Research Spotlight

Posted July 15th 2016

Image gallery: Cutaneous t-cell lymphoma mimicking a gyrate erythema.

Alan M. Menter M.D.

Alan M. Menter M.D.

Cizenski, J., J. Griffin and A. Menter (2016). “Image gallery: Cutaneous t-cell lymphoma mimicking a gyrate erythema.” Br J Dermatol 174(5): e42.

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A 22-year-old white man was evaluated for a mildly pruritic scaly rash of 6 years’ duration, which began on his chest and recently spread to the axillae and back. He initially presented to his primary doctor, who provided him with topical steroids without benefit. The eruption never ulcerated. Examination revealed pink annular and polycyclic patches on the chest, axillae and flanks without nodules, tumours or adenopathy. There was very faint scale at the borders of the lesions. A potassium hydroxide stain was negative for dermatophytes. Two biopsies revealed a CD8 predominant epidermotropic infiltrate of atypical lymphocytes with a clonal T-cell receptor rearrangement. Complete staging revealed stage IA disease. The indolent behaviour is consistent with mycosis fungoides with aberrant CD8+ phenotype. Current treatment includes a potent topical corticosteroid and close follow-up.


Posted July 15th 2016

Racial-Ethnic Differences in Psychiatric Diagnoses and Treatment Across 11 Health Care Systems in the Mental Health Research Network.

Laurel A. Copeland Ph.D.

Laurel A. Copeland Ph.D.

Coleman, K. J., C. Stewart, B. E. Waitzfelder, J. E. Zeber, L. S. Morales, A. T. Ahmed, B. K. Ahmedani, A. Beck, L. A. Copeland, J. R. Cummings, E. M. Hunkeler, N. M. Lindberg, F. Lynch, C. Y. Lu, A. A. Owen-Smith, C. M. Trinacty, R. R. Whitebird and G. E. Simon (2016). “Racial-ethnic differences in psychiatric diagnoses and treatment across 11 health care systems in the mental health research network.” Psychiatr Serv 67(7): 749-757.

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OBJECTIVE: The objective of this study was to characterize racial-ethnic variation in diagnoses and treatment of mental disorders in large not-for-profit health care systems. METHODS: Participating systems were 11 private, not-for-profit health care organizations constituting the Mental Health Research Network, with a combined 7,523,956 patients age 18 or older who received care during 2011. Rates of diagnoses, prescription of psychotropic medications, and total formal psychotherapy sessions received were obtained from insurance claims and electronic medical record databases across all health care settings. RESULTS: Of the 7.5 million patients in the study, 1.2 million (15.6%) received a psychiatric diagnosis in 2011. This varied significantly by race-ethnicity, with Native American/Alaskan Native patients having the highest rates of any diagnosis (20.6%) and Asians having the lowest rates (7.5%). Among patients with a psychiatric diagnosis, 73% (N=850,585) received a psychotropic medication. Non-Hispanic white patients were significantly more likely (77.8%) than other racial-ethnic groups (odds ratio [OR] range .48-.81) to receive medication. In contrast, only 34% of patients with a psychiatric diagnosis (N=548,837) received formal psychotherapy. Racial-ethnic differences were most pronounced for depression and schizophrenia; compared with whites, non-Hispanic blacks were more likely to receive formal psychotherapy for their depression (OR=1.20) or for their schizophrenia (OR=2.64). CONCLUSIONS: There were significant racial-ethnic differences in diagnosis and treatment of psychiatric conditions across 11 U.S. health care systems. Further study is needed to understand underlying causes of these observed differences and whether processes and outcomes of care are equitable across these diverse patient populations.


Posted July 15th 2016

Developing more open and equitable relationships with industry to improve advancements in clinical research in dermatology.

Alan M. Menter M.D.

Alan M. Menter M.D.

Campa, M., C. Ryan and A. Menter (2016). “Developing more open and equitable relationships with industry to improve advancements in clinical research in dermatology.” Br J Dermatol 174(6): 1365-1369.

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Relationships between physicians, scientists, and the pharmaceutical industry can be complicated by conflicts of interest. Honest and equitable relationships, however, are essential to the advancement of dermatologic clinical research. Several factors can increase transparency in clinical trials including preregistration of clinical trials, reporting of all data produced from clinical trials, non-industry ownership of clinical trial data, clarity of statistical methods and publication of both positive and negative results. Through collaborative, scientifically rigorous studies, physicians and industry can achieve significant advances in dermatologic care.


Posted July 15th 2016

The clinical utility of next generation sequencing results in a community-based hereditary cancer risk program.

Joanne L. Blum M.D.

Joanne L. Blum M.D.

Bunnell, A. E., C. A. Garby, E. J. Pearson, S. A. Walker, L. E. Panos and J. L. Blum (2016). “The clinical utility of next generation sequencing results in a community-based hereditary cancer risk program.” J Genet Couns. 2016 Jun 9. [Epub ahead of print]

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Since the 2013 Supreme Court ruling on BRCA1/BRCA2 patenting, hereditary cancer gene panels now include BRCA1 and BRCA2, making these panels an option for first-tier testing. However, questions remain about the clinical utility and implications of these panels for medical management with inclusion of genes of unknown to moderate penetrance. To better understand how use of these panels affected our practice, we reviewed patients who underwent testing in our clinic from July 1, 2013 through May 23, 2014. Indications for testing included personal and/or family history of breast and/or ovarian cancer. A total of 136 patients underwent panel testing via a single commercial laboratory; 12 (8.8 %) patients were positive for a pathogenic or likely pathogenic mutation (four BRCA2 mutations, two TP53 mutations, one CDH1 mutation, two ATM mutations, and one patient each with a CHEK2, NBN, or PALB2 mutation). Of these positive patients, 100 % met the National Comprehensive Cancer Network (NCCN) guidelines for Hereditary Breast and Ovarian Cancer genetic testing (2.2014). Mutations in seven of twelve (58 %) patients led to changes in medical management; three of seven (43 %) had a non-BRCA1 or BRCA2 gene mutation. Our findings suggest that there is clinical utility of panels that include genes of unknown to moderate penetrance.


Posted July 15th 2016

Icos(+)pd-1(+)cxcr3(+) t follicular helper cells contribute to the generation of high-avidity antibodies following influenza vaccination.

Hideki Ueno M.D.

Hideki Ueno M.D.

Bentebibel, S. E., S. Khurana, N. Schmitt, P. Kurup, C. Mueller, G. Obermoser, A. K. Palucka, R. A. Albrecht, A. Garcia-Sastre, H. Golding and H. Ueno (2016). “Icos(+)pd-1(+)cxcr3(+) t follicular helper cells contribute to the generation of high-avidity antibodies following influenza vaccination.” Sci Rep 6: 26494.

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The immune mechanism leading to the generation of protective antibody responses following influenza trivalent inactivated vaccine (TIV) vaccinations remains largely uncharacterized. We recently reported that TIV vaccination induced a transient increase of circulating ICOS(+)PD-1(+)CXCR3(+) T follicular helper (cTfh) cells in blood, which positively correlated with the induction of protective antibody responses measured at day 28. However, whether and how these T cells directly contribute to antibody response remains unclear. In this study, we analyzed the changes after TIV vaccination in the amount and the avidity of the polyclonal antibodies specific for the HA1 subunit of the pandemic H1N1 virus, and analyzed the correlation with the increase of ICOS(+)PD-1(+)CXCR3(+) cTfh cells. We found that both the amount and the avidity of specific antibodies rapidly increased during the first 7 days after TIV. Importantly, the increase of ICOS(+)PD-1(+)CXCR3(+) cTfh cells strongly correlated with the increase in the avidity of antibodies, particularly in subjects who did not have high affinity antibodies at baseline. We propose that ICOS(+)PD-1(+)CXCR3(+) Tfh cells directly contribute to the generation of high-avidity antibodies after TIV vaccinations by selectively interacting with high affinity B cells at extrafollicular sites.