Faculty Bibliography

Background: Intraductal papillary mucinous neoplasm (IPMN) is premalig-nant pancreatic lesion. International guidelines suggest several treatments and malignancy predictors but offer limited predictors of individual risk. A nomo-gram to predict individual IPMN malignancy risk was released with good diagnostic performance, basedona cohort of2258 Korean or Japanese patients with IPMN. This study validated a nomogram to predict malignancy risk and inva-siveness of IPMN, using Eastern and Western cohorts.
Method(s): We collected clinicopathological and radiological data of patients who underwent pancreas resection for IPMN at 4 centers each in Eastern and Western countries. After excluding patients with >=1 missing malignancy predictor in the nomogram (main pancreatic duct diameter, cyst size, presence of mural nodule, serum CEA and CA 19-9 levels, and age), we analyzed data of the remaining 393 patients (Eastern: n = 265; Western: n = 128).
Result(s): Although mean age, sex, log value of serum CA 19-9, tumor location, main duct diameter, cyst size and presence of mural nodule differed between the Korea/Japan, Eastern and Western cohorts, rates of malignancy and invasive cancer did not significantly differ. Areas under the receiver operating characteristics curve (AUC) values using the nomogram to predict malignancy were Eastern: 0.745, Western: 0.856, and combined cohorts: 0.776; and to predict in-vasiveness were Eastern: 0.736, Western: 0.891, and combined cohorts: 0.788.
Conclusion(s): External validation of the nomogram showed good performance in predicting malignancy and invasive cancer in both Eastern and Western IPMN patients. The nomogram could be globally applicable to decide customized treatment options for patients with IPMN

Background and Objectives: We previously proposed a nomogram predicting individual risks of malignancy and invasiveness of intraductal papillary mucinous neoplasms and validated it in an external cohort. However, it is difficult to apply if data on tumor marker are lacking. The aim of the current study was to develop a new nomogram based on radiologic findings using previous nomogram development and an external validation cohort.
Material(s) and Method(s): A total of 3049 patients who underwent surgical resection at 30 tertiary institutes in 7 countries were enrolled and clinicopathologic data were retrospectively analyzed. Based on fitted model, area under the receiver operating characteristics curve (AUC) was calculated using 10-fold cross validation by exhaustive search.
Result(s): The study consisted of 1914 (62.8%) patients for previous nomogram development and 1135 patients (37.2%) in the external validation cohort. Among patients, 1898 (62.3%) had low, 577 (18.9%) had high grade dysplasia, and 574 (18.8%) had invasive carcinoma. Patients were allocated randomly into model development and test sets to construct the nomogram, with fixed ratios according to malignancy and invasiveness. Exhaustive search resulted in three variables (cyst size, duct dilatation, and mural nodule) for malignancy and four variables (cyst size, duct dilatation, mural nodule, and location) for invasiveness being selected to construct the nomogram, and AUC was 0.742 and 0.741, respectively. AUC for test set was 0.727 and 0.704, respectively, and Hosmer-Lemeshow goodness of fit test showed good discrimination power (p = 0.066 and 0.067, respectively).
Conclusion(s): The new nomogram based on radiologic findings is accurate and helpful in identifying patients at risk of malignancy and invasiveness and selecting treatment options in clinical settings.
Copyright

We have recently reported in male rats that medial prefrontal cortex (mPFC) neurons that project to the basolateral nucleus of the amygdala (BLA) are resilient to stress-induced dendritic remodeling. The present study investigated whether this also occurs in female rats. This pathway was identified using the retrograde tracer Fast Blue injected into the BLA of ovariectomized female rats with estrogen replacement (OVX + E) and without (OVX + veh). Animals were exposed for 10 days either to 2-h immobilization stress or to home cage rest, after which layer III mPFC neurons that were either retrogradely labeled by Fast Blue or unlabeled were filled with Lucifer Yellow and analyzed for apical dendritic length and spine density. No dendritic remodeling occurred in unlabeled neurons from OVX + veh or OVX + E animals. In BLA-projecting neurons, however, stress had no effect on length in OVX + veh animals, but stressed OVX + E females showed greater dendritic length than controls at intermediate branches. Stress also caused an increase in spine density in all neurons in OVX + veh animals and a spine density increase in BLA-projecting neurons in OVX + E females. Estrogen also increased spine density on BLA-projecting neurons in unstressed animals. These data demonstrate both independent effects of estrogen on pyramidal cell morphology and effects that are interactive with stress, with the BLA-projecting neurons being sensitive to both kinds of effects.

BACKGROUND: Actinic keratosis (AK) is the earliest clinical manifestation of squamous cell carcinoma. Metastatic SCC causes the majority of the 1300 to 2300 deaths attributed to nonmelanoma skin cancer in the United States each year. Recent studies have shown that intralesional administration of interferon can be used successfully in the treatment of AK. OBJECTIVE: Imiquimod is an immune response modifier, currently approved for the treatment of genital warts. The topically applied immune response modifier acts by up-regulating interferon and other cytokines involved in the cell-mediated immune response at the site of application. The aim of this was to determine the efficacy and safety of imiquimod 5% cream for the treatment of AK. METHODS: Twenty-two patients with AK lesions were treated with imiquimod 5% cream, initially at 3 times per week for 8 weeks, or until total clearance of lesions. Patients applied imiquimod to lesions on one side of the body and vehicle cream to the other side. A total of 17 patients who completed treatment were evaluated for number of lesions and adverse reactions before treatment and at weeks 2, 4, 6, and 8 after initiation of treatment. AK lesions were also assessed 4 and 8 weeks after treatment. RESULTS: A significant reduction in the average number of lesions per patient was observed for patients treated with imiquimod. The most frequent reactions to treatment were erythema, itching, and scabbing; however, all adverse events were mild to moderate. CONCLUSION: Imiquimod 5% cream may be a promising treatment for AK

OBJECTIVE: To examine the safety and efficacy of a pulsed alexandrite laser for treatment of leg telangiectasia and reticular veins. DESIGN: Observational study. SETTING: Laser and Skin Surgery Center of New York, New York, NY. SUBJECTS: Twenty women with skin phototypes I to III and with 54 patches of leg veins measuring 0.3 to 2.0 mm in diameter. INTERVENTIONS: Each patch was treated once using 1 to 3 passes of a 755-mm, 3-millisecond alexandrite laser. An 8-mm spot and fluences of 60 to 80 J/cm(2) were used, with dynamic epidermal cooling. MAIN OUTCOME MEASURES: Subjects underwent evaluation at 4 and 12 weeks for degree of clearance, based on a quartile grading system, and incidence of adverse effects. RESULTS: At the 4-week follow-up, 17 (35%) of 48 treatment sites showed greater than 75% clearance and an additional 16 (33%) showed greater than 50% clearance. By 12 weeks, 33 (65%) of 51 treatment sites showed greater than 75% clearance, and there was greater than 50% clearance in an additional 11 (22%). Hyperpigmentation was observed in 18 (35%) of 51 treatment sites. CONCLUSION: A single treatment with a 755-nm, 3-millisecond alexandrite laser at high fluence in conjunction with cryogen skin cooling produced excellent clearance of telangiectasia and reticular veins of the leg with minimal adverse effects

BACKGROUND: Multiple laser systems are available for the purpose of hair removal. OBJECTIVE: The purpose of this study was to determine the safety and long-term efficacy of the 800 nm, pulsed diode laser at reducing hair count. METHODS: Fifty volunteers, primarily Fitzpatrick skin types II and III, with dark brown or black hair, were treated with a diode laser (800 nm, 10-40 J/cm2, 5-30 msec, 9 mm 9 mm, 5 degrees C chilled handpiece). Each subject had eight treatment sites at varying fluences and pulse durations, as well as a varying number of treatments and pulses. Hair counts were obtained at each site at baseline, 1, 3, 6, 9, and an average of 20 months after treatment. RESULTS: After one treatment, hair regrowths ranged from 22 to 31% at the 1-month follow-up visit, then remained stable between 65 and 75% from the 3-month to the averaged 20-month follow-up. After two treatments there were relatively longer growth delays, with hair regrowths plateauing beginning at 6 months after treatment and ranging from 47 to 66% for the remainder of the follow-up evaluations. Side effects were limited to pigmentary changes, transient in subjects with skin types II and III. CONCLUSIONS: This 800 nm diode laser with a chilled sapphire tip and variable pulse duration is safe and effective for long-term hair reduction in individuals with skin types II and III

BACKGROUND: Pulsed dye laser treatments usually result in purpura. Any topical application that eliminates or shortens the duration of purpura would be extremely useful. OBJECTIVE: The purpose of this prospective study was to determine the safety and efficacy of topical vitamin K cream in shortening the duration of laser-induced purpura. METHODS: Twenty adult subjects were enrolled. Each subject had five 1.5 cm sites treated with a pulsed dye laser at 585 nm, 450 nsec, 7 mm spot size at each subject's respective threshold fluence. Each subject had a control site where no topical application was used and four other sites where a different formulation was applied to each for 2 weeks before and for 2 weeks after laser irradiation. Five vitamin K formulations with or without retinol were studied: 3% vitamin K in acrylates copolymer cream, 5% vitamin K in acrylates copolymer cream, 1% vitamin K and 0.3% retinol in acrylates copolymer cream, 1% vitamin K and 0.15% retinol in acrylates copolymer cream, 1% free vitamin K cream. Purpuric discoloration at each site was rated on days 0, 1, 3, 7, 10, and 14 after laser treatment on a quartile scale. Each site was assigned 100% discoloration on day 0 after laser irradiation. RESULTS: Laser-induced purpuric discoloration resolved faster with 1% vitamin K and 0.3% retinol in acrylates copolymer cream than with no topical application. The difference is statistically significant from day 3 onward. CONCLUSION: A combination of 1% vitamin K and 0.3% retinol in acrylates copolymer cream hastened the resolution of laser-induced purpura