bluuebunny/crossref_metadata_2025 huggingface dataset:
Race, Identity and Nationality: Relocating Nepali Nationalism in India
Authors: Subba Tanka B.
Published: April 2018

This article contextualises the relationship between race, identity and nationality with the case of Nepalis in India, who are historically, racially, culturally, and linguistically heterogeneous but socially constructed as a homogenous community in India. It surmises that relocating Indian Nepalis, without a reference to the country of their origin no matter when they came from Nepal, without considering India’s bilateral relationship with Nepal, and without linking Indian Nepalis with the Madhesi or Nepal Nepalis, seems an extremely challenging, if not impossible, task.
Sikh Women Diaspora in Malaysia: The Reality of their Role and Status in the Religious Domain
Authors: Kaur Charanjit , Gill Sarjit S.
Published: April 2018

This article aims to examine how the Sikh women diaspora from two generations exercised their rights within the religious domain in Malaysia. Sikhism has a unique world view of gender ideology; from a gender perspective, God is symbolically described as a husband to all of humanity, whereby all humans, irrespective of gender, are perceived as having the status of wives to God. Since the Sikh religion focuses on the concept of the spirit rather than the physical body; therefore, the position of God and mankind should be cognized from the viewpoint of transformation of spirit. Most significantly, every human being, be they male or female, is held in equal importance, with each individual being conferred the same position, status, rights and opportunity to live this life as God has ordained. In fact, tenets of life that define practices as being praiseworthy, or to be avoided, are not gender specific. This makes the philosophy of gender equality of the Sikh religion particularly interesting and worthy of academic scrutiny. To what extent is it true that women have equal status with men? The authors discovered that patriarchal cultural practices have clearly dominated Sikh women’s views about their roles in daily life, as well as in the perception of their own status. This article concludes with specific recommendations to uplift and strengthen gender equality among the Sikh community in the religious domain.
Successful sedation of pediatric patients via chloral hydrate during diagnostic studies
Authors: Lee Choung Ah , Park Ju Ok , Choi Sang Cheon , Park Seung Min
Published: May 2018

Background and Objectives:

Patients’ movements often need to be restrained to obtain high‐quality diagnostic images. Chloral hydrate is the primary agent for pediatric sedation prior to diagnostic studies in some countries. However, because of the agent's long half‐life, the need for augmentation must be minimized by ensuring the success of the initial dose. This study aimed to identify factors influencing sedation success rate and sedation duration.

Methods:

Pediatric patients’ age, sex, and dose according to body weight, type of clinic, duration of stay, and weight‐for‐age percentile were analyzed in univariate and multivariate regression analyses.

Results:

Of the total of 1590 patients, 1325 (82.7%) were successfully sedated. Predictors of successful sedation were a minimum dosage of 60 mg/kg and a younger age. Early sedation (mean − 1 standard deviation, <18 min) occurred in 10.9% of the pediatric patients who were successfully sedated. For this value, visits to emergency center B (adjusted odds ratio, 2.673; 95% confidence interval, 1.660–4.305) and visits during daytime hours appeared to be influencing factors.

Conclusion:

For safe and successful pediatric sedation, the child's age and appropriate dose must be thoroughly reviewed, and a quiet and secluded environment must be ensured. Furthermore, taking into account that the patient's age and developmental stage can affect induction time, care should be taken to avoid unnecessary augmentation
A local review of child abuse in Hong Kong: From the perspective of emergency physicians
Authors: So Chung Wai , Lui Chun Tat , Ng Paulin , Fung Hin Tat
Published: May 2018

Background:

Child abuse occurs all over the world, including Hong Kong. The Accident and Emergency Department is one of the places in which cases of child abuse may present to.

Objectives:

As an emergency physician in the hospital, we need to understand the signs and symptoms and the risk factors of child abuse. We also need to perform risk assessment and formulate the plan of management.

Methods:

Databases in Hong Kong were searched to obtain the current situation of child abuse in Hong Kong. Literature about the nature of child abuse was also searched.

Results:

The epidemiology of child abuse in Hong Kong was reviewed. Signs and symptoms, risk factors, and management of child abuse were summarized in this review article. Conclusion: High vigilance is needed for emergency physicians to pick up cases of child abuse. Most cases of child abuse would finally need assessment from a multidisciplinary team.
The Relationship Between Time and Birth Mother Satisfaction With Relinquishment
Authors: Madden Elissa E. , Ryan Scott , Aguiniga Donna M. , Killian Michael , Romanchik Brenda
Published: April 2018

Using data from an online survey of 223 birth mothers who had relinquished an infant for adoption during the last 25 years, this analysis examines the influence of the length of time that has passed since relinquishment on birth mothers’ satisfaction with their decision to place their child for adoption. Time since relinquishment, age of the respondent, education level, and income had a significant inverse relationship with birth mothers’ satisfaction to place their child for adoption. Two variables were predictive of increased satisfaction with their decision: having current contact with the child and full-time employment. The findings underscore the importance of agencies and adoption professionals ensuring that birth mothers have access to ongoing postrelinquishment support services throughout the life course.
Combined Tongue-Palate Fusion With Alveolar Bands in a Patient With Pierre Robin Sequence and Van der Woude Syndrome
Authors: Robbins Alexa , Zarate Yuri A. , Hartzell Larry D.
Published: April 2018

This report describes the presentation of a newborn male with circumferential tongue-palate fusion associated with cleft palate and alveolar bands. After intraoral adhesions lysis, the patient was diagnosed with Pierre Robin sequence. A family history of cleft lip and palate was noted, and interferon regulatory factor 6 ( IRF6) sequencing revealed a heterozygous variant, confirming the diagnosis of van der Woude syndrome. The disruption of IRF6 resulted in abnormal orofacial development including micrognathia and intraoral adhesions as well as tongue-palate fusion, then resulting in glossoptosis with airway obstruction and cleft palate.
Face-to-face Contacts, Facebook Connections and Academic Support: Adolescents’ Networks between and across Gender and Culture in Finland
Authors: Li Shupin , Palonen Tuire , Lehtinen Erno , Hakkarainen Kai
Published: April 2018

The purpose of the present study is to investigate gender and cultural background similarities among adolescents’ patterns of networking within a multicultural Finnish school. The participants consisted of 109 seventh to ninth graders who represented three cultural groups: major-culture ( n = 50; 46%), bi-culture ( n = 26; 24%) and minor-culture ( n = 33; 30%). A social networking questionnaire was administered to trace face-to-face, Facebook and academic support networks within each classroom. Results of social network analysis revealed that bi-culture students were culturally the most open to network with their classmates in face-to-face contacts, Facebook connections and peer academic support. Female students were more inclined to use Facebook to connect with other female classmates, whereas males were equally likely to connect with either gender via Facebook. No gender similarities were found in academic support network although female students were more apt to engage in academic support than their male counterparts.
Computational fluid dynamics investigations of the effect of water injection timing on thermal stratification and heat release in thermally stratified compression ignition combustion
Authors: Rahimi Boldaji Mozhgan , Sofianopoulos Aimilios , Mamalis Sotirios , Lawler Benjamin
Published: April 2018

Advanced combustion concepts, like homogeneous charge compression ignition, are limited by their narrow operating range, which stems from a lack of control over the heat release process. This study explores a new advanced combustion mode, called thermally stratified compression ignition, which uses a direct water injection event to control the heat release process in low-temperature combustion. A three-dimensional computational fluid dynamics model coupled with detailed chemical kinetics is used to better understand the effects of direct water injection on thermal stratification in the cylinder and the resulting heat release process. Previous results showed that increasing the injection pressure results in a significantly broader temperature distribution due to increased evaporative cooling. In this way, direct water injection can control low-temperature combustion heat release and extend significantly the operable load range. In this study, simulations were performed over a range of start of injection timings in order to determine its effect on thermal stratification and heat release. The results show that for both low and high injection pressures advancing the start of water injection results in increased thermal stratification and reduced peak pressure and heat release rate for injections occurring after −60 °CAD. Before −60 °CAD, advancing the water injection has a varied effect on thermal stratification and heat release depending on the injection pressure and mass of the injected water.
Geolocating a WeChat user based on the relation between reported and actual distance
Authors: Shi Wenqi , Luo Xiangyang , Zhao Fan , Peng Ziru , Cheng Qingfeng , Gan Yong
Published: April 2018

The combination of social networks and the Internet of Things has raised a new wave of network technology application. However, the presence of malicious social network users poses a potential threat to Internet of Things security, and the research on social network user geolocation technology is of great significance. The accuracy of existing geolocation methods for WeChat users depends on the stable correspondence between the reported distance and actual distance. In view of the difficulty to pinpoint users’ location in the real world due to WeChat location protection strategy, a WeChat user geolocation algorithm based on the reported and actual distance relation analysis is proposed. The proposed algorithm selects the target reported distance and determines the initial target space based on statistical characteristics of the relation between the reported distance and actual distance. What is more, stepwise strategies are taken to improve the accuracy rate of space partition. Experimental results show that, on the premise that target users can be discovered, the proposed algorithm could achieve higher accuracy compared with the classical space partition–based algorithm and the heuristic number theory based algorithm. The highest geolocation accuracy is within 10 m and 56% of geolocation results are within 60 m.
Association Between Erectile Dysfunction and Subsequent Prostate Cancer Development: A Population-Based Cohort Study With Double Concurrent Comparison Groups
Authors: Kok Victor C. , Hsiao Yi-Hsuan , Horng Jorng-Tzong , Wang Kung-Liang
Published: April 2018

Recent studies indicate that erectile dysfunction (ED) and prostate cancer share common potential risk factors such as chronic inflammation, prostatitis, cigarette smoking, obesity, a high animal fat diet, sedentarism, and depression. There is great interest in knowing if ED is associated with prostate cancer. This study aimed to investigate if men afflicted with ED harbor an increased risk of prostate cancer, utilizing two concurrent comparison groups, constructed from the Taiwan NHIRD, with up to 8 years’ follow-up. Among men with no preexisting prostate cancer, an ED group of 3,593 men ≥ 40 years of age and two non-ED comparison groups of 14,372 men from the general population, 1:4 matched by age and index date (GENPOP); and 3,594 men with clinical benign prostatic hyperplasia (BPH), matched by similar criteria were assembled. A Cox model was constructed to calculate the adjusted hazard ratio (aHR) after controlling for age, socioeconomic factors, and various medical comorbidities. During the 11,449 person-year follow-up for the ED group, 24 incident prostate cancer developed. During the 44,486 and 11,221 person-year follow-up for the GENPOP and the BPH group, respectively, there were 33 and 25 incidents of prostate cancer. The ED group demonstrated a 2.6-fold greater risk of prostate cancer than that by the GENPOP with an aHR of 2.63 (95% confidence interval [CI] [1.51, 4.59], p < .001). There was no significant difference in risk between ED and BPH group (aHR = 0.83, 95% CI [0.46, 1.48]). This concurrent, double comparison, longitudinal study revealed a positive association between ED and subsequent prostate cancer incidence.
Facing the facts: Naive participants have only moderate insight into their face recognition and face perception abilities
Authors: Bobak Anna K , Mileva Viktoria R , Hancock Peter JB
Published: April 2018

A reliable self-report measure to assess the broad spectrum of face recognition ability (FRA) from developmental prosopagnosia (DP) to super-recognition would make a valuable contribution to initial screening of large populations. We examined the performance of 96 naive participants and seven super-recognisers (SRs) using a range of face and object processing tasks and a newly developed 20-item questionnaire, the Stirling Face Recognition Scale (SFRS). Overall, our findings suggest that young adults have only moderate insight into their FRA, but those who have been previously informed of their (exceptional) performance, the SRs, estimate their FRA accurately. Principal component analysis of SFRS yielded two components. One loads on questions about low ability and correlates with perceptual tasks, and one loads on questions about high FRA and correlates with memory for faces. We recommend that self-report measures of FRA should be used in addition to behavioural testing, to allow for cross-study comparisons, until new, more reliable instruments of self-report are developed. However, self-report measures should not be solely relied upon to identify highly skilled individuals. Implications of these results for theory and applied practice are discussed.
Perioperative metabolic acidosis: The Bradford Anaesthetic Department Acidosis Study
Authors: Lawton TO , Quinn A , Fletcher SJ
Published: April 2018

Metabolic acidosis is considered deleterious but is common in post-surgical patients admitted to intensive care unit. We evaluated the prevalence and time course of metabolic acidosis in elective major surgery, and generated hypotheses about causes, by hourly arterial blood sampling in 92 patients. Metabolic acidosis began before incision and most had occurred by the next hour. Seventy-eight per cent of patients had a significant metabolic acidosis post-operatively. Two overlapping phases were observed. The early phase started before incision, characterised by a rising chloride and falling anion gap, unrelated to saline use. The late phase was partly associated with lactate, related to surgery type, and early fluids appeared protective. There was a trend towards longer intensive care unit (+1.3 days) and hospital (+3.2 days) stay with metabolic acidosis. This is the first large study of the evolution of this common finding, demonstrating a pre-incision component. The early phase appears unavoidable or unpredictable, but the late phase might be modified by early fluid administration. It remains unclear whether acidosis of this type should be avoided.
The role of genetic testing in the prevention of acute aortic dissection
Authors: Carino Davide , Agostinelli Andrea , Molardi Alberto , Benassi Filippo , Gherli Tiziano , Nicolini Francesco
Published: April 2018

Although much has been learned about disease of the thoracic aorta, most diagnosis of thoracic aortic aneurysm (TAA) is still incidental. The importance of the genetic aspects in thoracic aortic disease is overwhelming, and today different mutations which cause TAA or alter its natural history have been discovered. Technological advance has made available testing which detects genetic mutations linked to TAA. This article analyses the genetic aspects of TAA and describes the possible role of genetic tests in the clinical setting in preventing devastating complications of TAA.
Association of baseline level of physical activity and its temporal changes with incident hypertension and diabetes mellitus
Authors: Lee Jong-Young , Ryu Seungho , Sung Ki-Chul
Published: May 2018

Background

The association between baseline and temporal changes in physical activity and incident hypertension or diabetes mellitus in initially non-hypertensive or non-diabetic subjects is rarely known.

Methods

Among individuals who underwent consecutive comprehensive health screenings, their physical activity level was measured using a self-reported international physical activity questionnaire. First, subjects were classified into four categories: no regular physical activity with a sedentary lifestyle; minimal physical activity (<75 min/week); insufficient physical activity (≥75 min but <150 min/week); and sufficient physical activity (≥150 min/week). Second, subjects were sub-grouped, based on temporal changes in physical activity level between baseline and consecutive follow-up: increase, no change, and decrease.

Results

Finally, among 174,314 subjects (mean age 36.7 ± 6.9 years), 5544 (3.18%) and 21,276 (12.2%) developed incident diabetes mellitus and arterial hypertension, respectively. After a multivariate adjustment, sufficient baseline physical activity was associated with significantly lower risk for incident hypertension (hazard ratio 0.89; 95% confidence interval (CI) 0.81 to 0.97), but the difference was not significant, and showed a lower trend in diabetes mellitus incidence (hazard ratio 0.87; 95% CI 0.69 to 1.04) in reference to no regular physical activity group. Regardless of the baseline physical activity level, subjects with a temporal increase in physical activity showed significantly decreased risk for incident hypertension (hazard ratio 0.93; 95% CI 0.87 to 0.99) and diabetes mellitus (hazard ratio 0.83; 95% CI 0.74 to 0.92) compared with those with a temporal decrease in their physical activity level.

Conclusion

Both sufficient baseline physical activity level and its temporal increase were associated with a lower risk of incident hypertension and diabetes mellitus in a large, relatively healthy, cohort.
Seven lessons for interdisciplinary research on interactive digital health interventions
Authors: Blandford Ann , Gibbs Jo , Newhouse Nikki , Perski Olga , Singh Aneesha , Murray Elizabeth
Published: May 2018

Research and development for interactive digital health interventions requires multi-disciplinary expertise in identifying user needs, and developing and evaluating each intervention. Two of the central areas of expertise required are Health (broadly defined) and Human–Computer Interaction. Although these share some research methods and values, they traditionally have deep differences that can catch people unawares, and make interdisciplinary collaborations challenging, resulting in sub-optimal project outcomes. The most widely discussed is the contrast between formative evaluation (emphasised in Human–Computer Interaction) and summative evaluation (emphasised in Health research). However, the differences extend well beyond this, from the nature of accepted evidence to the culture of reporting. In this paper, we present and discuss seven lessons that we have learned about the contrasting cultures, values, assumptions and practices of Health and Human–Computer Interaction. The lessons are structured according to a research lifecycle, from establishing the state of the art for a given digital intervention, moving through the various (iterative) stages of development, evaluation and deployment, through to reporting research results. Although our focus is on enabling people from different disciplinary backgrounds to work together with better mutual understanding, we also highlight ways in which future research in this interdisciplinary space could be better supported.
Mind-Body Skills Training for Resident Wellness: A Pilot Study of a Brief Mindfulness Intervention
Authors: Romcevich Laura E , Reed Suzanne , Flowers Stacy R , Kemper Kathi J , Mahan John D
Published: April 2018

Background:

Interventions to address burnout include mind-body skills training (MBST), but few studies have evaluated the feasibility of MBST for busy pediatric residents.

Objective:

In this pilot study, we tested the feasibility of a brief MBST intervention, using in-person peer-led training supported by online modules, to decrease stress and burnout in pediatric resident physicians.

Methods:

Of 99 (10%) residents, 10 residents at Nationwide Children’s Hospital in Ohio participated in up to four 90-minute MBST sessions more than 1 month, led by a co-resident with 5 years of informal training in mind-body skills. Participants were offered 8 assigned online modules through OSU Center for Integrative Health and Wellness. Measures including Maslach Burnout Inventory (MBI), Cohen’s Perceived Stress, Smith’s Brief Resilience, Cognitive and Affective Mindfulness Scale-Revised, and Neff’s Self-Compassion Scale (NSS) were administered before (T1) and after (T2) the course. Participants were offered optional monthly “maintenance” sessions for 6 months and completed a third set of measures at this follow-up (T3).

Results:

The residents completed an average of 4.3/8 online modules and attended an average of 2.8/4 in-person sessions. There was significant improvement in positive attitude, perceived stress, and resilience post intervention (T2). Follow-up evaluation (T3) also demonstrated significant improvement in burnout (depersonalization) and mindfulness. More than 75% of participants found the course worthwhile.

Conclusions:

A short mixed-method mindfulness-based skills course may be a practical way to offer resilience and stress management training to busy resident physicians.
Treatment of Psoriasis in Women of Childbearing Potential
Authors: Hadi Ahmed
Published: April 2018

While it may be best to avoid any therapies during pregnancy, when treatment is necessary, several options exist. Most topical therapies pose little risk during pregnancy with the notable exception of tazarotene. Phototherapy with broad-band UVB or narrow-band UVB is probably as safe as sunlight. PUVA is rated pregnancy category C because of its mechanism of action. Of the currently available oral medications, methotrexate and acitretin are clearly teratogenic, while cyclosporine appears to be the safest of these medications. With the introduction of biologic agents, we now have many new therapies that may be safely administered during pregnancy if psoriasis is severe.
Compatibility of Ammonium Lactate 12% with Halobetasol Propionate 0.05% and Hydrocortisone Valerate 0.2%
Authors: Cheng Ruofan , Krazmien Rick , Czopp Mark , Panaro Stephen A. , Patel Bhiku
Published: April 2018

Background

Topical corticosteroids are the most common agents used to treat psoriasis in the United States but are associated with a number of side effects including cutaneous atrophy. Ammonium lactate is proven to prevent cutaneous atrophy by preserving dermal ground substance and reducing steroid-induced epidermal atrophy.

Objective

To determine the compatibility of ammonium lactate with halobetasol propionate and hydrocortisone valerate when mixed together.

Methods

0.05% halobetasol propionate ointment and 0.2% hydrocortisone valerate ointment were mixed with 12% buffered ammonium lactate lotion and analyzed at regular time intervals for evidence of degradation via high-pressure liquid chromatography.

Results

No significant degradation of either halobetasol propionate or hydrocortisone valerate was observed after mixing with ammonium lactate 12%.

Conclusion

It is possible to treat psoriasis with the simultaneous application of either halobetasol propionate ointment or hydrocortisone valerate ointment, and ammonium lactate 12% lotion.

Limitations

Clinical correlation should be performed examining the concomitant application of halobetasol propionate or hydrocortisone valerate, and ammonium lactate 12%.
An Open-Label Trial of Thalidomide in the Treatment of Chronic Plaque Psoriasis
Authors: Tusa Mark G. , Pearce Daniel , Camacho Fabian , Willard Joy , McCarty Ann , Feldman Steven R.
Published: April 2018

Background

Thalidomide inhibits tumor necrosis factor (TNF)-α.

Purpose

To assess the effectiveness of thalidomide in the treatment of psoriasis.

Methods

Twenty subjects with moderate to severe psoriasis were treated with 200 mg of thalidomide daily. Clinical response was observed for 16 weeks with the last dose of thalidomide at 12 weeks.

Results

The severity of psoriasis improved as measured by both psoriasis area and severity index (PASI) and body surface area (BSA) with 40% having >50% improvement by 16 weeks. Mean PASI improvement at weeks 12 and 16 was 32% and 48%, respectively. Lower extremity edema developed in three of the first six patients enrolled, and the starting dose was amended from 200 mg/day to 100 mg/day.

Limitations

The open-label study design and concomitant therapy, albeit inadequately effective, complicates interpretation.

Conclusion

Thalidomide was effective and moderately well-tolerated in patients with psoriasis.
Special Report: IPC Presents Top Psoriasis Research Articles
Authors: Horn Elizabeth J. , Bachelez Hervé , Ståhle Mona , Menter Alan
Published: April 2018

The International Psoriasis Council (IPC) is a global nonprofit organization dedicated to advancing psoriasis research and treatment by providing a forum for education, collaboration and innovation among physicians, researchers and other professionals interested in psoriasis. Each year, IPC identifies the top papers in psoriasis research. Papers are nominated for inclusion by the IPC Board of Directors and then circulated to the IPC membership to identify the most important papers. This selection of top papers includes articles that enhance our understanding of adaptive and innate immunity in psoriasis, the genes that lead to psoriasis susceptibility, clinical research focusing on a new class of drugs, a TNF-inhibitor studied in children, and a population study that uncovers an increased risk of mortality. Summaries were constructed by Elizabeth Horn, Ph.D., M.B.I.; and Hervé Bachelez, M.D., Ph.D., and Mona Ståhle, M.D., Ph.D., provided expert commentary on each article and its value to clinical practice.
Clinical Experience with Alefacept in Canadian Patients with Psoriasis: The Amevive Wisdom Acquired from Real-world Evidence (AWARE) Study
Authors: Landells Ian , Searles Gordon , Shear Neil , Bissonnette Robert
Published: April 2018

Background

Alefacept was the first biologic therapy approved for the treatment of chronic plaque psoriasis in Canada.

Objective

The AWARE study was an observational phase IV study whose main goal was to describe the outcomes of alefacept treatment in a broad population of Canadian psoriasis patients.

Methods

A total of 426 patients with chronic plaque psoriasis were enrolled from 37 clinics across Canada. Patients were treated with up to two courses of alefacept and followed for up to 60 weeks.

Results

The majority of patients had a moderate to marked response to alefacept treatment. Treatment with concomitant systemic therapy was discontinued or reduced in up to a third of subjects. Forty percent completed the entire follow-up period without receiving a second course of alefacept.

Conclusion

In routine clinical settings in Canada, alefacept is an effective and safe option for the treatment of a wide range of patients with psoriasis.
Development of Multiple Viral Warts in a Patient Receiving the TNF-α Inhibitor Etanercept
Authors: Ferreira Torres Tiago Costa , Vasconcelos Sanches Madalena , Manuela Selores Maria
Published: April 2018

The development, recurrence or exacerbation of some cutaneous viral infections, such as molluscum contagiosum, plantar warts and genital condylomata, in patients receiving treatment with tumor necrosis factor-α (TNF-α) antagonists have been described in the literature. We report the development of multiple viral warts in a patient receiving the TNF-α inhibitor etanercept, and their resolution only after the discontinuation of the biologic therapy. TNF-α has an important role in the immune response to infection, including antiviral defense that is probably compromised by TNF-α inhibitors. Patients treated with TNF-α inhibitors may have a higher susceptibility to viral skin infections, and physicians should be aware of this potential complication.
Narrow-band UVB: Is It Carcinogenic?
Authors: Price Meredith , Lim Henry W.
Published: April 2018

Background

Phototherapy has been used for many years as a treatment for psoriasis. It has progressed from simple heliotherapy, to the utilization of specific wavelengths including ultraviolet light A (UVA), psoralen plus UVA (PUVA photochemotherapy), broad-band ultraviolet light B (BB-UVB), and narrow-band UVB (NB-UVB). NB-UVB in particular has become a much utilized treatment for psoriasis due to its efficacy and safety profile.

Objective

This paper reviews the published literature regarding the question of increased carcinogenesis with the use of NB-UVB in psoriasis.

Methods

Studies published between 1980 and 2008 with English abstracts identified in PubMed, with the key words psoriasis, phototherapy, carcinogenesis, and NB-UVB, were reviewed.

Results

Rates of carcinogenesis with the use of NB-UVB are lower than or equal to other current phototherapy modalities.

Conclusion

NB-UVB is an effective and overall safe treatment option in the therapy of psoriasis.
Cellular Interactions in Vitro: Psoriatic Keratinocytes Enhance T Lymphocyte Survival
Authors: Rosa Fortin Marie-Michèle , Poubelle Patrice E. , Soucy Jacques , Pouliot Roxane
Published: April 2018

Background

The pathogenesis of psoriasis vulgaris is attributed to an immune dysregulation of T lymphocytes, and psoriatic plaques result from interactions between keratinocytes and T lymphocytes.

Objective

To decipher the impact of keratinocyte-T lymphocyte interactions on cell survival during active cutaneous psoriasis by using a new in vitro model of psoriasis.

Methods

Cocultures of psoriatic or healthy keratinocytes were performed with normal human blood T lymphocytes. Apoptosis was detected by flow cytometry after labeling cells with annexin V and propidium iodide.

Results

Psoriatic keratinocytes were significantly more efficient than healthy keratinocytes in enhancing T lymphocyte survival.

Conclusion

Our in vitro model is pertinent to understanding the immunopathogenesis of psoriasis and to discovering new pharmacological targets.
Psoriasiform Eruption following the Treatment of Cutaneous Sarcoidosis with Infliximab
Authors: Andrews Israel D. , Schlauder Scott M. , Gottlieb Alice B.
Published: April 2018

Psoriasiform eruptions have been reported to occur in patients who have undergone treatment with etanercept, infliximab or adalimumab for a myriad of conditions, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Behçets disease and Crohn's disease. Additionally, the paradoxical occurrence of psoriasiform eruptions following the treatment of psoriasis with tumor necrosis factor-alpha (TNF-α) inhibitors has given rise to a number of case series and several theories concerning the mechanism underlying TNF-α flare. Herein, we report a psoriasiform eruption following the treatment of cutaneous sarcoidosis with infliximab. To our knowledge, this is the first such documented case.
A Guide to the Use of Adalimumab
Authors: Timashev Leonid , Fernandes Neil F.
Published: April 2018

Adalimumab, a fully human monoclonal antibody, is a newer member of the tumor necrosis factor-α antagonist class of drugs. The Food and Drug Administration approved it in 2008 for the treatment of moderate to severe chronic plaque psoriasis, and it has proved highly effective when compared with other conventional therapies. Herein we describe the indications, administration, contraindications, and potential adverse effects (e.g., immunosuppression) of adalimumab as well as its safety record for both short- and long-term use. An important advantage of adalimumab is that it can be administered by patients themselves.
Infliximab in the Management of Psoriasis in Patients Previously Treated with Other Biologic Agents
Authors: Vergou Theognosia , Moustou Aikaterini E. , Tseke Paraskevi , Stratigos Alexander J. , Katsambas Andreas , Antoniou Christina
Published: April 2018

Objective

To determine the efficacy of infliximab in psoriatic patients with moderate to severe disease who failed to respond, relapsed, or experienced an adverse event with other biologics.

Methods

We evaluated 19 patients with plaque-type psoriasis. Ten also suffered from psoriatic arthritis. All subjects had been previously treated with one or more biologics and discontinued treatment either because of no response or adverse events from the precedent therapy. We evaluated the Psoriatic Area and Severity Index (PASI) score as a response to treatment.

Results

Overall, there was a statistically significant reduction in PASI (P = 0.002). At week 14, 88% had achieved PASI 50, 61% PASI 75, and 44% PASI 90. At this time point, no patient had discontinued treatment for any reason. Before completion of the first year of treatment, four patients discontinued infliximab because they had not seen any response. At week 78, the result remained the same as at week 14, taking into consideration the bias caused by some patients' discontinuation. Two patients discontinued because of serious adverse events.

Conclusions

In the small cohort of patients with moderate to severe psoriasis refractory to other biologics, infliximab is an important and safe therapeutic pathway. Differences in chemical structure, mode of action, or immunogenicity could explain the successful change to infliximab. The expanding use of biologics in clinical dermatology will allow us to describe and delineate more fully the benefit of switching from one biologic agent to another.
Update on Combination Treatment with Acitretin for Generalized Psoriasis
Authors: Bhutani Tina
Published: April 2018

Acitretin (Soriatane) is the only systemic retinoid approved for the treatment of psoriasis. Unlike all other anti-psoriasis systemic agents, acitretin is the only clinically nonimmunosuppressive systemic medication that works primarily by enhancing differentiation and maturation of cells. More than any other systemic agents, acitretin is used in combination with other agents. Combination therapy provides effective treatment while allowing lower doses of individual medications and decreasing the occurrence of side effects. This article reviews the available literature on combination therapy with acitretin and provides an update for combined use of acitretin with topical agents, other systemic medications, and phototherapy.
The Role of Cardiovascular Disease in the Patient with Psoriasis
Authors: Patel Rita V.
Published: April 2018

Psoriasis is an immune-mediated disease that affects up to 3% of the general population. Cardiovascular disease types like coronary artery disease, cerebrovascular disease, and peripheral vascular disease occur independently in the patient with psoriasis when controlling for confounding factors. Additionally, population-based studies report that cardiovascular disease risk factors like hypertension, obesity, diabetes, smoking, and metabolic syndrome occur with a higher prevalence in the psoriasis patient population. This review article highlights those studies detailing the cardiovascular disease types and risk factors that arise with increased prevalence in patients with psoriasis. Additionally, this article reviews those trials that investigated the disease-specific inflammatory markers (i.e., hyperhomocysteinemia, C-reactive protein, and tumor necrosis factor-α) and comorbid risk factors (i.e., insulin resistance and metabolic syndrome) that might be impacted when systemic therapies are implemented in the patient with psoriasis.
A Strategic Approach to Setting the Research Agenda in Psoriasis
Authors: Barker Jonathan , Kimball Alexa Boer , William Tebbey Paul , Sterry Wolfram ,   for the International Psoriasis
Published: April 2018

Research into all the relevant facets of disease characteristics—including epidemiology, genetics, and pathogenesis—has historically yielded important insights that result in a progression of understanding as well as advances in treatment of disease. Certainly psoriasis can be highlighted as an example of a disease that through history has benefitted from the integration of serendipitous observation and defined research strategy, an interaction that has resulted in dramatically improved clinical comprehension and management of the condition. Despite this progress, major gaps still exist in our understanding of the different elements of the disease that could be used to guide the medical community's approach to research. Traditionally, medical research is organized along geopolitical and departmental divisions. This structure tends to impede collaboration in a multidisciplinary manner or by multiple organizations working congruently. To overcome this impediment, the objective of this International Psoriasis Council initiative was to leverage the available knowledge to highlight the key research needs in psoriasis and to convene appropriate experts, without regard for geography or research specialty, to make major strides in improving the overall outcomes for psoriasis patients.
Care of Generalized Psoriasis in Elderly Patients beyond Topical Therapy: A Review and a Proposed Algorithm
Authors: Matsunaga Matthew , Lee Eric S. , Heller Misha M. , Koo John
Published: April 2018

Treatment of psoriasis in the elderly population can present many challenges to the physician. Herein we propose a treatment algorithm for psoriasis in this age group. When choosing a therapy for generalized psoriasis in elderly patients, ultraviolet treatments should be attempted first because of their efficacy and safety. Of the external treatment approaches, Goeckerman, although one of the safest and most effective therapies, should be a later treatment option, reserved for the most severe, recalcitrant cases. Acitretin is the next best approach because of its nonclinically immunosuppressive nature. If combination therapy of acitretin with phototherapy proves inadequate, etanercept, adalimumab, alefacept, ustekinumab, and infliximab should then be considered, in successive order. The penultimate treatment options to consider should be the oral agents, cyclosporine and methotrexate, because of their greater risk of major organ toxicity. The last option involves combination therapy with systemic immunosuppressant agents.
Selection of Therapies in Patients with Psoriasis and Psoriatic Arthritis
Authors: Stevenson Mary L. , Markowitz Orit
Published: April 2018

Background

Psoriatic arthritis is a chronic and debilitating condition. The biologic therapies are targeted therapeutic options that have shown promise; notably, there are substantial data supporting the use of the anti–tumor necrosis factor (TNF) agents in the treatment of psoriatic arthritis and in the prevention of radiographic progression of joint destruction. We report three cases that demonstrate the selective benefits of ustekinumab and of TNF blockers, depending on the relative severities of joint and cutaneous symptoms.

Observations

We describe three cases of psoriatic arthritis and psoriasis in patients being treated with anti-TNF agents who, after switching to ustekinumab from TNF blockers, complained of worsening joint pain, although their cutaneous findings improved. Two of these patients opted to discontinue their therapy with ustekinumab and restart anti-TNF therapy; they prioritized control of their joint pain over the skin clearing they had while taking ustekinumab.

Conclusions

Ustekinumab may not be as efficacious as agents that block TNF for the treatment of psoriatic arthritis. Further study is needed to assess its efficacy in psoriatic arthritis.
The Role of Vitamin D in Psoriasis
Authors: Gold Lauren , Haddican Madelaine M.
Published: April 2018

The function of vitamin D in regulating the inflammation, proliferation, and differentiation of keratinocytes has led to the use of topical vitamin D analogs for the treatment of plaque psoriasis. Both calcipotriene, a synthetic form of vitamin D, and calcitriol, a naturally occurring form of vitamin D, are commonly prescribed topical agents that have demonstrated significant improvement in the treatment of mild to moderate plaque psoriasis compared with vehicle alone. The most effective use of vitamin D analogs for plaque psoriasis has been in combination with topical corticosteroids. The low side-effect profile of these topical vitamin D agents also makes them an important therapeutic option for plaque psoriasis. This article summarizes the major studies involving topical vitamin D analogs for plaque psoriasis with suggestions for areas of future study.
Increased Prevalence of Sleep Disorders and Medical Comorbidities in Psoriatic Arthritis Patients Compared with Patients with and without Psoriasis
Authors: Wong Bob , Machan Mac , Krueger Gerald G. , Duffin Kristina Callis
Published: April 2018

Background

The relationship between sleep quality and medical comorbidities of psoriasis and psoriatic arthritis is poorly understood.

Objective

To evaluate the association of sleep disturbance and medical comorbidities in patients with psoriasis and psoriatic arthritis compared with healthy volunteers.

Methods

This cross-sectional study compared patients with psoriasis, patients with psoriatic arthritis, and control participants. The Pittsburgh Sleep Quality Inventory (PSQI) and the Global Fatigue Scale were used to measure sleep disturbance and fatigue.

Results

The psoriatic arthritis, psoriasis, and control groups had elevated mean PSQI scores indicating poor sleep quality; the psoriatic arthritis group had the statistically highest mean score. Psoriatic arthritis patients had higher mean body mass index and a higher prevalence of diabetes, restless leg syndrome, and insomnia.

Conclusions

Poor sleep quality and medical comorbidities were prevalent in patients with psoriasis and psoriatic arthritis but are highest in patients with psoriatic arthritis. The link between sleep disorder, psoriatic disease, and medical comorbidities deserves more study.
Biologic Therapy and the Risk of Malignancy in Psoriasis
Authors: Wolinsky Claire , Lebwohl Mark
Published: April 2018

Biologic agents are currently regarded as a highly efficacious systemic treatment for moderate to severe psoriasis. However, their use in patients with a history of malignancy or an increased risk of cancer is not recommended. The current recommendations are based on several case reports and observational studies, as well as data from randomized, controlled trials, associating these medications with tumorigenic properties. Furthermore, some reports describe malignancies arising de novo in patients using biologic agents. Psoriasis patients are at an increased risk of lymphoproliferative diseases and nonmelanoma skin cancers because of the inflammatory nature of the disease. A blockade of tumor necrosis factor-alpha (TNF-α) reduces inflammation but also may enhance tumor proliferation. Trials have not shown a significant increase in the risk of malignancy, with the exceptions of lymphoma and nonmelanoma skin cancers, with the use of TNF blockers. However, any risk may be unacceptable in a patient with a history or elevated risk of cancer. Ustekinumab acts on a different inflammatory pathway and may have a different profile regarding the risk of malignancy. A comprehensive review of the literature shows some consensus that relative contraindications are active malignancies and malignancies within the past 5 years. There is debate about nonmelanoma skin cancers and melanoma, but it seems prudent to use biologics more cautiously in a patient with a history of aggressive skin cancer, a high risk of recurrent skin cancer, or a history of extreme ultraviolet exposure. Additionally, certain combinations of immunosuppressive therapies, such as purine analogs, with biologics may lead to unacceptable risks of malignancy. Some subgroups, such as patients with chronic obstructive pulmonary disease, are already predisposed to lung cancer because of a significant smoking history; these patients require closer monitoring during biologic therapy. As the biologics are in use longer for psoriasis, more data on the long-term safety of these therapeutics will be available.
A Review of Home Phototherapy and Available Home and Handheld Phototherapy Units
Authors: Narang Kirti , Gottlieb Alice B.
Published: April 2018

Psoriasis is considered one of the most prevalent immune-mediated inflammatory diseases, which leads to physical and emotional disabilities that can severely impact patients' quality of life. Phototherapy with ultraviolet (UV) radiation has been an effective treatment for psoriasis for well over 85 years. Home phototherapy is becoming more popular as several factors act as a barrier for outpatient phototherapy for moderate to severe psoriasis.

Various studies have shown home phototherapy to be an effective and safe option. Today, many phototherapy units are available for home use. In this article, we will review the efficacy and safety of home phototherapy and briefly discuss the available home phototherapy units, including handheld units for scalp psoriasis and psoriasis limited to smaller body surface area.
Paving the Way for Future Medical Dermatology Leaders in Psoriasis and Psoriatic Arthritis: 1st Annual Mentoring Program for Dermatology Fellows
Authors: Husni M. Elaine , Duch Daniel , Korman Neil
Published: April 2018

There is a growing shortage of dermatologists in the United States, with fewer dermatologists concentrating on the management of chronic diseases such as psoriasis and psoriatic arthritis. There are no programs focused on fellows interested in medical dermatology. To address this need, a mentoring conference was developed for dermatology fellows. They were nominated for the program by their advisors, and selected based on their academic potential, research interests, and experience. The conference was highly interactive with a focus on building relationships with like-minded individuals interested in academic medicine. Faculty presented the most recent, clinically relevant knowledge regarding classification, diagnosis, and treatment of psoriatic diseases. Other topics included developing research questionnaires, solidifying a hypothesis, and optimizing interactions with a mentor. Fellows presented original research and were given the opportunity to respond to critiques. The conference was considered by all to be highly successful. Plans to strengthen and expand the program for next year are under way.