PLOS ONE: [sortOrder=DATE_NEWEST_FIRST, sort=Date, newest first, q=subject:"Dermatology"]PLOShttps://journals.plos.org/plosone/webmaster@plos.orgaccelerating the publication of peer-reviewed sciencehttps://journals.plos.org/plosone/search/feed/atom?sortOrder=DATE_NEWEST_FIRST&unformattedQuery=subject:%22Dermatology%22&sort=Date,+newest+firstAll PLOS articles are Open Access.https://journals.plos.org/plosone/resource/img/favicon.icohttps://journals.plos.org/plosone/resource/img/favicon.ico2024-03-29T12:06:15ZClimate factors associated with cancer incidence: An ecological study covering 33 cancers from population-based registries in 37 countriesHaowen WangHongmei ZengHui MiaoChang ShuYuming GuoJohn S. Ji10.1371/journal.pclm.00003622024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Haowen Wang, Hongmei Zeng, Hui Miao, Chang Shu, Yuming Guo, John S. Ji</p>
Cancer etiology is multifactorial, with climate change and environmental factors such as extreme weather events and ozone layer destruction potentially increasing cancer risk. Investigating climate factors with cancer incidence can provide valuable insights for prevention and future disease burden prediction. We conducted a population-based ecological study using data from the World Health Organization’s Cancer Incidence in Five Continents (CI5plus, 89 cancer registries from 1998 to 2012) and the Surveillance, Epidemiology, and End Results (SEER, 607 US counties from 2000 to 2018) Program. We tracked climate factors through satellite-based remote sensing, including green space, stratospheric ozone concentration, solar radiation, precipitation, and temperature. We performed linear panel regression models to estimate the effects of both long-term exposure, lag effect, and change rate of climate factors on cancer incidences. We adjusted for smoking prevalence, air pollution, and gross domestic product (GDP) per capita to account for potential confounding factors. Our study included more than 430 million underlying populations across 37 countries. Higher green space exposure (per 0.1-unit normalized difference vegetation index, NDVI) was associated with decreased incidence of lung cancer (up to 6.66 cases [95%CI 4.38–8.93] per 100,000) and prostate cancer (up to 10.84 cases [95% CI 7.73–13.95] per 100,000). Increased solar radiation was associated with a higher incidence of melanoma, but a lower incidence of prostate cancer. No evidence was found to suggest associations between temperature or precipitation and cancer incidence. However, a rapid increase in temperature was linked to higher incidences of corpus uteri cancer and melanoma. Long-term exposure and rapid changes in climate factors may influence changes in cancer incidence, particularly lung and prostate cancers. While some associations were supported by existing evidence (such as solar radiation and melanoma), further research is necessary to investigate the etiology of novel cancer risk factors.GraphMHC: Neoantigen prediction model applying the graph neural network to molecular structureHoyeon JeongYoung-Rae ChoJungsoo GimSeung-Kuy ChaMaengsup KimDae Ryong Kang10.1371/journal.pone.02912232024-03-27T14:00:00Z2024-03-27T14:00:00Z<p>by Hoyeon Jeong, Young-Rae Cho, Jungsoo Gim, Seung-Kuy Cha, Maengsup Kim, Dae Ryong Kang</p>
Neoantigens are tumor-derived peptides and are biomarkers that can predict prognosis related to immune checkpoint inhibition by estimating their binding to major histocompatibility complex (MHC) proteins. Although deep neural networks have been primarily used for these prediction models, it is difficult to interpret the models reported thus far as accurately representing the interactions between biomolecules. In this study, we propose the GraphMHC model, which utilizes a graph neural network model applied to molecular structure to simulate the binding between MHC proteins and peptide sequences. Amino acid sequences sourced from the immune epitope database (IEDB) undergo conversion into molecular structures. Subsequently, atomic intrinsic informations and inter-atomic connections are extracted and structured as a graph representation. Stacked graph attention and convolution layers comprise the GraphMHC network which classifies bindings. The prediction results from the test set using the GraphMHC model showed a high performance with an area under the receiver operating characteristic curve of 92.2% (91.9-92.5%), surpassing a baseline model. Moreover, by applying the GraphMHC model to melanoma patient data from The Cancer Genome Atlas project, we found a borderline difference (0.061) in overall survival and a significant difference in stromal score between the high and low neoantigen load groups. This distinction was not present in the baseline model. This study presents the first feature-intrinsic method based on biochemical molecular structure for modeling the binding between MHC protein sequences and neoantigen candidate peptide sequences. This model can provide highly accurate responsibility information that can predict the prognosis of immune checkpoint inhibitors to cancer patients who want to apply it.The role of GAPDH in the selective toxicity of CNP in melanoma cellsClaudia von MontfortElif AplakLara EbbertChantal-Kristin WenzelNiklas P. KlahmWilhelm StahlPeter Brenneisen10.1371/journal.pone.03007182024-03-21T14:00:00Z2024-03-21T14:00:00Z<p>by Claudia von Montfort, Elif Aplak, Lara Ebbert, Chantal-Kristin Wenzel, Niklas P. Klahm, Wilhelm Stahl, Peter Brenneisen</p>
Background <p>Malignant melanoma is the most aggressive form of skin cancer with a rather poor prognosis. Standard chemotherapy often results in severe side effects on normal (healthy) cells finally being difficult to tolerate for the patients. Shown by us earlier, cerium oxide nanoparticles (CNP, nanoceria) selectively killed A375 melanoma cells while not being cytotoxic at identical concentrations on non-cancerous cells. In conclusion, the redox-active CNP exhibited both prooxidative as well as antioxidative properties. In that context, CNP induced mitochondrial dysfunction in the studied melanoma cells via generation of reactive oxygene species (primarily hydrogen peroxide (H<sub>2</sub>O<sub>2</sub>)), but that does not account for 100% of the toxicity.</p> Aim <p>Cancer cells often show an increased glycolytic rate (Warburg effect), therefore we focused on CNP mediated changes of the glucose metabolism.</p> Results <p>It has been shown before that glyceraldehyde 3-phosphate dehydrogenase (GAPDH) activity is regulated via oxidation of a cysteine in the active center of the enzyme with a subsequent loss of activity. Upon CNP treatment, formation of cellular lactate and GAPDH activity were significantly lowered. The treatment of melanoma cells and melanocytes with the GAPDH inhibitor heptelidic acid (HA) decreased viability to a much higher extent in the cancer cells than in the studied normal (healthy) cells, highlighting and supporting the important role of GAPDH in cancer cells.</p> Conclusion <p>We identified glyceraldehyde 3-phosphate dehydrogenase (GAPDH) as a target protein for CNP mediated thiol oxidation.</p>HDS-Net: Achieving fine-grained skin lesion segmentation using hybrid encoding and dynamic sparse attentionYou XueXinya ChenPei LiuXiaoyi Lv10.1371/journal.pone.02993922024-03-21T14:00:00Z2024-03-21T14:00:00Z<p>by You Xue, Xinya Chen, Pei Liu, Xiaoyi Lv</p>
Skin cancer is one of the most common malignant tumors worldwide, and early detection is crucial for improving its cure rate. In the field of medical imaging, accurate segmentation of lesion areas within skin images is essential for precise diagnosis and effective treatment. Due to the capacity of deep learning models to conduct adaptive feature learning through end-to-end training, they have been widely applied in medical image segmentation tasks. However, challenges such as boundary ambiguity between normal skin and lesion areas, significant variations in the size and shape of lesion areas, and different types of lesions in different samples pose significant obstacles to skin lesion segmentation. Therefore, this study introduces a novel network model called HDS-Net (Hybrid Dynamic Sparse Network), aiming to address the challenges of boundary ambiguity and variations in lesion areas in skin image segmentation. Specifically, the proposed hybrid encoder can effectively extract local feature information and integrate it with global features. Additionally, a dynamic sparse attention mechanism is introduced, mitigating the impact of irrelevant redundancies on segmentation performance by precisely controlling the sparsity ratio. Experimental results on multiple public datasets demonstrate a significant improvement in Dice coefficients, reaching 0.914, 0.857, and 0.898, respectively.The causal relationship between gut microbiota and immune skin diseases: A bidirectional Mendelian randomizationFei FengRuicheng LiRui TianXueyi WuNannan ZhangZhenhua Nie10.1371/journal.pone.02984432024-03-21T14:00:00Z2024-03-21T14:00:00Z<p>by Fei Feng, Ruicheng Li, Rui Tian, Xueyi Wu, Nannan Zhang, Zhenhua Nie</p>
Background <p>Increasing evidence suggests that alterations in gut microbiota are associated with a variety of skin diseases. However, whether this association reflects a causal relationship remains unknown. We aimed to reveal the causal relationship between gut microbiota and skin diseases, including psoriasis, atopic dermatitis, acne, and lichen planus.</p> Methods <p>We obtained full genetic association summary data for gut microbiota, psoriasis, atopic dermatitis, acne, and lichen planus from public databases and used three methods, mainly inverse variance weighting, to analyze the causal relationships between gut microbiota and these skin diseases using bidirectional Mendelian randomization, as well as sensitivity and stability analysis of the results using multiple methods.</p> Results <p>The results showed that there were five associated genera in the psoriasis group, seven associated genera were obtained in the atopic dermatitis group, a total of ten associated genera in the acne group, and four associated genera in the lichen planus group. The results corrected for false discovery rate showed that Eubacteriumfissicatenagroup (P = 2.20E-04, OR = 1.24, 95%CI:1.11–1.40) and psoriasis still showed a causal relationship. In contrast, in the reverse Mendelian randomization results, there was no evidence of an association between these skin diseases and gut microbiota.</p> Conclusion <p>We demonstrated a causal relationship between gut microbiota and immune skin diseases and provide a new therapeutic perspective for the study of immune diseases: targeted modulation of dysregulation of specific bacterial taxa to prevent and treat psoriasis, atopic dermatitis, acne, and lichen planus.</p>Analysis of dermoscopy images of multi-class for early detection of skin lesions by hybrid systems based on integrating features of CNN modelsMohammed AlshahraniMohammed Al-JabbarEbrahim Mohammed SenanIbrahim Abdulrab AhmedJamil Abdulhamid Mohammed Saif10.1371/journal.pone.02983052024-03-21T14:00:00Z2024-03-21T14:00:00Z<p>by Mohammed Alshahrani, Mohammed Al-Jabbar, Ebrahim Mohammed Senan, Ibrahim Abdulrab Ahmed, Jamil Abdulhamid Mohammed Saif</p>
Skin cancer is one of the most fatal skin lesions, capable of leading to fatality if not detected in its early stages. The characteristics of skin lesions are similar in many of the early stages of skin lesions. The AI in categorizing diverse types of skin lesions significantly contributes to and helps dermatologists to preserve patients’ lives. This study introduces a novel approach that capitalizes on the strengths of hybrid systems of Convolutional Neural Network (CNN) models to extract intricate features from dermoscopy images with Random Forest (Rf) and Feed Forward Neural Networks (FFNN) networks, leading to the development of hybrid systems that have superior capabilities early detection of all types of skin lesions. By integrating multiple CNN features, the proposed methods aim to improve the robustness and discriminatory capabilities of the AI system. The dermoscopy images were optimized for the ISIC2019 dataset. Then, the area of the lesions was segmented and isolated from the rest of the image by a Gradient Vector Flow (GVF) algorithm. The first strategy for dermoscopy image analysis for early diagnosis of skin lesions is by the CNN-RF and CNN-FFNN hybrid models. CNN models (DenseNet121, MobileNet, and VGG19) receive a region of interest (skin lesions) and produce highly representative feature maps for each lesion. The second strategy to analyze the area of skin lesions and diagnose their type by means of CNN-RF and CNN-FFNN hybrid models based on the features of the combined CNN models. Hybrid models based on combined CNN features have achieved promising results for diagnosing dermoscopy images of the ISIC 2019 dataset and distinguishing skin cancers from other skin lesions. The Dense-Net121-MobileNet-RF hybrid model achieved an AUC of 95.7%, an accuracy of 97.7%, a precision of 93.65%, a sensitivity of 91.93%, and a specificity of 99.49%.Add-on effects of Chinese herbal medicine external application (FZHFZY) to topical urea for mild-to-moderate psoriasis vulgaris: Protocol for a double-blinded randomized controlled pilot trial embedded with a qualitative studyJunyue WangClaire Shuiqing ZhangAnthony Lin ZhangJingjie YuHao DengHaiming ChenCharlie Changli XueChuanjian Lu10.1371/journal.pone.02978342024-03-21T14:00:00Z2024-03-21T14:00:00Z<p>by Junyue Wang, Claire Shuiqing Zhang, Anthony Lin Zhang, Jingjie Yu, Hao Deng, Haiming Chen, Charlie Changli Xue, Chuanjian Lu</p>
Psoriasis vulgaris is a chronic dermatological disease with a high global prevalence. It significantly reduces patients’ quality of life and is associated with a substantial economic burden. Conventional therapies for mild-to-moderate psoriasis are often associated with insufficient long-term symptomatic relief and side effects. Chinese herbal medicine (CHM) is commonly used for psoriasis management. A CHM formula, namely <i>Fu zheng he fu zhi yang</i> (FZHFZY), has shown promising treatment effects in clinical practice when used as a bath therapy. However, its efficacy and safety has not been evaluated by a rigorous randomized controlled trial (RCT). Therefore, we designed a double-blinded pilot RCT embedded with a qualitative study on CHM formula FZHFZY plus topical urea for mild-to-moderate psoriasis vulgaris to advance the evidence development and practice of CHM external application for psoriasis. This will be a mixed-method design consisting of a pilot RCT and a qualitative study. The pilot RCT is a two-arm, parallel, placebo-controlled, double-blinded trial. Sixty eligible participants will be randomized at a 1:1 ratio to receive eight weeks’ treatment of either FZHFZY plus 10% urea cream, or placebo plus 10% urea cream, with 12-week follow-up visits after the treatment phase. The CHM or placebo will be administered externally as a bath therapy. Outcome measures include trial feasibility, efficacy and safety. The primary efficacy outcome will be Psoriasis Area Severity Index (PASI). Secondary efficacy outcomes include Physician Global Assessment, PASI-75, PASI-50, Body Surface Area, Dermatology Life Quality Index, Skindex-16, itch visual analogue scale and relapse. The qualitative study will be conducted to collect participants’ feedback on CHM external application and their experience with the pilot RCT. This study will advance the evidence-based clinical practice of using CHM for psoriasis vulgaris and then to support translation of findings into clinical practice in the future.
Trial registration number: ChiCTR2200064092.DVFNet: A deep feature fusion-based model for the multiclassification of skin cancer utilizing dermoscopy imagesAhmad NaeemTayyaba Anees10.1371/journal.pone.02976672024-03-20T14:00:00Z2024-03-20T14:00:00Z<p>by Ahmad Naeem, Tayyaba Anees</p>
Skin cancer is a common cancer affecting millions of people annually. Skin cells inside the body that grow in unusual patterns are a sign of this invasive disease. The cells then spread to other organs and tissues through the lymph nodes and destroy them. Lifestyle changes and increased solar exposure contribute to the rise in the incidence of skin cancer. Early identification and staging are essential due to the high mortality rate associated with skin cancer. In this study, we presented a deep learning-based method named DVFNet for the detection of skin cancer from dermoscopy images. To detect skin cancer images are pre-processed using anisotropic diffusion methods to remove artifacts and noise which enhances the quality of images. A combination of the VGG19 architecture and the Histogram of Oriented Gradients (HOG) is used in this research for discriminative feature extraction. SMOTE Tomek is used to resolve the problem of imbalanced images in the multiple classes of the publicly available ISIC 2019 dataset. This study utilizes segmentation to pinpoint areas of significantly damaged skin cells. A feature vector map is created by combining the features of HOG and VGG19. Multiclassification is accomplished by CNN using feature vector maps. DVFNet achieves an accuracy of 98.32% on the ISIC 2019 dataset. Analysis of variance (ANOVA) statistical test is used to validate the model’s accuracy. Healthcare experts utilize the DVFNet model to detect skin cancer at an early clinical stage.Association between multiple sclerosis and cancer risk: A two-sample Mendelian randomization studyZeyu LiuTeng FanXiaoyan MoJun KanBei Zhang10.1371/journal.pone.02982712024-03-19T14:00:00Z2024-03-19T14:00:00Z<p>by Zeyu Liu, Teng Fan, Xiaoyan Mo, Jun Kan, Bei Zhang</p>
Multiple Sclerosis (MS) is an immune-related disease and the relationship between MS and cancer has raised attention. Previous studies of the relationship between MS and cancer have reached conflicting conclusions. In this study, the two-sample MR method is used to investigate whether MS has a causal correlation with cancers and offer scientific evidence for cancer prevention. Single nucleotide polymorphisms (SNPs) related to MS were obtained from the genome-wide association study (GWAS) based on International Multiple Sclerosis Genetics Consortium (IMSGC) and SNPs related to 15 types of cancers were obtained from the GWASs based on UK Biobank. Inverse variance weighted (IVW) method was mainly used to assess causal effects. Sensitivity analyses were conducted with Cochran’s <i>Q</i>-test, MR Egger intercept, leave-one-out test, and MR Steiger method. IVW analysis showed that MS was only associated with a marginal increased risk of cervical cancer (OR 1.0004, 95% CI 1.0002–1.0007, <i>p</i> = 0.0003). Sensitivity analyses showed that the results of MR analysis were robust and found no heterogeneity, no pleiotropy, and no reverse causation. In conclusion, this study finds no causal relationship between MS and 15 types of cancers except cervical cancer.Impact of COVID-19-related experiences on health-related quality of life in cancer survivors in the United StatesAmy K. OttoSarah PrinslooAkina NatoriRichard W. WagnerTelma I. GomezJewel M. OchoaShelley S. TworogerCornelia M. UlrichSairah AhmedJennifer L McQuadeAnita R. PeoplesMichael H. AntoniJulienne E. BowerLorenzo CohenFrank J. Penedo10.1371/journal.pone.02970772024-03-14T14:00:00Z2024-03-14T14:00:00Z<p>by Amy K. Otto, Sarah Prinsloo, Akina Natori, Richard W. Wagner, Telma I. Gomez, Jewel M. Ochoa, Shelley S. Tworoger, Cornelia M. Ulrich, Sairah Ahmed, Jennifer L McQuade, Anita R. Peoples, Michael H. Antoni, Julienne E. Bower, Lorenzo Cohen, Frank J. Penedo</p>
Objective <p>Little evidence exists on the impact of the COVID-19 pandemic on cancer survivors, limiting recommendations to improve health-related quality of life (HRQoL) in this population. We describe survivors’ pandemic experiences and examine associations between COVID-19-related exposures, psychosocial experiences, and HRQoL.</p> Methods <p>Between May 2020-April 2021, survivors completed cross-sectional questionnaires capturing COVID-19-related exposures (e.g., exposure to virus, job loss); psychosocial experiences (i.e., COVID-19-related anxiety/depression, disruptions to health care and daily activities/social interactions, satisfaction with providers’ response to COVID, financial hardship, perceived benefits of the pandemic, social support, and perceived stress management ability); and HRQoL.</p> Results <p>Data were collected from <i>N</i> = 11,325 survivors in the United States. Participants were mostly female (58%), White (89%) and non-Hispanic (88%), and age 63 on average. Breast cancer was the most common diagnosis (23%). Eight percent of participants reported being exposed to COVID-19; 1% tested positive. About 6% of participants lost their jobs, while 24% lost household income. Nearly 30% avoided attending in-person oncology appointments because of the pandemic. Poorer HRQoL was associated with demographic (younger age; female; non-Hispanic White), clinical (Medicare; stage IV disease; hematologic/digestive/respiratory system cancer), and psychosocial factors (low perceived benefits and stress management ability; more disruption to health care and daily activities/social interactions; financial hardship).</p> Conclusions <p>COVID-19-related stressors were associated with various psychosocial experiences in cancer survivors, and these psychosocial experiences were associated with HRQoL above and beyond demographic and clinical factors.</p>Timing of surgery in acute deep partial-thickness burns: A study protocolRoos F. C. SalemansDenise van UdenMargriet E. van BaarTjitske M. HaanstraCarine H. M. van SchiePaul P. M. van ZuijlenYmke LucasSonja M. H. J. Scholten-JaegersAnnebeth Meij-de VriesFiona M. WoodDale W. EdgarInge SpronkCornelis H. van der VliesNational Burn Care, Education & Research group, the Netherlands10.1371/journal.pone.02998092024-03-11T14:00:00Z2024-03-11T14:00:00Z<p>by Roos F. C. Salemans, Denise van Uden, Margriet E. van Baar, Tjitske M. Haanstra, Carine H. M. van Schie, Paul P. M. van Zuijlen, Ymke Lucas, Sonja M. H. J. Scholten-Jaegers, Annebeth Meij-de Vries, Fiona M. Wood, Dale W. Edgar, Inge Spronk, Cornelis H. van der Vlies, National Burn Care, Education & Research group, the Netherlands </p>
For deep partial-thickness burns no consensus on the optimal treatment has been reached due to conflicting study outcomes with low quality evidence. Treatment options in high- and middle-income countries include conservative treatment with delayed excision and grafting if needed; and early excision and grafting. The majority of timing of surgery studies focus on survival rather than on quality of life. This study protocol describes a study that aims to compare long-term scar quality, clinical outcomes, and patient-reported outcomes between the treatment options. A multicentre prospective study will be conducted in the three Dutch burn centres (Rotterdam, Beverwijk, and Groningen). All adult patients with acute deep-partial thickness burns, based on healing potential with Laser Doppler Imaging, are eligible for inclusion. During a nine-month baseline period, standard practice will be monitored. This includes conservative treatment with dressings and topical agents, and excision and grafting of residual defects if needed 14–21 days post-burn. The subsequent nine months, early surgery is advocated, involving excision and grafting in the first week to ten days post-burn. The primary outcome compared between the two groups is long-term scar quality assessed by the Patient and Observer Scar Assessment Scale 3.0 twelve months after discharge. Secondary outcomes include clinical outcomes and patient-reported outcomes like quality of life and return to work. The aim of the study is to assess long-term scar quality in deep partial-thickness burns after conservative treatment with delayed excision and grafting if needed, compared to early excision and grafting. Adding to the ongoing debate on the optimal treatment of these burns. The broad range of studied outcomes will be used for the development of a decision aid for deep partial-thickness burns, to fully inform patients at the point of consent to surgery and support optimal person-centred care.New, simplified versus standard photodynamic therapy (PDT) regimen for superficial and nodular basal cell carcinoma (BCC): A single-blind, non-inferiority, randomised controlled multicentre studyEidi ChristensenErik MørkOlav Andreas FossCato MørkSusanne KroonLars Kåre DotterudPer HelsingØystein VatneEirik SkogvollPatricia MjønesIngeborg Margrethe Bachmann10.1371/journal.pone.02997182024-03-08T14:00:00Z2024-03-08T14:00:00Z<p>by Eidi Christensen, Erik Mørk, Olav Andreas Foss, Cato Mørk, Susanne Kroon, Lars Kåre Dotterud, Per Helsing, Øystein Vatne, Eirik Skogvoll, Patricia Mjønes, Ingeborg Margrethe Bachmann</p>
Background <p>Topical photodynamic therapy (PDT) is an approved and widely used treatment for low-risk basal cell carcinoma (BCC), comprising two sessions with an interval of 1 week. Simplification of the treatment course can be cost-effective, easier to organize, and cause less discomfort for the patients.</p> Methods and findings <p>We performed an investigator-initiated, single-blind, non-inferiority, randomized controlled multicentre study with the objective of investigating whether a simpler and more flexible PDT regimen was not >10% less effective than the standard double PDT in the treatment of primary, superficial, and nodular ≤2 mm-thick BCC and evaluate the cosmetic outcome. With a non-inferiority margin of 0.1 and an expected probability complete response of 0.85, 190 tumours were required in each group. Histologically verified BCCs from seven centres in Norway were randomly assigned (1:1) to either receive a new regimen of single PDT with one possible re-treatment of non-complete responding tumours, or the standard regimen. The primary endpoint was the number of tumours with complete response or treatment failure at 36 months of follow-up, assessed by investigators blinded to the treatment regimen. Intention-to-treat and per-protocol analyses were performed. The cosmetic outcome was recorded. The study was registered with ClinicalTrials.gov, NCT-01482104, and EudraCT, 2011-004797-28.A total of 402 BCCs in 246 patients were included; 209 tumours assigned to the new and 193 to the standard regimen. After 36 months, there were 61 treatment failures with the new and 34 failures with the standard regimen. Complete response rate was 69.5% in the new and 81.1% in the standard treatment group. The difference was 11.6% (upper 97.5% CI 20.3), i.e. > than the non-inferiority margin of 10%. Cosmetic outcomes were excellent or good in 92% and 89% following the new and standard regimens, respectively.</p> Conclusions <p>Single PDT with possible re-treatment of primary, superficial, and nodular ≤ 2-mm-thick BCC was significantly less effective than the approved standard double treatment. The cosmetic outcome was favorable and comparable between the two treatment groups.</p>Streptolysin S is required for <i>Streptococcus pyogenes</i> nasopharyngeal and skin infection in HLA-transgenic miceBlake A. ShannonJacklyn R. HurstRonald S. FlannaganHeather C. CraigAanchal RishiKatherine J. KasperStephen W. TuffsDavid E. HeinrichsJohn K. McCormick10.1371/journal.ppat.10120722024-03-07T14:00:00Z2024-03-07T14:00:00Z<p>by Blake A. Shannon, Jacklyn R. Hurst, Ronald S. Flannagan, Heather C. Craig, Aanchal Rishi, Katherine J. Kasper, Stephen W. Tuffs, David E. Heinrichs, John K. McCormick</p>
<i>Streptococcus pyogenes</i> is a human-specific pathogen that commonly colonizes the upper respiratory tract and skin, causing a wide variety of diseases ranging from pharyngitis to necrotizing fasciitis and toxic shock syndrome. <i>S</i>. <i>pyogenes</i> has a repertoire of secreted virulence factors that promote infection and evasion of the host immune system including the cytolysins streptolysin O (SLO) and streptolysin S (SLS). <i>S</i>. <i>pyogenes</i> does not naturally infect the upper respiratory tract of mice although mice transgenic for MHC class II human leukocyte antigens (HLA) become highly susceptible. Here we used HLA-transgenic mice to assess the role of both SLO and SLS during both nasopharyngeal and skin infection. Using <i>S</i>. <i>pyogenes</i> MGAS8232 as a model strain, we found that an SLS-deficient strain exhibited a 100-fold reduction in bacterial recovery from the nasopharynx and a 10-fold reduction in bacterial burden in the skin, whereas an SLO-deficient strain did not exhibit any infection defects in these models. Furthermore, depletion of neutrophils significantly restored the bacterial burden of the SLS-deficient bacteria in skin, but not in the nasopharynx. In mice nasally infected with the wildtype <i>S</i>. <i>pyogenes</i>, there was a marked change in localization of the tight junction protein ZO-1 at the site of infection, demonstrating damage to the nasal epithelia that was absent in mice infected with the SLS-deficient strain. Overall, we conclude that SLS is required for the establishment of nasopharyngeal infection and skin infection in HLA-transgenic mice by <i>S</i>. <i>pyogenes</i> MGAS8232 and provide evidence that SLS contributes to nasopharyngeal infection through the localized destruction of nasal epithelia.Prevalence and antimicrobial-resistant patterns of <i>Pseudomonas aeruginosa</i> among burn patients attending Yekatit 12 Hospital Medical College in Addis Ababa, EthiopiaFedasan Alemu AbdiAbdi Negash MotummaAlem Abrha KalayuWoldearegay Erku Abegaz10.1371/journal.pone.02895862024-03-07T14:00:00Z2024-03-07T14:00:00Z<p>by Fedasan Alemu Abdi, Abdi Negash Motumma, Alem Abrha Kalayu, Woldearegay Erku Abegaz</p>
Background <p>Burns are one of the most common forms of trauma globally. <i>P</i>. <i>aeruginosa</i> plays a prominent role as an etiological agent among burn patients. There is a paucity of information about the prevalence and antimicrobial resistance patterns of <i>P</i>. <i>aeruginosa</i> among burn patients in Ethiopia. Hence, this study was designed to assess the prevalence and antimicrobial-resistant patterns of <i>P</i>. <i>aeruginosa</i> among burn patients attending Yekatit 12 Hospital Medical College in Addis Ababa, Ethiopia.</p> Methods <p>Hospital-based cross-sectional study was conducted at Yekatit 12 Hospital Medical College among burn patients from November 2020 to April 2021. Identification of <i>P</i>. <i>aeruginosa</i> was performed using Culture, Biochemical tests, and, Gram staining. Antimicrobial resistance testing was done using the Kirby-Bauer disc diffusion method. Logistic regression was computed to determine associated factors.</p> Results <p>From 210 burn wound cultures, 27 (12.86%) were found positive for <i>P</i>. <i>aeruginosa</i>. All the isolates showed greater than 70% susceptibility to the tested antibiotics except Gentamycin, Ceftazidime, and, Ciprofloxacin. In addition, 33.33% of <i>P</i>. <i>aeruginosa</i> isolates were multidrug-resistant. Admission type, Hospital stay time and Total body surface area (TBSA) had a statistically significant association (all with P-value <0.05) with the acquisition of <i>P</i>. <i>aeruginosa</i> infection.</p> Conclusion <p>Overall, the prevalence of <i>P</i>. <i>aeruginosa</i> isolates among burn patients is almost 13%. Most <i>P</i>. <i>aeruginosa</i> isolates were sensitive to Imipenem, while they were most resistant to Gentamycin. One-third of <i>P</i>. <i>aeruginosa</i> were multidrug-resistant. This suggests the need to monitor the treatment of infection with the pathogen to limit the possibility of the emergence of multidrug-resistant isolates in burn centers.</p>Development of an intervention for reducing infant bathing frequencyLucy P. GoldsmithMichael R. PerkinCharlotte WahlichLakshmi ChandrasekaranVictoria CorneliusRobert J. BoyleCarsten FlohrAmanda RobertsKathryn WillisMichael Ussher10.1371/journal.pone.02983352024-02-29T14:00:00Z2024-02-29T14:00:00Z<p>by Lucy P. Goldsmith, Michael R. Perkin, Charlotte Wahlich, Lakshmi Chandrasekaran, Victoria Cornelius, Robert J. Boyle, Carsten Flohr, Amanda Roberts, Kathryn Willis, Michael Ussher</p>
Background <p>Bathing babies less frequently and intensively in the first six months of life may prevent eczema, but this has not yet been definitively tested in a randomised controlled trial. Such a trial would require evidence-based support to help parents engage with a minimal bathing routine. The present study reports the development of this support.</p> Methods <p>We adopted a four-stage design process: (i) Pregnant women and their families (n = 31) were interviewed to ascertain key barriers and facilitators towards following the minimal bathing intervention. (ii) These barriers and facilitators were mapped to behaviour change techniques, focussing on the intervention types of education, persuasion and environmental restructuring, alongside appropriate modes of delivery, and prototype intervention materials were developed. (iii) We iteratively refined these materials in a workshop with multidisciplinary experts and Patient and Public Involvement and Engagement (PPIE) representatives (n = 13) and an (iv) intervention walkthrough with families (n = 5). The design process was informed by the Behaviour Change Wheel, Theoretical framework of acceptability and the Template for intervention description and replication.</p> Results <p>Social influences and motivational factors are likely to influence both uptake and adherence to the intervention. Anticipated emotional reward from participating in research for the benefit of others was indicated to be a strong facilitator for intervention uptake. Alternatives to bathing, having fun with the baby and the night-time routine, alongside family support, were notable facilitators suggested to aid adherence to the intervention. Barriers included hygiene concerns and anticipated negative social appraisal. Barriers and facilitators were mapped to thirty-six behaviour change techniques, focussing on the intervention types of education, persuasion and environmental restructuring, all of which were embedded into the package of support. The prototype intervention materials received positive feedback from the expert workshop and study walkthrough with families. The final package of support comprises printed and digital prompts and cues, a study booklet, video, and digital tool for self-monitoring.</p> Conclusions <p>The intervention design process incorporated the ‘real world’ views and experiences of families, experts and PPIE representatives, alongside criteria for designing behavioural interventions. The effectiveness of the package of support will be tested in a feasibility trial and embedded process evaluation.</p>