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Colon capsule endoscopy was approved for reimbursement under the national health insurance system of Japan in 2014. However, the capsule excretion rate after recommended bowel preparation reportedly ranges from 70% to 90%, and administration of boosters is also necessary. The caster oil-based booster had an emission rate of 97%, but required a total water content of 3L. Considering whether it is possible to popularize colon capsule endoscopy by reducing the amount of water, including dialysis patients with water restrictions, we will consider whether the capsule discharge rate can be improved by combining new laxatives.

Background: Axillary hyperpigmentation is a common and troublesome complaint especially among dark-skinned women. It is believed to be a form of post-inflammatory hyperpigmentation and so far, there is no universally accepted treatment for the disorder. Objective: The aim of this study is to assess the efficacy of fractional CO2 laser in the treatment of axillary hyperpigmentation Patients and methods: Thirty Egyptian females with axillary hyperpigmentation were recruited. The severity of the condition was estimated by both self-assessment and expert dermatologist before treatment. Four sessions of fractional CO2 laser were done. Both the efficacy and complications were assessed by the patient and the dermatologist six month after the last session. Results: There was a statistically significant difference of percentage of improvement of pigmentation before compared to one month after treatment as detected by self-assessment (p value= 0.002) and the observer’s assessment (p value= 0.001). Conclusion: Fractional CO2 laser, in properly chosen parameters, is an effective method for the treatment of axillary hyperpigmentation.

Background: Treatment of resistant alopecia totalis AT is a major problem in general practice. Some studies reported the use of either excimer-308 or intra-muscular triamcinolone acetonide as a monotherapy, with conflicting results. Objective: To evaluate the therapeutic effect of combining 308-excimer phototherapy and intramuscular triamcinolone acetonide for the treatment of alopecia totalis. Methods and Material: Ten patients with alopecia totalis were evaluated in this prospective interventional study. All patients were assigned to receive the thera-peutic regimen that includes monthly IM triamcinolone acetonide (TAC) for a maximum of six pulses and twice-weekly excimer phototherapy for 24 sessions. Results: The overall response rate for this regimen was 90%, with four patients 40% achieving complete regrowth of hair (100%). Three patients have exhibited a satisfactory response (>70% regrowth). Unsatisfactory response ( >10-< 70% regrowth) was reported in two patients . Younger patients responded better, as did those with a shorter history of the disease P < 0.05. At follow-up, which continued for 8–12 months, recurrence was noted in two (22.2%) of the nine responders. Conclusions: Combining excimer phototherapy with triamcinolone acetonide showed a promising effect on resistant AT. This treatment modality was effective and well tolerated particularly in young patients.

Background: Most previous research has focused on acne vulgaris characteristics and their association with psychological disorders, such as anxiety and depression. Objective: In the present study, we aimed to show whether acne characteristics are associated with several aspects of psychological well-being namely self-esteem, body satisfaction, anxiety-depression and dermatological life quality. Methods: This was a study of 200 patient with acne and190 healthy controls that was carried out in Antalya, Turkey. Main outcome measures were the Rosenberg’s Self-Esteem Scale, Body Image Concern Inventory (BICI), hospital anxiety and depression scale (HAD) and dermatological life quality index (DLQI). Also we recorded global acne grading score (GAGS) of acne patients. Results: The findings of statistical analysis indicated that patients with acne had lower levels of self-esteem, high depression and HAD score compared with healthy controls (respectively p=0.01, p˂0.01, p=0.01). Also the DLQI scores of severe and very severe group had higher than mild and moderate group (p= 0.013) Conclusion: The emotional well-being of the patients presenting with the acne needs to be recognized more fully, particularly in relation to the low self-esteem, high depression score. The psychosocial impact of acne vulgaris should be valued in the management of patients with this condition. The results of this study raise implications for clinical practice and suggest that a multidisciplinary approach to the management of patient with acne.

Introduction: Vaping has become an epidemic with serious health concerns. The Centers for Disease Control and Prevention recently released a national alert on vaping hazards and its associations with a mysterious lung disease. The prevalence of alternative tobacco products such as waterpipe and vaping have been on the rise, with health hazards similar to those of cigarettes. However, the public is less aware of those hazards. Because the literature on alternative tobacco use among Veterans is limited, the purpose of this study is to examine veterans’ use, perceptions, and knowledge of the hazards linked to alternative tobacco products. Materials and Methods: A convenience sample of 200 veterans seeking medical care at the Rocky Mountain Regional VA Medical Center, primary care clinics completed a survey on tobacco use. Results: Cigarettes remain the most prevalent form of tobacco used by veterans. The prevalence of “ever use” of waterpipe and/or vaping was 21% among participants, and almost all of those participants also reported cigarette use, 20.5%. About 42% of participants were unaware of harm levels from waterpipe. Discussion: Veterans are unaware of the risks associated with vaping and other alternative tobacco products and show similar use rates as the general population. Because educational campaigns have proven to be successful in decreasing smoking, the next step is to conduct educational campaigns on the hazards of alternative tobacco products among the veteran population to address myths and misperceptions regarding those products.

The concept of sustainable development has recently become a significant issue among industrial, academic, and government sectors. As consumers have more green awareness of products, the markets of natural and organic products set to be flourish, the organic certification approach is then expected to be a crucial role between consumers and green brands. For the green cosmetic brands, it might bring more benefits to the brand than just being a proof of organic ingredients. The study conducted a quantitative questionnaire survey which was developed for this study and based on the four components of brand equity: brand associations, brand loyalty, perceived quality and brand awareness. Taking COSMOS-standard as an example, the study explores the influence it might have on green cosmetic brand equity and purchase intentions. Using snowball sampling for data collection, the total number of respondents was 867 and the number of valid questionnaires was 623. The statistical software SPSS 22.0 was used for the analysis. The results indicate that COSMOS-Standard organic certification has positive impacts on brand equity and purchase intention; significant differences on brand association and brand loyalty are caused by different disposable income; the effects on improving purchase intention works better on toiletries than facial care products. The cosmetic brands can see the results as suggestions on brand management and marketing strategies.

Angiokeratomas (AK) are probably the vascular lesions that induce more confusion in the literature. The most accepted classification of AK was performed by Imperial and Helwig , and they divide these lesions into five classical types: Mibelli’s AK, Fordyce’s AK, corporis diffusum AK, circumscribed naeviforme AK and solitary or multiple acquired angiokeratomas. Nevertheless, in the clinical practice, is not unusual to see AK type lesions associated to different types of vascular anomalies, and these lesions have difficult handling. In ISSVA classification AKs have been included as vascular anomalies provisionally unclassified. We perform the differential diagnoses of AKs and according to clinical picture, histopathological aspect, immunohistochemical markers and radiological findings proposed to divide AKs mainly in two groups. Primary AKs are the classical types. The new immunohistochemical findings suggest that these lesions might be included as mixed capillary-lymphatic malformations. Secondary AKs are related with different vascular anomalies, secondary to other process with lymphatic obstruction, related to drugs, or associated with no vascular lesions as lymphoid lesions. Different underlying vascular anomelies might be related with AKs including deep capillary-lymphatic malformations (CLM), venous-lymphatic malformations (VLM), capillary-lymphatic-venous malformations (CLVM) (Klippel-Trenaunauy Sd), deep lymphatic malformations (LM), venous malformations (VM) as hyperkeratotic venous malformation, cavenomatous cerebral malformations, traumatic arteriovenous fistula and eccrine angiokeratomatous hamartoma. Clinical aspect, radiological studies and histopathological examination might help to do a correct diagnosis of this heterogenous entity.

Alpha-fetoprotein-producing gastric carcinoma (AFP-GC) is a rare malignant tumor, and has been regarded as a distinct category because of its particularly aggressive biological behavior and poor patient prognosis. In the literature, AFP-GC was never reported in neuroendocrine carcinoma of the stomach. In this article, we described a 60-year old man who sought medical attention because of epigastric pain and poor appetite. His laboratory data were within normal limits except for elevated serum level of alpha-fetoprotein. He was found to have an ulcer on gastroscopic examination which led to the final diagnosis of AFP producing neuroendocrine carcinoma of the stomach. He underwent a radical gastrectomy followed by chemotherapy using leucovorin and 5-fluorouracil.His disease was brought under remission for only six months before radiological recurrence occurred. His recurrent disease was treated with irinotican plus cisplatin without a significant response. His prognosis looked grave. We reported the first case of AFP producing gastric neuroendocrine carcinoma to share our experience.

Treatment with immune checkpoint inhibitors is a landmark in the treatment of melanoma and other cancers. These treatments have been very effective and have increased the survival of cancer patients. The promise of immunotherapy also comes with a variety of adverse events. One of the common sites of immune related adverse events (irAEs) is skin. The cutaneous irAEs present a unique challenge to the success of immunotherapy. It is important to diagnose and understand the mechanism related to these cutaneous irAEs to increase the effectiveness of immune checkpoint inhibitor therapy. In this review, we have characterized the various cutaneous irAEs associated with immune checkpoint inhibitor therapies and their possible mechanisms.

Diabetes is considered a multifactorial disease that afflicts populations of the most diverse classes worldwide, being among the main health problems today. Among the types of diabetes, type 2 diabetes mellitus (DM-2) is considered the most prevalent pathology. This is due to the direct relationship between the cause of this disease and people’s eating behavior. These factors justify the growing search for the development of drugs for DM-2, given that current drugs act on targets that are not very efficient for the treatment. Therefore, the objective of this review is to evaluate the progress of research related to the search for new synthetic drugs for a more selective treatment for DM-2. The researches were searched in the main academic databases (National Center for Biotechnology Information (NCBI), Science Direct and Google Scholar), and research tools such as Drug Bank and Clinical Trials. Seventy articles were selected that were causally related to the descriptors used. According to the survey, about 60 compounds of synthetic origin were found and present in the various phases of the study and some molecules already approved for use. A variety of strategies and new therapies related to DM-2 grows each year, as new targets involved are elucidated. Therefore, it is possible to envision a promising future for the treatment of DM-2. because studies like this show the evolution of biochemical research methods and the advances in medicinal chemistry, it will be possible in the future that a multifactorial disease of this type can be treated in a specific way for each patient.