vasile
Published: April 2018

Background

Stress could be involved as a precipitating or aggravating factor in psoriasis. In the literature, few sources refer to this subject in the pediatric field and even fewer to case-control studies.

Objective

The purpose of the study was to note any stressful situations that occur before the onset or extension of psoriasis in children aged 16 years and younger.

Methods

The study comprised 41 children (23 girls, 18 boys) with psoriasis who were enrolled in a comparative study.

Results

Between March 2001 and December 2007, 9,940 children (≤16 years old) were examined. The incidence of psoriasis among new dermatologic conditions was 0.43%. The mean age of the children was 11.97 years. There was a family history of the disease in 29.26% of cases; 31% of children with psoriasis had onset of psoriasis less than 3 months before the evaluation, and 38% had recent extensions or recurrence. In 14.6% of psoriasis cases, an inflammatory focus was identified. Stressful events had occurred in 41% of the psoriasis group, compared with 17% of controls. The difference was statistically significant (χ2 = 4.77, P = .028). The odds ratio was 3.44 (95% CI, 1.23–9.57). Most of these children had mentioned one event that may have had an impact on the development of psoriasis. Girls with psoriasis vulgaris and boys with guttate lesions were most often affected by stressful situations. Family problems (death, illnesses, disputes, parents working abroad, financial restrictions) were more often described in psoriatic cases. Also, school situations were often mentioned as influencing the psoriatic lesions.

Conclusions

The recollection of past events within the patient's family or by the patient and the dimensions of the sample could be considered limitations of the study. However, the presence of stressful events could be taken in consideration as influencing the onset, recurrence, or extension of psoriasis in children.
Treatment of Psoriasis during Pregnancy
Authors: Prioleau Phoebe , Levy Lauren , Fuchs Aaron
Published: April 2018

Data on pregnant or lactating women with psoriasis are limited, in part because of the ethical ramifications of placing pregnant women in clinical trials. This article reviews topical and systemic treatment options for women with psoriasis who are pregnant or nursing. Caution is advised both when prescribing treatments with known risks to the fetus and when prescribing treatments for which data are lacking.
Juvenile Psoriasis: A Systematic Review of Comorbid Diseases
Authors: Chase Elizabeth P. , Armstrong April W.
Published: April 2018

Objective

To systematically summarize the literature examining comorbidities associated with juvenile psoriasis.

Data Sources

Ovid MEDLINE articles published between January 1, 1946, and January 21, 2012, and a manual search. Results were limited to English publications and human, “all child” patients, ages 0 to 18 years.

Study Selection

All investigations that examined the presence or prevalence of comorbidities associated with juvenile psoriasis were included.

Data Extraction

Study design, patient characteristics, psoriasis comorbidities, relevant outcomes, and measures of association were extracted.

Data Synthesis

The search resulted in 20 articles. Obesity, hyperlipidemia, hypertension, diabetes, depression, and Crohn's disease occur more frequently in patients with juvenile psoriasis than in their disease-free counterparts. Although the overall rate of comorbidities among patients with juvenile psoriasis appears twice that of children without psoriasis, this rate does not include psychiatric diseases.

Conclusion

The literature exploring relationships between juvenile psoriasis and comorbid conditions is sparse, and the evidence for these associations is lacking. The strongest evidence supports an association between obesity and juvenile psoriasis. Support for many other comorbidities was predominantly anecdotal. Additional research assessing physical and psychiatric comorbid conditions among the juvenile psoriasis population is required if clinicians are to make recommendations regarding prevention and management of comorbidities associated with juvenile psoriasis.
Recent Observations on the Heterogeneity of Human Effector Memory T Cells and Novel Cytokines Implicated in Cutaneous Inflammation and Psoriasis
Authors: Edwards Carl K. , Pedler Michelle , Fulan Yang Diana , Fitzpatrick James E. , Fujita Mayumi , Jonscher Karen , Norris David A.
Published: April 2018

Psoriasis is a chronic inflammatory skin disease that affects 2.2% of Americans and is a substantial detriment on the quality of life. Psoriasis is a complex interaction between numerous immune cells and has been considered largely a T-helper type 1 (Th1) T-cell-mediated response. Although numerous cytokines, including tumor necrosis factor-αβ, interleukin 1β, and interferon-γ, have been identified with distinct roles in skin inflammation and psoriasis, proinflammatory functions of newly identified cytokines have been linked recently to the alternative T-cell subsets Th17 and Th22 that are distinct in their functions and cytokine profiles. This review summarizes the basic research, translational applications, and new therapeutic developments contributing to the understanding of the diversity of human effector CD4+ Th1, Th17, and Th22 T cells, as well as the proinflammatory cytokines associated with these subsets in psoriasis.
Etanercept-Induced Lupus Panniculitis with Continued Improvement after Treatment with Adalimumab for Psoriatic Arthritis
Authors: Chen Tinley K. , Haddican Madelaine M. , Phelps Robert G. , Spiera Harry
Published: April 2018

Drug-induced lupus erythematosus caused by anti-tumor necrosis factor (TNF)-α therapy is considered a rare event. Although different forms of lupus erythematosus have been associated with anti-TNF-α therapy, lupus panniculitis has not been reported previously. We present a patient who developed lupus panniculitis during treatment with etanercept for psoriatic arthritis. Our patient was successfully switched to adalimumab for continued treatment of her psoriatic arthritis and experienced a simultaneous reduction in the clinical findings of lupus panniculitis. This case helps highlight the different forms of drug-induced lupus erythematosus that can occur during anti-TNF-α therapy. This case also provides additional evidence that patients with anti-TNF-α–induced lupus erythematosus can be successfully rechallenged with an alternative anti-TNF-α agent without recurrence of drug-induced lupus erythematosus.
Merits of Maintenance Phototherapy for Psoriasis
Authors: Gupta Rishu , Levin Ethan , Nguyen Tien V. , Shinkai Kanade
Published: April 2018

Psoriasis is a chronic skin condition that requires long-term maintenance therapy, sometimes lifelong. Phototherapy (narrowband ultraviolet B, broadband ultraviolet B, and psoralen plus ultraviolet A) is a safe and effective method of treating generalized psoriasis. Although there are numerous publications demonstrating the efficacy of phototherapy for the initial clearance of psoriasis, there has not been a review evaluating the merits of phototherapy for the maintenance of remission in patients with psoriasis once they clear their skin disease. We searched PubMed for articles evaluating the efficacy of phototherapy for maintaining remission in patients with treated generalized psoriasis. The majority of published trials supported the use of maintenance phototherapy after clearance of generalized psoriasis. Typically, the studies showed that maintenance phototherapy reduces the rate of disease relapse and prolongs the duration of remission of psoriasis after initial clearance. There is available evidence supporting phototherapy, including psoralen plus ultraviolet A, as a safe and effective treatment option for maintenance of remission in patients with generalized psoriasis. Further studies are needed to adequately assess narrowband ultraviolet B for maintenance therapy, and additional studies are also necessary to directly compare the efficacy of different phototherapy types for remission maintenance.
Tumor Necrosis Factor-α Triad: Psoriasis, Cardiovascular Disease, and Depression
Authors: Leon Argentina , Liao Wilson J. , Gupta Rishu , Koo John Y. M. , Wu Jashin J.
Published: April 2018

Tumor necrosis factor-α (TNF-α) plays an intricate role in immune defense mechanisms. Over the past decades, studies have demonstrated that inflammatory cytokines, such as TNF-α and interleukin-6, may play an important role in the pathophysiology of psoriasis and depression. More recently, studies suggested an additional association of TNF-α with cardiovascular disease, which has attracted much attention. People with psoriasis, cardiovascular disease (i.e., heart failure or myocardial infarction [MI]), and depression have been found to have higher levels of proinflammatory cytokines, especially TNF-α. This article reviews the roles of TNF-α in psoriasis, cardiovascular disease, and depression.
Successful and Rapid Treatment of Nail Psoriasis Using Topical Indigo Naturalis Oil Extract
Authors: Rosen Jamie M. , Stern Dana K.
Published: April 2018

Background

Nail psoriasis, characterized by chronic inflammation, is a debilitating disease that affects many patients worldwide. Currently, we are lacking standardized therapeutic treatment regimens for controlling and remitting nail psoriasis because delivering sufficient concentrations of drugs into the nail plate and nail bed is difficult.

Observation

This case describes a 43-year-old female with an 8-year history of refractory nail bed psoriasis. The patient was treated unsuccessfully with a variety of therapies (e.g., corticosteroids, intralesional injections, phototherapy). The patient responded well to topical application of indigo naturalis oil extract, achieving significant improvement of the onycholysis and splinter hemorrhages and complete recovery in subungual hyperkeratosis of the affected fingernails.

Conclusion

While additional studies are needed, indigo naturalis oil extract appears to be a safe and effective alternative treatment for nail psoriasis. Indigo naturalis oil extract is an inexpensive, easy to use, and low-risk therapy that demonstrates improved patient compliance and outcomes.
Years of Work Results in Win: D.C. Releases First-Ever Psoriasis Public Health Agenda
Authors: Abernethy April S. , Howard Leah McCormick
Published: April 2018

The Centers for Disease Control and Prevention (CDC) led collaborative efforts among clinical, biomedical and public health experts to develop the first-ever public health agenda for psoriasis and psoriatic arthritis, giving federal recognition to millions of Americans living with these diseases. In 2009, after a multiyear advocacy campaign by National Psoriasis Foundation advocates and leaders, Congress allocated $1.5 million to the CDC to commence the first-ever government data collection effort on psoriasis and psoriatic arthritis. Through extensive collaboration, the coalition created a list of priorities, needs and unanswered questions in psoriatic disease research. The agenda clearly states the need for research into basic questions, such as the age at which psoriasis and psoriatic arthritis appear, how the diseases start and develop over time, and possible differences in how they affect certain groups, such as younger versus older people.
How Insurers Attempt to Discourage Biologic Therapy for Psoriasis
Authors: Rutter Russell D. , Haddican Madelaine M. , Rigel Darrell S.
Published: April 2018

Background

Biologic therapy for psoriasis is costly, and insurance companies vary in the pre-authorization procedures required for these treatments.

Methods

A survey was performed of more than 300 of the approximately 600 practicing dermatologists at the Fall Clinical Dermatology Conference.

Results

More than 80% of those surveyed prescribe biologic therapies for psoriasis. Sixty percent have to obtain prior authorizations more than 80% of the time before prescribing biologics. For many patients, prior authorizations have to be repeated every three months. The median amount of time spent on prior authorizations was between 30 and 60 minutes and 50% of dermatologists require at least one-quarter of a full-time employee to deal with the paperwork. Eighty percent of dermatologists thought that reimbursement hurdles prevent them from using ideal therapies for psoriasis.

Conclusion

The paperwork associated with prescribing biologic agents generates unreimbursed expenses and may interfere with ideal treatments for patients with psoriasis.
Merits of Mycophenolate Mofetil for Psoriasis: Is It Effective?
Authors: Sheinin Renee , Au Shiu-Chung , Gottlieb Alice
Published: April 2018

Background

Mycophenolate mofetil (MMF) is a widely used immune suppressant. It is derived from mycophenolic acid, which was once used as an anti-psoriatic agent, but was discontinued due to adverse effects. MMF has a lower incidence of adverse effects and could be a therapeutic option for psoriasis patients.

Objective

To review the current literature on the safety and efficacy of MMF as a treatment for psoriasis.

Methods

We searched PubMed and the Cochrane Library using the search terms “psoriasis” and “mycophenolate mofetil” for articles evaluating the efficacy and safety of MMF in patients with psoriasis.

Results

Studies showed that MMF reduced disease severity and had minimal adverse effects. However, most studies had a small sample size.

Conclusions

There is available evidence supporting MMF as a well-tolerated, effective treatment of psoriasis. Further studies in the form of randomized control trials should be considered to confirm these limited data.
Addressing Comorbid Diseases in Patients with Moderate-to-Severe Psoriasis
Authors: Yeung Howa , Takeshita Junko , Gelfand Joel M.
Published: April 2018

Psoriasis is a common, chronic inflammatory skin disease that has been increasingly associated with major systemic effects. Dose-response relationships between objectively determined psoriasis severity and increased comorbid disease burden were recently demonstrated in a large, population-based study. Significant associations with cardiovascular disease, diabetes mellitus and its complications, chronic kidney disease, chronic pulmonary disease, mild liver disease, peptic ulcer disease, and rheumatologic disease were shown in patients with increasingly severe psoriasis. Future research should confirm novel comorbid disease associations and investigate the impact of psoriasis therapy on comorbid disease outcomes. For now, dermatologists, as well as primary care physicians, medical specialists, and patients suffering from moderate-to-severe psoriasis, should be aware of these associations to improve multi-disciplinary approaches for screening, monitoring, and treatment of comorbid diseases. Future evidence-based guidelines should incorporate strategies on how clinicians should address cardiovascular and other comorbid diseases, particularly for patients with more severe psoriasis.