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Background Hand eczema is the most common occupational skin disease. The etiology is multifactorial. Systemic alitretinoin, a pan-retinoic receptor agonist, has proven efficacy in the treatment of recalcitrant chronic hand eczema; however, its precise mechanism of action in hand eczema is not fully understood.Aims Assessment of the level of expression of retinoid receptors (RAR and RXR) in the skin of patients with hand eczema in an attempt to explain their possible role in the pathogenesis of the disease.Methods Thirty patients with hand eczema and 30 age-and sex-matched healthy controls were included. Full clinical examination was done, and tissue levels of retinoic acid receptor (RAR) and retinoid x receptor (RXR) were measured by quantitative real-time PCR (qRT-PCR). ResultsThe levels of RAR and RXR expression were significantly downregulated in the patient group compared to the control group; (P < 0.001) for both. In addition, there was a statistically significant negative correlation between Osnabr€ uck Hand Eczema Severity Index (OHSI) and the levels of RAR and RXR expression (P < 0.001).Conclusion Deficient retinoid receptor expression has a primary role in the pathogenesis, clinical phenotype, and severity of hand eczema and sheds light on the mechanism of action of retinoids in the treatment of chronic hand eczema.

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P ulmonary arteriovenous malformations (PAVMs) are abnormal direct fistulous communications between a pulmonary artery and a pulmonary vein, which may be present alone or in association with other vascular anomalies as in hereditary hemorrhagic telangiectasia (1, 2). As a result of this abnormal communication, a right to left shunt can develop and may lead to serious neurologic complications due to paradoxical embolization (2, 3).Introduced in 1977, transcatheter embolization is now the first line of management for PAVMs (4). Coils and amplatzer vascular plugs (AVP or AVP 2, St. Jude Medical) are the current endovascular approaches available. The occlusion time (OT) of an embolic device, which is defined as the time between the deployment of the device until complete occlusion of the artery, is of paramount importance, particularly in right-to-left shunt lesions such as PAVMs. The reason is that the thrombus formed on the surface of these embolic devices after deployment can migrate with the blood flow through the PAVM into the systemic circulation resulting in devastating complications related to paradoxical embolization (2, 5, 6).The OT of AVP devices in the treatment of PAVMs has been previously studied and the results documented its safety with an acceptable OT of 2-3 min without higher risk of systemic paradoxical embolization (8). Compared with the AVP device, the AVP 2 has a finer, more densely woven nitinol frame and a multisegmented design, which allows for increased length-wise expansion (9). Theoretically, this design should decrease the OT and have greater efficacy (10).The purpose of our study is to calculate the OT of AVP and AVP 2 used in treatment of PAVMs and correlate it to the type of the device used and the percent of device oversizing. Immediate technical success rates, persistence rates, and complications were also recorded for both devices. I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEOcclusion time (OT) is an important factor in the treatment of pulmonary arteriovenous malformations (PAVMs) since it can lead to serious complications. The purpose of our study is to calculate the OT of Amplatzer vascular plug (AVP, St Jude Medical), and correlate it to the type of the device used (AVP or AVP 2) and the percent of device oversizing. Technical success rates and complications were also recorded. METHODSWe retrospectively studied a total of 19 patients with 47 PAVMs who received percutaneous transcatheter embolization therapy using either AVP or AVP 2. We recorded the location, type, feeding artery diameter, AVP device used, and OT of each PAVM. We correlated the percent of device oversizing and the type of AVP with the OT. We also studied the rate of persistence of PAVM for both devices. RESULTSForty-six (98%) of the PAVMs were simple. Device diameters ranged from 4.0-16.0 mm with device oversizing ranging between 14% and 120%. There was a statistically significant difference in the OT of AVP and AVP 2 (3 min 54 s vs. 5 min 30 s, P = 0.030). There was a we...

e20539 Background: Malignant mesothelioma of the pleura (MMP) is a rare and aggressive malignancy and predominantly affects patients of White race in the U.S. Despite treatment advancements, the 5-year survival rate remains between 5% and 10%. Studies assessing racial disparities in MMP are lacking. We conducted a retrospective study to evaluate prevalence, survival and mortality trends among racial groups. Methods: We used the SEER database to determine the racial prevalence of all histological subtypes of MMP between 2000 and 2019. We calculated racial and histological subtype survival Cox proportional hazard ratios while controlling for age, gender, ethnicity, surgery, chemotherapy, and radiation use. Second, we used the CDC WONDER database to identify all mesothelioma deaths for the same period. Age-adjusted mortality (AAM) rates per 100,000 persons were standardized to 2000 US census data and stratified by race. Results: A total of 12791 patients were identified, mostly White (95%), followed by Blacks (%5) and Asians (0.4%). The percentages of patients with epithelioid, sarcomatoid and biphasic histologies were as follows: Whites (67.6%, 19.2%, 13.2%), Blacks (70.4%, 19.4%, 10.1%), and Asians (64.4%, 23.6%, 11.9%). As demonstrated in Table 1, compared to Whites, regardless of stage, survival was worse for Blacks (HR 1.16) and Asians (HR 1.14). As expected, survival was inferior for pts with sarcomatoid MMP followed by biphasic. Epithelioid MMP had the most favorable prognosis. Lastly, using the CDC WONDER database over the same period, there were 47,323 White, 2,068 Black, and 541 Asian MMP deaths. AAM was 0.8, 0.3, and 0.2 per 100,000 persons for White, Black, and Asian patients, respectively. AAM declined from 2000 to 2019 by 22% (0.9 to 0.7) in White, 50% (0.4 to 0.2) in Black, and 33% (0.3 to 0.2) in Asian. Conclusions: This is one of the largest population-based studies analyzing MMP racial disparities and histologic subtypes. Mortality analysis revealed declines across all racial groups, with the greatest decline among Blacks, which is two-fold that of Whites. However, a survival gap between races and histological subtypes persists. Despite no differences in the prevalence of histologic subtypes, mortality was 16% higher for Black patients when compared to Whites. Asian patients also had a higher risk of death of 14%, though the aggressive sarcomatoid subtype was more prevalent in this racial group. Social determinants of health and biological differences, could be responsible. Further studies are needed. [Table: see text]