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Psoriasiform and eczematous eruptions are the most common dermatological adverse reactions linked to anti-tumour necrosis factor (TNF)-α therapy. Yet, a detailed characterization of their immune phenotype is lacking.To characterize anti-TNF-α-induced inflammatory skin lesions at a histopathological, cellular and molecular level, compared with psoriasis, eczema (atopic dermatitis) and healthy control skin.Histopathological evaluation, gene expression (quantitative real-time polymerase chain reaction) and computer-assisted immunohistological studies (TissueFAXS) were performed on 19 skin biopsies from patients with inflammatory bowel disease (n = 17) and rheumatoid arthritis (n = 2) with new-onset inflammatory skin lesions during anti-TNF-α-therapy.Although most biopsies showed a psoriasiform and/or spongiotic (eczematous) histopathological architecture, these lesions were inconsistent with either psoriasis or eczema on a molecular level using an established chemokine (C-C motif) ligand 27/inducible nitric oxide synthase classifier. Despite some differences in immune skewing depending on the specific histopathological reaction pattern, all anti-TNF-α-induced lesions showed strong interferon (IFN)-γ activation, at higher levels than in psoriasis or eczema. IFN-γ was most likely produced by CD3/CD4/Tbet-positive T helper 1 lymphocytes.New-onset anti-TNF-α-induced eruptions previously classified as psoriasis or spongiotic dermatitis (eczema) exhibit a molecular profile that is different from either of these disorders.

ZusammenfasungAnti-TNF-α-Antikörper haben die Therapie chronisch-entzündlicher Darmerkrankungen und anderer immunmediierter inflammatorischer Erkrankungen revolutioniert. Der zunehmende Einsatz dieser Substanzen war Anlass, den Konsensusbericht zur sicheren Anwendung von Infliximab der Arbeitsgruppe für Chronisch Entzündliche Darmerkrankungen der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie aus dem Jahr 2010 zu aktualisieren und auf alle anti-TNF-α-Antikörper zu erweitern. Der vorliegende Konsensusbericht fasst die aktuelle Datenlage zur sicheren Anwendung von anti-TNF-α-Antikörpern zusammen und berücksichtigt folgende Themen: allgemeines Infektionsrisiko, bakterielle Infekte (inkl. Clostridium difficile, Tuberkulose, Nahrungsmittelhygiene), Pneumozystis jiroveci, virale Infektionen (inkl. Hepatitis B, Hepatitis C, HIV, CMV, VZV), Impfungen und Impfempfehlungen, gastrointestinale Aspekte (perianale Fistel, abdominale Fistel, Stenose), dermatologische Aspekte (Haut-Malignome, Ekzem-ähnliche anti-TNF-α-assoziierte Hautläsionen), Infusionsreaktionen und Immunogenität, demyelinisierende Erkrankungen, Hepatotoxizität, Hämatotoxizität, Herzinsuffizienz, Malignomrisiko und Einsatz nach Malignomen, sowie Schwangerschaft und Stillen. Da der Konsensusbericht als praktischer Leitfaden für die sichere Anwendung dieser Substanzen dienen soll, wurden die relevanten Aspekte in einer Checkliste zusammengefasst, die sich in zwei Teile „vor Therapie“ und „während Therapie“ gliedert.

The Universal Soil Loss Equation (USLE) is the most frequently applied erosion prediction model and it is also implemented as official decision-making instrument for agricultural regulations. The USLE itself was already validated by different approaches. Additional errors, however, arise from input data and interpolation procedures that become necessary for field-specific predictions on a national scale for administrative purposes. In this study, predicted event soil loss using the official prediction system in Bavaria (Germany) was validated by comparison with aerial photo erosion classifications of 8100 fields. Values for the USLE factors were mainly taken from the official Bavarian high-resolution (5 x 5 m2) erosion cadastre. As series of erosion events were examined, the cover and management factor was replaced by the soil loss ratio. The event erosivity factor was calculated from high-resolution (1 x 1 km2, 5 min), rain gauge-adjusted radar rain data (RADOLAN). Aerial photo erosion interpretation worked sufficiently well and average erosion predictions and visual classifications correlated closely. This was also true for data broken down to individual factors and different crops. There was no reason to assume a general invalidity of the USLE and the official parameterization procedures. Event predictions mainly suffered from errors in the assumed crop stage period and tillage practices, which do not reflect interannual and farm-specific variation. In addition, the resolution of radar data (1 km2) did not seem to be sufficient to predict short-term erosion on individual fields given the strong spatial gradients within individual rains. The quality of the input data clearly determined prediction quality. Differences between USLE predictions and observations are most likely caused by parameterization weaknesses but not by a failure of the model itself.

Rainfall events exhibit high spatio-temporal variability and cause soil erosion when thresholds of rainfall amount or intensity are exceeded. Analogously high variability in space and time is assumed for erosivity ( R ). RADOLAN, from the German Weather Service, provides radar rainfall data at high spatio-temporal resolution (1 × 1 km 2 , 5 min), adjusted in 60 min intervals by measurements from a dense rain-gauge network that potentially could overcome present limitations of R estimations from sparse rain gauges. This new database was used to analyse the spatio-temporal variability of rain depth and R for single events (event R ) which occurred in an area of ∼15 000 km 2 in southern Germany over a period of two years to illustrate the need for such high spatio-temporal resolution in rain data for R estimations. Further, the effect of calibrating 5 min resolved radar data using hourly adjustment factors to rain-gauge data was explored. The spatial gradients of event R were steep, even steeper than for rain intensity, and call for such highly resolved data. Erosivity exhibited a clear maximum late in the afternoon. Daily rainfall differed from erosive rainfall due to rain breaks and rain extending over more than one day. Event R between adjacent 1 km 2 cells differed by up to 120 N h −1 . Even on an annual scale, erosivity at grid cells not further than 10 km apart could differ by more than a factor of five. Adjustment of the rain data was indispensable when calculating event R because adjustment could change event R by a factor of two. Even if long-term averages are used, differences by lacking adjustment would not be levelled. RADOLAN thus provides, for the first time, rain data as required in distributed erosion modelling for time periods shorter than 20 years.

Anti-TNFα-antibodies have revolutionized the therapy of inflammatory bowel diseases and other immune-mediated inflammatory diseases. Due to the increasing application of these substances, the Working Group of Inflammatory Bowel Diseases of the Austrian Association of Gastroenterology and Hepatology intended to update their consensus report on the safe use of Infliximab (published in 2010) and to enlarge its scope to cover all anti-TNFα-antibodies. The present consensus report summarizes the current evidence on the safe use of anti-TNFα-antibodies and covers the following topics: general risk of infection, bacterial infections (i. e., Clostridium difficile, Tuberculosis, food hygiene), Pneumocystis jiroveci, viral infections (i. e., Hepatitis B, Hepatitis C, HIV, CMV, VZV), vaccination in general and recommendation for vaccines, gastrointestinal aspects (i. e., perianal fistula, abdominal fistula, intestinal strictures, stenosis and bowel obstruction), dermatologic aspects (skin malignancies, eczema-like drug-related skin eruption), infusion reactions and immunogenicity, demyelinating diseases, hepatotoxicity, haematotoxicity, congestive heart failure, risk and history of malignancies, and pregnancy and breast feeding. For practical reasons, the relevant aspects are summarized in a checklist which is divided into two parts: issues to be addressed before therapy and issues to be addressed during therapy.Anti-TNF-α-Antikörper haben die Therapie chronisch-entzündlicher Darmerkrankungen und anderer immunmediierter inflammatorischer Erkrankungen revolutioniert. Der zunehmende Einsatz dieser Substanzen war Anlass, den Konsensusbericht zur sicheren Anwendung von Infliximab der Arbeitsgruppe für Chronisch Entzündliche Darmerkrankungen der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie aus dem Jahr 2010 zu aktualisieren und auf alle anti-TNF-α-Antikörper zu erweitern. Der vorliegende Konsensusbericht fasst die aktuelle Datenlage zur sicheren Anwendung von anti-TNF-α-Antikörpern zusammen und berücksichtigt folgende Themen: allgemeines Infektionsrisiko, bakterielle Infekte (inkl. Clostridium difficile, Tuberkulose, Nahrungsmittelhygiene), Pneumozystis jiroveci, virale Infektionen (inkl. Hepatitis B, Hepatitis C, HIV, CMV, VZV), Impfungen und Impfempfehlungen, gastrointestinale Aspekte (perianale Fistel, abdominale Fistel, Stenose), dermatologische Aspekte (Haut-Malignome, Ekzem-ähnliche anti-TNF-α-assoziierte Hautläsionen), Infusionsreaktionen und Immunogenität, demyelinisierende Erkrankungen, Hepatotoxizität, Hämatotoxizität, Herzinsuffizienz, Malignomrisiko und Einsatz nach Malignomen, sowie Schwangerschaft und Stillen. Da der Konsensusbericht als praktischer Leitfaden für die sichere Anwendung dieser Substanzen dienen soll, wurden die relevanten Aspekte in einer Checkliste zusammengefasst, die sich in zwei Teile „vor Therapie“ und „während Therapie“ gliedert.

The interplay between natural site conditions and farming raises erosion by water above geological background levels. We examined the hypothesis that farmers take erosion into account in their farming decisions and switch to farming practices with lower erosion risk the higher the site-specific hazard becomes. Erosion since the last tillage was observed from aerial orthorectified photographs for 8100 fields belonging to 1879 farmers distributed across Bavaria (South Germany) and it was modeled by the Universal Soil Loss Equation using highly detailed input data (e.g., digital terrain model with 5×5m2 resolution, rain data with 1×1km2 and 5min resolution, crop and cropping method from annual field-specific data from incentive schemes). Observed and predicted soil loss correlated closely, demonstrating the accuracy of this method. The close correlation also indicted that the farmers could easily observe the degree of recent erosion on their fields, even without modelling. Farmers clearly did not consider erosion in their decisions. When natural risk increased, e.g. due to steeper slopes, they neither grew crops with lower erosion potential, nor reduced field size, nor used contouring. In addition, they did not compensate for the cultivation of crops with higher erosion potential by using conservation techniques like mulch tillage or contouring, or by reducing field size. Only subsidized measures, like mulch tillage or organic farming, were applied but only at the absolute minimum that was necessary to obtain subsidies. However, this did not achieve the reduction in erosion that would be possible if these measures had been fully applied. We conclude that subsidies may be an appropriate method of reducing erosion but the present weak supervision, which assumes that farmers themselves will take erosion into account and that subsidies are only needed to compensate for any disadvantages caused by erosion-reducing measures, is clearly not justified.

In agricultural soils, the formation of soil organic matter largely depends on the carbon (C) input by crop residues and rhizodeposition, which is thus of decisive importance for the management and prediction of soil organic carbon (SOC) stocks in cropland and grassland. However, there is a remarkable lack of reliable, crop-specific C input data. We used a plant C allocation approach to estimate the C input of major crops and grassland into agricultural soils of Bavaria in southeast Germany. Historic and recent plant C allocation coefficients were estimated and C inputs were calculated for a 60-year period (1951–2010) using long-term agricultural statistics. The spatial distribution of C inputs within Bavaria was derived from county-specific statistical data. The results revealed increases of the C input by 107–139% for cereals, 173–188% for root, forage and leguminous crops and 34% for grassland in the last 60 years. This increase was related to linear yield increases until 1995 despite significant changes of plant C allocation. However, from 1995 onwards, crop yields and related C inputs stagnated, which allowed a robust estimation of recent crop-specific C input values. A total C input of 3.8–6.7 t ha−1 yr−1 was estimated for cereals, 5.2–6.3 t ha−1 yr−1 for root, forage and leguminous crops and 2.4 t ha−1 yr−1 for grassland. These amounts were partly higher compared to estimations in the literature. A generally high spatial variability of C inputs was detected within Bavaria with differences of up to 40% between adjacent counties. The results of this study could be used to optimize the C input of crop rotations and thus promote the formation of soil organic matter and C sequestration in agricultural soils on the basis of a soil carbon model. Moreover, recent estimations of C inputs could be used to model the future development of agricultural SOC stocks. A further stagnation of crop yields and the related C input under an ongoing temperature increase bears the risk of a future decrease of SOC stocks in cropland soils of Bavaria.

Background Growth differentiation factor 15 (GDF-15) can serve as a biomarker for cardiovascular disease burden and risk. We evaluated a new, fully automated electrochemiluminescence immunoassay for measuring GDF-15. Methods Six laboratories independently characterized the Elecsys® GDF-15 assay (Roche Diagnostics) under routine conditions. Within-run precision (repeatability), within-laboratory precision (intermediate precision), and between-laboratory precision (reproducibility) were assessed. Plasma-serum sample correlation, reagent lot-to-lot reproducibility, and instrument comparisons were performed. The Elecsys assay was compared to a research immunoradiometric assay (IRMA) and a commercially available ELISA. GDF-15 concentrations were measured with the Elecsys assay in 739 apparently healthy individuals. Results CVs for within-run and within-laboratory precision ranged from 0.7% to 7.7% and 1.7% to 8.6%, respectively, for samples containing 670–16039 ng/L. CVs for between-laboratory precision ranged from 7.1% to 8.9% (766–14289 ng/L). Recovery of GDF-15 was comparable for serum, Li-heparin plasma, K2- and K3-EDTA plasma, and citrated plasma, between 2 reagent lots, and on the cobas e 411 and cobas e 601 analyzers (Roche Diagnostics). GDF-15 concentrations in the clinically relevant range (400–3000 ng/L) measured with the Elecsys assay showed a good correlation and agreement with those measured by IRMA or ELISA. GDF-15 concentrations in apparently healthy individuals increased with age but did not vary by sex. Conclusions The Elecsys GDF-15 assay demonstrates a robust analytic performance under routine conditions and provides an automated method for measuring GDF-15 concentrations in serum and plasma.

Climate change and stagnating crop yields may cause a decline of SOC stocks in agricultural soils leading to considerable CO2 emissions and reduced agricultural productivity. Regional model-based SOC projections are needed to evaluate these potential risks. In this study, we simulated the future SOC development in cropland and grassland soils of Bavaria in the 21(st) century. Soils from 51 study sites representing the most important soil classes of Central Europe were fractionated and derived SOC pools were used to initialize the RothC soil carbon model. For each site, long-term C inputs were determined using the C allocation method. Model runs were performed for three different C input scenarios as a realistic range of projected yield development. Our modelling approach revealed substantial SOC decreases of 11-16% under an expected mean temperature increase of 3.3 °C assuming unchanged C inputs. For the scenario of 20% reduced C inputs, agricultural SOC stocks are projected to decline by 19-24%. Remarkably, even the optimistic scenario of 20% increased C inputs led to SOC decreases of 3-8%. Projected SOC changes largely differed among investigated soil classes. Our results indicated that C inputs have to increase by 29% to maintain present SOC stocks in agricultural soils.

Infliximab (IFX) has tremendously enriched the therapy of inflammatory bowel diseases (IBD) and other immune mediated diseases. Although the efficacy of IFX was undoubtedly proven during the last decade numerous publications have also caused various safety concerns. To summarize the immense information concerning adverse events and safety issues the Austrian Society of Gastroenterology and Hepatology launched this evidence based consensus on the safe use of IFX which covers the following topics: infusion reactions and immunogenicity, skin reactions, opportunistic infections (including tuberculosis), non-opportunistic infections (bacterial and viral), vaccination, neurological complications, hepatotoxicity, congestive heart failure, haematological side effects, intestinal strictures, stenosis and bowel obstruction (SSO), concomitant medication, malignancy and lymphoma, IFX in the elderly and the young, mortality, fertility, pregnancy and breast feeding. To make the vast amount of information practicable for routine application the consensus was finally condensed into a checklist for a safe use of IFX which consists of two parts: issues to be addressed prior to anti‐TNF therapy and issues to be addressed during maintenance. Both parts are further divided into obligatory and facultative items.

Background: Epidemiological screening to examine possible ultraviolet-induced ocular changes and pathologies in Austrian farmers. Methods: The study was performed on behalf of the Austrian farmer insurance (Sozialversicherungsanstalt der Bauern). Randomly selected farmers and office workers as controls, both at the age of 35–55 years, underwent ophthalmic screening examinations. All subjects underwent complete ophthalmic examinations by slit lamp examination and Schirmer’s test 1. A survey, regarding per- sonal habits in the sun, was also conducted. Results: Three hundred and ninety-two subjects underwent ophthalmic examinations of whom 297 were farmers and 95 were controls. Due to the survey, 89.7% of the farmers claimed to protect themselves from the sun during work. From these subjects, 83.7% wear a head protection, 71.0% wear sunglasses, and 54.4% usually work in the shade. There were significant differences in lid (p = 0.021) and conjunctival pathologies (p < 0.0001) between farmers and controls. Conclusion: Austrian farmers are at a higher risk for developing lid and conjunctival tumours which require treatment at some point. We believe that the study group was too young to show significant differences within the lens and the posterior pole. A 5-year follow-up is planned.

Solar ultraviolet radiation (UVR) is known to be the main cause of skin cancer, the incidence of which is rising with national differences across Europe. With this observation study we aimed to determine the impact of nationality on sun behaviour and personal UVR exposure on sun and ski holidays. 25 Danish and 20 Spanish sun-seekers were observed during a sun holiday in Spain, and 26 Danish and 27 Austrian skiers were observed during a ski holiday in Austria. The participants recorded their location and clothing in diaries. Personal time-logged UVR data were recorded as standard erythema doses (SEDs) by an electronic UVR dosimeter worn on the wrist. Danish sun-seekers were outdoors for significantly longer, received significant higher percentages of ambient UVR, and received greater accumulated UVR doses than Spanish sun-seekers. Danish skiers were also outdoors for significantly longer than Austrian skiers, but the behaviour of the Danish skiers did not result in significantly greater accumulated UVR doses. Both Danish and Spanish sun-seekers and Danish and Austrian skiers received substantial UVR doses. The behaviour’s influence on the UVR doses received by the Danish participants may indicate an explanation of the higher skin cancer incidence among Scandinavians compared with other European populations.

Background: Photoinstability of sunscreens because of ultraviolet (UV) exposure is a well-known and common phenomenon. Recently, it was also shown that sunscreens with complex filter combinations are photoinactivated by UV exposures, which can easily be acquired by solar exposure over several hours. Objectives: To assess the change of the spectral transmission after UV exposure (UV-challenged protective performance) of 27 commercially available photoprotective lipsticks. Methods: Quartz slides were covered with a lipstick layer (area density 1.0 � 0.1 mg/cm 2 ) and irradiated with increasing doses of solar-simulated radiation. The spectral transmission (T) was measured spectrophotometrically before and after 5, 12.5, 25, and 50 standard erythema doses (SED) of exposure. We calculated the change in transmission (photoinstability) as the difference between the spectral transmission before and after a defined UV exposure, DT, and the arithmetic mean, for both the UVA (DTA) and UVB (DTB) ranges. A product was labelled as photounstable if the mean photoinstability in the UVA, DTA, or UVB range, DTB, was higher than 5% for an UV exposure of 12.5 SED. Results: Eleven products showed a significant photoinstability in the UVA range (DTA between 6% and 27%), only one product in the UVB range (DTB 5 13%), and one product in both the UVA (DTA 5 31%) and UVB (DTB 5 9%) range. In one product photoinstability became significant in the UVA range at higher UV exposures. Conclusions: Out of 27 lipsticks only 13 products showed a photostable performance (DTAo5% and DTBo5% for 12.5 SED). We propose therefore that only products, which fulfil these UV photostability criteria should be marketed.

Myiasis is a common travel-associated dermatosis. Travelers to many parts of Central and South America are susceptible to infestation by Dermatobia hominis. Despite the common name of human botfly, D hominis infests a broad range of mammals and is a severe pest to economically important farm animals in endemic regions. The adult female does not lay the eggs on the host. Instead, the adult female infests hosts indirectly by using blood-feeding arthropods to serve as phoretic vectors to transport the eggs. We present a patient who acquired Dermatobia when bitten by a day-active mosquito during a visit to Guatemala. He had a locally painful, firm furuncular lesion with a central pore that drained serosanguineous exudates. The patient applied an occlusive ointment and recovered the larva after it emerged. In this report we discuss the life cycle of D hominis, the differential diagnosis, and therapeutic approaches.

Two siblings, 16 months and 5 years of age, came into contact with the urticating hairs (setae) of oak processionary caterpillars, the larvae of Thaumetopoea processionea L., when the family moved to a suburb of Vienna, where mass gradation of T. processionea had started the year before. The setae were being spread by the wind from an infested oak tree in the neighbourhood. Both children repeatedly suffered bouts of dermatitis during the 10 weeks of the larval development. Owing to the fact that T. processionea often infests oak trees, whether isolated or at the edges of forests, there is a high likelihood of people being affected. Children frequently explore their surroundings and are at an even greater risk of developing lepidopterism. Caterpillar dermatitis should therefore be taken into consideration in the differential diagnosis of a pruritic rash in infants from regions with caterpillar-infested trees, especially during the larval development of T. processionea.

Regarding the outdoor behavior of the Caucasian population, modern sunscreens should provide high and broad-spectrum ultraviolet protection in the ultraviolet B as well as in the ultraviolet A range and should be photochemically stable for ultraviolet doses, which can be expected in solar radiation. At present an assessment of the photostability of suncare products is not a general requirement before marketing. In order to evaluate the photostability of suncare products we conducted an in vitro test and measured the spectral absorbance of 16 sunscreens before, and after exposure to increasing biologically weighted standard erythema doses (5, 12.5, 25, 50) of solar-simulated radiation. Seven of 16 suncare products showed a significant dose- and wavelength-dependent decrease of the ultraviolet A protective capacity, whereas the ability to absorb ultraviolet B was not affected. In the ultraviolet A range, the decrease of absorbance (photoinactivation), respectively, the increase of transmission was 12-48% for an ultraviolet exposure of 25 standard erythema dose. Photoinactivation started in the wavelength range between 320 and 335 nm with a maximum above 350 nm. Furthermore, our analysis showed that the behavior of suncare products was not predictable from its individual ingredients. Neither complex combinations of organic filters nor addition of inorganic filters could absolutely prevent photoinactivation. The inclusion of a single photounstable filter did not mean photoinstability of the complete suncare product. Photoinactivation of sunscreens appears to be an underestimated hazard to the skin, first, by formation of free radicals, second, by increased ultraviolet A transmission.

Background We analysed incidence, predictors, histological features and specific treatment options of anti-tumour necrosis factor α (TNF-α) antibody-induced psoriasiform skin lesions in patients with inflammatory bowel diseases (IBD). Design Patients with IBD were prospectively screened for anti-TNF-induced psoriasiform skin lesions. Patients were genotyped for IL23R and IL12B variants. Skin lesions were examined for infiltrating Th1 and Th17 cells. Patients with severe lesions were treated with the anti-interleukin (IL)-12/IL-23 p40 antibody ustekinumab. Results Among 434 anti-TNF-treated patients with IBD, 21 (4.8%) developed psoriasiform skin lesions. Multiple logistic regression revealed smoking (p=0.007; OR 4.24, 95% CI 1.55 to 13.60) and an increased body mass index (p=0.029; OR 1.12, 95% CI 1.01 to 1.24) as main predictors for these lesions. Nine patients with Crohn9s disease and with severe psoriasiform lesions and/or anti-TNF antibody-induced alopecia were successfully treated with the anti-p40-IL-12/IL-23 antibody ustekinumab (response rate 100%). Skin lesions were histologically characterised by infiltrates of IL-17A/IL-22-secreting T helper 17 (Th17) cells and interferon (IFN)-γ-secreting Th1 cells and IFN-α-expressing cells. IL-17A expression was significantly stronger in patients requiring ustekinumab than in patients responding to topical therapy (p=0.001). IL23R genotyping suggests disease-modifying effects of rs11209026 (p.Arg381Gln) and rs7530511 (p.Leu310Pro) in patients requiring ustekinumab. Conclusions New onset psoriasiform skin lesions develop in nearly 5% of anti-TNF-treated patients with IBD. We identified smoking as a main risk factor for developing these lesions. Anti-TNF-induced psoriasiform skin lesions are characterised by Th17 and Th1 cell infiltrates. The number of IL-17A-expressing T cells correlates with the severity of skin lesions. Anti-IL-12/IL-23 antibody therapy is a highly effective therapy for these lesions.

A 34-year-old woman who was 20 weeks pregnant developed pyoderma gangrenosum while receiving treatment for infarct pneumonia. Because of her septic condition an abortion was performed. The patient received intravenous prednisolone as a pulse treatment for her pyoderma gangrenosum, which was followed by oral methylprednisolone and oral dapsone for 6 weeks. After dose reduction the patient had a severe relapse. The steroid dose was increased and dapsone was replaced by cyclosporin A. The smaller ulcers healed spontaneously, but skin grafting had to be performed for the large ulcer. The steroid therapy was tapered and discontinued. Cyclosporin A was continued for 10 weeks as monotherapy. Subsequently, the patient was free of symptoms for 7 months. Twelve months after the diagnosis of pyoderma gangrenosum the patient developed acute myeloid leukaemia accompanied by a recurrence of the skin disease.

Optoelectronic personal UV-meters were used to monitor the occupational facial solar erythemally effective exposure of 12 Austrian full-time farmers with high temporal resolution. To ensure high quality measurements several quality assurance procedures were applied, like calibration with respect to solar elevation and total ozone column. From April to October the test persons carried the UV-meters on the forehead during working hours. A digital diary (activity, location, weather, photoprotective measures) was completed on an hourly basis. Our field test produced 1427 complete daily records (measurement and diary). The total exposures showed high variability (77 –757 standard erythema dose [SED]) which correlates with the number of working days and even stronger with the little numbers of days with high exposure (>10 SED). Risk factors for high exposures were: mixed-culture farms with aggravated working conditions, low degree of automation of working processes, inadequate operating logistics (summarized as manual work outdoor), driving machines without cabins, and female gender. UV exposure of female farmers was approximately twice as high as that of men: Women received 15% of ambient radiation while men got 8%. Avoiding daily exposure >10 SED could reduce exposure down to 40% and the risk in developing skin cancer by a factor of 40.

Since the nineteen fifties the attitude of the fair-skinned world population towards the sun has changed dramatically. Tanned skin, which before was regarded as the stigma of the underprivileged working classes, became fashionable and desirable. The science of photoprotection primarily focuses on ultraviolet exposure during leisure time activities, whereas ultraviolet radiation is still underestimated as a risk factor for UV-induced skin and eye problems. The actual discussion on the registration of UV-induced skin tumours as occupational diseases, however, has drawn more attention to this important issue. Ambient radiation, the working process itself and the photoprotective behaviour of an outdoor worker are the main factors which influence the actual UV exposure. However, the total risk for the development of actinic damage results from the interaction of both the occupational and the leisure time exposure. It is evident that there is a high need for photoprotective measures for outdoor workers. Topical sunscreens as a part of a comprehensive UV protection strategy for outdoor workers have to fulfil special requirements: reasonable price, high water resistance, non-sticky appearance. At present only a few products are available which meet these criteria. This is the reason why sunscreens are not so well accepted by outdoor workers. Great efforts have to be undertaken to improve sunscreen formulations and to convince people to apply them correctly and regularly.

This study was intended to calculate the augmentation volume for a sinus lift procedure based on cross-sectional computerized tomography (CT) scans for 2 different augmentation heights.Based on area calculations of cross-sectional CT scans, the volume of additional bone needed was calculated for 44 sinus lift procedures. The amount of bone volume needed to raise the sinus floor to heights of both 12 and 17 mm was calculated.To achieve a sinus floor height of 12 mm, it was necessary to increase the height by a mean of 7.2+/-2.1 mm (range, 3.0 to 10.5 mm), depending on the residual ridge height; to achieve a height of 17 mm, a mean of 12.4+/-2.0 mm (range, 8.5 to 15.5 mm) was required (P.01). The calculated augmentation volume for an augmentation height of 12 mm was 1.7+/-.9 cm3; for an augmentation height of 17 mm, the volume required was 3.6+/-1.5 cm3. Increasing the height of the sinus lift by 5 mm, ie, from 12 mm to 17 mm augmentation height, increased the augmentation volume by 100%. A significant correlation was found between augmentation height and the calculated sinus lift augmentation volume (r = 0. 78, P.01).Detailed preoperative knowledge of sinus lift augmentation volume is helpful as a predictive value in deciding on a donor site for harvesting autogenous bone and on the ratio of bone to bone substitute to use. Calculation of the augmentation size can help determine the surgical approach and thus perioperative treatment and the costs of the surgery for both patients and clinicians.

This paper presents a method for the fully automatic surveying of cutaneous hemangiomas by means of a hemangioma segmentation and a ruler visible in the images. The algorithm computes the spatial resolution of an image. Hemangioma segmentation is accomplished by a single-layer perceptron classification by means of pixel color features. The algorithm was evaluated on a set of 120 images. It achieves satisfactory results on images with clearly visible, saturated hemangiomas.

There is a great need for photochemical and photobiological experiments to mimic the spectral distribution of solar ultraviolet radiation by artificial ultraviolet sources. The spectral distribution of various ultraviolet sources were compared with a reference solar spectrum which represents a realistic maximum solar spectrum under cloudless sky. Various methods to compare the artificial sources with the COLIPA solar reference spectrum were presented. Beside a graphical method which is based on the Lorenz curve also integral indices were used to characterize the deviations from the solar spectrum. Following parameters should be used to characterize an artificial source: (1) total output of the biologically effective irradiance, (2) maximum deviation of the cumulative relative spectral irradiance of the biologically effective solar simulated radiation, (3) spectral distribution of the difference of the cumulative relative spectral irradiance of the biologically effective solar simulated radiation, and (4) the index of the goodness of the spectral fit. Further on upper and lower limit values are suggested to improve the quality of the spectral fit of solar simulated radiation and the irradiance maximum should be limited to the range in which dose reciprocity is known to be conserved.

Summary Background Thaumetopoea processionea L. (order Lepidoptera), the oak processionary moth, is found in oak forests in most European countries. Its third to sixth larval instars are armed with poisonous hairs (setae) containing an urticating toxin (thaumetopoein) potentially harmful to humans. Because T. processionea infests trees at the edges of forests or standing alone people frequently come into contact with its setae. In the woodland bordering on the western suburbs of Vienna conditions favouring its increase have led to frequent outbreaks of lepidopterism. Objectives To determine the incidence of lepidopterism in a suburban environment with three separate caterpillar-infested oak trees and to ascertain the frequency of the various symptoms of lepidopterism and the manner of contact with setae. Methods We conducted a telephone survey of all the households/institutions located within 500 m of the infested trees. To gain more information on patients' symptoms and on situations likely to lead to increased contact with setae we asked those who reported cutaneous reactions to complete a questionnaire. As part of the environmental study we described the outbreak site, examined patients and, with tape-strip samples taken from the surface of the soil, looked for setae persisting in the environment. Results Of 1025 people surveyed 57 (5·6%) reported one or more symptoms of lepidopterism: 55 (96%) reported pruritus, 54 (95%) dermatitis, eight (14%) conjunctivitis, eight (14%) pharyngitis and two (4%) respiratory distress. The questionnaire was returned by 37 (69%) of the individuals with dermatitis. Of those, 16% had reacted with weal formation, 49% with papular rash and 22% with toxic irritant dermatitis. In 13% of respondents it was not possible to define the reaction. The risk factor analysis showed that airborne contamination was the most important cause: 97% of people had frequently passed an infested tree, 57% lived near a tree (in a neighbouring garden) and 32% had a tree in their own garden. Direct contact with larvae was of minor importance (38%). In four of the tape-strip samples intact setae were identified 1 year after the infestation. Conclusions Lepidopterism caused by T. processionea is a public health problem of increasing significance. In years with outbreaks of the pest it can reach epidemic proportions in communities located near infested trees. Contact with airborne setae was mainly responsible for the occurrence of the disease.

SummaryBackground The thickness of the sunscreen layer that is actually applied by consumers under usual conditions has been determined for photoprotective lotions and creams; however, this question is still unanswered for photoprotective lipsticks. Objectives To assess lipstick thickness (area density) and frequency of application per day for two commercially available photoprotective lipsticks with different consistency. Methods The study consisted of a laboratory test and a field experiment. In the laboratory test the applied lipstick thickness was determined as area density in mg cm−2 for a group of 28 panellists under standardized conditions. In a separate group of 18 subjects we assessed the area density and the frequency of application per day for two photoprotective lipsticks during a 6-day skiing course. Results In the laboratory test the median and 95% confidence interval of the area density was 0·98 mg cm−2 (0·66–1·65) and 0·86 mg cm−2 (0·63–1·40) for products A and B, respectively. The respective values of the field experiment were 1·58 mg cm−2 (0·79–2·23) (product A) and 1·76 mg cm−2 (1·16–3·50) (product B). Only 11% of all applications of lipstick A and 6% of all applications of lipstick B reached the reference area density of 2·0 mg cm−2. The difference between the median of the area density for lipstick A (firm consistency) and lipstick B (soft consistency) was not statistically significant. No statistically significant influence on the area density was found for age, sex, photobiological skin type or regular lipstick use. The median daily frequency of application was 2·2 times for lipstick A and 3·0 times for lipstick B. Conclusions Our investigation shows that photoprotective lipsticks are applied in a much thinner layer than recommended by international standards (2 mg cm−2). This results in a significant reduction of the photoprotective capacity. Furthermore, the frequency of application is too low for adequate protection. Therefore, we propose that the sun protection factor (SPF) should be assessed for an area density that reflects the actual usage patterns. As long as the test protocol is not adapted to the reduced area density, photoprotective lipsticks with high and ultrahigh SPF should be recommended, especially for individuals with increased risk for the development of lip malignancies.

SummaryExposing human skin to ultraviolet radiation causes DNA damage, sunburn, immune alterations, and eventually, skin cancer. We wished to determine whether liposomes containing a DNA repair enzyme could prevent any of the acute effects of irradiation when applied after ultraviolet exposure. Fifteen human patients with a prior history of skin cancer were exposed to two minimal erythema doses of ultraviolet radiation on their buttock skin. Liposomes containing T4 endonuclease V or heat-inactivated enzyme were applied immediately and at 2, 4, and 5 h after ultraviolet irradiation. Transmission electron microscopy after anti-T4 endonuclease V-staining and immunogold labeling on biopsies taken at 6 h after ultraviolet exposure revealed that the enzyme was present within cells in the skin. Immunohistochemical DNA damage studies suggested a trend toward improved DNA repair at the active T4 endonuclease V liposome-treated test sites. Although the active T4 endonuclease V liposomes did not significantly affect the ultraviolet-induced erythema response and microscopic sunburn cell formation, they nearly completely prevented ultraviolet-induced upregulation of interleukin-10 and tumor necrosis factor-α RNA message and of interleukin-10 protein. These studies demonstrate that liposomes can be used for topical intracellular delivery of small proteins to human skin and suggest that liposomes containing DNA repair enzymes may provide a new avenue for photoprotection against some forms of ultraviolet-induced skin damage.

Der Begriff Photodermatosen bezeichnet dermatologische Erkrankungen, die bei ansonsten gesunden Individuen durch Bestrahlung der Haut mit ultraviolettem (UV) oder sichtbarem Licht ohne Einwirkung eines externen Photosensibilisators ausgelost werden. In diese Gruppe fallen die polymorphe Lichtdermatose, die Hydroa vacciniforme, die aktinische Prurigo und die solare Urtikaria. All diesen Erkrankungen ist gemeinsam, das sie durch Sonnenlicht oder kunstliches ultraviolettes, teilweise auch sichtbares Licht ausgelost werden und die exakten Pathomechanismen, die zur klinischen Manifestation dieser Krankheitsbilder fuhren, bis zum heutigen Zeitpunkt nur bruchstuckhaft bekannt sind. Insbesonders ist noch vollig ungeklart, welches die verantwortlichen Chromophore in der Haut sind, die durch die Bestrahlung mit naturlichem oder artefiziellem Licht photochemisch aktiviert werden und als Initialzundung fur den in der Folge ablaufenden entzundlich-immunologischen Prozes fungieren. Ein weiteres Charakteristikum dieser auch als „idiopathisch“ bezeichneten Photodermatosen ist der Umstand, das ihre Diagnostik in erster Linie auf Phototestungen beruht und histopathologischen oder Laboruntersuchungen nur eine untergeordnete Rolle zukommen.

Unter den kutanen T-Zell-Lymphomen (CTCL) versteht man eine Gruppe verschiedener Non-Hodgkin-Lymphome, die sich primar an der Haut manifestieren und deren Infiltrate zum Grosteil aus malignen T-Lymphozyten bestehen. Die haufigste klinische CTCL-Variante ist die sogenannte Mycosis fungoides (MF). Die MF gehort zu den niedrigmalignen Non-Hodgkin-Lymphomen, deren klinischer Verlauf durch eine langsame Progression von einem fruhen Plaquestadium uber ein Tumorstadium bis hin zur Lymphknoten- und Organbeteiligung gekennzeichnet ist. Haufig uberlappen sich jedoch die klinischen Stadien, oder es kommt zum Uberspringen einzelner Stadien. Das Sezary-Syndrom (SS) ist eine Sonderform der MF mit generalisiertem Hautbefall im Sinne einer Ery-throdermie und einer Leukozytose mit malignen Lymphozyten. Weitere typische klinische Zeichen sind Befall der Handflachen und Fussohlen mit palmoplantarer Hyperkeratose und tumorose Infiltrate des Gesichtes (Facies leonina). MF und SS sind histopathologisch durch infiltrierende und/oder zirkulierende kleine T-Lymphozyten mit zerebriformen Zellkernen gekennzeichnet, die typischerweise den T-Helferphanotyp aufweisen (CD3+, CD4+, CD8+) .

The significance of oral psoralen photochemotherapy (PUVA) for the development of nonmelanoma skin cancers (NMSC) is still controversial.We evaluated 496 psoriatics, who received PUVA treatment according to the European PUVA protocol in order to reassess the influence of the cumulative UVA dose on the development of NMSC and to answer the question if there is a UVA threshold dose above which the carcinogenic risk is increased.The study was conducted as a retrospective investigation. All patients were seen personally. Age, sex, skin type, cumulative UVA dose and carcinogenic risk factors (arsenic, X-rays, tar, UVB, methotrexate) were recorded and investigated by marginal (MA) and partial effects analyses (PA) according to the Cox regression model.In 14 patients (2.8%), one or multiple histologically confirmed NMSC were diagnosed. Nine patients (1.8%) had squamous cell carcinoma (SCC), 5 patients (1.0%) had basal cell carcinoma (BCC). No patient had both types of NMSC. None of the SCC had metastasized. By taking the appearance of BCC and SCC as the endpoint, arsenic [MA: relative risk (RR) = 7.62; PA:RR = 5.36], tar (MA:RR = 4.51; PA:RR = 3.83) and methotrexate (MTX; MA:RR = 4.97; PA:RR = 4.07) appear to produce strong and significant effects (p0.05), both in MA and PA. Using the endpoint SCC only, the effect of the natural logarithm of UVA (ln UVA; RR = 2.47), arsenic (RR = 11.2), tar (RR = 9.92) and MTX (RR = 7.1) is significant (p0.05) in MA. In PA, only the effect of arsenic (RR = 5.19) is strong and significant (p0.05) while the effects of tar (RR = 7.85), MTX (RR = 3.22) and ln UVA (RR = 2.77) are strong but of borderline significance (p = 0.05-0.11). Nonlinear effects of ln UVA on the risk of SCC were far from significant (p0.2).PUVA with the European treatment protocol appears to be only a weak carcinogen by itself for SCC with a linear increase in tumor risk but not for BCC development.

A new flavonolglycoside, quercetin-3-α-ʟ-(2-O-α-ʟ- rhamnopyranosidoarabo-pyranoside, has been isolated from seeds of Brassica nigra. Its structure is prooven by 13C-NMR.