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Generalized pustular psoriasis (GPP) is a recurrent and sometimes life-threatening sterile pustular disease. Because interleukin (IL)-36 is the central cytokine in disease formation, spesolimab, which interferes with IL-36 receptor signaling, is highly effective. Here, we report a patient with GPP with a heterozygous hypomorphic MPO variant refractory to intravenous spesolimab. Although spesolimab showed excellent clinical efficacy in resolving pre-existing pustules and erythema, it did not suppress the emergence of new pustules and erythema, which did not decrease the peripheral blood neutrophil count, therefore bimekizumab, an anti-IL-17A/IL-17F antibody, was administered after the second spesolimab infusion, which resolved the pustules and erythema. We discuss the possible reasons for the resistance mechanism to spesolimab., (© 2024 Japanese Dermatological Association.)

Activities on sandy soil are known to contribute to improved leg strength and balance. Lifesavers (LSs) have shown that sandy soil activity promotes intrinsic foot muscle development and improves balance. LS improves leg strength and balance through activities on sandy soil. However, the effect of foot muscle development on the actual muscle activity of LS remains unclear. We aimed to evaluate the effect of foot muscle development on muscle activity in lifeguards on a sandy beach compared with the corresponding in healthy participants. Fifteen LSs and 15 healthy adults underwent a Y-balance test to assess dynamic balance and surface electromyography to measure muscle activity. The LSs exhibited a significantly higher percentage of maximum voluntary contraction values in the tibialis anterior muscle in all directions than the healthy adults. The LSs showed increased peroneus longus and abductor hallucis muscle activity in the posterolateral and posteromedial directions, suggesting their involvement in contralateral postural control during dynamic balance. These findings suggest that engaging in barefoot activities on sandy soil enhances foot muscle activity and improves dynamic balance in LSs., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Review Committee of Waseda University issued approval 2023-370. Written informed consent was obtained from the participants, who were informed in advance. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Suzuki et al.)

Balance is important in lifesaving competitions. We aimed to investigate the relationship between dynamic balance and physical characteristics and functions in elite lifesavers by measuring the foot muscle cross-sectional area, ankle joint muscle strength, toe grasp strength, plantar superficial sensation, and dynamic balance (Y-balance test). In this observational study, we measured the foot muscle cross-sectional area, ankle dorsiflexion, plantar flexion, external flexion, isometric muscle strength, toe grasp strength, and superficial foot sensation of 15 adult lifesavers (12 males). The results show that toe grasp strength and ankle plantar flexion isometric muscle strength are particularly important for the dynamic balance of elite lifesavers working on sandy surfaces. Sand training improves intrinsic muscle strength and dynamic balance function. However, high training intensity may reduce plantar surface sensation; this needs to be verified through sand training interventions in the future.

Background: Atopic dermatitis (AD) is a common chronic eczematous skin disease with severe pruritus. Several new therapeutic agents for AD such as dupilumab, an anti-IL-4Rα antibody, have been developed in recent years. We need to predict which agent is the best choice for each patient, but this remains difficult., Objective: Our aim was to examine clinical background factors and baseline biomarkers that could predict the achievement of improved clinical outcomes in patients with AD treated with dupilumab., Methods: A multicenter, prospective observational study was conducted on 110 patients with AD. The Eczema Area and Severity Index was used as an objective assessment, and the Patient-Oriented Eczema Measure and Numerical Rating Scale for Pruritus were used as patient-reported outcomes. In addition, some clinical background factors were evaluated., Results: The achievement of an absolute Eczema Area and Severity Index of 7 or less was negatively associated with current comorbidity of food allergy and baseline serum lactate dehydrogenase (LDH) levels. There were negative associations between achievement of a Patient-Oriented Eczema Measure score of 7 or less and duration of severe AD and between achievement of an itching Numerical Rating Scale for Pruritus score of 1 or less and current comorbidity of allergic conjunctivitis or baseline serum periostin level. Furthermore, signal detection analysis showed that a baseline serum LDH level less than 328 U/L could potentially be used as a cutoff value for predicting the efficacy of dupilumab., Conclusion: Baseline biomarkers such as LDH and periostin and clinical background factors such as current comorbidity of food allergy and a long period of severe disease may be useful indicators when choosing dupilumab for systemic treatment for AD, as they can predict the efficacy of dupilumab., Competing Interests: Supported by 10.13039/100004339Sanofi and 10.13039/100009857Regeneron (grant SGZ-2018-11996). These companies had no influence on the design of the study, collection and analysis of the data, or decision to publish the article. Disclosure of potential conflict of interest: K. Izuhara has received grants and personal fees from Shino-test Co, Ltd. H. Saeki has received lecture fees, research costs, or scholarship donations from Mitsubishi Tanabe Pharma, Taiho Pharmaceutical, 10.13039/100016730Torii Pharmaceutical, Maruho, Kyowa Kirin, Sanofi, AbbVie, Novartis Pharma, Eli Lilly Japan, Kyorin Pharmaceutical, Eisai, Tokiwa Pharmaceutical, Japan Tobacco, and LEO Pharma. Y. Kataoka has received lecturer honoraria from Sanofi and AbbVie and research funding from Sanofi, Leo Pharma, Pfizer, Maruho, Lilly, AbbVie, and Otsuka. S. Kaneko has received grants as an investigator from Eli Lilly Japan and honoraria as a speaker from Eli Lilly Japan. A. Tanaka has received honoraria from Eli Lilly, Kaken Seiyaku, Sanofi, Taiho Pharma, AbbVie, Kyorin Pharmaceutical, Mitsubishi-Tanabe, Torii Pharmaceutical, and Maruho as a speaker and research grants from Eli Lilly, Sanofi, Teijin Pharma, Taiho Pharma, Mitsubishi-Tanabe, Torii Pharmaceutical, and Maruho. M. Hide has received lecture and/or consultation fees from AbbVie, Eli Lilly, Kaken Pharmaceutical, Kyowa Kirin, Kyorin Pharmaceutical, Maruho, Mitsubishi-Tanabe Pharma, MSD, Novartis, Sanofi, Taiho Pharma, Teikoku Seiyaku, Torii, and Uriach. R. Tamagawa-Mineoka has received research grants from Maruho and 10.13039/501100012351Mitsubishi Tanabe Pharma. K. Masuda has received honoraria as a speaker for Sanofi and grants as an investigator for Eli Lilly Japan. T. Takeichi has received grants paid to his institution (10.13039/501100004823Nagoya University) from Boehringer Ingelheim. M. Akiyama has received research support from Novartis and Boehringer Ingelheim; personal fees from Maruho and Sanofi; and grants paid to his institution (Nagoya University) from Mitsubishi-Tanabe, Taiho, AbbVie, Maruho, Ono, and Sun Pharma. Y. Ishiuji has received honoraria as a speaker for Eli Lilly Japan. Y. Hatano has received honoraria and consultancies to sponsoring organizations from 10.13039/100004339Sanofi, Taiho Pharma, Janssen Pharma, Maruho, Pfizer Japan, Sun Pharma Japan, Torii Pharmaceutical, AbbVie, KAKEN, and UCB Japan. N. Katoh has received honoraria as a speaker/consultant for Sanofi, Maruho, AbbVie, Eli Lilly Japan, and Leo Pharma and grants as an investigator from Maruho, Eli Lilly Japan, Sun Pharma, Taiho Pharmaceutical, Torii Pharmaceutical, Boehringer Ingelheim Japan, and Leo Pharma. Takeshi Nakahara has received lecture fees and research costs from Mitsubishi Tanabe Pharma, Taiho Pharmaceutical, Torii Pharmaceutical, Maruho, Sanofi, AbbVie, Eli Lilly Japan, and Sun Pharma. The rest of the authors declare that they have no relevant conflicts of interest., (© 2024 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology.)

Objective: Obesity is not only a risk factor for lifestyle-related diseases but also causes skin barrier dysfunction, which leads to a reduced quality of life due to dryness, itching, and scratching, and thus requires appropriate treatment. However, there are no studies on this issue. Therefore, this study aimed to examine whether oral intake of linseed oil is effective for skin barrier function in obesity and to confirm how the effect is demonstrated., Methods: TSOD mice received either sterile distilled water (Control group) or linseed oil (Omega group), containing a high level of omega-3 fatty acids, including α-linolenic acid, orally for eight weeks. Mice were then irradiated with ultraviolet B (UVB) and three days later, transepidermal water loss (TEWL), which is the primary outcome of skin barrier function, was measured and gross skin appearance was observed. Hematoxylin and eosin (HE) staining and Ki-67 immunostaining were performed on skin samples. mRNA expression levels of the inflammatory markers Tnfα , Cox2 , Mcp1 , and Hmox1 were measured by real-time reverse transcriptase-polymerase chain reaction (RT-PCR). We also performed fatty acid analysis of skin and erythrocytes by gas chromatography. Statistical analysis was performed using unpaired Student's t-test and Pearson's correlation analysis., Results: Compared with the Control group, the Omega group exhibited lower TEWL values and little skin erythema. Histological analysis revealed thinner epidermis and fewer Ki-67 positive cells. Additionally, in the Omega group, mRNA levels of four inflammation-related genes were lower, α-linolenic acid levels in both skin and erythrocytes were higher, and a lower n-6/n-3 ratio was observed. And α-linolenic acid levels in the skin were negatively correlated with the expression levels of inflammation-related genes., Conclusion: Oral intake of linseed oil was found to inhibit skin barrier dysfunction in obesity. This effect was mediated by α-linolenic acid, a major component of linseed oil with anti-inflammatory properties, which was taken up by erythrocytes and supplied to the skin. Therefore, oral intake of linseed oil is expected to be a useful therapeutic method for skin barrier dysfunction in obesity., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: Yokohama City University Animal Experiment Committee Issued protocol number F-A-23-051. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: This study was supported by the Japan Academy of Nursing Science (JANS) and the Association for Fordays Self-Reliance Support in Japan. Financial relationships: Yoshiko Horie declare(s) a grant from Japan Academy of Nursing Science (JANS) . Yoshiko Horie declare(s) a grant from Association for Fordays Self-Reliance Support in Japan. Toru Moriguchi (Chairman), Akiko Harauma (Director) declare(s) non-financial support from Japan Society for Lipid Nutrition. Toru Moriguchi, Akiko Harauma declare(s) a grant from Ota Oil Co., Ltd. Endowment course. Toru Moriguchi declare(s) non-financial support from Krill Association. Director. Toru Moriguchi declare(s) non-financial support from Society of Preventive Medicine for Animals and Humans. Director. Intellectual property info: Akiko Harauma and Toru Moriguchi have a patent planned, issued, or pending: 095P001JP1; Toru Moriguchi has a patent planned, issued, or pending: TPJ0508AZU. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Horie et al.)

Vitiligo is an autoimmune skin disease with acquired depigmentation. Dietary habits may modulate the pathogenesis of vitiligo. We evaluated dietary habits in adult Japanese patients with nonsegmental vitiligo, and compared their results with those of age- and sex-matched controls. We also examined the relationship between dietary habits and Vitiligo Area Scoring Index (VASI), or vitiligo on different anatomical sites. The intakes of energy, nutrients, and foods in the participants were analyzed using a brief-type self-administered diet history questionnaire. Patients with vitiligo showed higher body mass index (BMI) and lower intakes of manganese, vitamin D, pulses, and confection, compared with controls. Multivariate logistic regression analysis showed that vitiligo was associated with high BMI. VASI was higher in males than in females, and negatively correlated with age or intakes of potatoes and vegetables other than green/yellow vegetables. Linear multivariate regression analysis showed that high VASI was associated with younger age. Multivariate logistic regression analysis showed that moderate to severe vitiligo (VASI ≥ 4.25) was associated with male sex and longer disease duration. Multivariate logistic regression analyses showed the following association with vitiligo on respective anatomical sites: high intake of eggs and dairy products and high VASI on the head or neck, high intake of oils and fats and high VASI on the trunk, high intake of cereals and high VASI on the upper limbs, male sex and high VASI on the lower limbs, and high BMI and high VASI on the hands or feet. In conclusion, the control of obesity might have prophylactic or therapeutic effects on vitiligo., (© 2024 The Authors. The Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Dermatological Association.)

Various complications can occur during robot-assisted thoracic surgery for mediastinal tumors owing to carbon dioxide (CO2) insufflation. This study reports the case of a 43-year-old woman who underwent robot-assisted surgery for an anterior mediastinal tumor with the subxiphoid approach. Shortly after starting CO2 insufflation, the blood pressure decreased significantly. Subsequent examination of the mediastinum revealed a left-sided pericardial injury. Cardiac tamponade due to entry of CO2 gas into the pericardial cavity was suspected. A deliberate incision was made in the right pericardium, ultimately resolving the cardiac tamponade and substantially improving the patient's blood pressure., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 International Anesthesia Research Society.)

Melanoma accounts for the majority of skin cancer-related mortality, highlighting the need to better understand melanoma initiation and progression. In-depth molecular analysis of neoplastic melanocytes in whole tissue biopsies may be diluted by inflammatory infiltration, which may obscure gene signatures specific to neoplastic cells. Thus, a method is needed to precisely uncover molecular changes specific to tumor cells from a limited sample of primary melanomas. Here, we performed laser capture microdissection (LCM) and gene expression profiling of patient-derived frozen sections of pigmented lesions and primary cutaneous melanoma. Compared to bulk tissue analysis, analysis of LCM-derived samples identified 9528 additional differentially expressed genes (DEGs) including melanocyte-specific genes like PMEL and TYR, with enriched of pathways related to cell proliferation. LCM methodology also identified potentially targetable kinases specific to melanoma cells that were not detected by bulk tissue analysis. Taken together, our data demonstrate that there are marked differences in gene expression profiles depending on the method of sample isolation. We found that LCM captured higher expression of melanoma-related genes while whole tissue biopsy identified a wider range of inflammatory markers. Taken together, our data demonstrate that LCM is a valid approach to identify melanoma-specific changes using a relatively small amount of primary patient-derived melanoma sample., (© 2023 The Authors. Pigment Cell & Melanoma Research published by John Wiley & Sons Ltd.)