Study of efficacy and safety of noncultured, extracted follicular outer root sheath cell suspension transplantation in the management of stable vitiligo

Abstract

Background

Noncultured, extracted follicular outer root sheath suspension (NC-EHF-ORS-CS) is a recently introduced technique for the treatment of stable vitiligo.

Objective

To study the clinical efficacy of this technique and to determine the viability and cell composition of the suspension.

Methods

Twenty-five patients with stable vitiligo were included in this prospective study. Fifty follicles were extracted from occipital scalp and were incubated with trypsin–ethylenediaminetetraacetic acid to separate outer root sheath cells. The cell suspension was filtered and centrifuged to obtain a cell pellet, which was resuspended and applied to the dermabraded recipient area. Cell viability of the suspension was assessed using trypan blue staining, and markers of keratinocyte stem cells (CD200) and melanocytes (S100) were evaluated using flow cytometry and immunocytochemistry, respectively.

Results

At 6 months, the mean (±SD) repigmentation was 52 ± 25.1%, and >75% repigmentation was seen in 8/25 (32%) patients. Mean percentage cell viability of the suspension was 80 ± 17.2% with a mean concentration of CD200 + and S100 + cells being 7.91 ± 8.68% and 9.93 ± 1.22% (n = 3), respectively. Recipient site infection was seen in 4 of 25 (16%) patients and a color mismatch in 11 of 25 (44%) patients.

Conclusion

NC-EHF-ORS-CS is a useful minimally invasive therapy for vitiligo.

http://ift.tt/2kj8O7A

Acne keloidalis nuchae in Latin America: is there a different phenotype?

http://ift.tt/2xbJJ4s

Nevus trichilemmocysticus

http://ift.tt/2kh04ia

Dermatoscopic evaluation and histopathological correlation of acquired dermal macular hyperpigmentation

Abstract

Background

Acquired dermal macular hyperpigmentation (ADMH) is a hypernym encompassing Riehl's melanosis, lichen planus pigmentosus, and ashy dermatoses that show significant clinicopathological overlap. We sought to describe the dermatoscopic features of ADMH and correlate them with histopathological findings.

Methods

This was a prospective observational study performed in two phases. A detailed clinical and dermatoscopic examination was performed, and skin biopsies were obtained in 51 patients. Two dermatologists and a blinded dermatopathologist studied archived dermatoscopic images and histopathology specimens, respectively.

Results

Dermatoscopic features noted were (i) pigment structures; dots (82.4%), globules (66.7%) and blotches (56.9%) that spared the eccrine and hair follicle openings; (ii) telangiectasia (82.4%); (iii) accentuation of the normal pseudoreticular pigmentary network (33.3%); (iv) owl's eye structures (15.7%). Four dermatoscopic grades of disease severity were identified: grade 1 – dotted; grade 2 – Chinese letter; grade 3 – reticulate; and grade 4 – diffuse. Density of melanin incontinence on histopathology correlated positively with size of pigment structures (r = 0.7, P < 0.000) and grades of disease severity (r = 0.75, P < 0.000) on dermatoscopy.

Conclusion

Increasing grades of disease severity can be detected dermatoscopically, which correlate well with histopathological features. A carefully performed dermatoscopy aids in better patient counseling regarding disease severity.

http://ift.tt/2xcq9Fd

Immunological classification of renal cell carcinoma patients based on phenotypic analysis of immune check-point molecules

Abstract

Objectives

To clarify comprehensive immunological signature patterns of tumour tissue-infiltrating lymphocytes in patients with renal cell carcinoma and show its clinical significance.

Materials and methods

We investigated the surface marker expressions of tumour tissue-infiltrating lymphocytes quantitatively and classified them based on their functional populations. We extracted 109 sets of tumour tissue-infiltrating lymphocytes from 80 patients who underwent surgical resection of renal cell carcinoma, of which 44 tumour tissue-infiltrating lymphocytes were multiply extracted from 15 patients. Each tumour tissue-infiltrating lymphocyte was characterised on the basis of functional T-cell populations using ten surface marker expressions measured by flow cytometry.

Results

All sets of the tumour tissue-infiltrating lymphocytes were classified into three groups, which correlated significantly with Fuhrman grade (OR 0.253, 95% CI 0.094–0.678, P = 0.006). Importantly, both overall metastasis-free survival (HR 0.449, 95% CI 0.243–0.832, P = 0.011) and recurrence-free survival (HR 0.475, 95% CI 0.238–0.948, P = 0.035) of the patients with the higher marker expressions were significantly inferior to those of the patients with the lower marker expressions by multivariate analysis. Six specific genes for this classification identified by microarray analysis verified our results using the TCGA KIRC data set. In addition, we discovered the presence of intra-tumoural diversity in the classification of 3 (20%) of the 15 patients.

Conclusions

This study showed that the presence of classable diversity in the immunological signature of tumour tissue-infiltrating lymphocytes correlated with prognosis and tumour aggressiveness that was observed even within individual tumours in some patients with renal cell carcinoma.

http://ift.tt/2kj7j9s

Abnormal Structural Brain Connectome in Individuals with Preclinical Alzheimer’s Disease

Abstract

Alzheimer's disease has a long preclinical phase during which amyloid pathology and neurodegeneration accumulate in the brain without producing overt cognitive deficits. It is currently unclear whether these early disease stages are associated with a progressive disruption in the communication between brain regions that subsequently leads to cognitive decline and dementia. In this study we assessed the organization of structural networks in cognitively normal (CN) individuals harboring amyloid pathology (A+N−), neurodegeneration (A−N+), or both (A+N+) from the prospective and longitudinal Swedish BioFINDER study. We combined graph theory with diffusion tensor imaging to investigate integration, segregation, and centrality measures in the brain connectome in the previous groups. At baseline, our findings revealed a disrupted network topology characterized by longer paths, lower efficiency, increased clustering and modularity in CN A−N+ and CN A+N+, but not in CN A+N−. After 2 years, CN A+N+ showed significant abnormalities in all global network measures, whereas CN A−N+ only showed abnormalities in the global efficiency. Network connectivity and organization were associated with memory in CN A+N+ individuals. Altogether, our findings suggest that amyloid pathology is not sufficient to disrupt structural network topology, whereas neurodegeneration is.

http://ift.tt/2fFYWzw

Intraoperative naloxone reduces remifentanil-induced postoperative hyperalgesia but not pain: a randomized controlled trial

Abstract

Background

Intraoperative use of a high-dose remifentanil may induce postoperative hyperalgesia. Low-dose naloxone can selectively reverse some adverse effects of opioids without compromising analgesia. We thus hypothesized that the intraoperative use of a high-dose remifentanil combined with a low-dose naloxone infusion reduces postoperative hyperalgesia compared with the use of remifentanil alone.

Methods

Patients undergoing elective thyroid surgery were randomly assigned into one of three groups, depending on the intraoperative effect-site concentration of remifentanil, with or without a continuous infusion of naloxone: 4 ng ml⁻¹ remifentanil with 0.05 μg kg⁻¹ h⁻¹ naloxone in the high-remifentanil with naloxone group, and 4 or 1 ng ml⁻¹ remifentanil with a placebo in the high- or low-remifentanil groups, respectively. We measured the pain thresholds (primary outcome) to mechanical stimuli using von Frey filaments and incidence of hyperalgesia on the peri-incisional area 24 h after surgery. We also measured pain intensity, analgesic consumptions and adverse events up to 48 h after surgery.

Results

The pain threshold presented as von Frey numbers [median (interquartile range)] was significantly lower in the high-remifentanil group (n=31) than in the high-remifentanil with naloxone (n=30) and the low-remifentanil (n=30) groups [3.63 (3.22–3.84) vs 3.84 (3.76–4.00) vs 3.80 (3.69–4.08), P=0.011]. The incidence of hyperalgesia was also higher in the high-remifentanil group than in the other groups [21/31 vs 10/30 vs 9/30, P=0.005]. Postoperative pain intensity, analgesic consumptions and adverse events were similar between groups.

Conclusions

The intraoperative use of low-dose naloxone combined with high-dose remifentanil reduced postoperative hyperalgesia but not pain.

Clinical trial registration

NCT02856087.

http://ift.tt/2xbFMwE