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Summary: Background and objectives: The knowledge of depth infiltration in non‐melanoma skin cancer (NMSC) using pre‐operative ultrasound could enable clinicians to choose the most adequate therapeutic approach, avoiding unnecessary surgeries and expensive imaging methods, delaying diagnosis and treatment. Our single‐center retrospective study determined the usefulness of high‐frequency ultrasound (HFUS) for depth infiltration assessment in auricular and nasal NMSC and assessed the subsequent change in therapeutic approach. Patients and Methods: In 60 NMSC cases, we assessed the accuracy of HFUS in cartilaginous/bone infiltration detection as well as the correlation of sonographic and histological parameters. Results: In 16.6% of cases, a deep cartilaginous/bone involvement or locoregional disease was identified pre‐operatively, resulting in a changed therapeutical scheme of radio‐immunological treatment rather than surgery. In two cases, pre‐operative HFUS identified local cartilage infiltration, reducing the number of surgical procedures. Forty‐eight remaining lesions with no depth infiltration were excised; a correlation of > 99% between the histologic and sonographic tumor depth (p<0.001) was found. Conclusions: Pre‐surgical HFUS influences the therapeutic management in NMSC by detecting subclinical involvement of deeper structures, avoiding more extensive diagnostics, reducing costs, and improving healthcare quality. High‐frequency ultrasound should be implemented in dermatosurgery before tumor excision for optimized therapy and improved patient counseling. [ABSTRACT FROM AUTHOR]

Psoriatic onychopathy represents a disabling manifestation of psoriasis, significantly affecting patients' life quality, as many therapies prove ineffective, limiting adherence.1 In patients with nail psoriasis, a thickening of the vessel wall as well as endothelial swelling is described, mainly because of deposition of immune complexes.2,3 These microcirculatory aspects can be quantified by the ultrasonographic resistivity index (RI), evaluating the resistance to blood flow by assessing systolic and diastolic peak flows of small nail bed vessels.4 RI depends on the inflammatory status: values around 0 show decreased tissue resistivity (no resistance to blood flow), while higher values showed an increased inflammation (maximum resistance to blood flow). Furthermore, we only assessed the RI at the level of the index finger of the dominant hand; further studies assessing RI in all involved fingernails and comparing the mean RI before/after therapy could provide more significant data regarding RI variation under therapy. Our patients presented a mean NAPSI score of 37.94 ± 7.91 and had a mean nail involvement of four nails.7,8 Furthermore, all patients had PASI score > 10, no signs of psoriatic arthritis, and were eligible for biological treatment. [Extracted from the article]

Background and purpose: Early pharmacological support for post‐stroke neurorehabilitation has seen an abundance of mixed results from clinical trials, leaving practitioners at a loss regarding the best options to improve patient outcomes. The objective of this evidence‐based guideline is to support clinical decision‐making of healthcare professionals involved in the recovery of stroke survivors. Methods: This guideline was developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. PubMed, Cochrane Library and Embase were searched (from database inception to June 2018, inclusive) to identify studies on pharmacological interventions for stroke rehabilitation initiated in the first 7 days (inclusive) after stroke, which were delivered together with neurorehabilitation. A sensitivity analysis was conducted on identified interventions to address results from breaking studies (from end of search to February 2020). Results: Upon manually screening 17,969 unique database entries (of 57,001 original query results), interventions underwent meta‐analysis. Cerebrolysin (30 ml/day, intravenous, minimum 10 days) and citalopram (20 mg/day, oral) are recommended for clinical use for early neurorehabilitation after acute ischaemic stroke. The remaining interventions identified by our systematic search are not recommended for clinical use: amphetamine (5, 10 mg/day, oral), citalopram (10 mg/day, oral), dextroamphetamine (10 mg/day, oral), Di‐Huang‐Yi‐Zhi (2 × 18 g/day, oral), fluoxetine (20 mg/day, oral), lithium (2 × 300 mg/day, oral), MLC601(3 × 400 mg/day, oral), phosphodiesterase‐5 inhibitor PF‐03049423 (6 mg/day, oral). No recommendation 'for' or 'against' is provided for selegiline (5 mg/day, oral). Issues with safety and tolerability were identified for amphetamine, dextroamphetamine, fluoxetine and lithium. Conclusions: This guideline provides information for clinicians regarding existing pharmacological support in interventions for neurorecovery after acute ischaemic stroke. Updates to this material will potentially elucidate existing conundrums, improve current recommendations, and hopefully expand therapeutic options for stroke survivors. [ABSTRACT FROM AUTHOR]