Desiree Wiegleb Edström

Photodynamic therapy with topical 5-aminolevulinic acid for mycosis fungoides : Clinical and histological response

There is no curative treatment for mycosis fungoides (MF), the most common primary cutaneous T-cell lymphoma. The aim of this study was to investigate the response of single lesions to photodynamic therapy (PDT). The study included 10 plaque MF lesions and 2 tumour MF lesions from 10 patients. First, 20% 5-aminolevulinic acid was applied topically to the lesion and adjacent skin for 5-6 h. The lesion was then exposed to red light at around 630nm. Skin biopsies were taken before treatment, after clinical improvement and after clinical remission. The expression of CD3, CD4, CD7, CD8, CD1a, CD34, CD68, CD71, Ki-67, bcl-2 and p53 was studied immunohistochemically. There was complete clinical clearance in seven of nine plaque lesions. Neither tumour lesion responded to PDT. The biopsies confirmed a regression of the infiltrate after treatment. In the sparse remaining infiltrate a few CD4+ and CD8+ cells were found, most of which showed normal bcl-2. There were also fewer proliferating cells, illustrated by a decrease in Ki-67 and CD71. In conclusion, PDT has good clinical and histological effects in treating local plaque MF lesions.

The mutagenic effect of ultraviolet‐A1 on human skin demonstrated by sequencing the p53 gene in single keratinocytes

Background:  Sun exposure is accepted as the major risk factor for developing skin cancer, the most common cancer in the western world. Ultraviolet‐B (UV‐B) radiation is considered the causative agent, but recently several findings suggest a role also for ultraviolet‐A (UV‐A) radiation. Repeated suberythemal doses of ultraviolet‐A1 (UV‐A1) on healthy human skin induce an increase of p53 immunoreactive cells in epidermis, which may indicate cell cycle arrest and/or occurrence of p53 mutations.

Effects on human skin of repetitive ultraviolet-A1 (UVA1) irradiation and visible light.

Background: Ultraviolet radiation (UVR) has a variety of effects on human skin. Best known are the effects of UVB (290–320 nm) and UVA2 (320–340 nm), which cause DNA damage and increased risk of cancer. However, the effects of UVA1 (340–400 nm) have been not completely investigated.

Long-term Follow-up of Photodynamic Therapy for Mycosis Fungoides

disease (2). We did not observe any local reaction at the site of injection in this case, but the patient complained of asthenia after morning injections, which prompted us to propose evening injections instead. Finally, we wish to speculate on alternative treatments blocking the IL-1 pathway (9), such as IL-1 soluble receptor (IL-1 trap) or caspase-I inhibitor (pralnacasan), or the IL-6 pathway, such as tocilizumab, a monoclonal antibody against human IL-6 receptor (10), as elevated IL-6 levels were observed in some patients (11,12). These treatments are still under development, but they may prove helpful in the future in the management of refractory SS. The authors declare no conflicts of interest.

Vitamin D levels after UVB radiation: effects by UVA additions in a randomized controlled trial

Ultraviolet B (UVB) radiation increases the serum level of 25‐hydroxyvitamin D [25(OH)D]. However, the impact of UVA on vitamin D synthesis by UVB is poorly understood clinically.

Antiviral Therapy in Children with Hydroa Vacciniforme

Hydroa vacciniforme is a rare, usually quite severe, photo-dermatosis. Association with Epstein-Barr virus infection and a possibly increased risk of lymphoproliferative malignancy have been demonstrated. We describe here four patients with Epstein-Barr virus-associated hydroa vacciniforme treated with acyclovir/valacyclovir therapy with a good clinical response. The children were reported to have less fatigue, fewer eruptions, less scarring, and increased ability to spend time outdoors without provoking new eruptions. This was also in agreement with clinical observations. However, one patient progressed into an anaplastic lymphoma kinase-1-negative anaplastic large-cell lymphoma in the upper jaw. This was preceded by an increase in EBV viral load. Acyclovir/valacyclovir therapy is a safe treatment. Further studies are required to confirm these results.

Attitudes and perceptions from nursing and medical students towards the other profession in relation to wound care

ABSTRACT Lack of nurse‒physician collaboration in wound care may result in prolonged healing times for patients. In order to facilitate future professional collaboration, undergraduate learning activities in interprofessional education (IPE) have been proposed. The aim of this study was to investigate nursing and medical students’ attitudes and perceptions towards each other’s future professions and interprofessional collaboration in wound care. Nursing and medical students took part in an interprofessional learning activity about wound care. Data were collected using the Jefferson Scale of Attitudes towards Physician‒Nurse Collaboration questionnaire to student groups before and after an IPE activity (pooled n = 221). Focus groups were conducted to deepen the knowledge about students’ attitudes and perceptions. The results showed high scores on the attitude scale (mean 53.2, possible maximum = 60) both before and after IPE, indicating positive attitudes towards nurse‒physician collaboration. Nursing students scored higher than medical students both pre-IPE (p < 0.001) and post-IPE (p = 0.006). However, no difference on scale scores could be identified between pre- and post-IPE. The following themes emerged in the analysis of focus group discussions: “Approaching patient care from different perspectives,” “Need for collaboration and clear professional roles in practice,” “Structures hindering future collaboration,” and “IPE as a tool for professional practice and roles.” The shared learning activity provided insights into the other profession’s competence. This kind of learning activity may increase future interprofessional collaboration, and thus, improve wound care.

Characteristics of two questionnaires used to assess interprofessional learning: psychometrics and expert panel evaluations

BackgroundInterprofessional learning activities are included in many curricula but are difficult to assess. For languages that are not widely spoken such as Swedish, few validated questionnaires exist that relate to interprofessional outcomes. Therefore, the aim was to examine two such questionnaires in relation to interprofessional competence domains.MethodsPsychometric characteristics, such as homogeneity of items and internal consistency, were assessed for the Swedish versions of the Jefferson Scale of Attitudes Towards Physician-Nurse Collaboration (JSAPNC) and the Readiness for Interprofessional Learning Scale (RIPLS). The questionnaires were distributed directly following IPL activities. Mokken scale analysis based on Loevinger’s coefficient for homogeneity and Cronbach’s alpha were used to evaluate the scales. Two expert panels performed a qualitative analysis of items in relation to four internationally defined interprofessional competences.ResultsIn total, 88 and 84 responded to the JSAPNC and RIPLS questionnaires, respectively. Estimates of homogeneity were low for both the JSAPNC (H = 0.16) and the RIPLS (H = 0.21). Reliabilities were weak (0.62 and 0.66, respectively) for the total scales. The expert panels categorised 68% of items into similar competence domains. However, their discussion revealed ambiguous wordings and imbalances in the two questionnaires in relation to domains.ConclusionInterprofessional competence domains are defined but few validated tools exist to assess them. Examined tools relating to interprofessional learning in Swedish do not qualify for assessing overarching IPL outcomes, and summed scores from these tools should be used with caution.

Response to Norval and de Gruijl's 'Comment on Sallander et al.'.

Our study (1) investigated reported UVA photodegradation effects (2, 3). We exposed three groups of subjects to mainly UVB (‘UVB’, n = 23), UVB + UVA (‘UVAB’, n = 23) or, as in sunbeds, mainly UVA (‘UVA’, n = 10). Exposure times were calculated from measurements of the exposure cabin’s spectral irradiance convoluted with the CIE previtamin D3 action spectrum to give the same vitaminD-weighted radiation dose (≤ 1 standard erythema dose, SED). A fourth group (controls, n = 19) was unexposed. Our responses to Norval and de Gruijl’s numbered comments are below. 1. Mary Norval and Frank de Gruijl argue that uncertainty may be the reason for our lack of evidence of a correlation between change in 25(OH)D levels and skin type. We observed a correlation between skin type and baseline 25(OH)D but noted that skin type does not seem to matter for the change in 25(OH)D levels during very short UV exposure, as also observed by others before us. Concerning over-representation of skin types V and VI in our comparatively small ‘UVA’ group, we noted and showed in Table 4 that ‘a subset consisting of the skin types II and III is congruent with the overall result’. 2. Norval and de Gruijl complain that none of our UV sources (designated ‘UVB’, ‘UVAB’ and ‘UVA’) emitted solely UVB or UVA wavebands. We investigated the impact on 25(OH)D of the same spectrally CIE-weighted vitamin-D-effective UV exposures but with different UVA content, that is, with unweighted UVA doses (320– 400 nm) 10 and 100 times as large as in our ‘UVB’ exposures. The small difference in exposure time between our ‘UVB’ and ‘UVAB’ exposures is due to the low factors of spectral weighting in the UVA region and a long wavelength end point at 330 nm for the CIE vitamin D3 action spectrum. Exposure time of the ‘UVAB’ cabin was settable in seconds and was calculated from spectral irradiance measurements during steady-state conditions about 3 min after start, then repeated after another 2–3 min with similar results. Several more measurements had also been made on other occasions, again with similar results. The relative spectral distribution of low-pressure fluorescent tube lamps do not significantly change during ‘warm-up’. However, total irradiance level vs. time does have a small but wide temperature-dependent peak. Therefore, the cabins were ‘warmed up’ for 3 min before the first subject was exposed. Thereafter, each exposure followed upon a previous one, delayed only by change of subjects and restart of the cabin. Concerning the single-grating spectroradiometer being used (SolaHazard), it was not a spectrally scanning type of instrument. The UV sensor of the SolaHazard instrument is an array of CCD diodes simultaneously accumulating radiation in the whole spectrum (250–400 nm) during a sample time chosen to be as long as possible (i.e. 20 s) without risk of saturating the part of the array that records the highest intensity of the radiation (usually the UVA peak). Therefore, the part of the array measuring the lower range of the spectrum (250–320 nm) may accumulate too little radiation (some of which would be stray light) and underestimate UVB. From its Photodermatology, Photoimmunology & Photomedicine