Premalignant lesions of cutaneous squamous cell carcinoma (SCC) are identified clinically as actinic keratoses (12,13). Several field-directed treatments including 5-fluorouracil (5-FU), diclofenac, ingenol, and imiquimod have been approved for the treatment of sun-damaged skin with multiple actinic keratoses (13-15). However, the long treatment duration and the severity BACKGROUND. Actinic keratosis is a precursor to cutaneous squamous cell carcinoma. Long treatment durations and severe side effects have limited the efficacy of current actinic keratosis treatments. Thymic stromal lymphopoietin (TSLP) is an epithelium-derived cytokine that induces a robust antitumor immunity in barrier-defective skin. Here, we investigated the efficacy of calcipotriol, a topical TSLP inducer, in combination with 5-fluorouracil (5-FU) as an immunotherapy for actinic keratosis. METHODS.The mechanism of calcipotriol action against skin carcinogenesis was examined in genetically engineered mouse models. The efficacy and safety of 0.005% calcipotriol ointment combined with 5% 5-FU cream were compared with Vaseline plus 5-FU for the field treatment of actinic keratosis in a randomized, double-blind clinical trial involving 131 participants. The assigned treatment was self-applied to the entirety of the qualified anatomical sites (face, scalp, and upper extremities) twice daily for 4 consecutive days. The percentage of reduction in the number of actinic keratoses (primary outcome), local skin reactions, and immune activation parameters were assessed. RESULTS.Calcipotriol suppressed skin cancer development in mice in a TSLP-dependent manner. Four-day application of calcipotriol plus 5-FU versus Vaseline plus 5-FU led to an 87.8% versus 26.3% mean reduction in the number of actinic keratoses in participants (P < 0.0001). Importantly, calcipotriol plus 5-FU treatment induced TSLP, HLA class II, and natural killer cell group 2D (NKG2D) ligand expression in the lesional keratinocytes associated with a marked CD4 + T cell infiltration, which peaked on days 10-11 after treatment, without pain, crusting, or ulceration.CONCLUSION. Our findings demonstrate the synergistic effects of calcipotriol and 5-FU treatment in optimally activating a CD4 + T cell-mediated immunity against actinic keratoses and, potentially, cancers of the skin and other organs.TRIAL REGISTRATION. ClinicalTrials.gov NCT02019355. FUNDING. Not applicable (investigator-initiated clinical trial).

Conflict of interest: LAC and SD are co-inventors on a filed patent for the use of calcipotriol plus 5-fluorouracil for the treatment of precancerous skin lesions (PCT/US2015/049434).

From the start of the modern spa in the mid-twentieth century, the spa industry has grown substantially worldwide. Part of that growth involves spas of different types—each with its own business model, including day spas, hotel-based spas, resort spas, and destination spas. Regardless of the type of spa, most operations provide massage and nutrition-related services, with nutrition growing substantially in importance. Recession has trimmed the industry’s sails, but barriers to exit are substantial enough that even weakened operations might continue in business. The spa industry is widely fragmented, despite some notable consolidation. Because of the pressure on prices, some spas have been tempted to offer services in a commoditized fashion, but the most successful spas will focus on their total operation to promote their brand. It seems likely that the spa industry’s growth will resume when economies improve.

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Oxidation and vitamin E loss in four frying oils (two partially hydrogenated soybean oils, one with methyl silicone, the other with tertiary butyl hydroquinone, citric acid and dimethyl siloxane added; a semisolid hydrogenated soybean and palm oil shortening with mono and diglycerides added; and 100% corn oil) were studied under experimental and 'actual' operational conditions. Vitamin E loss in the frying oil increased significantly with increasing fatty acid oxidation. Added antioxidants, vitamin E and hydrogenation of fat decreased the rate of vitamin E loss. No significant change in vitamin E of the French fries occurred during 4 days of commercial frying; a significant increase in French fry fat uptake improved the 40% reduction in vitamin E of the frying oil. Vitamin C in the French fries (a major source of the vitamin in fast food meals) decreased significantly as the vitamin E content of the oils was reduced.

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The authors conducted a study of burnout within the foodservice environments of five major hotel chains. The Maslach Burnout Inventory, a psychometric instrument, was used to measure three dimensions of burnout: • Emotional Exhaustion (EE) • Depersonalization (DP) • Personal Accomplishment (PA). Findings show a significant incidence of high burnout according to Maslach's three domains-especially on the emotional exhaustion (28%) and depersonalization (20%) subscales. We have also unequivocally demonstrated that the Maslach inventory is a reliable and valid instrument for measuring burnout in the food-service industry.

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