S. Morteza Seyed Jafari

Relative indexes of cutaneous blood perfusion measured by real-time laser Doppler imaging (LDI) in healthy volunteers

We used real-time LDI to study regional variations in microcirculatory perfusion in healthy candidates to establish a new methodology for global perfusion body mapping that is based on intra-individual perfusion index ratios. Our study included 74 (37 female) healthy volunteers aged between 22 and 30 years (mean 24.49). Imaging was performed using a recent microcirculation-imaging camera (EasyLDI) for different body regions of each volunteer. The perfusion values were reported in Arbitrary Perfusion Units (APU). The relative perfusion indexes for each candidates body region were then obtained by normalization with the perfusion value of the forehead. Basic parameters such as weight, height, and blood pressure were also measured and analyzed. The highest mean perfusion value was reported in the forehead area (259.21APU). Mean perfusion in the measured parts of the body correlated positively with mean forehead value, while there was no significant correlation between forehead blood perfusion values and room temperature, BMI, systolic blood pressure and diastolic blood pressure (p=0.420, 0.623, 0.488, 0.099, respectively). Analysis of the data showed that perfusion indexes were not significantly different between male and female volunteers except for the ventral upper arm area (p=.001). LDI is a non-invasive, fast technique that opens several avenues for clinical applications. The mean perfusion indexes are useful in clinical practice for monitoring patients before and after surgical interventions. Perfusion values can be predicted for different body parts for patients only by taking the forehead perfusion value and using the perfusion index ratios to obtain expected normative perfusion values.

Improvement of Flap Necrosis in a Rat Random Skin Flap Model by In Vivo Electroporation-Mediated HGF Gene Transfer.

Background: Despite great understanding of underlying mechanisms for flap necrosis and advances in surgical techniques, flap necrosis remains a critical issue. In the present study, the authors investigated the efficacy of electroporation-mediated hepatocyte growth factor (HGF) gene delivery to random dorsal skin flaps (McFarlane) to accelerate wound healing and reduce flap necrosis. Methods: Fifteen male Wistar rats (290 to 320 g) were divided randomly into three groups. Group a, the control group (n = 5), underwent surgery and received no gene transfer. Group b received electroporation-mediated HGF gene delivery 24 hours after surgery as a treatment. Group c received electroporation-mediated HGF gene delivery 24 hours before surgery as prophylaxis (n = 5). Planimetry, laser Doppler imaging, and immunohistochemistry were used to assess the efficacy of HGF gene therapy among the groups. Results: Electroporation-mediated HGF gene delivery significantly decreased flap necrosis percentage compared with the control group in prophylactic and treatment groups (p = 0.0317 and p = 0.0079, respectively) and significantly increased cutaneous perfusion compared with the control group (p = 0.0317 and p = 0.0159, respectively). Moreover, Spearman rank correlation showed a significant negative correlation between flap necrosis percentage and laser index (p = 0.0213 and r = −0.5964, respectively). Furthermore, significantly higher mean CD31+ vessel density was detected in treatment and prophylactic groups (p = 0.0079 and p = 0.0159, respectively). In addition, quantitative image analysis revealed significantly higher HGF protein expression in groups b and c (p = 0.0079 and p = 0.0079, respectively). Conclusion: These findings suggested in vivo electroporation-mediated HGF gene delivery enhanced viability and vascularity of the ischemic skin flap.

Apremilast in the treatment of moderate to severe hidradenitis suppurativa: A case series of 9 patients

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Post-operative monitoring of free muscle transfers by Laser Doppler Imaging: A prospective study

Despite different existing methods, monitoring of free muscle transfer is still challenging. In the current study we evaluated our clinical setting regarding monitoring of such tissues, using a recent microcirculation‐imaging camera (EasyLDI) as an additional tool for detection of perfusion incompetency.

Canakinumab for Severe Hidradenitis Suppurativa: Preliminary Experience in 2 Cases.

gernails, and her previous psoriasis vulgaris returned. Two months after stopping secukinumab therapy, ustekinumab treatment was begun, 45 mg by subcutaneous injection (standard dosing intervals), as well as (extemporaneously compounded) topical methotrexate, 1%, gel5 applied twice daily to her fingertips and fingernails. After 3 months of treatment with these 2 agents, both her psoriasis vulgaris and her fingertips and fingernails successfully responded (Figure 2).

Stereographic measurement of orbital volume, a digital reproducible evaluation method

Background/Aims Up to date, no standardised reproducible orbital volume measurement method is available. Therefore, this study aimed to investigate the accuracy of a new measurement method, which delineates the boundaries of orbital cavity three-dimensionally (3D). Methods In order to calculate the orbital volume from axial CT slice images of the patients, using our first described measurement method, the segmentation of the orbital cavity and the bony skull was performed using Amira 3D Analysis Software. The files were then imported into the Blender program. The stereographic skull model was aligned based on the Frankfurt horizontal plane and superposed according to defined anatomical reference points. The anterior sectional plane ran through the most posterior section of the lacrimal fossa and the farthest dorsal point of the anterior latero-orbital margin, which is positioned perpendicular to the Frankfurt horizontal plane. The volume of each orbital cavity was then determined automatically by the Blender program. Results The 10 consecutive subjects (5 female, 5 male) with mean age of 50.3±21.3 years were considered for analysis in the current study. The first investigator reported a mean orbital volume of 20.24±1.01 cm3 in the first and 20.25±1.03 cm3 in the second evaluation. Furthermore, the intraclass correlation coefficient (ICC) showed an excellent intrarater agreement (ICC=0.997). Additionally, the second investigator detected a mean orbital volume of 20.20±1.08 cm3 in his assessment, in which an excellent inter-rater agreement was found in ICC (ICC=0.994). Conclusions This method provides a standardised and reproducible 3D approach to the measurement of the orbital volume.

Laser doppler imaging as additional monitoring after digital replanting: A prospective study

Despite various exisiting monitoring methods, there is still a need for new technologies to improve the quality of post‐operative evaluation of digital replantation. The purpose of the study is using a laser Doppler imaging device (Easy‐LDI) as an additional tool to assess perfusion. In this method, the changes in the frequency of the laser ligth provide information regarding perfusion of the monitored tissue.

Association of Hidradenitis Suppurativa With T Helper 1/T Helper 17 Phenotypes: A Semantic Map Analysis

Importance In spite of progress in understanding the mechanisms underlying hidradenitis suppurativa (HS) as an inflammatory skin disease, there is still a demand for an overview on immunopathogenesis of HS. Objective To demonstrate the importance of the type 1/type 17 immune response in lesional HS skin by drawing a semantic connectivity map. Design, Setting, and Participants Single-center case series of 24 patients with HS. Association of HS with T helper 1/T helper 17 (TH1/TH17) phenotype was assessed using semantic map analysis. Main Outcomes and Measures Association of HS with TH1/TH17 phenotype. Results The analysis was performed on 24 lesional HS biopsy samples from untreated patients with HS (16 [67%] female; median age, 36.5 years [range, 21-51 years]) with a mean (SD) Hurley stage of 2.29 (0.62) and 9 punch biopsy samples from healthy controls (6 [67%] female; median age, 43 years [range, 23-66 years]). The map shows a clustering of all TH1/TH17-associated cytokines (interleukin 17 [IL-17], interferon &ggr;, IL-12, IL-23, IL-32, IL-1&bgr;, tumor necrosis factor) around overall lesional inflammation. Tumor necrosis factor, IL-12, and IL-17 are even directly connected via interferon &ggr;. In contrast, IL-13, a TH2-associated cytokine, was inversely correlated with the presence of TH1/TH17-associated cytokines, further highlighting the importance of the TH1/TH17 cytokines in HS pathogenesis. Conclusions and Relevance These findings suggest that HS may be a TH1/TH17-driven inflammatory skin disease.

Application of electrochemotherapy in the management of primary and metastatic cutaneous malignant tumours: a systematic review and meta-analysis

Electrochemotherapy is becoming a promising technique for the management of malignancies of skin and non-skin origin. The current review aims to clarify current knowledge on administration of electrochemotherapy for the treatment of various skin tumours. A systematic literature search was performed, up to the end of 2016, on studies in which the application of electrochemotherapy for management of primary and metastatic cutaneous malignant tumours was assessed. Having selected appropriate studies, pooled estimates of mean objective (complete) responses, with 95% confidence intervals (CIs), were calculated to assess treatment efficacy. Finally, the main emerging themes from the papers were discussed in more detail. From 465 records identified through database searching, a total of 128 studies were screened, of which 70 were included for review. After a pooled analysis, the estimate for mean objective response following electrochemotherapy was 84.02% (95% CI: 80.08-87.61). Furthermore, the pooled estimate of objective treatment response of evaluated studies was 83.91% (95% CI: 79.15-88.17%) for bleomycin and 80.82% (95% CI: 66.00-92.36%) for cisplatin. Electrochemotherapy is a feasible, inexpensive, fast and easy technique to perform local treatment, regardless of tumour type, with a low level of adverse effects and patient discomfort. This method can be applied alone for patients with primary cutaneous lesions, or local or locoregional metastases, or as an additional treatment modality in patients with distant metastases.

A Retrospective Cohort Study on Patients with Hidradenitis Suppurativa

Background: Hidradenitis suppurativa (HS) is one of the most distressing conditions observed in dermatology and has a substantial negative effect on the quality of life of affected persons. Objectives: The aim of this study was to evaluate different treatment strategies in patients with HS. Methods: In a retrospective cohort, all patients with HS (July 2015 to March 2017) were reviewed. Collected data consisted of patients’ demographics, clinical characteristics, psychosocial situation, and previous and current treatments. In addition, therapy response to the most recent prescribed treatments was assessed. Results: 102 patients (38 females, 64 males; median age 37.5 years) were included in this study. 68.4% of patients had BMI ≥25, and 76.5% of patients were current smokers. Hurley stages I, II, and III were detected in 13.5, 53.1, and 33.3% of patients, respectively. The most commonly administered treatments were surgery (67.6%), nonantibiotic topical therapies (72.5%), antibiotic topical therapies (55.9%), systemic antibiotics (88.2%), and biologics in 11.8% of the patients. 84.6% of the patients showed a response (27.5 and 47.1% partial and complete response, respectively) to the treatments. Conclusion: HS as a chronic, recurrent inflammatory skin disease is associated with smoking and obesity. Application of systemic antibiotics is the most frequent treatment strategy for this disease. However, surgical intervention seems to be the most effective treatment strategy.