Citations

AbstractBackgroundIntensive treatment options are lacking for patients with severe skin disease recalcitrant to outpatient therapy. The availability of inpatient dermatology care has almost disappeared in many parts of the United States. One possible solution for this is a day treatment center for patients with severe dermatologic disease recalcitrant to outpatient therapy.MethodsDescriptive study based on retrospective medical record review of all patients attending the day hospital for treatment in 2010. We collected data on patient demographics, distribution of admission diagnosis, treatments used, and length of stay.ResultsA total of 211 patients had 235 admissions. Mean age was 57.7 years (range 3.8–92.1 years). The most common indications for admission were dermatitis (139 admissions [59.2%]), psoriasis (58 [24.7%]), and mycosis fungoides (eight [3.4%]). The main treatment interventions were wet dressings (195 admissions [83.0%]) and Goeckerman treatment (38 [16.2%]). The median number of days of treatment was three (interquartile range, 2–5 days) for wet dressings and 22 days (interquartile range, 21–24 days) for Goeckerman therapy.ConclusionsThe dermatology day treatment center provided intensive skin‐directed therapy and filled a critical practice gap in the management of our patients with severe widespread skin diseases recalcitrant to outpatient therapy. We propose that the dermatology day treatment center is a valuable model that could be considered by both private practitioners and academic centers in the United States as an important adjunct to fill the gap in availability of intensive topical treatments for patients with severe skin disease.

AbstractBackgroundDermatology consultations are frequently requested by inpatient hospital services. As inpatient dermatology services in the USA decline, dermatology hospital consultations are becoming increasingly important.ObjectivesWe aim to describe the spectrum of skin diseases encountered and the health care subspecialties requesting dermatology hospital consultations.MethodsWe performed a retrospective chart review of adult patient (age: ≥18 years) dermatology hospital consultations from January 1 to December 31, 2010. We examined patient demographic characteristics, consultation requesting services, and consultation diagnoses.ResultsAmong dermatology services, 614 patients had 674 separate inpatient dermatology consultations during 2010. Of these patients, 55.9% were male (mean age: 59 years). In total, 205 consultations (30.4%) were requested by the internal medicine subspecialty, 137 (20.3%) by the hematology and oncology subspecialty, and 93 (13.8%) by the surgical subspecialty. The most common conditions seen by the hospital dermatology consulting service were skin infections (n = 125, 18.5%), dermatitis (n = 120, 17.8%), drug eruptions (n = 87, 12.9%), chronic wounds and ulcers (n = 55, 8.1%), cutaneous neoplasms (n = 39, 5.8%), graft‐versus‐host disease (n = 37, 5.5%), ecchymosis, purpura simplex or petechia (n = 26, 3.8%), intertrigo (n = 21, 3.1%), and urticaria (n = 20, 3.0%).ConclusionsThe majority of consultations conducted by the dermatology hospital consulting service were for the management of common skin diseases, such as cutaneous infections, dermatitis, and drug eruptions. Most consultations were requested by the departments of internal medicine, hematology and oncology, and surgical services.

Objective Several definitions have been proposed to distinguish the daughter sac when treating unruptured intracranial aneurysms. The aim of this study was to evaluate interobserver variability of aneurysm morphology, including the daughter sac, using criteria from the International Study of Unruptured Intracranial Aneurysms (ISUIA) and the Unruptured Cerebral Aneurysm Study of Japan (UCAS). Materials and methods After approval by the institutional review board, we analyzed three morphological features (daughter sac, lobulation, and irregular margin) from the ISUIA and UCAS using angiographic images from 102 saccular aneurysms. Four independent readers interpreted each morphological criterion using dichotomized scales (existence or not). The κ statistic was used to measure interobserver agreement, and κ>0.6 was considered substantial agreement. Results For discrimination of the daughter sac, interobserver agreement among the four readers was substantial using the UCAS criteria (k=0.626 for two-dimensional (2D) and 0.659 for three-dimensional (3D) images) but not for the ISUIA criteria (k=0.487 for 2D and 0.473 for 3D images; significant difference). Irrespective of the images used, pairwise pooled κ values for the UCAS were >0.6, except for one case (score of 0.54 between readers A and B). Regarding the proportion of positive reads, there was a significant difference between reads for the daughter sac using the UCAS and ISUIA criteria. Conclusions For discrimination of the daughter sac, the UCAS definition showed a higher reliability than the ISUIA. However, a further prospective study is necessary to validate this definition as the treatment standard for unruptured intracranial aneurysms.

Key points Sarcopenia of the diaphragm muscle, i.e. loss of muscle force and size with increasing age, may contribute to respiratory impairment in old age but the exact mechanisms underlying this are currently unknown. Across the lifespan in mice there is worsening neuromuscular function of the diaphragm muscle, specifically reduced force and impaired neuromuscular transmission. We tested the hypothesis that age‐related changes to the diaphragm muscle depend on brain‐derived neurotrophic factor (BDNF), acting through its high affinity receptor. BDNF improves neuromuscular transmission in the diaphragm muscle into early old age, but not older ages. Inhibition of BDNF signalling impairs neuromuscular transmission only in young adult mice. Our results suggest that the loss of endogenous BDNF precedes reduced activity of the high affinity receptor tropomyosin‐related kinase receptor B in the ageing mouse diaphragm muscle. Abstract The age‐related mechanisms underlying sarcopenia are largely unknown. We hypothesize that age‐related neuromuscular changes depend on brain‐derived neurotrophic factor (BDNF) acting through the tropomyosin‐related kinase receptor B (TrkB). Maximal specific force and neuromuscular transmission failure were assessed at 6, 18 and 24 months following control, BDNF or phosphoprotein phosphatase 1 derivative (1NMPP1) treatment in male TrkB F616A mice. Phosphoprotein phosphatase‐1 derivatives such as 1NMPP1 inhibit TrkB kinase activity as a result of this single amino acid mutation in the ATP binding domain. Maximal twitch and isometric tetanic force were reduced at 24 months compared to 6 and 18 months ( P < 0.001). Neuromuscular transmission failure significantly increased at 18 and 24 months compared to 6 months (age × treatment interaction: P < 0.001). Neuromuscular transmission was improved following BDNF at 6 and 18 months and was impaired only at 6 months following 1NMPP1 treatment. Age and inhibition of TrkB kinase activity had similar effects on neuromuscular transmission failure, supporting a critical role for BDNF/TrkB signalling on neuromuscular changes in ageing. These results suggest that an age‐related loss of endogenous BDNF precedes reductions in TrkB kinase activity in the diaphragm muscle.

ObjectiveTo determine trends in the incidence and clinical presentation of ankylosing spondylitis (AS), the incidence of cardiovascular disease (CVD), and cardiovascular (CV) risk factors among patients with AS and compare the observed incidence of CVD with that predicted by the Framingham Risk Score (FRS).MethodsA population‐based inception cohort of residents of Olmsted County, Minnesota age ≥18 years who fulfilled Modified New York Criteria for AS in 1980–2009 was assembled. Clinical features at presentation were recorded. Age‐ and sex‐adjusted incidence rates and survival were estimated. Incident CVD and CV risk factors were identified. The 10‐year CVD risk was calculated using the FRS. Standardized incidence ratios (ratios of observed CVD in AS to that predicted by the FRS) were calculated.ResultsEighty‐six patients were diagnosed with AS over the study period with an age‐ and sex‐adjusted incidence of 3.1 per 100,000 (95% confidence interval [95% CI] 2.5–3.8). The mean age at diagnosis was 35 years (range 19–69 years). Inflammatory back pain, seen in 90% of patients, was the most common presenting manifestation. The 10‐year mean ± SD cumulative incidence of CVD was 15.8% ± 6.1%, three times higher than the predicted events based on the FRS (standardized incidence ratio 3.01, 95% CI 1.35–6.69; P = 0.007). Overall survival was similar to the general population.ConclusionAS occurs in approximately 3 persons per 100,000 per year. Clinical features, extraarticular manifestations, and interval from symptom onset to diagnosis have remained constant in this population over the study period. The CVD risk in these patients is higher than expected and underestimated by the FRS.

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Abstract Objective To determine the prognosis of patients with non‐secretory myeloma. Methods We studied 124 patients diagnosed with multiple myeloma who had no monoclonal protein detected on serum and urine immunofixation at diagnosis and on all subsequent follow‐up testing (non‐secretory myeloma). The overall survival ( OS ) of patients with non‐secretory myeloma was compared with 6953 patients with typical myeloma seen during the same time period in whom a monoclonal protein was detected at the time of diagnosis. Results One hundred and twenty‐four patients met criteria for non‐secretory multiple myeloma. The median follow‐up was 102 months (range, 1–204 months). The median progression‐free survival with initial therapy was 28.6 months, and the median OS was 49.3 months. There was a significant improvement in OS since 2001; median survival 43.8 months (prior to 2001) vs. 99.2 months (2001–2012), P < 0.001. OS was superior in patients with a normal baseline FLC ratio ( n = 10) compared to patients with an abnormal ratio ( n = 19), medians not reached in both groups. Prior to 2001, OS was similar in non‐secretory myeloma ( n = 86) and secretory myeloma ( n = 4011), median 3.6 vs. 3.5 yr, respectively, P = 0.63. However, among patients diagnosed between 2001 and 2012, OS was superior in non‐secretory myeloma ( n = 36) compared to secretory myeloma ( n = 2942), median 8.3 vs. 5.4 yr, respectively, P = 0.03. Conclusions Non‐secretory myeloma is an uncommon subtype of multiple myeloma. In the last decade, there has been an improvement in the survival of non‐secretory myeloma and appears superior to secretory myeloma.