#cryolipolysis vs. #liposuction - non-invasive vs. surgical treatment for fat reduction.

Cryolipolysis is the result of continued innovation and development in the area of noninvasive body contouring in aesthetic plastic surgery.The demand for body contouring procedures is rising because of the advent of bariatric surgery. Body contouring procedures allow surgeons to treat isolated areas of excess fat that lead to asymmetric appearance and adiposity in unwanted locations. Currently, liposuction is the most frequently employed and effective technique for body contouring but, due to its invasive nature, comes with inherent risks including bleeding and infection with an associated longer recovery time. Furthermore, one of the most common complications of liposuction is contour irregularities. Cryolipolysis is a recent technology used for controlled, natural, and selective fat reduction utilizing localized cooling to extract heat from adipocytes. Although there are no established, formal indications of when to use this technology, it is used in a variety of clinical situations, from the patient who desires scarless reduction of adipose tissue to those who are unfit to tolerate the anesthesia required for more invasive forms of liposuction.

Although the exact mechanism is still being studied, cryolipolysis works at a cellular level by an overarching theme of inflammation followed by phagocytosis and apoptosis. Adipose tissue, as compared to other tissues, is more sensitive to cold temperatures. Adipose cells undergo an inflammatory response after exposure to cold temperatures (-1 to -7°C) within the first 72 hours, peaking at 14 days after treatment. Between 14 and 30 days, phagocytosis of adipose cells begins. By 60 to 90 days, the inflammatory process declines and the adipose cell volume decreases. This roughly 90-day cycle results in selective subcutaneous fat layer reduction.

Although one of the greatest advantages to cryolipolysis is its safety in the population, there have been documented unwanted side effects that occur. Symptoms include erythema, edema, decreased sensation, and pain in the treatment area, but none have been reported as permanent. Finally, although found to be effective, cryolipolysis is not a suitable replacement for high-volume liposuction because traditional liposuction can remove more adipose tissue whereas cryolipolysis is not intended for high volume removal of adipose tissue in a single sitting.

Clinical studies have shown cryolipolysis to be efficacious in reducing fat in the lower and upper abdomen, inner and outer thighs, flank area, and back. In terms of longevity, case studies report fat reduction sustained for 2 to 5 years posttreatment. Finally, studies show more than 80% satisfaction rate among patients, with more than 80% of patients willing to recommend treatment to a friend. Overall, cryolipolysis offers patients a safe, effective, controlled, and noninvasive method to deal with unwanted fat in various parts of the body.

Font: Medscape.

#hair #nutrition - how to improve hair growth & health eating the right foods!

The solution to overcome the hair problems can be easier and cheaper than you think: a proper nutrition. According to dermatologists, the right foods can be great allies for a beautiful and healthy hair. So better invest in good food than in expensive cosmetic or aesthetic treatments... Here are some tips to make your hair grow faster and leave it stronger and brighter. 

Activating growth: 
Vitamins A and C act by improving blood flow (including the scalp), therefore stimulating hair growth. And the complex B vitamins, such as fish, seafood, lean meats, whole grains and oilseeds, help in the cell turnover and in production of keratin.

For a shiny hair: 
Omega 3, found in fishes like sardines, tuna and salmon, is wonderful for moisturizing, also giving strength and shine to the hair. 

Preventing the hair loss: 
The minerals zinc (oysters, beef), copper (liver, cocoa powder) and iron (beans) are the most suitable. Besides avoiding the loss, they also act in the pigments that give color to the hair. 

Strengthening the hairs: 
Proteins found in meat, chicken, fish, eggs, cheese and derivatives stimulate the growth and strengthen the hair.

#breastcancer - Roche new drug appears to greatly extend patients lives (advanced/metastatic).

A drug used to treat advanced breast cancer has had what appears to be unprecedented success in prolonging lives in a clinical trial, researchers reported. Patients who received the drug — Perjeta, from the Swiss drug maker Roche — had a median survival time nearly 16 months longer than those in the control group.

That is the longest amount of time for a drug used as an initial treatment for metastatic breast cancer (metastasis means the cancer has spread to other parts of the body); and it may be one of the longest for the treatment of any cancer. Most cancer drugs prolong survival in patients with metastatic disease for a few months at most. “We’ve never seen anything like this before,” said Dr. Sandra M. Swain of the MedStar Washington Hospital Center in Washington, the lead author of the study. “It’s really unprecedented to have this survival benefit.”

The results were being presented in Madrid at the annual meeting of the European Society for Medical Oncology. Previous analyses of the clinical trial established that Perjeta, known generically as pertuzumab, increased survival by a statistically significant amount. But until now it was not known by how much, because patients had not been followed long enough. Two experts not involved in the study, Dr. Edith A. Perez of the Mayo Clinic in Jacksonville, Fla., and Dr. Harold J. Burstein of the Dana-Farber Cancer Institute in Boston, said the results were impressive. “Usually we see two months of improvement,” Dr. Perez said.

Perjeta, like the better-known Roche drug Herceptin, or trastuzumab, blocks the action of a protein called HER2, which spurs the growth of some breast tumors. Perjeta is meant to be used with Herceptin for the roughly 20 percent of breast cancers characterized by an abundance of HER2.

Perjeta was approved by the Food and Drug Administration in 2012 and is already considered the standard of care in the United States. Still, the results could lead to increased use of the drug. Only about half of the eligible women are being treated with the drug in the United States, according to Edward Lang Jr., a spokesman for Roche. And doctors say use is lower in many countries where cost is more of an issue. In the United States, Perjeta costs about $5,900 a month and Herceptin about $5,300 a month, Mr. Lang said. He said Perjeta was priced lower than some other new cancer medicines because it has to be used with Herceptin. Some recently approved cancer drugs cost more than $10,000 a month.

The trial, sponsored by Roche, involved 808 patients around the world with previously untreated HER2-positive metastatic breast cancer. Half of them received Perjeta, Herceptin and the chemotherapy drug docetaxel. The other half received Herceptin, docetaxel and a placebo in place of Perjeta. The median survival time for those who received Perjeta was 56.5 months, or about four and a half years, compared with 40.8 months for those in the control group, a difference of 15.7 months. By another measure, known as the hazard ratio, use of Perjeta reduced the risk of dying 32 percent.

Those receiving Perjeta had higher rates of diarrhea and rash and a lowering of white blood cell counts. The labels for both Perjeta and Herceptin contain warnings that the drugs can cause cardiac dysfunction and heart failure. But in the study, patients who received Perjeta did not experience any more of these problems than those in the control group.

Font: NY Times.

#Alzheimers #dementia - the memory fades, the emotion remains...

People with Alzheimer’s disease can experience severe memory impairments.However, according to a new study, the emotions associated with events can persist long after the events themselves have been forgotten. In their paper, the researchers, University of Iowa neurologists Edmarie Guzman-Velez and colleagues, showed volunteers a series of emotional video clips, chosen to be either very sad or very happy.

The eight sad clips, for example, included an excerpt from the movie Sophie’s Choice (1982) in which ‘a woman is forced to choose which of her children to keep at a Nazi concentration camp’. The happy videos, by contrast, featured such classics as ‘a collage of funny scenes with babies’ from America’s Funniest Home Videos.

Half of the participants had been diagnosed with Alzheimer’s disease, while half were healthy controls, matched for age and gender. Memory tests showed that the Alzheimer’s patients could recall few details of the sad film clips, even just minutes after watching them. Four of the patients couldn’t recall any facts about the movies, and one didn’t remember watching any video clips at all.

Despite this, the patients with Alzheimer’s reported feeling elevated levels of sadness that lasted for up to 30 minutes after the films, despite having little or no recollection of the content… Across all participants, the correlation between memory performance and sadness during the final rating was significant, but in a negative direction (r = 0.37, n = 34). This paradoxical effect actually suggests that the less the patients remembered about the films, the longer their sadness lasted. Despite their severe memory impairment, all 4 patients who could not recollect any details about the films reported sustained feelings of sadness after the memory test, and 3 reported feeling sad even 30 minutes later.

The story was much the same with the happy clips – the Alzheimer’s patients had little or no memory of them, but still reported feeling happy for some time afterwards. These researchers have previously published similar results relating to patients with another kind of memory impairment, amnesia following damage to the hippocampus. 

A free-floating state of emotion, especially a negative emotion, triggers a search process aimed at discovering the source of the emotional disturbance. Unfortunately, the amnesia in patients with Alzheimer’s prevents them from being able to make any conclusive discovery. Their inability to attribute the source of the aberrant emotional state draws further attention to it, in effect creating a positive feedback loop that hijacks the natural recovery process and ultimately leads to an abnormally prolonged state of emotion…

Font: Discover Magazine.

#dermatology #skincare - get to know the Vampire FaceLift (using your blood to rejuvenate your face)!

Do You Show These 3 Signs of Aging?

1. Skin color becomes more gray because of less blood flow.

2. Facial shape becomes collapsed and droopy as muscle and collagen decrease.

3. Skin texture  becomes less smooth. As a result, the person looks “worn”, or “tired” or “droopy.”  The lively, rosy hue (seen plainly in playing children of every skin color and in young adults) fades to a dull gray.

3 Steps of the Vampire FaceLift® Procedure

First, the injector (1) uses HA fillers to create a beautiful shape. (2) Then, the physician isolates growth factors from the patient’s blood.  (3) When these growth factors enter the face (injected by the physician), then muti-potent stem cells become activated to grow new tissue.  This new tissue includes new collagen, new fatty tissue (for smoothness), and new blood vessels (for a healthy glow).

1. Creating a Beautiful & Natural Shape

In the first part of the Vampire FaceLift® procedure, the physician uses an Hyaluronic Acid (HA) filler (like Restylane or Juvederm) in a very specific way to sculpt a younger appearing face–while still keeping the shape natural.

Providers of the Vampire Facelift procedure take into account the mathematics of beauty as defined by much research (starting with the notebooks of Leonardo da Vinci) to avoid at all costs creating an unnatural shape.  After creating a younger, natural shape, then the physician harvests from the woman’s own blood (hence the name Vampire) growth factors that her body would normally use to heal damaged tissue.

2) Isolating  & Activating the Magic from Your Blood

First,  the physician draws about  2 teaspoons of blood. Then, using a centrifuge, the physician isolates platelets from that blood (platelet-rich plasma or PRP)–all within about 10 minutes in the office!

Those platelets are "activated" to cause the release from the platelets of at least 8 growth factors that would normally be used to heal injured tissue.  These growth factors work like magic to cause increased collagen & new blood flow. To rejuvenate new skin, these growth factors must be put back into your face. 

(3) Injecting the Magic into Your Face

Using numbing cream and a very small needle (for almost no pain), the physician injects the patient’s own growth factors back into the face in a particular way. These growth factors activate multipotent stem cells  already in the skin. Done! A new younger tissue should be generated.

The multipotent stem cells then develop into new collagen, new blood vessels, and new fatty tissue. The result…younger-appearing skin!

The effects of the procedure improve for 2 to 3 months and last for at least 1 to 2 years!

IMPORTANT! The Vampire Facelift® procedure is not for everyone.  Many would do better with surgery, or laser therapy, or Botox®, or simply an HA filler used alone. A trustable professional will be able to offer the right procedure for your face.

#dermatology #cosmetics - how to do your "Beauty Garden" (plants with cosmetics properties).

Have you ever wondered if you could choose powerful cosmetics in your own garden? These plants can be grown in pots or planters that fit perfectly on your balcony or window. 

Initially, to mount your garden of beauty, it is necessary to prepare the vase properly: good drainage with some expanded clay, sand, and fertilized soil substrate. 

All plants should take at least two hours of sun daily. To protect the nutrients, the ideal is to finish with bark surrounding the little vase, and aesthetically it becomes. The use of fertilizer is important for the health of the plants, so they will always be pretty green with flowers. The indicated fertilizers are: 10-10-10 for the foliage and 4-14-08 for flowering. 


Aloe vera - Moisturizes face, body and hair.

Aloe vera can be grown in pots easily, because they do not like lots of water and are resistant to different climates. It should be irrigated twice a week. According to historians, aloe is considered the greatest beauty secret of Cleopatra in ancient Egypt. It has a gel inside the leaf that does miracles! It's super easy to remove and store this gel. 

Beauty tip: 
1 - Remove a whole aloe leaf 
2 - Wash with 2 drops of detergent 
3 - Remove the lateral spines with a knife 
4 - Remove the yellowish layer of gel 
5 - Cut into cubes 
6 - Wrap in cling film 
7 - Use a small cube for facial hydration 
8 - Put the rest in the freezer. 


Chamomile - Rest your eyes and brightens dark circles.

Should be irrigated four times per week. 

Beauty tip: 
1 - Take 3 sprigs of chamomile and put in one bag cloth 
2 - Add 250 ml water 
3 - Let the bag soak in water for 2 hours in the refrigerator 
4 - Make compresses several times a day 
5 - No need to rinse. 


Lavender 

Lavender is a powerful body's soothing. You can mix some of its branches in water and then just wet the body. If you have a tub, throw it in and leave for 30 minutes. The plant is rustic and easy to care for. Irrigate it 4 times a week. 

Lettuce 

You can have ttuce for salads as well for skin care! Irrigate five times per week. 

Beauty tip: 
1 - Get 3 lettuce leaves 
2 - From the leaves, make a tea with 300 ml of water 
3 - Apply the warm tea in the face using a gauze or cotton pad 
4 - Let stand for 20 minutes. 

Mint - Improves elasticity.

Mint is an herb very easy to care for. Irrigate mint five times per week. 

Beauty tip: 
1 - Add two tablespoons of fresh chopped mint leaves 
2 - Boil a cup of water and add the mint 
3 - Leave for 30 minutes 
4 - Apply on face 
5 - No need to rinse. 

Mauve/Mallow - Powerful emollient 

Besides its cosmetics properties, mauve also acts as a medicinal antiseptic. Irrigate mauve five times a week. Make a facial tonic with the plant. 

Beauty tip: 
1 - Add two tablespoons of chopped fresh leaves of mauve
2 - Boil a cup of water and add the sprigs 
3 - Leave for 30 minutes 
4 - Apply on face 
5 - No need to rinse. 

#depression - efficient alternative treatments, according to new researchs.

Depression is a tricky disease to treat, in part because it manifests so differently in those it afflicts. But promising new research shows there may be options outside the pill bottle and off the couch at a therapist’s office. That’s not to say you should stop taking prescribed antidepressants or break up with your therapist, but if you’d like to consider alternative treatments, read on:

TMS

A recent study on a kind of therapy called transcranial magnetic stimulation (TMS), which uses magnetic pulses to alleviate depression, showed that after a year of treatment, 68% of adult patients had improved depression symptoms and 45% had complete remission. Currently, TMS is used among patients who do not respond well to antidepressants, but some experts think the therapy could one day be used as a first-line treatment. In TMS, a large magnet is placed on the left side of a patient’s head, and magnetic pulses stimulate the under-active areas of the patient’s brain that are involved in mood regulation. The patient is awake the entire time, and there are few reported side effects aside from headaches in some. Other research published in August showed TMS could also have positive benefits for memory.

Acupuncture

Acupuncture is becoming an increasingly mainstream in the U.S. to treat a wide variety of ailments from chronic pain to anxiety: it’s thought that by inserting needles into parts of the body to manipulate energy can reduce tension. However, the National Center for Complementary and Alternative Medicine (NCCAM) notes that it’s still unknown whether acupuncture’s effects as a therapy are placebo.

Interpersonal therapy

Interpersonal therapy focuses on patients’ relationships with other people. It’s commonly recommended for young people, and is typically viewed as a short-term depression treatment. According to the National Health Service (NHS) in the U.K., some research has suggested it could be as effective as antidepressants in certain cases, though more research is needed. They are usually necessary 12- to 16 one-hour weekly sessions.

Exercise

Scientists are increasingly showing that exercise improves mental health. In 2012, a clinical trial of heart failure patients found that regular exercise help alleviate depressive symptoms. It’s believed that exercise increases hormones like serotonin and dopamine in the brain, subsequently making people feel better.

Exposure therapy

For depression symptoms that may be related to other mental health issues like phobias and obsessive compulsive disorder, exposure therapy can help patients become more accustomed to and comfortable with things that used to bring them fear and anxiety. Obviously this process is slow and gradual.

Mindfulness

Plenty of research supports meditation as a possible treatment for depression and anxiety. As TIME reported in January, many cognitive therapists have started recommending it for patients as a way to deal with their anxiety and depression since it can mitigate stress.

Electric shock treatment

Also known as electroconvulsive therapy (ECT), shock treatment is fairly common treatment in which electric currents are passed through the brain and trigger seizures. It’s believed that the shocks interfere with brain chemistry that might be out of wack. ECT is considered much safer today than it was in the past–which too high doses were given resulting in negative side effects like memory loss and physical injury.

Cognitive behavioral therapy (including online and over the phone)

People are likely familiar with cognitive behavioral therapy, which is a talk therapy usually recommend for patients with moderate to severe depression. The idea behind cognitive behavioral therapy is to help patients understand the events or emotions behind their current status, and figure out ways to mitigate how they’re feeling day-to-day. Some recent research has suggested that cognitive therapy can work even if it’s not necessarily done face to face: even phone therapy and video chats are helpful.

Font: TIME.

#brain research - altruists vs. psycopaths brains differences (anatomic & physiologic).

Altruism has posed a puzzle for psychologists and evolutionary biologists for centuries. Why is it that humans will help others even to their own detriment?

A new study sheds light on the answer to that question by studying the brains of extreme altruists – people on the extreme end of the caring continuum. In this case researchers chose to study people who donated a kidney to a complete stranger. They found that not only are extreme altruists’ brains different from a normal person’s, they’re basically the opposite of a psychopath’s in one key way – indicating that a specific brain region may play an important role in people’s ability to care for one another. 

Researchers tracked down 19 healthy adults that had given a kidney to a stranger, and 20 other adults who were recruited from the local community as a control. They presented these participants with images of people making a fearful, angry and neutral facial expressions while measuring their brain activity using fMRI.

Of all the expressions, researchers were most interested in participants’ responses to fearful faces. Past studies have shown that fearful expressions elicit feelings of compassion in altruistic people. And indeed, extreme altruists showed a much higher sensitivity to fearful expressions, evidenced by higher activity in their amygdalas (the walnut-shaped part of the brain that processes emotions). What’s more, the right side of the amygdala was 8 percent larger in altruists than in people who hadn’t donated an organ, based on structural MRI data. Researchers published their findings last week in Proceedings of the National Academy of Sciences.

A Brain Dichotomy

These findings offered a stunning contrast to the team’s previous research on the brains of psychopaths. In their 2013 study, researchers showed images of pain-inducing injuries to 14 teens with psychopathic traits and to a control group. They discovered that the right amygdala in psychopaths was smaller and less active than that of a normal person. Psychopaths were also far less sensitive to other people’s pain, indicating a lower ability to feel compassion.

Therefore, researchers believe that our neurological architecture, specifically the amygdala, helps shape our altruistic tendencies. The amygdala may act as the brain’s moral compass — active in compassionate people and muted in psychopaths.

Font: Discover Magazine

#braindeath - what to know and how to approach.

Brain death is irreversible and determined by absent motor responses, loss of all brainstem reflexes, and apnea after a CO₂challenge. It is not determined by further waiting. Support measures often fail and the ability to maintain a brain-dead body is "virtually impossible". Brain death is a distinct clinical neurologic state and is different from all other manifestations of acute or prolonged coma, where patients may eventually be able to breathe on their own and when some or all brainstem reflexes are preserved. "In the medical judgment of practicing neurointensivists, neurosurgeons, and all neurologic and neurosurgical societies and academies throughout the world, brain death constitutes death of the person," according to a review done by The Mayo Clinic Physicians.

Standards for determining pediatric brain death were established more than 25 years ago and have been adopted and revisited by the Society of Critical Care Medicine, the American Academy of Pediatrics, and the Child Neurology Society. The diagnosis, in a guideline released in 2011, requires 2 examinations, 12 hours apart, by 2 different attending physicians in children 1 year or older. Adult brain death diagnosis, on the other hand, requires just 1 full examination, with optional confirmation by another physician.

Many patients, family members, and the public at large remain confused about the differences between brain death (death) and other neurologic disorders such as coma or persistent vegetative state. It must be emphasized, however, that there is a strong consensus about brain death as a result of decades of discussion in medicine, law, and ethics. All our colleagues in critical care, neurosciences, and biomedical ethics should be encouraged to engage patients and local communities about matters related to brain death.

On the other hand, the reality of brain death can be very difficult for families to accept. There are counterintuitive aspects to brain death because the patient's heart is still beating, blood is circulating. Patients do not look like they are dead in terms of the traditional understanding of what a dead body looks like. That is one factor that can make brain death hard to understand. Besides, there is confusion about the term 'brain death. Many people confuse it with coma and they have read newspaper accounts of people believed to be in an irreversible coma who recover, and that adds to the scepticism or gives them hope that their loved one will simply recover. That does not happen if the diagnosis of brain death has been made accurately.

Explaining that a loved one is brain dead to a family can be difficult and requires sensitivity and compassion on the part of the health professional delivering the news. Maybe, a more appropriate term for brain death would be "death determined by the absence of brain function". The points that need to be communicated are that it's hopeless, irreversible, and that there is no benefit for any type of treatment. It's accepted as death in the law and it offers an opportunity for organ donation.

#antibiotics #bacteria - Get smart! Know when antibiotics work & avoid bacterial resistance. #CDC

If You Have a Cold or Flu, Antibiotics Won't Work For You!

Get Smart…Read The Chart!  [1 page] to know which common illnesses are usually viral or bacterial and when antibiotics are necessary.

• Antibiotics cure bacterial infections, not viral infections such as:
  • Colds or flu;
  • Most coughs and bronchitis;
  • Sore throats not caused by strep; or
  • Runny noses.
• Taking antibiotics for viral infections, such as a cold, cough, the flu, or most bronchitis, will not:
  • Cure the infections;
  • Keep other individuals from catching the illness; or
  • Help you feel better.

Taking antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.

What Can You Do To Protect Yourself Or Your Child?

When you use antibiotics appropriately, you do the best for your health, your family's health, and the health of those around you. "We want Americans to keep their families and communities healthy by getting smart about the proper use of antibiotics," said Lauri Hicks, D.O., medical director of CDC's Get Smart campaign.

What To Do

• Talk with your healthcare provider about antibiotic resistance.
• When you are prescribed an antibiotic,
  • Take it exactly as the doctor tells you. Complete the prescribed course even if you are feeling better. If treatment stops too soon, some bacteria may survive and re-infect you.
    This goes for children, too. Make sure your children take all medication as prescribed, even if they feel better.
    Throw away any leftover medication once you have completed your prescription

What Not To Do

• Antibiotics cure bacteria, not viruses such as:
  • Colds or flu;
  • Most coughs and bronchitis;
  • Sore throats not caused by strep; or
  • Runny noses.

#depression #antidepressants rapidly alter brain architecture.

A single dose of a popular class of psychiatric drug used to treat depression can alter the brain’s architecture within hours, even though most patients usually don’t report improvement for weeks, a new study suggests.

More than 1 in 10 adults in the U.S. use these drugs, which adjust the availability of a chemical transmitter in the brain, serotonin, by blocking the way it is reabsorbed. The so-called Selective Serotonin Reuptake Inhibitors, or SSRIs, include Prozac, Lexapro, Celexa, Paxil and Zoloft.  

The findings could be a first step toward figuring out whether a relatively simple brain scan might one day help psychiatrists distinguish between those who respond to such drugs and those who don’t, an area of mystery and controversy in depression treatment.

Researchers at the Max Planck Institute in Leipzig, Germany, used a magnetic resonance imaging machine to compare connections in the gray matter of those who took SSRIs and those who did not. They were particularly interested in what goes on when the brain is doing nothing in particular.

When more serotonin was available, this resting state functional connectivity decreased on a broad scale, the study found. This finding was not particularly surprising -- other studies have shown a similar effect in brain regions strongly associated with mood regulation. But there was a two-fold shock: Some areas of the brain appeared to buck the trend and become more interdependent. And all the changes were evident only three hours after the single dosage!

Most people who use antidepressants don't report any discernible change in mood for at least two weeks. The rapid connectivity shifts noted by the study might therefore be precursors to longer-term changes, perhaps starting with remodeling of synapses, the microscopic gaps where chemical neurotransmitters such as serotonin flood across to an adjacent brain cell, the study suggests. But this type of brain scanning can’t pick up changes at such a scale, so the hypothesis will have to be tested other ways. 

Study subjects did not have diagnoses of depression, so researchers will need to generate similar maps among those diagnosed with depression, and re-map them during and after depressive episodes, as well as after treatment. Comparisons might then show whether a certain initial architecture predicts treatment success. “In a perfect world, you would look not only at SSRIs, but all sorts of medications and non-pharmacological interventions,” Dr Sacher, one of the researchers said.

#dermatology + #psychiatry - the approach of factitious skin disorders (dermatitis artefacta).

Dermatitis artefacta (DA) is a factitious skin disorder caused by the deliberate production of skin lesions by patients with a history of underlying psychological problems. The patient may not be fully aware of this, and the true extent of this disorder, especially in children, is currently unknown. Management of these patients is challenging as many fail to engage effectively with their dermatologist.

A retrospective case note review was conducted of 28 patients attending the regional psychodermatology clinic at the Royal London Hospital from January 2003 to December 2011. The objectives of the study were to explore the various clinical presentations and strategies employed to treat DA in our local population, and note outcomes in order to evaluate effectiveness of our management.

Out of 28 patients identified with DA, the majority of patients were female, and the most frequent sites for skin lesions were the face and upper body. Anxiety, depression and personality disorders were common underlying psychiatric diagnoses. 93% of patients were successfully managed (i.e. the DA resolved or was in remission at the time of writing) in a combined psychodermatology clinic by a multidisciplinary psychocutaneous medicine team. 32% of the cases were children (aged < 16 years) and one of these was referred to local child protection services; 46% of patients had a concomitant mental health disease at the time of presentation with DA.

Concluding, a multidisciplinary psychocutaneous team is important in this condition particularly as the patient is likely to require psychological intervention (to facilitate the resolution of the precipitant), in addition to dermatological (to make the diagnosis and, importantly, to exclude organic disease) and psychiatric (to manage concomitant psychiatric disease) input. 

#cancer #stomach - Botox prevents development & spread of gastric cancer. Font: Medscape.

Cutting both branches of the vagus nerve to the stomach or blocking its chemical signal with botulinum toxin (Botox) injections prevents the development and progression of gastric cancer in mouse models, new research shows.

The advantage of botulinum toxin is that "it can be used locally and it targets cancer stem cells," said investigator Duan Chen from the Norwegian University of Science and Technology. It can also be injected through gastroscopy, and it only requires the patient to stay in the hospital for a few hours. The study was published online August 20 in Science Translational Medicine.

When studying gastric cancer, it was observed that there was a significant accumulation of nerves within the tumor microenvironment, and the density of the nerves seemed to correlate with prognosis, in the same way that blood vessels might be important to tumor growth. 

The vagus nerve branches into 2 separate trunks in the stomach, each innervating half of it. The investigators found that cutting both branches of the vagus nerve really blocked the development of gastric cancer in mouse models, whereas cutting only one branch prevented tumor growth on one side of the stomach but not the other— indicating that this was a very local effect

The investigators found that denervation of the vagus nerve with localized botulinum toxin injections was as effective as vagotomy for blocking the development and progression of early and later stages of gastric cancer. Botulinum toxin blocks the release of all neurotransmitters, including acetylcholine, so that nerve endings can no longer communicate with other nerves or, in this case, the cancer stems cells that are driving cancerous growth. Subsequent experiments in the same mouse models showed that denervation with botulinum toxin injections could enhance the effect of systemic chemotherapy, and could enhance survival even in mice with advanced tumors. Loss of nervous input appears to make cancer cells more vulnerable to chemotherapy, which makes chemotherapy more efficient.

This research could have applications in other tumor types. The nerve–tumor growth connection is likely to be true in other solid tumors, such as in prostate cancer. Results in animal models have been so positive that a phase 2 clinical trial is underway in Norway, where patients with inoperable stomach cancer will receive injections of botulinum toxin in an effort to denervate the stomach and stop tumor progression.

#staphylococcus #children - household surfaces may spread resistant strains of bacteria.

The homes of many children infected with methicillin-resistant Staphylococcus aureus (MRSA) may be environments in which MRSA strains live on common household surfaces, according to an article published online September 8 in JAMA Pediatrics.

That was the case for almost half of the children with MRSA infections in a recent study, in which researchers found MRSA on bed linens, television remote controls, and bathroom hand towels. Household pets also carried MRSA strains. Dr Stephanie A. Fritz (Department of Pediatrics, Washington University School of Medicine) and colleagues conducted a study involving 50 children with active or recent (within 2 months) community-acquired MRSA infection.

Twenty-one (42%) of the children were colonized with S aureus at one or more body sites. Colonization was exclusively MRSA for 14 (28%) children, exclusively methicillin-susceptible S aureus (MSSA) for 6 (12%) children, and both MRSA and MSSA at different body sites for 1 child (2%).

The researchers conducted enrollment visits in each child's home and administered questionnaires to collect data on medical history, prior infections, hygiene practices, and household characteristics. They collected colonization cultures from the anterior nares, axillae, and inguinal folds of each participant. The researchers also obtained surface samples from 21 household items they presumed to be frequently handled by household members. They also tested household pets.

They recovered S aureus from at least one household surface for 32 (64%) of the households. They recovered a total of 23 (46%) households with MRSA contamination. MRSA was most commonly found on bed linens (18%), television remote controls (16%), and bathroom hand towels (15%). S aureus had colonized in 6 (23%) of 26 dogs tested and one (7%) of 14 cats tested. 

Of the 50 children, 20 (40%) had either a colonizing or infecting strain type that was concordant with an environmental strain recovered from a household surface. Surfaces most commonly contaminated with a concordant strain were:

• children's bed linens (8 of 41, 20%),
• television remote controls (8 of 40, 20%),
• bathroom light switches (7 of 41, 17%),
• bathroom hand towel (5 of 31, 16%), and
• bathroom sink (6 of 41, 15%).

Interestingly, surfaces commonly perceived to be contaminated (such as toilet seats and door handles) were not major reservoirs of MRSA. Therefore, these recent data can inform better prevention strategies within the household. The authors noted that frequency of cleaning was not associated with the likelihood of surface contamination. In contrast, more individuals per 1000 square feet was associated with a higher proportion of surface contamination.

#skincancer and #genetics - the role of the sun damage in DNA mutations.

A previously unknown oncogene that is activated by ultraviolet (UV) light has been implicated in a considerable proportion of squamous cell carcinomas (SCCs) and in some melanomas as well, a new study shows. The research was published online September 7 in Nature Genetics.

A team from the Stanford University School of Medicine and from the Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, identified recurrent point mutations concentrated at an UV signature "hotspot" in KNSTRN, a gene involved in helping cells divide their DNA equally during cell division, in 17-19% of SCCs. The same KNSTRN mutation was identified in approximately 5% of all melanomas sequenced as well. Mutations at this UV hotspot are not found in any of the other cancers investigated — they occur only in skin cancers, senior author Paul Khavari, MD, PhD, professor of dermatology, Stanford University School of Medicine, said in a briefing.

This study highlights the importance of sun protection because it makes it clear that a single mutation in a single gene can start a process of catastrophe for the genome, which has real implications for how careful people should be about the sun, even more than ever suspected. Analysis of mutation type showed that the majority of tumors had mutational profile characteristics of exposure to ultraviolet light. Once the DNA is damaged, it needs to be repaired, and that repair process is not always perfect. The wrong repair  can lead to mutations, which can result in cancer later.