bluuebunny/crossref_metadata_2025 huggingface dataset:
Embedded Microelectromechanical Systems(MEMS) for Measuring Strain in Composites
Authors: Hautamaki Charles , Zurn Shayne , Mantell Susan C. , Polla Dennis L.
Published: July 2017

Microelectromechanical strain sensors were fabricated and embedded in laminated composites. These small scale sensors were designed to function as part of a wireless sensing network. The sensing element, signal conditioning, and telemetry circuitry have been developed to be fabricated on a single silicon wafer. In this paper, the sensor design and function are described. The most critical feature for sensor design was the strain transfer between the sensor and composite matrix. Finite element models were developed to investigate various designs prior to manufacture. Two types of sensors were produced, sensors which were integral to the wafer, and sensors which were thin silicon nitrate beams attached to the wafer only at the beam root. An overview of experimental data from an extensive series of tests will be presented.
Tuberin and Hamartin Expression Is Reduced in the Majority of Subependymal Giant Cell Astrocytomas in Tuberous Sclerosis Complex Consistent With a Two-Hit Model of Pathogenesis
Authors: Jóźwiak Sergiusz , Kwiatkowski David , Kotulska Katarzyna , Larysz-Brysz Magdalena , Lewin-Kowalik Joanna , Grajkowska Wiesława , Roszkowski Marcin
Published: July 2017

Subependymal giant cell astrocytomas are distinctive brain tumors that are seen only in tuberous sclerosis complex. Although histologically benign, they cause both moribidity and occasional mortality owing to progressive growth in some patients. Tuberous sclerosis complex is an autosomal dominant genetic disorder with a high sporadic case rate that is due to mutations in either of two genes, TSC1 and TSC2, encoding hamartin and tuberin, respectively. The pathogenesis of subependymal giant cell astrocytomas in tuberous sclerosis complex is uncertain. In this study, we examined the expression of tuberin and hamartin in subependymal giant cell astrocytomas from nine patients with tuberous sclerosis complex by immunohistochemistry with confocal microscopy. Loss of hamartin expression was seen in all subependymal giant cell astrocytomas, including five from patients with germline TSC2 mutations and two from patients with germline TSC1 mutations. The subependymal giant cell astrocytomas of six of nine patients had no expression of tuberin as well, whereas three patients retained some tuberin expression. Tuberin expression was seen in one patient with a TSC2 germline mutation and two patients whose mutational status was not determined. Overall, these data indicate a loss of both tuberin and hamartin expression in the subependymal giant cell astrocytomas of patients with both TSC1 and TSC2 mutations and are consistent with a two-hit disease pathogenesis model for the development of subependymal giant cell astrocytomas. ( J Child Neurol 2004;19:102—106).
Differentiating Autistic Children with Quantitative Encephalography: A 3-Month Longitudinal Study
Authors: Chan Agnes S. , Leung Winnie W. M.
Published: July 2017

The present study used a single-channel quantitative electroencephalographic (EEG) assessment to differentiate autistic children from normal control subjects. One hundred five normal and 17 autistic children participated in the study. In addition to amplitude measures of the frequency bands of delta, theta, alpha, sensorimotor rhythm, and beta and the theta to beta ratio, intra- (6 minutes) and intersessional (3 months) consistencies were also examined. The results indicated that autistic children showed significantly higher quantitative EEG amplitudes in many of the frequency bands than normal children; furthermore, their quantitative EEG activities were found to be relatively unstable within a 6-minute session compared with normal children. Discriminant function analyses revealed that absolute sensorimotor rhythm and beta amplitudes were the best predictors that correctly differentiated autistic children from normal children in the present sample, with a high accuracy rate of 95.2%. In addition, quantitative EEG measurements of normal and autistic children were found to be generally consistent across the 3-month period. ( J Child Neurol2006;21:391—399; DOI 10.2310/7010.2006.00094).
Second Malignant Neoplasms Following the Treatment of Brain Tumors in Children
Authors: Büyükpamukçu Münevver , Varan Ali , Yazici Nalan , Akalan Nejat , Söylemezoğlu Figen , Zorlu Faruk , Akyüz Canan , Kutluk M. Tezer
Published: July 2017

We investigated retrospectively 992 children with central nervous system tumors who were treated at our center between 1970 and 2004. All of the patients were treated by surgery, chemotherapy, and/or radiotherapy. Six patients developed second malignant neoplasms, and their clinical and histopathologic characteristics are reviewed in this article. The second malignant neoplasms were diagnosed as non-Hodgkin lymphoma, myelodysplastic syndrome, basal cell carcinoma, malignant melanoma, Kaposi sarcoma, and high-grade neuroectodermal tumor. The initial diagnoses were ependymoblastoma in one, medulloblastoma in three, and low-grade astrocytoma in two patients. The median latency time was 3.03 years (range 0.39—22.93 years). The outcome varied according to the histopathologic type of the second tumor. The patients who developed non-Hodgkin lymphoma and myelodysplastic syndrome died of progressive disease. The patients with second skin neoplasms are alive as of the time of this writing. The patient with Kaposi sarcoma developed one of the rare reported second malignant neoplasms following a primary brain tumor in childhood. A wide spectrum of second malignant neoplasms was detected after treatment of primary brain tumors with surgery, radiotherapy, and chemotherapy. Long-term follow-up is therefore necessary for the child who has survived a primary central nervous system tumor. ( J Child Neurol2006;21:433—436; DOI 10.2310/7010.2006.00108.
Metronidazole: Newly Recognized Cause of Autonomic Neuropathy
Authors: Hobson-Webb Lisa D. , Roach E. Steve , Donofrio Peter D.
Published: July 2017

Metronidazole is a commonly used antibiotic prescribed for the treatment of anaerobic and protozoal infections of the gastrointestinal and genitourinary tracts. It is associated with numerous neurologic complications, including peripheral neuropathy. Neuropathy is typically detected in patients on chronic therapy, although it has been documented in those taking large doses for acute infections. Numerous case reports have been published describing motor and sensory neuropathy, yet autonomic neuropathy has not been described with metronidazole use. A previously healthy 15-year-old girl presented with complaints of burning pain in her feet following a short course of metronidazole for vaginitis. She could obtain pain relief only by submerging her feet in ice water. Examination revealed cold and swollen lower extremities that became erythematous and very warm when removed from the ice water. Temperature perception was reduced to the upper third of the shin bilaterally. Deep tendon reflexes and strength were preserved. Nerve conduction studies demonstrated a peripheral neuropathy manifested by reduced sensory nerve and compound muscle action potentials. Reproducible sympathetic skin potential responses could not be obtained in the hand and foot, providing evidence of a concurrent autonomic neuropathy. A thorough evaluation revealed no other cause for her condition. Repeated nerve conduction studies and sympathetic skin potentials returned to normal over the course of 6 months, paralleling the patient's clinical improvement. Metronidazole is a potential cause of reversible autonomic neuropathy. ( J Child Neurol 2006;21:429—431; DOI 10.2310/7010.2006.00118).
SECMA 1®, a mitogenic hexapeptide from Ulva algeae modulates the production of proteoglycans and glycosaminoglycans in human foreskin fibroblast
Authors: Ennamany R , Saboureau D , Mekideche N , Creppy E E
Published: July 2017

SECMA 1® is a polypeptide purified from a green algeae of the Ulva species by several gel chromatographies, showing the following sequence (Glu-Asp-Arg-Leu-Lys-Pro). In order to determine the effect of SECMA 1® on human skin fibroblasts extracellular matrix, proteoglycans (PGs) and glycosaminoglycans (GAGs) were assayed after 24 h incubation of 20 day-old foreskin fibroblasts at the 2nd passage.

The results revealed that most of [35S]sulphate was associated with fibroblast membranes, which contained (67%) of the total de novo synthesized sulphated PGs, in two distinct forms: one hydrophilic (39%), and one hydrophobic (28%). The remaining `matrix' retained 5% of proteoglycans. The remaining 35S-label may represent the free label in the cytosol.

After 24 h incubation of skin fibroblasts with different concentrations of SECMA 1® (2, 4 and 10 μg/ml), the [35S] sulphate incorporation into PGs of Salt-extract, sodium deoxycholate (DOC) extract and Guanidine hydrochloride (GuA-HCl)-extract was increased significantly ( P<0.005) with 4 μg/ml, as compared to untreated control. The most effective concentration (4 μg/ml) increased the different [35S]sulphate PGs extracts (NaCl, DOC and GuA-HCl) by respectively (66; 17 and 75%).

The relative contents of iduronic and glucuronic acid in the GAG produced by skin fibroblasts were estimated. No effect of SECMA 1® on the incorporation of [35S]sulphate into Heparan sulphate was found. The incorporation of [35S]sulphate into (chondroïtine sulphate + heparan sulphate) and (chondroïtine sulphate + dermatan sulphate) was increased by respectively 37% and 11% by SECMA 1® (4 μg/ml).
Validity of the Kaufman Brief Intelligence Test
Authors: Canivez Gary L.
Published: July 2017

Concurrent validity of the Kaufman Brief Intelligence Test (K-BIT) with a sample of elementary- and middle-school students referred for multidisciplinary evaluations in a public school setting is presented. All correlations between the K-BIT and the Wechsler Intelligence Scale for Children–Third Edition (WISC-III) were significant. Correlations ranged from .36 ( r2 = .10) to .87 ( r2 = .75), Mr = .71 ( Mr2 = .50). K-BIT Vocabulary-Matrices discrepancy scores accounted for a significant but small proportion (13%) of the variability in WISC-III VIQ-PIQ discrepancies, but kappa ( k) coefficients for these discrepancies indicated that agreement was generally no better than chance. The K-BIT appears to be a promising general intellectual screening instrument when more comprehensive assessment is not possible or needed, but interpretation is best left at the IQ Composite level for the present time.
MMPI-A Scale-Level Factor Structure: Replication in a Clinical Sample
Authors: Archer Robert P. , Krishnamurthy Radhika
Published: July 2017

The adolescent form of the Minnesota Multiphasic Personality Inventory (MMPI-A) Structural Summary was developed from the results of a scale-level factor analysis conducted by Archer, Belevich, and Elkins based on the MMPI-A normative sample. The present study examined the scale-level factor structure of the MMPI-A in a clinical sample of 358 adolescents receiving outpatient or inpatient psychiatric services. A Principal Factor Analysis was performed using the raw score intercorrelation matrix from the 69 scales and subscales of the MMPI-A. The procedure yielded nine factors that accounted for 75.6% of the total variance in scale and subscale raw scores. Results from this clinical sample indicated that seven of the eight dimensions that appear on the MMPI-A Structural Summary were replicated in terms of producing highly similar factor structure correlation coefficients with those reported by Archer, Belevich, et al. for a normal sample. The present findings support the use of the MMPI-A Structural Summary for the assessment of adolescents in clinical settings.
Plasma Cholinesterase Levels of Nepalese Farmers Following Exposure to Organophosphate Pesticides
Authors: Neupane Dinesh , Jørs Erik , Brandt Lars Peter Andreas
Published: July 2017

Background:

Farmers in developing countries use highly toxic organophosphate pesticides. Thus, the aim of this study was to compare plasma cholinesterase (PChE) enzyme activity before and after exposure to organophosphate pesticides in a real-life setting.

Methods:

This was a prospective study conducted on 25 farmers spraying organophosphate pesticide in their farm. The PChE level was measured and clinical signs and symptoms of toxicity were asked before and immediately after spraying.

Results:

The mean level of PChE before and after spraying was 1.41 and 1.29 IU/L, respectively (8.51% decreased). Farmers reported more clinical signs and symptoms of intoxication after spraying pesticides.

Conclusions:

Increase in acute intoxication signs/symptoms and decrease in PChE indicate a serious public health problem among farmers who use organophosphate pesticides. Appropriate training to the farmers is needed to reduce exposure to organophosphate pesticide.
Eosinophilic Fasciitis Occurring Four Weeks after the Onset of Dialysis in a Renal Failure Patient
Authors: Florell Scott R. , Egan Conleth A. , Gregory Martin C. , Zone John J. , Petersen Marta J.
Published: July 2017

Background:

Eosinophilic fasciitis is a rare, scleroderma-like disease that usually affects the extremities of young to middle-aged males. The disease may cause flexion contractures and limit joint mobility and is associated with peripheral eosinophilia. The fascia, by definition, is infiltrated with mononuclear cells and typically with eosinophils. Eosinophilic fasciitis may be separated from another sclerodermatous disorder, linear scleroderma, by its response to systemic corticosteroids. The etiology is unclear but eosinophilic fasciitis has numerous disease associations. However, it has not previously been associated with renal failure and hemodialysis.

Objective:

This article reports a case of eosinophilic fasciitis occurring four weeks following the onset of hemodialysis.

Methods:

The clinical and histologic features confirmed the diagnosis of eosinophilic fasciitis. He was treated with systemic corticosteroids with good response.

Conclusion:

This is the first reported patient who developed eosinophilic fasciitis in close temporal relationship with the start of hemodialysis. While eosinophilic fasciitis may be coincidental with a common disorder, namely, renal failure, it is interesting to note that hemodialysis patients often have immune-regulation abnormalities and peripheral eosinophilia.
Management of Psoriasis Vulgaris with Methotrexate 0.25% in a Hydrophilic Gel: A Placebo-Controlled, Double-Blind Study
Authors: Syed Tanweer A. , Hadi Suhail M. , Qureshi Zulfiqar A. , Nordstrom Christine G. , Ali Shahida M.
Published: July 2017

Background:

Methotrexate has been used as one of the first and systemic therapies for psoriasis. In general, 70% of patients with psoriasis prefer topical therapy as the treatment of choice.

Objective:

The purpose of this placebo-controlled double-blind study was to evaluate the clinical efficacy and tolerability of methotrexate 0.25% incorporated in a hydrophilic gel (hydroxyethylcellulose 1%) to treat patients afflicted with psoriasis vulgaris.

Methods:

Sixty patients (37M/23F) ranging between 18 and 70 years of age, with slight to moderate chronic plaque-type psoriasis and PASI (Psoriasis Area and Severity Index) scores between 5.3 and 17.5 joined the study. The mean duration of the disease at entry was 9.6 years (range 1–24 years). The diagnosis of psoriasis was established by clinical and histopathologic methods. Patients were sequentially randomized into two parallel groups. Each patient was allocated a precoded 100-g tube (active or placebo) with instructions on how to self-administer the trial medication topically (without occlusion) to their lesions two times daily for 5 consecutive days per week. The study lasted for 12 weeks with 4 weeks of active treatment. Patients were examined on a weekly basis and those showing total clearing or remission of lesions were considered effectively treated.

Results:

By the end of the treatment, breaking the code disclosed that methotrexate 0.25% gel had significantly treated more patients than placebo (83.3% vs. 6.7%; p < 0.0001), reduced the PASI score to a mean of 2.2, and cleared more plaques (82.2% vs. 4.3%; p < 0.0001). Laboratory evaluations, including CBC with differential and platelet count, renal function, liver chemistry [SGOT (aspartate transaminase) and SGPT (alanine transaminase)], and serum creatinine, were within the normal limits. The treatment was well-tolerated by all the patients, with no adverse drug-related symptoms and no dropouts. The study was followed up for 12 months from the first day of the treatment; two cured patients had relapsed after 8 months.

Conclusion:

The findings of this study demonstrate that methotrexate 0.25% in a hydrophilic gel is well tolerated and significantly more effective than placebo as a patient-applied topical medication to treat psoriasis vulgaris.
Peroxisomes in Dermatology. Part II
Authors: Smith Kathleen J. , Dipreta Edward , Skelton Henry
Published: July 2017

Background:

Peroxisomes are small cellular organelles that were almost ignored for years because they were believed to play only a minor role in cellular functions. However, it is now known that peroxisomes play an important role in regulating cellular proliferation and differentiation as well as in the modulation of inflammatory mediators. In addition, peroxisomes have broad effects on the metabolism of lipids, hormones, and xenobiotics. Through their effects on lipid metabolism, peroxisomes also affect cellular membranes and adipocyte formation, as well as insulin sensitivity, and peroxisomes play a role in aging and tumorigenesis through their effects on oxidative stress.

Objective:

To review genetically determined peroxisomal disorders, especially those that particularly affect the skin, and some recent information on the specific genetic defects that lead to some of these disorders. In addition, we present some of the emerging knowledge of peroxisomal proliferator activator receptors (PPARs) and how ligands for these receptors modulate different peroxisomal functions. We also present information on how the discovery of PPARs, and the broad and diverse group of ligands that activate these members of the superfamily of nuclear binding transcription factors, has led to development of new drugs that modulate the function of peroxisomes.

Conclusion:

PPAR expression and ligand modulation within the skin have shown potential uses for these ligands in a number of inflammatory cutaneous disorders, including acne vulgaris, cutaneous disorders with barrier dysfunction, cutaneous effects of aging, and poor wound healing associated with altered signal transduction, as well as for side effects induced by the metabolic dysregulation of other drugs.
Epidermolysis Bullosa Acquisita Responsive to Dapsone Therapy
Authors: Hughes Amy P. , Callen Jeffrey P.
Published: July 2017

Background:

Epidermolysis bullosa acquisita (EBA) is a chronic subepidermal blistering disease that is frequently resistant to therapy.

Objective:

A 58-year-old man who had a one-year history of a bullous eruption involving the hands, forearms, trunk, scalp, and oral mucosa. Histopathology revealed a subepidermal bulla, and direct and indirect immunofluorescence studies were consistent with EBA. The patient failed respond to niacinamide and tetracycline and oral prednisone 40 mg per day.

Methods:

Complete control of his blistering was achieved within two months of initiating oral dapsone, 150 mg per day.

Conclusion:

Dapsone may be an effective agent for some patients with EBA.
An Unusual Case of Cutaneous Pancreatic Fat Necrosis
Authors: Agarwal Smita , Nelson Jennell E. , Stevens Seth R. , Gilliam Anita C.
Published: July 2017

Background:

Cutaneous pancreatic fat necrosis is a pathognomonic sign for pancreatic disease and usually presents as subcutaneous nodules in the pretibial region.

Objective:

A case of cutaneous pancreatic fat necrosis is presented in which the clinical presentation of diffuse erythema was unusual. This disease is discussed and its possible etiologies are reviewed.

Methods:

A MEDLINE search for cases of cutaneous pancreatic fat necrosis presenting as diffuse erythema without nodules was conducted.

Results:

Diffuse erythema is an unusual presentation of cutaneous pancreatic fat necrosis.

Conclusion:

This may be the first case of cutaneous pancreatic fat necrosis presenting as diffuse erythema.
Extragenital Bowenoid Papulosis Associated with Atypical Human Papillomavirus Genotypes
Authors: Papadopoulos Anthony J. , Schwartz Robert A. , Lefkowitz Aza , Tinkle Lily L. , Jänniger Camila K. , Lambert W. Clark
Published: July 2017

Background:

Bowenoid papulosis typically appears as grouped violaceous or red-brown papules in the genital or perianal regions and clinically resembles condylomata acuminata. Isolated extragenital bowenoid papulosis is rare and has been reported in only a few case reports.

Objectives:

A 51-year-old immunocompetent, healthy woman had two solitary papules on the elbow; a 41-year-old HIV-positive man had a solitary cutaneous plaque on the abdomen. No genital, periungual, or other extragenital sites of involvement were noted in either patient. The diagnosis was confirmed histologically in both cases. Lesional skin from the female patient was tested with the Digenehybrid HPV DNA assay and was positive for a mixture of low-risk HPV subtypes (6, 11, 42, 43, 44). Lesional skin from the male patient was tested with polymerase chain reaction (PCR). Consensus primers targeted for the HPV L1 region, which is a highly conserved sequence common to more than 20 HPV subtypes encoding a viral capsid protein, were used. PCR using the consensus primers was positive, but type-specific probes for HPV types 6, 11, 16, 18, 45, 31, 33, 35, and 39 were negative.

Conclusions:

To our knowledge, our male patient represents the first case of isolated bowenoid papulosis of the abdominal skin. Isolated upper-extremity bowenoid papulosis in our female patient is also a unique case in both location and involvement of low-risk HPV types (6, 11, 42, 43, 44), which have not been previously associated with extragenital bowenoid papulosis.
The Majority of Cutaneous Squamous Cell Carcinomas Arise in Actinic Keratoses
Authors: Czarnecki D. , Meehan C. J. , Bruce F. , Culjak G.
Published: July 2017

Background:

Retrospective studies have given conflicting results with respect to how many cutaneous squamous cell carcinomas (SCCs) arise in actinic keratoses (AK).

Objective:

This study was conducted to determine what percentage of SCCs arise in AKs and to obtain more information about two histological features of SCCs, namely, thickness and ulceration.

Methods:

A prospective study was done of all SCCs treated by the authors during one calendar year.

Results:

Two hundred eight patients with SCC were entered into the study. An AK was contiguous with an SCC in 72% of the cases. This was taken as evidence that the SCC arose in the AK. Men presented with thicker and more ulcerated SCCs than women, but these were not statistically significant: p = 0.06 for thickness and p = 0.07 for ulceration. Ulcerated SCCs were more likely to arise on the head and neck (p = 0.02), on patients who had multiple skin cancers ( p = 0.005), and on patients who had a family history of skin cancer ( p = 0.03).

Conclusion:

Actinic keratoses need to be removed before they turn into SCCs. The prognostic significance of ulceration of cutaneous SCCs needs to be determined.
The Use of Diphenylcyclopropenone in the Treatment of Recalcitrant Warts
Authors: Upitis Jennifer A. , Krol Alfons
Published: July 2017

Background:

The treatment of recalcitrant palmoplantar and periungual warts using topical immunotherapy with diphenylcyclopropenone (DPC) was reviewed retrospectively over a seven-year period.

Methods:

Two hundred eleven patients were sensitized during this time. The patients consisted of 90 males and 121 females and were between 5 and 78 years old. Twenty-three patients were lost to followup. Of the remaining, 4 were undergoing treatment at the time of evaluation, 1 patient failed sensitization, and 1 patient became pregnant. Four discontinued because of side effects, 3 because of financial reasons, and 18 patients discontinued treatment prior to completing the minimum required applications (defined as 6), producing a dropout rate of 12% (25/211). Three patients had additional treatment during the course of DPC and were not included in the study. The remaining 154 patients were classified as nonresponders or responders.

Results:

The responders consisted of 135 individuals (87.7%) that had complete clearance of warts. Reported adverse effects were local and included with pruritus (15.6%), with blistering (7.1%), and with eczematous reactions (14.2%). The majority of the patients tolerated the treatment very well. One patient developed local impetigo. Patients had an average of 5 treatments over a 6-month period.

Conclusions:

Topical immunotherapy using DPC is an effective treatment option for recalcitrant warts. It should be considered as first-line treatment for warts based on its high response rate, absence of scarring, and painless application.
Coma Blisters, Peripheral Neuropathy, and Amitriptyline Overdose: A Brief Report
Authors: Maguiness Sheilagh , Guenther Lyn , Shum David
Published: July 2017

Background:

Coma blisters are most commonly associated with barbiturate and benzodiazepine overdose; however, they have also been described in association with many other substances, including amitriptyline.

Objective:

To review the literature on the clinical manifestations of coma blisters in the setting of amitriptyline overdose.

Methods:

Case report and literature review.

Results:

Coma blisters in association with amitriptyline overdose have rarely been documented in the literature. Of the few reported cases, peripheral neuropathy has been present two (including our case report) out of four times.

Conclusion:

Amitriptyline is known to impair endothelial cell tight junction integrity. Thus, individuals with amitriptyline overdose may be predisposed to microvascular damage during the compression imposed from a comatose state. This may help to explain the tendency for patients to present with the interesting triad of coma, blisters, and neuropathy.
Histopathologic Features Seen with Radiation Recall or Enhancement Eruptions
Authors: Smith Kathleen J. , Germain Marguerite , Skelton Henry
Published: July 2017

Background:

Although a radiation recall or enhancement eruption has been associated with a number of chemotherapeutic drugs, the histologic features have rarely been described.

Objective:

Our goal was to define the histologic features of radiation recall and enhancement eruptions in order to better understand their pathogenesis.

Methods:

We present ten patients on chemotherapeutic agents who developed erythematous maculopapular to psoriasiform eruptions often with associated follicular pustules. These eruptions occurred at the sites of prior or concurrent radiation therapy.

Results:

The most common class of drugs inducing these reactions were antibiotic chemotherapeutic agents alone or in combination with other chemotherapeutic drugs. In addition to routine histology, in four patients immunohistochemical staining for p53 was performed at the sites of the eruptions after resolution and at noninvolved sites matched for ultraviolet radiation (UVR) exposure. Histologic features in patients receiving concurrent radiation therapy included epidermal dysplasia, keratinocytes showing features of necrosis, increased mitotic figures, and a mixed inflammatory infiltrate. At sites of prior radiation therapy, the biopsy specimens showed a similar spectrum of epidermal changes and, in some cases, psoriasiform dermatitis with clearing within cells in the upper layers of the epidermis. Additional dermal changes included dermal fibrosis, vasodilatation, and atypical fibroblasts. Moderate to marked solar elastosis was seen in the majority of biopsy specimens. Immunohistochemical studies after resolution showed only a modest increase in p53 staining in epidermal keratinocytes in 3 of 4 sites of recall and enhancement eruptions after resolution of the reactions compared to skin that was matched for similar UVR exposure.

Conclusion:

Cumulative direct DNA damage and oxidative stress are probably important in radiation recall and enhancement eruptions, and these changes may be modulated by underlying nutritional deficits. Cumulative p53 mutations may play some role but are probably not a major factor in these eruptions. Mitochondrial dysfunction, which is known to occur with prior and concurrent radiation and chemotherapy, may be important in these eruptions. In addition to improvements in general nutrition, topical or oral antioxidant therapy may be a potential therapy to avoid radiation enhancement and recall reactions.
Facial Lipoatrophy following Systemic Lupus Erythematosus
Authors: Dupéré Audrey , Poulin Yves
Published: July 2017

Background:

Acquired partial lipodystrophy is a rare disorder. An association with systemic lupus erythematosus has been reported. In these cases, an immunologic basis is suggested by the presence of C3 nephritic factor and hypocomplementemia.

Objective:

The following report presents the case of a woman who developed a rapid loss of facial subcutaneous fat a few months after complete spontaneous resolution of cutaneous lesions of lupus.

Conclusion:

Absence of C3NeF in this case suggests that other immunological factors may be involved in the pathogenesis.
Insights into the Passive Partitioning of Amino Acids and Codeine into Human Hair
Authors: Krueger Gerald G. , Pitcher Carla , Liimatta Andrew P. , Knapp Todd L. , Miller Kenneth J. , Wilkins Diana G. , Rollins Douglas E.
Published: July 2017

Background:

Cells that form hair are among the body's most rapidly dividing cells, with each daughter cell becoming part of the hair shaft as it differentiates and lengthens. It follows that hair might contain concentrations of xenobiotics (environmental chemicals, therapeutic drugs, illicit substances, etc.) reflective of the concentration in blood at the time of division and onset of differentiation of cells that give rise to hair.

Objective:

This study was designed to gain insight into the passive incorporation of xenobiotics into hair.

Methods:

This study focused on the parameters of the passive partitioning of three agents, two water-soluble amino acids (cysteine and glutamine) and codeine into hair. Undamaged black hair from various ethnic groups was incubated in solutions containing the three agents as a function of time and concentration. Hair was washed extensively; time and dose to steady state as well as partitioning coefficients were determined for each agent. Codeine washing with a pH gradient also was carried out.

Results:

Data show that the partitioning coefficient of the agents is linear but not stoichiometric. At low doses passive partitioning into hair is efficient, a 1 minute exposure leading to significant retention. Washing extensively with deionized water, the fluid used for passive partitioning of the test agent, will not reversibly extract all of the agent, regardless of race.

Conclusion:

Hair can effectively absorb and retain agents of the environment, and this retention occurs via mechanisms other than those inherent to an ion exchange column.
Basal Cell Carcinoma of the Periocular Region
Authors: Arlette John P. , Carruthers Alastair , Threlfall William J. , Warshawski Laurence M.
Published: July 2017

Background:

Basal cell carcinomas of the periocular area present a particular challenge because of the likelihood of damage to vital structures.

Objective:

More than 10-years experience of treating basal cell carcinomas by Mohs micrographic surgery was reviewed.

Methods:

Chart analysis of 233 periocular basal cell carcinomas was performed. All patients were contacted either in clinical follow-up or by telephone review.

Results:

Two hundred and thirty-three periocular basal cell carcinomas were analyzed out of a total of 3,192 basal cell carcinomas treated during this period (7.3%). Patients ranged in age from 17 to 102 years with a mean age of 58.8 years and a median of 59.0 years. Of the patients, 54.5% were female. Mohs micrographic surgery was the prime therapy in 177 patients (75.9%). Of the lesions, 48.5% occurred in the medial canthal area, 35.2% on the lower eyelid, 10.7% on the upper eyelid, and 5.6% on the lateral canthus. There was no significant difference between the left/right distribution in males and females. The average follow-up time was 34 months (standard deviation 26.38 months). A cumulative rate of no recurrence tabulated by modified life table analysis was 0.9864.

Conclusion:

This study further documents the problems associated with basal cell carcinoma of the periocular area as well as the value of Mohs micrographic surgery as treatment.
How Do Physicians React to New Knowledge: The Experience of Jonathan Hutchinson 1828–1913 with Comments on its Relevance Today
Authors: Jackson Robert
Published: July 2017

Background:

In the late 20th century, physicians are being challenged to absorb new knowledge at an ever-increasing pace.

Objective:

This article will review the acquisition of new knowledge by Sir Jonathan Hutchinson, a prominent Victorian surgeon in the 19th century. At that time, new knowledge was presented much more slowly. How well Hutchinson absorbed new knowledge will be outlined and, in the light of his background and training, what events were there that either helped or hindered this process.

Conclusion:

Assuming good physical and mental health, age and basic training are often important in how physicians react to new knowledge; the timing of the release of new knowledge also plays a role. Training in the basic attributes of scientific medicine as well as continuing medical education will help in the processing of new knowledge. One common response by physicians to the increasing load of new information is the narrowing of the individual's field of expertise.
Phytodermatitis
Authors: Sasseville Denis
Published: July 2017

Background:

Most dermatologists can recognize the classic patterns of presentation of plant contact dermatitis; however, few can recognize the offending plants or know the name and chemical structure of the allergens or irritants that they contain.

Objective:

Five basic clinical patterns of phytodermatitis are reviewed: 1) allergic phytodermatitis, 2) photophytodermatitis, 3) irritant contact dermatitis, 4) pharmacologic injury, and 5) mechanical injury. The plants responsible for each pattern are presented by families, according to current scientific taxonomy. The chemical structure of the offending substances is described, and principles of investigation, prevention, and treatment are outlined.

Conclusions:

Plant contact dermatitis remains an extremely vast and complex topic. Exotic plants and woods are now present in our gardens and homes. The newfound interest in aromatherapy, phytotherapy, and so-called “natural” therapies is the cause of a tremendous increase in exposure to plant products and extracts. This is responsible for the appearance of atypical patterns of plant contact dermatitis with which the practising dermatologist must become familiar.
Organizational Memetics?
Authors: Price If
Published: July 2017

Companies are not only systems created and controlled by those who manage them but also self-organizing entities that evolve through learning. Whereas an organism is a creation of natural replicators, genes, an organization can be seen as a product of an alternative replicator, the meme or mental model, acting, like a gene, to preserve itself in an Evolutionary Stable System. The result is an organization which self-organizes around a set of unspoken and unwritten rules and assumptions. Biological evolution is stimulated by environmental change and reproductive isolation: the process of punctuated equilibrium. Corporate innovation shows the same pattern. Innovations in products and processes occur in groups isolated from prevailing mental norms. Successful organic strains possess a genetic capability for adaptation. Organizations which wish to foster learning can develop an equivalent, mental capability. Unlike their biological counterparts they can exert conscious choice and puncture the memetic codes that seek to keep them stable: the mental models of individuals, and the strategies, paradigms and unwritten rules at the company level.
Databank: South Asia
Authors: Fletcher John , Latham John
Published: July 2017

Tourism activity and economic performance, particularly in the major tourism generating and receiving countries, are closely linked. The purpose of this section is to provide those indicators which are regarded as being most relevant to international movements and spend. In Volume 1, Number 1, information relating to the global and regional pictures of tourism were presented, together with some specific details regarding tourism activity with respect to the most significant nations. Subsequent issues have concentrated on specific world regions. In this issue, economic indicators relating to tourism in South Asia, the final region to be covered in this section, are provided.
The Flower Children of Sudbury
Authors: Smiley C. W.
Published: July 2017

In the summer of 1973 an effort was made to provide medical and social services to the hippie or counter culture population of Sudbury. Sudbury is a city of 50000 people located in Northern Ontario, Canada. Beginning in early 1973 a sizeable hippie group had developed. Because of the numerous medical and social problems exhibited by these people and their expressed unwillingness to seek help from the normal hospital and social agencies a free or street clinic was developed. The clinic was unusual in that it was free, there was no paid staff, it was informal, it was an evening clinic, and medical records were not kept. This article is a detailed description of the clinic, why and how it was organized, the medical and social problems we encountered, the work we were involved in and what we experienced and learned.
Survival Patterns Following Primary Prosthetic Replacement for Acute Femoral Neck Fractures in the Elderly
Authors: Søreide Odd , Lillestøl Jostein
Published: July 2017

Theoretical statistical models have been used to study survival patterns following primary prosthetic replacement for acute femoral neck fractures in the elderly with special emphasis on the nature of the potential excess mortality following trauma and operation. The chances of our patients surviving given periods of time are well below those of the standard population. The excess mortality has been quantified using the proportional hazard model. The high death rate for our patients is limited to the first 4–6 postoperative months; thereafter the death rate is similar to that of the standard population. Similarly we can show that mortality following surgery is primarily dependent on the age of the patient. Survival probability and expected longevity have been calculated for different age groups. The relative longevity expected for patients below the age of 70 is very good compared with a very reduced expected longevity for patients older than 90 years. The practical consequences of our findings are discussed.
A Suggestion for Improving Intelligibility in Multivariate Confounder Adjustment Using Alcohol Intake and Birth Weight as an Example
Authors: Olsen Jørn , Olsen Sjurdur F.
Published: July 2017

Adjustment for multiple confounding is usually done by applying some kind of regression model. This requires assumptions about the type of relationship between the exposure of interest and outcome. It has been suggested to use confounder scores within strata of which the relationship can be scrutinised whihout such assumptions. Adjusting continuous outcomes for confounding factors, like birth weight for gestational age and lung function measures for age, is sometimes done by using the ratio of the observed outcome to an outcome expected from a reference series external to the study, with a concomitant risk of introducing new confounding. In some cases, the ideas from both these approaches can, slightly modified, be successfully combined. By using an internal rather than an external reference series, i.e. a group within the data with constant exposure, expected values for outcome can be derived as the fitted values from some model, appropriate for the purpose, depicting outcome conditional on all the potential confounders that are registered and for which control is desired. The relationship between the exposure of interest and the outcome, now represented by the fractional departure for each individual from the value expected conditional on her/his confounder status, can be scrutinised without any assumptions about the form of this relationship but, contrary to the confounder score approach, on the basis of the entire data set. This method also provides a way of presenting the relationship of interest, adjusted for confounding, that is easier to understand than the traditional regression approach. The impact of alcohol intake during pregnancy on birth weight will be given as an example.
Effects of Film Blowing Conditions on Molecular Orientation and Mechanical Properties of Polyethylene Films
Authors: Ghaneh-Fard Akbar
Published: July 2017

An experimental study of the effects of material characteristics and processing parameters on the orientation and mechanical properties of different polyethylene (PE) films is presented. Several counter-intuitive results were observed. For the linear low density PE (LLDPE) the machine direction (MD) and transverse direction (TD) modulus values decreased with increasing take-up-ratio (TUR). For the low density PE (LDPE) the moduli also decreased with increasing TUR at high blow-up-ratio (BUR). At low BUR, however, there was a considerable overall increase in the TD modulus as TUR increased while the MD modulus was not much affected as TUR increased. Upon increasing BUR, the TD modulus drastically decreased, while the MD modulus remained almost constant. The extrusion temperature and frost line height did not significantly influence the modulus of the films studied. For the LLDPE, it is shown that the modulus somewhat decreased with increasing polymer flow rate. Significant variations of birefringence along the TD and MD were observed in blown films. At low BUR, the in-plane birefringence of the LLDPE increased with TUR up to a maximum, before decreasing to negative values. No general correlation between the birefringence and tensile modulus data could be found. Based on our present and previous results, we believe that it is also unlikely that final film properties can be related to strain rates and stresses occurring in the film blowing zone by any simple correlation. Many processing variables and polymer structural factors affect the ultimate film properties. Any attempt to control film properties will have to take those into account.
Genomic analysis of 220 CTCLs identifies a novel recurrent gain-of-function alteration in RLTPR (p.Q575E)
Authors: Park Joonhee , Yang Jingyi , Wenzel Alexander T. , Ramachandran Akshaya , Lee Wung J. , Daniels Jay C. , Kim Juhyun , Martinez-Escala Estela , Amankulor Nduka , Pro Barbara , Guitart Joan , Mendillo Marc L. , Savas Jeffrey N. , Boggon Titus J. , Choi Jaehyuk
Published: July 2017

Key Points

Genomic analysis of 220 CTCLs identifies 55 genes in lymphomagenesis, including 17 genes not previously implicated in CTCL. RLTPR (p.Q575E) is a novel gain-of-function mutation that potentiates T-cell receptor signaling via selective upregulation of the NF-κB pathway.
The contribution of the C5 protein subunit of Escherichia coli ribonuclease P to specificity for precursor tRNA is modulated by proximal 5′ leader sequences
Authors: Niland Courtney N. , Anderson David R. , Jankowsky Eckhard , Harris Michael E.
Published: July 2017

Recognition of RNA by RNA processing enzymes and RNA binding proteins often involves cooperation between multiple subunits. However, the interdependent contributions of RNA and protein subunits to molecular recognition by ribonucleoproteins are relatively unexplored. RNase P is an endonuclease that removes 5′ leaders from precursor tRNAs and functions in bacteria as a dimer formed by a catalytic RNA subunit (P RNA) and a protein subunit (C5 in E. coli). The P RNA subunit contacts the tRNA body and proximal 5′ leader sequences [N(−1) and N(−2)] while C5 binds distal 5′ leader sequences [N(−3) to N(−6)]. To determine whether the contacts formed by P RNA and C5 contribute independently to specificity or exhibit cooperativity or anti-cooperativity, we compared the relative kcat/Km values for all possible combinations of the six proximal 5′ leader nucleotides (n = 4096) for processing by the E. coli P RNA subunit alone and by the RNase P holoenzyme. We observed that while the P RNA subunit shows specificity for 5′ leader nucleotides N(−2) and N(−1), the presence of the C5 protein reduces the contribution of P RNA to specificity, but changes specificity at N(−2) and N(−3). The results reveal that the contribution of C5 protein to RNase P processing is controlled by the identity of N(−2) in the pre-tRNA 5′ leader. The data also clearly show that pairing of the 5′ leader with the 3′ ACCA of tRNA acts as an anti-determinant for RNase P cleavage. Comparative analysis of genomically encoded E. coli tRNAs reveals that both anti-determinants are subject to negative selection in vivo.
Techniques and Behaviors Associated with Exemplary Inpatient General Medicine Teaching: An Exploratory Qualitative Study
Authors: Houchens Nathan , Harrod Molly , Moody Stephanie , Fowler Karen E. , Saint Sanjay
Published: July 2017

BACKGROUND

Clinician educators face numerous obstacles to their joint mission of facilitating high‐quality learning while also delivering patient‐centered care. Such challenges necessitate increased attention to the work of exemplary clinician educators, their respective teaching approaches, and the experiences of their learners.

OBJECTIVE

To describe techniques and behaviors utilized by clinician educators to facilitate excellent teaching during inpatient general medicine rounds.

DESIGN

An exploratory qualitative study of inpatient teaching conducted from 2014 to 2015.

SETTING

Inpatient general medicine wards in 11 US hospitals, including university‐affiliated hospitals and Veterans Affairs medical centers.

PARTICIPANTS

Participants included 12 exemplary clinician educators, 57 of their current learners, and 26 of their former learners.

MEASUREMENTS

In‐depth, semi‐structured interviews of exemplary clinician educators, focus group discussions with their current and former learners, and direct observations of clinical teaching during inpatient rounds.

RESULTS

Interview data, focus group data, and observational field notes were coded and categorized into broad, overlapping themes. Each theme elucidated a series of actions, behaviors, and approaches that exemplary clinician educators consistently demonstrated during inpatient rounds: (1) they fostered positive relationships with all team members by building rapport, which in turn created a safe learning environment; (2) they facilitated patient‐centered teaching points, modeled excellent clinical exam and communication techniques, and treated patients as partners in their care; and (3) they engaged in coaching and collaboration through facilitation of discussion, effective questioning strategies, and differentiation of learning among team members with varied experience levels.

CONCLUSION

This study identified consistent techniques and behaviors of excellent teaching during inpatient general medicine rounds.