Publications by authors named "Audrey Wang"

45 Publications

Updated SARS-CoV-2 single nucleotide variants and mortality association.

J Med Virol 2021 Jul 10. Epub 2021 Jul 10.

Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indiana University - Purdue University Indianapolis, Indianapolis, Indiana, USA.

By analyzing newly collected SARS-CoV-2 genomes and comparing them with our previous study about SARS-CoV-2 single nucleotide variants (SNVs) before June 2020, we found that the SNV clustering had changed remarkably since June 2020. Apart from that the group of SNVs became dominant, which is represented by two nonsynonymous mutations A23403G (S:D614G) and C14408T (ORF1ab:P4715L), a few emerging groups of SNVs were recognized with sharply increased monthly incidence ratios of up to 70% in November 2020. Further investigation revealed sets of SNVs specific to patients' ages and/or gender, or strongly associated with mortality. Our logistic regression model explored features contributing to mortality status, including three critical SNVs, G25088T(S:V1176F), T27484C (ORF7a:L31L), and T25A (upstream of ORF1ab), ages above 40 years old, and the male gender. The protein structure analysis indicated that the emerging subgroups of nonsynonymous SNVs and the mortality-related ones were located on the protein surface area. The clashes in protein structure introduced by these mutations might in turn affect the viral pathogenesis through the alteration of protein conformation, leading to a difference in transmission and virulence. Particularly, we explored the fact that nonsynonymous SNVs tended to occur in intrinsic disordered regions of Spike and ORF1ab to significantly increase hydrophobicity, suggesting a potential role in the change of protein folding related to immune evasion.
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http://dx.doi.org/10.1002/jmv.27191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8426680PMC
July 2021

Fine-Grained Mapping of Cortical Somatotopies in Chronic Complex Regional Pain Syndrome.

J Neurosci 2019 11 30;39(46):9185-9196. Epub 2019 Sep 30.

Neuroscience Research Australia, Sydney, New South Wales 2031, Australia.

It has long been thought that severe chronic pain conditions, such as complex regional pain syndrome (CRPS), are not only associated with, but even maintained by a reorganization of the somatotopic representation of the affected limb in primary somatosensory cortex (S1). This notion has driven treatments that aim to restore S1 representations in CRPS patients, such as sensory discrimination training and mirror therapy. However, this notion is based on both indirect and incomplete evidence obtained with imaging methods with low spatial resolution. Here, we used fMRI to characterize the S1 representation of the affected and unaffected hand in humans (of either sex) with unilateral CRPS. The cortical area, location, and geometry of the S1 representation of the CRPS hand were largely comparable with those of both the unaffected hand and healthy controls. We found no differential relation between affected versus unaffected hand map measures and clinical measures (pain severity, upper limb disability, disease duration). Thus, if any map reorganization occurs, it does not appear to be directly related to pain and disease severity. These findings compel us to reconsider the cortical mechanisms underlying CRPS and the rationale for interventions that aim to "restore" somatotopic representations to treat pain. This study shows that the spatial map of the fingers in somatosensory cortex is largely preserved in chronic complex regional pain syndrome (CRPS). These findings challenge the treatment rationale for restoring somatotopic representations in complex regional pain syndrome patients.
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http://dx.doi.org/10.1523/JNEUROSCI.2005-18.2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6855684PMC
November 2019

Is a 10-minute surgical scrub necessary in urologic prosthetic surgery? A randomized study of the effect of a 5- vs 10-minute surgical scrub on bacterial colony counts in the genital skin.

Neurourol Urodyn 2019 03 22;38(3):990-995. Epub 2019 Feb 22.

Department of Urology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.

Aims: To determine the antiseptic efficacy on bacterial colony counts of a 5- vs 10-minute surgical site scrub in urologic surgery.

Methods: A prospective cohort study was conducted in 101 patients presenting for elective urological procedures. Patients were randomized to a 5- or 10-minute groin scrub with Betadine (povidone-iodine). Skin swabs were taken immediately after skin clipping and following routine painting with Betadine. A third swab was taken after the betadine skin scrub. Bacterial colony counts were reported as a number of colony-forming units (CFUs). The primary outcome measure was a quantitative comparison of CFUs in the two arms.

Results: Fifty-three patients were randomized to a 5-minute scrub and 48 to a 10-minute scrub. After Betadine painting, CFUs were present in 38% of patients in the 5-minute group (mean, 33.5 CFU) and in 27% of the 10-minute group (mean, 45.4 CFU). Following the surgical scrub, only 7.5% of the 5-minute group and 8.3% of the 10-minute group had a measurable CFU count of greater than or equal to 1, and colony counts were low in both groups (5- minute group: mean, 1.5 CFU; 10-minute group: mean, 2.0 CFU). There was no significant difference in CFUs following a 5- or 10-minute scrub (P = 0.28).

Conclusions: The addition of a surgical skin scrub leads to a fourfold reduction in the skin CFU count compared with Betadine painting. However, there is no difference between the antibacterial effects of a 5- and 10-minute scrub. A 5-minute scrub may be sufficient in urologic prosthetic surgery.
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http://dx.doi.org/10.1002/nau.23945DOI Listing
March 2019

Female Pelvic Medicine & Reconstructive Surgery (FPMRS) challenges on behalf of the collaborative research in pelvic surgery consortium (CoRPS): managing complicated cases series 2: management of urinary incontinence in a neurogenic patient.

Int Urogynecol J 2019 Feb 7;30(2):193-196. Epub 2018 Nov 7.

Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA.

Discussion and management of incontinence in a patient with spina bifida by four international experts followed by a literature review.
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http://dx.doi.org/10.1007/s00192-018-3806-0DOI Listing
February 2019

A Novel Finger Illusion Reveals Reduced Weighting of Bimanual Hand Cortical Representations in People With Complex Regional Pain Syndrome.

J Pain 2019 02 14;20(2):171-180. Epub 2018 Sep 14.

Neuroscience Research Australia, Randwick, Sydney, Australia.; University of South Australia, Adelaide, Australia. Electronic address:

Complex regional pain syndrome (CRPS) is associated with deficits in sensorimotor control. Herein we have used a novel finger illusion to investigate whether CRPS is associated with reduced weighting of bimanual hand representations. The illusion normally induces a compelling feeling that the hands are close together when in fact they are 12 cm apart. People with CRPS and age, gender, and dominant hand-matched controls tested the illusion in the midline then on either side of the midline. The illusion had 2 variants; the passive pincer-grip position, without contact (no grasp condition) and with contact (grasp condition) of the artificial finger. The primary outcome was the perceived vertical distance between the index fingers. Twenty people with CRPS and 20 controls participated (mean age 44.4 ± 11.7 years). During the no grasp condition, participants with CRPS perceived the vertical distance significantly closer to the actual 12 cm (mean 8.0 cm, 95% confidence interval 6.5-9.5 cm), than controls did (mean 6.4 cm, 95% confidence interval 5.5-7.2 cm]). That is, the illusion was weaker in people with CRPS than in controls during no grasp. There was no such difference during grasp; that is, both groups showed the predicted illusion response. There was no effect of hand placement relative to midline or relative to the opposite hand. We conclude that people with unilateral CRPS have lower weighting of bimanual hand representation than controls have, independent of hand location. However, adding additional cutaneous input returns those with CRPS to the expected performance. We suggest the results have clear clinical and research implications. PERSPECTIVE: An abnormal weighting of bilateral hand representation may reflect a vulnerability for chronic CRPS, an adaptation to the disease, and/or a potential therapeutic target. That addition of cutaneous input immediately normalizes the problem points to the possible role of bimanual tasks in prevention or rehabilitation.
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http://dx.doi.org/10.1016/j.jpain.2018.08.008DOI Listing
February 2019

Biomarkers of Cellular Senescence and Skin Aging.

Front Genet 2018 23;9:247. Epub 2018 Aug 23.

Cell Ageing, Skin Research Institute of Singapore (SRIS), A∗STAR, Singapore, Singapore.

Cellular senescence is an irreversible growth arrest that occurs as a result of different damaging stimuli, including DNA damage, telomere shortening and dysfunction or oncogenic stress. Senescent cells exert a pleotropic effect on development, tissue aging and regeneration, inflammation, wound healing and tumor suppression. Strategies to remove senescent cells from aging tissues or preneoplastic lesions can delay tissue dysfunction and lead to increased healthspan. However, a significant hurdle in the aging field has been the identification of a universal biomarker that facilitates the unequivocal detection and quantification of senescent cell types and . Mammalian skin is the largest organ of the human body and consists of different cell types and compartments. Skin provides a physical barrier against harmful microbes, toxins, and protects us from ultraviolet radiation. Increasing evidence suggests that senescent cells accumulate in chronologically aged and photoaged skin; and may contribute to age-related skin changes and pathologies. Here, we highlight current biomarkers to detect senescent cells and review their utility in the context of skin aging. In particular, we discuss the efficacy of biomarkers to detect senescence within different skin compartments and cell types, and how they may contribute to myriad manifestations of skin aging and age-related skin pathologies.
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http://dx.doi.org/10.3389/fgene.2018.00247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6115505PMC
August 2018

Mapping Color to Meaning in Colormap Data Visualizations.

IEEE Trans Vis Comput Graph 2019 01 3;25(1):810-819. Epub 2018 Sep 3.

To interpret data visualizations, people must determine how visual features map onto concepts. For example, to interpret colormaps, people must determine how dimensions of color (e.g., lightness, hue) map onto quantities of a given measure (e.g., brain activity, correlation magnitude). This process is easier when the encoded mappings in the visualization match people's predictions of how visual features will map onto concepts, their inferred mappings. To harness this principle in visualization design, it is necessary to understand what factors determine people's inferred mappings. In this study, we investigated how inferred color-quantity mappings for colormap data visualizations were influenced by the background color. Prior literature presents seemingly conflicting accounts of how the background color affects inferred color-quantity mappings. The present results help resolve those conflicts, demonstrating that sometimes the background has an effect and sometimes it does not, depending on whether the colormap appears to vary in opacity. When there is no apparent variation in opacity, participants infer that darker colors map to larger quantities (dark-is-more bias). As apparent variation in opacity increases, participants become biased toward inferring that more opaque colors map to larger quantities (opaque-is-more bias). These biases work together on light backgrounds and conflict on dark backgrounds. Under such conflicts, the opaque-is-more bias can negate, or even supersede the dark-is-more bias. The results suggest that if a design goal is to produce colormaps that match people's inferred mappings and are robust to changes in background color, it is beneficial to use colormaps that will not appear to vary in opacity on any background color, and to encode larger quantities in darker colors.
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http://dx.doi.org/10.1109/TVCG.2018.2865147DOI Listing
January 2019

Loss of lamin B1 is a biomarker to quantify cellular senescence in photoaged skin.

Sci Rep 2017 Nov 15;7(1):15678. Epub 2017 Nov 15.

Cell Ageing, Institute of Medical Biology, 8A Biomedical Grove, #06-06, Immunos, 138648, Singapore.

Skin ageing is an inevitable consequence of life and accelerated by exposure to ultraviolet (UV) rays. Senescence is an irreversible growth arrest and senescent cells accumulate in ageing tissues, at sites of age-related pathologies and in pre-neoplastic lesions. Conventionally, senescent cells have been detected by senescence associated-β-galactosidase (SA-β-gal) staining, a procedure that requires enzymatic activity, which is lost in fixed tissue samples. We previously demonstrated that loss of lamin B1 is a novel marker to identify senescent cells. Here, we demonstrate that loss of lamin B1 facilitates the detection and quantification of senescent cells upon UV-exposure in vitro and upon chronic UV-exposure and skin regeneration in vivo. Taken together, this marker enables the study of environmental conditions on tissue ageing and regeneration in vivo, serves as a diagnostic tool to distinguish senescent from proliferating cells in pre-neoplastic lesions, and facilitates investigating the role of senescent cells in various age-related pathologies.
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http://dx.doi.org/10.1038/s41598-017-15901-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688158PMC
November 2017

Semi-Automatic Electronic Stent Register: a novel approach to preventing ureteric stents lost to follow up.

ANZ J Surg 2017 Oct 2;87(10):837-841. Epub 2017 Aug 2.

Department of Urology, Westmead Hospital, Westmead, New South Wales, Australia.

Background: Ureteric stents are indispensable tools in modern urology; however, the risk of them not being followed-up once inserted poses medical and medico-legal risks. Stent registers are a common solution to mitigate this risk; however, manual registers are logistically challenging, especially for busy units.

Methods: Western Sydney Local Health District developed a novel Semi-Automatic Electronic Stent Register (SAESR) utilizing billing information to track stent insertions. To determine the utility of this system, an audit was conducted comparing the 6 months before the introduction of the register to the first 6 months of the register.

Results: In the first 6 months of the register, 457 stents were inserted. At the time of writing, two of these are severely delayed for removal, representing a rate of 0.4%. In the 6 months immediately preceding the introduction of the register, 497 stents were inserted, and six were either missed completely or severely delayed in their removal, representing a rate of 1.2%. A non-inferiority analysis found this to be no worse than the results achieved before the introduction of the register.

Conclusion: The SAESR allowed us to improve upon our better than expected rate of stents lost to follow up or severely delayed. We demonstrated non-inferiority in the rate of lost or severely delayed stents, and a number of other advantages including savings in personnel costs. The semi-automatic register represents an effective way of reducing the risk associated with a common urological procedure. We believe that this methodology could be implemented elsewhere.
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http://dx.doi.org/10.1111/ans.14126DOI Listing
October 2017

Pediatric Psoriasis Comorbidity Screening Guidelines.

JAMA Dermatol 2017 07;153(7):698-704

Departments of Dermatology and Pediatrics, Rady Children's Hospital San Diego and University of California, San Diego School of Medicine, San Diego.

Importance: Psoriasis is a complex inflammatory skin condition associated with serious medical comorbidities in adults, including obesity, hypertension, dyslipidemia, type 2 diabetes mellitus, psoriatic arthritis, nonalcoholic fatty liver disease, depression, anxiety, and decreased quality of life. Because psoriasis begins in childhood in almost one-third of patients, early identification of risk may be critical to minimizing effects on future health.

Objective: To develop the first set of guidelines for comorbidity screening for patients with pediatric psoriasis based on current evidence.

Evidence Review: A literature review was performed using PubMed from January 1999 through December 2015. Limiting the search to human studies published in English and removing reviews and editorials produced 153 relevant manuscripts. An expert panel in psoriasis, pediatric dermatology, pediatric rheumatology, pediatric gastroenterology, pediatric endocrinology, and adult and pediatric cardiology used the patient-centered Strength of Recommendation Taxonomy (SORT) method to evaluate and grade the quality of evidence.

Findings: Because of the limited number of pediatric studies published on these topics, the strength of the panel's recommendations is classified as SORT level C expert consensus recommendations. The majority of recommendations coincide with those endorsed by the American Academy of Pediatrics for the general pediatric patient but with added attention to signs and symptoms of arthritis, depression, and anxiety. The panel also identified key areas for further investigation.

Conclusions And Relevance: Patients with pediatric psoriasis should receive routine screening and identification of risk factors for associated comorbidities. These guidelines are relevant for all health care providers caring for patients with pediatric psoriasis, including primary care clinicians, dermatologists, and pediatric specialists. Because these are the first pediatric guidelines, re-review and refinement will be necessary as studies further detail, and possibly stratify, risk in affected children.
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http://dx.doi.org/10.1001/jamadermatol.2017.0499DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5748031PMC
July 2017

Nuclear envelope localization of LEMD2 is developmentally dynamic and lamin A/C dependent yet insufficient for heterochromatin tethering.

Differentiation 2017 Mar - Apr;94:58-70. Epub 2017 Jan 2.

Department of Biology II, Ludwig-Maximilians-University Munich, Grosshadernerstrasse 2, 82152 Planegg-Martinsried, Germany. Electronic address:

Peripheral heterochromatin in mammalian nuclei is tethered to the nuclear envelope by at least two mechanisms here referred to as the A- and B-tethers. The A-tether includes lamins A/C and additional unknown components presumably INM protein(s) interacting with both lamins A/C and chromatin. The B-tether includes the inner nuclear membrane (INM) protein Lamin B-receptor, which binds B-type lamins and chromatin. Generally, at least one of the tethers is always present in the nuclear envelope of mammalian cells. Deletion of both causes the loss of peripheral heterochromatin and consequently inversion of the entire nuclear architecture, with this occurring naturally in rod photoreceptors of nocturnal mammals. The tethers are differentially utilized during development, regulate gene expression in opposite manners, and play an important role during cell differentiation. Here we aimed to identify the unknown chromatin binding component(s) of the A-tether. We analyzed 10 mouse tissues by immunostaining with antibodies against 7 INM proteins and found that every cell type has specific, although differentially and developmentally regulated, sets of these proteins. In particular, we found that INM protein LEMD2 is concomitantly expressed with A-type lamins in various cell types but is lacking in inverted nuclei of rod cells. Truncation or deletion of Lmna resulted in the downregulation and mislocalization of LEMD2, suggesting that the two proteins interact and pointing at LEMD2 as a potential chromatin binding mediator of the A-tether. Using nuclei of mouse rods as an experimental model lacking peripheral heterochromatin, we expressed a LEMD2 transgene alone or in combination with lamin C in these cells and observed no restoration of peripheral heterochromatin in either case. We conclude that in contrary to the B-tether, the A-tether has a more intricate composition and consists of multiple components that presumably vary, at differing degrees of redundancy, between cell types and differentiation stages.
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http://dx.doi.org/10.1016/j.diff.2016.12.002DOI Listing
September 2017

Testicular infarction and rupture: an uncommon complication of epididymo-orchitis.

J Surg Case Rep 2016 May 10;2016(5). Epub 2016 May 10.

Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.

Epididymo-orchitis is a common diagnosis in men presenting with unilateral testicular pain. It can be of an infectious or non-infectious aetiology. Clinical examination and laboratory investigations do not reliably differentiate testicular infarction secondary to epididymo-orchitis from uncomplicated epididymo-orchitis. Definitive diagnosis is usually made by ultrasound. Misdiagnosis and under-treatment can lead to poor outcome, such as infarction and loss of the affected testis. We present an uncommon case of epididymo-orchitis resulting in testicular infarction and rupture despite normal initial investigations.
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http://dx.doi.org/10.1093/jscr/rjw077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862172PMC
May 2016

Perceptions of Aesthetic Outcome of Linear vs Multiple Z-Plasty Scars in a National Survey.

JAMA Facial Plast Surg 2016 Jul;18(4):263-7

Department of Dermatology, University of Southern California, Los Angeles.

Importance: The process of Z-plasty scar revision breaks up a linear scar into multiple parts with the purpose of camouflage and improvement of the cosmetic appearance of surgical scars. Although this postulation guides the practices of many reconstructive surgeons, few studies support improved aesthetic outcomes.

Objective: To compare the perceived cosmetic appearance of linear scars vs zigzag scars by the general public.

Design, Setting, And Participants: A computer-generated image of a mature scar was designed in linear and zigzag configurations and overlaid on the faces of standardized headshots of 4 white individuals. Twelve sets of images of linear vs zigzag scars were arranged in side-by-side comparisons in an Internet-based national survey. Respondents rated each scar on the 10-point Patient and Observer Scar Assessment Scale, where a lower score indicated likeness with normal skin and a higher score, the worst scar imaginable. Data were collected from May 1 through June 30, 2013, and analyzed from July 31 to September 1, 2013.

Main Outcomes And Measures: Aesthetic rating of scars by the survey respondents.

Results: Eight hundred seventy-six participants responded to the survey (24.5% response rate); of these, 810 completed the survey (379 men [46.1%] and 443 women [53.9%]; 148 [18.0%] were 18 to 29 years, 171 [20.8%] were 30 to 44 years, 290 [35.3%] were 45 to 60 years, and 213 [25.9%] were older than 60 years). Significantly lower scores and better perceived cosmetic outcomes were found for linear scars compared with zigzag scars in every assessed group of images on the Patient and Observer Scar Assessment Scale (mean [SD] scores, 2.9 [1.6] vs 4.5 [2.2], respectively; P < .001).

Conclusions And Relevance: The lay public has a significantly better perception of the appearance of linear scars compared with zigzag scars in 3 facial locations (temple, cheek, and forehead) of white patients in various age groups.

Level Of Evidence: NA.
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http://dx.doi.org/10.1001/jamafacial.2016.0107DOI Listing
July 2016

Rare myxoid dermatofibrosarcoma protuberans masquerading as a pilar cyst in a child.

JAAD Case Rep 2015 May 4;1(3):129-31. Epub 2015 May 4.

Department of Dermatology, University of California San Diego Health System, San Diego, California; Division of Adolescent and Pediatric Dermatology, Rady Children's Hospital, San Diego, California.

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http://dx.doi.org/10.1016/j.jdcr.2015.02.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808710PMC
May 2015

Intravesical OnabotulinumtoxinA Injection for Overactive Orthotopic Ileal Neobladder: Feasibility and Efficacy.

Int Neurourol J 2016 Mar 7;20(1):81-5. Epub 2016 Mar 7.

Department of Urology, Austin Hospital, University of Melbourne, Melbourne, Australia.

The efficacy of intravesical onabotulinumtoxinA (BTXA) in the treatment of overactive bladder (OAB) has been well documented. The use of BTXA injection in orthotopic neobladders is yet to be studied. We present 4 cases of patients injected with intravesical BTXA for overactive orthotopic ileal neobladder. We recorded patient demographics, presenting and follow-up symptoms, urodynamic profiles, and Patient Global Impression of Improvement (PGI-I) scores. The 4 patients reported varying degrees of subjective improvements in the symptoms, including urgency, urge incontinence, and pad usage. Mean follow-up duration was 8.3 months (range, 5-14 months). Average PGI-I score was 3 ("a little better") (range, 2-4). To our knowledge, the current study is the first case series examining BTXA injection for orthotopic neobladder overactivity. BTXA injection yielded varying degrees of objective and subjective improvements, without significant complications. Intravesical BTXA injection is feasible and may be considered as a potential treatment alternative for OAB in orthotopic neobladders, although further study is warranted.
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http://dx.doi.org/10.5213/inj.1630380.190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4819152PMC
March 2016

Rumpel-Leede Phenomenon Associated With Tourniquet-like Forces of Baby Carriers in Otherwise Healthy Infants: Baby Carrier Purpura.

JAMA Dermatol 2016 06;152(6):728-30

Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California3University of California, San Diego, La Jolla4DermOne LLC, West Conshohocken, Pennsylvania.

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http://dx.doi.org/10.1001/jamadermatol.2015.6270DOI Listing
June 2016

"EB, or Not EB?" Neonatal Desquamative Impetigo in a Degloving Pattern.

Pediatr Dermatol 2016 Mar-Apr;33(2):e147-8. Epub 2016 Jan 29.

Rady Children's Hospital, San Diego, California.

We present the case of a 7-day-old boy with significant, rapidly spreading blistering and desquamation in a "degloving" pattern on the hands that mimicked epidermolysis bullosa but was ultimately diagnosed as bullous impetigo caused by a clinically aggressive strain of Staphylococcus aureus. Bullous impetigo is a desquamating condition caused by local release of S. aureus exfoliative toxin A and is more commonly seen in children. This case highlights the fragility of newborn skin and reviews the major diagnoses that should be considered in an infant with significant blistering.
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http://dx.doi.org/10.1111/pde.12766DOI Listing
January 2017

Reply to: "Wound edge eversion: Tradition or science?".

J Am Acad Dermatol 2015 Aug;73(2):e65

Department of Dermatology, University of California, Davis, California. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2015.04.043DOI Listing
August 2015

V1-distributed Herpes Zoster and Meningitis in a Two-year Old.

J Clin Aesthet Dermatol 2015 May;8(5):53-4

University of California, San Diego, La Jolla, California; ; Rady Children's Hospital, San Diego, California;

Since the advent of the varicella vaccine, occurrence of herpes zoster in children has been rare. However, a subset of patients may develop herpes zoster after receiving the vaccine. Herein the authors report a case of a two-year-old boy who developed herpes zoster in the V1 distribution and meningitis following a single dose of varicella vaccine.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445898PMC
May 2015

Effect of Automated Online Counseling on Clinical Outcomes and Quality of Life Among Adolescents With Acne Vulgaris: A Randomized Clinical Trial.

JAMA Dermatol 2015 Sep;151(9):970-5

Department of Dermatology, University of Colorado, Denver, Aurora.

Importance: Effective patient education is necessary for treating patients with acne vulgaris. Automated online counseling simulates face-to-face encounters and may be a useful tool to deliver education.

Objective: To compare the effectiveness of a standard educational website with that of an automated-counseling website in improving clinical outcomes and quality of life among adolescents with acne.

Design, Setting, And Participants: Randomized clinical trial conducted between March 27, 2014, and June 27, 2014, including a 12-week follow-up in a local inner-city high school. Ninety-eight students aged at least 13 years with mild to moderate acne were eligible for participation. A per-protocol analysis of the evaluable population was conducted on clinical outcome data.

Interventions: Participants viewed either a standard educational website or an automated-counseling website.

Main Outcomes And Measures: The primary outcome was the total acne lesion count. Secondary measures included the Children's Dermatology Life Quality Index (CDLQI) scores and general skin care behavior.

Results: Forty-nine participants were randomized to each group. At baseline, the mean (SD) total acne lesion count was not significantly different between the standard-website group and the automated-counseling-website group (21.33 [10.81] vs 25.33 [12.45]; P = .10). Improvement in the mean (SD) acne lesion count was not significantly different between the standard-website group and the automated-counseling-website group (0.20 [9.26] vs 3.90 [12.19]; P = .10). The mean (SD) improvement in CDLQI score for the standard-website group was not significantly different from that of the automated-counseling-website group (0.17 [2.64] vs 0.39 [2.94]; P = .71). After 12 weeks, a greater proportion of participants in the automated-counseling-website group maintained or adopted a recommended anti-acne skin care routine compared with the standard-website group (43% vs 22%; P = .03).

Conclusions And Relevance: Internet-based acne education using automated counseling was not superior to standard-website education in improving acne severity and quality of life. However, a greater proportion of participants who viewed the automated-counseling website reported having maintained or adopted a recommended anti-acne skin care regimen.

Trial Registration: clinicaltrials.gov Identifier: NCT02031718.
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http://dx.doi.org/10.1001/jamadermatol.2015.0859DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985004PMC
September 2015

Effectiveness of a novel interactive health care education tool on clinical outcomes and quality of life in acne patients: A randomized controlled pilot study.

J Dermatolog Treat 2015 Oct 20;26(5):435-9. Epub 2015 Mar 20.

c Department of Dermatology , University of Colorado, Denver , Aurora , CO , USA.

Background: We developed an Internet-based education tool (My Personalized Application for health Care Education, MyPACE) to promote patient comprehension about acne.

Objective: To determine if MyPACE improves clinical outcomes and quality of life in acne patients.

Methods: Modeling the spaced education approach, 50 participants received weekly multiple-choice questions for 12 weeks. Those randomized to the intervention group received acne-related questions, while those in the control group received non-dermatologic health-related questions. Acne lesion counts and Dermatology Life Quality Index (DLQI) scores were recorded at initial enrollment and at 12 weeks.

Results: Within-group analysis for the intervention group showed a significant mean change in inflammatory and non-inflammatory acne lesions per person (-3.2 ± 1.3, p = 0.0219; -4.4 ± 1.8, p = 0.0267, respectively). The control group only demonstrated a significant mean change in inflammatory lesions (-2.8 ± 0.80, p = 0.0040). Both groups had statistically significant improvement in DLQI score. Compared with participants in the control group, those receiving acne-related questions experienced greater improvement in clinical outcomes and quality of life.

Limitations: The small sample size limited our ability to detect statistically significant differences.

Conclusion: Internet-based, disease-specific, spaced education tools may be more effective than non-targeted tools for improving clinical outcomes and quality of life.
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http://dx.doi.org/10.3109/09546634.2015.1020915DOI Listing
October 2015

Tissue specific loss of A-type lamins in the gastrointestinal epithelium can enhance polyp size.

Differentiation 2015 Jan-Feb;89(1-2):11-21. Epub 2015 Jan 8.

Developmental and Regenerative Biology, Institute of Medical Biology, 8A Biomedical Grove, 138648, Singapore.

The nuclear lamina, comprised of the A and B-type lamins, is important in maintaining nuclear shape and in regulating key nuclear functions such as chromatin organization and transcription. Deletion of the A-type lamins results in genome instability and many cancers show altered levels of A-type lamin expression. Loss of function mutations in the mouse Lmna gene result in early postnatal lethality, usually within 3-5 weeks of birth making an analysis of the role of lamins in carcinogenesis difficult. To circumvent early lethality, and determine the role of the A-type lamins in specific tissues in older mice we derived a conditional allele of Lmna(FL/FL) (floxed). Lmna(FL/FL) was specifically deleted in the gastrointestinal (GI) epithelium by crossing the Lmna(FL/FL) mice with Villin-Cre mice. Mice lacking Lmna in the GI are overtly normal with no effects on overall growth, longevity or GI morphology. On a GI specific sensitized (Apc(Min/+)) background, polyp numbers are unchanged, but polyp size is slightly increased, and only in the duodenum. Our findings reveal that although A-type lamins are dispensable in the postnatal GI epithelium, loss of Lmna under malignant conditions may, to a limited extent, enhance polyp size indicating that A-type lamins may regulate cell proliferation in the transformed GI epithelium.
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http://dx.doi.org/10.1016/j.diff.2014.12.002DOI Listing
January 2016

Comparing the effectiveness of automated online counseling to standard web-based education on improving acne knowledge: a randomized controlled trial.

Am J Clin Dermatol 2015 Feb;16(1):55-60

Department of Dermatology, University of California, Davis, Sacramento, CA, USA.

Background: Evidence regarding what comprises effective education for acne vulgaris patients is lacking. Internet-based education may improve patient knowledge of this condition.

Objectives: Our objective was to compare the effectiveness of standard web-based education and an automated counseling website in improving acne knowledge.

Design: In a randomized trial, participants visited either a standard website or an automated counseling website to learn about acne. Multiple-choice questions were administered at baseline and after 12 weeks to assess change in acne knowledge.

Results: A total of 97 high school students were enrolled, and 95 completed the study. The standard website group had a significant increase in knowledge from baseline (3.61 ± 1.22) to 12-week follow-up (5.46 ± 1.31, p < 0.001). Similarly, the automated counseling website group had a significant increase in knowledge between both time points (3.53 ± 1.50 vs. 6.49 ± 1.06, p < 0.001). After 12 weeks, mean improvement in knowledge was higher in the automated counseling group (2.96 ± 1.85) than in the standard website group (1.85 ± 1.46, d = 0.67, p = 0.002). The number of website visits was positively correlated with improvement in knowledge in both groups. Finally, the automated counseling website group rated their educational material more useful (p = 0.004) and more enjoyable to view (p = 0.003) than did the standard website group.

Limitations: This study is limited to adolescents with mild-to-moderate acne vulgaris.

Conclusion: Internet-based patient education appears to be an effective method of improving acne knowledge among adolescents.
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http://dx.doi.org/10.1007/s40257-014-0104-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591056PMC
February 2015

Spontaneous ureteric rupture secondary to an invasive desmoid tumour.

Int J Surg Case Rep 2014 22;5(12):944-7. Epub 2014 Oct 22.

Department of Urology, Westmead Hospital, Sydney, Australia.

Introduction: Spontaneous ureteric rupture is a rare entity that presents as an extravasation of urine from the ureter without previous surgery, ureteric manipulation and external trauma of the ureter. We report the case of a desmoid tumour presenting as spontaneous ureteric rupture which was managed in our institution.

Presentation Of Case: A 28 years old healthy male presented with a four day history of generalised abdominal pain secondary to spontaneous right ureteric rupture. Patient was initially managed via insertion of nephrostomy tube and antibiotics. After unsuccessful attempts of retrograde and antegrade ureteric stent insertion, patient was subsequently managed via elective surgical intervention. The excised specimen revealed desmoid tumour as cause of the ureteric rupture.

Discussion: Desmoid tumours are rare benign tumours arising from fascial or musculoaponeurotic structures that do not metastasise, but tend to invade locally. It is often initially managed medically prior to undertaking a definitive surgical intervention. To our knowledge this is the first reported case of ureteric perforation secondary to a desmoid tumour of the mesentery.

Conclusion: Spontaneous rupture of the ureter is often misdiagnosed as other conditions. History taking and examination can be unreliable, hence a high level of suspicion and further investigations should be utilised. Once the diagnosis is made, treatment can be individualised based on aetiology.
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http://dx.doi.org/10.1016/j.ijscr.2014.10.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4275862PMC
December 2014

Set-back versus buried vertical mattress suturing: results of a randomized blinded trial.

J Am Acad Dermatol 2015 Apr 14;72(4):674-80. Epub 2014 Aug 14.

Department of Dermatology, University of California-Davis, Sacramento, California. Electronic address:

Background: The set-back suture, an absorbable dermal suturing technique, purportedly improves wound eversion and cosmetic outcomes.

Objective: We sought to conduct a split-wound, prospective, randomized study to compare the cosmetic outcome and wound eversion achieved with the set-back suture and the buried vertical mattress suture (BVMS).

Methods: A total of 46 surgical elliptical wounds were randomized to subcuticular closure with the set-back suture on half and the BVMS on the other. Maximum eversion height and width were measured immediately postoperatively. At 3 months, 2 blinded observers evaluated each scar using a 7-point Likert physician global scar assessment scale. Subjects and observers also completed the validated Patient and Observer Scar Assessment Scale, where a score of 6 represents normal-appearing skin and 60 represents worst imaginable scar.

Results: In all, 42 subjects completed the study. The set-back suture provided statistically significant wound eversion. On the Likert scale, observers rated the set-back suture side 1 point better than the BVMS side. Both patient and observer total Patient and Observer Scar Assessment Scale scores were significantly lower for the set-back suture side (subject mean 13.0 ± 8.7 vs 16.2 ± 12.0 [P = .039]; observer mean 24.5 ± 10.4 vs 27.7 ± 13.6 [P = .028], respectively).

Limitations: Single institution experience and relatively short follow-up are limitations.

Conclusion: The set-back suture provides superior wound eversion and better cosmetic outcomes than the BVMS.
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http://dx.doi.org/10.1016/j.jaad.2014.07.018DOI Listing
April 2015

Multiple firm nodules and tender, indurated plaques.

JAMA Dermatol 2014 May;150(5):569-70

University of California, Davis, Sacramento.

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http://dx.doi.org/10.1001/jamadermatol.2013.8734DOI Listing
May 2014

The "smile-and-fill" injection technique: a dynamic approach to midface volumization.

J Drugs Dermatol 2014 Mar;13(3):288-90

Injectable poly-L-lactic acid (PLLA) is a biodegradable, biocompatible, synthetic polymer that acts as a scaffold to promote collagen formation and is FDA-approved for the correction of facial lipoatrophy in patients with human immunodeficiency virus (HIV) infection. The safety and efficacy of injectable PLLA for the treatment of HIV-associated facial lipoatrophy has been demonstrated in clinical studies and is accompanied by improvement in patient quality of life. Volumization of the mid-face is regarded as complex. The importance of respecting patient mid-face differences at rest and in motion was highlighted in a study that demonstrated effectiveness of silicone microdroplets (0.01 mL) in a depot manner to treat HIV patients with facial lipoatrophy. One of the challenges of facial volume rejuvenation with these techniques is preserving and enhancing dynamic facial movements after treatment. To address this challenge, we developed an injection technique termed "smile-and-fill." In this case series, we describe three patients treated by this technique to restore the malar aspect of the mid-face with improvement several months post-treatment.
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March 2014

Treatment of a symptomatic dermatofibroma with fractionated carbon dioxide laser and topical corticosteroids.

J Drugs Dermatol 2013 Dec;12(12):1483-4

Dermatofibromas are benign skin lesions that may be treated if symptomatic or for cosmetic concerns. We present a case of an African American woman with an enlarging, pruritic dermatofibroma on the thigh that was treated with fractionated carbon dioxide (CO2) laser three times approximately 5 weeks apart. Between laser treatments, topical corticosteroids were applied to the lesion for a total of 13 weeks. The dermatofibroma completely flattened and became asymptomatic within 1 month after the final laser treatment. We hypothesize that the fractionated CO2 laser ablated a portion of the stromal component of the lesion and introduced microscopic channels that facilitated deeper penetration of the topical corticosteroids into the lesion. This is the first reported case demonstrating the successful treatment of a symptomatic dermatofibroma using combination therapy with fractionated CO2 laser and topical corticosteroids.
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December 2013

Shiitake mushroom-induced flagellate erythema: A striking case and review of the literature.

Dermatol Online J 2013 Apr 15;19(4). Epub 2013 Apr 15.

Department of Dermatology, University of California Davis, Sacramento, California.

Ingestion of raw or undercooked shiitake mushrooms is associated with a distinctive flagellate erythema. We describe a 61-year-old Caucasian man who presented with a pruritic, erythematous eruption of multiple linear streaks on the trunk and extremities starting 1 day after eating raw shiitake mushrooms. His symptoms and skin lesions resolved with minimal hyperpigmentation within approximately 1 week after treating with topical steroids and oral antihistamines. Skin biopsy showed non-specific findings, including a sparse perivascular and interstitial dermatitis as well as focal vacuolar interface changes. Our case illustrates that this condition is a visibly striking dermatitis with a self-limited course. The pathomechanism of the skin eruption remains unclear.
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April 2013
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