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Notes: The treatment of venous ulcers must start with compression and if the ankle brachial index is greater than 0.8 high compression bandages can be applied. Despite edema control, there are a number of venous ulcers that do not heal at the expected rate. Patients with venous ulcers of greater than 4 weeks duration were treated with a prolonged release absorptive nanocrystalline silver dressing (Acticoat 7) under the 4 layer bandage, Profore for 12 weeks, or until healing. Biopsies were obtained from the ulcer base at week 0 for histology and bacterial burden. Duplicate biopsies for quantitative bacteriology were performed with one submitted whole and the second bisected into superficial and deep components. The paired biopsies were then repeated after a median of 6.5 weeks (range 2 to 12 weeks). The histological specimens were examined by the histopathologist (SR). Inflammatory infiltrates were identified in the superficial, middle and deep segments of the biopsies. Acute infiltrates were identified through the concentration of neutrophils and chronic infiltrates by the presence of lymphocytes. Each biopsy and each segment was graded for infiltrates on a four point semi quantitative score. A total of 15 patients (9 male, and 6 female) were enrolled into the study. The median age was 63 years (range 30–83 years). The median duration of current ulceration was 17.3 weeks (range 4 weeks to 11 years) and the median ulcer area was 4.8 cm2(range 1.8–43.9 cm2). The median exposure to Acticoat 7 was 82 days (range 8–86 days).There were 12 sets of paired biopsies that were analyzed. There was a statistically significant reduction (p = 0.0114) in the log10(total bacterial count) between the baseline and final biopsies (median 4.48 and 3.00, respectively). Four patients healed, 8 patients continued to the end of the 12-week study period and three patients were discontinued early. For all patients, the median percentage reduction in ulcer area was 94.4% and the median final ulcer area was 0.4 cm2. Analysis of the histology and bacteriology data demonstrated that the presence of a high neutrophilic infiltrate in skin biopsies was associated with high bacterial counts (superficial compartment of the quantitative biopsies) at week 4 and delayed healing (p = 0.037). In the week 0 biopsy, increased lymphocytic infiltrates within the superficial and middle segments were associated with accelerated healing in the first 4 weeks (p = 0.26 and 0.09). The nanocrystalline silver dressing has demonstrated an anti-bacterial and permissive but selective anti-inflammatory action allowing lymphocytic infiltrates to increase associated with an accelerated reduction in ulcer size.

Notes: Often chronic wounds have an increased bacterial burden that can impair healing without the classical clinical signs of infection. Silver dressings may provide an alternative topical method to control bacterial burden.The primary aim of this study was to evaluate the effect of 2–4 weeks therapy with the Silver Containing Hydrofiber® dressing on quantitative bacterial burden and clinical improvement in chronic wounds not healing at the expected rate.This was a single centre, four-armed study which included a total of 30 patients with diabetic foot ulcers, leg ulcers, pressure ulcers and miscellaneous wounds that did not fit into any of the above categories. Patients had a baseline quantitative bacterial biopsy and this was repeated at weeks 2 to 4. The wound size was recorded along with a semi quantitative estimate of exudate and the periwound temperatures. Repeat measurements were performed at the follow-up visits and the decrease in wound size calculated. The underlying cause of the ulceration was be treated and corrected. This was followed by application of silver containing hydrofiber® dressing. There was a significant delay in healing of the leg ulcers associated with increased bacterial burden in the quantitative biopsy bacterial burden results at week 0 and healing at week 2. (p = 0.01). Other subgroups had a similar association that did not reach statistical significance. The presence of an increased exudate in the leg ulcers at week two was associated with delayed healing at week 4 (p = 0.05). There was also a significant increase in skin surface temperature of the surrounding skin with an increased quantitative bacterial biopsy of the deep wound compartment for venous, diabetic neurotrophic foot ulcers and pressure ulcers with p values of 0.05, 0.01 and 0.01 respectively. There was no significant decrease in exudate or increased healing of the wounds with the application of the silver hydrofiber dressing in this difficult to heal population. The population studied in this case series had increased bacterial burden in the deep compartment as measured with increased exudate and or an increased temperature of the periwound skin. These patients have an increased bacterial burden in the deep wound compartment that does not respond to topical ionized silver in the dressing studied.

Notes: This article first examines the ideological composition of American university faculty and then tests whether ideological homogeneity has become self-reinforcing. A randomly based national survey of 1643 faculty members from 183 four-year colleges and universities finds that liberals and Democrats outnumber conservatives and Republicans by large margins, and the differences are not limited to elite universities or to the social sciences and humanities. A multivariate analysis finds that, even after taking into account the effects of professional accomplishment, along with many other individual characteristics, conservatives and Republicans teach at lower quality schools than do liberals and Democrats. This suggests that complaints of ideologically-based discrimination in academic advancement deserve serious consideration and further study. The analysis finds similar effects based on gender and religiosity, i.e., women and practicing Christians teach at lower quality schools than their professional accomplishments would predict.

Notes: Birt-Hogg-Dube (BHD) syndrome is a rare autosomal genodermatosis characterized by the triad of fibrofolliculomas, trichodyscomas and acrochordons. The gene for BHD was localised to chromosome 17p11.2 and a germline insertion/deletion was identified to cause premature truncation of the BHD protein, folliculin. Patients carry increased risk for developing lung cysts, spontaneous pneumothorax, and renal carcinoma. Prompt diagnosis is important for patient clinical management. We encountered a 41 year-old white male, otherwise healthy, with classic clinical presentation of BHD, i.e. numerous firm, smooth, whitish papules covering his face and neck, which were developed after adolescence. There is no related family history. Nine biopsies were taken during the past 5 years. The following changes are present: markedly dilated hair follicles, telangiectasia in fibrosing stroma, and melanocytic nevus cells. Diagnoses of epidermal inclusion cyst, fibrous papules, and dermal nevus were given. However, some subtle but diagnostic histopathological features for fibrofolliculoma, perifolliculafibroma, and trichodyscoma were overlooked. Correct diagnosis was reached upon review of all the biopsies. Patient is currently undergoing genetic testing and clinical workups. We present this case to update our knowledge on this rare disease, particularly the diagnostic criteria, differential diagnosis, and diagnostic pitfalls, in order to avoid the delay of correct diagnosis.

Notes: [Auszug] Membrane fusion occurs when SNAREpins fold up between lipid bilayers. How much energy is generated during SNAREpin folding and how this energy is coupled to the fusion of apposing membranes is unknown. We have used a surface forces apparatus to determine the energetics and dynamics of SNAREpin ...

Notes: Background  Epidemiological studies indicate that occupational hand eczema (OHE) often is associated with persistent dermatitis and prolonged sick leave, which may lead to unemployment. Previous studies suggest that OHE caused by allergic contact dermatitis and atopic dermatitis (AD) carries the worst prognosis.Objectives  To evaluate and compare the severity and consequences of recognized OHE in different diagnostic and subdiagnostic groups.Methods  Between October 2001 and November 2002, all new cases of recognized OHE were identified from the Danish National Board of Industrial Injuries Registry (758 cases). Severity was graded from 0 to 2 depending on the intensity of skin response and the frequency of relapse. To supplement the information from the Registry, we surveyed the study population using a postal questionnaire which included questions about disease duration, sick leave, current occupation and loss of job.Results  The overall response rate to the questionnaire was 82%. We observed substantially greater severity among those with occupational irritant contact dermatitis (ICD) and AD than for any other diagnoses. Age above 50 years was also associated with increased severity of OHE. Prolonged sick leave due to OHE was reported by 19·9% and was associated with AD and severe OHE. We found a higher proportion of prolonged sick leave among those in food-related occupations (27·2%) compared with those in wet occupations (20·1%) and other occupations (16·5%). Twenty-three per cent reported that they had lost their job at least once during the past 12 months due to OHE. The only strong association with loss of job was food-related occupations.Conclusions  Occupational ICD and AD appear to be strongly associated with severity of OHE. AD and severity of OHE were independently associated with prolonged sick leave. Having a food-related occupation appears to be associated with increased risk of loss of job.